hllj/quesmed huggingface dataset:
A 29-year-old woman with asthma presents to the Emergency Department in extreme respiratory distress. An arterial blood gas is taken:


||||
|--------------|:-------:|------------------|
|pH|7.54|7.35 - 7.45|
|PaO₂|6.8 kPa|11 - 15|
|PaCO₂|3.8 kPa|4.6 - 6.4|
|Bicarbonate|27 mmol/L|22 - 30|


 - FiO2 0.21



Which of the following acid-base disturbances does this patient have?

Options:
explanation: Correct-  The elevated serum pH indicates alkalosis. This elevated pH is caused by a decreased concentration of CO2 in the bloodstream. It is uncompensated as her bicarbonate levels are still within normal range. Hyperventilation is a common cause of respiratory alkalosis.
name: Uncompensated respiratory alkalosis
label: a
answer: yes
explanation: Incorrect - This is not an acidosis as the pH is elevated. The elevated pH is caused by a decreased concentration of CO2 in the blood stream. It is uncompensated as her bicarbonate levels are still within normal range.
name: Compensated respiratory acidosis
label: e
answer: no
explanation: Incorrect -  The bicarbonate levels are within normal range which indicates this is not a metabolic alkalosis. Instead, it is the decreased CO2 concentration driving the alkalosis.
name: Uncompensated metabolic alkalosis
label: d
answer: no
explanation: Incorrect - The woman's pH is elevated, which is consistent with alkalosis. This elevated pH is caused by a decreased concentration of CO2 in the blood stream. It is not a compensated alkalosis as her bicarbonate levels are still within normal range.
name: Compensated respiratory alkalosis
label: b
answer: no
explanation: Incorrect - The bicarbonate levels are within normal range which indicates this is not a metabolic alkalosis. Instead, it is the decreased CO2 concentration driving the alkalosis.
name: Compensated metabolic alkalosis
label: c
answer: no

Correct answer: a
A 83-year-old male presents to A&E with central chest pain. An ECG reveals ST elevation across the inferior leads. He undergoes a percutaneous coronary intervention (PCI), which identifies blockage of the posterior interventricular artery.

Which of the following cardiac structures is most likely to have been damaged?

Options:
explanation: Incorrect - The left bundle branch receives its blood supply from the left anterior descending artery, a branch of the left coronary artery. As the blood supply to this area during the myocardial infarction would not have been disrupted, it is unlikely that any damage occurred.
name: Left Bundle Branch
label: e
answer: no
explanation: Correct - The posterior interventricular artery is typically a branch of the right coronary artery. It runs along the posterior sulcus of the heart and supplies area in which the sinoatrial node is located.
name: Atrioventricular Node
label: a
answer: yes
explanation: Incorrect - The sinoatrial nodal artery supplies the sinoatrial node and is not associated with the posterior interventricular artery. As blood supply to this area during the myocardial infarction would not have been disrupted, it is unlikely that any damage occurred.
name: Sinoatrial node
label: b
answer: no
explanation: Incorrect - The purkinjie fibres receive their blood supply from the circumflex branch of the left coronary artery. As the blood supply to this area during the myocardial infarction would not have been disrupted, it is unlikely that any damage occurred.
name: Purkinje Fibres
label: c
answer: no
explanation: Incorrect - The right bundle branch receives its blood supply from the left anterior descending artery, a branch of the left coronary artery. As the blood supply to this area during the myocardial infarction would not have been disrupted, it is unlikely that any damage occurred.
name: Right Bundle Branch
label: d
answer: no

Correct answer: a
A 28-year-old woman who is 32 weeks pregnant presents to her GP. She has been experiencing gradually worsening shortness of breath on exertion throughout her pregnancy and has noticed that her breathing rate has increased. However, on assessment, her observations are all within the normal limits given her current stage of pregnancy.

Which of the following lung volumes increase during late pregnancy?

