hllj/quesmed huggingface dataset:
Case presentation: A 25-year-old woman attends her GP appointment with a one-week history of vaginal discharge. She describes the discharge as thin and white and has a fishy odour. A swab is performed and clue cells are seen under the microscope.  

The patient is advised to commence treatment with metronidazole 400mg PO twice daily for 7 seven days.

Question: Select the most appropriate information that should be provided for this patient.

Options:
explanation: It is important to remind the patients not to consume any alcohol during the course of treatment and for 48 hours after the completion of therapy. Metronidazole can interact with alcohol to produce a disulfiram-like reaction that brings about side effects such as hot flushes, palpitation and headache
name: She should not drink alcohol during the course of treatment
label: a
answer: yes
explanation: Metronidazole is an antibiotic that is highly effective against anaerobic bacteria and protozoa
name: Metronidazole is an antifungal medication
label: b
answer: no
explanation: Patients should continue the full course of treatment even if they have felt better to in order to prevent the development of antibiotic resistance in the future
name: She should stop taking the medication once the discharge has gone to reduce the risk of side effects
label: c
answer: no
explanation: Metronidazole is associated with decrease in appetite
name: Metronidazole can lead to increased appetite and weight gain
label: d
answer: no
explanation: Dark urine is a rare side effect of metronidazole
name: Dark urine is a common side effect of metronidazole
label: e
answer: no

Correct answer: a
Case presentation: A 32-year-old woman attends the dermatology clinic for her acne vulgaris medication review. She complains that her acne problem has not improved despite taking the medication prescribed diligently.  

Physical examination: Widespread nodules and cysts over the face as well as the presence of multiple ice pick scars.
DH: Topical adapalene once daily; Tetracycline 500mg PO twice daily
The patient is advised to commence treatment with Isotretinoin 25mg PO OD under the supervision of her dermatologist.

Question: Select the most appropriate information that should be provided for this patient.

Options:
explanation: Usage of isotretinoin during pregnancy is linked to an increased risk of serious congenital abnormalities. Hence, patients who are sexually active are required to use effective contraception during the course of treatment and for four weeks after discontinuation of medication
name: She should not get pregnant during treatment and for at least 1 month after cessation of treatment
label: a
answer: yes
explanation: Isotretinoin is not associated with excessive sweat. On the other hand, it can cause the skin to become dry and sensitive to sunlight
name: Excessive sweat is a common side effect of isotretinoin
label: e
answer: no
explanation: Isotretinoin is a vitamin A derivative (retinoid) that is used to treat severe acne vulgaris
name: Isotretinoin is a Vitamin D derivative
label: b
answer: no
explanation: Patients are not allowed to donate blood while taking isotretinoin in case the donated blood is given to a pregnant woman
name: She can donate blood while taking isotretinoin
label: c
answer: no
explanation: Isotretinoin does not specifically interact with pineapples. Patients are generally allowed to eat and drink normally while taking isotretinoin
name: She should avoid pineapple during the course of treatment
label: d
answer: no

Correct answer: a
Case presentation: A 54-year-old woman attends the GP with back pain. This back pain started after she bent over to pick up her phone off the floor yesterday. She has no neurological or sensory deficits. She is not incontinent.



**PH**
Depression

**DH**
Sertraline 50mg

One of the medications offered includes ibuprofen, which is offered to the patient to relieve their back pain.

Question: Select the most important information that should be provided for this patient.

Options:
explanation: There is no requirement to check the function of the liver before taking ibuprofen.
name: She must have liver function tests before starting taking ibuprofen
label: d
answer: no
explanation: Gastrointestinal discomfort is a very common side effect of ibuprofen use, especially with long term use. Ibuprofen inhibits the cyclo-oxygenase enzyme. This in turn increases the production of prostanoids such as prostaglandins. These prostaglandins then reduce the efficacy of the mucosal barrier within the stomach, making stomach ulcers more likely.
name: A long course of ibuprofen increases her risk of stomach ulcers
label: a
answer: yes
explanation: Ibuprofen can increase a patient's cardiovascular risk however this is often the case in those with pre-existing cardiovascular disease who are taking ibuprofen long term.
name: A long course of ibuprofen will decrease her cardiovascular risk
label: b
answer: no
explanation: A penicillin allergy has no cross-sensitivity with penicillin based medications, it does however have cross-sensitivity with other non steroidal anti-inflammatories and aspirin.
name: She must not take ibuprofen if she has an allergy to amoxicillin
label: c
answer: no
explanation: Whilst constipation is a side effect of ibuprofen it is a rare/very rare side effect and therefore is unlikely to occur.
name: She is likely to experience constipation when taking ibuprofen
label: e
answer: no

Correct answer: a
An 84-year-old woman with a history of poorly controlled type 2 diabetes is admitted to the Vascular ward for treatment of a new diabetic foot infection. The resulting microbiology from her wound swab is only sensitive to Vancomycin. She weighs 50kg.


