Instruction: Which of the following statements about valvular heart disease is less appropriate?

Input: (A) If the patient has symptoms at rest and a diastolic murmur is detected, an urgent echocardiogram is recommended, even if vital signs are stable. (B) If the patient experiences syncope, it is necessary to identify whether it is aortic stenosis. Hospitalization and observation and arrangement of echocardiogram are recommended. (C) If the chest X-ray shows that the heart is normal in size but there is severe pulmonary edema, it is necessary to identify whether it is acute mitral regurgitation. (D) The typical symptoms of aortic stenosis are wheezing, chest pain, and dizziness. However, many patients with severe aortic stenosis have no symptoms. (E) If the diagnosis is aortic detachment with acute aortic regurgitation, β-blocker treatment is recommended.

Output: E


Instruction: Which of the following patient's behavioral symptoms is more consistent with functional (Psychiatric)psychosis?

Input: (A) Aged over 40, with alcoholism, sometimes irritable and abnormal behavior, sometimes normal. (B) Occasional hallucinations, drowsiness, often not knowing the time, not recognizing places and people. (C) Sudden confusion, inability to speak, only sounds, weakness in hands and feet. (D) Unable to do simple calculations, poor recent memory, but good long-term memory, unable to feed himself. (E) Delusions, flat expression, incoherent speech, auditory hallucinations, occasionally maintaining a rigid posture.

Output: E


Instruction: A 35-year-old male patient complained of a sudden nosebleed while resting. Examination revealed persistent bleeding from the right nostril. Which of the following statements is more appropriate?

Input: (A) When using a nasal speculum to examine the nostrils, they must be spread horizontally so that the nasal septum can be examined. (B) The most common site of anterior epistaxis is the inferior nasal concha. (C) When bleeding persists, the use of silver nitrate chemical cautery is a better way to stop the bleeding. (D) If nasal packing is used, antibiotics must be prescribed to prevent toxic shock syndrome. (E) Patients with nosebleeds may consider injection of tranexamic acid.

Output: E


Instruction: A 50-year-old male had cardiac arrest before arriving at the hospital. He was sent to the emergency department and returned to spontaneous circulation (ROSC) after CPR. Which of the following statements about the current assessment and targeted temperature management (TTM) is more appropriate?

Input: (A) TTM may cause side effects such as hyperkalemia, increased coagulopathy, and tremors. (B) TTM can improve both survival and neurological outcomes. (C) If the patient is conscious, sedatives can be given before TTM. (D) Brain damage and edema will stop worsening after ROSC. (E) Clinical neurological reflex deficits or abnormalities can predict poor outcomes.

Output: B


Instruction: A 32-week pregnant woman fell off her motorcycle. She was conscious, with a heart rate of 100 beats/min, blood pressure of 120/80 mmHg, respiration rate of 18 breaths/min, multiple abrasions on her limbs, and a tightness in her abdomen without obvious external injuries. Abdominal ultrasound showed no intra-abdominal bleeding, and the fetal heart rate was about 140 beats/min. Which of the following statements is more appropriate for this pregnant patient?

Input: (A) She needs to be hospitalized immediately for a cesarean section. (B) Even if there is no obvious abdominal injury, it is recommended to use tocodynamometry for observation for 2 hours before discharge. (C) The patient's blood type is Rh negative, and giving Rho(D) immune globulin can prevent the occurrence of pre-eclampsia. (D) Antibodies produced by the injection of tetanus toxoid can cross the placenta and reduce the possibility of neonatal tetanus. (E) If vaginal secretions increase and the pH is equal to 5, amniotic membrane rupture should be highly suspected.

Output: D


Instruction: In a fire accident, if you want to follow the simple triage and rapid treatment (START) rule, which of the following scenarios is more appropriate?

Input: (A) A four-year-old girl has a deformed left leg and keeps crying and looking for her mother. The triage is green. (B) A man in his sixties has carbon particles in his mouth and nose. He still does not breathe after opening his airway. The triage is red. (C) The young woman rescued from the stairwell had only a scratch on her forehead and her vital signs were stable. When her identity was confirmed, she answered questions irrelevantly and was unable to follow simple instructions. Her injury was red. (D) A woman in her thirties had extensive burns on her limbs and ran anxiously to call her daughter. Her injury was yellow. (E) A middle-aged man fell to the ground. His pulse could not be felt in his limbs. His breathing was shallow and rapid. His injury was yellow.

Output: C


Instruction: Which of the following substances has a more appropriate description of the poisoning mechanism?

Input: (A) Pufferfish poisoning: It can increase the permeability of nerve axons and muscle cells to sodium ions, thereby changing the balance of ions inside and outside the cells. (B) Organophosphate poisoning: mainly related to the surface expander POEA (polyoxyethylene-amine) it contains. (C) Strong acid: produces liquefaction necrosis of the exposed part, which can damage blood vessels, cells, and subcutaneous tissue, leading to deep tissue damage. (D) Cyanide poisoning: cyanide ions combine with trivalent iron ions of mitochondrial cytochrome oxidase (cytochrome oxidase aa3), causing it to lose its function, inhibiting the use of oxygen by tissues, causing intracellular hypoxia, and causing metabolic acidosis. (E) Coral reef fish toxin poisoning: can inhibit the permeability of cell membranes to sodium ions, and can also inhibit cholinergic receptors on central nervous system or ganglia.

Output: D


Instruction: A 9-month-old girl, weighing 10 kg, complained that she had paroxysmal abdominal pain and crying since 6 hours ago. She vomited once at the checkpoint. Her family opened her diaper and found no blood in her stool. Which of the following diagnoses is less likely?

Input: (A)Midgut volvulus. (B)Pyloric stenosis. (C)Intussusception. (D)Incarcerated hernia. (E)Vir al enterocolitis.

Output: B


Instruction: Which of the following statements about peripheral vertigo and central vertigo is less appropriate?

Input: (A) Peripheral vertigo is generally shorter-lived, while central vertigo symptoms may last weeks to months. (B) Symptoms of peripheral vertigo are more likely to be affected by head position than those of central vertigo. (C) Horizontal head impulse test will produce abnormal reactions in patients with peripheral vertigo. (D) Nystagmus in peripheral vertigo is usually direction-changing horizontal nystagmus, while in central vertigo it may be horizontal, circular, or vertical. (E) Vertigo combined with hearing loss or tinnitus is more likely to be peripheral vertigo, while headache or neck pain should be considered central vertigo.

Output: D


Instruction: Which of the following patients is more likely to experience non-classic chest pain?

Input: (A) Middle-aged male. (B) Hypertension. (C) Hyperlipidemia. (D) Mental illness.

Output: D


Instruction: A 57-year-old female patient was sent to the emergency room because of unconsciousness. Her family mentioned that the patient had been taking an unknown drug purchased from a radio station for long-term joint pain, but had recently stopped taking the drug due to gastrointestinal discomfort. Her blood pressure was 90/60 mmHg, blood glucose was 65 mg/dL, and blood sodium was 123 mEq/L. Which of the following treatments is more appropriate?

Input: (A) Lumbar puncture followed by antibiotic Ceftriaxone. (B) Hydrocortisol. (C) Thyroxine. (D) 3% Saline.

Output: B


Instruction: A 28-year-old male had headaches, lower abdominal pain, and red eyes for about 10 days. He went to the clinic for a checkup and was told that he had a cold. After the symptoms were slightly relieved, he developed fever, muscle soreness, jaundice, and oliguria. A week before the onset of symptoms, he had gone mountain climbing for several days, swam in the river, and drank river water. Results of an emergency blood test: WBC 10,600/µL, 70.0% PMN, platelets 100,000/µL, AST 157 IU/L, ALT 57 IU/L, bilirubin 4.0 mg/dL, BUN 47 mg/dL, Cr 5.7 mg/dL. Which of the following statements is more appropriate?

Input: (A) This patient has a mild case, accounting for 10~20%, and most cases can heal on their own. (B) This patient should be considered for reporting a Category IV notifiable infectious disease and be isolated. (C) A rapid screening test kit for this disease is already available in the country and can be used as a confirmation. (D) Intravenous Penicillin or third-generation Cephalosporins are recommended for treatment.

Output: D


Instruction: A 14-year-old junior high school student developed acute respiratory distress and altered consciousness two days after a right femur fracture. Several small petechiae appeared on the patient's chest. Vital signs were blood pressure 95/45 mmHg, heart rate 130 beats/min, respiration 36 times/min, body temperature 38.6°C, and SpO₂ 80% under a 100% oxygen mask. Which of the following treatments should be given priority?

Input: (A)1L (A) Lung abscesses are usually located in the basal segments of lower lobes or posterior segment of upper lobes. (B) Heparin bolus 80 Units/kg. (C) Intravenous lipid emulsion. (D) Endotracheal intubation with rapid sequence intubation.

Output: D


Instruction: A 75-year-old nursing home resident was taken to the emergency department with complaints of fever, cough, and shortness of breath. A chest X-ray showed suspected left lung abscess with pleural effusion. Which of the following statements is less appropriate?

Input: (A) Lung abscesses are often located in the basal segments of lower lobes or posterior segment of upper lobes. (B) If pulmonary abscesses appear in multiple lobes at the same time, endocarditis or Lemierre's syndrome should be suspected. (C) For this patient, the choice of piperacillin-tazobactam is a reasonable empirical medication. (D) If the development of empyema is only in the first stage of exudative stage and has not yet developed into the fibrinopurulent stage, appropriate antibiotic treatment is very important, and chest tube drainage is usually not required.

Output: D


Instruction: Regarding diaphragmatic injury, which of the following descriptions is more appropriate?

Input: (A) Usually more on the right side than on the left side. (B) More common in puncture wounds in the chest and abdomen. (C) The threat to vital signs is mainly hemorrhagic shock. (D)Computed tomography (CT scan) has a high diagnostic rate for minor diaphragm injuries.

Output: B


Instruction: Which of the following statements about diabetic ketoacidosis (DKA) and hyperosmotic state (HHS) is more appropriate?

Input: (A)The treatment of both focuses on fluid resuscitation. (B)Both can cause severe acidemia due to increased blood ketones. (C)The blood sugar level in DKA is often higher than that in HHS. (D)DKA is common in the elderly, while HHS is common in young people.

Output: A


Instruction: Which of the following statements is more appropriate regarding craniofacial nerve palsy?

Input: (A) The presence of ptosis, pupil constriction, and neck pain at the same time requires consideration of vertebral artery dissection. (B) When the third cranial nerve is palsied due to compression by a hemangioma, the pupil appears constricted. (C) When the third cranial nerve is palsied due to hypertension and diabetes, the pupil size is not affected. (D) When the facial nerve is combined with the sixth cranial nerve on the same side, viral infection should be considered first.

