afrimedqa/afrimedqa_v2 huggingface dataset:
Specialty: General_Surgery
Which of the following is NOT true of a normal-sized spleen?
Answer options: option1: It is 7 to 11 cm in length
option2: It weighs between 70 and 250 g
option3: It is palpable about 1 cm below the left costal margin
option4: It is the size of the patient's clenched fist
option5: All of the above
Correct answer: option3
Specialty: Rheumatology
A 45-year-old man has sudden swelling of his right knee which is tender to touch. Joint aspiration reveals weakly positive birefringent crystals of calcium pyrophosphate. What is the most likely diagnosis?
Answer options: option1: Septic arthritis
option2: Gout
option3: Osteoarthritis
option4: Pseudogout
option5: Reiter’s disease
Correct answer: option4
Specialty: General_Surgery
. Elective splenectomy is planned but there is a concern about thedevelopment of post-splenectomy sepsis. What is generally considered the best time for immunization for this patient? 
Answer options: option1: . On the way to the operating room
option2: The day after surgery
option3: One month after surgery
option4: 2 weeks before surgery
option5: 3 Months before surgery
Correct answer: option4
Specialty: Rheumatology
Which of the following is not considered in the diagnostic criteria for rheumatoid arthritis according to the EULAR/ACR criteria?
Answer options: option1: Joint involvement
option2: Radiological evidence of joint erosion
option3: Positive rheumatoid factor and/or anti-CCP
option4: Elevated CRP and/or ESR
option5: Patient self-reporting of duration of signs and symptoms
Correct answer: option2
Specialty: Hematology
Chronic Myeloid Leukaemia is characterised by 

Answer options: option1: Splenomegaly
option2: Marked leukocytosis
option3: Basophilia
option4: Myelocyte bulge
option5: all of the above
Correct answer: option5
Rationale: CML is a form of leukemia characterized by the increased and unregulated growth of myeloid cells in the bone marrow and the accumulation of these cells in the blood. 
Chronic Myeloid Leukaemia is characterised by Splenomegaly, Marked leukocytosis, Basophilia, Myelocyte bulge
Specialty: General_Surgery
A 23-year old woman undergoes splenectomy following trauma. On postoperative day four, she developstachycardia and peritonitis, andshe has dark, bloody output from the nasogastric tube. What is the complication of greatest concern? 
Answer options: option1: Gastric necrosis with perforation
option2: Unrecognized esophageal varices
option3: Overwhelming post-splenectomy infection (OPSI)
option4: Missed enterotomy
option5: Bleeding gastric veins
Correct answer: option1
Specialty: Pulmonary_Medicine
In the treatment of patients with COVID-19, which statement is TRUE?
Answer options: option1: At least 25% of patients in the Kenyan set-up have critical disease
option2: Patients with mild COVID-19 disease should be put on anticoagulation
option3: All patients who test positive for COVID-19 should be on antibiotics
option4: Prone positioning has minimal role in the management of hospitalized COVID-19 patients
option5: Dexamethasone is only beneficial in patients requiring oxygen therapy
Correct answer: option5
Specialty: General_Surgery
You are performing a splenectomy on a patient with hypersplenism. Thrombocytopenia is the major problem with this patient. Special attention to which technical aspect of the procedure is advised? 
Answer options: option1: Ligation of the splenic artery before the vein
option2: Division of the short gastric vessels before approach to the hilum
option3: Medial visceral rotation of the entire spleen, pancreas and leftcolon.
option4: Minimal touching or manipulation of the spleen
option5: Ligation of the splenic vein before the artery
Correct answer: option1
Specialty: Pulmonary_Medicine
Regarding the transmission of COVID-19, choose the FALSE statement:
Answer options: option1: The incubation period can be as short as 2 days
option2: The virus is mainly spread by droplets
option3: Airborne transmission in the community is common
option4: Droplet transmission occurs when a person is in close contact (usually < 1 metre)
option5: Faecal-oral transmission is not a recognized mode of transmission
Correct answer: option3
Specialty: General_Surgery
A 35-year old man presents with recurrent hypersplenism 6 years after having undergone splenectomy for idiopathic thrombocytopenicpurpura. You suspect an accessory spleen. The most likely location forthis is: 
Answer options: option1: Within the greater omentum
option2: At remnant of the vascular pedicle of the spleen that was removed
option3: Within the tail of the pancreas
option4: Within the gastrocolic ligament
option5: None of the above
Correct answer: option2
Specialty: Pulmonary_Medicine
Regarding the investigations for COVID-19, which statement is FALSE?
Answer options: option1: Both the nasopharyngeal swab and the oropharyngeal swab are placed together in the same tube.
option2: The virus has been recovered in stool specimens
option3: Bronchoalveolar lavage has a greater sensitivity compared to the nasopharyngeal swab.
option4: Serological testing is more reliable in identifying those with active disease
option5: The viral transport media has both an antibiotic and an antifungal agent
Correct answer: option4
Specialty: General_Surgery
A 25-year old male underwent percutaneous drainage of a periappendiceal abscess. If interval appendectomy is to be performed, at which of the following times post-admission should it be performed? 
Answer options: option1: 1 week
option2: 2 weeks
option3: 3 months
option4: 1 year
option5: Never
Correct answer: option3
Specialty: Hematology
The least number of bone marrow blast cells required to diagnose acute leukemia is 

