hllj/quesmed huggingface dataset:
A 75-year-old woman has had a gradual reduction in visual acuity, particularly for near-field objects, for the last 12 months. Upon further questioning, these symptoms fluctuate from day to day, and she sometimes experiences glare around objects and difficulty adapting to the dark.

What is the most likely finding upon fundoscopy?

Options:
explanation: A cherry-red macula is associated with central retinal artery occlusion, which would classically present with sudden profound visual loss.
name: Cherry-red macula
label: e
answer: no
explanation: As their name suggests, these are large haemorrhages on the retina that look 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: d
answer: no
explanation: Cotton wool spots are commonly seen in diabetic retinopathy. They are small white superficial lesions that occur due to tiny infarctions of the neuroretinal layer. Diabetic retinopathy would present clinically with overall gradually worsening vision which is blurred and patchy and a history of diabetes mellitus.
name: Cotton wool spots
label: c
answer: no
explanation: Pan-retinal photocoagulation is the first-line treatment for proliferative diabetic retinopathy. It is seen as clusters of pale markings on the retina. The patient is presenting with features of age-related macular degeneration, not diabetic retinopathy, so the most likely finding upon fundoscopy is drusen.
name: Pan-retinal photocoagulation
label: b
answer: no
explanation: The clinical features in the vignette point to a diagnosis of age-related macular degeneration (ARMD). The most common fundoscopy finding in patients with ARMD is drusen, yellow-white flecks around the macular region, due to the deposition of remnants of dead retinal pigment epithelium.
name: Drusen
label: a
answer: yes

Correct answer: a
Which statement regarding the neurovascular supply of the nose is correct?

Options:
explanation: Most nosebleeds arise from the anterior part of the nose, commonly from Kisselbach’s plexus- an area of anastomoses between the ethmoid, sphenopalatine and major palatine arteries. Woodruff’s plexus is a common site in posterior nosebleeds.
name: Woodruff’s plexus is a common site involved in anterior nosebleeds
label: c
answer: no
explanation: The anterior ethmoid nerve arises from the nasociliary nerve, a branch of the ophthalmic trigeminal nerve. The anterior ethmoid nerve supplies the external skin of the nose and the mucous membrane of the nasal vestibule.
name: The mucous membrane of the nasal vestibule is supplied by the anterior ethmoid nerve
label: a
answer: yes
explanation: The nasopalatine nerve is a branch of the maxillary trigeminal nerve, which supplies the skin of the roof and lateral wall of the nose. The mucous glands of the nose are supplied by the greater petrosal nerve, a branch of the facial nerve.
name: The mucous glands of the nose are innervated by the nasopalatine nerve
label: e
answer: no
explanation: The maxillary trigeminal nerve joins the facial nerve in the pterygopalatine ganglion.
name: The ophthalmic trigeminal nerve joins the facial nerve in the pterygopalatine ganglion
label: d
answer: no
explanation: The anterior and posterior ethmoidal arteries are branches of the ophthalmic artery, which itself comes from the internal carotid artery.
name: The anterior and posterior ethmoidal arteries are branches of the maxillary artery
label: b
answer: no

Correct answer: a
A 67-year-old man with a history of hypertension, hypercholesterolaemia and type 2 diabetes mellitus presents to the emergency department with sudden-onset weakness and loss of sensation to his right arm and face, excluding his forehead. He is also demonstrating aphasia.

What is the most likely pathophysiology underlying this presentation?

Options:
explanation: The weakness and sensory loss of a right-sided stroke would affect the left side, as the primary motor and somatosensory cortices control the contralateral side of the body. Sudden-onset weakness and loss of sensation to the lower, not upper, limb would be more consistent with anterior cerebral artery stroke.
name: Right anterior cerebral artery stroke
label: d
answer: no
explanation: Bell’s palsy is a lower motor neuron paralysis of the facial nerve. This would present with weakness or paralysis of facial muscles, including those of the forehead. It would not affect the arm or result in aphasia.
name: Bell's palsy
label: b
answer: no
explanation: Anterior cerebral artery strokes may present similarly to middle cerebral artery strokes. A commonly used differentiator between the two is the area affected by the weakness and loss of sensation. According to the cortical homunculus, the area of primary motor and somatosensory cortices supplied by the anterior cerebral artery represents the lower limb, so sudden-onset weakness and loss of sensation to the lower limb would be more consistent with anterior cerebral artery stroke.
name: Left anterior cerebral artery stroke
label: c
answer: no
explanation: Posterior cerebral artery strokes are commonly associated with visual defects, due to infarction of the visual cortex in the occipital lobe. The weakness and sensory loss of a right-sided stroke would affect the left side, as the primary motor and somatosensory cortices control the contralateral side of the body.
name: Right posterior cerebral artery stroke
label: e
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. 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. Aphasia most commonly occurs due to damage to either Broca’s area, Wernicke’s area or both- these areas are supplied by the left MCA. The patient also has multiple risk factors for ischaemic stroke such as hypertension, hypercholesterolaemia and type 2 diabetes mellitus.
name: Left middle cerebral artery stroke
label: a
answer: yes

Correct answer: a
Which statement correctly describes an aspect of the bony anatomy of the skull?

