hllj/quesmed huggingface dataset:
A 63 year old man presents to the Emergency Department with epigastric pain. The foundation doctor recalls that epigastric pain originates from foregut structures.

Which of the following is a foregut structure?

Options:
explanation: This is correct. The foregut gives rise to the oesophagus, stomach, liver, gallbladder, bile ducts, pancreas and proximal duodenum, ending after the entry of the common bile duct into the duodenum.

Therefore, the proximal duodenum is a foregut structure.
name: Proximal duodenum
label: a
answer: yes
explanation: This is incorrect. The foregut gives rise to the oesophagus, stomach, liver, gallbladder, bile ducts, pancreas and proximal duodenum, ending after the entry of the common bile duct into the duodenum.

Therefore, the descending colon is not a foregut structure. It is part of the hindgut.
name: Descending colon
label: d
answer: no
explanation: This is incorrect. The foregut gives rise to the oesophagus, stomach, liver, gallbladder, bile ducts, pancreas and proximal duodenum, ending after the entry of the common bile duct into the duodenum.

Therefore, the distal duodenum is not a foregut structure. It is part of the midgut
name: Distal duodenum
label: b
answer: no
explanation: This is incorrect. The foregut gives rise to the oesophagus, stomach, liver, gallbladder, bile ducts, pancreas and proximal duodenum, ending after the entry of the common bile duct into the duodenum.

Therefore, the caecum is not a foregut structure. It is a midgut structure
name: Caecum
label: e
answer: no
explanation: This is incorrect. The foregut gives rise to the oesophagus, stomach, liver, gallbladder, bile ducts, pancreas and proximal duodenum, ending after the entry of the common bile duct into the duodenum.

Therefore, the jejunum is not a foregut structure. It is part of the midgut.
name: Jejunum
label: c
answer: no

Correct answer: a
A 57 year old man presents to the Emergency Department with severe epigastric pain. He has vomited bright red blood and blood tests show a raised urea, as well as a reduced haemoglobin.

Upon questioning, he admits to drinking an average of 50 units of alcohol per week. He takes amlodipine for hypertension and regular naproxen for chronic lower back pain.

An oesophago-gastro-duodenoscopy (OGD) shows a bleeding ulcer in the proximal duodenum.

Which of the following arteries is the most likely source of the bleeding?

Options:
explanation: This is incorrect. The common hepatic artery gives rise to the gastroduodenal artery however is not itself closely related to the duodenum.
name: Common hepatic artery
label: e
answer: no
explanation: This is incorrect. The superior mesenteric artery arises below the level of the coeliac trunk at L1. The inferior duodenum can be found posterior to the superior mesenteric artery, however it is not the most closely related to the duodenum and thus not the most likely source of the bleed.
name: Superior mesenteric artery
label: b
answer: no
explanation: This is incorrect. The superior pancreaticoduodenal artery is a branch of the gastroduodenal artery. It does provide some blood supply to the duodenum, however, is not the most closely related vessel and thus is not the most likely source of the bleed.
name: Superior pancreaticoduodenal artery
label: d
answer: no
explanation: This is correct. The gastroduodenal artery runs directly behind the posterior duodenal wall. Deep peptic ulcers in the duodenum may erode the artery and cause significant bleeding.
name: Gastroduodenal artery
label: a
answer: yes
explanation: This is incorrect. The left gastric artery is not directly related to the duodenum. It runs along the lesser curvature of the stomach and supplies the upper right portions of the fundus and body of the stomach, as well as the lower oesophagus.
name: Left gastric artery
label: c
answer: no

Correct answer: a
A 30 year old male presents to his General Practitioner with a 10-week history of diarrhoea, 4kg weight loss and frequent episodes of loose, foul-smelling stools. The diarrhoea is worse after he has just eaten a meal containing lots of carbohydrates. He reports feeling weak and fatigued despite maintaining a regular diet. Stool samples have shown high levels of unabsorbed sugars.

Which of the following transport proteins is responsible for the absorption of monosaccharides from the enterocyte into the interstitial space?

