hllj/quesmed huggingface dataset:
A 68-year-old man presents to the Emergency Department with severe left back pain, radiating to his lower abdomen. He has a history of renal stones.

Given the most likely diagnosis, what results would you expect to find positive in this patient's urine dipstick?

Options:
explanation: Urine bilirubin levels are an indicator of hepatobiliary health. Bilirubin is synthesised in the liver - when there is a blockage in the hepatobiliary system, bilirubin builds up, and begins to be excreted in the urine as the body tried to expel the excess.

This patient is having left back and abdominal pain - a lesion in the liver and gallbladder would cause right-sided abdominal pain. This patient also has a history of renal stones, making his most likely diagnosis renal colic from a stone in his ureters. You would not expect to find positive urine bilirubin in his urine dipstick.
name: Urine Bilirubin
label: c
answer: no
explanation: This patient is presenting with renal colic - a severe 'loin to groin' pain that usually results from a large renal stone being blocked in the ureters.

Renal stones can cause haematuria - blood in the urine - when they get lodged in the ureters they damage the epithelial cells lining them, causing some blood loss.
name: Blood in Urine
label: a
answer: yes
explanation: Urine glucose is positive on a urine dipstick if there is an increased level of glucose in the urine. This can happen in disorders such as Diabetes Mellitus.

We would not expect to find a positive glucose in this patient - he does not have a history of diabetes, and his symptoms are pointing towards a diagnosis of renal colic due to his history of renal stones.
name: Urine Glucose
label: d
answer: no
explanation: Urine ketones are found to be positive when there are excess ketones in the urine. This can happen in a Type I Diabetes Mellitus complication known as Diabetic Ketoacidosis (DKA), where ketones are released into the blood since the body is unable to absorb any glucose.

We would not expect to see positive ketones in this patient - he does not have a history of Type I Diabetes Mellitus.
name: Urine Ketones
label: e
answer: no
explanation: This patient is presenting with renal colic, most likely due to his renal stones getting stuck in his left ureter.

This would cause blood in the urine as the renal stone is damaging epithelial cells in the ureters, but it should not cause protein loss in the urine. Proteinuria is indicative of abnormal kidney function, which should not be the case in this patient - the renal stone is what is causing pain, not a diseased kidney.
name: Urine Protein
label: b
answer: no

Correct answer: a
The Glomerular Filtration Rate (GFR) is the volume of liquid that is filtered by the kidneys per unit of time. It is measured in mL/min, with a substance called inulin, which is freely filtered by the kidneys.


The equation to calculate GFR is:


GFR x Plasma concentration of inulin = Urine Flow Rate x Urine Concentration of Inulin.


If a patient's plasma inulin concentration was 0.11mmol/L, their urine concentration of inulin was 11mmol/L and their urine flow rate was 1.1mL/min, what would this patient's GFR be?

Options:
explanation: GFR = (Urine Flow Rate x Urine Concentration of Inulin) / Plasma concentration of inulin

GFR = (1.1mL/min x 11mmol/L) / 0.11mmol/L
GFR = 110mL/min
name: 110mL/min
label: a
answer: yes
explanation: GFR = (Urine Flow Rate x Urine Concentration of Inulin) / Plasma concentration of inulin

GFR = (1.1mL/min x 11mmol/L) / 0.11mmol/L
GFR = 110mL/min
name: 0.11mL/min
label: e
answer: no
explanation: GFR = (Urine Flow Rate x Urine Concentration of Inulin) / Plasma concentration of inulin

GFR = (1.1mL/min x 11mmol/L) / 0.11mmol/L
GFR = 110mL/min
name: 1100mL/min
label: c
answer: no
explanation: GFR = (Urine Flow Rate x Urine Concentration of Inulin) / Plasma concentration of inulin

GFR = (1.1mL/min x 11mmol/L) / 0.11mmol/L
GFR = 110mL/min
name: 1.1mL/min
label: d
answer: no
explanation: GFR = (Urine Flow Rate x Urine Concentration of Inulin) / Plasma concentration of inulin

GFR = (1.1mL/min x 11mmol/L) / 0.11mmol/L
GFR = 110mL/min
name: 11mL/min
label: b
answer: no

Correct answer: a
The brain can regulate the force a single muscle can produce in a mechanism where, as the firing rate of a motor unit increases, the force produced by the motor unit also increases.

