Instruction: A 46-year-old male was brought to the emergency room by ambulance. His family said that the patient had a fever, headache, and confusion within a day. The ambulance technician said that the patient's consciousness deteriorated significantly during the transportation. When he arrived at the emergency room, his temperature was 40℃, his heart rate was 130 beats/min, his blood pressure was 110/60 mmHg, his respiratory rate was 20 times/min, and his blood oxygen concentration was 95%. His neck was slightly stiff. Which of the following treatments is the most priority?

Input: (A) Blood culture and antibiotic treatment. (B) Arrange a contrast-enhanced head CT scan. (C) Administer 10 mg of dexamethasone intravenously. (D) Perform a lumbar puncture to obtain cerebrospinal fluid (CSF). (E) Arrange an urgent MRI scan.

Output: A


Instruction: Which of the following statements is inappropriate when using succinylcholine as a muscle relaxant to assist in intubation?

Input: (A) The use of succinylcholine may cause bradycardia in the patient. (B) The use of succinylcholine may cause increased intragastric and intracranial pressure in the patient. (C) In premedication, it is recommended to use a low-dose nondepolarizing muscle relaxant to avoid muscle tremors. (D) Succinylcholine Do not use in patients with known hyperkalemia, neuromuscular disease, or myasthenia gravis. (E) If a patient develops unexplained fever and muscle stiffness after administration of succinylcholine, consider administering dantrolene sodium.

Output: C


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

Input: (A) Endotracheal intubation does not relieve bronchoconstriction. (B) Ketamine is contraindicated when a patient requires intubation because it increases intrathoracic pressure. (C) For intubated patients, the goal is to immediately correct respiratory acidemia to normal limits. (D) Administration of Heliox can reduce intubation rates, intensive care unit admissions, and length of hospital stay. (E) Magnesium sulfate can be given intravenously for treatment, but attention should be paid to the side effects of hypertension and neuromuscular blockade.

Output: A


Instruction: Which of the following statements about pneumonia in specific groups of patients is less appropriate?

Input: (A) M. pneumoniae and Legionella are more common pathogens in nursing home residents. (B) Gram-negative bacilli (P. aeruginosa), S. aureus and Legionella are common species in patients after liver transplantation in the first three months. (C) Pregnant women who have been exposed to chickenpox and have cough and respiratory symptoms should be recommended to have a chest X-ray. (D) The most common pathogen in alcoholics is S. pneumoniae, but Klebsiella species are also important pathogens. (E) Atypical pneumonia is more common in younger people.

Output: A


Instruction: Which of the following statements is more appropriate for the diagnosis and treatment of spontaneous pneumothorax?

Input: (A) If the patient has tracheal deviation, decreased blood pressure and blood oxygen, and decreased breath sounds on one side, a chest X-ray should be performed first. (B) When the patient's chest ultrasound shows a comet tail sign, it can help diagnose pneumothorax. (C) According to the American College of Chest Physicians, if the distance from the top of the chest cavity to the top of the lung (apex-cupola) is less than 5 cm on a standing chest X-ray, it can be classified as a small pneumothorax and observation and treatment can be considered. (D) Oxygen can be given to the patient, which helps absorb the pneumothorax. (E) If the patient's pneumothorax requires drainage, the only drainage method is chest tube placement.

Output: D


Instruction: A 77-year-old male stroke patient has been bedridden for a long time. He is sent to the emergency department because of fever and shortness of breath. Blood tests show elevated white blood cells and C-reactive protein. Chest X-ray shows a 5-cm cavitary lesion in the right lower lung. Which of the following statements is less appropriate?

Input: (A) Pulmonary abscesses are associated with aspiration pneumonia. (B) Pulmonary abscesses are more commonly infected by anaerobic bacteria. (C) Pulmonary abscesses usually do not require drainage. (D) Anaerobic infections have a worse prognosis than aerobic infections. (E) The antibiotic ampicillin- sulbactam is a reasonable initial empirical medication.

Output: D


Instruction: Which of the following statements about a patient who is coughing up blood is more appropriate?

Input: (A) For a small amount of hemoptysis, since it is mostly caused by acute bronchitis, there is no need for X-rays. (B) For all cases of hemoptysis, hospitalization for observation and examination should be arranged. (C) For a large amount of hemoptysis, the vital signs are stable, and since the diagnostic rate of X-rays is low, a CT scan should be arranged directly. (D) For a large amount of hemoptysis, the airway should be maintained, and the use of rapid sequence intubation should be avoided during intubation. (E) For a large amount of hemoptysis, the vital signs are unstable, and direct intubation and bronchoscopy should be considered.

Output: E


Instruction: A 75-year-old male patient is brought to the emergency room because of emotional agitation and violent behavior. On examination, his blood pressure is 165/104 mmHg, his respiratory rate is 16 breaths/min, his heart rate is 105 beats/min, and his temperature is 37.2℃. The patient has a history of hypertension and dementia and is being followed up in the neurology clinic. In recent days, the patient has begun to suspect that family members have stolen his money or that someone is trying to hurt him. Which of the following statements is less appropriate?

Input: (A) The differential diagnosis should include delirium. (B) Causes of delirium include medications, electrolyte imbalance, infection, etc. (C) If the patient is agitated, physical restraints are usually the first choice. (D) If the patient is agitated, non-pharmacological treatments may include providing a quiet, comfortable environment and family companionship. (E) If the patient is agitated and non-pharmacological treatments fail, oral risperidone may be considered.

Output: C


Instruction: A 35-year-old male presents to the emergency department with runny nose, tearing eyes, nausea, vomiting, diarrhea, and abdominal cramps. During the history, he denies any past medical conditions, but his medical record shows a history of heroin abuse. Physical examination reveals dilated pupils and goosebumps on the skin. Which of the following statements is less appropriate?

Input: (A) This patient may be experiencing heroin withdrawal syndrome. (B) Most heroin withdrawal syndromes occur 36-72 hours after discontinuation of the drug and can last 7-10 days. (C) The opioid with the longest-lasting withdrawal symptoms is methadone. (D) The most severe opioid withdrawal syndrome is heroin. (E) For mild opioid withdrawal syndrome, buprenorphine or naloxone can be considered.

Output: B


Instruction: A 30-year-old male is brought to the emergency department with general rigidity, confusion, and a high fever. The patient is prescribed antipsychotics as a rule in the psychiatric clinic. The initial diagnosis is neuroleptic malignant syndrome (NMS). Which of the following statements about NMS is less appropriate?

Input: (A) General rigidity can be treated with dentrolene sodium or bromocriptine. (B) Autonomic dysfunction may occur, such as rapid heart rate, sweating, and abnormal blood pressure. (C) Mortality rate may be as high as 20%. (D) Antipsychotics must be discontinued. (E) Anticholinergic medications are usually helpful.

Output: E


Instruction: Which of the following statements about alcohol withdrawal syndrome is less appropriate?

Input: (A) Alcohol withdrawal seizures are usually diffuse tonic-clonic seizures. (B) For alcohol withdrawal seizures, benzodiazepines are the first choice for drug treatment. (C) For alcohol withdrawal seizures, phenytoin is also a commonly used drug. Repeated initial doses (repeated (D) Alcohol withdrawal delirium, which often occurs within 3 to 5 days after the last drink and can last 48 to 72 hours or even longer. (E) Alcohol withdrawal hallucinations, which are often treated with antipsychotics.

Output: C


Instruction: Which of the following statements is more appropriate about peritoneal dialysis catheter (PD catheter) infection?

Input: (A) Fever is usually present, but there is rarely local redness, swelling or pain at the catheter exit site. (B) Streptococcus viridans is the most common species. (C) If the patient can be followed up in the outpatient clinic, first-generation oral cephalosporins can be used as empirical antibiotic treatment. (D) If ascites is drawn for testing, the leukocyte count must be greater than 250/mm³ and the neutrophil count must be greater than 50% for diagnosis to be confirmed. (E) All patients with PD catheter infection should be hospitalized.

Output: C


Instruction: A 17-year-old male came to the clinic because of unbearable testicular pain. The clinic doctor suspected that it was acute testicular torsion and referred the patient to the emergency department. Which of the following descriptions of this disease is less appropriate?

Input: (A) There will be local tenderness in the testicle on the affected side. (B) During physical examination, the cremasteric reflex on the affected side may be normal or absent. (C) During physical examination, lifting the affected testicle will relieve pain, and it is quite sensitive in distinguishing testicular torsion from epididymitis. (D) This is a urinary emergency and should be treated with an urgent urologist, who should consider manual detorsion. (E) If pain is relieved after manual detorsion, Doppler ultrasound can be used to confirm whether blood flow to the testicle has been restored.

Output: C


Instruction: A 25-year-old male complained of progressive left lower abdominal pain for 3 days, painful urination, and yellowish discharge from the urethra. His vital signs are as follows: blood pressure 135/80 mmHg, heart rate 110 beats/min, respiration 22 times/min, and body temperature 38.4°C. Urine laboratory examination: RBC 0-3/HPF, WBC 50-99/HPF. Which of the following statements about this patient is less appropriate?

Input: (A) If left-sided tenderness is found upon palpation of the scrotum, epididymitis may be present. (B) If this patient is diagnosed with epididymitis, the common pathogens are mainly Gram-negative bacilli such as E. coli and K. pneumoniae. (C) The left lower abdominal pain in this patient may be referral pain. (D) If combined with testicular and epididymitis, under color Doppler ultrasound, it can be seen that the blood flow of the left testis is slightly increased compared with the right testis. (E) The first choice of antibiotics is a single intramuscular injection of ceftriaxone 250mg and oral doxycycline for 10 days.

Output: B


Instruction: A 45-year-old male went to the emergency department because of left-sided low back pain. The urine test results were as follows: RBC >100/HPF, WBC 0-3/HPF, Bacteria (-). Ultrasound examination revealed a 0.8 cm left ureteral stone. Which of the following statements is less appropriate?

Input: (A) The ureteropelvic junction is one of the common sites of ureteral stone. (B) 10%-15% of patients will not have hematuria. (C) There is a 98% chance that the stone will be discharged spontaneously with urine within one month. (D) NSAIDs are the first choice for pain control in acute attacks. (E) Non-contrast CT is a more sensitive diagnostic tool than ultrasound.

Output: C


Instruction: A 35-year-old female patient comes to the hospital with dizziness and vomiting. Examination reveals that the patient is agitated, has horizontal nystagmus, diplopia, unsteady gait (ataxia), and gingival hyperplasia. Which of the following is the most likely diagnosis?

Input: (A) Amphetamine intoxication. (B) Hyperthyroidism. (C) Opioid withdrawal syndrome. (D) Phenytoin intoxication. (E) Rabies.

Output: D


Instruction: A 65-year-old female collapsed at home and was brought to the emergency room by her family. BT: 35.5℃, HR: 50 times/min, RR: 16 times/min, BP: 80/50mmHg, GCS: E3V5M6, the patient complained of a recent cold, general weakness, loss of appetite for nearly a month, constipation, but no weight loss, hair loss, multiple joint pain, swollen eyelids, dry skin. Which of the following is the most likely diagnosis?

