hllj/quesmed huggingface dataset:
A 43-year-old male presents to A&E with severe epigastric pain and diarrhoea. He has known peptic ulcer disease and has been taking antacids for the past year. However his symptoms have worsened, and he is diagnosed with Zollinger-Ellison syndrome.

Which of the following describes the underlying pathophysiology of cause of Zollinger-Ellison syndrome?

Options:
explanation: Secretin is a hormone produced by the small intestine that regulates fluid and electrolyte secretion. Zollinger-Ellison syndrome does not directly influence secretin production.
name: Overproduction of secretin
label: d
answer: no
explanation: Insulin is produced by the pancreas and regulates glucose metabolism. Zollinger-Ellison syndrome does not directly influence insulin production.
name: Overproduction of insulin
label: c
answer: no
explanation: Zollinger-Ellison syndrome is characterised by an increase in the production of gastric acid, not a decrease.
name: Reduced production of gastric acid
label: b
answer: no
explanation: Zollinger-Ellison syndrome occurs when tumour(s), or gastrinomas, occur in the pancreas or duodenum. These gastrinomas produce large amounts of gastrin, which stimulates the production of gastric acid. This leads to excessive acid secretion and the development of peptic ulcers. Symptoms include nausea, vomiting, diarrhoea, and weight loss.
name: Increased production of gastric acid
label: a
answer: yes
explanation: CCK is a hormone produced by the small intestine that stimulates release of digestive enzymes from the pancreas and bile from the gall bladder. Zollinger-Ellison syndrome does not directly influence CCK production.
name: Overproduction of cholecystokinin (CCK)
label: e
answer: no

Correct answer: a
A 25-year-old female is brought to A&E after fainting at work. She reports that she has been fasting for 48 hours, consuming only protein supplements. However, her capillary blood glucose is 18.

Overconsumption of which of the following amino acids is associated with hyperglycaemia?

Options:
explanation: Asparagine is a non-glucogenic amino acid, meaning that it cannot be converted into glucose by the liver. It therefore does not commonly cause hyperglycaemia.
name: Asparagine
label: c
answer: no
explanation: Arginine is a non-glucogenic amino acid, meaning that it cannot be converted into glucose by the liver. It therefore does not commonly cause hyperglycaemia.
name: Arginine
label: b
answer: no
explanation: Alanine is a glucogenic amino acid, meaning that it can be converted into glucose by the liver and used as a source of energy. Overconsumption of protein supplements can lead to an overproduction of alanine, which can cause hyperglycaemia.
name: Alanine
label: a
answer: yes
explanation: Cysteine is a non-glucogenic amino acid, meaning that it cannot be converted into glucose by the liver. It therefore does not commonly cause hyperglycaemia.
name: Cysteine
label: d
answer: no
explanation: Tyrosine is a non-glucogenic amino acid, meaning that it cannot be converted into glucose by the liver. It therefore does not commonly cause hyperglycaemia.
name: Tyrosine
label: e
answer: no

Correct answer: a
A 75-year-old man attends A&E with a distal radius fracture. He is keen to reduce his risk of sustaining further fractures, and asks about the composition of bone.

Which of the following is the main component of the bone matrix?

Options:
explanation: Calcium hydroxyapatite constitutes the majority of the bone matrix. The matrix is 65% inorganic. Of this, 95% is made up of calcium hydroxyapatite.
name: Calcium hydroxyapatite
label: a
answer: yes
explanation: Collagen makes up 28% of the 35% organic composition of the bone matrix. It is mainly type 1 collagen, necessary for tensile strength.
name: Collagen
label: b
answer: no
explanation: Vitamin D is important for bone health as it helps the body absorb calcium, but it is not the main component of the bone matrix.
name: Vitamin D
label: d
answer: no
explanation: Water makes up 5% of the matrix of the bone.
name: Water
label: e
answer: no
explanation: Phosphorus is a mineral that is important for bone health, but it is not the main component of the bone matrix.
name: Phosphorous
label: c
answer: no

Correct answer: a
A 29-year-old man attends his GP practice with pain in his hand. Four days prior, he tripped at work and fell onto his hand. He did not seek medical attention at the time of the injury. The GP elicits pain in the anatomical snuffbox.

Which of the following is the most likely complication of the injury?

