hllj/quesmed huggingface dataset:
Which of the following cells synthesises prolactin?

Options:
explanation: This is not the correct answer. Somatotrophs in pars distalis produce growth hormone.
name: Somatotrophs in pars distalis
label: b
answer: no
explanation: This is not the correct answer. Corticotropic basophils in the pars intermedia secrete melanocyte-stimulating hormone (MSH).
name: Basophils in pars intermedia
label: d
answer: no
explanation: This is not the correct answer. Basophils in pars tuberalis surround the infundibular stem, which is a collection of axons that project into the pituitary gland from the hypothalamus and stores anti-diuretic hormone (or vasopressin) and oxytocin.
name: Basophils in pars tuberalis
label: e
answer: no
explanation: This is the correct answer. The anterior lobe (adenohypophysis) of the pituitary gland consists of three parts: pars distalis (or pars anterior), pars intermedia, and pars tuberalis. The pars distalis consists of chromophils (acidophils and basophils) and chromophobes. Acidophils consist of somatotrophs and mammotrophs (or lactotrophs), which produce growth hormone and prolactin respectively. Basophils consist of gonadotrophs that produce follicle-stimulating hormone (FSH) and luteinizing hormone (LH), corticotrophs which produce adrenal corticotropic hormone (ACTH), and thyrotrophs which produce thyroid-stimulating hormone (TSH).
name: Acidophils in pars distalis
label: a
answer: yes
explanation: This is not the correct answer. Gonadotrophs in pars distalis produce follicle-stimulating hormone (FSH) and luteinizing hormone (LH).
name: Gonadotrophs in pars distalis
label: c
answer: no

Correct answer: a
Which of the cells of the anterior pituitary secrete adrenal corticotropic hormone (ACTH)?

Options:
explanation: This is the correct answer. Basophils consist of gonadotrophs that produce follicle-stimulating hormone (FSH) and luteinizing hormone (LH), corticotrophs which produce adrenal corticotropic hormone (ACTH), and thyrotrophs which produce thyroid-stimulating hormone (TSH).
name: Basophils in pars distalis
label: a
answer: yes
explanation: This is not the correct answer. The posterior lobe (neurohypophysis) of the pituitary gland consists of the pars nervosa and the infundibulum. The infundibulum is continuous with the median eminence located at the base of the hypothalamus, where neurosecretory cells release hypothalamic-releasing hormones into the portal capillary bed for transport to the anterior pituitary.
name: Neurosecretory cells in the median eminence
label: e
answer: no
explanation: This is not the correct answer. Corticotropic basophils in the pars intermedia secrete melanocyte-stimulating hormone.
name: Basophils in pars intermedia
label: b
answer: no
explanation: This is not the correct answer. Neurons of the supraoptic and paraventricular nuclei in the hypothalamus, located in the supraoptic region, synthesize anti-diuretic hormone (or vasopressin) and oxytocin. These hypothalamic hormones are stored in axons containing Herring's bodies, filled with neurosecretory granules, in the pars nervosa of the neurohypophysis.
name: Neurons of the supraoptic and paraventricular nuclei in the hypothalamus
label: d
answer: no
explanation: This is not the correct answer. Chromophobes stain poorly with H&E staining and are the progenitor cells, also known as resting or undifferentiated chromophils.
name: Chromophobes in pars distalis
label: c
answer: no

Correct answer: a
A 50-year-old woman visits her general practitioner for a routine diabetes check-up. She has type two diabetes mellitus. She has a BMI of 32kg/m2 and struggles with glycemic control. She is currently on metformin and dapagliflozin. The doctor suggests adding another drug, exenatide, to help her control her blood glucose levels.

What class of drug is exenatide?

