hllj/quesmed huggingface dataset:
Which of the following best describes the mechanism of action of furosemide?

Options:
explanation: Furosemide is a loop diuretic that works by inhibiting the reabsorption of sodium, potassium and chloride ions in the loop of Henle. This leads to increased delivery of these ions to the distal tubule, which results in increased excretion of electrolytes (and by extension water) in the urine.
name: Blocks the reabsorption of sodium, potassium and chloride ions in the loop of Henle
label: a
answer: yes
explanation: This is the mechanism of action of thiazide diuretics, not furosemide.
name: Inhibits the sodium/chloride co-transporter in the distal convoluted tubule
label: c
answer: no
explanation: This is the mechanism of action of carbonic anhydrase inhibitors, not furosemide.
name: Inhibition of bicarbonate resorption primarily in the proximal tubule
label: d
answer: no
explanation: This is the mechanism of action of potassium-sparing diuretics, not furosemide.
name: Increases the excretion of sodium and water whilst preventing the loss of potassium in the urine
label: b
answer: no
explanation: This is the mechanism of action of osmotic diuretics, not furosemide.
name: Inhibition of water reabsorption in the proximal convoluted tubule, loop of Henle and collecting duct
label: e
answer: no

Correct answer: a
Which of the following options is most likely to be a feature of osteoarthritis?

Options:
explanation: This better describes the disease distribution of rheumatoid arthritis. Osteoarthritis typically affects the distal interphalangeal joints of the hands, or the knee and hip joints.
name: Metacarpophalangeal and proximal interphalangeal joints are most affected
label: e
answer: no
explanation: This is typically a feature of rheumatoid arthritis which causes pain and stiffness in joints for prolonged periods of time, particularly in the morning. In osteoarthritis, morning stiffness usually subsides within an hour of waking.
name: Morning stiffness lasting more than one hour
label: c
answer: no
explanation: Typically, patients with osteoarthritis experience pain that worsens with increased usage. Conversely, the usage of affected joints in rheumatoid arthritis can actually improve pain symptoms.
name: Joint pain that worsens with usage
label: a
answer: yes
explanation: This is typically a feature of rheumatoid arthritis which affects joints on both sides of the body.
name: Symmetrical joint involvement
label: b
answer: no
explanation: This is a diagnostic criterion for rheumatoid arthritis but is not a feature of osteoarthritis.
name: Positive rheumatoid factor
label: d
answer: no

Correct answer: a
Which of the following treatment regimens are used first-line in the treatment of H.

Pylori infection?

Options:
explanation: NICE guidelines recommend a proton pump inhibitor such as lansoprazole and two antibacterials, not just one as suggested here. Amoxicillin should be added here as long as the patient is not allergic to penicillin.
name: Lansoprazole and clarithromycin for 7 days
label: c
answer: no
explanation: NICE guidelines recommend a proton pump inhibitor such as lansoprazole and two antibacterials, not just one as suggested here. Clarithromycin or metronidazole, for example, could be added to the amoxicillin in this answer choice.
name: Lansoprazole and amoxicillin for 7 days
label: b
answer: no
explanation: NICE guidelines suggest triple therapy with a proton pump inhibitor (PPI) and two antibacterials for the treatment of H. Pylori infection. Lansoprazole and amoxicillin can be used, however, 7 days is the recommended treatment course. Furthermore, ranitidine is an H2-receptor antagonist, which would not be used alongside a PPI.
name: Lansoprazole, ranitidine and amoxicillin for 14 days
label: d
answer: no
explanation: First-line treatment for H. Pylori usually involves a 7-day triple-therapy regimen involving a proton pump inhibitor (lansoprazole here) and two antibacterials - amoxicillin and clarithromycin.
name: Lansoprazole, amoxicillin and clarithromycin for 7 days
label: a
answer: yes
explanation: Whilst the drugs suggested here are all correct, NICE guidelines recommend 7 days of treatment for H. Pylori infection, not 14.

**Need to edit the last five questions**
name: Lansoprazole, amoxicillin and clarithromycin for 14 days
label: e
answer: no

Correct answer: a
Which of these valvular defects can cause a pan-systolic murmur?

