hllj/quesmed huggingface dataset:
A 45 year old man attends A&E with acute shortness of breath. He has been feeling generally unwell for the past 5 days, with a cough productive of green sputum. He is a long-term smoker with a known diagnosis of COPD. An arterial blood gas (ABG) is performed.

Which of the following ABG results are in keeping with respiratory acidosis?

Options:
explanation: This is incorrect; this ABG shows a metabolic alkalosis. This is indicated by the high pH value and the fact that the bicarbonate is high.
name: pH- 7.51, PaO2-12.0kPa, PaCO2- 6.1kPa, HCO3-35mmol/L
label: e
answer: no
explanation: This is incorrect; this ABG shows respiratory **alkalosis** rather than acidosis. This is indicated by the alkaline (raised) pH and the low carbon dioxide.
name: pH- 7.48, PaO2-12.0kPa, PaCO2- 3.8kPa, HCO3-22mmol/L
label: b
answer: no
explanation: This is incorrect; this ABG is normal.
name: pH- 7.36, PaO2-14.0kPa, PaCO2- 6.2kPa, HCO3-25mmol/L
label: c
answer: no
explanation: This is incorrect. Whilst this ABG does show acidosis, this appears to have a metabolic rather than respiratory cause. This is indicated by a low/normal CO2 and a low bicarbonate. The low bicarbonate level indicates that more bicarbonate is being used to react with hydrogen ions to make carbonic acid, which makes the blood more acidic. The carbon dioxide being low/normal suggests the respiratory system is beginning to compensate for this decrease in pH by expelling more (acidic) CO2.
name: pH- 7.3, PaO2-12.0kPa, PaCO2- 4.5kPa, HCO3-14mmol/L
label: d
answer: no
explanation: This is correct; these ABG results are in keeping with respiratory acidosis. Note there is a low pH, demonstrating acidosis, coupled with a high PaCO2, which indicates a respiratory cause. The slightly raised bicarbonate level also indicates some metabolic compensation. This in turn suggests a more chronic respiratory acidosis.
name: pH- 7.3, PaO2-10.5kPa, PaCO2- 7.0kPa, HCO3-32mmol/L
label: a
answer: yes

Correct answer: a
A 52 year old male attends his GP surgery for an annual medical review, as required for his profession as a lorry driver. He is found to have a Qrisk score of 15%. The GP recommends he commence atorvastatin to reduce his risk of having a major cardiovascular event.

Which of the following describes the mechanism of action of atorvastatin?

Options:
explanation: This is incorrect. This is the mechanism of ticagrelor, an anti-platelet that can be used as part of secondary prevention for cardiovascular disease. Atorvastatin is a statin that reduces cholesterol by inhibiting HMG-CoA reductase; an enzyme involved in the liver's production of cholesterol.
name: P2Y12 receptor antagonist
label: e
answer: no
explanation: This is correct. Atorvastatin is a type of statin, which can be given as primary prevention of cardiovascular disease when Qrisk score is raised (>10%). Statins reduce cholesterol by inhibiting HMG-CoA reductase; an enzyme involved in the liver's production of cholesterol.
name: Inhibition of HMG-CoA reductase
label: a
answer: yes
explanation: This is incorrect. ACE inhibitors such as ramipril are used as part of secondary prevention for cardiovascular disease. Atorvastatin is a statin that reduces cholesterol by inhibiting HMG-CoA reductase; an enzyme involved in the liver's production of cholesterol.
name: Inhibition of Angiotensin converting enzyme (ACE)
label: b
answer: no
explanation: This is incorrect. Aldosterone antagonists are used as part of secondary prevention for cardiovascular disease if the patient has clinical heart failure. Atorvastatin is a statin that reduces cholesterol by inhibiting HMG-CoA reductase; an enzyme involved in the liver's production of cholesterol.
name: Antagonism of aldosterone
label: d
answer: no
explanation: This is incorrect. Beta-blockers are used as part of secondary prevention for cardiovascular disease. Atorvastatin is a statin that reduces cholesterol by inhibiting HMG-CoA reductase; an enzyme involved in the liver's production of cholesterol.
name: Blockade of beta adrenergic receptors
label: c
answer: no

Correct answer: a
A 67 year old female patient presents to A&E with central crushing chest pain that radiates down her left arm. She also reports nausea and dizziness but has not yet vomited. Her observations are all within the normal range.

