hllj/quesmed huggingface dataset:
Which of the following is correct regarding the mechanism by which insulin deficiency causes hyperkalaemia?

Options:
explanation: This is incorrect. Insulin stimulates the Na+/K+ ATPase on the surface of cells to uptake more K+. Insulin deficiency therefore results in a loss of this stimulation, reducing cellular K+ uptake and increasing serum K+ levels.
name: Increased activation of Na+/K+ ATPase
label: d
answer: no
explanation: This is incorrect. Insulin stimulates the Na+/K+ ATPase on the surface of cells to uptake more K+. Insulin deficiency therefore results in a loss of this stimulation, reducing cellular K+ uptake and increasing serum K+ levels.
name: None of the above
label: e
answer: no
explanation: This is incorrect. Insulin affects K+ levels via the Na+/K+ ATPase rather than through the effects of aldosterone. Insulin stimulates the Na+/K+ ATPase on the surface of cells to uptake more K+. Insulin deficiency therefore results in a loss of this stimulation, reducing cellular K+ uptake and increasing serum K+ levels.
name: Reduced aldosterone levels
label: c
answer: no
explanation: This is incorrect. Insulin affects K+ levels via the Na+/K+ ATPase rather than through the effects of aldosterone. Insulin stimulates the Na+/K+ ATPase on the surface of cells to uptake more K+. Insulin deficiency therefore results in a loss of this stimulation, reducing cellular K+ uptake and increasing serum K+ levels.
name: Increased aldosterone levels
label: b
answer: no
explanation: This is correct. Insulin stimulates the Na+/K+ ATPase on the surface of cells to uptake more K+. Insulin deficiency therefore results in a loss of this stimulation, reducing cellular K+ uptake and increasing serum K+ levels.
name: Reduced activation of Na+/K+ ATPase
label: a
answer: yes

Correct answer: a
Which of the following is the correct transcription factor that regulates the release of erythropoietin?

Options:
explanation: This is incorrect. PPAR is a transcription factor involved in carbohydrate metabolism. The correct answer was HIF-2. In response to hypoxia, mesangial cells in the kidney are stimulated to release erythropoietin. This is regulated primarily by the transcription factor hypoxia-induced factor 2 (HIF-2). HIF-2 is degraded by iron and hence during hypoxia, when iron levels are low, the raised HIF-2 levels stimulate more erythropoietin release.
name: PPAR
label: e
answer: no
explanation: This is incorrect. CREB is a transcription factor involved in cell proliferation and differentiation. The correct answer was HIF-2. In response to hypoxia, mesangial cells in the kidney are stimulated to release erythropoietin. This is regulated primarily by the transcription factor hypoxia-induced factor 2 (HIF-2). HIF-2 is degraded by iron and hence during hypoxia, when iron levels are low, the raised HIF-2 levels stimulate more erythropoietin release.
name: CREB
label: c
answer: no
explanation: This is incorrect. PDX-1 is a transcription factor involved in glucose homeostasis. The correct answer was HIF-2. In response to hypoxia, mesangial cells in the kidney are stimulated to release erythropoietin. This is regulated primarily by the transcription factor hypoxia-induced factor 2 (HIF-2). HIF-2 is degraded by iron and hence during hypoxia, when iron levels are low, the raised HIF-2 levels stimulate more erythropoietin release.
name: PDX-1
label: b
answer: no
explanation: This is correct. In response to hypoxia, mesangial cells in the kidney are stimulated to release erythropoietin. This is regulated primarily by the transcription factor hypoxia-induced factor 2 (HIF-2). HIF-2 is degraded by iron and hence during hypoxia, when iron levels are low, the raised HIF-2 levels stimulate more erythropoietin release.
name: HIF-2
label: a
answer: yes
explanation: This is incorrect. STAT3 is a transcription factor involved in cell proliferation and differentiation. The correct answer was HIF-2. In response to hypoxia, mesangial cells in the kidney are stimulated to release erythropoietin. This is regulated primarily by the transcription factor hypoxia-induced factor 2 (HIF-2). HIF-2 is degraded by iron and hence during hypoxia, when iron levels are low, the raised HIF-2 levels stimulate more erythropoietin release.
name: STAT3
label: d
answer: no

Correct answer: a
Which of the following is a potassium-sparing diuretic?

