hllj/quesmed huggingface dataset:
A 49 year old woman attends her GP surgery with low mood and frequent hot flushes. Her periods are gradually becoming more infrequent. She is keen to learn more about the menopause and the changes taking place in her body.

Which of the following statements about menopause is true?

Options:
explanation: This is the correct answer. Although the quality and quantity of oocytes in ovarian follicles decrease significantly, uterine tissue is still capable of responding to the hormonal signals it receives. The responsiveness of the uterus to hormones is not solely dependent on the ovaries; it is also influenced by the presence of hormone receptors in uterine tissue and the overall health of the uterine lining. This explains why pregnancy is still possible after menopause with exogenous hormonal stimulation and assisted reproductive technology.
name: Loss of ovarian hormonal function in menopause does not directly affect uterine hormone responsiveness
label: a
answer: yes
explanation: Cardiovascular risk normally increases after menopause, due to reduced oestrogen levels. Oestrogen functions to promote vascular remodelling and elasticity, and regulate reactive dilation and local inflammatory activity. Loss of oestrogen may lead to impaired endothelial function and vascular changes. Therefore, the risk of cardiovascular conditions such as atherosclerosis and ischaemic heart disease increases.
name: Cardiovascular risk decreases after menopause
label: c
answer: no
explanation: Although HRT provides symptom control, research suggests oral HRT brings an increased risk of breast cancer, ovarian cancer and thrombosis. Therefore, some women are not suitable for HRT, particularly breast, endometrium, and ovarian cancer patients. There is no one-size-fits-all management plan for menopause.
name: Hormone replacement therapy (HRT) is recommended for all women during menopause to alleviate symptoms
label: e
answer: no
explanation: Smoking has been associated with an earlier onset of menopause. Women who smoke may experience menopause, on average, about one to two years earlier than non-smokers. Alcohol can disrupt hormonal balance, including changes in oestrogen levels, which can influence the timing of menopause. Both smoking and alcohol can exacerbate menopausal symptoms.
name: Smoking and alcohol consumption have no impact on the timing and severity of menopause symptoms
label: d
answer: no
explanation: The average age of menopause is 51 years old, with typical range from 45 to 55 years old.
name: The average age of menopause is 55 years old, with typical range from 50 to 60 years old
label: b
answer: no

Correct answer: a
A 21 year old female is investigated by her GP for treatment-resistant hypertension. She reports a healthy diet and active lifestyle, and reports drinking lots of water. She notes feeling more tired than usual for the past 6 months, and has frequent headaches, but can work full time as a shop assistant.

She undergoes a range of blood tests, which find an elevated aldosterone/renin ratio as well as a mild hypokalaemia. The clinician explains there is an overproduction of a hormone produced by the zona glomerulosa of the adrenal cortex.

Which of the following it the most likely underlying diagnosis?

Options:
explanation: Pheochromocytoma is a rare adrenal gland tumour that can lead to the overproduction of catecholamines, epinephrine and norepinephrine. Catecholamines originate from the adrenal medulla, not the zona glomerulosa of the adrenal cortex. This option is therefore incorrect.
name: Pheochromocytoma
label: d
answer: no
explanation: Addison's disease is characterised by adrenal insufficiency, resulting in low levels of cortisol and aldosterone. Similarly, hypotension and hyperkalaemia are most commonly seen in Addison's disease, whereas the opposite is true in this case. The high aldosterone/renin ratio further supports a diagnosis of Conn's syndrome.
name: Addison's disease
label: b
answer: no
explanation: This is the correct answer. Conn's syndrome, also known as primary hyperaldosteronism, is a condition characterised by the overproduction of aldosterone, primarily originating from the zona glomerulosa. Aldosterone plays a crucial role in regulating sodium and potassium balance in the body. Excess aldosterone can lead to hypertension and low potassium levels.
name: Conn's syndrome
label: a
answer: yes
explanation: CAH is characterised by enzyme deficiencies in the adrenal glands, leading to excessive production of androgens and, in some cases, mineralocorticoids. Androgens are produced in the zona reticularis of the adrenal cortex, while aldosterone is produced in the zona glomerulosa. This option is therefore incorrect.
name: Congenital Adrenal Hyperplasia (CAH)
label: e
answer: no
explanation: Cushing's syndrome involves the overproduction of cortisol, leading to symptoms such as weight gain, high blood pressure, and easy bruising. It is commonly associated with hypotension and hyperkalaemia, thus making Cushing's syndrome an unlikely diagnosis in this case.
name: Cushing's syndrome
label: c
answer: no

