hllj/quesmed huggingface dataset:
Which of the following statements correctly describes an aspect of the autonomic supply to the head and neck?

Options:
explanation: The upper cervical ganglion contains fibres from C1-4, the middle ganglion from C5-6 and the inferior cervical ganglion from C7-T1.
name: The upper cervical ganglion of the sympathetic trunk contains fibres from C2-5
label: d
answer: no
explanation: Parasympathetic fibres supplying the head and neck begin in 4 nuclei in the brainstem, each associated with a cranial nerve: ciliary (oculomotor), pterygopalatine (facial), submandibular (facial) and otic (glossopharyngeal). No spinal nerves contribute.
name: The parasympathetic supply of the head and neck is provided by cranial nerves only
label: a
answer: yes
explanation: They are located alongside the carotid sheaths, just anterior to the transverse processes of vertebrae.
name: The sympathetic trunks are located just posterior to the transverse processes of vertebrae
label: e
answer: no
explanation: The facial nerve provides parasympathetic innervation to both the submandibular and sublingual salivary glands.
name: The facial nerve provides parasympathetic innervation to the submandibular salivary gland only
label: b
answer: no
explanation: The parotid gland’s parasympathetic supply comes from the lesser petrosal nerve (branch of the glossopharyngeal). The superior cervical ganglion provides its sympathetic supply.
name: The parotid gland’s parasympathetic supply comes from the superior cervical ganglion
label: c
answer: no

Correct answer: a
The progressive degeneration of the corticospinal tract and alpha motor neurons is the pathophysiological process underlying which of the following conditions?

Options:
explanation: The pathophysiological process underlying Parkinson’s disease is the degeneration of dopaminergic neurons in the substantia nigra.
name: Parkinson's disease
label: b
answer: no
explanation: The primary pathological process occurring in multiple sclerosis is inflammation, which causes demyelination and axon loss.
name: Multiple sclerosis
label: d
answer: no
explanation: This is the most common form of motor neurone disease, which is caused by the degeneration of the corticospinal tract and alpha motor neurons. This results in the characteristic mix of upper and lower motor neurone signs seen.
name: Amyotrophic lateral sclerosis
label: a
answer: yes
explanation: This is a Parkinson’s plus syndrome associated with tau neurofibrillary tangles and death of both neurons and glial cells in multiple brain areas.
name: Progressive supranuclear palsy
label: e
answer: no
explanation: The pathophysiological process underlying Huntington’s disease is the expansion of trinucleotide repeats in the Huntingtin gene, which causes degeneration of the cholinergic and GABAergic neurons in the striatum.
name: Huntington's disease
label: c
answer: no

Correct answer: a
Which of the following statements best describes an aspect of the auditory perception pathway?

Options:
explanation: This is a key step in auditory perception, as it allows the transduction of the mechanical vibration of sound waves into chemical signals, which can be transmitted to the auditory areas of the brain.
name: The mechanical movement of hair cells on the basilar membrane triggers membrane potential changes, which are transmitted by the vestibulocochlear nerve
label: a
answer: yes
explanation: Vibrations transmitted by oval window travel via the endolymph of the scala vestibuli to the apex, then across the helicotrema, and out through the scala tympani.
name: Vibrations are transmitted via the endolymph of the scala tympani, through the helicotrema, and then through the scala vestibuli
label: e
answer: no
explanation: Although this is the correct function of the tensor tympani muscle, it is innervated by the mandibular division of the trigeminal nerve, not the facial nerve.
name: The tensor tympani muscle, innervated by the facial nerve, acts to dampen sound vibrations from the tympanic membrane
label: c
answer: no
explanation: The vibration of the stapes transmits vibrations to the perilymph via its footplate, which rests on the oval window, not the round window.
name: The footplate of the stapes rests on the round window, transmitting vibrations to the endolymph of the inner ear
label: b
answer: no
explanation: The basilar membrane is narrower and stiffer at its base, but wider at its apex so higher-frequency sounds displace the basilar membrane more at its base.
name: Higher frequency sounds displace the basilar membrane more at its apex
label: d
answer: no

Correct answer: a
A 59-year-old patient with type 2 diabetes mellitus presents with gradually worsening vision which is blurred and patchy.

Which of the following is most likely to be found upon fundoscopy?