Options:
explanation: Incorrect - Increased inspiratory capacity and tidal volume, and decreased residual volume result in expiratory reserve volume becoming decreased during pregnancy.
name: Expiratory Reserve Volume
label: c
answer: no
explanation: Incorrect - Elevation of the diaphragm decreases the total capacity of the lungs during pregnancy.
name: Total Capacity
label: e
answer: no
explanation: Incorrect - Increased lung expansion, engorgement of the respiratory mucosa, and an elevated diaphragm all contribute to a decrease, rather than an increase, in functional residual capacity during pregnancy.
name: Functional Residual Capacity
label: b
answer: no
explanation: Incorrect - Elevation of the diaphragm and decreased total lung capacity contribute to a decrease in residual volume during pregnancy.
name: Residual Volume
label: d
answer: no
explanation: Correct - Tidal volume, or the amount of air that passes in or out of the lungs with each breath, is expected to increase during pregnancy. This helps to compensate for the decreased residual volume and functional residual capacity. Vital capacity also increases slightly in late pregnancy due to decreased residual volume.
name: Tidal Volume
label: a
answer: yes

Correct answer: a
A baby boy is born with a congenital cardiac defect associated with an abnormal septation of the truncus arteriosus and bulbus cordis. On examination he appears pink and well-perfused.

Which of the following cardiac defects is the baby most likely to have?

Options:
explanation: Incorrect - Atrial septal defects are non-cyanotic but would be associated with abnormal development in either the sinus venosus or the atria. It is not associated with abnormal septation of the truncus arteriosus and bulbus cordis.
name: Atrial Septal Defect
label: b
answer: no
explanation: Incorrect - Tetralogy of Fallot is a cyanotic congenital heart defect. It is a combination of right ventricular hypertrophy, a ventricular septal defect with an overriding aorta, and pulmonary stenosis. This results from multiple areas of abnormal development, not just the truncus arteriosus and bulbus cordis.
name: Tetralogy of Fallot
label: c
answer: no
explanation: Incorrect - Persistent truncus arteriosus is a cyanotic defect.
name: Persistent Truncus Arteriosus
label: d
answer: no
explanation: Correct - Ventricular septal defects (VSDs) are non-cyanotic. The truncus arteriosus develops into the aorta and the pulmonary trunk through septum formation. Abnormal septation would lead to the development of a membranous VSD. The bulbus cordis develops into the outflow region of both ventricles
name: Membranous Ventricular Septal Defect
label: a
answer: yes
explanation: Incorrect - The foramen ovale provides a shunt in foetal circulation allowing blood to bypass the lungs. Typically it closes and becomes the fossa ovalis after birth, however it can sometimes remain open. It is not  associated with an abnormal septation of the truncus arteriosus and bulbus cordis.
name: Patent Foramen Ovale
label: e
answer: no

Correct answer: a
A 53-year-old man is admitted to the respiratory ward for the management of a pulmonary embolism. He is commenced on treatment dose low molecular weight heparin (LMWH).

Which of the following describes the mechanism of action of LMWH?

Options:
explanation: Incorrect - A direct thrombin inhibitor works through thrombin inhibition. LMWH binds and activates antithrombin III, through induction of conformational change. Heparin-activated antithrombin III binds to factor Xa directly, inactivating it. Although this indirectly brings about a reduction in thrombin activation, LMWH does not directly inhibit it.
name: Limits secondary haemostatic plug formation through thrombin inhibition
label: c
answer: no
explanation: Incorrect - Fibrinogen is converted into fibrin by thrombin, which drives clot formation. LMWH inhibits this process.
name: Converts fibrinogen into fibrin
label: b
answer: no
explanation: Correct - LMWH binds and activates antithrombin III, through induction of a conformational change. This activated antithrombin III then binds to Factor Xa directly, preventing its activation. Factor Xa plays a role in thrombin generation, which drives platelet activation and clot formation. LMWH, therefore, inhibits this process, exerting its anticoagulant effects.
name: Limits secondary haemostatic plug formation through Factor Xa inhibition
label: a
answer: yes
explanation: Incorrect - LMWH does not inactivate Factor VIIa. LMWH binds and activates antithrombin III, through induction of conformational change. Heparin-activated antithrombin III binds to factor Xa directly, inactivating it.
name: Limiting primary haemostatic plug formation through factor VIIa inhibition
label: e
answer: no
explanation: Incorrect - While unfractionated heparin inactivates both thrombin and factor Xa, LMWH primarily works through factor Xa inactivation.
name: Limits secondary haemostatic plug formation through thrombin and factor Xa inhibition
label: d
answer: no

Correct answer: a
A 16-year-old boy presents to Accident and Emergency with acute onset testicular pain. He denies any history of trauma. The pain is so severe that he has vomited twice. On examination, his scrotum appears swollen and erythematous. Testicular torsion is suspected.

