hllj/quesmed huggingface dataset:
A 15-year-old presents to the GP with a painless swelling on one of his testicles for the past four months. Blood tests reveal raised tumour marker alpha-fetoprotein (AFP). Other testicular tumour markers are normal.

What is the most likely type of testicular tumour present?

Options:
explanation: These are fast-growing tumours that tend to spread to other body parts, such as bones, lymph nodes, lungs, and brain - causing symptoms in these areas. They are also associated with haemorrhage and are usually present in mixed germ cell tumours. They will raise HCG as well.
name: Choriocarcinoma
label: d
answer: no
explanation: Embryonal carcinoma is present in 40% of testicular tumours, but are often components of mixed cell tumours. However, as well as raised AFP, embryonal carcinoma will have raised human chorionic gonadotropin (HCG) too.
name: Embryonal carcinoma
label: c
answer: no
explanation: Pure teratomas of the testicle are rare, but are often components of mixed germ cell tumours. Teratomas of the testicle are always malignant. Teratomas of the ovary, however, are benign.
name: Teratoma
label: e
answer: no
explanation: Seminomas are much more slow-growing and spreading than non-seminomatous germ cell tumours (the other answers all fall into this category of testicular cancer). They may cause a raised LDH.
name: Seminoma
label: b
answer: no
explanation: This the most common form of testicular cancer in children, and is rarer in adults. They cause a raised AFP.
name: Yolk sac carcinoma
label: a
answer: yes

Correct answer: a
The ovaries receive blood supply from the ovarian artery.

The ovarian artery is a branch of what larger artery?

Options:
explanation: The anterior division of the internal iliac artery supplies most of the pelvis. However, it does not supply the gonads.
name: Anterior division of the internal iliac artery
label: d
answer: no
explanation: The internal pudendal is a branch off the anterior division of the internal iliac artery. It supplies the external genitalia.
name: Internal pudendal
label: e
answer: no
explanation: The external iliac artery eventually becomes the femoral artery. Before this, it has two branches: inferior epigastric and deep circumflex arteries.
name: External iliac artery
label: b
answer: no
explanation: The posterior division of the internal iliac artery has three branches: iliolumbar, lateral sacral, and superior gluteal.
name: Posterior division of the internal iliac artery
label: c
answer: no
explanation: In embryological development, the gonads (ovaries and testes) start above the pelvis in the abdomen. This is where their blood supply starts. As they develop and descend into the pelvis, they bring this artery down with them. Other arteries in the pelvis that do not branch from the iliac arteries are the median sacral artery (a branch from the abdominal aorta) and superior rectal artery (a branch from inferior mesenteric artery).
name: Aorta
label: a
answer: yes

Correct answer: a
All of the five people below have been having regular unprotected intercourse for two years with the aim to conceive.

According to NICE guidelines, who will be offered the most cycles of in vitro fertilisation (IVF) from the cases below?

Options:
explanation: Because she is between 40-42 and has never had IVF before, one cycle of IVF should be followed as long as tests show that her ovaries respond normally to fertility drugs. Doctors should discuss the risks of fertility treatment if over 40.
name: A 41-year-old woman who has never had IVF before
label: b
answer: no
explanation: He should be offered two cycles of IVF. If transgender men stop taking testosterone for four months, they have similar egg yields to cisgender women.
name: A 38-year-old transgender man taking testosterone who has used cycles of intrauterine insemination, and has had one previous cycle of IVF
label: c
answer: no
explanation: She should not be offered any more IVF because she is over 42.
name: A 43-year-old woman who has had one cycle of IVF before
label: e
answer: no
explanation: She should not be offered any more cycles of IVF as she already had three cycles. This is because the chances of having a baby fall with the number of unsuccessful cycles of IVF.
name: A 37-year-old woman who has had three previous cycles of IVF
label: d
answer: no
explanation: This woman should be offered three cycles of IVF. This is because she is under 40 and has been trying to get pregnant through regular unprotected sexual intercourse for a total of two years. Three cycles of IVF can also be offered if someone is under 40, has used artificial insemination to conceive and has not become pregnant after 12 cycles (with at least six of these cycles should have used intrauterine insemination).
name: A 39-year-old woman who has used 12 cycles of intrauterine insemination
label: a
answer: yes

Correct answer: a
A 12-year-old girl presents to A&E with abdominal pain and vomiting. She is known to have an ovarian cyst. On examination, she shows guarding and rigidity, and a mass is palpable. A pregnancy test is negative. Vitals show a heart rate of 134 BPM and a temperature of 38.2 C.

