hllj/quesmed huggingface dataset:
A 27-year-old male presents to the GP after feeling generally unwell with fever, muscle aches and fatigue. He admits to being an IV drug user.

On examination, he appears jaundiced. The GP orders a PCR assay for Hepatitis C Virus (HCV) RNA.

Which of the following is a characteristic unique to RNA?

Options:
explanation: DNA is double-stranded, whereas RNA is single-stranded.
name: Double-stranded
label: c
answer: no
explanation: RNA does contain guanine, but so does DNA. Therefore containing guanine is not a characteristic unique to RNA.
name: Contains guanine
label: e
answer: no
explanation: Deoxyribose sugar is found in DNA. Ribose is the sugar in RNA.
name: Contains deoxyribose sugar
label: b
answer: no
explanation: RNA does not contain thymine. Thymine is found in DNA.
name: Contains thymine
label: d
answer: no
explanation: This is the correct answer. RNA contains uracil. This is different to DNA, which contains thymine instead.
name: Contains uracil
label: a
answer: yes

Correct answer: a
A 14-year-old boy attends the Emergency Department with widespread swelling, most notably around his eyes. Nephrotic syndrome is suspected and urinalysis is carried out. It demonstrates proteinuria.

Which of the following is the start codon that every protein begins with?

Options:
explanation: All proteins start with AUG, which codes for the amino acid methionine.
name: AUG (adenine, uracil, guanine)
label: a
answer: yes
explanation: UAG codes for a stop codon, not a start codon.
name: UGA (uracil, guanine, adenine)
label: d
answer: no
explanation: UAG codes for a stop codon, not a start codon.
name: UAG (uracil, adenine, guanine)
label: b
answer: no
explanation: UGG does not code for a start codon. UGG codes for the amino acid tryptophan.
name: UGG (uracil, guanine, guanine)
label: c
answer: no
explanation: UAG codes for a stop codon, not a start codon.
name: UAA (uracil, guanine, adenine)
label: e
answer: no

Correct answer: a
A 30-year-old male presents to his GP complaining of recurrent bronchial infections. He also mentions that his partner and himself have been struggling to conceive.

The GP refers him for further investigations and he is subsequently diagnosed with Kartagener's Syndrome. This condition affects the cilia in the respiratory tract and the flagella of sperm.

Which type of cytoskeleton filament is responsible for the movement of cilia and flagella?

Options:
explanation: Intermediate filaments produce a network of fibres inside cells that provide tensile strength, allowing cells to resist external forces such as stretching. They also strengthen cell contact via desmosomes.
name: Intermediate filament
label: b
answer: no
explanation: Actin microfilaments are found near the cell surface and regulate the cell cortex (cell shape) and cell movement (such as cell crawling, phagocytosis and cell division) using ATP.
name: Actin microfilament
label: c
answer: no
explanation: Microtubules have several functions including facilitating cell division, anchoring cell organelles, and facilitating intracellular transport. Microtubules also form cilia and flagella to assist in cell locomotion. Kartagener's Syndrome is an autosomal recessive condition in which cilia are defective. This results in increased bronchial infections and male infertility due to poor sperm motility.
name: Microtubule
label: a
answer: yes
explanation: Nuclear lamin is a nuclear intermediate filament protein found inside the cell's nucleus. It provides attachment sites for DNA (as chromatin).
name: Nuclear lamin
label: d
answer: no
explanation: Centrosomes anchor microtubules near the cell's nucleus. Microtubules anchored to the centrosome can grow and shrink independently - this is known as dynamic instability.
name: Centrosome
label: e
answer: no

Correct answer: a
A 41-year-old female presents to her GP with a 1-week history of fever 1 after returning from central Africa. A thick and thin blood smear is carried out and the patient is diagnosed with malaria.

Which of the following is the route of malaria transmission?

