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-{"instruction": "A 10-month-old boy was brought to the emergency room by his parents because he was agitated and had altered consciousness. The mother said that the boy had been vomiting and having diarrhea since the previous night. He vomited every time he ate, so he had not taken anything for nearly half a day. Physical examination revealed that the boy was very lethargic and had dry mucous membranes. A bedside rapid blood glucose test revealed that his blood glucose level was 35 mg/dL. Which of the following is the most appropriate treatment for this child?", "input": "(A) Intravenous injection of 1 ml of 50% glucose solution per kg of body weight. (B) Intravenous injection of 10 ml of 5% glucose solution per kg of body weight. (C) Intravenous injection of 5 ml of 10% glucose solution per kg of body weight. (D) Intravenous injection of 2 ml of 25% glucose solution per kg of body weight. (E)Observe vital signs, wait until the blood sugar report from the formal laboratory comes out, and then deal with it according to the blood sugar level. ", "output": "C"} 
-{"instruction": "A 16-year-old male patient was sent to the emergency room. He was confused, sweating all over and his clothes were wet. The electrocardiogram monitor showed a heart rate of 180 beats/minute, blood pressure of 220/110 mmHg, pupil size of both sides was 8 mm, and light reflex was not obvious. Which of the following drugs could be poisoning? ", "input": "(A)Lithium. (B)Meperidine. (C)Organophosphates. (D)Amphetamine. (E)Antihistamine. ", "output": "D"} 
-{"instruction": "20 A 6-year-old female was brought to the hospital by her mother. She complained of shortness of breath and abdominal pain. She was thirsty and urinated a lot recently. Her blood pressure was 92/60 mmHg, heart rate was 120 beats/min, respiration was 32 breaths/min, body temperature was 35.2℃, white blood cell count was 6800/mm³, hemoglobin was 13.2 g/dL, platelets were 182000/mm³, glucose was 520 mg/dL, and blood ketone was (+). Which of the following statements about the possible symptoms and signs of this patient is incorrect? ", "input": "(A) The patient may have Kussmaul breathing. (B) The patient may have fruity breath. (C) The patient is very likely to have Chvostek or Trousseau sign. (D) If the patient is found to have symptoms of headache, nausea and drowsiness during treatment, the possibility of cerebral edema should be considered. (E) Low body temperature is mainly caused by peripheral vascular dilation. ", "output": "C"} 
-{"instruction": "A healthy male weighing 70 kg loses about 1800 ml of blood due to trauma. Which of the following statements about his physiological manifestations is correct? ", "input": "(A) The patient's pulse pressure will increase, blood pressure is normal, and heart rate is normal. (B) The patient's pulse pressure will be normal or slightly decreased, blood pressure is normal, and heart rate is accelerated (> 100 beats/minute). (C) The patient's pulse pressure will decrease, blood pressure is decreased, and heart rate is accelerated (> 120 beats/minute). (D) The patient's pulse pressure will increase, blood pressure will decrease, and heart rate will increase (> 120 beats/minute). (E) The patient's pulse pressure will increase, blood pressure will be normal, and heart rate will increase (> 100 beats/minute). ", "output": "C"} 
-{"instruction": "A 25-year-old female, currently 28 weeks pregnant, fell down the stairs and injured her right waist and went to the emergency department. The patient's vital signs are normal and stable, with no abdominal pain, uterine contractions, ruptured membranes, or vaginal bleeding. What is the most appropriate next step? ", "input": "(A) Arrange an ultrasound examination. If no abnormality is found, discharge the patient to his home for observation. (B) Arrange an abdominal CT scan. (C) Discharge the patient to his home for observation, provide health education, and arrange outpatient follow-up. (D) Hospitalization for observation for at least 48 hours. (E) Extracorporeal tocodynamometric monitoring for at least 4 hours. ", "output": "E"} 