Options:
explanation: Mitral regurgitation is the only valvular defect here that can cause a pan-systolic murmur. The murmur occurs due to the backflow of blood through the mitral valve during systole.
name: Mitral regurgitation
label: a
answer: yes
explanation: Mitral valve prolapse is a condition in which the mitral valve does not close properly and produces a specific type of murmur called a mid-systolic click-murmur. It is not known to cause a pan-systolic murmur.
name: Mitral valve prolapse
label: e
answer: no
explanation: Aortic stenosis is a valvular defect that causes a crescendo-decrescendo systolic murmur, also known as an ejection systolic murmur. It does not cause a pan-systolic murmur.
name: Aortic stenosis
label: b
answer: no
explanation: Mitral stenosis is a valvular defect that causes a mid-systolic murmur, not a pan-systolic murmur.
name: Mitral stenosis
label: d
answer: no
explanation: Tricuspid stenosis is a valvular defect that causes a mid-diastolic murmur at the left lower sternal border.
name: Tricuspid stenosis
label: c
answer: no

Correct answer: a
How does a female patient with partial 21-hydroxylase deficiency typically present?

Options:
explanation: This is incorrect as it describes a third-degree heart block, also known as complete heart block. P waves and QRS complexes are regular in complete heart block but have no relationship to each other.
name: With a type of heart block characterised by a complete failure of the electrical impulse to reach the ventricles
label: b
answer: no
explanation: This is incorrect as it best describes a Mobitz-type I heart block. This is also a type of second-degree heart block, but here there is variation in PR interval length. It is also known as Wenckebach heart block.

**Please may you rewrite the incorrect answer choices for this question. The question asks for presentations of partial 21-hydroxylase deficiencies but 4 out of the 5 answer choices are on types of heart block. Hence it is too obvious what the correct answer is.**
name: A type of heart block where gradual prolongation of PR intervals is seen until a QRS complex is dropped
label: e
answer: no
explanation: This is incorrect, as it best describes a first-degree heart block. Here, the PR interval is simply prolonged with no dropped QRS complexes. It is the most benign heart block.
name: A type of heart block characterised by prolonged PR intervals with a regular rhythm and 1:1 ratio of P waves to QRS complexes
label: d
answer: no
explanation: This is incorrect as it best describes a left bundle branch block. It can indicate underlying heart disease, including dilated cardiomyopathy or hypertrophic cardiomyopathy.
name: A type of heart block characterised by a delay or block in the bundle of His on the left side of the heart
label: c
answer: no
explanation: A patient with partial 21-hydroxylase deficiency has insufficient aldosterone and cortisol due to the reduced conversion of progesterone to 11-deoxycorticosterone and 17-hydroxyprogesterone in the 21-hydroxylase pathway. Overall, this results in reduced aldosterone and cortisol, but there is still enough for survival as it is only a partial deficiency. Furthermore, there is an increase in adrenal testosterone. This is because pre-cursors of aldosterone and cortisol build up in the adrenal glands and are converted to androgens. This results in hirsutism and virilisation in females.
name: Deficient aldosterone and cortisol but enough to get by. Clinical presentation may include hirsutism and virilisation
label: a
answer: yes

Correct answer: a
What is the primary function of angiotensin II in the body?

Options:
explanation: Angiotensin II does not play a direct role in regulating blood glucose levels.
name: Glucose homeostasis
label: b
answer: no
explanation: Angiotensin II is responsible for maintaining blood pressure and stimulating aldosterone secretion. Parathyroid hormone is important in calcium homeostasis.
name: Regulating calcium reabsorption in the kidneys
label: c
answer: no
explanation: Angiotensin II promotes water retention, not excretion, by the kidneys.
name: Promoting water excretion by the kidneys
label: e
answer: no
explanation: Angiotensin II is a hormone that is part of the renin-angiotensin-aldosterone system (RAAS) and is primarily responsible for increasing blood pressure and stimulating the secretion of aldosterone. When the body detects a decrease in blood pressure or blood volume, the kidney releases renin which converts angiotensinogen into angiotensin I. Angiotensin-converting enzyme (ACE) then converts angiotensin I into angiotensin II which causes vasoconstriction, increased sodium reabsorption, and increased water retention in the kidneys.
name: Maintaining blood pressure
label: a
answer: yes
explanation: Angiotensin II is not involved in this process. RAnaemia, ischaemic stress and high altitude can all promote erythropoiesis in the bone marrow. Erythropoiesis is stimulated by erythropoietin.
name: Stimulating erythropoiesis in the bone marrow
label: d
answer: no

Correct answer: a
The attachment phase is the first stage of implantation. In this stage, the outer trophoblast cells come into contact with the uterine surface epithelial cells.