Which of the following blood markers is released following damage to cardiac myocytes?

Options:
explanation: This is incorrect. CRP is an inflammatory marker which is raised in inflammatory disorders or infections. It is not specific to ischaemic cardiac myocyte damage.
name: CRP
label: c
answer: no
explanation: This is incorrect. Actin is a contractile protein present in skeletal muscle that the myosin head attaches to in muscle contraction. It is not released in cardiac myocyte injury.
name: Actin
label: d
answer: no
explanation: This is correct. Troponin is a cardiac enzyme that is released following damage to cardiac myocytes. It is elevated in myocardial infarction, however, it can also be raised due to other conditions such as pericarditis or aortic dissection.
name: Troponin
label: a
answer: yes
explanation: This is incorrect. Raised serum cholesterol levels are a risk factor for the development of coronary artery disease. However, it is not raised secondary to cardiac myocyte damage, making this option incorrect.
name: Cholesterol
label: e
answer: no
explanation: This is incorrect. Creatine kinase is released in response to general muscle damage; the specific type released when cardiac muscle is damaged is creatine kinase myocardial band (CK-MB). This is useful in determining whether reinfarction has occurred as it has a shorter half-life than troponin. As this option is creatine kinase, not CK-MB, it is not the single best answer.
name: Creatine kinase
label: b
answer: no

Correct answer: a
A 35 year old female presents to endocrinology clinic to discuss a new diagnosis of primary hyperaldosteronism (Conn's syndrome).

Which of the following investigations is most likely to confirm the diagnosis?

Options:
explanation: This is incorrect. High levels of aldosterone cause increased sodium resorption from the distal tubule of the nephron. This causes hypernatraemia rather than hyponatraemia.
name: Hyponatraemia
label: c
answer: no
explanation: This is correct. Conn's syndrome causes hypokalaemia due to high levels of aldosterone. Aldosterone is released from the zona glomerulosa of the adrenal gland and acts on the nephron to increase potassium secretion from the distal tubule. Thus, hypokalaemia is a feature of Conn's syndrome.
name: Hypokalaemia
label: a
answer: yes
explanation: This is incorrect. Renin will be low in primary hyperaldosteronism, as its release is suppressed by the high blood pressure seen in Conn's syndrome.
name: Raised serum renin
label: d
answer: no
explanation: This is incorrect. Aldosterone is high in Conn's syndrome, which causes an increase in sodium reabsorption from the kidney. Water follows sodium in the kidney, therefore the volume of the blood is higher. This increases stroke volume and thus cardiac output. If cardiac output is increased then mean arterial pressure will be increased (mean arterial pressure = cardiac output x peripheral resistance). Thus, hypertension is a feature of Conn's syndrome, not hypotension.
name: Low blood pressure
label: b
answer: no
explanation: This is incorrect. High levels of aldosterone will cause an increase in the secretion of hydrogen ions from the collecting ducts. This will increase the pH, causing metabolic alkalosis.
name: Metabolic acidosis
label: e
answer: no

Correct answer: a
A 50 year old man presents to his GP with anxiety and palpitations. He has struggled for many years to control his hypertension, despite optimal medical management. He is otherwise fit and well with no other medical conditions.

On examination, his blood pressure reads at 180/94. He appears sweaty, with a heart rate of 120 beats per minute. The GP decides to refer him to secondary care, where he is diagnosed with a phaeochromocytoma.

Which of the following cell types make up a phaeochromocytoma?

