hllj/quesmed huggingface dataset:
You take a history from a patient on the respiratory who came in due to an acute infective exacerbation of COPD. He says he was treated with doxycycline.

What is the mechanism of action of doxycycline?

Options:
explanation: This is the mechanism of action of penicillins, cephalosporins and carbapenems.
name: Inhibits cell wall synthesis
label: b
answer: no
explanation: This is the mechanism of action of macrolides - such as clarithromycin.
name: Inhibition of bacterial protein synthesis by binding to the 50S subunit of the ribosome
label: c
answer: no
explanation: This is the mechanism of action of Quinolones, such as ciprofloxacin.
name: Inhibition of topoisomerases
label: d
answer: no
explanation: Doxycycline is a tetracycline antibiotic, which binds to the 30S subunit of the bacterial ribosome and prevents tRNA from binding, and therefore protein synthesis is inhibited.
name: Inhibition of bacterial protein synthesis by binding to the 30S subunit of the ribosome
label: a
answer: yes
explanation: This is the mechanism of action of metronidazole, which is a specific antibiotic for anaerobic bacterial infections.
name: Inhibition of bacterial DNA synthesis
label: e
answer: no

Correct answer: a
You are going through a patient's blood results and are concerned they may have an acute infection of hepatitis B.

The presence of which antibody in the blood would suggest an acute primary infection?

Options:
explanation: This is a mucosal antibody which is secreted into mucus, saliva, tears and colostrum.
name: IgA
label: c
answer: no
explanation: This acts as a B cell antigen receptor but its full function is unclear, and so it is not used to indicate primary infection.
name: IgD
label: e
answer: no
explanation: This is the main antibody that occurs in primary immune responses. Its presence indicates primary infection.
name: IgM
label: a
answer: yes
explanation: This antibody is involved in allergies and fighting parasitic infections. It binds to mast cells and basophils.
name: IgE
label: d
answer: no
explanation: This is the main antibody in secondary responses.
name: IgG
label: b
answer: no

Correct answer: a
A 30-year-old woman brings her baby in for her post-natal check. She is concerned because the baby has not smiled yet and wants to know the youngest age at which a baby should do this.

What is the most appropriate response?

Options:
explanation: This is much too old for a baby's first smile and this would be very concerning. By this age, a baby should be able to hold objects in their hands.
name: Six months
label: e
answer: no
explanation: This may be the age a baby is when they have their first smile and this would not be concerning. However, many babies will smile before this age.
name: Eight weeks
label: d
answer: no
explanation: Typically babies smile between the ages of 6-12 weeks, unless there is something preventing them from doing this.
name: Six weeks
label: a
answer: yes
explanation: This is the age at which a referral to paediatrics would be made if a baby has still not yet smiled to investigate for causes.
name: 10 weeks
label: b
answer: no
explanation: This is younger than would be expected for a typical baby's first smile.
name: Three weeks
label: c
answer: no

Correct answer: a
A six-year-old boy is reviewed following surgical management of a supracondylar humeral fracture. He is complaining of tingling and numbness in his little and ring fingers.

Which nerve is most likely to have been damaged?

Options:
explanation: This provides sensory innovation to the lateral forearm, and motor innervation to biceps brachii, brachialis and coracobrachialis.
name: Musculocutaneous nerve
label: e
answer: no
explanation: This supplies sensory innervation to the dorsal aspects of the arm and forearm.
name: Radial nerve
label: c
answer: no
explanation: This provides sensory input to lateral three fingers (including the thumb) and is also at risk of injury in a supracondylar fracture. However, the tingling and numbness would be in the lateral three fingers.
name: Median nerve
label: b
answer: no
explanation: This would cause reduced sensation over the lateral aspect of the deltoid muscle and the lateral shoulder, known as the "soldier's badge" region. It is susceptible to injury in a humeral neck fracture.
name: Axillary nerve
label: d
answer: no
explanation: The ulnar nerve supplies sensation over the little finger and the medial side of the ring finger. It is also susceptible to injury in a supracondylar fracture due to its anatomical course.
name: Ulnar nerve
label: a
answer: yes

Correct answer: a
A patient is awaiting an ECG for suspected heart block, which is most likely due to a problem with the AV node.

