hllj/quesmed huggingface dataset:
A 36-year-old woman presents to her GP complaining of burning in her fingers. She mentions that they turn blue in the cold.

She later reveals that she is having trouble with gritty eyes, and confides that she is experiencing pain during sexual intercourse.

The GP decides to conduct a simple test of her eyes using a 35mm x 5mm filter paper test strip.

What is the name of the test being conducted?

Options:
explanation: The glabella tap test is a neurological test used to assess the glabella reflex. It involves tapping on the forehead to elicit a blinking reflex that is eventually suppressed by the individual. A positive test (in which blinking is not suppressed) is commonly seen in patients with Parkinson’s disease.
name: Glabella tap test
label: e
answer: no
explanation: The Trendelenburg test is used in a musculoskeletal examination to assess the function of the gluteal muscles.
name: Trendelenburg
label: b
answer: no
explanation: The Mentzer index is a calculated value used to differentiate between iron deficiency anaemia and beta thalassaemia.
name: Mentzer index
label: d
answer: no
explanation: This patient likely has Sjogren’s syndrome. This is suggested by the gritty eyes (dry eyes) and pain during sexual intercourse (dyspareunia which occurs due to vaginal dryness), accompanied by Raynaud’s syndrome in her hands. Schirmer's test is a commonly performed test to assess for dry eyes and involves the use of a 35mm x 5mm filter paper test strip.
name: Schirmer
label: a
answer: yes
explanation: The Coombs test is a laboratory test used in the diagnosis of autoimmune haemolytic anaemia.
name: Coombs
label: c
answer: no

Correct answer: a
Which genetic condition is the karyotype below seen in?

[lightgallery]
ZooWeb - Karyotypes, 47, XX +13 (wisc.edu)

Options:
explanation: The karyotype in Klinefelter’s syndrome is XXY, that is, there is an extra X chromosome in a karyotypically male patient.
name: Klinefelter's syndrome
label: d
answer: no
explanation: The karyotype in Edward’s syndrome is trisomy 18.
name: Edward’s syndrome
label: c
answer: no
explanation: The karyotype in Turner syndrome is 45X, that is there is one less X chromosome compared to the normal female karyotype.
name: Turner syndrome
label: e
answer: no
explanation: The karyotype in Down’s syndrome is trisomy 21.
name: Down’s syndrome
label: b
answer: no
explanation: This karyotype shows trisomy 13 which is characteristic of Patau’s syndrome.
name: Patau's syndrome
label: a
answer: yes

Correct answer: a
What type of receptor is implicated in dull pain?

Options:
explanation: Alpha motor neurones are motor neurones that stimulate skeletal muscle contraction.
name: Alpha motor neurones
label: d
answer: no
explanation: Pacinian corpuscles are sensory receptors that detect changes in pressure and vibration in the skin.
name: Pacinian corpuscles
label: c
answer: no
explanation: C fibres are non-myelinated pain fibres that are responsible for dull pain that is poorly localised.
name: C fibres
label: b
answer: yes
explanation: These are myelinated pain fibres that are responsible for sharp, localised pain.
name: A-delta fibres
label: a
answer: no
explanation: Beta-adrenergic receptors are found abundantly in the body (e.g. beta-1 receptors in heart tissue, beta-2 receptors in the respiratory system), but they do not play a role in the processing or sensation of dull pain.
name: Beta-adrenergic receptors
label: e
answer: no

Correct answer: b
An ST2 doctor in cardiology decides to conduct a study to assess the true treatment effect of a new drug for heart failure.

He consents 55 patients from the hospital to try the new drug, 29 male and 26 female. The study is a blinded randomised control trial.

What type of bias is most likely to occur in this study?

Options:
explanation: Gender bias is not likely to be implicated in this study. Although there are marginally more males than females in this study, the difference in numbers is unlikely to bias the results.
name: Gender bias
label: b
answer: no
explanation: Performance bias is introduced when the methodology of a trial introduces differences between the intervention and control groups other than the intervention being tested. However, due to the use of blinding, this type of bias is unlikely.
name: Performance bias
label: c
answer: no
explanation: Publication bias is introduced when there is a failure to publish research data based on the true findings or true intention of the study. It may occur when there is a conflict of interest. Nothing is known about the publishing of the findings in this scenario.
name: Publication bias
label: e
answer: no
explanation: Berkson bias is a type of bias that occurs when findings from hospital studies are not generalisable to a wider community of patients. This may occur in this study as the researcher is only using hospital patients to study the effectiveness of the new drug. His sample may not be representative of all the patients in the community, so his findings may not be generalisable.
name: Berkson bias
label: a
answer: yes
explanation: Attrition bias is introduced when participants drop out of the study, reducing the sample size and amount of data that can be collected from the research. This study has not been carried out yet, so attrition bias cannot be assessed.
name: Attrition bias
label: d
answer: no

Correct answer: a
A study was conducted to compare the effects of cognitive behavioural therapy versus a control therapy on the treatment of schizophrenia.

