hllj/quesmed huggingface dataset:
Which of the following correctly describes the mechanism through which Glyceryl trinitrate (GTN) spray treats angina symptoms?

Options:
explanation: This is incorrect as GTN is broken down to release nitric oxide, not endothelins. Furthermore, since angina is caused by a reduction in blood flow to the heart, GTN must cause smooth muscle relaxation and hence vasodilation.
name: GTN is broken down to release endothelins. This causes activation of Ca2+ channels and hence contraction of smooth muscle cells
label: d
answer: no
explanation: This is incorrect as GTN is broken down to release nitric oxide, not prostaglandins. Furthermore, since angina is caused by a reduction in blood flow to the heart, GTN must cause smooth muscle relaxation and hence vasodilation.
name: GTN is broken down to release prostaglandins. This causes activation of Ca2+ channels and hence contraction of smooth muscle cells
label: e
answer: no
explanation: This is correct. Once inside the body, GTN is broken down to release nitric oxide, a potent vasodilator. Via increasing levels of intracellular cGMP, nitric oxide results in inhibition of Ca2+ channels, reducing intracellular Ca2+ and hence lowering smooth muscle contractility. This causes vasodilation and hence improves the symptoms of angina.
name: GTN is broken down to release nitric oxide which increases cGMP levels. This causes inhibition of Ca2+ channels and hence relaxation of smooth muscle cells
label: a
answer: yes
explanation: This is incorrect as nitric oxide increases, not decreases, the levels of cGMP. Via increasing levels of intracellular cGMP, nitric oxide results in inhibition of Ca2+ channels, reducing intracellular Ca2+ and hence lowering smooth muscle contractility. This causes vasodilation and hence improves the symptoms of angina.
name: GTN is broken down to release nitric oxide which decreases cGMP levels. This causes inhibition of Ca2+ channels and hence relaxation of smooth muscle cells
label: b
answer: no
explanation: This is incorrect as GTN is broken down to release nitric oxide, not prostaglandins.
name: GTN is broken down to release prostaglandins. This causes inhibition of Ca2+ channels and hence relaxation of smooth muscle cells
label: c
answer: no

Correct answer: a
Which of the following is the correct mechanism of action of minoxidil?

Options:
explanation: This is incorrect. Minoxidil works by opening K+ channels. This results in hyperpolarisation of smooth muscle cells, inhibiting calcium channel opening which causes relaxation and hence vasodilation. This increases blood flow to the hair follicles.
name: Activates Ca2+ channels
label: e
answer: no
explanation: This is incorrect. Minoxidil works by opening K+ channels. This results in hyperpolarisation of smooth muscle cells, inhibiting calcium channel opening which causes relaxation and hence vasodilation. This increases blood flow to the hair follicles.
name: Activates Na+ channels
label: c
answer: no
explanation: This is incorrect. Minoxidil works by opening K+ channels. This results in hyperpolarisation of smooth muscle cells, inhibiting calcium channel opening which causes relaxation and hence vasodilation. This increases blood flow to the hair follicles.
name: Inhibits Na+ channels
label: d
answer: no
explanation: This is correct. Minoxidil is a drug used to treat hair loss which works via opening K+ channels. This results in hyperpolarisation of smooth muscle cells, inhibiting calcium channel opening which causes relaxation and hence vasodilation. This increases blood flow to the hair follicles.
name: Activates K+ channels
label: a
answer: yes
explanation: This is incorrect. Minoxidil works by opening K+ channels. This results in hyperpolarisation of smooth muscle cells, inhibiting calcium channel opening which causes relaxation and hence vasodilation. This increases blood flow to the hair follicles.
name: Inhibits K+ channels
label: b
answer: no

Correct answer: a
Why does the concurrent use of simvastatin and diltiazem increase the risk of rhabdomyolysis?

