hllj/quesmed huggingface dataset:
A 32 year old pregnant woman presents to her General Practitioner with tingling and sensory loss in her hand. The GP diagnoses her with carpal tunnel syndrome.

Which part of the hand will the sensory loss affect?

Options:
explanation: This is incorrect. Carpal tunnel syndrome does not typically affect the back of the hand. It primarily involves the palmar side of the hand, specifically the thumb, index, and middle fingers due to median nerve compression at the carpal tunnel.
name: Back of the hand
label: e
answer: no
explanation: This is incorrect. Carpal tunnel syndrome primarily affects the thumb, index, and middle fingers, as the median nerve, which is compressed in the carpal tunnel, supplies sensation to these areas.
name: Palm and fingers
label: b
answer: no
explanation: This is incorrect. While carpal tunnel syndrome can cause discomfort, weakness, and sensory disturbances in the hand, it primarily affects the thumb, index, and middle fingers, not the entire hand.
name: Entire hand
label: d
answer: no
explanation: This is incorrect. The pinky finger and ring finger are primarily innervated by the ulnar nerve, which is not usually affected by carpal tunnel syndrome.
name: Pinky finger and ring finger
label: c
answer: no
explanation: Correct. Carpal tunnel syndrome typically results in sensory loss or numbness in the thumb, index, and middle fingers. These are the specific areas innervated by the median nerve, which is compressed as it passes through the carpal tunnel in the wrist. Pregnancy is a risk factor for carpal tunnel syndrome
name: Thumb, index and middle fingers
label: a
answer: yes

Correct answer: a
A 68 year old male is diagnosed with aortic stenosis and undergoes a mechanical aortic valve replacement. Following the surgery, he is prescribed warfarin.

Which of the following describes the primary mechanism of action of warfarin?

Options:
explanation: This is incorrect. Warfarin doesn't enhance fibrinolysis but instead works by inhibiting the synthesis of vitamin K-dependent clotting factors (Factors II, VII, IX, and X), which are essential for blood coagulation.
name: Enhancement of fibrinolysis
label: d
answer: no
explanation: This is incorrect. Warfarin works by inhibiting the synthesis of vitamin K-dependent clotting factors (Factors II, VII, IX, and X), which are essential for blood coagulation. Fibrinolysis is a process whereby clots are broken down. Inhibiting this process would therefore increase the tendency of the blood to clot, rather than work as an anticoagulant.
name: Inhibition of fibrinolysis
label: e
answer: no
explanation: This is incorrect. While warfarin does indirectly affect thrombin production through its impact on clotting factors, it doesn't directly inhibit thrombin production. It inhibits vitamin K-dependent clotting factors. By contrast, dabigatran inhibits the action of thrombin, thus preventing the conversion of fibrinogen to fibrin.
name: Inhibition of thrombin production
label: c
answer: no
explanation: Correct. Warfarin works by inhibiting the synthesis of vitamin K-dependent clotting factors (Factors II, VII, IX, and X), which are essential for blood coagulation. This is the primary mechanism of action of warfarin.
name: Inhibition of vitamin-K-dependent clotting factors
label: a
answer: yes
explanation: This is incorrect. Warfarin primarily affects the coagulation cascade by inhibiting the production of vitamin K-dependent clotting factors, rather than by preventing platelet aggregation.
name: Inhibition of platelet aggregation
label: b
answer: no

Correct answer: a
A 32 year old male presents to his General Practitioner with symptoms of acid reflux. He reports drinking an average of 20 units of alcohol per week. The GP prescribes omeprazole to improve his acid reflux and refers him to the local drug and alcohol liaison service.

Which of the following best describes the mechanism of action of omeprazole?

