hllj/quesmed huggingface dataset:
A 72-year-old patient suffered a cardiac arrest. Once intravenous access was obtained, 1mg of adrenaline was administered. This was repeated and in total, the same dose was given three times until there was return of spontaneous circulation. Adrenaline is available as a 1:10000 solution.


What was the total volume of adrenaline given?

Options:


The definition of 1:10000 is 1kg in 10000L = 1mg in 0.01L = 1mg in 10mL. Since each dose of adrenaline is 1mg, the corresponding volume given is 10mL. Since three doses of adrenaline were given, the total volume given was 30mL.

Concentration ratios (1:10000 in this case) are based on units of kilogram and litre as they belong to the International System of Units (SI units) which are used by convention.
A 71-year-old patient is noted to have a severely low corrected calcium level of 1.6mmol/L (normal range 2.2-2.6 mmol/L). As part of emergency management, he has already been given 10mL of 10% calcium gluconate infusion. To prevent recurrence, he is prescribed a further 100mL of calcium gluconate 10% diluted in 1 litre of glucose 5% to be given at 50mL/ hour. 0.11mmol is equivalent to 0.5mL of calcium gluconate 10%.




Based on the information given above, what is the rate at which calcium gluconate is given (in mmol per hour)?

Options:


0.5mL of calcium gluconate 10% = 0.11mmol

100mL of calcium gluconate 10% = 22mmol

Now, after diluting 100mL of calcium gluconate 10% in 1 litre of glucose 5%, the total volume is: 100mL + 1L = 1100mL. Since the rate at which the solution is to be given is 50mL/hour, the total amount of time for the volume of 1.1L solution to be infused is: 1100mL ÷ 50ml/hour = 22 hours

Therefore, the dose of calcium gluconate being given is: 22mmol ÷ 22 hours = 1mmol/hour.
An 80-year-old gentleman was admitted to the Hyperacute Stroke Unit following an episode of ischemic stroke. He was determined to have an unsafe swallow following SALT assessment and has been kept NBM since. His next SALT review will be in 2 days. PMH Alzheimer’s Disease. DH Rivastigmine 6mg PO BD.

Patients taking 3-6mg PO OD should initially switch to 4.6mg/24 hours patch. Patients taking 12mg PO OD should switch to 9.5mg/24 hours patch.

What is the total dose of rivastigmine patch prescribed for this patient before his next review?

Options:


Current dose of rivastigmine a day = 12mg
12mg PO OD = 9.5mg/24 hours patch.
Total dose prescribed for 2 days
= 9.5mg x 2
= 19mg
A 55-year-old patient suffers from Addison's disease and currently takes 5mg of prednisolone as a once-daily regimen. She has recently been taken ill with vomiting and unable to have any oral intake. The doctor decides to administer corticosteroid replacement using intravenous hydrocortisone instead with a view of doubling the normal dose in line with sick-day rules.


Given that 1mg of prednisolone is equivalent to 4mg of hydrocortisone, what is the total dose of hydrocortisone given per day?

Options:


Normal dose of prednisolone per day = 5mg
Equivalent dose of hydrocortisone per day = 20mg
Double dose of hydrocortisone in line with sick day rules = 40mg

Note that most patients are given hydrocortisone as this is the most physiological choice of corticosteroid, although adherence might be an issue as this is a thrice-daily regimen. In addition, the reason why hydrocortisone is given instead is because prednisolone cannot be given intravenously.
A 77- year-old man was admitted to the care of the elderly ward for infective exacerbation of COPD. PMH Mild COPD, Osteoarthritis of left knee. DH Paracetamol 1g QDS, Ibuprofen 400mg TDS PO, Tramadol 200mg BD PO, Ipratropium bromide 40 micrograms INH, Salbutamol 200 micrograms INH QDS


Tramadol tablets are available in 50mg, 100mg, 150mg and 200mg.

How many 200mg tablets should the patient be discharged with for a duration of 10days?