Output: C


Instruction: A 40-year-old woman was stabbed in the left lower back with a knife. Her vital signs are stable. Which of the following statements about follow-up treatment is more prioritized and appropriate?

Input: (A) A CT scan with contrast should be performed. (B) The wound can be explored and the injury can be assessed under appropriate light and local anesthesia. (C) If FAST is negative, the patient should not be seriously injured. (D) The patient should be hospitalized for hemoglobin tracking.

Output: A


Instruction: Which of the following descriptions of the treatment of hemorrhagic shock in trauma patients is more appropriate?

Input: (A) Patients with bilateral hip fractures and hypotension should first be infused with crystalloid fluid, with the goal of restoring the patient's blood pressure to normal. (B) For trauma patients, rapid and adequate infusion treatment is far more important than controlling bleeding. (C) Tranexamic acid given within 3 hours can improve the survival rate of trauma patients. (D) Massive transfusion is defined as the transfusion of more than 10 units of red blood cells and plasma within 24 hours.

Output: C


Instruction: Which of the following statements about the clinical manifestations of systemic lupus erythematosus (SLE) is less appropriate?

Input: (A) It increases the risk of coronary artery disease and venous embolism. (B) An increase in C-reactive protein (CRP) should give priority to infection rather than disease activity. (C) An increase in prothrombin time (PT) alone should be considered as antiphospholipid antibodies. (D) All organ systems are affected by this disease.

Output: C


Instruction: A 12-year-old female dislocated her right elbow after a fall. She was unable to abduct her fingers and had numbness on the palm of her little finger. Which of the following nerves was damaged?

Input: (A) Median nerve. (B) M usculocutaneous nerve. (C)Radial nerve. (D)U lnar nerve.

Output: D


Instruction: A 56-year-old male with recurrent syncope went to the emergency room and was diagnosed with subclavian steal syndrome. Which of the following descriptions is more appropriate?

Input: (A)This lesion is a neurological syncope. (B)This lesion often occurs in the right upper limb. (C)This lesion can cause transient frontal ischemia. (D)The blood pressure on the affected side is usually higher, and the pulse on the affected upper limb feels stronger.

Output: A


Instruction: An 8-year-old boy was rushed to the emergency room after a 2-day fever and a second seizure within 30 minutes. He was no longer seizure-free when he arrived at the checkpoint. His blood pressure was 70/50 mmHg. Laboratory tests revealed WBC 21,000/µL, blood glucose 45mg/dL, and blood sodium 120 mEq/L. Cerebrospinal fluid examination results were as follows: glucose 37 mg/dL, protein 300 mg/dL, WBC 1,120/µL. Which of the following treatments is more appropriate?

Input: (A) It may be bacterial meningitis. Ampicillin and Gentamicin are recommended. (B) Correct low blood sugar and low blood sodium first, then treat epilepsy. (C) First stabilize vital signs, then perform lumbar puncture, and then CT scan of the head. (D) It is recommended to give Dexamethasone treatment to reduce inflammation of the central nervous system. It should be given after the use of antibiotics.

Output: B


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

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

Output: C


Instruction: Which of the following statements is more appropriate for diagnosing patients with acute abdominal pain?

Input: (A) Abdominal X-rays are a commonly used screening tool for various causes of abdominal pain. (B) The severity of abdominal pain is proportional to the severity of the disease. (C) Opioid analgesics can delay diagnosis of the disease. (D) Malnutrition can affect the clinical manifestations of abdominal pain in patients.

Output: D


Instruction: A 25-year-old female with no past medical history complained of chest tightness and wheezing for a day when walking or lying down. She began to have cold symptoms such as body aches and cough 4 days ago. When she arrived at the hospital, her blood pressure was 78/56mmHg, heart rate 128 beats/min, respiratory rate 30 times/min, body temperature 37.7℃, SpO₂ 90%, auscultation showed bilateral gurgling sounds, CXR showed increased bilateral lung patterns, and electrocardiogram showed rapid heartbeat and diffuse T wave inversion. Which of the following treatments is more appropriate?

Input: (A) Give β-blocker and check for hyperthyroidism. (B) Give Aspirin and Levophed, check troponin, and consult the cardiology department to prepare for cardiac catheterization. (C) Give appropriate infusion, ultrasound examination, and activate ECMO if necessary. (D) Check D-dimer and arrange chest CT immediately.

Output: C


Instruction: A 35-year-old male underwent bariatric surgery two weeks ago and came to the hospital tonight with severe abdominal pain, nausea, and vomiting. Which of the following statements is more appropriate?

Input: (A) Common surgical procedures include band gastrectomy, sleeve gastrectomy, Roux-en-Y gastric bypass, and jejunal shortening. (B) Gastrointestinal obstruction must be considered first. An abdominal X-ray or abdominal CT scan can be performed directly for diagnosis. (C) Except for band gastrectomy, other surgical procedures will remove most of the stomach and then reconstruct it. Therefore, leakage or bleeding at the sutures must be ruled out first. (D) Banding the stomach often causes the proximal gastric pouch and esophagus to expand due to being tied too tightly, which requires emergency upper gastrointestinal endoscopy for diagnosis.

Output: C


Instruction: When auricular never block is necessary due to auricular suture, where is the anesthetic needle injected on the auricle?

Input: (A) Above and below. (B) Front and back. (C) Above and back. (D) Below and front.

Output: A


Instruction: A 45-year-old male was diagnosed with AIDS (Acquired Immunodeficiency Syndrome) two years ago. He took antiviral drugs irregularly. Last month, his CD4+ was 450 cells/µL. After five days of fever, headache, and fatigue, he was sent to the emergency room due to persistent high fever. Chest X-ray and brain CT scan showed no abnormalities. The patient was lying on his side for a spinal puncture. The initial cerebrospinal fluid pressure was 280 mmH 2O. 12 ml of cerebrospinal fluid was collected and sent for testing: white blood cells 40 /µL, sugar 87mg/dL, protein 27 mg/dL, acid-fast stain, Gram stain, and India ink stain were all negative. Which of the following statements is more appropriate?

Input: (A) The patient's spinal tap results suggest bacterial meningitis is the most likely cause. (B) Spinal taps performed in the lateral position are more reliable than those performed in the sitting position in measuring cerebrospinal fluid pressure. (C) The negative India ink stain rule out cryptococcal meningitis. (D) The sensitivity of acid-fast staining for diagnosing tuberculous meningitis using >10 ml of cerebrospinal fluid is about 80%.

Output: B、D


Instruction: Which clinical symptom is more appropriate for bee stings and anaphylactic shock?

Input: (A) Anaphylactic shock usually occurs within 15 minutes after a bee sting. The more stings there are, the greater the chance of shock. (B) If a rash appears on the whole body and there is persistent abdominal pain and vomiting, give Epinephrine 0.3mg IM injection. (C) A large number of bee stings (>100 stings) often cause heart failure, as well as liver and kidney failure. (D) Symptoms such as urticaria, lymphadenitis and arthritis often occur 72 hours after a bee sting.

Output: B


Instruction: According to the 2019 American Heart Association guidelines for pediatric emergency care, which of the following statements is less appropriate?

Input: (A) During prehospital cardiac arrest, advanced airway devices (endotracheal tubes or supraglottic airway devices) are more appropriate than bag-valve-mask ventilation for children. (B) For term and late preterm newborns (35 weeks of gestation or more) who receive respiratory support at birth, the initial use of 21% oxygen is a reasonable approach. (C) For OHCA patients younger than 18 years who remain unconscious after spontaneous breathing and heartbeat are restored, hypothermia is recommended. (D) For children with cardiac disease and in-hospital cardiac arrest, extracorporeal CPR (ECPR) can be considered if experienced ECMO staff are available.

Output: A


Instruction: Which of the following treatments for patients with acute respiratory distress syndrome (ARDS) has been shown to reduce mortality?

Input: (A) Early administration of broad-acting antibiotics. (B) Using a low tidal volume setting on the ventilator. (C) Administering packed red blood cell transfusions. (D) Administering prophylactic steroids.

Output: B


Instruction: Regarding seizures in children, which of the following is more appropriate?

Input: (A) Early use of anti-epileptic drugs has no significant difference in the treatment of epilepsy and gravitational syndrome. (B) Ketamine can be considered as a second-line drug for epilepsy and gravitational syndrome, and there is no need to worry about it causing increased intracranial pressure. (C) About 50% of patients with simple febrile seizures over 1 year old will have a second febrile seizure. (D) For children with complex febrile seizures, routine blood draws and imaging examinations are recommended.

Output: B


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

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

Output: C


Instruction: When a seizure occurs after using Flumazenil, which of the following drugs is the best choice to stop the seizure?

Input: (A)Benzodiazepine. (B)Phenytoin. (C)Propofol. (D)Sodium Valproate.

Output: C


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

Input: (A) It can be transmitted through air, droplets or contact with nasopharyngeal secretions of patients, but after infection, one will have lifelong immunity. (B) Symptoms such as cough, rhinitis, conjunctivitis, high fever, and fatigue will appear first, followed by white spots on the mucosa of the inner cheek opposite the lower molars in the mouth, called Koplik spots. (C) The typical maculopapular rash will appear in an eccentric shape, first appearing on the trunk, and then gradually spreading to the entire back of the ear, face and limbs. (D) Although the MMR vaccine in childhood can produce active immunity, if an adult wants to travel to a measles-endemic area, it is recommended to get a dose of MMR vaccine before going there.

Output: C


Instruction: During the summer vacation, Xiao Ming participated in a marathon competition. During the process, Xiao Ming felt thirsty, weak and dizzy, so he went to the medical station to sit down and rest. The medical station staff found that Xiao Ming's temperature was 39.5℃, E4V5M6, and he could answer clearly. Which of the following statements is more appropriate?

Input: (A) Because it is hot in summer, Xiao Ming may have suffered heat stroke. (B) The medical station let Xiao Ming lie down and replenish water, and also gave him Acetaminophen 500mg to assist in cooling down. (C) If Xiao Ming's consciousness gradually becomes confused during the rest process, an intravenous line can be established to give him physiological saline. (D) The medical station should not wait until Xiao Ming's consciousness changes, and should consider using 4℃ intravenous injection to quickly cool him down.

Output: C


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

Input: (A) The severity of kidney damage caused by trauma is closely related to the amount of hematuria. (B) Urine examination found red blood cell cylinders (red cell (C) Hematuria in children does not need to be considered a tumor. (D) Hematuria caused by glomerulonephritis is more common in middle-aged and elderly people.

Output: B


Instruction: A 4-year-old boy was sent to the emergency room because of fever, cough, dyspnea and lethargy. Vital signs: blood pressure 70/55mmHg, heart rate 149 beats/min, respiration 28 times/min, cold limbs, mottled skin, capillary refill of 5 seconds, blood test white blood cell count 21,000/µ L, X-ray showed right-sided pneumonia. Which of the following judgments and treatments is less appropriate?