Input: (A)Angiostrongylus cantonensis infection. (B)Digoxin intoxication. (C)Hepatic encephalopathy. (D)Lead poisoning. (E)Myxedema coma.

Output: E


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

Input: (A) Most patients with diarrhea are caused by viruses. (B) Clostridium difficile infection is common in hospitals 7 to 10 days after the use of antibiotics. (C) Pseudomembranous colitis mostly occurs in the large intestine, and yellow-white pseudomembranous membranes can be seen under endoscopy. (D) Traveler's diarrhea is mostly caused by bacterial infection. (E) Patients with infectious diarrhea should not use loperamide to relieve symptoms.

Output: E


Instruction: A 70-year-old male complained of sudden headache and right-sided vision loss 1 hour ago. Examination revealed that he could not see the right half of both eyes. The pupils of both eyes were equal in size, the light response was normal, and the muscle strength of the limbs was normal. Which of the following is the most likely differential diagnosis?

Input: (A) Glaucoma. (B) Left occipital lobe infarction. (C) Pituitary apoplexy. (D) Right occipital lobe arteriovenous malformation. (E) Right optic neuritis.

Output: B


Instruction: Which of the following statements about the symptoms of intestinal obstruction is more appropriate?

Input: (A) Only about half of the patients have abdominal pain. (B) Proximal obstruction rarely causes vomiting. (C) The pain is mostly continuous, and rarely paroxysmal colic. (D) Adynamic intestinal obstruction is usually more painful than mechanical obstruction. (E) Large intestinal obstruction often causes pain in the hypogastric region.

Output: E


Instruction: A 55-year-old woman drank a large amount of herbicide two hours ago and was sent to the emergency room because of continuous vomiting and confusion. The patient's clothes were covered with blue-green liquid. Her coma index was E1V2M5, her blood pressure was 100/65 mmHg, her heart rate was 105 beats/min, her respiration was 26 times/min, and her SpO₂ was 86%. Which of the following statements is less appropriate?

Input: (A) The patient needs endotracheal intubation. (B) It is paraquat poisoning. (C) The patient's liver function index may be elevated. (D) There is currently no antidote. (E) The main treatment is supportive therapy.

Output: B


Instruction: According to Lake Louise Acute Mountain Sickness (Lake Louise Acute Mountain Sickness Sickness) diagnosis, which of the following clinical symptoms must be present to diagnose acute mountain sickness?

Input: (A) Headache. (B) Gastrointestinal symptoms such as loss of appetite, nausea or vomiting. (C) Fatigue or weakness. (D) Dizziness. (E) Insomnia.

Output: A


Instruction: A 25-year-old male climbed Yushan Mountain. On the first night, he stayed at Paiyun Villa (3,402 meters above sea level). On the second day, after climbing the main peak of Yushan Mountain, he reached the North Peak of Yushan Mountain (3,850 meters above sea level) in the afternoon. At night, he developed difficulty breathing at the North Peak of Yushan Mountain and coughed up foamy and bloody sputum. Which of the following treatments is the least appropriate?

Input: (A) Give oxygen. (B) Descend altitude. (C) Treatment with a hyperbaric chamber. (D) Treatment with nifedipine. (E) Treatment with Diamox (acetazolamide).

Output: E


Instruction: Which of the following is less appropriate for the prevention and treatment of decompression sickness?

Input: (A) Decompression sickness is caused by nitrogen accumulation in tissues or blood vessels. (B) The deep joint pain caused by Type I decompression sickness most often occurs in the knee or shoulder joints. (C) For severe symptoms of decompression sickness, recompression therapy should be used as soon as possible. (D) Intravenous injection is recommended to increase tissue perfusion. (E) For patients with arterial gas embolism, it is not recommended to transport them in a supine position.

Output: E


Instruction: A 55-year-old woman, slightly overweight, came to the emergency department because of upper abdominal pain combined with nausea and vomiting. The blood test results were as follows: WBC 18,000/mm³ (normal range <10,000/mm³), GOT (AST) 150 IU/L (normal value: 8-40 IU/L), Total Bilirubin 1.2 mg/dL (normal value: 0.4-1.2 mg/dL), Direct bilirubin 0.4 mg/dL (normal range: <0.4 mg/dL). Which of the following statements is most appropriate?

Input: (A)Acute acalculous cholecystitis is more common than calculous cholecystitis. (B)Emphysematous cholecystitis is more common in young people and patients with diabetes. (C)Murphy's sign is to press the right upper abdomen, and the patient will stop exhaling due to pain. (D)Abdominal ultrasound examination shows gallbladder wall thickness > 2mm plus pericholecystic fluid, which can diagnose cholecystitis. (E)Abdominal ultrasound examination is the preferred imaging diagnostic tool for this patient.

Output: E


Instruction: Which of the following statements about spontaneous bacterial peritonitis is less appropriate?

Input: (A)The annual incidence of spontaneous bacterial peritonitis in patients with cirrhosis and ascites is about 30%. (B) The diagnostic criteria are white blood cell count>250/mm³, or neutrophil count>50/mm³. (C) The most common pathogens are Escherichia coli, Klebsiella pneumoniae, and Streptococcal pneumoniae. (D) The use of third-generation cephalosporins is a reasonable choice for treatment. (E) When diagnosing spontaneous bacterial peritonitis, giving albumin 1.5g/kg and giving albumin 1g/kg on the third day can help reduce the chance of acute renal failure.

Output: B


Instruction: An 18-year-old male young man went on a binge drinking spree and developed chest pain due to violent vomiting. Which of the following statements is less appropriate?

Input: (A) The pain caused by esophageal rupture is often acute and radiates to the back. (B) The patient may have symptoms such as dysphagia, dyspnea, vomiting blood, and cyanosis. (C) If mediastinal emphysema is not found on the initial X-ray examination, a rupture of the lower esophagus cannot be ruled out. (D) If the rupture is located in the high esophagus (cervical perforations), it is often complicated by pleural effusion. (E) Esophageal rupture often occurs on the left side of the distal esophagus.

Output: D


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

Input: (A) About 80% of patients have only mild inflammation, and the mortality rate is less than 1%. (B) Most patients do not require antibiotic treatment. (C) Common causes include gall stones, alcohol, etc. (D) You must wait until the abdominal pain disappears before trying a liquid diet. (E) When the patient's clinical manifestations and various test data are consistent with the diagnosis of acute pancreatitis, it is not necessarily necessary to arrange an abdominal CT examination.

Output: D


Instruction: A 5-year-old girl complained of mild cold symptoms starting 3 days ago. Two days ago, he started to have intermittent abdominal pain. He went to the emergency room because of the worsening abdominal pain. At that time, he had obvious pain in both knee joints and lower limbs. There were red spots and bruise-like lesions in his lower limbs. There was blood in his stool. He had no fever, vomiting, or history of trauma. He had no chronic diseases or allergies in the past. The results of emergency blood tests were as follows: sugar 78 mg/dL, BUN 18 mg/dL, amylase 51 U/L, AST 45 U/L, CRP 0.85 mg/L, WBC 12,100/uL, Hb 11.8 g/dL, Hct 36.5%, platelet 389 k/uL, urine test results: WBC 5/HPF, RBC 40/HPF. Which of the following is the most likely diagnosis for this patient?

Input: (A)Immune thrombocytopenic purpura (ITP). (B)Hemophilia. (C)Henoch-Schonlein purpura. (D)V on Willebrand disease. (E)Meningocococemia.

Output: C


Instruction: A 27-week pregnant woman had an emergency delivery in the emergency room and underwent an amputation by the emergency physician. Examination revealed no cyanosis, rosacea, and limbs. The body was bent. The face responded when respiratory secretions were suctioned. The cry was weak and the heart rate was 88 beats/min. What is the APGAR score calculation result?

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

Output: D


Instruction: A 9-month-old girl weighing 10 kg, her family reported that she had convulsions 20 minutes ago. The clinical manifestations were eyes drooping, loss of consciousness, stiffness of both limbs and subsequent twitching, which lasted for 15-20 minutes. She was drowsy when she arrived at the emergency room. Her family said that she had cold symptoms recently and had a poor appetite. The vital signs were as follows: breathing 26 times/min, heart rate 162 times/min, blood oxygen saturation 97% without the use of supplementary oxygen, capillary refilling time <2 seconds. The child cries occasionally, breathes shallowly but not laboredly, has rosy skin, and is soft and tender to the touch. He has no hepatosplenomegaly, normal lung sounds, and no heart murmurs. Which of the following statements is inappropriate?

Input: (A) The first priority is to ensure a patent airway and stabilize vital signs. (B) If hypoglycemia is the cause, 100 mL of 10% glucose water should be immediately administered intravenously. (C) If convulsions persist, consider giving 1 mg of lorazepam intravenously. (D) If convulsions persist and intravenous drips are not possible, 5 mg of diazepam should be administered through the rectum. (E) If the convulsion persists, consider intravenous injection of midazolam 2mg load, plus continuous intravenous injection of midazolam 1mcg/kg/min.

Output: B


Instruction: Which of the following descriptions of the causes, symptoms and treatments of diseases related to acute limb artery occlusion is less appropriate?

Input: (A) Embolism is caused by atrial fibrillation, rheumatic heart disease, etc., and the symptom is intermittent claudication. It should be treated with drugs first, and then interventional treatment should be considered. (B) Raynaud's disease is caused by spasm of small arteries due to cold or pressure, resulting in pain, pallor, cyanosis, etc., and is treated with rewarming and medications such as calcium blockers or beta blockers. (C) Trash foot or blue toe syndrome is caused by cholesterol/platelet aggregation embolism, resulting in pain and cyanosis in part of the foot, while the rest of the foot is warm. (D) Buerger's disease is common in smokers, and is an inflammation of small and medium-sized blood vessels without atherosclerosis, resulting in painful nodules, ulcers or gangrene. (E) Hypothenar hammer syndrome is caused by the use of vibrating tools, which leads to the degeneration and narrowing of the ulnar artery or aneurysm, resulting in pain and discoloration of the ulnar fingers (one or more) except the thumb.

Output: A


Instruction: Which of the following is not included in the causes of QT prolongation leading to Torsades de Pointes?

Input: (A) Stroke (including subarachnoid hemorrhage). (B) Severe bradycardia or atrioventricular block. (C) Drugs such as organophosphorus and antihistamines. (D) Antibiotics, especially third-generation cephalosporins. (E) Class IA and IC antiarrhythmic drugs.

Output: D


Instruction: According to the American Heart Association's 2015 guidelines for cardiopulmonary resuscitation, which of the following descriptions of basic life-saving techniques for adults is more appropriate?

