Instruction: A 30-year-old female, 32 weeks pregnant, seeks medical attention for wheezing. She is conscious and has vital signs: blood pressure 126/72 mmHg, heart rate 110 beats/min, respiration 28 times/min, temperature 36.0℃, SpO₂ 85% (room air), and normal breath sounds. The examination and testing meet the diagnostic benefit and cause the least harm to the fetus. Which of the following is more appropriate?

Input: (A)Chest radiography. (B)Chest CT pulmonary angiography (CTPA). (C)P ulmonary perfusion scan. (D)C hest magnetic resonance imaging with gadolinium contrast enhancement.

Output: B


Instruction: A 70-year-old male with a history of asthma and heart failure has chest pain, cold sweats, and shortness of breath at home. When he goes to the emergency room, his blood pressure is 220/130 mmHg, his respiratory rate is 26 breaths/min, his heart rate is 114 beats/min, his body temperature is 36℃, and his blood oxygen concentration is 92%. The diagnosis is acute aortic detachment. Which of the following statements is more appropriate?

Input: (A) This is a hypertensive urgency. (B) The blood pressure of the upper limbs may be different, usually by 5 to 10 mmHg. (C) Urgent antihypertensive medication is required, with Labetalol intravenous injection being the preferred medication. (D) Systolic blood pressure should be controlled between 100 and 140 mmHg, and heart rate should be controlled to less than 60 beats/min.

Output: D


Instruction: Which of the following statements is more appropriate regarding the possible complication of local anesthetic systemic toxicity (LAST) during nerve block surgery?

Input: (A) Generally speaking, the longer-acting local anesthetic is, the less likely it is to develop LAST. (B) When LAST occurs, local muscle twitching occurs earlier than tongue numbness. (C) When a patient has cardiac arrest due to LAST, intravenous lipid emulsion should be used for treatment. (D) When seizures occur, magnesium sulfate (MgSO 4) treatment should be considered first.

Output: C


Instruction: Computed tomography revealed ascending colon diverticulitis with a 3-cm surrounding abscess. Which of the following statements is less appropriate?

Input: (A) Liquid food can be used. (B) Abscess drainage surgery is usually not required. (C) Large-volume infusion therapy is used to replenish water. (D) Broad-spectrum antibiotics are given.

Output: A


Instruction: Regarding Guillain-Barré syndrome (GBS), which of the following statements is less appropriate?

Input: (A) The motor nerves are mainly affected, which manifests as asymmetric limb weakness, usually affecting the lower limbs first and then the upper limbs. (B) The most obvious finding on neurological examination is the absence of deep tendon reflex. (C) Although the patient may have some complaints of abnormal sensations, neurological examinations show that the sensory nerves are normal. (D) The occurrence of Guillain-Barré syndrome is related to acute Campylobacter jejuni infection.

Output: A


Instruction: A 1-year-old boy has bruises and hemorrhages all over his body, no other symptoms, good mental energy and appetite, blood test results: WBC 13,900/µL (segment 40%, lymphocyte 52%, monocyte 8%), Hb 11g/dL, Platelets <5,000/µ L. Which of the following statements is more appropriate?

Input: (A) Idiopathic thrombocytopenic purpura (ITP) Generally, low platelets will become chronic and last for more than 6 months. (B) The diagnosis of ITP is mainly based on medical history, physical examination, complete blood count and peripheral blood smear examination. Shrunken platelets can be seen in the smear. (C) Bone marrow examination is not an immediately necessary test. (D) Steroid treatment can be used and platelet transfusions must be given quickly to prevent possible bleeding.

Output: C


Instruction: Which of the following statements about tracheobronchial injury is more appropriate?

Input: (A) The most common cause is a puncture wound to the neck. (B) About 1/3 of patients have mild or no symptoms. (C) Most intrathoracic tracheobronchial injuries occur 2 cm below the cricoid cartilage. (D) Bronchial lacerations that are larger than 1/3 of the bronchial circumference require surgical repair.

Output: D


Instruction: A 75-year-old male with a history of myocardial infarction and cerebral infarction, who takes anticoagulants regularly, was admitted to the hospital after falling from a bicycle. A head CT scan revealed right subdural hemorrhage. Which of the following treatments is more appropriate?

Input: (A) Prothrombin concentrate complex, plasma, and Vitamin K can be given. (B) If the patient is taking new anticoagulants such as Xarelto, reversal drugs can be given. (C) A blood test can be performed to confirm whether the patient has coagulation abnormalities caused by taking antithrombotic drugs. (D) If the patient is taking Coumadin, Protamine sulfate can be given.

Output: A


Instruction: Which of the following statements about complications of the neck in systemic rheumatic immune disease is less appropriate?

Input: (A) Ankylosing spondylitis is more likely to cause cervical instability than rheumatoid arthritis. (B) Rheumatoid arthritis patients should maintain cervical stability even with minor injuries. (C) Ankylosing spondylitis patients should avoid flexion and extension during intubation to prevent cervical spinal cord disease caused by atlantoaxial joint instability. (D) Rheumatoid arthritis patients should be suspected of cervical instability when they experience severe neck pain radiating to the occipital region and abnormal sensations in the upper limbs.

Output: A


Instruction: A 60-year-old woman has had right neck and shoulder pain for a week. Which of the following physical examinations is more likely to indicate a muscle strain?

Input: (A) Continuous breath-holding and exertion (Valsalva) will increase pain in the right neck and right shoulder. (B) The patient can reduce the pain on the affected side by abduction of the right upper arm. (C) When the neck is flexed and the chin is close to the chest wall, the upper arm will produce pain like electrical stimulation. (D) The pain will be worse when the patient turns his head to the left.

Output: D


Instruction: A patient with lung cancer (non-small cell carcinoma), brain, liver, adrenal glands and multiple bone metastases, received Ipilimumab immunotherapy last month. He had a high fever, diarrhea, and worsening mental state in the past three days. He was taken to the emergency room. Which of the following descriptions or treatments is more appropriate?

Input: (A)This drug is a synthetic monoclonal antibody that stimulates specific white blood cell anti-PD-1 antigens to enhance the ability of T lymphocytes and NK cells to kill tumor cells. (B)Patients with advanced cancer have poor immunity and are often infected. Even if the source of infection cannot be found in the initial evaluation, broad-spectrum antibiotics, antiviral and antifungal drugs can be given first. (C)If immune-related adverse events are suspected, methylprednisolone, 1-2 mg/kg/day, is given first, and the dose is reduced after three days. (D)Common side effects of Ipilimumab immunotherapy are pulmonary fibrosis or myocarditis.

Output: C


Instruction: Which of the following statements about MDMA is more appropriate?

Input: (A) The mechanism of action is to inhibit cytochrome P-450 2D6 to reduce the concentration of serotonin, dopamine, and norepinephrine, thereby exerting its effect. (B) It will cause excessive secretion of antidiuretic hormone (ADH), which will lead to hypernatremia. (C) When acute poisoning occurs, there will be changes in consciousness, respiratory depression, mydriasis, etc. (D) The treatment of poisoning is mainly supportive therapy, and there is currently no specific antidote available.

Output: D


Instruction: Which of the following statements about medications used for eclampsia and preeclampsia is more appropriate?

Input: (A) When controlling blood pressure, Hydralazine works faster than Labetalol, so it is the first-line medication. (B) When epilepsy occurs, the first-line medication is Diazepam or Lorazepam. (C) Avoid using antiplatelet drugs in pregnant women to prevent preeclampsia or HELLP syndrome. (D) If side effects of high magnesium levels occur during treatment, Calcium gluconate can be administered.

Output: D


Instruction: Which of the following statements about REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) is less appropriate?

Input: (A) REBOA may be considered for patients with subdiaphragmatic trauma and hemorrhagic shock that are life-threatening. (B) Arterial dissection, extreme ischemia, and spinal cord injury are all possible complications of REBOA. (C) If used for patients with severe intra-abdominal bleeding, retroperitoneal bleeding, or even traumatic cardiac arrest, the balloon should be placed in Zone 2, i.e., the distal thoracic aorta. (D) If used for patients with severe proximal lower limb trauma and hypovolemic shock, the balloon should be placed in Zone 3, i.e., the distal abdominal aorta.

Output: C


Instruction: A 24-year-old female is found unconscious and brought to the emergency department with dilated pupils, nystagmus, increased neuromuscular reflexes, diarrhea and sweating, blood pressure 190/108 mmHg, heart rate 126 beats/min, and temperature 39℃. Which of the following diagnoses is less likely?

Input: (A)Cholinergic toxidrome s. (B)Sympathomimetics. (C)Serotonin toxidrome s. (D)Neuroleptic Malignant Syndrome.

Output: A


Instruction: Which of the following is not helpful in assisting the diagnosis of atypical Kawasaki disease?

Input: (A)Creatinine. (B)Urine analysis. (C)C-reactive protein. (D)Albumin.

Output: A


Instruction: Which of the following is a risk factor for post–lumbar puncture headache?

Input: (A)Draining too much cerebrospinal fluid. (B)Using a larger needle (>22 gauge). (C)Not lying down after the procedure. (D)High opening pressure of cerebrospinal fluid.

Output: B


Instruction: A 30-year-old female accidentally ingested Datura stramonium and began to talk nonsense. Her entire body felt dry and hot. Her temperature was 38.5°C, her breathing was 25 breaths/min, her heart rate was 120 beats/min, her blood pressure was 162/105 mmHg, and her GCS was E4V2M5. Which of the following treatments is less appropriate?

Input: (A) Give the patient appropriate fluids and monitoring. (B) Sedate the patient with Lorazepam. (C) Cool the patient with Acetaminophen. (D) Hemodialysis will not improve this patient's prognosis.

Output: C


Instruction: Which of the following statements about surgical airway is more appropriate?

Input: (A) For children under 8 years of age, cricothyrotomy is recommended. (B) When the trachea or larynx is injured, cricothyrotomy is recommended. (C) Cricothyrotomy can easily cause airway stenosis, and tracheostomy is usually performed within 24 hours. (D) Good jet ventilation can provide adequate ventilation, and it is not necessary to immediately reestablish other types of airways.

Output: D


Instruction: A 65-year-old male patient went to the clinic for treatment due to right ear pain and hearing loss. He was diagnosed with otitis media. After 3 days of oral antibiotics (Amoxicillin 1g TID), his condition did not improve and he went to the emergency room. Which of the following treatments is more appropriate?

Input: (A) If there is no middle ear effusion, the patient can continue to take the antibiotics prescribed by the clinic. (B) If there is middle ear effusion, an otolaryngologist should be consulted to perform tympanic membrane puncture and drainage. (C) Hearing loss problems usually improve as the middle ear effusion is absorbed. (D) Facial nerve palsy is a common complication and can be treated with steroids.