Prior to administration, Vancomycin needs to be diluted with sodium chloride 0.9% to a concentration that does not exceed 5 mg/mL.

What is the minimum volume (mL) to which each dose of Vancomycin (20 mg/kg) should be diluted?

Options:


Dose = 50 kg x 20 mg = 1000mg
Since maximum concentration is 5 mg/mL, minimum volume is 1000/5 = 200 mL
Case Presentation: A 45-year-old man is recovering on the gastroenterology unit following an elective pan proctocolectomy for his UC five days ago. PMH Type 2 diabetes mellitus, Resistant hypertension, Migraine. DH His current regular medicines are listed (below).


Investigation
Platelet 100 x 109/L (150-400)


Question: Select the prescription that is most likely to contribute to his thrombocytopenia.

Options:
explanation: Ibuprofen does not commonly cause thrombocytopenia
name: Ibuprofen 400mg PO PRN
label: e
answer: no
explanation: Gliclazide does not commonly cause thrombocytopenia
name: Gliclazide 30mg PO OD
label: c
answer: no
explanation: LMWH (Dalteparin sodium) is common or very commonly associated with immune-mediated, drug induced thrombocytopenia. Heparin, which is negatively charged binds to platelet factor 4 (PF4), a positively charged molecule that is released into the circulation upon the activation of platelets. This heparin-PF4 complex acts as a immunogen, which leads to antibody production and the activation and aggregation of platelets. The clearance of the activated platelets can then lead to thrombocytopenia
name: Dalteparin sodium 2500 units SC OD
label: a
answer: yes
explanation: Furosemide does not commonly cause thrombocytopenia
name: Furosemide 40mg PO OD
label: d
answer: no
explanation: Metformin does not commonly cause thrombocytopenia
name: Metformin 1g BD PO
label: b
answer: no

Correct answer: a
Case presentation: A 45-year-old man presents to GP with a visual problem. He is concerned that his vision has a yellow tinge.  

PMH: Diabetes Mellitus, Hypertension, Depression, Atrial fibrillation
DH: His current regular prescriptions are listed
Observations: Temperature 36.5, Respiratory rate 14, Blood pressure 128/85, Heart rate 76, Oxygen saturation 100% (on air)
On Examination: 6/6 visual acuity

Question: Select the prescription that is most likely to be contributing his yellow-tinted vision?

Options:
explanation: Sertraline can cause visual impairment such as blurry vision but is generally less associated with xanthopsia
name: Sertraline 50 mg PO OD
label: e
answer: no
explanation: Blurred vision is a rare or very rare side effect of captopril
name: Captopril 25 mg PO BD
label: d
answer: no
explanation: Metformin is not known to cause xanthopsia
name: Metformin 500 mg PO TDS
label: b
answer: no
explanation: Gliclazide is not known to cause xanthopsia
name: Gliclazide 40mg PO OD
label: c
answer: no
explanation: Visual disorders are common or very common side effects of digoxin. Digoxin toxicity should be suspected in a case of xanthopsia (yellow vision). Toxicity is increased by electrolyte disturbances such as hypercalcaemia, hypokalaemia and hypomagnesaemia. Serum electrolytes and renal function tests should be arranged besides plasma-digoxin concentration assay
name: Digoxin 250 micrograms PO OD
label: a
answer: yes

Correct answer: a
A 67-year-old woman presents to the accident and emergency department with nausea, vomiting and confusion. Two days ago her GP started digoxin 125 micrograms PO once daily for her atrial fibrillation.
 **PMH:** Type 2 Diabetes Mellitus, Atrial fibrillation, Heart failure
**Observations:** Temperature 36.5°C , blood pressure 125/80 mmHg, heart rate 54 bpm, respiratory rate 18; oxygen saturation 100% (on air).
 
