hllj/quesmed huggingface dataset:
A 43-year-old female presents to the ophthalmology clinic. She has been finding it difficult to move her eyes, especially when redirecting her attention to new visual targets. She has also noticed she has been finding it difficult to maintain a steady gaze.

Which subcortical region in the brain is affected?

Options:
explanation: The pretectum is a region of the midbrain located anterior to the superior colliculus and posterior to the thalamus. It serves several important functions related to visual processing and the pupillary light reflex.
name: Pretectum
label: c
answer: no
explanation: The superior colliculus is a paired structure located in the midbrain of the brainstem. The retina projects to the superior colliculus in one of the secondary visual pathways. It plays a crucial role in the control of visual processing and eye movements.
name: Superior colliculus
label: a
answer: yes
explanation: The lateral geniculate nucleus (LGN) is a paired structure located in the thalamus. The LGN serves as a key part of the primary visual pathway and plays a central role in the processing and relay of visual information from the eyes to the primary visual cortex in the occipital lobe.
name: Lateral geniculate nucleus
label: d
answer: no
explanation: The inferior colliculus is a paired structure located in the midbrain, specifically within the tectum. It plays a crucial role in the processing of auditory information and is an integral part of the brain's auditory pathway.
name: Inferior colliculus
label: e
answer: no
explanation: The hypothalamus is a small region located at the base of the brain, just above the brainstem. It receives projections from the retina in one of the secondary visual pathways. It is involved in regulating the body's internal clock and circadian rhythms, which influence sleep-wake cycles, hormone secretion, and other daily patterns.
name: Hypothalamus
label: b
answer: no

Correct answer: a
A 76-year-old female has recently been diagnosed with a right-sided neck of femur fracture following a fall. The orthopaedic surgeon informs you that she requires immediate surgery to prevent avascular necrosis.

Which branch of the femoral artery is implicated in avascular necrosis of the head of the femur?

Options:
explanation: This branch arises from the proximal part of the femoral artery and supplies blood to the skin and muscles of the lower abdominal wall and inguinal region.
name: Superficial epigastric arter
label: e
answer: no
explanation: The medial circumflex femoral artery, a branch of the profunda femoris artery, supplies blood to the head and neck of the femur, as well as the hip joint.
name: Medial femoral circumflex artery
label: a
answer: yes
explanation: The femoral artery continues as the superficial femoral artery, which runs down the thigh and provides blood to the anterior thigh muscles.
name: Superficial femoral artery
label: d
answer: no
explanation: The profunda femoris artery is a major branch that arises from the femoral artery in the thigh. It provides a significant blood supply to the muscles of the thigh, including the quadriceps femoris muscle group. It gives off the perforating branches, lateral femoral circumflex artery, medial femoral circumflex artery and the descending genicular artery.
name: Profunda femoris artery
label: c
answer: no
explanation: The lateral circumflex femoral artery is a branch of the profunda femoris artery. It supplies blood to the lateral and anterior aspects of the thigh.
name: Lateral circumflex femoral artery
label: b
answer: no

Correct answer: a
A 73-year-old male patient presents to the neurology clinic for a follow-up appointment. He has been started on levodopa, however, he is still experiencing some symptoms including bradykinesia and a resting tremor. The consultant prescribes selegiline.

What is the mechanism of action of selegiline?

