hllj/quesmed huggingface dataset:
Which other hormone is produced in the same area of the pituitary gland which produces the hormone which stimulates uterine contractions to deliver a baby and milk ejection from a pregnant woman's breasts?

Options:
explanation: The hormone that stimulates uterine contractions and milk ejection is oxytocin. Oxytocin is produced in the posterior pituitary, alongside arginine vasopressin (AVP), a hormone responsible for regulating the body's water content. (It is also known as anti-diuretic hormone (ADH)).
name: Arginine Vasopressin (AVP)
label: a
answer: yes
explanation: Thyroxine is produced in the anterior pituitary gland, not the posterior pituitary gland where AVP and oxytocin (hormone causing uterine contractions and milk ejection) are produced.
name: Thyroxine
label: c
answer: no
explanation: Similar to thyroxine, growth hormone is also produced in the anterior pituitary gland, not the posterior pituitary gland where AVP and oxytocin (hormone causing uterine contractions and milk ejection) are produced.
name: Growth Hormone
label: d
answer: no
explanation: Prolactin is also produced in the anterior pituitary gland, not the posterior pituitary gland where AVP and oxytocin (hormone causing uterine contractions and milk ejection) are produced.
name: Prolactin
label: e
answer: no
explanation: Dopamine is produced in an area known as the substantia nigra in the brain, not the posterior pituitary gland, where AVP and oxytocin are produced.

Oxytocin is the hormone responsible for milk ejection and uterine contractions.

The relation that dopamine has to the pituitary gland is that it inhibits the production of prolactin, from the anterior pituitary gland.
name: Dopamine
label: b
answer: no

Correct answer: a
A 79-year-old man presents to the Emergency Department with peripheral vision loss in both eyes.

You suspect he may have a tumour - which of the following tumours are you most concerned about?

Options:
explanation: This is a cancer found in the large bowel - this would not cause this specific visual disturbance on its own. It could cause a bitemporal hemianopia if it metastasises to the pituitary gland - however, this is extremely rare and it would not be the tumour you are **most** concerned about in this case.
name: Colorectal adenocarcinoma
label: b
answer: no
explanation: The specific type of visual loss described in this question is bitemporal hemianopia.

This is a classic presenting symptom of a pituitary tumour - the tumour can get so large that it compresses the optic chiasm, causing peripheral vision loss in both eyes.
name: Pituitary adenoma
label: a
answer: yes
explanation: A vestibular schwannoma is a tumour found in the vestibulocochlear nerve. This is the 8th Cranial Nerve and is responsible for conducting hearing information to the brain and helping the body maintain balance.

A tumour in this nerve would result in symptoms such as hearing loss and/or a loss of balance. It would not result in a bitemporal hemianopia (loss of peripheral vision on both sides).
name: Vestibular schwannoma
label: c
answer: no
explanation: An oligodendroglioma is a tumour in oligodendrocytes, the myelinating cells of the central nervous system. These tumours are usually found in the brain but can spread to the spinal cord as well.

This type of tumour can grow very large and is therefore likely to cause headaches, seizures, nausea/vomiting, and a loss of sensation in the limbs.

It can also cause speech, vision or memory problems. However, the visual loss associated with this type of brain tumour is likely to be gradual, with blurriness and double vision, or an increasing blind spot.

It is much less likely to cause a bitemporal hemianopia - the loss of peripheral vision on both sides - this is much **more likely** to be due to a pituitary adenoma compressing the optic chiasm.
name: Oligodendroglioma
label: d
answer: no
explanation: An ocular melanoma is a tumour found in the eye - this is likely to cause visual loss in one eye only.

Visual loss of both sides is more indicative of an issue in the brain - in this case, a  pituitary tumour is the **most likely** cause of the tumour.
name: Ocular melanoma
label: e
answer: no

Correct answer: a
A 38 year old female presents to General Practice with a 5 month history of fatigue, weight gain and hair loss. She also complains that she often feels cold on a hot summer day.

After taking some blood from this patient, which blood marker is most likely to be raised in this patient?

Options:
explanation: Ferritin is a marker of iron stored in the body. Fatigue is a classical symptom of iron deficiency anaemia - which is due to a decrease in iron levels.

