hllj/quesmed huggingface dataset:
A young woman is brought into the emergency department requiring a blood transfusion. Her blood group is B and she is Rhesus negative.

Which of the following could be her genotype?

Options:
explanation: AB would be a co-dominant genotype and manifest in an AB blood type. Rhesus negative blood type has to have a dd recessive genotype.
name: AB, dd
label: e
answer: no
explanation: BO genotype would manifest in a group B blood type. Rhesus negative blood type has to have a dd recessive genotype. Dd would manifest in a Rhesus-positive blood type.
name: BO, Dd
label: c
answer: no
explanation: For the patient's blood group to be group B, her genotype has to either be BB or BO. AB would be co-dominant and manifest in an AB blood type. Rhesus negative blood type has to have a dd recessive genotype.
name: BO, dd
label: a
answer: yes
explanation: BB genotype would manifest in a group B blood type. Rhesus negative blood type has to have a dd recessive genotype. DD would manifest in a Rhesus-positive blood type.
name: BB, Dd
label: d
answer: no
explanation: AB genotypes would be co-dominantly expressed and would manifest in an AB blood type, not a group B blood type. Rhesus negative blood type has to have a dd recessive genotype.
name: AB, dd
label: b
answer: no

Correct answer: a
A patient is referred to the haematology clinic after noticing they tend to bleed easily and their gums bleed excessively after brushing their teeth. They undergo a panel of clotting tests.

Their clotting tests reveal a normal PT and TT, and a prolonged APTT and bleeding time.

Which of the following is the most likely cause of their presentation?

Options:
explanation: Vitamin K deficiency leads to a prolonged PT, due to the involvement of the extrinsic pathway of the clotting cascade.
name: Vitamin K deficiency
label: e
answer: no
explanation: Haemophilia B is an inherited bleeding disorder caused by a deficiency of clotting factor IX. You would expect to see a prolonged APTT, with normal TT, PT and bleeding time.
name: Haemophilia B
label: c
answer: no
explanation: Haemophilia A is an inherited bleeding disorder caused by a deficiency of clotting factor VIII. You would expect to see a prolonged APTT, with normal TT, PT and bleeding time.
name: Haemophilia A
label: b
answer: no
explanation: Antiphospholipid syndrome is an acquired autoimmune disease which is characterised by a predisposition to venous and arterial thromboses. A key point to remember is that in antiphospholipid syndrome, there is an isolated prolongation of APTT!
name: Antiphospholipid syndrome
label: d
answer: no
explanation: Von Willebrand disease is the most common inherited bleeding disorder, and thus should be learnt well for exams! Clotting tests reveal normal PT and TT, prolonged APTT (functional factor VIII deficiency) and bleeding time.
name: Von Willebrand disease
label: a
answer: yes

Correct answer: a
A patient presents to their GP with acute symptoms of paleness, jaundice and fatigue. The GP finds out that the patient has eaten fava beans last night.

A blood test reveals a normocytic anaemia with increased reticulocyte counts and elevated serum uric acid.

Which of the following is the most likely cause of this patient's presentation?

Options:
explanation: Autoimmune haemolytic anaemias are normocytic anaemias caused by an autoimmune process whereby red blood cells are targeted and destroyed. There are two classes - hot and cold, and this is classified at which temperature haemolysis occurs. This would not be exacerbated following fava bean consumption.
name: Autoimmune haemolytic anaemia
label: b
answer: no
explanation: Hereditary spherocytosis is an autosomal dominant condition, seen in northern European populations, caused by mutations in structural red cell membrane proteins. This is not associated with fava bean consumption.
name: Hereditary spherocytosis
label: c
answer: no
explanation: Pernicious anaemia is an autoimmune macrocytic anaemia which impairs the absorption of vitamin B12. As it causes a macrocytic anaemia and not a normocytic anaemia, this option can be ruled out immediately.
name: Pernicious anaemia
label: e
answer: no
explanation: G6PD is an X-linked recessive red-cell enzyme disorder which may present in the neonatal period with jaundice, or later in life with episodic intravascular haemolysis following exposure to oxidative stressors. Eating fava beans can trigger a haemolytic anaemia described in the question stem above.
name: G6PD Deficiency
label: a
answer: yes
explanation: Sickle cell anaemia is a congenital disorder of red blood cells, which causes a normocytic anaemia. You would expect to see other clues in the history associated with sickle cell disease. It is not linked to fava bean consumption.
name: Sickle cell anaemia
label: d
answer: no

Correct answer: a
A 35 year old woman presents to the GP complaining of tiredness, weakness and lethargy. She mentions she has heavy periods.

