Instruction: Which of the following options is less appropriate regarding the identification and management of acute agitation?

Input: (A) Elderly patients with acute agitation need to be carefully assessed for their state of consciousness. If their consciousness and cognitive functions change rapidly, their course fluctuates, their attention is poor, and their alert level of consciousness or disorganized thinking is poor, then they meet the diagnosis of delirium in the Confusion Assessment Methods. (B) If the agitated patient has a long-term habit of drinking strong alcohol and suddenly stops drinking in the past two days for some reason, and the agitation is also manifested by sympathetic nervous system overexcitement and tremors, alcohol withdrawal should be considered, and adequate doses of benzodiazepines should be given to prevent the occurrence of delirium tremens. (C) If an acutely agitated patient also exhibits psychotic symptoms, such as visual hallucinations, auditory hallucinations, or persecutory delusions, an antipsychotic may be used as an acute sedative; if there are no obvious psychotic symptoms but the patient is agitated or irritable, benzodiazepines may be considered. (D) The primary treatment principle for elderly patients with delirium is to identify and treat the cause of the delirium, and sedatives should be selected from benzodiazepines, antihistamines, or muscle relaxants as much as possible.

Output: D


Instruction: A young person used a laughing gas (N2O) balloon for the first time at a party and was sent to the emergency room with delirium, agitation, and inability to calm down. Which of the following treatments is more appropriate?

Input: (A)Benzodiazepines (BZD) can be given to reduce delirium. (B)Vitamin B 12 treatment is not necessary. (C)If hypoxemia persists after oxygen administration, hyperbaric oxygen therapy should be considered. (D)If hypotension occurs, norepinephrine drip should be given as a priority.

Output: B


Instruction: A middle-aged male was found lying at the entrance of a subway station for an unknown period of time. His fingertip blood sugar level was 130 mg/dL. He had a distinct smell of alcohol, but no needle marks. He was unable to focus on answering questions. GCS E3V4M5, blood alcohol concentration was 150 mg/dL. Which of the following statements is more appropriate?

Input: (A) ABG pH 7.10, HCO₃ 10 mmol/L, Ketone 3 +, Lactate negative, insulin treatment was given. (B) ABG pH 7.10, HCO₃ 10 mmol/L, Ketone negative, Lactate negative, intravenous infusion treatment was given. (C) After being observed in the emergency department for 24 hours, a seizure suddenly occurred and Lorazepam injection treatment was given. (D) If the patient has not regained consciousness after 24 hours of observation in the emergency department, intravenous infusion therapy should be given.

Output: C


Instruction: Which of the following descriptions of enterovirus is more appropriate?

Input: (A)The virus that causes herpetic pharyngitis is mainly coxsackie B virus. (B)Children are less at risk of enterovirus infection than adults, so most children have mild enterovirus disease. (C)Patients are contagious before they show symptoms, but they will not excrete the virus for a long time after infection. (D)Enterovirus can pass through the placenta and cause vertical transmission from mother to fetus.

Output: D


Instruction: A 68-year-old male with a history of alcoholic cirrhosis and diabetes mellitus is admitted to the emergency department with a large mouthful of blood (approximately 500 ml). Which of the following related treatments is more appropriate?

Input: (A) It is unreliable to quickly determine that there is upper gastrointestinal bleeding based on the presence of blood-red or brown liquid in the vomitus. (B) The blood test shows hemoglobin of 8.0 g/dL. No blood transfusion is required at this time. Vital signs and the amount of bleeding can be observed first. (C) Antibiotic treatment should be given as soon as possible to prevent infection and reduce recurrence of bleeding. (D) The use of balloon tamponade is only a temporary treatment for varicose vein bleeding and is no longer recommended for emergency use.

Output: C


Instruction: A 37-year-old female with a history of mental illness who was taking medication to control her condition was sent to the emergency room because of confusion. When she arrived at the hospital, she was found to have high temperature, high blood pressure, rapid heartbeat, sweating, muscle twitching (myoclonus), and increased reflexes (hyperreflexia). Based on the patient's condition, which of the following is more appropriate?

Input: (A) The patient should be taking antipsychotic drugs to cause neuroleptic malignant syndrome. (B) Bromocriptine can be used to reduce fever and body stiffness, but it may cause high blood pressure. (C) Most patients may recover after 24 hours, and the most common cause of death is severe hyperthermia. (D) Dantrolene can be used to reduce temperature and treat muscle stiffness, reducing the mortality rate.

Output: C


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

Input: (A) Esophageal rupture may cause elevated amylase in pleural effusion. (B) Pleural effusion caused by pulmonary embolism may be transudates. (C) Pleural effusion caused by rheumatoid arthritis will have elevated glucose. (D) Pleural effusion caused by cancer will have mainly lymphocytes.

Output: C


Instruction: Regarding neck trauma, which of the following is less appropriate?

Input: (A) Coughing is not a hard sign of neck strangulation. (B) Up to 20% of puncture wounds of the neck are accompanied by pneumothorax or hemothorax. (C) If the neck is overstretched due to sudden acceleration and deceleration, be careful of esophageal injury. (D) Neck puncture wounds that do not penetrate the cervical platysma are usually not life-threatening.

Output: A


Instruction: Which of the following oral hypoglycemic drugs is more likely to cause euglycemic ketoacidosis?

Input: (A) Biguanides, such as Metformin. (B) Sulfonylureas, such as Glimepiride. (C) DPP4 Inhibitors (Dipeptidyl peptidase-4 inhibitor), such as Sitagliptin. (D) SGLT2 Inhibitors (Sodium-Glucose Cotransporter 2 Inhibitors), such as Dapagliflozin.

Output: D


Instruction: A 37-year-old American male with a history of conservatively treated diverticulitis of the descending colon presents with fever and left lower abdominal pain. His vital signs are stable, and he has no vomiting, diarrhea, or urinary discomfort. Physical examination is characterized by local tenderness in the left lower abdomen, without rebound tenderness or signs of peritonitis. Laboratory tests show WBC 8,300/µL, Hb 13.5 g/dL, creatinine 0.8 mg/dL, and CRP 12 mg/d L. Which of the following is inappropriate regarding this patient's description?

Input: (A) Because the patient's symptoms are similar to those of previous diverticulitis, imaging studies are not necessary. (B) The location of the patient's diverticulitis is consistent with current worldwide epidemiological statistics. (C) Metronidazole plus Aztreonam is one of the reasonable antibiotic options. (D) The role of procalcitonin in guiding the use of antibiotics for diverticulitis is still unclear.

Output: C


Instruction: Which of the following drugs commonly used by transgender people and their side effects is more appropriate?

Input: (A) Testosterone users do not need to take a pregnancy test during clinical examinations because of its contraceptive properties. (B) 17-β-Estradiol increases the production of coagulation factors, leading to an increased risk of venous thromboembolism. (C) Adult female transgender people often use the drug spironolactone, which may cause side effects such as high blood potassium, low blood pressure, and increased urination. (D) Testosterone use can cause leukocytosis, which in turn increases the risk of cerebrovascular disease and thrombotic disease.

Output: B


Instruction: A 25-year-old male patient with acquired immune deficiency syndrome developed fever and fatigue. He later went to the emergency room with a rash and blisters on his genitals and perineum and enlarged inguinal lymph nodes. Which of the following statements is more appropriate?

Input: (A) It may be caused by an infection with an orthopoxvirus. This case is unlikely to become a serious illness. (B) The infectious period of this disease is from 5 days before the rash appears until all lesions have crusted over. (C) The principle for handling suspected cases of this disease is to admit them to a single room with an independent bathroom in the hospital. (D) According to the recommendation of the CDC, antiviral drugs are not required in this case.

Output: C


Instruction: The severity of acute pancreatitis is very important for the subsequent treatment and prognosis of patients. According to the Atlanta criteria, the following indicators can all predict severe pancreatitis, except which one?

Input: (A)APACHE II score ≤ 8. (B)Ranson score ≧ 3. (C)Serum creatinine > 2mg/dL, before fluid resuscitation. (D)Serum calcium ≦ 7.5 mg/dL.

Output: C


Instruction: An 84-year-old male was brought to the emergency room by his family. He complained of inattention, incoherent speech, nighttime hyperactivity and daytime sleepiness over the past two days. His temperature was 37.6℃, his heart rate was 115 beats/min, and his blood pressure was 154/96 mmHg. Which of the following statements is more appropriate?

Input: (A) Delirium can be divided into hyperactive, hypoactive and mixed types, of which hyperactive is the most common. (B) Compared with dementia, delirium is less likely to produce visual and auditory hallucinations. (C) Avoid using antihistamines on this patient to prevent worsening of symptoms. (D) The patient continues to be agitated and exhibits disorganized behavior in the emergency room. Short-acting benzodiazepines are the first choice for treatment.

Output: C


Instruction: Which of the following statements about early arrhythmias after acute myocardial infarction is more appropriate?

Input: (A) The presence of sinus bradycardia is associated with a higher mortality rate. (B) When complete AV block occurs, the use of temporary pacing can reduce mortality. (C) Persistent sinus tachycardia is associated with a poor prognosis. (D) The presence of ventricular tachycardia indicates a poor prognosis.

Output: C


Instruction: A 55-year-old male patient was transferred to our hospital after emergency intubation at another hospital due to massive hemoptysis and respiratory failure. He was found to have a temperature of 36°C, heart rate of 110 beats/min, blood pressure of 120/80 mmHg, and blood oxygen concentration of 86%. He was also found to have persistent respiratory bleeding. Bedside X-ray showed obvious infiltration of the left lung, and the tip of the endotracheal tube was 3 cm above the tracheal carina. Which of the following treatments is less appropriate?

Input: (A) Place the patient on his right side. (B) Continue to push the endotracheal tube into the right main bronchus. (C) Arrange bronchoscopy to locate the bleeding site. (D) If bronchoscopy fails to stop the bleeding, arrange bronchial artery embolization.

Output: A


Instruction: A 60-year-old male with a history of hepatitis B and cirrhosis who has not been followed up regularly presents with fever, abdominal distension, and delayed reactions. Laboratory tests show WBC 6,700/µL, Hb 11.5 g/dL, ALT 47 U/L, creatinine 3.7 mg/dL, T-bil 3.7 mg/dL, and Ammonia 130 µg/dL. Bedside ultrasound shows signs of ascites. Which of the following statements about this patient is inappropriate?

Input: (A) Runyon criteria can help identify the source of infection in this patient. (B) HBeAg and HBV DNA can be tested to detect viral replication. (C) Albumin and vasoactive drugs can be used for treatment. (D) In addition to Lactulose, oral Neomycin can also be used as an adjuvant treatment.

