Instruction: Which of the following statements about hypertensive emergencies is incorrect?

Input: (A) Hypertensive encephalopathy is caused by blood pressure exceeding the upper limit of cerebrovascular self-regulation, resulting in cerebral hyperperfusion and loss of the integrity of the blood-brain barrier, resulting in cerebral edema and severe cerebral vasoconstriction. (B) The treatment of hypertensive encephalopathy should try to lower blood pressure to normal (around 110/70 mmHg) with drugs. (C) Choice of drug: Intravenous infusion of nitroprusside can achieve the goal of faster blood pressure reduction. (D) Angiotensin converting enzyme inhibitor (ACEI) should be avoided in patients with poor renal function and pregnant women. (E) If the patient has aortic detachment dissection), beta-blocker should be used concurrently with intravenous infusion of nitroprusside to avoid reflex tachycardia

Output: B


Instruction: Which of the following statements about ventricular tachycardia (VT) and supraventricular tachycardia (SVT) is incorrect?

Input: (A) If it is impossible to distinguish VT or SVT with aberrancy clinically, it can be treated as VT first. (B) If atrioventricular dissociation appears on the electrocardiogram, it should be treated as VT. (C) If fusion beats are present on the ECG, VT should be treated. (D) When WPW syndrome is accompanied by atrial fibrillation, drugs that act on the AV node, such as beta blockers and calcium channel blockers, should not be given. In this case, digoxin or amiodarone can be used. (E) When WPW syndrome is accompanied by narrow QRS tachycardia, adenosine can be considered.

Output: D


Instruction: Which of the following statements about the clinical manifestations of staphylococcal scalded skin syndrome (SSSS) is incorrect?

Input: (A) It usually occurs in children under 6 years of age. (B) It is caused by infection with phage group 2 serotoxin-producing staphylococci. (C) Symptoms begin with a rash and peeling around the mouth, which then spreads down the trunk. (D) Mucous membranes are often affected. (E) The lesions dry up and disappear quickly within 3 to 7 days after the skin peels.

Output: D


Instruction: Which of the following is incorrect about toxic shock syndrome?

Input: (A) Clinical signs indicate that the disease involves multiple organs. (B) The rash is usually systemic and peels in the later stages, especially on the palms and soles. (C) There is no conjunctival congestion. (D) Because Kawasaki disease rarely causes muscle aches, abdominal pain, and diarrhea, it can be used as a basis for differential diagnosis. (E) Possible pathogens include Staphylococcus aureus and Streptococcus pyogenes.

Output: C


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

Input: (A)Basically, this is a clinical diagnosis, usually accompanied by fever, sometimes up to 40°C. (B)The patient will present with symptoms of the central nervous system. (C)Depressive heart failure is a common abnormal manifestation of the cardiovascular system. (D)Gastrointestinal symptoms include anorexia, jaundice, and hepatomegaly. (E)Thyroid function tests can clearly distinguish between thyrotoxicosis without complications and thyroid storm.

Output: E


Instruction: Which of the following statements about the acute symptoms caused by botulinum toxin is incorrect?

Input: (A) Symptoms of food poisoning usually appear within 12 to 36 hours. (B) Symptoms usually start in the lower limbs and gradually spread to the brain nerves. (C) They are usually symmetrical. (D) Autonomic nervous system disorders may occur, but sensory nerves are generally not affected. (E) Symptoms caused by infected wounds usually have a longer incubation period and fewer gastrointestinal symptoms.

Output: B


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

Input: (A) An almond flavor may be present. (B) Metabolic acidosis will occur. (C) The speed at which symptoms appear is related to the route of exposure, the form of the poison, and the dose, and can take from a few seconds to a few hours. (D) Even if the patient has not yet developed respiratory failure, obvious cyanosis can be seen at the beginning, which is a characteristic of this type of poisoning. (E) The treatment of methemoglobinemia caused by taking nitrate drugs is very different from that of cyanide poisoning.

Output: D


Instruction: The elimination of carbon monoxide in the body is closely related to the composition of the oxygen breathed by the patient. When breathing normal air, it takes about 5 hours to eliminate half of the carbon monoxide; breathing pure oxygen can shorten the time to about 80~90 minutes. If hyperbaric oxygen therapy is given, the elimination of carbon monoxide can be accelerated, shortening the time to 20 minutes. Which of the following statements about the indications for hyperbaric oxygen therapy is incorrect?

Input: (A) Coma or loss of consciousness for any period of time. (B) Signs of myocardial ischemia or arrhythmia. (C) COHb > 40% for general patients and COHb > 15% for pregnant women, because fetal hemoglobin is more sensitive to carbon monoxide than adult hemoglobin, which is more likely to cause poisoning and hypoxia. (D) COHb > 25% for patients with coronary heart disease. (E) Symptoms are relieved under 100% pure oxygen therapy.

Output: E


Instruction: Which of the following statements about acute necrotizing fasciitis is incorrect?

Input: (A) In addition to redness, swelling and heat on the skin surface, there is often disproportionate numbness and pain, and signs of systemic toxemia, such as high fever, tachycardia, changes in consciousness, and even shock. (B) It often occurs in patients with diabetes, cirrhosis, alcoholism and immunodeficiency, but may also occur in healthy young people. (C) Those occurring in the lower limbs are mostly group A β-hemolytic streptococci infections, and may be complicated by streptococcal toxic shock syndrome. (D) If it occurs in the perineum (Fournier's gangrene), it is usually a multi-species infection (including anaerobic bacteria), often complicated by perineal trauma or infection around the anus. (E) Broad-spectrum intravenous antibiotic treatment should be started immediately. If there is no significant improvement within 72 hours, the surgeon should be consulted for surgical debridement.

Output: E


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

Input: (A) Early goal-directed therapy is an important direction for the treatment of sepsis. It can reduce the mortality rate of patients with severe sepsis and septic shock by 16%. It should be started from the emergency department and continued to the subsequent intensive care unit. (B) Central venous oxygen saturation (mixed venous saturation, Scvo2) is a parameter representing tissue perfusion and should be maintained above 70%. (C) If blood pressure is still difficult to maintain after adequate infusion therapy, vasopressors should be added, with the goal of maintaining mean arterial pressures of at least 70 mmHg. Evidence shows that whether dopamine or norepinephrine is used, achieving the above goals will significantly reduce mortality. (D) Sodium bicarbonate (NaHCO₃) may cause bizarre intracellular acidosis and should only be considered in severe acidosis (pH <7.0-7.2). (E) Activated protein C has been shown in large-scale studies to reduce mortality by 6.1% in patients with severe sepsis.

Output: C


Instruction: A 48-year-old male was fishing at the seaside and accidentally injured his right foot with a fish bone. 12 hours later, his right foot was swollen and hemorrhagic blisters formed. He was sent to the hospital and had septic shock. Which of the following statements about this patient is wrong?

Input: (A) The patient may have necrotizing fasciitis. (B) In Taiwan, the most likely infection is Vibrio vulnificus, which is a Gram-positive bacterium. (C) The patient may have other chronic diseases. (D) Later-line antibiotic treatment is often required, such as the third-generation or fourth-generation cephalosporin. (E) Surgical intervention is often required to clean the wound.

Output: B


Instruction: Regarding the prevention of altitude sickness (such as altitude sickness, high altitude cerebral edema, and high altitude pulmonary edema), which of the following drugs is wrong?

Input: (A) Acetazolamide. (B) Dexamethasone. (C) Furosemide. (D) Nifedipine. (E) Sildenafil.

Output: C


Instruction: A 30-year-old female patient presented to the emergency department with fever, sore throat, and body aches for one day. She had headaches and vomiting that worsened with activity the night before, and had intermittent confusion. She had petechiae all over her body before coming to the hospital. The patient had no travel history. On arrival, her temperature was 38.3°C, pulse was 120/min, respirations were 18/min, and blood pressure was 80/60 mmHg. Laboratory examination showed: WBC 17600/mm³, hemoglobin 13.6 g/dL, platelet 54000/mm³, BUN 57 mg/dL, creatinine 3.3 mg/dL, APTT >120 seconds, INR 2.14, D-Dimer >10 µg/mL. Which of the following is the most likely diagnosis?

Input: (A) Toxic shock syndrome. (B) Acute gonococcemia. (C) Rocky Mountain spotted fever. (D) Infective endocarditis. (E) Meningococcemia.

Output: E


Instruction: Which of the following is incorrect about anterior cord syndrome of spinal cord injury?

Input: (A) Anterior spinal artery thrombosis is one of the causes of anterior cord syndrome. (B) Hyper-extension of the cervical spine is one of the causes of anterior cord syndrome. (C) Compression of the spinal cord by cervical fracture is one of the causes of anterior cord syndrome. (D) Direct injury to the anterior spinal cord due to puncture is one of the causes of anterior cord syndrome. (E) Flexion of the cervical spine is one of the causes of anterior cord syndrome.

Output: B


Instruction: The correct choice of drugs used for rapid sequence intubation of trauma patients, Which of the following is least appropriate?

Input: (A)Fentanyl is used in patients with low blood pressure. (B)Ketamine is used in patients with traumatic brain injury. (C)Lidocaine is used before intubation of patients with head trauma. (D)Rocuronium is used in patients with crush injuries after an earthquake. (E)Succinylcholine is used in patients suspected of having traumatic brain injury.

Output: B


Instruction: Which of the following statements about the clinical manifestations of traumatic asphyxia is incorrect?

Input: (A)Craniocervical cyanosis of the face and neck. (B)Craniocervical petechiae of the face and neck. (C)Subconjunctival hemorrhage hemorrhage). (D) Thoracic crush injury. (E) Edema of the lower limbs.

Output: E


Instruction: A 45-year-old male was riding a motorcycle when he was hit by a car from behind at a speed of about 40 km/hr. The patient was thrown 10 meters away from the motorcycle. When he was sent to the emergency room by ambulance, his vital signs were body temperature 36.7°C, respiratory rate 25 times/minute, heart rate 135 times/minute, and blood pressure 100/67 mmHg. The patient complained of severe chest pain and difficulty breathing. Physical examination revealed obvious abrasions on the right chest, local tenderness and crepitus accompanied by decreased breath sounds. Which of the following is incorrect about chest contusion?

Input: (A) Most patients with aortic rupture caused by trauma die at the scene of the crime. The few survivors are mostly injured in the ligamentum arteriosum. (B) Tension pneumothorax is a clinical diagnosis. Usually, hypotension occurs first, followed by cyanosis. (C) If the chest X-ray diagnoses suspected right-sided hemothorax, a chest tube should be placed in the right chest for treatment. If more than 1500 ml of blood is immediately drained, a thoracotomy is required to stop the bleeding. (D) If air continues to be drained after the chest tube is placed, bronchial damage should be considered and a bronchoscope should be arranged for diagnosis. At this time, an endotracheal tube can be placed in the other main bronchus to provide single-lung breathing to maintain ventilation. (E) For patients with blunt cardiac injury, troponins are more useful than electrocardiograms for emergency clinical judgment and treatment.