Input: (A) It may be cold septic shock. (B) The preferred pressor drug is Norepinephrine rather than Dopamine or Epinephrine. (C) The infection may be Gram-positive bacteria. (D) Broad-acting antibiotics and 30ml/kg infusion are required within 1 hour for recovery.

Output: B, D


Instruction: A 65-year-old male patient complained of fainting and loss of consciousness for about 3 minutes. His blood pressure was 167/88 mmHg, his heart rate was 77 beats/min, and his EKG showed ST depression over lead II, III, and aVF. His troponin level was elevated and his D-dimer level was 300 ng/mL. Which of the following statements is less appropriate?

Input: (A) The patient had a non-ST-band elevation myocardial infarction, which has a mortality rate higher than that of ST elevation MI. (B) The patient had cardiac-related syncope, which has a mortality rate of more than 10% in half a year and is the most dangerous type of syncope. (C) The patient underwent percutaneous coronary intervention (PCI) within 24 to 48 hours, which did not reduce the mortality rate or recurrent MI. (D) Troponin peaked at about 48 hours and could remain elevated for up to 10 days.

Output: C


Instruction: A 30-year-old male found himself weak and unable to move when he got up in the morning and went to the emergency room. 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 less appropriate?

Input: (A) The diagnosis may be hyperthyroidism combined with periodic paralysis. (B) The affected muscles are mostly distal muscles. The lower limbs are more susceptible to the impact than the upper limbs. There is symmetry and they are often accompanied by abnormal sensations. (C) The patient is more likely to have an attack if he eats foods high in starch and salt. (D) Do not give the patient dextrose solution with KCL.

Output: B


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

Input: (A) Gauze can be inserted between the gums and cheeks to increase the tightness of the mask during BVM. (B) Dentures should be removed before using BVM to give oxygen to prevent them from falling off and causing airway obstruction. (C) A rapid heartbeat is an early sign of ischemic shock. (D) Shock is only considered when the required systolic pressure is less than 100 mmHg.

Output: A


Instruction: A 25-year-old female has had left lower abdominal pain and excessive vaginal discharge for about one week. The patient came to the emergency department with a fever. Internal examination revealed purulent vaginal discharge, cervical tenderness, and ultrasound showed a mass on the left side of the uterus. Which of the following statements is more appropriate for this patient?

Input: (A) If left untreated, the mass may rupture and cause peritonitis. (B) Cervical tenderness during internal examination is highly specific for diagnosing pelvic infection. (C) The diagnosis is Fitz-Huge-Curtis syndrome. (D) If the pus culture is not Neisseria gonorrhoeae, Neisseria gonorrhoeae infection can be ruled out.

Output: A


Instruction: A 60-year-old male has had left upper arm pain for one week. Which of the following neurological examination descriptions is less appropriate?

Input: (A) If accompanied by abnormal nerve sensation, it is a sign of radiculopathy. (B) Performing the Valsalva maneuver will increase the pain, which may be a radiculopathy. (C) Abduction will increase the pain in the left neck, which may be a symptom of nerve root compression. (D) When the neck is flexed and the chin is brought close to the chest wall, the upper arm will produce pain like electrical stimulation, which may be a symptom of cervical spinal cord compression.

Output: C


Instruction: A 55-year-old female presented to the emergency department with a high fever of 39.5°C and right upper abdominal pain. She was drowsy, with a heart rate of 95 beats/min, a blood pressure of 98/56 mmHg, yellow skin and sclera, and a white blood cell count of 16,000/µL. The initial diagnosis was acute cholangitis. Which of the following statements is more appropriate?

Input: (A) According to the 2016 Sepsis-3 guideline, a qSOFA score of 2 is calculated based on a high fever of ≥39°C and a systolic blood pressure of ≤100 mmHg. The patient is suspected to have an infection with sepsis. (B) Give at least 30 mL/kg of crystalloid intravenously within the first 3 hours of treatment. (C) When pressor therapy is needed, norepinephrine is the first choice. It has only an α-adrenergic effect that causes peripheral vasoconstriction, but is less likely to affect heart rate. (D) If blood pressure remains low after massive infusion and pressor therapy, corticosteroids should be injected as soon as possible.

Output: B


Instruction: Which of the following patients who were successfully resuscitated after cardiac arrest is suitable for targeted temperature management?

Input: (A) A 60-year-old male has hypertension. A CT scan of his head revealed approximately 10 cc of hemorrhage in the brain stem. (B) A 29-year-old female died after arriving at the hospital after a car accident. After recovery, a large amount of intra-abdominal blood was found. (C) A 70-year-old male had no medical history and 30 cc of coffee-colored gastric fluid was drained through a nasogastric tube. (D) A 35-year-old male was able to nod after first aid, and the electrocardiogram showed an increase in ST-segment.

Output: C


Instruction: Which of the following statements about Bell's palsy is more appropriate?

Input: (A) It is more common in the elderly and preschool children with poor immunity. (B) Imaging examination is the diagnostic standard. (C) Incision and drainage and needle aspiration have the same therapeutic effect. (D) Tonsillectomy is the first choice of treatment.

Output: C


Instruction: Which of the following statements about Bell's palsy is more appropriate?

Input: (A) If the facial nerve (cranial nerve VII) is affected, the patient may experience symptoms of hyperacusis. (B) If the glossopharyngeal nerve (cranial nerve IX), the patient may have decreased taste in the back third of the tongue. (C) Since ear infections are rare, routine ear examinations are not necessary and oral steroids can be given first. (D) Giving antiviral drugs and steroids to patients at the same time will cause more side effects, so it is not recommended to use them together.

Output: A


Instruction: A 19-year-old male was taken to the emergency room in a state of agitation and confusion after allegedly taking an unknown hallucinogen in a nightclub. Which of the following statements is more appropriate?

Input: (A) Tachycardia and hypotension are common symptoms of hallucinogen intoxication, so the patient's vital signs must be monitored more closely. (B) Supportive therapy is the most commonly used method, which requires gastric lavage and the use of activated carbon to remove drugs. (C) Urinalysis must be done immediately to detect what type of hallucinogen the patient has taken and to give the corresponding antidote. (D) If the patient shows symptoms of extreme agitation or palpitations, most of them can be treated with BZD.

Output: D


Instruction: Which of the following statements about graft versus host disease (GVHD) is less appropriate?

Input: (A) Acute GVHD occurs within 100 days after transplantation. (B) The most common symptoms of Acute GVHD are fever and diarrhea. (C) Acute GVHD After recovery, patients are prone to chronic GVHD. (D) Currently, drugs commonly used to prevent GVHD include Tacrolimus and Methotrexate.

Output: B


Instruction: A 20-year-old male hits his head on the bottom of a swimming pool while diving. The patient is conscious and complains that he cannot move his hands and feet at all. He cannot feel pain from the clavicle down, but proprioception and vibration sensation in his limbs are normal. An X-ray of the cervical spine shows no fractures. What diagnosis is most likely for this patient?

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

Output: B


Instruction: A 25-year-old male presents to the emergency department with right-sided headache accompanied by nausea and photophobia. Which of the following statements is more appropriate?

Input: (A) Typical migraine symptoms include unilateral, persistent, non-throbbing pain, accompanied by photophobia and phonophobia. (B) Antihistamines alone (such as intravenous diphenhydramine) can also relieve migraine pain. (C) After excluding life-threatening diseases, nonsteroidal anti-inflammatory drugs and antiemetics can be used in combination to treat migraine. (D) Steroids are not helpful in reducing the recurrence of migraine.

Output: C、D


Instruction: Which of the following statements about the physical examination and clinical symptoms of abdominal emergencies is more appropriate?

Input: (A) Bruising and bleeding around the navel of a patient with pancreatitis is a Grey Turner's sign. (B) Compared with morphine, the use of nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief is less likely to conceal clinical symptoms and delay diagnosis. (C) Low risk modified Alvarado score (0-4 points) has low sensitivity and should not be used as the main tool for exclusion diagnosis. (D) Fitz-Curtis-Hugh syndrome pain is mainly located in the left upper abdomen.

Output: C


Instruction: Which of the following major or minor criteria for the diagnosis of infective endocarditis is less appropriate?

Input: (A) Two separate sets of blood cultures grow typical bacteria. (B) Cardiac ultrasound shows floating organisms or abscesses on the valve. (C) New onset of right bundle branch block (RBBB). (D) Fever greater than 38°C.

Output: C


Instruction: Which of the following descriptions of sedatives for acute agitation is more appropriate?

Input: (A) Benzodiazepines can cause electrocardiographic changes such as QTc prolongation. (B) First-generation antipsychotics such as Haloperidol do not cause respiratory depression. (C) Second-generation antipsychotics such as Quetiapine do not cause electrocardiographic changes such as QTc prolongation. (D) Second-generation antipsychotics such as Risperidone do not cause extrapyramidal symptoms.

Output: B


Instruction: A 66-year-old female patient presented with upper lip and tongue swelling three days ago. She had no fever, rashes, or signs of local tissue infection. She had hypertension and hyperlipidemia and had been treated with Enalapril 10mg qd and Atorvastatin 10mg qd a week ago. She had not taken any other medications. Which of the following treatments is inappropriate?

Input: (A) The pathogenesis is related to bradykinin. (B) Attention should be paid to the presence of airway obstruction. (C) Current treatment should be based on oral steroids and antihistamines. (D) If other antihypertensive drugs are used, angiotensin II receptor-blocking agents should be avoided.

Output: C


Instruction: A 65-year-old male with a history of epilepsy and mental illness was sent to the emergency room after taking an overdose of Phenytoin and becoming unconscious. Which of the following statements is more appropriate?

Input: (A) Nystagmus is related to the dose of the patient's poisoning. If the nystagmus is relieved, the possibility of severe poisoning can be ruled out. (B) Phenytoin's cardiotoxicity is common with intravenous medication and rarely occurs with oral medication. (C) Hemodialysis is helpful in removing Phenytoin, but has limited effect on improving symptoms of neurological poisoning. (D) Usually, once the serum concentration of phenytoin drops below normal, the patient can be discharged from the hospital for observation at home after a psychiatric consultation.

Output: B


Instruction: Which of the following statements about qSOFA is more appropriate for evaluating patients with infectious diseases?

Input: (A) There are three qSOFA assessment items in total. As long as two of them are met, the patient can be diagnosed with sepsis. (B) Platelet count less than 10,000/µL is one of the qSOFA assessment items. (C) Respiratory rate ≥ 20 times/min is one of the qSOFA assessment items. (D) Systolic blood pressure less than or equal to 100 mmHg is one of the qSOFA assessment items.

