hllj/quesmed huggingface dataset:
With reference to the surgical management of carpal tunnel syndrome, which of the following structures is divided?

Options:
explanation: The brachial plexus is a complex network of nerves that serves the upper extremity. It is not involved in carpal tunnel syndrome or its surgical management.
name: Brachial plexus
label: e
answer: no
explanation: The median nerve is the structure affected by carpal tunnel syndrome, and the goal of surgical intervention is to relieve pressure on this nerve. The median nerve is not divided during the procedure.
name: Median nerve
label: b
answer: no
explanation: During carpal tunnel release surgery, the flexor retinaculum (transverse carpal ligament) is divided. This surgical procedure involves cutting the ligament to relieve pressure on the median nerve and alleviate symptoms.
name: Flexor retinaculum
label: a
answer: yes
explanation: The ulnar nerve is not typically involved in carpal tunnel syndrome, and it is not divided during carpal tunnel release surgery.
name: Ulnar nerve
label: c
answer: no
explanation: The radial artery is not divided during carpal tunnel release surgery. The surgical focus is on releasing the pressure on the median nerve.
name: Radial artery
label: d
answer: no

Correct answer: a
High ankle sprains, also known as syndesmotic ankle injuries, primarily involve which ligamentous structure in the ankle joint?

Options:
explanation: The ATFL is primarily associated with lateral ankle sprains and is not involved in high ankle sprains. High ankle sprains involve the ligaments higher up in the leg, closer to the tibia and fibula.
name: Anterior talofibular ligament (ATFL)
label: b
answer: no
explanation: The CFL is also associated with lateral ankle sprains and is not a part of the high ankle sprain mechanism.
name: Calcaneofibular ligament (CFL)
label: c
answer: no
explanation: High ankle sprains involve the disruption of the anterior inferior tibiofibular ligament (AITFL), which connects the tibia and fibula just above the ankle joint. This ligament plays a key role in maintaining the stability of the ankle joint.
name: Anterior inferior tibiofibular ligament (AITFL)
label: a
answer: yes
explanation: The deltoid ligament is a strong, broad ligament on the medial (inner) side of the ankle. It is not the primary structure involved in high ankle sprains.
name: Deltoid ligament
label: d
answer: no
explanation: The PTFL is primarily involved in lateral ankle sprains, not high ankle sprains.
name: Posterior talofibular ligament (PTFL)
label: e
answer: no

Correct answer: a
Which of the following best describes the cause of varicose veins?

Options:
explanation: Varicose veins result from venous insufficiency rather than arterial insufficiency. They occur in the superficial venous system, not the arterial system.
name: Arterial insufficiency leading to vein dilation
label: b
answer: no
explanation: Whilst lymphatic system disorders can lead to various medical conditions, they are not a primary cause of varicose veins. Varicose veins are primarily a result of venous insufficiency.
name: Deficiency of the lymphatic system
label: e
answer: no
explanation: Excessive exercise and muscle hypertrophy do not directly cause varicose veins. In fact, regular exercise can help improve venous circulation and reduce the risk of varicose veins.
name: Excessive exercise and muscle hypertrophy
label: c
answer: no
explanation: Cold temperatures are not a known cause of varicose veins. Varicose veins are more influenced by factors related to vein function and genetics.
name: Chronic exposure to cold temperatures
label: d
answer: no
explanation: Varicose veins are primarily caused by impaired venous valves and increased venous pressure. When these valves fail to function properly, blood flows backward and pools in the veins, causing them to dilate and become varicose.
name: Impaired venous valves and increased venous pressure
label: a
answer: yes

Correct answer: a
A 52-year-old male patient presents with unilateral lower extremity pain, swelling, and redness.

Based on the clinical presentation and initial evaluation, which of the following diagnostic tests is most commonly used for confirming the diagnosis of deep vein thrombosis (DVT)?