Output: D


Instruction: A 45-year-old male patient underwent cardiac catheterization for myocardial infarction one month ago. Today he went to the emergency room for fever, weakness, and chest pain. Body temperature 38℃, blood pressure 100/60mmHg, heart rate 120 beats/min. Echocardiogram showed some pericardial effusion, electrocardiogram showed no new changes, and chest X-ray showed some pleural effusion but no pneumonia. Which of the following treatments is more appropriate?

Input: (A) Perform pericardial aspiration. (B) Give antibiotics immediately. (C) Arrange cardiac catheterization. (D) Give high doses of Aspirin and Colchicine.

Output: D


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

Input: (A) According to Burch and Wartofsky's diagnostic criteria, six major items need to be scored, including body temperature, central nervous system assessment, gastrointestinal symptom assessment, heart rate, degree of heart failure and whether there is atrial fibrillation. (B) Continuing from the above description, as long as the total score is greater than 8 points, thyroid storm can be suspected. (C) In terms of treatment, Propylthiouracil (PTU) or Methimazole can be used to reduce the synthesis of thyroid hormone. Methimazole should be avoided in the first trimester. (D) Treatment with iodine, such as Lugol solution, must be given after giving Thionamides.

Output: B


Instruction: A 26-week pregnant woman has proteinuria during prenatal check-up, complains of dizziness, blurred vision, and convulsions. Her current consciousness is GCS E3V5M5, blood pressure 197/115 mmHg, heart rate 105 beats/min, respiration 20 times/min, SpO₂ 99%. Which of the following is less appropriate?

Input: (A) Give Magnesium sulfate 4~6 g, and continue 2 g every hour for 24 hours. (B) Arrange a brain CT scan. (C) Give Labetalol 5 mg IV, re-evaluate and repeat the medication after 20 minutes. (D)Administering corticosteroids can help delay delivery and improve fetal outcomes.

Output: C


Instruction: A 33-week pregnant woman has sudden lower abdominal cramps and bloody transparent vaginal discharge. Which of the following is inappropriate?

Input: (A)The fetal heart rate is 103 beats/min, which is already fetal distress. The woman should lie on her left side, receive intravenous fluids, and be given oxygen. (B)Before doing a bimanual pelvic examination, ultrasound should be used to rule out placenta previa. (C)When using a speculum examination, lubricants should not be used to avoid affecting the test results. (D)The vaginal fluid was tested with a test strip and the pH value was 5, which is suspected to be amniotic fluid rupture.

Output: D


Instruction: Using the National Emergency X-radiography Utilization Study (NEXUS) criteria to evaluate patients with cervical spine injuries, in which of the following cases would the patient's collar be considered for removal?

Input: (A) Pain caused by neck movement. (B) Injury caused by high-speed impact. (C) Injury caused by toxic substances and alcohol reactions. (D) Altered mental status.

Output: B


Instruction: Requesting a medical evacuation of an intubated and chest-tubed trauma patient, which of the following pre-flight actions would be inappropriate?

Input: (A) The endotracheal tube's cuff is deflated before it is lifted into the air. (B) The FiO2 of the ventilator is set to 100%. (C) A chest tube is drained using a Heimlich valve or connected to a suction. (D) A nasogastric or orogastric tube is placed for drainage.

Output: A


Instruction: A 24-year-old female returned to Taiwan 2 days ago after a honeymoon trip to Southeast Asia. She presented with symptoms of nausea, diarrhea, and bloody stools. Vital signs were examined: temperature 37.7℃, heart rate 110 beats/min, respiration 18 breaths/min, blood pressure 105/75 mmHg. After preliminary questioning and physical examination, the patient was unable to determine the last menstrual period. Which of the following is more appropriate?

Input: (A) Oral rehydration with an electrolyte solution containing glucose and lactose is recommended. (B) Loperamide can be used in combination with antibiotics to improve the condition and is suitable for patients with diarrhea, mucus and bloody stools. (C) Probiotics and Proton pump inhibitors are safe and beneficial when used together with supplemental infusion therapy. (D) After confirming that there are no other contraindications, the first choice of antibiotic is Azithromycin 1,000mg taken once.

Output: D


Instruction: A 55-year-old male patient with no past medical history has right-sided pneumonia on chest X-ray. Based on the risk assessment of pneumonia severity, which of the following statements is less appropriate?

Input: (A) Pneumonia Severity Index is superior to CURB-65 rule in assessing risk and recommending hospitalization. (B) CURB-65 assesses BUN in the blood, while Pneumonia Severity Index assesses creatinine. (C) If the calculated CURB-65 rule score is 1, outpatient treatment can be considered. (D) If the calculated Pneumonia Severity Index is class II, outpatient treatment is recommended.

Output: B


Instruction: The patient was unconscious after a severe blow to the head. He had large hematomas on his forehead and top of the head, and blood in his ears and nose. Neurological examination revealed bilateral pinpoint pupils, decorticate rigidity, and positive Babinski's signs on both sides. Which of the following is the most likely cause of this injury?

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

Output: A


Instruction: A tourist was bitten on the right lower limb by an unknown fish while diving in Kenting. Which of the following treatments is less appropriate?

Input: (A) Apply topical Lidocaine for pain relief. (B) Soak the affected limb in room temperature water at 20℃ to 30℃. (C) Wash the wound with seawater. (D) Take Fluoroquinolone orally.

Output: B


Instruction: A 2.5-month-old male baby, born at full term, was brought to the emergency department by his parents because of vomiting for four days. Which of the following statements is more appropriate?

Input: (A) Upper GI tract contrast study can help with differential diagnosis. (B) If the vomitus has bile color, congenital pyloric stenosis should be considered. (C) If it is congenital pyloric stenosis, the patient is prone to dehydration and is prone to acidosis in the early stages of the disease. (D) If abdominal ultrasound reveals congenital pyloric stenosis, the patient should be referred to the surgical department for emergency surgery.

Output: A


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

Input: (A) If an abscess needs to be drained, routine bacterial culture is required. (B) It contains both aerobic and anaerobic bacteria, and antibiotics must be given routinely. (C) Routine X-rays are required to rule out foreign bodies or fractures. (D) During drainage, the nail does not need to be completely removed, partial removal is sufficient.

Output: D


Instruction: Which of the following statements is less appropriate for acute lower back pain?

Input: (A) If the patient's medical history and physical examination do not show obvious risk factors, conservative treatment can be used and no diagnostic tests are required in the emergency department. (B) If the patient has urinary retention of more than 500 ml, he or she should be referred to a neurosurgeon for follow-up examinations. (C) Neurogenic claudication will improve with extending the spine and worsen with forward flexing. (D) If symptoms of Cauda equina syndrome are present, urinary retention is most common.

Output: C


Instruction: Which of the following is more suitable for emergency thoracotomy?

Input: (A) A 75-year-old male was stabbed in the left chest with a utility knife by a neighbor. He was sent to the hospital and had an asystole. E-FAST showed no pericardial effusion. (B) A 39-year-old female, 24 weeks pregnant, was stabbed in the left chest with a kitchen knife. She became PEA after entering the emergency room. (C) A 57-year-old male was thrown out of the car in a car accident. He had a deep laceration on his chest and bubbles continued to come out of the wound. The scene was an asystole. (D) A 25-year-old female was in a motorcycle accident. She had an obvious large right chest contusion. She had no spontaneous heartbeat and breathing from the scene to 20 minutes after being sent to the hospital.

Output: B


Instruction: The patient has long-term hip pain and may suffer from Paget's Disease. Which of the following tests is more appropriate?

Input: (A) Serum calcium concentration. (B) Serum vitamin D concentration. (C) Serum alkaline phosphatase concentration. (D) Serum parathyroid hormone concentration.

Output: D


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

Input: (A) The patient's mean arterial pressure (MAP) is 164 mmHg and the cerebral perfusion pressure (CPP) is 78 mmHg. (B) The patient's mean arterial pressure is 180 mmHg and the CPP 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 will cause the Cushing reflex. , including high blood pressure, bradycardia and shallow breathing.

Output: A


Instruction: A 70-year-old man was bitten on his right foot by an unknown snake while picking bamboo shoots in the mountains. Which of the following treatments is less appropriate?

Input: (A) If there is no local swelling, but there is local numbness or muscle weakness, you can consider injecting antivenom. (B) If there is local swelling, tissue necrosis or neurological symptoms, you can consider injecting antivenom. (C) If there is local swelling, obvious bruising, a small amount of blood blisters, and the coagulation function is generally normal, you can consider injecting antivenom. (D) If there is local swelling, obvious bruising, multiple blood blisters, PT and APTT is prolonged, and platelets are significantly decreased. Consider administering snake venom serum.

Output: C


Instruction: A 25-year-old HIV male has coughed for a week and has a mild fever. He comes to the hospital for treatment. X-ray shows infiltration of the right upper lung, which is suspected of pulmonary tuberculosis. Which of the following treatment statements is more appropriate?

Input: (A) Interferon γ release assays (IGRAs) are helpful for diagnosis. (B) Patients are more likely to see tuberculosis bacteria in sputum smears due to immunodeficiency. (C) The diagnostic sensitivity of the nuclear acid amplification test (NAAT) is higher than that of sputum smears. (D) No diagnosis is required. Empirical anti-tuberculosis drugs should be given in the emergency department first, and then outpatient follow-up should be arranged.

Output: C


Instruction: A 78-year-old male with a history of hypertension and arrhythmia complained of blood-streaked cough for the past two days and coughed up about 600 mL of blood half an hour before visiting the emergency department. The patient was conscious but weak, with 22 breaths/min, blood pressure 86/46 mmHg, and heart rate 137 beats/min but irregular. Chest X-ray showed infiltration in the left lower lung field. Which of the following statements is more appropriate?

Input: (A) Give continuous positive pressure oxygen to correct hypoxia. (B) Inform the thoracic surgeon to perform an emergency thoracotomy. (C) Insert a large-caliber endotracheal tube deep into the right mainstem bronchus. (D) A fiberoptic bronchoscope is more suitable for hemostasis than a rigid bronchoscope.

Output: C


Instruction: In summer, the beach is always full of people playing in the water. Which of the following emergency patients should be treated appropriately?

