hllj/quesmed huggingface dataset:
A 32-year-old male attends his local blood donation centre to donate his blood. He is found to have blood group O+.

Which of the following blood groups can receive an O+ blood donation?

Options:
explanation: This answer is incorrect. Whilst blood group O can donate to A, B, AB, and O blood groups, as he is Rhesus +, he can only donate blood to other Rhesus + individuals and not those who are Rhesus -.
name: Any blood group
label: b
answer: no
explanation: This answer is incorrect. As he is Rhesus +, he can only donate to other Rhesus + individuals.
name: A-, B-, AB-, O-
label: d
answer: no
explanation: This answer is incorrect. As he is Rhesus +, he can only donate to other Rhesus + individuals.
name: O+ and O-
label: c
answer: no
explanation: This answer is correct. Blood type O has no antigens on the cell surface and can therefore be received by any blood group. However, because he is Rhesus +, he can only donate to other Rhesus + individuals.
name: A+, B+, AB+, O+
label: a
answer: yes
explanation: This answer is incorrect. Those with blood group O have no antigens on the cell surface and can therefore donate to blood groups A, B, AB, and O. However, Rhesus + individuals can only donate to other Rhesus + individuals.
name: O+ only
label: e
answer: no

Correct answer: a
A 19-year-old male with a history of Haemophilia B attends A&E with a nosebleed which is still bleeding heavily after 45 minutes. In the department, he has routine blood tests.

Which of the following is the most likely biochemical abnormality found?

Options:
explanation: This answer is incorrect. The activated partial thromboplastin time (aPTT) is elevated in individuals with haemophilia B.
name: No abnormalities detected
label: e
answer: no
explanation: This answer is correct. Haemophilia B is caused by a deficiency in factor IX, which is involved in the intrinsic coagulation pathway. The activated partial thromboplastin time (aPPT) assesses the intrinsic and common pathways and will be elevated in haemophilia B.
name: Elevated activated partial thromboplastin time (aPTT)
label: a
answer: yes
explanation: This answer is incorrect. INR is a number derived from prothrombin time, which is normal in haemophilia A.
name: High INR
label: d
answer: no
explanation: This answer is incorrect. In haemophilia B, prothrombin time is typically normal. The prothrombin time is elevated in haemophilia A which is caused by a deficiency in factor VIII.
name: Elevated prothrombin time (PT)
label: c
answer: no
explanation: This answer is incorrect. In haemophilia B, platelet levels are typically normal.
name: Low platelet count
label: b
answer: no

Correct answer: a
An 82-year-old woman with a history of COPD is brought into A&E with a 3-day history of fever, shortness of breath, and a worsening cough.


Observations:


 * HR - 104bpm


 * RR - 24/min


 * BP - 135/80 mmHg


 * Temperature - 38.7 degrees


 * Oxygen saturations - 85% on room air


Arterial blood gas:


||||
|--------------|:-------:|------------------|
|pH|7.28|7.35 - 7.45|
|PaO₂|7.2 kPa|11 - 15|
|PaCO₂|10.2 kPa|4.6 - 6.4|
|Bicarbonate|26 mmol/L|22 - 30|


Which of the following describes her acid-base balance?

Options:
explanation: This answer is incorrect. The low pH and raised PaCO2 confirms a respiratory acidosis but the normal bicarbonate levels show that there is no metabolic compensation.
name: Respiratory acidosis with partial metabolic compensation
label: b
answer: no
explanation: This answer is incorrect. Whilst the low pH confirms acidosis, the raised PaCO2 reflects a respiratory cause. In a metabolic acidosis, the bicarbonate level is low. If there was respiratory compensation for acidosis, the PaCO2 would be low rather than high.
name: Metabolic acidosis with respiratory compensation
label: c
answer: no
explanation: This answer is incorrect. Whilst the low pH confirms acidosis, in metabolic acidosis the bicarbonate level would be low. The high PaCO2 reflects a respiratory cause of the acidosis.
name: Metabolic acidosis with no respiratory compensation
label: e
answer: no
explanation: This answer is incorrect. The low PH demonstrates acidosis rather than alkalosis.
name: Respiratory alkalosis with no metabolic compensation
label: d
answer: no
explanation: This answer is correct. The low pH confirms acidosis and the raised PaCO2 highlights that it is respiratory in origin. The bicarbonate is within normal limits which shows that there is no metabolic compensation.
name: Respiratory acidosis with no metabolic compensation
label: a
answer: yes

Correct answer: a
A 63-year-old woman is referred for bronchoscopy after her chest X-ray is reported as abnormal.

