Instruction: A young male with no medical history was sent to the emergency room due to altered consciousness while participating in a marathon. He was unconscious on arrival, with a temperature of 42°C and dry, hot skin. Blood tests for white blood cells and CRP were both within normal ranges, with no evidence of meningitis. CT and chest X-rays were also normal. Which of the following statements is correct?

Input: (A) Patients with parasympathetic stimulant overdose will also have similar clinical manifestations. (B) The patient should be cooled quickly to below 37°C to reduce the damage to the nerves caused by high body temperature. (C) During the cooling process, if the patient shivers, he can be treated with short-acting benzodiazepine. (D) After adequate fluid therapy, if hypotension persists, Norepinephrine should be used as a pressor. (E) Because the patient is dehydrated, typical hyperkalemia and hypernatremia can be seen in the blood.

Output: C


Instruction: Which of the following statements about lower limb ligament injuries is correct?

Input: (A) When a patient is suspected of having anterior cruciate ligament rupture, the sensitivity of the physical examination Lachman test is higher than that of the anterior drawer sign. (B) Posterior cruciate ligament rupture is more likely to occur than anterior cruciate ligament rupture. (C) Long-term use of steroids or third-generation cephalosporins are risk factors for spontaneous tendon rupture. (D) Spontaneous posterior tibialis tendon rupture often occurs during strenuous exercise, so young male patients are more likely to suffer from it. (E) When joint hematoma occurs, the probability of posterior cruciate ligament rupture is higher than that of anterior cruciate ligament rupture.

Output: A


Instruction: Which of the following statements about Antiphospholipid Syndrome is incorrect?

Input: (A) It is more common in women. (B) When acute thrombosis is suspected, D-dimer is an important test to determine the risk of this disease. (C) Patients with positive reaction to Lupus anticoagulant have a 50% chance of developing arteriovenous embolism within 20 years. (D) This disease is treated with Warfarin, and the International Normalized Ratio (INR) should be maintained at 3. (E) Pregnant women with Antiphospholipid Syndrome can be treated with low molecular weight heparin or low-dose aspirin.

Output: B


Instruction: Which of the following statements about Gout is incorrect?

Input: (A) It often occurs in the first metatarsophalangeal joint of the big toe, but it may occur in joints throughout the body. (B) The diagnosis must be confirmed by testing the crystal composition of the joint fluid. (C) If it cannot be differentiated from septic arthritis, hospitalization is the safest approach. (D) Generally speaking, pain is relieved in about 2 days after administration of NSAIDs. (E) Intravenous colchicine is often associated with serious side effects, such as bone marrow suppression, so it is rarely used.

Output: D


Instruction: Which of the following statements about acute sinusitis is incorrect?

Input: (A) The top three common pathogens are the same as the common pathogens of otitis media. (B) Clinical manifestations include yellow-green thick nasal discharge, nasal congestion, fullness of the nose and face, and even decreased sense of smell. (C) For patients with yellow-green thick nasal discharge, the possibility of bacterial infection must be highly suspected and antibiotic treatment must be given. (D) For patients who are allergic to penicillin, Cefuroxime is a reasonable alternative to antibiotics. (E) The diagnostic value of X-ray examination is not high and is not routinely recommended for all patients with acute sinusitis.

Output: C


Instruction: Which of the following statements about myasthenia gravis is incorrect?

Input: (A) Most patients present with general weakness, especially in the proximal limb muscle groups. (B) Elderly patients with new facial muscle weakness are easily misdiagnosed as having a stroke. (C) Patients often have worsening respiratory failure due to infection, surgery, or discontinuation of medication. (D) If a patient requires intubation for respiratory failure, pancuronium is the first choice. (E) Patients with heart disease may experience bradycardia when treated with edrophonium.

Output: D


Instruction: Which of the following is incorrect about the management of complications after receiving Fibrinolytic therapy?

Input: (A) After starting Fibrinolytic therapy, check hemoglobin every 4 to 6 hours. When hemoglobin drops > 1 to 2 g/dL, bleeding should be suspected. (B) When a patient has intra-abdominal or intracranial bleeding, thrombolytic drugs, antiplatelet drugs and heparin should be stopped immediately. (C) If a patient has bleeding at the injection site, protamine should be injected immediately. (D) If bleeding occurs after receiving heparin, protamine can be injected. (E) In case of massive bleeding, blood coagulation factor cryoprecipitate or FFP should be transfused.

Output: C


Instruction: Which of the following factors is less relevant to inducing acute angle-closure glaucoma?

Input: (A) Use ocular antihistamines. (B) Use pseudoephedrine for patients with nasal congestion. (C) Use inhaled ethylenediamine sympathetic stimulants for patients with asthma. (D) Bright light environment. (E) Emotional stress.

Output: D


Instruction: From December to March of the following year, influenza is prevalent. Emergency rooms in major hospitals are crowded with patients with fever. Which of the following statements about severe complications of influenza is incorrect?

Input: (A) The reporting condition is that the patient needs to be treated in the intensive care unit or dies within one week due to complications such as pneumonia after the onset of influenza-like symptoms. (B) It is currently a Category 4 infectious disease and must be reported within one week. (C) Both type A and type B influenza can be treated with Zanamivir. (D) Zanamivir mainly reduces the severity of infection by inhibiting neuraminidase. (E) Since 2016, the seasonal influenza A types in Taiwan are mainly H1N1 and H3N2.

Output: A


Instruction: According to the Regulations on the Management of Necessary Emergency Rescue Equipment in Public Places, regarding the use of Automated External Defibrillators (AEDs) in public places, which of the following does not belong to the eight categories of public places specified in the regulations?

Input: (A) Taoyuan Chiang Kai-shek International Airport. (B) Guanxi Rest Area of Taipei Second High School. (C) Taiwan Railway stations above second-class stations. (D) Schools above high school. (E) A ferry that can carry 90 people from Tamsui to Bali.

Output: E


Instruction: According to the Guideline of the Wilderness Medical Society in December 2014, regarding the emergency treatment of frostbite, which of the following is not recommended?

Input: (A) Rapidly rewarm the frozen sore limb with warm water at 37-39℃. (B) For blisters containing clear fluid, consider draining the fluid with a needle. (C) For hemorrhagic blisters, use a needle to drain the fluid from the blister. (D) For those at risk of amputation, consider giving thrombolytic agent (tPA) treatment. (E) Consider giving tetanus prophylaxis.

Output: C


Instruction: According to the 2015 new version of the AHA ACLS guidelines for tachycardia (≥150 beats/min), a 50-year-old male has sudden palpitations, no chest tightness or nausea, and the electrocardiogram shows regular monomorphic wide QRS tachycardia, and it is unclear whether it is VT. The pulse is about 180 beats/min, and the blood pressure is 106/76mmHg. There are no symptoms such as hypotension, shock, and ischemic chest pain. Which of the following treatments should be prioritized?

Input: (A) Adenosine, initial dose of 6mg intravenous push over 1~3 seconds, plus 20ml of normal saline for rapid administration. (B) Amiodarone, initial dose of 300mg intravenous push. (C) Synchronous rectification 100J. (D) Synchronous rectification, bi-phase wave 120~200 J or single-phase wave 200 J. (E) Synchronous rectification 50 J.

Output: A


Instruction: According to the 2015 new AHA ACLS guidelines for tachycardia (≥150 beats/min), which of the following statements about the treatment of symptoms such as hypotension, shock, and ischemic chest pain is incorrect?

Input: (A) For narrow, regular QRS complexes, the dose is 50~100J synchronous rectification. (B) For narrow, irregular QRS complexes, the dose is 120~200J (biphasic) or 200J (monophasic) synchronous rectification. (C) For wide, regular QRS complexes, the dose is 100J synchronous rectification. (D) For wide, irregular QRS complexes, the dose is 120~200J (biphasic) or 200J (monophasic) synchronous rectification. (E) Paroxysmal supraventricular tachycardia (PSVT) can be treated by rapid intravenous injection of Adenosine 6mg. If it is effective, no electric shock is needed.

Output: D


Instruction: According to the classification and reporting regulations of emerging infectious disease cases (including suspected cases) in Taiwan, which of the following is not included in the reporting within 24 hours?

Input: (A) Acute viral hepatitis A. (B) Severe complications of influenza. (C) Human immunodeficiency virus infection. (D) Rabies. (E) Middle East respiratory syndrome coronavirus infection.

Output: B


Instruction: For a patient with cardiopulmonary arrest whose initial rhythm is pulseless electrical activity and has not been cured after 10 minutes of first aid, which of the following treatments is the least appropriate?

Input: (A) A pulsatile blood test can differentiate hypoxia, acidosis, and hyperkalemia/hypokalemia. (B) The medical history and the setting where the patient was found, or measuring body temperature, can help determine the possibility of hypothermia. (C) Bedside ultrasound can help determine cardiac tamponade, acute pulmonary embolism, tension pneumothorax, and hypovolemia, etc. (D) The medical history, the patient's medication history, or the setting where the patient was found, can help determine the possibility of drug or toxin poisoning. (E) Bedside X-ray can help determine the possibility of tension pneumothorax.

Output: E


Instruction: When facing patients with in-hospital cardiac arrest (IHCA), the first priority is to prevent it from happening. Therefore, we advocate the establishment of rapid response teams (RRTs) or medical emergency teams (METs). Which of the following descriptions of RRTs/METs is incorrect?

Input: (A) The establishment of RRTs/METs is mainly to ensure that a team can work together to provide emergency treatment to patients after IHCA occurs, thereby increasing the patient's chance of recovery. (B) The establishment of RRTs/METs can improve the survival rate of hospitalized patients. (C) Through Early Warning Sign Systems, we can identify dangerous hospitalized patients and prevent the occurrence of IHCA. (D) In addition to first aid skills, RRTs/METs training also includes the establishment of a teamwork concept. (E) In addition to helping adult patients, the establishment of RRTs/METs may also be helpful for pediatric patients.

Output: A


Instruction: According to the Management Regulations for Rescue Technicians, the rescue items that can be performed by intermediate rescuers do not include the following:

Input: (A) Operate a manual defibrillator. (B) Give an intravenous injection. (C) Deliver an emergency baby. (D) Assist with the use of inhaled bronchodilators. (E) Use a laryngeal mask airway (LMA).

Output: A


Instruction: According to the recommendations of the Centers for Disease Control of the Ministry of Health and Welfare, which of the following statements is correct regarding the treatment of suspected rabies when a person is scratched or bitten by an animal and has skin wounds or saliva contact?

Input: (A) If you are exposed by scratches or bites from stray dogs or cats, seek medical attention immediately and get vaccinated. If the stray dogs or cats are asymptomatic after 7 days of observation, you can stop vaccinating. (B) If you are exposed by scratches or bites from domestic dogs or cats, do not give the vaccine for the time being. Observe the domestic dogs or cats. If suspected rabies symptoms appear after one month, give the vaccine. (C) When the wound needs to be injected with immunoglobulin at the same time, it is recommended to suture it after a few hours (≧2 hours). (D) When rabies immunoglobulin is needed, intravenous injection is better than wound infiltration injection. Immunoglobulin can be administered at the same time as the first dose of vaccine after exposure. (E) The dosage of human rabies immunoglobulin (HRIG) is 20 IU/kg. Perform a skin sensitivity test before administration.