Which of these is a role of the atrioventricular node?

Options:
explanation: This is the role of the atrioventricular valves (tricuspid and mitral valves).
name: Prevents blood from following backwards into the atria
label: d
answer: no
explanation: The atrioventricular node delays the transmission of the action potential between the atria and the ventricles to allow the ventricles to efficiently fill with blood. It also prevents abnormal atrial rhythms from being transmitted to the ventricles.
name: Delays the conduction of action potentials from the atria to the ventricles
label: a
answer: yes
explanation: This is the role of the left and right bundle branches, which form from the Bundle of His.
name: Transmits the action potential up through the ventricles causing ventricular contraction
label: e
answer: no
explanation: This is the role of the Bundle of His.
name: Conducts action potentials through the ventricles
label: c
answer: no
explanation: This is the role of the sinoatrial node in the heart. It is known as the "pacemaker" of the heart.
name: Spontaneously generates action potentials to cause contraction of the heart
label: b
answer: no

Correct answer: a
Small cell lung cancer can cause ectopic ACTH production.

If this occurs, which of the following biochemical abnormalities is most likely to be present?

Options:
explanation: Calcium is not typically affected by ACTH and cortisol. Hypercalcaemia is more common in squamous cell carcinoma of the lung due to PTHrp production.
name: Hypercalcaemia
label: e
answer: no
explanation: Ectopic ACTH release causes increased cortisol secretion and therefore Cushing's syndrome. Increased cortisol increases sodium retention and potassium excretion so hypernatraemia would be more likely.
name: Hyponatraemia
label: b
answer: no
explanation: Ectopic ACTH release causes increased cortisol secretion and therefore Cushing's syndrome. Increased cortisol increases sodium retention and potassium excretion.
name: Hypokalaemia
label: a
answer: yes
explanation: ACTH causes increased cortisol secretion. Cortisol is responsible for stimulating gluconeogenesis and lipolysis. Therefore, blood glucose levels are usually increased.
name: Low blood glucose
label: d
answer: no
explanation: ACTH stimulates the adrenal cortex to produce cortisol and so there would be high cortisol.
name: Low morning cortisol
label: c
answer: no

Correct answer: a
A patient in ED is asking about why they have developed a deep vein thrombosis (DVT). You explain Virchow's Triad.

Which of the following is a risk factor for DVT?

Options:
explanation: Immobility is a known risk factor for DVT and other types of venous thromboembolism due to venous stasis. Venous stasis is one of the three elements of Virchow's triad.
name: Recent immobility
label: a
answer: yes
explanation: Liver failure causes clotting factor deficiency and, as a result, makes a person more susceptible to bleeding rather than clotting.
name: Liver failure
label: b
answer: no
explanation: Dehydration increases the risk of DVT, not overhydration.
name: Fluid overload
label: e
answer: no
explanation: These reduce the stasis of venous blood in the legs, reducing the risk of DVT formation.
name: Use of compression stockings
label: c
answer: no
explanation: This is not a recognised risk factor for DVT, although some of the risk factors for MIs and DVTs will overlap. Additionally, if someone has had an MI they are likely to be on antiplatelets/anticoagulation which will reduce the risk of DVT formation
name: History of myocardial infarction (MI)
label: d
answer: no

Correct answer: a
Many antihypertensives work on the renin-angiotensin-aldosterone system.

Where in the body is renin produced?

Options:
explanation: The atria release atrial natriuretic peptide in response to being stretched due to increased blood pressure - this actually inhibits renin production.
name: Atria
label: e
answer: no
explanation: This is where sodium delivery to the distal convoluted tubule is detected.
name: Macula densa cells of the kidney
label: b
answer: no
explanation: This is where aldosterone is produced in response to angiotensin II.
name: Adrenal cortex
label: d
answer: no
explanation: This is where the majority of angiotensin I is converted by angiotensin-converting enzyme (ACE) into angiotensin II.
name: Vascular endothelial cells of the lungs
label: c
answer: no
explanation: Renin is released by granular cells which are located in the juxtaglomerular apparatus in the kidneys. Renin is released in response to reduced sodium in the distal convoluted tubule, reduced perfusion to the kidneys or sympathetic stimulation.
name: Juxtaglomerular apparatus of the kidney
label: a
answer: yes

Correct answer: a
A 68-year-old male with a known pancoast tumour (apical lung cancer) presents with symptoms that have occurred due to compression of the sympathetic chain.