Options:
explanation: Correct. Omeprazole is a proton pump inhibitor (PPI) which works by irreversibly blocking the hydrogen-potassium ATPase (proton pump) in the gastric parietal cells, thus reducing the secretion of stomach acid.
name: Inhibition of gastric acid secretion by blocking the H+/K+ ATPase pump
label: a
answer: yes
explanation: Omeprazole is a proton pump inhibitor (PPI) which works by irreversibly blocking the hydrogen-potassium ATPase (proton pump) in the gastric parietal cells, thus reducing the secretion of stomach acid. Although this does indirectly protect the oesophageal lining by reducing its exposure to corrosive acid, it is not the best description of its mechanism of action.
name: Protection of the oesophageal lining
label: c
answer: no
explanation: This is incorrect. Omeprazole is a proton pump inhibitor (PPI) which works by irreversibly blocking the hydrogen-potassium ATPase (proton pump) in the gastric parietal cells, thus reducing the secretion of stomach acid.
name: Enhancement of acid production in the stomach
label: b
answer: no
explanation: This is incorrect. Omeprazole is a proton pump inhibitor (PPI) which works by irreversibly blocking the hydrogen-potassium ATPase (proton pump) in the gastric parietal cells, thus reducing the secretion of stomach acid. It does not directly inhibit histamine release but can indirectly reduce the effects of histamine by blocking the final step in acid production.
name: Inhibition of histamine release
label: d
answer: no
explanation: This is incorrect. Omeprazole is a proton pump inhibitor (PPI) which works by irreversibly blocking the hydrogen-potassium ATPase (proton pump) in the gastric parietal cells, thus reducing the secretion of stomach acid. PPIs do not stimulate mucus production.
name: Stimulation of mucus production in the stomach
label: e
answer: no

Correct answer: a
A 27 year old woman consults her GP about persistent muscle pain and fatigue. She has recently begun training for a marathon and is adhering to a strict exercise schedule. She is keen to learn more about the way her muscles work.

Which of the following is a characteristic of type I muscle fibres?

Options:
explanation: This is incorrect. Type I muscle fibres primarily rely on aerobic (oxidative) energy production, not anaerobic energy production.
name: Anaerobic energy production
label: d
answer: no
explanation: This is correct. Type I muscle fibres have a high fatigue resistance and are capable of sustaining contractions for extended periods.
name: High resistance to fatigue
label: a
answer: yes
explanation: This is incorrect. Type I muscle fibres tend to have a smaller cross-sectional area compared to type II (fast-twitch) muscle fibres, as they are adapted for endurance rather than force production.
name: Large cross-sectional area
label: e
answer: no
explanation: This is incorrect. Type I muscle fibres have a relatively high myoglobin content, providing oxygen delivery and thus supporting their aerobic metabolism.
name: Low myoglobin content
label: c
answer: no
explanation: This is incorrect. Fast contraction speed is not a characteristic of type I muscle fibres. Type I fibers are known for their slow contraction speed, but high fatigue resistance.
name: Fast contraction speed
label: b
answer: no

Correct answer: a
A 61 year old white male with type 2 diabetes visits his General Practitioner for an annual health check. His blood pressure is measured at 154/100.  The reading from his previous appointment is 146/97. The GP diagnoses him with hypertension and prescribes ramipril, an angiotensin-converting enzyme inhibitor (ACE-inhibitor).

By which of the following mechanisms do ACE inhibitors lower blood pressure?

Options:
explanation: This is correct. ACE-inhibitors, as the name suggests, inhibit the enzyme angiotensin-converting enzyme (ACE), which plays a crucial role in converting angiotensin I into angiotensin II. Angiotensin II is a potent vasoconstrictor. By inhibiting its production, ACE inhibitors reduce vasoconstriction and ultimately lower blood pressure.
name: Inhibition of angiotensin II production
label: a
answer: yes
explanation: This is incorrect. While ACE inhibitors can indirectly affect aldosterone levels, their primary mechanism of action is related to angiotensin II inhibition, not aldosterone suppression. Reduced aldosterone levels are a secondary effect of ACE inhibitors.
name: Inhibition of aldosterone secretion
label: c
answer: no
explanation: This is incorrect. ACE inhibitors do not inhibit nitric oxide production; in fact, they may increase nitric oxide levels. Nitric oxide is a vasodilator, which means it helps relax blood vessels, leading to lower blood pressure.
name: Inhibition of nitric oxide production
label: e
answer: no
explanation: This is incorrect. ACE inhibitors do the opposite and actually reduce angiotensin II levels, leading to a decrease in the stimulation of angiotensin II receptors.
name: Stimulation of angiotensin II receptor
label: b
answer: no
explanation: This is incorrect. ACE inhibitors do not stimulate the sympathetic nervous system. They typically have a mild inhibitory effect on the sympathetic nervous system, which helps lower blood pressure.
name: Stimulation of the sympathetic nervous system
label: d
answer: no

Correct answer: a
A 56-year-old woman presents to her General Practitioner for a review of her chronic hypertension. She has been on ramipril and amlodipine for a number of years, but her blood pressure has been consistently elevated. The patient is keen to learn more about the hormones involved in the regulation of blood pressure.