Options:
explanation: This patient has a scaphoid fracture. 80% of the vasculature of the scaphoid bone is derived from the dorsal carpal branch of the radial artery in a retrograde fashion. Problems with this blood supply such as those seen in fracture risk vascular interruption, hence avascular necrosis is the correct answer.
name: Avascular necrosis of the proximal scaphoid bone
label: a
answer: yes
explanation: Osteoarthritis of the wrist is not a specific complication of scaphoid fractures, but can occur as a result of wear and tear of the joints through repetitive use.
name: Osteoarthritis
label: e
answer: no
explanation: Malunion refers to a fracture that heals in an incorrect position. It is not a specific complication of scaphoid fractures, but can occur with any type of fracture.
name: Malunion
label: d
answer: no
explanation: Radial nerve palsy is associated with midshaft fractures of the humerus, presenting with wrist drop. It is not associated with scaphoid fractures.
name: Radial nerve palsy
label: b
answer: no
explanation: This describes axillary nerve damage, unrelated to scaphoid fractures.
name: Sensory loss over the shoulder
label: c
answer: no

Correct answer: a
A 17-year-old rugby player is assessed on the orthopaedic ward. He returned from theatre after receiving a femoral intramedullary nail around 4 hours ago, but is now complaining of worsening pain in his thigh. It is not responding to IV morphine.

On examination, there are no visible changes to the lower limb, but his injured limb is markedly weaker, with a tingling feeling spreading down into the foot.

The bandaging has already been removed. Which of the following is the best next step?

Options:
explanation: Incorrect, this patient needs fasciotomy to alleviate the intracompartmental pressure. This is a medical emergency, to prevent irreversible damage to the neurovascular supply and ultimately amputation.
name: Email the orthopaedic consultant to see the patient first thing tomorrow
label: e
answer: no
explanation: This is compartment syndrome. It can occur following fractures and is characterised by increased pressure within a confined space. This causes tissue perfusion to be compromised, resulting in necrosis. It is highlighted by pain, parasthesiae, pallor, pulseless, paralysis, poikilothermia. Prompt alleviation of the intracompartmental pressure is essential to avoid tissue necrosis.
name: Fasciotomy
label: a
answer: yes
explanation: Incorrect, this patient needs fasciotomy to alleviate the intracompartmental pressure.
name: Begin aggressive fluid resuscitation
label: b
answer: no
explanation: Incorrect, this patient needs fasciotomy to alleviate the intracompartmental pressure, treating the cause of his pain. Although adequate analgesia should also be prescribed, it is noted that he is already on IV morphine without significant response.
name: Prescribe oramorph
label: d
answer: no
explanation: Incorrect, this patient needs fasciotomy to alleviate the intracompartmental pressure, treating the cause of his pain. Although adequate analgesia should also be prescribed, it is noted that he is already on IV morphine without significant response.
name: Prescribe IV paracetamol
label: c
answer: no

Correct answer: a
A newborn baby is assessed by the on-call paediatrician. They were born by instrumental delivery, which was induced due to maternal gestational diabetes and foetal macrosomia. On examination, the baby appears pink and active, however is noted to have a left sided arm weakness. Erb-Duchenne palsy is suspected.

Which of the following best describes the presentation of an Erb-Duchenne palsy?

Options:
explanation: Incorrect, the arm is held close to the body,
name: Arm is held outstretched, with the elbow bent and the hand rotated inward
label: c
answer: no
explanation: Erb-Duchenne palsy is a type of brachial plexus injury that affects the nerves that control the arm and shoulder. C5-C6 damage causes loss of sensation on the lateral aspect of the arm, and paralysis of the muscles of the shoulder and arm supplied by C5-C6 (deltoid, infraspinatus, biceps, brachialis). This causes an adducted shoulder, medially rotated arm, extended and pronated elbow with a flexed wrist held in a 'waiter's tip' position.
name: Arm is held close to the body, with the elbow bent and the wrist flexed
label: a
answer: yes
explanation: Incorrect, the arm is held close to the body with the hand rotated inward.
name: Arm is held outstretched, with the elbow bent and the hand rotated outward
label: d
answer: no
explanation: Incorrect, the arm is held close to the body.
name: Arm is held straight, with the hand rotated inward
label: e
answer: no
explanation: Incorrect, the hand would be rotated inward, with a flexed wrist in a 'waiter's tip' position.
name: Arm is held close to the body, with the elbow bent and the hand rotated outward
label: b
answer: no

Correct answer: a
A 45-year-old man attends his GP surgery with a muscle sprain sustained after lifting weights in the gym. He is keen to know more about the physiology of skeletal muscle contraction, to avoid injuring himself again.

