questions.json

[
  {
    "instance_id": "SS-HF-HFREF-001",
    "patient_vignette": "A 71-year-old man has heart failure with reduced ejection fraction (LVEF 32%), currently asymptomatic on guideline-directed therapy review. No other significant past medical history; renal and hepatic function normal; not on other prescription medications; no known drug allergies.",
    "question": "For this patient, which of the following drugs should be avoided?",
    "options": {
      "A": "Verapamil",
      "B": "Dextromethorphan-quinidine",
      "C": "Diltiazem",
      "D": "Amlodipine",
      "E": "Cilostazol"
    },
    "answer": [
      "A",
      "B",
      "C",
      "E"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "calcium-channel blockers",
      "antiarrhythmics",
      "pde3 inhibitors/peripheral vascular drugs"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-HF-HFPEF-001",
    "patient_vignette": "A 71-year-old man has heart failure with preserved ejection fraction (LVEF 58%), currently asymptomatic. No other significant past medical history; renal and hepatic function normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications are potentially inappropriate for this patient?",
    "options": {
      "A": "Metformin",
      "B": "Dextromethorphan-quinidine",
      "C": "Cilostazol",
      "D": "Atorvastatin",
      "E": "None of the above need to be avoided"
    },
    "answer": [
      "B",
      "C"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "antiarrhythmics",
      "pde3 inhibitors/peripheral vascular drugs"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-HF-NOHF-001",
    "patient_vignette": "A 71-year-old man presents for a routine geriatric review. He has no history of heart failure and a recent echocardiogram showed normal left ventricular function (LVEF 62%). No other pertinent past medical history; kidney and liver function are normal; not on any other prescription drugs; no known drug allergies.",
    "question": "Given this patient's condition, which of the drugs below are unsuitable?",
    "options": {
      "A": "None of the above need to be avoided",
      "B": "Metformin",
      "C": "Empagliflozin",
      "D": "Dextromethorphan-quinidine",
      "E": "Levothyroxine"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "antidiabetics",
      "antiarrhythmics",
      "thyroid hormones"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-HF-HFREF-002",
    "patient_vignette": "An 82-year-old woman has heart failure with reduced ejection fraction (LVEF 28%) on stable medical therapy and is currently free of decompensation symptoms. No other significant past medical history; renal and hepatic function normal; not on other prescription medications; no known drug allergies.",
    "question": "Based on safe prescribing principles for older adults, which of these drugs should this patient avoid?",
    "options": {
      "A": "Diltiazem",
      "B": "Verapamil",
      "C": "Dextromethorphan-quinidine",
      "D": "Cilostazol",
      "E": "None of the above need to be avoided"
    },
    "answer": [
      "A",
      "B",
      "D"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "calcium-channel blockers",
      "antiarrhythmics",
      "pde3 inhibitors/peripheral vascular drugs"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-HF-HFPEF-002",
    "patient_vignette": "An 82-year-old woman has heart failure with preserved ejection fraction (LVEF 55%) and is currently asymptomatic. No other pertinent past medical history; kidney and liver function are normal; not on any other prescription drugs; no known drug allergies.",
    "question": "Which of the following options constitute potentially inappropriate medications for this patient?",
    "options": {
      "A": "Dextromethorphan-quinidine",
      "B": "Diltiazem",
      "C": "Verapamil",
      "D": "None of the above need to be avoided",
      "E": "Cilostazol"
    },
    "answer": [
      "A",
      "E"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "antiarrhythmics",
      "pde3 inhibitors/peripheral vascular drugs"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-HF-NOHF-002",
    "patient_vignette": "An 82-year-old woman presents for a wellness visit. She has no history of heart failure and her cardiac function is normal (LVEF 60%). Otherwise unremarkable medical history; normal renal and hepatic function; not taking other prescription drugs; no known allergies.",
    "question": "Looking at this patient, which medications would you not prescribe?",
    "options": {
      "A": "Lisinopril",
      "B": "Atorvastatin",
      "C": "None of the above need to be avoided",
      "D": "Amlodipine",
      "E": "Cilostazol"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "ras inhibitors",
      "statins",
      "calcium-channel blockers",
      "pde3 inhibitors/peripheral vascular drugs"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-HF-HFPEF-003",
    "patient_vignette": "A 76-year-old man with heart failure with preserved ejection fraction (LVEF 62%) is followed in a geriatric clinic. He has no current decompensation. Otherwise unremarkable medical history; normal renal and hepatic function; not taking other prescription drugs; no known allergies.",
    "question": "Considering this patient's history, which drugs below should be avoided?",
    "options": {
      "A": "Amlodipine",
      "B": "None of the above need to be avoided",
      "C": "Cilostazol",
      "D": "Metformin",
      "E": "Dextromethorphan-quinidine"
    },
    "answer": [
      "C",
      "E"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "pde3 inhibitors/peripheral vascular drugs",
      "antiarrhythmics"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-HF-SYMP-004",
    "patient_vignette": "A 79-year-old woman has heart failure and is currently symptomatic with NYHA class III symptoms (dyspnea on minimal exertion and lower-extremity edema). Remainder of medical history is unremarkable; renal and hepatic function within normal limits; not on additional prescription medications; no drug allergies reported.",
    "question": "Which of the listed medications poses a concern for this patient?",
    "options": {
      "A": "Dronedarone",
      "B": "None of the above need to be avoided",
      "C": "Metformin",
      "D": "Pioglitazone",
      "E": "NSAIDs and COX-2 inhibitors"
    },
    "answer": [
      "A",
      "D",
      "E"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "antiarrhythmics",
      "thiazolidinedione antidiabetics",
      "nsaids/antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-HF-NOHF-004",
    "patient_vignette": "A 79-year-old woman presents for a medication review. She has no history of heart failure and her cardiac function is normal. Remainder of medical history is unremarkable; renal and hepatic function within normal limits; not on additional prescription medications; no drug allergies reported.",
    "question": "Reviewing this patient's profile, which of these medications would you avoid?",
    "options": {
      "A": "None of the above need to be avoided",
      "B": "Bisoprolol",
      "C": "Pioglitazone",
      "D": "Metformin",
      "E": "Empagliflozin"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "thiazolidinedione antidiabetics",
      "antidiabetics"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-SY-POS-005",
    "patient_vignette": "An 80-year-old man has a documented history of recurrent syncope, with episodes attributed to bradycardia. No other significant past medical history; renal and hepatic function normal; not on other prescription medications; no known drug allergies.",
    "question": "Which agents below are potentially inappropriate in this patient?",
    "options": {
      "A": "None of the above need to be avoided",
      "B": "Acetaminophen",
      "C": "Donepezil",
      "D": "Galantamine",
      "E": "Rivastigmine"
    },
    "answer": [
      "C",
      "D",
      "E"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "cholinesterase inhibitors"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-SY-NEG-005",
    "patient_vignette": "An 80-year-old man has no history of syncope and presents for a routine medication review. Past medical history is otherwise unremarkable; renal and hepatic function are normal; not currently on other prescription medications; no drug allergies.",
    "question": "For this patient, which of the following drugs should be avoided?",
    "options": {
      "A": "Acetaminophen",
      "B": "None of the above need to be avoided",
      "C": "Atorvastatin",
      "D": "Galantamine",
      "E": "Lisinopril"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "antipyretic analgesics",
      "statins",
      "cholinesterase inhibitors",
      "ras inhibitors"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-SY-POS-006",
    "patient_vignette": "A 78-year-old woman has a history of recurrent syncope attributed to orthostatic hypotension. No other significant past medical history; renal and hepatic function normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications are potentially inappropriate for this patient?",
    "options": {
      "A": "Doxazosin",
      "B": "Prazosin",
      "C": "Imipramine",
      "D": "Amitriptyline",
      "E": "Terazosin"
    },
    "answer": [
      "A",
      "B",
      "C",
      "D",
      "E"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "alpha-1 receptor blockers",
      "tricyclic antidepressants"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-SY-NEG-006",
    "patient_vignette": "A 78-year-old woman presents for medication review with no history of syncope or near-syncope. Remainder of medical history is unremarkable; renal and hepatic function within normal limits; not on additional prescription medications; no drug allergies reported.",
    "question": "Given this patient's condition, which of the drugs below are unsuitable?",
    "options": {
      "A": "Amlodipine",
      "B": "None of the above need to be avoided",
      "C": "Metformin",
      "D": "Levothyroxine",
      "E": "Lisinopril"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "calcium-channel blockers",
      "antidiabetics",
      "thyroid hormones",
      "ras inhibitors"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-SY-POS-007",
    "patient_vignette": "A 75-year-old man has a documented history of syncope. No other significant past medical history; renal and hepatic function normal; not on other prescription medications; no known drug allergies.",
    "question": "Based on safe prescribing principles for older adults, which of these drugs should this patient avoid?",
    "options": {
      "A": "Lisinopril",
      "B": "Chlorpromazine",
      "C": "None of the above need to be avoided",
      "D": "Cetirizine",
      "E": "Olanzapine"
    },
    "answer": [
      "B",
      "E"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "antipsychotics"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-SY-NEG-007",
    "patient_vignette": "A 75-year-old man has no history of syncope and presents for an annual review. No other significant past medical history; renal and hepatic function normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following options constitute potentially inappropriate medications for this patient?",
    "options": {
      "A": "Empagliflozin",
      "B": "None of the above need to be avoided",
      "C": "Metformin",
      "D": "Lisinopril",
      "E": "Cetirizine"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "antidiabetics",
      "ras inhibitors",
      "antihistamines"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-DE-POS-008",
    "patient_vignette": "A 78-year-old woman is hospitalized and currently has active delirium. Past medical history is otherwise unremarkable; renal and hepatic function are normal; not currently on other prescription medications; no drug allergies.",
    "question": "Looking at this patient, which medications would you not prescribe?",
    "options": {
      "A": "Hydroxyzine",
      "B": "Metformin",
      "C": "Acetaminophen",
      "D": "None of the above need to be avoided",
      "E": "Diphenhydramine"
    },
    "answer": [
      "A",
      "E"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "antihistamines"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-DE-NEG-008",
    "patient_vignette": "A 78-year-old woman is seen in outpatient clinic; she has no delirium and no risk factors for delirium. Past medical history is otherwise unremarkable; renal and hepatic function are normal; not currently on other prescription medications; no drug allergies.",
    "question": "Among the options below, which are inappropriate for this patient?",
    "options": {
      "A": "Lisinopril",
      "B": "Metformin",
      "C": "Atorvastatin",
      "D": "None of the above need to be avoided",
      "E": "Loratadine"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "ras inhibitors",
      "antidiabetics",
      "statins",
      "antihistamines"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-DE-POS-009",
    "patient_vignette": "An 81-year-old man is admitted to the hospital with acute delirium. Otherwise unremarkable medical history; normal renal and hepatic function; not taking other prescription drugs; no known allergies.",
    "question": "Considering this patient's history, which drugs below should be avoided?",
    "options": {
      "A": "Empagliflozin",
      "B": "Eszopiclone",
      "C": "Lorazepam",
      "D": "Zolpidem",
      "E": "None of the above need to be avoided"
    },
    "answer": [
      "B",
      "C",
      "D"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "z-drugs",
      "benzodiazepines"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-DE-NEG-009",
    "patient_vignette": "An 81-year-old man attends a geriatric clinic; he is alert, fully oriented, and has no delirium or risk factors for delirium. Past medical history is otherwise unremarkable; renal and hepatic function are normal; not currently on other prescription medications; no drug allergies.",
    "question": "Which of the listed medications poses a concern for this patient?",
    "options": {
      "A": "None of the above need to be avoided",
      "B": "Atorvastatin",
      "C": "Acetaminophen",
      "D": "Metformin",
      "E": "Lisinopril"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "statins",
      "antipyretic analgesics",
      "antidiabetics",
      "ras inhibitors"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-DE-POS-010",
    "patient_vignette": "A 73-year-old woman is hospitalized with active delirium following an acute illness. Otherwise unremarkable medical history; normal renal and hepatic function; not taking other prescription drugs; no known allergies.",
    "question": "In this patient, which of the following drugs should not be initiated?",
    "options": {
      "A": "None of the above need to be avoided",
      "B": "Omeprazole",
      "C": "Nizatidine",
      "D": "Famotidine",
      "E": "Cimetidine"
    },
    "answer": [
      "C",
      "D",
      "E"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "h2-receptor antagonists"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-DE-NEG-010",
    "patient_vignette": "A 73-year-old woman is seen in outpatient clinic; she has no delirium and is not at elevated risk. Past medical history is otherwise unremarkable; renal and hepatic function are normal; not currently on other prescription medications; no drug allergies.",
    "question": "Reviewing this patient's profile, which of these medications would you avoid?",
    "options": {
      "A": "Metformin",
      "B": "None of the above need to be avoided",
      "C": "Ondansetron",
      "D": "Loratadine",
      "E": "Cetirizine"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "antidiabetics",
      "antihistamines"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-DE-POS-011",
    "patient_vignette": "A 76-year-old man is admitted with acute delirium. No other significant past medical history; renal and hepatic function normal; not on other prescription medications; no known drug allergies.",
    "question": "Which agents below are potentially inappropriate in this patient?",
    "options": {
      "A": "None of the above need to be avoided",
      "B": "Oxycodone",
      "C": "Empagliflozin",
      "D": "Prednisone",
      "E": "Acetaminophen"
    },
    "answer": [
      "B",
      "D"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "opioids"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-DE-NEG-011",
    "patient_vignette": "A 76-year-old man is seen in outpatient clinic with no delirium and no risk factors. Otherwise unremarkable medical history; normal renal and hepatic function; not taking other prescription drugs; no known allergies.",
    "question": "For this patient, which of the following drugs should be avoided?",
    "options": {
      "A": "Metformin",
      "B": "Acetaminophen",
      "C": "None of the above need to be avoided",
      "D": "Oxycodone",
      "E": "Amlodipine"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "antidiabetics",
      "antipyretic analgesics",
      "opioids",
      "calcium-channel blockers"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-DM-POS-012",
    "patient_vignette": "A 79-year-old woman has mild-to-moderate dementia of the Alzheimer type. Remainder of medical history is unremarkable; renal and hepatic function within normal limits; not on additional prescription medications; no drug allergies reported.",
    "question": "Which of the following medications are potentially inappropriate for this patient?",
    "options": {
      "A": "Empagliflozin",
      "B": "Lisinopril",
      "C": "Diphenhydramine",
      "D": "Oxybutynin",
      "E": "None of the above need to be avoided"
    },
    "answer": [
      "C",
      "D"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "antihistamines"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-DM-NEG-012",
    "patient_vignette": "A 79-year-old woman has no cognitive impairment on formal testing and presents for a routine review. Past medical history is otherwise unremarkable; renal and hepatic function are normal; not currently on other prescription medications; no drug allergies.",
    "question": "Given this patient's condition, which of the drugs below are unsuitable?",
    "options": {
      "A": "Loratadine",
      "B": "Levothyroxine",
      "C": "Amlodipine",
      "D": "None of the above need to be avoided",
      "E": "Bisoprolol"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "antihistamines",
      "thyroid hormones",
      "calcium-channel blockers"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-DM-POS-013",
    "patient_vignette": "A 84-year-old man has moderate dementia. Otherwise unremarkable medical history; normal renal and hepatic function; not taking other prescription drugs; no known allergies.",
    "question": "Based on safe prescribing principles for older adults, which of these drugs should this patient avoid?",
    "options": {
      "A": "Zolpidem",
      "B": "Metformin",
      "C": "Lorazepam",
      "D": "Eszopiclone",
      "E": "None of the above need to be avoided"
    },
    "answer": [
      "A",
      "C",
      "D"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "z-drugs",
      "benzodiazepines"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-DM-NEG-013",
    "patient_vignette": "A 84-year-old man has fully preserved cognition on formal testing and presents for a wellness review. Otherwise unremarkable medical history; normal renal and hepatic function; not taking other prescription drugs; no known allergies.",
    "question": "Which of the following options constitute potentially inappropriate medications for this patient?",
    "options": {
      "A": "Cetirizine",
      "B": "Loratadine",
      "C": "None of the above need to be avoided",
      "D": "Amlodipine",
      "E": "Acetaminophen"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "antihistamines",
      "calcium-channel blockers",
      "antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-FA-POS-014",
    "patient_vignette": "A 76-year-old woman has a documented history of multiple falls, including a wrist fracture last year. No other significant past medical history; renal and hepatic function normal; not on other prescription medications; no known drug allergies.",
    "question": "Looking at this patient, which medications would you not prescribe?",
    "options": {
      "A": "Diphenhydramine",
      "B": "Oxybutynin",
      "C": "Amlodipine",
      "D": "None of the above need to be avoided",
      "E": "Mirabegron"
    },
    "answer": [
      "A",
      "B"
    ],
    "taxonomy_clinical_department": "geriatric medicine",
    "taxonomy_clinical_system": "skeletal system",
    "taxonomy_drug_categories": [
      "antihistamines"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-FA-NEG-014",
    "patient_vignette": "A 76-year-old woman has no history of falls or fractures and presents for routine review. Otherwise unremarkable medical history; normal renal and hepatic function; not taking other prescription drugs; no known allergies.",
    "question": "Among the options below, which are inappropriate for this patient?",
    "options": {
      "A": "Loratadine",
      "B": "Metformin",
      "C": "Levothyroxine",
      "D": "None of the above need to be avoided",
      "E": "Acetaminophen"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "geriatric medicine",
    "taxonomy_clinical_system": "skeletal system",
    "taxonomy_drug_categories": [
      "antihistamines",
      "antidiabetics",
      "thyroid hormones",
      "antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-FA-POS-015",
    "patient_vignette": "A 82-year-old man has had two falls in the past year, including a hip fracture six months ago. No other pertinent past medical history; kidney and liver function are normal; not on any other prescription drugs; no known drug allergies.",
    "question": "Considering this patient's history, which drugs below should be avoided?",
    "options": {
      "A": "None of the above need to be avoided",
      "B": "Sertraline",
      "C": "Metformin",
      "D": "Venlafaxine",
      "E": "Amitriptyline"
    },
    "answer": [
      "B",
      "D",
      "E"
    ],
    "taxonomy_clinical_department": "geriatric medicine",
    "taxonomy_clinical_system": "skeletal system",
    "taxonomy_drug_categories": [
      "tricyclic antidepressants"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-FA-NEG-015",
    "patient_vignette": "A 82-year-old man has no history of falls or fractures and presents for an annual review. No other significant past medical history; renal and hepatic function normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the listed medications poses a concern for this patient?",
    "options": {
      "A": "Lisinopril",
      "B": "Cetirizine",
      "C": "Metformin",
      "D": "None of the above need to be avoided",
      "E": "Levothyroxine"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "geriatric medicine",
    "taxonomy_clinical_system": "skeletal system",
    "taxonomy_drug_categories": [
      "ras inhibitors",
      "antihistamines",
      "antidiabetics",
      "thyroid hormones"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-FA-POS-016",
    "patient_vignette": "A 78-year-old woman has a documented history of recurrent falls and a vertebral compression fracture. She has no history of syncope. Remainder of medical history is unremarkable; renal and hepatic function within normal limits; not on additional prescription medications; no drug allergies reported.",
    "question": "In this patient, which of the following drugs should not be initiated?",
    "options": {
      "A": "Cetirizine",
      "B": "Metformin",
      "C": "None of the above need to be avoided",
      "D": "Risperidone",
      "E": "Haloperidol"
    },
    "answer": [
      "D",
      "E"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "antipsychotics"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-FA-NEG-016",
    "patient_vignette": "A 78-year-old woman has no history of falls or fractures and is reviewed for medication safety. She has no history of syncope. Past medical history is otherwise unremarkable; renal and hepatic function are normal; not currently on other prescription medications; no drug allergies.",
    "question": "Reviewing this patient's profile, which of these medications would you avoid?",
    "options": {
      "A": "Cetirizine",
      "B": "Metformin",
      "C": "None of the above need to be avoided",
      "D": "Memantine",
      "E": "Atorvastatin"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "antihistamines",
      "antidiabetics",
      "statins"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-FA-POS-017",
    "patient_vignette": "An 80-year-old woman has had multiple falls in the past year and one prior hip fracture. Past medical history is otherwise unremarkable; renal and hepatic function are normal; not currently on other prescription medications; no drug allergies.",
    "question": "Which agents below are potentially inappropriate in this patient?",
    "options": {
      "A": "Zolpidem",
      "B": "Lorazepam",
      "C": "Levothyroxine",
      "D": "None of the above need to be avoided",
      "E": "Eszopiclone"
    },
    "answer": [
      "A",
      "B",
      "E"
    ],
    "taxonomy_clinical_department": "geriatric medicine",
    "taxonomy_clinical_system": "skeletal system",
    "taxonomy_drug_categories": [
      "z-drugs",
      "benzodiazepines"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-FA-NEG-017",
    "patient_vignette": "An 80-year-old woman has no history of falls or fractures and is reviewed in clinic. Past medical history is otherwise unremarkable; renal and hepatic function are normal; not currently on other prescription medications; no drug allergies.",
    "question": "For this patient, which of the following drugs should be avoided?",
    "options": {
      "A": "Levothyroxine",
      "B": "Lisinopril",
      "C": "None of the above need to be avoided",
      "D": "Metformin",
      "E": "Acetaminophen"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "geriatric medicine",
    "taxonomy_clinical_system": "skeletal system",
    "taxonomy_drug_categories": [
      "thyroid hormones",
      "ras inhibitors",
      "antidiabetics",
      "antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-FA-SEIZMOOD-018",
    "patient_vignette": "A 73-year-old man has a documented history of falls. He has a diagnosis of epilepsy with seizures controlled on antiepileptic therapy. No other pertinent past medical history; kidney and liver function are normal; not on any other prescription drugs; no known drug allergies.",
    "question": "Which of the following medications are potentially inappropriate for this patient?",
    "options": {
      "A": "None of the above need to be avoided",
      "B": "Carbamazepine",
      "C": "Loratadine",
      "D": "Pregabalin",
      "E": "Phenytoin"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "geriatric medicine",
    "taxonomy_clinical_system": "skeletal system",
    "taxonomy_drug_categories": [
      "antihistamines",
      "gabapentinoids",
      "antiepileptics"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-FA-OTHERIND-018",
    "patient_vignette": "A 73-year-old man has a documented history of falls. He is being considered for an antiepileptic agent for chronic peripheral neuropathic pain (not seizures or a mood disorder). Remainder of medical history is unremarkable; renal and hepatic function within normal limits; not on additional prescription medications; no drug allergies reported.",
    "question": "Given this patient's condition, which of the drugs below are unsuitable?",
    "options": {
      "A": "Carbamazepine",
      "B": "Pregabalin",
      "C": "None of the above need to be avoided",
      "D": "Cetirizine",
      "E": "Gabapentin"
    },
    "answer": [
      "A",
      "B",
      "E"
    ],
    "taxonomy_clinical_department": "geriatric medicine",
    "taxonomy_clinical_system": "skeletal system",
    "taxonomy_drug_categories": [
      "gabapentinoids"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-FA-ACUTE-019",
    "patient_vignette": "An 81-year-old woman has a documented history of recurrent falls. She presents with a displaced femur fracture causing severe acute pain. Past medical history is otherwise unremarkable; renal and hepatic function are normal; not currently on other prescription medications; no drug allergies.",
    "question": "Based on safe prescribing principles for older adults, which of these drugs should this patient avoid?",
    "options": {
      "A": "Empagliflozin",
      "B": "None of the above need to be avoided",
      "C": "Morphine",
      "D": "Acetaminophen",
      "E": "Amlodipine"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "geriatric medicine",
    "taxonomy_clinical_system": "skeletal system",
    "taxonomy_drug_categories": [
      "antidiabetics",
      "opioids",
      "antipyretic analgesics",
      "calcium-channel blockers"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-FA-CHRONIC-019",
    "patient_vignette": "An 81-year-old woman has a documented history of recurrent falls. She has chronic non-cancer musculoskeletal pain that is not a severe acute pain episode. Otherwise unremarkable medical history; normal renal and hepatic function; not taking other prescription drugs; no known allergies.",
    "question": "Which of the following options constitute potentially inappropriate medications for this patient?",
    "options": {
      "A": "Morphine",
      "B": "None of the above need to be avoided",
      "C": "Hydrocodone",
      "D": "Oxycodone",
      "E": "Empagliflozin"
    },
    "answer": [
      "A",
      "C",
      "D"
    ],
    "taxonomy_clinical_department": "geriatric medicine",
    "taxonomy_clinical_system": "skeletal system",
    "taxonomy_drug_categories": [
      "opioids"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-PD-POS-020",
    "patient_vignette": "A 75-year-old man has a confirmed diagnosis of Parkinson disease, currently on dopaminergic therapy. Remainder of medical history is unremarkable; renal and hepatic function within normal limits; not on additional prescription medications; no drug allergies reported.",
    "question": "Looking at this patient, which medications would you not prescribe?",
    "options": {
      "A": "None of the above need to be avoided",
      "B": "Metoclopramide",
      "C": "Prochlorperazine",
      "D": "Acetaminophen",
      "E": "Promethazine"
    },
    "answer": [
      "B",
      "C",
      "E"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "multiple drug categories (composite rules)"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-PD-NEG-020",
    "patient_vignette": "A 75-year-old man attends a routine geriatric review. He does not have Parkinson disease or any other movement disorder. No other significant past medical history; renal and hepatic function normal; not on other prescription medications; no known drug allergies.",
    "question": "Among the options below, which are inappropriate for this patient?",
    "options": {
      "A": "Metformin",
      "B": "Levothyroxine",
      "C": "None of the above need to be avoided",
      "D": "Atorvastatin",
      "E": "Acetaminophen"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "antidiabetics",
      "thyroid hormones",
      "statins",
      "antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-UL-POS-021",
    "patient_vignette": "An 80-year-old woman has a history of a duodenal ulcer confirmed on prior endoscopy. No other significant past medical history; renal and hepatic function normal; not on other prescription medications; no known drug allergies.",
    "question": "Considering this patient's history, which drugs below should be avoided?",
    "options": {
      "A": "Aspirin",
      "B": "Naproxen",
      "C": "Ibuprofen",
      "D": "Lisinopril",
      "E": "None of the above need to be avoided"
    },
    "answer": [
      "A",
      "B",
      "C"
    ],
    "taxonomy_clinical_department": "gastroenterology",
    "taxonomy_clinical_system": "digestive system",
    "taxonomy_drug_categories": [
      "nsaids/antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-UL-NEG-021",
    "patient_vignette": "An 80-year-old woman has no history of gastric or duodenal ulcers and presents for routine geriatric review. No other pertinent past medical history; kidney and liver function are normal; not on any other prescription drugs; no known drug allergies.",
    "question": "Which of the listed medications poses a concern for this patient?",
    "options": {
      "A": "None of the above need to be avoided",
      "B": "Clopidogrel",
      "C": "Bisoprolol",
      "D": "Cetirizine",
      "E": "Acetaminophen"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "gastroenterology",
    "taxonomy_clinical_system": "digestive system",
    "taxonomy_drug_categories": [
      "antihistamines",
      "antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-UI-POS-022",
    "patient_vignette": "A 72-year-old woman has urinary incontinence (mixed type). Past medical history is otherwise unremarkable; renal and hepatic function are normal; not currently on other prescription medications; no drug allergies.",
    "question": "In this patient, which of the following drugs should not be initiated?",
    "options": {
      "A": "Lisinopril",
      "B": "Oral and transdermal estrogen",
      "C": "Terazosin",
      "D": "Prazosin",
      "E": "Doxazosin"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "urology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "alpha-1 receptor blockers"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-UI-NEG-022",
    "patient_vignette": "A 72-year-old woman has no urinary incontinence and presents for a routine health review. Remainder of medical history is unremarkable; renal and hepatic function within normal limits; not on additional prescription medications; no drug allergies reported.",
    "question": "Reviewing this patient's profile, which of these medications would you avoid?",
    "options": {
      "A": "Lisinopril",
      "B": "Loratadine",
      "C": "Metformin",
      "D": "None of the above need to be avoided",
      "E": "Atorvastatin"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "urology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "ras inhibitors",
      "antihistamines",
      "antidiabetics",
      "statins"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-BPH-POS-023",
    "patient_vignette": "A 77-year-old man has lower urinary tract symptoms and a confirmed diagnosis of benign prostatic hyperplasia. Remainder of medical history is unremarkable; renal and hepatic function within normal limits; not on additional prescription medications; no drug allergies reported.",
    "question": "Which agents below are potentially inappropriate in this patient?",
    "options": {
      "A": "Empagliflozin",
      "B": "Cetirizine",
      "C": "None of the above need to be avoided",
      "D": "Strongly anticholinergic drugs",
      "E": "Lisinopril"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "urology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "multiple drug categories (composite rules)"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-BPH-NEG-023",
    "patient_vignette": "A 77-year-old man attends a general geriatric review. He has no lower urinary tract symptoms and no diagnosis of benign prostatic hyperplasia. Past medical history is otherwise unremarkable; renal and hepatic function are normal; not currently on other prescription medications; no drug allergies.",
    "question": "For this patient, which of the following drugs should be avoided?",
    "options": {
      "A": "Levothyroxine",
      "B": "Metformin",
      "C": "None of the above need to be avoided",
      "D": "Loratadine",
      "E": "Empagliflozin"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "urology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "thyroid hormones",
      "antidiabetics",
      "antihistamines"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-HF-HFREF-005",
    "patient_vignette": "A 69-year-old man has heart failure with reduced ejection fraction (LVEF 30%) and is currently free of decompensation symptoms on stable therapy. Remainder of medical history is unremarkable; renal and hepatic function within normal limits; not on additional prescription medications; no drug allergies reported.",
    "question": "In this patient, which of the following drugs should not be initiated?",
    "options": {
      "A": "None of the above need to be avoided",
      "B": "Cilostazol",
      "C": "Verapamil",
      "D": "Dextromethorphan-quinidine",
      "E": "Diltiazem"
    },
    "answer": [
      "B",
      "C",
      "E"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "pde3 inhibitors/peripheral vascular drugs",
      "calcium-channel blockers",
      "antiarrhythmics"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-HF-HFPEF-005",
    "patient_vignette": "A 69-year-old man has heart failure with preserved ejection fraction (LVEF 60%) and is currently asymptomatic. Past medical history is otherwise unremarkable; renal and hepatic function are normal; not currently on other prescription medications; no drug allergies.",
    "question": "Looking at this patient, which medications would you not prescribe?",
    "options": {
      "A": "Dextromethorphan-quinidine",
      "B": "Cilostazol",
      "C": "Verapamil",
      "D": "None of the above need to be avoided",
      "E": "Diltiazem"
    },
    "answer": [
      "A",
      "B"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "antiarrhythmics",
      "pde3 inhibitors/peripheral vascular drugs"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-SY-POS-025",
    "patient_vignette": "A 75-year-old man is referred for medication review following two documented episodes of syncope in the past year. No other pertinent past medical history; renal and hepatic function are within normal limits; not taking other prescription medications; no drug allergies.",
    "question": "Which of the following medications are potentially inappropriate for this patient?",
    "options": {
      "A": "Galantamine",
      "B": "Metoprolol",
      "C": "Doxazosin",
      "D": "Lisinopril",
      "E": "None of the above need to be avoided"
    },
    "answer": [
      "A",
      "C"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "cholinesterase inhibitors",
      "alpha-1 receptor blockers"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-SY-NEG-025",
    "patient_vignette": "A 75-year-old man attends a routine geriatric medication review. He has no history of syncope or near-syncopal episodes. No other pertinent past medical history; renal and hepatic function are within normal limits; not taking other prescription medications; no drug allergies.",
    "question": "For this patient, which of the following drugs should be avoided?",
    "options": {
      "A": "Galantamine",
      "B": "Metoprolol",
      "C": "Amlodipine",
      "D": "Lisinopril",
      "E": "None of the above need to be avoided"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "cholinesterase inhibitors",
      "calcium-channel blockers",
      "ras inhibitors"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-DM-POS-026",
    "patient_vignette": "A 79-year-old woman has a confirmed diagnosis of mild-to-moderate Alzheimer's dementia and is under outpatient neurology follow-up. She has no history of syncope. Renal and hepatic function are normal; not currently on other prescription medications; no known drug allergies.",
    "question": "Among the options below, which medications would be inappropriate to prescribe for this patient?",
    "options": {
      "A": "Donepezil",
      "B": "Lorazepam",
      "C": "None of the above need to be avoided",
      "D": "Zolpidem",
      "E": "Acetaminophen"
    },
    "answer": [
      "B",
      "D"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "benzodiazepines",
      "z-drugs"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-DM-NEG-026",
    "patient_vignette": "A 79-year-old woman attends a routine geriatric review. She has no diagnosis of dementia or cognitive impairment and performs within normal limits on cognitive screening. She has no history of syncope. Renal and hepatic function are normal; not currently on other prescription medications; no known drug allergies.",
    "question": "Given this patient's profile, which of these drugs should be avoided?",
    "options": {
      "A": "Atorvastatin",
      "B": "Metformin",
      "C": "None of the above need to be avoided",
      "D": "Lisinopril",
      "E": "Acetaminophen"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "statins",
      "antidiabetics",
      "ras inhibitors",
      "antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-PD-POS-027",
    "patient_vignette": "A 71-year-old man with a confirmed diagnosis of Parkinson disease is seen in a neurology clinic for routine follow-up. No other significant past medical history; renal and hepatic function are normal; not currently on other prescription medications; no known drug allergies.",
    "question": "Based on safe prescribing principles for older adults, which of the drugs below should be avoided for this patient?",
    "options": {
      "A": "Prochlorperazine",
      "B": "None of the above need to be avoided",
      "C": "Ondansetron",