Options:
explanation: Airborne transmission involves particles with a diameter smaller than 5µm. These particles can be carried large distances in the air in aerosol form. Microorganisms that spread via airborne transmission are very difficult to control as special ventilation systems are required. Airborne transmission is also referred to as aerosol transmission.
name: Airborne
label: d
answer: no
explanation: Malaria is spread by vector transmission. Vector transmission involves animals transporting a pathogen to a susceptible host. In malaria, the female Anopheles mosquito can spread malaria to humans through bites.
name: Vector
label: a
answer: yes
explanation: This is not the route of malaria transmission. Contact transmission can be either direct or indirect. Direct contact involves pathogens being transferred by direct physical contact, such as touch and sex. Indirect contact involves the transfer of pathogens via an object, e.g. someone sneezing onto a surface that someone else touches.
name: Contact
label: b
answer: no
explanation: Droplet transmission involves particles with a diameter larger than 5µm travelling less than 2m. These can come from the respiratory tract, for example, when coughing or sneezing.
name: Droplet
label: c
answer: no
explanation: Vertical transmission refers to infections passing down from mothers to children. Examples of diseases that can be transmitted via vertical transmission include hepatitis B and HIV.
name: Vertical
label: e
answer: no

Correct answer: a
An 82-year-old man attends his GP with weight loss, fatigue, and rectal bleeding. The GP refers him for further investigations and he is diagnosed with colorectal cancer.

Cancer can be caused by uncontrolled mitosis and cells dividing out of control.

Which of the following is a feature of mitosis?

Options:
explanation: Mitosis is used for the growth and repair of cells. This differs from meiosis, which is used for producing gametes for sexual reproduction.
name: Used for growth and repair
label: a
answer: yes
explanation: This is incorrect. Mitosis produces two daughter cells per cycle. Meiosis involves the creation of four daughter cells per cycle.
name: Four daughter cells per cycle
label: c
answer: no
explanation: This is incorrect. Mitosis involves one cell division, creating two daughter cells. Meiosis involves two cell divisions, creating four daughter cells.
name: Involves two cell divisions
label: b
answer: no
explanation: This is incorrect. Mitosis produces two daughter cells that are genetically identical per cycle. Meiosis on the other hand creates genetically unique daughter cells.
name: Daughter cells are genetically different
label: d
answer: no
explanation: This is incorrect. Mitosis occurs in somatic cells, whereas meiosis occurs in germline cells (eggs in females and sperm in males) and is used in sexual reproduction.
name: Occurs in germline cells
label: e
answer: no

Correct answer: a
A 23-year-old male is admitted from the Emergency Department after a motorcycle crash. The x-ray shows he has fractured his right femur.

Which of the following types of collagen is found in bone?

Options:
explanation: Type Two collagen is usually found in cartilage, not bone. This can be remembered by using the memory aid "carTWOlage". However, fibrocartilage contains Type One collagen fibres.
name: Type Two
label: b
answer: no
explanation: Type Three collagen is found in reticular fibres. These are thin fibres that form a delicate net-like framework in the liver, spleen, lymph nodes and other locations where blood and lymph are filtered.
name: Type Three
label: c
answer: no
explanation: Type Four collagen is the main collagenous component of basement membranes. This can be remembered through the memory aid "Type Four is on the floor".
name: Type Four
label: d
answer: no
explanation: Type Five collagen is a fibrillar collagen and is essential for the fibrillation of Types One and Three collagen. Classical Ehlers-Danlos Syndrome is associated with mutations in Type Five collagen.
name: Type Five
label: e
answer: no
explanation: Type One collagen is found in bone. This can be remembered by using the memory aid "bONE".
name: Type One
label: a
answer: yes

Correct answer: a
A 70-year-old woman presents to the GP with a 6-month history of dull localised chest pain which is tender on palpation. The GP suspects costochondritis.

Which of the following types of cartilage make up the costal cartilage?

Options:
explanation: Hyaline cartilage makes up the costal cartilage. Hyaline cartilage is also found elsewhere, for example in the articular surfaces of bones, the trachea and bronchi, and the nasal cavity and nose. Hyaline cartilage functions to provide stiff (but somewhat flexible support) and reduce friction between bony surfaces.
name: Hyaline
label: a
answer: yes
explanation: Spongy is a type of bone, not cartilage. Spongy bone is organised into trabeculae which are formed of longitudinal layers of lamellae. These surround red marrow spaces.
name: Spongy
label: e
answer: no
explanation: Elastic cartilage is not found in costal cartilage. Elastic cartilage allows for flexibility and is found in places such as the epiglottis and the pinna of the external ear.
name: Elastic
label: b
answer: no
explanation: Fibrocartilage is not found in the costal cartilages. Fibrocartilage acts to resist compression, prevent bone-to-bone contact and reduce relative movement. It is found in the intervertebral discs, tendon insertions, pubic symphysis and menisci of the knee joint.
name: Fibrocartilage
label: c
answer: no
explanation: Reticular fibres are not a type of cartilage. These are thin fibres that form a delicate net-like framework in the liver, spleen, lymph nodes and other locations where blood and lymph are filtered.
name: Reticular
label: d
answer: no

Correct answer: a
A 5-day-old infant receives a heel prick test. The test comes back positive for an inherited metabolic disease.

