hllj/quesmed huggingface dataset:
A 26-year-old man presents to his GP with severe pain and swelling in his left knee after a skiing accident. He can still walk and bear weight upon his left knee, but reports that the joint feels ‘unstable’. Upon examination of his left knee, anterior drawer and Lachman’s tests are positive, but the posterior drawer test is negative.

Which structure is most likely to be injured in this patient?

Options:
explanation: Although patella fracture can be associated with complications of ligament damage, the findings in this situation are more likely to be due to anterior cruciate ligament rupture alone. Patella fractures commonly present with an inability to bend or straighten the knee, and it is unlikely that the patient would be able to walk.
name: Patella
label: c
answer: no
explanation: Injury to the posterior cruciate ligament would result in a positive posterior drawer test, as the tibia would be able to be displaced too far posteriorly when the knee is flexed.
name: Posterior cruciate ligament
label: b
answer: no
explanation: Although injury to the medial meniscus can often occur in conjunction with injury to the anterior cruciate ligament, the information given here does not suggest this as the most likely damaged structure. Injury to the medial meniscus would give severe pain upon medial rotation of the knee.
name: Medial meniscus
label: d
answer: no
explanation: Injury to the patellar ligament would result in clinical findings including the inability to straight leg raise, movement of the patella proximally up the quadriceps and a loss of tendon tone. This results in the patient not being able to stand or walk, as the knee would buckle and give way.
name: Patellar ligament
label: e
answer: no
explanation: This is the characteristic picture of injury to the anterior cruciate ligament. Rupture of this allows the tibia to be displaced too far anteriorly when the knee is flexed, resulting in a positive anterior drawer and Lachman’s tests.
name: Anterior cruciate ligament
label: a
answer: yes

Correct answer: a
A 72-year-old man presents to his GP with chronic knee pain and stiffness that worsens upon exertion. The GP orders a plain X-ray, which shows osteophytes, sub-periosteal cysts, sclerosis and loss of joint space.

Which of the following is the most likely diagnosis?

Options:
explanation: Patella fracture would result in more sudden-onset, acute pain, and is usually associated with a history of trauma. It is unlikely that the patient would be able to walk. The X-ray findings are also not consistent with those of a fracture.
name: Patella fracture
label: b
answer: no
explanation: Gout is a form of inflammatory arthritis, which has an acute onset of pain, swelling, redness and heat of the affected joint. X-ray findings in gout are usually normal, and blood tests and sometimes synovial fluid analysis can be used to support the diagnosis.
name: Gout
label: c
answer: no
explanation: Osteoporosis is a systemic skeletal condition characterised by low bone mass and is most common in post-menopausal women. It most commonly results in vertebral, hip or forearm fractures. X-ray features of osteoporosis include increased radiolucency and cortical thinning.
name: Osteoporosis
label: d
answer: no
explanation: Rheumatoid arthritis is a systemic condition that primarily affects the joints. Joint pain and swelling are worse after periods of rest, and usual X-ray findings include osteopenia near the joint and soft tissue swelling.
name: Rheumatoid arthritis
label: e
answer: no
explanation: This is a set of findings characteristic of osteoarthritis. Breakdown of joint cartilage and underlying bone results in painful, stiff and often swollen joints. X-ray findings are used to confirm the diagnosis, and include those listed above.
name: Osteoarthritis
label: a
answer: yes

Correct answer: a
Which of the following statements, regarding the sensory innervation of the hand, is correct?

Options:
explanation: The radial nerve supplies the most lateral aspect of the thumb, wrapping around its dorsal side. The median nerve supplies the thumb’s palmar surface, nail and dorsal surface of the distal phalanx.
name: The sensory innervation of the thumb is contributed to by both the radial and median nerves
label: a
answer: yes
explanation: The median nerve supplies the lateral two-thirds of the palm. The medial aspect of the palm is innervated by the ulnar nerve.
name: Injury to the median nerve results in the loss, or altered sensation of, the medial surface of the palm
label: c
answer: no
explanation: The nail and nail beds of the medial 1.5 digits are supplied by the ulnar nerve.
name: The median nerve supplies the nails and nail beds of all digits
label: e
answer: no
explanation: The radial nerve supplies the dorsal surface of the hand, and the proximal and middle phalanges of the lateral 3.5 digits but the nail and dorsal surface of these are innervated by the median nerve.
name: The radial nerve supplies the dorsal surface of the hand and lateral 3.5 digits
label: b
answer: no
explanation: This branch supplies the medial third of the palm and the palmar surface of the medial 1.5 digits.
name: The palmar cutaneous branch of the ulnar nerve supplies the medial third of the palm only
label: d
answer: no

Correct answer: a
Which of the following statements, regarding the rotator cuff, is correct?

