hllj/quesmed huggingface dataset:
Long-term antipsychotic use can cause movement disorders such as tardive dyskinesia.

Upregulation of which receptor is responsible for this?

Options:
explanation: D2 (dopamine) receptors are inhibitory. D2 activation in the striatum inhibits the indirect pathway, leading to promoting movement. Antipsychotics antagonise D2 receptors. With long-term use, the brain adapts by upregulating more receptors to the synapse. This upregulation of D2 is irreversible. This results in promotion of movement, and movement disorders called tardive dyskinesia.
name: D2
label: a
answer: yes
explanation: GABA a receptors are inhibitory ionotropic receptors. Antipsychotics may affect GABA and its receptors, but this is not their primary mechanism of action.
name: GABA a
label: e
answer: no
explanation: Typical (newer) antipsychotics affect various serotonin receptors. However, serotonin is not involved in movement.
name: 5-HT2a
label: b
answer: no
explanation: Reduction of NMDA receptors has a role in the development of schizophrenia. Antipsychotics do not directly affect NMDA receptors.
name: NMDA
label: d
answer: no
explanation: Muscarinic receptors M1, M3, and M5 are found in smooth muscles and glands. Antagonism of these receptors causes hypersalivation in patients on certain antipsychotics (such as clozapine).
name: M3
label: c
answer: no

Correct answer: a
What medication is used during an opioid overdose?

Options:
explanation: Naloxone antagonises opioid receptors, reversing the effects of any opioids in someone's body.
name: Naloxone
label: a
answer: yes
explanation: Methadone is another opioid given to someone addicted to opioids (such as heroin) to help them stop taking street opioids.
name: Methadone
label: c
answer: no
explanation: Flumazenil is used to treat benzodiazepine overdose.
name: Flumazenil
label: b
answer: no
explanation: Buprenorphine is another opioid given to someone addicted to opioids (such as heroin) to help them stop taking street opioids.
name: Buprenorphine
label: d
answer: no
explanation: Amitriptyline is a tricyclic antidepressant used primarily to treat neuropathic pain. It is not the first-line treatment in depression as an overdose can be fatal.
name: Amitriptyline
label: e
answer: no

Correct answer: a
A 17-year-old female presents to the GP for the first time with a three-month history saying she feels worried all time, and has sensitivity to noise, poor concentration, and restlessness. She describes headaches, sickness, and stomach aches that come and go throughout the day.

Which first-line medication can be offered?

Options:
explanation: Benzodiazepines, such as diazepam, have good immediate effects in anxiety. However, patients develop tolerance. Withdrawal from these drugs causes anxiety, and they can be addictive.
name: Diazepam
label: b
answer: no
explanation: Lithium is the gold-standard treatment in bipolar, not GAD.
name: Lithium
label: d
answer: no
explanation: This patient is experiencing symptoms suggestive of generalized anxiety disorder (GAD). Selective serotonin reuptake inhibitors (SSRIs) are the first-line treatment in patients with GAD. Patients with anxiety should be offered therapy in conjunction with medication, such as cognitive behavioural therapy (CBT). Therapy and medication together have been shown to have the largest benefit in many mental health disorders.
name: Fluoxetine
label: a
answer: yes
explanation: Buspirone can be used in the treatment of GAD, but is not a first-line treatment.
name: Buspirone
label: c
answer: no
explanation: Risperidone is an atypical antipsychotic. These are rarely used in treating anxiety alone.
name: Risperidone
label: e
answer: no

Correct answer: a
A 52-year-old female comes to the emergency department with a two-month history of passing lots of urine and feeling thirsty, as well as being more confused than normal. Over the past three days, she has had pain while urinating and offensive smelling urine. She has a past medical history of Type 2 Diabetes.

What is the leading cause of mortality in patients who develop the complication most likely seen in this patient?