Output: C


Instruction: 56-year-old male patient, with a history of diabetes, takes medication regularly. He traveled to Hualien and played in the stream 10 days ago. He complained of recurrent chills with fever, headache and muscle aches 5 days ago. Mild jaundice and decreased urine volume have occurred in the past three days. Emergency vital signs include blood pressure 106/62 mmHg, body temperature 37.8℃, heart rate 122 beats/min, respiration 20 times/min, SpO₂ 96%, and no heart murmurs. The total white blood cell count in the blood is 12,600/μL, liver function is abnormal, and there is mild jaundice and kidney function abnormality. Regarding diagnosis and treatment, which of the following statements is less appropriate?

Input: (A) Leptospirosis, bacterial endocarditis, obstructive jaundice complicated with cholangitis, and hepatic abscess are all possible differential diagnoses. (B) Abdominal ultrasound or CT is an important diagnostic tool for diagnosing hepatic abscess and obstructive jaundice complicated with cholangitis. (C) Blood culture can be used to diagnose the above three infections, but if bacterial endocarditis caused by HACEK bacteria is suspected, a longer blood culture period is required. (D) For empirical antibiotic treatment, third-generation cyclosporin may be considered, combined with intravenous penicillin-G or oral doxycycline.

Output: C


Instruction: Which of the following statements about blood transfusion is less appropriate?

Input: (A)Reduces red blood cell concentrates are less likely to cause allergic fever during transfusion. (B)The platelet count should be maintained above 50,000/µL before performing a lumbar puncture. (C)Cryoprecipitate may be considered for bleeding caused by uremia. (D)Acute lung injury caused by blood transfusion should be treated with diuretics.

Output: D


Instruction: Which of the following descriptions is more appropriate regarding the complications of acute coronary heart disease?

Input: (A) The electrocardiogram shows accelerated idioventricular rhythms, which has a poor prognosis. (B) Cardiomastoid muscle rupture, which occurs more commonly in anterior wall infarcts. (C) If the patient is complicated by primary ventricular fibrillation, the prognosis will not be affected as long as it is treated promptly. (D) If Dressler's syndrome occurs, aspirin 100 mg should be taken daily.

Output: C


Instruction: A 3-year-old boy was in a car accident while sitting in a safety seat at the back of the car. He suffered a 3-cm scalp laceration and abdominal bruising, with a blood pressure of 100/65 mmHg. The child hugged his mother tightly, sometimes crying loudly, with his eyes tightly closed, and only opened his eyes when his mother called him. Which of the following is more appropriate?

Input: (A) It is mandatory to use a rear-facing safety seat according to regulations. (B) Ultrasound can be used to rule out solid organ damage in the abdomen. (C) If the child develops into shock, the scalp laceration should not be the main cause. (D) This child scored 14 points on the Modified Pediatric Glasgow Coma Scale.

Output: D


Instruction: Which of the following statements about Shigella spp and the diarrheal illness they cause is less appropriate?

Input: (A) Children in day care centers are a susceptible group. (B) Azithromycin can be used for treatment. (C) The course of disease can be self-limited. (D) Symptoms caused by S. sonnei are more severe than in other subgroups.

Output: D


Instruction: A 38-week pregnant woman was sent to the emergency room after a motorcycle accident. She had GCS E3V4M5, abrasions on her left face, subcutaneous edema on her left chest, bruises on her left abdomen, and a little blood on her underwear. Her blood pressure was 87/45 mmHg, her heart rate was 146 beats/min, her respirations were 23 breaths/min, and her SpO₂ was 95%. Which of the following statements is more appropriate?

Input: (A) Stabilizing the pregnant woman first will give the fetus a better prognosis. The fetal condition should be assessed after the pregnant woman has been stabilized and secondary assessment has been performed. (B) The arterial blood showed PaO 2 91mmHg and PaCO₂ 38mmHg. The pregnant woman should be considered to be in imminent respiratory failure. (C) In addition to pushing the uterus to the left or lying on the left side, fluid infusion, blood transfusion, and pressor drugs should be started as soon as possible to prevent fetal hypoxia. (D) The vaginal fluid was tested with a test strip and the pH value was 5. There should be a high suspicion of amniotic membrane rupture and obstetrics and gynecology should be consulted as soon as possible.

Output: B


Instruction: A 24-year-old male patient presents to the emergency department with bloody stools for 2 days. Clinically, infectious gastroenteritis is suspected. Possible bacterial species include Salmonella, Shigella, Yersinia, Vibrio and E. coli. Which of the following is the most appropriate first-line antibiotic choice?

Input: (A)Trimethoprim-sulfamethoxazole. (B)Metronidazole. (C)Erythromycin. (D)Ciprofloxacin.

Output: D


Instruction: Four children with a day-long fever are admitted to the emergency pediatric department. All four are active, have no obvious respiratory or gastrointestinal symptoms, and have been vaccinated on time. Which one does not need a urine test initially?

Input: (A)A 3-month-old boy with a temperature of 38.5℃. (B)1.5 6-year-old boy, uncircumcised, temperature 38.0℃. (C) 1.5-year-old girl, temperature 38.0℃. (D) 4-year-old girl, temperature 38.0℃.

Output: D


Instruction: While performing traditional laryngoscope endotracheal intubation on an adult non-traumatic patient, when only half of the glottal triangle can be seen with the laryngoscope, which of the following is more appropriate?

Input: (A) Reposition the patient to a supine nodding position. (B) Reposition the patient with the head raised approximately 10 cm under the occipital area. (C) Apply cricoid pressure using the BURP maneuver. (D) Apply cricoid pressure using the Sellick maneuver.

Output: B


Instruction: Which of the following statements about pneumonia in patients infected with human immunodeficiency virus (HIV) is less appropriate?

Input: (A) Bacterial pneumonia still has the highest incidence compared to other pathogens. (B) The most prominent feature of pneumocystic pneumonia is hypoxemia. (C) The typical chest X-ray findings of tuberculosis infection are not common in terminally ill patients. (D) Cytomegalovirus pneumonia is common in the early stages of HIV infection.

Output: D


Instruction: Which of the following statements about JumpSTART for the assessment of massive casualties in children is more appropriate?

Input: (A) As with adult assessment, the first step is to assess the presence of breathing. (B) AV PU is a tool for assessing awareness in JumpSTART. The first A is airway. (C) The order of assessment: whether the patient can walk → pulse → breathing. (D) As long as the patient can walk, it is minor and the patient should proceed to the second round of examination.

Output: D


Instruction: A 35-year-old male was injured in a car accident. MRI examination revealed that the spinal cord injury was located at approximately T10. In addition to weakness in both lower limbs, the patient also lost pain and temperature sensation in the lower body, but still retained proprioception. Which of the following statements is more appropriate?

Input: (A) The chance of neurological shock is high. (B) Light touch sensation in both lower limbs will not disappear completely. (C) The range of temperature sensation loss may begin below T6. (D) Neurological examination of the lower limbs will show decreased deep tendon reflexes and Barbinski's sign (positive).

Output: B


Instruction: Which of the following statements about blood transfusion in trauma patients is more appropriate?

Input: (A) Transfusion of more than 8 units of blood within 24 hours meets most definitions of massive transfusion. (B) Massive transfusions must be accompanied by calcium supplementation to prevent hypocalcemia. (C) PRBCs that match blood type and are crossmatched should be given as soon as possible, but this may be an exception in cases of massive injuries. (D) Type O PRBCs and fresh frozen plasma can be given in an emergency, while platelets are not considered based on blood type.

Output: C


Instruction: Which of the following statements about the management of acute ischemic stroke is more appropriate?

Input: (A) Systolic blood pressure must be actively controlled to below 120 mmHg before intravenous thrombolytics can be administered. (B) After the administration of intravenous thrombolytics, if the diastolic blood pressure exceeds 140 mmHg, consider using nitroprusside intravenous drip to control blood pressure. (C) 12 hours after the administration of intravenous thrombolytics, oral Aspirin should be started to reduce the risk of blood vessel re-blockage. (D) If the blood sugar is less than 50 mg/dL, but the clinical manifestations resemble a stroke, intravenous thrombolytics should still be administered first.

Output: B


Instruction: Regarding valproic acid poisoning, which of the following is more appropriate?

Input: (A) Slow-release valproic acid poisoning only requires a single dose of activated charcoal. (B) In poisoned patients, blood concentrations are strongly correlated with the occurrence of seizures. (C) Hemodialysis cannot be used to increase excretion. (D) It will cause an increase in ammonia in the blood and can be treated with L-carnitine.

Output: D


Instruction: Which is more appropriate for intubation using video laryngoscopes (VL) or direct laryngoscopes (DL)?

Input: (A) The blade curvature of VL and DL laryngoscopes is usually the same. (B) When inserting VL and DL, a tongue sweep must be performed from the corner of the mouth. (C) After the VL and DL are inserted, the front end of the blade targets the vallecula. (D) The first intubation success rate using VL is significantly higher than that using DL, and the complication rate is lower.

Output: C


Instruction: Which of the following statements about blood products is more appropriate?

Input: (A) Fresh frozen plasma (FFP) can be directly thawed by heating in emergency transfusion situations, and it can remain active for five days after thawing. (B) Fresh frozen plasma does not need to be matched with blood type before it is released from storage. (C) The indications for cryoprecipitate include bleeding in patients with severe liver disease with fibrinogen less than 100 mg/dL. (D) Fresh frozen plasma is recommended for treatment of patients with excessive bleeding from novel oral anticoagulants.

Output: C


Instruction: A 50-year-old male with myasthenia gravis comes to the emergency department with shortness of breath. Which of the following statements is more appropriate?

Input: (A) If intubation is required, avoid administering depolarizing or nondepolarizing paralytic agents. (B) Neck symptoms are more pronounced in flexor weakness than in extensor weakness. (C) Distal limb weakness is the most common symptom in this patient population. (D) Patients with respiratory symptoms, even mild ones, should be admitted to the ICU for observation.

Output: A


Instruction: About Crohn's disease Which of the following statements is more appropriate?

Input: (A) The most common site of disease is the jejunum. (B) Anemia is not a common symptom of this disease. (C) It is more common in Asians. (D) Prednisolone (60 mg per day) can be given when symptoms are severe.

Output: D


Instruction: Which of the following is less appropriate when a nurse draws blood from a patient and then pricks him with a needle?

Input: (A) If the nurse has never received the hepatitis B vaccine and it is unknown whether the patient is infected with HBV, hepatitis B immune globulin should be given. (B) If the nurse is eligible for hepatitis B immune globulin, it should be given within 24 hours of the prick. (C) If the patient has acquired immune deficiency syndrome, the nurse's chance of contracting HIV is approximately 0.3%. (D) Post-exposure prophylaxis for HIV is recommended to be given as soon as possible.

Output: A


Instruction: Which of the following statements about acute viral hepatitis is less appropriate?

Input: (A) Hepatitis A rarely develops into chronic hepatitis. (B) Acute infection with hepatitis C is usually asymptomatic. (C) 75% of adults infected with hepatitis B will develop chronic hepatitis. (D) Repeated infection with hepatitis B and hepatitis D can easily develop into fulminant hepatitis.