Input: (A) An 8-year-old boy fell on a reef and suffered a 5-cm laceration on his left calf. He was sutured in the emergency room. (B) A 24-year-old woman was stung by a jellyfish on her right calf. She was first given ice to relieve the pain. (C) A 30-year-old man stepped on a sea urchin and had several spines inserted into the sole of his foot. He was given local anesthesia to remove the spines. (D) A 42-year-old woman was stung by a jellyfish on her left forearm. She applied glacial acetic acid to the local wound.

Output: C


Instruction: Which of the following is more appropriate for the treatment of trauma during pregnancy?

Input: (A)Because pregnant women may begin to show signs of shock when their fluid loss is relatively small, the amount of fluid infusion for resuscitation should be reduced to 50-75% of the normal level. (B)If a pregnant woman's heart stops for more than 7 minutes and the fetus is older than 24 weeks, an emergency cesarean section should be considered. (C)The order of primary assessment for pregnant women is different from that for non-pregnant women, and circulation should be placed first. (D)If the pH value of vaginal secretions of a pregnant woman is 7 at the time of trauma, it is reasonable to suspect that the pregnant woman has broken water.

Output: D


Instruction: A gangster attacked passers-by with a sharp knife. Four stabbed victims with stable vital signs were sent to the emergency room. Which of the following is less appropriate?

Input: (A) A puncture wound on the back of the neck, no neurological symptoms, do not use a neck collar to fix the neck to avoid covering up changes in the neck injury. (B) A puncture wound next to the navel, it is recommended not to explore the wound in the emergency department. (C) Two puncture wounds on the back of the waist, it is not recommended to explore the posterior waist wound in the emergency department. (D) A puncture wound on the right chest, the wound leaks gas with breathing, it is not recommended to place a chest tube for drainage from the wound.

Output: B


Instruction: A 4-year-old girl developed a persistent foreign body sensation after eating chicken. The parents tried to let the patient drink water, but it caused severe coughing. Which of the following statements is more appropriate?

Input: (A) If there is food obstruction in the esophagus, the esophageal wall can secrete mucus, which can relieve the obstruction by itself after lubrication. There is no need to force yourself to drink water to avoid choking. (B) In the physiological and anatomical structure of the esophagus, adults have three strictures; children are smaller and have four strictures. (C) If the medical history clearly shows that it is a protein obstruction, consider taking protein enzymes to soften the meat mass. (D) If imaging examinations reveal suspected small amounts of bone fragments in the esophageal food mass, a gastroscopy should be arranged within 24 hours.

Output: D


Instruction: A 38-year-old woman presents to the emergency department with a one-week history of pain in the anterior right thigh that is aggravated by tight clothing and exercise. She denies any trauma or surgery to the area. Which of the following is the most likely diagnosis?

Input: (A) Lateral femoral cutaneous nerve entrapment. (B) Obturator nerve entrapment. (C) Ilioinguinal nerve entrapment. (D) Piriformis syndrome.

Output: A


Instruction: A 66-year-old male with a history of rheumatoid arthritis and a mitral valve replacement presents to the emergency department with fever, malaise, and painless erythema on his hands. He has no history of injecting drugs. His temperature is 38.5°C, his blood pressure is 130/80 mmHg, and his heart rate is 95 beats/min. Echocardiography shows no specific abnormalities, and one of three blood cultures showed Streptococcus bovis. Which of the following statements is more appropriate?

Input: (A) According to the Modified Duke diagnostic criteria, this is definite endocarditis. (B) Streptococcus bovis is the most common endocarditis. (C) This patient's rash is an immunologic phenomenon called Osler's nodes. (D) Vancomycin can be used in combination , Gentamicin and Rifampin.

Output: D


Instruction: Which of the following statements about children swallowing foreign bodies is less appropriate?

Input: (A) X-rays are usually unable to detect foreign bodies in the respiratory tract, so routine irradiation is still necessary. (B) If a button battery is swallowed and is already in the stomach without any symptoms, it can be observed and followed up first. (C) If the anteroposterior film shows a coin and the coin is shown on the disc side instead of the side, the coin is presumed to beIt is stuck in the esophagus rather than the trachea. (D) If it is found that the esophagus is blocked by a piece of meat and there are no obvious complications, it can be observed first. If there is no improvement after more than 12 hours, proteolytic enzymes can be fed.

Output: D


Instruction: The right forearm was sprayed with 50% hydrofluoric acid (HF) about 3% of the body surface area. Which of the following treatments is more appropriate?

Input: (A) Calcium chloride (CaCl 2) injection is given through a central venous catheter. (B) Directly immerse the right arm in a calcium gluconate solution. (C) Calcium gluconate is dripped into the right elbow vein. (D) Inject calcium chloride (CaCl 2) solution into the exposed area for infiltration therapy.

Output: A


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

Input: (A) Patients over 35 years old are less likely to develop compartment syndrome. (B) If there is no history of trauma, this diagnosis can be ruled out. (C) When the difference between diastolic blood pressure and compartment pressure is less than 30 mmHg, fasciotomy should be performed. (D) If compartment syndrome has occurred for more than 48 hours, fasciotomy should not be performed.

Output: B


Instruction: A 51-year-old male with a history of colorectal cancer sought medical attention due to painful defecation and fever. Physical examination revealed tenderness in the perianal tissues. Which of the following statements is more appropriate?

Input: (A) First confirm whether the patient's immunity has been weakened by chemotherapy. It is not recommended to rashly perform anal examination. (B) Anorectal abscesses are commonly infected by a single bacterial species, and most of them are anaerobic bacteria. (C) The location of anorectal abscesses varies, among which pelvirectal abscesses are the most common. (D) If the patient is found to have a simple peripheral rectal abscess, drainage can be performed in the emergency department. A puncture drainage should be arranged in the emergency department.

Output: A


Instruction: Which of the following treatments for patients with salicylic acid poisoning and severe metabolic acidosis is more appropriate?

Input: (A) Oral sodium bicarbonate (NaHCO₃) is as effective as intravenous injection. (B) Hemodialysis and hemoperfusion can both remove salicylic acid. (C) For patients with endotracheal intubation, hyperventilation is given to achieve respiratory alkalinity to maintain normal blood pH. (D) Clinically, it is easy to cause hyperglycemia, so supplementation with glucose intravenous drips should be avoided.

Output: B


Instruction: Which of the following descriptions of trauma to pregnant women is less appropriate?

Input: (A) Pregnant women will only experience shock symptoms when their overall circulating blood volume increases and bleeding exceeds 30% of their circulatory volume. (B) The most effective way to diagnose placental abruption is when fetal heart rate monitoring shows uterine contractions > 3 times/min. (C) Ultrasound can be used to diagnose uterine rupture. (D) For pregnant women older than 20 weeks, it is recommended to conduct fetal heart rate monitoring for 4 to 6 hours continuously.

Output: C


Instruction: A 45-year-old male presents with asthma. He is conscious and afebrile. His SpO₂ is 89% on examination. He is breathing 32 times/min with accessory muscles. Chest X-ray shows no obvious abnormalities. He has been treated with albuterol and ipratropium inhalers but with poor results. His symptoms have not improved after IV methylprednisolone. Which of the following treatments is more appropriate?

Input: (A)Aminophylline 250 mg IV infusion for about 20 minutes. (B)Combined use of nebulized magnesium has a good effect. (C)Magnesium sulfate 10 g IV infusion for about 30 minutes. (D)Formoterol has a better affinity for β2 receptors and should be considered.

Output: B


Instruction: A 65-year-old male comes to the clinic for swallowing difficulties for several hours. Double tongue sign can be seen in the mouth. Which of the following descriptions is more appropriate?

Input: (A) The disease may progress rapidly, so early intubation should be considered. (B) Sedatives and muscle relaxants should be given appropriately during intubation to relieve patient discomfort and increase the success rate. (C) If there is no respiratory distress, consider not intubating first and use antibiotics for 3 days. (D) If there is difficulty in expectoration, consider giving expectorant inhalants first and then observe whether there is improvement.

Output: A


Instruction: A pregnant woman with eclampsia needs intubation. Which of the following descriptions is more appropriate?

Input: (A)The ventilator settings are the same as those for non-pregnant women, with PaCO₂ set at 28~35 mmHg. (B)The choice of endotracheal tube is similar to that for general patients. (C)Due to the weight gain of pregnant women, the dosage of drugs should be adjusted when using RSI. (D)After pre-oxygenation, it is not necessary to continue to use a nasal cannula for oxygen administration.

Output: A


Instruction: Which of the following descriptions of patients with vertigo is more appropriate?

Input: (A)The HINTS (Head Impulse test, Nystagmus, and Test of Skew deviation) test is applicable when the vertigo stops and there is no nystagmus. (B)New onset of hearing loss is more likely to be peripheral vertigo. (C) The Epley maneuver can diagnose benign paroxysmal positional vertigo. (D) When performing the Head Impulse Test, patients with peripheral vertigo often experience catch up saccades.

Output: D


Instruction: Which of the following descriptions is less appropriate regarding the use of ultrasound to measure the optic nerve sheath to monitor intracranial pressure?

Input: (A) Because ultrasound imaging is better at 5 mm behind the eyeball, the diameter of the nerve sheath is measured at this location. (B) When the diameter of the optic nerve sheath reaches 6 mm, the patient's intracranial pressure is more than 70% greater than 20 mmHg. (C) Eyeball trauma, optic neuritis, etc. may cause the diameter of the optic nerve sheath to increase. (D) This examination is not recommended for patients with suspected eyeball rupture.

Output: A


Instruction: A 45-year-old female with a medical history of myasthenia gravis seeks emergency treatment for shortness of breath. Which of the following statements and treatments is less appropriate?

Input: (A) The most common complaints may be weakness of the limb muscles, neck extensors, and facial muscles. (B) Considering whether there is a myasthenic crisis, acetylcholinesterase inhibitors such as pyridostigmine should be given as soon as possible. (C) If pneumonia is present, aminoglycosides or quinolone should be avoided as antibiotics to avoid worsening of the condition. (D) If the patient has respiratory failure and requires intubation, succinylcholine should be avoided and rocuronium can be used.

Output: D


Instruction: A 33-year-old female, married with children, was transferred to the emergency department due to unexplained vaginal bleeding. Which of the following is more appropriate?

Input: (A) The possibility of pregnancy should be considered for all women of childbearing age, unless the patient has a uterine contraceptive device. (B) If the patient is pregnant, vaginal bleeding is less related to pregnancy and other causes should be considered. (C) If the bleeding occurs between menstrual periods, taking birth control pills may be a common cause. (D) NSAIDs can relieve pain during menstrual bleeding, but they cannot reduce bleeding.

