hllj/quesmed huggingface dataset:
A mother brings her three-year-old child to the GP concerned that he is squinting when looking at objects and is falling over more than other children. She reports that the optometrist has diagnosed the child with amblyopia.

What is the consequence of amblyopia if left untreated?

Options:
explanation: Ptosis is another cause of amblyopia which comes under deprivation amblyopia. It causes an obstruction of the visual axis interfering with the formation of a retinal image in the affected eye. Two different retinal images are sent to the brain, specifically the visual cortex. The visual cortex suppresses the image from the affected eye. If left untreated this can result in permanent blindness in the affected eye.
name: Ptosis
label: d
answer: no
explanation: When two different retinal images are sent to the brain, specifically the visual cortex, the visual cortex suppresses the image from the affected eye. When this happens during visual development (this takes place mainly during the first 3 years of life but carries on until about 8 years), a reduction in the visual acuity of the affected eye results. The persistence of disuse of the affected eye during visual development can result in permanent blindness in the affected eye if left untreated.
name: Permanent vision loss
label: a
answer: yes
explanation: Strabismus (when the eyes point in different directions) is a cause of amblyopia. It results in two different retinal images being sent to the brain, specifically the visual cortex. The visual cortex suppresses the image from the affected eye. If left untreated this can result in permanent blindness in the affected eye.
name: Strabismus
label: b
answer: no
explanation: Astigmatism is another cause of amblyopia (comes under anisometropia as a cause of amblyopia). The cornea or lens may have an oblong shape instead of a curved one, causing light to focus unevenly on the retina. It results in two different retinal images being sent to the brain, specifically the visual cortex. The visual cortex suppresses the image from the affected eye. If left untreated this can result in permanent blindness in the affected eye.
name: Astigmatism
label: c
answer: no
explanation: Myopia is another cause of amblyopia (comes under anisometropia as a cause of amblyopia). Due to the short-sightedness, it results in different focus of the retinal images. the higher the refractive error the less focused the image is. Two different retinal images are sent to the brain, specifically the visual cortex. The visual cortex suppresses the image from the affected eye. If left untreated this can result in permanent blindness in the affected eye.
name: Myopia
label: e
answer: no

Correct answer: a
A mother comes in with her 15-month-old infant concerned about his hearing. She informs you that when she speaks to her baby, he doesn’t look or respond to this. She is concerned that he is unable to hear. There is no familial history of hearing difficulties.

What hearing test would be appropriate to do?

Options:
explanation: Conditioned play audiometry is used for children who are more than 24 months old.
name: Conditioned play audiometry
label: b
answer: no
explanation: Auditory brainstem responses are an objective measure to test a child's hearing when they are under 6 months old. However, it can be used in adults too.
name: Auditory brainstem responses
label: e
answer: no
explanation: Conventional audiometry is used in children who are more than 3 years old.
name: Conventional audiometry
label: c
answer: no
explanation: Otoacoustic emissions are used in the newborn hearing screening program.
name: Otoacoustic emissions
label: d
answer: no
explanation: Visual reinforcement audiometry is used for infants between the age of 6-24 months. It utilises a combination of auditory stimuli with visually engaging rewards to evaluate their hearing abilities when they are unable to provide verbal responses thereby, facilitating early intervention and treatment.
name: Visual reinforcement audiometry
label: a
answer: yes

Correct answer: a
A 35-year-old male patient presents to the outpatient ENT clinic with hearing loss. The doctor performs a basic hearing assessment with a tuning fork. On placing the tuning fork in the centre of his head, the patient hears the sound most in his left ear. In both his left and right ears, the sound from the tuning fork was heard loudest when placed in front of the ear rather than on the bone.

What type of hearing loss is this patient experiencing?

