hllj/quesmed huggingface dataset:
An 8-year-old female is brought to the GP by her parents as she is repeatedly tugging on her left ear. She also complains of pain coming from that ear. There has been no fever or hearing loss and this is the first time she has been experiencing these symptoms. The symptoms have been going on for 2 months.

The GP performs otoscopy and sees a bulging tympanic membrane, indicating otitis media with effusion.

What is the management of this patient?

Options:
explanation: According to NICE, a patient with otitis media with effusion without hearing loss should be monitored for 3 months, with regular examinations and audiology assessments if needed.
name: Watch and wait for a month
label: a
answer: yes
explanation: NICE advises to not prescribe corticosteroids for otitis media with effusion as there is no evidence that they change the outcome or the course of the disease. This patient needs to be monitored for another month as her symptoms should resolve spontaneously.
name: Prescribe prednisolone
label: e
answer: no
explanation: As this patient has no fever or systemic upset, antibiotics are not needed. Otitis media with effusion usually resolves spontaneously without any treatment. Giving antibiotics unnecessarily might incur antimicrobial resistance.
name: Prescribe a 7-day course of amoxicillin
label: b
answer: no
explanation: These may be offered to children with persistent bilateral otitis media with effusion and hearing loss instead of surgery. This patient does not have hearing loss and this is the first time she has experienced these symptoms, so it is not appropriate to give her hearing aids.
name: Hearing aids
label: d
answer: no
explanation: NICE has certain criteria for referring a patient to ENT with otitis media: hearing loss or persistent foul-smelling discharge indicative of cholesteatoma. As this patient has none of these, there is no indication to refer to ENT.
name: Referral to ENT
label: c
answer: no

Correct answer: a
A 37-year-old male is at a football game when his team scores a goal. The noise level increases dramatically as everyone celebrates. The man's acoustic reflex helps protect his ears from the damage of the loud noises surrounding him.

In the acoustic reflex, which muscle contracts and pulls the malleus medially?

Options:
explanation: The stapedius muscle attaches to the stapes and is innervated by the facial nerve. This question asks about which muscle pulls on the malleus, not the stapes.
name: Stapedius
label: b
answer: no
explanation: The tensor tympani pulls the handle of the malleus medially when contracting during the acoustic reflex. It is innervated by the tensor tympani nerve, which is a branch of the mandibular nerve. The acoustic reflex is when the muscles of the inner ear contract in response to loud noise, inhibiting the vibrations of the auditory ossicles and reducing the transmission of sound to the inner ear.
name: Tensor tympani
label: a
answer: yes
explanation: The membranous labyrinth lies within the bony labyrinth of the inner ear. It consists of the cochlear duct, semi-circular ducts, utricle and saccule. The cochlear duct is an organ of hearing and the semi-circular ducts, utricle and saccule are organs of balance. They play no role in the acoustic reflex.
name: Membranous labyrinth
label: e
answer: no
explanation: The pars tensa is part of the tympanic membrane but is not a muscle. It may play some role in the acoustic reflex but it does not contract (as it is not a muscle) to pull the malleus medially.
name: Pars tensa
label: c
answer: no
explanation: The tragus is located anterior to the beginning of the external acoustic meatus. It is an elevation of cartilaginous tissue and plays no part in the acoustic reflex.
name: Tragus
label: d
answer: no

Correct answer: a
A 72-year-old male presents to the GP with a tremor that is present at rest. The GP also notices that the patient takes slow, little steps when walking. The patient has no other medical conditions.

The GP asks the patient to write some words on a bit of paper and notices that his handwriting gets smaller and the tremor disappears while doing this.

What is the most likely diagnosis?

