Instruction: A 25-year-old male was riding a bicycle and was crushed by a truck. When he arrived at the hospital, he had a deformed abdomen and pelvic fracture and right thigh deformity. He was conscious, his blood pressure was 80/45 mmHg, his heart rate was 145 beats/min, his breath sounds were clear and symmetrical, and there were tire marks on the upper abdomen. Which of the following statements is correct about the first aid of this patient?

Input: (A) Prioritize the two 22-Gauge (B) Use FAST (Focused Assessment Sonography in Trauma) ultrasound to check for potential bleeding in the posterior peritoneal cavity. (C) When the FAST ultrasound is negative, surgery can be ruled out. (D) Rapidly insert a large-caliber intravenous catheter to give blood transfusions, preferably from the femoral vein rather than the subclavian vein. (E) When the FAST ultrasound is negative, consider pelvic fixation and arrange emergency angiography.

Output: E


Instruction: A 25-year-old male was randomly stabbed with a knife while riding the subway. The wound was located at the 4th intercostal space on the left anterior chest. The victim's cardiopulmonary function stopped 1 minute before arriving at the hospital, and the EMT immediately performed CPR. After arriving at the hospital, the medical staff took over the first aid. At this time, the carotid artery pulse could not be felt, but a fast and narrow QRS wave pattern appeared on the EKG monitor. After emergency CPR and endotracheal intubation, it was found that the breath sounds on both sides were equal and not weakened. What is the most appropriate next step?

Input: (A) Immediately give a large amount of fluid. (B) Immediately insert chest tubes into both sides of the chest. (C) Immediately perform pericardial puncture. (D) Immediately perform emergency thoracotomy (ED thoracotomy) in the emergency department. (E) Immediately give ACLS first aid and send to the operating room for thoracotomy.

Output: D


Instruction: A 1-year-old child has bloody and mucous stools and continues to have intermittent abdominal pain and crying. The emergency department arranges an abdominal X-ray and abdominal ultrasound examination, which reveals intestinal obstruction. You judge that it is very likely to be intussusception and explain the necessity of air reduction to the family. The family asks whether this technique has any contraindications. Which of the following is wrong?

Input: (A) It should not be performed when there is blood in the stool, for fear that pressure may cause intestinal perforation. (B) If there are signs of intestinal perforation or peritonitis, surgery should be performed. (C) Patients with hypovolemia or septic shock need to consult a surgeon for surgery. (D) If lymphoma causes intussusception, nonsurgical reduction is not appropriate. (E) Nonsurgical reduction is not appropriate if symptoms persist for more than 24 hours.

Output: A


Instruction: A 1.5-year-old and a 3-year-old brother were riding a motorcycle with their father. Their mother was holding the children from the back seat without wearing a helmet. They fell off the motorcycle when turning. Both children had a perfect GCS score, but the younger brother had a hematoma on his left temporal side and the older brother had a hematoma on his occipital side. They were taken to the emergency room by ambulance. They did not vomit and could be comforted. After careful questioning about the accident process, it was found that the speed of the car was slow and they were not at high risk of injury. According to the Pediatric Emergency Care Applied Research Network (PECARN) recommendation for brain CT examination, which of the following is correct?

Input: (A) Although the children are conscious, they both have hematoma at the back of their skull. Both should undergo a CT scan of the brain. (B) The elder brother's injury is at a high risk, so he should undergo a CT scan of the brain. (C) Both are conscious. Even if they lost consciousness for a few seconds, they should just be observed. (D) The younger brother is younger than 2 years old. If his parents are worried, they can arrange a CT scan of the brain. (E) The elder and younger brothers have the same principle in deciding to have a CT scan.

Output: D


Instruction: A 10-year-old boy weighs 20 kilograms. He is conscious but has a slight wheezing breath. His family said that the child has been wanting to drink water recently and has intermittent abdominal pain and vomiting. Blood test showed acidemia (pH=7.10), ketone body 2+, blood sugar 911 mg/dL, diagnosed as diabetic ketoacidosis, which of the following treatments is wrong?

Input: (A) 0.9% Normal Saline 200~400 ml should be given within 1~2 hours. (B) If blood pH < 6.9, combined with high potassium, bicarbonate treatment should be given. (C) Immediately give insulin 4U per hour. (D) After blood sugar drops to 300 mg/dL, start giving 5% G/W. (E) Supplementing bicarbonate will actually increase the risk of cerebral edema.

Output: C


Instruction: An 18-year-old woman underwent a cesarean section 6 days ago and went to the emergency department complaining of abdominal pain and foul-smelling bloody vaginal discharge. Physical examination showed obvious lower abdominal tenderness, clean and intact surgical wounds, mild swelling and tenderness of both breasts but no fever, vital signs: blood pressure 155/79 mmHg, heart rate 110 beats/min, respiration 20 times/min, body temperature 39℃. Which of the following diagnoses best explains the cause of this fever?

Input: (A) Endometritis. (B) Mastitis. (C) Pyelonephritis. (D) Intra-abdominal gauze retention. (E) Appendicitis.

Output: A


Instruction: A 26-year-old female was 25 weeks pregnant when she was driving on the highway and had a car accident. The paramedics found that the airbag was deployed. She was conscious when she was transferred to the hospital but complained of lower abdominal pain. Her vital signs at the emergency room were: heart rate 88 beats/min, blood pressure 105/70 mmHg. Which of the following statements is incorrect?

Input: (A) Pregnancy increases the mother's total blood volume, so it will present hypervolemic. Therefore, it is possible that blood loss of more than 30% will lead to abnormal vital signs. (B) At 12 weeks of pregnancy, the height of the uterine fundus is approximately at the pubic symphysis, and at 20 weeks it is approximately at the height of the navel. Thereafter, the uterine fundus rises by about 1 cm with each additional week. (C) To avoid affecting venous return, it is recommended to lie on the left side. If a long backboard is used, place something under the long backboard in the right hip area so that the patient is tilted about 30° with the left lower and the right higher. (D) Abdominal contusion often leads to fetal death due to uterine rupture and placental rupture. (E) If the pregnant woman is found to have right-sided hemothorax after examination, the position of the chest tube is the same as that of an ordinary adult.

Output: E


Instruction: A 28-year-old female was found unconscious at home by her family and sent to the emergency room. Her symptoms included dilated pupils, eye spasms, increased neuromuscular reflexes, muscle spasms, blood pressure 190/108 mmHg, heart rate 126 beats/min, respiration 32 times/min, and body temperature 39.5℃. Which of the following is the least likely diagnosis for the patient?

Input: (A) Amphetamine. (B) Tricyclic antidepressants. (C) Serotonin syndrome. (D) Organophosphate pesticide poisoning. (E) Antipsychotic drug malignancy syndrome.

Output: D


Instruction: A 28-year-old pregnant woman, 35 weeks pregnant, drove to her prenatal checkup by herself. Because the car in front of her braked suddenly and failed to react in time, she crashed into the car in front of her. When she arrived at the hospital, she was conscious, her blood pressure was 130/80 mmHg, her heart rate was 100 beats/min, and her breathing was 20 breaths/min. Physical examination revealed an obvious seat belt mark under her navel. Which of the following statements about the assessment and treatment of this patient is incorrect?

Input: (A) Uterine rupture is a relatively rare complication. When uterine rupture occurs, the fetal mortality rate is greater than that of the mother. (B) Ultrasound examination can detect placental detachment better than fetal monitoring. (C) Placental detachment is the most common cause of fetal death after maternal death. (D) After the mother's condition stabilizes, she should be seen by the obstetrics and gynecology department as soon as possible to evaluate the fetus's condition, whether there is water rupture or vaginal bleeding. (E) Most obstetricians and gynecologists believe that if the number of contractions per hour in the first 4 hours of monitoring is less than 3, the pregnant woman can be discharged from the hospital and return home.

Output: B


Instruction: A 29-year-old female, 20 weeks pregnant, came to the emergency department complaining of right lower abdominal pain for 2 days. Before coming to the clinic, she had poor appetite and vomited several times, but no diarrhea. Vital signs: temperature 37℃, heart rate 108 beats/min, respiratory rate 20 times/min, blood pressure 112/76mmHg. Physical examination revealed obvious tenderness in the right lower abdomen and rebound tenderness. Laboratory examination revealed WBC 7,800/μL, Neutrophil 78%, Hb 13 g/dL, PLT 242,000/μL. Sugar 102mg/dL, Creatinine 0.8 mg/dL, AST 38 U/L. Which of the following statements is correct?

Input: (A) According to the modified Alvarado score, it can be estimated that the patient has a less than 10% chance of appendicitis. (B) If ultrasound examination finds that the appendix is non-compressible and the diameter is greater than 3mm, appendicitis can be diagnosed. (C) If a pregnant woman undergoes abdominal CT, it is estimated that the fetus absorbs about 20~30 rad of radiation. (D) This patient can choose abdominal magnetic resonance imaging (MRI) to help with diagnosis. (E) Too many imaging examinations will greatly increase the chance of appendicitis perforation, and a surgeon should be consulted early for surgery.

Output: D


Instruction: A 2-year-old girl had a fever for 5 days, drooling, ulcers on the tongue, gums, and lips, bad breath, swollen lymph nodes in the neck, and red and swollen blisters on the right thumb. Examination of other parts of the body was normal. The clinic gave her oral Amoxicillin but she still had a fever. What is the most likely pathogen?

Input: (A) Group A streptococcus. (B) Coxsackievirus. (C) Staphylococcus aureus. (D) Herpes simplex virus. (E) Adenovirus.

Output: D


Instruction: A 30-year-old female was bitten by a stray cat and was accompanied by her family to the emergency room for treatment. The patient reported that she had not received a tetanus vaccine or a rabies vaccine since graduating from elementary school. Wound examination revealed a 3-cm laceration on the right forearm. Which of the following is correct about the treatment of cat bites?

Input: (A) Primary sutures increase the chance of infection, so preventive antibiotic treatment should be used. (B) Because it is a high-risk wound for tetanus infection, tetanus immunoglobulin should be administered. (C) Because rabies infection is possible, at least 3 doses of rabies vaccine should be administered. (D) For highly infected wounds, antibiotics are recommended, with Moxifloxacin being the preferred drug. (E) After wound treatment, if hospitalization is not arranged, it is recommended to return to the outpatient clinic for follow-up within 72 hours.

Output: C


Instruction: A 35-year-old male patient is HIV positive and has not taken medication as prescribed in the past 3 months. He comes to the emergency department complaining of fever and increasing breathlessness in the past 2 weeks. When he arrived at the emergency department, his vital signs were: heart rate 110 beats/min, blood pressure 135/75 mmHg, respiratory rate 22 breaths/min, blood oxygen concentration 92% (room air), and his body temperature is now normal; the blood test report is as follows: WBC 2,000/uL; chest X-ray found diffuse interstitial infiltrates on both sides. Which of the following drugs is not suitable for the treatment of his current condition?

Input: (A) Pentamidine. (B) Prednisone. (C) Pyrimethamine. (D) Sulfamethoxazole. (E) Trimethoprim.