Options:
explanation: This is incorrect. Na+/K+ ATPase is responsible for maintaining electrochemical gradients that allow monosaccharide absorption but does not directly transport monosaccharides.
name: Na+/K+ ATPase
label: e
answer: no
explanation: This is incorrect, GLUT-5 is responsible for the absorption of fructose from the lumen of the digestive tract into epithelial cells.
name: GLUT-5
label: b
answer: no
explanation: This is correct. GLUT-2 is the protein responsible for transporting monosaccharides from the epithelial cells of the digestive tract into the interstitial space.
name: GLUT-2
label: a
answer: yes
explanation: This is incorrect. Aquaporin-1 (AQP-1) is a water channel found in the kidney.
name: AQP1
label: d
answer: no
explanation: This is incorrect, SGLT-1 is responsible for the absorption of glucose and galactose from the lumen of the digestive tract into epithelial cells
name: SGLT-1
label: c
answer: no

Correct answer: a
A 38 year old woman with a previous liver infarction attends her GP surgery for monitoring of her liver function. The GP explains that the hepatic portal system is responsible for carrying nutrient-rich blood to the liver.

Which of the following blood vessels contributes to the hepatic portal venous system?

Options:
explanation: The right hepatic vein is responsible for draining segments VI and VII of the liver, and occasionally segments V and VIII. It drains into the inferior vena cava near the upper border of the caudate lobe of the liver, and does not contribute to the portal venous system
name: Right hepatic vein
label: b
answer: no
explanation: This is incorrect. The hepatic artery supplies oxygenated blood to the liver. However, it is not part of the portal venous system, which carries deoxygenated blood from the small bowel.
name: Hepatic artery
label: c
answer: no
explanation: This is incorrect. The common iliac vein is formed by the external and internal iliac veins, which drain blood from the lower limbs and gluteal region. It does not contribute to the hepatic portal vein.
name: Common iliac vein
label: e
answer: no
explanation: This is incorrect. The inferior vena cava carries blood from multiple hepatic veins and returns deoxygenated blood to the heart. It does not contribute to the hepatic portal vein.
name: Inferior vena cava
label: d
answer: no
explanation: the superior mesenteric vein and its tributaries are part of the portal system and drain the midgut structures.
name: Superior mesenteric vein
label: a
answer: yes

Correct answer: a
A 34 year old woman with chronic obesity is prescribed a new medication by the weight management clinic. This acts on a G-protein coupled receptor (GPCR).

Activation of the GPCR leads to an increase in the intracellular concentration of cyclic AMP (cAMP). This is achieved by the conversion of ATP to cAMP by an enzyme.

Which enzyme is responsible for the conversion of ATP to cAMP?

Options:
explanation: This is incorrect. Guanylate cyclase (also known as guanyl cyclase and guanylyl cyclase) is responsible for the conversion of GTP to cGMP.
name: Guanylate cyclase
label: b
answer: no
explanation: This is incorrect. Phospholipase C is responsible for the hydrolysis of inositol phospholipids into inositol triphosphate (IP3) and diacylglycerol (DAG).
name: Phospholipase C
label: d
answer: no
explanation: This is correct. There are 6 classes of adenylate cyclase (also known as adenyl cyclase and adenylyl cyclase) enzymes, all of which are responsible for catalysing the conversion of ATP to cAMP + diphosphate.
name: Adenylate cyclase
label: a
answer: yes
explanation: This is incorrect. Phosphodiesterase catalyses the reaction that converts cAMP to AMP
name: Phosphodiesterase
label: c
answer: no
explanation: This is incorrect. Acetylcholinesterase (AChE) is responsible for the hydrolysis of acetylcholine into acetic acid and choline.
name: Acetylcholinesterase
label: e
answer: no

Correct answer: a
A woman is brought into the emergency department by ambulance after being found unresponsive with a low respiratory rate. On examination, she has pinpoint pupils.

Opioid overdose is suspected, and she is given naloxone. The clinician explains that naloxone acts on the same receptor site as opioid molecules but does not activate the receptor.

Which of the following terms best describes the mechanism of action of naloxone?

