hllj/quesmed huggingface dataset:
Which of the following best describes the role of the enzyme lysozyme in saliva?

Options:
explanation: This is the action of lactoferrin which is an enzyme also found within saliva. Lysozyme acts to break down the cell walls of gram-negative bacteria via hydrolysing peptidoglycans.
name: Chelation of iron to prevent microbial multiplication
label: d
answer: no
explanation: This is the action of alpha-amylase (AKA Ptyalin) which is an enzyme which is also found within saliva. Lysozyme acts to break down the cell walls of gram-negative bacteria via hydrolysing peptidoglycans.
name: Hydrolysis of alpha-1,4-glycosidic bonds in starch
label: b
answer: no
explanation: Lysozyme is an enzyme present in saliva which acts to break down the cell walls of gram-negative bacteria via hydrolysing peptidoglycans.
name: Hydrolysis of peptidoglycans in the cell wall of gram-negative bacteria
label: a
answer: yes
explanation: This is the action of kallikrein which is an enzyme also found within saliva. Lysozyme acts to break down the cell walls of gram-negative bacteria via hydrolysing peptidoglycans.
name: Converts plasma protein alpha-2-globulin into bradykinin
label: e
answer: no
explanation: This is the action of lipase which is an enzyme also found within saliva. Lysozyme acts to break down the cell walls of gram-negative bacteria via hydrolysing peptidoglycans.
name: Hydrolysis of lipid triglycerides to fatty acid and diglycerides
label: c
answer: no

Correct answer: a
What kind of pancreatic juice is produced via the action of the hormone cholecystokinin (CCK)?

Options:
explanation: This is the type of pancreatic juice produced via the action of the hormone secretin, which is secreted from ductal cells in the duodenum in the presence of highly acidic chyme. CCK release into the small intestine is triggered by chyme-containing fat and protein products. Once released, it then stimulates the acinar cells of the pancreas to release enzyme-rich pancreatic juice into the duodenum in order to digest the fat and protein within the chyme.
name: High-volume, HCO<sub>3</sub><sup>-</sup> rich, low-enzyme pancreatic juice
label: b
answer: no
explanation: Whilst the pancreatic juice produced via the action of CCK is enzyme-rich in order to digest the protein and fat present within the chyme, it is not HCO<sub>3</sub><sup>-</sup> rich - as the chyme is not acidic and thus does not require neutralisation. HCO<sub>3</sub><sup>-</sup> rich pancreatic juice would be secreted in response to the hormone secretin.
name: Low-volume, HCO<sub>3</sub><sup>-</sup> rich, enzyme-rich pancreatic juice
label: c
answer: no
explanation: CCK release into the small intestine is triggered by chyme-containing fat and protein products. Once released, it then stimulates the acinar cells of the pancreas to release enzyme-rich pancreatic juice into the duodenum in order to digest the fat and protein within the chyme.
name: Low-volume, enzyme-rich pancreatic juice
label: a
answer: yes
explanation: CCK does produce enzyme-rich pancreatic juice in order to digest protein and fat in chyme with high protein and fat content. However, much lower volumes of pancreatic juice are produced in response to CCK in comparison to other triggers, such as secretin.
name: High-volume, enzyme-rich pancreatic juice
label: e
answer: no
explanation: Pancreatic juice should be alkaline in nature in order to neutralise acidic gastric acid. CCK causes release of low-volume, enzyme-rich pancreatic juice in order to digest protein and fat in chyme with high protein and fat content.
name: H<sup>+</sup> rich, low-enzyme pancreatic juice
label: d
answer: no

Correct answer: a
Which of the following tests would be first-line for the investigation of a patient with suspected coeliac disease?

