hllj/quesmed huggingface dataset:
What is the parasympathetic supply to the bladder?

Options:
explanation: This is the correct answer. The nervous supply to the bladder consists of autonomic and somatic input. In terms of autonomic input, the hypogastric nerve (T12-L2) provides the sympathetic supply which allows the bladder to relax the detrusor muscle to promote urine retention, while the pelvic nerve (S2-S4) provides the parasympathetic supply which allows the bladder to contract the detrusor muscle to stimulate micturition. In terms of somatic innervation, the pudendal nerve (S2-S4) innervates the external urethral sphincter and provides voluntary control over micturition. In addition to the efferent nerves supplying the bladder, there are sensory (afferent) nerves that signal the need to urinate when the bladder becomes full.
name: Pelvic nerve
label: a
answer: yes
explanation: This is not the correct answer. This is the sympathetic innervation to the bladder. The nervous supply to the bladder consists of autonomic and somatic input. In terms of autonomic input, the hypogastric nerve (T12-L2) provides the sympathetic supply which allows the bladder to relax the detrusor muscle to promote urine retention, while the pelvic nerve (S2-S4) provides the parasympathetic supply which allows the bladder to contract the detrusor muscle to stimulate micturition. In terms of somatic innervation, the pudendal nerve (S2-S4) innervates the external urethral sphincter and provides voluntary control over micturition. In addition to the efferent nerves supplying the bladder, there are sensory (afferent) nerves that signal the need to urinate when the bladder becomes full.
name: Hypogastric nerve
label: b
answer: no
explanation: This is not the correct answer. This is the somatic innervation to the bladder, more specifically the external urethral sphincter. It provides voluntary control over micturition. The nervous supply to the bladder consists of autonomic and somatic input. In terms of autonomic input, the hypogastric nerve (T12-L2) provides the sympathetic supply which allows the bladder to relax the detrusor muscle to promote urine retention, while the pelvic nerve (S2-S4) provides the parasympathetic supply which allows the bladder to contract the detrusor muscle to stimulate micturition. In addition to the efferent nerves supplying the bladder, there are sensory (afferent) nerves that signal the need to urinate when the bladder becomes full.
name: Pudendal nerve
label: c
answer: no
explanation: This is not the correct answer. The sacral splanchnic nerves are not involved in the parasympathetic innervation of the bladder. In general, splanchnic nerves are bilateral visceral autonomic nerves that consist of the thoracic, lumbar, sacral and pelvic splanchnic nerves. However, all of these except for the pelvic splanchnic nerves (parasympathetic) provide sympathetic innervation to the respective organs.
name: Sacral splanchnic nerves
label: e
answer: no
explanation: This is not the correct answer. This is the sympathetic innervation to the rectum, alongside the superior and inferior hypogastric plexuses
name: Lumbar splanchnic nerves
label: d
answer: no

Correct answer: a
What is the epithelial lining of the vagina?

Options:
explanation: This is not the correct answer. The vagina is a muscular tube which is composed of four histological layers, where the outermost epithelial layer is the stratified squamous epithelium. However, the epithelium is not keratinized as stated in this option.
name: Stratified squamous keratinised epithelium
label: b
answer: no
explanation: This is not the correct answer. Simple cuboidal epithelium is commonly found in glandular secreting tissue and kidney tubules. On the other hand, the vagina is a muscular tube which is composed of four histological layers, where the outermost epithelial layer is the stratified squamous non-keratinised epithelium. This layer provides protection and is lubricated by cervical mucus.
name: Simple cuboidal epithelium
label: d
answer: no
explanation: This is not the correct answer. Simple columnar epithelium can be found in the endocervical canal (endocervix). On the other hand, the vagina is a muscular tube which is composed of four histological layers, where the outermost epithelial layer is the stratified squamous non-keratinised epithelium. This layer provides protection and is lubricated by cervical mucus.
name: Simple columnar epithelium
label: c
answer: no
explanation: This is the correct answer. The vagina is a muscular tube which is composed of four histological layers, where the outermost epithelial layer is the stratified squamous non-keratinised epithelium. This layer provides protection and is lubricated by cervical mucus. The ectocervix, which is the distal portion of the cervix that projects into the vagina, is also lined by this type of epithelium.
name: Stratified squamous non-keratinised epithelium
label: a
answer: yes
explanation: This is not the correct answer. This describes the transformation zone between the ectocervix and endocervix, which is the usual site at risk of human papillomavirus high-risk subtypes (16 and 18) infection and cervical carcinoma. On the other hand, the vagina is a muscular tube which is composed of four histological layers, where the outermost epithelial layer is the stratified squamous non-keratinised epithelium. This layer provides protection and is lubricated by cervical mucus.
name: Combination of non-keratinized stratified squamous and simple columnar
label: e
answer: no

