hllj/quesmed huggingface dataset:
A pregnant woman is asking you about the analgesic options available for delivery and wants to know what is involved in an epidural.

Which of the following is the best site to administer an epidural injection?

Options:
explanation: This is the level of the transition between the lumbar and sacral spine. Although the risk to the spinal cord is the same as for L2,3,4, it is more challenging to identify the anatomical landmarks needed to safely insert the needle at this level.
name: L5-S1
label: d
answer: no
explanation: This is the level of the aortic arch on the left and the superior vena cava on the right. Epidural anaesthesia at this level will risk damaging the spinal cord.
name: T4-T5
label: b
answer: no
explanation: This is the level of the umbilicus. Injection into this site will risk damage to the spinal cord.
name: T10-T11
label: c
answer: no
explanation: This is the base of the neck. Injection here would not target the correct nerve roots and would risk damage to the spinal cord.
name: C6-C7
label: e
answer: no
explanation: Epidural is safer anywhere below L2, with L2-L3 or L3-L4 preferred. This will target the lumbar nerve roots involved in the pain sensation associated with childbirth.
name: L3-L4
label: a
answer: yes

Correct answer: a
A 55-year-old woman is suspected to have oestrogen receptor-positive breast cancer.

Which of the following is a risk factor for the development of this type of cancer?

Options:
explanation: Increased hormone exposure is a risk factor for breast cancer.
The intrauterine device is a non-hormonal method of contraception and so does not contribute to hormone exposure.
name: Use of intrauterine device/ copper coil
label: d
answer: no
explanation: Late menopause is a risk factor for breast cancer for the same reason as early menarche- there is increased exposure to sex hormones.
name: Premature menopause
label: e
answer: no
explanation: This is the correct answer as this increases hormone exposure. It also reduces the chance of having multiple separate pregnancies.
name: Late first pregnancy
label: a
answer: yes
explanation: Early menarche is a risk factor for development of breast cancer due to longer exposure to oestrogen.
name: Late menarche
label: b
answer: no
explanation: Nulliparity is a risk factor for development of breast cancer due to increased hormone exposure, so having multiple pregnancies reduces this.
name: Multiparity
label: c
answer: no

Correct answer: a
A 67-year-old gentleman with a known pituitary adenoma presents with bitemporal hemianopia visual field loss.

Which part of the optic tract is most likely to be affected?

Options:
explanation: Damage to the right optic nerve causes right-sided monocular vision loss, meaning the patient is unable to see anything from the right eye.
name: Right optic nerve
label: c
answer: no
explanation: This causes contralateral (right) homonymous hemianopia.
name: Left optic tract
label: e
answer: no
explanation: This causes contralateral (left) homonymous hemianopia.
name: Right optic tract
label: d
answer: no
explanation: Damage to the left optic nerve causes left-sided monocular vision loss, meaning the patient is unable to see anything from the left eye.
name: Left optic nerve
label: b
answer: no
explanation: The optic chiasm is where the fibres of the left and right nasal retina cross over, correlating to the vision from the temporal visual fields. Therefore damage to this area causes temporal field loss on both sides. The easiest way to understand this concept is to learn the optic tract diagram and draw it out in exam questions.
name: Optic chiasm
label: a
answer: yes

Correct answer: a
A woman is being seen by her GP as her recent blood results suggest she has primary hyperparathyroidism.

Which of these results would have prompted this suspicion?

Options:
explanation: Although the parathyroid gland has 'thyroid' in the name, it does not contribute to the production of thyroid hormones. Therefore unless there was co-existent thyroid disease, thyroid function tests would be normal.
name: High serum thyroxine
label: e
answer: no
explanation: In primary hyperparathyroidism, there is excess production of PTH which causes bone resorption, increased calcium reabsorption in kidneys and increased absorption of calcium from the small intestine indirectly via vitamin D synthesis which raises serum calcium.
name: High serum calcium
label: a
answer: yes
explanation: In primary hyperparathyroidism, there is excessive production of parathyroid hormone(PTH) which increases serum calcium. There is low serum calcium in secondary hyperparathyroidism.
name: Low serum calcium
label: c
answer: no
explanation: In primary hyperparathyroidism serum phosphate is typically low as PTH decreases renal reabsorption of phosphate, lowering serum levels.
name: High serum phosphate
label: d
answer: no
explanation: This would suggest Stage 3b chronic kidney disease, which causes secondary and then tertiary hyperparathyroidism due to chronically low calcium.
name: eGFR 30ml/min/1.73m^2
label: b
answer: no

Correct answer: a
A pregnant woman at eight weeks gestation rings the GP requesting antibiotics for a suspected UTI. She asks for Trimethoprim, as she had it four months ago and it worked well. Trimethoprim inhibits folic acid formation.

