Instruction: A 38-year-old female with a history of depression and long-term alcohol consumption, but no history of epilepsy, was found unconscious and convulsing for 2 minutes by her family and sent to the emergency room. She was still in a coma when she arrived at the hospital. Which of the following treatments is less appropriate?

Input: (A) Arrange a brain CT. (B) Give Thiamine. (C) Give Flumazenil. (D) Arrange an EEG examination.

Output: C


Instruction: A 4-year-old boy was sent to the emergency room because of cardiac arrest. According to the 2020 Advanced Cardiovascular Lifesaving Procedures Guidelines provided by the American Heart Association (AHA), which description of the patient's emergency resuscitation is more appropriate?

Input: (A) Prioritize intubation with a cuffed endotracheal tube and straight blades. (B) Consider cricoid compression, which increases the chances of successful intubation and decreases the chances of gastroesophageal reflux. (C) If intubated, ventilate at a rate of approximately 1 breath every 6 seconds without interrupting chest compressions. (D) If a palpable pulse is present but breathing is not normal after first aid, perform artificial respiration at a rate of approximately 12-20 breaths per minute.

Output: A


Instruction: Which of the following statements about Henoch-Schönlein purpura is less appropriate?

Input: (A) Prone to diffuse abdominal pain or colic with vomiting. (B) It is easy to affect the knee or ankle joints, causing swelling and pain. (C) The typical rash often occurs on the face, buttocks and soles of the feet. (D) Hematuria can be seen with the naked eye, indicating that the kidneys are affected.

Output: C


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

Input: (A) Urine examination may show purgation. (B) Viral infection is one of the causes. (C) Ultrasound shows increased blood flow to the epididymis. (D) Lifting the affected testicle upward will make it more painful due to pulling.

Output: D


Instruction: A 60-year-old patient with a tracheostomy tube tube) for 1 month and comes to the emergency department with heavy bleeding from his tracheostomy. Which of the following is a more appropriate initial measure to stop the bleeding?

Input: (A)Utley maneuver. (B)Esophageal pressure with a catheter balloon. (C)Local injection or ligation of the blood vessel with a bronchoscope. (D)Inflate the balloon of the tracheostomy tube a little more.

Output: D


Instruction: A 40-year-old male with no past medical history presents with sudden onset of severe upper abdominal pain. Which of the following treatment and management considerations is more appropriate?

Input: (A)Intravenous morphine is less likely to affect the diagnosis than nonsteroidal anti-inflammatory analgesics. (B) Studies have shown that an abdominal pain panel can be established and used in the emergency department. It can be performed quickly and has clinical benefits. (C) Abdominal X-rays (plain radiographs) have a screening effect in most abdominal emergencies and can be included in routine examinations. (D) When an abdominal aortic aneurysm is found on bedside ultrasound and the creatinine level is 3 mg/dL, magnetic resonance imaging should be arranged urgently.

Output: A


Instruction: A 30-year-old male accidentally ingested about 150 mL of an unknown chemical three hours ago. He was sent to the hospital for drowsiness, vomiting, and restlessness. His temperature was 36.5℃, his breathing was 14 times/min, his heart rate was 70 times/min, his blood pressure was 140/80 mmHg, and his blood tests showed Na 135 meq/L, Cl 100 meq/L, BUN 28 mg/dL, ethanol <0.2 mg/dL, glucose 90 mg/dL, blood ketone 6 mmol/L, blood osmolality 320 mOsm/Kg. Arterial blood gas analysis showed pH 7.40, PCO₂ 42 mmHg, HCO₃- 23 meq/L. The most likely cause of substance poisoning is substance poisoning. Which is the most appropriate?

Input: (A) Methanol. (B) Ethylene glycol. (C) Propylene glycol. (D) Isopropanol.

Output: D


Instruction: An 82-year-old male was sent to the emergency department with fever, wheezing, 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, his blood pressure was 132/84 mmHg, and his blood oxygen concentration was 85%. Arterial blood gas analysis PaCO₂ was 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 nasogastric tube decompression should be used to prevent inhalation events. (C) E2V3M4 and anticholinergic therapy should be given. (D) Endotracheal intubation should be considered.

Output: B


Instruction: Regarding shoulder dystocia, which of the following statements is more appropriate?

Input: (A) Gaskin maneuver will increase the difficulty of this delivery. (B) Consider McRoberts maneuver and apply pressure to the fundus of the uterus. (C) Insert fingers into the birth canal and press the front shoulder of the newborn as close to the chest as possible. (D) The mother should be asked to bend her legs as much as possible and turn her knees outward.

Output: D


Instruction: A 65-year-old male with multiple metastatic lung adenocarcinoma has recently developed lower back pain and weakness in both legs. He went to the emergency department this morning because he was completely unable to walk, had loss of sensation in both legs, and had fecal incontinence. Which of the following assessments and interventions is more appropriate?

Input: (A) Give 10 mg of dexamethasone intravenously before performing spinal MRI. (B) This patient has a good chance of regaining lower limb function with emergency spinal decompression surgery. (C) Perform a complete neurological assessment to determine the area of the spine that needs to be imaged for MRI. (D) Urgently arrange for a spinal MRI with gadolinium-based contrast agents.

Output: A


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

Input: (A) If it is combined with aortic stripping, blood pressure needs to be controlled to below 120 mmHg systolic as soon as possible, and heart rate should be controlled to no more than 100 beats/min. (B) For patients with infarct stroke, if thrombolytic drugs are to be administered, blood pressure must be controlled to below 185 mmHg systolic. (C) If it is caused by acute sympathetic crisis, the first-line antihypertensive drug is calcium channel blocker. (D) Hypertensive encephalopathy , is a clinical diagnosis after excluding infarction or hemorrhagic stroke. MRI can show frontal lobe edema.

Output: B


Instruction: A 26-year-old male accidentally injured his right hand while operating a machine. Which of the following treatments is less appropriate?

Input: (A) For finger lacerations with no exposed bone or injuries to the finger bed, wounds less than 1 cm can be considered for wound dressing change and outpatient follow-up. (B) For finger lacerations, if the fingertip flap continues to bleed, consider using a tourniquet tied to the proximal knuckle to stop bleeding and treat the wound. (C) If a patient is suspected of having a vascular injury in the right forearm, and if there is a small, stable hematoma, consider continuing to observe the hematoma. (D) If the right radial artery cannot be palpated, consider immediately consulting a vascular surgeon.

Output: C


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

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

Output: C


Instruction: A 61-year-old female with breast cancer has been receiving chemotherapy for about a month. Two or three days ago, she began to have mild cough, nausea, poor appetite, abdominal distension and other symptoms. Today, she has become unconscious and has a fever. When the patient sought medical attention, GCS E2M4V1, blood pressure 140/68 mmHg, heart rate 126 beats/min, respiration 26 times/min, SpO₂ 96%, body temperature 38.3℃. Which assessment and treatment is more appropriate for this patient?

Input: (A) Based on the consciousness performance of the Taiwan Emergency Examination Urgency Scale, the examination level is 2. (B) The patient's breath sounds are normal, blood oxygen is normal, and there is no pneumonia on the chest X-ray, which can rule out the diagnosis of pneumonia. (C) When WBC is 1,000/µL, Segment is 30%, and there is no obvious source of infection, an anorectal examination should be performed as soon as possible to determine whether there is a rectal ulcer. (D) When the blood calcium is 15.2 mg/dL (3.8 mEq/L), fluid therapy should be given immediately to accelerate the excretion of calcium ions from the urine.

Output: D


Instruction: A 40-year-old woman developed pain in the right sole after practicing marathon running. Which of the following statements is more appropriate?

Input: (A) Tenderness on the anterior and medial side of the calcaneus may be calcaneus bursitis. (B) If a bone spur is clearly seen in the heel area on X-ray, plantar fasciitis can be diagnosed. (C) Local injection of steroid drugs has long-term effects, but has more side effects. (D) Dorsiflexion and foot massage can help improve symptoms.

Output: D


Instruction: Which of the following respiratory infectious diseases has a shorter incubation period than the latent period?

Input: (A) Coronavirus disease 2019, COVID-19. (B) Seasonal influenza. (C) Severe acute respiratory syndrome (SARS). (D) Measles.

Output: C


Instruction: Which of the following is less appropriate in terms of drug treatment options for status epilepticus?

Input: (A) The use of Lorazepam may cause respiratory depression and hypotension. (B) The infusion rate of Phenytoin should not be too fast, and it should not be used with glucose drip. (C) The use of Valproic acid may cause liver damage or pancreatic inflammation. (D) The use of Propofol should be noted that it may cause side effects such as hypokalemia and rhabdomyolysis.

Output: D


Instruction: A 60-year-old female patient had diabetes and hypertension in the past. This time, she was treated in the emergency department for urinary tract infection and septic shock. She has been given NS 1,000 mL, dry oral mucosa, no urine in the past 2 hours, and the blood sugar level is 380 mg/dL. Which of the following statements is more appropriate for the treatment of this patient?

Input: (A) Give regular Insulin from IV. (B) The blood sugar goal is to control it at 200-250 mg/dL. (C) Give IV hydration first, and do not give hypoglycemic drugs for the time being. (D) Give the drugs prescribed in the outpatient clinic (Glyburide and Repaglinide).

Output: A


Instruction: A worker had his finger crushed by a factory machine. Which of the following statements is less appropriate?

Input: (A) Contraindications to finger amputation (including relative) include children, crush injuries, and hypoxia of the amputated part for more than 12 hours. (B) If it is a soft tissue amputation of the distal fingertip, the area is less than 1 square centimeter, and there is no exposed bone or nail bed, conservative treatment with daily dressing changes can be performed. (C) If the fingertip amputation has exposed bone but is less than 0.5 cm and the soft tissue defect is less than 1 square centimeter, the bone can still be trimmed back and the dressing can be changed for conservative treatment. (D) If the two-point discrimination sensation of the volar pad on the affected side is significantly larger on one side than the other, or exceeds 10 mm, suspect digital nerve damage.

Output: A


Instruction: Which of the following descriptions of the autonomic response to shock is less appropriate?

Input: (A) Arteriolar vasodilation, leading to redistribution of blood flow in the body. (B) Increased cardiac output, increasing heart rate and contractility. (C) Venous capacitance vasoconstriction, increasing venous return. (D) Release of vasoactive hormones to increase arteriolar and venous tone.

Output: A


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

Input: (A) X-ray and CT measurements of the stone will show it to be smaller than the actual size. (B) Rebound pain and muscle stiffness (guarding) may be present. (C) More than 95% of patients have hematuria. (D) If acute obstruction causes unilateral hydronephrosis, most patients will have elevated creatinine.