What is the likely ovarian cause?

Options:
explanation: Ovarian torsion presents with acute abdominal pain with nausea and vomiting. There will be signs of tachycardia and pyrexia due to ischaemia. Infarction to the ovary has occurred at the time of surgery, but salpingo-oophorectomy is the usual treatment.
name: Ovarian torsion
label: a
answer: yes
explanation: Ectopic pregnancies may present with pain, bleeding, or missed period. It is an important differential to rule out with a pregnancy test.
name: Ectopic pregnancy
label: e
answer: no
explanation: Ovarian rupture may present similarly to this, however, symptoms depend on amount and character of cyst contents that are released. It is unlikely to be this as, if the cyst had ruptured, it would not be palpable. If symptoms are mild, conservative management is an option, but patients should be monitored for signs of peritonitis.
name: Rupture
label: c
answer: no
explanation: Fibroids are not found in the ovary, but in and around the uterus. The most common symptom is vaginal bleeding after menopause.
name: Fibroid
label: d
answer: no
explanation: People with ovarian cancer often present with abdominal bloating, which may be shown as trouble eating or feeling full too quick. They may also have other features of cancer, such as weight loss and fatigue. It is unlikely to present acutely.
name: Cancer
label: b
answer: no

Correct answer: a
A 33-year-old sexually active woman has a one-week history of unusual discharge and pain on urination. She last had a sexually transmitted infection (STI) screening two months ago.

Which pathogen is most likely to cause this presentation?

Options:
explanation: Candida (thrush) is a fungal infection that causes discharge, and is often accompanied by itching. It is a non-sexually transmitted infection.
name: Candida
label: b
answer: no
explanation: Syphilismay cause generalized symptoms in the primary stage, such as flu, headache, ulcers, or lymphadenopathy.
name: Syphilis
label: e
answer: no
explanation: This presentation is similar to gonorrhoea. However, as chlamydia is the most prevalent STI, this is the most likely cause of this woman's symptoms.
name: Gonorrhoea
label: d
answer: no
explanation: Herpes may cause pain on urination and discharge. However, when the virus is in an active state, it is accompanied by ulcers and pain. On examination, there may be lymphadenopathy.
name: Herpes simplex
label: c
answer: no
explanation: Chlamydia is the most common STI, but a swab and culture is necessary to confirm the diagnosis. Initial symptoms are as described, but may also may cause pain. If untreated, it may progress to infertility or pelvic inflammatory disease, which causes chronic pain.
name: Chlamydia
label: a
answer: yes

Correct answer: a
Which strains of HPV are most likely to cause cervical cancer?

Options:
explanation: These are some other high-risk strains.
name: 31 and 33
label: d
answer: no
explanation: These numbers were chosen at random.
name: 8 and 12
label: c
answer: no
explanation: These strains of HPV are most likely to cause ano-genital warts. These are usually vaccinated against too.
name: 6 and 11
label: b
answer: no
explanation: These numbers were chosen at random.
name: 8 and 20
label: e
answer: no
explanation: These strains of HPV are most likely to cause cervical cancer. Vaccination is done against these strains.
name: 16 and 18
label: a
answer: yes

Correct answer: a
In the complement system, the three pathways all converge to cleave which component?

Options:
explanation: As above, C3b is first needed before cleavage of C5 occurs.
name: C5
label: d
answer: no
explanation: C1 is part of the classical pathway. It must bind at least two Fc domains of an antibody-antigen complex.
name: C1
label: e
answer: no
explanation: All pathways act to cleave C3 into C3b using a C3 convertase enzyme. There are two different C3 convertases (C4b2a in classical and lectin, C3bBb in alternative). C3b becomes a core component of C5 convertase, which cleaves C5 into C5b. C5b forms part of the membrane attack complex which perforates pathogens open. People with C3 deficiencies have the most severe infections out of any complement deficiency.
name: C3
label: a
answer: yes
explanation: Both lectin and classical pathways cleave C4 - the alternative pathway does not.
name: C4
label: c
answer: no
explanation: The classical and lectin pathways both act on C2 - the alternative pathway does not.
name: C2
label: b
answer: no

Correct answer: a
Children should receive tetanus vaccines as a part of the childhood UK vaccination schedule.