Which of the following structures in the foetus is at risk if she was to take it?

Options:
explanation: Trimethoprim reduces folic acid synthesis. Adequate levels of folic acid are required to ensure the closure of the neural tube in embryological development in the first trimester. Therefore taking trimethoprim during this time increases the risk of neural tube defects, such as spina bifida.
name: Neural tube
label: a
answer: yes
explanation: Paramesonephric ducts develop into the female reproductive system. Folic acid is not important in this process.
name: Paramesonephric ducts
label: b
answer: no
explanation: Mesonephric ducts develop into the male reproductive system. Folic acid is not important in this process.
name: Mesonephric ducts
label: e
answer: no
explanation: The foregut forms the oesophagus, stomach, liver, gallbladder, bile ducts, pancreas and proximal duodenum. This does not depend on folic acid.
name: Foregut
label: d
answer: no
explanation: The primitive heart tube is the first structure in the formation of the heart. This process is not dependent on folic acid.
name: Primitive heart tube
label: c
answer: no

Correct answer: a
A 75-year-old man with known atrial fibrillation presents with sudden onset central abdominal pain. He is diagnosed with acute mesenteric ischaemia.

Which part of the bowel is most commonly affected by acute bowel ischaemia?

Options:
explanation: This receives its own blood supply from the sigmoidal branches of the inferior mesenteric artery.
name: Sigmoid colon
label: e
answer: no
explanation: This is part of the small intestine and is supplied by the ileocolic artery which is a branch of the superior mesenteric artery. The superior mesenteric artery is most likely to be affected by a thrombus. However, due to the watershed region created by the blood supply of the splenic flexure, the splenic flexure is more likely to be affected.
name: Ileum
label: d
answer: no
explanation: This is supplied by the superior mesenteric artery, which is where the thrombus is most likely to affect. However, due to the watershed region created by the blood supply of the splenic flexure, the splenic flexure is more likely to be affected.
name: Hepatic flexure
label: b
answer: no
explanation: This is supplied by the ileocolic artery which is a branch of the superior mesenteric artery, which is where the thrombus is most likely to affect. However, due to the watershed region created by the blood supply of the splenic flexure, the splenic flexure is more likely to be affected.
name: Caecum
label: c
answer: no
explanation: This is the correct answer. The splenic flexure is where the transverse colon becomes the descending colon. Although the most common cause of mesenteric ischaemia is occlusion of the superior mesenteric artery, the splenic flexure is supplied by terminal branches of both the superior and inferior mesenteric arteries. However, this creates a watershed region and so as it lacks its own blood supply it is more susceptible to ischaemia.
name: Splenic flexure
label: a
answer: yes

Correct answer: a
Progesterone plays an important role in the menstrual cycle, which of these changes occurs as a result of progesterone release?

Options:
explanation: This is what the LH surge stimulates - ovulation.
name: Release of the ovum from the ovary into the fallopian tube
label: c
answer: no
explanation: This is a role of oestrogen in the proliferative phase of the menstrual cycle. It allows sperm to enter the uterus and fertilise the ovum.
name: Production of thin alkaline cervical mucus
label: b
answer: no
explanation: This is the role of inhibin, which is produced by granulosa cells.
name: Selective inhibition of FSH production
label: e
answer: no
explanation: During the secretory phase, progesterone stimulates production of thick and acidic cervical mucus to prevent more than one sperm from fertilising the ovum.
name: Production of thick acidic cervical mucus
label: a
answer: yes
explanation: During the follicular phase, LH and FSH stimulate follicle growth.
name: Follicle growth
label: d
answer: no

Correct answer: a
You are watching a 60-year-old woman who presented with persistent dysphagia and reflux undergoing endoscopy for suspected oesophageal cancer. The consultant asks you about oesophageal histology.

Which of these is the normal epithelial lining of the lower oesophagus?