Options:
explanation: In essential tremor, the tremor persists and the handwriting stays the same size, unlike in this patient where his handwriting gets smaller and his tremor disappears. This, along with the bradykinesia, suggests a diagnosis of Parkinson's disease over essential tremor.
name: Essential tremor
label: b
answer: no
explanation: In functional tremor, there is uncontrollable shaking of a part of the body. This is due to the nervous system not working properly, not due to an underlying neurological disease.
name: Functional tremor
label: e
answer: no
explanation: An intention tremor happens during deliberate, voluntary movements. It happens as the consequence of cerebellar dysfunction, particularly on the same side as the tremor. As this tremor is present at rest, an intentional tremor is unlikely.
name: Intention tremor
label: d
answer: no
explanation: This patient has no medical conditions which makes the diagnosis of hyperthyroidism unlikely. The handwriting getting smaller and the tremor disappearing are also suggestive of Parkinson's disease.
name: Hyperthyroidism
label: c
answer: no
explanation: The symptoms of resting tremor and bradykinesia (slow, little steps) suggest a diagnosis of Parkinson's disease. The handwriting getting smaller and the tremor disappearing suggests PD over essential tremor as in essential tremor, the tremor persists and the handwriting remains the same size.
name: Parkinson's disease (PD)
label: a
answer: yes

Correct answer: a
A 66-year-old female has just been diagnosed with breast cancer and asks what has caused the cancer to grow as fast as it has done, as she only noticed the lump on her breast a few weeks ago. The doctor explains that there are regions at the end of DNA strands that protect them from damage, and every time a cell divides they get shorter. When they get too short, the cell they are in usually dies. However, some cancer cells can evade this death by making these regions longer, allowing them to continue proliferating.

What structure is the doctor referring to?

Options:
explanation: HER2 is a proto-oncogene that, when activated, leads to the increased production of downstream proteins and signalling molecules that promote cell growth and differentiation.
name: HER2
label: c
answer: no
explanation: Telomeres are the structures at the end of chromosomes that control how many replications a cell can undergo. As DNA is replicated, the very end of the strand is lost. As a healthy cell divides, the telomeres shorten and once there are no telomeres, the cell undergoes apoptosis. Cancer cells can evade this apoptosis by making more telomerase enzymes which prevent the telomeres from getting shorter.
name: Telomeres
label: a
answer: yes
explanation: TNF-alpha is a pro-inflammatory chemokine that is produced by white blood cells during inflammation and leads to the necrosis or apoptosis of cells.
name: TNF-alpha
label: e
answer: no
explanation: p53 is a tumour suppressor gene which repairs DNA damage if detected. It is often inactivated in breast cancer, hence disrupting the cell cycle and allowing the cancerous cells to keep dividing.
name: p53
label: b
answer: no
explanation: BRCA1 encodes a protein that recognises and repairs ds-DNA breaks. Therefore, cells that lack BRCA proteins have a reduced ability to detect and repair damaged DNA, leading to a significant increase in the risk of that cell progressing through the cell cycle without being destroyed. This means that there is a higher chance of the cells becoming cancerous.
name: BRCA1
label: d
answer: no

Correct answer: a
A 35-year-old female presents to the GP with pain around her eye and swelling around the upper eyelid. There is no change to her vision.

On closer examination, the GP notices that there is a swollen infected hair follicle.

What is the most likely diagnosis?

Options:
explanation: A stye is an infection of a hair follicle within the eyelid. It can present as a little bump on the eyelid and is usually painful. The most common organism that causes styes is *S. aureus*. Usually, no treatment is needed, but a warm compress can be used to help relieve symptoms.
name: Stye
label: a
answer: yes
explanation: Entropion is where the eyelid is turned inwards, leading to the eyelashes scraping the cornea. As there is no mention of the eyelid being turned inwards in this question, this answer choice is unlikely.
name: Entropion
label: e
answer: no
explanation: Herpes simplex keratitis (HSK) is inflammation of the cornea, not the eyelid. The symptoms are typically a painful, gritty sensation in the eye, along with decreased visual acuity.
name: Herpes simplex keratitis
label: c
answer: no
explanation: Ectropion is where the eyelid is turned outwards, leading to a watery, inflamed eye. It is almost always the lower eyelid, so is unlikely to happen in this patient as their swelling is on the upper eyelid. The treatment for ectropion is surgical correction of the eyelid.
name: Ectropion
label: d
answer: no
explanation: A chalazion is a swelling of the eyelid due to a blocked Meibomian gland (which contributes to creating tears) and is usually firmer than a stye. It can be differentiated from a stye as a chalazion is not usually painful, whereas a stye usually is.
name: Chalazion
label: b
answer: no

Correct answer: a
A 45-year-old male presents to the neurology clinic after being referred by his GP. The patient describes a loss of sensation in his upper lip. He says that eating is now a strange feeling due to this.