A full blood count is obtained, and the following results are noted: Low haemoglobin, low mean cellular volume (MCV), low ferritin and high iron binding capacity.

What is the most likely cause of this patient's presentation?

Options:
explanation: Anaemia is indicated by low haemoglobin. Iron deficiency anaemia is a microcytic anaemia, so you would expect to see a low MCV. Low ferritin and high iron binding capacity are expected in iron deficiency anaemia. Additionally, classic symptom presentation is described in the question stem.
name: Iron deficiency anaemia
label: a
answer: yes
explanation: Sickle cell disease causes a microcytic anaemia upon investigation, so would fit the low MCV described in the question stem. However, you would expect to see other clues in the history such as pain from the vaso-occlusive crisis. Low iron and ferritin would not be associated with sickle cell disease.
name: Sickle cell disease
label: c
answer: no
explanation: Although the patient has anaemia denoted by their low haemoglobin, pernicious anaemia causes high MCV, and would not have an affected on iron levels. You would expect to see a low vitamin B12 serum level and a low or normal folic acid serum level.
name: Pernicious anaemia
label: b
answer: no
explanation: Low haemoglobin indicates anaemia, and would not indicate a deep vein thrombosis (DVT). DVT refers to the intra-luminal occlusion of any vein within the deep system of a limb (either arm or leg) or the pelvis. You would expect to see symptoms of a unilateral warm, swollen calf and pitting oedema.
name: Deep Vein Thrombosis (DVT)
label: e
answer: no
explanation: Chronic liver disease is associated with a megaloblastic anaemia, which would lead to raised MCV. Heavier periods and clues about iron should point towards an iron deficiency anaemia instead.
name: Chronic liver disease
label: d
answer: no

Correct answer: a
A 47-year-old woman presents to her GP with lethargy, pallor and a sore tongue. She additionally has type 1 diabetes mellitus.

A full blood count reveals a macrocytic anaemia with hypersegmented polymorphs on the blood film.

Options:
explanation: Iron deficiency anaemia would cause a microcytic anaemia, and would be associated with low ferritin and iron serum levels. Blood film would not show hypersegmented polymorphs, as this is a feature of pernicious anaemia.
name: Iron deficiency anaemia
label: b
answer: no
explanation: Beta Thalassaemia is an inherited disorder which causes abnormal haemoglobin production. It typically causes a microcytic, not macrocytic anaemia. You would additionally expect to see a family history of beta thalassaemia, as it is inherited as an autosomal recessive pattern.
name: Beta Thalassaemia
label: e
answer: no
explanation: Aplastic anaemia is a condition where the body stops producing enough new blood cells. It is characterised by anaemia, thrombocytopenia (low platelet count) and neutropenia (low neutrophil count). You would expect other symptom pointers in the question stem to hint at aplastic anaemia.
name: Aplastic anaemia
label: d
answer: no
explanation: Pernicious anaemia is a deficiency in red blood cells caused by a lack of vitamin B12 in the blood. Pernicious anaemia is a macrocytic anaemia, and upon blood film investigation you would see hypersegmented polymorphs. Additionally, it is associated with other autoimmune diseases.
name: Pernicious anaemia
label: a
answer: yes
explanation: Anaemia of chronic disease can be caused by malignancy or chronic infections such as TB. The red cells in anaemia of chronic disease are initially of normocytic type, however, this can progress to a microcytic type. The question stem describes pernicious anaemia, a type of macrocytic anaemia.
name: Anaemia of chronic disease
label: c
answer: no

Correct answer: a
Which of the following describes the anatomical location of where an intercostal catheter should be inserted to drain a pleural effusion?

