hllj/quesmed huggingface dataset:
Which of the following is a risk factor for developing Chronic obstructive pulmonary disease (COPD)?

Options:
explanation: Silica dust causes inflammation in the central airways, peripheral airways, and lung parenchyma. The long term inflammation leads to structural remodeling of the lungs. Around 20% of diagnosed cases of COPD are associated with occupational exposure.
name: Silica exposure
label: a
answer: yes
explanation: Alcohol is not a risk factor for developing COPD, it is a risk factor for developing alcohol liver disease.
name: Alcohol
label: b
answer: no
explanation: Cocaine is not a risk factor for developing COPD, it is a risk factor for aortic dissection, coronary artery spasm and rhabdomyolysis.
name: Cocaine
label: c
answer: no
explanation: Ecstasy (MDMA, 3,4-Methylenedioxymethamphetamine)is not a risk factor for developing COPD, it can however cause hyponatraemia and rhabdomyolysis.
name: Ecstasy
label: d
answer: no
explanation: Benzodiazepines are not a risk factor for developing COPD, however patients commonly develop a tolerance and dependence to benzodiazepines and can experience withdrawl symptoms if they are stopped suddenly.
name: Benzodiazepines
label: e
answer: no

Correct answer: a
Which of the following is a blood marker used in the diagnosis of heart failure?

Options:
explanation: NT-pro BNP is a hormone produced by the left ventricular myocardium in response to strain. In heart failure, the left ventricle is under increased strain, and thus NT-pro BNP is produced in greater quantities. NT-pro BNP can also be raised in Chronic Kidney Disease.
name: N-terminal pro B-type natriuretic peptide (NT-pro BNP)
label: a
answer: yes
explanation: D-dimer is not typically used to diagnose heart failure, it is used for investigating pulmonary embolisms.
name: D-dimer
label: b
answer: no
explanation: Troponin T is not typically used to diagnose heart failure, it is used for investigating myocardial infarction.
name: Troponin T
label: d
answer: no
explanation: Troponin I is not typically used to diagnose heart failure, it is used for investigating myocardial infarction.
name: troponin I
label: e
answer: no
explanation: CK-MB is not typically used to diagnose heart failure, it is used for investigating re-infarction following myocardial infarction.
name: CK-MB
label: c
answer: no

Correct answer: a
Which of the following best describes the following arterial blood gas?

| Parameter        | Result           | Reference range  |
| ------------- |:-------------:| -----:|
| pH  | 7.28 | 7.35 - 7.45 |
| PaO<sub>2<sub/>     | 7.8      |   11 - 15 |
| PaCO<sub>2<sub/>  | 6.7      |    4.6 - 6.4 |
| HCO3<sup>-<sup/>   | 35.4      |   22 - 30 |
| Base excess | -5      |    -2 - +2 |

pH 7.28

PaO2 7.8

PaCO2 6.7

HCO3- 35.4

BE -5

Options:
explanation: In type 1 respiratory failure carbon dioxide is normal, and the oxygen is low. The raised carbon dioxide is causing the acidosis, meaning it is a respiratory acidosis, not metabolic.
name: Type 1 respiratory failure, metabolic acidosis with partial metabolic compensation
label: c
answer: no
explanation: The metabolic compensation is only partial as the bicarbonate is not sufficiently raised to correct the pH
name: Type 2 respiratory failure, respiratory acidosis with full metabolic compensation
label: e
answer: no
explanation: In respiratory alkalosis, the pH would be above 7.45 and the carbon dioxide would be low.
name: Type 2 respiratory failure, respiratory alkalosis with partial metabolic compensation
label: d
answer: no
explanation: In type 1 respiratory failure carbon dioxide is normal, and the oxygen is low.
name: Type 1 respiratory failure, respiratory acidosis with partial metabolic compensation
label: b
answer: no
explanation: This is type 2 respiratory failure, as the oxygen is low and the carbon dioxide is high. This is respiratory acidosis, as the pH is below 7.35 and the carbon dioxide is raised which has caused the low pH. There is partial metabolic compensation here, as the bicarbonate is raised, however it is not sufficiently raised to correct the pH, so it is only partial.
name: Type 2 respiratory failure, respiratory acidosis with partial metabolic compensation
label: a
answer: yes

Correct answer: a
A 56 year old patient with a diagnosis of type 2 diabetes mellitus is to be started on an antihypertensive following home ambulatory blood pressure readings averaging 150/97 mmHg.

