hllj/quesmed huggingface dataset:
A patient presents with pain in her shoulders and hips which is worse in the morning but relieved on exercise. The doctor diagnoses polymyalgia rheumatica.

Which of the following markers is the GP most likely to measure in order to assess inflammation?

Options:
explanation: Vitamin B12 is needed to form red blood cells and DNA. It is also a key player in the function and development of brain and nerve cells. In a clinical context, B12 deficiency usually gives rise to a macrocytic anaemia, but does not have a role as an inflammatory marker.
name: Vitamin B12
label: b
answer: no
explanation: Troponin is a protein involved in cardiac muscle contractility. It is raised in the context of cardiac muscle damage such as during a myocardial infarction (MI). However, it is not measured as an inflammatory marker in polymyalgia rheumatica.
name: Troponin
label: e
answer: no
explanation: Potassium, along with sodium, has a key role in regulating the level of fluid within our cells. It may be raised in kidney injury, however it is not measured as an inflammatory marker in polymyalgia rheumatica.
name: Potassium
label: d
answer: no
explanation: C-reactive Protein (CRP) is an acute-phase protein (APP) released from the liver in response to interleukin-6 (IL-6) secretion by macrophages and T-cells during inflammatory processes in the body.
name: CRP
label: a
answer: yes
explanation: Creatinine is released into the bloodstream as a skeletal muscle waste product. The kidneys then filter the creatinine out of the blood and into the urine. Creatinine may be elevated in kidney injury, but it is not measured as an inflammatory marker in polymyalgia rheumatica.
name: Creatinine
label: c
answer: no

Correct answer: a
The GP decides to calculate the eGFR of a patient with known chronic kidney disease (CKD). He uses the MDRD equation.

Which parameters are included in this equation?

Options:
explanation: This option does not contain the correct combination of parameters for the MDRD equation. Another parameter used in the calculation of the glomerular filtration rate is "inulin clearance" which is considered the gold standard in estimating the GFR. It depends on measuring the clearance of inulin from the bloodstream which is 100% excreted via the glomeruli and, although gold standard, it has its own practical challenges as it requires an inulin infusion and urine collection for hours.
name: Sex, serum potassium, inulin, age
label: d
answer: no
explanation: This option has substituted "serum creatinine" for "serum potassium" so therefore does not contain the correct combination of parameters for the MDRD equation.
name: Age, sex, serum potassium and race
label: e
answer: no
explanation: This option has substituted "serum creatinine" for "weight" so therefore does not contain the correct combination of parameters for the MDRD equation. Another equation used in the calculation of the glomerular filtration rate is the Cockcroft-Gualt equation which uses age, weight, sex, creatinine and race. However, its use is inaccurate in pregnancy, amputation, extremes of weight and low/high protein diets.
name: Weight, age, race and sex
label: b
answer: no
explanation: The Modification of Diet in Renal Disease Study Group (MDRD) equation is a method used for estimating kidney function in patients. It involves four parameters - age, sex, serum creatinine and race. It is important to note that it will be inaccurate in pregnancy, amputation, extremes of weight and low/high protein diets.
name: Age, sex, serum creatinine and race
label: a
answer: yes
explanation: This option has substituted "race" for "weight" therefore does not contain the correct combination of parameters for the MDRD equation. Another equation used in the calculation of the glomerular filtration rate is the Cockcroft-Gualt equation which uses age, weight, sex, creatinine and race. However, its use is inaccurate in pregnancy, amputation, extremes of weight and low/high protein diets.
name: Weight, sex, serum creatinine, age
label: c
answer: no

Correct answer: a
A patient has an ECG performed which shows tall tented T-waves. He is currently on maximum treatment for hypertension and his drug history includes atorvastatin, amlodipine, paracetamol, cetirizine and spironolactone. He has no significant past medical history.

Given the most likely electrolyte abnormality, which of these medications is most likely to be causing this side effect?

