hllj/quesmed huggingface dataset:
Which of the following structures is **NOT** retroperitoneal?

Options:
explanation: Incorrect, the inferior vena cava is a retroperitoneal structure

Use the mnemonic SAD PUCKER to help you remember the retroperitoneal organs:

S: suprarenal gland

A: aorta/IVC

D: duodenum (second and third part)

P: pancreas (except tail)

U: ureters

C: colon (ascending and descending)

K: kidneys

E: (o)esophagus

R: rectum
name: Inferior vena cava
label: c
answer: no
explanation: Correct. The liver is an intraperitoneal organ.

Use the mnemonic SAD PUCKER to help you remember the retroperitoneal organs:

S: suprarenal gland

A: aorta/IVC

D: duodenum (second and third part)

P: pancreas (except tail)

U: ureters

C: colon (ascending and descending)

K: kidneys

E: (o)esophagus

R: rectum
name: Liver
label: a
answer: yes
explanation: Incorrect, the pancreas is a retroperitoneal organ

Use the mnemonic SAD PUCKER to help you remember the retroperitoneal organs:

S: suprarenal gland

A: aorta/IVC

D: duodenum (second and third part)

P: pancreas (except tail)

U: ureters

C: colon (ascending and descending)

K: kidneys

E: (o)esophagus

R: rectum
name: Pancreas
label: b
answer: no
explanation: Incorrect, the uterers are retroperitoneal structures

Use the mnemonic SAD PUCKER to help you remember the retroperitoneal organs:

S: suprarenal gland

A: aorta/IVC

D: duodenum (second and third part)

P: pancreas (except tail)

U: ureters

C: colon (ascending and descending)

K: kidneys

E: (o)esophagus

R: rectum
name: Ureters
label: e
answer: no
explanation: Incorrect, the kidneys are retroperitoneal structures

Use the mnemonic SAD PUCKER to help you remember the retroperitoneal organs:

S: suprarenal gland

A: aorta/IVC

D: duodenum (second and third part)

P: pancreas (except tail)

U: ureters

C: colon (ascending and descending)

K: kidneys

E: (o)esophagus

R: rectum
name: Kidneys
label: d
answer: no

Correct answer: a
Which specific vessel supplies the inner third of the cortex and medulla of the kidney?

Options:
explanation: Correct. They branch from efferent arterioles and are long, straight arteries.
name: Vasa recta
label: a
answer: yes
explanation: Incorrect. This is a division of interlobar arteries and interlobular arteries branch off them.
name: Arcuate artery
label: d
answer: no
explanation: Incorrect. These form the glomerulus where filtration of blood occurs.
name: Afferent arterioles
label: c
answer: no
explanation: Incorrect. Whilst it the renal artery does branch from the abdominal aorta, this answer is not specific enough for the question.
name: Abdominal aorta
label: e
answer: no
explanation: Incorrect. They branch from the efferent arterioles and supply the outer two-thirds of the cortex.
name: Peritubular capillaries
label: b
answer: no

Correct answer: a
Where does lymph from the kidneys drain into?

Options:
explanation: Incorrect. Lymph drains into these nodes from the body of the pancreas.
name: Superior mesenteric lymph nodes
label: c
answer: no
explanation: Correct. Lymph drains directly into these nodes, which are found around the abdominal aorta and inferior vena cava.
name: Para-aortic lymph nodes
label: a
answer: yes
explanation: Incorrect. Lymph drains into these nodes from the oesophagus, mediastinum and posterior surface of diaphragm.
name: Posterior mediastinal lymph nodes
label: d
answer: no
explanation: Incorrect. Lymph drains into these nodes from the descending and sigmoid colon.
name: Inferior mesenteric lymph nodes
label: e
answer: no
explanation: Incorrect. Lymph drains into these nodes from the oesophagus, stomach and pancreas, along with other abdominal organs.
name: Splenic lymph nodes
label: b
answer: no

Correct answer: a
What is the gold standard test for measuring glomerular filtration rate?

Options:
explanation: Incorrect. The Modification of Diet in Renal Disease Study Group (MDRD) equation is widely used but certain factors such as pregnancy can make it inaccurate so it is not the gold standard.
name: MDRD equation
label: c
answer: no
explanation: Incorrect. This is widely used but is not the gold standard test.
name: Cockcroft-Gualt equation
label: b
answer: no
explanation: Correct. Inulin is 100% secreted by the glomeruli which makes it the most accurate test.
name: Inulin clearance
label: a
answer: yes
explanation: Incorrect. This cannot measure GFR but can give a rough idea of kidney function.
name: Dipstick Urine test
label: e
answer: no
explanation: Incorrect. This is used to predict the probability of hydronephrosis in patients with acute kidney injury.
name: Licurse Score
label: d
answer: no

Correct answer: a
A 34 year old female patient presents with polyuria and polydipsia after a traumatic head injury.

