hllj/quesmed huggingface dataset:
A 68-year-old male presents to the GP with shortness of breath and swelling of his legs which have gradually gotten worse over the last 5 months. He has noticed that he cannot walk to the shops without getting out of breath and that his shoes are getting tighter around his ankles. The GP suspects he has heart failure and orders a specific blood test to help confirm the diagnosis.

Given the diagnosis, what molecule is this blood test measuring and where is it released from?

Options:
explanation: C-type natriuretic peptide (CNP) is released from the vascular endothelium, not the ventricles. These peptides cause vasodilatation and natriuresis (which is an increase in sodium excretion) in an attempt to decrease fluid overload.
name: C-type natriuretic peptide (CNP) from the ventricles
label: d
answer: no
explanation: BNP is released from the ventricles in response to cardiac strain. BNP, along with atrial natriuretic peptide and C-type peptide cause vasodilatation and natriuresis (which is an increase in sodium excretion) in an attempt to decrease fluid overload.
name: Brain natriuretic peptide (BNP) from the ventricles
label: a
answer: yes
explanation: Atrial natriuretic peptide (ANP) is released from the atria, not the vascular endothelium. These peptides cause vasodilatation and natriuresis (which is an increase in sodium excretion) in an attempt to decrease fluid overload.
name: Atrial natriuretic peptide (ANP) from the vascular endothelium
label: e
answer: no
explanation: Atrial natriuretic peptide (ANP) is secreted from the atria, not the ventricles. These peptides cause vasodilatation and natriuresis (which is an increase in sodium excretion) in an attempt to decrease fluid overload.
name: Atrial natriuretic peptide (ANP) from the ventricles
label: c
answer: no
explanation: Even though the name might suggest this, BNP is secreted from the ventricles, not the brain. These peptides cause vasodilatation and natriuresis (which is an increase in sodium excretion) in an attempt to decrease fluid overload.
name: Brain natriuretic peptide (BNP) from the brain
label: b
answer: no

Correct answer: a
A 55-year-old male comes into the ED via ambulance after experiencing palpitations. His ECG shows an ST elevation myocardial infarction. Treatment is commenced and he is admitted to the hospital. The doctors want to know the underlying cause of this presentation so arrange for the cardiology team to investigate. They find that the patient has a reduced blood supply to the sino-atrial (SA) node upon completion of an angiogram.

What is the blood supply to the SA node?

Options:
explanation: This artery supplies the posterior parts of the right and left ventricles, as well as the posterior interventricular septum.
name: Posterior interventricular artery
label: b
answer: no
explanation: This artery supplies the right ventricle and the apex of the heart.
name: Right marginal artery
label: c
answer: no
explanation: This artery supplies the left atrium and ventricle.
name: Left circumflex artery
label: e
answer: no
explanation: This artery supplies the anterior parts of the right and left ventricles, as well as the anterior interventricular septum.
name: Left anterior descending artery
label: d
answer: no
explanation: The right coronary artery supplies the right atrium and SA node. It arises from the right aortic sinus within the aorta.
name: Right coronary artery
label: a
answer: yes

Correct answer: a
A 25-year-old male presents to the GP as his parents have noticed that his right eye is looking different. The patient has experienced no new symptoms. The GP looks into the patient's eye and finds that his right pupil is dilated, even when a torch is shone on it.

Given the diagnosis, what nerve is affected?

Options:
explanation: This is correct as this patient has a pupil that will not constrict, meaning that it is permanently dilated. The nerve that causes constriction of the pupil is the oculomotor nerve.
name: Oculomotor nerve
label: a
answer: yes
explanation: This nerve provides sensation to the upper lip, nose and lower eyelid, along with parasympathetic innervation to the lacrimal gland.
name: Maxillary branch of the trigeminal nerve
label: b
answer: no
explanation: The vestibulocochlear nerve's function is hearing (cochlear portion) and balance (vestibular portion). It plays no role in eye movement or pupil size.
name: Vestibulocochlear nerve
label: c
answer: no
explanation: The glossopharyngeal nerve provides parasympathetic innervation to the parotid, submandibular and sublingual glands. It also provides sensation to the middle ear cavity via the tympanic plexus within the middle ear cavity.
name: Glossopharyngeal nerve
label: d
answer: no
explanation: The facial nerve supplies taste to the posterior 1/3rd of the tongue, motor function to muscles of facial expression, and sensory function to a small area of the skin around the external ear.
name: Facial nerve
label: e
answer: no

Correct answer: a
A 63-year-old male with a history of gout presents to the GP with a hot, swollen first metatarsophalangeal joint (big toe joint). The GP suspects another flare-up of gout and thinks it may be due to some of his medications.

