hllj/quesmed huggingface dataset:
A 3-year-old boy presents to the paediatric clinic, with concerns from his parents that he is 'always falling over'. He also has trouble with activities such as running and jumping.

A diagnosis of Duchenne's muscular dystrophy is suspected.

Which of the following best describes the implicated gene and inheritance pattern of this condition?

Options:
explanation: No, this is not the correct answer. Duchenne's muscular dystrophy occurs when there is a mutation in the dystrophin gene, which is inherited in an x-linked recessive fashion. The RyR1 gene is however associated with an increased susceptibility to malignant hyperthermia, which causes severe reactions to anaesthetics such as succinylcholine.
name: RyR1 (Ryanodine Receptor 1) gene and X-linked recessive
label: e
answer: no
explanation: No, this is not the correct mode of inheritance.  Duchenne's muscular dystrophy occurs when there is a mutation in the dystrophin gene, which is inherited in an x-linked recessive fashion.
name: Dystrophin gene and autosomal recessive
label: b
answer: no
explanation: Yes, this is the correct answer. Duchenne's muscular dystrophy occurs when there is a mutation in the dystrophin gene, which is inherited in an x-linked recessive fashion. The dystrophin protein is responsible for joining the sarcolemma to the actin microfibre. The absence of dystrophin leads to the excessive intake of calcium into striated muscle cells and subsequently into mitochondria. This leads to the transport of water into the cells and mitochondria by osmosis, and the subsequent bursting of mitochondria. Rhabdomyolysis can result, leading to the increase of creatinine kinase and myoglobin in the bloodstream.

Clinically, this presents as proximal muscle wasting and atrophy, that progresses to include more distal muscle groups and an increased level of disability as time goes on.
name: Dystrophin gene and X-linked recessive
label: a
answer: yes
explanation: No, this is not the correct answer. Duchenne's muscular dystrophy occurs when there is a mutation in the dystrophin gene, which is inherited in an x-linked recessive fashion. The TNNT2 gene is associated with familial cardiomyopathy.
name: TNNT2 (Troponin-T) gene and autosomal dominant
label: d
answer: no
explanation: No this is not the correct answer. Duchenne's muscular dystrophy occurs when there is a mutation in the dystrophin gene, which is inherited in an x-linked recessive fashion. The RyR1 gene is however associated with an increased susceptibility to malignant hyperthermia, which causes severe reactions to anaesthetics such as succinylcholine.
name: RyR1 (Ryanodine Receptor 1) gene and autosomal dominant
label: c
answer: no

Correct answer: a
A 5-year-old boy presents to the paediatric clinic. His parents are concerned about his short stature, and wonder if his bones are growing correctly. On examination, there is evidence of "bowed" legs and an antalgic gait.

Which of the following dietary deficiencies may account for this presentation?

Options:
explanation: No, this is not the correct answer. Vitamin B12 deficiency is associated with macrocytic anaemia. By contrast, this patient demonstrates evidence of Rickets.
name: Vitamin B12 deficiency
label: c
answer: no
explanation: No, this is not the correct answer. This is likely to cause symptoms of scurvy such as fatigue, joint swelling and swollen gums. By contrast, this patient demonstrates evidence of Rickets.
name: Vitamin C deficiency
label: b
answer: no
explanation: Yes, this is the correct answer. The patient is demonstrating bowed legs and bone pain, characteristic of Rickets in children. This is caused by a vitamin D deficiency, which in turn reduces the production of calcitriol (activated vitamin D3). Hence there is reduced absorption of calcium and phosphate from the gastrointestinal tract, which is required for adequate mineralisation of bone.
name: Vitamin D deficiency
label: a
answer: yes
explanation: No this is not the single best answer. As this patient is deficient in vitamin D, there is less absorption of calcium and phosphate from the gastrointestinal tract, causing poor mineralisation of bone. However, as the majority of calcium is obtained through sunlight rather than dietary sources, low calcium levels are typically secondary to a vitamin D deficiency. Vitamin D deficiency is therefore a more accurate answer.
name: Calcium deficiency
label: d
answer: no
explanation: No, this is not the correct answer. This patient demonstrates evidence of Rickets, commonly caused by a vitamin D deficiency.
name: Iodine defiency
label: e
answer: no

Correct answer: a
A 39-year-old woman attends the reproductive clinic. She has been struggling to conceive, and is keen to explore in vitro fertilisation (IVF). This involves the fertilisation of an oocyte in vitro, which grows to become embryo before being implanted inside the uterus.

