hllj/quesmed huggingface dataset:
Which of the following describes an example of positive feedback?

Options:
explanation: High FSH/LH levels in the blood will prevent GnRH release from the hypothalamus. This will in turn stop the release of FSH/LH from the anterior pituitary and is therefore an example of negative feedback.
name: Relationship between FSH/LH levels and GnRH release from the hypothalamus
label: e
answer: no
explanation: This is an example of positive feedback because the release of oxytocin from the posterior pituitary gland during labour causes more release of oxytocin.
name: Releasing oxytocin from the posterior pituitary gland during labour
label: a
answer: yes
explanation: High growth hormone levels in the blood will prevent GHRH release from the hypothalamus. This will in turn stop the release of GH from the anterior pituitary and is therefore an example of negative feedback.
name: Relationship between growth hormone levels and GHRH release from the hypothalamus
label: d
answer: no
explanation: High glucocorticoid levels in the blood will prevent CRH release from the hypothalamus. This will in turn stop the release of ACTH from the anterior pituitary and is therefore an example of negative feedback.
name: Relationship between glucocorticoid levels and CRH release from the hypothalamus
label: c
answer: no
explanation: High thyroxine levels in the blood will prevent TRH release from the hypothalamus. This will in turn stop the release of TSH from the anterior pituitary and is therefore an example of negative feedback.
name: Relationship between thyroxine levels and TRH release from the hypothalamus
label: b
answer: no

Correct answer: a
Which of the following definitions describes the potency of a drug?

Options:
explanation: This description refers to desensitisation.

Desensitisation will reduce the response to a specific agonist.
name: Prolonged/repeated exposure to agonists reduces the response
label: d
answer: no
explanation: This describes the therapeutic window. A therapeutic window lies between the toxic concentration and the effective concentration of a drug. It is a range of values which describe a suitable dosage plasma concentration of the drug.
name: Range of dosages between the effective and toxic concentration of a drug
label: e
answer: no
explanation: Low potency will mean that more drug is required to produce an effect, whereas high potency will mean that less drug is required to produce an effect. Most drugs are highly potent thus requiring low doses to produce an effect.
name: This is the amount of drug required to produce an effect
label: a
answer: yes
explanation: This refers to efficacy. If a drug has maximal efficacy it will bind to all of the available receptors and produce a maximal response, Competition will affect the efficacy of a drug.
name: Maximum response achievable by application of a drug
label: c
answer: no
explanation: This refers to affinity. Usually, a potent drug will have a high affinity.
name: Strength of drug-receptor interaction
label: b
answer: no

Correct answer: a
Which one of the following describes a partial low-efficacy agonist?

Options:
explanation: This describes what occurs when there is no agonist/neutral antagonist.
There is no response except for some negligible spontaneous channel opening.
name: When there is no agonist bound and there is no response
label: d
answer: no
explanation: This describes an irreversible antagonist. This binds at the same site as an agonist and decreases the maximal response to agonists by inactivating and degrading receptors. This decreases the number of available receptors.
name: A structure which binds irreversibly at an agonist site to decrease the maximal response to agonists
label: e
answer: no
explanation: This describes a full, high-efficacy agonist.
name: An agonist which when bound to a receptor opens the channel. These receptors are capable of a maximal response
label: b
answer: no
explanation: This describes a partial, low-efficacy agonist.
name: An agonist which when bound to a receptor doesn't open a channel as readily. These receptors are not capable of maximal response
label: a
answer: yes
explanation: This describes an inverse agonist.
name: An agonist which when bound to a receptor makes the channels less likely to open
label: c
answer: no

Correct answer: a
Which one of the following is an example of an allosteric antagonist?

