hllj/quesmed huggingface dataset:
A 45-year-old female was prescribed Citalopram by her GP for depression and anxiety.

What is the mechanism of action of this drug?

Options:
explanation: This is incorrect. This describes the mechanism of action for Serotonin-norepinephrine reuptake inhibitors (SNRIs)
name: Blocks the reabsorption of serotonin and norepinephrine into the presynaptic cell
label: b
answer: no
explanation: This is correct. Citalopram is a selective serotonin re-uptake inhibitor (SSRI), meaning that it blocks the reabsorption of serotonin into the presynaptic cell. This results in a greater concentration of extracellular serotonin.
name: Blocks the reabsorption of serotonin into the presynaptic cell
label: a
answer: yes
explanation: This is incorrect as SSRIs such as citalopram work by inhibiting the reabsorption of serotonin into the synaptic cell, resulting in more extracellular serotonin available.
name: Facilitates the reabsorption of serotonin into the presynaptic cell
label: e
answer: no
explanation: This is incorrect. This describes how benzodiazepines work.
name: Increases the effect of the neurotransmitter GABA
label: d
answer: no
explanation: This is incorrect. This describes the mechanism of action for Monoamine oxidase inhibitors (MAOIs)
name: Inhibits activity of monoamine oxidase enzymes
label: c
answer: no

Correct answer: a
A 35-year old female requires 0.5g of paracetamol intravenously. In the store room, the solution has a concentration of 10mg/ml.

What volume of solution is required?

Options:
explanation: 0.5 g = 500 mg

500/10 = 50 ml of solution required
name: 50ml
label: a
answer: yes
explanation: Incorrect
name: 100 ml
label: d
answer: no
explanation: Incorrect
name: 500ml
label: b
answer: no
explanation: Incorrect
name: 5 ml
label: c
answer: no
explanation: Incorrect
name: 10 ml
label: e
answer: no

Correct answer: a
A 73 year-old male needs with severe hospital-acquired pneumonia needs 4500 mg of piperacillin with tazobactam IV infusion. However the solution only comes in 3.375g/100ml.

How much solution should be

Options:
explanation: Incorrect
name: 60 ml
label: e
answer: no
explanation: This is correct:

3.375 / 100 = 0.03375 g in 1 ml

4500mg = 4.5g

4.5 / 0.03375 = 133.33 ml

Therefore, 133 ml of the drug is required to be the nearest whole number.
name: 133 ml
label: a
answer: yes
explanation: Incorrect
name: 1.33 ml
label: d
answer: no
explanation: Incorrect
name: 1333 ml
label: c
answer: no
explanation: Incorrect
name: 13 ml
label: b
answer: no

Correct answer: a
A 68 year old man presents with central crushing chest pain. Bloods are taken and show a raised troponin which raises suspicions of a myocardial infarction.

Which of the following does not commonly cause a raised blood troponin level?

Options:
explanation: Pericarditis can cause inflammation to the muscular layers of the heart which causes troponin to be released from the cardiac myocytes.
name: Pericarditis
label: b
answer: no
explanation: This will not cause a rise in troponin levels as it will not specifically damage cardiac myocytes.
name: Anxiety
label: a
answer: yes
explanation: A PE can cause ischaemia in the right ventricle which causes the increase in troponin.
name: Pulmonary embolus
label: d
answer: no
explanation: Troponin is released from cardiac myocytes which they are damaged. This can happen in most diseases affecting the heart.
name: Arrythmias
label: c
answer: no
explanation: The mechanism for this is not fully understood. It is thought to relate to the reduced clearance of cardiac troponin, as everyone has small quantities within their blood.
name: Chronic kidney disease
label: e
answer: no

Correct answer: a
55 year old male patient presents to diabetes clinic for a review of blood sugar control. He has recently been diagnosed with Type 2 diabetes and has tried using metformin for blood glucose control. This is not successful so Dapgliflozin is added to his medication regime.

What is the mechanism of Dapgliflozin?

Options:
explanation: This is the mechanism of sulfonylureas such as gliclazide.
name: Depolarise islet cells in the pancreas to increase insulin release
label: e
answer: no
explanation: Dapgliflozin is a SLGT2 inhibitor which acts to secrete glucose into the urine.
name: Increase urinary glucose loss
label: a
answer: yes
explanation: This is the mechanism of DPP4 inhibitors such as sitagliptin.
name: Inhibit GLP1 breakdown
label: c
answer: no
explanation: This is the mechanism of thiazolidinediones such as pioglitazone
name: Increase peripheral insulin sensitivity
label: d
answer: no
explanation: This is the mechanism of intestinal alpha-glucosidase inhibitors such as acarbose.
name: Delay intestinal carbohydrate absorption
label: b
answer: no

Correct answer: a
Which of the following statements best describes the electron transport chain?

