hllj/quesmed huggingface dataset:
The ligamentum teres is a physiological remnant of which embryological feature?

Options:
explanation: This is the correct answer. The umbilical cord contains 2 umbilical arteries and 1 umbilical vein, where the latter carries oxygenated blood from the placenta to the fetus. The physiological remnant of this structure is the ligamentum teres (also known as the round ligament) which is a fibrous cord that runs from the umbilicus to the left lobe of the liver in the free border of the falciform ligament.
name: Umbilical vein
label: a
answer: yes
explanation: This is not the correct answer. The allantois is a canal within the umbilical cord that drains urine from the bladder of the fetus. The physiological remnant of the allantois is a fibrous structure known as the urachus, which then definitively forms the median umbilical ligament later on.
name: Allantois
label: c
answer: no
explanation: This is not the correct answer. The ductus arteriosus is a blood vessel connecting the proximal descending aorta to the trunk of the pulmonary artery in the developing fetus. This allows the majority of the blood from the right ventricle to bypass the fetus's fluid-filled and non-functioning lungs. The physiological remnant of this structure, which is formed within three weeks post-birth, is the ligamentum arteriosum.
name: Ductus arteriosus
label: d
answer: no
explanation: This is not the correct answer. In the developing fetus, the ductus venosus is a shunt that allows some of the oxygenated blood from the umbilical vein to bypass the liver and directly flow into the inferior vena cava. The ductus venosus, ductus arteriosus and, foramen ovale contribute to the essential role of shunting oxygenated blood preferentially to the fetal brain. The physiological remnant of this structure, a fibrous structure that may be continuous with the ligamentum teres, is the ligamentum venosum.
name: Ductus venosus
label: e
answer: no
explanation: This is not the correct answer. The umbilical cord contains 2 umbilical arteries and 1 umbilical vein, where the former carries deoxygenated blood from the fetus to the placenta. The physiological remnants of the umbilical arteries are the round ligaments of the bladder.
name: Umbilical artery
label: b
answer: no

Correct answer: a
Which pharyngeal pouch do the superior parathyroid glands originate from?

Options:
explanation: This is not the correct answer. In human embryos, there are five pairs of pharyngeal pouches, but only four give rise to the head and neck structures. As such, there is no fifth pharyngeal pouch involved in the formation of structures in the head and neck such as the superior parathyroid glands.
name: Fifth pharyngeal pouch
label: e
answer: no
explanation: This is the correct answer. In the fourth and fifth weeks of development, mesenchymal (connective) tissue growth in the cranial region results in the formation of the pharyngeal arches. Simultaneously, outpocketings form on the lateral aspect of the pharynx known as pharyngeal pouches. The pharyngeal arches are separated by pharyngeal clefts on the endodermal surface, and by pharyngeal pouches on the ectodermal surface. In human embryos, there are five pairs of pharyngeal pouches, but only four give rise to the head and neck structures. The fourth pharyngeal pouch gives rise to the superior parathyroid glands.
name: Fourth pharyngeal arch
label: a
answer: yes
explanation: This is not the correct answer. The third pharyngeal pouch gives rise to the inferior parathyroid glands and the thymus.
name: Third pharyngeal pouch
label: d
answer: no
explanation: This is not the correct answer. The first pharyngeal pouch gives rise to the Eustachian tube and middle ear cavity
name: First pharyngeal pouch
label: b
answer: no
explanation: This is not the correct answer. The second pharyngeal pouch gives rise to the lining of the palatine tonsils.
name: Second pharyngeal pouch
label: c
answer: no

Correct answer: a
Which option is most appropriate to complete this statement - The definitive kidney is formed by week __ and becomes functional by week __

