hllj/quesmed huggingface dataset:
A 23-year-old man of Pakistani heritage presents to the GP with intermittent periods of yellow-tinted sclera. He notes that this tends to happen after periods of illness or if he takes ibuprofen. A blood smear shows Heinz bodies and bite cells. The GP suspects a diagnosis of G6PD deficiency.

Which of the following describes the mode of inheritance of G6PD deficiency?

Options:
explanation: G6PD is a sex linked recessive disease
name: Autosomal recessive
label: b
answer: no
explanation: G6PD is a sex linked recessive disease
name: Mitochondrial
label: d
answer: no
explanation: G6PD is a sex linked recessive disease
name: X linked dominant
label: e
answer: no
explanation: G6PD is an inherited sex-linked recessive disease. The most severe "Mediterranean" variant commonly affects those in Southern Europe, Northern Africa and the Middle East Deficiency in G6PD results in haemolytic anaemia which is worse after taking ibuprofen
name: Sex linked recessive
label: a
answer: yes
explanation: G6PD is a sex linked recessive disease
name: Autosomal dominant
label: c
answer: no

Correct answer: a
An 88-year-old woman with a history of atrial fibrillation and osteoarthritis presents to A&E with her son. He says that she has been complaining of her heart "feeling funny" and has become very confused since breakfast. Additionally, she has become distressed and is complaining of "yellow vision". Her regular medications include digoxin, rivaroxaban, bisoprolol and paracetamol.

Her bloods show raised serum potassium levels and her ECG shows bradycardia with prolonged PR intervals and QRS complexes.

What is the single most likely cause of her presentation?

Options:
explanation: Digoxin toxicity typically presents with hyperkalaemia and bradycardia with prolonged PR and QRS complexes. The most common ocular manifestation of dioxin toxicity is yellow/green tinted vision. Treatment of digoxin toxicity is with "digibind."
name: Digoxin toxicity
label: a
answer: yes
explanation: Beta blocker toxicity may produce bradycardia. However, it is also likely to produce hypotension, hypothermia and hypoglycaemia. It would not cause yellow tinted vision
name: Beta blocker toxicity
label: c
answer: no
explanation: Rivaroxaban toxicity could result in a haemorrhagic stroke which could lead to ocular manifestations like yellow-tinted vision. However, it is unlikely to produce hyperkalaemia seen is this patient
name: Haemorrhagic stroke secondary to rivaroxaban toxicity
label: d
answer: no
explanation: Early onset dementia may explain her period of confusion, however, it would not explain her hyperkalaemia, bradycardia or yellow tinted vision
name: Early onset dementia
label: b
answer: no
explanation: A urinary tract infection may produce the symptoms of confusion seen in this patient. However, a UTI is unlikely to produce the bradycardia, hyperkalaemia nor yellow tinted vision that this patient is experiencing
name: Urinary tract infection
label: e
answer: no

Correct answer: a
Haem is the prosthetic group of haemoglobin that allows oxygen to bind to haemoglobin.

What is the maximum amount of oxygen molecules that can bind to a molecule of haemoglobin?

Options:
explanation: The haemoglobin molecule has 4 binding sites for oxygen
name: 4
label: a
answer: yes
explanation: The haemoglobin molecule has 4 binding sites for oxygen
name: 2
label: c
answer: no
explanation: The haemoglobin molecule has 4 binding sites for oxygen
name: 5
label: e
answer: no
explanation: The haemoglobin molecule has 4 binding sites for oxygen
name: 3
label: d
answer: no
explanation: The haemoglobin molecule has 4 binding sites for oxygen. Myoglobin, a protein similar to haemoglobin, has capacity to bind to 1 molecule of oxygen
name: 1
label: b
answer: no

Correct answer: a
Which of the following describes the movement of ions during phase 0 of the cardiac action potential?

Options:
explanation: This describes the movement of ions during the cells' resting potential. This is maintained by sodium/potassium pumps.
name: 3 sodium ions are pumped out of the cell and 2 potassium ions are pumped into the cell
label: e
answer: no
explanation: This describes the movement of ions in phase 1 where sodium channels close and potassium channels open briefly.
name: Potassium ions flow out of the cell through potassium channels
label: c
answer: no
explanation: Phase 0 describes the rapid depolarisation of cardiac cells. This occurs through a net movement of positive sodium ions into the cell causing membrane potential to become more positive
name: Sodium ions flow into the cell through sodium channels
label: a
answer: yes
explanation: This describes the movement of ions in phase 2. The flow of calcium ions creates a plateau in membrane potential.
name: Calcium ions flow into the cell through L-type calcium channels
label: d
answer: no
explanation: This would cause membrane potential to become more negative and cardiac cells would be unable to reach the threshold potential for depolarisation
name: Sodium ions flow out of the cell through sodium channels
label: b
answer: no

Correct answer: a
A 21-year-old student returns from a night out and falls asleep on a chair with his hand hanging over the back of the seat. When he wakes up he is unable to lift his wrist or make a thumbs up.

