hllj/quesmed huggingface dataset:
A 64-year-old woman with a history of Cushing's syndrome presents to A&E with an abnormal fracture of her wrist. There is minimal trauma in her history and doctors consider a diagnosis of osteoporosis.

What are the minimum values of her T score which would be consistent with this diagnosis?

Options:
explanation: This is suggestive of normal, healthy bone density
name: 1.0 at the femoral neck
label: c
answer: no
explanation: This T score is suggestive of osteopenia. This may progress to osteoporosis if left untreated
name: -1.5 at the femoral neck
label: b
answer: no
explanation: This T score is suggestive of osteopenia. This may progress to osteoporosis if left untreated
name: -2.0 at the femoral neck
label: d
answer: no
explanation: Osteoporosis is defined as a T score of -2.5 or less at the femoral neck
name: -2.5 at the femoral neck
label: a
answer: yes
explanation: This T score is suggestive of normal, healthy bone (-1 and above is considered normal)
name: -0.5 at the femoral neck
label: e
answer: no

Correct answer: a
At which phase of the cardiac cycle do class III antiarrhythmics act?

Options:
explanation: There is no phase 5 of the cardiac cycle
name: Phase 5
label: e
answer: no
explanation: Class II and class IV antiarrhythmics act on the plateau phase
name: Phase 2
label: b
answer: no
explanation: Class II antiarrhythmics act on phase 4
name: Phase 4
label: d
answer: no
explanation: Class I antiarrhythmics act on phase 0
name: Phase 0
label: c
answer: no
explanation: Phase 3 describes the repolarisation phase of the cardiac cycle. Class III antiarrhythmics (including sotalol and amiodarone) significantly prolong the cardiac action potential and, therefore, the refractory period of cardiac tissue. This can result in a prolonged QT interval (which may, paradoxically, cause arrhythmias)
name: Phase 3
label: a
answer: yes

Correct answer: a
Which of the following embryological structures becomes the right ventricle?

Options:
explanation: The bulbus cordis lies ventral to the primitive ventricle. It provides an outflow tract for both ventricles and develops into the right ventricle
name: Bulbus cordis
label: a
answer: yes
explanation: Embryologically connected to the primitive atrium, it develops into the superior vena cava
name: Right sinus horn
label: d
answer: no
explanation: The primitive ventricle develops into the left ventricle
name: Primitive ventricle
label: b
answer: no
explanation: The sinus venosus is the confluence of umbilical, vitelline and cardinal veins. It forms right and left sinus horns which develop into the superior and inferior vena cava
name: Sinus venosus
label: e
answer: no
explanation: The primitive atrium develops into the left and right atria
name: Primitive atrium
label: c
answer: no

Correct answer: a
Which of the following describes a side effect of angiotensin receptor blockers?

Options:
explanation: Gingival hyperplasia (overgrowth of gums) is a potential side effect of calcium channel blockers
name: Gingival hyperplasia
label: e
answer: no
explanation: Peripheral oedema is a potential side effect of calcium channel blockers.
name: Peripheral oedema
label: c
answer: no
explanation: Flushing, secondary to vasodilation, is a potential side effect of calcium channel blockers
name: Flushing
label: d
answer: no
explanation: Changes to hepatic function are very rare.
name: Decreased hepatic function
label: b
answer: no
explanation: Angioedema describes the swelling of the deep layers of skin. It can occur anywhere in the body but commonly affects eyes, lips and genitalia. It is a side effect of both ARBs and ACE inhibitors.
name: Angioedema
label: a
answer: yes

Correct answer: a
According to Frank-Starling law, which of the following will increase the stroke volume of the left ventricle?

Options:
explanation: Increased skeletal pump activity increases venous return to the heart and causes ventricular myocytes to stretch to accommodate more blood. This allows the heart to generate a more forceful contraction
name: Increased skeletal pump activity
label: a
answer: yes
explanation: Tachyarrhythmias reduce the time for filling and, therefore, reduce preload and myocyte stretch
name: Tachyarrhythmias
label: d
answer: no
explanation: Atrial arrhythmias impair the amount of blood entering the ventricles and, therefore, reduce preload
name: Atrial arrhythmias
label: e
answer: no
explanation: Hypovolaemia leads to a decreased venous return to the heart which reduces ventricular myocyte stretch, therefore the force of contraction would be less
name: Hypovolaemia
label: b
answer: no
explanation: Restrictive cardiomyopathy would prevent myocytes from stretching and, therefore, reduces their force of contraction and stroke volume of the left ventricle
name: Restrictive cardiomyopathy
label: c
answer: no

Correct answer: a
Which of the following best describes the results of a lung function test performed on a 59-year-old male with idiopathic pulmonary fibrosis?