It is suspected that they have cranial diabetes insipidus.

Which hormone is involved in this condition?

Options:
explanation: Correct. A lack of ADH production leads to cranial diabetes insipidus.
name: Anti-diuretic hormone
label: a
answer: yes
explanation: Incorrect. Prolactin causes breast growth and lactation
name: Prolactin
label: b
answer: no
explanation: Incorrect. Excessive growth hormone can lead to acromegaly but is not related to diabetes insipidus.
name: Growth hormone
label: c
answer: no
explanation: Incorrect. Insulin is involved in diabetes mellitus but not diabetes insipidus.
name: Insulin
label: d
answer: no
explanation: Incorrect. Adrenocorticotrophic hormone is involved in the production and release of cortisol.
name: Adrenocorticotrophic hormone
label: e
answer: no

Correct answer: a
A 65 year old female patient presents with new diagnosis of lung cancer and is incidently found to have an anaemia.

What is the most likely pathophysiology of this type of anaemia?

Options:
explanation: Incorrect. This scenario suggests an anaemia of chronic disease. Iron transporters (ferroportin) are involved in anaemia of chronic disease but they are not affected in this way.
name: Cancer cells stimulate necrosis of iron transporters in intestinal cells
label: b
answer: no
explanation: Correct. This scenario suggests an anaemia of chronic disease. Chronic disease precipitates the formation of inflammatory cytokines such as IL-6. Ferroportin is involved in transporting absorbed iron into the bloodstream, so when activity of this is decreased less haemoglobin can be made.
name: High levels of IL-6 stimulate hepcidin release from the liver which decreases the activity of ferroportin
label: a
answer: yes
explanation: Incorrect. This describes sideroblastic anaemia, whereas the scenario suggests anaemia of chronic disease.
name: Ineffective erythropoiesis leads to increased iron absorption
label: e
answer: no
explanation: Incorrect. This describes pernicious anaemia, whereas the scenario suggests anaemia of chronic disease. Intrinsic factor is involved in the absorption of Vitamin B12.
name: Autoimmune destruction of the parietal cells in the stomach, leading to decreased production of intrinsic factor
label: d
answer: no
explanation: Incorrect. This describes aplastic anaemia, whereas the scenario suggests anaemia of chronic disease.
name: Pancytopenia with hypocellular bone marrow
label: c
answer: no

Correct answer: a
A 70 year old female presents to the GP and states they are feeling tired all the time. They have a past medical history of gastritis and diabetes.

Blood tests show a low Hb, high MCV and MCH, normal MCHC.

What type of anaemia is this patient presenting with?

Options:
explanation: Incorrect. This would usually be diagnosed at a younger age, and bloods would show a microcytic anaemia with haemolysis.
name: Sickle Cell anaemia
label: e
answer: no
explanation: Incorrect. This would usually be diagnosed at a younger age, and bloods would show a isolated microcytosis
name: Beta thalassemia
label: c
answer: no
explanation: Correct. Pernicious anaemia is associated with high MCH and MCV. Gastritis is also linked to this condition.
name: Pernicious anaemia
label: a
answer: yes
explanation: Incorrect. This would usually be diagnosed at a younger age, and bloods would show a microcytic anaemia.
name: Alpha Thalassemia
label: b
answer: no
explanation: Incorrect. Bloods in this condition would show a microcytic anaemia along with a high serum ferritin
name: Sideroblastic anaemia
label: d
answer: no

Correct answer: a
8 year old female with pre-existing sickle cell anaemia presents with intense pain and is found to be in a vaso-occlusive crisis.

What is the pathophysiology of vaso-occlusive crisis?