Which of the following is immediately distal to the terminal bronchioles in the respiratory tree?

Options:
explanation: This answer is incorrect. The conducting bronchioles are immediately proximal to the terminal bronchioles.
name: Conducting bronchioles
label: e
answer: no
explanation: This answer is incorrect. The tertiary bronchi are proximal to the bronchioles
name: Tertiary bronchi
label: d
answer: no
explanation: This answer is correct. The respiratory bronchioles are a continuation of the terminal bronchioles. They are approximately 0.5mm in diameter.
name: Respiratory bronchioles
label: a
answer: yes
explanation: This answer is incorrect. The alveolar sacs are the most distal part of the respiratory tree.
name: Alveolar sacs
label: b
answer: no
explanation: This answer is incorrect. The alveolar ducts are distal to the respiratory bronchioles.
name: Alveolar ducts
label: c
answer: no

Correct answer: a
A 74-year-old man attends the emergency department with an exacerbation of COPD. He is dyspnoeic and unable to talk in full sentences. On examination, it is noted that he is using accessory muscles to breathe.

Which of the following muscles is involved in forced expiration?

Options:
explanation: This answer is incorrect. Serratus anterior is involved in forced inspiration, where it elevates the ribcage.
name: Serratus anterior
label: c
answer: no
explanation: This answer is incorrect. The scalenes are involved in forced inspiration to elevate the upper ribs.
name: Scalenes
label: b
answer: no
explanation: This answer is correct. The rectus abdominis is involved in forced expiration to raise intra-abdominal pressure and elevate the diaphragm.
name: Rectus abdominis
label: a
answer: yes
explanation: This answer is incorrect. Latissimus dorsi is involved in forced inspiration, where it elevates the lower ribs.
name: Latissimus dorsi
label: d
answer: no
explanation: This answer is incorrect. Sternocleidomastoid is involved in forced inspiration, where it elevates the lower ribs.
name: Sternocleidomastoid
label: e
answer: no

Correct answer: a
A 65-year-old woman presents to her GP with a three-month history of worsening wheeze. The GP refers her for spirometry testing.

In which of the following conditions would her FEV1/FVC ratio be preserved?

Options:
explanation: This answer is incorrect. Asthma is an example of an obstructive lung disease where the FEV1/FVC ratio is reduced.
name: Asthma
label: d
answer: no
explanation: This answer is incorrect. COPD is an example of obstructive lung disease where the FEV1/FVC ratio is reduced.
name: COPD
label: b
answer: no
explanation: This answer is correct. Pulmonary fibrosis is an example of restrictive lung disease, where the FEV1/FVC ratio is preserved.
name: Pulmonary fibrosis
label: a
answer: yes
explanation: This answer is incorrect. Bronchiectasis is an example of an obstructive lung disease where the FEV1/FVC ratio is reduced.
name: Bronchiectasis
label: c
answer: no
explanation: This answer is incorrect. Chronic bronchitis is an example of an obstructive lung disease where the FEV1/FVC ratio is reduced.
name: Chronic bronchitis
label: e
answer: no

Correct answer: a
In his classical conditioning experiment, Pavlov showed that dogs could be conditioned to salivate at the sound of a bell if the sound was repeatedly presented at the same time as food. Before conditioning, the food caused the dogs to salivate.

Which of the following roles did the food play during this experiment?

Options:
explanation: This answer is correct. The food acted as an unconditioned stimulus as it elicited salivation prior to conditioning by the sound of the bell.
name: Unconditioned stimulus
label: a
answer: yes
explanation: This answer is incorrect. As the food caused salivation before conditioning by the sound of the bell, it is known as an unconditioned stimulus. After conditioning, the sound of the bell also elicited salivation and therefore acted as a conditioned stimulus.
name: Conditioned stimulus
label: b
answer: no
explanation: This answer is incorrect. A neutral stimulus would elicit no response. The food caused salivation before conditioning by the sound of the bell and therefore it is an unconditioned stimulus.
name: Neutral stimulus
label: c
answer: no
explanation: This answer is incorrect. The food acted as a stimulus, not a response. The response in this experiment was the salivation by the dogs.
name: Unconditioned response
label: d
answer: no
explanation: This answer is incorrect. The food acted as a stimulus, not a response. The response in this experiment was the salivation by the dogs.
name: Conditioned response
label: e
answer: no

Correct answer: a
A 47-year-old man is found to have a lesion in his hippocampus on an MRI scan.

Which of the following defects is he most likely to have presented with?

