hllj/quesmed huggingface dataset:
A 61 year old woman receives a new diagnosis of ovarian cancer. She is currently taking hormone replacement therapy that contains oestrogen, and wonders whether she should stop.

Which of the following best describes the role of oestrogen in the pathophysiology of ovarian cancer?

Options:
explanation: This is the correct answer. Oestrogen can have an anti-apoptotic effect, which means it can reduce or inhibit the normal apoptosis of cells. This effect is particularly relevant in the context of cancer because apoptosis serves as a natural mechanism to eliminate damaged or potentially cancerous cells from the body.
name: Decreases apoptosis activity
label: a
answer: yes
explanation: Oestrogen is not typically associated with anti-inflammatory functions; it can promote inflammation in some cases of ovarian cancers. Oestrogen is involved in the initiation and progression of ovarian cancer. It also plays a role in increasing oncogenes and decreasing apoptosis and tumour suppressors in the ovaries.
name: Anti-inflammatory function
label: c
answer: no
explanation: Oestrogen has been linked to decreasing tumour suppressors in ovarian cancer. Oestrogen is involved in the initiation and progression of ovarian cancer. It also plays a role in increasing oncogenes and decreasing apoptosis in the ovaries.
name: Increases tumour suppressors
label: d
answer: no
explanation: Oestrogen is involved in the initiation and progression of ovarian cancer. It plays a role in transforming the ovarian cells; including the surface epithelial cells, germ cells and stromal cells into carcinogenic cells. It also plays a role in increasing oncogenes and decreasing apoptosis and tumour suppressors in the ovaries.
name: Decreases the risk of epithelial cell transformation
label: e
answer: no
explanation: Oestrogen has been associated with stimulating the growth and proliferation of cells, rather than inhibiting or slowing down their proliferation. Oestrogen can have a proliferative effect on various tissues, including the ovaries. By contrast, progesterone slows down the proliferation of ovarian cells, as it represses oestrogen-induced gene expression.
name: Slows down the proliferation of ovarian cells
label: b
answer: no

Correct answer: a
A 44 year old woman is concerned about the recent changes in her menstrual cycle. She has been experiencing regular monthly periods throughout her life but has not had a menstrual period for the past 2-3 months. She reports weight gain and occasional night sweats. Her husband adds that she sometimes becomes more irritable than usual. Her exercise routine has remained consistent with her usual activity level. She is sexually active, and takes no regular medications.

A physical examination is unremarkable.

What is the best initial investigation?

Options:
explanation: Serum FSH could be taken if pregnancy is ruled out and perimenopause is suspected, in which a marked increase in FSH levels would be seen. In this vignette, the patient describes symptoms that could be seen in both pregnancy and menopause, such as weight gain, night sweats and mood changes. Therefore, the initial step is to first rule out pregnancy with a urinary β-hCG test.
name: Serum FSH
label: b
answer: no
explanation: Prolactin levels are more commonly assessed when there is a suspicion of hyperprolactinemia as a cause of amenorrhea. This condition can lead to irregular menstrual cycles and can sometimes present with other symptoms, but it is not as time-sensitive as ruling out pregnancy. Therefore, the initial step is to rule out pregnancy with a urinary β-hCG test.
name: Serum prolactin
label: d
answer: no
explanation: Thyroid function tests can be considered, as a thyroid imbalance can cause menstrual irregularities. However, the combination of symptoms described, including oligomenorrhoea and weight gain, should prompt us to consider the possibility of pregnancy, especially given the patient's age and the fact that she is sexually active. Therefore, the initial step is to rule out pregnancy with a urinary β-hCG test.
name: Thyroid function tests
label: e
answer: no
explanation: Serum oestrogen levels is not the initial investigation of choice because they do not directly address the primary concern of missed menstruation and the potential for pregnancy. Once pregnancy is ruled out, further evaluation including assessing hormonal levels, can be considered to investigate the underlying cause of secondary amenorrhea and associated symptoms. Therefore, the initial step is to rule out pregnancy with a urinary β-hCG test.
name: Serum oestrogen
label: c
answer: no
explanation: This is the correct answer. Remember that it is essential to rule out pregnancy as a potential cause of amenorrhoea in women who are sexually active and are potentially at childbearing age. A urinary β-hCG test can quickly and definitively determine whether the patient is pregnant. When an embryo attaches to the uterine lining, it begins to produce hCG. In a healthy pregnancy, hCG levels rise rapidly in the early weeks.
name: Urinary β-hCG
label: a
answer: yes

Correct answer: a
A 12 year old male presents to his GP with concerns about delayed puberty.

On examination, he has testicular volume of 6 mL bilaterally, and his pubic hair is limited to a few fine, straight hairs at the base of the penis.

Based on Tanner staging, which of the following best represents this patient's current stage of pubertal development?