Options:
explanation: This is a genetic test for genes which are associated with coeliac disease. It is typically reserved for children found to have a positive TTGA, and is used in such patients in place of biopsies.
name: Testing for HLA-D2 and HLA-DQ8
label: d
answer: no
explanation: This may be used to investigate for coeliac disease, as a raised endomysial IgA does indicate coeliac disease. The test is 100% specific, but only 90% sensitive - making TTGA the preferred, first-line, test due to it's higher sensitivity.
name: Endomysial IgA
label: b
answer: no
explanation: This is a test used to measure inflammation of the intestine, and is used to screen for inflammatory bowel disease (IBD) e.g. Crohn's Disease or Ulcerative Colitis. It may be used to screen this patient for IBD. However, it would not be diagnostic for coeliac disease.
name: Faecal calprotectin
label: e
answer: no
explanation: A series of duodenal biopsies can be used to confirm a diagnosis of coeliac disease. Diagnosis is confirmed by seeing villous atrophy, crypt hyperplasia, and increased lymphocytes when a person is consuming gluten. Villous atrophy should then be seen to recover on a gluten-free diet. However, a biopsy is only carried out after initial blood tests. The first-line investigative blood test specifically for coeliac disease is TTGA.
name: Duodenal biopsy via upper GI endoscopy
label: c
answer: no
explanation: This is the first-line investigation for coeliac disease. It is 98% sensitive and 96% specific. If positive, then further tests may be carried out to confirm the diagnosis e.g. biopsies. It should also be ordered alongside a test for total IgA because if the person has an IgA deficiency, TTGA may not be detected even if the person does have coeliac disease.
name: Tissue transglutamase IgA (TTGA)
label: a
answer: yes

Correct answer: a
Which of the following is used routinely as part of the NHS bowel cancer screening program for 60- to 74-year-olds?

Options:
explanation: A FIT is offered every two years to patients in the UK between the ages of 60-74 years. It is a home testing kit which is sent to a laboratory for analysis. It works as an antibody-antigen reaction and tests for occult blood within the stool. If it is found to be positive, the patient is referred for a colonoscopy for further investigation.
name: FIT (Faecal Immunochemical Test)
label: a
answer: yes
explanation: Faecal calprotectin is a marker of inflammation, which is a relatively specific test for inflammatory bowel disease e.g. Crohn's disease and ulcerative colitis. It is not used to screen for bowel cancer.
name: Faecal calprotectin
label: b
answer: no
explanation: A colonoscopy is the ideal screening method for bowel cancer, and is used for bowel cancer in the USA. However, it requires sedation, expertise, and is associated with a 1-2% of bowel perforation. Therefore, it is not included in the screening program in the UK.
name: Colonoscopy
label: e
answer: no
explanation: TTGA is a highly specific and sensitive test used in the diagnosis of coeliac disease. It is not used in screening for bowel cancer.
name: Tissue transglutamase IgA (TTGA)
label: c
answer: no
explanation: Flexible sigmoidoscopy is offered to all patients in the UK at 55-years-old. However, between the ages of 60-74 years, they receive a Faecal Immunochemical Test (FIT) every two years as part of the bowel cancer screening program.
name: Flexible sigmoidoscopy
label: d
answer: no

Correct answer: a
A 32-year-old male presents with appendicitis. Whilst waiting for surgery, he is given 60mg of codeine for pain relief. One hour later, he is still complaining of the same level of pain, and says that the codeine has not helped at all.

Which of the following is the most likely explanation for this?

Options:
explanation: This should never be the first diagnosis for a patient complaining of inadequate analgesia. A range of analgesia should be trialled, and a thorough drug and social history relating to opiate drug use and previous presentations to medical services should be taken prior to considering drug-seeking as a diagnosis. Also, this patient has already been diagnosed with appendicitis - so will be in considerable pain, making it completely reasonable for him to require additional analgesia.
name: Drug-seeking behaviour
label: e
answer: no
explanation: Codeine is metabolised by the enzyme CYP2D6, not by CYP450. Also, this patient's lack of response to codeine would be caused by CYP2D6 polymorphism with poor metaboliser effect, not ultra-rapid metaboliser effect.
name: CYP450 polymorphism with ultra-rapid metaboliser effect
label: c
answer: no
explanation: Codeine is metabolised by the enzyme CYP2D6, not by CYP450.
name: CYP450 polymorphism with poor metaboliser effect
label: d
answer: no
explanation: Codeine is metabolised by the enzyme CYP2D6 in the liver, which converts codeine into morphine - its active metabolite. CYP2D6 polymorphism with ultra-rapid metaboliser effect, meaning two copies of the CYP2D6 gene with increased activity, would cause Codeine to be rapidly broken down into Morphine, leading to an exaggerated response to Codeine and possible opiate toxicity. This is the opposite to this patient's findings, meaning that he has CYP2D6 polymorphism with poor metaboliser effect, rather than an ultra-rapid effect.
name: CYP2D6 polymorphism with ultra-rapid metaboliser effect
label: b
answer: no
explanation: Codeine is metabolised by the enzyme CYP2D6 in the liver, which converts codeine into morphine - its active metabolite. This patient likely has CYP2D6 polymorphism with poor metaboliser effect, meaning that he has two inactive copies of CYP2D6. This means that pain relief is inadequate with codeine as it is unable to be converted into morphine.
name: CYP2D6 polymorphism with poor metaboliser effect
label: a
answer: yes