Options:
explanation: These are yellow-white flecks around the macular region, due to the deposition of remnants of dead retinal pigment epithelium. This is caused by age-related macular degeneration.
name: Drusen
label: d
answer: no
explanation: As their name suggests, these are large haemorrhages that appear like flames. These occur due to pre-capillary arteriole or small vein rupture and occur in hypertensive retinopathy, thrombocytopenia, retinal vein occlusion and trauma.
name: Flame haemorrhages
label: b
answer: no
explanation: These are small, white superficial lesions which are due to tiny infarctions of the neuroretinal layer, and are commonly seen in diabetic retinopathy.
name: Cotton wool spots
label: a
answer: yes
explanation: This is the first line treatment for proliferative diabetic retinopathy and is seen as clusters of pale markings on the retina, which are due to the burning by the laser used. As the patient is presenting with vision changes, we should assume that they haven’t had this procedure.
name: Pan-retinal photocoagulation
label: c
answer: no
explanation: This is associated with central retinal artery occlusion, which typically presents with sudden profound visual loss.
name: Cherry-red macula
label: e
answer: no

Correct answer: a
A 71-year-old man has experienced a left middle cerebral artery infarct.

Which of the following are the most likely set of clinical findings upon examination of this patient?

Options:
explanation: Although contralateral homonymous hemianopia can be caused by MCA stoke, this is a less common finding. Visual deficits would be more commonly associated with posterior circulation strokes, as these can cause infarction of the visual cortex in the occipital lobe. The weakness and sensory loss would affect the right side, as the primary motor and somatosensory cortices control the contralateral side of the body.
name: Weakness and sensory loss in the left arm and face and visual deficits
label: e
answer: no
explanation: The lower limb is most often spared in MCA strokes, as according to the cortical homunculus, the area of primary motor and somatosensory cortices representing the lower limb is supplied by the anterior cerebral artery.
name: Weakness and sensory loss in the right arm, face and lower limb
label: c
answer: no
explanation: The left middle cerebral artery (MCA) supplies the parts of the motor and somatosensory cortices representing the right arm and face, so infarction here causes upper motor neuron signs in these areas. Aphasia most commonly occurs due to damage to either Broca’s area, Wernicke’s area or both. These areas are both supplied by the left MCA, and therefore are likely to be damaged in this patient.
name: Weakness and sensory loss in the right arm and face (excluding forehead) and aphasia
label: a
answer: yes
explanation: The primary motor and somatosensory cortices control the contralateral side of the body. This means that a stroke affecting the left MCA causes infarction to parts of the left primary motor and somatosensory cortices, and therefore the right side of the body is affected.
name: Weakness and sensory loss in the left arm and face (excluding forehead) and aphasia
label: d
answer: no
explanation: Weakness to the forehead muscles occurs due to lower motor neuron lesions, for example in Bell’s palsy. The forehead muscles are spared in unilateral upper motor neuron lesions, such as left MCA stroke. This is due to their bilateral cortical representation, meaning that the alternative pathway can still provide innervation.
name: Weakness and sensory loss in the face (including the forehead)
label: b
answer: no

Correct answer: a
Which statement best describes a feature of imaging modalities commonly used in neurology?

Options:
explanation: Although both modalities have their advantages and disadvantages, CT scans are much faster than MRI and are therefore the investigation of choice in trauma and other acute neurological presentations.
name: MRI scans are much faster than CT scans, so are more commonly used in trauma and other emergencies
label: e
answer: no
explanation: Acute infarcted areas may not be visible with CT. In suspected acute ischaemic stroke, the main purpose of a CT head scan is to exclude intracranial haemorrhage, which would show as hyperdense (light) areas.
name: Acute infarcts may not be visible with CT
label: a
answer: yes
explanation: This is an application of diffusion-weighted MRI, although this modality is achieved by combining T2-weighted images with restricted diffusion of water, not T1.
name: Diffusion-weighted MRI imaging combines T1-weighted images with restricted diffusion of water, allowing the visualisation of acute strokes
label: d
answer: no
explanation: CSF appears dark, but fat appears white on the T1-weighted MRI. In the more commonly used T2-weighted imaging, fat, CSF and other fluids all appear white.
name: In T2-weighted MRI imaging, CSF appears dark
label: c
answer: no
explanation: White matter does appear darker on CT, however, this is due to its lower density than grey matter.
name: White matter appears darker on CT imaging due to its high density
label: b
answer: no

Correct answer: a
Which of the following statements best describes an aspect of the course of the facial nerve?

