hllj/quesmed huggingface dataset:
Which of the following best describes the role of a chylomicron?

Options:
explanation: This is the role of low-density lipoproteins (LDLs).
name: Transports cholesterol from the blood to the tissues
label: c
answer: no
explanation: This is the role of very low-density lipoproteins (VLDLs).
name: Transports cholesterol from the liver to the blood
label: d
answer: no
explanation: This is the role of high-density lipoproteins (HDLs).
name: Transports cholesterol from the blood to the liver
label: b
answer: no
explanation: This is the role of a chylomicron. They are large triglyceride-rich lipoproteins with a central lipid core.
name: Transports cholesterol from the small intestine to the liver and adipose tissue
label: a
answer: yes
explanation: This explains what can happen to intermediate-density lipoproteins (IDLs).
name: Breaks down into cholesterol and fatty acids
label: e
answer: no

Correct answer: a
At what spinal level is the aortic hiatus found?

Options:
explanation: This is the level of the caval hiatus.
name: T8
label: b
answer: no
explanation: An easy way to remember this is to remember that the phrase "aortic hiatus" has 12 letters (T12).
name: T12
label: a
answer: yes
explanation: This is not correct. The aortic hiatus is found at the level of T12.
name: C1
label: e
answer: no
explanation: This is the level of the oesophageal hiatus. Oesophagus has 10 letters (T10).
name: T10
label: c
answer: no
explanation: This is where the phrenic nerve originates from.
name: C3
label: d
answer: no

Correct answer: a
Where can the costotransverse joint be found between?

Options:
explanation: It does refer to the tubercle of the rib but it joints with the transverse process of the corresponding vertebra, not the one below.
name: Tubercle of the rib and the transverse process of the vertebra below
label: d
answer: no
explanation: This describes the neck of the rib.
name: Head and body of rib
label: c
answer: no
explanation: The costotransverse joint is the joint between the facet of the tubercle of the rib and the adjacent transverse process of a thoracic vertebra. It is a plane joint that allows gliding movements.
name: Tubercle of the rib and the transverse process of the corresponding vertebra
label: a
answer: yes
explanation: This describes the costovertebral joint.
name: Head of the rib and articular facet of rib above and below
label: b
answer: no
explanation: This describes the costotransverse ligament.
name: Neck of the rib and transverse process of vertebra
label: e
answer: no

Correct answer: a
What is the approximate expected partial pressure of oxygen in expired air?

Options:
explanation: This is the partial pressure of oxygen in inspired air.
name: 21.2
label: b
answer: no
explanation: This is the partial pressure of carbon dioxide in expired air.
name: 3.6
label: c
answer: no
explanation: This is the partial pressure of oxygen in the arteries.
name: 12.7
label: e
answer: no
explanation: The partial pressure of oygen in the air that is inspired is about 21.2. The alveoli subtract oxygen to use in respiration, but they do not use all of it. When air is expired, the partial pressure is now about 15.5.
name: 15.5
label: a
answer: yes
explanation: This is the partial pressure of carbon dioxide in inspired air.
name: 3.1
label: d
answer: no

Correct answer: a
Which nerve supplies the cricothyroid muscle?

Options:
explanation: This supplies all of the intrinsic muscles of the larynx, except the cricothyroid muscles. It also supplies sensation to the larynx below the level of the vocal cords.
name: Recurrent laryngeal nerve
label: c
answer: no
explanation: This supplies the infrahyoid muscles.
name: Ansa Cervicalis
label: e
answer: no
explanation: This innervates the diaphragm.
name: Phrenic nerve
label: d
answer: no
explanation: It is supplied by the external branch of the superior laryngeal nerve.
name: Internal branch of the superior laryngeal nerve
label: b
answer: no
explanation: The cricothyroid muscle is supplied by the external branch of the superior laryngeal nerve.
name: External branch of the superior laryngeal nerve
label: a
answer: yes

Correct answer: a
A three-hour-old baby presents with respiratory distress syndrome which is due to underlying surfactant deficiency.

