hllj/quesmed huggingface dataset:
Case presentation: A 32-year-old woman visits the GP to discuss about contraception. She is interested in having combined oral contraceptive pill (COCP) after hearing about it from her friends. The first day of her last menstrual period was 9 days ago. The patient is advised to start taking ethinylestradiol 30 micrograms/ levonorgestrel 150 micrograms one tablet PO daily for 21 days of each cycle . She does not have any contraindications to the medication.  

Physical examination: HS 1+11 + 0, chest clear with no added lung sounds, abdomen SNT
She would like to know if she needs additional contraception if she were to start taking the pill from today and also of the appropriate actions that should be done if she misses her pills.

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

Options:
explanation: A pill is considered missed if 24 hours have passed since the time it should be taken
name: A pill is considered missed if it has been more than 12 hours since the time it should be taken
label: c
answer: no
explanation: She does not need emergency contraception because she would already have been protected against pregnancy if COCO was consistently taken in the previous 7 days
name: She needs emergency contraception if she misses two pills and has unprotected sexual intercourse in week two after hormone free interval
label: e
answer: no
explanation: If 2 or more pills have been missed in week 3, the patient should take the most recent missed pill, omit the hormone free interval and take the precautionary step of using an additional barrier contraception until 7 consecutive pills have been taken
name: She should omit the upcoming hormone free interval if she misses two or more pills in week three
label: a
answer: yes
explanation: If a patient starts taking COCP within the first 5 days of period, she will be protected from pregnancy straight away. However, since the patient is in day 9 of her menstrual cycle, she should avoid sexual intercourse or use a barrier method of contraception such as a condom for the first 7 days
name: There is no need for additional contraception as COCP offers immediate protection once taken
label: b
answer: no
explanation: . If the patient has missed a pill, she should take the last missed pill (and leave any earlier missed pills if she missed more than 1 pills) immediately, even if this means that she is taking 2 pills in 1 day
name: She should never take a double dose to replace a missed dose
label: d
answer: no

Correct answer: a
Case presentation: A 65-year-old woman attends the memory clinic with a six-month gradual onset memory decline. Her children report that she has been misplacing items and appears to be disoriented at times. The patient denies being low in mood, feeling tired or having any problems deriving joy from her hobbies.  

Physical examination: HS 1+11 + 0, chest clear with no added lung sounds, abdomen SNT, normal neurological exam
Investigation: Mini Mental State Examination (MMSE) score is 20/30.
She is advised to commence treatment with Donepezil Hydrochloride 5mg PO daily.

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

Options:
explanation: Donepezil can be prescribed in the form an orodispersible tablet. The tablet should be placed on the tongue, allowed to disperse and swallowed
name: Donepezil orodispersible tablet should be chewed and placed below the tongue to allow easy absorption
label: c
answer: no
explanation: It is important to remind patients to refrain from drinking alcohol while taking donepezil because alcohol can reduce the effectiveness of donepezil and increase the risk of side effects
name: He can drink alcohol while taking donepezil
label: d
answer: no
explanation: Non-steroidal anti-inflammatory drugs (NSAIDs) should be taken with caution because concurrent usage of NSAID and donepezil may increase risk of ulceration
name: He can take over-the-counter anti-inflammatory painkillers such as ibuprofen without consulting a health professional first
label: e
answer: no
explanation: Donepezil is a reversible cholinesterase inhibitor that is used to manage mild to moderate Alzheimer’s disease. It helps to alleviate some symptoms like being forgetful or confused but does not completely cure Alzheimer’s disease
name: Donepezil is a glutamate receptor antagonist that is used to treat mild-to-moderate Alzheimer’s disease
label: b
answer: no
explanation: Most common side effects of donepezil include diarrhoea, headache and nausea. Through accumulation of acetylcholine at muscarinic receptors, donepezil causes diarrhoea by increasing the gastrointestinal motility
name: Diarrhoea is a common side effect of donepezil
label: a
answer: yes

Correct answer: a
Case presentation: A 60-year-old woman attends the rheumatology clinic with a two-week history of fatigue and morning stiffness in the shoulder. She complains that the stiffness usually lasts more than 1 hour.  


Investigations:
 -ESR 45mm/hr [(age+10)/2]
 -CRP 20 mg/l (<10 )
A diagnosis of polymyalgia rheumatica is made and patient is advised to commence treatment with Prednisolone 10 mg PO daily.