Options:
explanation: This answer is incorrect. Ataxia, or co-ordination disorder, results from lesions to the cerebellum.
name: Ataxia
label: b
answer: no
explanation: This answer is incorrect. Retrograde amnesia, or loss of previously formed memories, arises from damage to the dorsomedial thalamus.
name: Retrograde amnesia
label: e
answer: no
explanation: This answer is incorrect. Receptive aphasia, or difficulty comprehending written or spoken language, arises from damage to Wernicke's area in the temporal lobe.
name: Receptive aphasia
label: d
answer: no
explanation: This answer is incorrect. Expressive aphasia, in which patients struggle to communicate verbally despite intact comprehension, arises from damage to Broca's area in the frontal cortex.
name: Expressive aphasia
label: c
answer: no
explanation: This is the correct answer. Lesions in the hippocampus can cause anterograde amnesia, in which new events are not transferred into long-term memory.
name: Anterograde amnesia
label: a
answer: yes

Correct answer: a
A 65-year-old man with a three-month history of asymmetrical tremors and bradykinesia is diagnosed with Parkinson's Disease.

In the direct pathway in the basal ganglia, which of the following inhibitory neurotransmitters is responsible for the disinhibition of the ventroanterior/ventrothalamic (VA/VL) complex in the thalamus?

Options:
explanation: This is the correct answer. Two consecutive GABA-mediated inhibitory signals (from the corpus striatum and internal globus pallidus) result in disinhibition of the VA/VL complex in the thalamus.
name: GABA
label: a
answer: yes
explanation: This answer is incorrect. Glutamate is an excitatory neurotransmitter. In the direct basal ganglia pathway, glutamatergic neurons are responsible for excitatory input into the corpus striatum from the cerebral cortex.
name: Glutamate
label: c
answer: no
explanation: This answer is incorrect. In the direct basal ganglia pathway, there is excitatory dopaminergic input from the substantia nigra pars compacta to the corpus striatum. This is not involved in disinhibition, where there are two consecutive inhibitory signals.
name: Dopamine
label: b
answer: no
explanation: This answer is incorrect. Serotonin is not a key neurotransmitter involved in the direct basal ganglia pathway.
name: Serotonin
label: d
answer: no
explanation: This answer is incorrect. Noradrenaline is not a key neurotransmitter involved in the direct basal ganglia pathway.
name: Noradrenaline
label: e
answer: no

Correct answer: a
A 62-year-old man with a history of chronic alcohol excess is brought into A&E by ambulance after being found on the street weak, lethargic, and confused. On examination, he is ataxic and hypotonic with depressed reflexes globally. An MRI brain shows atrophy of the spinocerebellum.

Which of the following syndromes arises as a result of spinocerebellar atrophy?

Options:
explanation: This answer is incorrect. Flocculonodular syndrome is most commonly seen in children with a medulloblastoma in the fourth ventricle. It is characterised by poor balance and disordered eye movements.
name: Flocculonodular syndrome
label: b
answer: no
explanation: This answer is incorrect. Locked-in syndrome is caused by damage to the pons in the brainstem and causes paralysis.
name: Locked-in syndrome
label: e
answer: no
explanation: This answer is incorrect. Frontal lobe syndrome arises from damage to the frontal lobe in the cerebral cortex. Symptoms typically include personality changes, inappropriate behaviour and lack of impulse control.
name: Frontal lobe syndrome
label: d
answer: no
explanation: This answer is incorrect. Neocerebellar syndrome is caused by damage to the neocerebellum. Symptoms include slurred speech, dysmetria and dysdiadochokinesia.
name: Neocerebellar syndrome
label: c
answer: no
explanation: This answer is correct. Anterior lobe syndrome is caused by damage to the spinocerebellum. It is often seen in alcoholics due to malnutrition and lack of B vitamins.
name: Anterior lobe syndrome
label: a
answer: yes

Correct answer: a
An 18-year-old student accidentally burns their arm when taking their pizza out of the oven.

Which of the following nerve fibres is responsible for the initial pain following a noxious stimulus?

Options:
explanation: This answer is incorrect. C fibres are unmyelinated and are responsible for the sensation of ongoing, lasting pain after a noxious stimulus is applied.
name: C fibres
label: b
answer: no
explanation: This answer is incorrect. A-alpha fibres carry information related to proprioception rather than pain.
name: A-alpha fibres
label: c
answer: no
explanation: This answer is incorrect. D fibres are not a recognised category of nerve fibre.
name: D fibres
label: e
answer: no
explanation: This answer is correct. A-delta fibres are thinly myelinated and carry information related to pain and temperature. They are responsible for the first sensation of pain after a noxious stimulus is applied.
name: A-delta fibres
label: a
answer: yes
explanation: This answer is incorrect. Gamma fibres are efferent motor fibres rather than afferent sensory fibres.
name: Gamma fibres
label: d
answer: no

Correct answer: a
A 24-year-old woman is diagnosed with epilepsy and is commenced on ethosuximide by her neurologist.

