hllj/quesmed huggingface dataset:
A 42 year old woman presents to the emergency department complaining of pain and swelling in her right calf. On questioning, she states that she recently returned from visiting family in Australia and takes the combined oral contraceptive pill. On examination, the right calf is 4cm larger than the left and is visibly red. The right calf is also extremely tender to touch.

An ultrasound scan confirms the presence of a deep vein thrombosis (DVT) and she is given a direct oral anticoagulant (DOAC).

Which of the following clotting factors is primarily inhibited by DOACs?

Options:
explanation: This is incorrect. While some DOACs, specifically the direct thrombin inhibitors, can inhibit Factor IX, the primary target of most DOACs is Factor Xa.
name: Factor IX
label: d
answer: no
explanation: This is incorrect. Factor VIII is involved in the intrinsic pathway of coagulation, while DOACs primarily target the common pathway by inhibiting Factor Xa or thrombin (Factor IIa).
name: Factor VIII
label: b
answer: no
explanation: This is incorrect. Factor XIII is involved in the final stabilization of fibrin clots and is not a direct target of DOACs.
name: Factor XIII
label: e
answer: no
explanation: This is incorrect. Factor VIIa is part of the extrinsic pathway and is not directly inhibited by DOACs.
name: Factor VIIa
label: c
answer: no
explanation: This is correct. Most DOACs, such as apixaban, rivaroxaban, and edoxaban, primarily inhibit Factor Xa. This is a key factor in the common pathway of the coagulation cascade. By inhibiting Factor Xa, these medications reduce the formation of thrombin, which is essential for blood clot formation.
name: Factor Xa
label: a
answer: yes

Correct answer: a
A 2 week old baby boy is brought to the paediatric emergency department when his parents noticed that he was breathing more rapidly than usual. They note poor feeding since birth, and failure to gain weight.

Upon examination, a continuous heart murmur is heard, it is loudest over the left upper chest area. A clinical diagnosis of a patent ductus arteriosus is made.

Which of the following statements correctly describes the path of the ductus arteriosus in the foetal circulation?

Options:
explanation: This is incorrect. The right atrium connects to the right ventricle through the tricuspid valve. By contrast, the ductus arteriosus is a foetal blood vessel that connects the pulmonary artery to the aorta.
name: The ductus arteriosus connects the right atrium to the right ventricle
label: b
answer: no
explanation: This is incorrect. The left atrium connects to the left ventricle through the mitral (bicuspid) valve. By contrast, the ductus arteriosus is a foetal blood vessel that connects the pulmonary artery to the aorta.
name: The ductus arteriosus connects the left atrium to the left ventricle
label: c
answer: no
explanation: This is incorrect. The pulmonary veins carry oxygenated blood from the lungs to the left atrium. By contrast, the ductus arteriosus is a foetal blood vessel that connects the pulmonary artery to the aorta.
name: The ductus arteriosus connects the pulmonary vein to the left atrium
label: e
answer: no
explanation: This is incorrect. The connection between the aorta and the superior vena cava is not primarily associated with the ductus arteriosus. The ductus arteriosus is a foetal blood vessel that connects the pulmonary artery to the aorta.
name: The ductus arteriosus connects the aorta to the superior vena cava
label: d
answer: no
explanation: This is correct. The ductus arteriosus is a foetal blood vessel that connects the pulmonary artery to the aorta. It allows a portion of the blood to bypass the lungs in the foetal circulation, as the lungs are not yet functional in the uterus.
name: The ductus arteriosus connects the pulmonary artery to the aorta
label: a
answer: yes

Correct answer: a
A 28 year old man attends the haematology clinic. He has a history of haemochromatosis, for which he undergoes regular phlebotomy.

Which of the following represents the correct order of layers in a typical blood vessel, arranged from the most deep to most superficial?