Input: (A) If the patient is suspected of opioid intoxication and has cardiac arrest, consider giving the antidote naloxone before performing CPR. (B) According to the few empirical studies currently available, the location of chest compression is no different for patients, whether it is the center of the chest or the lower half of the sternum, so the lower half of the sternum is recommended as the chest compression location. (C) The chest compression speed is set at 100-120 times/minute because studies have shown that too fast a chest compression speed will cause rescuers to quickly become overworked and affect the quality of chest compression. (D) The chest compression depth is set at 5-6 cm because studies have shown that a depth of more than 6 cm can easily cause patient injury, and professional rescuers often compress too deep. (E) For chest massage, be sure to try not to interrupt it for more than 10 seconds and chest compression fraction (CCF) At least 50%.

Output: B


Instruction: An 80-year-old man with a history of asthma needs to be intubated immediately due to pneumonia, sepsis and multiple organ failure. His blood pressure is 60/40 mmHg, heart rate is 110 beats/min, renal function creatinine is 12.6mg/dL, and potassium is 7.0 mmol/L. When performing rapid sequence intubation, which of the following statements is inappropriate?

Input: (A) High-concentration oxygen should be given before intubation to maintain the blood oxygen concentration at 100% before intubation as much as possible. (B) Premedication, lidocaine can be given to reduce adverse physiological reactions caused by intubation. (C) A large amount of fluid should be given quickly to treat hypotension. (D) Propofol can be preferred as a sedative. (E) Rocuronium can be selected as a muscle relaxant.

Output: D


Instruction: A 26-week pregnant woman went to the emergency room with palpitations and cold sweats. Her blood pressure was 60/40 mmHg, her heart rate was 170 beats/min, and her breathing was 30 breaths/min. Which of the following statements is more appropriate for emergency resuscitation of the pregnant woman?

Input: (A) According to the 2015 AHA ACLS guidelines, during the resuscitation process, a long backboard and a bed blanket should be used to assist in raising the bed and keep the pregnant woman lying on her left side to maintain the return of body fluids. (B) If endotracheal intubation is required, rapid-sequence intubation drugs can still be used as usual, and the drug dosage is no different from that of ordinary adults. (C) The intravenous injection route should give priority to the inguinal central venous catheter. (D) There is no need to consider emergency cesarean section for fetuses under 28 weeks. (E) Adenosine can have serious adverse effects on the fetus and should be avoided in pregnant women.

Output: B


Instruction: A 60-year-old male with a history of smoking and diabetes suddenly collapsed and lost consciousness at work this afternoon. He was sent to the emergency room by 119. He had no vital signs before arriving at the hospital. After CPR and defibrillation, his spontaneous circulation was restored. According to the 2015 AHA standard treatment process for post-cardiac arrest care, which of the following statements is more appropriate?

Input: (A) If the patient continues to be comatose, hypothermia may be required, with the goal of maintaining a body temperature of 31-33℃. (B) If the patient's blood pressure is too low, dopamine 5-10mcg/kg/min should be given to maintain mean arterial pressure≥90mmHg. (C) The patient does not need to be given 100% oxygen throughout the whole process. Adjust FiO2 until the patient's SpO₂ ≥94%. (D) If the patient is still not conscious within 12 hours after resuscitation, it can be judged as a poor neurological prognosis, and it is necessary to discuss with the family about giving up emergency treatment. (E) If the electrocardiogram does not show STEMI, there is no need to consider coronary reperfusion treatment. Other causes should be found as soon as possible.

Output: C


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

Input: (A) According to the WHO definition, it is before 20 weeks of gestation or the fetus is less than 800 grams. (B) Most cases occur before 8 weeks of pregnancy. (C) The most common symptom is abdominal pain plus vaginal bleeding. (D) The most common cause is infection. (E) Most cases of threatened abortion result in the loss of the fetus.

Output: B


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

Input: (A) It is defined as persistent vomiting accompanied by weight loss, dehydration, and high sodium levels. (B) Evidence shows that ketonemia caused by dehydration is harmful to the fetus. (C) Serial measurements of urine ketones can be used to determine the success of treatment. (D) It is often accompanied by abdominal pain, so be careful to differentiate it from other diseases. (E) It can be treated with vitamin B12.

Output: C


Instruction: Which of the following is less appropriate regarding the side effects or complications of cathinones?

Input: (A) Compartment syndrome. (B) Retrograde amnesia amnesia). (C) acute kidney injury. (D) hyperthermia. (E) delirium.

Output: B


Instruction: A town was attacked by a plane carrying poison gas bombs, and many people were killed or injured. The symptoms of poisoning are increased bronchial secretions, pupil constriction, nausea and vomiting, and abdominal cramps. Which of the following poisonous gases is less likely to be the cause?

Input: (A)Sarin (GB). (B)Tabun (GA). (C)Sulfur mustard (HD). (D)Cyclosarin (GF). (E)Soman (GD).

Output: C


Instruction: Which of the following is less appropriate in the assessment and treatment of rib fractures in elderly patients with chest trauma?

Input: (A) The conditions for hospitalization should be lenient and the observation time should be sufficient. (B) Arterial oxygen saturation should be continuously monitored and oxygen should be supplied to maintain >95%. (C) The patient can only be discharged after the expectoration ability and pain control have been stabilized. (D) When flail chest, pulmonary contusion, or hemothorax occurs after injury, the elderly are more likely to lose their compensation ability, regardless of their original lung function. (E) The elderly have a reduced tolerance to opium analgesics, which can easily lead to respiratory failure and hypotension.

Output: D


Instruction: Which of the following statements about spontaneous nosebleeds (epistaxis) is less appropriate?

Input: (A) It occurs more often in dry seasons. (B) It occurs more often in middle-aged people between the ages of 30 and 50. (C) Bleeding occurs more often in the anterior than in the posterior nasal cavity. (D) Bleeding in the anterior nasal cavity most often originates from the Kiesselbach plexus. (E) Bleeding in the posterior nasal cavity most often originates from the sphenopalatine artery.

Output: B


Instruction: A trauma patient from an outlying island needs to be transferred to the main island by air. Which combination of medical personnel on board will give the patient the best prognosis?

Input: (A) Nurse and paramedic. (B) Nurse and nurse. (C) Nurse and doctor. (D) Nurse and respiratory therapist. (E) No special difference.

Output: E


Instruction: Which of the following is not an indication for air ambulance in Taiwan?

Input: (A) Two or more long bone fractures. (B) Burns to the perineum. (C) Third-degree burns covering 10% of the area. (D) Trauma that has caused limb paralysis. (E) Broken fingers.

Output: E


Instruction: A 35-year-old male was injured in a car accident and was sent to the emergency room with paraplegia of the lower body. Examination revealed that his spinal cord injury level was approximately T10. In addition to paraplegia, the patient lost pain and temperature sensation below the T10 level, but still retained touch. What type of spinal cord injury does this patient have?

Input: (A)Anterior cord syndrome. (B)Brown-Séquard syndrome. (C)Cauda-Equina syndrome. (D)Central cord syndrome. (E)Posterior cord syndrome.

Output: A


Instruction: A 2-year-old boy was brought to the emergency room by his parents. He weighed 13 kg, had a heart rate of 160 beats/min, a blood pressure of 84/38 mmHg, and an oxygen saturation of 90%. X-ray examination showed left hemopneumothorax, rib fractures, and a rotational fracture of the humerus. Which of the following statements is less appropriate?

Input: (A) This fracture strongly suggests child abuse and should be reported to the child protection agency within 48 hours. (B) The heart rate is too fast, but the blood pressure is still above the lower limit of blood pressure for that age. (C) Give 260 mL of normal saline as soon as possible. (D) The chest tube needs to be inserted higher than that of an adult because a child's diaphragm is higher than that of an adult. (E) After the left chest tube is placed, if the bleeding continues to exceed 130 mL per hour, the large blood vessels may be injured.

Output: A


Instruction: A 25-year-old female, 8 months pregnant, suddenly felt right chest pain and difficulty breathing, which became more severe during physical activity. She was conscious when she was examined in the emergency room, with a heart rate of 120 beats/min, a respiration rate of 30 breaths/min, a blood pressure of 85/50 mmHg, a temperature of 37.5℃, and a blood oxygen concentration of 90%. Auscultation revealed clear lung sounds on both sides, with no obvious heart murmurs. ECG There are extensive T wave inversions. The compression test of the lower extremity venous ultrasound is normal. Which of the following treatments is more appropriate?

Input: (A) Consider subcutaneous injection of low molecular weight heparin and oral warfarin at the same time. (B) Give oxygen first and arrange for chest CT to confirm the diagnosis. (C) Give inhaled bronchodilators first and start steroids. (D) Antibiotics should be given, and amoxicillin/clavulanate and clarithromycin can be used. (E) The risk of progression to septic shock is high, and the initiation of a sepsis bundle should be considered.

Output: B


Instruction: According to the National Health Insurance Medical Service Benefit Items and Payment Standards, after a patient with cardiac arrest recovers spontaneous circulation, which of the following is suitable for the use of targeted temperature management (TTM) management)？

Input: (A)Resumption of spontaneous circulation for more than 12 hours. (B)Systolic blood pressure 100 mmHg. (C)Computed tomography of the brain shows intracranial hemorrhage. (D)Consciousness GCS 9 after resuscitation after cardiac arrest. (E)There is a large amount of active internal bleeding.

Output: B


Instruction: Which of the following actions, if performed on a patient with right neck and shoulder pain, is more likely to be a muscle strain?

Input: (A) The patient tilts his head back and rotates to the side. The examiner stands behind him and presses the top of the patient's forehead with both hands. The patient experiences radiating pain or numbness in the upper limb. (B) The patient raises his right palm and places it on the top of his head to relieve the pain on the affected side. (C) When the patient bends his neck and touches his chin to his chest, it will induce an electric shock sensation or paresthesias in the right upper arm. (D) The pain is worse when the patient turns his head to the left. (E)Continued breath-holding will increase pain in the right neck and shoulder.

Output: D


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

Input: (A)The pulmonary artery is responsible for 99% of the blood flow to the lungs and is therefore often the main cause of hemoptysis. (B)Rasmussen's aneurysm is often caused by Aspergillus infection. (C)For patients with massive hemoptysis and instability, bronchoscopy after intubation is the first line of diagnosis and treatment. (D)In order to avoid the difficulty of intubation, a smaller endotracheal tube is usually selected for the treatment of patients with massive hemoptysis. (E)If a tracheotomy patient has a trachea-innominate fistula, it is usually impossible to temporarily stop the bleeding by applying pressure, and surgical treatment should be requested immediately.

Output: C


Instruction: A 70-year-old male with a history of diabetes underwent right thoracotomy two weeks ago. He presented to the emergency department today with fever, dyspnea, and severe chest pain on inspiration. A chest X-ray showed a moderate right pleural effusion, which was aspirated with a fine needle and revealed purulent material. Which of the following statements is more appropriate for the diagnosis and management of this patient?