Answer options: option1: Blast cells greater than 30%
option2: Blast cels greater than or equal to 20%
option3: Normoblast greater than 60%
option4: Absence of normoblasts
option5: Blast cells greater than 60%
Correct answer: option2
Rationale: The most immature cells are called myeloblasts (or blasts). The percentage of blasts in the bone marrow or blood is particularly important. Having at least 20% blasts in the marrow or blood is generally required for a diagnosis of AML
Specialty: Gastroenterology
A 50-year-old man known to have esophageal varices presents after a bout of massive haematemesis that day. He is pale, with a blood pressure of 80/52 mmHg and a pulse rate of 120/min. Which one of these statements is NOT TRUE?
Answer options: option1: Terlipressin lowers portal pressure and lowers mortality in the setting of acute variceal bleeding.
option2: Antibiotics should be administered.
option3: The immediate priority is to undertake an upper GI endoscopy to control the bleeding.
option4: Proton pump inhibitors are indicated
option5: With optimal management his risk of mortality from this admission would be below 40%
Correct answer: option3
Specialty: General_Surgery
A patient presents with a 5-cm appendiceal abscess identified onultrasound. Which of the following would be the best course of management? 
Answer options: option1: . Open appendectomy and washout
option2: Laparoscopic appendectomy and washout
option3: Non operative management with IV antibiotics
option4: Percutaneous drainage under ultrasound guidance
option5: All of the above
Correct answer: option4
Specialty: General_Surgery
A 42 years old patient presents with a 5-cm appendiceal phlegmon identified onultrasound. Which of the following would be the best course of management?
Answer options: option1: Open appendectomy and washout
option2: . Laparoscopic appendectomy and washout
option3: Non operative management with IV antibiotics
option4: Percutaneous drainage under ultrasound guidance
option5: None of the above
Correct answer: option3
Specialty: Gastroenterology
A 55-year-old diabetic lady presents with right upper quadrant pain for the past 2 days. She has had shorter episodes of similar pain on and off over the preceding 2 years. On examination she is febrile, has jaundice and right upper quadrant tenderness. What is the most likely diagnosis?
Answer options: option1: Biliary Colic
option2: Acute Cholangitis
option3: Choledocholithiasis
option4: Acute Pancreatitis
option5: Acute Cholecystitis
Correct answer: option2
Specialty: General_Surgery
A 74-year old male is referred to your hospital with a diagnosis of "appendicitis" listed in a note from the referring hospital. He has pain and tenderness in the right abdomen. He has vomited several times over the course of the past 2 days. He has a temperature of 37.5°C. His family states that he has lost some weight over the past few weeks; they don't think he's been eating as well asusual. He is tender on physical examination but without rebound or guarding. His white blood cellcount is normal. What is the next best step in your management? 
Answer options: option1: Admit the patient for antibiotics and serial abdominal exams.
option2: Proceed with CT.
option3: Proceed with colonoscopy.
option4: Proceed to the operating room for appendectomy
option5: Proceed with ultrasound to rule out appendicitis.
Correct answer: option2
Specialty: Internal_Medicine
describe the drug management of TB meningitis in malawi 


Rationale: a. Rifampicin 
b. Isoniazid 
c. Pyrizinamide 
d. Streptomycin for 2 months, then RH for 7 months 
e. Prednisolone 40mg od to prevent neurological sequale and cranial nerve palsies
Specialty: Hematology
Pancytopenia can result from:

