hllj/quesmed huggingface dataset:
A 39-year-old male patient has recently been diagnosed with young-onset Parkinson's disease. He has depression. He is recently unemployed, smokes 20 cigarettes a day and is struggling financially as a result of a gambling addiction. He currently lives with his mother in his family home.

Which medication should be avoided?

Options:
explanation: Benserazide is a peripheral decarboxylase inhibitor. It is often given in combination with levodopa. It is not known to cause impulse control disorders.
name: Benserazide
label: c
answer: no
explanation: Selegiline is a monoamine oxidase-B inhibitor. It does not commonly cause impulse control disorders.
name: Selegiline
label: e
answer: no
explanation: Impulse control disorders are less commonly a side effect of levodopa. Dyskinesia, an on-off phenomenon and wearing-off effect are long-term side effects.
name: Levodopa
label: b
answer: no
explanation: Entacapone is a catechol-O-Methyl Transferase (COMT) inhibitor. It is used in conjunction with levodopa. It is not commonly known to cause impulse control disorders.
name: Entacapone
label: d
answer: no
explanation: Ropinirole is a dopamine agonist. A notable side effect of dopamine agonists is the development of impulse control disorders.
name: Ropinirole
label: a
answer: yes

Correct answer: a
A 34-year-old woman has been contacted by the Macmillan cancer nurse following a positive diagnosis of stage three colon cancer. She declines to take the call, does not turn up to appointments and returns letters from the hospital.

Which coping mechanism is the patient demonstrating in response to her new diagnosis?

Options:
explanation: Problem-focused coping involves taking concrete steps to change or eliminate the stressor. Examples include seeking information, making a plan, problem-solving, and seeking social support to find solutions.
name: Problem-focused Coping
label: c
answer: no
explanation: Approach coping refers to actively engaging with a stressor, problem, or challenging situation. It involves taking proactive steps to confront and address the issue, rather than avoiding it or simply enduring it.
name: Approach coping
label: d
answer: no
explanation: Emotion-focused coping strategies are designed to manage the emotional responses to a stressor. Instead of directly addressing the problem, these strategies aim to regulate the emotional impact. Examples include seeking emotional support, relaxation techniques, meditation, and expressive writing.
name: Emotion-focused Coping
label: b
answer: no
explanation: Maladaptive coping strategies involve actions that may provide short-term relief but are ultimately detrimental in the long run. Examples include substance abuse, denial, and aggressive behaviour.
name: Maladaptive coping
label: e
answer: no
explanation: In avoidance coping, individuals try to avoid or escape the stressor or their emotional response to it. This can involve denial, distraction, or turning to activities or substances to numb or avoid the emotions associated with the stressor.
name: Avoidance coping
label: a
answer: yes

Correct answer: a
A 45-year-old male patient presents to A&E with severe lower back pain, bilateral leg weakness and saddle anaesthesia. He is unable to walk. He informs you that he cannot control his bowels or bladder.

Given the likely diagnosis, what is the definitive management of this patient?

Options:
explanation: Physiotherapy might be needed postoperatively to regain strength and mobility. However, it is not an option for the definitive management of caudal equina syndrome.
name: Physiotherapy
label: d
answer: no
explanation: Immunoglobulins may be given for neurological conditions affecting gait, such as Guillan-Barre syndrome and multiple sclerosis. There is no role for immunoglobulins in cauda equina syndrome.
name: Immunoglobulins
label: c
answer: no
explanation: This patient has cauda equina syndrome. In the majority of cases, surgical decompression is the primary treatment. The goal of surgery is to relieve pressure on the cauda equina nerves. It is important to detect and treat it as soon as possible to prevent irreversible nerve injury.
name: Surgical decompression
label: a
answer: yes
explanation: There is no role for antibiotics in the management of cauda equina syndrome.
name: Antibiotics
label: e
answer: no
explanation: Although patients with caudal equina syndrome may experience significant pain and analgesia should be given, it is not the definitive management.
name: Analgesia
label: b
answer: no

Correct answer: a
A 26-year-old male patient with arm pain. He informs you that he sustained a laceration on the medial aspect of his forearm last week that required stitches. The skin feels hot to the touch, he describes the pain as dull in quality. On palpation of the area, there is hypersensitivity and the patient limits the movement of his arm. He has no fever.

What type of pain is the patient experiencing?

