hllj/quesmed huggingface dataset:
A 50-year-old female was recently diagnosed with type 2 diabetes and given pioglitazone.

Which of the following is the mechanism of action of thiazolidinediones?

Options:
explanation: This is the mechanism of action of biguanides such as metformin. As well as reducing the hepatic production of glucose, metformin also increases insulin sensitivity and decreases glucose absorption in the intestines.
name: Decreases gluconeogenesis
label: b
answer: no
explanation: This refers to the mechanism of action of DPP4 inhibitors, also known as dipeptidyl peptidase-4 inhibitors. DPP4 breaks down incretin hormones such as GLP-1 and GIP. By inhibiting this enzyme, the levels of incretins increase which inhibit glucagon and stimulate insulin secretion thereby decreasing blood sugar levels.
name: Inhibits the enzyme DPP4 which breaks down incretin hormones
label: e
answer: no
explanation: Pioglitazone, alongside other thiazolidinediones, are agonists at the peroxisome proliferator-activated receptor-gamma (PPARγ) receptor. Through activation of this receptor, thiazolidinediones enhance tissue sensitivity to insulin and reduce gluconeogenesis.
name: They activate PPARγ receptors which increase peripheral insulin sensitivity
label: a
answer: yes
explanation: This is the mechanism of action of sulfonylurea medication. An example of this class of medication is gliclazide.
name: Bind and close the potassium ATP channels causing depolarisation of beta cells and the release of insulin
label: c
answer: no
explanation: This is the mechanism of action of sodium-glucose cotransporter 2 inhibitors (SGLT2 inhibitors). These co-transporters are found in the proximal tubule of the nephron and are responsible for glucose re-absorption. By inhibiting this protein, SGLT2 inhibitors promote glucosuria. An example of this class of medication is dapagliflozin.
name: Promotes glucose excretion through the kidney
label: d
answer: no

Correct answer: a
A 30-year-old male complains of his jaw and tongue getting larger and his shoes no longer fitting him properly. His IGF1 levels are raised.

Which of the following factors inhibit growth hormone secretion?

Options:
explanation: Hypoglycaemia stimulates the hypothalamus to increase growth hormone-releasing hormone (GHRH) and decrease somatostatin production. This increases the pituitary release of growth hormone.
name: Hypoglycaemia
label: c
answer: no
explanation: Growth hormone acts on adipose tissue to increase lipolysis: the breakdown of lipids into fatty acids. Decreased fatty acids will exert negative feedback on the hypothalamus and pituitary gland to increase growth hormone production and secretion.
name: Decreased fatty acids
label: d
answer: no
explanation: Ghrelin acts on and stimulates both the hypothalamus and pituitary gland to increase growth hormone concentration.
name: Ghrelin
label: b
answer: no
explanation: Growth hormone-releasing hormone (GHRH) is released from the hypothalamus and acts on the pituitary gland to increase growth hormone secretion.
name: Growth hormone-releasing hormone (GHRH)
label: e
answer: no
explanation: Somatostatin is also known as growth hormone inhibiting hormone (GHIH). Somatostatin is released by the hypothalamus and acts on the pituitary gland to reduce GH secretion.
name: Somatostatin
label: a
answer: yes

Correct answer: a
Which of the following is a feature of Addison’s disease?