From which of the following tissues is the cremasteric fascia derived?

Options:
explanation: Incorrect - The transversalis fascia becomes the internal spermatic fascia. It is not the tissue from which the cremasteric fascia is derived.
name: Transversalis Fascia
label: c
answer: no
explanation: Incorrect - The pampiniform plexus is the venous plexus associated with the spermatic cord. It is not the tissue from which the cremasteric fascia is derived.
name: Pampiniform Plexus
label: b
answer: no
explanation: Incorrect - The external oblique aponeurosis becomes the external spermatic fascia. It is not the tissue from which the cremasteric fascia is derived.
name: External Oblique Muscle
label: e
answer: no
explanation: Incorrect - Dartos fascia originates from Scarpa's fascia. It becomes Colle's fascia upon meeting the perineal body. It is not the tissue from which the cremasteric fascia is derived.
name: Dartos Fascia
label: d
answer: no
explanation: Correct - The internal oblique muscle forms the roof of the inguinal canal and becomes the cremasteric fascia.
name: Internal Oblique Muscle
label: a
answer: yes

Correct answer: a
A group of researchers are examining the correlation between depression and the development of cancer later in life. Rather than asking participants to report whether they have ever been diagnosed with depression, researchers took the history of depression from medical records.

Which of the following types of bias is minimised through this approach?

Options:
explanation: Incorrect - Attrition bias is the systematic difference between groups in the loss of participants from the study.
name: Attrition bias
label: e
answer: no
explanation: Incorrect - Length time bias argues that slowly developing, asymptomatic diseases are those that are most likely to be detected in a screening programme. They are also associated with a better prognosis. This therefore exaggerates the efficacy of a screening programme, as it is these slowly developing diseases that are detected by them. Length time bias is a common type of bias within screening research, but is not relevant to the methodology described here.
name: Length Time Bias
label: b
answer: no
explanation: Correct - Recall bias is the systematic difference in recall about a potential exposure by cases versus controls. Recall bias is a commonly found bias within case-control studies. Utilising the patient's medical records minimises the risk of incorrect information being obtained when collecting data.
name: Recall Bias
label: a
answer: yes
explanation: Incorrect - Overdiagnosis is understood to be the correct diagnosis of a disease, but one that is clinically irrelevant as the disease will never cause symptoms within the patient's lifetime. Overdiagnosis is an ethical problem, particularly in screening programmes. It is not relevant to the research methodology described here.
name: Overdiagnosis
label: d
answer: no
explanation: Incorrect - Lead time bias states that screening will alter the time at which a diseases is detected. Through screening, a disease may be detected earlier before the patient begins showing symptoms. This therefore exaggerates the efficacy of a screening programme. It is not relevant to the methodology described here.
name: Lead Time bias
label: c
answer: no

Correct answer: a
A 47-year-old man presents to Accident and Emergency with neck stiffness, photophobia, and a non-blanching rash. A lumbar puncture is performed.

From which of the following anatomical regions is cerebrospinal fluid (CSF) taken during a lumbar puncture?