Options:
explanation: Nociplastic pain is characterised by altered pain processing in the nervous system without clear evidence of ongoing tissue damage or nerve injury.
name: Nociplastic pain
label: d
answer: no
explanation: Referred pain occurs when the pain is felt in a location different from the actual source of the problem. It is often due to shared nerve pathways.
name: Referred pain
label: e
answer: no
explanation: Nociceptive pain is the most common type and is typically caused by the activation of pain receptors (nociceptors) in response to tissue damage or injury. Nociceptive pain feels sharp, aching, or throbbing. It's often caused by an external injury, like stubbing your toe, having a sports injury, or a dental procedure.
name: Nociceptive pain
label: b
answer: no
explanation: Neuropathic pain results from damage or dysfunction of the nervous system, particularly the nerves themselves. It is often described as a burning, shooting, or electric shock-like pain.
name: Neuropathic pain
label: c
answer: no
explanation: Inflammatory pain results from the body's inflammatory response to injury or infection. It is a protective form of pain during the healing process.
name: Inflammatory pain
label: a
answer: yes

Correct answer: a
A 22-year-old female in involved in a car accident. She opens her eyes to pain. She is unable to tell you her past medical history and makes inappropriate conversation to your questions. She pulls away from painful stimulus.

What is her Glasgow coma scale score?

Options:
explanation: The patient scores eye-opening: 2, verbal response: 4, motor response: 5. This equates to 11.
name: 12
label: c
answer: no
explanation: Eye-opening: 2, verbal response: 4, motor response: 5.
name: 11
label: a
answer: yes
explanation: The patient scores eye-opening: 2, verbal response: 4, motor response: 5. This equates to 11.
name: 13
label: e
answer: no
explanation: The patient scores eye-opening: 2, verbal response: 4, motor response: 5. This equates to 11.
name: 10
label: b
answer: no
explanation: The patient scores eye-opening: 2, verbal response: 4, motor response: 5. This equates to 11.
name: 9
label: d
answer: no

Correct answer: a
A 35-year-old male presents with opiate dependence. He would like to quit but is fearful of withdrawing. He has had four previous overdoses caused by opioids.

What is the safest medication we can give him to help with his withdrawal symptoms?

Options:
explanation: Methadone is a full-agonist of the mu receptor. It is long-acting and there is a risk of overdose, making this a less safe option.
name: Methadone
label: b
answer: no
explanation: Naltrexone is an antagonist of the mu receptor. It is used when a person overdoses on opiates.
name: Naltrexone
label: c
answer: no
explanation: Buprenorphine is a partial agonist of the mu receptor. It has a ceiling effect, which reduces the risk of overdose and limits the euphoria caused by opioid use.
name: Buprenorphine
label: a
answer: yes
explanation: Acamprosate is used for alcohol use disorder. It helps reduce alcohol cravings and may alleviate some withdrawal symptoms. It is not used for opiate addiction.
name: Acamprosate
label: d
answer: no
explanation: Disulfiram is also used in alcohol use disorder. It causes unpleasant adverse reactions when alcohol is consumed, discouraging its use. It is not used for opiate addiction.
name: Disulfiram
label: e
answer: no

Correct answer: a
A 26-year-old female athlete who runs long-distance marathons presents to the clinic with back pain. You ask the patient to stand up to examine her.

Which muscle unit is recruited to maintain an upright posture?

Options:
explanation: These fibres provide intermediate contraction speed. They display moderate fatigue resistance due to the reliance on both aerobic and anaerobic metabolism. They are recruited in activities requiring both endurance and strength, such as middle-distance running and swimming.
name: Type IIa (intermediate muscle fibres)
label: b
answer: no
explanation: There is no type IV motor unit.
name: Type IV (fast twitch muscle fibres)
label: e
answer: no
explanation: There is no type III motor unit.
name: Type III (slow twitch muscle fibres)
label: d
answer: no
explanation: These fibres provide slow and sustained contractions and hence are well suited to maintain an upright posture. They display high fatigue resistance due to a rich blood supply and numerous mitochondria. They primarily rely on aerobic respiration (oxidative phosphorylation) for energy production.
name: Type I (Slow twitch muscle fibres)
label: a
answer: yes
explanation: These fibres provide fast and powerful contractions. They display low fatigue resistance due to reliance on anaerobic metabolism. They are suited for high-intensity, short-duration activities, such as weightlifting and sprinting.
name: Type IIb (fast twitch muscle fibres)
label: c
answer: no

Correct answer: a
A 38-year-old female patient presents to the ENT outpatient clinic with reduced hearing. In the left ear, Rinne’s test is positive. In the right ear, bone conduction is greater than air conduction. Weber’s test lateralises to the right ear.