Output: E


Instruction: A 45-year-old male fell from about 3 meters to the ground at a building construction site. Witnesses found that the patient had landed on his head. The patient lost consciousness briefly and woke up to forget that he had an accident. When he was taken to the emergency room by ambulance, his vital signs were body temperature 36.7°C, breathing 16 times/minute, heart rate 102 times/minute, and blood pressure 120/67 mmHg. The patient complained of weakness in his limbs and abnormal sensation. Which of the following is incorrect about the patient's possible spinal cord injury?

Input: (A)Anterior cord syndrome is usually caused by neck flexion. Only proprioception and vibration are retained below the injured site. (B)Central cord syndrome is more likely to occur in young people. The weakness of the lower limbs is greater than that of the upper limbs. (C)Brown-Sequard syndrome is weakness on the same side, loss of proprioception on the same side, and loss of pain and temperature sensation on the opposite side. (D)Cauda equina has a better prognosis, mainly because the injured nerve is a peripheral nerve, which has a chance of regeneration. (E)If the nerve damage is determined to be at the C5 position, it is necessary to consider intubation in advance to prevent respiratory failure.

Output: B


Instruction: In a fire incident, you are the first medical personnel to arrive at the scene. According to START (Simple Triage And Rapid Treatment), which of the following injuries is classified as yellow?

Input: (A) 22-year-old female, rapid breathing, black carbon particles attached to the mouth and nose, unconscious. (B) 21-year-old female, left thigh fracture, normal breathing and pulse, clear consciousness. (C) 18-year-old female, panic, running around, crying and shouting that classmates are still in the classroom, right hand slightly burned. (D) 25-year-old female, no breathing, large facial burns. (E) 40-year-old female, breathing 25 times per minute, capillary refill time 3 seconds.

Output: B


Instruction: An emergency patient's blood test results showed pH 7.25, sodium ion concentration 138 mEq/L, potassium ion concentration 3.4 mEq/L, chloride ion concentration 102 mEq/L, bicarbonate 16 mEq/L. Which of the following conditions is least likely?

Input: (A) Alcohol ketoacidosis. (B) Diabetic ketoacidosis. (C) Diarrhea. (D) Isopropyl alcohol poisoning. (E) Sepsis.

Output: C


Instruction: A 25-year-old female experienced photophobia, eye pain, blurred vision, and purulent discharge after wearing contact lenses for nearly 24 hours. Examination revealed a corneal ulcer. Which of the following statements is incorrect?

Input: (A) In addition to using antibiotic solution, an eye patch must be used to prevent infection. (B) If an ophthalmologist is unable to provide emergency consultation, quinolone antibiotics can be administered first, and an ophthalmologist must be scheduled for a follow-up visit within 24 hours. (C) A cycloplegic agent can be administered to help relieve pain. (D) Contact lens-related corneal ulcers are most commonly caused by Pseudomonas infection. (E) Although the anesthetic solution makes the patient feel very comfortable, it should not be given home for use as it may cause blindness.

Output: A


Instruction: A 67-year-old male presents to the emergency department with blurred vision and right head injury. Physical examination reveals hematoma of the right fronto-temporal scalp and upper outer orbit. Both pupils are 2 mm equal in size. Light reflexes are normal, as are limb movements and deep tendon reflexes. Gait is steady, but he is prone to bumping into objects on the right side. Visual field examination reveals right homonymous hemianopsia. What is the most likely diagnosis?

Input: (A) Right central retinal artery occlusion. (B) Right epidural hemorrhage. (C) Left occipital infarction. (D) Left subdural hemorrhage. (E) Pituitary tumor.

Output: C


Instruction: A 45-year-old male with a history of hemophilia A accidentally fell and hit his right elbow yesterday. He came to the emergency room because of swelling and pain in his right forearm. Physical examination revealed multiple bruises on his right forearm and the patient looked very painful when he was passively stretched. An X-ray showed no obvious fracture. Which of the following statements is wrong?

Input: (A) If there is accompanying numbness, it may be compartment syndrome and hospitalization is required. (B) Factor VIII 20-40U/Kg can be given. (C) Even if there is no obvious fracture on the X-ray, splinting can still be considered when the bleeding has been controlled because of the pain in the affected area. (D) The chamber pressure can be measured after the coagulation factor is replenished. (E) If painkillers are needed, they can be injected intramuscularly.

Output: E


Instruction: A 70-year-old male with a history of gout and diabetes came to the emergency department with complaints of mild fever and right knee pain. In the emergency department, the blood pressure was 120/70 mmHg, the pulse was 80 times/min, the respiratory rate was 16 times/min, and the body temperature was 38.3℃. Physical examination revealed local redness and swelling of the right knee and limited movement. The joint fluid examination results showed that the color was slightly cloudy, WBC 67000/mm³, PMN 98%. Which of the following statements about this patient is correct?

Input: (A) If crystals are found under microscopic examination of the joint fluid, it can be diagnosed as gouty arthritis. (B) Uric acid should be tested immediately in the emergency room, which is very helpful in diagnosing gouty arthritis. (C) If it is diagnosed as gouty arthritis, allopurinol should be given immediately as a treatment for acute attacks. (D) Oral steroids can be given to patients who are contraindicated with NSAIDs. (E) Regardless of whether it is gouty arthritis or infectious arthritis, the glucose value of the joint fluid examination is less than 50% of the blood glucose value.

Output: D


Instruction: Which of the following statements about carpal tunnel syndrome does not include?

Input: (A) It is a peripheral neuropathy. (B) It is caused by compression of the radial nerve. (C) Symptoms include numbness and pain on the palm of the thumb, index finger, middle finger, and radial side of the ring finger. (D) Symptoms are aggravated by edema during pregnancy. (E) The causative factor is excessive use of the wrist with repeated bending and extension.

Output: B


Instruction: Which of the following statements about first aid for patients with acute ischemic stroke is incorrect?

Input: (A) If it is an acute ischemic stroke and meets the requirements, thrombolytic therapy can be performed with r-tPA, with a dose of 15 mg intravenous push over 1 minute, 50 mg intravenous drip over 30 minutes, and 35 mg intravenous drip over 30 minutes. (B) After r-tPA is administered, antithrombotic drugs such as heparin should not be given at the same time within 24 hours. (C) When establishing an intravenous route, glucose-free infusions should be used as much as possible. (D) The National Institutes of Health Stroke Scale (NIHSS) assessment should be completed as soon as possible. (E) Intravenous thrombolytic agents should be used within 3 hours of the onset of stroke symptoms.

Output: A


Instruction: Which of the following statements about the treatment of other coexisting diseases during pregnancy is incorrect?

Input: (A) Pregnancy with hyperthyroidism may increase the risk of preeclampsia. (B) Radioactive iodine therapy should not be used to treat pregnant women with thyroid storm. (C) Captopril and lasix are quick and effective treatments for hypertensive emergencies during pregnancy. (D) Pregnant women with paroxysmal supraventricular tachycardia can safely be treated with verapamil (isoptin). (E) Pregnant women with atrial fibrillation can be treated with low molecular weight heparin to prevent thrombosis.

Output: C


Instruction: A 34-year-old pregnant woman who is 28 weeks pregnant with twins comes to the emergency department with right side low back pain. Her vital signs show: blood pressure 138/73 mmHg, heart rate 101 beats/min, respiratory rate 22 breaths/min, ear temperature 36.8 ℃. Physical examination shows mild tenderness in the right abdomen but no rebound tenderness, and percussion pain in the right posterior low back. Which of the following statements is incorrect about the management of this patient?

Input: (A) When choosing analgesics, narcotics should not be used to avoid affecting the fetus. (B) Blood tests, general biochemical tests and routine urine tests can be arranged. (C) If the urine test is normal, but the ultrasound shows right kidney edema, it is necessary to consider that the pain is caused by kidney edema caused by the fetus and uterus compressing the ureter. (D) If necessary, an abdominal X-ray can be arranged. (E) Acute appendicitis should be included in the differential diagnosis.

Output: A


Instruction: Which of the following statements about perforated peptic ulcer is incorrect?

Input: (A) If no free air is seen on a standing chest X-ray, the possibility of perforation can be ruled out. (B) X-rays after nasogastric insufflation are not currently recommended. (C) Elderly people may not have sudden onset of pain or obvious signs of peritonitis. (D) Symptoms are often sudden, severe upper abdominal pain. (E) Patients may not have a history of peptic ulcers or symptoms of ulcers.

Output: A


Instruction: A 30-year-old male came to the emergency room with shortness of breath and chest pain. His vital signs were: blood pressure: 160/80 mmHg, heart rate: 89 beats/min, respiration: 30 beats/min, temperature: 36.7℃, pulse oximeter 99%; he began to complain of numbness on the left side of his body during the interview. EKG showed normal sinus rhythm, and CXR showed free air in the diaphragmatic cavity. After a detailed medical history, it was found that the symptoms occurred two hours after surfacing from scuba diving. Which of the following treatments is more appropriate?

Input: (A) Acute coronary syndrome is highly suspected. Give aspirin and NTG, and check myocardial enzymes. (B) Highly suspected of mediastinitis, give antibiotics, and contact the thoracic surgery department. (C) Highly suspected of panic disorder, give Vena symptomatic treatment, and observe. (D) Highly suspected of pulmonary barotrauma, give symptomatic treatment, and observe. (E) Highly suspected of pulmonary barotrauma combined with arterial gas embolism, give hyperbaric oxygen therapy.

Output: E


Instruction: A 45-year-old male was sent to the emergency room after driving a passenger car under the influence and crashing into a roadside vehicle. The EMT used a collar, head restraint and long backboard to fix him. The patient was reportedly wearing a seat belt and the airbag was deployed. He was talking nonsense and resisted being sent to the hospital at the scene. When he arrived at the hospital, he was half asleep and half awake. When he was awake, he kept clamoring to remove the collar and fixation, but fell asleep again immediately. During the initial assessment, there were no obvious injuries on the body, breathing was smooth, heart rate: 105 beats/minute, blood pressure: 148/85mmHg, pupils on both sides were equal in size and responded to light; there was no obvious tenderness in the midline of the neck, the neck was twisted continuously when the collar was loosened for examination, and the muscle strength and reflexes of the limbs were normal. The most appropriate treatment at this time is:

Input: (A) The patient has no obvious signs of cervical spine injury, and the collar can be removed directly. (B) First send the patient to take a complete cervical spine X-ray (including C-spine AP+Lat and Open mouth view). If the interpretation is normal, remove the collar. (C) Directly order a cervical spine computerized tomography (CT Scan). If the interpretation is normal, remove the collar. (D) Do not remove the collar for now, but if a brain CT scan is necessary, a cervical spine CT scan can be arranged at the same time. (E) Consult a neurosurgeon for further advice.