Options:
explanation: This is correct. Competitive antagonists bind to the same receptor site as the agonist (opioid molecules in this case) but do not activate it, thus blocking the agonist's action.
name: Competitive antagonist
label: a
answer: yes
explanation: This is incorrect. An agonist would bind to the receptor and activate it. Naloxone does not activate the receptor and thus is not an agonist.
name: Agonist
label: c
answer: no
explanation: This is incorrect. A non-competitive antagonist prevents the activation of a receptor by binding to an allosteric (non-agonist) site on the receptor. Because naloxone binds to the same receptor site as the opioid molecules, it is not a non-competitive antagonist.
name: Non-competitive antagonist
label: b
answer: no
explanation: This is incorrect. A negative allosteric modulator would lower the affinity/efficacy of the agonist. Naloxone binds to the same receptor site as opioid molecules and does not activate the receptor, making it a competitive antagonist and not a negative allosteric modulator.
name: Negative allosteric modulator
label: e
answer: no
explanation: This is incorrect. A positive allosteric modulator would increase the affinity and/or efficacy of the agonist. Naloxone prevents the agonist from binding to the receptor, so it is not a positive allosteric modulator. It is a competitive antagonist.
name: Positive allosteric modulator
label: d
answer: no

Correct answer: a
A 47 year old male is undergoing investigations for a suspected neuromuscular dystrophy. As part of this, a muscle biopsy is taken and sent for histological examination.

Which of the following is a feature of skeletal muscle fibres?

Options:
explanation: This is incorrect. Skeletal muscle is voluntarily controlled. Smooth muscle and cardiac muscle are not.
name: Involuntarily controlled
label: b
answer: no
explanation: This is incorrect. Skeletal muscle does not make up the composition of internal organs. Instead, it is found in the muscles that attach to bone to move the body. Smooth muscle and cardiac muscle are found in internal organs.
name: Found in internal organs
label: c
answer: no
explanation: This is incorrect. Nitric oxide (NO) causes relaxation in smooth muscle cells, not striated muscle cells.
name: Nitric oxide causes relaxation
label: e
answer: no
explanation: This is correct. Skeletal muscle and cardiac muscle are striated. This refers to the 'striped' appearance on microscopic examination, which comes from their repeating functional units or sarcomeres that allow skeletal muscle contraction.
name: Striated
label: a
answer: yes
explanation: This is incorrect. Smooth muscle cells are linked by gap junctions, to allow a rapid spread of depolarisation. Skeletal muscle cells are not linked by gap junctions.
name: Cells are linked by gap junctions
label: d
answer: no

Correct answer: a
A 55 year old woman is reviewed in the bone health clinic after falling and sustaining her third wrist fracture. The clinician explains that osteoblasts are important cells involved in bone formation.

Which of the following correctly describes osteoblasts?

Options:
explanation: This is incorrect. Osteoclasts are bone-resorbing cells. By contrast, osteoblasts synthesise bone and deposit osteoid to form bone tissue.
name: Osteoblasts are bone-resorbing cells
label: b
answer: no
explanation: This is incorrect. Osteoprogenitor cells (also called osteogenic cells) are precursor bone cells. Osteoblasts synthesise bone and deposit osteoid to form bone tissue.
name: Osteoblasts act as a precursor to bone cells
label: e
answer: no
explanation: This is correct. Osteoblasts synthesise bone and deposit osteoid to form bone tissue.
name: Osteoblasts are responsible for the synthesis and mineralisation of the matrix
label: a
answer: yes
explanation: This is incorrect. Osteocytes are mature bone cells. Osteoblasts synthesise bone and deposit osteoid to form bone tissue. Osteoblasts become osteocytes following calcification.
name: Osteoblasts are mature bone cells
label: c
answer: no
explanation: This is incorrect. Osteocytes are found in lacunae in the central canal of compact bone. Osteoblasts are found along the surface of bone.
name: Osteoblasts are found in the central canal of compact bone
label: d
answer: no

Correct answer: a
A 35 year old woman attends A&E after falling on an outstretched hand. X-ray shows a dorsal radius fracture. The patient is keen to know more about the composition of bone.

Which of the following types of collagen is found in bone tissue?