Options:
explanation: This is incorrect. Acetazolamide is a carbonic anhydrase inhibitor which works by increasing Na+ excretion and hence causing diuresis. Potassium-sparing diuretics, on the other hand, work by inhibiting aldosterone. One of the functions of aldosterone is to stimulate the Na+/K+ exchanger which pumps Na+ into the filtrate and pumps K+ out of the filtrate. Spironolactone therefore reduces the activity of the Na+/K+ exchanger, reducing Na+ reabsorption and hence causing diuresis. It also reduces K+ excretion and hence is called potassium-sparing.
name: Acetazolamide
label: d
answer: no
explanation: This is incorrect. Indapamide is a thiazide-like diuretic which inhibits the Na+/Cl- transporter in the distal convoluted tubule. Potassium-sparing diuretics, on the other hand, work by inhibiting aldosterone. One of the functions of aldosterone is to stimulate the Na+/K+ exchanger which pumps Na+ into the filtrate and pumps K+ out of the filtrate. Spironolactone therefore reduces the activity of the Na+/K+ exchanger, reducing Na+ reabsorption and hence causing diuresis. It also reduces K+ excretion and hence is called potassium-sparing.
name: Indapamide
label: c
answer: no
explanation: This is incorrect. Hydrochlorothiazide is a thiazide diuretic which inhibits the Na+/Cl- transporter in the distal convoluted tubule. Potassium-sparing diuretics, on the other hand, work by inhibiting aldosterone. One of the functions of aldosterone is to stimulate the Na+/K+ exchanger which pumps Na+ into the filtrate and pumps K+ out of the filtrate. Spironolactone therefore reduces the activity of the Na+/K+ exchanger, reducing Na+ reabsorption and hence causing diuresis. It also reduces K+ excretion and hence is called potassium-sparing.
name: Hydrochlorothiazide
label: e
answer: no
explanation: This is correct. Spironolactone is a potassium-sparing diuretic that works by inhibiting aldosterone. One of the functions of aldosterone is to stimulate the Na+/K+ exchanger which pumps Na+ into the filtrate and pumps K+ out of the filtrate. Spironolactone therefore reduces the activity of the Na+/K+ exchanger, reducing Na+ reabsorption and hence causing diuresis. It also reduces K+ excretion and hence is called potassium-sparing.
name: Spironolactone
label: a
answer: yes
explanation: This is incorrect. Furosemide is a loop diuretic which inhibits the Na-K-Cl cotransporter (NKCC2). This transporter causes reabsorption of Na+, K+, and Cl- and hence inhibition of it results in more K+ loss. Therefore, furosemide is not a potassium-sparing diuretic.
name: Furosemide
label: b
answer: no

Correct answer: a
Which of the following is the primary site of H+ secretion in the nephron?

Options:
explanation: This is incorrect. H+ ions are primarily secreted at the distal convoluted tubule via active transport. This is done through apical H+/K+ ATPase and H+ ATPase.
name: Proximal convoluted tubule
label: b
answer: no
explanation: This is correct. H+ ions are primarily secreted at the distal convoluted tubule via active transport. This is done through apical H+/K+ ATPase and H+ ATPase.
name: Distal convoluted tubule
label: a
answer: yes
explanation: This is incorrect. H+ ions are primarily secreted at the distal convoluted tubule via active transport. This is done through apical H+/K+ ATPase and H+ ATPase.
name: Glomerulus
label: e
answer: no
explanation: This is incorrect. H+ ions are primarily secreted at the distal convoluted tubule via active transport. This is done through apical H+/K+ ATPase and H+ ATPase.
name: Bowman's capsule
label: d
answer: no
explanation: This is incorrect. H+ ions are primarily secreted at the distal convoluted tubule via active transport. This is done through apical H+/K+ ATPase and H+ ATPase.
name: Collecting duct
label: c
answer: no

Correct answer: a
A 35-year-old female presents to the GP wishing to become pregnant. She has one child with spina bifida. She has no significant past medical history and is not on any regular medications. Her blood tests show normal levels of haemoglobin and folate.

What dose of folic acid should be prescribed?

