hllj/quesmed huggingface dataset:
A 37-year-old man is brought into A&E after being in a traffic accident. On examination, he has a very fast respiratory rate. His trachea is deviated to the right. He has asymmetrical chest expansion and absent breath sounds on the left. His observations show RR 30 bpm, HR 118 bpm, BP 84/66 mmHg and O2 89% on air.

What is the most likely cause of his condition?

Options:
explanation: Flail chest describes 2 or more contiguous rib fracture that results in destabilisation of the chest wall and results in paradoxical movement of the ribcage during the breath cycle
name: Flail chest
label: d
answer: no
explanation: A catastrophic haemorrhage may cause his fall in blood pressure but does not explain the asymmetrical chest expansion or tracheal deviation
name: Catastrophic haemorrhage
label: b
answer: no
explanation: Cardiac tamponade describes the accumulation of fluid in the pericardiac sac and results in a decrease in cardiac output. It would not, however, lead to a mediastinal shift or absent breath sounds seen in this patient.
name: Cardiac tamponade
label: e
answer: no
explanation: Tension pneumothorax describes the accumulation of air within the pleural cavity which causes a mediastinal shift. This has led to his trachea deviating to the left and reduced breath sounds on the right. The increase in intrathoracic pressure prevents the return of blood to the heart and leads to hypotension.
name: Tension pneumothorax
label: a
answer: yes
explanation: Spontaneous pneumothorax also describes an accumulation of air within the pleural cavity but it occurs without any evidence of trauma/iatrogenic causes
name: Spontaneous pneumothorax
label: c
answer: no

Correct answer: a
Heart failure describes a situation where the cardiac output fails to supply enough blood to organs to fulfil their demand.

Which of the following is an example of systolic left-sided heart failure?

Options:
explanation: Dilated cardiomyopathy is a disease which causes the stretching of heart muscles and results in the enlargement of ventricles and thinning of the heart muscle wall. This results in reduced contraction strength and, therefore, reduced cardiac output.
name: Dilated cardiomyopathy
label: a
answer: yes
explanation: Hypertrophic cardiomyopathy describes the enlargement of the muscle wall of the heart. This leads to diastolic heart failure as the ventricles are not able to fill as much and, therefore, cardiac output is reduced.
name: Hypertrophic cardiomyopathy
label: c
answer: no
explanation: Restrictive cardiomyopathy leads to diastolic heart failure as it reduces the capacity of the heart to fill with blood, therefore, reducing the cardiac output
name: Restrictive cardiomyopathy
label: d
answer: no
explanation: Aortic stenosis leads to diastolic heart failure. This is due to the valves blocking the outflow of blood from the left ventricle and, therefore, reducing cardiac output
name: Aortic stenosis
label: b
answer: no
explanation: Cor pulmonale describes abnormal enlargement of the right side of the heart. This is due to hypoxia resulting in pulmonary arteriole constriction and hypertension.
name: Cor pulmonale
label: e
answer: no

Correct answer: a
At rest, neurons have a resting potential that is maintained by the movement of ions across the membrane.

Which of the following describes the composition of ions in the extracellular space relative to the intracellular space when the neuron is **resting**?

Options:
explanation: For the resting potential to be maintained three molecules of sodium are pumped out of the cell for every two molecules of potassium pumped into the cell. This results in a net deficit of positive ions within the cell and a negative potential across the cell membrane. Therefore the concentration of potassium ions inside the cell must be high compared to the outside
name: [Na+]: high, [K+]:high
label: e
answer: no
explanation: The concentrations of sodium and potassium are maintained by the sodium-potassium pump. This leads to 3 sodium ions being pumped out of the neuron for every 2 potassium ions being pumped in leading to the resting potential of the cell membrane being around -70mV. High concentrations of extracellular potassium would lead to an increased equilibrium potential of potassium and a less negative cell membrane potential
name: [Na+]: high, [K+]:high
label: b
answer: no
explanation: For the resting potential to be maintained three molecules of sodium are pumped out of the cell for every two molecules of potassium pumped into the cell. This results in a net deficit of positive ions within the cell and a negative potential across the cell membrane. Therefore the concentration of sodium ions outside of the cell must be high compared to the inside
name: [Na+]: low, [K+]:low
label: d
answer: no
explanation: The concentrations of sodium and potassium are maintained by the sodium-potassium pump. This leads to 3 sodium ions being pumped out of the neuron for every 2 potassium ions being pumped in leading to the resting potential of the cell membrane being around -70mV. This results in a high concentration of sodium out of the cell and a low concentration of potassium in the cell
name: [Na+]: low, [K+]:high
label: c
answer: no
explanation: The concentrations of sodium and potassium are maintained by the sodium-potassium pump. This leads to three sodium ions being pumped out of the neuron for every two potassium ions being pumped in leading to the resting potential of the cell membrane being around -70mV.
name: [Na+]: high, [K+]:low, [Ca2+]: high
label: a
answer: yes