Output: D


Instruction: A 3-year-old boy complained of cold symptoms starting 5 days ago, 3 The patient started to feel abdominal discomfort days ago. His family took him to the emergency room because of the worsening abdominal pain. At that time, he had obvious pain in his calves on both sides, and red spots and bruises appeared on his lower limbs. His family said that he had no history of trauma, vomiting, chronic diseases, or allergies. The results of the emergency blood test were as follows: Sugar 80 mg/dL, BUN 12 mg/dL, Amylase 50 U/L, AST 52 U/L, CRP 0.9 mg/L, WBC 11200/uL, Hb 12.6 g/dL, Hct 37.5%, Platelet 300 k/uL, and urine test results: WBC 0/HPF, RBC 30/HPF. Which of the following is the most likely diagnosis for this patient:

Input: (A)Von Willebrand disease. (B)Henoch-Schonlein purpura. (C)Meningocococemia. (D)Immune thrombocytopenic purpura(ITP). (E)Hemophilia.

Output: B


Instruction: A 40-year-old male patient was sent to the hospital due to fainting. After diagnosis and treatment by the emergency doctor, it was found that the patient suffered from acute inferior wall ST elevation myocardial infarction (STEMI) and shock. The consulting cardiologist evaluated and recommended that the patient should receive emergency cardiac catheterization. If the patient regains consciousness, who is most suitable to sign the cardiac catheterization consent form?

Input: (A)The patient himself. (B)The patient's wife. (C)The eldest son who does not live with the patient. (D)The daughter who lives with the patient. (E)The patient's father.

Output: A


Instruction: A 41-year-old male who had been taking lithium carbonate (300 mg bid) regularly for 10 years was brought to the emergency room by his family. His main complaints were anorexia, insufficient urination, and gradual changes in consciousness for about a week. No medication deficiency was found. Physical examination showed coma index E3V2M4, equal pupils on both sides, severe ataxia, blood pressure: 72/48 mmHg, heart rate: 52 beats/minute, respiration: 18 beats/minute, body temperature: 37.2℃. Blood test report: Na: 146 mEq/L, K: 3.3 mEq/L, Cl: 104 mEq/L, glucose: 406 mg/dL, BUN: 83.7 mg/dL, Cr: 2.6 mg/dL, lithium salt concentration is 3.3 mEq/L. Which of the following statements is incorrect?

Input: (A) Occurs in patients who chronically take lithium salts and use excessive doses. This type of patient is usually more serious than patients with acute poisoning. (B) Give diuretics such as Lasix to accelerate the excretion of lithium salts. (C) Accept hemodialysis. (D) No need to use activated carbon. (E) Use amiloride to treat nephrogenic diabetes insipidus caused by lithium salt poisoning.

Output: B


Instruction: A 45-year-old female motorcyclist fell to the ground after a collision with a tour bus. When the EMT arrived at the scene, they found the victim lying next to the right rear wheel of the tour bus. Except for her left lower limb under the bus, the rest of her body was outside the bus. The scene was safe and the victim's helmet was not removed. She complained of pain in her left thigh and was unable to move. Initial assessment showed that the victim was conscious, breathing normally, heart rate: 120 beats/minute, blood pressure: 100/60 mmHg, exposed body showed bruises and swelling on the left thigh, and there was a tire mark about 20 cm wide near the groin. The rest of the examination showed no obvious abnormalities. Regarding immobilization before arrival at the hospital, which of the following statements is least appropriate?

Input: (A)Before the EMT moves the victim from under the vehicle, he should remove the victim's helmet while protecting the cervical spine. (B)Because the victim may have a cervical spine injury, the assistant should use appropriate manual methods to fix the cervical spine after removing the helmet. (C)After preliminary assessment, the victim may have a left femur fracture, and cervical spine problems cannot be ruled out, so a cervical collar is needed for fixation. (D)The victim may have a left femur fracture, so after preliminary assessment, a traction splint should be used for fixation. (E)Before transporting the victim, the whole body should be fixed with a long backboard to avoid secondary injuries.

Output: D


Instruction: A 49-year-old male with depression was in a bad mood one morning and drank a bottle of alcohol lamp fuel for hot pot to commit suicide. He felt difficulty breathing, blurred vision and abdominal pain, so he was sent to the hospital by his family. The patient became agitated and gradually fell into a coma. After taking the medical history, physical examination and laboratory analysis, the fundus showed edema of the optic disc with unclear edges. Arterial blood gases, under 2 liters of oxygen per minute, pH was 7.092, PaO2 110.5 mmHg, PaCO2 20.9 mmHg, HCO₃- 6.1 mmol/l, oxygen saturation was 100%, blood anion gap was 28.9, and ethanol concentration was undetectable. Which of the following statements about the treatment you gave is incorrect?

Input: (A) NaHCO₃ injection therapy. (B) Fomepizole 10-20 mg/kg/day. (C) Ethanol treatment, give 1 g /kg loading dose, then 66 mg/kg/hr, and 132 mg/kg/hr during hemodialysis. (D) Folic acid injection treatment. (E) Hemodialysis treatment is not necessary when Fomepizole antidote is available.

Output: E


Instruction: Five guests staying in a B&B with good ventilation, had not showered yet after dinner for one hour. They sought medical attention one after another because of tachycardia, tachypnea and cyanosis, and even confusion, hypotension and respiratory failure. Although continuous use of oxygen had no obvious effect, the oxygen partial pressure of arterial blood oxygen gas analysis PaO2 was 95-100 mmHg, and the oxygen partial pressure of venous blood oxygen gas analysis PvO2 was 38-42 mmHg. There was no improvement in cyanosis. What kind of antidote was used to treat the patients?

Input: (A)Fomipezole. (B)Methylene blue. (C)Hydroxocobalamine. (D)Calcium gluconate. (E)Flumazenil.

Output: B


Instruction: A 70-year-old man was sent to the emergency room for shock. Which of the following statements about the assessment and treatment of shock patients, infusion therapy, and pressor drugs is incorrect?

Input: (A) Dopamine, Epinephrine, and Norepinephrine have similar stimulation intensity on α receptors, but Norepinephrine has the strongest stimulation intensity on α receptors and has no effect on β2 receptors. (B) Blood pressure is a sensitive indicator for detecting insufficient tissue perfusion. Shock can cause insufficient tissue perfusion and oxygen, severe systemic inflammatory response syndrome (SIRS), multiple organ failure, and even death. (C) The early goals of emergency treatment for septic shock are central venous pressure (CVP) of 8~12mmHg, mean arterial pressure (MAP) of 65~90mmHg, and central venous oxygen saturation (Scvo2) >70%, which can significantly reduce mortality. (D) Dopamine and norepinephrine are both first-line treatments for septic shock. (E) The 3:1 physiological rule of crystalloid fluid infusion resuscitation is mainly because about 30% of the crystalloid fluid remains in the blood vessels, so three times the amount of crystalloid fluid is needed to replenish blood loss.

Output: B


Instruction: Magnesium sulfate can be used for many critically ill patients. Which of the following situations is not suitable for it?

Input: (A) Polymorphic ventricular tachycardia suspected to be Torsades de pointes. (B) Eclampsia. (C) Severe asthma. (D) Ventricular arrhythmia caused by tricyclic antidepressant poisoning. (E) All of the above are appropriate.

Output: E


Instruction: The patient is a male with terminal lung cancer with multiple metastases to the brain, liver, and bones. Which of the following statements is incorrect?

Input: (A) If the patient wishes to sign a palliative care consent form, two or more persons with full behavioral capacity must be present as witnesses, excluding medical staff. (B) If the patient has signed a palliative care and medical consent form, the patient may withdraw the consent at any time, but it must be in writing. (C) Even if the patient has signed a palliative care and medical consent form, if the patient regrets and requests intubation, the doctor should intubate the patient. (D) If the doctor learns that the patient has made a palliative care and medical consent form after completing intubation, the doctor may not immediately withdraw the patient's life support equipment based on this consent. (E) If the patient's wife, son, or father decides to sign a consent form to withdraw cardiopulmonary resuscitation after the doctor completes intubation, the doctor may withdraw the patient's life support equipment based on this consent.

Output: E


Instruction: Which of the following statements is incorrect about a marathon runner who developed a high body temperature and impaired consciousness during a race?

Input: (A) Heatstroke is typically characterized by a high body temperature (>40°C), central nervous system abnormalities, and anhidrosis. (B) The mortality rate can be as high as 30%. (C) The cerebellum is sensitive to heat damage, which may lead to unsteady gait. (D) Delayed cooling can increase the mortality rate. (E) When treating heatstroke, the goal of rapid cooling is to reduce the core body temperature to 37°C to avoid overshoot hypothermia.

Output: E


Instruction: Which of the following acute illnesses occurring within 1 to 3 days of an earthquake disaster is less common?

Input: (A) Crush Syndrome. (B) Respiratory Failure. (C) Renal Failure. (D) Depression. (E) Burn.

Output: D


Instruction: Which of the following is not a feature of simple febrile convulsion?

Input: (A) Only one convulsion occurs within 24 hours. (B) Combined with fever (≧38ºC). (C) Partial seizure. (D) Occurs in children aged 6 months to 5 years. (E) Seizure lasts <15 minutes.

Output: C


Instruction: Which of the following is incorrect in the management of a patient with esophageal rupture?

Input: (A) Boerhaave syndrome is a disease in which the esophageal rupture is caused by increased intraesophageal pressure during examination. (B) Mediastinal emphysema may not be seen on images of patients with esophageal rupture. (C) Pain caused by esophageal rupture is often acute and radiates to the back. (D) Dysphagia, dyspnea, and vomiting blood are possible symptoms. (E) The time from esophageal rupture to treatment will affect the patient's prognosis.

Output: A


Instruction: For a patient who recently returned from a foreign trip and developed a fever, which of the following statements is incorrect in the differential diagnosis of clinical diagnosis?

Input: (A) If the patient has returned from a tropical area, malaria is the first differential diagnosis that must be excluded. Its typical clinical manifestations are fever, splenomegaly, and thrombocytopenia. (B) Malaria patients will have periodic fever. Therefore, if the patient does not have a periodic fever, the possibility of malaria infection can be preliminarily ruled out. (C) If malaria infection is ruled out, and the patient has thrombocytopenia and petechial hemorrhages, dengue hemorrhagic fever, meningococcal bacteremia, and hemorrhage should be considered first. (D) If a patient returns from North America with a fever and delirium, in addition to ruling out common bacterial meningitis, the possibility of West Nile virus infection causing encephalitis should be considered. (E)Except for malaria, the incubation period of the above diseases is within three weeks (≦ 21 days). If the patient develops symptoms such as infection and fever three weeks after returning to the country, in addition to malaria, the possibility of viral hepatitis, syphilis, acute human immunodeficiency virus infection, amebic liver abscess, rabies, and other parasitic infections must be considered.