Output: D


Instruction: A 24-year-old male had 3-second glue dropped into his right eye 10 minutes ago. The main ingredient of the product is cyanoacrylate. Examination revealed that a small part of the upper and lower eyelashes were stuck and could not be opened. The sclera was slightly congested, the eyeball moved freely, and the vision was normal. There is no ophthalmologist in the hospital. Which of the following treatments should be prioritized?

Input: (A) Apply acetone with a cotton swab to the stuck area to dissolve the stickiness of the 3-second glue. (B) You can try to remove the stuck eyelashes with your bare hands. (C) Inform the patient that it may cause cataracts in the future. (D) You must be transferred to a hospital with an ophthalmologist on duty immediately.

Output: B


Instruction: A 61-year-old female with breast cancer has been receiving chemotherapy for about a month. She started to have mild cough, nausea, poor appetite, abdominal distension and other symptoms two or three days ago. Today, she became unconscious and had a fever. When she went to the hospital, her GCS was E2M4V1, her blood pressure was 140/68 mmHg, her heart rate was 126 beats/min, her respirations were 26 breaths/min, SpO₂ was 96%, and her temperature was 38.3℃. Which of the following is more appropriate for this patient?

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

Output: D


Instruction: Which of the following descriptions of the physiological changes and emergency treatment during pregnancy is more appropriate?

Input: (A) Cardiac output and blood volume will increase, so blood pressure can be higher than when not pregnant. (B) Respiratory secretions decrease, which does not affect intubation. (C) Prolonged gastric emptying time and more relaxed ventricular dilator muscles require prevention of aspiration pneumonia. (D) Tidal volume increases due to hormonal factors, making pregnant women less likely to suffer from hypoxia.

Output: C


Instruction: According to the announcement of the Taiwan Centers for Disease Control, which of the following statements is more appropriate regarding home quarantine measures related to the novel coronavirus infection epidemic?

Input: (A) People under home quarantine can go out after reporting when they need to purchase daily necessities. (B) The head of the village or the village official is responsible for the health care of the self-health manager. (C) For people under home quarantine, the responsible unit is the local health authority. (D) For people under home quarantine, the responsible unit is the local health authority.

Output: C


Instruction: A 22-year-old female suddenly developed severe pain in the lower abdomen and went to the emergency room for medical treatment. She was conscious and her vital signs were stable. She had no trauma and no fever. Her last menstruation was about 2 weeks ago. Her menstruation is regular, about 30-32 days in cycle. She suffered abdominal pain when walking. Her hemoglobin was 12.4 g/dL and her pregnancy test was negative. An abdominal CT scan showed a cystic mass of about 3.8 cm on the right ovary, which contained a high-density content, a non-calcified cyst, and pelvic effusion. Which of the following diagnoses or treatments is more appropriate?

Input: (A) Ovary torsion. Contact the obstetrics and gynecology department and arrange surgery immediately. (B) Rupture of appendicitis , contact the surgical department and arrange surgery. (C) Rupture of corpus luteum cyst , contact the obstetrics and gynecology department and follow up with abdominal ultrasound. (D) Complicated nephrolithiasis , pain relief and observation.

Output: C


Instruction: A 65-year-old male was sent to the emergency room by a passerby because of chest tightness. The patient complained of squeezing pain in the chin and left shoulder. He had been in good physical condition in the past and had no history of heart-related diseases. The only medicine he was currently taking was Levitra (Vardenafil). The electrocardiogram showed ST-segment elevation, and the blood test report showed elevated troponin-I and CK-MB, and normal D-Dimer values. The emergency physician initially diagnosed the patient with acute coronary syndrome. Which of the following is the more appropriate treatment?

Input: (A) Immediately give nitroglycerin (0.4mg sublingual tablet), up to three doses (5 minutes apart each time). (B) Unless there are contraindications such as hypotension, morphine (4mg, IVP) should be given routinely to relieve chest tightness. (C) Even if the patient is allergic to aspirin, clopidogrel (300mg) should be used instead. (D) ACE inhibitors should not be used in patients with normal LVEF (left ventriculo lar ejection fraction).

Output: C


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

Input: (A) Lightning injuries are usually fatal. (B) Lightning will not strike the same place twice. (C) Mobile phones and electronic products can attract lightning. (D) Lightning injuries can cause neurological deficits and sequelae.

Output: D


Instruction: A 63-year-old male complained of dyspnea and chest tightness, orthopnea and edema of both feet. His body temperature was 36.8ºC, his heart rate was 143 beats/min, his respirations were 23 times/min, and his blood pressure was 187/110mmHg. The 12-lead electrocardiogram showed atrial fibrillation and left ventricular hypertrophy. Which of the following treatments is more appropriate?

Input: (A) Use Diltiazem to lower the heart rate. (B) Use Labetalol to lower blood pressure. (C) Use Dobutamine to relieve lung congestion. (D) Use Captopril to lower blood pressure.

Output: D


Instruction: Which of the following descriptions of the diagnosis of urinary tract infection (UTI) is more appropriate?

Input: (A) Urine culture and blood culture are important for the diagnosis and management of UTI. (B) The patient's chief complaint and description of symptoms can correctly diagnose UTI. (C) Urine test for WBC count is not helpful for diagnosis. (D) Urine test for nitrite reaction has high specificity for diagnosing UTI.

Output: D


Instruction: A 21-year-old male came to the emergency department complaining of right chest pain and dyspnea. On arrival, his heart rate was 140 beats/min, blood pressure was 76/50 mmHg, respiratory rate was 34 breaths/min, and blood oxygen concentration was 86%. Physical examination showed no breath sounds on the right side, and percussion showed excessive reflex on the right side. Which of the following statements is inappropriate?

Input: (A) This patient should have tension pneumothorax and should undergo needle decompression immediately. (B) An ultrasound examination of the right chest cavity should show a positive sliding sign. (C) Oxygen therapy with an oxygen fraction (FiO2) greater than 28% will increase pleural air absorption by 3 to 4 times. (D) This patient requires a 24-36 French chest tube after acupuncture for chest decompression.

Output: B


Instruction: A healthy 3-year-old boy who was born at term and received vaccinations, including pneumococcal vaccine, complained of right ear pain due to a 2-day fever. Examination revealed a bulging, red, and secretory right eardrum. Which of the following is more appropriate?

Input: (A) Penicillin V is a safe and effective first-line drug of choice. (B) If the patient is allergic to Penicillin, Clindamycin is the drug of choice. (C) The patient must be re-evaluated within 3 days. (D) Antihistamines and steroids are also important therapeutic drugs.

Output: C


Instruction: A 40-year-old worker was doing pipe maintenance in a factory. A pipe containing aniline ruptured and caused splashing. Four hours later, he felt unwell and went to the emergency room on his own. Which treatment is more appropriate for the patient?

Input: (A) If there is contamination on the body, perform decontamination, gastric lavage and use activated carbon. (B) If blood pressure is low, give fluids and pressors (Dopamine or Norepinephrine). (C) If consciousness changes, give methylene blue (1% solution) 5~10 mg/kg intravenous drip. (D) If cyanosis of the extremities occurs, give oxygen and monitor with a pulse oximeter.

Output: B


Instruction: Which of the following statements is more appropriate about the differences between the respiratory structure of 5-year-old children and adults?

Input: (A) The epiglottic ligament is harder, so it is difficult to lift the laryngoscope during intubation. (B) The epiglottis is narrower in children and its angle with the trachea is more vertical. (C) The larynx of children is located approximately at the fourth to fifth cervical vertebrae. (D) The chest has more cartilage, so the chest has greater elastic recoil.

Output: B


Instruction: A 40-year-old male, weighing 60 kg, with a history of asthma and no heart disease, has been admitted to the emergency room for 3 days with high fever and shortness of breath. The diagnosis is that he may have acute asthma with pneumonia. His heart rate is 118 beats/min and his blood pressure is 92/45 mmHg. He needs intubation, rapid-sequence intubation (RSI). What is your top choice of drug combination?

Input: (A) 20 mg Etomidate, 50 mg Rocuronium. (B) 100 mg Ketamine, 50 mg Rocuronium. (C) 100 mg Lidocaine, 20 mg Etomidate. (D) 100 mg Lidocaine, 10 mg Midazolam, 20 mg Etomidate.

Output: B


Instruction: Regarding emergency wound treatment, which tetanus toxoid prophylaxis injection is more appropriate?

Input: (A) Infants under 1 year old with wounds should be injected with toxoid 0.01ml/kg. (B) The dose for people over 65 years old should be 0.5mL. (C) Pregnant women should avoid toxoid injection during the first trimester. (D) Toxoid injection should not be used concurrently with Tetanus Immune Globulin (TIG) to avoid neutralization of the toxoid.

Output: B


Instruction: According to the recommendations of the Taiwan Centers for Disease Control and the WHO, which treatment is more appropriate for patients suspected of novel coronavirus infection?

Input: (A) Ibuprofen is recommended as an antipyretic drug, and Acetaminophen is not recommended. (B) When using a closed-end suction tube, the endotracheal tube must be clamped when disconnecting the breathing tube. (C) When the patient is still breathing on his own, a resuscitation ball can be used for compression ventilation. (D) To avoid splashing during intubation, a video-assisted laryngoscope should not be used.

Output: B


Instruction: A patient with a history of overseas travel comes to the emergency room with a fever. According to the 2019 CDC case statistics, which of the following statements is more appropriate?

Input: (A) Dengue fever is the most common imported case of legally contagious diseases in Taiwan. (B) Acute viral hepatitis A infection is mainly seen in patients returning from Vietnam and Indonesia. (C) If a patient returns from Singapore with fever and skin rash, dengue fever or measles infection should be highly suspected. (D) Amebic dysentery is often seen in patients returning from Africa with fever, abdominal pain, and diarrhea.

Output: A


Instruction: Which of the following is more appropriate for the description of gallstones and their complications?

Input: (A) Abdominal CT scan has a higher sensitivity than ultrasound examination in diagnosing gallstones. (B) Nonsteroidal anti-inflammatory drugs (NSAIDs) can be used as the first choice of analgesics when colic attacks. (C) Testing for C-reactive protein is not helpful in diagnosing acute cholecystitis. (D) Ultrasound has a high specificity in diagnosing cholecystitis and detecting thickening of the gallbladder wall and peri-gallbladder effusion.

Output: B


Instruction: Which of the following steps is more appropriate to diagnose unexplained shock using the Rapid Ultrasound in Shock (RUSH) protocol?

