hllj/quesmed huggingface dataset:
A 32-year-old man presents to the GP with easy bruising of the skin, hair loss, and severe gum disease. He has a busy job as a medical registrar, where he is often unable to find time to buy fresh fruit and vegetables. He is diagnosed with vitamin C deficiency, also known as scurvy.

Which of the following enzymes is most likely to be affected by vitamin C deficiency?

Options:
explanation: Yes, this is the correct answer. Prolyl Hydroxylase is responsible for the hydroxylation of proline and lysine amino acid residues on tropocollagen. This causes the stabilisation of the triple helix of collagen by forming hydrogen bonds between the tropocollagen units. A deficiency of vitamin C results in poor activity of prolyl hydroxylase and hence poor hydroxylation of proline and lysine residues, leading to less stabilisation of the tropocollagen triple helix. This leads to weak collagen fibres resulting in symptoms such as bruising, hair loss and gum disease.
name: Prolyl Hydroxylase
label: a
answer: yes
explanation: No, this is not the correct answer. This enzyme is used to break down collagen. It does not depend upon vitamin C in order to function.
name: Collagenase
label: e
answer: no
explanation: No, this is not the correct answer. Acetylcholinesterase enzymes at found at postsynaptic neuromuscular junctions, and work by breaking down acetylcholine. They do not depend upon vitamin C in order to function.
name: Acetylcholinesterase
label: b
answer: no
explanation: No, this is not the correct answer. This enzyme is responsible for the cleavage of N and C-terminal peptides of the procollagen molecules in order to form tropocollagen molecules. It does not depend upon vitamin C in order to function.
name: Procollagen peptidase
label: c
answer: no
explanation: No, this is not the correct answer. This enzyme is responsible for the cleavage of the signal peptide of preprocollagen to form procollagen. It does not depend upon vitamin C in order to function.
name: Signal peptidase
label: d
answer: no

Correct answer: a
A 32-year-old man presents to the GP with sudden weight gain, muscle weakness, bruising, and purple striae on his abdomen. He is referred to an endocrinologist who diagnoses the man with Cushing’s disease.

Which of the following describes the underlying pathophysiology in Cushing’s disease?

Options:
explanation: Although high-dose iatrogenic steroid administration can cause cushingoid symptoms, Cushing’s disease is glucocorticoid excess caused by an ACTH-secreting pituitary tumour.
name: Iatrogenic glucocorticoid administration
label: d
answer: no
explanation: A subarachnoid haemorrhage can present as a severe, sudden onset headache, and is caused by a bleed into the subarachnoid space between the brain and surrounding meninges. It is not the pathophysiology of Cushing's disease.
name: A bleed into the subarachnoid space
label: e
answer: no
explanation: The adrenal medulla is responsible for releasing adrenaline and noradrenaline. A tumour in this area is known as a pheochromocytoma and would present with headaches, tachycardia, high blood pressure, and sweating.  It is not the pathophysiology of Cushing's disease.
name: Increased activity of the adrenal medulla due to a tumour
label: b
answer: no
explanation: This is the typical pathophysiology of Addison’s disease in which the adrenal glands do not produce enough cortisol and aldosterone. It is not the pathophysiology of Cushing's disease.
name: Reduced glucocorticoid and mineralocorticoid secretion due to autoimmune destruction of the adrenal cortex
label: c
answer: no
explanation: The underlying pathophysiology of Cushing’s disease is glucocorticoid excess caused by an ACTH-secreting pituitary tumour. This represents a specific form of Cushing's syndrome, which describes an endocrine disorder of glucocorticoid excess. Symptoms include weight gain, proximal muscle weakness, easy bruising and abdominal striae.
name: Glucocorticoid excess due to a pituitary tumour
label: a
answer: yes

Correct answer: a
A new-born baby girl is born at term via an uncomplicated caesarean section. Her mother attended all antenatal scans, which were unremarkable. After delivery, an abnormality is observed on the infant's back. It is a small cyst, which contains both cerebrospinal fluid and spinal cord. The cyst transilluminates very poorly. On examination of the infant, no other abnormalities are detected. All observations are normal.

Which of the following best describes this abnormality?