Output: C


Instruction: A 35-year-old female, 38 weeks pregnant, fell off her motorcycle and was sent to the hospital. She was conscious, with blood pressure of 100/50 mmHg, heart rate of 120 beats/min, respiration of 20 breaths/min, and body temperature of 36℃. She complained of lower abdominal discomfort. Physical examination revealed lower abdominal tenderness but no obvious signs of peritonitis. Which of the following statements is more appropriate?

Input: (A) The uterus has sufficient blood flow but is relatively small in size. Injury will not cause shock to the pregnant woman. (B) Because the enlarged uterus pulls on the peritoneum, there may be no obvious signs of peritonitis after intra-abdominal bleeding. (C) At this stage, the fetal head has descended into the pelvic cavity. Even if the pelvis is fractured, it will not directly injure the fetal head. (D) The total blood volume is the highest during pregnancy, and shock symptoms will only appear when the blood loss reaches more than 30% of the total blood volume.

Output: B


Instruction: Which of the following statements about forensic toxicology is less appropriate?

Input: (A) Blood after death is a colloid that looks like hemolysis. (B) The correlation between the concentration of the sample measured in urine and the effect of the drug in the body at the time is very weak. (C) The determination of the alcohol concentration in the eyeball fluid is an important basis for determining whether the deceased drank alcohol before his death. (D) The concentration of poisons measured in bile is not affected by enterohepatic circulation.

Output: D


Instruction: A woman was sent to the emergency room because of wrist cutting. Her thumb could not do the palm-to-palm (opposition) movement. Which of the following injuries should be suspected?

Input: (A) median nerve. (B) palmar digital nerve. (C) radial nerve. (D) ulnar nerve.

Output: A


Instruction: What is the most common cause of fetal death due to trauma to pregnant women, except for maternal shock or maternal death?

Input: (A)Abruptio placentae。 (B)Premature rupture of membranes。 (C)Rh blood type incompatibility。 (D)Uterine rupture。

Output: A


Instruction: Which of the following statements is less appropriate for the diagnosis and treatment of patients with nosebleeds?

Input: (A)The most likely site of bleeding is Kiesselbach's plexus. (B)The initial hemostatic treatment can be to ask the patient to tilt his head forward and pinch the nose with his fingers. (C)You can consider using NSAIDs to enhance vasoconstriction and achieve better hemostasis. (D)If nasal packing is placed for more than 48 hours, antibiotics should be used in combination.

Output: C


Instruction: Which of the following statements about thyrotoxic hypokalemic periodic paralysis is more appropriate?

Input: (A) Renal loss is the cause of hypokalemia. (B) Spot urinary potassium UK⁺> 10 Eq/L. (C) Transtubular K⁺ gradient value>3 mEq/L. (D) Urine calcium/phosphate ratio>1.7 has high sensitivity and specificity for the diagnosis of this disease.

Output: D


Instruction: Which of the following statements is more appropriate for the treatment of asthma?

Input: (A) Rapid-onset β1-adrenergic agonist is the first choice for the treatment of bronchoconstriction. (B) Giving steroids within one hour of arriving at the emergency department may reduce the chance of hospitalization. (C) After the acute attack is relieved, the amount of inhaled steroids prescribed should be minimized at the time of discharge. (D) Intravenous MgSO 4 can be given for severe asthma, but steam inhalation is not recommended.

Output: B


Instruction: A 1.5-year-old boy was brought to the emergency room after having bloody stools for 3 days. The boy had no fever, abdominal pain, vomiting, ascites, joint pain, or hematuria. His blood test results, including hemoglobin, platelets, and coagulation function, were all normal. What is the most likely diagnosis for this boy?

Input: (A) Intussusception. (B) Meckel's diverticulum. (C) Henoch-Schönlein purpura. (D) Hemolytic-uremic syndrome.

Output: B


Instruction: A 16-year-old teenager had a dull look in his eyes and was unable to talk after attending a party. His friends confessed that he used laughing gas. Which of the following treatments or tests is more appropriate?

Input: (A) An MRI of the head may reveal abnormalities. (B) Vitamin B12 injections can relieve symptoms. (C) Urine screening can confirm the diagnosis. (D) Blood tests can confirm the diagnosis.

Output: B


Instruction: Which of the following statements about Guillain-Barre' syndrome is more appropriate?

Input: (A) Neurological examination can reveal increased deep tendon reflexes and mild sensory abnormalities. (B) It may occur after a viral or bacterial infection, usually starting in the lower limbs and progressing upward. (C) The main method of diagnosis is a lumbar puncture. (D) Steroid treatment can shorten the time it takes for symptoms to recover.

Output: B


Instruction: Which of the following vitamins should we be more concerned about toxicity when taking large amounts?

Input: (A) Vitamin B1. (B) Vitamin B2. (C) Vitamin B3. (D) Vitamin B12.

Output: C


Instruction: A patient with hemophilia who lacks factor VIII comes to the hospital with sudden onset of left hip pain and left leg numbness. His vital signs are stable and he has no fever. Which of the following statements is more appropriate?

Input: (A) Assist the patient to straighten his left thigh. The patient's pain symptoms should improve. (B) Ultrasound examination shows no effusion in the hip joint, so there is no need to consider coagulation factor supplementation. (C) If shock occurs, retroperitoneal bleeding should be considered. (D) In case of shock, it is recommended to immediately establish a central venous line to administer coagulation factors.

Output: C


Instruction: Regarding the principles of handling foreign bodies in the pediatric digestive tract, which of the following is less appropriate?

Input: (A) If a button battery with a diameter of 1.5 cm is swallowed, an abdominal X-ray will show that it is in the stomach, and an upper gastrointestinal endoscopy should be arranged urgently. (B) If a suture needle of about 3 cm is swallowed, an abdominal X-ray will show that it is in the small intestine. If there are no symptoms, a series of follow-up X-rays are required to observe clinical symptoms and whether it is expelled. (C) If a NT$50 coin (diameter 2.8 cm) is swallowed, it is difficult for it to pass through the pylorus and needs to be removed endoscopically as soon as possible. (D) If multiple magnets are swallowed, an endoscopic examination and consultation with a pediatric surgeon should be performed as soon as possible.

Output: A


Instruction: Which of the following statements about blast and crush injuries is more appropriate?

Input: (A) The most common cause of death from primary blast injury is barotrauma of the lungs. (B) Bleeding from wounds caused by exsanguination can be stopped by applying pressure, but the use of tourniquets is not recommended. (C) Among the 5P symptoms of compartment syndrome, the most common is numbness. (D) Crush syndrome may cause high blood potassium and high blood calcium, which may further cause cardiac arrest.

Output: A


Instruction: A 28-year-old AIDS patient who had not taken medication regularly for half a year was sent to the emergency room due to fever and shortness of breath. When he arrived at the emergency room, he was conscious, with blood pressure of 107/73 mmHg, respiratory rate of 32 times/min, heart rate of 120 times/min, SpO₂ 85%, and CXR showed pulmonary consolidation. Which of the following statements is less appropriate?

Input: (A) Pulmonary tuberculosis should be considered, and the patient can be placed in an isolation room first. (B) β-lactam antibiotics plus Macrolides can be given for the most common pathogens. (C) Testing CD4 counts can help infer the pathogen. (D) The most common pathogen is Pneumocystis jirovecii.

Output: D


Instruction: Which of the following statements is less appropriate regarding the use of ophthalmic ultrasound in emergency situations?

Input: (A) Low-energy ultrasound should be used. (B) Increased intracranial pressure can be determined from ocular ultrasound. (C) Ultrasound can assist in the diagnosis of vitreous hemorrhage. (D) Suspected eyeball rupture should be confirmed with ultrasound.

Output: D


Instruction: Which of the following statements is more appropriate when narrow-QRS complex PEA persists during emergency treatment of adults with cardiac arrest?

Input: (A) It usually indicates metabolic causes of circulation. (B) Common causes include hyperkalemia, acidemia, or sodium channel blocker poisoning. (C) Ultrasound examination of the heart often reveals a hyperdynamic left ventricle. (D) Compared with wide-QRS complex PEA, ultrasound examination is less likely to reveal the cause in this patient.

Output: C


Instruction: Which of the following descriptions of HELLP syndrome in a 32-week pregnant woman is less appropriate?

Input: (A) This syndrome is more common in multiparas than primiparas. (B) High doses of Labetalol may cause neonatal hyperglycemia. (C) Renal function may be normal. (D) Steroid therapy may improve fetal outcomes.

Output: B


Instruction: Which of the following descriptions of laboratory tests and diagnostic tools for acute pancreatitis is less appropriate?

Input: (A) Lipase is more sensitive to alcoholic pancreatitis than amylase. (B) Amylase begins to rise within hours of symptom onset and peaks within 48 hours. (C) Acute pancreatitis is already evident Symptoms and laboratory test reports require early arrangement of abdominal CT to assess the severity of the disease. (D) ALT greater than 150 U/L within 48 hours has a greater than 85% positive predictive rate of gallstone pancreatitis.

Output: C


Instruction: Which of the following descriptions of Acute coronary syndrome is less appropriate?

Input: (A) If the electrocardiogram shows LBBB and the V1-V3 discordant ST elevation>5 mm is used according to the Sgarbossa criteria, STEMI equivalent can be diagnosed. (B) Aspirin ≥ 162 mg should be given. If the patient has not used Aspirin before, 325 mg should be given. (C) When IV NTG is required, if the chest pain symptoms are relieved, the dosage should be adjusted according to the blood pressure. (D) Oral β-blocker drugs can be considered within 24 hours for STEMI/NSTEMI patients without contraindications.

Output: A


Instruction: The Internet is already a part of life. Which of the following will do the most harm to patient privacy and medical confidence?

Input: (A) A motorcycle rider was run over by a truck. He took a photo of the abdominal indentation with his personal mobile phone and synchronized it to his personal cloud drive for future teaching purposes. (B) Posted a photo of a man who was accidentally shot in the head while hunting on Facebook and shared it publicly to remind everyone to pay attention to safety and first aid. (C) An Internet celebrity used his mobile phone to live broadcast his emergency medical treatment. Immediately remind him that it is absolutely not allowed. Photograph other patients, family members and staff. (D) When encountering difficult and complicated diseases, immediately post text and image data without personal information to professional groups to seek opinions from other professionals.

Output: B


Instruction: A fisherman was cut by a shipboard 4 days ago. He started to have difficulty opening his mouth yesterday. Today, he came to the hospital for treatment because of facial spasm (risus sardonicus), abdominal stiffness and muscle spasms. He is conscious. Which of the following statements about this disease is more appropriate?

Input: (A) The mortality rate is about 40%. It is a Gram-negative bacillus infection and can be treated with ceftriaxone. (B) The incubation period can be shorter than one day or longer than one month. The longer the incubation period, the worse the prognosis of the patient. (C) Consider debridement of the wound before administering immunoglobulin. The dose of immunoglobulin for adults is 250 units IM injection. (D) Reduce environmental stimulation during care. If respiratory failure occurs, succinylcholine can be used to assist in intubation.

Output: D


Instruction: Which of the following statements about bacterial meningitis is more appropriate?