Input: (A) The most common possible pathogen in this patient is S. pneumococcus. (B) The diagnostic criteria for empyema include a pleural fluid glucose level greater than 40 mg/dL and an LDH level greater than 1,000 U/L. (C) The pH value of the pleural fluid is 6.9, which can strengthen the diagnosis. (D) The preferred antibiotics are amoxicillin/clavulanate. (E) The disease is in the organizational stage and can be cured by antibiotics and chest tube drainage.

Output: C


Instruction: A 67-year-old male is currently taking rivaroxaban regularly in the cardiology department. He suffered pelvic and femoral neck fractures in a car accident. Which of the following statements about this patient is more appropriate?

Input: (A) Reversal agents can be used to avoid major bleeding. (B) If you want to understand the coagulation status, the aPTT time will be more accurate than the PT time. (C) This patient should regularly track coagulation factors. (D) Poor renal function will lead to a decrease in the excretion rate of rivaroxaban. (E) If the patient has massive bleeding, emergency hemodialysis is recommended to metabolize the drugs.

Output: D


Instruction: A 30-year-old female, 32 weeks pregnant, weighing 60kg, came to the emergency room with convulsions at home. Her family said that the patient had no history of seizures. The patient had several more seizures in the emergency room, and her blood pressure was 180/90 mmHg. Which of the following drugs should be considered first?

Input: (A)Lorazepam 6mg iv. (B)Labetalol 10mg iv. (C)Magnesium sulfate 4g iv. (D)Midazolam 10mg im. (E)Propofol 60mg iv.

Output: C


Instruction: A 5-year-old girl was brought to the emergency room by her mother for suspected abnormal behavior in the kindergarten. The teacher found that the girl often bit her lips for up to 10 minutes recently, her eyes were dull, she was not interactive, there were no bruises on her body, and she would occasionally turn her head to respond when called. The mother said that she also found similar situations at home. The emergency room measured vital signs and found blood pressure of 106/55 mmHg, heart rate of 96 beats/min, respiration of 20 times/min, body temperature of 36.3℃, and no fever or cough recently. During the physical examination, the girl had no errors in communication. Which of the following statements is more appropriate?

Input: (A) The girl's behavior is abnormal and she is suspected of being mentally stimulated. The child prevention and protection process (domestic violence or sexual assault) should be initiated. (B) The girl's eyes were dull, which was suspected to be an infection. Blood tests and blood sugar tests were performed. (C) The girl's behavior was recurrent, which was suspected to be a brain tumor. A CT scan was performed. (D) The girl often bit her lips and had recurrent seizures. She was suspected of epilepsy. An EEG test was arranged. (E) The girl's interaction was poor, which was suspected to be developmental delay. An evaluation was performed.

Output: D


Instruction: Regarding the renal injury scale (Grade IV), which of the following statements is more appropriate?

Input: (A) Grade III and above recommends surgical exploration. (B) Injuries to the medulla are at least Grade III. (C) Most renal gunshot and puncture injuries require surgical exploration. (D) Urinary extravasation on imaging is an indication for surgical exploration. (E) Sequential complications of kidney injury may include delayed bleeding, urinoma, and hypertension.

Output: E


Instruction: A male patient complained of chest tightness and shortness of breath and came to the emergency department. After the first-line resident gave the patient nitroglycerin via intravenous pump infusion, the patient's blood pressure dropped severely. You took over the treatment. Which of the following causes is less likely?

Input: (A) Hypertrophic obstructive cardiomyopathy. (B) Right ventricular infarction. (C) Aortic stenosis. (D) Anaphylaxis. (E) Mitral regurgitation.

Output: E


Instruction: A 2-year-old boy was taken to the emergency room with fever and wheezing three days ago. In the emergency room, you decide to perform endotracheal intubation. Which of the following statements is more appropriate?

Input: (A) When performing endotracheal intubation, if the glottis cannot be seen, it is advisable to place a pillow behind the boy's neck to align the trachea and oropharynx. (B) If difficult intubation occurs, surgical cricothyroidotomy should be performed urgently. (C) If oral endotracheal intubation fails multiple times, nasal intubation can be tried. (D) If a 4.5 mm endotracheal tube is used for endotracheal intubation, a cuffed endotracheal tube should be used and the cuff pressure should be continuously monitored. (E) When performing endotracheal intubation, a curved laryngoscope blade should be used.

Output: D


Instruction: A 50-year-old female patient who has been on peritoneal dialysis for many years presents to the emergency department with vomiting, abdominal pain, and a 2-day history of fever. Analysis of the peritoneal dialysis fluid reveals: WBC 90/mm³, of which 40% are neutrophils. Which of the following is more appropriate?

Input: (A) It is likely peritonitis, and a general surgeon should be consulted immediately. (B) It is likely peritonitis related to peritoneal dialysis, and IV antibiotics should be given immediately. (C) It is very likely peritoneal dialysis-related peritonitis. IP antibiotics should be given immediately (antibiotics are added to the dialysate). (D) It is unlikely to be peritoneal dialysis-related peritonitis. Peritoneal dialysis should be stopped immediately and a nephrology consultation will be conducted. (E) It is unlikely to be peritoneal dialysis-related peritonitis. Other tests should be arranged immediately to confirm the diagnosis.

Output: E


Instruction: A 3-year-old boy came to the emergency department because of difficulty breathing for three days and the symptoms became increasingly severe. The family said that the boy had been vaccinated on time in the past. In the past few days, his breathing has been more rapid and labored, and he has been less energetic. Physical examination findings: Chest auscultation revealed obvious stridor when the boy was resting, and the boy kept coughing, and the sound was like a barking cough. ; Appearance: There is chest retraction when breathing. Which of the following actions is more appropriate?

Input: (A) Give antibiotic treatment. (B) Immediately give steroid (dexamethasone) treatment, and it should be given intravenously, not orally. (C) Inhaled Beta-agonist drugs are not recommended because this action may aggravate the upper airway obstruction. (D) Immediately give inhaled Epinephrine treatment, which will not help the boy's condition. (E) Use a thicker endotracheal tube for endotracheal intubation.

Output: C


Instruction: To perform a Dix-Hallpike examination, what position do you need to arrange to start?

Input: (A) The patient is sitting on the examination bed. (B) The patient lies supine on the examination bed with the head facing upward. (C) The patient lies supine on the examination bed with the head tilted to one side. (D) The patient lies supine with the head tilted back outside the headboard and the head facing upward. (E) The patient lies supine with the head tilted back outside the headboard and the head tilted to one side.

Output: A


Instruction: Which of the following statements is more appropriate for patients with intestinal obstruction?

Input: (A) Postoperative adhesions rarely lead to large intestinal obstruction. (B) Anticonvulsant drugs such as Buscopan (hyoscine butylbromide) should be used as soon as possible to relieve the patient's abdominal pain. (C) Incarcerated groin hernia is the most common cause of small intestinal obstruction. (D)Nasogastric tube placement is often necessary and should be used early. (E)Severe intestinal obstruction leads to intestinal ischemic necrosis, with a mortality rate of about 50%.

Output: A


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

Input: (A)The average mortality rate of Toxic epidermal necrolysis is 60-70%. (B)When Toxic epidermal necrolysis affects more than 30% of the body surface area (BSA), it is called Stevens-Johnson syndrome. (C)Toxic epidermal necrolysis does not invade the conjunctiva and cornea. (D)The initial symptoms are often fever, sore throat, and muscle pain. (E)Skin rashes may appear all over the body, especially on the trunk.

Output: D


Instruction: Which description of symptom treatment for palliative care is more appropriate?

Input: (A) The biggest concern with actively using opioids to control pain is that it will cause sudden respiratory depression. (B) For terminal patients with shortness of breath, in addition to treating the underlying condition, the starting dose of morphine is twice the dose used to treat pain. (C) For persistent nausea and vomiting, morphine can be used at half the dose used to treat pain. (D) When prescribing opium to treat terminal pain, a stimulant or osmotic laxative should be prescribed at the same time to prevent constipation. (E) For terminally agitated patients, there is evidence that the use of antipsychotics, hypnotics, or opioids can hasten death.

Output: D


Instruction: A 25-year-old male drowned in a river with transient unconsciousness and was brought to the emergency department with a Glasgow Coma Scale score of 15 and SaO2 of 95%. Which of the following is less appropriate?

Input: (A) Often associated with head trauma or excessive neck extension, routine use of a cervical collar is recommended. (B) Observation for 4-6 hours is recommended, and follow-up chest X-rays are not necessary if physical examination shows normal lungs. (C) Blood tests for low sodium and low potassium are uncommon. (D) Prophylactic antibiotics are not routinely required. (E) If SaO2 drops to 91%, in addition to chest X-ray and routine blood tests, drug screening should be considered.

Output: A


Instruction: A 25-year-old female accidentally ingested about 120 ml of an unknown chemical. 14 hours later, she went to the emergency room for dizziness and nausea. The patient said that the drug tasted sweet. At the time of consultation, her temperature was 36.8℃, her breathing was 18 times/min, her heart rate was 92 times/min, her blood pressure was 169/85 mmHg, Na was 142 mmol/L, Cl was 109 mmol/L, BUN was 7 mg/dL, glucose was 131 mg/dL, ketone body: negative, Ethanol was 3 mg/dL, blood osmolality was 319 mOsm/Kg, and arterial blood gas analysis showed pH 7.29, PCO₂ 25.4 mmHg, HCO₃ 12.5 mmol/L, urine analysis was Calcium oxalate crystals were detected. Which of the following substances is the patient most likely to have ingested?

Input: (A) Methanol. (B) Toluene. (C) Ethylene glycol. (D) 2-chloroethanol. (E) Isopropyl alcohol.

Output: C


Instruction: A 6-year-old boy was walking across the street when he was hit by a car traveling at 35 km/h. Which of the following statements is more appropriate regarding the care of this victim?

Input: (A) Because of the large impact on the thorax, flail chest is common. (B) The likelihood of symptomatic cardiac contusion is higher than in adults. (C) The chance of tension pneumothorax is higher than in adults. (D) The chance of transection of the thoracic aorta is higher than in adults. (E) Rib fractures are common in children with this mechanism of injury.

Output: C


Instruction: Which of the following statements about the use of thrombolytic agents (r-tPA) to treat ischemic stroke is less appropriate?

Input: (A) If the patient is suffering from epileptic seizure and unconsciousness, thrombolytic therapy should not be considered. (B) If all conditions are met, r-tPA can be considered for brain tumors that have been cured for more than three months. (C) The patient's blood pressure should be maintained at less than 185 mmHg systolic and less than 110 mmHg diastolic before medication. (D) It should never be used in patients with unclear symptom onset. (E) If the patient is eligible for arterial embolectomy, r-tPA can still be given before embolectomy.

Output: B


Instruction: A 50-year-old male driver was hit by a truck. When he arrived at the emergency room, his vital signs were as follows: temperature 36.2℃, respiration 40 times/min, heart rate 140 times/min, blood pressure 70/40 mmHg, blood oxygen 80%, confusion, and coma index 14. Primary assessment showed that his airway was patent and free of foreign objects, his trachea was deviated to the left, his cervical veins were distended, and there was subcutaneous edema on the right chest wall. Which of the following treatments is more appropriate?