This patient is most likely suffering from a thyroid induced issue, however, even if ferritin is measured, you would expect it to be **below** the normal ranges, not above.
name: Ferritin
label: d
answer: no
explanation: T3 is similar to thyroxine (T4) - it is the precursor to T4. This patient is most likely presenting with hypothyroidism - a decrease in the thyroxine (T4) levels in the body, Since T3 is the precursor to T4, this means that we would also expect to find a **decreased** level of T3 in the body.
name: Triiodothyronine (T3)
label: c
answer: no
explanation: This patient is presenting with classical symptoms of hypothyroidism. This is a decrease in the levels of thyroxine in her body.

If this is due to the woman's thyroid not producing enough T4, there would be an **increase** in thyroid stimulating hormone (TSH) since this patient's pituitary gland will be trying to compensate for the decrease in T4 levels. This patient's thyroid gland however is not reacting to the increased TSH levels.
name: Thyroid-stimulating hormone (TSH)
label: a
answer: yes
explanation: Transferrin is a protein produced by the liver that binds to iron. The more iron bound to transferrin, the less transferrin there is available in the body.

Transferrin is a good indicator for iron deficiency anaemia, where you would expect to find an increased level of it.

However, this patient is more likely to suffer from hypothyroidism than iron-deficiency anaemia (IDA). Despite her fatigue, which is a symptom in both hypothyroidism and IDA, her hair loss, weight gain, low mood and cold intolerance are much more indicative of hypothyroidism. TSH levels are more likely to be raised than transferrin in this patient.
name: Transferrin
label: e
answer: no
explanation: This woman is presenting with classical symptoms of hypothyroidism. Hypothyroidism indicates a decrease in the levels of thyroxine in the body (hypo- means below in Latin).

You would therefore expect to find a **decreased** level of thyroxine in this patient.
name: Thyroxine (T4)
label: b
answer: no

Correct answer: a
A 68-year-old man is diagnosed with Cushing's syndrome.

Which of the following symptoms are you most likely to find in this patient?

Options:
explanation: These are symptoms of hyperthyroidism - an overproduction of thyroxine.

Thyroxine regulates metabolism, and an increased level of thyroxine increases the body's metabolism, producing symptoms such as increased appetite but weight loss, sweating, agitation and always feeling hot (heat-intolerance).
name: Increased appetite, heat intolerance, agitation
label: c
answer: no
explanation: These are symptoms of a pituitary adenoma. A tumour in the pituitary gland can compress the optic chiasm, causing blindness in the peripheries of both eyes (bitemporal hemianopia). If the pituitary adenoma produces excess prolactin, known as a prolactinoma, it can also cause erectile dysfunction and gynaecomastia (discharge from the nipple in men).
name: Bitemporal hemianopia, erectile dysfunction, gynaecomastia
label: d
answer: no
explanation: This presentation is symptomatic of a condition known as acromegaly, or gigantism if it occurs in children. This is also usually due to a pituitary tumour, but this time one that causes excess secretion of Growth Hormone (GH), which leads to increased tongue and hand size.
name: Sweating, increased tongue size, increased hand size
label: e
answer: no
explanation: These are symptoms that are characteristic of hypothyroidism - a decrease in thyroxine levels in the body.

Thyroxine is responsible for regulating the body's metabolism, and a decrease in thyroxine slows metabolism down, explaining why a person may always feel cold (cold-intolerance), be low in mood and feel tired.
name: Cold intolerance, fatigue, low mood
label: b
answer: no
explanation: Cushing's syndrome is caused by an excess production of the hormone cortisol. Cortisol is produced in the early mornings to wake us up. It is also produced in times when we are stressed, to increase the levels of glucose in the bloodstream available for cells to use.

An excess of cortisol will produce the symptoms listed above, and therefore these are the symptoms you would expect to find in Cushing's syndrome.
name: Red striae, central obesity, red and puffy face
label: a
answer: yes

Correct answer: a
What is the role of the hormone fibroblast growth factor 23 (FGF23) in the human body?

Options:
explanation: FGF23 **decreases** the serum levels of Vitamin D3. FGF23's main job is to decrease serum phosphate. Vitamin D3 on the other hand increases serum phosphate by stimulating uptake in the small intestines, and reabsorption in the kidneys.