Options:
explanation: This shows a function test reflective of obstructive lung disease (e.g. COPD). FEV1, FVC and TLCO are reduced. FEV1/FVC ratio is not preserved
name: FEV1 - 2.6, FVC - 4.2, FEV1/FVC ratio - 0.62, reduced TLCO
label: b
answer: no
explanation: The FEV1, FVC, FEV1/FVC ratio values are reflective of obstructive lung disease, however, TLCO is reduced in restrictive lung disease
name: FEV1 - 2.6, FVC - 4.2, FEV1/FVC ratio - 0.62, increased TLCO
label: d
answer: no
explanation: Restrictive lung disease shows a reduced FEV1, reduced FVC, reduced TLCO with a preserved (>0.7) FEV1/FVC ratio
name: FEV1 - 3.1, FVC - 4.3, FEV1/FVC ratio - 0.72, reduced TLCO
label: a
answer: yes
explanation: The FEV1, FVC, FEV1/FVC ratio values are reflective of restrictive lung disease, however, TLCO is reduced in restrictive lung disease
name: FEV1 - 3.1, FVC - 4.3, FEV1/FVC ratio - 0.72, increased TLCO
label: c
answer: no
explanation: This is reflective of normal lung function
name: FEV1 - 3.6, FVC - 5.0, FEV1/FVC ratio - 0.72, normal TLCO
label: e
answer: no

Correct answer: a
Truncus arteriosus is a congenital malformation of the heart where the truncus arteriosus fails to divide resulting in the mixing of blood from the right and left ventricles.

Which of the following is a consequence of truncus arteriosus?

Options:
explanation: The mixing of oxygenated and deoxygenated blood results in cyanosis within the first couple of days of life. It also increases the volume of blood directed to the lungs leading to fluid overload and right-sided heart failure
name: Cyanosis
label: a
answer: yes
explanation: This is a consequence of coarctation of the aorta, where a segment is narrowed after the aorta branches into vessels supplying the upper limbs. Lower limbs tend to be hypotensive and cyanotic
name: Increased pulse pressure in the upper extremities
label: c
answer: no
explanation: Wide pulse pressure is characteristic of patent ductus arteriosus. Patent ductus arteriosus is when the ductus arteriosus fails to close leading to a left-right shunt in the atria
name: Wide pulse pressure
label: b
answer: no
explanation: This is a characteristic feature of tetralogy of Fallot and occurs during periods of exertion
name: Hypercyanotic episodes
label: d
answer: no
explanation: Right sided heart failure is a consequence of truncus arteriosus, not left sided. This is due to the increased blood flow to the lungs leading to fluid overload.
name: Left sided heart failure
label: e
answer: no

Correct answer: a
Hyperkalaemia can lead to arrhythmias due to overexcitability of cardiomyocytes.

Which of the following describes the effect of hyperkalaemia on the resting potential of cardiac cells?

Options:
explanation: Resting membrane potential is -90mV, it is shifted to -80mV
name: Resting membrane potential is shifted from +90mV to +80mV
label: c
answer: no
explanation: This occurs in hypokalaemia and means that cells require more stimulation to become excited
name: Resting membrane potential is shifted to a more negative value
label: b
answer: no
explanation: The resting potential of cardiomyocytes is shifted from around -90mV to -80mV, this allows cells to be more easily excited
name: Resting membrane potential is shifted to a less negative value
label: a
answer: yes
explanation: Resting membrane potential is shifted from -90mV to -80mV
name: Resting membrane potential is shifted from +80mV to +90mV
label: d
answer: no
explanation: Hyperkalaemia causes the resting membrane potential to be shifted from -90mV to -80mV, this is closer to the threshold potential of 75mV
name: Hyperkalaemia does not affect the resting membrane potential of cardiomyocytes
label: e
answer: no

Correct answer: a
Premature babies are at risk of having too little surfactant in their lungs. Surfactant is produced by type II pneumocytes which develop during the terminal sac stage.

At what week does the terminal sac stage begin?