Which interleukin is most significantly involved in the attachment phase of implantation?

Options:
explanation: IL-6 is produced by a variety of cells, including T cells, B cells, macrophages, and fibroblasts, and is involved in a wide range of immune and inflammatory responses. IL-6 stimulates the production of acute-phase proteins by the liver and is involved in the differentiation of T cells and the activation of B cells.
name: IL-6
label: d
answer: no
explanation: IL-5 is mainly produced by Th2 cells and is involved in the growth and differentiation of eosinophils, a type of white blood cell that is involved in the immune response to parasites and allergic reactions.
name: IL-5
label: c
answer: no
explanation: IL-10 is mainly produced by regulatory T-cells and activated macrophages and is involved in downregulating immune responses. IL-10 has anti-inflammatory effects and is involved in inhibiting the production of pro-inflammatory cytokines and the activation of macrophages and dendritic cells.
name: IL-10
label: e
answer: no
explanation: IL-11, or interleukin-11, is the interleukin most significantly involved in the attachment phase of implantation. It is released by endometrial cells into the uterine fluid.
name: IL-11
label: a
answer: yes
explanation: IL-4 is mainly produced by T-helper 2 (Th2) cells and mast cells and is involved in stimulating the production of immunoglobulin E (IgE) by B cells, promoting the differentiation of Th2 cells, and inhibiting the differentiation of Th1 cells. IL-4 also has a role in regulating immune responses to parasites.
name: IL-4
label: b
answer: no

Correct answer: a
What is the mechanism of action of lamotrigine?

Options:
explanation: Lamotrigine blocks voltage-gated Na+ channels. This prevents the depolarisation of glutamatergic neurones and reduces glutamate neurotoxicity.
name: It blocks voltage-gated Na+ channels, preventing Na+ influx
label: a
answer: yes
explanation: This is the mechanism of action of sodium valproate. Through this mechanism, it increases GABA concentrations in synapses and prolongs GABA action within synapses.
name: It inhibits GABA transaminase, preventing the breakdown of GABA
label: b
answer: no
explanation: This is the mechanism of action of an SSRI, or selective serotonin reuptake inhibitor. This is not an anti-epileptic drug and is instead used in the treatment of depression.
name: It inhibits the reuptake of serotonin, thereby increasing serotonin activity
label: e
answer: no
explanation: This is the mechanism of action of diazepam. Here, increased chloride ion influx is associated with the hyperpolarisation of excitatory neurones.
name: It increases chloride ion influx in response to GABA binding at the GABA A receptor
label: c
answer: no
explanation: This is the mechanism of action of levetiracetam. Levetiracetam inhibits this protein and prevents vesicle exocytosis. A reduction in glutamate secretion reduces glutamate excitotoxicity.
name: It inhibits the synaptic vesicle protein SV2A
label: d
answer: no

Correct answer: a
Which of the following are functions of glucagon in the control of blood glucose?

Options:
explanation: Although glycogenolysis (breakdown of glycogen into glucose molecules) is a function of glucagon, glycogenesis (formation of glycogen from glucose molecules) is a function of insulin.
name: Glycogenolysis and glycogenesis
label: c
answer: no
explanation: Glucagon is a peptide hormone secreted by alpha cells in the pancreas. One of the key functions of glucagon is to increase the concentration of glucose in the blood. The two main methods through which this is achieved are glycogenolysis (breakdown of glycogen into glucose molecules) and gluconeogenesis (conversion of amino acids into glucose).
name: Glycogenolysis and gluconeogenesis
label: a
answer: yes
explanation: Glycogenesis (formation of glycogen from glucose molecules) and lipogenesis (formation of triglycerides) are both functions of the hormone insulin.
name: Glycogenesis and lipogenesis
label: b
answer: no
explanation: Although glycogenolysis (breakdown of glycogen into glucose molecules) is a function of glucagon, lipogenesis (formation of triglycerides) is a function of insulin.
name: Glycogenolysis and lipogenesis
label: e
answer: no
explanation: Although gluconeogenesis (conversion of amino acids into glucose molecules) is a function of glucagon, glycogenesis (formation of glycogen from glucose molecules) is a function of insulin.
name: Glycogenesis and gluconeogenesis
label: d
answer: no

Correct answer: a
Which of the following hormones is secreted into the blood by the posterior pituitary gland?

