Split (1)

test · 467 rows

instance_id stringlengths 9 18	patient_vignette stringlengths 52 559	question stringlengths 52 139	options dict	answer listlengths 1 5	taxonomy_clinical_department stringclasses 11 values	taxonomy_clinical_system stringclasses 9 values	taxonomy_drug_categories listlengths 1 4	taxonomy_patient_info_type stringclasses 8 values	taxonomy_population_source stringclasses 3 values	taxonomy_reasoning_operation stringclasses 5 values	benchmark_task_family stringclasses 2 values
TS-EDO-003	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.	Which of the following edoxaban prescriptions is most appropriate given this patient's renal function?	{ "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" }	[ "A" ]	nephrology	urinary system	[ "factor xa inhibitors/anticoagulants" ]	dose threshold	older adults	static risk identification	guideline_following
TS-DOF-001	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.	Which of the following dofetilide prescriptions is most appropriate given this patient's renal function?	{ "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" }	[ "B" ]	nephrology	urinary system	[ "antiarrhythmics" ]	dose threshold	older adults	static risk identification	guideline_following
TS-DOF-002	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.	Which of the following dofetilide prescriptions is most appropriate given this patient's renal function?	{ "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" }	[ "C" ]	nephrology	urinary system	[ "antiarrhythmics" ]	dose threshold	older adults	static risk identification	guideline_following
TS-DOF-003	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.	Which of the following dofetilide prescriptions is most appropriate given this patient's renal function?	{ "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" }	[ "D" ]	nephrology	urinary system	[ "antiarrhythmics" ]	dose threshold	older adults	static risk identification	guideline_following
TS-TMP-001	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.	Which of the following TMP-SMX prescriptions is most appropriate given this patient's renal function?	{ "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" }	[ "E" ]	nephrology	urinary system	[ "antibacterials" ]	dose threshold	older adults	static risk identification	guideline_following
TS-TMP-002	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.	Which of the following TMP-SMX prescriptions is most appropriate given this patient's renal function?	{ "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" }	[ "D" ]	nephrology	urinary system	[ "antibacterials" ]	dose threshold	older adults	static risk identification	guideline_following
TS-TMP-003	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.	Which of the following TMP-SMX prescriptions is most appropriate given this patient's renal function?	{ "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" }	[ "D" ]	nephrology	urinary system	[ "antibacterials" ]	dose threshold	older adults	static risk identification	guideline_following
TS-TRA-001	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.	Which of the following tramadol prescriptions is most appropriate given this patient's renal function?	{ "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" }	[ "B" ]	nephrology	urinary system	[ "opioid-like analgesics" ]	dose threshold	older adults	static risk identification	guideline_following
TS-AB-001	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.	Which of the following antibiotic prescriptions is most appropriate given this patient's renal function?	{ "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" }	[ "C" ]	nephrology	urinary system	[ "antibacterials" ]	dose threshold	older adults	static risk identification	guideline_following
TS-AB-002	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.	Which of the following antibiotic prescriptions is most appropriate given this patient's renal function?	{ "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" }	[ "E" ]	nephrology	urinary system	[ "antibacterials" ]	dose threshold	older adults	static risk identification	guideline_following
TS-AB-003	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.	Which of the following antibiotic prescriptions is most appropriate given this patient's renal function?	{ "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" }	[ "B" ]	nephrology	urinary system	[ "antibacterials" ]	dose threshold	older adults	static risk identification	guideline_following
TS-AC-001	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.	Which of the following anticoagulant prescriptions is most appropriate given this patient's renal function?	{ "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" }	[ "B" ]	nephrology	urinary system	[ "anticoagulants" ]	dose threshold	older adults	static risk identification	guideline_following
TS-AC-002	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.	Which of the following anticoagulant prescriptions is most appropriate given this patient's renal function?	{ "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" }	[ "E" ]	nephrology	urinary system	[ "anticoagulants" ]	dose threshold	older adults	static risk identification	guideline_following