Options:
explanation: This is within the terminal sac stage; however, it begins 2 weeks earlier at week 26
name: Week 28
label: e
answer: no
explanation: This is the beginning of the canalicular stage where terminal bronchioles divide into respiratory bronchioles and primitive alveoli begin to form
name: Week 16
label: b
answer: no
explanation: This is the beginning of the pseudoglandular stage where bronchial buds begin to differentiate and tertiary bronchi begin to form
name: Week 5
label: c
answer: no
explanation: This is the beginning of the terminal sac stage. Type I pneumocytes are in direct contact with the capillary bed and type II pneumocytes secrete large volumes of surfactant
name: Week 26
label: a
answer: yes
explanation: This is when the alveolar stage begins and the number of adult alveoli increases. This continues until the child is around 8 years old
name: Week 36
label: d
answer: no

Correct answer: a
Hard callus formation is essential in fracture healing.

Which of the following best describes this process?

Options:
explanation: This describes the formation of granulation tissue which occurs days to weeks after the initial injury
name: Mesenchymal cells and inflammatory cells are recruited to the fracture site and form fibrin-rich granulation tissue which provides provisional stability
label: c
answer: no
explanation: Hard callus formation describes the calcification of the soft callus. This occurs weeks after the initial injury
name: Endochondral ossification results in the calcification of a cartilaginous callus
label: a
answer: yes
explanation: This describes soft callous formation which occurs before hard callus formation
name: Mesenchymal cells differentiate resulting in chondrogenesis and a fibrocartilaginous network connecting the fracture ends
label: d
answer: no
explanation: This describes bone remodelling of the hard callus and occurs weeks to months after the initial injury
name: Osteoclast and osteoblast activity leads to the formation of compact bone at the callus centre and lamellar bone at the callus edges
label: b
answer: no
explanation: This occurs immediately after the initial injury due to disruption of blood vessels surrounding the fracture
name: A haematoma forms at the site of the fracture and provides a framework for subsequent healing
label: e
answer: no

Correct answer: a
2,4-Dinitrophenol (DNP) is an illegal drug that can be used for weight loss. It makes the mitochondrial membrane more permeable to protons.

Which of the following describes the effects of 2,4-DNP on ATP production?

Options:
explanation: DNP causes the mitochondrial membrane to become leakier. This means fewer protons pass through H+/ATPase and therefore leads to a reduced production of ATP. The energy generated by the electrochemical gradient results in a release of heat and hyperthermia. Oxygen uptake is increased as a result of increased cell metabolism.
name: Reduced ATP production with increased oxygen uptake and increased heat production
label: a
answer: yes
explanation: DNP reduces the number of protons passing through ATPase and therefore reduces ATP production. Energy is released as heat instead resulting in hyperthermia. Oxygen uptake increases as a result of increased cell metabolism.
name: No change in ATP production with increased oxygen uptake and increased heat production
label: b
answer: no
explanation: DNP reduces the number of protons passing through ATPase and therefore reduces ATP production. Energy is released as heat instead resulting in hyperthermia. Oxygen uptake increases as a result of increased cell metabolism.
name: Increased ATP production with increased oxygen uptake and decreased heat production
label: e
answer: no
explanation: DNP reduces the number of protons passing through ATPase and therefore reduces ATP production. Energy is released as heat instead resulting in hyperthermia. Oxygen uptake increases as a result of increased cell metabolism.
name: Reduced ATP production with increased oxygen uptake and decreased heat production
label: d
answer: no
explanation: DNP reduces the number of protons passing through ATPase and therefore reduces ATP production. Energy is released as heat instead resulting in hyperthermia. Oxygen uptake increases as a result of increased cell metabolism.
name: Increased ATP production with decreased oxygen uptake and increased heat production
label: c
answer: no

Correct answer: a
Low-dose aspirin can be used as an antiplatelet agent in cardiovascular disease.

Which of the following describes the mechanism by which it does this?

Options:
explanation: This is the mechanism of heparin
name: Activation of antithrombin leading to inactivation of thrombin factors Xa and IXa
label: c
answer: no
explanation: Aspirin is an irreversible inhibitor of COX-1 enzymes
name: Reversible inhibition of COX-2 enzymes preventing thromboxane synthesis
label: d
answer: no
explanation: This is the mechanism of action for glycoprotein IIb/IIIa inhibitors, such as abciximab
name: Blockade of glycoprotein IIb/IIIa binding to fibrinogen
label: b
answer: no
explanation: Aspirin is a cyclooxygenase inhibitor, at low doses it inhibits thromboxane synthesis, thereby preventing platelet aggregation
name: Irreversible inhibition of COX-1 enzymes preventing thromboxane synthesis
label: a
answer: yes
explanation: This is the mechanism of action of warfarin
name: Inhibition of vitamin K epoxide reductase
label: e
answer: no

Correct answer: a
A 27-year-old woman presents to her GP with her partner to discuss plans for starting a family. She is concerned about her family history of heart disease, as several relatives have died from myocardial infarctions at a young age. Her maternal grandfather passed away at 45, and both her mother and maternal uncle died at 48 and 52, respectively, from heart attacks. Her 35-year-old brother recently underwent a triple heart bypass. Her grandmother lived to 89 and was healthy, and her father has no known health issues. 