Output: C


Instruction: A 37-year-old male was treated in the outpatient clinic for Schizophrenia. The medication he took was Seroquel 100mg and Lexotan (bromazepam) 3mg (1 tablet each before bedtime). A few days later, he became unconscious and stiff and was sent to the hospital. The measured vital signs are as follows: GCS E4M4V1, blood pressure 85/51 mmHg, heart rate 168 beats/min, body temperature 40.2℃, respiration 22 times/min, SpO₂ 94%. The pupils on both sides are 3.5mm. Other physical examination findings include: DTR: hyporeflexia, Babinski sign (-), Rigidity: (+) similar limbs, sweating. CT scan showed no obvious abnormality, and the electrocardiogram showed a sinusoidal pulse. Blood test reference: CK 319 U/L, Cr 1.3 mg/dL, Na 122 mEq/L, AST 94 U/L, ALT 126 U/L. In the case of suspected poisoning, which of the following diagnoses is correct?

Input: (A)Cholinergic toxidrome. (B)Anticholinergic toxidrome. (C)Sympathomimetics. (D)Serotonin syndrome. (E)Neuroleptic malignant syndrome.

Output: E


Instruction: A 38-year-old female patient was taken to the emergency room by her family due to impaired consciousness. The patient presented with lethargy. Her blood sugar level was normal and she had no history of medication. According to her family, she was unable to breastfeed when she gave birth to her second child 6 years ago. Physical examination revealed pale complexion, blood pressure 90/60 mmHg, heart rate 64 beats/min, and respiration 14 times/min. She had decreased body hair. Laboratory examination revealed Hb 8.8 g/dL and Na 124 mEq/L. Which of the following treatments is most appropriate?

Input: (A) After giving 3% NaCl drip, if the blood sodium level is normal and the patient is conscious, she can be discharged home. Encourage the patient to consume more salt. (B) Give a transfusion of two units of packed RBC. If there is no obvious source of bleeding and the hemoglobin level improves, she can be discharged home. (C) All the symptoms of the patient can be explained by adrenal hypofunction. After being given adrenal cortisol, he can be discharged home. (D) This patient may have Sheehan's syndrome and needs to be examined and treated for hypopituitarism. (E) Since this patient is in shock, he should be treated with Dopamine first.

Output: D


Instruction: A 39-year-old male with a long history of epilepsy was found to have an epileptic seizure at home by his family today. When the patient was taken to the emergency room, he was fully conscious. Which of the following statements about the treatment of this patient is incorrect?

Input: (A) Many patients like this one are caused by not taking anti-epileptic drugs regularly. (B) If the patient is suspected of not taking anti-epileptic drugs regularly, the concentration of anti-epileptic drugs in the serum should be tested before the initial dose of anti-epileptic drugs is administered. (C) If the concentration of anti-epileptic drugs in the patient's serum is appropriate, a supplemental dose should be considered to prevent the recurrence of epilepsy. (D) Even patients with epilepsy who are well controlled with anti-epileptic drugs may still have occasional epileptic attacks. (E) There is currently no evidence-based criterion to determine how long the patient should stay in the emergency department.

Output: C


Instruction: A 40-year-old woman hanged herself after suspected drug use. She was sent to the emergency room without any signs of life. Which of the following statements is incorrect?

Input: (A) According to the method of hanging, if the body is in the air and the feet do not touch the ground, it is called complete, and all other methods are called incomplete. (B) Death is usually caused by three factors: damage to the spinal cord or brain stem, compression of the neck structure, or bradycardia leading to cardiac arrest. (C) If the height of the hanging is greater than or equal to the patient's height, the cause of death should be excessive pressure, resulting in compression of the internal blood vessels in the neck and brain death. (D) Bradycardia is caused by the pressure of hanging stimulating the carotid sinus and causing increased vagal tone. (E) If cervical spine injury cannot be ruled out, it is best to use a cervical collar for fixation.

Output: C


Instruction: A 77-year-old male was admitted to the outpatient clinic for Parkinsonism. He was taking Madopar (levodopa) 250mg 1# tid, Enzil (amantadine) 100mg ½ # bid. Past medical history: uremia receiving hemodialysis, heart bypass surgery. The patient was sent to the hospital due to unconsciousness, fever, and general stiffness. The measured vital signs were as follows: GCS E4M6V5 (but the correct location could not be determined), blood pressure 162/76 mmHg, heart rate 84 beats/min, body temperature 39.2℃, respiration 16 times/min, SpO₂ 96%. The pupil size was 3.0mm on both sides. Babinski sign(-), Rigidity:(+) All four limbs are similar. There are no obvious signs of infection, no obvious abnormalities in CT, and no obvious abnormalities in EKG. Blood test reference: CK 319U/L; Cr 1.3mg/dL; Na 142mEq/L; AST 20U/L; WBC 9,450 µ/L. In the case of suspected poisoning, which of the following diagnoses is correct?

Input: (A)Cholinergic toxidrome. (B)Anticholinergic toxidrome. (C)Sympathomimetics. (D)Serotonin syndrome. (E)Neuroleptic malignant syndrome.

Output: D


Instruction: EMT rescued a severely burned patient from a fire scene and sent him to the emergency department of a nearby critical care hospital. After first aid, the emergency doctor wanted to transfer the patient because the hospital did not have a burn intensive care unit. However, he could not find a nearby hospital with a burn intensive care unit. Later, the family insisted on transferring the patient to the emergency department of Medical Center A. Which of the following is correct?

Input: (A) The emergency doctor should call the regional emergency medical response center (rROC) in the area and request assistance in the transfer. (B) Before transferring the patient, the doctor should fill out an emergency disease referral form. (C) This case should be considered an automatic discharge, and the doctor does not need to contact the emergency department of Medical Center A. (D) This is a critical case. The hospital is responsible for severe emergency treatment. It is inappropriate to transfer the patient to another hospital. (E) This case is a case where the family insisted on transferring the patient to another hospital. This case does not fall under the Emergency Medical Rescue Act.

Output: B


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

Input: (A) Most cases of diarrhea are non-infectious, while infectious diarrhea is usually caused by viruses. (B) Less than 10% of elderly people with mesenteric ischemia present with diarrhea, while persistent diarrhea in young people should be considered as a form of sexually transmitted infection. (C) Blood biochemistry tests and complete blood counts are often helpful in diagnosing diarrhea. (D) Wright stain is used to detect white blood cells in stool, and about 80% of positive tests can culture pathogens. (E) If the stool contains blood, it is usually not necessary to culture stool bacteria.

Output: D


Instruction: Which of the following ways to reach Yushan North Peak (3,850 meters) and stay at Yushan North Peak that night has the highest risk of developing severe high altitude illness?

Input: (A) Take a helicopter directly to Yushan North Peak from the ground. (B) From Dongpu Hot Spring in Nantou County (1,100 meters), walk to Guangao (2,800 meters) via the Batongguan Ancient Trail, stay at Guangao the first night, and walk from Guangao to Yushan North Peak on the second day. (C) Depart from Taipei, take a night train to Tatajia in Yushan National Park, walk to Paiyun Villa (3,402 meters) from the Tatajia trailhead (2,600 meters) in the morning, and walk from Paiyun Villa to Yushan North Peak on the third day. (D) Depart from Taipei, take a bus and stay at the Alishan Youth Activity Center (2,000 meters above sea level) on the first night. In the morning, walk from the Tatajia trailhead to Paiyun Villa. On the third day, walk from Paiyun Villa to the North Peak of Yushan. (E) Depart from Taichung, take a bus and stay at Dongpu Villa (2,500 meters above sea level) on the first night. In the morning, walk from the Tatajia trailhead to Paiyun Villa. On the third day, walk from Paiyun Villa to the North Peak of Yushan.

Output: A


Instruction: Which of the following electrolyte abnormalities will not occur in patients with heat stroke?

Input: (A) High sodium. (B) High potassium. (C) High calcium. (D) Low sodium. (E) Low potassium.

Output: C


Instruction: Which of the following acidic liquid burns should be considered for treatment with calcium ion solution injection?

Input: (A)Acetic acid (Acetic acid). (B)Chromic acid (Chromic acid). (C)Formic acid (Formic acid). (D)Nitric acid (Nitric acid). (E)Oxalic acid (Oxalic acid).

Output: E


Instruction: Which of the following drug poisoning patients is not suitable for multidose activated charcoal therapy?

Input: (A)Theophylline. (B)Carbamazepine. (C)Phenobarbital. (D)Quinine. (E)Acetaminophen.

Output: E


Instruction: Which of the following antibiotics is more correct?

Input: (A)33-year-old alcoholic male with pneumonia, given ceftriaxone 1g (B) A 7-year-old boy with acute pharyngitis was given tetracyclines 50 mg/kg orally every day. (C) A 5-year-old girl with acute meningitis was given azithromycin 10 mg/kg intravenously every day. (D) A 26-year-old male basketball player with mild pneumonia was given moxifloxacin 400 mg orally once a day. (E) A 28-year-old pregnant woman with urinary tract infection was given ciprofloxacin 500 mg orally twice a day.

Output: A


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

Input: (A) Hyponatremia will not have any special manifestations or effects on the patient's muscle tone and function. (B) In patients without seizure complications, the rate of correction of blood sodium should not exceed 0.5-1 mEq/L per hour. (C) If the patient has had an epileptic seizure, the rate of correction of blood sodium can be increased to 1-2 mEq/L per hour. (D) In the treatment of patients with chronic hyponatremia, if the rate of increase is greater than 0.5 mEq/L per hour, central putamen myelinolysis and neurological dysfunction are likely to occur. (E) Clinical symptoms usually begin to appear when Na is less than 120 mEq/L, and epilepsy is more likely to occur when it is less than 113 mEq/L.

Output: D


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

Input: (A) Common pathogens are Streptococcus pneumoniae, Haemophilus influenzae (nontypeable) and Moraxella catarrhalis. (B) The diagnostic criterion is the detection of redness of the eardrum (erythema) during physical examination. (C) For children over two years old with acute otitis media, if they do not have severe symptoms, it may be considered to observe them for 48 hours before deciding whether to give them antibiotic treatment. (D) Antibiotic treatment includes amoxicillin or amoxicillin-clavulanate. (E) About half of the patients may still have middle ear effusion (OME) after treatment.

Output: B


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

Input: (A)The most common bleeding site is Kiesselbach's plexus (or Little's area) on the anterior and inferior side of the nasal septum. (B)Children's nasal bleeding is also prone to occur in Kiesselbach's plexus (or Little's area). (C)Hypertension is an important cause of epistaxis. When patients with nasal bleeding are also measured with high blood pressure, the blood pressure should be lowered as soon as possible. (D)Available treatments include oxymetazoline spray and pledgets. (E)Silver nitrate chemically cauterizes is not recommended for bilateral anterior nasal bleeding at the same time.

Output: C


Instruction: Lower back pain is a common chief complaint in emergency departments. Which of the following statements about the common causes of lower back pain is correct?

