afrimedqa/afrimedqa_v2 huggingface dataset:
Specialty: Neurology
A 35-year-old man presents for evaluation of muscle weakness. He was well until 3 days ago, when he started developing progressive weakness in his arms and legs. On the morning of presentation, he had significant difficulty walking and presented to the emergency department. He reports an episode of severe diarrhea 4 weeks ago and denies associated pain. Examination reveals normal facial strength; quadriparesis with 3/5 strength in proximal upper and lower extremities and 0/5 strength in bilateral ankle dorsiflexion, plantarflexion, inversion and eversion; intact sensory function; and generalized areflexia. Nerve conduction studies demonstrate reduced distal motor amplitudes, but no evidence of conduction block. Sensory conduction studies are normal. What is the most likely diagnosis?
Answer options: option1: Aute inflammatory demyelinating polyneuropathy (AIDP)
option2: Acute motor axonal neuropathy (AMAN)
option3: Acute motor-sensory axonal neuropathy (AMSAN)
option4: Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP)
option5: NONE OF THE ABOVE
Correct answer: option2
Specialty: Neurology
A 45-year-old man with diabetes mellitus is evaluated for abrupt-onset headache and double vision. Examination shows left ptosis and lateral and downward deviation of the left eye. The left pupil is dilated and its constriction to light is impaired. When the left eye is abducted, attempts to look down fail to elicit intorsion of the globe. Which of the following is the most likely diagnosis?
Answer options: option1: Anterior midbrain infarction
option2: Cavernous sinus aneurysm
option3: Expanding posterior communicating artery aneurysm
option4: Ischemic oculomotor neuropathy
option5: NONE OF THE ABOVE
Correct answer: option2
Specialty: Pediatrics
Write short notes herd immunity in the control of vaccine-preventable diseases
Rationale: Immunisation prevents an infection either by direct protection of successfully immunized individuals or indirectly by reducing the population of susceptible individuals who can contract and thereafter pass on the infection. 

A key concept relating to herd immunity is the basic reproductive rate of an infection (RO). This represents the average number of secondary cases produced by one primary case in a wholly susceptible population. For an infection to sustain itself, the average number of secondary cases must be greater than 1. The average number of secondary cases depends on the biology of the organism, but also on the number of contacts an infectious individual has with susceptible individuals. The number of susceptible contacts depends in turn on the population density of individuals susceptible to the infection (and complex social and behavioural variables).

Immunization reduces the density of the susceptible population, thereby reducing the number of secondary cases per primary case. There is a critical proportion of immune individuals above which the number of secondary cases per primary case will fall below 1, and the infection will be eradicated. This critical proportion depends on the type of infection. For example, in a homogeneously mixed population, measles with RO of 15-17 has a critical proportion above 90% whereas polio, with RO of 5-6, has a critical proportion of 80-85%. Higher immunisation coverage is thus required to eradicate measles from a population than to eradicate polio.
Specialty: Pediatrics
Discuss the benefits of kangaroo mother care.
Rationale: Kangaroo care is defined as skin-to-skin contact between a mother and her low birth weight infant in a hospital setting.

Benefits:
•	Breast feeding
•	Prolonged
•	Breast milk production more stable
•	Increased feeds per day
•	Physiologic stability
•	Stable skin and core temperature
•	Heart rate stable
•	Improved oxygen saturation and consumption
•	Improved quiet sleep
•	Maternal confidence and bonding
•	Infection possibly decreased
•	Cost savings
Specialty: Neurology
Your patient complains that he cannot tell the difference between hot or cold water when he washes his hands, and he also notes that both upper limbs tire easily. You note that the thenar eminences of both hands of the patient appear wasted. You suspect that the patient has
Answer options: option1: Amyotrophic lateral sclerosis
option2: Tabes dorsalis
option3: Poliomyelitis
option4: Syringomyelia
option5: NONE OF THE ABOVE
Correct answer: option4
Specialty: Pediatrics
What are the factors affecting maternal-to-child transmission of HIV infection
Rationale: i)	Feeding practices- exclusive bottle or breast feeding, mixed feeding
ii)	Use of antiretroviral medications: ACTG 076 TRIAL, Petra, Thai and nevarapine regime
iii)	Concurrent maternal infections ie stds and IUI
iv)	Mode of delivery caesarian section as compared to normal vaginal deliveries
v)	Multivitamins and Vitamin A use – controversial
vi)	Douching not beneficial
vii)	Minimising invasive procedures
viii)	Sexual practices and partners during pregnancy
ix)	Avoid pregnancy because accelerates HIV disease
x)	Use of Antiretrovirals in newborns babies
xi)	Avoid blood products as far as possible
Specialty: Pediatrics