TS-PA-001	A 71-year-old woman with osteoarthritis and chronic pain has an estimated CrCl of 20 mL/min. Her physician is selecting an analgesic.	Which of the following analgesic prescriptions is most appropriate given this patient's renal function?	{ "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" }	[ "C" ]	nephrology	urinary system	[ "analgesics" ]	dose threshold	older adults	static risk identification	guideline_following
TS-PA-002	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.	Which of the following analgesic prescriptions is most appropriate given this patient's renal function?	{ "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" }	[ "B" ]	nephrology	urinary system	[ "analgesics" ]	dose threshold	older adults	static risk identification	guideline_following
SS-CF-SY-001-POS	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. Ren...	Which of the following medications should be avoided in this patient?	{ "A": "Galantamine", "B": "None of the above", "C": "Donepezil", "D": "Rivastigmine", "E": "Famotidine" }	[ "A", "C", "D" ]	neurology	nervous system	[ "cholinesterase inhibitors" ]	disease presence	older adults	risk activation	counterfactual
SS-CF-SY-001-NEG	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.	Which of the following medications should be avoided in this patient?	{ "A": "Galantamine", "B": "None of the above", "C": "Donepezil", "D": "Rivastigmine", "E": "Famotidine" }	[ "B" ]	neurology	nervous system	[ "cholinesterase inhibitors", "h2-receptor antagonists" ]	disease presence	older adults	risk deactivation	counterfactual
SS-CF-SY-002-POS	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 histor...	Which of the following drugs is potentially inappropriate for this patient?	{ "A": "Doxazosin", "B": "None of the above", "C": "Terazosin", "D": "Metoclopramide", "E": "Prazosin" }	[ "A", "C", "E" ]	neurology	nervous system	[ "alpha-1 receptor blockers" ]	disease presence	older adults	risk activation	counterfactual
SS-CF-SY-002-NEG	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 ...	Which of the following drugs is potentially inappropriate for this patient?	{ "A": "Doxazosin", "B": "None of the above", "C": "Terazosin", "D": "Metoclopramide", "E": "Prazosin" }	[ "B" ]	neurology	nervous system	[ "alpha-1 receptor blockers" ]	disease presence	older adults	risk deactivation	counterfactual
SS-CF-SY-003-POS	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 taki...	For this patient, which of the following medications should not be prescribed?	{ "A": "None of the above", "B": "Famotidine", "C": "Chlorpromazine", "D": "Olanzapine", "E": "Nitrofurantoin" }	[ "C", "D" ]	neurology	nervous system	[ "antipsychotics" ]	disease presence	older adults	risk redistribution	counterfactual
SS-CF-SY-003-NEG	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.	For this patient, which of the following medications should not be prescribed?	{ "A": "None of the above", "B": "Famotidine", "C": "Chlorpromazine", "D": "Olanzapine", "E": "Nitrofurantoin" }	[ "E" ]	neurology	nervous system	[ "h2-receptor antagonists", "antipsychotics", "antibacterials" ]	disease presence	older adults	risk redistribution	counterfactual
SS-CF-SY-004-POS	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 document...	Which of the following medications should be avoided in this patient?	{ "A": "Metoclopramide", "B": "None of the above", "C": "Doxazosin", "D": "Terazosin", "E": "Donepezil" }	[ "C", "D", "E" ]	neurology	nervous system	[ "cholinesterase inhibitors", "alpha-1 receptor blockers" ]	disease presence	older adults	risk activation	counterfactual
SS-CF-SY-004-NEG	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...	Which of the following medications should be avoided in this patient?	{ "A": "Metoclopramide", "B": "None of the above", "C": "Doxazosin", "D": "Terazosin", "E": "Donepezil" }	[ "B" ]	neurology	nervous system	[ "alpha-1 receptor blockers", "cholinesterase inhibitors" ]	disease presence	older adults	risk deactivation	counterfactual
SS-CF-SY-005-POS	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/1.7...	Which of the following medications would be most appropriate to avoid in this patient?	{ "A": "None of the above", "B": "Famotidine", "C": "Donepezil", "D": "Nitrofurantoin", "E": "Chlorpromazine" }	[ "C", "E" ]	neurology	nervous system	[ "antipsychotics", "cholinesterase inhibitors" ]	disease presence	older adults	risk redistribution	counterfactual
SS-CF-SY-005-NEG	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 tak...	Which of the following medications would be most appropriate to avoid in this patient?	{ "A": "None of the above", "B": "Famotidine", "C": "Donepezil", "D": "Nitrofurantoin", "E": "Chlorpromazine" }	[ "E" ]	neurology	nervous system	[ "h2-receptor antagonists", "cholinesterase inhibitors", "antibacterials", "antipsychotics" ]	disease presence	older adults	risk redistribution	counterfactual