Options:
explanation: Amlodipine is a calcium-channel blocker (CCB) used to treat high blood pressure and coronary artery disease. It is taken by mouth. Common side effects include peripheral oedema, feeling tired, abdominal pain, and nausea. Electrolyte disturbances to be aware of, although rare, are hyponatraemia and hyperkalaemia. Hyperkalaemia has only been known to occur in patients who have known kidney disease which this patient does not have.
name: Amlodipine
label: d
answer: no
explanation: Atorvastatin is a statin medication taken by mouth. It is used as both primary and secondary prevention of cardiovascular disease in those at high risk of ischaemia and to treat abnormal lipid levels. It is known to increase creatine kinase (CK) levels in patients also taking macrolide antibiotics due to the interaction that causes myopathy. The most reported electrolyte abnormalities related to statins are hypokalemia, hypomagnesemia, and hypocalcemia.
name: Atorvastatin
label: b
answer: no
explanation: The patient is presenting with hyperkalaemia. Spironolactone is a potassium-sparing diuretic which is used to offload fluid for patients with oedema and also has antihypertensive effects. Spironolactone competitively inhibits aldosterone-dependant sodium-potassium exchange channels in the distal convoluted tubule. This action leads to increased sodium and water excretion, but more potassium retention, which predisposes patients to hyperkalaemia.
name: Spironolactone
label: a
answer: yes
explanation: Cetirizine is a second-generation antihistamine used to treat allergic rhinitis, dermatitis, and urticaria. Non-sedating antihistamines such as cetirizine hydrochloride cause less sedation and psychomotor impairment than the older antihistamines. They have not been reported to affect the concentration of electrolytes within the body.
name: Cetirizine
label: e
answer: no
explanation: Paracetamol is a medication used to treat fever and mild to moderate pain. Adverse effects include liver impairment, particularly if taken in excessive quantities or if a patient has a body weight <50kg. It is not known to cause electrolyte disturbances.
name: Paracetamol
label: c
answer: no

Correct answer: a
Within the wall of the stomach are the gastric pits.

Which of the following cells are involved in secreting the enzyme somatostatin which is responsible for inhibiting gastric acid secretion?

Options:
explanation: These produce mucus to protect the stomach lining.
name: Goblet cells
label: e
answer: no
explanation: These secrete pepsinogen which helps break down proteins.
name: Chief cells
label: c
answer: no
explanation: These produce somatostatin which works to inhibit gastric acid secretion.
name: D-cells
label: a
answer: yes
explanation: These secrete gastric acid (hydrochloric acid) to maintain the acidity of the stomach crucial to its role in digestion.
name: Parietal cells
label: d
answer: no
explanation: These produce gastrin which works in the opposite way to somatostatin. Gastrin stimulates acid secretion.
name: G-cells
label: b
answer: no

Correct answer: a
The secondary class of protein structure is held together by hydrogen bonds.

Which of the following structures is an example of this class of protein?

Options:
explanation: This is an example of a primary protein structure. Amino acid chains are held together by peptide bonds.
name: Amino acid chain
label: b
answer: no
explanation: This is an example of a tertiary protein structure. Tertiary structures consist of four bonds - ionic bonds, disulfide bridges, hydrophobic forces and hydrogen bonds.
name: Myoglobin
label: d
answer: no
explanation: Beta-sheets are an example of a secondary protein structure. Both beta sheets and alpha helices are examples of secondary protein structures, and these are held together by hydrogen bonds.
name: Beta-sheets
label: a
answer: yes
explanation: This is an example of a quaternary protein structure. Quaternary structures are proteins consisting of more than one amino acid chain.
name: Haemoglobin
label: c
answer: no
explanation: This is an example of a quaternary protein structure. Quaternary structures are proteins consisting of more than one amino acid chain.
name: Actin microfilament
label: e
answer: no

Correct answer: a
Which of the following is a byproduct of anaerobic respiration in humans?

Options:
explanation: Oxygen is utilised for aerobic respiration.
name: Oxygen
label: b
answer: no
explanation: During anaerobic respiration, muscle cells use glucose to form ATP. In anaerobic respiration, they do not use oxygen to do this. This process produces lactate, which in a very short time gets converted to lactic acid, which is responsible for the burn felt during exercise.
name: Lactic acid
label: a
answer: yes
explanation: This is a byproduct of anaerobic respiration that occurs in plants via alcoholic fermentation.
name: Ethanol
label: e
answer: no
explanation: This is a byproduct of anaerobic respiration that occurs in plants via alcoholic fermentation and in animals via aerobic respiration.
name: Carbon dioxide
label: c
answer: no
explanation: This is a byproduct of aerobic respiration.
name: Water
label: d
answer: no

Correct answer: a
The universal energy currency of the cell, produced by anaerobic respiration is termed "ATP".

What components constitute this molecule?