Input: (A) Emergency thoracotomy on the right side. (B) Bag-valve-mask ventilation. (C) Non-invasive positive pressure ventilator. (D) A tube thoracotomy was placed in the fifth intercostal space on the right side. (E) A needle decompression was placed in the fifth intercostal space on the right side.

Output: E


Instruction: A six-year-old child weighing 20 kg was sent to the emergency room with abdominal contusion during a kindergarten trip. There were no abnormal findings in the respiratory tract or breathing. There was abdominal tenderness with rebound tenderness. The blood pressure was 70/30 mmHg with symptoms of shock. Which of the following statements is more appropriate for emergency treatment?

Input: (A) 1,000 ml of isotonic crystalloid solution should be given for fluid resuscitation and reassessed. (B) 400 ml of isotonic crystalloid solution should be given for fluid resuscitation. (C) If the child is still in shock after the first infusion, 10 ml of isotonic crystalloid solution per kilogram can be given for the second or third infusion. (D) Because the child has a lower tolerance to shock, direct blood transfusion can be given as a priority. (E) Transfusion therapy is 20 ml packed RBC per kg.

Output: B


Instruction: You are preparing to extract knee joint fluid. Which of the following statements is more appropriate?

Input: (A) It is best to extract in a sitting position. (B) It is best to extract with the knees bent. (C) The two finger widths (about 3 cm) just below the patella are used as the reference point. (D) The needle is inserted on the inside or outside of the reference point and moves horizontally toward the midpoint of the posterior side of the patella. (E) When extracting, avoid milking the joint cavity at the same time to avoid bleeding in the joint cavity.

Output: D


Instruction: Which of the following options is more appropriate for the description of migraine?

Input: (A) Combination use of antihistamines and nonsteroidal anti-inflammatory drugs (NSAIDs) can help migraines, but antihistamines alone are not helpful. (B) The most common age of onset is around 40 years old, and the prevalence is greater in men than in women. (C) The use of steroids does not reduce the risk of recurrence of headaches after emergency department discharge. (D) Initial treatment recommends the use of morphine combined with antiemetics. (E) It is usually unilateral and pulsatile, and there may be phobia of light and sound.

Output: A


Instruction: A 75-year-old woman with a history of rheumatic heart disease and hypertension recently complained of chest tightness and shortness of breath. I was sent to the emergency room today because of syncope. When I arrived at the hospital, my blood pressure was 108/76 mmHg, my heart rate was 135 beats/min, my respiration rate was 25 breaths/min, and my SpO₂ was 89%. I heard humming sounds on both sides of my chest, and S4 gallop was heard on my heart sounds. My chest X-ray showed bilateral pulmonary edema, and my electrocardiogram showed atrial fibrillation. Which of the following statements is more appropriate?

Input: (A) Beta-blockers or calcium ion blockers can be given, which have a good effect on controlling heart rhythm. (B) This lesion is often caused by endocarditis, so routine preventive antibiotics are required. (C) If the lesion is severe, surgery is often required. If surgery is not performed, the mortality rate within one year is high. (D) Give oxygen, sublingual NTG and furosemide, and sometimes positive pressure breathing to treat pulmonary edema. (E) Give aspirin and clopidogrel, check for troponin, and arrange for cardiac catheterization immediately.

Output: C


Instruction: Which of the following recommendations for post-cardiac arrest care for patients with cardiac arrest is more appropriate?

Input: (A) Cooling the patient with ice water before arrival at the hospital helps the patient's neurological prognosis and survival rate to discharge. (B) If the patient is unconscious and unable to follow verbal commands after resuscitation, consider targeted temperature management of 32-36℃ for 48-72 hours. (C) Emergency coronary angiography and percutaneous coronary intervention (PCI) after resuscitation have been shown to help patients' prognosis. (D) Complications such as bradycardia, coagulation abnormalities, hyperkalemia and QT prolongation are more likely to occur during cooling. (E) If a patient develops fever after rewarming, it should be actively controlled.

Output: E


Instruction: Which of the following is more appropriate for the diagnosis and treatment of acute pancreatitis?

Input: (A) Laboratory tests must include both amylase and lipase for a correct diagnosis. (B) The level of lipase can represent the severity of the disease. (C) Abdominal CT is a good diagnostic tool and this imaging examination can be arranged early. (D) To avoid worsening of the condition, the patient must be prohibited from taking food orally and should be given intravenous fluids instead. (E) Antibiotics do not help prevent complications of infection.

Output: E


Instruction: A 27-year-old male with fever and sore throat for two days went to the emergency room due to continued worsening pain, difficulty swallowing, and difficulty breathing. His temperature was 38.3℃, his respiratory rate was 20 times/min, his heart rate was 108 times/min, and his blood pressure was 123/76 mmHg. Which of the following statements about this patient is more appropriate?

Input: (A) Patients with acute anaphylaxis often present with drooling, dysphagia, and respiratory distress. (B) According to the original Centor criteria: tonsillar exudate, anterior cervical lymphadenopathy, no cough, and fever, if two or more of the four criteria are met, Group A β-hemolytic Streptococcus (GABHS) pharyngitis may be suspected and antibiotic treatment may be considered. (C) Ludwig's angina often originates from infection of the retropharyngeal space, which then spreads to the sublingual and submental spaces. (D) When the patient has stridor and difficulty swallowing, the patient can be asked to lie down and given epinephrine nebulization inhalation to relieve the symptoms. (E) Retropharyngeal abscess, in addition to sore throat, is often accompanied by neck swelling and muffled voice.

Output: B


Instruction: Typical symptoms of Kawasaki disease include fever >39 to 40°C for at least 5 days. In addition to fever, there are 5 other typical diagnostic factors, at least 4 of which must be present, but not including?

Input: (A) Chapped lips, erythema, strawberry tongue, redness and congestion of the mouth and pharynx. (B) Bilateral conjunctival congestion without discharge. (C) Rash: maculopapular rash, diffuse erythroderma, or multiforme erythema. (D) Redness and swelling of the hands and feet in the acute phase, and or peeling of the nail ends of the limbs in the subacute phase. (E) Cervical lymphadenopathy (usually bilateral and ≥1.5 cm in diameter).

Output: E


Instruction: A 30-year-old male patient with schizophrenia is taking medication to control his condition. However, he has been seeing doctors and taking medications frequently due to depression in recent days. He was taken to the emergency room by his family. He complained of confusion and body stiffness starting this morning. GCS E3V3M3, blood pressure 187/78 mmHg, heart rate 120 beats/min, respiration 30 times/min, body temperature 39°C, no distension of the jugular vein, clear lung auscultation without wet sounds, irregular heart rhythm, no heart murmurs, soft abdomen, abnormal stiffness of limbs, unable to flex. Initial laboratory examination: WBC 20,600/μL, Hb 13.9 g/dL, platelet 160,000/μL, CRP 1.9 mg/dL, BUN 50 mg/dL, Cr 2.0 mg/dL, GOT 40 U/L, Na 140 mmol/L, K 4.2 mmol/L, CK 1,250 U/L, arterial blood gas: metabolic acidosis. Based on the current test results, which of the following diagnostic options is more appropriate?

Input: (A)Epilepsy. (B)Meningitis. (C)Neuroleptic malignant syndrome. (D)Serotonin syndrome. (E)Thyroid storm.

Output: C


Instruction: Which of the following statements is more appropriate for the primary assessment and resuscitation of traumatic injuries in the elderly?

Input: (A) During rapid sequence intubation, the drug dosage remains unchanged. (B) When hypoxia is imminent and respiratory failure is imminent, the heart rate will significantly increase. (C) The following auxiliary methods are recommended to identify the early symptoms of shock, including base deficit, serum lactamase, shock index, etc. (D) For patients with traumatic shock, early placement of advanced monitoring such as central venous pressure is not helpful. (E) To avoid potential and undetected spinal injuries, the neck collar and long back fixation should not be removed prematurely.

Output: C


Instruction: Which of the following is less appropriate regarding the clinical manifestations of anaphylaxis?

Input: (A) Typical initial symptoms are itching and urticaria. (B) Vocal cord paralysis and hoarseness are common. (C) The faster the symptoms develop, the more severe the condition. (D) About half of deaths occur within 60 minutes of the onset of symptoms. (E) There is still a risk of recurrence after the symptoms disappear.

Output: B


Instruction: An 82-year-old male was sent to the emergency department because of fever, wheezing, and use of accessory muscles, obvious wheezing, and altered consciousness. On arrival, his temperature was 39°C, his heart rate was 120 beats/min, his respirations were 28 breaths/min, and his blood pressure was 132/84 mmHg, blood oxygen concentration 85%. Arterial blood gas analysis PaCO₂ 80 mmHg. Which of the following treatments is less appropriate for this patient?

Input: (A) Oxygen therapy should be given to maintain a blood oxygen concentration of at least 90%. (B) A non-invasive positive pressure ventilator should be given, and a nasogastric tube should be used to reduce pressure to prevent aspiration events. (C) Inhaled treatment with type II sympathomimetic agents and anticholinergics should be given. (D) If the cough is accompanied by thick sputum, broad-spectrum antibiotics should be given, covering Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis species. (E) Endotracheal intubation should be considered.

Output: B


Instruction: Which is the first priority when conducting a complete eye examination?

Input: (A) Test intraocular pressure. (B) Test vision. (C) Test pupil size. (D) Test the eyelid and conjunctiva. (E) Test the activity of the extraocular muscles.

Output: B


Instruction: A 75-year-old woman was found lying at home by her family, vomiting green objects, suspected of intoxication from ingesting an unknown liquid. The vital signs measured after emergency intubation are as follows: E1V TM4, blood pressure 85/51 mmHg, heart rate 148 beats/min, body temperature 35.4℃, respiration 32 times/min, SpO₂ 83%, and both pupils are 3mm without light reflex. The patient was restless and sweating all over. The brain CT scan showed no obvious abnormality, and the electrocardiogram showed a sinus rhythm. Arterial blood oximetry: pH 7.35, PCO₂ 36.7 mmHg, PO 2 314.8 mmHg, HCO₃ 19.8 mm/L, SBE-5.8 mm/L, Sat 99.7%, P(Aa)O 2 341.0 mmHg, FiO 2 100%. In the case of suspected poisoning, which of the following is the most likely diagnosis?

Input: (A) Caustics intoxication. (B) Cyanide intoxication. (C) Methanol intoxication. (D) Methemoglobinemia. (E) Paraquat intoxication.

Output: D


Instruction: A 36-year-old male presents with multiple painful ulcers on his penis and purulent nodules in the bilateral inguinal clefts. Which of the following treatments is appropriate?

Input: (A) Ceftriaxone. (B) Doxycycline. (C) Metronidazole. (D) Pencillin-G benzathine. (E) Valacyclovir.