SS-CF-HF-002-POS	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 antip...	Which of the following medications should be avoided in this patient?	{ "A": "Dronedarone", "B": "None of the above", "C": "Pioglitazone", "D": "Prochlorperazine", "E": "Ibuprofen" }	[ "A", "C", "E" ]	cardiology	cardiovascular system	[ "antiarrhythmics", "nsaids/antipyretic analgesics", "thiazolidinedione antidiabetics" ]	disease presence	older adults	risk activation	counterfactual
SS-CF-HF-002-NEG	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...	Which of the following medications should be avoided in this patient?	{ "A": "Dronedarone", "B": "None of the above", "C": "Pioglitazone", "D": "Prochlorperazine", "E": "Ibuprofen" }	[ "B" ]	cardiology	cardiovascular system	[ "antiarrhythmics", "thiazolidinedione antidiabetics", "nsaids/antipyretic analgesics" ]	disease presence	older adults	risk deactivation	counterfactual
SS-CF-HF-003-POS	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.	Which of the following drugs is potentially inappropriate for this patient?	{ "A": "Famotidine", "B": "Dextromethorphan-quinidine", "C": "None of the above", "D": "Prochlorperazine", "E": "Cilostazol" }	[ "B", "E" ]	cardiology	cardiovascular system	[ "pde3 inhibitors/peripheral vascular drugs", "antiarrhythmics" ]	disease presence	older adults	risk activation	counterfactual
SS-CF-HF-003-NEG	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 fun...	Which of the following drugs is potentially inappropriate for this patient?	{ "A": "Famotidine", "B": "Dextromethorphan-quinidine", "C": "None of the above", "D": "Prochlorperazine", "E": "Cilostazol" }	[ "C" ]	cardiology	cardiovascular system	[ "h2-receptor antagonists", "antiarrhythmics", "pde3 inhibitors/peripheral vascular drugs" ]	disease presence	older adults	risk deactivation	counterfactual
SS-CF-DE-001-POS	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.	Which of the following medications should be avoided in this patient?	{ "A": "Cimetidine", "B": "Famotidine", "C": "Nizatidine", "D": "Prochlorperazine", "E": "None of the above" }	[ "D" ]	neurology	nervous system	[ "h2-receptor antagonists" ]	disease presence	older adults	risk activation	counterfactual
SS-CF-DE-001-NEG	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.	Which of the following medications should be avoided in this patient?	{ "A": "Cimetidine", "B": "Famotidine", "C": "Nizatidine", "D": "Prochlorperazine", "E": "None of the above" }	[ "E" ]	neurology	nervous system	[ "h2-receptor antagonists" ]	disease presence	older adults	risk deactivation	counterfactual
SS-CF-DE-002-POS	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. ...	Which of the following drugs is potentially inappropriate for this patient?	{ "A": "Morphine", "B": "Hydromorphone", "C": "Oxycodone", "D": "None of the above", "E": "Donepezil" }	[ "A", "B", "C" ]	neurology	nervous system	[ "opioids" ]	disease presence	older adults	risk redistribution	counterfactual
SS-CF-DE-002-NEG	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 o...	Which of the following drugs is potentially inappropriate for this patient?	{ "A": "Morphine", "B": "Hydromorphone", "C": "Oxycodone", "D": "None of the above", "E": "Donepezil" }	[ "E" ]	neurology	nervous system	[ "opioids", "cholinesterase inhibitors" ]	disease presence	older adults	risk redistribution	counterfactual
SS-CF-DE-003-POS	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. ...	For this patient, which of the following medications should not be prescribed?	{ "A": "Risperidone", "B": "None of the above", "C": "Chlorpromazine", "D": "Ibuprofen", "E": "Haloperidol" }	[ "A", "C", "E" ]	cardiology	cardiovascular system	[ "antipsychotics" ]	disease presence	older adults	risk redistribution	counterfactual
SS-CF-DE-003-NEG	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...	For this patient, which of the following medications should not be prescribed?	{ "A": "Risperidone", "B": "None of the above", "C": "Chlorpromazine", "D": "Ibuprofen", "E": "Haloperidol" }	[ "C" ]	cardiology	cardiovascular system	[ "antipsychotics", "nsaids/antipyretic analgesics" ]	disease presence	older adults	risk redistribution	counterfactual
SS-CF-DE-004-POS	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 h...	Which of the following medications would be most appropriate to avoid in this patient?	{ "A": "None of the above", "B": "Famotidine", "C": "Morphine", "D": "Prochlorperazine", "E": "Oxycodone" }	[ "B", "C", "E" ]	neurology	nervous system	[ "h2-receptor antagonists", "opioids" ]	disease presence	older adults	risk redistribution	counterfactual
SS-CF-DE-004-NEG	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 ...	Which of the following medications would be most appropriate to avoid in this patient?	{ "A": "None of the above", "B": "Famotidine", "C": "Morphine", "D": "Prochlorperazine", "E": "Oxycodone" }	[ "D" ]	neurology	nervous system	[ "h2-receptor antagonists", "opioids" ]	disease presence	older adults	risk redistribution	counterfactual
SS-CF-DE-005-POS	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 hep...	Which of the following should be avoided when prescribing medications for this patient?	{ "A": "None of the above", "B": "Prednisone", "C": "Hydromorphone", "D": "Donepezil", "E": "Methylprednisolone" }	[ "B", "C", "E" ]	neurology	nervous system	[ "multiple drug categories (composite rules)" ]	disease presence	older adults	risk activation	counterfactual