What is the most likely cause of his symptoms?

Options:
explanation: This would not cause any of the symptoms experienced by the patient.
name: Damage to flexor carpi muscles
label: e
answer: no
explanation: This would cause the patient's inability to produce a thumbs up but would not cause the wrist drop experienced
name: Damage to extensor pollicis longus
label: d
answer: no
explanation: Compression of the ulnar nerve occurs at the elbow (Cubital tunnel syndrome) or wrist (ulnar tunnel syndrome). It results in pain/numbness in the forearm and 4th and 5th fingers.
name: Compression of the ulnar nerve
label: b
answer: no
explanation: This history is characteristic of "Saturday night palsy" where the radial nerve is compressed against the spiral groove of the humerus. It results in patients being unable to make a thumbs up, loss of finger extension and wrist drop
name: Compression of the radial nerve
label: a
answer: yes
explanation: This would cause the "wrist drop" experienced by the patient but would not affect his ability to form a thumbs-up
name: Damage to extensor carpi muscles
label: c
answer: no

Correct answer: a
Which of the following describes a method of preventing widespread anti-microbial resistance?

Options:
explanation: Stopping antibiotic courses early may mean that not all of the pathogens have been destroyed. It is important to complete courses to prevent relapse and antibiotic resistance.
name: Stop antibiotic courses before the course is due to end if the patient feels better
label: e
answer: no
explanation: Whilst it is important to complete a course of antibiotics, there is little clinical benefit from using longer courses than recommended if the infection was cleared by the initial course.
name: Use longer courses than recommended antibiotics to ensure that infections are completely cleared
label: d
answer: no
explanation: Vaccination of animals prevents the transmission of infection between animals and reduces the need for antibiotics
name: Ensure livestock are vaccinated to prevent the spread of disease
label: a
answer: yes
explanation: Evidence has shown that infections with delayed treatment have a higher rate of antibiotic resistance. Less severe infections are also more likely to require weaker antibiotics and enable clinicians to preserve the use of strong antibiotics
name: Delayed treatment of infections until patients need antibiotics
label: b
answer: no
explanation: Overuse of antibiotics in animals who do not need them is a massive factor in widespread antibiotic resistance. Farmers should use vaccinations to prevent the spread of disease, not antibiotics
name: Use of antibiotics in agriculture to prevent transmission of infection through food and animals
label: c
answer: no

Correct answer: a
Arachidonic acid is an essential fatty acid that is used in the synthesis of prostaglandins, leukotrienes and thromboxane. Non-steroidal anti-inflammatory drugs inhibit its conversion into these inflammatory mediators.

Which enzyme do NSAIDs inhibit?

Options:
explanation: 5-lipooxygenase catalyses the conversion of arachidonic acid into 5-HpETE. It is involved in the production of leukotrienes.
name: 5-lipooxygenase
label: c
answer: no
explanation: Cyclo-oxygenase (COX) enzymes 1 and 2 catalyse the conversion of arachidonic acid into prostaglandin H2. NSAIDs are COX inhibitors and prevent the production of prostaglandin H2 and downstream inflammatory mediators.
name: Cyclo-oxygenase enzymes 1 and 2
label: a
answer: yes
explanation: Thromboxane synthase catalyses the formation of thromboxane from prostaglandin H2
name: Thromboxane synthase
label: e
answer: no
explanation: Cytochrome P450 is a hepatic enzyme that catalyses the breakdown of many NSAIDs, such as ibuprofen
name: Cytochrome P450
label: d
answer: no
explanation: Phospholipase A2 catalyses the conversion of phospholipids into arachidonic acid in response to injury.
name: Phospholipase A2
label: b
answer: no

Correct answer: a
A 35-year-old is undergoing some pulmonary function testing.

His tidal volume is 500ml, his vital capacity is 4.5L, his functional redidual capacity is 2.5L and his residual volume is 1.5L.

