hllj/quesmed huggingface dataset:
Which statement regarding the pelvis and its associated structures is correct?

Options:
explanation: The tubercle of the iliac crest is on its anterolateral side.
name: The tubercle of the iliac crest is located on its posteromedial side
label: e
answer: no
explanation: The gluteus maximus originates from the external ilium posterior to the posterior gluteal line. It also has some fibres that originate from the dorsal sacrum, coccyx and sacrotuberous ligament.
name: The gluteus maximus muscle originates from the external ilium anterior to the posterior gluteal line
label: c
answer: no
explanation: The pubic symphysis is a secondary cartilaginous joint.
name: The pubic symphysis is a primary cartilaginous joint
label: b
answer: no
explanation: The obturator membrane doesn’t cover the whole of the obturator foramen. A small space is left called the obturator canal, through which the obturator nerve and vessels travel.
name: The obturator membrane spans the whole of the obturator foramen
label: d
answer: no
explanation: The sacroiliac joint is a synovial joint, with excessive movement being prevented by many interosseous ligaments.
name: The sacroiliac joint is a synovial joint
label: a
answer: yes

Correct answer: a
A mother brings her 6-year-old son to the GP, concerned that he bruises very easily. Upon further discussion, his mother admits that he also has ‘stretchy skin’ and is ‘very flexible.’ The child’s father also has these features.

Given the most probable diagnosis, the child is likely to have inherited a defect in which protein?

Options:
explanation: Defects in type IV collagen result in Alport syndrome, which has characteristic features of renal impairment, eye changes (especially to the lens or cornea), and sensorineural hearing loss.
name: Type IV collagen
label: d
answer: no
explanation: Defects in fibrillin result in Marfan syndrome, characterised by disproportionally long and slender limbs, anterior chest wall deformity, lens dislocation, heart murmurs and spontaneous pneumothoraces.
name: Fibrillin
label: c
answer: no
explanation: Defects in type III collagen cause Ehlers-Danlos vascular type which is associated with features such as thin, fragile, translucent skin, short stature, fragile blood vessels that can rupture, and characteristic facial features. The features listed in the vignette are more consistent with classical Ehlers-Danlos.
name: Type III collagen
label: b
answer: no
explanation: Abnormal forms, or a reduction in Von Willebrand factor result in Von Willebrand disease, the most common inherited bleeding disorder which characteristically causes bruising, epistaxis and menorrhagia. Von Willebrand's disease would not account for the joint hypermobility and skin elasticity described in the vignette.
name: Von Willebrand factor
label: e
answer: no
explanation: The child in the vignette likely has Ehlers-Danlos classical type (formally called type 1), an autosomal dominant condition associated with elastic skin, bruising and joint hypermobility. This is caused by defects in type V collagen.
name: Type V collagen
label: a
answer: yes

Correct answer: a
Which statement, regarding the brachial plexus, is correct?

Options:
explanation: The brachial plexus is formed from the roots of the ventral rami of C5-T1 spinal levels. These enter the neck between the anterior and middle scalene muscles, posterior to the subclavian artery.
name: The nerve roots that form the brachial plexus enter the neck between the anterior and middle scalene muscles
label: a
answer: yes
explanation: The axillary nerve branches from the posterior cord to supply the deltoid, teres minor and skin on the upper lateral part of the arm.
name: The axillary nerve branches from the lateral cord
label: c
answer: no
explanation: The medial brachial and antebrachial cutaneous nerves arise from the medial cord. The superior trunk gives off the nerve to the subclavius and the suprascapular nerves.
name: The medial brachial and antebrachial cutaneous nerves arise from the superior trunk
label: e
answer: no
explanation: The median nerve is formed from the lateral and medial cords. The radial nerve is formed as a continuation of the posterior cord.
name: The radial nerve is formed from the lateral and medial cords
label: d
answer: no
explanation: The long thoracic nerve does branch from the roots in the neck, but from spinal levels C5-7.
name: The long thoracic nerve branches from C6-8 nerve roots in the neck
label: b
answer: no

Correct answer: a
Which statement regarding structures in the knee is correct?