Options:
explanation: This patient may develop sepsis if her infection is untreated but, in the context of hyperosmolar hyperglycaemic state, thrombosis is the most common cause of mortality.
name: Sepsis
label: c
answer: no
explanation: This patient's history is suggestive of hyperosmolar hyperglycaemic state (HHS). HHS presents with a slow onset of increasing thirst (polydipsia) and urination (polyuria). Patients with HHS are at high risk of thromboembolic events, such as myocardial infarction or stroke. It is important to anticoagulate them to prevent this.
name: Thrombosis
label: a
answer: yes
explanation: The history of underlying Type 2 diabetes, polyuria and polydypsia is suggestive of hyperosmolar hyperglycaemic state (HHS). This patient could likely develop an acute kidney injury (AKI) in her current presentation because of her urinary tract infection. Patients with HHS are often profoundly dehydrated, also contributing to AKI. However, the most common cause of mortality in patients with HHS is thrombosis.
name: Acute kidney injury
label: b
answer: no
explanation: Patients with HHS may go into heart failure. This is because dehydration contributes to renal failure, which may progress to shock, then cardiovascular collapse. However, this is not the leading cause of mortality.
name: Heart failure
label: d
answer: no
explanation: Patients with Type 2 diabetes can develop DKAs. However, this is much rarer than HHS and would have a more acute presentation. In HHS, the leading cause of mortality is thrombosis.
name: Diabetic ketoacidosis
label: e
answer: no

Correct answer: a
A 35-year-old male comes to the GP with tiredness and bone aches.

Which blood results would support a diagnosis of vitamin D deficiency?

Options:
explanation: High calcium in the blood should feedback to the parathyroids to stop producing PTH. As this feedback is not happening and PTH is excessively released, there must something causing this hyperparathyroidism. This is commonly caused by a parathyroid adenoma, but there may be secondary or tertiary hyperparathyroidism causing this.
name: Hypercalcaemia and raised parathyroid hormone
label: d
answer: no
explanation: Hypercalcaemia in the blood will suppress PTH. Non-parathyroid malignancies or vitamin D excess may cause this finding.
name: Hypercalcaemia and reduced parathyroid hormone
label: b
answer: no
explanation: Normocalcaemia may be found in vitamin D deficiency. However, this can only be the case if there is enough PTH to raise the calcium to normal.
name: Normocalcaemia and normal parathyroid hormone
label: e
answer: no
explanation: Vitamin D is needed to absorb calcium from the diet. Without it, calcium in the blood is reduced. The parathyroid glands will sense this and release PTH into the bloodstream.
name: Hypocalcaemia and raised parathyroid hormone
label: a
answer: yes
explanation: Reduced calcium in the blood is sensed by the parathyroids, which should release PTH to increase calcium in the blood. However, because PTH is not being released in this finding, there must be an issue with the parathyroid. This could be due to a primary hypoparathyroidism from DiGeorge syndrome or post-thyroid surgery, for example.
name: Hypocalcaemia and reduced parathyroid hormone
label: c
answer: no

Correct answer: a
A 47-year-old female has a two-month history of worsening weakness in her legs, which is affecting her walking. She also reports feeling more tired and down than usual. She has a past medical history of well-controlled type 2 diabetes mellitus with metformin, which developed after giving birth 10 years ago. Her HbA1c has remained in the normal range over the years. On examination, there is mild sensory loss to the lower limbs and bilateral loss of ankle reflex.

What is the most likely cause of her weakness?

Options:
explanation: Symptoms of ALS and B12 deficiency are similar. Both cause progressive muscle weakness and loss of reflexes. However, ALS weakness and loss of tendon reflexes are usually asymmetric. In ALS, people may have speech and swallowing difficulties but the mind remains in tact as ALS does not affect upper motor neurons.
name: Amylotrophic lateral sclerosis (ALS)
label: c
answer: no
explanation: Diabetic neuropathy is a similar presentation to B12 deficiency as they are both length-dependent neuropathies (i.e. longest neurons in the legs are affected first). However, diabetic neuropathy is more likely to happen in people who do not control their diabetes as well as this patient does (indicated by the stable HbA1c). Fine touch is the first sense to go in diabetic neuropathy.
name: Diabetic neuropathy
label: b
answer: no
explanation: Sciatica is asymmetrical and only affects one side of the lower limb. However, like B12 deficiency, there are reduced reflexes. Sensory loss in sciatica has a "saddle distribution" around the perineal area.
name: Sciatica
label: e
answer: no
explanation: Chronic metformin use can cause B12 deficiency. B12 deficiency will manifest with cognitive symptoms such as fatigue, brain fog, or depression. There may also be symmetrical muscle weakness that mainly affects the lower limbs, as well as loss of reflexes or pins and needles.
name: B12 deficiency
label: a
answer: yes
explanation: Symptoms of MS and B12 deficiency are similar. Both conditions can cause cognitive dysfunction, sensory disturbance, and progressive muscle weakness. However, B12 deficiency affects both sides of the body equally and is more pronounced in the legs. Also, MS may be more predominant on one side of the body than the other.
name: Multiple sclerosis (MS)
label: d
answer: no

