hllj/quesmed huggingface dataset:
A 63-year-old man is brought into the Emergency Department after being found collapsed on the floor at home. He had two transient ischaemic attacks in close succession one month ago, as a result of vertebrobasilar insufficiency. On examination, his pupils are fixed and dilated.

Which of the following lesion sites would result in dilated pupils?

Options:
explanation: Correct - Unreactive pupils means that the normal pupillary light reflex, involving cranial nerve II and cranial nerve III, has been impaired. Dilated pupils suggest that the sympathetic nervous innervation has not been affected, and the underlying pathology is likely to be a cranial nerve III lesion. This cranial nerve is situated in the midbrain.
name: Midbrain
label: a
answer: yes
explanation: Incorrect - This would not affect the pupillary light reflex. If the medulla were damaged the patient would have problems with breathing and swallowing. The gag, sneeze, and cough reflexes may also be lost.
name: Medulla
label: c
answer: no
explanation: Incorrect - Damage to the frontal lobe may produce weakness on one side of the body or the face, impaired judgement, reduced sense of taste or smell, mood changes, or increased falls. The pupillary light reflexes would not be affected.
name: Frontal Lobe
label: e
answer: no
explanation: Incorrect - The pons is responsible for unconscious processes such as the sleep-wake cycle and breathing regulation. Damage to the pons can cause the loss of all muscle function except for eye movement. Pupillary reflexes would still be intact.
name: Pons
label: b
answer: no
explanation: Incorrect - The occipital lobe is not responsible for pupillary light reflexes. Damage to the occipital lobe would produce visual illusions, difficulties in colour processing, faulty distance and depth perception, and prosopangosia.
name: Occipital Lobe
label: d
answer: no

Correct answer: a
An 11-year-old boy is brought to Accident and Emergency by his parents. On examination, he has a non-blanching rash. He reports that his neck feels stiff, and he is covering his eyes to avoid the light.


A lumbar puncture is performed and his results are:


||||
|---------------------------------|:-------:|-------------------------|
|Total Protein|1.9 g/L|0.15 - 0.45|
|Glucose|0.3 mmol/L|3.2 - 4.4|
|Cell Count|9500/μL|< 5|
|Lymphocyte Count|50|60 - 70|


The cerebrospinal fluid (CSF) has a turbid appearance. The opening pressure is raised.


Which of the following types of meningitis is this indicative of?

Options:
explanation: Incorrect - In cases of viral meningitis the CSF is often clear in appearance. The white blood cell count is made predominantly of lymphocytes. Glucose and protein levels are typically normal.
name: Viral
label: b
answer: no
explanation: Incorrect - In fungal meningitis the CSF is typically clear or cloudy, has raised proteins, and a normal or elevated white cell count. Monocytes are the predominant white blood cell type found within the CSF.
name: Fungal
label: c
answer: no
explanation: Correct - In bacterial meningitis the CSF typically has a turbid appearance. The opening pressure tends to be raised. Within the CSF, protein levels are raised, as are white blood cells, with a predominance of neutrophils.
name: Bacterial
label: a
answer: yes
explanation: Incorrect - The opening pressure and protein levels in meningitis caused by tuberculosis is often high, which matches the given presentation. However, meningitis associated with tuberculosis has a predominance of monocytes within the CSF, rather than the neutrophil predominance seen in this case.
name: Tuberculosis
label: d
answer: no
explanation: Incorrect - This is a classic presentation of bacterial meningitis.
name: Meningitis is not indicated from this history and these results
label: e
answer: no

Correct answer: a
A 37-year-old woman suffered a traumatic brain injury after being involved in a car crash. She sustained significant trauma to the head, and has since experienced a loss of vision.

Which of the following visual field defects are expected following lesions to the right occipital cortex?