Options:
explanation: Inferior to the lower rib border would stick the needle through the neurovascular bundle. This would not be indicated in pleural effusion drainage.
name: Inferior to the lower rib border
label: b
answer: no
explanation: In each intercostal space, the neurovascular bundle runs inferiorly, protected by the costal groove of the superior rib. To avoid damage, a pleural effusion needle is placed superiorly to the lower rib border, thus avoiding the neurovascular bundle.
name: Superior to the lower rib border
label: a
answer: yes
explanation: This is clearly an incorrect answer. To avoid damage, a pleural effusion needle is placed superiorly to the lower rib border, thus avoiding the neurovascular bundle.
name: Through the neurovascular bundle
label: e
answer: no
explanation: Placing the needle through the middle, between the two rib borders is still considered unsafe, especially when there are better fitting options available. To avoid damage, a pleural effusion needle is placed superiorly to the lower rib border, thus avoiding the neurovascular bundle.
name: Middle of intercostal space
label: c
answer: no
explanation: Inferior to the superior rib border will place the needle straight through the neurovascular bundle, which you would want to avoid. To avoid damage, a pleural effusion needle is placed superiorly to the lower rib border, thus avoiding the neurovascular bundle.
name: Inferior to the superior rib border
label: d
answer: no

Correct answer: a
Which of the following statements best describes the vasculature of the heart?

Options:
explanation: This is incorrect as the posterior interventricular artery is a branch of the right coronary artery.
name: The posterior interventricular artery is a branch of the left coronary artery
label: e
answer: no
explanation: The heart receives oxygenated blood from the lungs through pulmonary veins, not arteries. This is a common mistake to make!
name: The heart receives oxygenated blood from the lungs through pulmonary arteries
label: c
answer: no
explanation: This is correct. The brachiocephalic artery then proceeds to divide into the right common carotid artery and the right subclavian artery.
A good tip for remembering: write from right to left (anatomically) B-C-S to represent brachiocephalic, common carotid and subclavian arteries. These are in alphabetical order! The brachiocephalic then splits into the right subclavian and common carotid which mirrors the left side!
name: The aortic arch consists of the brachiocephalic artery, the left common carotid artery and the left subclavian artery
label: a
answer: yes
explanation: The circumflex artery is one of the branches of the left coronary artery. It supplies blood to the back and lateral side of the heart.
name: The circumflex artery is a branch of the right carotid artery
label: b
answer: no
explanation: This is incorrect, as it is the right coronary artery and its branches which supply blood to the sinoatrial and atrioventricular nodes. Thinking logically, those are located on the right side of the heart, so the right circumflex artery would supply them!
name: The left circumflex artery supplies blood to the sinoatrial and atrioventricular nodes
label: d
answer: no

Correct answer: a
A 3-year-old girl was playing with little toys. She put some into her mouth and started choking.

Which of the following is the most likely site for a foreign object to be lodged?

Options:
explanation: The right inferior lung lobe has a steeper and wider bronchus, than that of the left side. This makes it more likely for foreign objects to lodge.
name: Right inferior lung lobe
label: a
answer: yes
explanation: Although this is an anatomical landmark of the lungs, it is not a landmark of the large airway structures such as the bronchi. Therefore foreign objects cannot lodge here.
name: Cardiac notch
label: c
answer: no
explanation: Although the oblique fissure is an anatomical landmark of the lungs, it is not a landmark of the large airway structures such as bronchi. Therefore foreign objects cannot lodge here.
name: Right oblique fissure
label: e
answer: no
explanation: Objects are more likely to travel their way down the right primary bronchus and end up in the right inferior, not superior lung lobe.
name: Right superior lung lobe
label: d
answer: no
explanation: The right inferior lung lobe is more likely to lodge foreign objects because it has a steeper and wider bronchus than that of the left.
name: Left inferior lung lobe
label: b
answer: no

Correct answer: a
A 64-year-old male with chronic liver disease is admitted to the hospital with oesophageal varices resulting from portal hypertension.

Which of the following veins drains directly into the portal vein?