Correct answer: a
A 55-year-old female with a history of coronary artery disease presents to A&E with crushing chest pain radiating to the left arm. She has a past medical history of obesity and type 2 diabetes mellitus. An ECG shows a raised ST segment in the chest leads V2-V5.

Which coronary artery is affected?

Options:
explanation: This would show ST elevation in leads II, III and aVF and would affect the inferior portion of the myocardium
name: Right coronary artery
label: b
answer: no
explanation: This causes an anterior myocardial infarction and causes ST elevation in V2-5. You would also expect ST elevation in leads avL and I and reciprocal Q wave formation.
name: Left anterior descending
label: a
answer: yes
explanation: This would show ST elevation in leads I, and aVL and would affect the lateral side of the myocardium
name: Left circumflex coronary artery
label: c
answer: no
explanation: There is no right anterior descending artery.
name: Right anterior descending
label: e
answer: no
explanation: This would cause a posterolateral myocardial infarction. It would cause ST depression in V1-3 and ST elevation in V7-9 (posterior leads)
name: Right coronary artery and left circumflex
label: d
answer: no

Correct answer: a
A 64-year-old long-term smoker is diagnosed with COPD after years of suffering from exertional shortness of breath and a productive cough with sticky mucus.

Which of the following describes a pathological process involved in chronic emphysema?

Options:
explanation: Inhalation of tobacco smoke activates **type II pneumocytes** and results in inflammation and the release of proteases
name: Inhalation of tobacco smoke leads to the activation of type I pneumocytes and the release of collagenase and elastase leading to the breakdown of alveolar walls
label: e
answer: no
explanation: This describes chronic bronchitis.
name: Tobacco smoke leads to the hypertrophy and hyperplasia of goblet cells and mucinous glands
label: b
answer: no
explanation: Alpha-1-anti-trypsin protects against the action of proteases. Deficiency results in panacinar emphysema
name: Release of alpha-1-anti-trypsin, leukotriene B4 and elastase leads to the breakdown of alveolar walls
label: d
answer: no
explanation: This describes asthma.
name: Inhalation of tobacco smoke leads to bronchial hyperresponsiveness and intermittent airway obstruction
label: c
answer: no
explanation: Inhalation of tobacco smoke activates type II pneumocytes and leads to inflammation and the release of proteases which breakdown alveolar walls
name: Release of leukotriene B4, collagenase and elastase leads to the breakdown of alveolar walls
label: a
answer: yes

Correct answer: a
Nitric oxide is a potent vasodilator that is used to regulate blood vessel tone. It is produced in the walls of blood vessels and stimulates the production of cGMP.

In which layer of the blood vessel wall is it produced?

Options:
explanation: The tunica externa provides basic structural support to blood vessels but does not produce NO.
name: Tunica externa
label: d
answer: no
explanation: The internal elastic lamina is a fenestrated sheet that forms a barrier between the tunica intima and tunica media.
name: Internal elastic lamina
label: b
answer: no
explanation: Smooth muscle provides the tone of blood vessels. Whilst NO is an important vasodilator which acts on vascular smooth muscle, it is not produced in vascular smooth muscle
name: Smooth muscle
label: c
answer: no
explanation: The external elastic lamina helps to maintain the elasticity of the arterial wall but does not produce NO
name: External elastic lamina
label: e
answer: no
explanation: Endothelial cells regulate the exchange of substances between the circulating blood and surrounding tissue. NO is continuously produced by the endothelium and acts on the smooth muscle to cause smooth muscle relaxation. Production can be increased by increased sheer stress (e.g. increased blood pressure)
name: Endothelium
label: a
answer: yes

Correct answer: a
Which of the following routes of administration has a bioavailability of 100%?

