hllj/quesmed huggingface dataset:
A 53 year old man attends his GP surgery with concerns about soreness and itching around his penis. The GP diagnoses a genital mycotic infection. The patient has a history of type 2 diabetes, for which he takes medication.

Which of the following diabetic medications is most likely to have contributed to this patient's symptoms?

Options:
explanation: DPP-4 inhibitors are considered a 2nd line treatment option for type 2 diabetes. Known side effects of this group include hypoglycaemia and nausea. They are not as closely linked to genital mycotic infections as SGLT-2 inhibitors, making this answer incorrect.
name: Sitagliptin (DPP-4 inhibitor)
label: e
answer: no
explanation: SGLT-2 inhibitors are prescribed 1st line for type 2 diabetes if individuals have risk factors for cardiovascular disease. They are associated with a predisposition to developing fungal infections, particularly genital mycotic infections as seen in this case.
name: Dapagliflozin (SGLT-2 inhibitor)
label: a
answer: yes
explanation: Metformin is typically prescribed as 1st line in type 2 diabetes. Known side effects include gastrointestinal upset and more rarely, lactic acidosis. Metformin can be prescribed as a modified-release version to overcome gastrointestinal upset side effects. It is not as closely linked to genital mycotic infections as SGLT-2 inhibitors, making this answer incorrect.
name: Metformin (Biguanide)
label: d
answer: no
explanation: Thiazolidinediones are typically 2nd line options for type 2 diabetes, after metformin and SGLT-2 inhibitors. Known side effects of this drug group include oedema and weight gain. They are not as closely linked to genital mycotic infections as SGLT-2 inhibitors, making this answer incorrect.
name: Pioglitazone (thiazolidinedione)
label: c
answer: no
explanation: Sulphonylureas are typically a 2nd line option for type 2 diabetes, after metformin and SGLT-2 inhibitors. They can be used 1st line for steroid-induced hyperglycaemia. Known side effects of this group include hypoglycaemia and weight gain. They are not as closely linked to genital mycotic infections as SGLT-2 inhibitors, making this answer incorrect.
name: Gliclazide (sulphonylurea)
label: b
answer: no

Correct answer: a
A 22 year old woman is brought to the emergency department by ambulance after being found lying on the floor of her bedroom by her sister. Her sister notes she was holding an empty medication bottle when found, but is unsure what it contained.

On examination, the patient is finding it difficult to speak, muttering indistinct words and only opening her eyes to verbal commands. She is unable to pinch the fingers of one of the nurses when asked but is capable of localising to supraorbital pain. In addition, her pupils are bilaterally reduced in size. She has a respiratory rate of 8 breaths per minute, but all other observations are within the normal limits.

Which of the following is the most appropriate acute management option?

Options:
explanation: This is the 1st line treatment for opioid dependence, not an acute overdose as seen in this case. Taking methadone is known to reduce patients' withdrawal symptoms and cravings for opioids. However, the patient in this case demonstrates acute opioid toxicity, making naloxone the most appropriate management option.
name: Methadone
label: b
answer: no
explanation: This is a very potent, short-acting opioid. However, the patient in this case demonstrates acute opioid toxicity, making naloxone the most appropriate management option. It would not be appropriate to administer further opioid medications.
name: Alfentanil
label: e
answer: no
explanation: This is an opioid receptor agonist used in the treatment of diarrhoea. However, the patient in this case demonstrates acute opioid toxicity, making naloxone the most appropriate management option.
name: Loperamide
label: d
answer: no
explanation: This is the 1st line treatment for individuals suffering from an acute benzodiazepine overdose. Key signs of a benzodiazepine overdose include ataxia and slurred speech. However, the patient in this case demonstrates acute opioid toxicity, making naloxone the most appropriate management option.
name: Flumazenil
label: c
answer: no
explanation: The signs of respiratory depression, reduced consciousness and pinpoint pupils are strongly suggestive of an opioid overdose. Acute reversal is needed. Naloxone is the recommended reversal agent in opioid toxicity, acting as a full antagonist at opioid receptors.
name: Naloxone
label: a
answer: yes

Correct answer: a
A 45 year old male is seen in a specialist neurology clinic. For the past month, he has been experiencing difficulty chewing, swallowing and forming words. The clinician explains that the corticobulbar tract is responsible for the motor innervation of the head and neck muscles.