The paediatrician informs the parents that, if left untreated, the infant may suffer from developmental delay, seizures, motor deficits and psychiatric issues amongst other consequences. The paediatrician also informs the parents that the child will have to follow a lifelong restrictive diet.

Which of the following amino acids is high in this condition?

Options:
explanation: The condition described here is phenylketonuria (PKU), which is associated with high phenylalanine levels. Methionine (Met) is not involved in PKU.
name: Methionine
label: e
answer: no
explanation: The condition described here is phenylketonuria (PKU). Tyrosine (Tyr) is an incorrect answer. Tyrosine is the amino acid that phenylalanine is normally converted to by phenylalanine hydroxylase. This is reduced or absent in PKU. In PKU, tyrosine often needs supplementation as less is produced.
name: Tyrosine
label: b
answer: no
explanation: The condition described here is phenylketonuria (PKU), which is associated with high phenylalanine levels. Proline (Pro) is not involved in PKU.
name: Proline
label: d
answer: no
explanation: The condition described here is phenylketonuria (PKU), which is associated with high phenylalanine levels. Cysteine (Cys) is not involved in PKU.
name: Cysteine
label: c
answer: no
explanation: The condition described here is phenylketonuria (PKU). This is an autosomal recessive condition, and the main issue is the accumulation of the amino acid phenylalanine which is toxic to the brain. The three-letter code for phenylalanine is Phe.
name: Phenylalanine
label: a
answer: yes

Correct answer: a
A 34-year-old female presents to her GP with a purple rash on her eyelids and scaly patches on her knuckles. She also complains of muscle pain and weakness.

A diagnosis of dermatomyositis is suspected. To confirm the diagnosis, a biopsy is taken from her biceps muscle.

Which of the following histological features will the pathologist look for when he is reviewing the biopsy sample to confirm he is looking at skeletal muscle?

Options:
explanation: Skeletal muscle is striated, with smooth muscle being non-striated. This is because smooth muscle contains thick and thin filaments that do not arrange into sarcomeres.
name: Non-striated appearance
label: c
answer: no
explanation: Smooth muscle consists of spindle-shaped cells, not skeletal muscle.
name: Spindle-shaped cells
label: d
answer: no
explanation: This is the correct answer. Peripherally located nuclei are one of the key features of skeletal muscle.
name: Peripherally located nuclei
label: a
answer: yes
explanation: This is a feature of cardiac muscle, not skeletal muscle. Cardiac muscle has intercalated discs. They are important in cardiac muscle as they provide mechanical strength to hold the myocytes together (the heart is constantly beating) and facilitate rapid communication between cells, allowing them to contract in a wave-like pattern.
name: Presence of intercalated discs
label: e
answer: no
explanation: Branched cells are found in cardiac muscle, not skeletal muscle. The branching of the cardiac myocytes allows for the faster spread of the wave of depolarization.
name: Branched cells
label: b
answer: no

Correct answer: a
A 27-year-old athlete presents to their General Practitioner with pain in the anterior aspect of their thigh, which is worse on movement. The GP suspects a muscle strain.

During muscle contraction, what does calcium bind to?

Options:
explanation: In high calcium conditions, calcium binds to troponin (on tropomyosin) and the positions of troponin and tropomyosin on actin are altered, making the binding sites available for myosin to attach to.
name: Troponin
label: a
answer: yes
explanation: Tropomyosin proteins block myosin binding sites on the actin filament (in low calcium conditions). On tropomyosin proteins, there are troponin complexes and it is these that bind calcium.
name: Tropomyosin
label: b
answer: no
explanation: Actin (and myosin) are contractile proteins found in every cell. However, they are found in much higher quantities in muscle cells. During muscle contraction, the myosin head attaches to the myosin-binding site on actin, forming a cross-bridge. The myosin head then pivots from a 90-degree to a 45-degree angle, and actin slides past myosin.
name: Actin
label: d
answer: no
explanation: Myosin (and actin) are contractile proteins found in every cell. However, they are found in much higher quantities in muscle cells. During muscle contraction, the myosin head attaches to the myosin-binding site on actin, forming a cross-bridge. The myosin head then pivots from a 90-degree to a 45-degree angle, and actin slides past myosin.
name: Myosin
label: c
answer: no
explanation: Myofibrils are bundles of myofilaments (actin and myosin). Bundles of myofibrils make up a muscle fibre. Myofibrils do not bind calcium.
name: Myofibril
label: e
answer: no

Correct answer: a
An 89-year-old female is admitted to the orthopaedic ward after falling from standing height and fracturing her wrist.