Correct answer: a
A 63-year-old woman comes in with visual problems. The results of her visual field test are shown. Damage to which part of the visual pathway has caused this visual field defect?

[lightgallery]

Options:
explanation: The optic tract is after the optic chiasm, which is where visual information crosses over. The optic tract carries visual information from either the left or right side only. The most common cause is stroke, which damages one side of the brain. If the right side of the brain is damaged, the left visual field will be affected (i.e. contralaterally). This visual field finding is called contralateral homonymous hemianopia.
name: Optic tract
label: a
answer: yes
explanation: The optic radiations carry information from one-quarter of each eye to the visual cortex. Damage will cause contralateral quadrantopia.
name: Optic radiation
label: b
answer: no
explanation: Damage to an area of the visual cortex will cause scotoma in both eyes. This is where patchy visual loss occurs in the same visual fields from both eyes.
name: Occipital cortex
label: e
answer: no
explanation: The optic nerve carries information from one eye. Damage to one optic nerve will cause blindness in one eye. This is known as monocular vision loss.
name: Optic nerve
label: d
answer: no
explanation: The optic chiasm is where information from the outer visual field crosses over. Compression of the optic chiasm will cause a visual field defect affecting the outer visual fields of both eyes. The visual field defect is called bitemporal hemianopia. Often, a pituitary tumour below will compress the chiasm, causing this presentation.
name: Optic chiasm
label: c
answer: no

Correct answer: a
A patient presents to the GP with fatigue, weight gain and cold intolerance. The GP tests their thyroid status for the first time.

Which test results indicate primary hypothyroidism?

Options:
explanation: These antibodies are more likely to be present in primary hyperthyroidism caused by Graves disease. Hypothyroidism is more likely to detect anti-thyroid peroxidase antibodies. However, some patients will not have this autoantibody even if they have primary hypothyroidism.
name: Presence of thyroid-stimulating hormone receptor antibodies
label: d
answer: no
explanation: Reduced TSH and reduced fT4 suggest there is a problem higher up in the thyroid axis, in the hypothalamus or pituitary, that has caused reduced fT4. This is consistent with secondary hypothyroidism.
name: Reduced thyroid-stimulating hormone, reduced fT4
label: e
answer: no
explanation: Reduced fT4 is responsible for the symptoms of hypothyroidism. Lack of negative feedback on the pituitary gland releases TSH into circulation. Thyroid-stimulating hormone (TSH) is the best biomarker for thyroid status.
name: Raised thyroid-stimulating hormone and reduced free T4
label: a
answer: yes
explanation: Raised fT4 will cause symptoms of hyperthyroidism (sweating, agitation, tachycardia, weight loss). This will feedback to the pituitary gland to release less TSH. fT3 is used to diagnose hyperthyroidism, as well as TSH and fT4.
name: Reduced thyroid-stimulating hormone, and raised free T4 and T3
label: b
answer: no
explanation: In primary hypothyroidism, both of these hormones would be raised due to the lack of negative feedback provided by reduced levels of fT4.
name: Reduced thyrotropin-releasing hormone and raised thyroid-stimulating hormone
label: c
answer: no

Correct answer: a
A 17-year-old with Addison's disease is unwell with the flu.

What change to their usual medications should they make?