Options:
explanation: This epithelial lining is found in ducts and secretory tissue e.g. kidney tubules.
name: Simple cuboidal
label: c
answer: no
explanation: This is the epithelial lining of the stomach and other parts of the digestive tract, bronchi, uterine tubes, and uterus. It secretes mucus and enzymes
name: Simple columnar
label: e
answer: no
explanation: This is often ciliated epithelium, and it lines the trachea and most of the upper respiratory tract. It allows mucus to be moved.
name: Pseudostratified columnar
label: d
answer: no
explanation: This is the lining of the air sacs of the lungs, heart, blood vessels and lymphatic vessels.
name: Simple squamous
label: b
answer: no
explanation: It also lines the mouth and vagina as well - protecting against abrasion.
name: Stratified squamous
label: a
answer: yes

Correct answer: a
You are examining a female patient's abdomen and you identify a scar in the right iliac fossa.

What is the most likely surgery she has undergone in the past?

Options:
explanation: This would typically result in a left-sided subcostal scar - diagonal or parallel to the costal margin.
name: Splenectomy
label: e
answer: no
explanation: Abdominal aortic aneurysm repair is typically done through a midline laparotomy, an incision that goes from the xiphoid process to just above or just below the umbilicus.
name: Abdominal aortic aneurysm repair
label: c
answer: no
explanation: This would typically result in a right-sided subcostal scar - diagonal or parallel to the costal margin.
name: Cholecystectomy
label: d
answer: no
explanation: Caesarean section is typically done via a Pfannenstiel incision, which is a central incision along the suprapubic crease/bikini line.
name: Elective caesarean section
label: b
answer: no
explanation: Appendicectomy is done via a McBurney incision, which is located two-thirds of the way from the umbilicus to the right anterior superior iliac spine.
name: Appendicectomy
label: a
answer: yes

Correct answer: a
Which of these microscopic findings would suggest a diagnosis of Gonorrhoea infection?

Options:
explanation: This would indicate genital candidiasis/thrush infection.
name: Blastospores, pseudohyphae and neutrophils
label: b
answer: no
explanation: This is the correct answer, allowing diagnosis of Gonorrhoea.
name: Gram-negative diplococci
label: a
answer: yes
explanation: Neisseria gonorrhoea would be seen on microscopy. You would expect no microscopy findings in chlamydia infection.
name: No abnormalities would be seen on microscopy
label: d
answer: no
explanation: There are multiple gram-positive diplococci bacteria. One of the most important ones to be aware of is streptococcus pneumoniae.
name: Gram-positive diplococci
label: e
answer: no
explanation: This would indicate Trichomonas vaginalis infection.
name: Motile flagellated protozoa
label: c
answer: no

Correct answer: a
Haloperidol is an antipsychotic but is sometimes used in palliative care as an anti-emetic, which receptors in the brain does this drug work on?

Options:
explanation: Haloperidol blocks dopamine receptors in the central nervous system, specifically D2 receptors.
name: Dopamine receptors
label: a
answer: yes
explanation: Anti-emetics, such as cyclizine are histamine receptor antagonists. They also have no antipsychotic effect.
name: Histamine receptors
label: b
answer: no
explanation: Anti-emetics such as Ondansetron are 5HT3 receptor antagonists, and have no antipsychotic effect.
name: 5HT3 receptors
label: c
answer: no
explanation: These are not involved in nausea and vomiting and so there is no antiemetic that acts on the GABA receptors. Benzodiazepines (e.g. diazepam) act on GABA receptors, as does alcohol.
name: GABA receptors
label: e
answer: no
explanation: Antimuscarinics, such as hyoscine hydrobromide act on muscarinic receptors. They are used as anti-emetics, but also to reduce respiratory secretions (especially in palliative care).
name: Muscarinic acetylcholine receptors
label: d
answer: no

Correct answer: a
A patient presents to ED with persistent epistaxis (nose bleed). He says he currently takes warfarin.

As warfarin inhibits vitamin K, which of the following clotting factors will be affected by taking warfarin?

Options:
explanation: This is factor I, and is affected in disseminated intravascular coagulation. It is not a vitamin K-dependent factor.
name: Fibrinogen
label: c
answer: no
explanation: This is involved in platelet aggregation for clot formation. It is not dependent on vitamin K.
name: Von Willebrand Factor
label: e
answer: no
explanation: Warfarin is a vitamin K antagonist and so affects the vitamin K-dependant clotting factors, which are II, VII, IX and X (often remembered using by '1972').
name: Factor X
label: a
answer: yes
explanation: This is factor III and a co-factor of factor VII, which is not dependent on vitamin K.
name: Tissue Factor
label: d
answer: no
explanation: This is affected in haemophilia A, and is not a vitamin K-dependant clotting factor.
name: Factor VIII
label: b
answer: no

Correct answer: a
A 60-year-old gentleman has a left-sided varicocele.