Correct answer: a
A 34 year old man with a benign pituitary adenoma is reviewed in an endocrinology clinic. He is keen to learn more about the hormones of the pituitary gland.

Which of the following hormones is produced in the posterior pituitary gland?

Options:
explanation: Growth hormone is produced by the anterior pituitary gland. There are only two hormones that are produced in the posterior pituitary gland, which are oxytocin and vasopressin (also known as ADH). Growth hormone is produced by the anterior pituitary gland.
name: Growth hormone
label: d
answer: no
explanation: Prolactin is produced by the anterior pituitary gland. There are only two hormones that are produced in the posterior pituitary gland, which are oxytocin and vasopressin (also known as ADH).
name: Prolactin
label: c
answer: no
explanation: Adrenocorticotrophic hormone is produced by the anterior pituitary gland. There are only two hormones that are produced in the posterior pituitary gland, which are oxytocin and vasopressin (also known as ADH).
name: Adrenocorticotrophic hormone
label: b
answer: no
explanation: Thyroid-stimulating hormone is produced by the anterior pituitary gland. There are only two hormones that are produced in the posterior pituitary gland, which are oxytocin and vasopressin (also known as ADH).
name: Thyroid-stimulating hormone (TSH)
label: e
answer: no
explanation: This is the correct answer. There are only two hormones that are produced in the posterior pituitary gland, which are oxytocin and vasopressin (also known as ADH).
name: Oxytocin
label: a
answer: yes

Correct answer: a
A 65 year old woman with recurrent low-impact fractures is assessed in the bone health clinic. She is found to have hypercalcaemia and an elevated plasma parathyroid hormone (PTH) level. The clinician explains that PTH acts upon bones, stimulating the release of calcium and thus weakening them.

Which of the following other organs does PTH act upon directly to influence calcium metabolism?

Options:
explanation: This is the correct answer. In addition to bone, PTH directly influences calcium metabolism in the kidneys by regulating calcium reabsorption and promoting the excretion of phosphate. PTH helps to conserve calcium and increase its concentration in the bloodstream by enhancing its reabsorption in the renal tubules.
name: Kidneys
label: a
answer: yes
explanation: Although PTH indirectly influences calcium absorption in the intestines by stimulating calcitriol production, its primary sites of action for calcium regulation are the bones and kidneys.
name: Intestines
label: e
answer: no
explanation: The parathyroid gland that produces PTH is located behind the thyroid gland. Despite the close location, the thyroid gland is not involved in calcium metabolism. It only helps to regulate the blood calcium levels, by producing and releasing the calcitonin hormone. It opposes the action of the PTH.
name: Thyroid gland
label: c
answer: no
explanation: The vast majority of vitamin D is produced in the skin through exposure to UV light. Activated vitamin D increases calcium absorption. However, PTH does not act on the skin to affect calcium metabolism.
name: Skin
label: d
answer: no
explanation: The liver's primary function related to calcium is the synthesis of vitamin D-binding protein and the conversion of 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D (calcitriol). Calcitriol is increased by PTH and is essential for calcium absorption in the intestines. Although the liver is involved in the production of calcitriol, which indirectly influences calcium absorption, it is not a direct target of PTH in calcium regulation.
name: Liver
label: b
answer: no

Correct answer: a
A 30 year old woman with hypothyroidism attends a routine review with her GP. She is prescribed levothyroxine, which she understands targets thyroid hormone receptors.

Which of the following best describes the biochemical properties of levothyroxine?