Options:
explanation: Incorrect - The peritoneal cavity is not related to the spinal cord and does not contain CSF. It is the space inside the abdomen that contains abdominal viscera.
name: Peritoneal Cavity
label: e
answer: no
explanation: Correct - CSF is found in the subarachnoid space, between the arachnoid mater and the pia mater, of the brain and spinal cord. This is accessed during a lumbar puncture. CSF is also found within the ventricular system of the brain.
name: Subarachnoid Space
label: a
answer: yes
explanation: Incorrect - The central canal is a small canal that runs through the spinal cord. Lumbar punctures should be taken below the point of spinal cord termination and should never contact the spinal cord.
name: Central Canal
label: c
answer: no
explanation: Incorrect - The epidural space is primarily fat-filled. It does not contain any CSF.
name: Epidural Space
label: b
answer: no
explanation: Incorrect - The subdural space is a very small potential space between the epidural and subarachnoid space. It does not contain any CSF.
name: Subdural Space
label: d
answer: no

Correct answer: a
A 34-year-old presents to her GP with pain on urination and a frequent urge to pass urine. Her GP suspects she has a urinary tract infection and prescribes trimethoprim.

In which patient group are antifolates, such as trimethoprim, contraindicated?

Options:
explanation: Incorrect - It is safe for patients with epilepsy to take trimethoprim, provided they are not pregnant. However the BNF should always be consulted for any potential drug interactions.
name: Epilepsy
label: b
answer: no
explanation: Incorrect - Trimethoprim is contraindicated in patients with megaloblastic anaemia due to folate deficiency, but it is not contraindicated in patients with iron deficiency anaemia.
name: Iron Deficiency Anaemia
label: e
answer: no
explanation: Incorrect - Trimethoprim is typically well tolerated in patients with renal impairment. The BNF recommends the dose be reduced in renal impairment, but it is not contra-indicated.
name: Renal Impairment
label: c
answer: no
explanation: Correct - Trimethoprim interferes with folate which is important for foetal central nervous system development. Therefore, it is contraindicated in women in the first trimester of pregnancy.
name: Pregnancy
label: a
answer: yes
explanation: Incorrect - Trimethoprim is not contraindicated in elderly patients.
name: The elderly
label: d
answer: no

Correct answer: a
A 37-year-old woman attends the GP surgery to discuss an essential tremor that involves her right hand. It has been present for the past five years, and makes it difficult to perform fine motor activities such as drawing and sewing.

Which nucleus within the brain is associated with the generation of tremors?

Options:
explanation: Incorrect - The subthalamic nucleus is part of the subthalamic nucleus. It is implicated in the pathogenesis of hemiballismus, or involuntary movements. This is a form of gross motor dysfunction, as opposed to the fine motor disturbance in essential tremors.
name: Subthalamic Nucleus
label: d
answer: no
explanation: Incorrect - The supraoptic nucleus is part of the hypothalamus. It regulates blood pressure through the secretion of ADH, and social bonding behaviours through oxytocin release. It is not implicated in tremors.
name: Supraoptic Nucleus
label: e
answer: no
explanation: Incorrect - The nucleus solitarius receives special sensory information via visceral afferent fibres from cranial nerves VII, IX, and X. It is not responsible for the production of tremors.
name: Nucleus Solitarius
label: c
answer: no
explanation: Incorrect - The nucleus ambiguus is involved in the motor supply to the branchiomotor muscles of the pharynx, palate, and larynx and parasympathetic supply to the cardiac muscle. It provides a motor nucleus for cranial nerves IX, X, and XI. It is not responsible for the production of tremors.
name: Nucleus Ambiguus
label: b
answer: no
explanation: Correct - The globus pallidus is part of the basal ganglia, a key brain region involved in motor selection and control. Disruptions to neural activation within the globus pallidus will result in decreased thalamic inhibition and hence greater excitation of the motor cortex. This produces tremors.
name: Globus Pallidus
label: a
answer: yes

Correct answer: a
A 55-year-old woman with multiple sclerosis presents to her GP after noticing a progressive worsening in her symptoms over the past 6 weeks. She reports a sensation similar to an electric shock travelling down her spine and into her legs, that occurs whenever she flexes her neck.

Which of the following cell types is damaged in patients with multiple sclerosis?