Output: C


Instruction: Which of the following statements is correct in treating respiratory failure in a 1-year-old infant?

Input: (A) The vocal cord is the narrowest part of the respiratory tract. (B) The infectious cause of lower respiratory tract obstruction is croup. (C) Non-depolarizing neuromuscular blocking agents should be given before rapid-sequence intubation. (D) Before intubation, the headrest should be raised to facilitate the sniffing position. (E) When intubating, the length of the laryngeal lobe should be selected by measuring the distance from the upper incisor to the mandible.

Output: E


Instruction: There are several injured in a series of car accidents. Given limited medical resources, the nearest trauma hospital can only treat four patients at a time. Which of the following patients would you recommend being sent to the nearest non-critical emergency hospital for evaluation?

Input: (A) A 55-year-old male car driver suffered facial contusion and chest puncture wound. He was breathing 30 times/min at the scene. (B) A 30-year-old male motorcycle driver was thrown 3 meters away at the scene of the accident. His right upper arm and right thigh were deformed. He was conscious and had no head injury. His pulse was 80 beats/min and his blood pressure was 120/80 mmHg. (C) A 40-year-old female passenger in a car with an airbag that exploded, suffered burns on about 25% of her body, complained of numbness and weakness in her limbs, was conscious, had a pulse of 70 beats/min, and a blood pressure of 80/40 mmHg. (D) A 25-year-old pregnant pedestrian was hit by a motorcycle at 60 km/hr. She was conscious and had stable vital signs. She had only abrasions on her limbs and complained of abdominal pain. (E) A 40-year-old male riding a bicycle was hit by a car at 20 km/hr. He was conscious and had stable vital signs. His right forearm was deformed and had an open wound, but his peripheral circulation was normal.

Output: E


Instruction: Which of the following statements about the treatment of patients with traumatic shock is incorrect?

Input: (A) The goal is to control bleeding and restore adequate circulatory volume. (B) When clinical assessment shows that the amount of bleeding is more than 30% of the total blood volume, crystalloid fluid and blood products should be given as soon as possible. (C) When treating patients with crystalloid fluid and blood products, hypothermia and coagulopathy should be carefully monitored. (D) In the treatment of patients with traumatic hypovolemic shock, pressors should be given as soon as possible to provide sufficient blood pressure to achieve adequate peripheral tissue perfusion. (E) In addition to giving infusion therapy as soon as possible, the bleeding site should also be found as soon as possible to achieve the goal of early control of bleeding.

Output: D


Instruction: Which of the following statements about spinal cord injury in adults is incorrect?

Input: (A) The prognosis of Anterior cord syndrome is better than that of other spinal cord syndromes. (B) Upper limb weakness in Central cord syndrome is more severe than that in lower limbs. (C) Cauda equina syndrome may present with symptoms of abnormal bowel and bladder function and loss of perineal pain. (D) Thrombosis of anterior spinal artery may cause anterior cord syndrome. (E) The most common cause of Brown-Sequard syndrome is spinal puncture.

Output: A


Instruction: Regarding influenza, some patients have a higher risk of complications. Which of the following is not included?

Input: (A) 3-year-old children. (B) Diabetic patients. (C) 28-year-old woman one week postpartum. (D) 16-year-old male, long-term use of Aspirin. (E) 50-year-old male, BMI (body mass index) is 29.

Output: E


Instruction: Which of the following statements about the diagnosis and management of pneumonia in special groups is correct?

Input: (A) P. aeruginosa is a common pathogen in alcoholics. (B) H. influenzae is a common pathogen in diabetics. (C) Pregnant women with respiratory symptoms and a history of varicella exposure should have a chest X-ray to rule out pneumonia. (D) P. aeruginosa is a common pathogen in influenza-associated bacterial pneumonia in the elderly. (E) S. aureus is a common pathogen in nursing home residents.

Output: C


Instruction: Which of the following statements about the diagnosis and management of diabetic patients in the emergency department is incorrect?

Input: (A) An 8-hour fasting blood glucose level greater than 126 mg/dL (7.0 mmol/L) or any blood sugar level greater than 200 mg/dL (11.1 mmol/L) can confirm diabetes. (B) Diabetic patients are more likely to experience atypical chest pain, and may even experience myocardial infarction without chest pain. (C) For diabetic patients with hypertension, Angiotensin II receptor blockers or Angiotensin-converting enzyme inhibitors should be used to control blood pressure first. (D) Even if there is no hypertension, Angiotensin-converting enzyme inhibitors can prevent or slow down kidney disease (diabetic nephropathies) caused by diabetes. (E) If the patient's renal function is not ideal, Metformin should not be used as the first-line blood sugar-lowering drug.

Output: A


Instruction: About Increased Intracranial Pressure in Patients with Head Trauma (Increased Intracranial Pressure (IICP), which of the following statements is incorrect?

Input: (A) Intracranial pressure greater than 20 mmHg will increase mortality. (B) If uncal transtentorial herniation occurs, it may cause dilation of the patient's ipsilateral pupil and weakness of the contralateral limb. (C) It is recommended to maintain PaCO₂ at 25~30 mmHg. Too low PaCO₂ may cause cerebral ischemia. (D) Elevating the patient's head of the bed 30 degrees can promote the outflow of cerebrospinal fluid from the skull, thereby reducing intracranial pressure. (E) In addition to reducing intracranial pressure, Mannitol can also help scavenge free radicals.

Output: C


Instruction: Regarding crush injury, which of the following statements is incorrect?

Input: (A) It may cause compartment syndrome at the injured site, usually with compartment pressure greater than 30 mmHg. (B) It may cause the injured to suffer from hypovolemia, hyperkalemia, hypercalcemia, and acidemia. (C) It may cause the injured to suffer from disseminated intravascular coagulation and severe complications of renal failure. (D) Before being rescued, 1~2 L of saline and bicarbonate treatment can be given. (E) The injured may receive fasciotomy or hyperbaric oxygen treatment.

Output: B


Instruction: A 35-year-old female presented to the emergency department with fever and body aches for 5 days. She had upper abdominal pain, nausea, and loss of appetite. Physical examination revealed abdominal tenderness. Blood tests showed white blood cell count of 2,500/mm³, hematocrit of 15.6 g/dL, platelet count of 45,000/mm³, GOT of 176 IU/L, and GPT of 180 IU/L. Which of the following statements is correct?

Input: (A) The dengue NS1 rapid test can be used to assist in the diagnosis. The test detects IgM antibodies in the blood, but its sensitivity and specificity are not high. (B) Dengue fever may be complicated by acute cholecystitis, and treatment should still include surgery or percutaneous transhepatic gallbladder drainage. (C) The patient should be given platelet transfusion to avoid bleeding. (D) For fever, acetaminophen should be given. If nausea and inability to eat occur, ketoprofen injection should be used instead. (E) If the patient's vital signs are stable and there is no obvious bleeding, he belongs to group B and should be hospitalized for observation and treatment.

Output: E


Instruction: Which of the following conditions will increase the risk of onset or aggravation in the mountains compared to on the plains, excluding the following?

Input: (A) Chronic kidney disease. (B) Heart failure. (C) Asthma. (D) Gastrointestinal bleeding. (E) Epilepsy.

Output: C


Instruction: Which of the following common imaging manifestations of diaphragmatic injury is wrong?

Input: (A) A collar sign appears on chest CT images. (B) A chest X-ray shows an elevated diaphragm on the affected side. (C) A chest X-ray shows that the longitudinal diaphragm cavity is shifted toward the affected side. (D) A chest X-ray shows an air-fluid level in the chest cavity. (E) A chest X-ray shows a nasogastric tube curled up in the chest cavity.

Output: C


Instruction: Which of the following diseases that can cause acute visual impairment or visual loss can cause eye pain?

Input: (A) Central retinal artery occlusion. (B) Central retinal vein occlusion. (C) Cytomegalovirus retinitis. (D) Methanol intoxication. (E) Optic neuritis.

Output: E


Instruction: Which of the following statements is incorrect about the treatment of patients with hypertensive acute heart failure?

Input: (A) If a patient develops hypotension after using Nitroglycerin, he or she needs to be treated with fluid infusion immediately. (B) Non-invasive ventilators may be considered for patients with stable blood circulation. (C) Diuretics need to be used in combination with vasodilators. Using diuretics alone may increase mortality. (D) Long-term use of Nitroprusside may cause cyanide toxicity. (E) In the acute phase, if the blood pressure is greater than 150/100 mmHg, high doses of Nitroglycerin can be used and adjusted according to symptoms and blood pressure.

Output: A


Instruction: A pregnant woman is in the emergency room and has an emergency delivery. The previous prenatal checkup revealed polyhydramnios. After the baby was born in the emergency room, the emergency doctor found that the body was ruddy but all four limbs were cyanotic and paralyzed. When the respiratory secretions were suctioned, the face was responsive, the breathing was weak, and the heart rate was 90 beats/min. What is the APGAR score calculation result?

Input: (A) 3. (B) 4. (C) 5. (D) 6. (E) 7.

Output: B


Instruction: According to the latest recommendations of the 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, which of the following statements is incorrect?

Input: (A) For full-term or premature infants, if emergency treatment is not required, delaying clamping of the umbilical cord for 30 seconds after birth may be beneficial for the newborn. (B) Preterm newborns are given emergency treatment, and it is recommended to use 100% oxygen first, and then reduce it depending on the situation. (C) The recommendation for the use of atropine for bradycardia remains unchanged. (D) The pressure-to-inflation ratio for neonatal cardiopulmonary resuscitation is 3:1. If it is of cardiac origin, the pressure-to-inflation ratio can be 15:2. (E) When tracheal intubation cannot be successfully established, laryngeal mask can be used for full-term newborns or premature infants over 34 weeks. This recommendation is Class I.

Output: B


Instruction: A long-term bedridden patient in a nursing home was sent to the emergency room for treatment. The doctor found that the patient had multiple itches on his body, especially on the navel, armpits and genitals. He was diagnosed with scabies. Which of the following suggestions for the treatment of scabies is the least appropriate?

Input: (A) Use Ivermectin for treatment. (B) Use Lindane for treatment. (C) Use Permethrin for treatment. (D) Contacts need to be treated together. (E) Applying Cortisone after deworming can improve skin itching.

Output: B


Instruction: A 70-year-old woman is brought to the emergency department. Physical examination reveals unilateral eyelid ptosis, miosis, and anhydrosis on the same side of the face. Which of the following is not included in the clinical differential diagnosis?

Input: (A) Herpes zoster. (B) CN3 palsy. (C) Internal carotid artery dissection. (D) Cerebral infarction. (E) Lung cancer.