Output: B


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

Input: (A) Compared with low-voltage AC, lightning is more likely to cause ventricular fibrillation. (B) Injuries caused by lightning often affect the patient's eyes, and the most common sequelae is retinal damage. (C) Lightning is more likely to cause deep muscle damage and require fasciotomy than high-voltage AC. (D) In a comatose patient struck by lightning, anisocoria does not necessarily mean a poor prognosis.

Output: D


Instruction: For a patient with head trauma, blood pressure is 228/132 mmHg and intracranial pressure (ICP) is 86 mmHg. Which of the following statements is more appropriate?

Input: (A) The patient's mean arterial pressure (MAP) is 164 mmHg and cerebral perfusion pressure (CPP) is 78 mmHg. (B) The patient's mean arterial pressure is 180 mmHg and cerebral perfusion pressure is 94 mmHg. (C) Under normal circumstances, autoregulation can be adjusted to accommodate a CPP of 50-120 mmHg. CPP < 50 mmHg is considered to be the lower limit of human autoregulation. (D) Increased intracranial pressure can cause a Cushing's reflex. reflex), including high blood pressure, bradycardia, and shallow tachypnea.

Output: A


Instruction: A 59-year-old HIV-infected male with a chronic mild cough has a pleural effusion on chest X-ray. Which of the following is least likely to occur, other than pneumonia?

Input: (A) Non-Hodgkin lymphoma. (B) Kaposi sarcoma. (C) Adenocarcinoma. (D) Squamous cell carcinoma.

Output: D


Instruction: A 38-year-old male with a history of type 1 diabetes. Two weeks ago, the patient underwent partial gastrectomy and Roux-en-Y gastrojejunostomy due to obesity. Today, he was diagnosed with fever, abdominal pain, nausea and vomiting. Which of the following statements is more appropriate?

Input: (A) If physical examination reveals redness, swelling and exudation at the surgical wound, oral antibiotics can be prescribed and the patient can be sent home for follow-up. (B) If clinical suspicion of anastomotic leak is present at the anastomotic site, fasting and conservative treatment with intravenous antibiotics are required. (C) Anastomotic leaks are more common at the esophagus and colon surgery site. (D) The most common source of infection at this time point is pneumonia or urinary tract infection.

Output: C


Instruction: Regarding the drug treatment of acute agitation in the elderly, which of the following is more appropriate?

Input: (A) Antihistamine drugs can relieve delirium. (B) Benzodiazepine is the preferred drug. (C) Ziprasidone is more likely to cause QTc prolongation. (D) Olanzapine and Benzodiazepine drugs are recommended to be used simultaneously.

Output: C


Instruction: A 32-year-old male was taken to the emergency room by ambulance due to sudden chest tightness, chest pain, and shortness of breath. The patient was sitting on the sofa when the symptoms occurred, and then he had tingling in the fingertips, abdominal pain, and diarrhea. When the EMT arrived at the scene, the patient's vital signs were a heart rate of 118 beats/min and a respiration of 24 breaths/min; when he arrived at the emergency room, the patient's heart rate was 92 beats/min and respiration was 16 breaths/min. According to the medical records, the patient has visited the doctor several times for similar symptoms within a month. Relevant blood tests, electrocardiograms, and chest X-rays showed no significant abnormalities. Which of the following diagnoses is more appropriate?

Input: (A)Agoraphobia. (B)Acute stress disorder. (C)Munchausen syndrome. (D)Panic disorder.

Output: D


Instruction: Which of the following statements about pneumonia in pregnant women is more appropriate?

Input: (A)Pregnancy prolongs the course of bacterial pneumonia. (B)The prognosis of viral pneumonia during pregnancy is as severe as that of non-pregnant patients. (C)Giving acyclovir to patients with varicella pneumonia as early as possible will improve the prognosis. (D)Antiviral drugs should be given as early as possible for influenza viral pneumonia, especially H1N1.

Output: D


Instruction: A 45-year-old male was clearly intoxicated and was agitated and uncooperative when he arrived at the hospital. Which of the following drugs is more appropriate to treat his agitation?

Input: (A) Flumazenil. (B) Haloperidol. (C) Lorazepam. (D) Thiamine.

Output: B


Instruction: A 22-year-old male was diagnosed with schizophrenia last month and began taking antipsychotic drugs. Recently, he has developed facial and back muscle spasms, neck twisting, and eyes drooping. These symptoms are most likely to be side effects induced by antipsychotic drugs?

Input: (A) Neuroleptic-Induced Akathisia. (B) Neuroleptic-Induced Parkinsonism. (C) Neuroleptic-Induced dystonia. (D) Neuroleptic-Induced Tardive Dyskinesia.

Output: C


Instruction: A 65-year-old female underwent surgery for esophageal cancer 6 weeks ago and had a jejunostomy tube placed for feeding. This time she came to the emergency room because the jejunostomy tube slipped. Which of the following statements is more appropriate?

Input: (A) The stoma is not yet mature, so the stoma tube should not be put back immediately. The surgeon must be consulted first. (B) Jejunal stoma tubes are usually smaller and should be placed with a 8-14 French dedicated tube or urinary catheter. (C) If the surgeon recommends putting a urinary catheter back into the stoma, a 5-10 mL water balloon should be used after placement to prevent it from slipping. (D) If the area around the stoma is red, swollen, and purulent, a larger stoma tube can be placed instead.

Output: B


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

Input: (A) Surgical cricothyroidotomy is suitable for patients over 10 years old. (B) In an emergency, tracheostomy can establish a secure airway more quickly than cricothyroidotomy. (C) In recent years, percutaneous tracheostomy has been proven to be more suitable for emergency trauma patients than traditional tracheotomy. (D) Surgical cricothyroidotomy can use an endotracheal tube with an inner diameter of 5 mm to 7 mm.

Output: A、D


Instruction: Which of the following is more appropriate for the treatment of lower gastrointestinal bleeding?

Input: (A) The most common cause is colorectal polyps. In about 80% of cases, bleeding will stop on its own. (B) Ischemic colitis usually requires surgical intervention as soon as possible. (C) Generally speaking, patients with bloody stools and hemoglobin levels below 8 g/dL should be given a blood transfusion. (D) Patients with stable blood flow, no persistent bloody stools, and no related comorbidities can be followed up in the outpatient clinic.

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) Weed poisoning. (D) Pyrethrum poisoning.

Output: C


Instruction: Which of the following statements is more appropriate for fracture fixation in the emergency department?

Input: (A) For clavicle fracture fixation, a shoulder strap is better than an arm sling. (B) A cock-up wrist splint is effective for wrist fracture fixation. (C) A thumb splint is used to fix the wrist in an OK position, retaining the pinching function. (D) For Achilles tendon rupture, the ankle should be placed perpendicular to the calf and fixed with a short-leg cast.

Output: C


Instruction: A 53-year-old male with chronic alcoholism has been receiving regular wound care for chronic wounds on both feet for the past 3 months. He complains of cough with fever and chills for 3 days. Auscultation reveals a rhonchi in the right chest, and chest X-ray shows a right lobar infiltrate. Which of the following statements is less appropriate?

Input: (A) It meets the definition of healthcare-associated pneumonia. (B) The most common pathogen is Klebsiella pneumoniae. (C) The patient's risk of bacteremia should also be considered when arranging follow-up examinations and treatment. (D) The pneumonia severity index assessment is less appropriate for this patient.

Output: B


Instruction: A 65-year-old male presents to the emergency department with sudden, persistent upper abdominal pain that moves to the back. Pain is relieved by bending forward. Pain index is 9 points, vital signs are stable, Chvostek's and Trousseau's signs: negative. WBC 18,000/mm³, Glucose 220 mg/dL, AST 270 IU/L, Lipase 200 U/L (13- 60 U/L), Calcium 7.5 mg/dL(8.5 to 10.2 mg/dL)Which of the following is more appropriate?

Input: (A) Early administration of fluid resuscitation therapy is important because it can reduce the mortality rate. (B) Lactated Ringer's solutions are recommended for intravenous administration because they have a better prognosis. (C) Quinolone and Metronidazole can reduce the need for future surgical intervention and lower mortality. (D) Hypocalcemia may be due to hypoalbuminemia, and calcium ion supplementation should be given during intravenous therapy.

Output: B


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

Input: (A) Hurricanes often cause more injuries and deaths in the acute phase than in the recovery phase. (B) Deaths caused by earthquakes often occur within the first 3 hours. (C) Infectious diseases caused by floods often appear after the acute phase. (D) Carbon monoxide poisoning from natural disasters such as blizzards is likely to increase during and after the disaster.

Output: A


Instruction: Which of the following is less appropriate for the management of a patient with unstable abdominal aortic aneurysms?

Input: (A) Give two large IVs and give large amounts of fluid to control blood pressure above 120 mmHg. (B) Call a cardiac surgeon to arrange emergency repair surgery. (C) If the patient's vital signs are stable after the treatment, a CT scan can be arranged. (D) Ultrasound can be used to examine and measure the diameter of the aorta as a preliminary diagnosis.

Output: A


Instruction: Which of the following is less appropriate for the concept of neonatal emergency care?

Input: (A) Neonatal bradycardia is often caused by hypoxia or respiratory failure. The first step is to give oxygen and re-treat the airway instead of using drugs to treat the slow heart rate. (B) If the neonate's bradycardia is still < 60 times/min after 30 seconds of positive pressure respiration, CPR should be started immediately. (C) The ratio of chest compression to airflow in neonatal CPR is 15:2. (D) When the heart rate exceeds 60 times/min, CPR should be stopped immediately and positive pressure respiration should be started at a rate of about 40-60 times/min.

Output: C


Instruction: Which of the following is more appropriate for the diagnosis of acute heart failure?

Input: (A) The most sensitive symptom is dyspnea on exertion. (B) More than 90% of patients will have pulmonary congestion on chest X-ray. (C) BNP (B-type natriuretic peptide) greater than 500 pg/mL is the gold standard for diagnosis. (D) Ultrasound imaging shows that the inferior vena cava is larger than 2 cm and collapses less than 50% with breathing, which can be diagnosed.

Output: A


Instruction: A 30-year-old male doctor was suturing a patient's wound when his right index finger was pierced by the needle used for suturing. The wound was bleeding. The patient's blood test showed that the HIV antibody test was positive and the HBsAg is positive, Anti-HCV is positive; the doctor's blood draw shows anti-HBs is positive. Which of the following is more appropriate regarding the subsequent treatment of this doctor's occupational exposure?

