hllj/quesmed huggingface dataset:
Case Presentation: A 24 year old woman has had pain in her left breast for the last three days. She is currently 6 weeks post-partum, and while she has been taking simple oral analgesia and continuing to express milk at the advice of her health visitor, her symptoms remain unresolving. She has no known drug allergies.


**O/E**

Right breast grossly normal, no palpable lumps. Left breast area of erythema at 3 o’ clock position from the areola, measuring approximately 2 x 3 cm. Warm and very tender to touch, but no nipple fissuring or fluctuant lumps on palpation.

Temperature 37.1°C. HR 70, RR 12.

Question: Select the most appropriate management at this stage.

Options:
explanation: Clindamycin has activity against common Gram-positive bacteria responsible for skin and soft tissue infections, but would not be a first line option to treat uncomplicated lactational mastitis
name: Clindamycin 300mg PO TDS for 7 days
label: c
answer: no
explanation: flucloxacillin is recommended first line to treat lactational mastitis
name: Flucloxacillin 500mg PO QDS for 14 days
label: a
answer: yes
explanation: All tetracycline antibiotics are contraindicated in breastfeeding due to the risk of irreversible teeth discolouration in the infant
name: Doxycycline 200mg PO OD for 14 days
label: d
answer: no
explanation: Ciprofloxacin is a fluoroquinolone antibiotic with a mid to broad spectrum of activity. It is not generally used to treat lactational mastitis
name: Ciprofloxacin 400mg PO BD for 7 days
label: b
answer: no
explanation: Erythromycin is an acceptable second line agent to treat lactational mastitis
name: Erythromycin 500mg PO QDS for 14 days
label: e
answer: no

Correct answer: a
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: Metronidazole is associated with decrease in appetite
name: Metronidazole can lead to increased appetite and weight gain
label: d
answer: no
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: 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 35-year-old woman attends the breast clinic to discuss about hormonal therapy for her oestrogen-receptor positive breast cancer.  

PMH: Breast cancer, Hypertension
DH: Amlodipine 5mg OD
SH: Lives alone, smoker (10 pack-year history)
She is advised to commence treatment with Tamoxifen 20mg PO daily.

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

Options:
explanation: Tamoxifen increases risk of thromboembolism. Hence, patients should seek medical attention straightaway if they suddenly experience breathlessness, chest pain and other signs that are suggestive of pulmonary embolus
name: She should immediately seek medical help if she experiences sudden onset breathlessness and chest pain
label: a
answer: yes
explanation: Cataract is a common side effect while corneal changes are rarely caused by Tamoxifen
name: Tamoxifen more commonly causes corneal changes than cataract
label: e
answer: no
explanation: Angioedema is a rare side effect of tamoxifen
name: Angioedema is a common side effect of tamoxifen
label: d
answer: no
explanation: Tamoxifen is contraindicated during pregnancy due to its teratogenicity. Patients should use effective contraception during treatment and for 2 months after cessation of treatment
name: She could attempt to get pregnant during the course of treatment
label: b
answer: no
explanation: Tamoxifen is associated with increased endometrial changes that can subsequently lead to hyperplasia, polyps and cancer
name: Tamoxifen reduces the risk of endometrial hyperplasia and polyps
label: c
answer: no

Correct answer: a
Case presentation: A 30-year-old woman visits her GP complaining of weight loss, excessive thirst and frequent urination.  

PMH: Coeliac disease, Vitiligo
FH: Type 1 Diabetes Mellitus
Investigation: HbA1c 63 mmol/mol (20-42)
Treatment with insulin is to be initiated.

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

Options:
explanation: When administering insulin, patients are advised to inject it at a different spot each time to prevent lipohypertrophy
name: She should inject insulin at the same spot each time
label: b
answer: no
explanation: Insulin should be stored in the fridge and not the freezer because very low temperatures might damage the insulin
name: She should store the insulin in the freezer when not using
label: c
answer: no
explanation: Insulin could cause hypoglycaemia, hence patients are encouraged to bring along a source of sugar with them at all times
name: Insulin is not known to cause hypoglycaemia
label: e
answer: no
explanation: During sickness, patients are advised to check blood glucose levels every 2 to 4 hours and adjust the insulin dose accordingly. It is common for patients to need an increased insulin dose during sickness to help keep the blood glucose level within control. There is a need for insulin dose to be increased because adrenaline and cortisol produced by the body to fight against infection may contribute to insulin resistance, ultimately leading to stress hyperglycaemia. Hence, patients are advised to never omit their insulin (especially basal long-acting insulin) even if there is a reduction in dietary intake
name: She should continue her long-acting insulin during sickness
label: a
answer: yes
explanation: Insulin may lead to weight gain
name: Insulin may cause weight loss
label: d
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: 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: 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: 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 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: 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 65-year-old man attends the Parkinson clinic with increasing frequencies of involuntary and uncontrollable movement.  

