Instruction: A 28-year-old young woman was sent to the emergency room and complained of gradual weakness in her limbs over the past 4 days. The muscle weakness progressed from the extremities to the proximal parts of the limbs. The patient was conscious and neurological examination showed normal cranial nerve function. The muscles in her limbs were weakened and could not resist gravity. She had symptoms of gastroenteritis such as diarrhea and abdominal pain 2 weeks before the onset of limb weakness. Which of the following statements about Guillain-Barré syndrome (GBS) is incorrect?

Input: (A) This disease is the most common acute systemic neuropathy and may be related to acute campylobacter jejuni infection. (B) It mainly affects the motor nerves, manifested as symmetrical limb weakness, usually affecting the lower limbs first and then the upper limbs. (C) The most obvious neurological examination is that the patient will lose deep tendon reflexes. (D) The patient will have some abnormal sensory complaints and abnormal sensory neurological examination. (E) Plasmapheresis treatment may be considered.

Output: D


Instruction: A 29-year-old healthy male with no history of any disease tested positive for influenza A in another hospital 2 days ago and started taking Tamiflu. He came to the clinic today because of persistent high fever and difficulty breathing. A chest X-ray shows bilateral pulmonary infiltrates. Which of the following actions is incorrect?

Input: (A) The patient should be reported to the Centers for Disease Control as a severe influenza patient. He or she may develop respiratory failure or even die, and hospitalization is necessary. (B) If the blood oxygen saturation is < 95%, oxygen must be given. A moist bottle should be used for oxygen administration, and bronchodilators should be given to make sputum easier to cough up. (C) If there are no symptoms of bacterial infection, intravenous antibiotics should not be used. (D) If hypoxia persists (PaO 2/FiO 2 < 200 and PaCO₂ > 50 mmHg or pH < 7.25), intubation and ventilator treatment must be considered. Non-invasive ventilators (such as BiPAP, CPAP, etc.) are not recommended because they may increase viral spread. (E) The local area is not an epidemic area for drug-resistant viruses, and routine addition or switching to zanamivir is not encouraged.

Output: B


Instruction: A 30-year-old male came to the emergency room because he felt weak and unable to move when he got up in the morning. The patient described a similar attack 3 months ago. In the past six months, the patient has had symptoms such as palpitations and weight loss. When he arrived at the hospital, his blood pressure was 120/70 mmHg, heart rate was 110 beats/min, respiratory rate was 20 breaths/min, and body temperature was 37 ℃. Other physical examinations were normal except for symmetrical weakness in the limbs. Which of the following statements is incorrect?

Input: (A) Biochemical examinations need to test changes in potassium ions, magnesium ions, calcium ions, etc. (B) The diagnosis may be hyperthyroidism combined with periodic paralysis. (C) The affected muscle groups are mostly distal muscles. The lower limbs are more susceptible to the effects than the upper limbs. They are symmetrical and often accompanied by abnormal sensations. (D) The patient is more likely to have an attack if he eats foods high in starch and salt. (E) The patient should not be given dextrose solution with KCL.

Output: C


Instruction: A 32-year-old female was sent to the emergency room after falling from a motorcycle accident. Her right thigh was deformed. An endotracheal tube was placed in the patient, and a ventilator was used to assist her breathing. Her initial blood pressure in the emergency room was 80/60 mmHg and her heart rate was 120 beats/min. After intravenous resuscitation and emergency treatment, her blood pressure returned to 120/80 mmHg. One hour later, her blood pressure dropped to 90/75 mmHg and her heart rate was 130 beats/min. , what is the top priority at this time?

Input: (A) Emergency placement of a chest tube. (B) Appropriate infusion therapy, find the bleeding point and stop the bleeding. (C) Give a large amount of infusion to rescue. (D) Conduct a secondary assessment from head to toe. (E) Repeated primary survey.

Output: E


Instruction: A 38-year-old male was drunk and fought with others. He was sent to the emergency room by EMT. It was found that the bleeding of the scalp laceration had stopped, the face and chin were deformed and swollen, the blood pressure was 86/56 mmHg, the heart rate was 126 times/min, the respiration was 24 times/min, and the consciousness was unclear. Which of the following treatments should be performed first?

Input: (A) Nasopharyngeal tube placement. (B) 2,000 ml of Ringer's solution infusion. (C) Vascular embolism therapy. (D) Brain CT scan. (E) Cricoid chondrotomy.

Output: E


Instruction: A 3-year-old girl was brought to the emergency room by her mother, complaining of a 1-day fever. After examining the skin and oral cavity, the initial diagnosis was hand, foot and mouth disease. The girl's vital signs were stable and she did not need to be hospitalized immediately. During health education, the mother should be informed of the serious conditions that require prompt medical attention, which of the following is not included?

Input: (A) Myoclonic jerk. (B) Continuous vomiting. (C) Continuous lethargy. (D) Continuous diarrhea. (E) Rapid breathing and heartbeat.

Output: D


Instruction: A 40-year-old female had headache, nausea and fever 5 days ago. She started to be confused and delirious 3 days ago. She became drowsy yesterday. She had convulsion today and came to the hospital. Her temperature was 38.5℃ when she was admitted to the hospital. There were no abnormalities in her chest and abdomen. Her neck was stiff and her cranial nerve examination was normal. Her tendon reflexes were normal. Babinski sign was negative. WBC was 9,000/mm3. The initial pressure of lumbar puncture was 180 mmH2O. The results of cerebrospinal fluid examination were white blood cells 193/mm3 (polynuclear cells 12, lymphocytes 141, monocytes 40), red blood cells 6,500/mm3, protein 92 mg/dL, glucose 40 mg/dL. Which of the following is the most likely diagnosis?

Input: (A) Subarachnoid hemorrhage. (B) Herpes simplex virus encephalitis. (C) Acute purulent meningitis. (D) Tuberculous meningitis. (E) Meningitis caused by parasites.

Output: D


Instruction: A 40-year-old male was injured by lightning on the golf course. Which of the following statements is correct?

Input: (A) Lightning injury can easily cause ventricular fibrillation due to the extremely high voltage. (B) If the patient survives the lightning injury, he or she is prone to neuropsychiatric complications, including schizophrenia. (C) Lightning injury causes a large number of casualties and requires on-site treatment. Patients with red labels in the injury classification should be given the first priority. (D) When heavy rain and lightning strike, people should evacuate to open areas to avoid being crushed by collapsed buildings. (E) The principles of intravenous fluid supplementation are the same for patients with electric shock and lightning injuries.

Output: B


Instruction: A 45-year-old patient with cirrhosis was hospitalized for fever and abdominal distension. Physical examination revealed ascites, abdominal tenderness and rebound pain. Which of the following statements about spontaneous bacterial peritonitis is incorrect?

Input: (A) Symptoms of fever, abdominal pain and leukocytosis are common. (B) White blood cells >1,000/mm3 and neutrophils >250/mm3 in ascites are a confirmed diagnosis. (C) It is recommended to use third-generation antibiotics. (D) Lactic acid should be tested. If it is severe sepsis, crystalloid 20 ml/kg should be given. (E) The most common bacteria in the country are Gram-negative bacteria, such as Escherichia coli.

Output: D


Instruction: A 45-year-old male came to the emergency room early in the morning because of crooked eyes and crooked mouth. Examination showed that the patient had right peripheral type facial palsy. Careful examination revealed that the patient also had right ear pain and vesicular rash on the right outer ear. Which of the following statements is incorrect?

Input: (A) This is Ramsay Hunt Syndrome, not Bell's palsy. (B) This is an infection with the varicella-zoster virus (VZV). (C) The initial clinical manifestations of Ramsay Hunt Syndrome may not include a rash. (D) Antiviral drugs such as acyclovir and steroids can be used as early as possible. (E) Ramsay Hunt Syndrome has a better recovery rate from facial nerve palsy than Bell's palsy.

Output: E


Instruction: A 5-year-old boy was hit by a reversing SUV. When he was sent to the emergency room, he was found to be unconscious, with cold skin, weak limbs and no tension. His blood pressure was 74/52 mmHg, heart rate was 142 beats/min, respiratory rate was 36 breaths/min, and blood oxygen saturation was 88%. Which of the following statements is incorrect?

Input: (A) A size 4.5 endotracheal tube can be used. (B) The goal of infusion is a urine output of 1 ml/kg/hr. (C) The estimated blood loss for this patient should be greater than 20%. (D) Children are less likely to suffer from traumatic asphyxia when their chest is injured because their bones are soft and flexible. (E) The placement of a nasogastric tube and a urinary catheter will help assess abdominal injuries.

Output: D


Instruction: A 4-year-old girl was brought to the emergency room by her father, complaining of poor appetite and fever for 1 day. When she arrived at the hospital, her respiratory rate was 32 times/min, her heart rate was 148 times/min, and her temperature was 39 ℃. The girl was reluctant to speak, and it was difficult to understand what she said when she opened her mouth, but she was sure that she did not have a runny nose or cough. During the physical examination, she looked very weak, but was unwilling to lie flat, had difficulty breathing and saliva flowed from the corners of her mouth, and stridor murmurs could be heard in the neck when she inhaled. Which of the following statements and treatments is the least appropriate?

Input: (A) Do not force the girl to lie down while she is awake. (B) Give her oxygen and monitor her oxygen saturation. (C) Avoid examining the throat to prevent acute airway obstruction. (D) If possible, a lateral neck X-ray may be taken, but an endotracheal tube must be available for emergency treatment. (E) When X-ray or endoscopy confirms significant swelling, antibiotics should be considered. The most common causative agent is Hemophilus influenzae type A.

Output: E


Instruction: A 4-year-old boy has had a high fever for 5 days. The doctor suspects Kawasaki disease. Which of the following statements about the disease is incorrect?

Input: (A) The main symptoms include red and cracked lips and strawberry tongue. (B) Unilateral non-purulent cervical lymphadenopathy. (C) Polymorphous exanthem. (D) Desquamation near the anus. (E) NSAIDs and aspirin are the first choice of drugs.

Output: E


Instruction: A 50-year-old male had an argument with someone after drinking alcohol 5 days ago. He went to the doctor because of neck pain and swelling. During the examination, it was found that the lower end of the annular cartilage was swollen, his voice was normal, his right pupil was constricted, and his eyelids were drooping. Which of the following statements is incorrect?

Input: (A) Symptoms of sympathetic cranial nerve damage appear. (B) A head CT scan can be arranged. (C) An arterial angiography can be arranged. (D) If the diagnosis is carotid artery injury, anticoagulants can be considered. (E) A bronchoscopy can be performed.

Output: E


Instruction: 50 A 50-year-old male patient comes to the emergency department with chest discomfort. He took 40 tablets of amlodipine (Norvasc 5 mg/tab) 30 minutes ago and is unconscious. His blood pressure is 60/30 mmHg, heart rate is 40 beats/min, respiratory rate is 20 breaths/min, and body temperature is 37 ℃. Based on current research evidence, which of the following treatments is the most effective?