Options:
explanation: The sutures between individual skull bones persist until the neurocranium and viscerocranium reach adult morphology at around 21 years old and ossify after this, mostly completed by around the 5th decade.
name: The sutures between individual skull bones persist until the start of puberty when they ossify
label: c
answer: no
explanation: The temporal suture is located between the temporal and parietal bones, on the lateral side of the skull.
name: The temporal suture is located between the temporal bone and the occipital bone
label: b
answer: no
explanation: Fontanelles are present to allow deformation of the skull during birth and to accommodate postnatal growth of skull bones and the developing brain. They are placed in the areas of most growth in the skull vault- the midsagittal line and between the temporal/occipital bones, and mostly close within the first year of life.
name: The fontanelles, large membranous-filled gaps between skull bones, close mostly in the first year of life
label: a
answer: yes
explanation: The maxillary trigeminal nerve exits the intracranial space through the foramen rotundum in the sphenoid bone. The mandibular branch of the trigeminal nerve exits through the foramen ovale.
name: The maxillary trigeminal nerve leaves the intracranial space through the foramen ovale in the sphenoid bone
label: d
answer: no
explanation: The pterion is the area at which the sutures between the frontal, sphenoid, parietal and temporal bones converge. As it is the point where several bones meet, it is structurally weak. Deep to the pterion is the middle meningeal artery- fracture to the skull at this point often leads to an extradural haematoma.
name: The sutures between the frontal, temporal, sphenoid and ethmoid bones meet at the pterion, causing this area to be structurally weak
label: e
answer: no

Correct answer: a
Which set of clinical features would most likely be seen in a patient with Parkinson’s disease?

Options:
explanation: These features are characteristic of Alzheimer’s disease, a neurodegeneration involving hippocampal neuronal loss and cortical atrophy.
name: Insidious cognitive impairment and episodic memory loss
label: d
answer: no
explanation: The features listed here are characteristic of progressive supranuclear palsy (PSP), a Parkinson-plus syndrome. PSP can involve some features of Parkinsonism such as bradykinesia and tremor, however, the features of impaired vertical gaze and cognitive impairment are more indicative of PSP than true Parkinson’s disease.
name: Postural instability and falls, impaired vertical gaze, bradykinesia, cognitive impairment
label: b
answer: no
explanation: These features are the classical triad of features seen in normal pressure hydrocephalus, a reversible cause of dementia. This is most commonly seen in the elderly and is thought to be due to decreased absorption of cerebrospinal fluid at the arachnoid villi.
name: Urinary incontinence, dementia, slow shuffling gait
label: e
answer: no
explanation: Although present in the later stages of multiple neurodegenerative diseases, these features would unlikely be seen alone in Parkinson’s disease, and are more likely to point to a diagnosis of behavioural variant frontotemporal dementia.
name: Disinhibition, apathy, loss of executive dysfunction
label: c
answer: no
explanation: These three features are characteristic of Parkinson’s disease. Other features of Parkinson’s disease include postural hypotension due to autonomic dysfunction, mask-like facies, depression, dementia and sleep disturbance.
name: ‘Cogwheel’ rigidity, resting ‘pill-rolling tremor, slow shuffling gait with a stopped posture
label: a
answer: yes

Correct answer: a
Which statement regarding the anatomy of the tongue is correct?