Cerebral palsy Patient with Weight for Height <-3 SD, with no edema: what is the diagnosis and how can you manage him 
Rationale: Anticipate 2 problems in this patient and where we are you going to refer them
(1)	Contractures and other deformities that need Physiotherapists and occupational therapists 
(2)	Kyphoscoliosis and dislocation of bones that require Orthopaedical surgeons
(3)	Myopia, squint that requires Ophthalmologists
(4)	Sensorineural deafness and problems in language comprehension that require Speech therapists
Specialty: Neurology
A 44-year-old man is seen in the emergency department with several days of progressive quadriparesis. His neurologic history is notable for vision loss in the right eye 5 years ago, for which he did not seek any medical attention. His examination shows 20/400 vision in the right eye with associated right optic disc pallor and a right afferent pupillary defect; 3/5 power in both arms; paralysis of both legs; and bilateral extensor plantar responses. MRI of the brain shows minimal nonspecific T 2/fluid-attenuated inversion recovery (FLAIR) white matter hyperintensities not located in periventricular or juxtacortical locations. Which of the following is the most likely diagnosis?
Answer options: option1: Acute disseminated encephalomyelitis (ADEM)
option2: Multiple sclerosis
option3: Neuromyelitis optica (NMO
option4: Progressive multifocal leukoencephalopathy
option5: NONE OF THE ABOVE
Correct answer: option3
Specialty: Pediatrics
Clinical Signs of Shock
Rationale: COMPENSATED: Vital organ function viz brain and heart is conserved by sympathetic reflexes which increase systemic arterial resistance, divert blood away from non-essential tissues, constrict the venous reservoir and increase the heart rate to maintain cardiac output)
(the systolic BP remains normal whereas the diastolic pressure may be elevated due to increased systemic arterial resistance

-mild agitation
-confusion
-skin pallor
increased heart rate
cold peripheral skin
decreased capillary return


UNCOMPENSATED: compensatory mechanisms start to fail and the circulatory system is no longer efficient
-falling blood pressure
-very slow capillary return
-tachycardia
cold peripheries
-acidotic respiration
-depressed cerebral state
absent urinary output


IRREVERSIBLE SHOCK: a retrospective diagnosis
(damage to key organs viz heart and brain is of such magnitude that death occurs despite adequate restoration of the circulation.
Specialty: Gastroenterology
A 68 yr old woman presented with persistent dysphagia to both solid and liquid, no regurgitation. There is history of use of bisphosphonates. What is the likely diagnosis?
Answer options: option1: Achalasia
option2: Benign oesophageal stricture
option3: Oesophageal ca
option4: Diffuse oesophageal spasm
option5: NONE OF THE ABOVE
Correct answer: option2
Specialty: Gastroenterology
A middle-aged man presented with history and physical examination finding in 
keeping with biliary obstruction. Which of the LFT parameters depicts obstruction?

Answer options: option1: Increased ALP and GGT
option2: Increased ALT
option3: Increased AST
option4: Low bilirubin and albumin
option5: NONE OF THE ABOVE
Correct answer: option1
Specialty: Gastroenterology
46 yr old woman presented with RUQ pain , associated yellowness of the eyes and fever.
Murphy sign was positive. What is the diagnosis?

Answer options: option1: Biliary colic
option2: Choledocholithiasis
option3: Acute cholecystitis
option4: Acute pancreatitis
option5: NONE OF THE ABOVE
Correct answer: option3
Specialty: Gastroenterology
41 yr old presented with recurrent right upper quadrant paint radiating to right shoulder, 
       usually worsened by heavy meal, no fever.
What is the diagnosis?