Input: (A) Give 10% Ca gluconate 0.6 ml/kg. (B) Arrange hemodialysis to enhance elimination. (C) Perform gastric lavage as soon as possible and give activated charcoal. (D) Give 1.0 U/kg/hr insulin. (E) Give glucagon 5 mg.

Output: D


Instruction: A 50-year-old male patient comes to the emergency department with chest discomfort. On arrival, his vital signs are blood pressure 102/60 mmHg, heart rate 56 times/min, respiratory rate 22 times/min, blood oxygen saturation 95%. The electrocardiogram shows that Lead II, III and aVF all have obvious ST elevation. Which of the following statements is wrong?

Input: (A) A right EKG should be considered. (B) If V4R in the right EKG does not have obvious ST elevation, right ventricular myocardial infarction can be ruled out. (C) Regardless of whether V4R in the right EKG has obvious ST elevation, nitroglycerin and morphine should not be given. (D) The clinical manifestations of right ventricular myocardial infarction are hypotension, distended cervical veins and no pulmonary edema. (E) When appropriate intravenous fluids are given for suspected right ventricular myocardial infarction complicated by hypotension, it is not appropriate to use the central venous pressure value as a reference data.

Output: B


Instruction: A 60-year-old woman developed blurred vision and limb paralysis after eating canned pickled oysters yesterday. Her blood pressure was 90/60 mm Hg, her heart rate was 110 beats/min, and her blood oxygen saturation was 85%. Which of the following statements about botulism is incorrect?

Input: (A) Normal light reflex of pupils. (B) Body temperature is usually higher than 38.5 ℃. (C) Descending paralysis. (D) Normal mental status. (E) The toxin includes A and B chains, and it is mainly the A chain that causes axonal nerve conduction abnormalities.

Output: B


Instruction: A 63-year-old male with a medical history of hypertension and diabetes was sent to the emergency room because of acute chest pain extending to the back. When he sought medical attention, his blood pressure was 220/110 mmHg, his heart rate was 102 beats/min, and his respiratory rate was 22 breaths/min. A chest X-ray showed mediastinum widening, and an electrocardiogram showed left ventricular hypertrophy. Which of the following is incorrect about the diagnosis and clinical treatment of this patient?

Input: (A) Clinically, aortic dissection should be strongly suspected, and a CT scan should be arranged immediately. (B) Pulse deficit is helpful for diagnosis, but has low sensitivity. (C) Less than half of patients with aortic detachment have calcium signs on their chest X-rays. (D) Aortic detachment usually causes pericardial tamponade, which has a high mortality rate. (E) Regarding blood pressure control in this patient, nitroprusside alone should not be used to avoid reflex tachycardia.

Output: D


Instruction: A 67-year-old male presented to the emergency department with an accidental left head injury. Physical examination revealed a left fronto-temporal scalp laceration and left orbital hematoma. The pupils were equal in size (2 mm) and the light reflex was normal. The patient was conscious and complained of blurred vision for 3 months. Visual field examination revealed left homonymous hemianopsia. What is the most likely diagnosis?

Input: (A) Left supradural hemorrhage. (B) Fracture of the skull base and intracranial hemorrhage. (C) Right occipital infarct stroke. (D) Left cerebellar hemorrhage. (E) Pituitary tumor.

Output: C


Instruction: 68 A 60-year-old male was taken to the hospital for treatment because of weakness, nausea, and vomiting in recent days. The patient had a history of heart disease and kidney disease. The long-term medications he took include digitalis, aspirin, and diuretics. A blood test revealed WBC 4,800/mm 3 (band:0%, seg:70%), BUN 53 mg/dL, Creatinine 4.2 mg/dL, K⁺ 7.3 mEq/L, and Digoxin level 1.75 ng/ µL. Which of the following statements is correct?

Input: (A) Digoxin level 1.75 ng/ µL cannot rule out the possibility that the symptoms are caused by digitalis poisoning. (B) Emergency hemodialysis cannot quickly improve the condition. (C) If unstable VT occurs, synchronized cardioversion can be used, starting with a bidirectional 100 joule shock. (D) If the digoxin level is greater than 2.5 ng/ µL, digoxin-specific Fab antibody treatment is necessary. (E) Using digoxin-specific Fab antibody, it will be most beneficial to the patient if the digoxin level can be reduced to less than 0.5 ng/ µL.

Output: E


Instruction: A 74-year-old female patient suddenly had difficulty speaking and swallowing. Physical examination showed dysphonia, tongue deviation to the right, right face drooping, right facial sensory loss, right arm weakness and aphasia. Which part of the body is most likely to be affected by the above symptoms?

Input: (A) Left brain stem. (B) Cerebellum. (C) Left cerebrum. (D) Pons. (E) Right midbrain.

Output: C


Instruction: Which of the following is incorrect about the stages of acetaminophen poisoning?

Input: (A) Stage 1 (0-24 hours): Symptoms such as nausea, vomiting, and fatigue may occur, and low blood potassium may occur. (B) Stage 2 (24-48 hours): Symptoms usually worsen and right upper abdominal pain may occur, but liver function and prothrombin time are still normal. (C) Stage 3 (72-96 hours): There will be obvious liver cell necrosis, resulting in jaundice, vomiting, and obvious liver function, bilirubin, and PT abnormalities. In severe cases, acute liver and kidney failure, hepatic encephalopathy, hepatic coma, and hemorrhage may occur. (D) In the fourth stage (5-14 days), if the poisoning is not severe, liver function may recover completely. (E) The antidote for acetaminophen poisoning is N-acetylcysteine.

Output: B


Instruction: An earthquake victim was crushed by a collapsed house and was taken to the hospital 8 hours later. What is the least likely injury to occur at this time?

Input: (A) Hypothermia. (B) Rhabdomyolysis. (C) Traumatic asphyxia. (D) Cardiac arrhythmia and sudden death due to tissue reperfusion. (E) Severe infection of the wound leading to sepsis.

Output: E


Instruction: There is a fire scene with a large number of casualties. The on-site medical examiner found a patient lying on the ground without breathing. After opening the airway, he still could not breathe on his own. According to the START (Simple Triage and Rapid Treatment) medical examination principle, which is the most appropriate next step?

Input: (A) Give mouth-to-mouth artificial respiration. (B) Insert a laryngeal mask airway. (C) Check for pulse. (D) Give external cardiac massage. (E) Give up first aid.

Output: E


Instruction: Regarding pediatric trauma, which of the following statements is correct?

Input: (A) In order to achieve the sniffing position, the occiput should be raised during intubation. (B) Because of the placement of the intraosseous needle It may damage the growth plates, so it is recommended for children under 6 years old only when both intravenous catheters and central venous catheters cannot be established. (C) If a 6-year-old child has severe bleeding, give 10 ml/kg of fluid therapy. (D) If the chest X-ray does not show rib fractures, pneumothorax or hemothorax, the chance of pulmonary contusion is extremely low. (E) The normal urine output of infants under 1 year old should be greater than 2 ml/kg/hr.

Output: E


Instruction: Which of the following descriptions of acute abdominal pain in pregnant women is incorrect?

Input: (A) In the early stages of pregnancy, the most common symptoms are ectopic pregnancy and threatened abortion. (B) In the late stages of pregnancy, the most common symptoms are early uterine contractions and placental abruption. (C) The incidence of gallstones increases during pregnancy, and it is the disease that most pregnant women need emergency surgery for. (D) The incidence of acute appendicitis remains the same in pregnant women, but the proportion of delayed diagnosis is higher. (E) Ultrasound is the preferred diagnostic tool for pregnant women with acute abdominal pain.

Output: C


Instruction: Regarding the 'Public places that should be equipped with automatic external cardiac defibrillators' announced by the Ministry of Health and Welfare in 2013, which of the following does not belong to the eight categories of public places stipulated in the regulations?

Input: (A) Taiwan Railway stations above second class. (B) Passenger aircraft with more than 19 seats and cabin crew members. (C) Movie theaters with an average of 3,000 people entering and leaving per day. (D) Schools above junior high school level. (E) Hotels, inns, and guest houses with more than 250 guest rooms (limited to those with dormitories).

Output: D


Instruction: Which of the following statements about acute appendicitis in children is incorrect?

Input: (A) Non-ruptured appendicitis is more common in boys, with the peak period being between 9 and 12 years old, and is less common in children under 2 years old. (B) Acute appendicitis may present with local peritoneal signs, but if the coccyx is located in the pelvic cavity, this sign is less likely to occur. (C) The patient will experience anorexia, vomiting, and right lower abdominal pain. Children with non-ruptured appendicitis may have a fever, but the fever of children with ruptured appendicitis is higher. (D) The chance of rupture of appendicitis in children over 10 years old is higher than that in children under 3 years old. (E) Non-ruptured appendicitis can progress to ruptured appendicitis within 8 to 24 hours after the onset of symptoms, so it is necessary to see a surgeon as soon as possible.

Output: D


Instruction: Which of the following statements about the diagnosis of roseola infantum is incorrect?

Input: (A) It is mainly caused by human herpes virus type 6. (B) The most common age is 6 months to 3 years old. (C) The fever subsides soon after the rash appears. (D) The rash mainly appears on the neck, trunk, buttocks and oral mucosa. (E) The chance of fever seizure is high.

Output: E


Instruction: Which of the following statements about the American Heart Association (AHA) emergency treatment for acute ischemic stroke patients is incorrect?

Input: (A) The National Institutes of Health Stroke Scale (NIHSS) assessment should be completed as soon as possible. (B) If the patient is not using oral anticoagulants, if time is urgent, r-tPA treatment can be given before the coagulation test results come out. However, if the test results later show that INR > 1.7 or prolonged aPTT time, treatment should be stopped. (C) If the regulations and indications are met, thrombolytic therapy can be performed with r-tPA. The recommended dose is 0.9 mg/kg, 10% intravenous push over 1 minute, and the remaining 90% intravenous drip over 1 hour. (D) When r-tPA is administered, aspirin should be given as soon as possible. (E) If r-tPA has been administered, it is not recommended to administer anticoagulants such as heparin.

Output: D


Instruction: Which of the following statements about the National Institutes of Health Stroke Scale (NIHSS) is incorrect?

Input: (A) Covers a complete neurological examination to assess acute stroke patients. (B) Can assess the clinical severity of stroke patients. (C) Scores range from 0 to 42. (D) Higher scores indicate more severe conditions. (E) Generally speaking, thrombolytic agents are not recommended for patients with scores greater than 25.

Output: A


Instruction: Which of the following statements about the differential diagnosis of vertigo is incorrect?

Input: (A) The symptoms of benign paroxysmal positional vertigo will subside with repeated inductions. (B) The age at which Ménière's disease first occurs is usually under 65 years old. (C) If gait disturbance, hearing loss and unilateral poor vision are combined, a cerebellopontine angle tumor should be considered. (D) Vestibular neuronitis usually lasts for a few days and usually does not recur. (E) Labyrinthitis is often associated with hearing loss.

Output: B


Instruction: Which of the following statements about out-of-hospital emergency response operations is incorrect?