What structure produces surfactant?

Options:
explanation: These are the other type of cells within the alveolus, but they do not produce surfactant. They are the site of gas exchange in the lungs.
name: Type I pneumocytes
label: b
answer: no
explanation: This is a type of white blood cell responsible for mediating the immune response.
name: Alveolar macrophages
label: e
answer: no
explanation: The salivary glands produce saliva, as well as secreting lipases and amylases.
name: Salivary glands
label: c
answer: no
explanation: These secrete oil in the skin.
name: Sebaceous gland
label: d
answer: no
explanation: Surfactant is produced by type II pneumocytes. Surfactant is important for reducing the surface tension of the lungs and preventing collapse of the airways.
name: Type II pneumocytes
label: a
answer: yes

Correct answer: a
Which artery supplies the ascending colon?

Options:
explanation: This supplies the transverse colon.
name: Middle colic artery
label: b
answer: no
explanation: This supplies the sigmoid colon.
name: Sigmoid branches of inferior mesenteric artery
label: d
answer: no
explanation: This supplies the descending colon.
name: Left colic artery
label: c
answer: no
explanation: This supplies the middle portion of the rectum.
name: Middle rectal artery
label: e
answer: no
explanation: The ascending colon is supplied by the right colic artery, which is a branch of the superior mesenteric artery.
name: Right colic artery
label: a
answer: yes

Correct answer: a
Which of the following best describes the mechanism of loperamide as an anti-diarrhoeal?

Options:
explanation: Some types of diarrhoea may be due to bacteria, but loperamide is not an antibiotic.
name: Anti-bacterial
label: d
answer: no
explanation: This is the mechanism of racecadotril and it decreases excessive secretion of water. It has been found to be better tolerated than loperamide as it causes less flatulence and constipation, especially in children.
name: Inhibition of the enzyme neutral endopeptidase found in the intestinal wall
label: c
answer: no
explanation: It does this by acting on opioid receptors.
name: Decreases smooth muscle tone in the intestinal walls
label: a
answer: yes
explanation: Many people with diarrhoea require oral rehydration therapy but this is not the role of loperamide.
name: Replacement of lost electrolytes
label: b
answer: no
explanation: This is the mechanism of stimulant laxatives such as senna.
name: Increase intestinal motility
label: e
answer: no

Correct answer: a
Which of the following is a function of the thyroid gland?

Options:
explanation: Blood sugar control is largerly mediated by the pancreas releasing glucagon and insulin.
name: Blood sugar control
label: b
answer: no
explanation: C cells in the thyroid gland releases calcitonin which lowers serum calcium.
name: Calcium homeostasis
label: a
answer: yes
explanation: The thyroid gland does not have a dominant role in blood pressure control.
name: Blood pressure control
label: d
answer: no
explanation: This is mainly managed by the kidneys through the renin-angiotensin-aldosterone system (RAAS).
name: Sodium homeostasis
label: e
answer: no
explanation: This is mainly carried out by enzymes produced by the pancreas.
name: Digestion of food
label: c
answer: no

Correct answer: a
Which of the following best describes the role of a basophil?

Options:
explanation: This describes a macrophage.
name: Recognise PAMPs on pathogens and kill via phagocytosis
label: b
answer: no
explanation: This describes a plasma B cell.
name: Secrete antibodies
label: e
answer: no
explanation: This describes the role of a eosinophil
name: Release chemicals which are toxic to pathogens, particularly parasites
label: d
answer: no
explanation: This describes a neutrophil.
name: Travel to inflamed areas and kill pathogens via phagocytosis
label: c
answer: no
explanation: This describes the role of basophils and mast cells.
name: Degranulate to release pro-inflammatory cytokines
label: a
answer: yes

Correct answer: a
Which of the following is true regarding chronic obstructive pulmonary disorder (COPD) pathophysiology?