PMH: Parkinson’s disease, Diabetes Mellitus, Hypertension
DH: Co-Beneldopa (immediate-release) 200mg PO QDS, Metformin hydrochloride 500mg PO TDS, Captopril 50mg PO BD
The patient is advised to add pramipexole 88 micrograms PO TDS as an adjunct to his current treatment regime to help control the dyskinesia.

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

Options:
explanation: Dose of pramipexole needs to be reduced gradually before it can be stopped completely to reduce the risk of neuroleptic malignant syndrome(NMS). NMS is characterised by fever, altered mental status, muscle rigidity and autonomic dysfunction
name: He should immediately stop taking pramipexole if it causes him to feel dizzy
label: d
answer: no
explanation: Pramipexole is linked with impulsive control disorders such as binge eating, pathological gambling and hypersexuality. 
name: Pramipexole is associated with impulsive control disorder
label: a
answer: yes
explanation: Pramipexole is a dopamine-receptor agonist that is used alone or as an adjunct to co-careldopa or co-beneldopa to treat Parkinson’s disease
name: Pramipexole is converted into dopamine in the body
label: b
answer: no
explanation: Patients are usually given a small dose to start with before the dose gets gradually increased over time to reduce side effects such as dizziness
name: Maximum dose of pramipexole is usually given at the start to ensure complete control of the symptoms
label: c
answer: no
explanation: Pramipexole increases risk of postural hypotension, especially at the start of treatment. Hence, it is recommended to monitor the blood pressure of patients on initiation of the treatment
name: Pramipexole could lead to high blood pressure
label: e
answer: no

Correct answer: a
A 62-year-old patient who weighs 70kg suffers from acute pyelonephritis. He is prescribed a gentamicin infusion of 5mg/kg using a once-daily regimen. The dose is rounded up to the nearest 20mg increment for doses less than 200mg and 40mg above this.


Gentamicin is diluted in 50mL of 0.9% sodium chloride and given over 60 minutes. His BMI and creatinine clearance are both within normal limits.

What is the dose of gentamicin given per minute?

Options:


The dose of gentamicin to be given is: 70kg x 5mg/kg = 350mg. As this is above 200mg, this is rounded up to the nearest 40mg, which is 360mg. Since this is given over 60 minutes, the dose given per minute is: 360mg ÷ 60 minutes = 6mg/min.

The fact that his BMI and creatinine clearance are both normal mean that additional calculations to account for extremes of body weight and impaired renal function respectively are not required. In addition, the volume of 0.9% sodium chloride required for dilution is a distraction.
A 6-month old boy is brought to the emergency department by his mother because he was very unwell and was noted to have blisters across both sides of his cheeks. He was subsequently diagnosed with erysipelas and was to be started on clarithromycin 7.5mg/kg PO twice daily due to a previous penicillin allergy. Weight 7.5kg.


Clarithromycin is available as 125mg/5mL oral suspension

What volume (mL) of clarithromycin oral solution should he be given at each dose?

Options:


Dose = 7.5 mg/kg
Weight = 7.5kg
Amount of clarithromycin needed
= 7.5 mg/kg x 7.5kg = 56.25mg
Volume of clarithromycin solution
= 56.25mg x 5mL/125mg = 2.25mL
A 8-year-old patient who weighs 28kg requires maintenance fluids. He is prescribed 0.9% sodium chloride intravenously. What is the rate (in mL per hour) of 0.9% sodium chloride he is to be given? Round off your answer to the nearest mL per hour.



Options:


The total daily requirement of maintenance fluids for a paediatric patient is as follows:

- 1st 10kg = 100ml/kg/day = 1000mL
- 2nd 10kg = 50ml/kg/day = 500mL
- Remaining = 20ml/kg/day = 8kg x 20ml/kg/day = 160mL

The total is 1660mL a day. Hence, the rate in mL per hour is: 1660mL ÷ 24 hours = 69.2mL/hour ≈ 69mL/hour.
A 30-week pregnant woman is admitted to the Emergency Department with seizure. Her blood test confirmed eclampsia and she is treated with a short course of magnesium before being sent to theatre for the delivery of her baby.

Her IV medication has been prescribed as below:

* IV Magnesium 4g 5-15min.
* IV Magnesium 24g for 24 hours.


Magnesium sulphate is available as 10% solution for injection in 10mL ampoules.
Weight 75kg.

How many ampoules of magnesium sulphate solution is required in total for the prescribed medication above?