Options:
explanation: This is the function of the articularis genus muscle. The popliteus muscle unlocks and stabilises the knee joint.
name: The popliteus muscle keeps the suprapatellar bursa taut during leg extension
label: c
answer: no
explanation: The medial meniscus is attached to the tibia, joint capsule and tibial collateral ligament. The lateral meniscus is unattached so is more mobile and less likely to tear.
name: The medial meniscus is not attached to the joint capsule, so is more mobile and less likely to tear
label: d
answer: no
explanation: The tibial collateral ligament is also known as the medial collateral ligament and attaches to the medial meniscus.
name: The tibial collateral ligament attaches to the lateral meniscus
label: b
answer: no
explanation: The popliteus muscle is innervated by the tibial nerve, which consists of fibres from L4-S1. The popliteus unlocks the knee joint by laterally rotating the femur and stabilises the knee by resisting lateral tibial rotation.
name: The popliteus muscle is innervated by the tibial nerve
label: a
answer: yes
explanation: The soleal line is on the posterior surface of the tibia and is where the soleus muscle arises from. The bony prominence on the anterior surface of the tibia is the tibial tuberosity.
name: The soleal line is located on the anterior surface of the tibia
label: e
answer: no

Correct answer: a
A 34-year-old woman presents with double vision and eyelid drooping, which is worse at the end of the day. Upon investigation, all of her reflexes are normal, and an EMG shows a diminishing response of muscle fibres with repetitive electrical stimulation.

What is the most likely pathophysiology underlying this condition?

Options:
explanation: Although 10-20% of patients with myasthenia graves will have a thymoma, this is not the underlying pathophysiology causing the myasthenia gravis symptoms.
name: Thymoma
label: b
answer: no
explanation: This is the pathophysiology of multiple sclerosis. Although this commonly presents in women under the age of 40, it would not account for the fatigue seen on EMG. Multiple sclerosis also classically presents with different symptoms, such as unilateral loss of vision with pain upon eye movement (optic neuritis).
name: Inflammation causes demyelination and axonal loss
label: d
answer: no
explanation: This is the pathophysiology of amyotrophic lateral sclerosis, the commonest form of motor neurone disease. Degeneration of the corticospinal tract and alpha motor neurons results in the characteristic mix of upper and lower motor neurone signs seen.
name: Progressive degeneration of the corticospinal tract and alpha motor neurons
label: e
answer: no
explanation: This is the pathophysiology of Lambert-Eaton myasthenic syndrome, which is characterised by muscle weakness that improves with exercise. Lower limb weakness, hyporeflexia and an incremental response to repetitive stimulation would be seen.
name: Autoantibodies against presynaptic voltage-gated calcium channels in the peripheral nervous system
label: c
answer: no
explanation: The vignette describes the classical presentation of myasthenia gravis (MG). 85% of MG cases are caused by autoantibodies against the nicotinic acetylcholine receptors at the neuromuscular junction. This blockade stops the acetylcholine from triggering muscle contraction. During repeated or sustained muscle contraction, more receptors become blocked, accounting for the muscle weakness seen with increased activity.
name: Autoantibodies against the nicotinic acetylcholine receptors at the neuromuscular junction
label: a
answer: yes

Correct answer: a
Which statement correctly describes a structure found in the foot?

Options:
explanation: The cuboid bone is lateral to the three cuneiform bones.
name: The cuboid bone is medial to the cuneiform bones
label: d
answer: no
explanation: The long plantar ligament connects the calcaneus to the cuboid and metatarsal bases. The plantar calcaenonavicular, or spring, ligament connects the calcaneus to the navicular, working to support the head of the talus and maintain the medial arch of the foot.
name: The plantar calcaenonavicular, or spring, ligament connects the calcaneus to the cuboid and metatarsal bases
label: b
answer: no
explanation: It is the posterior branch of the popliteal artery that enters the foot to divide into the medial and lateral plantar arteries.
name: The anterior branch of the popliteal artery enters the foot to divide into the medial and lateral plantar arteries
label: c
answer: no
explanation: The lateral plantar nerve provides the sensory supply over the lateral sole of the foot and the plantar surface of the lateral 1.5 digits. The superficial fibular nerve provides the sensory supply over most of the foot dorsum.
name: The superficial fibular nerve provides the sensory supply over the plantar surface of the lateral 1.5 digits
label: e
answer: no
explanation: The contents of the tarsal tunnel (from medial to lateral) are tibialis posterior, flexor digitorum longus, posterior tibial artery, posterior tibial vein, tibial nerve, flexor hallucis longus.
name: The tibial nerve passes through the tarsal tunnel
label: a
answer: yes

Correct answer: a
Which statement regarding the anatomy of the lumbosacral plexus is correct?