What does the left testicular vein drain into?

Options:
explanation: This drains the splenic, superior mesenteric and inferior mesenteric veins.
name: Hepatic portal vein
label: e
answer: no
explanation: The left testicular vein drains into the left renal vein, which then drains into the inferior vena cava. Hence, it is possible for a left-sided renal cancer to present as a left-sided varicocele.
name: Left renal vein
label: a
answer: yes
explanation: These drain the right common iliac vein and then drain into the inferior vena cava directly.
name: Lumbar veins
label: d
answer: no
explanation: The left testicular vein branches off higher up (more proximally) than the common iliac due to embryological origins.
name: Left common iliac vein
label: c
answer: no
explanation: The right testicular vein drains straight into the inferior vena cava, but the left drains into the left renal vein first.
name: Inferior vena cava
label: b
answer: no

Correct answer: a
A patient presenting with renal colic has a CT KUB, showing a renal stone at the pelvic-ureteric junction.

What vertebral level is this located at?

Options:
explanation: This is the vertebral level of the pelvic brim and bifurcation of the abdominal aorta into the right and left common iliac arteries, which is another common site for renal stones to become stuck.
name: L4
label: e
answer: no
explanation: The pelvic-ureteric junction (PUJ) is one of the three most common sites for renal stones to become lodged. The PUJ is located at the hilum of the kidneys which is at the L2 vertebral level.
name: L2
label: a
answer: yes
explanation: This is the vertebral level of the superior pole of the kidneys.
name: T12
label: b
answer: no
explanation: This is the vertebral level of the inferior pole of the kidneys.
name: L3
label: c
answer: no
explanation: This is the vertebral level of the sacral promontory.
name: S1
label: d
answer: no

Correct answer: a
A neonate born 3 hours ago at 33 weeks gestation develops an increased respiratory rate, subcostal recessions and nasal grunting. He is assessed by the on-call doctor who suspects neonatal respiratory distress syndrome due to surfactant deficiency.

Which cells produce surfactant?

Options:
explanation: These cells produce mucus.
name: Goblet cells
label: b
answer: no
explanation: These cover most of the alveolar surface and allow gas exchange to occur.
name: Type 1 alveolar cells
label: c
answer: no
explanation: These are the macrophages of the alveoli.
name: Dust cells
label: d
answer: no
explanation: These are a type of epithelial cells that produce surfactant, starting at 24-28 weeks gestation.
name: Type 2 alveolar cells
label: a
answer: yes
explanation: These cells are located in the airways and propel mucus up the airway to remove pathogens and particulate matter.
name: Ciliated epithelial cells
label: e
answer: no

Correct answer: a
Menopause can be confirmed by a blood test comparing the levels of LH and FSH.

Which cells produce these two hormones?

Options:
explanation: These are cells of the ovaries, which produce oestrogen and progesterone during the menstrual cycle.
name: Granulosa cells
label: c
answer: no
explanation: These cells are located in the anterior pituitary and produce the gonadotropins - FSH and LH.
name: Gonadotropes
label: a
answer: yes
explanation: These cells are present in males in the testes and secrete testosterone.
name: Leydig cells
label: e
answer: no
explanation: These cells are located in the anterior pituitary, but they produce growth hormone.
name: Somatotropes
label: b
answer: no
explanation: These cells are located in the anterior pituitary, but they produce prolactin which promotes milk secretion.
name: Lactotropes
label: d
answer: no

Correct answer: a
You visit a patient on the general surgery ward. They have just undergone a bowel resection of some kind, and they ask you which part of their bowel has been removed. However, all they can recall is that the surgeon said they would need to have their vitamin B12 regularly checked and replaced.

Which part of their bowel is most likely to have been removed?

