hllj/quesmed huggingface dataset:
Case presentation: An 8-year-old boy receives a new diagnosis of type 1 diabetes mellitus after being admitted to the hospital with diabetic ketoacidosis. 


**PH**
Type 1 Diabetes Mellitus
Downs Syndrome

**DH**
NKDA

Management with an insulin regime is initiated.

Question: Select the most important information that should be provided to this patient and their parents.

Options:
explanation: Blood glucose measurements should generally be taken before each meal and at bedtime. These measurements may be taken more regularly when a child is newly diagnosed with Diabetes.
name: Blood glucose should be checked after each meal with a finger prick
label: d
answer: no
explanation: Insulin pens should be kept in the fridge. The low temperatures of a  freezer may damage the insulin.
name: Insulin pens should be kept in the freezer
label: e
answer: no
explanation: Patients are advised to inject insulin at a different site each time to prevent lipohypertrophy and excessive skin irritation.
name: Insulin should be injected at the same site each time
label: b
answer: no
explanation: Glucose tablets and glucose gel, as well as sugary sweets and drinks, can be used to treat hypoglycaemia. Insulin therapy leaves patients at a greater risk of hypoglycaemia. Patients and their parents should be educated on what to do if they experience hypoglycaemia.
name: Start carrying glucose tablets or glucose gel
label: a
answer: yes
explanation: A side effect of insulin is weight gain, not weight loss.
name: Insulin may lead to weight loss
label: c
answer: no

Correct answer: a
Case presentation: A 14-year-old girl attends the GP with erythematous, itchy and sore skin in her elbow and knee flexures. The GP prescribes her 1% Hydrocortisone cream to manage this. 


**PH**
Atopic eczema

**DH**
E45 Lotion
NKDA

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

Options:
explanation: Hydrocortisone cream is a corticosteroid cream used to treat eczema and other skin conditions such as psoriasis. Steroid creams should be applied in the direction of hair growth to reduce the risk of irritation to hair follicles.
name: Apply to the skin against the direction of hair growth
label: d
answer: no
explanation: Hydrocortisone cream is a corticosteroid cream used to treat eczema and other skin conditions such as psoriasis. Steroid creams should only be applied once or twice daily to reduce the risk of side effects such as skin thinning and skin depigmentation. Emollients used to moisturise the eczematous skin should be applied 3-4 times daily.
name: Apply the cream 3-4 times daily
label: b
answer: no
explanation: Hydrocortisone cream is a corticosteroid cream used to treat eczema and other skin conditions such as psoriasis. The dose of steroid creams is often given in FTUs. One FTU is the amount of cream in a line squeezed out from the tip of the finger to the first crease, this is approximately 500mg. One FTU is enough to cover one hand, front and back.
name: One fingertip unit (FTU) is enough to cover the palm of one hand
label: c
answer: no
explanation: Hydrocortisone cream is a corticosteroid cream used to treat eczema and other skin conditions such as psoriasis. The slowing of growth in children is a serious but very rare side effect of prolonged corticosteroid use. This is very unlikely where low doses are used short-term, as in this case, and so would be inappropriate information to provide at this stage.
name: Slowing growth is a common side effect
label: e
answer: no
explanation: Hydrocortisone cream is a corticosteroid cream used to treat eczema and other skin conditions such as psoriasis. Steroid creams should be applied thinly to reduce the risk of side effects such as skin thinning and skin depigmentation.
name: Apply the cream thinly to the affected areas
label: a
answer: yes

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: 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: 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: 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: 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
Case presentation: A 44-year-old woman attends the GP with mood swings, hot flushes and an irregular menstrual cycle. She is having a menstrual bleed for around 4 days every 30-35 days. 


**PH**
Asthma

**DH**
Beclometasone inhaler

Salbutamol inhaler

Combined Cyclical Hormone Replacement Therapy (HRT) in the form of transdermal oestrogen patches and an oral progestogen are offered to the patient.

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

Options:
explanation: Vaginal dryness is a common symptom of menopause. HRT should help to prevent vaginal dryness. Topical preparations of oestrogen can be used to treat vaginal dryness where only local symptoms are menopause are bothersome.
name: HRT may cause vaginal dryness
label: d
answer: no
explanation: Cyclical HRT is a combination of oestrogen and a progestogen where the progestogen is taken in the second half of a 28day cycle. Patients taking this regimen will have a regular withdrawal bleed. The progestogen causes the uterus lining to build up. This is then shed when the progestogen is stopped. It is important to note that this is not a period as HRT does not restore/maintain ovulation.
name: HRT will stop your bleeding
label: c
answer: no
explanation: Oral Progestogen should be taken later on in your cycle to induce a withdrawal bleed, this is usually from day 14-28.
name: Oral progestogen should be taken in the first 10 days of your cycle
label: b
answer: no
explanation: HRT is not a contraceptive and women under 40 should continue to use contraception until 2 years after their last period. Women over 50 should continue to use contraception for a year after their last period.
name: You should continue to use contraception for 2 years after your last period
label: a
answer: yes
explanation: HRT patches should be applied below the waistline, usually on the buttock or lower abdomen.
name: HRT transdermal patches should be applied above the waistline
label: e
answer: no