Output: A


Instruction: A 60-year-old male presents to the emergency department with right calf pain and intermittent claudication for approximately 7 days. Physical examination reveals a weak right dorsalis pedis artery, right arm BP of 160/100 mmHg, and right ankle BP of 100/60 mmHg. Which statement about this patient is more appropriate?

Input: (A) The pain is difficult to localize and is usually not relieved by rest. Elevation of the limb is often required to improve symptoms. (B) This patient most likely has a lesion in the right common femoral artery. (C) This patient's ankle-brachial index is 0.625. (D) Treatment Low molecular weight heparin (LMWH) is the first-line treatment. (E) Even if treatment is successful, the ankle-brachial index will not return to the normal range.

Output: C


Instruction: A 30-year-old male who often drinks alcohol for social events. One month ago, he went to the urology clinic because of stinging and burning sensations when urinating. After examination, he was diagnosed with chlamydial urethritis. He recovered after a course of antibiotic treatment. Recently, he began to feel stiffness and pain in his lower back, and even a dull pain in his right knee. He went to the pharmacy to buy a topical pain-relieving patch, but it did not relieve the pain. Instead, his ankle joints on both sides and his right toes became swollen and painful, making him unable to walk. He also had red and swollen eyes. What is the most likely diagnosis for this patient?

Input: (A) Behcet's disease. (B) Psoriatic arthritis. (C) Reiter's syndrome). (D) Gonococcal arthritis. (E) Ankylosing spondylitis.

Output: C


Instruction: Which of the following descriptions of sonographic B lines in pulmonary ultrasound is more appropriate?

Input: (A) They can be used in conjunction with vena cava ultrasound to assist in the diagnosis of heart failure. (B) They occur in patients with acute respiratory distress syndrome, pulmonary fibrosis, pneumonia, and massive pneumothorax. (C) They run parallel to the pleura. (D) If the patient does not have sonographic B lines in the lungs, heart failure can be ruled out. (E) If the patient has sonographic B lines on both sides of the lungs, heart failure can be diagnosed.

Output: A


Instruction: 28-year-old female, vital signs are blood pressure 132/84 mmHg, heart rate 85 beats/min, respiration 18 times/min, body temperature 36.4℃; in the emergency department, she complained of lower abdominal pain and abnormal vaginal bleeding. She said that her last menstrual period was about two weeks ago. She has no past medical history, G0P0. Physical examination revealed tenderness in the left lower abdomen and pelvic cavity without rebound tenderness; blood test results were as follows: white blood cells 9,300/μL, hemoglobin 10.3 g/dL, platelets 263,000 /μL; β-hCG 3,600 mIU/mL; abdominal ultrasound showed no abnormal ascites, and no gestational sac was found in the uterus. Which of the following inferences is more appropriate?

Input: (A) If the estimated gestational period is about two weeks, and the β-hCG level rises smoothly after two days, it may be diagnosed as threatened abortion. (B) If the estimated gestational period is about two weeks, and the β-hCG level drops after two days, it may be diagnosed as missed abortion. (C) If the estimated gestational period is more than five weeks, and the transvaginal ultrasound does not find the gestational sac in the uterus, it may be diagnosed as threatened abortion. (D) If the estimated gestational period is more than five weeks, and the transvaginal ultrasound does not find the gestational sac in the uterus, it may be diagnosed as ectopic pregnancy. (E) If the estimated gestational period is more than five weeks and no intrauterine gestational sac is found by transvaginal ultrasound, it may be implantation bleeding.

Output: D


Instruction: Which of the following statements about the treatment of acute heart failure is more appropriate?

Input: (A) Compared with drug therapy alone, the combination of noninvasive ventilation and drug therapy does not reduce the chance of intubation. (B) If a patient with acute heart failure develops hypotension, adequate fluids should be given before using cardiotonic drugs, such as norepinephrine. (C) The use of acetaminophen to relieve headaches caused by nitroglycerin is often ineffective. (D) The use of morphine to treat acute heart failure can reduce the patient's anxiety, but it will prolong hospital stay and increase mortality. (E) Late-stage heart failure is caused by pulmonary microvascular wedge pressure. pressure) is high, chest X-ray will almost always show typical pulmonary edema.

Output: D


Instruction: A 32-year-old male went to the emergency department because of intermittent fever and oral ulcers for two weeks. He had herpes zoster two months ago. Because of clinical suspicion of human immunodeficiency virus (HIV) infection, which of the following statements is more appropriate?

Input: (A) Currently, HIV 1+2 ELISA test is often used as a preliminary test to detect HIV virus antigens. (B) Most Taiwanese patients are infected with HIV-2. (C) If HIV is diagnosed, the patient is not suitable for tetanus vaccine in the future. (D) For lesions in the mouth, suspected Candida infection can be treated first with amphotericin B. (E) Lymphoma is the most common tumor in HIV-infected patients and can also cause fever in patients.

Output: E


Instruction: A 60-year-old male complained of a brief fainting spell 30 minutes ago and is now wheezing and having chest pain. Auscultation of the heart sounds revealed systolic murmurs; when palpating his right pulse, a significant brachioradial delay was found. Which of the following statements is more appropriate for the diagnosis and treatment of this patient?

Input: (A) Electrocardiograms can often reveal left ventricular hypertrophy, and oxygen should be given for treatment. (B) The patient's chest X-ray may show pulmonary edema. At this time, positive pressure respiration should be avoided and nitroglycerin is the first choice for treatment. (C) This disease usually does not require surgical treatment. (D) If atrial fibrillation occurs during the treatment observation period, the use of beta-blockers for heart rate control should be considered first. (E) Endocarditis is a very common complication of this disease, so prophylactic antibiotics should be given.

Output: A


Instruction: A young woman suffered severe head injuries when her motorcycle hit a telegraph pole and her helmet flew off. In the emergency room, her GCS was 6 points, her blood pressure was 140/90 mmHg, and her heart rate was 80 beats/min. After receiving endotracheal intubation and ventilator ventilation, the pupils were equal to 3mm, both sides reacted to light, and there were no other obvious injuries. What is the most important treatment principle for this patient?

Input: (A) Avoid hypotension. (B) Give osmotic diuretics. (C) Actively treat hypertension. (D) Increase the metabolic rate of brain tissue. (E) Differentiate between intracranial hematoma and cerebral edema.

Output: A


Instruction: A 27-year-old pregnant woman had frequent contractions and ruptured membranes. She was 38 weeks pregnant and was expecting her second child. She gave birth in the emergency room shortly after arriving at the hospital. The mother is emaciated and pale (Hb 5.0 g/dL). The emergency department measures her vital signs: clear consciousness, blood pressure 126/75 mmHg, heart rate 130 beats/min, respiration 20 times/min, body temperature 36.3℃. The mother is suspected to be a drug addict. The newborn is not very active, has shallow breathing, and a heart rate of 75 beats/min. After back stimulation, there is still no improvement. Which of the following statements is more appropriate for the emergency treatment of this newborn?

Input: (A) The newborn is not very active and the mother has broken water. Antibiotics should be injected immediately if sepsis is suspected. (B) The newborn is not very active and the mother is severely anemic. The newborn needs blood transfusion. (C) If there is still no improvement after stimulation, give the newborn chest compression first aid and inject epinephrine. (D) Suspected withdrawal syndrome, injection of sugar solution and administration of antidote. (E) No improvement after stimulation, airway clearance and positive pressure oxygen breathing.

Output: E


Instruction: A 3-year-old boy suffered a facial laceration due to a fall. Ketamine was used for sedation during suture. Which of the following statements is more appropriate?

Input: (A) Intramuscular or intravenous injection is acceptable, and the sedative effect lasts for the same period of time. (B) The intramuscular injection dose is 1 mg/kg. (C) After the drug takes effect, the patient may still have movements and muscle tension. (D) The additional dose is mainly used to increase the depth of anesthesia, not to prolong the duration of action. (E) Compared with other sedatives, it is more likely to have respiratory depression and blood pressure effects.

Output: C


Instruction: Which statement about urinary tract infection is less appropriate?

Input: (A) Visual inspection or assessment of urine odor is usually not helpful in determining infection. (B) Fluoroquinolones are recommended as empirical antibiotics for patients with HIV/AIDS. (C) A positive urine nitrogen test (urine nitrite) combined with a positive leukocyte esterase test can improve the diagnosis of urinary tract infection. (D) Pseudomonas converts nitrates in the urine to nitrites, which will result in a positive urine nitrogen test (urine nitrite). (E) Pregnant women and those who are about to undergo invasive urinary tract surgery should still be treated for asymptomatic bacteriuria.

Output: D


Instruction: A 60-year-old male with a history of hypertension and diabetes mellitus was sent to the emergency department with complaints of acute chest pain extending to the back. On examination, his blood pressure was 220/110 mmHg, heart rate 98 beats/min, respiration 20 times/min, chest X-ray shows mediastinum widening, and the electrocardiogram shows no special changes. Which of the following is more appropriate for the diagnosis and clinical treatment of this patient?

Input: (A) If the laboratory test D-dimer is normal, the possibility of pulmonary embolism and aortic detachment can be ruled out. (B) The sensitivity of pulse deficits in patients with aortic detachment is high. (C) 80-90% of patients with aortic detachment will have abnormal chest X-rays. (D) Aortic stripping sometimes affects coronary perfusion, and the most commonly affected coronary artery is the left coronary artery, which can cause anterior wall myocardial infarction. (E) Nitroglycerin or nicardipine should be used first to control blood pressure.

Output: C


Instruction: A non-traumatic adult female who was in shock upon arriving at the emergency department was immediately evaluated by bedside ultrasound. The diameter of the patient's inferior vena cava was measured to be approximately 2.4 cm below the sphenoid process (subxiphoid), and the change in the diameter of the inferior vena cava was <50% during breathing. The apical four chamber view of cardiac ultrasound evaluation found that the RV/LV end-diastolic diameter ratio was >1. Which of the following is the most likely cause of shock in this patient?

Input: (A) Massive upper gastrointestinal bleeding. (B) Acute pulmonary embolism. (C) Acute heart failure with pulmonary edema. (D) Septic shock. (E) Rupture of abdominal aortic aneurysm.

Output: B


Instruction: Which of the following statements is more appropriate for the diagnosis of patients with acute appendicitis?

Input: (A) Alvarado score is the gold standard for clinical diagnosis. (B) Many empirical data show that abdominal ultrasound can improve the diagnosis rate of acute appendicitis. (C) Early appendicitis usually presents with epigastric pain. (D) Up to 50% of patients present with atypical symptoms. (E) Patients with simple right lumbar pain should be able to reasonably rule out acute appendicitis.

Output: D


Instruction: Which of the following tests can help diagnose lumbar disc herniation syndrome and has the highest specificity?

Input: (A)Straight leg raise test. (B)Lhermitte's sign. (C)Spurling's sign. (D)Abductor sign. (E)Cr ossed straight leg raise test.