Input: (A) This doctor should use disinfectants to clean the wound. (B) This doctor should receive HIV post-exposure prophylaxis (PEP). (C) This doctor should receive hepatitis B immune globulin (HBIG) treatment. (D) This doctor should receive hepatitis C antiviral drug treatment.

Output: B


Instruction: A 7-year-old boy accidentally fell 10 minutes ago and avulsed his upper right front teeth. His mother brought him and his intact teeth to the emergency room. Which of the following statements is less appropriate?

Input: (A) First determine whether it is a permanent tooth. If it is just a deciduous tooth, it cannot be reimplanted. (B) If you want to reimplant, first brush the dirt off the tooth with a toothbrush and rinse it with saline. (C) If it can be reimplanted, first store the tooth in ice milk and try to reimplant it as soon as possible. (D) If the tooth reimplantation time is delayed for more than 1 hour after the incident, the probability of successful reimplantation is almost zero.

Output: B


Instruction: An earthquake caused a building to collapse. A man's right foot was pinned by an overturned closet for 14 hours before he was found by rescuers. Before he was rescued, which of the following actions would be more appropriate?

Input: (A) Only in shock should a large amount of fluid be infused to avoid excessive swelling of the limbs. (B) Lactated Ringer's solution is also a good choice for large-scale fluid infusion on site. (C) NaHCO₃ combined with a large amount of physiological saline for infusion. (D) Tourniquets will increase the patient's pain and are not recommended for routine use.

Output: C


Instruction: In a series of car accidents with heavy casualties, which of the following patients would need to be sent to the hospital first?

Input: (A) A middle-aged male with bleeding from the mouth and nose, and still not breathing after opening the airway. (B) A young woman with a deformed left thigh, constantly shouting for help. She breathes 20 times/min and her radial pulse can be felt. (C) A young man with pain and bruises on the right chest, anxiously looking for his daughter's whereabouts. (D) A middle-aged female with hematoma on the right forehead answered questions irrelevantly and was unable to follow the doctor's instructions. Respiration rate 20 times/min, capillary refill time 2 seconds.

Output: D


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

Input: (A) Patients with vestibular neuritis have symptoms such as ear pain, hearing loss, and tinnitus. (B) Patients with stroke are often misdiagnosed with peripheral vestibular disorder in the emergency department. (C) Both peripheral and central vertigo will cause symptoms to worsen due to movements that change the position of the head. (D) When evaluating patients with vertigo in the emergency department, Dix-Hallpike testing and HINT plus testing should be performed simultaneously.

Output: C


Instruction: Which of the following descriptions and treatments for acute renal injury is less appropriate?

Input: (A) Community-type acute renal injury is often reversible, but the 3-year mortality rate associated with it is as high as 45% to 66%. (B) Electrocardiogram can quickly screen for high blood potassium. When K > 6.5 meq/L, it will often cause high-pitched T waves, and its sensitivity can reach 80%. (C) Giving low-dose (renal-dose) Dopamine will not promote the recovery of renal function, nor will it reduce mortality. (D) Patients with a glomerular filtration rate ≤ 30 mL/min/1.73 m2 who receive contrast injection should stop using metformin for 48 hours.

Output: B


Instruction: Which of the following conditions is more appropriate for platelet transfusion therapy?

Input: (A) For patients with hemophilia (V on Willebran's disease) with gastrointestinal bleeding, platelet 40,000/mm³. (B) For patients with uremia before central venous catheter placement, platelet 25,000/mm³. (C) For patients with suspected meningitis before lumbar puncture, platelet 60,000/mm³. (D) For patients with idiopathic thrombocytopenic purpura without bleeding symptoms, platelet 6,000/mm³.

Output: A


Instruction: A 60-year-old male ate wild mushrooms 30 minutes ago and had vomiting and diarrhea, accompanied by sweating and incontinence. Physical examination revealed cold and wet skin and wet gurgling in both lungs. Which of the following statements is more appropriate?

Input: (A) In addition to toxin poisoning, it may also be caused by enteric invasive pathogens, such as intestinal amoeba and Vibrio cholerae infections. (B) Do not give antiemetics to avoid prolonging the course of poisoning. (C) This toxic syndrome is usually relieved within 12 hours after treatment. (D) This is cholinergic toxidrome. Give the antidote Pralidoxime 1g.

Output: C


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

Input: (A) The diagnostic criteria for purulent chest include a thoracentesis fluid pH < 7.35. (B) In tuberculous purulent chest, the number of lymphocytes in the thoracentesis fluid will be significantly increased. (C) POCUS can distinguish pleural effusion from purulent chest. (D) Fibrinolytics can improve the drainage of purulent chest and significantly reduce the mortality rate or the need for surgery.

Output: B


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

Input: (A)Pneumococcal pneumonia Laboratory test results may show elevated serum bilirubin or hyponatremia. (B)Klebsiella pneumonia is commonly seen in clinical practice as currant jelly sputum. (C)Haemophilus influenzae pneumonia is more common in the elderly, and pleural effusions and multilobar infiltrations are common. (D)Patients at risk of aspiration pneumonia should consider Staphylococcus aureus infection.

Output: B


Instruction: Which of the following statements is least likely to be caused by violence by a close partner?

Input: (A)Injuries with violent characteristics, such as nail scratches and bites. (B)Multiple injuries on the body from different periods of time, distributed in the center of the body (head, trunk). (C) The injured part is on the palm, knee or other parts of the body that are easily movable. (D) Delay in seeking medical treatment and suicidal tendency.

Output: C


Instruction: Which of the following is less appropriate when distinguishing between delirium, dementia, and mental illness?

Input: (A) All three levels of concentration are impaired, with dementia being the more obvious. (B) Asterixis is more common in patients with delirium. (C) Delirium is more likely to be accompanied by visual or auditory hallucinations, which is less common in patients with dementia. (D) Dementia and mental illness are usually conscious, while patients with delirium are more likely to be in reduced consciousness or hyperalert.

Output: A


Instruction: A 2-year-old boy is sent to the emergency department because of a seizure. After two doses of Lorazepam, the seizure cannot be controlled. Which medication to give next time is less appropriate?

Input: (A) Fosphenytoin. (B) Levetiracetam. (C)Phenobarbital. (D)Propofol.

Output: D


Instruction: A 48-year-old female with a history of asthma was rushed to the emergency room with sudden dyspnea. Examination revealed that the patient's SpO₂ was 80%, and her skin was pale and cyanotic. She was diagnosed with acute asthma. After treatment, her symptoms improved and she asked to go home. Regarding the increased risk of death after discharge, which one is more appropriate?

Input: (A)She used up a bottle of Fenoterol metered spray last month. (B)The β2-agonists she used three times in this emergency room. (C)She came to the emergency room for acute asthma attacks four times in the past year. (D)She still has wheezing when breathing.

Output: C


Instruction: Which of the following statements about the physical examination of a patient with spinal cord injury who was injured in a car accident is more appropriate?

Input: (A) If the patient's residual urine volume is greater than 100-200 mL, spinal cord compression is highly suspected. (B) Patients with spinal cord injury may have hyperactive reflexes but no clonus. (C) If there is no hyperactive reflex within 1 hour after the injury, spinal cord injury can be ruled out. (D) Babinski's sign will not appear.

Output: A


Instruction: Which of the following situations is more likely to be a bioterrorism incident involving exposure to a biotoxin?

Input: (A) Patients with typical risk factors develop similar diseases. (B) Epidemiological investigations trace back to many different sources of infection. (C) Animals and humans in the same area develop the same disease. (D) A large number of people with multiple chronic diseases die suddenly in a short period of time.

Output: C


Instruction: Regarding virus pericarditis, which of the following statements is less appropriate?

Input: (A) The electrocardiogram may show multi-lead ST segment elevation and PR segment depression. (B) NSAIDs and Colchicine can be given for treatment. (C) If NSAIDs are not well tolerated, corticosteroid treatment can be considered. (D) Most patients require hospitalization.

Output: D


Instruction: Regarding arthrocentesis in the emergency department, which of the following statements is more appropriate?

Input: (A) For patients taking oral anticoagulants, routine coagulation function tests should be performed before arthrocentesis. (B) When performing arthrocentesis for suspected septic arthritis, local anesthetics can be injected into the joint cavity to reduce pain. (C) When extracting elbow joint fluid, the inner side of the elbow is the preferred choice for needle insertion. (D) When extracting wrist joint fluid, the needle should be inserted between the ulnar radial tuberosity and the tendons of the extensor pollicis longus and the common extensor tendons of the index finger.

Output: D


Instruction: Which of the following statements about selective serotonin reuptake inhibitors (SSRIs) is less appropriate?

Input: (A) Common side effects include nausea, vomiting, drowsiness, and headache. (B) It may increase suicidal ideation, especially in patients under 25 years of age. (C) Symptoms that occur after sudden discontinuation are often fatal and require emergency treatment. (D) When taking concomitant drugs that may increase serotonin, be aware of serotonin syndrome.

Output: C


Instruction: Regarding angioedema caused by angiotensin converting enzyme inhibitors, which of the following statements is more appropriate?

Input: (A) Tranexamic acid is the first choice for treatment. (B) High-dose corticosteroids are effective in treating laryngeal edema. (C) When therapeutic drugs are in short supply, cryoprecipitate infusion can be given. (D) If treatment of hypertension is required, angiotensin receptor blockers can be given instead.

Output: A


Instruction: Regarding abdominal diseases in the elderly, which of the following statements is more appropriate?

Input: (A) Viral enteritis is more common in the elderly than bacterial enteritis. (B) Intestinal obstruction is the most common reason for abdominal surgery in the elderly. (C) The elderly may consider using imaging tests to rule out unexplained abdominal pain. (D) Elderly people rarely need surgery for abdominal pain, and symptoms are often subtle and difficult to diagnose.

Output: C


Instruction: Which of the following is more common in lightning injuries?

Input: (A) Eye injury. (B) Kidney failure. (C) Rhabdomyolysis. (D) Ventricular arrhythmia.

Output: A


Instruction: Which of the following statements is more appropriate regarding the decision-making of computed tomography (CT) of the brain, the description of the New Orleans Criteria and the Canadian CT Head Rule?

Input: (A) The New Orleans Criteria is for patients with mild head trauma and a GCS score of 13 to 15. (B) The Canadian CT Head Rule is for patients with a GCS score of 15. Those with a GCS score of less than 15 are not applicable. (C) Based on the New Orleans Criteria, the following are included: headache, vomiting, persistent amnesia, evidence of trauma above the clavicle, signs of cranial fracture, and epileptic seizures. (D) Based on the Canadian CT Head Rule, the following are included: 2 Hours of GCS <15 points, vomiting more than 1 time, retrograde amnesia >30 minutes.