Options:
explanation: Addison's disease involves low cortisol levels due to adrenal insufficiency. Cortisol increases blood glucose by decreasing glucose intake into muscles and adipose tissue and increasing lipolysis. Therefore, hypocortisolism, as is the case in Addison's, leads to **hypoglycaemia**.
name: Hyperglycaemia
label: d
answer: no
explanation: Addison's disease is a primary adrenal insufficiency leading to inadequate production of the steroid hormones aldosterone and cortisol. Aldosterone acts on Na+-K+ pumps to increase urinary potassium secretion and sodium reabsorption. Deficit of this hormone therefore leads to a high potassium (hyperkalaemia) and a low sodium (hyponatremia).
name: Hyponatremia
label: a
answer: yes
explanation: Patients with Addison's disease may develop **hypercalcaemia** due to reduced calcium removal by the kidneys.
name: Hypocalcaemia
label: b
answer: no
explanation: The adrenal glands produce androgens such as oestrogen and testosterone in the zona reticularis. Adrenal impairment means there will be low production and secretion of androgens.
name: Hyperandrogenism
label: e
answer: no
explanation: Addison's disease is a primary adrenal insufficiency leading to inadequate production of the steroid hormones aldosterone and cortisol. Aldosterone acts on Na+-K+ pumps to increase urinary potassium secretion and sodium reabsorption. Deficit of this hormone therefore leads to a high potassium **(hyperkalaemia)** and a low sodium (hyponatremia).
name: Hypokalaemia
label: c
answer: no

Correct answer: a
Glucose is uptaken into organs by a family of glucose transporters known as GLUT.

Which of the following organs contains the highest expression of GLUT1 transporters?

Options:
explanation: The pancreas contains GLUT2 transporters. This transporter has a low affinity for glucose and therefore allows glucose to equilibrate across membranes.
name: Pancreas
label: d
answer: no
explanation: The kidneys contain GLUT2 transporters. This transporter has a low affinity for glucose and therefore allows glucose to equilibrate across membranes.
name: Kidneys
label: c
answer: no
explanation: The liver contains GLUT2 transporters. This transporter has a low affinity for glucose and therefore allows glucose to equilibrate across membranes.
name: Liver
label: b
answer: no
explanation: Muscle and adipose tissue contain GLUT4 transporters. This transporter has a medium affinity for glucose and allows insulin-dependent uptake of glucose into cells.
name: Muscle and adipose tissue
label: e
answer: no
explanation: These transporters are found in the blood-brain barrier. They are also found in erythrocytes. This transporter has a high affinity for glucose and therefore allows a constant uptake of glucose into the brain.
name: Brain
label: a
answer: yes

Correct answer: a
Cholecystokinin (CCK) has several important functions in the body, including secretion of bile from the gallbladder, inhibition of gastric acid secretion, and control of food intake.

Which of the following best describes the central and peripheral effects of CCK?

Options:
explanation: CCK is a satiety factor, which means it inhibits further food intake. Injection of CCK into the hypothalamus would reduce appetite.
name: It slows down gastric emptying and inhibits appetite if injected into the hypothalamus
label: a
answer: yes
explanation: Fat ingestion causes the release of CCK which slows gastric emptying and induces a state of satiety. CCK then decreases gastric emptying to promote gastric distension and further increase satiety.
name: Fat ingestion inhibits CCK release and increases gastric emptying
label: d
answer: no
explanation: This is incorrect as CCK acts centrally in the hypothalamus to reduce appetite.
name: It does not have any central effects, but it suppresses a sense of fullness by stimulating the fundus
label: e
answer: no
explanation: CCK is a satiety factor, which means it inhibits further food intake. Injection of CCK into the hypothalamus would reduce appetite.
name: It increases one’s sense of fullness and improves appetite if injected into the hypothalamus
label: c
answer: no
explanation: Although CCK does promote gastric emptying, it decreases appetite as a result of its central effects on the hypothalamus.
name: It slows down gastric emptying and increases appetite
label: b
answer: no

Correct answer: a
A 47-year-old male presents to his GP with a burning sensation in his throat and chest, and difficulty swallowing solid foods. He is prescribed an H2-receptor antagonist for the treatment of gastro-oesophageal reflux disease.

Which of the following is an H2-receptor antagonist?