Options:
explanation: Whilst MRI can be used for diagnosing DVT in specific situations, the most commonly employed diagnostic tool is Doppler ultrasound which is easier and cheaper to carry out.
name: Magnetic resonance imaging
label: d
answer: no
explanation: Chest X-rays are not typically used for diagnosing DVT. They are more commonly employed to evaluate conditions of the chest and lungs, such as pneumonia or pneumothorax.
name: Chest X-ray
label: b
answer: no
explanation: Electrocardiograms are used to assess the electrical activity of the heart and are not a primary diagnostic tool for DVT. However, they may be performed to rule out other cardiac conditions if there are associated symptoms.
name: Electrocardiogram
label: c
answer: no
explanation: ABG analysis assesses oxygen and carbon dioxide levels in the blood and is not used for diagnosing DVT. It is primarily used in the evaluation of respiratory and metabolic disorders.
name: Arterial blood gas (ABG) analysis
label: e
answer: no
explanation: Doppler ultrasound is the most commonly used diagnostic test for confirming DVT. It is a non-invasive and highly sensitive method for visualising blood flow in deep veins and identifying the presence of blood clots.
name: Doppler ultrasound
label: a
answer: yes

Correct answer: a
A 45-year-old patient presents with a history of a fall onto an outstretched hand and presents with a characteristic deformity of the wrist. On physical examination, there is dorsal displacement of the distal radius.

Based on these findings, which of the following is the most likely diagnosis for this wrist injury?

Options:
explanation: The patient's presentation, with dorsal displacement of the distal radius following a fall onto an outstretched hand, is indicative of a Colles fracture. Colles fractures are common wrist fractures, often resulting from a fall onto an outstretched hand with the wrist extended.
name: Colles fracture
label: a
answer: yes
explanation: A Smith fracture, also known as a reverse Colles fracture, is characterised by volar (palmar) displacement of the distal radius, rather than dorsal displacement.
name: Smith fracture
label: e
answer: no
explanation: Scaphoid fractures typically present with pain in the anatomical snuffbox and are less likely to cause dorsal displacement of the distal radius. The anatomical snuffbox is a depression on the thumb side of the wrist.
name: Scaphoid fractures
label: b
answer: no
explanation: Monteggia fractures involve a fracture of the proximal ulna and dislocation of the radial head. They occur at the elbow, not the wrist, and are not consistent with the presentation described.
name: Monteggia fracture
label: c
answer: no
explanation: Galeazzi fractures involve a fracture of the distal radius and dislocation of the distal ulna. Whilst it includes a distal radius fracture, the displacement pattern and location described in this question are not consistent with a Galeazzi fracture.
name: Galeazzi fracture
label: d
answer: no

Correct answer: a
In older adults, which of the following conditions is the most common underlying reason for falls, often due to factors such as altered mental status and gait disturbances?

Options:
explanation: Whilst hyperthyroidism can have a range of effects on an individual's health, including changes to metabolism and heart rate, it is not the most common underlying reason for falls in older adults.
name: Hyperthyroidism
label: e
answer: no
explanation: Osteoarthritis can lead to joint pain and decreased mobility, but it is not generally the primary reason for falls in older adults. Falls in this population are often due to other factors.
name: Osteoarthritis
label: d
answer: no
explanation: Hypertension can increase the risk of cardiovascular events such as strokes but is not the most common reason for falls in older adults.
name: Hypertension
label: c
answer: no
explanation: Peripheral neuropathy, a condition that affects the nerves in the extremities, can contribute to balance and gait issues, but it is not the leading reason for falls in older adults.
name: Peripheral neuropathy
label: b
answer: no
explanation: Urinary tract infections (UTIs) are a common underlying reason for falls in older adults. UTIs can lead to altered mental status, confusion, and gait disturbances, which increase the risk of falls.
name: Urinary tract infection (UTI)
label: a
answer: yes

Correct answer: a
When comparing osteoarthritis (OA) and rheumatoid arthritis (RA), which of the following correctly identifies the joints most commonly affected in each condition?

