hllj/quesmed huggingface dataset:
A 36-year-old patient has eczema that affects her hands. She uses 2 finger-tip units per application (one finger-tip for each hand), which is equivalent to 1g of Betnovate cream. Betnovate cream contains 250 micrograms per 1 gram of the active ingredient, betamethasone.

If she is applying Betnovate cream twice daily, how many mg of betamethasone will she use in 2 weeks? 

Options:


1 x 2 = 2g used daily

2g x 14 = 28g used in 2 weeks

28 x 250 = 7000 micrograms of betamethasone = 7mg
Case Presentation:

A 75-year-old woman is admitted to the medical ward for palliative care. Her regular medicines are listed (below). Weight 60kg.

**PH** Hypertension, Hypercholesterolaemia, Osteoarthritis, Iron deficiency anaemia

**DH** Amlodipine 5mg PO OD, Morphine 15mg PO QDS

She is still complaining that she is in pain. She is being given 10mg morphine tablets as a way to manage her breakthrough pain.

Throughout the day, the patient requires 3 breakthrough doses to control her pain.

Given that hospital only stocks 10mg tablets, how many morphine tablets will the patient have had by the end of the day?

Options:


Since the hospital only has 10mg tablets, that means for her regular morphine dose, she requires 1.5 tablets each time. 1.5 x 4 = 6

She has had 3 doses of 10mg morphine as breakthrough pain which is 3 tablets. 6 + 3 = 9 tablets.
Case Presentation:

A 34-year-old patient with hypertension in pregnancy is prescribed labetalol by intravenous infusion.

She was initially given 10mg/hour, which was increased to 20mg/hour after 30 minutes, this was continued for 30 minutes and then increased to 40mg/hour. After another 30 minutes this was finally increased to 80mg/hour.

This continued for 15 minutes, after which the response was satisfactory and the infusion was stopped.

What is the average hourly rate at which this infusion has been given? Give your answer to one decimal place.

Options:


- Dose of labetalol given at 10mg/hour: 10mg/hour x 0.5 hours = 5mg
- Dose of labetalol given at 20mg/hour: 20mg/hour x 0.5 hours = 10mg
- Dose of labetalol given at 40mg/hour: 40mg/hour x 0.5 hours = 20mg
- Dose of labetalol given at 80mg/hour: 80mg/hour x 0.25 hours = 20mg

Total dose of labetalol given: 5mg + 10mg + 20mg + 20mg = 55mg

10mg given for 30 minutes (0.5 hours).
20mg given for 30 minutes (0.5 hours).
40mg given for 30 minutes (0.5 hours).
80mg given for 15 minutes (0.25 hours).

1.75 hours total. 55/1.75 = 31.4285714

To one decimal place = 31.4mg/hr
A 89-year-old patient requires maintenance fluids as she is Nil-by-mouth due to an unsafe swallow. She is prescribed 1200ml of 0.9% sodium chloride every 24 hours - calculated based on requirements of 25ml/kg/day.

How many mmol of potassium should she be given in 24 hours?

Options:


To calculate the patients weight: volume required/volume per hour= 1200/25= 48kg

Patients require the replacement of 1mmol/kg of potassium each day.

1x48=48mmol required
Case Presentation:

A 64-year-old gentleman attends his GP complaining of a productive cough and shortness of breath. His regular medicines are listed (below). Weight kg.

**PH** Osteoarthritis, Depression

**DH** Ibuprofen 200mg PO QDS, Omeprazole 20mg PO OD, Sertraline 50mg PO OD

**On examination**
BP 134/74mmHg, HR 78, RR 16, patient is alert

Respiratory exam: Crepitations heard in the left middle zone on auscultation

The GP decides that this is a community acquired pneumonia and prescribes the patient 250mg amoxicillin capsules to take at home.

How many amoxicillin tablets should the patient be discharged with for a duration of 5 days?

Options:


The patient requires a daily dose of 1.5g (1500mg) of amoxicillin (500mg to be taken 3 times a day).

They have been discharged with 250mg tablets. 1500/250 = 6 tablets needed per day.