Through which part of the internal capsule do fibres of the corticobulbar tract pass?

Options:
explanation: Whilst this is a part of the internal capsule, corticobulbar fibres do not pass through the anterior limb. They pass through the middle of the internal capsule, the genu, before going on to synapse with cranial nerve nuclei.
name: Anterior limb
label: b
answer: no
explanation: This is not a part of the internal capsule, but rather a structure of the basal ganglia. The internal capsule sits between the basal ganglia and the thalamus in the brain.
name: Putamen
label: d
answer: no
explanation: Whilst this is a part of the internal capsule, corticobulbar fibres do not pass through this structure. Corticobulbar fibres pass through the middle of the internal capsule, the genu, before going on to synapse with cranial nerve nuclei.
name: Posterior limb
label: c
answer: no
explanation: This is not a part of the internal capsule, but rather a structure of the basal ganglia. The internal capsule sits between the basal ganglia and the thalamus in the brain.
name: Globus pallidus
label: e
answer: no
explanation: Correct - after leaving the motor cortex and supplementary motor association area, corticobulbar fibres first pass through the corona radiata. They then pass through the middle of the internal capsule, the genu, before going on to synapse with cranial nerve nuclei.
name: Genu
label: a
answer: yes

Correct answer: a
A 57 year old woman is reviewed in a specialist neurology clinic following a traumatic brain injury. She reports that she sometimes struggles to orientate herself towards sounds or sights in her environment. The clinician explains that there is a specific neurological tract that works to initiate reflex postural movements of the head in response to auditory and visual stimuli.

Which of the following extrapyramidal motor pathways is responsible for modulating reflex responses of the head to auditory and visual stimuli?

Options:
explanation: This extra-pyramidal tract is responsible for modulating rotation and lifting of the head via cranial nerve XI (Spinal accessory nerve).
name: Medial vestibulospinal tract
label: d
answer: no
explanation: This is not an extrapyramidal or motor tract but rather a sensory tract. It relays information on pain, temperature and crude touch from the face and forehead to the sensory cortex.
name: Spinal tract V
label: e
answer: no
explanation: This extrapyramidal tract is responsible for maintaining posture. It works through motor neuron stimulation of the leg extensors and musculature of the trunk.
name: Lateral vestibulospinal tract
label: c
answer: no
explanation: This extrapyramidal tract is responsible for modulating flexor muscle tone, modulating flexor reflexes e.g. to withdraw one's hand away from a hot pan.
name: Rubrospinal tract
label: b
answer: no
explanation: Correct. This extrapyramidal tract originates in the superior colliculus. It is involved in coordinating reflex responses to bright lights and loud noises on the contralateral side of the body, orienting the head towards auditory and visual information.
name: Tectospinal tract
label: a
answer: yes

Correct answer: a
A 38 year old man presents to the emergency department with a 3 day history of fever, right upper quadrant abdominal pain and yellowing of the skin. A clinician explains that this yellowing is known as jaundice, which is caused by a build-up of bilirubin in his blood.

Which of the following substances is initially produced from the breakdown of haem?

