hllj/quesmed huggingface dataset:
A 24-year-old male presents to the GP with a painful knee. On analysis of joint fluid following aspiration and subsequent genetic testing, he is diagnosed with haemophilia A.

What factor is defective in this condition?

Options:
explanation: Haemophilia B (also known as Factor IX deficiency) is a type of clotting disorder.
name: Factor IX
label: b
answer: no
explanation: Haemophilia A (also known as Classic Haemophilia or Factor VIII deficiency) is the most well-known type of clotting disorder.
name: Factor VIII
label: a
answer: yes
explanation: Haemophilia C (also known as Factor XI deficiency) is an extremely rare form of haemophilia clotting disorder.
name: Factor XI
label: d
answer: no
explanation: Factor V Leiden is a mutation of one of the clotting factors in the blood. This mutation can increase your chance of developing abnormal blood clots, most commonly in the legs or lungs. This is in contrast to haemophilia where patients bleed into muscles, joints and tissues. Patients with Factor V Leiden are pro-thrombotic.
name: Factor V
label: e
answer: no
explanation: Factor X deficiency (previously known as the Stuart-Prower factor) deficiency is a type of clotting disorder. However, Factor X deficiency does not cause haemophilia.
name: Factor X
label: c
answer: no

Correct answer: a
A patient presents to his GP with recurrent falls. He mentions that he feels his foot dragging across the floor and his partner often has to tell him "to pick his feet up". On examination, the GP is able to identify a particular affected area of sensory loss over lateral the aspect of the foot.

To which root value is the GP referring?

Options:
explanation: The L5 dermatome is tested on the area of the skin on the plantar aspect of the foot and the posterior leg. The L5 myotome is responsible for great toe extension.
name: L5
label: b
answer: no
explanation: The L4 dermatome is tested on the area of the skin overlying the knee. The L4 myotome is responsible for ankle dorsiflexion.
name: L4
label: d
answer: no
explanation: The L1 dermatome supplies the area of the groin near the inguinal ligament. The L1 myotome supplies the hip flexors.
name: L1
label: e
answer: no
explanation: The T10 dermatome is tested on the area of skin overlying the navel.
name: T10
label: c
answer: no
explanation: The S1 dermatome is tested on the area of the skin on the lateral aspect of the foot and the posterior leg. The S1 myotome is responsible for ankle plantarflexion.
name: S1
label: a
answer: yes

Correct answer: a
A 27-year-old man presents to ED with leg weakness having travelled back from meeting family in America two weeks ago. He had several outdoor parties and barbecues whilst away, but since coming home he has not felt quite himself. Investigations have shown the presence of anti-ganglioside antibodies.

What is the most likely diagnosis given his history and investigation findings?

Options:
explanation: Although a SAH could present with weakness, given the patient history and antibody findings, the likely diagnosis is GBS.
name: Subarachnoid haemorrhage (SAH)
label: e
answer: no
explanation: Miller-Fisher Syndrome (MFS) is one of the rare forms of a spectrum of Guillain-Barré syndrome (GBS). In contrast to GBS, which typically affects the lower body first (as seen in this case), MFS tends to affect the upper body first. Anti-ganglioside antibodies are associated with several immunologically mediated peripheral neuropathies e.g. anti-GM1 (IgM) with multifocal motor neuropathy, GQ1b (IgG) with Miller-Fisher syndrome, and GM1 (IgG) with Guillain-Barre syndrome.
name: Miller-Fisher Syndrome (MFS)
label: b
answer: no
explanation: Although a TIA could present with weakness, given the patient history and antibody findings, the likely diagnosis is GBS.
name: Transient ischaemic attack (TIA)
label: c
answer: no
explanation: Infection with Campylobacter jejuni, commonly infecting individuals who consume undercooked poultry, is one of the most common causes of Guillian-Barre syndrome (GBS). Given this patient's holiday history and anti-ganglioside antibodies, GBS is the correct diagnosis. Anti-ganglioside antibodies are associated with several immunologically mediated peripheral neuropathies e.g. anti-GM1 (IgM) with multifocal motor neuropathy, GQ1b (IgG) with Miller-Fisher syndrome, and GM1 (IgG) with Guillain-Barre syndrome.
name: Guillian-Barre syndrome (GBS)
label: a
answer: yes
explanation: Although a stroke could present with weakness, given the patient's history and antibody findings, the likely diagnosis is GBS.
name: Ischaemic stroke
label: d
answer: no

Correct answer: a
A 21-year-old woman presents to the GP with a headache. She mentions that these attacks are becoming more frequent. The GP takes a thorough history to rule out sinister causes and diagnoses  the patient as having migraines.