Options:
explanation: Lansoprazole is a proton pump inhibitor which acts on the H+/K+ ATPase enzyme system at the secretory surface of gastric parietal cells.
name: Lansoprazole
label: b
answer: no
explanation: Omeprazole is a proton pump inhibitor which acts on the H+/K+ ATPase enzyme system at the secretory surface of gastric parietal cells.
name: Omeprazole
label: d
answer: no
explanation: Latanoprost is a prostaglandin F2-alpha analogue. It is not used to decrease gastric acid secretion as the stomach does not contain F2-alpha receptors. Its main indication is in glaucoma to reduce intraocular pressure.
name: Latanoprost
label: e
answer: no
explanation: Cimetidine binds to H2-receptors located on the basolateral membrane of gastric parietal cells to block the effects of histamine. This results in decreased gastric acid secretion. Other H2 receptor antagonists include ranitidine and lafutidine.
name: Cimetidine
label: a
answer: yes
explanation: Misoprostol is a prostaglandin E1 analogue which stimulates E1 receptors on the parietal cells in the stomach to reduce gastric acid secretion.
name: Misoprostol
label: c
answer: no

Correct answer: a
A 55-year-old male presents with abdominal pain and bloating. After several tests are conducted, he is diagnosed with gastroparesis and given metoclopramide for symptomatic relief.

How does metoclopramide promote gastric motility and emptying?

Options:
explanation: Metoclopramide stimulates inhibitory nitrergic neurons which results in coordinated gastric motility.
name: Metoclopramide inhibits inhibitory nitrergic neurons
label: d
answer: no
explanation: Metoclopramide increases lower oesophageal sphincter and gastric tone to increase intragastric pressure. This helps to stimulate gastric motility and accelerate gastric emptying.
name: It decreases intragastric pressure
label: c
answer: no
explanation: Metoclopramide **inhibits** D2 receptors. This increases the release of acetylcholine which increases lower oesophageal sphincter tone and gastric contractions.
name: It stimulates presynaptic and postsynaptic D2 receptors which promotes the release of acetylcholine from intrinsic myenteric cholinergic neurons
label: b
answer: no
explanation: Metoclopramide inhibits 5-HT3 receptors.
name: It stimulates 5-HT3 receptors
label: e
answer: no
explanation: Inhibition of D2 receptors by metoclopramide increases the release of acetylcholine. Acetylcholine acts on the parasympathetic nervous system to increase digestion and excretion.
name: It stimulates the release of acetylcholine which increases peristalsis of the small intestine
label: a
answer: yes

Correct answer: a
A 70-year-old male with a background of type 1 diabetes, hypertension and hypertriglyceridaemia attends his GP for a check-up appointment for his chronic kidney disease (CKD).

Which of the following is a consequence of chronic kidney disease?

Options:
explanation: Chronic kidney disease decreases glomerular filtration (GFR) which decreases phosphate excretion. This stimulates the production of FGF-23 which inhibits 1-alpha hydroxylase. This decreases the level of calcitriol and hence reduces intestinal calcium absorption. As a result, the parathyroid gland is stimulated to release more parathyroid hormone. Therefore chronic kidney disease causes secondary **hyperparathyroidism**.
name: Secondary hypoparathyroidism
label: c
answer: no
explanation: Due to kidney damage in CKD, there is reduced production of erythropoietin and hence reduced production of red blood cells.
name: Anaemia
label: a
answer: yes
explanation: Chronic kidney disease results in the reduced conversion of calcidiol to calcitriol. This leads to decreased calcium absorption from the small intestine and subsequent **hypocalcaemia**.
name: Hypercalcaemia
label: e
answer: no
explanation: Chronic kidney disease causes sodium and fluid retention. This stimulates the renin-angiotensin-aldosterone system which increases sympathetic nervous system activity and vasoconstriction, and results in **hypertension**.
name: Hypotension
label: d
answer: no
explanation: This is incorrect as chronic kidney disease decreases glomerular filtration (GFR) therefore decreasing potassium excretion. This leads to a high serum potassium level, i.e. **hyperkalaemia**.
name: Hypokalaemia
label: b
answer: no

Correct answer: a
A 40-year-old patient taking thiazide diuretics presents with nausea, muscle cramps and palpitations. His ABG shows a potassium level of 2.5mmol/L (3.5-5.3 mmol/L).