Options:
explanation: The subscapularis originates in the subscapular fossa and is the only rotator cuff muscle to insert onto the lesser tubercle of the humerus. The other rotator cuff muscles insert into the greater tubercle of the humerus.
name: The subscapularis is the only rotator cuff muscle to insert onto the lesser tubercle of the humerus
label: a
answer: yes
explanation: The supraspinatus acts to initiate arm abduction, therefore injury to it results in patients having difficulty abducting their arm, not laterally or medially rotating it.
name: Injury to the supraspinatus can cause a laterally rotated arm
label: c
answer: no
explanation: This is the action of the teres major muscle, which is not part of the rotator cuff. The teres minor acts to laterally rotate the arm.
name: The teres minor acts to medially rotate and extend the arm
label: b
answer: no
explanation: The innervation is by the suprascapular, axillary and sub-scapular nerves, which originate from C5-7 nerve roots.
name: The innervation of the rotator cuff muscles originates from C6-C8 spinal nerve roots
label: e
answer: no
explanation: The infraspinatus is innervated by the suprascapular nerve. The inferior subscapular nerve innervates the teres major and subscapularis.
name: The infraspinatus is innervated by the inferior subscapular nerve
label: d
answer: no

Correct answer: a
A 36-year-old pregnant woman presents with ‘pins and needles’ in her thumb, index and middle fingers, and across the lateral aspect of her palm, which becomes worse at night. Upon examination, she has weak thumb abduction and Tinel’s sign is positive.

Which of the following is the most likely diagnosis?

Options:
explanation: These are classical findings of carpal tunnel syndrome, the compression of the median nerve within the carpal tunnel. Altered sensation in the distribution of the median nerve is the most common finding, which becomes worse at night as it is common to sleep with flexed wrists, which increases pressure on the nerve.

Pregnancy is a risk factor for carpal tunnel syndrome. Weakness of the abductor pollicis brevis can occur as this muscle is supplied by the median nerve. Light percussion of the median nerve just proximal to the flexor retinaculum will elicit paraesthesia in carpal tunnel syndrome, which is known as a positive Tinel’s sign. Severe carpal tunnel syndrome can also cause paralysis and wasting of the thenar eminence.
name: Carpal tunnel syndrome
label: a
answer: yes
explanation: Palsy of the median nerve, for example at the elbow, would likely result in these findings plus an inability to pronate the forearm, weak wrist flexion and ulnar deviation of the wrist.
name: Median nerve palsy
label: d
answer: no
explanation: Scaphoid fracture is mostly caused by a traumatic injury, most commonly a fall onto an outstretched hand. This usually presents with pain along the radial aspect of the wrist, at the base of the thumb and in the anatomical snuffbox, with an associated loss of grip strength. Typical signs include pain worsening on longitudinal compression of the thumb, wrist joint effusion (especially in acute presentations), and pain on ulnar deviation of the wrist.
name: Scaphoid fracture
label: b
answer: no
explanation: Ulnar nerve palsy results in a characteristic ‘claw hand’ deformity. The ulnar nerve innervates most intrinsic muscles of the hand (apart from the thenar eminence and the lateral two lumbricals), therefore its damage results in hyperextension of the metacarpophalangeal joints and flexion of the 4th and 5th digit interphalangeal joints. Wasting and paralysis of the hypothenar eminence and other intrinsic hand muscles innervated by the ulnar nerve would also be seen. Sensory loss or changes would be in the ulnar distribution (palmar and dorsal aspects of the medial 1.5 digits).
name: Ulnar nerve palsy
label: c
answer: no
explanation: This is caused by compression of a particular nerve root (e.g. C5) as it leaves the spinal cord. Typical symptoms of cervical radiculopathy include pain corresponding to a particular dermatome and muscle weakness corresponding to a particular myotome. The symptoms, in this case, are not associated with either of these, but with the distribution of a particular peripheral nerve, the median nerve. Paraesthesia in cervical radiculopathy is also usually provoked by particular neck movements.
name: Cervical radiculopathy
label: e
answer: no

Correct answer: a
An 8-year-old boy is brought to his GP by his mother due to slowly progressing hearing loss. Upon investigation, this is found to be bilateral sensorineural hearing loss. Other investigation findings include impaired renal function, haematuria and lenticonus.