The duration of treatment is 5 days. 5 x 6 = 30. 30 total tablets are therefore needed.
Case Presentation: A 24-year-old man attends his GP due to feelings of social anxiety. He has been struggling to sleep and is constantly worrying about university interactions with his tutor, his relationship and his friendships. He does not report any suicidal ideations or any plans to harm others. He has tried cognitive behavioural therapy but he feels it has not made much of a difference.


## PH
Type 1 diabetes mellitus

## DH
Humulin I 10 units subcutaneous OD, actrapid 6 units subcutaneous BD (after breakfast and dinner). NKDA.

## On examination

He appears low in mood, his speech is quiet and laboured. He doesn't particularly engage with the review.

Temperature 36.4°C, HR 106, RR 19, BP 118/78, O<sub>2</sub> 99% RA, GCS 15, Weight 64kg

## Investigations

Nil.

## Prescribing Request

Write a prescription for one drug that is most appropriate to treat his anxiety.

Options:


## Drug choice feedback

This gentleman has generalised anxiety disorder. They require pharmacological intervention alongside psychological intervention. The first line medication to treat generalised anxiety disorder is sertraline.

## Dose/Route/Frequency/Duration feedback

The first line treatment for this gentleman's anxiety is Sertraline 25mg PO OD. NICE advise: *if sertraline is ineffective,* offer an alternative SSRI, for example, paroxetine or escitalopram, or a selective serotonin-noradrenaline re-uptake inhibitor (SNRI), such as duloxetine or venlafaxine. 


Initially, 25 mg daily is prescribed for 1 week, then increased to 50 mg daily, then increased in steps of 50 mg at intervals of at least 1 week if required, increase only if response is partial and if drug is tolerated; maximum 200 mg per day.
Case Presentation: A 18-year-old gentleman is brought to the emergency department with a swollen face, widespread rash and difficulty breathing. His friend with him says that the symptoms randomly happened during a meal at a restaurant.


## PH
Asthma

## DH
Salbutamol 200 micrograms INH QDS. NKDA.

## On examination

Airway patent, patient is alert and orientated.

Temperature 37.3°C, HR 128, RR 26, BP 101/653, O<sub>2</sub> 94% RA, GCS 15, Weight 60kg

Respiratory exam: widespread wheeze heard on auscultation.

Cardiovascular exam: HS 1 + 2 + 0, his pulse feels weak.

Abdominal exam: abdomen soft and non tender with no palpable organomegaly

Neurological exam: grossly intact

Multiple hives are seen over his abdomen and thorax when his top is removed.

## Investigations

FBC: Hb 139, WCC 4.6, Plts 255 x 10^9

CRP 18

U&Es: Na 140, K 4.2, Ur 4.9, Cr 54, eGFR >90mL/min/1.73m<sup>2</sup>

Ca2+ (adjusted): 2.3

Mg2+: 0.9

Phosphate: 0.81

LFTs: ALP 30, ALT 24, bilirubin 13

ECG - sinus tachycardia

## Prescribing Request

Write a prescription for one drug that is most appropriate to treat this condition.

Options:


## Drug choice feedback

This patient is in acute anaphylaxis. The treatment for this is adrenaline (also known as epinephrine). As this patient is an adult the standard dose that he should be given is 500 micrograms IM in the anterolateral aspect of his thigh. There is a reduced dose of 300 micrograms for children aged 6-11 years, 150 micrograms for children aged 6 months-5years

## Dose/Route/Frequency/Duration feedback

The following prescription is appropriate to treat this patient's anaphylaxis:

- Adrenaline/Epinephrine 1 in 1000 (1 mg/mL) 500 micrograms  IM every 5 minutes
Case Presentation: A 63-year-old gentleman is brought onto the orthopaedic ward for an elective total knee replacement of his right knee. 


## PH
Osteoarthritis

## DH
Ibuprofen 400mg PO QDS, lansoprazole 30mg PO OD. NKDA.

## On examination

Temperature 37.1°C, HR 68, RR 13, BP 131/75, O<sub>2</sub> 98% RA, GCS 15, Weight 90kg

## Investigations

Nil

## Prescribing Request

Write a prescription for one drug that is most appropriate to provide cover against venous thromboembolism. It is the day before his elective surgery.

