hllj/quesmed huggingface dataset:
What is the Bolam Test?

Options:
explanation: This is the definition for the doctrine of double effect
name: If doing something morally good has a morally bad side-effect it's ethically permissible to do, providing the bad side-effect wasn't intended
label: d
answer: no
explanation: If a doctor reaches the standard, they are not negligent
name: If a doctor reaches the standard of a responsible body of medical opinion, they are negligent
label: b
answer: no
explanation: This is the definition of patient autonomy
name: The right of competent adults to make informed decisions about their own medical care
label: c
answer: no
explanation: The standard is agreed by a responsible body of MEDICAL opinion, not public
name: If a doctor reaches the standard of a body of public opinion, they are not negligent
label: e
answer: no
explanation: The Bolam test takes account of evolving standards of care once collectively expressed in practice. It helps to establish a typical action doctors may take in a clinical situation to be able to assess the appropriate standard of reasonable care in negligence cases.
name: If a doctor reaches the standard of a responsible body of medical opinion, they are not negligent
label: a
answer: yes

Correct answer: a
Which of the following do **emollient**s mimic?

Options:
explanation: The hydration of keratin is increased, not basal cells
name: Mimic the barrier effect of surface lipids that are defective - this increases the hydration of the basal cells in the stratum corneum
label: d
answer: no
explanation: Keratin is hydrated in in the stratum corneum, not the stratum spinosum
name: Mimic the barrier effect of surface lipids that are defective - this increases the hydration of the keratin in the stratum spinosum
label: e
answer: no
explanation: Emollients mimic surface lipids, not keratinocytes
name: Mimic the barrier effect of keratinocytes that are defective - this increases the hydration of the keratin in the stratum corneum
label: b
answer: no
explanation: Emollients mimic surface lipids, not merkel cells
name: Mimic the barrier effect of merkel cells that are defective - this increases the hydration of the keratin in the stratum corneum
label: c
answer: no
explanation: Emollients such as E45 come in different formulations such as lotions, creams and ointments. They are used in dermatological conditions such as psoriasis and eczema and create a barrier for the skin.
name: Mimic the barrier effect of surface lipids that are defective - this increases the hydration of the keratin in the stratum corneum
label: a
answer: yes

Correct answer: a
What is the lifetime risk of women with a BRCA1 mutation developing breast cancer?

Options:
explanation: This is the lifetime risk of women developing colorectal cancer. The correct answer is 65 to 79%
name: 1 in 26
label: b
answer: no
explanation: The BRCA1 gene is a tumour suppressor gene, most mutations promote frameshifts resulting in missense or non-functional proteins. Women are also at risk of developing ovarian cancer.
name: 65-79%
label: a
answer: yes
explanation: This is the risk men with BRCA2 mutation have of developing breast cancer. The correct answer is 65 to 79%
name: 6%
label: c
answer: no
explanation: This is the lifetime risk of developing breast cancer for women who do not have a BRCA mutation. The correct answer is 65 to 79%
name: 15%
label: e
answer: no
explanation: The correct answer is 65 to 79%
name: 20-35%
label: d
answer: no

Correct answer: a
Which of the following is the correct definition of patient autonomy?

Options:
explanation: This is the correct definition. It means that doctors must seek the informed agreement of the patient before any investigation or treatment takes place.
name: The right of competent adults to make informed decisions about their own medical care
label: a
answer: yes
explanation: This is the definition of beneficence
name: All doctors have a moral duty to prioritise patient care and wellbeing and work in the best interests of the patient
label: e
answer: no
explanation: Patients should be fully informed by their doctors about risk, benefits and options before making decisions about their medical care
name: The right of competent adults to make uninformed decisions about their own medical care
label: b
answer: no
explanation: This is the first prinicple in assessing mental capacity in a patient
name: The presumption that patients have capacity
label: c
answer: no
explanation: Children do not always have the right to make decisions about their healthcare, under the age of 16 years children may have capacity to consent to treatment, depending on their ability to understand what is involved. However, under 16 they may not refuse treatment.
name: The right of children to make informed decisions about their own medical care
label: d
answer: no

Correct answer: a
Which of the following factors would lead to a reduced affinity of haemoglobin for oxygen?