Input: (A) Triage is done using simple triage and rapid treatment (START). (B) If there is a situation that endangers rescue workers at the disaster scene, the principle should be to reduce on-site treatment and transfer quickly. (C) Patients with minor injuries can be sent to a more distant hospital to avoid congestion in the local hospital's emergency department, which makes it impossible to effectively treat seriously ill patients. (D) In order to rescue the disaster as quickly as possible, the commander should ask the nearest emergency hospital to send medical personnel to form a rescue team for rescue. (E) The response command center needs to keep in close contact with the local hospital and communicate the conditions of patients who need to be transferred to the hospital in order to achieve perfect coordination.

Output: D


Instruction: Which of the following statements about septic shock is wrong?

Input: (A) Septic shock is a complication of sepsis with an average arterial pressure of less than 65 mmHg, and it is still hypotension after rapid infusion of 30 ml/kg. (B) A central venous catheter (CVP) should be placed and the CVP level should be maintained at around 8-12 mmHg. (C) Most cases of community meningitis with septic shock are caused by S. pneumoniae or N. meningitidis. (D) If pressors are considered, dopamine should be used first. (E) Septic shock caused by soft tissue infection is often accompanied by bacteremia.

Output: D


Instruction: Which of the following statements about adrenal insufficiency is incorrect?

Input: (A)Addison disease is currently believed to be mostly related to people with immune diseases. (B)According to statistics worldwide, the most common infectious cause of adrenal insufficiency is tuberculosis. (C)One of the complications that patients may experience after pituitary surgery. (D)HIV can directly damage the adrenal glands and cause adrenal insufficiency. (E) Sheehan syndrome is a postpartum blood loss that causes necrosis of the anterior pituitary gland, leading to endocrine disorders, including adrenal insufficiency.

Output: D


Instruction: Which of the following statements about tumor lysis syndrome is incorrect?

Input: (A) It is mainly a malignant tumor that occurs in the blood. (B) The most likely ion imbalance to cause fatality in tumor lysis syndrome is high potassium. (C) High calcium is also common in tumor lysis syndrome. (D) Treatment of hyperuricemia includes alkalinizing urine, intravenous infusion, and administration of acetazolamide. (E) Intravenous infusion and the use of the uric acid-lowering drug allopurinol can reduce the occurrence of tumor lysis syndrome.

Output: C


Instruction: Which of the following statements is correct about emergency thoracotomy?

Input: (A) Blunt wound, no pulse, EKG is asystole. (B) Blunt wound, no pulse, EKG is pulseless electrical activity (PEA). (C) Puncture wound, no pulse, EKG is asystole. (D) Puncture wound, no pulse, EKG is PEA. (E) Puncture wound, pulse, obvious shock.

Output: D


Instruction: Which of the following statements is correct about decompression sickness caused by diving?

Input: (A) After diving to a depth of 30 meters, limb and joint pain is caused, which is Type II decompression sickness (Type II DCS). (B) After participating in diving tourism activities, if you want to take a plane back to Taiwan, you must wait at least 6 hours after the diving activity ends to avoid decompression sickness. (C) The most effective treatment for decompression sickness is to use hyperbaric oxygen (HBO) therapy directly in a pressurized chamber 3ATA. (D) For the adjuvant treatment of decompression sickness, heparin has not been effective in humans in empirical medical research. (E) The pathological mechanism of decompression sickness caused by diving is due to the supersaturation and accumulation of helium in the body.

Output: D


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

Input: (A) Puncture injuries are more common than blunt contusions. (B) Blunt contusions are more likely to occur on the left side. (C) Minor diaphragm injuries are difficult to detect on CT cross-sectional examinations. (D) They are easily misdiagnosed as unilateral hemothorax. (E) The main clinical manifestation is hemorrhagic shock.

Output: E


Instruction: Which of the following statements about status epilepticus is incorrect?

Input: (A) The definition of epileptic state is continuous or intermittent seizures lasting more than 30 minutes without recovery of consciousness. (B) Patients taking epileptic medications usually need to monitor the concentration of epileptic medications. (C) The common cause of the first epileptic seizure in the elderly is cerebral stroke. (D) Depakine is more suitable than phenytoin for patients with epileptic state with arrhythmia. (E) The recommended dose of phenytoin is 20 mg/kg. It should not be added to an infusion containing glucose, and the rate should not exceed 50 mg/min.

Output: A


Instruction: You are treating a 3 Which of the following medical histories would be least helpful in helping you determine whether the infant is at high risk for sudden infant death syndrome (SIDS)?

Input: (A) The parents let the boy sleep on his stomach. (B) The boy was a premature baby. (C) The boy slept in a separate crib in the same room as his parents. (D) The parents let the baby sleep on a soft mattress. (E) The father is a smoker.

Output: C


Instruction: You are treating a 5-day-old newborn. The mother said that the baby girl was found to have blood stains when changing her diaper. Because she had found similar phenomena 3-4 times, the mother was very worried and took the baby to the emergency room for treatment. The baby girl is very active and is eating as she did in the nursery. Physical examination is unremarkable. Which of the following diagnoses is most appropriate?

Input: (A) False menstruation and vaginal discharge. (B) Infectious colitis. (C) Urinary tract infection. (D) Diaper rash. (E) Anal fissure.

Output: A


Instruction: You are caring for a 6-month-old febrile baby girl whose mother says she has Tetralogy of Fallot and has not yet undergone full surgical correction. On physical examination, you find that the baby is suddenly agitated, tachypneic, and cyanotic. Which of the following actions is least appropriate?

Input: (A) Provide oxygen, with the baby in a knee-bent chest position. (B) Give digoxin (30-50 micrograms per kilogram). (C) Give propranolol (0.2 milligrams per kilogram). (D) Give morphine (0.1-0.2 milligrams per kilogram). (E) Give saline infusion therapy (20 milliliters per kilogram).

Output: B


Instruction: Based on the structure and content of the Taiwan Triage & Acuity Scale (TTAS), regarding child triage, which of the following statements is incorrect?

Input: (A) If a child with a level 3 triage waits for more than 30 minutes, the triage staff must reassess the urgency of the child's condition. (B) If the triage staff determines the urgency based on the absolute heart rate of different ages, it is more likely to cause overtriage. (C) Pain is divided into peripheral pain and central pain. (D) Coagulation abnormalities are not included in the judgment criteria. (E) High-risk injury risk has been included in the judgment criteria.

Output: C


Instruction: Which of the following statements about the protective clothing of responders in nuclear, biological and chemical incidents is incorrect?

Input: (A) Level A protective clothing for toxic chemicals, including a self-contained air bottle (SCBA) plus a full-body airtight protective suit, provides the highest level of protection. (B) Level C protective clothing for toxic chemicals, including a full-face mask plus an appropriate filter canister, and a full-body splash-proof protective suit. (C) Medical personnel who come into contact with and treat chemical disaster patients in hospital emergency rooms must wear Level B protective clothing. (D) These protective suits do not protect against penetrating radiation. (E) Protective clothing commonly used in radiation disasters is mainly used to prevent personnel from being contaminated by radiation dust.

Output: C


Instruction: According to the 2010 ILCOR and AHA/ACC ACLS guidelines, which of the following statements is incorrect?

Input: (A) For emergency treatment of patients with ventricular fibrillation, the first epinephrine should be given after the second defibrillation. (B) For unstable PSVT, you can try to give adenosine 6 mg once; if it fails, synchronize the shock. (C) For stable wide QRS complex tachycardia that is not sure whether it is VT, you can try to give adenosine 6 mg once; if it fails, switch to amiodarone or procainamide. (D) For unstable atrial fibrillation combined with WPW, synchronize the shock. (E) For unstable torsades de pointes, defibrillation shock should be used.

Output: D


Instruction: According to the new version of the Palliative Care Ordinance, which of the following statements is correct?

Input: (A) When a patient signs a consent form, there must be two witnesses. In an emergency, if family members are not available, hospital doctors, nurses and social workers can serve as witnesses. (B) A terminally ill cancer patient is intubated in the emergency room due to coma and respiratory failure. Although he has not signed a consent form to waive emergency treatment, life support equipment can still be removed after his spouse arrives and signs a consent form. (C) Two doctors are required to judge and sign for the diagnosis of terminally ill patients, at least one of whom must be a relevant specialist. (D) If a terminally ill cancer patient who has lost his spouse falls into a coma, and his father and adult son have different opinions on whether to intubate the patient, the father's opinion shall prevail according to the law. (E)Terminal cancer patients can only be recorded in the medical institution's medical records after signing a consent form, but they cannot be recorded in the health insurance card due to the Personal Information Act.

Output: B


Instruction: The patient's oxygen concentration (FiO 2) is 40%, and his PaO 2 is 185 mmHg, and PaCO₂ is 40 mmHg. What is the estimated alveolar-arterial oxygen difference (Aa DO 2) of the patient?

Input: (A)50. (B)100. (C)150. (D)200. (E)250.

Output: A


Instruction: Intussusception is a common abdominal emergency in children. Which of the following statements is incorrect?

Input: (A) Barium enema is one of the diagnostic methods. (B) Currant jelly stools are (C) Ultrasound may reveal a target sign. (D) If there is evidence of intestinal perforation, surgery should be recommended. (E) The most common type is ileo-colic.

Output: B


Instruction: Which of the following statements is incorrect for a patient with suspected thoracic vertebral fracture and displacement?

Input: (A) Arrange a spine CT scan immediately. (B) Perform a physical examination to check anal tone immediately. (C) There is insufficient literature to support the routine use of steroids. (D) If hypotension and tachycardia are present, neurological shock should be considered. (E) Arrange surgery as soon as possible to perform reduction and fixation.

Output: D


Instruction: For a patient with head trauma and a coma index of 14 points, which of the following statements is incorrect for the indications of a head CT scan?

Input: (A) Only dizziness and nausea. (B) Symptoms of amnesia. (C) Local neurological abnormalities. (D) Confusion or seizure. (E) History of abnormal coagulation function.

Output: A


Instruction: Which of the following statements about testicular torsion is incorrect?

Input: (A) Testicular torsion often occurs after strenuous exercise. (B) The diagnostic rate of unilateral disappearance of the cremasteric reflex can reach 99%. (C) Doppler ultrasound can be used for diagnosis, and reduced blood flow on the affected side can be seen. (D) If the entire testicle is painful and swollen during testicular torsion, holding it with the hand will relieve testicular pain. (E) The golden treatment period is within 6 hours of onset.

Output: A


Instruction: Which of the following statements about bystander CPR and public access defibrillation (PAD) is incorrect?

Input: (A) If a patient with ventricular fibrillation (VF) is not defibrillated in time, the survival rate decreases by 7-10% per minute. (B) After the revision of Taiwan's Emergency Medical Rescue Act this year, it is stipulated that eight types of public places should be equipped with automated external defibrillators (AEDs) or other necessary emergency rescue equipment. (C) PADs must be used in conjunction with bystander CPR to effectively achieve the purpose of first-time rescue. (D) The aforementioned amendment stipulates that if a person other than a rescuer uses emergency rescue equipment or performs emergency measures to eliminate the imminent danger to the life of another person, the provisions of the Civil Code and the Criminal Code on emergency evacuation exemption shall apply. (E) Regardless of whether the patient is in the hospital when VF occurs and collapses, or whether an AED/defibrillator is present, CPR should be performed for 1.5 to 3 minutes before defibrillation. This will increase the patient's chance of survival and prognosis.