Output: B


Instruction: Which of the following is not a common feature of child physical abuse?

Input: (A) Multiple fractures of different stages. (B) Rib fracture. (C) Immersion burns. (D) Retinal hemorrhage. (E) Mongolian spots.

Output: E


Instruction: Which of the following statements is incorrect about the patient presenting with acute abdominal pain and abdominal muscle rigidity, often leading to shock?

Input: (A) The patient suffers from acute perforated peptic ulcer. (B) The patient suffers from esophageal rupture. (C) The patient suffers from splenic rupture. (D) The patient suffers from intestinal torsion. (E) The patient suffers from acute hemorrhagic pancreatitis.

Output: D


Instruction: Which of the following statements is incorrect about the clinical conditions that affect the interpretation of the ST wave band on the electrocardiogram?

Input: (A) Early repolarization and left ventricular hypertrophy, both of which can cause an increase or decrease in the ST wave band. (B) Left bundle branch block and left ventricular hypertrophy, both of which can cause an increase or decrease in the ST wave band or T wave inversion. (C) Hypokalemia and digitalis poisoning, both of which can cause ST wave depression. (D) Mitral valve prolapse and pulmonary embolism can cause T wave inversion. (E) Spontaneous pneumothorax will not cause T wave inversion.

Output: E


Instruction: After initial warming and drying, the newborn has difficulty breathing and mild cyanosis, heart rate: 80 beats/minute, the next treatment is:

Input: (A) Keep warm and continue to assess the physical condition. (B) Give emergency medicine Epinephrine. (C) Give positive pressure ventilation. (D) Start chest compression. (E) Prepare for intubation.

Output: C


Instruction: Which of the following statements about wide QRS tachycardia is incorrect?

Input: (A) If there is ventriculo-atrial dissociation, it is indicated as ventricular origin. (B) If it is polymorphic ventricular tachycardia and the previous EKG shows QTc prolongation or low magnesium ion concentration, direct administration of MgSO4 can be considered. (C) If there is a highly consistent QRS complex but the regularity is extremely irregular, plus intermittent narrow QRS complexes, atrial fibrillation combined with WPW syndrome should be considered. (D) If hemodynamics is unstable, synchronized electric shock therapy is appropriate. (E) If hemodynamics is stable, adenosine therapy is not appropriate.

Output: E


Instruction: Regarding urinary system trauma, which of the following can leave the emergency room with medicine and go home for observation?

Input: (A) 10-year-old boy, lumbar contusion, urine test RBC 25/HPF, no lumbar percussion pain. (B) 75-year-old man, car accident back pain, persistent hematuria (gross hematuria), anemia. (C) 16-year-old girl fell off her bike, urine test RBC 90/HPF, lower abdominal pain. (D) 40-year-old truck driver, car accident, hematuria, abdominal muscle stiffness. (E) 25-year-old woman slipped while doing housework, lower abdominal pain, back pain, urine test RBC 200/HPF.

Output: A


Instruction: Which of the following statements about the patient who is experiencing massive hemoptysis is less likely?

Input: (A) The patient has a bronchiectasis emergency. (B) The patient has cavitary tuberculosis. (C) The patient has aspergilloma. (D) Pulmonary artery rupture caused by manipulation of the pulmonary artery catheter. (E) The patient has a mitral regurgitation emergency.

Output: E


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

Input: (A) An autosomal dominant genetic defect. (B) Complete loss of sodium channel function. (C) The key electrocardiogram shows early repolarization of the V2-V6 leads with positive T waves. (D) In Southeast Asian countries, it accounts for 40-50% of patients with unexplained ventricular fibrillation (VF). (E) The most effective treatment is the implantation of an internal cardioverter-defibrillator.

Output: C


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

Input: (A) It can cause fatal chest pain. (B) It often occurs after a bout of violent vomiting. (C) It can cause transdiaphragmatic emphysema. (D) It can cause fatal gastric rupture. (E) It can be associated with pneumothorax.

Output: D


Instruction: Which of the following statements is incorrect about the absolute contraindications to the use of thrombolytic agents in the setting of myocardial infarction?

Input: (A) The patient has a history of cerebral hemorrhage. (B) The patient has a history of brain tumor. (C) The patient has cerebral vascular lesions. (D) The patient is menstruating. (E) The patient is suspected of having aortic detachment.

Output: D


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

Input: (A) It is the most common cause of intestinal obstruction in children aged 3 months to 6 years. (B) Currant jelly stool may sometimes be seen. (C) Some children present with lethargy. (D) Abdominal ultrasound shows target appearance. (E) If intussusception recurs, surgery should be performed immediately.

Output: E


Instruction: Which of the following statements about necrotizing fasciitis is incorrect?

Input: (A) Most patients do not require surgery and can be treated with strong antibiotics. (B) The mortality rate is about 25% to 35%. (C) Pain that exceeds physical examination assessment may be an important feature for early diagnosis. (D) The infection can spread as fast as 1 inch per hour. (E) Common risk factors for the disease include old age, diabetes, alcoholics, poor resistance, etc.

Output: A


Instruction: Which of the following statements about the clinical manifestations and diagnosis of necrotizing fasciitis is incorrect?

Input: (A) In the early stages of the disease, it is difficult to distinguish it from common cellulitis. Therefore, patients with diabetes, liver cirrhosis, the elderly, and those with weakened immune systems such as blood tumors or those receiving chemotherapy need to be highly alert to the possibility of this disease. (B) Unlike common cellulitis, necrotizing fasciitis is a severe deep tissue infection that triggers a systemic inflammatory response. Therefore, all patients will have fever and tachycardia. (C) When patients develop hemorrhagic blisters at the site of infection, the lesions expand rapidly, the degree of subjective pain is disproportionate to the appearance of the affected area (such as severe pain but only slight redness and swelling), and sinus tachycardia that cannot be explained by fever, the possibility of necrotizing fasciitis must be ruled out immediately. (D) Necrotic fasciitis that occurs on the trunk or head and neck is usually a polymicrobial infection. When considering drug treatment, it is necessary to consider antibiotics that effectively cover anaerobic bacteria. Examples of such infections are gas gangrene, Fournier's gangrene, and Ludwig's angina. (E) Fasciotomy for debridement of necrotic tissue is the most important factor in the success of treatment. Patients may need to undergo multiple surgical debridements or even amputation depending on the course of the disease and response to treatment.

Output: B


Instruction: Which of the following statements about the causes of wide anion gap metabolic acidosis is incorrect?

Input: (A) Patients with renal failure. (B) Patients with methemoglobinemia. (C) Patients with cyanide poisoning. (D) Patients with metformin poisoning. (E) Patients taking acetaminophen.

Output: E


Instruction: Which of the following is incorrect about the management of patients with acute cholecystitis?

Input: (A) Antibiotic treatment is required as soon as the diagnosis is confirmed. (B) Cephalosporin plus metronidazole is an antibiotic of choice. (C) Fluoroquinolone plus metronidazole is an antibiotic of choice. (D) Severe complications such as ascending cholangitis may result if left untreated. (E) Opioids are more effective than non-steroidal analgesics. Anti-inflammatory drugs (NSAIDS) are more suitable for the pain relief of acute cholecystitis.

Output: E


Instruction: Regarding the rescue items that the rescue technician management regulations stipulate that intermediate rescuers can perform, which of the following statements is incorrect?

Input: (A) Blood sugar monitoring. (B) Administering oral glucose. (C) Administering inhaled bronchodilators or nitroglycerin sublingual tablets. (D) Setting up and maintaining peripheral vascular access. (E) Administering glucose (water), lactated Ringer's solution or normal saline.

Output: C


Instruction: Regarding the treatment of pneumothorax, which of the following statements is incorrect?

Input: (A) Tension pneumothorax should be treated with needle decompression immediately and then a chest tube should be inserted for drainage. (B) Administration of oxygen helps absorb the air in the pleural cavity. (C) Ultrasound cannot diagnose pneumothorax. (D) CT scan helps diagnose pneumothorax in patients with severe COPD and bullae in the lungs. (E) Secondary spontaneous pneumothorax is usually related to chronic obstructive pulmonary disease.

Output: C


Instruction: Which of the following does not meet the definition of systemic inflammatory response syndrome (SIRS)?

Input: (A) White blood cell count: 20,000/mm³. (B) Body temperature: 40° C. (C) Respiratory rate: 25 beats/min. (D) Blood pressure: 80/40 mmHg. (E) Heart rate: 100 beats/min.

Output: D


Instruction: Which of the following statements about the clinical manifestations and diagnosis of bacterial endocarditis is correct?

Input: (A) Valvular heart disease and intravenous addictive drug injection are known to be important predisposing factors. Therefore, if the patient is not found to have the above predisposing factors during the medical history inquiry, the possibility of bacterial endocarditis can be ruled out. (B) Because bacteria attach to the valve and cause damage or rupture of the mitral papillary muscles, leading to acute valvular regurgitation, all patients with bacterial endocarditis can be found to have heart murmurs by auscultation during physical examination. (C) Fever is the most common clinical sign, and only less than 50% of patients can be found to have skin manifestations of bacterial endocarditis during physical examination. (D) Among patients who have not received prosthetic valve replacement, the prevalence of all pathogens is the highest among the viridans group streptococci, followed by Staphylococcus aureus and Enterococcus species. (E) Transthoracic echocardiography has a very high sensitivity and specificity for the diagnosis of bacterial endocarditis. Therefore, if no valvular vegetation is found by transthoracic echocardiography, the diagnosis of bacterial endocarditis can be completely ruled out.

Output: C


Instruction: Which of the following statements about blood components and blood transfusions is incorrect?

Input: (A) Concentrated red blood cells are stored for about 21 to 42 days. Usually, at least 2 units of blood are transfused at a time, which can increase the hematocrit by 6% and the hemoglobin by 2 g/dL. (B) Platelet count less than 10,000/mm³ without symptoms (e.g. ITP, TTP), less than 20,000/mm³ with coagulation disorders or minor bleeding, less than 30,000/mm³ with major bleeding, less than 50,000/mm³ If invasive treatment or general surgery is required, consider platelet transfusion. (C) Fever, chills, flushing, shock, and hemoglobinuria after transfusion are severe transfusion reactions of acute intravascular hemolysis. Transfusion must be stopped immediately, and fluid supplementation and cardiopulmonary support therapy must be given. It may be fatal. (D) As above, blood type and cross-test, direct and indirect Coombs test, complete blood test (CBC), creatinine, PT&APTT, Haptoglobin, LDH, etc. must be re-tested. (E) Mild transfusion reaction, itching, urticaria, suspend transfusion and give antihistamine treatment. If symptoms improve, transfusion can be continued. Just notify the blood bank, no further blood test is required.