Output: C


Instruction: An 80-year-old male has a history of prostatic hypertrophy and has been using a long-term silicone urinary catheter for more than a year. He has been changing it regularly, and the last time he changed the catheter was 30 days ago. Which of the following statements is less appropriate?

Input: (A) If this patient comes to the clinic with a complaint of upper abdominal pain, without fever or other symptoms, a urine test showing pyuria and a urine culture showing gram-positive cocci would diagnose a urinary tract infection. (B) When a patient with a long-term urinary catheter develops a urinary tract infection, multiple bacterial species can usually be cultured. (C) If this patient is diagnosed with a urinary tract infection, Morganella morganii and Proteus mirabilis are common pathogens. (D) If the patient is diagnosed with a urinary tract infection, it is recommended to remove the catheter or replace it with a new one.

Output: A


Instruction: Regarding the use of medications during recovery, which of the following has the highest risk of pregnancy?

Input: (A) Epinephrine. (B) Lidocaine. (C) Dobutamine. (D) Magnesium sulfate.

Output: D


Instruction: A 36-year-old female has a history of lupus erythematosus, which is controlled by regular medication in the outpatient clinic. Today, she had a severe headache and blurred vision. She was later sent to the emergency room because of a seizure. Her blood pressure was 210/100. mmHg, fundus examination showed no mastoid edema, and CT of the brain showed no special abnormalities. Which of the following is more appropriate for differential diagnosis?

Input: (A)Intracranial hypotension. (B)Occipital neuralgia. (C)Posterior reversible encephalopathy syndrome. (D)Pseudotumor cerebri syndrome.

Output: C


Instruction: A 35-year-old female with no history of hypertension or coronary artery disease. She has had symptoms such as malaise, fatigue, fever, loss of appetite, and nausea for 3 months. She has limb weakness during activities, which is more obvious in the upper limbs; heart auscultation is normal, but the pulsation of one brachial artery is weakened. Which of the following diagnoses of arterial ischemia is more appropriate?

Input: (A)Thromboangiitis obliterans (Buerger's disease). (B)Takayasu's arteritis. (C)Hypothenar hammer syndrome. (D)Raynaud's disease.

Output: B


Instruction: Which of the following fracture scenarios is least likely to be child abuse?

Input: (A)A four-year-old boy has a left humeral metaphyseal fracture. His father says it was caused by crossing the street while holding hands. (B)An 11-month-old baby has a right femur fracture. His mother says it was caused by accidentally falling from the crib. (C)A three-year-old boy has a non-displaced spiral fracture of the right distal tibia. His father cannot explain the cause. (D) A five-year-old boy fractured the 7th and 8th ribs on his left back. His mother said it was caused by a fall while running.

Output: C


Instruction: Which of the following statements is more appropriate regarding the GRIEV_ING protocol for informing of death?

Input: (A) G stands for Gathering, which means gathering family members in a quiet environment for discussion. (B) R stands for Respect, which means respecting the opinions of each family member during communication with family members. (C) E stands for Empathy, which means considering the emotions of family members and showing empathy. (D) V stands for Vacancy, which means stopping talking and giving family members some time to deal with grief.

Output: A


Instruction: According to the SALT triage algorithm, which of the following is less appropriate?

Input: (A) First, divide the patients into three categories and distinguish the assessment priorities. (B) Patients who cannot walk but can wave their arms are the first priority for assessment. (C) If tension pneumothorax is found, chest puncture and decompression should be performed as soon as possible. (D) If the patient is in poor consciousness but may survive, the patient's triage is red.

Output: B


Instruction: Which of the following descriptions of chest trauma is less appropriate?

Input: (A) About 50% of rib fractures are not obvious on chest X-ray. (B) When the first and second rib fractures are found, attention should be paid to whether there is combined heart, trachea, or aorta injury. (C) Tracheal injury usually occurs near the carina. (D) Severe chest trauma is often accompanied by aspiration pneumonia, and antibiotics are recommended to prevent infection.

Output: D


Instruction: A 62-year-old male with a history of alcoholic cirrhosis and ascites, and normal renal function in the past, has a fever for 5 days accompanied by nausea, vomiting, and oliguria, and seeks treatment in the emergency department. The body temperature is 38.8℃, and the blood test report shows that the renal function has significantly deteriorated. The creatinine value is 3 times the upper limit of the normal value of the test. Which of the following statements is more appropriate?

Input: (A) This patient may be diagnosed with hepatorenal syndrome, which is often associated with spontaneous bacterial peritonitis. (B) If the patient has no abdominal pain or tenderness, spontaneous bacterial peritonitis can be ruled out. (C) Renal cytology usually shows abnormal findings. (D) Ascitic fluid analysis with WBC > 100/mm³ and neutrophils > 50% is diagnostic of spontaneous peritonitis.

Output: A


Instruction: A 46-year-old woman receiving peritoneal dialysis presents to the emergency department with acute abdominal pain. The peritoneal dialysis fluid analysis is as follows: WBC count 182/mm³, Neutrophil 64%, Mononuclear 36%, Protein <0.1 g/dL. Which of the following statements is less appropriate?

Input: (A) Physical examination should pay attention to whether there is abdominal wall hernia, and surgical treatment is required if necessary. (B) Consider adding heparin to the peritoneal dialysis fluid to reduce the production of fibrin clot. (C) The most common bacterial species cultured in peritoneal dialysis fluid is Streptococcus species. (D) If the Gram stain of the peritoneal dialysis fluid shows GNB, the third-generation cephalosporin or amionoglycoside drugs are selected for empirical antibiotic treatment.

Output: C


Instruction: Which of the following statements about conjunctivitis in children is less appropriate?

Input: (A)Swelling of the preauricular lymph nodes is common in viral infections. (B)Bacterial conjunctivitis can be treated without oral antibiotics. (C)If combined with otitis media, it is often caused by H. influenza. (D)Bacterial infections often involve Staphylococcus aureus (S. aureus) and Pseudomonas aeruginosa (P. aeruginosa).

Output: D


Instruction: Based on the 2020 AHA Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Regarding pediatric airway oxygen resuscitation, which of the following is less appropriate?

Input: (A) For pediatric resuscitation in all situations, the recommended rate of auxiliary ventilation is increased to 1 ventilation every 2-3 seconds (20-30 ventilations per minute). (B) Cricocartilage compression is no longer recommended for routine intubation. (C) For patients of any age who require intubation, the use of cuffed endotracheal tubes (ETTs) is no longer recommended to reduce the frequency of tracheal compression injuries. (D) For patients with arterial catheters, the feedback generated by continuous measurement of arterial blood pressure can improve the quality of CPR.

Output: C


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

Input: (A) For patients suspected of having open-globe injury, the initial treatment should be to cover the eyeball to protect it, and avoid forcibly opening the patient's eyes for examination if the patient is unable to cooperate. (B) For patients suspected of having open-globe injury, if the eyelids are swollen and a detailed ophthalmic examination cannot be performed, the examination can be postponed until the surgery. (C) For patients with intraocular foreign bodies, CT is a necessary examination. (D) Among intraocular foreign bodies, copper is the most toxic and should be removed surgically as soon as possible.

Output: C


Instruction: A 36-year-old male has a steel bar puncture wound in the right thigh. Which of the following is less appropriate?

Input: (A) During the primary assessment, if the wound is bleeding, the first thing to consider is local pressure to stop the bleeding or use a tourniquet. (B) During the secondary assessment, the patient should be assessed for signs of arterial injury, such as absent pulse, cold distal limbs, etc. (C) If the ankle-brachial index is > 0.9, vascular injury should be considered. (D) If the femoral nerve is injured, knee extension can be tested to assess function.

Output: C


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

Input: (A)The size measured on the X-ray image is mostly smaller than the actual size, and the difference may be up to 20%. (B)Urinary tract stones are the most commonly misdiagnosed diagnosis of ruptured abdominal aortic aneurysms. (C)Urinary tract stones, acute pyelonephritis, and acute renal infarction may all present with back pain and hematuria. (D)Hypertension, diabetes, unilateral nephrectomy, and renal transplantation are all risk factors for acute renal failure in patients with urinary tract stones.

Output: A


Instruction: The patient complains of stumbling while walking. If it is suspected to be a sign of intimate partner violence, which of the following is less appropriate?

Input: (A)Causes multiple bruises on the body and trunk. (B) Bruising and hematoma of both knees. (C) Chronic pelvic pain with multiple visits to the emergency room. (D) Multiple bruises on the neck and forearms.

Output: B


Instruction: Which of the following is the most important feature of adhesive capsulitis?

Input: (A) Localized tingling in the shoulder. (B) Limited range of active and passive motion. (C) Complete loss of sensation in the upper arm. (D) Ultrasound shows increased blood flow.

Output: B


Instruction: Which of the following is less appropriate for trauma in the elderly?

Input: (A) Rib fractures are more likely to occur due to chest trauma, followed by pneumonia and respiratory failure, and hospitalization should be recommended. (B) If the X-ray is normal but a hip fracture is suspected, further imaging examination is recommended. (C) People with head trauma are more likely to have epidural hemorrhage than young people. (D) If a person taking anticoagulants has a head trauma and has symptoms or not, it is recommended to arrange a head CT scan.

Output: C


Instruction: A 65-year-old male underwent tracheotomy for hypopharyngeal cancer 2 weeks ago. Today, he was hospitalized for mild bleeding in the tracheotomy tube. During the observation period, he suddenly had heavy bleeding. Which of the following descriptions is less appropriate?

Input: (A) If bleeding continues, you can apply pressure on the trachea and slowly pull the tracheotomy tube outward to stop the bleeding. (B) If bleeding continues, you can consider removing the tracheotomy tube, inserting an endotracheal tube through the mouth, and placing the balloon as low as possible below the bleeding point. (C) If bleeding continues, a finger can be placed along the tracheotomy and pressed on the innominate artery behind the sternum to help stop the bleeding. (D) The patient may have a tracheoinnominate artery fistula due to excessive cuff pressure. The cuff should be deflated immediately.

Output: D


Instruction: A 65-year-old male was sent to the emergency department 30 minutes ago because of right upper limb weakness, headache, and slurred speech. On admission, his temperature was 36°C, his heart rate was 85 beats/min, his respirations were 20 breaths/min, and his blood pressure was 201/145 mmHg. Which of the following statements is less appropriate?

Input: (A) PCA infarction is suspected when the patient has a concurrent neurological symptom of contralateral homonymous hemianopia. (B) Before a thrombolytic is administered, the patient's blood pressure must be controlled to SBP ≤ 185 mmHg and DBP ≤ 110 mmHg. (C) Regardless of whether the patient receives a thrombolytic, an antiplatelet agent such as aspirin should be given immediately. (D) Intra-arterial embolectomy should be performed within 6 hours of symptom onset.