Options:
explanation: Tanner stage 1 describes the prepubertal stage, with testicular volume <1.5ml, and no pubic hair. By contrast, this patient currently fits Tanner stage 2.
name: Stage 1
label: b
answer: no
explanation: This is the correct answer. Tanner stage 2 describes penis growth in length only, testicular volume 1.5-6ml, and some downy hair at the base of the penis in males. This therefore fits the clinical vignette.
name: Stage 2
label: a
answer: yes
explanation: Tanner stage 4 describes the development of the glans penis, darkening of the scrotal skin, testicular volume 12-20ml, and adult pubic hair, not spreading to the thighs. By contrast, this patient currently fits Tanner stage 2.
name: Stage 4
label: d
answer: no
explanation: Tanner stage 3 describes penis growth further in length as well as circumference, testicular volume 6-12ml, and coarser, plus thicker and curlier hair that spreads laterally to cover more of the pubis. By contrast, this patient currently fits Tanner stage 2.
name: Stage 3
label: c
answer: no
explanation: Tanner stage 5 describes adult genitalia, testicular volume >20ml, and adult pubic hair spreading to the medial thighs. By contrast, this patient currently fits Tanner stage 2.
name: Stage 5
label: e
answer: no

Correct answer: a
A 17 year old female attends her GP surgery for a review of her thyroid medication. She is noted to have a short stature, webbed neck, and delayed puberty.

Examination reveals a high-arched palate and widely spaced nipples. There is no evidence of any congenital heart defects.

Which of the following is the most likely karyotype for this patient?

Options:
explanation: This karyotype represents Triple X syndrome, a genetic condition in females characterised by an extra X chromosome. It is associated with mild developmental and learning difficulties but does not typically manifest with the specific features described in this vignette.
name: 47, XXX
label: b
answer: no
explanation: This karyotype represents Klinefelter syndrome, which typically presents in males with features such as tall stature, gynaecomastia, delayed puberty, and often infertility. This patient is female and does demonstrate these clinical features.
name: 47, XXY
label: c
answer: no
explanation: This karyotype represents Tetrasomy X. It is not typically associated with distinctive physical features, although some individuals with XXXX Syndrome may have a taller stature than average for their age, as opposed to the short stature in this vignette. Subtle learning and behavioural differences are sometimes seen.
name: 48, XXXX
label: e
answer: no
explanation: This is the correct answer. Turner syndrome is a genetic condition that typically occurs in females and is characterised by the partial or complete absence of one X chromosome. The clinical features mentioned, including short stature, webbed neck (known as 'pterygium colli'), delayed puberty, high-arched palate, and widely spaced nipples, are consistent with Turner syndrome. While some individuals with Turner syndrome may have congenital heart defects, the absence of such defects in this patient does not rule out the diagnosis.
name: 45, XO
label: a
answer: yes
explanation: This karyotype represents Down syndrome. Down syndrome is characterised by distinctive facial features, intellectual disability, speech delays, and an increased risk of congenital heart defects. Although also associated with short stature, the other symptoms described in this vignette such as a high-arched palate and widely spaced nipples are more suggestive of Turner syndrome.
name: 47, XX, +21
label: d
answer: no

Correct answer: a
A 24 year old male attends his GP surgery with difficulty conceiving. He and his partner have been trying to conceive through regular sexual intercourse for around 18 months.

On examination, a tall stature, long limbs, and small testes are noted. There is also evidence of gynaecomastia. A karyotype analysis reveals a 47, XXY chromosomal pattern.

Which of the following hormones is primarily responsible for the development of gynecomastia in this case?

Options:
explanation: This patient with 47 XXY karyotype has Klinefelter syndrome. Although prolactin has a role in breast development, elevated prolactin is not typically associated with Klinefelter syndrome. Elevated prolactin levels are more commonly associated with other medical conditions, such as prolactinomas, certain medications and stress.
name: Elevated prolactin levels
label: d
answer: no
explanation: This patient with 47 XXY karyotype has Klinefelter syndrome. Elevated LH levels are indeed a common feature of Klinefelter syndrome. In response to testicular dysfunction and decreased testosterone production, the pituitary gland releases higher levels of FSH and LH in an attempt to stimulate the testes. However, LH is not the primary hormone causing gynaecomastia; oestrogen is.
name: Elevated LH levels
label: c
answer: no
explanation: This patient with 47 XXY karyotype has Klinefelter syndrome. Elevated FSH levels are indeed a common feature of Klinefelter syndrome. In response to testicular dysfunction and decreased testosterone production, the pituitary gland releases higher levels of FSH and LH in an attempt to stimulate the testes. However, FSH is not the primary hormone causing gynaecomastia; oestrogen is.
name: Elevated FSH levels
label: b
answer: no
explanation: This patient with 47 XXY karyotype has Klinefelter syndrome. It is characterised by reduced testosterone levels due to testicular dysfunction and impaired testosterone production. Furthermore, if testosterone levels were to be elevated, it would not cause gynaecomastia. Instead, it would cause hyperandrogenic features such as hirsutism and acne.
name: Elevated testosterone levels
label: e
answer: no
explanation: This is the correct answer. This patient with 47 XXY karyotype has Klinefelter syndrome. The additional X chromosome leads to testicular dysfunction, leading to reduced testosterone production. With lower testosterone levels and an inadequate testosterone-to-oestrogen ratio, there is a relative excess of oestrogen in the body. This hormonal imbalance can result in the development of secondary sexual characteristics that are more characteristic of females, such as gynaecomastia and less body and facial hair.
name: Elevated oestrogen levels
label: a
answer: yes