Options:
explanation: This is the normal dose used for the prevention of neural tube defects in those at low risk of conceiving a child with a neural tube defect.
name: 400 micrograms daily until week 12 of pregnancy
label: b
answer: no
explanation: This is the dose used for the prevention of neural tube defects in those who are at high risk of conceiving a child with a neural tube defect. Indications for a higher dose of folic acid in pregnancy are diabetes, sickle cell disease, those taking anti-epileptic medication, those on antiretrovirals for HIV, women with a BMI of 30 kg/m2 or above, a familial history of neural tube defects or a previous pregnancy affected by a neural tube defect.
name: 5 milligrams daily until week 12 of pregnancy
label: a
answer: yes
explanation: This is the dose required to treat a pregnant patient with folate-deficient megaloblastic anaemia in malabsorption states.
name: 15 milligrams daily until term
label: e
answer: no
explanation: This is the dose required to treat a pregnant patient with folate-deficient megaloblastic anaemia. Our patient's folate levels are normal.
name: 5 milligrams daily until term
label: c
answer: no
explanation: This is the dose required to prevent methotrexate-induced side-effects in rheumatic disease.
name: 5 milligrams once weekly
label: d
answer: no

Correct answer: a
A 24-year-old pregnant female attends an appointment with her obstetrician following an isolated elevated alpha-fetoprotein (AFP) level detected on a blood test. The obstetrician is concerned about foetal development and would like to perform an ultrasound.

What sign is the obstetrician most likely looking for?

Options:
explanation: The obstetrician is concerned about the possibility of a neural tube defect. AFP is mainly produced by the foetal liver. Rises in AFP may indicate leakage through an open neural tube defect. The lemon sign can be detected on the scan due to the decrease in the intraspinal pressure which in turn decreases the intracranial pressure resulting in the flattening or scalloping inwards of the frontal bones giving us the lemon sign. The lemon sign is only present until 24 weeks.
name: Lemon sign
label: a
answer: yes
explanation: The double bleb sign is the earliest sign of an embryo on ultrasound. The two blebs represent the amniotic sac adjacent to the yolk sac. It would not explain the increased AFP.
name: Double bleb sign
label: c
answer: no
explanation: This would be found on abdominal x-ray in those with a diagnosis of sigmoid volvulus. It would not be a cause for isolated AFP increase and has no relevance to pregnancy/ultrasound.
name: Coffee bean sign
label: b
answer: no
explanation: Nuchal translucency is the collection of fluid behind the foetal neck. It forms part of the down syndrome screening programme. In Down Syndrome. AFP is reduced as opposed to elevated.
name: Nuchal translucency
label: d
answer: no
explanation: The crown-rump length is useful in estimating the gestational age. It has no relevance to the isolated AFP increase.
name: Crown-rump length
label: e
answer: no

Correct answer: a
A mother has just given birth to her newborn son. On observation, the newborn is noted to have noisy breathing, trouble swallowing and periods of apnoea. The doctor is concerned about an Arnold-Chiari malformation.

Which of the following conditions is most closely associated with an Arnold-Chiari malformation?

Options:
explanation: Spina bifida occulta is the mildest and most common form of spina bifida, where one or more of the vertebrae are malformed. A layer of skin covers the opening in the bones of the spine.
name: Spina bifida occulta
label: b
answer: no
explanation: This malformation is characterized by downward displacement of the medulla, fourth ventricle and cerebellum into the cervical spinal canal, as well as elongation of the pons and fourth ventricle. This type occurs almost exclusively in patients with myelomeningocele. Myelomeningocele is a congenital condition in which the spinal cord and column do not close properly during fetal development, resulting in an open spinal cord defect at birth.
name: Myelomeningocele
label: a
answer: yes
explanation: Closed neural tube defects are a diverse group of disorders in which the spine may have malformations of fat, bone, or the meninges that cover the spinal cord.
name: Closed neural tube defect
label: d
answer: no
explanation: Meningocele occurs when the meninges protrude through the spine and cause a sac of spinal fluid on the back. This fluid is typically only around the brain and spine, but a problem with the bony covering over the spine allows it to poke out. The malformation contains no nerves and may or may not be covered by a layer of skin. Individuals with meningocele may have minor symptoms.
name: Meningocele
label: c
answer: no
explanation: Anencephaly results in a baby being born without the forebrain and cerebrum. It is a type of neural tube defect. There is no known cure or standard treatment for anencephaly. Almost all babies born with anencephaly will die shortly after birth.
name: Anencephaly
label: e
answer: no

Correct answer: a
A 27-year-old female presents to the hospital with worsening visual acuity over the last few days and the sensation of colours seeming duller. She is very concerned that she is losing her vision.