Options:


Current dose of tramadol a day = 400mg a day
Number of tablets a day
= 400mg/ 200mg tablets
= 2 tablets a day
Number of tablets for 10 days
= 2 tablets x 10days
= 20 tablets for 10 days
Case presentation: A 34-year-old pregnant woman is admitted to hospital for community-acquired pneumonia. She is a primigravida and is currently 22 weeks into her pregnancy. She has hyperemesis gravidarum and is not able to tolerate oral medication well.  

Observations: Temperature 37.5, Respiratory rate 32, Blood pressure 88/64, Heart rate 76
On examination: Coarse crackles at left lung base, normal antenatal examination
The junior doctor would like to discuss with the obstetric consultant commencing treatment with Co-amoxiclav 1.2 g TDS because the junior doctor is concerned that co-amoxiclav may increase the risk of a particular neonatal condition.

Question: Select the neonatal condition that is most likely to be caused by Co-amoxiclav

Options:
explanation: Co-amoxiclav is associated with an increased risk of necrotising enterocolitis in neonates
name: Necrotising enterocolitis
label: a
answer: yes
explanation: Co-amoxiclav is not known to discolour the teeth. On the other hand, tetracycline and doxycycline are associated with bone and teeth discolouration
name: Teeth discolouration
label: c
answer: no
explanation: Co-amoxiclav is not known to cause cholestatic jaundice in neonates
name: Cholestatic jaundice
label: b
answer: no
explanation: Co-amoxiclav is not known to cause hepatic failure in neonates
name: Hepatic failure
label: e
answer: no
explanation: Co-amoxiclav is not known to cause auditory nerve damage. On the other hand, streptomycin is associated with foetal ototoxicity
name: Auditory nerve damage
label: d
answer: no

Correct answer: a
Case Presentation: An 85-year-old man is transferred to the care of the elderly ward following an episode of syncope. PMH Hypertension, BPH, Epilepsy, Parkinson disease. DH His current regular medicines are listed (below).


On examination
Lying BP 120/85mmHg, HR 80/min; standing BP 90/70mmHg, HR 100/min

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


Options:
explanation: Co-careldopa does not commonly cause orthostatic hypotension
name: Co-careldopa 25/100 TDS PO
label: b
answer: no
explanation: Carbamazepine does not commonly cause orthostatic hypotension
name: Carbamazepine
label: c
answer: no
explanation: Tamsulosin, an alpha1-adrenoreceptor blocker is known to cause postural hypotension due to the inhibition of alpha-1 receptors, leading to vascular smooth muscle relaxation and vasodilation the loss of reflex vasoconstriction upon standing
name: Tamsulosin 400 micrograms PO OD
label: a
answer: yes
explanation: Daleparin does not commonly cause orthostatic hypotension
name: Dalteparin sodium 2500 units SC OD
label: e
answer: no
explanation: Amlodipine can cause dizziness but is not known to commonly cause orthostatic hypotension
name: Amlodipine 5mg PO daily
label: d
answer: no

Correct answer: a
Case presentation: A 50-year-old woman visits her GP for medication review  


PMH: Bipolar disoder, Type 2 Diabetes Mellitus, Hypertension, Hypercholesterolaemia
DH: Her current regular prescriptions, in addition to lithium carbonate 600 mg PO twice daily, are listed in the options below
Investigations:


||||
|---------------------------|:-------:|--------------------|
|Sodium|138 mmol/L|135 - 145|
|Potassium|3.2 mmol/L|3.5 - 5.3|
|Urea|5 mmol/L|2.5 - 7.8|
|Creatinine|120 µmol/L|60 - 120|
|Thyroid Stimulating Hormone|2.5 mU/L|0.3 - 4.2|
|Total T4|120 nmol/L|60 - 150|


Question: Select the prescription that is most likely to interact with lithium carbonate to cause the abnormal blood test results?