FGF23 blocks the production of Vitamin D3 to prevent its effect on phosphate reabsorption - therefore, it **decreases** serum Vitamin D3.
name: Increases serum Vitamin D3 levels
label: c
answer: no
explanation: The main job of FGF23 in the body is to promote the excretion of phosphate through the urine by inhibiting the sodium-phosphate co-transporter found in the proximal convoluted tubule.

It also inhibits the production of calcitriol (Vitamin D3), which has a potent effect of causing phosphate reabsorption in the kidneys and bowels - which FGF23 is trying to stop.
name: Reduces serum phosphate
label: a
answer: yes
explanation: FGF23 is responsible for regulating serum phosphate levels in the body (lowering serum phosphate levels) - it does not affect serum potassium levels.
name: Decreases serum potassium levels
label: e
answer: no
explanation: FGF23 does the exact opposite - its main role is to **decrease** the serum phosphate in the body.

It does so by increasing the excretion of phosphate through the urine and decreasing the levels absorbed from the kidneys and bowels (which it does by inhibiting the production of Vitamin D3).
name: Increase serum phosphate
label: b
answer: no
explanation: FGF23 blocks the production of Vitamin D3 to prevent its effect on phosphate reabsorption.

Vitamin D3 is responsible for increasing the levels of calcium absorption in the body. Therefore, a decrease in the levels of Vitamin D3 would cause a **decrease** in serum calcium levels.
name: Increases serum calcium levels
label: d
answer: no

Correct answer: a
A 32-year-old woman presents to General Practice with exophthalmos, pretibial myxoedema and a tremor.

Which of the following is the most likely diagnosis?

Options:
explanation: Cushing's Disease occurs when symptoms of Cushing's Syndrome are caused by a pituitary tumour.

Symptoms of Cushing's Syndrome include low mood, central obesity (fat around the abdomen but not around the limbs), a red and puffy face, and red striae (stretch marks).

These symptoms are not what we are seeing in our patient - Cushing's disease is the incorrect diagnosis.
name: Cushing's Disease
label: b
answer: no
explanation: Hashimoto's thyroiditis is also an autoimmune condition that affects the thyroid.

However, it causes hypothyroidism, not hyperthyroidism. This would result in symptoms such as fatigue, weight gain despite decreased appetite, low mood and cold intolerance.
name: Hashimoto's Thyroiditis
label: d
answer: no
explanation: This patient's symptoms are consistent with a diagnosis of Graves' Disease.

Graves' Disease is an autoimmune condition where the body produces high levels of antibodies binding to the TSH receptors, activating them. The body responds by increasing its production of Thyroxine, leading to symptoms of hyperthyroidism such as heat-intolerance, diarrhoea, tremors and agitation.

TSH receptors are also found at the back of the eye, on the shins. Graves' disease causes an accumulation of hormone behind these structures too - leading to exophthalmos and pretibial myxoedema.
name: Graves' Disease
label: a
answer: yes
explanation: Addison's Disease occurs when there is a decreased level of cortisol in the body.

This is the opposite of Cushing's syndrome - this can cause symptoms such as tanned skin, weight loss, decreased appetite and fatigue.
name: Addison's Disease
label: c
answer: no
explanation: Conn's Syndrome occurs when a tumour produces increased levels of aldosterone in the body. This increases serum sodium, leading to hypertension (high blood pressure) and hypokalaemia (low potassium levels).
name: Conn's Syndrome
label: e
answer: no

Correct answer: a
A 45-year-old man presents to General Practice with a coarsening of facial features, and sleep apnoea and reports his wedding ring no longer fits.

Which of the following conditions is the most likely diagnosis?

Options:
explanation: Gigantism produces similar symptoms to acromegaly - however, it is defined as a condition that affects children.

When these symptoms affect an adult (our patient is 45), it is known as acromegaly.
name: Gigantism
label: b
answer: no
explanation: Eczema is an autoimmune dermatological condition that results in dry, scaly skin that is pruritus (itchy).

It would not result in sleep apnoea, coarsening of facial features or soft tissue hypertrophy.
name: Eczema
label: c
answer: no
explanation: Cushing's Syndrome is caused by an increased level of serum cortisol. You would expect to see a patient complaining of symptoms such as weight gain, stretch marks, and a red and puffy face.

These symptoms are not observed in this patient.
name: Cushing's Syndrome
label: e
answer: no
explanation: This patient is presenting with symptoms of acromegaly - most likely due to a pituitary adenoma secreting excess Growth Hormone (GH).