Options:
explanation: This is not the correct answer. Pioglitazone is an example of a thiazolidinedione. Thiazolidinediones increase peripheral insulin sensitivity, thus lowering blood glucose levels. It is an add-on option for dual therapy or an alternative initial treatment if metformin is not tolerated. Thiazolidinediones are contraindicated in heart failure, hepatic impairment, and bladder cancer.
name: Thiazolidinediones
label: d
answer: no
explanation: This is not the correct answer. Metformin is an example of a biguanide that lowers blood glucose levels by increasing peripheral insulin sensitivity and enhancing hepatic glucose uptake. It is offered as initial treatment if the person fails to meet the recommended HbA1c target of < 48mmol/mol (6.5%) with lifestyle changes. It is contraindicated in patients with severe renal or hepatic impairment.
name: Biguanide
label: b
answer: no
explanation: This is not the correct answer. Dapagliflozin is an example of an SGLT2 inhibitor. SGLT2 is the major co-transporter for glucose reabsorption in the proximal convoluted tubule. As such, SGLT2 inhibitors increase urinary glucose excretion, consequently reducing blood glucose levels. SGLT2 inhibitors are an add-on option for dual therapy or an alternative initial treatment if metformin is not tolerated. Important adverse effects include urogenital infections and it is contraindicated in severe renal impairment.
name: SGLT2 inhibitor
label: e
answer: no
explanation: This is the correct answer. GLP-1 agonists stimulate insulin secretion and simultaneously reduce glucagon secretion. It is contraindicated in patients with renal impairment and/or a history of pancreatitis.
name: GLP-1 agonist
label: a
answer: yes
explanation: This is not the correct answer. Gliclazide is an example of a sulfonylurea. Sulfonylureas stimulate pancreatic beta cells to produce insulin. It is an add-on option for dual therapy or an alternative initial treatment if metformin is not tolerated. Sulfonylureas are contraindicated in type 1 diabetes mellitus and patients with severe renal or hepatic impairment.
name: Sulfonylurea
label: c
answer: no

Correct answer: a
An 18-year-old male is visiting his GP for an army medical assessment. He is normal weight, but complains of polyuria, fatigue and weight loss without trying. His sister and mother have type one diabetes.

Which of the following investigations can help assess his endogenous insulin production?

Options:
explanation: This is not the correct answer. A random blood glucose of ≥ 11.1mmol/l or fasting plasma glucose of ≥ 7mmol/l is one of the results which is sufficient for diagnosis of type 1 diabetes mellitus in symptomatic patients. However, it does not assess endogenous insulin production.
name: Random blood glucose and Fasting plasma glucose
label: e
answer: no
explanation: This is not the correct answer. The presence of urinary ketones may suggest concurrent DKA. It does not assess endogenous insulin production.
name: Urine ketones
label: d
answer: no
explanation: This is not the correct answer. A HbA1C of ≥ 48mmol/mol (6.5%) is one of the results which is sufficient for diagnosis of type 1 diabetes mellitus in symptomatic patients. However, it does not assess endogenous insulin production.
name: HbA1c
label: b
answer: no
explanation: This is not the correct answer. Identification of specific antibodies (e.g. anti-GAD, ICA, IAA) helps in confirming the diagnosis of type 1 diabetes mellitus as it indicates the autoimmune nature. However, it is not part of the diagnostic criteria and it does not assess endogenous insulin production.
name: Auto-antibodies testing
label: c
answer: no
explanation: This is the correct answer. C-peptide and insulin are packaged into vesicles in the Golgi apparatus and are secreted in equal concentrations. As such, low C-peptide levels would indicate low endogenous insulin levels, which is characteristic of type 1 diabetes mellitus as it is an autoimmune condition where the destruction of insulin-producing beta cells in the pancreas results in insulin deficiency.
name: C-peptide levels
label: a
answer: yes

Correct answer: a
A 40-year-old man presents with weight gain around his truncal area, stretch marks on his stomach and bruises on his limbs despite having no recollection of injury. He has a past medical history of asthma and is on daily prednisolone.

What is the most appropriate first-line investigation to carry out?

