hllj/quesmed huggingface dataset:
43 year old female presents to the GP with deterioration of their previously well controlled schizophrenia. You discover they have recently stopped taking their medication.

Whilst taking their history you note feelings of anhedonia, auditory hallucinations, difficulty maintaining personal hygiene as well as slowing of movements and a poor sex drive

Which symptom is a first rank symptom of schizophrenia?

Options:
explanation: Correct. This is a first rank symptom of schizophrenia and is usually in the form of a third person commentary.
name: Auditory hallucinations
label: a
answer: yes
explanation: Incorrect. This is seen in many patients with schizophrenia but it is not a first rank symptom.
name: Slowing of movements
label: d
answer: no
explanation: Incorrect. This is a negative symptom of schizophrenia but is not a first rank symptom.
name: Anhedonia
label: c
answer: no
explanation: Incorrect. This is seen in many patients with schizophrenia but it is not a first rank symptom.
name: Loss of libido
label: e
answer: no
explanation: Incorrect. This is seen in many patients with schizophrenia but it is not a first rank symptom.
name: Difficulty maintaining personal hygiene
label: b
answer: no

Correct answer: a
Which structure opens in response to a meal to allow bile to flow from the pancreas into the duodenum?

Options:
explanation: Correct. This structure guards the opening of the ampulla of vater into the duodenum
name: Sphincter of Oddi
label: a
answer: yes
explanation: Incorrect. This structure is where the left and right hepatic ducts join to form the common hepatic duct.
name: Porta hepatis
label: d
answer: no
explanation: Incorrect. This is when the main pancreatic duct joins the common bile duct
name: Ampulla of vater
label: b
answer: no
explanation: Incorrect. This recieves ducts from the lower part of the head of the pancreas
name: Accessory pancreatic duct
label: e
answer: no
explanation: Incorrect. This strucutre is formed by the common hepatic duct joining the cystic duct
name: Common bile duct
label: c
answer: no

Correct answer: a
Which of the following is **NOT** a extrinsic muscle of the tongue?

Options:
explanation: Incorrect. This is an extrinsic muscle, attaching to the inner mandible and hyoid bone.
name: Genioglossus
label: b
answer: no
explanation: Incorrect. This is an extrinsic muscle, attaching to the hyoid bone
name: Hyoglossus
label: c
answer: no
explanation: Incorrect. This is an extrinsic muscle, attaching inner mandible and hyoid bone.
name: Palatoglossus
label: e
answer: no
explanation: Correct. This is an intrinsic muscle of the tongue.
name: Transverse
label: a
answer: yes
explanation: Incorrect. This is an extrinsic muscle, attaching to styloid process of temporal bone
name: Styloglossus
label: d
answer: no

Correct answer: a
A 3 year old female patient is brought to the GP with her caregiver after a week of lethargy. She now has bilateral swelling of the jaw and are diagnosed with mumps.

Which structure has become swollen?

Options:
explanation: Incorrect. This would present as a central swelling in the neck.
name: Thyroid gland
label: e
answer: no
explanation: Incorrect. This gland can be swollen in sialadenitis but isn't the swelling seen in mumps.
name: Submandibular gland
label: b
answer: no
explanation: Incorrect. This gland can be swollen in sialadenitis but isn't the swelling seen in mumps.
name: Sublingual gland
label: c
answer: no
explanation: Incorrect. Lipoma is a soft fatty lump but isn't what is seen in this patient.
name: Fatty tissue
label: d
answer: no
explanation: Correct. Parotitis is almost always seen in mumps
name: Parotid gland
label: a
answer: yes

Correct answer: a
A 54 year old female patient is having a pancreaticoduodenectomy to remove a pancreatic tumour.

One of the blood vessels supplying the duodenum is the superior pancreaticoduodenal artery

Which vessel does the superior pancreaticoduodenal artery branch from?

Options:
explanation: Incorrect. This artery branches to give oesophageal arteries.
name: Left gastric artery
label: e
answer: no
explanation: Correct. The gastroduodenal artery branches from the common hepatic artery
name: Gastroduodenal artery
label: a
answer: yes
explanation: Incorrect. The inferior pancreaticoduodenal artery branches from this artery.
name: Superior mesenteric artery
label: b
answer: no
explanation: Incorrect. The superior rectal artery is a branch of the inferior mesenteric artery.
name: Inferior mesenteric artery
label: c
answer: no
explanation: Incorrect. This artery branches into the left gastric, splenic and common hepatic arteries.
name: Coeliac trunk
label: d
answer: no

Correct answer: a
Which of the following best describes the peritoneal covering in the lower third of the rectum?