-{"instruction": "A 25-year-old woman goes to the emergency department with right lower abdominal pain. Which of the following statements is incorrect? ", "input": "(A) Women of childbearing age who are suspected of acute appendicitis should undergo a pregnancy test. (B) It is challenging to diagnose acute appendicitis in women of childbearing age because other gynecological and obstetric diseases can easily be misdiagnosed as acute appendicitis. (C) If the pregnancy test is positive, then ectopic pregnancy can be diagnosed, and the diagnosis of acute appendicitis can be ruled out. (D) If there is vaginal discharge and tenderness of the cervix, it is more likely to be pelvic inflammation rather than acute appendicitis. (E) If there is migration of pain and the tenderness is concentrated in the right lower abdomen, it is more likely to be acute appendicitis rather than pelvic inflammation. ", "output": "C"} 
-{"instruction": "A 26-year-old female patient went to the emergency room because of difficulty breathing. She felt more labored breathing 3 days ago, and the situation became more serious day by day. She also found that she had become weak recently, her hands were too weak to comb her hair, and she had double vision when she looked at things. The above symptoms are milder when getting up in the morning and become more severe in the evening. What is the most likely diagnosis? ", "input": "(A)Guillain-Barre syndrome。 (B)Cervical cord myelopathy。 (C)Myasthenia gravis。 (D)Duchenne muscular dystrophy。 (E)Amyotrophic lateral sclerosis。 ", "output": "C"} 
-{"instruction": "The 3-year-old girl was rescued by rescue technicians at the fire scene and sent to the emergency room for treatment. The girl's GCS: E3M5V4, shortness of breath, extensive burns on the face, chest and abdomen, hoarse voice, blood pressure 110/45 mmHg, heart rate 120 beats/minute, temperature 36.5 °C, respiration 32 times/minute, SpO₂ 87%, emergency intubation and ventilator required, regarding respiratory measures, which of the following statements is wrong?", "input":"(A) It is best to choose an endotracheal tube without a cuff. (B) Measure the carboxyhemoglobin concentration in the blood and consider hyperbaric oxygen therapy. (C) For auxiliary drugs used for intubation, succinylcholine is the first choice for muscle relaxants. (D) Sedatives for intubation should be used, such as midazolam. (E) If intubation is not smooth, tracheostomy should be avoided as much as possible.", "output": "C"} 
-{"instruction": "A 30-year-old male patient was sent to the emergency department by ambulance. He complained that he had just been in a car accident and had been hit in the chest. He now felt chest tightness and difficulty breathing. His blood pressure was 98/62 mmHg, heart rate was 120 beats/min, and respiratory rate was 26 beats/minute, body temperature 37.2℃. Which of the following statements about possible symptoms and signs of this patient is incorrect? ", "input": "(A) Beck triad manifestations of pericardial tamponade include distended cervical veins, hypotension, and muffled heart sounds. (B) Pericardial tamponade may present with Kussmaul signs, where the cervical vein will dilate further when the patient exhales deeply. (C) If the patient has a Hamman sign, the possibility of pneumomediastinum should be considered. (D) If physical examination reveals a puncture wound in the midline of the right clavicle, heart injury should be included in the differential diagnosis. (E) Traumatic aortic rupture may show esophageal deviation from the fourth thoracic vertebra on chest X-ray. The right side of the spinous process is larger than 1-2 cm. ", "output": "B"}
-{"instruction": "A 30-year-old female patient presented to the emergency department with fever, sore throat, and body aches for 1 day. She had headache and vomiting that worsened with activity the previous night, and had intermittent confusion. She had petechiae all over her body before presentation. She had no travel history. On presentation, her temperature was 38.3 °C, her heart rate was 120 beats/min, her respiratory rate was 18 breaths/min, and her blood pressure was 80/60 mmHg. Her white blood cell count was 17600/mm³, her hemoglobin was 13.6 g/dL, her platelets were 54000/mm³, her blood urea nitrogen was 57 mg/dL, her creatinine was 3.3 mg/dL, her activated partial thromboplastin time was > 120 seconds, her international normalized ratio (INR) was 2.14, and her 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": "A 