Which of the following biochemicals does calcium bind to during skeletal muscle contraction?

Options:
explanation: Calcium binds to the protein troponin, which is located on the thin filaments of skeletal muscle fibers. This binding triggers a conformational change in the troponin-tropomyosin complex, exposing the binding sites on actin for myosin cross-bridges. This initiates the sliding of the actin and myosin filaments, leading to muscle contraction.
name: Troponin
label: a
answer: yes
explanation: Calcium only binds to troponin, not any of the others.
name: All of the above
label: e
answer: no
explanation: Calcium binds to troponin, not tropomyosin.
name: Tropomyosin
label: d
answer: no
explanation: Calcium does not bind directly to actin, but rather to troponin.
name: Actin
label: b
answer: no
explanation: Calcium does not bind directly to myosin, but rather to troponin.
name: Myosin
label: c
answer: no

Correct answer: a
A 55-year-old woman presents to her GP with six months of shoulder pain that is worse on movement. It is interfering with her work as a painter and decorator.

On examination, the pain is localised to her right shoulder joint, and is experienced during the first 30 degrees of abduction.

Which of the following joints performs the first 30 degrees of abduction?

Options:
explanation: The acromioclavicular joint is not involved in shoulder abduction.
name: Acromioclavicular joint
label: c
answer: no
explanation: The glenohumeral and scapulothoracic joints move in a 2:1 ratio after the first 30 degrees of abduction.
name: Scapulothoracic joint
label: b
answer: no
explanation: After 30 degrees, shoulder abduction is performed by both the glenohumeral joint and the scapulothoracic joint. The glenohumeral joint is responsible for the majority of shoulder abduction, while the scapulothoracic joint contributes to a lesser extent by rotating the scapula to create more room for the arm to move. However, the first 30 degrees of abduction is performed by the glenohumeral joint.
name: Scapulothoracic joint
label: e
answer: no
explanation: The sternoclavicular joint is not involved in shoulder abduction.
name: Sternoclavicular joint
label: d
answer: no
explanation: The first 30 degrees of shoulder abduction is performed by the glenohumeral joint. The glenohumeral joint is responsible for the majority of shoulder abduction at all degrees of motion.
name: Glenohumeral joint
label: a
answer: yes

Correct answer: a
A 31-year-old footballer presents to A&E with knee pain and instability after a twisting injury.

Which of the following three injuries constitute the 'unhappy triad' of knee trauma?

Options:
explanation: A tear in the ACL, MCL, and LCL does not constitute the unhappy triad.
name: A tear in the anterior cruciate ligament (ACL), medial collateral ligament (MCL), and lateral collateral ligament (LCL)
label: c
answer: no
explanation: A tear in the ACL, LCL, and lateral meniscus does not constitute the unhappy triad.
name: A tear in the anterior cruciate ligament (ACL), lateral collateral ligament (LCL), and lateral meniscus
label: d
answer: no
explanation: This does not constitute the unhappy triad. Furthermore, achilles injuries do not typically result from twisting injuries to the knee.
name: A tear in the posterior cruciate ligament (PCL), medial meniscus and achilles tendon
label: e
answer: no
explanation: The unhappy triad refers to a combination of injuries that commonly occur together in knee trauma, namely a tear in the ACL, MCL, and medial meniscus. This injury is called the unhappy triad because it can cause long-term knee instability, pain, and functional limitation.
name: A tear in the anterior cruciate ligament (ACL), medial collateral ligament (MCL), and medial meniscus
label: a
answer: yes
explanation: A tear in the ACL, PCL, and meniscus does not constitute the unhappy triad.
name: A tear in the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and  medial meniscus
label: b
answer: no

Correct answer: a
A 60-year-old man presents to A&E with sudden onset weakness of the left side of his face. On examination, the weakness is limited to the left eye, cheek, and mouth. He is able to move his forehead on both sides.

Which of the following is the most likely cause of this condition?