Which of the following factors is most consistent with this diagnosis?

Options:
explanation: Scalp tenderness is commonly seen in giant cell arteritis (GCA).
name: Scalp tenderness
label: e
answer: no
explanation: Nasal congestion is commonly seen in cluster headaches.
name: Nasal congestion
label: d
answer: no
explanation: Features of a migraine can be remembered by the mnemonic "POUND" - pulsatile, onset (sudden), unilateral, nausea + neurological symptoms, and disabling (patients often have photophobia and phonophobia).
name: Unilateral
label: a
answer: yes
explanation: Migraines typically last 4-72 hours. A severe headache lasting longer than this warrants further investigation to rule out other causes such as subarachnoid haemorrhage or meningitis.
name: Duration of more than two weeks
label: c
answer: no
explanation: Migraines are typically unilateral.
name: Bilateral
label: b
answer: no

Correct answer: a
An 84-year-old woman presents with pain at the level of her belly button. She mentions that the pain has been present since she was diagnosed with shingles. She is diagnosed with post-herpetic neuralgia and is commenced on appropriate treatment.

Given the distribution of the pain, what dermatome is likely to have been affected by the herpes zoster virus?

Options:
explanation: The area of skin overlying the navel is innervated by the T10 dermatome.
name: T10
label: a
answer: yes
explanation: The C5 dermatome supplies the area of skin overlying the shoulder area, clavicular area, and upper scapular area.
name: C5
label: d
answer: no
explanation: The C7 dermatome supplies the area of skin overlying the lateral arm and forearm to the index, long, and ring fingers.
name: C7
label: c
answer: no
explanation: The C2 dermatome supplies the area of skin overlying the temple, forehead, and occiput.
name: C2
label: e
answer: no
explanation: The T4 dermatome supplies the area of skin overlying the nipple.
name: T4
label: b
answer: no

Correct answer: a
A 76-year-old woman is commenced on bisphosphonates. The GP explains the mechanism of action of this drug.

Which of the following is correct?

Options:
explanation: Osteocytes regulate local mineral deposition and chemistry of the bone matrix. Evidence shows that bisphosphonates may indirectly promote osteocyte activity and have direct anti-apoptotic effects on these cells.
name: Inhibit osteocyte activity
label: d
answer: no
explanation: Osteoclasts are the cells that degrade bone to initiate normal bone remodelling and mediate bone loss in pathologic conditions such as osteoporosis by increasing their resorptive activity. Bisphosphonates work to inhibit osteoclast activity thus aiming to maintain bone structure and density.
name: Inhibit osteoclast activity
label: a
answer: yes
explanation: Osteoblasts are the bone cells that are primarily responsible for synthesizing bone matrix proteins and minerals. Evidence shows that bisphosphonates have anti-apoptotic effects on osteoblasts and thus are likely to promote rather than inhibit their activity.
name: Inhibit osteoblast activity
label: b
answer: no
explanation: Osteoclasts are the cells that degrade bone to initiate normal bone remodelling and mediate bone loss in pathologic conditions such as osteoporosis by increasing their resorptive activity. Bisphosphonates work to inhibit osteoclast activity thus aiming to maintain bone structure and density.
name: Promote osteoclast activity
label: c
answer: no
explanation: This is not a function of bisphosphonates.
name: Stimulates blood vessel formation
label: e
answer: no

Correct answer: a
A 75-year-old woman with known osteoporosis presents to A+E with wrist drop and reduced sensation over the anatomical snuffbox on her left side. She recalls falling earlier that day. An x-ray shows a fracture of a specific area of the humerus.

Given the clinical picture, which area of bone is most likely to have been affected?

Options:
explanation: The patient presents with signs of a radial nerve injury. A common injury that causes this is a broken midshaft humerus. The name given to the midshaft is the diaphysis. The growth plate is the area of tissue near the ends of long bones in children and teens that determines the future length and shape of the mature bone. The growth plate is usually fused by the age of 13-15 years in females.
name: Growth plate
label: d
answer: no
explanation: The patient presents with signs of a radial nerve injury. A common injury that causes this is a broken midshaft humerus. The name given to the midshaft is the diaphysis. The epiphysis is located at the narrow end of long bones.
name: Epiphysis
label: b
answer: no
explanation: The patient presents with signs of a radial nerve injury. A common injury that causes this is a broken midshaft humerus. The name given to the midshaft is the diaphysis. The metaphyses are the wide portions of long bones and the regions of the bone where growth occurs.
name: Metaphysis
label: c
answer: no
explanation: The talus is a bone in the foot. A talus fracture often occurs during a high-energy event, such as a car collision.
name: Talus
label: e
answer: no
explanation: The patient presents with signs of a radial nerve injury. A common injury that causes this is a broken midshaft humerus. The name given to the midshaft is the diaphysis.
name: Diaphysis
label: a
answer: yes

Correct answer: a
What is the name given to the amount of air left in the lungs after maximal expiration?