Which of the following anti-hypertensives should he be started on?

Options:
explanation: Propanolol is an beta blocker used in the management of hypertension, however it is not first line.
name: Propanolol
label: d
answer: no
explanation: Spironolactone is an aldosterone antagonist used in the management of hypertension, however it is not first line.
name: Spironolactone
label: c
answer: no
explanation: Indapamide is a thiazide-like diuretic used in the management of hypertension, however it is not first line.
name: Indapamide
label: e
answer: no
explanation: Ramipril is an angiotensin converting enzyme inhibitor which is first line in the treatment of hypertension in patients with diabetes.
name: Ramipril
label: a
answer: yes
explanation: Amlodipine is a calcium channel blocker and is used first line for patients over 55 years, however angiotensin converting enzyme inhibitors such as ramipril are first line in diabetic patients.
name: Amlodipine
label: b
answer: no

Correct answer: a
What causes the rapid depolarisation in phase 0 of a cardiac myocyte action potential?

Options:
explanation: There is rapid Na+ inflow through open fast Na+ channels leading to a rise in membrane potential from -90mV to above 0mV. This causes the rapid depolarisation in phase 0 of a cardiac myocyte action potential.
name: Inflow of Na+
label: a
answer: yes
explanation: The inflow of Ca2+ through L-type Ca2+ channels is electrically balanced by the outflow of K+ through delayed K+ channels. This causes the plateau in phase 2 of a cardiac myocyte action potential.
name: Slow inflow of Ca2+
label: c
answer: no
explanation: Na+ and Ca2+ channels close and the open K+ channels keep the membrane potential at -90mV. This causes the resting potential in phase 4 of a cardiac myocyte action potential.
name: Outflow of K+
label: e
answer: no
explanation: Ca2+ channels close, but the delayed K+ channels remain open and drop the membrane potential to -90mV. This causes the repolarisation in phase 3 of a cardiac myocyte action potential.
name: Outflow of K+ and inflow of Ca2+ stops
label: d
answer: no
explanation: Transient K+ channels open and K+ outflow returns the membrane potential to 0mV as Na+ inflow stops. This causes partial depolarisation in phase 1 of a cardiac myocyte action potential.
name: Outflow of K+ and inflow of Na+ stops
label: b
answer: no

Correct answer: a
What nerve causes bronchoconstriction of the airways?

Options:
explanation: These provide sympathetic stimulation through beta-2 adrenergic receptors, leading to bronchodilation.
name: T2-T4 sympathetic trunk ganglia
label: b
answer: no
explanation: The vagus nerve provides parasympathetic stimulation to the airways through muscarinic ACh receptors, leading to bronchoconstriction.
name: Vagus nerve
label: a
answer: yes
explanation: This provides motor innervation to the cricothyroid muscle. The recurrent laryngeal nerve then provides motor innervation for all other intrinsic muscles of the larynx.
name: External branch of superior laryngeal nerve
label: d
answer: no
explanation: These provide innervation to the pleura. The phrenic nerve innervates the mediastinal pleura and the majority of the diaphragmatic pleura, causing referred pain in C3-C5 dermatomes (shoulder tip pain). The intercostal nerves supply the costal pleura, causing pain to be felt in relation to the thoracic wall.
name: Phrenic nerve (C3-C5) and intercostal nerves (T1-T11)
label: c
answer: no
explanation: This provides sensory innervation to the larynx above the level of the vocal cords.
name: Internal branch of superior laryngeal nerve
label: e
answer: no

Correct answer: a
Which of the following is true with regard to protein digestion and absorption?

Options:
explanation: This is the function of exopeptidases. Endopeptidases split the internal bonds of non-terminal amino acids.
name: Endopeptidases cleave amino acids off the ends of polypeptides
label: e
answer: no
explanation: Amino acids are absorbed through facilitated diffusion and co-transport. Amino acids are absorbed alongside Na+, while peptides can be co-transported with H+.
name: Amino acids are absorbed alongside H+ across the intestinal brush border
label: c
answer: no
explanation: In the duodenum, peptide digestion occurs at the brush border, intestinal lumen and intracellularly.
name: Peptide digestion only occurs at the brush border of the duodenum
label: b
answer: no
explanation: Pepsinogen is secreted from chief cells in the stomach body. Secretion is activated by HCl release from parietal cells, which is stimulated by parasympathetic and enteric nerve activity.
name: Pepsinogen secretion is inhibited by HCl release
label: d
answer: no
explanation: This statement is true.
name: Pepsin action is terminated upon exit from the stomach
label: a
answer: yes

Correct answer: a
The epiphyseal growth plate is a thin cartilage between the primary and secondary ossification centres produced in endochondral ossification.