Output: C


Instruction: Which statement about acute otitis externa is more appropriate?

Input: (A) Ofloxacin ear drops are safe for patients with a ruptured tympanic membrane. (B) Methicillin-resistant S. aureus is a common cause of malignant otitis externa. externa) is the most common infecting bacteria. (C) Acetic acid ear drops are contraindicated in otitis externa. (D) Antifungal ear drops are not recommended if fungal infection is suspected.

Output: A


Instruction: Which of the following statements is more appropriate regarding the treatment of nasal bone fractures?

Input: (A) Routine X-rays are performed to assist in diagnosis, and CT scans are performed in combination with other facial fractures. (B) Hematoma of the nasal septum can be observed first, and then drained if it has not been absorbed. (C) The treatment principles for nasal bone fractures combined with lacerations are different from those for other open fractures. (D) Nose deformity requires consultation with an ENT department, and evaluation is conducted after the swelling subsides within 6 to 10 days.

Output: D


Instruction: Which of the following descriptions of blast injuries is more appropriate?

Input: (A) If the patient's injured eye initially has poor vision, the prognosis is poor. (B) The condition of the eardrum injury can be used to assess the severity of the blast injury. (C) Patients with intra-abdominal organ injuries due to explosions are very close to the source of the blast. (D) Cardiac arrhythmia is the most common cause of death in blast injuries.

Output: C


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

Input: (A) Nonsteroidal anti-inflammatory drugs (NSAIDs) can be used as the first choice of analgesics during biliary colic attacks. (B) Ultrasound diagnosis of cholecystitis has a high specificity for the detection of gallbladder wall thickening and peri-gallbladder effusion. (C) The mortality rate of emphysematous cholecystitis is lower than that of general cholecystitis. (D) Acalculous cholecystitis is less likely to have complications than calculous cholecystitis.

Output: A


Instruction: Which of the following statements about transfusion-associated graft-versus-host disease is less appropriate?

Input: (A) If this disease occurs, the mortality rate is extremely high. (B) The use of leukocyte-reduces products can reduce the chance of occurrence. (C) Patients with congenital immunodeficiency are at high risk for this disease. (D) Patients with Hodgkin's disease who have remitted are still at high risk.

Output: B


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

Input: (A) EKG may show left ventricular hypertrophy. (B) If the patient develops pulmonary edema, the patient's blood pressure should be closely monitored when using nitrates or diuretics. (C) Classic triad aortic stenosis is characterized by wheezing, chest pain, and syncope. (D) It is often accompanied by endocarditis, and prophylactic antibiotics are required.

Output: D


Instruction: Which of the following tools is inappropriate for pregnant women or postpartum women to diagnose or rule out pulmonary embolism and venous embolism?

Input: (A) Breastfeeding does not need to be stopped after a standard pulmonary artery computed tomography. (B) Breastfeeding must be stopped for 12 hours after a ventilation-perfusion scan. (C)Magnetic resonance imaging without contrast has reliable sensitivity and specificity for diagnosing pelvic venous embolism. (D)Pulmonary perfusion examination can reduce fetal radiation exposure compared with standard pulmonary artery computed tomography.

Output: D


Instruction: Which of the following descriptions of hip trauma in the elderly is less appropriate?

Input: (A)Shenton line is an unreliable imaging basis for diagnosing femoral neck fractures. (B)For femoral neck fractures, skeletal traction can be used to stabilize the affected area first. (C)If the X-ray is normal but the patient is still in pain and unable to move, CT or MRI should be arranged. (D)MRI The sensitivity for diagnosing hip fractures is close to 100%.

Output: B


Instruction: An 80-year-old female with a history of arrhythmia, hypertension, and heart failure is now seen in the emergency department with wheezing and orthopnea. Which is more appropriate?

Input: (A)Chest ultrasound with more than one B line in the same image is highly specific for diagnosing pulmonary edema. (B)High-dose nitroglycerin is helpful for the acute treatment of hypertensive heart failure, but may cause hypotension in the presence of aortic insufficiency. (C)Morphine is used in patients with acute heart failure to dilate blood vessels, reduce the chance of endotracheal intubation, and reduce mortality. (D)β-Blockers can reduce sympathetic nerve activity, lower heart rate, and reduce mortality in patients with acute heart failure.

Output: D


Instruction: Which of the following emergency treatments is less appropriate for patients with mood disorders?

Input: (A)For patients with mild depression who do not require hospitalization, SSRI (selective serotonin reuptake inhibitors) drug treatment may be considered. (B) A suicide risk assessment is required to determine the appropriate next steps. (C)When a patient is agitated, treating the agitation takes precedence over fully identifying its cause. (D)For acute mania, atypical antipsychotics such as Ziprasidone cannot be used as a single prescription and must be used in combination with other mood stabilizers (Lithium, Valproic acid).

Output: D


Instruction: Which of the following descriptions of spinal cord injury is less appropriate?

Input: (A) Anterior cord syndrome is common in direct anterior spinal cord compression or cervical flexion. Motor function and thermal and pain sensation below the injured site disappear, but proprioception and vibration sensation are retained. Even with appropriate treatment, the prognosis is still poor. (B) Central cord syndrome is common in cervical degeneration combined with hyperextension. It mainly manifests as upper limb pain, decreased temperature sensation, and decreased limb strength, with mild lower limb symptoms. After appropriate treatment, the prognosis is good. (C) Brown-Séquard syndrome is common in spinal puncture or lateral compression. Symptoms include loss of proprioception and vibration sensation, limb weakness on the same side below the injured site, and loss of pain and temperature sensation on the opposite side. Even after appropriate treatment, the prognosis is still poor. (D) Cauda equina syndrome is common in transverse fractures of the sacral vertebra. The clinical manifestations are mainly abnormal bowel and bladder function, abnormal sensation in the perineum and inner thigh of the buttocks, combined with varying degrees of abnormal sensation and limb weakness in the lower limbs.

Output: C


Instruction: A 50-year-old female syncope occurred at work. She is now fully conscious but has no recollection of the event. Which of the following statements is more appropriate for the patient's assessment?

Input: (A) If there is no complete loss of consciousness, the risk is lower. (B) Neurological, cardiac, and reflex mediated syncope have a higher risk of death. (C) Patients with prodromal symptoms such as dizziness, cold sweats, and paleness before syncope have a lower risk than patients with unexplained syncope. (D) Most drug-induced syncope is caused by suppression of consciousness.

Output: C


Instruction: A 50-year-old male with no chronic diseases found himself dizzy and nauseous when he got up. The symptoms worsened with activity and were relieved by lying down and resting for a while. His temperature was 36°C, heart rate was 70 beats/min, blood pressure was 160/90 mmHg, and blood oxygen concentration was 99%. Initial examination showed no nystagmus. Which of the following treatments is less appropriate?

Input: (A) Ask whether he has headache, neck pain, or other neurological symptoms. (B) Consider giving Diphenhydramine. (C) Consider performing otolith repositioning. (D) Consider performing HINTS plus testing.

Output: D


Instruction: An 80-year-old man was sent to the emergency room because he forgot that he had not eaten recently and thought someone had taken his things. His calculation ability deteriorated, he got lost, and had auditory and visual hallucinations. Which of the following assessments and treatments is less appropriate?

Input: (A) Lewy body dementia often has hallucinations and Parkinson's-like symptoms. (B) Mini-cog screening assessment, after 3 minutes, he recalled the three fruits just mentioned and could only name one, which indicates cognitive impairment. (C) Abnormal behavior is a common reason for dementia patients to be sent to the emergency room. (D) Before diagnosing dementia, it is necessary to first assess whether it affects independent daily activities or is due to delirium, depression and schizophrenia.

Output: B


Instruction: A 55-year-old male worked in Africa and was bitten by mosquitoes. He returned home 10 days ago and has had fever, chills, headache, and muscle aches for 3 days. COVID-19 and dengue antigen rapid screening were negative. Physical examination revealed an enlarged spleen. Which of the following statements is more appropriate?

Input: (A) When the thin-layer blood smear is negative for malaria parasites, a thick-layer blood smear must be performed because the density of malaria parasites may be lower than 100/μL. (B) Because the thin-layer blood smear is negative, if the thick-layer blood smear is negative for malaria parasites, malaria can be ruled out. (C) In more than 90% of cases, the first blood smear test result is positive. (D) The World Health Organization issued a certificate of malaria eradication in Taiwan in 1965, but Anopheles minimus is still prevalent in the mountainous areas of various counties and cities in Taiwan.

Output: C


Instruction: A 67-year-old male with a history of hypertension has no history of hospitalization within a year. He complained of coughing with sputum and intermittent high fever of 39°C in the past two days. He was conscious but weak when he went to the emergency room. His respiratory rate was 26 times/min, his blood pressure was 110/80 mmHg, and his SpO₂ was 96%. Blood tests showed WBC 12,900/uL, CRP 16.88 mg/dL, BUN 34 mg/dL, Creatinine 1.6 mg/dL, and chest X-ray showed consolidation in the right lower lung field. , which of the following statements is less appropriate?

Input: (A) This patient is a case of community pneumonia. (B) Common pathogens are S. pneumoniae, S. aureus, H. influenzae. (C) According to the severity assessment of the CURB-65 index, this patient has moderate pneumonia and is recommended to be hospitalized for observation and treatment. (D) According to the 2018 Taiwan Pneumonia Guidelines, this patient is recommended to be treated with Aztreonam antibiotics.

Output: D


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

Input: (A) If it occurs at rest, carotid artery detachment should be highly suspected. (B) It is defined as a severe headache that occurs suddenly and reaches its maximum intensity within 1 minute. (C) If it is associated with Valsalva maneuve, the most likely diagnosis is acute glaucoma. (D) Cerebral venous thrombosis will not cause this type of headache.

Output: B


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

Input: (A) Metronidazole, which is mainly used to treat anaerobic bacteria, is the first choice of antibiotic. (B) More than 30% of patients require surgical or percutaneous drainage. (C) Transbronchial drainage is less likely to affect the healthy lung. (D) When antibiotic treatment is ineffective, consider percutaneous, transbronchial or open drainage.

Output: D


Instruction: Which of the following statements is inappropriate for the treatment of urinary tract stones?