      "D": "Levodopa",
      "E": "Metoclopramide"
    },
    "answer": [
      "A",
      "E"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "multiple drug categories (composite rules)"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-PD-NEG-027",
    "patient_vignette": "A 71-year-old man attends a geriatric outpatient clinic for a preventive medication review. He does not have Parkinson disease or any movement disorder. No other significant past medical history; renal and hepatic function are normal; not currently on other prescription medications; no known drug allergies.",
    "question": "Looking at this patient, which of the following drugs are unsuitable?",
    "options": {
      "A": "Prochlorperazine",
      "B": "None of the above need to be avoided",
      "C": "Ondansetron",
      "D": "Metformin",
      "E": "Bisoprolol"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "antidiabetics"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-PD-POS-028",
    "patient_vignette": "An 83-year-old woman is being evaluated in a geriatric clinic for medication safety review. She has a diagnosis of Parkinson disease. No other significant past medical history; renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications are potentially inappropriate for this patient?",
    "options": {
      "A": "Acetaminophen",
      "B": "Metoclopramide",
      "C": "Lisinopril",
      "D": "None of the above need to be avoided",
      "E": "Ondansetron"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "multiple drug categories (composite rules)"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-PD-NEG-028",
    "patient_vignette": "An 83-year-old woman is seen in a geriatric outpatient clinic. She does not have Parkinson disease or any other movement disorder. No other significant past medical history; renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "For this patient, which of the following drugs should be avoided?",
    "options": {
      "A": "Acetaminophen",
      "B": "Metformin",
      "C": "Lisinopril",
      "D": "None of the above need to be avoided",
      "E": "Ondansetron"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "antipyretic analgesics",
      "antidiabetics",
      "ras inhibitors"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-UL-POS-029",
    "patient_vignette": "A 73-year-old man has a documented history of peptic ulcer disease and presents for a medication safety review. Renal and hepatic function are normal; not currently on other prescription medications; no known drug allergies.",
    "question": "Which of the listed drugs should this patient avoid?",
    "options": {
      "A": "Ibuprofen",
      "B": "None of the above need to be avoided",
      "C": "Pantoprazole",
      "D": "Aspirin",
      "E": "Acetaminophen"
    },
    "answer": [
      "A",
      "D"
    ],
    "taxonomy_clinical_department": "gastroenterology",
    "taxonomy_clinical_system": "digestive system",
    "taxonomy_drug_categories": [
      "nsaids/antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-UL-NEG-029",
    "patient_vignette": "A 73-year-old man presents for a routine geriatric health review. He has no history of peptic ulcer disease or gastrointestinal ulceration. Renal and hepatic function are normal; not currently on other prescription medications; no known drug allergies.",
    "question": "Among these options, which medications pose a concern for this patient?",
    "options": {
      "A": "Clopidogrel",
      "B": "None of the above need to be avoided",
      "C": "Loratadine",
      "D": "Bisoprolol",
      "E": "Acetaminophen"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "gastroenterology",
    "taxonomy_clinical_system": "digestive system",
    "taxonomy_drug_categories": [
      "antihistamines",
      "antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-UL-POS-030",
    "patient_vignette": "An 80-year-old woman has a confirmed history of duodenal ulcer disease. No other significant past medical history; renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Reviewing this patient's profile, which of these medications would you not prescribe?",
    "options": {
      "A": "Celecoxib",
      "B": "Naproxen",
      "C": "Aspirin",
      "D": "Lisinopril",
      "E": "None of the above need to be avoided"
    },
    "answer": [
      "B",
      "C"
    ],
    "taxonomy_clinical_department": "gastroenterology",
    "taxonomy_clinical_system": "digestive system",
    "taxonomy_drug_categories": [
      "nsaids/antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-UL-NEG-030",
    "patient_vignette": "An 80-year-old woman attends a routine geriatric review. She has no history of peptic ulcer disease or gastrointestinal ulceration. No other significant past medical history; renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "For this patient, which of the following drugs should be avoided?",
    "options": {
      "A": "Celecoxib",
      "B": "Clopidogrel",
      "C": "Loratadine",
      "D": "Lisinopril",
      "E": "None of the above need to be avoided"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "gastroenterology",
    "taxonomy_clinical_system": "digestive system",
    "taxonomy_drug_categories": [
      "nsaids/antipyretic analgesics",
      "antihistamines",
      "ras inhibitors"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-UI-POS-031",
    "patient_vignette": "A 77-year-old woman has a diagnosis of mixed urinary incontinence and is seen in a urology outpatient clinic. Renal and hepatic function are normal; not currently on other prescription medications; no known drug allergies.",
    "question": "Which of the following options constitute potentially inappropriate medications for this patient?",
    "options": {
      "A": "Prazosin",
      "B": "Metformin",
      "C": "None of the above need to be avoided",
      "D": "Estradiol (oral)",
      "E": "Lisinopril"
    },
    "answer": [
      "A",
      "D"
    ],
    "taxonomy_clinical_department": "urology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "alpha-1 receptor blockers"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-UI-NEG-031",
    "patient_vignette": "A 77-year-old woman presents for a routine geriatric medication review. She has no history of urinary incontinence. Renal and hepatic function are normal; not currently on other prescription medications; no known drug allergies.",
    "question": "Given this patient's clinical profile, which of these drugs should be avoided?",
    "options": {
      "A": "Amlodipine",
      "B": "Metformin",
      "C": "None of the above need to be avoided",
      "D": "Acetaminophen",
      "E": "Lisinopril"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "urology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "calcium-channel blockers",
      "antidiabetics",
      "antipyretic analgesics",
      "ras inhibitors"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-UI-POS-032",
    "patient_vignette": "A 68-year-old woman presents to her geriatric physician for a medication safety evaluation. She reports bothersome urinary incontinence. Renal and hepatic function are normal; not currently on other prescription medications; no known drug allergies.",
    "question": "For this patient, which of the following drugs should be avoided?",
    "options": {
      "A": "None of the above need to be avoided",
      "B": "Atorvastatin",
      "C": "Doxazosin",
      "D": "Metoprolol",
      "E": "Amlodipine"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "urology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "alpha-1 receptor blockers"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-UI-NEG-032",
    "patient_vignette": "A 68-year-old woman attends a wellness visit with her geriatric physician. She has no history of urinary incontinence. Renal and hepatic function are normal; not currently on other prescription medications; no known drug allergies.",
    "question": "Looking at this patient, which medications would you not prescribe?",
    "options": {
      "A": "None of the above need to be avoided",
      "B": "Atorvastatin",
      "C": "Cetirizine",
      "D": "Metoprolol",
      "E": "Amlodipine"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "urology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "statins",
      "antihistamines",
      "calcium-channel blockers"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-BPH-POS-033",
    "patient_vignette": "A 72-year-old man has lower urinary tract symptoms due to benign prostatic hyperplasia and is being seen in a urology outpatient clinic. No other significant past medical history; renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Among the options below, which are inappropriate for this patient?",
    "options": {
      "A": "Tamsulosin",
      "B": "Diphenhydramine",
      "C": "None of the above need to be avoided",
      "D": "Lisinopril",
      "E": "Finasteride"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "urology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antihistamines"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-BPH-NEG-033",
    "patient_vignette": "A 72-year-old man presents for a routine geriatric review. He has no lower urinary tract symptoms and no diagnosis of benign prostatic hyperplasia. No other significant past medical history; renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications are potentially inappropriate for this patient?",
    "options": {
      "A": "Loratadine",
      "B": "Metformin",
      "C": "None of the above need to be avoided",
      "D": "Lisinopril",
      "E": "Levothyroxine"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "urology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antihistamines",
      "antidiabetics",
      "ras inhibitors",
      "thyroid hormones"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-BPH-POS-034",
    "patient_vignette": "An 80-year-old man attends a urology clinic with worsening lower urinary tract symptoms attributable to benign prostatic hyperplasia. No other significant past medical history; renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Based on safe prescribing principles for older adults, which of these drugs should this patient avoid?",
    "options": {
      "A": "Hydroxyzine",
      "B": "None of the above need to be avoided",
      "C": "Amlodipine",
      "D": "Tamsulosin",
      "E": "Atorvastatin"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "urology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antihistamines"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-BPH-NEG-034",
    "patient_vignette": "An 80-year-old man presents for a routine geriatric health review. He has no lower urinary tract symptoms and no history of benign prostatic hyperplasia. No other significant past medical history; renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "For this patient, which of the following medications are unsuitable?",
    "options": {
      "A": "Metformin",
      "B": "None of the above need to be avoided",
      "C": "Amlodipine",
      "D": "Cetirizine",
      "E": "Atorvastatin"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "urology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antidiabetics",
      "calcium-channel blockers",
      "antihistamines",
      "statins"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "CS-HF-001",
    "patient_vignette": "A 74-year-old man has heart failure with reduced ejection fraction (LVEF 38%), stable on guideline-directed therapy. Renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Diltiazem",
      "B": "Bisoprolol",
      "C": "Metformin",
      "D": "None of the above need to be avoided",
      "E": "Cilostazol"
    },
    "answer": [
      "A",
      "E"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "calcium-channel blockers",
      "pde3 inhibitors/peripheral vascular drugs"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "CS-HF-002",
    "patient_vignette": "A 74-year-old man has heart failure with preserved ejection fraction (LVEF 55%), currently asymptomatic. Renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Cilostazol",
      "B": "Metformin",
      "C": "None of the above need to be avoided",
      "D": "Diltiazem",
      "E": "Bisoprolol"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "pde3 inhibitors/peripheral vascular drugs"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "CS-HF-003",
    "patient_vignette": "A 74-year-old man has no history of heart failure; a recent echocardiogram shows normal LVEF (60%). Renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Dextromethorphan-quinidine",
      "B": "Bisoprolol",
      "C": "None of the above need to be avoided",
      "D": "Metformin",
      "E": "Cilostazol"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "antiarrhythmics",
      "antidiabetics",
      "pde3 inhibitors/peripheral vascular drugs"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "CS-NS-001",
    "patient_vignette": "An 81-year-old woman is assessed for analgesic safety. She has symptomatic heart failure (LVEF 40%). She has no history of peptic ulcer disease. No other significant past medical history; Renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Bisoprolol",
      "B": "Ibuprofen",
      "C": "Celecoxib",
      "D": "None of the above need to be avoided",
      "E": "Acetaminophen"
    },
    "answer": [
      "B",
      "C"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "nsaids/antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "CS-NS-002",
    "patient_vignette": "An 81-year-old woman is assessed for analgesic safety. She has symptomatic heart failure (LVEF 40%). She has a documented history of peptic ulcer disease. No other significant past medical history; Renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "None of the above need to be avoided",
      "B": "Acetaminophen",
      "C": "Ibuprofen",
      "D": "Bisoprolol",
      "E": "Celecoxib"
    },
    "answer": [
      "C",
      "E"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "nsaids/antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "CS-NS-004",
    "patient_vignette": "An 81-year-old woman is assessed for analgesic safety. She has no history of heart failure. She has a documented history of peptic ulcer disease. No other significant past medical history; Renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Bisoprolol",
      "B": "None of the above need to be avoided",
      "C": "Celecoxib",
      "D": "Acetaminophen",
      "E": "Ibuprofen"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "nsaids/antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "CS-NS-005",
    "patient_vignette": "An 81-year-old woman is assessed for analgesic safety. She has no history of heart failure. She has no history of peptic ulcer disease. No other significant past medical history; Renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Acetaminophen",
      "B": "Bisoprolol",
      "C": "Loratadine",
      "D": "None of the above need to be avoided",
      "E": "Celecoxib"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "antipyretic analgesics",
      "antihistamines",
      "nsaids/antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "CS-OP-001",
    "patient_vignette": "A 79-year-old man is evaluated for pain management. He has active delirium. He has no history of falls or fractures. He presents with chronic lower back pain. No other significant past medical history; Renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications should be avoided given this patient's clinical status?",
    "options": {
      "A": "Oxycodone",
      "B": "Bisoprolol",
      "C": "Celecoxib",
      "D": "None of the above need to be avoided",
      "E": "Acetaminophen"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "opioids"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "CS-OP-002",
    "patient_vignette": "A 79-year-old man is evaluated for pain management. He has active delirium. He has no history of falls or fractures. He presents with severe acute pain following a procedure. No other significant past medical history; Renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications should be avoided given this patient's clinical status?",
    "options": {
      "A": "Bisoprolol",
      "B": "Celecoxib",
      "C": "Acetaminophen",
      "D": "None of the above need to be avoided",
      "E": "Oxycodone"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "opioids"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "CS-OP-003",
    "patient_vignette": "A 79-year-old man is evaluated for pain management. He has no delirium. He has a history of recurrent falls. He presents with severe acute pain following a rib fracture. No other significant past medical history; Renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications should be avoided given this patient's clinical status?",
    "options": {
      "A": "Oxycodone",
      "B": "Bisoprolol",
      "C": "Acetaminophen",
      "D": "None of the above need to be avoided",
      "E": "Celecoxib"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "opioids",
      "antipyretic analgesics",
      "nsaids/antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "CS-OP-004",
    "patient_vignette": "A 79-year-old man is evaluated for pain management. He has no delirium. He has a history of recurrent falls. He presents with chronic osteoarthritis pain. No other significant past medical history; Renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications should be avoided given this patient's clinical status?",
    "options": {
      "A": "Bisoprolol",
      "B": "Celecoxib",
      "C": "None of the above need to be avoided",
      "D": "Acetaminophen",
      "E": "Oxycodone"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "opioids"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "CS-OP-005",
    "patient_vignette": "A 79-year-old man is evaluated for pain management. He has active delirium. He has a history of recurrent falls. He presents with severe acute pain. No other significant past medical history; Renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications should be avoided given this patient's clinical status?",
    "options": {
      "A": "Acetaminophen",
      "B": "Celecoxib",
      "C": "Bisoprolol",
      "D": "None of the above need to be avoided",
      "E": "Oxycodone"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "opioids"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "CS-OP-006",
    "patient_vignette": "A 79-year-old man is evaluated for pain management. He has no delirium. He has no history of falls or fractures. No other significant past medical history; Renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications should be avoided given this patient's clinical status?",
    "options": {
      "A": "Acetaminophen",
      "B": "Bisoprolol",
      "C": "Celecoxib",
      "D": "None of the above need to be avoided",
      "E": "Oxycodone"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "antipyretic analgesics",
      "nsaids/antipyretic analgesics",
      "opioids"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "CS-OP-007",
    "patient_vignette": "A 79-year-old man is evaluated for pain management. He has active delirium. He has a history of recurrent falls. He presents with chronic lower back pain. No other significant past medical history; Renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications should be avoided given this patient's clinical status?",
    "options": {
      "A": "Bisoprolol",
      "B": "Acetaminophen",
      "C": "Celecoxib",
      "D": "None of the above need to be avoided",
      "E": "Oxycodone"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "opioids"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "CS-AP-001",
    "patient_vignette": "An 83-year-old woman is evaluated for medication safety. She has a history of syncope. She has no history of falls and does not have Parkinson disease. No other significant past medical history; Renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications should be avoided given this patient's conditions?",
    "options": {
      "A": "Bisoprolol",
      "B": "Chlorpromazine",
      "C": "None of the above need to be avoided",
      "D": "Haloperidol",
      "E": "Metformin"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "antipsychotics"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "CS-AP-002",
    "patient_vignette": "An 83-year-old woman is evaluated for medication safety. She has a history of falls and fractures. She has no syncope and does not have Parkinson disease. No other significant past medical history; Renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications should be avoided given this patient's conditions?",
    "options": {
      "A": "Metformin",
      "B": "None of the above need to be avoided",
      "C": "Bisoprolol",
      "D": "Quetiapine",
      "E": "Haloperidol"
    },
    "answer": [
      "D",
      "E"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "antipsychotics"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "CS-AP-003",
    "patient_vignette": "An 83-year-old woman is evaluated for medication safety. She has Parkinson disease. She has no history of syncope and no falls. No other significant past medical history; Renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications should be avoided given this patient's conditions?",
    "options": {
      "A": "Quetiapine",
      "B": "Haloperidol",
      "C": "None of the above need to be avoided",
      "D": "Metformin",
      "E": "Bisoprolol"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "antipsychotics"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "CS-AP-004",
    "patient_vignette": "An 83-year-old woman is evaluated for medication safety. She has a history of syncope and has Parkinson disease. No history of falls. No other significant past medical history; Renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications should be avoided given this patient's conditions?",
    "options": {
      "A": "None of the above need to be avoided",
      "B": "Bisoprolol",
      "C": "Quetiapine",
      "D": "Metformin",
      "E": "Chlorpromazine"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "antipsychotics"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "CS-AP-005",
    "patient_vignette": "An 83-year-old woman is evaluated for medication safety. She has a history of syncope and a history of falls. No Parkinson disease. No other significant past medical history; Renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications should be avoided given this patient's conditions?",
    "options": {
      "A": "Quetiapine",
      "B": "Metformin",
      "C": "Chlorpromazine",
      "D": "Bisoprolol",
      "E": "None of the above need to be avoided"
    },
    "answer": [
      "A",
      "C"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "antipsychotics"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "CS-AP-006",
    "patient_vignette": "An 83-year-old woman is evaluated for medication safety. She has a history of falls and has Parkinson disease. No history of syncope. No other significant past medical history; Renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications should be avoided given this patient's conditions?",
    "options": {
      "A": "None of the above need to be avoided",
      "B": "Metformin",
      "C": "Haloperidol",
      "D": "Bisoprolol",
      "E": "Quetiapine"
    },
    "answer": [
      "C",
      "E"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "antipsychotics"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "CS-AP-007",
    "patient_vignette": "An 83-year-old woman is seen for a routine medication safety review. She has no history of syncope, no history of falls, and does not have Parkinson disease. No other significant past medical history; Renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications should be avoided given this patient's conditions?",
    "options": {
      "A": "Metformin",
      "B": "Acetaminophen",
      "C": "Loratadine",
      "D": "None of the above need to be avoided",
      "E": "Bisoprolol"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "antidiabetics",
      "antipyretic analgesics",
      "antihistamines"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "CS-AP-008",
    "patient_vignette": "An 83-year-old woman is evaluated for medication safety. She has a history of syncope and falls, and has Parkinson disease. No other significant past medical history; Renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications should be avoided given this patient's conditions?",
    "options": {
      "A": "Quetiapine",
      "B": "Bisoprolol",
      "C": "Metformin",
      "D": "None of the above need to be avoided",
      "E": "Chlorpromazine"
    },
    "answer": [
      "A",
      "E"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "antipsychotics"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "CS-AD-001",
    "patient_vignette": "A 76-year-old woman is being considered for antidepressant therapy. She has a history of syncope. She has no history of falls. No other significant past medical history; Renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Amitriptyline",
      "B": "None of the above need to be avoided",
      "C": "Sertraline",
      "D": "Metformin",
      "E": "Bisoprolol"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "tricyclic antidepressants"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "CS-AD-002",
    "patient_vignette": "A 76-year-old woman is being considered for antidepressant therapy. She has no history of syncope. She has a history of recurrent falls. No other significant past medical history; Renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Metformin",
      "B": "Bisoprolol",
      "C": "Venlafaxine",
      "D": "None of the above need to be avoided",
      "E": "Sertraline"
    },
    "answer": [
      "C",
      "E"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "multiple drug categories (composite rules)"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "CS-AD-003",
    "patient_vignette": "A 76-year-old woman is being considered for antidepressant therapy. She has a history of syncope. She has a history of recurrent falls. No other significant past medical history; Renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Sertraline",
      "B": "Bisoprolol",
      "C": "Amitriptyline",
      "D": "Metformin",
      "E": "None of the above need to be avoided"
    },
    "answer": [
      "A",
      "C"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "tricyclic antidepressants"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "CS-AD-004",
    "patient_vignette": "A 76-year-old woman is being considered for antidepressant therapy. She has no history of syncope. She has no history of falls. No other significant past medical history; Renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Loratadine",
      "B": "Bisoprolol",
      "C": "Venlafaxine",
      "D": "Sertraline",
      "E": "None of the above need to be avoided"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "antihistamines"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "CS-A1-001",
    "patient_vignette": "A 77-year-old woman has a history of syncope and stress urinary incontinence. No other significant past medical history; Renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Metformin",
      "B": "None of the above need to be avoided",
      "C": "Doxazosin",
      "D": "Bisoprolol",
      "E": "Prazosin"
    },
    "answer": [
      "C",
      "E"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "alpha-1 receptor blockers"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "CS-A1-002",
    "patient_vignette": "A 77-year-old woman has a history of syncope. She has no urinary incontinence. No other significant past medical history; Renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "None of the above need to be avoided",
      "B": "Bisoprolol",
      "C": "Loratadine",
      "D": "Terazosin",
      "E": "Metformin"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "alpha-1 receptor blockers"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "CS-A1-003",
    "patient_vignette": "A 77-year-old woman has stress urinary incontinence. She has no history of syncope. No other significant past medical history; Renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "None of the above need to be avoided",
      "B": "Prazosin",
      "C": "Metformin",
      "D": "Bisoprolol",
      "E": "Loratadine"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "alpha-1 receptor blockers"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "CS-A1-004",
    "patient_vignette": "A 75-year-old man has a history of syncope. No other significant past medical history; Renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Metformin",
      "B": "Bisoprolol",
      "C": "Doxazosin",
      "D": "Loratadine",
      "E": "None of the above need to be avoided"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "alpha-1 receptor blockers"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "CS-A1-005",
    "patient_vignette": "A 75-year-old man has lower urinary tract symptoms. He has no history of syncope. No other significant past medical history; Renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "None of the above need to be avoided",
      "B": "Bisoprolol",
      "C": "Famotidine",
      "D": "Metformin",
      "E": "Loratadine"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "h2-receptor antagonists",
      "antidiabetics",
      "antihistamines"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "CS-A1-006",
    "patient_vignette": "A 77-year-old woman is reviewed for routine medication safety. She has no history of syncope and no urinary incontinence. No other significant past medical history; Renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Metformin",
      "B": "Bisoprolol",
      "C": "Loratadine",
      "D": "None of the above need to be avoided",
      "E": "Famotidine"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "antidiabetics",
      "antihistamines",
      "h2-receptor antagonists"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "CS-A1-007",
    "patient_vignette": "A 75-year-old man has a history of syncope and urinary incontinence. No other significant past medical history; Renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "None of the above need to be avoided",
      "B": "Bisoprolol",
      "C": "Loratadine",
      "D": "Metformin",
      "E": "Terazosin"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "alpha-1 receptor blockers"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "CS-A1-008",
    "patient_vignette": "A 75-year-old man is reviewed for routine medication safety. He has no history of syncope and no urinary symptoms. No other significant past medical history; Renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Bisoprolol",
      "B": "None of the above need to be avoided",
      "C": "Metformin",
      "D": "Loratadine",
      "E": "Famotidine"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "antidiabetics",
      "antihistamines",
      "h2-receptor antagonists"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "CS-AC-001",
    "patient_vignette": "A 75-year-old man presents for a medication safety review. He has benign prostatic hyperplasia (BPH). He has no urinary incontinence. No other significant past medical history; Renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "None of the above need to be avoided",
      "B": "Loratadine",
      "C": "Bisoprolol",
      "D": "Metformin",
      "E": "Oxybutynin"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "urology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "multiple drug categories (composite rules)"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "CS-AC-002",
    "patient_vignette": "A 75-year-old man presents for a medication safety review. He has benign prostatic hyperplasia (BPH). He also has urge urinary incontinence. No other significant past medical history; Renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Bisoprolol",
      "B": "Loratadine",
      "C": "None of the above need to be avoided",
      "D": "Oxybutynin",
      "E": "Metformin"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "urology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antihistamines",
      "antidiabetics"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "CS-AC-003",
    "patient_vignette": "A 75-year-old man presents for a medication safety review. He has no benign prostatic hyperplasia. He also has urge urinary incontinence. No other significant past medical history; Renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Loratadine",
      "B": "Metformin",
      "C": "Oxybutynin",
      "D": "Bisoprolol",
      "E": "None of the above need to be avoided"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "urology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antihistamines",
      "antidiabetics"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "CS-AC-004",
    "patient_vignette": "A 75-year-old man presents for a medication safety review. He has no benign prostatic hyperplasia. He has no urinary incontinence. No other significant past medical history; Renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Metformin",
      "B": "Acetaminophen",
      "C": "Loratadine",
      "D": "None of the above need to be avoided",
      "E": "Bisoprolol"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "urology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antidiabetics",
      "antipyretic analgesics",
      "antihistamines"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "CS-AC-005",
    "patient_vignette": "A 75-year-old man has benign prostatic hyperplasia. He has no urinary incontinence. No other significant past medical history; Renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Oxybutynin",
      "B": "Bisoprolol",
      "C": "Tolterodine",
      "D": "None of the above need to be avoided",
      "E": "Metformin"
    },
    "answer": [
      "A",
      "C"
    ],
    "taxonomy_clinical_department": "urology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "multiple drug categories (composite rules)"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "CS-AC-006",
    "patient_vignette": "A 75-year-old man has BPH and urge urinary incontinence. No other significant past medical history; Renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Metformin",
      "B": "Oxybutynin",
      "C": "Tolterodine",
      "D": "None of the above need to be avoided",
      "E": "Bisoprolol"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "urology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antidiabetics"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "CS-AC-007",
    "patient_vignette": "A 75-year-old woman has lower urinary tract symptoms but no urinary incontinence. No other significant past medical history; Renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Bisoprolol",
      "B": "Metformin",
      "C": "None of the above need to be avoided",
      "D": "Loratadine",
      "E": "Acetaminophen"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "urology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antidiabetics",
      "antihistamines",
      "antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "CS-AC-008",
    "patient_vignette": "A 75-year-old man has BPH. He has no urinary incontinence. Solifenacin is being considered. No other significant past medical history; Renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Loratadine",
      "B": "Solifenacin",
      "C": "Bisoprolol",
      "D": "Metformin",
      "E": "None of the above need to be avoided"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "urology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "multiple drug categories (composite rules)"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "CS-DE-001",
    "patient_vignette": "A 78-year-old man is evaluated for medication safety. He has benign prostatic hyperplasia (BPH). He is currently experiencing delirium. He has no urinary incontinence. No other significant past medical history; Renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications should be avoided given this patient's conditions?",
    "options": {
      "A": "Bisoprolol",
      "B": "Oxybutynin",
      "C": "Acetaminophen",
      "D": "Famotidine",
      "E": "None of the above need to be avoided"
    },
    "answer": [
      "B",
      "D"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "h2-receptor antagonists"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "CS-DE-002",
    "patient_vignette": "A 78-year-old man is evaluated for medication safety. He has benign prostatic hyperplasia (BPH). He is fully alert with no delirium. He has no urinary incontinence. No other significant past medical history; Renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications should be avoided given this patient's conditions?",
    "options": {
      "A": "Acetaminophen",
      "B": "None of the above need to be avoided",
      "C": "Oxybutynin",
      "D": "Bisoprolol",
      "E": "Famotidine"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "multiple drug categories (composite rules)"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "CS-DE-003",
    "patient_vignette": "A 78-year-old man is evaluated for medication safety. He has no BPH. He is currently experiencing delirium. He has no urinary incontinence. No other significant past medical history; Renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications should be avoided given this patient's conditions?",
    "options": {
      "A": "None of the above need to be avoided",
      "B": "Famotidine",
      "C": "Oxybutynin",
      "D": "Bisoprolol",
      "E": "Acetaminophen"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "h2-receptor antagonists"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "CS-DE-004",
    "patient_vignette": "A 78-year-old man is evaluated for medication safety. He has no BPH. He is fully alert with no delirium. He has no urinary incontinence. No other significant past medical history; Renal and hepatic function are normal; not on other prescription medications; no known drug allergies.",
    "question": "Which of the following medications should be avoided given this patient's conditions?",
    "options": {
      "A": "Bisoprolol",
      "B": "Famotidine",
      "C": "Cilostazol",
      "D": "Metformin",
      "E": "None of the above need to be avoided"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "h2-receptor antagonists",
      "pde3 inhibitors/peripheral vascular drugs",
      "antidiabetics"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "DDI-RK-POS-001",
    "patient_vignette": "A 72-year-old man with CKD Stage 3b (eGFR 38 mL/min) is currently taking aliskiren for hypertension.",
    "question": "Which of the following medications would be inappropriate to add to this patient's regimen?",
    "options": {
      "A": "Amiloride",
      "B": "Metoprolol",
      "C": "Amlodipine",
      "D": "Omeprazole",
      "E": "None of the above"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "renin-angiotensin system inhibitors"
    ],
    "taxonomy_patient_info_type": "drug interaction",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "DDI-RK-POS-002",
    "patient_vignette": "A 68-year-old woman with CKD Stage 3a (eGFR 51 mL/min) is currently taking triamterene for fluid retention.",
    "question": "Which of the following medications would be inappropriate to add to this patient's regimen?",
    "options": {
      "A": "Amlodipine",
      "B": "Aliskiren",
      "C": "Atorvastatin",
      "D": "None of the above",
      "E": "Metoprolol"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "potassium-sparing diuretics"
    ],
    "taxonomy_patient_info_type": "drug interaction",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "DDI-RK-NEG-001",
    "patient_vignette": "A 72-year-old man with normal renal function (eGFR 82 mL/min) is currently taking aliskiren for hypertension.",
    "question": "Which of the following medications would be inappropriate to add to this patient's regimen?",
    "options": {
      "A": "Amiloride",
      "B": "Metoprolol",
      "C": "Amlodipine",
      "D": "None of the above",
      "E": "Omeprazole"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "renin-angiotensin system inhibitors"
    ],
    "taxonomy_patient_info_type": "drug interaction",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "DDI-OB-POS-001",
    "patient_vignette": "A 75-year-old woman is on long-term opioid therapy for chronic musculoskeletal pain.",
    "question": "Which of the following medications would be inappropriate to add to this patient's regimen?",
    "options": {
      "A": "Lorazepam",
      "B": "None of the above",
      "C": "Acetaminophen",
      "D": "Omeprazole",
      "E": "Amlodipine"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "pain medicine",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "opioids"
    ],
    "taxonomy_patient_info_type": "drug interaction",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "DDI-OB-POS-002",
    "patient_vignette": "A 70-year-old man is on scheduled opioid analgesia for chronic cancer pain.",
    "question": "Which of the following medications would be inappropriate to add to this patient's regimen?",
    "options": {
      "A": "Atorvastatin",
      "B": "Ondansetron",
      "C": "Metoprolol",