-32-year-old male complains of weakness in his limbs, clear consciousness, more weakness in his proximal limbs than in his distal limbs, abnormal eye movement, poor pupillary light reflex, and normal sensation and reflexes in his limbs. Which of the following is the most likely diagnosis?", "input": "(A)Botulism. (B) Myasthenia gravis. (C) Acute intermittent porphyria. (D) Lead poisoning. (E) Guillain-Barre syndrome. ", "output": "A"} 
-{"instruction": "A 34-year-old female was brought to the emergency room by ambulance due to shortness of breath. The patient was 8 weeks pregnant, with a blood pressure of 70/40 mmHg, respiratory rate of 32 breaths/minute, and heart rate of 130 beats/minute. According to her family, the patient recently came to the clinic to get medicine for a cold. After taking the first dose, she began to complain of dizziness, shortness of breath, and obvious facial swelling 20 minutes later. Breath sounds were bilateral wheezing. Which of the following treatments is more correct?", "input": "(A) Give oxygen, epinephrine 0.3 mg IM, diphenhydramine 20 mg IV, methylprednisolone 125 mg IV, 1000 ml of saline solution, rapid infusion. (B) Give oxygen, diphenhydramine 20 mg IV, methylprednisolone 125 mg IV, 1000 ml of saline solution, rapid infusion. (C) Give oxygen, methylprednisolone 125 mg IV, 1000 ml of saline solution, rapid infusion. (D) Give oxygen, diphenhydramine 20 mg IV, 1000 ml of saline solution, rapid infusion. (E) Give oxygen, 1000 ml of saline solution, rapid infusion. ", "output": "A"} 
-{"instruction": "A 34-year-old male came to the emergency room with confusion and shortness of breath. His temperature was 36.4 ℃, blood pressure was 86/50 mmHg, heart rate was 110 beats/min, and respiration was 30 breaths/min. Arterial blood gas analysis showed pH: 7.10, PCO₂: 20 mmHg, PO₂: 96 mmHg, HCO₃⁻: 8 mEq/L, blood Na⁺: 145 mEq/L, K⁺: 2.7 mEq/L, Cl⁻: 105 mEq/L. Which of the following statements is incorrect? ", "input": "(A) The patient may have cyanide poisoning. (B) The patient may have iron poisoning. (C) The patient may have been poisoned by metformin. (D) The patient may have been poisoned by methanol. (E) The patient may have been poisoned by isopropyl alcohol. ", "output": "E"} 
-{"instruction": "A 35-year-old woman who was 24 weeks pregnant and weighed 65 kg was hit in the abdomen by a bicycle on the sidewalk. When she was taken to the emergency room by ambulance, her temperature was 36.7℃, her respiratory rate was 23 times/minute, her heart rate was 110 times/minute, and her blood pressure was 120/80 mmHg. The patient complained of severe lower abdominal pain and felt contractions. Physical examination revealed lower abdominal tenderness but no rebound tenderness combined with a small amount of vaginal bleeding. Which of the following statements about this pregnant woman is incorrect? ", "input": "(A) The pregnant woman does not know her own blood type, but it is known that the blood type of her husband is type O Rh(-). Therefore, no matter what the mother's blood type is, she does not need to be given Rh⁰D immune globulin. (B) The most common cause of fetal death caused by trauma is maternal death, and the second most common is placenta previa. (C) Tocolytic drugs may affect the initial trauma assessment. (D) Although the pregnant woman's blood pressure is still within the normal range, her bleeding volume may still exceed 1500 ml. (E) If the mother's heart stops beating after emergency treatment, emergency cesarean section can be considered. ", "output": "B"} 
-{"instruction": "A 36-year-old male has his right hand exposed to hydrofluoric acid. Which of the following statements is correct? ", "input": "(A) In case of severe burns, calcium gluconate can be infused through the upstream artery. (B) Calcium chloride solution can be injected for infiltration therapy. (C) Pain and redness of the skin will not occur after 6 hours. (D) If blisters appear on the affected area, it is not recommended to break the blisters to avoid infection. (E) Attention should be paid to hypocalcemia and hypokalemia, which may cause arrhythmia. ", "output": "A"} 