Options:
explanation: This describes the citric acid cycle, which is a precursor to the electron transport chain.
name: Acetyl-CoA is added to oxaloacetate to produce citrate
label: c
answer: no
explanation: This describes the process of glycolysis which is a precursor to the electron transport chain.
name: 6-carbon sugars are broken down into 2 molecules of pyruvate, 2 NADH and 2 ATP
label: b
answer: no
explanation: This is correct as it describes the final part of the electron transport chain, and is where the energy comes from.
name: ATP is generated by H+ moving into the mitochondrial matrix from the intermembrane space
label: a
answer: yes
explanation: This is an indirect effect of the electron transport chain, but it is not the best description of the process.
name: Production of reactive oxygen species
label: e
answer: no
explanation: This is incorrect as the electrons move through a series of 4 proteins in the mitochondrial membrane.
name: Electrons move through a series of 6 proteins embedded in the mitochondrial membrane
label: d
answer: no

Correct answer: a
Which two lobes of the brain does the central sulcus separate?

Options:
explanation: Correct.
name: Frontal and parietal lobe
label: a
answer: yes
explanation: Incorrect. It is the Lateral (sylvian) sulcus separating these lobes.
name: Frontal and temporal lobe
label: b
answer: no
explanation: Incorrect. It is the Lateral (sylvian) sulcus separating these lobes.
name: Parietal and temporal lobe
label: c
answer: no
explanation: Incorrect. It is the parieto-occipital sulcus separating these lobes.
name: Parietal and occipital lobe
label: d
answer: no
explanation: Incorrect. It is the parieto-occipital sulcus separating these lobes.
name: Temporal and occipital lobe
label: e
answer: no

Correct answer: a
20 year old female presents to the GP requiring a blood test. They state that they have an intense fear of needles and can be seen to be shaking. You explain the phyiology of this to them, and explain that many symptoms are caused by adrenaline release.

Which structure releases adrenaline?

Options:
explanation: Incorrect. This structure secretes many hormones including thyrotropin-releasing hormone (TRH), somatostatin and dopamine.
name: Hypothalamus
label: e
answer: no
explanation: Incorrect. This structure secretes oxytocin and anti-diuretic hormone.
name: Posterior pituitary gland
label: d
answer: no
explanation: Incorrect. This structure secretes many hormones including growth hormones, prolactin and thyroid stimulating hormone.
name: Anterior pituitary gland
label: c
answer: no
explanation: Incorrect. This structure secretes mineralocorticoids, glucocorticoids and sex hormones.
name: Cortex of adrenal gland
label: b
answer: no
explanation: Correct. Adrenaline is released from the medulla of the adrenal gland, this region is closest to the central adrenomedullary vein.
name: Medulla of adrenal gland
label: a
answer: yes

Correct answer: a
A 44 year old male presents with adrenal insufficiency secondary to pituitary pathology.

Which hormone stimulates the production and release of cortisol?

Options:
explanation: Incorrect. This stimulates the thyroid gland to produce thyroid hormone production.
name: Thyroid stimulating hormone (TSH)
label: b
answer: no
explanation: Incorrect. This is also known as anti-diuretic hormone and acts on the kidney to reduce water excretion.
name: Vasopressin
label: c
answer: no
explanation: Correct. This hormone stimulates the adrenal gland to produce cortisol.
name: Adrenocorticotrophin (ACTH)
label: a
answer: yes
explanation: Incorrect. This stimulates breast tissue and induces lactation
name: Prolactin
label: e
answer: no
explanation: Incorrect. This, along with follicle stimulating hormone, stimulates the gonads to produce sex steroids and promotes ovulation in females and spermatogenesis in males.
name: Luteinising hormone
label: d
answer: no

Correct answer: a
4 year old female presents with a dry cough, conjunctivitis, and mild fever which has been ongoing for 10 days. They are diagnosed with whooping cough, the causative agent of this is *bordetella pertussis*.

What type of bacteria is *bordetella pertussis*?

