hllj/quesmed huggingface dataset:
What is the definition of positive predictive value?

Options:
explanation: Positive predictive value describes the ability of a diagnostic test to correctly identify people with a certain disease as doing so. Positive predictive value can be calculated from the test’s sensitivity, specificity and condition prevalence.
name: The proportion of those who test positive for a disease that actually have the disease
label: a
answer: yes
explanation: This is the definition of the 95% confidence interval. For example, if the prevalence of a disease is measured as 0.7% (CI 0.63-0.85%), we can be 95% sure that the true value of the prevalence is between 0.63% and 0.85%.
name: The interval around an estimate in which there is 95% confidence that the true value lies
label: e
answer: no
explanation: This is the definition of the statistical concept ‘number needed to treat’ (NNT). For example, if a drug has an NNT of 8, it means that 8 patients would have to be treated with the drug to prevent 1 additional detrimental outcome.
name: The number of patients over a certain time period that would need treatment to prevent a particular detrimental outcome
label: d
answer: no
explanation: This is the definition of sensitivity, which is used in the evaluation of diagnostic tests. Ideally, diagnostic tests should be highly sensitive and highly specific.
name: The probability that an individual with a disease will test positive for the disease
label: c
answer: no
explanation: This is the definition of specificity, which is a measure used to evaluate the suitability of diagnostic tests. Ideally, diagnostic tests should be highly sensitive and highly specific.
name: The probability that an individual without a disease will test negative for the disease
label: b
answer: no

Correct answer: a
Which statement best describes an advantage of case-control studies?

Options:
explanation: Case-control studies may find a correlation or association between a certain exposure (a risk factor for a particular disease) and an outcome (the disease itself). However, as the study is retrospective, it cannot be proved that this link is definitely causal.
name: They are useful in confirming causal relationships between certain exposures and outcomes
label: e
answer: no
explanation: Case-control studies may use different methods to obtain data. If the measures of health outcomes used were subjective, for example, self-reporting symptoms on a questionnaire, this could lead to false reporting by subjects. However, objective measures such as antibody levels or past medical documentation could not be falsely reported by the subject.
name: Subjects are less likely to falsely report health outcomes in a case-control study
label: b
answer: no
explanation: In case-control studies, a group of subjects with the disease and a group of controls without the disease are selected, and their past exposure (risk factor) status is compared. Case-control studies are good for studying rare conditions, as a group of subjects with the disease is selected at the beginning of the study.
name: They are useful in the study of rare diseases
label: a
answer: yes
explanation: A confounding factor is something that is associated with the exposure (risk factor) and outcome (condition X) and can distort the apparent relationship between them. All observational studies, such as case-control studies, are subject to influence by confounding factors.
name: They reduce the chance of results being affected by confounding factors
label: c
answer: no
explanation: Double-blinding is a feature where neither the subjects nor the researchers or clinicians know which group the subjects are in, and aims to reduce bias in the study. This can be implemented in interventional studies, such as randomised control trials, but does not apply to observational studies such as case-control studies.
name: They can be double-blinded, reducing bias
label: d
answer: no

Correct answer: a
A GP is travelling by train on his way to a family holiday when a call goes out for medical assistance as a person in another carriage has just collapsed.

Which statement best describes the duty of care of a GP in this scenario?

Options:
explanation: GMC guidance states that doctors have a professional duty to offer assistance, taking into account their own safety, competence and availability of other options for care.
name: The doctor should not offer to help as there is no duty of care
label: e
answer: no
explanation: To win a claim for clinical negligence, the claimant must prove that a duty of care existed, that this duty was breached and that harm was caused by the breach. As there is no legal duty of care in this situation, the doctor is not at risk of a negligence claim. The doctor should still offer help though, because there is a professional duty to do so.
name: The doctor should offer to help as he is at risk of a negligence claim if he does not
label: c
answer: no
explanation: Although there is indeed no Good Samaritan law in the UK, and therefore there is no legal duty of doctors to help injured or ill people, GMC guidance states that doctors have a professional duty to offer assistance.
name: The doctor should not offer to help, as there is no Good Samaritan law in place in the UK
label: d
answer: no
explanation: There is no Good Samaritan law in the UK, and therefore there is no legal duty of doctors to help injured or ill people in situations like this. If the collapse had happened inside the GP surgery when the GP was working, there would be a legal duty for the doctor to offer assistance.
name: The doctor should offer to help as there is a legal duty to do so
label: b
answer: no
explanation: GMC guidance states that doctors have a professional duty to offer assistance, taking into account their own safety, competence and availability of other options for care. Failure to offer assistance in an emergency could prompt disciplinary action by the GMC.
name: The doctor should offer assistance as there is a professional duty to do so
label: a
answer: yes

