afrimedqa/afrimedqa_v2 huggingface dataset:
Specialty: Neurology
A 45-year-old woman presents to her physician with an 8-month history of gradually increasing limb weakness. She first noticed difficulty climbing stairs, then problems rising from chairs, walking more than half a block, and, finally, lifting her arms above shoulder level. Aside from some difficulty swallowing, she has no ocular, bulbar, or sphincter problems and no sensory complaints. Family history is negative for neurological disease. Examination reveals significant proximal limb and neck muscle weakness with minimal atrophy, normal sensory findings, and intact deep tendon reflexes. Which of the following is the most likely diagnosis in this patient?


Answer options: option1: Polymyositis
option2: Cervical myelopathy
option3: Myasthenia gravis
option4: Mononeuropathy multiplex
option5: Limb-girdle muscular dystrophy
Correct answer: option1
Specialty: Neurology
A 76-year-old woman presents with numbness and mild weakness in the legs. She has noticed mild numbness in the fingertips bilaterally. The symptoms have been slowly progressive over the past year. She rarely goes to the doctor and takes no medications. Neurological exam shows sensory loss to light touch to the knees and wrists in a symmetric pattern. Joint position sensation is less severely affected. Ankle reflexes are absent and she has mild distal weakness. Which of the following is the most likely abnormality on laboratory testing?

Answer options: option1: Hyperglycemia
option2: Macrocytic anemia with a low vitamin B12 level
option3: Positive ELISA test for HIV
option4: Low T4, elevated TSH
option5: Oligoclonal banding
Correct answer: option1
Specialty: Neurology
A 56-year-old woman develops difficulty ambulating several weeks after receiving an influenza vaccine. She is found to have distal muscle weakness and areflexia in the lower extremities. During a 2-day observation period the weakness ascends, and she begins to notice weakness of the hands. She notices mild tingling, but the sensory examination is normal. The diagnosis of Guillain-Barré syndrome is strongly suspected. The workup of this patient is most likely to show which of the following?
Answer options: option1: Acellular spinal fluid with high protein
option2: Abnormal EMG that shows axonal degeneration
option3: Positive Tensilon test
option4: Elevated CPK
option5: Respiratory alkalosis by arterial blood gases
Correct answer: option1
Specialty: Neurology
Three weeks after an upper respiratory illness, a 25-year-old male develops weakness of his arms and legs over several days. On physical exam he is tachypneic, with shallow respirations and symmetric muscle weakness in both arms and legs. There is no obvious sensory deficit, but motor reflexes cannot be elicited. Which of the following is the most likely diagnosis?

Answer options: option1: Myasthenia gravis
option2: Multiple sclerosis
option3: Guillain-Barré syndrome
option4: Dermatomyositis
option5: Diabetes mellitus
Correct answer: option3
Specialty: Neurology
A 20-year-old woman complains of weakness that is worse in the afternoon, worse during repetitive activity, and improved by rest. When fatigued, the patient is unable to hold her head up, speak, or chew her food. On physical exam, there is no loss of reflexes, sensation, or coordination. Which of the following is the underlying pathogenesis of this disease?
Answer options: option1: Serum antiacetylcholine receptor antibodies causing neuromuscular transmission failure
option2: Destruction of anterior horn cells by virus
option3: Progressive muscular atrophy
option4: Demyelinating disease
option5: Molecular mimicry
Correct answer: option1
Specialty: Neurology
A 50-year-old male complains of slowly progressive weakness over several months. Walking has become more difficult, as has using his hands. There are no sensory, bowel, or bladder complaints, or any problems in thinking, speech, or vision. Examination shows distal muscle weakness with muscle wasting and fasciculations. There are also upper motor neuron signs, including extensor plantar reflexes and hyperreflexia in wasted muscle groups. Which of the following laboratory tests is most likely to be abnormal in this patient?
Answer options: option1: Cerebrospinal fluid white blood cell count
option2: Sensory conduction studies
option3: CT scan of the brain
option4: Electromyography
option5: EEG
Correct answer: option4
Specialty: Neurology
A 26-year-old woman presents for follow-up of her multiple sclerosis. She has had two separate episodes of optic neuritis and has noticed stutteringly progressive weakness in her lower extremities. She has a mild neurogenic bladder. MRI scanning reveals several plaques in the periventricular white matter and several other plaques in the brainstem. Which of the following best summarizes the role of interferon β for this disease?
Answer options: option1: It can reduce the number of relapses and the appearance of new lesions on MRI
option2: It can cure one-third of patients
option3: It improves survival
option4: It improves patients’ symptoms and has no significant side effects
option5: It reduces relapse rate by 50%
Correct answer: option1
Specialty: Neurology
A 30-year-old male complains of leg weakness and paresthesias of the arm and leg. Five years previously he had an episode of transient visual loss. On physical exam, there is hyperreflexia, bilateral Babinski signs, and cerebellar dysmetria with poor finger-to-nose movement. When the patient is asked to look to the right, the left eye does not move normally past the midline. Nystagmus is noted in the abducting eye. A more detailed history suggests the patient has had several episodes of gait difficulty that have resolved spontaneously. He appears to be stable between these episodes. He has no systemic symptoms of fever or weight loss. Which of the following is the most appropriate next test to order?

