hllj/quesmed huggingface dataset:
For which one of the following reasons can you break patient confidentiality?

Options:
explanation: Healthcare professionals are not allowed to disclose confidential information to anyone that is not the patient. Unless the patient has given explicit consent to do so.
name: Telling a patient's test results to her husband because the patient is unavailable
label: c
answer: no
explanation: Even when a patient passes away, you must maintain patient confidentiality, you cannot disclose the cause of death.
name: When a patient asks about the cause of death of someone who has passed away on the ward
label: d
answer: no
explanation: You would only be required to disclose information about serious communicable diseases.
name: Disclosing information relating to the influenza infection
label: b
answer: no
explanation: According to the Fraser guidelines relating to contraception and sexual health, a teenager can start contraception without parental consent if they are deemed Gillick competent.
name: When the parents of a 15-year-old Gillick competent teenager ask if their daughter has seen you regarding oral contraception
label: e
answer: no
explanation: It is your professional duty to break confidentiality when there is a threat to others.
name: If there is a threat to others
label: a
answer: yes

Correct answer: a
According to the House of Lords classification of CAM (Complementary and Alternative therapies) which one of the following therapies is located in group 2?

Options:
explanation: This is classified as a group 1 therapy, which are professionally organised alternative therapies.
name: Chiropractor
label: c
answer: no
explanation: This is classified as a group 1 therapy, which are professionally organised alternative therapies.
name: Herbal medicine
label: d
answer: no
explanation: This is classified as a group 1 therapy, which are professionally organised alternative therapies.
name: Acupuncture
label: b
answer: no
explanation: This is a group 2 therapy. Group 2 includes complementary therapies.
name: Meditation
label: a
answer: yes
explanation: This is classified as a group 1 therapy, which are professionally organised alternative therapies.
name: Homeopathy
label: e
answer: no

Correct answer: a
Which one of the following about the Equality Act is correct?

Options:
explanation: Incorrect. Gender reassignment is a protected characteristic.
name: Gender reassignment is not a protected characteristic
label: e
answer: no
explanation: The Equality Act was formed in 2010.
name: The Equality Act was formed in 2009
label: c
answer: no
explanation: It actually encourages fair employment opportunities.
name: It discourages fair employment opportunities
label: d
answer: no
explanation: This is not a protected characteristic.
name: Occupation is a protected characteristic under the Equality Act
label: b
answer: no
explanation: This is correct.
name: Age is a protected characteristic under the Equality Act
label: a
answer: yes

Correct answer: a
Which one of the following is correct with respect to the Ottawa charter’s fundamental conditions for health?

Options:
explanation: Inequity is **not** a fundamental condition for health.
name: Inequity, food, shelter, and education are all included as fundamental conditions for health
label: b
answer: no
explanation: There are actually 9 fundamental conditions for health. These include peace, shelter, education, food, income, a stable ecosystem sustainable resources, social justice, and equity.
name: There are 7 fundamental conditions for health according to the Ottawa Charter
label: d
answer: no
explanation: The Ottawa charter **does** include sustainable resources as a fundamental condition for health.
name: The Ottawa charter does not include sustainable resources as a fundamental condition for health
label: e
answer: no
explanation: This is correct. These are all mentioned in the Ottawa Charter.
name: Peace, shelter, food, and education are all included as fundamental conditions for health
label: a
answer: yes
explanation: There are actually 9 fundamental conditions for health. These include peace, shelter, education, food, income, a stable ecosystem,  sustainable resources, social justice, and equity.
name: There are 8 fundamental conditions for health according to the Ottawa Charter
label: c
answer: no

Correct answer: a
Which of the following is the pathophysiology of Guillain-Barré syndrome?

Options:
explanation: This is the process that occurs due to Botulinum toxin, preventing the release of acetylcholine from the neuromuscular junction.
name: Breakdown of SNARE proteins
label: c
answer: no
explanation: Guillain-Barre syndrome is a rare complication of an initial viral infection leading to an autoimmune response.
name: Post-infectious autoimmune neuropathy
label: a
answer: yes
explanation: This is the pathophysiology of motor neurone disease.
name: Spontaneous death of motor neurons
label: b
answer: no
explanation: This is the pathophysiology of poliomyelitis.
name: Cell death of cell bodies in the ventral horn
label: d
answer: no
explanation: This is describing myasthenia gravis.
name: Rare autoimmune disease of the neuromuscular junction
label: e
answer: no

Correct answer: a
Which of the following occurs at the neuromuscular junction?