The effectiveness was assessed by measuring the incidence of psychotic episodes over 2 years (24 months).

The findings are shown below:

|  | Exposed group | Non-exposed group |
| --- | --- | --- |
| Psychotic episodes | 45 | 67 |
| No psychotic episodes	 | 74 | 56 |

Calculate the relative risk of a psychotic episode.

Options:
explanation: This is incorrect.
name: 0.8
label: b
answer: no
explanation: Relative risk is calculated by dividing the risk of an adverse event in the exposed group by the risk in the non-exposed group. In this case, the calculation would be [(45/119)]/[(67/123)], which equals 0.69.
name: 0.69
label: a
answer: yes
explanation: This is incorrect.
name: 1.3
label: d
answer: no
explanation: This is incorrect.
name: 1
label: c
answer: no
explanation: This is incorrect.
name: 1.5
label: e
answer: no

Correct answer: a
A researcher decides to analyse his findings comparing the effect of denosumab and alendronic acid on bone mineral density after 5 years of treatment.

The findings are detailed in the table below.

| T score	| Alendronic acid | Denosumab |
| --- | --- | --- |
| T < -2.5 | 	a | b |
| –1 < T < –2.5 | c | d |
| T > -1 | e | f |

Which of the following options is the correct formula to calculate the percentage of patients that had osteopenia after 5 years of denosumab?

Options:
explanation: This formula calculates the total percentage of patients that had osteopenia after 5 years so is incorrect.
name: [(c+d)/ (a+b+c+d+e+f)] x 100
label: c
answer: no
explanation: This formula calculates the percentage of patients that had Osteopenia after 5 years of Denosumab so is correct. Remember, osteopenia is defined as a T score between –1 and –2.5.
name: [(d)/ (b+d+f)] x 100
label: a
answer: yes
explanation: This formula calculates the percentage of patients that had a normal bone mineral density after 5 years so is incorrect.
name: [(e+f)/ (a+b+c+d+e+f)] x 100
label: d
answer: no
explanation: This formula calculates the percentage of patients that had a normal bone density after 5 years on Alendronic acid so is incorrect.
name: [(e)/ (a+c+e)] x 100
label: e
answer: no
explanation: This formula calculates the total percentage of patients that had osteoporosis after 5 years. Remember a T score <-2.5 is diagnostic of osteoporosis.
name: [(a+b)/ (a+b+c+d+e+f)] x 100
label: b
answer: no

Correct answer: a
Which of the following is the correct definition of a cost-effective analysis?

Options:
explanation: ‘Analysis used to compare the benefits of a decision versus the costs of the same decision’ describes a cost-benefit analysis.
name: Method used to compare the benefits of a decision versus the costs of the same decision
label: b
answer: no
explanation: ‘The ratio of total costs to total benefits of an intervention’ describes a cost-benefit ratio.
name: The ratio of total costs to total benefits of an intervention
label: c
answer: no
explanation: ‘Method used to compare the costs and effects of alternative interventions’ describes a cost-utility analysis.
name: Method used to compare the costs and effects of alternative interventions
label: e
answer: no
explanation: ‘The net cost divided by the changes in health outcomes’ describes a cost-effectiveness ratio.
name: The net cost divided by the changes in health outcomes
label: d
answer: no
explanation: This is the correct description of a cost-effective analysis. Cost-effective analyses are used to compare 2 or more interventions to determine how much it costs for each intervention to gain 1 unit of a health outcome. For example, a cancer screening programme might cost an extra £1000 per life saved compared to treating patients once they develop symptoms. It is up to institutions such as hospitals and the government to decide whether this cost is acceptable.
name: Method used to assess the health and cost impacts of an intervention
label: a
answer: yes

Correct answer: a
Which embryological structure gives rise to the appendicular skeleton?

