hllj/quesmed huggingface dataset:
A 3-hour-old baby has just been found to have a patent ductus arteriosus (PDA). The consultant opts to close this with indomethacin.

Indomethacin acts on which of the following enzymes?

Options:
explanation: This is an essential enzyme in the biosynthesis of cholesterol. Statins such as atorvastatin and simvastatin act on this enzyme to reduce serum cholesterol levels. It is not influenced by indomethacin.
name: HMG-CoA reductase
label: b
answer: no
explanation: This enzyme breaks down acetylcholine, a neurotransmitter that is key for neuronal signalling and is thought to be reduced in Alzheimer's disease. Drugs like donepezil and galantamine inhibit this enzyme, thus increasing levels of acetylcholine. It is not influenced by indomethacin.
name: Acetylcholinesterase
label: c
answer: no
explanation: Ceruloplasmin is a copper carrying enzyme. Deficiency causes Wilson disease, in which copper is deposited around the body. It is not influenced by indomethacin.
name: Ceruloplasmin
label: e
answer: no
explanation: Indomethacin is a non-steroidal anti-inflammatory (NSAID) medication. It inhibits the production of prostaglandins by inhibiting the enzyme cox-2. Prostaglandins are increased in inflammatory states and are associated with pain, fever, immunosuppression, clotting, and vasoconstriction. They can also inhibit the closure of a PDA, making indomethacin a helpful treatment option in preterm infants with PDA.
name: Cyclo-oxygenase 2
label: a
answer: yes
explanation: Monoamine oxidases (MOAs) are a family of enzymes involved in removing serotonin, dopamine, and norepinephrine from the brain. MOA-inhibitors are used to treat conditions in which serotonin, dopamine and norepinephrine are dysregulated: particularly depression and Parkinson's disease. Selegiline is an example of a MOA-inhibitor. It is not influenced by indomethacin.
name: Monoamine oxidase
label: d
answer: no

Correct answer: a
A 68-year-old man with renal failure requires emergency cardiac surgery. After the procedure, he is given an anticoagulation medication to reduce his risk of thrombosis.

Which of the following biochemicals does heparin act upon?

Options:
explanation: Heparin does not directly act upon folate. Folate is a B vitamin that is vital for the production of functional red blood cells.
name: Folate
label: d
answer: no
explanation: Heparin does not directly act upon thrombin. Dabigatran is an alternative anticoagulation medication that acts by inhibiting thrombin.
name: Thrombin
label: c
answer: no
explanation: Heparin does not act directly upon dopamine. Dopamine is a neurotransmitter involved in neuronal signalling. It does not play a role in haemostasis.
name: Dopamine
label: e
answer: no
explanation: This is correct. Heparin acts on antithrombin III, forming a complex that inhibits thrombin, factor Xa, IXa, XIa and XIIa. It has a short duration of action so can be terminated quickly with protamine sulfate.
name: Antithrombin III
label: a
answer: yes
explanation: Heparin does not act upon vitamin K. In fact, vitamin K is pro-thrombotic and would not be helpful in reducing a patient's thrombosis risk. Warfarin is a vitamin K antagonist that is commonly prescribed as an anti-coagulant.
name: Vitamin K
label: b
answer: no

Correct answer: a
Glycolysis is a key metabolic process that is necessary to generate ATP.

In the final stage of glycolysis, converting glucose to pyruvate generates how many molecules of ATP from ADP?

Options:
explanation: Incorrect, the answer is 4
name: 6
label: e
answer: no
explanation: Incorrect, the answer is 4
name: 1
label: b
answer: no
explanation: Incorrect, the answer is 4
name: 3
label: d
answer: no
explanation: Incorrect, the answer is 4
name: 5
label: c
answer: no
explanation: Glycolysis is the final stage of cellular respiration, taking place in the cytoplasm of the cell. It leads to the total production of four molecules of ATP.

Glucose is a six-carbon compound and pyruvate acid is a three-carbon compound. In the process of oxidation of glucose (loss of hydrogen), four inorganic phosphate molecules are attached to four ADP molecules. This generates a total of four ATP molecules produced.

As two molecules of ATP are used to provide energy to allow glycolysis to occur, the net gain is two molecules of ATP.
name: 4
label: a
answer: yes

Correct answer: a
Antibodies can mediate a range of different biological functions, and they have different shapes.

Which immunoglobulin is pentameric?