Which of the following investigations is best for diagnosing osteoporosis?

Options:
explanation: Serum alkaline phosphatase is normal in osteoporosis, and therefore cannot be used for diagnosis. If elevated, it could indicate other conditions such as osteomalacia or Paget's Disease of the Bone.
name: Serum alkaline phosphatase
label: c
answer: no
explanation: DEXA scans are the gold standard investigation to measure bone density. A T-score of ≤-2.5 indicates osteoporosis.
name: DEXA scan
label: a
answer: yes
explanation: An X-ray may reveal osteopenia and/or fractures but does not diagnose osteoporosis. X-rays can be used to justify the need for DEXA scans when osteopenia is detected coincidentally.
name: Wrist x-ray
label: d
answer: no
explanation: Serum calcium levels are normal in osteoporosis. Hypocalcaemia could indicate osteomalacia, whilst hypercalcaemia could indicate hyperparathyroidism or malignancy.
name: Serum calcium
label: e
answer: no
explanation: An MRI of the spine has no role in the diagnosis of osteoporosis. The investigation of choice is a DEXA scan.
name: MRI spine
label: b
answer: no

Correct answer: a
An 82-year-old female is admitted to the geriatric ward following a fall at home.

Which of the following is the best tool for predicting fracture risk?

Options:
explanation: The FRAX score is used to evaluate fracture risk. It estimates the probability of a fracture occurring within the next 10 years.
name: FRAX
label: a
answer: yes
explanation: CURB-65 is used to estimate mortality in patients with community-acquired pneumonia. It is useful in predicting outcomes and deciding whether to give inpatient or outpatient treatment.
name: CURB-65
label: e
answer: no
explanation: The Gleason Score is used for staging prostate cancer based on biopsy findings. The greater the Gleason Score, the more poorly differentiated the tumour and the worse the prognosis.
name: Gleason Score
label: c
answer: no
explanation: DAS28 is used in patients with rheumatoid arthritis and indicates how active a patient’s rheumatoid arthritis is currently.
name: DAS28
label: b
answer: no
explanation: QRISK 3 is used to predict cardiovascular risk. It gives a percentage which indicates the likelihood of a person developing a heart attack or stroke over the next 10 years.
name: QRISK 3
label: d
answer: no

Correct answer: a
A 74-year-old overweight male presents to the GP with chronic pain in his left knee. An x-ray is obtained and it shows signs of osteoarthritis.

Which of the following is the GP’s most likely first step in management?

Options:
explanation: Prescribing opioid analgesia should not be the GP's first step. First-line pharmacological management of knee osteoarthritis should be a topical non-steroidal anti-inflammatory drug (NSAID). Paracetamol or weak opioids should not be routinely offered (except for when they are used infrequently for short-term pain relief or all other treatments are ineffective or unsuitable). Strong opioids should not be offered.
name: Prescribe opioid analgesia
label: c
answer: no
explanation: Acupuncture should not be recommended in patients with osteoarthritis. The GP's first steps should be to encourage exercise and weight loss.
name: Advise acupuncture
label: e
answer: no
explanation: For all patients with osteoarthritis, therapeutic exercise should be recommended. It is important to advise patients that exercise may initially cause pain or discomfort, but there will be long-term benefits. For patients that are overweight or obese, weight loss should also be advised.
name: Encourage weight loss and exercise
label: a
answer: yes
explanation: Referral for knee replacement should only be considered if the joint symptoms are having a significant impact on quality of life and non-surgical management is either ineffective or unsuitable. It should not be the GP's first step.
name: Refer for knee replacement
label: b
answer: no
explanation: Rest is not recommended for osteoarthritis. The GP's first steps should be to encourage exercise and weight loss.
name: Encourage rest
label: d
answer: no

Correct answer: a
A 17-year-old female falls off her horse, landing on the proximal part of her arm.

She attends ED and on examination, she has no sensation over the "regimental patch" area of her arm.

Which of the following nerves is most likely to be damaged?