      "D": "Temazepam",
      "E": "None of the above"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "pain medicine",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "opioids"
    ],
    "taxonomy_patient_info_type": "drug interaction",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "DDI-OG-NEG-001",
    "patient_vignette": "A 73-year-old man on long-term opioid therapy is being deliberately transitioned to pregabalin by his physician, with the explicit goal of tapering and discontinuing opioid use.",
    "question": "Which of the following medications would be inappropriate to prescribe during this transition?",
    "options": {
      "A": "Pregabalin",
      "B": "None of the above",
      "C": "Acetaminophen",
      "D": "Omeprazole",
      "E": "Metoprolol"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "pain medicine",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "opioids"
    ],
    "taxonomy_patient_info_type": "drug interaction",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "DDI-AC-POS-001",
    "patient_vignette": "A 70-year-old woman is taking amitriptyline for depression.",
    "question": "Which of the following medications would be inappropriate to add to this patient's regimen?",
    "options": {
      "A": "None of the above",
      "B": "Diphenhydramine",
      "C": "Loratadine",
      "D": "Omeprazole",
      "E": "Atorvastatin"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "psychiatry",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "tricyclic antidepressants/anticholinergics"
    ],
    "taxonomy_patient_info_type": "drug interaction",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "DDI-AC-POS-002",
    "patient_vignette": "A 74-year-old man is taking hydroxyzine for anxiety.",
    "question": "Which of the following medications would be inappropriate to add to this patient's regimen?",
    "options": {
      "A": "Cetirizine",
      "B": "Dicyclomine",
      "C": "Metoprolol",
      "D": "None of the above",
      "E": "Acetaminophen"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "pulmonology",
    "taxonomy_clinical_system": "respiratory system",
    "taxonomy_drug_categories": [
      "first-generation antihistamines/anticholinergics"
    ],
    "taxonomy_patient_info_type": "drug interaction",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "DDI-AC-NEG-001",
    "patient_vignette": "A 70-year-old woman is taking amitriptyline for depression.",
    "question": "Which of the following medications would be inappropriate to add to this patient's regimen?",
    "options": {
      "A": "Loratadine",
      "B": "Atorvastatin",
      "C": "Omeprazole",
      "D": "None of the above",
      "E": "Metoprolol"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "psychiatry",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "tricyclic antidepressants/anticholinergics"
    ],
    "taxonomy_patient_info_type": "drug interaction",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "DDI-CN-POS-001",
    "patient_vignette": "A 72-year-old man is currently taking gabapentin for neuropathic pain.",
    "question": "Which of the following medications would be inappropriate to add to this patient's regimen?",
    "options": {
      "A": "None of the above",
      "B": "Lorazepam",
      "C": "Metoprolol",
      "D": "Omeprazole",
      "E": "Acetaminophen"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "gabapentinoids"
    ],
    "taxonomy_patient_info_type": "drug interaction",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "DDI-CN-POS-002",
    "patient_vignette": "A 75-year-old woman is taking zolpidem for insomnia.",
    "question": "Which of the following medications would be inappropriate to add to this patient's regimen?",
    "options": {
      "A": "Omeprazole",
      "B": "None of the above",
      "C": "Amitriptyline",
      "D": "Amlodipine",
      "E": "Atorvastatin"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "psychiatry",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "z-class hypnotics"
    ],
    "taxonomy_patient_info_type": "drug interaction",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "DDI-CN-POS-003",
    "patient_vignette": "A 68-year-old man is taking quetiapine for bipolar disorder.",
    "question": "Which of the following medications would be inappropriate to add to this patient's regimen?",
    "options": {
      "A": "Metoprolol",
      "B": "Omeprazole",
      "C": "Cyclobenzaprine",
      "D": "Levothyroxine",
      "E": "None of the above"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "psychiatry",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "antipsychotics"
    ],
    "taxonomy_patient_info_type": "drug interaction",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "DDI-CN-POS-004",
    "patient_vignette": "A 71-year-old woman is taking clonazepam for anxiety.",
    "question": "Which of the following medications would be inappropriate to add to this patient's regimen?",
    "options": {
      "A": "None of the above",
      "B": "Amlodipine",
      "C": "Acetaminophen",
      "D": "Metoprolol",
      "E": "Methocarbamol"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "psychiatry",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "benzodiazepines"
    ],
    "taxonomy_patient_info_type": "drug interaction",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "DDI-CN-NEG-001",
    "patient_vignette": "A 72-year-old man is currently taking gabapentin for neuropathic pain.",
    "question": "Which of the following medications would be inappropriate to add to this patient's regimen?",
    "options": {
      "A": "Metoprolol",
      "B": "Omeprazole",
      "C": "Amlodipine",
      "D": "Atorvastatin",
      "E": "None of the above"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "gabapentinoids"
    ],
    "taxonomy_patient_info_type": "drug interaction",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "DDI-CN-POS-005",
    "patient_vignette": "A 78-year-old woman is taking haloperidol for behavioral symptoms of dementia. Her physician is considering additional medications.",
    "question": "Which of the following medications would be inappropriate to add to this patient's regimen? Select all that apply.",
    "options": {
      "A": "Omeprazole",
      "B": "Lorazepam",
      "C": "Metoprolol",
      "D": "Zolpidem",
      "E": "None of the above"
    },
    "answer": [
      "B",
      "D"
    ],
    "taxonomy_clinical_department": "psychiatry",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "antipsychotics"
    ],
    "taxonomy_patient_info_type": "drug interaction",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "DDI-LI-POS-001",
    "patient_vignette": "A 65-year-old woman with bipolar disorder is taking lithium for mood stabilization. She is newly diagnosed with hypertension.",
    "question": "Which of the following medications would be inappropriate to add to this patient's regimen? Select all that apply.",
    "options": {
      "A": "Lisinopril",
      "B": "Amlodipine",
      "C": "Metoprolol",
      "D": "None of the above",
      "E": "Furosemide"
    },
    "answer": [
      "A",
      "E"
    ],
    "taxonomy_clinical_department": "psychiatry",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "lithium"
    ],
    "taxonomy_patient_info_type": "drug interaction",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "DDI-LI-POS-002",
    "patient_vignette": "A 65-year-old woman with bipolar disorder is taking lithium for mood stabilization. She develops lower extremity edema.",
    "question": "Which of the following medications would be inappropriate to add to this patient's regimen?",
    "options": {
      "A": "Amlodipine",
      "B": "None of the above",
      "C": "Metoprolol",
      "D": "Furosemide",
      "E": "Atorvastatin"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "psychiatry",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "lithium"
    ],
    "taxonomy_patient_info_type": "drug interaction",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "DDI-LI-POS-003",
    "patient_vignette": "A 65-year-old man with bipolar I disorder is taking lithium. His new cardiologist is reviewing his medication list for potential interactions.",
    "question": "Which of the following medications would be inappropriate to add to this patient's regimen? Select all that apply.",
    "options": {
      "A": "Atorvastatin",
      "B": "None of the above",
      "C": "Lisinopril",
      "D": "Metoprolol",
      "E": "Furosemide"
    },
    "answer": [
      "C",
      "E"
    ],
    "taxonomy_clinical_department": "psychiatry",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "lithium"
    ],
    "taxonomy_patient_info_type": "drug interaction",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "DDI-AL-POS-001",
    "patient_vignette": "A 74-year-old woman with hypertension is taking terazosin. She develops lower extremity edema and her physician considers adding a diuretic.",
    "question": "Which of the following medications would be inappropriate to add to this patient's regimen?",
    "options": {
      "A": "Furosemide",
      "B": "Omeprazole",
      "C": "Metoprolol",
      "D": "Atorvastatin",
      "E": "None of the above"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "nonselective alpha-1 receptor blockers"
    ],
    "taxonomy_patient_info_type": "drug interaction",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "DDI-AL-NEG-001",
    "patient_vignette": "A 76-year-old man with hypertension is taking doxazosin. He develops lower extremity edema and his physician considers adding a diuretic.",
    "question": "Which of the following medications would be inappropriate to add to this patient's regimen?",
    "options": {
      "A": "Furosemide",
      "B": "None of the above",
      "C": "Omeprazole",
      "D": "Metoprolol",
      "E": "Atorvastatin"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "nonselective alpha-1 receptor blockers"
    ],
    "taxonomy_patient_info_type": "drug interaction",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "DDI-PH-POS-001",
    "patient_vignette": "A 69-year-old man taking phenytoin for epilepsy develops a urinary tract infection.",
    "question": "Which of the following medications would be inappropriate to add to this patient's regimen?",
    "options": {
      "A": "Trimethoprim-sulfamethoxazole",
      "B": "Amoxicillin",
      "C": "None of the above",
      "D": "Nitrofurantoin",
      "E": "Doxycycline"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "antiepileptics"
    ],
    "taxonomy_patient_info_type": "drug interaction",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "DDI-TH-POS-001",
    "patient_vignette": "A 71-year-old man with COPD is taking theophylline. He reports new heartburn symptoms.",
    "question": "Which of the following medications would be inappropriate to add to this patient's regimen?",
    "options": {
      "A": "Cimetidine",
      "B": "Famotidine",
      "C": "None of the above",
      "D": "Omeprazole",
      "E": "Pantoprazole"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "pulmonology",
    "taxonomy_clinical_system": "respiratory system",
    "taxonomy_drug_categories": [
      "theophyllines"
    ],
    "taxonomy_patient_info_type": "drug interaction",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "DDI-TH-POS-002",
    "patient_vignette": "A 71-year-old man with COPD is taking theophylline. He develops an acute respiratory tract infection requiring antibiotics.",
    "question": "Which of the following medications would be inappropriate to add to this patient's regimen?",
    "options": {
      "A": "Amoxicillin",
      "B": "Azithromycin",
      "C": "None of the above",
      "D": "Ciprofloxacin",
      "E": "Doxycycline"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "pulmonology",
    "taxonomy_clinical_system": "respiratory system",
    "taxonomy_drug_categories": [
      "theophyllines"
    ],
    "taxonomy_patient_info_type": "drug interaction",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "DDI-TH-POS-003",
    "patient_vignette": "A 71-year-old man with COPD is taking theophylline. His physician is reviewing medications for potential drug interactions.",
    "question": "Which of the following medications would be inappropriate to add to this patient's regimen? Select all that apply.",
    "options": {
      "A": "Famotidine",
      "B": "Cimetidine",
      "C": "None of the above",
      "D": "Azithromycin",
      "E": "Ciprofloxacin"
    },
    "answer": [
      "B",
      "E"
    ],
    "taxonomy_clinical_department": "pulmonology",
    "taxonomy_clinical_system": "respiratory system",
    "taxonomy_drug_categories": [
      "theophyllines"
    ],
    "taxonomy_patient_info_type": "drug interaction",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "DDI-WA-POS-001",
    "patient_vignette": "A 72-year-old woman with persistent atrial fibrillation is taking warfarin. She lives in a rural area with unreliable access to INR monitoring, and her INR levels have been difficult to control. Her cardiologist is considering additional medication for rate or rhythm management.",
    "question": "Which of the following medications would be inappropriate to add to this patient's regimen?",
    "options": {
      "A": "Amiodarone",
      "B": "Metoprolol",
      "C": "Atenolol",
      "D": "Flecainide",
      "E": "None of the above"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "anticoagulants"
    ],
    "taxonomy_patient_info_type": "drug interaction",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "DDI-WA-POS-002",
    "patient_vignette": "A 72-year-old woman taking warfarin for atrial fibrillation develops a urinary tract infection.",
    "question": "Which of the following medications would be inappropriate to add to this patient's regimen?",
    "options": {
      "A": "Amoxicillin",
      "B": "Nitrofurantoin",
      "C": "Ciprofloxacin",
      "D": "None of the above",
      "E": "Doxycycline"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "anticoagulants"
    ],
    "taxonomy_patient_info_type": "drug interaction",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "DDI-WA-POS-003",
    "patient_vignette": "A 72-year-old woman taking warfarin for atrial fibrillation develops a urinary tract infection resistant to first-line antibiotics.",
    "question": "Which of the following medications would be inappropriate to add to this patient's regimen?",
    "options": {
      "A": "Amoxicillin",
      "B": "None of the above",
      "C": "Trimethoprim-sulfamethoxazole",
      "D": "Doxycycline",
      "E": "Fosfomycin"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "anticoagulants"
    ],
    "taxonomy_patient_info_type": "drug interaction",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-CIP-NEG-001",
    "patient_vignette": "A 73-year-old woman presents with a complicated urinary tract infection. Her kidney function is stable with an estimated CrCl of 75 mL/min. She has no known drug allergies. Her physician is selecting an antibiotic regimen.",
    "question": "Which of the following medications requires dose reduction given this patient's renal function?",
    "options": {
      "A": "None of the above",
      "B": "Doxycycline",
      "C": "Ciprofloxacin",
      "D": "Amoxicillin-clavulanate",
      "E": "Azithromycin"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "fluoroquinolone antibacterials"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-CIP-POS-001",
    "patient_vignette": "A 76-year-old man presents with a complicated urinary tract infection. He has chronic kidney disease with an estimated CrCl of 18 mL/min. His physician is selecting an antibiotic.",
    "question": "Which of the following medications requires dose reduction given this patient's renal function?",
    "options": {
      "A": "None of the above",
      "B": "Azithromycin",
      "C": "Doxycycline",
      "D": "Clindamycin",
      "E": "Ciprofloxacin"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "fluoroquinolone antibacterials"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-NIT-POS-001",
    "patient_vignette": "A 72-year-old woman presents with a urinary tract infection. Her estimated CrCl is 18 mL/min. Her physician is selecting an antibiotic.",
    "question": "Which of the following medications should be avoided given this patient's renal function?",
    "options": {
      "A": "Azithromycin",
      "B": "None of the above",
      "C": "Doxycycline",
      "D": "Nitrofurantoin",
      "E": "Fosfomycin"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "urinary antibacterials"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-TMP-POS-001",
    "patient_vignette": "A 78-year-old woman requires trimethoprim-sulfamethoxazole for Pneumocystis jirovecii prophylaxis. Her estimated CrCl is 22 mL/min.",
    "question": "Which of the following medications requires dose reduction (rather than complete avoidance) given this patient's renal function?",
    "options": {
      "A": "Trimethoprim-sulfamethoxazole",
      "B": "None of the above",
      "C": "Clindamycin",
      "D": "Azithromycin",
      "E": "Doxycycline"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antibacterials"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-TMP-POS-002",
    "patient_vignette": "An 80-year-old man with advanced chronic kidney disease requires antibiotic coverage. His estimated CrCl is 10 mL/min. His physician is reviewing antibiotic options including trimethoprim-sulfamethoxazole.",
    "question": "Which of the following medications should be avoided given this patient's renal function?",
    "options": {
      "A": "Trimethoprim-sulfamethoxazole",
      "B": "Amoxicillin",
      "C": "Azithromycin",
      "D": "None of the above",
      "E": "Doxycycline"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antibacterials"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-KSP-NEG-001",
    "patient_vignette": "A 75-year-old man with heart failure and hypertension is managed with multiple medications. His estimated CrCl is 48 mL/min.",
    "question": "Which of the following medications should be avoided given this patient's renal function?",
    "options": {
      "A": "Triamterene",
      "B": "Furosemide",
      "C": "Spironolactone",
      "D": "Amiloride",
      "E": "None of the above"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "potassium-sparing diuretics"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-KSP-POS-001",
    "patient_vignette": "A 74-year-old man with chronic kidney disease and multiple comorbidities has an estimated CrCl of 45 mL/min. His physician is reviewing his current medication list for agents that may require dose adjustment.",
    "question": "Which of the following medications requires dose reduction given this patient's renal function? Select all that apply.",
    "options": {
      "A": "None of the above",
      "B": "Metoprolol",
      "C": "Gabapentin",
      "D": "Famotidine",
      "E": "Amiloride"
    },
    "answer": [
      "C",
      "D"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "potassium-sparing diuretics"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-DAB-POS-001",
    "patient_vignette": "A 79-year-old woman with nonvalvular atrial fibrillation has an estimated CrCl of 18 mL/min. Her physician is evaluating anticoagulation options.",
    "question": "Which of the following medications should be avoided given this patient's renal function?",
    "options": {
      "A": "Warfarin",
      "B": "Apixaban",
      "C": "None of the above",
      "D": "Dabigatran",
      "E": "Heparin"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "direct thrombin inhibitors/anticoagulants"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-DOF-NEG-001",
    "patient_vignette": "A 72-year-old man with persistent atrial fibrillation is being evaluated for dofetilide for rhythm control. His estimated CrCl is 75 mL/min.",
    "question": "Which of the following medications requires dose reduction given this patient's renal function?",
    "options": {
      "A": "Flecainide",
      "B": "None of the above",
      "C": "Dofetilide",
      "D": "Amiodarone",
      "E": "Metoprolol"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antiarrhythmics"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-DOF-POS-001",
    "patient_vignette": "A 76-year-old woman with persistent atrial fibrillation is being considered for dofetilide. Her estimated CrCl is 35 mL/min.",
    "question": "Which of the following medications requires dose reduction given this patient's renal function?",
    "options": {
      "A": "Dofetilide",
      "B": "None of the above",
      "C": "Amiodarone",
      "D": "Metoprolol",
      "E": "Diltiazem"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antiarrhythmics"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-DOF-POS-002",
    "patient_vignette": "An 80-year-old man with persistent atrial fibrillation has an estimated CrCl of 12 mL/min. His physician is reviewing antiarrhythmic options.",
    "question": "Which of the following medications should be avoided given this patient's renal function?",
    "options": {
      "A": "Amiodarone",
      "B": "None of the above",
      "C": "Metoprolol",
      "D": "Diltiazem",
      "E": "Dofetilide"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antiarrhythmics"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-EDO-POS-001",
    "patient_vignette": "A 77-year-old man with atrial fibrillation requires anticoagulation. His estimated CrCl is 30 mL/min.",
    "question": "Which of the following medications requires dose reduction given this patient's renal function?",
    "options": {
      "A": "Heparin",
      "B": "Apixaban",
      "C": "None of the above",
      "D": "Warfarin",
      "E": "Edoxaban"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "factor xa inhibitors/anticoagulants"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-EDO-POS-002",
    "patient_vignette": "An 83-year-old woman with atrial fibrillation has an estimated CrCl of 10 mL/min due to advanced chronic kidney disease.",
    "question": "Which of the following medications should be avoided given this patient's renal function?",
    "options": {
      "A": "None of the above",
      "B": "Heparin",
      "C": "Warfarin",
      "D": "Apixaban",
      "E": "Edoxaban"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "factor xa inhibitors/anticoagulants"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-ENO-POS-001",
    "patient_vignette": "A 78-year-old woman with a pulmonary embolism has an estimated CrCl of 18 mL/min. She requires anticoagulation.",
    "question": "Which of the following medications requires dose reduction given this patient's renal function?",
    "options": {
      "A": "Enoxaparin",
      "B": "None of the above",
      "C": "Apixaban",
      "D": "Warfarin",
      "E": "Unfractionated heparin"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "low-molecular-weight heparin anticoagulants"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-FON-POS-001",
    "patient_vignette": "A 75-year-old man with a deep vein thrombosis has an estimated CrCl of 18 mL/min. His physician is selecting anticoagulation. Enoxaparin at this CrCl requires dose reduction but can still be used.",
    "question": "Which of the following medications should be avoided (rather than dose-adjusted) given this patient's renal function?",
    "options": {
      "A": "Fondaparinux",
      "B": "Apixaban",
      "C": "Enoxaparin",
      "D": "Warfarin",
      "E": "None of the above"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "factor xa inhibitors/anticoagulants"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-RIV-POS-001",
    "patient_vignette": "A 76-year-old woman with venous thromboembolism has an estimated CrCl of 40 mL/min. Her physician is reviewing anticoagulation options.",
    "question": "Which of the following medications requires dose reduction given this patient's renal function?",
    "options": {
      "A": "Dabigatran",
      "B": "None of the above",
      "C": "Warfarin",
      "D": "Apixaban",
      "E": "Rivaroxaban"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "factor xa inhibitors/anticoagulants"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-RIV-POS-002",
    "patient_vignette": "An 81-year-old man with atrial fibrillation has an estimated CrCl of 10 mL/min due to advanced chronic kidney disease.",
    "question": "Which of the following medications should be avoided given this patient's renal function?",
    "options": {
      "A": "Heparin",
      "B": "Rivaroxaban",
      "C": "None of the above",
      "D": "Warfarin",
      "E": "Apixaban"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "factor xa inhibitors/anticoagulants"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-BAC-NEG-001",
    "patient_vignette": "A 71-year-old woman with spasticity due to multiple sclerosis is being considered for baclofen. Her estimated eGFR is 75 mL/min/1.73 m².",
    "question": "Which of the following medications should be avoided given this patient's renal function?",
    "options": {
      "A": "Diazepam",
      "B": "Tizanidine",
      "C": "None of the above",
      "D": "Cyclobenzaprine",
      "E": "Baclofen"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "muscle relaxants"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-BAC-POS-001",
    "patient_vignette": "A 75-year-old man with severe spasticity secondary to spinal cord injury has an estimated eGFR of 38 mL/min/1.73 m².",
    "question": "Which of the following medications should be avoided given this patient's renal function?",
    "options": {
      "A": "Cyclobenzaprine",
      "B": "Baclofen",
      "C": "None of the above",
      "D": "Diazepam",
      "E": "Tizanidine"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "muscle relaxants"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-DUL-POS-001",
    "patient_vignette": "A 74-year-old woman with depression and diabetic neuropathy has an estimated CrCl of 18 mL/min. Her physician is considering antidepressant options with dual benefit for neuropathic pain.",
    "question": "Which of the following medications should be avoided given this patient's renal function?",
    "options": {
      "A": "None of the above",
      "B": "Sertraline",
      "C": "Escitalopram",
      "D": "Duloxetine",
      "E": "Venlafaxine"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antidepressants/analgesics"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-GPT-NEG-001",
    "patient_vignette": "A 72-year-old man with postherpetic neuralgia has an estimated CrCl of 75 mL/min. His physician is considering neuropathic pain medications.",
    "question": "Which of the following medications requires dose reduction given this patient's renal function?",
    "options": {
      "A": "Amitriptyline",
      "B": "Gabapentin",
      "C": "None of the above",
      "D": "Capsaicin cream",
      "E": "Pregabalin"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "gabapentinoids"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-GPT-POS-001",
    "patient_vignette": "A 79-year-old woman with chronic kidney disease and several comorbidities has an estimated CrCl of 45 mL/min. Her physician is reviewing her medications for potential dose adjustments.",
    "question": "Which of the following medications requires dose reduction given this patient's renal function? Select all that apply.",
    "options": {
      "A": "Colchicine",
      "B": "None of the above",
      "C": "Amlodipine",
      "D": "Cimetidine",
      "E": "Levetiracetam"
    },
    "answer": [
      "A",
      "D",
      "E"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "gabapentinoids"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-LEV-POS-001",
    "patient_vignette": "A 75-year-old woman with epilepsy on levetiracetam has an estimated CrCl of 55 mL/min. Her neurologist is reviewing her medications.",
    "question": "Which of the following medications requires dose reduction given this patient's renal function?",
    "options": {
      "A": "None of the above",
      "B": "Phenytoin",
      "C": "Lamotrigine",
      "D": "Levetiracetam",
      "E": "Valproic acid"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antiepileptics"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-NSA-NEG-001",
    "patient_vignette": "A 71-year-old man with osteoarthritis seeks oral analgesic options. His estimated CrCl is 48 mL/min.",
    "question": "Which of the following medications should be avoided given this patient's renal function?",
    "options": {
      "A": "Ibuprofen",
      "B": "Acetaminophen",
      "C": "Celecoxib",
      "D": "None of the above",
      "E": "Naproxen"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "nsaids/antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-NSA-POS-001",
    "patient_vignette": "A 77-year-old woman with chronic kidney disease has an estimated CrCl of 25 mL/min. Her physician is reviewing her current medications for agents that should be avoided.",
    "question": "Which of the following medications should be avoided given this patient's renal function? Select all that apply.",
    "options": {
      "A": "Losartan",
      "B": "Amiloride",
      "C": "Duloxetine",
      "D": "None of the above",
      "E": "Acetaminophen"
    },
    "answer": [
      "B",
      "C"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "nsaids/antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-TRA-POS-001",
    "patient_vignette": "A 76-year-old woman with moderate chronic pain has an estimated CrCl of 18 mL/min. Her physician is considering tramadol immediate-release for pain management.",
    "question": "Which of the following medications requires dose reduction given this patient's renal function?",
    "options": {
      "A": "Lidocaine patch",
      "B": "Tramadol immediate-release",
      "C": "Capsaicin cream",
      "D": "None of the above",
      "E": "Acetaminophen"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "opioid-like analgesics"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-TRA-POS-002",
    "patient_vignette": "A 77-year-old man with chronic low back pain has an estimated CrCl of 18 mL/min. His physician is considering tramadol extended-release for pain management.",
    "question": "Which of the following medications should be avoided given this patient's renal function?",
    "options": {
      "A": "Tramadol extended-release",
      "B": "None of the above",
      "C": "Acetaminophen",
      "D": "Lidocaine patch",
      "E": "Capsaicin cream"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "opioid-like analgesics"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-H2B-POS-001",
    "patient_vignette": "An 80-year-old man with chronic kidney disease has an estimated CrCl of 22 mL/min. His physician is reviewing his current medications for agents that should be avoided.",
    "question": "Which of the following medications should be avoided given this patient's renal function? Select all that apply.",
    "options": {
      "A": "Triamterene",
      "B": "Fondaparinux",
      "C": "Lisinopril",
      "D": "None of the above",
      "E": "Warfarin"
    },
    "answer": [
      "A",
      "B"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "h2-receptor blockers"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-COL-POS-001",
    "patient_vignette": "A 75-year-old man with an acute gout flare has an estimated CrCl of 18 mL/min. His physician is selecting treatment.",
    "question": "Which of the following medications requires dose reduction given this patient's renal function?",
    "options": {
      "A": "Methylprednisolone",
      "B": "Colchicine",
      "C": "None of the above",
      "D": "Febuxostat",
      "E": "Prednisone"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antigout agents"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-PRO-POS-001",
    "patient_vignette": "A 75-year-old woman with gout and chronic kidney disease has an estimated CrCl of 18 mL/min. Her physician is selecting urate-lowering therapy. Colchicine at this CrCl requires dose reduction but can be used.",
    "question": "Which of the following medications should be avoided (rather than dose-adjusted) given this patient's renal function?",
    "options": {
      "A": "Febuxostat",
      "B": "Colchicine",
      "C": "Probenecid",
      "D": "None of the above",
      "E": "Allopurinol"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antigout agents"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-NIT-NEG-001",
    "patient_vignette": "A 70-year-old woman with recurrent urinary tract infections has a stable estimated CrCl of 60 mL/min. Her physician is selecting an antibiotic for prophylaxis or treatment.",
    "question": "Which of the following medications should be avoided given this patient's renal function?",
    "options": {
      "A": "Amoxicillin",
      "B": "Cephalexin",
      "C": "Fosfomycin",
      "D": "None of the above",
      "E": "Nitrofurantoin"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "urinary antibacterials"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-TMP-NEG-001",
    "patient_vignette": "A 71-year-old man with a bacterial infection requires antibiotic therapy. His estimated CrCl is 45 mL/min.",
    "question": "Which of the following medications requires dose reduction given this patient's renal function?",
    "options": {
      "A": "Azithromycin",
      "B": "Doxycycline",
      "C": "None of the above",
      "D": "Trimethoprim-sulfamethoxazole",
      "E": "Amoxicillin"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antibacterials"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-DAB-NEG-001",
    "patient_vignette": "A 74-year-old man with nonvalvular atrial fibrillation requires long-term anticoagulation. His estimated CrCl is 55 mL/min.",
    "question": "Which of the following medications should be avoided given this patient's renal function?",
    "options": {
      "A": "Heparin",
      "B": "Dabigatran",
      "C": "None of the above",
      "D": "Apixaban",
      "E": "Warfarin"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "direct thrombin inhibitors/anticoagulants"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-EDO-NEG-001",
    "patient_vignette": "A 71-year-old woman with deep vein thrombosis requires anticoagulation. Her estimated CrCl is 65 mL/min.",
    "question": "Which of the following medications requires dose reduction given this patient's renal function?",
    "options": {
      "A": "None of the above",
      "B": "Warfarin",
      "C": "Edoxaban",
      "D": "Heparin",
      "E": "Apixaban"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "factor xa inhibitors/anticoagulants"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-ENO-NEG-001",
    "patient_vignette": "A 70-year-old man with a pulmonary embolism requires bridging anticoagulation. His estimated CrCl is 48 mL/min.",
    "question": "Which of the following medications requires dose reduction given this patient's renal function?",
    "options": {
      "A": "Apixaban",
      "B": "None of the above",
      "C": "Warfarin",
      "D": "Unfractionated heparin",
      "E": "Enoxaparin"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "low-molecular-weight heparin anticoagulants"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-FON-NEG-001",
    "patient_vignette": "A 72-year-old woman with a deep vein thrombosis is being evaluated for anticoagulation. Her estimated CrCl is 48 mL/min.",
    "question": "Which of the following medications should be avoided given this patient's renal function?",
    "options": {
      "A": "Apixaban",
      "B": "None of the above",
      "C": "Warfarin",
      "D": "Fondaparinux",
      "E": "Enoxaparin"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "factor xa inhibitors/anticoagulants"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-RIV-NEG-001",
    "patient_vignette": "A 73-year-old man with atrial fibrillation is being considered for rivaroxaban. His estimated CrCl is 65 mL/min.",
    "question": "Which of the following medications requires dose reduction given this patient's renal function?",
    "options": {
      "A": "None of the above",
      "B": "Dabigatran",
      "C": "Rivaroxaban",
      "D": "Warfarin",
      "E": "Apixaban"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "factor xa inhibitors/anticoagulants"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-DUL-NEG-001",
    "patient_vignette": "A 69-year-old woman with depression and generalized anxiety disorder has an estimated CrCl of 48 mL/min. Her psychiatrist is selecting an antidepressant.",
    "question": "Which of the following medications should be avoided given this patient's renal function?",
    "options": {
      "A": "Duloxetine",
      "B": "Sertraline",
      "C": "Escitalopram",
      "D": "Venlafaxine",
      "E": "None of the above"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antidepressants/analgesics"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-LEV-NEG-001",
    "patient_vignette": "A 68-year-old man with epilepsy managed with levetiracetam has an estimated CrCl of 90 mL/min. His neurologist is reviewing his antiepileptic regimen.",
    "question": "Which of the following medications requires dose reduction given this patient's renal function?",
    "options": {
      "A": "None of the above",
      "B": "Valproic acid",
      "C": "Lamotrigine",
      "D": "Levetiracetam",
      "E": "Phenytoin"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antiepileptics"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-TRA-NEG-001",
    "patient_vignette": "A 73-year-old man with moderate chronic back pain has an estimated CrCl of 48 mL/min. His physician is considering tramadol for pain management.",
    "question": "Which of the following medications requires dose reduction or avoidance given this patient's renal function?",
    "options": {
      "A": "Acetaminophen",
      "B": "Tramadol",
      "C": "None of the above",
      "D": "Lidocaine patch",
      "E": "Capsaicin cream"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "opioid-like analgesics"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-H2B-NEG-001",
    "patient_vignette": "A 74-year-old man with GERD requiring acid suppression has an estimated CrCl of 65 mL/min. His physician is selecting a medication.",
    "question": "Which of the following medications requires dose reduction given this patient's renal function?",
    "options": {
      "A": "None of the above",
      "B": "Famotidine",
      "C": "Nizatidine",
      "D": "Omeprazole",
      "E": "Cimetidine"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "h2-receptor blockers"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-COL-NEG-001",
    "patient_vignette": "A 70-year-old man with a history of gout has an estimated CrCl of 48 mL/min. His physician is evaluating colchicine therapy for gout prophylaxis.",
    "question": "Which of the following medications requires dose reduction given this patient's renal function?",
    "options": {
      "A": "Probenecid",
      "B": "Prednisone",
      "C": "Febuxostat",
      "D": "None of the above",
      "E": "Colchicine"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antigout agents"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-PRO-NEG-001",
    "patient_vignette": "A 71-year-old man with hyperuricemia and recurrent gout has an estimated CrCl of 48 mL/min. His physician is considering urate-lowering therapy.",
    "question": "Which of the following medications should be avoided given this patient's renal function?",
    "options": {
      "A": "Colchicine",
      "B": "Febuxostat",
      "C": "Probenecid",
      "D": "None of the above",
      "E": "Allopurinol"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antigout agents"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-AMI-POS-001",
    "patient_vignette": "A 74-year-old man with hypertension and peripheral edema has been managed with amiloride. His estimated CrCl is 18 mL/min.",
    "question": "Which of the following medications should be avoided given this patient's renal function?",
    "options": {
      "A": "None of the above",
      "B": "Furosemide",
      "C": "Amlodipine",
      "D": "Amiloride",
      "E": "Metoprolol"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antiarrhythmics"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-SPI-POS-001",
    "patient_vignette": "A 76-year-old woman with heart failure with reduced ejection fraction is managed with spironolactone for aldosterone blockade. Her estimated CrCl is 18 mL/min.",
    "question": "Which of the following medications should be avoided given this patient's renal function?",
    "options": {
      "A": "Sacubitril-valsartan",
      "B": "Spironolactone",
      "C": "None of the above",
      "D": "Carvedilol",
      "E": "Furosemide"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "aldosterone receptor antagonists"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-TRI-POS-001",
    "patient_vignette": "A 71-year-old man with hypertension and peripheral edema is prescribed triamterene for diuresis. His estimated CrCl is 18 mL/min.",
    "question": "Which of the following medications should be avoided given this patient's renal function?",
    "options": {
      "A": "Metoprolol",
      "B": "Triamterene",
      "C": "Amlodipine",
      "D": "None of the above",
