hllj/quesmed huggingface dataset:
Which of the following best describes the ‘Justice’ principle of medical ethics?

Options:
explanation: Doing no harm describes the ethical principle of ‘non-maleficence.’
name: Doing no harm
label: c
answer: no
explanation: The right to make one's own decisions is the best description of the ethical principle of 'autonomy'.
name: Right to make one's own decisions
label: d
answer: no
explanation: The greater good for the majority is a description of the ethical principle ‘of utilitarianism.’
name: The greater good for the majority
label: e
answer: no
explanation: Fairness and equality is the best description of the ethical principle of 'justice’.
name: Fairness and equality
label: a
answer: yes
explanation: Acting in the patient’s best interests describes the ethical principle of ‘beneficence’.
name: Acting in the patient’s best interests
label: b
answer: no

Correct answer: a
All doctors have a duty of care to their patients. A doctor that does not comply with this is said to have been clinically negligent.

What test of law can be used by a doctor to defend themselves in a clinical negligence case?

Options:
explanation: The Human Rights Act (1998) is the law regarding the treatment of all people. It is based on principles such as fairness, respect, equality, confidentiality and dignity.
name: Human Rights Act 1998
label: e
answer: no
explanation: The Bolam test is the test for clinical negligence. If a board of doctors of a similar level to the practising doctor would have made the same decision regarding patient care, then the doctor has not been clinically negligent.
name: Bolam
label: a
answer: yes
explanation: ‘Bolitho vs Hackney’ was the law case that gave rise to the ‘Bolam’ test.
name: Bolitho
label: b
answer: no
explanation: The Mental Capacity Act (2005) is the law regarding the treatment of patients with and without capacity. It has 5 core principles.
name: Mental Capacity Act 2005
label: d
answer: no
explanation: Gillick competence is used to determine whether a child under 16 years can understand, retain, weigh up and communicate back decisions regarding their medical treatment. If competent, the child may consent to their treatment.
name: Gillick competence
label: c
answer: no

Correct answer: a
Which of the following is a key principle of the Mental Capacity Act 2005?

Options:
explanation: This is not a principle of the Mental Capacity 2005 but is a core principle of the Mental Health Act.
name: Treat all patients with respect and dignity
label: d
answer: no
explanation: This is not a principle of the Mental Capacity 2005 but is a core principle of the Mental Health Act.
name: Treatment must have a purpose and must be effective
label: e
answer: no
explanation: This is not a principle of the Mental Capacity 2005. Patients have a right to make decisions which we may deem unwise; this can include the refusal of treatment.
name: Right to refuse treatment
label: b
answer: no
explanation: In the Mental Capacity Act 2005, patients aged 16 and over are presumed to have capacity, not those aged 18 and over.
name: Assume capacity if a person is aged 18 years and over
label: c
answer: no
explanation: In the Mental Capacity Act 2005, patients aged 16 and over are presumed to have capacity.
name: Assume capacity if a person is aged 16 years and over
label: a
answer: yes

Correct answer: a
A 13-year-old girl visits the GP surgery whilst you are on placement.

She asks if you could prescribe her some contraception as she wants to start being sexually active with her boyfriend.

What is the most appropriate next step?

Options:
explanation: The home circumstances for this child are unknown and we cannot predict her parents' reaction. We also have to be careful about breaking the child's confidentiality and trust in health care professionals. Therefore, calling her parents is inappropriate.
name: Call her parents
label: b
answer: no
explanation: Giving her contraception is inappropriate. A child under 13 years should not be engaging in sexual activity, even if Gillick competent. Also, as a medical student, you must not prescribe as this is outside the limits of your competence.
name: Give her contraception
label: d
answer: no
explanation: Doing nothing is completely inappropriate. This will not help the situation and can result in safeguarding issues.
name: Do nothing
label: e
answer: no
explanation: The safeguarding team will guide you on how to proceed and can take further action regarding this matter, so this is the most appropriate option.
name: Inform the safeguarding team
label: a
answer: yes
explanation: Calling the police is inappropriate as it is unlikely to be of much benefit in this situation. It is much more appropriate to discuss this case with the local safeguarding team to come up with a safe and effective management plan.
name: Call the police
label: c
answer: no

Correct answer: a
What is the name for naïve T-helper cells with regards to their cell surface receptor?