Which of these signs/symptoms is the patient most likely to have?

Options:
explanation: This describes prominence of the eyes out of the skull and it occurs in graves disease (hyperthyroidism). It is not typically associated with pancoast lung tumours
name: Exophthalmos
label: c
answer: no
explanation: Pancoast tumours can compress the sympathetic chain, causing a collection of symptoms (Horner's syndrome). Sympathetic innervation to the pupil causes dilation and so if damaged there is paralysis of the dilator pupillae muscle and so the pupil is constricted.
name: Miosis
label: a
answer: yes
explanation: This is the opposite of what is expected and would occur if parasympathetic innervation to the pupils was damaged or in response to raised intracranial pressure.
name: Fixed and dilated pupils
label: b
answer: no
explanation: As the sympathetic chain is damaged, there is usually decreased sweating.
name: Increased sweating
label: d
answer: no
explanation: This occurs in a facial nerve palsy, such as Bell's palsy. In Pancoast tumours, there is typically partial ptosis/drooping of the upper eyelid.
name: Unilateral full facial drop/paralysis
label: e
answer: no

Correct answer: a
A child with a brain tumour starts developing signs of raised intracranial pressure.

Which of the following triads is indicative of raised intracranial pressure?

Options:
explanation: This is known as Cushing's triad and occurs in response to raised intracranial pressure to try and maintain cerebral perfusion.
name: Bradycardia, widened pulse pressure and irregular respiratory rate
label: a
answer: yes
explanation: This is not Cushing's triad, as hypotension would reduce cerebral perfusion rather than improve it.
name: Hypotension, irregular respirations and bradycardia
label: d
answer: no
explanation: Headaches and vomiting are symptoms of raised intracranial pressure and would make you suspicious of raised intracranial pressure, but they are not as specific or indicative of raised intracranial pressure.
name: Headache, hypertension and vomiting
label: e
answer: no
explanation: This is known as Charcot's triad, which is associated with ascending cholangitis.
name: Fever, right upper quadrant pain and fever
label: c
answer: no
explanation: This triad occurs in hypovolaemic and distributive shock, such as sepsis, anaphylaxis and major haemorrhage.
name: Hypotension, tachycardia and tachypnoea
label: b
answer: no

Correct answer: a
A 19-year-old male returns from his gap year travelling around Africa. He has contracted schistosomiasis (a parasitic infection).

Which of the following cells is most likely to be predominantly raised in the patient's blood results?

Options:
explanation: These are the dominant cells involved in the immune response against bacterial infections. They may be slightly raised as part of the immune response, but it is the eosinophils that are likely to be the most pronounced.
name: Neutrophils
label: b
answer: no
explanation: These are part of the adaptive immune response, and are dominant in the response against viral infections.
name: Lymphocytes
label: c
answer: no
explanation: Schistosomiasis is a parasitic infection. These are the subtype of white blood cells involved in the immune response against parasites.
name: Eosinophils
label: a
answer: yes
explanation: These are red blood cells and are typically not affected in parasitic infections but schistosomiasis can cause anaemia - therefore red blood cells would be low.
name: Erythrocytes
label: e
answer: no
explanation: These differentiate into macrophages, which are involved in the innate immune response but not specific to parasitic infections.
name: Monocytes
label: d
answer: no

Correct answer: a
You perform an arterial blood gas on a patient in ED, who presented with shortness of breath. The results are:

|      |    |         |
| -------------- | :-------: | ------------------ |
| pH               |  7.51       | 7.35 - 7.45        |
| PaO₂             | 11 kPa       | 11 - 15          |
| PaCO₂            | 2.8 kPa      | 4.6 - 6.4         |
| Lactate          | 1 mmol/L        | 0.6 - 1.4    |
| Bicarbonate      | 25 mmol/L        | 22 - 30      |

Which of the following best describes the results?