Correct answer: a
What is the mode of action of the depolarising agent suxamethonium?

Options:
explanation: This is the mode of action of non-depolarising muscle relaxants, such as atracurium and vecuronium, which are competitive antagonists of the nicotinic receptor.
name: It competes with acetylcholine for the nicotinic receptor orthosteric binding site but does not activate the receptor
label: c
answer: no
explanation: Depolarising agents are agonists of the nicotinic acetylcholine receptor. They bind to the orthosteric ligand binding site, causing receptor activation and cation influx into the motor end plate.
name: It binds to an allosteric site on the nicotinic acetylcholine receptor
label: d
answer: no
explanation: Depolarising agents are agonists of the postsynaptic nicotinic acetylcholine receptor, causing receptor activation and cation influx into the motor end plate. They do not inhibit presynaptic acetylcholine release.
name: It inhibits the presynaptic release of acetylcholine
label: e
answer: no
explanation: Depolarising agents are agonists of the nicotinic acetylcholine receptor, causing receptor activation and cation influx into the motor end plate.
name: It activates the nicotinic acetylcholine receptor, allowing cation influx
label: a
answer: yes
explanation: Suxamethonium is an agonist of the nicotinic acetylcholine receptor, like acetylcholine. As suxamethonium is not broken down by acetylcholinesterase, it produces a more prolonged depolarisation of the motor end plate but doesn’t have any inhibitory effect on the breakdown of acetylcholine itself.
name: It inhibits the breakdown of acetylcholine
label: b
answer: no

Correct answer: a
Which set of side effects are most characteristic of 1st generation (‘typical’) antipsychotic medications, such as haloperidol?

Options:
explanation: These are effects associated with long-term glucocorticoid use, for example in the treatment of autoimmune conditions.
name: Osteoporosis, facial erythema, acne, central obesity, skin thinning
label: d
answer: no
explanation: These are side effects associated with lithium, a mood-stabilising drug often used in the treatment of bipolar affective disorder.
name: Diabetes insipidus, lethargy, hypothyroidism, metallic taste in the mouth
label: c
answer: no
explanation: Metabolic side effects, such as weight gain, type 2 diabetes mellitus, hyperlipidaemia, and anticholinergic side effects, such as dry mouth, constipation, urine retention and blurred vision, commonly occur with the 2nd generation, ‘atypical’ antipsychotics. These may also occur with the 1st generation antipsychotics, but less commonly and to a lesser degree. Extrapyramidal and hyperprolactinaemia side effects are more characteristic of the 1st generation antipsychotic drugs.
name: Weight gain, type 2 diabetes mellitus, hyperlipidaemia, dry mouth, constipation
label: b
answer: no
explanation: These are side effects of bisphosphonates and pyrophosphate analogues used in the prevention and treatment of osteoporosis. An acute phase response involving fever, myalgia and arthralgia is common, whereas oesophagitis and osteonecrosis of the jaw are rare.
name: Oesophagitis, fever, myalgia, arthralgia, osteonecrosis of the jaw
label: e
answer: no
explanation: 1st generation, or ’typical’, antipsychotics are associated with a wide range of side effects, the most characteristic being extrapyramidal side effects, such as tardive dyskinesia, akathisia, rigidity and tremor. They are also associated with hyperprolactinaemia, causing sexual dysfunction, osteoporosis, amenorrhoea, galactorrhea and gynecomastia. A variety of others may also occur, such as metabolic and anticholinergic side effects, but these are less specific to 1st generation antipsychotics and may occur with a range of medications.
name: Rigidity, tremor, sexual dysfunction, tardive dyskinesia, galactorrhea
label: a
answer: yes

Correct answer: a
Which is the correct order of tissues, from superficial to deep, surrounding the kidneys?