Options:
explanation: CD4 cells are naïve T-Helper cells. They become mature CD4 cells once they have developed in the thymus.
name: CD4 cells
label: a
answer: yes
explanation: CD20 receptors are found on B cells, not T cells.
name: CD20 cells
label: d
answer: no
explanation: CD8 receptors are found on cytotoxic T-cells after they have matured in the bone marrow.
name: CD8 cells
label: b
answer: no
explanation: CD3 receptors are involved in the activation of cytotoxic and T Helper cells.
name: CD3 cells
label: c
answer: no
explanation: CD2 receptors are mainly found on natural killer (NK) cells.
name: CD2 cells
label: e
answer: no

Correct answer: a
Which cell releases histamine during the acute inflammatory response?

Options:
explanation: Neutrophils do not release histamine. They are phagocytes and contain neutrophil elastase. Neutrophils are the first type of cell to arrive at sites of inflammation.
name: Neutrophil
label: c
answer: no
explanation: Eosinophils do not release histamine. They are granulocytes that act as phagocytes and are particularly relevant in parasitic infections, vasculitis, and allergy.
name: Eosinophil
label: b
answer: no
explanation: Monocytes do not release histamine. They circulate in the bloodstream and act as antigen-presenting cells as well as phagocytes. They become macrophages when they move into tissues.
name: Monocyte
label: e
answer: no
explanation: Basophils are granulocytes that secrete histamine. Histamine stimulates vasodilation and increases vascular permeability leading to tumor (oedema), calor (heat) and rubor (redness) – all features of acute inflammation.
name: Basophil
label: a
answer: yes
explanation: Dendritic cells do not release histamine. They are phagocytes as well as antigen-presenting cells.
name: Dendritic
label: d
answer: no

Correct answer: a
What is the biochemical target of Rituximab?

Options:
explanation: CD3 receptors are found on T-cells. They are not targeted by Rituximab.
name: CD3 receptors
label: d
answer: no
explanation: CD4 receptors are found on mature T-cells in the thymus. They are not targeted by Rituximab.
name: CD4 receptors
label: b
answer: no
explanation: CD2 receptors are found on natural killer (NK) cells. They are not the target of action of Rituximab.
name: CD2 receptors
label: e
answer: no
explanation: Rituximab targets CD20 receptors on B cells.
name: CD20 receptors
label: a
answer: yes
explanation: CD8 receptors are found on cytotoxic T-cells after they have matured in the bone marrow. They are not targeted by Rituximab.
name: CD8 receptors
label: c
answer: no

Correct answer: a
This graph represents the change in blood morphine levels over time.

From this graph, determine the half-life of morphine.

[lightgallery]

Options:
explanation: Half-life is the time taken for the concentration of a drug to drop by half. At 0 hours, the concentration of morphine is 100%. It becomes 50% at 1 hour.
name: 1 hour
label: a
answer: yes
explanation: This is incorrect. At 3 hours, the concentration of morphine is roughly 12-13%.
name: 3 hours
label: c
answer: no
explanation: This is incorrect. At 4 hours, the concentration of morphine in the blood is roughly 6-7%
name: 4 hours
label: d
answer: no
explanation: This is incorrect. At 2 hours, the concentration of morphine is 25%.
name: 2 hours
label: b
answer: no
explanation: This is incorrect. At 8 hours, the concentration of morphine in the blood is nil.
name: 8 hours
label: e
answer: no

Correct answer: a
A 43-year-old woman with fibromyalgia presents to her local GP. She is on multiple medications to manage her pain including paracetamol, pregabalin and morphine.

She has found herself taking greater doses of morphine to manage her pain and feels nervous, agitated, and unwell when she misses a dose.

Which areas of the brain are likely to be responsible for her behaviour and symptoms?

Options:
explanation: The amygdala and hypothalamus are part of the mesolimbic system. They play a role in managing emotions and regulating autonomic and endocrine functions respectively.
name: Amygdala and hypothalamus
label: c
answer: no
explanation: The occipital lobe is responsible for visual information processing. It contains the visual cortex which receives and integrates visual information from surrounding stimuli.
name: Occipital lobe
label: e
answer: no
explanation: The nucleus accumbens and VTA play an important role in addiction. They release dopamine as part of the dopamine reward pathway which leads to physiological dependence.
name: Nucleus accumbens and ventral tegmental area (VTA)
label: a
answer: yes
explanation: The amygdala and hippocampus are part of the mesolimbic system, and play a role in managing emotions and memory respectively.
name: Amygdala and hippocampus
label: b
answer: no
explanation: The nucleus raphe magnus plays a role in nociception (processing noxious stimuli).
name: Nucleus raphe magnus
label: d
answer: no

Correct answer: a
Which of the following is the most abundant cell type in bone?

