hllj/quesmed huggingface dataset:
A 32 year old woman is looking to conceive her first baby. She asks her gynaecologist what happens during embryological development.

Which of the following occurs in weeks 3-4 post-fertilisation?

Options:
explanation: Synaptic pruning only occurs after birth and continues into adolescence. The early postnatal phase is marked by an extraordinary level of neural plasticity, allowing the brain to adapt and learn from new experiences and environmental stimuli. As a child progresses through infancy and early childhood, selective elimination and weakening of synapses that are less frequently used or are less essential for efficient neural circuitry occurs.
name: Synaptic pruning
label: e
answer: no
explanation: Formation of bilaminar embryonic disc occurs approximately on day 9 post-fertilisation. After implantation, the inner cell mass differentiates into the epiblast and the hypoblast. These two layers are separated by a thin basal lamina and form the bilaminar disc.
name: Formation of bilaminar disc
label: c
answer: no
explanation: Gastrulation occurs in the week 2 post-fertilisation. The process of gastrulation converts the bilaminar disc into a trilaminar disc. Through gastrulation, the three primary germ layers, ectoderm, mesoderm and endoderm are formed.
name: Gastrulation
label: b
answer: no
explanation: Myelination occurs in the third trimester around week 30 post-fertilisation and continues well into adulthood. During the embryonic and foetal stages, oligodendrocytes in the central nervous system and Schwann cells in the peripheral nervous system are responsible for producing myelin. After birth, myelination continues, and it is most pronounced in the early years of life. Myelination is essential for the development of motor skills, sensory perception, and cognitive functions by allowing rapid neuronal conduction.
name: Myelination
label: d
answer: no
explanation: Neurulation occurs in weeks 3-4 post-fertilisation and stimulates the development of the nervous system. The process starts with the formation of a flat, thickened sheet of ectodermal cells called the neural plate along the dorsal surface of the embryo. The neural plate will eventually give rise to the central nervous system.
name: Neurulation
label: a
answer: yes

Correct answer: a
A 45 year old man is reviewed in a neurology clinic following changes to his sensory perception of stimuli. He experienced a spinal injury in a road traffic accident the previous year, and although he is gradually regaining functionality in his limbs has noted ongoing sensory problems.

Which of the following sensory modalities is transmitted via the spinothalamic tract?

Options:
explanation: This is the correct answer. The spinothalamic tract (also referred to as the anterolateral system) is an ascending pathway of the spinal cord. It is responsible for the transmission of pain, temperature, and crude touch to the somatosensory region of the thalamus.
name: Temperature
label: a
answer: yes
explanation: Pressure sensation is the perception of mechanical pressure applied to the skin. It is transmitted primarily through the dorsal column pathway. The spinothalamic tract transmits pain, temperature and crude touch while the dorsal column transmits vibration, proprioception, and fine touch.
name: Pressure
label: d
answer: no
explanation: Vibration sensation involves the perception of rapid oscillations or vibrations applied to the skin. Vibration sensation is carried by the dorsal column pathway. The spinothalamic tract transmits pain, temperature and crude touch while the dorsal column transmits vibration, proprioception, and fine touch.
name: Vibration
label: c
answer: no
explanation: Two-point discrimination is the ability to distinguish between two separate points of contact on the skin. It is mediated by the dorsal column pathway. Spinothalamic tract transmits pain, temperature and crude touch while dorsal column transmits vibration, proprioception, and fine touch.
name: Two point discrimination
label: b
answer: no
explanation: Kinesthesia is the conscious awareness of limb movement and position. It relies on proprioceptive signals carried by the dorsal column system. The spinothalamic tract does not play a role in conveying information related to muscle sense. It transmits pain, temperature and crude touch while the dorsal column transmits vibration, proprioception, and fine touch.
name: Kinesthesia
label: e
answer: no

Correct answer: a
A 66 year old man attends his GP surgery with his wife due to a concerning pattern of behaviour. The patient's wife reports that he has started getting out of bed at night and walking around the house without seeming to wake up. These episodes are becoming extremely disruptive to the rest of the household, and they are worried that he may fall down the stairs. The patient has no memory of these episodes upon waking, but notes he does feel very tired.

In which of the following sleep phases is this phenomenon most likely to occur?