Options:
explanation: Compared to adult hemoglobin, it has a significantly higher affinity for oxygen
name: Fetal hemoglobin
label: e
answer: no
explanation: Increases in CO2 decrease hemoglobin saturation, while decreases in CO2 increase hemoglobin saturation.
name: Decreased PaCO2
label: b
answer: no
explanation: The affinity that hemoglobin has on oxygen is decreased when the pH of blood is decreased e.g. in acidosis.
name: High pH
label: d
answer: no
explanation: A high level of 2,3-DPG increases the Bohr effect on Hb-O2 affinity and helps with O2 unloading in muscles during exercise. An increase in 2,3-DPG concentration can be found in congenital heart diseases, chronic lung diseases, some acquired anaemias, at high altitudes and in alkalosis.
name: Increased 2, 3 – DPG levels
label: a
answer: yes
explanation: Increased temperature decreases the affinity of hemoglobin for oxygen which allows for the unloading of oxygen in metabolising tissues.
name: Hypothermia
label: c
answer: no

Correct answer: a
A patient weighs 39kg and is 169cm tall, what is her body mass index (BMI)?

Options:
explanation: The correct answer is 13.6. BMI is calculated by dividing a person's weight in kilograms by the square of height in meters. The healthy BMI range is 18.5 to 24.9.
name: 18.5
label: b
answer: no
explanation: The correct answer is 13.6. BMI is calculated by dividing a person's weight in kilograms by the square of height in meters. The healthy BMI range is 18.5 to 24.9.
name: 16.4
label: e
answer: no
explanation: The correct answer is 13.6. BMI is calculated by dividing a person's weight in kilograms by the square of height in meters. The healthy BMI range is 18.5 to 24.9.
name: 15.2
label: c
answer: no
explanation: BMI is calculated by dividing a person's weight in kilograms by the square of height in meters. The healthy BMI range is 18.5 to 24.9 kg/m<sup>2</sup>.
name: 13.6
label: a
answer: yes
explanation: The correct answer is 13.6. BMI is calculated by dividing a person's weight in kilograms by the square of height in meters. The healthy BMI range is 18.5 to 24.9.
name: 14.7
label: d
answer: no

Correct answer: a
The RANK/RANKL pathway plays a key role in bone remodelling and the immune system.

Abnormality in this pathway can lead to which of the following conditions?

Options:
explanation: The RANKL system plays a critical role in breast cancer development, during initial tumorigenesis promoting the survival and proliferation of epithelial cells during the development of mammary glands and up-regulating the expression of RANK.
name: Breast cancer and secondary tumours in the bone
label: a
answer: yes
explanation: The RANKL system is involved in the development of certain cancer, and also in bone modelling. Alcoholic liver disease is due to the fibrosis of hepatocytes.
name: Alcoholic liver disease
label: b
answer: no
explanation: The RANKL system is involved in the development of certain cancers, and also in bone modelling. Schistosomiasis is a disease caused by parasitic worms that can be acute or chronic.
name: Schistosomiasis
label: d
answer: no
explanation: The RANKL system is involved in the development of certain cancers, and also in bone modelling. Malaria is due to infected female anopheles mosquitos biting and allowing Plasmodium parasites to enter the bloodstream.
name: Malaria
label: e
answer: no
explanation: The RANKL system is involved in the development of certain cancers, and also in bone modelling. Dermatophyte fungi are the predominant pathogens that cause onychomycosis.
name: Onychomycosis
label: c
answer: no

Correct answer: a
You are investigating patients' ideas about medication adherence and are conducting interviews.

Which of the following will you do to prevent selection bias?

Options:
explanation: This would be a way of avoiding selection bias. Bias is introduced by the selection of individuals, groups, or data for analysis in such a way that proper randomisation is not achieved
name: Randomly choose participants until thematic saturation is reached
label: a
answer: yes
explanation: This is the definition of a systematic review. You may complete a literature review prior to your interviews.
name: Identify,  synthesise and appraise all high quality research relevant to medication adherence
label: d
answer: no
explanation: This is the definition of a prospective study
name: Follow participants over months/ years to determine how a specific exposure or intervention affects specific outcomes
label: c
answer: no
explanation: This is an example of selection bias. Bias is introduced by the selection of individuals, groups, or data for analysis in such a way that proper randomisation is not achieved.
name: Choose participants who you have previously treated and who struggle with medication adherence
label: e
answer: no
explanation: This is an example of selection bias. Bias is introduced by the selection of individuals, groups, or data for analysis in such a way that proper randomisation is not achieved
name: Choose participants who you feel hold the most interesting views
label: b
answer: no

Correct answer: a
You're treating a 43 year old female patient and your consultant prescribes gentamicin. This is an aminoglycoside.

Which of the following best describes it's mechanism of action?