Options:
explanation: This is not the correct answer. The paranephric fat layer is the most superficial while the renal capsule is the deepest layer.
name: Perinephric fat, renal fascia, renal capsule, paranephric fat
label: e
answer: no
explanation: This is the correct answer as this is the anatomically correct order from superficial to deep. The paranephric fat separates the kidney from the abdominal wall muscles. The renal fascia is a dense, elastic connective tissue layer that separates the paranephric and perinephric fat. The perinephric fat is a simple connective tissue that protects the kidney and its associated vasculature from external physical stimulation such as temperature changes. Lastly, the renal capsule is composed mainly of tough fibres which help protect the kidney from damage due to trauma or injuries.
name: Paranephric fat, renal fascia, perinephric fat, renal capsule
label: a
answer: yes
explanation: This is not the correct answer. The paranephric fat is superficial to the renal fascia and is the outermost layer. In addition, the renal capsule is the first layer surrounding the kidneys and, therefore the deepest.
name: Perinephric fat, renal capsule, renal fascia, paranephric fat
label: b
answer: no
explanation: This is not the correct answer as this is the order from deep to superficial
name: Renal capsule, perinephric fat, renal fascia, paranephric fat
label: c
answer: no
explanation: This is not the correct answer. The paranephric fat is superficial to the renal fascia and is the outermost layer. In addition, the renal capsule is the first layer surrounding the kidneys and, therefore the deepest.
name: Renal fascia, paranephric fat, renal capsule, perinephric fat
label: d
answer: no

Correct answer: a
Which of the following statements about the adrenal parenchymal cells is correct?

Options:
explanation: This is not the correct answer. The cells of the zona glomerulosa produce mineralocorticoids such as aldosterone.
name: The cells of the zona glomerulosa produce glucocorticoids
label: d
answer: no
explanation: This is the correct answer. Chromaffin cells in the adrenal medulla contain secretory granules which synthesize and store adrenaline and noradrenaline. An easy way to remember the adrenal cortical histology and function from superficial to deep is the saying " GFR, the deeper you go, the sweeter it gets " I.e. Salt (zona glomerulosa, aldosterone), Sugar (zona fasciculata, glucocorticoids) and Sex (zona Reticularis, androgens)
name: The cells of the adrenal medulla produce adrenaline and noradrenaline
label: a
answer: yes
explanation: This is not the correct answer. The cells of the zona fasciculata produce glucocorticoids such as cortisol.
name: The cells of the zona fasciculata produce androgens
label: b
answer: no
explanation: This is not the correct answer. The cells of the zona reticularis produce androgens such as dehydroepiandrosterone (DHEA).
name: The cells of the zona reticularis produce mineralocorticoids
label: c
answer: no
explanation: This is not the correct answer. The cortical parenchymal cells do not contain secretory granules as they do not store the hormones they secrete.
name: The cells of the adrenal cortex contain numerous secretory granules
label: e
answer: no

Correct answer: a
Which of the following structures is intraperitoneal?

Options:
explanation: This is the correct answer. A useful way to remember retriperitoneal structures is the mnemonic "SAD PUCKER": Suprarenal (I.e. adrenal gland), Aorta (and IVC), Duodenum (except first part), Pancreas (except tail), Ureter, Colon, Kidney, Esophagus, and Rectum.
name: Pancreatic tail
label: a
answer: yes
explanation: This is not the correct answer. The oesophagus lies behind the posterior sheath of the peritoneum and is, therefore, a retroperitoneal organ.
name: Oesophagus
label: d
answer: no
explanation: This is not the correct answer. The retroperitoneum contains the large vessels of the abdomen and pelvis, which include the aorta and its branches as well as the inferior vena cava (IVC) and its tributaries.
name: Aorta
label: e
answer: no
explanation: This is not the correct answer. The adrenal gland is located in the retroperitoneal space, between T11 and L1, anteromedial to the upper pole of the kidney.
name: Adrenal gland
label: b
answer: no
explanation: This is not the correct answer. Aside from the duodenojejunal flexure, which is the first part of the duodenum, the second and third parts are retroperitoneal.
name: Duodenum second part
label: c
answer: no

Correct answer: a
At what level does the superior mesenteric artery branch off the abdominal aorta?

