hllj/quesmed huggingface dataset:
A 31-year-old man with drug-resistant focal, impaired awareness seizures is scheduled to undergo a left temporal lobectomy for hippocampal sclerosis.

What visual defect could be seen postoperatively?

Options:
explanation: This is correct. The temporal lobe contains the inferior optic radiating fibres (also known as Meyer's loop). The Meyer loop gives rise to vision in the contralateral superolateral visual field. Therefore, damage to the temporal lobe can cause damage to Meyer's loop, causing contralateral homonymous superior quadrantanopia (loss of vision in the contralateral superolateral visual field). This is also known as a pie-in-the-sky field cut.
name: Contralateral homonymous superior quadrantanopia
label: a
answer: yes
explanation: This is incorrect. Contralateral homonymous hemianopia with macular sparing occurs due to lesions or damage in the visual cortex located in the occipital lobe (calcarine sulcus). Partial damage to the visual cortex will spare the macula as the macula is represented in a very large region of the cortex and is spread out. This is often caused by a stroke or a tumour.
name: Contralateral homonymous hemianopia with macular sparing
label: d
answer: no
explanation: This is incorrect. Contralateral homonymous hemianopia is due to damage to the optic nerve after the optic chiasm i.e. in the optic tract. Damage to the optic tract results in the whole half of the contralateral field being lost in both eyes. This is usually caused by a tumour or a stroke.
name: Contralateral homonymous hemianopia
label: c
answer: no
explanation: This is incorrect. A central scotoma is a blurry, grey/black or blind spot in the middle of the vision. This is usually due to lesions of the optic nerve itself or the macula.
name: Central Scotoma
label: e
answer: no
explanation: This is incorrect. Bitemporal hemianopia is caused by damage to the optic chiasm. This is commonly due to compression of the optic chiasm from tumours (frequently pituitary tumours), aneurysms or lesions over the optic chiasms. This is because the fibres that give rise to the temporal half of vision on both eyes cross over at the optic chiasm.
name: Bitemporal hemianopia
label: b
answer: no

Correct answer: a
Within the ear there are outer and inner hair cells, both contributing towards the hearing sound.

What is the function of the outer hair cells?

Options:
explanation: This is incorrect. Outer hair cells are not precursor stem cells for inner hair cells.
name: Precursor stem cells for inner hair cells
label: b
answer: no
explanation: This is incorrect. This is the role of the inner hair cells.
name: Convert the vibrations of the basilar membrane into electrical signals which are transmitted to the brain
label: c
answer: no
explanation: The outer hair cells play a vital role in amplifying sound waves to aid the cochlea in detecting sounds with higher sensitivity.
name: Local amplification of sound within the cochlear
label: a
answer: yes
explanation: This is incorrect. The vibration of the basilar membrane is vital for the inner hair cells to convert into electrical signals.
name: Act to reduce vibration of the basilar membrane
label: e
answer: no
explanation: This is incorrect. The cochlea is responsible for relaying sound pitch.
name: Relay of sound pitch
label: d
answer: no

Correct answer: a
A 51-year-old man presents to the GP with his wife. His wife is concerned about the patient's recent change in personality. She explains that he recently has been swearing at strangers in public unprovoked. Upon further questioning, the wife also found the patient urinating in the garden last night at their friend's house.

Which area of the brain is most likely to have a lesion resulting in these symptoms?

Options:
explanation: This is incorrect. The dorsolateral prefrontal cortex is involved in cognitive functions including task switching, planning and working memory.
name: Dorsolateral prefrontal cortex
label: b
answer: no
explanation: This is incorrect. The hippocampus is involved in learning and memory.
name: Hippocampus
label: e
answer: no
explanation: This is correct. The orbit medial prefrontal cortex is responsible for decision-making, processing and regulating emotions as well as the inhibitory control of behaviour. A lesion in this area can therefore leave to impulsive behaviour and apathy.
name: Orbitomedial prefrontal cortex
label: a
answer: yes
explanation: This is incorrect. The pars opercularis is involved with recognising a tone of voice and the production of language. This area is situated within Broca's area. A lesion within Broca's area causes Broca's aphasia.
name: Pars opercular's
label: c
answer: no
explanation: This is incorrect. Wernicke's area is involved in understanding speech and the meaning of words. A lesion in this area leads to Wernicke's aphasia.
name: Wernicke's area
label: d
answer: no

Correct answer: a
Hemispatial neglect is a condition resulting in a deficit in awareness of one side of the field of vision. This usually results due to damage to one hemisphere of the brain.