Options:
explanation: IgG is a 'y shaped' monomer.
name: IgG
label: b
answer: no
explanation: IgE is a 'y shaped' monomer.
name: IgE
label: c
answer: no
explanation: A pentamer is a protein molecule composed of five sub-units. IgM is an example of a pentameric antibody. Remember - pentaMeric. IgM is made first in immune responses.
name: IgM
label: a
answer: yes
explanation: IgA is a dimeric molecule.
name: IgA
label: d
answer: no
explanation: IgD is 'y shaped' monomer.
name: IgD
label: e
answer: no

Correct answer: a
A 75-year-old man is seen in the acute medical unit after an unwitnessed fall at home. As he lives alone, he was on the floor for 16 hours prior to being found by a neighbour. The doctors are concerned about the possibility of rhabdomyolysis.

Which of the following renal structures is most likely to be affected by the toxic effects of myoglobin in a case of rhabdomyolysis?

Options:
explanation: The renal pelvis is incorrect. The renal pelvis is the upper part of the ureter and is not directly affected by myoglobin toxicity.
name: The renal pelvis
label: d
answer: no
explanation: In rhabdomyolysis, myoglobin is particularly toxic to the proximal renal tubules, which are responsible for reabsorbing important nutrients, electrolytes, and water. This can lead to acute kidney injury (AKI) as well as other complications.
name: The proximal tubules
label: a
answer: yes
explanation: The renal vasculature is not affected by the toxic effects of myoglobin in rhabdomyolysis.
name: The renal vasculature
label: e
answer: no
explanation: The glomeruli is incorrect. While the glomeruli do play a role in filtering blood, they are not as directly affected by myoglobin toxicity compared to the proximal tubules.
name: The glomeruli
label: b
answer: no
explanation: The renal medulla is incorrect. The renal medulla plays a role in regulating blood pressure and is not directly affected by myoglobin toxicity.
name: The renal medulla
label: c
answer: no

Correct answer: a
A 41-year-old Caucasian female presents to the GP surgery with recurrent headaches. After a high clinic blood pressure reading, she is referred for ambulatory blood pressure monitoring. This confirms stage 2 hypertension.

She is otherwise fit and well, with no past medical history other than asthma. She uses a salbutamol inhaler as needed but has no other prescribed medications.

Which of the following drugs would be the most appropriate initial treatment for this patient?

Options:
explanation: Amlodipine is a calcium channel blocker used in the treatment of hypertension. As per the NICE guidelines, it is the first-line treatment for those aged 55 and over, and people of Afro-Caribbean descent. As this patient is Caucasian and under 55 years old, an angiotensin-converting enzyme inhibitor (ACEi) is a more appropriate first-line option.
name: Amlodipine
label: c
answer: no
explanation: Montelukast is a leukotriene receptor antagonist (LTRA) that is used to treat asthma. It is not suitable for the treatment of hypertension.
name: Montelukast
label: e
answer: no
explanation: Metoprolol is a beta-blocker that can be used to treat hypertension and angina. However, it is not the best choice for this patient because it can worsen asthma symptoms. Even without a past medical history of asthma, is it not recommended in the NICE guidelines as a first-line treatment option.
name: Metoprolol
label: b
answer: no
explanation: Hydrocortisone is a corticosteroid medication. It is not used in the management of hypertension, and can in fact increase blood pressure.
name: Hydrocortisone
label: d
answer: no
explanation: Lisinopril is an angiotensin-converting enzyme inhibitor (ACEi). As per the NICE guidelines, it is the first-line treatment option for Caucasian patients who are aged under 55. It is particularly useful in this patient population because it can help control both hypertension and asthma by decreasing inflammation in the airways.
name: Lisinopril
label: a
answer: yes

Correct answer: a
A 75-year-old man with a history of hypertension and a previous myocardial infarction presents to his GP for a medication review. He asks the doctor about one of his new medications.

Which of the following receptors does bisoprolol act on?

Options:
explanation: Incorrect, this is the site of action for drugs like salbutamol
name: Beta-2 receptor
label: c
answer: no
explanation: Bisoprolol is a beta-blocker. It selectively blocks the action of beta-1 at the beta-1 receptor, which causes a reduction in heart rate, blood pressure and myocardial oxygen demand.