Correct answer: a
A 55-year-old man complains of frequent heartburn and is prescribed cimetidine by his GP.

What is this medication's class of drug?

Options:
explanation: This is not the correct answer. Anti-muscarinic agents such as dicycloverine can be used to reduce gastrointestinal motility and associated symptoms seen in conditions such as irritable bowel syndrome (IBS) or diverticular disease. On the other hand, cimetidine is an H2 receptor antagonist. It competitively inhibits histamine in H2 receptors of parietal cells, suppressing the normal secretion of stomach acid from parietal cells, thus treating acid-related gastrointestinal conditions such as dyspepsia, peptic ulcer disease and gastro-oesophageal reflux disease.
name: Anti-muscarinic
label: e
answer: no
explanation: This is the correct answer. Cimetidine is a H2 receptor antagonist. It competitively inhibits histamine in H2 receptors of parietal cells, suppressing the normal secretion of stomach acid from parietal cells, thus treating acid-related gastrointestinal conditions such as heartburn (dyspepsia), peptic ulcer disease and gastro-oesophageal reflux disease.
name: H2 receptor antagonist
label: a
answer: yes
explanation: This is not the correct answer. H1 receptor antagonists such as cyclizine are anti-emetics used to treat nausea and vomiting. On the other hand, cimetidine is an H2 receptor antagonist. It competitively inhibits histamine in H2 receptors of parietal cells, suppressing the normal secretion of stomach acid from parietal cells, thus treating acid-related gastrointestinal conditions such as heartburn (dyspepsia), peptic ulcer disease and gastro-oesophageal reflux disease.
name: H1 receptor antagonist
label: b
answer: no
explanation: This is not the correct answer. Antacids such as aluminium hydroxide, calcium carbonate, sodium bicarbonate and so forth can come in liquid form or as chewable tablets. They neutralize stomach acid to relieve symptoms such as heartburn and dyspepsia, which this patient has. However, in this case, cimetidine was used which is a H2 receptor antagonist. It competitively inhibits histamine in H2 receptors of parietal cells, suppressing the normal secretion of stomach acid from parietal cells, thus treating acid-related gastrointestinal conditions such as dyspepsia, peptic ulcer disease and gastro-oesophageal reflux disease.
name: Antacid
label: d
answer: no
explanation: This is not the correct answer. Mebeverine is an example of an antispasmodic used to relax intestinal smooth muscle, thus relieving symptoms associated with irritable bowel syndrome (IBS) such as crampy abdominal pain caused by intestinal spasms and bloating. On the other hand, cimetidine is an H2 receptor antagonist. It competitively inhibits histamine in H2 receptors of parietal cells, suppressing the normal secretion of stomach acid from parietal cells, thus treating acid-related gastrointestinal conditions such as dyspepsia, peptic ulcer disease and gastro-oesophageal reflux disease.
name: Antispasmodic
label: c
answer: no

Correct answer: a
Which type of cell secretes renin?