What type of vaccine is this?

Options:
explanation: Adjuvants boost response to antigens. They are used as components in other vaccines.
name: Adjuvants
label: b
answer: no
explanation: Inactivated (killed) vaccines use the entire organism, but the viability of them to reproduce is destroyed.
name: Inactivated
label: d
answer: no
explanation: These vaccines make organisms that are adapted to live in culture, meaning they are viable inside the body, but cannot cause disease.
name: Live-attenuated viruses
label: c
answer: no
explanation: mRNA vaccines are novel approaches to vaccination, such as SARS-CoV2 vaccines Pfizer and Moderna.
name: mRNA
label: e
answer: no
explanation: These vaccines only use a critical part of the organism. The type of subunit vaccine to treat tetanus is a toxoid vaccine. Once injected, IgG antibodies form. These neutralise the toxin molecules if present in circulation.
name: Subunit
label: a
answer: yes

Correct answer: a
Gut-associated lymphatic tissue is found throughout our alimentary tract.

Which cells deliver antigens from the gut into the Peyer's patch?

Options:
explanation: M cells transport antigens from the gut lumen to subepithelial lymphoid structures.
name: M cells
label: a
answer: yes
explanation: Follicular dendritic cells uptake antigens and present them to B cells. Like dendritic cells, they do not transport the antigen from the gut into the Peyer's patch.
name: Follicular dendritic cells
label: c
answer: no
explanation: Paneth cells produce human defensin 5 and 6 (antimicrobial peptides), as well as trypsin (for proteolytic cleavage of pathogens).
name: Paneth cells
label: b
answer: no
explanation: Goblet cells produce mucus.
name: Goblet cells
label: d
answer: no
explanation: Dendritic cells uptake the antigen once inside the Peyer's patch and process it. However, they do not transport the antigen from the gut into here.
name: Dendritic cells
label: e
answer: no

Correct answer: a
An IGRA test is performed for a patient with suspected tuberculosis. Which structure is the arrow pointing to?

[lightgallery]

Options:
explanation: IFN-gamma causes macrophages to phagocytose pathogens more. Tuberculosis lives inside the phagolysosome of macrophages.
name: Macrophage
label: e
answer: no
explanation: This is the antibody that has conjugate dye attached to it and causes the colour change if IFN-gamma is present.
name: Detection antibody
label: d
answer: no
explanation: Tuberculosis is not measured in an ELISA test.
name: Tuberculosis antigens
label: c
answer: no
explanation: This is the antibody attached to the assay plate.
name: Anti-IFN gamma antibody
label: b
answer: no
explanation: This is the cytokine used in the specific ELISA test for tuberculosis. IFN-gamma comes from Th1 cells in response to tuberculosis antigens (ESTAT-6 and CFP10).
name: IFN-gamma
label: a
answer: yes

Correct answer: a
After vaccination, when an individual is exposed to the pathogen that they were vaccinated against, the immunoglobulin that encounters it in the blood is already complementary to its antigens.

Which isotype of antibody is responsible for this type of immune response?

Options:
explanation: IgA is the antibody found in mucosal surfaces.
name: IgA
label: d
answer: no
explanation: IgD is one of the antibodies expressed on naive B cells. B cells would have been primed for this pathogen already, so the antibodies would have undergone a class-switch from IgD to something else (such as IgG).
name: IgD
label: e
answer: no
explanation: IgG is the main circulating immunoglobulin and is the isotype present during the secondary immune response. As the patient has already been vaccinated (primary immune response), and is now exposed to the pathogen (secondary immune response), IgG will encounter it.
name: IgG
label: a
answer: yes
explanation: IgE is the antibody found on mast cells and is responsible for histamine release and allergy.
name: IgE
label: c
answer: no
explanation: IgM is the main antibody present during a primary immune response.
name: IgM
label: b
answer: no

Correct answer: a
A 56-year-old man comes to the GP with a first flare of gout. After the patient is treated for the flare, the GP mentions starting a long-term medication to reduce the incidence of gout in the future.

