afrimedqa/afrimedqa_v2 huggingface dataset:
Specialty: General_Surgery
Differences between large bowel and small bowel obstruction 
Rationale: Small bowel obstruction:                
1. Vomiting is an early feature 
2. Acute onset  
3. Central in location radiologically 
4. Presence of valvulae connniventes on erect abdominal X ray  
5. Abdominal pain cramping in nature lasting for shorter durations in crescendo decrescendo pattern. 
6. Small bowel dilatation of > 3cm on an erect abdominal X ray 
7. Commonest etiology adhesions, hernia  

Large bowel obstruction:
1. Vomiting is a late feature 
2. Gradual in onset. (Acute on chronic) 
3. Peripheral in location radiologically 
4. Presence of haustrations on erect abdominal X ray 
5. Abdominal pain lasting for longer duration 
6. Large bowel dilatation of > 6cm at the level of colon, and > 9cm at the caecum 
7. Commonest etiology malignancies
Specialty: General_Surgery
Parameters of the Ranson criteria 
Rationale: 
•	Partial pressures of oxygen < 60 mmHg 
•	Age > 55 years 
•	Neutrophils > 16 
•	Calcium levels < 2mmol/l 
•	Renal function urea >16mmol/l 
•	Enzymes LDH > 600IU/L, AST, ALT 
•	Albumin < 32g/l in serum 
•	Sugar > 10mmol/l
Specialty: General_Surgery
Write short notes on Acute pancreatitis under the following subheadings: Complications 
 

Rationale: Local 
•	Necrosis 
•	Gangrene of transverse mesocolon 
•	Splenic artery thrombosis 
•	Pseudocysts 
•	Chronic pancreatitis 
•	Pancreatic abscesses 
•	Pancreatic fistulas  
 
Systemic 
•	ARDS 
•	Pleural effusion 
•	DIC 
•	Acute Kidney injury 
•	Paralytic ileus 
•	Peritonitis 
•	Electrolyte imbalances i.e., Hypocalcemia
Specialty: General_Surgery
Write short notes on Acute pancreatitis under the following subheadings: Management 
Rationale: 1. Management is supportive 
2. Fluid therapy to correct dehydration. Use isotonic crystalloids. Consider comorbidities like CCF when administering fluids to prevent complications associated with fluid overload 
3. Insert urethral catheter, monitor fluid input output using a fluid chart 
4. Nutritional support. Initially NPO if no bowel sounds. If there are bowel sounds oral sibs. To those who can’t feed consider TPN, or enteral feeding through NG tube, NJ tube 
5. NG tube decompression in persistent Nausea and vomiting. Anti-emetics such as Ondansetron 
6. Analgesia for the pain 
7. Correct electrolyte imbalances
Specialty: General_Surgery
Write short notes on Acute pancreatitis under the following subheadings: Investigations 
Rationale: 1. 	Laboratory 
•	Pancreatic function tests- serum amylase and lipase elevated • 	Lipase more specific. 
•	Complete blood count and differential white cell count 
•	UECs to check for kidney function, electrolyte imbalances 
•	Lipid profile. Hypertriglyceridemia is a risk factor 
•	Arterial blood gases, assessing severity. Part of Ranson's criteria, ARDS is also a complication of pancreatitis. 
•	Random blood sugar. Part of the Ranson criteria 
•	LFTs and serum albumin 
•	Enzymatic assay LDH 
•	Coagulation screen 
•	Urinalysis 
  
2. 	Imaging 
•	Abdominal ultrasound. Important to rule out gallstone pancreatitis 
•	Abdominal pelvis CT scan with contrast. Also, useful to rule out other causes of acute abdomen and for grading of Acute pancreatitis. (NB: CT scan picks findings after 72 hours) 
•	ERCP acute gallstone pancreatitis with persistent biliary obstruction or cholangitis 
•	MRCP 
•	Plain erect Abdominal X-ray. Picks ileus as a result of AP. Findings include sentinel loop, colonic cut-off sign 
•	Chest X ray. May show pleural effusions
Specialty: General_Surgery
Write short notes on Acute pancreatitis under the following subheadings: Risk factors 

Rationale: 1.	G -gallstones 
2.	E- ethanol 
3.	T- trauma  
4.	S – Steroids (prolonged use of steroids) 
5.	M - Mumps 
6.	A - Autoimmune 
7.	S – Scorpion sting 
8.	H – Hyperlipidemia/hypercalcemia 
9.	E - ERCP 
10.	D – Drugs
Specialty: General_Surgery
What are the differential diagnoses for acute epigastric abdominal pain? 