In which of the following regions of the uterus should an embryo ideally be implanted during IVF?

Options:
explanation: No, this is not the correct answer. Implantation of the embryo into the upper posterior uterine wall is associated with the greatest chance of a successful pregnancy.
name: Anterior uterine wall
label: c
answer: no
explanation: Yes, this is the correct answer. Implantation of the embryo into the upper posterior uterine wall is associated with the greatest chance of a successful pregnancy.
name: Posterior uterine wall
label: a
answer: yes
explanation: No, this is not the correct answer. Implantation in this area will cause an ectopic pregnancy.
name: Fallopian tube
label: d
answer: no
explanation: No, this is not the single best answer. Whilst the embryo implants within the stroma deep to the endometrium, the endometrium is lining the entire uterus. The questions is asking for the specific anatomical location of implantation within the uterus.
name: Stroma deep to the endometrium
label: e
answer: no
explanation: No, this is not the correct answer. Implantation in this location is likely to cause placenta praevia.
name: Lower uterine segement
label: b
answer: no

Correct answer: a
A 35-year-old man attends neurology clinic with symptoms of diplopia and dysarthria. He has also been troubled by episodes of muscle spasms and constipation. He is diagnosed with multiple sclerosis (MS).

MS is associated with the autoimmune degradation of the neuronal myelin sheaths, which are critical for the normal functioning of the central nervous system.

Which of the following cell types are responsible for myelination of the central nervous system?

Options:
explanation: Schwann cells are responsible for the myelination of neurons in the peripheral nervous system, not the central nervous system.
name: Schwann cells
label: b
answer: no
explanation: No. this is not the correct answer. Astrocytes are responsible for the regulation of nerve impulses by releasing glutamate and also contribute to the blood-brain barrier. They do not produce myelin.
name: Astrocytes
label: c
answer: no
explanation: Yes, this is the correct answer. Oligodendrocytes are responsible for the myelination of axons within the central nervous system. This myelin aids neuronal connectivity by increasing the conduction velocity of action potentials. In MS, there is autoimmune degradation of the myelin, causing reduced conduction velocity of neurons and consequently a range of sensory and motor symptoms.
name: Oligodendrocytes
label: a
answer: yes
explanation: No, this is not the correct answer. The myelin sheath is not a cell type.
name: Myelin sheath cells
label: d
answer: no
explanation: No, this is not the correct answer. Microglial cells are the immune cells of the central nervous system.
name: Microglial cells
label: e
answer: no

Correct answer: a
A 7-year-old boy is admitted into A&E with difficulty breathing and a sore throat. He is pyrexial, with a temperature of 38.4°C. A diagnosis of epiglottitis is suspected.

The consultant explains that epiglottitis involves inflammation of the epiglottis and supraglottic tissues of the larynx.

Which of the following cartilage and collagen types compose the epiglottis?

Options:
explanation: Yes, this is the correct answer. The epiglottis is composed of elastic cartilage and type II collagen. This provides the necessary strength and elasticity to the epiglottis.
name: Elastic cartilage and type II collagen
label: a
answer: yes
explanation: No, this is not the correct answer. The epiglottis is composed of elastic cartilage and type II collagen.
name: Hyaline cartilage and type II collagen
label: c
answer: no
explanation: No, this is not the correct answer. The epiglottis is composed of elastic cartilage and type II collagen.
name: Fibrocartilage and type I collagen
label: d
answer: no
explanation: No, this is not the correct answer. The epiglottis is composed of elastic cartilage and type II collagen.
name: Elastic cartilage and type I collagen
label: b
answer: no
explanation: No, this is not the correct answer. The epiglottis is composed of elastic cartilage and type II collagen.
name: Hyaline cartilage and type IV collagen
label: e
answer: no

Correct answer: a
A 50-year-old man is reviewed in the cardiology clinic for the management of his atrial fibrillation. They discuss the possible benefit of commencing amiodarone, however, the consultant is concerned that this may interact with his existing medications, which include warfarin.

Warfarin is known to become metabolised by the CYP2C9 enzyme during hepatic metabolism.
Amiodarone is an inhibitor of the CYP2C9 enzyme.

Which of the following consequences may result from prescribing warfarin alongside amiodarone?