      "E": "Furosemide"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "potassium-sparing diuretics"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-GAB-POS-001",
    "patient_vignette": "A 77-year-old woman with postherpetic neuralgia has an estimated CrCl of 35 mL/min. Her physician is considering gabapentin for neuropathic pain.",
    "question": "Which of the following medications requires dose reduction given this patient's renal function?",
    "options": {
      "A": "Gabapentin",
      "B": "None of the above",
      "C": "Amitriptyline",
      "D": "Lamotrigine",
      "E": "Lidocaine patch"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "gabapentinoids"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-PRE-POS-001",
    "patient_vignette": "A 73-year-old man with diabetic peripheral neuropathy has an estimated CrCl of 35 mL/min. His physician is considering pregabalin for pain management.",
    "question": "Which of the following medications requires dose reduction given this patient's renal function?",
    "options": {
      "A": "None of the above",
      "B": "Pregabalin",
      "C": "Capsaicin cream",
      "D": "Duloxetine",
      "E": "Amitriptyline"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "gabapentinoids"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-CIM-POS-001",
    "patient_vignette": "A 75-year-old man with GERD is managed with cimetidine. His estimated CrCl is 30 mL/min.",
    "question": "Which of the following medications requires dose reduction given this patient's renal function?",
    "options": {
      "A": "None of the above",
      "B": "Omeprazole",
      "C": "Pantoprazole",
      "D": "Calcium carbonate",
      "E": "Cimetidine"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "h2-receptor blockers"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-FAM-POS-001",
    "patient_vignette": "A 72-year-old woman with peptic ulcer disease is treated with famotidine. Her estimated CrCl is 30 mL/min.",
    "question": "Which of the following medications requires dose reduction given this patient's renal function?",
    "options": {
      "A": "Omeprazole",
      "B": "Sucralfate",
      "C": "Misoprostol",
      "D": "None of the above",
      "E": "Famotidine"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "h2-receptor blockers"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-NIZ-POS-001",
    "patient_vignette": "A 69-year-old man with GERD is currently taking nizatidine. His estimated CrCl is 30 mL/min.",
    "question": "Which of the following medications requires dose reduction given this patient's renal function?",
    "options": {
      "A": "Sucralfate",
      "B": "Pantoprazole",
      "C": "Nizatidine",
      "D": "None of the above",
      "E": "Calcium carbonate"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "h2-receptor blockers"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-AMI-NEG-001",
    "patient_vignette": "A 74-year-old man with hypertension managed with amiloride has an estimated CrCl of 48 mL/min.",
    "question": "Which of the following medications should be avoided given this patient's renal function?",
    "options": {
      "A": "Amiloride",
      "B": "Furosemide",
      "C": "Metoprolol",
      "D": "None of the above",
      "E": "Amlodipine"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antiarrhythmics"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "RK-GAB-NEG-001",
    "patient_vignette": "A 70-year-old woman with chronic neuropathic pain managed with gabapentin has an estimated CrCl of 75 mL/min.",
    "question": "Which of the following medications requires dose reduction given this patient's renal function?",
    "options": {
      "A": "Duloxetine",
      "B": "Amitriptyline",
      "C": "None of the above",
      "D": "Gabapentin",
      "E": "Oxycodone"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "gabapentinoids"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "TS-RIV-001",
    "patient_vignette": "A 78-year-old man with non-valvular atrial fibrillation has an estimated CrCl of 10 mL/min. His physician is determining the appropriate rivaroxaban regimen for stroke prevention.",
    "question": "Which of the following rivaroxaban prescriptions is most appropriate given this patient's renal function?",
    "options": {
      "A": "Do not prescribe rivaroxaban in this patient",
      "B": "Rivaroxaban 20 mg daily",
      "C": "Rivaroxaban 15 mg daily",
      "D": "None of the above",
      "E": "Rivaroxaban 2.5 mg twice daily"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "factor xa inhibitors/anticoagulants"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "TS-RIV-002",
    "patient_vignette": "A 78-year-old man with non-valvular atrial fibrillation has an estimated CrCl of 35 mL/min. His physician is determining the appropriate rivaroxaban regimen for stroke prevention.",
    "question": "Which of the following rivaroxaban prescriptions is most appropriate given this patient's renal function?",
    "options": {
      "A": "None of the above",
      "B": "Rivaroxaban 15 mg daily",
      "C": "Do not prescribe rivaroxaban in this patient",
      "D": "Rivaroxaban 20 mg daily",
      "E": "Rivaroxaban 2.5 mg twice daily"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "factor xa inhibitors/anticoagulants"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "TS-RIV-003",
    "patient_vignette": "A 78-year-old man with non-valvular atrial fibrillation has an estimated CrCl of 60 mL/min. His physician is determining the appropriate rivaroxaban regimen for stroke prevention.",
    "question": "Which of the following rivaroxaban prescriptions is most appropriate given this patient's renal function?",
    "options": {
      "A": "Rivaroxaban 20 mg daily",
      "B": "Rivaroxaban 15 mg daily",
      "C": "None of the above",
      "D": "Rivaroxaban 2.5 mg twice daily",
      "E": "Do not prescribe rivaroxaban in this patient"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "factor xa inhibitors/anticoagulants"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "TS-EDO-001",
    "patient_vignette": "A 74-year-old woman with venous thromboembolism has an estimated CrCl of 10 mL/min. Her physician is selecting an edoxaban regimen for anticoagulation.",
    "question": "Which of the following edoxaban prescriptions is most appropriate given this patient's renal function?",
    "options": {
      "A": "Edoxaban 15 mg daily",
      "B": "Do not prescribe edoxaban in this patient",
      "C": "Edoxaban 30 mg daily",
      "D": "Edoxaban 60 mg daily",
      "E": "None of the above"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "factor xa inhibitors/anticoagulants"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "TS-EDO-002",
    "patient_vignette": "A 74-year-old woman with venous thromboembolism has an estimated CrCl of 35 mL/min. Her physician is selecting an edoxaban regimen for anticoagulation.",
    "question": "Which of the following edoxaban prescriptions is most appropriate given this patient's renal function?",
    "options": {
      "A": "Edoxaban 30 mg daily",
      "B": "None of the above",
      "C": "Edoxaban 15 mg daily",
      "D": "Do not prescribe edoxaban in this patient",
      "E": "Edoxaban 60 mg daily"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "factor xa inhibitors/anticoagulants"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "TS-EDO-003",
    "patient_vignette": "A 74-year-old woman with venous thromboembolism has an estimated CrCl of 65 mL/min. Her physician is selecting an edoxaban regimen for anticoagulation.",
    "question": "Which of the following edoxaban prescriptions is most appropriate given this patient's renal function?",
    "options": {
      "A": "Edoxaban 60 mg daily",
      "B": "Edoxaban 15 mg daily",
      "C": "Do not prescribe edoxaban in this patient",
      "D": "Edoxaban 30 mg daily",
      "E": "None of the above"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "factor xa inhibitors/anticoagulants"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "TS-DOF-001",
    "patient_vignette": "A 73-year-old woman with persistent atrial fibrillation has an estimated CrCl of 15 mL/min. Her physician is determining the appropriate dofetilide regimen.",
    "question": "Which of the following dofetilide prescriptions is most appropriate given this patient's renal function?",
    "options": {
      "A": "Dofetilide 125 mcg twice daily",
      "B": "Do not prescribe dofetilide in this patient",
      "C": "Dofetilide 500 mcg twice daily",
      "D": "None of the above",
      "E": "Dofetilide 250 mcg twice daily"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antiarrhythmics"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "TS-DOF-002",
    "patient_vignette": "A 73-year-old woman with persistent atrial fibrillation has an estimated CrCl of 30 mL/min. Her physician is determining the appropriate dofetilide regimen.",
    "question": "Which of the following dofetilide prescriptions is most appropriate given this patient's renal function?",
    "options": {
      "A": "Dofetilide 250 mcg twice daily",
      "B": "Do not prescribe dofetilide in this patient",
      "C": "Dofetilide 125 mcg twice daily",
      "D": "Dofetilide 500 mcg twice daily",
      "E": "None of the above"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antiarrhythmics"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "TS-DOF-003",
    "patient_vignette": "A 73-year-old woman with persistent atrial fibrillation has an estimated CrCl of 50 mL/min. Her physician is determining the appropriate dofetilide regimen.",
    "question": "Which of the following dofetilide prescriptions is most appropriate given this patient's renal function?",
    "options": {
      "A": "None of the above",
      "B": "Dofetilide 500 mcg twice daily",
      "C": "Dofetilide 125 mcg twice daily",
      "D": "Dofetilide 250 mcg twice daily",
      "E": "Do not prescribe dofetilide in this patient"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antiarrhythmics"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "TS-TMP-001",
    "patient_vignette": "A 77-year-old woman with an uncomplicated urinary tract infection has an estimated CrCl of 10 mL/min. Her physician is considering trimethoprim-sulfamethoxazole therapy.",
    "question": "Which of the following TMP-SMX prescriptions is most appropriate given this patient's renal function?",
    "options": {
      "A": "TMP-SMX DS (800/160 mg) twice daily",
      "B": "TMP-SMX SS (400/80 mg) once daily",
      "C": "None of the above",
      "D": "TMP-SMX SS (400/80 mg) twice daily",
      "E": "Do not prescribe TMP-SMX in this patient"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antibacterials"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "TS-TMP-002",
    "patient_vignette": "A 77-year-old woman with an uncomplicated urinary tract infection has an estimated CrCl of 22 mL/min. Her physician is considering trimethoprim-sulfamethoxazole therapy.",
    "question": "Which of the following TMP-SMX prescriptions is most appropriate given this patient's renal function?",
    "options": {
      "A": "TMP-SMX DS (800/160 mg) twice daily",
      "B": "TMP-SMX SS (400/80 mg) once daily",
      "C": "Do not prescribe TMP-SMX in this patient",
      "D": "TMP-SMX SS (400/80 mg) twice daily",
      "E": "None of the above"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antibacterials"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "TS-TMP-003",
    "patient_vignette": "A 77-year-old woman with an uncomplicated urinary tract infection has an estimated CrCl of 45 mL/min. Her physician is considering trimethoprim-sulfamethoxazole therapy.",
    "question": "Which of the following TMP-SMX prescriptions is most appropriate given this patient's renal function?",
    "options": {
      "A": "None of the above",
      "B": "TMP-SMX SS (400/80 mg) once daily",
      "C": "TMP-SMX SS (400/80 mg) twice daily",
      "D": "TMP-SMX DS (800/160 mg) twice daily",
      "E": "Do not prescribe TMP-SMX in this patient"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antibacterials"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "TS-TRA-001",
    "patient_vignette": "A 72-year-old man with moderate chronic pain has an estimated CrCl of 22 mL/min. His physician is selecting a tramadol regimen for pain management.",
    "question": "Which of the following tramadol prescriptions is most appropriate given this patient's renal function?",
    "options": {
      "A": "Tramadol ER 200 mg daily",
      "B": "Tramadol IR 50 mg four times daily (200 mg/day)",
      "C": "Tramadol IR 100 mg four times daily (400 mg/day)",
      "D": "None of the above",
      "E": "Tramadol should not be used in patients with CrCl <30 mL/min"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "opioid-like analgesics"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "TS-AB-001",
    "patient_vignette": "A 75-year-old woman with a urinary tract infection has an estimated CrCl of 18 mL/min. Her physician is selecting an antibiotic regimen.",
    "question": "Which of the following antibiotic prescriptions is most appropriate given this patient's renal function?",
    "options": {
      "A": "Nitrofurantoin 100 mg twice daily",
      "B": "TMP-SMX DS (800/160 mg) twice daily",
      "C": "Ciprofloxacin 250 mg twice daily",
      "D": "None of the above",
      "E": "Ciprofloxacin 500 mg twice daily"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antibacterials"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "TS-AB-002",
    "patient_vignette": "A 73-year-old man with a urinary tract infection has an estimated CrCl of 22 mL/min. His physician is selecting an antibiotic regimen.",
    "question": "Which of the following antibiotic prescriptions is most appropriate given this patient's renal function?",
    "options": {
      "A": "None of the above",
      "B": "TMP-SMX DS (800/160 mg) twice daily",
      "C": "Ciprofloxacin 500 mg twice daily",
      "D": "Nitrofurantoin 100 mg twice daily",
      "E": "TMP-SMX SS (400/80 mg) twice daily"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antibacterials"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "TS-AB-003",
    "patient_vignette": "An 80-year-old woman with a urinary tract infection has an estimated CrCl of 10 mL/min. Her physician is selecting an antibiotic regimen.",
    "question": "Which of the following antibiotic prescriptions is most appropriate given this patient's renal function?",
    "options": {
      "A": "TMP-SMX DS (800/160 mg) twice daily",
      "B": "Ciprofloxacin 250 mg twice daily",
      "C": "Nitrofurantoin 100 mg twice daily",
      "D": "None of the above",
      "E": "TMP-SMX SS (400/80 mg) twice daily"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antibacterials"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "TS-AC-001",
    "patient_vignette": "A 76-year-old woman with non-valvular atrial fibrillation has an estimated CrCl of 22 mL/min. Her physician is selecting an anticoagulant for stroke prevention.",
    "question": "Which of the following anticoagulant prescriptions is most appropriate given this patient's renal function?",
    "options": {
      "A": "Edoxaban 60 mg daily",
      "B": "Warfarin with dose adjusted to target INR 2-3",
      "C": "Dabigatran 150 mg twice daily",
      "D": "Rivaroxaban 20 mg daily",
      "E": "None of the above"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "anticoagulants"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "TS-AC-002",
    "patient_vignette": "A 74-year-old man with non-valvular atrial fibrillation has an estimated CrCl of 22 mL/min. His physician is selecting an anticoagulant for stroke prevention.",
    "question": "Which of the following anticoagulant prescriptions is most appropriate given this patient's renal function?",
    "options": {
      "A": "Rivaroxaban 20 mg daily",
      "B": "Edoxaban 60 mg daily",
      "C": "None of the above",
      "D": "Dabigatran 110 mg twice daily",
      "E": "Apixaban 5 mg twice daily"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "anticoagulants"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "TS-PA-001",
    "patient_vignette": "A 71-year-old woman with osteoarthritis and chronic pain has an estimated CrCl of 20 mL/min. Her physician is selecting an analgesic.",
    "question": "Which of the following analgesic prescriptions is most appropriate given this patient's renal function?",
    "options": {
      "A": "None of the above",
      "B": "Tramadol ER 100 mg daily",
      "C": "Acetaminophen 500 mg every 6 hours",
      "D": "Naproxen 250 mg twice daily",
      "E": "Ibuprofen 400 mg three times daily"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "analgesics"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "TS-PA-002",
    "patient_vignette": "A 73-year-old man with chronic back pain has an estimated CrCl of 20 mL/min. His physician is selecting an analgesic. Acetaminophen has already been tried and provides insufficient pain relief.",
    "question": "Which of the following analgesic prescriptions is most appropriate given this patient's renal function?",
    "options": {
      "A": "None of the above",
      "B": "Tramadol IR 50 mg four times daily (200 mg/day)",
      "C": "Tramadol ER 200 mg daily",
      "D": "Celecoxib 200 mg daily",
      "E": "No oral analgesic is appropriate at this CrCl level"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "analgesics"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "SS-CF-SY-001-POS",
    "patient_vignette": "An 82-year-old woman with mild-to-moderate Alzheimer's disease presents to her neurologist for medication optimization. She has a documented history of recurrent syncope attributed to symptomatic bradycardia confirmed on Holter monitoring. She has no history of Parkinson's disease and no prior episodes of delirium. Renal and hepatic function are within normal limits.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Galantamine",
      "B": "None of the above",
      "C": "Donepezil",
      "D": "Rivastigmine",
      "E": "Famotidine"
    },
    "answer": [
      "A",
      "C",
      "D"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "cholinesterase inhibitors"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-SY-001-NEG",
    "patient_vignette": "An 82-year-old woman with mild-to-moderate Alzheimer's disease presents to her neurologist for medication optimization. She has no history of syncope or bradyarrhythmia. She has no history of Parkinson's disease and no prior episodes of delirium. Renal and hepatic function are within normal limits.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Galantamine",
      "B": "None of the above",
      "C": "Donepezil",
      "D": "Rivastigmine",
      "E": "Famotidine"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "cholinesterase inhibitors",
      "h2-receptor antagonists"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-SY-002-POS",
    "patient_vignette": "A 78-year-old man with lower urinary tract symptoms due to benign prostatic hyperplasia (BPH) and gastroparesis presents for medication review. He is being evaluated for alpha-1 blocker therapy to manage his LUTS. He has a documented history of recurrent syncope associated with orthostatic hypotension. He has no history of Parkinson's disease and has not had any episodes of delirium. He has no history of urinary incontinence.",
    "question": "Which of the following drugs is potentially inappropriate for this patient?",
    "options": {
      "A": "Doxazosin",
      "B": "None of the above",
      "C": "Terazosin",
      "D": "Metoclopramide",
      "E": "Prazosin"
    },
    "answer": [
      "A",
      "C",
      "E"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "alpha-1 receptor blockers"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-SY-002-NEG",
    "patient_vignette": "A 78-year-old man with lower urinary tract symptoms due to benign prostatic hyperplasia (BPH) and gastroparesis presents for medication review. He is being evaluated for alpha-1 blocker therapy to manage his LUTS. He has no history of syncope or orthostatic hypotension. He has no history of Parkinson's disease and has not had any episodes of delirium. He has no history of urinary incontinence.",
    "question": "Which of the following drugs is potentially inappropriate for this patient?",
    "options": {
      "A": "Doxazosin",
      "B": "None of the above",
      "C": "Terazosin",
      "D": "Metoclopramide",
      "E": "Prazosin"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "alpha-1 receptor blockers"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-SY-003-POS",
    "patient_vignette": "A 76-year-old man with schizophrenia and recurrent urinary tract infections presents for medication review. He has a documented history of recurrent syncope attributed to orthostatic hypotension. He has no history of delirium. His renal function is within normal limits (eGFR 68 mL/min/1.73 m²). He is not currently taking antipsychotic medications.",
    "question": "For this patient, which of the following medications should not be prescribed?",
    "options": {
      "A": "None of the above",
      "B": "Famotidine",
      "C": "Chlorpromazine",
      "D": "Olanzapine",
      "E": "Nitrofurantoin"
    },
    "answer": [
      "C",
      "D"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "antipsychotics"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk redistribution",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-SY-003-NEG",
    "patient_vignette": "A 76-year-old man with schizophrenia and recurrent urinary tract infections presents for medication review. He has no history of syncope or orthostatic hypotension. He has no history of delirium. His renal function is within normal limits (eGFR 68 mL/min/1.73 m²). He is not currently taking antipsychotic medications.",
    "question": "For this patient, which of the following medications should not be prescribed?",
    "options": {
      "A": "None of the above",
      "B": "Famotidine",
      "C": "Chlorpromazine",
      "D": "Olanzapine",
      "E": "Nitrofurantoin"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "h2-receptor antagonists",
      "antipsychotics",
      "antibacterials"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk redistribution",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-SY-004-POS",
    "patient_vignette": "An 80-year-old man with mild Alzheimer's disease, lower urinary tract symptoms due to benign prostatic hyperplasia (BPH), and gastroparesis presents for a comprehensive medication review. He is being evaluated for alpha-1 blocker therapy for LUTS and a cholinesterase inhibitor for Alzheimer's disease. He has a documented history of recurrent syncope with both a bradycardic component and orthostatic hypotension confirmed on tilt-table testing. He has no history of Parkinson's disease and no prior episodes of delirium.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Metoclopramide",
      "B": "None of the above",
      "C": "Doxazosin",
      "D": "Terazosin",
      "E": "Donepezil"
    },
    "answer": [
      "C",
      "D",
      "E"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "cholinesterase inhibitors",
      "alpha-1 receptor blockers"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-SY-004-NEG",
    "patient_vignette": "An 80-year-old man with mild Alzheimer's disease, lower urinary tract symptoms due to benign prostatic hyperplasia (BPH), and gastroparesis presents for a comprehensive medication review. He is being evaluated for alpha-1 blocker therapy for LUTS and a cholinesterase inhibitor for Alzheimer's disease. He has no history of syncope, bradyarrhythmia, or orthostatic hypotension. He has no history of Parkinson's disease and no prior episodes of delirium.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Metoclopramide",
      "B": "None of the above",
      "C": "Doxazosin",
      "D": "Terazosin",
      "E": "Donepezil"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "alpha-1 receptor blockers",
      "cholinesterase inhibitors"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-SY-005-POS",
    "patient_vignette": "A 79-year-old woman with mild Alzheimer's disease, schizophrenia, and recurrent urinary tract infections presents for medication review. She has a documented history of recurrent syncope attributed to orthostatic hypotension. She has no history of delirium. Her renal function is within normal limits (eGFR 68 mL/min/1.73 m²). She is not currently taking psychotropic medications or cholinesterase inhibitors.",
    "question": "Which of the following medications would be most appropriate to avoid in this patient?",
    "options": {
      "A": "None of the above",
      "B": "Famotidine",
      "C": "Donepezil",
      "D": "Nitrofurantoin",
      "E": "Chlorpromazine"
    },
    "answer": [
      "C",
      "E"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "antipsychotics",
      "cholinesterase inhibitors"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk redistribution",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-SY-005-NEG",
    "patient_vignette": "A 79-year-old woman with mild Alzheimer's disease, schizophrenia, and recurrent urinary tract infections presents for medication review. She has no history of syncope or orthostatic hypotension. She has no history of delirium. Her renal function is within normal limits (eGFR 68 mL/min/1.73 m²). She is not currently taking psychotropic medications or cholinesterase inhibitors.",
    "question": "Which of the following medications would be most appropriate to avoid in this patient?",
    "options": {
      "A": "None of the above",
      "B": "Famotidine",
      "C": "Donepezil",
      "D": "Nitrofurantoin",
      "E": "Chlorpromazine"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "h2-receptor antagonists",
      "cholinesterase inhibitors",
      "antibacterials",
      "antipsychotics"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk redistribution",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-HF-002-POS",
    "patient_vignette": "A 75-year-old man with paroxysmal atrial fibrillation, type 2 diabetes, and an acute musculoskeletal injury presents for medication review. He has symptomatic heart failure (NYHA Class III, LVEF 38%). He has no history of peptic ulcer disease, no history of Parkinson's disease, and is not taking anticoagulants or antiplatelet agents. Renal function is normal.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Dronedarone",
      "B": "None of the above",
      "C": "Pioglitazone",
      "D": "Prochlorperazine",
      "E": "Ibuprofen"
    },
    "answer": [
      "A",
      "C",
      "E"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "antiarrhythmics",
      "nsaids/antipyretic analgesics",
      "thiazolidinedione antidiabetics"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-HF-002-NEG",
    "patient_vignette": "A 75-year-old man with paroxysmal atrial fibrillation, type 2 diabetes, and an acute musculoskeletal injury presents for medication review. He has no history of heart failure and maintains normal cardiac function (LVEF 60%). He has no history of peptic ulcer disease, no history of Parkinson's disease, and is not taking anticoagulants or antiplatelet agents. Renal function is normal.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Dronedarone",
      "B": "None of the above",
      "C": "Pioglitazone",
      "D": "Prochlorperazine",
      "E": "Ibuprofen"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "antiarrhythmics",
      "thiazolidinedione antidiabetics",
      "nsaids/antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-HF-003-POS",
    "patient_vignette": "A 71-year-old man with symptomatic heart failure (NYHA Class II, LVEF 40%), peripheral arterial disease with intermittent claudication, and pseudobulbar affect presents for medication review. He has no history of Parkinson's disease and no prior episodes of delirium. Renal and hepatic function are normal.",
    "question": "Which of the following drugs is potentially inappropriate for this patient?",
    "options": {
      "A": "Famotidine",
      "B": "Dextromethorphan-quinidine",
      "C": "None of the above",
      "D": "Prochlorperazine",
      "E": "Cilostazol"
    },
    "answer": [
      "B",
      "E"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "pde3 inhibitors/peripheral vascular drugs",
      "antiarrhythmics"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-HF-003-NEG",
    "patient_vignette": "A 71-year-old man with peripheral arterial disease with intermittent claudication and pseudobulbar affect presents for medication review. He has no history of heart failure and maintains normal cardiac function (LVEF 62%). He has no history of Parkinson's disease and no prior episodes of delirium. Renal and hepatic function are normal.",
    "question": "Which of the following drugs is potentially inappropriate for this patient?",
    "options": {
      "A": "Famotidine",
      "B": "Dextromethorphan-quinidine",
      "C": "None of the above",
      "D": "Prochlorperazine",
      "E": "Cilostazol"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "h2-receptor antagonists",
      "antiarrhythmics",
      "pde3 inhibitors/peripheral vascular drugs"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-DE-001-POS",
    "patient_vignette": "An 84-year-old man with gastroesophageal reflux disease and nausea is admitted to the general medicine ward. He develops acute delirium during hospitalization. He has no history of Parkinson's disease. Renal and hepatic function are within normal limits.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Cimetidine",
      "B": "Famotidine",
      "C": "Nizatidine",
      "D": "Prochlorperazine",
      "E": "None of the above"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "h2-receptor antagonists"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-DE-001-NEG",
    "patient_vignette": "An 84-year-old man with gastroesophageal reflux disease and nausea is admitted to the general medicine ward for an elective procedure. He is alert and fully oriented with no history of delirium. He has no history of Parkinson's disease. Renal and hepatic function are within normal limits.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Cimetidine",
      "B": "Famotidine",
      "C": "Nizatidine",
      "D": "Prochlorperazine",
      "E": "None of the above"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "h2-receptor antagonists"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-DE-002-POS",
    "patient_vignette": "An 80-year-old woman with chronic musculoskeletal pain is admitted to hospital following elective abdominal surgery. She develops acute delirium on post-operative day two. She has no history of dementia or cognitive impairment. She has no history of falls or fractures. She has no history of syncope or bradyarrhythmia. Renal and hepatic function are normal.",
    "question": "Which of the following drugs is potentially inappropriate for this patient?",
    "options": {
      "A": "Morphine",
      "B": "Hydromorphone",
      "C": "Oxycodone",
      "D": "None of the above",
      "E": "Donepezil"
    },
    "answer": [
      "A",
      "B",
      "C"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "opioids"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk redistribution",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-DE-002-NEG",
    "patient_vignette": "An 80-year-old woman with chronic musculoskeletal pain is admitted to hospital following elective abdominal surgery. She has no history of delirium and remains cognitively at baseline post-operatively. She has no history of dementia or cognitive impairment. She has no history of falls or fractures. She has no history of syncope or bradyarrhythmia. Renal and hepatic function are normal.",
    "question": "Which of the following drugs is potentially inappropriate for this patient?",
    "options": {
      "A": "Morphine",
      "B": "Hydromorphone",
      "C": "Oxycodone",
      "D": "None of the above",
      "E": "Donepezil"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "opioids",
      "cholinesterase inhibitors"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk redistribution",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-DE-003-POS",
    "patient_vignette": "An 81-year-old man admitted to a medical ward develops acute delirium. He has an acute musculoskeletal injury requiring short-term pain management. He has no history of peptic ulcer disease and no history of heart failure. He has no history of falls or fractures. He is not taking anticoagulants or antiplatelet agents. Renal and hepatic function are within normal limits.",
    "question": "For this patient, which of the following medications should not be prescribed?",
    "options": {
      "A": "Risperidone",
      "B": "None of the above",
      "C": "Chlorpromazine",
      "D": "Ibuprofen",
      "E": "Haloperidol"
    },
    "answer": [
      "A",
      "C",
      "E"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "antipsychotics"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk redistribution",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-DE-003-NEG",
    "patient_vignette": "An 81-year-old man with schizophrenia and an acute musculoskeletal injury presents for outpatient medication review. He has no history of delirium and is fully oriented. He has no history of peptic ulcer disease and no history of heart failure. He has no history of falls or fractures. He is not taking anticoagulants or antiplatelet agents. Renal and hepatic function are within normal limits.",
    "question": "For this patient, which of the following medications should not be prescribed?",
    "options": {
      "A": "Risperidone",
      "B": "None of the above",
      "C": "Chlorpromazine",
      "D": "Ibuprofen",
      "E": "Haloperidol"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "antipsychotics",
      "nsaids/antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk redistribution",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-DE-004-POS",
    "patient_vignette": "An 83-year-old man with gastroesophageal reflux disease, chronic musculoskeletal pain, and nausea is admitted to hospital. He develops acute delirium on hospital day one. He has no history of Parkinson's disease. He has no history of dementia or cognitive impairment. He has no history of falls or fractures. Renal and hepatic function are within normal limits.",
    "question": "Which of the following medications would be most appropriate to avoid in this patient?",
    "options": {
      "A": "None of the above",
      "B": "Famotidine",
      "C": "Morphine",
      "D": "Prochlorperazine",
      "E": "Oxycodone"
    },
    "answer": [
      "B",
      "C",
      "E"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "h2-receptor antagonists",
      "opioids"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk redistribution",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-DE-004-NEG",
    "patient_vignette": "An 83-year-old man with gastroesophageal reflux disease, chronic musculoskeletal pain, and nausea presents to the outpatient clinic. He is alert and fully oriented with no history of delirium. He has no history of Parkinson's disease. He has no history of dementia or cognitive impairment. He has no history of falls or fractures. Renal and hepatic function are within normal limits.",
    "question": "Which of the following medications would be most appropriate to avoid in this patient?",
    "options": {
      "A": "None of the above",
      "B": "Famotidine",
      "C": "Morphine",
      "D": "Prochlorperazine",
      "E": "Oxycodone"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "h2-receptor antagonists",
      "opioids"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk redistribution",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-DE-005-POS",
    "patient_vignette": "An 86-year-old woman with chronic obstructive pulmonary disease and chronic back pain is admitted to hospital with a COPD exacerbation. She develops delirium on day two of admission. She has no history of dementia. She has no history of falls or fractures. She has no history of syncope or bradyarrhythmia. Renal and hepatic function are normal.",
    "question": "Which of the following should be avoided when prescribing medications for this patient?",
    "options": {
      "A": "None of the above",
      "B": "Prednisone",
      "C": "Hydromorphone",
      "D": "Donepezil",
      "E": "Methylprednisolone"
    },
    "answer": [
      "B",
      "C",
      "E"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "multiple drug categories (composite rules)"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-DE-005-NEG",
    "patient_vignette": "An 86-year-old woman with chronic obstructive pulmonary disease and chronic back pain presents for outpatient medication review. She has no history of delirium and is not considered at high risk for delirium. She has no history of dementia. She has no history of falls or fractures. She has no history of syncope or bradyarrhythmia. Renal and hepatic function are normal.",
    "question": "Which of the following should be avoided when prescribing medications for this patient?",
    "options": {
      "A": "None of the above",
      "B": "Prednisone",
      "C": "Hydromorphone",
      "D": "Donepezil",
      "E": "Methylprednisolone"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "cholinesterase inhibitors"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-DE-006-POS",
    "patient_vignette": "A 84-year-old man with rheumatoid arthritis is admitted to hospital. He develops acute delirium on day one of admission. He requires treatment for an acute flare of his rheumatoid arthritis. He has no history of dementia or cognitive impairment. He has no history of syncope or bradyarrhythmia. Renal and hepatic function are within normal limits.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "None of the above",
      "B": "Methylprednisolone",
      "C": "Dexamethasone",
      "D": "Donepezil",
      "E": "Prednisone"
    },
    "answer": [
      "B",
      "C",
      "E"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "multiple drug categories (composite rules)"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk redistribution",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-DE-006-NEG",
    "patient_vignette": "A 84-year-old man with rheumatoid arthritis presents for outpatient medication review. He requires treatment for an acute flare of his rheumatoid arthritis. He has no history of delirium and is not at elevated risk for delirium. He has no history of dementia or cognitive impairment. He has no history of syncope or bradyarrhythmia. Renal and hepatic function are within normal limits.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "None of the above",
      "B": "Methylprednisolone",
      "C": "Dexamethasone",
      "D": "Donepezil",
      "E": "Prednisone"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "cholinesterase inhibitors"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk redistribution",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-DM-001-POS",
    "patient_vignette": "An 85-year-old woman with moderate Alzheimer's disease and behavioral and psychological symptoms of dementia (BPSD) presents for psychiatric medication review. She is at her cognitive baseline with no active delirium. She has no history of falls or fractures. She has no history of Parkinson's disease. She has no history of syncope or orthostatic hypotension. Renal and hepatic function are within normal limits.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Fluphenazine",
      "B": "Prochlorperazine",
      "C": "Chlorpromazine",
      "D": "None of the above",
      "E": "Famotidine"
    },
    "answer": [
      "A",
      "C"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "antipsychotics"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-DM-001-NEG",
    "patient_vignette": "An 85-year-old woman with late-onset schizophrenia presents for psychiatric medication review. She has no history of dementia or cognitive impairment. She has no active delirium. She has no history of falls or fractures. She has no history of Parkinson's disease. She has no history of syncope or orthostatic hypotension. Renal and hepatic function are within normal limits.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Fluphenazine",
      "B": "Prochlorperazine",
      "C": "Chlorpromazine",
      "D": "None of the above",
      "E": "Famotidine"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "antipsychotics",
      "h2-receptor antagonists"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-DM-002-POS",
    "patient_vignette": "A 78-year-old man with mild-to-moderate Alzheimer's disease and behavioral disturbance presents for psychiatric medication review. He has an acute musculoskeletal injury requiring short-term pain management. He is at his cognitive baseline with no active delirium. He has no history of falls or fractures. He has no history of syncope or bradyarrhythmia. He has no history of peptic ulcer disease and no history of heart failure. He is not taking anticoagulants or antiplatelet agents. Renal and hepatic function are normal.",
    "question": "Which of the following drugs is potentially inappropriate for this patient?",
    "options": {
      "A": "Quetiapine",
      "B": "Ibuprofen",
      "C": "Aripiprazole",
      "D": "None of the above",