Options:
explanation: In OA, the hips and knees are frequently affected, whereas RA predominantly affects the small joints of the hands and wrists, such as the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints.
name: OA primarily affects the hips and knees, whilst RA primarily affects the small joints of the hands and wrists
label: a
answer: yes
explanation: This option is not accurate. Whilst there can be some overlap in joint involvement, OA and RA typically affect different joints.
name: OA and RA both primarily affect the same joints, such as the wrists and ankles
label: e
answer: no
explanation: In OA, the weight-bearing joints like the hips and knees are more affected. In contrast, RA commonly involves the small joints of the hands and wrists.
name: OA primarily affects the small joints of the hands and wrists, whilst RA primarily affects the hips and knees
label: b
answer: no
explanation: This option incorrectly attributes shoulder and ankle joint involvement to RA, which is not the most common pattern of joint involvement in this condition.
name: OA primarily affects the large weight-bearing joints like the knees and hips, whilst RA primarily affects the shoulders and ankle joints
label: d
answer: no
explanation: This option does not accurately describe the most common patterns of joint involvement in OA and RA.
name: OA primarily affects the spine and the sacroiliac joints, whilst RA primarily affects the shoulder and elbow joints
label: c
answer: no

Correct answer: a
On radiographic imaging of osteoarthritis (OA), which of the following are common X-ray findings that may suggest the presence of this degenerative joint condition?

Options:
explanation: Soft tissue calcifications and joint subluxation are not common X-ray findings in OA. They may be seen in other musculoskeletal conditions but are not specific to OA.
name: Soft tissue calcifications and joint subluxation
label: e
answer: no
explanation: Pannus formation and joint ankylosis are associated with inflammatory arthritis, particularly rheumatoid arthritis, and are not typical X-ray findings in OA.
name: Pannus formation and joint ankylosis
label: d
answer: no
explanation: Narrowed joint space and osteophyte formation are common X-ray findings in osteoarthritis. These changes result from the gradual loss of cartilage in the affected joint and the body's attempt to repair the damage by forming bony outgrowths (osteophytes).
name: Narrowed joint space and osteophyte formation
label: a
answer: yes
explanation: Joint effusion and synovial hypertrophy are more commonly associated with inflammatory arthritis, such as rheumatoid arthritis, and are not typical X-ray findings in OA.
name: Joint effusion and synovial hypertrophy
label: b
answer: no
explanation: Periarticular erosions and subchondral cysts are typically seen in inflammatory arthropathies like rheumatoid arthritis. They are not common X-ray findings in OA.
name: Periarticular erosions and subchondral cysts
label: c
answer: no

Correct answer: a
Methotrexate is commonly used in the management of rheumatoid arthritis (RA).

Which of the following side effects is associated with methotrexate and is attributed to its immunosuppressive properties?

Options:
explanation: Methotrexate can cause gastrointestinal side effects, including nausea and ulcerative mucositis, but gastrointestinal bleeding is not primarily attributed to its immunosuppressive properties.
name: Gastrointestinal bleeding
label: b
answer: no
explanation: Methotrexate is an immunosuppressive medication and can weaken the immune system. This is an important aspect of its use in RA, as it helps to reduce the autoimmune inflammatory response associated with the disease.
name: Immunosuppression
label: a
answer: yes
explanation: Haemolytic anaemia is not a typical side effect of methotrexate's immunosuppressive action. Anaemia can occur due to other mechanisms but is not directly related to immunosuppression.
name: Haemolytic anaemia
label: d
answer: no
explanation: Whilst methotrexate is primarily metabolised by the kidneys, nephrotoxicity is not a common side effect related to its immunosuppressive action.
name: Nephrotoxicity
label: c
answer: no
explanation: Osteoporosis can be a concern with long-term methotrexate use, but it is not primarily attributed to its immunosuppressive properties.
name: Osteoporosis
label: e
answer: no

Correct answer: a
In the context of myotomes and their corresponding spinal nerve roots, which spinal nerve roots are primarily responsible for the abduction of the shoulder, a movement commonly associated with the function of the brachial plexus?