Options:
explanation: Haem is formed from the breakdown of haemoglobin into haem and globin. Globin is then broken down into amino acids, whilst haem is converted to iron and biliverdin via the enzyme haem oxygenase. Biliverdin is then reduced into unconjugated bilirubin. Unconjugated bilirubin is then transported to the liver where glucuronyl transferase adds glucuronic acid to the bilirubin to make it into conjugated bilirubin.
name: Conjugated bilirubin
label: c
answer: no
explanation: Haem is formed from the breakdown of haemoglobin into haem and globin. Globin is then broken down into amino acids, whilst haem is converted to iron and biliverdin via the enzyme haem oxygenase. Biliverdin is then reduced into unconjugated bilirubin.
name: Unconjugated bilirubin
label: b
answer: no
explanation: Haem is formed from the breakdown of haemoglobin into haem and globin. Globin is then broken down into amino acids, whilst haem is converted to iron and biliverdin via the enzyme haem oxygenase. Biliverdin is then reduced into unconjugated bilirubin. Unconjugated bilirubin is then transported to the liver where glucuronyl transferase adds glucuronic acid to the bilirubin to make it into conjugated bilirubin. This then travels into the colon, where bacteria deconjugate it into urobilinogen.
name: Urobilinogen
label: e
answer: no
explanation: Haem is formed from the breakdown of haemoglobin into haem and globin. Globin is then broken down into amino acids, whilst haem is converted to iron and biliverdin via the enzyme haem oxygenase. Biliverdin is then reduced into unconjugated bilirubin. Unconjugated bilirubin is then transported to the liver where glucuronyl transferase adds glucuronic acid to the bilirubin to make it into conjugated bilirubin. This then travels into the colon, where bacteria deconjugate it into urobilinogen.

The majority of urobilinogen is oxidised by bacteria in the intestine to form stercobilin, prior to faecal excretion.
name: Stercobilin
label: d
answer: no
explanation: Haem is formed from the breakdown of haemoglobin into haem and globin. Globin is then broken down into amino acids, whilst haem is converted to iron and biliverdin via the enzyme haem oxygenase. Biliverdin is therefore the first breakdown product to be formed of the options listed.
name: Biliverdin
label: a
answer: yes

Correct answer: a
A 35 year old women is assessed on the surgical admissions ward. She reports cramping right upper quadrant pain, especially after she has just eaten a fatty meal. She wants to better understand how fatty acids in the body are digested. The clinician explains how the hormone cholecystokinin (CCK) promotes the production of bile and stimulates the gallbladder to contract.

Which of the following cell types secretes CCK?

Options:
explanation: The G cells in the pyloric antrum of the stomach release the hormone gastrin, not CCK. There are many functions of gastrin including the stimulation of gastric acid secretion, promotion of gastric mucosa growth, and acceleration of gastric emptying via relaxation of the pyloric sphincter.
name: G cells in the pyloric antrum of the stomach
label: e
answer: no
explanation: The PP cells of the pancreas secrete the hormone pancreatic polypeptide, not CCK. Pancreatic polypeptide counteracts CCK, inhibiting pancreatic secretion and gallbladder contraction.
name: PP cells of the pancreas
label: d
answer: no
explanation: The M cells in the small intestine crypts secrete the hormone motilin, not CCK. Motilin functions to increase peristalsis and accelerate gastric emptying during a fasted state.
name: M cells in the small intestine crypts
label: c
answer: no
explanation: The S cells of the duodenum secrete the hormone secretin, not CCK. Secretin functions to neutralise acid in the duodenum by stimulating the release of sodium bicarbonate. Secretin also has an osmoregulatory function in the hypothalamus
name: S cells of the duodenum
label: b
answer: no
explanation: Correct - I cells of the duodenum secrete CCK. The presence of fatty/amino acids in the chyme stimulates the release of CCK. CCK inhibits gastric emptying (allowing time for the digestion of food further down the gastrointestinal tract) and stimulates the acinar cells of the pancreas to release digestive juices.
name: I cells of the duodenum
label: a
answer: yes

Correct answer: a
A 72 year old man is seen by his GP. He has developed bilateral pitting oedema across both ankles, which is making it uncomfortable to walk long distances. The GP suggests trialling a loop diuretic.

Which of the following transporter acts within the thick limb of the loop of Henle?