Rationale: a.	Acute Pancreatitis 	 
b.	Cholelithiasis            
c.	Acute gastritis  
d.	Acute cholecystitis 
e.	Peptic ulcer disease (PUD) 
f.	Perforated ulcer 
g.	Appendicitis  
h.	Small bowel obstruction 	 
i.	Ruptured AAA 	 
j.      Referred pain from myocardial infarction
Specialty: General_Surgery
Which of the following patients with primary hyperparathyroidism should undergo parathyroidectomy? 

Answer options: option1: A 62-year-old asymptomatic woman
option2: A 54-year-old woman with fatigue and depression
option3: A 42-year-old woman with a history of kidney stones
option4: A 60-year-old woman with mildly decreased bone mineral density measured at the hip of less than 2 standard deviations below peak bone density
option5: A 70-year-old man with recurrent episodes of pancreatitis
Correct answer: option3
Specialty: General_Surgery
Following surgical resection of a large thyroid mass, a patient complains of persistent hoarseness and a weak voice. What is the most likely cause of these symptoms? 

Answer options: option1: Traumatic intubation
option2: Prolonged intubation
option3: Injury to the recurrent laryngeal nerve
option4: Injury to the superior laryngeal nerve
option5: Hematoma formation
Correct answer: option3
Specialty: Pediatrics
A 1-year-old child presents with crying continuously and drawing his legs up. The mother reports associated episodes of passing bloody mucus per rectum. A long, thin mass is palpable in the right upper quadrant of the abdomen. No peritoneal signs are present. Intussusception is suspected. Which of the following is the most appropriate next step? 


Answer options: option1: Hydrostatic reduction with air enema
option2: Diagnostic laparoscopy with laparoscopic reduction
option3: Exploratory laparotomy with bowel resection
option4: Decompressive colonoscopy with placement of a rectal tube
option5: Administration of IV fluids and observation
Correct answer: option1
Specialty: Pediatrics
Which of the following statements regarding nutritional requirements in infants is NOT TRUE? 

Answer options: option1: The total daily water requirement is estimated to be 100 ml/kg
option2: The resting energy expenditure is approximately twice that of an adult
option3: The highest rate of nitrogen retention with parenteral nutrition occurs in infants given approximately 40% of the calories as carbohydrate and the remainder as fat
option4: The protein requirement for a newborn infant is approximately 1 g/kg/day
option5: The caloric intake needs to be adjusted based on growth and weight gain
Correct answer: option4
Specialty: Pediatrics
Which of the following statements are TRUE regarding the premature neonate? 

Answer options: option1: A 15% to 20% right-to-left shunt occurs across the foramen ovale and patent ductus arteriosus
option2: Surfactant levels are normal after 30 weeks' gestation
option3: Fluid requirements are lower than in a full-term baby
option4: Rectal temperature is the best indicator of core body temperature
option5: Premature neonates have a higher risk of hypoglycemia
Correct answer: option1
Specialty: Pediatrics
Which of the following statements is TRUE of infants with gastroschisis? 

Answer options: option1: It is not associated with malrotation
option2: There is a high incidence of associated anomalies
option3: There is prolonged adynamic ileus following repair
option4: It is associated with chromosomal syndromes
option5: It frequently results in complications from infection
Correct answer: option3
Specialty: Pediatrics
Which of the following statements is TRUE about infants with gastroschisis? 

Answer options: option1: It is not associated with malrotation
option2: There is a high incidence of associated anomalies
option3: The condition is usually associated wi  th trisomy 21
option4: It is always linked with maternal alcohol use
option5: It frequently involves a defect in the umbilical ring
Correct answer: option1
Specialty: General_Surgery
A 72-year-old patient with obesity and superficial varicose veins was admitted to the surgical department with a strangulated large incisional hernia. On the next day after the operation, the patient complained of pain in the left thigh. On day 3 after the operation, during an attempt to stand up, the patient experienced inspiratory dyspnea, dull chest pain, systolic BP of 60 mmHg, and a heart rate of 130 beats per minute. Which method of treatment would be most effective in this case? 

Answer options: option1: Therapy for pulmonary edema
option2: Surgical embolectomy
option3: Thrombolysis
option4: Heparin
option5: Observation and supportive care
Correct answer: option3
Specialty: Orthopedic_Surgery
Because of his involvement in a motor vehicle accident, a 23-year-old football player has a chest wall injury. The only abnormal findings on clinical and radiologic examination are a fracture of the left fifth to seventh ribs and a small hemothorax. What should treatment include? 

