hllj/quesmed huggingface dataset:
A 19-year-old man is brought to Accident and Emergency by his friends after falling over and hitting his head on a night out. On assessment he seems confused and not entirely sure of where he is. His friends confirm that this is highly unusual for him.

It is decided that he will need a CT head to rule out an intracranial bleed. Upon hearing this, the patient becomes agitated and threatens to leave the hospital. He doesn't appear to understand attempts to explain why the scan is necessary.

Which of these is a sign the patient lacks capacity?

Options:
explanation: Incorrect - Disagreeing with a management plan is not a sign of diminished capacity. If the patient cannot clearly articulate why they disagree with the management plan, or cannot remember the plan, then their capacity may be reduced. However, disagreeing is not evidence of diminished capacity in itself.
name: The patient disagrees with the proposed management plan
label: c
answer: no
explanation: Incorrect - Disagreeing with the proposed course of action, or stating a preference for a different investigation, is not a sign of diminished capacity in itself. As long as patients can retain, understand and weigh information, as well as communicate their decision, they are entitled to refuse (but not demand) treatment.
name: The patient would rather have an MRI as they have heard it is more accurate
label: d
answer: no
explanation: Incorrect - The ability to communicate a decision is a key component of a capacity assessment. However, writing is a form of communication. Provided the patient fulfils other components of the capacity assessment, this is not a sign of diminished capacity.
name: The patient writes out their decision rather than saying it
label: e
answer: no
explanation: Incorrect - An individual making a decision which is not in their best interests is not a sign of diminished capacity, provided they can retain, understand and weigh information, as well as communicate their decision.
name: The patient makes a decision that is not in their best interest
label: b
answer: no
explanation: Correct - A key feature of capacity is the ability of the patients to understand and weigh the information presented to them. If a patient is disorientated to place and cannot appreciate the importance of having such an investigation, they are unlikely to have capacity to refuse treatment.
name: The patient appears confused
label: a
answer: yes

Correct answer: a
A 23-year-old woman has just given birth when the midwife notices a large amount of vaginal bleeding. The patient appears pale and sweaty. On examination, she has an increased pulse and respiratory rate. An urgent CT angiogram reveals damage to the ovarian artery.

Which of the following arteries does the ovarian artery originate from?

Options:
explanation: Incorrect - The ovarian artery, sometimes referred to as the gonadal artery, arises from the abdominal aorta. It branches off at the level of L2, below the superior mesenteric artery. It does not arise from the pudendal artery.
name: Pudendal Artery
label: e
answer: no
explanation: Incorrect - The ovarian artery, sometimes referred to as the gonadal artery, arises from the abdominal aorta. It branches off at the level of L2, below the superior mesenteric artery. It does not arise from the external iliac artery.
name: The external iliac artery
label: d
answer: no
explanation: Incorrect - The ovarian artery, sometimes referred to as the gonadal artery, arises from the abdominal aorta. It branches off at the level of L2, below the superior mesenteric artery. It does not arise from the internal iliac artery.
name: The internal iliac artery
label: c
answer: no
explanation: Correct - The ovarian artery, sometimes referred to as the gonadal artery, arises from the abdominal aorta. It branches off at the level of L2, below the superior mesenteric artery.
name: The aorta
label: a
answer: yes
explanation: Incorrect - The ovarian artery, sometimes referred to as the gonadal artery, arises from the abdominal aorta. It branches off at the level of L2, below the superior mesenteric artery. It does not arise from the common iliac artery.
name: The common iliac artery
label: b
answer: no

Correct answer: a
A 79-year-old man attends his GP surgery for a medication review. He is currently taking six daily medications.

According to the national service framework for older people, how frequently should the patient have a medication review?