      "E": "Donepezil"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "antipsychotics"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-DM-002-NEG",
    "patient_vignette": "A 78-year-old man with major depressive disorder (treatment-resistant) and an acute musculoskeletal injury presents for psychiatric medication review. He has no history of dementia or cognitive impairment. He has no active delirium. He has no history of falls or fractures. He has no history of syncope or bradyarrhythmia. He has no history of peptic ulcer disease and no history of heart failure. He is not taking anticoagulants or antiplatelet agents. Renal and hepatic function are normal.",
    "question": "Which of the following drugs is potentially inappropriate for this patient?",
    "options": {
      "A": "Quetiapine",
      "B": "Ibuprofen",
      "C": "Aripiprazole",
      "D": "None of the above",
      "E": "Donepezil"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "antipsychotics",
      "nsaids/antipyretic analgesics",
      "cholinesterase inhibitors"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-DM-003-POS",
    "patient_vignette": "An 82-year-old woman with moderate Alzheimer's disease and behavioral and psychological symptoms of dementia (BPSD) presents for psychiatric medication review. She has no active delirium. She has no history of falls or fractures. She has no history of Parkinson's disease. She has no history of syncope or orthostatic hypotension. Renal and hepatic function are normal.",
    "question": "Which of the following drugs is potentially inappropriate for this patient?",
    "options": {
      "A": "Quetiapine",
      "B": "Olanzapine",
      "C": "Risperidone",
      "D": "None of the above",
      "E": "Haloperidol"
    },
    "answer": [
      "B",
      "C",
      "E"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "antipsychotics"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk redistribution",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-DM-003-NEG",
    "patient_vignette": "An 82-year-old woman with late-onset bipolar disorder and psychotic features presents for psychiatric medication review. She has no history of dementia or cognitive impairment. She has no active delirium. She has no history of falls or fractures. She has no history of Parkinson's disease. She has no history of syncope or orthostatic hypotension. Renal and hepatic function are normal.",
    "question": "Which of the following drugs is potentially inappropriate for this patient?",
    "options": {
      "A": "Quetiapine",
      "B": "Olanzapine",
      "C": "Risperidone",
      "D": "None of the above",
      "E": "Haloperidol"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "antipsychotics"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk redistribution",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-FA-001-POS",
    "patient_vignette": "A 77-year-old man with schizophrenia and a documented history of recurrent falls presents for medication review. His most recent fall resulted in a wrist fracture. He has no history of Parkinson's disease. He has no active delirium and no history of dementia. Renal and hepatic function are normal.",
    "question": "Which of the following drugs is potentially inappropriate for this patient?",
    "options": {
      "A": "None of the above",
      "B": "Quetiapine",
      "C": "Prochlorperazine",
      "D": "Haloperidol",
      "E": "Risperidone"
    },
    "answer": [
      "B",
      "D",
      "E"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "antipsychotics"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk redistribution",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-FA-001-NEG",
    "patient_vignette": "A 77-year-old man with schizophrenia presents for medication review. He has no history of falls or fractures. He has no history of Parkinson's disease. He has no active delirium and no history of dementia. Renal and hepatic function are normal.",
    "question": "Which of the following drugs is potentially inappropriate for this patient?",
    "options": {
      "A": "None of the above",
      "B": "Quetiapine",
      "C": "Prochlorperazine",
      "D": "Haloperidol",
      "E": "Risperidone"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "antipsychotics"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk redistribution",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-FA-002-POS",
    "patient_vignette": "A 79-year-old woman with major depressive disorder presents for medication review. She has a documented history of recurrent falls, with one resulting in a vertebral compression fracture. She has no history of syncope or bradyarrhythmia. She has no active delirium and no history of dementia. She has no history of Parkinson's disease. Renal and hepatic function are normal.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Fluoxetine",
      "B": "Citalopram",
      "C": "Donepezil",
      "D": "None of the above",
      "E": "Escitalopram"
    },
    "answer": [
      "A",
      "B",
      "E"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "multiple drug categories (composite rules)"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-FA-002-NEG",
    "patient_vignette": "A 79-year-old woman with major depressive disorder presents for medication review. She has no history of falls or fractures. She has no history of syncope or bradyarrhythmia. She has no active delirium and no history of dementia. She has no history of Parkinson's disease. Renal and hepatic function are normal.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Fluoxetine",
      "B": "Citalopram",
      "C": "Donepezil",
      "D": "None of the above",
      "E": "Escitalopram"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "cholinesterase inhibitors"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-FA-003-POS",
    "patient_vignette": "An 80-year-old man with major depressive disorder, diabetic neuropathy, and gastroesophageal reflux disease presents for medication review. He has a documented history of multiple falls, including one that resulted in a hip fracture. He has no active delirium. He has no history of Parkinson's disease. He has no history of seizures or mood disorders requiring anticonvulsants. He has no history of syncope or orthostatic hypotension. Renal and hepatic function are normal.",
    "question": "For this patient, which of the following medications should not be prescribed?",
    "options": {
      "A": "Venlafaxine",
      "B": "Gabapentin",
      "C": "Duloxetine",
      "D": "Famotidine",
      "E": "None of the above"
    },
    "answer": [
      "A",
      "B",
      "C"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "gabapentinoids"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-FA-003-NEG",
    "patient_vignette": "An 80-year-old man with major depressive disorder, diabetic neuropathy, and gastroesophageal reflux disease presents for medication review. He has no history of falls or fractures. He has no active delirium. He has no history of Parkinson's disease. He has no history of seizures or mood disorders requiring anticonvulsants. He has no history of syncope or orthostatic hypotension. Renal and hepatic function are normal.",
    "question": "For this patient, which of the following medications should not be prescribed?",
    "options": {
      "A": "Venlafaxine",
      "B": "Gabapentin",
      "C": "Duloxetine",
      "D": "Famotidine",
      "E": "None of the above"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "gabapentinoids",
      "h2-receptor antagonists"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-FA-004-POS",
    "patient_vignette": "An 83-year-old woman with schizophrenia and peripheral neuropathic pain presents for medication review. She has a documented history of recurrent falls. She has no history of syncope or bradyarrhythmia. She has no active delirium. She has no history of seizures or mood disorders requiring anticonvulsant therapy. Renal and hepatic function are normal.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Donepezil",
      "B": "None of the above",
      "C": "Gabapentin",
      "D": "Olanzapine",
      "E": "Pregabalin"
    },
    "answer": [
      "C",
      "D",
      "E"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "antipsychotics",
      "gabapentinoids"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-FA-004-NEG",
    "patient_vignette": "An 83-year-old woman with schizophrenia and peripheral neuropathic pain presents for medication review. She has no history of falls or fractures. She has no history of syncope or bradyarrhythmia. She has no active delirium. She has no history of seizures or mood disorders requiring anticonvulsant therapy. Renal and hepatic function are normal.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Donepezil",
      "B": "None of the above",
      "C": "Gabapentin",
      "D": "Olanzapine",
      "E": "Pregabalin"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "cholinesterase inhibitors",
      "gabapentinoids",
      "antipsychotics"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-FA-005-POS",
    "patient_vignette": "An 81-year-old woman with major depressive disorder, chronic non-cancer musculoskeletal pain, and gastroesophageal reflux disease presents for medication review. She has a documented history of falls, the most recent of which resulted in a forearm fracture. She has no active delirium and no history of dementia. She has no history of Parkinson's disease. Renal and hepatic function are normal.",
    "question": "Which of the following medications would be most appropriate to avoid in this patient?",
    "options": {
      "A": "Morphine",
      "B": "Famotidine",
      "C": "None of the above",
      "D": "Sertraline",
      "E": "Venlafaxine"
    },
    "answer": [
      "A",
      "D",
      "E"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "opioids"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-FA-005-NEG",
    "patient_vignette": "An 81-year-old woman with major depressive disorder, chronic non-cancer musculoskeletal pain, and gastroesophageal reflux disease presents for medication review. She has no history of falls or fractures. She has no active delirium and no history of dementia. She has no history of Parkinson's disease. Renal and hepatic function are normal.",
    "question": "Which of the following medications would be most appropriate to avoid in this patient?",
    "options": {
      "A": "Morphine",
      "B": "Famotidine",
      "C": "None of the above",
      "D": "Sertraline",
      "E": "Venlafaxine"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "opioids",
      "h2-receptor antagonists"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-FA-006-POS",
    "patient_vignette": "A 78-year-old man with chronic non-cancer low back pain presents for medication review. He has a documented history of recurrent falls. He has no history of Parkinson's disease. He has no active delirium and no history of dementia. He has no history of syncope. Renal and hepatic function are normal.",
    "question": "For this patient, which of the following medications should not be prescribed?",
    "options": {
      "A": "Tramadol",
      "B": "Prochlorperazine",
      "C": "None of the above",
      "D": "Oxycodone",
      "E": "Morphine"
    },
    "answer": [
      "A",
      "D",
      "E"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "opioids"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-FA-006-NEG",
    "patient_vignette": "A 78-year-old man with chronic non-cancer low back pain presents for medication review. He has no history of falls or fractures. He has no history of Parkinson's disease. He has no active delirium and no history of dementia. He has no history of syncope. Renal and hepatic function are normal.",
    "question": "For this patient, which of the following medications should not be prescribed?",
    "options": {
      "A": "Tramadol",
      "B": "Prochlorperazine",
      "C": "None of the above",
      "D": "Oxycodone",
      "E": "Morphine"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "opioids"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-PD-002-POS",
    "patient_vignette": "A 78-year-old woman with Parkinson's disease and Parkinson's disease psychosis presents for psychiatric medication review. She has no active delirium. She has no history of falls or fractures. She has no history of dementia. She has no history of syncope or orthostatic hypotension. Renal and hepatic function are normal.",
    "question": "Which of the following drugs is potentially inappropriate for this patient?",
    "options": {
      "A": "Haloperidol",
      "B": "Quetiapine",
      "C": "Olanzapine",
      "D": "None of the above",
      "E": "Risperidone"
    },
    "answer": [
      "A",
      "C",
      "E"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "antipsychotics"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-PD-002-NEG",
    "patient_vignette": "A 78-year-old woman with late-onset bipolar disorder and psychotic features presents for psychiatric medication review. She has no history of Parkinson's disease or parkinsonism. She has no active delirium, no history of falls or fractures, no history of dementia, and no history of syncope or orthostatic hypotension. Renal and hepatic function are normal.",
    "question": "Which of the following drugs is potentially inappropriate for this patient?",
    "options": {
      "A": "Haloperidol",
      "B": "Quetiapine",
      "C": "Olanzapine",
      "D": "None of the above",
      "E": "Risperidone"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "antipsychotics"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-PD-003-POS",
    "patient_vignette": "A 76-year-old man with Parkinson's disease, Parkinson's disease psychosis, and gastroparesis presents for a comprehensive medication review. He has nausea related to delayed gastric emptying. He has no active delirium. He has no history of falls or fractures. Renal and hepatic function are normal.",
    "question": "Which of the following should be avoided when prescribing medications for this patient?",
    "options": {
      "A": "Famotidine",
      "B": "Quetiapine",
      "C": "Haloperidol",
      "D": "None of the above",
      "E": "Metoclopramide"
    },
    "answer": [
      "C",
      "E"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "antipsychotics"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-PD-003-NEG",
    "patient_vignette": "A 76-year-old man with late-onset schizophrenia and gastroparesis presents for a comprehensive medication review. He has nausea related to delayed gastric emptying. He has no history of Parkinson's disease or parkinsonism. He has no active delirium, no history of falls or fractures, and no history of dementia. Renal and hepatic function are normal.",
    "question": "Which of the following should be avoided when prescribing medications for this patient?",
    "options": {
      "A": "Famotidine",
      "B": "Quetiapine",
      "C": "Haloperidol",
      "D": "None of the above",
      "E": "Metoclopramide"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "h2-receptor antagonists",
      "antipsychotics"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-PU-001-POS",
    "patient_vignette": "A 73-year-old man with a documented history of peptic ulcer disease and an acute musculoskeletal injury presents for pain management review. He is not currently taking a proton-pump inhibitor or misoprostol. He is not taking anticoagulants or antiplatelet agents. He has no history of syncope or bradyarrhythmia. Renal and hepatic function are normal.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Naproxen",
      "B": "Diclofenac",
      "C": "Donepezil",
      "D": "Ibuprofen",
      "E": "None of the above"
    },
    "answer": [
      "A",
      "B",
      "D"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "nsaids/antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-PU-001-NEG",
    "patient_vignette": "A 73-year-old man with an acute musculoskeletal injury presents for pain management review. He has no history of peptic ulcer disease. He is not currently taking a proton-pump inhibitor or misoprostol. He is not taking anticoagulants or antiplatelet agents. He has no history of syncope or bradyarrhythmia. Renal and hepatic function are normal.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Naproxen",
      "B": "Diclofenac",
      "C": "Donepezil",
      "D": "Ibuprofen",
      "E": "None of the above"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "nsaids/antipyretic analgesics",
      "cholinesterase inhibitors"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-PU-003-POS",
    "patient_vignette": "A 76-year-old man with a documented history of peptic ulcer disease and an acute musculoskeletal injury presents for pain management review. He is not currently taking a proton-pump inhibitor or misoprostol. He is not taking anticoagulants or antiplatelet agents. He has no history of Parkinson's disease. Renal and hepatic function are normal.",
    "question": "For this patient, which of the following medications should not be prescribed?",
    "options": {
      "A": "Ibuprofen",
      "B": "Diclofenac",
      "C": "Naproxen",
      "D": "Celecoxib",
      "E": "None of the above"
    },
    "answer": [
      "A",
      "B",
      "C"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "nsaids/antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-PU-003-NEG",
    "patient_vignette": "A 76-year-old man with an acute musculoskeletal injury presents for pain management review. He has no history of peptic ulcer disease. He is not currently taking a proton-pump inhibitor or misoprostol. He is not taking anticoagulants or antiplatelet agents. He has no history of Parkinson's disease. Renal and hepatic function are normal.",
    "question": "For this patient, which of the following medications should not be prescribed?",
    "options": {
      "A": "Ibuprofen",
      "B": "Diclofenac",
      "C": "Naproxen",
      "D": "Celecoxib",
      "E": "None of the above"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "nsaids/antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-HF-001-HFREF",
    "patient_vignette": "A 73-year-old man with heart failure with reduced ejection fraction (HFrEF, LVEF 32%) presents for medication optimization. He is currently asymptomatic on guideline-directed medical therapy. He has no history of Parkinson's disease and no prior episodes of delirium. Renal function is normal.",
    "question": "Which of the following drugs is potentially inappropriate for this patient?",
    "options": {
      "A": "Cilostazol",
      "B": "Dextromethorphan-quinidine",
      "C": "None of the above",
      "D": "Diltiazem",
      "E": "Verapamil"
    },
    "answer": [
      "A",
      "B",
      "D",
      "E"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "calcium-channel blockers",
      "pde3 inhibitors/peripheral vascular drugs",
      "antiarrhythmics"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-HF-001-HFPEF",
    "patient_vignette": "A 73-year-old man with heart failure with preserved ejection fraction (HFpEF, LVEF 58%) presents for medication optimization. He is currently asymptomatic on guideline-directed medical therapy. He has no history of Parkinson's disease and no prior episodes of delirium. Renal function is normal.",
    "question": "Which of the following drugs is potentially inappropriate for this patient?",
    "options": {
      "A": "Cilostazol",
      "B": "Dextromethorphan-quinidine",
      "C": "None of the above",
      "D": "Diltiazem",
      "E": "Verapamil"
    },
    "answer": [
      "A",
      "B"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "pde3 inhibitors/peripheral vascular drugs",
      "antiarrhythmics"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "SS-CF-HF-001-NOHF",
    "patient_vignette": "A 73-year-old man with normal cardiac function (LVEF 62%, normal echocardiogram) presents for medication review. He has no history of heart failure. He has no history of Parkinson's disease and no prior episodes of delirium. Renal function is normal.",
    "question": "Which of the following drugs is potentially inappropriate for this patient?",
    "options": {
      "A": "Cilostazol",
      "B": "Dextromethorphan-quinidine",
      "C": "None of the above",
      "D": "Diltiazem",
      "E": "Verapamil"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "pde3 inhibitors/peripheral vascular drugs",
      "antiarrhythmics",
      "calcium-channel blockers"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "CS-CF-HF-001-A",
    "patient_vignette": "A 74-year-old woman with heart failure with reduced ejection fraction (HFrEF; echocardiography: LVEF 28%, NYHA class III) presents for medication reconciliation. She is maintained on guideline-directed medical therapy (sacubitril-valsartan, carvedilol, spironolactone, dapagliflozin). She has no history of peptic ulcer disease, Parkinson's disease, or syncope. She has no active delirium and no history of recurrent falls. Hepatic and renal function are within normal limits.",
    "question": "Which of the following drugs is potentially inappropriate for this patient?",
    "options": {
      "A": "Dextromethorphan-quinidine",
      "B": "Verapamil",
      "C": "None of the above",
      "D": "Diltiazem",
      "E": "Cilostazol"
    },
    "answer": [
      "A",
      "B",
      "D",
      "E"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "pde3 inhibitors/peripheral vascular drugs",
      "antiarrhythmics",
      "calcium-channel blockers"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk redistribution",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "CS-CF-HF-001-B",
    "patient_vignette": "A 74-year-old woman with heart failure with preserved ejection fraction (HFpEF; echocardiography: LVEF 62%, diastolic dysfunction grade II, NYHA class II) presents for medication reconciliation. She is maintained on diuretics for symptom control and antihypertensives for blood pressure management. She has no history of peptic ulcer disease, Parkinson's disease, or syncope. She has no active delirium and no history of recurrent falls. Hepatic and renal function are within normal limits.",
    "question": "Which of the following drugs is potentially inappropriate for this patient?",
    "options": {
      "A": "Dextromethorphan-quinidine",
      "B": "Verapamil",
      "C": "Diltiazem",
      "D": "None of the above",
      "E": "Cilostazol"
    },
    "answer": [
      "A",
      "E"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "pde3 inhibitors/peripheral vascular drugs",
      "antiarrhythmics"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk redistribution",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "CS-CF-NS-001-A",
    "patient_vignette": "A 79-year-old man with symptomatic heart failure (LVEF 38%, NYHA class II) presents with moderate-to-severe osteoarthritis pain of the right knee requiring analgesic therapy. He has no history of peptic ulcer disease and is not currently taking corticosteroids, anticoagulants, or antiplatelet agents. He has no active delirium, no history of recurrent falls, and no history of Parkinson's disease or syncope. Renal function: eGFR 62 mL/min/1.73m².",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Ibuprofen",
      "B": "Celecoxib",
      "C": "None of the above",
      "D": "Naproxen",
      "E": "Acetaminophen"
    },
    "answer": [
      "A",
      "B",
      "D"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "nsaids/antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk redistribution",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "CS-CF-NS-001-B",
    "patient_vignette": "A 79-year-old man with a history of peptic ulcer disease (confirmed by upper endoscopy 8 months ago; Helicobacter pylori eradicated; no current PPI therapy) presents with moderate-to-severe osteoarthritis pain of the right knee requiring analgesic therapy. He has no history of heart failure (LVEF 60% on recent echocardiogram) and is not currently taking corticosteroids, anticoagulants, or antiplatelet agents. He has no active delirium, no history of recurrent falls, and no history of Parkinson's disease or syncope. Renal function: eGFR 62 mL/min/1.73m².",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Ibuprofen",
      "B": "None of the above",
      "C": "Celecoxib",
      "D": "Naproxen",
      "E": "Acetaminophen"
    },
    "answer": [
      "A",
      "D"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "nsaids/antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk redistribution",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "CS-CF-OP-001-A",
    "patient_vignette": "An 82-year-old woman is on postoperative day 1 following emergency repair of a right femoral neck fracture. She is experiencing severe acute postoperative pain (NRS 9/10) and has developed hyperactive delirium (Confusion Assessment Method [CAM] positive). She has NO prior history of recurrent falls or fractures before this admission. She has no history of heart failure, Parkinson's disease, syncope, or peptic ulcer disease. She is not receiving anticoagulation therapy.",
    "question": "Which of the following should be avoided when prescribing medications for this patient?",
    "options": {
      "A": "Acetaminophen",
      "B": "Morphine",
      "C": "Celecoxib",
      "D": "Oxycodone",
      "E": "None of the above"
    },
    "answer": [
      "B",
      "D"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "opioids"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "CS-CF-OP-001-B",
    "patient_vignette": "An 82-year-old woman is on postoperative day 1 following elective right total hip arthroplasty for severe osteoarthritis. She is experiencing severe acute postoperative pain (NRS 9/10) and remains cognitively intact and fully oriented (CAM negative; no delirium). She has a documented history of recurrent falls (three falls in the preceding 12 months). She has no history of heart failure, Parkinson's disease, syncope, or peptic ulcer disease. She is not receiving anticoagulation therapy.",
    "question": "Which of the following should be avoided when prescribing medications for this patient?",
    "options": {
      "A": "Acetaminophen",
      "B": "Morphine",
      "C": "None of the above",
      "D": "Celecoxib",
      "E": "Oxycodone"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "antipyretic analgesics",
      "opioids",
      "nsaids/antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "CS-CF-AD-001-A",
    "patient_vignette": "A 77-year-old woman with major depressive disorder is being evaluated for antidepressant pharmacotherapy. She has a documented history of vasovagal syncope (confirmed by head-up tilt table test; one episode in the past 4 months). She has NO prior history of recurrent falls or fractures. She has no active delirium, no Parkinson's disease, no heart failure, and no peptic ulcer disease. Renal and hepatic function are normal.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Amitriptyline",
      "B": "None of the above",
      "C": "Sertraline",
      "D": "Venlafaxine",
      "E": "Bupropion"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "tricyclic antidepressants"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk redistribution",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "CS-CF-AD-001-B",
    "patient_vignette": "A 77-year-old woman with major depressive disorder is being evaluated for antidepressant pharmacotherapy. She has a documented history of recurrent falls (two falls in the preceding 6 months, one resulting in a distal radius fracture). She has NO history of syncope. She has no active delirium, no Parkinson's disease, no heart failure, and no peptic ulcer disease. Renal and hepatic function are normal.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Amitriptyline",
      "B": "Sertraline",
      "C": "Venlafaxine",
      "D": "Bupropion",
      "E": "None of the above"
    },
    "answer": [
      "A",
      "B",
      "C"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "tricyclic antidepressants"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk redistribution",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "CS-CF-A1-001-A",
    "patient_vignette": "A 76-year-old man with benign prostatic hyperplasia (BPH) managed with alpha-1 adrenergic blocker therapy for lower urinary tract symptoms (LUTS) presents after a witnessed syncopal episode (orthostatic hypotension confirmed on tilt table test). He has no urinary incontinence. He has no history of Parkinson's disease, recurrent falls, heart failure, or peptic ulcer disease. He has no active delirium.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Prazosin",
      "B": "Doxazosin",
      "C": "Terazosin",
      "D": "Tamsulosin",
      "E": "None of the above"
    },
    "answer": [
      "A",
      "B",
      "C"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "alpha-1 receptor blockers"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "CS-CF-A1-001-B",
    "patient_vignette": "A 76-year-old man presents with urinary urgency and urgency incontinence of 6 months' duration. He has no history of syncope or orthostatic hypotension. His urologist is considering alpha-1 adrenergic blocker therapy for symptom management. He has no history of Parkinson's disease, recurrent falls, heart failure, or peptic ulcer disease. He has no active delirium.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Prazosin",
      "B": "Doxazosin",
      "C": "None of the above",
      "D": "Terazosin",
      "E": "Tamsulosin"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "alpha-1 receptor blockers"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "CS-CF-HF-002-A",
    "patient_vignette": "A 78-year-old man with heart failure with preserved ejection fraction (HFpEF; echocardiography: LVEF 64%, diastolic dysfunction grade II, NYHA class II) presents with newly developed bilateral lower extremity edema. He is managed with hydrochlorothiazide and a low-sodium diet. He has no history of peptic ulcer disease, Parkinson's disease, or syncope. He has no active delirium and no history of recurrent falls. Hepatic and renal function are within normal limits.",
    "question": "Which of the following drugs is potentially inappropriate for this patient?",
    "options": {
      "A": "Diltiazem",
      "B": "Cilostazol",
      "C": "Verapamil",
      "D": "Dextromethorphan-quinidine",
      "E": "None of the above"
    },
    "answer": [
      "B",
      "D"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "pde3 inhibitors/peripheral vascular drugs",
      "antiarrhythmics"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "CS-CF-HF-002-B",
    "patient_vignette": "A 78-year-old man with normal cardiac function (recent echocardiogram: LVEF 64%, no diastolic dysfunction, no history of heart failure) presents for a routine medication safety review. He has no history of peptic ulcer disease, Parkinson's disease, or syncope. He has no active delirium and no history of recurrent falls. Hepatic and renal function are within normal limits.",
    "question": "Which of the following drugs is potentially inappropriate for this patient?",
    "options": {
      "A": "Diltiazem",
      "B": "Cilostazol",
      "C": "None of the above",
      "D": "Verapamil",
      "E": "Dextromethorphan-quinidine"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "calcium-channel blockers",
      "pde3 inhibitors/peripheral vascular drugs",
      "antiarrhythmics"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "CS-CF-NS-002-A",
    "patient_vignette": "An 81-year-old woman with symptomatic heart failure (LVEF 40%, NYHA class III, exertional dyspnea and lower extremity edema) and a documented history of peptic ulcer disease (upper endoscopy confirmed; currently on pantoprazole) presents with moderate musculoskeletal shoulder pain requiring analgesic therapy. She is not taking anticoagulants or antiplatelet agents. She has no active delirium, no history of recurrent falls, and no history of Parkinson's disease or syncope. Renal function: eGFR 65 mL/min/1.73m².",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Celecoxib",
      "B": "Ibuprofen",
      "C": "None of the above",
      "D": "Acetaminophen",
      "E": "Naproxen"
    },
    "answer": [
      "A",
      "B",
      "E"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "nsaids/antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk redistribution",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "CS-CF-NS-002-B",
    "patient_vignette": "An 81-year-old woman with asymptomatic heart failure (LVEF 45%, NYHA class I — no dyspnea at rest or with minimal exertion, no peripheral edema) and a documented history of peptic ulcer disease (upper endoscopy confirmed; currently on pantoprazole) presents with moderate musculoskeletal shoulder pain requiring analgesic therapy. She is not taking anticoagulants or antiplatelet agents. She has no active delirium, no history of recurrent falls, and no history of Parkinson's disease or syncope. Renal function: eGFR 65 mL/min/1.73m².",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Celecoxib",
      "B": "None of the above",
      "C": "Ibuprofen",
      "D": "Acetaminophen",
      "E": "Naproxen"
    },
    "answer": [
      "C",
      "E"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "nsaids/antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk redistribution",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "CS-CF-OP-002-A",
    "patient_vignette": "A 77-year-old man with a documented history of recurrent falls (two falls in the preceding year) is on postoperative day 1 following open reduction and internal fixation of a right tibial plateau fracture. He is experiencing severe acute postoperative pain (NRS 8/10) and has developed hypoactive delirium (Confusion Assessment Method [CAM] positive; new-onset inattention and disorganized thinking). He has no history of heart failure, Parkinson's disease, syncope, or peptic ulcer disease. He is not receiving anticoagulation therapy.",
    "question": "Which of the following should be avoided when prescribing medications for this patient?",
    "options": {
      "A": "None of the above",
      "B": "Acetaminophen",
      "C": "Morphine",
      "D": "Oxycodone",
      "E": "Celecoxib"
    },
    "answer": [
      "C",
      "D"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "opioids"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "CS-CF-OP-002-B",
    "patient_vignette": "A 77-year-old man with a documented history of recurrent falls (two falls in the preceding year) is on postoperative day 1 following open reduction and internal fixation of a right tibial plateau fracture. He is experiencing severe acute postoperative pain (NRS 8/10) and is cognitively intact and fully oriented (CAM negative; no delirium). He has no history of heart failure, Parkinson's disease, syncope, or peptic ulcer disease. He is not receiving anticoagulation therapy.",
    "question": "Which of the following should be avoided when prescribing medications for this patient?",
    "options": {
      "A": "Acetaminophen",
      "B": "Morphine",
      "C": "None of the above",
      "D": "Oxycodone",
      "E": "Celecoxib"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "antipyretic analgesics",
      "opioids",
      "nsaids/antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "CS-CF-AP-002-A",
    "patient_vignette": "An 83-year-old woman with a documented history of recurrent falls (three falls in the preceding 12 months, one resulting in a wrist fracture) presents for a comprehensive medication safety review. She has NO Parkinson's disease and no history of syncopal episodes. She has no active delirium or dementia. She has no history of heart failure, peptic ulcer disease, or urinary incontinence.",
    "question": "Which of the following drugs is potentially inappropriate for this patient?",
    "options": {
      "A": "None of the above",
      "B": "Aripiprazole",
      "C": "Quetiapine",
      "D": "Chlorpromazine",
      "E": "Haloperidol"
    },
    "answer": [
      "B",
      "C",
      "D",
      "E"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "antipsychotics"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk redistribution",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "CS-CF-AP-002-B",
    "patient_vignette": "An 83-year-old woman with Parkinson's disease presents with new-onset vivid visual hallucinations consistent with Parkinson's disease psychosis. Her neurologist is considering antipsychotic pharmacotherapy. She has NO history of recurrent falls or fractures and no history of syncopal episodes. She has no active delirium or dementia. She has no history of heart failure, peptic ulcer disease, or urinary incontinence.",
    "question": "Which of the following drugs is potentially inappropriate for this patient?",
    "options": {
      "A": "Aripiprazole",
      "B": "Quetiapine",
      "C": "Chlorpromazine",
      "D": "Haloperidol",
      "E": "None of the above"
    },
    "answer": [
      "A",
      "C",
      "D"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "antipsychotics"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk redistribution",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "CS-CF-A1-002-A",
    "patient_vignette": "A 73-year-old woman presents with urinary urgency and stress urinary incontinence of 8 months' duration. Her gynecologist is evaluating pharmacological options including alpha-1 adrenergic blocker therapy for symptom management. She has no history of syncope or orthostatic hypotension. She has no history of Parkinson's disease, recurrent falls, heart failure, or peptic ulcer disease. She has no active delirium.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Doxazosin",
      "B": "Terazosin",
      "C": "Tamsulosin",
      "D": "None of the above",
      "E": "Prazosin"
    },
    "answer": [
      "A",
      "B",
      "E"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "alpha-1 receptor blockers"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "CS-CF-A1-002-B",
    "patient_vignette": "A 73-year-old man presents with urinary urgency and urge urinary incontinence of 8 months' duration. His urologist is evaluating pharmacological options including alpha-1 adrenergic blocker therapy for symptom management. He has no history of syncope or orthostatic hypotension. He has no history of Parkinson's disease, recurrent falls, heart failure, or peptic ulcer disease. He has no active delirium.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Doxazosin",
      "B": "Terazosin",
      "C": "Tamsulosin",
      "D": "None of the above",
      "E": "Prazosin"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "alpha-1 receptor blockers"
    ],
    "taxonomy_patient_info_type": "composite clinical context",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "DDI-CF-RK-001-A",
    "patient_vignette": "A 72-year-old man with hypertension and type 2 diabetes is currently taking lisinopril 10 mg daily for blood pressure control and nephroprotection. His most recent laboratory values reveal serum creatinine 1.8 mg/dL (eGFR 38 mL/min/1.73m², CKD Stage 3b) and serum potassium 4.3 mEq/L. His blood pressure remains above goal and his cardiologist is considering the addition of a diuretic. He has no history of heart failure, syncope, or peptic ulcer disease. He has no active delirium and no history of recurrent falls.",
    "question": "Which of the following medications would be potentially inappropriate to add to this patient's current regimen?",
    "options": {
      "A": "Furosemide",
      "B": "Amiloride",
      "C": "Triamterene",
      "D": "Hydrochlorothiazide",
      "E": "None of the above"
    },
    "answer": [
      "B",
      "C"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "ras inhibitors/potassium-sparing diuretics"
    ],
    "taxonomy_patient_info_type": "drug interaction",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "interaction identification",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "DDI-CF-RK-001-B",
    "patient_vignette": "A 72-year-old man with hypertension and type 2 diabetes is currently taking lisinopril 10 mg daily for blood pressure control. His most recent laboratory values reveal serum creatinine 0.9 mg/dL (eGFR 82 mL/min/1.73m², no CKD) and serum potassium 4.1 mEq/L. His blood pressure remains above goal and his cardiologist is considering the addition of a diuretic. He has no history of heart failure, syncope, or peptic ulcer disease. He has no active delirium and no history of recurrent falls.",
    "question": "Which of the following medications would be potentially inappropriate to add to this patient's current regimen?",
    "options": {
      "A": "Furosemide",
      "B": "None of the above",
      "C": "Amiloride",
      "D": "Triamterene",
      "E": "Hydrochlorothiazide"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "ras inhibitors/potassium-sparing diuretics"
    ],
    "taxonomy_patient_info_type": "drug interaction",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "interaction identification",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "DDI-CF-OB-001-A",
    "patient_vignette": "A 75-year-old man with chronic low back pain is currently taking morphine extended-release 30 mg twice daily for pain management. He does not take any other CNS-active medications. He has no history of heart failure, CKD, hepatic disease, or seizure disorder. His physician is evaluating additional medications to address comorbid insomnia and anxiety.",