Given the probable diagnosis, the patient is likely to have inherited a defect in which of the following proteins?

Options:
explanation: Defects in this most commonly result in Marfan syndrome, which is characterised by disproportionally long and slender limbs, anterior chest wall deformity, lens dislocation, heart murmurs and spontaneous pneumothoraces.
name: Fibrillin
label: c
answer: no
explanation: Defects in type III collagen cause Ehlers-Danlos vascular type (also known as Sack-Barabas syndrome). This is associated with features such as thin, fragile, translucent skin, short stature, fragile blood vessels that can rupture, and characteristic facial features.
name: Type III collagen
label: d
answer: no
explanation: This is the type of collagen found in most connective tissues, including cartilage, bones, tendons and skin. Defects in type I collagen are associated with numerous conditions, depending on the part of the molecule affected, but these conditions generally affect the aforementioned tissues, not the triad of eyes, ears and kidneys seen with type IV collagen defects.
name: Type I collagen
label: b
answer: no
explanation: The probable diagnosis here is Alport syndrome, which has the characteristic triad of renal impairment, eye changes (especially to the lens or cornea), and sensorineural hearing loss. This is due to a defect in one of the genes coding for type IV collagen, a protein needed for the normal functioning of the eyes, ears and kidneys. As these genes are located on the X chromosome, this disorder is often more severe in males.
name: Type IV collagen
label: a
answer: yes
explanation: Defects in type V collagen cause Ehlers-Danlos classical type (formally called type 1). This is an autosomal dominant condition associated with elastic skin, bruising and joint hypermobility.
name: Type V collagen
label: e
answer: no

Correct answer: a
Which of the following statements, regarding blood vessels in the thigh, is correct?

Options:
explanation: The inferior gluteal artery is a branch of the internal iliac artery.
name: The inferior gluteal artery is a branch of the external iliac artery
label: b
answer: no
explanation: The obturator artery is a branch of the internal iliac. It passes through the obturator canal, dividing into anterior and posterior branches to supply the medial compartment.
name: The obturator artery supplies blood to the medial compartment of the thigh
label: a
answer: yes
explanation: The femoral artery is the continuation of the external iliac artery.
name: The femoral artery is the continuation of the internal iliac artery
label: d
answer: no
explanation: The great saphenous vein does run superficially, but its course is along the medial side of the thigh.
name: The great saphenous vein runs superficially along the lateral side of the thigh
label: c
answer: no
explanation: The femoral vein drains from the popliteal vein, receiving tributaries such as the deep femoral, great saphenous, lateral and medial circumflex, terminating as the external iliac vein just posterior to the inguinal ligament.
name: The femoral vein drains from the popliteal vein, terminating as the internal iliac vein
label: e
answer: no

Correct answer: a
A patient presents with an adducted, medially rotated arm and extended, pronated forearm after a fall causing injury to their neck and shoulder.

Which structure is most likely to have been injured?