Output: B


Instruction: A 75-year-old woman has cervical spondylosis. Past medical history: A patient was sent to the emergency room for neck pain due to a car accident. Emergency examination revealed that the patient had obvious weakness in both upper limbs and loss of pain and temperature sensation. What is the possible diagnosis for this patient?

Input: (A) Brown-Séquard syndrome. (B) Carotid dissection. (C) Central cord syndrome. (D) Posterior cord syndrome. (E) Vertebral artery dissection.

Output: C


Instruction: Which of the following statements about myocardial infarction is incorrect?

Input: (A) The mortality rate of combined cardiogenic shock can reach 80%. (B) Dressler's syndrome can occur within 2-10 weeks after myocardial infarction. (C) Patients with persistent sinus tachycardia have a poor prognosis. (D) The most common arrhythmia in the early stage is VPCs (ventricular premature contractions). (E) Patients with AIVR (accelerated idioventricular rhythms) have a poor prognosis and need active treatment.

Output: E


Instruction: Which of the following statements about the use of painkillers for acute abdominal pain is incorrect?

Input: (A) Opioids relieve pain and will not affect abdominal physical examination, delay diagnosis, or lead to increased morbidity and mortality. (B) Ketorolac is an NSAID and a pure analgesic that will not mask early symptoms of peritoneal inflammation. (C)Nasogastric suction can help diagnose upper gastrointestinal bleeding, and nasogastric drainage can also be used to reduce pressure in cases of intestinal obstruction. (D)Administering antiemetics such as Metoclopramide can improve abdominal pain caused by postoperative vomiting, but headache is a possible side effect. (E)The intravenous dose of Metoclopramide is 10 mg, and slow administration can reduce extra pyramidal side effects.

Output: B


Instruction: A 46-year-old female went to the emergency department because of sudden stiffness on the left side of her face, crooked face and mouth, and facial nerve palsy. Which of the following symptoms does not require brain imaging?

Input: (A) Limb weakness. (B) Facial plegia sparing the forehead. (C) Unable to look out. (D) Difficulty swallowing, drooling. (E) Abnormal taste in the front two-thirds of the tongue.

Output: E


Instruction: A 47-year-old ranger was bitten by a badger in the mountains of Taitung. His right calf was lacerated 2 cm and bleeding. Which of the following was wrong in the treatment after he went to the emergency room?

Input: (A) The patient should be asked whether he had ever received a rabies vaccine injection in the past. If the patient had not received the injection, he should be given a rabies vaccine and immunoglobulin injection this time. (B) Rabies immunoglobulin should be injected by soaking around the wound to avoid intravenous injection. (C) The patient had received a rabies vaccine three years ago, so he does not need to be given a rabies vaccine this time. (D) The patient should be asked whether he has ever received a tetanus shot in the past. If he has not, he should be given a tetanus shot this time. (E) If the patient had received a tetanus shot three years ago, he does not need to be given a tetanus shot this time.

Output: C


Instruction: Which of the following statements about the possible complications of early rhabdomyolysis is incorrect?

Input: (A)Acute renal failure. (B)Disseminated intravascular coagulation. (C)Hypercalcemia. (D)Hyperkalemia. (E)Hyperuricemia.

Output: C


Instruction: Which of the following statements about the clinical manifestations of patients with migraine is inappropriate?

Input: (A) The intensity of the headache often reaches above the moderate level on the pain scale. (B) Its symptoms can generally last up to 72 hours (average is about 4-72 hours). (C) The most common precursors are lightheadedness and visual blind spots (scotoma). (D) It is characterized by unilateral, pulsatile headaches that worsen with activity. (E) Symptoms rarely occur in childhood and usually peak around age 40.

Output: E


Instruction: A 50-year-old woman was sent to the emergency room and complained of weakness. Her blood sodium level was 126 meq/L. The patient had no obvious edema. Subsequent examination revealed that her urine sodium was 30 (normal value: 27-287) meq/L, which of the following diseases is the most likely diagnosis?

Input: (A) liver cirrhosis. (B) SIADH. (C) heart failure. (D) nephrotic syndrome. (E) severe GI loss.

Output: B


Instruction: Which of the following statements about esophageal corrosive injury is incorrect?

Input: (A) Endoscopic examination should be performed as soon as possible to assess the extent of mucosal damage. (B) Strong acid causes shallow coagulation necrosis, more severe gastric damage, stenosis of the vestibule pylorus, and acidosis, with a lower mortality rate than strong alkali. (C) Strong alkali causes deeper liquefaction necrosis, more severe esophageal damage, and stenosis of the esophagus. (D) If a child accidentally swallows a button-type battery and suspects it is stuck in the esophagus, endoscopic examination should be completed within 6 hours. (E) If a child accidentally swallows a button-type battery and suspects it is stuck in the esophagus, and the child's vital signs are stable but endoscopic examination cannot be performed immediately, if it is confirmed that the battery was ingested within two hours, then Foley Balloon catheter technique can be considered for removal.

Output: B


Instruction: When a hazardous substance is discovered, as an emergency medical worker, you should respond accordingly. Which of the following statements is incorrect?

Input: (A) Assess the risk of hazardous substances to community safety (community risk assessment). (B) Confirm the occurrence of a hazardous substance incident (recognition of an event). (C) Identify what type of hazardous substances are involved in this incident (identification of the substances involved). (D) Isolate and perform on-site hazardous substance control (isolation and scene control). (E) Decontaminate, stabilize the patient's vital signs and establish triage (decontamination, stabilization and triage). The first step in decontamination is to immediately flush the patient with large amounts of clean water in the hot zone (hot zone).

Output: E


Instruction: About acute pericarditis (acute pericarditis), which of the following statements is correct?

Input: (A)The severity of chest pain symptoms is usually unrelated to posture. (B)If there is a large pericardial effusion, the electrocardiogram may show electrical alternans. (C)Computed tomography is more sensitive than ultrasound for diagnosing pericardial effusion. (D)The electrocardiogram may show PR elevation. (E)Viral pericarditis often requires hospitalization to drain the pericardial effusion.

Output: B、D


Instruction: Regarding the differential diagnosis of patients with arthritis in the emergency department, which of the following is more often manifested in a monoarticular manner?

Input: (A)Gonococcal arthritis. (B)Lyme disease. (C)Gout. (D) Reactive arthritis. (E) Viral arthritis.

Output: C


Instruction: A 30-year-old woman is 36 weeks pregnant (G4P1AA0SA2) and is clinically suspected of acute pulmonary embolism. Which of the following treatments is correct?

Input: (A) r-tPA will cross the placenta and is contraindicated during pregnancy. (B) If pulmonary vascular computed tomography (CT-PA) is not suitable, magnetic resonance imaging (MRI) can be considered. (C) Wells' Criteria can be used to predict the possibility of pulmonary embolism in pregnant women. (D) If ultrasound reveals DVT, unfractionated heparin or low-molecular-weight heparin can be used directly for anticoagulant therapy. (E) A V/Q scan should be arranged to reduce the radiation dose to the fetus.

Output: D


Instruction: Which of the following statements about severe asthmaticus attacks is incorrect?

Input: (A) Inhaled bronchodilators and steroids usually do not improve the condition. (B) Injection or inhalation of magnesium sulfate can be used as an adjunctive treatment for severe asthma, but it can easily cause hypotension and neuromuscular blockade. (C) If intubation is required, Ketamine is a good adjunctive drug during the process and after ventilation is started. (D) In refractory situations, adults can be given epinephrine SC or IM, 0.5 mg. (E) The use of a ventilator does not reduce airway obstruction caused by asthma, but it only reduces the patient's work of breathing and improves oxygenation.

Output: B


Instruction: A 32-year-old male auto repair shop worker committed suicide by drinking 100 mL of plating solution. He went to the emergency department with sore throat and abdominal pain. The patient reported that the plating solution contained a high concentration of chromic acid. Which of the following treatments and dispositions is inappropriate?

Input: (A) Arrange emergency gastroscopy. (B) Give succimer (DMSA) chelation therapy. (C) Give Vitamin C. (D) Give Acetylcysteine. (E) Perform endotracheal intubation.

Output: B


Instruction: A 23-year-old female is sent to the emergency department with complaints of fever and confusion. Her past medical history is unknown. Blood test results, arterial blood gas analysis (ABG): pH 7.39, PCO₂ 24 mmHg, PaO 2 89 mmHg, HCO₃ 14 meq/L; Na 130 meq/L, K 5.0 meq/L, Cl 96 meq/L, BUN 20 mg/dL, Cr 1.3 mg/dL, Glucose 300 mg/dL. Which of the following is not included in the differential diagnosis of acidosis in this patient?

Input: (A) Ketoacidosis. (B) Renal tubular acidosis. (C)Metformin poisoning. (D)Salicylates poisoning. (E)Lactic acidosis.

Output: B


Instruction: Which of the following statements about antiphospholipid syndrome (APS) is incorrect?

Input: (A) It is more common in women and often causes venous thrombosis in clinical practice. (B) Catastrophic APS can cause small blood vessel obstruction in multiple organs. (C) The clinical course of catastrophic APS progresses rapidly, and the mortality rate can be as high as 50%. (D) Considering the possibility of miscarriage, pregnant women with antiphospholipid syndrome should avoid the use of low molecular weight heparin or aspirin for treatment. (E) Healthy patients with positive antiphospholipid antibodies who have no history of thrombosis do not need to be given prophylactic antithrombotic treatment.

Output: D


Instruction: A 2.5-month-old full-term boy was brought to the emergency department by his parents because of vomiting for four days. Which of the following statements is correct?

Input: (A) It should be gastroesophageal reflux. No further examination is needed. Antiemetics should be given. (B) Upper GI tract contrast study can help with differential diagnosis. (C) If the vomitus has bile color, congenital pyloric stenosis should be considered. (D) If it is congenital pyloric stenosis, the patient is prone to dehydration and acidemia in the early stages of the disease. (E) If abdominal ultrasound reveals congenital pyloric stenosis, the patient should be referred to the surgical department for emergency surgery.

Output: B


Instruction: Which of the following statements is incorrect regarding the training of first aid technicians?

Input: (A) The teaching staff for first aid training and continuing education courses at all levels are limited to doctors, nurses, or senior and intermediate first aid technicians who have been engaged in emergency medical rescue work for more than three years. (B) Civil groups or foundations under the jurisdiction of the Ministry of Health and Welfare that have established a purpose related to emergency medical rescue and whose directors and board members meet the requirements may conduct primary and intermediate first aid technician training after applying for permission. (C) General-level and above emergency hospitals may conduct primary first aid technician training after applying for permission. (D) Hospitals with intermediate or higher emergency responsibilities may conduct intermediate rescue technician training after applying for permission. (E) Hospitals with severe emergency responsibilities may conduct advanced rescue technician training after applying for permission.

Output: E


Instruction: Which of the following statements about pseudomembranous colitis is incorrect?

Input: (A) Most cases occur in the large intestine, and yellow pseudomembranes can be seen under endoscopy. (B) Diagnosis includes stool culture, stool toxins, and colonoscopy. (C) The third-generation cephalosporins antibiotics are the most effective for this disease, and it can be cured in about a week. (D) The most common clinical manifestations include diarrhea, fever, elevated white blood cells, and abdominal pain. (E) The most common bacteria causing this disease is Clostridium difficile.