Options:
explanation: This is the mechanism fo action of levodopa. Levodopa is converted into dopamine in the brain. Dopamine cannot cross the blood-brain barrier, but levodopa can. Once in the brain, it is converted to dopamine, increasing dopamine levels and improving motor symptoms.
name: Crosses the blood-brain barrier where it is converted to dopamine by decarboxylation in the presynaptic terminals of dopaminergic neurons
label: b
answer: no
explanation: Selegiline is a selective and irreversible inhibitor of monoamine oxidase type B (MAO-B). MAO is an enzyme that breaks down dopamine in the brain. By inhibiting MAO-B, selegiline prevents the breakdown of dopamine, thereby increasing dopamine levels in the brain. It is usually used as an adjunct to Levodopa in the treatment of Parkinson's.
name: Binds to MAO-B receptor within the nigrostriatal pathways and blocks the microsomal metabolism of dopamine
label: a
answer: yes
explanation: This is the mechanism of action of selective serotonin reuptake inhibitors, such as sertraline.
name: Inhibits serotonin re-uptake
label: e
answer: no
explanation: This is the mechanism of action of entacapone and tolcapone. COMT is an enzyme that metabolises levodopa in the brain. COMT inhibitors prevent the breakdown of levodopa, extending its duration of action. It is typically used with levodopa.
name: Prevents the peripheral degradation of levodopa, allowing a higher concentration to cross the blood-brain barrier
label: d
answer: no
explanation: This is the mechanism of action or ropinirole or pramipexole. They directly activate dopamine receptors in the brain, mimicking the effects of dopamine. They are usually used as an adjunct to Levodopa in the treatment of Parkinson's but can be used alone.
name: Selectively stimulates dopamine (D2) receptors within the caudate putamen
label: c
answer: no

Correct answer: a
Which ion is responsible for initiating muscle contraction?

Options:
explanation: Magnesium does not initiate the muscle contraction process, calcium ions do that. However, Magnesium ions are involved in various enzymatic reactions during muscle contraction, including the hydrolysis of ATP to release energy for the cross-bridge cycle.
name: Magnesium (Mg2+)
label: d
answer: no
explanation: When a nerve impulse stimulates the muscle, it triggers the release of calcium ions from the sarcoplasmic reticulum. Calcium binds to troponin, a protein on the actin filament, exposing the myosin binding sites and allowing for cross-bridge formation.
name: Calcium (Ca2+)
label: a
answer: yes
explanation: Muscle contraction begins with the generation of an action potential, which travels along the sarcolemma. Sodium ions are crucial for initiating this action potential however they do not initiate the muscle contraction process, calcium ions do that.
name: Sodium (Na+)
label: b
answer: no
explanation: Potassium ions do not initiate the muscle contraction process, calcium ions do that. However, after the depolarisation phase during the action potential, repolarisation is essential to reset the muscle cell's membrane potential for subsequent contractions. This involves the movement of potassium ions out of the cell, which helps restore the negative resting membrane potential. Repolarisation is crucial for muscle relaxation.
name: Potassium (K+)
label: c
answer: no
explanation: Hydrogen ions do not initiate the muscle contraction process, calcium ions do that. Hydrogen ions can be produced during intense muscle contractions, such as during strenuous exercise leading to acidosis and muscle fatigue.
name: Hydrogen ions (H+)
label: e
answer: no

Correct answer: a
A 22-year-old female athlete presents to A&E with pain and swelling in the left knee after landing from a jump incorrectly. She has a positive drawer test, indicating an anterior cruciate ligament injury.

Where does the anterior cruciate ligament attach anteriorly?

Options:
explanation: The anterior cruciate ligament attaches at the anterior intercondylar region of the tibia where it blends with the medial meniscus. It ascends posteriorly to attach to the femur in the intercondylar fossa. It prevents anterior dislocation of the tibia onto the femur.
name: Attaches to the anterior intercondylar region of the tibia where it blends with the medial meniscus
label: a
answer: yes
explanation: This is the attachment of the posterior cruciate ligament. The ACL attaches to the anterior intercondylar region of the tibia.
name: Attaches to the posterior intercondylar region of the tibia
label: d
answer: no
explanation: This is the attachment for the medial collateral ligament.
name: Attaches to the medial epicondyle of the femur
label: e
answer: no
explanation: This is the posterior attachment of the ACL.
name: Attaches to the femur in the intercondylar fossa
label: b
answer: no
explanation: This is the anterior attachment of the posterior cruciate ligament.
name: Attaches to the anteromedial femoral condyle
label: c
answer: no

Correct answer: a
A 42-year-old male is presenting with signs of raised Intracranial pressure including vomiting, drowsiness and diminished levels of consciousness following a traumatic head injury.

Which one of the following options is used to lower intracranial pressure and maintain cerebral blood flow?