Options:
explanation: This is not the correct answer. In the fourth week, the pronephros appear in the cervical region of the embryo. It is non-functional and regresses completely by the end of that week, leading to the development of the mesonephros which functions as the primitive excretory system. As such, while it is true that the kidneys become functional by the twelfth week of gestation, it is not accurate that the definitive kidney, the metanephros, is formed by week 4 as the metanephric system is formed in the fifth week of gestation.
name: 4, 12
label: b
answer: no
explanation: This is the correct answer. In the fourth week of gestation, the pronephros appear in the cervical region of the embryo. It is non-functional and regresses completely by the end of that week, leading to the development of the mesonephros which functions as the primitive excretory system. Ureteric buds develop from the mesonephric ducts, which are a remnant of the pronephric duct, and this induces the development of the definitive kidney known as the metanephros by week 5 of development. The metanephric system is composed of the excretory and collecting system and its development is initiated in the pelvis during the fifth week before the kidneys ascend into the abdomen and become functional by the twelfth week of gestation.
name: 5, 12
label: a
answer: yes
explanation: This is not the correct answer. While it is correct that the definitive kidney (i.e. the metanephros) is formed in week 5, it is not true that the kidneys become functional by week 7. By the seventh week of gestation, the cloaca is divided into two structures by the urorectal septum, namely the urogenital sinus and the anal canal. The kidneys become functional when they ascend into the abdomen by the twelfth week of gestation.
name: 5, 7
label: d
answer: no
explanation: This is not the correct answer. While it is correct that the kidneys become functional by the twelfth week of gestation, it is not true that the definitive kidney, the metanephros, is formed by week 7 as the metanephric system is formed in the fifth week of gestation.
name: 7, 12
label: e
answer: no
explanation: This is not the correct answer. The metanephric system is formed in the fifth week of gestation, as such, the definitive kidney (i.e. the metanephros) is formed in week 5, not 4. The significance of the seventh week of gestation is that during weeks 4-7 of gestation, the cloaca is divided into two structures by the anorectal septum, namely the urogenital sinus and the anal canal. It does not indicate the stage of gestation when the kidney becomes functional as the development of the metanephros is initiated in the pelvis during the fifth week before the kidneys ascend into the abdomen and become functional by the twelfth week of gestation.
name: 4, 7
label: c
answer: no

Correct answer: a
What is the parasympathetic nerve innervating the sigmoid colon?

Options:
explanation: This is not the correct answer. This is the sympathetic innervation for the midgut which extends from the common bile duct to the proximal two-thirds of the transverse colon, whereas the sigmoid colon is part of the hindgut.
name: Lesser splanchnic nerve
label: e
answer: no
explanation: This is the correct answer. The sigmoid colon is part of the hindgut which extends from the distal one-third of the transverse colon to the anorectal junction (cloacal membrane). It receives innervation from the inferior mesenteric plexus where the sympathetic innervation is from the lumbar splanchnic nerve and the parasympathetic innervation is from the pelvic splanchnic nerve.
name: Pelvic splanchnic nerve
label: a
answer: yes
explanation: This is not the correct answer. This is the parasympathetic innervation for the foregut which extends from the oesophagus to the proximal duodenum just before the opening of the common bile duct, whereas the sigmoid colon is part of the hindgut. The foregut arises from the endoderm and is therefore developmentally distinct from the midgut and hindgut. The vagus nerve and the enteric nervous system contribute to the innervation of the foregut structures.
name: Vagus nerve
label: c
answer: no
explanation: This is not the correct answer. This is the parasympathetic innervation for the midgut which extends from the common bile duct to the proximal two-thirds of the transverse colon, whereas the sigmoid colon is part of the hindgut.
name: Superior mesenteric plexus
label: d
answer: no
explanation: This is not the correct answer. While it arises from the inferior mesenteric plexus which is the nerve supply for the hindgut organs, the lumbar splanchnic nerve is the sympathetic innervation to the hindgut, not the parasympathetic innervation.
name: Lumbar splanchnic nerve
label: b
answer: no

Correct answer: a
Which of the following is a derivative of the ectoderm?

Options:
explanation: This is not the correct answer. The endoderm forms cells of many internal organs and glands such as the lining of the airways, thyroid and pancreatic cells.
name: The lining of the airways
label: b
answer: no
explanation: This is not the correct answer. The endoderm forms cells of many internal organs and glands such as the lining of the airways, thyroid and pancreatic cells.
name: Thyroid and pancreatic cells
label: c
answer: no
explanation: This is not the correct answer. The mesoderm forms the cells of the heart, blood, bone and cartilage, muscles (smooth, cardiac and skeletal), and kidneys.
name: Muscle cells
label: d
answer: no
explanation: This is not the correct answer.
name: Cardiac cells
label: e
answer: no
explanation: This is the correct answer. Gastrulation begins after the formation of the primitive streak, where epiblasts migrate into the primitive streak and form three distinct germ layers known as the endoderm (inner), mesoderm (middle) and ectoderm (outer) germ layer. The ectoderm is responsible for the formation of epidermal cells, as well as cells of the nervous system, eyes, inner ears and many connective tissues
name: Epidermis and epithelial line of the mouth and anus
label: a
answer: yes

Correct answer: a
What is the order of the development of the kidney and in which corresponding anatomical region, where the developmental stages are from the earliest stage to the latest stage? The corresponding anatomical region is shown in the brackets.