Which of the following best describes the action of aldosterone?

Options:
explanation: This is incorrect. Aldosterone does not directly affect GFR. It exerts its effects by increasing the expression of epithelial sodium channels (ENaCs) in the collecting ducts of the nephron. This brings about the reabsorption of sodium and excretion of potassium.
name: Increases glomerular filtration rate (GFR)
label: c
answer: no
explanation: This is incorrect. ADH primarily regulates water reabsorption in the collecting ducts. Aldosterone exerts its effects by increasing the expression of epithelial sodium channels (ENaCs) in the collecting ducts of the nephron. This brings about the reabsorption of sodium and excretion of potassium.
name: Stimulates the secretion of antidiuretic hormone (ADH)
label: e
answer: no
explanation: This is correct. Aldosterone is a mineralocorticoid that is released from the zona glomerulosa of the adrenal cortex. It exerts its effects by increasing the expression of epithelial sodium channels (ENaCs) in the collecting ducts of the nephron. This brings about the reabsorption of sodium and excretion of potassium.
name: Increases the expression of epithelial sodium channels in the collecting ducts
label: a
answer: yes
explanation: This is incorrect. While the sodium-potassium pump is involved in sodium reabsorption, aldosterone primarily acts on the collecting ducts, not the proximal tubules. It exerts its effects by increasing the expression of epithelial sodium channels (ENaCs) in the collecting ducts of the nephron. This brings about the reabsorption of sodium and excretion of potassium.
name: Directly stimulates the sodium-potassium pump (Na+/K+ pump) in the proximal tubules
label: b
answer: no
explanation: This is incorrect. This describes the mechanism of ACE inhibitors such as ramipril, which reduces angiotensin II levels. Aldosterone exerts its effects by increasing the expression of epithelial sodium channels (ENaCs) in the collecting ducts of the nephron. This brings about the reabsorption of sodium and excretion of potassium.
name: Inhibits angiotensin-converting enzyme (ACE)
label: d
answer: no

Correct answer: a
A 40 year old man presents to the Emergency Department with complaints of extreme fatigue, muscle weakness and confusion. He has a history of chronic kidney disease and type 2 diabetes. Blood tests reveal severe metabolic acidosis.

Which of the following describes the renal mechanism by which acid-balance status is usually maintained?

Options:
explanation: This is incorrect. The distal tubules are critically involved in acid-base balance, and while the proximal tubules play a role in reabsorbing bicarbonate, the primary regulation of H+ ion secretion occurs in the distal tubules.
name: The distal tubules play a minimal role in acid-base balance, with the primary regulation occurring in the proximal tubules
label: d
answer: no
explanation: This is incorrect. The primary function of the distal tubules is to secrete H+ ions and reabsorb bicarbonate ions, which is the reverse of what this option suggests.
name: The distal tubules primarily reabsorb H+ ions and excrete bicarbonate ions to maintain acid-base balance
label: e
answer: no
explanation: This is correct. The distal tubules are crucial for regulating acid-base balance. They secrete H+ ions into the urine and reabsorb bicarbonate ions to help maintain proper pH in the body.
name: H+ ions are secreted into urine at the distal tubules whilst bicarbonate ions are reabsorbed
label: a
answer: yes
explanation: This is not correct. While the proximal tubules are involved in various processes, including bicarbonate reabsorption, the primary site for H+ ion secretion to regulate acid-base balance is the distal tubules.
name: H+ ion secretion occurs primarily in the proximal tubules
label: b
answer: no
explanation: This is incorrect. Impaired H+ ion secretion in the distal tubules would lead to metabolic acidosis, not metabolic alkalosis.
name: Impaired H+ ion secretion in the distal tubules contributes to metabolic alkalosis
label: c
answer: no

Correct answer: a
A 46 year old woman attends the Emergency Department with reports of severe dizziness that is worse on standing. Her blood pressure is measured at 86/45. The clinician explains that the renin-angiotensin-aldosterone system (RAAS) is activated in response to low blood pressure.

Which of the following electrolytes are reduced by RAAS activation?