Output: C


Instruction: A 20-year-old male developed unsteady gait and mental changes (GCS E3V4M6) at 10 pm at Pai Yun Villa (3,402 meters) in Yushan. Which of the following treatments is inappropriate?

Input: (A) Consider descending the mountain immediately. (B) Give oxygen. (C) Use a hyperbaric bag. (D) Give an injection of dexamethasone. (E) Give Viagra, Sildenafil.

Output: E


Instruction: Which of the following statements about sinusitis is correct?

Input: (A) Most infections are bacterial. (B) Use of intranasal corticosteroid sprays may prolong the course of the disease. (C) The first-line antibiotic for treatment is a sulfonamide. (D) Orbital cellulitis is most often caused by infection of the ethmoid sinus. (E) Confirmation of uncomplicated sinusitis requires CT.

Output: D


Instruction: Which of the following chest trauma patients is less likely to require surgery?

Input: (A) Two fractures in three consecutive ribs. (B) Left-sided hemopneumothorax without rib fractures. (C) X-ray shows a nasogastric tube in the chest cavity. (D) More than 1,500 mL of blood comes out after the chest tube is placed. (E) After the pneumothorax is drained through the chest tube, there is still a lot of gas leakage.

Output: A


Instruction: A 65-year-old female with a history of heart failure, chronic renal failure, and bipolar disorder was taken to the emergency room by her family for confusion and involuntary hand shaking. Her blood pressure was 150/75 mmHg, heart rate was 88 beats/min, respiration was 25 times/min, body temperature was 36.5°C, coma index was E3V3M5, blood test results showed creatinine 5.6mg/dL, lithium concentration was 3.5 mEq/L. Which of the following is the best treatment and management?

Input: (A) Hemodialysis. (B) Intravenous administration of large amounts of saline. (C) Intravenous injection of diuretics. (D) Gastric lavage. (E) Administer sodium bicarbonate intravenously.

Output: A


Instruction: Which of the following interpretations of pleural effusion is incorrect?

Input: (A) Esophageal rupture may cause an increase in amylase in pleural effusion. (B) Pleural effusion caused by pulmonary embolism may be transudates. (C) Pleural effusion caused by rheumatoid arthritis will have increased glucose. (D) When the pH value is less than 7.1, thoracotomy can be diagnosed and chest tube drainage is an indication. (E) Pleural effusion caused by cancer will have a predominantly lymphocyte white blood cell classification.

Output: C


Instruction: An 82-year-old male with a history of hypertension, heart disease, and prostate hypertrophy complained of difficulty in defecation and urination and general discomfort and went to the emergency room for treatment. Physical examination revealed a mass in the lower abdomen. Blood tests: BUN 30 mg/dL, Creatinine 2.0 mg/dL; routine urine examination WBC/PUS: 3-5/HPF, RBC: 15-20/HPF. Which of the following statements is incorrect?

Input: (A) Patients with significantly elevated BUN or Creatinine after urinary retention can be considered for hospitalization. (B) Routine use of antibiotics is recommended to prevent urinary tract infections. (C) Bedside ultrasound can diagnose whether there is acute urinary retention. (D) The retention balloon of the catheter expands in the urethra, which may cause urethral injury. (E) If acute urinary retention causes pain, after several failed attempts at catheterization, suprapubic catheterization can be performed as long as there is no obvious pelvic trauma or abnormal anatomical structure in the lower abdomen.

Output: B


Instruction: A young man was beaten with a baseball bat and sent to the emergency room. Physical examination revealed: weakness in the lower limbs, and normal muscle strength in the upper limbs except for problems with abduction of the little finger; numbness in the chest approximately below the clavicle and the inner side of the upper arm. Which segment of the spinal cord should be suspected to be damaged clinically?

Input: (A)C4. (B)T1. (C)T4. (D)T8. (E)L3.

Output: B


Instruction: A 28-year-old HIV-positive patient complained that he had not been taking medication regularly for the past six months. He felt increasingly short of breath and had a fever in the past week. When he arrived at the emergency room, his vital signs were: blood pressure 105/75 mmHg, respiratory rate 32 times/min, heart rate 120 times/min, blood oxygen concentration 89%. Chest X-ray revealed diffuse interstitial infiltrates on both sides. Pneumocystis pneumonia infection was suspected. Which of the following statements and treatments is wrong?

Input: (A) Pneumocystis pneumonia pneumonia) is the most common opportunistic infection in AIDS patients. (B) Trimethoprim-sulfamethoxazole antibiotics can be given for treatment. (C) Pentamidine can also be considered as a treatment drug. (D) Steroids should be avoided at this time to avoid increasing the risk of systemic infection. (E) For patients with CD4+ T-cell counts less than 200 cells/mm³, antibiotics should be given prophylactically to prevent recurrence.

Output: D


Instruction: Which of the following statements about qSOFA is correct?

Input: (A) There are three items in qSOFA. As long as two of them are met, the patient can be diagnosed with sepsis. (B) Total bilirubin (T-bilirubin) in the blood is greater than 2.0 mg/dL, which is one of the qSOFA assessment items. (C) Platelet count is less than 10,000/mm³, which is one of the qSOFA assessment items. (D) Respiratory rate ≧20 times/min is one of the qSOFA assessment items. (E) Systolic blood pressure is less than or equal to 100 mmHg, which is one of the qSOFA assessment items.

Output: E


Instruction: During a sarin gas terrorist attack, a 70-year-old woman was sent to the emergency room for suspected poisoning. Which of the following symptoms does not include:

Input: (A) Tears (lacrimation). (B) Muscle fasciculations. (C) Slow heartbeat (bradycardia). (D) Seizures. (E) Anhidrosis.

Output: E


Instruction: Which of the following statements about intraocular pressure and eye-related emergencies is incorrect?

Input: (A) Intraocular pressure should not be measured when there is a suspected rupture of the eyeball. (B) Normal intraocular pressure is between 10 and 20 mmHg. (C) Hyphema generally causes an increase in intraocular pressure. (D) An eyeball rupture generally causes a decrease in intraocular pressure. (E) Uveitis generally causes an increase in intraocular pressure.

Output: E


Instruction: A 65-year-old man is brought to the emergency room after being assaulted by a club. Which of the following conditions may affect the performance or interpretation of a focused assessment with sonography for trauma (FAST)?

Input: (A) Subcutaneous emphysema. (B) Long-term peritoneal dialysis. (C) Prior abdominal surgery. (D) Obesity. (E) Cirrhosis without ascites.

Output: E


Instruction: Which of the following statements about airway management of a pregnant patient is incorrect?

Input: (A) During preoxygenation, high-flow oxygen of 15 L/min can be continuously given through a nasal cannula until paralysis to prevent the patient from hypoxia. (B) If intubation fails, bronchoscopic intubation should be considered, because laryngeal mask airway is not suitable for pregnant women. (C) The use of a video laryngoscope can increase the success rate of the first-pass. (D) The pregnant woman should be intubated in a supine position, and an assistant should be asked to push the pregnant uterus to the left. (E) Standard doses of RSI drugs should be used.

Output: B


Instruction: A 58-year-old male with a history of nasopharyngeal carcinoma is currently undergoing radiation therapy. He has had a loss of appetite and general weakness for nearly a week. A blood test revealed Ca2+ of 15.5 mg/dL and Albumin of 3.0 g/dL. Which of the following statements is incorrect?

Input: (A)Corrected Ca2+ = 16.3 mg/dL. (B)The electrocardiogram may show ST segment depression and QT segment shortening. (C)1,000 mL of normal saline can be given by drip for two hours. (D)Hemodialysis can effectively reduce calcium ions in the blood. (E)Bisphospho nates is more effective and faster than Calcitonin and is the first choice.

Output: E


Instruction: Which of the following is wrong about the landing zone for helicopter takeoffs and landings?

Input: (A) The landing zone is a dangerous area during helicopter takeoffs and landings because the helicopter blades are drooping but still have a minimum speed. (B) Crew members should be more than 100 feet away from the landing zone during helicopter takeoffs and landings, and medical personnel should be more than 200 feet away. Both should have proper eye and ear protection. (C) All medical supplies (IV stands, etc.) should be kept below shoulder height. (D) It is safer for ground staff to operate the helicopter door. (E) Do not approach or leave from the rear of the helicopter. When approaching or leaving, you must crouch facing the rear door of the helicopter and keep your head down.

Output: D


Instruction: In mass casualty events, the JumpSTART Pediatric MCI Triage© system is currently used to triage pediatric patients. Which of the following statements about this system is wrong?

Input: (A) The assessment is: ability to move or walk → presence of breathing → respiratory rate → presence of pulse → consciousness status. (B) Triage is divided into four categories: death, immediate evacuation, delayed evacuation, and mild illness. (C) The modified Glasgow Coma Scale is used for consciousness status. (D) Each patient should receive a detailed secondary assessment. (E) In principle, cardiac compression is not performed on patients with cardiac arrest during the triage process of mass casualty events.

Output: C


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 correct?

Input: (A) SpO₂ 98%, normal breathing, no need for intubation. (B) Place a nasogastric tube to relieve pressure, but generally glucose infusion is not required for the first 24 hours. (C) Give morphine for pain relief. To reduce the risk of respiratory depression, intramuscular injection is better than intravenous injection. (D) Give steroids to reduce laryngeal edema. Hydrocortisone 100mg STAT+Q8H IV. (E) According to Parkland Formula, drip Ringer's solution at 150 ml per hour for the first 8 hours and 75 ml per hour for the next 16 hours.

Output: B


Instruction: A 5-year-old boy with sickle cell anemia was brought to the emergency room by his nanny because of a high fever and inability to walk. Physical examination revealed a red, hot and painful left knee, with no other respiratory or urinary tract symptoms. Which of the following statements about pediatric septic arthritis is correct?

Input: (A) Based on the patient's age, Haemophilus influenzae is also among the top three most common bacterial species in purulent arthritis, in addition to MSSA and MRSA. (B) Knee X-rays cannot diagnose septic arthritis in the early stages, so they are not necessary. (C) If septic arthritis is suspected during clinical diagnosis, it is necessary to wait for the blood test results before performing arthrocentesis. (D) Because one-third of the bacterial culture results of joint fluid are negative, when there is a high degree of clinical suspicion, turbid joint fluid can help diagnose suspected cases. (E) This patient has no other symptoms, so there is no need to collect urine, skin wounds, throat, and rectum for bacterial culture.

Output: D


Instruction: To distinguish between Anticholinergic toxidromes and Sympathomimetic toxidromes, which of the following clinical symptoms is most likely to distinguish the two?

Input: (A) Confusion. (B) Rapid heartbeat. (C) High blood pressure. (D) High body temperature. (E) Sweating.

Output: E


Instruction: A 37-year-old male drank a large amount of chemical liquid and was taken to the emergency room by his family because of confusion. Which of the following situations would not be recommended for treatment with Fomepizole?