Options:
explanation: This is not the correct answer. While the order of the developmental stages from the earliest stage to the latest stage is correct, the corresponding anatomical regions are inaccurate.
name: Pronephros (abdominal region), Mesonephros (cervical region), Metanephros (pelvic region)
label: e
answer: no
explanation: This is not the correct answer. While the corresponding anatomical regions are accurate, the order of the developmental stages from the earliest stage to the latest stage is incorrect
name: Pronephros (cervical region), Metanephros (pelvic region), Mesonephros (abdominal region)
label: b
answer: no
explanation: This is not the correct answer. Both the order of the developmental stages from the earliest stage to the latest stage and the corresponding anatomical regions are incorrect.
name: Mesonephros (cervical region), Pronephros (abdominal region), Metanephros (pelvic region)
label: d
answer: no
explanation: This is the correct answer. In the fourth week of gestation, the pronephros appear in the cervical region of the embryo. It is non-functional and regresses completely by the end of that week, leading to the development of the mesonephros which functions as the primitive excretory system. Ureteric buds develop from the mesonephric ducts, which are a remnant of the pronephric duct, and this induces the development of the definitive kidney known as the metanephros. The metanephric system is composed of the excretory and collecting system and its development is initiated in the pelvis before the kidneys ascend into the abdomen. As such, the corresponding anatomical regions for the mesonephros and metanephros are the abdominal region and pelvic region respectively.
name: Pronephros (cervical region), Mesonephros (abdominal region), Metanephros (pelvic region)
label: a
answer: yes
explanation: This is not the correct answer. While the corresponding anatomical regions are accurate, the order of the developmental stages from the earliest stage to the latest stage is incorrect
name: Mesonephros (abdominal region), Pronephros (cervical region), Metanephros (pelvic region)
label: c
answer: no

Correct answer: a
Which of the following features is most consistent with a patient presenting with hyperkalemia?

Options:
explanation: This is not the correct answer. This is one of the ECG features of hypokalaemia, which includes prolongation of the PR interval, increased P wave amplitude, widespread ST depression and T wave flattening or inversion, and prominent U waves in precordial leads V2-V3. Aside from hypokalaemia, this feature can also be found in the digoxin effect but the downsloping ST depressions have a characteristic "reverse tick" or "Salvador Dali sagging" appearance.
name: Widespread ST depression and T wave flattening or inversion
label: d
answer: no
explanation: This is not the correct answer. This is one of the ECG features of hypokalaemia, which includes prolongation of the PR interval, increased P wave amplitude, widespread ST depression and T wave flattening or inversion, and prominent U waves in precordial leads V2-V3. Aside from severe hypokalaemia, prominent U waves can also be found in bradycardia.
name: Prominent U waves in precordial leads V2-V3
label: e
answer: no
explanation: This is the correct answer. Features of hyperkalaemia include peaked (tall) T waves, PR prolongation, bradyarrhythmias, conduction blocks and QRS widening with bizarre morphology
name: Broad QRS complex
label: a
answer: yes
explanation: This is not the correct answer. This is one of the ECG features of hypokalaemia, which includes prolongation of the PR interval, increased P wave amplitude, widespread ST depression and T wave flattening or inversion, and prominent U waves in precordial leads V2-V3. Aside from hypokalaemia, peaked P waves, especially in lead II, can also be found in right atrial enlargement (E.g. P pulmonale)
name: Increased P wave amplitude
label: c
answer: no
explanation: This is not the correct answer. In terms of T wave morphology, hyperkalaemia classically presents with peaked/ tall T waves. T wave inversion is commonly seen as a normal finding in children, or as a pathological finding in bundle branch block, pulmonary embolism, myocardial ischemia or infarction, ventricular hypertrophy and so forth.
name: T wave inversion
label: b
answer: no

Correct answer: a
What type of epithelium lines upper 2/3rd the oesophagus?