Options:
explanation: Traumatic lateral bending of the neck, for example during childbirth or a fall, can result in Erb’s palsy, which is described here. The most commonly affected nerves are the suprascapular, musculocutaneous and axillary nerves. This causes lower motor neuron signs such as flaccid muscle paralysis and atrophy of the supraspinatus, infraspinatus, deltoid, biceps and brachialis muscles (so there is unopposed action of the arm adductors, medial rotators, forearm extensors and pronators).
name: C5-6 nerve root
label: a
answer: yes
explanation: Traumatic hyperabduction of the arm can cause injury to the C8-T1 nerve root, which is known as Klumpke’s palsy. This presents with the characteristic feature of a ‘claw hand’, whereby the forearm is supinated, the wrist extended and fingers flexed (due to paralysis of intrinsic hand muscles, flexor carpi ulnaris and ulnar half of flexor digitorum profundus).
name: C8-T1 nerve root
label: b
answer: no
explanation: Palsy of the median nerve would result in signs such as an inability to pronate the forearm, weak wrist flexion and ulnar deviation of the wrist. It also causes an inability to flex the distal interphalangeal joints of the second and third digits, resulting in the characteristic ‘Pope blessing’ sign when the patient is asked to make a fist.
name: Median nerve
label: d
answer: no
explanation: Damage to the radial nerve or posterior cord of the brachial plexus can arise due to humeral fracture, ‘Saturday night palsy’ or improper use of crutches. This results in a loss of extensor function, causing ‘wrist drop’ and loss of sensation on the posterior forearm, elbow and dorm of hand.
name: Radial nerve
label: c
answer: no
explanation: Ulnar nerve palsy results in a characteristic ‘claw hand’ deformity. The ulnar nerve innervates most intrinsic muscles of the hand (apart from the thenar eminence and the lateral two lumbricals), therefore its damage results in hyperextension of the metacarpophalangeal joints and flexion of the 4th and 5th digit interphalangeal joints. Wasting and paralysis of the hypothenar eminence and other intrinsic hand muscles innervated by the ulnar nerve would also be seen. Sensory loss or changes would be in the ulnar distribution (palmar and dorsal aspects of the medial 1.5 digits).
name: Ulnar nerve
label: e
answer: no

Correct answer: a
Which statement, regarding lumbar vertebrae anatomy, is correct?

Options:
explanation: The articulation of superior and inferior articular processes from the arches of adjacent vertebrae are synovial joints. Cartilaginous joints (symphyses) are found between adjacent vertebral bodies.
name: The articulation of superior and inferior articular processes from the arches of adjacent vertebrae are cartilaginous joints
label: e
answer: no
explanation: The processes on the posterior aspect of each superior articular process are the mammillary processes. The accessory processes are on the posterior aspect of the base of each transverse process.
name: The accessory processes are found on the posterior aspect of each superior articular process of the lumbar vertebrae
label: c
answer: no
explanation: The lumbosacral joint is strengthened by the iliolumbar ligaments, however, these run from the transverse processes of L5 to the ilia of the pelvis.
name: The lumbosacral joint is strengthened by the iliolumbar ligaments, which run from the spinous process of L5 to the ilia of the pelvis
label: b
answer: no
explanation: Deep back muscles attach to the accessory and mammillary processes, but not the spinous processes.
name: The spinous processes act as a site of attachment for deep back muscles
label: d
answer: no
explanation: The articular processes are vertically orientated, and articulate with adjacent vertebrae via synovial joints, allowing flexion and extension movements.
name: The vertical facets of the articular processes of the lumbar vertebrae allow flexion and extension of the lumbar spine
label: a
answer: yes

Correct answer: a
The loss of which cell type is responsible for the demyelination seen in multiple sclerosis?

Options:
explanation: The number of astrocytes in multiple sclerosis often increases as neurons become damaged and destroyed (this is called astrogliosis) however are not responsible for demyelination.
name: Astrocytes
label: c
answer: no
explanation: Macrophages have been shown to assemble in their activated forms at sites of neurodegeneration in multiple sclerosis. This is an inflammatory reactive process, not a demyelinating one and there is no loss of macrophages seen.
name: Macrophages
label: e
answer: no
explanation: Microglia have been shown to assemble in their activated forms at sites of neurodegeneration in multiple sclerosis. This is an inflammatory reactive process, not a demyelinating one and there is no loss of microglia seen.
name: Microglia
label: d
answer: no
explanation: Oligodendrocytes are a type of neuroglial cell responsible for the insulation of axons in the central nervous system. They do this by the creation and maintenance of myelin, which allows the efficient transmission of action potentials. Loss of oligodendrocytes in multiple sclerosis results in demyelination of neuronal axons, so the neurons are unable to conduct action potentials as effectively.
name: Oligodendrocytes
label: a
answer: yes
explanation: Although neurons can be damaged and destroyed as the disease progresses, this process is not responsible for the characteristic loss of myelin seen in multiple sclerosis.
name: Neurons
label: b
answer: no

Correct answer: a
Which of the following structures is supplied by the posterior cerebral artery?