Which of the following medications could precipitate his gout?

Options:
explanation: Ondansetron is an anti-emetic. It works by blocking 5HT-3 receptors in the gastrointestinal tract and the CNS. It does not affect gout.
name: Ondansetron
label: d
answer: no
explanation: Losartan is an angiotensin II receptor blocker which affects the RAAS system and blood pressure. It decreases the risk of gout as it causes a decrease in uric acid levels within the blood.
name: Losartan
label: b
answer: no
explanation: Tazocin is an antibiotic comprising of piperacillin and tazobactam. It has no role in gout, only in treating bacterial infections.
name: Tazocin
label: e
answer: no
explanation: Bendroflumethiazide is a thiazide diuretic that can also directly increase uric acid re-absorption in the proximal renal tubules, which can cause hyperuricaemia. As gout is due to a build-up of urate crystals in a joint, having a higher concentration of uric acid in the blood will increase the likelihood of a flare-up.
name: Bendroflumethiazide
label: a
answer: yes
explanation: Allopurinol is a gout treatment, so would not cause a flare-up of this patient's gout. Allopurinol blocks the effects of xanthine oxidase - the protein that converts hypoxanthine to uric acid - reducing the level of uric acid within the body.
name: Allopurinol
label: c
answer: no

Correct answer: a
A 93-year-old female is being treated for a UTI with broad-spectrum antibiotics. She is not feeling any better so urine cultures are sent to microbiology, who call back saying that there are bacteria present that have a mecA plasmid resistance.

What antibiotic would be best to treat this kind of bacteria?

Options:
explanation: 3rd generation cephalosporins such as ceftriaxone are useful against TEM-1 bacteria, however, are ineffective against ESBL A&B-producing bacteria. This means that these drugs will not be effective at treating mecA plasmid bacteria.
name: Ceftriaxone
label: b
answer: no
explanation: Macrolides such as doxycycline are ineffective as the mecA plasmid usually has genes that encode proteins that make all macrolides ineffective. This means that doxycycline is not the correct antibiotic of choice for this patient.
name: Doxycycline
label: d
answer: no
explanation: Aminoglycosides such as gentamicin are ineffective as the mecA plasmid usually has genes that encode proteins that make all aminoglycosides ineffective.
name: Gentamicin
label: e
answer: no
explanation: The only class of drugs that counter mecA plasmid bacteria are glycopeptides. Vancomycin is a glycopeptide so can be used in this patient to help treat her infection.
name: Vancomycin
label: a
answer: yes
explanation: Aminopenicillins such as amoxicillin are ineffective as the mecA plasmid bacteria produce PBP2a (which the mecA plasmid gene encodes), which cannot be effectively inhibited by any beta-lactam. Therefore, this class of antibiotics are ineffective at treating mecA plasmid bacteria.
name: Amoxicillin
label: c
answer: no

Correct answer: a
A 23-year-old female is being treated for an asthma exacerbation in the ED. She has been given a variety of drugs but now complains of having a tremor in her hands, making it difficult for her to eat and drink. She would like to know what is the cause of this tremor.

What medication is causing this patient's tremor?

