hllj/quesmed huggingface dataset:
A 55-year-old male with stage 3b Chronic Kidney Disease (CKD) presents to A&E complaining of fatigue that is interfering with his everyday life. He also looks particularly pale.

Which of the following deficiencies is likely responsible for this presentation?

Options:
explanation: Potassium is commonly elevated in patients with CKD as there is reduced excretion from the kidney. Additionally, symptoms do not coincide with hypokalaemia.
name: Potassium
label: d
answer: no
explanation: Folate deficiency can result in macrocytic anaemia and is often caused by dietary insufficiency. However, due to the presence of chronic kidney disease, a deficiency in EPO is more likely.
name: Folate
label: e
answer: no
explanation: This is a hormone that is naturally produced in the kidneys. It is responsible for stimulating red blood cell synthesis. A deficiency of this hormone is commonly observed in patients with kidney disease. This results in a normocytic anaemia which is what this patient is presenting with.
name: Erythropoietin (EPO)
label: a
answer: yes
explanation: Vitamin B12 is essential for neurological function and red blood cell synthesis. Deficiency can cause macrocytic anaemia, however, in this case, an EPO deficiency is more likely due to chronic kidney disease.
name: Vitamin B12
label: b
answer: no
explanation: Vitamin C deficiency is responsible for scurvy which may present with symptoms similar to anaemia. However, given that this patient has chronic kidney disease, and there is no particular evidence they are lacking vitamin C in their diet, this answer is unlikely.
name: Vitamin C
label: c
answer: no

Correct answer: a
A 17-year-old female presents to A&E complaining of being systemically unwell over the last 3 days since eating a "dodgy takeaway." A venous blood gas (VBG) shows:


||||
|--------------|:-------:|------------------|
|pH|7.32|7.35 - 7.45|
|PaO₂|12.0 kPa|11 - 15|
|PaCO₂|4.9 kPa|4.6 - 6.4|
|Bicarbonate|19 mmol/L|22 - 30|
|Anion gap|+9 mmol/L|8 - 14|

Which of the following is the most likely cause of this presentation?

Options:
explanation: Sepsis is a life-threatening emergency involving systemic infection of the blood. Septic shock results in lactic acidosis which will cause a raised anion gap metabolic acidosis. Therefore, this is not the correct answer.
name: Sepsis
label: b
answer: no
explanation: This patient is likely suffering from gastroenteritis. Symptoms often include diarrhoea and vomiting. Diarrhoea can cause a metabolic acidosis with a normal anion gap due to loss of bicarbonate from the GI tract. This is what the VBG results are showing.
name: Diarrhoea
label: a
answer: yes
explanation: This is a life-threatening emergency which occurs in diabetics. Common signs and symptoms include breathlessness, stomach pain and vomiting. It will cause a raised anion gap metabolic acidosis, similar to septic shock. Therefore, this is not the correct answer.
name: Diabetic ketoacidosis
label: c
answer: no
explanation: Hyperventilation results in the loss of CO~2~ from the body causing a respiratory alkalosis. Therefore, this answer is incorrect.
name: Hyperventilation
label: e
answer: no
explanation: Vomiting can be a symptom of gastroenteritis. However, it results in metabolic alkalosis due to the loss of hydrogen ions and therefore is incorrect.
name: Vomiting
label: d
answer: no

Correct answer: a
A 35 year old man has recently returned from travelling around Africa. He mentioned he was drinking local water.

He is complaining of itchiness, urinary frequency and haematuria. An abdominal X-ray shows calcification of the bladder. Which of the following is the likely organism responsible for this presentation?

Options:
explanation: This is a type of diploid fungus that is often associated with antibiotic use. It commonly causes candidiasis (thrush) which can present with dysuria, abnormal discharge and itching. This does not match this patient's presentation and therefore, this answer is unlikely.
name: Candida albicans
label: c
answer: no
explanation: This is a gram-positive bacteria found in the normal microbiota of the female perineum and vagina and commonly causes urinary tract infections. It is less common in men and is not associated with bladder calcification. Therefore this is an unlikely causative pathogen.
name: Staphylococcus saprophyticus
label: e
answer: no
explanation: This man is presenting with symptoms of a urinary tract infection. Schistosoma haematobium is a trematode worm found in contaminated water in tropical and subtropical areas which causes schistosomiasis. It gains access to the host through the skin, matures in the liver and lays eggs which can travel to and penetrate the bladder. This can cause bladder calcification in addition to other complications. It is treated with praziquantel.
name: Schistosoma haematobium
label: a
answer: yes
explanation: Escherichia coli is a gram-negative bacteria and is the most common pathogen causing urinary tract infections (UTIs). While it is the most common cause of UTIs, it is not known to cause bladder calcification.
name: Escherichia coli
label: b
answer: no
explanation: This is a protozoan that is responsible for causing trichomoniasis, a sexually transmitted infection. It is uncommon in males and therefore in this case is unlikely.
name: Trichomonas vaginalis
label: d
answer: no

Correct answer: a
Which of the following substances is measured to provide the most accurate estimate of the glomerular filtration rate?