Options:
explanation: Lying the patient flat is incorrect. The head should be elevated to 30 degrees to avoid obstructing the jugular venous return.
name: Lie the patient flat
label: c
answer: no
explanation: Mannitol is a type of osmotic diuretic, often used in the treatment of cerebral oedema. By osmotically drawing water out of brain tissue and into the bloodstream, it can help alleviate brain swelling and pressure.
name: IV Mannitol
label: a
answer: yes
explanation: Corticosteroids are not used in situations of raised ICP due to traumatic brain injury.
name: Corticosteroids
label: d
answer: no
explanation: Hypoventilation is incorrect. Controlled hyperventilation (increased breathing rate) is typically used when there is raised ICP following head injuries. It can temporarily reduce arterial carbon dioxide levels, and cause vasoconstriction, which in turn can help lower ICP.
name: Hypoventilation
label: b
answer: no
explanation: Hyperthermia is incorrect. Hypothermia can be used, however, not enough evidence shows improvement in outcomes.
name: Hyperthermia
label: e
answer: no

Correct answer: a
A 55-year-old obese female patient presents with a life-threatening asthma attack and develops acute respiratory failure. She requires the insertion of an endotracheal tube. She is going to be given a muscle relaxant to aid with the insertion of the endotracheal tube.

Which muscle relaxant is a depolarising blocker?

Options:
explanation: Atracurium is a medication classified as a non-depolarising neuromuscular blocking agent. It is used in anaesthesia to induce muscle relaxation. Atracurium works by blocking the action of acetylcholine at the neuromuscular junction, preventing the transmission of nerve impulses to muscle cells.
name: Atracurium
label: d
answer: no
explanation: Suxamethonium is a medication classified as a neuromuscular blocking agent or a depolarising muscle relaxant. It acts by mimicking the neurotransmitter acetylcholine at the neuromuscular junction. It initially depolarises the muscle membrane, causing a brief muscle contraction, and then it prevents repolarisation due to constant depolarization that results in desensitisation, resulting in sustained muscle relaxation.
name: Suxamethonium
label: a
answer: yes
explanation: Propofol is commonly used for the induction and maintenance of general anaesthesia during surgeries and other medical procedures. Propofol acts as a central nervous system depressant by enhancing the inhibitory effects of gamma-aminobutyric acid (GABA) neurotransmission.
name: Propofol
label: b
answer: no
explanation: Alfentanyl is primarily used in surgical and anaesthesia settings to provide pain relief during surgery. It is an opioid analgesic that acts on mu-opioid receptors in the central nervous system.
name: Alfentanil
label: c
answer: no
explanation: Isoflurane is a volatile inhalation anaesthetic agent commonly used for the induction and maintenance of general anaesthesia during surgery and other medical procedures. Isoflurane works by depressing the central nervous system.
name: Isoflurane
label: e
answer: no

Correct answer: a
In a study related to lung cancer, researchers investigate the effect of quitting smoking. They compare a group of smokers and ex-smokers and monitor the instances of lung carcinoma.

What type of study is this?

Options:
explanation: These studies collect data from a population at a single point in time to assess the prevalence of a particular condition or characteristic.
name: Cross-sectional studies
label: c
answer: no
explanation: In cohort studies, a group of individuals (the cohort) is followed over time to determine the incidence of an outcome and identify risk factors.
name: Cohort studies
label: b
answer: no
explanation: These are detailed descriptions of individual cases, often used to report rare or unique medical conditions or treatments.
name: Case reports
label: e
answer: no
explanation: Case–control studies bring together two groups, a case study group and a control group. The case study group has a particular attribute while the control group does not. The two groups are then compared, to see if the case group exhibits a particular characteristic more than the control group.
name: Case-control study
label: a
answer: yes
explanation: These are experimental studies where participants are randomly assigned to different groups (e.g., treatment and control) to assess the effects of an intervention or treatment.
name: Randomised controlled trials
label: d
answer: no

Correct answer: a
A 28-year-old previously well patient presents to the GP with her mother. She describes “rotting from the inside” and feels that her “organs are dead inside of her.”

What type of delusion is this?