What cranial nerve is affected?

Options:
explanation: The glossopharyngeal nerve provides sensation to the oropharynx, carotid body and sinus, posterior 1/3 of the tongue, middle ear cavity and Eustachian tube. It provides motor function to the stylopharyngeus muscle in the pharynx, provides taste sensation to the posterior 1/3 of the tongue and provides parasympathetic innervation to the parotid gland.
name: Glossopharyngeal nerve
label: c
answer: no
explanation: The zygomatic branch of the facial nerve provides motor function to the orbicularis oculi muscle, which closes the eyelid.
name: Zygomatic branch of the facial nerve
label: e
answer: no
explanation: The maxillary branch of the trigeminal nerve provides sensation to the upper lip, mucosa of the nose and upper teeth. It also has some parasympathetic fibres that go to the lacrimal, nasal and palatine glands.
name: Maxillary branch of the trigeminal nerve
label: a
answer: yes
explanation: The mandibular branch of the trigeminal nerve provides motor function to the muscles of mastication and sensation to the lower part of the face and chin and anterior 2/3rds of the tongue.
name: Mandibular branch of the trigeminal nerve
label: d
answer: no
explanation: The vestibulocochlear nerve has the function of hearing (cochlear portion) and balance (vestibular portion).
name: Vestibulocochlear nerve
label: b
answer: no

Correct answer: a
Which of the following phases of the cell cycle is responsible for determining the length of the cell cycle?

Options:
explanation: This is the process of the cytoplasm and cell membrane splitting into 2 daughter cells at the end of the cycle.
name: Cytokinesis Phase
label: c
answer: no
explanation: The G1 phase is the longest phase of the cell cycle and the beginning of interphase. It occurs in between the M-phase and the S-phase. During this phase, cells are the most metabolically active. The duration of G1 varies thus determining the length of the cell cycle.
name: G1 Phase
label: a
answer: yes
explanation: The G2 phase is also a growth phase but different to G1. The DNA has already been duplicated so during the G2 phase, the cell prepares for division and corrects any errors in chromosome number.
name: G2 Phase
label: b
answer: no
explanation: The M phase, or mitosis, is the phase of actual cell division. Whilst it's a critical part of the cell cycle, it doesn't determine the length of the entire cell cycle. The M phase is relatively short and follows the G2 phase.
name: M Phase (Mitosis)
label: e
answer: no
explanation: The S phase comes after G1 during interphase. Cellular DNA is replicated during this phase.
name: S Phase
label: d
answer: no

Correct answer: a
During the cell cycle, genetic variation is introduced in specific phases.

Which of the following is a correct example of this?

Options:
explanation: During anaphase, chromosomes move towards opposite poles of the cell. There is no further introduction of genetic variation in this stage.
name: Anaphase
label: d
answer: no
explanation: The G2 phase occurs after DNA replication (S phase) and is mainly associated with further preparation for cell division (mitosis). It is not a phase where genetic variation is introduced but rather one where the cell ensures that it is ready for mitosis.
name: G2 phase
label: e
answer: no
explanation: Telophase is the fifth and final phase of mitosis, the process that separates the duplicated genetic material carried in the nucleus of a parent cell into two identical daughter cells. There is no introduction of genetic variation during this phase.
name: Telophase
label: b
answer: no
explanation: During pachytene in prophase 1, genetic information is exchanged between homologous pairs of chromosomes at the chiasmata. This is an example of genetic variation being introduced as the chromosomes come from 2 genetically unique individuals.
name: Pachytene
label: a
answer: yes
explanation: This is the first phase of prophase during which the chromosomes just begin to condense. There is no "crossing over" yet and thus no introduction of genetic variation.
name: Leptotene
label: c
answer: no

Correct answer: a
With regards to the metabolism of iron, where is iron absorbed in the GI tract?