Options:
explanation: In left-sided conductive hearing loss, Rinne’s test would be negative in the left ear (bone conduction > air conduction) and Weber’s test would lateralise to the left ear also.
name: Conductive hearing loss of the left ear
label: d
answer: no
explanation: In normal hearing, Weber’s test is heard in the centre of the forehead.
name: Normal hearing in both ears
label: e
answer: no
explanation: In sensorineural hearing loss, Rinne’s test is positive (indicating air conduction is better than bone conduction) and Weber’s is heard in the unaffected ear.
name: Sensorineural hearing loss of the right ear
label: a
answer: yes
explanation: In right-sided conductive hearing loss, Rinne’s test would be negative in the right ear (bone conduction > air conduction) and Weber’s test would lateralise to the right ear also.
name: Conductive hearing loss of the right ear
label: c
answer: no
explanation: In left-sided sensorineural hearing loss, Weber’s test would lateralise to the right (unaffected) ear.
name: Sensorineural hearing loss of the left ear
label: b
answer: no

Correct answer: a
A 45-year-old female patient with a current diagnosis of facial nerve palsy is troubled by hyperacusis.

Which muscle is responsible for her symptoms?

Options:
explanation: The tensor tympani decreases sound transmission through the middle ear. It is innervated by the mandibular branch of the trigeminal nerve.
name: Tensor tympani
label: b
answer: no
explanation: Frontalis muscle is one of the facial muscles producing facial expressions. It is innervated by the facial nerve and would be paralysed in facial nerve palsy. However, it has no role in hyperacusis.
name: Frontalis muscle
label: e
answer: no
explanation: The transverse muscle of the auricle modifies the auricular shape, it has no function in dampening noises to protect the middle and inner ear.
name: Transverse muscle of the auricle
label: d
answer: no
explanation: The temporalis muscle is one of the muscles of mastication. It is innervated by the trigeminal nerve.
name: Temporalis muscle
label: c
answer: no
explanation: The stapedius is a small muscle in the middle ear, innervated by the facial nerve. Its primary function is to stabilize the stapes bone and regulate sound, protecting your inner ear from damage due to loud noises. Its function can be lost with facial nerve palsy, producing hyperacusis due to loss of dampening.
name: Stapedius muscle
label: a
answer: yes

Correct answer: a
A 74-year-old male presents to A&E with his wife complaining of speech difficulties. His wife informs you that when he is speaking, he no longer makes sense. The patient can speak fluently but answers inappropriately to questions and is easily frustrated due to no one understanding him.

What type of aphasia is the patient experiencing?

Options:
explanation: In conduction aphasia, the lesion is in the arcuate fasciculus. This is the white matter found between Wernicke's and Broca's area. Comprehension is preserved but fluency is slightly reduced. However, repetition is severely impaired.
name: Conduction aphasia
label: d
answer: no
explanation: Receptive aphasia, otherwise known as Wernicke’s aphasia, is caused by a lesion in the superior temporal gyrus. It is characterised by impaired comprehension with preserved fluency. The content of their speech is often incoherent, filled with neologisms, and may lack proper grammar and syntax. In some cases, people with Wernicke's aphasia may produce what appears to be a "word salad." To remember it **W**ernicke's is **W**ordy but makes no sense or **W**ernicke's= "**W**hat?".
name: Receptive aphasia
label: a
answer: yes
explanation: In global aphasia fluency and comprehension are both lost and loss of both language production and understanding. Both Broca's and Wernicke's areas are affected.
name: Global aphasia
label: c
answer: no
explanation: Dysarthria is a motor speech disorder that results from impaired or weakened control over the muscles involved in speech production. This can affect speech, including articulation, pronunciation, voice quality, and speech fluency.
name: Dysarthria
label: e
answer: no
explanation: Expressive aphasia occurs from a lesion in Broca's area which is located in the inferior frontal gyrus in the dominant hemisphere. Comprehension is persevered but fluency is impaired. Patients would know what they want to say but cannot articulate it. To remember it **B**rocas's **B**roken **B**oca.
name: Expressive aphasia
label: b
answer: no

Correct answer: a
A 72-year-old man presents to A&E with left-sided weakness and speech difficulties. His symptoms started two hours ago. He has a past medical history of peripheral vascular disease and is a smoker. A CT head showed a hyper-dense right middle cerebral artery.

Given the likely diagnosis, what is the initial management?