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

Options:
explanation: Prednisolone is a steroid medication used to reduce inflammation in rheumatological condition such as polymyalgia rheumatica. During sickness, patients are advised to increase the dose of prednisolone for two days before returning to the usual dose. This action aims to mimic the natural response of adrenal glands that increase the production of steroid hormones during illness
name: She should double the dose of prednisolone during sickness
label: a
answer: yes
explanation: Prednisolone is not known to cause hypoglycaemia
name: Prednisolone increases the risk of hypoglycaemia
label: e
answer: no
explanation: Prednisolone could cause insomnia through the release of catecholamines. Hence, patients are usually advised to take prednisolone in the morning so that it does not keep them awake at night
name: She should take prednisolone at night before sleeping
label: b
answer: no
explanation: Dose of prednisolone needs to be reduced gradually before the treatment is stopped completely to reduce the risk of withdrawal symptoms
name: She should immediately stop taking prednisolone once her symptoms have improved to reduce the risk of developing side effects
label: c
answer: no
explanation: Peptic ulcer is a common side effect of all systemic corticosteroids
name: Prednisolone decreases the risk of peptic ulcer
label: d
answer: no

Correct answer: a
Case presentation: A 55-year-old man attends the diabetes clinic for review of his diabetic medication. He still complains of thirst and frequent urination despite the up-titration of his metformin dose 3 months ago.  

PMH: Type 2 Diabetes Mellitus, Hypertension
DH: Metformin hydrochloride 1g PO BD, Captopril 50mg PO BD
Investigations: HbA1c 65 mmol/mol (20-42)
The patient is advised to add a new prescription of gliclazide 40mg PO daily to his current treatment regime.

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

Options:
explanation: Gliclazide is usually taken life-long
name: Gliclazide can only be used for short-term treatment to prevent long-term side effects
label: b
answer: no
explanation: Gliclazide can cause weight gain by increasing the concentration of insulin, which is an anabolic hormone that promotes fat storage
name: Gliclazide may cause weight loss
label: e
answer: no
explanation: Gliclazide can sometimes lead to hypoglycaemia due to the increase in insulin synthesis. Hence, patients are advised to avoid missing meals and to carry a source of sugar with them at all times
name: He should avoid missing meals to prevent low blood sugar from happening
label: a
answer: yes
explanation: If a dose of gliclazide is missed, patients are advised to take the next dose at the usual time. Patients should not take a double dose to make up for the forgotten dose
name: If he has forgotten to take gliclazide the day before, he should take a double dose to make up for the forgotten dose
label: d
answer: no
explanation: Gliclazide is a sulfonylurea that increases the amount of insulin produced by the body
name: Gliclazide is a biguanide that decreases glucose production by liver
label: c
answer: no

Correct answer: a
Case presentation: A 60-year-old man attends the rapid access chest pain clinic with a two-month history of dull, constricting chest pain that is brought upon by exertion and relieved by rest within 5 minutes. He is currently not in any pain and his resting 12-lead ECG is normal.  

PMH: Hypertension, Hypercholesterolaemia
DH: Amlodipine 5mg PO OD, Simvastatin 40mg ON
One of the medications offered includes a Glyceryl Trinitrate (GTN) spray, which is offered to the patient to relieve episodes of chest pain when they arise.

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

Options:
explanation: Patients are advised to repeat the dose at 5 minutes interval if the pain persists and to call an emergency ambulance if the pain has not gone 5 minutes after taking the second dose
name: He should call an emergency ambulance if the pain has not gone 5 minutes after taking the first dose
label: d
answer: no
explanation: The correct method of administering GTN is to spray it under the tongue and close the mouth
name: GTN should be sprayed onto the tongue
label: b
answer: no
explanation: Patients are advised to repeat the dose at 5 minutes interval if the pain persists and to call an emergency ambulance if the pain has not gone 5 minutes after taking the second dose
name: He should repeat the dose at 15 minutes interval if the pain has not gone
label: c
answer: no
explanation: Glyceryl Trinitrate (GTN) is a medication used for prophylaxis and treatment of angina. Once in the body, It is converted into nitric oxide, an active metabolite that causes vasodilation and increases blood flow to the heart. Headache is a common side effect of all nitrates
name: GTN spray may cause headache
label: a
answer: yes
explanation: GTN does not increase the risk of oral thrush
name: GTN spray may increase risk of oral thrush
label: e
answer: no

Correct answer: a
A 47-year-old patient with focal seizures was initially prescribed levetiracetam (Keppra(R)) at a maintenance dose of 1g twice daily. Due to co-existing renal impairment, it has been decided that the dose should be reduced by 50% as per the manufacturer's advice. This is diluted in 100mL of 0.9% sodium chloride solution and given over 15 minutes.


What is the rate (in mg per minute) of levetiracetam he is to be given at each dose? Round off your answer to the nearest mg per minute.