Output: E


Instruction: Which of the following statements about the clinical diagnosis and treatment of H7N9 influenza is incorrect?

Input: (A) There is currently no phenomenon of sustained human-to-human transmission, but limited human-to-human transmission cannot be ruled out. (B) Taiwan has classified this case as a Category 5 infectious disease. (C) The infectious period is within 7 days after onset of illness. (D) For acute respiratory tract infection, clinical symptoms must include at least fever (≧38 ℃) and cough as one of the clinical conditions. (E) One of the test conditions is the isolation and identification of H7N9 influenza virus in clinical specimen culture.

Output: C


Instruction: Regarding head trauma, if hyperventilation is used to temporarily reduce intracranial pressure, what range of PaCO₂ should be maintained?

Input: (A) Above 35 mmHg. (B) 30~35 mmHg. (C) 25~30 mmHg. (D) 20~25 mmHg. (E) < 20 mmHg.

Output: B


Instruction: Regarding cardiac tamponade, which of the following statements is incorrect?

Input: (A)Possible causes include pericarditis, hypothyroidism, cancer, uremia, ventricular rupture, and trauma. (B)Typical clinical manifestations are hypotension, jugular vein distension, and distant, muffled heart sounds. However, these symptoms are often absent in patients with trauma or combined bleeding. (C)If a patient with acute chest pain suddenly faints and his blood pressure cannot be measured, and bedside ultrasound reveals a moderate amount of pericardial effusion, myocardial infarction with myocardial rupture or aortic detachment should be considered. (D)For non-traumatic or non-mechanical pericardial tamponade, the first treatment to consider is norepinephrine. (E) For traumatic or nonmechanical pericardial tamponade, surgical pericardiotomy should usually be considered.

Output: D


Instruction: Which of the following statements is correct about the clinical manifestations and management of varicella-zoster virus?

Input: (A) The varicella rash extends from the face and scalp to the trunk and limbs, with more lesions on the covered than exposed parts of the body, and the rash changes at all stages can be seen at the same time. The smallpox rash is distributed eccentrically, and the rash evolves in a regular and uniform pattern. (B) Children infected with varicella should avoid using acetaminophen as a fever-reducing drug to prevent the occurrence of Reye syndrome. (C) Clinical infection is mostly self-limiting, and the antiviral drug acyclovir may cause teratogenicity. Therefore, it is not recommended to treat pregnant women with varicella infection with the antiviral drug acyclovir. (D) The main causes of death in adults are myocarditis and viral encephalitis, while in children they are mainly sepsis and primary viral pneumonia. (E) The mode of transmission is direct skin contact with varicella or herpes zoster scabs, respiratory droplets or airborne transmission. It is one of the most contagious diseases along with open tuberculosis and measles.

Output: A


Instruction: Which of the following concepts about traumatic hemorrhagic shock and transfusion is most appropriate?

Input: (A) Massive transfusion usually refers to the administration of more than 5 units of concentrated red blood cells (PRBC) within 12 hours. (B) When massive transfusion is required, red blood cells, plasma, and platelets should be given as soon as possible, and large amounts of crystalloid transfusion should be avoided. (C) When normal temperature transfusion is given, the chance of survival can be increased. (D) The most common reason for poor response to transfusion emergency is uncontrolled bleeding. (E) Excessive transfusion does not cause coagulation abnormalities.

Output: B


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

Input: (A) For patients with hyperthyroidism, thyroid storm is a clinical diagnosis. (B) The most common triggering cause is infection. (C) When hyperthyroidism without complications turns into thyroid storm, free T4, T4 and T3 will increase significantly. (D) Patients may experience symptoms of the central nervous system such as drowsiness, convulsions and coma. (E) Patients may experience symptoms of the gastrointestinal system such as anorexia, jaundice and liver enlargement.

Output: C


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

Input: (A) Hemorrhagic shock usually does not cause rapid heartbeat. (B) In case of hypotension, crystalloid can be given once, 1-2 liters. Elderly people should be given blood transfusion earlier than the general population. (C) In case of head trauma, the elderly are more likely to have epidural hemorrhage than the general population. (D) Cervical fractures occur more frequently in the elderly and are more difficult to diagnose. (E) The most common sites of fractures in the elderly are the hip, humerus, and wrist.

Output: C


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

Input: (A) Proton pump inhibitor can reduce the rebleeding rate of hemorrhagic gastric ulcers and can also reduce the need for blood transfusions and surgery. (B) If there is obvious or large amounts of blood in the stool, a nasogastric tube should be placed to rule out upper gastrointestinal bleeding. (C) Angiography can be used as a diagnostic tool, but the bleeding rate must be at least 0.5 ml/min to be detected. (D) Sengstaken-Blakemore tube (SB tube) is no longer recommended for the treatment of esophageal varicose bleeding due to too many complications. (E) Nasogastric tube placement can be considered for upper gastrointestinal bleeding, even if esophageal varicose bleeding is suspected.

Output: D


Instruction: Regarding chest trauma, rib and scapula fractures, which of the following statements is incorrect?

Input: (A) Scapula fractures usually do not require surgical treatment. (B) Fractures of ribs 1 to 3 are prone to complications of major blood vessels or thoracic spinal cord injury, with a mortality rate of about 10%. (C) Fractures of the sternum or scapula are common in direct impacts. (D) Fractures of ribs 10 to 12 are often associated with liver and spleen damage. (E) Rib fractures require attention to the presence of pneumothorax, hemothorax, and subsequent pneumonia.

Output: B


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

Input: (A) Symptoms appear 6-24 hours after stopping drinking. (B) Symptoms may last for about 2-7 days. (C) Patients with alcohol withdrawal often experience sweating, unsteady gait (ataxia), and hallucinations. (D) Blood pressure rises and the heart rate increases. (E)Consciousness changes are mainly characterized by drowsiness.

Output: E


Instruction: Which of the following statements about the treatment of paroxysmal supraventricular tachycardia is incorrect?

Input: (A)The vast majority of PSVT cases are narrow QRS complex, but a few are wide QRS complex. (B)In the emergency treatment of PSVT in the hospital, there is no need to perform carotid sinus massage first, and adenosine can be used directly. (C)In places where no drugs are available, carotid sinus massage should be performed on the right side of the PSVT patient to avoid more severe right-sided hemiplegia in case the patient suffers a stroke. (D)Adenosine can be used to treat PSVT in pregnant women. (E) Adenosine can be used for PSVT caused by WPW syndrome.

Output: C


Instruction: Which of the following statements about hydrofluoric acid is incorrect?

Input: (A) Hydrofluoric acid is a relatively weak acid. It dissociates hydrogen ions about 1000 times slower than strong acids such as hydrochloric acid, so it is not easy to cause chemical burns. (B) The severity of the injury depends on the concentration of hydrofluoric acid and the duration of exposure. (C) It destroys oxidative phosphorylation, glycolysis and other cellular metabolism. (D) It causes hypocalcemia, hypomagnesemia and hyperkalemia. (E) The main toxicity comes from fluoride ions.

Output: A


Instruction: Which of the following statements about abdominal aortic aneurysm is incorrect?

Input: (A) Abdominal aortic aneurysms smaller than 4 cm have a low chance of rupture. (B) Most intact abdominal aortic aneurysms are painless. When they are painful, it indicates that the aneurysm may have ruptured. (C) Whether hypotension occurs is an important factor affecting the prognosis of ruptured abdominal aortic aneurysms. (D) If aortic rupture is accompanied by hypotension, a large amount of blood and fluid transfusion should be actively given to restore blood pressure to normal. The prognosis of surgery is better. (E) If hemodynamics is unstable and there is a high suspicion of abdominal aortic rupture, surgical treatment should be performed immediately and should not be delayed to wait for CT angiography.

Output: D


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

Input: (A) The most commonly injured organs are the spleen and liver. (B) If the vital signs of liver and spleen injuries are stable, non-surgical treatment can be adopted. (C) If the vital signs are unstable and ultrasound reveals a large amount of abdominal bleeding, surgery can be performed directly. (D) Intestinal injuries often have no symptoms in the early stages of abdominal trauma, and the patient's symptoms and physical examinations must be continuously observed. (E) Diaphragm injuries are more common on the right side.

Output: E


Instruction: Which of the following laboratory data is most supportive of pleural fluid examination for empyema?

Input: (A) Pleural fluid culture is positive for bacteria. (B) Pleural fluid lactate dehydrogenase is greater than 1,000 IU/L. (C) Pleural fluid pH is less than 7.1. (D) Pleural fluid white blood cell count is greater than 10,000/mm3. (E) Pleural fluid glucose is less than 40 mg/dL.

Output: D


Instruction: A 6-year-old girl weighing approximately 30 kg was brought to the emergency room by her family and was drowsy and had rapid breathing. Her blood pressure was 80/40 mmHg, her heart rate was 130 beats/min, and her blood sugar was 500 mg/dL. The emergency physician assessed that she had a 10% Regarding dehydration, which of the following statements is incorrect regarding treatment and prognosis?

Input: (A) It may be considered to give priority to infusing 600 ml of 0.9% saline solution to increase blood pressure. (B) If the child's consciousness improves and perfusion is appropriate after infusing 600 ml of 0.9% saline solution once, the infusion should not exceed 1.5 times the maintenance infusion within 48 hours. (C) After the saline solution infusion, regular insulin 0.1 unit/kg/hr is immediately given by continuous intravenous infusion. (D) If the hyponatremia still cannot be stabilized after blood sugar is corrected, it is considered one of the risks of cerebral edema. (E) Appropriate saline infusion, bicarbonate and regular insulin supplementation can reduce the occurrence of cerebral edema.

Output: E


Instruction: Which of the following statements about pregnant women's trauma is wrong?

Input: (A) The best initial treatment for the fetus is to provide the best treatment for the mother's injuries and to conduct early assessment of the fetus. (B) The general priority of treatment is the same as that for non-pregnant women. (C) The best lying position for pregnant women is generally to raise the left side. (D) When the blood gas analysis PaCO2 is 40 mmHg, respiratory failure should be considered. (E) Tetanus toxoid can be used in early pregnancy.

Output: C


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

Input: (A) It usually occurs on the left side. (B) Blunt injuries are more likely to cause large radial lacerations in the diaphragm, while puncture injuries cause small holes. (C) X-rays in the early stages of injury are often mistaken for elevated diaphragms or localized hemothorax. (D) When left-sided diaphragmatic rupture is suspected, a gastric tube can be placed. If a chest X-ray shows the gastric tube in the chest cavity, the diagnosis can be confirmed. (E) For smaller diaphragmatic injuries, the diagnosis rate of CT scan is very high.