Options:
explanation: Incorrect - Lesions affecting the occipital lobe can result in a macular sparing homonymous hemianopia.  The visual field on the contralateral side is affected. As this patient has a lesion in their right occipital cortex, we would expect a macular-sparing left homonymous hemianopia, rather than a right.
name: Macular-Sparing Right Homonymous Hemianopia
label: b
answer: no
explanation: Correct - Lesions affecting the occipital lobe can result in a macular-sparing homonymous hemianopia. The visual field on the contralateral side is affected. As this patient has a lesion in their right occipital cortex, we would expect a macular-sparing left homonymous hemianopia.
name: Macular-Sparing Left Homonymous Hemianopia
label: a
answer: yes
explanation: Incorrect - Monocular blindness usually results from damage to the optic nerve on the affected side.
name: Left Monocular Blindness
label: e
answer: no
explanation: Incorrect - Right homonymous hemianopias result from damage to the left optic tract. The visual field defect the patient is suffering from is macular sparing, indicating the lesion lies within the occipital lobe.
name: Right Homonymous Hemianopia
label: c
answer: no
explanation: Incorrect - Left homonymous hemianopias result from damage to the right optic tract. The visual field defect the patient is suffering from is macular sparing, indicating the lesion lies within the occipital lobe.
name: Left Homonymous Hemianopia
label: d
answer: no

Correct answer: a
A 6-year-old girl is taken to see the GP after her school teacher noticed that she seems to ‘go blank’ in lessons. These episodes last for around thirty seconds, and when they come on the child is not responsive to voice. Afterward, she resumes her normal activities as if nothing had happened.

Which of the following drugs is first-line management for this condition?

Options:
explanation: Incorrect - This patient demonstrates absence seizures. Lamotrigine is the second-line in absence seizure treatment. It is also used to treat generalised seizures in pregnant women and bipolar disorder. It is a sodium channel blocker.
name: Lamotrigine
label: b
answer: no
explanation: Incorrect - This patient demonstrates absence seizures. Vigabatrin inhibits GABA breakdown. It is used as an epilepsy adjunct and increases the available levels of GABA within the system.  It is not the first-line treatment for absence seizures.
name: Vigabatrin
label: d
answer: no
explanation: Incorrect - This patient demonstrates absence seizures. Midazolam is the treatment for status epilepticus within the community. It is a benzodiazepine. It is not the first line treatment for absence seizures.
name: Midazolam
label: c
answer: no
explanation: Incorrect - This patient demonstrates absence seizures. Flumazenil is used to reverse the effect of benzodiazepines, and is a competitive antagonist. It is not the first line treatment for absence seizures.
name: Flumazenil
label: e
answer: no
explanation: Correct - This patient demonstrates absence seizures. Ethosuximide is the first-line drug in the treatment of absence seizures. It is an antiepileptic and calcium channel blocker. The other first-line drug for absence seizures is sodium valproate.
name: Ethosuximide
label: a
answer: yes

Correct answer: a
A 57-year-old male is reviewed following a stroke. The clinician attempts to elicit a gag reflex using a tongue depressor. There is unilateral contraction of the soft palate on the left side, with a failure to rise on the right. Sensation on both sides of the oral cavity is intact. Deviation of the uvula to the left side is observed.

Which of the following cranial nerves is damaged?

Options:
explanation: Incorrect - cranial nerve VII (the facial nerve) supplies the muscles of facial expression. It is not involved in eliciting the gag reflex, and so damage to this region would not cause deviation of the uvula.
name: Right Cranial Nerve VII
label: b
answer: no
explanation: Correct - Cranial nerve X (the vagus nerve) has a range of functions in supplying sensory and motor innervation to the larynx, pharynx and abdominal viscera. In particular, it supplies the muscles of the soft palate responsible for swallowing and speech. Damage can cause characteristic deviation of the uvula. Deviation of the uvula away from the affected side (towards the left) and absence of contraction on the right are indicative of a right sided cranial nerve X lesion.
name: Right Cranial Nerve X
label: a
answer: yes
explanation: Incorrect - cranial nerve XII (the hypoglossal nerve) supplies the muscles of the tongue. It is not involved in eliciting the gag reflex. Damage to this region would not cause deviation of the uvula.
name: Right Cranial Nerve XII
label: c
answer: no
explanation: Incorrect - cranial nerve XI (the accessory nerve) is responsible for innervating the sternocleidomastoid and trapezius muscles. It is not involved in the elicitation of the gag reflex. Damage to this region would not cause deviation of the uvula.
name: Right Cranial Nerve XI
label: e
answer: no
explanation: Incorrect - cranial nerve IX (the glossopharyngeal nerve) is responsible for sensation when eliciting the gag reflex. As the patient still has sensation, cranial nerve IX is not affected. Furthermore, damage to this region would not cause deviation of the uvula.
name: Right Cranial Nerve IX
label: d
answer: no

Correct answer: a
A 56-year-old women presents to the accident and emergency department with heart palpitations, shortness of breath, and chest pain. An ECG is performed.