Options:


After adjusting for renal impairment, the dose to be given is: 50% x 1g = 500mg.
Hence, the rate at which levetiracetam is to be given is: 500mg ÷ 15 minutes = 33.3ml/min ≈ 33mL/min.
The volume of 0.9% sodium chloride solution required for dilution is a distraction.
A 75-year-old man who was admitted for a severe chest infection developed cellulitis on his third day of admission. He is to be treated with vancomycin 20mg/kg IV 8-hrly. Weight 85kg.

Prior to administration, vancomycin needs to be diluted with sodium chloride 0.9% to a concentration not exceeding 5mg/mL.

What is the minimum volume (mL) to which each dose of vancomycin should be diluted?

Options:


Dose = 20mg/kg 8-hrly
Weight = 85kg
Total dose= 20mg/kg 8-hrly x 85kg
= 1.7g 8-hrly
Drug concentration = 5mg/mL
Minimum volume required
= 1700mg/(5mg/mL) = 340mL
A 55-year-old gentleman is admitted to Surgical Assessment Unit with likely acute pancreatitis. Following surgical review, he has been kept NBM and IV fluid has been prescribed. Weight 80kg.


His IV fluid regimen has been prescribed as below:

* IV 0.9% Normal Saline 500mL 10mmol KCl over 1 hour
* IV 0.9% Normal Saline 1L 20mmol KCl over 2 hours
* IV 0.18% Normal Saline 4% Dextrose 1L 40mmol KCl over 8 hours

What dose (mmol) of potassium will have been administered IV in the first 5 hours?

Options:


1st hour = 10mmol KCl
Next 2 hours = 20mmol KCl
Next 2 hours = (2/8 x 40mmol KCl) = 10mmol KCl

Total dose of potassium in 5 hours
= 10 + 20 + 10 mmol KCl
= 40mmol KCl
A 45-year-old patient is admitted to Hyperacute Stroke Unit for left MCA stroke. SALT assessment concluded that he has unsafe swallow and kept him NBM. PMH Focal seizure DH Carbamazepine 500mg PO BD.


Suppositories of 125mg may be considered to be approximately equivalent in therapeutic effect to tablets of 100mg but final adjustment should always depend on clinical response.

What is the total dose (mg) of carbamazepine in suppositories that is needed in a day?

Options:


Dose of carbamazepine
= 500mg BD = 1000mg a day
Suppositories 125mg =100mg
Number of suppositories needed in a day
= 1000mg /100mg x 125mg
= 1250mg
A 5-year-old boy is admitted to Emergency Department with Kussmaul breathing and ketotic breath following 3 days of polyuria and polydipsia. He was diagnosed with DKA and was started on the appropriate treatment. Fluids was prescribed and fixed rate Actrapid infusion was initiated at a rate of 0.1units/kg/hr. Weight 20kg.


For intravenous infusion of Actrapid, give continuously in Sodium Chloride 0.9% @ 1units in 1mL of 0.9% sodium chloride solution.

What is the volume (mL) of 0.9% sodium chloride solution needed for a fixed rate 24 hour Actrapid infusion?

Options:


Dose = 0.1units/kg/hr
Weight = 20kg
Total insulin needed/hour
= 0.1units/kg/hr x20kg = 2units/hr
Total insulin needed for a day
= 2units/hr x 24hrs = 48 units
= 48units require 48mL of 0.9% sodium chloride.
Case Presentation: A 75-year-old man is recovering on the Orthopaedic Ward following an elective left knee replacement two days ago. Post-operatively, he was prescribed paracetamol, an NSAID and a weak opioid for pain relief. On the second day after his operation, he developed tachycardia. An ECG was performed showing sinus tachycardia with prolongation of QT interval. PMH Severe depression, Parkinson’s disease, IBD. DH Citalopram 40mg OD, Paracetamol 1g QDS PO, Ibuprofen 400mg TDS, Co-beneldopa 50mg BD, Rotigotine 8mg TD OD


Question: Select the prescription that is most likely to contribute to the prolongation of his QT interval

Options:
explanation: Ibuprofen does not commonly prolongs QT interval
name: Ibuprofen 400mg TDS
label: b
answer: no
explanation: C0-beneldopa does not commonly prolongs QT interval
name: Co-beneldopa 50mg BD
label: d
answer: no
explanation: Rotigotine does not commonly prolongs QT interval
name: Rotigotine 8mg OD
label: e
answer: no
explanation: Paracetamol does not commonly prolongs QT interval
name: Paracetamol 1g QDS
label: c
answer: no
explanation: Citalopram and escitalopram are examples of drugs that are used for depressive illness. They can commonly cause side effects including prolongation of QT interval especially when other risk factors are present such as age extremity, stress or shock. The exact mechanism of the effect of citalopram on QT interval, however, is not known
name: Citalopram 40mg OD
label: a
answer: yes

