afrimedqa/afrimedqa_v2 huggingface dataset:
Specialty: Pediatrics
9)	A 12-month-old boy comes to the emergency department with a 3-day history of intractable
vomiting and watery diarrhea. His mother reports decreased urine output for the past 24 hours.
His heart rate is 180 beats/min, and his blood pressure is 85/40 mmHg. He is lethargic but
responds to stimulation. His mucous membranes are very dry, his skin turgor is decreased, and
his capillary refill is 3 seconds. The remainder of his physical examination findings are
unremarkable.
Of the following, the laboratory data that are MOST consistent with this patient's clinical
presentation are

Answer options: option1: . Serum Sodium: High; Serum Osmolality: High; Urine Sodium: Low; Urine Osmolality: Low
option2: Serum Sodium: Low; Serum Osmolality: Low; Urine Sodium: Low; Urine Osmolality: High
option3: Serum Sodium: Low; Serum Osmolality: Low; Urine Sodium: High; Urine Osmolality: Hig
option4: Serum Sodium: Low; Serum Osmolality: Normal; Urine Sodium: High; Urine Osmolality: High
option5: Serum Sodium: Normal; Serum Osmolality: Normal; Urine Sodium: Low; Urine Osmolality: Low
Correct answer: option2
Specialty: Hematology
List 5 indications of blood transfusion in sickle cell disease (5 m)


Rationale: i)	Symptomatic anaemia: Aplastic crisis, Acute Splenic sequestration
ii)	Acute hepatic sequestration/ intrahepatic cholestasis
iii)	Acute Chest Syndrome (ACS)
iv)	Acute multiorgan failure
v)	Preoperative (Surgeries lasting >1hr and require general anesthesia)
vi)	Pregnancy
Specialty: Pulmonary_Medicine
Which of the following is TRUE regarding pulmonary thromboembolism?

Answer options: option1: Cardiac emboli are important causes
option2: Typical chest radiograph finding is an occlusive clot in a pulmonary vein
option3: Doppler ultrasound of lower limbs is recommended
option4: All patients should receive thrombolysis
option5: Factor VIII deficiency is an important cause
Correct answer: option3
Specialty: Pediatrics
8)	A pregnant woman was found to be a carrier for severe hemophilia A (FVIII deficiency). She wants to know what is the chance having a boy with Hemophilia. Which of the following is your best answer? 
Answer options: option1: 0%; Hemophilia is dependent on the father
option2: 25%; 1 in 4 will be affected
option3: 50%; 1 in 2 will be affected
option4: 100%; unfortunately they will all be affected.
option5: It is impossible to tell.
Correct answer: option3
Specialty: Pulmonary_Medicine
A 24-year-old presents with fever, dyspnea, and cough for 3 weeks. Chest auscultation is unremarkable. Chest radiograph shows bilateral peri-hilar interstitial infiltrates in a butterfly pattern. His HIV antibody test is positive. Which of the following is TRUE?
Answer options: option1: Cryptococcosis is the most likely diagnosis
option2: Cotrimoxazole is second-line therapy in patients who do not respond to macrolides
option3: Dapsone has no role in the management
option4: Tuberculous lymphadenitis explains the findings
option5: Oral corticosteroids are indicated if oxygen saturation falls below 88%
Correct answer: option5
Specialty: Pediatrics
7)	A 6-week-old child arrives with a complaint of “breathing fast” and a cough. On examination you note the child to have no temperature elevation, a respiratory rate of 65 breaths per minute, and her oxygen saturation to be 94%. Physical examination also is significant for rales and rhonchi. The past medical history for the child is positive for an eye discharge at 3 weeks of age, which was treated with a topical antibiotic drug. Which of the following organisms is the most likely cause of this child’s condition?
Answer options: option1: Neisseria gonorrhoeae
option2: b. Staphylococcus aureus
option3: Group B streptococcus
option4: Chlamydia trachomatis
option5: Herpesvirus
Correct answer: option4
Specialty: Pulmonary_Medicine
A 70-year-old man is diagnosed with a lower respiratory tract infection. He has no risk factors for healthcare-associated pneumonia. Which of the following is NOT TRUE?
Answer options: option1: Streptococcus pneumoniae is the commonest isolated organism
option2: Doxycycline is recommended in uncomplicated cases
option3: One antibiotic active against Pseudomonas should be offered
option4: Mycoplasma pneumoniae is an unlikely pathogen in this case
option5: A raised BUN (urea) is a criteria for inpatient treatment
Correct answer: option2
Specialty: Pediatrics
A previously healthy 18-month-old has been in a separate room from his family. The family notices the sudden onset of coughing, which resolves in a few minutes. Subsequently, the patient appears to be normal except for increased amounts of drooling and refusal to take foods orally. Which of the following is the most likely explanation for this toddler’s condition
Answer options: option1: Severe gastroesophageal reflux
option2: Foreign body in the airway
option3: Croup
option4: Epiglottitis
option5: Foreign body in the esophagus
Correct answer: option5
Specialty: Pulmonary_Medicine
Which of the following statements is TRUE?
Answer options: option1: Bacteria are the commonest cause of upper respiratory tract infection
option2: Tobacco smoking is the greatest risk factor for bronchogenic carcinoma
option3: Respiratory Syncytial Virus is the commonest etiology in acute coryza
option4: Tamiflu (oseltamivir) is effective in lower respiratory tract infections due to Hemophilus influenza
option5: Interferon gamma release assays are superior to ZN stain for the diagnosis of pulmonary tuberculosis
Correct answer: option2
Specialty: Pulmonary_Medicine
A Level Six student doing a clinical clerkship in the medical wards is concerned about the risk of getting tuberculosis. Which of the following is TRUE?
Answer options: option1: He should get vaccinated with BCG
option2: A positive Mantoux test indicates excellent protection against TB
option3: N-95 Filter is more effective than a surgical mask in preventing aerosol inhalation
option4: He should offer IPT (Isoniazid preventive therapy) to HIV patients with cough, fever, and night sweats
option5: He should delay anti-retroviral therapy in HIV/TB co-infected patients till they complete TB therapy
Correct answer: option3
Specialty: Pediatrics
2)	A 4-year-old girl is brought to the emergency department by her aunt because the child
has suddenly become clumsy, and her speech has become slurred over the last hour. On
physical examination, the girl is afebrile and dysarthric. She has prominent vertical and
horizontal nystagmus, along with truncal and appendicular ataxia. Deep tendon reflexes are
normal, as are results of the remainder of the physical examination.
Of the following, the MOST likely diagnosis is