Options:
explanation: Hydrocortisone IV is given if oral prednisolone cannot be given. Both hydrocortisone and prednisolone are corticosteroid drugs, so hydrocortisone has the same side effect profile as prednisolone and does not cause a tremor.
name: Hydrocortisone
label: c
answer: no
explanation: Omeprazole is a proton pump inhibitor (PPI) and plays no role in treating asthma exacerbations. It also does not cause a tremor.
name: Omeprazole
label: e
answer: no
explanation: Prednisolone is used in acute exacerbations of asthma, however, it does not cause a tremor. The main side effects of prednisolone are GI discomfort, and increased risk of peptic ulcer and osteoporosis if used long-term.
name: Prednisolone
label: b
answer: no
explanation: Co-amoxiclav is an antibiotic used if there is a suspected infective cause of the asthma exacerbation. It does not cause a tremor, but a serious side effect can be anaphylaxis if the patient is allergic to penicillin, so remember to check the patient's allergies before giving it.
name: Co-amoxiclav
label: d
answer: no
explanation: The exact mechanism by which salbutamol causes tremor is still unknown, but the leading theory is that salbutamol acts on beta-2 adrenoreceptors in muscles, leading to incomplete muscle relaxation and contraction, leading to tremors. There is also an alternative theory that suggests that salbutamol causes hypokalaemia which subsequently causes the tremor.
name: Salbutamol
label: a
answer: yes

Correct answer: a
A 53-year-old male comes into the hospital as he is feeling tired all the time and experiencing occasional dizziness. The doctor performs some blood tests and finds that he has a haemoglobin of 58g/dl. The doctor organises a blood transfusion for this patient as his haemoglobin is low.

However, during the blood transfusion, the patient starts to develop a fever. The doctor on-call thinks this is due to a hypersensitivity reaction.

Which type of hypersensitivity reaction has this patient experienced?

Options:
explanation: This patient has most likely been given the wrong type of blood, which causes IgG antibodies to be produced towards the incompatible blood type, leading to the agglutination of these cells and inflammation.
name: Type II hypersensitivity reaction
label: a
answer: yes
explanation: There is no type V hypersensitivity reaction, so this option is incorrect.
name: Type V hypersensitivity reaction
label: e
answer: no
explanation: This is when an antigen-antibody complex is deposited into the small vasculature, causing an immune response which leads to inflammation. This can cause autoimmunity; an example of a type III hypersensitivity reaction is rheumatoid arthritis.
name: Type III hypersensitivity reaction
label: c
answer: no
explanation: An example of this is contact dermatitis. The reactive molecule binds as a hapten to an endogenous protein which is recognised and taken up by Langerhans cells. This causes T helper cells to secrete IFN-γ and cause a pro-inflammatory state within the tissue. This patient is not experiencing this type of reaction.
name: Type IV hypersensitivity reaction
label: d
answer: no
explanation: This is when an allergen is picked up by dendritic cells which activate B cells and produce IgE antibodies. These IgE antibodies attach to mast cells and cause them to degranulate, releasing histamine. This patient has experienced a type II, not type I hypersensitivity reaction.
name: Type I hypersensitivity reaction
label: b
answer: no

Correct answer: a
A 34-week-old premature neonate is being treated for respiratory distress. The neonatal consultant suspects that they are deficient in surfactant.

What is responsible for producing surfactant in the lungs?

Options:
explanation: This is where the trachea bifurcates and splits into the left and right primary (main) bronchi. It is located at the level of the sternal angle.
name: Carina
label: d
answer: no
explanation: These cells are found in the walls of the alveoli and they form the squamous epithelium. This allows for a very small barrier for gaseous exchange, therefore increasing the concentration of oxygen getting into the capillaries and carbon dioxide leaving the capillaries.
name: Type 1 pneumocytes
label: b
answer: no
explanation: These cells are found in the walls of alveoli and their main role is to produce surfactant. Surfactant is produced to prevent the collapse of the alveoli when there is positive pressure in the lungs (during expiration).
name: Type 2 pneumocytes
label: a
answer: yes
explanation: Bronchioles have ciliated columnar epithelium with very few goblet cells. They do not contain cartilage or submucosal glands as the walls are mostly smooth muscle. Bronchioles do not secrete surfactant or mucus.
name: Bronchioles
label: c
answer: no
explanation: The visceral pleura covers the lungs and is adherent to all its surfaces. It contains a small volume of serous fluid, which has 2 major functions:

* Lubricates the surface of the pleurae, allowing them to slide over each other
* Produces surface tension, pulling the parietal and visceral pleura together – this ensures that when the thorax expands, the lungs also expand, allowing it to be filled up with air.

The visceral pleura does not secrete surfactant.
name: Visceral pleura
label: e
answer: no

Correct answer: a
A 34-year-old male presents to the GP with blood-streaked sputum. He has recently returned from Nigeria. The medical team suspect tuberculosis.