Options:
explanation: The facial nerve does travel through the parotid gland but does not contribute towards its innervation. The glossopharyngeal nerve supplies the parotid gland with parasympathetic fibres.
name: The facial nerve travels through the parotid gland, supplying it with parasympathetic fibres
label: c
answer: no
explanation: The facial nerve arises in the pons of the brainstem, travelling through the internal acoustic meatus into the facial canal, which is located in the petrous part of the temporal bone. They eventually leave the facial canal via the stylomastoid foramen.
name: Motor fibres of the facial nerve leave the temporal bone through the stylomastoid foramen
label: a
answer: yes
explanation: The first extracranial branch to arise is the posterior auricular nerve, which supplies some muscle fibres around the ear. The motor branches to the digastric and stylohyoid muscles arise just distal to this.
name: The first extracranial branches of the facial nerve are the motor branches to the digastric and stylohyoid muscles
label: d
answer: no
explanation: This describes the course of the greater petrosal branch. The chorda tympani accompanies the mandibular trigeminal branch to supply taste sensation to the tongue.
name: The chorda tympani branch of the facial nerve accompanies the ophthalmic nerve to supply the lacrimal gland
label: b
answer: no
explanation: The parasympathetic fibres supplying the submandibular and sublingual glands do travel with the chorda tympani but through the submandibular, not the pterygopalatine ganglion.
name: The parasympathetic fibres supplying the submandibular and sublingual glands travel through the pterygopalatine ganglion with the chorda tympani
label: e
answer: no

Correct answer: a
A 44-year-old woman has left-sided ptosis, anhidrosis of the face and miosis.

Which of the following is the most likely location of the lesion causing this presentation?

Options:
explanation: The hypothalamus is a key brain region in the sympathetic supply to the eye, as this is where the first-order neurones originate. Lesions to the hypothalamus can therefore result in Horner’s syndrome features, however, these can be differentiated from cervical chain lesions due to the area affected by the anhidrosis. First-order (central) Horner’s causes anhidrosis to the face, arm and trunk.
name: Hypothalamus
label: c
answer: no
explanation: Lesions to the ophthalmic nerve most commonly involve loss of the corneal reflex and altered sensation to the upper face and anterior scalp.
name: Right ophthalmic nerve
label: d
answer: no
explanation: The cervical chains supply the ipsilateral side, so a lesion to the right chain would produce these symptoms on the right-hand side.
name: Right cervical sympathetic chain
label: b
answer: no
explanation: The presentation here is that of Horner’s syndrome, whereby there is a lesion to part of the sympathetic chain supplying the ipsilateral side. The location of the lesion along the sympathetic chain is best identified by the sites affected by the anhidrosis. The second-order neuron in this pathway travels to the head via the sympathetic cervical chain. Lesions to this neuron cause ipsilateral anhidrosis of the face, along with the characteristic mitosis and ptosis.
name: Left cervical sympathetic chain
label: a
answer: yes
explanation: Lesions to the ophthalmic nerve most commonly involve loss of the corneal reflex and altered sensation to the upper face and anterior scalp.
name: Left ophthalmic nerve
label: e
answer: no

Correct answer: a
Which of the following accurately describes the function of the pineal gland?

Options:
explanation: This is the function of the paraventricular nucleus. Its magnocellular cells secrete oxytocin and vasopressin, extending into the posterior pituitary gland.
name: Secretes oxytocin, vasopressin, and projects neurons to the posterior pituitary gland
label: e
answer: no
explanation: These sex hormones are secreted by the gonadotrophin cells of the anterior pituitary gland.
name: Secretes follicle-stimulating hormone and luteinising hormone
label: c
answer: no
explanation: This is the function of the superior cervical ganglion. The superior cervical ganglion also provides sympathetic innervation to the pineal gland
name: Provides sympathetic innervation to structures of the head and neck, including the lacrimal, salivary and thyroid glands
label: b
answer: no
explanation: The pineal gland produced melatonin, a hormone related to serotonin that is implicated in the modulation of sleep-wake cycles.
name: Produces melatonin, thereby modulating sleep-wake cycles
label: a
answer: yes
explanation: This is true of the superior colliculi. These are found near the pineal gland, and pathology within them can cause compression of surrounding structures, including the pineal gland.
name: Its function is complex and largely unknown, but it receives input from the retina and is implicated in gaze shift and eye movement
label: d
answer: no

Correct answer: a
A 26-year-old man presents with severe headaches that have been gradually worsening over the past 3 months and palpitations. On examination, he is tachycardic, sweating and has a blood pressure of 188/90mmHg.