Options:
explanation: Tidal volume is the amount of air that moves in or out of the lungs with each respiratory cycle. It measures around 500 mL in an average healthy adult male, and approximately 400 mL in a healthy female.
name: Tidal volume (TV)
label: b
answer: no
explanation: Residual volume is the amount of air that remains in a person's lungs after fully exhaling. RV is needed to keep the lungs from collapsing.
name: Residual volume (RV)
label: a
answer: yes
explanation: This is the total amount of air exhaled after maximal inhalation. The value is about 4800mL and it varies according to age and body size. It is calculated by summing tidal volume, inspiratory reserve volume, and expiratory reserve volume. VC = TV+IRV+ERV.
name: Vital capacity (VC)
label: e
answer: no
explanation: The inspiratory reserve volume is the amount of air a person can inhale forcefully after normal tidal volume inspiration.
name: Inspiratory reserve volume (IRV)
label: d
answer: no
explanation: The expiratory reserve volume is the amount of air a person can exhale forcefully after a normal exhalation.
name: Expiratory reserve volume (ERV)
label: c
answer: no

Correct answer: a
A patient presents to ED with pain in her chest and haemoptysis. She is diagnosed with a pulmonary embolism (PE) following a CTPA. The consultant mentions that her left lung had no perfusion and subsequently no gas exchange.

What is the name given to the space to which he is referring?

Options:
explanation: Ventilation/perfusion (V/Q) mismatch does occur in PE, however this is not the name given to the dead space where the mismatch occurs.
name: V/Q mismatch
label: d
answer: no
explanation: Anatomical dead space is the volume of air that is in the conducting zone of the lung
name: Anatomical dead space
label: b
answer: no
explanation: Alveolar dead space is the volume of air that fills the gas-exchanging regions of the lung but does not participate in gas exchange. A number of factors can contribute to elevations in pulmonary dead space, including excessive PEEP (intrinsic or extrinsic), low cardiac stroke volume, hypovolemia, and pulmonary embolism.
name: Alveolar dead space
label: a
answer: yes
explanation: Physiological dead space is the combination of anatomical dead space plus alveolar dead space.
name: Physiological dead space
label: c
answer: no
explanation: Mechanical dead space is dead space in an external breathing apparatus in which the breathing gas must flow in both directions as the user breathes in and out. It increases the necessary respiratory effort to get the same amount of usable air or breathing gas, and risks accumulation of carbon dioxide from shallow breaths.
name: Mechanical dead space
label: e
answer: no

Correct answer: a
The kidney has several valuable roles, one of which is regulating blood pressure.

What is the name of the cells within the kidney that maintain blood pressure homeostasis?

Options:
explanation: Renal tubular epithelial cells are involved in the immune response in the kidney through the production of pro-inflammatory cytokines/chemokines and via interactions with immune cells.
name: Renal tubular epithelial cell
label: c
answer: no
explanation: Podocytes cooperate with mesangial cells to support the structure and function of the glomerulus.
name: Podocyte
label: b
answer: no
explanation: The macula densa, mesangium extraglomerular cells and granular cells together make up the juxtaglomerular apparatus. The mesangium extraglomerular cells are a type of smooth muscle cell, and although their function is yet to be fully clarified, they play a role in autoregulation of blood flow to the kidney and regulation of systemic blood pressure through the renin-angiotensin system.
name: Mesangium extraglomerular cells
label: e
answer: no
explanation: Macula densa (MD) cells are chief cells within the kidney, playing key sensory and regulatory functions in the maintenance of body fluid, electrolyte homeostasis, and blood pressure. The macula densa, mesangium extraglomerular cells and granular cells together make up the Juxtaglomerular apparatus.
name: Macula densa (MD) cells
label: a
answer: yes
explanation: The macula densa, mesangium extraglomerular cells and granular cells together make up the juxtaglomerular apparatus. Granular cells are cells in the kidney that synthesize, store, and secrete the enzyme renin. They are specialized smooth muscle cells mainly in the walls of the afferent arterioles (and some in the efferent arterioles) that deliver blood to the glomerulus.
name: Granular cells
label: d
answer: no

Correct answer: a
Where does the majority of water reabsorption occur within the kidney?