Options:
explanation: Amlodipine is not known to interact with lithium to cause hypokalaemia
name: Amlodipine 10 mg PO OD
label: b
answer: no
explanation: Indapamide is a thiazide-like diuretic that is used in the treatment of hypertension. It inhibits the Na+/Cl- cotransporter at the distal convoluted tubule of nephron, thereby leading to reduced sodium reabsorption and decreased water retention. It is important to note that it can cause hypokalaemia when given with lithium, thus potentially increasing the risk of torsade de pointes
name: Indapamide 2.5 mg PO daily in the morning
label: a
answer: yes
explanation: Metformin is not known to interact with lithium to cause hypokalaemia
name: Metformin hydrochloride 500 mg PO TDS
label: c
answer: no
explanation: Simvastatin is not known to interact with lithium to cause hypokalaemia
name: Simvastatin 40 mg PO ON
label: e
answer: no
explanation: Captopril can increase the concentration of lithium but is not known to interact with lithium to cause hypokalaemia. Angiotensin-converting-enzyme inhibitors like captopril are known to cause hyperkalaemia
name: Captopril 75 mg PO BD
label: d
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: 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
explanation: Gliclazide is not known to cause xanthopsia
name: Gliclazide 40mg PO OD
label: c
answer: no
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

Correct answer: a
Case presentation: A 35-year-old man presents to the accident and emergency department with a two-day history of gradual onset confusion and muscle rigidity. He is highly agitated and sweats excessively.  

PMH: Schizophrenia, Depression, Type 2 Diabetes Mellitus, Hypertension, Hypercholesterolaemia
DH: Her current regular prescriptions are listed below
Observations: Temperature 40°C , blood pressure 181/95 mmHg, heart rate 100 bpm, respiratory rate 25; oxygen saturation 100% (on air)
On examination: Lead pipe rigidity. Normal pupillary sizes
Investigation: Negative urine toxicology screen

Question: Select the prescription that is most likely to be contributing to the clinical picture described above?

Options:
explanation: Simvastatin is not known to cause NMS
name: Simvastatin 40 mg PO ON
label: e
answer: no
explanation: Sertraline is not associated with NMS but an overdose of sertraline can cause serotonin syndrome, which share some similarities with NMS. Both NMS and serotonin syndrome can bring about hypertension, tachycardia and hyperthermia. However, NMS is different from serotonin syndrome in that it is associated with hyporeflexia, normal pupillary sizes and a gradual onset while serotonin syndrom is characterised by hyperreflexia, myadriasis and a rapid onset
name: Sertraline 50 mg PO OD
label: b
answer: no
explanation: Lisinopril is not known to casuse NMS
name: Lisinopril 20 mg PO OD
label: d
answer: no
explanation: The clinical picture described above is that of neuroleptic malignant syndrome (NMS). NMS is an uncommon but potentially fatal side effect of all antipsychotic drugs. Antipsychotic medications lead to NMS through their antagonism of dopamine D2 receptors. NMS is characterised by a tetrad of hyperthermia, changed mental status, muscle rigidity and autonomic instability
name: Olanzapine 10 mg PO OD
label: a
answer: yes
explanation: Metformin is not known to casuse NMS
name: Metformin hydrochloride 500 mg PO TDS
label: c
answer: no

Correct answer: a
Case Presentation: A 56 year old woman with no significant past medical history attends her GP with intermittent chest pain. The pain is central and constricting with no radiation into her jaw or arms. She only has the pain a few times a week and notices that it comes on when she is either climbing stairs or running for the bus. She denies syncope, sweating, shortness of breath or any other symptoms of ill health.


**Investigations**

ECG: Normal sinus rhythm

Her GP decides to make a routine referral to the outpatient cardiology clinic and prescribes bisoprolol fumarate 5mg PO OD.

Question: Select the most appropriate option to assess the beneficial effects of this treatment.

Options:
explanation: Stress echocardiography may be indicated following a full specialist assessment but is unlikely to be used to demonstrate effectiveness of treatment with bisoprolol
name: Stress echocardiogram
label: d
answer: no
explanation: Her blood pressure is likely to be lowered due to beta blockade and blunting of the sympathetic response, but it is not a useful marker of effective treatment
name: Blood pressure
label: b
answer: no
explanation: An increase in exercise tolerance due to a reduction in angina symptoms indicates effective treatment with bisoprolol
name: Exercise tolerance
label: a
answer: yes
explanation: Her heart rate is likely to be lowered due to beta blockade and blunting of the sympathetic response, but it is not a useful marker of effective treatment
name: Heart rate
label: c
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 to determine effectiveness of treatment with bisoprolol
name: Troponin
label: e
answer: no

Correct answer: a
Case Presentation: An 88 year old woman attends a follow-up appointment for review at her GP. One month ago she was seen in the outpatient dermatology clinic for a surgical excision of a basal cell carcinoma. She was incidentally diagnosed at the time with multiple-nail onychomycosis on her left foot and started on terbinafine 250mg PO OD.