Options:
explanation: Oxytocin is a peptide hormone produced by the hypothalamus and secreted into the blood by the posterior pituitary gland. Oxytocin plays a role in social bonding, reproduction and the stimulation of contractions during labour.
name: Oxytocin
label: a
answer: yes
explanation: Follicle-stimulating hormone is secreted by the gonadotropic cells of the anterior pituitary gland. FSH plays a role in growth, pubertal development and the regulation of the menstrual cycle.
name: Follicle-Stimulating Hormone (FSH)
label: b
answer: no
explanation: Prolactin is secreted by lactotrophs in the anterior pituitary gland. Prolactin plays a role in the development of mammary glands within breast tissue, as well as milk production.
name: Prolactin
label: c
answer: no
explanation: Cortisol is a hormone secreted by the zona fasciculata of the adrenal glands, rather than the posterior pituitary gland. Cortisol plays a role in the regulation of the stress response, as well as metabolism.
name: Cortisol
label: e
answer: no
explanation: Somatotropin (also known as growth hormone) is secreted by the anterior lobe of the pituitary gland. Somatotropin plays a role in height determination, muscle health and bone structure.
name: Somatotropin
label: d
answer: no

Correct answer: a
A 43-year-old female presents to General Practice with symptoms of fatigue, weakness and increased thirst which have developed over the past 4 months. She mentions that her mood has also been quite low recently, and she is eating a bit less than usual. On examination, she is found to have areas of hyperpigmentation, particularly noticeable over the buccal mucosa.

Given the most likely diagnosis, what is the gold standard investigation for this condition?

Options:
explanation: Anti-CCP is an antibody commonly measured to diagnose rheumatoid arthritis. Whilst rheumatoid arthritis sometimes presents with fatigue, it is commonly associated with pain in the small joints and does not usually involve symptoms of increased thirst or areas of hyperpigmentation.
name: Anti-cyclic citrullinated peptide (anti-CCP)
label: e
answer: no
explanation: The dexamethasone suppression test is used to diagnose Cushing's syndrome, rather than Addison's disease. Cushing's syndrome classically presents with central obesity, abdominal striae and easy bruising.
name: Dexamethasone suppression test
label: b
answer: no
explanation: Although Addison's disease may result in a derangement of electrolytes with hyponatraemia and hyperkalaemia, these electrolyte changes are not specific enough for diagnosis. Instead, the short synacthen test offers a more definitive method of measuring adrenal function and diagnosing Addison's disease.
name: Urea and electrolytes
label: d
answer: no
explanation: While tiredness and fatigue may be seen in hypothyroidism, the regions of hyperpigmentation and symptom of increased thirst are highly suggestive of Addison's disease. This condition requires a short synacthen test to measure adrenal function, rather than measuring thyroid function.
name: Thyroid function tests
label: c
answer: no
explanation: This patient is presenting with signs and symptoms characteristic of Addison's disease, particularly demonstrated by the areas of hyperpigmentation seen over the buccal mucosa. Addison's disease is a condition in which there is hyposecretion of hormones from the adrenal glands. The gold standard investigation for Addison's disease is the short synacthen test in which synthetic adrenocorticotropic hormone (ACTH) is administered to a patient, and their serum cortisol level is measured afterwards to determine whether their adrenal glands are responding appropriately.
name: Short synacthen test
label: a
answer: yes

Correct answer: a
A 31-year-old female presents to General Practice with symptoms of fatigue, weakness and cold sensitivity which have developed over the past 4 months. She also mentions that she has gained a significant amount of weight over this time despite eating the same balanced diet. Examination reveals a uniform, non-tender swelling of the thyroid gland.

What is the most likely diagnosis for this patient?