Options:
explanation: This is not the correct answer. While this is a good test to determine whether it is Cushing's disease (Pituitary source), a more ideal investigation would be to start with a low-dose dexamethasone suppression test to confirm cortisol excess. Lack of suppression with low dose suggests Cushing's syndrome such as exogenous steroid use or cortisol producing adrenal adenoma, lack of suppression with low dose but suppression with high dose suggests Cushing's disease, and lastly, lack of suppression by both low or high dose suggests ectopic ACTH source such as an ACTH producing tumour.
name: High-dose dexamethasone suppression test
label: c
answer: no
explanation: This is not the correct answer. While it is a useful follow-up investigation to localize tumour(s) that may be secreting ACTH or cortisol, it is important to confirm cortisol excess with preliminary diagnostic investigations first.
name: CT chest and abdomen
label: d
answer: no
explanation: This is not the correct answer. While it is a useful follow-up investigation to localize an ACTH-secreting pituitary tumour (Cushing's disease), it is important to confirm cortisol excess with preliminary diagnostic investigations first.
name: MRI of the Pituitary
label: e
answer: no
explanation: This is not the correct answer. While this is a good test to localise the source of cortisol excess by determining whether it is ACTH-dependent or ACTH-independent causes.
name: Plasma ACTH levels
label: b
answer: no
explanation: This is the correct answer. The clinical presentation of this patient suggests cortisol excess. As such, to determine cortisol excess, a positive result must be obtained from 2 of the following 3 investigations; Late-night salivary cortisol, 24-hour urinary free cortisol, and a low-dose dexamethasone suppression test.
name: Late-night salivary cortisol
label: a
answer: yes

Correct answer: a
A 48-year-old woman complains of feeling hot all the time alongside diarrhoea, anxiety and restlessness. On examination, her positive findings include finger clubbing, mild proptosis and a heart rate of 98 beats per minute. Her TFT results show Free T4 of 35pmol/L (9 - 25 pmol/L) and TSH 0.1mu/L (0.3 - 4.2 mU/L).

What is her most likely diagnosis?

Options:
explanation: This is not the correct answer. Toxic multinodular goitre is when there are multiple thyroid nodules producing thyroid hormones which, as the name suggests, lead to goitre. This patient does not have a nodular goitre.
name: Toxic multinodular goitre
label: c
answer: no
explanation: This is not the correct answer. De-Quervain's (subacute) thyroiditis is the painful inflammation of the thyroid thought to be triggered by a viral infection. It generally occurs in women aged 20 to 50 years old, but it also presents with features this patient did not have such as a high temperature and pain in the neck and/or jaw and/or ear.
name: De-Quervain's thyroiditis
label: d
answer: no
explanation: This is not the correct answer. Features of hyperthyroidism such as restlessness, mood changes such as depression and anxiety and so forth can overlap with features of anxiety disorder, as such, it is an important diagnosis to consider. However, it should be considered as a separate diagnosis, especially in a patient who presents with other hyperthyroidism associated features.
name: Anxiety disorder
label: e
answer: no
explanation: This is the correct answer. Raised free T4 and low TSH, along with the clinical features, imply hyperthyroidism. Hyperthyroidism mostly affects women and the elderly, and Grave's disease is the predominant cause. Grave's disease is an autoimmune condition involving thyroid receptor antibodies (Anti-TSH) which bind to TSH receptors and result in increased thyroid hormone synthesis and follicular enlargement (may manifest as goitre). Other manifestations include Grave's ophthalmoplegia, thyroid acropachy, and pretibial myxoedema, where the first two are present in this patient in the form of proptosis and finger clubbing respectively.
name: Grave's disease
label: a
answer: yes
explanation: This is not the correct answer. Hashimoto's thyroiditis is an autoimmune cause of hypothyroidism involving autoantibodies to thyroid peroxidase (Anti-TPO) and thyroglobulin (Anti-thyroglobulin) antibodies. In rare cases, initial destruction of the thyroid gland can release the thyroid hormones and cause temporary transient hyperthyroidism, known as hashitoxicosis, which is almost always followed by hypothyroidism. In most circumstances, thyroid function tests would show a low T4 and raised TSH, unlike the raised free T4 and low TSH in this patient.
name: Hashimoto's thyroiditis
label: b
answer: no

Correct answer: a
A 32-year-old pregnant female, with a concurrent diagnosis of hyperthyroidism, is being reviewed by her endocrinologist. She is currently in trimester one of pregnancy and is having her first child.

Given the above, what medication should be used to treat her hyperthyroidism?