What lobe of the brain is most associated with hemispatial neglect?

Options:
explanation: This is incorrect. The occipital lobe is responsible for visual processing, distance and depth perception, object and face recognition and the perception of colour.
name: Non-dominant occipital lobe
label: d
answer: no
explanation: This is incorrect. The dominant temporal lobe is involved in understanding language and retaining verbal information. The Wernicke's area is located here.
name: Dominant temporal lobe
label: e
answer: no
explanation: This is incorrect. The occipital lobe is responsible for visual processing, distance and depth perception, object and face recognition and the perception of colour.
name: Dominant occipital lobe
label: c
answer: no
explanation: This is incorrect. The dominant parietal lobe is involved in controlling language and calculation. The non-dominant side is involved in contralateral spatial awareness.
name: Dominant parietal lobe
label: b
answer: no
explanation: This is correct. The non-dominant parietal lobe is involved in contralateral spatial navigation. As a result, lesions in the non-dominant lobe lead to inattention and hemispatial neglect of the contralateral side. This can be seen in patients whilst drawing where they typically miss out on one side of the drawing.
name: Non-dominant parietal lobe
label: a
answer: yes

Correct answer: a
A 25-year-old man comes into A+E with a painful right eye along with a decrease in vision following impact to his eye. He is diagnosed with retinal detachment.

Which two structural components of the eye become separated in retinal detachment?

Options:
explanation: This is incorrect. The neural retina lies between the vitreous and retinal pigment epithelium.
name: Vitreous and retinal pigment epithelium
label: d
answer: no
explanation: This is incorrect. If the vitreous separates from the neural retina it is called vitreous detachment.
name: Vitreous and neural retina
label: c
answer: no
explanation: This is correct. Retinal detachment occurs when the neurosensory retina separates from the underlying retinal pigment epithelium.
name: Neural retina and retinal pigment epithelium
label: a
answer: yes
explanation: This is incorrect. The choroid contains the blood vessels and lies deeper into the retinal pigment epithelium.
name: Choroid and retinal pigment epithelium
label: b
answer: no
explanation: This is incorrect. The retinal pigment epithelium lies between the neural retina and the choroid.
name: Neural retina and choroid
label: e
answer: no

Correct answer: a
The pathway of dis conjugate eye movements involves the vergence centre sending out signals.

During convergence of the eyes, which of the following signals are sent out by the vergence centre?

Options:
explanation: This is incorrect. The ciliary ganglion innervates the muscles that constrict the pupil and control the shape of the lens in the eye. The vergence centre sends signals to the Edinger-Westphal nucleus during convergence of the eyes.
name: Signals are sent to the ciliary ganglion via sympathetic fibres of the oculomotor nerve
label: e
answer: no
explanation: This is incorrect. The pretectal nucleus receives afferents from both the retina and optic tectum. The pretectal nucleus is involved in controlling the motor responses to changing visual inputs.
name: Signals are sent to the pretectal nucleus
label: d
answer: no
explanation: This is incorrect. The ciliary ganglion innervates the muscles that constrict the pupil and control the shape of the lens in the eye. The vergence centre sends signals to the Edinger-Westphal nucleus during the convergence of the eyes.
name: Signals are sent to the ciliary ganglion via parasympathetic fibres of the optic nerve
label: c
answer: no
explanation: This is incorrect. The abducens nucleus is involved in coordinating the conjugate gaze, not in the dis conjugate gaze pathway. The abducens nucleus is the originating nucleus from where the abducens nerve emerges.
name: Signals are sent to the abducens nucleus
label: b
answer: no
explanation: This is correct. The Edinger-Westphal nucleus supplies preganglionic parasympathetic fibres to the eye. It plays a role in constricting the pupil, the convergence of the eyes and accommodation.
name: Signals are sent to the Edinger-Westphal nucleus
label: a
answer: yes

Correct answer: a
During activation of the reflex arc, there is presynaptic inhibition of the antagonist muscle group spindle afferents by the agonist muscle group spindle afferents.