 **On examination:** Irregular S1, S2 with presence of S3; chest is clear with no added lung sounds; abdomen soft and non tender

 **ECG:** Downsloping ST depression with a ‘hockeystick’ pattern, flattened T wave, shortened QT interval
Select the prescription that is most likely to have interacted with digoxin to cause the clinical picture described above?

Options:
explanation: Carvedilol is not known to interact with digoxin, although it can increase the risk of bradycardia.
name: Rivaroxaban 20 mg PO OD
label: d
answer: no
explanation: Metformin is not known to interact with digoxin
name: Metformin hydrochloride 500 mg PO TDS
label: c
answer: no
explanation: Lisinopril is not known to interact with digoxin
name: Lisinopril 2.5mg PO OD
label: e
answer: no
explanation: Chlortalidone is a thiazide-like diuretic that can be used to treat oedema secondary to heart failure. It inhibits the Na+/Cl- cotransporter at the distal convoluted tubule of nephron, thereby leading to reduced sodium reabsorption and decreased water retention. Chlortalidone is predicted to increase the risk of digoxin toxicity when given with digoxin. (Severity of interaction: Severe; Evidence for interaction: Study). Chlortalidone can lead to hypokalaemia that increases risk of digoxin toxicity. Digoxin normally competes with potassium to bind to cellular Na+/K+-ATPase pumps. Hence, when potassium levels are low, digoxin can more easily bind to the pumps
name: Chlortalidone 50 mg PO OD
label: a
answer: yes
explanation: Carvedilol is not known to interact with digoxin, although it can increase the risk of bradycardia.
name: Carvedilol 3.125 mg PO BD
label: b
answer: no

Correct answer: a

Chlortalidone 50 mg PO OD
Case presentation: A 60-year-old man is brought to the accident and emergency department. He had a fall this morning after accidentally walking into a glass door. Besides his prescribed medication, he has been taking some herbal supplements lately.  

PMH: Atrial fibrillation
DH: Warfarin Sodium 10 mg PO once daily, Bisoprolol 10 mg PO once daily
Observations: Temperature 36.5°C , blood pressure 125/80 mmHg, heart rate 80 bpm, respiratory rate 18; oxygen saturation 100% (on air)
On examination: Minor bleeding from a cut on his right hand (and no other bleeding sites), cannot weight bear, pain on external rotation of left leg
Investigations: Pelvic x-ray: Left Intracapsular neck of femur fracture ; INR: 8.2

Question: Select the most appropriate option for the management of this adverse drug event.

Options:
explanation: Haemorrhage is a common or very common side effect of warfarin. In a situation where there is minor bleeding and an INR of more than 8, NICE recommends to stop warfarin and give 0.5–1 mg phytomenadione by slow intravenous injection, or 5 mg by mouth
name: Stop warfarin and give phytomenadione 1mg slow IV injection
label: a
answer: yes
explanation: Phytomenadione needs to be given if there is bleeding and INR is 8 or more
name: Omit two doses of warfarin and restart thereafter
label: c
answer: no
explanation: Urgent intravenous treatment with phytomenadione (vitamin K1), and/or dried prothrombin complex concentrate (factors II, VII, IX, and X), or fresh frozen plasma 15mL/kg is only required if there is heavy bleeding
name: Stop warfarin and commence urgent intravenous treatment with phytomenadione and prothrombin complex concentrate
label: e
answer: no
explanation: Warfarin needs to be stopped. Phytomenadione also needs to be given if there is bleeding and INR is 8 or more
name: Continue with current dose
label: d
answer: no
explanation: Phytomenadione needs to be given if there is bleeding and INR is 8 or more
name: Reduce the dose of warfarin to 5 mg PO OD
label: b
answer: no

Correct answer: a
Case Presentation: A 56-year-old gentleman is admitted to the acute medical unit with pneumonia. Weight 90kg. His Medications are listed (below). 




 **PMH**


 * Hypertension
 * GORD
 * Type II diabetes mellitus


 **On examination**


 * Chest: coarse crackles in left mid to lower zones.
 * HS S1 S2 + no added sounds
 * Abdo SNT
 * Temperature 38.1, BP 110/84, HR 96


 **Investigation**


||||
|---------------------------|:-------:|--------------------|
|Sodium|136mmol/L|135 - 145|
|Potassium|5.5 mmol/L|3.5 - 5.3|
|Urea|5 mmol/L|2.5 - 7.8|
|Creatinine|96 µmol/L|60 - 120|


Question: Which medication is most likely to have contributed to his electrolyte abnormality?