SS-CF-DE-005-NEG	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 brad...	Which of the following should be avoided when prescribing medications for this patient?	{ "A": "None of the above", "B": "Prednisone", "C": "Hydromorphone", "D": "Donepezil", "E": "Methylprednisolone" }	[ "A" ]	neurology	nervous system	[ "cholinesterase inhibitors" ]	disease presence	older adults	risk deactivation	counterfactual
SS-CF-DE-006-POS	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 functio...	Which of the following medications should be avoided in this patient?	{ "A": "None of the above", "B": "Methylprednisolone", "C": "Dexamethasone", "D": "Donepezil", "E": "Prednisone" }	[ "B", "C", "E" ]	neurology	nervous system	[ "multiple drug categories (composite rules)" ]	disease presence	older adults	risk redistribution	counterfactual
SS-CF-DE-006-NEG	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 brad...	Which of the following medications should be avoided in this patient?	{ "A": "None of the above", "B": "Methylprednisolone", "C": "Dexamethasone", "D": "Donepezil", "E": "Prednisone" }	[ "D" ]	neurology	nervous system	[ "cholinesterase inhibitors" ]	disease presence	older adults	risk redistribution	counterfactual
SS-CF-DM-001-POS	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 histor...	Which of the following medications should be avoided in this patient?	{ "A": "Fluphenazine", "B": "Prochlorperazine", "C": "Chlorpromazine", "D": "None of the above", "E": "Famotidine" }	[ "A", "C" ]	neurology	nervous system	[ "antipsychotics" ]	disease presence	older adults	risk activation	counterfactual
SS-CF-DM-001-NEG	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...	Which of the following medications should be avoided in this patient?	{ "A": "Fluphenazine", "B": "Prochlorperazine", "C": "Chlorpromazine", "D": "None of the above", "E": "Famotidine" }	[ "D" ]	neurology	nervous system	[ "antipsychotics", "h2-receptor antagonists" ]	disease presence	older adults	risk deactivation	counterfactual
SS-CF-DM-002-POS	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 hist...	Which of the following drugs is potentially inappropriate for this patient?	{ "A": "Quetiapine", "B": "Ibuprofen", "C": "Aripiprazole", "D": "None of the above", "E": "Donepezil" }	[ "D" ]	cardiology	cardiovascular system	[ "antipsychotics" ]	disease presence	older adults	risk deactivation	counterfactual
SS-CF-DM-002-NEG	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 bradyarrhythmi...	Which of the following drugs is potentially inappropriate for this patient?	{ "A": "Quetiapine", "B": "Ibuprofen", "C": "Aripiprazole", "D": "None of the above", "E": "Donepezil" }	[ "E" ]	cardiology	cardiovascular system	[ "antipsychotics", "nsaids/antipyretic analgesics", "cholinesterase inhibitors" ]	disease presence	older adults	risk activation	counterfactual
SS-CF-DM-003-POS	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 hy...	Which of the following drugs is potentially inappropriate for this patient?	{ "A": "Quetiapine", "B": "Olanzapine", "C": "Risperidone", "D": "None of the above", "E": "Haloperidol" }	[ "B", "C", "E" ]	neurology	nervous system	[ "antipsychotics" ]	disease presence	older adults	risk redistribution	counterfactual
SS-CF-DM-003-NEG	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 ...	Which of the following drugs is potentially inappropriate for this patient?	{ "A": "Quetiapine", "B": "Olanzapine", "C": "Risperidone", "D": "None of the above", "E": "Haloperidol" }	[ "E" ]	neurology	nervous system	[ "antipsychotics" ]	disease presence	older adults	risk redistribution	counterfactual
SS-CF-FA-001-POS	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.	Which of the following drugs is potentially inappropriate for this patient?	{ "A": "None of the above", "B": "Quetiapine", "C": "Prochlorperazine", "D": "Haloperidol", "E": "Risperidone" }	[ "B", "D", "E" ]	neurology	nervous system	[ "antipsychotics" ]	disease presence	older adults	risk redistribution	counterfactual
SS-CF-FA-001-NEG	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.	Which of the following drugs is potentially inappropriate for this patient?	{ "A": "None of the above", "B": "Quetiapine", "C": "Prochlorperazine", "D": "Haloperidol", "E": "Risperidone" }	[ "C" ]	neurology	nervous system	[ "antipsychotics" ]	disease presence	older adults	risk redistribution	counterfactual
SS-CF-FA-002-POS	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 Parki...	Which of the following medications should be avoided in this patient?	{ "A": "Fluoxetine", "B": "Citalopram", "C": "Donepezil", "D": "None of the above", "E": "Escitalopram" }	[ "A", "B", "E" ]	neurology	nervous system	[ "multiple drug categories (composite rules)" ]	disease presence	older adults	risk activation	counterfactual
SS-CF-FA-002-NEG	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.	Which of the following medications should be avoided in this patient?	{ "A": "Fluoxetine", "B": "Citalopram", "C": "Donepezil", "D": "None of the above", "E": "Escitalopram" }	[ "D" ]	neurology	nervous system	[ "cholinesterase inhibitors" ]	disease presence	older adults	risk deactivation	counterfactual