Answer options: option1: Thoracotomy to treat a hemothorax in the left base
option2: Insertion of an intercostal drain to avoid pneumothorax
option3: Insertion of a metal plate to fix the fracture
option4: Administration of analgesic medication
option5: Immediate surgical intervention to remove damaged ribs
Correct answer: option4
Specialty: Pediatrics
Which one of the following statements concerning chest X-ray in patients with congenital heart diseases is FALSE? 


Answer options: option1: Always shows an enlarged heart in heart failure
option2: May show pulmonary oligemia in congenital heart disease
option3: May show a characteristic heart shadow in Transposition of the great arteries called "egg on a string"
option4: Shows a characteristic boot-shaped heart shadow in Tetralogy of Fallot
option5: Is not useful in diagnosing congenital heart diseases
Correct answer: option1
Specialty: Pediatrics
A patent ductus arteriosus: 


Answer options: option1: Can be a cause of heart failure but may also be life-saving
option2: Causes a left-to-right shunt
option3: Is uncommonly associated with intraventricular hemorrhage, pulmonary hemorrhage, and necrotizing enterocolitis
option4: Is normal on day 14 of life
option5: Spontaneously resolves without any complications
Correct answer: option2
Specialty: General_Surgery
A 46-year-old man is diagnosed with an estrogen receptor-positive invasive ductal carcinoma of the right breast after having discovered a lump 3 months before. The patient is found to have multiple involved axillary lymph nodes, and the tumor is of an aggressive phenotype. The most appropriate treatment option for this patient is: 


Answer options: option1: Cytotoxic chemotherapy and Tamoxifen but no surgery
option2: Mastectomy + axillary clearance + systemic chemotherapy + radiotherapy and  Tamoxifen
option3: Wide local excision and Tamoxifen only
option4: Mastectomy + postoperative radiotherapy only
option5: Observation without intervention
Correct answer: option2
Specialty: Oncology
A 67-year-old woman with a 25-year smoking history presents to the clinic expressing concerns regarding an increase in the size of her right breast over the last 4 months. On examination, you find a non-tender, mobile, lobulated 10 cm mass with relatively smooth edges in the right breast. The right breast is significantly larger than the left and has a 'teardrop' appearance. The most likely diagnosis here is: 


Answer options: option1: Inflammatory breast carcinoma
option2: Breast abscess
option3: Malignant phyllodes tumor
option4: Fibroadenoma
option5: Lipoma
Correct answer: option3
Specialty: General_Surgery
Which of the following is TRUE regarding benign prostate hyperplasia and prostate related issues

Answer options: option1: All men with BPH demonstrate lower urinary tract symptoms (LUTS), and all men with LUTS have BPH
option2: The risk for acute urinary retention (AUR) increases with age
option3: Prostate volume typically decreases over time in men with BPH
option4: Complications such as bladder stones or recurrent urinary tract infections are frequent
option5: None of the above are true
Correct answer: option2
Specialty: General_Surgery
 A 57-year old nulliparous woman comes 2 weeks after noticing a lump in the right breast. Her last mammogram was done 4 years ago and showed no abnormalities. Menopause began 2 years ago, during which time the patient was prescribed hormone replacement therapy for severe hot flashes and vaginal dryness. Vital signs are within normal limits. Examination of the right breast shows a firm, non-tender mass close to the nipple. There are no changes in the skin or nipple and there is no palpable axillary adenopathy. The abdomen is soft and nontender. Mammography shows a suspicious 2 cm mass adjacent to the nipple. Which of the following is the most appropriate next step in management?


Answer options: option1: Fine needle aspiration
option2: Excisional biopsy
option3: Bone scan
option4: Measurement of serum CA 15-3
option5: Core needle biopsy
Correct answer: option5
Specialty: General_Surgery
 A 29-year old woman comes to the physician for evaluation of a mass in the left breast noticed 2 weeks ago. During this period the mass has not increased in size and has no pain. Three months ago she hit her left chest against a door and it was painful for a day. Menses occur at regular 28 day intervals and last for 5 days. Her last menstrual period was 3 weeks ago. Physical examination shows dense breasts and 2.5 cm well defined, rubbery, mobile mass that is non tender in the upper outer quadrant of the left breast. There is no axillary adenopathy. Which of the following is the most likely diagnosis?

Answer options: option1: Phyllodes tumour
option2: Intraductal papilloma
option3: Fibrocystic changes of the breast
option4: Fibroadenoma
option5: Fat necrosis
Correct answer: option4
Specialty: General_Surgery
A 36-year-old woman who is breastfeeding her first child complains of a smooth, mobile, painless lump in the outer quadrant of the right breast. Core biopsy is attempted and a white opaque fluid is expressed. The most likely diagnosis in this patient is:  

Answer options: option1: Pregnancy-associated breast cancer
option2: Fibroadenoma
option3: Lobular breast cancer
option4: Galactocele
option5: Breast abscess
Correct answer: option4
Specialty: General_Surgery
A woman undergoes a triple assessment for a left upper outer quadrant breast lump. The results of the clinical assessment show the lump to be 4.5 cm in diameter, with mobile lymph nodes on the same side and no evidence of distant metastases. Which of the following is her TNM classification?      