Options:
explanation: The thyroid hormones, thyroxine (T4) and triiodothyronine (T3) are lipid-soluble molecules. Therefore, levothyroxine, as a synthetic form of T4, needs to be lipophilic to mimic the properties of the natural hormone. The cell membrane is primarily composed of a lipid bilayer. Lipophilic substances, like levothyroxine, have the advantage of being able to pass through the lipid bilayer of cell membranes efficiently.
name: Hydrophilic, diffuses through cell membrane
label: b
answer: no
explanation: The thyroid hormones, thyroxine (T4) and triiodothyronine (T3), are lipid-soluble molecules. Therefore, levothyroxine, as a synthetic form of T4, needs to be lipophilic to mimic the properties of the natural hormone. The cell membrane is primarily composed of a lipid bilayer. Lipophilic substances, like levothyroxine, have the advantage of being able to pass through the lipid bilayer of cell membranes efficiently. It does not require vesicles to be transported.
name: Lipophilic, transported in vesicles
label: e
answer: no
explanation: The thyroid hormones, thyroxine (T4) and triiodothyronine (T3) are lipid-soluble molecules. Therefore, levothyroxine, as a synthetic form of T4, needs to be lipophilic to mimic the properties of the natural hormone. The cell membrane is primarily composed of a lipid bilayer. Lipophilic substances, like levothyroxine, have the advantage of being able to pass through the lipid bilayer of cell membranes efficiently. It does not require carrier proteins to be transported; these are normally for hydrophilic molecules.
name: Hydrophilic, transport mediated by carrier proteins
label: c
answer: no
explanation: The thyroid hormones, thyroxine (T4) and triiodothyronine (T3) are lipid-soluble molecules. Therefore, levothyroxine, as a synthetic form of T4, needs to be lipophilic to mimic the properties of the natural hormone. The cell membrane is primarily composed of a lipid bilayer. Lipophilic substances, like levothyroxine, have the advantage of being able to pass through the lipid bilayer of cell membranes efficiently. It does not require carrier proteins to be transported, these are normally for hydrophilic molecules.
name: Lipophilic, transport mediated by carrier proteins
label: d
answer: no
explanation: This is the correct answer. The thyroid hormones, thyroxine (T4) and triiodothyronine (T3) are lipid-soluble molecules. Therefore, levothyroxine, as a synthetic form of T4, needs to be lipophilic to mimic the properties of the natural hormone. The cell membrane is primarily composed of a lipid bilayer. Lipophilic substances, like levothyroxine, have the advantage of being able to pass through the lipid bilayer of cell membranes efficiently.
name: Lipophilic, diffuses through cell membrane
label: a
answer: yes

Correct answer: a
A 39 year old patient has been recently diagnosed with hyperthyroidism. Her endocrinologist has prescribed her a medication called carbimazole to help manage her condition. They counsel her regarding its use.

Which of the following is true of carbimazole?

Options:
explanation: This is the correct answer. Agranulocytosis is a condition in which there is a severe reduction of neutrophils. Therefore, any symptoms of infection, such as high fever, sore throat, or mouth ulcers must be reported promptly, as these could be early signs of agranulocytosis. The exact mechanism by which carbimazole induces agranulocytosis is not fully understood, but it is believed to be an idiosyncratic reaction in some individuals.
name: Carbimazole has a rare side effect of agranulocytosis
label: a
answer: yes
explanation: Carbimazole is not administered as a one-time injection. It is usually prescribed in tablet form and taken orally. The treatment involves taking the medication over an extended period, often for several months, to manage hyperthyroidism.
name: Carbimazole is typically administered as a one-time injection for long-term management of hyperthyroidism
label: e
answer: no
explanation: In pregnant women with overt hyperthyroidism, the use of anti-thyroid medications like carbimazole requires very careful consideration, and its continuation or discontinuation depends on the specific clinical circumstances. Carbimazole is known to cross the placenta and can affect the developing foetus. There is an associated risk of foetal congenital anomalies, particularly involving the development of the thyroid gland. In pregnancy, propylthiouracil is often preferred over carbimazole due to its lower risk of causing congenital anomalies.
name: Carbimazole should be continued by pregnant women with overt hyperthyroidism
label: b
answer: no
explanation: Carbimazole inhibits the thyroid peroxidases (TPO) enzyme that catalyses the iodination of tyrosine residues in thyroglobulin. It also decreases the inorganic iodine uptake and concentration by thyroid cells. Eventually, it reduces both T3 and T4 levels.
name: Carbimazole functions to increase T3 and decrease T4
label: d
answer: no
explanation: Carbimazole has no role in the treatment of allergies or hay fever. It is specific to thyroid-related conditions, particularly hyperthyroidism, as its mechanism of action is inhibition of thyroid peroxidases (TPO) that catalyses the iodination of tyrosine residues in thyroglobulin.
name: Carbimazole can also be used to treat seasonal allergies and hay fever
label: c
answer: no

