hllj/quesmed huggingface dataset:
Which of the following factors is responsible for an increase in Reynolds number?

Options:
explanation: Similarly, this would result in a lower Reynolds number and therefore more laminar blood flow.
name: Reduced diameter of vessels
label: c
answer: no
explanation: Reynolds number (Re) is used to indicate whether blood flow is likely laminar or turbulent. As Reynolds number increases, turbulent blood flow becomes more likely. Re = ( ( Velocity of flow ) x ( radius of the vessel ) ) / ( Viscosity ). Therefore according to the equation, the reduction in viscosity will result in a larger Reynolds number.
name: Reduced blood viscosity
label: a
answer: yes
explanation: According to the equation for the Reynolds number, this would result in a lower value and more laminar flow.
name: Low-velocity flow
label: b
answer: no
explanation: This would result in more laminar blood flow and a lower Reynolds number as abnormal vessel walls result in increased turbulence.
name: Normal vessel walls
label: e
answer: no
explanation: As observed in the Reynolds equation this does not directly contribute to blood flow.
name: Increased serum sodium
label: d
answer: no

Correct answer: a
Which muscle of mastication is responsible for opening the mouth?

Options:
explanation: This is not a muscle of mastication and is responsible for drawing the tongue upwards and backwards.
name: Styloglossus muscle
label: e
answer: no
explanation: This is another muscle of mastication. Its primary role is elevating the mandible and also laterally deviating it.
name: Medial Pterygoid
label: b
answer: no
explanation: This is another muscle of mastication. The primary role of the masseter is to elevate and protract the mandible.
name: Masseter
label: c
answer: no
explanation: This is the only muscle of mastication that opens the mouth. It achieves this by depressing the mandible in conjunction with the anterior belly of the digastric muscle and the mylohyoid muscle.
name: Lateral Pterygoid Muscle
label: a
answer: yes
explanation: This is another muscle of mastication. It is primarily responsible for closing the mouth and movements of the mandible at the temporomandibular joint.
name: Temporalis
label: d
answer: no

Correct answer: a
A 47-year-old patient attends his GP complaining of colicky right upper quadrant radiating to his shoulder.

Which of the following nerves is responsible for this pattern of pain?

Options:
explanation: This nerve provides motor supply to the deltoid and teres minor muscles of the shoulder and sensory innervation to the regimental badge region. It is not responsible for referred pain from the gallbladder.
name: Axillary nerve
label: c
answer: no
explanation: This nerve is a branch of the brachial plexus, it provides motor supply to the anterior compartment of the arm and sensory supply to the forearm. It is not involved in referred pain related to the gallbladder.
name: Musculocutaneous Nerve
label: b
answer: no
explanation: This nerve is made up of T5-T9 nerve fibres and supplies sympathetic supply to the stomach and duodenum.
name: Greater splanchnic nerve
label: d
answer: no
explanation: This is a classic presentation of biliary colic with referred pain to the shoulder. Pain from the gallbladder is usually referred to the epigastrium, but if the adjacent peritoneum is involved, pain may be referred to the right shoulder by the supraclavicular nerve (C3,4,5).
name: Supraclavicular nerve
label: a
answer: yes
explanation: This nerve supplies the somatic motor function of the external urethral sphincter.
name: Pudendal nerve
label: e
answer: no

Correct answer: a
A 24-year-old female attends her GP after being diagnosed with coeliac disease. She has concerns after reading that it is linked to cancer.

Which of the following cancers is she at an increased risk of getting after this diagnosis?

Options:
explanation: This is the most common cancer diagnosed in children. However, it has no link with coeliac disease.
name: Acute Lymphoblastic Leukemia
label: c
answer: no
explanation: Enteropathy-associated T-cell lymphoma (EATL) is a rare type of non-Hodgkin's lymphoma and is a specific complication of coeliac disease.
name: T-cell lymphoma
label: a
answer: yes
explanation: This is caused by the translocation of genes between chromosomes 9 and 22, also known as the Philadelphia chromosome. There is no increased risk in patients with Coeliac disease.
name: Chronic Myeloid Leukemia
label: d
answer: no
explanation: Stomach Cancer has not been linked with coeliac disease.
name: Stomach cancer
label: b
answer: no
explanation: Several studies have shown coeliac disease may be protective against breast cancer. There is no increased risk in patients with coeliac disease.
name: Breast Cancer
label: e
answer: no

Correct answer: a
An 18-year-old man attends his GP complaining of bloody mucoid diarrhoea along with the feeling of incomplete emptying after going to the toilet. These symptoms have been ongoing for 2 months.