Answer options: option1: T1N3M0
option2: T2N1M0
option3: T3N0M0
option4: T2N3M1
option5: T4N0M0
Correct answer: option2
Specialty: General_Surgery
Which of the following statements regarding acute extradural haematoma is False?

Answer options: option1: It is often caused by a skull fracture with laceration of the middle meningeal artery
option2: It commonly occurs at the pterion.
option3: There is often a lucid interval.
option4: Treatment is with a burrhole.
option5: All of the above.
Correct answer: option4
Specialty: General_Surgery
A 29-year-old woman attends A&E with a tender, swollen left breast. Her temperature is 38°C. She is two weeks post-partum and is breastfeeding. Ultrasound shows a cystic mass in the left breast. What is the most appropriate next step in management?  


Answer options: option1: Advise to stop breastfeeding
option2: Arrange mammograms of both breasts
option3: Needle aspiration of the collection
option4: Start bromocriptine
option5: Continue breastfeeding
Correct answer: option3
Specialty: Neurosurgery
You are the Medical Officer in Accident and Emergency department. A patient with Head Injury presents to you. Which imaging modality will you order in the acute setting: 

Answer options: option1: A PET CT Scan
option2: An MRI Of The BRAIN
option3: An EEG
option4: A Head CT scan
option5: A Skull Xray
Correct answer: option4
Specialty: Orthopedic_Surgery
A 78-year-old male presents with low back pain which is worst at night. What would be your next plan of management. 


Answer options: option1: Put him on analgesics and review him six weeks later
option2: Refer him to the physical therapist for immediate physiotherapy
option3: Request for a lumbo-sacral X-ray
option4: Put him on a Lumbar Corset
option5: Order a bone scan
Correct answer: option3
Specialty: Orthopedic_Surgery
The following lesions are noted in patients with Recurrent Anterior Shoulder Dislocations 
EXCEPT: 


Answer options: option1: Hill Sachs Lesion
option2: Bankart Lesion
option3: Rotator cuff tear
option4: Inferior Glenoid Rim Fracture
option5: Reverse Hill Sachs Lesion
Correct answer: option5
Specialty: Orthopedic_Surgery
A 65-year-old man has had pain in the left hip joint for a few years that has begun to subside but he then has noticed a reduction in the joint range of motion in the same hip. The most useful single thing he should do is? 

Answer options: option1: Engage in sessions of physiotherapy to loosen the joint
option2: Start a two-week trial of anti-inflammatory drugs to further reduce the pain
option3: Test for rheumatoid factor
option4: Consider hip replacement surgery
option5: Take an x ray of the pelvis
Correct answer: option5
Specialty: Orthopedic_Surgery
The following is true of closed Fractures of the femoral shaft in adults. 

Answer options: option1: They can only be managed by locked intramedullary nailing
option2: May need blood transfusion
option3: Fat embolism
option4: Traction treatment should not be instituted at home
option5: They are not associated with significant blood loss
Correct answer: option2
Specialty: Orthopedic_Surgery
A 15-year-old boy presents with a single episode of displacement of his left knee cap while playing football but “it returned” spontaneously. 

Answer options: option1: Physiotherapy, a knee support and observation would be adequate initial management
option2: A knee CT scan should be done before definitive management and advice can be given
option3: A knee arthroscopy is advised
option4: Immediate surgery is recommended
option5: All of the above apply
Correct answer: option1
Specialty: General_Surgery
How is cerebral perfusion pressure defined?

Answer options: option1: Systolic arterial blood pressure minus diastolic blood pressure
option2: Systolic arterial blood pressure minus venous pressure
option3: Mean arterial blood pressure minus venous pressure
option4: Mean arterial blood pressure minus intracranial pressure (ICP)
option5: Venous pressure minus ICP
Correct answer: option4
Specialty: Orthopedic_Surgery
A patient develops compartment syndrome following manipulation and plaster for fracture of both bones of the leg. What is the best treatment? 