Answer options: option1: brain tumor
option2: cerebellar hemorrhage
option3: Guillain-Barré syndrome
option4: meningoencephalitis
option5: toxic ingestion
Correct answer: option5
Specialty: Other
Two hundred children with severe ITP were enrolled in a randomized clinical trial to compare the rate of nose bleeds between children who received anti D therapy and those who receive no treatment. One hundred were assigned to each group. Which of the following is the most appropriate statistical procedure? 
Answer options: option1: Independent t test
option2: Chi square
option3: Analysis of variance
option4: Paired t -test
option5: Non parametric test
Correct answer: option2
Specialty: Hematology
When considering preventive therapy in HIV patients which of these statements is TRUE?
Answer options: option1: Universal prophylaxis with Cotrimoxazole is mandatory for all patients unless contraindicated
option2: Dapsone can be used when Cotrimoxazole is contraindicated for prophylaxis and should be continued indefinitely
option3: Primary prophylaxis for PCP may be discontinued when the CD4 is maintained >200cells/uL for more than 6 months
option4: A course of Isoniazid preventive therapy should only be offered to patients who have a history of TB contact
option5: Pre-emptive Fluconazole therapy should be given to all patients with a CD4 < 100cells/uL when they are initiating antiretroviral treatment
Correct answer: option3
Specialty: Hematology
A patient who has been on antiretrovirals for 6 years and who has maintained undetectable viral loads with his first-line regimen presents with an HIV-RNA viral load of 245 copies/ml. Which of the following is TRUE?
Answer options: option1: An intercurrent infection can cause this
option2: He should have adherence counseling and directly observed treatment and repeat the viral load in a year
option3: A repeat viral load should be done in 6 months and if similar levels are obtained, he should be switched to a second-line regimen
option4: The viremia would be expected to continue rising with time
option5: Laboratory variations and errors are not a consideration
Correct answer: option1
Specialty: Rheumatology
A 45-year-old man presents with a tender, warm and swollen left knee. He denies any trauma. Which of these is LEAST LIKELY to cause this?

Answer options: option1: Gonococcal infection
option2: Brucellosis
option3: Acute Gout
option4: Staphylococcal infection
option5: Parvovirus B19 infection
Correct answer: option5
Specialty: Neurology
With respect to lumbar puncture which is true?