Options:


## Drug choice feedback

This patient requires a low molecular weight heparin as prophylactic treatment of venous thromboembolism prior to his surgery. The options available are tinzaparin, enoxaparin, bemiparin and dalteparin. They are often given at 6pm, this provides cover until the day of the surgery. DOACs such as rivaroxaban are now also licensed to be given as VTE prophylaxis **AFTER** (and so are incorrect answers for this question) specific procedures (such as knee and hip replacements) and these should be taken daily for 2 weeks. Similarly, Fondaparinux is not acceptable as per the BNF, which only provides information on prescribing it for VTE prophylaxis **post-surgery.**

# Dose/Route/Frequency/Duration feedback

The following prescriptions are appropriate to provide prophylaxis against venous thromboembolism:

- Enoxaparin 40mg subcutaneous OD
- Tinzaparin 4500 units subcutaneous OD
- Dalteparin 5000 units subcutaneous OD
- Bemiparin 3500 units subcutaneous OD
Case Presentation: A 68-year-old gentleman attends his GP complaining of constipation.



## PH
Osteoarthritis, hypercholesterolaemia

## DH
Ibuprofen 400mg PO QDS, lansoprazole 30mg PO OD, atorvastatin 20 mg PO OD

## FHx

No family history of lower gastrointestinal cancer

## On examination

He is alert and oriented. Abdomen is soft and non tender, with no palpable organomegaly.

Temperature 36.7°C, HR 70, RR 14, BP 127/82mmHg O<sub>2</sub> 99% RA, GCS 15, Weight 94kg

## Investigations

FBC: Hb 149, WCC 6.1, Plt 271

Colonoscopy performed 4 weeks ago: no abnormalities detected.

## Prescribing Request

Write a prescription for one drug that is most appropriate to treat this patient's constipation. He would prefer you to prescribe an osmotic or stimulant laxative - not a bulk-forming or poo-softener laxative. He does not want to take any medication rectally.

Options:


## Drug choice feedback

This gentleman has constipation. He only wants a stimulant or osmotic laxative - the laxatives that fall inside this group are lactulose, macrogol, bisacodyl, senna and sodium picosulfate. The bulk forming laxatives include ispaghula husk and poo-softener laxatives include docusate.

## Dose/Route/Frequency/Duration feedback

The following prescriptions are appropriate to treat this man's constipation:

- Lactulose 15ml PO BD
- Macrogol 2 sachets PO OD
- Bisacodyl 5-10mg PO OD
- Senna 7.5-15mg PO ON
- Sodium picosulfate 5-10mg PO ON
Case Presentation: A 33-year-old 37 week pregnant woman attends the maternity ward as she has gone into labour.


## PH
Nil.

## DH
Nil. NKDA.

## On examination

Patient comfortable at rest. No evidence of any oedema or the face or peripheral areas.

Symphysial-fundal height is 37cm, the position of the foetus is a longitudinal lie with cephalic palpation.

Temperature 37.3°C, HR 88, RR 16, BP 126/78, O<sub>2</sub> 98% RA, GCS 15, Weight 85kg

## Investigations

FBC: Hb 124, WCC 4.8, Plts 253 x 10^9

CRP 2

U&Es: Na 141, K 4.3, Ur 5.0, Cr 64, eGFR >90mL/min/1.73m<sup>2</sup>

Ca2+ (adjusted): 2.4

Mg2+: 0.8

Phosphate: 0.82

LFTs: ALP 31, ALT 23, bilirubin 12

TFTs: TSH 1.3, T4 11, T3 8

MSU: Streptococcus agalactiae

## Prescribing Request

Write a prescription for one drug that is most appropriate to give while she is in labour.

Options:


## Drug choice feedback

This patient has a group B streptococcus infection. Streptococcus agalactiae is the most common pathogen that belongs to the Group B streptococcus family. Treatment of Group B strep during labour is with IV benzylpenicillin, initially this should be a 3g IV infusion followed by 1.5g IV infusions every 4 hours until delivery.