Options:
explanation: Emphysema in the distal acinar airways can be caused by fibrosis and atelectasis.
name: Emphysema is mainly found in the distal airways, and can be due to fibrosis
label: a
answer: yes
explanation: Alpha 1 antitrypsin decreases excessive activity of neutrophil elastase.
name: Alpha 1 antitrypsin increases activity of neutrophil elastase
label: b
answer: no
explanation: This is true for emphysema, not chronic bronchitis.
name: Air trapping is a problem in chronic bronchitis
label: e
answer: no
explanation: There is hypersecretion of mucus.
name: In chronic bronchitis there is decreased mucus production
label: c
answer: no
explanation: Cigarrette smoke has a role in both chronic bronchitis and emphysema.
name: Cigarette smoke only contributes to chronic bronchitis types of COPD
label: d
answer: no

Correct answer: a
Oxybutynin (an anti-muscarinic) is given to a 75-year-old male patient to improve symptoms of urinary incontinence.

What side effect is this medication LEAST likely to cause?

Options:
explanation: Oxybutynin is an antimuscarinic which is not associated with hypotension.
name: Hypotension
label: a
answer: yes
explanation: Oxybutynin is an antimuscarinic which are known to cause a dry mouth.
name: Dry mouth
label: d
answer: no
explanation: Oxybutynin is an antimuscarinic which is known to cause diarrhoea.
name: Diarrhoea
label: b
answer: no
explanation: Oxybutynin is an antimuscarinic which are known to cause dizziness.
name: Dizziness
label: e
answer: no
explanation: Oxybutynin is an antimuscarinic which are known to cause headaches.
name: Headache
label: c
answer: no

Correct answer: a
Which of the following statements best explains why redness occurs in inflammation?

Options:
explanation: This is why pain occurs in inflammation.
name: Stimulation of nerve endings
label: d
answer: no
explanation: Inflamamtion leads to vasodilation as this allows immune cells to leave the vessels to enter tissues. This leads to increased blood flow, which causes redness.
name: Inflammation leads to vasodilation
label: a
answer: yes
explanation: In inflammation, there is increased blood flow, not decreased.
name: Decreased blood flow
label: e
answer: no
explanation: This is one of the hallmarks of inflammation, but does not cause the redness.
name: Increase in temperature
label: b
answer: no
explanation: This is why swelling occurs in inflammation.
name: Increased vessel permeability
label: c
answer: no

Correct answer: a
A 19 year old teenager attends a medication review with his GP, after being diagnosed with epilepsy last year. He takes daily sodium valproate, and on this has remained seizure-free for 2 months.

The patient holds a current driving licence, but only occasionally drives. He reports that he has not informed any authority including the Driver and Vehicle Licensing Agency (DVLA) about his diagnosis.

Which of the following actions should be taken next?

Options:
explanation: This advice violates the DVLA regulations. Once diagnosed with epilepsy, one is legally required to inform the DVLA and stop driving immediately. Driving normally must cease for 12 months from the date of the most recent seizure.
name: Advise the teenager to inform the DVLA only if they experience a seizure while driving
label: d
answer: no
explanation: This is the correct answer. In the UK, it is a legal requirement to inform the DVLA about a diagnosis of epilepsy. This is because epilepsy can impact a person's ability to drive safely and may pose a risk to both the individual and other road users. Upon an epilepsy diagnosis, one must not drive and must notify the DVLA. Driving normally must cease for 12 months from the date of the most recent seizure.
name: Advise the teenager to immediately inform the DVLA about the epilepsy diagnosis
label: a
answer: yes
explanation: While this is practical advice, it does not address the legal requirement to inform the DVLA about the epilepsy diagnosis. Individuals with epilepsy need to comply with legal regulations regarding driving and take appropriate measures to ensure their road safety.
name: Advise the teenager to explore alternative transportation options, such as public transit or carpooling
label: c
answer: no
explanation: Although this teenager has been seizure-free for 2 months, DVLA specifies that a person with epilepsy may qualify for a driving licence only if they have been free from any seizure for 1 year. This needs to include being free of minor seizures, including those that do not involve a loss of consciousness and epilepsy signs such as limb jerking and auras.
name: Advise the teenager to continue taking sodium valproate and hold off informing the DVLA
label: b
answer: no
explanation: While the doctor may make changes to the drug dosage according to the frequency and severity of seizures, it does not change the fact that a person with epilepsy must inform the DVLA about a diagnosis of epilepsy and stop driving immediately.
name: Advise the teenager to gradually stop taking sodium valproate and take no further action
label: e
answer: no