Input: (A) Giving large amounts of intravenous fluids will not accelerate the passage of urinary tract stones. (B) If the patient is not suitable for nonsteroidal anti-inflammatory drugs (NSAIDs), Narcotics can be used for pain relief, but these drugs cannot promote the passage of urinary tract stones. (C) Calcium channel blockers and alpha blockers can both be used to promote the passage of urinary tract stones. (D) If urinary tract stones are combined with acute urosepsis, hospitalization should be considered.

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) The assessment is: ability to move or walk → breathing → respiratory rate → pulse → consciousness. (B) Triage is divided into four categories: death, immediate evacuation, delayed evacuation, and mild illness. (C) The modified Glasgow Coma Scale is used to assess consciousness. (D) Each patient should receive a detailed secondary assessment.

Output: C


Instruction: 10-year-old boy, abdominal pain combined with abilious vomiting. Blood pressure 85/60 mmHg, heart rate 130 beats/min; arterial gas analysis: pH 7.20, PaCO₂ 30 mmHg, HCO₃ 12 mEq/L, blood biochemistry results: sodium 140 mEq/L, potassium 2.0 mEq/L, chloride 108 mEq/L, glucose 360 mg/dL, BUN 28 mg/dL, ketone bodies in urine. Which of the following descriptions is more appropriate?

Input: (A) The anion-gap is 22 mEq/L. (B) The effective osmolality is 300 mOsm/kg. (C) The most common fatal complication of this disease is pulmonary edema. (D) It is recommended to immediately give 20 mL/kg bolus normal saline plus 0.1 unit/kg bolus insulin.

Output: B


Instruction: Which of the following statements about the treatment of subarachnoid hemorrhage is less appropriate?

Input: (A) Systolic blood pressure should be controlled at 120-160 mmHg. Nicardipine can be considered first. (B) Nitroglycerin can be considered as a second-line drug for patients with high blood pressure that is poorly controlled. (C) Nimodipine can be considered to prevent subsequent vasospasm. (D) Some patients may experience epilepsy, which can be prevented with anti-epileptic drugs.

Output: B


Instruction: Traumatic cerebral hemorrhage is often complicated by brain herniation syndrome. Which of the following statements about this syndrome is more appropriate?

Input: (A) The most common is uncal herniation, which is often caused by a blood clot in the midline of the brain, such as a blood clot in the frontal lobe or occipital lobe. (B) Uncal herniation often compresses the trochlear nerve, blocking the pupillary parasympathetic nerve signal, and clinically manifests as unilateral or bilateral pupil dilation. (C) The clinical symptoms of central herniation are mainly bilateral pupil dilation, bilateral Babinski's positivity and increased muscle tension. (D) The clinical symptoms of cerebellar tonsillar herniation are often bilateral pupil constriction, limb paralysis or sudden death.

Output: D


Instruction: Which of the following is not included in the criteria for determining a stable pneumothorax patient?

Input: (A) Not complicated with hemothorax. (B) Respiratory rate less than 24 times/min. (C) PaCO₂ less than 45 mmHg. (D) Room air oxygen concentration greater than 90%.

Output: C


Instruction: Traumatic shock requires consideration of emergency REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) placement. Which of the following statements is more appropriate?

Input: (A) If chest X-ray shows widening of the diaphragm, REBOA should be placed in zone 3. (B) If pelvic bleeding is suspected, REBOA should be placed in zone 2. (C) If intra-abdominal bleeding is suspected, REBOA should be placed in zone 3. (D) The depth of placement can be referred to the distance from the needle insertion site to the scrotum and navel.

Output: D


Instruction: A 40-year-old male feels dizzy, ear discomfort, and joint pain 2 hours after diving. Which of the following statements is more appropriate?

Input: (A) Ascent may cause barotitis, which may lead to rupture of the eardrum. (B) Using the San Diego Diving and Hyperbaric Organizations Criteria assessment, a score of 3 or above can be diagnosed as arterial gas embolism. (C) Type I decompression sickness can cause joint pain, and in severe cases, limb weakness or numbness. (D) Alternobaric vertigo is usually temporary and does not require special treatment.

Output: D


Instruction: Which of the following statements is more appropriate for the management of patients with temporomandibular dislocation?

Input: (A) Routine X-rays are performed to rule out fractures. (B) Wrist rotation is most commonly used. (C) Temporomandibular dislocation is often posterior. (D) Wrist rotation is more effective than traditional reduction.

Output: D


Instruction: Upper limb trauma is often accompanied by nerve damage. Which of the following statements is less appropriate?

Input: (A) Anterior dislocation is often associated with axillary nerve damage, and the main clinical manifestations are weakness in shoulder abduction and paresthesia. (B) Humerus shaft fracture is often associated with radial nerve damage, and the main symptoms are wrist drop and paresthesia in the dorsal part of the thumb and index finger. (C) Supracondylar fracture is often associated with posterior interosseous nerve damage, which is derived from the median nerve. (D) Olecranon fracture is often associated with ulnar nerve damage, and the main symptoms are inability to abduct the fingers and paresthesia in the ring and little fingers.

Output: C


Instruction: Which of the following should receive a tetanus toxoid injection?

Input: (A) An 8-year-old child with a complete vaccination history suffered multiple abrasions and bruises on his limbs while riding a bicycle. (B) A 78-year-old man suffered minor burns, but had received a tetanus toxoid injection 6 years ago. (C) A 28-week pregnant woman was bitten by a dog, but had received a tetanus toxoid injection 1 year ago. (D) A 23-year-old worker accidentally cut his hand on a piece of glass while cleaning sewage, but had received a tetanus toxoid injection 1 year ago.

Output: C


Instruction: Which of the following statements is more appropriate?

Input: (A) The most common cause of sudden cardiac death in young athletes is coronary artery disease. (B) In Brugada syndrome, abnormalities in the limb leads are common. (C) In patients with hereditary channelopathies, sudden death often occurs during exercise. (D) Severe left ventricular dysfunction combined with an ejection fraction ≤ 35% requires consideration of implantable cardioverter-defibrillator placement.

Output: D


Instruction: A 50-year-old male drank home-brewed rice wine and went to the emergency room 10 hours later due to dizziness, nausea, and blurred vision. Vital signs: temperature 36.8℃, breathing 18 times/min, heart rate 92 times/min, blood pressure 169/85 mmHg, test report: Na 142 mEq/L, Cl 109 mEq/L, BUN 14 mg/dL, Glu 126 mg/dL, Ketone body: negative, Ethanol 9 mg/dL, Blood osmolality 320 mOsm/Kg, and arterial blood ABG pH 7.29, PCO₂ 25.4 mmHg, HCO₃ 12.5 mEq/L , Based on the above data, it is judged that the case may have accidentally ingested methanol. What is the most likely methanol concentration in the case's blood at this time?

Input: (A)20 mg/dL. (B)40 mg/dL. (C)70 mg/dL. (D)150 mg/dL.

Output: C


Instruction: A 68-year-old male was diagnosed with acute exacerbation of chronic obstructive pulmonary disease and hypercapnic respiratory failure. He was admitted to the intensive care unit after emergency intubation. The PCR test for COVID-19 was negative. After three days of staying in the emergency room, the patient developed intermittent decreases in blood oxygen concentration and increased endotracheal tube secretions. Follow-up chest X-ray showed new infiltration in the right lower lobe. Which of the following antibiotics is more appropriate?

Input: (A)Ceftriaxone and metronidazole. (B)Cefepime and vancomycin. (C)Levofloxacin and metronidazole. (D)Piperacillin-tazobactam.

Output: B


Instruction: A 25-year-old male was found unconscious at home by his family. The last time he was normal was unclear. His past medical history included schizophrenia, and he took medication at the clinic. When he arrived at the hospital, his consciousness was E1M4V1, his temperature was 39℃, and the rest of his vital signs were normal. Which of the following statements is more appropriate?

Input: (A) This patient may have symptoms caused by infection or drugs, and there is no need to rule out organic lesions. (B) The most important treatment for neuroleptic malignant syndrome is to give the BZD antagonist Flumazenil. (C) If the patient is taking Clozapine , clinical manifestations show muscle rigidity, and the patient is more likely to have serotonin syndrome. (D) For this patient, a nondepolarizing muscle relaxant should be preferred for intubation.

Output: D


Instruction: Which of the following descriptions of disseminated intravascular coagulation (DIC) is less appropriate?

Input: (A) The primary goal is to treat the underlying cause of DIC. (B) If there is no evidence of bleeding, low molecular weight heparin should be used to prevent thrombosis. (C) It causes a decrease in platelet count and an increase in fibrinogen/D-dimer/FDP. (D) The difference from severe liver disease is that D-dimer in patients with liver disease will not increase significantly.

Output: C


Instruction: For obese patients with BMI ≧ 30 kg/m2, the patient's weight should be considered when administering the drug to adjust the appropriate drug dosage. For which of the following drugs, the actual body weight (total body weight) of the patient should be used to calculate the dosage?

Input: (A) Enoxaparin. (B) Gentamicin. (C) Hydrocortisone. (D) Levofloxacin.

Output: A


Instruction: A 55-year-old female fainted while working and lost consciousness briefly. She was taken to the emergency room by a colleague. Which of the following judgments based on the medical history is less appropriate?

Input: (A) If the fainting is caused by arrhythmia, it is usually sudden and there are no premonitory symptoms. (B) If it occurs slowly and gradually, combined with specific circumstances, vasovagal syncope should be suspected. (C) Postural hypotension causes fainting that only occurs within 3 minutes after standing up from a changed position. (D) When symptoms such as tongue biting and urinary incontinence occur, it should be considered an epileptic seizure rather than a simple fainting.

Output: C


Instruction: A pedestrian is hit by a car from the side. He is conscious when he arrives at the hospital, and his blood pressure is 75/45 mmHg. Physical examination reveals pelvic tenderness. E-FAST examination shows no pneumothorax, no pericardial effusion, and no peritoneal effusion. X-ray shows a lateral compression fracture of the left pelvis. Which of the following is inappropriate?

Input: (A) The use of a pelvic fixation belt will help reduce the amount of blood loss for this injury. (B) After active fluid resuscitation and blood transfusion, the blood pressure is 80/50 mmHg. The next step is to perform angiographic embolization. (C) The pelvic fracture is more likely to cause shock due to bleeding from the superior gluteal or obturator arteries. (D) In conscious patients, physical examination has a sensitivity of greater than 90% for diagnosing pelvic fractures.