Output: E


Instruction: Which of the following statements about scratches and bites from suspected rabid animals is incorrect?

Input: (A) Avoid suturing the wound if possible. If suturing is necessary, it should be as loose as possible. (B) Antibiotics, tetanus vaccine, or tetanus immune globulin should be given as is the treatment for other scratches and bites. (C) Post-exposure vaccination is not recommended for scratches and bites from domestic dogs and cats. (D) Vaccination is recommended for stray dogs and cats if the exposure level is Category II or above. (E) For non-immunocompromised individuals, rabies immune globulin should be given if the exposure level is Category II.

Output: E


Instruction: Regarding shock, the human body uses a compensatory mechanism formed by the autonomic response to increase blood flow to important organs. Which of the following statements is incorrect?

Input: (A) Small arteries located in the skin, muscles, kidneys and spleen contract. (B) Heart rate and cardiac contraction increase to increase cardiac output. (C) Promote the release of antidiuretic hormone to retain water and salt in the body and increase blood vessel volume. (D) Reduce the release of vasoactive hormones, such as dopamine and epinephrine. (E) Veins contract to increase blood return.

Output: D


Instruction: Which of the following statements about aeromedical transportation is incorrect?

Input: (A) When transporting patients by helicopter, patients with poor consciousness should consider placing a nasogastric tube to reduce the risk of aspiration pneumonia. If the patient has been intubated, the cuff pressure should be maintained at the highest limit before boarding. (B) In terms of patient safety, fixed-wing aircraft is a better choice than helicopters. (C) Patients with blast injuries must be particularly careful about the deterioration of pneumothorax, hollow organ rupture, and arterial air embolism. (D) In addition to meeting the indications for air ambulance, air transfer is limited to cases where the hospital in the area is unable to provide complete treatment due to its equipment and expertise, and if air transfer is not performed, the time limit for emergency medical treatment will be affected. (E) Taiwan has the National Aeromedical Counseling Center (NACC), which is responsible for reviewing applications for the use of publicly funded air transfers to transport injured patients in Taiwan.

Output: A


Instruction: A mother and daughter, aged 44 and 15 respectively, both began to experience symptoms such as vomiting, diarrhea, dizziness, drooping eyelids, muscle weakness, and difficulty swallowing and breathing two days ago. Both were admitted to the intensive care unit for further treatment due to respiratory failure. Which of the following diagnoses best fits the clinical presentation of the mother and daughter?

Input: (A) Guillain-Barre syndrome. (B) Myasthenia Gravis. (C) Muscular dystrophy. (D) Botulism. (E) CO intoxication.

Output: D


Instruction: Which of the following antidotes is the least appropriate when used in the case of poisoning by a substance?

Input: (A) Simple asphyxiant: 100% oxygen. (B) Carbon monoxide (CO): 100% oxygen. (C) Azide: Sodium thiosulfate. (D) Aniline: Methylene blue. (E) Datura: Physostigmine.

Output: C


Instruction: Which of the following statements about the public version of the CPR+AED teaching materials published by the Ministry of Health and Welfare is incorrect?

Input: (A) It is divided into three levels: the simple version, the complete version, and the AED administrator version. (B) The biggest difference between the teaching process of the three-level teaching materials and the professional version is that artificial respiration is not taught. (C) The teaching material contains a special paragraph that emphasizes the legal protection of kind rescuers. (D) The AED administrator course is a complete course with the AED setup process added. (E) The teaching materials at all three levels teach people how to identify agonal breathing.

Output: B


Instruction: Which of the following is a wound that is susceptible to tetanus-prone?

Input: (A) A second-degree burn. (B) A depth of 0.5 centimeters. (C) Glass cut. (D) Within 4 hours of injury. (E) Linear wound.

Output: A


Instruction: Which of the following statements about pneumonia and pathogens is incorrect?

Input: (A)MRSA, Mycoplasma pneumoniae and Legionella are all common pneumonia pathogens in nursing home residents. (B) In addition to fever and dry cough, Legionella pneumophila is also commonly seen in clinical practice with gastrointestinal symptoms such as diarrhea and vomiting. (C) Pseudomonas aeruginosa is a common pneumonia-causing bacterium in patients with a recent history of hospitalization and immunosuppression. (D) Staphylococcus aureus is a common pneumonia-causing bacterium following viral infection. (E) Klebsiella pneumoniae is an important pneumonia-causing bacterium in alcoholics, and one of the characteristics is the bulging fissure sign on chest X-ray.

Output: A


Instruction: Which of the following children with fever (temperature ≥ 38℃) has the highest chance of suffering from severe bacterial infection?

Input: (A) A 2-month-old male infant with no other relevant symptoms, with a white blood cell count of 20,000/µL. (B) A 4-month-old male infant with no other relevant symptoms, with no abnormal findings on urine examination. (C) A 2-month-old female infant with no other relevant symptoms, with a white blood cell count of 8,200/µL. (D) A 4-month-old female infant with diarrhea, with no abnormal findings in stool examination. (E) A 6-month-old male infant with no other relevant symptoms, with no abnormal findings in urine examination.

Output: A


Instruction: For acute myocardial infarction with cardiogenic shock, which of the following treatments or medications is inappropriate?

Input: (A) Aspirin 300 mg orally. (B) Captopril 25 mg orally. (C) Dopamine 5 mcg/kg/min intravenous infusion. (D) Intra-Aortic Balloon Counterpulsation. (E) Instruct the cardiologist to perform percutaneous coronary intervention.

Output: B


Instruction: A pregnant woman with a history of asthma at 26 weeks of gestation presents to the emergency department with dyspnea. Which of the following statements is incorrect?

Input: (A) Even if there is no wheezing during auscultation, the possibility of an acute asthma attack cannot be ruled out. (B) Spirometry can be used to assess the severity of an acute asthma attack and the effectiveness of treatment. (C) Oxygen should be given to maintain a blood oxygen concentration > 95%, and a fetal monitor should be installed to closely observe whether there is fetal distress. (D) Inhaled β2 agonists are the first line of treatment for pregnant women with acute asthma attacks. (E) Systemic corticosteroids are not recommended for pregnant women with acute asthma attacks.

Output: E


Instruction: Which of the following statements about the characteristics of organophosphorus pesticide preparations is incorrect?

Input: (A) There are many types of these phosphorus-containing organic compounds, which are widely used in agriculture to kill insects, bacteria and mites. (B) These organophosphorus pesticides have low fat solubility and a garlicky odor. (C) They are easily absorbed from the human gastrointestinal tract, skin, eyes or respiratory tract, causing local or systemic effects. (D) The severity of poisoning is related to the dose and the body's absorption and elimination rate of the poison. (E) The special symptoms of Muscarinic poisoning are increased glandular secretions, slow heartbeat, and constricted pupils.

Output: B


Instruction: Which of the following statements about salicylate poisoning is incorrect?

Input: (A) To accurately assess the severity, it is recommended to measure the blood concentration, compare the time of administration, and use the Done nomogram to make a judgment. (B) If a patient complains of tinnitus while taking salicylate drugs chronically, the possibility of poisoning should be considered. (C) In acute overdose in adults, the severity is closely related to the dosage of the drug. (D) Salicylate poisoning is mainly manifested as high anion gap metabolic acidosis, but if the blood draw shows normal anion gap metabolic acidosis, the possibility cannot be completely ruled out. (E) If the patient has renal failure, altered consciousness, or acute lung injury, emergency hemodialysis treatment should be considered.

Output: A


Instruction: Which of the following statements about transfusion-related acute lung injury (TRALI) is incorrect?

Input: (A) It is one of the main causes of transfusion-related death. (B) It usually occurs during or within 6 hours after transfusion. (C) It more often occurs after FFP or platelet transfusion and less often after packed RBC transfusion alone. (D) Because TRALI is accompanied by pulmonary edema, diuretics should be actively administered. (E) In most patients, lung injury will gradually improve on its own after supportive treatment.

Output: D


Instruction: Which of the following statements about blunt chest injury in adults is incorrect?

Input: (A) Most patients with aortic rupture caused by trauma die at the scene. The few survivors are mostly injured in the ligamentum arteriosum. (B) Tension pneumothorax is a clinical diagnosis. Usually, hypotension occurs first, followed by cyanosis. (C) If chest X-ray and ultrasound diagnose hemothorax, a chest tube should be placed. If more than 1,500 ml of blood is immediately drained, thoracotomy should be arranged to stop bleeding. (D) If air continues to be drained after the chest tube is placed, tracheobronchial injury should be considered, and bronchoscopy should be arranged for diagnosis. (E) For patients with blunt cardiac injury, blood tests for Troponin I should be performed. It is more useful for clinical emergency judgment and treatment than electrocardiogram.

Output: E


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

Input: (A) Anterior cord syndrome: Proprioception and vibration sensation will be lost below the injured site. (B) Central cord syndrome is more likely to occur in the elderly. The injury mechanism is usually hyperextension, and upper limb weakness is greater than lower limb weakness. (C) Cauda equina syndrome has a better prognosis, mainly because the injured nerves are peripheral nerves, which have a chance of regeneration. (D) Brown-Sequard syndrome is weakness and loss of body sensation on the same side, combined with loss of pain and temperature sensation on the opposite side. (E) Spinal cord injury causes neurogenic shock, usually with warmth in the limbs, low blood pressure but a relatively slow heartbeat (relative bradycardia).

Output: A


Instruction: Which of the following statements is incorrect about the comparison of typical symptoms of common causes of fatal chest pain and the evaluation of acute coronary heart disease?

Input: (A) Angina pain is located behind the sternum or in the upper abdomen, with a stuffy or oppressive feeling; large-area pulmonary embolism is a heavy and tight feeling throughout the chest. (B) The pain of aortic detachment and esophageal rupture is mainly located below the sternum. The former is often tearing pain and transfers to the back between the shoulder blades, while the latter is often a sudden sharp pain after severe vomiting and transfers to the back. (C) Aortic detachment, respiratory failure, sepsis and burns may cause an increase in Troponin. (D) Acute stroke or subarachnoid hemorrhage will not cause an increase in Troponin. (E) In addition to acute coronary heart disease, chronic alcoholism, prostate cancer, and carbon monoxide poisoning are all related to elevated CK-MB.

Output: D


Instruction: Which of the following statements about compartment syndrome is correct?

Input: (A) Tibial fractures are a common site of occurrence, and compartment syndrome can also occur in the hand. (B) When the chamber pressure exceeds 45 mmHg, tissue ischemia will occur. (C) The inability to feel the proximal arterial pulsation of the limb is an early sign of compartment syndrome. (D) The patient can be advised to raise the affected limb to reduce the chamber pressure. (E) Doppler ultrasound is a good diagnostic tool.

Output: A


Instruction: Which of the following statements about neck injury is wrong?