Options:
explanation: Endothelial cells are a type of bone marrow stromal cell (supporting cells). They line blood vessels and provide a short diffusion distance that facilitates the rapid diffusion of nutrients and oxygen into bone marrow cells.
name: Endothelial cells
label: e
answer: no
explanation: Osteoblasts build bone by secreting osteoid and helping in the synthesis of hydroxyapatite. They are not the most abundant cell type in bone.
name: Osteoblasts
label: c
answer: no
explanation: Osteoclasts are macrophages that break down bone by secreting collagenases and other proteases – this releases calcium and phosphate into the blood. They are not the most abundant cell type in bone.
name: Osteoclasts
label: b
answer: no
explanation: Lining cells are immature cells that can differentiate into any type of bone cell. They are not the most abundant cell type in bone.
name: Lining cells
label: d
answer: no
explanation: Osteocytes are the most abundant cells in bone. They are mature osteoblasts that act as mechanoreceptors in bone and are found in lacunae.
name: Osteocytes
label: a
answer: yes

Correct answer: a
A 73-year-old woman has a fall in which she lands on the palm of her hand.

On examination, she has a dinner fork deformity.

What is the correct description of the injury she sustained?

Options:
explanation: ‘Incomplete fracture with dorsal angulation and displacement’ is incorrect. An incomplete fracture would not result in displacement.
name: Incomplete fracture with dorsal angulation and displacement
label: e
answer: no
explanation: This describes a greenstick fracture. It is a common fracture in young children.
name: Partial cortical breach with no displacement or angulation
label: b
answer: no
explanation: This is the description of a Colle’s fracture. The scenario describes a 'fall onto out-stretched hand (FOOSH)' injury which often results in a Colle’s fracture and a dinner fork deformity.
name: Complete fracture with dorsal angulation and displacement
label: a
answer: yes
explanation: This is the description of a Smith fracture. This presents with a spade deformity and is acquired when an individual falls onto the dorsum of their hand.
name: Complete fracture with ventral angulation and displacement
label: d
answer: no
explanation: This describes a scaphoid fracture. It is commonly acquired alongside a Colle’s fracture in a 'fall onto out-stretched hand (FOOSH)' injury.
name: Complete fracture with tenderness of the anatomical snuffbox
label: c
answer: no

Correct answer: a
This is an X-Ray of a 65 year old woman with renal failure. What is the correct garden classification of this injury?

[lightgallery]

Femoral neck fracture: the reliability of radiologic classifications | BMC Musculoskeletal Disorders | Full Text (biomedcentral.com)

Options:
explanation: A Garden Type 3 fracture is a complete neck of femur fracture with partial displacement.
name: Garden 3
label: a
answer: yes
explanation: A Garden Type 1 fracture is an incomplete neck of femur fracture, so this is incorrect.
name: Garden 1
label: b
answer: no
explanation: A Garden Type 5 fracture does not exist. The Garden classification ranges from Types 1 to 4.
name: Garden 5
label: e
answer: no
explanation: A Garden Type 4 fracture is a complete neck of femur fracture with complete displacement, so this is incorrect.
name: Garden 4
label: d
answer: no
explanation: A Garden Type 2 fracture is a complete neck of femur fracture with no displacement, so this is incorrect.
name: Garden 2
label: c
answer: no

Correct answer: a
What is the most important side effect to warn a patient about who is taking alendronic acid?

Options:
explanation: Bronchospasm is an uncommon side effect of bisphosphonate medication.
name: Bronchospasm
label: e
answer: no
explanation: Stomach ulcers are an important side effect of bisphosphonates. However, it is not the most important side effect to inform patients of.
name: Stomach ulcers
label: b
answer: no
explanation: Oesophagitis is an important and common side effect of bisphosphonates. As a result, patients are advised to take their bisphosphonate first thing in the morning with a full glass of water, in the upright position (e.g. sitting upright or standing up), and then stay upright for at least 30 minutes afterwards.
name: Oesophagitis
label: a
answer: yes
explanation: Muscle aches are not a recognized side effect of bisphosphonates. They are more common with statins.
name: Muscle ache
label: d
answer: no
explanation: Atypical femoral fractures are a recognized side effect of bisphosphonates. However, they are relatively uncommon.
name: Atypical femoral fractures
label: c
answer: no

Correct answer: a
A 67-year-old man presents to the GP with pain in his right leg. He also has hearing loss. The doctor conducts some blood tests.


