hllj/quesmed huggingface dataset:
A 29-year-old female presents to her GP with tiredness and fatigue. On further assessment, she is found to have a drooping eyelid with double vision which worsens through the day. She is getting increasingly tired and weak as well.
Through further investigations, she gets diagnosed with an autoimmune condition.

What type of hypersensitivity reaction is involved in this condition?

Options:
explanation: Myasthenia gravis is not a T cell-mediated delayed hypersensitivity reaction. This is classically in dermatitis and the Mantoux test.
name: Type IV hypersensitivity
label: c
answer: no
explanation: Myasthenia gravis is not an antigen-antibody immune complex-mediated hypersensitivity reaction. This is classically in rheumatoid arthritis, post-streptococcal glomerulonephritis
name: Type III hypersensitivity
label: e
answer: no
explanation: Myasthenia gravis is not an antibody-mediated stimulatory hypersensitivity reaction. This is classically in Grave's disease.
name: Type V hypersensitivity
label: d
answer: no
explanation: This patient most likely has myasthenia gravis characterised by increasing weakness during the day, drooping eyelids and muscle fatiguability. Myasthenia gravis is an autoimmune condition wherein auto-antibodies bind to acetylcholine receptors in the neuromuscular junction leading to their IgG-mediated immune destruction. This type of hypersensitivity reaction with IgG antibody-mediated cytotoxic reaction is classically a type II hypersensitivity reaction
name: Type II hypersensitivity
label: a
answer: yes
explanation: Myasthenia gravis is not an immediate IgE-mediated hypersensitivity reaction. This is classically in allergic and atopic diseases.
name: Type I hypersensitivity
label: b
answer: no

Correct answer: a
A 62 year old male is brought into GP with joint pain in his hands that improves on movement. He also mentions occasionally getting painful red eyes.

On examination, there are bilateral red swollen stiff MCP joints associated with reduced range of movement.

Given the likely diagnosis, what sign will be seen on the X-Ray of his hands?

Options:
explanation: This may be seen in rheumatoid arthritis, but it is mostly a sign seen on X-Ray of joints with osteoarthritis.
name: Subarticular sclerosis
label: e
answer: no
explanation: Rheumatoid arthritis is associated with loss of joint space.
name: Increased joint space
label: d
answer: no
explanation: This man is likely to have Rheumatoid arthritis. On X-Ray, there will be subarticular osteopenia due to a decrease in bone mineral density near affected joint due to an autoimmune-mediated attack.
name: Subarticular osteopaenia
label: a
answer: yes
explanation: This is a sign seen on X-Ray of joints with osteoarthritis.
name: Osteophytes
label: b
answer: no
explanation: This is a sign seen on an X-Ray of joints with osteoarthritis.
name: Subchondral cysts
label: c
answer: no

Correct answer: a
A 27-year-old female is on methotrexate for rheumatoid arthritis.

Which of the following medications is absolutely contraindicated in this patient?

Options:
explanation: Although both methotrexate and cefotaxime increase likelihood of nephrotoxicity, it is not contraindicated.
name: Cefotaxime
label: c
answer: no
explanation: There are no drug-drug interactions between nitrofurantoin and methotrexate.
name: Nitrofurantoin
label: b
answer: no
explanation: Both trimethoprim and methotrexate inhibit dihydrofolate reductase in folic acid metabolism. When prescribed together, they can lead to bone marrow suppression. Hence, trimethoprim is absolutely contraindicated in this patient.
name: Trimethoprim
label: a
answer: yes
explanation: There are no drug-drug interactions between clarithromycin and methotrexate.
name: Clarithromycin
label: e
answer: no
explanation: Although both methotrexate and vancomycin increase the likelihood of nephrotoxicity, it is not absolute contraindicated.
name: Vancomycin
label: d
answer: no

Correct answer: a
A 77-year-old male comes in with recurrent episodes of hot, swollen, stiff, painful knee. He is diagnosed with pseudogout on analysing the joint aspirate under a polarised light microscope.

What were the most likely findings of his joint aspirate?