SS-CF-FA-003-POS	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...	For this patient, which of the following medications should not be prescribed?	{ "A": "Venlafaxine", "B": "Gabapentin", "C": "Duloxetine", "D": "Famotidine", "E": "None of the above" }	[ "A", "B", "C" ]	neurology	nervous system	[ "gabapentinoids" ]	disease presence	older adults	risk activation	counterfactual
SS-CF-FA-003-NEG	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 anticonvulsa...	For this patient, which of the following medications should not be prescribed?	{ "A": "Venlafaxine", "B": "Gabapentin", "C": "Duloxetine", "D": "Famotidine", "E": "None of the above" }	[ "E" ]	neurology	nervous system	[ "gabapentinoids", "h2-receptor antagonists" ]	disease presence	older adults	risk deactivation	counterfactual
SS-CF-FA-004-POS	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 ...	Which of the following medications should be avoided in this patient?	{ "A": "Donepezil", "B": "None of the above", "C": "Gabapentin", "D": "Olanzapine", "E": "Pregabalin" }	[ "C", "D", "E" ]	neurology	nervous system	[ "antipsychotics", "gabapentinoids" ]	disease presence	older adults	risk activation	counterfactual
SS-CF-FA-004-NEG	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 hep...	Which of the following medications should be avoided in this patient?	{ "A": "Donepezil", "B": "None of the above", "C": "Gabapentin", "D": "Olanzapine", "E": "Pregabalin" }	[ "B" ]	neurology	nervous system	[ "cholinesterase inhibitors", "gabapentinoids", "antipsychotics" ]	disease presence	older adults	risk deactivation	counterfactual
SS-CF-FA-005-POS	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...	Which of the following medications would be most appropriate to avoid in this patient?	{ "A": "Morphine", "B": "Famotidine", "C": "None of the above", "D": "Sertraline", "E": "Venlafaxine" }	[ "A", "D", "E" ]	neurology	nervous system	[ "opioids" ]	disease presence	older adults	risk activation	counterfactual
SS-CF-FA-005-NEG	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 ...	Which of the following medications would be most appropriate to avoid in this patient?	{ "A": "Morphine", "B": "Famotidine", "C": "None of the above", "D": "Sertraline", "E": "Venlafaxine" }	[ "C" ]	neurology	nervous system	[ "opioids", "h2-receptor antagonists" ]	disease presence	older adults	risk deactivation	counterfactual
SS-CF-FA-006-POS	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.	For this patient, which of the following medications should not be prescribed?	{ "A": "Tramadol", "B": "Prochlorperazine", "C": "None of the above", "D": "Oxycodone", "E": "Morphine" }	[ "A", "D", "E" ]	neurology	nervous system	[ "opioids" ]	disease presence	older adults	risk activation	counterfactual
SS-CF-FA-006-NEG	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.	For this patient, which of the following medications should not be prescribed?	{ "A": "Tramadol", "B": "Prochlorperazine", "C": "None of the above", "D": "Oxycodone", "E": "Morphine" }	[ "C" ]	neurology	nervous system	[ "opioids" ]	disease presence	older adults	risk deactivation	counterfactual
SS-CF-PD-002-POS	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...	Which of the following drugs is potentially inappropriate for this patient?	{ "A": "Haloperidol", "B": "Quetiapine", "C": "Olanzapine", "D": "None of the above", "E": "Risperidone" }	[ "A", "C", "E" ]	neurology	nervous system	[ "antipsychotics" ]	disease presence	older adults	risk activation	counterfactual
SS-CF-PD-002-NEG	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. R...	Which of the following drugs is potentially inappropriate for this patient?	{ "A": "Haloperidol", "B": "Quetiapine", "C": "Olanzapine", "D": "None of the above", "E": "Risperidone" }	[ "D" ]	neurology	nervous system	[ "antipsychotics" ]	disease presence	older adults	risk deactivation	counterfactual
SS-CF-PD-003-POS	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.	Which of the following should be avoided when prescribing medications for this patient?	{ "A": "Famotidine", "B": "Quetiapine", "C": "Haloperidol", "D": "None of the above", "E": "Metoclopramide" }	[ "C", "E" ]	neurology	nervous system	[ "antipsychotics" ]	disease presence	older adults	risk activation	counterfactual
SS-CF-PD-003-NEG	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 an...	Which of the following should be avoided when prescribing medications for this patient?	{ "A": "Famotidine", "B": "Quetiapine", "C": "Haloperidol", "D": "None of the above", "E": "Metoclopramide" }	[ "D" ]	neurology	nervous system	[ "h2-receptor antagonists", "antipsychotics" ]	disease presence	older adults	risk deactivation	counterfactual
SS-CF-PU-001-POS	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 a...	Which of the following medications should be avoided in this patient?	{ "A": "Naproxen", "B": "Diclofenac", "C": "Donepezil", "D": "Ibuprofen", "E": "None of the above" }	[ "A", "B", "D" ]	neurology	nervous system	[ "nsaids/antipyretic analgesics" ]	disease presence	older adults	risk activation	counterfactual