Correct answer: a
A 47 year old man is reviewed in an endocrinology clinic, and diagnosed with a syndrome of inappropriate antidiuretic hormone release (SIADH).

Which of the following is a primary physiological function of ADH in the human body?

Options:
explanation: Body temperature regulation is primarily controlled by the hypothalamus in the brain and involves other mechanisms and hormones, such as sweating, shivering, and the regulation of blood flow to the skin. The primary physiological function of ADH in the human body is to regulate and control the balance of body fluids by conserving water.
name: Control of body temperature
label: e
answer: no
explanation: The primary physiological function of ADH in the human body is to regulate and control the balance of body fluids by conserving water. It increases the permeability of the renal collecting ducts to water. This allows the kidneys to reabsorb more water from the urine, reducing the volume of urine and concentrating it.
name: Conservation of water by increasing water reabsorption in the kidneys
label: a
answer: yes
explanation: The hormone that primarily regulates blood pressure by increasing heart rate is epinephrine, also known as adrenaline. In addition, norepinephrine, released by the adrenal glands, also plays a role in regulating blood pressure and heart rate. Both hormones are part of the sympathetic nervous system's response to stress and are essential for adjusting cardiovascular function during fight-or-flight situations. The primary physiological function of ADH in the human body is to regulate and control the balance of body fluids by conserving water.
name: Regulation of blood pressure by increasing heart rate
label: b
answer: no
explanation: When ADH is released into the bloodstream, it binds to receptors on the smooth muscle cells of blood vessels to bring about vasoconstriction. This leads to the contraction of smooth muscle, resulting in a reduction in the diameter of the blood vessels, which, in turn, increases vascular resistance. Increased vascular resistance leads to a rise in blood pressure. This answer is therefore incorrect.
name: Vasoconstriction to reduce blood pressure
label: d
answer: no
explanation: The stretching of the bladder wall as it fills with urine is an important mechanism that stimulates the urge to urinate. When the bladder reaches a certain level of distension, mechanoreceptors in the bladder wall send signals to the brain, indicating that it's time to empty the bladder. ADH reduces urine production by concentrating urine. As a result, one may feel less urgency to urinate when ADH levels are higher, however, this is not its direct effect.
name: Stimulation of sensation of urge to urinate
label: c
answer: no

Correct answer: a
A 32 year old woman presents to her gynaecologist with a history of severe pelvic pain and dysmenorrhea. She describes the pain as progressively worsening over the past few years and is particularly noticeable during sexual intercourse. The pain is not relieved by over-the-counter pain relievers. Sometimes, she observes vaginal bleeding between her periods.

She has a single sexual partner and denies any abnormal vaginal discharge. She and her partner are currently awaiting an appointment with a fertility specialist, as they have not been able to conceive despite trying for over a year.

On physical examination, there is tenderness upon palpation of the pelvic area. All observations are within normal limits.

Which of the following is the most likely cause of this patient's symptoms?