Answer options: option1: Systemic lupus erythematosus
option2: Hairy cell Leukaemia
option3: paroxysmal nocturnal hemoglobinuria
option4: Hypersplenism
option5: all of the above
Correct answer: option5
Rationale: Pancytopenia may be caused by certain autoimmune, bone marrow, or genetic disorders. It may also be caused by infection, poor nutrition, pregnancy, cancer treatment (such as chemotherapy or radiation therapy), or exposure to certain toxins, chemicals, or medicines.
Specialty: General_Surgery
What is the next best step in your management? 
Answer options: option1: . Proceed with ultrasound to rule out appendicitis.
option2: Proceed with CT to rule out appendicitis.
option3: Proceed to the operating room for appendectomy.
option4: Admit the patient for antibiotics and serial abdominal exams
option5: Proceed with an MRI to be sure of his diagnosis
Correct answer: option3
Specialty: Gastroenterology
A 23-year old female presents to the emergency department with pain and tenderness in the right iliac fossa that has moved there over the past 24 hours. She has no nausea or vomiting though shestates that she has no appetite. Her temperature is 36.9°C. The pain does not increase when you release pressure when palpating the right lower quadrant. Her white blood cell count is 13 x 109 cells/L and neutrophils make up 60% of the white blood cells. How would you calculate her likelihood of appendicitis based on these clinical parameters? 
Answer options: option1: The patient has a low likelihood of appendicitis
option2: The patient has a moderate likelihood of appendicitis and further imaging should be considered.
option3: The patient has a high likelihood of appendicitis.
option4: He has an Alvarado score of 8 hence he needs an urgent operation
option5: He has an Alvarado score of 8 hence he needs an urgent operation
Correct answer: option2
Specialty: Internal_Medicine
Mention six causes of atrial fibrillation 

Rationale: a. Hypertension 
b. Chest infections 
c. Alcohol 
d. Hyperthyroidism 
e. Myocardial infarction 
f. Electrolyte imbalance LOW potassium (K) AND magnesium (Mg) 
g. Drugs e.g. cocaine
Specialty: Hematology
Monocytosis can be observed in 

Answer options: option1: Tuberculosis
option2: Malaria
option3: Chronic Myelomonocytic Leuckemia
option4: none of the above
option5: all of the above
Correct answer: option5
Rationale: Monocytosis happens when your monocyte count is too high. Monocytosis is often linked to infectious diseases and autoimmune diseases including malaria, tuberculosis and CML.
Specialty: Hematology
A patient has the following features on her blood count: Hb 10.5 g/dl, MCV 112 fl. Which of the following is LEAST likely to be associated with these features?

Answer options: option1: Chronic liver disease
option2: Hemolysis
option3: Vitamin B12 deficiency
option4: Zidovudine
option5: Hyperthyroidism
Correct answer: option5
Specialty: General_Surgery
Regarding imaging findings of appendicitis, each of the 
following is true EXCEPT: 

Answer options: option1: A non-compressible appendix on ultrasound is concerning for appendicitis
option2: An appendiceal diameter ≥ 6mm on CT scan is concerning for appendicitis.
option3: Plain abdominal radiographs are an important imaging tool in   appendicitis as appendicoliths can frequently be seen and are  diagnostic for appendicitis.
option4: MRI is often used to help diagnose appendicitis in  pregnant women andchildren because of its lack of  radiation.
option5: A and B
Correct answer: option3
Specialty: Internal_Medicine
What are the drug groups that improve mortality-beta-blockers and angiotensin inhibitors

Mention six physical examination findings one would note in a patient that presents with cardiac tamponade 

Rationale: a. Muffled heart sounds 
b. Raised JVP 
c. Hypotension 
d. Tachycardia 
e. Kussmaul’s sign (rise in JVP on inspiration) 
f. Pulsus paradoxus (systolic BP drop more than 10mmHg on inspiration)
Specialty: Neurology
Which of the following statements regarding epilepsy is INCORRECT?
Answer options: option1: The incidence of suicide is higher in epileptic patients than it is in the general population.
option2: Mortality is no different in patients with epilepsy than it is in age-matched controls.
option3: A majority of patients with epilepsy that are completely controlled with medication eventually will be able to discontinue therapy and remain seizure-free.
option4: Surgery for mesial temporal lobe epilepsy (MTLE) decreases the number of seizures in over 70% of patients.
option5: Tricyclic antidepressants lower the seizure threshold and may precipitate seizure
Correct answer: option2
Specialty: Internal_Medicine
76-Year-old man with shortness of breath and at rest for 3 weeks. Smoker with 24 Pack Years heavy alcohol. On exam tachypneic Respiratory Rate 34, Pulse rate 102 BP 112/89. 
a) 4 Possible causes of the condition 
-
Rationale: 1. pulmonary TB 
2. Lung cancer 
3. bronchitis 
4. heart failure
Specialty: Pathology
Eosinophilia is not present in:

