hllj/quesmed huggingface dataset:
A 30-year-old female presents to General Practice with a 2-week history of difficulty walking. On examination, you note weakness of foot dorsiflexion and eversion as well as a foot-dropping gait. You also note reduced sensation over the lateral calf and dorsal aspect of the foot. The patient is a keen skier and recently returned from a skiing trip.

Which of the following is the most likely diagnosis?

Options:
explanation: Although the peroneal nerve is implicated in foot drop, the superficial branch is not. The superficial peroneal nerve supplies the lateral compartment of the lower leg and thus is responsible for eversion of the foot. The superficial peroneal nerve does not supply foot dorsiflexors, that function is fulfilled by fibres of the deep fibular nerve. Superficial peroneal nerve injury is therefore unlikely in this patient.
name: Superficial peroneal nerve
label: e
answer: no
explanation: The tibial nerve is not implicated in foot drop presentations. The tibial nerve supplies the posterior muscle compartment of the lower leg which is responsible for plantarflexion of the foot. In this patient, dorsiflexion is impaired but plantarflexion is preserved. Furthermore, tibial nerve injury typically results in impaired sensation over the plantar aspect of the foot, not the dorsum. It is therefore unlikely this patient is experiencing tibial nerve damage.
name: Tibial nerve injury
label: d
answer: no
explanation: Damage to the L3 nerve root is unlikely to produce foot drop. Typically L3 radiculopathies present with weakness of knee extension (quadriceps) as well as sensory loss over the knee and anterior thigh.
name: L3 radiculopathy
label: b
answer: no
explanation: Common peroneal nerve lesions are the most common cause of foot drop. The common peroneal nerve gives off the deep fibular nerve which innervates the muscles of the anterior compartment. The anterior compartment muscles are responsible for dorsiflexion of the foot, and impaired innervation produces foot drop. The common peroneal nerve provides sensation to the lateral lower leg and dorsum of the foot. Risk factors for common peroneal nerve injury include trauma, surgical positioning, and certain sports that may compress the nerve at the fibular neck.
name: Common peroneal nerve injury
label: a
answer: yes
explanation: The common femoral nerve is the largest branch of the lumbar plexus and receives input from L2-4. Damage to the common femoral nerve results in impairment of the hip flexors and knee extenders but does not cause foot drop. Furthermore, common femoral nerve injury typically causes sensory impairment of the medial thigh, lower leg, and foot. It would not cause sensory impairment of the lateral aspect of the calf and dorsal foot.
name: Common femoral nerve injury
label: c
answer: no

Correct answer: a
A 32-year-old male presents to the Emergency Department with a 3-day history of sore throat, fever, joint pain, and a new rash. On examination, you identify generalised lymphadenopathy and a maculopapular rash across his trunk. Further history reveals his only foreign travel recently was a trip to South Africa, where he admits he solicited sex work. This was, however, 4 months ago.

Which of the following is the most likely diagnosis?

Options:
explanation: HIV seroconversion illness occurs when the body develops antibodies against the human immunodeficiency virus. This can result in the manifestation of a wide range of symptoms, including fever, sore throat, maculopapular rash, malaise, arthralgia, lymphadenopathy, and oro-genital ulceration. Due to the non-specific nature of the presentation, a high index of suspicion is required. Seroconversion typically occurs in the first few weeks after infection, however, can occur up to 6 months after initial exposure. HIV diagnosis can be confirmed with antibody and antigen testing and treatment should be initiated immediately regardless of CD4 cell count.
name: HIV seroconversion
label: a
answer: yes
explanation: Malaria is an important differential in individuals returning from endemic areas. However, it is an unlikely differential in this case. *Plasmodium falciparum* is the most common cause of malaria worldwide, and almost always presents within 3 months of exposure. Furthermore, although malaria can present with cutaneous symptoms, it would be very uncommon to present with a maculopapular rash.
name: Malaria
label: d
answer: no
explanation: An important differential but unlikely in this patient's case. Although influenza is likely to present with fever, sore throat, and lymphadenopathy, influenza would be unlikely to present with a maculopapular rash. Furthermore, the history of sexual solicitation in a country of high HIV prevalence should further raise the index of suspicion.
name: Influenza
label: c
answer: no
explanation: Gonococcal meningitis is a very rare complication of gonorrhoea infection which occurs when the infection becomes disseminated. However, this diagnosis is unlikely in this patient. This patient has presented without headache or nuchal rigidity, which are cardinal symptoms of meningitis. Therefore meningitis of any origin is unlikely in this patient.
name: Gonococcal meningitis
label: b
answer: no
explanation: Dengue fever is a viral infection spread by the *Aedes aegypti* mosquito. Although an important differential, it is an unlikely diagnosis here due to timing. Dengue fever typically presents with fever, rash, headache, and sometimes severe myalgia and arthralgia. However, Dengue typically presents within 2 weeks of exposure and would not present in an individual after 4 months. Dengue fever is therefore an unlikely diagnosis.
name: Dengue fever
label: e
answer: no