Options:
explanation: An infection of the female reproductive organs is pelvic inflammatory disease (PID). Although it can present with pelvic pain, it is often associated with symptoms like fever, abnormal vaginal discharge, and a history of sexually transmitted infections. The absence of these characteristic features in the patient's history makes PID less likely in this case.
name: An infection of the female reproductive organs
label: d
answer: no
explanation: Benign uterine growths, called fibroids can cause pelvic pain and other symptoms. However, the key feature in this case is the progressive nature of the pain and its association with dysmenorrhea, which is more indicative of endometriosis rather than fibroids. Fibroids tend to cause more chronic, non-cyclical pain and may lead to heavy menstrual bleeding.
name: Benign uterine growths
label: b
answer: no
explanation: This is the correct answer. The vignette describes endometriosis, which is characterised by endometrial tissue outside the uterus. Endometriosis is known for causing severe pelvic pain, which is often cyclical and can worsen over time. This aligns with the patient's complaint of progressively worsening pain. The symptoms of dysmenorrhea, dyspareunia, subfertility and bleeding between periods fit the clinical picture of endometriosis. Examination findings of tenderness upon palpation of the pelvic area indicate endometriotic lesions causing localised inflammation and sensitivity in this region.
name: Endometrial tissue outside the uterus
label: a
answer: yes
explanation: Idiopathic or primary dysmenorrhea is characterised by crampy pelvic pain at the onset of menses with no identifiable pelvic pathology. However, in this vignette, the clinical picture points to endometriosis, with dysmenorrhoea, dyspareunia, bleeding between periods and subfertility.
name: Idiopathic, no pelvic pathology
label: e
answer: no
explanation: Ovarian cysts are fluid-filled sacs that can form in the ovaries. They can cause discomfort and pain, but the patient's symptoms, including severe pelvic pain and painful intercourse, are more strongly associated with endometriosis. This is characterised by endometrial tissue outside the uterus.
name: Fluid-filled sacs in the ovaries
label: c
answer: no

Correct answer: a
A 31 year old woman consults her GP regarding contraception. She would like to try the combined oral contraceptive pill.

Which of the following medical condition represents an unacceptable health risk for the use of the combined oral contraceptive pills, according to the UK Medical Eligibility Criteria?

Options:
explanation: This is a situation where the advantages generally outweigh the risks of prescribing a combined oral contraceptive pill. Since combined oral contraceptive pills increase cardiovascular risks, it is safe to be prescribed to diabetic patients without vascular disease, for safe contraception and even reduced risk of ovarian and endometrial cancers.
name: Type 2 diabetes mellitus, no vascular disease
label: d
answer: no
explanation: This is a situation whereby the risks may outweigh the advantages of prescribing a combined oral contraceptive pill. However, it is not considered an 'unacceptable' health risk. Combined oral contraceptive pills can also increase the risk of cardiovascular events, such as venous thromboembolism and stroke. Consistent hypertension (systolic ≥160 mmHg or diastolic ≥100 mmHg) is an unacceptable health risk to using combined oral contraceptive pills, but if blood pressure is controlled their use is permissible.
name: Hypertension controlled with antihypertensive medication
label: b
answer: no
explanation: This is a situation where the advantages generally outweigh the risks of prescribing a combined oral contraceptive pill. Irregular bleeding is common in the first few months of oral contraceptive use, but a change in preparation or method should be considered if it persists and is troublesome for the patient.
name: Unexplained vaginal bleeding
label: e
answer: no
explanation: This is the correct answer. If an individual with a history of VTE were to use combined oral contraceptive pills, there is a greater likelihood of experiencing recurrent VTE events, which can be life-threatening. Oestrogen-containing contraceptives induce a procoagulant state, increasing the likelihood of blood clot formation.
name: Previous venous thromboembolism (VTE)
label: a
answer: yes
explanation: This is a situation whereby proven risks usually outweigh the advantages of prescribing a combined oral contraceptive pill. However, it is not considered an 'unacceptable' health risk. Current breast cancer is an unacceptable health risk to using combined oral contraceptive pills, as the oestrogen they contain can promote cell growth in breast tissue.
name: Past breast cancer
label: c
answer: no

Correct answer: a