Answer options: option1: Allergic Disease
option2: Myxedema
option3: Hodgkin Disease
option4: Drug Sensitivities
option5: Myeloproliferative Diseases
Correct answer: option2
Rationale: Eosinophils are a type of white blood cell that play an important role in the body's response to allergic reactions, asthma, and infection with parasites. Myxedema is a condition of severe hypothyroidism not related to increased eosinophil count.
Specialty: Gastroenterology
Which of the following is true of hyperplastic polyps of the appendix? 
Answer options: option1: They may present as appendicitis.
option2: If a hyperplastic polyp is removed entirely by appendectomy,  thereis no need for colonoscopy.
option3: They may or may not have dysplastic changes.
option4: They are non-neoplastic lesions
option5: None of the above
Correct answer: option1
Specialty: Neurology
A 60 year old woman presents with slurred speech and weakness involving the left side of the body. There is facial drooping to the opposite side of the body. On examination, tone on the affected side is increased with brisk reflexes. What is the likely arterial territory for this presentation?
Answer options: option1: Left middle cerebral artery stroke
option2: Right middle cerebral artery stroke
option3: Left anterior cerebral artery stroke
option4: Right anterior cerebral artery stroke
option5: Right middle cerebellar artery stroke
Correct answer: option2
Specialty: General_Surgery
Which of the following seems to be true of appendicitis 
in sub-Saharan Africa? 

Answer options: option1: Complicated appendicitis is less frequent than in Western countries.
option2: A majority of patients present with the classic symptoms of vague periumbilical pain the migrates to the right lower quadrant with anorexia followed by nausea and vomiting
option3: Patients have a shorter duration of symptoms than in  Westerncountries.
option4: Right iliac fossa pain is the most common symptom
option5: Appendicitis is not common in sub Saharan Africa
Correct answer: option4
Specialty: Internal_Medicine
27 yr woman presents with a three-month history of palpitations, headaches, tiredness and dizziness Full Blood Count shows 
Hb 6 g, 
WCC 5.5 X 10 ^ 8 
Platelets 156 X 10 ^ 8 /L 
MCV 68 
MCHC Low. 

1) What’s the Diagnosis? 
2) Features on PBF to support the diagnosis? 
3) What is the underlying cause?
4) Further Investigations apart from PBF?
5) How Would You empirically treat this patient? 
Rationale: 1) Iron deficiency anemia 
2)  Microcytic RBCs, hypochromic RBCs, absent target cells 
3) Iron deficiency 
4) Ferritin levels 
5) Transfuse RBCs and give ferrous sulphate tablets
Specialty: General_Surgery
Which of the following is true of non-operative management of uncomplicated appendicitis as compared to operative management of uncomplicated appendicitis? 
Answer options: option1: Non-operative management with antibiotics is now part of  consensus guidelines as therecommended treatment for   uncomplicated appendicitis
option2: Around 85-90% of patients managed with antibiotics for  uncomplicated appendicitiswill avoid surgery on initial  admission.
option3: About 10% of patients initially managed nonoperatively for  uncomplicated appendicitiswill develop recurrent appendicitis  within the first year and require appendectomy.
option4: There is about a lifetime risk of 70% for recurrent appendicitis after initial non-operativemanagement for uncomplicated  appendicitis.
option5: B and C
Correct answer: option2
Specialty: Neurology
A 57 year old known hypertensive who is poorly controlled presents with sudden onset headache which he describes as the worst headache of his life. You suspect he might be having a subarachnoid hemorrhage. A CT scan is unavailable to you. What is the ideal time to do a lumbar puncture to confirm your suspicion?
Answer options: option1: a.After 12 hours of headache onset
option2: b.After 6 hours of headache onset
option3: After 1 hour of headache onset
option4: After 4 hours of headache onset
option5: After headache has resolved
Correct answer: option1
Specialty: General_Surgery
Which of the following is true of open appendectomy as compared to laparoscopic appendectomy? 
Answer options: option1: . Open appendectomy has a higher rate of organ/space  surgicalsite infectionthan laparoscopic appendectomy.
option2: Open appendectomy has a higher rate of incisional  surgicalsite infection than laparoscopic appendectomy
option3: Open appendectomy has a shorter length of hospitalstay  than laparoscopicappendectomy.
option4: Open appendectomy has a longer operating time than  laparoscopicappendectomy
option5: None of the above
Correct answer: option2
Specialty: Pediatrics
Which of the following is a definite indication for 
operation in apediatric trauma patient? 