Options:
explanation: No, this is not the correct answer. Amiodarone acts to increase the plasma concentration of warfarin, and hence increase the INR. This would mean the patient is more anticoagulated hence thrombosis would be less likely to occur.
name: Increased INR and thrombosis
label: b
answer: no
explanation: No, this is not the correct answer. The patient would have an increased INR associated with an increased risk of bleeding. A malar rash is often seen in cases of systemic lupus erythematosus (SLE). It is not associated with warfarin or amiodarone.
name: Decreased INR and malar rash
label: d
answer: no
explanation: No, this is not the correct answer. The patient would have an increased INR associated with an increased risk of bleeding.
name: Decreased INR and bleeding
label: c
answer: no
explanation: No, this is not the correct answer.
name: No change in INR and no adverse effect
label: e
answer: no
explanation: Yes, this is the correct answer. You are not expected to be able to memorise drug-drug interactions, however, it is helpful to be able to interpret the information given and be able to draw conclusions. Warfarin is metabolised by the cytochrome P450 CYP2C9 enzyme, but amiodarone is an inhibitor of this enzyme. If amiodarone inhibits CYP2C9, then there would be lower amounts of CYP2C9 enzymes which are actually metabolising warfarin. This results in less metabolism of warfarin within the liver, and hence an increased plasma concentration of warfarin.

INR is essentially a measure of a patient's prothrombin time (PT). A high INR means that the patient is more anticoagulated, while a low INR means the patient is less anticoagulated. Warfarin is an anticoagulant. An increased plasma concentration of warfarin as a result of taking amiodarone would make the patient more anticoagulated and at a high risk of bleeding. The INR would also be increased.
name: Increased INR and bleeding
label: a
answer: yes

Correct answer: a
A 48-year-old woman visits the GP surgery with difficulty swallowing her food. She has also been experiencing some double vision. On examination, the GP notes left-sided ptosis. A diagnosis of myasthenia gravis is considered.

Which of the following receptor types is affected by myasthenia gravis?

Options:
explanation: No, this is not the correct answer.
name: Intracellular receptor
label: d
answer: no
explanation: No, this is not the correct answer.
name: G-protein coupled receptor
label: b
answer: no
explanation: No, this is not the correct answer.
name: Cell surface receptor
label: e
answer: no
explanation: No, this is not the correct answer.
name: Enzyme-linked receptor
label: c
answer: no
explanation: Yes, this is the correct answer. Myasthenia gravis is caused by the production of autoantibodies specific to the nicotinic acetylcholine receptor, leading to a reduced influx of sodium ions at the motor end plate. This leads to reduced synaptic transmission at the motor end plate and therefore intermittent muscle weakness. The nicotinic acetylcholine receptor is known as a ligand-gated ion channel.
name: Ligand-gated ion channels
label: a
answer: yes

Correct answer: a
An 18-year-old male presents to A&E after falling on an outstretched hand. He reports pain and tenderness in his right anatomical snuffbox.

An X-ray of the hand is taken, and a diagnosis of a scaphoid fracture is made.

Which of the following structures form the medial and lateral borders of the anatomical snuffbox?

Options:
explanation: No, this is not the correct answer. Make sure you don't confuse the medial and lateral borders of the anatomical stuff.
name: Tendons of abductor pollicis longus and extensor pollicis longus
label: e
answer: no
explanation: No, this is not the correct answer.
name: Tendons of extensor pollicis longus and extensor carpi radialis
label: c
answer: no
explanation: Yes, this is the correct answer. Make sure you can identify which muscle tendon is medial and which is lateral. You can do this by orientating your hand in the anatomical position where the thumb is pointing laterally.
name: Tendons of extensor pollicis longus and abductor pollicis longus
label: a
answer: yes
explanation: No, this is not the correct answer.
name: Tendons of abductor pollicis longus and abductor pollicis brevis
label: d
answer: no
explanation: No, this is not the correct answer.
name: Tendons of extensor pollicis brevis and abductor pollicis longus
label: b
answer: no

Correct answer: a
A 43-year-old man presents to A&E with severe vomiting, diarrhoea, and increased salivation from his oral cavity. These symptoms started around a week ago, and have been gradually worsening.

The patient is a farmer by occupation. He reports recently using a very old batch of insecticide on his crops.
It is eventually discovered that this contained the organophosphate known as parathion.