Answer options: option1: Acute cholecystitis
option2: Biliary colic
option3: Acute pancreatitis
option4: Myocardial infarction
option5: NONE OF THE ABOVE
Correct answer: option2
Specialty: Gastroenterology
Which of the following is true about coeliac disease?
Answer options: option1: Patient is placed on glutein diet prior to diagnostic investigation
option2: Glutein diet is reintroduced 6 weeks prior to diagnostic investigation
option3: Glutein diet is reintroduced 2 weeks prior to diagnostic investigation
option4: Treatment is with antibiotics
option5: NONE OF THE ABOVE
Correct answer: option2
Specialty: Gastroenterology
A 40 yr old man known chronic alcoholic presented to the emergency with complaints vomiting containing blood after binge of alcohol. What is the likely diagnosis?
Answer options: option1: Liver cirrhosis
option2: Oesophageal varices
option3: Mallory-Weiss
option4: Gastric cancer
option5: NONE OF THE ABOVE
Correct answer: option3
Specialty: Gastroenterology
A 35 yr old presented with abdominal pain , diarrhea, weakness , bloating. Transglutaminase test was positive. What is the likely diagnosis?
Answer options: option1: IBS
option2: Crohns disease
option3: Ulcerative colitis
option4: Coeliac disease
option5: NONE OF THE ABOVE
Correct answer: option4
Specialty: Pediatrics
Write short notes on immune reconstitution inflammatory syndrome
Rationale: Immune reconstitution inflammatory syndrome (IRIS) is defined as: paradoxical clinical deterioration after starting HAART, resulting from improving immune system interaction with organisms that have colonised the body during the early stages of HIV infection.

A wide range of pathogens causes IRIS. These include Mycobacterium tuberculosis (MTB), Mycobacterium avium complex, Cryptococcus neoformans, Aspergill, Candida albicans, Pneumocystis carini, CMV, human herpes viruses, and hepatitis B. 

IRIS usually presents within 6 weeks of starting HAART. Clinical presentations vary and depend on the causative organism and the organ system that is colonised. For example, IRIS caused by MTB may present with high fever, lymphadenopathy, worsening of the original TB lesion, and/or deteriorating chest radiographic manifestations, including the development of a military pattern or pleural effusion.

Managing IRIS includes specific antimicrobial therapy (e.g. TB treatment for IRIS caused by MTB). In severe reactions, glucocorticosteroids and/or temporarily discontinuing HAART may help.
Specialty: Gastroenterology
A patient has intermittent dysphagia usually precipitated by cold. Barium meal shows corkscrew pattern. What is the diagnosis

Answer options: option1: Diffuse oesophageal spasm
option2: Achalasia
option3: Scleroderma
option4: Oesophageal Ca
option5: NONE OF THE ABOVE
Correct answer: option1
Specialty: Gastroenterology
25 yr old presents with lethargy and increased skin pigmentation. Investigation requested revealed deranged LFT and impaired glucose tolerance. Given likely diagnosis of haemochromatosis. What is the most appropriate initial investigation?
Answer options: option1: Transferrin saturation +ferritin
option2: Hemoprotein +ferritin
option3: Liver biopsy with pearl stain
option4: Serum iron +haematocrit
option5: NONE OF THE ABOVE
Correct answer: option1
Specialty: Rheumatology
A 25-year-old female gives birth to a baby with complete heart block who subsequently requires pacemaker insertion. Which of the following antibodies is implicated in the pathogenesis? 


Answer options: option1: Anti-double-stranded deoxyribonucleic acid (dsDNA) antibodies
option2: Anti-endomysial antibodies
option3: Anti-SCL70 antibodies
option4: Anti-Ro/SSA antibodies
option5: n/a
Correct answer: option4
Specialty: Rheumatology
A 46-year-old woman was diagnosed to have systemic sclerosis. The pathophysiologic mechanisms in this condition include except one

Answer options: option1: Vasculopathy
option2: Human leukocyte antigen (HLA) B27
option3: Cellular auto-immunity
option4: Humoral auto- immuinity
option5: n/a
Correct answer: option2
Specialty: Gastroenterology
A 40 yr old male presented with history of fever, vomiting, and yellowness of the eyes. Chest Xray showed elevation of right hemidiaphragm. What is the diagnosis?
Answer options: option1: Amoebic Liver abscess
option2: Liver cirrhosis
option3: Polycystic kidney disease
option4: Acute malaria
option5: NONE OF THE ABOVE
Correct answer: option1
Specialty: Gastroenterology
A 54 yr old man has been having dyspeptic symptoms for 6 months, Upper Gi endoscopy was done which showed multiple in the stomach and duodenum. Serum gastrin was done and it was elevated. What is the diagnosis?
Answer options: option1: Pancreatic cancer
option2: Gastric cancer
option3: Zollinger-Ellison Syndrome
option4: Achalasia
option5: NONE OF THE ABOVE
Correct answer: option3
Specialty: Pediatrics
4 weeks old male presented with projectile non-bilious vomiting for 2 days. A diagnosis of Duodenal atresia was made. What is the management? 