Correct answer: a
A 53-year-old female presents to the Emergency Department with a 3-day history of high fever, headache, arthralgia, malaise, and fatigue.

The patient returned 1 week ago from Zimbabwe where she was visiting family.

Examination reveals a temperature of 39C and a full blood count reveals anaemia and thrombocytopenia. Thick and thin blood smears reveal the presence of trophozoites in the blood.

Which of the following is the best treatment for this patient?

Options:
explanation: Hydroxychloroquine is a drug used in the treatment of systemic lupus erythematosus. It may also be used instead of chloroquine to treat malaria, however, chloroquine-based therapies are no longer recommended as the first line due to increasing levels of resistance. Instead, artemisinin-based combination therapy is recommended as a first-line treatment by the WHO.
name: Hydroxychloroquine
label: e
answer: no
explanation: Symptomatic management alone is not appropriate management for malaria. Paracetamol is recommended for use to manage fever in malaria, but additional treatment to target the parasite is recommended by the WHO.
name: Symptomatic management
label: d
answer: no
explanation: This patient is suffering from malaria. Malaria is a parasitic infection caused by *Plasmodium* parasites and transmitted by the *Anopheles* mosquito. Malaria classically presents with a high fever, headache, fatigue, myalgia/arthralgia as well as signs and symptoms of red blood cell destruction (e.g. anaemia, jaundice). Artemisinin-based combination therapy (ACT) is the treatment of choice for malaria. Chloroquine-based therapies may still be used but due to the increase in chloroquine resistance across many endemic countries, the WHO recommend the use of ACT instead.
name: Artemisinin-based combination therapy
label: a
answer: yes
explanation: Praziquantel is the treatment of choice for schistosomiasis. Schistosomiasis is a parasitic infection that typically manifests in the genitourinary tract or intestinal tract. It most commonly presents with fever, rash, abdominal pain and urinary symptoms. Schistosomiasis would not present with trophozoites on blood film and therefore can be ruled out.
name: Praziquantel
label: c
answer: no
explanation: Although chloroquine was previously the mainstay of malaria management, recent rises in chloroquine resistance have resulted in the WHO recommending the use of artemisinin-based combination therapy in place of chloroquine.
name: Chloroquine
label: b
answer: no

Correct answer: a
Which of the following reactions is catalysed by the enzyme carbonic anhydrase within gastric parietal cells in order to decrease the pH of the stomach?