Options:
explanation: In craniorachischisis, the entire neural tube remains open. This leads to anencephaly plus a bony defect of the spinal cord. 'Cranio' refers to the head, 'rachi' to the spine, and 'schisis' means to split.
name: Craniorachischisis
label: e
answer: no
explanation: A meningocele occurs when there is incomplete fusion of the vertebrae, with herniation of a meningeal sac containing cerebrospinal fluid, but no spinal cord. Unlike a meningomyelocele, this transilluminates very well due to the large amount of cerebrospinal fluid that is present.
name: Meningocele
label: d
answer: no
explanation: A myelomeningocele occurs when there is incomplete fusion of the vertebrae with herniation of the meningeal sac containing cerebrospinal fluid and spinal cord. This can be inferred from the name itself, with 'myelo' referring to the spinal cord, 'meningo' referring to the meningeal layers, and 'coele' referring to a fluid-filled cyst. Myelomeningoceles transilluminate poorly due to the presence of spinal cord in the cyst
name: Myelomeningocele
label: a
answer: yes
explanation: A myelocoele occurs when the spinal cord fails to develop and the lumen of the neural tube is exposed to the outside world. This is a rare condition, and can be differentiated from a myelomeningocele through the lack of meningeal covering. It is also flatter in appearance, and not possible to transilluminate.
name: Myelocoele
label: b
answer: no
explanation: Anencephaly occurs when the cranial tube fails to close so that parts or all of the brain fail to form. This can be taken from the name itself: 'an' means without, while 'cephaly' refers to the brain.
name: Anencephaly
label: c
answer: no

Correct answer: a
A 55-year-old man presents to the Medical Assessment Unit with a drooping eyelid on his right side. On examination, his right pupil is constricted and despite it being a very hot day, he is not producing any sweat on the right side of his forehead. The rest of the examination is unremarkable.

Which of the following is the most likely diagnosis?

Options:
explanation: Stroke often presents with new-onset unilateral facial weakness. However, as this is an upper motor neuron facial palsy, motor innervation to the forehead would be spared in an acute stroke. Furthermore, the other features (meiosis, anhidrosis) of the presenting history and examination are not typical of a stroke.
name: Stroke
label: e
answer: no
explanation: Bell's palsy is an idiopathic syndrome affecting the facial nerve. It is characterised by: unilateral facial weakness, ear pain, hyperacusis, altered taste and dry eyes/mouth. While this patient demonstrates eyelid droop, there is no evidence of generalised facial weakness or other features of Bell’s palsy.
name: Bell’s palsy
label: b
answer: no
explanation: Myasthenia gravis is an autoimmune disorder resulting in insufficient functioning of the acetylcholine receptors to allow muscle contraction. While this condition does present with ptosis, it does not affect the pupil or sweat glands and therefore would not produce meiosis or anhydrosis.
name: Myasthenia gravis
label: d
answer: no
explanation: Horner's syndrome is characterised by ptosis (eyelid droop) and meiosis (pupillary constriction), with or without anhydrosis (a lack of sweating), as demonstrated by this patient. It is caused by an interruption of the sympathetic nerve supply to the eye.
name: Horner’s syndrome
label: a
answer: yes
explanation: CN III is responsible for pupillary constriction. In CN III palsy, the pupil would be dilated and the patient would be experiencing symptoms such as double vision and strabismus.
name: Third cranial nerve palsy
label: c
answer: no

Correct answer: a
A 27-year-old female presents to the GP with a small, painful lump on her eyelid. The eyelid appears red, and swollen and it is hot to the touch. Her vision is unaffected and her eye movements are normal. She is systemically well with normal observations. The GP concludes that this is most likely a stye.

Which of the following causes a stye?