What is the likely diagnosis?

Options:
explanation: The patient has a negative Rinne’s test in the right ear and Weber’s test lateralises to the right. In normal hearing, air conduction should be greater than bone conduction and Weber’s test should be heard equally in both ears.
name: Normal hearing
label: e
answer: no
explanation: In left sensorineural hearing loss, Rinne’s test would be positive in both ears and Weber’s test would lateralise to the right (the unaffected ear).
name: Left sensorineural hearing loss
label: d
answer: no
explanation: In left conductive hearing loss, Rinne’s test would be negative in the left ear and Weber’s test would lateralise to the left.
name: Left conductive hearing loss
label: b
answer: no
explanation: This patient has right conductive hearing loss, characterised by a negative Rinne’s test in the affected ear and lateralisation of Weber’s test to the affected ear.
name: Right conductive hearing loss
label: a
answer: yes
explanation: In right sensorineural hearing loss, Rinne’s test would be positive in both ears and Weber’s test would lateralise to the left (the unaffected ear).
name: Right sensorineural hearing loss
label: c
answer: no

Correct answer: a
A 35-year-old male has sustained a traumatic spinal cord injury. He tells you he has difficulties perceiving pain and temperature.

Which tract has been affected?

Options:
explanation: The spinothalamic tract carries sensory information about pain, temperature, crude touch and pressure from the periphery to the brain.
name: Spinothalamic tract
label: a
answer: yes
explanation: The dorsal columns carry discriminative touch, vibration and proprioception.
name: Dorsal column
label: c
answer: no
explanation: The medial vestibulospinal tract performs the synchronization of the movement of the eyes with the movement of the head so that the eyes do not lag when the head moves to one side.
name: Medial vestibulospinal tract
label: b
answer: no
explanation: This tract carries motor information from the brain to the spinal cord and then to the periphery. Lesions in the corticospinal tract cause paralysis or weakness in the muscles controlled by the affected part of the tract.
name: Corticospinal tract
label: e
answer: no
explanation: The nerve cells of the corona radiata are afferent and efferent, meaning they carry messages to and from the body. They have no role in perception of pain or temperature.
name: Corona radiata
label: d
answer: no

Correct answer: a
A 5-year-old boy tripped and hurt his knee. His mother started rubbing his knee to help ease the pain.

Which nerve fibre is being recruited to block the pain signals?

Options:
explanation: Aα fibre is a large diameter, myelinated afferent nerve fibre that carries information about proprioception from muscles. It is not involved in the pain gate theory.
name: Aα fibres
label: b
answer: no
explanation: Aβ is a large diameter, myelinated afferent nerve fibre that carries information about heavy pressure, light touch, deep touch and vibration. Rubbing the knee causes signals to travel down the Aβ fibres blocking pain signals traveling in the C-fibres. In the pain gate theory, this action closes the pain gate.
name: Aβ fibres
label: a
answer: yes
explanation: Aδ fibre is a small-diameter, myelinated afferent nerve fibre that carries information about pain and temperature. It is not involved in the pain gate theory.
name: Aδ fibres
label: c
answer: no
explanation: Aγ fibre is a small-diameter, myelinated nerve fibre that innervates muscle spindles and is involved in regulating muscle spindle sensitivity and muscle tone. It is not involved in the pain gate theory.
name: Aγ fibres
label: e
answer: no
explanation: C fibre is a small-diameter, unmyelinated nerve fibre that carries information about pain and temperature. The action of rubbing causes signals to travel down the Aβ fibres blocking pain signals traveling in the C-fibres. In the pain gate theory, this action closes the pain gate.
name: C fibres
label: d
answer: no

Correct answer: a
A 57-year-old female patient presented to the GP with symptoms of low mood. This is accompanied by loss of enjoyment in her daily activities and difficulties sleeping. She has poor concentration and cannot read more than 5 pages of her book. She is on the waiting list for cognitive behavioural therapy and would like medication to help with her symptoms. The GP decides to prescribe her mirtazapine.

What is the mechanism of action of mirtazapine?