Options:
explanation: The DCT regulates pH by absorbing bicarbonate and secreting protons (H+) into the filtrate.
name: Distal convoluted tubule (DCT)
label: c
answer: no
explanation: This is the filtering unit of the kidney. It filters small solutes from the blood.
name: Glomerulus
label: d
answer: no
explanation: Afferent arterioles have two functions: they serve to connect the renal artery to the glomerular capillaries and they take an active role in controlling not only the local blood pressure inside the kidney but also the body's overall blood pressure. An efferent arteriole is a blood vessel in the urinary system that brings filtered blood from the glomerulus to the rest of the kidney and back to the general circulation.
name: Afferent arteriole
label: e
answer: no
explanation: The proximal convoluted tubule avidly reabsorbs filtered glucose into the peritubular capillaries so that it is all reabsorbed by the end of the proximal tubule. The PCT secretes acids and bases e.g. bile salts, oxalate and catecholamines (waste products of metabolism), and hydrogen ions (H+) – important in maintaining acid/base balance in the body. H+ secretion allows the reabsorption of bicarbonate via the use of the enzyme carbonic anhydrase.
name: Proximal convoluted tubule (PCT)
label: a
answer: yes
explanation: The collecting ducts are the last opportunity to resorb H2O and concentrate urine before they lead urine to the minor calyces. Antidiuretic Hormone (ADH, from the hypothalamus) directs the collecting ducts to concentrate urine.
name: Collecting duct
label: b
answer: no

Correct answer: a
What is the effect of NSAIDs on GFR and what is the underlying mechanism?

Options:
explanation: Constriction of the afferent arteriole would reduce the eGFR as less blood reaches the kidney. NSAIDs reduce the eGFR by constricting the afferent arteriole. ACEis reduce the eGFR by dilating the efferent arteriole. Both of these mechanisms reduce the filtration pressure in the Bowman's capsule, thus reducing the eGFR.
name: Increase eGFR, occurring due to constriction of the afferent arteriole
label: b
answer: no
explanation: Dilation of the efferent arteriole would reduce the eGFR. This is the mechanism whereby ACEis reduce eGFR rather than NSAIDs. NSAIDs reduce the eGFR by constricting the afferent arteriole. ACEis reduce the eGFR by dilating the efferent arteriole. Both of these mechanisms reduce the filtration pressure in the Bowman's capsule, thus reducing the eGFR.
name: Reduce eGFR, occurring due to dilation of the efferent arteriole
label: c
answer: no
explanation: Constricting the efferent arteriole would increase the eGFR due to an increase in the filtration pressure in the glomerulus. NSAIDs reduce the eGFR by constricting the afferent arteriole. ACEis reduce the eGFR by dilating the efferent arteriole. Both of these mechanisms reduce the filtration pressure in the Bowman's capsule, thus reducing the eGFR.
name: Increase eGFR, occurring due to constriction of the efferent arteriole
label: d
answer: no
explanation: NSAIDs reduce the eGFR by constricting the afferent arteriole. ACEis reduce the eGFR by dilating the efferent arteriole. Both of these mechanisms reduce the filtration pressure in the Bowman's capsule, thus reducing the eGFR.
name: Reduce eGFR, occurring due to constriction of the afferent arteriole
label: a
answer: yes
explanation: NSAIDs reduce the eGFR by constricting the afferent arteriole. ACEI reduce the eGFR by dilating the efferent arteriole. Both of these mechanisms reduce the filtration pressure in the Bowman's capsule, thus reducing the eGFR.
name: No change
label: e
answer: no

Correct answer: a
Which of the following drugs are renoprotective in CKD?

Options:
explanation: Exposure of tubular cells to cisplatin activates signalling pathways that are cell death-promoting (p53, and reactive oxygen species).
name: Cisplatin
label: d
answer: no
explanation: ACEis are renoprotective in CKD. The renoprotective mechanism of ACEis is that they reduce systemic vascular resistance in patients with hypertension, heart failure or chronic renal disease.
name: Angiotensin-converting enzyme inhibitors (ACEis)
label: a
answer: yes
explanation: NSAIDs are nephrotoxic as they constrict the afferent arteriole, thus reducing blood flow to the kidney.
name: NSAIDs
label: b
answer: no
explanation: The most commonly described mechanism of MTX nephrotoxicity is the crystallization of MTX in the renal tubular lumen. Other mechanisms have also been proposed such as constriction of the afferent capillary and direct effects on the mesangial or tubular epithelial cells.
name: Methotrexate (MTX)
label: e
answer: no
explanation: Gentamicin induces nephrotoxicity by inhibiting protein synthesis in renal cells that specifically causes necrosis of cells in the renal proximal tubule, resulting in acute tubular necrosis, followed by acute renal failure.
name: Gentamicin
label: c
answer: no

Correct answer: a
You are participating in a 100m sprint race to raise money for your ward.