Where in the nephrons do thiazide diuretics act?

Options:
explanation: Amiloride and Triamterene bind to epithelial sodium channels, known as ENaC, to inhibit sodium reabsorption and potassium loss.
name: Epithelial sodium channels in the collecting duct
label: d
answer: no
explanation: This is the site where carbonic anhydrase works. This reduces the availability of hydrogen ions in the lumen and increases the excretion of sodium, bicarbonate and water.
name: Na-H channels in the proximal convoluted tubule
label: b
answer: no
explanation: The thick ascending loop of Henle is where loop diuretics, such as furosemide, exert their effects.
name: Na-K-Cl channels in the loop of Henle
label: e
answer: no
explanation: Aldosterone receptor antagonists competitively bind to receptors on sodium-potassium channels in the distal convoluted tubule. This causes the excretion of sodium and water and the retention of potassium. They are therefore also known as potassium-sparing diuretics.
name: Na-K channels in the distal convoluted tubule
label: c
answer: no
explanation: Thiazide diuretics inhibit Na and Cl uptake via a co-transporter in the distal convoluted tubule.
name: Na-Cl channels in the distal convoluted tubule
label: a
answer: yes

Correct answer: a
A 50-year-old patient is brought to the hospital by their daughter due to increasing confusion and agitation. Blood tests reveal a sodium level of 149 mmol/L (normal range 135-145 mmol/L).


Which of the following is a possible cause of this patient’s hypernatremia?

Options:
explanation: Thiazides act on the Na-Cl co-transporter in the distal convoluted tubule. They inhibit chloride reabsorption, causing the excretion of chloride, sodium and water. This leads to hyponatremia.
name: Thiazide diuretic use
label: e
answer: no
explanation: Excessive antidiuretic hormone (ADH) results in increased water reabsorption in the collecting ducts, diluting the blood. This excess water reduces the sodium concentration, causing hyponatraemia.
name: Syndrome of inappropriate ADH (SIADH)
label: b
answer: no
explanation: Adrenal insufficiency refers to an inadequate production of the steroid hormones, aldosterone and cortisol. Aldosterone acts on Na+-K+ pumps to increase urinary potassium secretion and increase sodium reabsorption. A deficit of this hormone therefore leads to a high potassium (hyperkalaemia) and a low sodium (hyponatremia).
name: Adrenal insufficiency
label: d
answer: no
explanation: Diabetes insipidus is the lack of production or response to anti-diuretic hormone (ADH). This causes decreased water reabsorption from the collecting duct into the vasculature which decreases blood volume and increases sodium concentration (hypernatremia).
name: Diabetes insipidus
label: a
answer: yes
explanation: Nephrotic syndrome causes loss of albumin in the glomerulus which decreases the plasma oncotic pressure, inducing hyponatremia.
name: Nephrotic syndrome
label: c
answer: no

Correct answer: a
A 22-year-old female presents to hospital with chest tightness and shortness of breath. The patient tells you that she thinks she is having a panic attack. On examination, she is distressed and tachypnoeic at a respiratory rate of 30. Her ABG is as follows:


||||
|--------------|:-------:|------------------|
|pH|7.49|7.35 - 7.45|
|PaCO₂|3.1 kPa|4.6 - 6.4|
|Bicarbonate|24 mmol/L|22 - 30|

Which acid-base imbalance does this patient have?