Which of the following ion channels does ethosuximide target?

Options:
explanation: This answer is incorrect. Ethosuximide targets T-type calcium channels.
name: Chloride channels
label: d
answer: no
explanation: This answer is incorrect. Ethosuximide targets T-type calcium channels.
name: Sodium channels
label: b
answer: no
explanation: This answer is correct. Ethosuximide targets T-type calcium channels. It is the anti-epileptic drug of choice in absence seizures.
name: Calcium channels
label: a
answer: yes
explanation: This answer is incorrect. Ethosuximide targets T-type calcium channels.
name: Potassium channels
label: c
answer: no
explanation: This answer is incorrect. Ethosuximide targets T-type calcium channels.
name: Hydrogen channels
label: e
answer: no

Correct answer: a
A 32-year-old woman attends a follow-up with her GP with a 10-day history of insomnia that is causing her significant daytime impairment. An initial trial of sleep hygiene measures has failed and the GP agrees to prescribe a short course of medication to help her sleep.

Which of the following medications induces sleep by increasing GABA release via binding to the alpha-1 subunit of GABA receptors?

Options:
explanation: This answer is incorrect. Melatonin is a substance naturally produced in the body which promotes sleep through regulation of the sleep/wake cycle via melatonin receptors.
name: Melatonin
label: d
answer: no
explanation: This answer is incorrect. Lorazepam is a benzodiazepine which acts to induce sleep via binding to benzodiazepine receptors on the postsynaptic GABA-A ligand-gated chloride ion channels.
name: Lorazepam
label: c
answer: no
explanation: This answer is correct. Zopiclone is an example of a Z-drug that binds to the alpha-1 subunit of GABA receptors to increase GABA release and induce sleep.
name: Zopiclone
label: a
answer: yes
explanation: This answer is incorrect. Diphenhydramine is a first-generation antihistamine which acts as an inverse agonist at the H1 histamine receptor. It is used for insomnia due to its sedating properties.
name: Diphenhydramine
label: b
answer: no
explanation: This answer is incorrect. Doxepin is a tricyclic antidepressant. One of its main side effects is sedation as it also antagonises the H1 receptor, and hence can be useful in insomnia.
name: Doxepin
label: e
answer: no

Correct answer: a
A 42-year-old man presents to his GP with a 4-week history of low mood, anhedonia, and feelings of guilt and hopelessness. After careful assessment, he is referred for cognitive behavioural therapy and commenced on citalopram.

What is the relative affinity of citalopram on serotonin, norepinephrine and dopamine transporters in the brain?

Options:
explanation: This answer is correct. Citalopram is an example of a selective serotonin re-uptake inhibitor (SSRI). SSRIs have a strong affinity for serotonin receptors but a weak affinity for norepinephrine and dopamine receptors.
name: Serotonin - strong affinity, norepinephrine - weak affinity, dopamine - weak affinity
label: a
answer: yes
explanation: This answer is incorrect. Whilst SSRIs such as citalopram have a strong affinity for serotonin receptors, their affinity for norepinephrine and dopamine receptors is weak.
name: Serotonin - strong affinity, norepinephrine - strong affinity, dopamine - strong affinity
label: b
answer: no
explanation: This answer is incorrect. SSRIs such as citalopram have a strong affinity for serotonin receptors, but weak affinity for norepinephrine and dopamine receptors.
name: Serotonin - weak affinity, norepinephrine - strong affinity, dopamine - weak affinity
label: e
answer: no
explanation: This answer is incorrect. Whilst SSRIs such as citalopram have a weak affinity for norepinephrine and dopamine receptors, their affinity for serotonin receptors is strong.
name: Serotonin - weak affinity, norepinephrine - weak affinity, dopamine - weak affinity
label: c
answer: no
explanation: This answer is incorrect. Whilst SSRIs such as citalopram have a strong affinity for serotonin receptors, their affinity for norepinephrine and dopamine receptors is weak.
name: Serotonin - strong affinity, norepinephrine - weak affinity, dopamine - strong affinity
label: d
answer: no

Correct answer: a
An 8-year-old boy attends the fracture clinic with his father after falling off a swing and sustaining a fracture to his left distal radius 10 days ago.