Which zone of the growth plate is primarily responsible for growth?

Options:
explanation: Here, maturation and enlargement of chondrocytes prepare the matrix for calcification in the next zone.
name: Hypertrophic zone
label: c
answer: no
explanation: Here, osteoblasts and vessels penetrate the empty spaces produced from the calcification zone and create new bone, whilst osteoclasts break down the calcified cartilaginous matrix.
name: Ossification zone
label: e
answer: no
explanation: Here, there is no cellular proliferation. It instead acts as a site of matrix production and storage for lipids, glycogen, and proteoglycan.
name: Reserve zone
label: b
answer: no
explanation: Here, calcification of the matrix causes chondrocytes to die as it restricts nutrient diffusion, producing empty spaces.
name: Calcification zone
label: d
answer: no
explanation: Here, chondrocytes divide rapidly through mitosis and form columns within the matrix. This proliferation of chondrocytes pushes the diaphysis away from the epiphysis, leading to longitudinal growth.
name: Proliferative zone
label: a
answer: yes

Correct answer: a
A 50-year-old man is assessed on the neurology ward and diagnosed with ataxia, which causes him to have poor control over his voluntary movements.

Which region of the brain is responsible for coordination of voluntary movements?

Options:
explanation: The cerebellum is a region at the back of the brain within the posterior cranial fossa. It is responsible for maintaining posture, balance, muscle tone and coordinating voluntary movements of muscles and the eye. It is attached to the midbrain by the superior peduncle which is responsible for mainly efferent output, the middle peduncle which informs voluntary motor output, and the inferior peduncle which conveys muscle proprioception and vestibular inputs.
name: Cerebellum
label: a
answer: yes
explanation: This is located on the pre-central gyrus of the frontal lobe and is the highest level in the brain for controlled movement. Each hemisphere controls the contralateral half of the body and is made up of a direct pathway that increases movement, and an indirect pathway that decreases or stops movement.
name: Primary motor cortex
label: b
answer: no
explanation: These areas are responsible for language. Broca’s area is found in the dominant frontal lobe and is responsible for the production of speech. Wernicke’s area is found in the temporal lobe and is responsible for understanding language.
name: Broca's and Wernicke’s area
label: c
answer: no
explanation: The basal ganglia contains a group of nuclei deep within the cerebral hemisphere. These help to facilitate purposeful movements and inhibit unwanted movements, and carry out a variety of cognitive and emotional functions.
name: Basal ganglia
label: d
answer: no
explanation: The parietal lobe receives and interprets sensations. It contains the primary somatosensory cortex on the post-central gyrus.
name: Parietal lobe
label: e
answer: no

Correct answer: a
Typically, how many days after fertilisation does implantation of the blastocyst occur?

Options:
explanation: During this time is cavitation and differentiation of the embryo to form an early blastocyst
name: Five days
label: d
answer: no
explanation: Day six is when the hatching of the blastocyst occurs. This is where the late-stage blastocyst expands and hatches out of the zona pellucida, which is essential for implantation.
name: Six days
label: e
answer: no
explanation: This is when compaction occurs, where the cells flatten and maximise intracellular contacts, forming tight junctions and polarisation of outer cells, which are needed for quick differentiation.
name: Four days
label: c
answer: no
explanation: The process of implantation in the uterus occurs eight to nine days after fertilisation, or on the 21st day of the menstrual cycle.
name: Eight to nine days
label: a
answer: yes
explanation: This is when the initial cleavage of the zygote takes place, resulting in increased cell numbers for sufficient cell differentiation.
name: Two to three days
label: b
answer: no

Correct answer: a
Which of the following is secreted from the zona glomerulosa in the adrenal gland?