Options:
explanation: Iron is not absorbed in the stomach, but Fe3+ is converted to Fe2+ here. The proximal jejunum is where the absorption of iron occurs.
name: Stomach & proximal jejunum
label: b
answer: no
explanation: This is an incorrect choice as the stomach is not a site for iron absorption.
name: Stomach & duodenum
label: d
answer: no
explanation: At physiological pH, iron exists in the oxidised, ferric (Fe3+) state. To be absorbed, iron must be in the ferrous (Fe2+) state or bound by a protein such as heme. It is absorbed in the duodenum and proximal jejunum.
name: Duodenum & proximal jejunum
label: a
answer: yes
explanation: The colon is primarily responsible for water and electrolyte absorption, but it is not involved in the absorption of iron. The anus is the endpoint of the GI tract and is not involved in the absorption of nutrients.
name: Colon & anus
label: e
answer: no
explanation: The distal jejunum is responsible for small absorption of B12, water and sodium. Larger amounts of these are absorbed in the ileum.
name: Distal jejunum & ileum
label: c
answer: no

Correct answer: a
What is the effect of a competitive inhibitor on the Vmax of an enzyme?

Options:
explanation: In competitive inhibition, Vmax remains the same. Competitive inhibitors compete with the substrate for the active site of an enzyme but do not affect the maximum rate of the enzyme-catalysed reaction.
name: Vmax is decreased
label: b
answer: no
explanation: Vmax is unaffected because competitive inhibitors do not alter an enzyme's maximal catalytic capacity. Instead, they primarily affect the affinity of an enzyme for its substrate. This can easily be overcome by increasing the concentration of the substrate.
name: Vmax is unaffected
label: a
answer: yes
explanation: Competitive inhibition does not lead to an increase in Vmax. It specifically affects the affinity of an enzyme for its substrate but not the maximum rate of the reaction.
name: Vmax is increased
label: c
answer: no
explanation: Competitive inhibition does not directly inhibit Vmax. Instead, it reduces the effectiveness of the enzyme-substrate interaction by competing with the substrate for the active site.
name: Vmax is partially inhibited
label: d
answer: no
explanation: This is a general statement that applies to Michaelis-Menten kinetics, but it is not specific to competitive inhibition. Competitive inhibition primarily affects the Km (Michaelis constant), which is a measure of the affinity of an enzyme for its substrate, and not the Vmax.
name: Vmax is inversely proportional to substrate concentration
label: e
answer: no

Correct answer: a
Ehlers-Danlos syndrome (EDS) is an example of which of the following defects?

Options:
explanation: EDS is not an immune system disorder. Immune system disorders are distinct from EDS.
name: Immune system disorder
label: d
answer: no
explanation: EDS primarily affects the connective tissues and does not directly relate to respiratory disorders. However, EDS can lead to respiratory issues if it affects the structural integrity of the chest wall.
name: Respiratory disorder
label: c
answer: no
explanation: EDS can have neurological symptoms, but it is not primarily a neurological disorder. The neurological symptoms are often related to complications arising from structural weaknesses in connective tissues, such as Chiari malformations. EDS is fundamentally a connective tissue disorder.
name: Neurological disorder
label: e
answer: no
explanation: EDS is indeed an example of a connective tissue disorder. It is a group of inherited disorders that affect the connective tissues in the body, primarily due to defects in collagen production or structure. This leads to various physical and physiological manifestations, including joint hypermobility, skin hyperelasticity, and fragility of tissues, such as blood vessels and internal organs. It is said to be associated primarily with a Type 1 collagen defect.
name: Connective tissue disorder
label: a
answer: yes
explanation: EDS primarily affects connective tissues, leading to symptoms such as hypermobility of joints, skin hyperelasticity, and tissue fragility. Whilst cardiovascular issues can be associated with EDS due to its effects on blood vessels, EDS itself is not primarily a cardiovascular disorder.
name: Cardiovascular disorder
label: b
answer: no

Correct answer: a
Which of the following is an example of where transitional epithelium is found in the body?