Input: (A) Serum methanol concentration greater than 20 mg/dL. (B) Unexplained osmolar gap greater than 10 mOsm/L. (C) Serum isopropyl alcohol concentration greater than 100 mg/dL. (D) Unexplained metabolic acidosis (pH less than 7.3). (E) Serum ethylene glycol concentration greater than 20 mg/dL.

Output: C


Instruction: A 42-year-old woman went to the emergency room with a fever for 3 days. Physical examination revealed an eschar on her thigh and suspected scrub typhus. Which of the following statements is correct?

Input: (A) Ciprofloxacin is the first choice of antibiotic. (B) It is a Category IV infectious disease and requires infectious disease notification and hospitalization for isolation. (C) Most patients have a history of travel and were infected abroad. (D) The pathogen is Orientia tsutsugamushi, and the incubation period is usually 9 to 12 days. (E) Without treatment, the mortality rate can reach 80%.

Output: D


Instruction: Which of the following is correct about the symptoms of spinal cord injury syndrome?

Input: (A) Spinal shock: low blood pressure, but warm extremities and slow heartbeat. (B) Central cord syndrome: limb weakness accompanied by decreased partial pain and temperature sensation, with the lower limbs more severe than the upper limbs. (C) Brown-Séquard syndrome: limb weakness, proprioception and vibration sensation on the same side of the injury, and disappearance of pain and temperature sensation on the opposite side. (D) Anterior cord syndrome: proprioception and vibration sensation below the injury site disappear, but pain and temperature sensation are retained. (E) Cauda equina syndrome: loss of bowel and bladder function, weakness in the lower body, with only the perineum, buttocks and inner thighs feeling normal.

Output: C


Instruction: Which of the following statements about transfusion-related complications is correct?

Input: (A) If the patient has had a febrile transfusion reaction in the last few transfusions, irradiated blood should be used for this transfusion. (B) If the patient has an allergic transfusion reaction during transfusion, diphenhydramine can be given for treatment, and transfusions can be continued after evaluation. (C) Transfusion-related acute lung injury (TRALI) often occurs after PRBC transfusion and less frequently after FFP or Platelet transfusion. (D) Transfusion-related acute lung injury (TRALI) can cause pulmonary edema, and diuretics should be given as soon as possible. (E) Regarding extravascular hemolytic transfusion reactions, hemolysis usually occurs in the liver and bone marrow, and less often in the spleen.

Output: B


Instruction: A 77-year-old male drank a large amount of Dimethoate 44% and committed suicide. He was taken to the emergency room by his family because of vomiting, coma and seizures. Which of the following treatments is most likely to improve the patient's prognosis?

Input: (A) Gastric lavage. (B) Give activated charcoal. (C) Urinary alkalinization. (D) Give atropine. (E) Give Pralidoxime.

Output: D


Instruction: A 60-year-old male went to the emergency department complaining of two days of right facial pain and herpes, and right eye redness, pain and photophobia. The diagnosis was Herpes Zoster Ophthalmicus. Which of the following statements about this disease is incorrect?

Input: (A) Most cases involve the upper eyelid on the same side. (B) Some patients may develop optic neuritis. (C) The dosage of antiviral drugs should be adjusted according to the patient's renal function. (D) Oral valacyclovir may be considered for treatment. (E) If herpes appears on the tip of the nose, it is called Hutchinson sign, and the prognosis is better.

Output: E


Instruction: A 65-year-old woman was sent to the emergency room due to a car accident. At the time of the accident, she was sitting in the passenger seat of the car and had fastened her seat belt. Physical examination revealed a seat belt sign on her abdomen and she complained of left shoulder pain. However, the patient's left shoulder joint movement was normal. Based on the above symptoms, which of the following injuries is the patient most likely to have?

Input: (A) T12 chance fracture. (B) T10 compression fracture. (C) Splenic rupture. (D) Liver laceration. (E) Duodenum hematoma.

Output: C


Instruction: A 2-year-old girl was admitted to the emergency room. Her mother said that she had a congenital respiratory disease and had just suddenly become wheezing and had poor response. Initial assessment in the emergency room showed that she was labored in breathing and had a pale complexion. After airway suction and oxygen administration with a resuscitation ball, her vital signs were as follows: blood pressure 55/32 mmHg, respiration 42 times/min, heart rate 56 times/min (regular), and body temperature 35°C. Which of the following was not included in the initial emergency treatment?

Input: (A) Use bronchodilator therapy. (B) Use epinephrine inhalation therapy. (C) During intubation, the best choice of sedative is ketamine. (D) Use steroid injection. (E) Perform chest compression and oxygen 15:2 first aid.

Output: E


Instruction: A 10-year-old boy weighs 25 kg, is in poor spirits, has slow reactions, BT 38℃, HR 140 beats/min, RR 32 beats/min, BP 80/50 mmHg, and O 2 Sat 96%. Blood test results show that glucose is greater than 500 mg/dL. Which of the following statements is incorrect?

Input: (A) An ABG should be ordered and the ketone body concentration in the blood should be tested. (B) Because the symptoms of shock are obvious, IV 250-500 mL normal saline should be given first to restore the capillary refilling time to normal. (C) IV bolus insulin 2.5 IU should be given as soon as possible. (D) IV infusion 2.5 IU/hr should be maintained continuously. (E) The rate of blood glucose decrease should be less than 50-100 mg/dL per hour.

Output: C


Instruction: Computed tomography without contrast injection has a higher sensitivity for diagnosing subarachnoid hemorrhage in the head as the time after symptom onset:

Input: (A) 6-12 hours. (B) 12 to 23 hours. (C) 24 to 47 hours. (D) 48 to 71 hours. (E) Greater than 72 hours.

Output: A


Instruction: A 40-year-old male is referred to the emergency department with a suspected diagnosis of thrombotic thrombocytopenic purpura. Which of the following clinical manifestations is not included?

Input: (A) Fever. (B) Prolonged prothrombin time. (C) Thrombocytopenia. (D) Neurological findings. (E) Hemolytic anemia.

Output: B


Instruction: A 48-year-old male hemophilia A patient fell yesterday and developed obvious hematoma in his left elbow joint and swelling and pain in his left forearm. X-ray examination showed no obvious fracture. Which of the following statements is wrong?

Input: (A) Factor VIII 15-30 IU/kg can be given for treatment. (B) Clinical tests of hemophilia patients show abnormal APTT (activated partial thromboplastin time). (C) If the patient has swelling in the left forearm accompanied by severe pain and numbness, compartment syndrome should be considered. syndrome), after replenishing the coagulation factors, the chamber pressure can be measured. (D) To avoid hematoma caused by intravenous injection, NSAID can be given intramuscularly for pain relief. (E) Severe hemophilia patients often present with spontaneous bleeding or uncontrolled bleeding after trauma.

Output: D


Instruction: Regarding unexplained syncope, which of the following is not a risk factor that requires hospitalization for evaluation and examination?

Input: (A) History of heart failure. (B) Hematocrit is less than 30%. (C) Family history of sudden cardiac death. (D) The patient is 40 years old. (E) Systolic arterial pressure is less than 90 mmHg.

Output: D


Instruction: When facing patients with in-hospital cardiac arrest (IHCA), the first priority is to prevent it from happening. Therefore, we advocate the establishment of rapid response teams (RRTs) or medical emergency teams (METs). Which of the following descriptions of RRTs/METs is incorrect?

Input: (A) The establishment of RRTs/METs is mainly to ensure that a team can work together to provide emergency treatment to patients after IHCA occurs, thereby increasing the patient's chance of recovery. (B) The establishment of RRTs/METs can improve the survival rate of hospitalized patients. (C) Through Early Warning Sign Systems, we can identify dangerous hospitalized patients and prevent the occurrence of IHCA. (D) In addition to first aid skills, RRTs/METs training also includes the establishment of a teamwork concept. (E) Current research shows that the establishment of RRTs/METs may be helpful to pediatric patients in addition to adults.

Output: A


Instruction: Which of the following statements about epilepsy caused by alcohol withdrawal is most appropriate?

Input: (A) Localized epileptic seizures are more common. (B) Most patients will only have one seizure. (C) About two-thirds of patients will experience delirium after an epileptic seizure. (D) About 90% of patients will have an seizure within 48 hours after stopping drinking. (E) A small number of patients with multiple seizures will have multiple seizures within 12 hours, but will not have another seizure afterwards.

Output: D


Instruction: A 35-year-old male was found unconscious during an ultra-marathon and was taken to the emergency room. In the emergency room, GCS E3V3M5, blood pressure 100/50 mmHg, pulse 110 beats/min, respiration 22 breaths/min, body temperature 37℃, blood glucose 100 mg/dL, brain CT scan was normal, and blood sodium 115 meq/L. Which of the following is the most appropriate treatment for this low blood sodium?

Input: (A) 500 mL of 3% NaCl intravenous drip (IV drip) for 24 hours. (B) 500 mL of 3% NaCl intravenous drip (IV drip) for 48 hours. (C) 100 mL of 3% NaCl as an IV bolus. (D) 500 mL of 3% NaCl as an IV bolus. (E) 500 mL of 0.9% NaCl as an IV bolus.

Output: C


Instruction: Which of the following statements about gout and pseudogout (also known as calcium pyrophosphate deposition) in crystal induced synovitis is incorrect?

Input: (A) Gout and pseudogout, like most septic arthritis, are monoarthritis. (B) Acute gout attacks are common in middle-aged men over 40 years old. Attacks in women of childbearing age may be related to gestational diabetes. (C) Yellow uric acid crystals can be seen in Gout's joint fluid under a polarizing microscope, while calcium pyrophosphate in pseudogout is blue. (D) Uric acid, calcium, and phosphorus in the blood cannot be used as a basis for diagnosing gout or pseudogout. (E) Colchicine can treat acute gout and pseudogout attacks, but intravenous injection may lead to serious side effects such as bone marrow suppression and death.

Output: C


Instruction: Which of the following statements about pneumonia is correct?

Input: (A) Legionnaires' disease has a distinct seasonal pattern, with most cases occurring in the summer. (B) Streptococcus pneumoniae most often follows a viral infection. (C) Staphylococcus aureus is the most common cause of pneumonia in alcoholics. (D) Mycoplasma pneumoniae often presents with extrapulmonary symptoms, such as a rash or gastrointestinal symptoms. (E) If the patient is discharged from the hospital within seven days, the antibiotic chosen should cover the treatment of Pseudomonas aeruginosa.

Output: E


Instruction: Which of the following statements about lung abscess is incorrect?

Input: (A) The mortality rate of secondary cases is higher than that of primary cases. (B) Eighty percent of cases are secondary cases, which are more common in patients with cancer or weakened immune system. (C) Multiple lesions are not common, but Lemierre's syndrome can be seen with multiple lesions in the lungs. (D) When the pathogen is an anaerobic bacterium, the infection route is usually inhalation. (E) Generally speaking, drug treatment can control this disease. The reasons for the failure of drug treatment include bronchial obstruction or non-bacterial infection sources.