Options:
explanation: This is the correct answer. The juxtaglomerular apparatus functions in regulating glomerular blood flow, filtration rate and systemic blood pressure regulation. It is formed by three cell types, namely the macula densa, juxtaglomerular granular (JG) cells and extraglomerular mesangial cells (Lacis cells). JG cells are modified smooth muscle cells found surrounding the afferent arteriole and sometimes efferent arteriole as well. Systemic blood pressure is regulated by the renin-angiotensin-aldosterone system (RAAS), where baroreceptors are stimulated by low systemic blood pressure and trigger the JG cells to secrete renin. Renin then activates the RAAS, raising blood pressure through the actions of angiotensin and aldosterone.
name: Juxtaglomerular cells
label: a
answer: yes
explanation: This is not the correct answer. The juxtaglomerular apparatus functions in regulating glomerular blood flow, filtration rate and systemic blood pressure regulation. It is formed by three cell types, namely the macula densa, juxtaglomerular granular (JG) cells and extraglomerular mesangial cells (Lacis cells). The macula densa responds to high sodium levels by releasing vasoconstrictor chemicals that constrict the afferent arteriole. On the other hand, JG cells secrete renin and help in the regulation of systemic blood pressure through the renin-angiotensin-aldosterone system (RAAS).
name: Macula densa cells
label: c
answer: no
explanation: This is not the correct answer. Podocytes are found on the visceral layer of the Bowman's capsule. These cells have finger-like projections (pedicles) and form part of the glomerular filtration barrier which consists of the podocytes, the glomerular basement membrane and the glomerular capillaries from superficial to deep.
name: Podocytes
label: b
answer: no
explanation: This is not the correct answer. intercalated cells fall under one of the cell types found in the collecting duct of the renal tubule. They are scattered amongst principal cells and have a role in acid-base balance. On the other hand, JG cells secrete renin and help in the regulation of systemic blood pressure through the renin-angiotensin-aldosterone system (RAAS).
name: Intercalated cells
label: e
answer: no
explanation: This is not the correct answer. The juxtaglomerular apparatus functions in regulating glomerular blood flow, filtration rate and systemic blood pressure regulation. It is formed by three cell types, namely the macula densa, juxtaglomerular granular (JG) cells and extraglomerular mesangial cells (Lacis cells). Lacis cells are located in the space between the afferent and efferent arterioles. On the other hand, JG cells secrete renin and help in the regulation of systemic blood pressure through the renin-angiotensin-aldosterone system (RAAS).
name: Extraglomerular mesangial cells
label: d
answer: no

Correct answer: a
Podocytes are found on the epithelial lining of which structure?

Options:
explanation: This is not the correct answer. The proximal convoluted tubule is made of simple cuboidal epithelium and functions in the absorption and secretion of water and molecules. On the other hand, podocytes are found on the visceral layer of the Bowman's capsule.
name: Proximal convoluted tubule
label: d
answer: no
explanation: This is the correct answer. The Bowman's capsule consists of two layers, parietal (outer) and visceral (inner), where the visceral layer is made of podocytes. Podocytes have finger-like projections (pedicles) and form part of the glomerular filtration barrier which consists of the podocytes, the glomerular basement membrane and the glomerular capillaries from superficial to deep.
name: Visceral layer Bowman's capsule
label: a
answer: yes
explanation: This is not the correct answer. The Bowman's capsule consists of two layers, parietal (outer) and visceral (inner), where the visceral layer is made of podocytes while the parietal layer is made of simple squamous epithelium.
name: Parietal layer Bowman's capsule
label: b
answer: no
explanation: This is not the correct answer. Similar to the proximal convoluted tubule, the distal convoluted tubule is made of simple cuboidal epithelium and functions in the absorption and secretion of water and molecules. However, it has less well-developed microvilli as its reabsorption and secretion occur to a lesser degree comparatively. On the other hand, podocytes are found on the visceral layer of the Bowman's capsule.
name: Distal convoluted tubule
label: e
answer: no
explanation: This is not the correct answer. the glomerular capillaries are made of fenestrated endothelium, where the fenestration functions as pores. The glomerular capillaries form part of the glomerular filtration barrier which consists of the podocytes, the glomerular basement membrane and the glomerular capillaries from superficial to deep. On the other hand, podocytes are found on the visceral layer of the Bowman's capsule.
name: Glomerular capillaries endothelium
label: c
answer: no

Correct answer: a
The corpus luteum switches to producing progesterone after ovulation. If implantation fails to occur, it will regress.

Which hormone is responsible for the maintenance of the corpus luteum if fertilisation occurs?