Output: B


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

Input: (A) Proton pump inhibitor can reduce the rebleeding rate of hemorrhagic gastric ulcers and can also reduce the need for blood transfusion and surgery. (B) If there is obvious or large amounts of blood in the stool, a nasogastric tube should be placed to rule out upper gastrointestinal bleeding. (C) Angiography can be used as a diagnostic tool, but the bleeding rate must be at least 0.5 ml/min to be detected. (D) If gastrointestinal bleeding is suspected to be caused by esophageal varices, nasogastric tube placement is not recommended to avoid rupture and bleeding of the esophageal varicose veins. (E) UGI endoscopy is the most accurate method for diagnosing upper gastrointestinal bleeding and allows for early treatment of patients with significant bleeding.

Output: D


Instruction: Which of the following statements about foreign body aspiration in children is wrong?

Input: (A) Chest X-rays can almost always reveal obvious changes. (B) Bronchoscopy is the golden standard for diagnosis and treatment. (C) Food (such as peanuts) and small toys are common foreign bodies. (D) A choking history is an important diagnostic basis. (E) It is a common cause of death in infants and young children.

Output: A


Instruction: Which of the following statements is correct about tumor emergencies?

Input: (A) Superior vena cava syndrome rarely presents with dyspnea or cough. (B) The first priority in the emergency treatment of hypercalcemia caused by malignant tumors is the administration of calcitonin. (C) The symptoms of high blood calcium caused by malignant tumors depend on the blood calcium level, not the rate at which the blood calcium increases. (D) The most common malignant tumors that cause high blood calcium are breast cancer, lung cancer, and multiple myeloma. (E) The most common malignant tumor that causes superior vena cava syndrome is lymphoma.

Output: D


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

Input: (A) It is mostly related to the transfusion of fresh frozen plasma and platelets. (B) It also often occurs when packed RBCs are transfused alone. (C) It often causes bilateral lung infiltrates. (D) It often occurs within 6 hours after transfusion. (E) The treatment is supportive care.

Output: B


Instruction: Which of the following statements about the diagnosis of soft tissue foreign body is incorrect?

Input: (A) Plain radiography can diagnose 3mm glass fragments. (B) X-ray examination has a low diagnostic rate for wood foreign bodies. (C) Ultrasound cannot diagnose whether there are plastic foreign bodies. (D) When no foreign body is found after wound exploration but a foreign body is still suspected, imaging examination can be considered. (E) Computed tomography (CT) may misjudge wood foreign bodies as bubbles.

Output: C


Instruction: Which of the following statements is incorrect about the treatment goal of severe sepsis within 6 hours (Stop Sepsis Bundle)?

Input: (A) Physiological saline is needed to maintain CVP at 8-12 mmH2O. (B) ScvO2 needs to be maintained at >80%. (C) If ScvO2 is insufficient, hemoglobin Hb needs to be maintained above 10 g/dL. (D) If Hb is sufficient but ScvO2 is insufficient, Dopamine and Dobutamine need to be used. (E) If Hb is sufficient but ScvO2 is insufficient, a ventilator can be used to increase ScvO2.

Output: A、B


Instruction: A factory worker accidentally gets electrocuted. When you provide medical treatment, which of the following statements is incorrect?

Input: (A) The higher the voltage, the greater the damage. (B) The cause of death before arrival at the hospital is mostly cardiac arrest or ventricular fibrillation. (C) After electrical injury, pay attention to whether rhabdomyolysis or acute renal failure occurs. (D) Long-term exposure to high-voltage electrical injury will produce compartment syndrome. (E) Patients with electrical injuries to the head and neck may develop cataracts in the future.

Output: D


Instruction: Which of the following statements is inappropriate for the treatment of high blood pressure during acute stroke?

Input: (A) If the systolic blood pressure does not exceed 220 mmHg and the diastolic blood pressure does not exceed 120 mmHg for ischemic stroke, there is no need to specifically lower blood pressure. (B) If it is a hemorrhagic stroke, the systolic blood pressure should be appropriately lowered to around 160 mmHg. (C) If an ischemic stroke patient arrives at the hospital within the golden time of 3 hours and has no other contraindications, and the blood pressure can be reduced to below 185/110 mmHg, thrombolytic therapy can still be considered. (D) The choice of antihypertensive drugs includes Labetalol, Nicardipine or Nitroglycerine drip and adjustment at any time. (E) All of the above are appropriate.

Output: E


Instruction: Suppose you are on duty in the emergency room. There are many children waiting for hospitalization in the emergency observation area. They are stranded in the emergency room because there are no beds in the ward. When you enter the observation room, many parents are at a loss because their children have a fever. They are very worried that their children's brains will be damaged. I ask you how to deal with children with fever. Regarding the following health education content, which of the following is the least appropriate?

Input: (A) The temperature measurement results of infants are in the order of rectal temperature > oral temperature > axillary temperature, and the difference between each temperature is about 0.6℃ (1℉). (B) If the temperature of infants under 3 months old exceeds 38℃, about 3-4% may have serious bacterial infection and need to check the cause of fever. (C) For infants aged 3-36 months, if the temperature exceeds 39.5℃, there will be a higher incidence of bacteremia. If it exceeds 40℃, the incidence of pneumococcal bacteremia will gradually increase. (D) If the white blood cell (WBC) in the blood exceeds 15,000/uL, it is one of the indicators of possible bacteremia. (E) For infants aged 3-36 months, the body temperature is not suitable as a reference for deciding whether to draw blood for examination.

Output: E


Instruction: Which of the following statements is less likely to be the cause of delayed recovery of gastrointestinal function in patients after surgery?

Input: (A) Electrolyte imbalance. (B) Intra-abdominal inflammation or infection. (C) Pancreatitis. (D) Anemia. (E) Drugs (such as morphine-like analgesics, opioids, and phenothiazides).

Output: D


Instruction: After a patient with cardiopulmonary arrest has recovered spontaneous circulation through emergency resuscitation, which of the following statements is incorrect?

Input: (A) Efforts should be made to maintain stable hemodynamic circulation and avoid hypotension. (B) Hyperventilation should be avoided to prevent low carbon dioxide concentration from causing cerebral vasoconstriction and affecting brain tissue perfusion. (C) Efforts should be made to maintain high oxygen concentration within one day after resuscitation to improve the hypoxia of various organs and tissues. (D) If the patient does not wake up immediately and there are no special contraindications, hypothermia therapy should be started as soon as possible to try to improve the prognosis. (E) If acute coronary heart disease is the cause of cardiopulmonary arrest, cardiac catheterization and interventional treatment should be performed.

Output: C


Instruction: Patients with aortic detachment and acute coronary heart disease often present with chest pain. Which of the following statements is inappropriate?

Input: (A) Aortic detachment and lateral and posterior wall myocardial infarction are clinically associated with chest pain, which may migrate to the back. (B) In addition to paying attention to whether there is a significant difference in blood pressure between the four limbs during physical examination, if a new aortic regurgitation murmur is heard, it is necessary to consider the possibility that the aortic detachment affects the base of the aorta. (C) In patients with myocardial infarction who are diagnosed with ST wave elevation on the electrocardiogram, there is still a small possibility that the cause is aortic detachment and coronary artery disease. (D) Acute coronary heart disease patients may experience chest pain after receiving heparin or fibrinolytic therapy. Before surgery, be sure to carefully review the chest X-ray to see if the mid-thoracic diaphragm is widened or if the aorta is abnormally bulging. (E) For safety reasons, CT scans should be routinely performed to exclude aortic detachment before cardiac catheterization for ST wave ascending myocardial infarction.

Output: E


Instruction: A middle-aged male diabetic patient was sent to the emergency room due to unconsciousness. A finger blood glucose test revealed that his blood sugar was too high to be measured. Regarding the assessment and treatment of hyperglycemia crisis, which of the following statements is incorrect?

Input: (A) Hyperosmotic hyperglycemic state (HHS) is characterized by blood sugar levels often above 600 mg/dL, effective serum osmolarity greater than 320 mOsm/L, and arterial pH Value>7.3, HCO₃- >15 mEq/L, no ketone bodies or a small amount in the blood, but attention should be paid to whether there is a mixed acid-base balance abnormality. (B) Gastrointestinal bleeding, infection, renal insufficiency, hemodialysis and pulmonary embolism can all trigger HHS, and the use of lithium salts, diuretics, and steroids can also be used. (C) The average body fluid deficit in HHS is about 20~25% of body weight or 8~12 liters. Half of it must be replenished in the first 12 hours and balanced as much as possible within one day. It is recommended to start infusion with normal saline 15~20 ml/kg/hr (first hour), and then 4~14 ml/kg/hr and determined by the body fluid status. (D) As above, insulin treatment starts with 0.1 units/kg/hr, blood sugar is measured every hour. If the drop is less than 50 mg/dL in the first hour, the hourly insulin dose is doubled until the blood sugar drops steadily by 50-70 mg/dL every hour. (E) Continuing from above, when the blood sugar drops to 250 mg/dL, switch to saline infusion containing 5% sugar water to maintain the blood sugar at 150-200 mg/dL.

Output: E


Instruction: A middle-aged man goes to the emergency room for severe abdominal pain. Which of the following statements about the assessment and treatment of acute abdominal pain is incorrect?

Input: (A) The common symptom of appendicitis is right lower abdominal pain, while the symptoms of retrocecal appendicitis can cause right upper abdominal pain. Early appendicitis can cause widespread abdominal pain. (B) Peptic ulcers often present with persistent severe upper abdominal pain, while gastric ulcers and gastritis often present with left upper abdominal pain, and duodenal ulcer perforation presents with right upper abdominal pain. (C) In X-rays of patients with intestinal perforation, free air can be seen in about 40%. (D) In the first routine blood test of a patient with acute abdominal pain, even if the white blood cell count is normal, it cannot rule out the need for surgery. (E) Metabolic diseases (such as Addisonian crisis and uremia) can present with widespread abdominal pain.

Output: C


Instruction: A middle-aged man goes to the emergency room with severe chest pain. Regarding the comparison of typical symptoms of common causes of life-threatening chest pain and the evaluation of acute coronary heart disease, which of the following statements is incorrect?

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

Output: D


Instruction: In case of trauma combined with spinal cord injury and abdominal breathing, where should the injury be located?

Input: (A) The fourth cervical vertebra. (B) The seventh cervical vertebra. (C) The twelfth thoracic vertebra. (D) The first lumbar vertebra. (E) The fifth lumbar vertebra.

Output: A


Instruction: If bitten by a jellyfish, which of the following treatment methods is less appropriate?