Output: B


Instruction: A 29-year-old male patient with depression. According to his friends, the patient took an unknown type of sleeping pill (Benzodiazepine) and tricyclic antidepressants (Tricyclic antidepressants, TCA) in total of 40 tablets, and the coma index when he arrived at the hospital was E2V2M4. Which of the following statements is incorrect?

Input: (A) Patients poisoned by tricyclic antidepressants have dry skin. (B) Considering airway protection, after endotracheal intubation, gastric lavage and activated charcoal are performed. (C) The electrocardiogram has a high R wave in aVR (i.e., right axis deviation in the last 40 milliseconds), which indicates TCA poisoning. (D) Flumazenil (Anexate) can be given as an antidote for Benzodiazepine poisoning in this patient. (E) 1 mEq/kg of NaHCO₃ can be given as an antidote for TCA poisoning in this patient.

Output: D


Instruction: An 11-month-old boy, weighing about 10 kg, has persistent paroxysmal abdominal pain and cries at home. His parents are the primary caregivers. Bloody stools were found in his diapers. The bedside abdominal ultrasound image showed a high probability of intussusception. Which of the following is wrong?

Input: (A) Children of this age usually cannot find the leading point. (B) When there are signs of peritonitis, the pressure of air reduction must be reduced to avoid intestinal perforation. (C) The presence of bloody stools is not a contraindication to air reduction. (D) The incidence rate varies in different seasons and may be related to viral infection. (E) If air reduction fails, reassessment is needed to determine whether it is incarcerated hernia.

Output: B


Instruction: A 25-year-old male patient with schizophrenia came to the emergency room 30 minutes ago because of dyspnea and neck and jaw stiffness. His companion said that his psychiatrist had changed his prescription for him 2 days ago. There were no special abnormalities in his vital signs. Physical examination revealed stiffness in the mandible and neck and stridor in the upper respiratory tract. The patient did not have skin rash, tongue swelling, or wheezing. Which of the following treatments is more appropriate?

Input: (A) Diazepam 5 mg intravenous injection. (B) Diphenhydramine 50 mg intravenous injection. (C) Intubation after direct visualization of the airway through a fiberoptic endoscope. (D) Methylprednisolone 125 mg Intravenous injection. (E) Rapid sequence intubation with oral endotracheal tube intubation.

Output: B


Instruction: A 42-year-old female with a history of hyperthyroidism and no regular outpatient follow-up has been feverish and wheezing for two days. When she was sent to the emergency department, her coma index was E2V2M4, her temperature was 42.1℃, her heart rate was 180 beats/min, her electrocardiogram showed atrial fibrillation, her blood oxygen saturation was 76%, her lungs were auscultated with bilateral humours, her lung ultrasound showed extensive and numerous B lines, and her blood pressure was 70/40 mmHg. Which of the following is more appropriate for the treatment of this patient?

Input: (A) After the TSH and Free T4 test values are confirmed, give Methimazole or Propythiouracil. (B) Give Amiodarone 150 mg to correct arrhythmia. (C) Give Acetylsalicylic acid to reduce fever. (D) Give NTG drip to reduce preload. (E) Give Propylthiouracil 600 mg orally, and then give Lugol solution 10 drops one hour later.

Output: E


Instruction: A 1-year-old child returned to Taiwan for medical treatment after developing fever and systemic rash symptoms in Guangdong, China. Which of the following statements is correct?

Input: (A) If Koplik spots are found during oral examination, the patient should be advised to be hospitalized in a negative pressure isolation ward. (B) In differential diagnosis, measles usually develops a rash the day after the fever subsides. The rash usually first appears on the hands and feet, then spreads to the trunk and face, and the oral mucosa is usually not affected. (C) In differential diagnosis, German measles is not a legal infectious disease. Those with mild symptoms can be discharged from the hospital and go home for observation. (D) Scarlet fever is caused by a single-stranded DNA virus that can be transmitted through droplets. It is recommended to be hospitalized in a single ward. (E) The rash of infantile roseola appears together with the fever, and disappears after the fever subsides.

Output: A


Instruction: A 30-year-old male was found unconscious while running a marathon and was sent to the emergency room. In the emergency room, GCS E3V3M5, blood pressure 100/50 mmHg, pulse 120 beats/min, respiration 22 times/min, body temperature 41℃, blood sugar 100 mg/dL, which of the following treatments is most appropriate?

Input: (A) The patient should be wet with cold tap water and given an electric fan. (B) The patient's sweat should be wiped off as soon as possible. (C) The patient's body temperature should be lowered to below 37℃ as soon as possible. (D) The patient should be allowed to undergo a brain CT scan first. (E) The patient should be given a sports drink to replenish water.

Output: A


Instruction: Which of the following statements about metabolic acidosis is incorrect?

Input: (A) It can be caused by rapid infusion of large amounts of normal saline. (B) When the blood pH is lower than 7.1, respiratory physiological compensation function will deteriorate. (C) If the blood potassium concentration is normal, the intracellular potassium ion may be severely low. (D) Ethanol is often the main cause of severe metabolic acidosis. (E) Potassium-sparing diuretics can cause normal anion gap metabolic acidosis.

Output: D


Instruction: Which of the following descriptions about epidural hematoma is correct?

Input: (A) Epidural hematoma is more common in the elderly and children under 2 years old. (B) Epidural hematoma most often occurs in the frontal region. (C) If the patient with epidural hematoma is in coma, the mortality rate is high, up to 80%. (D) Epidural hematoma usually looks crescent-shaped on brain CT images. (E) On brain CT images, epidural hematoma usually does not extend beyond the suture line.

Output: E


Instruction: According to the latest recommendations of the 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, which of the following statements is incorrect?

Input: (A) Atropine is not recommended for routine use in critically ill children and newborns for preintubation to prevent bradycardia caused by emergency intubation. (B) The atropine dose is 0.02 mg/kg, and the minimum dose used each time is 0.1 mg. (C) Evidence-based medicine shows that atropine can be used for patients with bradycardia. (D) Both amiodarone and lidocaine can be used for shock-refractory VF or pulseless VT. (E) In clinical settings where critical care resources (e.g., ventilators, pressors) are not readily available, administering large volumes of fluids to children in septic shock may be harmful.

Output: B


Instruction: A 5-year-old girl was admitted to the emergency room. Her mother said that she had a congenital respiratory disease. She had just had 3 convulsions, each lasting about 5 minutes, and was accompanied by cyanosis. She was taken to the hospital by ambulance. When she arrived at the emergency room, the girl still had opisthotonos, eyes drooping, clenched teeth, and cyanotic lips. Which of the emergency treatments is correct, airway intubation or epilepsy treatment?

Input: (A) Ketamine 4 mg/kg IM injection. (B) Midazolam 0.1 mg/kg IM injection. (C) Phenytoin 20 mg/kg IM infusion. (D) Succinylcholine 1.5 mg/kg IM injection. (E)Valium 5 mg IM injection.

Output: B


Instruction: For various acute poisoning-induced cardiac arrests, in addition to giving ACLS first aid, which of the following antidotes is less effective?

Input: (A)Digoxin poisoning is treated with Digoxin Fab. (B)Organophosphates poisoning is treated with Atropine. (C)Sodium channel blocker poisoning is treated with Sodium bicarbonate. (D)Calcium channel blocker poisoning is treated with Glucagon. (E)Local anesthetic agents poisoning is treated with IV lipid emulsion.

Output: D


Instruction: According to the American Burn Association, major burns should be admitted to a burn center. Which of the following does not require admission to a burn center?

Input: (A) 40-year-old male, no past medical history, second-degree burns on the extremities, 29% BSA. (B) 40-year-old male, no past medical history, third-degree burns on the back, 11% BSA. (C) 70-year-old male, no past medical history, second-degree burns on the extremities, 17% BSA. (D) 4-year-old girl, no past medical history, third-degree burns on the perineum and buttocks, 3% BSA. (E) 30-year-old female, no past medical history, second-degree burns on the anterior chest, 4% BSA, combined with carbon deposits in the oropharynx and gradual hoarseness of the voice.

Output: A、B、C、D、E


Instruction: Which of the following statements about hypoxemia is correct?

Input: (A) In the case of right-to-left shunt, the oxygen in the artery (PaO 2) will increase significantly as long as the oxygen supply is increased. (B) Hypoventilation alone will only increase PaCO₂, but the Aa O 2 gradient is normal, which is unrelated to the oxygen supply. (C) In the case of ventilation-perfusion mismatch, the oxygen in the artery (PaO 2) will not increase significantly even if the oxygen supply is increased, but the Aa O 2 gradient will increase. (D) In the case of diffusion impairment, the oxygen in the artery (PaO 2) will increase as long as the oxygen supply is increased, but the Aa O 2 gradient will not change significantly. (E) When the oxygen partial pressure in the atmosphere decreases, as long as the oxygen supply is increased, the oxygen in the artery (PaO 2) will increase significantly, but the Aa O 2 gradient will decrease.

Output: B


Instruction: A 28-year-old male is a type 1 diabetes patient. He is currently using an insulin pump to control blood sugar. He has been vomiting and diarrhea and has a poor appetite since the day before yesterday. This morning, he suddenly developed slurred speech and felt weaker in his right limbs. When he went to the emergency room, his blood sugar was 40 mg/dL. Which of the following is wrong about the treatment of this patient?

Input: (A) Hypoglycemia can cause symptoms suspected of stroke, so it is better to treat hypoglycemia first. (B) Sugar-containing infusions are more effective than glucagon and should be used first. (C) Temporarily stop using insulin pump for at least 24 hours. (D) Infection, worsening renal function, and acute coronary heart disease may all lead to hypoglycemia. (E) Blood glucose test strips may be inaccurate for peritoneal dialysis patients, and blood should be drawn again to confirm blood glucose levels.

Output: C


Instruction: According to the 2007 ABCD2 score, which of the following factors is most likely to cause a subsequent stroke in patients with a transient ischemic attack?

Input: (A) Age younger than 60 years old. (B) Anemia. (C) Attack duration greater than 10 minutes. (D) Family history of coronary heart disease. (E) Symptoms associated with vision during the attack.

Output: C


Instruction: Which of the following is not a location scanned by Focused Assessment with Sonogra phy for Trauma, FAST?

Input: (A) The junction between the liver and the right kidney (hepatorenal recess). (B) The junction between the spleen and the left kidney (splenorenal recess). (C) The aorta. (D) The pelvic cavity (pelvic view). (E) The subxiphoid process (subxiphoid view).

Output: C


Instruction: Which of the following statements about Fresh frozen plasma (FFP) is correct?

Input: (A) Type AB can be a universal donor. (B) Patients who need urgent gastroscopy and have coagulopathy should first receive FFP. (C) FFP can be used to treat coagulation disorders caused by Dabigatran. (D) Patients must undergo ABO-type and Rh compatible testing before receiving FFP transfusion. (E) After thawing, FFP must be used within 48 hours.