Correct answer: a
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: 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: 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: 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 75-year-old man was admitted to the Care of the Elderly Ward following a urinary tract infection 3 days ago. A day after his admission, he felt nauseous and vomited twice in the morning. There was no blood noted in the vomitus. He was prescribed a medication for symptomatic relief of his nausea and vomiting by the on call doctor. However, on the next day, he started experiencing visual hallucinations. PMH Lewy Body Dementia. DH Rivastigmine, Levodopa.


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

Options:
explanation: Clozapine would not be prescribed for nausea and vomiting, and does not commonly cause visual hallucinations
name: Clozapine 12.5mg PO OD
label: c
answer: no
explanation: Cyclizine does not commonly cause visual hallucinations
name: Cyclizine 50mg PO TDS
label: d
answer: no
explanation: Selegiline would not be prescribed for nausea and vomiting, and does not commonly cause visual hallucinations
name: Selegiline hydrochloride 5mg PO OD
label: b
answer: no
explanation: Haloperidol exert its anti-emetic effect by blocking central dopamine receptors in the chemoreceptor trigger zone in the brain. Its inhibition on D2 receptors, in particular, can worsen the symptoms of LBD as patients with LBD has increased neuroleptic sensitivity and when given typical antipsychotics like haloperidol, they can experience worsening hallucination, cognition and increased parkinsonism
name: Haloperidol 5mg PO BD
label: a
answer: yes
explanation: Ondansetron does not commonly cause visual hallucinations
name: Ondansetron 8mg PO BD
label: e
answer: no

Correct answer: a
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: 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
explanation: Gliclazide does not commonly cause thrombocytopenia
name: Gliclazide 30mg PO OD
label: c
answer: no

Correct answer: a
Case Presentation: A 19 year old man presents to A&E with chest pain and shortness of breath. **PMH** asthma, has had 3x previous A&E attendances for acute exacerbations and 1x hospitalisation stay. **DH** salbutamol 200 micrograms inhaler PRN, beclomethasone with formoterol (Fostair NEXThaler) 100/6 micrograms powder inhaler 2 puffs BD. Allergic to pollen and cat fur – exacerbates asthma.


**O/E**

Visibly short of breath with tripoding and use of accessory neck muscles. Sweaty. Peripherals warm and well-perfused. HR 103, RR 29, BP 129/68, O2 100% 15L reservoir mask. Widespread polyphonic wheeze on chest auscultation.

**Investigations**

CXR: No consolidation or pneumothoraces

PEFR: 45% of normal predicted value

He has been given back to back salbutamol and ipratropium nebulisers and is being started on an aminophylline infusion.

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

Options:
explanation: Intravenous magnesium is commonly given for severe acute exacerbations of asthma and levels may be monitored during treatment. However it is not being used here
name: Serum magnesium
label: e
answer: no
explanation: This patient is at risk of hypokalaemia due to repeated salbutamol nebulisers and commencement of an aminophylline infusion. Renal function should be monitored
name: Urea and electrolytes
label: a
answer: yes
explanation: This would be useful as a baseline as aminophylline is metabolised hepatically. However routine monitoring is not necessary
name: Liver function tests
label: c
answer: no
explanation: This would be a useful marker of beneficial effects of the treatment rather than adverse effects
name: Respiratory rate
label: d
answer: no
explanation: This would be a useful marker of beneficial effects of the treatment rather than adverse effects
name: Bedside spirometry
label: b
answer: no

Correct answer: a
Case Presentation: A 65 year old man is admitted to the surgical ward prior to an elective total knee replacement. He is due to receive gentamicin 300mg IV as a one-off dose for surgical prophylaxis prior to the procedure.


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

Options:
explanation: This is not necessary prior to administering gentamicin
name: Visual fields assessment
label: e
answer: no
explanation: Renal function should be checked at baseline and during ongoing treatment as gentamicin is nephrotoxic
name: Renal function tests
label: a
answer: yes
explanation: This is not necessary as there is nothing to make one suspicion of any ongoing infection
name: Full blood count
label: c
answer: no
explanation: This may be useful as a baseline but is not routinely done prior to administering gentamicin
name: Liver function tests
label: d
answer: no
explanation: This is not necessary as there is nothing to make one suspicion of any inflammatory process or ongoing infection
name: C-reactive protein
label: b
answer: no

Correct answer: a