Options:
explanation: Incorrect  - All patients aged 75 years or over should have an annual review of their repeat medication. Those taking 4 or more medicines should be reviewed every 6 months. As this patient is taking 6 daily medications, he should be reviewed every 6 months.
name: Every 4 months
label: b
answer: no
explanation: Incorrect - If the patient were taking 3 or fewer medications then in accordance with the national service framework for older people, he should be reviewed every 12 months. However, as this patient is taking 6 daily medications, he should be reviewed every 6 months.
name: Every 12 months
label: c
answer: no
explanation: Correct - All patients aged 75 years or over should have an annual review of their repeat medication. Those taking 4 or more medicines should be reviewed every 6 months. As this patient is taking 6 daily medications, he should be reviewed every 6 months.
name: Every 6 months
label: a
answer: yes
explanation: Incorrect - All patients aged 75 years or over should have an annual review of their repeat medication. Those taking 4 or more medicines should be reviewed every 6 months. As this patient is taking 6 daily medications, he should be reviewed every 6 months.
name: Every 3 months
label: d
answer: no
explanation: Incorrect - All patients aged 75 years or over should have an annual review of their repeat medication. Those taking 4 or more medicines should be reviewed every 6 months. As this patient is taking 6 daily medications, he should be reviewed every 6 months.
name: Every month
label: e
answer: no

Correct answer: a
A 6-month-old baby boy is brought to the GP surgery by his mother. When changing the baby's nappy she has noticed that he does not seem to urinate out of the end of his penis. On examination, the GP identifies hypospadias.

Which of the following embryological tissue does the shaft of the penis originate from?

Options:
explanation: Incorrect - The urachus ultimately becomes the allantois, a fibrous cord, that passes from the bladder to the umbilicus. It is not associated with the development of the penis or reproductive system.
name: Urachus
label: e
answer: no
explanation: Incorrect - the genital swellings form the scrotum in males and the labia in females.
name: Genital Swellings
label: b
answer: no
explanation: Incorrect - The inguinal ligament is not associated with the development of the penis or reproductive system.
name: Inguinal Ligament
label: d
answer: no
explanation: Incorrect - The genital tubercle forms the glans of the penis and erectile tissue in males and the clitoris in females.
name: Genital tubercle
label: c
answer: no
explanation: Correct - The shaft of the penis originates from the urethral folds. Failure of their fusion can result in epispadias (where the urethral opening arises from the dorsal aspect of the penis) or hypospadias (where the urethral opening arises from the ventral aspect of the penis).
name: Urethral Folds
label: a
answer: yes

Correct answer: a
A 67-year-old man presents to Accident and Emergency with severe chest pain that is radiating down his left arm and up to his jaw. He is sweaty and nauseous. His pain is not alleviated by GTN spray, and it is suspected he is having a myocardial infarction. An ECG is performed.

Which of the following ECG leads would demonstrate an anterior ST elevation infarction?

Options:
explanation: Incorrect - V5 and V6 provide a lateral view of the heart. ST elevation would not be seen in these leads if the infarction was isolated to the anterior aspect of the heart
name: V5 and V6
label: b
answer: no
explanation: Incorrect - Leads V1 and V2 provide an septal view of the heart, and ST elevation would not be seen in these leads if the infarction was isolated to the anterior aspect of the heart.
name: V1 and V2
label: e
answer: no
explanation: Correct - Leads V3 and V4 provide an anterior view of the heart. In the case of an anterior ST elevation myocardial infarction, ST elevation would be seen in these leads.
name: V3 and V4
label: a
answer: yes
explanation: Incorrect - Leads I and aVL provide a lateral view of the heart. ST elevation would not be seen in these leads if the infarction was isolated to the anterior aspect of the heart.
name: Leads I and aVL
label: d
answer: no
explanation: Incorrect - Leads II and III provide an inferior view of the heart. ST elevation would not be seen in these leads if the infarction was isolated to the anterior aspect of the heart.
name: Leads II and III
label: c
answer: no

Correct answer: a
A newborn baby girl is reviewed by the midwife one minute after birth. She appears pink in colour, aside from her hands and feet which are still a little blue, and is flexing her arms and legs. She has a strong cry in response to stimulation. Her heart rate is 125.

Which of the following best describes the infant's APGAR score?