Which medication is the GP referring to?

Options:
explanation: NSAIDs are one of the options for treating acute flare of gout.
name: Naproxen
label: b
answer: no
explanation: Colchicine is one of the options for treating acute flare of gout.
name: Colchicine
label: c
answer: no
explanation: Allopurinol can be started after an acute flare of gout. It works to reduce urate as urate crystals are responsible for gout. It is important to take this as people may get chronic arthritis from gout and it prevents adverse cardiovascular risks.
name: Allopurinol
label: a
answer: yes
explanation: Methotrexate is a medication used to treat rheumatoid arthritis.
name: Methotrexate
label: e
answer: no
explanation: A short dose of oral steroids is one of the options for treating acute flare of gout.
name: Prednisolone
label: d
answer: no

Correct answer: a
If patients with giant cell arteritis (GCA) present to the emergency department and are not treated urgently, what permanent complication are they at risk of?

Options:
explanation: If patients are not treated immediately with high-dose steroids, they may become permanently blind.
name: Blindness
label: a
answer: yes
explanation: This may be a long-term complication of steroid treatment, but not GCA itself.
name: Osteoporosis
label: b
answer: no
explanation: GCA may mimic malignancy at first, as both have systemic symptoms of fever, weight loss, and fatigue.
name: Malignancy
label: c
answer: no
explanation: AKI can be a complication of small vessel vasculitis. GCA is a large vessel vasculitis.
name: Acute kidney injury
label: e
answer: no
explanation: GCA is a large vessel vasculitis. Other arteries vasculitis may affect include the aorta. However, this may be a late-stage complication of GCA, not immediate.
name: Aortic aneurysm
label: d
answer: no

Correct answer: a
Once an antibody has been made from its genetic sequence, which process introduces further diversity?

Options:
explanation: Somatic hypermutation in lymph nodes adds further diversity to the already rearranged VDJ segments. The enzyme AID does this by introducing point mutations to the variable region of the antibody.
name: Somatic hypermutation
label: a
answer: yes
explanation: This process happens by B cells to produce more antibodies with an increased affinity to a specific antigen.
name: Affinity maturation
label: c
answer: no
explanation: When B cells have antibodies that are complementary to antigens, they will undergo clonal expansion, which makes more copies of that B cell and antibody.
name: Clonal expansion
label: e
answer: no
explanation: This is the initial process at a genetic level that gives rise to antibody diversity. The immunoglobulin protein is yet to be made at this point.
name: Somatic recombination
label: b
answer: no
explanation: This process generates the different isotypes of antibodies (eg IgG, IgA, IgE). It happens by changing the constant region of an antibody.
name: Class switch recombination
label: d
answer: no

Correct answer: a
Which type of cell in bone usually lie silent in order to maintain bone?

Options:
explanation: OsteoClasts Cut bone, breaking it down. They are active in the constant process of bone remodelling.
name: Osteoclast
label: b
answer: no
explanation: These stem cells found in the bone marrow are responsible for producing all of the cells in the blood. Osteoclasts have the same precursor as monocytes, which are formed from haematopoetic stem cells.
name: Haematopoetic cells
label: d
answer: no
explanation: These are the stem cells that make osteoblasts. Osteoblasts become osteocytes once trapped in layers of bone.
name: Osteoprogenitor cells
label: e
answer: no
explanation: Osteocytes are found in bones and lie within the layers of fully formed bone.
name: Osteocyte
label: a
answer: yes
explanation: OsteoBlasts Build bone. They are active in the constant process of bone remodelling.
name: Osteoblasts
label: c
answer: no

Correct answer: a
A patient has a tight plaster cast around their calf and ankle. Once removed, they cannot dorsiflex or evert their foot. There is also some sensory loss to the dorsum of the foot and outer aspect of the lower leg.

Injury to which nerve has likely caused this foot drop?