Which of the following ECG changes is indicative of hyperkalaemia?

Options:
explanation: Incorrect - U waves are usually the result of hypokalaemia. They are also seen in patients with ventricular hypertrophy, bradycardia, hypothyroidism, hypocalcaemia, and hypothermia.
name: Visible U Waves
label: b
answer: no
explanation: Incorrect - ST depression is associated cardiac ischaemia, as well as hypokalaemia. It is not associated with hyperkalaemia.
name: ST Depression
label: d
answer: no
explanation: Incorrect - Hyperkalaemia causes small or indiscernible p waves. They presence of large p waves is a sign of right atrial enlargement.
name: Increased amplitude of the P wave
label: e
answer: no
explanation: Correct - Tall, tented T waves on ECG are a common sign of hyperkalaemia. This must be treated urgently, to avoid progression into a potentially fatal arrhythmia.
name: Tall, tented T waves
label: a
answer: yes
explanation: Incorrect - Hyperkalaemia causes widening of the QRS complex. A narrow QRS complex reflect rapid activation of the ventricles through a normal His-Purkinje system.
name: Narrowing of the QRS complex
label: c
answer: no

Correct answer: a
A 36-year-old man attends the GP surgery with a tingling sensation on the outer aspect of his left thigh. He denies a history of trauma, although notes that he often wears underwear that is a little tight.

Which of the following spinal nerve roots are implicated in this condition?

Options:
explanation: Incorrect - This patient demonstrates meralgia paresthetica, caused by irritation to the lateral femoral cutaneous nerve, which is supplied by L2 and L3. By contrast, L4 to S1 describes the supply to the superior gluteal nerve. This does not cause meralgia paresthetica.
name: L4 to S1
label: e
answer: no
explanation: Incorrect - This patient demonstrates meralgia paresthetica, caused by irritation to the lateral femoral cutaneous nerve, which is supplied by L2 and L3. By contrast, L4 to S3 describes the supply to the sciatic nerve. This does not cause meralgia paresthetica.
name: L4 to S3
label: d
answer: no
explanation: Incorrect - This patient demonstrates meralgia paresthetica, caused by irritation to the lateral femoral cutaneous nerve, which is supplied by L2 and L3. By contrast, L1 and L2 is the supply for the genitofemoral nerve. Damage to the genitofemoral nerve can cause symptoms such as groin pain, paraesthesia, and a burning sensation spreading from the lower abdomen to the medial aspect of the thigh. It does not cause meralgia paresthetica.
name: L1 and L2
label: b
answer: no
explanation: Correct - This patient demonstrates meralgia paresthetica, caused by irritation to the lateral femoral cutaneous nerve. It is characterised by a tingling, numbness, or burning sensation in the outer thigh. The lateral femoral cutaneous nerve is supplied by L2 and L3, making this the correct answer.
name: L2 and L3
label: a
answer: yes
explanation: Incorrect - This patient demonstrates meralgia paresthetica, caused by irritation to the lateral femoral cutaneous nerve, which is supplied by L2 and L3. By contrast, S1-S3 describes the supply for the posterior femoral nerve. This does not cause meralgia paresthetica.
name: S1 to S3
label: c
answer: no

Correct answer: a
A 26-year-old woman visits the GP surgery for support managing her constipation. She is advised to increase the amount of fluid and fibre in her diet. She is also prescribed a laxative.

Which of the following laxatives decreases motility in the proximal colon and increases motility in the distal colon?