Correct answer: a
A 24 year old man attends his GP surgery with difficulty walking. He broke his left leg in a skiing accident several months ago. Although the fracture has healed well, he has noted ongoing difficulty in lifting his left foot from the floor.

On examination, he is unable to dorsiflex the right foot and therefore has difficulty in lifting the toes while walking. Sensation is reduced on the dorsum of the left foot and lateral aspect of the left leg. Both feet are peripherally warm and well perfused. All other lower limb examinations are normal.

Which of the following is the most likely underlying diagnosis?

Options:
explanation: The lateral femoral cutaneous nerve provides sensory innervation to the skin of the lateral thigh. It does not control motor function. Injury to this nerve could cause sensory disturbances such as such as numbness and tingling. 'Cutaneous' in the name of a nerve suggests that it provides nerve supply to the skin and has sensory functions only.
name: Lateral femoral cutaneous nerve injury
label: e
answer: no
explanation: This is the correct answer. This vignette describes an isolated right foot drop. The common fibular nerve, a branch of the sciatic nerve, is particularly susceptible to injury at the fibular head and is more commonly associated with isolated foot drop due to its role in dorsiflexion of the foot. Causes of common fibular nerve damage include fractures of the fibula and the use of a tight plaster cast.
name: Common fibular nerve injury
label: a
answer: yes
explanation: The femoral nerve primarily innervates the muscles of the anterior thigh, such as the quadriceps muscles, and is not directly responsible for dorsiflexion of the foot. As all other lower limb examinations are normal, it is unlikely femoral nerve. Injury to the femoral nerve would lead to other motor deficits such as weakness in knee extension (due to innervation of quadriceps), but not isolated foot drop.
name: Femoral nerve injury
label: c
answer: no
explanation: The sciatic nerve is a major nerve that provides both sensory and motor innervation to the lower limbs, including the muscles responsible for leg and foot movement. A proximal lesion of the sciatic nerve could potentially affect the common fibular nerve and lead to foot drop, however, a direct injury to the sciatic nerve itself is less common and typically causes more widespread neurological deficits than just an isolated foot drop.
name: Sciatic nerve injury
label: b
answer: no
explanation: The tibial nerve primarily innervates the posterior leg muscles and is responsible for plantarflexion of the foot, not dorsiflexion. The tibial nerve also supplies the muscles involved in flexing the toes, such as the flexor digitorum longus and the flexor hallucis longus. Injury to the tibial nerve could affect toe flexion.
name: Tibial nerve injury
label: d
answer: no

Correct answer: a
A 43 year old woman schedules an appointment with her ophthalmologist due to concerning changes in her vision. She explains that over the past few weeks, she had been experiencing a persistent issue that is particularly noticeable while driving. She mentioned that when she was on the road, she had difficulty seeing objects and pedestrians at the side of her vision, like having 'tunnel vision'.

Which of the following is the most likely site of pathology?