Options:
explanation: Urea is reabsorbed in the kidney tubules and contributes to the osmolarity of the medullary interstitial gradient during dehydration. Therefore, it is not an accurate marker of GFR.
name: Urea
label: c
answer: no
explanation: Urinary inulin is the gold standard for calculating eGFR as it is freely filtered by the glomerulus, not secreted or reabsorbed in the tubules and is not metabolized or synthesized by the kidneys.
name: Inulin
label: a
answer: yes
explanation: Sodium is reabsorbed throughout the kidney tubules and would not be a reliable marker of GFR.
name: Sodium
label: d
answer: no
explanation: Similar to sodium, water is reabsorbed throughout the kidney tubules and would not be a reliable marker of GFR.
name: Water
label: e
answer: no
explanation: Albumin is a protein and therefore is not freely filtered in the glomerulus under normal conditions. Therefore it would not be an accurate marker of GFR.
name: Albumin
label: b
answer: no

Correct answer: a
Which of these statements is correct regarding spermatogenesis?

Options:
explanation: This statement is incorrect. Spermatogenesis requires a lower temperature to occur.
name: It requires a normal body temperature
label: e
answer: no
explanation: This statement is incorrect. Oogenesis results in the production of a finite number of oocytes as the ovaries have no stem cells. In spermatogenesis, there are an infinite number of sperm produced as the testis has a stem cell population.
name: It results in the production of a finite number of sperm
label: d
answer: no
explanation: This statement is incorrect. The process of spermatogenesis in males is continuous, unlike oogenesis which is discontinuous with periods of arrest.
name: It is discontinuous
label: b
answer: no
explanation: This statement is incorrect, sperm cells are highly motile. It is female gametes that are immotile.
name: It results in the production of immotile gametes
label: c
answer: no
explanation: Unlike oogenesis, where meiosis begins before birth and where the initial stimulus is not steroidal, in spermatogenesis meiosis is indirectly dependent on progesterone which increases significantly during puberty.
name: Meiosis begins at puberty
label: a
answer: yes

Correct answer: a
Which pelvic gateway does the sciatic nerve pass through?

Options:
explanation: This is another pelvic gateway. It allows the passage of the obturator neurovascular bundle as the name suggests.
name: Obturator canal
label: c
answer: no
explanation: The greater sciatic foramen is an opening in the posterior aspect of the pelvis which allows structures to pass into the gluteal region. It allows the passage of the sciatic nerve and the gluteal neurovascular bundle.
name: Greater sciatic foramen
label: a
answer: yes
explanation: The pelvic inlet is marked by the pelvic brim. It consists of the sacral prominence posteriorly, the arcuate line laterally and the pectineal line of the pubis and the pubic symphysis anteriorly.
name: Pelvis inlet
label: e
answer: no
explanation: The lesser foramen is separated from the greater foramen by the sacrospinous ligament. It allows the passage of the pudendal nerve and the internal pudendal vessels.
name: Lesser sciatic foramen
label: b
answer: no
explanation: This is the medial compartment of the femoral sheath. It contains lymphatic vessels which drain the deep inguinal lymph nodes, the lacunar node, empty space and loose connective tissue.
name: Femoral canal
label: d
answer: no

Correct answer: a
An 18-year-old male presents to his GP with concerns that he is not developing appropriately.

Examination reveals a small penis and sparse pubic hair.

He also complains that he is having trouble smelling things.

Blood tests are performed showing low FSH, LH and testosterone. Which of the following is the most likely diagnosis?