Answer options: option1: Coagulopathy is a contraindication
option2: Papilloedema is an absolute contraindication
option3: The procedure may cause meningitis
option4: The less CSF is removed, the less likely coning is to occur
option5: Postlumbar puncture headache is related to the size of the needle used
Correct answer: option1
Specialty: Hematology
With regards to antiretroviral drugs, which of these statements is TRUE?
Answer options: option1: Zidovudine and Abacavir are both thymidine analogs
option2: Dolutegravir has a low genetic barrier to resistance
option3: Enfuvirtide exerts its action by binding to gp41
option4: Non-nucleoside reverse transcriptase inhibitors can be used to treat both HIV-1 and HIV-2 infections
option5: Boosting with ritonavir increases the metabolism of the partner drug, thereby reducing toxicity
Correct answer: option3
Specialty: Pathology
The first vascular response to injury is
Answer options: option1: slowing of the ciruclation
option2: venular dilaltion
option3: recruitment of vascular beds
option4: capillary engorgement
option5: arteriolar vasoconstriction.
Correct answer: option5
Rationale: When tissue is first injured, the small blood vessels in the damaged area constrict momentarily, a process called vasoconstriction. Following this transient event, which is believed to be of little importance to the inflammatory response, the blood vessels dilate (vasodilation), increasing blood flow into the area.
Specialty: Infectious_Disease
Which of these statements regarding tuberculosis (TB) and HIV infection is true?

Answer options: option1: The lifetime risk for developing active TB in HIV-infected individuals is twice that of HIV-uninfected individuals.
option2: Active TB accelerates HIV disease
option3: In patients with Pulmonary TB and a CD4 < 50 cells/uL, initiation of antiretroviral therapy should be delayed to 8 weeks after initiating anti-TB therapy
option4: In HIV-infected individuals, glucocorticoids are contraindicated in the treatment of tuberculous meningitis.
option5: Isoniazid prophylaxis is indicated for patients with a CD4 < 100 cells/uL.
Correct answer: option2
Specialty: General_Surgery
6 During a hernia examination, the deep inguinal ring was occluded and the patient asked to cough. The swelling was seen medial to the examiners index finger. What is the lateral border of this anatomical region where the swelling was seen? 
Answer options: option1: lateral border of the rectus sheath
option2: the inguinal ligament
option3: Spigelian line
option4: inferior epigastric vessels
option5: n/a
Correct answer: option4
Specialty: Dermatology
Which of these statements regarding human papilloma viruses (HPV) is TRUE?
Answer options: option1: Almost 90% of anal cancer is caused by HPV
option2: The development of benign or malignant lesions after infection by human disease-causing HPV is dependent on the host immune response to the virus.
option3: HPV vaccination is recommended for all sexually active individuals.
option4: Once HPV vaccination is administered to females as per the guidelines then there is no further need for cervical screening
option5: During pregnancy genital warts usually decrease in size and may disappear
Correct answer: option1
Specialty: Dermatology
A 38-year-old man presents with mild fever and malaise. He has generalized lymphadenopathy and a maculopapular rash over the trunk and limbs with involvement of the palms and soles. He recalls that he had a penile ulcer about 3 months earlier which resolved without treatment within 2 weeks. Which of these is NOT TRUE of his condition?
Answer options: option1: These clinical manifestations will resolve without treatment
option2: The antibody tests used for diagnosis persist after effective treatment and cannot be used to document cure.
option3: Neurological complications do not occur at this stage of his illness.
option4: He should be tested for HIV
option5: An acute febrile reaction may complicate treatment
Correct answer: option3
Specialty: Infectious_Disease
In HIV infection, which is TRUE?
Answer options: option1: The p24 antigen can be detected during the eclipse period
option2: The humoral immune response is more effective than the cell-mediated immune response in controlling the infection.
option3: CD4 B lymphocytes and macrophages are the primary target of infection
option4: The seroconversion window period refers to the time from infection to the time when the laboratory is able to detect HIV antibodies
option5: The Oral HIV test demonstrates that there is some risk of transmission from oral secretions.
Correct answer: option4
Specialty: Urology
A sexually active 25-year-old man presents with purulent urethral discharge for 2 days. In the absence of any further evaluation, which of the following is an appropriate treatment?
Answer options: option1: Oral Cefixime stat and Azithromycin stat
option2: Intramuscular Ceftriaxone stat plus oral Doxycycline for 2 days
option3: Intramuscular Gentamycin stat plus oral Azithromycin stat
option4: Intramuscular Ceftriaxone stat
option5: Oral Levofloxacin stat and Erythromycin stat
Correct answer: option1
Specialty: General_Surgery
During an inguinal hernia examination, the swelling was seen below and lateral to the examiners index finger on the pubic tubercle. This finding is consistent with…? 
Answer options: option1: an inguinal hernia
option2: inguinoscrotal hernia
option3: femoral hernia
option4: obturator hernia
option5: n/a
Correct answer: option3
Specialty: Dermatology
A 33-year-old man presents with a painless penile ulcer which has persisted for 5 months. The lesion started as a papule which later ulcerated and has been enlarging. Physical examination reveals a nontender friable ulcer with rolled borders. Which of these is the most likely causative organism?
Answer options: option1: A Gram-positive coccus
option2: A flagellated protozoa
option3: A Gram-negative rod
option4: A Spirochete
option5: A Gram-negative diplococcus
Correct answer: option3
Specialty: Otolaryngology
A 65-year-old man presents with a 3-cm hard mass in the right upper cervical region (Level II). If this is a metastatic lymph node, which of the following is the most likely primary site for the malignancy
Answer options: option1: The oral cavity.
option2: The maxillary sinus
option3: The thyroid
option4: The upper trachea
option5: None of the above.
Correct answer: option1
Specialty: Otolaryngology
You are asked to see a 10-year-old male emergently. He is having
difficulty breathing and swallowing. He has a fever of 38.5 C and is sitting up and leaning slightly forward on the bed when you arrive. You note that there is swelling in the submental and submandibularregions with protrusion of his tongue. You are concerned about a severe infection in the floor of the mouth. Which of the following is true of this condition? 