Options:
explanation: Incorrect. The lower third of the rectum is completely extraperitoneal.
name: Complete peritoneal covering
label: e
answer: no
explanation: Incorrect. No part of the posterior rectum is covered by peritoneum
name: Peritoneal covering on the posterior aspect
label: d
answer: no
explanation: Correct. The lower third lies below the pelvic peritoneum meaning it has no extraperitoneal covering itself.
name: Completely extraperitoneal
label: a
answer: yes
explanation: Incorrect. This describes the peritoneal covering of the upper third of the rectum
name: Anterolateral peritoneal covering
label: c
answer: no
explanation: Incorrect. This is the peritoneal covering of the middle third of the rectum
name: Peritoneum on anterior aspect
label: b
answer: no

Correct answer: a
A 4 year old child presents to the GP with learning difficulties. They are found to also have a short stature and suffer with poor feeding. They are subsequently diagnosed with prader willi syndrome.

This condition is inherited via genomic imprinting, which of the following best describes this inheritance method?

Options:
explanation: Correct. In Prader Willi syndrome, only the maternally inherited version is expressed.
name: Only one copy of the gene is expressed
label: a
answer: yes
explanation: Incorrect, this describes X linked inheritance.
name: The genetic varient is found on the X chromosome
label: b
answer: no
explanation: Incorrect, this describes epigenetic changes
name: Environmental factors causing alterations in the way the body reads DNA
label: e
answer: no
explanation: Incorrect, this describes autosomal inheritance
name: Inheritance of one autosome from each parent, expressing a mixture of the two
label: c
answer: no
explanation: Incorrect, this describes genetic mosaicism
name: A selection of the gametes carry the mutation, but the remainder are normal
label: d
answer: no

Correct answer: a
A 8 year old male has recently been diagnosed with type 1 diabetes and have been prescribed daily insulin. They have recently used a low dose of insulin to manage blood sugar levels, but suddenly found this requirement to increase.

What is the most likely explaination for this?

Options:
explanation: Incorrect, this is something all diabetic patients should do to decrease the chances of lipodystrophy.
name: Different location of injection
label: e
answer: no
explanation: Incorrect, this is unlikely to occur, and destruction of beta cells is much more likely
name: Increased metabolism of insulin
label: d
answer: no
explanation: Incorrect, this scenario is something which can commonly occur in type 1 diabetes
name: The original diagnosis of Type 1 diabetes was incorrect
label: c
answer: no
explanation: Incorrect, this could cause a change in insulin but it would be unlikely to cause a significant prolonged change.
name: Change in diet
label: b
answer: no
explanation: Correct, this is known as the honeymoon period and occurs if the patient still has beta cells producing insulin
name: Any remaining beta cells have been destroyed
label: a
answer: yes

Correct answer: a
Which of the following cardiac defects is **NOT** included in tetralogy of fallot?

Options:
explanation: This is part of the tetralogy of fallot, meaning blood which is low in oxygen can travel into the aorta.
name: Overriding aorta
label: e
answer: no
explanation: This is part of the tetralogy of fallot, occuring as the heart needs to work harder to pump blood through it.
name: Right ventricular hypertrophy
label: d
answer: no
explanation: This is part of the tetralogy of fallot, involving narrowing of the pulmonary valve
name: Pulmonary stenosis
label: b
answer: no
explanation: This is part of the tetralogy of fallot, involving a hole between the left and right ventricles
name: Ventricular septal defect
label: c
answer: no
explanation: Correct, this is not part of the tetralogy of fallot but instead is a separate condition.
name: Patent ductus arteriosis
label: a
answer: yes

Correct answer: a
A 21-year-old male presents to A&E with on-and-off fevers and chills for the past 36 hours. He complains of muscle aches and waking up in a pool of sweat last night.

He just returned from Malaysia a week ago from a business trip. He did not take any vaccinations before travelling. What is the best investigation to diagnose the ongoing condition?