Options:
explanation: This is the absence of both testes at birth. It results in hypergonadotropic hypogonadism. Therefore, FSH and LH levels are abnormally elevated.
name: Anorchia
label: e
answer: no
explanation: This condition is also known as Kallman's syndrome. Symptoms include hypogonadism, small genitalia, scanty pubic hair and anosmia. This is due to low levels of LH, FSH and testosterone. It is treated by monthly testosterone injections.
name: Kallman's Syndrome
label: a
answer: yes
explanation: This is where there is a temporary delay of puberty due to the underdevelopment of the hypothalamic-pituitary-gonadal axis. This results in low levels of FSH and LH. However, anosmia is not observed in this condition and therefore this answer is unlikely.
name: Constitutional delay of puberty
label: d
answer: no
explanation: This is a type of hypergonadotrophic hypogonadism. It is a result of an XXY chromosome karyotype. It presents similarly to Kallman's syndrome with hypogonadism, small genitalia, scanty pubic hair and additionally gynecomastia. In Klinefelter's syndrome, FSH and LH levels are abnormally raised. Therefore this answer is incorrect.
name: Klinefelter's Syndrome
label: b
answer: no
explanation: Malnutrition can cause a temporary delay in puberty.
name: Malnutrition
label: c
answer: no

Correct answer: a
A 23-year-old male presents to A&E complaining of sudden onset severe testicular pain. The patient is noted to have an absent cremasteric reflex.

Which spinal level is implicated in this reflex?

Options:
explanation: The cremasteric reflex tests the L1 spinal level.
name: T10
label: b
answer: no
explanation: The cremasteric reflex tests the L1 spinal level.
name: T9
label: d
answer: no
explanation: The cremasteric reflex tests the spinal level L1. It is characterized by the ipsilateral testicular retraction upon stroking the superior medial thigh. It is absent in patients with testicular torsion which is what this patient is presenting with.
name: L1
label: a
answer: yes
explanation: The cremasteric reflex tests the L1 spinal level.
name: S2
label: e
answer: no
explanation: The cremasteric reflex tests the L1 spinal level.
name: L3
label: c
answer: no

Correct answer: a
A pregnant woman comes into the hospital for her antenatal combined screening test. She is 12 weeks pregnant.

Which of the following results would suggest a possible diagnosis of Down's syndrome?

Options:
explanation: Down Syndrome is suggested if HCG is elevated, PAPP-A is reduced and nuchal translucency is thickened. Therefore, this is not correct.
name: Reduced HCG; Reduced PAPP-A and normal nuchal translucency
label: b
answer: no
explanation: Down's Syndrome is suggested if HCG is elevated, PAPP-A is reduced and nuchal translucency is thickened. Therefore, this is not correct.
name: Elevated HCG; Elevated PAPP-A and normal nuchal translucency
label: d
answer: no
explanation: The combined test is a standard pre-natal test screening for Down's syndrome. It measures nuchal translucency, serum B-HCG and pregnancy-associated plasma protein A (PAPP-A), and the above results suggest a diagnosis of Down's syndrome.
name: Elevated HCG; Reduced PAPP-A and thickened nuchal translucency
label: a
answer: yes
explanation: Alpha-fetoprotein is measured as part of the quadruple test, which is a screening test used for Down's syndrome screening test used if women present later in their pregnancy. A lowered alpha-fetoprotein suggests a possible diagnosis of Down's syndrome. Therefore, this is incorrect.
name: Elevated Alpha-fetoprotein
label: c
answer: no
explanation: Oestriol is measured as part of the quadruple test, which is a screening test used for Down's syndrome screening test used if women present later in their pregnancy. A lowered oestriol is suggestive of a possible diagnosis of Down's syndrome. Therefore, this is incorrect.
name: Elevated oestriol
label: e
answer: no

Correct answer: a
A 43-year-old woman has recently been diagnosed with breast cancer. She is started on tamoxifen.

Which of the following describes the mechanism of action of this drug?

Options:
explanation: This is the mechanism of action of the drug trastuzumab (Herceptin). Epidermal Growth Factor Receptor 2 (HER2) is over-expressed in 20-30% of breast cancers. Trastuzumab prevents signalling, suppresses angiogenesis and growth and mediates cytotoxicity.
name: HER2 monoclonal antibody
label: b
answer: no
explanation: Oestrogen can promote the expression of genes in breast cancer that can stimulate cancer growth. Therefore, tamoxifen prevents this from happening. It is often used prophylactically after surgery for early-stage breast cancer.
name: Oestrogen receptor antagonist
label: a
answer: yes
explanation: A substance that would stimulate estrogen receptors would be counterintuitive. Around 60% of breast cancers are oestrogen receptor-positive.  Oestrogen acts to promote the proliferation of the cancer. Therefore this is incorrect.
name: Oestrogen receptor agonist
label: d
answer: no
explanation: This is the mechanism of action of the drug docetaxel which can be used to treat certain types of breast cancer. By stabilizing microtubules, there are aberrant, multipolar spindles and chromosomes are unable to segregate leading to apoptosis of the cancerous cells.
name: Stabilizes microtubules
label: c
answer: no
explanation: This is the mechanism of action of Gardasil which is used for HPV vaccination. This is used for prophylaxis of cervical cancer due to the HPV virus being a significant risk factor for cervical cancer.
name: Stimulates human papillomavirus (HPV) targeting antibodies
label: e
answer: no