Input: (A) IVC → Aorta → Heart → Intraperitoneum (Morison's Pouch, EFAST) → Lungs. (B) Heart → Aorta → IVC → Intraperitoneum (Morison's Pouch, EFAST) → Lungs. (C) Aorta → Heart → IVC → Intraperitoneum (Morison's Pouch, EFAST) → Lungs. (D) Heart → IVC → Intraperitoneum (Morison's Pouch, EFAST)→ aorta→ lungs.

Output: D


Instruction: A 36-year-old middle-aged man who reeked of alcohol was sent to the emergency room by EMT and police because of domestic violence. His wife said that the patient had been drinking for a long time. The EMT described that there was an attack at the scene, so he had been restrained. You quickly checked the pupils and muscle strength of the hands and feet and found no abnormalities, and there was no obvious trauma to the head. Which of the following treatments is more appropriate?

Input: (A) Olanzapine 5 mg + Loraze pam 1 mg intramuscular injection. (B) Haloperidal 10 mg intravenous injection. (C) Lorazepam will cause excessive sedation for such patients and is not recommended. (D) If the patient wishes, Olanzapine fast-dissolving tablets 5 mg can be given orally.

Output: D


Instruction: A 21-year-old male presents with a 14-day history of intermittent fever and sore throat. The patient has multiple sexual partners. Physical examination reveals several small blisters on the upper lip, multiple ulcers on the oral mucosa, swollen tonsils with white discharge on both sides, painful cervical lymph nodes, slightly enlarged liver, and no skin rash. Which pathogen is most likely to cause the above symptoms?

Input: (A) HIV. (B) Cytomegalovirus. (C) Epstein-Barr virus. (D) Herpes simplex virus.

Output: D


Instruction: If a spinal fracture affects breathing and the diaphragm, which segment (or more) of damage would require the use of advanced airway?

Input: (A) C5. (B) C6. (C) C7. (D) T1.

Output: A


Instruction: Which of the following statements about PD-related peritonitis is less appropriate?

Input: (A) The cell count of ascitic fluid is usually greater than 500 WBC/µL and greater than 50% PMN. (B) Common pathogens are S. epidermidis, S. aureus, Streptococcus species and gram-negative bacteria. (C) Common symptoms are abdominal pain, which may sometimes be accompanied by fever. (D) Antibiotics are given first-generation Cephalosporin plus Gentamycin intraperitoneally first.

Output: A


Instruction: A 65-year-old woman presents to the emergency department with two days of lower back pain and right calf pain. Which of the following statements is more appropriate?

Input: (A) For suspected disc herniation, a CT scan of the relevant parts should be arranged to confirm the diagnosis. (B) For suspected sciatica, no diagnostic examination is required in the emergency department unless there is a risk of other serious diseases. (C) Steroid treatment of disc herniation can improve neurological function, but it cannot reduce the possibility of requiring surgery. (D) The patient should be advised to rest in bed for 2 weeks and avoid continuous daily activities to reduce pain symptoms.

Output: B


Instruction: Which of the following oral anti-epileptic drugs is most likely to require electrocardiogram monitoring in the event of an overdose?

Input: (A)Carbamazepine. (B)Levetiracetam. (C)Phenytoin. (D)Valproic acid.

Output: A


Instruction: A 4-year-old boy has a barking cough and fever for 2 days. He was treated with epinephrine vapor in the emergency room yesterday but did not improve. Today, he was found to have a hoarse voice and progressive dyspnea. Physical examination revealed stridor on both inspiration and expiration, drowsiness, facial cyanosis, use of accessory muscles for breathing, and a capillary refill time of 2 seconds. Which of the following is the most likely diagnosis?

Input: (A) Bacterial tracheitis. (B) Croup. (C) Epiglottis. (D) Retropharyngeal abscess.

Output: A


Instruction: A 36-year-old female who has no exercise habits signs up for a marathon. After several weeks of practice, she often feels pain in the front of her knee when walking and climbing stairs. Which of the following statements is more appropriate?

Input: (A) It is more common in women with weak quadriceps and Q angle less than 20 degrees. (B) Symptoms often occur in both feet at the same time and are gradual pain. (C) If you feel discomfort in your knees during activities, you should keep your knees bent and rest. (D) Arthroscopic surgery may promote the release of calcium pyrophosphate, causing severe synovitis.

Output: D


Instruction: An 82-year-old male was sent to the emergency room of a nursing home with symptoms such as difficulty concentrating, mood swings, and cognitive abnormalities. He had a history of dementia. Which of the following statements is more appropriate?

Input: (A) The patient should be provided with a comfortable isolation environment as soon as possible, and the hospital should send staff to guard the patient to reduce the stimulation of family contact with the patient. (B) If the patient becomes agitated, it is recommended to give Benzodiazepines drugs first to help relieve symptoms. (C) Physical restraints are recommended to be used on agitated patients as early as possible to prevent the patient from self-harm. (D) Symptoms of patients with depression may resemble those of hypoactive dementia, but symptoms of patients with depression are less likely to fluctuate rapidly.

Output: D


Instruction: Which of the following is a condition listed in the Ottawa knee rule that requires an X-ray?

Input: (A)Fibular head tenderness. (B)Tibial condyle tenderness. (C)Age older than 65 years. (D)Ability to bear weight and walk 2 steps.

Output: A


Instruction: Which of the following drugs does not reduce the occurrence of major adverse cardiac events after acute myocardial infarction?

Input: (A)Aspirin and Clopidogrel. (B)Bisoprolol. (C)Captopril. (D)Dilitazem.

Output: D


Instruction: A 70-year-old male was transferred from another hospital with traumatic pneumothorax, pelvic fracture and pelvic hemorrhage. He has received 10 units of packed red blood cells (RBC) transfusions. Which of the following statements is more appropriate for this patient?

Input: (A) According to the definition of massive transfusion, this patient has not yet received massive transfusion. (B) It would be best if the patient could receive platelet and plasma transfusions in the next blood transfusion. Empirical evidence shows that the ratio of the three should be 1:1:1. (C) Attention should be paid to whether the patient has hypothermia, coagulation abnormalities, and transfusion-induced pulmonary edema. These three events are called the fatal triangle of trauma. (D)Continuous blood transfusions require attention to hypocalcemia caused by the combination of citric acid and calcium ions in the blood.

Output: D


Instruction: A 54-year-old healthy woman has traveled abroad in the past 14 days. She began to have fever, muscle aches, cough and abnormal taste and smell 3 days ago. She went to the emergency room due to persistent high fever, general fatigue and wheezing. Chest X-ray showed patchy interstitial infiltrates in the bilateral lower lobes. Which of the following statements is more appropriate?

Input: (A)It may be COVID-19 (2019 novel coronavirus disease), the pathogen is an alpha coronavirus. (B) The patient meets the reporting conditions of the CDC's fifth category of statutory infectious diseases, severe specific infectious pneumonia, and needs to collect throat swab fluid, sputum and serum. (C) If this patient is a confirmed case, her husband who lives with her and has no symptoms needs to manage his own health. (D) COVID-19 is diagnosed based on a positive nucleic acid test PCR, and virus culture is not easy.

Output: D


Instruction: Which of the following statements about the treatment of acute pulmonary edema is less appropriate?

Input: (A) Reducing cardiac afterload can reduce the chance of intubation. (B) Compared with the simultaneous use of vasodilators, the use of intravenous injection of Furosemide alone does not reduce the chance of intubation. (C) Treatment with morphine-like drugs may increase hospitalization time and mortality. (D) Non-invasive positive pressure ventilation will increase cardiac afterload.

Output: D


Instruction: A 28-year-old female, 24 weeks pregnant, rear-ends the car in front of her. She is wearing her seat belt, the airbag did not deploy, her vital signs are normal, her abdominal pain is 5/10, and an ultrasound examination in the emergency department shows no ascites, no uterine or placental abnormalities, normal amniotic fluid volume and a clearly visible fetal heart rate of 150 beats/min. Which of the following actions should be prioritized?

Input: (A) Perform diagnostic peritoneal lavage (DPL) by open supra-umbilical. (B) Arrange an abdominal MRI scan. (C) See the obstetrics department for fetal tocodynamometry monitoring. (D) Follow up ultrasound examination after 4-6 hours of observation.

Output: C


Instruction: A 55-year-old male suddenly developed dizziness, vomited twice, turned pale, and had weakness in his limbs. His family took him to the emergency room. During the triage, his blood pressure was 180/110 mmHg, his heart rate was 95 beats/min, and his temperature was 37℃. Which of the following statements is more appropriate?

Input: (A) Severe vertigo and vomiting are central vertigo. (B) Immediately arrange a CT scan of the brain. (C) The head impulse test was normal, which is common in peripheral vertigo. (D) If the Dix-Hallpike test is positive, the patient has benign paroxysmal positional vertigo.

Output: C、D


Instruction: A patient on hemodialysis was transferred to the emergency department because his blood pressure dropped to 80/40 mmHg. Bedside ultrasound revealed pericardial effusion and the right ventricle was equal in size to the left ventricle. Under the parasternal short axis view of ultrasound, the left ventricle showed the D sign of the ventricular septum deviating toward the left ventricle. Which of the following is the most likely diagnosis?

Input: (A) Air embolism. (B) Cardiac tamponade. (C) Sepsis. (D) Myocardial ischemia.

Output: A


Instruction: A 40-year-old male was injured in the left calf by a heavy object at a construction site. He was freed and sent to the emergency room two hours later. He complained of abnormal pain and numbness in the left calf, which was swollen and deformed. His vital signs are currently stable. Which of the following descriptions of this patient is more appropriate?

Input: (A) It is necessary to evaluate the distal pulse of the injured area as soon as possible, because the presence or absence of a pulse is one of the necessary conditions for diagnosing compartment syndrome. (B) Although tissue pressure exceeding 30 mmHg is one of the diagnostic conditions for compartment syndrome, it is not necessary to measure pressure to confirm the diagnosis. (C) Capillary refill time (capillary refill time time) is a highly reliable physical examination for diagnosing compartment syndrome. (D) Give the patient bone traction and plaster fixation to relieve the pain caused by the fracture.

Output: B


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

Input: (A) The patient has type I decompression syndrome (type I (A) Drug-assisted intubation is recommended for respiratory treatment. Ketamine is not recommended for patients with head trauma and intracranial hypertension because it may worsen cerebral blood circulation. (B) 100% oxygen, intravenous fluids, and hyperbaric oxygen therapy should be given immediately. (C) The patient should be placed in a Trendelenburg position as much as possible. (D) Intubation and respirator therapy should be given priority over hyperbaric oxygen therapy.

Output: B


Instruction: Which of the following statements is more appropriate for the steps of cricothyroidotomy?

Input: (A)Right-handed people should stand on the patient's right side to perform the operation. (B)The cricothyroid membrane is located at the midpoint between the chin and the sternal notch. (C)After locating the cricothyroid membrane, the skin is incised with a horizontal incision. (D)After the cricothyroid membrane is incised, a No. 6 endotracheal tube is inserted and fixed at a depth of about 10 cm.