Options:
explanation: The posterior cerebral artery supplies the occipital lobe, the inferolateral surface of the temporal lobe, the midbrain, the thalamus and the choroid plexus.
name: Occipital lobe
label: a
answer: yes
explanation: This is supplied by the middle cerebral artery.
name: Broca's area
label: d
answer: no
explanation: Most of the pons is supplied by the pontine arteries, which branch from the basilar artery. Some of the pons is supplied by the anterior and posterior cerebellar arteries.
name: Pons
label: e
answer: no
explanation: This receives blood supply from 3 main arteries originating from the vertebrobasilar system: the superior cerebellar artery, the anterior inferior cerebellar artery and the posterior inferior cerebellar artery.
name: Cerebellum
label: c
answer: no
explanation: This is supplied by the anterior cerebral artery.
name: Corpus callosum
label: b
answer: no

Correct answer: a
An 81-year-old male presents to the GP with a ‘pill-rolling’ tremor at rest, ‘cogwheel’ rigidity and a shuffling gait with a stooped posture.

Which of the following is the most likely histopathological finding on a biopsy of the brain?

Options:
explanation: This is the neuropathological hallmark of multiple sclerosis, which is not associated with any of the symptoms listed in the vignette.
name: Demyelination
label: b
answer: no
explanation: The features described are those of Parkinson’s disease. Although other causes (e.g. drugs) can result in similar syndromes, the most likely neuropathological finding is Lewy bodies.
name: Lewy bodies
label: a
answer: yes
explanation: These are spherical inclusions in neuronal cytoplasm, found in behavioural variant frontotemporal dementia. This disease has clinical features including disinhibition, apathy and loss of executive dysfunction.
name: Pick bodies
label: e
answer: no
explanation: These can be found in some Parkinson’s plus syndromes such as progressive supranuclear palsy (PSP), as well as Alzheimer’s disease. PSP results in postural instability and rigidity, vertical gaze palsy and little tremor. Alzheimer’s disease characteristically results in cognitive impairment and episodic memory loss.
name: Tau neurofibrillary tangles
label: c
answer: no
explanation: These are characteristics of Alzheimer’s disease, which has clinical features of cognitive impairment and episodic memory loss.
name: Amyloid-beta plaques
label: d
answer: no

Correct answer: a
Which of the following statements, regarding muscles in the face, is correct?

Options:
explanation: The lateral pterygoid depresses and protrudes the mandible- it moves the articular disc of the temporomandibular joint forwards.
name: The lateral pterygoid depresses and retracts the mandible
label: e
answer: no
explanation: The medial pterygoid originates on the medial surface of the lateral pterygoid plate of the sphenoid and inserts onto the medial mandibular angle via 2 heads. It acts to elevate and protrude the mandible.
name: The medial pterygoid elevates and protrudes the mandible
label: a
answer: yes
explanation: The buccinator is a muscle of facial expression, not mastication. It is innervated by the facial nerve.
name: The buccinator is innervated by the mandibular division of the trigeminal nerve
label: c
answer: no
explanation: The masseter inserts onto the angle of the mandible.
name: The masseter inserts onto the superior edge of the ramus of the mandible
label: d
answer: no
explanation: All masticatory muscles are innervated by the mandibular branch of the trigeminal nerve.
name: The temporalis muscle is innervated by the maxillary division of the trigeminal nerve
label: b
answer: no

Correct answer: a
A visual field test reveals that a patient has left superior quadrantanopia.

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

Options:
explanation: This would result in a right inferior quadrantanopia. The acronym to remember is PITS (parietal inferior, temporal superior).
name: Left optic radiation in the parietal lobe
label: c
answer: no
explanation: Lesions to the optic radiation always affect the contralateral side. The acronym to remember is PITS (parietal inferior, temporal superior).
name: Right optic radiation in the temporal lobe
label: a
answer: yes
explanation: This would result in right superior quadrantanopia as lesions to the optic radiation always affect the contralateral side.
name: Right optic radiation in the parietal lobe
label: d
answer: no
explanation: This would result in right superior quadrantanopia as lesions to the optic radiation always affect the contralateral side.
name: Left optic radiation in the temporal lobe
label: b
answer: no
explanation: Lesions in the occipital cortex result in contralateral homonymous hemianopia with macular sparing. If there was no macular sparing with the homonymous hemianopia, this would suggest a lesion of the optic tract.
name: Right occipital cortex
label: e
answer: no

Correct answer: a