Answer options: option1: Split the plaster
option2: Infusion of low molecular weight dextran
option3: Elevate the leg after splitting the plaster
option4: Do operative decompression of fasciae compartments
option5: Apply a cold compress to the leg
Correct answer: option4
Specialty: General_Surgery
A 45-year-old male patient complains of dysphagia of 2 years’ duration. He seems to have greater difficulty swallowing liquids than solids. Recently he has noticed that at night he is woken up by coughing. He has lost about 7–8 kg in weight in 6 months. The most likely diagnosis in this patient is

Answer options: option1: Peptic stricture
option2: Carcinoma
option3: Achalasia
option4: Diffuse oesophageal spasm
option5: Schatzki’s ring
Correct answer: option3
Specialty: Orthopedic_Surgery
A 28-year-old man is brought by ambulance to the emergency department after falling from the roof of his home four hours ago. Upon initial evaluation, he has visible deformities of his bilateral lower extremities and a positive FAST exam. Heart rate is 135, blood pressure 85/58, and urine output is 40 cc over 3 hours. According to ATLS guidelines, what percentage of his blood volume has this patient likely lost? 

Answer options: option1: <15%
option2: 15-30%
option3: 30-40%
option4: 40-50%
option5: >50%
Correct answer: option3
Specialty: Orthopedic_Surgery
A 26-year-old male sustains a right mid-shaft Fracture of the femur. Which of the following radiological investigations are important in his management. 

Answer options: option1: Antero-posterior x-ray view of the Pelvis
option2: X-ray view of the Right Shoulder
option3: Antero-posterior view of the Left Femur
option4: MRI Scan of the Right Femur
option5: Lateral x-ray view of the Right Femur
Correct answer: option1
Specialty: Orthopedic_Surgery
A lady who is 4 months pregnant presents with some pain in her right knee with a swelling that has been increasing slowly in the previous 2 months. There is only a slight decrease in flexion but not much added pain. A radiolucent lesion is noted in the subchondral region of the distal femur. 

Answer options: option1: It is important to counsel the lady about the possible amputation of the affected femur
option2: Nothing should be done until the lady delivers her baby
option3: Urgent surgery of the lesion should be considered
option4: The patient must be prepared for chemotherapy once her baby is delivered
option5: MRI should be done immediately
Correct answer: option3
Specialty: General_Surgery
Which of the following are true regarding medical therapy for thyrotoxicosis?

Answer options: option1: Propranolol and nadolol reduce free T3 (fT3) and free T4 (fT4) levels.
option2: Antithyroid drugs most often cure thyrotoxicosis due to a toxic nodule.
option3: Carbimazole can be safely given in pregnancy and lactation.
option4: Agranulocytosis is an uncommon problem with antithyroid drugs.
option5: Patients with ophthalmopathy respond best to medical management
Correct answer: option4
Specialty: General_Surgery
A 41-year-old man is seen in clinic with bright red rectal bleeding, seen on the toilet tissue intermittently over the last several months. He is an insurance agent, exercises regularly, and eats a well-balanced diet. He denies changes in bowel habits. Family history is unremarkable. His vital signs are normal. His abdomen exam is normal. Digital rectal exam is normal, and blood is identified on the examining finger. Anoscopy shows no other pathology. What is the next best step in diagnosis?

Answer options: option1: Fecal occult blood test
option2: Complete blood count (CBC): if normal, no further evaluation is indicated
option3: Barium enema
option4: Flexible sigmoidoscopy
option5: Colonoscopy
Correct answer: option5
Specialty: General_Surgery
 A 50-year-old woman is seen in clinic because of weight loss, restlessness, and palpitations. She also has noted leg swelling and excessive hair loss. Her past medical history is unremarkable. She takes no medications. She is afebrile. On exam, she is tachycardic and has a fine tremor. She has mild exophthalmos. Her thyroid is smooth and uniformly enlarged. TSH levels are low and T 3 and T 4 levels are elevated. What is the next best step in management?


Answer options: option1: Radioactive iodine
option2: Early operation
option3: Propranolol
option4: Antithyroid medication
option5: Thyroxine suppression
Correct answer: option4
Specialty: General_Surgery
A 20-year-old woman is seen in clinic because of a thyroid nodule. She is asymptomatic and her past medical history is unremarkable. She takes no medications. There is a 1-cm fi rm, solitary, nodule in
the lateral aspect of the left lobe of the thyroid. A radionuclide scan showed no uptake of tracer in the nodule. Ultrasonography shows a solid, homogenous 1-cm mass. Fine-needle aspiration cytology
shows a follicular neoplasm. What is the next best step in management?


Answer options: option1: Irradiation (radioactive iodine)
option2: Thyroid suppression with thyroxine
option3: Incisional biopsy and enucleation if benign
option4: Total thyroidectomy
option5: Left thyroid lobectomy
Correct answer: option5