Output: A


Instruction: A 44-year-old male experienced cardiac arrest with return of spontaneous circulation. Which of the following statements regarding follow-up care is inappropriate?

Input: (A) Targeted temperature management (TTM) can help reduce neurological damage. (B) Performing a brain CT scan can assess the severity of intracerebral hemorrhage and brain edema. (C) TTM exclusion criteria include being conscious and able to follow instructions and having poor neurological performance to begin with. (D) During the TTM cooling period, attention should be paid to electrolyte imbalances, mainly the manifestations of high potassium and magnesium levels.

Output: D


Instruction: Regarding blood pressure control (blood pressure 190/110 mmHg) in various hypertensive emergencies, which of the following is more appropriate?

Input: (A) For acute stroke patients who are not suitable for thrombolytic agents, Labetalol should be used. (B) For aortic detachment, Nicardipine should be used first. (C) For amphetamine poisoning, Benzodiazepine should be used first. (D) For acute renal failure, Nitroprusside should be used first.

Output: C


Instruction: Regarding the description of abdominal aortic aneurysms, which of the following is more appropriate?

Input: (A) If the diameter is greater than 5 cm, the chance of rupture increases greatly. (B) It is more common in women than in men. (C) If the aneurysm ruptures, it can be observed first if the hemodynamics are stable. (D) After endovascular repair, there is no risk of rupture.

Output: A


Instruction: Which of the following statements about cirrhosis and spontaneous peritonitis is more appropriate?

Input: (A) The patient has no fever, so spontaneous bacterial peritonitis can be ruled out. (B) Leukocyte esterase test strips for ascites can be used as a quick reference for diagnosis. (C) Ascites analysis reveals that neutrophils are greater than 100/µL, which can be diagnosed. (D) Up to 70% of patients with cirrhosis and ascites will have spontaneous peritonitis.

Output: B


Instruction: A 33-year-old female developed fever symptoms yesterday, combined with redness, swelling, pain and inability to bend the left knee joint. Which of the following statements is more appropriate?

Input: (A) Migratory arthritis often occurs after Staphylococcus aureus infection. (B) Use ESR >30mm/h is highly specific for assessing septic arthritis and is a better diagnostic tool. (C)Neisseria gonorrhoeae infection, this species can be cultured in >60% of the joint fluid. (D)Salmonella is the most common cause of septic arthritis in patients with sickle-type erythrocytes.

Output: D


Instruction: A 74-year-old female patient suddenly developed difficulty speaking and swallowing. Physical examination showed dysarthria, tongue deviation to the right, left soft palate paralysis, left face drooping, loss of left facial sensation, and right arm weakness. Which lesion is most likely to be the above symptoms?

Input: (A)Left brain stem. (B) Right cerebellum. (C) Left cerebrum. (D) Right midbrain.

Output: A


Instruction: A 30-year-old male seeks medical attention for fever, headache, and neck stiffness for 3 days. Which of the following statements is more appropriate?

Input: (A) If bacterial meningitis is clinically suspected, antibiotics can be used directly before performing brain imaging and lumbar puncture. (B) When bacterial meningitis is suspected, Dexamethasone should not be used to avoid affecting the patient's immune function. (C) In meningitis caused by diabetes combined with sinus infection, the cerebrospinal fluid examination is WBC 300/ µL, 65% PMN, Aspergillus infection should be considered first. (D) Patients diagnosed with herpes simplex virus encephalitis have typical MRI images showing invasion of the gray matter of the occipital lobe, resulting in mental and behavioral abnormalities.

Output: A


Instruction: An 8-year-old girl came to the pediatric emergency department complaining of a 3-day fever. During physical examination, it was found that the girl had slapped-cheek appearance on her cheeks and lacy, reticulated appearance on her limbs. The rash did not itch. What is the most likely diagnosis?

Input: (A) Scarlet fever. (B) Erythema infectiosum. (C) Kawasaki disease disease). (D) Roseola.

Output: B


Instruction: According to the announcement of the Taiwan Centers for Disease Control, which of the following descriptions is more appropriate regarding the personal protective equipment of medical caregivers in response to novel coronavirus infection?

Input: (A) Paramedics who assist in the transfer of patients must wear surgical masks for respiratory protection. (B) N95 masks and surgical masks must be fit-checked before use. (C) When removing an N95 mask, the lower elastic band should be removed first, followed by the upper elastic band. (D) When the emergency department nurse inquires about the chief complaint and TOCC, she must wear a one-piece isolation suit.

Output: C


Instruction: A 35-year-old female patient presented with fever for 4 days. She had traveled to Southeast Asia last week. She had a temperature of 39℃ and body aches. She also had nausea, vomiting, upper abdominal pain and tenderness. Blood tests showed white blood cell count of 2,500/μl, hemoglobin of 14g/dl, platelet count of 85,000/μl, AST/ALT of 135/110 U/L. Chest X-ray and urine tests were normal. Which of the following statements is less appropriate?

Input: (A) The patient meets the CDC's dengue reporting clinical criteria. (B) If the patient tests positive for dengue NS1 (non-structural protein 1) antigen, she is a confirmed case. (C) If the patient is dengue-positive, then he/she meets the diagnosis of severe dengue fever (2009 WHO case classification definition). (D) If the patient is dengue-positive and abdominal imaging reveals gallbladder wall edema, suspected of acute cholecystitis, invasive treatment should be avoided.

Output: C


Instruction: After an earthquake, a person was trapped for 16 hours under the crush of a collapsed beam. Which of the following matters should be noted by on-site search and rescue and medical rescue personnel?

Input: (A) The crushed limbs may develop compartment syndrome, the most common symptom of which is numbness and weakness. (B) The victim may develop high potassium and high calcium levels, which may further induce fatal arrhythmias. (C) As long as there is no renal failure, large-volume intravenous infusion with lactated Ringer's solution is recommended. (D) Fasciotomy is not a routine treatment because it increases the chances of infection and amputation.

Output: D


Instruction: Which of the following clinical symptoms and signs of acute appendicitis has the highest positive likelihood ratio?

Input: (A) Vomiting occurs before abdominal pain symptoms appear. (B) The obturator sign is positive. (C) The psoas sign is positive. (D) The abdominal pain shifts from the upper abdomen or around the umbilicus to the right lower abdomen.

Output: D


Instruction: A 35-year-old female, receiving treatment for infertility. She came to the emergency room today with sudden left lower abdominal pain. The urine pregnancy test is positive, and the urinalysis is normal. The bedside ultrasound shows an intrauterine pregnancy of about 6 weeks, with moderate ascites. Which of the following is more appropriate?

Input: (A) The patient is diagnosed with ovarian hyperstimulation syndrome (OHSS) and a pelvic examination should be performed to fully assess the patient's condition. (B) The patient is diagnosed with OHSS and diuretics can be given to relieve symptoms. (C) The patient may have a heterotopic pregnancy. (D) The patient has been confirmed to have an intrauterine pregnancy. If the fetal heartbeat can be further observed, ectopic pregnancy can be ruled out.

Output: C


Instruction: Which of the following is more appropriate for the emergency treatment of patients with acute psychosis?

Input: (A) A psychiatric diagnosis should be established to help the emergency physician decide the patient's subsequent disposition. (B) Fever or rapid heartbeat are usually caused by the patient's high emotions or agitation, and no special tests are needed. (C) Auditory hallucinations are more likely to be caused by physiological reasons than visual hallucinations. (D) If the patient admits to drinking or taking illegal drugs when he is sober, further examination is not necessary to confirm it.

Output: D


Instruction: Which of the following statements is more appropriate regarding the primary assessment and resuscitation of elderly people with trauma?

Input: (A) To avoid potential undetected spinal damage, it is not advisable to remove the collar too early. (B) Due to the high severity of traumatic brain injuries in the elderly, the mortality rate is also high. (C) Fractures in the elderly, such as pelvic fractures and hip fractures, are mostly caused by car accidents. (D) The sequence and items of primary assessment of trauma in the elderly are different from those in young people.

Output: A


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

Input: (A) Massive pulmonary embolism is characterized by systolic blood pressure below 90 mmHg for more than 15 minutes; pulse cannot be felt; or heart rate is less than 40 beats/min, combined with symptoms of shock. (B) When the troponin concentration in the blood is elevated, or the NT-proBNP concentration in the blood exceeds 900 pg/ml, it indicates that the patient's pulmonary embolism has caused right ventricular strain. (C) If cardiac arrest, hypotension, respiratory failure, or right ventricular strain occurs, intravenous thrombolytic therapy should be considered. (D) Compared with intravenous injection of thrombolytic agents, thrombolytic effects of thrombolytic agents injected into the pulmonary artery are better.

Output: D


Instruction: Which of the following is not a Pulmonary Embolism Rule-Out Criteria for pulmonary embolism?

Input: (A)Age < 50 years old. (B)No hormone use. (C)No hemoptysis. (D)Oxygen saturation > 90%.

Output: D


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

Input: (A) Sepsis treatment begins with giving the patient a large amount of fluid, and then giving pressor drugs after the body has enough water. (B) Giving too much fluid to a Sepsis patient will cause the patient's prognosis to deteriorate. (C) The preferred fluid for Sepsis is colloid, which is less likely to cause acute kidney injury or require hemodialysis than normal saline. (D) Blood transfusion should be given to keep the patient's Hb>8 g/dL to maintain tissue oxygen supply and perfusion.

Output: B


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

Input: (A) The typical electrocardiogram change is ST-segment depression, especially in leads I, V5, and V6. (B) The increased troponin concentration in the blood in the laboratory diagnostic data indicates the possibility of myocarditis. (C) The sensitivity of CT for diagnosing pericardial effusion is much higher than that of echocardiography. (D) Treatment drugs include non-steroidal anti-inflammatory drugs (NSAIDs), steroids, and colchicine. The patient must be hospitalized for treatment and observation.

Output: B


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

Input: (A) If hematuria is accompanied by proteinuria, acute renal function damage, edema, hypertension and joint disease, it may be glomerulonephritis. (B) If hematuria occurs after an upper respiratory tract infection, the serum ANA is negative and C3 is normal, it is highly suspected to be IgA nephropathy. (C) If there are combined symptoms of gastrointestinal abdominal pain, skin petechiae and renal function damage, Henoch-Schönlein purpura (HSP) should be considered. The use of corticosteroids can relieve abdominal pain symptoms and improve renal function damage. (D) Urinary tract infection is the most common cause of hematuria in adolescents. Patients often have fever and local lower urinary tract symptoms, such as frequent urination, urgency, and difficulty urinating. Urinary tract infection should be considered.