## Dose/Route/Frequency/Duration feedback

The following prescription is appropriate to treat this patient's group B streptococcus infection:

- Benzylpenicillin 3g IV once-off, and then 1.2g every 4 hours
Case Presentation: A 23-year-old woman attends her GP to shortness of breath and wheeze. She experiences this intermittently, her symptoms are most likely to occur at night and after exercising. Her FeNO level is re-checked and it is not raised. She is keen to avoid using any more inhalers.


She has good inhaler technique and is taking her prescribed medications as recommended.

## PMH
Asthma

## DH
Moderate-dose MART.

NKDA.

## On examination

Temperature 36.6°C, HR 68, RR 16, BP 115/78, O<sub>2</sub> 98% RA, GCS 15, Weight 55kg

A polyphonic wheeze is heard on auscultation of her chest, no other abnormalities found.

## Investigations

FEV1/FVC ratio: 56%. FeNO level and blood eosinophils are normal.

## Prescribing Request

Write a prescription for one drug that is most appropriate to treat her asthma based on NICE guidelines.

Options:


## Drug choice feedback

This patient's asthma isn't controlled. She is already taking moderate-dose MART. The next step in her treatment would be trial of LAMA or a leukotriene receptor antagonist, in accordance with NICE guidelines. However, because the patient is keen to avoid additional inhalers, montelukast would be the most appropriate option.

## Dose/Route/Frequency/Duration feedback

The options available to treat this patients uncontrolled asthma are as follows:

- Montelukast 10mg PO OD
Case presentation: A 28-year-old woman is attends her GP complaining of nausea in the morning.  


**PH** Bipolar disorder, asthma, type 2 diabetes mellitus, acne, allergic rhinitis

**DH** Her regular medicines are listed (below). Weight 108kg.

**Investigation**

Urinary beta hCG ++

Question 1: Select the FOUR prescriptions that she will need to stop taking given her urinary beta hCG test results (mark them with a tick in column A)

Question 2: Select the ONE prescription that contains a serious dosing error (mark it with a tick in column B).

Options:
name: Gliclazide;80mg;PO;OD
label: g
answer: no
name: Cetirizine;10mg;PO;OD
label: i
answer: no
name: Metformin;500mg;PO;BD
label: c
answer: no
name: Lithium carbonate (Liskonum);450mg;PO;OD
label: a
answer: no
name: Isotretinoin;20mg;PO;OD
label: d
answer: no
name: Fluticasone;200 micrograms;INH;BD
label: f
answer: no
name: Paracetamol;1mg;PO;QDS
label: b
answer: no
name: Salbutamol;200 micrograms;INH;QDS
label: e
answer: no
name: Fluoxetine;60mg;PO;OD
label: h
answer: no


1. Lithium and isotretinoin are teratogenic. Lithium is linked with an increased risk of Ebstein's anomaly occurring. Isotretinoin is linked with an increased risk of cardiovascular and ear malformations. Gliclazide should be stopped due to the increased risk of neonatal hypoglycaemia. The BNF advises that antihistamines should be avoided during pregnancy. NB: newer research now suggests that SSRIs including fluoxetine can be safely taken during pregnancy, however the pros and cons should be considered, and it should be given at the lowest effective dose.

2. The dose of paracetamol should be 1g PO QDS in this patient, 1mg is an incorrect dose.
Case presentation: A 78-year-old female is admitted to the cardiology ward. During her stay she has been complaining of cold peripheries.


**PH** Congestive cardiac failure, type 2 diabetes mellitus, hypertension, oseteoarthritis hypercholesterolaemia, COPD, ADHD, depression

**DH** Her current medications are listed (below). Weight 110kg.

**On Examination**

HR 88/min, BP 114/89mm Hg, RR 24, O2 sats 92% RA. HS I + II with no added heart sounds. Bilateral basal crepitations heard on auscultation of the lungs.

**Investigation**

CXR shows bilateral pleural effusions

Question 1: Select the TWO prescriptions that are most likely to be the cause of her cold peripheries (mark them with a tick in column A)

Question 2: Select the ONE prescription that contains a serious dosing error (mark it with a tick in column B).