Input: (A)Neurogenic claudication is relieved by rest but is aggravated by forward flexion of the spine. (B)The most common symptom of cauda equina syndrome is decreased anal sphincter tension, not urinary retention. (C)When epidural compression syndrome is suspected to be caused by a tumor, steroid treatment should be given before MRI confirmation. (D)To diagnose spinal epidural abscess, the three symptoms of severe back pain, fever, and neurological deficits must be present at the same time. (E)X-ray manifestations of spinal osteomyelitis often show bone hyperplasia and intervertebral disc stenosis.

Output: C


Instruction: Among the various intrinsic factors that cause acute renal failure (intrinsic renal failure), which of the following is wrong?

Input: (A)Acute interstitial nephritis. (B)Hemorrhagic shock. (C)Ischemic acute tubular necrosis (ATN). (D)Rapid progressive glomerulonephritis. (E)Rhabdomyolysis.

Output: B


Instruction: Which of the following statements is correct when a pregnant woman dies suddenly and cardiopulmonary resuscitation is required?

Input: (A)When using mask ventilation, if the resistance is large and the tidal volume is insufficient, the ventilation rate can be increased to compensate. (B)When performing rapid sequence intubation, succinylcholine should be avoided when using muscle relaxants. (C)Emergency cesarean section is not considered for fetuses under 28 weeks. (D)Inguinal central venous catheter placement should be the first choice during chest compression. (E)Amiodarone can have serious adverse effects on the fetus and should be avoided in pregnant women.

Output: E


Instruction: Young children are admitted to the emergency room due to trauma. Which of the following injuries is most likely to be caused by accidental injury or child abuse?

Input: (A) The caregiver reported that the 1.5-year-old child played with his own genitals and caused a laceration. (B) The caregiver reported that the 1.5-year-old child fell while running, and an examination revealed a fractured clavicle. (C) The caregiver reported that the 2-year-old child fell while running, and an examination revealed a lacerated chin. (D) The caregiver reported that the 10-month-old child fell while learning to walk, and an examination revealed a fractured thigh. (E) The caregiver reported that the 10-month-old child fell from the bed, and an examination revealed multiple rib fractures.

Output: C


Instruction: In the emergency room, a 5-year-old child was undergoing a forehead laceration suture surgery. The child was emotionally agitated and unable to cooperate. Even after appropriate comfort, he was still unable to cooperate. Which of the following statements is incorrect:

Input: (A) Chloral hydrate can be used, but the effect is slow and the duration of action is long. It is not an ideal sedative for emergency invasive treatment. (B) Ketamine can be injected intramuscularly to produce a combined sedative and analgesic effect. (C) Midazolam can be given because it is safe, effective and has a short duration of action. (D) Ketamine can be used in combination with midazolam to reduce the occurrence of hallucinations. (E) Ketamine can also be used in infants under 3 months old, but be careful about excessive saliva to prevent airway obstruction.

Output: B


Instruction: Which of the following ultrasound signs has the highest specificity for the diagnosis of pneumothorax?

Input: (A)Comet-tail artifacts. (B)Lung point sign. (C)Lung pulse sign. (D)Seashore sign. (E)Stratosphere sign.

Output: B


Instruction: An AIDS patient comes to the emergency department complaining of general weakness, weight loss, poor appetite, pigmentation on the teeth, and physical examination reveals hypotension. What complications should be highly suspected in this patient?

Input: (A)Sepsis. (B)Adrenal insufficiency. (C)Kaposi's sarcoma. (D)Heart failure. (E)Malnutrition.

Output: B


Instruction: Which of the following statements about cardiac tamponade is incorrect?

Input: (A) The electrocardiogram may show electrical alternans. (B) Possible causes include pericarditis, hypothyroidism, cancer, uremia, trauma, etc. (C) There may be Kussmaul signs, where the patient's carotid veins become more dilated when he or she exhales deeply. (D) Typical clinical manifestations of Beck triad include: low blood pressure, venous distension, and distant, muffled heart sounds. (E) At the end of diastole, the right and left atrial pressures are similar or equal.

Output: C


Instruction: Which of the following statements about the clinical manifestations of common venomous snake bites in Taiwan is incorrect?

Input: (A) Hemorrhagic venomous snake bites will cause tooth marks and local swelling and pain, and subcutaneous hemorrhage, blisters or blood blisters may be seen. (B) Hemorrhagic venomous snake bites may have complications such as hemolysis, rhabdomyolysis, and diffuse intravascular coagulation (DIC). (C) In the case of a serpentine bite, tooth marks (small tooth marks) are not easily found. (D) Cobra venom contains cytotoxins, which can cause local swelling and pain, hemorrhagic subcutaneous hemorrhage, blisters or blood blisters, and in severe cases, skin necrosis. (E) After being bitten by a cobra, the patient will experience nausea, vomiting, abdominal pain, diarrhea, and severe neuromuscular blockade.

Output: E


Instruction: Which of the following descriptions of botulism is incorrect?

Input: (A) It is caused by the toxin secreted by Clostridium botulinum, and symptoms occur 6 to 48 hours after ingestion. (B) First, double vision, drooping eyelids, eye movement disorders, slurred speech, and difficulty swallowing occur. (C) Then, muscle strength decreases from the upper limbs to the lower limbs, and respiratory distress gradually occurs, and finally respiratory failure occurs. (D) Abnormal sensory function and tendon reflex function will occur. (E) Symptoms usually include urine retention, blurred vision, and dry skin and eyes.

Output: D


Instruction: Which of the following statements about marine toxins is correct?

Input: (A) Pufferfish toxins can be destroyed by frying, marinating, or cooking. (B) Pufferfish poisoning symptoms usually develop 24 hours after ingestion. (C) The formation of toxins in coral reef fish is related to the biological chain. (D) Histamine in fish is destroyed by cooking, so if the fish is cooked, it will not cause poisoning. (E) Jellyfish stings often present on the skin as red lines with a special lymphatic distribution. Flushing with large amounts of clean water can inactivate the stinging cells.

Output: C


Instruction: What is wrong with air medical treatment?

Input: (A) Safety is the primary guiding principle of air medical treatment. (B) The captain needs to fully understand the aircraft and weather conditions before departure, and also needs to understand the patient's information and condition. (C) Air medical nurses usually have experience in intensive care units or emergency medical care. (D) About 50% of air medical medical instructors have an emergency background. (E) The physical condition and stress of the crew will affect flight safety.

Output: B


Instruction: Which of the following statements about patients with acute heart failure and pulmonary edema is incorrect?

Input: (A) Natriuretic peptide is recommended for diagnosing or excluding heart failure, but routine testing is still controversial. (B) If the patient's blood pressure is greater than 150/100 mmHg, nitroglycerin can be used. The maximum dose is 100 mg/min. The end point of adjusting the dose is the improvement of blood pressure or symptoms. (C) Diuretics must be used in combination with vasodilators. If diuretics are used alone, they may increase mortality. (D) Non-invasive ventilators can be used in patients with acute heart failure or pulmonary edema. (E) Non-invasive respirators can be used in patients with moderate to severe acute heart failure and respiratory failure, and blood circulation stabilization is required.

Output: B


Instruction: Which of the following statements about resuscitation treatment for patients injured in dust explosions is incorrect?

Input: (A) A 60 kg adult with second- and third-degree burns covering 40% of the body surface area requires 8 hours of infusion of 3,600 ml of lactated Ringer solution. (B) Patients with full-thickness burns on the face require immediate endotracheal intubation. (C) The particulate matter contained in smoke is usually less than 0.5 micrometer in size, which is formed by the incomplete combustion of organic materials. (D) Small particles in smoke can reach the terminal bronchioles, causing an inflammatory response and leading to bronchial spasm and edema. (E) When inhalation injury exists, fluid resuscitation should be performed with caution to avoid aggravating pulmonary edema and acute respiratory distress syndrome. It is recommended to establish hemodynamic monitoring at an early stage.

Output: A


Instruction: Which of the following statements is incorrect about the emergency clinical treatment of severe hemoptysis (life-threatening hemoptysis)?

Input: (A) Bleeding lung down is often used in clinical practice, which may cause a more serious ventilation-perfusion mismatch. (B) If the patient has respiratory failure or unstable vital signs, intubation should be given immediately. The diameter of the endotracheal tube should be as large as possible, preferably 8 mm or more. (C) If the patient is taking wafarin, coagulation function should be tested, and fresh frozen plasma (FFP) should be transfused after the report is released. (D) Emergency bronchoscopy should be performed as soon as possible, which is the first-line choice for diagnosis and treatment. (E) If the bleeding continues to be uncontrolled, BAE (bronchial artery angiography and embolization) or surgery should be considered.

Output: C


Instruction: You are treating an 8-year-old boy with left knee pain and fever for 3 days. After initial evaluation, you highly suspect that the boy has acute septic arthritis. Which of the following is the least likely pathogen to cause the boy's septic arthritis?

Input: (A)Methicillin-resistant Staphylococcus aureus. (B)Methicillin-sensitive Staphylococcus aureus. (C)Streptococcus sepcies. (D)H. Influenzae. (E)Gram-negative bacilli.

Output: D


Instruction: Two motorcycles were involved in a car accident. EMTs were notified and rushed to the scene. There were one EMT-P, one EMT-II, and one Phoenix volunteer EMT-I in the ambulance. One patient was not breathing or having a heartbeat at the scene. A passerby was giving CPR. Phoenix volunteers immediately inserted a laryngeal mask airway into the patient, EMT-P gave the patient an IV drip, and after EMT-II connected the AED, the AED voice said: Electric shock recommended. In this process, who violated the current regulations for the management of emergency technicians?

Input: (A) No one violated the regulations. (B) Phoenix volunteer EMT-I. (C) EMT-II. (D) EMT-P. (E) Passersby.

Output: B


Instruction: The operation of air medical transfer is related to altitude. Which of the following statements is correct?

Input: (A) Boyle's Law: The higher the altitude → the lower the pressure → the larger the bubble volume. (B) Henry's Law: At a constant temperature, the amount of gas dissolved in a liquid is inversely proportional to the partial pressure of the gas above the liquid. (C) The patient has an endotracheal tube, and the cuff does not need to be replaced with liquid, such as saline. (D) The patient has a urinary catheter, and the liquid in the balloon should be replaced with gas. (E) For a 10% pneumothorax, there is no need to insert a chest tube to reduce pressure before air transfer.

Output: A


Instruction: The severity of acute pancreatitis is very important for the subsequent treatment and prognosis of patients. According to the Atlanta criteria , the following are indicators that can 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. (E)Presence of pancreatic pseudocyst.

Output: C


Instruction: A patient complained of coughing up blood and went to the emergency department. Which of the following statements is incorrect?