Options:
explanation: The pH is high, indicating alkalosis rather than acidosis.
name: Respiratory acidosis with no metabolic compensation
label: d
answer: no
explanation: There is raised pH indicating alkalosis. PaCO2 is low which would suggest a respiratory cause of the alkalosis. HCO3- is normal suggesting it is not contributing to or compensating for the alkalosis. This typically occurs in conditions causing hyperventilation, such as during PEs and panic attacks.
name: Respiratory alkalosis with no metabolic compensation
label: a
answer: yes
explanation: There is raised pH indicating alkalosis. PaCO2 is low which would suggest a respiratory cause of the alkalosis. However, HCO3- is normal suggesting it is not contributing to or compensating for the alkalosis. If there was metabolic compensation the HCO3- would be lower than normal (<22).
name: Respiratory alkalosis with metabolic compensation
label: b
answer: no
explanation: The pH is high rather than low, which is what you would expect in acidosis, making this incorrect. Additionally, if there was metabolic compensation there would be a high HCO3-.
name: Respiratory acidosis with metabolic compensation
label: e
answer: no
explanation: There is raised pH indicating alkalosis. However, CO2 is low and so this indicates a respiratory cause. Additionally, HCO3- would be high if there was a metabolic cause.
name: Metabolic alkalosis with respiratory compensation
label: c
answer: no

Correct answer: a
You are performing a shoulder examination on a patient who reports weakness and pain when moving the left shoulder. Examination reveals a left winged scapula.

Which of the following muscles is most likely to be affected to cause this presentation?

Options:
explanation: This is involved in adduction and internal rotation of the arm at the shoulder joint.
name: Pectoralis major
label: d
answer: no
explanation: This muscle is responsible for internal rotation, adduction and extension of the arm.
name: Latissimus dorsi
label: b
answer: no
explanation: This is responsible for the abduction of the arm after the first 15 degrees.
name: Deltoid
label: c
answer: no
explanation: This muscle is responsible for protraction of the scapula. Therefore, winging of the scapula is caused by damage to the long thoracic nerve which innervates the serratus anterior.
name: Left serratus anterior
label: a
answer: yes
explanation: This muscle is responsible for arm flexion, not protraction of the scapula.
name: Biceps brachii
label: e
answer: no

Correct answer: a
An oncologist is concerned that a patient with testicular cancer has developed lymph node metastases.

Which of the following lymph node groups is most likely to have been affected?

Options:
explanation: These drain the membranous and cavernous portions of the urethra and superior rectum.
name: Internal iliac
label: d
answer: no
explanation: These drain the glans penis in males.
name: Deep inguinal
label: e
answer: no
explanation: Due to the embryological origin of the testes higher up in the abdominal cavity, their lymphatic drainage is more proximal than the location of the testes at the L2 vertebral level.
name: Para-aortic
label: a
answer: yes
explanation: These drain the bladder, membranous part of the urethra and prostate in males.
name: External iliac
label: c
answer: no
explanation: These drain the scrotum.
name: Superificial inguinal
label: b
answer: no

Correct answer: a
A patient is being detained on the ward under section 2 of the mental health act.

How long does this last for?

Options:
explanation: A section 136 can be extended to this if it is not possible to assess the patient properly in the 24 hours due to physical health concerns.
name: 36 hours
label: d
answer: no
explanation: This section enables patients to be admitted without consent for assessment for a maximum of 28 days.
name: 28 days
label: a
answer: yes
explanation: This is the duration a patient can be admitted for under section 3, which is for treatment.
name: Six months
label: b
answer: no
explanation: This is the length of time a section 5(2) lasts, which allows a doctor to detain a patient who is already in hospital to be detained for an assessment to determine if they require further detention under the Mental Health Act.
name: 72 hours
label: e
answer: no
explanation: This is the typical duration for a section 136, which the police can use to keep a patient in a place of safety to allow proper assessment.
name: 24 hours
label: c
answer: no

Correct answer: a
Coughing is a common side effect of ACE inhibitors.

Which of the following best describes the way in which they cause this side effect?