Output: D


Instruction: Which of the following is inappropriate for the treatment of a patient with spontaneous intracranial hemorrhage?

Input: (A) If Heparin is used within 3 hours, Protamine should be given. (B) If Warfarin is used, Vit-K and Prothrombin complex concentrate should be given regardless of the INR value on the blood test. (C) If an anti-platelet agent is used, platelets should be transfused and Desmopressin should be given. (D) If Dabigatran is used, Idarucizumab should be given.

Output: C


Instruction: Which of the following is inappropriate for the evaluation and management of acute gastroenteritis in children?

Input: (A) C-reactive protein can be used to distinguish between bacterial and viral gastroenteritis. (B) Those with severe dehydration should have their blood sugar and blood electrolytes checked. (C) BUN values cannot easily distinguish those with mild dehydration, and bicarbonate (HCO₃-) values can be used to exclude those without dehydration. (D) Continuing to eat can alleviate dehydration and promote recovery of the intestinal mucosa.

Output: A


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

Input: (A) The thoracic spine is relatively less likely to be injured because of the articulation protection formed with the ribs. (B) Injury to the third lumbar vertebra can affect the terminal nerves of the spinal cord and cause bladder function damage. (C) Compression fractures are often caused by excessive extension (hyperextension) squeezing the front of the spine during the injury. (D) Compression fractures with 20% collapse of the lumbar vertebral body height may require outpatient treatment.

Output: D


Instruction: Which of the following statements about the treatment of anaphylactic shock is more appropriate?

Input: (A) Albumin can be used for fluid resuscitation to reduce the problems caused by large amounts of crystalloid fluid. (B) For patients who usually take beta-blockers, treatment with Epinephrine may cause severe hypertension. (C) The deltoid muscle has a thinner fat layer, which can ensure that the EpiPen® is completely injected into the muscle layer, making it the most appropriate injection site. (D) The efficacy of an expired EpiPen® declines rapidly, and it is not recommended for use in this situation.

Output: B


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

Input: (A)Scaphoid fracture is the most common fracture of the wrist. Clinically, it can be seen as tenderness in the snuffbox of the affected side and pain when moving the thumb of the affected side. (B)Capitate fracture often occurs together with scaphoid bone fracture and is prone to avascular necrosis. (C)Lunate fracture is often caused by falling on the hand or hyperextension of the wrist. (D)Triquetrum fracture is relatively rare and is easier to diagnose in the frontal view (AP view) of the wrist X-ray.

Output: D


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

Input: (A) A blood test may reveal DIC. (B) A cardiac ultrasound may show left ventricular dysfunction. (C) A cardiac ultrasound may show right ventricular dysfunction. (D) Patients have a high survival rate after aggressive blood transfusion.

Output: D


Instruction: Which is the best predictor of repeated emergency room visits or hospitalizations in elderly patients?

Input: (A) The presence or absence of cancer. (B) The presence or absence of dementia. (C) The number of chronic diseases. (D) Acute functional decline.

Output: D


Instruction: What is the appropriate treatment for organophosphate poisoning?

Input: (A) If Succinylcholine is used during intubation, the onset of the drug's effect will be delayed. (B) Intermediate syndrome, which often occurs 1-4 days after acute poisoning, is mainly characterized by weakness in the distal limbs. (C) For the antidote Atropine, the dosage is adjusted according to the heart rate. (D) For the antidote Pralidoxime, the sooner the drug is given, the better the effect.

Output: D


Instruction: Which of the following descriptions of rash symptoms and fever in children is less appropriate?

Input: (A) Measles starts with fever, and a few days later the rash begins to spread from the face. (B) In German measles, fever is followed by rash, which begins to spread from the face. (C) Scarlet fever rash appears one or two days after the onset of fever, starting from the limbs and spreading to the trunk and face. (D) Roseola infantum rash appears after the onset of fever, and there is no obvious difference in the direction of spread.

Output: C


Instruction: Which of the following descriptions of the pathophysiology and clinical manifestations of traumatic shock is less appropriate?

Input: (A) Trauma damages the endothelium, stimulating the expression of thrombomodulin on the endothelium to increase its binding to thrombin, thereby activating protein C. (B) Early trauma causes coagulopathy, which regulates anticoagulation and hyperfibrinolysis through the protein C pathway. (C) The percentage of blood loss is estimated based on systolic pressure, heart rate, and GCS to classify the severity of bleeding. This classification is very reliable and can be used to guide resuscitation. (D) Patients with intra-abdominal hemorrhage may experience bradycardia or a normal heart rate due to increased vagal tone caused by the accumulation of blood in the peritoneum.

Output: C


Instruction: Which of the following is less appropriate for monitoring common adverse reactions to psychiatric drugs?

Input: (A) Aripiprazole If a patient has a fever, severe muscle stiffness, and unconsciousness, blood sugar levels should be monitored. (B) Carbamazepine It is recommended to undergo HLA-B 1502 gene testing before use. (C) Clozapine If a patient has chest pain, dyspnea, or fever, an electrocardiogram should be monitored. (D) Olanzapine Patients should monitor prolactin regularly.

Output: D


Instruction: A 30-year-old female with no medical history complained of coughing with sputum for about a week. The patient's temperature was 37.1℃, blood pressure was 114/72 mmHg, and respiratory rate was 16 times/min, blood oxygen concentration is 96%. Chest X-ray does not show obvious pneumonia, and breath sounds are normal. Which of the following descriptions of this patient is more appropriate?

Input: (A) β2-agonists are routinely used to relieve symptoms. (B) Atypical bacteria are also possible pathogens. (C) If the sputum is yellow-green, it can be inferred that it is a bacterial infection. (D) The forced expiratory volume in the first second (FEV1) can help with differential diagnosis.

Output: B


Instruction: Patients with hypertrophic cardiomyopathy may hear a systolic heart murmur at the apex of the heart. Which of the following actions can increase the intensity of this heart murmur?

Input: (A) Stand up from a squatting position. (B) Make fists with both hands. (C) Maintain a squatting position. (D) Passively raise the legs.

Output: A


Instruction: Which of the following statements about sudden hearing loss is more appropriate?

Input: (A) It can be divided into sensorineural and conductive hearing loss. About 70% of patients can find the cause of hearing loss. (B) Viral infection is one of the common causes of hearing loss, among which the herpes simplex virus is the most common. (C) Use a tuning fork placed on the patient's forehead to perform a Weber test , if the right ear can hear clear sounds, it means that the right ear has conductive hearing loss, or the left ear has sensorineural hearing loss. (D) Use a tuning fork to perform a Rinne test on the right mastoid and external auditory canal. If the sound is clearer at the mastoid, it means that the right ear has sensorineural hearing loss.

Output: C


Instruction: Which of the following statements about ischemic stroke syndrome related to specific diseases is more appropriate?

Input: (A) Type B aortic detachment may manifest as ischemic stroke and myocardial infarction at the same time. (B) If contraindications are excluded, thrombolytic agents can also be injected when ischemic stroke and myocardial infarction are combined at the same time. (C) For ischemic stroke associated with sickle cell anemia, thrombolytic injection is not recommended. (D) Patients with a recent history of trauma should be cautious about vertebral artery dissection in young stroke patients, but this diagnosis is usually only considered for severe cervical trauma.

Output: B


Instruction: A 30-year-old woman who is 35 weeks pregnant suddenly has a large amount of clear fluid flowing out of her vagina. Which of the following statements is more appropriate?

Input: (A) If necessary, digital examination can be performed. (B) Lubricants should not be used when using a speculum examination. (C) The pH value of the fluid is usually between 4.5 and 5.5. (D)When the liquid is immediately placed under a microscope, fern-like crystals can be seen (ferning test).

Output: B


Instruction: Regarding urinary tract infection in infants and young children, which of the following is not a possible cause of urine culture-negative pyuria?

Input: (A)Kawasaki's disease. (B)Appendicitis. (C)Chlamydia Sexually Transmitted Disease. (D)Balanitis.

Output: D


Instruction: Regarding tetanus, which of the following statements is more appropriate?

Input: (A)The shorter the incubation period of tetanus, the less severe the disease and the better the prognosis. (B) Local tetanus usually causes stiffness of the muscles distal to the injury and fully recovers after weeks to months. (C) General tetanus usually begins with the shorter axonal nerves being affected, resulting in descending paralysis. (D) Cephalic tetanus usually results from head trauma and will result in dysfunction of the fifth cranial nerve.

Output: C


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

Input: (A) A deep sulcus sign is seen in the costophrenic angle on the affected side, more often when the patient is sitting for the X-ray. (B) Giving the patient a non-rebreathing mask can accelerate the absorption of pneumothorax more quickly than giving oxygen through a nasal cannula. (C) If the patient has symptoms such as tracheal deviation and hypotension, acupuncture decompression should be performed as soon as possible above the ribs in the fourth intercostal space of the mid-axillary line. (D) The safe position for chest tube insertion is between the fifth intercostal space, the pectoralis major muscle and the latissimus dorsi muscle.

Output: D


Instruction: A 70-year-old male has been on long-term dialysis. He is prone to bruising and bleeding when his hands and feet collide. This time he vomited blood and went to the emergency room for treatment. The blood test data were normal except for anemia and poor renal function. Gastroscopy found that the digestive ulcer was difficult to stop bleeding and continued to ooze blood on the surface of the ulcer. Which of the following is less appropriate?

Input: (A)Cryoprecipitate, 10 units over 30 mins. (B)Conjugated estrogens, 25 mg IV. (C)Desmopressin, 0.3 μg/kg IV. (D)Vitamin K1, 10mg slow IV.

Output: D


Instruction: Which of the following descriptions of genitourinary emergencies is less appropriate?

Input: (A) Testicular torsion can be manually restored in a manner similar to turning the pages of a book, rotating approximately 360 degrees on the affected side. (B) Blood gas analysis of the corpus cavernosum can distinguish between ischemic and non-ischemic priapism. (C) Paraphimosis can be treated with an elastic bandage wrapped around the glans for 5 minutes to help reduce edema. (D) Prostate massage is usually not necessary to confirm suspected acute prostatitis and may cause bacteremia or sepsis.

Output: A


Instruction: A 65-year-old male patient presents to the emergency department with sudden chest pain and dyspnea. Physical examination shows mid-diastolic murmur at the apex of the heart, Corrigan pulse, Duroziez sign, de Musset sign, and Quincke sign while lying on the left side. Cardiovascular CT scan shows Stanford Type A aortic dissection. Which of the following treatments is less appropriate?

Input: (A) Give oxygen therapy. (B) Give Labetalol. (C) Give Nitroglycerin. (D) Arrange for surgical treatment.