Options:
explanation: This is incorrect. Phaeochromocytomas are catecholamine-secreting tumours of the chromaffin cells in the adrenal medulla. By contrast, spongiocytes are located within the zona fasciculata of the adrenal cortex. This is responsible for the release of cortisol, and so whilst it may cause hypertension, it would not account for the other aspects of the clinical presentation and is not the location of a phaeochromocytoma.
name: Spongiocytes
label: c
answer: no
explanation: This is incorrect. Phaeochromocytomas are catecholamine-secreting tumours of the chromaffin cells in the adrenal medulla. By contrast, chief cells are located in the parathyroid gland and are responsible for the secretion of parathyroid hormone. This is not the location of a phaeochromocytoma.
name: Chief cells
label: e
answer: no
explanation: This is correct. Hypertension, tachycardia, anxiety and sweating are all suggestive of high levels of adrenaline and noradrenaline. These hormones are secreted by the chromaffin cells of the adrenal medulla. Tumours of the chromaffin cells are known as phaeochromocytomas and are an important differential in cases of resistant hypertension.
name: Chromaffin Cells
label: a
answer: yes
explanation: This is incorrect. Phaeochromocytomas are catecholamine-secreting tumours of the chromaffin cells in the adrenal medulla. Whilst a tumour of the zoma glomerulosa would explain this patient's resistant hypertension (due to hyperaldosteronism), it would not explain the palpitations, sweating and tachycardia and is not the location of a phaeochromocytoma.
name: Zona glomerulosa cells
label: b
answer: no
explanation: This is incorrect. Phaeochromocytomas are catecholamine-secreting tumours of the chromaffin cells in the adrenal medulla. By contrast, the zona reticularis is responsible for the secretion of androgen precursors. A tumour of these cells would not give rise to the clinical presentation above and is not the location of a phaeochromocytoma.
name: Zona reticularis cells
label: d
answer: no

Correct answer: a
A 32 year old female patient consults the GP about her reducing regime of steroids. Whilst on a high dose she struggled with low mood, abdominal striae and weight gain. Fortunately, these symptoms have improved significantly since the dose was lowered.

She is keen to learn more about where in the body cortisol is produced.

Which of the following glands is responsible for endogenous cortisol production?

Options:
explanation: This is incorrect. Cortisol is released by the zona fasciculata of the adrenal cortex. The zona reticularis is responsible for the production of androgen precursors.
name: Zona reticularis of the adrenal cortex
label: d
answer: no
explanation: This is incorrect. Cortisol is released by the zona fasciculata of the adrenal cortex. The zona glomerulosa is responsible for the production of mineralocorticoids.
name: Zona glomerulosa of the adrenal cortex
label: c
answer: no
explanation: This is incorrect, the anterior pituitary gland is responsible for the production of ACTH amongst other things. ACTH stimulates the zona fasciculata to produce cortisol. Cortisol is released by the zona fasciculata of the adrenal cortex.
name: Anterior pituitary gland
label: e
answer: no
explanation: This is incorrect. Cortisol is released by the zona fasciculata of the adrenal cortex. The adrenal medulla is responsible for the production of adrenaline and noradrenaline.
name: Adrenal medulla
label: b
answer: no
explanation: This is correct. Cortisol is released by the zona fasciculata of the adrenal cortex. Cushing's syndrome is caused by high levels of exogenous glucocorticoids, as opposed to Cushing’s disease (caused by an ACTH-secreting pituitary tumour). It is characterised by a range of symptoms including a round 'moon' face, central obesity and abdominal striae. It can also cause psychiatric features such as depression.
name: Zona fasciculata of the adrenal cortex
label: a
answer: yes

Correct answer: a
A 55 year old female patient with a long history of coeliac disease presents to her GP to discuss the findings of her recent endoscopy. It showed extensive damage to the lining of the duodenum and proximal jejunum.

Which of the following complications is this patient at risk of, given her endoscopy findings?

Options:
explanation: This is incorrect. Coeliac disease is associated with hyposplenism, giving patients a higher susceptibility to infections.
name: Splenomegaly
label: c
answer: no
explanation: This is correct. Iron is largely absorbed in the duodenum, which is extensively damaged in this patient. She is therefore at particular risk of iron deficiency anaemia, and should be monitored regularly.
name: Iron deficiency anaemia
label: a
answer: yes
explanation: This is incorrect. Patients with coeliac disease who do not adhere to a gluten-free diet are associated with an increased risk of enteropathy-associated T-cell lymphoma, which is a rare non-Hodgkin lymphoma.
name: Hodgkin lymphoma
label: b
answer: no
explanation: This is incorrect. Cushing's syndrome is caused by exogenous glucocorticoid excess. The management of coeliac disease is a gluten-free diet or surgery in extreme cases. Whilst glucocorticoids are used in select, severe cases, there is no indication for their use in this case. This option is therefore incorrect.
name: Cushing's syndrome
label: d
answer: no
explanation: This is incorrect. Electrolytes can be absorbed in the duodenum and upper jejunum, so cases of severe damage could lead to electrolyte abnormalities. However, hypokalaemia due to reduced absorption is more likely than hyperkalaemia. This option is therefore incorrect.
name: Hyperkalaemia
label: e
answer: no

Correct answer: a
A 36-year-old male presents with bloody diarrhoea (up to 20 times daily), vomiting, and recent haematuria, starting after eating undercooked steak. He has not traveled abroad in the past year.  