Options:
explanation: The middle colic vein drains the transverse colon. It subsequently drains into the superior mesenteric vein. It does not form a direct connection with the portal vein.
name: Middle colic vein
label: b
answer: no
explanation: The inferior mesenteric vein drains into the splenic vein which then merges with the superior mesenteric vein to form the portal vein. It does not form a direct connection with the portal vein.
name: Inferior mesenteric vein
label: e
answer: no
explanation: The inferior pancreaticoduodenal vein drains the head of the pancreas as well as the descending duodenum. It subsequently drains into the superior mesenteric vein. It does not form a direct connection with the portal vein.
name: Inferior pancreaticoduodenal vein
label: d
answer: no
explanation: This question is testing which veins drain into the portal vein. The portal vein drains all gastrointestinal organs and delivers blood to the liver for detoxification. The splenic vein and superior mesenteric vein combine to form the portal vein.
name: Splenic vein
label: a
answer: yes
explanation: The right colic vein drains the right flexure and ascending colon. It subsequently drains into the superior mesenteric vein. It does not form a direct connection with the portal vein.
name: Right colic vein
label: c
answer: no

Correct answer: a
A 67-year-old man is brought to the emergency department with an aortic aneurysm in the superior mesenteric artery. This subsequently leads to ischaemia of an abdominal organ.

Which of the following is the most likely to be affected?

Options:
explanation: The anus is supplied by branches of the inferior mesenteric artery. The inferior mesenteric artery supplies the distal one-third of the transverse colon up through to the rectum and anus. The superior rectal artery, which is a branch of the inferior mesenteric artery supplies the anus.
name: Anus
label: e
answer: no
explanation: The adrenal glands are supplied by suprarenal arteries. These are branches of the inferior phrenic artery which is a branch of the abdominal aorta. Thus, they do not stem from the superior mesenteric artery.
name: Left adrenal gland
label: d
answer: no
explanation: The superior mesenteric artery supplies the intestine from the lower duodenum up until two-thirds of the transverse colon. Importantly, it supplies the head of the pancreas with blood.
name: Pancreas
label: a
answer: yes
explanation: Renal arteries are direct branches originating from the abdominal aorta. Thus, they do not stem from the superior mesenteric artery.
name: Right kidney
label: b
answer: no
explanation: Testes and testicles are supplied by the gonadal arteries which are direct branches of the abdominal aorta. Thus, they do not stem from the superior mesenteric artery.
name: Left testicle
label: c
answer: no

Correct answer: a
Which of the following tissue types is correctly matched to its gastrulation origin?

Options:
explanation: The pancreas originates from the endoderm. The endoderm makes up most of the digestive tract including the liver, pancreas and gallbladder.
name: Ectoderm -- pancreas
label: b
answer: no
explanation: The liver originates from the endoderm. The endoderm makes up most of the digestive tract including the liver, pancreas and gallbladder.
name: Mesoderm -- liver
label: c
answer: no
explanation: Kidneys originate from the mesoderm. Mesoderm makes up cartilage, bone, kidneys, blood, muscle and connective tissue.

A useful mnemonic is that the mesoderm makes up most things that help us move - kidneys because you need to move to go pee!
name: Endoderm -- kidney
label: d
answer: no
explanation: Muscle originates from the mesoderm. The mesoderm makes up cartilage, bone, kidneys, blood, muscle and connective tissue.

A useful mnemonic is that the mesoderm makes up most things that help us move - kidneys because you need to move to go pee!
name: Endoderm -- muscle
label: e
answer: no
explanation: Ectoderm gives rise to the nervous system and the epidermis of the skin.
name: Ectoderm -- epidermis
label: a
answer: yes

Correct answer: a
Which of the following statements is correct regarding fertilisation?

Options:
explanation: This is true. Most ectopic pregnancies implant in the fallopian tube. They may also implant in the ovary, abdomen and cervix, although this is uncommon. This is a serious complication for the mother.
name: Ectopic pregnancies most often occur in the fallopian tubes
label: a
answer: yes
explanation: The sperm interacts with the ZP3 receptor, which is a human-specific sperm receptor. It allows the sperm to penetrate the surrounding egg-protective zona pellucida membrane.
name: Sperm interacts with the ZP2 receptor to enter the egg
label: c
answer: no
explanation: This is untrue as the first two cell types the cell differentiates into are the trophoblast and inner cell mass. The inner cell mass then proceeds to divide into epiblast and hypoblast.
name: The first two cell types the cell differentiates into are trophoblast and epiblast
label: e
answer: no
explanation: Cleavage divisions occur in the first 24 hours and are accompanied by an increase in cell number, not an increase in cell size. Compaction allows the cells to fit in the zona pellucida membrane.
name: Cleavage divisions occur in the first 24 hours and are accompanied by cell growth
label: d
answer: no
explanation: Fertilisation occurs in the ampulla of the fallopian tube, also known as an oviduct. It implants in the uterine wall approximately six days after ovulation.
name: Fertilisation occurs in the uterine wall
label: b
answer: no

Correct answer: a
A keen medical student is asking her GP questions about embryology and gastrulation.

