hllj/quesmed huggingface dataset:
A 43-year-old woman presents to A&E with a severe sudden-onset headache towards the back of her head. She has vomited once since arriving at the hospital. She has a past medical history of polycystic kidney disease.

Which medication should be given to this patient?

Options:
explanation: This is a classical history of a subarachnoid haemorrhage with a sudden-onset occipital headache and a risk factor of polycystic kidney disease. This should be urgently managed with surgical treatments like coiling and clipping, but patients should also be given nimodipine in the interim to prevent vasospasm.
name: Nimodipine
label: a
answer: yes
explanation: This is a classical history of a subarachnoid haemorrhage with a sudden-onset occipital headache and a risk factor of polycystic kidney disease. This should be urgently managed with surgical treatments like coiling and clipping, but patients should also be given nimodipine in the interim to prevent vasospasm. Amlodipine is a calcium-channel blocker like nimodipine and is used to manage hypertension. However, it is not routinely administered to prevent vasospasm in subarachnoid haemorrhages.
name: Amlodipine
label: d
answer: no
explanation: This is a classical history of a subarachnoid haemorrhage with a sudden-onset occipital headache and a risk factor of polycystic kidney disease. This should be urgently managed with surgical treatments like coiling and clipping, but patients should also be given nimodipine in the interim to prevent vasospasm. Losartan is an angiotensin-II receptor blocker used to manage hypertension. This has no role in the management of subarachnoid haemorrhages.
name: Losartan
label: c
answer: no
explanation: This is a classical history of a subarachnoid haemorrhage with a sudden-onset occipital headache and a risk factor of polycystic kidney disease. This should be urgently managed with surgical treatments like coiling and clipping, but patients should also be given nimodipine in the interim to prevent vasospasm. Furosemide is a loop diuretic used to manage oedema. It has no role in the management of subarachnoid haemorrhages.
name: Furosemide
label: e
answer: no
explanation: This is a classical history of a subarachnoid haemorrhage with a sudden-onset occipital headache and a risk factor of polycystic kidney disease. This should be urgently managed with surgical treatments like coiling and clipping, but patients should also be given nimodipine in the interim to prevent vasospasm. Ramipril is an ACE-inhibitor used to manage hypertension. It has no role in the management of subarachnoid haemorrhages.
name: Ramipril
label: b
answer: no

Correct answer: a
A 25-year-old patient is currently receiving treatment for a pulmonary embolism in the hospital. The patient is stable, but the prognosis is unclear. The patient has no emergency contacts or documented next of kin.

The patient's friend approaches the doctor managing the patient and asks if she is caring for the patient and whether she can explain how the patient is doing now.

What is the most appropriate action?

Options:
explanation: The patient has no emergency contact or next of kin, and they have the right to confidentiality. Commenting on the patient's clinical status would be a breach of their confidentiality.
name: The doctor cannot confirm whether they are caring for the patient but can comment on the clinical condition of the patient
label: b
answer: no
explanation: The patient has no emergency contact or next of kin and they have the right to confidentiality. Commenting on the stability of the patient is still a breach of their confidentiality.
name: The doctor cannot confirm whether they are caring for the patient, but they can comment that they have heard that the patient is stable
label: e
answer: no
explanation: The patient has no emergency contact or next of kin, and they have the right to confidentiality. The doctor should not divulge any information to the patient's friend.
name: The doctor can confirm whether they are caring for the patient and can comment that the patient is stable now
label: c
answer: no
explanation: The patient has no emergency contact or next of kin, and they have the right to confidentiality. Hence, the doctor should avoid providing any information to the patient's friend.
name: The doctor cannot confirm whether they are caring for the patient, and cannot comment on the clinical condition of the patient
label: a
answer: yes
explanation: The patient has no emergency contact or next of kin and they have the right to confidentiality. It is also a lie to say that they can be discharged tomorrow as the prognosis is still unclear.
name: The doctor can confirm whether they are caring for the patient, and can comment that the patient is ready to be discharged tomorrow
label: d
answer: no

Correct answer: a
A 54-year-old man is brought to the Emergency Department following a serious road traffic collision. He has lost a significant amount of blood and the major haemorrhage protocol is activated.