SS-CF-PU-001-NEG	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 hep...	Which of the following medications should be avoided in this patient?	{ "A": "Naproxen", "B": "Diclofenac", "C": "Donepezil", "D": "Ibuprofen", "E": "None of the above" }	[ "E" ]	neurology	nervous system	[ "nsaids/antipyretic analgesics", "cholinesterase inhibitors" ]	disease presence	older adults	risk deactivation	counterfactual
SS-CF-PU-003-POS	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 hepa...	For this patient, which of the following medications should not be prescribed?	{ "A": "Ibuprofen", "B": "Diclofenac", "C": "Naproxen", "D": "Celecoxib", "E": "None of the above" }	[ "A", "B", "C" ]	neurology	nervous system	[ "nsaids/antipyretic analgesics" ]	disease presence	older adults	risk activation	counterfactual
SS-CF-PU-003-NEG	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 fu...	For this patient, which of the following medications should not be prescribed?	{ "A": "Ibuprofen", "B": "Diclofenac", "C": "Naproxen", "D": "Celecoxib", "E": "None of the above" }	[ "E" ]	neurology	nervous system	[ "nsaids/antipyretic analgesics" ]	disease presence	older adults	risk deactivation	counterfactual
SS-CF-HF-001-HFREF	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.	Which of the following drugs is potentially inappropriate for this patient?	{ "A": "Cilostazol", "B": "Dextromethorphan-quinidine", "C": "None of the above", "D": "Diltiazem", "E": "Verapamil" }	[ "A", "B", "D", "E" ]	cardiology	cardiovascular system	[ "calcium-channel blockers", "pde3 inhibitors/peripheral vascular drugs", "antiarrhythmics" ]	disease presence	older adults	risk activation	counterfactual
SS-CF-HF-001-HFPEF	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.	Which of the following drugs is potentially inappropriate for this patient?	{ "A": "Cilostazol", "B": "Dextromethorphan-quinidine", "C": "None of the above", "D": "Diltiazem", "E": "Verapamil" }	[ "A", "B" ]	cardiology	cardiovascular system	[ "pde3 inhibitors/peripheral vascular drugs", "antiarrhythmics" ]	disease presence	older adults	risk activation	counterfactual
SS-CF-HF-001-NOHF	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.	Which of the following drugs is potentially inappropriate for this patient?	{ "A": "Cilostazol", "B": "Dextromethorphan-quinidine", "C": "None of the above", "D": "Diltiazem", "E": "Verapamil" }	[ "C" ]	cardiology	cardiovascular system	[ "pde3 inhibitors/peripheral vascular drugs", "antiarrhythmics", "calcium-channel blockers" ]	disease presence	older adults	risk deactivation	counterfactual
CS-CF-HF-001-A	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 ...	Which of the following drugs is potentially inappropriate for this patient?	{ "A": "Dextromethorphan-quinidine", "B": "Verapamil", "C": "None of the above", "D": "Diltiazem", "E": "Cilostazol" }	[ "A", "B", "D", "E" ]	cardiology	cardiovascular system	[ "pde3 inhibitors/peripheral vascular drugs", "antiarrhythmics", "calcium-channel blockers" ]	composite clinical context	older adults	risk redistribution	counterfactual
CS-CF-HF-001-B	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...	Which of the following drugs is potentially inappropriate for this patient?	{ "A": "Dextromethorphan-quinidine", "B": "Verapamil", "C": "Diltiazem", "D": "None of the above", "E": "Cilostazol" }	[ "A", "E" ]	cardiology	cardiovascular system	[ "pde3 inhibitors/peripheral vascular drugs", "antiarrhythmics" ]	composite clinical context	older adults	risk redistribution	counterfactual
CS-CF-NS-001-A	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 d...	Which of the following medications should be avoided in this patient?	{ "A": "Ibuprofen", "B": "Celecoxib", "C": "None of the above", "D": "Naproxen", "E": "Acetaminophen" }	[ "A", "B", "D" ]	cardiology	cardiovascular system	[ "nsaids/antipyretic analgesics" ]	composite clinical context	older adults	risk redistribution	counterfactual
CS-CF-NS-001-B	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 echocard...	Which of the following medications should be avoided in this patient?	{ "A": "Ibuprofen", "B": "None of the above", "C": "Celecoxib", "D": "Naproxen", "E": "Acetaminophen" }	[ "A", "D" ]	cardiology	cardiovascular system	[ "nsaids/antipyretic analgesics" ]	composite clinical context	older adults	risk redistribution	counterfactual
CS-CF-OP-001-A	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 ...	Which of the following should be avoided when prescribing medications for this patient?	{ "A": "Acetaminophen", "B": "Morphine", "C": "Celecoxib", "D": "Oxycodone", "E": "None of the above" }	[ "B", "D" ]	cardiology	cardiovascular system	[ "opioids" ]	composite clinical context	older adults	risk activation	counterfactual
CS-CF-OP-001-B	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 f...	Which of the following should be avoided when prescribing medications for this patient?	{ "A": "Acetaminophen", "B": "Morphine", "C": "None of the above", "D": "Celecoxib", "E": "Oxycodone" }	[ "C" ]	cardiology	cardiovascular system	[ "antipyretic analgesics", "opioids", "nsaids/antipyretic analgesics" ]	composite clinical context	older adults	risk deactivation	counterfactual