Input: (A) For physical examination of neck trauma, hard signs usually represent more serious injuries relative to soft signs. (B) Physical examination found expanding hematoma and stridor/hoarseness, both of which are hard signs of neck trauma. (C) Zone II injuries of the neck are compared to Zones I and III. If necessary, direct surgical exploration can be considered, and conventional angiography is not necessary. (D) If the vital signs of the patient with a puncture injury of the neck are stable, CTA (CT angiography) can be arranged first to check for vascular damage. (E) Blunt neck injuries can cause carotid artery dissection. After diagnosis, anticoagulant therapy should be given to prevent stroke.

Output: B


Instruction: Which of the following statements is correct about avoiding the occurrence of decompression illness?

Input: (A) Ascend quickly after diving into the deep sea. (B) Take a plane within 12 hours after diving. (C) Do strenuous exercise after diving. (D) Drink plenty of water after diving. (E) Take a car up the mountain after diving.

Output: D


Instruction: Which of the following statements about glyphosate pesticide poisoning is incorrect?

Input: (A) It is a kind of herbicide, and the common commercial herbicide Nipro is of this type. (B) The main ingredients are 41% of sugar phosphates and 15% of non-ionic surfactants (surfactant polyoxyethyleneamine). (C) It has a corrosive effect, so when ingested, it may cause irritation and erosion of the gastrointestinal and upper respiratory tract mucosa. (D) The main toxicity mechanism is related to the sugars and phosphates it contains. (E) Severe poisoning can cause cardiotoxicity, metabolic acidosis, and hyperkalemia.

Output: D


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

Input: (A) When rhabdomyolysis occurs, the use of NSAIDs should be avoided. (B) When a urine dipstick test shows hematuria, but microscopic examination reveals no red blood cells in the urine, the patient should be considered to have myoglobinuria. (C) The acute renal failure caused by rhabdomyolysis is intrinsic acute renal failure. (D) Blood electrolyte abnormalities that may be caused by rhabdomyolysis include hyperkalemia, hypocalcemia, and hyperphosphatemia. (E) The diagnostic criteria for rhabdomyolysis are that the CK value in plasma is more than 10 times the upper limit of normal value after confirming that there is no damage to the heart and brain.

Output: E


Instruction: Which of the following statements about patient selection for air medical treatment is incorrect?

Input: (A) For patients with severe trauma (but not fatal) and those who are located farther away, air evacuation is more effective than ground transportation. (B) For patients with heart disease who need emergency bypass surgery or balloon pump support, air medical transfer can be considered. (C) Pregnant women with heart disease who are in premature labor or have early amniotic fluid rupture are not suitable for air medical transfer. (D) Patients with acute ischemic stroke are suitable for air medical transfer. (E) Premature newborns can still be transported by professionals for air medical transfer.

Output: C


Instruction: Which of the following statements about trauma in the elderly is incorrect?

Input: (A) It is usually not easy to see an increased heart rate in hemorrhagic shock. (B) In case of hypotension, a crystalloid can be used to give a 250-500 ml infusion first, and the patient can be closely evaluated and repeated if necessary. (C) In head trauma, the elderly are more likely to have epidural hemorrhage than the average person. (D) Cervical fractures are more likely to occur in the elderly and are more difficult to diagnose. (E) The most common locations for fractures in the elderly are the pelvis, hip, humerus and wrist.

Output: C


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

Input: (A) For patients with a history of epilepsy who are controlled by medication, relapses are often caused by forgetting to take medication, drinking alcohol, or lack of sleep. (B) For patients with a history of epilepsy who occasionally have epilepsy, the most important tests are blood sugar and anti-epileptic drug levels in the blood. (C) For pregnant women who suspect that eclampsia is causing epileptic seizures, magnesium sulfate 4-6 g IV can be given first, followed by 1-2 g/hr. (D) Epileptic seizures refer to continuous or intermittent seizures lasting more than 5 minutes without recovery of consciousness. (E) The anti-epileptic drug Phenytoin can be combined with sugar-containing drips or intramuscular injections.

Output: E


Instruction: Which of the following statements about Herpes simplex encephalitis is incorrect?

Input: (A) It is more common in people under 20 years old and over 50 years old. (B) If untreated, the mortality rate is as high as 70%. (C) Survivors may have long-term neurological sequelae. (D) CT or MRI imaging examinations often show frontal lobe lesions. (E) If clinical symptoms are difficult to distinguish from bacterial meningitis, empirical antibiotics and antiviral drugs should be given.

Output: D


Instruction: Which of the following statements about the treatment of migraine is incorrect?

Input: (A) Dihydroergotamine (DHE) may cause symptoms of nausea, vomiting, and diarrhea. (B) Ketorolac is not suitable for use in the third trimester of pregnancy. (C) Opioids are best used in patients with chronic and recurrent migraine. (D) Olanzapine can cause QT wave prolongation on the electrocardiogram. (E) Prochlorperazine also has an antiemetic effect.

Output: C


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

Input: (A) The pathogen is the Gram-positive bacillus Clostridium tetani. (B) The toxin produced is Tetanospasmin, which can act on skeletal muscle, spinal cord, brain and sympathetic nervous system. (C) Diagnosis is based mainly on clinical symptoms. (D) If wound debridement is to be performed, tetanus immune globulin should always be given first. (E) After debridement, it is recommended to inject Penicillin to treat systemic tetanus infection.

Output: E


Instruction: Which of the following statements about the causes of peripheral vertigo is incorrect?

Input: (A) Benign paroxysmal positional vertigo. (B) Labyrinthitis. (C) Vestibular neuritis. (D) Migraine. (E) Meniere's disease.

Output: D


Instruction: According to the CURB-65 score, which of the following is not a risk factor for severe community-acquired pneumonia?

Input: (A) New onset of confusion. (B) Blood urea nitrogen (BUN) ≥ 7 mmol/l (19 mg/dL). (C) Respiratory rate ≥ 30 times/min. (D) Body temperature ≥ 39 ℃. (E) Age ≥ 65 years old.

Output: D


Instruction: According to the American College of Emergency Physicians guidelines and The San Francisco Syncope Rule, which of the following 5 patients with initially unexplained syncope is less likely to require hospitalization?

Input: (A) Blood creatinine 5 mg/dl. (B) Hematocrit 28%. (C) The electrocardiogram shows a new atrioventricular block. (D) Has a family history of sudden cardiac death. (E) Age 85 years.

Output: A


Instruction: Regarding the management of patients with severe sepsis and septic shock, according to the latest 2012 International Guidelines for Management of Severe Sepsis and Septic Shock (2012), which of the following statements is correct?

Input: (A) Broad-acting antibiotics should be given within 2 hours of clinical diagnosis of septic shock or severe sepsis. (B) Severe sepsis refers to tissue hypoperfusion or organ dysfunction in the setting of suspected clinical infection. The definition of acute lung injury in organ dysfunction is that in the absence of pneumonia, the patient's PaO2/FiO2 < 200 mmHg. (C) The goal of emergency treatment in the first 6 hours is to maintain a central venous pressure (CVP) between 8 and 12 mmHg, a mean arterial pressure (MAP) ≧ 65 mmHg, urine output ≥ 0.5 mL/kg/hr, and a superior vena cava oxygen partial pressure (ScvO2) > 70 mmHg or mixed venous oxygen saturation (Sv O2) > 65 mmHg. Only after the emergency department achieves the above goals can the patient be transferred to the intensive care unit for continued treatment. (D) For patients who are in shock and do not respond to initial fluid therapy, the vasopressor dopamine should be used first, with the goal of raising the mean arterial pressure (MAP) to 65 mmHg. (E) For patients who do not have tissue perfusion insufficiency after fluid therapy and do not have severe hypoxia, acute hemorrhage or myocardial infarction, the patient's hemoglobin is recommended to be maintained at 7~9 g/dL.

Output: E


Instruction: For patients with pulmonary embolism, which of the following is an indication for the injection of fibrinolytic agents?

Input: (A)Computed tomography revealed pulmonary emboli on both sides. (B)O2 needs to be above 6 L/min to maintain SaO2 greater than 90%. (C) Deep vein thrombosis in the lower extremities. (D) Systolic pressure less than 90 mmHg. (E) Chest pain and 12 leads EKG with S1Q3T3 pattern changes.

Output: D


Instruction: A 10-year-old girl with blunt abdominal injury was diagnosed with Grade III splenic laceration by CT scan. She was therefore admitted to the pediatric intensive care unit for close observation. Her vital signs are currently stable. Which of the following situations should require immediate laparotomy?

Input: (A) Amylase was 400 U/L in a blood draw. (B) White blood cells were found to be 16,000/mm. (C) Extraperitoneal bladder rupture. (D) Due to abdominal pain, CT scan revealed intraperitoneal free air. (E) 24 hours later, hemoglobin dropped from 11 g/dL to 8.5 g/dL.

Output: D


Instruction: Which of the following statements about patients suspected of being infected with Ebola in Taiwan is incorrect?

Input: (A) Ask the patient to go to the nearest quarantine hospital for medical treatment. (B) Ask the patient to call 1922 and a specialist will assist him in seeking medical treatment. (C) Patients infected with Ebola virus often have symptoms such as muscle pain, headache, vomiting, and diarrhea. (D) Ebola virus is a member of the Filoviridae family. (E) The mortality rate of patients infected with Ebola virus can be as high as 90%.

Output: A


Instruction: When the patient came to the hospital for chest pain, his blood pressure was 155/95 mmHg, his heart rate was 65 beats/min, and the electrocardiogram showed ST-segment elevation of lead V1-V3. He continued to have chest pain in the emergency room. The following treatments can be given at this time. Which of the following is the least appropriate?

Input: (A) Atenolol 25 mg orally. (B) Dobutamine 5 mcg/kg/min (C) Morphine 3 mg intravenous injection. (D) NTG 0.6 mg sublingually. (E) Instruct the cardiologist to consider percutaneous coronary intervention.

Output: B


Instruction: The patient has a history of hypertrophic cardiomyopathy and complains of chest pain in the emergency room. Which of the following treatments should be considered first?

Input: (A) Clopidogrel 300 mg orally. (B) Dobutamine 5 mcg/kg/min. (C) Nitroglycerin 5 mcg/min. (D) Norepinephrine 2 mcg/min. (E) Propanolol 10 mg orally.

Output: E


Instruction: An 8-year-old boy accidentally swallowed a brand new button battery 3 hours ago and was accompanied to the emergency room by his mother. Which of the following treatments is wrong?

Input: (A) If the button battery is stuck in the esophagus, it may cause esophageal rupture within 6 hours. (B) If the X-ray shows that the button battery is stuck in the esophagus, the first priority is to try foley balloon catheter technique to remove the foreign body. (C) For children younger than 6 Children aged 1-2 years need to be followed up with an X-ray every 48 hours to confirm that the battery has passed through the pylorus of the stomach. (D) If there are no symptoms, most button batteries can be discharged on their own after 48-72 hours. (E) If the battery has passed through the esophagus and stomach, but there are symptoms of gastrointestinal pain, a surgeon is still required to evaluate whether surgery is needed to remove the foreign body.