As part of the physiological response to hypovolaemia, the renin-angiotensin-aldosterone system is activated.

Which of the following is a direct trigger for aldosterone release?

Options:
explanation: Antidiuretic hormone (ADH) is also released upon stimulation by angiotensin II, however, it does not directly stimulate aldosterone release. ADH is released from the posterior pituitary and acts to increase water reabsorption from the collecting duct.
name: Increased ADH levels
label: c
answer: no
explanation: Parathyroid hormone (PTH) levels are not increased in hypovolaemia. PTH is involved in calcium homeostasis. The most common cause of primary hyperparathyroidism is an adenoma of the parathyroid glands.
name: Increased PTH levels
label: b
answer: no
explanation: Whilst increased renin levels indirectly cause increased aldosterone production via the renin-angiotensin-aldosterone system by converting angiotensinogen to angiotensin I, it is angiotensin II that directly acts on the adrenal cortex to increase aldosterone production. The question specifies that the answer should be a direct trigger.
name: Increased renin levels
label: e
answer: no
explanation: Adrenocorticotropic hormone (ACTH) is released from the anterior pituitary. It stimulates the zona fasciculata of the adrenal cortex to produce glucocorticoids. Whilst increased ACTH levels have a very minimal role in increasing aldosterone secretion, decreased ACTH levels do not.
name: Decreased ACTH levels
label: d
answer: no
explanation: In response to hypovolaemia, the juxtaglomerular cells of the kidney secrete renin. Renin acts to convert angiotensinogen (a hormone produced by the liver) to angiotensin I. Angiotensin I in turn is converted by angiotensin-converting enzyme (ACE) to angiotensin II. Angiotensin II acts on the zona glomerulosa of the adrenal cortex to increase aldosterone release.
name: Increased angiotensin II levels
label: a
answer: yes

Correct answer: a
A 64-year-old female with a history of asthma presents to the Emergency Department with palpitations and lightheadedness. She describes previously experiencing episodes of her heart racing which then spontaneously resolved. An ECG is performed, and she receives a diagnosis of supraventricular tachycardia (SVT). The doctor encourages her to blow into a syringe but this is ineffective. She is given a calcium channel blocker as part of her acute management.

Which of the following drugs is she most likely to have been given?

Options:
explanation: Whilst adenosine is the first-line drug therapy for SVT, the patient has a history of asthma so adenosine is contraindicated. The question also specifies that she was given a calcium channel blocker.
name: Adenosine
label: b
answer: no
explanation: Whilst amlodipine is a calcium channel blocker, it is non-rate limiting so would not be useful in treating SVT. Amlodipine is primarily used in the treatment of hypertension in patients over 55 or of Black African or African-Caribbean family origin.
name: Amlodipine
label: c
answer: no
explanation: Lisinopril is an ACE inhibitor and has no anti-arrhythmic effect. It is mainly used as an antihypertensive or post-myocardial infarction.
name: Lisinopril
label: d
answer: no
explanation: Verapamil is a rate-limiting calcium channel blocker and can be given to treat SVT.

SVTs often resolve spontaneously or with reflex vagal stimulation i.e. the Valsalva manoeuvre (such as blowing into a syringe) or carotid sinus massage. If these are ineffective, the patient can be given adenosine or verapamil (verapamil is given if adenosine is ineffective or contraindicated). In this question the patient has a history of asthma, so adenosine is contraindicated.
name: Verapamil
label: a
answer: yes
explanation: Bisoprolol is a beta blocker, not a calcium channel blocker. Whilst beta blockers reduce the heart rate, they are not indicated for the acute management of SVT. Beta-blockers should also be avoided in patients with asthma as they can cause airway narrowing and precipitate an asthma attack.
name: Bisoprolol
label: e
answer: no

Correct answer: a
A 74-year-old female is referred by her GP to the cardiology clinic. She complains of being no longer able to climb the stairs at home. When questioned, she states she uses 4 pillows in bed at night. On examination, she is dyspnoeic with a raised JVP and ankle oedema. The cardiology registrar starts her on medication for symptomatic relief.

Where on the nephron is this medication most likely to act?