On examination, when shining the light into the right eye. both pupils constrict, however, when shining it in the left eye, both eyes remained dilated.

Which cranial nerve is affected?

Options:
explanation: The trigeminal nerve serves both sensory (facial sensation) and motor innervation to several muscles, including the muscles of mastication (masseter, temporalis, medial pterygoid and lateral pterygoid) as well as the anterior belly of digastric, mylohyoid, tensor tympani & tensor veli palatini. It does not affect pupillary constriction or dilation.
name: Trigeminal nerve
label: e
answer: no
explanation: The oculomotor nerve innervates the levator palpebrae superioris, inferior oblique and superior, medial and inferior recti muscles. It is responsible for pupillary constriction and contains parasympathetic fibres which innervate the sphincter pupillae and ciliary muscles. If the oculomotor nerve was affected on the left side, the right eye would still constrict.
name: Oculomotor nerve
label: c
answer: no
explanation: The trochlear nerve provides motor innervation to the superior oblique muscle. It does not affect pupillary constriction or dilation.
name: Trochlear nerve
label: b
answer: no
explanation: The patient has presented with a relative afferent pupil defect (RAPD), common in conditions such as optic neuritis. It is caused by injury to the optic nerve. Normal optic function causes bilateral pupil constriction when light is shone, and bilateral pupil dilation when light is removed.
name: Optic nerve
label: a
answer: yes
explanation: The Abducens nerve provides motor innervation to the lateral rectus muscle. It does not affect pupillary constriction or dilation.
name: Abducens nerve
label: d
answer: no

Correct answer: a
A 65-year-old male presents to the GP with worsening visual acuity over months. He is a solicitor and is now struggling to read documents for his clients. He complains of vision loss in the right halves of his visual fields bilaterally. On wider questioning, he notes that he has been losing weight and has a daily headache, which is worse when coughing and sneezing.

Where is the lesion?

Options:
explanation: A lesion of the left optic radiation results in a contralateral homonymous quadrantanopia.
name: Left optic radiation
label: e
answer: no
explanation: A lesion of the right optic nerve would result in ipsilateral vision loss in the right eye.
name: Right optic nerve
label: b
answer: no
explanation: A lesion of the right optic tract results in a contralateral homonymous hemianopia.
name: Right optic tract
label: d
answer: no
explanation: Lesions in the central optic chiasm would result in bitemporal hemianopia as the fibres from the nasal retina cross in the optic chiasm.
name: Optic chiasm
label: c
answer: no
explanation: The patient has presented with a right-sided homonymous hemianopia, secondary to a likely brain tumour. A lesion of the left optic tract that carries axons from the ganglion cells of the temporal retina of the left eye and the nasal retina of the right eye (both see objects in the left visual hemifield) results in blindness in the right field of vision. The most common causes of homonymous hemianopias are vascular events, such as intracranial haemorrhages, followed by brain tumours, trauma, surgical intervention and central nervous system infections.
name: Left optic tract
label: a
answer: yes

Correct answer: a
A 4-year-old male patient is seen by an ophthalmologist and diagnosed with colour blindness, an X-linked recessive condition. His parents are unaffected. His parents would like his sister to be tested.

What is the likelihood that his little sister is colour-blind?