Options:
explanation: This transporter is found on the basolateral membrane of epithelium within the distal convoluted tubule. Its role is to secret sodium ions into the extracellular fluid, to reduce intracellular sodium levels. This creates a sodium gradient for sodium to move into the epithelial cells via the apical sodium/chloride co-transporter.
name: Sodium/Potassium ATPase co-transporter
label: c
answer: no
explanation: This active transporter is crucial in creating an osmotic gradient between the urine in the loop of Henle and the blood surrounding it. It draws water out of the urine and increases the concentration of the urine that passes into the collecting ducts of the nephron.
name: Sodium/Potassium/2-Chloride cotransporter
label: a
answer: yes
explanation: These are found in the proximal convoluted tubule apical epithelium. Sodium ions move down a concentration gradient into the epithelial cells. These sodium ions are co-transported alongside other solutes such as amino acids, enabling the movement of these solutes against their concentration gradient.
name: Sodium-amino acid linked transporters
label: e
answer: no
explanation: These are found in the proximal convoluted tubule apical epithelium. Sodium ions move along their own concentration gradient into the epithelial cells. These sodium ions are co-transported alongside other solutes such as glucose, enabling the movement of these other solutes against their concentration gradient.
name: Sodium-glucose linked transporters
label: d
answer: no
explanation: This is found on the apical membrane of epithelial cells of the distal convoluted tubule. It acts to transport sodium and chloride into the cell following a sodium gradient.
name: Sodium/chloride cotransporter
label: b
answer: no

Correct answer: a
A 65 year old man with heart failure is keen to conduct his own review of the literature on effective treatments. He asks his cardiology consultant to explain some key statistical terms, such as the concept of a type II error.

Which of the following best describes a type II statistical error?

Options:
explanation: Correct - A type II error can be thought of as a 'false negative', where the alternative hypothesis has been rejected in favour of the null hypothesis when in fact the alternative hypothesis is true.
name: Declaring results not to be statistically significant (P>0.05) when in reality there is a statistically significant difference between groups
label: a
answer: yes
explanation: This is the correct outcome and is not a statistical error. When P values are equal to or greater than 0.05, it can be said that there is not a statistically significant difference between the groups.
name: Declaring results to be not statistically significant (P>0.05) when there is no difference between the groups
label: c
answer: no
explanation: This is the correct outcome and is not a statistical error. When P values are less than 0.05, it can be said that there is a statistically significant difference between the groups.
name: Declaring results to be statistically significant (P<0.05) when there is a difference between the groups
label: d
answer: no
explanation: This describes a type I statistical error. This can be thought of as a 'false positive', where the null hypothesis has been rejected in favour of the alternative hypothesis when in fact the null hypothesis is true.
name: Declaring results to be statistically significant (P<0.05) when in reality there is not a statistically significant difference between groups
label: b
answer: no
explanation: This describes a study being underpowered. The power of a study is the probability that the study will find a statistically significant difference between groups should it exist. Studies not having enough participants can lead to low power and an inability to detect significant differences that may be present between groups.
name: When the sample size used in a study is not large enough to be able to detect any significant differences that may exist between groups
label: e
answer: no

Correct answer: a
A 35 year old woman presents to the emergency department complaining of a sudden headache that seems to focus in pain and intensity behind her eyes. In addition, she has signs of an oculomotor nerve palsy. An MRI scan identifies pituitary apoplexy. She is concerned about the long term implications of this.

Which of the following hormones is secreted from the anterior pituitary gland?