Correct answer: a
Case presentation: A 26-year-old man attends his GP with low mood. This has persisted for 6 months. He has lost interest in his hobbies, has difficulty sleeping, has low energy levels and a low appetite. He has no active plans to harm himself or others although he does state 'sometimes I wish I wouldn't wake up'. He has no periods of heightened mood or psychotic symptoms. 



**PH**
Ankylosing spondylitis

**DH**
Ibuprofen 600mg QDS, omeprazole 20mg OD

One of the medications offered to treat his depression includes a sertraline which is offered to the patient to help treat his low moods.

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

Options:
explanation: Renal function tests are not required before starting sertraline.
name: He will need renal function tests before starting sertraline
label: c
answer: no
explanation: The use of antidepressants such as sertraline have been linked to suicidal thoughts and behaviour. This predominantly occurs near the beginning of treatment and should be monitored for.
name: His mood may worsen for a few weeks after starting sertraline
label: a
answer: yes
explanation: Liver function tests are not required before starting sertraline.
name: He will need liver function tests before starting sertraline
label: e
answer: no
explanation: There is no listed interaction between sertraline and omeprazole. The ibuprofen he is taking does however interact with sertraline to increase the risk of bleeding.
name: He will need to stop taking his omeprazole due to it increasing the risk of bleeding when taken with sertraline
label: b
answer: no
explanation: Periorbital oedema is an uncommon side effect of sertraline, therefore it is not very likely to occur.
name: It is very likely that he will experience periorbital swelling after starting sertraline
label: d
answer: no

Correct answer: a
Case Presentation: A 82-year-old woman attends her GP. She has been feeling dizzy since being started on Oxybutynin for urge incontinence. Her regular medicines are listed (below).


**PH** Osteoporosis, Type 2 Diabetes Mellitus, Hayfever Overactive Bladder

**DH** Alendronic acid 10mg PO once weekly, Metformin 500mg PO BD, Gliclazide 80mg PO OD, Paracetamol 1g PO BD, Chlorphenamine 10mg PO PRN, Cholecalciferol 800U OD

**On examination**
BP 136/76mmHg, HR 71, RR 14, Weight 50kg

**Investigation**

Neurological examination is normal.

Question: Select the prescription that is most likely to interact with the patient’s oxybutynin to cause dizziness.

Options:
explanation: Metformin does not commonly cause dizziness.
name: Metformin 500mg PO BD
label: b
answer: no
explanation: Cholecalciferol does not commonly cause dizziness.
name: Cholecalciferol 800U OD
label: e
answer: no
explanation: Gliclazide does not commonly cause dizziness.
name: Gliclazide 80mg PO OD
label: c
answer: no
explanation: Chlorphenamine is a H1 antagonist used to treat hayfever. It can commonly cause drowsiness and dizziness; the latter is more likely when taken with oxybutynin as there is a higher risk of antimuscarinic side effects.
name: Chlorphenamine 10mg PO PRN
label: a
answer: yes
explanation: Paracetamol does not commonly cause dizziness.
name: Paracetamol 1g PO BD
label: d
answer: no

Correct answer: a
Case Presentation: A 21-year-old female patient is brought to A&E drowsy and confused. Her friend reports that she has been taking recreational drugs. 


**PMH**
None

**On examination**
* Chest: clear, RR 12
* HS: S1 S2 + no added sounds
* Cranial Nerves: Nystagmus and dysarthria. Pupils are equal and reactive to light, normal size.

**Investigation**

Routine blood tests are normal.

Question: Which recreational drug is most likely to have caused these clinical signs?