Options:
explanation: This is incorrect as depolarisation of the pre-synaptic neurone would cause voltage-gated Ca<sup>2+</sup> ions to open.
name: Depolarisation of the pre-synaptic neurone causes voltage-gated Mg<sup>2+</sup> channels to open
label: e
answer: no
explanation: This process is describing the role of Ca<sup>2+</sup> in excitation-contraction coupling. The influx of Ca<sup>2+<sup/> leads to a conformational change of synaptotagmin (a protein) which causes ACh vesicles to fuse with the presynaptic membrane, resulting in exocytosis.
name: Ca<sup>2+</sup> influx in the pre-synaptic neurone triggers acetylcholine (ACh) release into the synapse
label: a
answer: yes
explanation: The opposite occurs – the EPP decreases further away from the end-plate as there is a lack of nicotinic acetylcholine receptors away from the synapse.
name: The end-plate potential (EPP) increases further away from the motor end-plate
label: d
answer: no
explanation: ACh is hydrolysed by acetylcholinesterase to acetyl and choline.
name: Acetylcholine (ACh) is broken down by acetylcholinase within the synaptic cleft
label: c
answer: no
explanation: This is incorrect. Little K+ efflux occurs here as the resting membrane potential of the muscle fibre is very close to the K<sup>+</sup> equilibrium constant (E<sup>k</sup>).
name: Many K<sup>+</sup> ions leave the muscle cell membrane after the binding of acetylcholine (ACh)
label: b
answer: no

Correct answer: a
Which of the following is the definition of neuropraxis?

Options:
explanation: This is the definition of neurotmesis. Causes include severe contusion, stretch and laceration.
name: The entire nerve fibre is cut
label: c
answer: no
explanation: This is the definition for axonotmesis, not neuropraxis. Causes include crush injuries, traction and compression.
name: Damage to the axon but not the endoneurium, lost portion of axon regenerates
label: b
answer: no
explanation: This is the correct definition.
name: Loss of neuronal function only, due to focal demyelination
label: a
answer: yes
explanation: This cannot occur if the cell body dies as neurons are post-mitotic and therefore not replaced.
name: Regeneration of neurone after cell death
label: d
answer: no
explanation: This is the definition of re-innervation.
name: Re-growth of a nerve to re-supply a muscle/effector
label: e
answer: no

Correct answer: a
Which of these describes the spinal route of anaesthetic administration?

Options:
explanation: This describes a topical route of administration.
name: Application onto the surface of the region
label: e
answer: no
explanation: This is also known as intrathecal administration. It is used for genital, urinary tract, or lower body procedures.
name: Injection into CSF within subarachnoid space
label: a
answer: yes
explanation: This is infiltration anaesthesia not spinal.
name: Injection into the tissue
label: c
answer: no
explanation: This is an example of a nerve block.
name: Injection close to nerve course
label: b
answer: no
explanation: This is epidural anaesthesia used in labour and delivery, or operations involving the pelvis and legs. The epidural space is the area between the dura mater and the vertebral bodies.
name: Injection into the epidural space
label: d
answer: no

Correct answer: a
Which one of the following neurotransmitters is classified as a monoamine?

Options:
explanation: Acetylcholine is not a monoamine neurotransmitter. The monoamine neurotransmitters include noradrenaline, dopamine and 5-hydroxytryptamine (serotonin). Acetylcholine is found at the neuromuscular junction.
name: Acetylcholine
label: c
answer: no
explanation: The monoamine neurotransmitters include noradrenaline, dopamine and 5-hydroxytryptamine (serotonin).
name: Noradrenaline
label: a
answer: yes
explanation: This is an example of an amino acid neurotransmitter.
name: Glycine
label: d
answer: no
explanation: This is an example of an amino acid neurotransmitter.
name: Glutamate
label: e
answer: no
explanation: This is an example of a neuroactive peptide.
name: Secretin
label: b
answer: no

Correct answer: a
How does hyperpolarisation occur during an action potential?

