hllj/quesmed huggingface dataset:
A patient comes in with type 1 diabetes mellitus. The doctor questions what has caused the autoimmune response in this patient. He suspects that epitope spreading has played a key role in this.

Which of the following is the best description of epitope spreading?

Options:
explanation: Epitope spreading is when the pool of self-reactive T cells responds to self-antigens. These can spread and react to the same antigens in other parts of the body, leading to inflammation in those areas.
name: Continuous destruction of cells leading to further antigens being presented
label: a
answer: yes
explanation: This is the process of releasing 'cryptic antigens'. The destruction of superficial tissue causes the release of hidden antigens which are recognised by self-reactive cells, causing inflammation.
name: Tissue damage causing the release of hidden antigens
label: b
answer: no
explanation: This is the proposed mechanism of systemic lupus erythematosus (SLE) in which small autoantibody complexes attach to small blood vessels. Phagocytes then try to clear these complexes leading to inflammation.
name: Autoantibodies binding to small vessels causing inflammation
label: e
answer: no
explanation: This is bystander activation, whereby self-reactive T and B cells come into contact with dendritic cells which are presenting self-antigens in the presence of inflammation from a different source of infection.
name: Presentation of antigens and presence of inflammation overcoming anergy
label: d
answer: no
explanation: This is molecular mimicry. This is where pathogen antigens are very similar in structure to self-antigens, and so cause an immune response against them. This happens in Gullain-Barre syndrome.
name: Pathogen antigens resembling self-antigens
label: c
answer: no

Correct answer: a
A 68-year-old man is brought to the emergency department via ambulance. His temperature is 38.3 degrees, his heart rate is 115bpm and his blood pressure is 96/73mmHg. His oxygen saturation is 94%. It is suspected that he has an infection in his urinary tract.

What is the next appropriate step in his management?

Options:
explanation: This man has urosepsis, so the main priority is to rapidly perform the sepsis 6 protocol. Prescribing pain relief may be part of the treatment plan, but it will not be the first priority in the management of this patient.
name: Prescribe pain relief
label: e
answer: no
explanation: This man has urosepsis, so the main priority is to rapidly perform the sepsis 6 protocol as it has been shown to improve mortality. Prescribing a beta blocker might help his heart rate but can also cause hypotension which would make his blood pressure even worse.
name: Prescribe a beta blocker
label: d
answer: no
explanation: This man has urosepsis, so the main priority is to rapidly perform the sepsis 6 protocol as it has been shown to improve mortality. Performing a digital rectal examination does not form any part of the management of this patient.
name: Perform a digital rectum examination
label: c
answer: no
explanation: This man has urosepsis, so the first priority is to undertake the sepsis 6:

* Give IV fluids
* Start empirical antibiotics
* Give oxygen
* Measure urine output
* Take blood cultures
* Check lactate
name: Give IV fluids
label: a
answer: yes
explanation: This man has urosepsis, so the main priority is to rapidly perform the sepsis 6 protocol as it has been shown to improve mortality. If the patient continued to desaturate or also had signs of a chest infection then a chest X-ray would be warranted.
name: Perform a chest X-ray
label: b
answer: no

Correct answer: a
A 74-year-old woman has a biopsy taken to investigate a breast cancer diagnosis. The pathologist's report states 'severe cell differentiation indicative of malignancy contained within the basement membrane'.

What is the best treatment for this malignancy?

Options:
explanation: Whilst it is important to surgically remove the breast cancer, most centres would also advise radiotherapy after surgery to prevent the breast cancer from coming back in the future.
name: Surgical removal of tumour
label: c
answer: no
explanation: This malignancy needs to be surgically removed to allow the patient to be cured. Hormonal therapy can be initiated once the biopsy/tumour has been analysed for hormone receptor positivity.
name: Hormonal therapy
label: e
answer: no
explanation: This will not be sufficient to cure this patient of the malignancy as it needs to be surgically excised.
name: Chemotherapy
label: d
answer: no
explanation: As this is only local disease, the best treatment option is to surgically remove the cancer, as well as a margin of normal tissue to ensure that all of the cancer has been removed. Most centres also advise radiotherapy after surgery to prevent the breast cancer from coming back in the future.
name: Surgical removal of tumour and radiotherapy
label: a
answer: yes
explanation: This malignancy is only carcinoma in-situ which means that surgical excision with preventative radiotherapy will be sufficient for this patient. The side effects of chemotherapy outweigh the benefits of giving her this treatment.
name: Surgical removal of tumour and chemotherapy
label: b
answer: no

Correct answer: a
A 26-year-old woman becomes pregnant and is screened for hereditary conditions. It is found that she is a carrier for cystic fibrosis which is an autosomal recessive condition. Her partner is screened for cystic fibrosis and is found to not have the trait or be a carrier.