Options:
explanation: Correct. This is the pathophysiology of sickle cell crisis and can lead to ischaemia of vital organs.
name: Abnormal red blood cells stick together and cause clotting in the microvasculature across the body
label: a
answer: yes
explanation: Incorrect. This describes the pathophysiology of disseminated intravascular coagulation.
name: Inappropriate activation of clotting cascade, leading to thrombus formation and depletion of clotting factors
label: e
answer: no
explanation: Incorrect. This is not the pathophysiology of vaso-occlusive crisis
name: Blood flows too slowly through the vessels, causing irritation to the vessels
label: b
answer: no
explanation: Incorrect. This describes why the red blood cells have a sickle shape, but it is not the direct cause of the crisis.
name: Crystals form in blood cells, enabling polymers to form
label: c
answer: no
explanation: Incorrect. This describes paroxysmal nocturnal haemoglobinuria.
name: Haemolysis occurs due to an abnormal glycoprotein on the surface of red blood cells
label: d
answer: no

Correct answer: a
Baby is born and found to have severe anaemia so is taken to the neonatal, requiring an urgent blood transfusion.

The mother has a blood group of A and the father has a blood group of B

Which of the following statements is true?

Options:
explanation: Incorrect. In adults this would be the blood group of choice, but it is unnessary to cross match newborn babies.
name: Only blood group O can be given
label: b
answer: no
explanation: Incorrect. It is a possibility as the baby can be given any blood type however they can have more than only B
name: Only blood group B can be given
label: e
answer: no
explanation: Incorrect. It is a possibility as the baby can be given any blood type however they can have more than only AB.
name: Only blood group AB can be given
label: c
answer: no
explanation: Correct. ABO antigens are not expressed until 16 weeks after birth so there is no need to cross match a newborn baby.
name: Any blood group which is available can be given
label: a
answer: yes
explanation: Incorrect. It is a possibility as the baby can be given any blood type however they can have more than only A.
name: Only blood group A can be given
label: d
answer: no

Correct answer: a
A 43 year old male has been recently diagnosed with type 2 diabetes mellitus.

Diet and lifestyle modifications have been attempted but these don't control his symptoms so is given metformin.

What is the mechanism of metformin?

Options:
explanation: Incorrect. This is the mechanism of intestinal alpha-glucosidase inhibitors such as acarbose
name: Delay intestinal carbohydrate absorption
label: e
answer: no
explanation: Correct. This is the mechanism of biguanides, of which metformin is an example of.
name: Increase peripheral insulin sensitivity and hepatic glucose uptake
label: a
answer: yes
explanation: Incorrect. This is the mechanism of GLP1 analogues such as evenatide
name: Increase insulin secretion and sensitivity
label: d
answer: no
explanation: Incorrect. This is the mechanism of sulfonureas such as gliclazide
name: Depolarise islet cells in the pancreas increasing insulin release
label: b
answer: no
explanation: Incorrect. This is the mechanism of SGLT2 inhibitors such as dapgliflozin
name: Increase urinary glucose loss
label: c
answer: no

Correct answer: a
83 year old female presents with a productive cough with haemoptysis. On examination finger clubbing is found and coarse inspiratory crepitations can be heard on auscultation.

Sputum culture is performed and confirms presence of haemophilus influenzae and a chest X-ray shows thickened bronchial walls

What is the most likely diagnosis?

Options:
explanation: Correct. This scenario suggests bronchiectasis, haemophilus influenzae is a common causative organism and other symptoms shown are indicative of this condition.
name: Bronchiectasis
label: a
answer: yes
explanation: Incorrect. This could be a differential in this patient, however haemoptysis would be unlikely and the X-ray findings would instead be bullae and hyperinflation.
name: Emphysema
label: c
answer: no
explanation: Incorrect. The haemoptysis makes this differental more likely however the clubbing and X-ray findings decrease the chances.
name: Pneumonia
label: d
answer: no
explanation: Incorrect. This could be a differential in this patient, however haemoptysis would be unlikely and the X-ray findings would instead be bullae and hyperinflation.
name: Chronic bronchitis
label: b
answer: no
explanation: Incorrect. The cough would be more likely to not be productive, and the X-ray would show bilateral lymphadenopathy and pulmonary fibrosis.
name: Sarcoidosis
label: e
answer: no

Correct answer: a
What is the pathophysiology of chronic bronchitis?

Options:
explanation: Incorrect. This is the pathophysiology of cystic fibrosis.
name: Mutation of the CFTR gene leading to thick mucus
label: d
answer: no
explanation: Incorrect. This is the pathophysiology of emphysema
name: Loss of alpha1-antitrypsin
label: b
answer: no
explanation: Incorrect. This is the pathophysiology of transudative pleural effusion.
name: Heart failure increasing the capillary hydrostatic pressure
label: c
answer: no
explanation: Incorrect. This is the pathophysiology of asbestosis
name: Inhalation of particles leading to pleural plaque formation
label: e
answer: no
explanation: Correct. Noxious particles can come from cigarette smoking and air pollutants
name: Noxious particles cause hypersecretion of mucus, and cigarette smoke interferes with cilia in removing these particles
label: a
answer: yes

Correct answer: a
A 57 year old male presents with shortness of breath and a productive cough.