Options:
explanation: Incorrect. This is an example of mycobacterium tuberculosis as its cell wall shows features of being both gram negative and gram positive.
name: Aerobic bacillus, neither gram positive nor gram negative
label: d
answer: no
explanation: Incorrect. Gram positive coccus include streptococcus and pneumococcus.
name: Gram positive coccus
label: b
answer: no
explanation: Incorrect. An example of this type of bacteria is E.coli
name: Anaerobic gram negative bacillus
label: c
answer: no
explanation: Correct. Coccobacillus is an intermediate shape between coccus and bacillus. The gram negative element means it doesn't absorb the staining so will show up pink.
name: Gram negative coccobacillus
label: a
answer: yes
explanation: Incorrect. This is an example of listeria monocytogenes.
name: Gram positive bacillus
label: e
answer: no

Correct answer: a
50 year old man presents to the GP for annual type 2 diabetes review and is found to have hypertension. They are from a white heritage and apart from diabetes, they have no other medical conditions.

What is the first line drug which the GP should prescribe?

Options:
explanation: Correct. Due to this man having pre-existing diabetes the first line drug group should be a ACE inhibitor or ARB. Ramipril is a commonly used ACE inhibitor.
name: Ramipril
label: a
answer: yes
explanation: Incorrect. Amlodipine is an example of a calcium channel blocker, which would be first line if the patient was over 55, was from an African-Caribbean origin
name: Amlodipine
label: b
answer: no
explanation: Incorrect. Indapamide is an example of a thiazide-like diuretic which is an option if first line treatments fail to control the blood pressure.
name: Indapamide
label: c
answer: no
explanation: Incorrect. Spirolactone is an adjunct to treatment of resistant hypertension.
name: Spironolactone
label: d
answer: no
explanation: Incorrect. This is given in pregnancy when there is severe hypertension or pre-eclampsia.
name: Magnesium sulfate
label: e
answer: no

Correct answer: a
A 40 year old woman presents to the GP for a health check appointment. She has her observations taken and is found to have a blood pressure of 155/93mmHg.

What is the best classification of hypertension in this patient?

Options:
explanation: Incorrect. Her BP is above 140/90mmHg which indicates stage 1 hypertension.
name: She doesn't have hypertension
label: b
answer: no
explanation: Incorrect. This would be true if she had a systolic pressure above 180mmHg or a diastolic pressure above 110mmHg
name: Stage 3
label: d
answer: no
explanation: Incorrect. She would have stage 2 hypertension if her BP was above 160/100mmHg
name: Stage 2
label: c
answer: no
explanation: Correct. She has stage 1 hypertension as her BP is above 140/90mmHg but below 160/100mmHg
name: Stage 1
label: a
answer: yes
explanation: Incorrect. This would be true if she had a systolic pressure above 180mmHg or a diastolic pressure above 120mmHg and evidence of end organ damage.
name: Malignant
label: e
answer: no

Correct answer: a
Which of the following is the posterior border of the anterior mediastinum?

Options:
explanation: Incorrect. This is one of the structures found within the anterior mediastinum in children.
name: Thymus gland
label: e
answer: no
explanation: Correct. The anterior mediastinum lies anterior to the pericardium.
name: Anterior border of pericardium
label: a
answer: yes
explanation: Incorrect. This is the inferior border of the anterior mediastinum.
name: Diaphragm
label: d
answer: no
explanation: Incorrect. This is the anterior border of the posterior mediastinum
name: Posterior border of pericardium
label: b
answer: no
explanation: Incorrect. This is the posterior border of the posterior mediastinum.
name: Thoracic vertebrae T5 to T12
label: c
answer: no

Correct answer: a
Which of the following region does not have blood supply from a branch of the thoracic aorta?

Options:
explanation: Incorrect. The oesophageal arteries are unpaired arteries which branch to supply the oesophagus.
name: Oesophagus
label: b
answer: no
explanation: Incorrect. The subcostal arteries are small paired arteries which branch off to supply the abdominal wall muscles.
name: Abdominal wall muscles
label: e
answer: no
explanation: Correct. Posterior intercostal arteries supply the intercostal spaces, except for the 1st and 2nd which are supplied by the internal thoracic artery which is a branch of the subclavian artery.
name: 1st intercostal space
label: a
answer: yes
explanation: Incorrect. The pericardial arteries are small, unpaired arteries which branch to supply the dorsal pericardium
name: Pericardium
label: d
answer: no
explanation: Incorrect. The superior phrenic arteries are paired branches of the thoracic aorta.
name: Superior aspect of the diaphragm
label: c
answer: no

Correct answer: a
A 67 year old male presents with chest pain & breathlessness. An ECG is performed and shows ST elevation.

Which of the following best describes the physiological basis of ST segment in relation to cardiac function?