    "question": "Which of the following medications would be potentially inappropriate to add to this patient's current regimen?",
    "options": {
      "A": "Temazepam",
      "B": "None of the above",
      "C": "Metoclopramide",
      "D": "Pantoprazole",
      "E": "Lorazepam"
    },
    "answer": [
      "A",
      "E"
    ],
    "taxonomy_clinical_department": "pain medicine",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "opioids"
    ],
    "taxonomy_patient_info_type": "drug interaction",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "interaction identification",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "DDI-CF-OB-001-B",
    "patient_vignette": "A 75-year-old man with type 2 diabetes is currently taking metformin 1000 mg twice daily for glycemic control. He does not take any CNS-active medications. He has no history of heart failure, CKD, hepatic disease, or seizure disorder. His physician is evaluating additional medications to address comorbid insomnia and anxiety.",
    "question": "Which of the following medications would be potentially inappropriate to add to this patient's current regimen?",
    "options": {
      "A": "Temazepam",
      "B": "Metoclopramide",
      "C": "None of the above",
      "D": "Pantoprazole",
      "E": "Lorazepam"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "pain medicine",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "opioids"
    ],
    "taxonomy_patient_info_type": "drug interaction",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "interaction identification",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "DDI-CF-OG-001-A",
    "patient_vignette": "A 68-year-old woman with diabetic neuropathy is currently taking oxycodone extended-release 20 mg twice daily for chronic neuropathic pain. Her pain is adequately controlled on the current dose, and no change in opioid therapy is planned. She does not take benzodiazepines, gabapentinoids, or other CNS-active medications. Her physician is considering additional analgesic options to improve pain control.",
    "question": "Which of the following medications would be potentially inappropriate to add to this patient's current regimen?",
    "options": {
      "A": "Gabapentin",
      "B": "Acetaminophen",
      "C": "None of the above",
      "D": "Celecoxib",
      "E": "Pregabalin"
    },
    "answer": [
      "A",
      "E"
    ],
    "taxonomy_clinical_department": "pain medicine",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "opioids"
    ],
    "taxonomy_patient_info_type": "drug interaction",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "interaction identification",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "DDI-CF-OG-001-B",
    "patient_vignette": "A 68-year-old woman with diabetic neuropathy is currently taking oxycodone extended-release 20 mg twice daily but is beginning a planned opioid-to-gabapentinoid transition to reduce opioid dependence. Her pain management team has initiated a structured opioid taper protocol, with gabapentinoid therapy intended to supplant opioid analgesia over the coming weeks. She does not take benzodiazepines. Her physician is now selecting the gabapentinoid to incorporate into this transition plan.",
    "question": "Which of the following medications would be potentially inappropriate to add to this patient's current regimen?",
    "options": {
      "A": "Gabapentin",
      "B": "None of the above",
      "C": "Acetaminophen",
      "D": "Celecoxib",
      "E": "Pregabalin"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "pain medicine",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "opioids"
    ],
    "taxonomy_patient_info_type": "drug interaction",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "interaction identification",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "DDI-CF-AC-001-A",
    "patient_vignette": "A 71-year-old woman with major depressive disorder is currently taking amitriptyline 50 mg at bedtime, initiated for depression and comorbid insomnia. She does not take other psychotropic medications. Her primary care physician is now considering additional medications to address her seasonal allergies and irritable bowel syndrome-related abdominal cramping. She has no history of heart failure, CKD, delirium, or recurrent falls.",
    "question": "Which of the following medications would be potentially inappropriate to add to this patient's current regimen?",
    "options": {
      "A": "Metformin",
      "B": "Diphenhydramine",
      "C": "Dicyclomine",
      "D": "Amlodipine",
      "E": "None of the above"
    },
    "answer": [
      "B",
      "C"
    ],
    "taxonomy_clinical_department": "psychiatry",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "tricyclic antidepressants/anticholinergics"
    ],
    "taxonomy_patient_info_type": "drug interaction",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "interaction identification",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "DDI-CF-AC-001-B",
    "patient_vignette": "A 71-year-old woman with major depressive disorder is currently taking sertraline 100 mg daily. She does not take other psychotropic medications. Her primary care physician is now considering additional medications to address her seasonal allergies and irritable bowel syndrome-related abdominal cramping. She has no history of heart failure, CKD, delirium, or recurrent falls.",
    "question": "Which of the following medications would be potentially inappropriate to add to this patient's current regimen?",
    "options": {
      "A": "Metformin",
      "B": "Diphenhydramine",
      "C": "Dicyclomine",
      "D": "None of the above",
      "E": "Amlodipine"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "psychiatry",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "tricyclic antidepressants/anticholinergics"
    ],
    "taxonomy_patient_info_type": "drug interaction",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "interaction identification",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "DDI-CF-CN-001-A",
    "patient_vignette": "A 76-year-old man with postherpetic neuralgia is currently taking gabapentin 600 mg three times daily for neuropathic pain management. He does not take any other CNS-active medications. He has no history of heart failure, CKD, or hepatic disease. His physician is evaluating additional medications to treat comorbid insomnia and hypertension.",
    "question": "Which of the following medications would be potentially inappropriate to add to this patient's current regimen?",
    "options": {
      "A": "None of the above",
      "B": "Lorazepam",
      "C": "Lisinopril",
      "D": "Amlodipine",
      "E": "Zolpidem"
    },
    "answer": [
      "B",
      "E"
    ],
    "taxonomy_clinical_department": "psychiatry",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "central nervous system depressants"
    ],
    "taxonomy_patient_info_type": "drug interaction",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "interaction identification",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "DDI-CF-CN-001-B",
    "patient_vignette": "A 76-year-old man with type 2 diabetes is currently taking metformin 1000 mg twice daily for glycemic control. He does not take any CNS-active medications. He has no history of heart failure, CKD, or hepatic disease. His physician is evaluating additional medications to treat comorbid insomnia and hypertension.",
    "question": "Which of the following medications would be potentially inappropriate to add to this patient's current regimen?",
    "options": {
      "A": "Lorazepam",
      "B": "Lisinopril",
      "C": "Amlodipine",
      "D": "Zolpidem",
      "E": "None of the above"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "psychiatry",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "central nervous system depressants"
    ],
    "taxonomy_patient_info_type": "drug interaction",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "interaction identification",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "DDI-CF-LI-001-A",
    "patient_vignette": "A 67-year-old man with bipolar I disorder is currently taking lithium carbonate 300 mg three times daily, with a stable serum lithium level of 0.8 mEq/L. He is presenting for management of newly diagnosed hypertension and bilateral lower extremity edema, and his physician is considering antihypertensive and diuretic therapy. He has no history of peptic ulcer disease, syncope, or CKD.",
    "question": "Which of the following medications would be potentially inappropriate to add to this patient's current regimen?",
    "options": {
      "A": "Lisinopril",
      "B": "Atenolol",
      "C": "Metformin",
      "D": "Furosemide",
      "E": "None of the above"
    },
    "answer": [
      "A",
      "D"
    ],
    "taxonomy_clinical_department": "psychiatry",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "lithium"
    ],
    "taxonomy_patient_info_type": "drug interaction",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "interaction identification",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "DDI-CF-LI-001-B",
    "patient_vignette": "A 67-year-old man with bipolar I disorder is currently taking valproate 500 mg twice daily for mood stabilization, with stable serum valproate levels within therapeutic range. He is presenting for management of newly diagnosed hypertension and bilateral lower extremity edema, and his physician is considering antihypertensive and diuretic therapy. He has no history of peptic ulcer disease, syncope, or CKD.",
    "question": "Which of the following medications would be potentially inappropriate to add to this patient's current regimen?",
    "options": {
      "A": "Lisinopril",
      "B": "Atenolol",
      "C": "Metformin",
      "D": "Furosemide",
      "E": "None of the above"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "psychiatry",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "lithium"
    ],
    "taxonomy_patient_info_type": "drug interaction",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "interaction identification",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "DDI-CF-PH-001-A",
    "patient_vignette": "A 69-year-old woman with focal epilepsy is currently taking phenytoin 300 mg daily, with a stable serum phenytoin level of 14 mg/L (therapeutic range 10–20 mg/L). She presents with a urinary tract infection requiring antibiotic therapy. Her physician is selecting an appropriate antibiotic. She has no sulfa allergy. She has no history of heart failure, CKD, or hepatic disease.",
    "question": "Which of the following medications would be potentially inappropriate to add to this patient's current regimen?",
    "options": {
      "A": "Trimethoprim-sulfamethoxazole",
      "B": "Nitrofurantoin",
      "C": "None of the above",
      "D": "Azithromycin",
      "E": "Amoxicillin-clavulanate"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "antiepileptics"
    ],
    "taxonomy_patient_info_type": "drug interaction",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "interaction identification",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "DDI-CF-PH-001-B",
    "patient_vignette": "A 69-year-old woman with focal epilepsy is currently taking levetiracetam 1000 mg twice daily for seizure control. She presents with a urinary tract infection requiring antibiotic therapy. Her physician is selecting an appropriate antibiotic. She has no sulfa allergy. She has no history of heart failure, CKD, or hepatic disease.",
    "question": "Which of the following medications would be potentially inappropriate to add to this patient's current regimen?",
    "options": {
      "A": "Trimethoprim-sulfamethoxazole",
      "B": "Nitrofurantoin",
      "C": "Azithromycin",
      "D": "None of the above",
      "E": "Amoxicillin-clavulanate"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "neurology",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "antiepileptics"
    ],
    "taxonomy_patient_info_type": "drug interaction",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "interaction identification",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "DDI-CF-TH-001-A",
    "patient_vignette": "A 73-year-old man with COPD is currently taking theophylline extended-release 200 mg twice daily for bronchodilation, with a most recent serum theophylline level of 12 mg/L (therapeutic range 8–15 mg/L). He presents with an acute COPD exacerbation complicated by a suspected community-acquired pneumonia. His pulmonologist is selecting antibiotic therapy, and his gastroenterologist is also considering acid suppression therapy for recently diagnosed peptic ulcer disease.",
    "question": "Which of the following medications would be potentially inappropriate to add to this patient's current regimen?",
    "options": {
      "A": "Ranitidine",
      "B": "Ciprofloxacin",
      "C": "Azithromycin",
      "D": "None of the above",
      "E": "Cimetidine"
    },
    "answer": [
      "B",
      "E"
    ],
    "taxonomy_clinical_department": "pulmonology",
    "taxonomy_clinical_system": "respiratory system",
    "taxonomy_drug_categories": [
      "theophyllines"
    ],
    "taxonomy_patient_info_type": "drug interaction",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "interaction identification",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "DDI-CF-TH-001-B",
    "patient_vignette": "A 73-year-old man with COPD and comorbid asthma is currently taking montelukast 10 mg daily for leukotriene-mediated airway inflammation. He presents with an acute COPD exacerbation complicated by a suspected community-acquired pneumonia. His pulmonologist is selecting antibiotic therapy, and his gastroenterologist is also considering acid suppression therapy for recently diagnosed peptic ulcer disease.",
    "question": "Which of the following medications would be potentially inappropriate to add to this patient's current regimen?",
    "options": {
      "A": "None of the above",
      "B": "Ranitidine",
      "C": "Ciprofloxacin",
      "D": "Azithromycin",
      "E": "Cimetidine"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "pulmonology",
    "taxonomy_clinical_system": "respiratory system",
    "taxonomy_drug_categories": [
      "theophyllines"
    ],
    "taxonomy_patient_info_type": "drug interaction",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "interaction identification",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "DDI-CF-WA-001-A",
    "patient_vignette": "A 74-year-old woman with chronic atrial fibrillation is currently taking warfarin 5 mg daily for stroke prevention, with a therapeutic INR maintained between 2.0 and 3.0. She presents with a urinary tract infection and her physician is also considering additional antihypertensive therapy. Culture and sensitivity results indicate that only the antibiotic options listed below provide adequate pathogen coverage; no non-interacting alternatives are suitable for this infection. She has no history of heart failure, CKD, or seizure disorder.",
    "question": "Which of the following medications would be potentially inappropriate to add to this patient's current regimen?",
    "options": {
      "A": "Trimethoprim-sulfamethoxazole",
      "B": "Amlodipine",
      "C": "Ciprofloxacin",
      "D": "Atenolol",
      "E": "None of the above"
    },
    "answer": [
      "A",
      "C"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "anticoagulants"
    ],
    "taxonomy_patient_info_type": "drug interaction",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "interaction identification",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "DDI-CF-WA-001-B",
    "patient_vignette": "A 74-year-old woman with chronic atrial fibrillation is currently taking apixaban 5 mg twice daily for stroke prevention. She presents with a urinary tract infection requiring antibiotic therapy, and her physician is also considering additional antihypertensive therapy. She has no history of heart failure, CKD, or seizure disorder.",
    "question": "Which of the following medications would be potentially inappropriate to add to this patient's current regimen?",
    "options": {
      "A": "Trimethoprim-sulfamethoxazole",
      "B": "None of the above",
      "C": "Amlodipine",
      "D": "Ciprofloxacin",
      "E": "Atenolol"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "cardiology",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "anticoagulants"
    ],
    "taxonomy_patient_info_type": "drug interaction",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "interaction identification",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "RK-CF-CIP-001-A",
    "patient_vignette": "A 74-year-old woman presents with a complicated lower urinary tract infection requiring oral antibiotic therapy. Her most recent serum creatinine is 2.2 mg/dL, corresponding to an estimated CrCl of 22 mL/min. She has no known drug allergies and culture results indicate susceptibility to the antibiotics listed below. Her physician is selecting an appropriate antibiotic regimen.",
    "question": "Which of the following antibiotics requires dose reduction given this patient's renal function?",
    "options": {
      "A": "None of the above",
      "B": "Ciprofloxacin",
      "C": "Azithromycin",
      "D": "Amoxicillin",
      "E": "Doxycycline"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "fluoroquinolone antibacterials"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "RK-CF-CIP-001-B",
    "patient_vignette": "A 74-year-old woman presents with a complicated lower urinary tract infection requiring oral antibiotic therapy. Her most recent serum creatinine is 1.0 mg/dL, corresponding to an estimated CrCl of 52 mL/min. She has no known drug allergies and culture results indicate susceptibility to the antibiotics listed below. Her physician is selecting an appropriate antibiotic regimen.",
    "question": "Which of the following antibiotics requires dose reduction given this patient's renal function?",
    "options": {
      "A": "Ciprofloxacin",
      "B": "Azithromycin",
      "C": "Amoxicillin",
      "D": "Doxycycline",
      "E": "None of the above"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "fluoroquinolone antibacterials"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "RK-CF-NIT-001-A",
    "patient_vignette": "A 78-year-old woman with a history of recurrent urinary tract infections presents with dysuria and urinary frequency. Her estimated CrCl is 18 mL/min due to progressive chronic kidney disease. She has no sulfa allergy. Urine culture is pending but her physician is initiating empirical antibiotic therapy for an uncomplicated UTI.",
    "question": "Which of the following antibiotics should be avoided given this patient's renal function?",
    "options": {
      "A": "Fosfomycin",
      "B": "None of the above",
      "C": "Trimethoprim",
      "D": "Nitrofurantoin",
      "E": "Amoxicillin"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "urinary antibacterials"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "RK-CF-NIT-001-B",
    "patient_vignette": "A 78-year-old woman with a history of recurrent urinary tract infections presents with dysuria and urinary frequency. Her estimated CrCl is 48 mL/min. She has no sulfa allergy. Urine culture is pending but her physician is initiating empirical antibiotic therapy for an uncomplicated UTI.",
    "question": "Which of the following antibiotics should be avoided given this patient's renal function?",
    "options": {
      "A": "None of the above",
      "B": "Fosfomycin",
      "C": "Trimethoprim",
      "D": "Nitrofurantoin",
      "E": "Amoxicillin"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "urinary antibacterials"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "RK-CF-TMP-001-A",
    "patient_vignette": "A 76-year-old man with HIV on antiretroviral therapy requires Pneumocystis jirovecii pneumonia prophylaxis. His estimated CrCl is 22 mL/min due to HIV-associated nephropathy. He has no known sulfa allergy. His physician is selecting the most appropriate prophylactic antibiotic regimen and is reviewing any necessary renal dosing adjustments.",
    "question": "Which of the following antibiotics requires dose reduction given this patient's renal function?",
    "options": {
      "A": "Amoxicillin",
      "B": "None of the above",
      "C": "Trimethoprim-sulfamethoxazole",
      "D": "Azithromycin",
      "E": "Doxycycline"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antibacterials"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "RK-CF-TMP-001-B",
    "patient_vignette": "A 76-year-old man with HIV on antiretroviral therapy requires Pneumocystis jirovecii pneumonia prophylaxis. His estimated CrCl is 52 mL/min. He has no known sulfa allergy. His physician is selecting the most appropriate prophylactic antibiotic regimen and is reviewing any necessary renal dosing adjustments.",
    "question": "Which of the following antibiotics requires dose reduction given this patient's renal function?",
    "options": {
      "A": "Amoxicillin",
      "B": "Trimethoprim-sulfamethoxazole",
      "C": "Azithromycin",
      "D": "None of the above",
      "E": "Doxycycline"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antibacterials"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "RK-CF-TMP-002-A",
    "patient_vignette": "A 80-year-old man with HIV on antiretroviral therapy requires Pneumocystis jirovecii pneumonia prophylaxis. His estimated CrCl is 10 mL/min due to advanced chronic kidney disease. He has no known sulfa allergy. His physician is determining which antibiotic options should be completely avoided rather than dose-adjusted in this patient.",
    "question": "Which of the following antibiotics should be avoided given this patient's renal function?",
    "options": {
      "A": "Azithromycin",
      "B": "Trimethoprim-sulfamethoxazole",
      "C": "None of the above",
      "D": "Doxycycline",
      "E": "Amoxicillin"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antibacterials"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "RK-CF-TMP-002-B",
    "patient_vignette": "A 80-year-old man with HIV on antiretroviral therapy requires Pneumocystis jirovecii pneumonia prophylaxis. His estimated CrCl is 22 mL/min due to chronic kidney disease. He has no known sulfa allergy. His physician is determining which antibiotic options should be completely avoided rather than dose-adjusted in this patient.",
    "question": "Which of the following antibiotics should be avoided given this patient's renal function?",
    "options": {
      "A": "Azithromycin",
      "B": "Trimethoprim-sulfamethoxazole",
      "C": "Doxycycline",
      "D": "Amoxicillin",
      "E": "None of the above"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antibacterials"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "RK-CF-DAB-001-A",
    "patient_vignette": "A 79-year-old man with nonvalvular atrial fibrillation and a CHA₂DS₂-VASc score of 4 requires anticoagulation for stroke prevention. His estimated CrCl is 22 mL/min due to diabetic nephropathy. He has no history of mechanical heart valve or significant hepatic disease. His physician is selecting an appropriate oral anticoagulant.",
    "question": "Which of the following oral anticoagulants should be avoided given this patient's renal function?",
    "options": {
      "A": "Warfarin",
      "B": "None of the above",
      "C": "Heparin",
      "D": "Apixaban",
      "E": "Dabigatran"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "direct thrombin inhibitors/anticoagulants"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "RK-CF-DAB-001-B",
    "patient_vignette": "A 79-year-old man with nonvalvular atrial fibrillation and a CHA₂DS₂-VASc score of 4 requires anticoagulation for stroke prevention. His estimated CrCl is 52 mL/min. He has no history of mechanical heart valve or significant hepatic disease. His physician is selecting an appropriate oral anticoagulant.",
    "question": "Which of the following oral anticoagulants should be avoided given this patient's renal function?",
    "options": {
      "A": "Warfarin",
      "B": "Heparin",
      "C": "Apixaban",
      "D": "Dabigatran",
      "E": "None of the above"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "direct thrombin inhibitors/anticoagulants"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "RK-CF-DOF-001-A",
    "patient_vignette": "A 73-year-old woman with persistent atrial fibrillation refractory to rate control is being evaluated for rhythm control therapy. Her estimated CrCl is 35 mL/min. Her QTc interval is 420 ms and she has no history of torsades de pointes. Her cardiologist is reviewing antiarrhythmic options and considering necessary renal dose adjustments.",
    "question": "Which of the following antiarrhythmic medications requires dose reduction given this patient's renal function?",
    "options": {
      "A": "Dofetilide",
      "B": "Metoprolol",
      "C": "None of the above",
      "D": "Amiodarone",
      "E": "Flecainide"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antiarrhythmics"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "RK-CF-DOF-001-B",
    "patient_vignette": "A 73-year-old woman with persistent atrial fibrillation refractory to rate control is being evaluated for rhythm control therapy. Her estimated CrCl is 75 mL/min. Her QTc interval is 420 ms and she has no history of torsades de pointes. Her cardiologist is reviewing antiarrhythmic options and considering necessary renal dose adjustments.",
    "question": "Which of the following antiarrhythmic medications requires dose reduction given this patient's renal function?",
    "options": {
      "A": "Dofetilide",
      "B": "Metoprolol",
      "C": "Amiodarone",
      "D": "None of the above",
      "E": "Flecainide"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antiarrhythmics"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "RK-CF-DOF-002-A",
    "patient_vignette": "A 76-year-old woman with persistent atrial fibrillation and advanced chronic kidney disease is being considered for rhythm control. Her estimated CrCl is 15 mL/min. Her QTc is 430 ms. Her cardiologist is determining which antiarrhythmic agents should be completely avoided rather than dose-adjusted given her renal function.",
    "question": "Which of the following antiarrhythmic medications should be avoided given this patient's renal function?",
    "options": {
      "A": "Metoprolol",
      "B": "Amiodarone",
      "C": "Flecainide",
      "D": "None of the above",
      "E": "Dofetilide"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antiarrhythmics"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "RK-CF-DOF-002-B",
    "patient_vignette": "A 76-year-old woman with persistent atrial fibrillation and chronic kidney disease is being considered for rhythm control. Her estimated CrCl is 35 mL/min. Her QTc is 430 ms. Her cardiologist is determining which antiarrhythmic agents should be completely avoided rather than dose-adjusted given her renal function.",
    "question": "Which of the following antiarrhythmic medications should be avoided given this patient's renal function?",
    "options": {
      "A": "None of the above",
      "B": "Metoprolol",
      "C": "Amiodarone",
      "D": "Flecainide",
      "E": "Dofetilide"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antiarrhythmics"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "RK-CF-EDO-001-A",
    "patient_vignette": "A 75-year-old man with nonvalvular atrial fibrillation requires long-term anticoagulation. His estimated CrCl is 30 mL/min. He has no history of mechanical heart valve or significant hepatic disease. His physician is reviewing which anticoagulants require dose reduction given his current renal function.",
    "question": "Which of the following oral anticoagulants requires dose reduction given this patient's renal function?",
    "options": {
      "A": "Heparin",
      "B": "Warfarin",
      "C": "None of the above",
      "D": "Apixaban",
      "E": "Edoxaban"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "factor xa inhibitors/anticoagulants"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "RK-CF-EDO-001-B",
    "patient_vignette": "A 75-year-old man with nonvalvular atrial fibrillation requires long-term anticoagulation. His estimated CrCl is 75 mL/min. He has no history of mechanical heart valve or significant hepatic disease. His physician is reviewing which anticoagulants require dose reduction given his current renal function.",
    "question": "Which of the following oral anticoagulants requires dose reduction given this patient's renal function?",
    "options": {
      "A": "Heparin",
      "B": "Warfarin",
      "C": "Apixaban",
      "D": "Edoxaban",
      "E": "None of the above"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "factor xa inhibitors/anticoagulants"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "RK-CF-EDO-002-A",
    "patient_vignette": "A 78-year-old woman with nonvalvular atrial fibrillation and severe chronic kidney disease requires anticoagulation. Her estimated CrCl is 10 mL/min. She has no mechanical heart valve. Her physician is determining which anticoagulants should be completely avoided rather than dose-adjusted given her renal function.",
    "question": "Which of the following oral anticoagulants should be avoided given this patient's renal function?",
    "options": {
      "A": "None of the above",
      "B": "Apixaban",
      "C": "Warfarin",
      "D": "Heparin",
      "E": "Edoxaban"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "factor xa inhibitors/anticoagulants"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "RK-CF-EDO-002-B",
    "patient_vignette": "A 78-year-old woman with nonvalvular atrial fibrillation and moderate chronic kidney disease requires anticoagulation. Her estimated CrCl is 30 mL/min. She has no mechanical heart valve. Her physician is determining which anticoagulants should be completely avoided rather than dose-adjusted given her renal function.",
    "question": "Which of the following oral anticoagulants should be avoided given this patient's renal function?",
    "options": {
      "A": "Apixaban",
      "B": "Warfarin",
      "C": "None of the above",
      "D": "Heparin",
      "E": "Edoxaban"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "factor xa inhibitors/anticoagulants"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "RK-CF-ENO-001-A",
    "patient_vignette": "A 72-year-old woman with a provoked pulmonary embolism requires parenteral anticoagulation bridging to long-term therapy. Her estimated CrCl is 22 mL/min. She has no contraindications to anticoagulation. Her physician is reviewing which parenteral anticoagulants require dose reduction given her renal function.",
    "question": "Which of the following parenteral anticoagulants requires dose reduction given this patient's renal function?",
    "options": {
      "A": "Enoxaparin",
      "B": "Unfractionated heparin",
      "C": "None of the above",
      "D": "Warfarin",
      "E": "Apixaban"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "low-molecular-weight heparin anticoagulants"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "RK-CF-ENO-001-B",
    "patient_vignette": "A 72-year-old woman with a provoked pulmonary embolism requires parenteral anticoagulation bridging to long-term therapy. Her estimated CrCl is 52 mL/min. She has no contraindications to anticoagulation. Her physician is reviewing which parenteral anticoagulants require dose reduction given her renal function.",
    "question": "Which of the following parenteral anticoagulants requires dose reduction given this patient's renal function?",
    "options": {
      "A": "Enoxaparin",
      "B": "Unfractionated heparin",
      "C": "None of the above",
      "D": "Warfarin",
      "E": "Apixaban"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "low-molecular-weight heparin anticoagulants"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "RK-CF-FON-001-A",
    "patient_vignette": "A 74-year-old man with a proximal deep vein thrombosis requires anticoagulation therapy. His estimated CrCl is 22 mL/min. He has no history of heparin-induced thrombocytopenia and no mechanical heart valve. His physician is selecting which anticoagulant options should be avoided entirely given his renal function.",
    "question": "Which of the following parenteral anticoagulants should be avoided given this patient's renal function?",
    "options": {
      "A": "Apixaban",
      "B": "Fondaparinux",
      "C": "Enoxaparin",
      "D": "Warfarin",
      "E": "None of the above"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "factor xa inhibitors/anticoagulants"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "RK-CF-FON-001-B",
    "patient_vignette": "A 74-year-old man with a proximal deep vein thrombosis requires anticoagulation therapy. His estimated CrCl is 52 mL/min. He has no history of heparin-induced thrombocytopenia and no mechanical heart valve. His physician is selecting which anticoagulant options should be avoided entirely given his renal function.",
    "question": "Which of the following parenteral anticoagulants should be avoided given this patient's renal function?",
    "options": {
      "A": "Apixaban",
      "B": "None of the above",
      "C": "Fondaparinux",
      "D": "Enoxaparin",
      "E": "Warfarin"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "factor xa inhibitors/anticoagulants"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "RK-CF-RIV-001-A",
    "patient_vignette": "A 77-year-old woman with nonvalvular atrial fibrillation and a history of venous thromboembolism requires long-term anticoagulation. Her estimated CrCl is 30 mL/min. She has no mechanical heart valve or significant hepatic disease. Her physician is reviewing which oral anticoagulants require dose reduction given her renal function.",
    "question": "Which of the following oral anticoagulants requires dose reduction given this patient's renal function?",
    "options": {
      "A": "None of the above",
      "B": "Warfarin",
      "C": "Apixaban",
      "D": "Dabigatran",
      "E": "Rivaroxaban"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "factor xa inhibitors/anticoagulants"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "RK-CF-RIV-001-B",
    "patient_vignette": "A 77-year-old woman with nonvalvular atrial fibrillation and a history of venous thromboembolism requires long-term anticoagulation. Her estimated CrCl is 70 mL/min. She has no mechanical heart valve or significant hepatic disease. Her physician is reviewing which oral anticoagulants require dose reduction given her renal function.",
    "question": "Which of the following oral anticoagulants requires dose reduction given this patient's renal function?",
    "options": {
      "A": "Warfarin",
      "B": "Apixaban",
      "C": "Dabigatran",
      "D": "None of the above",
      "E": "Rivaroxaban"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "factor xa inhibitors/anticoagulants"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "RK-CF-BAC-001-A",
    "patient_vignette": "A 71-year-old woman with multiple sclerosis presents with worsening spasticity significantly limiting her mobility. Her most recent eGFR is 38 mL/min/1.73m² due to hypertensive nephrosclerosis. She has no hepatic disease. Her neurologist is selecting a muscle relaxant and is reviewing which options should be avoided given her renal function.",
    "question": "Which of the following muscle relaxants should be avoided given this patient's renal function?",
    "options": {
      "A": "Baclofen",
      "B": "Tizanidine",
      "C": "Dantrolene",
      "D": "None of the above",
      "E": "Methocarbamol"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "muscle relaxants"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "RK-CF-BAC-001-B",
    "patient_vignette": "A 71-year-old woman with multiple sclerosis presents with worsening spasticity significantly limiting her mobility. Her most recent eGFR is 75 mL/min/1.73m². She has no hepatic disease. Her neurologist is selecting a muscle relaxant and is reviewing which options should be avoided given her renal function.",
    "question": "Which of the following muscle relaxants should be avoided given this patient's renal function?",
    "options": {
      "A": "Baclofen",
      "B": "Tizanidine",
      "C": "Dantrolene",
      "D": "None of the above",
      "E": "Methocarbamol"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "muscle relaxants"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "RK-CF-DUL-001-A",
    "patient_vignette": "A 74-year-old woman with major depressive disorder and diabetic peripheral neuropathy is being considered for an antidepressant that also addresses neuropathic pain. Her estimated CrCl is 22 mL/min due to diabetic nephropathy. She has no history of seizures or hepatic disease. Her physician is reviewing which antidepressants should be avoided given her renal function.",
    "question": "Which of the following antidepressants should be avoided given this patient's renal function?",
    "options": {
      "A": "Duloxetine",
      "B": "None of the above",
      "C": "Bupropion",
      "D": "Sertraline",
      "E": "Escitalopram"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antidepressants/analgesics"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "RK-CF-DUL-001-B",
    "patient_vignette": "A 74-year-old woman with major depressive disorder and diabetic peripheral neuropathy is being considered for an antidepressant that also addresses neuropathic pain. Her estimated CrCl is 50 mL/min. She has no history of seizures or hepatic disease. Her physician is reviewing which antidepressants should be avoided given her renal function.",
    "question": "Which of the following antidepressants should be avoided given this patient's renal function?",
    "options": {
      "A": "None of the above",
      "B": "Duloxetine",
      "C": "Bupropion",
      "D": "Sertraline",
      "E": "Escitalopram"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antidepressants/analgesics"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "RK-CF-GPT-001-A",
    "patient_vignette": "A 78-year-old woman with diabetic peripheral neuropathy presents for evaluation of neuropathic pain management. Her estimated CrCl is 35 mL/min due to diabetic nephropathy. She has no history of delirium or recurrent falls. Her physician is reviewing neuropathic pain medications and identifying those that require dose reduction given her renal function.",
    "question": "Which of the following neuropathic pain medications requires dose reduction given this patient's renal function? Select all that apply.",
    "options": {
      "A": "None of the above",
      "B": "Capsaicin cream",
      "C": "Pregabalin",
      "D": "Amitriptyline",
      "E": "Gabapentin"
    },
    "answer": [
      "C",
      "E"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "gabapentinoids"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "RK-CF-GPT-001-B",
    "patient_vignette": "A 78-year-old woman with diabetic peripheral neuropathy presents for evaluation of neuropathic pain management. Her estimated CrCl is 75 mL/min. She has no history of delirium or recurrent falls. Her physician is reviewing neuropathic pain medications and identifying those that require dose reduction given her renal function.",
    "question": "Which of the following neuropathic pain medications requires dose reduction given this patient's renal function? Select all that apply.",
    "options": {
      "A": "Capsaicin cream",
      "B": "Pregabalin",
      "C": "Amitriptyline",
      "D": "Gabapentin",
      "E": "None of the above"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "gabapentinoids"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "RK-CF-LEV-001-A",
    "patient_vignette": "A 75-year-old woman with focal epilepsy is maintained on levetiracetam 1000 mg twice daily with good seizure control. Her estimated CrCl is 55 mL/min. Her neurologist is reviewing her antiepileptic regimen and identifying medications that require dose reduction based on her renal function.",
    "question": "Which of the following antiepileptic medications requires dose reduction given this patient's renal function?",
    "options": {
      "A": "Levetiracetam",
      "B": "Lamotrigine",
      "C": "None of the above",
      "D": "Phenytoin",
      "E": "Valproic acid"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antiepileptics"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "RK-CF-LEV-001-B",
    "patient_vignette": "A 75-year-old woman with focal epilepsy is maintained on levetiracetam 1000 mg twice daily with good seizure control. Her estimated CrCl is 90 mL/min. Her neurologist is reviewing her antiepileptic regimen and identifying medications that require dose reduction based on her renal function.",
    "question": "Which of the following antiepileptic medications requires dose reduction given this patient's renal function?",
    "options": {
      "A": "None of the above",
      "B": "Levetiracetam",
      "C": "Lamotrigine",
      "D": "Phenytoin",
      "E": "Valproic acid"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antiepileptics"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "RK-CF-NSA-001-A",