Options:
explanation: This is incorrect. Chloride levels are closely linked to sodium levels in the body, and the activation of RAAS tends to increase sodium reabsorption. Consequently, chloride levels also tend to increase in response to RAAS activation.
name: Cl-
label: c
answer: no
explanation: This is correct. When the RAAS is stimulated, aldosterone is released. Aldosterone primarily acts on the distal tubules of the kidney, promoting the reabsorption of sodium and the excretion of potassium. This can result in reduced levels of potassium in the bloodstream, a condition known as hypokalaemia.
name: K+
label: a
answer: yes
explanation: This is incorrect. Activation of RAAS generally leads to increased sodium reabsorption in the distal tubules of the kidney. At the same time, it increases the excretion of potassium, thus leading to hypokalaemia in some cases.
name: Na+
label: b
answer: no
explanation: This is incorrect. RAAS activation does not have a direct effect on phosphate levels in the blood. Phosphate regulation primarily occurs through mechanisms involving parathyroid hormone (PTH) and dietary intake, rather than the RAAS.
name: PO4-
label: d
answer: no
explanation: This is incorrect. While RAAS indirectly affects calcium levels by promoting the reabsorption of sodium and water, leading to volume expansion, it does not have a direct effect on calcium levels. Calcium regulation is primarily under the control of parathyroid hormone (PTH) and calcitonin.
name: Ca++
label: e
answer: no

Correct answer: a
A 16 year old female attends the lung function clinic for spirometry testing.

Her tidal volume is 500ml, respiratory rate 12 breaths/minute. The fraction of inspired oxygen is 0.21.

Atmospheric pressure (PATM) is 760mmHg. The partial pressure of water (PH2O) is 47mmHg and the partial pressure of carbon dioxide (PaCO2) is 40mmHg.

Calculate the apparent alveolar partial pressure of oxygen (PO2) using the alveolar gas equation.

Options:
explanation: This is the assumed PaCO2 used in the alveolar gas equation but is not the alveolar PO2.
name: 40mmHg
label: e
answer: no
explanation: This is incorrect. This is the partial pressure of water vapour (PH2O).
name: 47mmHg
label: b
answer: no
explanation: This is incorrect. This is the atmospheric pressure, not the alveolar PO2
name: 760mmHg
label: d
answer: no
explanation: This is incorrect. It does not represent the alveolar PO2
name: 150mmHg
label: c
answer: no
explanation: Correct. This is the calculated apparent alveolar PO2 using the alveolar gas equation, taking into account the given FiO2, atmospheric pressure, and assuming a PaCO2 of 40 mmHg and a respiratory exchange ratio of 0.8.

The alveolar gas equation is PAO2 = (FiO2 * (PATM - PH2O)) - (PaCO2 / R), where R is 0.8. Inserting the above values into this equation gives a PAO2 of 100mmHg.
name: 100mmHg
label: a
answer: yes

Correct answer: a
A 60-year-old patient with a history of smoking and a recent diagnosis of pulmonary fibrosis presents to the emergency department. The patient is experiencing increasing difficulty breathing and is coughing frequently. The clinician suspects a decrease in lung compliance and requests a chest X-ray for evaluation.

Which of the following statements about lung compliance is correct?

Options:
explanation: This is correct. Pulmonary fibrosis is a lung disease characterized by the formation of scar tissue within the lung parenchyma. This scar tissue makes the lungs stiff and less compliant.
name: Decreased lung compliance is associated with conditions like pulmonary fibrosis
label: a
answer: yes
explanation: This is incorrect. Decreased lung compliance can lead to impaired gas exchange due to reduced lung expansion and difficulty in ventilating the alveoli effectively.
name: Decreased lung compliance improves the efficiency of gas exchange in the alveoli
label: c
answer: no
explanation: This is incorrect. Decreased lung compliance is primarily caused by factors that reduce lung elasticity, such as pulmonary fibrosis or scarring of lung tissue. Increased lung elasticity would typically lead to increased lung compliance, making it easier to expand the lungs during inhalation.
name: Decreased lung compliance is primarily caused by increased lung elasticity
label: e
answer: no
explanation: This is incorrect. Decreased lung compliance results in increased work of breathing for the patient as more effort is required to expand the lungs and overcome the reduced compliance.
name: Decreased lung compliance results in reduced work of breathing for the patient
label: d
answer: no
explanation: This is incorrect. Decreased lung compliance actually makes it harder for the lungs to expand during inhalation, which can lead to increased effort required for breathing.
name: Decreased lung compliance leads to easier expansion of the lungs during inhalation
label: b
answer: no

Correct answer: a
A 55 year old female is admitted to the general medical ward with severe dehydration and electrolyte imbalances due to prolonged vomiting and diarrhoea.