What is the likelihood of the child being a carrier for cystic fibrosis?

Options:
explanation: This is incorrect as the patient has an autosomal recessive condition, so a child can never be a 100% carrier of the condition.
name: 100%
label: e
answer: no
explanation: As the mother has an autosomal recessive trait and the partner does not have the trait, the child has a 50% chance of being a carrier of cystic fibrosis. The child will not inherit the disease.
name: 50%
label: a
answer: yes
explanation: As the mother has the disease trait, there will always be a 50% chance that the child is a carrier and a 50% chance of the child being homozygous normal (i.e. not having any cystic fibrosis trait at all).
name: 0%
label: b
answer: no
explanation: This would be the likelihood of a child having cystic fibrosis if one parent was a carrier and the other parent had the disease.
name: 75%
label: d
answer: no
explanation: This would be the likelihood of a child having cystic fibrosis if both patients were carriers.
name: 25%
label: c
answer: no

Correct answer: a
A 48-year-old woman presents to her GP with lethargy. After ruling out lack of sleep, the GP decides to do some blood tests. The results show that she has autoantibodies against intrinsic factor.

Where in the body is the molecule that intrinsic factor binds to absorbed?

Options:
explanation: This is incorrect as the kidney plays no part in the absorption of vitamin B12, the molecule that intrinsic factor binds to. This complex is absorbed in the terminal ileum.
name: Kidney
label: d
answer: no
explanation: The molecule that intrinsic factor binds to is vitamin B12. Vitamin B12 needs intrinsic factor to bind to it so it can be absorbed in the terminal ileum.
name: Terminal ileum
label: a
answer: yes
explanation: This is where gastric parietal cells secrete intrinsic factor, not where vitamin B12 (which binds to intrinsic factor) is absorbed in the body.
name: Stomach
label: b
answer: no
explanation: Vitamin B12 is the molecule that is bound to intrinsic factor and is absorbed in the terminal ileum. The liver plays no role in the absorption of vitamin B12.
name: Liver
label: c
answer: no
explanation: This is incorrect as the jejunum absorbs vitamins A, D, E, and K. It does not absorb vitamin B12 which is what intrinsic factor binds to. Vitamin B12 is absorbed in the terminal ileum.
name: Jejunum
label: e
answer: no

Correct answer: a
A 53-year-old male comes into the clinic expressing pains in his stomach. He describes it as waves of squeezing pains. The doctor explains that it is his intestines undergoing peristalsis which is where the smooth muscle in the intestines contract in waves.

With regards to calcium-dependent smooth muscle contraction, what molecule unblocks the binding sites of actin?

Options:
explanation: Myosin light chain kinase needs to be phosphatised into myosin light chain phosphatase before it can activate myosin. This has no role in unblocking the binding sites of actin.
name: Myosin light chain kinase
label: d
answer: no
explanation: Protein kinase C can independently activate myosin light chain kinase, without the need for the calcified calmodulin. Myosin light chain kinase needs to be phosphatised into myosin light chain phosphatase before it can activate myosin.
name: Protein Kinase C
label: e
answer: no
explanation: Myosin light chain phosphatase causes the activation of myosin which binds to actin causing smooth muscle contraction.
name: Myosin light chain phosphatase
label: b
answer: no
explanation: This is the correct answer as calcified calmodulin binds to calponin to unblock actin-binding sites and myosin light chain phosphatase to activate myosin. The binding of myosin to actin causes smooth muscle contraction.
name: Calponin
label: a
answer: yes
explanation: Calmodulin is the molecule that once calcified, activates both calponin and myosin light chain phosphatase, which in turn causes smooth muscle contraction.
name: Calmodulin
label: c
answer: no

Correct answer: a
A 26-year-old female attends the GP surgery following laboratory tests which indicate she has coeliac disease. The doctor has thought about the mechanism by which this diagnosis has occurred.

Which of the following is a step in the pathogenesis of coeliac disease?