Options:
explanation: This is not the correct answer. The abdominal aorta begins at T12 and ends at L4.
name: T10
label: b
answer: no
explanation: This is not the correct answer. L3 is the level where the inferior mesenteric artery branches off the abdominal aorta.
name: L3
label: d
answer: no
explanation: This is the correct answer. The superior mesenteric artery branches off the abdominal aorta at the vertebral level L1 about 1cm lower than the coeliac trunk.
name: L1
label: a
answer: yes
explanation: This is not the correct answer. L4 is the level where the bifurcation into right common iliac and left common iliac occurs.
name: L4
label: e
answer: no
explanation: This is not the correct answer. T12 is the level where the coeliac artery branches off the abdominal aorta.
name: T12
label: c
answer: no

Correct answer: a
What type of epithelium lines the anal canal proximal to the pectinate line?

Options:
explanation: This is not the correct answer. This describes the epithelium of the cutaneous zone, which is below the pectinate line. the cutaneous zone is histologically equal to the skin, is strongly pigmented and is associated with skin-associated structures such as sweat glands, sebaceous glands, hair follicles, and other structures.
name: Stratified squamous keratinized epithelium
label: c
answer: no
explanation: This is not the correct answer. The upper two-thirds of the anal canal, which is derived from endoderm and lies above the pectinate line, is lined by simple columnar epithelium.
name: Simple cuboidal epithelium
label: e
answer: no
explanation: This is the correct answer. The anal canal is divided into the colorectal, transitional, anoderm ("white zone"), and cutaneous (squamous) zones. The pectinate (dentate) line divides the anal canal into upper two-thirds (derived from endoderm) and lower one-third (derived from ectoderm). The colorectal zone lies above the pectinate line and has simple columnar epithelium. The transitional zone has a mix of simple columnar and stratified squamous epithelium. The anoderm has stratified non-keratinized epithelium and lastly, the cutaneous zone has stratified squamous keratinized epithelium.
name: Simple columnar epithelial cells
label: a
answer: yes
explanation: This is not the correct answer. This describes the epithelium of the transitional zone, which contains transverse mucous folds with crypts and anal glands.
name: A mix of simple columnar and stratified squamous epithelia
label: d
answer: no
explanation: This is not the correct answer. This describes the epithelium of the anoderm, which is below the pectinate line. The anoderm is densely packed with sensory neurons that detect whether the intestinal content is solid, liquid or gaseous.
name: Stratified squamous non-keratinized epithelium
label: b
answer: no

Correct answer: a
What is the arrangement of the following in an anterior-to-posterior order?

Options:
explanation: This is the correct answer as this is the anatomically correct order from anterior to posterior. The renal hilus consists of the renal vein which drains into the inferior vena cava, the renal artery which is the branch of the abdominal aorta, and the renal pelvis which is the funnel-shaped dilated part of the ureter in the kidney formed by the convergence of the major calyces.
name: Renal vein, renal artery, renal pelvis
label: a
answer: yes
explanation: This is not the correct answer. The renal vein is the most anterior structure in the renal hilus, followed by the renal artery and lastly, the renal pelvis. The order of these structures can also be remembered with the handy mnemonic "VAD" (renal Vein, renal Artery and renal Duct i.e. ureter)
name: Renal pelvis, renal vein, renal artery
label: d
answer: no
explanation: This is not the correct answer. The renal vein is the most anterior structure in the renal hilus, followed by the renal artery and lastly, the renal pelvis. The order of these structures can also be remembered with the handy mnemonic "VAD" (renal Vein, renal Artery and renal Duct i.e. ureter)
name: Renal vein, renal pelvis, renal artery
label: e
answer: no
explanation: This is not the correct answer. The renal vein is the most anterior structure in the renal hilus, followed by the renal artery and lastly, the renal pelvis. The order of these structures can also be remembered with the handy mnemonic "VAD" (renal Vein, renal Artery and renal Duct i.e. ureter)
name: Renal artery, renal vein, renal pelvis
label: b
answer: no
explanation: This is not the correct answer as this is the order from posterior to anterior.
name: Renal pelvis, renal artery, renal vein
label: c
answer: no

Correct answer: a
Which of the following structures is found on the superior pole of the kidneys?