Output: E


Instruction: A 17-year-old female was sent to the emergency room after she developed confusion and agitated behavior in a nightclub with a temperature of 39°C and a blood pressure of 150/96 mmHg. Her friend said that the patient had taken ecstasy. Which of the following statements is more appropriate?

Input: (A)Patients often have high fever, high blood pressure, dehydration, and high sodium levels. (B) Giving activated charcoal will not help much. (C) If the patient has a fever over 40℃, the prognosis is poor, but cooling should not be too rapid to avoid epilepsy. (D) If the patient still has a high fever after cooling, consider using dantrolene. (E) If the patient has symptoms similar to serotonin syndrome, consider using serotonin agonist drugs.

Output: D


Instruction: An 88-year-old male resident of a nursing home went to the emergency department with cough, fever, and shortness of breath. Chest X-ray showed right-sided pneumonia, and the doctor recommended hospitalization. Which of the following is less suitable as his choice of empirical antibiotic?

Input: (A) Vancomycin. (B) Tazocin (Piperacillin/Tazobactam). (C)Levofloxacin. (D)Cefepime. (E)Cef uroxime.

Output: E


Instruction: Which of the following statements about the use of antiplatelet and antithrombotic drugs in the treatment of acute stroke is less appropriate?

Input: (A) In patients with ischemic stroke and acute atrial fibrillation, antithrombotic drugs should be used as early as possible in the emergency department to prevent worsening of stroke or secondary stroke. (B) Antiplatelet or antithrombotic drugs should not be used within 24 hours of thrombolytic treatment. (C) Antiplatelet drugs should be given within 24 to 48 hours after the onset of stroke symptoms. (D) Patients with transient ischemic attack can use two different antiplatelet drugs in combination. (E) The ABCD2 score is not effective in identifying patients at high risk of transient ischemic attack.

Output: A、B、C、D


Instruction: A 30-year-old male with asthma attacks went to the emergency room for treatment. He had no fever and no special findings on chest X-ray. He had inhaled albuterol and ipratropium three times in the emergency room and had been given IV steroids. After tracking, SpO₂ 90%, arterial PCO₂ 45 mmHg, blood pressure 102/75 mmHg, heart rate 145 beats/min, respiratory rate 35 breaths/min, combined with the use of respiratory auxiliary muscles, which of the following descriptions and treatments is more appropriate for this patient?

Input: (A) If there is no wheezing breath sound during the second auscultation, giving bronchodilators at this time is unlikely to be helpful. (B) Salmeterol xinafoate and formoterol are better than albuterol in binding to the β 2-receptor and can be considered for use in patients. (C) Magnesium 2 grams IV drip can be considered, but nebulized magnesium should not be considered. (D) If there is no pneumothorax, non-invasive positive pressure ventilator (NIPPV) has the potential to increase airflow, but it will not reduce the chances of intubation and hospitalization. (E) If intubation is necessary, ketamine is a good choice, but intubation cannot solve the problem of airflow obstruction.

Output: E


Instruction: A 23-year-old woman who was 12 weeks pregnant had sudden palpitations, shortness of breath, and sweating during a prenatal checkup. When she was sent to the emergency department, her temperature was 38.8°C, her heart rate was 148 beats/min, her respiratory rate was 25 breaths/min, and her blood pressure was 145/100 mmHg. She had no past or family medical history. Physical examination showed a slightly enlarged thyroid gland. Especially when the thyroid gland was palpated, the patient's heart rate was 160 beats/min. Which of the following treatments is less appropriate?

Input: (A) Give supportive treatment including oxygen, intravenous infusion; if necessary, give oral acetaminophen 325-650 mg to help reduce fever. (B) Give methimazole 40 mg orally, 25 mg every 4 hours; total daily dose 120 mg. (C) One hour after the above treatment steps are completed; give 8-10 drops of Lugol solution every 6-8 hours until the desired effect is achieved. (D) Give propranolol 1-2 mg slowly intravenously, repeat every 10 to 15 minutes, until the desired effect is achieved. (E) Give hydrocortisone 100 mg intravenously, repeat 100 mg 3 times within 24 hours, until the desired effect is achieved.

Output: B


Instruction: A 46-year-old female with no history of illness. She usually runs a food stall in Kinmen Traditional Market. She recently traveled to the Hualien Mountains. She complained of intermittent fever, headache, soreness in both calf muscles, mild cough, and non-suppurative conjunctivitis in both eyes about 10 days ago. The above symptoms subsided after 5 days, but she began to have darker urine and decreased urine volume 3 days ago. Blood pressure 125/78 mmHg, heartbeat 100 beats/min, respiration 25 breaths/min, and body temperature 38°C. WBC 12,500/μL (Seg. 89%, Lym. 9%), Hb 11.8 g/dL, Platelet 230,000/μL, AST 658 U/L, ALT 586 U/L, T-Bil. 3 mg/dL, creatinine 4.5 mg/dL, no obvious changes on chest X-ray. Which of the following pathogens is most likely?

Input: (A) Hepatitis A virus. (B) Rickettsia tsutsugamushi. (C) Measles virus. (D) Leptospirosis. (E) Dengue virus.

Output: D


Instruction: A factory employee accidentally entered an industrial irradiation room and was irradiated by the radiation source above. He was taken to the emergency room with general discomfort. Which of the following statements is more appropriate?

Input: (A) By asking the patient about the time when vomiting occurred after being exposed to the radiation source, the radiation exposure dose can be estimated. (B) A decrease in the absolute neutrophil count is more often used to estimate the exposure dose than a decrease in the absolute lymphocyte count. (C) Colony-stimulating factor (CSF) is not very effective when the patient's blood cell count is reduced. (D) When handling patients, emergency medical staff should wear Class B protective clothing to avoid inhaling radioactive materials. (E) When patients are decontaminated, they need to be quickly rinsed with large amounts of clean water to avoid worsening injuries.

Output: A


Instruction: A 14-day-old boy was brought to the emergency room by his family today because of tea-colored urine, grayish-white stools, and yellow sclera and skin. The family pointed out that the child had been breastfed since birth. On the second day, the child developed yellow skin and sclera, and had anorexia and poor activity, which has not improved so far. In the emergency room, the rectal temperature was measured at 37.4℃. What is the most likely cause of the child's jaundice?

Input: (A) Physiological jaundice. (B) Breast milk jaundice. (C) Biliary atresia. (D) Septic jaundice. (E) Hemolysis jaundice.

Output: C


Instruction: Which of the following statements about the cause of shoulder pain is more appropriate?

Input: (A) The most serious vascular injury is acute thrombosis of the axillary artery. (B) Thoracic outlet syndrome is a possible differential diagnosis for shoulder pain, which often occurs in middle-aged men. (C) Patients with splenic injury may have symptomatic right shoulder pain due to diaphragm irritation. (D) Nerve compression in the neck often causes shoulder pain, such as C7-C8 disc herniation. (E) Brachial plexus neuritis is a possible cause of shoulder pain, which usually begins with weakness and then pain.

Output: A


Instruction: A 70-year-old female patient developed sudden dizziness when she got up. Which of the following statements is more appropriate?

Input: (A) The patient experienced rotation and horizontal nystagmus, which are often manifestations of central nervous system disease. (B) The patient opened her eyes, was able to stand steadily on both feet, and her hands did not tremble, indicating that the cerebellum functioned normally. (C) Because water flowed out of the corners of the patient's mouth when she rinsed her mouth, and she easily choked when she drank water, the clinical diagnosis was peripheral facial nerve palsy (Bell's palsy). (D) If the diagnosis was left lateral medullary infarction, the symptoms should be right facial numbness, loss of corneal reflex, Horner's syndrome, and dysphagia. (E) If dizziness is caused by postural hypotension, do not use prochlorperazine and chlorpromzine for antiemetic purposes.

Output: E


Instruction: Which of the following statements about acute limb weakness is more appropriate?

Input: (A) If the patient's weakness first develops in the upper limbs and then progresses to the lower limbs, tick paralysis should be considered. (B) When the patient's weakness is greater in the distal limbs than in the proximal limbs, myasthenia gravis should be considered first. (C) Guillain-Barre syndrome can lead to autonomic dysfunction. (D) Multiple sclerosis is a demyelinating disease, and clinically, symptoms may improve with temperature rise. (E) From the symptom perspective, whether it is a central nervous system or peripheral nervous system problem can be distinguished by whether there is diplopia or dysphagia.

Output: C


Instruction: Which of the following statements about airway management principles for pregnant women is more appropriate?

Input: (A) The more the pregnant woman gains weight, the lower the Mallampati Class index will be before intubation. (B) Upper airway edema is more common in late pregnancy, so the use of a laryngeal mask airway (LMA) is not recommended for pregnant women who have difficulty intubating. (C) For pregnant women who are assessed to have difficulty in intubation, it is recommended to try non-microscopic nasotracheal intubation first. (D) When rapid drug-guided intubation is to be used, the drugs and dosage considerations used by pregnant women are no different from those for general patients. (E) After intubation is completed, the frequency of ventilation can be increased to create a mild respiratory alkaline state to increase uteroplacental blood flow.

Output: D


Instruction: A 65-year-old male drank an unknown pesticide and went to the emergency room a few hours later for gastrointestinal discomfort. He immediately developed changes in consciousness and soon even had a seizure and respiratory failure. The blood test report showed hyperammonemia. Although he was actively rescued and his consciousness gradually recovered after a few days, he continued to have anterograde and retrograde amnesia. Which type of pesticide poisoning is most likely?

Input: (A) Paraquat poisoning. (B) Organophosphate poisoning. (C) Securitol poisoning. (D) Pyrethrin poisoning. (E) Glyphosate poisoning.

Output: C


Instruction: A 15-year-old female student had sex with her boyfriend four days ago and was taken to the emergency room by her family, who requested that the sexual assault process be carried out. After private questioning, the girl said that this was a consensual relationship. Which of the following statements is more appropriate?

Input: (A) According to the Convention on the Rights of the Child, the best interests of the child should be given priority, so the parents were tactfully informed to respect their daughter's wishes and to reach a consensus before informing the doctor whether to carry out the sexual assault process. (B) According to the injury classification regulations, this is a second-level condition. (C) In order to determine whether there has been any violent injury, it is necessary to remove the clothes and take photos, and carefully check for wounds, bruises, and tenderness, especially on the limbs, neck, and perineum. (D) Internal examination or use colposcopy to check if there are any wounds on the vagina and cervix, and use Wood's lamp to check if there is any semen residue on the body surface. (E) Blood test for complete blood count, liver function, hepatitis B/C, syphilis and HIV virus, and urine test for pregnancy and drug-facilitated rape.

Output: D


Instruction: A 40-year-old male has pain in the third molar of the right mandible for a week. Today he has a fever and cannot lie flat. Saliva keeps overflowing from the corners of his mouth. There is obvious stridor when breathing. Physical examination found redness and swelling on the right side of the face, which extends to the chin and neck, and clenched teeth. Use simple mask 6L/min The subsequent blood oxygen concentration was 95%. Which follow-up treatment is more appropriate?