Input: (A) Coughing up more than 600 mL of blood within 24 hours is called massive hemoptysis. (B) Bronchial artery embolization has a 1.4-6.5% risk of spinal artery obstruction, leading to unilateral paralysis. (C) Computed tomography with contrast agent and bronchoscopy have similar accuracy in diagnosing bleeding points. (D) 15-30% of patients with hemoptysis have normal chest X-rays. (E) Pulmonary blood flow is supplied by two sets of vascular systems (Bronchial and pulmonary vessels), and coughing up blood that requires emergency treatment is mostly bleeding from bronchial vessels.

Output: B


Instruction: Which of the following statements is incorrect regarding pediatric trauma treatment?

Input: (A) The principles of first aid treatment for pediatric trauma are the same as those for adults. (B) For traumatic massive hemothorax in children, the definition of recommended surgery is that the amount of immediate bleeding after chest tube placement is greater than 15mL/kg or greater than 4mL/kg/h. (C) If signs of shock appear, 20mL/kg of normal saline can be given three times. If the signs of shock still cannot be improved, 10mL/kg of blood transfusion can be given. (D) If there is cerebral hemorrhage and the patient is suspected of having an injury with increased intracranial pressure, hyperventilation can be given appropriately, and PaCO₂ should ideally be controlled between 30 and 34mmHg. (E) In pediatric trauma, if vital signs are stable and there is suspected blunt renal contusion, urine tests can be performed. If it is greater than 5 RBCs/HPF, further examination and treatment should be arranged.

Output: E


Instruction: For incomplete spinal cord injury, which of the following statements is correct?

Input: (A) Central cord syndrome will cause complete paralysis below the lesion and loss of pain and temperature sensation. (B) Anterior cord syndrome will cause paralysis of the limbs, some of which may lead to decreased pain and temperature sensation, and the symptoms in the upper limbs are greater than those in the lower limbs. (C) Brown-sequard syndrome will cause weakness of the limbs below the lesion, loss of proprioception, and loss of pain and temperature sensation on the opposite side. (D) Cauda equina is a central nerve injury, which is accompanied by incontinence. (E) Brown-sequard syndrome has the worst prognosis among the above four.

Output: C


Instruction: For acute appendicitis (Acute Which of the following statements is incorrect about the examination of acute appendicitis?

Input: (A) CRP doubles every 8 hours and peaks at 36 to 50 hours. (B) If the modified Alvarado score is greater than 6 points, you can directly consult a surgeon without imaging examination. (C) Even if the ultrasound examination is negative, it cannot rule out acute appendicitis. (D) The abdominal CT is negative, which should rule out acute appendicitis. (E) Laparoscopy can be used for diagnosis and treatment.

Output: D


Instruction: Septic arthritis is a problem that needs to be ruled out for acute joint pain. In the adolescent population, gonococci are the most common pathogens. Which of the following statements is correct regarding gonococcal septic arthritis?

Input: (A) Repeated aspiration of joint fluid increases the chance of infection, and daily aspiration of joint fluid is not recommended. (B) Septic arthritis caused by gonococci can be treated with third-generation cephalosporins. (C) After the onset of arthritis, patients often develop tenosynovitis. (D) Rheumatic arthritis, alcohol abuse, and steroid treatment are all common risk factors. (E) Bacterial cultures of joint fluid are usually positive, and there is no need to culture the cervix or urethra.

Output: B


Instruction: Deep venous thrombosis (DVT) refers to the symptoms of the affected limb caused by the blockage of blood flow in the deep veins. Which of the following is correct?

Input: (A) This disease often occurs in the lower limbs. More than 50% of patients will have symptoms such as redness, swelling, pain and temperature rise in the affected limb. (B) In severe cases, it will cause blue phlebitis (Phlegmasia cerulea dolens), which may cause blood circulation obstruction, causing compartment syndrome and ischemic necrosis of the affected limb. If it is not treated in time, it may even lead to amputation. (C) Homan sign means that the calf will feel extreme pain when the dorsum of the foot is flexed forcefully. It has good sensitivity for diagnosing deep venous embolism. (D) Because duplex ultrasonography is greatly affected by the examiner's technique, it is not a recommended option for deep venous embolism examination of the lower extremities. (E) Outpatient patients taking the anticoagulant drug Warfarin should frequently monitor the international normalized ratio (INR) value, which is recommended to be maintained at 1.0-2.0.

Output: B


Instruction: Which of the following statements is correct for the treatment of snake bites?

Input: (A) Open the wound and suck out the toxin. (B) Apply pressure with a tourniquet to collapse the artery and prevent the artery from transporting toxins throughout the body. (C) Inject antivenom serum directly from the snake species identified by the patient. (D) Do not soak in ice water. (E) Establish an intravenous line in the affected limb so that antivenom can be injected later.

Output: D


Instruction: Many diseases present with shoulder and neck pain as clinical symptoms. Which of the following statements is correct?

Input: (A) When neck pain is accompanied by neurological symptoms, if there is no abnormality in the X-ray, an electromyogram or nerve conduction test should be arranged instead of an MRI. (B) Central cord syndrome will cause the lower limbs to be weaker than the upper limbs. (C) The most common cancer metastases of the cervical spine are gastric cancer and colorectal cancer. (D) Thoracic outlet syndrome is more common in pregnant women. (E) The most common cause of shoulder transfer pain is myocardial infarction.

Output: D


Instruction: The differential diagnosis of infectious diseases often requires consideration of exposure to specific epidemiological risk factors. Which of the following statements about epidemiological risk factors related to infectious diseases is incorrect?

Input: (A) West Nile encephalitis ←→ Eastern Europe, Kazakhstan, Russia. (B) Ebola virus infection ←→ Travel history to West African countries. (C) Leptospirosis ←→ Local typhoons or flooding areas in Taiwan. (D) Meningococcal Meningitis ←→ Sub-Saharan African countries. (E) Malaria ←→ Travel history to Southeast Asia, Africa, and Oceania.

Output: A


Instruction: Which of the following is wrong about the treatment of chemical splashes into the eyes?

Input: (A) Alkaline agents often cause more serious damage than acidic agents. (B) From the first moment, flush with large amounts of water until the pH value returns to normal. (C) Avoid using anesthetic analgesics during the flushing process to avoid affecting the assessment of the injury. (D) If the eyelids are stuck in their normal position due to the 3-second glue spray, consider observation and treatment. (E) All unknown solvents should be treated as acid-base sprays and flushed with large amounts of water.

Output: C


Instruction: Which of the following treatments is wrong for patients with eye pain or red eyes?

Input: (A) Persistent blurred vision requires immediate referral to an ophthalmologist. (B) Topical analgesics and steroids can be given first, and if symptoms do not improve after more than 48 hours, referral to an ophthalmologist should be made. (C) Non-traumatic red eyes without visual changes or severe pain can be given medication first and observed for 48 hours. (D) If the red eye and pain are unilateral and accompanied by headache and vomiting, glaucoma should be considered even if there are no visual changes. (E) Patients who wear contact lenses should be referred to an ophthalmologist.

Output: B


Instruction: Evaluation and comparison of typical symptoms of common causes of potentially life-threatening chest pain. Which of the following statements is incorrect?

Input: (A) Aortic detachment mainly causes severe tearing pain below the sternum and transfers to the back between the shoulder blades. Chest X-rays may show widening of the diaphragm and calcium sign. (B) A young man comes to the clinic with sudden severe pleuritic chest pain, combined with respiratory distress and shock. Physical examination reveals unilateral jugular vein distension and unilateral decreased breath sounds. Needle decompression should be considered at this time. (C) If the patient comes to the clinic with a sudden sharp pain that moves to the back after violent vomiting after drinking alcohol 30 minutes ago, clinically, esophageal rupture should be suspected. If the upper esophageal perforation occurs, diaphragmatic emphysema is rarely seen on chest X-rays. (D) Clinically, Westermark's sign or Hampton hump may occasionally be seen on chest X-rays of pulmonary embolism. (E) Typical acute coronary heart disease is dull pain or pressure behind the sternum or in the upper abdomen, which may be accompanied by nausea, vomiting, cold sweats, and wheezing.

Output: C


Instruction: A 26-week pregnant woman was taken to the emergency room by 119 personnel after her motorcycle collided with a car. Which of the following statements is correct regarding the assessment and treatment of the pregnant woman's injuries?

Input: (A) Even minor injuries may have a significant impact on the fetus, so the fetus should be treated first, and then the pregnant woman's injuries should be assessed. (B) When the pH value of vaginal secretions is around 5, it indicates amniotic membrane rupture. (C) The most common cause of fetal death is placental detachment (abruptio placentae), with a mortality rate of 50-80%. (D) Regardless of the severity of the injury, pregnant women are absolutely contraindicated for radiation examinations such as X-rays and CT. (E) Fetal monitoring should be arranged. At least 4 to 6 hours. If the patient has symptoms such as vaginal bleeding and contractions, the patient should be monitored for 24 hours.

Output: E


Instruction: Regarding Alcoholic Ketoacidosis, which of the following statements is incorrect?

Input: (A) The patient has a large anion gap because of high serum ketones. (B) The patient's blood alcohol level is usually very high. (C) The patient is in a state of starvation and dehydration. (D) Treatment can be given with glucose and saline infusion. (E) Thiamine 50 to 100 mg should be given before glucose to prevent the induction of Wernicke's disease.

Output: B


Instruction: Regarding Nerve gases (nerve poison gas), which of the following statements and treatments are correct?

Input: (A)2-PAM can be used to counteract the muscarinic effects of neurotoxins. (B)Atropine can be used to counteract the nicotinic effects of neurotoxins. (C)Benzodiazepines can be used to treat seizures. (D)GA, GB, GD, and VF are all well-known neurotoxins and are organophosphate poisons. (E)SLUD syndrome is caused by salivation, lacrimation, urination, and desaturation.

Output: C


Instruction: Which of the following statements is correct about Thyroid Storm?

Input: (A)A daily dose of 300 mg of hydrocortisone steroid supplement can be given. (B) Agitation and abnormal liver function are common manifestations of non-thyroid storm. (C) Thyroid storm may cause high body temperature, and acetaminophen or salicylate (salicylic acid) must be given to reduce the body temperature as quickly as possible. (D) Iodine is used to reduce the thyroid hormone T4 in the peripheral blood and convert it into the more active T3 form. (E) Propranolol can not only control tachycardia, but also reduce the release of thyroid hormone from the thyroid gland.

Output: A


Instruction: Which of the following statements about the diagnosis of lower gastrointestinal bleeding is incorrect?

Input: (A) Angiography can only diagnose bleeding when the bleeding volume is greater than 0.5mL/min. (B) Tc-99m-labeled RBC Scintigraphy can diagnose bleeding as long as the bleeding volume is greater than 0.1 mL/min. (C) Computed tomography is not helpful in the diagnosis of lower gastrointestinal bleeding. (D) In general, the diagnostic rate of endoscopy is higher than that of angiography and scintigraphy. (E) If small intestinal bleeding is suspected, the patient can be recommended to be referred to a hospital equipped with capsule endoscopy.

Output: C


Instruction: Which of the following is incorrect about the various risk factors for preeclampsia?

Input: (A) Chronic kidney disease. (B) Multiple pregnancy. (C) Multiparous women. (D) Chronic hypertension. (E) Pre-pregnancy diabetes.