Which of the following is correct?

Options:
explanation: This is statement is correct as somites give rise to dermatomes, myotomes and sclerotomes. These correspond to the skin, muscle and skeletal organisation of our body.
name: Somites from mesoderm give rise to dermatomes, myotomes and sclerotomes
label: a
answer: yes
explanation: The most common neural tube defect is spina bifida which is when the spinal cord portion of the neural plate fails to close. Anencephaly is less common and is a failure of the cephalic portion of the neural plate to close.
name: The most common neural tube defect is anencephaly
label: d
answer: no
explanation: In neurulation, the neural tube closes starting from the rostral neuropore caudally. The caudal neuropore closes last.
name: In neurulation, the neural tube closes starting from the caudal neuropore
label: c
answer: no
explanation: This is incorrect as the intermediate mesoderm forms the kidneys and the reproductive systems. The lateral plate mesoderm gives rise to the connective tissue and smooth muscle layers of the gut and cardiac system.
name: The intermediate mesoderm gives rise to the connective tissue and smooth muscle layers of the gut and cardiac system
label: b
answer: no
explanation: The notochord forms the nucleus pulposus in adults, which is the inner intervertebral disk.
name: The notochord forms the outer intervertebral disk
label: e
answer: no

Correct answer: a
A woman who is trying to conceive with her partner attends her GP practice and asks questions about a healthy pregnancy. She enquires about which supplement she needs to take to minimise the risk of neural tube defects.

Which of the following is the most likely option the patient is enquiring about?

Options:
explanation: The correct choice is folic acid. Adding folic acid to the diet may reduce neural tube defects by as much as 70%. It is advised that women take a daily supplement of folic acid when they are trying to conceive.
name: Tryptophan
label: d
answer: no
explanation: The correct choice is folic acid. Adding folic acid to the diet may reduce neural tube defects by as much as 70%. It is advised that women take a daily supplement of folic acid when they are trying to conceive. Increased intake of caffeine has been linked to an increased risk of neural tube defects.
name: Caffeine
label: c
answer: no
explanation: The correct choice is folic acid. Adding folic acid to the diet may reduce neural tube defects by as much as 70%. It is advised that women take a daily supplement of folic acid when they are trying to conceive. Vitamin D deficiency is common among pregnant women, however, large-scale studies have not been done concerning neural tube defects.
name: Calcium
label: b
answer: no
explanation: The correct choice is folic acid. Adding folic acid to the diet may reduce neural tube defects by as much as 70%. It is advised that women take a daily supplement of folic acid when they are trying to conceive.
name: Magnesium
label: e
answer: no
explanation: Adding folic acid to the diet may reduce neural tube defects by as much as 70%. It is advised that women take a daily supplement of folic acid when they are trying to conceive
name: Folic acid
label: a
answer: yes

Correct answer: a
A 43-year-old man presents to his emergency department following vomiting around 750 ml of blood. A nurse obtains his vital signs.

Which of the following best described his expected vital signs?

Options:
explanation: Haemorrhagic shock causes tachycardia and hypotension. This is really important to know for your exams!
name: Tachycardia, hypotension
label: a
answer: yes
explanation: A haemorrhagic shock would not cause this. You would expect to see hypotension, not hypertension
name: Tachycardia, hypertension
label: c
answer: no
explanation: This is incorrect as you would expect to see a change in vital signs during a haemorrhagic shock. Tachycardia and hypotension are expected to be seen!
name: No change to their vital signs
label: e
answer: no
explanation: Bradycardia, widening pulse pressure and irregular breathing are known as Cushing's triad. This occurs when there is increased intracranial pressure.
name: Bradycardia, hypertension
label: b
answer: no
explanation: In a haemorrhagic shock, you would expect to see tachycardia, not bradycardia. This is important to know for your exams!
name: Bradycardia, hypotension
label: d
answer: no

Correct answer: a