Options:
explanation: This is incorrect. Type II collagen is found in cartilage. Type I collagen is found in bone.
name: Type II
label: b
answer: no
explanation: This is incorrect. Type V collagen is found in cell surfaces, hair and the placenta. Type I collagen is found in bone.
name: Type V
label: e
answer: no
explanation: This is incorrect. Type IV collagen forms the basal lamina of the basement membrane. Type I collagen is found in bone.
name: Type IV
label: d
answer: no
explanation: This is incorrect. Type III collagen is secreted by reticular cells. It makes up reticulin fibres, a type of connective tissue that makes up the liver, bone marrow and lymphatic system. By contrast, type I collagen is found in bone.
name: Type III
label: c
answer: no
explanation: This is correct. Type I collagen is found in bone and can also be found in skin, tendons, vasculature and organs
name: Type I
label: a
answer: yes

Correct answer: a
A 43 year old woman presents to the Emergency Department with sudden onset loin to groin pain. She describes this as a 10/10 severity and has just started vomiting. A CT scan of the renal tract reveals an obstructing stone.

Which of the following is the most likely place for a renal stone to cause obstruction?

Options:
explanation: A renal stone in the bladder is unlikely to cause obstruction, as to reach the bladder the stone must be small enough to pass through the strictures of the ureter.
name: Bladder
label: e
answer: no
explanation: This is correct. The pelviureteric junction (PUJ) is the narrowest part of the ureter, and therefore is the most likely place for a renal stone to obstruct.
name: Pelviureteric junction (PUJ)
label: a
answer: yes
explanation: A renal stone in the urethra is unlikely to cause obstruction, as to reach the urethra the stone must be small enough to pass through the strictures of the ureter.
name: Urethra
label: d
answer: no
explanation: This is incorrect. Renal stones are most likely to be found obstructing the pelviureteric junction (PUJ) as this is the narrowest part of the ureter. The vesicoureteric Junction (VUJ), and the point at which the ureter crosses the pelvic brim, are also common sites of stone obstruction.
name: Distal third of the ureter
label: b
answer: no
explanation: This is incorrect. The vas deferens is a tubular structure in the male reproductive system that transports sperm cells from the epididymis. It is not directly connected to the ureters and would not contain a renal stone.
name: Vas deferens
label: c
answer: no

Correct answer: a
A 17 year old male fractures his left tibia while playing rugby. As part of his management, his tibia is immobilised in a plaster cast. After the cast is removed, he presents to his General Practitioner struggling to lift the front of his left foot from the floor. To compensate, he has been lifting each leg high in the air to allow him to walk.

Which of the following nerves has been damaged?

Options:
explanation: This is incorrect. This is a classic example of foot drop, which is caused by common peroneal nerve injury. By contrast, tibial nerve damage would present with impaired foot plantarflexion and inversion, and sensory loss to the sole of the foot. The tibial nerve is not commonly injured as it is deep and well-protected. However, it can be injured in popliteal trauma and posterior knee dislocation.
name: Tibial nerve
label: d
answer: no
explanation: This is correct. This is a classic example of foot drop, which is caused by common peroneal nerve injury. Because of the relatively superficial relation of the common peroneal nerve to the fibular head, the common peroneal nerve is susceptible to damage following compression by plaster casts.
name: Common peroneal nerve
label: a
answer: yes
explanation: This is incorrect. This is a classic example of foot drop, which is caused by common peroneal nerve injury. By contrast, sciatic nerve damage would present with impaired knee flexion and hip adduction, as well as impaired foot plantarflexion, eversion and foot drop. The sciatic nerve splits into the tibial nerve and common peroneal nerve and is susceptible to injury with lumbar disc herniation, posterior hip dislocation and direct trauma.
name: Sciatic nerve
label: e
answer: no
explanation: This is incorrect. This is a classic example of foot drop, which is caused by common peroneal nerve injury. By contrast, femoral nerve damage would present with impaired hip flexion and sensory loss to the anterior and medial aspect of the thigh and lower leg. The femoral nerve is particularly susceptible to injury in hip and pelvic trauma.
name: Femoral nerve
label: b
answer: no
explanation: This is incorrect. This is a classic example of foot drop, which is caused by common peroneal nerve injury. By contrast, obturator nerve damage will present with impaired hip adduction and sensory loss/paraesthesia over the inner aspect of the thigh. The obturator nerve is particularly susceptible to injury in anterior hip dislocation and pelvic surgery.
name: Obturator nerve
label: c
answer: no

Correct answer: a
A 26 year old man is brought to the emergency department after falling off a ladder. An x-ray shows a fracture of the midshaft of his right humerus.