Options:
explanation: ACE inhibitors have no effect on bronchial dilation or constriction.
name: Bronchoconstriction
label: c
answer: no
explanation: This is the mechanism by which amlodipine (another antihypertensive) causes swollen ankles - a common side effect.
name: Dilation of blood vessels
label: b
answer: no
explanation: This activates pro-inflammatory peptides (prostaglandins and substance P) and therefore a release of histamine, which causes a hypersensitivity cough.
name: Build up of bradykinin
label: a
answer: yes
explanation: This is a potential risk of ACE inhibitors. However, it does not cause a cough and also occurs due to the accumulation of bradykinin.
name: Angioedema of upper airways
label: d
answer: no
explanation: ACE inhibitors reduce protein loss in the urine. They are used to treat/prevent proteinuria.
name: Increased protein loss
label: e
answer: no

Correct answer: a
There is a patient on the ward with a new diagnosis of Conn's syndrome, a cause of primary hyperaldosteronism.

Which of the following electrolytes is most likely to be low in this patient?

Options:
explanation: Aldosterone does not have a significant impact on magnesium.
name: Magnesium
label: e
answer: no
explanation: Aldosterone does not have a significant impact on calcium.
name: Calcium
label: c
answer: no
explanation: Aldosterone promotes sodium retention and potassium excretion through increased ENaC activity and so excess levels lower potassium levels in the blood.
name: Potassium
label: a
answer: yes
explanation: Raised aldosterone increases sodium retention and so sodium is most likely to be raised.
name: Sodium
label: b
answer: no
explanation: Aldosterone does not have a significant impact on phosphate.
name: Phosphate
label: d
answer: no

Correct answer: a
The ward team are discussing a patient with Cushing's disease, which has occurred as a result of excess production of cortisol (a glucocorticoid).

Where is the usual site of cortisol production?

Options:
explanation: This is the part of the adrenal glands that produce catecholamines (adrenaline/noradrenaline).
name: Adrenal medulla
label: d
answer: no
explanation: This is where ACTH is produced, which stimulates cortisol production from the zona fasciculata of the adrenal glands.
name: Anterior pituitary gland
label: e
answer: no
explanation: This is the layer of the adrenal cortex that produces androgens - DHEA/testosterone.
name: Zona reticularis of the adrenal glands
label: c
answer: no
explanation: This is the layer of the adrenal cortex that produces mineralocorticoids - aldosterone.
name: Zona glomerulosa of the adrenal glands
label: b
answer: no
explanation: This is the middle layer of the adrenal cortex which produces glucocorticoids, including cortisol in response to ACTH.
name: Zona fasciculata of the adrenal glands
label: a
answer: yes

Correct answer: a
An 80-year-old female has fallen down the stairs at home. The paramedics are concerned she has broken her neck of femur.

Which of these complications is this type of fracture most likely to cause?

Options:
explanation: This is more likely to occur after surgical repair of the fracture, such as due to hip replacement. It is also a risk of posterior hip dislocation.
name: Sciatic nerve palsy
label: c
answer: no
explanation: This patient may well have osteoporosis which has increased her risk of getting a neck of femur fracture. However, osteoporosis would not be a result of the fracture
name: Osteoporosis
label: d
answer: no
explanation: This can occur in the thigh after a neck of femur fracture, but is less common than avascular necrosis of the femoral head and is more likely in lower leg fractures.
name: Compartment syndrome
label: b
answer: no
explanation: The blood supply to the head of the femur is retrograde and therefore can be disrupted by a fracture of the neck of the femur.
name: Avascular necrosis of the femoral head
label: a
answer: yes
explanation: This could occur, especially if this was an open fracture, but is not a common complication of neck of femur fracture.
name: Sepsis
label: e
answer: no

Correct answer: a
A new mum is struggling with breastfeeding.

Which of the following hormones is required for milk production?

Options:
explanation: Oxytocin is released from the posterior pituitary gland in response to suckling which causes the milk to be ejected. However, it does not cause milk production.
name: Oxytocin
label: d
answer: no
explanation: This is involved in breast growth and development during pregnancy, but does not trigger secretion.
name: Progesterone
label: c
answer: no
explanation: This is involved in early pregnancy and is produced by cells of placenta to stimulate the corpus luteum to produce progesterone and maintain the pregnancy.
name: beta-hCG
label: e
answer: no
explanation: Prolactin is the primary driver of milk production and is stimulated by suckling and  reduced dopamine levels.
name: Prolactin
label: a
answer: yes
explanation: This is involved in breast growth and development during pregnancy, but does not trigger secretion.
name: Oestrogen
label: b
answer: no

Correct answer: a