Options:
explanation: The obturator nerve consists of fibres from the ventral rami of L2-4.
name: The obturator nerve consists of fibres from L4-S1 spinal levels
label: d
answer: no
explanation: The sciatic nerve is the largest nerve in the body, arising from the lumbosacral plexus at nerve roots L4-S3. It travels down the thigh, innervating the posterior thigh muscles. It terminates at the apex of the popliteal fossa by bifurcating into the common fibular and tibial nerves.
name: The sciatic nerve terminates at the apex of the popliteal fossa by bifurcating into the common fibular and tibial nerves
label: a
answer: yes
explanation: The lumbosacral plexus arises from the ventral rami of L1-S4.
name: The lumbosacral plexus arises from the ventral rami of L2-S2 spinal levels
label: c
answer: no
explanation: The superior gluteal nerve supplies the gluteus medius, gluteus minimus and tensor fasciae muscles. The gluteus maximus is supplied by the inferior gluteal nerve.
name: The superior gluteal nerve supplies the gluteus maximus, gluteus medius and gluteus minimus muscles
label: e
answer: no
explanation: The femoral nerve travels through the subinguinal gap to supply the obturator externus and muscles of the anterior thigh. The superior and inferior gluteal nerves travel through the greater sciatic foramen.
name: The femoral nerve travels through the greater sciatic foramen
label: b
answer: no

Correct answer: a
The neurodegenerative condition Parkinson’s disease is associated with the loss of which cell type?

Options:
explanation: The degeneration of the corticospinal tract and alpha motor neurons is the pathophysiological process underlying amyotrophic lateral sclerosis, the commonest form of motor neurone disease.
name: Alpha motor neurons
label: e
answer: no
explanation: Deposition of intracellular tau protein and extracellular amyloid beta plaques leads to the degeneration of hippocampal neurons in Alzheimer’s disease. This neuronal loss then spreads to other brain areas.
name: Hippocampal neurons
label: c
answer: no
explanation: Loss of cholinergic and GABAergic neurons in the striatum is the pathophysiological process underlying Huntington’s disease. This occurs due to the expansion of trinucleotide repeats in the Huntingtin gene.
name: Cholinergic and GABAergic neurons in the striatum
label: d
answer: no
explanation: Inflammation leading to the loss of oligodendrocytes in the central nervous system is the pathophysiological process underlying multiple sclerosis.
name: Oligodendrocytes
label: b
answer: no
explanation: Degeneration of dopaminergic neurons in the substantia nigra is the pathophysiological process underlying Parkinson’s disease.
name: Dopaminergic neurons of the substantia nigra
label: a
answer: yes

Correct answer: a
Which of the following structures receives its blood supply from the anterior cerebral artery?

Options:
explanation: Wernicke’s area, a region in the superior temporal gyrus of the dominant hemisphere, is supplied by the middle temporal branches of the middle cerebral artery.
name: Wernicke's area
label: d
answer: no
explanation: Cortical branches of the anterior cerebral artery run into the frontal lobe to supply the majority of the corpus callosum, cingulate gyrus and medial frontal gyrus.
name: Corpus callosum
label: a
answer: yes
explanation: The blood supply to the basal ganglia is mostly by the lenticulostriate branches of the middle cerebral artery.
name: Basal ganglia
label: e
answer: no
explanation: The primary motor cortex, or precentral gyrus, receives a mixed blood supply. The upper limb areas are supplied by the middle cerebral artery and the lower limb areas are supplied by the anterior cerebral artery, accounting for the respective deficits seen when each of these vessels is affected by stroke.
name: Upper limb areas of the primary motor cortex
label: c
answer: no
explanation: Broca’s area, a region in the frontal lobe of the dominant hemisphere, is supplied by the middle cerebral artery.
name: Broca's area
label: b
answer: no

Correct answer: a
Which statement describing the facial nerve is correct?