Options:
explanation: Ca2+ ions are not involved in the hyperpolarisation of a neurone.
name: Ca2<sup>+</sup> efflux
label: d
answer: no
explanation: This is the cause of depolarisation, not hyperpolarisation.
name: Voltage-gated Na<sup>+</sup> channels open
label: b
answer: no
explanation: In an inhibitory response, the impulse would cause a Cl<sup>-</sup> **influx** to hyperpolarise the cell membrane
name: Cl<sup>-</sup> efflux
label: e
answer: no
explanation: This is what allows the process of repolarisation to occur.
name: Voltage-gated Na<sup>+</sup> channels close
label: c
answer: no
explanation: The membrane potential lowers more than the resting potential because of the delayed closing of the voltage-gated K+ channels, allowing more K+ ions to leave the membrane.
name: Due to excess K<sup>+</sup> efflux
label: a
answer: yes

Correct answer: a
Which one of the following describes the propagation of an action potential in a myelinated axon?

Options:
explanation: A refractory period is the time from the initial depolarisation of the first action potential to the point at which a second action potential can be stimulated.
name: Refractory period
label: d
answer: no
explanation: Conductance is a measure of ion channel activity. If more ion channels are present within the membrane, these channels' activity will increase. Therefore, the conductance will also be higher.
name: Through conductance
label: c
answer: no
explanation: This occurs in a myelinated axon. The myelin will increase the speed of transmission of an action potential along the axon as the ions flow from one node to another. This causes depolarisation and opens voltage-gated sodium channels to produce another action potential.
name: Saltatory conduction
label: a
answer: yes
explanation: This happens in an unmyelinated axon. Differences in charges inside the axon will cause positive ions to flow forwards or backwards. These ions will move and depolarise the membrane. The depolarisation will open voltage-gated channels in that section of the membrane and cause an action potential. This will then trigger further action potentials in the next part of the axon.
name: Electrotonic spread
label: b
answer: no
explanation: This refers to the net movement of small molecules from an area of high concentration to an area of low concentration and does not relate to action potentials.
name: Diffusion
label: e
answer: no

Correct answer: a
Which of the following cells functions in the central nervous system (CNS) to myelinate axons?

Options:
explanation: These are star-shaped cells located in the CNS. They have multiple functions some of which include: forming the blood-brain barrier, providing nutrients to nervous tissue and repairing after infection/traumatic injuries.
name: Astrocytes
label: e
answer: no
explanation: Ependymal cells are types of glial cells that line the ventricles in the brain as well as the central columns of the spinal cord. They secrete cerebrospinal fluid.
name: Ependymal cells
label: d
answer: no
explanation: These are located in the peripheral nervous system (PNS) and cover neuronal cell bodies in the ganglia.
These provide nutrient support and protection to neurones.
name: Satellite cells
label: b
answer: no
explanation: These are located in the CNS and create myelin sheaths for ~50 axons. These sheaths support and insulate the axons.
name: Oligodendrocytes
label: a
answer: yes
explanation: These are located in the peripheral nervous system (PNS). Each Schwann cell will produce a myelin sheath for 1 axon. These sheaths support and insulate the axons.
name: Schwann cells
label: c
answer: no

Correct answer: a
Which one of the following is the most outer tissue envelope of a spinal nerve?

Options:
explanation: This is a connective tissue layer which holds nerve fascicles together. It is loose and protects the inner fascicles against outside pressure.
name: Epineurium
label: a
answer: yes
explanation: This is the most dense and thinnest layer. It has perineural cells which form tight junctions. These protect the cell by forming a blood-nerve barrier.
name: Perineurium
label: c
answer: no
explanation: This is a thin layer of connective tissue which surrounds an individual nerve fibre.
name: Endoneurium
label: e
answer: no
explanation: This is a small bundle of nerve fibres enclosed by perineurium. A fascicle is **not** a tissue envelope.
name: Fascicle
label: b
answer: no
explanation: This refers to the axon of a neurone and is **not** a tissue envelope.
name: Nerve fibre
label: d
answer: no

Correct answer: a
Which of the following is a sign of an upper motor neurone (UMN) lesion?