Options:
explanation: Steroids should in fact be doubled during illness to support the body in mounting a stress response. If steroids are being stopped, they should be weaned down slowly under guidance, but this should not be done during illness.
name: Slowly wean down the steroids throughout the illness
label: c
answer: no
explanation: People who take steroid replacement therapy should aim to mimic what happens in the body when physiologically stressed by doubling their usual dose.
name: No changes necessary
label: d
answer: no
explanation: When ill, physiologically there are more endogenous steroids released into our circulation. Patients with Addison's disease do not have functioning adrenal glands. This means they may not mount an adequate "stress response" that happens when healthy people become ill. Because of this, they should double their steroid dose until they feel better.
name: Double steroid dose
label: a
answer: yes
explanation: Patients should never reduce their steroid dose without special guidance as they may go into an adrenal crisis.
name: Half steroid dose
label: e
answer: no
explanation: Patients who take long-term steroids, for example in Addison's disease, must never abruptly stop taking their steroids. They may go into an adrenal crisis due to the lack of cortisol. This can be fatal.
name: Stop taking steroids
label: b
answer: no

Correct answer: a
A patient with a family history of MEN2A has developed spells of palpitations, headaches, and anxiety. An endocrine tumour is suspected.

From where has the tumour arisen?

Options:
explanation: Pituitary tumours can cause a variety of symptoms, but the symptoms this patient is experiencing are more typical of phaeochromacytoma. Symptoms of pituitary tumours may include visual changes (bitemporal hemianopia), headache, or nausea. Pituitary tumours are associated with MEN1, not MEN2A.
name: Pituitary gland
label: e
answer: no
explanation: MEN2A does increase the risk of medullary thyroid cancer. However, the symptoms described here are more typical of phaeochromacytoma.
name: Thyroid gland
label: c
answer: no
explanation: This patient has symptoms classic of phaeochromacytoma: spells of palpitations, headache, and anxiety. The tumour arises from the adrenal medulla, which makes catecholamines. These hormones are responsible for the symptoms experienced. Symptoms may be constant, or come and go in "spells". MEN is a genetic condition that predisposes people to multiple endocrine neoplasia (MEN). In MEN2A, people are at increased risk of parathyroid hyperplasia, medullary C cell carcinoma, and phaeohromacytoma.
name: Adrenal medulla
label: a
answer: yes
explanation: Symptoms from pancreatic tumours can be hard to spot, but include jaundice, stool changes, and indigestion. Pancreatic tumours are associated with MEN1, not MEN2A.
name: Pancreas
label: d
answer: no
explanation: Parathyroid hyperplasia is a feature of MEN2A. However, hyperparathyroidism would cause calcium release from bones, which may cause problems such as bone fracture, abdominal pain, kidney stones, or psychiatric changes (bones, groans, stones, moans).
name: Parathyroid gland
label: b
answer: no

Correct answer: a
A 24-year-old woman in her first-trimester of pregnancy presents to the emergency department with pain and bleeding. On examination, the cervical os is open. There is no evidence of foetal tissue having passed.

What type of miscarriage does this describe?

Options:
explanation: Missed miscarriages are diagnosed incidentally (e.g. on a dating scan) and do not have any symptoms. This may happen when an embryo never develops or stops developing early (anembryonic pregnancy).
name: Missed
label: e
answer: no
explanation: In an inevitable miscarriage, there is bleeding and/or pain. On examination, the cervical os is open as the miscarriage is ongoing or about to begin.
name: Inevitable
label: a
answer: yes
explanation: An incomplete miscarriage will have the same symptoms as an inevitable miscarriage (pain/bleeding and open os). However, in incomplete miscarriage, some tissue has been expelled from the uterus.
name: Incomplete
label: c
answer: no
explanation: There is pain and/or bleeding in a threatened miscarriage, yet the intrauterine pregnancy is still present and the cervical os remains closed.
name: Threatened
label: b
answer: no
explanation: In complete miscarriage, no tissue remains and the cervical os will be closed.
name: Complete
label: d
answer: no

Correct answer: a
A baby is born and is found to have a swelling at the floor of their mouth under the tongue. It is blue in colour and fluctuant when examined.

What is the likely pathology?