Options:


Total mass (g) of magnesium sulphate required = 28g

10% 10mL ampoule
= 10g in 100mL
= 1g in 10mL ampoule

Total 10% 10mL ampoule required for 28g of magnesium sulphate
= 28 10% 10mL ampoules
A 75-year-old gentleman attended his GP clinic for a follow up appointment following his discharge from the hospital for a chest infection. The discharge summary noted that the patient was diagnosed with Type 2 Diabetes on admission and requested the GP to change his standard formulation gliclazide to modified release medication. PMH Type 2 Diabetes Mellitus DH Metformin 500mg tablets (2 tablets BD), standard formulation Gliclazide 80mg BD.  

Gliclazide modified release 30mg and standard formulation Gliclazide 80mg are bioequivalent.

How many Gliclazide modified release 30mg tablets does the GP need to dispense for a treatment duration of 2 weeks?

Options:


Tablets needed a day
= Standard formulation gliclazide 80mg BD
= 2 modified release 30mg a day
Total tablets in 2 weeks
= 2 x 14 days = 28 tablets
Case presentation: A 40-year-old woman visits her GP to discuss about contraception. She is interested in having combined oral contraceptive pills (COCP) after hearing about them from her friends.  

PMH: Depression, Tuberculosis, Epilepsy, Iron-deficiency anaemia
DH: Her current regular prescriptions are listed below
Her GP advises her against COCP because one of her current prescriptions is known to reduce the efficacy of COCP

Question: Select the prescription that is most likely to decrease the efficacy of COCP?

Options:
explanation: Sodium valproate is a cytochrome P450 inhibitor. It does not reduce the efficacy of COCP
name: Sodium valproate 500 mg PO BD
label: d
answer: no
explanation: Ferrous sulphate is not known to interact with COCP
name: Ferrous sulphate 200 mg PO TDS
label: e
answer: no
explanation: Citalopram is not known to reduce the efficacy of COCP
name: Citalopram 20 mg PO OD
label: b
answer: no
explanation: Isoniazid is a cytochrome P450 inhibitor. It does not reduce the efficacy of COCP
name: Isoniazid 300 mg PO OD
label: c
answer: no
explanation: COCP is metabolised via cytochrome P450 system. Rifampicin is a cytochrome P450 inducer. It increases enzyme activity and speeds up the clearance of COCP, thereby reducing its efficacy
name: Rifampicin 600 mg PO OD
label: a
answer: yes

Correct answer: a
Case Presentation: A 54-year-old man is admitted to the medical ward with acute gout. PMH AF, gout, hypertension. DH His current regular medicines, in addition to rivaroxaban, are listed on the right.


On examination
Swollen, red and tender left metatarsophalangeal joint.
Dark, black tarry stools reported.

Investigation
FBC Hb 13g/dL (13.5-17.5g/dL)
Fine needle aspiration of joint: negative birefringent urate crystals seen in polarized light.

Question: Select the prescription that is most likely to interact with the patient’s rivaroxaban to cause gastrointestinal bleeding.

Options:
explanation: Digoxin does not commonly cause bleeding
name: Digoxin 125 micrograms PO daily
label: c
answer: no
explanation: Bisoprolol does not commonly cause bleeding
name: Bisoprolol fumarate 5mg PO daily
label: b
answer: no
explanation: NSAIDs (indomethacin) and antiplatelet (rivaroxaban) interact to increase the risk of gastrointestinal bleeding. Indomethacin is a non-selective COX inhibitor, its effect on COX-1, in particular, decreases the production of thromboxane A2 and prevents platelet aggregation. When used in combination with antiplatelet or anticoagulant agents, it can increase the bleeding risk in patients
name: Indomethacin 100mg PO BD
label: a
answer: yes
explanation: Ramipril does not commonly cause bleeding
name: Ramipril 2.5mg PO daily
label: d
answer: no
explanation: Amlodipine does not commonly cause bleeding
name: Amlodipine 10mg PO daily
label: e
answer: no

Correct answer: a
Case Presentation: A 75-year-old gentleman was admitted to the acute medical unit two days ago due to acute pulmonary edema secondary to decompensated heart failure. Subsequently, he complained of severe loin to groin pain that started this morning and was subsequently reviewed by the urology team. PMH HTN, Familial hypercholesterolemia, Heart failure, BPH. DH His current regular medicines are listed (below).

Investigation
Non contrast CT scan revealed radiopaque stones in the right ureter.

Question: Select the prescription that is most likely to contribute to his renal stones

Options:
explanation: Bisoprolol does not commonly cause renal stones
name: Bisoprolol 10mg PO OD
label: b
answer: no
explanation: Dalteparin does not commonly cause renal stones
name: Dalteparin 5000 units SC OD
label: d
answer: no
explanation: Atorvastatin does not commonly cause renal stones
name: Atorvastatin 10mg PO OD
label: c
answer: no
explanation: Tamsulosin does not commonly cause renal stones
name: Tamsulosin 400 micrograms PO OD
label: e
answer: no
explanation: Loop diuretics act by competing for the chloride site on the Na-K-2Cl cotransporter and inhibiting sodium and calcium reabsorption in the thick ascending limb of Loop of Henle. This results in an increased excretion of calcium in the urine and a hypercalciuric state, which results in the formation of renal calculi
name: Furosemide 40mg PO OD
label: a
answer: yes

Correct answer: a
Case presentation: A 40-year-old man visits his GP for medication review.  