Options:
explanation: Blood vessels are lined with simple squamous epithelium, also known as endothelium, which is adapted for the exchange of substances between blood and tissues. It does not have the stretching properties of transitional epithelium.
name: Blood vessels
label: d
answer: no
explanation: The oesophagus is lined with stratified squamous epithelium to withstand the mechanical stress of food passing through it. Transitional epithelium is not found in the oesophagus.
name: Oesophagus
label: e
answer: no
explanation: The small intestine is primarily lined with simple columnar epithelium to aid in nutrient absorption, not transitional epithelium.
name: Lining of the small intestine
label: b
answer: no
explanation: The trachea is lined with pseudostratified ciliated columnar epithelium to help trap and remove foreign particles from the respiratory tract. It does not require the stretching and contraction capabilities of transitional epithelium.
name: Trachea
label: c
answer: no
explanation: Transitional epithelium is found in the urinary bladder and the urinary tract in general. It allows the bladder to stretch as it fills with urine and then contract when the urine is expelled. It is also found in the renal pelvis, the ureter and parts of the urethra.
name: Urinary bladder
label: a
answer: yes

Correct answer: a
An F2 doctor suspects meningitis in a 25-year-old man. As part of his investigations, he needs to perform a lumbar puncture.

Which of the following sites should the needle be inserted into?

Options:
explanation: Inserting the needle directly into the spinal cord is not the correct procedure for a lumbar puncture and can be extremely dangerous or fatal.
name: Spinal Cord
label: b
answer: no
explanation: The intervertebral foramen is a passageway for spinal nerves, and inserting the needle here is not the correct site for a lumbar puncture. This can cause permanent disability.
name: Intervertebral Foramen
label: d
answer: no
explanation: The epidural space is located outside the dura mater and contains fat and blood vessels. A lumbar puncture is not performed in the epidural space.
name: Epidural Space
label: c
answer: no
explanation: A lumbar puncture is performed by inserting a needle into the subarachnoid space, which is located between the arachnoid mater and the pia mater. This is where cerebrospinal fluid (CSF) is found and can be safely obtained for diagnostic purposes. This should be done at the L3-L4 or L4-L5 interspace as this is considered the safe zone away from the spinal cord which is prone to injury. Inserting the needle at the wrong site can cause lasting damage and is a never-event.
name: Subarachnoid space
label: a
answer: yes
explanation: Inserting the needle between vertebral discs can risk damaging the spinal cord, nerves, and blood vessels. A lumbar puncture is typically performed in the subarachnoid space, not between the vertebral discs.
name: Between the vertebral discs
label: e
answer: no

Correct answer: a
What ion is primarily responsible for the depolarisation phase (rising phase) of an action potential in a typical neuron?

Options:
explanation: Calcium ions are not primarily responsible for the depolarisation phase of the action potential. They play a significant role in synaptic transmission and various cellular processes but are not the key ions involved in the rising phase of the action potential.
name: Calcium (Ca2+)
label: d
answer: no
explanation: Magnesium ions are not involved in the depolarisation phase of the action potential. Magnesium primarily serves as a cofactor in enzymatic reactions and does not play a significant role in the ionic mechanism of action potentials.
name: Magnesium (Mg2+)
label: e
answer: no
explanation: In a typical neuron, the depolarisation phase of an action potential is primarily driven by the influx of sodium ions (Na+) through voltage-gated sodium channels. This influx of positive sodium ions into the cell leads to a rapid change in membrane potential, creating the rising phase of the action potential.
name: Sodium (Na+)
label: a
answer: yes
explanation: Chloride ions do play a role in the action potential, but they are primarily responsible for the hyperpolarisation phase (falling phase) and the maintenance of the resting membrane potential. They are not responsible for the initial depolarisation.
name: Chloride (Cl-)
label: b
answer: no
explanation: Potassium ions do play a role in the repolarisation and hyperpolarisation phases of the action potential. They are responsible for returning the membrane potential to its resting state and maintaining it. They are not the ions responsible for the initial depolarisation.
name: Potassium (K+)
label: c
answer: no

Correct answer: a