His past medical history includes type 1 diabetes, and he takes insulin. He denies a personal or family history of inflammatory bowel disease or colorectal cancer.



Blood results are as follows:



||||
|--------------|:-------:|---------------|
|Haemoglobin|88 g/L|(M) 130 - 170, (F) 115 - 155|
|Mean Cell Volume (MCV)|84 fL|80 - 96|
|White Cell Count|10.2x10<sup>9</sup>/L|3.0 - 10.0|
|Platelets|72x10<sup>9</sup>/L|150 - 400|
|Sodium|135 mmol/L|135 - 145|
|Potassium|4.0 mmol/L|3.5 - 5.3|
|Urea|12.1 mmol/L|2.5 - 7.8|
|Creatinine|146 µmol/L|60 - 120|



Which of the following organisms is the most likely cause of this patient's gastroenteritis?

Options:
explanation: This is incorrect. Salmonella tends to cause watery diarrhoea which resolves within a week. It is not implicated in the development of HUS and is therefore incorrect.
name: Salmonella
label: e
answer: no
explanation: This is incorrect. Staphylococcus aureus tends to cause gastroenteritis. Symptoms start within hours of ingestion and last only 12-24 hours. This bacterium is not implicated in the development of HUS.
name: Campylobacter Jejuni
label: d
answer: no
explanation: This is incorrect. Bacillus cereus causes a watery diarrhoea which resolves within 24 hours. It is classically caused by eating fried rice that has been left at room temperature.
name: Bacillus Cereus
label: c
answer: no
explanation: This is correct. This patient is presenting with haemolytic uraemic syndrome (HUS), which can be identified by his anaemia, thrombocytopenia and an acute kidney injury following a bout of gastroenteritis. HUS is commonly caused by the shiga toxin. This is classically produced by the E.coli 0157 bacterium.
name: E.coli 0157
label: a
answer: yes
explanation: This is incorrect. Staphylococcus aureus tends to cause gastroenteritis. Symptoms start within hours of ingestion and last only 12-24 hours. This bacterium is not implicated in the development of HUS.
name: Staphylococcus Aureus
label: b
answer: no

Correct answer: a

E.coli 0157
A 22 year old female presents to the GP to discuss the results of her recent colonoscopy. She has been having abdominal pains and diarrhoea with some blood. Her colonoscopy revealed a diagnosis of ulcerative colitis (UC).

Which of the following is a feature of this condition?

Options:
explanation: This is incorrect. UC is associated with primary sclerosing cholangitis, which is an autoimmune condition causing inflammation of the bile ducts. Although gallstones can feature in UC, they are more commonly a feature of Crohn's disease.
name: Gallstones
label: e
answer: no
explanation: This is incorrect. UC is associated with pseudopolyps on endoscopy. Cobblestone appearance on endoscopy is a feature of Crohn's disease.
name: Cobblestone appearance on endoscopy
label: d
answer: no
explanation: This is incorrect. UC is associated with continuous disease. Skip lesions are a feature of Crohn's disease.
name: Skip lesions
label: c
answer: no
explanation: This is correct. Ulcerative colitis is associated with crypt abscesses on histology, secondary to migration of neutrophils through the walls of glands.
name: Crypt abscesses
label: a
answer: yes
explanation: This is incorrect. UC is associated with inflammation that starts at the rectum and does not spread beyond the ileocaecal valve. Lesions that may occur anywhere along the GI tract are a feature of Crohn's disease.
name: Lesions anywhere along the GI tract
label: b
answer: no

Correct answer: a
A 62 year old man presents to the Emergency Department describing a crushing, left sided chest pain that radiates down the left arm and is associated with nausea. No ST-segment elevation is seen on electrocardiogram, but repeat troponin levels are raised. He is diagnosed with a myocardial infarction (MI).

As part of the secondary prevention regime, he is prescribed atorvastatin 80mg.

Which of the following describes the mechanism of action of atorvastatin?