Input: (A) Rapid sequence intubation should be used as soon as possible to establish an advanced airway. (B) Rocuronium injection can relieve the problem of lockjaw. (C) Succinylcholine injection will worsen the problem of lockjaw. (D) When using a bag-valve mask to actively administer oxygen, jaw thrust can effectively open the patient's airway. (E) Awake intubation should be arranged as soon as possible.

Output: E


Instruction: Which of the following is not a common complication caused by high-voltage electrical injuries?

Input: (A) Aspiration pneumonia. (B) Delayed cataract. (C) Hearing loss. (D) Delayed thrombosis in the injured limb. (E) Bone necrosis.

Output: E


Instruction: Taiwan is located in an earthquake zone and may experience large-scale Richter earthquakes every year. According to the operating guidelines of the Central Disaster Response Center, which of the following statements is more appropriate?

Input: (A) If a first-level disaster response center is established by the central government, the highest authority should be the Presidential Office, and the then-president will usually be the commander of the disaster response center. (B) The timing of the opening of the response center is determined to be when the magnitude of the earthquake announced by the Central Weather Bureau reaches 7 or above. (C) If rescue teams from other counties and cities want to assist in rescue, they should go directly to the scene after assembling to facilitate dispatch by local commanders. (D) If a foreign search and rescue team wishes to assist in the rescue, the Ministry of the Interior's Fire Department should assess the manpower needs and coordinate the command. (E) In the event of a radiation disaster caused by an earthquake, the Director of the Atomic Energy Commission of the Executive Yuan shall serve as the commander.

Output: D


Instruction: A 20-year-old female pedestrian was hit by a car at a speed of 70 kilometers per hour. When she arrived at the emergency room, her vital signs were as follows: body temperature 36.4℃, respiration 12 times/min, heart rate 120 times/min, blood pressure 88/60 mmHg, blood oxygen 96%, coma index 15, primary assessment showed that the airway was open and free of foreign objects, breathing was normal and effortless, there was no tracheal deviation, lung sounds on both sides were normal, and heart sounds were normal. Abdominal tenderness and pelvic instability, ultrasound shows posterior peritoneal fluid accumulation. Which of the following treatments should be prioritized?

Input: (A) Arrange CT of the abdomen and pelvis. (B) Inform the orthopedic surgeon to prepare external fixation of the pelvis. (C) Inform the surgeon to prepare for emergency laparotomy. (D) Inform the radiologist to prepare angiography. (E) Inject two 18-gauge IVs, give 1,000 ml of warm saline, prepare blood products, and fix with a pelvic fixation belt.

Output: E


Instruction: Which statement about heat stroke is more appropriate?

Input: (A) The diagnosis must meet the three clinical symptoms of body temperature greater than 40℃, altered consciousness and anhidrosis. (B) Because the cerebellum is sensitive to high body temperature, unsteady gait (ataxia) may be an early clinical symptom of heat stroke. (C) Epileptic seizures are common in heat stroke, especially when the patient's body temperature is highest. (D) During cooling therapy, no matter what method is used, the body temperature must be lowered to the target temperature of 37℃ as soon as possible, and hypothermia should be avoided. (E) Clinically, cooling with cold water gastric lavage and urinary bladder lavage is safe and effective, but water intoxication should be noted.

Output: B


Instruction: Which of the following statements is appropriate regarding neonatal resuscitation?

Input: (A) For term and premature infants who do not require resuscitation at birth, delaying umbilical cord clamping for approximately 20 seconds is appropriate. (B) When tracheal intubation cannot be successfully established, laryngeal mask is not recommended for term neonates or premature infants older than 34 weeks. (C) If the infant is born with meconium-stained amniotic fluid and has poor muscle tone and inappropriate labored breathing, he or she should be placed under a radiation warmer and positive pressure ventilation should be initiated if necessary. (D) In neonatal cardiac arrest, chest compression as early as possible is the focus of initial resuscitation. (E) Resuscitation of premature newborns of less than 35 weeks' gestation should start with a high oxygen concentration close to 100% and then adjust the oxygen to achieve preductal oxygen saturation close to that of healthy full-term newborns.

Output: C


Instruction: A 20-year-old female presented to the emergency department with lower abdominal pain for several days. Her vital signs were normal. Pelvic examination revealed tenderness in the patient's lower abdomen, uterus, bilateral adnexa, and cervix, and mucopurulent vaginal discharge. Urine pregnancy test was negative, and urine analysis showed no special findings. Which of the following treatments is more appropriate?

Input: (A) Arrange CT scan to confirm pelvic inflammation before treatment. (B) Arrange vaginal ultrasound to confirm pelvic inflammation before treatment. (C) Draw blood for Procalcitonin test. If the value is <0.5 ng/mL, no antibiotics are needed. (D) Wait for the cervical culture report and then decide on the most effective treatment. (E) Direct antibiotic treatment.

Output: E


Instruction: Which of the following statements is more appropriate for the management of trauma in women at 28 weeks of gestation?

Input: (A) Loss of 10-15% of total blood volume will cause shock symptoms. (B) Pelvic examination takes precedence over ultrasound in secondary assessment. (C) The pH value can be used to distinguish whether it is ruptured amniotic fluid or vaginal discharge: neutral for amniotic fluid, acidic for vaginal discharge. (D) The sensitivity and specificity of transabdominal ultrasound in diagnosing ascites are lower than those of non-pregnant patients. (E) If there is no obvious abdominal trauma, ultrasound examination shows no evidence of internal bleeding and the fetal heart rate is greater than 120 beats/min, the pregnant woman can be discharged from the hospital after appropriate health education.

Output: C


Instruction: A 50-year-old female patient was sent to the emergency department due to general weakness. On examination, she was unconscious, with a blood pressure of 100/70 mmHg, a sinus rhythm on the electrocardiogram, a heart rate of 54 beats/min, a body temperature of 34℃, and a respiration rate of 10 breaths/min. The serum sodium level was 128 meq/L and the blood glucose level was 90 mg/dL. The face and lower limbs showed non-pitting edema. Which of the following descriptions of differential diagnosis and treatment is more appropriate?

Input: (A) Diagnosed as adrenal crisis, hydrocortisol was given. (B) Diagnosed as hypoglycemic coma, D50W was given intravenously. (C) Diagnosed as water intoxication, 3% saline was given Correct hyponatremia. (D) Diagnose bradycardia and cardiogenic shock, give dopamine. (E) Diagnose myxedema coma, give thyroxine.

Output: E


Instruction: A 58-year-old male reported that he was bitten on the right forearm by a white-nosed croaker trapped in a hunting trap while hunting in the mountains of Nantou about a day ago. The wound had obvious deep teeth marks and dried blood, and the area around the wound was red. The captured white-nosed croaker was also brought in in a cage and seemed calm. According to the treatment guidelines and the latest national policies, after the wound is cleaned and tetanus vaccine is injected, which of the following treatments is more appropriate?

Input: (A) Give a complete course of rabies vaccination and immediately administer rabies immunoglobulin infiltration around the wound. (B) Give a single injection of rabies vaccine and submit the white nose to the agricultural department for testing for rabies. If the test is positive, complete the subsequent vaccination course. (C) Give a single injection of rabies vaccine and submit the white nose to the agricultural department for testing for rabies. If the test is negative, stop the subsequent vaccination course. (D) Give a complete course of rabies vaccination. (E) Administer oral antibiotic therapy.

Output: A


Instruction: Which of the following statements is more appropriate regarding upper gastrointestinal bleeding?

Input: (A) BUN and creatinine (B) Routine abdominal radiograph should be arranged as soon as possible. (C) Nasogastric tube placement does not increase the chance of bleeding from esophageal varicose veins. (D) The nasogastric tube aspirate is negative for occult blood, which should reasonably rule out upper gastrointestinal bleeding. (E) Emergency endoscopic examination should not be used on high-risk patients after emergency treatment.

Output: C


Instruction: Which of the following antithrombotic treatments is less appropriate?

Input: (A) The advantage of low molecular weight heparin is that it does not require blood monitoring. (B) Warfarin overdose can consider transfusing fresh frozen plasma. (C) Antiplatelet drugs are more effective than anticoagulants for venous embolism. (D) The new anticoagulant drug rivaroxaban is an inhibitor of coagulation factor X. (E) The antiplatelet drug aspirin has an anticoagulant effect that lasts for 7 days.

Output: C


Instruction: The San Francisco Syncope Rule is a tool used to assess the risk of syncope. It requires the assessment of five indicators. Which of the following statements about the five indicators is more appropriate?

Input: (A) History of coronary artery disease. (B) Hemoglobin less than 9.0 g/dL indicates that the patient may have acute bleeding. (C) EEG indicates that the patient may have epilepsy. (D) Sick sinus syndrome, caused by bradycardia leading to syncope. (E) Systolic pressure. A systolic pressure less than 90 mmHg is a high-risk factor.

Output: E


Instruction: A 63-year-old male went to the emergency department of Hospital A and complained of persistent chest pain that began one hour ago. The electrocardiogram showed ST segment elevation in leads II, III, and aVF. If Hospital A cannot provide primary percutaneous coronary intervention (PCI) treatment, which of the following actions is less appropriate?

Input: (A) The emergency physician at Hospital A should immediately contact the base hospital of the emergency patient referral network to confirm the time when the patient can receive primary PCI treatment. (B) Hospital A's emergency department should send the patient to the base hospital as soon as possible, preferably within 30 minutes. (C) If the base hospital assesses that the patient cannot receive primary PCI treatment within 120 minutes, it should inform Hospital A. (D) If primary PCI is not possible within 120 minutes, Hospital A should transfer the patient to the base hospital as soon as possible for thrombolytic treatment. (E) For thrombolytic treatment, the injection of thrombolytics should be started within 30 minutes of arrival.

Output: D


Instruction: A 26-year-old male was taken to the emergency department by EMT and police escort, with his limbs restrained on a stretcher. According to his family, he had not slept for five or six days and was mumbling all day. He had a conflict with his family today and behaved violently. When he saw the patient, he was still emotional and kept yelling that he wanted to fight the police. He also kept twisting and turning to break free from the restraints. He even had to be supported by the EMT to be stable when he was stretched on the bed. You are the doctor in charge of the patient. What is the most reasonable next step?

Input: (A) Give oral olanzapine FC 5 mg (film-coated tablets). (B) In order to quickly suppress symptoms and protect patients and medical staff, lorazepam 2 mg and haloperidol 5 mg should be injected intravenously. (C) The patient's current symptoms are related to whether he can be hospitalized involuntarily. No medication should be given to avoid the psychiatric consultation doctor being unable to obtain evidence. (D) Intramuscular injection of olanzapine 5 mg. (E) Inject ketamine 5 mg intramuscularly to temporarily dissociate the patient, but monitor his breathing.

Output: D