Routine blood tests show that her total cholesterol is 230mg/dL (normal <210mg/dL).


Given her family history, what is the most likely mode of inheritance for this disorder?

Options:
explanation: Her history suggests a diagnosis of familial hypercholesterolaemia. Her strong family history (where all generations are affected) indicates that this is more likely to be autosomal dominant
name: Autosomal recessive
label: b
answer: no
explanation: Her history suggests a diagnosis of familial hypercholesterolaemia. Her strong family history (where all generations are affected) indicates that this is more likely to be autosomal dominant
name: Mitochondrial
label: d
answer: no
explanation: Her family history indicates that both males AND females are affected by the condition. X-linked recessive conditions typically show a preference for males as there is only one X chromosome (the other being a Y), therefore they always inherit the disease.
name: X-linked recessive
label: c
answer: no
explanation: X-linked dominant disorders can affect males and females of a generation equally; however, it is impossible for a male with an X-linked dominant condition to pass it on to their sons (i.e. her uncle)
name: X-linked dominant
label: e
answer: no
explanation: Her family history and high cholesterol levels in relation to her age indicate a diagnosis of familial hypercholesterolaemia. This is due to mutations in LDLR, APOB, and PCSK9 genes. It is an autosomal dominant condition.
name: Autosomal dominant
label: a
answer: yes

Correct answer: a

Autosomal dominant
Androgen receptors, retinoic acid receptors and thyroid hormone receptors are all examples of which type of receptor?

Options:
explanation: Androgens, retinoic acid and thyroid hormone are all lipid soluble. Activation of this type of receptor exerts control over gene expression
name: Steroid receptor
label: a
answer: yes
explanation: G protein coupled receptors are transmembrane proteins that translate extracellular signals into intracellular signals. Examples include muscarinic acetylcholine receptors
name: G protein coupled receptors
label: b
answer: no
explanation: This is a major example of an enzyme linked receptor, insulin and growth factor receptors have tyrosine kinase activity
name: Tyrosine kinase linked receptor
label: e
answer: no
explanation: Activation of ligand gated ion channels allows rapid changes in electrochemical gradients. Examples include GABA and serotonin receptors
name: Ligand gated ion channel
label: c
answer: no
explanation: Enzyme linked receptors are transmembrane proteins with enzymatic activity. Receptor tyrosine kinases are an example of enzyme linked receptors
name: Enzyme linked receptor
label: d
answer: no

Correct answer: a
A 65-year-old woman presents to her GP with pain and stiffness in her hands when trying to complete her daily activities. The GP suspects osteoarthritis.

Which of the following would be most suggestive of osteoarthritis?

Options:
explanation: Heberden's nodes are bony spurs that occur close to the DIP joint of the hand. They are a characteristic feature of osteoarthritis of the hands
name: Heberden's nodes
label: a
answer: yes
explanation: This is characteristic of rheumatoid and psoriatic arthritis, pain typically worsens with use in osteoarthritis
name: Pain and stiffness that improves with movement
label: e
answer: no
explanation: Rheumatoid nodules occur close to joints affected by rheumatoid arthritis. They are the most common dermatologic manifestation of rheumatoid arthritis
name: Freely moveable lumps on the fingers and forearm
label: c
answer: no
explanation: This would be suggestive of a diagnosis of psoriatic arthritis
name: Patches of a silver scaly rash
label: b
answer: no
explanation: This is characteristic of rheumatoid arthritis. Osteoarthritis of the hands typically affects the DIP and PIP joints
name: Pain and stiffness affecting the MCP and PIP joints of the hand
label: d
answer: no

Correct answer: a
A 36-year-old female presents to the GP with difficulty walking. On examination, she finds it difficult to lift or move her left foot and toes. She is unable to dorsiflex. She recalls that over the past two weeks, she has been kneeling for long amounts of time whilst interacting with children as a nursery worker.

Given the likely diagnosis, which nerve is likely to be injured nerve?