Which of the following describes the underlying pathophysiology of the patient's symptoms?

Options:
explanation: No, this is not the correct answer. The patient demonstrates symptoms of a cholinergic crisis, caused by acetylcholine excess at the neuromuscular junction.
name: Dopamine deficiency
label: e
answer: no
explanation: No, this is not the correct answer. The patient demonstrates symptoms of a cholinergic crisis, caused by acetylcholine excess at the neuromuscular junction.
name: Acetylcholine deficiency
label: b
answer: no
explanation: No, this is not the correct answer. The patient demonstrates symptoms of a cholinergic crisis, caused by acetylcholine excess at the neuromuscular junction. Nicotinic acetylcholine receptor autoantibody formation describes the underlying pathophysiology of myasthenia gravis.
name: Nicotinic acetylcholine receptor autoantibody formation
label: c
answer: no
explanation: No, this is not the correct answer. The patient demonstrates symptoms of a cholinergic crisis, caused by acetylcholine excess at the neuromuscular junction.
name: Dopamine excess
label: d
answer: no
explanation: Yes, this is the correct answer. The patient demonstrates symptoms of a cholinergic crisis, also known as SLUDGE syndrome. This can be remembered by the mnemonic SLUDGE: **S**alivation, **L**acrimation, **U**rination, **D**efecation, **G**astrointestinal distress, and **E**mesis. Organophosphate poisoning is a relatively common cause of this. Acetylcholine excess causes overstimulation at the neuromuscular junction, resulting in the signs and symptoms demonstrated by this patient.
name: Acetylcholine excess
label: a
answer: yes

Correct answer: a
A 7-year-old girl presents to A&E with severe shortness of breath following the accidental ingestion of a peanut. She has a known peanut allergy.

The heart rate and blood pressure of this patient is recorded:

Heart Rate 145 beats/min

Blood Pressure: 60/42 mmHg

Adrenaline is used in the management of an anaphylactic reaction, which leads to the vasoconstriction of arteries to maintain the patient's blood pressure. Adrenaline does this by binding to a G-protein coupled receptor on vascular smooth muscle cells.

Which of the following receptors does adrenaline bind to and which effector protein is stimulated?

Options:
explanation: No, this is not the correct answer. Physiological levels of circulating adrenaline will bind to beta 2 receptors on vascular smooth muscle, leading to the vasodilation of arteries.
name: Beta 2 and G-alpha-S
label: c
answer: no
explanation: No, this is not the correct answer. Physiological levels of circulating adrenaline will bind to beta 2 receptors on vascular smooth muscle, leading to the vasodilation of arteries.
name: Beta 2 and G-alpha-Q
label: d
answer: no
explanation: No, this is not the correct answer. This is the incorrect G-protein.
name: Alpha 1 and G-alpha-S
label: b
answer: no
explanation: Yes, this is the correct answer. At higher concentrations (for example due to EpiPen injection), adrenaline will bind to alpha 1 receptors on vascular smooth muscle, leading to stimulation of G-alpha-Q and vasoconstriction of arteries.
name: Alpha 1 and G-alpha-Q
label: a
answer: yes
explanation: No, this is not the correct answer. The beta 1 receptor is found within the cardiac muscle. Activation by noradrenaline would cause an increase in heart rate and an increase in the force of contraction generated by cardiac muscle.
name: Beta 1 and G-alpha-S
label: e
answer: no

Correct answer: a
A 54-year-old man presents to A&E  with central crushing chest pain referring to the jaw and arm. An ECG shows ST-segment elevation in leads I, avL, V5 & V6.

A diagnosis of a lateral STEMI is made. Creatine Kinase (CK) can be used to confirm this diagnosis.

The reaction catalysed by creatine kinase is shown below:

**Creatine + ATP ⇌ Phosphocreatine + ATP**

0.1 ml of serum was assayed and was shown to produce 1.5 x 10^-7 moles of phosphocreatine per minute.

What is the activity of creatine kinase (CK) in units per litre of serum?