Options:
explanation: This is not the correct answer. This describes the epithelial lining of the lower 1/3rd of the oesophagus. This is also why adenocarcinomas are often found in the lower third of the oesophagus, as opposed to squamous cell carcinoma in the upper 2/3rd as the latter is lined by non-keratinized stratified squamous epithelium.
name: Simple columnar
label: b
answer: no
explanation: This is not the correct answer. The oesophagus does not have keratinized epithelium as it is not exposed to dryness, friction or abrasion.
name: Keratinized stratified squamous epithelium
label: d
answer: no
explanation: This is not the correct answer. Simple cuboidal epithelium is commonly found in glandular secreting tissue and kidney tubules. The upper 2/3rd of the oesophagus is lined by non-keratinized stratified squamous epithelium.
name: Simple cuboidal epithelium
label: e
answer: no
explanation: This is not the correct answer. This describes the "Z line" at the gastroesophageal (squamocolumnar) junction, which demarcates the transition from non-keratinized stratified squamous epithelium to simple columnar epithelium of the gastric cardia. This is also the landmark for Barrett's oesophagus in oesophagogastroduodenoscopy and on biopsy where the Z line will appear irregular due to intestinal metaplasia. The upper 2/3rd of the oesophagus is lined by non-keratinized stratified squamous epithelium.
name: Combination of non-keratinized stratified squamous and simple columnar
label: c
answer: no
explanation: This is the correct answer. This describes the epithelial lining of the upper 2/3rd of the oesophagus, while the lower 1/3rd is lined by simple columnar epithelium. This is also why adenocarcinomas are often found in the lower third of the oesophagus, as opposed to squamous cell carcinoma in the upper 2/3rd.
name: Non-keratinized stratified squamous epithelium
label: a
answer: yes

Correct answer: a
Where is vitamin B12 primarily absorbed?

Options:
explanation: This is not the correct answer. This is where the majority of the absorption of iron takes place. The absorption of vitamin B12 takes place mainly in the terminal ileum.
name: Duodenum
label: b
answer: no
explanation: This is not the correct answer. The stomach is where intrinsic factor (IF) is secreted by gastric parietal cells. B12 then binds to IF to be absorbed in the terminal ileum.
name: Stomach
label: c
answer: no
explanation: This is not the correct answer. This is where the majority of the absorption of vitamin B3 (niacin) takes place. The absorption of vitamin B12 takes place mainly in the terminal ileum.
name: Upper ileum
label: e
answer: no
explanation: This is not the correct answer. This is where amino acids, folic acid, iron, water, sugars (glucose, fructose, galactose, maltose), and various other substances are absorbed. The absorption of vitamin B12 takes place mainly in the terminal ileum.
name: Duodenom and upper jejunum
label: d
answer: no
explanation: This is the correct answer. Vitamin B12 binds to an intrinsic factor (secreted by gastric parietal cells in the stomach), which then binds to specific receptors in the terminal ileum for absorption called cubulin. The B12 is then absorbed and binds to transcobalamin.
name: Terminal ileum
label: a
answer: yes

Correct answer: a
What vitamin aids the absorption of non-ferrous (ferric) iron, Fe3+?

Options:
explanation: This is not the correct answer. Vitamin K is a fat-soluble vitamin that is needed for the synthesis of clotting factors II, VII, IX and X. It does not aid in the absorption of non-ferrous iron.
name: Vitamin K
label: d
answer: no
explanation: This is not the correct answer. Vitamin A is a fat-soluble vitamin that is important for the maintenance of the immune system, for vision, and embryological growth and development. It does not aid in the absorption of non-ferrous iron.
name: Vitamin A
label: c
answer: no
explanation: This is not the correct answer. Vitamin B12 (cobalamin) is a water-soluble vitamin that is important for DNA synthesis, maintaining nerve function (synthesis of myelin), and in the circulatory system (maturation of red blood cells). It does not aid in the absorption of non-ferrous iron.
name: Vitamin B12 (Cobalamin)
label: b
answer: no
explanation: This is the correct answer. Vitamin C (Ascorbic acid) is a water-soluble vitamin that is important for tissue repair and collagen formation, has an important role in the functioning of a normal immune system, and helps to keep iron in the reduced ferrous state. After uptake of iron, it binds to a protein, transferrin, and is absorbed in the duodenum. Transferrin contains the non-ferrous (ferric) iron, Fe3+, and is reduced from Fe3+ to Fe2+ (ferrous) iron in the bone marrow, allowing it to be stored as ferritin. Ferritin is then incorporated into haemoglobin, allowing iron to be stored and released in a controlled manner as needed. As such, vitamin C aids in the absorption of non-ferrous iron by keeping it in the reduced ferrous state which is more soluble and easily absorbable.
name: Vitamin C (Ascorbic acid)
label: a
answer: yes
explanation: This is not the correct answer. Vitamin D is a fat-soluble vitamin that is important for calcium homeostasis and metabolism. It does not aid in the absorption of non-ferrous iron.
name: Vitamin D
label: e
answer: no