Options:
explanation: This is a competitive antagonist which blocks the receptor site for catecholamines. This is often used to control the heart rhythm and also has a mortality benefit when used after a heart attack.
name: Propranolol at beta-adrenoceptors
label: c
answer: no
explanation: This is an allosteric antagonist. This binds reversibly at a distant site from the agonist and causes a conformational change to the receptor. This prevents an agonist from binding to its active site and causing an effect.
name: Beta-carbolines at GABA(A) receptor
label: a
answer: yes
explanation: This is a competitive antagonist. It blocks the muscarinic acetylcholine (ACh) receptor to prevent activation of the parasympathetic nervous system.
name: Atropine at muscarinic receptors
label: b
answer: no
explanation: This is a competitive antagonist. It is a PDE5 inhibitor which inhibits the degradation of cGMP and allows for vasodilatation of the vessels to occur.
name: Sildenafil at phosphodiesterase-5 (PDE5)
label: d
answer: no
explanation: This is a competitive antagonist at the benzodiazepine site of the GABA(A) receptor. It is utilised to reverse a benzodiazepine overdose.
name: Flumazenil acting at the GABA(A) receptor
label: e
answer: no

Correct answer: a
Which one of the following tests is most appropriate to monitor long term glycaemic control in diabetes mellitus?

Options:
explanation: The urine analysis will detect glucose and ketones. In those with type 1 diabetes, the glucose will be excreted in the urine. A patient may present with diabetic ketoacidosis (DKA) and in this instance, urinary ketones will also be raised. It is useful in diabetic emergencies, but not in routine monitoring of glycaemic control.
name: Urine analysis
label: b
answer: no
explanation: When blood glucose is taken randomly, it should not exceed 11.1 mmol/L. If it does, this is indicative of diabetes. Random blood glucose values are used to monitor glucose levels multiple times a day in Type 1 Diabetes but does not indicate long term glycaemic control.
name: Random blood glucose values
label: d
answer: no
explanation: When blood glucose is taken after fasting it should not exceed 7.0 mmol/L. If it does, this is indicative of diabetes. It does not indicate long term glycaemic control.
name: Fasting blood glucose
label: e
answer: no
explanation: This value reflects ambient circulating glucose (glycation of Hb) for the last 2-3 months and is used routinely to monitor glycaemic control.
name: HbA1c
label: a
answer: yes
explanation: This is the gold standard for diagnosis of diabetes mellitus. The patient's fasting glucose is measured and the patient is given a 75g glucose drink. After 2 hours, the blood glucose is measured again. These values are compared to those of a healthy patient. It is not used for routine monitoring.
name: Oral glucose tolerance test
label: c
answer: no

Correct answer: a
A 45-year-old female patient has presented to her GP with complaints of amenorrhea.

Upon examination, she has central obesity and purple striae, which one of the following tests would you conduct to diagnose the patient?

Options:
explanation: This value reflects ambient circulating glucose (glycation of Hb) for the last 2-3 months. It is useful for those with suspected type 2 diabetes.
name: HbA1c
label: b
answer: no
explanation: In this test basal TSH levels are determined before giving an IV bolus of TRH. TSH levels are measured once again and compared to the baseline.

If there is an increase in TSH this means that the cause of the hypothyroidism is the hypothalamus (tertiary hypothyroidism). If there is no TSH increase or a slight increase this is indicative of the anterior pituitary not secreting TSH. This test would be used if there is normal TSH but low thyroid output.
name: TRH stimulation test
label: d
answer: no
explanation: When given dexamethasone, ACTH is downregulated and endogenous cortisol should be suppressed.

This patient likely has Cushing's syndrome, as there is a glucocorticoid excess, cortisol secretion would be autonomous and not responsive to feedback. Therefore cortisol levels will remain high and the test will be positive.
name: Dexamethasone suppression test (DST)
label: a
answer: yes
explanation: This is a test where exogenous ACTH is given and there should be high cortisol in response to this.