Options:
explanation: This is not an observation in pseudogout. The crystals are usually rhomboid-shaped, not circular.
name: Positively birefringent circular crystals
label: e
answer: no
explanation: These are the typical crystals of calcium pyrophosphate observed under polarised light microscopy in pseudogout.
name: Positively birefringent rhomboid crystals
label: a
answer: yes
explanation: This is not an observation in pseudogout. The crystals are positively birefringent, not negatively.
name: Negatively birefringent rhomboid crystals
label: c
answer: no
explanation: This is an observation in gout.
name: Negatively birefringent needle-shaped crystals
label: d
answer: no
explanation: This is not an observation in pseudogout. The crystals are rhomboid-shaped, not needle shaped.
name: Positively birefringent needle-shaped crystals
label: b
answer: no

Correct answer: a
The epiglottis is a flap of tissue in the larynx below the tongue that is involved in preventing food from entering the airways. It is made of cartilage, a special form of connective tissue with many functions.

What type of collagen is cartilage mostly comprised of?

Options:
explanation: The extracellular matrix in cartilage consists of fibrous proteins of mostly type II collagen fibres which provides mechanical stability. It is also made of type IX, X and XI collagen fibres
name: Type II collagen fibres
label: a
answer: yes
explanation: These are major component of the basal lamina in structures like alveoli and glomeruli for membrane transport.
name: Type IV collagen fibres
label: d
answer: no
explanation: These are major components in bone extracellular matrix. They are also present in tendons and ligaments.
name: Type I collagen fibres
label: b
answer: no
explanation: These are major components in hollow organs like blood vessels, bowels etc.
name: Type III collagen fibres
label: c
answer: no
explanation: These are major components of the skin and are associated with type I collagen fibres.
name: Type V collagen fibres
label: e
answer: no

Correct answer: a
An 88 year old female comes into A&E after a fall, with a suspected fracture of the neck of the femur.

Which of the following is a sign seen most commonly observed in a fractured neck of femur?

Options:
explanation: This is not usually observed with any neck or femur pathology.
name: Flexed and internally rotated leg
label: c
answer: no
explanation: This may be observed with a posterior hip dislocation.
name: Shortened flexed leg
label: b
answer: no
explanation: This is usually associated with a posterior hip dislocation.
name: Shortened internally rotated leg
label: d
answer: no
explanation: This is not usually observed with any neck or femur pathology.
name: Flexed and externally rotated leg
label: e
answer: no
explanation: A fractured neck of femur causes this appearance due to discontinuity in the hip flexors and extensors. This shortens the leg and leads to the unopposed pull of the iliopsoas muscle attached to lesser trochanter on the femur, leading to external rotation.
name: Shortened externally rotated leg
label: a
answer: yes

Correct answer: a
A woman undergoes prolonged labour along with shoulder dystocia. The new born is found to have an internally rotated arm.

What is the most likely type of nerve injury?

Options:
explanation: This involves the radial nerve and causes weakness in the forearm and wrist and leads to wrist drop. This is not observed with shoulder dystocia.
name: Radial nerve palsy
label: e
answer: no
explanation: This involves C8-T1 nerve roots that usually causes sensory loss and weakness in the intrinsic muscles of the hand. This is not usually observed with shoulder dystocia.
name: Klumpke's palsy
label: b
answer: no
explanation: This involves the ulnar nerve and causes sensory loss and weakness in the medial wrist and leads to clawing the hand. This is not observed with shoulder dystocia.
name: Cubital tunnel syndrome
label: d
answer: no
explanation: Shoulder dystocia is most associated with Erb's palsy, involving C5-C6 nerve roots in the brachial plexus. This leads to shoulder adduction, elbow extension, forearm pronation and wrist flexion, which is seen in the neonate.
name: Erb's palsy
label: a
answer: yes
explanation: This involves the median nerve and causes sensory loss and weakness in the lateral wrist. This is not observed with shoulder dystocia.
name: Carpal tunnel syndrome
label: c
answer: no

Correct answer: a
A 26-year-old female footballer is brought into A&E after taking a hit to the back of her right knee in a game. She heard a painful 'pop' sound when she got hit and has been unable to walk ever since.

On assessment, she has a tender swollen right knee and positive anterior drawer test. There are no other findings on further examination.

What structure is the most likely to have been damaged?