Correct answer: a
Which of the following blood vessels are the direct branches of the coeliac artery?

Options:
explanation: The splenic artery and hepatic artery are both branches of the coeliac artery. However, it is the left gastric artery, not the right gastric artery, which is the third branch of the coeliac artery.
name: Right gastric artery, splenic artery, and hepatic artery
label: b
answer: no
explanation: This vessel is a branch of the splenic artery, therefore does not directly arise from the coeliac artery.
name: Greater pancreatic artery
label: e
answer: no
explanation: The splenic artery, hepatic artery, and left gastric artery are the three main branches of the coeliac artery which arise from the abdominal aorta at T12/L1 level. These supply blood to the spleen, liver, and stomach respectively.
name: Splenic artery, hepatic artery, and left gastric artery
label: a
answer: yes
explanation: These two arteries arise from the abdominal aorta, alongside the coeliac artery itself.
name: Superior mesenteric artery and inferior mesenteric artery
label: d
answer: no
explanation: These are the three vessels which arise from the hepatic artery. The hepatic artery itself does arise from the coeliac artery.
name: Gastroduodenal artery, right hepatic artery, and left hepatic artery
label: c
answer: no

Correct answer: a
Which of the following relaxes in response to the presence of fatty food within the duodenum?

Options:
explanation: The common bile duct transports bile from the gallbladder. It fuses with the pancreatic duct to form the ampulla of Vater which then passes through the sphincter of Oddi and into the duodenum. If there is a high concentration of fatty food in the duodenum, the sphincter of Oddi may relax to allow bile (and pancreatic juice) to pass through the ampulla of Vater into the duodenum to emulsify fats.
name: Common bile duct
label: e
answer: no
explanation: The duct of Santorini is an accessory duct from the main pancreatic duct (Wirsung duct). It exits into the duodenum around 2cm superiorly to the ampulla of Vater. This usually acts only as a safety feature for if the Wirsung duct is unable to drain pancreatic juice, and is usually largely non-functioning.
name: Duct of Santorini
label: c
answer: no
explanation: The sphincter of Oddi is a muscular valve which surrounds the exit of the common bile duct and pancreatic duct, which join to create the Ampulla of Vater which exits into the duodenum. When fatty foods move into the duodenum, bile and pancreatic juices are needed to digest them. Therefore, the sphincter of Oddi relaxes to allow bile and pancreatic juice to enter the duodenum via the ampulla of Vater.
name: Sphincter of Oddi
label: a
answer: yes
explanation: The ampulla of Vater is the point where the bile duct and pancreatic duct join and pass into the duodenum. It is surrounded by the sphincter of Oddi, which relaxes to allow bile and pancreatic juice to pass into the duodenum when fatty food is present. The ampulla of Vater itself does not relax or contract, and is controlled by the Sphincter of Oddi.
name: Ampulla of Vater
label: b
answer: no
explanation: The Wirsung duct is the main pancreatic duct. It joins with the common bile duct to create the ampulla of Vater which allows bile and pancreatic juice to flow into the duodenum. However, the flow of bile into the duodenum when fatty food is present in the duodenum is controlled by the sphincter of Oddi - which the ampulla of Vater flows through.
name: Wirsung duct
label: d
answer: no

Correct answer: a
A 36-year-old female presents with right upper quadrant pain and jaundice. From her history, you find out that her stool has also been pale in recent weeks. Her LFT results are shown below.

[lightgallery]

Which of the following is her most likely diagnosis?