Options:
explanation: MDMA is a stimulant recreational drug known as 'ecstasy'. MDMA toxicity leads to confusion, coma, convulsions, ventricular arrhythmias, hyperthermia, rhabdomyolysis, acute renal failure, acute hepatitis, disseminated intravascular coagulation, adult respiratory distress syndrome, hyperreflexia, hypotension and intracerebral haemorrhage. Self-induced water intoxication can also lead to hyponatraemia.
name: Methylenedioxymethamphetamine (MDMA)
label: c
answer: no
explanation: Cocaine is a stimulant drug used recreationally. Cocaine toxicity can lead to effects signs such as agitation, dilated pupils, tachycardia, hypertension, hallucinations, hyperthermia, hypertonia, and hyperreflexia. In severe cases, cocaine can cause myocardial infarction and arrhythmias.
name: Cocaine
label: d
answer: no
explanation: Amphetamines are stimulant recreational drugs. Toxicity leads to signs such as wakefulness, excessive activity, paranoia, hallucinations, hypertension and in more severe cases; exhaustion, convulsions, hyperthermia, and coma.
name: Amphetamine
label: e
answer: no
explanation: This patient is suffering from benzodiazepine toxicity. Benzodiazepine toxicity leads to muscarinic effects such as ataxia, dysarthria and nystagmus and in severe cases, respiratory depression which can be fatal.
name: Diazepam
label: a
answer: yes
explanation: Oxycodone is an opioid that is sometimes used recreationally. Opioid overdose has a similar clinical presentation to this patient in the form of respiratory depression and drowsiness. However, opioid toxicity causes different eye signs, most notably, constricted pinpoint pupils.
name: Oxycodone
label: b
answer: no

Correct answer: a
Case Presentation: A 16-year-old boy is brought to A&E by his mother as he is very drowsy. He is a known type 1 diabetic and treats this with insulin. He has recently had an ear infection, which is currently being treated with antibiotics by his GP. His regular medicines are listed (below).




 **PH** Type 1 diabetes mellitus, Depression, Eczema, Allergic Rhinitis


 **DH** Sertraline 50mg PO OD, Hydromol cream one application to affected area BD, Clarithromycin 500mg PO BD, Paracetamol 1g PO QDS, Cetirizine 10mg PO OD


Allergic to penicillin - comes out in a rash


 **On examination**
BP 109/68mmHg, HR 108, RR 24


Neurological exam: Difficult to rouse the patient.


 **Investigation**


||||
|--------------|:-------:|------------------|
|pH|7.27|7.35 - 7.45|
|PaO₂|10.0 kPa|11 - 15|
|PaCO₂|3.4 kPa|4.6 - 6.4|
|Bicarbonate|14 mmol/L|22 - 30|
|Lactate|3 mmol/L|0.6 - 1.4|


Serum BM 2.6 mmol/L (Fasting: 4.0 - 5.4 mmol/L, 2hrs post prandial: <7.8 mmol/L) , ketones 0.4mmol/L (<0.6 mmol/L)


Question: Select the medication that is most likely to have interacted with this patient's diabetes medication to produce this clinical picture.

Options:
explanation: Paracetamol does not commonly interact with insulin to precipitate hypoglycaemia.
name: Paracetamol 1g PO QDS
label: d
answer: no
explanation: Clarithromycin can increase the likelihood of hypoglycaemia when taken alongside insulin. Clarithromycin is a macrolide antibiotic that works by inhibiting bacterial protein synthesis by binding to the 50s ribosomal subunit.
name: Clarithromycin 500mg PO BD
label: a
answer: yes
explanation: Hydromol cream does not commonly interact with insulin to precipitate hypoglycaemia.
name: Hydromol cream one application to affected area BD
label: c
answer: no
explanation: Cetirizine does not commonly interact with insulin to precipitate hypoglycaemia.
name: Cetirizine 10mg PO OD
label: e
answer: no
explanation: Sertraline does not commonly interact with insulin to precipitate hypoglycaemia.
name: Sertraline 50mg PO OD
label: b
answer: no

Correct answer: a
Case Presentation: A 67-year-old man attends GP for follow-up after discharge from hospital following a crescendo TIA. His medications are listed on the right. He is discharged on dual antiplatelet therapy for 90 days.  


**PMH**

* Stroke
* Hypertension
* Hyperlipidaemia
* GORD

**On examination**

* Chest: Clear, RR 18
* HS: S1 S2 + no added sounds

Question: Which of the following medications should the GP consider stopping due to an adverse drug reaction to clopidogrel?