Options:
explanation: Gliclazide is a sulphonylurea used to treat type 2 diabetes. It is not known to cause hyperkalaemia.
name: Gliclazide 80mg OD
label: c
answer: no
explanation: This patient has hyperkalaemia. Ramipril is an angiotensin-converting enzyme inhibitor (ACE-i), a known adverse effect of ACE-is is hyperkalaemia.
name: Ramipril 5mg
label: a
answer: yes
explanation: Metformin is a biguanide used to treat type 2 diabetes. It is not known to cause hyperkalaemia.
name: Metformin 500mg BD
label: b
answer: no
explanation: Co-amoxiclav is an antibiotic used to treat infections such as pneumonia. It is not known to cause hyperkalaemia.
name: Co-amoxiclav 250/125mg TDS
label: d
answer: no
explanation: Omeprazole is a proton pump inhibitor used to treat gastro-oesophageal reflux disease (GORD). It is known to cause electrolyte imbalances such as hypokalaemia, hyponatraemia, hypocalcaemia and hypomagnesia due to increased renal losses. This patient has hyperkalaemia so this is unlikely to have been caused by omeprazole.
name: Omeprazole 40mg BD
label: e
answer: no

Correct answer: a
Case Presentation: A 18-year-old woman attends her GP asking for the combined oral contraceptive pill.  Her regular medicines are listed (below).


**PH** Asthma, Epilepsy, Eczema, Allergic rhinitis

**DH** Salbutamol 200micrograms INH QDS, Budesonide 400 micrograms INH BD, Carbamazepine 200mg PO BD, Cetirizine 10mg PO OD, Hydromol cream one application to affected area BD

Question: Select the prescription that is most likely to reduce the efficacy of the combined oral contraceptive pill.

Options:
explanation: Salbutamol does not commonly interact with combined oral contraception
name: Salbutamol 200micrograms INH QDS
label: b
answer: no
explanation: Budesonide does not commonly interact with combined oral contraception
name: Budesonide 400 micrograms INH BD
label: c
answer: no
explanation: Cetirizine does not commonly interact with combined oral contraception
name: Cetirizine 10mg PO OD
label: d
answer: no
explanation: Hydromol does not commonly interact with combined oral contraception
name: Hydromol cream one application to affected area BD
label: e
answer: no
explanation: Carbamazepine is a PY450 enzyme inducer, this is the enzyme responsible for the metabolism of the combined oral contraceptive pills. Increased activity of said enzyme results in the combined oral contraceptive pill being metabolised quicker and therefore having a lower efficacy. Other PY450 inducers include phenytoin, phenobarbital, felbamate, topiramate, oxcarbazepine and primidone.
name: Carbamazepine 200mg PO BD
label: a
answer: yes

Correct answer: a
Case Presentation: A 67-year-old lady is admitted to the acute medical ward for treatment of ongoing cellulitis which did not respond to oral antibiotics. On day 2 of her admission she develops jaundice.




 **PH** Hypertension, IHD, Type 2 diabetes


 **DH** Her current regular medicines are listed (below).


 **On examination** Yellow sclera


 **Investigations**


||||
|---------------------------|:-------:|--------------------|
|Alanine Aminotransferase (ALT)|100 IU/L|10 - 50|
|Aspartate Aminotransferase (AST)|30 IU/L|10 - 40|
|Alkaline Phosphatase (ALP)|190 IU/L|25 - 115|
|Bilirubin|69 µmol/L|< 17|

Question: Select the prescription that is most likely to be contributing to the jaundice.

Options:
explanation: Statins uncommonly cause hepatitis but are not known to cause jaundice.
name: Atorvastatin 40mg PO OD
label: d
answer: no
explanation: The BNF states metformin can cause hepatitis however the frequency is not known and it is not known to produce a cholestatic picture.
name: Metformin 1mg OD PO
label: b
answer: no
explanation: Cholestatic jaundice is a recognised side effect of penicillins and can occur either during or shortly after treatment.
name: Flucloxacillin 1g IV 6-hourly
label: a
answer: yes
explanation: Aspirin does not cause jaundice
name: Aspirin 75mg PO OD
label: e
answer: no
explanation: Amlodipine does not cause jaundice.
name: Amlodipine 5mg PO OD
label: c
answer: no

Correct answer: a
Case Presentation: A 27-year-old woman presents to the GP complaining of feeling tired all the time. She suffers heavy periods, and subsequent blood tests reveal a microcytic anaemia. She is commenced on ferrous fumarate 210mg OD.