Correct answer: a
Which of the following hormones is responsible for preventing menstruation during pregnancy?

Options:
explanation: Progesterone is an important hormone involved in a variety of important reproductive processes. In pregnancy, it is important for preventing uterine contractions. It is not responsible for halting menstruation.
name: Progesterone
label: b
answer: no
explanation: This answer is incorrect. During pregnancy, serum FSH concentrations are decreased due to the inhibitory effects of elevated estrogen and progesterone levels.
name: Follicle-stimulating hormone (FSH)
label: d
answer: no
explanation: Maternal testosterone levels are elevated during pregnancy. However, they are not responsible for amenorrhea.
name: Testosterone
label: e
answer: no
explanation: Oestrogen levels significantly increase during pregnancy. It is specifically responsible for improving the vascularization of the placenta during pregnancy.
name: Oestrogen
label: c
answer: no
explanation: Human chorionic gonadotropin (hCG) is a hormone produced by the placenta during pregnancy. HCG levels rise after conception and continue to rise until approximately 10 weeks into pregnancy. This encourages the thickening of the uterine lining to support a growing embryo.
name: HCG
label: a
answer: yes

Correct answer: a
A 22-year-old male comes to his GP complaining of dysuria and discharge from his penis. A genital swab confirms a diagnosis of gonorrhoea.

Which of the following describes the causative pathogen when visualised under light microscopy?

Options:
explanation: 90% of males with a penile urethral gonorrhoea infection will have symptoms. This includes urethral discharge and pain. Light microscopy is one of the three basic microbial testing methods for sexually transmitted infections. Neisseria gonorrhoeae is a gram-negative intracellular diplococcus which infects epithelial cells of the mucous membrane of the genito-urinary tract or rectum.
name: Gram-negative diplococci
label: a
answer: yes
explanation: This is how Chlamydia trachomatis is characterized under a light microscope.
name: Obligate, intracellular Gram-negative
label: d
answer: no
explanation: Candida albicans is a gram-positive diploid fungus which can infect the vulva and/or vagina.
name: Gram-positive diploid
label: b
answer: no
explanation: This is how Trichomonas vaginalis appears under light microscopy.
name: Pear shaped flagellate
label: e
answer: no
explanation: This is the gram stain of Treponema pallidum under light microscopy. This is also referred to as syphilis.
name: Gram negative spirochete
label: c
answer: no

Correct answer: a
Which of these is a severe possible side-effect of the combined oral contraceptive pill?

Options:
explanation: There is an increased risk of endometrial cancer in patients taking progesterone-only hormone replacement therapy unopposed to oestrogen. However, this is not a complication in patients taking the combined oral contraceptive pill.
name: Endometrial cancer
label: d
answer: no
explanation: Weight gain is a common side effect of the combined contraceptive pill but it is not acutely life-threatening or severe.
name: Weight Gain
label: e
answer: no
explanation: Coronary heart disease is a severe side effect of anabolic androgen steroids. However, it is not linked to the combined oral contraceptive pill.
name: Coronary heart disease
label: c
answer: no
explanation: Flushing is defined as the sudden reddening of the face or skin due to vasodilation. This is a common side effect of the combined contraceptive pill but it is not severe or life-threatening.
name: Flushing
label: b
answer: no
explanation: The combined contraceptive pill contains oestrogen and progestogen. There is a small increased risk of thromboembolism in patients who take it and this can be life-threatening.
name: Thromboembolism
label: a
answer: yes

Correct answer: a
A 38-year-old woman comes into her GP asking about in-vitro fertilisation (IVF). She has been unable to conceive with her partner naturally over the past year and wants to know the likelihood of IVF being successful in someone her age.

Which of the following states the change of successful pregnancy through IVF?