Options:
explanation: This is incorrect. The tunica intima should be the innermost layer, followed by the tunica media and then the tunica externa.
name: Tunica externa, tunica intima, tunica media
label: e
answer: no
explanation: This is correct. In a blood vessel, the layers are arranged in the following order from superficial to deep: tunica externa (outermost layer), tunica media and tunica intima (innermost layer).
name: Tunica intima, tunica media, tunica externa
label: a
answer: yes
explanation: This is incorrect. The tunica media should be between the tunica intima and tunica externa.
name: Tunica media, tunica intima, tunica externa
label: c
answer: no
explanation: This is incorrect. In a typical blood vessel, the tunica intima is the innermost layer, followed by the tunica media, and the tunica externa is the outermost layer.
name: Tunica externa, tunica media, tunica intima
label: b
answer: no
explanation: This is incorrect. The tunica media should be located between the tunica intima and tunica externa.
name: Tunica intima, tunica externa, tunica media
label: d
answer: no

Correct answer: a
A 14 year old girl attends a paediatric clinic complaining of frequent urination and fatigue. She has often been waking in the night needing to urinate. It is noted that the girl has lost a significant amount of weight since the last time she was weighed 6 months ago.


Her blood glucose reading is 16.6mmol/L (normal <6.1 mmol/L). She is diagnosed with type 1 diabetes mellitus.


Which of the following cells are normally responsible for insulin production in the pancreas?

Options:
explanation: This is incorrect. Delta cells in the pancreas produce somatostatin, a hormone that regulates the release of both insulin and glucagon. They do not directly produce insulin.
name: Delta cells
label: c
answer: no
explanation: This is incorrect. Gamma cells do not exist as a recognized cell type in the pancreas.
name: Gamma cells
label: d
answer: no
explanation: This is incorrect. Parietal cells can be found in the stomach where they secrete stomach acid. They are not found in the pancreas, nor do they secrete insulin.
name: Parietal cells
label: e
answer: no
explanation: This is correct. Beta cells in the pancreas are responsible for producing insulin. In type 1 diabetes, there is a loss of functional beta cells, leading to a lack of insulin production and elevated blood glucose levels.
name: Beta cells
label: a
answer: yes
explanation: This is incorrect. Alpha cells in the pancreas are responsible for producing glucagon, not insulin. Glucagon and insulin have opposing roles in regulating blood glucose levels.
name: Alpha cells
label: b
answer: no

Correct answer: a
A 36 year old woman attends her GP surgery with chronic diarrhoea. She has a known history of bile-acid malabsorption associated with Crohn's disease.

Which of the following sites is usually responsible for the majority of bile acid reabsorption?

Options:
explanation: This is incorrect. The colon is not primarily responsible for bile acid reabsorption. Bile acids are primarily reabsorbed in the ileum of the small intestine.
name: Colon
label: e
answer: no
explanation: This is correct. The majority of bile acid reabsorption takes place in the ileum, the last segment of the small intestine. Bile acids are reabsorbed in the ileum and recycled back to the liver in a process called enterohepatic circulation.
name: Ileum
label: a
answer: yes
explanation: This is incorrect. The jejunum is not the primary site for bile acid reabsorption. The majority of bile acid reabsorption occurs in the ileum.
name: Jejunum
label: d
answer: no
explanation: This is incorrect. The stomach is not primarily involved in bile acid reabsorption. Bile acids are primarily reabsorbed in the lower part of the small intestine.
name: Stomach
label: b
answer: no
explanation: This is incorrect. While the duodenum is an important part of the small intestine for digestion, it is not the primary site for bile acid reabsorption. Bile acids are reabsorbed further down in the small intestine.
name: Duodenum
label: c
answer: no

Correct answer: a
A 45 year old woman presents to the General Practitioner with chronic diarrhoea. The patient has been experiencing loose stools for almost 2 weeks and is concerned about becoming dehydrated.

Where is the majority of fluid normally absorbed in the gastrointestinal tract?

Options:
explanation: This is incorrect. While the duodenum is involved in digestion, the majority of fluid absorption takes place in the lower parts of the small intestine, specifically the jejunum.
name: Duodenum
label: c
answer: no
explanation: This is incorrect. While the colon does absorb some fluids, the majority of fluid absorption takes place in the small intestine, primarily the jejunum.
name: Colon
label: e
answer: no
explanation: This is incorrect. The jejunum plays a role in nutrient absorption, but the majority of fluid absorption occurs in the jejunum
name: Ileum
label: d
answer: no
explanation: This is incorrect. The stomach is primarily responsible for the digestion of food, but it is not a significant site for fluid absorption. Fluid absorption primarily occurs in the jejunum.
name: Stomach
label: b
answer: no
explanation: This is the correct answer. The jejunum is the primary site for the absorption of the majority of fluid in the GI tract.
name: Jejunum
label: a
answer: yes

Correct answer: a
A 45 year old woman approaches her General Practitioner with concerns about hot flashes, mood swings, and irregular menstrual cycles. She has noticed these symptoms gradually worsening over the past several months. Investigations reveal reduced oestrogen levels.