Options:
explanation: This is not the correct answer. This is not the correct answer. Luteinizing hormone (LH) and follicular stimulating hormone (FSH) are secreted by the anterior pituitary gland and their secretion correlates with the menstrual cycle in females where they rise during the follicular phase, peak around ovulation, and fall after. FSH acts on Sertoli cells to promote spermatogenesis in males and follicular development (oestrogen production) in females.
name: Follicular stimulating hormone (FSH)
label: c
answer: no
explanation: This is not the correct answer. After the implantation of a fertilized egg, the corpus luteum secretes progesterone in the early pregnancy until the placenta develops and takes over progesterone production for the remainder of the pregnancy. Progesterone is involved in prepping the endometrium for implantation of the fertilized egg and maintenance of the pregnancy.
name: Progesterone
label: e
answer: no
explanation: This is the correct answer. If uterine implantation of the fertilized egg takes place, the syncytiotrophoblast cells of the blastocyst secrete human chorionic gonadotropin (HCG) which is responsible for the maintenance of the corpus luteum. Subsequently, the corpus luteum secretes progesterone in the early pregnancy until the placenta develops and takes over progesterone production for the remainder of the pregnancy. HCG is secreted by day nine, as such, HCG levels can be used to ascertain a pregnancy 10-11 days after conception.
name: human chorionic gonadotropin (hCG)
label: a
answer: yes
explanation: This is not the correct answer. Luteinizing hormone (LH) and follicular stimulating hormone (FSH) are secreted by the anterior pituitary gland and their secretion correlates with the menstrual cycle in females where they rise during the follicular phase, peak around ovulation, and fall after. LH acts on Leydig cells to promote testosterone production in males and corpus luteum development (progesterone production) in females.
name: Luteinizing hormone (LH)
label: b
answer: no
explanation: This is not the correct answer. Gonadotropin-releasing hormone (GnRH) is released by the hypothalamus and stimulates the release of luteinizing hormone (LH) and follicular stimulating hormone (FSH) from the anterior pituitary gland.
name: Gonadotropin-releasing hormone (GnRH)
label: d
answer: no

Correct answer: a
A 40 year old man presents to the Emergency Department with a 4 day history of a cough that is productive of green sputum. He has also noticed fevers and night sweats.

He is currently homeless and uses heroin recreationally, but takes no prescribed medications and has not seen a GP for many years.

Acid-fast bacilli are seen on sputum sample and interferon gamma release assay is positive for tuberculosis. A chest x-ray displays a cavitating lesion in the upper left lobe. The patient is started on the tuberculosis protocol.

Which of the following medications is a CYP450 inducer?

Options:
explanation: This is a CYP450 enzyme inhibitor, not an inducer.
name: Isoniazid
label: e
answer: no
explanation: This is a CYP450 enzyme inhibitor, not an inducer.
name: Grapefruit
label: b
answer: no
explanation: This does not affect the CYP450 enzyme system.
name: Pyrazinamide
label: d
answer: no
explanation: This does not affect the CYP450 enzyme system.
name: Ethambutol
label: c
answer: no
explanation: Rifampicin is a hepatic enzyme (p450) inducer. Therefore it is important to check interactions with other medications such as oral contraceptives as this will greatly reduce the efficacy. Patients who are on oral contraceptives and rifampicin should be counselled to use alternative contraception during treatment.
name: Rifampicin
label: a
answer: yes

Correct answer: a
A 25 year old female attends the GP wishing to understand the ketogenic diet in more detail, in particular which amino acids are associated. The GP explains that proteins can be degraded into amino acids for energy, particularly during long stages of fasting.

Which of the following are ketogenic amino acids?

Options:
explanation: This is a proteinogenic non-essential amino acid. Under stress, it may be essential to obtain from diet as the body's demand has increased.
name: Glutamine
label: d
answer: no
explanation: This is a proteinogenic essential amino acid. This is used in the synthesis of proteins.
name: Methionine
label: b
answer: no
explanation: This is the correct answer. Leucine is a branched-chain essential amino acid with the primary end products being acetyl-CoA and acetoacetate, precursors for ketone body synthesis. The only other pure ketogenic amino acid is lysine.
name: Leucine
label: a
answer: yes
explanation: This is a proteinogenic non-essential amino acid. This is used in the synthesis of proteins.
name: Alanine
label: c
answer: no
explanation: This is a proteinogenic essential amino acid.
name: Valine
label: e
answer: no

Correct answer: a
A 60 year old caucasian female attends the dermatology clinic as they are concerned about a raised nodule on their ear. She states the growth has been slow but that the lesion has recently started bleeding. She is otherwise fit and well, with no regular medications. Although she is now retired, she used to work as a gardener.