Following management of the fracture, it is noted that the man cannot extend his right wrist, and has sensory loss to the area between the dorsal aspect of the 1st and 2nd metacarpals on his right side. Examination of the left upper limb is normal.

Which of the following nerves has been damaged?

Options:
explanation: This is incorrect. The median nerve is classically susceptible to palsy in carpal tunnel syndrome. Median nerve injury would present with sensory loss to the palmar aspect of the lateral three and a half digits. Motor deficits vary depending on the location of the median nerve lesion, with lesions at the elbow leading to a loss of pronation of the forearm and weak wrist flexion, and lesions at the wrist leading to paralysis of the thenar muscles and opponens pollicis.
name: Median nerve
label: b
answer: no
explanation: This is incorrect. The axillary nerve is classically injured following a humeral neck fracture or dislocation. It presents with sensory loss to the 'regimental badge' area (the inferior region of the deltoid) and weakness of shoulder abduction.
name: Axillary nerve
label: d
answer: no
explanation: This is incorrect. Isolated musculocutaneous nerve injury is rare; it is often injured as part of a brachial plexus injury. However, it would present with sensory loss to the lateral part of the forearm and weakness of elbow flexion and supination.
name: Musculocutaneous nerve
label: e
answer: no
explanation: This is correct. The radial nerve is classically damaged in humeral midshaft fractures, and palsy results in wrist drop (inability to extend the wrist). The radial nerve gives sensory innervation to a small area on the dorsum of the hand between the 1st and 2nd metacarpals.
name: Radial nerve
label: a
answer: yes
explanation: This is incorrect. The ulnar nerve is classically susceptible to damage following a fracture of the medial epicondyle. It would present with sensory loss to the medial one and a half digits, and weak wrist flexion. The classic sign is a 'claw hand'.
name: Ulnar nerve
label: c
answer: no

Correct answer: a
A 24 year old woman presents to the Emergency Department following a fall from a horse. An x-ray of her right arm shows a fracture of the surgical neck of the humerus.

On examination, it is noted that she has lost the ability to abduct her right arm, and has lost sensation to her lower right deltoid muscle. The left side is normal on examination.

Which of the following nerves has been damaged?

Options:
explanation: This is incorrect. A fracture of the surgical neck of the humerus is most likely to cause axillary nerve injury. The long thoracic nerve is susceptible to damage during chest drain insertion, thoracic surgery or the prolonged use of crutches.

Furthermore, long thoracic nerve damage typically causes 'winging' of the scapula, and would not affect shoulder abduction or sensation in the regimental badge area.
name: Long thoracic nerve
label: e
answer: no
explanation: This is incorrect. A fracture of the surgical neck of the humerus is most likely to cause axillary nerve injury. A midshaft fracture of the humerus would be more likely to cause radial nerve damage.

Furthermore, radial nerve injury would result in wrist drop, and would not affect shoulder abduction or sensation in the regimental badge area.
name: Radial nerve
label: b
answer: no
explanation: This is incorrect. A fracture of the surgical neck of the humerus is most likely to cause axillary nerve injury. The median nerve is most commonly affected in carpal tunnel syndrome.

Furthermore, median nerve injury would result in paralysis and wasting of the muscles of the thenar eminence and opponens pollicis, as well as sensory loss to the lateral three and a half digits. It would not affect shoulder abduction or sensation in the regimental badge area.
name: Median nerve
label: d
answer: no
explanation: This is correct. The axillary nerve is often damaged in fractures of the surgical neck of the humerus. In this case, the patient cannot abduct their arm as the axillary nerve supplies the deltoid muscle. It also provides sensory innervation to the lower deltoid area ('regimental badge' area).
name: Axillary nerve
label: a
answer: yes
explanation: This is incorrect. A fracture of the surgical neck of the humerus is most likely to cause axillary nerve injury. A fracture affecting the medial epicondyle of the humerus would be likely to cause an ulnar nerve injury.

Furthermore, ulnar nerve injury would result in a claw hand deformity and loss of sensation to the medial one and a half, and would not affect shoulder abduction or sensation in the regimental badge area.
name: Ulnar nerve
label: c
answer: no

Correct answer: a