Options:
explanation: Although the high pH and low CO2 point to a respiratory alkalosis, there are no signs of compensation (i.e. a low bicarbonate level).
name: Respiratory alkalosis with metabolic compensation
label: d
answer: no
explanation: This is incorrect as the bicarbonate in this case is normal. Therefore the acid-base balance cannot be metabolic in nature.
name: Metabolic alkalosis
label: e
answer: no
explanation: To determine whether this is an acidosis or an alkalosis, look at the pH value. A value less than 7.35 is an acidosis and a value above 7.45 is an alkalosis. As the pH is above the normal range, this is an alkalosis. Next, to determine whether this is due to the kidneys or lungs, we look at the concentration of carbon dioxide (indicative of a respiratory cause) and bicarbonate (indicative of a metabolic cause). A low CO2 will cause an alkalosis and a high CO2 will cause an acidosis. The opposite applies to bicarbonate, in other words, a low bicarbonate will cause an acidosis. Therefore this is a respiratory alkalosis.
name: Respiratory alkalosis
label: a
answer: yes
explanation: This is incorrect as the pH is above the normal range, making it an alkalosis.
name: Respiratory acidosis
label: c
answer: no
explanation: This is incorrect as the pH is above the normal range, making it an alkalosis.
name: Metabolic acidosis
label: b
answer: no

Correct answer: a
A 27-year-old slim male is brought to A&E after being stabbed in the chest. He is diagnosed with a traumatic pneumothorax.

Which changes would you expect to see in the lung volume, pleural cavity volume and intrapleural pressure in the affected lung?

Options:
explanation: This is incorrect as a pneumothorax will increase the pleural cavity space and pressure due to air entering the pleural space.
name: Decreased lung volume, decreased pleural cavity volume, decreased intrapleural pressure
label: b
answer: no
explanation: This is incorrect as a pneumothorax will increase the pleural cavity space due to air entering the pleural space.
name: Decreased lung volume, decreased pleural cavity volume, increased intrapleural pressure
label: c
answer: no
explanation: Intrapleural pressure is naturally subatmospheric (negative) due to the opposing recoil of the lungs and chest wall. A pneumothorax refers to air entering the pleural space due to a rupture of the pleura. This increases the pleural cavity volume. As the pressure of the cavity is naturally negative, the addition of more gas molecules will increase the intrapleural pressure. As a result, the lung and chest wall will no longer be attached and will start to recoil in different directions causing the lung to collapse (decreased lung volume).
name: Decreased lung volume, increased pleural cavity volume, increased intrapleural pressure
label: a
answer: yes
explanation: This is incorrect as a pneumothorax will increase the pleural cavity pressure due to air entering the pleural space.
name: Decreased lung volume, increased pleural cavity volume, decreased intrapleural pressure
label: d
answer: no
explanation: This is incorrect as a pneumothorax will cause the collapse of the lung, reducing lung volume.
name: Increased lung volume, increased pleural cavity, increased intrapleural pressure
label: e
answer: no

Correct answer: a
Bile acids may be primary or secondary depending on their metabolism.

Which of the following is a primary acid?

Options:
explanation: This is a secondary bile acid. In the large intestine, bacterial 7α-dehydroxylase removes a hydroxyl from cholic acid (a primary bile acid) to form deoxycholic acid (a secondary bile acid).
name: Deoxycholic acid
label: b
answer: no
explanation: This is not a bile acid.
name: Lactic acid
label: e
answer: no
explanation: This is a primary bile acid and is produced in the liver.
name: Cholic acid
label: a
answer: yes
explanation: This is a secondary bile acid. In the large intestine, bacterial 7α-dehydroxylase removes a hydroxyl from chenodeoxycholic acid (a primary acid) to form lithocholic acid (a secondary bile acid).
name: Lithocholic acid
label: c
answer: no
explanation: This is a secondary bile acid. In the large intestine, bacterial 7α-dehydroxylase removes a hydroxyl from chenodeoxycholic acid (a primary bile acid) to form ursodeoxycholic acid (a secondary bile acid).
name: Ursodeoxycholic acid
label: d
answer: no

Correct answer: a
Glycolysis is the breakdown of glucose to pyruvate to produce ATP which serves as a source of energy for aerobic respiration.