Spirometry shows an FEV1 of 50% and so are diagnosed with COPD.

They have never smoked and are found to have an alpha1-antitrypsin deficency.

What is the role of α1-antitrypsin?

Options:
explanation: Incorrect. This is not the role of neutrophil elastase.
name: Clear bacterial debris found in the lung parenchyma
label: e
answer: no
explanation: Incorrect. This is not the role of neutrophil elastase.
name: Reduce the inflammation caused by cytokines in the epithelial tissue
label: d
answer: no
explanation: Incorrect. This is the role of CFTR gene.
name: Increase sodium absorption and chloride secretion in airway epithelial cells
label: c
answer: no
explanation: Correct. In COPD there is no inhibition which means it is overactive, leading to loss of elastic recoil.
name: Inhibiting excessive activity of neutrophil elastase
label: a
answer: yes
explanation: Incorrect. This is the role of the cilia.
name: Remove noxious particles from the airways
label: b
answer: no

Correct answer: a
Which part of a typical rib articulates with the transverse process of the corresponding vertebrae?

Options:
explanation: Correct. The tubercle is a smooth facet articulation of the rib with the corresponding vertebrae
name: Tubercle
label: a
answer: yes
explanation: Incorrect. This marks attachment of erector spinae.
name: Angle of the body
label: d
answer: no
explanation: Incorrect. This structure contains the neurovascular bundle.
name: Subcostal groove
label: b
answer: no
explanation: Incorrect. This is part of rib 1 and is where the subclavian artery is found
name: Subclavian groove
label: e
answer: no
explanation: Incorrect. This structure articulates with the vertebrae above.
name: Articular facet
label: c
answer: no

Correct answer: a
Which of the following is **NOT** a surface of the lung?

Options:
explanation: Incorrect, this surface relates to costal pleura of internal thoracic wall.
name: Costal
label: c
answer: no
explanation: Incorrect, this surface relates to the superior surface of the diaphragm
name: Diaphragmatic
label: d
answer: no
explanation: Correct. This is not a surface of the lung, the mediastinal surface is the surface relating to the pericardium.
name: Pericardial
label: a
answer: yes
explanation: Incorrect, this surface relates to lateral aspect of pericardium
name: Mediastinal
label: e
answer: no
explanation: Incorrect. This surface projects into the root of the neck.
name: Apical
label: b
answer: no

Correct answer: a
A 24 year old male patient presents with a stab wound to the chest. On examination they have tracheal deviation and oxygen saturations of 94%.

What is the **first** step in management of this patient?

Options:
explanation: Correct. This is the immediate management needed as it is suspected that this patient has a tension pneumothorax. ATLS guidelines now recommend accessing the 5th intercostal space mid-axillary line in **traumatic** tension pneumothorax following studies that have shown improved success in reaching the thoracic cavity when the 4th or 5th intercostal space in the mid-axillary line is used instead of the 2nd intercostal space in the mid-clavicular line in adult patients. 
name: Needle decompression at the fifth intercostal space, mid-axillary line
label: a
answer: yes
explanation: Incorrect. This would likely be management at a later stage, however as this patient has a tension pneumothorax it needs urgent decompression.
name: Chest drain
label: b
answer: no
explanation: Incorrect. This patient has a tension pneumothorax and needs immediate management. A patient with asymptomatic pneumothorac may be admitted for observations without any immediate management.
name: Admit for observations
label: c
answer: no
explanation: Incorrect. This patient has a suspected tension pneumothorax, meaning a chest X-ray is unnecessary.
name: Chest X-Ray
label: e
answer: no
explanation: Incorrect. This is the correct management plan but in the incorrect location.
name: Needle decompression at the second intercostal space, mid-axillary line
label: d
answer: no

Correct answer: a
A 31 year old female patient who is already admitted on the ward begins to complain of swollen lips and a widespread rash after taking a dose of antibiotics.

What is the first line management plan for this patient?