Options:
explanation: The first and second pharyngeal pouches give rise to the thyroid gland.
name: 1st and 2nd pharyngeal pouches
label: e
answer: no
explanation: The paraxial mesoderm gives rise to the axial skeleton. This consists of the bones in the midline (I.e. the skull, sternum, ribs, vertebrae, sacrum and coccyx).
name: Paraxial mesoderm
label: b
answer: no
explanation: The metanephric blastema gives rise to the main structures of the nephron, including the bowman’s capsule, proximal convoluted tubule, loop of Henle and distal convoluted tubule.
name: Metanephric blastema
label: d
answer: no
explanation: The ureteric bud gives rise to the collecting system of the urogenital system. This includes the collecting duct, ureters and renal calyces.
name: Ureteric bud
label: c
answer: no
explanation: The lateral plate mesoderm gives rise to the appendicular skeleton. This consists of all the limb bones, shoulder girdles and pelvic bones.
name: Lateral plate mesoderm
label: a
answer: yes

Correct answer: a
A 46-year-old man presents to secondary care with an acute, hot, swollen big toe.

His current medications include paracetamol, bendroflumethiazide and ferrous sulphate.

What findings are you most likely to find on joint aspiration?

Options:
explanation: This man likely has gout. A painful big toe (also known as podagra) is the classic presentation of gout. Negatively birefringent needle-shaped uric acid crystals are the most likely to be found on joint aspiration.
name: Negatively birefringent needle-shaped uric acid crystals
label: a
answer: yes
explanation: This man likely has gout. Positively birefringent rhomboid-shaped crystals are characteristically found in pseudogout, whilst negatively birefringent needle-shaped crystals are seen in gout.
name: Negatively birefringent rhomboid-shaped crystals
label: d
answer: no
explanation: This man likely has gout. Dumbbell-shaped calcium oxalate stones are characteristically found in renal calculi (renal stones).
name: Dumbbell-shaped calcium oxalate stones
label: e
answer: no
explanation: This man likely has gout. Positively birefringent rhomboid-shaped crystals are characteristically found in pseudogout.
name: Positively birefringent rhomboid-shaped crystals
label: c
answer: no
explanation: This man likely has gout. Negatively birefringent needle-shaped uric acid crystals are the most likely to be found on joint aspiration.
name: Positively birefringent needle-shaped uric acid crystals
label: b
answer: no

Correct answer: a
What type of prevention is the Human Papilloma Virus (HPV) vaccine?

Options:
explanation: The HPV vaccine is given to schoolchildren before their 15th birthday. It is a form of primary prevention against HPV infection and decreases the risk of cervical cancer.
name: Primary
label: a
answer: yes
explanation: Tertiary prevention aims to reduce the effects of a disease once it is established in an individual. Cardiac rehabilitation is an example of tertiary prevention.
name: Tertiary
label: c
answer: no
explanation: Secondary prevention measures (e.g. screening) allow for the identification of diseases in their earliest stage before the onset of signs and symptoms. Screening for breast cancer using mammography is an example of a secondary prevention programme.
name: Secondary
label: b
answer: no
explanation: Quaternary prevention is not a type of healthcare prevention strategy.
name: Quaternary
label: d
answer: no
explanation: Contemporary prevention is not a type of healthcare prevention strategy.
name: Contemporary
label: e
answer: no

Correct answer: a
Which channel and mechanism allows for the transport of glucose into cells?

Options:
explanation: Active transport is the movement of a substance against its concentration gradient and involves the use of ATP. Glucose is not transported into cells via active transport; it is transported via facilitated diffusion.
name: GLUT channel: Active transport
label: d
answer: no
explanation: Glucose is transported into cells via GLUT channels in the plasma membrane. This occurs through facilitated diffusion as glucose moves passively down its concentration gradient through the channel proteins into cells.
name: GLUT channel: Facilitated diffusion
label: a
answer: yes
explanation: Osmosis is the passive movement of water down a water potential gradient. Glucose is not transported into cells via osmosis; it is transported via facilitated diffusion.
name: GLUT channel: Osmosis
label: c
answer: no
explanation: Glucose is transported into cells via GLUT channels in the plasma membranes. However, this does not occur through simple diffusion which would involve the passive movement of glucose molecules down their concentration gradient and through the phospholipid bilayer into cells
name: GLUT channel: Simple diffusion
label: b
answer: no
explanation: K+ and Cl- ion exchanges are not involved in the transport of glucose into cells.
name: GLUT channel: K+/Cl- exchange
label: e
answer: no

Correct answer: a
What product is formed from a condensation reaction between two glucose molecules?