In Addison's disease there is decreased mineralocorticoid and glucocorticoid synthesis. Despite receiving exogenous ACTH there will be low plasma cortisol.
name: Short synacthen test
label: c
answer: no
explanation: This is the gold standard for the diagnosis of diabetes. The patient's fasting glucose is measured and the patient is given a 75g glucose drink. After 2 hours, the blood glucose is measured again. These values are then compared to those of a healthy patient.
name: Oral glucose tolerance test (OGTT)
label: e
answer: no

Correct answer: a
Which one of the following effects occurs within the body when someone is hypocalcaemic?

Options:
explanation: There will be increased calcium reabsorption from the kidneys and intestines as the body wants to prevent calcium loss.
name: Decreased calcium reabsorption
label: e
answer: no
explanation: There will be decreased urinary calcium as the body wants to prevent calcium loss.
name: Increased urinary calcium
label: c
answer: no
explanation: Osteoclasts are stimulated via osteoblast-released cytokines. This causes increased calcium release from bone.
name: Increased bone resorption
label: a
answer: yes
explanation: In response to hypocalcemia, PTH will be increased. This leads to increased calcium reabsorption in the renal distal tubule, increased intestinal calcium reabsorption and increased bone resorption.
name: Decreased PTH (Parathyroid hormone) secretion
label: b
answer: no
explanation: There will be increased urinary phosphate.

Phosphorus and calcium have an inverse relationship. As phosphorus increases, calcium will decrease because phosphorus binds to free calcium in the blood. Therefore, losing more phosphorus should increase calcium levels.
name: Decreased urinary phosphate
label: d
answer: no

Correct answer: a
A patient has presented to the GP with complaints of vision disturbance, particularly double vision. Upon examination, it is found that the patient has bitemporal hemianopia.

Which part of the optic pathway is most likely affected?

Options:
explanation: This would cause a loss of the nasal field in the left eye and the temporal field of the right eye. This would result in a right homonymous hemianopia where the right visual field in each eye is lost.
name: Left optic tract
label: d
answer: no
explanation: This would cause a loss of the temporal field in the left eye and the nasal field of the right eye. This would result in a left homonymous hemianopia where the left visual field in each eye is lost.
name: Right optic tract
label: e
answer: no
explanation: This would cause a total loss of vision in the right eye **not** bitemporal hemianopia
name: Right optic nerve
label: c
answer: no
explanation: This would cause a total loss of vision in the left eye **not** bitemporal hemianopia
name: Left optic nerve
label: b
answer: no
explanation: A pituitary tumour will compress the optic chiasm. This will lead to impaired peripheral vision in the temporal halves of the visual field.
name: The optic chiasm
label: a
answer: yes

Correct answer: a
Which one of the following descriptions defines the birth rate?

Options:
explanation: This describes the total fertility rate.
name: The average number of children that a woman would bear if they experience the age-specific fertility rates at that point in time
label: c
answer: no
explanation: This is correct as it describes birth rate.
name: The number of live births per 1000 of the population
label: a
answer: yes
explanation: This describes prevalence.
name: The proportion of people in a population who have a particular disease at a specific point in time
label: d
answer: no
explanation: This describes the general fertility rate.
name: Number of live births per 1000 women aged 15-44
label: b
answer: no
explanation: This describes incidence.
name: Number of new cases over a period of time in a population
label: e
answer: no

Correct answer: a
Which one of the following describes the social selection theory regarding the association of health and socioeconomic deprivation?

Options:
explanation: This describes the artefact theory, not the social selection theory.
name: Observed associations between health and socioeconomic deprivation are not genuine but exist due to methods of measuring health and deprivation
label: b
answer: no
explanation: This describes the behavioural/cultural theory, not the social selection theory.
name: Those in deprived areas are more likely to smoke, eat poor diets and not exercise
label: c
answer: no
explanation: This describes the psychosocial theory, not the social selection theory.
name: The stress of working in a poorly paid, low-status job with little autonomy causes biological changes within the body
label: d
answer: no
explanation: This describes the material theory, not the social selection theory.
name: Poor health is a direct effect of poverty
label: e
answer: no
explanation: This is correct as it describes the social selection theory.
name: Health determines socio-economic status rather than socio-economic status causing poor health
label: a
answer: yes

Correct answer: a
Which one of the following describes Kleinmann’s model of healthcare systems?