Which mechanism of muscle regulation is this describing?

Options:
explanation: Summation is a phenomenon that occurs when motor unit action potentials fire so quickly that they are not able to relax in between action potentials.
name: Summation
label: b
answer: no
explanation: Rate coding is one of the two mechanisms the brain uses to control muscle force.

There are three different types of motor units - slow, fast fatiguable and fast fatigue resistant. A motor unit is capable of firing at a range of different speeds. In rate coding, slower units fire at a lower frequency and produce less force. Faster units fire at a faster frequency, producing more force.
name: Rate coding
label: a
answer: yes
explanation: The recruitment principle of motor unit regulation means that smaller units are recruited first, followed by larger units if more force is required. This allows for better control of muscles.
name: Recruitment
label: c
answer: no
explanation: Isometric muscle contraction occurs when the muscle is contracted, but there is no movement of the muscle - no shortening or lengthening. For example, if you held a weight out in front of you and did not move.
name: Isometric
label: e
answer: no
explanation: Concentric muscle contraction is a muscle contraction where the muscles shorten, such as doing a bicep curl.
name: Concentric
label: d
answer: no

Correct answer: a
A 78-year-old man presents to the Emergency Department with a heart rate of 136 bpm. After doing an echocardiogram, his end-diastolic volume is 100mL, with an end-systolic volume of 75mL.

What is this patient's cardiac output in litres/minute?

Options:
explanation: CO = SV x HR
SV = 100mL - 75mL

CO = 25mL x 136bpm
CO = 3.4L/min
name: 10.2L/min
label: d
answer: no
explanation: CO = SV x HR
SV = 100mL - 75mL

CO = 25mL x 136bpm
CO = 3.4L/min
name: 13.6L/min
label: c
answer: no
explanation: Cardiac output is calculated with the following equation:

Cardiac output (CO) = Stroke Volume (SV) x Heart Rate (HR)
CO = SV x HR

Stroke Volume (SV) = End-diastolic volume (EDV) - End-systolic volume (ESV)
SV = EDV - ESV

For this patient:
SV = 100mL - 75mL
SV = 25mL

CO = 25mL x 136bpm
CO = 3400mL/min
CO = 3.4L/min
name: 3.4L/min
label: a
answer: yes
explanation: This patient's cardiac output is 3400mL/min, 3.4L/min

CO = SV x HR
SV = 100mL - 75mL

CO = 25mL x 136bpm
CO = 3.4L/min
name: 3400L/min
label: b
answer: no
explanation: CO = SV x HR
SV = 100mL - 75mL

CO = 25mL x 136bpm
CO = 3.4L/min
name: 4.1L/min
label: e
answer: no

Correct answer: a
Which phenomenon can the law of LaPlace explain in terms of cardiac mechanics?

Options:
explanation: The tendency for a tissue to distort under pressure is known as the tissue's compliance:

Compliance (C) = Change in volume (mL) / Change in pressure (mmHg)
name: Veins have an increased tendency to distort under pressure
label: e
answer: no
explanation: This is explained by the Frank-Starling Law, which states that as the heart fills up with more blood in diastole, it contracts and pumps out more blood during systole.
name: Stroke volume increases as end-diastolic volume increases
label: b
answer: no
explanation: This is explained by the cardiac length-tension relationship, which states that cardiac muscle length is proportional to the force produced.
name: The force of cardiac muscle contraction depends on the number of myosin-actin bridges formed
label: c
answer: no
explanation: This is explained through the equation for Mean Arterial Pressure (MAP).

Mean Arterial Pressure (MAP) = Cardiac Output (CO) x Peripheral Vascular Resistance (PVR)
name: Cardiac output is inversely proportional to peripheral vascular resistance
label: d
answer: no
explanation: The Law of LaPlace is a law in physics that states that the wall tension of a cylinder is proportional to the pressure of its contents and the radius of the cylinder:

Wall tension = pressure x radius

Arteries are like cylinders - therefore, the wall tension in arteries is dependent on the pressure of the blood flowing through it, and the radius.