Options:
explanation: The taste sensation posterior to the terminal sulcus is supplied by the glossopharyngeal nerve, which also supplies touch, temperature and pain sensation to this area.
name: The taste sensation posterior to the terminal sulcus is supplied by the vagus nerve
label: d
answer: no
explanation: The hypoglossal nerve provides the motor innervation to all tongue muscles (apart from the palatoglossus, which is innervated by the vagus nerve). If the hypoglossal nerve on one side becomes damaged, the tongue deviates laterally towards the side of injury, due to the unopposed action of the genioglossus muscle on the intact side.
name: Damage to the hypoglossal nerve results in the tongue deviating laterally towards the side of the injury
label: a
answer: yes
explanation: The chorda tympani branch of the facial nerve supplies taste sensation to the anterior 2/3 of the tongue. The touch, temperature and pain sensation to this area is supplied by the lingual nerve, a branch of the mandibular trigeminal nerve.
name: The chorda tympani branch of the facial nerve supplies touch, temperature and pain sensation to anterior 2/3 of the tongue
label: e
answer: no
explanation: The genioglossus and styloglossus muscles are innervated by the hypoglossal nerve whereas the palatoglossus is innervated by the vagus nerve.
name: The genioglossus, styloglossus and palatoglossus muscles are all innervated by the hypoglossal nerve
label: c
answer: no
explanation: Filiform papillae are touch-detecting papillae located on the anterior 2/3 of the tongue, arranged in rows parallel to the terminal sulcus. Fungiform papillae are club-shaped projections found on the tip and sides of the tongue, which detect taste.
name: Filiform and fungiform papillae are found across the whole surface of the tongue
label: b
answer: no

Correct answer: a
Which statement correctly describes structures found in the orbit?

Options:
explanation: The long and short nerves of the eyeball are branches of the ophthalmic trigeminal nerve within the orbit’s muscular cone.
name: The optic nerve branches to give off the long and short nerves of the eyeball
label: c
answer: no
explanation: The superior division of the oculomotor nerve supplies the superior rectus and levator palpebrae muscles. The inferior division supplies the inferior rectus, medial rectus and inferior oblique muscles.
name: The superior division of the oculomotor nerve supplies the superior and medial rectus muscles
label: d
answer: no
explanation: The optic nerve and ophthalmic artery leave the intracranial space to enter the orbit through the optic foramen, an opening in the sphenoid bone.
name: The optic nerve enters the orbit through the optic foramen and the tendinous ring
label: a
answer: yes
explanation: The venous drainage of the orbit mostly occurs via the superior ophthalmic vein to the cavernous sinus. The veins from the forehead and face can also drain via the orbit, presenting a potential risk to track infections of these areas to the cavernous sinus.
name: The venous drainage of the orbit mostly occurs via the inferior ophthalmic vein and pterygoid plexus to the sigmoid sinus
label: e
answer: no
explanation: The lacrimal artery is a branch of the ophthalmic artery. It runs on the lateral side of the orbit with the lateral rectus muscle to supply the lacrimal gland, eyelids and conjunctiva.
name: The lacrimal artery runs on the medial side of the orbit with the medial rectus muscle to supply the lacrimal gland, eyelids and conjunctiva
label: b
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 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: 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
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: 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

Correct answer: a
Which of the following statements correctly describes a hormone involved in the hypothalamic-pituitary-adrenal axis?

Options:
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: d
answer: no
explanation: Adrenocorticotropic hormone (ACTH) is secreted by the anterior pituitary gland.
name: Adrenocorticotropic hormone is secreted by the hypothalamus
label: e
answer: no
explanation: Cortisol acts on many tissues in the body, but in the brain, it mediates its effects by stimulating both mineralocorticoid receptors and glucocorticoid receptors.
name: In the brain, cortisol acts on glucocorticoid receptors only
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.
name: Epinephrine and norepinephrine released by the adrenal medulla feedback to increase the breakdown of POMC into adrenocorticotropic hormone
label: a
answer: yes
explanation: Adrenocorticotropic hormone (ACTH) regulates secretion of glucocorticoid hormones from the zona fasciculata of the adrenal cortex.
name: Adrenocorticotropic hormone is a peptide hormone that regulates the secretion of hormones from the zona reticularis of the adrenal cortex
label: c
answer: no

Correct answer: a
A 19-year-old male has a telephone consultation with his GP to discuss concerns about his lack of facial, pubic and armpit hair. He is also concerned about his testicles being too small, which is affecting his self-esteem. During a face-to-face follow-up appointment, he is seen to have a tall stature and gynaecomastia. Blood tests show a high FSH and LH and a low testosterone.

What is the most likely underlying diagnosis?