The patient is keen to know more about how oestrogen usually binds to steroid receptors to exert its effect.

In which of the following structures are steroid receptors primarily located within cells?

Options:
explanation: This is incorrect. Steroid receptors are not primarily located in the Golgi apparatus. The Golgi apparatus is involved in processing and modifying proteins and lipids.
name: Golgi apparatus
label: e
answer: no
explanation: This is incorrect. Steroid receptors can be found in the cytoplasm, but their primary site of action is in the nucleus, where they modulate gene transcription.
name: Cytoplasm
label: b
answer: no
explanation: This is correct. Steroid receptors are primarily located in the nucleus of the cell. When bound to their ligands (steroid hormones), they act as transcription factors, influencing gene expression by regulating DNA transcription.
name: Nucleus
label: a
answer: yes
explanation: This is incorrect. Steroid receptors are not typically located on the cell membrane. Cell membrane receptors are responsible for signalling in response to non-steroid hormones.
name: Cell membrane
label: c
answer: no
explanation: This is incorrect. Steroid receptors are not primarily located in the endoplasmic reticulum. The endoplasmic reticulum has other roles in cellular processes such as protein synthesis.
name: Endoplasmic reticulum
label: d
answer: no

Correct answer: a
A 60 year old male patient is admitted to the hospital with severe abdominal pain, nausea, and vomiting. He has a history of atherosclerosis and was recently diagnosed with a blocked superior mesenteric artery (SMA).

To plan for potential revascularization, the team conducts diagnostic tests to precisely determine the vertebral level at which the SMA originates within the abdominal aorta.

At which of the following vertebral levels does the SMA typically originate?

Options:
explanation: This is incorrect. This is the level at which the aorta bifurcates The SMA typically originates at the vertebral level of L1, which is just below the origin of the coeliac trunk.
name: L4
label: d
answer: no
explanation: This is incorrect. The SMA typically originates at the vertebral level of L1, which is just below the origin of the coeliac trunk.
name: L2
label: b
answer: no
explanation: This is incorrect. This is the origin of the inferior mesenteric artery (IMA). The SMA typically originates at the vertebral level of L1, which is just below the origin of the coeliac trunk.
name: L3
label: e
answer: no
explanation: This is incorrect. This is the origin of the coeliac trunk. The SMA typically originates at the vertebral level of L1, which is just below the origin of the coeliac trunk.
name: T12
label: c
answer: no
explanation: This is correct. The SMA typically originates at the vertebral level of L1, which is just below the origin of the coeliac trunk.
name: L1
label: a
answer: yes

Correct answer: a
A 55 year old woman presents to the General Practitioner with a painful lump in the right side of her groin. On examination, there is an irreducible lump located inferolateral to the pubic tubercle.

The GP diagnoses a femoral hernia. This is where the bowel herniates into the femoral canal.

Name the structures of the femoral canal from lateral to medial.

Options:
explanation: This is correct. The femoral nerve is the most lateral structure, followed by the femoral artery and then the femoral vein.
name: Femoral nerve, femoral artery, femoral vein
label: a
answer: yes
explanation: This is incorrect as it is the order from medial to lateral. The femoral nerve is the most lateral structure, followed by the femoral artery and then the femoral vein.
name: Femoral artery, femoral vein, femoral nerve
label: c
answer: no
explanation: This is incorrect because it reverses the positions of the femoral nerve and femoral vein. The femoral nerve is the most lateral structure, followed by the femoral artery and then the femoral vein.
name: Femoral artery, femoral nerve, femoral vein
label: e
answer: no
explanation: This is incorrect because it reverses the positions of the femoral artery and femoral vein. The femoral artery is typically more lateral than the femoral vein in the femoral canal.
name: Femoral vein, femoral artery, femoral nerve
label: d
answer: no
explanation: This is incorrect because it reverses the positions of the femoral vein and femoral artery. In the femoral canal, the femoral artery is typically more lateral than the femoral vein.
name: Femoral nerve, femoral vein, femoral artery
label: b
answer: no

Correct answer: a
A 36 year old woman attends a rheumatology clinic to discuss a recent autoimmune diagnosis.

Which of the following is an organ-specific autoimmune disease?