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

Options:
explanation: It is recommended to measure liver function prior to and at 4-6 weeks after starting this drug as terbinafine is known to be hepatotoxic
name: No routine monitoring is required
label: c
answer: no
explanation: This is not a necessary monitoring requirement for this drug
name: Platelet count
label: d
answer: no
explanation: It is recommended to measure liver function prior to and at 4-6 weeks after starting this drug as terbinafine is known to be hepatotoxic
name: Liver function tests
label: a
answer: yes
explanation: It is recommended that the dose of terbinafine should be reduced in patients with renal impairment, but routine monitoring of renal function is not necessary
name: Serum creatinine
label: e
answer: no
explanation: This is not a necessary monitoring requirement for this drug
name: Fasting lipid profile
label: b
answer: no

Correct answer: a
A 15 year old girl attends her GP to ask for the combined oral contraceptive pill. During the consultation, her GP is satisfied that there are no safeguarding concerns regarding her partner and that she meets the Fraser guidelines. She is prescribed ethinylestradiol with desogestrel 1 tablet daily for 21 days and a 7-day pill free break.


Question: Select the most appropriate monitoring option required before starting her contraception.

Options:
explanation: While deep-vein thromboses are a well-known adverse effect of taking oestrogen-containing contraception, it is not necessary to rule out an existing DVT prior to starting contraception
name: Venous doppler ultrasound
label: c
answer: no
explanation: It is recommended to monitor the blood pressure and weight prior to starting and while taking the COCP
name: No routine monitoring is required
label: e
answer: no
explanation: A D-dimer is a specific blood test that is useful in helping to guide clinical diagnosis of a DVT. It is not necessary to perform one prior to starting contraception
name: D-dimer
label: d
answer: no
explanation: Hypertension is a common adverse effect of the combined oral contraceptive pill and it is recommended that blood pressure should be checked before and while taking the COCP
name: Blood pressure
label: a
answer: yes
explanation: It is not necessary to perform an ECG prior to starting contraception
name: ECG
label: b
answer: no

Correct answer: a
Case Presentation: A 67 year old man attends a follow-up appointment at his GP after being discharged from hospital. He had been admitted for three days to manage an acute infective exacerbation of COPD, during which it was noted that his recorded blood pressure consistently ran above 150/90mmHg. The medical team have requested the GP to prescribe antihypertensive treatment.


The GP decides to prescribe amlodipine 5mg PO OD and schedules a follow-up appointment in 2 weeks.

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

Options:
explanation: It is not necessary to monitor bone profile during anti-hypertensive treatment with calcium channel blockers
name: Bone profile
label: b
answer: no
explanation: It is not necessary to monitor creatine kinase during anti-hypertensive treatment with calcium channel blockers
name: Creatine kinase
label: c
answer: no
explanation: Calcium channel blockers are not known to cause renal impairment. It is not necessary to monitor renal function during treatment
name: Renal function tests
label: e
answer: no
explanation: It is generally not necessary to perform routine monitoring during anti-hypertensive treatment with calcium channel blockers apart from asking about adverse symptoms to optimise adherence
name: No routine monitoring is required
label: a
answer: yes
explanation: It is not necessary to perform routine ECG monitoring during anti-hypertensive treatment with calcium channel blockers
name: ECG
label: d
answer: no

Correct answer: a
Case Presentation: A 25 year old man is seen in the primary care psychiatry outreach clinic and diagnosed with schizophrenia with predominantly positive symptoms. He is advised to commence treatment with aripiprazole 15mg PO OD and to attend a follow-up appointment in two weeks.


Question: Select the most appropriate monitoring option required before starting aripiprazole.