Output: C


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

Input: (A) After an earthquake, the majority of casualties in hospitals are those with fractures or crush injuries. (B) Acute stress disorder often occurs during the recovery period. (C) After a disaster, traumatic injuries usually occur during the acute and recovery periods. (D) After a disaster, vector-borne diseases (such as dengue fever) usually occur during the recovery period. (E) Usually, a large number of deaths occur within the first three hours after a major earthquake.

Output: B


Instruction: Which of the following statements about blunt cardiac trauma is incorrect?

Input: (A) If the ST-T segment is elevated on the electrocardiogram, coronary artery dissection should be considered. (B) When cardiac enzymes are normal, blunt cardiac trauma cannot be ruled out. (C) Transthoracic echocardiography is more sensitive than transesophageal echocardiography (TEE) in diagnosing blunt cardiac trauma. (D) Blunt cardiac trauma is most likely to cause sudden arrhythmia within 24 hours. (E) If the patient suffers from cardiogenic shock, it is necessary to consider whether the patient's heart structure is damaged and surgical treatment is required if necessary.

Output: C


Instruction: Which of the following is incorrect about the treatment of aortic stripping?

Input: (A) An intravenous line should be established immediately and vital signs such as blood pressure, pulse, and heart rhythm should be closely monitored. (B) The patient's blood pressure is usually very high, and the first priority is to lower the blood pressure as quickly as possible with antihypertensive drugs such as labetalol. This should be given as soon as possible before the patient is sent for a CT scan. (C) If the patient's blood pressure is low, necessary infusion or even blood transfusion should be performed, and bedside ultrasound should be used to confirm the possibility of complications such as pericardial tamponade or hemothorax. (D) If Stanford type B (E) If the patient's blood pressure is undetectable and pulseless electrical activity (PEA) is present, mechanical adjuvant therapy such as intra-aortic balloon pump (IABP) or extracorporeal membrane oxygenation (ECMO) should be considered, and the patient should be quickly connected to surgical treatment.

Output: E


Instruction: Which of the following is incorrect about ear diseases and treatment?

Input: (A) Although aminoglycoside is ototoxic, it is a local treatment for otitis externa with a very low chance of absorption causing systemic or local side effects, making it a cheap and safe drug. (B) The main clinical manifestation of Ramsay Hunt syndrome is otalgia. (C) When ear pain (otalgia) occurs, mandibular impacted molars or molar abscesses should also be included in the common differential diagnosis. (D) NSAID drugs including aspirin are common causes of drug-induced tinnitus. (E) Mumps infection may lead to hearing loss as a complication.

Output: A


Instruction: Which of the following statements about the Tourniquet Test is incorrect?

Input: (A) The pressure of the blood pressure cuff is the average of the systolic and diastolic pressures. (B) Place a blood pressure cuff on the upper arm for 10 minutes and observe the number of punctate hemorrhages within a 1-inch square on the forearm. (C) A positive reaction is considered if 20 or more punctate hemorrhages are present per square inch (6.25 square centimeters). (D) The test can be repeated if the previous test was negative or there was no bleeding. (E) This test is helpful in the clinical diagnosis of dengue fever.

Output: B


Instruction: Which of the following statements is correct regarding the use of medications during rapid sequence intubation?

Input: (A) Fentanyl should not be used in patients with coronary artery disease. (B) Lidocaine should not be used in patients with asthma attacks. (C) Ketamine can be used in patients with low blood pressure. (D)diazepam is suitable for induction. (E)rocuronium has a sedative effect, so it is not necessary to use an induction drug at the same time.

Output: C


Instruction: Which of the following statements about rabies and rabies vaccine injection is incorrect?

Input: (A)Rabies is a Class I notifiable infectious disease. (B)Rabies vaccine may not be given temporarily if bitten by a domestic dog. (C)If bitten by a wild dog, the first dose of rabies vaccine should be injected immediately. If possible, the wild dog should be observed for 10 days. If there are no symptoms, vaccination can be stopped. (D)If bitten by a wild dog, if the wound exposure level is Class II, it is recommended to inject rabies immunoglobulin at the same time. (E) The number of rabies vaccines injected after the first exposure is 5 times, and the second dose of vaccine is injected on the 3rd day after the first dose.

Output: D


Instruction: Which of the following statements about children's rash diseases is correct?

Input: (A) To avoid complications of bacterial infection, local steroids should be avoided in the treatment of neonatal atopic dermatitis. (B) If a child has a persistent high fever due to varicella, consider alternating the use of acetaminophen and aspirin to enhance the antipyretic effect. (C) Measles, enterovirus, and herpes simplex virus may all cause lesions on the mucosa. (D) A 12-year-old child who develops a rash all over his body 3 days after having a headache and fever and whose cuff test is positive should report dengue fever to the CDC within 1 week. (E) Scarlet fever is a common Staphylococcus aureus infection in school-age children and can be treated with Oxacillin.

Output: C


Instruction: Which of the following statements is incorrect about the treatment of children who swallow foreign objects?

Input: (A) If a button battery is swallowed and confirmed to be in the stomach by X-ray and the child has no symptoms, he can be sent home for observation and arranged for outpatient follow-up. (B) If a sharp object is swallowed and has passed through the duodenum, the most common site of intestinal perforation is the ileocecal valve. (C) If a blunt object (such as a coin) is stuck in the esophagus, the patient can observe it for 48 hours without symptoms. If it is still in the esophagus, it needs to be removed. (D) If a button battery is stuck in the esophagus, it may cause esophageal perforation within 6 hours and must be removed as soon as possible. (E) If an X-ray confirms that a sharp object is in the stomach after accidental swallowing, and the patient has no symptoms, it must still be removed as soon as possible.

Output: C


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

Input: (A) A temporary loss of consciousness and muscle tone. When arriving at the emergency room, patients often recover spontaneously. In half of cases, the cause may not be found. (B) The causes are all benign, such as vasovagal event, so patients should not worry. (C) Vasovagal event is caused by excessive sympathetic excitement, resulting in excessive heart rate. (D) Common causes of carotid sinus hypersensitivity include: boys shaving, tight collars, and turning heads. It is common in young patients. (E) San Francisco Syncope Rules Rule) can screen out patients who are prone to complications and need hospitalization within a short period of time after syncope, and the subsequent examination must focus on neurology.

Output: A


Instruction: Which of the following statements about the treatment of acute coronary heart disease is incorrect?

Input: (A) According to the American Heart Association treatment guidelines, if the onset time is less than 12 hours, and the ST wave of the precordial leads V1 to V5 on the electrocardiogram shows a 3mm decrease, and only the aVR lead shows an ST wave increase of more than 1mm, immediate cardiac catheterization and coronary intervention should be considered. (B) If the ST wave of V1 to V4 rises by 3mm and the patient still has severe chest pain, but it has been 14 hours since the onset, coronary intervention should not be considered. (C) If the patient has severe acute pulmonary edema, emergency cardiac catheterization surgery should be performed even if the onset time has exceeded 12 hours. (D) If the patient presents with severe cardiogenic shock, emergency cardiac catheterization should be considered regardless of the time since the onset of the attack. (E) If the patient has an ST-segment elevation myocardial infarction (STEMI) with an onset within 12 hours, your hospital cannot perform coronary intervention, and the patient is not suitable for thrombolytic therapy because of a history of cerebral hemorrhage, then even if the transfer takes 1 hour, you should try to transfer to another hospital for coronary intervention.

Output: B


Instruction: Which of the following statements about the emergency assessment and treatment of acute asthma is incorrect?

Input: (A) FEV1 less than 40% is a severe asthma attack. (B) Give oxygen therapy to maintain SaO 2≧ 90%. (C) After treatment, FEV1 has reached 50%, indicating that the treatment is effective and the patient can be considered to go home without hospitalization. (D) Low socioeconomic class or chronic mental illness history are risk factors for death from asthma. (E) Arterial blood gas analysis of pregnant women with asthma PaCO₂ within the normal range often indicates that carbon dioxide has begun to accumulate in the blood.

Output: C


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

Input: (A) A blood test of a patient with acute abdominal pain revealed a normal white blood cell count, and it is not possible to rule out the need for surgery. (B) A young woman with lower abdominal pain comes to the clinic. She has a history of pelvic inflammation in the past, and the possibility of ectopic pregnancy should be considered. (C) Diverticulitis is more common in men and its incidence increases with age. It is often located in the sigmoid colon. (D) Severe upper abdominal pain accompanied by nausea, vomiting, and cold sweats requires consideration of an electrocardiogram. (E) X-ray findings of patients with intestinal perforation show free air in most cases, except for a small number of 5% of patients.

Output: E


Instruction: Which of the following statements about severe enterovirus disease is incorrect?

Input: (A) Enterovirus 71 is the main cause in Taiwan. (B) The direct cause of death is renal failure. (C) Most patients with severe complications have brain stem encephalitis. (D) Persistent lethargy, persistent vomiting and myoclonic jerks are the three major precursors of severe illness. (E) The mortality rate of critically ill patients is about 3% to 20%.

Output: B


Instruction: Which of the following statements about peritonitis in peritoneal dialysis is incorrect?

Input: (A) Antibiotics can be given first with the first-generation cephalosporin. (B) In terms of treatment, antibiotics can be added to the dialysate and do not need to be given intravenously. (C) The most common bacteria causing peritonitis is Staphylococcus aureus, accounting for about 40%. (D) The recommended treatment period is 7 to 10 days. (E) The white blood cell count in the dialysate is usually greater than 100/mm³, and the neutrophil count is greater than 50%.

Output: C


Instruction: Which of the following statements about bladder rupture is incorrect?

Input: (A) Extraperitoneal rupture is more likely to cause infection and intra-abdominal ulcer formation than intraperitoneal rupture. (B) Extraperitoneal rupture is more common than intraperitoneal rupture. (C) Extraperitoneal rupture of the bladder is treated with catheter drainage. (D) Intraperitoneal rupture of the bladder requires surgical exploration and bladder repair. (E) The gold standard for diagnosis is retrograde cystogram.

Output: A


Instruction: Which of the following statements about diabetic ketoacidosis is correct?

Input: (A) It only occurs in patients with insulin-dependent type. (B) The diagnostic criteria are blood glucose greater than 400 mg/dL, anion gap greater than 10, bicaronate less than 15 mEq/L, and pH less than 7.3. (C) As the patient is dehydrated, it is recommended to start with 0.45% normal saline. (D) The course of the disease is usually longer than that of hyperosmotic non-ketoacid coma. (E) The patient is about 5 to 10 liters of water short.

Output: E


Instruction: Which of the following statements and treatments is wrong about radiation damage?