Options:
explanation: This is correct. In type 1 diabetes, the immune system targets and damages the insulin-producing beta cells in the pancreas. As a result, the organ-specific target is the pancreas, leading to insulin deficiency and hyperglycaemia.
name: Type 1 diabetes
label: a
answer: yes
explanation: This is incorrect. Perennial rhinitis is a form of allergic rhinitis and is not an autoimmune disease.
name: Perennial rhinitis
label: d
answer: no
explanation: This is incorrect. RA is an inflammatory condition primarily affecting the joints. However, it can also impact other organ systems such as the lungs, so is not an organ-specific autoimmune disease.
name: Rheumatoid arthritis (RA)
label: c
answer: no
explanation: This is incorrect. SLE is a systemic autoimmune disease affecting multiple organs and systems in the body. Thus, it is not organ-specific.
name: Systemic lupus erythematosus (SLE)
label: b
answer: no
explanation: This is incorrect. Chronic granulomatous disease is a primary immunodeficiency that inhibits the body's ability to combat infections. It is not an organ-specific autoimmune disease.
name: Chronic granulomatous disease
label: e
answer: no

Correct answer: a
A male baby is born at 28 weeks gestation via caesarean section. The child shows signs of respiratory distress and is given supplemental oxygen. He is diagnosed with neonatal respiratory distress syndrome.

Which of the following deficiencies leads to neonatal respiratory distress syndrome?

Options:
explanation: This is incorrect. A deficiency in haemoglobin would lead to anaemia, a condition characterized by a reduced ability of the blood to carry oxygen. However, respiratory distress in a premature infant is primarily related to lung pathology, not haemoglobin deficiency.
name: Haemoglobin
label: b
answer: no
explanation: This is incorrect. Vitamin D deficiency in a child would cause rickets. This presents with aching bones and joints and bow leg or knock knee deformity. It is not related to the pathophysiology of neonatal respiratory distress syndrome.
name: Vitamin D
label: d
answer: no
explanation: This is incorrect. A deficiency in immunoglobulins could lead to an impaired immune system and an increased susceptibility to infections. However, immunoglobulin deficiency is not the primary cause of respiratory distress in a premature baby.
name: Immunoglobulin
label: c
answer: no
explanation: This is correct. In premature infants, particularly those born before 28 to 32 weeks of gestation, surfactant production may not be fully developed. Surfactant deficiency leads to neonatal respiratory distress syndrome, where the baby experiences difficulty breathing due to alveolar collapse.

This condition is common in premature infants and requires supplemental oxygen and supportive care.
name: Surfactant
label: a
answer: yes
explanation: This is incorrect. Vitamin C deficiency causes scurvy, which presents with easy bruising, bleeding and receding gums and poor wound healing. It is not related to the pathophysiology of neonatal respiratory distress syndrome.
name: Vitamin C
label: e
answer: no

Correct answer: a
A 37 year old man attends the emergency department with an acute asthma exacerbation. They have an increased respiratory rate and are seen to be using accessory muscles to help them breathe.

Which of the following muscles raises the ribcage and sternum during inspiration?

Options:
explanation: This is incorrect. The serratus anterior does attach to the ribs, but its function is to rotate the scapula to allow the arm to be raised over 90 degrees.
name: Serratus anterior
label: d
answer: no
explanation: This is incorrect. In inspiration, the diaphragm contracts and flattens, this increases the vertical diameter of the thoracic cavity. The diaphragm does not move the ribs.
name: Diaphragm
label: c
answer: no
explanation: This is correct. The external intercostal muscles connect the ribs in such a way that the contraction of the muscles lifts the ribs and rib cage, expanding the anteroposterior dimensions of the ribcage.
name: External intercostal muscles
label: a
answer: yes
explanation: This is incorrect. The internal intercostal muscles depress the ribs in forced expiration, they do not have a role in inspiration.
name: Internal intercostal muscles
label: b
answer: no
explanation: This is incorrect. The sternocleidomastoid rotates the head to the opposite side and flexes the neck.
name: Sternocleidomastoid
label: e
answer: no

Correct answer: a
A 47 year old woman patient with chronic kidney disease presents to the renal clinic. She has been feeling extremely tired recently and becomes short of breath upon minimal exertion. She denies any changes to her diet and any blood loss. Blood tests show a low haemoglobin.

Which of the following hormones is normally produced by the kidney to stimulate the production of red blood cells?