The sodium-potassium pump is a critical ion transporter in maintaining cell function.

Which of the following describes the movement of sodium and potassium ions for each cycle of the sodium-potassium pump?

Options:
explanation: This is incorrect. The sodium-potassium pump actively transports 3 sodium ions out of the cell and 2 potassium ions into the cell in each cycle.
name: 1 sodium ion out, 1 potassium ion in
label: b
answer: no
explanation: This is correct. The sodium-potassium pump is a transmembrane ATPase pump. In each cycle, it actively moves 3 sodium ions out of the cell and 2 potassium ions into the cell. This is a fundamental process in maintaining cell function and regulating the electrochemical gradients across the cell membrane.
name: 3 sodium ions out, 2 potassium ions in
label: a
answer: yes
explanation: This is incorrect. The sodium-potassium pump transports 3 sodium ions out of the cell and 2 potassium ions into the cell in each cycle.
name: 3 sodium ions out, 3 potassium ions in
label: c
answer: no
explanation: This is incorrect. The sodium-potassium pump actively transports 3 sodium ions out of the cell and 2 potassium ions into the cell in each cycle.
name: 2 sodium ions out, 1 potassium ion in
label: d
answer: no
explanation: This is incorrect. The sodium-potassium pump actively transports 3 sodium ions out of the cell and 2 potassium ions into the cell in each cycle.
name: 1 sodium ion out, 2 potassium ions in
label: e
answer: no

Correct answer: a
A 54 year old male patient attends the lung function clinic for spirometry testing. As part of the test, the patient breathes in as deeply as they can and then exhales as much as they can until their lungs feel empty.

Which of the following measures of lung function is being tested?

Options:
explanation: This is correct. The procedure described, whereby the patient breathes in as much as they can and then exhales as much as they can, is typically used to measure Vital Capacity (VC). Vital Capacity represents the maximum amount of air a person can inhale and then exhale during a single, maximal effort, and it is a common measure of lung function in spirometry.
name: Vital capacity (VC)
label: a
answer: yes
explanation: This is incorrect. FRC is the volume of air remaining in the lungs after a normal exhalation and does not involve maximal inhalation and exhalation.
name: Functional residual capacity (FRC)
label: b
answer: no
explanation: This is incorrect. Total Lung Capacity is the maximum volume of air the lungs can hold at full inspiration.
name: Total lung capacity (TLC)
label: d
answer: no
explanation: This is incorrect. FEV1 is a specific spirometric measurement that assesses the volume of air a person can forcibly exhale in one second after taking a deep breath.
name: Forced expiratory volume in 1 second (FEV1)
label: e
answer: no
explanation: This is incorrect. IRV represents the additional volume of air that can be inhaled after a normal inspiration.
name: Inspiratory reserve volume (IRV)
label: c
answer: no

Correct answer: a
A 13 year old boy presents to the General Practitioner with his father. The boy has noticed blood in his urine but denies any pain. His father describes him as 'coming down with a cold and sore throat' 3 days previously. He is usually fit and well with no past medical history and no regular medications.

Which of the following structures of the glomerulus is most likely damaged?

Options:
explanation: This is incorrect. Damage to the afferent arteriole is more likely to affect glomerular blood flow and filtration pressure rather than causing haematuria.
name: Afferent arteriole
label: c
answer: no
explanation: This is correct. This vignette is consistent with post-streptococcal glomerulonephritis, as indicated by the recent sore throat and haematuria. Haematuria (blood in urine) is often associated with damage to the glomerular basement membrane, a critical filtration barrier within the glomerulus. When the basement membrane is compromised, red blood cells can leak into the urine.
name: Glomerular basement membrane
label: a
answer: yes
explanation: This is incorrect. Damage to the efferent arteriole can impact glomerular haemodynamics but is less likely to directly result in haematuria.
name: Efferent arteriole
label: d
answer: no
explanation: This is incorrect. Damage to podocytes can also lead to haematuria, but it is not the primary structure associated with blood in the urine. Podocytes play a role in maintaining the integrity of the glomerular filtration barrier.
name: Podocytes
label: b
answer: no
explanation: This is incorrect. Damage to Bowman's capsule is more likely to affect the initial collection of filtrate but is less likely to be the primary cause of blood in the urine.
name: Bowman's capsule
label: e
answer: no

Correct answer: a