Options:
explanation: Used for volatile/gaseous anaesthetics and aerosols. This route can produce rapid adjustments in the plasma concentration of the drug. Drugs delivered via aerosol will often produce high local concentrations of drug without systemic effects
name: Inhalation
label: d
answer: no
explanation: Subcutaneous injection will usually produce effects faster than oral administration but must be absorbed into circulation from the injection site. This can be limited by diffusion through tissue and removal by local blood flow.
name: Subcutaneous injection
label: e
answer: no
explanation: Very little absorption of most drugs takes place until it reaches the small intestine. Around 75% of the drug will be absorbed in 1-3 hours. Factors affecting absorption include gut content, gut motility, blood flow and formulation.
name: Oral
label: b
answer: no
explanation: This allows 100% of the active drug to be delivered into the systemic circulation and is not limited by diffusion or first-pass metabolism
name: Intravenous injection
label: a
answer: yes
explanation: Absorption following administration can be unreliable but can be more complete than oral/buccal administration as less of the capillary drainage returns to circulation via the portal vein
name: Rectal
label: c
answer: no

Correct answer: a
Vitamin K is used as an antidote to warfarin.

Which option best describes its function in the clotting cascade?

Options:
explanation: Vitamin K donates electrons to gamma-glutamyl carboxylase
name: Vitamin K receives electrons from gamma-glutamyl carboxylase, converting non-functional forms of clotting factors II, VII, IX and X into functional forms
label: b
answer: no
explanation: Vitamin K is involved in the maturation of II, VII, IX and X
name: Vitamin K donates electrons to gamma-glutamyl carboxylase, converting non-functional forms of clotting factors III, V, VI and VIII into functional forms
label: c
answer: no
explanation: Vitamin K donates electrons to gamma-glutamyl carboxylase and is involved in the maturation of II, VII, IX and X
name: Vitamin K receives electrons from gamma-glutamyl carboxylase, converting non-functional forms of clotting factors III, V, VI and VIII into functional forms
label: d
answer: no
explanation: Vitamin K is required for the conversion of II, VII, IX and X into functional forms
name: Vitamin K donates electrons to gamma-glutamyl carboxylase, converting functional forms of clotting factors II, VII, IX and X into non-functional forms
label: e
answer: no
explanation: Vitamin K regulates the clotting cascade by converting coagulation factors to mature clotting factors. Dietary Vitamin K is converted to vitamin K hydroquinone which allows it to donate electrons to gamma-glutamyl carboxylase.
name: Vitamin K donates electrons to gamma-glutamyl carboxylase, converting non-functional forms of clotting factors II, VII, IX and X into functional forms
label: a
answer: yes

Correct answer: a
A 56-year-old gentleman presents to the GP with crushing central pain when walking uphill. He informs you that this resolves when he rests. He has a past medical history of peripheral vascular disease, type 2 diabetes and his BMI is 32.

What is the most common cause of stable angina?

Options:
explanation: Cocaine, amphetamine and marijuana use are common precipitating factors in the development of vasospastic angina.
name: Illicit drug use
label: d
answer: no
explanation: This is a common cause of unstable angina and myocardial infarction. A thrombus forms on top of an atherosclerotic plaque and ruptures resulting in an almost-complete blockage of a blood vessel and ischaemia.
name: Ruptured atherosclerotic plaque
label: e
answer: no
explanation: Atherosclerosis involves the narrowing of the coronary arteries, causing a reduced blood flow to the cardiac muscle. It is the most common cause of stable angina.
name: Atherosclerosis
label: a
answer: yes
explanation: A thrombus may lead to stable angina, however, it is more commonly linked to unstable angina and sudden cardiac death when they rupture and lead to complete occlusion of a coronary vessel.
name: Thrombosis
label: c
answer: no
explanation: Type 2 diabetes mellitus is a risk factor, not a cause.
name: Uncontrolled blood sugar
label: b
answer: no

Correct answer: a
A 19-year-old male has recently had his asthma medications re-evaluated and has been told to continue his blue inhaler and the doctor has added in a twice-daily steroid inhaler. He is interested in the pharmacology behind the medications.