Options:
explanation: The phenomenon described is a sleep disorder known as sleepwalking or somnambulism. Sleepwalking usually occurs during the deepest stage of non-rapid eye movement (NREM) sleep, in N3 (slow-wave sleep), rather than during the initial sleep onset (N1) stage, which is a lighter stage of sleep.
name: Stage 1 of NREM
label: c
answer: no
explanation: The phenomenon described is a sleep disorder known as sleepwalking or somnambulism. Sleepwalking typically occurs during non-rapid eye movement (NREM) sleep, specifically in the stage of N3, which is also referred to as slow-wave sleep. N3 is the deepest stage of NREM sleep and is associated with reduced arousal thresholds, making it more likely for sleepwalking episodes to occur during this phase.
name: Stage 3 of NREM
label: a
answer: yes
explanation: The phenomenon described is a sleep disorder known as sleepwalking or somnambulism. During wakefulness, the brain is in a state of consciousness. By contrast, sleepwalking is a disorder in which individuals engage in complex behaviours during sleep without conscious awareness. Therefore, sleepwalking usually occurs during the deepest stage of non-rapid eye movement (NREM) sleep, in N3 (slow-wave sleep). The reduced arousal thresholds make it more likely for sleepwalking episodes to occur during this phase.
name: Wake stage
label: e
answer: no
explanation: The phenomenon described is a sleep disorder known as sleepwalking or somnambulism. Sleepwalking usually occurs during the deepest stage of non-rapid eye movement (NREM) sleep, in N3 (slow-wave sleep), rather than the N2 stage, which is relatively lighter.
name: Stage 2 of NREM
label: d
answer: no
explanation: The phenomenon described is a sleep disorder known as sleepwalking or somnambulism. Sleepwalking typically occurs during non-rapid eye movement (NREM) sleep, specifically in the stages of N3. By contrast, REM sleep is a distinct phase characterised by rapid eye movements, vivid dreaming, and temporary large muscle paralysis to prevent acting out dreams.
name: REM
label: b
answer: no

Correct answer: a
A 30 year old patient is assessed in A&E following a serious road traffic collision. He is able to answer questions fluently, but the content of his responses does not make much sense, and he believes he is in the supermarket. He is not able to follow instructions to move his limbs, but when pressure is applied to the patient’s supraorbital notch, he reaches towards the pressure site and his hand goes above the clavicle. His eyes open spontaneously.

Which of the following Glasgow Coma Scale (GCS) scores best describes this patient's consciousness level?

Options:
explanation: This is the correct answer. Eye-opening response score is 4 for spontaneous opening, verbal response is 4 as he is confused, and motor response is 5 as he moves to localised pain. The total GCS score is 13.
name: 13
label: a
answer: yes
explanation: This is the correct answer. Eye-opening response score is 4 for spontaneous opening, verbal response is 4 as he is confused, and motor response is 5 as he moves to localised pain. The total GCS score is 13.
name: 12
label: d
answer: no
explanation: This is the correct answer. Eye-opening response score is 4 for spontaneous opening, verbal response is 4 as he is confused, and motor response is 5 as he moves to localised pain. The total GCS score is 13.
name: 14
label: e
answer: no
explanation: This is the correct answer. Eye-opening response score is 4 for spontaneous opening, verbal response is 4 as he is confused, and motor response is 5 as he moves to localised pain. The total GCS score is 13.
name: 11
label: c
answer: no
explanation: Eye-opening response score is 4 for spontaneous opening, verbal response is 4 as he is confused, and motor response is 5 as he moves to localised pain. The total GCS score is 13.
name: 10
label: b
answer: no

Correct answer: a
A 29 year old female with a new diagnosis of narcolepsy discusses her condition in neurology clinic. The clinician explains that narcolepsy is associated with low levels of the neuropeptide hypocretin. This neuropeptide acts across several brain regions, including one that is involved in the arousal system.

Which of the following brain regions contains the orexin-producing neurons implicated in narcolepsy?

Options:
explanation: This is the correct answer. Narcolepsy is a neurological disorder characterised by disturbances in the sleep-wake cycle and is often linked to a deficiency of hypocretin (also known as orexin), a neuropeptide produced by neurons in the posterior lateral hypothalamus. Hypocretin/orexin plays a critical role in regulating wakefulness and maintaining arousal. It promotes alertness and prevents transitions into sudden sleep episodes. The posterior lateral hypothalamus contains the neurons that produce hypocretin/orexin. Dysfunction of these neurons can lead to narcolepsy.
name: Posterior lateral hypothalamus
label: a
answer: yes
explanation: It is important to note that the midbrain reticular formation is indeed involved in the regulation of arousal and wakefulness, but the specific neuropeptide mentioned here, hypocretin, is produced by cells in the hypothalamus.
name: Midbrain reticular formation
label: b
answer: no
explanation: It is important to note that while the intralaminar nucleus in the thalamus is indeed involved in the regulation of arousal and wakefulness, hypocretin is primarily produced in the hypothalamus.
name: Intralaminar nucleus in the thalamus
label: e
answer: no
explanation: The suprachiasmatic nucleus is a critical component of the hypothalamus involved in regulating the body's circadian rhythms and the sleep-wake cycle. Although it does influence the timing of sleep and wakefulness, hypocretin is primarily produced in the hypothalamus.
name: Suprachiasmatic nucleus in the hypothalamus
label: d
answer: no
explanation: The ventral tegmental area is primarily associated with the reward system and the release of dopamine. Although it has an impact on motivation and mood, it is not directly involved in the regulation of the sleep-wake cycle or arousal system. Hypocretin is primarily produced in the hypothalamus.
name: Ventral tegmental area
label: c
answer: no

Correct answer: a
A 80 year old gentleman has just been diagnosed with Alzheimer's disease. His daughter is keen to learn more about the different types of memory.