Options:
explanation: Cholesterol is a precursor for all corticosteroids (produced in the adrenal cortex). Synthesis takes place in the cytoplasm and in the endoplasmic reticulum of cells.
name: Cholesterol
label: e
answer: no
explanation: Dehydroepiandrosterone (DHEA) is a type of androgen, which is produced from the zona reticularis of the adrenal cortex.
name: Dehydroepiandrosterone
label: c
answer: no
explanation: Cortisol is a type of glucocorticoid, which is produced from the zona fasciculata of the adrenal cortex.
name: Cortisol
label: b
answer: no
explanation: Aldosterone is a type of mineralocorticoid, which is produced from the zona glomerulosa of the adrenal cortex.
name: Aldosterone
label: a
answer: yes
explanation: Adrenaline, along with noradrenaline, is a catecholamine, which are produced in the adrenal medulla.
name: Adrenaline
label: d
answer: no

Correct answer: a
Which of the following does **NOT** develop from the paramesonephric ducts in the absence of testosterone?

Options:
explanation: In the absence of Mullerian-inhibiting factor, the paramesonephric (Mullerian) ducts do not degenerate and instead develop into the uterus, cervix, fallopian tubes and uterus and upper two-thirds of the vagina.
name: Fallopian tubes
label: c
answer: no
explanation: In the absence of testosterone, the Wolffian duct degenerates and the lower one-third of the vagina and female external genitalia on the surface develop from the urogenital sinus.
name: Lower one-third of the vagina
label: a
answer: yes
explanation: In the absence of mullerian-inhibiting factor, the paramesonephric (Mullerian) ducts do not degenerate and instead develop into the uterus, cervix, fallopian tubes and uterus and upper two-thirds of the vagina.
name: Upper two-thirds of the vagina
label: b
answer: no
explanation: In the absence of mullerian-inhibiting factor, the paramesonephric (Mullerian) ducts do not degenerate and instead develop into the uterus, cervix, fallopian tubes and uterus and upper two-thirds of the vagina.
name: Uterus
label: d
answer: no
explanation: In the absence of mullerian-inhibiting factor, the paramesonephric (Mullerian) ducts do not degenerate and instead develop into the uterus, cervix, fallopian tubes and uterus and upper two-thirds of the vagina.
name: Cervix
label: e
answer: no

Correct answer: a
In a 70kg male, how many litres of his total body water distribution is accounted for by the extracellular fluid?

Options:
explanation: This is the volume of the transcellular fluid compartment.
name: 0.5L
label: e
answer: no
explanation: This is the volume of the extracellular fluid compartment. It is one-third of the total volume of fluid or 20% of the total body weight. It is comprised of intravascular fluid (3L) and extravascular fluid (11L).
name: 14L
label: a
answer: yes
explanation: This is the volume of the extravascular fluid compartment. It is comprised of interstitial fluid (10.5L) and transcellular fluid (0.5L).
name: 11L
label: d
answer: no
explanation: This is the volume of the intracellular fluid compartment. It is two-thirds of the total volume of fluid, or 40% of the total body weight.
name: 28L
label: c
answer: no
explanation: This is the total volume of the body's fluid compartments. It is 60% of the total body weight.
name: 42L
label: b
answer: no

Correct answer: a
A senior registrar in A&E is admitting a patient with a suspected stroke. However, as it is very busy in the department the patient is not seen promptly and the registrar does not end up performing a CT head until two hours after the patient’s admission, leading to a late diagnosis of a stroke.

What type of error is this describing?

Options:
explanation: This is a type of human error where actions or omissions do not meet the standards of an ordinary, skilled professional who has competence.
name: Error of negligence
label: c
answer: no
explanation: Errors occur due to inexperience, leading to the incorrect course of action. It is more likely to occur in complex tasks.
name: Knowledge-based error
label: e
answer: no
explanation: Errors occur during a routine, well-learnt task due to poor concentration, or by becoming distracted or interrupted which can result in slips of action or memory lapses.
name: Skill-based error
label: d
answer: no
explanation: This is a type of human error where the incorrect action is taken.
name: Error by commission
label: b
answer: no
explanation: This is a type of human error where the required action is delayed or not taken. In the scenario, the doctor ends up doing the correct investigations, but it was delayed and not carried out in the recommended time.
name: Error by omission
label: a
answer: yes

Correct answer: a
Which of the following is not a Starling force?