Options:
explanation: This is the mechanism of action of ciprofloxacin, a quinolone antibiotic
name: Inhibits topoisomerase II (DNA gyrase) and topoisomerase IV (both Type II topoisomerases)
label: c
answer: no
explanation: This is the mechanism of action of cephalexin, a cephalosporin
name: Inhibits bacterial cell wall peptidoglycan synthesis by inhibition of penicillin-sensitive enzymes (transpeptidases, carboxypeptidases)
label: e
answer: no
explanation: This is the mechanism of action of digoxin, a drug that can be used in the treatment of hart failure
name: Inhibits the sodium/potassium-ATPase within the plasma membrane of cardiac myocyte
label: d
answer: no
explanation: Aminoglycosides bind to the aminoacyl site of 16S ribosomal RNA within the 30S ribosomal subunit, leading to misreading of the genetic code and inhibition of translocation
name: Bind to the 16S ribosomal RNA so inhibit translocation
label: a
answer: yes
explanation: This is the mechanism of action of penicillin
name: Bind the beta-lactam ring to DD-transpeptidase, inhibiting its cross-linking activity and preventing new cell wall formation
label: b
answer: no

Correct answer: a
Which of the follow best describes the term 'validity' in research?

Options:
explanation: This describes correlation
name: A mutual relationship or connection between two or more things
label: e
answer: no
explanation: Reliability and validity are used to evaluate the quality of research. Reliability is about the consistency of a measure, and validity is about the accuracy of a measure.
name: The design and execution of research leads to unbiased results and an accurate estimate of the effect that is being measured
label: a
answer: yes
explanation: This describes reliability. Reliability is about the consistency of a measure, and validity is about the accuracy of a measure.
name: The extent to which the results can be reproduced when the research is repeated under the same conditions
label: b
answer: no
explanation: This describes the null hypothesis
name: When one variable is tested against another, there will be no difference between the variables, or no association between the variables
label: c
answer: no
explanation: This describes "skewness"
name: A measure of the asymmetry of the distribution of a variable
label: d
answer: no

Correct answer: a
A patient comes in with a productive cough. There are no signs of meningism. A chest x-ray identifies consolidation of the upper zone with ipsilateral hilar enlargement, active tuberculosis is confirmed.

Which is the appropriate treatment regimen?

Options:
explanation: This is an example of a regimen you can use to manage latent tuberculosis. This patient has active tuberculosis so the regimen described above is indicated.
name: Rifampicin - 3 months; Isoniazid - 3 months
label: e
answer: no
explanation: This is incorrect, pyrazinamine and ethambutol should be given for 2 months, not 6
name: Rifampicin - 6 months; Isoniazid - 6 months; Pyrazinamine - 6 months; Ethambutol - 6 months
label: b
answer: no
explanation: This is the correct regimen for the treatment of active tuberculosis. Pyridoxine (Vitamin B6) should also be given to patients to prevent peripheral neuropathy associated with isoniazid
name: Rifampicin - 6 months; Isoniazid - 6 months; Pyrazinamine - 2 months; Ethambutol - 2 months
label: a
answer: yes
explanation: Ethambutol is now recommend routinely in NICE guidelines - previously this was only added if drug-resistant tuberculosis was suspected
name: Rifampicin - 6 months; Isoniazid - 6 months; Pyrazinamine - 2 months
label: d
answer: no
explanation: This is the specific treatment regimen for patients with meningeal tuberculosis
name: Rifampicin - 12+ months; Isoniazid - 12+ months; Pyrazinamine - 12+ months; Ethambutol - 12+ months
label: c
answer: no

Correct answer: a
Which of the following is a lymphoid immune cell?

Options:
explanation: Eosinophils are myeloid cells. Myeloid cells are blood cells that arise from a progenitor cell for granulocytes, monocytes, erythrocytes, and platelets.
name: Eosinophils
label: c
answer: no
explanation: Natural Killer cells are lymphoid cells. Other lymphoid cells are B-cells and T-cells. Lymphocytes develop in the thymus and yellow bone marrow.
name: Natural Killer cell
label: a
answer: yes
explanation: Dendritic cells are myeloid cells. Myeloid cells are blood cells that arise from a progenitor cell for granulocytes, monocytes, erythrocytes, and platelets.
name: Dendritic cells
label: e
answer: no
explanation: Prostaglandin A1 is an inflammatory mediator. Prostaglandins are unsaturated carboxylic acids involved in vasodilation, vasoconstriction, bronchoconstriction and in both the promotion and resolution of inflammation.
name: Prostaglandin A1
label: b
answer: no
explanation: Ganglion cells are found in the nervous system. In the retina they project their axons along the optic nerve and are responsible for the propagation of visual stimuli to the brain, they are not involved in inflammation
name: Ganglion cells
label: d
answer: no

Correct answer: a
What is the mechanism of action of lactoferrin?