Which of the following is the most likely diagnosis?

Options:
explanation: This is defined as an infection of the appendix and is the most common in young people aged 10-20. However, this presents more acutely and not over 2 months. Additionally, symptoms commonly include abdominal pain, non-bloody diarrhoea, and anorexia. Therefore this diagnosis is unlikely.
name: Acute appendicitis
label: e
answer: no
explanation: This is the other type of irritable bowel disease. Unlike ulcerative colitis, this can affect the whole GI tract from the mouth to the anus and is non-continuous with healthy sections of the gut. It is less common for stool to be full of blood and mucous and tenesmus is more commonly observed in ulcerative colitis. Hence, Crohn's is less likely in this patient.
name: Crohn's Disease
label: b
answer: no
explanation: This is a type of inflammatory bowel disease which is characterized by continuous inflammation limited to the colon. Ulcerative colitis commonly presents with bloody mucoid stools and tenesmus, which is a feeling of incomplete emptying of the bowels after going to the toilet.
name: Ulcerative Colitis
label: a
answer: yes
explanation: Commonly presents with non-specific symptoms of GI disturbance including bloating, changes in bowel habits and/or abdominal pain lasting for at least 6 months. Bloody stools are not observed in irritable bowel syndrome.
name: Irritable bowel syndrome
label: c
answer: no
explanation: *Escherichia coli* commonly causes gastroenteritis and is characterized by watery stools, abdominal cramps and nausea.
name: *Escherichia coli* infection
label: d
answer: no

Correct answer: a
A 65-year-old male is on the acute medical ward after being diagnosed with a chest infection. He complains that he has been unable to move his bowels for 2 days. He is prescribed docusate to relieve his symptoms.

Which of the following describes the mechanism of action of this medication?

Options:
explanation: This class of laxatives acts on opioid receptors. An example includes methylnaltrexone bromide.
name: Peripheral opioid receptor antagonist
label: e
answer: no
explanation: This is a type of laxative that softens the stool by drawing water into the bowel, having an osmotic effect. An example of this type of laxative includes lactulose.
name: Osmotic laxative
label: b
answer: no
explanation: This class of laxatives acts on the intestinal mucosa, altering water and electrolyte secretion. In addition, they stimulate peristalsis in the bowel. An example of a simulant laxative is senna.
name: Stimulant laxative
label: d
answer: no
explanation: This type of laxative provides increased stool volume and promotes peristalsis via distension. An example of this includes ispaghula husk.
name: Bulk-forming laxative
label: c
answer: no
explanation: Docusate is a laxative that is classified as a stool softener, it works by softening the stool making it easier to be expelled from the body.
name: Faecal Softener
label: a
answer: yes

Correct answer: a
A 75-year-old male who has recently been diagnosed with a peptic ulcer presents to the Emergency Department complaining of acute onset severe epigastric pain. He is haemodynamically unstable.

Which of the following is expected on a chest X-ray to support the likely diagnosis?

Options:
explanation: This occurs when fluid gathers in the lowest part of the chest when a patient is upright during a chest x-ray forming a "meniscus." It is a classic sign of a pleural effusio,n not a perforation.
name: Meniscus sign
label: d
answer: no
explanation: This is a classical sign of colon cancer found on abdominal X-rays. Thus, this is not the correct answer.
name: Apple Core Lesion
label: b
answer: no
explanation: This patient is presenting with signs of a perforated peptic ulcer. A chest X-ray would show free air under the diaphragm in patients with a perforation. This sign is known as a pneumoperitoneum.
name: Pneumoperitoneum
label: a
answer: yes
explanation: This is a characteristic sign of heart failure found on a chest X-ray. It is described as horizontal lines on the periphery of the lung that extend to the pleural surface.
name: Kerley B lines
label: c
answer: no
explanation: This describes the presence of exudate in the lungs and is oftentimes a sign of pneumonia.
name: Consolidation
label: e
answer: no

Correct answer: a
A 14-year-old boy is brought into A&E by his mother who is concerned that he has turned yellow. She mentions that he has been recovering from a sinus infection. Aside from a raised bilirubin, all other LFTs are within normal range.

Which of the following is the most likely diagnosis?