Options:
explanation: There are no respiratory infective symptoms, such as cough or shortness of breath, to suggest chest infections. This may be a part of the initial investigations to identify signs of any lung pathologies like Tuberculosis (fever in returning travellers) or malignancies like lymphoma (fever). However, the investigation is not diagnostic and the cyclical fever pattern is more indicative of malaria than a respiratory cause.
name: Chest X-Ray
label: c
answer: no
explanation: This is generally a part of the initial investigations for fever in a returning traveller. Raised CRP is a sign of inflammation and elevated white cells may be seen in other causes of fever like neutrophils in TB etc. However, this is not diagnostic of any condition and just indicates the presence of an infection. In malaria, neutrophils may be elevated and lymphocytes may be reduced.
name: CRP and WCC
label: b
answer: no
explanation: This can be conducted to identify any viral causes of fever in returning travellers like dengue. However, the presentation of dengue fever would not be cyclical, so this investigation is less likely to be diagnosing the cause of the fever.
name: Serology and viral PCR
label: e
answer: no
explanation: For fever in a returning traveller from the tropics, Malaria is an important diagnosis to rule out. A pattern of cyclical fever over 24-48 hours, chills, night sweats and muscle aches is characteristic of Malaria, with an incubation period <7 days typical for *Plasmodium falciparum*. The diagnosis is made by analysing thick film for the presence of parasites, and thin film to identify the species causing the infection.
name: Thick and thin blood films
label: a
answer: yes
explanation: This may be a probable investigation to rule out fatal causes of fever in returning travellers like Japanese encephalitis (JE). However, the patient does not present with any symptoms like headache, neck stiffness or seizures. Also, the risk of contracting JE is very low, so it is less likely to be the cause of the fever.
name: Lumbar Puncture
label: d
answer: no

Correct answer: a
A 32-year-old female presents to
the sexual health clinic with painless round ulceration on the vulva.

On further investigation, she is diagnosed with primary syphilis. If left untreated, what is a complication that can develop in the long term?

Options:
explanation: This is inflammatory arthritis usually occurring after an infection like food poisoning or STIs like chlamydia. It is generally characterised by the triad of arthritis, conjunctivitis and urethritis.
name: Reactive arthritis
label: d
answer: no
explanation: While any bacterial infection can spread into the bloodstream, it is extremely rare for syphilis to cause sepsis. STIs like gonorrhoea if left untreated are more likely to cause a systemic life-threatening infection.
name: Sepsis
label: e
answer: no
explanation: Tertiary syphilis appears 20-40 years after primary infection if it is left untreated. This tends to present with loss of proprioception, vibration and fine touch due to degeneration of dorsal columns in the spinal cord. Patients present with paraesthesia, absent reflexes and progressive ataxia.
name: Tabes dorsalis
label: a
answer: yes
explanation: This is conjunctivitis of the newborn baby contracted during birth due to contact with the maternal birth canal which is infected with an STI like chlamydia or gonorrhoea.
name: Ophthalmia neonatorum
label: c
answer: no
explanation: This is a more common complication of sexually transmitted infections (STI) like chlamydia or gonorrhoea. These bacterial infections, if untreated, spread upwards from the vagina or cervix and cause infection of the upper reproductive tract.
name: Pelvic inflammatory disease
label: b
answer: no

Correct answer: a
66y/o female, tells A&E doctor about a recent fall, on examination unable to lift up her right arm and leg, neglecting her right visual field, identify the type of stroke

A 66 year old female is brought into A&E in an ambulance after a recent fall. She has a past medical history of hypertension and a previous MI at 62.

On examination, she has slurred speech and is unable to raise her right upper and lower limb. There are no visual changes. What is the most probable type of stroke?