Options:
explanation: This force pushes water from the interstitial fluid and into the capillary. It is an osmotic produced from the plasma protein concentration.
name: Capillary oncotic pressure
label: d
answer: no
explanation: This is not a Starling force. Starling forces determine the rate at which water exchange occurs and the direction of net water movement between the capillary circulation and interstitial fluid.
name: Intracellular hydrostatic pressure
label: a
answer: yes
explanation: This force pushes water out of the capillary and into the interstitial fluid.
name: Capillary hydrostatic pressure
label: b
answer: no
explanation: This force pushes water out of the capillary and into the interstitial fluid. It is an osmotic produced from the interstitial-fluid protein concentration.
name: Interstitial oncotic pressure
label: e
answer: no
explanation: This force pushes water from the interstitial fluid and into the capillary.
name: Interstitial fluid hydrostatic pressure
label: c
answer: no

Correct answer: a
A 30-year-old woman undergoes spirometry and gas dilution to measure her lung capacity due to concerns about her breathing. Her results are below:
- Inspiratory reserve volume = 2.1L

- Expiratory reserve volume = 1.4L

- Tidal volume = 0.4L

- Functional residual capacity = 2.0L

What is her vital capacity?

Options:
explanation: This is representative of the total lung capacity. Total lung capacity = residual volume + vital capacity.
name: 4.5L
label: b
answer: no
explanation: This is representative of the vital capacity, which is the maximum air expelled after maximum inspiration. Vital capacity = expiratory reserve volume + inspiratory reserve capacity + tidal volume.
name: 3.9L
label: a
answer: yes
explanation: This is representative of residual volume, which is the air remaining in the lungs after maximum expiration to prevent lung collapse. Residual volume = functional residual capacity - expiratory reserve volume.
name: 0.6L
label: d
answer: no
explanation: This is representative of inspiratory capacity, which is the maximum air inhaled after normal tidal expiration. Inspiratory capacity = inspiratory reserve volume + tidal volume.
name: 2.5L
label: c
answer: no
explanation: This is just the tidal volume, which is the volume inhaled or exhaled in a normal breath, and is combined with the inspiratory and expiratory reserve volumes to calculate the vital capacity
name: 0.4L
label: e
answer: no

Correct answer: a
Which of the following initiates the gastric phase of pancreatic secretion?

Options:
explanation: Digestion of food in the stomach is followed by the release of acidic chyme into the duodenum which initiates the intestinal phase of pancreatic secretion. The majority of pancreatic enzyme secretion occurs during this phase and is regulated by hormonal and neural mechanisms.
name: Presence of gastric acid in the duodenum
label: e
answer: no
explanation: Sensory inputs such as sight, smell and taste of food, lead to the anticipation of food. These sensations initiate the cephalic phase of pancreatic secretion, which involves parasympathetic vagus nerve stimulation of acinar cells to produce digestive enzymes.
name: Smell of food
label: b
answer: no
explanation: This initiates the gastric phase of pancreatic secretion. It primarily involves parasympathetic vagus nerve stimulation of acinar cells to produce digestive enzymes, similar to the cephalic phase.
name: Entry of food into the stomach
label: a
answer: yes
explanation: Tasting food prior to mastication can lead to the anticipation of food, which initiates the cephalic phase of pancreatic secretion.
name: Interaction of long-chain fatty acids with oral cavity receptors
label: c
answer: no
explanation: The presence of amino acids and fatty acids in the duodenum causes the release of cholecystokinin which relaxes the sphincter of Oddi and induces gallbladder contraction, causing enzyme secretion. This occurs by the end of the gastric phase.
name: Presence of food in the duodenum
label: d
answer: no

Correct answer: a
Which of the following is false with regards to bone remodelling?

Options:
explanation: This statement is true.
name: Bone remodelling may occur in response to loading
label: b
answer: no
explanation: Modelling occurs primarily in children. The gross shape of the bone is altered as bone is added or taken away. Remodelling primarily occurs in adults where all of the old bone is removed and replaced by new bone.
name: Occurs primarily in children during growth
label: a
answer: yes
explanation: This statement is true.
name: Secondary osteons cut through layers of lamellae and drive remodelling
label: c
answer: no
explanation: This statement is true.
name: In remodelling, osteoclasts attach to the bone surface and secrete acid, which dissolves the bone mineral to form resorption cavities
label: d
answer: no
explanation: This statement is true.
name: In remodelling, osteoblasts are recruited to the resorbed bone and secrete osteoid matrix, which is mainly comprised of collagen
label: e
answer: no

Correct answer: a