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

Options:
explanation: Salbutamol is a short acting beta-2 agonist (SABA) that acts on the beta-2 receptors on bronchiole smooth muscle to cause dilation. They have little effect on bronchial hyperreactivity and are used to mediate bronchospasm.
name: Beta 2 receptor agonist
label: a
answer: yes
explanation: Administration of a beta-2 receptor antagonist (or Beta blocker) would lead to increased pulmonary resistance and worsen the effects of an asthma attack.
name: Beta 2 receptor antagonist
label: b
answer: no
explanation: Alpha 1 receptors are predominantly located in vascular smooth muscle. They are commonly prescribed to treat hypertension as they cause smooth muscle relaxation.
name: Alpha 1 receptor antagonist
label: e
answer: no
explanation: The leukotriene receptor antagonists block the activity of cysteinyl leukotrienes at their receptors (CysLT1) on bronchial smooth muscle.
name: Leukotriene receptor antagonist
label: c
answer: no
explanation: Beta 1 receptors are predominantly found in the heart, kidneys and adipose tissue. Beta 1 antagonists are commonly used in the treatment of hypertension due to their negative chronotropic and ionotropic effects on the heart.
name: Beta 1 receptor antagonist
label: d
answer: no

Correct answer: a
A busy carpenter presents to his GP with elbow pain, it is worse when he is gripping and rotating objects. He sometimes takes ibuprofen to ease the pain.

On examination, there is tenderness when the GP palpates along the lateral side of the distal humerus and tenderness when the wrist is extended against resistance.

He has no history of injury to his elbow and this is the first time that he is presenting to his GP.

What is the most likely diagnosis?

Options:
explanation: Cubital tunnel syndrome is due to compression of the ulnar nerve at the elbow. It causes shooting pains, numbness and weakness along the medial side of the forearm and 4th and 5th digits.
name: Cubital tunnel syndrome
label: d
answer: no
explanation: This describes inflammation of the bursa of the Olecranon. When bursa become inflamed they accumulate fluid and can swell. This can be due to trauma or prolonged pressure.
name: Olecranon bursitis
label: e
answer: no
explanation: Medial epicondylitis (golfer's elbow) is a chronic overuse injury caused by repeat wrist flexion. Pain can be reproduced by wrist flexion against resistance.
name: Medial epicondylitis
label: b
answer: no
explanation: Lateral epicondylitis (tennis elbow) is a chronic overuse injury caused by repeated wrist extension. It is commonly seen in tennis players and pain can be reproduced when patients extend their wrists against resistance.
name: Lateral epicondylitis
label: a
answer: yes
explanation: Carpal tunnel syndrome describes compression of the median nerve at the wrists. Patients will often experience pain and weakness when they try to grip objects.
name: Carpal tunnel syndrome
label: c
answer: no

Correct answer: a
A keen woodworker presents to his GP with elbow pain, it is worse when he is gripping and rotating objects. He sometimes takes ibuprofen to ease the pain.

On examination, there is tenderness when the GP palpates along the lateral side of the distal humerus and tenderness when the wrist is extended against resistance.

He has no history of injury to his elbow and this is the first time that he is presenting to his GP.

What is the most likely diagnosis?

Options:
explanation: Carpal tunnel syndrome describes compression of the median nerve at the wrists. Patients will often experience pain and weakness when they try to grip objects.
name: Carpal tunnel syndrome
label: c
answer: no
explanation: Medial epicondylitis (golfer's elbow) is a chronic overuse injury caused by repeat wrist flexion. Pain can be reproduced by wrist flexion against resistance.
name: Medial epicondylitis
label: b
answer: no
explanation: This describes inflammation of the bursa of the Olecranon. When bursa become inflamed they accumulate fluid and can swell. This can be due to trauma or prolonged pressure.
name: Olecranon bursitis
label: e
answer: no
explanation: Lateral epicondylitis (tennis elbow) is a chronic overuse injury caused by repeated wrist extension. It is commonly seen in tennis players and pain can be reproduced when patients extend their wrists against resistance.
name: Lateral epicondylitis
label: a
answer: yes
explanation: Cubital tunnel syndrome is due to compression of the ulnar nerve at the elbow. It causes shooting pains, numbness and weakness along the medial side of the forearm and 4th and 5th digits.
name: Cubital tunnel syndrome
label: d
answer: no

Correct answer: a
A 28-year-old male who has returned from travelling Africa presents to the emergency department with profuse painless diarrhoea, abdominal discomfort, borborygmi and vomiting in the absence of fever. The doctor suspects cholera.