Please calculate his inspiratory reserve volume

Options:
explanation: This is the expiratory reserve volume
name: 1L
label: b
answer: no
explanation: Vital capacity is equal to inspiratory reserve volume + tidal volume + expiratory reserve volume. Expiratory reserve volume is equal to functional residual capacity - residual volume (2500ml-1500ml=1000ml). Therefore, inspiratory reserve volume is equal to 4.5L - 0.5L - 1l = 3L
name: 3L
label: a
answer: yes
explanation: This is equal to vital capacity - tidal volume. To calculate inspiratory reserve volume, expiratory reserve volume must also be calculated and then subtracted from vital capacity
name: 4L
label: e
answer: no
explanation: This is equal to vital capacity - tidal volume - residual capacity. The residual volume must be added to this to make an inspiratory reserve volume of 3L
name: 1.5L
label: c
answer: no
explanation: This is equal to vital capacity - tidal volume - residual volume. To calculate inspiratory reserve volume, expiratory reserve volume must be calculated first which is equal to functional residual capacity - residual volume
name: 2.5L
label: d
answer: no

Correct answer: a
A 53-year-old male presents to his GP after noticing that he is unable to straighten his ring finger on his right hand. He says that this has been progressive over the last year

On examination, his ring finger is flexed to around 35 degrees and the GP is unable to correct the deformity with passive movement and the skin of his ring finger appears thickened. He is not in any pain. He is a long-term smoker and was diagnosed with type-2 diabetes mellitus 4 years ago.

What is the likely diagnosis?

Options:
explanation: Radial nerve palsy would not affect the ring finger as it is supplied by the ulnar nerve. Palsy of the radial nerve causes wrist drop, loss of finger extension and loss of the ability to make a thumbs up.
name: Radial nerve palsy
label: c
answer: no
explanation: Ulnar nerve palsy would also affect the 4th and 5th fingers of the hands, however, it would produce a sensory deficit in these fingers and the medial portion of the forearm
name: Ulnar nerve palsy
label: b
answer: no
explanation: Dupuytren's contracture is the abnormal thickening of tissue in the palm. It causes fingers to curl towards the hand. It can be hereditary but it is also linked to smoking, alcoholism and diabetes
name: Dupuytren's contracture
label: a
answer: yes
explanation: Median nerve palsy commonly manifests as carpal tunnel syndrome. It causes pain/numbness/weakness in the first 3 fingers of the hand.
name: Median nerve palsy
label: e
answer: no
explanation: Flexor tendinopathy may cause fingers to curl over, however, it does not cause the thickening of the skin and it usually causes pain
name: Flexor tendinopathy
label: d
answer: no

Correct answer: a
Which of the following are examples of kinase-linked receptors

Options:
explanation: Acetylcholine receptors are an example of G-protein coupled receptors
name: Acetylcholine receptors
label: c
answer: no
explanation: GABA receptors are an example of ligand gated receptors
name: GABA receptors
label: d
answer: no
explanation: Serotonin receptors are an example of ligand gated receptors
name: Serotonin receptors
label: e
answer: no
explanation: Androgen receptors are an example of steroid receptors
name: Androgen receptors
label: b
answer: no
explanation: Insulin receptors are tyrosine kinase-linked receptors. When insulin binds to its receptor it triggers a signalling cascade that regulates metabolism and cell growth
name: Insulin receptors
label: a
answer: yes

Correct answer: a
Where in the cell does the Krebs cycle take place?

Options:
explanation: No stages of respiration take place in the outer membrane
name: Mitochondrial outer membrane
label: e
answer: no
explanation: The Krebs cycle (citric acid cycle) takes place in the mitochondrial matrix. It yields 12 ATP molecules per cycle
name: Mitochondrial matrix
label: a
answer: yes
explanation: No stages of respiration take place in the nucleus
name: Nucleus
label: d
answer: no
explanation: The Krebs cycle takes place in the mitochondrial matrix. Glycolysis takes place in the cytoplasm
name: Cytoplasm
label: b
answer: no
explanation: The Krebs cycle takes place in the mitochondrial matrix. The electron transport chain takes place in the cytoplasm
name: Mitochondrial inner membrane
label: c
answer: no

Correct answer: a
A 35-year-old man presents to A&E after a car accident. He has a displaced fracture of his left ulna and is sent to theatres for open reduction and internal fixation. He is complaining of severe, intractable pain in his left arm that is uncontrolled with pain relief. He is also complaining of tingling in the fingers of his left hand which has gotten progressively worse since surgery.