This law explains why the left ventricle thickens in patients that have decreased cardiac output. The radius of a cylinder is inversely proportional to the pressure in the cylinder. This means the ventricle radius needs to decrease to maintain the same pressure through the cardiovascular system.
name: Left Ventricular Hypertrophy
label: a
answer: yes

Correct answer: a
Which of the following would lead to vasoconstriction?

Options:
explanation: Adrenaline causes vasoconstriction - when the body is in 'fight or flight', triggered by adrenaline, vasoconstriction keeps most of the body's blood close to the major organs, ensuring they are perfused first. This also minimises blood loss should that happen.
name: Decreased adrenaline
label: d
answer: no
explanation: Vasopressin, otherwise known as anti-diuretic hormone (ADH), is a potent vasoconstriction.

Increased vasopressin causes increased water retention in the body, raising the blood pressure, and causing vasoconstriction at the same time. This follows the Law of LaPlace - the pressure is inversely related to artery radius - when artery pressure increases, the radius must decrease.

Decreased vasopressin, therefore, has the opposite effect - vasodilation.
name: Decreased vasopressin
label: c
answer: no
explanation: Increased oxygen usage leads to vasodilation. Increased oxygen consumption indicates an increased metabolic need in the body - this can happen, for example, when someone is exercising.

Cells need more oxygen when this occurs, therefore, vasodilation occurs to supply all cells with enough oxygen - this is why our bodies get warmer when we exercise.
name: Increased oxygen usage
label: e
answer: no
explanation: Increased blood temperature causes vasodilation. Think about having a warm shower - it would make your skin warmer from vasodilation. The opposite, such as putting an ice pack on your ankle after an injury would cause vasoconstriction, decreasing blood flow to that area.
name: Increased blood temperature
label: b
answer: no
explanation: Increased angiotensin II would lead to vasoconstriction. Angiotensin II is responsible for increasing blood pressure - when blood pressure rises, vasoconstriction follows. This is due to the Law of Laplace - the blood pressure in a vessel is inversely related to vessel radius - when artery pressure increases, the radius must decrease.
name: Increased Angiotensin II
label: a
answer: yes

Correct answer: a
A 20-year-old female presents to the Emergency Department with a 6-day history of shortness of breath, dizziness and palpitations.

An ECG is performed, showing an irregularly irregular heartbeat, with an absence of p-waves.

Which of the following is the most likely diagnosis?

Options:
explanation: Atrial fibrillation is a common arrhythmia that can occur in the heart.

On ECG, there is an absence of p-waves - the atria are not working properly, and an irregularly irregular rhythm.

Atrial fibrillation is also a classic cause of syncope (fainting), shortness of breath, palpitations and dizziness.

These are all signs and symptoms that our patient is reporting - therefore, her most likely diagnosis is atrial fibrillation.
name: Atrial fibrillation
label: a
answer: yes
explanation: A non-ST elevated myocardial infarction (NSTEMI) is an occlusion of a cardiac vessel that occurs without ST elevation on the ECG. You would still expect to see p-waves, however.
name: Non ST-Elevated Myocardial Infarction
label: b
answer: no
explanation: Mobitz I Heart Block is a type of secondary heart block. It can be seen on an ECG as a progressive prolongation of the PR interval until a P wave is no longer followed by a QRS complex.

This condition can cause a patient to feel faint, have shortness of breath and have chest pain.
name: Mobitz I Heart Block
label: e
answer: no
explanation: Unstable angina is a condition that occurs when someone experiences chest pain, associated with cardiac ischaemia, at rest.

However, what differentiates unstable angina from a STEMI is that there is no ST-elevation on the ECG. There may be ST depression, but you would still see p-waves.

Unstable angina can be differentiated from a Non-ST-elevated myocardial infection (NSTEMI) through a troponin blood test - troponin levels are elevated in an NSTEMI.
name: Unstable Angina
label: c
answer: no
explanation: In an ST-Elevated Myocardial Infarction (STEMI), you would expect to see an elevated ST segment on the ECG.

A myocardial infarction is unlikely to occur in this patient demographic - risk factors for a STEMI include smoking, hyperlipidaemia, hypertension and diabetes mellitus.
name: ST-Elevated Myocardial Infarction
label: d
answer: no

Correct answer: a
A 23-year-old man presents to the Emergency Department with a stab wound, and a large amount of blood loss.