Input: (A) Antibiotics should not be given before a lumbar puncture is completed. (B) If pneumococcal meningitis is suspected, dexamethasone is recommended. (C) Analysis of cerebrospinal fluid often reveals high opening pressure, elevated white blood cells, and hyperglycemia. (D) Empirical antibiotics include ceftriaxone and levofloxacin.

Output: B


Instruction: Which of the following patient's behavioral symptoms is more consistent with functional (psychiatric)psychosis?

Input: (A) Occasional visual hallucinations, drowsiness, often not knowing the time, and not recognizing people in places. (B) Sudden onset of confusion, inability to speak, only sounds, and weakness in hands and feet. (C) Unable to do simple calculations, poor recent memory but good long-term memory, unable to feed himself. (D) Delusions, flat expression, incoherent speech, auditory hallucinations, occasionally maintaining a rigid posture.

Output: D


Instruction: For patients with suspected pulmonary embolism, which of the following conditions is most likely to cause a false-negative D-dimer test value?

Input: (A) Pregnancy. (B) Hyperlipidemia. (C) Rheumatoid arthritis. (D) Underwent liposuction and breast augmentation surgery three days ago.

Output: B


Instruction: Which of the following statements about influenza is more appropriate?

Input: (A) Amantadine is no longer recommended for the treatment of influenza due to severe drug resistance. (B) Zanamivir (Relenza®) is an inhaled formulation and is not suitable for patients with renal dysfunction. (C) If a patient has pneumonia and needs to be hospitalized, he or she should immediately report the fourth category of infectious diseases - influenza complicated with severe illness. (D) According to the latest regulations, family members who are close contacts of critically ill patients can be directly given publicly funded preventive anti-influenza drugs.

Output: A


Instruction: Which of the following symptoms is more common in patients over the age of 85 with myocardial infarction?

Input: (A) Chest pain. (B) Dyspnea. (C) Fainting. (D) Altered consciousness.

Output: B


Instruction: Which of the following descriptions of sedatives for acute agitation is more appropriate?

Input: (A)Benzodiazepines can cause ECG changes such as QTc prolongation. (B)First-generation antipsychotics such as Haloperidol do not cause respiratory depression. (C)Second-generation antipsychotics such as Quetiapine do not cause ECG changes such as QTc prolongation. (D)Second-generation antipsychotics such as Risperidone do not cause extrapyramidal symptoms.

Output: B


Instruction: Which of the following statements about cerebral venous thrombosis is more appropriate?

Input: (A) It is a rare and dangerous cause of headaches, with an average age of onset of over 60 years. (B) It is more common in men, especially those with a recent history of surgery. (C) About 80% of cases will develop into cerebral hemorrhage. (D) Clinical manifestations may include thunderclap headache.

Output: D


Instruction: Which of the following statements about syncope is less appropriate?

Input: (A) In addition to heart failure and arrhythmia, if the patient faints while lying on his back or without prodromal symptoms, hospitalization for observation should be considered. (B) If the symptoms are reproduced during carotid sinus massage and the ECG shows an asystole greater than 3 seconds, carotid sinus sensitivity can be diagnosed. (C) If the ECG shows left fascicular block, whether new or old, the mortality rate increases significantly. (D) The most common cause is psychogenic syncope.

Output: D


Instruction: Which of the following statements about diabetic ketoacidosis (DKA) in children is more appropriate?

Input: (A) The standard diagnosis is blood pH less than 7.3, Bicarbonate less than 15 mEq/L, blood glucose greater than 250 mg/dL, and blood ketone bodies. (B) If blood glucose is greater than 500 mg/dL, insulin therapy can be given with a loading bolus of 0.1 unit/kg. (C) If blood pH is 7.1 combined with hemodynamic instability, sodium bicarbonate 0.5-2 mEq/kg can be given. (D) More than 60% of the causes of death in children with diabetic ketoacidosis are related to cerebral edema.

Output: D


Instruction: A 23-year-old male returned to Taiwan from Africa a week ago. The patient complained of high fever of 40.2℃, tremors, general weakness, and abdominal pain. Heart rate was 122 beats/min, and respiration was 24 breaths/min. There was no obvious rash on the body and no joint pain. Laboratory examination revealed total bilirubin 4.9 mg/dL, direct bilirubin 1.1 mg/dL, ALT 247 U/L, and AST 236 U/L. Ultrasound examination revealed an enlarged liver, but no gallstones, bile duct enlargement, or liver abscess. Which of the following tests is most helpful in diagnosis?

Input: (A) Blood smear. (B) Hepatitis markers. (C) Leptospiral microscopic agglutination test. (D) Check the stool for parasites and eggs.

Output: A


Instruction: Neck lesions often cause pain that transfers to the shoulder. Which of the following statements is more appropriate?

Input: (A) Thoracic outlet syndrome is more common in women and is often caused by compression of the brachial nerve plexus and blood vessels. (B) In addition to causing shoulder pain, Pancoast's tumor may also cause Horner syndrome, with symptoms of unilateral constriction, ptosis, and sweating. (C) Brachial plexus neuritis is mostly characterized by weakness, and most cases are not accompanied by pain. (D) Symptoms of cervical compression caused by a herniated C3-C4 disc are similar to those of a rotator cuff tear.

Output: A


Instruction: A 79-year-old female patient was brought to the emergency room by her family and complained of being sleepy for the past three days, but sometimes she could be awake and behave normally. She had no fever or head trauma in the past month, and she had to be shaken vigorously when talking to her. Which of the following statements is more appropriate for this patient?

Input: (A) Infection can cause the above situation, the most common source of infection is meningitis. (B) Urinary retention may contribute to or cause the above situation. (C) If the patient is agitated, the preferred medication is an anti-histamine. (D) Avoid the patient using hearing aids to avoid excessive stimulation.

Output: B


Instruction: A 4-month-old boy developed constipation and poor appetite after consuming a honey-containing food supplement yesterday. He was found to have limb weakness and a temperature of 38.3℃ when he was admitted to the emergency department. Physical examination revealed dilated pupils and no response to light. Which of the following statements is more appropriate about the boy's possible illness?

Input: (A) The muscles innervated by the cranial nerves are the last to be affected. (B) Nausea, vomiting, abdominal cramps and diarrhea or constipation may occur, which can easily be misdiagnosed as acute gastroenteritis. (C) Sympathomimetic symptoms may occur. (D) Typical cases present with symmetrical ascending paralysis without sensory loss or pain.

Output: B


Instruction: A 50-year-old male presented to the emergency department with sudden onset of left upper abdominal pain and vomiting. Past medical history included diaphragmatic hernia and gastroesophageal reflux. Blood pressure 86/40 mmHg, heart rate 121 beats/min, temperature 37°C, respiratory rate 20 breaths/min, SpO₂ 98%. The main abnormalities on physical examination were epigastric bloating, tympanic percussion, and decreased breath sounds in the left lower lung. Laboratory reports revealed lactate 28 mg/dL, pH 7.13, HCO₃-8.1 m Eq/L, and Hb 12 g/dL. A chest X-ray shows that the stomach is distended and located above the diaphragm. In addition to appropriate infusion therapy, which of the following is more appropriate?

Input: (A) Consult for surgical treatment. (B) Arrange for a gastroscopy. (C) Transfuse red blood cell concentrates (PRBCs). (D) Intravenous injection of sodium bicarbonate.

Output: A


Instruction: Fournier's gangrene is a type of necrotizing fasciitis that occurs in the perineum. Which of the following statements is more appropriate?

Input: (A) Women are more likely to develop it than men. (B) Hyperbaric oxygen therapy before and after surgery can improve the patient's mortality rate. (C) About 40% of patients initially have no obvious local symptoms of redness and swelling except pain. (D) Risk factors include alcohol abuse and risky sexual behavior.

Output: C


Instruction: 58-year-old male, began to have difficulty breathing 2 hours ago, SpO₂ 86%, respiratory rate 35 times/min, blood pressure 108/76 mmHg, heart rate 122 times/min. The condition worsened and he was intubated. Which of the following statements is more appropriate?

Input: (A) The ventilator mode should be volume-targeted mode because pressure-targeted mode is more likely to cause harm. (B) When the patient is given 100% oxygen, the patient's blood oxygen analysis PaO2 is 96 mmHg. According to the definition of acute respiratory distress syndrome, the patient should be in moderate respiratory distress. (C) When the patient uses volume-targeted mode, a tidal volume of 10 mL/kg ideal body weight will have better results. (D) When the patient's condition improves and he can breathe on his own, the volume-targeted mode can be changed to pressure support mode, and the patient will be more comfortable.

Output: D


Instruction: Regarding patients with diverticulitis, which of the following statements is less appropriate?

Input: (A) The incidence rate increases with age. Under 40 years old, men are more likely to be affected than women. (B) Half of the patients report having experienced similar abdominal pain in the past. (C) The most common sites of the disease are the transverse colon, sigmoid colon, and ascending colon, respectively. (D) Abdominal CT is the preferred diagnostic tool.

Output: C


Instruction: A facial trauma patient was found to have an orbital fracture and intraorbital ecchymosis on CT scan. The patient complained of blurred vision, swollen and painful eyes, tight eyelids that were difficult to close, and significantly elevated intraocular pressure. Which treatment option is more appropriate?

Input: (A) Canthotomy. (B) Canthotomy + cantholysis. (C) Ice packing. (D) Mannitol 20% 1g/kg bolus.

Output: B


Instruction: Which of the following statements about intercostal nerve block is less appropriate?

Input: (A) Rib fractures are one of the indications. (B) It has a good analgesic effect on thoracic herpes zoster. (C) If long-acting local anesthetics (such as Bupivacaine) are used, the analgesic effect can last for more than 8 hours. (D) After the local injection is completed, a chest X-ray is required to detect whether there is a complication of pneumothorax.

Output: D


Instruction: Which of the following statements about lightning injuries is more appropriate?

Input: (A) It is easy to cause ventricular fiber fibrillation. (B) For unconscious patients, pupil dilation is a sign of poor prognosis. (C) The damage is mostly to the superficial tissue, and fasciotomy is rarely required. (D) Acute kidney damage often occurs.

Output: C


Instruction: Which of the following statements about urinary tract stones is more appropriate?

Input: (A) Alpha-blockers cannot promote the excretion of urinary tract stones, so they are not recommended for patients with urinary tract stones. (B) Uric acid stones often do not show up on X-rays, and the pH value of urine is mostly acidic. (C) There are many risk factors for kidney stones, including obesity, a diet low in salt and meat, gout, and hyperthyroidism. (D) Giving large amounts of intravenous fluids can help control pain or increase the rate of stone excretion.

Output: B


Instruction: Which of the following statements is more appropriate for a peritoneal dialysis patient to present to the emergency department with abdominal pain and cloudy dialysate?

Input: (A) Hospitalization is required as long as there is a fever. (B) Peritonitis can only be diagnosed when the leukocyte count in the ascitic fluid is at least 250/mm³ and the neutrophil count is greater than 50%. (C) Antibiotics should be first-generation cephalosporins (Cefazolin) administered intravenously. (D) The most common pathogen is Staphylococcus epidermidis.