Options:
explanation: This is incorrect. It is diltiazem which inhibits cytochrome P3A4, not simvastatin. This results in a rise in simvastatin levels which can result in pathological muscle breakdown and eventually rhabdomyolysis.
name: Simvastatin inhibits cytochrome P3A4 which causes a rise in diltiazem
label: b
answer: no
explanation: This is incorrect. Diltiazem inhibits cytochrome P3A4, the enzyme responsible for breaking down simvastatin. This results in a rise in simvastatin levels which can result in pathological muscle breakdown and eventually rhabdomyolysis.
name: Diltiazem activates cytochrome P3A4 which causes a rise in simvastatin
label: c
answer: no
explanation: This is incorrect. Diltiazem inhibits cytochrome P3A4, the enzyme responsible for breaking down simvastatin. This results in a rise in simvastatin levels which can result in pathological muscle breakdown and eventually rhabdomyolysis.
name: Both drugs are broken down by the same enzyme and hence concurrent use causes elevation in levels of both
label: e
answer: no
explanation: This is correct. Diltiazem inhibits cytochrome P3A4, the enzyme responsible for breaking down simvastatin. This results in a rise in simvastatin levels which can result in pathological muscle breakdown and eventually rhabdomyolysis.
name: Diltiazem inhibits cytochrome P3A4 which causes a rise in simvastatin levels
label: a
answer: yes
explanation: This is incorrect. Diltiazem inhibits cytochrome P3A4, the enzyme responsible for breaking down simvastatin. This results in a rise in simvastatin levels which can result in pathological muscle breakdown and eventually rhabdomyolysis.
name: Simvastain activates cytochrome P3A4 which causes a rise in diltiazem
label: d
answer: no

Correct answer: a
As part of the baroreceptor reflex, once a drop in blood pressure has been detected at the carotid sinus, which area of the brain is an impulse sent to?

Options:
explanation: This is incorrect. Whilst the caudal ventrolateral medulla is involved in the baroreceptor reflex pathway, it is not the site where afferent fibres from the carotid sinus first arrive as that is the nucleus tractus solitatius. Instead, it receives electrical activity from the nucleus tractus solitarius to, along with the rostral ventrolateral medulla, increase sympathetic activity to the heart and blood vessels.
name: Caudal ventrolateral medulla
label: d
answer: no
explanation: This is incorrect. Whilst the nucleus ambiguus is involved in the baroreceptor reflex pathway, it is not the site where afferent fibres from the carotid sinus first arrive as that is the nucleus tractus solitatius. Instead, it receives electrical activity from the nucleus tractus solitarius to raise the heart rate.
name: Nucleus ambiguus
label: b
answer: no
explanation: This is correct. Baroreceptor afferent fibres are sent to the nucleus tractus solitarius. This then sends further impulses to other areas of the brain, such as the nucleus ambiguus, rostral ventrolateral medulla, caudal ventrolateral medulla, and paraventricular nucleus which bring about the reflex actions.
name: Nucleus tractus solitarius
label: a
answer: yes
explanation: This is incorrect. Whilst the rostral ventrolateral medulla is involved in the baroreceptor reflex pathway, it is not the site where afferent fibres from the carotid sinus first arrive as that is the nucleus tractus solitatius. Instead, it receives electrical activity from the nucleus tractus solitarius to, along with the caudal ventrolateral medulla, increase sympathetic activity to the heart and blood vessels.
name: Rostral ventrolateral medulla
label: c
answer: no
explanation: This is incorrect. Whilst the paraventricular nucleus is involved in the baroreceptor reflex pathway, it is not the site where afferent fibres from the carotid sinus first arrive as that is the nucleus tractus solitatius. Instead, it receives electrical activity from the nucleus tractus solitarius to increase ADH release from the hypothalamus.
name: Paraventricular nucleus
label: e
answer: no

Correct answer: a
Which of the following is the correct explanation of sinus arrhythmia?

Options:
explanation: This is incorrect. This describes complete heart block. Sinus arrhythmia refers to the normal fluctuations in heart rate associated with breathing.
name: A desynchronization of atrial and ventricular contraction due to damage to the AV node
label: d
answer: no
explanation: This is correct. It is normal in young, healthy individuals to see fluctuations in the heart rate associated with breathing. There is a drop in heart rate during expiration and a rise during inspiration. This is called sinus arrhythmia.
name: Normal fluctuations in heart rate are associated with breathing
label: a
answer: yes
explanation: This is incorrect. This describes ventricular tachycardia. Sinus arrhythmia refers to the normal fluctuations in heart rate associated with breathing.
name: A rapid, irregular heartbeat originating from the ventricles
label: c
answer: no
explanation: This is incorrect. This describes Wolff-Parkinson-White syndrome. Sinus arrhythmia refers to the normal fluctuations in heart rate associated with breathing.
name: An abnormal accessory pathway from the atrium to the ventricle resulting in periods of tachycardia
label: e
answer: no
explanation: This is incorrect. This describes atrial fibrillation. Sinus arrhythmia refers to the normal fluctuations in heart rate associated with breathing.
name: An irregularly irregular heartbeat originates from the atria
label: b
answer: no

Correct answer: a
Which of the following correctly distinguishes concentric from eccentric hypertrophy?