It does not directly act upon alpha-1 receptor or beta-2 receptors. Dopamine and serotonin receptors are not involved in its mechanism of action. Think '1 heart and 2 lungs' to remember that beta-1 acts upon the heart while beta-2 acts upon the lungs.
name: Beta-1 receptor
label: a
answer: yes
explanation: Incorrect, this is the site of action for drugs such as tamsulosin and doxasozin.
name: Alpha-1 receptor
label: b
answer: no
explanation: Incorrect, this is the site of action for drugs like ropinirole.
name: Dopamine receptor
label: d
answer: no
explanation: Incorrect, this is the site of action for drugs like ondansetron.
name: Serotonin receptor
label: e
answer: no

Correct answer: a
A 32-year-old woman is being investigated for recurrent syncope. As part of a full workup, the doctor wants to measure her cardiac output.

Which of the following investigations is most suitable initial method for measuring cardiac output?

Options:
explanation: Incorrect, this is used to visualise the structure of the heart and lungs. As it is a static image taken at one moment in time, it cannot measure cardiac output.
name: Chest x-ray
label: c
answer: no
explanation: Transoesophageal doppler involves a flexible ultrasound probe that is inserted into the oesophagus. Whilst this can accurately measure cardiac output, it is more invasive and so would be tried after doppler ultrasound.
name: Transoesophageal doppler
label: d
answer: no
explanation: CT can be used to visualise the structure of the heart and lungs. As it is a static image taken at one moment in time, it cannot measure cardiac output.
name: CT thorax
label: e
answer: no
explanation: Incorrect, this is used to measure the electrical signals from the heart. It is useful in detecting cardiac ischaemia, however cannot measure cardiac output.
name: Electrocardiography
label: b
answer: no
explanation: This method uses ultrasound and the doppler effect. Blood velocity through the first part of the aorta causes a doppler shift in the frequency of returning ultrasound waves. This shift can be used to calculate flow velocity. The cross-sectional area of the tract can be measured by ultrasound, thus obtaining cardiac output (heart rate x stroke volume).
name: Doppler ultrasound
label: a
answer: yes

Correct answer: a
A 67-year-old man takes an angiotensin-converting enzyme (ACE) inhibitor, enalapril, for hypertension. He has recently developed a dry and distressing cough, and so consults his GP for advice.

His observations are unremarkable, and he is apyrexial.

Which of the following describes the mechanism by which ACE inhibitors cause a dry cough?

Options:
explanation: Interstitial lung disease is a category of respiratory conditions causing lung fibrosis. Symptoms typically include breathlessness and a cough. However, it is not caused by ACE-inhibitors.
name: Interstitial lung disease
label: c
answer: no
explanation: Aldosterone is a mineralocorticoid hormone produced by the adrenal cortex. It plays a key role in maintaining fluid balance, primarily through it's role in regulating sodium reabsorption. ACE-inhibitors reduce aldosterone levels, helping to drive their antihypertensive effect. However, this is not the mechanism by which they can cause a dry cough.
name: Excess aldosterone levels due to renin release
label: e
answer: no
explanation: Chronic obstructive pulmonary disease (COPD) is a chronic respiratory condition associated with shortness of breath and a cough. Infective exacerbations can occur, in which a bacterial, viral or fungal infection causes an exacerbation of these chronic symptoms. However, is not caused by ACE inhibitors.
name: Chronic obstructive pulmonary disease (COPD) exacerbation
label: d
answer: no
explanation: Histamine-mediated bronchoconstriction is typically associated with a cough generated through an allergic response. It is not triggered by an ACE-inhibitor.
name: Histamine-mediated bronchoconstriction
label: b
answer: no
explanation: Bradykinin is a peptide derived from the respiratory endothelium. It causes dilation of blood vessels via prostacyclin and nitric oxide release. ACE inhibitors increase bradykinin by inhibiting its degradation, which then causes a dry cough via bronchoconstriction. This patient should be trialled on an angiotensin receptor blocker instead of an ACE-inhibitor to avoid this side effect.
name: Build up of bradykinin
label: a
answer: yes

Correct answer: a
A 68-year-old man is admitted to the emergency department with a possible spinal cord injury, after falling off a ladder. He becomes increasingly short of breath, and auscultation finds reduced breath sounds on the left side. The medical team is concerned that the nerve supplying the diaphragm has been damaged.

Which of the following nerves supplies the diaphragm?