Options:
explanation: Somatic delusions involve delusions of bodily functions and sensations, for example infestation of parasites on a well patient.
name: Somatic delusions
label: e
answer: no
explanation: Grandiose delusions often involve beliefs that you have more power, wealth, smarts, or other grand traits than is true.
name: Grandiose delusions
label: c
answer: no
explanation: Nihilistic delusions are characterized by the delusional belief of being dead, decomposed or annihilated, having lost one's own internal organs or even not existing entirely as a human being.
name: Nihilistic delusion
label: a
answer: yes
explanation: A delusion that another person, more frequently someone of higher status is in love with the individual.
name: Erotomanic delusions
label: d
answer: no
explanation: People with delusions of reference believe things refer to them, such as TV and radio shows.
name: Delusions of reference
label: b
answer: no

Correct answer: a
A 54-year-old male presents to the pain clinic. He has been experiencing neuropathic pain after having had a stroke. He would like to know more about his pain.

Which protective mechanism is reduced in neuropathic pain?

Options:
explanation: In neuropathic pain conditions, there can be impairments in the descending inhibition system. The brain may not effectively send inhibitory signals to the spinal cord to modulate the pain signals coming from damaged or malfunctioning nerves. The neurotransmitters that are typically involved include serotonin, noradrenaline and opioids.
name: Descending inhibition
label: a
answer: yes
explanation: There is synaptic reorganisation within the spinal cord. This results in allodynia in neuropathic pain.
name: Synaptic reorganisation
label: d
answer: no
explanation: There is an increase in the Sodium channel gene expression resulting in increased excitability of the nociceptors in neuropathic pain.
name: Sodium channel activity
label: c
answer: no
explanation: There is an increase in the inflammatory cells and mediators as opposed to a decrease in neuropathic pain. They result in direct receptor-mediated excitatory effects which have both short and long-term effects on neuronal excitability.
name: Inflammatory cells and mediators
label: b
answer: no
explanation: Catastrophising personality can amplify the pain experience and this tends to happen more in patients with neuropathic pain.
name: Catastrophising personality
label: e
answer: no

Correct answer: a
A 23-year-old female patient has been recently discharged from an inpatient stay at a psychiatric unit. She informs you that she has been diagnosed with bipolar disorder.

What is a risk factor for this condition?

Options:
explanation: There is a higher prevalence of bipolar disorder in individuals who are separated or widowed. Traumatic or highly stressful life events, such as the loss of a loved one or relationship issues can trigger the onset of bipolar symptoms or episodes in vulnerable individuals.
name: Being married
label: c
answer: no
explanation: Family history plays a significant role in bipolar disorder. Having a close relative, such as a parent or sibling, with bipolar disorder increases the risk of developing the condition.
name: Family history
label: a
answer: yes
explanation: Although abuse is associated with bipolar disorder. It has not been proven that smoking tobacco increases the risk.
name: Smoking tobacco
label: d
answer: no
explanation: While bipolar disorder affects both men and women, some research suggests that women may be more likely to experience rapid cycling and mixed episodes.
name: Male
label: e
answer: no
explanation: Bipolar disorder is more prevalent in high-income countries as opposed to low-income countries
name: Living in low-income countries
label: b
answer: no

Correct answer: a
An 18-year-old male presents to A&E after collapsing whilst presenting a poster in front of his class. He is breathing fast and taking lots of deep breaths and is complaining of tingling in his fingers and around his mouth.

An ABG is taken which shows a pH of 7.5, pO2 of 14, pCO2 of 3.4, and an HCO3- of 22. His base excess is +2.

Which of the following is the most accurate description of his acid-base balance

Options:
explanation: Respiratory alkalosis occurs as a result of hyperventilation, shown by a low pCO2 and a high pO2. His bicarbonate and base excess are normal and do not indicate metabolic compensation.