Options:
explanation: Mirtazapine blocks the alpha-2 adrenergic receptors. By doing so, it enhances the release of norepinephrine and serotonin in the brain. Increased levels of these neurotransmitters are associated with improved mood.
name: Alpha-2 adrenergic receptor antagonist
label: a
answer: yes
explanation: This is the mechanism of action of monoamine oxidase inhibitors. Monoamine oxidase is an enzyme that breaks down neurotransmitters like serotonin, norepinephrine, and dopamine. Inhibiting it increases the levels of these neurotransmitters.
name: Inhibition of monoamine oxidase
label: c
answer: no
explanation: This is one of the mechanisms of action of serotonin-norepinephrine re-uptake inhibitors. This leads to the increase of catecholamines in the synaptic cleft.
name: Inhibition of the noradrenaline re-uptake transporter
label: d
answer: no
explanation: This is the mechanism of selective serotonin re-uptake inhibitors. This leads to an increase in the serotonin in the synaptic cleft.
name: Inhibition of the serotonin re-uptake
label: b
answer: no
explanation: This is the mechanism of action of typical antipsychotics, such as haloperidol, typically used in acute episodes of psychosis. It blocks the activity of dopamine.
name: Dopamine (D2) receptor antagonist
label: e
answer: no

Correct answer: a
A 72-year-old male patient is brought to A&E by his wife who is concerned that he has been unsteady, drowsy and confused. He has reduced consciousness. His wife notes that he fell over six weeks ago, but seemed fine. His CT head shows a crescent-shaped collection of blood in the right hemisphere.

What is the diagnosis?

Options:
explanation: A subarachnoid haemorrhage occurs in the subarachnoid space, the area between the arachnoid mater and the pia mater. It is often caused by the rupture of an aneurysm. The hallmark symptom of SAH is a sudden, severe headache, often described as "the worst headache of my life." It is characterised by the presence of blood in the subarachnoid space on a CT scan.
name: Subarachnoid haemorrhage
label: c
answer: no
explanation: Extradural haemorrhage occurs between the skill and the dura mater. It typically results from head trauma, which damages the middle meningeal artery. It shows as a biconvex/lens-shaped collection of blood on CT scan.
name: Extradural haemorrhage
label: b
answer: no
explanation: A subdural haemorrhage occurs between the dura mater and the arachnoid mater. It is often the result of head trauma. The trauma causes the bridging veins to rupture, leading to bleeding in the space between the dura and the arachnoid mater. Symptoms include headache, altered mental status, confusion, drowsiness, weakness, seizures, and focal neurological deficits. A crescent-shaped collection of blood is a characteristic sign on CT.
name: Subdural haemorrhage
label: a
answer: yes
explanation: Intracerebral haemorrhage occurs within the brain tissue itself, leading to the accumulation of blood in the brain. Intracerebral haemorrhage is most commonly caused by the rupture of small blood vessels (typically small arteries) within the brain. Hypertension is a major risk factor. A CT scan will show a collection of blood within the brain parenchyma.
name: Intracerebral haemorrhage
label: d
answer: no
explanation: Ischaemic strokes are the most common type of stroke and are typically caused by a blockage or clot in a blood vessel that supplies blood to the brain. It is not caused by head trauma. Ischaemic strokes typically present as areas of hypo-density on a CT scan.
name: Ischaemic Stroke
label: e
answer: no

Correct answer: a
A 36-year-old male patient presents to A&E following a road traffic accident. The paramedic report notes that he did lose consciousness, but has since regained consciousness. The nurse is worried because he seems to be getting more drowsy again. A CT head shows a lens-shaped collection of blood from the middle meningeal artery.

Given the likely diagnosis, which foramen does the implicated artery pass through?