Rationale: 1. Supportive Management: Administer IV fluids, prepare the child for surgery
2. Definitive Management: Treated surgically through duodenoduodenostomy; a new connection between the upper duodenum and distal duodenum is created to bypass the blockage
Specialty: Neurology
A 75-year-old hypertensive woman presents with whirling vertigo, nausea, and weakness on the right side of her body. On exam she has nystagmus, left facial sensory loss, and right arm and leg weakness. What is the most likely diagnosis?
Answer options: option1: Internal carotid artery
option2: Middle cerebral artery
option3: Midbasilar artery
option4: Anterior cerebral artery
option5: Penetrating branch, middle cerebral artery
Correct answer: option3
Specialty: Neurology
An elderly man has noticed three episodes of visual loss in his right eye. The vision in that eye goes black “like somebody pulling down a window shade.” The symptom lasts 20 to 30 min and resolves promptly. Between episodes he feels well. What is the likely diagnosis?

Answer options: option1: Internal carotid artery
option2: Middle cerebral artery
option3: Midbasilar artery
option4: Anterior cerebral artery
option5: Penetrating branch, middle cerebral artery
Correct answer: option1
Rationale: N//A
Specialty: Pediatrics
Differences between Caput succedaneum, Subgaleal hemorrhages and Cephalohematoma 
Rationale: a.	Caput succedaneum
i.	 It is diffuse subcutaneous fluid collection with poorly defined margin often crossing the suture lines caused by pressure on the presenting part of the head during delivery. 
ii.	It does not usually cause complications and resolves over the first few days

b.	Subgaleal hemorrhages
i.	It occurs between the scalp and the periosteum and form a large, fluctuant collection which crosses suture lines.
ii.	They are rare but may cause life-threatening blood loss

c.	Cephalohematoma
i.	It is a sub-periosteal hemorrhage which occurs in 1-2% of infants and may increase in size after birth.
ii.	The hemorrhage is bound to periosteum, the swelling does not cross the suture line in contrast to a caput succedaneum
iii.	More common with instrumental delivery and may cause jaundice
Specialty: Neurology
An 82-year-old woman complains of worsening headaches and episodes of transient visual loss and diplopia. When she chews, her jaw muscles ache until she stops chewing. Exam reveals a tender nodular right temporal artery. She has a mild normocytic anemia; sedimentation rate is 95.
What is the likely diagnosis?


Answer options: option1: Temporal arteritis
option2: Brain tumor
option3: Sinusitis
option4: Temporomandibular joint dysfunction
option5: Tic doloureux
Correct answer: option1
Specialty: Neurology
A 33-year-old man complains of episodes of severe unilateral headache. The pain is localized to one cheekbone and is described as “like an icepick.” Each headache lasts 30 to 60 min but may recur several times a day; walking around helps the pain somewhat. He notices lacrimation of the eye on the affected side, usually associated with clear rhinorrhea. What is the likely diagnosis?

Answer options: option1: Cluster headache
option2: Migraine headache
option3: Temporal arteritis
option4: Brain tumor
option5: Sinusitis
Correct answer: option1
Specialty: Neurology
A 42-year-old executive complains of a bandlike tightness across the temples and neck, worse in the afternoon, usually relieved by aspirin or acetaminophen. Neurological exam is normal. What is the likely diagnosis?

Answer options: option1: Tension headache
option2: Cluster headache
option3: Migraine headache
option4: Temporal arteritis
option5: Brain tumour
Correct answer: option1
Specialty: Neurology
A 50-year-old presents with rapidly progressive change in mental status over 3 months. Numerous myoclonic jerks accompany the dementia; the EEG shows repetitive high-voltage polyphasic discharges. What is the likely diagnosis?
Answer options: option1: Multi-infarct dementia
option2: Vitamin B12 deficiency
option3: Dementia with Lewy bodies
option4: Creutzfeldt-Jakob disease
option5: Normal pressure hydrocephalus
Correct answer: option4
Specialty: Rheumatology
The most sensitive clinical feature differentiating CREST and systemic sclerosis with more extensive involvement in a young female presenting with severe Raynaud’s disease is