Options:
explanation: Turner’s syndrome is caused by the deletion of a whole X-chromosome, or deletion of its short arm, causing the karyotype 45X. Features of Turner’s syndrome include a webbed neck, short stature, amenorrhoea, renal and cardiac abnormalities and a high FSH and LH.
name: Turner's syndrome
label: c
answer: no
explanation: Androgen insensitivity syndrome is an X-linked recessive condition involving end-organ resistance to testosterone, which manifests as genetically male children (46XY karyotype) having a female phenotype. Groin swelling due to undescended testes, amenorrhoea, absence of body hair, high FSH and LH and high testosterone levels are seen.
name: Androgen insensitivity syndrome
label: e
answer: no
explanation: Kleinfelter’s syndrome, or primary hypogonadism, is associated with the karyotype 47XXY. Lack of secondary sexual characteristics such as facial, pubic and armpit hair, small testicles and infertility are key features. Other physical features such as gynaecomastia (enlargement of the breasts) and a tall stature may be present. High FSH and LH with low testosterone are also classical findings in Klinefelter’s syndrome.
name: Klinefelter's syndrome
label: a
answer: yes
explanation: Deletion of the Prader-Willi gene inherited from the father results in Prader-Willi syndrome, which is characterised by childhood obesity, learning difficulties, hypotonia, short stature and infertility.
name: Prader-Willi syndrome
label: b
answer: no
explanation: Kallman’s syndrome, or hypogonadotropic hypogonadism, is an X-linked recessive disorder, believed to occur due to the failure of GnRH-secreting cells to migrate. Features of Kallman’s syndrome include delayed puberty with normal stature, anosmia, and cryptorchidism (failure of testes descent). Typical blood test findings in Kallman’s syndrome are low testosterone with a high FSH and LH.
name: Kallman's syndrome
label: d
answer: no

Correct answer: a
Which statement best describes the function of the paraventricular nucleus?

Options:
explanation: This is the function of the pineal gland. Melatonin is a hormone related to serotonin and is implicated in the modulation of sleep-wake cycles.
name: Modulation of sleep-wake cycles through the production of melatonin
label: c
answer: no
explanation: Follicle-stimulating hormone and luteinising hormone are secreted by the gonadotrophin cells of the anterior pituitary gland.
name: Secretion of sex hormones follicle-stimulating hormone and luteinising hormone
label: e
answer: no
explanation: This is the function of the parvocellular neurosecretory cells of the medial hypothalamus. Their axons project to the median eminence, where they release hormones into the hypothalamic-pituitary-portal blood vessels.
name: Production and secretion of thyrotropin-releasing hormone, corticotrophin-releasing hormone and neurotensin
label: d
answer: no
explanation: The magnocellular neurons of the paraventricular nucleus secrete oxytocin and vasopressin, projecting into the posterior pituitary gland.
name: Projection of neurons to the posterior pituitary gland and secretion of oxytocin and vasopressin
label: a
answer: yes
explanation: The corticotrophic cells of the anterior pituitary gland produce and secrete an adrenocorticotrophic hormone (ACTH) in response to corticotrophin-releasing hormone from the hypothalamus. ACTH stimulates the adrenal glands to produce cortisol.
name: Production and secretion of adrenocorticotrophic hormone
label: b
answer: no

Correct answer: a
Which statement regarding the anatomy of the male genitalia is correct?

Options:
explanation: Helicine arterioles do provide some of the blood supply to the male penile erectile tissue, but they are dilated upon parasympathetic stimulation.
name: Penile erectile tissue is supplied by the helicine arterioles, which are dilated upon sympathetic stimulation
label: e
answer: no
explanation: The bulbospongiosus muscle is a striated muscle covering the penile erectile tissue. It acts to empty the penile urethra during ejaculation and is supplied by the pudendal nerve.
name: The bulbospongiosus muscle, a striated muscle covering the penile erectile tissue, is supplied by the pudendal nerve
label: a
answer: yes
explanation: The testes are covered by the tunica vaginalis, a layer of peritoneum, and tunica albugina, a fibrous outer layer. This double layer provides lubrication, enabling the testes to move around.
name: The testes are covered by the tunica albugina, a layer of peritoneum, and tunica vaginalis, a fibrous outer layer
label: b
answer: no
explanation: The dartos muscle in the layer surrounding the testes consists of sympathetically innervated smooth muscle which contracts in the cold, making the scrotum smaller to conserve heat. The cremaster muscle is a layer of striated muscle surrounding the spermatic cord, acting to raise the testis when cold.
name: The cremaster muscle consists of sympathetically innervated smooth muscle, which contracts in the cold to decrease the size of the scrotum
label: c
answer: no
explanation: The sensory supply to the scrotum is provided by 4 nerves: the anterior scrotal nerves supply the anterior surface and root of the penis, the posterior scrotal nerves supply the posterior surface, part of the anterolateral surface is supplied by the genitofemoral nerve and perineal branch of the posterior femoral cutaneous nerve supplies part of the inferior surface.
name: The sensory supply to the scrotum is entirely provided by the pudendal nerve
label: d
answer: no

Correct answer: a