Options:
explanation: Hepatitis B leads to damage to the hepatocytes - thus causing a hepatic picture in the LFTs, which is not seen in this patient's results. Instead, an obstructive pattern is seen with raised bilirubin, GGT and ALP, alongside a lesser rise in ALT. These results, alongside right upper quadrant pain, jaundice and pale stool, are consistent with biliary obstruction. Considering her age and gender, gallstones are the most likely cause of this obstructive picture.
name: Hepatitis B
label: b
answer: no
explanation: The LFTs of this patient show an obstructive pattern, with raised GGT and ALP, alongside a lesser rise in ALT. Additionally, the right upper quadrant pain is consistent with biliary obstruction - which would also explain her jaundice. The presence of pale stools in her history also means that the cause of this obstruction is likely post-hepatic. Gallstones are the most common cause of biliary obstruction, and are post-hepatic. As she has no red flags for metastases, gallstones are the most likely diagnosis.
name: Gallstones
label: a
answer: yes
explanation: Alcoholic hepatitis would lead to hepatocellular disease and cause a hepatic picture in the LFTs, which is not seen in this patient's results. Instead, an obstructive pattern is seen with raised bilirubin, GGT and ALP, alongside a lesser rise in ALT. These results (alongside right upper quadrant pain, jaundice and pale stool) are consistent with biliary obstruction. Considering her age and gender, gallstones is the most likely cause of this obstructive picture.
name: Alcoholic hepatitis
label: c
answer: no
explanation: Primary sclerosing cholangitis may produce an obstructive LFT picture as it causes obstruction to the flow of bile out of the liver. It would also present with obstructive jaundice and right upper quadrant pain, and may cause pale stools. It is a differential diagnosis for this patient, and should be excluded via imaging. However, gallstones are by far the most common cause of biliary obstruction, especially in women around the age of 40 years. Therefore, gallstones are the most likely diagnosis.
name: Primary Sclerosing Cholangitis
label: e
answer: no
explanation: Gilberts Syndrome is an inherited, pre-hepatic, cause of jaundice that causes an isolated rise in bilirubin. This would not explain any of this patient's other symptoms e.g. pale stools and right upper quadrant pain. It also does not explain the derangement of any of her other LFTs.
name: Gilberts Syndrome
label: d
answer: no

Correct answer: a
A patient is prescribed 25mg of Midazolam. It must reach a plasma concentration of 10mg/L for it to take effect.

What is the volume of distribution (Vd) for this dose of Midazolam?

Options:
explanation: The volume of distribution is the theoretical volume which would be needed to contain a dose of a drug in order to keep it at the same concentration as the required plasma concentration.  Midazolam must reach 10mg/L within the plasma, and the dose being given is 25mg. Therefore, Vd = 25 /10 = 2.5 because Vd = Dose (mg) / Plasma concentration (mg/L). The dose is divided by the plasma concentration, not multiplied. Also, it is 'volume' of distribution, so the units are 'L' not 'mg'.
name: 250mg
label: d
answer: no
explanation: The correct calculation has been carried out here, as the volume of distribution is the theoretical volume which would be needed to contain a dose of a drug in order to keep it at the same concentration as the required plasma concentration.  Midazolam must reach 10mg/L within the plasma, and the dose being given is 25mg. Therefore, Vd = 25 /10 = 2.5 because Vd = Dose (mg) / Plasma concentration (mg/L). However, given it is 'volume' of distribution, the units are 'L' not 'mg'.
name: 2.5mg
label: c
answer: no
explanation: The volume of distribution is the theoretical volume which would be needed to contain a dose of a drug in order to keep it at the same concentration as the required plasma concentration. Midazolam must reach 10mg/L within the plasma, and the dose being given is 25mg. Therefore, Vd = 25 /10 = 2.5 because Vd = Dose (mg) / Plasma concentration (mg/L).
name: 2.5L
label: a
answer: yes
explanation: The volume of distribution is the theoretical volume which would be needed to contain a dose of a drug in order to keep it at the same concentration as the required plasma concentration. Midazolam must reach 10mg/L within the plasma, and the dose being given is 25mg. Therefore, Vd = 25 /10 = 2.5 because Vd = Dose (mg) / Plasma concentration (mg/L).
name: 15L
label: e
answer: no
explanation: The volume of distribution is the theoretical volume which would be needed to contain a dose of a drug in order to keep it at the same concentration as the required plasma concentration.  Midazolam must reach 10mg/L within the plasma, and the dose being given is 25mg. Therefore, Vd = 25 /10 = 2.5 because Vd = Dose (mg) / Plasma concentration (mg/L). The dose is divided by the plasma concentration, not multiplied.
name: 250L
label: b
answer: no

Correct answer: a
Which of the following hormones is secreted by the cortex of the suprarenal (AKA adrenal) glands?