Options:
explanation: An external hordeolum, commonly called a stye, is an abscess at an eyelash follicle often caused by staphylococcus.
name: Infectious blockage of an eyelash follicle
label: a
answer: yes
explanation: A Meibomian gland abscess is also called an internal hordeolum. It is initially painful, and if blockage of the gland occurs they can leave behind a non-tender swelling called a chalazion. It does not cause a stye.
name: Blockage of the Meibomian gland
label: b
answer: no
explanation: Trauma to the eye region would present with more diffuse tenderness, and there is no history of trauma described by the patient. Trauma does not cause a stye.
name: Trauma
label: c
answer: no
explanation: Sinusitis is a cause of orbital cellulitis, not a stye. Orbital cellulitis is associated with more diffuse tenderness, erythema and swelling around the orbit. This contrasts to the localised swelling and tenderness of a style. Individuals are often systemically unwell from orbital cellulitis, but are not from a stye.
name: Sinusitis
label: e
answer: no
explanation: An allergic reaction would result in periorbital oedema around both eyes, rather than a small, painful, unilateral lump. It would not cause a stye.
name: Allergic reaction
label: d
answer: no

Correct answer: a
A 35-year-old man presents to the GP with severe pain behind his left eye. The pain occurs intermittently, lasting between 30 minutes and 2 hours. When the episodes start, they tend to occur several times a day over the first few months, but then seem to reduce in frequency over the following months. During the episodes, his left eye becomes red and watery.

He is otherwise well, with no past medical history and no regular medications. He does not drink alcohol but has been a heavy smoker for the past 20 years.

Which of the following is the most likely diagnosis?

Options:
explanation: Migraines are twice as common in women as in men. They are characterised by a unilateral throbbing headache sometimes preceded by an aura, such as visual (eg. lines, zigzags) or sensory (paraesthesia spreading from fingers to face) symptoms. The headache may last 4-72 hours and is associated with photophobia and phonophobia. This contrasts with the shorter headache duration and presence of lacrimation seen in this patient.
name: Migraine
label: b
answer: no
explanation: Trigeminal neuralgia is characterised by recurrent short episodes of severe stabbing pain, affecting one side of the face, in the trigeminal nerve distribution. The pain may be triggered by touching the face, eating, or talking. Patients are typically over the age of 50.
name: Trigeminal neuralgia
label: d
answer: no
explanation: The most common cause of chronic recurring head pain, tension headaches are more likely to affect women than men. They present as bilateral, non-pulsatile headaches that can be described as a tight band around the head. They may be associated with tenderness of the scalp muscles, as it is thought that their contraction is the primary source of the pain.
name: Tension headache
label: c
answer: no
explanation: This is a type of headache associated with the long-term use of analgesics. This patient is not on any regular medication, making this option incorrect.
name: Medication-overuse headache
label: e
answer: no
explanation: Cluster headaches are one of the few primary headaches that affect men predominantly, as well as those who smoke. They are characterised by recurrent attacks of sudden-onset unilateral periorbital pain, associated with a watery and bloodshot eye, lacrimation, rhinorrhoea, miosis, ptosis, lid swelling, and facial flushing. Headaches last 15 minutes to 3 hours, typically occurring once or twice a day over a period of 4-12 weeks. They are often followed by a pain-free period of months before the next cluster begins.
name: Cluster headache
label: a
answer: yes

Correct answer: a
A 29-year-old pregnant woman is experiencing acute onset left-sided facial weakness, drooling, and a very dry left eye. She is otherwise well, has had no issues in her pregnancy so far and there is no recent history of any infections or coryzal symptoms.

She does not smoke or drink alcohol.

Which of the following is the most likely diagnosis?

Options:
explanation: Bell's palsy is an idiopathic syndrome affecting the facial nerve. It is characterised by: unilateral facial weakness, ear pain, hyperacusis, altered taste, and dry eyes/a dry mouth. This condition mainly affects 20-40-year-olds, and is more common in pregnant women.
name: Bell’s palsy
label: a
answer: yes
explanation: A traumatic injury could cause damage to the facial nerve through a basal skull fracture or following surgery. However, there are no features in the history or on examination (e.g. bruises or scars) that suggest a history of trauma in this case. It is therefore a less likely underlying diagnosis than Bell's palsy.
name: Traumatic injury
label: e
answer: no
explanation: Ramsay Hunt syndrome (herpes zoster oticus) is caused by the reactivation of the varicella zoster virus in the geniculate ganglion of the seventh cranial nerve. While it can present with facial nerve palsy, this is usually preceded by ear pain and a vesicular rash around the ear. It is therefore a less likely underlying diagnosis than Bell's palsy.
name: Ramsay Hunt syndrome
label: c
answer: no
explanation: Stroke often presents with new-onset unilateral facial weakness. However, on examination, this patient's presentation would be identified as an upper motor neuron facial palsy due to the presence of forehead sparing. Furthermore, the patient's young age and absence of any cardiovascular risk factors makes a stroke less likely.
name: Stroke
label: b
answer: no
explanation: Horner's syndrome is characterised by ptosis and meiosis, with or without anhidrosis. It is due to an interruption of the sympathetic nerve supply to the eye. As this patient does not demonstrate meiosis or anhidrosis, Bell's palsy is the most likely explanation.
name: Horner’s syndrome
label: d
answer: no