Output: C


Instruction: Which of the following statements is more appropriate for the diagnosis of necrotizing soft tissue infection?

Input: (A) Due to the severe necrotizing inflammation of deep tissues, the patient's disproportionately severe pain is a necessary condition for diagnosis. (B) Due to deep fascial infection causing skin vascular necrosis and thrombosis (thrombosis), the patient's skin in the affected area will develop hemorrhagic blisters in the early stage. (C) If the MRI with contrast shows no abnormalities in the intermuscular fascia of the affected area, this diagnosis can be ruled out. (D) The patient must have comorbidities that impair immune function, such as old age, diabetes, cirrhosis, or chemotherapy or immunosuppressive drugs, so the course of infection often worsens rapidly.

Output: C


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

Input: (A) Bright red blood in the stool can rule out the possibility that the bleeding point comes from the upper gastrointestinal tract. (B) For elderly people with many comorbidities, it is recommended that blood transfusion be considered only when the hemoglobin is ≤ 7 g/dL. (C) If a gastroscopy is to be performed, the use of drugs that promote gastrointestinal motility, such as metoclopramide, is contraindicated. (D) The patient also has a history of cirrhosis. Consider giving the antibiotic Ceftriaxone 1 gram IV.

Output: D


Instruction: Which of the following descriptions of common conjunctivitis in the emergency department is more appropriate?

Input: (A) Corneal foreign body is painful and accompanied by widespread congestion, and is less photophobia. (B) Allergic conjunctivitis is itchy and painful, but is less photophobia. (C) Acute angle-closure glucoma is often accompanied by blurred vision, photophobia, and headache. (D) Subconjunctival hemorrhage is neither painful nor itchy, and often affects vision.

Output: A


Instruction: There was heavy snow on the mountain. Xiao Ming carried his weak friend from the top of the mountain to the circle valley to rest. The snow on the road was very deep. It would take an estimated 4 hours to descend to the mountain resort. The preparations would start in 1 hour. Which of the following statements is less appropriate?

Input: (A) Xiao Ming has local clear blisters on his feet. After removing the wet shoes and socks, he can soak them in 37℃ warm water to slowly warm them up. (B) His friend's ear temperature is 34℃ and he is shivering all over. After removing the wet coat, he uses a blanket and warm drinks to warm him up. (C) Xiao Ming's hands are painful and itchy. After removing the wet gloves, he rubs his hands to keep warm. (D) Xiao Ming complains of pain in his feet and hands. The rescuer gives Xiao Ming the painkillers they carry with them.

Output: A


Instruction: Which of the following diagnoses and treatments is more appropriate for mandibular dislocation?

Input: (A) Anterior dislocation is common, while posterior dislocation is rare. (B) The patient can only be positioned in a sitting position during reduction. (C) The direction of the reduction force is to push the patient's chin upward and backward. (D) An X-ray is usually required immediately after reduction to confirm that the reduction is successful.

Output: A


Instruction: Which of the following statements is appropriate regarding infectious diarrhea?

Input: (A) If there are no contraindications, ciprofloxacin may be considered. (B) Loperamide does not improve outcomes. (C) If the diarrhea is bloody or inflammatory diarrhea is suspected, concomitant use of an antimotility agent is recommended. (D) Probiotics are not helpful in treating infectious diarrhea.

Output: A


Instruction: A 25-year-old male presents to the emergency department with multiple facial lacerations and cheek burns caused by a boiler explosion. Which of the following is appropriate?

Input: (A) All tongue lacerations should be sutured to prevent upper airway obstruction from hematomas. (B) Wounds within 0.6~0.8cm from the inner canthus of the eye need to be referred to the ophthalmologist. (C) Nasal tear duct rupture needs to be repaired by the ophthalmologist within 12 hours. (D) Silver sulfadiazine ointment can be used for cheek burns.

Output: B


Instruction: A 30-year-old male fell from a height of 6 meters and was sent to the emergency department. Physical examination revealed obvious right flail chest, tachypnea, 26 breaths/min, symmetrical breath sounds on both sides on auscultation, no dullness or hyperresonance on percussion, and oxygen mask at 6 L/min was given. Afterwards, arterial blood oximetry (ABG) showed: PaO2 45 mmHg, PCO₂ 28 mmHg, pH 7.47. Which of the following injuries is most likely the cause of this ABG abnormality?

Input: (A) Massive hemothorax. (B) Pulmonary contusion. (C) Hypoventilation. (D) Tension pneumothorax.

Output: B


Instruction: Which of the following is an indication for thrombolytic therapy in acute pulmonary thromboembolism?

Input: (A) Acute chest pain occurs within three hours. (B) The electrocardiogram shows S1Q3T3 pattern. (C) Hemodynamic instability and severe hypoxia. (D) There is a mismatch between the lung perfusion scan and ventilation scan.

Output: C


Instruction: A 2-year-old boy (11 kg) was in a car accident. His vital signs when he was sent to the emergency room were: temperature 37.8℃, respiration 50 times/min, heart rate 150 times/min, blood pressure 90/60 mmHg, blood oxygen 89%, and he kept crying. Which of the following trauma treatments for this boy is more appropriate?

Input: (A) Place an oropharyngeal airway to avoid upper airway obstruction due to head trauma. (B) Manually fix the cervical spine, open the airway, clear oral and nasal secretions and foreign objects, and then give oxygen to maintain appropriate blood oxygen. (C) Place a soft cushion under the head of the head to maintain an open airway when lying flat. (D) Select a size 4.5 endotracheal tube and perform nasotracheal intubation.

Output: B


Instruction: A 2-year-old boy was brought to the emergency department for 5 days of persistent fever and respiratory symptoms. Physical examination revealed bilateral conjunctival congestion without discharge, chapped lips, strawberry tongue, and red maculopapular rash on the trunk, but no cervical lymphadenopathy and no redness, swelling, or desquamation of the extremities. Which of the following is more appropriate for this patient?

Input: (A) This boy has typical Kawasaki disease. Intravenous immunoglobulin (IVIG) and high-dose aspirin should be considered for treatment. (B) This boy has atypical Kawasaki disease. Auxiliary diagnostic criteria include: white blood cells (WBC), hemoglobin (Hb), platelets (PLT), albumin, glutathione transaminase (ALT), and creatinine. (C) Ibuprofen can be used to reduce fever in case of high fever. (D) Aspirin should be avoided if infected with influenza at the same time.

Output: D


Instruction: A 60-year-old male was injured in a car accident and went to the emergency room for treatment. The emergency medical staff had already given him a collar and a long back board for fixation. The patient is conscious and complains of neck pain, but has no other obvious abrasions or contusions. Blood pressure is 60/30 mmHg, heart rate is 80 beats/min, and skin is warm to the touch. Which of the following assessments and treatments is more appropriate for this patient?

Input: (A) Based on the history and initial physical examination, hypotension caused by intra-abdominal organ injury can be ruled out. (B) This patient should have lower limb paralysis and increased deep reflexes. (C) Such symptoms may occur in patients with injuries to the fourth thoracic vertebra. (D) Vasopressors are of no benefit to this patient and will increase the risk of tissue insufficiency.

Output: C


Instruction: A 67-year-old male was taken to the emergency room by his family because he had a sudden whole-body convulsion half an hour ago and could not be awakened. The family said that the patient had a history of epilepsy, but it was unclear whether he took medication regularly to control it. The convulsion lasted about 15 minutes. Which of the following statements is more appropriate?

Input: (A) When the patient is sent to the emergency room, he continues to have symptoms of convulsions. Phenytoin can be given as the first-line medication in the early stage. (B) After using two anti-epileptic drugs for 1 hour, the symptoms still do not improve. Barbiturates will not help much at this time. (C) Barbiturates are used to treat patients with persistent epileptic seizures. Because the drug half-life is shorter, it helps to extubate intubated patients earlier. (D) Valproic acid should be used in combination with Phenytoin to achieve a better therapeutic effect, but be careful that Valproic acid may cause side effects such as liver failure and pancreatitis.

Output: B


Instruction: A 27-year-old woman was sent to the emergency room after swallowing a large amount of analgesics due to a bad mood. Which of the following statements is more appropriate?

Input: (A) Regardless of which NSAID is used, the proportion of side effects is roughly the same, and treatment is mainly supportive. (B) Oral activated charcoal 1 gram per kilogram of body weight can be considered, but if convulsions occur, the use of BZD is ineffective. (C) Once the patient has symptoms of discomfort, the prognosis is usually poor. (D) Most patients have no symptoms after 4 hours of observation and can go home for observation after a psychiatric consultation.

Output: A、B、C、D


Instruction: Which of the following metabolic abnormalities is less likely to cause shock in children?

Input: (A) Hypoglycemia. (B) Hypercalcemia. (C)Hyperkalemia. (D) Metabolic acidosis.

Output: B


Instruction: When an open wound is suspected of having radiation syndrome, which of the following statements is more appropriate?

Input: (A) The victim on the scene had brown vomitus, and it can be estimated that the radiation dose he received was 3~4 Gray. (B) Cytogenetic dosimetry can be used in the hospital to assess the severity of the injury and the prognosis. (C) The victim's clinical manifestations include nausea, vomiting, hypotension and upper gastrointestinal bleeding. Antiemetics should not be given. (D) The number of lymphocytes will decrease significantly after exposure to radiation. Therefore, continuous testing of the lymphocyte count for 48 hours can estimate the victim's exposure dose.

Output: B


Instruction: Which of the following is more appropriate for the identification and treatment of delirium in elderly patients?

Input: (A) The characteristics are acute onset, recurrent symptoms, possible hallucinations, but attention is not affected. (B) Urinary retention can lead to delirium, but an indwelling urinary catheter can also increase the chance of delirium. (C) Benzodiazepines are the first choice for drug treatment. (D) Antihistamine is a safer treatment for patients who are agitated due to delirium.

Output: B


Instruction: You are preparing to perform a Rapid Sequence Intubation (RSI) on a 6-year-old girl with respiratory distress. Which of the following drugs is most likely to cause masseter muscle spasm in this patient, resulting in difficult intubation?

Input: (A) Fentanyl. (B) Ketamine. (C) Succinylcholine. (D) Vecuronium.

Output: C


Instruction: Which of the following is less appropriate regarding antithrombotic therapy?

Input: (A) Antiplatelet drugs are more effective than anticoagulants for venous embolism. (B) Warfarin acts on the vitamin K-related coagulation pathway. (C) Dabigatran, a new anticoagulant, is a direct inhibitor of thrombin. (D) Rivaroxaban, a new anticoagulant, is an inhibitor of coagulation factor X.