Options:
explanation: Dermoid cysts are sacs that contain fluid or semi-solid material. Fusion of ectoderm may trap some elements underneath, meaning they continue to grow as a cyst. They are commonly found above the eyebrow (dermoid angular cysts).
name: Dermoid cyst
label: c
answer: no
explanation: Haemangioma is a common benign vascular neoplasm often found on the face, scalp, chest or back. They tend to disappear with time. However, an operation may be needed if it is around the eye.
name: Haemangioma
label: b
answer: no
explanation: Thyroglossal cysts will present with a lump near the hyoid bone that moves on swallowing. They develop when the thyroglossal duct from the caecum of the tongue to the thyroid does not close properly, leaving fluid (cyst).
name: Thyroglossal cyst
label: d
answer: no
explanation: Also known as lymphangioma, these are fluid-filled sacs (cysts) that develop as a result of the lymphatic system. They are commonly found around the neck and armpit.
name: Cystic hygroma
label: e
answer: no
explanation: Ranula may be present in up to 1% of neonates. It is a cyst in the floor of the mouth that occurs due to blockage of a salivary gland. They are usually blue, dome-shaped and fluctuant.
name: Ranula
label: a
answer: yes

Correct answer: a
A 32-year-old requires emergency contraception after unprotected intercourse four days ago.

What treatment is available for them?

Options:
explanation: The copper IUD is the most effective emergency contraception. It works up to 5 days after unprotected intercourse. Ulipristal is a hormonal option that is licensed for unprotected intercourse up to five days ago.
name: Copper intra-uterine device
label: a
answer: yes
explanation: This is the most effective method of contraception. However, it does not work as emergency contraception.
name: Progesterone-only implant
label: e
answer: no
explanation: This is a good hormonal emergency contraception. However, because this patient had unprotected intercourse more than 72 hours ago, this is not a suitable option.
name: Levonorgestrel
label: d
answer: no
explanation: Methotrexate is used to treat ectopic pregnancies as it acts to slow nucleic acid synthesis, interfering with DNA synthesis and cell growth. It is not contraception.
name: Methotrexate
label: b
answer: no
explanation: Misoprostol is used in inducing labour, and management of miscarriages and terminations. It is not contraception.
name: Misoprostol
label: c
answer: no

Correct answer: a
Ultrasound of a 12-week pregnant woman reveals that the foetus has a protrusion of tissue from the spine.

Failure to close of which embryological structure results in this condition?

Options:
explanation: Spina bifida is a neural tube defect that occurs when the posterior neural tube does not close fully. There are two types, occulta (hidden), or cystica (when the meninges project out).
name: Posterior neural tube
label: a
answer: yes
explanation: Anencephaly is a fatal neural tube defect that causes degeneration of the forebrain and skull.
name: Anterior neuropore
label: b
answer: no
explanation: The amniotic sac should enclose the foetus during pregnancy.
name: Amniotic sac
label: e
answer: no
explanation: When the foramen ovale in the heart remains open, this is known as a patent foramen ovale. Blood may flow between the atria. Most people do not experience complications from this.
name: Foramen ovale
label: c
answer: no
explanation: Failure of palate fusion can lead to a cleft palate.
name: Palate
label: d
answer: no

Correct answer: a
During puberty, changes to the cervix occur.

Which of the following is responsible for actively causing cell change at the transformation zone?

Options:
explanation: Lactobacilli are the most abundant bacteria in the vagina. They use glycogen as their substrate and make lactic acid, lowering the pH of the vagina. However, acid exposure drives metaplasia, not the presence of bacteria.
name: Bacteria
label: c
answer: no
explanation: Progesterone's role is to promote gestation (hence its name). It does this in many ways, such as thickening the lining of the uterus. At the cervix, it keeps mucus thick, keeping the contents of the uterus present.
name: Progesterone
label: d
answer: no
explanation: Glycogen is shed from squamous epithelial cells and provides a substrate for anaerobic organisms (such as lactobacilli) to use.
name: Glycogen
label: e
answer: no
explanation: During puberty, the cervix is exposed to acid. At the transformation zone, columnar epithelial cells are exposed to acid. They start to change to squamous epithelial cells. This physiological metaplasia occurs as squamous cells are more resistant to acidic environments than columnar epithelium.
name: Acid
label: a
answer: yes
explanation: Oestrogen is first needed to stimulate the maturation of the squamous cells. This happens before cell metaplasia can occur.
name: Oestrogen
label: b
answer: no

Correct answer: a