Correct answer: a
A 35-year-old woman attends an oncology clinic to assess her response to breast cancer treatment. She is keen to know whether her cancer is hereditary, and whether her two daughters are at risk.

Which of the following genes is most associated with an increased risk of developing breast cancer?

Options:
explanation: This is an oncogene associated with multiple types of cancer such as pancreatic, colon, bladder, and kidney. While it can be found to be mutated in breast cancer, it is not as common as BRCA 1 and BRCA 2.
name: RAS
label: e
answer: no
explanation: BRCA 1 (and BRCA 2) are the most common genes associated with familial breast cancer. BRCA 1 is found on chromosome 17 and mutations are inherited in an autosomal dominant pattern.
name: BRCA1
label: a
answer: yes
explanation: This is a tumour suppressor gene associated with an increased risk of developing various types of cancer. However, it is not specifically associated with breast cancer compared to BRCA 1 and BRCA 2.
name: P53
label: c
answer: no
explanation: This is a tumour suppressor gene associated with retinoblastoma.
name: pRb
label: d
answer: no
explanation: Mutations in the APC gene cause the development of polyps in the colon, thus causing colon cancer.
name: APC
label: b
answer: no

Correct answer: a
A 45-year-old man attends the GP surgery for management of his hypertension. He has been unable to reduce his blood pressure through lifestyle changes, so it is agreed he will be commenced on ramipril.

Which of the following is a common side effect of ramipril?

Options:
explanation: ACE inhibitors affect the respiratory system by causing an increase of substance P which exacerbates the cough reflex. This causes a dry cough and is the most commonly experienced side effect of this medication.
name: Persistent dry cough
label: a
answer: yes
explanation: Whilst ramipril can cause some gastrointestinal disturbances, it is very unlikely to cause duodenal bleeding.
name: Duodenal bleeding
label: c
answer: no
explanation: This is a very uncommon side effect of ramipril.
name: Confusion
label: b
answer: no
explanation: This is not a recognised side effect of ramipril.
name: Shortness of breath
label: e
answer: no
explanation: This is a very uncommon side effect of ramipril as the medication undergoes renal excretion.
name: Hepatic impairment
label: d
answer: no

Correct answer: a
A 23-year-old female presents to the emergency department with sudden onset left iliac fossa pain, which radiates to her left shoulder tip.

Her urine pregnancy test is positive and she is diagnosed with a ruptured ectopic pregnancy.

Which of the following anatomical structures is the most likely location of an ectopic pregnancy?

Options:
explanation: The ampulla is the widest section of the uterine tube. It is the most common location for an ectopic pregnancy. 97% of ectopic pregnancies will implant in the ampulla.
name: Ampulla
label: a
answer: yes
explanation: Similar to the ovary, the cervix can be a site of ectopic pregnancy implantation. However, this is rare and only occurs in about 1% of cases.
name: Cervix
label: e
answer: no
explanation: The isthmus is a possible location of implantation, however this is extremely rare. If implantation occurs in the isthmus, there is a higher risk of rupture or haemorrhage.
name: Isthmus
label: b
answer: no
explanation: The ovary is a site of ectopic pregnancy implantation. However, this is rare and only occurs in about 1% of cases.
name: Ovary
label: d
answer: no
explanation: The uterus is the site of embryo implantation in a normal pregnancy. Therefore this answer is not consistent with an ectopic pregnancy.
name: Uterus
label: c
answer: no

Correct answer: a
A 20-year-old female attends the GP surgery following an episode of unprotected sexual intercourse (UPSI). Upon questioning, she mentions the event occurred ‘about 4 days ago’ but she was too embarrassed to seek help earlier. She tells you that she would like a long-term contraceptive option.