Options:
explanation: This is not the correct answer. Propranolol is a beta-blocker that can be used for symptomatic relief of symptoms associated with increased sympathetic activity. It acts as an adjunct.
name: Propranolol
label: e
answer: no
explanation: This is not the correct answer. Carbimazole is normally the first line anti thyroid drug of choice due to having fewer adverse effects compared to propylthiouracil, but it is not first-line in pregnant patients in the first trimester.
name: Carbimazole
label: b
answer: no
explanation: This is not the correct answer. Radio-iodine is used as definitive management when anti-thyroid drugs are not tolerated or if the disease relapses. It is not a first-line anti-thyroid treatment in a pregnant patient in the first trimester.
name: Radio-iodine
label: d
answer: no
explanation: This is the correct answer. Propylthiouracil is an anti-thyroid drug. Anti-thyroid drugs are the first-line treatment for most patients, where carbimazole is preferred over propylthiouracil. However, for pregnant women or those planning a pregnancy, propylthiouracil is preferred in the first trimester.
name: Propylthiouracil
label: a
answer: yes
explanation: This is not the correct answer. Levothyroxine is an analogue of T4 and is used to replace thyroid levels in patients with hypothyroidism.
name: Levothyroxine
label: c
answer: no

Correct answer: a
Which of the following is the most common enzymatic defect in congenital adrenal hyperplasia?

Options:
explanation: This is not the correct answer. 3β-hydroxylase is an enzyme in the adrenal steroidogenesis pathway, but it is not the most common enzymatic defect in congenital adrenal hyperplasia.
name: 3β-hydroxylase
label: e
answer: no
explanation: This is not the correct answer. 11β-hydroxylase is an enzyme in the adrenal steroidogenesis pathway, but it is not the most common enzymatic defect in congenital adrenal hyperplasia.
name: 11β-hydroxylase
label: c
answer: no
explanation: This is not the correct answer. 17α-hydroxylase is an enzyme in the adrenal steroidogenesis pathway, but it is not the most common enzymatic defect in congenital adrenal hyperplasia.
name: 17α-hydroxylase
label: b
answer: no
explanation: This is not the correct answer. The steroidogenic acute regulatory protein is a regulator of cholesterol transfer within the mitochondria, which is also known as the rate-limiting step in the adrenal steroidogenesis pathway. However, it is not the most common enzymatic defect in congenital adrenal hyperplasia and is known to cause lipoid congenital adrenal hyperplasia if deficient.
name: Steroidogenic acute regulatory protein
label: d
answer: no
explanation: This is the correct answer. Congenital Adrenal Hyperplasia (CAH) is a group of inherited, autosomal recessive genetic disorders caused by enzyme defects in the adrenal cortex, which disrupts steroid hormone synthesis. The most common variant, 21-hydroxylase deficiency, is the only one you have to remember. Diagnosis is made through hormone assays and genetic testing.
name: 21-Hydroxylase
label: a
answer: yes

Correct answer: a
Aldosterone is a steroid hormone involved in the renin-angiotensin-aldosterone system (RAAS).

What is the effect of this hormone?

Options:
explanation: This is the correct answer. Aldosterone increases Na+ reabsorption and K+ secretion in the collecting duct and late distal convoluted tubule by stimulating the sodium-potassium ATPase on the basal side of the tubular cells
name: Increased Na+ reabsorption and K+ secretion in the collecting duct and late distal convoluted tubule
label: a
answer: yes
explanation: This is not the correct answer. Renin, secreted by juxtaglomerular cells, is responsible for converting angiotensinogen (produced in the liver) into angiotensin I.
name: It converts angiotensinogen to angiotensin I
label: b
answer: no
explanation: This is not the correct answer. This is one of the actions of angiotensin II, which also stimulates aldosterone secretion.
name: Directly stimulates vasoconstriction
label: e
answer: no
explanation: This is not the correct answer. The Angiotensin-Converting Enzyme (ACE), produced in the lungs, is responsible for converting angiotensin I to angiotensin II.
name: It converts angiotensin I to angiotensin II
label: c
answer: no
explanation: This is not the correct answer. This is one of the actions of angiotensin II, which also stimulates aldosterone secretion.
name: It increases Na+ resorption via stimulation of sodium-hydrogen ion exchanger activity via AT1 receptors in the tubular cells
label: d
answer: no

Correct answer: a
The histology of a thyroid gland being stimulated by thyroid stimulating hormone (TSH) would show which of the following features?