Given this patient's history, what is the most likely diagnosis?

Options:
explanation: Compartment syndrome is a painful condition caused by an increase in intra-compartment compression. This is often due to trauma and can lead to compression of arteries, veins and nerves resulting in pain, pallor, paraesthesia, pulselessness and, eventually, paralysis.
name: Compartment syndrome
label: a
answer: yes
explanation: Upper extremity deep vein thrombosis is rare but could occur following surgical fixation of an upper extremity fracture. Given this patient's history of trauma, the most likely diagnosis is compartment syndrome
name: Upper extremity deep vein thrombosis
label: d
answer: no
explanation: Surgery may cause nerve damage which can lead to pain. However, this is more likely to be burning/shooting pain and would not present with paraesthesia like this patient.
name: Neuropathic pain
label: e
answer: no
explanation: The patient's history does not suggest that this is a normal level of pain, especially as it has not gotten better with pain relief and there is evidence of paraesthesia
name: Normal post-operative pain
label: b
answer: no
explanation: Post-operative infections will typically appear 3-7 days after surgery. They will normally present with systemic symptoms, such as fever and malaise, alongside pain
name: Post-operative infection
label: c
answer: no

Correct answer: a
A 65-year-old man presents to A&E with a nosebleed that "just won't stop". It has been bleeding for 30 minutes. Three years ago, he underwent surgery to replace his aortic valve and has been taking warfarin regularly since.

When visiting his GP earlier this week, he was diagnosed with hypertension and has been actively making changes to his lifestyle to become healthier.

What is the most likely cause of his prolonged nosebleed?

Options:
explanation: Grapefruit is a CYP450 inhibitor, and, therefore, it inhibits the breakdown of warfarin and makes patients more susceptible to bleeds
name: Increased consumption of grapefruit
label: a
answer: yes
explanation: Spinach is rich in vitamin K and consumption should be limited as it may counteract the actions of warfarin making it less effective and patients susceptible to blood clots
name: Increased consumption of spinach
label: d
answer: no
explanation: Oranges/orange juice is a safe alternative to grapefruit if taking warfarin
name: Increased consumption of oranges
label: b
answer: no
explanation: Tomatoes are low in vitamin K and do not inhibit CYP450 enzymes. They are safe to consume whilst taking warfarin
name: Increased consumption of tomatoes
label: e
answer: no
explanation: Kale is rich in vitamin K and consumption should be limited as it may counteract the actions of warfarin making it less effective and patients susceptible to blood clots
name: Increased consumption of kale
label: c
answer: no

Correct answer: a
Which statement regarding the bones of the shoulder joint is correct?

Options:
explanation: The transverse ligament spans the suprascapular notch, not the greater scapular notch. The suprascapular nerve passes through this space.
name: The greater scapular notch is spanned by the transverse ligament
label: b
answer: no
explanation: The clavicle laterally articulates with the acromion of the scapula, forming the acromioclavicular joint.
name: The clavicle laterally articulates with the coracoid process of the scapula
label: c
answer: no
explanation: The subscapular fossa is visible on the anterior side of the scapula and the posterior side of the scapula has the supraspinous and infraspinous fossae.
name: The subscapular fossa is visible from the posterior view of the scapula
label: d
answer: no
explanation: The radial groove is a shallow depression in the humerus through which the radial nerve and deep brachial artery travel. This is continued laterally with the deltoid tuberosity.
name: The radial groove of the humerus is continuous laterally with the deltoid tuberosity
label: a
answer: yes
explanation: The lesser tubercle of the humerus is located anteriorly, the greater tubercle is located laterally.
name: The greater tubercle of the humerus is located anteriorly and the lesser tubercle is located posteriorly
label: e
answer: no

Correct answer: a
A 68-year-old woman has a longstanding diagnosis of rheumatoid arthritis. She undergoes a review due to experiencing increasing pain, stiffness and deformity in her hands.

What are the most likely findings on an X-ray of her hands?