Options:
explanation: The facial nerve does travel through the parotid gland but doesn’t contribute to its innervation. The parasympathetic supply to the parotid gland is by the glossopharyngeal nerve.
name: The facial nerve gives parasympathetic supply to the parotid gland
label: b
answer: no
explanation: The facial nerve gives motor supply to the facial muscles such as the buccinator. However, the motor supply to the extrinsic tongue muscles is via the hypoglossal and vagus nerves.
name: The facial nerve gives the motor supply to facial and extrinsic tongue muscles such as the buccinator, mylohyoid and palatoglossus
label: c
answer: no
explanation: The facial nerve innervates the efferent limb of the corneal reflex via the greater petrosal nerve, as this innervates the orbicularis oculi muscle. The afferent limb of the corneal reflex is via the ophthalmic division of the trigeminal nerve.
name: The facial nerve innervates the afferent limb of the corneal reflex via the greater petrosal nerve
label: d
answer: no
explanation: The terminal sulcus divides the tongue into portions: the anterior 2/3 and posterior 1/3. The taste sensation to the anterior 2/3 is supplied by the chorda tympani branch of the facial nerve.
name: Taste fibres to the anterior 2/3 of the tongue are supplied by the facial nerve
label: a
answer: yes
explanation: The chorda tympani travels with the mandibular trigeminal branch to supply taste sensation to the tongue. The greater petrosal nerve travels with the ophthalmic trigeminal nerve to supply the lacrimal gland.
name: The chorda tympani travels with the ophthalmic trigeminal nerve to supply the lacrimal gland
label: e
answer: no

Correct answer: a
An 82-year-old female has been diagnosed with Alzheimer’s disease.

What neuropathological finding would be most likely be found upon investigation?

Options:
explanation: These findings would likely be the case in vascular dementia, another disease which causes dementia in a characteristic stepwise deterioration pattern.
name: Microvessel occlusion and stenosis
label: e
answer: no
explanation: This is the neuropathological hallmark of multiple sclerosis.
name: Demyelination
label: c
answer: no
explanation: Lewy bodies are the neuropathological hallmark of Parkinson’s disease. They are also found in Lewy body dementia.
name: Lewy bodies
label: b
answer: no
explanation: Amyloid beta plaques are extracellular plaques formed from misfolded abnormalities. These, along with neurofibrillary tau tangles, are characteristic of Alzheimer’s disease.
name: Amyloid beta plaques
label: a
answer: yes
explanation: These are spherical inclusions in neuronal cytoplasm, found in behavioural variant frontotemporal dementia.
name: Pick bodies
label: d
answer: no

Correct answer: a
Which statement regarding the anatomy of the larynx is correct?

Options:
explanation: The larynx is located in the midline of the neck. However, it is inferior to C3-4 level and superior to the first cartilaginous tracheal ring.
name: The larynx is located in the midline of the neck at C2 level, inferior to the first cartilaginous tracheal ring
label: d
answer: no
explanation: The quadrangular membranes are some of the intrinsic ligaments that shape the inside of the larynx. They connect the lateral epiglottis to the arytenoid and thyroid cartilages, and their lower borders form the vestibular ligaments.
name: The lower borders of the quadrangular membranes form the vestibular ligaments
label: a
answer: yes
explanation: The mucous membranes are mostly lined with ciliated columnar epithelium, the exception to this being the vocal folds, which are lined with protective stratified squamous epithelium.
name: The mucous membrane of the larynx mainly consists of stratified squamous epithelium
label: c
answer: no
explanation: The blood supply to the larynx is via the superior and inferior laryngeal arteries, branches of the external carotid arteries.
name: The blood supply to the larynx is via branches of the internal carotid arteries
label: b
answer: no
explanation: Closing of the laryngeal sphincter is done by the aryepiglottic muscle and the oblique arytenoid muscles. The posterior cricoarytenoid muscles work to abduct and externally rotate the vocal folds.
name: The posterior cricoarytenoid muscles work to close the laryngeal sphincter
label: e
answer: no

Correct answer: a
A 64-year-old man had an ischaemic stroke, leading to damage to his left optic radiation in the parietal lobe.

What visual field defect would this man most likely experience?