Options:
explanation: Correct - The APGAR score is a rapid assessment of a baby's health immediately after birth, and is a useful method of risk stratification. It is made up of five components: activity, pulse, reflex irritability, appearance (level of perfusion), and respiration. The infant scored 2 points on all aspects of the APGAR assessment except appearance as she has cyanosis in her hands and feet.
name: 9
label: a
answer: yes
explanation: Incorrect - The infant scored 2 points on all aspects of the APGAR score except appearance as she has cyanosis in her hands and feet. Her total score is calculated as 9.
name: 8
label: c
answer: no
explanation: Incorrect - The infant scored 2 points on all aspects of the APGAR score except appearance as she has cyanosis in her hands and feet. Her total score is calculated as 9.
name: 7
label: d
answer: no
explanation: Incorrect - As the infant has cyanosis in her hands and feet she cannot score 10 on an APGAR assessment. She does, however, score 2 points for all of the other criteria. Her total score is calculated as 9.
name: 10
label: b
answer: no
explanation: Incorrect - The infant scored 2 points on all aspects of the APGAR score except appearance as she has cyanosis in her hands and feet. Her total score is calculated as 9.
name: 5
label: e
answer: no

Correct answer: a
A 54-year-old woman visits her GP as she is concerned that she might have osteoporosis. She asks the doctor if there are any tests that can be done to make sure her bones are healthy.

Which of the following is the main cell involved in bone resorption?

Options:
explanation: Incorrect - Fibroblasts migrate to and proliferate at the site of an injury and deposit extracellular matrix. They are not responsible for bone resorption.
name: Fibroblasts
label: e
answer: no
explanation: Incorrect - Osteocytes were once osteoblasts which have become trapped within the matrix they secreted. They are not involved in bone resorption.
name: Osteocytes
label: c
answer: no
explanation: Correct - Osteoclasts secrete enzymes and acid to break down extracellular matrix and mineralised bone to facilitate resorption. They are the primary cell type driving bone destruction, as is necessary for remodelling and repair. An imbalance of osteoclasts and osteoblasts, which are responsible for bone production, can lead to bone disorders such as osteoporosis.
name: Osteoclasts
label: a
answer: yes
explanation: Incorrect - Osteoblasts are responsible for bone production. They secrete osteoid (the organic bone matrix containing type 1 collagen) which is then mineralised to form bone. They are not involved in bone resorption.
name: Osteoblasts
label: b
answer: no
explanation: Incorrect - Basophils are a type of granulocyte. They are involved in immune response and the immune system. They are not involved in bone resorption.
name: Basophils
label: d
answer: no

Correct answer: a
An 38-year-old man attends the minor injuries unit complaining of pain and swelling in his hand. He has recently returned from a skiing holiday, and began to notice the pain on his final day.

Which of the following bones is damaged in a Bennett's fracture?

Options:
explanation: Correct - In a Bennett's fracture the proximal 1st metacarpal is damaged, usually by forced abduction of the thumb. It is associated with skiing and boxing, or falling on an outstretched hand. The patient will often present with swelling at the base of the thumb and on the thenar eminence, and will have difficulty grasping objects.
name: First Proximal Metacarpal
label: a
answer: yes
explanation: Incorrect - In a Bennett's fracture the proximal, not the distal, 1st metacarpal is damaged. This is usually by forced abduction of the thumb. It is associated with skiing and boxing, or falling on an outstretched hand. The patient will often present with swelling at the base of the thumb and on the thenar eminence, and will have difficulty grasping objects.
name: First Distal Metacarpal
label: b
answer: no
explanation: Incorrect - Fractures of the neck of the 5th metacarpal are often called Boxer's fractures. By contrast, in a Bennett's fracture the proximal 1st metacarpal is damaged, usually by forced abduction of the thumb. It is associated with skiing and boxing, or falling on an outstretched hand. The patient will often present with swelling at the base of the thumb and on the thenar eminence and will have difficulty grasping objects.
name: Fifth Distal Metacarpal
label: d
answer: no
explanation: Incorrect - Fractures of the neck of the 5th metacarpal are often called Boxer's fractures. By contrast, in a Bennett's fracture the proximal 1st metacarpal is damaged, usually by forced abduction of the thumb. It is associated with skiing and boxing, or falling on an outstretched hand. The patient will often present with swelling at the base of the thumb and on the thenar eminence and will have difficulty grasping objects.
name: Fifth Proximal Metacarpal
label: c
answer: no
explanation: Incorrect - In a Bennett's fracture the proximal 1st, rather than 2nd metacarpal is damaged, usually by forced abduction of the thumb. It is associated with skiing and boxing, or falling on an outstretched hand. The patient will often present with swelling at the base of the thumb and on the thenar eminence and will have difficulty grasping objects.
name: Second Proximal Metacarpal
label: e
answer: no