Options:
explanation: This is a viral infection of the liver that is spread through infected blood or body fluid. Features include jaundice, fever and raised liver transaminases (ALT and AST). Therefore, this diagnosis is unlikely.
name: Hepatitis B
label: d
answer: no
explanation: This is inflammation of the bile duct, often it is caused by gallstones. It usually presents with the classic Charcot's triad of abdominal pain, fever and jaundice which this patient does not have. You would also expect liver function test results to be more deranged.
name: Acute cholangitis
label: b
answer: no
explanation: Gilbert's syndrome is a benign liver condition that is caused by the impaired breakdown of bilirubin. It often presents with jaundice during a bout of illness, such as in this case as the patient is recovering from a sinus infection. It does not require any treatment and should resolve on its own.
name: Gilbert's syndrome
label: a
answer: yes
explanation: This is a condition of an unknown aetiology that is associated with other auto-immune conditions. It most commonly is seen in young females and would show deranged LFT results. Therefore this diagnosis is not likely.
name: Auto-immune hepatitis
label: e
answer: no
explanation: This commonly affects the head of the pancreas which can compress the bile duct. While this does often present with painless jaundice, it is unlikely in a patient of this boy's age. Additionally, you would expect the LFTs to show an obstructive picture.
name: Pancreatic cancer
label: c
answer: no

Correct answer: a
A 45-year-old woman presents to her GP with abdominal pain. She is concerned she has colon cancer as she mentions that Hereditary Non-Polyposis Colorectal Cancer (HNPCC) runs in the family.

Which of the following other types of cancer is she most at risk of?

Options:
explanation: Hereditary Non-Polyposis Colorectal Carcinoma (HNPCC) is an autosomal dominant condition and is the most common inherited form of colon cancer. Patients with HNPCC are also at a high risk of getting other cancers. Endometrial cancer is the next most common form of cancer after colon cancer in people with this condition.
name: Endometrial Cancer
label: a
answer: yes
explanation: Patients with HNPCC mutations are at risk of ovarian cancer, however, endometrial cancer is the most common extracolonic manifestation of HNPCC.
name: Ovarian cancer
label: c
answer: no
explanation: This is a form of skin cancer. It is not known to be linked to HNPCC.
name: Melanoma
label: b
answer: no
explanation: This is a type of brain tumour that patients with HNPCC are susceptible to. However, it is significantly rarer than endometrial cancer.
name: Glioma
label: e
answer: no
explanation: There is an increased risk of renal cancer in patients with HNPCC mutations. However, it is not as common as endometrial cancer.
name: Renal cell carcinoma
label: d
answer: no

Correct answer: a
A 27-year-old male presents to General Practice complaining of wheeze.

Spirometry is performed with the following results:

 - Tidal Volume: 480 ml
 - Inspiratory Respiratory Volume: 3.0 L
 - Expiratory Respiratory Volume: 850 ml

Which of the following is the patient's inspiratory capacity?

Options:
explanation: Inspiratory capacity is the maximum amount of air that can be inspired after the conclusion of a normal expiration. It is the sum of the tidal volume and inspiratory reserve volume (3.0 L + 480 ml).
name: 3.48 L
label: a
answer: yes
explanation: This is the patient's vital capacity, which is the sum of tidal volume, inspiratory respiratory volume and expiratory volume. This is defined as the volume of air that can be breathed in during maximum inspiration following a maximum expiration.
name: 4.33 L
label: b
answer: no
explanation: This is the average total lung capacity of a human. It is calculated by the summation of vital capacity and residual lung volume and cannot be recorded by spirometry alone.
name: 6 L
label: d
answer: no
explanation: This is the value of Expiratory Respiratory volume minus tidal volume. This is not a recorded volume in spirometry.
name: 370 ml
label: e
answer: no
explanation: This is Inspiratory Respiratory volume minus tidal volume. This is not used volume in spirometry
name: 2.52 L
label: c
answer: no

Correct answer: a
A 37-year-old was recently admitted to the hospital and started on clarithromycin for pneumonia.

She was discharged, and 4 days later became itchy and noticed she was turning yellow. Her LFTs show:

 - ALP: 328
 - ALT: 67
 - GGT: 401
 - Bilirubin: 156.

Which of the following is the most likely cause of this clinical presentation?