On examination, the lesion appears keratinised with scale and an ulcerated edge. It is tender on palpation.

Which of the following is the most likely diagnosis?

Options:
explanation: Actinic keratosis is a pre-malignant skin condition that can lead to squamous cell carcinoma (SCC). The lesions normally appear as thickened papules or plaques with the skin texture appearing erythematous and keratotic. The incidence rate is higher in populations with fairer complexions and increased sun exposure. The keratinised nature and ulcerated edge of the lesion in this case makes an SCC more likely than actinic keratosis.
name: Actinic Keratosis
label: c
answer: no
explanation: This answer is incorrect. Although dermatofibromas can sometimes present with mild tenderness on palpation, they tend to be asymptomatic and do not share the same characteristics of squamous cell carcinomas such as ulceration and bleeding.
name: Dermatofibroma
label: d
answer: no
explanation: This is incorrect. Keratoacanthomas typically grow rapidly and develop from hair follicles in sun-exposed skin. They tend to appear as a dome-shaped nodule with a central keratin-filled hole. They can appear similar to a squamous cell carcinoma and therefore excision is usually recommended.
name: Keratoacanthoma
label: e
answer: no
explanation: Squamous Cell Carcinomas (SSCs) tend to form on skin that is frequently exposed to the sun. They are a keratinocyte cancer, or non-melanoma, derived from cells within the epidermis that make keratin. They are invasive and can metastasise. SCCs can grow over weeks to months, may ulcerate and bleed, and are often painful.
name: Squamous Cell Carcinoma
label: a
answer: yes
explanation: This is incorrect. This type of skin cancer is also a non-melanoma which develops in the basal cells. These cells produce new types of skin cells when the older cells die off. Although basal cell carcinomas (BCC) also develop on sun exposed skin, these nodules tend to be asymptomatic (i.e. no pain or bleeding) and can have a pearly surface with a rolled edge.
name: Basal Cell Carcinoma
label: b
answer: no

Correct answer: a
A 78 year old female attends the GP complaining of intermittent palpitations and dizziness for the past three months. She describes the palpitations as a fluttering in her chest, as if her heart has skipped a beat. She feels lightheaded during these episodes.

The only past medical history of note is hypertension for which she takes amlodipine.

On examination the patient appears comfortable at rest and her pulse is irregularly irregular. The GP decides to take an ECG, as shown below. [lightgallery]

Which of the following is the most likely diagnosis?

Options:
explanation: Atrial fibrillation is characterised by irregular, uncontrolled electrical activity in the atria of the heart. This can be seen on the ECG as an absence of P waves and an irregularly irregular rhythm. The patient has been experiencing palpitations and dizziness which are also symptoms of atrial fibrillation.
name: Atrial Fibrillation
label: a
answer: yes
explanation: This is incorrect. Ventricular fibrillation is a life-threatening arrhythmia whereby the ventricles contract in an uncoordinated manner. Blood ceases to be pumped around the body, thus resulting in a cardiac arrest. Ventricular fibrillation is classed as a "shockable" rhythm that can respond well to defibrillation. It is characterised by rapid fibrillation waves of varying amplitude with no discernible P, QRS or T waves.
name: Ventricular Fibrillation
label: c
answer: no
explanation: This is incorrect. Although patients with atrial fibrillation commonly experience palpitations, in atrial flutter the electrical activity in the atria is coordinated. This leads to a rapid atrial rate and a reduced ventricular rate leading to the characteristic flutter or 'sawtooth' waves seen on an ECG.
name: Atrial Flutter
label: b
answer: no
explanation: This is incorrect. Ventricular tachycardia is a medical emergency. It can be pulsed or pulseless (i.e. when in cardiac arrest) and needs immediate management. Ventricular tachycardia would present on an ECG with a broad QRS complex and a rate greater than 100 beats per minute.
name: Ventricular Tachycardia
label: e
answer: no
explanation: This is incorrect. Anxiety and panic attacks can present with dizziness and palpitations, however, the pulse would be regular and the ECG would show a normal sinus rhythm.
name: Anxiety
label: d
answer: no

Correct answer: a