What nerve fibres will be used for this race?

Options:
explanation: Type 1 fibres are slow-twitch fibres. Slow oxidative fibres contract relatively slowly and use aerobic respiration (oxygen and glucose) to produce ATP. They produce low-power contractions over long periods and are slow to fatigue.
name: Type 1 fibres
label: b
answer: no
explanation: A type 1a sensory fibre, otherwise known as a primary afferent fibre, is a type of afferent nerve fibre. It is the sensory fibre of a stretch receptor called the muscle spindle found in muscles, which constantly monitors the rate at which a muscle stretch changes.
name: Type 1a fibres
label: d
answer: no
explanation: Type 2b fibres are fast-twitch glycolytic fibres. Type 2b (FG) fibres primarily use anaerobic glycolysis as their ATP source. They have a large diameter and possess high amounts of glycogen, which is used in glycolysis to generate ATP quickly to produce high levels of tension.
name: Type 2b fibres
label: a
answer: yes
explanation: There is no type 3 muscle or sensory fibre.
name: Type 3 fibres
label: e
answer: no
explanation: Type 2a fibres are fast-twitch oxidative fibres. Fast oxidative fibres have fast contractions and primarily use aerobic respiration, but because they may switch to anaerobic respiration (glycolysis), can fatigue more quickly than Type 1 fibres.
name: Type 2a fibres
label: c
answer: no

Correct answer: a
You are cooking a meal and, as you are very busy, you turn around and catch your hand on the edge of the frying pan. You feel a sharp, sudden, intense pain.

What nerve fibre is responsible for transmitting this signal?

Options:
explanation: A-alpha fibres carry proprioception signals. These are myelinated and thus the conduction speed is fast. In fact, they have the quickest conduction speed of all the nerve fibres listed.
name: A-alpha
label: d
answer: no
explanation: A-delta fibres carry pain (mechanical and thermal) signals. These are myelinated and thus the conduction speed is much quicker than C fibres, which also carry these signals, but are non-myelinated. A-delta fibres also have a much larger diameter than C fibres, allowing signals to be transmitted quicker along the nerve fibre.
name: A-delta
label: a
answer: yes
explanation: C fibres carry pain (mechanical, chemical and thermal) signals. These are non-myelinated and thus the conduction speed is much slower than A-delta fibres, which also carry these signals, but are myelinated. C fibres also have a much smaller diameter than A-delta fibres.
name: C fibres
label: c
answer: no
explanation: A-gamma fibres are typically motor neurons that control the intrinsic activation of the muscle spindle.
name: A-gamma
label: e
answer: no
explanation: A-beta fibres carry touch signals. These are myelinated fibres.
name: A-beta
label: b
answer: no

Correct answer: a
What structure of the neuron is specifically adapted to receiving signals from other neurons?

Options:
explanation: Also known as the soma, the cell body contains ribosomes and is the site of virtually all protein production in the neuron, apart from a small amount which is produced in the dendrites. The cell body maintains the neuronal structure.
name: Cell body
label: c
answer: no
explanation: Dendrites receive input from many other neurons and carry those signals to the cell body.
name: Dendrite
label: a
answer: yes
explanation: The myelin sheath functions by allowing signals to propagate down the axon faster than non-myelinated axons, as the signal is able to jump between myelinated sections into sections known as the nodes of Ranvier.
name: Myelin sheath
label: e
answer: no
explanation: The axon is a long cable-like structure which takes information from the cell body of the neuron down to the axon terminal and synapse.
name: Axon
label: b
answer: no
explanation: The Schwann cells are a type of glial cell of the peripheral nervous system that surrounds neurons. They function in myelinating the axon, allowing signals to propagate down the axon faster than non-myelinated axons, as the signal is able to jump between myelinated sections into sections known as the nodes of Ranvier. They are a major glial cell type in the peripheral nervous system.
name: Schwann cell
label: d
answer: no

Correct answer: a