Output: D


Instruction: Which of the following statements is more appropriate for a corneal abrasion?

Input: (A) The cornea should be stained with blue fluorescein before slit-lamp examination. (B) When operating the slit lamp, a yellow-green light source is used to illuminate the surface of the cornea for examination. (C) If a corneal abrasion is confirmed, it is usually recommended to give the patient antibiotic eye ointment. (D) Corneal cells grow slowly, and superficial abrasions usually take more than five days to heal.

Output: C


Instruction: 78-year-old male, long-term smoker. Sudden onset of right chest pain and wheezing, the pain worsened with deep breathing, but there was no significant increase in coughing and sputum. SpO₂ 90%, blood pressure and heart rate are within normal range. Which of the following statements is more appropriate?

Input: (A) If tension pneumothorax is strongly suspected, a CXR should be performed as soon as possible for confirmation. (B) If deep sulcus sign is found on CXR AP view, pneumothorax should be suspected. (C) If seashore sign is found on ultrasound examination, pneumothorax should be suspected. (D) COPD is the most common cause of primary pneumothorax.

Output: B


Instruction: When testicular torsion occurs, there is usually severe scrotal pain. Which of the following statements is more appropriate?

Input: (A) Testicular pain after scrotal trauma is not related to testicular torsion. (B) If the affected testicle is lifted, the pain will be relieved. This is called a positive Prehn's sign. This sign can be used to differentiate epididymitis from the diagnosis. (C) If surgical treatment can be performed within 12 hours, the chance of testicle salvage is as high as 80%. (D) Patients with cryptic testis are also prone to testicular torsion.

Output: D


Instruction: A 60-year-old male with a history of bronchiectasis went to the emergency department for hemoptysis (about 30 mL) and wheezing. Blood pressure 120/80 mmHg, heart rate 85 beats/min, respiration 19 times/min, SpO₂ 96%. Which of the following statements is more appropriate regarding the patient's assessment and treatment?

Input: (A) This patient's vital signs are stable and the amount of blood coughed up in a single cough is small, which meets the clinical definition of minor hemoptysis. (B) Most patients with a small amount of hemoptysis need to be hospitalized for observation for a few days because of the risk of rebleeding. They can go home only after they are stable. (C) While waiting for the test, the patient continues to cough up 200 mL of blood. At this time, the basal hemoglobin may be falsely normal. (D) For early hemostasis treatment of patients with massive hemoptysis, it is recommended to use flexible fiberoptic bronchoscopy for local hemostasis.

Output: C


Instruction: A 30-year-old male went to the emergency room because of severe headache. He had no recent head trauma. Which of the following statements is more appropriate?

Input: (A) If the patient complains that he has never had such pain in his life, more than 50% of him has subarachnoid hemorrhage. (B) The headache has not lasted for more than 6 hours, and the CT scan will have a positive predictive value of nearly 100% for subarachnoid hemorrhage. (C) The headache has lasted for more than 24 hours, and a normal CT scan can rule out subarachnoid hemorrhage. (D) The brain MRI is normal, which can rule out subarachnoid hemorrhage.

Output: B


Instruction: A 50-year-old female has undergone artificial heart valve replacement surgery for rheumatic heart disease and has a high fever and shortness of breath. The body temperature is 38.7°C, the blood pressure is 105/65 mmHg, the heart rate is 105 beats/min, and the SpO₂ is 95%. The patient has grade III systolic murmur. Both CXR and urine tests are normal. Which of the following statements is less appropriate?

Input: (A) To meet the Duke criteria for infective endocarditis, abnormal findings on cardiac ultrasound are necessary. (B) If Coxiella burnetii is cultured in the blood, the condition of possible infective endocarditis is met. (C) If this patient is suspected of infective endocarditis, it is reasonable to use antibiotics combined with gentamycin. (D) If this patient is suspected of infective endocarditis, the patient can continue to use the original anticoagulant.

Output: A


Instruction: A 25-week pregnant woman, sitting in the passenger seat of a car, was sent to the emergency room because of a car accident. Her blood pressure is normal, but there is obvious tenderness in the abdomen. Which of the following statements is more appropriate?

Input: (A) It is still recommended to use seat belts, but it is not recommended to sit in seats equipped with airbags. (B) The first aid and monitoring of fetuses are better than those of pregnant women. (C) Traumatic ultrasound shows ascites, and CT is not recommended to determine the injury. (D) It is recommended to arrange fetal heart rate monitoring and obstetric ultrasound as soon as possible without affecting first aid.

Output: D


Instruction: Which of the following statements is less appropriate regarding the steps of ultrasound-guided central jugular vein catheterization?

Input: (A) The internal jugular vein, internal jugular artery, and thyroid gland must be identified under ultrasound before the needle can be inserted. (B) There are three routes of insertion: central, posterior, and anterior. (C) When using the central route, the direction of needle insertion is toward the patient's xiphoid process. (D) When using the posterior approach, the direction of the needle is toward the patient's sternal notch.

Output: C


Instruction: Which of the following statements about Takotsubo cardiomyopathy is less appropriate?

Input: (A) It may be a cardiomyopathy caused by the use of cocaine. (B) Most patients are postmenopausal women. (C) It often causes apical ballooning of the left ventricle. (D) It causes permanent damage to the myocardial sympathetic nerves.

Output: D


Instruction: Which of the following statements about systemic rheumatic diseases is more appropriate?

Input: (A) Takayasu's arteritis occurs mostly in young men and is often accompanied by symptoms such as fever and abdominal pain. (B) Livedo reticularis accompanied by thrombocytopenia is an important clue for diagnosing Catastrophic antiphospholipid syndrome. The lungs are usually the first organ affected, and the mortality rate is 50%. (C) Raynaud phenomenon is common in patients with systemic sclerosis. Treatment includes rewarming, oral calcium blockers and nitroglycerin ointment. (D) Giant cell arteritis generally occurs in the elderly and is often accompanied by headaches, difficulty opening the mouth (jaw claudication) and hearing loss.

Output: C


Instruction: Which of the following statements about Taiwan's emergency medical rescue system is more appropriate?

Input: (A) It is a Franco-German EMSS system, in which trained EMTs send injured patients to the hospital. (B) Priority Dispatch means that when the dispatcher receives a report, he or she should act quickly. The sooner the ambulance is dispatched, the better. (C) According to the EMT Management Regulations, EMT-I, EMT-II and EMT-P can all perform pre-hospital emergency deliveries. (D) According to the EMT Management Regulations, EMT-I, EMT-II and EMT-P can all measure fingertip blood glucose for patients.

Output: C


Instruction: Which of the following statements is more appropriate for the differential diagnosis of delirium, dementia and psychiatric disorder?

Input: (A) The course of delirium symptoms is usually slower than that of dementia. (B) Dementia and mental illness usually cause hallucinations, but delirium is less likely to occur. (C) Dementia is more likely to cause asterixis, but delirium and mental illness are less likely to occur. (D) Dementia and mental illness are usually alert, while patients with delirium are more likely to be confused or hyperalert.

Output: D


Instruction: When a 2-year-old boy needs intubation for emergency treatment, which of the following statements is more appropriate?

Input: (A) A size 3.5 uncuffed endotracheal tube can be selected. (B) The endotracheal tube is inserted to a depth of approximately 12 cm. (C) It is advisable to use a curved laryngoscope for intubation. (D) If difficult intubation occurs, needle cricothyrotomy should be performed immediately.

Output: D


Instruction: Which of the following statements about rapid sequence intubation is more appropriate?

Input: (A) Ketamine should not be used in patients with severe asthma. (B) Succinylcholine should not be used in patients with myasthenia gravis. (C) For patients with cholinersterase deficiency, succinylcholine should be the first choice of neuromuscular blocking agents. (D) Sugammadex can reverse the effects of depolarizing neuromuscular blocking agents.

Output: B


Instruction: Which of the following statements about the use of local anesthetics is more appropriate?

Input: (A) Adding sodium bicarbonate (NaHCO₃) can prolong the duration of anesthesia. (B) Adding epinephrine can make the effect take effect more quickly. (C) When poisoning causes epilepsy, the first choice of treatment is Levetiracetam. (D) When poisoning causes cardiac arrest, consider using 20% lipid emulsion intravenous injection for treatment.

Output: D


Instruction: A 32-year-old female suffers from Graves' disease and recently stopped taking the medication due to side effects; she is confused, has a temperature of 40.1℃, an irregular heartbeat of 172 beats/min, respirations of 30 breaths/min, and a blood pressure of 177/76 mmHg, physical examination revealed yellowish sclera, wet sounds in the lower lungs and edema in both feet. Which of the following treatments is more appropriate?

Input: (A) Give Amiodarone to treat tachycardia. (B) Combine Acetaminophen and Aspirin to reduce fever. (C) Give diuretics and Nitroglycerine to treat high-output heart failure. (D) Give Methimazole orally first and then Lugol solution 1 hour later.

Output: D


Instruction: Which of the following statements about acute radiation syndrome is more appropriate?

Input: (A) If leukopenia, superficial burns, and gastrointestinal symptoms occur, a preliminary diagnosis of acute radiation syndrome can be made. (B) When the dose exceeds 2Gy, persistent and persistent hypotension, prostration, nausea, vomiting, and explosive bloody diarrhea will occur. (C) The latent duration is independent of the dose received and may last 1 to 3 weeks. (D) The morbidity and mortality depend on the resulting pancytopenia, immunosuppression, and bleeding.

Output: D


Instruction: Which of the following clinical manifestations and physical examinations is more appropriate for lower extremity venous thrombosis (DVT)?

Input: (A) The diameter difference between the left and right legs is measured 10 cm below the tibial tuberosity. If the difference is ≥ 2 cm, the possibility of DVT doubles. (B) DVT of the large occipital vein is less likely to cause phlebitis. (C) About three-quarters of DVT patients have tenderness and redness in the limb swelling, which is often misdiagnosed as cellulitis. (D) DVT of the calf vein may cause a positive Homan's sign, which has a high sensitivity but a low specificity.

Output: A


Instruction: Which of the following is less appropriate for differential diagnosis and assessment of cyanosis in full-term newborns?

Input: (A) If the blood oxygen concentration cannot be increased after 100% oxygen is given for 10 minutes, it may be a congenital heart disease. If necessary, prostaglandin E1 can be used for treatment. (B) If the respiratory rate increases and intercostal retractions are found, and the breath sounds are rhonchi, it may be caused by pulmonary reasons, and meconium aspiration syndrome should be considered. (C) The newborn has hypoglycemia, which is also one of the causes of cyanosis. It needs to be treated with 2 ml per kg of 10% glucose solution intravenously. (D) Except for the abnormal blood oxygen concentration, the newborn's other vital signs such as blood pressure, respiratory rate and heartbeat are normal. The cyanosis is central cyanosis.

Output: D


Instruction: Which of the following pediatric patients with normal activity levels is most in need of prophylactic antibiotic treatment?