The results are shown below:

||||
|---------------------------|:-------:|--------------------|
|Alkaline Phosphatase (ALP)|300 IU/L|25 - 115|
|Calcium|2.3 mmol/L|2.2 - 2.6|
|Vitamin D|30 nmol/L|>50|

The GP prescribes him paracetamol and alendronic acid.


 8 years later, the same patient presents to his GP complaining of night sweats, fever and weight loss.


What is the most likely complication of his original condition that has occurred here?

Options:
explanation: A chondroma is a benign cartilaginous growth which commonly affects the small bones of the hands and feet, the femur and the humerus. Typically, a chondroma does not present with red flag symptoms.
name: Chondroma
label: c
answer: no
explanation: Multiple myeloma is a malignant disease of bone marrow plasma cells characterised by >10% plasma cells in the bone marrow and CRAB (hyper**c**alcaemia, **r**enal failure, **a**naemia and lytic **b**one lesions) features. It is not a complication of Paget’s disease.
name: Multiple myeloma
label: d
answer: no
explanation: Ewing sarcoma is a primary malignancy of bone commonly affecting people under 25 years old. It largely affects the diaphysis of long bones and is associated with a t(11;22) translocation. It is not a complication of Paget’s disease.
name: Ewing sarcoma
label: b
answer: no
explanation: Acute lymphoblastic leukaemia is a common childhood blood cancer. It is most common in children with Down’s syndrome, a history of carcinogen exposure (e.g. benzene, arsenic), and positive family history of ALL. It is not a complication of Paget’s disease.
name: Acute lymphoblastic leukaemia (ALL)
label: e
answer: no
explanation: This man has Paget’s disease. A complication of Paget’s disease is malignant transformation, typically to osteosarcoma, which presents with red flag symptoms such as weight loss, night sweats and fever.
name: Osteosarcoma
label: a
answer: yes

Correct answer: a
The image below shows an X-ray. What is the structure marked with a red dot?

[lightgallery]

Options:
explanation: This option is incorrect. The hamate is an attachment point for some muscles and ligaments of the hand. It also forms part of the Carpal tunnel and Guyon’s canal.
name: Hamate
label: e
answer: no
explanation: This is the lunate bone. It is the carpal bone most likely to be dislocated. Lunate dislocations are typically associated with scaphoid fractures.
name: Lunate
label: a
answer: yes
explanation: This option is incorrect. The scaphoid bone is the carpal bone most likely to be fractured. It has a retrograde blood supply so is susceptible to avascular necrosis upon injury (e.g. fracture).
name: Scaphoid
label: b
answer: no
explanation: This option is incorrect. The triquetrum is the second most likely carpal bone to be fractured in the hand.
name: Triquetrum
label: c
answer: no
explanation: This option is incorrect. The trapezoid bone is the smallest in the distal row of carpal bones of the hand. It sits lateral to the capitate bone.
name: Trapezoid
label: d
answer: no

Correct answer: a
Vitamin D is important in calcium homeostasis. It increases calcium levels in the blood and can be obtained from several sources including the sun, supplements and Vitamin D-rich foods such as spinach and other green leafy vegetables.

With regards to the metabolism of Vitamin D, what is the enzyme responsible for the formation of 1,25-Hydroxyvitamin D?

Options:
explanation: 1-alpha hydroxylase is an enzyme made in the kidneys. It catalyses the hydroxylation of 25-hydroxyvitamin D3 into 1,25-hydroxyvitamin D, which is commonly known as calcitriol.
name: 1-alpha hydroxylase
label: a
answer: yes
explanation: Cytochrome P450 is a family of enzymes involved in the breakdown of proteins, steroids, hormones, and fatty acids. They are made by the liver.
name: Cytochrome P450
label: e
answer: no
explanation: Vitamin C ferrireductase is found in enteral cells (gut cells). It works by converting Fe3+ (ferric iron) to Fe2+ (ferrous iron).
name: Vitamin C ferrireductase
label: d
answer: no
explanation: Phospholipase A2 plays a role in the synthesis of arachidonic acid from phospholipids in the arachidonic acid pathway. It is a common target for anti-inflammatory drugs such as steroids.
name: Phospholipase A2
label: c
answer: no
explanation: Ferrochelatase catalyses the insertion of ferrous iron (Fe2+) into Protoporphyrin, allowing the synthesis of haem.
name: Ferrochelatase
label: b
answer: no

Correct answer: a
A 29-year-old woman presents to her GP with an erythematous facial rash and joint pain. Her current medications include ramipril, isoniazid, hydralazine, paracetamol PRN and Microgynon 30.