Input: (A) Rinse the wound with plenty of water. (B) Sprinkle alcohol (40% ~ 70% isopropyl alcohol) on the wound. (C) To avoid jellyfish bites, swimming in a diving suit is a good way. (D) Applying vinegar (5% acetic acid) has a soothing effect. (E) The wound should be immediately rinsed with plenty of saline water.

Output: A


Instruction: In the 2010 American Heart Association (AHA) First Aid Guidelines, regarding enhancing the willingness of bystanders to provide rescue, which of the following statements is incorrect?

Input: (A) Common barriers to performing cardiopulmonary resuscitation (CPR) include fear of hurting the patient, fear of operating errors, lack of physical fitness, fear of legal liability, and fear of infection. (B) In public first aid education classes, it is recommended to mention how to overcome panic reactions when facing situations requiring first aid, which is based on the advice of Class I evidence-based medicine. (C) When the rescuer is unwilling or unable to perform full CPR, we can teach them Hands-only CPR as a substitute. (D) The right time to teach rescuers to start CPR is when the patient is unconscious and not breathing, or is not breathing normally (such as gasping). (E) When the rescuer finds that the patient is unconscious and not breathing, or is not breathing normally, such as gasping, the emergency medical service (EMS) dispatcher should provide online CPR instructions.

Output: B


Instruction: In the 2010 American Heart Association (AHA) First Aid Guidelines, regarding the design of first aid education courses, which of the following is not based on the recommendations of Class I evidence-based medicine?

Input: (A) We should evaluate the effectiveness of first aid education programs and conduct such evaluations in a standardized manner. (B) For basic first aid skills (BLS) education, short video tutorials combined with synchronized hands-on practice are an effective alternative to traditional instructor-led instruction. (C) We should allow untrained bystanders to use AEDs. (D) We should plan and promote public training in the use of AEDs. (E) Advanced Cardiac Lifesaving Skills (ACLS) education programs should include teamwork and leadership training.

Output: C


Instruction: In the Incident Command System (ICS), safety officers fall under the jurisdiction of which of the following departments?

Input: (A) Command. (B) Finance. (C) Planning. (D) Logistics. (E) Operation.

Output: A


Instruction: Welcoming the first light of 2012 on the top of Yushan Mountain, the weather was very cold that night. A 70-year-old man suddenly changed consciousness and his whole body was shaking with cold. Which of the following statements is wrong?

Input: (A) The possible emergency is hypothermia. (B) Typical symptoms of hypothermia include altered consciousness and slow heartbeat. (C) On-site treatment should reduce further heat loss. (D) Remove damp clothing and use blankets or sleeping bags to keep warm. (E) Shorten the time to assess breathing and pulse. If there is no breathing and pulse within 10 seconds, immediately provide CPR.

Output: E


Instruction: Which of the following is the least likely cause of luminal obstruction of appendix?

Input: (A) Lymphatic tissue. (B) Tumor. (C) Parasites. (D) Fecalith. (E) Feces.

Output: E


Instruction: A 41-year-old male patient with a history of alcoholic hepatitis and cirrhosis due to long-term drinking complained of redness, swelling, heat and pain in his left lower limb this morning. The clinic doctor diagnosed it as cellulitis and prescribed oral antibiotics. Because the symptoms continued to show no improvement and he began to have a high fever and chills in the afternoon, he was accompanied by his family to the emergency room for treatment. The vital signs at the time of the emergency room were: blood pressure 86/58 mmHg, body temperature 35.8℃, pulse 128 beats per minute, respiration 20 breaths per minute, fingertip blood oxygen concentration 94%. The main physical examination showed that the patient had mild jaundice, spider angioma on the chest wall, and shifting dullness. Blood tests found that the total white blood cell count was 9680/µL, the segment form WBC ratio was 92%, and biochemical tests showed abnormal liver and kidney function indexes. Which of the following statements about the diagnosis and treatment of this patient is correct?

Input: (A) This patient was diagnosed with cellulitis and generally has a good prognosis with antibiotic treatment. (B) In Taiwan, the most common pathogen is methicillin-resistant Staphylococcus aureus. (C) Vibrio vulnificus and Aeromonas hydrophila are not common pathogens that need to be considered in this patient. (D) This type of infection is called Fournier's gangrene if it occurs in the perineum. In addition to intravenous antibiotics, both require immediate fasciotomy for wound debridement. (E) Antibiotics that are anti-Grammar-positive are preferred, such as oxacillin. However, if a methicillin-resistant Staphylococcus aureus (MRSA) infection is suspected, vancomycin is the first choice for antibiotic treatment.

Output: D


Instruction: Which of the following is correct about the so-called Mass Casualty Incident?

Input: (A) An incident that produces more than 15 casualties is called a Mass Casualty Incident. (B) It usually refers to those caused by trauma, and those caused by other diseases are generally not counted. (C) Because of the different resources in different regions and the severity of the injuries and illnesses, the standards may vary from place to place and community to community. (D) The fire department is responsible for on-site control, while the health department is responsible for medical rescue. (E) The order of treatment on the scene is generally to deal with those who can leave the scene quickly first, and then rescue those who cannot be moved.

Output: C


Instruction: A 12-year-old boy was brought to the emergency room because of anal bleeding. Inquiry into the medical history revealed that this phenomenon has lasted for about several months. In addition, the patient has a habit of constipation and occasional fecal incontinence. He denied that anyone had ever touched his private parts inappropriately. Physical examination revealed decreased anal tension, 3 anal fissures, and a scar at the 8 o'clock position. Which of the following clinical symptoms and physical examination results are most likely to be caused by this patient?

Input: (A)Hirschsprung disease (B)Constipation (C)Penetrating anal trauma (D)Hemorrhoids (E)Eczama

Output: C


Instruction: A 26-year-old male with a history of cocaine abuse presents to the emergency department with chest pain and ischemic changes on the electrocardiogram. Which of the following is the first-line treatment?

Input: (A)Phetolamine. (B)Labetalol. (C)Diazepam. (D)Verapamil. (E)Propanolol.

Output: C


Instruction: A 32-year-old female was injured by gunpowder that was accidentally ignited at work 4 hours ago. Her back is charred or blistered, and about 50% of her body surface is blistered or charred. She weighs 50 kg, blood pressure is 110/89 mmHg, heart rate is 120 beats/min, and she has 100 ml of urine through an indwelling urinary catheter. From the time of injury to now, she has been given 1000 ml of lactated Ringer's solution. If according to the Parkland formula, how many ml should be given per hour for the next 4 hours of infusion?

Input: (A)10000 ml. (B)5000 ml. (C)250 ml. (D)1000 ml. (E)500 ml.

Output: D


Instruction: A 32-year-old female was taken to the regional hospital emergency department with multiple injuries. Her blood pressure and heart rate were stable, her Glasgow Coma Score was 7, she had facial fractures and multiple lacerations, her chest X-ray showed a wide diaphragm, her breathing was good, her abdomen was soft, and her bowel sounds were normal. The hospital's surgeon was on vacation, the hospital had no surgical capabilities, and the nearest medical center capable of handling the case was 40 kilometers away. What is the next step, the most appropriate treatment?

Input: (A) Administer emergency fluids. (B) Place an endotracheal tube. (C) Perform a chest CT scan. (D) Place an emergency chest tube. (E) Transfer to a medical center immediately.

Output: B


Instruction: A 60 kg male with 2nd to 3rd degree burns covering approximately 30% of his body surface area, how much Ringer's lactate does he need in 24 hours in addition to his normal fluid needs?

Input: (A) 1.8 liter. (B) 3.6 liter. (C) 5.4 liter. (D) 7.2 liter. (E) 9.0 liter.

Output: D


Instruction: A full-term newborn, less than 24 hours old, is found to have yellow bile and is transferred from the obstetrics and gynecology clinic to the hospital emergency department for treatment. Which of the following is the least likely cause of the newborn's yellow bile?

Input: (A) Cephalohematoma caused by birth trauma. (B) Hemolysis caused by blood type incompatibility. (C) Hypothyroidism. (D) Sepsis. (E) Congenital infection.

Output: C


Instruction: A 28-year-old woman suspected of ectopic pregnancy went to the obstetrics and gynecology clinic 5 days ago and asked to go to the emergency department to see the report. The hCG on the first day was 800 IU/L and 850 IU/L after 72 hours. Vaginal ultrasound showed no intrauterine embryo on the first day and after 72 hours. Which of the following diagnoses is more appropriate?

Input: (A) Because the hCG concentration rose smoothly, although the ultrasound did not see the embryo in the uterus, it was still highly suspected to be a normal intrauterine pregnancy. (B) Because hCG The concentration rose smoothly, and the ultrasound did not show the embryo in the uterus, so it was highly suspected that it was an ectopic pregnancy. (C) Because the hCG concentration did not reach the rising rate, and the ultrasound did not show the embryo in the uterus, it was highly suspected that it had been aborted. (D) Because the hCG concentration did not reach the rising rate, and the ultrasound did not show the embryo in the uterus, it was highly suspected that it was an ectopic pregnancy. (E) Because the hCG concentration did not reach the rising rate, and although the ultrasound did not show the embryo in the uterus, it was still highly suspected that it was a normal intrauterine pregnancy.

Output: D


Instruction: A 30-year-old male came to the emergency room because he was surfing near Longdong yesterday and his right ankle was cut by a reef with a laceration of about 6 cm. Which of the following treatments is more appropriate?

Input: (A) Careful debridement, removal of possible foreign body, suture treatment, outpatient follow-up. (B) Careful debridement, removal of possible foreign body, no sutures, outpatient follow-up. (C) Careful debridement, removal of possible foreign body, no sutures, give Augmentin prophylactic antibiotics, outpatient follow-up. (D) Careful debridement, removal of possible foreign body, no sutures, suspected possible Vibrio species infection, give ciprofloxacin prophylactic antibiotics, outpatient follow-up. (E) Careful debridement, removal of possible foreign body, no sutures, suspected possible Aeromonas species infection, give trimethoprim-sulfamethoxazole prophylactic antibiotics, outpatient follow-up.

Output: D


Instruction: A 32-year-old woman gave birth to a full-term newborn in the emergency department. The newborn was found to be cyanotic and in respiratory distress. Physical examination revealed no heart sounds in the right chest, significantly quieter breath sounds on the left chest, and a scaphoid abdomen. What is the most appropriate next step?

Input: (A) Initiate bag-vacuum mask ventilation. (B) Intubate the trachea. (C) Initiate intravenous injection and give naloxone. (D) Start chest compression. (E) Initiate intraosseous injection and give epinephrine.