Options:
explanation: This patient is presenting with signs and symptoms characteristic of hypothyroidism, particularly demonstrated by her cold sensitivity and weight gain. The most common cause of hypothyroidism in developed countries is Hashimoto's thyroiditis, which is an autoimmune disease whereby autoantibodies are produced against normal thyroid cells. The main investigations for this condition are thyroid function tests, which classically reveal raised thyroid stimulating hormone (TSH) levels and reduced triiodothyronine/thyroxine (T3/T4) levels.
name: Hashimoto's thyroiditis
label: a
answer: yes
explanation: Toxic multinodular goitre would present with symptoms of hyperthyroidism (weight loss, heat sensitivity, anxiety), as opposed to symptoms of hypothyroidism.
name: Toxic multinodular goitre
label: d
answer: no
explanation: Graves' disease is the most common cause of hyperthyroidism in developed countries, as opposed to hypothyroidism. This would classically present with weight loss, heat sensitivity and anxiety.
name: Graves' disease
label: b
answer: no
explanation: Thyroid adenomas commonly present with symptoms of hyperthyroidism (weight loss, heat sensitivity, anxiety), as opposed to symptoms of hypothyroidism. Additionally, thyroid adenomas are usually associated with a non-uniform swelling of the thyroid gland.
name: Solitary thyroid adenoma
label: e
answer: no
explanation: De Quervain's thyroiditis commonly presents within a shorter timeframe, usually following a viral infection. Additionally, the condition is usually associated with a painful swelling of the thyroid gland.
name: De Quervain's thyroiditis
label: c
answer: no

Correct answer: a
What is the primary function of the corpus luteum during the menstrual cycle?

Options:
explanation: Follicle-stimulating hormone (FSH) is produced by the anterior pituitary gland, as opposed to the corpus luteum.
name: Secretion of follicle-stimulating hormone (FSH)
label: e
answer: no
explanation: Whilst the corpus luteum may secrete some inhibin A, its primary function is the secretion of progesterone.
name: Secretion of inhibin A
label: c
answer: no
explanation: The corpus luteum is a group of cells which arise from the remaining follicle after a maturing ovum is released. The main function of the corpus luteum is to secrete progesterone, thereby allowing the uterine wall to become more receptive to a fertilised egg. If pregnancy occurs, the corpus luteum continues secreting progesterone (and other hormones) until approximately week 12 of the pregnancy. If pregnancy does not occur, the corpus luteum breaks down and no longer secretes progesterone.
name: Secretion of progesterone
label: a
answer: yes
explanation: Whilst the corpus luteum may secrete some oestrogen, its primary function is the secretion of progesterone.
name: Secretion of oestrogen
label: b
answer: no
explanation: If pregnancy occurs, the production of human chorionic gonadotrophin (hCG) signals to the corpus luteum to continue secreting progesterone. However, hCG is not produced by the corpus luteum itself.
name: Secretion of human chorionic gonadotrophin (hCG)
label: d
answer: no

Correct answer: a
A 34-year-old female presents to General Practice with irregular periods, weight gain and difficulty conceiving despite trying for over one year. On examination, she is noted to have excessive hair growth around her face and upper back.

Which of the following investigations would be most useful in confirming this woman's diagnosis?

Options:
explanation: Although hypothyroidism may also present with weight gain and irregular periods, the presence of hirsutism points towards a diagnosis of PCOS. Whilst PCOS may sometimes be associated with some derangement in thyroid hormones, serum androgen levels are more specific in confirming the diagnosis.
name: Thyroid function tests
label: d
answer: no
explanation: This patient is presenting with signs and symptoms of polycystic ovarian syndrome (PCOS). In PCOS, the follicles which contain maturing eggs are often unable to release an egg, leading to irregular periods and potential infertility. PCOS is associated with high levels of serum androgens (e.g. testosterone), which can lead to hirsutism. Diagnosis of PCOS can be difficult but is often based on measuring serum androgen levels, measuring FSH/LH levels, and performing a transvaginal ultrasound scan to assess the ovaries for the presence of multiple follicles.
name: Serum androgen levels
label: a
answer: yes
explanation: Whilst PCOS may be associated with some derangement in insulin levels, serum androgen levels would be more specific in confirming the diagnosis.
name: Serum insulin levels
label: e
answer: no
explanation: Serum hCG levels may be useful for assessing whether a patient is pregnant. However, the presence of hirsutism, as well as the history of infertility, makes a diagnosis of PCOS more likely.
name: Serum human chorionic gonadotrophin (hCG) levels
label: b
answer: no
explanation: Transvaginal ultrasound scans (rather than CT scans) are used to assess the ovaries for multiple follicles in PCOS.
name: CT scan of ovaries
label: c
answer: no

Correct answer: a