Options:
explanation: This is unlikely as there are no left-sided symptoms and the presentation does not fulfil all the requirements of an anterior infarct.
name: Right Total Anterior Circulation Infarct (TACI)
label: b
answer: no
explanation: This is unlikely as the patient does not present with any left-sided symptoms, which would be more likely in a right PACI
name: Right Partial Anterior Circulation Infarct (PACI)
label: c
answer: no
explanation: This is unlikely as a patient with a LACI would present with one of the following; pure motor stroke OR pure sensory stroke OR mixed sensorimotor stroke OR ataxic hemiparesis
name: Left Lacunar Infarct (LACI)
label: d
answer: no
explanation: This is the most likely type of stroke as it fulfils two out of three requirements of an anterior infarct according to the Bamford criteria. This includes contralateral hemiparesis and aphasia. There is no homonymous hemianopia present in this patient.
name: Left Partial Anterior Circulation Infarct (PACI)
label: a
answer: yes
explanation: This is unlikely as the patient's presentation does not fulfil all the requirements for an anterior infarct. The patient has a normal visual examination and so there is no sign of homonymous hemianopia.
name: Left Total Anterior Circulation Infarct (TACI)
label: e
answer: no

Correct answer: a
A 3-month-old male is being transported to A&E in an ambulance. He is presenting with a 4 day history of fever and lethargy.

On examination, he has a non-blanching rash on his legs and a bulging fontanelle. He has no known allergies. What is the best initial management in the most probable condition?

Options:
explanation: The first line of treatment for suspected meningococcal disease while being transferred to hospital in an ambulance is an intramuscular or intravenous dose of benzylpenicillin. In the hospital, treatment is by intravenous cefotaxime or ceftriaxone based on local guidelines.
name: Nitrofurantoin IV
label: e
answer: no
explanation: Viral encephalitis will also be a differential for the presentation, and this can be covered with intravenous aciclovir till the confirmation of diagnosis. However, this cannot be administered in an ambulance setting, and is hence, not the most appropriate management.
name: Aciclovir IV
label: b
answer: no
explanation: A presentation of fever, lethargy, non-blanching rash and bulging fontanelle in a 3-month-old infant is meningitis with meningococcal septicaemia. This requires urgent treatment with antibiotics. As this infant is being transferred in an ambulance, the best initial treatment is an intramuscular (or intravenous) dose of benzylpenicillin.
name: Benzylpenicillin IM
label: a
answer: yes
explanation: The first line of treatment for suspected meningococcal disease while being transferred to a hospital in an ambulance is an intramuscular or intravenous dose of benzylpenicllin. Cefotaxime is the alternative given if the patient has a penicillin allergy, however, this is not indicated in the question.
name: Cefotaxime IM
label: c
answer: no
explanation: The first line of treatment for suspected meningococcal disease while being transferred to a hospital in an ambulance is an intramuscular or intravenous dose of benzylpenicillin. In the hospital, treatment is by intravenous cefotaxime or ceftriaxone based on local guidelines.
name: Amoxicillin IV
label: d
answer: no

Correct answer: a
A GP is testing the patellar reflexes of 4year old girl with a tendon hammer.

Which of these is the right pathway of signal transmission when eliciting the patellar tendon reflex?

Options:
explanation: This is incorrect as group Ia afferent fibres are involved in carrying signals from the muscle spindle fibres to the spinal cord.
name: Muscle spindle fibres &rarr; sensory IIa fibres &rarr; dorsal root ganglion &rarr; anterior horn of spinal cord &rarr; alpha-motor neuron &rarr; quadriceps muscle &rarr; contraction
label: c
answer: no
explanation: This is incorrect as the alpha-motor neuron fibres carry signals to the quadriceps muscle for contraction. Hamstrings are also involved in the patellar reflex, as there is reciprocal inhibition which causes relaxation of the hamstrings, allowing quadriceps to contract freely.
name: Muscle spindle fibres &rarr; sensory Ia fibres &rarr; dorsal root ganglion &rarr; anterior horn of spinal cord &rarr; alpha-motor neuron &rarr; hamstring muscles &rarr; contraction
label: d
answer: no
explanation: This is incorrect as there is no interneuron involved in the transmission of the stretch reflex. It is a monosynaptic reflex and the afferent Ia fibres directly synapse on the efferent alpha-motor neurons.
name: Muscle spindle fibres &rarr; sensory Ia fibres &rarr; dorsal root ganglion &rarr; anterior horn of spinal cord &rarr; interneuron &rarr; alpha-motor neuron &rarr; quadriceps muscles &rarr; contraction
label: e
answer: no
explanation: Muscle spindle fibres are involved in detecting the stretch of muscles and causing reflex contraction. This pathway is known as the stretch reflex, which is elicited when the tendon hammer strikes the patellar tendon. Muscle spindle fibres detect the stretch and send afferent signals via the group Ia fibres. These synapse on the alpha-motor neurons in the anterior horn of the spinal cord directly. The alpha-motor neuron then sends efferent signals to quadriceps muscle to flex, resulting in the involuntary knee jerk.
name: Muscle spindle fibres -> sensory Ia fibres -> dorsal root ganglion -> anterior horn of spinal cord -> alpha-motor neuron -> quadriceps muscle -> contraction
label: a
answer: yes
explanation: Golgi tendon organs are involved in detecting excess stretch in muscles and causing a reflex relaxation. This pathway is known as the golgi tendon reflex. It occurs when muscles are under excess tension for a long time, for example when weight lifting.
name: Golgi tendon organ &rarr; sensory Ib fibres &rarr; dorsal root ganglion &rarr; anterior horn of spinal cord &rarr; alpha-motor neuron &rarr; quadriceps muscle &rarr; relaxation
label: b
answer: no