Options:
explanation: This describes the health belief model.
name: This is a model which helps to explain and predict health behaviours such as a person's readiness to take health action
label: e
answer: no
explanation: This describes the biomedical model.
name: This model focuses on the physical processes (pathology, biochemistry and physiology) of disease. It looks for single-factor causes rather than contributory factors like genetics/alcoholism/smoking
label: c
answer: no
explanation: This describes the biopsychosocial model.
name: This is a model which takes a holistic approach and looks at all levels of disease, not just single-factor causes. It does not focus exclusively on illness as it looks at the continuum between health and illness
label: d
answer: no
explanation: This describes Kleinmann's model of healthcare systems. It shows who is consulted when someone's health begins to deteriorate.
name: This is a model relating to why patients consult. It includes a professional, folk and popular sector
label: a
answer: yes
explanation: This is known as the germ theory.
name: This model suggests that each disease has a single specific cause, and all research and interventions are targeted at this causal agent
label: b
answer: no

Correct answer: a
Which one of the following is a behavioural sign of stress?

Options:
explanation: This is a cognitive sign of stress as conscious intellectual activity is affected.
name: Poor concentration and memory
label: c
answer: no
explanation: This is a biochemical sign of stress, endorphin levels will be altered.
name: Alteration of endorphin levels
label: b
answer: no
explanation: This is an emotional sign of stress.
name: Mood swings and irritability
label: d
answer: no
explanation: This is a physiological sign of stress. Other signs may include rapid shallow breathing and digestive problems.
name: High blood pressure
label: e
answer: no
explanation: Stress can lead to behavioural changes such as drinking more alcohol and smoking as a method of coping.
name: Increased alcohol intake
label: a
answer: yes

Correct answer: a
A 67-year-old female presents to the hospital with complaints of fatigue, increased thirst, and increased frequency of urination. She has an eGFR of 23 mL/minute/1.73 m<sup>2</sup> and is found to be a type 2 diabetic.

Which one of the following drugs would be unsuitable to use when treating this patient?

Options:
explanation: Metformin is contraindicated in those with a low eGFR.
name: Metformin
label: a
answer: yes
explanation: These reduce glucose reabsorption and increase urinary glucose excretion. These are used as monotherapy if metformin is inappropriate or with other antidiabetic drugs.
name: SGLT2 inhibitors e.g. canagliflozin
label: d
answer: no
explanation: These increase insulin secretion and lower glucagon secretion.
This is used as monotherapy if metformin is inappropriate or with other antidiabetic drugs.
name: Incretins e.g. linagliptin
label: c
answer: no
explanation: These are utilised when there is some residual pancreatic beta-cell activity. Care should be taken when prescribing to the elderly. Contraindications include those with acute pyphorias for gliclazide, or anyone with DKA for all sulphonylureas.
name: Sulphonylureas e.g. gliclazide
label: e
answer: no
explanation: This is used as monotherapy if metformin is inappropriate or in combination with metformin or sulphonylureas.
name: Pioglitazone
label: b
answer: no

Correct answer: a
Which one of Zola's 5 triggers describes people waiting for symptoms to resolve after a certain period before consulting healthcare professionals?

Options:
explanation: This is one of Zola's triggers. If someone is unable to walk/carry out activity they are more likely to visit the GP.
name: Perceived interference with vocational or physical activity
label: c
answer: no
explanation: This is not one of Zola's 5 triggers and describes a different concept. Parson's sick role describes the role a patient may take on once they have been diagnosed with a condition. These people are unable to fulfill their normal social roles.
name: Assuming Parson's sick role
label: b
answer: no
explanation: This is one of Zola's triggers. People who do not want to consult healthcare professionals are often encouraged to by family members.
name: Sanctioning
label: e
answer: no
explanation: This is one of Zola's triggers. People usually wait a couple of days for symptoms to resolve, if these symptoms persist they are more likely to visit the GP.
name: Temporalising symptomatology
label: a
answer: yes
explanation: This is one of Zola's triggers. If a person's social life is affected they are more likely to visit the GP.
name: Perceived interference with social or personal relations
label: d
answer: no

Correct answer: a
Which one of the following descriptions relates to cascade iatrogenesis?