Which of the following types of memory is most commonly impaired in the initial stages of Alzheimer's disease?

Options:
explanation: This is the correct answer. Declarative memory is a category of long-term memory that includes facts, knowledge, and events that can be consciously recalled and verbally expressed. It can be further categorised into semantic memory, episodic memory, autobiographical memory and visual memory. It is distributed widely across the neocortex and is impaired in the early stages of Alzheimer's dementia.
name: Declarative memory
label: a
answer: yes
explanation: Implicit memory, also known as non-declarative memory, consists of memories that are outside of conscious awareness. This includes memory of skills or actions that can be performed without thinking. Implicit memory is typically preserved in early stages of Alzheimer's dementia.
name: Implicit memory
label: e
answer: no
explanation: Working memory refers to the short-term storage and manipulation of information for brief periods, typically seconds to minutes. Advanced Alzheimer's dementia can affect short-term memory to some extent, but it is the long-term memory that is more profoundly impacted and is more noticeably impaired during early stages.
name: Working memory
label: b
answer: no
explanation: Long-term memory includes both declarative memory and procedural memory. Although declarative memory is impaired in early-stage Alzheimer's dementia, procedural memory, which is responsible for the learning and execution of motor skills and habits, tends to be relatively preserved in the early stages. Procedural memory is closely associated with the basal ganglia and the cerebellum, whereas declarative long-term memory is more widely distributed across the neocortex.
name: Long-term memory
label: c
answer: no
explanation: Sensory memory is a very brief stage of memory that involves the temporary storage of sensory information for very short periods, typically fractions of a second to a few seconds. Sensory memory is not typically impaired in early-stage Alzheimer's dementia.
name: Sensory memory
label: d
answer: no

Correct answer: a
A 19 year old male teenager visits the GP with his mother, who is concerned about his mental health. He has started to perform certain behaviours obsessively, even when there seems to be no reason for them, such as turning the lights on and off and repetitive cleaning. He is otherwise fit and well, although has been to see the GP recently due to a teeth grinding habit that is still ongoing.

Which of the following brain structures is most likely implicated in this patient's behaviour?

Options:
explanation: The amygdala is most associated with emotional processing, particularly in the generation of fear and emotional responses. It is not a primary regulator of motor behaviours like teeth grinding and tidying obsessions. The correct answer is the basal ganglia, which has a role in the coordination of movements and regulating repetitive or habitual behaviours.
name: Amygdala
label: c
answer: no
explanation: The thalamus serves as a relay station for sensory information and plays a role in alertness and consciousness. Although it plays a vital role in processing sensory input, it is not a primary regulator of motor behaviours like teeth grinding and tidying obsessions. The correct answer is the basal ganglia, which has a role in the coordination of movements and regulating repetitive or habitual behaviours.
name: Thalamus
label: d
answer: no
explanation: The occipital cortex is part of the brain involved in the processing and perception of visual information. It does not generate motor responses. By contrast, the basal ganglia is associated with regulating repetitive or habitual behaviours, making this option incorrect.
name: Occipital cortex
label: b
answer: no
explanation: The hypothalamus is primarily responsible for regulating various essential functions, including temperature, hunger, thirst, and the body's circadian rhythm. It is more linked to autonomic functions, hormonal regulation, and basic survival behaviours. The correct answer is the basal ganglia, which has a role in the coordination of movements and regulating repetitive or habitual behaviours.
name: Hypothalamus
label: e
answer: no
explanation: This is the correct answer. The basal ganglia (striatum) are a collection of subcortical forebrain nuclei that function in the coordination of movements and regulating repetitive or habitual behaviours. Dysregulation of the basal ganglia can lead to the development of obsessive-compulsive disorder (OCD) and related behaviours, where individuals may have an overwhelming urge to perform certain actions repeatedly (obsessions) and feel compelled to do them (compulsions), as in this vignette.
name: Basal ganglia
label: a
answer: yes

Correct answer: a
A 19 year old female attends her GP surgery with concerns about excessive hair on her face and chest. She reports starting her period at 13 years old. These periods usually last 7 days and occur regularly. She takes antihistamines for hay fever during the summer and occasional paracetamol when she has a headache.

She is 162cm tall and weighs 68kg. Her blood pressure, luteinising hormone, follicle-stimulating hormone, prolactin, and testosterone levels are within normal limits. She undergoes a pelvic ultrasound scan which is unremarkable.