During which of the following stages of fracture healing is fibrocartilage replaced by woven bone?

Options:
explanation: This answer is incorrect. During the formation of the fracture haematoma blood from broken vessels forms a clot. This is the first stage of fracture healing following an injury.
name: Fracture haematoma
label: c
answer: no
explanation: This answer is incorrect. During the bone remodelling phase, osteoclasts remodel woven bone into compact bone.
name: Bone remodelling
label: b
answer: no
explanation: This answer is incorrect. Fracture necrosis is not a recognised stage of fracture healing.
name: Fracture necrosis
label: e
answer: no
explanation: This answer is incorrect. The soft callus consists of fibrocartilage which is later replaced by a hard callus of woven bone.
name: Formation of the soft callus
label: d
answer: no
explanation: This answer is correct. During the formation of the hard callus osteoblasts make woven bone which replaces the soft fibrocartilage callus.
name: Formation of the hard callus
label: a
answer: yes

Correct answer: a
A 55-year-old woman is diagnosed with osteoporosis after experiencing multiple fragility fractures. She asks her GP about the different types of bone.

Which of the following is true of cancellous bone?

Options:
explanation: This answer is incorrect. Cancellous bone is turned over 3-10 times quicker than cortical bone as it has a larger surface area and responds to stresses on the bone more rapidly.
name: It has a lower rate of turnover than cortical bone
label: e
answer: no
explanation: This answer is incorrect. Cortical bone makes up around 80% of the total bone mass in an adult due to its high density.
name: It makes up around 80% of the total bone mass in an adult
label: b
answer: no
explanation: This answer is incorrect. Cortical bone is arranged in osteons which are circular columns with a blood vessel running down the central Haversian canal.
name: It is arranged in osteons
label: c
answer: no
explanation: This answer is correct. The surface area of cancellous bone is ten-times higher than the surface area of cortical bone.
name: It has a higher surface area than compact bone
label: a
answer: yes
explanation: This answer is incorrect. Random collagen organisation is a feature of woven bone which is found in children, healing bone or pathological bone.
name: It has random collagen organisation
label: d
answer: no

Correct answer: a
An 82-year-old woman presents to her GP with pain in her right hip and thigh. She describes the pain as deep and boring in nature. Her examination is normal.


Bloods:


||||
|--------------|:-------:|---------------|
|Calcium|2.34 mmol/L|2.2 - 2.6|
|Phosphate|3.2 mmol/L|0.8 - 1.5|
|Parathyroid Hormone|1.9 pmol/L|1.6 - 8.5|
|Vitamin D|53 nmol/L|>50|
|Alkaline Phosphatase (ALP)|985 IU/L|25 - 115|

Which of the following conditions is she most likely to have?

Options:
explanation: This answer is incorrect. Patients with primary hyperparathyroidism will have a raised PTH, high calcium and low phosphate. ALP may be normal or slightly elevated.
name: Primary hyperparathyroidism
label: d
answer: no
explanation: This is the correct answer. Her presentation and abnormally high ALP with otherwise normal biochemistry is characteristic of Paget's disease. None of the other options would present with an ALP so markedly raised.
name: Paget's disease
label: a
answer: yes
explanation: This answer is incorrect. Patients with chronic renal failure will have low calcium and vitamin D with elevated phosphate and PTH. ALP may be normal or slightly elevated.
name: Chronic renal failure
label: e
answer: no
explanation: This answer is incorrect. Patients with osteoporosis typically have normal bone biochemistry.
name: Osteoporosis
label: b
answer: no
explanation: This answer is incorrect. Whilst patients with osteomalcia may have a high ALP, they typically have low calcium, phosphate and vitamin D and an elevated PTH.
name: Osteomalacia
label: c
answer: no

Correct answer: a
Which of the following is the most predominant type of collagen present in the extracellular matrix (ECM) of cartilage?

Options:
explanation: This answer is incorrect. Type I cartilage is not found in the ECM of cartilage.
name: I
label: e
answer: no
explanation: This answer is correct. Type X collagen is present in the ECM of calcified deep layers of cartilage only.
name: Type X
label: b
answer: no
explanation: This answer is incorrect. Only small amounts of type IX collagen are present in the ECM of cartilage.
name: Type IX
label: c
answer: no
explanation: This answer is correct. Type II collagen is the predominant type of collagen in ECM and is present in the ECM of all layers of cartilage.
name: Type II
label: a
answer: yes
explanation: This answer is incorrect. Only small amounts of type XI collagen are present in the ECM of cartilage.
name: Type XI
label: d
answer: no

Correct answer: a