Options:
explanation: The mechanism of injury to the back of the knee and the positive anterior draw test indicate laxity in the anterior cruciate ligament. This is most likely to have been damaged in this injury.
name: Anterior cruciate ligament
label: a
answer: yes
explanation: This is less likely as the injury was not to the lateral side of the knee.
name: Medial cruciate ligament
label: e
answer: no
explanation: This is less likely as the injury was not to the medial side of the knee.
name: Lateral cruciate ligament
label: d
answer: no
explanation: This is less likely as the injury was to the back of the knee.
name: Patella
label: b
answer: no
explanation: This is less likely as the injury was not to the front of the knee and anterior draw test was positive.
name: Posterior cruciate ligament
label: c
answer: no

Correct answer: a
A 16-year-old male is discharged after manual reducing an anteriorly dislocated right shoulder. He attends GP after 3 weeks with difficulty lifting his arm.

On examination, there is sensory loss over the lateral proximal right arm. He is also unable to hold his right arm up when passively extended.

Which nerve is most likely to have been damaged?

Options:
explanation: This is unlikely as damage to radial nerve causes weakness in extending the arm and fingers, leading to wrist drop.
name: Radial nerve
label: b
answer: no
explanation: This commonly occurs in anterior shoulder dislocation and affects motor function of the deltoid muscle. Damage to this nerve leads to weakness in shoulder abduction and sensory loss on the lateral deltoid, commonly known as the regimental patch.
name: Axillary nerve
label: a
answer: yes
explanation: This is unlikely as damage to median nerve causes the hand of benediction due to weak flexion of the lateral three fingers.
name: Median nerve
label: d
answer: no
explanation: This is unlikely as damage to the long thoracic nerve causes a winged scapula and affects protraction of the arm.
name: Long thoracic nerve
label: c
answer: no
explanation: This is unlikely as damage to the ulnar nerve causes claw hand deformity due to fixed flexion of the medial two fingers.
name: Ulnar nerve
label: e
answer: no

Correct answer: a
A male has come into a sexual health clinic to get a referral for an elective vasectomy.

What advice must he be given about vasectomies?

Options:
explanation: This is incorrect as vasectomies can be reversed. This is not routinely offered and the success rate varies, but they can be reversed under extreme circumstances.
name: Vasectomies are permanently irreversible
label: d
answer: no
explanation: This is needed before undergoing a vasectomy to exclude potential problems like varicocele or hydrocoele.
name: Vasectomies do not require a pre-procedural scrotal examination
label: b
answer: no
explanation: This is incorrect and the pre-sterilisation process is integral to identify people at risk of regret after permanent sterilisation and informing them of alternatives.
name: Vasectomies do not require a pre-sterilisation assessment
label: e
answer: no
explanation: Vasectomies involve sealing the ends of the vas deferens to prevent the transport of sperm from the testis to the penis. This prevents conception but does not protect against sexually transmitted infections. Patients may be recommended to use barrier contraception if indicated.
name: Vasectomies do not offer protection against sexually transmitted infections
label: a
answer: yes
explanation: This is incorrect and azoospermia needs to be confirmed by post-vasectomy semen analysis around 12 weeks after the procedure to deem vasectomy successful.
name: Vasectomies provide effective contraception immediately after surgery
label: c
answer: no

Correct answer: a
A female has come into GP to get a copper intra-uterine device (IUD) inserted.

What is the mechanism of action of this coil in preventing pregnancy?

Options:
explanation: This IUD releases copper ions which affect sperm motility. This prevents the sperm from entering the uterus and fallopian tubes to fertilise the egg.
name: Spermicidal
label: a
answer: yes
explanation: Copper IUD tends to thicken cervical mucus which decreases the likelihood of fertilisation.
name: Thins cervical mucus
label: d
answer: no
explanation: This is the mechanism of hormonal contraceptions like hormonal IUDs, combined pill and so on.
name: Suppresses ovulation
label: e
answer: no
explanation: This is the mechanism of action of condoms, diaphragms and so on.
name: Physical barrier
label: c
answer: no
explanation: This is the mechanism of action of a hormonal IUD.
name: Thins the uterine wall
label: b
answer: no

Correct answer: a
A female has come into GP requesting a prescription for the combined oral contraceptive pill (COCP).

Which of these is an absolute contraindication for prescribing the COCP?