Options:
explanation: This describes cultural iatrogenesis.
name: Destruction of traditional ways of dealing with death, suffering, and sickness
label: d
answer: no
explanation: This describes cascade/medical iatrogenesis.
name: Ill health contracted in hospital. This could be due to medical error or medicinal side effects
label: b
answer: no
explanation: This describes cascade iatrogenesis.
name: Serial development of multiple complications from a seemingly harmless first event e.g. polypharmacy
label: a
answer: yes
explanation: This describes iatrogenesis as a general concept. The other options mention different types of iatrogenesis: clinical/medical, social, cascade, and cultural.
name: Causation of a disease or other ill effects by any medical activity
label: e
answer: no
explanation: This describes social iatrogenesis.
name: Sponsoring sickness by reinforcing society to become consumers of medicine
label: c
answer: no

Correct answer: a
An 80-year-old male has presented to the emergency department following a fall at home resulting in a neck of femur fracture. He appears to be slightly confused but has not yet been assessed. You need him to consent to an operation to repair the fracture.

Which one of the following is the best course of action?

Options:
explanation: The patient's capacity has not yet been assessed. You cannot assume that a patient lacks capacity. If the patient did lack capacity this would be a reasonable course of action
name: Discuss with the family and make a best interest decision
label: d
answer: no
explanation: The patient's capacity has not yet been assessed. You cannot assume that a patient lacks capacity.
If the patient does lack capacity temporarily (e.g. loss of consciousness) and the decision is non-urgent you could wait but in this instance that would not apply.
name: Wait until the patient can give consent
label: b
answer: no
explanation: The patient's capacity has not yet been assessed. You cannot assume that a patient lacks capacity and that healthcare professionals are entitled to make decisions for them.
name: Take the patient for the operation immediately
label: c
answer: no
explanation: In this instance, the patient's capacity has been assessed. However, a best interest decision must be made taking into consideration the views of the family members and what is best for the patient.
name: Carry out the operation immediately, once the patient has been assessed as lacking capacity
label: e
answer: no
explanation: This is the best course of action as the patient has not yet been assessed, therefore carrying out a capacity assessment would tell you if the patient can make a decision about their care.
name: Carry out a capacity assessment
label: a
answer: yes

Correct answer: a
A 14-year-old girl has presented to the GP asking for contraception as she has recently become sexually active with her 15-year-old partner.

Which one of the following is the best course of action?

Options:
explanation: If the patient is Gillick competent then you cannot break confidentiality and inform her parents.
name: Inform her parents without her consent
label: d
answer: no
explanation: Gillick competency refers to a child under 16 years old being able to make decisions about their treatment without their parents'/carers' consent. If a child is Gillick competent then according to Fraser guidelines they can access contraception without the consent of their carers.
name: Assess if the patient has Gillick competency, as she is less than 16 years old
label: a
answer: yes
explanation: You have to assess whether the patient has Gillick competency first before discussing risks and benefits. If the patient is Gillick competent then the patient should be told about risks and benefits so she can make a well-informed decision.
name: Give it to her straight away without discussing the risks and benefits of the treatment
label: b
answer: no
explanation: This is an extreme measure and would not be considered unless the partner is significantly older and the patient is being groomed. In this instance, the parents would also be informed.
name: Call child services
label: e
answer: no
explanation: This would be an unsuitable response. If the patient is Gillick competent there is no reason for you to refuse to give oral contraception.
name: Don't give the contraception to her as she is too young and you think it is not appropriate for her age
label: c
answer: no

Correct answer: a