Options:
explanation: Incorrect - Methylcellulose is a bulk laxative. These work by increasing water retention in the intestinal lumen to soften & increase the bulk of stools. This drives colonic distention, which in turn stimulates intestinal motility and faecal transit.
name: Methylcellulose
label: c
answer: no
explanation: Correct - Senna is a stimulant purgative. These increase intestinal motility through stimulation of the myenteric plexus. Specifically, senna decreases motility in the proximal colon and increases motility in the distal colon.
name: Senna
label: a
answer: yes
explanation: Incorrect - Loperamide is used to treat diarrhoea and is not a laxative. It increases motility in the proximal colon, increasing the absorption of water, and decreases motility in the distal colon.
name: Loperamide
label: e
answer: no
explanation: Incorrect - Arachis oil is a faecal softener. This does not affect colonic motility. It works by lowering the surface tension of the stool, softening its consistency and hence making it easier to pass.
name: Arachis Oil
label: d
answer: no
explanation: Incorrect - Macrogol is an osmotic laxative. These work by promoting the movement of fluid across the bowel wall and into the lumen. This causes colonic distension, simulating and accelerating transit and hence defecation.
name: Macrogol
label: b
answer: no

Correct answer: a
A 6-month-old baby has recently been diagnosed with horseshoe kidney disease. His parents are confused as during the pregnancy they were informed that their child was healthy and developing well.

Which of the following embryological structures does the adult kidney develop from?

Options:
explanation: Incorrect - The urorectal septum divides the cloaca into the urogenital sinus and the rectum. Adult kidneys develop from the metanephros and the ureteric bud.
name: Urorectal Septum
label: d
answer: no
explanation: Incorrect - The early stage embryological kidney develops from the mesonephros but is ultimately resorbed. Adult kidneys develop from the metanephros and the ureteric bud.
name: Mesonephros
label: b
answer: no
explanation: Correct - The adult kidneys develop from the metanephros and the ureteric bud.
name: Metanephros
label: a
answer: yes
explanation: Incorrect - The bladder develops from the cloaca, and the perineal body is formed at the point where the urorectal septum meets the cloacal membrane. Adult kidneys develop from the metanephros and the ureteric bud.
name: Cloaca
label: c
answer: no
explanation: Incorrect - The urachus ultimately becomes the allantois, a fibrous cord, that passes from the bladder to the umbilicus. Adult kidneys develop from the metanephros and the ureteric bud.
name: Urachus
label: e
answer: no

Correct answer: a
A 53-year-old woman attends her GP surgery for support in managing her symptoms of menopause. She is particularly troubled by vaginal dryness, which has been interfering with her sex life significantly.

Which of the following oestrogen analogues is most commonly used to relieve menopausal symptoms?

Options:
explanation: Incorrect - Desogestrel is a progestin medication that is used as a form of contraception and in treating menopausal symptoms. It is not an oestrogen analogue.
name: Desogestrel
label: d
answer: no
explanation: Incorrect - Medroxyprogesterone is a combination of oestrogen and progesterone that is used to treat the symptoms of menopause. It can also be used as a contraceptive.
name: Medroxyprogesterone
label: b
answer: no
explanation: Incorrect - Norethisterone is a combination of oestrogen and progesterone that is used to treat the symptoms of menopause. It can also be used as a means of contraception, or to prevent uterine bleeding.
name: Norethisterone
label: c
answer: no
explanation: Correct - Estradiol is a natural oestrogen. Topical estradiol creams are often used to treat urogenital symptoms of menopause such as vaginal atrophy and dyspareunia.
name: Estradiol
label: a
answer: yes
explanation: Incorrect - The copper coil does not contain any hormones. It is primarily used as a method of contraception. It is not commonly used in the management of menopausal symptoms, as it tends to make uterine bleeding somewhat heavier. It is not an oestrogen analogue.
name: The copper coil
label: e
answer: no

Correct answer: a
A 68-year-old man suffered a spinal cord injury as a teenager in a road traffic accident. He has a long term indwelling catheter and has noticed blood in his urine. At cystoscopy the bladder is inflamed and there are patches of metaplastic white mucosa.

Which of the following types of epithelium would you normally expect to see in the bladder?