Options:
explanation: Fructose is a monosaccharide commonly found in sugary fruits and vegetables.
name: Fructose
label: c
answer: no
explanation: Amylase is an enzyme made by the pancreas that catalyses the breakdown of carbohydrates via a hydrolysis reaction.
name: Amylase
label: e
answer: no
explanation: Lactose is formed from a condensation reaction between a galactose molecule and a glucose molecule.
name: Lactose
label: b
answer: no
explanation: Sucrose is a disaccharide formed from a condensation reaction between a glucose molecule and a fructose molecule.
name: Sucrose
label: d
answer: no
explanation: A condensation reaction between 2 glucose molecules produces maltose and releases a water molecule. Maltose is a disaccharide.
name: Maltose
label: a
answer: yes

Correct answer: a
This is a blood film taken from a 53-year-old patient.

[lightgallery]

What is the name of the cell highlighted in the blood film?

Options:
explanation: Lymphocytes are part of the adaptive immune system. They are classified as B or T cells and contain very large nuclei.
name: Lymphocyte
label: c
answer: no
explanation: An erythrocyte is a discoid-shaped cell which is approximately 5-7 micrometres in diameter. It has no nucleus and contains the quaternary protein, haemoglobin, which transports oxygen and carbon dioxide around the body.
name: Erythrocyte
label: b
answer: no
explanation: A basophil is a phagocyte and is part of the innate immune system. Basophils stain blue under the microscope due to their basic pH. They contain and release histamine during acute inflammation.
name: Basophil
label: d
answer: no
explanation: This cell is a neutrophil. Neutrophils are phagocytes which have a multi-lobed nucleus and contain enzymes such as myeloperoxidase and neutrophil elastase. They are the first cells to arrive at sites of inflammation and are part of the innate immune system.
name: Neutrophil
label: a
answer: yes
explanation: An eosinophil is a phagocyte and is part of the innate immune system. Eosinophils stain pink under the microscope due to their acidic pH. They contain toxic granules that are important in destroying parasites as well as in vasculitis.
name: Eosinophil
label: e
answer: no

Correct answer: a
Which of the following is the correct description of an oncogene?

Options:
explanation: Oncogenes are dominant genes that promote cell proliferation. Their actions are balanced out by anti-oncogenes which promote apoptosis.
name: Dominant gene that promotes cell apoptosis
label: b
answer: no
explanation: Neither oncogenes nor anti-oncogenes promote tissue necrosis. Tissue necrosis occurs due to an insult to tissue e.g. ischaemia, infarction or trauma. There are different types of necrosis including fat, liquefactive, fibrinoid, caseous and gangrenous necrosis.
name: Dominant gene that promotes tissue necrosis
label: e
answer: no
explanation: This describes anti-oncogenes (e.g. p53) which are recessive genes that promote cell apoptosis. Mutations in anti-oncogenes lead to uncontrolled cell proliferation which predisposes individuals to cancer.
name: Recessive gene that promotes cell apoptosis
label: d
answer: no
explanation: Oncogenes are dominant genes, not recessive genes.
name: Recessive gene that promotes cell proliferation
label: c
answer: no
explanation: Oncogenes are dominant genes that promote cell proliferation. An example of an oncogene is the HER2 gene. Mutations in oncogenes lead to uncontrolled cell proliferation which predisposes individuals to cancer.
name: Dominant gene that promotes cell proliferation
label: a
answer: yes

Correct answer: a
What is the normal resting membrane potential of a cardiac myocyte?

Options:
explanation: This is the resting membrane potential of normal cells. It is also maintained via potassium-sodium pumps, potassium leak channels, negatively charged membrane proteins and voltage-gated ion channels.
name: -60 mV
label: b
answer: no
explanation: A cardiac myocyte maintains a resting membrane potential of –80 mV. This is achieved through potassium-sodium pumps, potassium leak channels, negatively charged membrane proteins and voltage-gated ion channels. All of these work together to maintain a greater number of cations outside the plasma membrane compared to inside.
name: -80 mV
label: a
answer: yes
explanation: A membrane potential of +300 mV is extremely high and is unlikely to be found in cells.
name: +300 mV
label: e
answer: no
explanation: A membrane potential of +30 mV is the typical threshold potential for an action potential to be fired. This threshold is reached via the opening of sodium (and calcium) ion channels and the closure of potassium channels. This causes an increase in cations inside the cell, and thus a positive charge.
name: +30 mV
label: d
answer: no
explanation: A membrane potential of –120 mV would indicate hyperpolarization of a cell. This typically occurs when there is an excess loss of cations from a cell, and it prevents an action potential from being generated.
name: -120 mV
label: c
answer: no

Correct answer: a
Which molecule tethers actin to the sarcomere?