Options:
name: Atorvastatin;80mg;PO;OD
label: d
answer: no
name: Ramipril;20mg;PO;OD
label: a
answer: no
name: Bisoprolol;7.5 mg;PO;OD
label: e
answer: no
name: Spironolactone;100mg;PO;OD
label: c
answer: no
name: Sertraline;50mg;PO;OD
label: i
answer: no
name: Metformin;500mg;PO;BD
label: f
answer: no
name: Methylphenidate hydrochloride;20 mg;PO;TDS
label: g
answer: no
name: Furosemide;40mg;PO;OD
label: b
answer: no
name: Paracetamol;500mg;PO;BD
label: h
answer: no


1. Both bisoprolol and methylphenidate can cause patient's to experience cold peripheries. Bisoprolol commonly causes cold peripheries as they reduce the amount of blood that is delivered to the fingers and toes.
2. The maximum dose of ramipril that a patient can take is 10mg PO OD therefore this prescription contains a mistake.
Case presentation: A 69-year-old gentleman attends his lithium clinic appointment  




 **PH** Bipolar disorder, seizures, hypertension, depression, asthma, osteoarthritis


 **DH** His regular medicines are listed (below). Weight Xkg.


 **Investigation**


Lithium concentration 1.5 mEq/L (0.8-1.2 mEq/L)


Question 1: Select the THREE prescriptions that are most likely to be interacting with his lithium to increase its serum concentration (mark them with a tick in column A)


Question 2: Select the ONE prescription that contains a serious dosing error (mark it with a tick in column B).

Options:
name: Lithium carbonate (Liskonum);450mg;PO;OD
label: a
answer: no
name: Captopril;10mg;PO;OD
label: b
answer: no
name: Salbutamol;200 micrograms;INH;QDS
label: h
answer: no
name: Sertraline;50mg;PO;OD
label: i
answer: no
name: Carbamazepine;400mg;PO;TDS
label: e
answer: no
name: Lansoprazole;30mg;PO;OD
label: g
answer: no
name: Amlodipine;10 mg;PO;OD
label: c
answer: no
name: Ibuprofen;400mg;PO;QDS
label: f
answer: no
name: Bendroflumethiazide;2.5g;PO;OD
label: d
answer: no


1. ACE inhibitors, NSAIDs and thiazide like diuretics all increase the serum concentration of lithium. This is due to their effects on kidney function, a reduction in kidney function results in a reduced clearance of lithium. This in turn then leads to higher serum concentration of lithium.
2. Bendroflumethiazide should be given as a 2.5mg tablet once daily in hypertensive patients, NOT 2.5g.
Case presentation: A 42-year-old woman is admitted to the general surgical ward due to gallstones. It is decided that she should have an outpatient laparoscopic cholecystectomy.


**PH** Depression, hypercholesterolaemia, hypertension, type 2 diabetes mellitus, asthma, chronic fatigue syndrome, allergic rhinitis

**DH** Her current medicines are listed (below). Weight 118kg.

**On Examination**
HR 81/min, BP 112/80mm Hg, RR 14, O2 Sats 96% RA, temperature 37.1

Abdomen soft, tender in RUQ. Bowel sounds present.

**Investigation**

USS abdomen - thickened gallbladder wall and multiple gallstones within the gallbladder. No perforation.

Question 1: Select the THREE prescriptions that are most likely to be stopped before her elective surgery (mark them with a tick in column A)

Question 2: Select the ONE prescription that contains a serious dosing error (mark it with a tick in column B).

Options:
name: Sertraline;50mg;PO;OD
label: c
answer: no
name: Salbutamol;200mg;INH;PRN
label: a
answer: no
name: Fluticasone;100 micrograms;intranasal, one application;OD
label: i
answer: no
name: Simvastatin;20mg;PO;OD
label: f
answer: no
name: Cetirizine;10mg;PO;OD
label: h
answer: no
name: Ramipril;10mg;PO;OD
label: e
answer: no
name: Microgynon 30;1 tablet;PO;daily for 21 days with a pill free week following this
label: g
answer: no
name: Paracetamol;1g;PO;QDS
label: b
answer: no
name: Metformin;500mg;PO;TDS
label: d
answer: no


1. Ramipril, microgynon 30 and metformin should be held before surgery. COCPs should be held for 4 weeks prior to surgery due to the increased risk of thromboembolism. ACE inhibitors/angiotensin-II receptor antagonists should be omitted the day before surgery due to an increases risk of severe hypotension after induction of anaesthesia. Metformin can also be held before surgery if there is an increased risk of lactic acidosis occurring.