Correct answer: a
A 13-year-old girl presents to Accident and Emergency after accidentally cutting her arm with a kitchen knife. She is concerned about the possibility of developing a permanent scar.

Which of the following cell types are responsible for the elaboration of extracellular matrix during scar formation?

Options:
explanation: Incorrect - Macrophages play a role in the inflammatory response of wound healing. They do not deposit extracellular matrix to form scars.
name: Macrophages
label: d
answer: no
explanation: Incorrect - Collagen does not deposit extracellular matrix. Fibroblasts produce collagen and ground substance (extracellular matrix) to facilitate wound healing.
name: Collagen
label: e
answer: no
explanation: Correct - Fibroblasts migrate to the site of an injury. Here they proliferate and deposit an extracellular matrix that facilitates scar formation.
name: Fibroblasts
label: a
answer: yes
explanation: Incorrect - Parenchymal cells are the cells that carry out the specific function of the organ or stroma, which in this case has become damaged. Scar formation is the replacement of parenchymal cells with stromal cells and a fibrotic extracellular matrix.
name: Parenchymal Cells
label: c
answer: no
explanation: Incorrect - Neutrophils will infiltrate a wound within 24 hours but do not release extracellular matrix.
name: Neutrophils
label: b
answer: no

Correct answer: a
A 56-year-old woman presents to her GP after finding a small lump on her labia majora. She is known to have uterine cancer, and is very worried that this new lump means her disease has spread.

Which of the following ligaments runs from the uterus to the labia majora?

Options:
explanation: Incorrect - The ovarian ligament runs from the ovary to the uterus. It does not travel to the labia majora.
name: Ovarian Ligament
label: b
answer: no
explanation: Incorrect - the broad ligament is a double layer of peritoneum that hangs from the fallopian tubes on either side of the pelvis. It supports the uterus, uterine tubes, and ovaries, and helps anchor the uterus to the pelvis. It has 3 main parts; the mesometrium, mesosalpinx, and mesovarium. It does not travel to the labia majora.
name: Broad Ligament
label: c
answer: no
explanation: Correct - The round ligament of the uterus travels from the uterus to the labia major and through the inguinal canal (in addition to lymphatics from the uterus, the ilioinguinal nerve, and the genital branch of the genitofemoral nerve).
name: Round ligament of the uterus
label: a
answer: yes
explanation: Incorrect - the cardinal ligament does not travel from the uterus to the labia majora. It is one of the key parametrial ligaments that form the tendinous arch to support the uterus, in addition to the utero-sacral ligament and pubocervical ligament. It is found lateral to the uterus.
name: Cardinal Ligament
label: e
answer: no
explanation: Incorrect - the uterosacral ligament does not travel from the uterus to the labia majora. It is one of the key parametrial ligaments that form the tendinous arch to support the uterus, in addition to the cardinal ligament and pubocervical ligament.
name: Utero-sacral ligament
label: d
answer: no

Correct answer: a
A 2-year-old boy attends his GP surgery for a review. His mum reports that he has recently begun to choose which toys he would like to play with and what clothes he would like to wear. He engages well in games directed by his older brother. He has also become fully toilet trained.

Which of the following stages of Erickson's stages of psychosocial development would this represent?