Which of the following signs would you expect to find in this patient?

Options:
explanation: You would expect to find a rapid pulse in this patient. He has experienced a large volume of blood loss, with which his blood pressure would decrease.

The body would try to compensate for this decreased blood pressure by increasing the heart rate - trying to make sure tissues are still being perfused.
name: Slow pulse
label: c
answer: no
explanation: You would expect to find a decreased urine output in this patient. Since he has lost a large volume of blood, his body will struggle to perfuse all his organs due to a drop in blood pressure.

This means his kidneys will be receiving little blood, causing only a small amount of urine production.
name: Increased urine output
label: e
answer: no
explanation: When the body undergoes a large amount of blood loss, it experiences hypovolaemic shock. During hypovolaemic shock, blood pressure drops, since there is an inadequate volume of blood in the cardiovascular system. This leads to other symptoms such as tachycardia.
name: Decreased blood pressure
label: a
answer: yes
explanation: This patient is likely to have a decreased body temperature.

He has lost a large volume of blood, which means his tissues will not be perfused as well as they usually are. Perfusion of the internal organs allows our bodies to be kept warm - this decrease in blood flow will decrease the body temperature as well.
name: Increased body temperature
label: d
answer: no
explanation: You would expect to see decreased blood pressure in this patient. He has had a large amount of blood loss. With decreased blood volume, the body would struggle to maintain a normal blood pressure.
name: Increased blood pressure
label: b
answer: no

Correct answer: a
You are gathering data about the number of children per family across the country.

Which type of variable best describes this measure?

Options:
explanation: Nominal data is a categorical type of qualitative data. It is very binary - for example, you are either infected with COVID-19, or you are not infected with COVID-19.

The number of children in a family would be quantitative data, more specifically, discrete data.
name: Nominal
label: c
answer: no
explanation: The number of children in a family is discrete data.

Discrete data is a quantitative form of data, which has to be a whole number. For example, you cannot have 5.7 children in a family.
name: Discrete
label: a
answer: yes
explanation: Descriptive data is qualitative data, written in text - such as interview quotes.

The number of children in a family is discrete data, which is a type of quantitative data.
name: Descriptive
label: e
answer: no
explanation: Ordinal data is a type of qualitative data that assigns data into groups. Body Mass Index (BMI) is a type of ordinal data.

BMI < 18 = category 1
BMI 18 - 25 = category 2
BMI 25 - 30 = category 3
BMI 35+ = category 4

The number of children in a family is quantitative, discrete data.
name: Ordinal
label: d
answer: no
explanation: Continuous data is a quantitative form of data, which can have any numerical value.

For example, temperature is a continuous form of data - you can have 38 degrees, 89.5 degrees, or 4536.25 degrees.

The number of children in a family has to be a whole number - you cannot have 2.5 children in a family. There are either 2 children or 3 children. This type of data is known as discrete.
name: Continuous
label: b
answer: no

Correct answer: a
Which of the following statements correctly describes a systematic review?

Options:
explanation: This is the definition of a randomised controlled trial. Randomised controlled trials are used to compare the efficacy of a new drug or treatment on the market compared to what is already available.

These are done on real patients and are usually 'double blind', meaning both the patient themselves nor the researcher do not know which participant is getting the treatment and who is not.
name: A group of participants are given a treatment for a condition, either the treatment being researched or a placebo (or what is currently being used in medicine)
label: d
answer: no
explanation: This is the definition of a case series. These are important in communicating the appearance of diseases that have not previously been reported - very commonly used in the field of infectious diseases.
name: A collection of patient reports detailing a constellation of symptoms and how they were treated, usually describing a condition that has not been studied before
label: e
answer: no
explanation: This is the definition of a systematic review. These are long projects where researchers will sometimes go through all of the studies done on a particular topic. This is done in a very structured way, known as the systematic review. The end result is a written paper summarising the consensus of all of the papers.
name: An analysis of multiple studies on a particular topic, usually randomised controlled trials, during which the reviewer assesses the quality, bias and confounding factors
label: a
answer: yes
explanation: This is the definition of a cohort study. For example, a group of people who have all smoked 20 cigarettes a day for 10 years, are monitored for the next 10 years to see who develops lung cancer and who does not. These studies are useful for identifying disease risk factors.
name: A group of people all exposed to the same factor are followed over time to see who acquires a certain condition and who does not
label: b
answer: no
explanation: This is the definition of a case-control study. These are retrospective studies that help to identify risk factors for conditions.
name: A group of people with a condition are compared alongside a group of people without a condition, to identify any common exposures in the group with the condition that is not present in the group without the condition
label: c
answer: no

Correct answer: a
Which of the following types of cells detect deep pressure and vibration in the skin?