Input: (A) For systemic radiation injuries, the patient's body excretions, including sputum, urine, feces, and vomitus, should be collected for radioisotope analysis. (B) For patients with only internal radiation contamination, the onset time of all symptoms should be recorded just like patients with systemic radiation injuries. (C) Even if the patient is only externally contaminated, CBC/DC and urinalysis should still be obtained from the patient. (D) The patient was exposed to a high whole-body dose of 30Gy and died after 3 days of severe shock and circulatory system collapse. (E) The patient was exposed to a whole-body dose of 4Gy and developed acute hematopoietic syndrome after a 3-week latent period. Infection and bleeding may occur.

Output: D


Instruction: A 32-year-old female was sent to the hospital for suicide by taking pesticides. The patient seemed to be in pain, vomiting, spitting out light blue-green foam from the mouth, and wheezing. Blood pressure 92/60 mmHg, respiratory rate 26 times/min, pulse 114 times/min, body temperature 36℃, blood oxygen concentration 88%, and the patient's oral mucosa had burn marks. Which of the following statements is most appropriate?

Input: (A) Give oxygen as soon as possible to reduce alveolar fiber production. (B) Hemodialysis within 6 hours is helpful. (C) It is well absorbed through normal skin and is easily poisoned after skin contact. (D) The concentration in the blood is an important basis for judging the prognosis. (E) Give antioxidants, such as superoxide dismutase It can inhibit substances from entering alveolar cells.

Output: D


Instruction: Which of the following statements about blast injuries is incorrect?

Input: (A) It may cause arterial gas embolism and produce neurological symptoms. (B) The most common cause of death in victims of primary blast injuries is intraperitoneal hemorrhage. (C) Primary blast injuries are likely to affect the victim's auditory system, respiratory system, and gastrointestinal system. (D) Primary blast injuries may cause delayed gastrointestinal rupture in victims, so the victim may even need to be observed for 48 hours to confirm. (E) Victims with isolated tympanic membrane rupture caused by the explosion should usually still undergo a chest X-ray examination.

Output: B


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

Input: (A) Status epilepticus (status (B) Epilepsy caused by alcohol withdrawal usually does not require long-term antiepileptic drug treatment. (C) Antiepileptic drugs are teratogenic and are not recommended for continued use in pregnant women with a history of epilepsy or epileptic symptoms. (D) Patients with epilepsy who do not respond well to lorazepam and phenytoin may also not respond to barbiturates. (E) Patients suspected of bacterial meningitis should be started on empirical antibiotics.

Output: C


Instruction: An 18-year-old female with a history of autoimmune hemolytic anemia seeks medical attention because of paleness and shortness of breath over the past 5 days. Which of the following statements about the management of this patient is incorrect?

Input: (A) The first-line treatment is high-dose corticosteroids. (B) Anti-immune drugs such as azathioprine 2~4mg/kg/day or cyclosporine can be used to reduce the steroid dose. (C) After splenectomy, the patient can be cured and will never relapse. (D) To prevent overwhelming post-splenectomy infection after splenectomy, the patient should be vaccinated with streptococcal vaccine. (E) In the acute phase, in addition to replenishing concentrated red blood cells (PRBC), plasma dialysis or exchange transfusion can also effectively remove autologous antibody concentrations.

Output: C


Instruction: A 1-year-old infant has a fever with no obvious source of infection. Which of the following statements is correct?

Input: (A) Routine urinalysis is not required. (B) For those at risk of urinary tract infection, bacterial culture is not required if the urinalysis is negative. (C) The sensitivity and specificity of Gram's staining of urine for bacterial identification in diagnosing urinary tract infection is less than 60%. (D) The accuracy of bag collection specimen in diagnosing urinary tract infection is very low. (E) Antibiotics should be used immediately without waiting for the receipt of urine specimens.

Output: D


Instruction: A 23-year-old male returned to Taiwan from Sao Tome and Principe, Africa, one week ago. He went to the emergency room complaining of a high fever of 40.2℃, tremors, general weakness, and abdominal pain. His pulse was 122 beats/min and his respirations were 24 breaths/min. There was no obvious rash on his body and no joint pain. Laboratory tests revealed total bilirubin 4.9mg/dL, direct bilirubin 1.1mg/dL, SGPT (ALT) 247 U/L, and SGOT (AST) 236 U/L. Ultrasound examination revealed an enlarged liver, but no gallstones or bile duct enlargement, nor liver abscesses. Which of the following tests is most helpful for diagnosis?

Input: (A) Blood smear. (B) Hepatitis markers. (C) Leptospiral microscopic agglutination test. (D) Abdominal CT. (E) Stool examination for parasites and eggs.

Output: A


Instruction: A 27-year-old male was stung by a stonefish on his left palm while diving. The local redness and swelling gradually extended to the arm and the pain was unbearable, so he sought medical attention. His vital signs were stable, and he had no shortness of breath or heart discomfort. Which of the following statements is correct?

Input: (A) Local soaking in hot water. (B) Antidote serum (antivenom) should be used. (C) Antibiotics should be injected. (D) Common hemorrhagic poisoning reaction. (E) Use large amounts of intravenous infusion for treatment.

Output: A


Instruction: A 28-year-old female, 26 weeks pregnant, was hit by a bus while crossing the road. When she was taken to the emergency room by ambulance, she was conscious, with a respiration rate of 26 breaths/min, a pulse of 140 beats/min, a blood pressure of 80/50 mmHg, and a body temperature of 36°C. The patient complained of abdominal pain and a small amount of vaginal bleeding. Which of the following statements about this patient is incorrect?

Input: (A) She can lie on her left side to avoid the uterus compressing the inferior vena cava. (B) The height of the fundus of this patient's uterus should be above the height of her belly button. (C) The amount of blood loss in this patient may have reached more than 30% of her total blood volume. (D) The pH of the vaginal secretions was 7.0, which should highly suspect amniotic membrane rupture. (E) The patient's blood type is Rh negative, and the fetus's father's blood type is also Rh negative, so the dose of Rh0(D) immunoglobulin needs to be doubled.

Output: E


Instruction: A 28-year-old male computer repairman was accidentally sprayed with hydrofluoric acid on the back of his hand and arm while working. The area was red, swollen and painful. He immediately sought medical attention after rinsing. After examination, the back of the hand and arm showed a local corrosive appearance and unbearable pain. Vital signs were measured: blood pressure 127/51 mmHg, respiration 16 times/min, pulse 52 times/min, body temperature 36.2℃, and clear consciousness. Which of the following statements is correct?

Input: (A) Rinse with plenty of clean water until the pain disappears. (B) Apply magnesium oxide ointment topically and inject calcium gluconate solution. (C) Severe pain and swelling, perform fasciotomy. (D) Use preventive antibiotics. (E) Hypercalcemia, hypermagnesium, and hypokalemia occur.

Output: B


Instruction: A 30-year-old female was sent to the emergency room due to high fever, cough, and weakness. In the emergency room, her temperature was 38.5℃, blood pressure was 110/70mmHg, pulse was 105 beats/min, and blood oxygen concentration was 95%. Physical examination revealed multiple pinholes in the patient's arms and heart murmurs. Lung X-ray and urine test were normal. Which of the following statements is wrong?

Input: (A) This patient needs to be referred to the cardiology department for a cardiac ultrasound. (B) If two blood cultures show bacteria, it can be considered a major criterion for the diagnosis of infective endocarditis. (C) A fever above 38°C is also a major criterion for diagnosis. (D) Use Vancomycin + Gentamicin + Nafcillin for treatment. (E) Some patients may see painless bleeding spots on their palms and soles.

Output: C


Instruction: A 36-year-old 8-month pregnant woman with a history of diabetes was seen collapsing while waiting for a prenatal check-up. You are the first medical staff to arrive at the scene. According to the 2015 AHA ACLS guidelines, you begin first aid. Which of the following actions is incorrect?

Input: (A) If the patient is unresponsive and unrespirable, ask the clinic nurse to activate the hospital emergency response system to obtain a defibrillator and support. (B) Tilt the patient to 27-30 degrees to the side to facilitate high-quality CPR. (C) If the patient's heart stops beating for 4 minutes, consider performing a perimortem cesarean delivery (PMCD). (D) There is no need to use Vasopressin instead of the second dose of Epinephrine. (E) If the patient's heartbeat and breathing are restored, consider hypothermia treatment for the patient.

Output: B


Instruction: A 38-year-old male complained of numbness and weakness in his limbs after a car accident. His vital signs are as follows: pulse 88 beats/min, blood pressure 70/40 mmHg. Which of the following statements is incorrect?

Input: (A) Neurogenic shock should be suspected only after other possible causes of shock have been ruled out. (B) Clinical signs of neurogenic shock are low blood pressure, slow pulse and cold extremities. (C) If neurogenic shock is suspected, pressors can be used after giving appropriate fluids. (D) Spinal cord injury above the fifth cervical vertebra may cause phrenic nerve injury in patients. (E) The use of high-dose steroids for spinal cord injury caused by contusion is still controversial.

Output: B


Instruction: A 39-week-old female baby was born with cyanosis, poor motility, and a pulse of 40 beats/min. After 60 seconds of bag-valve-mask positive pressure ventilation and chest compression, the pulse is still less than 60 beats/min. Which of the following procedures is more appropriate?

Input: (A) Place an endotracheal tube and inject Epinephrine intravenously. (B) Continue chest compression and ventilation at a ratio of 30:2 for 1 minute. (C) Place an endotracheal tube and inject Atropine intravenously. (D) Stop chest compression and start ventilation with oxygen. (E) Stop chest compression and place an endotracheal tube and ventilate with air.

Output: A


Instruction: A 40-year-old male was taken to the emergency room for two days of unexplained wheezing and was later diagnosed with pulmonary embolism. Which of the following statements is incorrect?

Input: (A) Common symptoms of pulmonary embolism are low blood oxygen, rapid heartbeat, rapid breathing, coughing up blood, cold sweats, and fever. (B) There is about a 50% chance of finding a deep vein thrombosis (DVT) in a patient. (C) If the emergency physician responsible for the diagnosis believes that the patient's risk of pulmonary embolism is extremely low and all of the Pulmonary Embolism Rule-Out Criteria (PERC Rule) are met, it is reasonable not to arrange any more tests for pulmonary embolism. (D) The severity of the symptoms is related to the size of the embolism in the pulmonary artery. (E) The patient's blood pressure dropped to 80/50 mmHg, which can be defined as massive pulmonary embolism (massive PE).

Output: D


Instruction: A 42-year-old male was treated in a mainland China hospital for 3 days due to acute illness and his vital signs are currently stable. Which of the following situations is more suitable for air transfer back to Taiwan for treatment?

Input: (A) Duodenal perforation, post-surgery. (B) Retina peeling, post-laser surgery. (C) Bloody stool, pancolonic endoscopy combined with polypectomy. (D) Femoral fracture surgery. (E) 10% pneumothorax.

Output: B


Instruction: A 45-year-old female traveled to Tibet and developed difficulty breathing and coughed up frothy, bloody sputum at the Everest Base Camp (5,200 meters). Which of the following treatments is least recommended?

Input: (A) Give oxygen. (B) Descend. (C) Use Viagra (Sildenafil). (D) Use Nifedipine. (E) Use the diuretic Lasix.