Input: (A) A 5-year-old boy who returned from a visit to Southeast Asia with his parents had multiple episodes of uncontrollable watery rice water stools during quarantine, but no obvious abdominal cramps. (B) A 4-year-old girl who developed a fever and abdominal cramps after eating raw eggs, and whose stool contained blood and mucus, but no arthralgia. (C) A 6-year-old boy who developed a fever, abdominal pain, and diarrhea after eating undercooked chicken, but no cramps. (D) A 5-year-old boy drank raw water while camping with his parents and developed a fever, right lower abdominal pain, and diarrhea with blood and mucus, but no chest tightness.

Output: A


Instruction: Which of the following is more appropriate regarding cardiac trauma?

Input: (A) Cardiac punctures are most likely to occur in the right ventricle. (B) If blunt cardiac arrest does not resume heartbeat after 20 minutes of first aid, resuscitative thoracotomy may be considered. (C) The diagnostic sensitivity of Troponin for blunt cardiac injury is approximately 70%. (D) Cardiac ruptures caused by blunt cardiac injury are most likely to occur in the right ventricle.

Output: A


Instruction: Which of the following treatments is more appropriate for the treatment of croup?

Input: (A) A single dose of steroids is sufficient, and no maintenance dose is required. (B) Intravenous steroids are more effective than oral steroids. (C) Patients with mild severity do not need to be given steroids. (D) Dexamethasone is not recommended for steroids.

Output: A


Instruction: A 35-year-old male developed headaches, persistent coughing with bloody sputum, and dyspnea while climbing Mount Yushan. Which of the following statements is more appropriate?

Input: (A) Give acetazolamide. (B) Give dexamethasone. (C) Give acetaminophen. (D) Give nifedipine.

Output: D


Instruction: Which of the following descriptions of Atypical Pneumonia is less appropriate?

Input: (A)Chlamydia infection Chest X-ray often shows patchy subsegmental infiltration. (B)Mycoplasma sometimes causes extrapulmonary symptoms, such as arthritis, rash, and neurological symptoms. (C)Long-term smokers, transplant recipients, and immunocompromised people are more susceptible to Legionella infection. (D)Empirical antibiotic treatment should at least select second-generation β-lactam antibiotics Cephalosporins or Penicillins.

Output: D


Instruction: A 62-year-old female patient came to the emergency department because of left lower abdominal pain. Clinically, acute sigmoid diverticulitis was suspected. Which of the following accompanying symptoms is more common?

Input: (A) Vomiting. (B) Dysuria. (C) Changes in bowel habits. (D) Anorexia.

Output: C


Instruction: Which of the following is the main difference between spontaneous pneumomediastinum and spontaneous pneumothorax?

Input: (A) Cough. (B) Occurring during strenuous exertion. (C) Chest pain. (D) Tachycardia.

Output: B


Instruction: Which of the following statements about acute heart failure is inappropriate?

Input: (A) If hypotension is found after using Nitroglycerin, consider giving 250-1,000 mL of normal saline solution. (B) Acute heart failure can be diagnosed by ultrasound showing bilateral B lines and inferior vena cava greater than 2 cm. (C) Non-invasive positive pressure respiration can reduce the chance of intubation and improve respiratory distress. (D) Using diuretics alone may increase mortality.

Output: B


Instruction: Which of the following is a high-risk group for successful suicide?

Input: (A) Took 24 tablets of Nitroglycerin last month. (B) Do not like to accept help from others. (C) Loss of self-control ability. (D) Patients with substance abuse.

Output: C


Instruction: Which of the following statements about the use of lipid emulsions to treat drug poisoning is more appropriate?

Input: (A) Lipid emulsions are ineffective in treating local anesthetic poisoning. (B) They can be considered for use in cases of fat-soluble drug poisoning (such as beta-blockers) that are ineffective with other treatments. (C) They are not recommended for patients with low blood pressure. (D) They cannot be given as bolus because of common side effects, such as acute allergies, hyperlipidemia, pancreatitis, and fat embolism.

Output: B


Instruction: An 88-year-old male has had fever, wheezing, and confusion for the past two days. He was hospitalized four times for COPD-related infections and was just discharged home two weeks ago. Which of the following is less appropriate for this patient's condition?

Input: (A) Common bacterial species in patients with acute COPD exacerbation are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. (B) In addition to infections, other causes should still be considered, such as pneumothorax and pulmonary embolism. (C) Considering that the patient was hospitalized two weeks ago, Pseudomonas aeruginosa should be included in the antibiotic selection. (D) Arterial blood test: pH 7.01, PCO₂ 90 mmHg, and then evaluate the patient to find that GCS E2V2M4, BiPAP should be used as soon as possible to improve the clinical condition.

Output: D


Instruction: A 30-year-old healthy male developed fever and general malaise and altered consciousness one day ago. His wife brought him to the emergency room. The patient's cerebrospinal fluid Gram stain showed Gram-positive diplococci. Which of the following drug preventive treatments for his wife is more appropriate?

Input: (A)Ciprofloxacin 500 mg PO × 1 dose. (B) Rocephin 250 mg IM × 1 dose. (C) Rifampin 600 mg PO Q12H for two days. (D) No preventive medication is required.

Output: D


Instruction: A 26-year-old female patient comes to the emergency department and complains of frequent binge eating behavior in the past year. She often induces vomiting to eliminate the food she eats. The patient's BMI is 21. Based on the above situation, which of the following statements is more appropriate?

Input: (A) According to DSM-V, people with normal BMI do not meet the diagnosis of eating disorder. (B) People who frequently induce vomiting may have painless parotid enlargement and calluses on the backs of their fingers. (C) When giving injections to patients with long-term malnutrition, special attention should be paid to whether it will cause hyperphosphatemia. (D) Inducing vomiting too vigorously may cause Boerhaave syndrome, combined with right thoracic abscess.

Output: B


Instruction: Which of the following is not included in the general characteristics of organic psychosis in children?

Input: (A) Delirium. (B) Visual hallucinations. (C) Auditory hallucinations. (D) Acute onset.

Output: C


Instruction: A 50-year-old female fell from a height and was unconscious. She was suspected of intracranial hemorrhage. Her blood pressure was 105/71 mmHg, her heart rate was 95 beats/min, and her SpO₂ was 92%. Which of the following statements is more appropriate?

Input: (A) Ketamine is the preferred induction agent. (B) The cervical collar can be opened first during intubation and then continued after insertion. This process requires the cooperation of at least two people. (C) Permissive hypotension is also suitable for this patient. (D) Mannitol has been proven to be ineffective for this patient and is not recommended for use even when blood pressure is normal.

Output: B


Instruction: A 55-year-old male with a history of chronic pulmonary hypertension complained of wheezing without activity for 1 day, with a temperature of 36.1℃, a heart rate of 140 beats/min, respirations of 35 breaths/min, a blood pressure of 115/80 mmHg, and SpO₂ of 75%. He was immediately intubated with an endotracheal tube and a ventilator upon arrival. Which of the following treatments is more appropriate?

Input: (A) Use Dopamine for treatment, because its β-agonist effect can improve RCA perfusion, and its inotropic effect can relieve right heart failure. (B) The blood oxygen target is to maintain SpO₂>90%, and the positive end-expiratory pressure (PEEP) should be increased as much as possible to avoid airway collapse. (C) Avoid using Norepinephrine, because its β-agonist effect will increase pulmonary artery pressure. (D) Milrinone can be used for treatment, but close monitoring is required to avoid hypotension.

Output: D


Instruction: Which of the following statements about pulmonary embolism is less appropriate?

Input: (A) The reference value of D-dimer should be adjusted upward with age, and the most commonly used method is (age x 10 ng/mL). (B) D-dimer has sufficient sensitivity and specificity, and still has sufficient reliability and validity 6 days after pulmonary embolism. (C) POCUS can show RV/LV ratio>1 and dilated IVC. (D) Common ECG abnormalities include sinus tachycardia, V1-4 T wave inversion and RBBB.

Output: B


Instruction: Which of the following statements about hypertrophic cardiomyopathy is less appropriate?

Input: (A) Clinical manifestations include shortness of breath combined with chest pain, palpitations, and syncope during activity. (B) Chest pain is best treated with nitroglycerin. (C) Diagnosis can be made with cardiac MRI or echocardiography. (D) Hypertrophic cardiomyopathy with syncope requires hospitalization.

Output: B


Instruction: A 35-year-old female complained of severe lower abdominal pain and nausea for about one day, with blood pressure of 132/84 mmHg, heart rate of 65 beats/min, respiration of 22 times/min, and body temperature of 36.4℃. She recently received IVF treatment in the clinic, underwent egg retrieval surgery 2 weeks ago, and 2 embryos were implanted 3 days after egg retrieval. Physical examination revealed obvious tenderness in the lower abdomen and pelvic cavity without rebound pain; white blood cell count of 14,600/mm³, Cr 0.78 mg/dL, Na 132 m Eq/L, β-hCG 453 mIU/mL; abdominal ultrasound revealed swollen ovaries and ascites, and no gestational sac was found in the uterus. Which of the following treatments and judgments is less appropriate?

Input: (A) Inform the obstetrician and gynecologist and conduct a bimanual pelvic examination. (B) Ectopic pregnancy must be included in the differential diagnosis, and the β-hCG index can be tracked after 48 hours. (C) Forced abortion must be taken into consideration and progesterone should be given intramuscularly. (D) Appropriate intravenous infusion and NSAIDs should be given for pain relief.

Output: A


Instruction: Which of the following descriptions of lower limb tendon injuries is less appropriate?

Input: (A) Achilles tendon rupture often presents with sudden pain and inability to stand on tiptoe. (B) A small number of people with complete Achilles tendon rupture are able to walk, and are easily misdiagnosed as ankle sprains. (C) Rupture of the anterior tibialis tendon is very rare and generally not very painful. Most cases do not require surgery. (D) Rupture of the posterior tibialis tendon has a slower and less obvious course of disease and often occurs in young men under 40 years old.

Output: D


Instruction: A 30-year-old male patient suffers from temporomandibular dislocation after laughing. Which of the following statements is less appropriate for the treatment of this patient?

Input: (A) The patient can be discharged directly after emergency reduction. (B) Before reduction, consider injecting a local anesthetic into the preauricular temporomandibular joint. (C) It is more common to have a posterior dislocation, and attention should be paid to whether the external auditory canal is damaged. (D)The most commonly used reduction method is to have the patient sit up and apply downward and backward force to the patient's lower molars on both sides.

Output: C


Instruction: Which of the following statements about diverticulitis is more appropriate?

Input: (A)Patients with recurrences require surgical treatment. (B)The use of antibiotics can prevent complications and recurrence rates. (C)Patients without complications can be considered for discharge from the emergency department and oral medication. (D)Confirmed patients need to fast.

Output: C


Instruction: For patients with acute respiratory distress, an emergency bedside lung ultrasound scan (BLUE protocol) is performed. Which of the following statements is less appropriate?

Input: (A)A-profile, the most likely diagnosis is pneumothorax. (B) B-profile, most likely diagnosis is pulmonary edema, but also possible interstitial pneumonia and pulmonary fibrosis. (C) A/B-profile, most likely diagnosis is pneumothorax. (D) B' or C-profile, most likely diagnosis is pneumonia.