Options:
explanation: Whilst stomach acid is HCl, H<sup>+</sup> and Cl<sup>-</sup> do not combine until inside the stomach lumen where they combine due to their differing charges. Cl<sup>-</sup> enters the stomach lumen via a Cl<sup>-</sup> channel in exchange for the HCO<sub>3</sub> <sup>-</sup> produced by the reaction CO<sub>2</sub> + H<sub>2</sub>O &rarr; H<sub>2</sub>CO<sub>3</sub> &rarr; HCO<sub>3</sub><sup>-</sup> in the gastric parietal cells (which is catalysed by carbonic anhydrase!)
name: 2Cl<sup>-</sup> + H<sub>2</sub>O &rarr; HCl + OH<sup>-</sup>
label: c
answer: no
explanation: This is the equation for the formation of calcium oxalate kidney stones, and whilst it does produce acidic H<sup>+</sup> ions, it has no link to stomach acidity.
name: Ca<sup>2+</sup> + C<sub>2</sub>O<sub>4</sub>H<sub>2</sub> &rarr; CaC<sub>2</sub>O<sub>4</sub> + 2H<sup>+</sup>
label: e
answer: no
explanation: This reaction is catalysed by carbonic anhydrase and is used for homeostasis in many systems, including within gastric parietal cells - causing them to secrete acidic H<sup>+</sup> into the stomach, thus decreasing the stomach pH.
name: CO<sub>2</sub> + H<sub>2</sub>O &rarr; H<sub>2</sub>CO<sub>3</sub> &rarr; H<sup>+</sup>+ HCO<sup>3</sup> <sup>-</sup>
label: a
answer: yes
explanation: H+ is produced by this reaction, so would decrease the stomach pH. However, the equation is not balanced in charge or molecules - there are two hydrogens on the left and three on the right, and the total charge on the left is 0, whilst it is +1 on the right.
name: CO<sub>2</sub> + H<sub>2</sub>O&rarr; 2H<sup>+</sup>+ HCO<sub>3</sub> <sup>-</sup>
label: b
answer: no
explanation: This reaction is the reversed version of the reaction which occurs within gastric parietal cells to produce H<sup>+</sup> and decrease the stomach pH, and whilst this reaction is also catalysed by carbonic anhydrase it is a neutralising reaction, rather than an acid-producing reaction, so if anything would increase the pH.
name: HCO<sub>3</sub><sup>-</sup> + H<sup>+</sup> &rarr; H<sub>2</sub>CO<sub>3</sub> &rarr; H<sub>2</sub>O + CO<sub>2</sub>
label: d
answer: no

Correct answer: a
Which of the following cell types line the upper respiratory tract?

Options:
explanation: This epithelium is named 'pseudostratified columnar' due to the single layer of column-shaped cells appearing to be arranged in layers. The epithelium surface is also ciliated to trap dust particles, warm the airway, and secrete mucus.
name: Pseudostratified ciliated columnar epithelium
label: a
answer: yes
explanation: The upper respiratory tract is lined by columnar cells (column-shaped), not squamous (flat). Additionally 'keratinised' refers to the protein keratin produced by keratinocytes in skin - hence why keratinised stratified squamous epithelium is found mainly in the skin. The upper respiratory tract epithelium is pseudo-stratified as it is exposed to less mechanical damage than areas which are protected by stratified epithelium.
name: Keratinised stratified squamous epithelium
label: c
answer: no
explanation: Whilst the cells which line the upper respiratory tract are pseudostratified, they are also ciliated and are columnar epithelial cells, not squamous epithelial cells.
name: Pseudostratified squamous epithelium
label: b
answer: no
explanation: Cuboidal cells are found in glands which secrete specialised substances, such as sweat glands. Whilst the respiratory tract does secrete small amounts of mucus, this is secreted by goblet cells which line the columnar cells of the pseudostratified ciliated columnar epithelium of the upper airway.
name: Stratified cuboidal epithelium
label: e
answer: no
explanation: The upper respiratory tract is lined by columnar epithelium, not squamous, and is pseudostratified not stratified. Non-keratinised stratified squamous epithelium is found in areas such as the oesophagus.
name: Non-keratinised stratified squamous epithelium
label: d
answer: no

Correct answer: a
Which structures are described as 'false ribs'?

Options:
explanation: The 11th and 12th ribs are the last two sets of ribs in the thoracic cage and  are known as the 'floating ribs'. There is no 13th rib.
name: 11th, 12th and 13th ribs
label: e
answer: no
explanation: The clavicle is not referred to as a rib at all, and does not form part of the thoracic cage.
name: The clavicle
label: d
answer: no
explanation: These ribs attach directly to the sternum via the costal cartilage and are known as 'true ribs'.
name: 1st, 2nd, 3rd, 4th, 5th, 6th and 7th ribs
label: c
answer: no
explanation: These ribs do not directly attach to the sternum, but instead attach the cartilage of the 7th ribs - and so are known as 'false ribs'.
name: 8th, 9th and 10th ribs
label: a
answer: yes
explanation: These ribs are the lowest two sets of ribs. They do not attach to the sternum or any other structure at all, and so are known as 'floating ribs'.
name: 11th and 12th ribs
label: b
answer: no

Correct answer: a
A 75-year-old woman is diagnosed with Stage-1 oestrogen-receptor positive (ER+) breast cancer. She would like to proceed with treatment.