Which of the following methods of emergency contraception is most suitable for her?

Options:
explanation: The combined hormonal contraceptive pill does provide effective ongoing contraception, but
does not function as emergency contraception so this is not a suitable option.
name: Combined oral contraceptive pill
label: c
answer: no
explanation: Levonorgestrel can be used as an emergency contraceptive for up to 72 hours following UPSI, so is not a suitable option for contraception in this case, as the patient’s UPSI occurred more than 72 hours prior. Moreover, it provides no ongoing contraception so is not the most suitable option.
name: Levonorgestrel
label: e
answer: no
explanation: Ulipristal acetate is suitable for use as an emergency contraceptive for up to 120 hours following UPSI so this is certainly an option for emergency contraception. However it provides no ongoing contraception so is not the most suitable option.
name: Ulipristal acetate
label: d
answer: no
explanation: The copper IUD can be inserted for the purpose of providing emergency contraception for up to 5 days after unprotected sexual intercourse (UPS). This can be left in situ to provide effective ongoing contraception.
name: Intrauterine device
label: a
answer: yes
explanation: Whilst the Mirena provides highly effective long acting contraception, it does not provide emergency contraception, so would not be suitable in this case where the patient has had UPSI recently.
name: Mirena Intrauterine system
label: b
answer: no

Correct answer: a
A 17-year-old girl visits the GP looking for contraceptive advice. She is currently using barrier contraception with her partner but she would like to start using another method of contraception. She has a history of migraines with aura, making the combined oral contraceptive pill unsuitable. The GP, therefore, offers her the progesteron-only pill (POP).

Which of the following best describes the mechanism of action of the POP?

Options:
explanation: Barrier contraception such as condoms work by preventing the sperm from entering the female genital tract and therefore preventing fertilisation of the female ovum. It does not describe the mechanism of action of the POP.
name: Prevents sperm entering the vagina
label: b
answer: no
explanation: This is the main mechanism of action of the intrauterine system (IUS), which also contains progesterone. It does not describe the mechanism of action of the POP.
name: Prevents endometrial proliferation
label: e
answer: no
explanation: This is the main mechanism of action of the POP. Some third generation POPs also inhibit ovulation. The other options are mechanisms of action of other contraceptive methods.
name: Thickens cervical mucus
label: a
answer: yes
explanation: Spermicides are non-hormonal contraceptives that work by decreasing sperm motility and survival. They come as either a diaphragm or a cap that can be inserted into the female genital tract. This option does not describe the mechanism of action of the POP.
name: Decreases sperm motility and survival
label: d
answer: no
explanation: This answer refers to the mechanism of action of the copper intrauterine device (IUD). The copper is toxic to both sperm and egg, therefore preventing implantation. This does not describe the mechanism of action of the POP.
name: Toxic to sperm and ovum
label: c
answer: no

Correct answer: a
A 25-year-old man with known epilepsy has an ongoing seizure that has now lasted over 25 minutes despite receiving benzodiazepines.

Which of the following medications should be administered next?

Options:
explanation: Diazepam is a type of benzodiazepine that can be administered within the first 15 minutes of the seizure beginning. PR diazepam is usually the treatment of choice in the community. It is not suitable in this case as the seizure has been going on for more than 15 minutes.
name: Diazepam
label: b
answer: no
explanation: Similar to midazolam, propofol is an anaesthetic agent which can be used for status epilepticus after 45 minutes. This is not the case for this patient. Phenytoin is a more appropriate next step.
name: Propofol
label: d
answer: no
explanation: In the management of status epilepticus, the patient should receive 2 doses of benzodiazepines, one at 5 minutes and another at 15. If the seizure does not stop after the second dose or lasts for more than 15 minutes, the next medication to administer is phenytoin.
name: Phenytoin
label: a
answer: yes
explanation: Midazolam is also a benzodiazepine, however it is usually an anaesthetic agent. It can be used for status epilepticus, if the seizure has lasted more than 45 minutes.
name: Midazolam
label: c
answer: no
explanation: Adrenaline is an emergency medication used in anaphylaxis and cardiac arrest. However, it is not a medication that can be used for status epilepticus.
name: Adrenaline
label: e
answer: no

Correct answer: a