Options:
explanation: Colour blindness is an x-linked recessive condition. As the father does not have colour blindness, this means that the boy has inherited the defective X-chromosome from the mother. A female inherits one X-chromosome from the mother and the father. The father has a normal X-chromosome, therefore she is unable to inherit the phenotype (she will be a carrier).
name: 0%
label: a
answer: yes
explanation: As the father is not affected, the mother carries the defective X-chromosome for colour blindness. There would only be a 100% chance that future daughters will be affected if both mother and father are colour-blind.
name: 100%
label: d
answer: no
explanation: This would be true for an autosomal recessive inheritance pattern. However, colour blindness is an X-linked recessive condition requiring both X-chromosomes to be defective in a girl.
name: 25%
label: b
answer: no
explanation: There is a 50% chance that the daughter will be a carrier of the condition. This is because there is a 50% chance she would inherit the defective X chromosome from the mother.
name: 50%
label: c
answer: no
explanation: 75% chance is not possible with an X-linked condition.
name: 75%
label: e
answer: no

Correct answer: a
A 65-year-old male patient presents to the hospital with right-sided weakness affecting the lower part of his face, arm and hand. His leg is largely spared. There is associated sensory loss in the same area. He has no visual abnormalities.

Given the likely diagnosis, which artery is most likely infarcted?

Options:
explanation: Infarcts affecting the anterior cerebral artery (ACA) result in contralateral leg weakness and sensory loss. The patient’s leg is largely spared, making an ACA infarct unlikely.
name: Left anterior cerebral artery
label: c
answer: no
explanation: This would cause symptoms on the left side of the body.
name: Right middle cerebral artery
label: b
answer: no
explanation: This would cause symptoms on the left side of the body.
name: Left anterior cerebral artery
label: e
answer: no
explanation: Infarcts affecting the middle cerebral artery (MCA) result in weakness and sensory loss on the contralateral side of the face and the body. MCA strokes affect the face and arm more severely than the leg.
name: Left middle cerebral artery
label: a
answer: yes
explanation: Posterior cerebral artery (PCA) infarcts commonly cause visual defects, specifically contralateral homonymous hemianopia. This patient has no visual abnormalities.
name: Right posterior cerebral artery
label: d
answer: no

Correct answer: a
During embryonic development, which primary vesicle does the thalamus form from?

Options:
explanation: The rhombencephalon (hindbrain) is the third primary vesicle. It later forms the metencephalon and the myelencephalon (secondary vesicles), which develop into the pons and cerebellum as well as the medulla, respectively. It additionally forms the 4th ventricle and central canal.
name: Rhombencephalon
label: c
answer: no
explanation: The notochord is the precursor of the neural plate. It secretes growth factors which stimulate the differentiation of the overlying ectoderm into neuroectoderm. This happens before the development of the primary vesicles.
name: Notochord
label: e
answer: no
explanation: The mesencephalon (midbrain) is the second primary vesicle. It has no secondary vesicles and forms the midbrain as well as the cerebral aqueduct.
name: Mesencephalon
label: b
answer: no
explanation: Prosencephalon (forebrain) is a primary vesicle that gives rise to the telencephalon and diencephalon (secondary vesicles). The diencephalon then goes on to form the thalamus, hypothalamus and epithalamus as well as the third ventricle.
name: Prosencephalon
label: a
answer: yes
explanation: The caudal end of the neural tube forms the spinal cord. The thalamus develops from the cranial end of the neural tube, specifically the forebrain.
name: Spinal cord
label: d
answer: no

Correct answer: a
Which morphogen is responsible for the differentiation of motor neurones along the dorsoventral axis of neural tube development?

Options:
explanation: Hox genes are involved in the process of segmentation which establishes regional identity in the body by dividing into repeating, similar segments or units, which eventually give rise to specific body parts and structures. It does not extend into the midbrain and forebrain.
name: Hox gene
label: d
answer: no
explanation: Retinoic acid is a secreted into the anterior axis (cephalic end) of the neural tube.
name: Retinoic acid
label: c
answer: no
explanation: Transforming growth factor-beta family (TGF-b) is a group of morphogens responsible for the patterning of the dorsal-ventral axis and contributes to the differentiation of sensory neurones.
name: Transforming growth factor-beta family
label: b
answer: no
explanation: Sonic hedgehog (SHH) is the morphogen responsible for the patterning of the dorsal-ventral axis and contributes to the differentiation of motor neurones. it is secreted by the notochord and floor plate.
name: Sonic hedgehog
label: a
answer: yes
explanation: Otx genes are responsible for the segmentation process that involves the prosencephalon. Emx genes are also involved.
name: Otx gene
label: e
answer: no

Correct answer: a