Answer options: option1: hemodynamically stable child with a hemoglobin of 6.7 g/dL and a CT showing blunt liver injury.
option2: A 20-kg child with initial chest tube output of 300 mL of blood.
option3: A 30-kg child with chest tube output of 65 mL/hour over the past 3 hours.
option4: A hemodynamically stable child with free intraperitoneal fluid onFAST
option5: All of the above
Correct answer: option2
Specialty: Obstetrics_and_Gynecology
Which of the following treatment modifications should be made in a pregnant patient?
Answer options: option1: Patients should be positioned with left lateral tilt (right side elevated) to alleviatecompression on the inferior vena cava during chest compressions in CPR.
option2: Because of the risk of fetal harm, tetanus toxoid should be avoided.
option3: Chest tube should be placed in 2 cm higher than in non-pregnant patients, thoughshould remain in the anterior axillary line.
option4: Diagnostic peritoneal lavage should be performed with a suprapubic entry point
option5: All of the above
Correct answer: option3
Specialty: Hematology
Erythrocyte Sedimentation Rate is low in :

Answer options: option1: Rheumatoid Arthritis
option2: Malignanacy
option3: SLE
option4: Pregnancy
option5: polycythemia
Correct answer: option5
Rationale: A decreased ESR is associated with a number of blood diseases in which red blood cells have an irregular or smaller shape that causes slower settling. In patients with polycythemia, too many red blood cells decrease the compactness of the rouleaux network and artifactually lower the ESR.
Specialty: Neurology
A 78-year-old man with diabetes mellitus presents with fever, headache and altered sensorium. On physical exam his temperature is 40.2°C, heart rate is 103 beats/min, blood pressure is 84/52 mmHg. His neck is stiff and he has photophobia. His cerebrospinal fluid (CSF) examination shows 2100 cells/µL, with 100% neutrophils, glucose 0.6 mmol/L , and protein 0.78 g/dL . CSF gram stain is negative. Empirical therapy should include which of the following?
Answer options: option1: Amphotericin
option2: Dexamethasone after antibiotics
option3: Dexamethasone prior to antibiotics
option4: Doxycycline
option5: Piperacillin/tazobactam
Correct answer: option3
Specialty: Anesthesiology
Which of the following anatomic factors makes the pediatric airway different than the adult airway? 
Answer options: option1: . Children have a relatively longer trachea as compared to body size.
option2: Adults have larger tongues relative to overall mouth size.
option3: The narrowest area of the pediatric airway is the cricoid cartilage
option4: Children have a cylindrical rather than funnel-shaped airway
option5: None of the above
Correct answer: option3
Rationale: n/A
Specialty: Neurology
A 49-year-old man is admitted to the hospital with a seizure. He does not have a history of seizures and he currently takes no medications. He has AIDS and is not under any care at this time. His physical examination is most notable for small, shoddy lymphadenopathy in the cervical region. A head CT shows a ring-enhancing lesion in the right temporal lobe, with edema but no mass effect. A lumbar puncture shows no white or red blood cells, and the Gram stain is negative. His serum Toxoplasma IgG is positive. Which of the following is the best course of action for this patient at this time?
Answer options: option1: Biopsy of the central nervous system (CNS) lesion
option2: Dexamethasone
option3: Search for systemic malignancy
option4: Treatment for CNS toxoplasmosis
option5: Whole-brain radiation therapy
Correct answer: option4
Specialty: Orthopedic_Surgery
Which of the following is TRUE about irrigation and 
debridement of openfractures? 

Answer options: option1: Several liters of irrigation should be used based on  the grade of openfracture.
option2: Use of antibiotic irrigation leads to fewer wound  infections than normalsaline alone in the washout of  open fractures.
option3: . Outcomes are improved with high-pressure irrigation  compared to low-pressure irrigation in open fractures
option4: Transverse incisionsshould be used to extend wounds  over fracture sites, as these show improved healing
option5: A and D
Correct answer: option1
Specialty: Orthopedic_Surgery
36-year-old woman presented with a comminuted tibia fracture. You are called to evaluate the patient for increasing pain in the lower leg and foot. She complains that the pain has awakened her from sleep. On exam, the limb is tense and swollen, and she has pain on passive range of motion of the foot. Which of the following is true of her condition? 
Answer options: option1: The patient should be given an extra dose of pain medication and reassessed in 2 hours.
option2: Pain with passive stretch is highly concerning.
option3: A CT scan is the best diagnostic modality
option4: She is unlikely to need intervention if distal pulses are palpable
option5: None of the above
Correct answer: option2