Options:
explanation: This is incorrect as the Th1 response is due to gliadin antigens, not gluten antigens. Tissue transglutaminases break down gluten into gliadin which then leads to the autoimmune response.
name: Th1 response happens in response to gluten antigens
label: d
answer: no
explanation: This is the pathogenesis of *Clostridium difficile* infection: an opportunistic infection in which antibiotics prescribed for another infection allow *C. difficile* bacteria into the gut and cause a diarrhoeal infection.
name: Antibiotics kill off colonised bacteria allowing harmful bacteria to enter the gut
label: e
answer: no
explanation: This is incorrect as it is a Th1 response that occurs due to gliadin antigens. This Th1 response causes antibodies to be released by B cells.
name: Th2 response happens in response to gliadin antigens
label: c
answer: no
explanation: This is the correct answer as the first step for coeliac disease to occur is the breakdown of gluten into gliadin. This then leads to dendritic cells taking up the antigens and presenting them to Th1 cells, resulting in antibody production.
name: Tissue transglutaminases break gluten down into gliadin
label: a
answer: yes
explanation: This is the incorrect answer as it is the gluten that is being broken down into gliadin, not the other way around.
name: Tissue transglutaminases break down gliadin into gluten
label: b
answer: no

Correct answer: a
A 38-year-old male with special dietary requirements due to progressive Crohn's disease is on the ward speaking to a dietician. They are wondering how their food gets into their body now that they have had many surgeries on their intestines.

Which cell and corresponding hormone are involved in amino acid and small peptide breakdown?

Options:
explanation: G cells in the duodenum secrete gastrin in response to amino acids and peptides in the stomach. The gastrin stimulates digestive enzyme secretion by acinar cells. Remember **G** cells as secreting **G**astrin.
name: G cells secrete gastrin
label: a
answer: yes
explanation: S cells secrete secretin, not cholecystokinin (CCK). Cholecystokinin (CCK) is produced by I cells in the duodenum.
name: S cells secrete cholecystokinin (CCK)
label: e
answer: no
explanation: S cells secrete secretin when chyme enters the duodenum and the pH is less than 4.5. Secretin has several roles including stimulating the secretion of bicarbonate-rich pancreatic fluid.
name: S cells secrete secretin
label: b
answer: no
explanation: This is incorrect as G cells secrete gastrin, not secretin. Gastrin is produced in response to amino acids and peptides in the stomach. Secretin is produced by S cells.
name: G cells secrete secretin
label: d
answer: no
explanation: This is the response to fatty acids, not amino acids and peptides. Cholecystokinin (CCK) causes contraction of the gallbladder and relaxation of the sphincter of Oddi.
name: I cells secrete cholecystokinin (CCK)
label: c
answer: no

Correct answer: a
A 66-year-old male comes to see the GP about his high blood pressure. The GP measures his blood pressure and it is 174/118mmHg. The GP is worried about this patient's kidney function due to his high blood pressure.

What happens to the afferent arteriole and renin secretion when blood pressure is high?

Options:
explanation: The afferent arteriole vasoconstricts in high blood pressure due to the influx of calcium via stretch-mediated calcium channels. This results in decreased renin secretion.
name: Afferent arteriole vasodilates and decreases renin secretion
label: c
answer: no
explanation: Even though the afferent arteriole vasoconstricts in high blood pressure, there is decreased renin secretion which reduces the effects of the renin-angiotensin-aldosterone (RAAS) system and subsequently reduces blood pressure.
name: Afferent arteriole vasoconstricts and increases renin secretion
label: b
answer: no
explanation: The increased blood pressure activates Ca2+ stretch-sensitive channels, causing an influx of calcium and leading to smooth muscle contraction in the afferent arteriole. This vasoconstriction causes renin secretion to be reduced.
name: Afferent arteriole vasoconstricts and reduces renin secretion
label: a
answer: yes
explanation: The afferent arteriole vasoconstricts in high blood pressure due to the influx of calcium via stretch-mediated calcium channels. This results in decreased renin secretion, not increased renin secretion. This is because the RAAS system will further increase the blood pressure, which is not what the patient needs if his blood pressure is already high.
name: Afferent arteriole vasodilates and increases renin secretion
label: d
answer: no
explanation: Even though the afferent arteriole does vasoconstrict, there is a decrease in renin secretion. As this patient's blood pressure is high, the RAAS system needs to be reduced. This is because when the RAAS system is activated it causes an increase in blood pressure.
name: Afferent arteriole vasoconstricts and there is no change in renin
label: e
answer: no

Correct answer: a
A 39-year-old male is brought to the emergency department following a car accident. They have a full-body trauma CT which shows a spinal cord injury at T11.