CS-CF-AD-001-A	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 P...	Which of the following medications should be avoided in this patient?	{ "A": "Amitriptyline", "B": "None of the above", "C": "Sertraline", "D": "Venlafaxine", "E": "Bupropion" }	[ "A" ]	cardiology	cardiovascular system	[ "tricyclic antidepressants" ]	composite clinical context	older adults	risk redistribution	counterfactual
CS-CF-AD-001-B	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, n...	Which of the following medications should be avoided in this patient?	{ "A": "Amitriptyline", "B": "Sertraline", "C": "Venlafaxine", "D": "Bupropion", "E": "None of the above" }	[ "A", "B", "C" ]	cardiology	cardiovascular system	[ "tricyclic antidepressants" ]	composite clinical context	older adults	risk redistribution	counterfactual
CS-CF-A1-001-A	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, ...	Which of the following medications should be avoided in this patient?	{ "A": "Prazosin", "B": "Doxazosin", "C": "Terazosin", "D": "Tamsulosin", "E": "None of the above" }	[ "A", "B", "C" ]	cardiology	cardiovascular system	[ "alpha-1 receptor blockers" ]	composite clinical context	older adults	risk activation	counterfactual
CS-CF-A1-001-B	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 pe...	Which of the following medications should be avoided in this patient?	{ "A": "Prazosin", "B": "Doxazosin", "C": "None of the above", "D": "Terazosin", "E": "Tamsulosin" }	[ "C" ]	cardiology	cardiovascular system	[ "alpha-1 receptor blockers" ]	composite clinical context	older adults	risk deactivation	counterfactual
CS-CF-HF-002-A	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,...	Which of the following drugs is potentially inappropriate for this patient?	{ "A": "Diltiazem", "B": "Cilostazol", "C": "Verapamil", "D": "Dextromethorphan-quinidine", "E": "None of the above" }	[ "B", "D" ]	cardiology	cardiovascular system	[ "pde3 inhibitors/peripheral vascular drugs", "antiarrhythmics" ]	composite clinical context	older adults	risk activation	counterfactual
CS-CF-HF-002-B	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...	Which of the following drugs is potentially inappropriate for this patient?	{ "A": "Diltiazem", "B": "Cilostazol", "C": "None of the above", "D": "Verapamil", "E": "Dextromethorphan-quinidine" }	[ "C" ]	cardiology	cardiovascular system	[ "calcium-channel blockers", "pde3 inhibitors/peripheral vascular drugs", "antiarrhythmics" ]	composite clinical context	older adults	risk deactivation	counterfactual
CS-CF-NS-002-A	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 no...	Which of the following medications should be avoided in this patient?	{ "A": "Celecoxib", "B": "Ibuprofen", "C": "None of the above", "D": "Acetaminophen", "E": "Naproxen" }	[ "A", "B", "E" ]	cardiology	cardiovascular system	[ "nsaids/antipyretic analgesics" ]	composite clinical context	older adults	risk redistribution	counterfactual
CS-CF-NS-002-B	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 analgesi...	Which of the following medications should be avoided in this patient?	{ "A": "Celecoxib", "B": "None of the above", "C": "Ibuprofen", "D": "Acetaminophen", "E": "Naproxen" }	[ "C", "E" ]	cardiology	cardiovascular system	[ "nsaids/antipyretic analgesics" ]	composite clinical context	older adults	risk redistribution	counterfactual
CS-CF-OP-002-A	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 Ass...	Which of the following should be avoided when prescribing medications for this patient?	{ "A": "None of the above", "B": "Acetaminophen", "C": "Morphine", "D": "Oxycodone", "E": "Celecoxib" }	[ "C", "D" ]	cardiology	cardiovascular system	[ "opioids" ]	composite clinical context	older adults	risk activation	counterfactual
CS-CF-OP-002-B	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 ne...	Which of the following should be avoided when prescribing medications for this patient?	{ "A": "Acetaminophen", "B": "Morphine", "C": "None of the above", "D": "Oxycodone", "E": "Celecoxib" }	[ "C" ]	cardiology	cardiovascular system	[ "antipyretic analgesics", "opioids", "nsaids/antipyretic analgesics" ]	composite clinical context	older adults	risk deactivation	counterfactual
CS-CF-AP-002-A	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 hist...	Which of the following drugs is potentially inappropriate for this patient?	{ "A": "None of the above", "B": "Aripiprazole", "C": "Quetiapine", "D": "Chlorpromazine", "E": "Haloperidol" }	[ "B", "C", "D", "E" ]	cardiology	cardiovascular system	[ "antipsychotics" ]	composite clinical context	older adults	risk redistribution	counterfactual
CS-CF-AP-002-B	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 deliriu...	Which of the following drugs is potentially inappropriate for this patient?	{ "A": "Aripiprazole", "B": "Quetiapine", "C": "Chlorpromazine", "D": "Haloperidol", "E": "None of the above" }	[ "A", "C", "D" ]	cardiology	cardiovascular system	[ "antipsychotics" ]	composite clinical context	older adults	risk redistribution	counterfactual