Options:
explanation: This is incorrect. Statins inhibit HMG-CoA reductase. Lipoprotein lipase (LPL) is responsible for the absorption of exogenous lipids by breaking down chylomicrons to release free fatty acids which are then taken up by cells.
name: Inhibits lipoprotein lipase
label: c
answer: no
explanation: This is incorrect. Statins inhibit HMG-CoA reductase. Acetyl-CoA carboxylase is responsible for the conversion of acetyl-CoA to malonyl-CoA in the fatty acid synthesis pathway.
name: Inhibits acetyl-CoA carboxylase
label: d
answer: no
explanation: This is correct. Statins inhibit HMG-CoA reductase, which catalyses the rate-limiting step in cholesterol synthesis. This prevents plaque buildup (atherosclerosis), thus reducing the risk of future MIs.
name: Inhibits HMG-CoA reductase
label: a
answer: yes
explanation: This is incorrect. Statins inhibit HMG-CoA reductase. Carnitine acetyltransferase facilitates the transfer of long-chain fatty acids to the mitochondria for β-oxidation.
name: Inhibits carnitine acetyltransferase
label: e
answer: no
explanation: This is incorrect. Statins inhibit HMG-CoA reductase. Increasing synthesis of HMG-CoA reductase would increase cholesterol synthesis, and thus increase the risk of a future MI.
name: Increases synthesis of HMG-CoA reductase
label: b
answer: no

Correct answer: a
A 22 year old male is diagnosed with atrial fibrillation (AF) after presenting to his General Practitioner with palpitations. AF is caused by a problem in the pacemaker cells of the heart.

Which of the following regions of the heart is the primary pacemaker?

Options:
explanation: This is incorrect. The primary pacemaker of the heart is the sinoatrial node. Atrial myocytes can display abnormal pacemaker activity, however, and this is believed to play an important role in the development of atrial fibrillation.
name: Atrial myocytes
label: e
answer: no
explanation: This is incorrect. Purkinje fibres are responsible for the conduction of impulses from the right and left bundle branches to the ventricular myocytes. Similarly to the atrioventricular node, they have latent pacemaker cells that are normally overridden in the healthy heart due to the sinoatrial node having the fastest rate.
name: Purkinje fibres
label: c
answer: no
explanation: This is incorrect. The bundle of His is responsible for conducting the electrical impulse down the interventricular septum from the atrioventricular node. It is not the primary pacemaker of the heart.
name: Bundle of His
label: d
answer: no
explanation: This is correct. The SAN is situated in the upper part of the wall of the right atrium. Cardiac pacemaker cells are mostly found in the SAN. The pacemaker cells continuously generate electrical impulses, thereby setting the normal rhythm and rate in a healthy heart; hence the SAN is known as the primary pacemaker.
name: Sinoatrial node (SAN)
label: a
answer: yes
explanation: This is incorrect. The AVN is responsible for conducting electrical impulses from the atria to the ventricles via the bundle branches. The AVN has latent pacemaker cells, however, the rate of the sinoatrial node is faster, so these are normally overridden.
name: Atrioventricular node (AVN)
label: b
answer: no

Correct answer: a
A 75 year old woman attends her GP surgery with concerns that she sometimes becomes dizzy upon standing. Her blood pressure is measured and found to be 130/95 on sitting but only 105/77 after 3 minutes of standing.

The GP explains that the baroreceptor reflex is one mechanism responsible for limiting the decrease in blood pressure.

In which of the following structures are **arterial** baroreceptors located?

Options:
explanation: This is correct. Baroreceptors are mechanoreceptors located in the aortic arch and carotid sinus which constantly monitor mean arterial blood pressure and pulse pressure. A decrease in arterial pressure results in increased baroreceptor activity, increasing sympathetic activity and thus raising blood pressure.
name: Carotid sinus and aortic arch
label: a
answer: yes
explanation: This is incorrect. The baroreceptors responsible for the baroreceptor reflex are located in the carotid sinus and aortic arch.
name: Abdominal aorta
label: d
answer: no
explanation: This is incorrect. The baroreceptors responsible for the baroreceptor reflex are located in the carotid sinus and aortic arch.
name: Carotid sinus and vertebral arteries
label: e
answer: no
explanation: This is incorrect. The baroreceptors responsible for the baroreceptor reflex are located in the carotid sinus and aortic arch. There are baroreceptors located in the atria and pulmonary arteries, however, these are not the arterial baroreceptors.
name: Atria and pulmonary arteries
label: c
answer: no
explanation: This is incorrect. The baroreceptors responsible for the baroreceptor reflex are located in the carotid sinus and aortic arch.
name: Renal arteries
label: b
answer: no

Correct answer: a