What is the correct statement regarding this patient's bowel control with this injury?

Options:
explanation: This is incorrect as the question asks about bowel control after the injury, not urine control.
name: Loss of voiding urine control
label: e
answer: no
explanation: As the lesion is above T12, the enteric nervous system and afferent spinal pathways are intact. These pathways allow the defecation reflex to occur even though the patient will have lost sensation in the bowel, meaning they will not know when their rectum is full.
name: The defecation reflex remains intact
label: a
answer: yes
explanation: In lesions above and below T12, there is a loss of descending control of the bowel, meaning that bowel sensation and the voluntary control to defecate are lost.
name: Bowel sensation remains intact
label: b
answer: no
explanation: This only occurs when the spinal injury is below T12. This is because, below the T12 level, there is a loss of afferent neurons from the bowel to the brain, meaning that the defecation reflex and tone of the anal sphincters are lost.
name: Loss of reflex tone of anal sphincters
label: c
answer: no
explanation: This only occurs when the spinal injury is below T12. This is because, below the T12 level, there is a loss of afferent neurons from the bowel to the brain, meaning that the defecation reflex and tone of the anal sphincters are lost.
name: Loss of defecation reflex
label: d
answer: no

Correct answer: a
A 28-year-old female is hiking up Mount Everest and requires oxygen due to the low oxygen levels at the high altitude. The doctor travelling with them explains to her how the kidneys work to help blood get more oxygen.

How does the kidney respond to hypoxia?

Options:
explanation: This is the response during dehydration as the body tries to absorb more water by increasing aquaporin channels in the collecting ducts. This results in more concentrated urine.
name: Increases production of aquaporin II channels
label: e
answer: no
explanation: Type II Na+/Pi transporters are important in modulating the uptake of the phosphate to maintain homoeostasis.
name: Increases type II Na+/Pi transporters
label: c
answer: no
explanation: Hypoxia prevents the hydroxylation of the transcription factor HIF-2α, encouraging EPO production in the kidneys. This leads to an increase in red blood cells and by extension, an increase in the capacity to carry oxygen.
name: Increases erythropoietin (EPO) production
label: a
answer: yes
explanation: Hypoxia increases the production of EPO, stimulating the production of more red blood cells and allowing for a greater capacity for the body to carry oxygen.
name: Decreases EPO production
label: b
answer: no
explanation: This is the response when there is an increase in blood pressure.
name: The afferent arteriole vasoconstricts
label: d
answer: no

Correct answer: a
A 93-year-old female on a ward is having difficulty swallowing. The speech and language therapists (SALT) come to review her and realise that the thyroid cartilage does not move when she swallows.

Which muscle acts to depress the thyroid cartilage?

Options:
explanation: This muscle acts to depress the hyoid bone, not the thyroid cartilage. It arises from the thyroid cartilage and ascends to attach to the hyoid bone.
name: Thyrohyoid muscle
label: d
answer: no
explanation: This is the only muscle that depresses the thyroid cartilage. It is found in the deep plane of the cervical fascia in the neck. It arises from the manubrium of the sternum and attaches to the thyroid cartilage.
name: Sternothyroid muscle
label: a
answer: yes
explanation: This muscle acts to depress the hyoid bone, not the thyroid cartilage. It originates from the sternum and sternoclavicular joint and then ascends and inserts onto the hyoid bone.
name: Sternohyoid muscle
label: c
answer: no
explanation: This muscle acts to depress the hyoid bone, not the thyroid cartilage, and has 2 muscle bellies, connected by a muscular tendon.
name: Omohyoid muscle
label: b
answer: no
explanation: This muscle performs lateral flexion, rotation, and extension for the neck. It is innervated by the accessory nerve (cranial nerve XI).
name: Sternocleidomastoid muscle
label: e
answer: no

Correct answer: a
A 26-year-old male presents to the GP with tremors, visual disturbances, and constant sweating. The GP examines the patient and finds a swelling in the neck.

The GP performs blood tests that show: TSH <0.01 (low), fT3 - 16 (high), and fT4 - 41 (high).

What is the finding that will confirm that this is Grave's disease?