Options:
explanation: This patient has presented with foot drop. Foot drop is due to an injury of the common peroneal nerve (a terminal branch of the sciatic nerve.) Damage results in loss of function of the ankle and foot dorsiflexors.
name: Common peroneal nerve
label: a
answer: yes
explanation: Like the common peroneal nerve, the tibial nerve is a terminal branch of the sciatic nerve. Injury to this nerve would cause a loss of inversion of the foot
name: Tibial nerve
label: d
answer: no
explanation: The obturator nerve provided motor innervation to the medial compartment of the thigh. Injury would cause weakness of leg extension and paraesthesia in the groin area
name: Obturator nerve
label: e
answer: no
explanation: The femoral nerve supplies muscles in the anterior thigh. Injury to the femoral nerve may cause difficulty in walking and straightening the knee, leg or ankle
name: Femoral nerve
label: b
answer: no
explanation: The saphenous nerve provides sensory innervation of the anterior surface of the leg. Injury would not produce motor symptoms like "foot drop"
name: Saphenous nerve
label: c
answer: no

Correct answer: a
An ABG is performed on a 68-year-old female in A&E. It shows the following:


||||
|--------------|:-------:|------------------|
|pH|7.3|7.35 - 7.45|
|PaO₂|7.5 kPa|11 - 15|
|PaCO₂|10.1 kPa|4.6 - 6.4|
|Bicarbonate|32 mmol/L|22 - 30|
|Base Excess|+3 mmol/L|-2 to +2|


Which of the following best describes a potential cause of this patient's abnormality?

Options:
explanation: Profuse vomiting leads to the expulsion of HCl from the stomach. This results in hypokalaemia, hypochloremic metabolic alkalosis
name: Profuse vomiting
label: b
answer: no
explanation: This patient is acidotic. Their PaO2 is low and their PaCO2 is high indicating that this is respiratory acidosis. Their base excess and HCO3- are high indicating metabolic compensation which means that this is a chronic respiratory acidosis. A neuromuscular weakness of respiratory muscles or chronic respiratory disease may lead to chronic respiratory acidosis.
name: Neuromuscular weakness resulting in chronic hypoventilation
label: a
answer: yes
explanation: Production of ketoacids in diabetic ketoacidosis results in metabolic acidosis. Compensatory hyperventilation would remove some carbonic acid from the blood and an ABG would show a reduced PaCO2 and elevated PaO2
name: Diabetic ketoacidosis resulting in compensatory hyperventilation
label: e
answer: no
explanation: Reduced end-organ perfusion means cells require anaerobic respiration to produce ATP. This leads to the production of lactic acid and results in metabolic acidosis. PaO2 and PaCO2 are likely to be normal in acute cases with a low HCO3- and base exces.
name: Sepsis leading to reduced end-organ perfusion and production of lactic acid by cells
label: d
answer: no
explanation: Hyperventilation results in a low PaCO2 and high PaO2. This results in reduced levels of carbonic acid in the blood and leads to respiratory alkalosis
name: Anxiety attack leading to acute hyperventilation
label: c
answer: no

Correct answer: a
Negative phase reactants are acute phase proteins whose concentration decreases as inflammation increases.

Which of the following is an example of a negative phase reactant?

Options:
explanation: Albumin levels decrease during inflammation. This is likely due to reduced production by the liver and increased loss
name: Albumin
label: a
answer: yes
explanation: Lipopolysaccharide binding protein is a positive phase protein that binds to bacterial lipopolysaccharide to induce an immune response
name: Lipopolysaccharide binding protein
label: c
answer: no
explanation: Fibrinogen is a plasma protein synthesised by the liver. Levels increase during inflammation, therefore, it is a positive acute phase reactant
name: Fibrinogen
label: e
answer: no
explanation: C-reactive protein is a positive-phase protein released by the liver in response to inflammation during the acute phase
name: C-reactive protein
label: b
answer: no
explanation: Synthesis of ferritin increases as a nonspecific response that makes up part of the inflammatory response
name: Ferritin
label: d
answer: no

Correct answer: a
Which of the following is a contraindication to propranolol?

Options:
explanation: Propranolol may be used as a preventive headache medication. It is not contraindicated in migraine.
name: Migraine with aura
label: c
answer: no
explanation: Propranolol can help with cardiac arrhythmias. It is not contraindicated.
name: Cardiac arrhythmia
label: d
answer: no
explanation: Beta-blockers, like propranolol, can increase airway reactivity and may interfere with the activity of beta-agonists. They are contraindicated in asthma as a result.
name: Asthma
label: a
answer: yes
explanation: Caution is advised against the use of beta-blockers in diabetic patients as a result of the risk of hypoglycaemia. It is not contraindicated, however.
name: Diabetes
label: e
answer: no
explanation: There is no contraindication to the use of beta-blockers in patients with COPD.
name: COPD
label: b
answer: no

Correct answer: a