Options:
explanation: This is inflammation of the gallbladder and presents with a fever and positive Murphy's sign. A positive Murphy's sign is defined as a painful palpable gallbladder in the RUQ during inspiration. It is important to note that acute cholecystitis rarely presents with jaundice, therefore this answer is incorrect.
name: Acute cholecystitis
label: c
answer: no
explanation: Biliary colic describes colicky right upper quadrant pain due to gallstones passing through the biliary tree. The pain is worse on eating and may radiate to the shoulder region. There is no jaundice or abnormal liver function tests in biliary colic.
name: Biliary colic
label: e
answer: no
explanation: Clarithromycin is a type of macrolide which are known to be hepatotoxic. This patient and her LFTs show a cholestatic picture (extremely raised ALP) which occurred after the initiation of the antibiotic treatment. Therefore, this is a drug-induced cholestasis picture.
name: Drug-induced cholestasis
label: a
answer: yes
explanation: This is a benign inherited liver condition involving impaired processing of bilirubin. Patients may experience jaundice when due to elevated levels of bilirubin but additional LFTs should not be abnormal.
name: Gilbert's Syndrome
label: b
answer: no
explanation: This involves inflammation of the pancreas. It is a life-threatening emergency and patients commonly present with severe epigastric pain radiating to the back and vomiting. The patient is not in any pain and therefore this diagnosis is unlikely.
name: Acute pancreatitis
label: d
answer: no

Correct answer: a
A 65-year-old man with reduced kidney function on the geriatric ward is diagnosed with renal artery stenosis.

Which of the following medications must be stopped urgently?

Options:
explanation: This is a short-acting beta agonist used as first-line treatment for asthma, it is not contraindicated in renal artery stenosis.
name: Salbutamol
label: e
answer: no
explanation: This is an opioid used for pain relief, it is not contraindicated in renal artery stenosis. Opioids however should be used with caution in renal impairment as they can accumulate.
name: Oral morphine
label: c
answer: no
explanation: ACE inhibitors are contraindicated in renal artery stenosis as they can exacerbate renal hypoperfusion.
name: Ramipril
label: a
answer: yes
explanation: Insulin is used to treat diabetes mellitus; it must be continued when patients are sick as long as they are eating and drinking and is not contraindicated in renal artery stenosis.
name: Insulin
label: d
answer: no
explanation: This is a calcium channel blocker used to control hypertension, it is not contraindicated in renal artery stenosis.
name: Amlodipine
label: b
answer: no

Correct answer: a
A 50-year-old male presents to A&E complaining of a cough and blood in his urine.

A Chest X-ray is performed and shows "cannonball" type lesions.

Which of the following is the most likely diagnosis?

Options:
explanation: While bladder cancer can present with haematuria, it does not commonly metastasize to the lung, unlike renal cell carcinoma.
name: Bladder Cancer
label: e
answer: no
explanation: While patients with a UTI can present with haematuria, there is no association with cannonball-type lesions on a chest X-ray and is not linked with a cough.
name: Urinary tract infection
label: d
answer: no
explanation: Renal cell carcinoma often presents with a triad of flank pain, renal mass and haematuria. Cannonball lesions are a classic sign of renal cell carcinoma metastasizing to the lungs.
name: Renal Cell Carcinoma
label: a
answer: yes
explanation: Pneumonia is characterized on a chest X-ray with areas of consolidation; it is not associated with cannonball-type lesions.
name: Pneumonia
label: c
answer: no
explanation: COPD can show hyperinflation of the lung fields but does not show cannonball-type lesions on a chest x-ray.
name: Chronic obstructive pulmonary disease (COPD)
label: b
answer: no

Correct answer: a
A 60-year-old male has recently been diagnosed with metastatic prostate cancer after complaining of haematuria and nocturia.

Which of the following structures can facilitate tumour spread from the prostate?

Options:
explanation: These are ducts of the para-urethral glands that open on each side of the lateral margins of the female urethra. Therefore, this is incorrect.
name: Skene's glands
label: b
answer: no
explanation: These are folds of mucosa that can be seen when the urinary bladder is empty. They permit distension of the bladder. They are not involved in the metastatic spread of prostate cancer.
name: Trigone of the Bladder
label: d
answer: no
explanation: This structure holds the neck of the bladder in place, allowing it to rest on the pelvic floor. It is not involved in metastatic spread.
name: Puboprostatic ligament
label: c
answer: no
explanation: These are valveless venous communications in the prostate that connect with the internal vertebral venous plexus and can facilitate tumour spread.
name: Batson Venous Plexus
label: a
answer: yes
explanation: This is a network of nerves which supplies the organs of the pelvic cavity including the bladder and urethra. It is not involved in the spread of prostate cancer.
name: Inferior hypogastric plexus
label: e
answer: no

Correct answer: a
A 35-year-old female presents to her GP complaining of being thirsty all the time.
Blood tests are performed and a urine sample is obtained.