Which of the following best describes the pathogenic mechanism of *Vibrio cholera*?

Options:
explanation: Cholera toxin is an exotoxin and leads to the activation of cAMP-mediated anion secretion and inhibition of NaCl absorption. This promotes massive chloride ion secretion and water loss into the gut causing secretory, "rice water" diarrhoea.
name: Cholera subunit B binds to enterocytes and facilitates the entry of cholera subunit A which promotes massive chloride ion secretion and water loss
label: a
answer: yes
explanation: Cholera toxin is an exotoxin**,** not an endotoxin. it does not react with lipopolysaccharide-sensitive cells
name: Cholera endotoxins react with lipopolysaccharide-sensitive cells resulting in the production of inflammatory mediators. This leads to the mass secretion of chloride ions and water loss
label: c
answer: no
explanation: Cholera toxin is an exotoxin. Subunit B facilitates the entry of subunit A into enterocytes and promotes the mass secretion of chloride ions into the gut. Water follows the movement of chloride ions leading to secretory diarrhoea
name: Cholera subunit B binds to lipopolysaccharide-sensitive cells resulting in the production of inflammatory mediators leading to mass absorption of chloride ions and water loss
label: d
answer: no
explanation: Secretory diarrhoea from cholera is due to the massive secretion of **chloride** ions, not sodium ions.
name: Cholera subunit B binds to enterocytes and facilitates the entry of cholera subunit A which promotes massive sodium ion secretion and water loss
label: b
answer: no
explanation: Cholera toxin is an exotoxin and leads to the activation of cAMP-mediated anion secretion and inhibition of NaCl absorption. This promotes massive chloride ion secretion and leads to the movement of water into the gut lumen resulting in secretory, "rice water" diarrhoea
name: Cholera subunit B binds to enterocytes and facilitates the entry of cholera subunit A which promotes massive chloride ion absorption and water loss
label: e
answer: no

Correct answer: a
Which of the following is a modifiable risk factor for hypertension?

Options:
explanation: Advancing age is a non-modifiable risk factor for hypertension.
name: Age
label: b
answer: no
explanation: Sex is a non-modifiable risk factor for hypertension. Typically, men are at a higher risk of hypertension compared to women.
name: Sex
label: c
answer: no
explanation: Smoking is a modifiable risk factor for hypertension. Research indicates that nicotine — the main active ingredient in cigarette smoke — stimulates the release of epinephrine and norepinephrine, which are hormones that increase blood pressure.
name: Smoking
label: a
answer: yes
explanation: Heroin lowers blood pressure. It is not a modifiable risk factor for hypertension.
name: Heroin use
label: f
answer: no
explanation: Ethnicity is a non-modifiable risk factor. Patients of an African, Caribbean or South Asian background are at a higher risk of developing hypertension.
name: Ethnicity
label: e
answer: no

Correct answer: a
A 64-year-old woman presents to the GP complaining of weakness. She says that she struggles to stand up from her chair but that this weakness improves the more she repeats a movement. She is currently undergoing chemotherapy for a recent diagnosis of small-cell lung cancer.

Which of the following is the most likely cause of her weakness?

Options:
explanation: Myasthenia gravis is a type II hypersensitivity reaction that causes an immune response to acetylcholine receptors Weakness worsens after repeated movements. It is associated with thymoma and bronchial carcinoma.
name: Myasthenia gravis
label: c
answer: no
explanation: Weakness caused by cord compression would not improve with repeated movements.
name: Spinal metastases resulting in cord compression
label: e
answer: no
explanation: Lambert-Eaton syndrome is a paraneoplastic syndrome associated with small cell lung cancer. It is a type II hypersensitivity reaction that causes an immune response to voltage-dependent calcium channels. Weakness improves after repeated movement due to sufficient accumulation of calcium.
name: Lambert-Eaton Syndrome
label: a
answer: yes
explanation: Chemotherapy can lead to general weakness and energy depletion, however, this is unlikely to improve with repeated movements.
name: General weakness following chemotherapy
label: d
answer: no
explanation: Chemotherapy can cause "glove and stocking" neuropathy that affects both the sensory and motor neurons. However, weakness produced by neuropathy is unlikely to improve with repeated movements.
name: Peripheral neuropathy due to chemotherapy
label: b
answer: no

Correct answer: a