Answer options: option1: It is an uncommon presentation of mumps of the submandibular gland.
option2: Airway protection may necessitate a tracheostomy
option3: . It is most commonly caused by Staphylococcus aureus.
option4: It usually arises in children as a complication of lymphoma.
option5: The child does not need to be intubated
Correct answer: option2
Specialty: Otolaryngology
A 60-year-old male presents with complaints of dysphagia and a 6-kg weightloss. He states that four weeks ago, he noticed a 2 cm hard mass in the upperneck (Level II on your exam). You see an ulcerated mass in the left pyriform sinus on indirect laryngoscopy. The best next step to confirm the diagnosis should be: 
Answer options: option1: A CT scan of the neck and chest.
option2: A panendoscopy with biopsy of the piriform sinus lesion
option3: A barium swallow.
option4: An open biopsy of the neck mass
option5: Needs a mass USS
Correct answer: option2
Specialty: Neurology
A 70-year-old male had a stroke six months ago. He can chew, but he frequently coughs when he swallowsfood or drinks water. He has had threeepisodes of pneumonia in the past four months. Which cranial nerve or nerves were most likely involved by the stroke
Answer options: option1: Hypoglossal (CN-XII) and glossopharyngeal (CN IX) nerves
option2: Vagus (CN X) and glossopharyngeal (CN IX) nerves
option3: Trigeminal (CN V), sensory branchesto the oral cavity and vagus (CN X)nerves
option4: Facial (CN-VII) and spinal accessory (CN-XI) nerves
option5: None of the above
Correct answer: option2
Specialty: Ophthalmology
3 months old infant with watering lacrimal sac on pressing causes regurgitation of mucopus material. What is the appropriate treatment? 
 