Answer options: option1: Lumbar puncture
option2: MRI
option3: Quantitative IgG levels
option4: Oligoclonal banding
option5: X-ray
Correct answer: option2
Specialty: Neurology
A 38-year-old woman is brought to the emergency room by her family. They know that she has recently been in a psychiatric hospital but do not know the diagnosis or her medications. She has been vomiting and taking little by mouth over the past few days. The woman is ataxic and confused. She has a coarse tremor that is more prominent with movement. A moderate-sized diffuse goiter is present. Which of the following treatments is most likely to be beneficial?
Answer options: option1: Gastric lavage and charcoal
option2: Intravenous saline
option3: Intravenous potassium
option4: Parenteral haloperidol
option5: Decomtamination
Correct answer: option2
Specialty: Neurology
A 70-year-old male complains of the sudden onset of syncope. It occurs without warning and with no sweating, dizziness, or lightheadedness. He believes episodes tend to occur when he turns his head too quickly or sometimes when he is shaving. The best way to make a definitive diagnosis in this patient is which of the following?
Answer options: option1: ECG
option2: Carotid massage with ECG monitoring
option3: Holter monitor
option4: Electrophysiologic studies to evaluate the AV node
option5: Echocardiogram
Correct answer: option2
Specialty: Neurology
A 35-year-old previously healthy woman complains of a severe, excruciating headache and then has a transient loss of consciousness. There are no focal neurologic findings. Which of the following is the best next step in evaluation?

Answer options: option1: CT scan without contrast
option2: CT scan with contrast
option3: Carotid angiogram
option4: Holter monitor
option5: Echocardiogram
Correct answer: option1
Specialty: Neurology
A 30-year-old male complains of unilateral headaches with rhinorrhea and tearing of the eye on the side of the headache. Episodes are precipitated by alcohol. Headaches may become a problem for weeks to months, after which a headache-free period occurs. Which of the following
is the most likely diagnosis?


Answer options: option1: Migraine
option2: Cluster headache
option3: Sinusitis
option4: Tension headache
option5: Alcohol abuse
Correct answer: option2
Specialty: Neurology
A 45 year old man is rushed to the emergency having been found lying in a pool of vomitus. His history is significant for chronic alcohol use. You notice he has multiple abrasions over his body. On your examination you find that extra-ocular movements are restricted on lateral gaze, and a horizontal nystagmus is present. He is disoriented and confused and has gait ataxia. What is the likely diagnosis?

Answer options: option1: Benzodiazepine toxicity
option2: Encephalitis
option3: Wernicke’s encephalopathy
option4: Central pontine myelinolysis
option5: Brain stem infarction
Correct answer: option3
Specialty: Ophthalmology
. A case presented with hypermemic lid margin, matting of eye lahes , yellow crustations. Which of the following is not a treatment option?
Answer options: option1: Local eyelid hygiene
option2: systmic antibitoics
option3: Electrolysis
option4: topical antibiotic ointment on eyelid.
option5: none of the above
Correct answer: option3
Specialty: Ophthalmology
Chalazion is defined as:
Answer options: option1: Acute suppurative inflammation of meibomian glands
option2: chronic suppurative inflammation of meibomian glands
option3: chronic inflammatory lipogranuloma of meibomian glands
option4: Chronic non-granulomatous inflammation of meibomian glands
option5: none of the above
Correct answer: option3
Specialty: Otolaryngology
. The cough reflex caused while cleanong he ear canal is mediated by stimulation of 
Answer options: option1: fifth cranial nerve
option2: innervationf of external ear canal by C1 and C2
option3: branches of the 7th cranial nerve
option4: the 8th cranial nerve
option5: the 10th cranial nerve
Correct answer: option5
Specialty: Allergy_and_Immunology
Infectious complications of Atopic Dermatitis 

Rationale: a.	Impetigo: secondary to staph. aureus & some from Strep. grp A
b.	Eczema herpeticum: secondary to HSV
c.	Molluscum contagiosum: secondary to Poxvirus
d.     Dermatophyte infection: Tinea
Specialty: Pediatrics
Discuss the following inheritance patterns and recurrence risks associated with it. Give at least one example. X-linked recessive inheritance