Options:
explanation: The jugular foramen, located between the temporal and occipital bones, allows the internal jugular vein and several cranial nerves (IX, X, and XI) to pass.
name: Jugular foramen
label: e
answer: no
explanation: Located at the base of the skull, the foramen magnum is the largest foramen and allows the spinal cord to pass from the brain into the spinal canal.
name: Foramen magnum
label: d
answer: no
explanation: The foramen ovale allows the mandibular division of the trigeminal nerve (V3) to pass through.
name: Foramen ovale
label: b
answer: no
explanation: This patient has an extradural haemorrhage, characterised by the lucid interval and haemorrhage from the middle meningeal artery. The foramen spinosum sits in the greater wing of the sphenoid bone and allows passage of the middle meningeal artery.
name: Foramen spinosum
label: a
answer: yes
explanation: This foramen, located in the sphenoid bone, transmits the maxillary division of the trigeminal nerve (V2).
name: Foramen rotundum
label: c
answer: no

Correct answer: a
A 15-year-old female patient presents to her GP requesting contraception. She is sexually active with her 15-year-old boyfriend. She has been using the pull-out method and would like to be started on the pill to prevent pregnancy. The GP counsels her on contraceptives, she can understand, weigh up and communicate her decision. She would like to try the mini-pill. She does not want her parents to know.

What should the GP do?

Options:
explanation: It is unnecessary to inform the police in this situation as there are no safeguarding concerns.
name: Inform the police
label: d
answer: no
explanation: The patient is deemed Gillick competent. She understood the GP's advice and was able to retain and weigh up the information and communicate it back.
name: Prescribe the contraceptive pill
label: a
answer: yes
explanation: The patient is Gillick competent. Persuading her to tell her parents may endanger your rapport.
name: Persuade her to tell her parents
label: c
answer: no
explanation: As she is deemed to be Gillick competent, the GP should not inform her parents and should maintain confidentiality.
name: Inform her parents
label: b
answer: no
explanation: The GP is not in a position to advise her against having sexual intercourse. She is Gillick competent and should be prescribed the contraceptive pill.
name: Promote abstinence as she is underage
label: e
answer: no

Correct answer: a
A 72-year-old male patient presents to the neurology clinic with unilateral resting tremor, bradykinesia and rigidity. He is diagnosed with Parkinson's disease.

Which one of the following is a risk factor for Parkinson's disease?

Options:
explanation: Living in rural areas or farming communities has been linked to a higher risk of Parkinson's disease, possibly due to pesticide exposure or other environmental factors.
name: Living in rural areas
label: d
answer: no
explanation: A history of significant head injuries, especially repeated head trauma (e.g., in professional athletes such as boxers), has been associated with an increased risk of Parkinson's disease.
name: Repeated head trauma
label: a
answer: yes
explanation: Some studies have suggested that smoking may be associated with a reduced risk of Parkinson's disease, though the health risks of smoking far outweigh any potential benefits.
name: Smoking
label: c
answer: no
explanation: Some studies have suggested that regular caffeine consumption may be associated with a reduced risk of Parkinson's disease
name: Caffeine use
label: b
answer: no
explanation: Males are more likely to develop Parkinson's disease than women. The reasons for this gender difference are not yet fully understood.
name: Female gender
label: e
answer: no

Correct answer: a
A new urine dipstick is being trialled in diagnosing urinary tract infections in a group of 150 patients. The dipstick has diagnosed 50 patients with urinary tract infections. Ten of these patients did not have infections. The other 100 patients screened negative for infection. However, 20 patients did have infection on alternate testing.

What is the specificity of the new urine dipstick?

Options:
explanation: This is not correct. For the specificity to be 50% the test only manages to identify half of the people who do not have the condition.
name: 50%
label: d
answer: no
explanation: This is the sensitivity of the test. The sensitivity of a diagnostic test is a measure of how well the test correctly identifies individuals who have a particular condition or disease (true positives). Sensitivity = (True Positives) / (True Positives + False Negatives).Sensitivity = (40)/(40+20)= 0.67X100=67%
name: 67%
label: b
answer: no
explanation: The specificity of a diagnostic test is a measure of how well the test correctly identifies individuals without a particular condition or disease (true negatives). It can be calculated by this formula: Specificity = (True Negatives) / (True Negatives + False Positives). Specificity = (80)/(80+10)=0.89 you then multiply by a 100 to give you a percentage.
name: 89%
label: a
answer: yes
explanation: This is not correct. For the specificity to be 100% the test correctly manages to identify all individuals without the condition i.e., no false positives.
name: 100%
label: e
answer: no
explanation: This is the positive predictive value (PPV). The Positive Predictive Value (PPV) is a statistical measure used to assess the proportion of individuals who test positive for a condition or disease and truly have the condition.The formula to calculate the Positive Predictive Value is as follows: PPV = (True Positives) / (True Positives + False Positives). PPV= (40)/(40+10)=0.8x100=80%
name: 80%
label: c
answer: no

Correct answer: a