Correct answer: a
A pharmaceutical company is conducting a clinical trial to test the effectiveness of a new medication for Type 2 diabetes. To recruit participants for the study, they decide to advertise the trial exclusively through online platforms and social media.

Which of the following forms of selection bias could affect the validity of this trial?

Options:
explanation: Susceptibility bias refers to the phenomenon in which a particular group of individuals within a study population may have a higher or lower susceptibility to the condition or outcome under investigation. It is unrelated to the way participants are recruited into the study but rather how certain factors or characteristics may make some participants more or less likely to develop the condition or experience the outcome.
name: Susceptibility bias
label: b
answer: no
explanation: Exclusion bias refers to the phenomenon whereby the researchers intentionally remove important variables or factors that should be included in the analysis from the model. For example, if the researchers purposely exclude some subgroups from the sample population. This is not the best answer because for this context because the researchers in this trial are not actively removing subgroups of participants from the clinical trial.
name: Exclusion bias
label: c
answer: no
explanation: Attrition bias refers to the phenomenon where there is a systematic loss of participants or data throughout the study. This loss of participants to follow up eventually leads to systematic differences between groups and thus unrepresentative samples. This is not the best answer for this context because it does not mention attrition of data or any participant dropouts.
name: Attrition bias
label: d
answer: no
explanation: Time interval bias refers to the phenomenon whereby researchers intentionally change a specified range of time or duration to support their desired findings. For example, when there is a discrepancy in the timing and duration of follow-up or observation between different study groups or exposure levels, it can lead to a distortion of the observed relationships or outcomes in the study. Although this is a type of selection bias, it does not fit this vignette.
name: Time interval bias
label: e
answer: no
explanation: This is the correct answer. By using only online mediums, this study primarily attracts tech-savvy, younger individuals who are active online and on social platforms. This is also known as convenience sampling. The trial excludes older adults and individuals with limited internet access. Therefore, the selection of participants for this clinical trial is not representative of the broader population or the specific patient group of interest, introducing sampling bias.
name: Sampling bias
label: a
answer: yes

Correct answer: a
A 37 year old man with colorectal cancer reviews some academic research into an experimental new treatment. He is concerned about the types of error that may be present.

Which of the following is an example of a type I error?

Options:
explanation: This is the correct answer. A type I error occurs when the null hypothesis is true (e.g. there is no effect, or no significant difference between groups), but researched falsely reject it in favour of the alternative hypothesis. It is also known as a 'false positive'.
name: Stating a treatment has a significant benefit when in fact it does not
label: a
answer: yes
explanation: This is not a type 1 error. A type I error occurs when the null hypothesis is true (e.g. there is no effect, or no significant difference between groups), but researched falsely reject it in favour of the alternative hypothesis. It is also known as a 'false positive'. However, a biased sample may reduce the validity of results.
name: Obtaining a biased sample to receive the treatment
label: e
answer: no
explanation: This is an example of a Type II error, which is also known as a false negative. A type I error occurs when the null hypothesis is true (e.g. there is no effect, or no significant difference between groups), but researched falsely reject it in favour of the alternative hypothesis. It is also known as a 'false positive'.
name: Stating a treatment has no significant benefit when in fact it does
label: b
answer: no
explanation: This is a correct outcome. A type I error occurs when the null hypothesis is true (e.g. there is no effect, or no significant difference between groups), but researched falsely reject it in favour of the alternative hypothesis. It is also known as a 'false positive'.
name: Stating a treatment has no significant benefit when in fact it does not
label: c
answer: no
explanation: This is an example of publication bias. A type I error occurs when the null hypothesis is true (e.g. there is no effect, or no significant difference between groups), but researched falsely reject it in favour of the alternative hypothesis. It is also known as a 'false positive'.
name: Only publishing significant results
label: d
answer: no

Correct answer: a
A researcher gathers data on the effectiveness of a novel antidepressant medication in reducing symptoms of low mood. They take care to ensure adequate statistical power.

Which of the following is true of statistical power?