What kind of receptors on the antagonist muscle group spindle afferents does this pathway involve?

Options:
explanation: This is correct. During a reflex, interneurons branch out from the alpha motor neurones in a specific muscle to innervate the presynpatic terminal of the spindle afferent of the antagonist's muscle. These interneurons therefore directly inhibit the antagonist's muscle. These interneurons are GABAergic and act through metabotropic receptors.
name: Metabotropic GABAergic receptors
label: a
answer: yes
explanation: This is incorrect. Glycinergic receptors are not involved in this process. During a reflex, interneurons branch out from the alpha motor neurones in a specific muscle to innervate the presynaptic terminal of the spindle afferent of the antagonist muscle. These interneurons therefore directly inhibit the antagonist muscle. These interneurons are GABAergic and act through metabotropic receptors.
name: Metabotropic glycinergic receptors
label: d
answer: no
explanation: This is incorrect. Glycinergic receptors are not involved in this process. During a reflex, interneurones branch out from the alpha motor neurones in a specific muscle to innervate the presynaptic terminal of the spindle afferent of the antagonist's muscle. These interneurons therefore directly inhibit the antagonist's muscle. These interneurons are GABAergic and act through metabotropic receptors.
name: Inotropic glycinergic receptors
label: c
answer: no
explanation: This is incorrect. Glutaminergic receptors are not involved in this process. During a reflex, interneurons branch out from the alpha motor neurones in a specific muscle to innervate the presynaptic terminal of the spindle afferent of the antagonist's muscle. These interneuroes therefore directly inhibit the antagonist's muscle. These interneurons are GABAergic and act through metabotropic receptors.
name: Ionotropic glutaminergic receptors
label: e
answer: no
explanation: This is incorrect. During a reflex, interneurones branch out from the alpha motor neurones in a specific muscle to innervate the presynaptic terminal of the spindle afferent of the antagonist muscle. These interneurons therefore directly inhibit the antagonist muscle. These interneurons are GABAergic and act through metabotropic receptors.
name: Ionotropic GABAergic receptors
label: b
answer: no

Correct answer: a
A 55-year-old woman presents to the GP with chronic pain. When the GP touches the woman's arm with cotton wool, the patient grimaces in pain.

What best describes this response?

Options:
explanation: This is incorrect. Analgesia is either the inability to feel pain or medication that acts to relieve pain.
name: Analgesia
label: e
answer: no
explanation: This is incorrect. Neuropathic pain is caused by a disease or a lesion in the somatosensory nervous system.
name: Neuropathic pain
label: c
answer: no
explanation: This is incorrect. Hyperalgesia occurs when there is increased sensitivity to pain with an increased response to a painful stimulus.
name: Hyperalgesia
label: b
answer: no
explanation: This is correct. Allodynia is defined as pain caused by a stimulus that does not usually provoke pain.
name: Allodynia
label: a
answer: yes
explanation: This is incorrect. Hypoalgesia defines as a decreased sensitivity to a painful stimulus.
name: Hypoalgesia
label: d
answer: no

Correct answer: a
A 49-year-old man is having his pupil reflexes assessed in A&E. When light is directed into his right eye, there is constriction of the right pupil but not the left pupil. When light is directed into his left eye, there is a contraction of the right pupil but not the left pupil.

Which structure is most likely damaged?