Options:
explanation: This combination is missing the three phosphate groups.
name: Carbon, hydrogen, nitrogen and oxygen
label: b
answer: no
explanation: This combination is missing the oxygen and nitrogen molecules.
name: Carbon, hydrogen and phosphate
label: e
answer: no
explanation: This combination is missing the nitrogen and phosphate molecules.
name: Carbon, hydrogen and oxygen
label: c
answer: no
explanation: The structure of ATP is a nucleoside triphosphate. It consists of a nitrogenous base (adenine), a ribose sugar, and three serially bonded phosphate groups. Its molecular formula is - C10H16N5O13P3.
name: Carbon, hydrogen, nitrogen, oxygen and phosphate
label: a
answer: yes
explanation: This combination is missing the oxygen, nitrogen and phosphate molecules.
name: Carbon and hydrogen
label: d
answer: no

Correct answer: a
A baby is born with a defect in the functioning of the neuronal plexus within the muscular layer of his stomach. The gastroenterologist explains how this muscular layer forms within the embryo from the germ layers.

From which specific germ layer is he referring?

Options:
explanation: This structure is derived from two structures: the ureteric bud (which branches from the nephric duct) and a region of spatially defined intermediate mesoderm termed the metanephric mesenchyme. It goes on to form the adult kidney. It provides large quantities of dilute urine for the maintenance of amniotic and allantoic fluid volumes, essential for normal placentation and development.
name: Metanephros
label: e
answer: no
explanation: The epiblast is derived from the inner cell mass and lies above the hypoblast. The epiblast gives rise to the three primary germ layers (ectoderm, definitive endoderm, and mesoderm) and to the extraembryonic mesoderm of the visceral yolk sac, the allantois, and the amnion.
name: Epiblast
label: d
answer: no
explanation: This gives rise to muscle, skeleton, kidneys and the reproductive system.
name: Mesoderm
label: a
answer: yes
explanation: This gives rise to the nervous system, the cornea and lens of the eye, and the skin.
name: Ectoderm
label: b
answer: no
explanation: This gives rise to the majority of the internal organs. As an overview, it gives rise to the endocrine glands, liver, lungs and digestive tract.
name: Endoderm
label: c
answer: no

Correct answer: a
The tetralogy of Fallot (TOF) is a combination of which four heart defects?

Options:
explanation: Pulmonary stenosis, not pulmonary regurgitation is part of TOF. TOF is a cyanotic disease seen in newborns. The four defects are a ventricular septal defect (VSD), pulmonary stenosis, a misplaced aorta and a thickened right ventricular wall (right ventricular hypertrophy). They usually result in a lack of oxygen-rich blood reaching the body.
name: Ventricular septal defect (VSD), pulmonary regurgitation, overriding aorta and right ventricular hypertrophy (RVH)
label: d
answer: no
explanation: TOF is a cyanotic disease seen in newborns. The four defects are a ventricular septal defect (VSD), pulmonary stenosis, a misplaced aorta and a thickened right ventricular wall (right ventricular hypertrophy). They usually result in a lack of oxygen-rich blood reaching the body.
name: Ventricular septal defect (VSD), pulmonary stenosis, overriding aorta and right ventricular hypertrophy (RVH)
label: a
answer: yes
explanation: ASD is not part of TOF. TOF is a cyanotic disease seen in newborns. The four defects are a ventricular septal defect (VSD), pulmonary stenosis, a misplaced aorta and a thickened right ventricular wall (right ventricular hypertrophy). They usually result in a lack of oxygen-rich blood reaching the body.
name: Ventricular septal defect (VSD), atrial septal defect (ASD), pulmonary stenosis and an overriding aorta
label: b
answer: no
explanation: Aortic stenosis is not part of TOF. TOF is a cyanotic disease seen in newborns. The four defects are a ventricular septal defect (VSD), pulmonary stenosis, a misplaced aorta and a thickened right ventricular wall (right ventricular hypertrophy). They usually result in a lack of oxygen-rich blood reaching the body.
name: Ventricular septal defect (VSD), aortic stenosis, overriding aorta and right ventricular hypertrophy (RVH)
label: c
answer: no
explanation: RVH not LVH is part of TOF. TOF is a cyanotic disease seen in newborns. The four defects are a ventricular septal defect (VSD), pulmonary stenosis, a misplaced aorta and a thickened right ventricular wall (right ventricular hypertrophy). They usually result in a lack of oxygen-rich blood reaching the body.
name: Ventricular septal defect (VSD), pulmonary stenosis, overriding aorta and left ventricular hypertrophy (LVH)
label: e
answer: no

Correct answer: a
A young woman is diagnosed with inflammatory bowel disease (IBD). As part of her diagnosis, she underwent a biopsy, which showed changes in her ascending colon.