Options:
explanation: Statistical power is the likelihood that an effect will be detected in the sample when one exists in reality. To increase statistical power, the sample size should be increased. Increasing the sample size reduces sampling variability; providing more precise estimates, increasing test sensitivity, narrowing confidence intervals, and improving the ability to detect both large and small effects.
name: It is unrelated to sample size
label: d
answer: no
explanation: This is the correct answer. Statistical power is the likelihood that an effect will be detected in the sample when one exists in reality. If we increase the significance level, we lower the bar for statistical significance, which makes it easier to obtain significant results. This therefore increases statistical power.
name: It increases with increasing significance level
label: a
answer: yes
explanation: Statistical power is the likelihood that an effect will be detected in the sample when one exists in reality. Greater statistical power is associated with a smaller standard deviation, or less variability in the data. This means a smaller sample size is required to achieve the same level of power, as it becomes easier to detect true effects or relationships in the data.
name: Greater statistical power is associated with a greater standard deviation
label: c
answer: no
explanation: Statistical power is the likelihood that an effect will be detected in the sample when one exists in reality. Greater statistical power is associated with a greater effect size. The effect size refers to the magnitude of the difference between groups or variables in a study. A larger effect size indicates a more substantial difference. The larger the effect size, the stronger the true effect is.
name: Greater statistical power is associated with a lower effect size
label: e
answer: no
explanation: Statistical power is the likelihood that an effect will be detected in the sample when one exists in reality. To increase statistical power, the sample size should be increased. Increasing the sample size reduces sampling variability; providing more precise estimates, increasing test sensitivity, narrowing confidence intervals, and improving the ability to detect both large and small effects.
name: It increases with decreasing sample size
label: b
answer: no

Correct answer: a
An 18-year-old male is brought to A&E by his flatmate, who is concerned that he has started behaving strangely over the past few hours. The patient confirms feeling muddled and reports that his neck feels stiff when he tries to move it. On examination, he is pyrexial with a new rash across both legs that does not fade when held against a glass. He is usually fit and well, and has just started studying at university.

A lumbar puncture is performed. Cerebrospinal fluid (CSF) analysis shows raised protein levels with low glucose.

Which of the following microorganisms is the most likely cause of this patient's symptoms?

Options:
explanation: A fungal cause of meningitis such as a Cryptococcus species is most likely when the patient is immunocompromised. A high opening pressure on lumbar puncture is also associated with fungal meningitis. In this case, the patient is otherwise fit and well, and the CSF results indicate bacterial meningitis. This answer is therefore incorrect.
name: Cryptococcus
label: e
answer: no
explanation: The presence of neck stiffness and a non-blanching rash suggest a diagnosis of bacterial meningitis. By contrast, rubella is characterised by lymphadenopathy of the head and neck. Although pyrexia and a rash are also seen in rubella, the rash tends to start on the face before spreading to the body. This answer is therefore incorrect.
name: Rubella
label: d
answer: no
explanation: This presentation is in keeping with bacterial meningitis. In adult populations, Streptococcus pneumoniae is one of the most common causes of meningitis.
name: Streptococcus pneumoniae
label: a
answer: yes
explanation: The herpes simplex virus is a common cause of viral meningitis. In this case, the presence of low glucose levels within the CSF indicates bacterial meningitis. This answer is therefore incorrect.
name: Herpes simplex virus
label: b
answer: no
explanation: This presentation is in keeping with bacterial meningitis. Staphylococcus aureus is a bacterium commonly associated with skin and soft tissue infections. It is not commonly implicated in meningitis, making this answer incorrect.
name: Staphylococcus aureus
label: c
answer: no

Correct answer: a
A 65 year old Caucasian male is seen in a neurology clinic with regard to his Parkinson's disease. He has been taking levodopa for 3 years now and is concerned about potential long-term side effects.

Which of the following is most likely to occur as a result of this long-term levodopa use?

Options:
explanation: Hypotension is another side effect one might see shortly after starting levodopa. Administration of a peripheral decarboxylase inhibitor can help with this.
name: Hypotension
label: c
answer: no
explanation: Hyperpigmentation is not a recognised side effect of levodopa therapy.
name: Hyperpigmentation
label: d
answer: no
explanation: Dystonic reactions to levodopa are commonly seen after 3-5 years of taking the drug. Patients should be counselled about this risk when starting the drug.
name: Involuntary jerking of his face and arms
label: a
answer: yes
explanation: Nausea and vomiting are most likely to be seen when first starting levodopa. Administration of a peripheral decarboxylase inhibitor can help with this.
name: Nausea and vomiting
label: b
answer: no
explanation: Isolated electrolyte abnormalities (i.e. not as a result of vomiting) are not commonly caused by long-term levodopa administration. Dystonic reactions are far more common.
name: Hyperchloraemia
label: e
answer: no

Correct answer: a