Options:
explanation: This is not the correct answer. The superior one-half of the anterior surface of the right kidney is associated with a layer of peritoneum separating it from the liver, where the potential space separating the liver and kidney is known as the hepatorenal pouch of Morison. This pouch is normally empty but may be filled with fluid due to certain pathological conditions such as haemoperitoneum and ascites. As this structure is not located on the superior pole of the kidney, it is not the correct answer.
name: Hepatorenal pouch of Morison
label: b
answer: no
explanation: This is not the correct answer. The left colic flexure (splenic flexure) is located at the lateral part of the inferior pole of the left kidney
name: Left colic flexure
label: e
answer: no
explanation: This is the correct answer. The abdominal organs are not paired, as such, the right kidney and left kidney relations differ in several ways. However, in both kidneys, the adrenal gland (suprarenal gland) is located on the superior pole.
name: Adrenal gland
label: a
answer: yes
explanation: This is not the correct answer. The right colic flexure (hepatic flexure) is located at the lateral part of the inferior pole of the right kidney
name: Right colic flexure
label: c
answer: no
explanation: This is not the correct answer. The right colic flexure (hepatic flexure) is located at the medial part of the inferior pole of the kidney
name: Jejunum
label: d
answer: no

Correct answer: a
Which vessel is the main supply of blood and nutrients to the liver from the gastrointestinal tract?

Options:
explanation: This is not the correct answer. The common hepatic artery is a branch of the coeliac artery, which divides into two terminal branches at the superior aspect of the duodenum, namely the hepatic artery proper and the gastroduodenal artery. The hepatic artery proper provides 25% of the blood supply to the liver.
name: Common hepatic artery
label: c
answer: no
explanation: This is not the correct answer. The cystic branch of the right hepatic artery supplies the gall bladder.
name: Cystic branch of the right hepatic artery
label: e
answer: no
explanation: This is not the correct answer. While it does supply the non-parenchymal structures of the liver with oxygenated blood, it makes up 25% of the blood supply of the liver. The hepatic portal vein supplies 75% of the blood supply to the liver and thus, is the main supply.
name: Hepatic artery proper
label: b
answer: no
explanation: This is the correct answer. The liver has a dual blood supply where the main component is the hepatic portal vein which supplies the liver parenchyma with partially deoxygenated blood and nutrients from the small intestine. It allows the liver to perform functions related to the gut such as detoxification. The hepatic artery proper is the other component of the dual blood supply, supplying 25% of the blood supply. It is derived from the coeliac trunk and supplies the non-parenchymal structures of the liver with oxygenated blood
name: Hepatic portal vein
label: a
answer: yes
explanation: This is not the correct answer. The gastroduodenal artery is one of the branches of the common hepatic artery which branches into the right gastroepiploic artery and the superior pancreatoduodenal artery. These supply the stomach and the greater omentum, and the head of the pancreas respectively.
name: Gastroduodenal artery
label: d
answer: no

Correct answer: a
Which of the following structures lies inferior to the spleen?

Options:
explanation: This is the correct answer. The splenic (left colic) flexure lies inferior to the spleen. The transverse colon extends from the hepatic (right colic) flexure to the splenic (left colic) flexure, which then turns downwards as the descending colon.
name: Splenic flexure/ Left colic flexure
label: a
answer: yes
explanation: This is not the correct answer. The tail of the pancreas, as well as the left kidney, lies medial to the spleen.
name: Tail of the pancreas
label: e
answer: no
explanation: This is not the correct answer. The diaphragm, as well as the left lung and the 9-11th ribs, lie posterior to the spleen.
name: Diaphragm
label: c
answer: no
explanation: This is not the correct answer. The stomach lies anterior to the spleen.
name: Stomach
label: b
answer: no
explanation: This is not the correct answer. The left kidney, as well as the tail of the pancreas, lies medial to the spleen.
name: Left kidney
label: d
answer: no

Correct answer: a