Options:
explanation: This is incorrect. In eccentric hypertrophy, new sarcomeres are added in series to the existing ones, resulting in an increase in chamber size without an increase in wall thickness. Concentric hypertrophy, on the other hand, does result in wall thickening.
name: Eccentric hypertrophy causes an enlargement in chamber size in proportion to an increase in wall thickness
label: b
answer: no
explanation: This is incorrect. This describes concentric hypertrophy. Eccentric hypertrophy occurs as a result of endurance training, not pressure overload.
name: Eccentric hypertrophy occurs when the heart adapts to pressure overload (e.g. in hypertension)
label: c
answer: no
explanation: This is incorrect. Eccentric hypertrophy is a form of physiological remodelling whereby the myocytes increase in length but not width. This results in an increase in chamber size without an increase in wall thickness. Concentric hypertrophy, on the other hand, occurs secondary to pressure overload (e.g. in hypertension) and involves significant wall thickening.
name: Eccentric and concentric hypertrophy are synonymous terms referring to the same process of cardiac remodelling
label: d
answer: no
explanation: This is incorrect. Concentric hypertrophy occurs when sarcomeres are added in parallel to the existing ones, resulting in the thickening of the chamber walls and hence an increase in myocardial mass.
name: Eccentric hypertrophy results in a reduction in myocardial mass
label: e
answer: no
explanation: This is correct. Eccentric hypertrophy is a form of physiological remodelling whereby the myocytes increase in length but not width. This results in an increase in chamber size without an increase in wall thickness.
name: Eccentric hypertrophy does not result in an increased myocardial wall thickness
label: a
answer: yes

Correct answer: a
Which of the following correctly lists the 3 points of constriction seen in the ureter?

Options:
explanation: This is incorrect. There are 3 sites of constriction along the course of the ureter where stones may lodge. These are the ureteropelvic junction (where the ureter emerges from the renal pelvis), the crossing of the ureter over the common iliac artery, and the uretorovesicular junction (where the ureter enters the bladder wall).
name: The ureteropelvic junction, crossing over the abdominal aorta, ureteral sphincter
label: e
answer: no
explanation: This is incorrect. There are 3 sites of constriction along the course of the ureter where stones may lodge. These are the ureteropelvic junction (where the ureter emerges from the renal pelvis), the crossing of the ureter over the common iliac artery, and the uretorovesicular junction (where the ureter enters the bladder wall).
name: The bladder neck, crossing over the femoral artery, uretorovesicular junction
label: c
answer: no
explanation: This is incorrect. There are 3 sites of constriction along the course of the ureter where stones may lodge. These are the ureteropelvic junction (where the ureter emerges from the renal pelvis), the crossing of the ureter over the common iliac artery, and the uretorovesicular junction (where the ureter enters the bladder wall).
name: The bladder neck, crossing over the common iliac artery, ureteral sphincter
label: d
answer: no
explanation: This is incorrect. There are 3 sites of constriction along the course of the ureter where stones may lodge. These are the ureteropelvic junction (where the ureter emerges from the renal pelvis), the crossing of the ureter over the common iliac artery, and the uretorovesicular junction (where the ureter enters the bladder wall).
name: Ureteropelvic junction, crossing over the femoral artery, uretorovesicular junction
label: b
answer: no
explanation: This is correct. There are 3 sites of constriction along the course of the ureter where stones may lodge. These are the ureteropelvic junction (where the ureter emerges from the renal pelvis), the crossing of the ureter over the common iliac artery, and the uretorovesicular junction (where the ureter enters the bladder wall).
name: Ureteropelvic junction, crossing over the common iliac artery, uretorovesicular junction
label: a
answer: yes

Correct answer: a
Which of the following is an example of a transcellular space?