Options:
explanation: Common peroneal nerve injuries are common because the nerve is very superficial. The patient's motor and sensory symptoms are caused by improper common peroneal nerve functioning.
name: Common peroneal
label: a
answer: yes
explanation: Sciatic nerve injury may cause a foot drop. However, sciatica is typically accompanied by shooting pain down one leg.
name: Sciatic
label: b
answer: no
explanation: It is rare to get lesions of this nerve. The tibial nerve is responsible for ankle plantar flexion and inversion.
name: Tibial
label: c
answer: no
explanation: The femoral nerve is responsible for knee extension and hip flexion. It does not affect the foot.
name: Femoral
label: d
answer: no
explanation: This may cause a foot drop. However, the presence of plaster cast would not affect the L4/5 root.
name: L4/5 root
label: e
answer: no

Correct answer: a
A trans-aortic valve implantation (TAVI) is a procedure that requires the insertion of a catheter into the femoral artery of the groin.

What structure is immediately lateral to the femoral artery?

Options:
explanation: The inguinal ligamnet is the superior border of the femoral triangle.
name: Inguinal ligament
label: d
answer: no
explanation: The femoral nerve is the closest lateral structure to the femoral artery.
name: Femoral nerve
label: a
answer: yes
explanation: The femoral vein is medial to the femoral artery.
name: Femoral vein
label: b
answer: no
explanation: The sartorius muscle is the lateral border of the femoral triangle. Between the femoral artery and sartorius muscle is the femoral nerve.
name: Sartorius
label: e
answer: no
explanation: Lymphatics are medial to the femoral vein.
name: Lymphatics
label: c
answer: no

Correct answer: a
Patients with carpal tunnel syndrome may have weakness and difficulty moving certain muscles.

Which muscle will not be affected in carpal tunnel syndrome?

Options:
explanation: This muscle is innervated by the median nerve.
name: Flexor pollicis brevis
label: d
answer: no
explanation: This muscle is innervated by the median nerve.
name: Abductor pollicis brevis
label: c
answer: no
explanation: The interossei muscles (both dorsal and ventral) are innervated by the ulnar nerve. In carpal tunnel syndrome, the median nerve is compressed. This leads to weakness of the LOAF muscles (which are the other options in this question).
name: Dorsal interossei
label: a
answer: yes
explanation: This muscle is innervated by the median nerve.
name: Opponens pollicis
label: b
answer: no
explanation: This muscle is innervated by the median nerve.
name: Lateral lumbricals
label: e
answer: no

Correct answer: a
Which of the following medications is typically used first-line in myasthenia gravis (MG)?

Options:
explanation: Some immunosuppressive drugs can be used to treat MG, but this is not first-line.
name: Azathioprine
label: d
answer: no
explanation: Corticosteroids may be used in the treatment of MG, but are not typically first-line.
name: Prednisolone
label: b
answer: no
explanation: This monoclonal antibody targets CD20 on B cells. It may be used to treat MG, but is not first-line.
name: Rituximab
label: e
answer: no
explanation: Acetylcholine esterase (AChE) inhibitors are usually the first-line treatment. MG is caused by a reduction in nicotinic receptors, which use acetylcholine (ACh) as the ligand to activate them. AChE breaks down acetylcholine (ACh). Treatment aims to increase ACh in the synapse, which can be done using pyridostigmine (a AChE).
name: Pyridostigmine
label: a
answer: yes
explanation: This treats malignant hyperthermia, which is caused by a reaction to some inhaled anaesthetics.
name: Dantroline sodium
label: c
answer: no

Correct answer: a
A patient for surgery is put under general anaesthetic using sevoflurane. They start to become tachypnoeic and pyrexic. Malignant hyperthermia is suspected.

Mutation to which structure is responsible for this condition?

Options:
explanation: SERCA working too hard is part of the pathophysiology of this process. However, it is not mutated in patients with malignant hyperthermia.
name: SERCA
label: b
answer: no
explanation: Mutation to dystrophin gene is X-linked and can cause Duchenne muscular dystrophy.
name: Dystrophin
label: d
answer: no
explanation: Nicotinic receptors are responsible for muscle contraction at the neuromuscular junction.
name: Nicotinic receptor
label: c
answer: no
explanation: A mutation in ryanodine receptors means gas anaesthetic causes calcium release. This makes the SERCA work harder to pump more Ca2+ back into the sarcoplasmic reticulum. This consumes ATP, O2, and leads to the consequences of malignant hyperthermia.
name: Ryanodine receptor
label: a
answer: yes
explanation: Creatine kinase is an energy store for muscle contraction.
name: Creatine kinase
label: e
answer: no

Correct answer: a