Options:
explanation: This is a later effect of **lower motor neurone (LMN)** lesions and occurs because of denervation and disuse of the muscle.
name: Muscle atrophy
label: e
answer: no
explanation: Alpha motor neurones stimulate target muscle fibres. A **lower motor neuron (LMN)** lesion will cause decreased muscle tone because the alpha motor neurons are damaged and therefore muscle fibres cannot be stimulated. In a UMN lesion, there will be hypertonia.
name: Hypotonia
label: c
answer: no
explanation: In a UMN lesion, inhibitory modulation of the descending pathways is lost. Therefore, the myotatic (stretch) reflex will be exaggerated thus causing hypertonia. In a lower motor neuron (LMN) lesion you will see hyporeflexia.
name: Hyperreflexia
label: a
answer: yes
explanation: Alpha motor neurones are affected in **lower motor neuron (LMN)** lesions, therefore, there will be abnormal activity thus causing fasciculations.
In UMN lesions alpha motor neurones are spared so there are no fasciculations present.
name: Fasciculations
label: d
answer: no
explanation: The alpha motor neurones causing muscle contraction become damaged in a **lower motor neuron (LMN)** lesion, therefore there is hyporeflexia. In a UMN lesion, you will see hyperreflexia.
name: Hyporeflexia
label: b
answer: no

Correct answer: a
In which of the following instances is it contraindicated to perform a lumbar puncture?

Options:
explanation: The patient being **on** anti-coagulation therapy would be a contraindication because of the associated increased risk of bleeding.
name: If the patient is not on anti-coagulant therapy
label: b
answer: no
explanation: If the patient had a spinal abscess this **would be** a contraindication for a lumbar puncture. This is because the procedure can cause bacteria to spread into the subarachnoid space.
name: If there is no clinical suspicion of a spinal abscess
label: d
answer: no
explanation: If a patient had thrombocytopenia or a clotting disorder this **would be** a contraindication for carrying out a lumbar puncture.
name: If the patient does not have thrombocytopenia or other clotting disorders
label: c
answer: no
explanation: Spinal trauma would be a contraindication for a lumbar puncture. This is because the anatomy and spinal structure would be altered thus resulting in the unsafe placement of the needle.
name: If there is no acute spinal trauma
label: e
answer: no
explanation: If a lumbar puncture is carried out in those with a raised intracranial pressure due to a space occupying lesion this can precipitate brainstem herniation. This is because there is a sudden decrease in pressure within the spinal cord by removing cerebrospinal fluid (CSF). Other causes of raised intracranial pressure can be treated with a lumbar puncture, for example in hydrocephalus.
name: If the patient has raised intracranial pressure due to a space occupying lesion
label: a
answer: yes

Correct answer: a
A 56-year-old male has presented to the emergency department. He describes that a week ago he had numbness in his feet and that this has now progressed, causing weakness in his legs and hands. He has no relevant past medical history except that a couple of weeks ago he caught a stomach bug from his grandson.

Which one of the following conditions is the most likely diagnosis?

Options:
explanation: This is a rapid-onset muscle weakness affecting peripheral nerves. It begins in the feet and hands and is usually bilateral. It can be life-threatening if the diaphragm is affected. The cause is unknown but most often the immune system's dysfunction is precipitated by an infection.
name: Guillain-Barré Syndrome
label: a
answer: yes
explanation: This is when the nerves in the lower back become compressed. The patient gets sciatica on both sides, saddle anaesthesia and weakness in both legs which becomes progressively worse. This is a medical emergency! In this scenario the patient has weakness but no sciatica so it is less likely to be cauda equina syndrome, however, it should always be considered as an important differential.
name: Cauda equina syndrome
label: d
answer: no
explanation: This is a condition caused by a lesion or damage in one half of the spinal cord. Paralysis and loss of proprioception occur on the ipsilateral side of the lesion and loss of pain/temperature sensation on the contralateral side. In this scenario, both sides of the patient's body are affected.
name: Brown-Séquard syndrome
label: c
answer: no
explanation: This is when the botulinum toxin attacks the nervous system. This results in muscle paralysis and can be reversed if given treatment. If the muscles of the diaphragm are affected it can be fatal. In this scenario, the patient has not presented with any muscle paralysis.
name: Botulism
label: e
answer: no
explanation: This is a demyelinating disease which damages nerve cells in the brain and spinal cord. Symptoms include diplopia, muscle weakness and sensation/coordination impairment. This may present similarly to Guillain-Barré Syndrome but its onset time is usually much longer thus making it more difficult to diagnose.
name: Multiple Sclerosis
label: b
answer: no

Correct answer: a
A 25-year-old male has presented to the emergency department by ambulance. The paramedics tell you that he described a sudden severe headache reaching maximal intensity almost immediately. He also had some nausea and vomiting.