Output: A


Instruction: A 75-year-old male. His family said that the patient had just fallen to the ground while sitting on a chair to rest and lost consciousness for about 1 minute. After waking up, he complained of pain in his lower back and back of the head. The patient said that he had palpitations before losing consciousness. The body temperature was 36℃, the heart rate was 80 beats/min, the blood pressure was 120/80 mmHg, and the blood oxygen concentration was 98%. Which of the following statements is more appropriate?

Input: (A) A 12-lead electrocardiogram should be arranged, which has about a 50% chance of obtaining a clear diagnosis. (B) A brain CT should be arranged to check for cerebral hemorrhage. (C) The blood test report shows that the hematocrit is 35% and the myocardial enzyme (troponin) is normal. The patient belongs to the low-risk group and can be discharged. (D) During the observation period, the patient suddenly has his eyes hanging and his limbs tremble. Diazepam 5mg should be injected intravenously immediately and the effect of the drug should be observed.

Output: B


Instruction: A 65-year-old patient came to the emergency room because of headache. He was conscious and his vital signs were stable. Which of the following assessments of this disease is less appropriate?

Input: (A) According to the Ottawa Subarachnoid Hemorrhage Rule, people over 65 years old are risk factors. It is recommended to arrange a head CT examination. (B) The patient describes unilateral headache, which is the most common symptom of carotid artery or vertebral artery dissection. It is advisable to consider arranging a CTA examination. (C) MRI examination has high sensitivity and a negative test can be ruled out. (D) If the diagnosis is SAH, in addition to controlling SBP to 120-160 mmHg, preventive anti-epileptic drugs can also be considered.

Output: C


Instruction: Regarding hypoglycemia caused by sulfonylurea, which of the following treatments is less appropriate?

Input: (A) 50% Dextrose. (B) Diazoxide. (C) Glucagon. (D) Octreotide.

Output: C


Instruction: A 68-year-old male was discharged from the hospital one week ago and received high-dose steroid treatment during hospitalization. He now goes to the emergency department for fever, dyspnea, and unconsciousness. After examination, he is diagnosed with bacterial pneumonia. Chest X-ray shows bilateral lower lobe infiltration. Which of the following pathogens is most likely to be the cause?

Input: (A) Klebsiella pneumoniae. (B) Pseudomonas aeruginosa. (C) Staphylococcus aureus. (D) Streptococcus pneumoniae.

Output: B


Instruction: Due to abnormal operation, a large amount of radioactive pollutants leaked from the No. 3 nuclear power plant. Regarding emergency preparation and patient treatment, which of the following statements is less appropriate?

Input: (A) Emergency medical staff in contaminated areas must wear waterproof isolation clothing, hats, shoes and double gloves to avoid contamination. (B) The method for cleaning contaminated wounds is the same as that for general wounds, but the spread of contamination during the cleaning process must be prevented. (C) All patients should first be decontaminated until the radiation value is less than 2 times the background value before medical treatment. (D) If vomiting and diarrhea occur, the number of lymphocytes should be monitored every 6 hours.

Output: C


Instruction: A 20-week pregnant woman presented to the emergency department with sudden onset of shortness of breath and chest pain two hours ago. Her vital signs were temperature 36.5°C, heart rate 170 beats/min, respiration 24 breaths/min, and blood pressure 125/86 mmHg. Which of the following is more appropriate?

Input: (A) If it is unstable ventricular tachycardia, a 100-joule synchronized shock can be given without reducing the dose. (B) If it is a myocardial infarction, the most likely cause is coronary spasm. (C) If pulmonary embolism is suspected, an MRI should be arranged, and a pulmonary V/Q scan should be avoided because the radiation dose may cause permanent damage to the fetus. (D) If it is severe asthma (status asthmaticus), MgSO 4 should not be given because it crosses the placenta and can cause neurological damage.

Output: A


Instruction: A 44-year-old male was hospitalized for left upper abdominal pain. Examination revealed that his lipase was approximately 10 times the normal value. He is now fasting in the emergency room, awaiting follow-up imaging examinations. Which of the following statements is more appropriate?

Input: (A) The diagnosis of typical pancreatitis must meet three criteria, including clinical symptoms, laboratory tests, and imaging examinations. (B) If the patient has no history of pancreatitis, a CT scan should be arranged as soon as possible, as ultrasound is sometimes easily interfered with by intestinal gas. (C) If pancreatitis is diagnosed, the patient needs to fast for a longer period of time, and preventive antibiotics should be used to prevent intestinal bacterial metastasis. (D) Treatment is mainly supportive, among which early and active fluid therapy can improve the prognosis. Lactated Ringer's solution is the first choice.

Output: D


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

Input: (A) If Koplik spots are found during oral examination, the patient should be advised to be hospitalized in a negative pressure isolation ward. (B) In differential diagnosis, measles usually develops a rash the day after the fever subsides. The rash usually appears on the hands and feet first, and then spreads to the trunk and face. The oral mucosa is usually not affected. (C) The pathogen of scarlet fever is a single-stranded DNA virus that can be transmitted through droplets. It is recommended to be hospitalized in a single ward. (D) The rash of roseola infantum appears with fever, and the rash disappears after the fever subsides.

Output: A


Instruction: Which assessment and medical treatment is more appropriate for patients with acute psychosis who are prone to violent injury?

Input: (A) Atypical antipsychotics such as Olanzapine are specific for dopamine receptors and are better than typical antipsychotics in reducing the side effect of QTc prolongation. (B) Physical examination findings are specific to acute mental illness, and abnormal appearance or disorganized behavior are not the primary basis for judgment. (C) The evaluation principle is to first rule out the existence of medical or traumatic problems and secondly to reduce the patient's potential harm. (D) Both sedatives (Benzodiazepines) and alcohol intoxication or withdrawal can cause acute psychosis.

Output: A


Instruction: A 50-year-old male rapidly develops respiratory failure due to viral pneumonia within 3 days. His PaO2 is 90 mmHg on 100% oxygen. He is intubated and uses a ventilator. Which of the following statements is more appropriate?

Input: (A) It is a severe Acute Respiratory Distress Syndrome (ARDS). (B) Respiratory alkalosis may occur, but it is acceptable if it is mild. (C) During treatment, respiratory monitoring can set the blood oxygen target SpO2 greater than 95%. (D) Low tidal volume and Positive end expiratory pressure (PEEP) should be used.

Output: A


Instruction: A 50-year-old male seeks emergency treatment due to sudden pain in the left upper abdomen and vomiting. Past medical history includes diaphragmatic hernia and gastroesophageal reflux. Blood pressure 86/40 mmHg, heart rate 121 beats/min, body temperature 37℃, respiration 20 times/min, SpO₂ 98%. The main abnormalities of physical examination are epigastric bloating and pain, tympanic percussion, and decreased breath sounds in the left lower lung. Laboratory reports found lactate 28 mg/dL, pH 7.13, HCO₃- 8.1 mEq/L, and Hb 12 g/dL. Chest X-ray found that the stomach was distended and located above the diaphragm. In addition to appropriate infusion therapy, which of the following is more appropriate?

Input: (A) Consult for surgical treatment. (B) Arrange for gastroscopy. (C) Transfusion of concentrated red blood cells (PRBCs). (D) Intravenous injection of sodium bicarbonate.

Output: A


Instruction: Which of the following statements is more appropriate regarding a bioterrorism attack?

Input: (A) In biological warfare, infectious pathogens are usually used that have properties similar to those of chemical warfare agents. (B) The initial symptoms of most biological warfare agents are easily distinguishable from those of common infectious diseases. (C) In the absence of obvious symptoms or confirmed exposure, preventive vaccination or treatment is not required. (D) Use the highest transmission precautions until the pathogen is understood and its mode of transmission is determined.

Output: D


Instruction: A 70-year-old male with no chronic diseases went to the emergency room within 1 hour of onset of acute left limb weakness. His left upper and lower limbs could only move in bed but could not be raised to resist gravity. After examination, he had no other neurological symptoms, and his vital signs and blood tests were normal. He was diagnosed with ischemic stroke. Which of the following treatment statements is less appropriate?

Input: (A) This patient currently meets the indications for intravenous thrombolytics in our country. (B) This patient currently meets the indications for intra-arterial embolectomy in our country. (C) Asians can use lower doses of thrombolytics to reduce complications. (D) Patients receiving intravenous thrombolytics can still receive intra-arterial embolectomy.

Output: B


Instruction: Which of the following is more appropriate regarding vascular lines that are placed in the emergency department?

Input: (A) Chylothorax is sometimes seen as a complication of right cervical central venous catheter placement. (B) When inserting a central venous catheter from the femoral vein, if the needle is placed above the inguinal ligament, intraperitoneal bleeding may occur. (C) For patients with severe orthopnea, inserting a central venous catheter from the clavicle is a feasible method. (D) If there is local pain, redness or swelling at the insertion site of the arterial catheter, the first step is to apply local pressure for 3 to 5 minutes before removing the needle.

Output: C


Instruction: 45-year-old with systemic sclerosis (systemic A male patient with sclerosis who was taking steroids and had normal renal function last month came to the emergency department with progressive headaches, nausea, and shortness of breath for three weeks. His vital signs were: blood pressure 250/150 mmHg, heart rate 95 beats/min, respiration 14 breaths/min, SpO₂ 95%, GCS E4V5M6. The blood values were as follows: Cr 21.73 mg/dL. Which of the following statements is more appropriate about this patient's condition?

Input: (A) About half of these patients will develop a scleroderma renal crisis within four years of onset. (B) Steroid treatment is not a precipitating factor. (C) First-line use of angiotensin-coverting enzyme inhibitors is not recommended. (D) After hemodialysis treatment, only about 10% of patients may recover their kidney function.

Output: A


Instruction: 70-year-old female, nursing home resident, hospitalized for pneumonia for 2 weeks, discharged 3 days ago, started to have 10 large yellow watery stools yesterday, poor appetite, no history of contact or gathering, temperature 38℃, heart rate 120 beats/min, blood pressure 90/60 mmHg, blood oxygen concentration 94%, blood WBC 16,000/mm³, stool toxin A and toxin B positive, which of the following treatments is more appropriate?

Input: (A) Give Vancomycin orally. (B) Give Vancomycin intravenously and transrectally. (C) Wait for the results of stool culture for Clostridium difficile (C. difficile) before deciding whether to give antibiotic treatment. (D) Before the report of C. difficile stool culture comes out, give Ciprofloxacin orally.

Output: B


Instruction: After the patient with unknown substance poisoning used a ventilator in the trachea, the ABG results were: pH 7.2, PaCO₂ 20 mmHg, PaO 2 300 mmHg, HCO₃- 10 mEq/L, but obvious cyanosis was still visible in the body appearance. Which of the following substances is more likely to be poisoning?