CS-CF-A1-002-A	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...	Which of the following medications should be avoided in this patient?	{ "A": "Doxazosin", "B": "Terazosin", "C": "Tamsulosin", "D": "None of the above", "E": "Prazosin" }	[ "A", "B", "E" ]	cardiology	cardiovascular system	[ "alpha-1 receptor blockers" ]	composite clinical context	older adults	risk activation	counterfactual
CS-CF-A1-002-B	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,...	Which of the following medications should be avoided in this patient?	{ "A": "Doxazosin", "B": "Terazosin", "C": "Tamsulosin", "D": "None of the above", "E": "Prazosin" }	[ "D" ]	cardiology	cardiovascular system	[ "alpha-1 receptor blockers" ]	composite clinical context	older adults	risk deactivation	counterfactual
DDI-CF-RK-001-A	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 go...	Which of the following medications would be potentially inappropriate to add to this patient's current regimen?	{ "A": "Furosemide", "B": "Amiloride", "C": "Triamterene", "D": "Hydrochlorothiazide", "E": "None of the above" }	[ "B", "C" ]	cardiology	cardiovascular system	[ "ras inhibitors/potassium-sparing diuretics" ]	drug interaction	older adults	interaction identification	counterfactual
DDI-CF-RK-001-B	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 ...	Which of the following medications would be potentially inappropriate to add to this patient's current regimen?	{ "A": "Furosemide", "B": "None of the above", "C": "Amiloride", "D": "Triamterene", "E": "Hydrochlorothiazide" }	[ "B" ]	cardiology	cardiovascular system	[ "ras inhibitors/potassium-sparing diuretics" ]	drug interaction	older adults	interaction identification	counterfactual
DDI-CF-OB-001-A	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 addres...	Which of the following medications would be potentially inappropriate to add to this patient's current regimen?	{ "A": "Temazepam", "B": "None of the above", "C": "Metoclopramide", "D": "Pantoprazole", "E": "Lorazepam" }	[ "A", "E" ]	pain medicine	nervous system	[ "opioids" ]	drug interaction	older adults	interaction identification	counterfactual
DDI-CF-OB-001-B	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 a...	Which of the following medications would be potentially inappropriate to add to this patient's current regimen?	{ "A": "Temazepam", "B": "Metoclopramide", "C": "None of the above", "D": "Pantoprazole", "E": "Lorazepam" }	[ "C" ]	pain medicine	nervous system	[ "opioids" ]	drug interaction	older adults	interaction identification	counterfactual
DDI-CF-OG-001-A	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 medication...	Which of the following medications would be potentially inappropriate to add to this patient's current regimen?	{ "A": "Gabapentin", "B": "Acetaminophen", "C": "None of the above", "D": "Celecoxib", "E": "Pregabalin" }	[ "A", "E" ]	pain medicine	nervous system	[ "opioids" ]	drug interaction	older adults	interaction identification	counterfactual
DDI-CF-OG-001-B	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 suppl...	Which of the following medications would be potentially inappropriate to add to this patient's current regimen?	{ "A": "Gabapentin", "B": "None of the above", "C": "Acetaminophen", "D": "Celecoxib", "E": "Pregabalin" }	[ "B" ]	pain medicine	nervous system	[ "opioids" ]	drug interaction	older adults	interaction identification	counterfactual
DDI-CF-AC-001-A	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 bo...	Which of the following medications would be potentially inappropriate to add to this patient's current regimen?	{ "A": "Metformin", "B": "Diphenhydramine", "C": "Dicyclomine", "D": "Amlodipine", "E": "None of the above" }	[ "B", "C" ]	psychiatry	nervous system	[ "tricyclic antidepressants/anticholinergics" ]	drug interaction	older adults	interaction identification	counterfactual
DDI-CF-AC-001-B	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 his...	Which of the following medications would be potentially inappropriate to add to this patient's current regimen?	{ "A": "Metformin", "B": "Diphenhydramine", "C": "Dicyclomine", "D": "None of the above", "E": "Amlodipine" }	[ "D" ]	psychiatry	nervous system	[ "tricyclic antidepressants/anticholinergics" ]	drug interaction	older adults	interaction identification	counterfactual
DDI-CF-CN-001-A	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 inso...	Which of the following medications would be potentially inappropriate to add to this patient's current regimen?	{ "A": "None of the above", "B": "Lorazepam", "C": "Lisinopril", "D": "Amlodipine", "E": "Zolpidem" }	[ "B", "E" ]	psychiatry	nervous system	[ "central nervous system depressants" ]	drug interaction	older adults	interaction identification	counterfactual
DDI-CF-CN-001-B	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.	Which of the following medications would be potentially inappropriate to add to this patient's current regimen?	{ "A": "Lorazepam", "B": "Lisinopril", "C": "Amlodipine", "D": "Zolpidem", "E": "None of the above" }	[ "E" ]	psychiatry	nervous system	[ "central nervous system depressants" ]	drug interaction	older adults	interaction identification	counterfactual

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