Answer options: option1: Facial telangiectasia
option2: Tightness of skin of the chest
option3: Autoamputation of digits
option4: Nailfold capillary changes of systemic sclerosis pattern
option5: n/a
Correct answer: option4
Specialty: Neurology
A 70-year-old male with history of hypertension and diabetes presents with a stepwise loss of intellectual function. Prior episodes have been associated with unilateral weakness and difficulty swallowing. A unilateral Babinski sign is found on neurological exam. What is the likely diagnosis?
Answer options: option1: Senile dementia of the Alzheimer’s type
option2: Multi-infarct dementia
option3: Vitamin B12 deficiency
option4: Dementia with Lewy bodies
option5: Normal pressure hydrocephalus
Correct answer: option2
Specialty: Neurology
An 80-year-old develops steady, progressive memory and cognitive deficit over 2 years. He has normal blood pressure and no focal neurologic findings, and workup for “treatable” causes of dementia is negative. What is the likely diagnosis?
Answer options: option1: Senile dementia of the Alzheimer’s type
option2: Multi-infarct dementia
option3: Vitamin B12 deficiency
option4: Dementia with Lewy bodies
option5: Creutzfeldt-Jakob disease
Correct answer: option1
Specialty: Neurology
A 37-year-old man is brought to the doctor by his family because of a rapid intellectual decline over the past 2 months. Exam reveals slow writhing movements with dystonic posturing. His father died of a similar illness. What is the likely diagnosis?

Answer options: option1: Parkinson’s disease
option2: Wilson’s disease
option3: Huntington’s disease
option4: Dystonia
option5: Tic
Correct answer: option3
Specialty: Neurology
An elderly woman notes a tremor associated with slowness of movements and a feeling of gait instability over the past 6 months. The tremor is a slow (3 per second) resting tremor that does not interfere with fine movements. What is the likely diagnosis?
Answer options: option1: Parkinson’s disease
option2: Huntington’s disease
option3: Dystonia
option4: Essential tremor
option5: Tic
Correct answer: option1
Specialty: Neurology
An 18-year-old male who is admitted to the hospital because of psychotic behavior is found to have a proximal “wing-beating” tremor, dystonia, and incoordination. Serum transaminases are moderately elevated, brownish corneal deposits are noted on slit-lamp exam. What is the likely diagnosis? 

Answer options: option1: Parkinson’s disease
option2: Wilson’s disease
option3: Huntington’s disease
option4: Dystonia
option5: Essential tremor
Correct answer: option2
Specialty: Neurology
A 37-year-old factory worker develops increasing weakness in the legs; coworkers have noted episodes of transient confusion. The patient has bilateral foot drop and atrophy; mild wrist weakness is also present. His CBC shows an anemia with a hemoglobin of 9.6 g/dL ; examination of the peripheral blood smear shows basophilic stippling. Which of the following is the most likely cause of this patient’s symptoms?
Answer options: option1: Amyotrophic lateral sclerosis
option2: Lead poisoning
option3: Overuse syndrome
option4: Myasthenia gravis
option5: Porphyria
Correct answer: option2
Specialty: Neurology
A 72-year-old woman is found unconscious at home by her daughter. In the emergency room the patient does not respond to verbal or noxious stimuli. Which of the following is the most likely cause of her condition?
Answer options: option1: Hypoglycemia
option2: Left posterior cerebral artery occlusion
option3: Lacunar infarct in the right internal capsule
option4: Middle cerebral artery occlusion
option5: Anterior cerebral artery occlusion
Correct answer: option1
Specialty: Neurology
A 60-year-old man with Parkinson’s disease is receiving levodopa/carbidopa therapy and complains of uncontrollable facial movements. Which of the following is correct?
Answer options: option1: Limb and facial dyskinesias are unusual side effects of chronic levodopa therapy
option2: Levodopa treatment, while ameliorating symptoms, does not alter the natural history of the disease
option3: Bromocriptine works by increasing the release of dopamine from the substantia nigra
option4: Trihexyphenidyl and benztropine mesylate have minimal side effects in the elderly
option5: Parkinson’s disease is curable
Correct answer: option2
Specialty: Neurology
A 40-year-old woman complains of headache associated with visual disturbance. Which of the following histories suggests migraine headache as a likely diagnosis?
Answer options: option1: Numbness or tingling of the left face, lips, and hand lasting for 5 to 15 min, followed by throbbing headache
option2: An increasingly throbbing headache associated with unilateral visual loss and generalized muscle aches
option3: A continuous headache associated with sleepiness, nausea, ataxia, and incoordination of the right upper limb
option4: An intense left retroorbital headache associated with transient left-sided ptosis and rhinorrhea
option5: A visual field defect that persists following cessation of a unilateral headache
Correct answer: option1
Specialty: Neurology
A 55-year-old diabetic woman suddenly develops weakness of the left side of her face as well as of her right arm and leg. She also has diplopia on left lateral gaze. The responsible lesion is probably located in which of the following?

Answer options: option1: Right cerebral hemisphere
option2: Left cerebral hemisphere
option3: Right side of the brainstem
option4: Left side of the brainstem
option5: Right median longitudinal fasciculus
Correct answer: option4