Respiratory alkalosis can be caused by anything that makes you hyperventilate - e.g. an anxiety attack, pain, hypoxia (in the ascent to altitude), pulmonary embolisms, pneumothorax and excessive mechanical ventilation.
name: Respiratory alkalosis with no metabolic compensation
label: a
answer: yes
explanation: His pH is alkalotic and his ABG suggests that this is due to a respiratory cause. However, both his bicarbonate and his base excess are normal suggesting that there has not been any metabolic compensation.
name: Respiratory alkalosis with partial metabolic alkalosis
label: b
answer: no
explanation: The patient is alkalotic
name: Respiratory acidosis with no metabolic compensation
label: e
answer: no
explanation: The patient is alkalotic
name: Respiratory acidosis with partial metabolic compensation
label: d
answer: no
explanation: Common causes of metabolic alkalosis include prolonged vomiting, hypovolaemia, diuretic use and hypokalaemia. This would result in a raised pH, bicarbonate and base excess.
name: Metabolic alkalosis with no respiratory compensation
label: c
answer: no

Correct answer: a
A 67-year-old female with a history of COPD presents to her GP complaining of swollen legs. After a full examination, the GP is concerned that she may have developed right heart strain due to her history of chronic lung disease.

Which of the following examination signs would likely be seen in keeping with the diagnosis?

Options:
explanation: Enlargement of the liver and spleen occurs secondary to venous congestion caused by right-sided heart failure. In acute cases, it can be tender.
name: Hepatosplenomegaly
label: a
answer: yes
explanation: "Orthopnoea" - this is usually indicative of **left**-sided heart failure and cardiogenic pulmonary oedema
name: Shortness of breath when the patient lies down
label: e
answer: no
explanation: This is a feature of pulmonary oedema, a characteristic feature of **left**-sided heart failure.
name: Cough producing of pink-tinged sputum
label: c
answer: no
explanation: This indicates pulmonary oedema which is a characteristic feature of **left**-sided heart failure, not right.
name: Crackles on auscultation of her lungs
label: b
answer: no
explanation: Due to her peripheral oedema, the patient is more likely to have an increase in weight since last visiting her GP. This is "water weight" from the accumulation of excess fluid in her tissues.
name: Weight loss
label: d
answer: no

Correct answer: a
Which of the following best describes a chylomicron?

Options:
explanation: This [[rw1\]](#_msocom_1) describes a chylomicron - an ultra-low-density lipoprotein. They help transport lipids from the small intestine into the systemic circulation.
name: Lipoprotein particles consisting of triglycerides, phospholipids and cholesterol
label: a
answer: yes
explanation: This describes a lysosome[[rw3\]](#_msocom_3)
name: Membrane-bound organelle that contains digestive enzymes
label: c
answer: no
explanation: This describes a micelle[[rw4\]](#_msocom_4)
name: An aggregation of surfactant amphipathic lipid molecules dispersed in a liquid
label: e
answer: no
explanation: This describes a vesicle[[rw2\]](#_msocom_2) .
name: A small fluid-filled sac enclosed by a lipid bilayer
label: b
answer: no
explanation: This is incorrect, long chain fatty acids require transport via chylomicrons. Only short-chain fatty acids can diffuse across the intestinal villi
name: They do not require specific transport molecules
label: d
answer: no

Correct answer: a
The Henderson-Hasselbach equation is used by clinicians in the treatment of acid-base abnormalities.

What does this equation describe the relationship between?

Options:
explanation: The Henderson-Hasselbach equation describes the relationship between the pH of a buffered solution and its pKa. When [HA] is equal to [A-] then the log of [A-]/[HA] is 0 and pH is equal to pKA. When an acid is added to the solution [HA] increases and [A-]/[HA] is negative, thus, the pH decreases and is less than pKa
name: pH and pKa
label: a
answer: yes
explanation: The concentration of acid and base in a buffered solution makes up part of the Henderson-Hasselbach equation, however, the equation describes the relationship between pH and pKa.
name: [HA] and [A-]
label: d
answer: no
explanation: Whilst both of these form part of the Henderson-Hasselbach equation, the equation describes the relationship between pH and pKa
name: pKa and [HA]
label: c
answer: no
explanation: Whilst both of these form part of the Henderson-Hasselbach equation, the equation describes the relationship between pH and pKa
name: pH and [HA]
label: e
answer: no
explanation: The Henderson-Hasselbach equation describes the relationship between the pH of a buffered solution and its pKa.
name: pOH and pKa
label: b
answer: no

Correct answer: a