Her results are as follows:


Plasma

||||
|---------------------------|:-------:|--------------------|
|Sodium|118 mmol/L|135 - 145|
|Urea|2.7 mmol/L|2.5 - 7.8|
|Serum Osmolality|250 mOsmol/kg|285 - 295|

Urine

||||
|---------------------------|:-------:|------------------------------|
|Sodium|41 mmol/L|75 - 300|
|Urine Osmolality|810 mOsmol/kg|50 - 1200|


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

Options:
explanation: Dehydration results in hypernatremia and an abnormally elevated serum osmolality. Thus, this is incorrect.
name: Dehydration
label: d
answer: no
explanation: Similarly to vomiting, diarrhoea can cause hypovolemic hyponatremia. However, the urine sodium is typically <20.
name: Diarrhoea
label: e
answer: no
explanation: This patient is hyponatraemic with a low plasma osmolality and a raised urine sodium. SIADH involves the excess release of ADH resulting in increased water reabsorption in the kidneys resulting in a euvolemic (dilutional) hyponatremia as observed in this patient. SIADH is most commonly caused by malignancy, pulmonary conditions or medications.
name: SIADH
label: a
answer: yes
explanation: This is a rare laboratory abnormality where there is a low measured sodium concentration in the presence of an actual normal serum sodium levels. It will show as hyponatremia with normal plasma osmolality.
name: Pseudo-hyponatremia
label: c
answer: no
explanation: Vomiting can cause hyponatremia, however, this would result in urinary sodium levels of <20.
name: Vomiting
label: b
answer: no

Correct answer: a
Where is the majority of sodium and water absorbed in the kidney?

Options:
explanation: The loop of Henle consists of a thin descending segment and a thick ascending limb 20% of filtered water and 25% of filtered sodium are reabsorbed here in addition to potassium and chloride.
name: Loop of Henle
label: d
answer: no
explanation: This is the specialized collection of capillaries that are responsible for the filtration of blood in the nephron. No absorption occurs here.
name: Glomerulus
label: e
answer: no
explanation: Approximately 5% of filtered sodium is absorbed here and the distal tubule is impermeable to water.
name: Distal convoluted tubule
label: c
answer: no
explanation: Less than 10% of filtered water and sodium ions are reabsorbed here. This is the final site for processing urine and therefore this part of the renal tubule determines urine output and composition.
name: Medullary collecting ducts
label: b
answer: no
explanation: 65% of filtered sodium and water is reabsorbed in the proximal tubule. This is predominately sodium pump driven.
name: Proximal convoluted tubule
label: a
answer: yes

Correct answer: a
A 2-year-old girl is brought into the GP surgery by her parents. They have noticed blood in her urine and describe left flank pain. Upon palpation of the left flank, a large mass is felt.

Which of the following genes is most likely responsible for this presentation?

Options:
explanation: This is one of the two BRCA genes that is linked to familial forms of breast cancer and ovarian cancer.
name: BRCA1 gene
label: e
answer: no
explanation: This is a gene which is formed by the exchange of genetic information between chromosome 9 and chromosome 22. This forms a Philadelphia chromosome which is often found in chronic myeloid leukaemia.
name: BCR-ABL gene
label: d
answer: no
explanation: This patient is presenting with a likely renal mass, specifically Wilm's tumour. This is a type of kidney cancer that typically presents in children below the age of 3. Specifically mutations in the WT1 gene, which is a tumour suppressor gene, cause Wilm's tumour.
name: WT1 gene
label: a
answer: yes
explanation: This is a tumour suppressor gene which is linked to the formation of retinoblastoma, a type of cancer in the eye found in young children.
name: RB1 gene
label: b
answer: no
explanation: This is a DNA mismatch repair gene. It is one of the genes which is linked to hereditary nonpolyposis colorectal cancer (HNPCC). This is the most common genetic form of colorectal carcinoma.
name: MSH2 gene
label: c
answer: no

Correct answer: a