Correct answer: a
A 32-year-old female comes in with second-degree burns to her fingertips. She is unable to feel fine touch at the ends of her fingers, but can feel pressure and vibration.

What type of sensory receptors are Pacinian corpuscles?

Options:
explanation: Pacinian corpuscles are skin mechanoreceptors present in the dermis of skin. They detect pressure changes and vibrations in the skin. When pressure is applied, the deformation of the receptor membrane causes sodium channels to open and depolarisation to occur.
name: Pressure-sensitive sodium ion channels
label: a
answer: yes
explanation: This is incorrect as Pacinian corpuscles are pressure-sensitive sodium channels. The sodium channels open and cause depolarisation when the membrane is deformed by external pressure.
name: Pressure-sensitive calcium ion channels
label: e
answer: no
explanation: This is incorrect as Pacinian corpuscles are pressure sensitive sodium channels. The sodium channels open and cause depolarisation when the membrane is deformed by external pressure.
name: Pressure-sensitive potassium ion channels
label: b
answer: no
explanation: This is incorrect as Pacinian corpuscles are mechanoreceptors, not free nerve endings that detect pain.
name: Nociceptors
label: c
answer: no
explanation: This is incorrect as Pacinian corpuscles are mechanoreceptors, not thermoreceptors.
name: Heat-sensitive sodium ion channels
label: d
answer: no

Correct answer: a
A 33-year-old male was brought into A&E after a stabbing incident. He has a knife embedded on the right side of the spinal cord at L2.

On examination, he has weakness in the right lower limb, loss of d touch, vibration and proprioception in the right lower limb. He also has a loss of pain and temperature sensation in the left lower limb. There is also total loss of sensation in his right thigh. He has no other signs or symptoms.

What is this type of spinal cord injury called?

Options:
explanation: This refers to a fluid filled cyst forming within the centre of the spinal cord. It presents gradually with neurological signs as the cyst grows bigger and compresses nerve fibres. It leads to back pain, loss of pain and temperature sensation and weakness in the upper extremities.
name: Syringomyelia
label: e
answer: no
explanation: This is an incomplete spinal cord injury from hemisection to the spinal cord, usually due to trauma. It leads to ipsilateral weakness or paralysis and loss of fine touch, vibration and proprioception below the level of injury. It also causes contralateral loss of pain and temperature sensation below the level of injury. There is also total ipsilateral loss of sensation at the level of injury.
name: Brown-Séquard syndrome
label: a
answer: yes
explanation: This is an incomplete spinal cord injury resulting from an infarction of the anterior spinal artery affecting the anterior two-thirds of the spinal cord. This results in complete bilateral paralysis and loss of pain and temperature sensation below the level of the lesion.
name: Anterior Cord Syndrome
label: c
answer: no
explanation: This refers to tertiary syphilis which appears 20-40 years after primary infection if left untreated. This tends to present with loss of proprioception, vibration and fine touch due to degeneration of dorsal columns in the spinal cord.
name: Tabes dorsalis
label: b
answer: no
explanation: This is a serious condition referring to the compression of the Cauda equina (lumbar and sacral nerve roots). It results in symptoms of bilateral weakness or paralysis, pain in the lower extremities. It also causes saddle anaesthesia, urinary retention and faecal incontinence.
name: Cauda equina syndrome
label: d
answer: no

Correct answer: a