Options:
explanation: This is incorrect. A lesion in the right optic nerve would result in a lack of pupil constriction in both the right and left eyes when light is shone into the right eye. However, if light is shone into the left eye, there is constriction of both eyes as the oculomotor nerves would be functioning. Additionally, there may also be ipsilateral vision loss.
name: Right optic nerve
label: c
answer: no
explanation: This is incorrect. A lesion in the left optic nerve would result in a lack of pupil constriction in both the right and left eyes when light is shone into the left eye. However, if the light is shone into the right eye, there is constriction of both eyes as the oculomotor nerves would be functioning. Additionally, there may also be ipsilateral vision loss.
name: Left optic nerve
label: d
answer: no
explanation: This is incorrect. The right pretectal nucleus receives an afferent from the retinal ganglion cells of the optic nerve when light is shone into the left eye. The right pretectal nucleus will then send signals to the Edinger-Westphal nucleus of both eyes which results in an efferent through the oculomotor nerve to cause pupillary constriction in both eyes via the ciliary ganglion. If the lesion was located here, neither the left nor right pupil would constrict when light is shone into the left eye. However, if the light is shone into the right eye, there is constriction of both eyes as the oculomotor nerves would be functioning.
name: Right pretectal nucleus
label: b
answer: no
explanation: This is incorrect. The left pretectal nucleus receives an afferent from the retinal ganglion cells of the optic nerve when light is shone into the right eye. The left pretectal nucleus will then send signals to the Edinger-Westphal nucleus of both eyes which results in an efferent through the oculomotor nerve to cause pupillary constriction in both eyes via the ciliary ganglion. If the lesion was located here, neither the left nor right pupil would constrict when light is shone into the right eye. However, if the light is shone into the left eye, there is constriction of both eyes as the oculomotor nerves would be functioning.
name: Left pretectal nerve
label: e
answer: no
explanation: This is correct. Firstly, as there is no constriction of the left pupil when light is shone in the left or the right eye, there is a lesion either in the left optic nerve or left oculomotor nerve. However, when light is shone into the left eye, there is constriction of the right pupil, indicating it is not an afferent nerve lesion. Therefore, the lesion must be located in the left oculomotor nerve, with failure to produce left pupil constriction.
name: Left oculomotor nerve
label: a
answer: yes

Correct answer: a
An 8-year-old girl presents to the GP with a history of longstanding eczema which has recently relapsed. There are increased areas of the rash along with crusting and weeping in the forearms and hands. The girl was diagnosed with atopic eczema when she was 1 year old.

Which of the following cells contributes a vital role in the pathophysiology of atopic eczema?

Options:
explanation: This is incorrect. Melanocytes produce the pigment melanin inside melanosomes. This contributes to skin pigmentation. The Langerhan cells play a vital role in the pathophysiology of atopic eczema.
name: Melanocytes
label: c
answer: no
explanation: This is incorrect. The subcutaneous adipose cells are involved in regulating the storage and usage of lipid energy. This aids in insulating the body, cushioning and protection against blunt trauma and conserving a source of energy. The Langerhans cells play a vital role in the pathophysiology of atopic eczema.
name: Subcutaneous adipose cells
label: d
answer: no
explanation: This is incorrect. Merkel cells are located in the epidermis and are essential for light touch sensation hence play a vital role in mechanoreceptor and nociceptive responses. The Langerhans cells play a vital role in the pathophysiology of atopic eczema.
name: Merkel cells
label: e
answer: no
explanation: This is the correct answer. Langerhans cells, located in the epidermis, act as the outermost guard of the skin against pathogens. Langerhans cells play a vital role in the development of atopic eczema as well as atopic dermatitis.
name: Langerhan cells
label: a
answer: yes
explanation: This is incorrect. Dermal fibroblasts are located in the dermis and are involved in wound healing. The Langerhans cells play a vital role in the pathophysiology of atopic eczema.
name: Dermal fibroblasts
label: b
answer: no

Correct answer: a
A 32-year-old man presents to the GP with itchy red patches of skin. The patient first noticed these patches 3 days ago after returning from a 3-week holiday in Thailand a week ago. On examination, two circular plaques are seen located on the dorsum of his right hand. The plaques are well defined with a pale centre surrounded by a red ring.

Which of the following is the most likely diagnosis?

Options:
explanation: This is the correct answer. Tinea is a fungal infection of the skin, commonly known as ringworm. This fungal infection is typically seen as red ring-shaped patches on the skin commonly seen on the scalp, legs, arms, trunk or feet.
name: Tinea
label: a
answer: yes
explanation: This is incorrect. Psoriasis causes patches of dry, scaly rashes that typically are seen in extensor surfaces such as the back of elbows. This ring-shaped rash is typical of tinea.
name: Psoriasis
label: d
answer: no
explanation: This is incorrect. Actinic keratoses are seen as rough and scaly patches which are usually found on sun-exposed areas of skin, typically in paler individuals. This ring-shaped rash is typical of tinea.
name: Actinic (solar) keratosis
label: e
answer: no
explanation: This is incorrect. Eczema rashes look like red, dry, scaly areas typically seen in flexor surfaces such as the insides of elbows, wrists and knees. This ring-shaped rash is typical of tinea.
name: Eczema
label: b
answer: no
explanation: This is incorrect. Contact dermatitis results in itchy, dry, red rashes that usually occur hours or days after contact with an irritant or allergen. This ring-shaped rash is typical of tinea.
name: Contact dermatitis
label: c
answer: no

Correct answer: a
A 12-year-old girl presents to the GP worried about her excessive sweating. The sweat is mostly apparent in the palms of her hands and has no odour.