Which part of the embryonic gut gives rise to the ascending colon?

Options:
explanation: This is the blood supply to the midgut.
name: Superior mesenteric artery
label: e
answer: no
explanation: This is the blood supply to the foregut.
name: Coeliac axis
label: d
answer: no
explanation: The foregut is from the oral cavity to the initial part of the duodenum.
name: Foregut
label: b
answer: no
explanation: The hindgut is from the later one-third transverse colon to the upper portion of the anus.
name: Hindgut
label: c
answer: no
explanation: The midgut is from the mid-duodenum to the initial two-thirds of the transverse colon.
name: Midgut
label: a
answer: yes

Correct answer: a
An eight-year-old boy with known anaphylaxis to nuts attends a birthday party. After eating some brownies he suddenly develops a wheeze. His mum administers adrenaline via her son's epipen.

Given that this is an anaphylactic reaction, what type of hypersensitivity reaction is this?

Options:
explanation: Type II hypersensitivity reactions are cytotoxic/antibody-mediated. Type II hypersensitivity reactions include haemolytic reactions, hyperacute graft rejections and Goodpasture syndrome.
name: Type II
label: b
answer: no
explanation: Type 3 hypersensitivity reactions are immune-complex-mediated. Type III hypersensitivity reactions include hypersensitivity pneumonitis, systemic lupus erythematosus and polyarteritis nodosa.
name: Type III
label: c
answer: no
explanation: Type I hypersensitivity reactions are IgE-allergy mediated and includes allergic reactions such as anaphylaxis. Type I hypersensitivity reactions occur suddenly after exposure. Common triggers are nuts, bee stings, latex and certain medications e.g. penicillins. Patients should be monitored for potential biphasic reactions. It is also important to distinguish these from non-IgE-mediated anaphylactoid reactions.
name: Type I
label: a
answer: yes
explanation: Type IV hypersensitivity reactions are delayed/cell-mediated. Type IV hypersensitivity reactions include chronic graft rejections, latex, nickel and poison ivy reactions.
name: Type IV
label: d
answer: no
explanation: There is no type V hypersensitivity reaction.
name: Type V
label: e
answer: no

Correct answer: a
To identify a specific pathogen, our cells contain proteins on their surfaces which allows the body to recognise and fight the infection.

What is the term used to describe these surface proteins?

Options:
explanation: An antigen is a molecular structure that is deemed foreign to the body. When an antibody binds an antigen it causes an immune response to be mounted by the body.
name: Antigens
label: a
answer: yes
explanation: The variable region includes the ends of the light and heavy chains. The primary role of the antibody variable region is to bind to the target antigen.
name: Variable region
label: e
answer: no
explanation: These are also known as immunoglobulins and are proteins which identify antigens on foreign pathogens.
name: Antibodies
label: b
answer: no
explanation: These are components of antibodies. Antibodies/immunoglobulins are formed when light chains link up with heavy chains, another type of protein.
name: Light chain
label: d
answer: no
explanation: These are components of antibodies. Antibodies/immunoglobulins are formed when light chains link up with heavy chains, another type of protein.
name: Heavy chain
label: c
answer: no

Correct answer: a
Our adaptive immune system allows us to fight infections relating to specific pathogens.

Which of the following cell types is specific to the adaptive immune system?

Options:
explanation: These are part of the innate immune system. They work in a similar way to neutrophils in that they phagocytose bacteria and secrete both pro-inflammatory and antimicrobial mediators. Once they have phagocytosed material, they then undergo programmed cell death.
name: Macrophage
label: b
answer: no
explanation: These are part of the innate immune system. They are one of the first immune cells to respond to pathogens. They destroy these pathogens via phagocytosis and degranulation.
name: Neutrophil
label: c
answer: no
explanation: Natural killer T-cells are part of both the innate and adaptive immune systems.
name: Natural killer T-cell
label: e
answer: no
explanation: Also known as "T-Helper" cells, CD4 t-cells have multiple functions. They are part of the adaptive immune system and activate both innate response cells and B-lymphocytes. They also play a role in suppressing the immune reaction when necessary.
name: CD4 T-cell
label: a
answer: yes
explanation: These are part of the innate immune system. They are found in tissues such as the skin and boost the immune response by acting as antigen-presenting cells (APCs) and presenting the antigens to the other cells of the immune system.
name: Dendritic cell
label: d
answer: no

Correct answer: a
The adaptive immune system includes both the CD4 and CD8 T cells. CD8 T cells are also known as "cytotoxic t cells" and induce cell death of virus-infected cells through cell lysis or apoptosis. A specific molecule is required for this process to occur.