On examination, the patient has double vision and has started to become increasingly drowsy.

Which of the following describes a subarachnoid haemorrhage?

Options:
explanation: This describes uncal herniation and is a complication of raised intracranial pressure. This can occur following a haemorrhage when there is lots of blood collecting within the skull.
name: Rising intracranial pressure causes the brain to move from one intracranial compartment to another
label: e
answer: no
explanation: This describes a subdural haemorrhage.
This usually occurs due to the tearing of veins across the subdural space. There is increased intracranial pressure leading to compression of the brain.
name: Blood collecting between the dura mater and arachnoid mater
label: b
answer: no
explanation: This describes subarachnoid haemorrhage. The subarachnoid space is located between the arachnoid mater and the pia mater. The patient usually describes a severe headache, reaching maximal intensity very quickly. The raised intracranial pressure begins to compress the brain and causes symptoms described in the scenario above.
name: Bleeding between the arachnoid mater and the pia mater
label: a
answer: yes
explanation: This describes an intraparenchymal haemorrhage. It can occur due to hypertension, arteriovenous malformations and aneurysm rupture.
name: Bleeding into the tissues of the brain
label: d
answer: no
explanation: This describes an epidural haemorrhage.
Symptoms usually include a severe headache and loss of consciousness however are usually post-trauma to the skull.
name: Typically due to middle meningeal artery damage leading to arterial bleeding into the epidural space
label: c
answer: no

Correct answer: a
A 70-year-old man presents to the rapid access chest pain clinic with constricting discomfort in the front of his chest, precipitated by physical exertion and relieved by rest within five minutes. He has no relevant past medical history and had been well before this occurred. His examination is entirely normal with no chest wall tenderness and his resting ECG is in sinus rhythm.

Which of the following is the most likely diagnosis?

Options:
explanation: Costochondritis is a cause of chest wall pain that results from inflammation of the costal cartilage, the cartilage that connects the ribs to the sternum. It classically presents with pain when taking a deep breath or in certain positions. It often occurs after a recent illness with coughing or after intense exercise and is mostly of unilateral origin. The pain is reproduced on palpation of the affected area too - commonly ribs two to five.
name: Costochondritis
label: d
answer: no
explanation: Myocarditis affects people of all ages (symptom onset is typically in those 20 to 50 years of age) and has a wide range of clinical presentations making its diagnosis challenging. Although it may be asymptomatic, the most common presenting features are chest pain (in 85–95% of cases), fever (in approximately 65%) and dyspnoea (19–49% of cases). Other features include palpitations, syncope and fatigue. Up to 80% of patients with acute myocarditis have prodromal symptoms. Patients may have a history of a preceding flu-like, respiratory and/or gastrointestinal illness, making this a less likely diagnosis.
name: Acute myocarditis
label: e
answer: no
explanation: Chest pain typical of angina is defined by the following three features: constriction-like pain in chest/neck/arm/jaw, brought on by physical activity, and alleviated by rest or glyceryl trinitrate within minutes. Two out of three features indicate atypical angina pain.
name: Stable angina
label: a
answer: yes
explanation: Unstable angina is defined as myocardial ischaemia at rest or on minimal exertion in the absence of acute cardiomyocyte injury/necrosis. It is characterised by specific clinical findings of prolonged (>20 minutes) angina at rest; new onset of 'severe' angina; angina that is increasing in frequency, longer in duration, or lower in threshold; or angina that occurs after a recent episode of myocardial infarction. None of these apply to this case of stable angina.
name: Unstable angina
label: b
answer: no
explanation: Acute Pericarditis is inflammation of the pericardial sac. It presents most often in men aged 20 to 50 years old with acute retrosternal, sharp, pleuritic chest pain that varies in severity. It is frequently exacerbated in the supine position, by coughing, and with inspiration. Classic ECG changes occur in around 90% of patients and include widespread concave upward ST-segment elevation and PR-segment depression without T-wave inversions.
name: Acute pericarditis
label: c
answer: no

Correct answer: a