Which gland is responsible for secreting this sweat?

Options:
explanation: This is incorrect. Holocrine is a term used to classify the mode of secretion in exocrine glands which involves plasma membrane rupture. Examples of holocrine glands are glands that include sebaceous glands of the skin and meibomian glands of the eyelid.
name: Holocrine glands
label: e
answer: no
explanation: This is incorrect. Whilst apocrine glands also produce sweat, they open into hair follicles and hence develop in areas where there are many hair follicles such as the scalp, armpits and groin. This patient had sweat in the palms of her hands where eccrine glands would predominate.
name: Apocrine glands
label: b
answer: no
explanation: This is correct. The eccrine glands are found over most of the body and play a role in maintaining homeostasis which involves secreting sweat to maintain the body temperature.
name: Eccrine glands
label: a
answer: yes
explanation: This is incorrect. Endocrine glands are responsible for releasing hormones, not sweat.
name: Endocrine glands
label: c
answer: no
explanation: This is incorrect. Sebaceous glands are responsible for producing and secreting sebum which contains olis, wax and cholesterol to lubricate and protect the skin against friction and provide moisture.
name: Sebaceous glands
label: d
answer: no

Correct answer: a
The stratum spinosum is a layer within the epidermis.

What links the cytoskeletons of adjacent cells in the stratum spinosum?

Options:
explanation: This is incorrect. Tight junctions are involved in maintaining and providing a barrier between various compartments of the body which restricts the diffusion of molecules between different compartments.
name: Tight junctions
label: d
answer: no
explanation: This is correct. Desmosomes are intercellular junctions which provide strong adhesions between adjacent cells in the stratum spinosum.
name: Desmosomes
label: a
answer: yes
explanation: This is incorrect. Fascia adherens play an important role in the cardiac muscle where they anchor cells together by linking the cell membrane to the actin cytoskeleton.
name: Fascia adherens
label: e
answer: no
explanation: This is incorrect. Gap junctions are channels that directly connect the cytoplasm of two cells whilst allowing direct cell-cell transfer of molecules. Desmosomes are important for anchoring the cytoskeletons of adjacent cells in the stratum spinosum.
name: Gap junctions
label: c
answer: no
explanation: This is incorrect. Actin plays a role in muscle contraction, cell movement and maintaining cell shape. Actin does not link adjacent cells together.
name: Actin
label: b
answer: no

Correct answer: a
A 22-year-old woman presents to the dermatology clinic with pale patches on her skin that she has noticed for the past 2 months. She is later diagnosed with vitiligo.

Malfunction of which cells cause vitiligo?

Options:
explanation: This is incorrect. Langerhans cells, located in the epidermis, act as the outermost guard of the skin against pathogens. Langerhan cells play a vital role in the development of atopic eczema as well as atopic dermatitis.
name: Langerhans cells
label: b
answer: no
explanation: This is correct. Melanocytes produce the pigment melanin inside melanosomes. This contributes to skin pigmentation. Vitiligo occurs when melanocytes die or stop producing melanin.
name: Melanocytes
label: a
answer: yes
explanation: This is incorrect. The subcutaneous adipose cells are involved in regulating the storage and usage of lipid energy. This aids in insulating the body, cushioning and protecting against blunt trauma and conserving a source of energy.
name: Subcutaneous adipose cells
label: e
answer: no
explanation: This is incorrect. Merkel cells are located in the epidermis and are essential for light touch sensation hence play a vital role in mechanoreceptor and nociceptive responses.
name: Merkel cells
label: c
answer: no
explanation: This is incorrect. Dermal fibroblasts are located in the dermis and are involved in wound healing.
name: Dermal fibroblasts
label: d
answer: no

Correct answer: a