Options:
explanation: This would suggest a diagnosis of Hashimoto's thyroiditis. This is also an autoimmune thyroid disease like Grave's disease, but this causes hypothyroidism, not hyperthyroidism.
name: TPO antibodies
label: e
answer: no
explanation: This would most likely suggest post-partum thyroiditis. This is because the beta chain of hCG is very similar to the beta chain of TSH, therefore it can mimic TSH and activate the thyroid gland to produce fT3 and fT4. The typical clinical progression of post-partum thyroiditis is hyperthyroidism, followed by hypothyroidism, before returning to euthyroidism.
name: The discovery that the patient gave birth 3 months ago
label: d
answer: no
explanation: This would most likely suggest a toxic adenoma due to there only being a single nodule on the thyroid gland. Even though there are signs of hyperthyroidism in the blood tests, the only way to confirm that this is Grave's disease is to look for the presence of TSH antibodies.
name: A single nodule on thyroid ultrasound
label: c
answer: no
explanation: This would most likely indicate a toxic multinodular goitre. Even though there are signs of hyperthyroidism in the blood tests, the only way to confirm that this is Grave's disease is to look for the presence of TSH antibodies.
name: Multiple nodules during the neck examination
label: b
answer: no
explanation: Grave's disease is an autoimmune condition in which there is an overproduction of antibodies that stimulate the TSH receptor. This causes an increase in fT3 and fT4, leading to symptoms of hyperthyroidism.
name: TSH antibodies
label: a
answer: yes

Correct answer: a
A 43-year-old female presents to the ED with right upper quadrant abdominal pain which is worse after eating fatty meals. The pain can stop suddenly without any explanation.

On examination, the patient is slightly pyrexic and is tender in the right upper quadrant. The doctor thinks this could be biliary colic.

What is the blood supply to the structure affected in this patient?

Options:
explanation: The left gastric artery supplies the oesophagus and lesser curvature of the stomach. It is a branch of the coeliac trunk. The structure affected in this patient is the gallbladder, which is supplied by the cystic artery.
name: Left gastric artery
label: d
answer: no
explanation: The middle adrenal artery supplies the adrenal glands. The structure affected in this patient is the gallbladder, which is supplied by the cystic artery.
name: Middle adrenal artery
label: c
answer: no
explanation: The cystic artery supplies the gallbladder which is the source of biliary colic pain. The cystic artery is a branch of the right hepatic artery.
name: Cystic artery
label: a
answer: yes
explanation: The splenic artery supplies the spleen and pancreas. The structure affected in this patient is the gallbladder, which is supplied by the cystic artery.
name: Splenic artery
label: b
answer: no
explanation: The right subclavian artery supplies the right upper limb, not the abdomen. It is a branch of the brachiocephalic trunk. The structure affected in this patient is the gallbladder, which is supplied by the cystic artery.
name: Right subclavian artery
label: e
answer: no

Correct answer: a
An 84-year-old woman comes into the hospital with a UTI and is treated on the wards. 3 days in, the patient develops a cough with purulent sputum. She is MRSA-negative and has no allergies. The doctor prescribes antibiotics for this patient.

As per NICE, which antibiotics would be given to this patient, given their new presentation?

Options:
explanation: Vancomycin is used for MRSA-associated infections. As this patient is MRSA-negative, there is no need to use this drug as it has more severe side effects than co-amoxiclav.
name: Vancomycin
label: c
answer: no
explanation: Doxycycline is used to treat hospital-acquired pneumonia if a patient is allergic to penicillin. This patient has no allergies so co-amoxiclav is the first choice.
name: Doxycycline
label: d
answer: no
explanation: This patient has developed hospital-acquired pneumonia from being on the wards for 3 days. The first-line treatment for hospital-acquired pneumonia as per NICE is co-amoxiclav.
name: Co-amoxiclav
label: a
answer: yes
explanation: Co-trimoxazole is typically used to treat ventilator-associated pneumonia. As this patient has not been ventilated, there is no need to use this drug to treat their hospital-acquired pneumonia. Co-trimoxazole contains trimethoprim and sulfamethoxazole. It can be used to treat hospital-acquired pneumonia if a patient is penicillin allergic or if there is a high resistance to penicillin in the local population.
name: Co-trimoxazole
label: b
answer: no
explanation: Nitrofurantoin is used to treat urinary tract infections, not pneumonia.
name: Nitrofurantoin
label: e
answer: no

Correct answer: a