Options:
explanation: The femoral nerve innervates the muscles in the thigh. It does not supply the diaphragm.
name: Femoral nerve
label: e
answer: no
explanation: Incorrect. The intercostal nerves innervate the intercostal muscles, which are located between the ribs and aid in breathing. It does not supply the diaphragm.
name: Intercostal nerve
label: c
answer: no
explanation: The radial nerve innervates the muscles in the arm and hand. It does not supply the diaphragm.
name: Radial nerve
label: d
answer: no
explanation: The phrenic nerve is responsible for innervating the diaphragm, allowing for proper muscle contraction and relaxation during breathing.
name: Phrenic nerve
label: a
answer: yes
explanation: The vagus nerve primarily innervates the larynx, pharynx, and viscera. It does not supply the diaphragm.
name: Vagus nerve
label: b
answer: no

Correct answer: a
A 43-year-old woman attends the emergency department with pain in her chest that occurs when she breaths deeply. Her observations show saturations of 90% on room air, but are otherwise unremarkable. Her respiratory rate is 16.

A CTPA demonstrates a pulmonary embolism (PE).

Which of the following best explains the effect of a PE on the ventilation perfusion ratio (V/Q)?

Options:
explanation: This is incorrect because a pulmonary embolism causes a blockage in the blood vessels of the lung, leading to a decrease in perfusion but no change in ventilation. This leads to a greater V/Q ratio.
name: Causes an increase in both ventilation and perfusion, leading to an increase in the ratio
label: e
answer: no
explanation: This is incorrect because a pulmonary embolism causes a blockage in the blood vessels of the lung, leading to a decrease in perfusion but no change in ventilation. This results in a increase in the V/Q ratio.
name: Causes a decrease in both ventilation and perfusion, leading to a decrease in the V/Q ratio
label: b
answer: no
explanation: If the blood flow within the lungs is obstructed due to an embolus, perfusion to the lung is decreased. The ventilation is divided by a smaller number, hence the increase in V/Q ratio. If the embolus completely occluded a pulmonary artery, leading to zero perfusion, the ratio would theoretically be infinite.
name: Causes a decrease in perfusion but no change in ventilation, leading to an increase in the V/Q ratio
label: a
answer: yes
explanation: This is incorrect because a pulmonary embolism causes a blockage in the blood vessels of the lung, leading to a decrease in perfusion but no change in ventilation. This leads to a greater V/Q ratio.
name: Causes a decrease in perfusion but an increase in ventilation, leading to an decrease in the ratio
label: c
answer: no
explanation: This is incorrect because a pulmonary embolism causes a blockage in the blood vessels of the lung, leading to a decrease in perfusion but no change in ventilation. This leads to a greater V/Q ratio.
name: Causes an increase in perfusion but a decrease in ventilation, leading to a decrease in the ratio
label: d
answer: no

Correct answer: a
A 55-year-old man attends his GP surgery with persistent tiredness despite adequate sleep. He is otherwise fit and well, exercising several times a week and eating a healthy vegan diet.

Blood investigations demonstrate a low serum B12 level.

Which of the following is the site of B12 absorption?

Options:
explanation: The terminal ileum is the primary location of B12 absorption. Calcium, folate, monosaccharides and other nutrients are absorbed in the jejunum.
name: Jejunum
label: e
answer: no
explanation: The stomach does not perform absorption of B12, but it is where B12 is bound to intrinsic factor. The terminal ileum is the primary location of B12 absorption.
name: Fundus of stomach
label: c
answer: no
explanation: Incorrect, the terminal ileum is the primary location of B12 absorption.
name: Large intestine
label: d
answer: no
explanation: Incorrect, the terminal ileum is the primary location of B12 absorption.
name: Duodenum
label: b
answer: no
explanation: The terminal ileum is the primary location of B12 absorption, along with water, sodium, and monoglycerides.
name: Ileum
label: a
answer: yes

Correct answer: a
An 8-year-old girl attends her GP surgery with diarrhoea and intermittent abdominal discomfort for the past six months. No one else in the family is unwell, and there is no history of overseas travel.

On examination her observations are all within normal range, however she appears pale and her height is below the fifth percentile for her age.

Which of the following is the most common cause of malabsorption in the Western world?