Options:
explanation: Correct - Oligodendroglia cells produce myelin in the central nervous system. This affects the conduction velocity of neuronal signalling. They are damaged in patients with multiple sclerosis, thus impairing the transmission of sensory and motor neuronal signalling.
name: Oligodendroglia
label: a
answer: yes
explanation: Incorrect - Ependymal cells are ciliated cuboidal epithelial cells that form the blood-cerebrospinal fluid barrier. They line the ventricles of the brain and the choroid plexus.
name: Ependymal
label: e
answer: no
explanation: Incorrect - Schwann cells produce myelin in the peripheral nervous system. They are not damaged in patients with multiple sclerosis, which targets the central nervous system.
name: Schwann cells
label: b
answer: no
explanation: Incorrect - Astrocytes have a homeostatic role within the nervous system. They maintain the blood brain barrier and preserve the chemical environment within the central nervous system by recycling ions and acting as transporters. They co-ordinate blood flow to match local activity, take up neurotransmitters and electrolytes such as potassium, and communicate with other astrocytes through gap junctions.
name: Astrocytes
label: c
answer: no
explanation: Incorrect - Microglia cells act as macrophages within the nervous system. Microglia are derived from bone marrow and are activated during injury and infection. They secrete cytokines and present antigens to lymphocytes as part of an immune response.
name: Microglia
label: d
answer: no

Correct answer: a
A 67-year-old man is reviewed following a recent stroke. He states that he has not noticed any major problems in his activities of daily living. However, it is noted that he has shaved only the right-hand side of his face.

On examination, when asked to raise both arms in the air, he raises only the right arm. However, when his attention is brought specifically to the left arm, the sensory and motor function is intact.

Which of the following brain regions is most likely to be affected in a patient with hemi-spatial neglect?

Options:
explanation: Incorrect - The temporal lobe is responsible for memory formation, recall, and hearing. The hippocampus and amygdala are found within the medial aspect of the temporal lobe. Damage to the temporal lobe does not cause hemi-spatial neglect.
name: Temporal lobe
label: d
answer: no
explanation: Correct - The parietal lobe is responsible for motor and sensory input to the contralateral side of the body. It is responsible for the recognition of sensation, proprioception, sense of space and time, as well as reading and comprehension. Damage to the parietal lobe is associated with hemi-spatial neglect.
name: Parietal lobe
label: a
answer: yes
explanation: Incorrect - The occipital lobe is responsible for visual information, processing, and understanding. Damage to the occipital lobe can cause visual changes and deficits in the processing of visual information such as prosopagnosia. It does not cause hemi-spatial neglect.
name: Occipital lobe
label: b
answer: no
explanation: Incorrect - The frontal lobe is responsible for executive functions. This includes voluntary movement, the ability to plan and consider the consequences of actions, problem-solving, and impulse control. Damage to the frontal lobe does not cause hemi-spatial neglect.
name: Frontal lobe
label: c
answer: no
explanation: Incorrect - The cerebellum is involved in the coordination and planning of movement. It modulates the activity of the motor cortex. Damage to the cerebellum does not cause hemi-spatial neglect.
name: Cerebellum
label: e
answer: no

Correct answer: a
A 43-year-old man attends his GP surgery to discuss his efforts to quit smoking. He proudly announces that he has now been smoke-free for six months. Although he experiences occasional cravings when stressed, he has learned to perform deep breathing exercises or chew gum when these come on.

Which of the following stages of the transtheoretical model of behaviour change best describes this patient?

Options:
explanation: Incorrect - The patient is not planning or preparing for change; he has already made this change. Therefore, he is not in the preparation phase.
name: Preparation
label: e
answer: no
explanation: Incorrect - The patient has already made the change and is not simply thinking about it. Therefore, he is not at the contemplation stage.
name: Contemplation
label: b
answer: no
explanation: Correct -  The transtheoretical model of behaviour change describes a series of six stages through which an individual must progress when making an intentional change in their health behaviour. This patient is ongoing in his practice of new and healthier behaviour. His behaviour is being sustained. Therefore, the patient is in the maintenance phase.
name: Maintenance
label: a
answer: yes
explanation: Incorrect - The patient has not recommenced smoking after temporarily quitting. Therefore, he has not relapsed.
name: Relapse
label: d
answer: no
explanation: Incorrect - The patient is not adopting new habits, he is maintaining them. Therefore, he is not in the action stage.
name: Action
label: c
answer: no

Correct answer: a