Based on the clinical features described, which of the following is the most likely diagnosis?

Options:
explanation: Migraine is a headache disorder characterised by episodes of severe, unilateral, throbbing headaches associated with nausea, photophobia and phonophobia. It would not account for the palpitations or severe hypertension seen in this patient.
name: Migraine
label: e
answer: no
explanation: This is the autoimmune destruction of the adrenal glands, reducing the production of cortisol and aldosterone. This would present with features such as lethargy, weakness, hypotension, hyperpigmentation, weight loss, nausea and vomiting.
name: Addison's disease
label: b
answer: no
explanation: Although this may account for the tachycardia, sweating and palpitations the patient is experiencing, other features that may be seen in thyrotoxicosis include weight loss, restlessness and heat intolerance, depending on the cause. Thyrotoxicosis would not account for the dangerously high blood pressure measured in this patient.
name: Thyrotoxicosis
label: d
answer: no
explanation: This is a rare catecholamine-secreting tumour that can be associated with other pathologies. The large amount of catecholamines (noradrenaline and adrenaline) secreted results in a really high blood pressure, as seen here. Other features associated with pheochromocytoma include headaches, palpitations, sweating and anxiety.
name: Phaeochromocytoma
label: a
answer: yes
explanation: This is the autoimmune destruction of the insulin-producing beta cells. The deficiency of insulin causes raised glucose levels. Although this often presents in childhood or early adult life, it involves features such as chronic weight loss, polydipsia and polyuria, or features of diabetic ketoacidosis (abdominal pain, vomiting, decreased consciousness).
name: Type 1 diabetes mellitus
label: c
answer: no

Correct answer: a
Which of the following statements regarding hormones in pregnancy is correct?

Options:
explanation: Prolactin does cause enlargement of the mammary glands during pregnancy, preparing them for milk production. It is produced and secreted by the anterior pituitary gland, not the placenta.
name: Prolactin produced by the placenta causes enlargement of the mammary glands during pregnancy
label: e
answer: no
explanation: Progesterone is mostly produced by the corpus luteum until around week 10 of pregnancy. After this, progesterone is mostly produced by the placenta.
name: The corpus luteum is the source of progesterone throughout pregnancy
label: b
answer: no
explanation: Oxytocin is produced at the start of labour, stimulating uterine muscle contractions. It is produced and secreted by the hypothalamus.
name: Oxytocin, produced by the hypothalamus, stimulates the contraction of the myometrium at the beginning of labour
label: a
answer: yes
explanation: Human chorionic gonadotrophin is produced by the placenta, and maintains the corpus luteum in early pregnancy. Its levels significantly decrease at weeks 15-16 of pregnancy.
name: Human chorionic gonadotrophin levels significantly decrease after week 30 of pregnancy
label: d
answer: no
explanation: The increase in oxytocin, not oestrogen, at the beginning of labour, triggers prostaglandin production, which helps to increase uterine contractions.
name: The increase in oestrogen at the beginning of labour triggers prostaglandin production, which helps to increase uterine contractions
label: c
answer: no

Correct answer: a
Which of the following statements correctly describes a medication used in the treatment of type 2 diabetes mellitus?

Options:
explanation: This is the mode of action of metformin, the first-line medication used in type 2 diabetes mellitus. Gliclazide is a sulfonylurea, which stimulates the pancreatic beta cells to secrete more insulin.
name: Gliclazide works by increasing peripheral sensitivity to insulin and decreasing hepatic gluconeogenesis
label: e
answer: no
explanation: This is the mode of action of the -gliflozins, such as empagliflozin. Sitagliptin inhibits DPP-4, increasing incretin levels which inhibits glucagon secretion.
name: Sitagliptin inhibits SGLT-2, thereby inhibiting the reabsorption of glucose by the kidneys
label: d
answer: no
explanation: This is the mode of action of the -gliptins, such as sitagliptin. Empagliflozin inhibits SGLT-2, thereby inhibiting the reabsorption of glucose by the kidneys.
name: Empagliflozin inhibits the enzyme DPP-4, resulting in the inhibition of glucagon secretion
label: c
answer: no
explanation: Metformin is the first-line medication used in type 2 diabetes mellitus, however, it works by increasing peripheral sensitivity to insulin and decreasing hepatic gluconeogenesis.
name: Metformin is the first line medication used in type 2 diabetes mellitus- it stimulates the pancreatic beta cells to secrete insulin
label: b
answer: no
explanation: Although insulin is primarily used in patients with type 1 diabetes mellitus, it is also sometimes used in patients with poorly controlled type 2 diabetes mellitus.
name: Subcutaneous insulin is a direct replacement for endogenous insulin
label: a
answer: yes