2. The maximum dose of salbutamol per administration is 200 micrograms NOT milligrams.
Case presentation: 


A 24-year-old woman attends the emergency department due to diarrhoea, vomiting and muscle spasms.

**PH** Depression, anxiety, bipolar disorder, fibromyalgia, Raynaud's syndrome, systemic lupus erythematosus

**DH** Her regular medicines are listed (below). Weight 67kg.

**On Examination**
HR 128/min regular rhythm, BP 164/97 mmHg, profusely sweating, dilated pupils.

Question 1: Select the TWO prescriptions that are most likely to have interacted with her sertraline to cause this presentation (mark them with a tick in column A)

Question 2: Select the ONE prescription that contains a serious dosing error (mark it with a tick in column B).

Options:
name: Ibuprofen;400mg;PO;QDS
label: g
answer: no
name: Paracetamol;1g;PO;QDS
label: i
answer: no
name: Tramadol hydrochloride;1g;PO;QDS
label: d
answer: no
name: Gabapentin;300mg;PO;TDS
label: c
answer: no
name: Sertraline;50mg;PO;OD
label: a
answer: no
name: Hydroxychloroquine;200mg;PO;OD
label: f
answer: no
name: Nifedipine;5mg;PO;TDS
label: e
answer: no
name: Lansoprazole;30mg;PO;OD
label: h
answer: no
name: Lithium carbonate (Liskonum);450mg;PO;OD
label: b
answer: no


1. This patient is experiencing serotonin syndrome. This can be inferred from the classic symptoms of diarrhoea, vomiting and muscle spasms combined with the dilated pupils and profuse sweating seen on examination. Tramadol and lithium increase the risk of serotonin syndrome in patient's taking sertraline. Tramadol is does this by increasing the concentration of serotonin in the synapses between the serotonergic neurones in the brain stem.
2. The max dose of tramadol should be 400mg daily. This patient would be receiving 10 times the maximum daily dose.
Case presentation: A 83-year-old gentleman attends his GP due to issues with his sleep.


**PH** Atrial fibrillation, hypercholesterolaemia, COPD, gout, benign prostatic hyperplasia, hypertension, depression

**DH** His regular medicines are listed (below). Weight 54kg.

Question 1: Select the THREE prescriptions that are most likely to be a cause of his issues with sleeping (mark them with a tick in column A)

Question 2: Select the ONE prescription that contains a serious dosing error (mark it with a tick in column B).

Options:
name: Allopurinol;200mg;PO;OD
label: e
answer: no
name: Salbutamol;200 micrograms;INH;PRN
label: d
answer: no
name: Bisoprolol;10mg;PO;OD
label: b
answer: no
name: Atorvastatin;40mg;PO;OD
label: c
answer: no
name: Tamsulosin;400 micrograms;PO;OD
label: g
answer: no
name: Apixaban;5mg;PO;BD
label: a
answer: no
name: Paracetamol;1g;PO;QDS
label: h
answer: no
name: Mirtazapine;30mg;PO;OD
label: f
answer: no
name: Felodipine;5mg;PO;OD
label: i
answer: no


1. Beta blockers, statins and mirtazapine all commonly can cause sleep disorders. Beta-blockers interfere with sleep by reducing melatonin levels due to inhibition of beta-1 adrenergic receptors. SSRIs disturb the regulation of muscle tone during REM sleep and exacerbate bruxism.
2. The maximum dose of apixaban in this patient is 2.5mg BD, as they are >80 years of age and <60kg. Other indications for reduced apixaban usage include: serum creatinine 133 micromol/litre and over, and patients with two of these criteria require reduced dosing.