Which investigation should be used to confirm the diagnosis of tuberculosis?

Options:
explanation: The Mantoux test is used to test for latent disease (when there are no symptoms), either before receiving the BCG vaccine or if there has been recent contact with a person with tuberculosis. This patient has an active tuberculosis infection so the best way to confirm the diagnosis is with a sputum culture.
name: Mantoux test
label: b
answer: no
explanation: An ECG will not help detect or confirm tuberculosis, but it might help detect any cardiac abnormalities.
name: ECG
label: e
answer: no
explanation: A chest x-ray might show that there is shadowing within the lung fields, however, it will not give a definite diagnosis of tuberculosis infection. There is usually lung cavitation and hilar lymph node shadowing on a chest x-ray during a tuberculosis infection.
name: Chest x-ray
label: c
answer: no
explanation: This is the correct answer as this patient has an active tuberculosis infection, therefore obtaining a sputum culture to look for acid-fast bacilli is the best way to confirm the diagnosis.
name: Sputum culture
label: a
answer: yes
explanation: This is used to test for latent disease, not active tuberculosis. It is a lot more sensitive and specific than Mantoux so allows for detection in immunosuppressed patients. It works because memory T cells release IFN-gamma upon detection of *M. tuberculosis* antigens which can be detected by a machine.
name: IFN-gamma release assay
label: d
answer: no

Correct answer: a
A 24-year-old female is undergoing spirometry for her asthma to assess how well-controlled it is. The doctor explains to the patient what each of the lines on the graph means.

As part of the test, the doctor asks the patient to take in the deepest breath that she can and then blow out as much air as she can.

What is the name given to this volume of air on the spirometry graph?

Options:
explanation: Residual volume is the volume of air remaining in the lungs after maximum forceful expiration. This air cannot be expelled from the lungs; otherwise, the alveoli would collapse.
name: Residual volume
label: c
answer: no
explanation: Vital capacity is the maximal volume of air that can be exhaled following maximum inspiration. It is usually measured from the highest peak to the lowest trough on the graph.
name: Vital capacity
label: a
answer: yes
explanation: Inspiratory capacity is the amount of air that can be inhaled after the end of a normal expiration. It can be worked out by combining the tidal volume and the inspiratory reserve volume.
name: Inspiratory capacity
label: d
answer: no
explanation: Tidal volume is the amount of air that moves in or out of the lungs with each respiratory cycle and is usually around 500ml.
name: Tidal volume
label: b
answer: no
explanation: Expiratory reserve volume is the reserve amount of air that can be exhaled forcefully after passive exhalation.
name: Expiratory reserve volume
label: e
answer: no

Correct answer: a
An 86-year-old male is being observed breathing by the medical team on the respiratory ward. It is noted that he is using his accessory muscles to breathe, which is concerning the medical team.

What accessory muscle elevates the sternum during inspiration?

Options:
explanation: The sternocleidomastoid muscle attaches to the manubrium and clavicle and helps elevate the sternum during inspiration. This increases the length of the thoracic cavity, allowing for greater expansion of the lungs, and increasing gaseous exchange.
name: Sternocleidomastoid muscle
label: a
answer: yes
explanation: The posterior scalene muscle attaches to the inner border of the second rib, elevating it during inspiration. The sternocleidomastoid muscle elevates the sternum during inspiration.
name: Posterior scalene muscle
label: c
answer: no
explanation: The diaphragm is located at the bottom of the ribcage, not connecting to the sternum at any point, and is dome-shaped. During inspiration, the dome descends, thus increasing the vertical dimension of the thoracic cavity.
name: Diaphragm
label: e
answer: no
explanation: The external intercostal muscles elevate the ribs during inspiration, causing an increase in thoracic cavity width. The sternocleidomastoid muscle elevates the sternum during inspiration.
name: External intercostal muscles
label: d
answer: no
explanation: The anterior scalene muscle attaches to the inner border of the first rib and elevates it during inspiration. The sternocleidomastoid muscle elevates the sternum during inspiration.
name: Anterior scalene muscle
label: b
answer: no

Correct answer: a
A 19-year-old male is on a ventilator after being involved in a severe car crash. The ventilator is taking over his breathing, replacing the function of the diaphragm.