Options:
explanation: This patient has presented with the signs and symptoms of heart failure including orthopnoea, reduced exercise tolerance, dyspnoea, raised JVP and ankle oedema. Her doctor would have prescribed her a loop diuretic such as furosemide for symptomatic relief of heart failure. Loop diuretics block the Na+/K+/2Cl- co-transporter in the loop of Henle. This prevents the reabsorption of salt and water and causes a diuresis effect.
name: Loop of Henle
label: a
answer: yes
explanation: The patient would have been given a loop diuretic such as furosemide for symptomatic relief of her heart failure - furosemide acts on the Loop of Henle, not the proximal convoluted tubule. Carbonic anhydrase inhibitors such as acetazolamide can act on the proximal convoluted tubule and have a weak diuretic action, however, are not routinely used for heart failure management.
name: Proximal convoluted tubule
label: b
answer: no
explanation: The patient will have been given a loop diuretic such as furosemide for symptomatic relief of their heart failure, which acts on the Loop of Henle, not the distal convoluted tubule. Potassium-sparing diuretics such as aldosterone antagonists (such as spironolactone) act on the late distal convoluted tubule and early collecting duct. Spironolactone can be used in heart failure but is not given purely for symptomatic relief.
name: Distal convoluted tubule
label: d
answer: no
explanation: The efferent arteriole is not part of the nephron and therefore cannot be the correct answer. The efferent arteriole is targeted by ACE inhibitors and ARBs which cause vasodilation. This can be useful to target in proteinuric diseases such as diabetic nephropathy.
name: Efferent arteriole
label: e
answer: no
explanation: The patient would have been given a loop diuretic such as furosemide for symptomatic relief of her heart failure - furosemide acts on the Loop of Henle, not the collecting duct. Potassium-sparing diuretics such as aldosterone antagonists (e.g. spironolactone) act on the late distal convoluted tubule and early collecting duct. Spironolactone can be indicated in heart failure but is not given for symptomatic relief.
name: Collecting duct
label: c
answer: no

Correct answer: a
A 30-year-old male attends his GP after noticing a tremor in his hands. He was diagnosed with asthma as a child and experienced frequent exacerbations, some of which required hospitalisation.

Which medication is the most likely cause of his symptoms?

Options:
explanation: Salbutamol is a beta-2 agonist, and one of its most characteristic adverse effects is tremor of the hands. This man presents with a strong history of asthma and is likely to have regularly used salbutamol for symptomatic relief during exacerbations. This makes salbutamol the most likely answer.
name: Salbutamol
label: a
answer: yes
explanation: IV hydrocortisone is often given as part of the acute management of severe asthma. However, hydrocortisone is not associated with a hand tremor.
name: Hydrocortisone
label: d
answer: no
explanation: Magnesium sulfate can be used to treat severe asthma exacerbations as it acts as a bronchodilator. However, magnesium sulfate is not associated with a hand tremor.
name: Magnesium sulfate
label: e
answer: no
explanation: Amiodarone can be associated with tremor of the hands, however, considering the asthma history (and lack of cardiac history) in this patient, it is not the most likely cause.
name: Amiodarone
label: b
answer: no
explanation: This patient is likely to be on an inhaled corticosteroid such as beclometasone as a preventer for his asthma. However, beclomethasone is not associated with a hand tremor.
name: Beclometasone
label: c
answer: no

Correct answer: a
A 37-year-old female is referred for further pulmonary investigations after experiencing dyspnoea.

Which of the following is associated with an increased transfer factor?

Options:
explanation: Bronchiectasis is caused by the permanent dilatation of the bronchi and bronchioles due to chronic infection. It is not associated with an increased transfer factor.
name: Bronchiectasis
label: c
answer: no
explanation: This is the correct answer. Transfer factor is a measure of how well the lungs can take up oxygen - it is measured indirectly by measuring the uptake of carbon monoxide by the lungs. In pulmonary haemorrhages, there is leakage of red blood cells into the alveolar space. These red blood cells, despite not being in the pulmonary vessels, are still able to carry oxygen (and carbon monoxide), which results in an increased transfer factor.
name: Pulmonary haemorrhage
label: a
answer: yes
explanation: Pneumonia is associated with the presence of fluid and blood in the alveoli. This increases the diffusion gradient for gases, thus resulting in a decreased transfer factor.
name: Pneumonia
label: e
answer: no
explanation: COPD is characterised by both chronic bronchitis and emphysema. Emphysema is associated with the destruction of elastin fibres and alveoli, which results in a reduced surface area for gas exchange, and thus a decreased transfer factor.
name: COPD
label: d
answer: no
explanation: Pulmonary fibrosis is characterised by increased interstitial collagen deposition which makes it harder for oxygen (and carbon monoxide) to be taken up by the lungs. This results in a decreased transfer factor.
name: Pulmonary fibrosis
label: b
answer: no