Output: A


Instruction: A 72-year-old male patient presented to the emergency department with abdominal distension and shortness of breath. Physical examination revealed distended cervical veins and shifting dullness in the abdomen. Ascites examination revealed a white blood cell count of 280/µL, with 40% polymorphonucleated cells. The albumin in the ascites is 1.3 g/dL, and the triglyceride is 300 mg/dL; the albumin in the blood is 2.6 g/dL. What is the most likely cause of the ascites?

Input: (A) Bacterial peritonitis. (B) Disseminated cancer in the abdomen. (C) Congestive heart failure. (D) Chylous ascites.

Output: C


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

Input: (A) During the epidemic period, in order to control the epidemic, patients must be quickly screened and diagnosed before taking medication. (B) Treatment of uncomplicated influenza patients with Tamiflu should be started within 72 hours to help with recovery. (C) If severe pneumonia occurs, antibiotics should be administered, which must cover drug-resistant Staphylococcus aureus. (D) People aged 5 to 50 who contract influenza are more likely to develop complications such as pneumonia and meningitis.

Output: C


Instruction: A 70-year-old female with a history of diabetes went to the emergency department with blurred vision on her left side for 2 days combined with pain and photophobia. Physical examination showed that her vital signs were stable, her temperature was 37.7℃, her left conjunctiva was congested without discharge, her cornea was normal, there were suspended cells in the anterior chamber, her left eye intraocular pressure was 22mmHg, and her fundus could not be assessed due to cataracts. Which of the following is the most likely diagnosis?

Input: (A) Acute angle-closure glaucoma. (B) Endophthalmitis. (C) Orbital cellulitis. (D) Viral conjunctivitis.

Output: B


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

Input: (A) The most common cause of low blood flow type is penile and perineal trauma, which causes blood flow to the cavernous artery of the penis to be blocked. (B) High blood flow type and low blood flow type often present with symptoms of penile pain. (C) One of the methods to distinguish between high blood flow type and low blood flow type is to draw blood from the cavernous body of the penis for blood gas analysis. (D) Children with priapism often suffer from blood diseases.

Output: C、D


Instruction: A 12-year-old boy, weighing 60 kg, has type 1 diabetes. He complains of general weakness, wheezing, and clear consciousness. His blood pressure is 80/50 mm Hg, heart rate is 145 beats/min, respiration is 28 breaths/min, blood sugar is 613 mg/dL, pH is 7.04, HCO₃ 2.1 mEq/L, Na is 134 mEq/L, K is 2.8 mEq/L. After 6 hours of infusion and insulin treatment, his current blood sugar is 180 mg/dL, pH is 7.283, HCO₃ is 13.8 mEq /L, Na is 144 mEq/L, K is 3.0 mEq/L. Which of the following is less appropriate?

Input: (A) After 6 hours, the infusion therapy can be 5% glucose plus 0.45% saline solution. (B) Hypokalemia after 6 hours is mainly caused by insulin therapy and improvement of metabolic acid. At this time, 0.2~0.3 mEq KCL/kg/hr can be used for treatment. (C) Sodium bicarbonate treatment is not required initially and after 6 hours. (D) The initial infusion therapy sequence is to give 6U RI (Regular Insulin) intravenous push first, and then give 1,200ml of saline solution within 1 hour after maintaining 6U drip every hour.

Output: D


Instruction: Regarding bleeding constitution, which of the following is less appropriate?

Input: (A) Problems with thrombocytopenia are more likely to cause punctate bleeding, hematuria or gum bleeding. (B) Problems with coagulation factors are more likely to cause deep bleeding, such as retroperitoneal bleeding and joint bleeding. (C) Platelet transfusion is not suitable for immune-induced thrombocytopenia (ITP) because it will cause further platelet destruction. (D) Steroid and immunoglobulin injections can be considered for ITP.

Output: C


Instruction: Which of the following statements is more appropriate regarding the symptoms and clinical manifestations of low calcium levels?

Input: (A) The symptoms of low calcium levels are unrelated to the rate at which calcium levels decrease. (B) Low calcium levels will not cause hallucinations. (C) Low calcium levels may cause changes in consciousness. (D) Clinically, the Chvostek sign is highly specific for diagnosing hypocalcemia.

Output: C


Instruction: Which of the following statements about diabetic ketoacidosis (DKA) in children is more appropriate?

Input: (A) Sodium bicarbonate can be used for treatment. (B) Sepsis is the main cause of death in children with DKA. (C) IV loading bolus Regular Insulin 0.1 units/kg should be given for treatment. (D) Age less than 5 years old is a risk factor for DKA complicated by cerebral edema.

Output: D


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

Input: (A) Cervical spine injury only occurs in a small number of drowning cases, and the main mechanisms are diving, falling from heights, and drowning after a car accident. (B) If the drowning case arrives at the emergency room with a full GCS score and normal breathing, a neck collar and head CT examination are still required. (C) If the drowning case arrives at the emergency room with OHCA and a body temperature of only 20℃, it can be determined as obvious death and the family members are advised to give up first aid. (D) In cases of OHCA caused by drowning, the cause of death is classified as trauma in the Utstein templates.

Output: A


Instruction: A 65-year-old male with no past medical history and normal vital signs complains of progressive limb weakness for about 4 weeks. Physical examination reveals symmetrical proximal muscle weakness, normal sensation, reflexes, and eye muscles. Which of the following differential diagnoses is least likely?

Input: (A) Dermatomyositis. (B) Polymyositis. (C) Myasthenia gravis. (D) Lambert-Eaton syndrome.

Output: C


Instruction: Which of the following statements about non-traumatic diseases of the hands is more appropriate?

Input: (A) Paronychia can be caused by minor trauma or nail biting. The most common infection is Gram-negative bacteria. (B) Kanavel's signs are all negative, which can rule out the diagnosis of flexor tenosynovitis. (C) For deep space infection, press the palm surface to check for pain, lumps or effusion. (D) Herpetic whitlow often produces vesicles and effusions, and treatment often requires incision and drainage.

Output: C


Instruction: A primipara has severe postpartum hemorrhage. She has received about 2,000 ml of blood transfusion and injected with Oxytocin. Her current vital signs are: blood pressure 76/32 mmHg, heart rate 132 beats/min, respiration 28 times/min, body temperature 36.0℃, SpO₂ 95% (room air), GCS E3M6V5. Which of the following treatments is effective and appropriate?

Input: (A) Emergency massive transfusion of FFP and platelets. (B) Massive blood transfusion, supplemented by vitamin K injection. (C) Notify the obstetrician and gynecologist to arrange a hysterectomy. (D) Notify the radiologist to arrange pelvic vessel embolization.

Output: D


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

Input: (A) The incidence of migraines, cluster headaches, and tension headaches decreases with age. (B) Headaches are a common symptom of fever, but fever is not a red flag sign for headaches. (C) Cerebral vasoconstriction and rebound vasodilation are common causes of migraines. (D) Primary hypertension often causes thunderclap headaches.

Output: A


Instruction: Which of the following statements about transfusion-related acute lung injury is less appropriate?

Input: (A) Mostly associated with transfusions of fresh frozen plasma and platelets. (B) Also common with transfusions of packed RBCs alone. (C) Often causes bilateral pulmonary infiltrates. (D) Often occurs within 6 hours of transfusion.

Output: B


Instruction: Regarding rabies vaccine and immunoglobulin injection, which of the following is more appropriate?

Input: (A) A woman in Chiayi County was slightly bitten by a badger that broke into her backyard. If it is judged to be a Class II wound, she will be vaccinated with immunoglobulin after the badger is tested and found to be virus-positive. (B) The wound needs to be injected with immunoglobulin at the same time. If sutures are required, it is recommended to do so within 30 minutes to prevent the immunoglobulin from leaking out with secretions. (C) If bitten by stray cats and dogs, do not give the vaccine for the time being. The dogs and cats should be observed for 7 days. If they show symptoms that are highly suspected of rabies, they should be given the vaccine. (D) Rabies immunoglobulin can be administered at the same time as the first dose of rabies vaccine after exposure to the same part of the body.

Output: A


Instruction: A 10-year-old boy swallowed 25 tablets of Acetaminophen 500mg/tab 4 hours ago. His vital signs were normal in the emergency room. The blood Acetaminophen level was immediately tested to be 300mg/mL. Which of the following statements is more appropriate?

Input: (A) This is a drug poisoning dose and he needs to be treated with N-acetylcysteine immediately. (B) There is a risk of hepatic coma within 24 hours. (C) He can be treated with activated carbon first through a nasogastric tube or orally, and then the blood Acetaminophen level can be determined after 4 hours before deciding on N-acetylcysteine treatment. (D) If poisoning occurs, he should be given a single dose of 160mg/kg of N-acetylcysteine, followed by 70mg/kg every 4 hours. The dose was given 17 times in a row.

Output: A、C


Instruction: What is the sensitivity of upright chest X-ray for detecting free air in the abdomen?

Input: (A)1 0%. (B)30%. (C)50%. (D)70%.

Output: B


Instruction: A 35-year-old male fell off a bicycle and lost his upper right front tooth. Which of the following treatments is more appropriate?

Input: (A) Just clean the wound. No tetanus vaccine is needed. (B) Before implanting the lost tooth into the alveolus, the entire tooth must be cleaned with saline and gauze. (C) Oral Doxycycline is the first choice of treatment. (D) There is a 2 cm laceration on the inner side of the upper lip. Rinse the wound clean and make sure there is no foreign body left. Then apply pressure to stop the bleeding. No suture is needed.

Output: C


Instruction: Which of the following is less appropriate in the treatment of acute aortic regurgitation?

Input: (A) Immediate surgical intervention should be considered. (B) β-blockers can be used to reduce the heart's oxygen demand. (C) Nitroprusside combined with Dobutamine can be used for the above patients. (D) Diuretics and Nitrates are usually ineffective for the above patients.

Output: B


Instruction: A middle-aged female who took a large amount of unknown drugs about 20 hours ago and was sent to her by a friend. It is only known that she had mental illness in the past. Clinical manifestations: body temperature of 41℃, confusion, agitation, sweating, dilated pupils, increased reflexes and muscle twitches (myoclonus). Which of the following treatments is more appropriate?

Input: (A) Give activated charcoal to reduce drug absorption. (B) Give Dantrolene to control muscle spasms. (C) Give Acetaminophen to control body temperature. (D) If intubation is required, Succinylcholine is not recommended.

Output: D


Instruction: Which of the following descriptions of alcohol withdrawal syndrome is more appropriate?

Input: (A) It is likely to occur as soon as 24 hours after stopping or reducing drinking. (B) If an epileptic seizure occurs, fewer than half of patients will have another seizure. (C) To prevent epileptic seizures, consider giving the anti-epileptic drug Phenytoin. (D) Among the therapeutic drugs, Lorazepam 1mg is equivalent to Midazolam 2mg, which is also equivalent to Diazepam 5mg.

Output: D