Rationale: Gene on X chromosome, will only express in absence of dominant gene (= only boys), Carrier mother (asymptomatic) has a 50% chance of affected son and 50% chance of carrier daughter, e.g. Haemophylia, Duchenne muscle dystrophy
Specialty: Pediatrics
Discuss the following inheritance patterns and recurrence risks associated with it. Give at least one example. autosomal recessive inheritance

Rationale: Both genes in a pair must be disease causing before disease is manifested, genes on autosome, no sex preference, if both parents heterozygous then 25% chance of affected (homozygous) child, e.g. Cystic fibrosis, Occulo-cutaneous albinism, Spino-muscular atrophy
Specialty: Pediatrics
Discuss the following inheritance patterns and recurrence risks associated with it. Give at least one example. autosomal dominant inheritance

Rationale: Presence of 1 dominant disease causing gene in a pair on autosome, no sex preference, heterozygous parent has 50% risk of having an affected child, e.g. Neurofibromatosis, Achondroplasia, Huntington’s chorea etc.
Specialty: Hematology
Discuss the oxygen hemoglobin dissociation curve

Rationale: This relates the partial pressure of oxygen to the percentage saturation of haemoglobin. 
Features of this curve include:
(1)	At the normal P02 of arterial blood (100mm Hg) , the haemoglobin is 97.5 % saturated with 02. 
(2)	At O2 tensions greater than 100 mmHg . haemoglobin cannot accept more O2.
(3)	When the PO2 is reduced from 100mm Hg down to 70 mm Hg , the haemoglobin saturation is 92% (ie “normal” despite a significant drop in PO2).
(4)	The sigmoid shape of the curve means that at a tissue oxygen tension of 60 down to 
10mm Hg , large amounts of O2 are rapidly made available for tissue utilization from 
haemoglobin 
(5)	A variety of factors affect the curve itself- including a change in temperature ,pH,
2,3DPG and type of haemoglobin.
Specialty: Pediatrics
How will you manage a child with asthma on discharge? 
Rationale: If the patient is no longer requiring oxygen and is able to to eat and drink discharge him with the following managements 
a.	4 hours in between salbutamol treatments 
b.	Continue around the clock salbutamol for next 48 hours then gradually space out 
c.	2nd dose of dexamethasone 36 hours after the first dose, 
d.    3-5 days of prednisone (2 mg/kg) first dose, then 1 mg/kg BD
Specialty: Cardiology
Which one of the following is most suggestive of myocardial ischemia
Answer options: option1: Epigastric discomfort after eating
option2: Exertional breathlessness and wheeze
option3: Exertional breathlessness and throat tightness
option4: Breathlessness with a period of digital paraesthesia
option5: Rapid palpitation on exertion
Correct answer: option3
Specialty: Pulmonary_Medicine
What is the Immediate management of asthma? 

Rationale: Grade the Asthma and the management will depend on the grade: 

1.	Intermittent: Salbutamol as needed (short acting beta-agonist, SABA) 
2.	Mild persistent: SABA as needed,  Daily low-dose inhaled corticosteroid (ICS) Exmaple is beclomethasone 
3.	Moderate persistent: SABA as needed,  Daily medium-dose ICS 
4.	Severe persistent: SABA as needed, Daily high-dose ICS or Daily medium-dose +leukotriene receptor antagonist (LTRA)
Specialty: Cardiology
Which of the following is not an appropriate indication for an exercise (stress) ECG 

Answer options: option1: Evaluation of stable angina
option2: Evaluation of unstable angina
option3: Assessment of prognosis following a myocardial infarction
option4: Assessment of outcomes following coronary angioplasty
option5: Diagnosis of exercise-induced arrhythmias
Correct answer: option2
Specialty: Otolaryngology
Stridor:
Answer options: option1: it is ony a symptom and not a sign
option2: recession of suprasternal, supraclavicalar, intercostal and subcostal space indicate mild form of respiratory difficulty
option3: Cyanosis indicate early stage
option4: Hemangioma can only be congenital
option5: it is never a diagnosis nor a disease
Correct answer: option5
Specialty: Otolaryngology
A 21 year old woman presents with a two ay history of sore throat and dysphagia. On examination she is pyrexial with hallitosis and cervical lymohadenopathy. What is the likely causative organism for her condition
Answer options: option1: Epstein-barr virus
option2: corynebacterium diphteriae
option3: neiserria gonorrhoea
option4: rotavirus
option5: Strptococcus pyogenes
Correct answer: option5
Specialty: Cardiology
Which of the following statements about the jugular venous pulse (JVP) is true
Answer options: option1: The height reflects left atrial pressure
option2: The JVP falls with abdominal compression
option3: It is best examined with the patient supine
option4: Large systolic waves are associated with tricuspid regurgitation
option5: Prominent a waves suggest atrial fibrillation
Correct answer: option4
Specialty: Cardiology
Which of the following is a contraindication to DC cardioversion for persistent atrial fibrillation
Answer options: option1: Age over 75
option2: Atrial fibrillation present for >1 year
option3: Moderate to severe left ventricular impairment
option4: Subtherapeutic INR
option5: Relapse after 2 previous cardioversions
Correct answer: option4
Specialty: Pediatrics
Describe how you can manage hyperkalemia
Rationale:  i)	Rapidly decrease the risk of life-threatening arrhythmias 