Which enzyme in the pathway converts phosphoenol pyruvate into pyruvate?

Options:
explanation: This enzyme converts glucose-6-phosphate into glucose. This reaction is involved in gluconeogenesis, the formation of glucose from non-carbohydrate substrates.
name: Glucose-6-phosphatase
label: e
answer: no
explanation: This enzyme converts oxaloacetic acid into phosphoenol pyruvate. This reaction is involved in gluconeogenesis, the formation of glucose from non-carbohydrate substrates.
name: Phosphoenolpyruvate carboxykinase
label: c
answer: no
explanation: This enzyme converts glucose into glucose-6-phosphate. This step is involved in glycolysis however it occurs before phosphoenol pyruvate is converted to pyruvate.
name: Hexokinase
label: d
answer: no
explanation: This enzyme converts phosphoenol pyruvate into pyruvate. Pyruvate kinase can be inhibited by glucagon.
name: Pyruvate kinase
label: a
answer: yes
explanation: This enzyme converts pyruvate into oxaloacetic acid. This step is involved in gluconeogenesis, the formation of glucose from non-carbohydrate substrates.
name: Pyruvate carboxylase
label: b
answer: no

Correct answer: a
Cell signalling is important in metabolic regulation.

Which of the following substrates bind to tyrosine kinase receptors?

Options:
explanation: Transforming growth factor β (TGF-β) receptors contain a serine-threonine receptor kinase. Binding causes dimerisation of the receptors, thus activating the receptor. This allows for the phosphorylation of the Smad protein. The complex then translocates to the nucleus where it regulates gene expression.
name: Transforming growth factor β (TGF-β)
label: c
answer: no
explanation: Thyroid hormone binds to nuclear receptors, which are types of intracellular receptors. Thyroid hormone is bound to a binding globulin and transported through the plasma membrane. It then diffuses across the nucleus to bind to the thyroid hormone receptor (THR), causing gene transcription.
name: Thyroid hormone
label: e
answer: no
explanation: Epidermal growth factor binds to tyrosine kinase receptors causing dimerisation and autophosphorylation. This activates other proteins in the signalling cascade.
name: Epidermal growth factor
label: a
answer: yes
explanation: Glucocorticoids bind to nuclear receptors, which are types of intracellular receptors. The glucocorticoid receptor (GR) is bound to a heat shock protein. Glucocorticoids cause dissociation of the heat shock protein and dimerisation of glucocorticoid receptors. This complex diffuses across the nuclear membrane to bind to the glucocorticoid response element which leads to gene transcription.
name: Glucocorticoids
label: d
answer: no
explanation: Growth hormone acts on the JakSTAT signalling pathway. The binding of growth hormone causes the dimerisation of receptors containing Jak proteins. Jak proteins contain kinase activity and cause autophosphorylation and subsequent phosphorylation of the receptors. This dimer is able to dissociate and migrate to the nucleus where it regulates gene expression.
name: Growth hormone
label: b
answer: no

Correct answer: a
Which of the following lipoproteins has the B48 apoprotein?

Options:
explanation: LDL contains B100 only.
name: Low-density lipoproteins (LDL)
label: e
answer: no
explanation: IDL contains B100 and Apo E
name: Intermediate-density lipoproteins (IDL)
label: c
answer: no
explanation: Chylomicrons contain B48, Apo C2 and Apo E.
name: Chylomicrons
label: a
answer: yes
explanation: HDL contains Apo A1, Apo A2, Apo C2, Apo C3, Apo D, Apo E.
name: High-density lipoproteins (HDL)
label: d
answer: no
explanation: VLDL contains B100, Apo C1, Apo C2, Apo C3 and Apo E.
name: Very low-density lipoproteins (VLDL)
label: b
answer: no

Correct answer: a