Input: (A) Carbon monoxide (CO). (B) Hydrogen cyanide (HCN). (C) Hydrogen sulfide (HS). (D) Sodium nitrite.

Output: D


Instruction: Which of the following statements is more appropriate regarding acute exacerbations of COPD?

Input: (A) Treating gastroesophageal reflux can reduce acute exacerbations. (B) Giving oxygen can help improve pulmonary vasoconstriction. (C) Acute exacerbations of COPD are caused by limited expiratory airflow. (D) Most patients have no evidence of viral or bacterial infection during an acute exacerbation.

Output: B


Instruction: Which of the following statements is more appropriate regarding the use of the Ottawa Subarachnoid Hemorrhage Rule?

Input: (A) It has a diagnostic specificity of 100%. (B) The diagnostic criteria include limited neck flexion. (C) The diagnostic criteria include unconsciousness. (D) Diagnostic conditions include age 45 years old.

Output: B


Instruction: Which of the following statements is less appropriate for emergency treatment of patients with left ventricular assist devices in the emergency department?

Input: (A) During CPCR (Cardio-Pulmonary-Cerebral-Resuscitation) of such patients, chest compression may cause left ventricular rupture. (B) If the patient's vital signs are unstable, auscultation must be performed immediately. If there is no machine sound, the battery or controller function must be confirmed. (C) When performing CPCR chest compression, the depth of chest compression must be deeper than that of normal patients. (D) If ventricular pulse is present, the shock dose is the same as that for normal patients.

Output: C


Instruction: Patients with systemic rheumatic diseases may have difficulty intubating due to the following reasons. Which of the following statements is less appropriate?

Input: (A) Patients with ankylosing spondylitis should be careful about incomplete dislocation of the atlas and the vertebrae. (B) Granulomatosis with polyangiitis may cause subglottic stenosis. (C) Scleroderma may affect the elasticity of the skin and the caliber of the oral opening. (D) Systemic lupus erythematosus may invade the temporomandibular joint.

Output: D


Instruction: A 40-year-old male is sent to the emergency room due to a car collision. The victim complains of abdominal pain. Which of the following is less appropriate?

Input: (A) Vital signs are unstable. Abdominal trauma is the focus. Ultrasound examination shows ascites. Emergency laparotomy should be prepared. (B) Vital signs are stable. CT scan shows spleen damage. The first-line treatment is splenectomy. (C) There is no obvious trauma, vital signs are stable, and CT scan shows no obvious bleeding, but there is persistent tenderness and peritoneal signs in the abdomen. Laparotomy is still recommended. (D) There is a suspected puncture wound on the anterior abdominal wall. Vital signs are stable. CT scan is recommended.

Output: B


Instruction: The patient complained of vomiting and diarrhea 3 days ago, but no fever. Yesterday, he began to have coughing and symmetrical upper limb weakness. Today, he went to the emergency room because of weakness in both lower limbs and urinary incontinence. Which of the following diseases is more likely?

Input: (A) Japanese encephalitis. (B) Guillain-Barre syndrome. (C) Botulinum toxin poisoning. (D) Myasthenia gravis.

Output: C


Instruction: Which of the following syndromes and diseases is more appropriate?

Input: (A)Boerhaave syndrome refers to rupture of the gastric fundus. (B)Ehlers-Danlos syndrome is a disease that is prone to aortic detachment. (C)Precordial catch syndrome is chest pain caused by myocardial contusion. (D)Tietze's syndrome refers to chest pain caused by tension pneumothorax.

Output: B


Instruction: Which of the following descriptions of traumatic hip dislocation is less appropriate?

Input: (A)Clinically, posterior dislocation is the most common, and it often occurs when the knee hits the dashboard in a car accident. Physical examination shows that the thigh is shortened, everted, and externally rotated. (B) It is often accompanied by pelvic, acetabulum, thigh fractures and knee ligament injuries, and CT is required to further evaluate the injury. (C) Detailed evaluation of nerve and vascular function is required. The sciatic nerve is the most common nerve injury. (D) It is an orthopedic emergency and hip reduction should be completed within 6 hours. Delayed reduction increases the risk of ischemic necrosis of the femoral head.

Output: A


Instruction: Which of the following hypertensive emergencies and corresponding treatment drugs and treatment goals is less appropriate?

Input: (A) Aortic detachment, use Labetalol to control systolic pressure at 100-120 mmHg. (B) Amphetamine poisoning, use Benzodiazepine to control systolic pressure below 140 mmHg. (C) Preeclampsia, use ACE inhibitors to control systolic pressure below 140 mmHg. (D) Subarachnoid hemorrhage, use Nicardipine to control systolic pressure below 160 mmHg.

Output: C


Instruction: Which of the following statements is more appropriate regarding the targeted temperature management (TTM) management of post-cardiac arrest care?

Input: (A) Inclusion criteria include: ROSC and GCS motor score <6, no other causes of coma, no DNR or DNI status, etc. (B) Exclusion criteria include: cardiac arrest due to trauma or severe bleeding, patients taking anticoagulants, etc. (C) Potential adverse reactions include: coagulation disorders with prolonged PTT, hyperkalemia during cooling, and hypokalemia during rewarming. (D) Reduce core body temperature to 32-36°C as soon as possible within 2 hours after restoration of spontaneous circulation.

Output: A


Instruction: A 25-year-old male with no past medical history presents with dyspnea and shock after a contrast injection CT scan. Breath sounds are wheezing on both sides and significant use of accessory muscles. Vital signs are 80/45 mmHg, heart rate 120 beats/min, respiration 36 breaths/min, temperature 38.3℃, blood oxygen 85%, GCS E4V5M6. Which of the following assessments and treatments is less appropriate?

Input: (A) Epinephrine 0.3 mg injected intramuscularly into the upper arm is preferred. (B) Administer large amounts of saline 1,000~2,000 cc intravenous infusion. (C) Administer high-concentration oxygen to maintain arterial oxygen concentration greater than 90%. (D) Give inhaled bronchodilators and intravenous injection of 2 g of magnesium sulfate.

Output: A


Instruction: Three patients in the emergency room ate mackerel lunch together and developed symptoms about 1 hour later, including headache, dizziness, diarrhea, and upper abdominal pain. The patients' vital signs were stable and they had no fever. Physical examination revealed that two patients had flushing on their faces and chests, while the rest of the body parts were normal. Which of the following treatments is more appropriate?

Input: (A) Symptoms appeared quickly, and the most likely pathogen is Staphylococcal enterotoxin. (B) Collect stool samples from the patients and give supportive treatment and oral antibiotics. (C) Provide supportive therapy and antihistamines. (D) Cooking food at high temperatures can prevent this type of food poisoning.

Output: C


Instruction: A 35-year-old female was admitted to the hospital for fever and unconsciousness. A brain CT scan showed no cerebral hemorrhage. Tests revealed WBC 3,700 /µL, Hb 5.0 g/dL, Platelet 15,000 /μL, Creatinine 3.5 mg/dL, T-Bil 5.3 mg/dL, D-Bil 1.2 mg/dL, INR 0.9, aPTT ratio 1.1, Heptoglobin 12 mg/dL (reference value 30~200 mg/dL) , which of the following statements about this patient is more appropriate?

Input: (A) The pathological mechanism is the overactivity of the protease ADAMTS-13. (B) Treatment includes plasma replacement and replenishment of red blood cells and platelets. (C) Differential diagnosis of human immunodeficiency virus (HIV) infection is required. (D) The prognosis after treatment is excellent and the recurrence rate is also very low.

Output: C


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

Input: (A) When drawing fluid, avoid milking the joint cavity at the same time to avoid bleeding in the joint cavity. (B) It is best to be in a bent knee position when drawing fluid. (C) The positioning point is two finger widths (about 3 cm) just below the patella. (D) The needle is inserted on the inside or outside of the positioning point and moves horizontally toward the midpoint of the posterior side of the patella.

Output: D


Instruction: A 32-year-old male has recently experienced upper abdominal pain and nausea. He went to another county for medical treatment two days ago and had a gastroscopy. He was told that he had a suspected bacterial infection in the stomach. Because the symptoms persisted after taking the medication, he went to the emergency room for medical treatment. Regarding proton pump inhibitors (PPIs), which of the following statements is more appropriate?

Input: (A) Compared with H2 receptor antagonists, PPIs have better therapeutic effects, but they are slower in treating ulcers. (B) They have the effect of inhibiting Helicobacter pylori. (C) Long-term use may increase the risk of pneumonia, fractures, and high magnesium levels. (D) It is not part of the three-in-one drug treatment combination for Helicobacter pylori, but can be prescribed together to improve symptoms and prognosis.

Output: B


Instruction: Which of the following drugs for the prevention and treatment of high-altitude disorders is less appropriate?

Input: (A) Acetazolamide can be used to prevent altitude sickness. It should be taken one day before climbing. It should be taken orally twice a day, 125-250 mg. (B) Nifedipine can be used to treat high-altitude pulmonary edema. It should be taken orally in an extended-release form, 30 mg every 12 hours. (C) Tadalafil can be used to prevent high-altitude pulmonary edema. It should be taken one day before climbing. It should be taken orally twice a day, 10 mg. (D)Dexamethasone can be used to prevent altitude sickness. It should be started when climbing a mountain, and should be taken orally at a rate of 4 mg every 6 hours.

Output: D


Instruction: An 11-month-old boy, weighing about 10 kg, has persistent episodes of abdominal pain and crying at home. His parents are the primary caregivers. Bloody stools were found in his diapers. Bedside abdominal ultrasound showed a high possibility of intussusception. Which of the following is less appropriate?

Input: (A)Children of this age usually cannot find the leading point. (B)When there are signs of peritonitis, the pressure of air reduction must be reduced to avoid intestinal perforation. (C)The presence of bloody stools is not a contraindication to air reduction. (D) If air repositioning fails, reassessment is required to determine whether it is incarcerated hernia.

Output: B


Instruction: Which of the following descriptions of Multisystem inflammatory syndrome in children (MIS-C) is less appropriate?

Input: (A) Age 0-12 years and fever ≥ 3 days are the current World Health Organization (WHO) diagnostic criteria for MIS-C. (B) Myocardial function is often impaired, combined with shock. (C) Evidence of SARS-CoV-2 infection is required, such as positive nucleic acid (RT-PCR) serology or recent contact with an infected person. (D) Commonly used treatment drugs are immunoglobulin and steroids.

Output: A