Which nerve roots innervate the diaphragm?

Options:
explanation: C6-T1 nerve roots form the majority of the brachial plexus. These nerves innervate the shoulder, arm and hand on each side of the body. These nerves do not innervate the diaphragm.
name: C6-T1
label: d
answer: no
explanation: C1,2 and 3 all innervate the head and neck, allowing for control of forward, backwards and sideways movement of the head and neck. They do not control the diaphragm.
name: C1-C3
label: b
answer: no
explanation: T1 and T2 are thoracic nerves and run between the ribs, with each thoracic nerve being named after the vertebra above it. These nerves innervate the intercostal muscles, not the diaphragm.
name: T1-T2
label: c
answer: no
explanation: C3,4 and 5 all innervate the diaphragm, causing it to flatten during inspiration and return to a dome shape during expiration. Remember the phrase 'C3,4,5 keeps the diaphragm alive'.
name: C3-C5
label: a
answer: yes
explanation: L4-S3 nerve roots form the sacral plexus, which forms the sciatic nerve. This nerve runs down from the lumbar region of the spinal cord, into the leg.
name: L4-S3
label: e
answer: no

Correct answer: a
A 26-year-old female presents to the GP with a 2-day history of pain behind the eye. She also describes a bit of blurriness and some changes to her red colour vision. The GP suspects this is optic neuritis and manages it accordingly.

What other pathology should be screened for in this woman?

Options:
explanation: Wilson's disease is a build-up of copper in the body due to an inability to excrete excess copper. If there were Kayser–Fleischer rings present (golden-brown eye discolouration), then it would be appropriate to screen for Wilson's disease.
name: Wilson's disease
label: c
answer: no
explanation: Scleritis is inflammation of the sclera and causes symptoms such as pain on eye movement. This does not need to be screened for when a patient presents with optic neuritis.
name: Scleritis
label: b
answer: no
explanation: This would be reasonable if the patient had xanthelasma around the eye and eyelid; however, this patient has presented with optic neuritis which can be the first sign of multiple sclerosis.
name: High cholesterol
label: e
answer: no
explanation: Thyroid eye disease would present with bulging, dry, irritated eyes. If this was the presentation, then it would be reasonable to do blood tests to check for hyperthyroidism and antibodies.
name: Graves' disease
label: d
answer: no
explanation: Optic neuritis is a very common first presentation for multiple sclerosis (MS). MS is screened for using MRI scans which have to show 2 separate lesions on 2 separate MRIs (McDonald criteria - an individual must have symptoms/radiological signs which are disseminated in both space and time to be diagnosed with MS).
name: Multiple sclerosis
label: a
answer: yes

Correct answer: a
A 64-year-old diabetic presents to the eye clinic complaining of some vision loss. The ophthalmologist shines a light into the patient's eye and diagnoses a cataract. The patient asks what is the cause of his inability to see specific parts of his visual field.

What is activated in the phototransduction pathway when white light is shone onto it?

Options:
explanation: Na+ channels in rod cells close in response to light as rhodopsin is activated. This leads to hyperpolarisation of the cell and a subsequent decrease in synaptic glutamate release due to the closure of voltage-gated calcium channels.
name: Na+ channels in rod cells
label: b
answer: no
explanation: Rod cells in the eye contain rhodopsin which is activated when light is shone onto it. This molecule closes Na+ channels, hyperpolarising the cell. This leads to a decrease in synaptic glutamate release due to the closure of voltage-gated calcium channels.
name: Rhodopsin
label: a
answer: yes
explanation: Drusen are yellow fat/protein deposits in the macular which cause photoreceptor loss, leading to dry age-related macular degeneration. This is pathological and is not usually found in healthy people, so has no role in normal visual pathways.
name: Drusen
label: e
answer: no
explanation: Vitreous humour is the jelly-like substance in the posterior chamber of the eye that helps maintain the eye's shape and acts as a shock absorber. It is not involved in the phototransduction pathway.
name: Vitreous humour
label: c
answer: no
explanation: Cone cells are activated by coloured lights. There are 3 types of cones: green cones, red cones and blue cones; all dedicated to detecting different wavelengths of light.
name: Cone cells
label: d
answer: no

Correct answer: a