What is the name given to this molecule?

Options:
explanation: As an antibody binds antigens, and recognises the bacteria/viruses as foreign, pathogens and triggers the cascade of the immune response.
name: Antibody
label: d
answer: no
explanation: An antigen is a foreign particle that induces an immune response when bound to antibodies on the surface of the cells of the innate immune system.
name: Antigen
label: c
answer: no
explanation: The major histocompatibility (MHC) class I antigen presentation pathway plays an important role in alerting the immune system to virally infected cells.
name: MHC Class I
label: a
answer: yes
explanation: Classical MHC class I molecules are ubiquitously expressed on all mammalian cells including cells of epithelial origin while MHC class II molecules are selectively expressed on antigen-presenting cells (APC) including dendritic cells (DC), macrophages, and B cells.
name: MHC Class II
label: b
answer: no
explanation: The hepatitis b surface antigen (HBsAg) is the antigen expressed by the hepatitis B virus specifically. It does not have a role in the cell lysis immune response.
name: HBsAg
label: e
answer: no

Correct answer: a
A couple attends the GP for the wife's antenatal appointment. They would like to know the risk of their child having cystic fibrosis (CF).

What is the % risk of their child having CF given that both parents are carriers of the CF gene?

Options:
explanation: This is the % chance of the child being a carrier.
name: 50%
label: b
answer: no
explanation: This is incorrect- there is a 25% chance given that CF is autosomal recessive.
name: 75%
label: c
answer: no
explanation: The inheritance pattern of CF is autosomal recessive.  This means that both copies of the gene in each cell must have a mutation for the individual to be affected rather than just a carrier of the gene. There is also a 25% chance that the child would be neither affected nor a carrier.
name: 25%
label: a
answer: yes
explanation: This is incorrect- there is a 25% chance given that CF is autosomal recessive.
name: 0%
label: e
answer: no
explanation: This is incorrect- there is a 25% chance given that CF is autosomal recessive.
name: 100%
label: d
answer: no

Correct answer: a
A 13-year-old boy has just become wheelchair bound having suffered with progressive weakness since he was a young child. He was diagnosed with Duchenne muscular dystrophy (DMD).

What is the inheritance pattern of this disease?

Options:
explanation: Duchenne muscular dystrophy (DMD) is inherited in an  X-linked recessive pattern. Examples of X-linked recessive disorders include red-green colour blindness, Beckers muscular dystrophy and haemophilia A and haemophilia B.
name: X-linked recessive
label: e
answer: no
explanation: Duchenne muscular dystrophy (DMD) is inherited in an  X-linked recessive pattern. Huntington's disease and Marfan syndrome are two examples of autosomal dominant disorders.
name: Autosomal Dominant (AD)
label: b
answer: no
explanation: Duchenne muscular dystrophy (DMD) is inherited in an X-linked recessive pattern. Mitochondrial inherited disorders are inherited from the mother as the father's DNA is destroyed when the sperm and egg fuse. Examples of mitochondrial inherited disorders include Leigh syndrome and Pearson syndrome.
name: Mitochondrial
label: d
answer: no
explanation: Duchenne muscular dystrophy (DMD) is inherited in an  X-linked recessive pattern. Males have only one copy of the X chromosome from their mother and one copy of the Y chromosome from their father. If their X chromosome has a DMD gene mutation, they will have Duchenne muscular dystrophy. Due to X-inactivation, it is rare that females (XX) suffer from DMD as this process means that all X chromosomes but one are silenced.
name: X-linked recessive
label: a
answer: yes
explanation: Duchenne muscular dystrophy (DMD) is inherited in an  X-linked recessive pattern. Examples of autosomal recessive disorders include cystic fibrosis and sickle cell anaemia.
name: Autosomal recessive (AR)
label: c
answer: no

Correct answer: a