Correct answer: a
A 28-year-old woman presents in the A&E with right upper quadrant pain, jaundice and fever. The doctor palpates the region where the costal margin meets the rectus abdominis on the right side, which induces pain. This indicates a positive sign.

What is the name of this sign?

Options:
explanation: This is not the correct answer. Blumberg's sign, more commonly known as rebound tenderness, is positive when there is pain upon removal of pressure rather than applying pressure to the abdomen, where the latter is known as abdominal tenderness. Positive rebound tenderness is classically elicited in peritonitis.
name: Blumber's sign
label: d
answer: no
explanation: This is not the correct answer. The McBurney's sign is classically elicited in acute appendicitis, where applying slow pressure and releasing over the McBurney's point located one-third of the distance between the anterior superior iliac spine and the umbilicus in the right lower quadrant will result in pain if positive.
name: McBurney's sign
label: b
answer: no
explanation: This is not the correct answer. Psoas sign is positive if the pain is felt when the examiner asks patients to actively extend their right hip against the examiner's hand while the patient is lying on their pack. This indicates iliopsoas muscle group irritation, which occurs specifically when the appendix is inflamed in the retrocaecal orientation as the iliopsoas muscle group is located retroperitoneally.
name: Psoas sign
label: e
answer: no
explanation: This is not the correct answer. The Rovsing sign is positive when pain is elicited in the right lower quadrant when palpating the left lower quadrant and is classically elicited in acute appendicitis.
name: Rovsing sign
label: c
answer: no
explanation: This is the correct answer. This patient is presenting with clinical features of acute cholecystitis. The classic sign elicited in these patients is the Murphy's sign, where a positive finding means there is pain when palpating the right subcostal area while the patient is asked to take in and hold a deep breath. This indicates gall bladder hypersensitivity, where pain occurs on inspiration as the inflamed gall bladder comes into contact with the surface under the examiner's hand.
name: Murphy's sign
label: a
answer: yes

Correct answer: a
A 72-year-old male with chronic kidney disease needs a medication review as his eGFR has dropped to 20ml/min/1.73m2.

What stage of CKD is this patient in?

Options:
explanation: This is the correct answer. Chronic kidney disease is defined as abnormalities in kidney function or structure for at least 3 months. The KDIGO guidelines classify the severity and progression of chronic kidney disease based on the level of persistent albuminuria and the Glomerular Filtration Rate (GFR). In this case, an eGFR of 20ml/min/1.73m^2 puts the patient in the category of stage 4, which ranges from 15-29ml/min/1.73m^2 and indicates severely decreased kidney function
name: Stage 4
label: a
answer: yes
explanation: This is not the correct answer. In stage 3b, the GFR ranges from 45-59ml/min/1.73m^2, which implies mild to moderately decreased kidney function.
name: Stage 3b
label: c
answer: no
explanation: This is not the correct answer. In stage 1, the GFR range is 90ml/min/1.73m^2 and above, which implies normal or high kidney function.
name: Stage 1
label: e
answer: no
explanation: This is not the correct answer. In stage 2, the GFR ranges from 60-89ml/min/1.73m^2, which implies mildly decreased kidney function.
name: Stage 2
label: d
answer: no
explanation: This is not the correct answer. In stage 2, the GFR ranges from 30-44ml/min/1.73m^2, which implies moderately to severely decreased kidney function.
name: Stage 3a
label: b
answer: no

Correct answer: a