Options:
explanation: A fracture in the proximal part of the humerus is most likely to damage the axillary nerve. The axillary nerve provides cutaneous innervation to the "regimental patch" area of the arm.
name: Axillary
label: a
answer: yes
explanation: The median nerve is most likely to be damaged in a fracture of the distal part of the humerus, not the proximal.
name: Median
label: b
answer: no
explanation: The radial nerve is most likely to be damaged in a fracture of the middle part of the humerus, not proximal. In "Saturday Night Palsy", the radial nerve is injured from prolonged direct pressure on the medial arm, commonly from hanging one's arm off a chair.
name: Radial
label: e
answer: no
explanation: The common fibular nerve is located in the lower limb, not the upper limb. Damage to the common fibular nerve most often occurs in fractures of the neck of fibula or from plaster casts that have been left on too long, or fitted too tight.
name: Common fibular
label: d
answer: no
explanation: The femoral nerve is located in the lower limb, not the upper limb. The femoral nerve innervates the anterior thigh muscles.
name: Femoral
label: c
answer: no

Correct answer: a
A 15-year-old female presents to her GP with persistent pain around her knee that is worse at night. The GP suspects a malignant bone condition.

Which of the following is the most likely diagnosis?

Options:
explanation: Osteochondroma is a benign bone tumour, not malignant. It often presents in male patients under the age of 25. It is often asymptomatic and may only present after a fracture or the development of mobility problems.
name: Osteochondroma
label: d
answer: no
explanation: Chondrosarcoma is a malignant tumour of cartilage, not bone. It most commonly affects the axial skeleton and typically presents in middle age.
name: Chondrosarcoma
label: b
answer: no
explanation: Enchondroma is a benign bone tumour, not malignant. It is a cartilage-forming tumour that develops in the medullary cavity of bone.
name: Enchondroma
label: c
answer: no
explanation: Osteoma is a benign bone tumour, not malignant. It causes a surface "overgrowth" of bone and most commonly presents on the skull.
name: Osteoma
label: e
answer: no
explanation: Osteosarcoma is the most common primary malignant bone tumour. It is seen mainly in children and adolescents, with the mean age of diagnosis being 15. Pain that is worse at night is a feature of osteosarcoma.
name: Osteosarcoma
label: a
answer: yes

Correct answer: a
An 18-year-old male presents to the GP after spraining his ankle. The GP recommends taking some simple analgesia.

Which of the following is an example of a simple analgesic?

Options:
explanation: Diamorphine is a strong opioid, not a simple analgesic.
name: Diamorphine
label: e
answer: no
explanation: Codeine is a weak opioid, not a simple analgesic. Codeine is converted in the liver to morphine.
name: Codeine
label: b
answer: no
explanation: Morphine is a strong opioid, not a simple analgesic.
name: Morphine
label: d
answer: no
explanation: Tramadol is a weak opioid, not a simple analgesic.
name: Tramadol
label: c
answer: no
explanation: Paracetamol is a simple analgesic and an anti-pyretic. Its exact mechanism of action remains unclear. It is most commonly used for mild to moderate pain without inflammation.
name: Paracetamol
label: a
answer: yes

Correct answer: a
A 67-year-old man attends a respiratory outpatient clinic with long-term exertional dyspnoea, wheeze and a chronic productive cough. He is calculated to have a 40-pack-year smoking history. He undergoes spirometry testing: his FEV1/FVC ratio is 0.5.

Which of the following is the most likely diagnosis?

Options:
explanation: This diagnosis is not the most likely considering the history given. There is no mention of a fever or purulent sputum.
name: Pneumonia
label: c
answer: no
explanation: This is the most likely diagnosis considering the patient's history and the obstructive findings on spirometry (FEV1/FVC ratio <0.7).
name: COPD
label: a
answer: yes
explanation: Whilst this patient is high risk for lung malignancy, there are no red flags mentioned in the history, such as weight loss or haemoptysis.
name: Lung malignancy
label: d
answer: no
explanation: Whilst asthma can present with exertional dyspnoea and wheeze, it is more associated with a dry cough. Furthermore, there is no mention in the history of symptom variability. The significant smoking history makes COPD more likely.
name: Asthma
label: b
answer: no
explanation: Pulmonary fibrosis typically presents with a dry cough and persistent, progressive dyspnoea that is worse on exertion. Pulmonary fibrosis is also associated with a restrictive profile on spirometry (reduced FVC, normal FEV1/FVC), not obstructive.
name: Pulmonary fibrosis
label: e
answer: no

Correct answer: a