Options:
explanation: Incorrect. This is shown by the T wave.
name: Ventricular repolarisation
label: c
answer: no
explanation: Incorrect. This is shown by the QT interval.
name: Ventricular depolarisation and repolarisation
label: e
answer: no
explanation: Correct. It is during the ST segment where the ventricles remain in a activated state, between ventricular depolarisation and repolarisation.
name: Ventricles are maximally contracted
label: a
answer: yes
explanation: Incorrect. This is shown by the PR interval
name: Conduction passing through the AV node
label: d
answer: no
explanation: Incorrect. This is shown by the P wave
name: Atrial depolarisation
label: b
answer: no

Correct answer: a
63 year old female presents to the GP with dizziness. They have a past medical history of heart failure and take medication for this.

Which heart failure drug is this most likely a side effect of?

Options:
explanation: Incorrect. This drug has side effects such as hypotension.
name: Furosemide
label: c
answer: no
explanation: Correct. This is a beta blocker which has a common side effect of dizziness.
name: Bisoprolol
label: a
answer: yes
explanation: Incorrect. This drug has side effects such as gynaecomastia.
name: Spironolactone
label: b
answer: no
explanation: Incorrect. This drug is used mainly used by heart failure specialists and has side effects such as arrythmias.
name: Amiodarone
label: d
answer: no
explanation: Incorrect. This drug is more widely used for the prevention of cardiac disease
name: Aspirin
label: e
answer: no

Correct answer: a
70 year old man presents with orthopnoea, tachypnoea and ankle swelling. He has recently moved to the UK from South America and is diagnosed with heart failure.

Which of the following infectious diseases is a common cause of heart failure in South America?

Options:
explanation: Correct. This is a condition caused by a parasite and can lead to eyelid swelling and an enlarged colon.
name: Chagas disease
label: a
answer: yes
explanation: Incorrect. This is an infection caused by a parasite and presents with muscle aches and lymphadenopathy.
name: Toxoplasmosis
label: d
answer: no
explanation: Incorrect. This condition is found in Western America which can lead to complications such as meningitis.
name: Colorado Tick Fever
label: c
answer: no
explanation: Incorrect. This is a condition affecting the respiratory system and can lead to complications such as myocarditis.
name: Diphtheria
label: b
answer: no
explanation: Incorrect. It is the most common vector-borne disease in California can lead to complications such as encephalitis.
name: West Nile Virus
label: e
answer: no

Correct answer: a
84 year old female is brought to A&E after a fall. She has an inability to weight bear and the leg is visibly shortened and externally rotated. She is diagnosed with a suspected intracapsular neck of femur fracture.

Which type of necrosis is she at highest risk of?

Options:
explanation: Incorrect. This occurs after a serious injury, but is more likely in peripheral areas such as the hands and feet.
name: Gangrenous necrosis
label: d
answer: no
explanation: Incorrect. This inolves damage to the tubule cells of the kidney, which is unlikely to happen due to this fall.
name: Acute tubular necrosis
label: c
answer: no
explanation: Incorrect. This is the death of fat tissue due to injury, whilst this could happen in this patient, avascular necrosis is significantly more likely.
name: Fat necrosis
label: b
answer: no
explanation: Correct. This occurs when there is limited blood supply to a bone, which can occur in intracapsular fractures due to the network of blood vessels.
name: Avascular necrosis
label: a
answer: yes
explanation: Incorrect. This is when the inside lining of blood vessels become damaged, it is often due to malignant hypertension or autoimmune conditions.
name: Fibrinoid necrosis
label: e
answer: no

Correct answer: a
50 year old male presents to A&E with chest pain and breathlessness. ECG indicates an anterior ST segment elevation myocardial infarction (STEMI).

Which artery is affected in an anterior STEMI?

Options:
explanation: Incorrect. This is a branch of the right marginal artery which would lead to an inferior MI.
name: Right Marginal Artery
label: e
answer: no
explanation: Incorrect. A good way to remember the blood supply in different MIs is:

-   Left Anterior Descending (LAD) - LADs sit at the front of the lecture hall (anterior MI)

-   Circumflex - Goes around the heart (Lateral MI)

-   Right Coronary - (Inferior MI)
name: Circumflex artery
label: b
answer: no
explanation: Correct. A good way to remember the blood supply in different MIs is:

-   Left Anterior Descending (LAD) - LADs sit at the front of the lecture hall (anterior MI)

-   Circumflex - Goes around the heart (Lateral MI)

-   Right Coronary - (Inferior MI)
name: Left Anterior Descending artery
label: a
answer: yes
explanation: Incorrect. A good way to remember the blood supply in different MIs is:

-   Left Anterior Descending (LAD) - LADs sit at the front of the lecture hall (anterior MI)

-   Circumflex - Goes around the heart (Lateral MI)

-   Right Coronary - (Inferior MI)
name: Right Coronary Artery
label: c
answer: no
explanation: Incorrect. This is the main venous drainage of the heart.
name: Coronary Sinus
label: d
answer: no

Correct answer: a
25 year old female presents after a fall from a horse. She has reduced sensation bilaterally in her lower limbs. On examination she is found to have several lacerations to her thorax and complains of mild abdominal pain.