Output: C


Instruction: A 76-year-old male with no history of chronic diseases and no use of anticoagulants. He presented to the emergency department with hemoptysis and normal vital signs. Which of the following statements is more appropriate?

Input: (A) The more common definition of massive hemoptysis is coughing up more than 1,000 ml of blood within 48 hours. (B) The first-line imaging diagnostic tool is chest X-ray, and nearly 50% of patients receive a preliminary possible diagnosis. (C)Fiberoptic bronchoscopy is more convenient than rigid bronchoscopy to stop bleeding in cases of massive hemoptysis. (D)When intubation is required, it is recommended to use a small endotracheal tube to avoid injuring the tracheal mucosa.

Output: B


Instruction: Which of the following statements is more appropriate when using a tourniquet for trauma?

Input: (A)If there is massive bleeding from a limb, it should be used immediately. (B)If the tourniquet is placed in the groin or axilla, a second tourniquet can be used if necessary. (C)Tourniquets placed on the upper limbs require greater pressure to stop bleeding than those placed on the lower limbs. (D)It has been shown that prolonged use may increase nerve or muscle damage.

Output: B


Instruction: A 30-year-old female was rescued from a fire. She weighed 60 kg and had burns covering 40% of her body surface area. There was carbon deposition in her oropharynx. Which of the following treatments is more appropriate?

Input: (A) According to the Parkland Formula, drip Ringer's solution at a rate of 150 ml per hour for the first 8 hours. (B) Place a nasogastric tube to reduce pressure, but glucose infusion is generally not required for the first 24 hours. (C) Give morphine for analgesia. To reduce the risk of respiratory depression, intramuscular injection is preferred to intravenous injection. (D) Give steroids to reduce laryngeal edema. Hydrocortisone 100mg STAT+Q8H IV.

Output: B


Instruction: A 77-year-old male with a history of myocardial infarction presents to the emergency department with labored breathing, orthopnea, and bilateral edema over the past two weeks. Which of the following statements is more appropriate?

Input: (A) If hypotension occurs after nitroglycerin treatment, the drug should be stopped first. If hypotension persists, cardiotonic drugs should be used. (B) If shock and hypertrophic obstructive cardiomyopathy occur, phenylephrine treatment is a good choice. (C) If a non-invasive positive pressure ventilator is used in combination with drug treatment, the in-hospital mortality rate can be significantly reduced. (D) When performing focused care ultrasound, E-point septal separation and fractional shortening are highly reliable indicators of left ventricular function.

Output: B


Instruction: Which of the following statements about toxic epidermal necrolysis is more appropriate?

Input: (A) It manifests as large areas of painful erythema, blisters and epidermal peeling on the skin, and does not invade the mucous membranes. (B) Early use of prophylactic antibiotics is recommended to prevent wound infection. (C) Such skin lesions are less likely to show Nikolsky sign. (D) Drugs are the most common cause of this disease.

Output: D


Instruction: A 3-year-old boy, weighing 15 kg, has been vomiting and diarrhea for 2 days. He is drowsy and has low activity, blood pressure 80/60 mmHg, heart rate 130 beats/min, respiratory rate 25 times/min, and body temperature 37.5℃. Which of the following statements is more appropriate?

Input: (A) The estimated amount of dehydration is 0.45 kg. (B) The first-line treatment is oral rehydration. (C) The initial dose of water replenishment is 1,000 cc of normal saline. (D) The maintenance dose of water replenishment is 1,250 cc of 0.9% normal saline or D5S glucose saline per day.

Output: D


Instruction: Which of the following statements about patients with mood disorders is more appropriate?

Input: (A) Depression is more likely to be inherited than bipolar disorder. (B) Manic patients' symptoms of racing thoughts can last for more than seven days. (C) Antidepressants should be given as early as possible to patients who may develop agitation. (D) Parkinson's disease is less related to depression.

Output: B


Instruction: A 26-year-old female patient has a history of deep venous embolism (DVT). She took warfarin for a long time before pregnancy and has stopped taking it because of pregnancy. She has difficulty breathing and is suspected of having a large-scale pulmonary embolism. Which of the following is more appropriate?

Input: (A) After the patient is stabilized by emergency treatment, she can continue to take warfarin to prevent the recurrence of thromboembolism. (B) If the patient does not have an acute bleeding tendency, there is no need to wait for a definitive diagnosis. Heparin can be given directly intravenously. (C) If the patient has renal failure, it is better to use low molecular weight heparin than unfractionated heparin. (D) Low molecular weight heparin can cross the placenta and cause teratogenicity, so it can only be given subcutaneously.

Output: B


Instruction: Which of the following statements about hypoglycemia is more appropriate?

Input: (A) The clinical manifestations of hypoglycemia can be divided into neuroglycopenic and autonomic symptoms; the manifestations of neuroglycopenic include anxiety, tremors, sensory abnormalities, and sweating. (B) Hypoglycemia caused by sulfonylurea overdose should be treated routinely with hemodialysis and activated carbon hemoperfusion. (C) For recurrent hypoglycemia caused by sulfonylurea, after glucose treatment, octreotide can be considered to reduce the risk of recurrent hypoglycemia. (D) Glucagon treatment of patients with hypoglycemia can increase blood sugar by 200 mg/dL.

Output: C


Instruction: Regarding ovarian torsion, which of the following statements is less appropriate?

Input: (A) Ovarian torsion is more likely to occur on the right side, and most patients experience nausea and vomiting. (B) The twisted ovary or mass is usually larger than 4 or 5 cm, but ovarian torsion that occurs before the onset of menstruation is usually normal size. (C) Torsion during pregnancy is common in the first trimester and early second trimester. (D) Ovarian torsion can be ruled out if there is a signal of ovarian blood flow on Doppler ultrasound.

Output: D


Instruction: Regarding diving-related diseases, which of the following statements is more appropriate?

Input: (A) Diving in shallow water will not cause pulmonary bronchitis. (B) After shallow water diving, it is relatively safe to stop diving and fly 2 days later. (C) Symptoms of decompression often develop gradually a few days after diving. (D) Complaining of shoulder pain after diving is a common symptom of type II decompression.

Output: B


Instruction: Which of the following descriptions of complications of head trauma is more appropriate?

Input: (A) Post-concussion syndrome has a good prognosis, and its prevalence rate is less than 5% one year after injury. (B) Chronic traumatic encephalopathy is more common in the elderly and often occurs after multiple head injuries. (C) Subdural hemorrhage (D) Second impact syndrome is caused by cerebral edema that occurs rapidly after a head impact, and the mortality rate can be as high as 60%.

Output: D


Instruction: A 26-year-old man complained of fever, dysuria with white discharge, and erythematous pain and swelling in the right knee joint for 3 days. Fluid from the right knee joint showed a white blood cell count of 68,000/mm³ and 92% neutrophils. Which treatment is less appropriate for this patient?

Input: (A) The first choice drug is Ceftriaxone, with a dose of 1 gm QD. (B) If the treatment is combined with Chlamydia For comorbid infection of trachomatis, Azithromycin can be used at a dose of 1 gm orally once. (C) An alternative drug is Doxycycline at a dose of 100 mg orally BID. (D) Joint fluid glucose and protein are helpful in the clinical diagnosis of this disease.

Output: D


Instruction: Which of the following clinical manifestations of aneurysm is more appropriate?

Input: (A) Popliteal artery aneurysm is defined as a tumor larger than 3 cm or 200% of the normal blood vessel diameter. It is the most common peripheral hemangioma. Clinical manifestations include swelling behind the knee and discomfort. (B) If the patient has upper limb pain, weakness, and non-segmental sensory changes, subclavian artery aneurysm should be considered. (C) The clinical manifestations of hepatic artery aneurysm may include biliary colic and upper gastrointestinal bleeding. If it ruptures and enters the common bile duct, biliary bleeding (hemobilia) may occur, but it will not manifest as jaundice. (D) Renal artery aneurysm may clinically present with low back pain and hematuria. Once ruptured, it may cause shock, but it will not cause obstruction of the urinary collecting system.

Output: B


Instruction: According to the AHA 2020 ACLS guidelines, which of the following statements is inappropriate for the care of patients after cardiac arrest and resuscitation?

Input: (A) For patients using ventilators, it is recommended to maintain SpO₂ at 92%-98%, and try to avoid prolonged hyperoxia PaO 2>300 mmHg. (B) It is recommended to maintain the partial pressure of carbon dioxide in the blood PaCO₂ at 35-45 mmHg. (C) If there is acute respiratory distress syndrome (ARDS), the ventilator tidal volume should be maintained at 4-8 mL/kg of predictive body weight. (D) The incidence of pneumonia in patients after resuscitation is high, and the prognosis of those who develop pneumonia is poor. It is recommended to routinely give broad-acting antibiotics for prevention.

Output: D


Instruction: Which of the following statements about acute myocardial infarction (AMI) and troponin (TnI) is more appropriate?

Input: (A) Six hours after AMI, the specificity of TnI is about 95%. (B) Six hours after AMI, the sensitivity of TnI is about 95%. (C) The value of TnI reaches its peak at about 36 hours after AMI. (D) The value of TnI returns to its original value (baseline) within about 72 hours after AMI.

Output: A


Instruction: Which of the following statements is less appropriate for a 32-week pregnant woman who presents to the emergency department with regular and increasingly frequent contractions and bloody vaginal discharge?

Input: (A) The fetal monitor shows a fetal heart rate of 103 beats/min, which is fetal distress. (B) If a digital vaginal examination is to be performed, a bedside ultrasound should be performed first to rule out placenta previa. (C) If the patient's water has broken, do not perform a digital vaginal examination to detect cervical dilation to avoid infection. (D) If an emergency vaginal delivery is to be performed, use an umbilical cord clamp to secure the fetus and cut the umbilical cord immediately after delivery to facilitate neonatal assessment and management.

Output: D


Instruction: Which of the following descriptions of genital ulcers is less appropriate?

Input: (A) Genital painless chancres can be a manifestation of primary syphilis and may result in a Jarisch-Herxheimer reaction during treatment. (B) The pathogen of syphilis is Treponena pallidum, and Penicillin is still the first choice for antibiotic treatment. (C) When painless chancres occur, testing VDRL/RPR (Venereal Disease Research Laboratory/Rapid Plasma Reagin) can diagnose syphilis. (D) HSV (Herpes simplex virus) can cause painful genital ulcers. Currently, HSV-2 accounts for the majority, but the number of HSV-1 infections continues to increase.

Output: C


Instruction: Which of the following is less appropriate for patients considering hospice and palliative care?

Input: (A) Lung cancer with metastases to the lungs, brain, and multiple bones. After trying targeted therapy and immunotherapy, the disease persists. ) The patient's condition worsened. He started tube feeding last month and his mental state gradually deteriorated. (B) An 80-year-old man had multiple myocardial infarctions and had 9 vascular stents installed. He was hospitalized four times in three months for heart failure and his discharge days were getting shorter and shorter. (C) After surgery for colorectal and bladder cancer, he had been on hemodialysis for eight years for terminal kidney disease. Recently, he expressed that he did not want to continue dialysis due to multiple blockages in the dialysis vessels. (D) A 40-year-old man trapped in a fire was intubated after escaping from smoke inhalation. When he arrived at the hospital, he had E2M5Vt and second- to third-degree burns except for the perineum.