Output: A


Instruction: Which of the following statements about possible side effects of laparoscopic Roux-en-Y gastric bypass surgery in obese patients is incorrect?

Input: (A) Fentanyl and Benzodiazepines are lipophilic drugs, and their half-lives are prolonged in obese patients. (B) Acute intestinal obstruction immediately after laparoscopic Roux-en-Y gastric bypass surgery is a surgical emergency and must be treated immediately. (C) Postoperative intestinal obstruction after laparoscopic Roux-en-Y gastric bypass surgery includes internal hernia and rotation of the Roux end. (D) Acute intestinal obstruction after laparoscopic Roux-en-Y gastric bypass surgery will not cause vomiting of bile. (E) Dumping syndrome syndrome) is caused by rapid postprandial gastric emptying, release of gastric hormones, and visceral vasodilation.

Output: D


Instruction: A 4-year-old girl, weighing 20 kg, has cold symptoms, lethargy, fever, fatigue, and loss of appetite for many days. Her blood pressure is 70/40 mmHg, her heart rate is 120 beats/min, O2 Sat 95%, and her breathing is about 24 times/min. Which of the following statements is incorrect?

Input: (A) The patient can be given 400 mL of 0.9% saline or lactated Ringer's solution for 5-10 minutes. (B) If myocarditis or cardiogenic shock is suspected, 0.9% saline or lactated Ringer's solution 100-200 mL can be given for 10-20 minutes. (C) If the treatment effect is not ideal, you can consider consulting a specialist. (D) If the child's urine output is 20 mL per hour, it means that the treatment response is not ideal. (E) If the child's blood pressure reaches 80/50 mmHg during treatment, the infusion should be stopped to avoid excessive administration.

Output: E


Instruction: A 28-year-old pregnant woman was sent to the emergency room after a car accident. She was unconscious, with a coma index of E3V4M5, a heart rate of 110 beats/min, and a blood pressure of 80/50 mmHg. She complained of abdominal pain and pain in the right thigh. Physical examination revealed rebound pain when pressing the lower abdomen, a uterine fundus approximately near the navel, clear fluid secretions from the vagina, a deformed right thigh, and a 15-centimeter laceration. Which of the following statements is correct?

Input: (A) Tetanus is not recommended for pregnant patients. (B) X-rays cannot be taken to confirm whether the right thigh is fractured. (C) Judging from vital signs, the amount of blood loss is approximately 15-30% of the total blood volume. (D) If the pH value of the vaginal secretions is 7, it may be amniotic fluid leaking out of the ruptured amniotic membrane. (E) The fetus is initially judged to be about 12 weeks old. Fetal heart rate and contraction monitor (cardiotochodynamometry) cannot be used yet. Only Doppler ultrasound can be used to evaluate fetal heart rate.

Output: D


Instruction: A 55-year-old female patient went directly to the emergency room from the airport after a 16-hour flight because of sudden difficulty breathing, chest pain, and sweating. When she arrived at the hospital, her blood pressure was 80/44 mm/Hg, her heart rate was 120 beats/min, her respiration was 22 times/min, her blood oxygen saturation was 88%, and the electrocardiogram monitor showed sinus tachycardia. The patient had no history of hypertension or heart disease, and after evaluation, pulmonary embolism was highly suspected. Which of the following related examinations of this patient is wrong?

Input: (A) This patient's chest X-ray may be completely normal. (B) A lower extremity venous ultrasound may reveal deep venous embolism. (C) A patient with pulmonary embolism may have an ECG with T wave inversion in V1-V4. (D) In patients with symptomatic pulmonary embolism, abnormal D-dimer values will not persist for more than 3 days. (E) Chest CT angiography is more difficult to diagnose pulmonary embolism in obese patients or patients with extremely rapid breathing.

Output: D


Instruction: A 1-year-old girl is admitted to the emergency department. Her parents say that she is developing normally. The patient has had a fever for 2 days, has a hoarse cough and hoarse speech, has a slightly wheezing breath, poor appetite, and slightly poor response. Initial assessment shows that the patient has shallow and rapid breathing, normal skin color, suprasternal retraction, and the following vital signs: blood pressure 96/58 mmHg, respiration 34 times/min, heart rate 116 times/min, body temperature 38℃, and blood oxygen 92%. Which of the following descriptions and treatments is incorrect?

Input: (A) Epinephrine inhalation therapy. (B) Heliox inhalation therapy. (C) Draw blood and arrange for neck and chest X-rays. (D) Inject steroids. (E) This patient has upper airway obstruction and should be intubated immediately.

Output: E


Instruction: About adrenal insufficiency (adrenal (A) It is common in chronic steroid users after discontinuation of medication or in tumor patients. (B) It can cause adrenal hemorrhage due to meningococcal infection. (C) CMV infection is the main cause of adrenal insufficiency in HIV patients. (D) Gastrointestinal infection is one of the common causes of adrenal crisis. (E) Secondary adrenal insufficiency will not cause a lack of Cortisol in the blood.

Output: E


Instruction: Which of the following statements about NOAC (novel oral anticoagulants) is incorrect?

Input: (A) Dabigatran is a direct thrombin inhibitor. (B) Rivaroxaban is a direct Factor Xa inhibitor. (C) Even if the Thrombin clotting time is normal, it cannot be ruled out that the patient's current coagulation abnormality is caused by Dabigatran. (D) Hemodialysis can remove Dabigatran from the blood. (E) When a patient using Rivaroxaban has a major bleeding event, an antifibrinolytic agent (such as tranexamic acid) can be given.

Output: C


Instruction: A 6-year-old girl presented to the emergency department with an itchy maculopapular rash and fever and malaise. Examination revealed white discharge from her tonsils, enlarged cervical lymph nodes, and enlarged liver and spleen. Which of the following is the most likely causative pathogen?

Input: (A) Group A Streptococcus. (B) Epstein-Barr virus. (C) Coxsackie virus. (D) Staphylococcus aureus. (E) Influenza virus.

Output: B


Instruction: Which of the following statements about malignant external otitis, which can cause life-threatening skull base osteomyelitis, is more appropriate?

Input: (A) Most cases can be treated with antibiotics. (B) The clinical stage can be determined by a lateral cranial X-ray. (C) An elevated inflammatory index such as C-reactive protein is required for diagnosis. (D) The most common pathogen is Streptococcus pneumoniae. (E) It most often causes lesions in the fifth cranial nerve.

Output: A


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

Input: (A) Steroids should not be given to avoid aggravating the infection. (B) Antibiotics include cefotaxime plus vancomycin. (C) Common pathogens include Streptococcus and Staphylococcus, but they may also be cultured negative. (D) The typical clinical symptoms are the so-called three Ds, namely drooling, dysphagia, and distress. (E) CT scans are not required to confirm the diagnosis.

Output: A


Instruction: A 22-year-old female patient went to the emergency department because her eyes became red, swollen and painful after falling asleep with contact lenses. Examination revealed corneal ulcers. What is the most likely pathogen causing the infection?

Input: (A) Varicella zoster virus (Varicella zoster virus). (B) Staphylococcus aureus. (C) Streptococcus pneumoniae. (D) Herpes simplex virus. (E) Pseudomonas aeruginosa.

Output: E


Instruction: Which of the following descriptions of the use of antithrombotics to treat venous embolism combined with pulmonary embolism is less appropriate?

Input: (A) Oral NOACs (novel oral anticoagulants) such as rivaroxaban can be used to treat venous embolism in patients undergoing dialysis. They are more convenient and safer than traditional treatments. (B) A platelet count below 100,000/mm³ is an absolute contraindication to the use of fibrinolytic therapy. (C) Anticoagulants are more effective than antiplatelets in preventing venous thromboembolism. (D) If the patient's blood pressure drops to 75/55 mmHg, fibrinolytic therapy may be considered. (E) Warfarin The initial 24-36 hours of treatment may increase thrombogenesis, which can be alleviated by combined intravenous heparin treatment for 3-5 days.

Output: A


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

Input: (A) Giving at least 10 units of PRBCs (packed red blood cells) within 24 hours can be called massive transfusion. (B) For patients who receive massive transfusions, the commonly recommended ratio of FFP (fresh frozen plasma): platelets: PRBCs is 2:1:1. (C) During massive transfusions, if the platelet count is less than 50,000/mm³, platelet transfusion is recommended. (D) During massive transfusions, if the monitored INR is greater than 1.5, FFP (fresh frozen plasma) is recommended. (E) During massive blood transfusion, if the fibrinogen level is less than 1 g/L or 100 mg/dL, cryoprecipitate or fibrinogen concentrate can be given.

Output: B


Instruction: Which of the following statements about systemic lupus erythematosus (SLE) is more appropriate?

Input: (A) When pericardial effusion occurs, high-dose glucocorticoid can reduce the need for pericardiocentesis. (B) When pericarditis occurs, NSAIDs (non-steroidal anti-inflammatory drugs) should be avoided. (C) When SLE patients who have been taking glucocorticoids for a long time develop pneumonia, second-generation cephalosporins are the first choice for treatment. (D) SLE patients do not have a significantly increased risk of developing coronary artery disease. (E) Erythrocyte sedimentation rate (ESR) can be used to differentiate between lupus enteritis and other causes of abdominal pain.

Output: A


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

Input: (A) The mortality rate of toxic epidermal necrolysis may be as high as 30%. (B) When toxic epidermal necrolysis affects more than 30% of body surface area (BSA), it is called Stevens-Johnson syndrome. (C) Treatment is mainly based on hydration, prevention of secondary infection and wound care. (D) Fever, sore throat and muscle pain are often the initial symptoms. (E) Skin rashes may appear all over the body, especially on the limbs.

Output: B


Instruction: According to the publicity of the Taiwan Centers for Disease Control to the public, when the following symptoms appear, it may represent a severe case of enterovirus, except which one?

Input: (A) Crying incessantly. (B) Rapid heartbeat. (C) Continuous vomiting. (D) Drowsiness. (E) Muscle twitching.

Output: A


Instruction: A 60-year-old male patient is sent to the emergency room. He seems to be unconscious. Neurological examination reveals that his limbs cannot move in response to any stimulation, and he cannot make any sound. However, you observe that the patient's eyes occasionally open and close on their own. Where is his lesion most likely to be?

Input: (A) Pons. (B) Cerebellum. (C) Hypothalamus. (D) Midbrain. (E) Medulla.

Output: A


Instruction: Which sign of bedside ultrasound examination of trauma patients would make you suspect that the patient has pneumothorax?

Input: (A) A-lines. (B) B-lines. (C) Lung point sign. (D)Lung sliding. (E)Tissue-like sign.

Output: C


Instruction: A 21-year-old male was taken to the emergency department with dyspnea after falling off his bicycle. He was very agitated and grabbed his clavicle. BP: 170/92 mmHg, HR: 140 times/min, RR: 31 times/min. Initial assessment found tachypnea with stridor, no trachea deviation, and decreased and symmetrical breath sounds on both sides. Which of the following diagnoses is most likely?