PMH: Diabetes Mellitus, Hypertension
DH: Metformin Hydrochloride 500 mg PO TDS, Captopril 75 mg PO BD
Observations: Temperature 36.5, Respiratory rate 14, Blood pressure 165/95, Heart rate 76, Oxygen saturation 100% (on air)
The patient is advised to add Amlodipine 5 mg PO OD to his current treatment regime in view that his blood pressure is not well controlled

Question: Select the adverse effect that is most likely to be caused by this treatment

Options:
explanation: Hyperglycaemia is a rare or very rare side effect of amlodipine
name: Hyperglycaemia
label: c
answer: no
explanation: Peripheral neuropathy is a rare or very rare side effect of amlodipine
name: Peripheral neuropathy
label: e
answer: no
explanation: Peripheral oedema is a common or very common side effect of all calcium channel blockers. It is thought to be caused by arteriolar dilation that leads to increasing capillary pressure and extravasation of fluids into the surrounding tissues
name: Peripheral oedema
label: a
answer: yes
explanation: Increased muscle tone is a rare or very rare side effect of amlodipine
name: Increased muscle tone
label: d
answer: no
explanation: Gingival hyperplasia is an uncommon side effect of all calcium channel blockers
name: Gingival hyperplasia
label: b
answer: no

Correct answer: a
Case presentation: A 55-year-old woman presents to her GP with a 2-month history of upper abdominal pain. He describes the pain as a dull ache that is relieved by food. He also notices three episodes of black, sticky stools. He denies having any change in bowel habits or rapid loss in weight.  

PMH: Depression, Rheumatic arthritis, Type 2 Diabetes Mellitus, Hypertension, Hypercholesterolaemia
DH: Her current regular prescriptions, in addition to Diclofenac 50 mg PO three times daily, are listed below
On examination: Mild epigastric tenderness on palpation. Bowel sounds present. Chest is clear with no added lung sounds. Heart sounds I+II+0.

Question: Select the prescription that is most likely to be contributing to the melaena along with diclofenac?

Options:
explanation: Methotrexate is not known to interact with diclofenac to cause ulceration or gastrointestinal bleeding
name: Methotrexate 7.5 mg once weekly
label: b
answer: no
explanation: Both sertraline and diclofenac can increase risk of bleeding. Hence, it is generally recommended to prescribe a gastroprotective drug such as a proton pump inhibitor in people who are taking non-steroidal anti-inflammatory drugs (NSAID), especially for elderly patients
name: Sertraline 50 mg PO OD
label: a
answer: yes
explanation: Lisinopril can increase the risk of hyperkalaemia if used together with diclofenac. However, it is not known to to interact with diclofenac to cause ulceration or gastrointestinal bleeding
name: Lisinopril 20 mg PO OD
label: d
answer: no
explanation: Metformin is not known to interact with diclofenac to cause ulceration or gastrointestinal bleeding
name: Metformin hydrochloride 500 mg PO TDS
label: c
answer: no
explanation: Simvastatin is not known to interact with diclofenac to cause ulceration or gastrointestinal bleeding
name: Simvastatin 40 mg PO nightly
label: e
answer: no

Correct answer: a
Case Presentation: A 70 year old man is seen in the outpatient urology clinic for consideration of starting tamsulosin hydrochloride 400 micrograms PO OD to treat benign prostatic hypertrophy. **PMH** temporal arteritis, depression. **DH** venlafaxine modified release 150mg PO OD


Question: Select the most appropriate option to monitor for adverse effects of tamsulosin.

Options:
explanation: As an alpha-blocker, tamsulosin may exacerbate orthostatic hypotension, particularly in the elderly
name: Blood pressure
label: a
answer: yes
explanation: This is not necessary prior to starting this drug
name: Arterial doppler ultrasound
label: b
answer: no
explanation: It is recommended that tamsulosin be avoided in patients with severe liver dysfunction but routine monitoring of liver function is not necessary
name: Liver function tests
label: d
answer: no
explanation: Tamsulosin blocks alpha adrenergic receptors rather than beta adrenergic receptors and has very limited activity on the heart
name: ECG
label: c
answer: no
explanation: It is recommended that tamsulosin be avoided in patients with severe renal dysfunction but routine monitoring of renal function is not necessary
name: Urea and electrolytes
label: e
answer: no

Correct answer: a