Acromegaly results in symptoms such as frontal bossing (prominent forehead), enlarged nose, prognathism (protruding jaw), and macroglossia (enlarged tongue).

Due to the enlarged features, it can cause sleep apnoea (when a patient has episodes where they cannot breathe whilst sleeping). At night the muscles in the patient's neck relax, and the weight of the enlarged features results in a collapse of the patient's airway.
name: Acromegaly
label: a
answer: yes
explanation: Hypothyroidism is characterised by a decrease in serum thyroxine levels. This would result in symptoms such as fatigue, cold intolerance (i.e. being cold all the time, despite hot weather), weight gain and constipation.
name: Hypothyroidism
label: d
answer: no

Correct answer: a
Which of the following blood test results would you expect to see in a 68-year-old woman who has already undergone menopause?

Options:
explanation: You would expect to find a decreased level of oestrogen in a post-menopausal woman as her ovaries would not respond to the FSH signal anymore. This is what leads to the absence of menses.
name: Elevated FSH, Elevated Oestrogen
label: d
answer: no
explanation: You would expect to see an elevated FSH and low oestrogen in a woman who has completed the pause.

During menopause, a woman's ovaries stop producing oestrogen. This results in an increase in FSH levels. The brain is still interpreting these low oestrogen levels and trying to stimulate an increase in oestrogen with increased levels of FSH, however, the woman's body is not responding to the raised FSH signal anymore.
name: Elevated Follicle Stimulating Hormone (FSH), Low Oestrogen
label: a
answer: yes
explanation: You would expect to find a low oestrogen in a post-menopausal woman, as her ovaries are not producing oestrogen anymore, and will atrophy.

This results in an increase in FSH levels as the body compensated for the decreased oestrogen. However, the post-menopausal ovaries will not respond to this signal anymore.
name: Low FSH, High Oestrogen
label: b
answer: no
explanation: You would indeed expect to find a low oestrogen level as the woman's ovaries stop producing oestrogen.

However, you would expect the FSH levels to be elevated. The brain is still interpreting the low oestrogen levels and will try to increase them to maintain homeostasis. However, this patient's ovaries will not respond to the high FSH levels any longer.
name: Low FSH, Low Oestrogen
label: c
answer: no
explanation: You would expect to find decreased levels of oestrogen in a post-menopausal woman as her ovaries will not be producing this hormone anymore. A high FSH level compensating for the decreased oestrogen levels would also be found.
name: Fluctuating FSH, Elevated Oestrogen
label: e
answer: no

Correct answer: a
A 58-year-old man presents to General Practice complaining of increased thirst, waking up at night to use the toilet, increased urinary frequency during the day, and feeling very tired.

Which investigation would you carry out to illicit the **most likely** diagnosis?

Options:
explanation: This patient is presenting with classical symptoms of type II diabetes (T2DM). To investigate for T2DM, we would test HbA1c levels, along with a fasted serum glucose level, random serum glucose and an oral glucose tolerance test (OGTT).

HbA1c should be under 42mmol/mol in patients who do **not** already have diabetes. It measures the proportion of red blood cells that have glucose bound to them - giving a 3-month average of how a person's blood sugar is being controlled.

Increased blood sugar levels prompt the body to increase its water levels (to dilute the blood sugar levels), explaining the polydipsia (increased thirst).

The kidneys also compensate by excreting more glucose - bringing fluids with it - explaining the nocturia (urinating at night) and polyuria (increased urine output).
name: HbA1c (Glycated haemoglobin)
label: a
answer: yes
explanation: Liver Function Tests are performed to investigate liver and gallbladder pathologies.

The patient's symptoms are not classically indicative of liver pathology - this would not be a first-line investigation.

We would investigate for Type II Diabetes in a patient with these symptoms.
name: Liver Function Tests (LFTs)
label: c
answer: no
explanation: Iron studies (iron, ferritin, transferrin & total iron binding capacity) blood tests are done to investigate Iron Deficiency Anaemia (IDA), which can lead to fatigue.