ii)	Shift potassium intracellularly:
(1)	Sodium bicarbonate administration (IV)
(2)	Insulin and glucose (IV)
(3)	β-agonist (salbutamol via nebulizer) 

iii)	Cardiac membrane stabilization
(1)	IV calcium iv

iv)	Remove potassium from the body 
(1)	Loop diuretic (IV or PO) 
(2)	Sodium polystyrene (PO or rectal) Dialysis
Specialty: Other
Antiretroviral therapy
Rationale: Types of antiretroviral drugs available:

1.	Nucleoside reverse transcriptase inhibitors (NRTIs): Examples include zidovudine, azidothymidine (AZT), didanosine (ddI),  stavudine (d4T) lamivudine (3TC), zalcitabine, abacavir

2.	Non nucleoside reverse transcriptase inhibitors: Examples include Nevirapine, Efavirenz, Delavirdine

3.	Protease inhibitors: Examples include ritonivar, nelfinavir, amprenavir and lopinavir/ritanovir combination.

4.	Fusion inhibitors: Example enfuvirtide
Specialty: Pulmonary_Medicine
The following is false about COPD
Answer options: option1: COPD seldom shows large responses to inhaled bronchodilators
option2: Air trapping and progressively less elastic recoil offering resistance to expiration
option3: The lung parenchyma provides progressively less elastic recoil offering resistance to expiration
option4: Major site of increased resistance in COPD is in airways less or equal to 2 mm in diameter
option5: Respirator bronchioles, alveolar ducts, and alveoli walls are involved in emphysema
Correct answer: option2
Specialty: Pediatrics
Write short notes on Innate immunity
Rationale: Innate immunity is the immunity an individual has from birth (vs. acquired immunity which only develops after contact with a noxious substance).

It includes the barrier of:
·	the skin (resistance to invasion of organisms)
·	stomach acid which destroys ingested material
·	phagocytosis by white cells and macrophages
·	substances in blood which also destroy foreign material i.e. lysozyme, the complement system, natural killer lymphocytes
Specialty: Infectious_Disease
In the management of salmonella
Answer options: option1: Blood cultures are most sensitive in the 3rd week of infection
option2: Widal test is the most sensitive test for the diagnosis of enteric fever
option3: Resistance to fluoroquinolones is not documented
option4: Eradication of chronic carriage required treatment with antibiotics for 2 weeks
option5: Vaccination is an effective method of preventing infection in travelers
Correct answer: option5
Specialty: Pediatrics
Define triage in the care of children
Rationale: The process of rapidly screening sick children on arrival to hospital, with the aim of reducing death in the first 24 hours of admission. This is handled by the triage nurse.  Where we categorized as Emergency, Priority and Queue.

What the categories represent 
a.	Emergency which require lifesaving treatment.
i.	Absent or obstructed breathing 
ii.	Severe respiratory distress 
iii.	Central cyanosis
iv.	Signs of shock
v.	Coma 
vi.	Convulsions 
vii.	Signs of severe dehydration in a child with diarrhea

b.	Priority means the patients have to be given priority in the queue 
i.	Tiny baby – any sick baby under 2 months old 
ii.	Temperature – the child is very hot
iii.	Trauma and other surgical intervention 
iv.	Severe Pallor 
v.	Poisoning 
vi.	Pain – severe 
vii.	Respiratory distress 
viii.	Restless, continuously irritable, or lethargic
ix.	Referral – urgent 
x.	Malnutrition, visible severe wasting
xi.	Oedema of both feet
xii.	Burns 