Options:
explanation: Lumbar spinal nerve roots L2 and L3 are associated with lower limb functions and are not involved in shoulder abduction.
name: L2 and L3
label: e
answer: no
explanation: C7 and T1 contribute to functions of the lower brachial plexus and upper thoracic regions and are not primarily responsible for shoulder abduction.
name: C7 and T1
label: d
answer: no
explanation: C6 and C7 are both part of the brachial plexus and contribute to shoulder abduction. However, they are not the primary spinal nerve roots responsible for this specific movement.
name: C6 and C7
label: c
answer: no
explanation: The spinal nerve roots C5 and C6 play a significant role in shoulder abduction, particularly in the context of the brachial plexus. The axillary nerve, a branch of the brachial plexus, innervates the deltoid muscle, which is a key muscle responsible for shoulder abduction.
name: C5 and C6
label: a
answer: yes
explanation: C7 and C8 are not primarily responsible for shoulder abduction. They are associated with different upper limb functions and regions.
name: C7 and C8
label: b
answer: no

Correct answer: a
The diaphragm, a critical respiratory muscle, contains several openings or passages through which structures pass.

Which of the following diaphragmatic openings allows the inferior vena cava to traverse from the abdomen to the thoracic cavity?

Options:
explanation: The oesophageal hiatus allows the oesophagus to pass through the diaphragm but is not the opening through which the inferior vena cava traverses.
name: Oesophageal hiatus
label: b
answer: no
explanation: The caval opening, also known as the caval foramen, is the diaphragmatic opening through which the inferior vena cava passes from the abdomen to the thoracic cavity.
name: Caval opening
label: a
answer: yes
explanation: The phrenic foramen is not a recognised diaphragmatic opening for major blood vessels. Instead, it is related to the passage of the phrenic nerve through the diaphragm.
name: Phrenic foramen
label: e
answer: no
explanation: The aortic hiatus permits the aorta to pass through the diaphragm, but it is not the correct opening for the inferior vena cava.
name: Aortic hiatus
label: c
answer: no
explanation: The sternal foramen is not associated with the diaphragm but is related to the sternum (breastbone).
name: Sternal foramen
label: d
answer: no

Correct answer: a
A patient presents with a loss of knee extension and sensory loss to the anterior and medial thigh after a stab injury to the upper thigh.

Which anatomical structure is most likely to be damaged in this case?

Options:
explanation: The sciatic nerve primarily innervates the posterior thigh and lower leg muscles. It is not responsible for knee extension or the sensory loss described in this question.
name: Sciatic nerve
label: b
answer: no
explanation: The genitofemoral nerve primarily provides sensory innervation to the genital region and the upper thigh. It is not responsible for knee extension.
name: Genitofemoral nerve
label: e
answer: no
explanation: The obturator nerve innervates the medial thigh and is not responsible for knee extension. It does not match the pattern of symptoms described in this question.
name: Obturator nerve
label: c
answer: no
explanation: The lateral femoral cutaneous nerve is responsible for providing sensation to the lateral thigh but does not control knee extension or innervate the areas described in this question.
name: Lateral femoral cutaneous nerve
label: d
answer: no
explanation: The femoral nerve innervates the anterior thigh muscles, including the quadriceps, which are essential for knee extension. Damage to the femoral nerve can result in the loss of knee extension and sensory deficits in the anterior and medial thigh.
name: Femoral nerve
label: a
answer: yes

Correct answer: a
A 37-year-old female presents to her general practitioner with irregular periods and weight loss. A series of blood tests are performed which show a suppressed TSH and high fT3 and fT4.

What is the likely diagnosis?

Options:
explanation: This is defined as a suppressed TSH with normal fT4 and fT3 in a patient with no symptoms. As the fT3 and fT4 levels in this case are high, this is not the correct answer.
name: Subclinical hyperthyroidism
label: d
answer: no
explanation: This is not correct as the fT4 levels are also raised. In T3 toxicosis, only fT3 levels are raised. This is usually seen in multinodular goitres.
name: T3 toxicosis
label: c
answer: no
explanation: Hypothyroidism, i.e. low thyroid hormone levels, increases thyroid-releasing hormone secretion from the hypothalamus and thyroid-stimulating hormone (TSH) secretion from the anterior pituitary via the hypothalamic-pituitary-thyroid axis. This results in a high TSH level with suppressed fT3 and fT4.
name: Hypothyroidism
label: b
answer: no
explanation: This is defined as a high TSH with normal fT4 and fT3 in a patient with no symptoms. As the TSH is suppressed and fT3 and fT4 levels are high, this is not the correct answer.
name: Subclinical hypothyroidism
label: e
answer: no
explanation: Hyperthyroidism is the presence of excess thyroid hormones (fT3 and fT4). These increased hormones act on the hypothalamic-pituitary-thyroid axis and activate a negative feedback loop. This decreases thyroid-releasing hormone (TRH) production from the hypothalamus as well as thyroid-stimulating hormone (TSH) from the anterior pituitary.
name: Hyperthyroidism
label: a
answer: yes

Correct answer: a
A 50-year-old female experiencing weight gain, excessive hair growth and proximal muscle wasting is referred to an endocrinologist for suspected Cushing’s syndrome. A high-dose dexamethasone test is performed which reveals a suppressed ACTH and a high cortisol level.