Input: (A)Tension pneumothorax. (B)Flail chest. (C)Posterior dislocation of clavicular head. (D)Massive hemothorax. (E)Hyperventilation.

Output: C


Instruction: Which of the following patients can be considered for emergency thoracotomy (resuscitative thoracotomy) in the emergency department?

Input: (A) A 35-year-old male fell from a height and had no breath sounds on the right side of his chest. He presented with asystole when he arrived at the hospital. (B) A 20-year-old male was stabbed in the left chest after a fight. He had no breath or heartbeat and presented with asystole when he arrived at the hospital. (C) A 19-year-old female was in a car accident and her chest hit the steering wheel. She had no breath or heartbeat when she arrived at the hospital. She presented with pulseless electrical activity (PEA). (D) A 25-year-old male suffered a gunshot wound to the left chest. He had no breath or heartbeat when he arrived at the hospital. He presented with PEA. (E) A 30-year-old male fell from a scaffold. His chest was deformed. He had no breath or heartbeat when he arrived at the hospital. He presented with asystole.

Output: D


Instruction: According to the latest version of neonatal resuscitation recommendations jointly released by the American Heart Association and the American Academy of Pediatrics in 2016, which of the following statements is more appropriate?

Input: (A) During the first aid process, the recommended site for measuring blood oxygen concentration is the left upper limb of the newborn. (B) After clearing the airway and providing positive pressure breathing for 30 seconds, if the heart rate is measured at 50 beats per minute, it is recommended to perform ventilation correction steps, including adjusting the mask, repositioning, suctioning the mouth and nose, opening the mouth, increasing ventilation pressure, and considering alternative airways. (C) During positive pressure ventilation (but not chest compression), do not use pure oxygen for ventilation; it should be set to 21-30% for those over 35 weeks old and 21% for those under 35 weeks old. (D) In the first golden minute, the rescue sequence is to maintain body temperature, assess medical history, and open the airway. (E) For chest compression, it is recommended to compress the chest 3 times and blow one breath every 3 seconds.

Output: B


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

Input: (A) In addition to fever, the initial symptoms often include nausea, vomiting, abdominal pain, diarrhea and loss of appetite. (B) The rash starts on the body, then spreads upward to the neck and head, and finally to the limbs, palms and soles. (C) Before the rash appears, it cannot be transmitted to other people. (D) This disease is a Class II notifiable infectious disease and must be reported within 24 hours. (E) It can be transmitted through droplets and oral and nasal secretions, but not through the air.

Output: D


Instruction: A 3-year-old boy complained of abdominal pain for more than a day, and his family said that he was not energetic and had a very poor appetite. He cried and was restless as soon as he was approached, and was unable to cooperate with physical examinations. Regarding pediatric abdominal pain, which of the following statements is less appropriate?

Input: (A) The first step in evaluating any child with poor activity and poor appetite is to check the bedside glucose. (B) If this child is ultimately diagnosed with appendicitis, it may have ruptured and complicated by peritonitis. (C) If there is arthritis and a generalized rash that is unevenly distributed, especially if the rash appears more frequently and earlier on the legs and buttocks than on the arms, chest, and abdomen, Henoch-Scholein purpura should be considered first. (D) If this child continues to have severe vomiting, weight loss, and signs of dehydration, pyloric stenosis should be considered first. (E) This child may also have intussusception, and should also be examined for other lesions such as lymphoma or Meckel's diverticulum.

Output: D


Instruction: Which of the following common side effects of anti-dizziness and anti-emetic drugs is less appropriate?

Input: (A)Antihistamines (e.g., diphenhydramine) have a common side effect of drowsiness. (B)Benzodiazepines (e.g., lorazepam) have a common side effect of sedation. (C)Benzamides (e.g., metoclopramide) have a common side effect of extrapyramidal symptoms. (D)Phenothiazines (e.g., prochlorperazine) have a common side effect of extrapyramidal symptoms. (E)Serotonin antagonists (e.g., ondansetron, granisetron) have a common side effect of extrapyramidal symptoms.

Output: E


Instruction: Which of the following is less appropriate when performing a stool examination on a patient with acute diarrhea?

Input: (A) Patients with acute diarrhea lasting more than 3 days should have a stool culture. (B) Immunocompromised patients with acute diarrhea should have a stool culture. (C) Stool cultures of patients with acute diarrhea often isolate pathogens. (D) Diarrhea suspected to be related to antibiotic use should be tested for Clostridium difficile toxin. (E) Stool cultures for Salmonella should be considered in patients with Reiter's syndrome with acute diarrhea.

Output: C


Instruction: An 88-year-old male is a type 2 diabetic. He is currently using metformin and glypizide to control his blood sugar. He was found unconscious by his family in the morning. When he went to the emergency room, his blood sugar was 36 mg/dL. He regained consciousness after being given 80mL of D50W. Which of the following statements is less appropriate?

Input: (A) If the patient's renal function deteriorates, attention should be paid to whether there is lactic acidosis. (B) If CT contrast agent is administered, metformin should be discontinued for 48 hours. (C) The patient should be kept in the hospital for observation until blood sugar is stable and there are no other reasons requiring treatment. The patient should be allowed to eat before leaving the hospital. (D) Metformin is more likely to cause hypoglycemia than glypizide. It is not recommended for elderly patients to use metformin. (E) Because glypizide is a long-acting drug, hypoglycemia may occur again. It is recommended to observe in the emergency department for a longer period of time.

Output: D


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

Input: (A) The diagnostic criterion is creatine kinase in plasma. (CK) value is more than 5 times the upper limit of normal value, but heart and brain diseases must be ruled out first. (B) Blood CK value can effectively predict the risk of acute kidney damage. (C) It can be combined with electrolyte abnormalities such as high potassium, high phosphorus and low calcium. (D) Treatment requires large amounts of infusion and alkaline urine, and it is best to maintain urine volume greater than 300 mL/hr. (E) Blood myoglobin has a shorter half-life than CK and is not recommended for diagnosing rhabdomyolysis after 24 hours.

Output: B、D


Instruction: A 40-year-old male has unexplained syncope. Which of the following is less likely to be at high risk for hospitalization?

Input: (A) Left bundle branch block on electrocardiogram. (B) History of heart failure. (C) Complaint of dyspnea. (D) Systolic blood pressure less than 90 mmHg. (E) Asystole lasting more than 3 seconds after carotid massage.

Output: E


Instruction: Which of the following is less appropriate for the treatment of aortic dissection?

Input: (A) For patients with Stanford type B, surgery can be performed if they continue to have severe chest pain. (B) Medications should be used to control heart rhythm before using vasodilators. (C) Ultrasound can be used to assess the presence of cardiac tamponade so that early treatment can be provided. (D) Calcium ion blockers are the first choice for lowering blood pressure. (E) Actively control systolic blood pressure to 100-120 mmHg.

Output: D


Instruction: Which of the following statements about antiplatelet drugs used in myocardial infarction is less appropriate?

Input: (A) Aspirin can reduce the mortality rate of patients with ST-segment elevation myocardial infarction by more than 20%. (B) Abciximab is not recommended for patients with coronary heart disease who do not undergo percutaneous coronary intervention. (C) Clopidogrel and omeprazole can enhance the effect when used together. (D) Prasugrel should not be used in patients with a history of transient ischemic attack. (E) Patients using ticagrelor are advised to stop taking the drug for at least 3 days before surgery.

Output: C


Instruction: Which of the following descriptions of psoas muscle abscess is less appropriate?

Input: (A) Symptoms are often manifested by latent fever, abdominal pain and lameness. (B) Pathogens can easily spread infection from distant sites via the bloodstream. (C) Pressing the patient's thigh on the affected side and asking the patient to lift his leg with force can induce pain. (D) It is most commonly caused by streptococcal infection. (E) The principle of treatment is antibiotics and percutaneous drainage surgery.

Output: D


Instruction: Which of the following descriptions of psoas muscle abscess is less appropriate?

Input: (A) A positive crossed straight leg raise test on the nonsymptomatic side has high specificity but low sensitivity for the diagnosis of a herniated disc. (B) In 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 and elevated protein. (E) In a blood test for vertebral osteomyelitis, white blood cells may be normal, but the erythrocyte sedimentation rate and C-reactive protein are almost always elevated.

Output: C


Instruction: The patient has pain and swelling in the prepatellar bursa of his right knee. Which of the following statements is less appropriate?

Input: (A) Bursitis most commonly occurs in the elbows and knees. (B) It may be caused by repeated trauma or gout. (C) Septic bursitis is most common in the prepatellar bursa and olecranon bursa. (D) The ratio of bursal fluid blood glucose to serum blood glucose is greater than 50%, which can be diagnosed as septic bursitis. (E) Staphylococcus aureus is the most common bacterial species in bursitis.

Output: D


Instruction: A 45-year-old male with no history of trauma developed gradual pain in his right knee joint a few hours ago. Which of the following statements is more appropriate?

Input: (A) Gout attacks are mainly characterized by inflammation of multiple joints. (B) Pseudogout is caused by the accumulation of calcium oxalate in the synovial bursa of the joints. (C) During an acute gout attack, the patient's blood uric acid level will rise. (D) Gout can be diagnosed if blue needle-shaped crystals are seen in the joint aspirate under a polarizing microscope. (E) Patients with renal dysfunction should consider treatment with colchicine.

Output: D


Instruction: The emergency medical technician brought a 19-year-old student from school. The school nurse and teacher said that he had an epileptic seizure in class. The seizure stopped before getting on the ambulance, but he had another seizure on the way to the hospital and it has continued until now. This seizure lasted for more than five minutes. The ambulance technician said that the blood sugar level measured in the car was 102 mg/dL, and the intravenous line was established before the seizure. Which of the following treatments is most appropriate?

Input: (A) Emergency endotracheal tube insertion. (B) Intravenous injection of lorazepam. (C) Intravenous injection of phenobarbital. (D) Intravenous injection of propofol. (E) Intravenous injection of fentanyl.

Output: B


Instruction: A 72-year-old woman was brought to the emergency room by her husband at 6:20 in the morning. The husband said that everything was normal when he went to bed last night. When he got up at around 6 o'clock this morning, he found that his wife had difficulty moving on the right side and could not speak clearly. Physical examination revealed right-sided limb weakness accompanied by aphasia and abnormal body sensation, and blood pressure of 170/100 mmHg, blood test showed no abnormalities, no bleeding risk factors, head CT scan showed no signs of cerebral hemorrhage, but the boundary between gray matter and white matter in the left median cerebral artery basin was unclear. The current time is 7:15. Which of the following treatments is most appropriate?

Input: (A)Aspirin. (B)Heparin. (C)Labetalol. (D)Nimodipine. (E)Thrombolysis.

Output: A


Instruction: A 25-year-old female with an autoimmune disease presents to the emergency department with increasing weakness. You suspect she has myasthenia gravis. Which of the following neurological tests would be most helpful in establishing a diagnosis?

Input: (A) Toe strength. (B) Eyelid movement. (C) Walking gait. (D) Joint reflexes. (E) Vibration sensation.

Output: B