Options:
explanation: This patient has presented within a 4.5-hour time frame so both thrombolysis and thrombectomy should be used. Thrombectomy only is indicated if the patient presents between 4-6 hours.
name: Thrombectomy only
label: c
answer: no
explanation: Patients with an ischaemic stroke presenting within 4.5 hours should be treated with thrombectomy and thrombolysis.
name: Thrombectomy and thrombolysis
label: a
answer: yes
explanation: Clopidogrel is used in the secondary prevention of stroke and not used initially.
name: Clopidogrel
label: e
answer: no
explanation: This patient has presented within a 4.5-hour time frame so both thrombolysis and thrombectomy should be used.
name: Thrombolysis only
label: d
answer: no
explanation: Warfarin should not be given in the acute phase of an ischaemic stroke.
name: Warfarin
label: b
answer: no

Correct answer: a
A 54-year-old female patient with known multiple sclerosis presents to her neurologist. She has been gradually deteriorating and is now unable to walk due to pain, muscle weakness and balance problems. She becomes upset during the consultation and informs you that she hasn’t ever had a remission period and is deteriorating much quicker than she had imagined. She has had no acute relapses.

Which type of multiple sclerosis fits her presentation?

Options:
explanation: This is a rare form of the condition which is characterised by a steady progression of disability from the beginning, with acute relapses. The patient describes no acute relapses.
name: Progressive relapsing multiple sclerosis
label: d
answer: no
explanation: Primary progressive multiple sclerosis is characterised by a steady progression of disability from the onset of the disease, with no relapses.
name: Primary progressive multiple sclerosis
label: a
answer: yes
explanation: Individuals with relapsing-remitting multiple sclerosis eventually transition into secondary-progressive multiple sclerosis. The disease becomes more steadily progressive and relapses become less frequent. There is a gradual accumulation of disability. The patient describes no remission periods and is more likely to have primary progressive multiple sclerosis.
name: Secondary progressive multiple sclerosis
label: b
answer: no
explanation: The patient does not describe any remission periods.
name: Relapsing-remitting multiple sclerosis
label: c
answer: no
explanation: This is a **single** episode of neurological symptoms resulting from inflammation and demyelination in the central nervous system.
name: Clinically isolated syndrome
label: e
answer: no

Correct answer: a
A 29-year-old man has been admitted to the neurology ward with lower limb weakness. He has an ataxic gait. His past medical history includes a single episode of optic neuritis. The neurologist would like to perform a lumbar puncture to look for evidence of multiple sclerosis.

What is the characteristic sign of multiple sclerosis on a lumbar puncture?

Options:
explanation: A turbid appearance would indicate infection.
name: Turbid appearance
label: c
answer: no
explanation: Although white cell count may be elevated in MS up to seven times the normal limit, a level over >100/µL would indicate a bacterial central nervous system infection.
name: Elevated neutrophil count, >100/µL
label: b
answer: no
explanation: An elevated protein level in the absence of leukocytosis is more suggestive of Guillain‐Barré syndrome, rather than MS.
name: Elevated protein level
label: e
answer: no
explanation: IgG oligoclonal bands (OCBs) are present in the cerebrospinal fluid (CSF) of more than 95% of patients with multiple sclerosis (MS), and are considered to be the immunological hallmark of disease.
name: Oligoclonal bands
label: a
answer: yes
explanation: Although white cell count may be elevated in MS up to seven times the normal limit, a level over >100/µL would indicate a viral central nervous system infection.
name: Elevated lymphocyte count, >100/µL
label: d
answer: no

Correct answer: a
A 35-year-old female patient has presented with persistent symptoms of severe anxiety associated with poor concentration, fatigue and muscle tension. The doctor has prescribed a short-term course of benzodiazepines.

What is the mechanism of action of benzodiazepines?