Options:
explanation: Incorrect. This is the incorrect dose but correct route to give.
name: 500 milligrams adrenaline IM
label: d
answer: no
explanation: Incorrect. It is likely that this patient is experiencing an anaphylactic reaction so needs immediate management.
name: Watch and wait to see if the reaction worsens
label: b
answer: no
explanation: Incorrect. This is the correct dose but incorrect route to give.
name: 500 micrograms adrenaline IV
label: c
answer: no
explanation: Correct. It is likely that this patient is experiencing an anaphylactic reaction so needs immediate management, and this is the correct dose and route to give.
name: 500 micrograms adrenaline IM
label: a
answer: yes
explanation: Incorrect. This is the incorrect dose but correct route to give. This dose would be given in children in age 6 to 12.
name: 300 micrograms adrenaline IM
label: e
answer: no

Correct answer: a
35 year old female patient presents with joint pain and swelling which has been ongoing for 6 months. They are diagnosed with rheumatoid arthritis.

What type of hypersensitivity reaction is associated with rheumatoid arthritis?

Options:
explanation: Incorrect. This type of hypersensitivity is a delayed type of hypersensitivity and is seen in graft versus host disease.
name: Type IV hypersensitivity
label: d
answer: no
explanation: Correct. In this type of hypersensitivity is mediated by the formation of immune complexes.
name: Type III hypersensitivity
label: a
answer: yes
explanation: Incorrect. This type of hypersensitivty is mediated by antibodies, examples include blood transfusion reactions.
name: Type II hypersensitivity
label: c
answer: no
explanation: Incorrect. This is not a type of hypersensitivity reaction
name: Type VI hypersensitivity
label: e
answer: no
explanation: Incorrect. This type of hypersensitivity is immediate and seen in conditions such as anaphylaxis.
name: Type I hypersensitivity
label: b
answer: no

Correct answer: a
A 34 year old female patient is considering starting long term oral corticosteroid therapy for multiple sclerosis.

Which of the following side effects is most important to warn the patient about?

Options:
explanation: This is a known side effect of corticosteroid use but it is not as significant as other side effects.
name: Acne
label: b
answer: no
explanation: This is a known side effect of corticosteroid use but it is not as significant as other side effects.
name: Dyspepsia
label: c
answer: no
explanation: This is not a known side effect of corticosteroid use
name: Stroke
label: e
answer: no
explanation: This is a side effect seen in long term corticosteroid use as the adrenal gland stops producing enough cortisol, and is significant as it can lead to complications.
name: Adrenal suppression
label: a
answer: yes
explanation: This is not a known side effect of corticosteroid use
name: Cardiac failure
label: d
answer: no

Correct answer: a
What is the first step in the alternative pathway?

Options:
explanation: Incorrect. This is one of the ways in which the complement pathway destroys pathogens.
name: Formation of the membrane attack complex
label: d
answer: no
explanation: Incorrect. This is the first step in the classical complement pathway.
name: An antibody binds to an antigen
label: b
answer: no
explanation: Incorrect. This is the first step in the lectin complement pathway.
name: Mannose-binding lectin binds to sugar residues on the surface of pathogens
label: c
answer: no
explanation: Correct. This is the first step in the alternative complement pathway.
name: C3 undergoes hydrolysis in the presence of a pathogen
label: a
answer: yes
explanation: Incorrect. This is one of the ways in which the complement pathway destroys pathogens.
name: Opsonisation of invading pathogens
label: e
answer: no

Correct answer: a
A 58 year old patient presents to A&E feeling generally unwell. They are found to have a temperature of 39ºC, heart rate of 120bpm and respiratory rate of 18 breaths per minute. They have recently been suffering with a productive cough

What is the most likely diagnosis in this case?

Options:
explanation: Incorrect. This is when the patient has a temperature for over 3 weeks without a diagnosis, despite investigations being performed
name: Pyrexia of unknown origin
label: e
answer: no
explanation: Incorrect. This would be diagnosed if there was sepsis with hypotension despite adequate fluid resuscitation.
name: Septic shock
label: d
answer: no
explanation: Correct. This patient has evidence of systemic inflammatory response syndrome, but the productive cough also suggests an infection.
name: Sepsis
label: a
answer: yes
explanation: Incorrect. This patient has evidence of systemic inflammatory response syndrome, but the productive cough also suggests an infection which means sepsis would be the diagnosis.
name: Systemic inflammatory response syndrome
label: b
answer: no
explanation: Incorrect. Severe sepsis would be diagnosed if they had evidence of organ dysfunction
name: Severe sepsis
label: c
answer: no

Correct answer: a