Options:
explanation: This is correct. Erythropoietin (EPO) is a glycoprotein hormone, naturally produced by the peritubular cells of the kidney. It stimulates red blood cell production. In chronic kidney disease, EPO deficiency contributes to anaemia.
name: Erythropoietin
label: a
answer: yes
explanation: This is incorrect. Thrombopoietin is released to stimulate and support platelet production.
name: Thrombopoietin
label: d
answer: no
explanation: This is incorrect. PTH is released by the parathyroid glands and acts to increase blood calcium levels. PTH can stimulate haematopoietic cells through mechanisms that are not entirely understood. However, it is not the primary cause of anaemia in chronic kidney disease.
name: Parathyroid hormone (PTH)
label: e
answer: no
explanation: This is incorrect. Aldosterone is a steroid hormone released by the adrenal glands as part of the renin-angiotensin system. Its main role is to reabsorb sodium and water in the kidneys to regulate blood pressure.
name: Aldosterone
label: c
answer: no
explanation: This is incorrect. Insulin is released by the beta cells of the pancreas. Its function is to reduce blood glucose.
name: Insulin
label: b
answer: no

Correct answer: a
A 32 year old male is brought to the Emergency Department following a road traffic collision. On arrival, he is conscious, alert and orientated.

His abdomen is bruised and distended. He is pale and sweaty. He has an elevated heart rate at 134bpm, a blood pressure of 84/67mmHg and a respiratory rate of 24 breaths per minute.

Which of the following best describes the main reason the patient appears pale and sweaty?

Options:
explanation: This is correct. The man's sympathetic nervous system has been activated due to the trauma. The sympathetic nervous system activates sweat glands via acetylcholine signalling.
name: Increased sympathetic activity
label: a
answer: yes
explanation: This is incorrect. There will be increased aldosterone secretion in response to the low blood pressure, however, the action of aldosterone is to retain water and sodium, not to cause sweating.
name: Increased aldosterone secretion
label: b
answer: no
explanation: This is incorrect. In an acute setting, raised cortisol is responsible for mobilizing glucose for energy, inhibiting pain and promoting a fight-or-flight response. It would not cause sweating.
name: Increased cortisol secretion
label: d
answer: no
explanation: This is incorrect. Increased antidiuretic hormone secretion would result in a lower volume of more concentrated urine being produced, not sweating.
name: Increased antidiuretic hormone secretion
label: c
answer: no
explanation: This is incorrect. Whilst reduced blood glucose can cause symptoms such as sweating, this man's glucose would not be reduced as hormones such as cortisol would increase blood glucose.
name: Reduced blood glucose
label: e
answer: no

Correct answer: a
A 60 year old woman undergoes a total thyroidectomy due to medullary thyroid cancer. Following the procedure, it is noted that her voice has become hoarse and breathy. The surgeon suspects intra-operative damage of a nerve.

Which of the following nerves has most likely been damaged?

Options:
explanation: This is incorrect. Phrenic nerve damage would most likely present with breathing difficulties. The phrenic nerve is more susceptible to damage in cardiac and thoracic surgery, rather than in thyroid surgery.
name: Phrenic nerve
label: b
answer: no
explanation: This is incorrect. Long thoracic nerve damage presents with a 'winged scapula' deformity. The long thoracic nerve is susceptible to damage following chest drain insertion or prolonged crutch use. It is not commonly damaged in thyroid surgery and is not associated with voice changes.
name: Long thoracic nerve
label: d
answer: no
explanation: This is incorrect. Hypoglossal nerve damage would present with tongue deviation/wasting. The hypoglossal nerve is susceptible to damage in a carotid endarterectomy, rather than in thyroid surgery.
name: Hypoglossal nerve
label: c
answer: no
explanation: This is correct. The recurrent laryngeal nerve is a branch of the vagus nerve and supplies the vocal cords. It is prone to damage in thyroid surgery, as well as thoracic surgery. Voice changes are a common sign of recurrent laryngeal nerve damage.
name: Recurrent laryngeal nerve
label: a
answer: yes
explanation: This is incorrect. Thoracodorsal nerve damage is likely to present with pain and weakness in the upper limb. The thoracodorsal nerve is vulnerable to injury in breast procedures. It is not commonly damaged in thyroid surgery and is not associated with voice changes.
name: Thoracodorsal nerve
label: e
answer: no

Correct answer: a