Options:
explanation: This is the mechanism of action of serotonin-norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine.
name: Inhibits the presynaptic neuronal uptake of serotonin and norepinephrine and prolongs the effects of the monoamines in the synaptic cleft
label: e
answer: no
explanation: This is the mechanism of selective serotonin reuptake inhibitors, such as sertraline.
name: Inhibits serotonin re-uptake in the synaptic cleft
label: b
answer: no
explanation: Benzodiazepines produce their effects by enhancing the binding of GABA to its receptor. GABA activates the chloride ion channel, allowing chloride ions to enter the neuron. The flow of chloride ions into the neuron hyperpolarizes and inhibits the neuron.
name: Enhance the binding of GABA to its receptor
label: a
answer: yes
explanation: This is the mechanism of action of monoamine oxidase inhibitors. Monoamine oxidase is an enzyme that breaks down neurotransmitters like serotonin, norepinephrine, and dopamine.
name: Blocks oxidative deamination to cause the accumulation of endogenous catecholamines
label: c
answer: no
explanation: This is the mechanism of action of mirtazapine. It acts as an antagonist at the noradrenergic alpha-2 heteroceptor on the serotonin terminal increasing the serotonin release.
name: Enhances the release of serotonin
label: d
answer: no

Correct answer: a
A 22-year-old male accompanied by his friend presents to the GP with delusions, auditory hallucinations and paranoia. His speech has been incoherent and often, there is no association between his words. He describes that he is unable to feel pleasure and no longer experiences joy in his work, hobbies or life in general.

Which one of his symptoms is an example of a negative symptom?

Options:
explanation: Auditory hallucinations are sensory experiences that occur in the absence of external stimuli. It is a positive symptom. Positive symptoms include any changes in behaviours, not usually seen in individuals without the disorder.
name: Auditory hallucinations
label: c
answer: no
explanation: Knight's move thinking describes disorganised thinking. This is characterised by incoherent or illogical thought processes. This is a positive symptom that comes under thought disorder. Positive symptoms include any changes in behaviours, not usually seen in individuals without the disorder.
name: Knight's move thinking
label: e
answer: no
explanation: Delusions are false beliefs that are resistant to reason or contrary to reality. It is a positive symptoms. Positive symptoms include any changes in behaviours, not usually seen in individuals without the disorder.
name: Delusions
label: b
answer: no
explanation: Negative symptoms describe the absence of capacities present normally. Symptoms include flat affect, alogia, anhedonia, asociality and avolition.
name: Anhedonia
label: a
answer: yes
explanation: This is the production of incoherent, jumbled speech that lacks meaning. The words are not associated with each other. This is a positive symptom that comes under thought disorder. Positive symptoms include any changes in behaviours, not usually seen in individuals without the disorder.
name: Word salad
label: d
answer: no

Correct answer: a
A 33-year-old male inpatient is being reviewed by his psychiatrist. During their conversation, he explains how news presenters on the television talk about him.

What type of delusion is this?

Options:
explanation: Persecutory delusions are the belief that one is being spied on and conspired against. They are often seen in schizophrenia.
name: Persecutory delusions
label: c
answer: no
explanation: Grandiose delusions are when one believes that they have special powers, importance or connections. It is commonly seen in manic patients.
name: Grandiose delusions
label: b
answer: no
explanation: These delusions involve the belief that one's thoughts, feelings, or actions are being controlled or manipulated by an external force, often experienced as an outside agency or technology. They are often seen in schizophrenia.
name: Delusions of control
label: e
answer: no
explanation: Nihilistic delusions centre around the belief that something significant is missing or that the world no longer exists. The patient can also sometimes believe they no longer exist. They are usually seen in psychotic depression.
name: Nihilistic delusions
label: d
answer: no
explanation: Delusions of reference happen when a person interprets unrelated events or stimuli as having personal significance.
name: Delusions of reference
label: a
answer: yes

Correct answer: a
A 34-year-old male patient with a known diagnosis of schizophrenia has relapsed. He presents to A&E with auditory hallucinations which are causing significant distress. He normally takes aripiprazole but has recently run out of the medication.

Which neurotransmitter is implicated during acute psychotic episodes in schizophrenia?