Options:
explanation: This is the last section of the bowel and mainly stores faeces until it is evacuated.
name: Sigmoid colon
label: d
answer: no
explanation: This is the only part of the small intestine where B12 is absorbed and so removal of this results in B12 deficiency.
name: Terminal ileum
label: a
answer: yes
explanation: This connects the terminal ileum and the ascending colon. Here, fluid and electrolytes are absorbed in preparation for faeces formation.
name: Caecum
label: c
answer: no
explanation: This has mainly digestive functions including neutralisation of the acidic gastric contents, mixing bile and pancreatic enzymes, absorption of water, and absorption of some electrolytes and nutrients. B12 is not one of these.
name: Duodenum
label: b
answer: no
explanation: This is located between the duodenum and ileum. It is where sugars, amino acids and fatty acids are absorbed.
name: Jejunum
label: e
answer: no

Correct answer: a
A 10-year-old girl presents with an acute asthma attack. She is given back-to-back salbutamol nebulisers to open up her airways.

Which of the following receptors does salbutamol act on?

Options:
explanation: These are mainly found in blood vessels and the bladder. When activated, they cause vasoconstriction, raised blood pressure and closure of bladder sphincters.
name: Alpha-1 adrenergic receptors
label: c
answer: no
explanation: These are located at skeletal muscle neuromuscular junctions. Stimulation causes muscle excitation.
name: Nicotinic acetylcholine receptors
label: d
answer: no
explanation: These are located in the heart, and increase heart rate and contractility when activated.
name: Beta-1 adrenergic receptors
label: b
answer: no
explanation: These are located in smooth muscles, cardiac muscle and glands. They cause bronchoconstriction in the lungs when activated.
name: Muscarinic acetylcholine receptors
label: e
answer: no
explanation: These receptors are located in the bronchioles. Activation of them causes bronchodilation. The location of beta-1 and beta-2 adrenergic receptors can be remembered by the fact that beta-1 receptors are located in the heart, and humans have one heart. However, beta-2 receptors are located in the lungs, and humans have two lungs.
name: Beta-2 adrenergic receptors
label: a
answer: yes

Correct answer: a
Which of these women would need an injection of anti-D to prevent haemolytic disease of the newborn?

Options:
explanation: Although miscarriage is a potential sensitising event where maternal blood can come into contact with fetal blood, the mother is rhesus-positive herself and so will not produce anti-rhesus antibodies.
name: Rhesus-positive woman with a rhesus-negative baby on a background of a past miscarriage
label: b
answer: no
explanation: Rhesus-negative mothers have no anti-rhesus antibodies. However, if exposed to the rhesus antigens of a rhesus-positive baby they will develop these antibodies. Therefore, in future pregnancies, there is a risk that these maternal antibodies can attack the rhesus antigens on the red blood cells of a future rhesus-positive fetus - causing haemolysis. To prevent this, anti-D immunoglobulin.
name: Rhesus-negative mother after delivery of a rhesus-positive baby
label: a
answer: yes
explanation: Although amniocentesis is a potential sensitising event where maternal blood can come into contact with fetal blood, the mother is rhesus-positive and so will not produce anti-rhesus antibodies.
name: Rhesus-positive woman with a rhesus-negative baby who underwent an amniocentesis
label: d
answer: no
explanation: As the fetus has no rhesus antigens in its blood even if the mother's blood is exposed to fetal blood, there will be no antibodies formed.
name: Rhesus-negative woman pregnant with a rhesus-negative baby
label: e
answer: no
explanation: Although miscarriage is a potential sensitising event where maternal blood can come into contact with fetal blood, the mother is rhesus-positive and so will not produce anti-rhesus antibodies.
name: Rhesus-positive woman with a rhesus-positive baby on a background of a past miscarriage
label: c
answer: no

Correct answer: a
You see a patient with suspected bacterial cellulitis of the leg. There are signs of acute inflammation.

Which of the following cells is most likely to be predominant at this stage?

Options:
explanation: These are associated with allergies and parasitic infections and so will not be prominent in the immune response to a bacterial infection.
name: Eosinophils
label: b
answer: no
explanation: These are present in the tissues and activate the adaptive immune response. They are predominantly involved after the acute inflammatory stage to clear debris and foreign substances.
name: Macrophages
label: d
answer: no
explanation: These are involved in the day-to-day regeneration of the layers of the epidermis and are involved in the wound-healing process after an infection.
name: Epidermal stem cells
label: e
answer: no
explanation: These cells are part of the adaptive immune response which takes four to seven days to occur, and are not predominant in the acute inflammatory stage.
name: B lymphocytes
label: c
answer: no
explanation: Neutrophils are predominantly involved in inflammation, as well as for phagocytosis of bacteria as part of the innate immune response, occurring immediately following the initial infection.
name: Neutrophils
label: a
answer: yes

Correct answer: a