Options:
explanation: This is incorrect. This describes the intracellular space. Transcellular spaces are special compartments within the human body whereby fluid volumes are very tightly controlled. These include cerebrospinal fluid, pleural fluid, and synovial fluid. These are separate spaces from the intracellular, intravascular and interstitial spaces.
name: A cardiac myocyte
label: c
answer: no
explanation: This is incorrect. The interstitial space is its own fluid compartment existing outside of the blood vessels and outside of the cells. Transcellular spaces are special compartments within the human body whereby fluid volumes are very tightly controlled. These include cerebrospinal fluid, pleural fluid, and synovial fluid. These are separate spaces from the intracellular, intravascular and interstitial spaces.
name: The interstitial space
label: b
answer: no
explanation: This is incorrect. This describes the intravascular space. Transcellular spaces are special compartments within the human body whereby fluid volumes are very tightly controlled. These include cerebrospinal fluid, pleural fluid, and synovial fluid. These are separate spaces from the intracellular, intravascular and interstitial spaces.
name: The plasma in the blood
label: d
answer: no
explanation: This is incorrect. Transcellular spaces are special compartments within the human body whereby fluid volumes are very tightly controlled. These include cerebrospinal fluid, pleural fluid, and synovial fluid. These are separate spaces from the intracellular, intravascular and interstitial spaces.
name: None of the above
label: e
answer: no
explanation: This is correct. Transcellular spaces are special compartments within the human body whereby fluid volumes are very tightly controlled. These include cerebrospinal fluid, pleural fluid, and synovial fluid. These are separate spaces from the intracellular, intravascular and interstitial spaces.
name: Cerebrospinal fluid
label: a
answer: yes

Correct answer: a
What is the mechanism through which mannitol is used to treat cerebral oedema?

Options:
explanation: This is incorrect. Whilst mannitol does increase the plasma osmolality, this draws fluid out of the intracellular space and into the interstitium and plasma.
name: It increases the plasma osmolality to draw fluid out of the interstitial space
label: c
answer: no
explanation: This is correct. Mannitol is a sugar alcohol which sits in the extracellular space and increases the osmolality. This pulls fluid out of the intracellular space down a water potential gradient and hence helps reduce cerebral oedema.
name: It increases the plasma osmolality to draw fluid out of the intracellular space
label: a
answer: yes
explanation: This is incorrect. This describes the mechanism of action of how dexamethasone reduces cerebral oedema. Mannitol is a sugar alcohol which sits in the extracellular space and increases the osmolality. This pulls fluid out of the intracellular space down a water potential gradient and hence helps reduce cerebral oedema.
name: It reduces the permeability of capillaries in the brain to prevent fluid leaking out
label: e
answer: no
explanation: This is incorrect. Whilst mannitol does draw fluid out of the intracellular space, it does this by increasing the plasma osmolality, not osmolarity.
name: It increases the plasma osmolarity to draw fluid out of the intracellular space
label: b
answer: no
explanation: This is incorrect. Mannitol is a sugar alcohol which sits in the extracellular space and increases the osmolality. This pulls fluid out of the intracellular space down a water potential gradient and hence helps reduce cerebral oedema.
name: It increases the plasma osmolarity to draw fluid out of the interstitial space
label: d
answer: no

Correct answer: a
Which layer of the glomerular filtration barrier is made up of podocytes with filtration slits between them?

Options:
explanation: This is correct. This is the third layer of the glomerular filtration barrier and is characterised by podocytes wrapping around the glomerular capillaries. Podocytes are specialised epithelial cells with foot processes known as pedicels which help to filter out any larger molecules from entering the nephron.
name: Epithelial layer of the Bowman's capsule
label: a
answer: yes
explanation: This is incorrect. Whilst this is a layer of the glomerular filtration barrier, it is not made up of podocytes.
name: Glomerular basement membrane
label: b
answer: no
explanation: This is incorrect. The proximal tubule epithelium is not a component of the glomerular filtration barrier. It is made up of the capillary endothelium, the glomerular basement membrane, and the epithelial layer of the Bowman's capsule. It is this third layer which is composed of podocytes.
name: Proximal tubule epithelium
label: d
answer: no
explanation: This is incorrect. The collecting duct is not a component of the glomerular filtration barrier. It is made up of the capillary endothelium, the glomerular basement membrane, and the epithelial layer of the Bowman's capsule. It is this third layer which is composed of podocytes.
name: Collecting duct
label: e
answer: no
explanation: This is incorrect. Whilst this is a layer of the glomerular filtration barrier, it is not made up of podocytes.
name: Capillary endothelium
label: c
answer: no

Correct answer: a
A man with a plasma creatinine concentration of 60 μmol/L (normal range 60-120μmol/L) undergoes a 24-hour urine collection. During the 24 hours, 1.9L of urine is collected with a urinary creatinine concentration of 6000 micromoles/L (normal ranges: (F) 6 - 13 (M) 9 - 19).

What is the man's GFR in L/hour?