Options:
explanation: The COCP is absolutely contraindicated in smokers above 35 years.
name: Smokers <35 years
label: b
answer: no
explanation: The COCP is contraindicated in patients with complications of diabetes like retinopathy, neuropathy or nephropathy.
name: Diabetes
label: c
answer: no
explanation: The COCP is absolutely contraindicated in patients with current breast cancer.
name: Family history of breast cancer
label: d
answer: no
explanation: The COCP is contraindicated in patients who are less than 6 weeks postpartum.
name: 8 weeks postpartum
label: e
answer: no
explanation: The COCP is absolutely contraindicated in patients experiencing migraines with aura as they increase the likelihood of ischaemic strokes.
name: Migraine with aura
label: a
answer: yes

Correct answer: a
A young couple have come into GP with concerns about not conceiving a child.

Which of the following is the definition of infertility?

Options:
explanation: This is the accepted definition of infertility according to WHO and NICE guidelines.
name: Failure to conceive after frequent unprotected sexual intercourse for one year
label: a
answer: yes
explanation: This does not specify unprotected sexual intercourse and cannot be considered the correct definition of infertility.
name: Inability to conceive after frequent sexual intercourse for 2 or more years
label: d
answer: no
explanation: This is the definition of surgical sterilisation.
name: Permanent prevention in conception
label: c
answer: no
explanation: This is the definition of secondary infertility.
name: Previously successful conception followed by inability to conceive for one year after unprotected sexual intercourse
label: e
answer: no
explanation: This is the definition of sub-fertility.
name: Prolonged delay in conception
label: b
answer: no

Correct answer: a
A new mother comes into GP enquiring about lactational amenorrhoeic method (LAM) of contraception.

What is the mechanism of LAM in preventing pregnancy?

Options:
explanation: This does not occur in LAM. It is likely to happen when using an intrauterine device.
name: Thickens cervical mucus
label: c
answer: no
explanation: Breastfeeding can temporarily prevent pregnancy as suckling by an infant reduces production of gonadotrophin. This leads to suppression of ovulation, which prevents conception.
name: Suppression of ovulation
label: a
answer: yes
explanation: This does not occur in LAM. It is associated with female sterilisation like tubectomy.
name: Prevents transport of egg through fallopian tube
label: e
answer: no
explanation: This does not occur in LAM. It is likely to happen when using hormonal contraceptives like the combined pill or intra-uterine device.
name: Alters vaginal pH
label: b
answer: no
explanation: This does not occur in LAM. It is likely to happen when using an intrauterine device.
name: Thins uterine lining
label: d
answer: no

Correct answer: a
A woman has recently delivered a baby followed by the placenta. She enquires about the function of the placenta.

Which structure carries oxygen from the placenta to the foetus?

Options:
explanation: This is the shunt which connects the pulmonary artery to the aorta to bypass the lungs in foetal circulation.
name: Ductus arteriosus
label: e
answer: no
explanation: This carries deoxygenated blood from the foetal peripheral circulation to the heart.
name: Superior vena cava
label: b
answer: no
explanation: This is the shunt that allows oxygenated blood in the umbilical vein to bypass the liver when entering foetal circulation.
name: Ductus venosus
label: d
answer: no
explanation: These carry deoxygenated blood from the foetus to the placenta.
name: Umbilical arteries
label: c
answer: no
explanation: The umbilical vein carries oxygenated blood from the placenta to the foetal heart via the inferior vena cava.
name: Umbilical vein
label: a
answer: yes

Correct answer: a
A neonate is being admitted into the Special Care Baby Unit on developing jaundice 36 hours after birth.

Which of the following is a risk factor for physiologic jaundice of the neonate?

Options:
explanation: This is a cause of breast milk jaundice or breastfeeding jaundice, not physiological jaundice.
name: Breastfeeding
label: d
answer: no
explanation: This is incorrect as neonates tend to have poorly developed at less effective hepatic bilirubin metabolism. This increases the likelihood of physiologic jaundice by causing unconjugated hyperbilirubinaemia.
name: Highly developed hepatic metabolism
label: e
answer: no
explanation: This is incorrect as neonatal red cells have shorter life span. This increases the breakdown to form bilirubin and the likelihood of physiologic jaundice.
name: Prolonged red cell life span
label: b
answer: no
explanation: This is incorrect as neonates tend to be relatively polycythaemic at birth. Anaemia in neonates is a pathological cause of jaundice.
name: Physiological anaemia
label: c
answer: no
explanation: Enterohepatic circulation is increased in neonates due to prolonged transit time and low bacterial levels in small intestine. This results in increased reabsorption of bilirubin, increasing the likelihood of physiologic jaundice.
name: Increased enterohepatic circulation
label: a
answer: yes

Correct answer: a
A mother brings in her 3 year old son to the GP with concerns regarding his development.