Options:
explanation: This is a lower motor neuron lesion. Patients demonstrate unilateral facial weakness, but not forehead sparing.
name: Ramsay-Hunt syndrome
label: c
answer: no
explanation: This is a lower motor neuron lesion. Patients demonstrate unilateral facial weakness, but not forehead sparing.
name: Human Immunodeficiency Virus (HIV)
label: d
answer: no
explanation: The patient's symptoms of sudden onset unilateral facial weakness but preserved forehead movement ('forehead sparing') suggests an upper motor neuron lesion. This is likely to be a lesion in the facial nucleus or the corticobulbar tract in the brainstem.
name: Brainstem stroke
label: a
answer: yes
explanation: This is a lower motor neuron lesion. Patients demonstrate unilateral facial weakness, but not forehead sparing. Also, acoustic neuromas generally do not rapidly enlarge.
name: Rapidly enlarging acoustic neuroma
label: e
answer: no
explanation: This is a lower motor neuron lesion. Patients demonstrate unilateral facial weakness, but not forehead sparing.
name: Bell's palsy
label: b
answer: no

Correct answer: a
A 35-year-old man presents to an endocrinology clinic with a tumour of the hypothalamus. It is noted that some surrounding structures are also affected.

To which structure do the hypothalamic cell bodies in the supraoptic and paraventricular nuclei project?

Options:
explanation: The hypothalamus has two kinds of outputs to the pituitary gland: directly to the posterior lobe, and indirectly to the anterior lobe (via a capillary plexus). Cell bodies in the supraoptic and paraventricular nuclei project down the pituitary stalk to the posterior lobe, and releasing peptides into the capillaries in the posterior pituitary. This is therefore the correct answer.
name: Posterior lobe of the pituitary
label: a
answer: yes
explanation: This is another name for the anterior pituitary gland. The hypothalamic cell bodies in the supraoptic and paraventricular nuclei do not project to it.
name: Adenohypophysis
label: d
answer: no
explanation: The cavernous sinus is the structure within which the pituitary is situated. The hypothalamic cell bodies in the supraoptic and paraventricular nuclei do not project to it.
name: Cavernous sinus
label: c
answer: no
explanation: Whilst there are axonal projections from the hypothalamus to the medulla, the hypothalamic cell bodies in the supraoptic and paraventricular nuclei project instead to the posterior lobe of the pituitary gland.
name: Medulla oblongata
label: e
answer: no
explanation: Hypothalamic cell bodies in many other nuclei (parvocellular) have shorter axons that release peptides onto a capillary plexus in the neck of the stalk, projecting down to the anterior lobe of the pituitary. However, the hypothalamic cell bodies in the supraoptic and paraventricular nuclei do not project to the anterior pituitary.
name: Anterior lobe of the pituitary
label: b
answer: no

Correct answer: a
A 41-year-old man presents to the GP surgery with excessive sweating. He has gained a small amount of weight, and reports that his wedding ring has become too small for him. There are no other changes in his physical appearance that he has noticed.

Which of the following visual defects is commonly associated with the patient's symptoms?

Options:
explanation: Proptosis refers to a forward displacement of the eye and is a common finding in thyroid eye disease, not acromegaly.
name: Proptosis
label: b
answer: no
explanation: Strabismus refers to a misalignment of the eyes and is not typically associated with acromegaly. Strabismus can be caused by a variety of conditions, including nerve damage, muscle weakness, or problems with the eye muscles.
name: Strabismus
label: d
answer: no
explanation: Diplopia, or double vision, is a symptom of misalignment of the eyes. Double vision can occur as a result of a variety of conditions, including nerve damage and muscle weakness. It is not a characteristic feature of a pituitary lesion.
name: Diplopia
label: e
answer: no
explanation: The symptoms point to a diagnosis of acromegaly, which is commonly caused by a pituitary lesion. A pituitary lesion that compresses the optic nerve will cause a bilateral reduction in vision in the temporal (lateral) fields. This causes bitemporal hemianopia. Patients often report difficulty driving or writing.
name: Bitemporal hemianopia
label: a
answer: yes
explanation: Ptosis refers to drooping of the upper eyelid and is not typically associated with acromegaly. It is found in Horner's syndrome and some types of stroke.
name: Ptosis
label: c
answer: no

Correct answer: a
A 25-year-old woman attends a neurology clinic with intracranial hypertension.

Which of the following structures produces cerebrospinal fluid (CSF)?