Options:
explanation: Incorrect - Trust vs mistrust is the first stage of psychosocial development and lasts from birth to around 18 months. During this stage, infants develop the ability to trust those around them and feel safe and secure in the world. This child has progressed past this stage.
name: Trust vs Mistrust
label: c
answer: no
explanation: Correct - Autonomy vs Shame and Doubt usually occurs between the ages of 18 months to approximately 3 years. This child is demonstrating many of the traits associated with this stage such as a desire to choose and being toilet trained.
name: Autonomy vs Shame and Doubt
label: a
answer: yes
explanation: Incorrect - Initiative vs Guilt is the third stage of psychosocial development and usually begins in children around the age of 3 to the age of 5. At this point in development, children begin to assert power and control over their surroundings, usually through directing play and other social interactions.
name: Initiative vs Guilt
label: b
answer: no
explanation: Incorrect - Industry vs Inferiority  is the fourth stage in psychosocial development and typically takes place in the early school year, between the ages of 5 to 11. During this stage children begin to develop a sense of pride in their accomplishments and abilities and begin to cope with new social and academic demands.
name: Industry vs Inferiority
label: d
answer: no
explanation: Incorrect - Identity vs Role confusion is usually experienced by teenagers and is centred around the development of social relationships.
name: Identity vs Role Confusion
label: e
answer: no

Correct answer: a
A 31-year-old pregnant woman attends the antenatal clinic for an ultrasound scan. She is keen to learn more about her baby's development.

Which of the following triggers the degeneration of the mesonephric duct in females?

Options:
explanation: Incorrect - It is the absence of anti-Mullerian hormone and testosterone that triggers the degeneration of the mesonephric duct within the female foetus. The presence of anti-Mullerian hormone, combined with testosterone, supports the persistence of the mesonephric duct in males.
name: Presence of Anti-Mullerian hormones
label: b
answer: no
explanation: Incorrect - It is the absence of anti-Mullerian hormone and testosterone that triggers the degeneration of the mesonephric duct within the female foetus. The presence of high testosterone levels, combined with anti-Mullerian hormone, supports the persistence of the mesonephric duct in males.
name: Presence of Testosterone
label: c
answer: no
explanation: Incorrect - The absence of oestrogen does not influence the persistence or degeneration of the mesonephric duct.
name: Absence of Oestrogen
label: e
answer: no
explanation: Correct. It is the absence of anti-Mullerian hormone and testosterone that triggers the degeneration of the mesonephric duct and supports the persistence of the paramesonephric ducts. This ultimately forms the uterine tubes, uterus, and upper vagina.
name: Absence of anti-Mullerian hormone
label: a
answer: yes
explanation: Incorrect - The presence of oestrogen does not influence the persistence or degeneration of the mesonephric duct.
name: Presence of Oestrogen
label: d
answer: no

Correct answer: a
Identify the region highlighted by the blue triangle

[lightgallery]

Options:
explanation: The triangular space is found medial to the quadrangular space. It is formed by the long head of triceps brachii, teres minor and teres major. The scapular circumflex artery passes through this space.
name: Triangular space
label: c
answer: no
explanation: This is another space that allows the axilla to communicate with the posterior compartment of the arm. It is bordered by the lateral margin of the long head of the triceps brachii, humeral shaft and the inferior margin of the teres major muscle. It is another useful anatomical landmark, and the radial nerve can be visualised as it passes through this space.
name: Triangular interval
label: d
answer: no
explanation: The axilla is a region that lies between the upper limb and the thorax. The medial border is formed by the serratus anterior muscle and the thoracic wall. The lateral border is formed by the intertubercular sulcus of the humerus and the anterior border is formed by the pectoralis major and minor muscles. Posteriorly, the axilla is bounded by latissimus dorsi, teres major and subscapularis muscles.
name: Axilla
label: a
answer: yes
explanation: This region is bounded by the pectoralis major, deltoid and clavicle. It is an opening in the anterior wall of the axilla.
name: Deltopectoral triangle
label: e
answer: no
explanation: The quadrangular space is a space found between the humerus, long head of triceps brachii and teres major. It is a useful anatomical landmark, as the axillary nerve passes through the quadrangular space.
name: Quadrangular space
label: b
answer: no

Correct answer: a