Output: B


Instruction: An 80-year-old male nursing home resident, accompanied by a caregiver, comes to the emergency department with complaints of unbearable itching all over his body in the middle of the night. His ear temperature is 37.0℃. Physical examination reveals multiple rashes and nail scratches on the lower abdomen, bilateral groin, and back. Which of the following diseases is the most likely cause?

Input: (A) Urticaria. (B) Scabies. (C) Contact dermatitis. (D) Eczema. (E) Psoriasis.

Output: B


Instruction: An 8-year-old boy was hit by a car while walking to school. He rolled over and fell to the ground. He was taken to the emergency room by ambulance. His temperature was 36.7℃, his respiratory rate was 30 times/min, his heart rate was 130 times/min, and his blood pressure was 80/65 mmHg. The patient was unconscious and unable to speak. Which of the following statements about first aid for pediatric trauma is incorrect?

Input: (A) The first priority is to protect the airway. If you want to choose an endotracheal tube, you can choose a size 6 with a cuff. (B) If peripheral vascular access is not possible, this patient may consider intraosseous injection of a proximal tibia. (C) Give crystalloid 20 ml/kg each time, with a goal of urine output of 1 ml/kg/hr. (D) Because the chest wall bones of children are more flexible, tension pneumothorax is less likely to occur in the event of a chest contusion. (E) Based on this patient's vital signs, the blood loss should be greater than 30% of the total blood volume.

Output: D


Instruction: A 78-year-old patient presents to the emergency department with an acute exacerbation of chronic obstructive pulmonary disease (COPD). Which of the following statements about contraindications to the use of noninvasive positive pressure ventilation (NPPV) is incorrect?

Input: (A) Respiratory rate > 25 bpm and using accessory muscles. (B) Unable to maintain airway patency. (C) Confusion. (D) Hemodynamic instability. (E) Extreme obesity.

Output: A


Instruction: A 70-year-old male chronic smoker presents to the emergency department with fever, cough, and dyspnea. The patient also has body aches, abdominal pain, and diarrhea. Vital signs are blood pressure 90/60 mmHg, respirations 30/min, heart rate 130/min, temperature 39°C, and oxygen saturation 90%. Chest X-ray shows bilateral pneumonia, and urine Legionella antigen test is positive. Which of the following statements about this disease is incorrect?

Input: (A) Pancreatitis may occur. (B) This disease is not contagious. (C) Low sodium levels are common test abnormalities. (D) Third-generation cephalosporin or carbapenem antibiotics are the first choice for treatment. (E) Sputum cultures often fail to isolate the causative bacteria.

Output: D


Instruction: A 65-year-old female patient was admitted to the emergency department with complaints of sudden dyspnea, wheezing, and chest tightness. Physical examination showed symmetrical breath sounds without gurgling; no edema in either leg. Heart rate 120 beats/min, room air SpO₂ 93%. Past medical history is breast cancer, surgery and chemotherapy; she was discharged from the hospital 2 weeks ago for right hip fracture. You suspect that this patient is most likely to have pulmonary embolism. Which of the following statements is incorrect?

Input: (A) This patient's AaDO2 (Alveolar-arterial gradient) may decrease. (B) This patient's Well's score is 7. (C) The electrocardiogram may show sinus tachycardia and S1Q3T3 pattern. (D) If the patient has sudden cardiac arrest, thrombolytic agents (Fibrinolysis), such as tPA, may be considered. (E) EKG and myocardial enzyme tests are still needed to rule out the possibility of acute coronary heart disease.

Output: A


Instruction: A 65-year-old female with a history of pancreatic cancer has had a swollen right foot for about a week. Which of the following statements is incorrect?

Input: (A) When performed by an experienced scanner, the sensitivity and specificity of vascular ultrasound for diagnosing deep venous embolism can reach over 90%. (B) The more obese the patient is, the more difficult it is to correctly diagnose deep venous embolism using vascular ultrasound. (C) Patients with a history of deep venous embolism are not easy to distinguish new from old clots using the compressive properties of ultrasound. (D) If this patient's veins cannot be flattened on ultrasound, a diagnosis of deep venous embolism can be made. (E) A thrombus must be visible on ultrasound to diagnose deep venous embolism.

Output: E


Instruction: A 65-year-old man fell and was cut by broken glass in the garden. He then fell into a pile of dirt and branches. Which of the following statements is correct?

Input: (A) The 5 cm facial wound has been injured for more than 12 hours. Considering the risk of infection, suture is not recommended. (B) Wounds on the thigh have a higher risk of wound infection than wounds on the scalp. (C) X-rays can detect more than 90% of broken glass or broken branches that are hidden under the skin. (D) The wound on the calf is deeper, so subcutaneous suture is recommended. (E) Choose 10% povidone-iodine solution without alcohol to clean the wound.

Output: B


Instruction: A 65-year-old male, a regular smoker with a history of hypertension, came to the emergency department complaining of unilateral headache. His temperature was 37°C, his heart rate was 84 beats/min, his breathing was 16 breaths/min, and his blood pressure was 142/84 mmHg. Which of the following statements about emergency headache differential diagnosis is correct?

Input: (A) If the patient has unilateral headache attacks in a short period of time, combined with unilateral tearing and runny nose, cluster headache should be suspected. Such patients may have neurological symptoms such as ptosis and miosis on the same side. (B) If the patient has severe unilateral, pulsatile headache that is more painful with movement, and is accompanied by nausea, vomiting, and photophobia, migraine should be suspected. Migraine does not present as bilateral headache. (C) If the patient has unilateral headache, tenderness in the temporal artery and increased pulse, normal ESR, and ptosis and miosis on the same side, it may be temporal arteritis. At the same time, attention should be paid to whether the patient has decreased vision and steroid treatment should be given as soon as possible. (D) Ischemic stroke may also present as headache, especially anterior cerebral artery stroke. (E) If the patient is taking anticoagulants, cerebral hemorrhage should be included in the differential diagnosis. If the CT scan shows no bleeding, a brain magnetic resonance imaging (MRI) should be arranged to exclude subarachnoid hemorrhage (SAH) if it is still strongly suspected clinically.

Output: A


Instruction: A 60-year-old male presented to the emergency department with dyspnea. His chest X-ray showed bilateral pleural effusion. After diagnostic pleural puncture, the laboratory analysis of the pleural effusion showed the following results: pH 7.57, pleural effusion/serum lactate dehydrogenase ratio (LDH ratio) 0.4, pleural effusion/serum protein ratio (Protein ratio) 0.2, cell count WBC 133 cells/µL (of which 65% are lymphocytes). Which of the following diagnoses is most appropriate?

Input: (A) Heart failure. (B) Bacterial pneumonia. (C) Lymphoma. (D) Tuberculosis. (E) Lupus erythematosus.

Output: A


Instruction: A 50-year-old male presents to the emergency department with hemoptysis. Which of the following statements is incorrect?

Input: (A) The priority should be to assess whether the airway is patent and whether the blood oxygen concentration is adequate. (B) The severity of the disease can be determined based on the amount of hemoptysis within 24 hours, where massive hemoptysis is defined as > 600 ml of hemoptysis within 24 hours. (C) Pulmonary embolism often causes massive hemoptysis. (D) Chest X-ray is a necessary examination, but there is a 15-30% chance that the chest X-ray will be normal. (E) If the color of the hemoptysis is dark red, it should be noted that the bleeding may come from the gastrointestinal tract.

Output: C


Instruction: A 48-year-old female is currently receiving Warfarin for deep venous embolism. One hour ago, she began to have massive bilateral epistaxis that could not be stopped by direct pressure. Her current blood pressure is 136/82 mmHg, heart rate is 110 beats/min, and blood draw results show platelets 170,000/µL, Hb 8 g/dL, Hct 23%, INR 8. Which of the following treatments is least appropriate?

Input: (A) Give desmopressin acetate(ddAVP). (B) Give fresh frozen plasma. (C) Give prothrombin complex concentrate. (D) Give vitamin K. (E) Stop Warfarin.

Output: A


Instruction: A 47-year-old male patient was taken to the emergency room with nausea and vomiting accompanied by shortness of breath after a drinking binge the day before yesterday. Vital signs: temperature 36.5 ℃, pulse 124 beats/min, respiration 26 breaths/min, blood pressure 103/61 mmHg, SpO₂ 100%, test report: arterial blood gas analysis: pH 7.27, PCO₂ 25 mmHg, HCO₃- 11 mmol/L, blood glucose 102 mg/dL, blood sodium concentration 142 mmol/L, blood potassium concentration 3.5 mmol/L, blood chloride concentration 106 mmol/L, serum ketones were positive. Which of the following statements is wrong?

Input: (A) This patient has high anion gap metabolic acidosis. (B) If alcoholic ketoacidosis is suspected, lactic acidosis caused by infection or drugs must be ruled out first. (C) Blood osmotic pressure and methanol concentration can be tested to rule out methanol or other organic acidosis. (D) If it is alcoholic ketoacidosis, the patient can be given a sugar solution to increase the glucose concentration in the body and replenish the fluid deficiency. (E) In alcoholic ketoacidosis, insulin supplementation is required to promote glucose utilization and reduce the production of ketoacids by fat breakdown.

Output: E


Instruction: A 5-year-old child weighing 20 kg was taken to the emergency room by ambulance accompanied by his mother for status epilepticus. He complained of convulsions for 30 minutes. Which of the following statements is incorrect?

Input: (A) Ensuring airway patency and stabilizing vital signs are the first priority. (B) If emergency testing reveals hypoglycemia, 10% G/W 100 ml should be immediately injected intravenously. (C) If convulsions persist, Lorazepam 2 mg should be given intravenously, which can be repeated. (D) If convulsions persist and intravenous drips cannot be given, Diazepam 2 mg should be given through the rectum. (E) If convulsions persist, consider intravenous Midazolam 2 mg, plus Midazolam 1 mcg/kg/min continuous intravenous infusion.

Output: D


Instruction: A 50-year-old male presents to the emergency department with right upper quadrant pain after lunch. His past medical history includes diabetes and hypertension. Which of the following statements is incorrect?

Input: (A) Most cases of biliary colic pain resolve within 1 to 5 hours. (B) The sensitivity and specificity of emergency ultrasound in diagnosing acute cholecystitis are only about 70%. (C) If the thickness of the gallbladder on this patient's abdominal ultrasound is greater than 3 mm, acute cholecystitis should be suspected. (D) If this patient has cholecystitis, ultrasound may not have sonographic Murphy's sign. (E)Morphine-like analgesics used in this patient may increase bile duct pressure and induce contraction of the Sphincter of Oddi.

Output: B


Instruction: A 40-year-old female with thyroid disease who did not take medication regularly was sent to the emergency room due to yellowish skin, drowsiness and dyspnea. Examination revealed: body temperature 39.2 ℃, blood pressure 145/75 mmHg, irregular pulse of about 145 beats/min, electrocardiogram showed atrial fibrillation with rapid ventricular rate, and chest X-ray revealed bilateral pulmonary edema. Based on the clinical manifestations, which of the following treatment statements is correct?