Options:
explanation: Merkel cells are non-encapsulated mechanoreceptors. These are responsible for detecting light touch. They are found in the stratum basale of the epidermis, just above the basement membrane.

Merkel cells are most commonly found on the fingertips, as well as in the soles of the feet, mouth and genitals.
name: Merkel Cells
label: b
answer: no
explanation: Meissner's corpuscles are encapsulated mechanoreceptors. They are responsible for detecting light touch and slow vibration of the skin.

They are most commonly found in the fingertips and lips.
name: Meissner's corpuscle
label: d
answer: no
explanation: Pilosebaceous units are hair follicles. Hair follicles are responsible for helping body hair grow, anchoring each hair into the skin. They are not responsible for the innervation of the skin.
name: Pilosebaceous units
label: e
answer: no
explanation: Ruffini corpuscles are slow-acting mechanoreceptors that are found deep in the dermis.

They are responsible for detecting skin stretching and are most commonly found in the fingertips.
name: Ruffini Corpuscle
label: c
answer: no
explanation: Pacinian corpuscles are encapsulated, rapidly adapting mechanoreceptors that detect deep touch in the skin.

They also play a role in detecting the texture of objects that the skin comes into contact with. These corpuscles are found in the skin of the hands and feet.
name: Pacinian Corpuscles
label: a
answer: yes

Correct answer: a
A 56-year-old man presents to the Emergency Department with chest pain, radiating to the left arm and jaw. He is also sweating and reports feeling nauseous.

Which of the following is the most likely diagnosis?

Options:
explanation: A first-degree heart block occurs when there is a regular prolongation of the PR interval on ECG. Most patients with first-degree heart block are asymptomatic - they certainly would not be experiencing chest pain that radiated to their left arm and jaw. These are signs of a myocardial infarction.
name: First-degree heart block
label: d
answer: no
explanation: Atrial Fibrillation (AF) is a cardiac arrhythmia that can result in a patient feeling faint, having palpitations, chest pain and shortness of breath.

Although our patient is having chest pain, it would not radiate anywhere in AF. Our patient is also not complaining of any other AF symptoms - they are much more likely to be having a myocardial infarction than atrial fibrillation.
name: Atrial Fibrillation
label: c
answer: no
explanation: Second-degree heart block can be split into Mobitz Type I and Mobitz Type II. In Mobitz Type I there is a regular pattern of gradual prolongation of the PR interval until a P wave is not followed by a QRS complex. In Mobitz Type II, there are P waves that are not followed by QRS complexes but there is no obvious pattern to which P wave will be skipped.

In second-degree heart block patients will experience symptoms such as feeling faint, palpitations, chest pain and shortness of breath.

Although our patient is experiencing chest pain, you would not expect chest pain in a second-degree heart block to radiate - this is indicative of a myocardial infarction, which is the condition our patient is more likely to have.
name: Second-degree heart block
label: e
answer: no
explanation: This patient is presenting with a myocardial infarction. Myocardial infarctions are commonly associated with chest pain that radiates to the left arm, jaw and back, sweating, nausea and shortness of breath.

We are unable to differentiate between a Non ST-Elevated Myocardial Infarction (NSTEMI) and an ST-Elevated Myocardial Infarction (STEMI) without an ECG, however, since this is the only myocardial infarction option present we can safely choose NSTEMI as the most likely diagnosis.
name: Non-ST-Elevation Myocardial Infarction (NSTEMI)
label: a
answer: yes
explanation: Congestive Heart Failure would present with more chronic symptoms. These symptoms include shortness of breath on exertion or lying down, peripheral oedema, palpitations and a cough with the production of pink sputum.

This patient is not presenting with any of these symptoms - he is presenting with classic symptoms of a myocardial infarction (MI).
name: Congestive Heart Failure
label: b
answer: no

Correct answer: a