Options:
explanation: Noradrenaline (and adrenaline) are produced in the medulla of the suprarenal glands, not the cortex. The cortices of the suprarenal glands produce adrenal corticosteroids e.g. cortisol and aldosterone, and sex hormones e.g. progesterone
name: Noradrenaline
label: c
answer: no
explanation: Adrenaline is produced by the medulla of the suprarenal glands, not the cortex. Noradrenaline is also produced here. The suprarenal gland cortices produce adrenal corticosteroids e.g. cortisol and aldosterone, and sex hormones e.g. progesterone.
name: Adrenaline
label: b
answer: no
explanation: Insulin is secreted by the beta cells of the pancreas, not by the suprarenal glands. The cortices of the suprarenal glands produce adrenal corticosteroids e.g. cortisol and aldosterone, and sex hormones e.g. progesterone
name: Insulin
label: d
answer: no
explanation: Glucagon is secreted by the alpha cells of the pancreas, not by the suprarenal glands. The cortices of the suprarenal glands produce adrenal corticosteroids e.g. cortisol and aldosterone, and sex hormones e.g. progesterone.
name: Glucagon
label: e
answer: no
explanation: The cortex of the suprarenal glands produces corticosteroids e.g. aldosterone and cortisol, and sex hormones e.g. progesterone.
name: Aldosterone
label: a
answer: yes

Correct answer: a
During glomerular filtration, the pressure within the glomerular capillary is 45mmHg, the plasma protein pressure is 25mmHg, and the pressure within the Bowman's capsule is 10mmHg. Calculate the net filtration pressure.



Options:
explanation: Net filtration pressure is the total pressure which drives fluid out of the capillary. The pressure within the glomerular capillary is hydrostatic pressure driving fluid out of the capillary. The plasma protein pressure is osmotic pressure into the capillary. The pressure within the Bowman's capsule is hydrostatic pressure into the capillary. Therefore, net filtration pressure = 45 - (25 +10), meaning net filtration pressure = 10mmHg.
name: 10 mmHg
label: a
answer: yes
explanation: Net filtration pressure is the total pressure which drives fluid out of the capillary. The pressure within the glomerular capillary is hydrostatic pressure driving fluid out of the capillary. The plasma protein pressure is osmotic pressure into the capillary. The pressure within the Bowman's capsule is hydrostatic pressure into the capillary. Therefore, net filtration pressure = 45 - (25 +10), meaning net filtration pressure = 10mmHg.
name: 80 mmHg
label: b
answer: no
explanation: Net filtration pressure is the total pressure which drives fluid out of the capillary. The pressure within the glomerular capillary is hydrostatic pressure driving fluid out of the capillary. The plasma protein pressure is osmotic pressure into the capillary. The pressure within the Bowman's capsule is hydrostatic pressure into the capillary. Therefore, net filtration pressure = 45 - (25 +10), meaning net filtration pressure = 10mmHg.
name: 18 mmHg
label: e
answer: no
explanation: Net filtration pressure is the total pressure which drives fluid out of the capillary. The pressure within the glomerular capillary is hydrostatic pressure driving fluid out of the capillary. The plasma protein pressure is osmotic pressure into the capillary. The pressure within the Bowman's capsule is hydrostatic pressure into the capillary. Therefore, net filtration pressure = 45 - (25 +10), meaning net filtration pressure = 10mmHg.
name: 30 mmHg
label: c
answer: no
explanation: Net filtration pressure is the total pressure which drives fluid out of the capillary. The pressure within the glomerular capillary is hydrostatic pressure driving fluid out of the capillary. The plasma protein pressure is osmotic pressure into the capillary. The pressure within the Bowman's capsule is hydrostatic pressure into the capillary. Therefore, net filtration pressure = 45 - (25 +10), meaning net filtration pressure = 10mmHg.
name: 205 mmHg
label: d
answer: no

Correct answer: a