Queue – these are patients who neither have emergency of priority signs
Specialty: Infectious_Disease
Which of the following is not a symptom of adverse malaria
Answer options: option1: Urine output (24 hours) of <400ml in adults
option2: Plasma glucose level of <2.2 mmol\L
option3: Venous lactate level of <5 mmol\L
option4: More than two generalized seizures in 24 hours
option5: Arterial PH <7.25
Correct answer: option3
Specialty: Pulmonary_Medicine
Which of the following drugs are used for the treatment of acute asthmatic attack
Answer options: option1: Nebulized bata-2-agonist and corticosteroids
option2: Intravenous aminophylline
option3: Oral anticholinergics and corticosteroids
option4: Leukotriene anatagonists
option5: Antibiotics
Correct answer: option1
Specialty: Pulmonary_Medicine
Which of the following is recommended for the treatment of community-acquired pneumonia

Answer options: option1: Ciprofloxacin and levofloxacin
option2: Ceftriaxone and clarithromycin
option3: Vancomycin
option4: Linezolid
option5: Co-amoxiclav and levofloxacin
Correct answer: option5
Specialty: Infectious_Disease
Infecivity of an infectious agent is:
Answer options: option1: (Number infected / number susceptible)x100
option2: .(Number of clinical disease/ number infected ) x 100
option3: (number of deaths/ number with disease) x 100
option4: Ratio of subclinical to clincal cases and prevalence rate respectively
option5: none of the above.
Correct answer: option1
Rationale: .
Specialty: Nephrology
A 27-year-old man is admitted with weight loss and headaches for 3 weeks. Upon evaluation, he was found to have cryptococcal meningitis and started amphotericin B. Two days later. Urea and creatinine are requested. Which of the following is a finding of concern
Answer options: option1: Hyponatremia
option2: Hypomagnesemia
option3: Hypokalemia
option4: Hypochloremia
option5: Hypophosphatemia
Correct answer: option3
Specialty: Nephrology
A 17-year-old boy presents with facial swelling and leg swelling for 1 week. He was previously well. On examination, blood pressure 115/60 mmHg, bilateral pleural effusion and ascites. Other systems are normal. Dipstick urinalysis shows proteinuria 4+. What is the most likely diagnosis of this patient
Answer options: option1: Nephritic nephrosis
option2: Nephritic syndrome
option3: Acute glomerulonephritis
option4: Chronic glomerulonephritis
option5: Nephrotic syndrome
Correct answer: option5
Specialty: Pulmonary_Medicine
A 27-year-old woman is taking anti-TB medications. She now presents with visual impairment. Which of the following is the most likely cause of her symptom
Answer options: option1: Pyrazinamide
option2: Isoniazid
option3: Streptomycin
option4: Rifampicin
option5: Ethambutol
Correct answer: option5
Specialty: Pulmonary_Medicine
Which of the following describes multi-drug resistant (MDR) tuberculosis (TB)
Answer options: option1: TB resistant to isoniazid
option2: TB resistant to pyrazinamide
option3: TB resistant to injectable anti-TB drugs
option4: TB resistant to rifampicin and isoniazid
option5: TB resistant to ethambutol and pyrazinamide
Correct answer: option4
Specialty: Neurology
Which of the following is true concerning acute stroke treatment
Answer options: option1: Use of stroke units improves mortality and reduces dependency
option2: No physiological abnormalities are detected during the first 72 hours following acute stroke
option3: Mobilization should be delayed after the first 72 hours
option4: Stroke units are only beneficial for patients who have been treated with thrombolysis
option5: Assuming there is no clinical deterioration, a routine repeat CT head is recommended after one week
Correct answer: option1
Specialty: Neurology
Which of the following is correct with regard to the pathology of acute disseminated encephalomyelitis (ADEM)

Answer options: option1: ADEM is a vasculitic condition
option2: ADEM is mainly driven by B cell mediated inflammation
option3: Lesions never occur in the grey matter
option4: Microglia are activated
option5: Most cases occur following vaccination
Correct answer: option4
Specialty: Neurology
Regarding pneumococcal meningitis, which of the following statements is correct
Answer options: option1: Early antibiotic therapy leads to poorer outcomes
option2: Low GCS on admission is a predictor of poor outcome
option3: Mortality is 5% in adults
option4: Most patients make a full recovery
option5: Vancomycin and\or rifampicin can be added if resistance is suspected
Correct answer: option2
Specialty: Infectious_Disease
Which of the following statements about malaria is true
Answer options: option1: Plasmodium falciparum infects only mature red blood cells
option2: Plasmodium malaria is associated with relapse
option3: Thick slides have higher sensitivity compared to thin slides on microscopy
option4: Rapid malaria tests have lower sensitivity compare to microscopy
option5: Plasmodium ovale is the commonest species causing malaria in Kenya
Correct answer: option3