Output: E


Instruction: A 45-year-old male with a history of diabetes. He underwent weight loss surgery (gastric bypass, Roux-en-Y gastric bypass) one month ago. The patient is undergoing a bypass surgery. He reports that he had just had dinner with friends. One hour after eating, he developed nausea, vomiting, abdominal cramps, abdominal distension, and diarrhea, accompanied by cold sweats. His blood pressure was 95/62 mmHg, his pulse was 106 beats/min, his respirations were 18 breaths/min, his temperature was 36.5°C, and his finger-stick blood glucose was 45 mg/dL. Which of the following postoperative complications is most likely?

Input: (A) Bowel obstruction. (B) Anastomotic leakage. (C) Enteric leak. (D) Cholelithiasis. (E) Dumping syndrome.

Output: E


Instruction: A 45-year-old male alcoholic with jaundice and ascites goes to the emergency room due to low blood pressure and general weakness. Which of the following statements is correct?

Input: (A) If there is no fever and abdominal pain, spontaneous peritonitis can be ruled out in most cases. (B) The annual incidence of spontaneous peritonitis in patients with ascites is about 70%. (C) The six-month survival rate of the first spontaneous peritonitis is about 70%. (D) Most pathogens are Enterobacteriaceae. (E) A white blood cell count >250/mm³ in ascitic fluid analysis can diagnose spontaneous peritonitis.

Output: D


Instruction: A 47-year-old male was prescribed Seroquel (Quetiapine) and Lexotan (Bromazepam) to treat his mental illness. His family found him unconscious with stiff and shaking limbs and sent him to the hospital. Vital signs measured: blood pressure 147/51 mmHg, respiration 21 times/min, pulse 162 times/min, coma index: E4M1V1, temperature 39.2℃. Physical examination revealed that the patient was sweating, his pupils were equal and reactive to light, and his limbs were stiff. Blood draw results showed no obvious abnormalities in liver and kidney function. What syndrome is the patient most likely to have?

Input: (A)Cholinergic toxidrome. (B)Anticholinergic toxidrome. (C)Sympathomimetics. (D) Serotonin syndrome. (E) Neuroleptic malignant syndrome.

Output: E


Instruction: A 50-year-old male presented to the emergency department with sudden onset of left upper abdominal pain and vomiting. His past medical history included hiatal hernia and gastroesophageal reflux disease. Vital signs on physical examination were blood pressure 86/40 mmHg, pulse 121 beats/min, temperature 37°C, respiration 20 breaths/min, and blood oxygen concentration 98%. The main abnormalities on physical examination were epigastric distension and pain, tympanic percussion, and decreased breath sounds in the left lower lung. Attempts to insert a nasogastric tube were unsuccessful and could not be inserted. Laboratory reports found lactate 28mg/dL, pH 7.13, HCO₃- 8.1, Hb 12 g/dL. Chest X-ray revealed a distended stomach above the diaphragm. In addition to appropriate fluid therapy, which of the following is more appropriate?

Input: (A) Consult for surgical treatment. (B) Arrange for gastroscopy. (C) Transfuse PRBC. (D) Intravenous injection of sodium bicarbonate. (E) Insert an orogastric tube.

Output: A


Instruction: A 4-year-old girl accidentally swallowed an unknown object. Which of the following statements is incorrect?

Input: (A) If an X-ray reveals an opened paper clip in the stomach, regardless of its size, the child should be taken to a pediatric gastroenterologist for immediate removal. (B) If a mother recalls that a button battery is missing from the table, an X-ray should be taken immediately. (C) If the child has congenital esophageal atresia and has undergone surgery, an esophagogram or endoscopy should be performed if the child is feeling unwell. (D) If a small, smooth, round, non-corrosive object is lodged in the middle of the esophagus, it can be observed for 36 hours. (E) If you are concerned about whether the foreign body in the stomach has been expelled from the body, an X-ray can be taken every 3 to 5 days.

Output: D


Instruction: A 5-year-old, 20-kg boy was hit by a car that ran a red light while crossing the road. He was taken to the emergency room by ambulance. His temperature was 35°C, his respiratory rate was 30 breaths/min, his pulse was 160 beats/min, his blood pressure was 70/40 mmHg, and his GCS was E1V2M4. Bedside ultrasound revealed hemothorax and a small amount of intraperitoneal bleeding. Which of the following statements about the first aid of this patient is incorrect?

Input: (A) Considering endotracheal intubation to protect the airway, a No. 5 cuffed endotracheal tube can be used. (B) After the right chest tube was placed, 150 ml of blood was immediately drained, and an immediate operative thoracotomy was required. (C) Rapid infusion of saline solution can be repeated 3 times, 400 ml each time. If the blood pressure is still low, another 200 ml of PRBC can be transfused. (D) If peripheral blood vessels cannot be injected, consider placing an intraosseous injection in the proximal tibia and drawing blood with the bone needle for blood preparation. (E) The infusion for this patient needs to be warmed first and hypothermia should be avoided.

Output: B


Instruction: A 5-year-old child fell from a height of about 60 cm 1 hour ago and has a 2*2 cm hematoma on the scalp. Which of the following statements is most appropriate?

Input: (A) If there is no neurological abnormality, a head CT examination should still be performed to rule out intracranial hemorrhage. (B) If a 5-year-old child has a scalp hematoma, the risk of fracture or intracranial hemorrhage is higher than that of a child under 2 years old. (C) If there are no neurological symptoms, no imaging examination is required and the patient can be sent home immediately. (D) After 4 hours of observation in the emergency department, if there are no neurological symptoms, the patient can be sent home without imaging examination. (E) The CT examination results are normal. 20% of patients will develop delayed neurological symptoms.

Output: D


Instruction: A 60-year-old male suddenly developed chest pain, which was as sharp as a knife in the front of the chest and cold sweats on the back. The blood pressure was 200/100 mmHg and the pulse was 100 beats/min. Ultrasound showed a dissection flap in the aorta. Which of the following statements is wrong?

Input: (A) When a young person is diagnosed with this disease, other causes should be sought, such as congenital cardiovascular disease, trauma or pregnancy. (B) The Stanford classification system is used to distinguish between type A and type B, with the brachiocephalic artery as the basis for classification. (C) The location of pain usually cannot reflect the location of the lesion, and the location of pain will change. (D) It often manifests as hypertension. When hypotension or shock occurs, pericardial tamponade, aortic hemorrhage, severe aortic regurgitation or myocardial infarction should be considered. (E) The best choice for controlling blood pressure is β-blockers, and the goal is to reduce the heart rate to 60-70 beats/min.

Output: A、B、C、D、E


Instruction: A 60-year-old male presents with OHCA. The electrocardiogram shows PEA (pulseless electrical activity). Echocardiography reveals significant right ventricular enlargement. Which of the following diagnoses is most likely?

Input: (A) Pericardial tamponade. (B) Hypovolemia. (C) Acute myocardial infarction. (D) Pulmonary embolism. (E) Tension pneumothorax.

Output: D


Instruction: A 60-year-old chronic alcoholic patient did not drink in the morning. In the evening, he went to the emergency room complaining of palpitations, nausea, and vomiting. Blood tests showed: pH 7.2, sodium bicarbonate: 6 mmol/L, sodium: 135 mmol/L, potassium: 4.0 mmol/L, chloride: 105 mmol/L, ketone body positive reaction, blood sugar: 110 mg/dL, lactate: 2.0 mmol/L. Which of the following descriptions is correct?

Input: (A) Methanol poisoning does not produce ketone bodies, and the acidosis caused by methanol poisoning is more serious. (B) The most common complication after massive infusion treatment of this disease is cerebral edema. (C) Infusions containing sugar should not be used to treat this disease. (D) Insulin can reduce the production of ketone bodies and is very beneficial for the treatment of this disease. (E) If the blood pH is less than 7.2, sodium bicarbonate should be given routinely to treat acidosis.

Output: A


Instruction: A 62-year-old male with prostate cancer is undergoing radiation therapy. He has had occasional fecal incontinence and tenesmus in the past 3 days and has started to have diarrhea with bloody stools today. Vital signs are blood pressure 136/78 mmHg, pulse 84 beats/min, and temperature 37.2℃. Physical examination shows that the abdomen is soft to the touch. Anal examination revealed diffuse tenderness, blood, and intact anal tone. Muscle strength, deep tendon reflexes, and sensation in both lower limbs were symmetrical and intact. Which of the following treatments is the most appropriate?

Input: (A) Empirically administer ceftriaxone and doxycycline. (B) Analgesics and oral sucralfate. (C) Intravenous pantoprazole. (D) Consult a surgeon for surgery. (E) Insert an anal cannula for decompression.

Output: B


Instruction: A 64-year-old female, who used to take unidentified pain medications, came to the clinic recently with loss of appetite and general weakness. Her vital signs were: temperature 36.9℃, pulse 68 beats/min, respiration 14 times/min, blood pressure 86/54mmHg, SpO₂: 98%, blood sugar 126mg/dL. Which of the following statements is incorrect?

Input: (A)Adrenal crisis may occasionally present with acute abdominal pain as a clinical manifestation. (B)Adrenal insufficiency may also present with clinical symptoms such as headache, confusion, visual changes, or gastrointestinal symptoms. (C)If serum cortisol is greater than 18mg/dL, adrenal insufficiency can generally be ruled out. (D)Primary adrenal insufficiency is easily found to have low potassium and low sodium levels in blood tests. (E)If the patient has hypotension, he can be given fluid supplements according to the emergency procedures for shock. If there is no response, consider giving hydrocortisone (100mg iv bolus).

Output: D


Instruction: A 65-year-old female with a history of hypertension and atrial fibrillation presented to the emergency department with dizziness and vomiting. Which of the following statements about this case is incorrect?

Input: (A) If there is unsteady gait, weakness of the ipsilateral facial muscles and loss of corneal reflex, a cerebellopontine angle tumor should be considered. (B) If the vertigo is sudden and accompanied by hearing loss, labyrinthitis should be considered. (C) If it is Meniere's Disease, the symptoms may last up to 12 hours and the frequency may range from several times a week to several times a month. (D) The clinical symptoms of peripheral vertigo are mainly treated with H2 antihistamines. (E) The use of calcium channel blockers can relieve the clinical symptoms of peripheral vertigo.

Output: D


Instruction: A 70-year-old male received general anesthesia and surgery for a femoral neck fracture 10 days ago. He now goes to the emergency room for unilateral leg pain and dyspnea. His vital signs are blood pressure 110/60 mmHg, pulse 130 beats/min, respiration 30 times/min, and temperature 37°C. Which of the following statements is correct?

Input: (A) Chest X-ray Westermark sign or Hampton hump has a high specificity for diagnosing pulmonary embolism. (B) When the right ventricular pressure is greater than 40 mmHg, inverted T waves can be found in V5 and V6 of the electrocardiogram. (C) D-dimer may show higher values due to hyperlipidemia or symptoms lasting more than five days. (D) Arterial blood gas analysis can reveal a decrease in alveolar-arterial oxygen tension gradient. (E) At this point, the patient will do better with thrombolytic therapy than heparin.