Options:
explanation: Patients aged 38-39 have a 21.8% chance of IVF treatments being successful. Therefore, this answer is incorrect.
name: 0.5%
label: e
answer: no
explanation: According to HFEA statistics on IVF in the UK, patients aged 38-39 have a 21.8% chance of IVF treatments being successful. Rates of success decrease significantly as the patients get older.
name: 21.8%
label: a
answer: yes
explanation: This is the success rate of patients aged 45 years and older having a successful IVF treatment.
name: 2.0%
label: c
answer: no
explanation: This is the rate of success of IVF treatment in patients aged 40-42.
name: 13.7%
label: d
answer: no
explanation: This is the likelihood of patients aged 18-34 years old having a successful.
name: 32.8%
label: b
answer: no

Correct answer: a
An 18-year-old male attends his GP practice complaining of diarrhoea and severe itchiness in his anus. A full blood count reveals eosinophilia.

Which of the following is the most likely diagnosis?

Options:
explanation: This is one of the most common causes of gastroenteritis. The majority of patients experience vomiting and diarrhoea but is not commonly associated with itchiness and an isolated eosinophilia.
name: Norovirus
label: b
answer: no
explanation: A. lumbricoides is a giant roundworm that can infect and inhabit a patient's gut. it can lead to digestive upsets, malnutrition, and intestinal blockages and may even invade the mouth and nose. It is not commonly associated with itchiness and therefore this diagnosis is unlikely.
name: Ascaris lumbricoides infection
label: c
answer: no
explanation: This protozoan causes an infection of the small intestine known as Giardiasis. It is one of the most common causes of travellers' diarrhoea. It normally presents with self-limiting diarrhoea whereby the stools are classically loose, foul-smelling and fatty. It is not associated with anal pruritis and is therefore unlikely.
name: Giardia lamblia
label: e
answer: no
explanation: This is a hookworm that is often picked up while walking barefoot in infected areas. It attaches to the small intestine and causes hypochromic anaemia. It is not associated with anal itchiness.
name: Ancylostoma duodenale
label: d
answer: no
explanation: Enterobius Vermicularis is a type of threadworm that can infect the GI tract. Female worms migrate to the anus at night and lay thousands of eggs. This results in intense itching of the anal region and also can lead to diarrhoea and elevated eosinophils. Therefore, this is the most likely diagnosis.
name: Enterobius Vermicularis infection
label: a
answer: yes

Correct answer: a
A 63-year-old man presents to A+E with speech problems. He is struggling to talk fluently and can only speak in short, disjointed sentences with continuous stuttering. However, he can understand what others say to him. An MRI was performed which showed a lesion in his left cerebral hemisphere.

In what area of the brain is the lesion most likely located?

Options:
explanation: Incorrect as this is not Broca's area. The cingulate gyrus is a component of the limbic system and is involved in behaviour regulation, processing emotions and regulating autonomic motor function.
name: Cingulate gyrus
label: b
answer: no
explanation: This patient is presenting with Broca's aphasia (non-fluent or expressive aphasia). Symptoms of Broca's aphasia include very poor or absent spontaneous speech with a difficulty in forming complete sentences. There is typically a loss of normal grammatical structure, trouble writing sentences and more difficulty using verbs than nouns. However, understanding is not affected so the patients can still understand others' speech. Broca's aphasia results from damage to the Broca's area which is located in the dominant hemisphere of the frontal lobe in the inferior frontal gyrus (on the left side in a right-handed individual or the right side in a left-handed individual). Therefore, the inferior frontal gyrus is correct.
name: Inferior frontal gyrus
label: a
answer: yes
explanation: Incorrect as this is not Broca's area. The lingual gyrus is involved in processing vision and is located in the occipitotemporal region.
name: Lingual gyrus
label: c
answer: no
explanation: Incorrect as this is not Broca's area. The superior temporal gyrus is the location of the Wernicke's area. Damage to this area leads to Wernicke's (fluent or receptive aphasia) aphasia which results in difficulty understanding others' speech or difficulty processing the meaning of words. Patient's with Wernicke's aphasia can articulate their words normally but speak in a jumbled "word salad" i.e. when speaking they string words together that don't make sense in a sentence. They are typically unaware of the mistakes in their speech.
name: Superior temporal gyrus
label: e
answer: no
explanation: Incorrect as this is not Broca's area. The superior parietal lobule is involved in attention and visuospatial perception.
name: Superior parietal lobule
label: d
answer: no

Correct answer: a