Which of the following is the most likely cause of this patient's Cushing’s syndrome?

Options:
explanation: Pseudo-Cushing's syndrome is thought to be caused by decreased clearance of cortisol by the liver leading to excess serum cortisol. In Pseudo-Cushing's syndrome, high-dose dexamethasone acts on the intact hypothalamus-pituitary-adrenal axis to reduce both ACTH and cortisol.
name: Pseudo-Cushing's Syndrome due to alcohol
label: e
answer: no
explanation: Exogenous corticosteroid use results in a raised cortisol which is completely independent from the hypothalamus-pituitary-adrenal axis. Therefore dexamethasone, which acts on this axis, does not affect cortisol levels.
name: Exogenous corticosteroid use
label: d
answer: no
explanation: This is incorrect as ectopic sources of ACTH, such as lung cancers, are independent of BOTH the hypothalamus and pituitary. These sources will produce excess ACTH which will act on the adrenals resulting in excess cortisol production. As dexamethasone only acts centrally on the hypothalamus and not on the ectopic source of ACTH, it will not suppress serum ACTH or cortisol levels.
name: Ectopic ACTH production
label: c
answer: no
explanation: This is incorrect as dexamethasone will act on the pituitary to suppress ACTH production. This will, by extension, suppress cortisol production from the adrenals.
name: Pituitary adenoma
label: b
answer: no
explanation: In patients with adrenal adenomas, cortisol production is independent from the pituitary as the excess production is derived from the adrenals. Therefore, even though dexamethasone will suppress the pituitary (resulting in low ACTH), cortisol levels will remain high due to the ectopic production from the adrenals.
name: Adrenal adenoma
label: a
answer: yes

Correct answer: a
A 30-year-old male presents to his GP with headache, sweating and abdominal pain. His father was previously diagnosed with multiple endocrine neoplasia 2 (MEN2). The GP measures his blood pressure and finds it to be 160/83.

Which of the following tests will confirm the diagnosis?

Options:
explanation: This is the first-line test used in the diagnosis of hyperaldosteronism. Although Conn’s syndrome and hyperaldosteronism can present with headaches and hypertension, the excess aldosterone will also cause increased urination and thirst as well as cramps due to hyperkalaemia.
name: Aldosterone:Renin ratio
label: c
answer: no
explanation: This test is used in the workup of Cushing’s syndrome. Cushing's syndrome can present with central obesity, buffalo hump, moon face, proximal myopathy and hirsutism.
name: 24-hour urinary cortisol
label: b
answer: no
explanation: The most likely diagnosis is phaeochromocytoma, a catecholamine-secreting tumour associated with MEN2. Adrenaline and noradrenaline secretion from the phaeochromocytoma stimulates the sympathetic nervous system which leads to excess sweating, palpitations, headaches and increased blood pressure through arterial vasoconstriction. The gold-standard investigation is the measurement of plasma and urinary metanephrines, which are metabolites of adrenaline.
name: Plasma and urinary metanephrines
label: a
answer: yes
explanation: This test is used to diagnose Addison’s disease. Addison's typically presents with **hypotension**, weakness, hyperpigmentation and GI symptoms such as nausea, vomiting and abdominal pain. There is no formal link between MEN2 and Addison's disease.
name: Short Synacthen test
label: d
answer: no
explanation: Aldosterone concentration may be helpful in the diagnosis of hyperaldosteronism and adrenal insufficiency. However, it alone cannot confirm either diagnosis and is not indicated in this case.
name: Plasma aldosterone concentration
label: e
answer: no

Correct answer: a