Question: Select the adverse affect most likely to be caused by this treatment.

**PH** Menorrhagia

Options:
explanation: Vomiting is an uncommon side effect of oral iron supplements, and so is not as common as dark stools.
name: Vomiting
label: c
answer: no
explanation: 'Bronze' skin is a feature of hereditary haemachromatosis, which is a genetic iron storage disease in which the body absorbs excessive amounts of iron from the diet. It is not a side effect of iron supplementation.
name: 'Bronzing' skin
label: e
answer: no
explanation: Darker (though not black, nor tarry) are a very common side effect of iron replacement therapy and patients should be warned of this in advance as it can be a later source of anxiety and non-compliance.
name: Dark stools
label: a
answer: yes
explanation: Reduced libido is not a known side effect of ferrous fumarate.
name: Reduced libido
label: d
answer: no
explanation: Sleeping problems are not a side effect of ferrous fumarate.
name: Sleeping problems
label: b
answer: no

Correct answer: a
Case Presentation: A 37 year old woman is referred to the anticoagulation clinic following a hospital admission for a pulmonary embolus. **PMH** systemic lupus erythematosus, antiphospholipid syndrome. **DH** hydroxychloroquine sulfate 300mg PO OD. NKDA **SH** ex-smoker (5 pack years).


Her consultant decides that it is appropriate to pursue lifelong anticoagulation with warfarin sodium at a starting dose of 5mg PO OD.

Question: Select the most appropriate option to monitor for adverse effects of this treatment in the first few months.

Options:
explanation: Warfarin has no effect on platelets and thus they have no role in monitoring either the dosing or adverse effects of warfarin
name: Platelet count
label: c
answer: no
explanation: The prothrombin time has no role in monitoring either the dosing or adverse effects of warfarin
name: Prothrombin time
label: d
answer: no
explanation: Dyspepsia is not a known adverse effect associated with warfarin
name: Patient reports new dyspepsia
label: b
answer: no
explanation: When starting anticoagulation treatment it is important for patients to report any new bruising or bleeding as they may be receiving too high a dose
name: Patient reports easy bruising
label: a
answer: yes
explanation: Vitamin K assays are not routinely done in patients taking warfarin as levels will almost certainly be lower and as such this is of negligible clinical usefulness
name: Vitamin K levels
label: e
answer: no

Correct answer: a
Case Presentation: A 62 year old man is sent to the rapid access chest pain clinic by his GP following the reported results of a 24 hour ECG holter monitor. **PMH** myocardial infarction with 100% LAD occlusion, hypertension. **DH** aspirin 75mg PO OD, bisoprolol fumarate 2.5mg PO OD, ramipril 5mg PO OD. NKDA


**Investigations**

24 hour ECG holter monitor: infrequent runs of ventricular tachycardia lasting 30-40 seconds

The cardiology consultant recommends starting amiodarone hydrochloride 200mg PO TDS whilst awaiting implantation of an ICD.

Question: Select the most appropriate monitoring option required before initiating amiodarone hydrochloride.

Options:
explanation: While blood dyscrasias have been reported with use of amiodarone, these are very rare and as such a full blood count would be useful as a baseline but is not routinely done
name: Full blood count
label: c
answer: no
explanation: Amiodarone is metabolised and excreted by the liver. Renal function would be useful as a baseline but not with respect to starting this drug
name: Creatinine clearance
label: b
answer: no
explanation: Amiodarone is a potassium channel blocker and as such imbalances in potassium should be corrected prior to starting this drug, rather than sodium
name: Serum sodium
label: d
answer: no
explanation: An elevation in cardiac enzymes may suggest some ongoing myocardial ischaemia and can be useful in the general clinical setting on a background of acute chest pain, but is of limited usefulness with respect to starting this drug
name: Troponin
label: e
answer: no
explanation: A potentially severe side effect of amiodarone use is pulmonary fibrosis. Existing lung damage should be ruled out prior to starting this drug
name: Chest X-ray
label: a
answer: yes

Correct answer: a