Input: (A) Supportive treatment, including oxygen and fluid replacement, is the main treatment. For fever, acetaminophen or aspirin can be given to help reduce fever. (B) Because the patient has atrial fibrillation with rapid ventricular rate, amiodarone can be given first to control the heart rate and prevent the symptoms of heart failure from worsening. (C) Propylthiouracil (PTU) and methimazole can both be used to inhibit thyroid hormone synthesis and inhibit the conversion of T4 to T3. (D) Lugol's solution contains iodine ions and must be used together with PTU to inhibit the production of thyroid hormone. (E) Glucocorticoids can inhibit the conversion of T4 to T3 and can improve the survival rate of patients with thyroid storm.

Output: E


Instruction: A 3-year-old child, who was healthy in the past, was complained by his family that he started to have diarrhea and intermittent abdominal pain two days ago. He received intravenous infusion treatment in the emergency department of a community hospital, but his condition did not improve and he even started to have bloody stools. The parents observed that the child was crying frequently and requested to be transferred to the emergency department of a evacuation hospital for treatment. The blood test results are as follows: WBC: 12,000/uL, Hb: 9 g/dL, PLT: 19,000/uL, glucose 75 mg/dL, BUN 50 mg/dL, Creatinine 5.5 mg/dL, AST 60 U/L, Na 125 mEq/L, K 4.8 mEq/L. Which of the following is correct?

Input: (A) The child's condition is probably caused by intussusception. (B) A blood smear is not helpful for diagnosis. (C) Children's oliguria rarely lasts for a week. (D) Antibiotics are very helpful in such cases. (E) It is more likely that toxins damage the colon mucosal epidermis and enter the blood, causing the impact.

Output: E


Instruction: A 38-year-old female with a history of hyperthyroidism was sent to the emergency room due to fever and shortness of breath. Her vital signs during examination were: temperature 39.5 ℃, pulse 143 beats/min, respiration 24 times/min, blood pressure 108/59 mmHg, SpO₂ 98%. Physical examination revealed: the patient was orthopnea with bilateral lower limb edema, bilateral breath sounds with wet rales, and the electrocardiogram showed sinus tachycardia. Which of the following statements is incorrect?

Input: (A) It is necessary to assess the patient's consciousness to see if there are symptoms such as drowsiness, convulsions, coma, and whether there are manifestations of hepatobiliary and gastrointestinal dysfunction such as anorexia, abdominal pain, and jaundice. (B) Based on the patient's history of hyperthyroidism, fever, and tachycardia accompanied by heart failure, if there are clinical symptoms such as central nervous system and hepatobiliary and gastrointestinal dysfunction, it is possible to suspect whether it is a thyroid storm. (C) The patient's thyroid function can be tested to determine whether it is thyrotoxicosis or thyroid storm. (D) Possible causes of thyroid storm include infection, diabetic ketoacidosis, or discontinuation of antithyroid drugs. (E) Other possible differential diagnoses need to be considered, such as infection, fever emergency, or use of sympathomimetic agents.

Output: C


Instruction: A 35-year-old male patient came to the emergency department because he had a small amount of blood in his stool this morning. Upon questioning, he had no history of abdominal pain or syncope. Which of the following statements about lower gastrointestinal bleeding is incorrect?

Input: (A) The most common cause of confirmed lower gastrointestinal bleeding is diverticular disease. (B) 10-14% of patients with bloody stools have bleeding spots from the upper gastrointestinal tract. (C) Patients with lower gastrointestinal bleeding without abdominal tenderness have a higher morbidity rate. (D) About 80% of patients with lower gastrointestinal bleeding will have spontaneous remission. (E) The Glasgow-Blatchford Bleeding score can be used as the only criterion for patients with lower gastrointestinal bleeding to be discharged from the outpatient clinic for follow-up treatment.

Output: E


Instruction: A 32-year-old female has received multiple packed RBC transfusions due to anemia caused by chronic menorrhagia. She had febrile nonhemolytic transfusion reactions during the last two transfusions. Her current Hb is 6.0 g/dL. After transfusion type and cross-matching, which of the following methods can reduce the possibility of a febrile nonhemolytic transfusion reaction occurring again?

Input: (A) Whole blood transfusion. (B) Irradiated red blood cell transfusion. (C) Reduce the transfusion rate so that the transfusion time exceeds 4 hours. (D) Volume-reduced red blood cell transfusion. (E) Leukocyte-reduced red blood cell transfusion.

Output: E


Instruction: A 32-year-old female was accidentally injured by ignited gunpowder while watching the National Day fireworks 4 hours ago. About 50% of her body surface was covered with blisters or charred. The patient weighs 50 kgw, has a blood pressure of 110/89 mmHg, a heart rate of 120 beats/min, and has 100 ml of urine through an indwelling urinary catheter. He has been given 1,000 ml of lactated Ringer's solution since the injury. How many ml should be given per hour for the next 4 hours of infusion according to the Parkland formula?

Input: (A)8,000 ml. (B)5,000 ml. (C)625 ml. (D)1,000 ml. (E)975 ml.

Output: D


Instruction: A 32-year-old male presents to the emergency department with symptoms of bilateral eye pain, photophobia, uncontrollable tearing, and blurred vision. He works as an electric welder. Today, he developed this symptom after working for 8 hours without wearing goggles. Which of the following drugs is most suitable for temporary pain relief?

Input: (A)Nonsteroidal anti-inflammatory drug eye drop. (B)Steroid eye drop. (C)Decongestant eye drop. (D)Topical anesthetics. (E)Antihistamine eye drop.

Output: D


Instruction: A 30-year-old female who is 12 weeks pregnant comes to the clinic because of migraine combined with nausea and vomiting. Which of the following drugs can be considered the most appropriate?

Input: (A)Chlorpromazine. (B)Dihydroergotamine. (C)Metoclopramide. (D)Prochlorperazine. (E)Sumatriptan.

Output: C


Instruction: A 30-year-old male was in a car accident and arrived at the hospital with a chest contusion. He was conscious, with a blood pressure of 145/75 mmHg, a heart rate of 115 beats/min, and respirations of 30 times/min. He had hazy breath sounds on the right side. His chest wall bulged when he exhaled and sunken when he inhaled. Which of the following statements about the first aid of this patient is wrong?

Input: (A) Examination of the right chest revealed pneumothorax, which required chest tube drainage. (B) This breathing pattern should raise the suspicion of flail chest. (C) The patient may be in shock. (D) Recommended examinations include 12-lead electrocardiogram and cardiac enzyme testing. (E) Typical pulmonary contusion changes often appear 6 hours after injury in radiographic examinations.

Output: E


Instruction: A 30-year-old male had been feeling weak for two days. This morning, he found that his limbs were becoming weaker and he had palpitations. He was taken to the emergency room by his family. The patient reported that he often had hand tremors and sweating, and he had also had limb weakness in the past. During the examination, his temperature was 36.2 ℃, his pulse was 65 times/min, his blood pressure was 128/79 mmHg, and his respiration was 16 times/min. Except for the symmetrical weakness in his limbs, there were no other abnormalities. A blood test revealed that the potassium concentration in his blood was 1.6 mmol/L, TSH was low, and T3 and Free T4 were high. Which of the following statements is incorrect?

Input: (A) This patient may be suspected of having hypokalemic periodic paralysis caused by hyperthyroidism. (B) The patient may have an attack after drinking alcohol or eating a lot of sweets, and the symptoms are mainly symmetrical distal weakness of the limbs. (C) The electrocardiogram may show flattening of the T wave, depression of the ST segment and the appearance of U waves. (D) When potassium chloride (KCl) injection is given by peripheral venous route, the potassium ion concentration should not exceed 40 mEq/L. (E) When potassium ions are given by peripheral venous route, the supplementation rate should not exceed 40 mEq/hr.

Output: B


Instruction: A 28-year-old male was in a car accident 1 hour ago and suffered blunt abdominal injuries. Which of the following statements is incorrect?

Input: (A) Go to the emergency department and immediately check amylase and lipase (A) The patient's right eye was red and had mucopurulent discharge after wearing contact lenses. (B) The patient was given a peritoneal lavage (DPL) immediately after arriving at the emergency department, which could exclude pancreatic damage. (C) An abdominal CT scan immediately after arriving at the emergency department could not exclude intestinal damage. (D) Blunt abdominal injuries are more common in the left diaphragm than in the right. (E) If the patient has only a simple liver laceration, non-surgical treatment may be used depending on the severity.

Output: B


Instruction: A 26-year-old female, 32 weeks pregnant and weighing 65 kg, was hit by a motorcycle while crossing a zebra crossing. When she was taken to the emergency room by ambulance, she was conscious, breathing 24 times/min, pulse 112 times/min, blood pressure 118/76 mmHg, and body temperature 36.5 ℃. The victim complained of lower abdominal pain and a small amount of vaginal bleeding. Physical examination revealed lower abdominal tenderness but no rebound pain. Which of the following statements about this pregnant woman is incorrect?

Input: (A) Although the pregnant woman's blood pressure is within the normal range, her bleeding may still exceed 1,500 ml, so she should be given crystalloid fluid infusion therapy and blood transfusion should be considered. (B) Although the pregnant woman does not know her own blood type, she knows that the fetus's blood type is type O Rh(-). Therefore, no matter what the mother's blood type is, she does not need to be given RhO(D)immunoglobulin. (C) The pregnant woman should lie on her left side to prevent the uterus from compressing the inferior vena cava. (D) When the pH value of vaginal secretions is around 5, it indicates amniotic membrane rupture. (E) If the pregnant woman's heart stops after emergency treatment, an emergency cesarean section can be considered.

Output: D


Instruction: A 26-year-old male drank a lot of mineral water and drinks to replenish water after sweating a lot during a marathon. After resting, he still felt dizzy and had a headache, so he continued to drink a lot of water. Later, as the symptoms worsened, he was taken to the emergency room by a friend. His temperature was 36.5℃, pulse 61 beats/min, blood pressure 110/75 mmHg, respiration 19 breaths/min, consciousness E3V4M5. Blood tests revealed that the blood sodium concentration was 128 mmol/L and the plasma osmolality was 266 mOsm/L. Which of the following statements is incorrect?

Input: (A) When evaluating a patient with hyponatremia, the status of the extracellular fluid must be evaluated first. (B) A patient with hyperglycemia may have pseudohyponatremia due to excessive blood sugar. (C) This patient may have hypoosmotic hyponatremia due to excessive drinking of water. (D) The speed of correction of low blood sodium should not exceed 0.5~1.0 mEq/L per hour. If the patient develops seizures, the speed can be doubled. (E) Correcting blood sodium too quickly may cause cerebral edema, which can be fatal in severe cases.

Output: E


Instruction: A 25-year-old female developed right eyelid redness and mucopurulent discharge after wearing contact lenses. discharge) to the emergency room. The eyes do not hurt. Which of the following drugs is most suitable for treating this patient?

Input: (A) Gentamicin/Betamethasone eye drops. (B) Tetracycline HCl eye ointment. (C) Rinderon-A eye ointment. (D) Erythromycin eye ointment. (E) Ciprofloxacin eye drops.

Output: E