Output: B


Instruction: A 32-year-old female mental patient took an overdose of psychiatric drugs. Her family found her unconscious and sweating. She was sent to the emergency room. Her injury classification was level 1, blood pressure: 170/100 mmHg, heart rate: 142 beats/min, body temperature 41.2℃, pulse oximetry SpO₂ 95%, coma index E1M2V2, facial flushing, pupil dilation, eye spasms, myoclonus and increased reflexes (lower limbs>upper limbs), EKG showed QRS and QTc prolongation. What syndrome does this patient have?

Input: (A) Neuroleptic malignant syndrome. (B) Malignant hyperthermia. (C) Serotonin syndrome. (D) Anticholinergic syndrome. (E) Sympathomimetic syndrome.

Output: C


Instruction: A 48-year-old male patient presents to the emergency department with the following test results: Na⁺ 147 mEq/L, K⁺ 4.7 mEq/L, Cl- 101 mEq/L, pH 7.126, HCO₃- 15.5 mEq/L, BUN 42 mg/dL, Cr 1.7 mg/dL, Glucose 207 mg/dL, and Ethanol 6.9 mg/dL. Given the above values, what are the anion gap and calculated osmolarity?

Input: (A)27.5 and 320.0 mOsm/L. (B)30.5 and 321.5 mOsm/L. (C)33.5 and 323.0 mOsm/L. (D)36.5 and 324.5 mOsm/L. (E)24.5 and 318.5 mOsm/L.

Output: B


Instruction: A 6-year-old boy with no vital signs is brought to the emergency department. Because he is unresponsive and has no vital signs, you begin intubation and your colleague also starts chest compressions. When you have completed the intubation and confirmed that it is in the correct position, the nurse assisting with the emergency treatment finds that the EKG monitor shows ventricular fibrillation. What is the most appropriate course of action for you at this time?

Input: (A) Establish intravenous access and give amiodarone 5 mg/kg. (B) Establish intravenous access and give epinephrine 0.1 mg/kg. (C) Establish intravenous access and give epinephrine 0.01 mg/kg. (D) Give defibrillation, starting with 4 J/kg. (E) Give defibrillation, starting with 2 J/kg.

Output: E


Instruction: A 62-year-old female was bitten by an animal on the back of her left foot at home. Two bite marks were clearly visible, and the wound was bleeding. Then redness, swelling and pain appeared around the wound, and there was hematuria, abdominal pain and back pain. She was sent to the emergency room 3 hours and 15 minutes later. The patient had a history of hypertension. Physical examination: blood pressure: 212/113 mm/Hg, heart rate 60 beats/minute, respiration 16 beats/minute and body temperature 35.8℃. In addition to slight redness and swelling around the wound on the left foot, there was tenderness in the abdomen and waist, but no rebound pain. Laboratory examination PT p: >100", PT c: 11.7", aPTT p: >150", aPTT c: 32.3", which of the following treatments is correct?

Input: (A) Anti-snake serum for the turtle shell flower and the red-tailed bamboo snake. (B) Anti-snake serum for the chain snake. (C) Anti-snake serum for the umbrella festival and the spectacled snake. (D) Rabies vaccine. (E) No vaccine or serum is needed, just continue to observe.

Output: B


Instruction: According to the provisions of Article 25 of the Emergency Medical Rescue Act, which was amended on July 11, 2007, the duties of the medical supervisor physician do not include the following?

Input: (A) Educating and training rescue technicians at all levels in the implementation of emergency rescue. (B) Supervising and evaluating rescue technicians at all levels in the implementation of emergency rescue. (C) Establishing quality indicators for rescue technicians at all levels and implementing quality monitoring. (D) Approving the rescue record form of senior rescue technicians performing emergency rescue in accordance with the pre-established medical process. (E) Providing online medical guidance to senior rescue technicians in the implementation of invasive rescue treatments on site.

Output: E


Instruction: Doctors should be as cautious as possible when issuing various diagnosis reports, especially those related to the cause of death. Regarding the issuance of medical certificates, which of the following statements is incorrect?

Input: (A) It is not appropriate to issue a death certificate for patients who did not die of illness. (B) For patients who died during referral, since they had no signs of life when they arrived at the receiving hospital, the receiving hospital may not issue a death certificate according to the Detailed Rules for the Implementation of the Medical Act. (C) According to the Physician Act, a doctor may not issue a medical certificate unless he or she has personally examined the patient. (D) For victims of sexual assault or domestic violence, doctors must issue an autopsy report and may not refuse without reason. (E) A doctor may not issue a death certificate unless he or she has personally examined the body.

Output: B


Instruction: Which of the following indicators is most suitable for evaluating the effectiveness of a pre-hospital emergency care system for patients with no heartbeat (OHCA) before arrival?

Input: (A) The average response time of OHCA cases. (B) The rate of OHCA cases attended by senior emergency technicians. (C) The rate of OHCA cases that survive to hospitalization. (D) The rate of OHCA cases that survive to hospital discharge. (E) The rate of OHCA cases that are witnessed by bystanders and whose initial monitored rhythm is ventricular fibrillation, and whose survival to hospital discharge.

Output: E


Instruction: Which of the following should be immediately addressed during the primary survey of adult trauma?

Input: (A) A 4 cm open fracture of the right palm. (B) Rapid breathing, 38 beats per minute. (C) Rapid heart rate, 108 beats per minute. (D) Fever, 39.5oC. (E) Glasgow Coma Score E2V3M5.

Output: B


Instruction: There are 15 patients who vomited, had diarrhea, drooled and sweated 20 minutes after lunch. Two of them lost consciousness. Most of the patients had pinpoint pupils on both sides, gurgling sounds in both lungs, and cold skin. Which of the following substances is the least likely to be poisoned?

Input: (A) Organophosphate poisoning. (B) Carbamate poisoning. (C) Amanita muscaria poisoning. (D) Mackerel poisoning. (E) Bethanechol poisoning.

Output: D


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

Input: (A) The antidote for Acetaminophen poisoning is N-acetylcysteine. (B) Acute liver failure is the most common cause of death from Acetaminophen poisoning. (C) Generally, about 5% of Acetaminophen is metabolized by Cytochrome P450. (D) Asparate aminotransferase begins to rise in 24-72 hours and reaches its peak in 72-96 hours. (E) The patient's blood concentration is 200 µg/ml 6 hours after ingesting Acetaminophen. You can observe first and do not need to give antidote.

Output: E


Instruction: Which of the following statements about extrapulmonary tuberculosis is correct?

Input: (A) About 10% of children under 4 years old present with this extrapulmonary tuberculosis. (B) The incidence rate is more in the genitourinary system than in the skeletal system. (C) Pleural extrapulmonary tuberculosis is usually asymptomatic, and the recurrence rate of patients who do not receive treatment is about 65%. (D) Flat X-rays are quite sensitive in diagnosing spinal extrapulmonary tuberculosis and cold abscesses. (E) Extrapulmonary tuberculosis of the central nervous system may be complicated by vasculitis, with the middle cerebral artery being the most commonly affected.

Output: C


Instruction: Which of the following statements about radiation injury descriptions and patient management is incorrect?

Input: (A)α Radiation cannot pass through the skin, so it is only when it enters the human body that it can cause harm. (B) If an accident occurs at a nuclear power plant in Taiwan, the hospitals responsible for nuclear disaster emergency treatment are divided into three levels. The first level is the employee clinic or medical room attached to the nuclear power plant. (C) For patients with acute radiation syndrome, the greater the exposure dose, the shorter the incubation period, and the more severe the symptoms. (D) For seriously ill patients who are contaminated, decontamination must be prioritized before emergency measures are taken. (E) Radiation contamination can be divided into exposure and internal and external contamination. Clinically, if there is only exposure, human body decontamination is not required.

Output: D


Instruction: About Ruptured abdominal aorta aneurysm), which of the following statements is incorrect?

Input: (A) It may be accompanied by nausea and vomiting. (B) Syncope may occur, and blood pressure is normal. (C) Typical symptoms are pain, low blood pressure and pulsating abdominal mass. (D) The pain may be in the abdomen, waist or back. (E) Abdominal pain for more than one month can rule out the possibility of rupture of the abdominal aorta.

Output: E


Instruction: Which of the following statements about the characteristics of Complex Emergencies (CE) is incorrect?

Input: (A) It is the most common man-made disaster in the past 20 years. (B) Political instability in the region leads to violence and conflict, which is the main cause of CE. (C) It refers to the occurrence of two or more natural disasters at the same time. (D) Conflicts over religious, ethnic and social issues make disaster management more difficult and dangerous. (E) Civilians, women, children and the elderly are the most vulnerable groups.

Output: C


Instruction: Which of the following statements about the concept of Mass Gathering is incorrect?

Input: (A) Generally speaking, a mass event is one where more than 500 people gather. (B) In 1999, the British Medical Journal recommended that there should be one paramedic for every 1,000 people, one ambulance with a high-level paramedic technician for every 2,000 people, and one emergency physician for every 5,000 people. (C) If advanced cardiac life-saving medical care cannot be provided on site within 5 minutes, an automatic external defibrillator must be available on site. (D) For every medical care, whether it is a minor or serious case, it is best to fill out a medical record form. (E) According to evidence-based medicine, the survival rate of cardiac arrest at large mass gatherings is about 20-80%.

Output: A


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

Input: (A) In a hypothermic electrocardiogram, an Osborn (J) wave may appear, which is a negative deflection at the end of the QRS complex. (B) Hypothermia may cause shivering, which can increase the basal metabolic rate by 2 to 5 times and is regulated in the spinal cord and anterior hypothalamus. (C) In temperature regulation, the posterior hypothalamus is responsible for non-shivering temperature retention and dissipation. (D) VF may occur when the body temperature drops below 25 degrees Celsius. The main reason is that the transmembrane resting potential increases, resulting in a lower threshold for VF. (E) When the body temperature drops below 33.5 degrees Celsius, the brain waves will be significantly reduced. When the body temperature reaches 19 to 20 degrees Celsius, the brain waves will stop.

Output: E


Instruction: Which of the following descriptions of poisonous snake and insect bites is correct?

Input: (A) In Taiwan, if you are bitten by a poisonous snake but do not know what kind of snake it is, according to literature statistics, it is recommended to inject multiple serums to achieve therapeutic effects. (B) For acute allergic reactions caused by wasp stings, adults can use 1:10000 epinephrine 0.3 to 0.5 mL intramuscular injection. (C) If you are bitten by a poisonous snake and have no symptoms when you go to the emergency room, you can be recommended to leave the hospital and follow up at the outpatient clinic without injecting serum. (D) According to literature statistics, the highest proportion of venomous snake bites causing acute renal damage in Taiwan are chain snake bites. (E) According to literature statistics, the highest proportion of venomous snake bites in Taiwan are turtle shell flower bites near homes.

Output: D


Instruction: Which of the following descriptions of diabetic ketoacidosis is incorrect?