Options:
explanation: This is not the correct answer. Parafollicular C cells & capillaries do not contain TSH receptors, and therefore would not respond to TSH.
name: Decreased number of parafollicular C cells and capillaries
label: e
answer: no
explanation: This is the correct answer. Follicular cells are simple cuboidal cells which constitute the major cell type in the thyroid gland. These cells are responsible for the production and secretion of thyroid hormones triiodothyronine (T3) and thyroxine (T4). When the thyroid gland is stimulated by TSH, the follicular cells become active and thus, columnar-shaped.
name: Columnar-shaped follicular cells
label: a
answer: yes
explanation: This is not the correct answer. Thyroid follicles contain colloid, thyroglobulin, which is a acidophilic secretory glycoprotein. In the resting (inactive) stage, follicular cells are simple squamous cells with abundant collide within the lumen. When stimulated by TSH, I.e. active, the follicular cells are simple columnar with a scanty volume of colloid in the lumen. As such, there would not be an abundance of colloid in the follicular cells' lumen.
name: Abundance of colloid in follicular cells' lumen
label: d
answer: no
explanation: This is not the correct answer. Parafollicular C cells are derived from the neural crest cells and secrete calcitonin, a polypeptide hormone. These cells do not contain TSH receptors, and therefore, are not stimulated by TSH.
name: Increased number of parafollicular C cells
label: c
answer: no
explanation: This is not the correct answer. TSH stimulates follicular cells to release thyroid hormones, it does not result in a decreased number of follicular cells.
name: Decreased number of follicular cells
label: b
answer: no

Correct answer: a
Which of the following hormones is secreted by the delta cells of the pancreatic islets?

Options:
explanation: This is the correct answer. Somatostatin (Growth hormone-inhibiting hormone) is produced and secreted by the delta cells of the endocrine pancreatic islets. It is released into the bloodstream after a meal and exerts an inhibitory effect on its target organs. D cells in the antrum of the stomach can also secrete somatostatin.
name: Somatostatin
label: a
answer: yes
explanation: This is not the correct answer. Insulin is secreted by the beta cells of the endocrine pancreas, which make up about 70% of the proportion of islet cells.
name: Insulin
label: b
answer: no
explanation: This is not the correct answer. Pancreatic polypeptide (PP) is secreted by the PP cells of the endocrine pancreas.
name: Pancreatic polypeptide
label: d
answer: no
explanation: This is not the correct answer. Glucagon is secreted by the alpha cells of the endocrine pancreas, which make up about 25% of the proportion of islet cells.
name: Glucagon
label: c
answer: no
explanation: This is not the correct answer. Somatotrophin (Growth hormone) is secreted by the anterior pituitary gland.
name: Somatotrophin
label: e
answer: no

Correct answer: a
Which of the following cells synthesises Adrenocorticotropic hormone (ACTH)?

Options:
explanation: This is the correct answer. Corticotrophic basophils in the pars distalis (anterior) of the pituitary gland synthesize ACTH.
name: Basophils in pars distalis
label: a
answer: yes
explanation: This is not the correct answer. Chromophobes are progenitor cells, also known as resting or undifferentiated chromophils, that do not secrete ACTH.
name: Chromophobes in the pars distalis
label: b
answer: no
explanation: This is not the correct answer. Not to be confused with the corticotropic basophils in the pars distalis, those in the pars intermedia secrete melanocyte-stimulating hormone (MSH).
name: Basophils in the pars intermedia
label: c
answer: no
explanation: This is not the correct answer. Neurons of the paraventricular nuclei in the hypothalamus synthesize anti-diuretic hormone (vasopressin) and oxytocin, not ACTH
name: Neurons of the paraventricular nuclei in the hypothalamus
label: e
answer: no
explanation: This is not the correct answer. The infundibulum of the posterior lobe (neurohypophysis) of the pituitary gland is continuous with the median eminence located at the base of the hypothalamus, where neurosecretory cells release hypothalamic-releasing hormones into the portal capillary bed for transport to the anterior pituitary.
name: Neurosecretory cells in the median eminence
label: d
answer: no

Correct answer: a