Output: B


Instruction: A 60-year-old male is injured in a car accident and presented to the emergency department. The paramedics have applied a collar and a long back board. He is conscious and complains of neck pain. He has no other obvious abrasions or contusions. His blood pressure is 60/30 mmHg, his heart rate is 80 beats/min, and his skin is warm to the touch. Which of the following assessments and treatments is appropriate for this patient?

Input: (A) Based on the history and initial physical examination, hypotension due to intra-abdominal organ injury can be ruled out. (B) This patient should have lower extremity paralysis and increased deep reflexes. (C) This presentation may occur in a patient with an injury to the fourth thoracic vertebra. (D) Vasopressors are of no benefit to this patient and may increase the risk of tissue hypoperfusion.

Output: C


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

Input: (A) When hemorrhagic blisters form, debridement should be performed. (B) There is no evidence to support the use of prophylactic antibiotics and tetanus. (C) Aloe vera ointment may promote wound repair. (D) Consider early surgical intervention.

Output: C


Instruction: A 40-year-old male with alcoholic cirrhosis presents to the emergency department with vomiting blood. Which of the following treatments is more appropriate?

Input: (A) It may be esophageal varicose vein bleeding. Do not place a nasogastric tube. (B) Give preventive antibiotics as soon as possible. (C) Endoscopic examination must be performed only after the patient is able to cooperate. (D) Tranexamic acid is of no benefit to this patient.

Output: B


Instruction: A shelter was hit by a missile. The building was slightly damaged but did not catch fire. Dozens of people had no obvious external injuries but were convulsing, foaming at the mouth and falling to the ground. Which of the following statements is more appropriate?

Input: (A) If the patient is comatose, has weak breathing, and has a lot of oral and nasal secretions, immediately protect the cervical spine with bare hands and perform endotracheal intubation and suction to maintain a patent airway. (B) Give patients with nasal discharge 0.5-1.0 mg of Atropine intravenously or subcutaneously until the oral and nasal secretions are reduced to a controllable level or the total dose has reached 0.1 mg/Kg. (C) For patients with obvious systemic symptoms, slowly inject Prolidoxime 1-2 g intravenously as soon as possible. When the number of patients exceeds the drug supply, the dose can be reduced by half to allow more people to receive treatment. (D) In addition to protecting the airway of patients with convulsions, any Benzodiazepines should be injected intravenously as soon as possible, and Phynetoin should be dripped intravenously at an initial dose of 20 mg/Kg.

Output: C


Instruction: Which of the following statements about pain and its treatment is more appropriate?

Input: (A) Changes in vital signs and the patient's facial expressions and movements are highly correlated with the patient's perceived pain index. (B) Patients with major trauma should be given nonsteroidal anti-inflammatory drugs first due to musculoskeletal pain. (C) Regardless of the severity of acute pain, a tiered approach to analgesia is required. (D) If a patient with abdominal pain improves after treatment, it does not necessarily mean that the condition has improved.

Output: D


Instruction: Which of the following descriptions of reactive arthritis is more appropriate?

Input: (A) It often occurs within one week after an infectious disease. (B) The joints of the upper limbs are more easily invaded than those of the lower limbs. (C) Conjunctivitis is less common in reactive arthritis following intestinal infection. (D) Chlamydia is a common bacterial infection in reactive arthritis.

Output: D


Instruction: Which of the following is more appropriate for the treatment of pulmonary hypertension?

Input: (A) Dobutamine can be used for right heart failure combined with shock symptoms. (B) High doses of Norepinephrine may increase pulmonary vascular resistance and worsen the condition. (C) When using a ventilator, low tidal volume and high positive end-expiratory pressure settings are required. (D) When shock is combined with insufficient left ventricular perfusion, 1L of fluid can be infused first to maintain blood pressure.

Output: B


Instruction: Regarding the placement of bone needles in the emergency department, which of the following is more appropriate?

Input: (A) Bone needles have more complications than central venous catheters, with extravasation being the most common. (B) The pH value, bicarbonate, and carbon dioxide partial pressure in the bone marrow blood are well correlated with the venous blood. (C) When inserting a bone needle into a child's distal tibia, it should be inserted vertically into the center of the medial malleolus to avoid injuring the great occlusal vein. (D) If pain occurs when instilling saline into the bone needle, 2% Lidocaine 0.5 mg/Kg can be given through the bone needle.

Output: D


Instruction: A 21-year-old male complained of fever and altered consciousness. A lumbar puncture diagnosed him with bacterial meningitis. On the same day, his family member also developed fever. Which of the following statements is less appropriate?

Input: (A) Bacterial meningitis is mainly transmitted through droplets and is highly contagious to close contacts. (B) If the culture result is N. meningitidis or S. pneumoniae, the contact needs to be given preventive antibiotics. (C) Preventive antibiotics given as early as within 24 hours of contact can achieve a higher protective effect. (D) Preventive medication can consider oral Rifampin, Ciprofloxacin, or intramuscular injection of Ceftriaxone.

Output: B


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

Input: (A)REBOA The intravascular balloon is inserted and inflated into the proximal aorta through the common femoral artery. (B) The balloon is inflated in zone 1 to control bleeding from below the diaphragm to above the renal arteries. (C) Zone 2 extends from the diaphragm to the renal arteries and is recommended for bleeding from renal injury. (D) The balloon can be inflated in zone 3 if the bleeding source is below the renal arteries, including severe pelvic, inguinal, or proximal lower extremity bleeding.

Output: C


Instruction: Which of the following statements about acute otitis media in children is more appropriate?

Input: (A) The most common pathogens are Streptococcus pneumoniae and Haemophilus influenzae. (B) Otitis media can be diagnosed by the specific symptom of red eardrum. (C) Antibiotic treatment is necessary, but analgesia is not recommended because it will delay the diagnosis of the disease and may even affect the course of the disease. (D) If the initial oral amoxicillin antibiotic treatment is repeatedly ineffective, it is necessary to switch to amoxicillin-clavulanate or ceftriaxone. Clindamycin is not recommended for patients with a history of penicillin allergy.

Output: A


Instruction: A 20-year-old female presented to the emergency department with abdominal pain, nausea, and bloody diarrhea two days ago after consuming undercooked chicken. Which of the following options is more appropriate for this patient's most likely pathogen?

Input: (A)Vibrio cholerae. (B)Campylobacter. (C)Clostridium botulinum. (D)Giardia.

Output: B


Instruction: Which of the following is more appropriate for controlling blood pressure in patients after myocardial infarction?

Input: (A)Labetalol + Captopril. (B)Thiazide + Captopril. (C)Nifedipine + Captopril. (D)Metoprolol + Nifedipine.

Output: A


Instruction: Which of the following is less appropriate for the diagnosis and treatment of a UTI?

Input: (A) In a young woman whose sex partner has a UTI and whose urine test shows mild purulent urine but no bacteria, a Chlamydia infection should be suspected. (B) In an inpatient whose urine test is positive for nitrite, a Pseudomonas or Acinetobacter species should be suspected. (C) In a young man whose centrifuged urine specimen shows bacteria and 2 WBCs/HPF, a drug for UTI should be given. (D) Fluoroquinolones would be a better choice than Trimethoprim-Sulfamethoxazole for an HIV patient with a UTI.

Output: B


Instruction: A 20-year-old student hit his right shoulder during judo class and complained of pain and inability to move. Which of the following statements is less appropriate?

Input: (A) If the right palm cannot touch the left shoulder, anterior dislocation is suspected. (B) X-ray examination of the shoulder should include AP view and scapular lateral view. (C) The most common complication of shoulder dislocation is rotator cuff tears. (D) Neuropraxia may occur, with motor and sensory abnormalities, but usually recovers on its own.

Output: C


Instruction: Which of the following statements is more appropriate for the patient's neurological examination?

Input: (A) When checking both eyes with a penlight, if the patient's pupil is dilated on one side, it may be a problem with the second pair of cranial nerves on one side. (B) For comatose patients, the doctor can hold the patient's forearm and observe whether it is adducted or sunken to assess whether there is a problem with upper limb weakness. (C) If there is a problem with the peripheral seventh pair of cranial nerves, the corner of the mouth on the same side will be crooked, the eyes will not close tightly, but there will still be forehead wrinkles. (D) If there is a problem with the central seventh pair of cranial nerves, the upper and lower parts of the opposite face will be affected, including the disappearance of forehead wrinkles and crooked corners of the mouth.

Output: B


Instruction: In a patient with head trauma who presents with bilateral pinpoint pupils, bilateral Babinski's sign, and increased muscle tone, which of the following types of herniation is more likely?

Input: (A) Uncal transtentorial herniation. (B) Central transtentorial herniation. (C) Cerebellar tonsillar herniation. (D) Upward posterior fossa herniation.

Output: B


Instruction: Which of the following descriptions of the labor process in pregnant women is more appropriate?

Input: (A) Active labor (active (B) The first stage is from the time the water breaks until the cervix is fully dilated. (C) The third stage is from the time the cervix is fully dilated until the baby is born. The average time for primiparas is more than twice that of multiparas. (D) The latent phase is when the uterus contracts irregularly and the cervix begins to soften and thin. It is the preparation period before delivery.

Output: D


Instruction: 29-year-old male with a history of drug abuse. He started to have dyspnea more than a month ago, which gradually worsened and was accompanied by loss of appetite, occasional dyspnea when standing, cough, and eventually edema of both feet and decreased urine output. Blood pressure 102/64 mmHg, heart rate 140 beats/min, body temperature 38.5℃, respiration 37 times/min, anemia and wet gurgling in both lungs, heart murmurs and S3 on heart auscultation, and X-ray showed enlarged heart. There was no hepatosplenomegaly in the abdomen, edema of both feet, cold sweat on the skin, purple spots and hemorrhagic spots. Blood bacterial culture showed: Viridans streptococci. According to Duke Criteria What is the basis for diagnosing acute endocarditis?

Input: (A)2 major criteria. (B)5 minor criteria. (C)1 major criterion & 3 minor criteria. (D)2 major criteria & 2 minor criteria.

Output: C


Instruction: Which of the following statements is more appropriate regarding airway management in the emergency department?

Input: (A)When intubating an adult, the shoulder should be raised by 10 cm and the external ear should be aligned with the sternal notch to obtain the best view of the glottis. (B)When intubating an adult, BURP (backward-upward-rightward pressure) can be used to apply pressure to the cricoid cartilage. The Sellick method should be avoided to avoid obstructing the view of the glottis. (C) The infant has a larger head, smaller tongue, smaller mandible, and more anterior larynx, so the shoulders need to be raised to obtain the best view of the glottis. (D) A 9-year-old boy, weighing 30 kg, was clinically diagnosed with epiglottitis and acute respiratory failure. After needle cricothyrotomy, he was connected to 15 psi oxygen ventilation.