Observations are taken and show her heart rate to be 63bpm, and blood pressure is 93/64mmHg.

Which type of shock is most likely in this patient?

Options:
explanation: Incorrect. This is when blood and oxygen cannot reach the patient's organs, this can be caused by cardiac tamponade and tension pneumothorax.
name: Obstructive shock
label: e
answer: no
explanation: Incorrect. This is caused by an allergic reaction which develops quickly after exposure to an allergen, which there is no evidence of in this patient.
name: Anaphylactic shock
label: c
answer: no
explanation: Correct. This history suggests a spinal injury which is the most common cause of neurogenic shock.
name: Neurogenic shock
label: a
answer: yes
explanation: Incorrect. This is caused by blood loss, which there is no evidence of in this patient.
name: Hypovolemic shock
label: b
answer: no
explanation: Incorrect. This occurs when the heart cannot pump enough oxygen and blood around the body, it is caused by conditions such as myocarditis.
name: Cardiogenic shock
label: d
answer: no

Correct answer: a
An 18 year old female presents with urinary frequency, loin pain, dysuria, urgency and foul-smelling urine

Which of their symptoms is suggestive of pyelonephritis?

Options:
explanation: Incorrect. This is a symptom of a urinary tract infection, however it is not indicative of a pyelonephritis.
name: Foul-smelling urine
label: e
answer: no
explanation: Incorrect. This is a symptom of a urinary tract infection, however it is not indicative of a pyelonephritis.
name: Dysuria
label: c
answer: no
explanation: Incorrect. This is a symptom of a urinary tract infection, however it is not indicative of a pyelonephritis.
name: Urgency
label: d
answer: no
explanation: Correct. This will rarely be seen in cystitis but is commonly seen in pyelonephritis.
name: Loin pain
label: a
answer: yes
explanation: Incorrect. This is a symptom of a urinary tract infection, however it is not indicative of a pyelonephritis.
name: Urinary frequency
label: b
answer: no

Correct answer: a
25 year old female presents to her GP with symptoms of a urinary tract infection. She is 8 weeks pregnant and has no other medical conditions.

What is the best first line antibiotic regime?

Options:
explanation: Incorrect. Amoxicillin would be the correct second line option, if there is no improvement after 48 hours, but it would need to be taken for 7 days.
name: Amoxicillin for 5 days
label: d
answer: no
explanation: Incorrect. This is a first line option for non-pregnant women but cannot be given to pregnant women as it has a teratogenic risk, especially in the first trimester.
name: Trimethoprim for 7 days
label: e
answer: no
explanation: Incorrect. This would be the correct second line option, if there is no improvement after 48 hours.
name: Amoxicillin for 7 days
label: c
answer: no
explanation: Correct. Nitrofurantoin is the first line drug choice for lower UTI, and as she is pregnant it is to be taken for 7 days.
name: Nitrofurantoin for 7 days
label: a
answer: yes
explanation: Incorrect. Nitrofurantoin is the first line drug choice for lower UTI, however as she is pregnant it is to be taken for 7 days, not 3 days.
name: Nitrofurantoin for 3 days
label: b
answer: no

Correct answer: a
67 year old man presents for a review of their pre-existing chronic kidney disease. It was previously diagnosed as stage 1.

His eGFR is now 39ml/min/1.73m2. What stage of CKD does he currently have?

Options:
explanation: Correct. Stage 3 is diagnosed if the eGFR is between 30 and 59
name: Stage 3
label: a
answer: yes
explanation: Incorrect. Stage 1 is diagnosed if the eGFR is >90 with demonstratable kidney damage
name: Stage 1
label: b
answer: no
explanation: Incorrect. Stage 2 is diagnosed if the eGFR is between 60 and 89 with demonstratable kidney damage.
name: Stage 2
label: c
answer: no
explanation: Incorrect. Stage 4 is diagnosed if the eGFR is below 15
name: Stage 5
label: e
answer: no
explanation: Incorrect. Stage 4 is diagnosed if the eGFR is between 15 and 30
name: Stage 4
label: d
answer: no

Correct answer: a