Which of the following treatments is most appropriate?

Options:
explanation: A double mastectomy in this instance would be an aggressive surgical approach given the cancer only being Stage-1. Instead, a more breast-conserving surgery would be preferred e.g. wide local excision. Tamoxifen is used to treat ER+ breast cancer. However, it is usually reserved for pre-menopausal women so would not be appropriate for a woman of this age.
name: Double mastectomy with adjuvant tamoxifen therapy
label: c
answer: no
explanation: Wide local excision would be appropriate to remove the cancer. However, trastuzumab is a monoclonal antibody used to treat HER2+ breast cancer - so it would not be appropriate to give this unless the patient was known to be HER2+.
name: Wide local excision of the lesion with adjuvant trastuzumab (@Herceptin) therapy
label: e
answer: no
explanation: Fine needle aspiration is a method of collecting cells from tumours for diagnostic purposes, it is not usually therapeutic. Hence, it would not be appropriate given that the cancer is already diagnosed and staged. However, adjuvant anastrozole would be appropriate following an excision.
name: Fine needle aspiration of the lesion with adjuvant anastrozole (@Arimidex) therapy
label: d
answer: no
explanation: Whilst both surgical excision and an aromatase inhibitor (e.g. Anastrozole) are the most appropriate choice for this patient, the hormone therapy should be given as an adjuvant treatment (after the surgery) rather than as a neoadjuvant treatment (before the surgery).
name: Wide local excision of the lesion with neoadjuvant anastrozole (@Arimidex) therapy
label: b
answer: no
explanation: Excision of the cancer followed by adjuvant endocrine therapy in the form of an aromatase inhibitor (e.g. anastrozole) is the first-line treatment to reduce the risk of recurrence of ER+ breast cancer. Aromatase inhibitors such as anastrozole are also first-line in post-menopausal patients with ER+ breast cancer. Therefore, given this patient's age, this would be the most appropriate treatment.
name: Wide local excision of the lesion with adjuvant anastrozole (@Arimidex) therapy
label: a
answer: yes

Correct answer: a
A 24-year-old male presents with loss of sensation over the umbilical region.

Which of the following is most likely to have caused this?

Options:
explanation: The T1 spinal nerve innervates a dermatome higher up than the umbilicus (above the nipple-line), so would not be responsible for this patient's symptoms.
name: Damage to the T1 spinal nerve
label: d
answer: no
explanation: Cauda Equina syndrome results due to compression of the cauda equina - a series of nerve roots which travel through the spinal canal after L2/3. The cauda equina supplies sensation, parasympathetic, and motor innervation to the lower limbs, bladder, and rectum. Therefore, compression leads to symptoms such as incontinence, saddle anaesthesia, and bilateral sciatica. Loss of sensation would not occur above the lower limbs.
name: Cauda Equina syndrome
label: e
answer: no
explanation: Pancoast tumours are a type of lung cancer affecting the pulmonary apex. They can lead to neurological symptoms by causing pressure on the sympathetic ganglion. However, these symptoms are ptosis, anhidrosis, and miosis.
name: Pancoast tumour
label: b
answer: no
explanation: The diaphragm is innervated by spinal nerves C3-5, which also innervate the dermatomes of the shoulder and parts of the arm. Therefore, diaphragm irritation can present as referred cutaneous shoulder pain.
name: Diaphragm irritation
label: c
answer: no
explanation: The T10 spinal nerve innervates the dermatome which covers the umbilical region. Therefore damage to the T10 spinal nerve may explain this patient's loss of sensation.
name: Damage to the T10 spinal nerve
label: a
answer: yes

Correct answer: a
A 24-year-old patient experienced nausea and vomiting following her weekly chemotherapy sessions at her local hospital. She now feels nauseous and vomits whenever she visits a hospital, despite finishing chemotherapy eight months ago.

Which of the following is this an example of?