Options:
explanation: This is the mechanism of action of Angiotensin converting enzyme (ACE) which plays an important role in the control of blood pressure
name: Converts inactive Angiotensin I to active Angiotensin II and degrade active bradykinin (BK)
label: c
answer: no
explanation: This is one of the mechanisms of action of angiotensin II. It also acts on the zona glomerulosa of the adrenal cortex to stimulate the release of aldosterone.
name: Interacts with Angiotensin receptors at various sites in the nephron to stimulate sodium reabsorption
label: d
answer: no
explanation: This is the mechanism of action of lactate dehydrogenase, it catalyzes the conversion of lactate to pyruvate and back
name: Removes electrons from NADH to makes NAD+, which is utilised in the glycolysis pathway to create ATP
label: e
answer: no
explanation: Lactoferrin is a globular glycoprotein found in breast milk, saliva, tears, and nasal secretions. It has antimicrobial activity (bacteriocide, fungicide) and is part of the innate defense at mucoses.
name: Antimicrobial factor which binds to iron in bacteria so it can't use it to grow
label: a
answer: yes
explanation: This is the mechanism of action of PGE2. PGE2 is a naturally occurring prostaglandin with oxytocic properties
name: Suppresses T cell receptor signaling and proliferation and acts as a direct vasodilator by acting on smooth muscle to cause dilation of blood vessels
label: b
answer: no

Correct answer: a
A previously fit and well 23 year old wants to become pregnant.

What advice should you give her regarding supplementation?

Options:
explanation: Folic acid should be taken as it helps form the neural tube and can prevent anencephaly and spina bifida.
name: 400 micrograms of folic acid every day – from planning pregnancy until 12 weeks pregnant
label: a
answer: yes
explanation: Folic acid should be taken as it helps form the neural tube once the neural tube has formed, there is no need to take it
name: 400 micrograms of folic acid every day – from planning pregnancy until birth
label: b
answer: no
explanation: The standard dose of folic acid for otherwise healthy women during pregnancy should be 400 micrograms. 5mg is given to women at higher risk of conceiving a child with a neural tube defect (NTD). Women are higher risk if: either partner has a NTD, they had a previous NTD pregnancy, family history of NTD, taking antiepileptic drugs, have coeliac disease, diabetes, or thalassaemia trait or if the woman is obese (body mass index of 30 kg/m2 or more).
name: 5mg of folic acid every day – from planning pregnancy until 12 weeks pregnant
label: d
answer: no
explanation: The standard dose should be 400 micrograms 5mg is given to women at higher risk of conceiving a child with a neural tube defect (NTD). Women are higher risk if: either partner has a NTD, they had a previous NTD pregnancy, family history of NTD, taking antiepileptic drugs, have coeliac disease, diabetes, or thalassaemia trait or if the woman is obese (body mass index of 30 kg/m2 or more). Additionally women should take it till 12 weeks of pregnancy.
name: 5mg of folic acid every day – from planning pregnancy until 8 weeks pregnant
label: e
answer: no
explanation: Folic acid should be taken until 12 weeks
name: 400 micrograms of folic acid every day – from planning pregnancy until 8 weeks pregnant
label: c
answer: no

Correct answer: a
What type of genetic inheritance pattern does Duchenne muscular dystrophy take?

Options:
explanation: Duchenne muscular dystrophy follows an X-linked recessive pattern, not an X-linked dominant. Alport syndrome is often an X-linked dominant.
name: X-linked dominant
label: b
answer: no
explanation: Duchenne muscular dystrophy follows an X-linked recessive pattern. The mutation is on the X chromosome and therefore the mutation will always expressed in males (as they only have one X chromosome) and in females who are homozygous for the gene mutation. Females with one copy of the mutated gene are carriers.
name: X-linked recessive
label: a
answer: yes
explanation: Duchenne muscular dystrophy follows an X-linked recessive pattern, the codominant inheritance pattern is seen in blood type inheritance (ABO).
name: Codominant inheritance pattern
label: e
answer: no
explanation: Duchenne muscular dystrophy follows an X-linked recessive pattern, not an autosomal dominant pattern. Marfan syndrome follows an autosomal dominant pattern.
name: Autosomal Dominant
label: c
answer: no
explanation: Duchenne muscular dystrophy follows an X-linked recessive pattern, not an autosomal recessive. Cystic Fibrosis is an autosomal recessive diseases.
name: Autosomal Recessive
label: d
answer: no

Correct answer: a
What is the risk of miscarriage with with Chorionic Villus Sampling (CVS)?