Options:
explanation: Alpha actinin tethers actin to the sarcomere.
name: Alpha-actinin
label: a
answer: yes
explanation: Myosin fibres form the thick filaments of the sarcomere. In the resting state, myosin is bound to tropomyosin and is inhibited from binding to the myosin binding site on actin.
name: Myosin
label: e
answer: no
explanation: Troponin C (TnC) binds calcium and causes a conformational change in the myosin-tropomyosin complex by inhibiting the Troponin I (TnI) inhibition of the actinomyosin ATPase.
name: Troponin C
label: b
answer: no
explanation: Troponin I (TnI) binds to the actinomyosin ATPase and inhibits myosin from forming a cross-bridge with actin, thus inhibiting muscle contraction.
name: Troponin I
label: c
answer: no
explanation: Tropomyosin binds to myosin forming a myosin-tropomyosin complex. When tropomyosin detaches from myosin, myosin can form a cross-bridge with actin causing muscle contraction.
name: Tropomyosin
label: d
answer: no

Correct answer: a
Which vaccination should a child of 3 years and 4 months receive according to the new NHS vaccination schedule?

Options:
explanation: This vaccine is given to children who are 12-13 years old.
name: Human Papilloma Virus (HPV)
label: d
answer: no
explanation: The 2nd MMR vaccine is given to children who are 3 years and 4 months old. The 4-in-1 preschool booster is also given at this age.
name: Measles, Mumps and Rubella (MMR) 2nd dose
label: a
answer: yes
explanation: This vaccine is given to children who are 1 year old. At this age, they also receive the Meningitis B, Meningitis C and Pneumococcal vaccines.
name: Measles, Mumps and Rubella (MMR) 1st dose
label: b
answer: no
explanation: This vaccine is given to children who are 1 year old. At this age, they also receive the Meningitis B, MMR 1st dose and Pneumococcal vaccine.
name: Meningitis C 1st dose
label: e
answer: no
explanation: This vaccine is given to children who are 14 years old.
name: Meningitis ACWY
label: c
answer: no

Correct answer: a
What type of virus is a Herpes virus?

Options:
explanation: Herpes viruses are DNA viruses. They do not contain RNA. Additionally, RNA comes in single strands only.
name: Triple-stranded RNA virus
label: d
answer: no
explanation: Herpes viruses are DNA viruses. They do not contain RNA.
name: DNA and RNA virus
label: e
answer: no
explanation: Herpes viruses are DNA viruses. They do not contain RNA.
name: Single-stranded RNA virus
label: b
answer: no
explanation: Herpes viruses are DNA viruses. They do not contain RNA. Additionally, RNA comes in single strands only.
name: Double-stranded RNA virus
label: c
answer: no
explanation: Herpes viruses are DNA viruses.
name: DNA Virus
label: a
answer: yes

Correct answer: a
A 61-year-old man is referred to the hospital by his GP due to an ongoing productive cough and fever.

A sputum sample is taken and sent to the lab for investigation.

The culture comes back and is positive. The following description has been provided by the microbiologist:

‘Gram-positive facultative anaerobic diplococci.’

Which of the following pathogens is responsible for this man’s presentation?

Options:
explanation: *Haemophilus influenzae* is a gram-negative coccobacilli and is a commensal pathogen within the respiratory system. *Haemophilus influenzae* is associated with epiglottitis which is life-threatening if not treated promptly.
name: *Haemophilus influenzae*
label: d
answer: no
explanation: *Staphylococcus aureus* is a gram-positive bacterium that is typically found in grape-like clusters. It is a commensal bacterium that typically causes bone infections (e.g. osteomyelitis) and skin infections (e.g. cellulitis).
name: *Staphylococcus aureus*
label: b
answer: no
explanation: *Pseudomonas aureginosa* is a rod-shaped gram-negative aerobic bacteria. It typically causes pneumonia in patients with bronchiectasis and is also associated with hot tub folliculitis.
name: *Pseudomonas aureginosa*
label: c
answer: no
explanation: *Salmonella typhi* is a gram-negative rod-shaped enterobaceteriae commonly found in raw poultry (e.g. raw chicken). It typically causes a diarrhoeal illness, but can also cause osteomyelitis in patients with sickle cell disease.
name: *Salmonella typhi*
label: e
answer: no
explanation: ‘Gram-positive facultative anaerobic diplococci is the microscopic description of *streptococcus pneumoniae*, which typically causes pneumonia.
name: *Streptococcus pneumoniae*
label: a
answer: yes

Correct answer: a