Options:
explanation: Lesions in the optic radiation affect the contralateral side, due to the crossing over of fibres at the optic chiasm, so we know damage to the left side will affect the right side of vision. The acronym to remember which quadrant is affected is ‘PITS’ (parietal inferior, temporal superior).
name: Right inferior quadrantanopia
label: a
answer: yes
explanation: Right superior quadrantanopia would arise from lesions to the left optic radiation in the temporal lobe.
name: Right superior quadrantanopia
label: b
answer: no
explanation: Lesions in the occipital cortex result in contralateral homonymous hemianopia with macular sparing. If the homonymous hemianopia did not have macular sparing, this would suggest a lesion of the optic tract.
name: Right homonymous hemianopia with macular sparing
label: c
answer: no
explanation: Lesions in the optic radiation affect the contralateral side, due to the crossing over of fibres at the optic chiasm, so left-sided visual defects are caused by lesions in the right optic radiation.
name: Left superior quadrantanopia
label: e
answer: no
explanation: Lesions in the optic radiation affect the contralateral side, due to the crossing over of fibres at the optic chiasm, so left-sided visual defects are caused by lesions in the right optic radiation.
name: Left inferior quadrantanopia
label: d
answer: no

Correct answer: a
What is the pathophysiological process underlying Huntington’s disease?

Options:
explanation: This process occurs during an ischaemic stroke. Blood vessel occlusion may occur due to atherosclerotic plaques in the carotid arteries, for example, or a blood clot may embolise from elsewhere in the body to the brain vessels, causing a blockage. Brain tissue eventually dies due to lack of blood supply.
name: Blood vessel occlusion causing tissue hypoxia and ischaemia
label: c
answer: no
explanation: Loss of cholinergic and GABAergic neurons in the striatum is the pathophysiological process underlying Huntington’s disease. This occurs due to the expansion of trinucleotide repeats in the Huntingtin gene, which causes intracellular aggregation of abnormal Huntington protein and therefore neuronal death.
name: Loss of cholinergic and GABAergic neurons in the striatum
label: a
answer: yes
explanation: This is the pathological process underling multiple sclerosis. Loss of oligodendrocytes in multiple sclerosis results in demyelination of neuronal axons, so the neurons are unable to conduct action potentials as effectively, eventually leading to axonal loss.
name: Inflammation leading to the loss of oligodendrocytes
label: b
answer: no
explanation: This is the pathophysiological process underlying Parkinson’s disease. The neuropathological hallmark of this is Lewy bodies, intracellular aggregates of misfolded alpha-synuclein protein.
name: Degeneration of dopaminergic neurons in the substantia nigra
label: e
answer: no
explanation: This is the pathophysiological process that occurs in Alzheimer’s disease. This initially starts in the hippocampus but spreads to other brain areas as the disease progresses.
name: Neuronal death due to accumulation of intracellular Tau tangles and extracellular amyloid beta plaques
label: d
answer: no

Correct answer: a
Which statement regarding the innervation of the ear is correct?

Options:
explanation: The mastoid antrum is mostly innervated by the glossopharyngeal nerve.
name: The mastoid antrum in the petrous temporal bone is innervated by the greater petrosal branch of the facial nerve
label: b
answer: no
explanation: The crista ampullaris is a ridge of sensory cells in the walls of the ampullae of the inner ear. These cells detect the movement of endolymph as the head moves. This movement is converted to electrical signals which are transmitted by the vestibular branch of the vestibulocochlear nerve.
name: The crista ampullaris transduces and fires signals via the vestibular branch of the vestibulocochlear nerve
label: a
answer: yes
explanation: The auriculotemporal branch of the mandibular trigeminal nerve innervates the superoanterior quadrant of the external auditory meatus. The superoposterior quadrant is innervated by the lesser occipital nerve, from C2 spinal level.
name: The superoposterior quadrant of the external auditory meatus is innervated by the auriculotemporal branch of the mandibular trigeminal nerve
label: e
answer: no
explanation: The superior half of the external tympanic membrane is innervated by the vagus nerve. The inferior half of the external tympanic membrane is innervated by the mandibular trigeminal nerve.
name: The external tympanic membrane is innervated by the greater auricular nerve from spinal levels C2-3
label: d
answer: no
explanation: The tensor tympani muscle is innervated by the mandibular branch of the trigeminal nerve, working to dampen sound vibrations from the tympanic membrane.
name: The tensor tympani muscle is innervated by the facial nerve
label: c
answer: no

Correct answer: a