Output: C


Instruction: Which of the following descriptions of Wellens' syndrome is less appropriate?

Input: (A) The patient's cardiac enzyme test is likely within the normal range. (B) When the patient has chest pain, the ECG may not show abnormal changes. (C) Deep and symmetrical inverted T waves may be found in some of the extremities of the ECG. (D) 25% of patients will have biphasic T waves on the ECG.

Output: C


Instruction: A 1-year-old infant vomits 5 times and has diarrhea 5 times. His vital signs are stable. There are no obvious abnormalities in physical and blood tests. He is not dehydrated. Which of the following treatments is more appropriate?

Input: (A) Loperamide can be used. (B) The BRAT diet (Banana, Rice, Applesauce, and Toast diet) is recommended. (C) The child's symptoms are still mild, so he can fast for four to six hours first. (D) Dopamine receptor agonists should not be used.

Output: D


Instruction: Which of the following statements about bacterial tracheitis in children is more appropriate?

Input: (A) Tenderness in the tracheal area is less common. (B) Neck X-rays may reveal supraglottic stenosis and irregular tracheal margins. (C) After intubation, bronchoscopy may aid in diagnosis and treatment. (D) Standard treatment requires the use of broad-spectrum antibiotics and steroids.

Output: C


Instruction: Which of the following statements about diabetic ketoacidosis (DKA) is more appropriate?

Input: (A) The initial blood glucose level in pregnant women with DKA is higher than that in normal patients. (B) The rate of blood sugar decline needs to be controlled at 50-75 mg/dL per hour. (C) Cerebral edema is a complication of DKA treatment and is more common in the elderly. (D) If the initial blood sugar is below 270 mg/dL, the possibility of DKA can be ruled out.

Output: B


Instruction: Which of the following is more appropriate for the examination and diagnosis of facial trauma?

Input: (A) When the eye is injured, if binocular diplopia occurs, it may be caused by lens dislocation. (B) The tongue blade test can assess whether the patient has an orbital bone fracture. (C) When the eye reacts to light with a Marcus Gunn pupil, optic nerve damage should be considered. (D) When the patient's nasal secretions are suspected to be cerebrospinal fluid leakage, beta-2 microglobulin in the secretions can be detected as a differential diagnosis.

Output: C


Instruction: Which of the following statements is more appropriate for the treatment of deep vein embolism or pulmonary embolism in pregnant women?

Input: (A) Wells score is applicable to pregnant women to evaluate deep vein embolism. (B) MRI/MRV with contrast agent has been shown to be effective in diagnosing pelvic deep vein embolism and is safe for pregnant women and fetuses. (C) Pregnant women with pulmonary embolism and unstable hemodynamics should be treated with Warfarin. (D) For pregnant women with stable hemodynamics, if ultrasound reveals deep venous embolism, anticoagulant therapy can be used if pulmonary embolism is clinically suspected.

Output: D


Instruction: A 26-year-old female patient with schizophrenia and no history of alcohol abuse is sent to the emergency department. The patient is roaring and agitated on the stretcher. Which next step is more appropriate?

Input: (A) Benzodiazepine should be the first choice of medication, such as intramuscular injection of Lorazepam. (B) Considering the medical history, Olanzapine IM can be chosen as the first choice at this time. (C) Use a constriction band as soon as possible to protect the patient and reduce the use of injections to avoid respiratory depression. (D) If the patient is pregnant, it is recommended that Haloperidol be used first.

Output: B


Instruction: A 40-year-old female with a history of asthma who takes medication regularly presents to the emergency department with labored breathing. Which statement is more appropriate for this patient?

Input: (A) After the endotracheal tube is inserted, the patient's tracheal obstruction pressure can be improved through a ventilator. (B) If this patient requires intubation, Ketamine will cause a significant increase in catecholamine and is contraindicated in such patients. (C) Patients hospitalized for acute asthma attacks should undergo CXR because there is a 50% chance of abnormality. (D) The combination of short-acting β-agonist and multi-dose Ipratropium can reduce the hospitalization rate of patients with moderate to severe acute asthma attacks.

Output: D


Instruction: Which of the following statements about sore throat is less appropriate?

Input: (A) Patients with dysphagia and shortness of breath should undergo immediate neck CT. (B) Group A β-hemolytic Streptococcus acute pharyngitis, with Penicillin as the first line of treatment. (C) Most deep neck infections are odontogenic, mostly in mandibular teeth. (D) When performing fine needle aspiration of tonsil abscesses, the needle should not be inserted more than 1 cm deep.

Output: A


Instruction: Which of the following statements is more appropriate regarding care after post-cardiac arrest syndrome?

Input: (A) Immediately after return of spontaneous circulation (ROSC), loss of bilateral pupillary light reflexes predicts a low chance of recovery of consciousness. (B) Targeted temperature management is not recommended for patients with prehospital OHCA who initially have a non-shockable rhythm. (C) For patients who are unconscious after resuscitation from cardiac arrest, routine use of anti-epileptic drugs is recommended to reduce the risk of non-convulsive status epilepticus. (D) Consciousness and neurological examination results after ROSC should not be used to determine whether a patient should undergo emergency cardiac catheterization.

Output: D


Instruction: A 60-year-old male patient began to have upper abdominal pain 2 hours ago, and had severe nausea and multiple bilious vomiting 1 hour ago. The patient has no history of heart disease and the electrocardiogram is normal. Which of the following is the most likely cause of the patient's vomiting?

Input: (A) Achalasia. (B) Gastric outlet obstruction. (C) Large bowel obstruction. (D) Small bowel obstruction.

Output: D


Instruction: Which of the following is less appropriate for the examination and management of an emergency patient with low back pain?

Input: (A) A positive crossed straight leg raise test on the nonsymptomatic side is highly specific but has low sensitivity for the diagnosis of a herniated disc. (B) For suspected dural compression caused by a tumor, dexamethasone should be used before definitive testing. (C) Neuropathic claudication due to lumbar spinal stenosis is aggravated by flexion of the spine and relieved by extension. (D) Cerebrospinal fluid examination in transverse myelitis often shows lymphocytosis. phocytosis) and elevated protein.

Output: C


Instruction: Which of the following statements about catastrophic antiphospholipid syndrome is more appropriate?

Input: (A) Only in a minority of patients can a precipitating factor be identified, such as infection, surgery, trauma, and exposure to exogenous estrogens. (B) The lungs are the most important organ affected, followed by the kidneys, central nervous system, heart, and skin. (C) Livedo reticularis may be found in the abdomen, and a minority of patients may develop thrombocytopenia. (D) Because unfractionated heparin has anti-inflammatory properties and is safe and effective, anticoagulant therapy is recommended for this population.

Output: D


Instruction: A pregnant woman with acute abdominal pain is diagnosed as acute appendicitis. Which of the following statements is more appropriate?

Input: (A) The incidence of appendicitis in pregnant women is about twice that of non-pregnant women. (B) Even in the third trimester, most pregnant women still experience appendicitis pain in the right lower abdomen. (C) Due to changes in the anatomical position of pregnant women, acute appendicitis most often occurs in the third trimester. (D) The incidence of fetal miscarriage in pregnant women with acute appendicitis and perforation is about 50%.

Output: B


Instruction: Regarding carbon monoxide poisoning, which of the following statements is more appropriate?

Input: (A) If epileptic symptoms occur, hyperbaric oxygen therapy is not yet indicated. (B) If the woman is pregnant, conscious, and has a COHb level of 10%, she is eligible for hyperbaric oxygen therapy. (C) If the SpO₂ measured by a pulse oximeter is > 94%, oxygen therapy is not necessary. (D) If severe metabolic acidosis occurs, she is eligible for hyperbaric oxygen therapy.

Output: D


Instruction: Which of the following statements is more appropriate for the treatment of foreign bodies in the esophagus?

Input: (A) If a child accidentally swallows a button battery, conservative treatment is usually safer. (B) Sharp foreign bodies often cause intestinal perforation after passing through the stomach. (C) Patients with esophageal obstruction will not experience dyspnea clinically. (D) Lithium batteries have a lower voltage and therefore cause less damage.

Output: B


Instruction: A 44-year-old male with a history of diabetes has had redness and swelling of the right lower limb for 3 days and a fever and went to the emergency room. Which of the following statements is more appropriate?

Input: (A) If he has been in contact with seawater, Vibrio vulnificus infection should be considered, and Vancomycin is the first choice for treatment. (B) The skin in the red and swollen area is intact without wounds and blisters, so necrotizing fasciitis can be ruled out. (C) Blisters appear in the red and swollen skin, and a CT scan is required to confirm necrotizing fasciitis. (D) Computed tomography revealed air in the soft tissue, which can be diagnosed as necrotizing fasciitis.

Output: D


Instruction: A 9-year-old child weighing 30 kg was sent to the emergency room due to abdominal contusion. He was conscious but had rapid breathing and cold sweats. He had abdominal tenderness combined with rebound pain, blood pressure of 100/50 mmHg, and heart rate of 130 beats/min. Which of the following treatments is more appropriate?

Input: (A) After evaluation, if there is internal bleeding, the bleeding grade is moderate (blood volume loss 30-45%). (B) Give 10 mL/kg isotonic crystalloid solution for the first infusion and re-evaluate. (C) If shock persists after the first infusion, a second or third 20 mL/kg isotonic crystalloid solution can be given. (D) If transfusion therapy is performed with 20 mL/kg PRBCs transfusion therapy.

Output: C


Instruction: For patients with terminal cancer who are receiving palliative care, if they have severe pain that cannot be relieved and come to the emergency department, which of the following analgesics is more appropriate?

Input: (A) Use oral Morphine. If the effect is not good after 60 minutes, add intravenous Morphine. (B) Use subcutaneous Morphine. If the effect is not good after 30 minutes, add intravenous Morphine. (C) Use intravenous Morphine. Inject it again after 15 minutes until the pain is relieved. (D) Use intramuscular Morphine. Inject it again after 20 minutes until the pain is relieved.

Output: C


Instruction: For pain caused by fractures in different parts, when performing ultrasound-guided nerve blocks in the emergency department for analgesia, which of the following pairs is less appropriate?

Input: (A) Mid-clavicular fracture → supraclavicular brachial plexus nerve block. (B) Right shoulder dislocation and humeral neck fracture → interscalene brachial plexus nerve block. (C) Left chest wall rib fracture → paravertebral nerve block. (D) Femoral neck fracture → fascia iliaca nerve block.

Output: A


Instruction: Which of the following statements is more appropriate for the treatment of snake bites in children?

Input: (A)The amount of serum administered to children should be reduced according to body weight. (B)If an intravenous line cannot be established, intraosseous injection can be used. (C) Start with a small dose and increase it as needed. (D) When there is limb swelling, fasciotomy should be considered.

Output: B