Options:
explanation: Yes, this is the correct answer. 1.5 x 10^-7 is converted to µmol by multiplying by 10^6. So 1.5 x 10^-7 x 10^6 = 0.15 µmol. If there is 0.15 µmol produced per 0.1 ml of serum. We can then calculate how much is produced in 1 litre. 0.15 x 10^4 = 1500 µmol/L. And since we know how much phosphocreatine was made in one minute, the activity would be 1500 µmol/L/min. Note that 1 unit is the amount of enzyme
that produces 1 µmol of product per minute.
name: 1500 µmol/L/min
label: a
answer: yes
explanation: No, this is not the correct answer.
name: 1500 nmol/L/min
label: b
answer: no
explanation: No, this is not the correct answer.
name: 0.3 mol/L/min
label: d
answer: no
explanation: No, this is not the correct answer.
name: 1.5 µmol/L/min
label: c
answer: no
explanation: No, this is not the correct answer.
name: 0.15 mmol/L/min
label: e
answer: no

Correct answer: a
A 32-year-old woman attends A&E with severe right-sided leg pain. She is usually fit and well, with no regular medication aside from the combined oral contraceptive pill (COCP). The right calf is visibly swollen in comparison to the left.

While awaiting D-dimer results, the patient begins to feel short of breath and reports pleuritic chest pain. A pulmonary embolism secondary to a deep vein thrombosis (DVT) is suspected.

Which of the following routes may a DVT take to reach the cardiopulmonary circulation?

Options:
explanation: Yes, this is the correct route. In this way, a DVT may travel to the cardiopulmonary circulation and result in a pulmonary embolism.
name: Popliteal vein, Femoral vein, External iliac, Common Iliac, IVC
label: a
answer: yes
explanation: No, this is not the correct answer. The femoral vein does not drain into the internal iliac vein, it drains into the external iliac.
name: Popliteal vein, Femoral vein, Internal iliac, Common Iliac, IVC
label: c
answer: no
explanation: No, this is not the correct route. The embolus would enter the right side of the heart via the IVC rather than the aorta.
name: Femoral vein, External Iliac, Common, Iliac, Aorta
label: b
answer: no
explanation: No, this is not the correct answer.
name: Femoral vein, Internal Iliac, Common Iliac, IVC
label: d
answer: no
explanation: No, this is not the correct answer.
name: Popliteal vein, External Iliac, Common, Iliac, IVC
label: e
answer: no

Correct answer: a
A 23-year-old man presents to A&E after tripping and falling during football practice. The injury involved varus angulation of the knee. He reports severe pain in his right knee. On examination, the patient demonstrates an antalgic gait, with right-sided knee swelling.

Which of the following ligaments of the knee are most likely damaged?

Options:
explanation: No, this is not the correct answer. This would occur in injuries involving valgus angulation of the knee.
name: Medial collateral ligament
label: b
answer: no
explanation: Yes, this is the correct answer. The patient reports varus angulation of his knee joint. This means that there would have been medial angulation of his tibia (distal portion) in relation to his femur. This mechanism of injury will stretch and risk injuring the ligaments on the lateral side of the knee joint, namely the lateral collateral ligament.
name: Lateral collateral ligament
label: a
answer: yes
explanation: No, this is not the correct answer.
name: Posterior meniscofemoral ligament
label: e
answer: no
explanation: No, this is not the correct answer.
name: Posterior cruciate ligament
label: d
answer: no
explanation: No, this is not the correct answer.
name: Anterior Cruciate ligament
label: c
answer: no

Correct answer: a
A 34-year-old woman attends a minor operations unit for the removal of a basal cell carcinoma (BCC).

A very common risk factor for BCC is excessive exposure or ultraviolet (UV) light. This is because UV light can induce frameshift mutations by a forming thymine dimer within DNA. However, there are many DNA repair mechanisms that can act to prevent this mutation from occurring.

Which of the following DNA repair mechanisms is responsible for repairing a thymine dimer?

Options:
explanation: No, this is not the correct answer. This is used for double strand breaks.
name: Non-homologous end joining
label: d
answer: no
explanation: No, this is not the correct answer. This is used for double strand breaks.
name: Homology-directed repair
label: e
answer: no
explanation: No, this is not the correct answer. This is used to repair a mismatch detected in newly synthesised DNA.
name: Mismatch repair
label: b
answer: no
explanation: Yes, this is the correct answer. This involves the detection of the mutated DNA followed by cleavage of this damage section on either side of a thymine dimer by nuclease enzymes.
name: Nucleotide excision repair
label: a
answer: yes
explanation: No, this is not the correct answer. This is used to repair the deamination of cytosine to uracil.
name: Base excision repair
label: c
answer: no

Correct answer: a