Options:
explanation: These X-ray features are consistent with the diagnosis of rheumatoid arthritis. Erosions and subluxation may also be seen.
name: Soft tissue swelling, periarticular osteopenia, swan neck deformity, ulnar deviation
label: a
answer: yes
explanation: These X-ray features are characteristic of osteoporosis, a systemic skeletal condition characterised by low bone density. Given the diagnosis of rheumatoid arthritis, soft tissue swelling, periarticular osteopenia, swan neck deformity and ulnar deviation are the most likely findings.
name: Increased radiolucency and cortical thinning
label: b
answer: no
explanation: Normal X-rays may be seen in some other arthropathies, for example, gout. In the early stages of rheumatoid arthritis, X-rays can be normal, however, we are told that this patient has a longstanding diagnosis and deformity in her hands, so we would not expect the X-ray to be normal.
name: Normal X-ray
label: c
answer: no
explanation: These X-ray findings are seen in osteoarthritis, due to the breakdown of joint cartilage and underlying bone.
name: Osteophytes, loss of joint space, sub-periosteal cysts and sclerosis
label: d
answer: no
explanation: These X-ray findings are characteristic of osteosarcoma, a type of malignant bone tumour, not rheumatoid arthritis.
name: Mixed lytic and sclerotic lesion with a 'sunburst’ periosteal reaction
label: e
answer: no

Correct answer: a
Which statement regarding muscles of the arm is correct?

Options:
explanation: The 3 heads of the triceps insert into the olecranon, allowing its action to extend the arm and forearm.
name: The triceps brachii inserts into the olecranon
label: a
answer: yes
explanation: All muscles in the anterior compartment of the arm are innervated by the musculocutaneous nerve. The radial nerve innervates the muscles in the posterior compartment (triceps and anconeus).
name: The biceps brachii is innervated by the radial nerve
label: c
answer: no
explanation: The short head of the biceps originates from the coracoid process. It is the long head of the biceps that originates from the supraglenoid tubercle.
name: The short head of the biceps brachii originates from the supraglenoid tubercle
label: e
answer: no
explanation: The coracobrachialis originates from the coracoid process of the scapula and inserts into the medial aspect of the humerus. As it does not span the elbow joint, it cannot work to flex the forearm.
name: The coracobrachialis aids forearm flexion
label: d
answer: no
explanation: The muscles of the arm are separated into anterior and posterior compartments by medial and lateral muscular septa. These septa span from the medial and lateral aspects of the humerus and are continuous with the deep fascia of the arm.
name: The muscles of the arm are separated into medial and lateral compartments by anterior and posterior muscular septa
label: b
answer: no

Correct answer: a
A 26-year-old man experiences ‘wrist drop’ and loss of sensation to his posterior forearm, elbow and dorsum of his hand following a fracture of his humeral shaft.

Which structure is most likely to have been damaged?

Options:
explanation: Klumpke’s palsy, or injury to the C8-T1 nerve root, is often caused by traumatic hyperabduction of the arm. Patients with Klumpke’s palsy have a characteristic ‘claw hand’, with a supinated forearm, extended wrist and flexed fingers (due to paralysis of intrinsic hand muscles, flexor carpi ulnaris and ulnar half of flexor digitorum profundus).
name: C8-T1 nerve root
label: e
answer: no
explanation: This is a classical history of radial nerve injury, which often occurs in association with humeral fractures, ‘Saturday night palsy’ or improper use of crutches. Injury to the radial nerve results in loss of extensor function, or ‘wrist drop’, and loss of sensation on the posterior forearm, elbow and dorsum of the hand.
name: Radial nerve
label: a
answer: yes
explanation: Damage to the C5-6 nerve root is also known as Erb’s palsy, which can occur during traumatic lateral bending of the neck, for example during childbirth or a fall. Flaccid muscle paralysis and atrophy of the supraspinatus, infraspinatus, deltoid, biceps and brachialis muscles are seen, resulting in an adducted, medially rotated arm and extended pronated forearm.
name: C5-6 nerve root
label: d
answer: no
explanation: Damage to the median nerve would result in signs such as an inability to pronate the forearm, weak wrist flexion and ulnar deviation of the wrist. It also causes an inability to flex the distal interphalangeal joints of the second and third digits, resulting in the characteristic ‘Pope blessing’ sign when the patient is asked to make a fist.
name: Median nerve
label: b
answer: no
explanation: Damage to the ulnar nerve results in a ‘claw hand’ deformity. The ulnar nerve innervates most intrinsic muscles of the hand (apart from the thenar eminence and the lateral two lumbricals), therefore its damage results in metacarpophalangeal joint extension and flexion of the 4th and 5th digit interphalangeal joints. Wasting and paralysis of the hypothenar eminence and other intrinsic hand muscles innervated by the ulnar nerve would also be seen. Sensory loss or changes would be in the ulnar distribution (palmar and dorsal aspects of the medial 1.5 digits).
name: Ulnar nerve
label: c
answer: no

Correct answer: a