Options:
explanation: Chronic pancreatitis can cause malabsorption as the production of pancreatic enzymes necessary for the digestion of fats, proteins and carbohydrates is impaired. Whilst a cause of malabsorption, it is not as common as coeliac disease.
name: Chronic pancreatitis
label: e
answer: no
explanation: Coeliac disease is a T cell-mediated inflammatory autoimmune disease affecting the small bowel. It causes villous atrophy, crypt hyperplasia and malabsorption. It can be diagnosed by antibody testing or occasionally by jejunal biopsy. It is the most common cause of malabsorption in the Western world.
name: Coeliac disease
label: a
answer: yes
explanation: Whipple disease is a rare bacterial infection which attacks joints and digestive system. Although it interferes with absorption, it is extremely rare.
name: Whipple disease
label: d
answer: no
explanation: Tropical sprue is a malabsorption syndrome causing diarrhoea, weight loss and intestinal inflammation due to flattening of the villi and inflammation of the small bowel. It is commonly found in tropical regions, but is extremely rare in the Western world.
name: Tropical sprue
label: c
answer: no
explanation: Pancreatic cancer can cause malabsorption as the production of pancreatic enzymes necessary for the digestion of fats, proteins and carbohydrates is impaired. Whilst a cause of malabsorption, it is not as common as coeliac disease.
name: Pancreatic cancer
label: b
answer: no

Correct answer: a
A 36-year-old woman attends her GP surgery, seeking advice on weight loss. Despite making efforts to improve her diet, she has struggled with frequent feelings of hunger. She asks about ghrelin, which she has heard referred to as a 'hunger hormone'.

Which of the following cell types produce ghrelin?

Options:
explanation: Delta cells produce somatostatin, also known as growth hormone inhibiting hormone. They do not produce ghrelin.
name: Delta cells
label: d
answer: no
explanation: Beta cells account for 60% of human islet cells and are responsible for insulin dysregulation in type 1 diabetes mellitus. They produce insulin, not ghrelin.
name: Beta cells
label: c
answer: no
explanation: Alpha cells account for 30% of human islet cells. They produce glucagon, not ghrelin.
name: Alpha cells
label: b
answer: no
explanation: There are 5 main types of cells in the Islets of Langerhans in the pancreas, each producing a different hormone. Ghrelin is produced by epsilon cells. It is released when you are hungry and decreases when sated.
name: Epsilon cells
label: a
answer: yes
explanation: Gamma cells produce pancreatic polypeptide. It modulates digestion by inhibiting gastric emptying and biliary secretions. They do not produce ghrelin.
name: Gamma cells
label: e
answer: no

Correct answer: a
A 35-year-old man presents to his GP surgery with jaundice and dark urine. Laboratory tests reveal elevated levels of conjugated bilirubin in his blood.

Which of the following biochemicals is bilirubin conjugated to?

Options:
explanation: Haemoglobin is involved earlier in the cycle of bilirubin production. Red blood cell breakdown in the spleen is the first step in the production of bilirubin, but haemoglobin is not conjugated with it.
name: Haemoglobin
label: e
answer: no
explanation: Bilirubin is conjugated to glucuronate in the liver and excreted into the bile. Elevated conjugated bilirubin in the blood suggests a blockage in the biliary system, hence causing jaundice and dark urine.
name: Glucuronate
label: a
answer: yes
explanation: Albumin helps to transport bilirubin in the blood. It is not conjugated to it.
name: Albumin
label: b
answer: no
explanation: Cholesterol is not involved in the conjugation of bilirubin.
name: Cholesterol
label: c
answer: no
explanation: Fructose is a sugar, not involved in the conjugation of bilirubin
name: Fructose
label: d
answer: no

Correct answer: a
A 50-year-old man presents to the emergency department with abdominal pain, nausea, and vomiting after taking an overdose of paracetamol.

Which of the following toxic compounds is produced by paracetamol metabolism?

Options:
explanation: Formaldehyde is a toxic and carcinogenic substance used as a disinfectant and preservative. It is not involved in the metabolism of paracetamol.
name: Formaldehyde
label: c
answer: no
explanation: NAC is used to treat paracetamol overdose, when the patient has presented an hour past the time of ingestion, or when the magnitude of the overdose is unknown.
name: N-acetyl-cysteine (NAC)
label: e
answer: no
explanation: Acetaldehyde is a toxic substance produced as a byproduct of alcohol metabolism. It is not a metabolite of paracetamol.
name: Acetaldehyde
label: d
answer: no
explanation: This is the normal conjugation partner of paracetamol in cases of therapeutic dosing.
name: Glucuronide
label: b
answer: no
explanation: Paracetamol is metabolised by cytochrome p450 enzymes. In overdose, the metabolic pathways by which paracetamol is normally conjugated with glucuronic acid become saturated, leading to the accumulation of NAPQI. This can cause hepatocellular damage and liver failure.
name: N-acetyl-p-benzoquinone imine (NAPQI)
label: a
answer: yes

Correct answer: a