Options:
explanation: Chorionic villus sampling can be carried out between the 11th and 14th weeks of pregnancy to detect genetic or chromosomal conditions such as Down's Syndrome, Patau's syndrome and sickle cell disease. During CVS, a small sample of cells is removed from the chorionic villus (part of the placenta) either transabdominally or transcervically. Other complications include infection and a crampy abdominal pain.
name: Less than 1 in 200 for most pregnancies, and around 1 in 100 for multiple pregnancies
label: a
answer: yes
explanation: The risk of miscarriage is less than 1 in 200 for most pregnancies, and around 1 in 100 for multiple pregnancies
name: Less than 2 in 100 for most pregnancies, and around 1 in 50 for multiple pregnancies
label: b
answer: no
explanation: The risk of miscarriage following CVS is less than 1 in 200 for most pregnancies, and around 1 in 100 for multiple pregnancies
name: Less than 1 in 400 for most pregnancies, and around 1 in 200 for multiple pregnancies
label: e
answer: no
explanation: The risk of miscarriage following CVS is less than 1 in 200 for most pregnancies, and around 1 in 100 for multiple pregnancies
name: Less than 1 in 250 for most pregnancies, and around 1 in 25 for multiple pregnancies
label: d
answer: no
explanation: The risk of miscarriage following CVS is less than 1 in 200 for most pregnancies, and around 1 in 100 for multiple pregnancies
name: Less than 1 in 500 for most pregnancies, and around 1 in 75 for multiple pregnancies
label: c
answer: no

Correct answer: a
Which DEXA (dual-energy X-ray absorptiometry) scan result correlates with a diagnosis of osteoporosis?

Options:
explanation: This result shows osteopaenia but not osteoporosis. A T-score of -1.0 to -2.5 shows osteopaenia.
name: BMD of the lumbar spine of 1.5 standard deviations below the T score
label: e
answer: no
explanation: This score would reach the criteria for osteoporosis, however the score must be calculated using a DEXA scan of either the hip or the lumbar spine
name: BMD of the radius of 2.5 standard deviations below the T score
label: b
answer: no
explanation: Osteoporosis is a disorder of bone mass loss and increases the risk of fragility fractures. A DEXA scan is used to assess bone density. The T score is based on the bone mass of a young reference population and a T-score of -1 means the patient has a bone mass one standard deviation below that of the young reference population. The scan needs to be of either the hip or the lumbar spine. A T-score of -1.0 to -2.5 shows osteopaenia.
name: BMD (bone mineral density) of the hip of 2.5 standard deviations below the T score
label: a
answer: yes
explanation: This would not be classified as a diagnosis of osteoporosis or osteopaenia
name: BMD of the lumbar spine of 0.5 standard deviations below the T score
label: d
answer: no
explanation: This result shows osteopaenia but not osteoporosis. A T-score of -1.0 to -2.5 shows osteopaenia.
name: BMD of the hip of 1.5 standard deviations below the T score
label: c
answer: no

Correct answer: a
Which of the following is a risk factor for osteoporosis?

Options:
explanation: Vitamin D supplements are not a risk factor for osteoporosis. Patients who have osteoporosis may require supplemental vitamin D.
name: Vitamin D supplements
label: d
answer: no
explanation: The risk of osteoporosis increases significantly in a patient who is taking prednisolone 7.5mg or more a day for 3 or more months as steroids reduce the absorption calcium and increase bone breakdown. These patients should receive bone protection medication to help proactively prevent osteoporosis.
name: Long term steroid use
label: a
answer: yes
explanation: Male sex is not a risk factor for osteoporosis, female sex is
name: Male sex
label: c
answer: no
explanation: Hormone replacement therapy not a risk factor for osteoporosis and can actually reduce the incidence of fractures. However it is not recommended for prevention of osteoporosis unless the woman is suffering from vasomotor symptoms associated with the menopause.
name: Hormone replacement therapy
label: e
answer: no
explanation: High BMI is not a risk factor for osteoporosis, low BMI is
name: High BMI
label: b
answer: no

Correct answer: a