Correct answer: a
A 44-year-old woman presents to her GP with concerns regarding very dry skin and scalp. She also notes that she has been feeling fatigued, and lethargic and is ‘cold all the time’. No goitre is noted upon examination. She has a past medical history of coeliac disease. Blood tests show a high TSH and low free T4.

What is the most likely diagnosis?

Options:
explanation: This is an autoimmune disease causing thyrotoxicosis (hyperthyroidism). The blood tests would most likely show low TSH but high free T4, and the clinical features would likely include exophthalmos, pretibial myxoedema, weight loss, heat intolerance and palpitations.
name: Graves' disease
label: c
answer: no
explanation: Babies are screened for congenital hypothyroidism at 5-7 days old using a heel-prick test. This is then treated in the first 4 weeks of life, and if untreated leads to irreversible cognitive impairment, short stature and hypotonia. As this woman is 44 years old and does not display any of these features, we can exclude this as a possibility.
name: Congenital hypothyroidism
label: b
answer: no
explanation: This is an autoimmune disorder of the thyroid gland associated with the typical features of hypothyroidism, including dry skin, coarse hair, lethargy, cold intolerance and weight gain. This is ten times more common in women and is associated with other autoimmune conditions (e.g. coeliac disease in this case). Hashimoto’s thyroiditis does not commonly cause goitre, and thyroid function tests show a high TSH and low free T4.
name: Hashimoto's thyroiditis
label: a
answer: yes
explanation: Subacute thyroiditis is associated with a painful goitre. As no goitre is noted in this case, we can exclude this as the most likely diagnosis.
name: Subacute (de Quervain's) thyroiditis
label: e
answer: no
explanation: This is a disease where fibrous tissue replaces the normal thyroid parenchyma, causing a painless goitre. As no goitre is noted in this case, we can exclude this as the most likely diagnosis.
name: Riedel thyroiditis
label: d
answer: no

Correct answer: a
Which of the following statements correctly describes an aspect of the HPA axis?

Options:
explanation: ACTH regulates the secretion of glucocorticoids from the zona fasciculata of the adrenal cortex.
name: Adrenocorticotropic hormone (ACTH) is a peptide hormone that regulates the secretion of glucocorticoid hormones from the zona reticularis of the adrenal cortex
label: b
answer: no
explanation: Epinephrine and norepinephrine are released by the adrenal medulla by sympathetic stimulation and local effects of cortisol. They positively feedback to the pituitary gland, increasing the breakdown of POMC into adrenocorticotropic hormone (ACTH).
name: Epinephrine and norepinephrine released by the adrenal medulla negatively feedback to the pituitary gland, reducing the breakdown of POMC into an adrenocorticotropic hormone
label: c
answer: no
explanation: Adrenocorticotropic hormone (ACTH) is secreted by the anterior pituitary gland.
name: Adrenocorticotropic hormone (ACTH) is secreted by the hypothalamus
label: d
answer: no
explanation: Corticotropin-releasing hormone is released from the hypothalamus onto the anterior pituitary gland. The posterior pituitary gland releases oxytocin and vasopressin.
name: Corticotropin-releasing hormone (CRH) is released from the posterior pituitary gland
label: e
answer: no
explanation: Cortisol is synthesised from cholesterol in the zona fasciculata of the adrenal cortex following stimulation by ACTH. Cortisol acts on many tissues in the body, but in the brain, it mediates its effects by stimulating mineralocorticoid receptors and glucocorticoid receptors.
name: Cortisol acts on two types of receptors in the brain- mineralocorticoid receptors and glucocorticoid receptors
label: a
answer: yes

Correct answer: a