Output: D


Instruction: 40-year-old patient with neck tumor, A patient had a tracheostomy 5 days ago. The tracheostomy tube slipped due to coughing. Blood oxygen concentration is 95%. Breathing is smooth but there is a little sputum. Which of the following approaches to replace the tracheostomy tube is more appropriate?

Input: (A) Replace it using a bronchoscope. (B) Have an experienced surgeon replace it. (C) Use an obturator and prepare a smaller tracheostomy tube. (D) Use a modified Seldinger technique (using a nasogastric tube or a sputum suction tube as a guidewire).

Output: B


Instruction: Which of the following approaches to pericardiocentesis is less appropriate?

Input: (A)Apical approach: Because it is closest to the left atrium and is most likely to cause ventricular puncture, you need to be careful about the risk of pneumothorax, but the advantage is that it is closest to the pericardium and has the shortest path. (B)Parasternal approach: The needle is inserted into the fifth intercostal space close to the sternal margin, so you need to be careful about puncturing internal thoracic vessels and the risk of pneumothorax. (C)Subxiphoid approach: The path is longer. If the hand-held angle is too vertical to the skin, it is easy to puncture the peritoneal cavity. If the direction is too biased to the midline, it will increase the risk of right atrium puncture. However, the advantage is that the risk of pneumothorax is relatively small. (D)If you don't have an ultrasound, you can connect the needle end of the V4 lead of the electrocardiogram machine. If a wide QRS suddenly appears, you must be careful that the needle tip has punctured the myocardium.

Output: D


Instruction: A 9-year-old boy was brought to the emergency room by his parents because of acute abdominal pain and related symptoms. Which of the following statements is more appropriate?

Input: (A) If it is acute appendicitis, about 70% of patients of this age will initially feel pain around the umbilicus, and then the pain will move to the right lower abdomen, with fever and vomiting. (B) If there is vomiting and diarrhea, the possibility of acute appendicitis can basically be ruled out. (C) Asking the child to cough hard or walk or jump will not help to diagnose peritonitis. (D) If the ultrasound shows that the appendix has a diameter of 7 mm, a wall thickness of 3 mm and is non-compressible, appendicitis can basically be diagnosed.

Output: D


Instruction: A 40-year-old woman has had upper abdominal pain, chest pain, vomiting and dysphagia for 2 days. Today she came to the emergency room because of a sudden fever (38.5℃). Physical examination revealed subcutaneous edema in the neck. Which of the following statements is more appropriate?

Input: (A) This patient does not have Macckler's triad. (B) First do a chest or upright abdominal X-ray. (C) An endoscopic examination can be arranged. (D) First arrange a chest CT scan, then consider an esophageal scintigraphy.

Output: B


Instruction: A 76-year-old woman has been sleepy for 3 days. She sometimes wakes up, but talks to herself, answers irrelevant questions, and stumbles day and night. Today, his condition became worse. He refused to get up to eat breakfast and was taken to the emergency room by his family. Which of the following assessment methods is more appropriate for this patient?

Input: (A) Confusion Assessment Methods. (B) Mini-Mental State Examination. (C) Identification of Seniors at Risk. (D) Clinical Dementia Rating.

Output: A


Instruction: Which of the following is less appropriate for the use of Amiodarone?

Input: (A) The total daily dose should not exceed 2.2 g. (B) The drug needs to be prepared with 5% dextrose water. (C) The dosage needs to be adjusted according to kidney function. (D) When used in combination with Warfarin, the dosage needs to be reduced.

Output: C


Instruction: Which of the following statements is more appropriate regarding the placement of tubes in the emergency department?

Input: (A) Nasogastric tubes can be routinely placed to treat patients with intestinal obstruction (i leus). (B) When replacing the jejunostomy tube with a urinary catheter, the balloon can be inflated to prevent slippage. (C) When acupuncture is performed to relieve pressure in tension pneumothorax, the needle can be inserted at the midclavicular line of the second intercostal space where the chest wall is thinnest. (D) If the patient's clinical condition worsens after a chest tube is inserted, the chest tube can be clamped and the patient can be sent to the operating room for emergency thoracotomy.

Output: D


Instruction: A 40-year-old woman presents to the emergency department with complaints of abdominal distension and discomfort. She received an ovulation injection a week ago for infertility. Which of the following statements is more appropriate?

Input: (A) Consider a bimanual pelvic examination. (B) Symptoms may include polyuria, abdominal distension, shortness of breath, and weight gain. (C) If the abdominal distension is accompanied by a large amount of ascites, transvaginal ultrasound drainage of the ascites may be considered. (D) In severe cases, the ovaries are usually enlarged to no more than 8 cm.

Output: C


Instruction: Which of the following statements about neurological examination of shoulder and neck pain is less appropriate?

Input: (A) Cervical disc herniation usually occurs at C5/6 and C6/7. (B) Increased pain with the Valsalva maneuver is more likely to be musculoskeletal pain. (C) Left arm muscle stiffness or increased pain with abduction and lifting is more likely to be musculoskeletal pain. (D) Pain in the right arm caused by flexing the neck and chin to the chest wall is more likely to be nerve root compression.

Output: B


Instruction: An 18-year-old female, weighing 45 kg, committed suicide by taking 30 tablets of Acetaminophen (500 mg/tablet). She was sent to the emergency room 4 hours later and complained of nausea and epigastric pain. She was conscious and her vital signs were stable. Blood tests revealed GPT 28 IU/L, GOT 32 IU/L, T-Bil 0.8 mg/dL, and the acetaminophen concentration in the blood is 250 mg/L. Which of the following statements is more appropriate?

Input: (A) The liver index is still normal 24 hours after taking the drug, indicating that the poisoning is not serious and the patient can return home for observation. (B) Renal failure occurs 5 days later, which is unlikely to be caused by acetaminophen poisoning. Other causes should be sought. (C) Start treatment with N-acetylcysteine and arrange for hospitalization. (D) Arrange for the patient to be hospitalized for observation. N-acetylcysteine can be temporarily withheld. The liver index is closely monitored and antidotes are given if it is elevated.

Output: C


Instruction: When considering carbon monoxide poisoning, which of the following interpretations of the COHb test results is more appropriate?

Input: (A) Carbon monoxide poisoning is diagnosed clinically. (B) < 2% Carbon monoxide poisoning can be ruled out. (C)>15% is severe poisoning. (D) For smokers, it should not exceed 5%.

Output: A


Instruction: A 7-year-old child was in a car accident, weighing 16 kg, with an open airway, breathing 24 times/min, systolic pressure 84 mmHg, drowsiness, eyes open when stimulated by pain, incoherent speech, limb retraction when stimulated by pain, large open lacerations on the left shoulder and left chest, and an open fracture on the left calf. What are his Pediatric Trauma Score (PTS) and Revised Trauma Score (RTS)?

Input: (A)PTS is 4 points and RTS is 10 points. (B)PTS is 3 points and RTS is 10 points. (C)PTS is 3 points, RTS is 9 points. (D)PTS is 2 points, RTS is 9 points.

Output: B


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

Input: (A) To relieve throat pain, topical Lidocaine can be given. (B) There may be complications of viral encephalitis and myocarditis. (C) It is mainly clinical diagnosis, and PCR (polymerase chain reaction) can also be used for diagnosis. (D) Common viruses include Coxsackievirus A16.

Output: A


Instruction: A 32-year-old male was sent to the emergency room. His companions described that the patient surfaced from a depth of 50 meters in the sea during a diving activity and lost consciousness 10 minutes after landing. After arriving at the hospital, his vital signs were stable but his coma index was E2V3M3. The results of blood arterial gas analysis (room air) were pH 7.236, PaO 2 82.3 mmHg, PCO₂ 48.2 mmHg, HCO₃ 20mM/L. Which of the following statements is more appropriate?

Input: (A) The patient has type I decompression sickness combined with arterial gas embolism. (B) 100% oxygen, intravenous infusion, and hyperbaric oxygen therapy should be given immediately. (C) Patients should be placed in the Trendelenburg position whenever possible. (D) Endotracheal intubation and mechanical ventilation should be given priority over hyperbaric oxygen therapy.

Output: B


Instruction: Which of the following is inappropriate for common important differences between cervical spine X-rays in children and adults?

Input: (A) Normal lordosis may disappear when children are in the supine position or wearing a rigid neck collar. (B) The posterior arch of the first cervical vertebra (C1) fuses at about 3 years of age, and the anterior arch fuses at about 10 years of age. (C) In a 10-year-old child, posterior wedging of the vertebra caused by the secondary growth center may be mistaken for a compression fracture. (D) In a 4-year-old child, a lateral cervical X-ray may show pseudo-subluxation at the C2-C3 position.

Output: C


Instruction: Which of the following descriptions and treatments for acute renal cholangitis is less appropriate?

Input: (A) If creatinine rises, the patient should be considered to have chronic renal failure or a single kidney, rather than the current obstruction. (B) Nonsteroidal anti-inflammatory drugs, morphines, or Lidocaine IV can all achieve analgesic or symptom relief. (C) The use of Tamsulosin can shorten the time it takes for stones to pass, especially those larger than 5 mm. (D) If a pregnant woman has back pain but ultrasound cannot explain her clinical symptoms, she should be referred to a urologist and obstetrician and gynecologist and have a KUB examination arranged.

Output: D


Instruction: A middle-aged male suffers a puncture wound to the neck. His vital signs are stable. Examination reveals that the injury is deep to the cervical dilator muscle (platysma). He has hoarseness, neck tenderness, and subcutaneous emphysema. Computed tomography angiography shows no obvious vascular damage, but laryngotracheal injury is suspected. Which of the following further examinations and treatments is more appropriate?

Input: (A) Esophagectomy or esophagoscopy. (B) Upper gastrointestinal tract panendoscopy. (C) Interventional angiography. (D) Color Doppler.

Output: B


Instruction: A 30-year-old male returned to Taiwan from Nigeria, West Africa, 14 days ago. He came to the emergency room with persistent fever and headache. The nucleic acid of the new coronavirus was negative. The blood test report showed anemia, jaundice and low platelets. Which of the following treatments is more appropriate?

Input: (A) Even if it is not confirmed, combined with clinical symptoms and travel history, the fourth category of legal infectious diseases should be reported within 24 hours. (B) A brain CT should be arranged to correct the low platelet count to more than 20,000/mm³, and a lumbar puncture should be performed. (C) Both thick and thin blood smears should be arranged, of which thin blood smears are more able to confirm the type of infection. (D) Because treatment drugs all have serious side effects, drugs should not be used rashly before a confirmed diagnosis.