Correct answer: a
A baby is born in the neonatal unit at 25 weeks gestation. The paediatrician notes that the baby is breathing very fast, and subsequently diagnoses them with neonatal respiratory distress syndrome due to a deficiency of surfactant.

Which of the following cells is responsible for surfactant production?

Options:
explanation: Type 1 pneumocytes are the primary cells involved in gas exchange in the epithelium of the alveoli. They are not involved in surfactant production.
name: Type 1 pneumocyte
label: b
answer: no
explanation: Goblet cells are mostly found in the epithelia of the respiratory and gastrointestinal tracts and they secrete mucous, not surfactant.
name: Goblet cell
label: d
answer: no
explanation: Surfactant is produced by Type 2 pneumocytes. The main function of surfactant is to reduce the surface tension across the alveoli, preventing their collapse. Type 2 pneumocytes develop their ability to secrete surfactant late in foetal development, so premature infants can have surfactant deficiency resulting in respiratory distress syndrome.
name: Type 2 pneumocyte
label: a
answer: yes
explanation: Clara cells are found in the bronchioles and serve to protect the bronchiolar epithelium. They also secrete a solution similar to surfactant to maintain a moist surface and reduce surface tension.
name: Clara cell
label: c
answer: no
explanation: Chief cells are found in the stomach and secrete pepsinogen which breaks down proteins. They have no role in surfactant production.
name: Chief cell
label: e
answer: no

Correct answer: a
A 67-year-old female presents to A&E with an exacerbation of COPD.

An ABG is carried out which shows a raised PCO2 and reduced PO2.

Which of the following parts of the brain detects raised carbon dioxide levels and stimulates an increase in respiratory rate?

Options:
explanation: The occipital lobe is the smallest lobe of the brain and is found posteriorly. The main role of the occipital lobe is visual processing.
name: Occipital lobe
label: e
answer: no
explanation: The pituitary gland is located at the base of the brain. The anterior pituitary responds to hormones released from the hypothalamus to release trophic hormones such as thyroid stimulating hormone (TSH). These hormones are released into the blood and target other endocrine glands in the body, such as the thyroid gland. The posterior pituitary releases ADH and oxytocin.
name: Pituitary gland
label: b
answer: no
explanation: The key role of the hypothalamus is to maintain homeostasis in the body, regulating parameters such as temperature and thirst. It is not involved in the respiratory drive.
name: Hypothalamus
label: c
answer: no
explanation: The respiratory centre is located in the medulla, which is a part of the brain stem. Here, there are central chemoreceptors that detect raised CO2 through an increase in H+ ion concentration. When the central chemoreceptors in the medulla detect an increased H+ ion concentration, they signal to the Dorsal Respiratory Group (DRG) which in turn increases firing to the Ventral Respiratory Group (VRG). The VRG fires impulses at an increased frequency to the diaphragm via the phrenic nerve, increasing the respiratory rate to "blow off" excess CO2.
name: Medulla
label: a
answer: yes
explanation: The frontal lobes are the largest lobes of the brain. They are important for movement and complex behaviours such as judgement, morality, emotion and personality.
name: Frontal lobe
label: d
answer: no

Correct answer: a
A 52-year-old male attends fracture clinic after fracturing his wrist. When questioned, he admits to having an 8-month history of pain in his bones prior to this recent fracture. The consultant orders further investigations and he is noted to have a raised alkaline phosphatase and changes to the bone on x-ray.

He is diagnosed with Paget's disease of bone. This condition is associated with increased bone resorption, formation, and remodelling.