Options:
explanation: This is incorrect. The GFR is calculated by multiplying the urine:plasma creatinine ratio by the rate of urine output in 24 hours. In this case, it is 6000/60 x 1.9/24 = 7.9 L/hour.
name: 0.019 L/hour
label: d
answer: no
explanation: This is incorrect. The GFR is calculated by multiplying the urine:plasma creatinine ratio by the rate of urine output in 24 hours. In this case, it is 6000/60 x 1.9/24 = 7.9 L/hour.
name: 190 L/hour
label: e
answer: no
explanation: This is incorrect. The GFR is calculated by multiplying the urine:plasma creatinine ratio by the rate of urine output in 24 hours. In this case, it is 6000/60 x 1.9/24 = 7.9 L/hour.
name: 90 L/hour
label: c
answer: no
explanation: This is correct. The GFR can be calculated by multiplying the urine:plasma creatinine ratio by the rate of urine output in 24 hours. In this case, it is 6000/60 x 1.9/24 = 7.9 L/hour.
name: 7.9 L/hour
label: a
answer: yes
explanation: This is incorrect. The GFR is calculated by multiplying the urine:plasma creatinine ratio by the rate of urine output in 24 hours. In this case, it is 6000/60 x 1.9/24 = 7.9 L/hour.
name: 0.00079 L/hour
label: b
answer: no

Correct answer: a
Through which transporter is the majority of glucose reabsorbed in the nephron?

Options:
explanation: This is incorrect. The aquaporin 1 channel (AQP1) is involved in water reabsorption, not glucose reabsorption. The Sodium-Glucose Linked Transporter 2 (SGLT2) is the primary transporter involved in the reabsorption of glucose in the nephron.
name: AQP1
label: c
answer: no
explanation: This is incorrect. Whilst the SGLT1 transporter is involved in glucose reabsorption, it is considerably less important than the SGLT2 transporter in the nephron. SGLT1 accounts for the majority of dietary glucose uptake in the gastrointestinal tract.
name: SGLT1
label: b
answer: no
explanation: This is incorrect. The Glucose/Hydrogen exchanger is not a component of the nephron. The Sodium-Glucose Linked Transporter 2 (SGLT2) is the primary transporter involved in the reabsorption of glucose in the nephron.
name: Glucose/Hydrogen exchanger
label: e
answer: no
explanation: This is incorrect. The Na-K-Cl cotransporter (NKCC2) is involved in Na+, K+, and Cl- reabsorption, not glucose reabsorption. The Sodium-Glucose Linked Transporter 2 (SGLT2) is the primary transporter involved in the reabsorption of glucose in the nephron.
name: NKCC2
label: d
answer: no
explanation: This is correct. The Sodium-Glucose Linked Transporter 2 (SGLT2) is the primary transporter involved in the reabsorption of glucose in the nephron. It sits in the proximal convoluted tubule and takes up a glucose molecule and Na+ ion together. It is responsible for the reabsorption of around 90% of the glucose.
name: SGLT2
label: a
answer: yes

Correct answer: a
Which acid-base disturbance can be seen with acetazolamide use?

Options:
explanation: This is incorrect. Acetazolamide is a carbonic anhydrase inhibitor and so reduces the reabsorption of bicarbonate. This leads to increased urinary bicarbonate loss and lower serum bicarbonate levels. This means there is less buffering of H+ ions, leading to metabolic acidosis.
name: It does not affect acid-base homeostasis
label: e
answer: no
explanation: This is incorrect. Acetazolamide is a carbonic anhydrase inhibitor and so reduces the reabsorption of bicarbonate. This leads to increased urinary bicarbonate loss and lower serum bicarbonate levels. This means there is less buffering of H+ ions, leading to metabolic acidosis.
name: Respiratory alkalosis
label: d
answer: no
explanation: This is correct. Acetazolamide is a carbonic anhydrase inhibitor and so reduces the reabsorption of bicarbonate. This leads to increased urinary bicarbonate loss and lower serum bicarbonate levels. This means there is less buffering of H+ ions, leading to metabolic acidosis.
name: Metabolic acidosis
label: a
answer: yes
explanation: This is incorrect. Acetazolamide is a carbonic anhydrase inhibitor and so reduces the reabsorption of bicarbonate. This leads to increased urinary bicarbonate loss and lower serum bicarbonate levels. This means there is less buffering of H+ ions, leading to metabolic acidosis.
name: Respiratory acidosis
label: c
answer: no
explanation: This is incorrect. Acetazolamide is a carbonic anhydrase inhibitor and so reduces the reabsorption of bicarbonate. This leads to increased urinary bicarbonate loss and lower serum bicarbonate levels. This means there is less buffering of H+ ions, leading to metabolic acidosis.
name: Metabolic alkalosis
label: b
answer: no

Correct answer: a