Options:
explanation: Blood dyscrasias are a rare adverse effect of antipsychotic medications but routine full blood count monitoring is usually not necessary (exception: clozapine)
name: Leucocyte count
label: c
answer: no
explanation: It is recommended to check serum prolactin at baseline prior to treatment as the anti-dopaminergic effects of all antipsychotic drugs may cause hyperprolactinaemia
name: Serum prolactin
label: a
answer: yes
explanation: It is not necessary to check or monitor liver function during treatment with aripiprazole
name: Liver function tests
label: d
answer: no
explanation: It is recommended to check serum prolactin at baseline prior to treatment as the anti-dopaminergic effects of all antipsychotic drugs may cause hyperprolactinaemia
name: No routine monitoring is required
label: e
answer: no
explanation: This questionnaire will give an indication of the severity of any co-existing affective disorders. It is not used routinely to determine adverse effects of antipsychotic treatment on mood
name: PHQ-9
label: b
answer: no

Correct answer: a
Case Presentation: A 73-year-old gentleman is brought to the Emergency Department with shortness of breath and ankle swelling. He denies any chest pain.


## PH

Ischaemic heart disease, Type 2 diabetes mellitus, Hyperlipidaemia

## DH

Aspirin 75mg OD PO, Ramipril 5mg OD PO, Metformin 1g BD PO, Empaglifozin 10mg, Bisoprolol 2.5mg PO OD, Atorvastatin 80mg PO OD (NKDA)

## On examination

Appears distressed. CRT 3s, peripheries cool. Cannula in situ. Bilateral peripheral oedema up to the mid-shins. JVP seen just inferior to earlobe.

Temperature 37.3°C, HR 110, RR 18, BP 156/68, O2 93% on 5L oxygen, GCS 14, Weight 79kg

## Investigations

FBC: Hb 152, WCC 5.3, Plts 311

U&Es: Na<sup>+</sup> 141, K<sup>+</sup> 4.2, Cl<sup>-</sup> 102, Ur 10.5, Cr 105, eGFR 64mL/min/1.73m<sup>2</sup>

ECG: NSR and left ventricular strain

CXR: cardiomegaly and interstitial oedema

# Prescribing Request

Write a prescription for one drug that is most appropriate to treat his shortness of breath and peripheral oedema.

Options:


# Drug choice feedback

Administration of furosemide, a loop diuretic, is the most appropriate treatment for this gentleman to alleviate his shortness of breath and peripheral oedema. It is an effective and inexpensive choice of diuretic.

# Dose/Route/Frequency/Duration feedback

The correct dose is 20-50mg intravenously for adults. This can be increased in steps of 20mg every 2 hours if further treatment is required. Furosemide can be given orally or intramuscularly as well, although the intravenous route is preferred in hospital due to more rapid onset of action and it is given that a cannula is in situ.
Case Presentation: A 5-year-old girl attends her GP with her mother with non-bullous lesions on her cheeks and chin. They are mildly itchy.

## PH

Atopic Eczema

## DH

None (Severe allergy to Penicillin - Anaphylaxis)

## On examination

Child looks well and not in distress. The lesions are tiny pustules localised to the face, some have evolved into honey-coloured crusted plaques, most tend to be under 2cm in diameter. MRSA is not clinically suspected.

Temperature 36.7°C, HR 95, RR 25, BP 100/68, O<sub>2</sub> 94% RA, GCS 15, Weight 21kg

## Investigations

None

## Prescribing Request

Write a prescription for one topical drug that is most appropriate for treating her condition.

Options:


# Drug choice feedback

This child is suffering from facial impetigo, an extremely common superficial skin infection usually caused by _Staphylococcus aureus_ or _Streptococcus pyogenes_. As the infection is localised and the patient is systemically well, as well as the infection being non-bullous and not around the eyes,  topical hydrogen peroxide 1% is first line as recommended by NICE. Fusidic acid can also be used, and is preferred if there is evidence of impetigo near the eyes. If impetigo were extensive, oral treatment with flucloxacillin would be recommended. 


# Dose/Route/Frequency/Duration feedback

The optimal frequency is two-three times a day for a duration of 5 days, as per NICE guidance.