Output: A


Instruction: A 75-year-old female, who had been bedridden for a long time due to a stroke, is usually cared for in a nursing home and has a nasogastric tube. She vomited and coughed after a feeding at noon. She also had dyspnea and persistent cough at night and was sent to the emergency room from the nursing home for treatment. Which of the following statements about the patient's clinical treatment is correct?

Input: (A) Antibiotics should be used preventively as long as there is a cough. (B) The use of steroids can prevent lung injury. (C) If aspiration pneumonia occurs, the most common pathogen is S. aureus. (D) The broad-spectrum antibiotic Levofloxacin can be used. (E) For patients whose condition is stable, they can be transferred back to the nursing home for care if they remain stable after 24 hours of observation.

Output: E


Instruction: A 76-year-old male sought medical attention due to unconsciousness. He has recently complained of diarrhea and abdominal pain. Vital signs are: temperature 39℃, pulse 140 beats/min, respiratory rate 20 times/min, blood pressure 148/98mmHg, SpO₂: 92%. Breath sounds were wet during auscultation, and blood tests revealed that the patient had hyperthyroidism. Which of the following statements is incorrect?

Input: (A) In differential diagnosis , in addition to infectious diseases, other diseases such as drugs, thyroid diseases, malignant neuroleptic syndrome or pheochromocytoma should be considered. (B) Thyroid storm is mainly diagnosed through clinical symptoms, and Burch and Wartofsky's Diagnostic Parameters and Scoring Points can also be used as a basis for diagnosis. (C) Symptoms of heart failure can be seen in thyroid storm. (D) Patients with high fever during thyroid storm should not use aspirin to reduce fever to avoid Reye syndrome. (E) This patient should be treated with methimazole first, and then iodine such as Lugol solution 1 to 2 hours later.

Output: D


Instruction: An 88-year-old male was hit by a car while crossing the road. His family said that he usually has mild dementia and takes medication. He also took anticoagulants for heart valve surgery. When he was sent to the emergency room, he had abrasions on his face, chest and abdomen, and a hematoma on the back of his brain. His vital signs were as follows: pulse 88 beats/min, blood pressure 105/70mmHg. The patient could not answer questions correctly. Which of the following statements is wrong?

Input: (A) Although there is no increased heart rate, the blood pressure may still be lower than usual, so we should inquire carefully. (B) The family members said that the consciousness is not much different from usual, so there is no suspicion of cerebral hemorrhage. (C) Blood gases and lactate can be used to assess the prognosis of patients in shock. (D) Be very careful when using contrast agents to examine elderly people in shock, as it may worsen the patient's renal function. (E) The probability of subdural hemorrhage (SDH) in elderly people with head trauma is higher than that of epidural hemorrhage (EDH).

Output: B


Instruction: An 8-month-old infant with Tetralogy of Fallot was taken to the emergency room by his mother because he developed systemic cyanosis after a bout of crying. After evaluation, the doctor believed that it was a blue spell and prescribed intravenous morphine, but due to the urgency of the situation, the nurse gave 10 times the therapeutic dose. Which of the following statements is least appropriate?

Input: (A) The treatment of this patient is mainly based on the following five principles: provide supportive treatment, prevent or reduce the absorption of toxins, increase the excretion of toxins, consider giving antidotes and prognosis assessment. (B) The pupil may shrink to the size of a pinpoint. (C) If the infant has impaired consciousness, consider giving intravenous injection of flumazenil. It can improve the infant's consciousness. (D) If the infant has symptoms such as coma and respiratory depression, give intravenous injection of naloxone antidote to improve the infant's symptoms. (E) When acute morphine poisoning causes respiratory depression, consider endotracheal intubation and use of a ventilator to maintain airway patency and respiratory function.

Output: C


Instruction: Which of the following most needs an emergency thoracotomy (resuscitative thoracotomy) in the emergency department?

Input: (A) A 25-year-old male driver was not wearing a seat belt and hit a street light. His steering wheel was deformed. When he arrived at the hospital, his cardiopulmonary function stopped and his electrocardiogram showed pulseless electrical activity (PEA). (B) A 60-year-old male was stabbed in the left anterior chest with a sharp knife. When he arrived at the hospital, his cardiopulmonary function stopped and his electrocardiogram showed PEA. (C) A 16-year-old male fell from a tree and was pierced through the chest by a branch. When he arrived at the hospital, his blood pressure was 80/40 mmHg. (D) A 40-year-old female was stabbed in the left anterior chest with a sharp knife. When she arrived at the hospital, her cardiopulmonary function stopped and her pupils had no light reflex. (E) A 20-year-old male was hit in the chest by a baseball and fell to the ground. When he arrived at the hospital, he was in cardiopulmonary arrest and his electrocardiogram showed ventricular fibrillation.

Output: B


Instruction: Which of the following patients is not at high risk for cervical spine injury?

Input: (A) A 30-year-old male pickup driver overturned on the highway. He was conscious and able to walk. One of his passengers died. (B) A 35-year-old female pedestrian was hit by a high-speed car that ran a red light while crossing the road. She now has neck pain. (C) A 40-year-old male worker fell from a 6-meter-high scaffold. He had no obvious neurological symptoms. (D) A 50-year-old male driver was hit by a car behind him when he stopped at a red light 1 day ago. He now has back neck pain. (E) An 80-year-old male fell and hit his head while walking. He was conscious, and a CT scan of his head revealed subdural hemorrhage.

Output: D


Instruction: Which of the following descriptions and treatments for pelvic fractures is incorrect?

Input: (A) Once a pelvic fracture is confirmed, the possibility of abdominal, retroperitoneal, reproductive and urinary system injuries must be ruled out. (B) Pelvic fracture injuries with unstable hemodynamics should be promptly arranged for angiography and embolization therapy. (C) Lateral compression is the most common mechanism leading to pelvic fractures. (D) Pelvic fractures lead to retroperitoneal bleeding, the main sources of which are venous and fracture edge bleeding, and arterial bleeding accounts for only 10-15%. (E) In addition to embolization, pelvic fixation can also control retroperitoneal bleeding, but it is more effective for venous and fracture edge bleeding.

Output: B


Instruction: Which of the following statements about intestinal obstruction is incorrect?

Input: (A) In developed countries, the most common cause is postoperative adhesions, followed by tumors and hernias. (B) In children aged 6 to 36 months, intussusception is the most common cause of obstruction. (C) The chance of recurrence of small bowel obstruction increases with the number of previous small bowel obstructions caused by postoperative adhesions. (D) Closed-loop intestinal obstruction has a higher risk of causing strangulation. (E) Bacterial translocation is common in simple intestinal obstruction. Routine antibiotic treatment is recommended for patients treated conservatively.

Output: E


Instruction: A middle-aged man sought medical attention for abdominal pain after heavy drinking. Examination revealed low blood pressure and a high anion gap (high anion gap) metabolic acidosis, which of the following statements is incorrect?

Input: (A) The absence of ketone in the blood does not rule out the diagnosis of alcoholic ketoacidosis. (B) First, give a normal saline solution containing 5% sugar water as an infusion, then change to half saline containing 5% sugar water as a maintenance infusion until oral intake is restored, and supplement potassium and magnesium. (C) The blood sugar of patients with alcoholic ketoacidosis may be slightly higher or lower than normal. (D) If the patient's arterial blood pH is lower than 7.2, consider supplementing with sodium bicarbonate to avoid fatal arrhythmias caused by acidemia. (E) Large amounts of fluids should be given and vitamin B1 (thiamine) should be used regularly.

Output: D


Instruction: A middle-aged man went to the emergency room due to fever and cough for several days. Chest X-ray showed pulmonary abscess. Which of the following statements is correct?

Input: (A) Lemierre's syndrome can occur after tonsillitis. (B) Multiple pulmonary abscesses are very common and are mostly caused by hematogenous infection. (C) The common pathogens in patients with normal immunity are aerobic bacteria, while those in patients with low immunity are anaerobic bacteria. (D) Seventy percent of patients require surgical drainage. (E) The incidence of this disease has increased dramatically in the past 40 years.

Output: A


Instruction: When a jellyfish stings you, you need to clean the wound. Which of the following is the wrong way to treat the wound?

Input: (A) Clean water. (B) Seawater. (C) Soak in 45℃ hot water. (D) 5% acetic acid. (E) Apply lidocaine.

Output: A


Instruction: Which of the following carbon monoxide poisoning patients is most in need of hyperbaric oxygen therapy?

Input: (A) The carbon monoxide concentration in the blood of pregnant women is 5%. (B) The carbon monoxide concentration in the blood of ordinary people is 15%. (C) Has experienced syncope or loss of consciousness. (D) The patient has symptoms of dizziness. (E) Face and hands become numb after poisoning.

Output: C


Instruction: Traumatic aortic injury is one of the most difficult and fatal injuries to diagnose in emergency. Which of the following statements about this injury is incorrect?

Input: (A) Most of them are caused by puncture injuries or deceleration injuries. (B) 90% of patients with blunt aortic injuries will die on the spot and will not be able to be sent to the hospital in time. (C) High rib fractures, asymmetric blood pressure in both upper limbs, and weak pulse in the lower limbs should all be considered as signs of aortic injury. (D) In most patients, chest X-rays may show widening of the diaphragm and left tracheal deviation. (E)For patients with stable vital signs, CT angiogram with contrast should be arranged if aortic injury is suspected.

Output: D


Instruction: This patient has chest pain and acute coronary syndrome caused by cocaine abuse. His pulse is 120 beats/min, blood pressure is 168/96 mmHg, and temperature is 37.2℃. Which drug is the first choice for treating this patient?

Input: (A)Diazepam. (B)Labetolol. (C)Phetolamine. (D)Tissue plasminogen activator (t-PA). (E)Verapamil.

Output: A


Instruction: Due to a major earthquake, many buildings collapsed and there were a large number of injured patients. The Department of Health dispatched your hospital to perform emergency medical rescue missions. You are responsible for the classification of patients on site. According to the Simple Triage and Rapid Treatment (START) principle of triage, which of the following statements is wrong?

Input: (A) Anonymous, male, no breathing and pulse, head and neck separated (black). (B) A 50-year-old male without breathing, breathing after opening the airway (red). (C) A 30-year-old female, breathing about 25 times/min, radial artery cannot be felt, right thigh deformity and combined wound with heavy bleeding (yellow). (D) An 18-year-old male, running around on the scene, with multiple abrasions on his right hand and feet (green). (E) A 21-year-old female with a left thigh fracture, normal breathing and pulse, and conscious color is yellow.

Output: C


Instruction: Which of the following treatments for incarcerated hernia is less appropriate in the emergency room?

Input: (A) If reduction is unsuccessful, fasting is required. (B) Give intravenous analgesics. (C) Apply hot compresses to the hernia to make reduction easier. (D) If reduction fails 1 to 2 times, consider seeking treatment from a surgeon. (E) After successful reduction, observation is still required for a period of time.

Output: C