Options:
explanation: Amlopidine is a calcium channel blocker used to treat hypertension. It is not known to interact with clopidogrel.
name: Amlodipine 10mg OD
label: c
answer: no
explanation: Aspirin is an anti-platelet used in conjunction with clopidogrel in dual antiplatelet therapy. Although used together there is an increased risk of bleeding, the benefits in preventing atherothrombotic events outweigh this risk when used short-term following high-risk TIAs.
name: Aspirin 75mg OD
label: e
answer: no
explanation: Esomeprazole is a proton pump inhibitor used to treat gastro-oesophageal reflux disease. Esomeprazole has been shown to decrease the efficacy of clopidogrel. Alternatives to esomeprazole such as H2 receptor antagonists should be considered.
name: Esomeprazole 40mg BD
label: a
answer: yes
explanation: Simvastatin is used to treat hypercholesterolaemia and reduce the risk of ischaemic events. Simvastatin is not known to interact with clopidogrel.
name: Simvastatin  40mg OD
label: d
answer: no
explanation: Ramipril is an angiotensin-converting enzyme inhibitor used to treat hypertension. It is not known to interact with clopidogrel.
name: Ramipril 5mg OD
label: b
answer: no

Correct answer: a
Case Presentation: A 62-year-old gentleman has recently undergone surgery for a broken neck of femur which was treated with a total hip replacement. He has been managing his post-operative pain with morphine. His regular medicines are listed (below). Weight 85kg.




 **PH** Depression, COPD, Hypercholesterolaemia, Ethanol excess


 **DH** Tranylcypromine 10mg PO OD, Atorvastatin 20mg PO OD, Salmeterol 50micrograms INH BD, Tiotropium 5micrograms INH OD, Paracetamol 1g PO QDS


 **On examination**
BP 109/68mmHg, HR 88, RR 4


Neurological exam: Difficult to rouse the patient. Pupils appear small.


 **Investigation**



||||
|--------------|:-------:|------------------|
|pH|7.24|7.35 - 7.45|
|PaO₂|6.0 kPa|11 - 15|
|PaCO₂|9.4kPa|4.6 - 6.4|
|Bicarbonate|18 mmol/L|22 - 30|



Question: Select the medication that is most likely to have contributed to this patient's clinical condition.

Options:
explanation: This patient is experiencing opioid toxicity. Tranylcypromine is a monoamine oxidase B inhibitor that is used to treat major depressive disorder. It has been shown to potentially increase the risk of opioid toxicity if taken alongside morphine.
name: Tranylcypromine 10mg PO OD
label: a
answer: yes
explanation: Atorvastatin does not commonly interact with morphine.
name: Atorvastatin 20mg PO OD
label: b
answer: no
explanation: Tiotropium does not commonly interact with morphine.
name: Tiotropium 5micrograms INH OD
label: d
answer: no
explanation: Paracetamol does not commonly interact with morphine.
name: Paracetamol 1g PO QDS
label: e
answer: no
explanation: Salmeterol does not commonly interact with morphine.
name: Salmeterol 50micrograms INH BD
label: c
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: 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: 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: 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: 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: 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 26-year-old known schizophrenic is seen in the outpatient psychiatric department.


**Investigations**

Cardiovascular examination: Heart sounds I + II present, no added sounds.

ECG today: normal sinus rhythm

Prolactin today: 6 ng/mL (<20 ng/mL)

He is complaining of ongoing symptoms despite being treated with risperidone. He has also previously been treated with quetiapine which had to be switched due to lack of efficacy.

It is decided that he should be switched from risperidone to clozapine.

Question: What monitoring is required if a patient is taking clozapine?

Options:
explanation: Clozapine monitoring includes: ECG, prolactin, full blood count, lipid profile and fasting blood glucose. A full blood count is part of routine monitoring due to the high risk of agranulocytosis when taking clozapine. A lipid profile is part of routine monitoring due to the increased risk of dyslipidaemia. A fasting blood glucose part of routine monitoring due to the increased risk of developing diabetes mellitus.
name: Full blood count, lipid profile, fasting blood glucose
label: a
answer: yes
explanation: Clozapine monitoring includes: ECG, prolactin, full blood count, lipid profile and fasting blood glucose. Renal function is not normally monitored in patients taking clozapine.
name: Full blood count, renal function, fasting blood glucose
label: b
answer: no
explanation: Clozapine monitoring includes: ECG, prolactin, full blood count, lipid profile and fasting blood glucose. Hepatic function is not normally monitored in patients taking clozapine.
name: Full blood count, liver function tests, lipid profile
label: c
answer: no
explanation: Clozapine monitoring includes: ECG, prolactin, full blood count, lipid profile and fasting blood glucose. Renal and hepatic function tests are not normally monitored in patients taking clozapine.
name: Full blood count, renal function, liver function tests
label: e
answer: no
explanation: Clozapine monitoring includes: ECG, prolactin, full blood count, lipid profile and fasting blood glucose. Hepatic function is not normally monitored in patients taking clozapine. A chest x-ray is also not a part of the routine monitoring.
name: Full blood count, chest x-ray, liver function tests
label: d
answer: no

Correct answer: a