Which of the following is responsible for producing bone extracellular matrix?

Options:
explanation: Osteoprogenitor cells do not produce the bone extracellular matrix. Osteoprogenitor cells give rise to osteoblasts, which form bone tissue. Osteoblasts can further mature into osteocytes, which maintain bone tissue.
name: Osteoprogenitor cell
label: d
answer: no
explanation: An osteon is also called a Haversion system. It is the structural and functional unit of compact bone. It consists of Type 1 collagen fibres arranged in concentric lamellae around a Haversian canal which contains blood vessels and nerves.
name: Osteon
label: e
answer: no
explanation: Osteoclasts are responsible for the resorption of bone, not the formation of bone. They do this by releasing enzymes such as collagenases. Osteoclasts are large multinucleated cells, derived from monocytes.
name: Osteoclast
label: b
answer: no
explanation: Osteoid is not a cell but is an unmineralised bone produced by osteoblasts. Osteoid consists of Type 1 collagen and a glycosaminoglycan gel which contains glycoproteins that bind calcium.
name: Osteoid
label: c
answer: no
explanation: Osteoblasts produce osteoid and release matrix vesicles. Osteoid consists of Type 1 collagen and a glycosaminoglycan gel which contains glycoproteins that bind calcium. Matrix vesicles contain enzymes such as alkaline phosphatase which increase local concentrations of calcium.
name: Osteoblast
label: a
answer: yes

Correct answer: a
A pathologist is reviewing slides. They identify the tissue they are looking at as stratified squamous non-keratinising epithelial tissue.

Which of the following is the most likely place the specimen was taken from?

Options:
explanation: The soft palate and cheeks are lined with stratified squamous non-keratinising epithelium. This epithelia type is often found at entrances and exits of the body, for example, the oesophagus, vagina and anal canal inferior to the pectinate line.
name: Soft palate
label: a
answer: yes
explanation: The skin has a stratified squamous keratinising epithelium. This allows it to withstand constant abrasion and desiccation.
name: Skin
label: b
answer: no
explanation: The small intestine typically has simple columnar epithelial tissue. This tissue type is most often associated with absorption and secretion.
name: Small intestine
label: c
answer: no
explanation: The bladder is lined with transitional cell epithelium. This epithelium is unique to the ureters and urinary bladder. Transitional cell epithelium changes between stretched (when the bladder is full) and relaxed (when the bladder is empty) states.
name: Bladder
label: e
answer: no
explanation: The trachea is lined with pseudostratified ciliated columnar epithelium. This epithelium extends to the bronchi, where it is replaced with a simple columnar epithelium in the bronchioles.
name: Trachea
label: d
answer: no

Correct answer: a
A 72-year-old retired factory worker attends a urology clinic after experiencing frank haematuria. They undergo cystoscopy and a biopsy is taken. They are subsequently diagnosed with bladder cancer.

Which of the following epithelia line the bladder?

Options:
explanation: Transitional epithelium, also known as urothelium, is unique to the urinary tract. Over 90% of bladder cancers are transitional cell carcinomas.
name: Transitional epithelium
label: a
answer: yes
explanation: Stratified squamous epithelia have a protective function, for example in the epidermis of the skin. It is not found in the bladder.
name: Stratified squamous epithelium
label: d
answer: no
explanation: Pseudostratified columnar epithelium is a variant of simple columnar. The cells are tightly packed together, squeezing the nuclei off-centre and giving the appearance of many layers. This epithelium is found in parts of the respiratory tract (trachea and bronchi) and parts of the male reproductive tract (vas deferens and epididymis).
name: Pseudostratified columnar epithelium
label: e
answer: no
explanation: Simple squamous epithelia are generally found where there is a need for passive diffusion of fluids or gases, such as the alveoli of the lungs. The fact that the epithelium is one cell thick aids the movement of fluids or gases.
name: Simple squamous epithelium
label: b
answer: no
explanation: Simple cuboidal epithelia are generally found lining small ducts and tubules and may have excretory, secretory or absorptive functions, for example in the proximal convoluted tubule of the nephron.
name: Simple cuboidal epithelium
label: c
answer: no

Correct answer: a