Options:
explanation: This vignette describes peripheral vision loss, essentially a bitemporal hemianopia. If the right optic nerve is damaged, the patient will experience complete right vision loss. This is because the right optic nerve fibres transmit visual signals from the whole of the right eye to the optic tract.
name: Right optic nerve
label: b
answer: no
explanation: This vignette describes peripheral vision loss, essentially a bitemporal hemianopia. If the right optic tract is damaged, the patient would experience left (contralateral) homonymous hemianopia, meaning the loss of the left half of the visual fields of both eyes. This is because the right optic tract carries nerve signals from the right half of both retinas, which receives visual signals from the left half of the visual fields.
name: Right optic tract
label: d
answer: no
explanation: This vignette describes peripheral vision loss, essentially a bitemporal hemianopia. If the left optic nerve is damaged, the patient will experience complete left vision loss. This is because the left optic nerve fibres transmit visual signals from the whole of the left eye to the optic tract.
name: Left optic nerve
label: c
answer: no
explanation: This vignette describes peripheral vision loss, essentially a bitemporal hemianopia. If the left optic tract is damaged, the patient would experience right (contralateral) homonymous hemianopia, meaning the loss of the right half of the visual fields on both eyes. This is because the left optic tract carries nerve signals from the left half of both retinas, which receives visual signals from the right half of the visual fields.
name: Left optic tract
label: e
answer: no
explanation: This is the correct answer. This vignette describes peripheral vision loss or bitemporal hemianopia. Visual signals from the temporal (outer) sides of each eye are transmitted to the nasal part of the retina. The optic nerve fibres transmit the signal and cross at the optic chiasm to opposite sides of the brain. Therefore, damage or pressure at the optic chiasm could create a tunnel-like visual experience, with the central vision intact.
name: Optic chiasm
label: a
answer: yes

Correct answer: a
A 46 year old patient who has a past medical history of relapsing-remitting multiple sclerosis (MS) is experiencing burning, tingling and pain in her hands. This has significantly impacted her day-to-day living. She was recently discharged from hospital following a myocardial infarction.

Which of the following drugs is the most suitable to alleviate this patient's pain?

Options:
explanation: This patient has neuropathic pain, characterised by a burning sensation, tingling and pain. According to NICE recommendations, there are four first-line medications to control neuropathic pain, which are gabapentin, pregabalin, amitriptyline and duloxetine. Since this patient has had a recent myocardial infarction (MI), amitriptyline is contraindicated, because it could cause arrhythmias. Arrhythmias can be particularly dangerous in patients with a recent MI, as the heart may already be vulnerable and more prone to irregular rhythms.
name: Amitriptyline
label: e
answer: no
explanation: This patient has neuropathic pain, characterised by a burning sensation, tingling and pain. According to NICE recommendations, there are four first-line medications to control neuropathic pain: gabapentin, pregabalin, amitriptyline and duloxetine. Tramadol, an opioid, is only recommended as an acute rescue option for short term alleviation of flares. Furthermore, tramadol, like other opioids, can affect the cardiovascular system, leading to changes in heart rate and blood pressure. This is not ideal given her recent recovery from myocardial infarction.
name: Tramadol
label: c
answer: no
explanation: This patient has neuropathic pain, characterised by a burning sensation, tingling and pain. According to NICE recommendations, there are four first-line medications to control neuropathic pain: gabapentin, pregabalin, amitriptyline and duloxetine. Naproxen, an NSAID, is more effective at reducing inflammation and relieving pain from inflammatory conditions such as arthritis or musculoskeletal injuries. Neuropathic pain is related to nerve damage and dysfunction, and it typically does not involve inflammation.
name: Naproxen
label: d
answer: no
explanation: This patient has neuropathic pain, characterised by a burning sensation, tingling and pain. According to NICE recommendations, there are four first-line medications to control neuropathic pain: gabapentin, pregabalin, amitriptyline and duloxetine. Gabapentin, an anticonvulsant, is commonly used to manage neuropathic pain associated with conditions like MS. It works by stabilising overactive nerve cells and reducing abnormal electrical activity, which can help alleviate symptoms of neuropathic pain.
name: Gabapentin
label: a
answer: yes
explanation: This patient has neuropathic pain, characterised by a burning sensation, tingling and pain. According to NICE recommendations, there are four first-line medications to control neuropathic pain: gabapentin, pregabalin, amitriptyline and duloxetine. Carbamazepine is a first-line medication only for a specific type of neuropathic pain, trigeminal neuralgia, which is characterised by severe, sharp, shooting facial pain.
name: Carbamazepine
label: b
answer: no

Correct answer: a