However, due to the urinary symptoms that this patient is also experiencing - the **most likely** diagnosis is Type II Diabetes, not IDA. We would not do an Iron Studies as a first-line investigation.
name: Iron Studies
label: b
answer: no
explanation: Thyroid Function Tests investigate hypo or hyperthyroidism. The patient is not presenting with any symptoms of hyperthyroidism, and the only symptom indicative of hypothyroidism is fatigue.

We would investigate this patient for Type II Diabetes as a first-line option due to this patient's urinary symptoms.
name: Thyroid Function Tests (TFTs)
label: d
answer: no
explanation: An Antinucleated antibody test investigates the presence of autoimmune conditions, such as Systemic Lupus Erythematous, Rheumatoid Arthritis, Scleroderma, and Sjögren's syndrome.

This patient's symptoms are classically indicative of Type II Diabetes - we would perform an HbA1c to investigate for this.
name: Antinucleated antibody test (ANA)
label: e
answer: no

Correct answer: a
Which cells in the ovaries are responsible for the production of testosterone?

Options:
explanation: Granulosa cells are found within the inner part of the ovarian follicles. They are responsible for converting androgens such as testosterone to oestrogen.

Theca cells, found on the outer part of the ovarian follicles, are the cells that produce testosterone in the ovaries.
name: Granulosa cells
label: b
answer: no
explanation: Sertoli cells are found within the seminiferous tubules of the testes. They secrete the hormones inhibin, activin, androgen-binding protein (ABP) and anti-mullerian hormone (AMH).

Sertoli cells are not found in the ovaries. Theca cells in the ovaries are responsible for the production of testosterone.
name: Sertoli cells
label: c
answer: no
explanation: Spermatocytes are premature spermatozoa that are formed as part of the gametogenesis process in males. They are not responsible for the production of testosterone.

Theca cells, found on the outer lining of ovarian follicles, are responsible for the production of testosterone in females.
name: Spermatocytes
label: e
answer: no
explanation: Leydig cells are found in between seminiferous tubules. They respond to LH stimulation to secrete testosterone. However - they are found in the testes, not the ovaries.

The equivalent to Leydig cells in the ovaries are the Theca cells. They produce testosterone in the ovaries.
name: Leydig cells
label: d
answer: no
explanation: The theca cells are found in the outer part of the ovarian follicles.

They support folliculogenesis, providing structural and nutritional support for growing follicles.

They also respond to LH stimulation by producing androgens such as testosterone.
name: Theca cells
label: a
answer: yes

Correct answer: a
A 12-year-old female makes an initial presentation to General Practice with a red, itchy rash on the insides of her elbows. Upon inspection, the rash is dry, scaly, with **no** signs of infection.

What is the first-line option to manage this patient's symptoms?

Options:
explanation: Tacrolimus is a calcineurin inhibitor, which are second-line treatments for moderate to severe eczema.

It is this patient's initial presentation, meaning that this is the first time that she has presented with this problem.

We would first try emollients to resolve her symptoms - this is the first-line treatment - before using second-line treatments for more severe symptoms.
name: Topical tacrolimus
label: d
answer: no
explanation: Phototherapy is a proven procedure used to manage eczema symptoms. However, it is not the first-line option that physicians should offer patients.

This is this patient's first presentation with eczema - emollients should be trialled to control her symptoms before medication and procedures are introduced.

This prevents the patient from being over-treated for their condition, which can be both time-consuming and financially costly.
name: Phototherapy
label: b
answer: no
explanation: This patient is presenting with symptoms of Eczema (atopic dermatitis).

Eczema classically presents with dry, itchy skin. This is usually accompanied by erythema (redness), scaling and lichenification in skin flexures (e.g. elbow).

Emollients - moisturising cream - are the first-line treatment for eczema. Topical corticosteroids are then considered if emollients insufficiently control symptoms.
name: Emollients
label: a
answer: yes
explanation: This patient is presenting with symptoms of eczema.

Systemic corticosteroids such as prednisolone, are a second-line treatment for eczema.

First-line treatments are emollients, followed by topical corticosteroids if symptoms are not controlled. Topical antibiotics are considered if there are signs of bacterial infection.
name: Systemic corticosteroids
label: c
answer: no
explanation: This patient is presenting with symptoms of eczema, but there are **no** indications of bacterial infection.

We would not use topical antibiotics in this case as there is no need for antibacterial therapy.
name: Topical antibiotics
label: e
answer: no

Correct answer: a