Answer options: option1: Dacryocystorhinostomy
option2: Probing
option3: Probing with syringing
option4: Massage with antibiotics up to age of 6 months
option5: Dacryocystectomy
Correct answer: option4
Specialty: Pathology
 In acute inflammation, which event occurs first
Answer options: option1: aretriolar dilatation
option2: arteriolar constricton
option3: . oedema
option4: leucocyte migration
option5: lood flow stasis
Correct answer: option1
Rationale: In the vascular phase, small blood vessels adjacent to the injury dilate (vasodilatation) and blood flow to the area increases. The endothelial cells initially swell, then contract to increase the space between them, thereby increasing the permeability of the vascular barrier.
Specialty: Otolaryngology
An 18-year-old male presents with a painful 6 cm swelling in the left upper cervical region (Level II), which has enlarged rapidly over the past 24 hours. Hehas a temperature of 39 C. He has trismus and a left-sided sore throat. Which of the following is the most likely diagnosis
Answer options: option1: Retropharyngeal abscess
option2: Acute tonsillitis
option3: Tuberculosis adenitis
option4: Parapharyngeal abscess
option5: None of the above
Correct answer: option4
Specialty: Otolaryngology
A patient has recently undergone parotidectomy for a pleomorphic adenoma. At his postoperative follow-up appointment, he tells you that he is experiencing flushing and sweating at the area surrounding the surgical site when he eats. This is the result of disordered innervation of the sweat glands by: 
Answer options: option1: Branches of the trigeminal nerve (CN V).
option2: The cutaneous nerves of the cervical plexus
option3: Branches of the spinal accessory nerve (CN XI).
option4: Branches of the facial nerve (CN VII).
option5: Branches of the Vagus nerve ( CN X)
Correct answer: option4
Specialty: Otolaryngology
. A 60-year-old man complains of a lump in front of the ear lobe. The lump has been growing gradually for years, and there is now a visiblemass. He does not have any pain or facial weakness. His examinationis otherwise normal. What is the most likely diagnosis? 
Answer options: option1: Adenoid cystic carcinoma
option2: Mucoepidermoid carcinoma
option3: Acinic cell carcinoma
option4: Pleomorphic adenoma
option5: Squamous cell carcinoma
Correct answer: option4
Specialty: Neurosurgery
Metaplasia 
Answer options: option1: can be caused by vit b12 deficiency
option2: preserves mucus secretion in the respiratory tract
option3: is typicaly an irreversible process
option4: is the process that occus in Barrett's oesophagus
option5: Is an increase in the number and size of cells i a tissue
Correct answer: option4
Rationale: Barrett's esophagus is the condition in which metaplastic columnar mucosa that predisposes to cancer development replaces the stratified squamous mucosa that normally lines the distal esophagus.
Specialty: Neurology
A 20-year old male presents in your emergency room with multiple facial lacerations after a motorvehicle collision. There is one particularly deep laceration through the tragus and 4 cm into the parotid gland. You remember to check the facial nerve function and find no motion around the eye or over the forehead. The nasal ala flares on deep breathing and the corner of the mouth appears normal on smiling. What area of the facial nerve is most likely injured? 
Answer options: option1: Main trunk
option2: Inferior division
option3: Superior division
option4: Temporal branch
option5: Zygomatic branch
Correct answer: option3
Specialty: Pediatrics
A 1-year-old female presents with a history of spiking fever from 38.5-39.5 Cfor the past two days. She had an upper respiratory infection one week ago. This morning, the mother noted redness and swelling behind the right ear. Onexamination of the tympanic 
membrane, it is bulging and does not have a light reflex. The most likely diagnosis would be

Answer options: option1: . Acute suppurative otitis media
option2: Acute mastoiditis
option3: Brain abscess complicating acute otitis media
option4: Sigmoid sinus thrombosis
option5: None of the above
Correct answer: option2
Specialty: Ophthalmology
A 30 years old male presents with a history of injury to the eye with a leaf 5 days ago and pain, photophobia and redness of the eye for 2 days. What would be the most likely pathology? 

Answer options: option1: Anterior uveitis
option2: Conjunctivitis
option3: Fungal corneal ulcer
option4: Corneal laceration
option5: n/a
Correct answer: option3
Specialty: Infectious_Disease
A 45-year-old man with insulin-dependent diabetes mellitus and rheumatoid arthritis treated with methotrexate is seen in the outpatient clinic after he tried to remove some cerumen (wax) from his ear at home. He has erythema and swelling of the ear canal anddescribes severe ear pain. You are concerned about malignant otitis externa. Which bacteria is most likely to cause this presentation? 
Answer options: option1: Pseudomonas aeruginosa.
option2: Staphylococcus aureus
option3: The infection is most likely to be multibacterial.
option4: Streptococcus pyogenes.
option5: . E Coli
Correct answer: option1
Specialty: Pathology
All of the following are features of apoptosis except
Answer options: option1: cell swelling
option2: chromatin condensation
option3: lack of inflammation
option4: phagocytosis of apoptotic bodies
option5: formation of cytoplasmic bodies
Correct answer: option1
Rationale: Apoptosis is characterised by a series of typical morphological events, such as shrinkage of the cell, fragmentation into membrane-bound apoptotic bodies and rapid phagocytosis by neighbouring cells . Internucleosomal fragmentation of genomic DNA has been the biochemical hallmark of apoptosis for many years