Options:
explanation: Incorrect - Simple squamous epithelium is ideal for exchange functions, including the exchange of gases or chemicals. It is found in the alveoli of the lings, glomerulus of the kidneys, and in capillaries. It is not found in the bladder.
name: Simple squamous
label: b
answer: no
explanation: Incorrect - Stratified squamous epithelium is designed for protection. It is the epithelium found at many of the body openings, such as the vagina, anal canal, and mouth. It is not seen in a healthy bladder.
name: Stratified Squamous
label: d
answer: no
explanation: Incorrect - Simple columnar epithelium is designed to facilitated motility, absorption, and processing. It has a high organelle density. It does not make up the bladder.
name: Columnar
label: c
answer: no
explanation: Incorrect - Pseudostratified columnar is found in areas where secretion and protection are the primary functions. For example, the respiratory tract. It is not seen in a healthy bladder.
name: Pseudostratified Columnar
label: e
answer: no
explanation: Correct - transitional epithelium lines the bladder. This allows the bladder to stretch as it fills with urine. Stratified squamous cell cancer is the most common form of bladder cancer.
name: Transitional cell
label: a
answer: yes

Correct answer: a
A 27-year-old man attends A&E after fracturing his humerus. This is his fifth fracture in the past six months, and each has occurred at a different site. He complains of a constant "ache" in his bones.

On examination, he is neurologically intact aside from some mild proximal muscle weakness in his lower limbs. A DEXA scan reveals low bone mineral density.

Which of the following vitamins is most likely to be deficient?

Options:
explanation: Incorrect - This patient is presenting with osteomalacia, which involves a softening of the bones and hence susceptibility to recurrent fractures. Vitamin C deficiency is the main risk factor for the development of scurvy. Individuals with scurvy will suffer from fatigue, irritability, severe joint and leg pain, swollen and bleeding gums, and will bruise easily. It is not implicated in the development of osteomalacia.
name: Vitamin C
label: c
answer: no
explanation: Incorrect - This patient is presenting with osteomalacia, which involves a softening of the bones and hence susceptibility to recurrent fractures. Vitamin B12 deficiency can cause a range of neuropsychiatric symptoms including numbness, muscle weakness, and fatigue. It is not implicated in the development of osteomalacia.
name: Vitamin B12
label: b
answer: no
explanation: Incorrect - This patient is presenting with osteomalacia, which involves a softening of the bones and hence susceptibility to recurrent fractures. Vitamin E deficiency is extremely rare. An individual suffering from vitamin E deficiency will have nerve and muscle damage, resulting in loss of sensation in the limbs, loss of body movement control, muscle weakness, and vision problems. However, it is not implicated in the development of osteomalacia.
name: Vitamin E
label: e
answer: no
explanation: Incorrect - This patient is presenting with osteomalacia, which involves a softening of the bones and hence susceptibility to recurrent fractures. Vitamin A deficiency can cause blindness and increased morbidity and mortality from infection. However, it is not implicated in the development of osteomalacia.
name: Vitamin A
label: d
answer: no
explanation: Correct - This patient is presenting with osteomalacia, which involves a softening of the bones and hence susceptibility to recurrent fractures. Vitamin D deficiency is the main risk factor for the development of osteomalacia in adults, and rickets in children. Calcium and phosphate deficiencies are also risk factors for developing osteomalacia.
name: Vitamin D
label: a
answer: yes

Correct answer: a
An 87-year-old woman is brought into the accident and emergency department by paramedics after falling in the street. She complains of severe pain on the left side of her pelvis.

An X-ray reveals a left-sided intracapsular fracture. Surgeons are concerned about her developing avascular necrosis.

Which of the following arteries supply blood to the femoral head?

Options:
explanation: Incorrect - The inferior gluteal artery supplies blood to gluteus maximus. It does not contribute to supplying blood to the femoral head.
name: Inferior Gluteal Artery
label: d
answer: no
explanation: Incorrect - The superior gluteal artery supplies blood to gluteus medius and minimus. It does not contribute to supplying blood to the femoral head.
name: Superior Gluteal Artery
label: c
answer: no
explanation: Incorrect - The pudendal artery supplies pelvic viscera, including the bulb of the penis in males, and the blub of the vestibule in females. It does not contribute to supplying blood to the femoral head
name: Pudendal Artery
label: e
answer: no
explanation: Correct - The femoral circumflex arteries supply blood to the head of the femur. In intracapsular fractures their ability to supply blood becomes compromised and the patient is at risk of avascular necrosis of the head of the femur.
name: Femoral Circumflex Arteries
label: a
answer: yes
explanation: Incorrect - The superficial femoral artery passes down the medial aspect of the thigh, eventually passing deep through the adductor hiatus. It does not contribute to supplying blood to the femoral head.
name: Superficial femoral Artery
label: b
answer: no

Correct answer: a