Options:
explanation: Sensory coding is a term used to describe how sensory information is encoded in memory. It does not explain how a person will react to a stimulus if they encounter it again.
name: Sensory coding
label: e
answer: no
explanation: Systematic desensitisation is a process by which a person can become 'desensitised' to something e.g. exposure therapy for a phobia via establishing a conditioned link between a fear and a relaxation technique.
name: Systematic desensitisation
label: b
answer: no
explanation: Operant conditioning is a form of conditioning which, unlike classical conditioning, relies on rewards and punishments to reinforce certain behaviours in a person by changing their association between the response and consequence. For example: 'star charts' for good behaviour in children.
name: Operant conditioning
label: c
answer: no
explanation: Classical conditioning is when two events commonly occur simultaneously, leading to somebody associating one with the other. In this case, the patient vomited whenever they were at hospital, so now when they go to a hospital they feel nauseous and vomit involuntarily.
name: Classical conditioning
label: a
answer: yes
explanation: Imitation and observation refers to how people learn from observing and imitating those around them.
name: Imitation and observation
label: d
answer: no

Correct answer: a
At what age are infants expected to be able to recognise words in the speech of those around them?

Options:
explanation: This is slightly too early for most infants to be able to recognise words in speech. At four-months-old, they have only just begun to make associations between facial movements and sounds.
name: Four-months-old
label: b
answer: no
explanation: By 12-months-old, infants will be learning how to produce sounds and 'rehearsing' different noises. They will have been able to recognise words in speech for some months already.
name: 12-months-old
label: c
answer: no
explanation: This is too early in development for infants to recognise words in speech. From newborn to this time, infants are expected to be responsive to human voices.
name: Two-months-old
label: e
answer: no
explanation: This is the age at which infants are typically able to recognise words in speech.
name: Six-months-old
label: a
answer: yes
explanation: It is expected for infants reaching milestones at a normal pace to be speaking at 18-months, and so they would have been recognising words in speech for many months by this point.
name: 18-months-old
label: d
answer: no

Correct answer: a
Which of the following is the correct classification of muscle for the deltoid?

Options:
explanation: Flat muscles consist of parallel fibres within an aponeurosis. The fascicles/fibres in the deltoids are arranged obliquely, not in parallel, and so they are flat muscles.
name: Flat
label: e
answer: no
explanation: Whilst the deltoid muscles do have a pennate structure, with the fascicles sitting obliquely to the tendon, they have four fascicles rather than two, so are known as 'multipennate' rather than 'bipennate'.
name: Bipennate
label: c
answer: no
explanation: The deltoid muscles have a multipennate structure, with many feather-like fascicles originating from various points (e.g. clavicle, acromion, and spine of scapula) which then converge and insert onto a singular central point (the deltoid tuberosity).
name: Multipennate
label: a
answer: yes
explanation: Circular muscles are exactly what they sound like - circular! They are concentrically arranged fascicles which increase and decrease the size of an opening. The fascicles of the deltoids are not arranged concentrically, and so the deltoids are not circular muscles.
name: Circular
label: d
answer: no
explanation: Deltoid muscles may appear fusiform (spindle-shaped) at first-glance. However, the arrangement of fascicles in an oblique pattern means that they are classified as pennate, and the number of fascicles means that they are 'multipennate'.
name: Fusiform
label: b
answer: no

Correct answer: a
Which of the following options correctly describes the structure of a nucleosome?

Options:
explanation: The histone octamer is positively charged so that it is attracted to the negatively charged double-stranded DNA.
name: Negatively charged double-stranded DNA wrapped around a negatively charged histone octamer
label: e
answer: no
explanation: The DNA in a nucleosome is double-stranded - not single-stranded.
name: Negatively charged single-stranded DNA wrapped around a positively charged histone octamer
label: c
answer: no
explanation: This structure is almost correct. However, the charges on the DNA and histone octamer are reversed. DNA is negatively charged and the histone octamer is positively charged.
name: Positively charged double-stranded DNA helix wrapped around a negatively charged histone octamer
label: b
answer: no
explanation: A nucleosome is the basic structural unit of DNA packaging, and is the basis of how such long strands of DNA can fit within cell nuclei. They consist of negatively charged double-stranded DNA tightly wrapped around a positively charged core particle called a histone octamer - which is made up of eight histones.
name: Negatively charged double-stranded DNA helix wrapped around a positively charged histone octamer
label: a
answer: yes
explanation: The DNA in a nucleosome is double-stranded, not single-stranded, and the core particle is a histone octamer (eight histones), not a histone pentamer (five histones).
name: Negatively charged single-stranded DNA wrapped around a positively charged histone pentamer
label: d
answer: no

Correct answer: a