Which of the following is a red flag for fine motor and vision development in a 3-year-old?

Options:
explanation: This is a fine motor skill that is expected in children at age 3.
name: Can only draw circles and lines
label: d
answer: no
explanation: This is a more advanced skill and children should be able to use scissors by age 4.
name: Unable to use scissors
label: b
answer: no
explanation: This is a red flag in their fine motor development as it shows difficulty in manipulating small objects
name: Unable to help dress themselves
label: a
answer: yes
explanation: This is a gross motor developmental feature and is also a red flag by age 3.
name: Unable to ride a tricycle
label: c
answer: no
explanation: This is a more advanced skill and children should be able to use knife and fork by age 5.
name: Unable to use knife and fork
label: e
answer: no

Correct answer: a
Which of the following is considered diagnostic for Down’s syndrome in the antenatal screening?

Options:
explanation: This is considered in the initial screening test for Down's syndrome. It is not diagnostic.
name: Serum hCG levels
label: d
answer: no
explanation: This is considered diagnostic for Down's Syndrome as the sample of fluid is taken directly from the foetus' amniotic sac to undergo genetic testing. This can identify chromosomal abnormalities in the foetus like Down's Syndrome.
name: Amniocentesis
label: a
answer: yes
explanation: This is considered in the quadruple test for screening for  Down's syndrome. It is not diagnostic.
name: Alpha-fetoprotein
label: e
answer: no
explanation: This is considered in the combined test for screening for Down's syndrome. It is not diagnostic.
name: Nuchal thickness measurement
label: c
answer: no
explanation: This is the second screening test that can be undergone to help decide whether to have the diagnostic test or not. It is not diagnostic.
name: Non-invasive prenatal test (NIPT)
label: b
answer: no

Correct answer: a
A new mother is being counselled about breastfeeding at GP. During the consultation, the GP turns to you to explain the physiology of breastfeeding.

Which hormone is released during breastfeeding that triggers breastmilk production?

Options:
explanation: This suppresses breast milk production during pregnancy. It is not involved in breast milk production.
name: Progesterone
label: d
answer: no
explanation: This is involved in the milk letdown reflex, not breast milk production. During breastfeeding, when the baby suckles, oxytocin is released from the posterior pituitary to cause smooth muscles around the alveoli to contract and eject milk from the milk duct.
name: Oxytocin
label: e
answer: no
explanation: Prolactin is the hormone involved in milk secretion by alveolar cells in the mammary tissue. It stimulates the growth and development of mammary tissue during pregnancy, and levels rise after delivery. During breastfeeding, when the baby suckles, the anterior pituitary increases prolactin production and secretion, which stimulates breast milk production by the alveoli.
name: Prolactin
label: a
answer: yes
explanation: This suppresses breast milk production during pregnancy. It is not involved in breast milk production.
name: Oestrogen
label: b
answer: no
explanation: Thyroid hormones are generally not involved in breast milk production.
name: Thyroid hormones
label: c
answer: no

Correct answer: a
A new mother is being counselled about breastfeeding at GP.

Which of the following is a benefit of formula feeding a baby over breastfeeding?

Options:
explanation: Breast milk also contains lactoferrin, which enhances iron absorption in the infant.
name: Helps in iron absorption
label: b
answer: no
explanation: This is more likely with breast milk, as infants cannot be overfed on breast milk but can on formula milk. Formula milk increases their likelihood of being overweight and developing diabetes in their young years.
name: Helps reduce risk of juvenile-onset diabetes
label: d
answer: no
explanation: Breast milk is far superior in helping boost the infant's immune system by transferring white cells, cytokines and immunoglobulins to the infant.
name: Boosts infant's immunity
label: c
answer: no
explanation: Breast milk is low in Vitamin D, which is available in most formula milk. Taking vitamin D supplements is recommended for all pregnant and breastfeeding women.
name: Good source of vitamin D
label: a
answer: yes
explanation: Formula milk is high in casein, while breast milk is high in whey protein. Whey protein is much easier to digest.
name: High in whey protein
label: e
answer: no

Correct answer: a