What is the likely autoantibody found in her condition?

Options:
explanation: Anti-Ro (and Anti-La) antibodies are diagnostic of Sjogren’s syndrome. Patients with Sjogren’s syndrome are known for being DRY (i.e. dry mucous membranes, dry skin, dry eyes, etc), and a common test used in the diagnostic workup of the syndrome is the Schirmer’s test.
name: Anti-Ro
label: d
answer: no
explanation: Anti-CCP antibodies are usually found in rheumatoid arthritis (RA). RA is unlikely to present with a facial rash. It typically presents with symmetrical polyarthritis affecting the MCPs and PIPs of the hand and sparing the DIPs, but it may also affect larger joints. Other features include extra-articular symptoms.
name: Anti-CCP
label: b
answer: no
explanation: Anti-cardiolipin antibodies are characteristic findings in anti-phospholipid syndrome. These patients typically present with a pro-coagulative state that leads to high numbers of miscarriages, venous thromboembolism events and musculoskeletal diseases (e.g. inflammatory arthritis).
name: Anti-cardiolipin
label: e
answer: no
explanation: Anti-histone antibodies are characteristic of drug-induced lupus which is the most likely diagnosis here. This patient is taking hydralazine and isoniazid which are drugs that commonly cause drug-induced Lupus.
name: Anti-histone
label: a
answer: yes
explanation: Anti-dsDNA antibodies are diagnostic of systemic lupus erythematosus (SLE). These patients have a variety of symptoms including joint pain, rash, serositis, and heart conduction abnormalities.
name: Anti-dsDNA
label: c
answer: no

Correct answer: a
A 22-year-old man presents to his GP with lower back pain, buttock pain and stiffness.

Which of the following features is most likely to suggest the underlying diagnosis?

Options:
explanation: Sacroiliitis is inflammation of the sacroiliac joints and can be diagnosed via an MRI scan. This patient likely has ankylosing spondylitis. Sacroiliitis is a diagnostic feature in the 'New York Diagnostic Criteria for Ankylosing Spondylitis'.
name: Sacroiliitis
label: a
answer: yes
explanation: Marginal erosions are not typically found in ankylosing spondylitis. They are mostly found in rheumatoid arthritis.
name: Marginal erosions
label: d
answer: no
explanation: Squaring of the vertebrae is usually found in the spine of a patient with ongoing ankylosing spondylitis but is not a diagnostic finding.
name: Squaring of the vertebrae
label: c
answer: no
explanation: Subchondral cysts are a common finding in arthritic diseases, including ankylosing spondylitis. However, they are not diagnostic of this condition.
name: Subchondral cysts
label: e
answer: no
explanation: Syndesmophytes are the same as osteophytes, except they are found in the spine. Although they are found in ankylosing spondylitis, they are not diagnostic.
name: Syndesmophytes
label: b
answer: no

Correct answer: a
A 62-year-old man presents to his GP with a 7-week history of pain in the joints of his hand. An x-ray of both his hands is conducted.

What is the most likely diagnosis?

[lightgallery]

Options:
explanation: Acute pseudogout is unlikely to last for 7 weeks and to be bilateral. Pseudogout presentations are typically unilateral. Chronic pseudogout (CPP disease), however, can mimic the presentation of osteoarthritis.
name: Acute pseudogout
label: e
answer: no
explanation: The x-ray shows characteristic features of osteoarthritis including a loss of joint space, osteophytes, subchondral cysts and subchondral sclerosis. The joints predominantly affected in this x-ray are the distal interphalangeal joints.
name: Osteoarthritis
label: a
answer: yes
explanation: Acute gout is unlikely to last for 7 weeks and is unlikely to be bilateral. Additionally, acute gout is unlikely to produce the findings in this x-ray.
name: Acute gout
label: d
answer: no
explanation: Rheumatoid arthritis is likely to present with a loss of joint space, marginal erosions, subchondral cysts and subchondral sclerosis. It also largely involves the metacarpophalangeal (MCP) joints and proximal interphalangeal (PIP) joints but spares the distal interphalangeal (DIP) joints. This x-ray does not show any marginal erosions. Also, the MCPs and PIPs are not affected.
name: Rheumatoid arthritis
label: b
answer: no
explanation: Psoriatic arthritis is most likely to present with a ‘pencil in cup appearance’ on x-ray. Depending on the type of psoriatic arthritis, various joints can be affected. The distal interphalangeal (DIP) predominant type would predominantly involve the DIPs.
name: Psoriatic arthritis
label: c
answer: no

Correct answer: a