Output: C


Instruction: A 50-year-old woman goes to the emergency room with vomiting and diarrhea. She says that her food was poisoned with arsenic (arsenic trioxide) a few hours ago. Which of the following statements is less appropriate?

Input: (A) The most common causes of death from arsenic poisoning are low blood pressure and arrhythmia. (B) An abdominal X-ray may reveal metallic flecks of arsenic. (C) A blood test to measure serum arsenic concentration can determine whether to give the chelating agent Dimercaprol. (D) If a physical examination reveals horizontal lines on the nails - Mees' lines - chronic poisoning should be suspected.

Output: C


Instruction: A 30-year-old female, 34 weeks pregnant, is brought to the emergency department after a car accident. Ultrasound shows right-sided pneumothorax. Which of the following statements is more appropriate for the management of this patient?

Input: (A) If a chest tube is considered, choose a 24F or 28F size. (B) The location of the chest tube should be considered at the intersection of the third or fourth intercostal space and the anterior axillary line. (C) When placing a chest tube, it is recommended to make a 1-2 cm skin incision parallel to and at the same level as the target intercostal space. (D) The path of the chest tube should be along the lower edge of the ribs.

Output: B


Instruction: A 20-year-old woman is about 20 weeks pregnant and has not had regular prenatal checkups. She comes to the hospital with persistent vomiting. Which of the following statements is less appropriate?

Input: (A) If the diagnosis is hyperemesis gravidarum, it is recommended to give her plenty of water to replenish her body fluids. (B) If the blood glucose level is 180 mg/dL, the possibility of ketoacidosis can be ruled out and she should be treated for hyperemesis gravidarum. (C) If the diagnosis is diabetic ketoacidosis, the insulin pump treatment is similar to that of non-pregnant women. (D) For intractable hyperemesis gravidarum, steroid treatment may be considered.

Output: B


Instruction: According to research, which of the following risk factors for the elderly becoming victims of abuse or the next generation becoming perpetrators is less appropriate?

Input: (A) The next generation with high socioeconomic status and busy work are more likely to become perpetrators. (B) Women and elderly people who cannot move independently are more likely to become victims of abuse. (C) The next generation with financial difficulties are more likely to become perpetrators. (D) Elderly residents of nursing homes are more likely to become victims of abuse.

Output: A


Instruction: Xiao Ming plans to climb Yushan Mountain and is worried about altitude sickness. Which of the following suggestions is more appropriate?

Input: (A) Dexamethasone can prevent altitude sickness. (B) Acetazolamide can be taken 24 hours before climbing. (C) Acetaminophen has no effect on headaches caused by altitude sickness. (D)Nifedipine is required for high altitude cerebral edema.

Output: B


Instruction: Which of the following compounds has the most similar mechanism of action for sarin poisoning?

Input: (A)Cyanide. (B)Halothane. (C)Organophosphate. (D)Phosphine.

Output: C


Instruction: Which of the following drugs is more likely to cause a false positive urine opioid screen?

Input: (A)Chlorpromazine. (B)Levofloxacin. (C)Ibuprofen. (D)Verapamil.

Output: B


Instruction: A 50-year-old male with no past medical history presents to the emergency department with fever for several days and upper abdominal pain, nausea and vomiting. Vital signs: temperature 39℃, blood pressure 110/83 mmHg, heart rate 100 beats/min, respiration 20 times/min. Physical examination revealed abdominal tenderness and gum bleeding. Blood test revealed platelet count 70,000/μL, GPT 200 IU/L. If dengue fever is suspected, which of the following is more appropriate?

Input: (A) NSAIDs should be used to reduce fever as soon as possible. (B) Ultrasound revealed edema of the gallbladder wall and some effusion next to the gallbladder. A surgeon should be consulted to arrange surgery. (C) Hospitalization is recommended and attention should be paid to whether it develops into a serious condition. If appropriate supportive treatment is not received, the mortality rate can reach 10-20%. (D)Dengue fever is a Category II infectious disease and should be reported within 1 week, and specimens should be collected for testing.

Output: C


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

Input: (A)It is often accompanied by multiple bacterial infections, mainly aerobic infections, and anaerobic infections are uncommon. In addition to antibiotic treatment, surgical drainage and debridement are often required. (B)Manibuli often cause masticator space infection, and the main clinical symptoms are facial pain and clenched jaw. Infections in the masticator space are not easy to spread to other deep neck spaces. (C) Infection of the submandibular, sublingual and submental spaces caused by the mandibular molars is called Ludwig's Angina. The tongue often moves backward due to infection, causing airway obstruction. (D) Ludwig's Angina progresses rapidly. In addition to antibiotic treatment, rapid sequence intubation should be used as soon as possible to establish an airway.

Output: C


Instruction: Which of the following causes of hypercoagulable state during pregnancy is less appropriate?

Input: (A) Uterine pressure causes venous obstruction. (B) The right iliac vein crosses the right iliac artery. (C) Increased platelet activation. (D) Protein C deficiency.

Output: B


Instruction: Which of the following statements most likely represents a patient with hernia combined with strangulation?

Input: (A) The patient has severe nausea and vomiting. (B) Ultrasound shows thickened intestinal wall and free fluid in the bulge. (C) Doppler ultrasound shows arterial flow in the bulge. (D) Ultrasound shows rapid peristalsis in the bulge.

Output: B


Instruction: Which of the following CT images is most common in traumatic aortic injury?

Input: (A) Aortic pseudoaneurysm. (B) Blood clot in the lumen at the site of intimal disruption. (C) Aortic transection. (D) Active bleeding from the aorta to the septal cavity.

Output: A


Instruction: A 26-year-old woman who is 28 weeks pregnant comes to the clinic because of pain in the lower right side of her belly button. The patient says that she has a persistent feeling of nausea today, but has no fever. Which of the following statements about this patient is more appropriate?

Input: (A) The incidence of appendicitis in pregnant women is 1.4 times higher than that of ordinary women, and it is easy to be misdiagnosed. (B) In terms of the number of weeks and the location of abdominal pain, the vast majority of appendicitis pain is on the upper right side. (C) If the right kidney is edematous and the white blood cell count in the urine is elevated, it can be treated as a urinary tract infection. (D) If an ultrasound examination is performed and the typical manifestations of appendicitis are seen, surgery is recommended.

Output: D


Instruction: Which of the following statements about the pathogens of pediatric pneumonia is less appropriate?

Input: (A) Mycoplasma pneumoniae: There will be a hacking dry cough. Extrapulmonary manifestations may include central nervous system diseases, joint pain, rash and other skin diseases. (B) Chlamydia trachomatis: Usually the course of the disease is fast and there will be high fever. It may even cause lung abscesses. It often occurs as a secondary infection after influenza infection. (C) Whooping cough pneumonia: Children cough for more than two weeks. Be careful of the risk of whooping cough. (D) Mycobacterium tuberculosis pneumonia: Persistent long-term cough and fever with extrapulmonary manifestations. Children with tuberculosis may not have symptoms of coughing up blood.

Output: B


Instruction: A 48-year-old male complained of cough, dyspnea and fever for several days. He also had recurrent chronic sinusitis, joint pain, proteinuria and subcutaneous nodules of unknown cause. Chest X-ray showed infiltrations and nodules of varying degrees in both lungs. Which of the following is the more likely diagnosis?

Input: (A)Hypersensitivity pneumonitis. (B)Sarcoidosis. (C)Wegener's granulomatosis. (D)Goodpasture's syndrome.

Output: C


Instruction: Which of the following statements is more appropriate for a patient with severe headache and suspected subarachnoid hemorrhage?

Input: (A) The preferred test is a brain CT without contrast, which gradually increases in sensitivity after 24 hours and can reach 98% around the third day. (B) If the CT is normal but the suspicion is still high, MRI can replace lumbar puncture to confirm whether there is subarachnoid hemorrhage. (C) Xanthochromia is caused by the degradation of hemoglobin into bilirubin. Light should be avoided before testing. (D) Within 1 hour after the rupture and bleeding of a brain aneurysm, the CT scan is normal, and the cerebrospinal fluid may show xanthochromia.

Output: C


Instruction: A 7-year-old girl went to the emergency department with wheezing, abdominal pain, polyuria, and altered consciousness. During the examination, she was found to be drowsy, pale, with a microvascular refill time of >3 seconds, a body temperature of 37.1℃, a heart rate of 152 beats/min, a respiration rate of 42 breaths/min, a blood pressure of 78/46 mmHg, a K of 4.5 mEq/L, a glucose of 450 mg/dL, a pH of 7.18, and a ketone body of 3.2mmol/L. Which of the following treatments and statements is more appropriate?

Input: (A) Insulin 0.1 unit/kg should be given immediately by intravenous injection to correct hyperglycemia. (B) Consider giving 20 mL/kg of 0.9% saline solution rapidly in the first hour. (C) After giving adequate saline infusion, give Insulin 0.04 unit/kg/hr immediately to eliminate ketoacids. (D) The current potassium level in the blood is within the normal range and no potassium supplement is needed.

Output: B


Instruction: Which of the following interpretations of pleural effusion is less appropriate?

Input: (A) Esophageal rupture may cause an increase in amylase in pleural effusion. (B) Pleural effusions caused by pulmonary embolism may be transudates. (C) Pleural effusions caused by rheumatic arthritis will have elevated glucose. (D) When the pH is less than 7.1, abscesses can be diagnosed and chest tube drainage is an indication.

Output: C


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

Input: (A) The patient has black stools (melena), and visual observation of nasogastric tube aspirates is coffee-ground, which is not enough to diagnose upper gastrointestinal bleeding. (B) The patient has black stools, which may be slow lower gastrointestinal bleeding. (C) The patient has bloody stools (hematochezia), if hemorrhoids are found during rectal examination and vital signs are stable, he can be referred to the colorectal department for outpatient treatment. (D) The most common cause of vomiting blood in patients with cirrhosis is peptic ulcer bleeding, followed by esophageal varicose vein bleeding.

Output: B


Instruction: Which of the following descriptions of the clinical characteristics and diagnostic treatment of elderly trauma is less appropriate?

Input: (A) For elderly patients with cervical spine injury, it is recommended to skip X-ray examination and directly arrange CT examination. (B) Excessive extension injury in the elderly may cause central cord syndrome, and motor dysfunction in the upper limbs is more common than in the lower limbs. (C) Cervical and lumbar fractures account for almost half of all osteoporotic fractures, and the second cervical and second lumbar vertebrae are the most common. (D) For elderly patients with mild head trauma and no symptoms who are taking Warfarin or Plavix, contrast-free brain CT will be recommended.