Options:
explanation: This describes the outer layer of the dura mater, lining the inside of the skull. CSF is in the subarachnoid space below the outer layer of the arachnoid mater. The dura mater does not produce CSF.
name: Periosteal dura of the dura mater
label: e
answer: no
explanation: Bone marrow is a soft tissue located in the cavities of bones that produces red and white blood cells and platelets. It does not produce CSF.
name: Bone marrow
label: d
answer: no
explanation: Cerebrospinal fluid (CSF) is a clear, colourless fluid that surrounds the brain and spinal cord. It is produced by structures called the choroid plexuses, which are located in the ventricles of the brain. These are primarily in the lateral ventricles but are also found elsewhere. The choroid plexuses are covered by ependymal cells that produce the CSF. The CSF acts as a cushion to protect the brain and spinal cord from injury, and it also helps to distribute nutrients and remove waste products from these tissues.
name: Choroid plexus
label: a
answer: yes
explanation: Arachnoid granulations are found in the superior sagittal sinus, through which most of the CSF drains through. They do not produce CSF.
name: Arachnoid granulations
label: c
answer: no
explanation: The kidneys are responsible for filtering waste products from the blood and producing urine. They do not produce CSF.
name: Renal interstitium
label: b
answer: no

Correct answer: a
A 65-year-old man presents to his GP surgery with poor vision. A recent optician's appointment suggested the pressures within his eyes were elevated.

Which of the following structures becomes obstructed in closed angle glaucoma?

Options:
explanation: The cornea is the clear outer layer of the eye that covers the iris and the pupil. It does not become obstructed in closed-angle glaucoma.
name: Cornea
label: d
answer: no
explanation: Glaucoma is a condition in which increased pressure inside the eye causes damage to internal structures, leading to visual impairment. The fluid inside the eye, called aqueous humor, is produced by the ciliary body and circulates through the anterior chamber of the eye. The fluid then leaves the eye through the trabecular meshwork, a network of tiny pores in the angle between the iris and the cornea. The trabecular meshwork acts as a drain for the fluid, allowing it to be reabsorbed into the bloodstream. If the trabecular meshwork becomes clogged or obstructed, the fluid cannot leave the eye, leading to increased pressure and risking damage to the optic nerve.
name: Trabecular meshwork
label: a
answer: yes
explanation: The retina is the inner layer of the eye that contains the photoreceptive cells responsible for converting light into electrical signals that are sent to the brain. It does not become obstructed in closed-angle glaucoma.
name: Retina
label: b
answer: no
explanation: The optic nerve is the nerve that carries electrical signals from the retina to the brain. The optic nerve is sensitive to increased pressure and can be damaged by glaucoma. However, it does not become obstructed in closed-angle glaucoma.
name: Optic nerve
label: c
answer: no
explanation: The iris is the coloured part of the eye that controls the size of the pupil. It does not become obstructed in closed angle glaucoma.
name: Iris
label: e
answer: no

Correct answer: a
A 25-year-old attends A&E with a painful jaw, after being hit in the side of the face with a cricket ball.

Which of the following three bones make up the oral cavity?

Options:
explanation: The frontal bone forms the forehead and the roof of the eye sockets, but it does not contribute to the formation of the oral cavity.
name: Maxilla, mandible, and frontal
label: c
answer: no
explanation: The zygoma is a bone that forms the cheekbone, but it does not contribute to the formation of the oral cavity.
name: Zygoma, mandible, and frontal
label: d
answer: no
explanation: The bony skeleton of the oral cavity is made up of the maxilla and mandible which house the upper and lower teeth respectively. The hard palate also has a contribution from the palatine bone.
name: Maxilla, mandible, palatine
label: a
answer: yes
explanation: The maxilla forms the upper jaw and the roof of the mouth, the mandible forms the lower jaw, and the sphenoid is a large, spongy bone that helps to support the skull. Whilst the maxilla and mandible are part of the oral cavity, the sphenoid is not.
name: Maxilla, mandible, and sphenoid
label: b
answer: no
explanation: The palatine and zygoma are bones that contribute to the formation of the face and skull, but the zygoma forms the cheekbone rather than the oral cavity. The maxilla, mandible, and palatine bones are the three bones that make up the oral cavity.
name: Palatine, maxilla, and zygoma
label: e
answer: no

Correct answer: a