Input: (A) Its clinical symptoms are mainly caused by high blood sugar, lack of body fluid and acidemia. (B) The primary treatment is to replenish water. (C) Fatal hypokalemia may occur during treatment. (D) Changes in consciousness are mainly caused by metabolic acidemia. (E) Differential diagnosis includes alcoholic ketoacidosis, lactic acidosis, renal failure and salicylic acidosis.

Output: D


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

Input: (A) Non-ruptured appendicitis is more common in boys, with the peak period being between 9 and 12 years old, and is less common in children under 2 years old. (B) Fecalith appears on abdominal X-rays in about 30% of cases. (C) Acute appendicitis may present with signs of local peritonitis, but this sign will not appear if the appendix is located in the pelvic cavity. (D) The patient will experience anorexia, vomiting, and right lower abdominal pain. Children with non-ruptured appendicitis may have a fever, but the temperature is lower than that of children with ruptured appendicitis. (E) Non-ruptured appendicitis can progress to ruptured appendicitis within 8 to 24 hours of the onset of symptoms, so it is necessary to consult a surgeon as soon as possible for treatment.

Output: B


Instruction: Which of the following statements in evidence-based medicine about the treatment of high-altitude pulmonary edema is wrong?

Input: (A)Labetalol 25 mg orally twice a day. (B)Sildenafil 50 mg orally three times a day. (C)Tadalafil 10 mg orally twice a day. (D)Give 4L/min oxygen. (E) Descend immediately.

Output: A


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

Input: (A) Causes of rhabdomyolysis in adults include drug abuse, trauma, excessive exercise, and infection. (B) In addition to active infusion therapy, loop diuretic diuretics (such as furosemide) are also standard treatment. (C) Influenza virus and Legionella are the most common sources of infection that cause rhabdomyolysis. (D) Possible complications of rhabdomyolysis include acute renal failure, metabolic disorders, compartment syndrome, and neuropathy. (E) Patients with severe rhabdomyolysis may experience nausea, vomiting, abdominal pain, and arrhythmia.

Output: B


Instruction: Which of the following statements about the emergency treatment of acute pulmonary edema is incorrect?

Input: (A) Efforts should be made to have the patient lie flat and elevate his legs. (B) First-line drug treatment includes furosemide diuretics. (C) If blood pressure permits, intravenous infusion of nitroglycerine can reduce venous blood return and lower pulmonary artery pressure, which is of great help in relieving pulmonary edema. (D) If it is caused by acute mitral or aortic regurgitation, in addition to drug treatment, surgical correction is often required to completely resolve it. (E) If drug treatment is ineffective, interventional therapy should be considered.

Output: A


Instruction: Which of the following statements is correct about the treatment of acute pulmonary embolism?

Input: (A)Warfarin can be used to treat acute pulmonary embolism of any cause. (B)The patient's risk level can be assessed based on changes in left ventricular function and hemodynamics. (C)For antithrombotic therapy, heparin or Low Molecular Weight Heparin can be considered. (D)Fibrinolysis therapy should be given to all patients. (E)Surgical embolectomy is not recommended for young patients with massive pulmonary embolism and hypotension.

Output: C


Instruction: In the description of acute myocarditis, which of the following statements is wrong?

Input: (A) Except for cases with severe symptoms of heart failure, clinical manifestations often include fever, muscle aches, headaches and other non-specific symptoms. (B) The most common abnormality in the electrocardiogram is sinus tachycardia out of proportion to the extent of fever. (C) Symptoms of chest pain are more likely to occur when combined with pericardial inflammation, and the electrocardiogram may also show localized symptoms. Or widespread ST band elevation. (D) Pathology shows local lymphocyte, plasma cell and histiocyte infiltration, combined with varying degrees of myocardial destruction or dissolution, and cardiac enzymes are almost always abnormally elevated. (E) Treatment is mainly supportive therapy, and immuno-suppressive therapy may be considered for severe cases.

Output: D


Instruction: Regarding hypothermia after cardiac resuscitation, according to the research results of evidence-based medicine, which of the following statements is wrong?

Input: (A) Cooling should not be performed before sending for cardiac catheterization to avoid the risk of arrhythmia. (B) 4℃ saline can be given through the femoral central venous catheter to quickly cool the patient. (C) 4℃ saline alone cannot maintain mild hypothermia after cardiac resuscitation. (D) Hypothermia has a diuretic effect, so central venous pressure must be monitored and fluids must be supplemented appropriately. (E) The most common arrhythmia when performing mild hypothermia is bradycardia.

Output: A


Instruction: Which of the following statements is correct regarding the differential diagnosis of vertigo?

Input: (A) Labyrinthitis is often associated with unilateral facial nerve palsy. (B) The symptoms of benign paroxysmal positional vertigo do not subside with repeated inductions. (C) If gait disorder, hearing loss and unilateral poor vision are present, a cerebellopontine angle tumor should be considered. (D) Vestibular neuritis usually lasts for several days. (E) The first onset of Ménière's disease is usually under 60 years old.

Output: D


Instruction: Which of the following statements about the evidence-based medical research results on central venous catheters is incorrect?

Input: (A) Although medicated central venous catheters are more expensive, they can prevent bloodstream infections. (B) Femoral central venous catheters are most susceptible to bloodstream infection, while subclavian veins are least susceptible. (C) Performing aseptic measures with the Central Line Bundle can prevent bloodstream infection. (D) Using betadine to disinfect central venous catheters reduces infection rates compared to using chlorhexidine. (E) Bloodstream infections caused by central venous catheters are mostly caused by Gram-positive G(+) bacteria.

Output: D


Instruction: Which of the following statements about febrile seizures is wrong?

Input: (A)Febrile seizures are the most common convulsive disease in young children, accounting for about 2~5% of children. (B)Not limited to any form of seizure. (C)Family history of disease: About 10~15% of family members have febrile seizures. (D)Mostly related to viral infection, especially human herpesvirus is often considered to be related. (E) Central nervous system infections, such as bacterial meningitis or acute viral encephalitis, must be excluded.

Output: B


Instruction: Regarding hospital disaster emergency response, according to the principles of emergency response management and the regulations of the Department of Health, which of the following statements is correct?

Input: (A) When a hospital responds to an emergency, six groups must be set up to carry out disaster relief, including the command group, warning group, evacuation group, rescue group, notification group and fire extinguishing group. This is called the Hospital Incident Command System (HICS). (B) In addition to caring for the injured patients caused by the disaster, the hospital should continue to provide necessary medical care and appropriate transfer and evacuation during an emergency disaster, which is called continuity of operation. (C) Tabletop simulation exercises cannot be regarded as formal exercises, but can only be regarded as rehearsals before exercises. (D) According to the principles of emergency response management, the hospital's emergency disaster response plan should include the response system, response organization and work responsibilities for each stage of disaster prevention, mitigation, response and recovery. (E) Hospital emergencies, other than fire, are generally referred to as mass casualties.

Output: B


Instruction: A 25-year-old female, 28 weeks pregnant, sprained her right ankle after falling down the stairs. The patient's vital signs are stable (mild abdominal pain and right lumbar contusion), and there is no rupture of membranes or vaginal bleeding. What is the most appropriate next step?

Input: (A) Discharge her home for observation, provide health education, and arrange for outpatient follow-up. (B) Arrange an ultrasound examination. If the ultrasound examination is normal, discharge her home for observation. (C) Arrange an abdominal MRI scan. (D) Inform the obstetrician and gynecologist and arrange fetal monitoring for at least 4 hours. (E) Arrange an abdominal CT scan.

Output: D


Instruction: A 25-year-old male took a bus from Taipei to the Yushan Tatajia trailhead, then walked to Paiyun Mountain Village (3,402 meters above sea level). That night, he had headaches, dizziness, nausea, vomiting, difficulty breathing, inability to lie flat, and coughing up bloody sputum. According to current recommendations, which of the following treatments is less appropriate?

Input: (A) Give oxygen therapy. (B) Allow the patient to lie in a hyperbaric bag for treatment. (C) Give nifedipine treatment. (D) Consider taking the patient down the mountain as quickly as possible overnight. (E) It is recommended to use furosemide for treatment.

Output: E


Instruction: 25 A 26-year-old male has a knife wound on the left third intercostal space, on the midline of the clavicle. The knife is still inserted into his body. His vital signs are blood pressure 120/70 mmHg, heart rate 120 beats/min, and blood oxygen saturation 99%. A left thoracic tube (tube thoracostomy) has been placed, and 2,000 ml of blood has been lost. Which of the following treatments is most appropriate?

Input: (A) Remove the knife as evidence and suture the wound. (B) Place a second chest tube in the same location. (C) Perform an emergency thoracotomy (ED thoracotomy) in the emergency department. (D) Perform an emergency thoracotomy in the operating room. (E) Perform a chest CT scan.

Output: D


Instruction: 26 A 26-year-old female patient went to the emergency room because of dyspnea. She felt more labored breathing 3 days ago and the condition has worsened. She feels weaker recently, cannot comb her hair with both hands, and sees double vision. Neurological examination showed proximal limb weakness more than distal weakness, abnormal eye movement, and normal sensation and reflexes in the limbs. What is the most likely diagnosis?

Input: (A)Amyotrophic lateral sclerosis. (B)Myasthenia gravis. (C)Acute intermittent porphoria. (D)Duchenne muscular dystrophy. (E)Guillain-Barre syndrome.

Output: B


Instruction: 26 A 24-year-old laborer was sent to the emergency room because of confusion and shortness of breath. Which of the following statements about heat injury is incorrect?

Input: (A) The skin of patients with heat stroke is usually dry and sweatless, but some patients with exercise-related heat injury may still have wet and hot skin. (B) Urgently lowering the body temperature is an important factor in determining the patient's prognosis. (C) Generally, cooling to 37 ℃ is in line with the normal body temperature standard. (D) The clinical symptoms of heat stroke usually exceed 40 ℃. (E) The body fluids of patients with heat stroke should be replenished by central venous catheter pressure and urine volume.

Output: C


Instruction: A 27-year-old foreign worker was sent to the emergency room complaining of agitation, restlessness, muscle twitching, combined with low-grade fever and confusion. The patient was bitten on the right hand and right thigh by a wild dog abroad one month ago. A medical staff member with a skin injury on his hand came into contact with the patient's saliva without wearing gloves. Which of the following statements is incorrect?

Input: (A) The wound should be immediately cleaned thoroughly with soap and water, and iodine solution (povidone-iodine) can also be used to irrigate the wound. (B) The medical staff should immediately receive 20 IU/kg of specific immunoglobulin, including injection around the wound. (C) The healthcare worker also needs to receive a full course of vaccines, which are given by intramuscular injection in the buttocks. (D) Even if the healthcare worker is pregnant, she still needs to be injected with specific immunoglobulin and vaccines. (E) Because the vaccine is prepared using detoxified viruses, it can be used in people with weakened immune systems.

Output: C