    "patient_vignette": "A 76-year-old man with osteoarthritis of the knees and hips reports inadequate pain control with non-pharmacologic measures. His estimated CrCl is 22 mL/min due to hypertensive nephropathy. He has no history of peptic ulcer disease. His physician is evaluating oral analgesic options and identifying those that should be avoided given his renal function.",
    "question": "Which of the following analgesics should be avoided given this patient's renal function? Select all that apply.",
    "options": {
      "A": "Naproxen",
      "B": "Ibuprofen",
      "C": "Acetaminophen",
      "D": "None of the above",
      "E": "Celecoxib"
    },
    "answer": [
      "A",
      "B",
      "E"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "nsaids/antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "RK-CF-NSA-001-B",
    "patient_vignette": "A 76-year-old man with osteoarthritis of the knees and hips reports inadequate pain control with non-pharmacologic measures. His estimated CrCl is 52 mL/min. He has no history of peptic ulcer disease. His physician is evaluating oral analgesic options and identifying those that should be avoided given his renal function.",
    "question": "Which of the following analgesics should be avoided given this patient's renal function? Select all that apply.",
    "options": {
      "A": "Naproxen",
      "B": "Ibuprofen",
      "C": "Acetaminophen",
      "D": "None of the above",
      "E": "Celecoxib"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "nsaids/antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "RK-CF-TRA-001-A",
    "patient_vignette": "A 73-year-old man with moderate chronic low back pain has an estimated CrCl of 22 mL/min. His pain is inadequately controlled with non-opioid analgesics alone. He has no history of seizures or substance use disorder. His physician is reviewing which analgesics require dose reduction given his renal function.",
    "question": "Which of the following analgesics requires dose reduction given this patient's renal function?",
    "options": {
      "A": "None of the above",
      "B": "Acetaminophen",
      "C": "Codeine",
      "D": "Hydrocodone",
      "E": "Tramadol immediate-release"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "opioid-like analgesics"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "RK-CF-TRA-001-B",
    "patient_vignette": "A 73-year-old man with moderate chronic low back pain has an estimated CrCl of 52 mL/min. His pain is inadequately controlled with non-opioid analgesics alone. He has no history of seizures or substance use disorder. His physician is reviewing which analgesics require dose reduction given his renal function.",
    "question": "Which of the following analgesics requires dose reduction given this patient's renal function?",
    "options": {
      "A": "Acetaminophen",
      "B": "Codeine",
      "C": "Hydrocodone",
      "D": "None of the above",
      "E": "Tramadol immediate-release"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "opioid-like analgesics"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "RK-CF-TRA-002-A",
    "patient_vignette": "A 74-year-old woman with chronic low back pain has an estimated CrCl of 22 mL/min. She requires around-the-clock analgesia for consistent pain relief. She has no history of seizures or substance use disorder. Her physician is identifying which analgesic options should be completely avoided given her renal function.",
    "question": "Which of the following analgesics should be avoided given this patient's renal function?",
    "options": {
      "A": "Hydrocodone",
      "B": "Codeine",
      "C": "Tramadol extended-release",
      "D": "None of the above",
      "E": "Acetaminophen"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "opioid-like analgesics"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "RK-CF-TRA-002-B",
    "patient_vignette": "A 74-year-old woman with chronic low back pain has an estimated CrCl of 52 mL/min. She requires around-the-clock analgesia for consistent pain relief. She has no history of seizures or substance use disorder. Her physician is identifying which analgesic options should be completely avoided given her renal function.",
    "question": "Which of the following analgesics should be avoided given this patient's renal function?",
    "options": {
      "A": "Hydrocodone",
      "B": "None of the above",
      "C": "Codeine",
      "D": "Tramadol extended-release",
      "E": "Acetaminophen"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "opioid-like analgesics"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "RK-CF-H2B-001-A",
    "patient_vignette": "A 79-year-old woman with gastroesophageal reflux disease and a history of peptic ulcer disease requires acid suppression therapy. Her estimated CrCl is 35 mL/min. She has no hepatic disease. Her physician is identifying which acid suppression medications require dose reduction given her renal function.",
    "question": "Which of the following acid suppression medications requires dose reduction given this patient's renal function? Select all that apply.",
    "options": {
      "A": "None of the above",
      "B": "Famotidine",
      "C": "Nizatidine",
      "D": "Omeprazole",
      "E": "Cimetidine"
    },
    "answer": [
      "B",
      "C",
      "E"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "h2-receptor blockers"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "RK-CF-H2B-001-B",
    "patient_vignette": "A 79-year-old woman with gastroesophageal reflux disease and a history of peptic ulcer disease requires acid suppression therapy. Her estimated CrCl is 65 mL/min. She has no hepatic disease. Her physician is identifying which acid suppression medications require dose reduction given her renal function.",
    "question": "Which of the following acid suppression medications requires dose reduction given this patient's renal function? Select all that apply.",
    "options": {
      "A": "Famotidine",
      "B": "Nizatidine",
      "C": "Omeprazole",
      "D": "Cimetidine",
      "E": "None of the above"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "h2-receptor blockers"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "RK-CF-COL-001-A",
    "patient_vignette": "A 72-year-old man with gout presents with an acute flare involving the right first metatarsophalangeal joint. His estimated CrCl is 22 mL/min. He has no hepatic disease or prior colchicine toxicity. His physician is reviewing which gout medications require dose reduction given his renal function.",
    "question": "Which of the following gout medications requires dose reduction given this patient's renal function?",
    "options": {
      "A": "Methylprednisolone",
      "B": "None of the above",
      "C": "Febuxostat",
      "D": "Allopurinol",
      "E": "Colchicine"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antigout agents"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "RK-CF-COL-001-B",
    "patient_vignette": "A 72-year-old man with gout presents with an acute flare involving the right first metatarsophalangeal joint. His estimated CrCl is 52 mL/min. He has no hepatic disease or prior colchicine toxicity. His physician is reviewing which gout medications require dose reduction given his renal function.",
    "question": "Which of the following gout medications requires dose reduction given this patient's renal function?",
    "options": {
      "A": "None of the above",
      "B": "Methylprednisolone",
      "C": "Febuxostat",
      "D": "Allopurinol",
      "E": "Colchicine"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antigout agents"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "RK-CF-PRO-001-A",
    "patient_vignette": "A 73-year-old woman with recurrent gout and tophi requires long-term urate-lowering therapy. Her estimated CrCl is 22 mL/min. She has no history of urolithiasis and no known drug allergies. Her physician is identifying which urate-lowering agents should be avoided entirely given her renal function.",
    "question": "Which of the following urate-lowering agents should be avoided given this patient's renal function?",
    "options": {
      "A": "Allopurinol",
      "B": "None of the above",
      "C": "Probenecid",
      "D": "Febuxostat",
      "E": "Colchicine"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antigout agents"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "RK-CF-PRO-001-B",
    "patient_vignette": "A 73-year-old woman with recurrent gout and tophi requires long-term urate-lowering therapy. Her estimated CrCl is 52 mL/min. She has no history of urolithiasis and no known drug allergies. Her physician is identifying which urate-lowering agents should be avoided entirely given her renal function.",
    "question": "Which of the following urate-lowering agents should be avoided given this patient's renal function?",
    "options": {
      "A": "Allopurinol",
      "B": "Probenecid",
      "C": "None of the above",
      "D": "Febuxostat",
      "E": "Colchicine"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "nephrology",
    "taxonomy_clinical_system": "urinary system",
    "taxonomy_drug_categories": [
      "antigout agents"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "older adults",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "PG-IBU-NEG-001",
    "patient_vignette": "A 28-year-old woman at 16 weeks of gestation presents with low back pain. She requests guidance on analgesic options.",
    "question": "Which of the following medications should be avoided due to trimester-specific pregnancy contraindications?",
    "options": {
      "A": "Cefalexin",
      "B": "None of the above",
      "C": "Codeine",
      "D": "Ibuprofen",
      "E": "Acetaminophen"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "nsaids/antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "gestational-week threshold",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "PG-IBU-POS-001",
    "patient_vignette": "A 28-year-old woman at 32 weeks of gestation presents with low back pain. She requests guidance on analgesic options.",
    "question": "Which of the following medications should be avoided due to trimester-specific pregnancy contraindications?",
    "options": {
      "A": "Cefalexin",
      "B": "None of the above",
      "C": "Codeine",
      "D": "Ibuprofen",
      "E": "Acetaminophen"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "nsaids/antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "gestational-week threshold",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "PG-IBU-POS-002",
    "patient_vignette": "A 25-year-old woman at 36 weeks of gestation presents with dental pain and requests an over-the-counter pain reliever.",
    "question": "Which of the following medications poses the greatest fetal risk if used at this gestational age?",
    "options": {
      "A": "Clotrimazole",
      "B": "Acetaminophen",
      "C": "Amoxicillin",
      "D": "Ibuprofen",
      "E": "None of the above"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "nsaids/antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "gestational-week threshold",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "PG-IBU-POS-003",
    "patient_vignette": "A 32-year-old woman at 30 weeks of gestation is being discharged after an outpatient procedure. The team is reviewing her discharge analgesic prescription.",
    "question": "Which of the following medications is inappropriate to include in the discharge prescription at this gestational age?",
    "options": {
      "A": "None of the above",
      "B": "Ibuprofen",
      "C": "Cefalexin",
      "D": "Acetaminophen",
      "E": "Amoxicillin"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "nsaids/antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "gestational-week threshold",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "PG-NAP-NEG-001",
    "patient_vignette": "A 33-year-old woman at 16 weeks of gestation presents with an acute headache. Her physician is selecting an analgesic.",
    "question": "Which of the following medications should be withheld due to gestational contraindications?",
    "options": {
      "A": "Naproxen",
      "B": "None of the above",
      "C": "Cefalexin",
      "D": "Amoxicillin",
      "E": "Acetaminophen"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "nsaids/antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "gestational-week threshold",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "PG-NAP-POS-001",
    "patient_vignette": "A 33-year-old woman at 34 weeks of gestation presents with an acute headache. Her physician is selecting an analgesic.",
    "question": "Which of the following medications should be withheld due to gestational contraindications?",
    "options": {
      "A": "Naproxen",
      "B": "None of the above",
      "C": "Cefalexin",
      "D": "Amoxicillin",
      "E": "Acetaminophen"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "nsaids/antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "gestational-week threshold",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "PG-NAP-POS-002",
    "patient_vignette": "A 31-year-old woman at 28 weeks of gestation has joint pain requiring analgesic treatment. The physician is reviewing available options.",
    "question": "Which of the following would be an inappropriate medication choice at this gestational age?",
    "options": {
      "A": "Acetaminophen",
      "B": "Naproxen",
      "C": "None of the above",
      "D": "Codeine",
      "E": "Cefalexin"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "nsaids/antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "gestational-week threshold",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "PG-NAP-POS-003",
    "patient_vignette": "A 27-year-old woman at 32 weeks of gestation has a mild osteoarthritis flare. The rheumatologist is reviewing her pain regimen.",
    "question": "Which of the following medications is contraindicated in the third trimester of pregnancy?",
    "options": {
      "A": "Naproxen",
      "B": "None of the above",
      "C": "Clotrimazole",
      "D": "Acetaminophen",
      "E": "Ampicillin"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "nsaids/antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "gestational-week threshold",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "PG-CEL-NEG-001",
    "patient_vignette": "A 29-year-old woman at 18 weeks of gestation with rheumatoid arthritis presents with a disease flare. Her physician is reviewing anti-inflammatory options.",
    "question": "Which of the following medications is contraindicated at this stage of pregnancy?",
    "options": {
      "A": "Amoxicillin",
      "B": "Codeine",
      "C": "None of the above",
      "D": "Celecoxib",
      "E": "Acetaminophen"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "nsaids/antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "gestational-week threshold",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "PG-CEL-POS-001",
    "patient_vignette": "A 29-year-old woman at 32 weeks of gestation with rheumatoid arthritis presents with a disease flare. Her physician is reviewing anti-inflammatory options.",
    "question": "Which of the following medications is contraindicated at this stage of pregnancy?",
    "options": {
      "A": "Amoxicillin",
      "B": "Codeine",
      "C": "None of the above",
      "D": "Celecoxib",
      "E": "Acetaminophen"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "nsaids/antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "gestational-week threshold",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "PG-CEL-POS-002",
    "patient_vignette": "A 34-year-old woman at 35 weeks of gestation requests continuation of her pre-pregnancy arthritis medications. Her current regimen includes celecoxib.",
    "question": "Which of the following should be discontinued given the patient's gestational age?",
    "options": {
      "A": "Acetaminophen",
      "B": "Celecoxib",
      "C": "None of the above",
      "D": "Cefalexin",
      "E": "Amoxicillin-clavulanate"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "nsaids/antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "gestational-week threshold",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "PG-CEL-POS-003",
    "patient_vignette": "A 31-year-old woman at 30 weeks of gestation is evaluated for musculoskeletal discomfort following a minor fall. She has no prior arthritis history and no known drug allergies. Her physician is selecting a short-course analgesic.",
    "question": "Which of the following medications is contraindicated at this gestational age?",
    "options": {
      "A": "Celecoxib",
      "B": "None of the above",
      "C": "Clotrimazole",
      "D": "Cefalexin",
      "E": "Acetaminophen"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "nsaids/antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "gestational-week threshold",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "PG-MEL-NEG-001",
    "patient_vignette": "A 29-year-old woman at 18 weeks of gestation with osteoarthritis requests pain management. Her physician is reviewing analgesic choices.",
    "question": "Which of the following medications is contraindicated at this gestational age?",
    "options": {
      "A": "Amoxicillin",
      "B": "Acetaminophen",
      "C": "None of the above",
      "D": "Meloxicam",
      "E": "Cefalexin"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "nsaids/antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "gestational-week threshold",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "PG-MEL-POS-001",
    "patient_vignette": "A 29-year-old woman at 32 weeks of gestation with osteoarthritis requests pain management. Her physician is reviewing analgesic choices.",
    "question": "Which of the following medications is contraindicated at this gestational age?",
    "options": {
      "A": "Amoxicillin",
      "B": "Acetaminophen",
      "C": "None of the above",
      "D": "Meloxicam",
      "E": "Cefalexin"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "nsaids/antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "gestational-week threshold",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "PG-MEL-POS-002",
    "patient_vignette": "A 31-year-old woman at 28 weeks of gestation is seen for pain management review. Her physician is assessing which medications should be removed from her regimen.",
    "question": "Which of the following should be excluded from the patient's medication regimen at this gestational age?",
    "options": {
      "A": "Amoxicillin",
      "B": "Meloxicam",
      "C": "Clotrimazole",
      "D": "Codeine",
      "E": "None of the above"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "nsaids/antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "gestational-week threshold",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "PG-DIC-NEG-001",
    "patient_vignette": "A 31-year-old woman at 16 weeks of gestation presents with acute musculoskeletal pain. Her physician is selecting an analgesic.",
    "question": "Which of the following medications is inappropriate for use at this gestational age?",
    "options": {
      "A": "Diclofenac",
      "B": "Cefalexin",
      "C": "Acetaminophen",
      "D": "None of the above",
      "E": "Amoxicillin"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "nsaids/antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "gestational-week threshold",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "PG-DIC-POS-001",
    "patient_vignette": "A 31-year-old woman at 32 weeks of gestation presents with acute musculoskeletal pain. Her physician is selecting an analgesic.",
    "question": "Which of the following medications is inappropriate for use at this gestational age?",
    "options": {
      "A": "Diclofenac",
      "B": "Cefalexin",
      "C": "Acetaminophen",
      "D": "None of the above",
      "E": "Amoxicillin"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "nsaids/antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "gestational-week threshold",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "PG-DIC-POS-002",
    "patient_vignette": "A 28-year-old woman at 34 weeks of gestation reports knee pain and asks about topical analgesic options. Her physician is reviewing the safety of topical agents.",
    "question": "Which of the following agents should be avoided at this gestational age?",
    "options": {
      "A": "None of the above",
      "B": "Diclofenac gel",
      "C": "Clotrimazole cream",
      "D": "Topical lidocaine",
      "E": "Cefalexin"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "nsaids/antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "gestational-week threshold",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "PG-ASP-NEG-001",
    "patient_vignette": "A 26-year-old woman at 18 weeks of gestation presents with a tension headache. Her physician is selecting an analgesic at standard therapeutic doses.",
    "question": "Which of the following medications is contraindicated based on trimester-specific pregnancy guidelines?",
    "options": {
      "A": "None of the above",
      "B": "Acetaminophen",
      "C": "Amoxicillin",
      "D": "Cefalexin",
      "E": "Aspirin"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "nsaids/antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "gestational-week threshold",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "PG-ASP-POS-001",
    "patient_vignette": "A 26-year-old woman at 34 weeks of gestation presents with a tension headache. Her physician is selecting an analgesic at standard therapeutic doses.",
    "question": "Which of the following medications is contraindicated based on trimester-specific pregnancy guidelines?",
    "options": {
      "A": "None of the above",
      "B": "Acetaminophen",
      "C": "Amoxicillin",
      "D": "Cefalexin",
      "E": "Aspirin"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "nsaids/antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "gestational-week threshold",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "PG-ASP-POS-002",
    "patient_vignette": "A 30-year-old woman at 38 weeks of gestation requests an over-the-counter pain reliever for mild discomfort. She is asking the pharmacist about options.",
    "question": "Which of the following medications should be avoided in the current trimester?",
    "options": {
      "A": "Aspirin",
      "B": "Acetaminophen",
      "C": "Clotrimazole",
      "D": "None of the above",
      "E": "Codeine"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "nsaids/antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "gestational-week threshold",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "PG-TMP-NEG-001",
    "patient_vignette": "A 27-year-old woman at 20 weeks of gestation is diagnosed with an uncomplicated urinary tract infection. Her physician is selecting an antibiotic.",
    "question": "Which of the following medications is contraindicated at the current gestational age?",
    "options": {
      "A": "None of the above",
      "B": "Amoxicillin",
      "C": "Cefalexin",
      "D": "Trimethoprim-sulfamethoxazole",
      "E": "Nitrofurantoin"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "sulfonamide antibacterials"
    ],
    "taxonomy_patient_info_type": "gestational-week threshold",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "PG-TMP-POS-001",
    "patient_vignette": "A 27-year-old woman at 35 weeks of gestation is diagnosed with an uncomplicated urinary tract infection. Her physician is selecting an antibiotic.",
    "question": "Which of the following medications is contraindicated at the current gestational age?",
    "options": {
      "A": "None of the above",
      "B": "Amoxicillin",
      "C": "Cefalexin",
      "D": "Trimethoprim-sulfamethoxazole",
      "E": "Nitrofurantoin"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "sulfonamide antibacterials"
    ],
    "taxonomy_patient_info_type": "gestational-week threshold",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "PG-TMP-POS-002",
    "patient_vignette": "A 29-year-old woman at 33 weeks of gestation presents with a recurrent urinary tract infection. Her physician is reviewing antibiotic options.",
    "question": "Which of the following would be an inappropriate medication choice at this gestational age?",
    "options": {
      "A": "Cefalexin",
      "B": "Amoxicillin",
      "C": "Fosfomycin",
      "D": "None of the above",
      "E": "Trimethoprim-sulfamethoxazole"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "sulfonamide antibacterials"
    ],
    "taxonomy_patient_info_type": "gestational-week threshold",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "PG-TMP-POS-003",
    "patient_vignette": "A 29-year-old woman at 38 weeks of gestation presents with an acute urinary tract infection. Her physician is reviewing the safety of common antibiotics at term.",
    "question": "Which of the following medications are contraindicated at this gestational age? (Select all that apply.)",
    "options": {
      "A": "Amoxicillin",
      "B": "Trimethoprim-sulfamethoxazole",
      "C": "None of the above",
      "D": "Nitrofurantoin",
      "E": "Cefalexin"
    },
    "answer": [
      "B",
      "D"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "sulfonamides/urinary antibacterials"
    ],
    "taxonomy_patient_info_type": "gestational-week threshold",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "PG-MTR-POS-001",
    "patient_vignette": "A 24-year-old woman at 9 weeks of gestation is diagnosed with trichomoniasis. Her physician is selecting appropriate treatment.",
    "question": "Which of the following treatments should be deferred due to trimester-specific concerns in this patient?",
    "options": {
      "A": "Clotrimazole",
      "B": "None of the above",
      "C": "Metronidazole",
      "D": "Amoxicillin",
      "E": "Cefalexin"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "nitroimidazole antibacterials"
    ],
    "taxonomy_patient_info_type": "gestational-week threshold",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "PG-MTR-NEG-001",
    "patient_vignette": "A 24-year-old woman at 22 weeks of gestation is diagnosed with trichomoniasis. Her physician is selecting appropriate treatment.",
    "question": "Which of the following treatments should be deferred due to trimester-specific concerns in this patient?",
    "options": {
      "A": "Clotrimazole",
      "B": "None of the above",
      "C": "Metronidazole",
      "D": "Amoxicillin",
      "E": "Cefalexin"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "nitroimidazole antibacterials"
    ],
    "taxonomy_patient_info_type": "gestational-week threshold",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "PG-MTR-POS-002",
    "patient_vignette": "A 26-year-old woman at 11 weeks of gestation presents with vaginal trichomoniasis confirmed on wet mount preparation.",
    "question": "Which of the following medications carries a trimester-specific contraindication in this patient?",
    "options": {
      "A": "None of the above",
      "B": "Cefalexin",
      "C": "Metronidazole",
      "D": "Amoxicillin",
      "E": "Nitrofurantoin"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "nitroimidazole antibacterials"
    ],
    "taxonomy_patient_info_type": "gestational-week threshold",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "PG-MTR-NEG-002",
    "patient_vignette": "A 26-year-old woman at 30 weeks of gestation presents with vaginal trichomoniasis confirmed on wet mount preparation.",
    "question": "Which of the following medications carries a trimester-specific contraindication in this patient?",
    "options": {
      "A": "None of the above",
      "B": "Cefalexin",
      "C": "Metronidazole",
      "D": "Amoxicillin",
      "E": "Nitrofurantoin"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "nitroimidazole antibacterials"
    ],
    "taxonomy_patient_info_type": "gestational-week threshold",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "PG-WAR-NEG-001",
    "patient_vignette": "A 34-year-old woman with atrial fibrillation requires long-term anticoagulation. She is not pregnant.",
    "question": "Which of the following medications is contraindicated in this patient?",
    "options": {
      "A": "None of the above",
      "B": "Heparin",
      "C": "Warfarin",
      "D": "Enoxaparin",
      "E": "Fondaparinux"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "anticoagulants"
    ],
    "taxonomy_patient_info_type": "pregnancy status",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "PG-WAR-POS-001",
    "patient_vignette": "A 34-year-old woman with atrial fibrillation requires long-term anticoagulation. She is confirmed to be 10 weeks pregnant.",
    "question": "Which of the following medications is contraindicated in this patient?",
    "options": {
      "A": "None of the above",
      "B": "Heparin",
      "C": "Warfarin",
      "D": "Enoxaparin",
      "E": "Fondaparinux"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "anticoagulants"
    ],
    "taxonomy_patient_info_type": "pregnancy status",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "PG-WAR-POS-002",
    "patient_vignette": "A 29-year-old woman at 12 weeks of gestation presents to the anticoagulation clinic. She was recently diagnosed with a proximal deep vein thrombosis and requires immediate anticoagulation therapy.",
    "question": "Which of the following medications should be avoided in this patient's treatment plan?",
    "options": {
      "A": "Warfarin",
      "B": "Enoxaparin",
      "C": "Unfractionated heparin",
      "D": "Fondaparinux",
      "E": "None of the above"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "anticoagulants"
    ],
    "taxonomy_patient_info_type": "pregnancy status",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "PG-ISO-NEG-001",
    "patient_vignette": "A 22-year-old woman presents with severe nodulocystic acne that has not responded to topical therapy or two courses of oral antibiotics. She is not pregnant and is using reliable contraception.",
    "question": "Which of the following medications is contraindicated in this patient?",
    "options": {
      "A": "None of the above",
      "B": "Benzoyl peroxide",
      "C": "Azelaic acid",
      "D": "Topical clindamycin",
      "E": "Isotretinoin"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "retinoids"
    ],
    "taxonomy_patient_info_type": "pregnancy status",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "PG-ISO-POS-001",
    "patient_vignette": "A 22-year-old woman presents with severe nodulocystic acne that has not responded to topical therapy or two courses of oral antibiotics. She is confirmed to be 8 weeks pregnant.",
    "question": "Which of the following medications is contraindicated in this patient?",
    "options": {
      "A": "None of the above",
      "B": "Benzoyl peroxide",
      "C": "Azelaic acid",
      "D": "Topical clindamycin",
      "E": "Isotretinoin"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "retinoids"
    ],
    "taxonomy_patient_info_type": "pregnancy status",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "PG-ISO-POS-002",
    "patient_vignette": "A 24-year-old woman at 6 weeks of gestation presents to a dermatology clinic with severe inflammatory acne. She is requesting guidance on safe treatment options.",
    "question": "Which of the following is absolutely contraindicated given this patient's current status?",
    "options": {
      "A": "Azelaic acid",
      "B": "Isotretinoin",
      "C": "Topical metronidazole gel",
      "D": "None of the above",
      "E": "Topical erythromycin"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "retinoids"
    ],
    "taxonomy_patient_info_type": "pregnancy status",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "PG-LEF-NEG-001",
    "patient_vignette": "A 35-year-old woman with rheumatoid arthritis has had an inadequate response to methotrexate. She is not pregnant and is using reliable contraception.",
    "question": "Which of the following medications is contraindicated in this patient?",
    "options": {
      "A": "Sulfasalazine",
      "B": "None of the above",
      "C": "Prednisone",
      "D": "Leflunomide",
      "E": "Hydroxychloroquine"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "immunomodulators"
    ],
    "taxonomy_patient_info_type": "pregnancy status",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "PG-LEF-POS-001",
    "patient_vignette": "A 35-year-old woman with rheumatoid arthritis has had an inadequate response to methotrexate. She is confirmed to be 9 weeks pregnant.",
    "question": "Which of the following medications is contraindicated in this patient?",
    "options": {
      "A": "Sulfasalazine",
      "B": "None of the above",
      "C": "Prednisone",
      "D": "Leflunomide",
      "E": "Hydroxychloroquine"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "immunomodulators"
    ],
    "taxonomy_patient_info_type": "pregnancy status",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "PG-MTX-NEG-001",
    "patient_vignette": "A 36-year-old woman with moderate Crohn's disease is being evaluated for systemic therapy following failure of aminosalicylates. She is not pregnant and is using reliable contraception.",
    "question": "Which of the following medications is contraindicated in this patient?",
    "options": {
      "A": "Methotrexate",
      "B": "None of the above",
      "C": "Budesonide",
      "D": "Sulfasalazine",
      "E": "Prednisone"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "antimetabolites/immunosuppressants"
    ],
    "taxonomy_patient_info_type": "pregnancy status",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "PG-MTX-POS-001",
    "patient_vignette": "A 36-year-old woman with moderate Crohn's disease is being evaluated for systemic therapy following failure of aminosalicylates. She is confirmed to be 7 weeks pregnant.",
    "question": "Which of the following medications is contraindicated in this patient?",
    "options": {
      "A": "Methotrexate",
      "B": "None of the above",
      "C": "Budesonide",
      "D": "Sulfasalazine",
      "E": "Prednisone"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "antimetabolites/immunosuppressants"
    ],
    "taxonomy_patient_info_type": "pregnancy status",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "PG-RBV-NEG-001",
    "patient_vignette": "A 32-year-old woman with chronic Hepatitis C infection (genotype 1) is being initiated on antiviral therapy. She is not pregnant and will use two forms of effective contraception throughout the course of treatment.",
    "question": "Which of the following medications is contraindicated in this patient?",
    "options": {
      "A": "Sofosbuvir",
      "B": "None of the above",
      "C": "Ribavirin",
      "D": "Ledipasvir",
      "E": "Daclatasvir"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "antivirals"
    ],
    "taxonomy_patient_info_type": "pregnancy status",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "PG-RBV-POS-001",
    "patient_vignette": "A 32-year-old woman with chronic Hepatitis C infection (genotype 1) is being initiated on antiviral therapy. She is confirmed to be 10 weeks pregnant.",
    "question": "Which of the following medications is contraindicated in this patient?",
    "options": {
      "A": "Sofosbuvir",
      "B": "None of the above",
      "C": "Ribavirin",
      "D": "Ledipasvir",
      "E": "Daclatasvir"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "antivirals"
    ],
    "taxonomy_patient_info_type": "pregnancy status",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "PG-MISO-NEG-001",
    "patient_vignette": "A 30-year-old woman requires long-term NSAID therapy for osteoarthritis. Her physician is adding a medication to reduce gastrointestinal side effects. She is not pregnant and is using reliable contraception.",
    "question": "Which of the following medications is contraindicated in this patient?",
    "options": {
      "A": "Omeprazole",
      "B": "Famotidine",
      "C": "Sucralfate",
      "D": "None of the above",
      "E": "Misoprostol"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "prostaglandins"
    ],
    "taxonomy_patient_info_type": "pregnancy status",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "PG-MISO-POS-001",
    "patient_vignette": "A 30-year-old woman requires long-term NSAID therapy for osteoarthritis. Her physician is adding a medication to reduce gastrointestinal side effects. She is 14 weeks pregnant.",
    "question": "Which of the following medications is contraindicated in this patient?",
    "options": {
      "A": "Omeprazole",
      "B": "Famotidine",
      "C": "Sucralfate",
      "D": "None of the above",
      "E": "Misoprostol"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "prostaglandins"
    ],
    "taxonomy_patient_info_type": "pregnancy status",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "PG-STAT-NEG-001",
    "patient_vignette": "A 42-year-old woman with familial hypercholesterolemia and elevated cardiovascular risk is being evaluated for lipid-lowering therapy. She is not pregnant.",
    "question": "Which of the following medications is contraindicated in this patient?",
    "options": {
      "A": "Omega-3 fatty acid supplements",
      "B": "Colesevelam",
      "C": "None of the above",
      "D": "Atorvastatin",
      "E": "Ezetimibe"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "statins"
    ],
    "taxonomy_patient_info_type": "pregnancy status",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "PG-STAT-POS-001",
    "patient_vignette": "A 42-year-old woman with familial hypercholesterolemia and elevated cardiovascular risk is being evaluated for lipid-lowering therapy. She is 8 weeks pregnant.",
    "question": "Which of the following medications is contraindicated in this patient?",
    "options": {
      "A": "Omega-3 fatty acid supplements",
      "B": "Colesevelam",
      "C": "None of the above",
      "D": "Atorvastatin",
      "E": "Ezetimibe"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "statins"
    ],
    "taxonomy_patient_info_type": "pregnancy status",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "PG-DRO-NEG-001",
    "patient_vignette": "A 38-year-old woman with paroxysmal atrial fibrillation is being evaluated for long-term rhythm control therapy. She is not pregnant.",
    "question": "Which of the following medications is contraindicated in this patient?",
    "options": {
      "A": "Metoprolol",
      "B": "Dronedarone",
      "C": "Digoxin",
      "D": "Flecainide",
      "E": "None of the above"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "hormonal drugs"
    ],
    "taxonomy_patient_info_type": "pregnancy status",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "PG-DRO-POS-001",
    "patient_vignette": "A 38-year-old woman with paroxysmal atrial fibrillation is being evaluated for long-term rhythm control therapy. She is confirmed to be 10 weeks pregnant.",
    "question": "Which of the following medications is contraindicated in this patient?",
    "options": {
      "A": "Metoprolol",
      "B": "Dronedarone",
      "C": "Digoxin",
      "D": "Flecainide",
      "E": "None of the above"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "hormonal drugs"
    ],
    "taxonomy_patient_info_type": "pregnancy status",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "PG-THAL-NEG-001",
    "patient_vignette": "A 45-year-old woman with newly diagnosed multiple myeloma is being initiated on combination therapy. She is not pregnant and is using two forms of reliable contraception.",
    "question": "Which of the following medications is contraindicated in this patient?",
    "options": {
      "A": "Dexamethasone",
      "B": "Carfilzomib",
      "C": "None of the above",
      "D": "Bortezomib",
      "E": "Thalidomide"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "immunomodulators"
    ],
    "taxonomy_patient_info_type": "pregnancy status",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "PG-THAL-POS-001",
    "patient_vignette": "A 45-year-old woman with newly diagnosed multiple myeloma is being initiated on combination therapy. She is confirmed to be 8 weeks pregnant.",
    "question": "Which of the following medications is contraindicated in this patient?",
    "options": {
      "A": "Dexamethasone",
      "B": "Carfilzomib",
      "C": "None of the above",
      "D": "Bortezomib",
      "E": "Thalidomide"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "obstetrics and gynecology",
    "taxonomy_clinical_system": "reproductive system",
    "taxonomy_drug_categories": [
      "immunomodulators"
    ],
    "taxonomy_patient_info_type": "pregnancy status",
    "taxonomy_population_source": "pregnancy",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "KD-GF-ARB-001",
    "patient_vignette": "A 2-week-old neonate with severe hypertension secondary to renal disease is being evaluated for antihypertensive therapy in the neonatal intensive care unit.",
    "question": "Which of the following medications should be used with particular caution in this patient?",
    "options": {
      "A": "Hydralazine",
      "B": "None of the above",
      "C": "Furosemide",
      "D": "Amlodipine",
      "E": "Losartan"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "cardiovascular drugs"
    ],
    "taxonomy_patient_info_type": "age threshold",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "KD-GF-ATV-001",
    "patient_vignette": "A 2-month-old infant with perinatal HIV exposure is being evaluated for antiretroviral therapy. Pharmacogenetic testing is not available.",