Which of the following is the most likely diagnosis?

Options:
explanation: PCOS can be diagnosed if at least two of the following criteria are met:

* Polycystic ovaries (>12 cysts seen on imaging or ovarian volume >10 cubic cm)
* Oligo-/anovulation
* Clinical or biochemical features of hyperandrogenism

Although this patient has some features of hyperandrogenism, such as hirsutism and a slightly elevated BMI, she has normal ovaries and normal menstrual function. Thus, she meets only one of the above criteria. In addition, she has normal LH, FSH and testosterone levels. These make PCOS unlikely.
name: Polycystic ovary syndrome (PCOS)
label: c
answer: no
explanation: This is the correct answer. Excessive hair growth may be hereditary and familial in some cases, without a specific underlying medical cause. This is more likely if there is a family history of hirsutism, although this is unknown from this vignette. Menstrual function and hormonal investigations are normal, suggesting that there are no underlying endocrine or gynaecological disorders.
name: Idiopathic or familial hirsutism
label: a
answer: yes
explanation: Drug-induced hirsutism can occur due to the use of certain medications, such as steroids and cyclosporine, that can lead to increased hair growth. It is not associated with antihistamine or paracetamol administration. Furthermore, the normal hormonal and ultrasound findings do not suggest a direct correlation with drug-induced hirsutism.
name: Drug induced hirsutism
label: b
answer: no
explanation: CAH typically results in elevated androgen levels due to an enzymatic deficiency in the adrenal glands, leading to virilising effects. However, in this patient, normal hormone levels are observed. CAH is also more likely to lead to irregular menstrual periods or even amenorrhea due to hormonal imbalances. This patient reports regular, albeit lengthy, menstrual cycles.
name: Congenital adrenal hyperplasia (CAH)
label: d
answer: no
explanation: Cushing's disease is an endocrine disorder normally caused by an ACTH-secreting pituitary adenoma, leading to excessive cortisol production. It typically presents with symptoms related to excess cortisol production, such as weight gain, central obesity, easy bruising, and a distinct clinical profile that includes high blood pressure. However, the patient's blood pressure is within normal limits. Although hirsutism is also a feature of Cushing's disease, the patient does not experience other prominent cushingoid symptoms or signs, making Cushing's disease unlikely.
name: Cushing's disease
label: e
answer: no

Correct answer: a
A 25 year old woman attends her GP surgery with concerns that she has lost weight despite eating a normal diet. She also reports feeling very hot and sweaty, but when she measured her temperature it is within the normal range. Laboratory blood tests show a high T4 and low thyroid stimulating hormone.

Which of the following additional symptoms are most likely to be reported?

Options:
explanation: This patient has hyperthyroidism as shown by her symptoms and laboratory results. Diarrhoea, rather than constipation, is commonly seen in hyperthyroidism. This option is therefore incorrect.
name: Constipation
label: d
answer: no
explanation: This patient has hyperthyroidism as shown by her symptoms and laboratory results. Brittle nails are a symptom of hypothyroidism. The reduced metabolic rate in hypothyroidism affects the body's ability to produce and utilise various nutrients. Slower metabolism can lead to impaired circulation to the nail bed, limiting the delivery of vital nutrients. Furthermore, the thyroid hormones also play a role in regulating protein synthesis, including the production of keratin, a key structural protein found in nails.
name: Brittle nails
label: e
answer: no
explanation: This patient has hyperthyroidism as shown by her symptoms and laboratory results. Bradycardia is a symptom of hypothyroidism. The slow metabolic rate reduces heart rate. In addition, hypothyroidism may shift our body towards increased parasympathetic nervous system activity, which slows down the heart rate. By contrast, hyperthyroidism is more commonly associated with tachycardia.
name: Bradycardia
label: b
answer: no
explanation: This patient has hyperthyroidism as shown by her symptoms and laboratory results. Cold sensitivity is a symptom of hypothyroidism. When thyroid hormone levels are reduced, the metabolic rate decreases, resulting in reduced heat production by the body. The body may also have difficulty maintaining adequate peripheral blood flow, which can lead to cold extremities and an overall feeling of coldness. By contrast, hyperthyroidism is more commonly associated with heat intolerance.
name: Cold sensitivity
label: c
answer: no
explanation: This is the correct answer. This patient has hyperthyroidism as shown by her symptoms and laboratory results. Elevated levels of thyroid hormones can lead to irregular or absent ovulation. Hyperthyroidism may shorten the luteal phase of the menstrual cycle, resulting in a shorter and lighter menstrual flow. Additionally, weight loss can disrupt normal hormonal signalling in the body, impacting the menstrual cycle.
name: Hypomenorrhea
label: a
answer: yes

Correct answer: a