Options:
explanation: This is a hormone secreted by the hypothalamus. It works to enable the anterior pituitary gland to secrete adrenocorticotrophic hormone as part of the biological stress response.
name: Corticotropin-releasing hormone
label: e
answer: no
explanation: This is a hormone secreted within the duodenum, pancreas and hypothalamus that acts to inhibit the function of growth hormone.
name: Somatostatin
label: d
answer: no
explanation: This is a hormone responsible for milk production and breast development, amongst other functions. Its release from the anterior pituitary gland is stimulated by thyrotropin-releasing hormone and inhibited by dopamine.
name: Prolactin
label: a
answer: yes
explanation: This is a hormone secreted by the posterior pituitary gland. Its functions include stimulating uterine contractions and encouraging milk flow.
name: Oxytocin
label: b
answer: no
explanation: This is a hormone secreted by the posterior pituitary gland. It acts upon the renal collecting duct to increase water reabsorption back into the blood. It can be inhibited by alcohol.
name: Anti-diuretic hormone
label: c
answer: no

Correct answer: a
A 35 year old man with asthma is reviewed by his GP. The patient has read about a new randomised control trial on the effectiveness of a novel short-acting beta agonist versus salbutamol. The paper states that the first participant in the study was randomly allocated to either the new drug group or the salbutamol group via a computer. After that, participants were randomly allocated to each condition whilst ensuring that prognostic factors (age, sex and total lung capacity) were balanced across each group.

Which of the following best describes the type of randomisation used to allocate trial participants to the groups in this study?

Options:
explanation: This is not a randomisation technique. Confounding is a phenomenon that occurs in research whereby an additional, unmeasured variable impacts both the independent variable (the 'cause') in the study and the outcome measure (the 'effect'). It therefore obscures the interpretation of results.
name: Confounding
label: e
answer: no
explanation: This is a randomisation technique aiming to maintain similar numbers of participants in each condition. It does this by dividing the participant population into smaller chunks and ensuring that a set amount of participants from each chunk are allocated to each group of the study.
name: Block randomisation
label: c
answer: no
explanation: This method of randomisation first divides up the participant population into groups (strata) of similar baseline characteristics. Each created strata are then allocated via simple randomisation to each study arm, with the aim being to ensure similar baseline characteristics amongst each arm of the trial.
name: Stratification
label: d
answer: no
explanation: This is a method of randomisation that seeks to equalise baseline characteristics between groups. It is used if multiple prognostic or confounding factors in the participant population need to be accounted for. It is an adaptive method of randomisation, as future participant allocation depends on the previous allocations of other participants.
name: Minimisation
label: a
answer: yes
explanation: This is a common method of participant allocation whereby a computer is used to randomly allocate trial participants to groups of a study. A limitation of simple randomisation is that baseline characteristics may differ between each condition.
name: Simple randomisation
label: b
answer: no

Correct answer: a
A couple attends a fertility clinic with a consultant obstetrician. They are eager to go ahead with an initial round of in-vitro fertility treatment, having been struggling to conceive for the past 2 years. As part of the counselling process, the clinician explains how the body produces egg cells.

Which of the following cell types are formed when oogonia multiply by mitosis?

Options:
explanation: This is the haploid cell type that is formed once the diploid primary follicle completes meiosis I during puberty. It is formed alongside the 1st polar body (also haploid) and is the cell that gets released during ovulation.
name: Secondary oocyte
label: e
answer: no
explanation: This is the haploid body that is formed when a primary oocyte (matured as a primary follicle by this point) is stimulated to complete meiosis I during puberty. A secondary oocyte is formed as a result of this division alongside the 1st polar body (both of which are haploid cells formed from the diploid primary follicle).
name: 1st polar body
label: d
answer: no
explanation: This is the end product of oogenesis. The ovum is formed at fertilisation when the secondary oocyte, released during ovulation, is stimulated to complete meiosis-II by being fertilised.
name: Ovum
label: b
answer: no
explanation: Oogonia multiply by mitosis to form primary oocytes, which are diploid. The primary oocyte later gives rise to secondary oocytes, which are haploid.
name: Primary oocyte
label: a
answer: yes
explanation: This is the primordial germ cell that starts the process of oogenesis before birth. These cells undergo mitosis to form oogonia cells.
name: Oogonium
label: c
answer: no

Correct answer: a