    "question": "Which of the following medications should be used with particular caution in this patient?",
    "options": {
      "A": "Lamivudine",
      "B": "Raltegravir",
      "C": "Zidovudine",
      "D": "Atazanavir",
      "E": "None of the above"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "lymphatic and immune system",
    "taxonomy_drug_categories": [
      "antivirals"
    ],
    "taxonomy_patient_info_type": "age threshold",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "KD-GF-CAM-001",
    "patient_vignette": "A 6-year-old child presents with upper respiratory symptoms, and the caregiver asks about topical chest-rub products for symptomatic relief.",
    "question": "Which of the following medications should be used with particular caution in this patient?",
    "options": {
      "A": "Saline nasal spray",
      "B": "Camphor (topical)",
      "C": "None of the above",
      "D": "Petrolatum ointment",
      "E": "Honey"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "integumentary system",
    "taxonomy_drug_categories": [
      "topical drugs"
    ],
    "taxonomy_patient_info_type": "pediatric-adult contraindication",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "KD-GF-CAR-001",
    "patient_vignette": "A 15-month-old toddler is brought to clinic for rhinorrhea and nighttime cough, and the family asks about antihistamine options.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "None of the above",
      "B": "Saline nasal spray",
      "C": "Cetirizine",
      "D": "Carbinoxamine",
      "E": "Humidified air"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "respiratory system",
    "taxonomy_drug_categories": [
      "antihistamines"
    ],
    "taxonomy_patient_info_type": "age threshold",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "KD-GF-CEF-001",
    "patient_vignette": "A 10-day-old neonate is being treated for suspected sepsis. This is not a one-time gonococcal treatment dose.",
    "question": "Which of the following medications should be used with particular caution in this patient?",
    "options": {
      "A": "Ceftriaxone",
      "B": "None of the above",
      "C": "Gentamicin",
      "D": "Ampicillin",
      "E": "Cefotaxime"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "lymphatic and immune system",
    "taxonomy_drug_categories": [
      "antibiotics"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "KD-GF-CHL-001",
    "patient_vignette": "A 2-week-old neonate with a serious bacterial infection is in the neonatal intensive care unit. Serum concentration monitoring is not available.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Chloramphenicol",
      "B": "Gentamicin",
      "C": "Ampicillin",
      "D": "None of the above",
      "E": "Cefotaxime"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "lymphatic and immune system",
    "taxonomy_drug_categories": [
      "antibiotics"
    ],
    "taxonomy_patient_info_type": "age threshold",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "KD-GF-COR-001",
    "patient_vignette": "A 10-month-old infant presents with diaper dermatitis, and the clinician is reviewing topical treatment choices.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Topical nystatin",
      "B": "Topical corticosteroids (high potency)",
      "C": "Zinc oxide barrier cream",
      "D": "Petrolatum ointment",
      "E": "None of the above"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "integumentary system",
    "taxonomy_drug_categories": [
      "dermatologic drugs"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "KD-GF-DAR-001",
    "patient_vignette": "A 2-year-old child weighing 9 kg with HIV infection is being evaluated for antiretroviral therapy.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "None of the above",
      "B": "Darunavir",
      "C": "Zidovudine",
      "D": "Dolutegravir",
      "E": "Lamivudine"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "lymphatic and immune system",
    "taxonomy_drug_categories": [
      "antivirals"
    ],
    "taxonomy_patient_info_type": "age threshold",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "KD-GF-DIC-001",
    "patient_vignette": "A 4-month-old infant is brought in for abdominal cramping, and the clinician is reviewing antispasmodic treatment options.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "None of the above",
      "B": "Dicyclomine",
      "C": "Simethicone",
      "D": "Glycerin suppository",
      "E": "Oral rehydration solution"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "digestive system",
    "taxonomy_drug_categories": [
      "gastrointestinal drugs"
    ],
    "taxonomy_patient_info_type": "age threshold",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "KD-GF-DIF-001",
    "patient_vignette": "A 9-year-old child is being treated for postoperative ocular inflammation, and ophthalmic medication options are under review.",
    "question": "Which of the following medications should be used with particular caution in this patient?",
    "options": {
      "A": "Artificial tears",
      "B": "None of the above",
      "C": "Difluprednate (ophthalmic)",
      "D": "Erythromycin ophthalmic ointment",
      "E": "Saline eye wash"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "ophthalmic drugs"
    ],
    "taxonomy_patient_info_type": "pediatric-adult contraindication",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "KD-GF-DIP-001",
    "patient_vignette": "A 3-year-old child presents with acute diarrhea, and the caregiver asks about antidiarrheal medication options.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "None of the above",
      "B": "Zinc supplementation",
      "C": "Diphenoxylate-atropine",
      "D": "Oral rehydration solution",
      "E": "Dietary modification"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "digestive system",
    "taxonomy_drug_categories": [
      "gastrointestinal drugs"
    ],
    "taxonomy_patient_info_type": "age threshold",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "KD-GF-FGA-001",
    "patient_vignette": "A 12-year-old child with severe agitation is being evaluated for psychiatric medication options.",
    "question": "Which of the following medications should be avoided in this patient? Select all that apply.",
    "options": {
      "A": "Melatonin",
      "B": "None of the above",
      "C": "Hydroxyzine",
      "D": "Haloperidol",
      "E": "Chlorpromazine"
    },
    "answer": [
      "D",
      "E"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "psychiatric medications"
    ],
    "taxonomy_patient_info_type": "pediatric-adult contraindication",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "KD-GF-PRODA-001",
    "patient_vignette": "An 18-month-old toddler presents with vomiting, and the clinician is reviewing antiemetic choices.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Oral rehydration solution",
      "B": "Ondansetron",
      "C": "Simethicone",
      "D": "None of the above",
      "E": "Prochlorperazine"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "psychiatric medications"
    ],
    "taxonomy_patient_info_type": "age threshold",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "KD-GF-SGA02-001",
    "patient_vignette": "A 14-year-old adolescent with psychiatric symptoms is being considered for maintenance treatment, and the team is reviewing medication plans.",
    "question": "Which of the following treatment plans should be avoided in this patient because of pediatric guideline restrictions on treatment duration?",
    "options": {
      "A": "Fluoxetine planned for 12 weeks",
      "B": "None of the above",
      "C": "Risperidone planned for 4 weeks",
      "D": "Olanzapine planned for 16 weeks",
      "E": "Olanzapine planned for 6 weeks"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "psychiatric medications"
    ],
    "taxonomy_patient_info_type": "pediatric-adult contraindication",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "KD-GF-MET-001",
    "patient_vignette": "A 10-month-old infant is brought in for persistent vomiting and poor feeding, and the team is reviewing symptomatic treatment options.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Metoclopramide",
      "B": "Oral rehydration solution",
      "C": "Ondansetron",
      "D": "None of the above",
      "E": "Simethicone"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "digestive system",
    "taxonomy_drug_categories": [
      "gastrointestinal drugs"
    ],
    "taxonomy_patient_info_type": "age threshold",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "KD-GF-PRO-001",
    "patient_vignette": "A 15-month-old toddler presents with nausea and vomiting, and antiemetic options are being reviewed.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "None of the above",
      "B": "Oral rehydration solution",
      "C": "Simethicone",
      "D": "Promethazine",
      "E": "Ondansetron"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "respiratory system",
    "taxonomy_drug_categories": [
      "antihistamines/antiemetics"
    ],
    "taxonomy_patient_info_type": "age threshold",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "KD-GF-TRIDA-001",
    "patient_vignette": "A 9-year-old child presents with vomiting, and the clinician is reviewing antiemetic choices.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Oral rehydration solution",
      "B": "None of the above",
      "C": "Trimethobenzamide",
      "D": "Simethicone",
      "E": "Ondansetron"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "digestive system",
    "taxonomy_drug_categories": [
      "gastrointestinal drugs"
    ],
    "taxonomy_patient_info_type": "pediatric-adult contraindication",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "KD-GF-BEN-001",
    "patient_vignette": "An 18-month-old toddler is brought in for painful oral ulcers and poor oral intake. The family asks about topical oral pain relief.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "None of the above",
      "B": "Benzocaine (topical oral)",
      "C": "Cold fluids",
      "D": "Acetaminophen",
      "E": "Saline oral rinse"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "integumentary system",
    "taxonomy_drug_categories": [
      "local anesthetics/topical drugs"
    ],
    "taxonomy_patient_info_type": "age threshold",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "KD-GF-LID-001",
    "patient_vignette": "A 20-month-old toddler is seen for painful oral lesions causing decreased oral intake, and topical oral treatments are under review.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "None of the above",
      "B": "Cold fluids",
      "C": "Lidocaine viscous (topical oral)",
      "D": "Saline oral rinse",
      "E": "Acetaminophen"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "integumentary system",
    "taxonomy_drug_categories": [
      "local anesthetics/topical drugs"
    ],
    "taxonomy_patient_info_type": "age threshold",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "KD-GF-GEN-001",
    "patient_vignette": "A 2-week-old neonate presents with eye discharge and eyelid irritation, and ophthalmic treatment options are being reviewed.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Warm compresses",
      "B": "None of the above",
      "C": "Erythromycin ophthalmic ointment",
      "D": "Gentamicin (ophthalmic ointment)",
      "E": "Saline eye drops"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "ophthalmic drugs"
    ],
    "taxonomy_patient_info_type": "age threshold",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "KD-GF-LAM-001",
    "patient_vignette": "An 11-year-old child with epilepsy is starting maintenance therapy, and the neurology team is reviewing medication choices that require slow titration because of pediatric safety concerns.",
    "question": "Which of the following medications should be used with particular caution in this patient?",
    "options": {
      "A": "Lamotrigine",
      "B": "None of the above",
      "C": "Levetiracetam",
      "D": "Valtoco",
      "E": "Clobazam"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "antiepileptics"
    ],
    "taxonomy_patient_info_type": "pediatric-adult contraindication",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "KD-GF-LOP-001",
    "patient_vignette": "A 2-year-old child presents with fever, watery stools, and suspected acute infectious diarrhea. The family asks about symptomatic medications.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Oral rehydration solution",
      "B": "Banana-rice diet",
      "C": "Zinc supplementation",
      "D": "None of the above",
      "E": "Loperamide"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "digestive system",
    "taxonomy_drug_categories": [
      "gastrointestinal drugs"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "KD-GF-MAC-001",
    "patient_vignette": "A 2-week-old neonate with fever and suspected bacterial sepsis is being evaluated in the neonatal intensive care unit. The team is considering antibiotics, and there is no evidence of Bordetella pertussis, Chlamydia trachomatis pneumonia, or Ureaplasma infection.",
    "question": "Which of the following medications should be avoided in this patient? Select all that apply.",
    "options": {
      "A": "None of the above",
      "B": "Azithromycin",
      "C": "Erythromycin",
      "D": "Ampicillin",
      "E": "Cefotaxime"
    },
    "answer": [
      "B",
      "C"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "lymphatic and immune system",
    "taxonomy_drug_categories": [
      "antibiotics"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "KD-GF-MIN-001",
    "patient_vignette": "A 7-month-old infant is evaluated for constipation, and the clinician is reviewing medication options.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Mineral oil",
      "B": "None of the above",
      "C": "Glycerin suppository",
      "D": "Lactulose",
      "E": "Prune juice"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "digestive system",
    "taxonomy_drug_categories": [
      "gastrointestinal drugs"
    ],
    "taxonomy_patient_info_type": "age threshold",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "KD-GF-NAL-001",
    "patient_vignette": "A term neonate in the delivery room requires postpartum resuscitation after maternal intrapartum opioid exposure. The resuscitation team is specifically deciding whether any medication should be avoided in this neonatal postpartum-resuscitation setting.",
    "question": "Which of the following medications should be avoided in this neonatal resuscitation setting?",
    "options": {
      "A": "Intravenous glucose",
      "B": "Naloxone",
      "C": "Positive-pressure ventilation",
      "D": "Supplemental oxygen",
      "E": "None of the above"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "opioid antagonists"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "KD-GF-NIT-001",
    "patient_vignette": "A 2-week-old neonate is being evaluated for urinary tract infection treatment, and antibiotic options are under review.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Cefotaxime",
      "B": "Ampicillin",
      "C": "None of the above",
      "D": "Gentamicin",
      "E": "Nitrofurantoin"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "lymphatic and immune system",
    "taxonomy_drug_categories": [
      "antibiotics"
    ],
    "taxonomy_patient_info_type": "age threshold",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "KD-GF-COD-001",
    "patient_vignette": "An 8-year-old child presents with acute pain after a minor orthopedic injury, and the clinician is selecting an analgesic regimen.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "None of the above",
      "B": "Acetaminophen",
      "C": "Naproxen",
      "D": "Codeine",
      "E": "Ibuprofen"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "opioids"
    ],
    "taxonomy_patient_info_type": "age threshold",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "KD-GF-COD02-001",
    "patient_vignette": "A 14-year-old adolescent is on postoperative day 1 after tonsillectomy and adenoidectomy and needs analgesic treatment.",
    "question": "Which of the following analgesics should be avoided in this postoperative patient?",
    "options": {
      "A": "Ibuprofen",
      "B": "Hydrocodone-acetaminophen",
      "C": "Acetaminophen",
      "D": "Codeine",
      "E": "None of the above"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "opioids"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "KD-GF-MEP-001",
    "patient_vignette": "A 3-week-old neonate requires analgesic review in the intensive care setting, and opioid choices are being considered.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Meperidine",
      "B": "Acetaminophen",
      "C": "None of the above",
      "D": "Morphine",
      "E": "Fentanyl"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "opioids"
    ],
    "taxonomy_patient_info_type": "age threshold",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "KD-GF-TRA-001",
    "patient_vignette": "A 10-year-old child presents with acute pain after a sports injury, and the team is reviewing oral analgesic options.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Naproxen",
      "B": "Tramadol",
      "C": "None of the above",
      "D": "Acetaminophen",
      "E": "Ibuprofen"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "opioids"
    ],
    "taxonomy_patient_info_type": "age threshold",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "KD-GF-TRA02-001",
    "patient_vignette": "A 15-year-old adolescent is recovering after tonsillectomy and adenoidectomy and needs postoperative analgesia.",
    "question": "Which of the following analgesics should be avoided in this postoperative patient?",
    "options": {
      "A": "None of the above",
      "B": "Ibuprofen",
      "C": "Hydrocodone-acetaminophen",
      "D": "Tramadol",
      "E": "Acetaminophen"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "opioids"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "KD-GF-PPF-001",
    "patient_vignette": "A 13-year-old patient in the intensive care unit requires ongoing sedation, and the team is reviewing infusion plans.",
    "question": "Which of the following medication plans should be avoided in this patient because of pediatric dose-duration safety guidance?",
    "options": {
      "A": "Dexmedetomidine infusion at standard dosing",
      "B": "Propofol infusion 2 mg/kg/hr for 12 hours",
      "C": "Propofol infusion 5 mg/kg/hr for 72 hours",
      "D": "None of the above",
      "E": "Midazolam infusion at standard dosing"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "anesthetics"
    ],
    "taxonomy_patient_info_type": "dose threshold",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "KD-GF-SAL-001",
    "patient_vignette": "A 9-year-old child with fever, myalgias, and suspected influenza is being evaluated for symptomatic treatment.",
    "question": "Which of the following medications should be used with particular caution in this patient?",
    "options": {
      "A": "Acetaminophen",
      "B": "Aspirin",
      "C": "Ibuprofen",
      "D": "Oral hydration",
      "E": "None of the above"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "antipyretic analgesics"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "KD-GF-SNP-001",
    "patient_vignette": "An 18-month-old toddler is brought in for constipation, and rectal medication options are being reviewed.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Lactulose",
      "B": "Sodium phosphate solution enema (rectal)",
      "C": "Glycerin suppository",
      "D": "Prune juice",
      "E": "None of the above"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "digestive system",
    "taxonomy_drug_categories": [
      "gastrointestinal drugs"
    ],
    "taxonomy_patient_info_type": "age threshold",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "KD-GF-SUL-001",
    "patient_vignette": "A 2-week-old neonate requires antibiotic review, and sulfonamide-containing options are under consideration.",
    "question": "Which of the following medications should be used with particular caution in this patient?",
    "options": {
      "A": "Cefotaxime",
      "B": "Ampicillin",
      "C": "None of the above",
      "D": "Gentamicin",
      "E": "Sulfamethoxazole"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "lymphatic and immune system",
    "taxonomy_drug_categories": [
      "antibiotics"
    ],
    "taxonomy_patient_info_type": "age threshold",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "KD-GF-TET01-001",
    "patient_vignette": "A 6-year-old child is being evaluated for treatment of an atypical bacterial infection, and antibiotic choices are under review.",
    "question": "Which of the following medications should be used with particular caution in this patient?",
    "options": {
      "A": "Tetracycline",
      "B": "Cefdinir",
      "C": "None of the above",
      "D": "Azithromycin",
      "E": "Amoxicillin"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "lymphatic and immune system",
    "taxonomy_drug_categories": [
      "antibiotics"
    ],
    "taxonomy_patient_info_type": "age threshold",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "KD-GF-TET02-001",
    "patient_vignette": "A 2-week-old neonate with a mild superficial skin infection is being evaluated for antibiotic therapy, and the team wants to avoid agents with specific age-related toxicity in neonates.",
    "question": "Which of the following medications should be used with particular caution in this patient?",
    "options": {
      "A": "Cefalexin",
      "B": "Clindamycin",
      "C": "None of the above",
      "D": "Ampicillin",
      "E": "Tetracycline"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "lymphatic and immune system",
    "taxonomy_drug_categories": [
      "antibiotics"
    ],
    "taxonomy_patient_info_type": "age threshold",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "KD-GF-TCA-001",
    "patient_vignette": "A 13-year-old adolescent is being evaluated for psychiatric medication treatment, and the clinician is reviewing antidepressant choices.",
    "question": "Which of the following medications should be avoided in this patient? Select all that apply.",
    "options": {
      "A": "Desipramine",
      "B": "Fluoxetine",
      "C": "Sertraline",
      "D": "None of the above",
      "E": "Imipramine"
    },
    "answer": [
      "A",
      "E"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "psychiatric medications"
    ],
    "taxonomy_patient_info_type": "pediatric-adult contraindication",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "KD-GF-VPA-001",
    "patient_vignette": "An 18-month-old toddler with seizures is being evaluated for maintenance antiepileptic therapy.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Clobazam",
      "B": "Valproic acid",
      "C": "Levetiracetam",
      "D": "Phenobarbital",
      "E": "None of the above"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "antiepileptics"
    ],
    "taxonomy_patient_info_type": "age threshold",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "KD-GF-VER-001",
    "patient_vignette": "A 6-month-old infant with supraventricular tachycardia is being evaluated for medication therapy.",
    "question": "Which of the following medications should be used with particular caution in this patient?",
    "options": {
      "A": "Verapamil",
      "B": "Digoxin",
      "C": "None of the above",
      "D": "Propranolol",
      "E": "Adenosine"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "cardiovascular system",
    "taxonomy_drug_categories": [
      "cardiovascular drugs"
    ],
    "taxonomy_patient_info_type": "age threshold",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "static risk identification",
    "benchmark_task_family": "guideline_following"
  },
  {
    "instance_id": "KD-CF-CHL-001-A",
    "patient_vignette": "A 2-week-old neonate is being treated for a serious bacterial infection in the neonatal intensive care unit. The care team is reviewing antimicrobial options and wants to avoid agents that are unsafe at this age.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Cefotaxime",
      "B": "Chloramphenicol",
      "C": "None of the above",
      "D": "Gentamicin",
      "E": "Ampicillin"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "lymphatic and immune system",
    "taxonomy_drug_categories": [
      "antibiotics"
    ],
    "taxonomy_patient_info_type": "age threshold",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "KD-CF-CHL-001-B",
    "patient_vignette": "A 3-month-old infant is being treated for a serious bacterial infection. The care team is reviewing antimicrobial options and wants to avoid agents that are unsafe at this age.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "None of the above",
      "B": "Cefotaxime",
      "C": "Chloramphenicol",
      "D": "Gentamicin",
      "E": "Ampicillin"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "lymphatic and immune system",
    "taxonomy_drug_categories": [
      "antibiotics"
    ],
    "taxonomy_patient_info_type": "age threshold",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "KD-CF-BEN-001-A",
    "patient_vignette": "An 18-month-old toddler is brought to clinic for painful oral irritation and poor feeding. The clinician is considering symptomatic treatment options for oral pain.",
    "question": "Which of the following options would be inappropriate for this patient?",
    "options": {
      "A": "Benzocaine (topical oral)",
      "B": "None of the above",
      "C": "Acetaminophen",
      "D": "Saline oral rinse",
      "E": "Ibuprofen"
    },
    "answer": [
      "A"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "integumentary system",
    "taxonomy_drug_categories": [
      "local anesthetics/topical drugs"
    ],
    "taxonomy_patient_info_type": "age threshold",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "KD-CF-BEN-001-B",
    "patient_vignette": "A 4-year-old child is brought to clinic for painful oral irritation and poor feeding. The clinician is considering symptomatic treatment options for oral pain.",
    "question": "Which of the following options would be inappropriate for this patient?",
    "options": {
      "A": "Benzocaine (topical oral)",
      "B": "None of the above",
      "C": "Acetaminophen",
      "D": "Saline oral rinse",
      "E": "Ibuprofen"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "integumentary system",
    "taxonomy_drug_categories": [
      "local anesthetics/topical drugs"
    ],
    "taxonomy_patient_info_type": "age threshold",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "KD-CF-LID-001-A",
    "patient_vignette": "A 15-month-old toddler is seen for painful oral ulcerations causing decreased oral intake. The pediatrician is reviewing topical and supportive treatment options.",
    "question": "Which of the following medications should not be prescribed for this patient?",
    "options": {
      "A": "Saline oral rinse",
      "B": "Lidocaine viscous (topical oral)",
      "C": "None of the above",
      "D": "Cold fluids",
      "E": "Acetaminophen"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "integumentary system",
    "taxonomy_drug_categories": [
      "local anesthetics/topical drugs"
    ],
    "taxonomy_patient_info_type": "age threshold",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "KD-CF-LID-001-B",
    "patient_vignette": "A 5-year-old child is seen for painful oral ulcerations causing decreased oral intake. The pediatrician is reviewing topical and supportive treatment options.",
    "question": "Which of the following medications should not be prescribed for this patient?",
    "options": {
      "A": "Saline oral rinse",
      "B": "Lidocaine viscous (topical oral)",
      "C": "Cold fluids",
      "D": "None of the above",
      "E": "Acetaminophen"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "integumentary system",
    "taxonomy_drug_categories": [
      "local anesthetics/topical drugs"
    ],
    "taxonomy_patient_info_type": "age threshold",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "KD-CF-GEN-001-A",
    "patient_vignette": "A 2-week-old neonate is evaluated for eye discharge and eyelid irritation. The clinician is reviewing ophthalmic treatment options and wants to avoid agents that are unsafe at this age.",
    "question": "Which of the following would be most appropriate to avoid in this patient?",
    "options": {
      "A": "None of the above",
      "B": "Erythromycin ophthalmic ointment",
      "C": "Gentamicin (ophthalmic ointment)",
      "D": "Saline eye drops",
      "E": "Warm compresses"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "ophthalmic drugs"
    ],
    "taxonomy_patient_info_type": "age threshold",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "KD-CF-GEN-001-B",
    "patient_vignette": "A 4-month-old infant is evaluated for eye discharge and eyelid irritation. The clinician is reviewing ophthalmic treatment options and wants to avoid agents that are unsafe at this age.",
    "question": "Which of the following would be most appropriate to avoid in this patient?",
    "options": {
      "A": "Erythromycin ophthalmic ointment",
      "B": "Gentamicin (ophthalmic ointment)",
      "C": "Saline eye drops",
      "D": "Warm compresses",
      "E": "None of the above"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "ophthalmic drugs"
    ],
    "taxonomy_patient_info_type": "age threshold",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "KD-CF-MET-001-A",
    "patient_vignette": "A 10-month-old infant is brought in for persistent vomiting and poor feeding. The pediatric team is reviewing symptom-directed treatment options.",
    "question": "Which of the following medications would be potentially inappropriate in this patient?",
    "options": {
      "A": "Ondansetron",
      "B": "Oral rehydration solution",
      "C": "Simethicone",
      "D": "Metoclopramide",
      "E": "None of the above"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "digestive system",
    "taxonomy_drug_categories": [
      "gastrointestinal drugs"
    ],
    "taxonomy_patient_info_type": "age threshold",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "KD-CF-MET-001-B",
    "patient_vignette": "A 3-year-old child is brought in for persistent vomiting and poor feeding. The pediatric team is reviewing symptom-directed treatment options.",
    "question": "Which of the following medications would be potentially inappropriate in this patient?",
    "options": {
      "A": "Ondansetron",
      "B": "Oral rehydration solution",
      "C": "Simethicone",
      "D": "None of the above",
      "E": "Metoclopramide"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "digestive system",
    "taxonomy_drug_categories": [
      "gastrointestinal drugs"
    ],
    "taxonomy_patient_info_type": "age threshold",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "KD-CF-COD-001-A",
    "patient_vignette": "An 8-year-old child presents with acute pain after a minor orthopedic injury. The clinician is selecting an analgesic regimen.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Naproxen",
      "B": "None of the above",
      "C": "Codeine",
      "D": "Acetaminophen",
      "E": "Ibuprofen"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "opioids"
    ],
    "taxonomy_patient_info_type": "age threshold",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "KD-CF-COD-001-B",
    "patient_vignette": "A 14-year-old adolescent presents with acute pain after a minor orthopedic injury. The clinician is selecting an analgesic regimen.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Naproxen",
      "B": "None of the above",
      "C": "Codeine",
      "D": "Acetaminophen",
      "E": "Ibuprofen"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "opioids"
    ],
    "taxonomy_patient_info_type": "age threshold",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "KD-CF-MEP-001-A",
    "patient_vignette": "A 3-week-old neonate requires short-term analgesia during inpatient treatment. The care team is reviewing pain-control options and wants to avoid agents that are unsafe at this age.",
    "question": "Which of the following options would be inappropriate for this patient?",
    "options": {
      "A": "None of the above",
      "B": "Meperidine",
      "C": "Acetaminophen",
      "D": "Morphine",
      "E": "Fentanyl"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "opioids"
    ],
    "taxonomy_patient_info_type": "age threshold",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "KD-CF-MEP-001-B",
    "patient_vignette": "A 4-month-old infant requires short-term analgesia during inpatient treatment. The care team is reviewing pain-control options and wants to avoid agents that are unsafe at this age.",
    "question": "Which of the following options would be inappropriate for this patient?",
    "options": {
      "A": "Meperidine",
      "B": "Acetaminophen",
      "C": "Morphine",
      "D": "None of the above",
      "E": "Fentanyl"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "opioids"
    ],
    "taxonomy_patient_info_type": "age threshold",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "KD-CF-SNP-001-A",
    "patient_vignette": "An 18-month-old toddler is seen for constipation with painful stooling. The pediatrician is reviewing bowel-management options.",
    "question": "Which of the following would be most appropriate to avoid in this patient?",
    "options": {
      "A": "None of the above",
      "B": "Glycerin suppository",
      "C": "Sodium phosphate solution enema (rectal)",
      "D": "Polyethylene glycol",
      "E": "Lactulose"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "digestive system",
    "taxonomy_drug_categories": [
      "gastrointestinal drugs"
    ],
    "taxonomy_patient_info_type": "age threshold",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "KD-CF-SNP-001-B",
    "patient_vignette": "A 4-year-old child is seen for constipation with painful stooling. The pediatrician is reviewing bowel-management options.",
    "question": "Which of the following would be most appropriate to avoid in this patient?",
    "options": {
      "A": "Glycerin suppository",
      "B": "Sodium phosphate solution enema (rectal)",
      "C": "None of the above",
      "D": "Polyethylene glycol",
      "E": "Lactulose"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "digestive system",
    "taxonomy_drug_categories": [
      "gastrointestinal drugs"
    ],
    "taxonomy_patient_info_type": "age threshold",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "KD-CF-VPA-001-A",
    "patient_vignette": "An 18-month-old child with recurrent seizures requires maintenance antiseizure therapy. The neurology team is reviewing medication options.",
    "question": "Which of the following medications would be potentially inappropriate in this patient?",
    "options": {
      "A": "None of the above",
      "B": "Topiramate",
      "C": "Valproic acid",
      "D": "Levetiracetam",
      "E": "Oxcarbazepine"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "antiepileptics"
    ],
    "taxonomy_patient_info_type": "age threshold",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "KD-CF-VPA-001-B",
    "patient_vignette": "A 5-year-old child with recurrent seizures requires maintenance antiseizure therapy. The neurology team is reviewing medication options.",
    "question": "Which of the following medications would be potentially inappropriate in this patient?",
    "options": {
      "A": "Topiramate",
      "B": "None of the above",
      "C": "Valproic acid",
      "D": "Levetiracetam",
      "E": "Oxcarbazepine"
    },
    "answer": [
      "B"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "antiepileptics"
    ],
    "taxonomy_patient_info_type": "age threshold",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "KD-CF-FGA-001-A",
    "patient_vignette": "A 15-year-old adolescent presents with severe agitation requiring urgent symptom control in a monitored setting. The psychiatry team is reviewing medication options.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Risperidone",
      "B": "Haloperidol",
      "C": "Lorazepam",
      "D": "Chlorpromazine",
      "E": "None of the above"
    },
    "answer": [
      "B",
      "D"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "psychiatric medications"
    ],
    "taxonomy_patient_info_type": "pediatric-adult contraindication",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "KD-CF-FGA-001-B",
    "patient_vignette": "A 24-year-old adult presents with severe agitation requiring urgent symptom control in a monitored setting. The psychiatry team is reviewing medication options.",
    "question": "Which of the following medications should be avoided in this patient?",
    "options": {
      "A": "Risperidone",
      "B": "Haloperidol",
      "C": "Lorazepam",
      "D": "Chlorpromazine",
      "E": "None of the above"
    },
    "answer": [
      "E"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "psychiatric medications"
    ],
    "taxonomy_patient_info_type": "pediatric-adult contraindication",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "KD-CF-TCA-001-A",
    "patient_vignette": "A 14-year-old adolescent is being evaluated for pharmacologic treatment of mood symptoms. The mental health team is reviewing medication options.",
    "question": "Which of the following medications should not be prescribed for this patient?",
    "options": {
      "A": "Imipramine",
      "B": "Desipramine",
      "C": "Fluoxetine",
      "D": "Sertraline",
      "E": "None of the above"
    },
    "answer": [
      "A",
      "B"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "psychiatric medications"
    ],
    "taxonomy_patient_info_type": "pediatric-adult contraindication",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "KD-CF-TCA-001-B",
    "patient_vignette": "A 29-year-old adult is being evaluated for pharmacologic treatment of mood symptoms. The mental health team is reviewing medication options.",
    "question": "Which of the following medications should not be prescribed for this patient?",
    "options": {
      "A": "Imipramine",
      "B": "Desipramine",
      "C": "Fluoxetine",
      "D": "None of the above",
      "E": "Sertraline"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "psychiatric medications"
    ],
    "taxonomy_patient_info_type": "pediatric-adult contraindication",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "KD-CF-LOP-001-A",
    "patient_vignette": "A 2-year-old child presents with acute febrile diarrhea after a daycare outbreak, with symptoms consistent with infectious gastroenteritis. The pediatrician is reviewing symptom-management options.",
    "question": "Which of the following options would be inappropriate for this patient?",
    "options": {
      "A": "Oral rehydration solution",
      "B": "Zinc sulfate",
      "C": "None of the above",
      "D": "Loperamide",
      "E": "Acetaminophen"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "digestive system",
    "taxonomy_drug_categories": [
      "gastrointestinal drugs"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "KD-CF-LOP-001-B",
    "patient_vignette": "A 2-year-old child presents with noninfectious loose stools related to recent diet change, without fever, blood in stool, or suspicion of infectious gastroenteritis. The pediatrician is reviewing symptom-management options.",
    "question": "Which of the following options would be inappropriate for this patient?",
    "options": {
      "A": "Oral rehydration solution",
      "B": "Zinc sulfate",
      "C": "None of the above",
      "D": "Loperamide",
      "E": "Acetaminophen"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "digestive system",
    "taxonomy_drug_categories": [
      "gastrointestinal drugs"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "KD-CF-COD-002-A",
    "patient_vignette": "A 15-year-old adolescent is being discharged after tonsillectomy and adenoidectomy. The surgical team is selecting a postoperative analgesic regimen.",
    "question": "Which of the following would be most appropriate to avoid in this patient?",
    "options": {
      "A": "None of the above",
      "B": "Ibuprofen",
      "C": "Acetaminophen",
      "D": "Codeine",
      "E": "Hydrocodone-acetaminophen"
    },
    "answer": [
      "D"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "opioids"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "risk activation",
    "benchmark_task_family": "counterfactual"
  },
  {
    "instance_id": "KD-CF-COD-002-B",
    "patient_vignette": "A 15-year-old adolescent presents with routine musculoskeletal pain after a sports injury. The clinician is selecting an outpatient analgesic regimen.",
    "question": "Which of the following would be most appropriate to avoid in this patient?",
    "options": {
      "A": "Ibuprofen",
      "B": "Acetaminophen",
      "C": "None of the above",
      "D": "Codeine",
      "E": "Hydrocodone-acetaminophen"
    },
    "answer": [
      "C"
    ],
    "taxonomy_clinical_department": "pediatrics",
    "taxonomy_clinical_system": "nervous system",
    "taxonomy_drug_categories": [
      "opioids"
    ],
    "taxonomy_patient_info_type": "disease presence",
    "taxonomy_population_source": "pediatrics",
    "taxonomy_reasoning_operation": "risk deactivation",
    "benchmark_task_family": "counterfactual"
  }
]