Output: C


Instruction: Which of the following statements about acute exacerbation of chronic obstructive pulmonary disease is more appropriate?

Input: (A) Antibiotics should be given for increased sputum volume and sputum color change. Sputum bacterial culture is helpful in the selection of emergency antibiotics. (B) A short-term course of steroids for 3 days can shorten recovery time. (C) Oxygen supplementation can help reverse pulmonary vasoconstriction. (D) Gastroesophageal reflux is a risk factor for worsening of COPD, and treating it can reduce worsening of the disease.

Output: C


Instruction: A 6-day-old newborn is sent to the emergency room because of high fever, lethargy and poor spirits. Which of the following statements is more appropriate?

Input: (A) It may be related to maternal or perinatal factors, such as early rupture of membranes, and the course of the disease is usually slower. (B) The threshold for septic workup, such as blood draw, urine test and lumbar puncture, is the same as that for older infants. (C) Antibiotic treatment should be started as early as possible, covering Gram-positive bacteria and intestinal bacteria, but ceftriaxone should be avoided. (D) Clinical manifestations may also include shortness of breath, poor appetite and even vomiting, and Kernig and Brudzinski signs are often present.

Output: C


Instruction: Regarding heparin-induced thrombocytopenia, which of the following statements is more appropriate?

Input: (A) Protamine can be used for treatment after the occurrence. (B) Fondaparinux should not be used for anticoagulation after the occurrence, as the mechanism is similar. (C) A small number of patients will have an allergic reaction within 30 minutes after intravenous injection of Heparin. (D) There is a high bleeding tendency after the occurrence, and platelet transfusions should be given prophylactically.

Output: C


Instruction: Regarding acute chest pain, which of the following statements is more appropriate?

Input: (A) An 18-year-old male who used cocaine and had chest pain for 2 days is less likely to have acute coronary heart disease. (B) 64 (C) A 70-year-old woman with diabetes has upper abdominal pain combined with soreness in both arms, which is unlikely to be a heart problem. (D) A 70-year-old man with cirrhosis and long-term alcoholism has chest pain after severe vomiting, so Boerhaave's syndrome should be considered. (D) Acute stroke patients do not affect the heart, so the myocardial index will not rise.

Output: C


Instruction: A 45-year-old female with a history of diabetes has had low back pain and lower abdominal distension for 2 days. She has frequent urination but it is not smooth. She has to strain to urinate and she also urinates stool. She also has numbness in the buttocks and inner thighs near the anus. Ultrasound estimates that the residual urine volume is 900 mL and there is mild edema on both sides. Which of the following statements or treatments is less appropriate?

Input: (A) A urinary catheter should be placed and blood drawn to test kidney function and electrolytes. (B) A check should be performed to see if there is a gynecological mass or pelvic inflammation causing obstruction. (C) If a tumor is suspected to be compressing the nerve, dexamethasone should be given first, and then a lumbar magnetic resonance imaging should be arranged. (D) More than 95% of patients will have reduced anal sphincter tension.

Output: D


Instruction: A 70-year-old male was transferred to our emergency department one month ago due to atrial fibrillation and infarct stroke. He is expected to stay in hospital for one month for rehabilitation treatment. The patient still needs to be given intravenous medication. Because peripheral intravenous catheters are difficult to place, it is recommended to place a central intravenous catheter. For this patient, the emergency physician chooses the location of the central intravenous catheter. Which one is more appropriate?

Input: (A) Right internal jugular vein. (B) Right external jugular vein. (C) Right subclavian vein. (D) Right femoral vein.

Output: A


Instruction: A 15-month-old boy presents to the emergency department with cough, runny nose, and shortness of breath. He is currently afebrile. Physical examination reveals intercostal retractions in the chest and wheezing on auscultation. Which of the following statements regarding the treatment of this patient is inappropriate?

Input: (A) Administer oxygen therapy if necessary to maintain blood oxygen concentration greater than 90%. (B) Combination therapy with the steroid dexamethasone and epinephrine may reduce hospitalization rates. (C) Treatment with β2 agonists may help reduce hospitalization rates and length of stay. (D) If respiratory distress is present, use of non-invasive positive pressure ventilation (NIPPV) may reduce or delay the need for intubation.

Output: C


Instruction: Which of the following statements is more appropriate for performing a spinal tap on a patient suspected of bacterial meningitis?

Input: (A) If there is no obvious abnormality in the blood test report and no obvious neurological symptoms, a spinal tap can be performed without a brain CT scan. (B) Spinal tap should be performed after antibiotics are used to avoid affecting bacterial culture. (C) Bacterial meningitis can easily cause an increase in cerebrospinal fluid pressure. It is advisable to perform a brain CT scan as a routine procedure before performing a spinal tap. (D) If the patient is unable to lie on his side, consider doing a spinal tap in a sitting position. The measured cerebrospinal fluid pressures will not differ much.

Output: A


Instruction: According to the Interim Guidelines for Clinical Management of Novel Coronavirus (SARS-CoV-2) Infection (17th Edition, April 19, 2022) issued by the Taiwan Centers for Disease Control, which of the following adults infected with the novel coronavirus can be classified as having severe pneumonia?

Input: (A) Fever or respiratory infection, combined with a respiratory rate of 26 times/min. (B) Fever or respiratory infection, combined with a blood oxygen saturation of 94% under room air. (C) Fever or respiratory infection, combined with a chest X-ray lung infiltration of 40%. (D) Fever or respiratory infection, combined with severe respiratory distress PaO 2/FiO 2=350.

Output: B


Instruction: A 70-year-old male patient has a history of diabetes. His anus has been swollen and itchy in the past few days. Whenever he defecates, the swollen material comes out of his anus, but he can push it back by himself. Fresh blood is found on the toilet paper. Which of the following statements is more appropriate?

Input: (A) This patient may have anal varicose veins. Pay attention to whether he has portal hypertension. (B) This patient can be advised to take a warm water (30℃) sitz bath and give him a laxative before leaving the emergency room. (C) This patient can be advised to use local Nifedipine (0.3%) and Lidocaine (1.5%) gel to relieve symptoms. (D) This patient can be advised to drink more water and eat low-fiber foods to make defecation easier.

Output: C


Instruction: Which of the following drugs is less likely to interact with grapefruit juice?

Input: (A)Amiodarone. (B)Calcium channel blocker. (C)Carbamazepine. (D)Theophylline.

Output: D


Instruction: An 82-year-old male presented with widespread abdominal pain that began 2 hours ago and did not radiate to the back, along with severe nausea and multiple episodes of bilious vomiting. The patient had no history of heart disease and his electrocardiogram was normal. Which of the following statements is more appropriate?

Input: (A)The most likely diagnosis for this patient is large bowel obstruction. (B) Due to the patient's age, the criteria for evaluating whether to accept imaging examinations should be stricter to avoid excessive contrast agents and radiation damage. (C) The patient's serum Lactate value is normal, but the possibility of acute mesenteric ischemia cannot be ruled out. (D) Opioid analgesics can reduce gastrointestinal motility, leading to an increase in the patient's mortality rate.

Output: C


Instruction: Which of the following descriptions of common symptoms of vision loss is less appropriate?

Input: (A) Acute angle-closure glaucoma is sudden vision change and unilateral eye pain and headache. (B) Uveitis is gradual vision change and pain. (C) Vitreous hemorrhage is sudden painless vision change. (D) Central retinal artery occlusion (CRAO) is ischemic pain and sudden vision change.

Output: D


Instruction: A 70-year-old male sought emergency treatment for general weakness. Blood tests revealed BUN 84 mg/dL, Creatinine 2.5 mg/dL, Na 143 mEq/L, and K 4.0 mEq/L. Which of the following statements about this patient is inappropriate?

Input: (A) The cause of the disease may be low blood volume, low blood pressure, high blood calcium, and microvascular thrombosis. (B) Improper use of NSAIDs, ACEIs, ARBs, etc. may also aggravate this condition. (C) The size of the kidney measured by ultrasound is about 12 cm, and it is speculated that the patient may be a CKD patient. (D) For fluid replenishment, lactate ringer may be more suitable than normal saline.

Output: C


Instruction: Which of the following statements about postoperative complications in urology is more appropriate?

Input: (A) Urinary tract infection is the most common complication of transurethral resection of the prostate. (B) After transurethral resection of the prostate, if blood clots block the prostate and cause acute urinary retention, it is almost always necessary to contact the urology department and arrange for the patient to be hospitalized. (C) After transurethral resection of the prostate, if blood clots block the prostate and the patient uses saline for bladder irrigation, blood tests are required to check for low sodium levels. (D) If acute urinary retention occurs after artificial urinary sphincters, a urethral catheter should not be placed.

Output: D


Instruction: A 70-year-old male with a history of diabetes underwent right thoracotomy two weeks ago. He went 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 found to be 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 pleural fluid is 6.9, which can strengthen the diagnosis. (D) The preferred antibiotics are amoxicillin/clavulanate.

Output: C


Instruction: A 26-year-old doctor was pierced on his index finger by the suture needle while suturing a wound for a patient. The patient's blood test showed: HIV antibody test was positive, HBsAg was negative, and anti-HCV was positive. The doctor has never been vaccinated against hepatitis B. Regarding the occupational exposure treatment of this doctor, which of the following is more appropriate?

Input: (A) Disinfectants should be used to disinfect the wound. (B) Condoms should be used during sexual intercourse within six to twelve weeks. (C) He should receive hepatitis B immune globulin (HBIG) treatment. (D) Should receive antiviral treatment for hepatitis C.

Output: B


Instruction: A 4-year-old boy was brought to the emergency room in kindergarten because of frequent diarrhea, poor appetite, and decreased mental activity. Which of the following statements is more appropriate?

Input: (A) In case of hypoglycemia, ketone bodies in blood or urine should be checked. (B) Oral fluid replenishment is not effective in reducing mortality. (C) Oral fluid replenishment should be diluted by half because sports drinks have high sugar content. (D) If dehydration and shock occur, 20 ml/kg of normal saline can be given by drip for 1 hour, repeated three times until there is an initial response.

Output: A


Instruction: A 50-year-old male presents to the emergency department with 3 days of redness and swelling around a wound on his left lower limb, combined with fever. The patient has no past medical history and is a farmer by occupation. 7 days ago, he accidentally injured his left foot while working, resulting in a 2-cm laceration. The patient did not take it seriously and continued to work and soaked the wound in wet soil. Which of the following options is more appropriate regarding the bacterial species that infected this patient?

Input: (A) Vibrio vulnificus. (B) Aeromonas hydrophila. (C) Pseudomonas aeruginosa. (D) Pasteurella species.

Output: B