Options:
explanation: Acetylcholine plays a critical role in cognitive functions, memory, and learning. It is implicated in processes related to attention, memory encoding, and consolidation. Dysfunction of the cholinergic system is associated with conditions like Alzheimer's disease.
name: Acetylcholine
label: d
answer: no
explanation: Noradrenaline is one of the main neurotransmitters implicated in depression.
name: Noradrenaline
label: c
answer: no
explanation: Serotonin is one of the main neurotransmitters implicated in depression. The serotonin system is involved in the regulation of mood and cognition.
name: Serotonin
label: b
answer: no
explanation: Gamma-aminobutyric Acid is the primary inhibitory neurotransmitter in the central nervous system. Low GABA levels are linked to anxiety disorders, including generalized anxiety disorder and social anxiety disorder.
name: Gamma-aminobutyric Acid
label: e
answer: no
explanation: Studies have shown that there is excessive dopamine release in the striatum during acute psychotic episodes observed in schizophrenia.
name: Dopamine
label: a
answer: yes

Correct answer: a
A 33-year-old male patient presents with symmetrical rigidity of his limbs, slowness of movement and lack of facial expression. He has a past medical history of schizophrenia and has recently been initiated on a new anti-psychotic medication.

What pathway in the dopamine system is implicated?

Options:
explanation: This pathway connects the substantia nigra to the mid-striatum. It is involved in associative functions, for example, learning, habituation, memory, attention, motivation, emotion, and volition. D2 receptor antagonism in the associative striatum reduces the positive symptoms that occur during psychosis.
name: Nigrostriatal associative pathway
label: e
answer: no
explanation: The tuberoinfundibular pathway connects the hypothalamus to the pituitary gland (tuberal region to the infundibular region at the top of the pituitary stalk). It plays a role in regulating the release of hormones from the pituitary gland, particularly prolactin. Dopamine acts as an inhibitory signal, inhibiting the release of prolactin. D2 receptor antagonism results in hyperprolactinaemia, as the inhibitory effect of dopamine is lost.
name: Tuberoinfundibular pathway
label: d
answer: no
explanation: This pathway also originates in the VTA but projects to the prefrontal cortex. It is involved in higher-order cognitive functions, including executive function, decision-making, and emotional regulation. D2 receptor antagonism may exacerbate low dopamine in this region, leading to deterioration in cognitive function.
name: Mesocortical pathway
label: c
answer: no
explanation: The nigrostriatal pathway connects the substantia nigra to the dorsal striatum. It is primarily involved in motor control. Dysfunction of this pathway leads to motor symptoms such as tremors, rigidity, and bradykinesia. Anti-psychotics reduce the amount of dopamine by acting as D2 receptor antagonists. It blocks the receptors in the nigrostriatal motor pathway causing Parkinsonism and extrapyramidal side effects.
name: Nigrostriatal motor pathway
label: a
answer: yes
explanation: The mesolimbic pathway originates in the ventral tegmental area (VTA) and projects to various regions in the limbic system, including the nucleus accumbens, amygdala, and hippocampus. It is associated with reward, pleasure, and reinforcement. Excessive D2 receptor antagonism results in worsening of the negative symptoms.
name: Mesolimbic pathway
label: b
answer: no

Correct answer: a
A 67-year-old male patient is referred to the neurology clinic. He is concerned that he may have Parkinson’s disease.

What is the characteristic triad of cardinal motor symptoms seen in Parkinson’s disease?

Options:
explanation: Parkinson's disease (PD) is a chronic progressive neurodegenerative disease that is clinically manifested by a triad of cardinal motor symptoms - rigidity, bradykinesia and tremor - due to loss of dopaminergic neurons.
name: Rigidity, bradykinesia and tremor
label: a
answer: yes
explanation: The motor triad of Parkinson’s disease is rigidity, bradykinesia and tremor.
name: Dyskinesia, bradykinesia and tremor
label: d
answer: no
explanation: The motor triad of Parkinson’s disease is rigidity, bradykinesia and tremor.
name: Rigidity, bradykinesia and cognitive dysfunction
label: b
answer: no
explanation: The motor triad of Parkinson’s disease is rigidity, bradykinesia and tremor.
name: Dystonia, postural instability and tremor
label: e
answer: no
explanation: The motor triad of Parkinson’s disease is rigidity, bradykinesia and tremor.
name: Freezing, bradykinesia and dystonia
label: c
answer: no

Correct answer: a