-{"instruction": "A 4-day-old female baby was sent to the emergency room because of bloody stools and persistent abdominal distension. CT scan revealed pneumatosis intestinalis, suspected to be necrotizing enterocolitis. Regarding necrotizing enterocolitis, which of the following statements is incorrect? ", "input":"(A) Premature and low-weight newborns are more susceptible. (B) Maternal cocaine use is a risk factor for necrotizing enteritis in full-term infants. (C) If diagnosed too late, it may lead to intestinal perforation and septic shock. (D) Laboratory diagnosis is not specific for necrotizing enteritis. (E) Regardless of whether there is intestinal perforation, patients with necrotizing enteritis require surgical treatment.", "output": "E"} 
-{"instruction": "45 A 6-year-old female with a history of rheumatoid arthritis came to the emergency room because she suddenly felt an electric shock on her back when she bent her neck during morning exercises. Physical examination showed no abnormalities, and the muscle strength on both sides was equal. Which step is the most appropriate next?", "input": "(A) Immediately inject methylprednisolone 30 mg/kg intravenously. (B) Urgently perform a cervical spine CT scan. (C) Tell the patient that more activity can reduce this abnormal sensation. (D) Immediately inject a large amount of physiological saline intravenously. (E) Draw blood to check the inflammation status. ", "output": "B"}
-{"instruction": "A 45-year-old male fell from a height of 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 body temperature was 36.7℃, his breathing was 16 times/minute, his heart rate was 102 times/minute, and his blood pressure was 120/67 mmHg. The patient complained of weakness in his limbs and abnormal sensation. Which of the following statements about the patient's possible spinal cord injury is incorrect?", "input": "(A) Anterior cord syndrome is usually caused by neck flexion, and only proprioception and vibration are retained below the injured area. (B) Central cord syndrome is more likely to occur in young people, and the weakness in the lower limbs is greater than that in the upper limbs. (C) Brown-Sequard syndrome is characterized by weakness on the same side, loss of proprioception on the same side, and loss of pain and temperature sensation on the opposite side. (D) The prognosis of Cauda equina syndrome is better, mainly because the injured nerves are peripheral nerves and have a chance of regeneration. (E) If the nerve damage is confirmed to be at the C5 position, it is necessary to consider intubation in advance to prevent respiratory failure. ", "output": "B"} 
-{"instruction": "A 45-year-old patient with cirrhosis was hospitalized due to fever and abdominal distension. Physical examination revealed ascites, and there was tenderness and rebound pain in the abdomen. Ascites examination showed that the white blood cell count in it was 1000/mm³, Among them, multinucleated spheres account for 90%. Which of the following statements about spontaneous bacterial peritonitis is incorrect? ", "input": "(A) The third-generation antibiotic of choice is cephalosporin. (B) If the protein concentration in the ascitic fluid is greater than 1 g/dL, the chance of spontaneous peritonitis increases. (C) The most common bacteria are Gram-negative bacteria, such as Escherichia coli. (D) If the multinucleated spheres in the ascitic fluid are greater than 250/mm³, the diagnosis can be confirmed and antibiotic treatment can be started. (E) The use of prophylactic antibiotics for high-risk patients with ascites can reduce the incidence of spontaneous bacterial peritonitis. ", "output": "B"} 
-{"instruction": "5 A 6-year-old girl has many papules the size of half a grain of rice all over her body (especially her trunk). Some of these papules are blister-like and have obvious erythema, while others are small scabs. She also had a fever two or three days ago. Which of the following diagnoses is most likely? ", "input": "(A) Measles. (B) Chickenpox. (C) Pityriasis rosea. (D) Eczema. (E) Staphylococcal scalded skin syndrome. ", "output": "B"} 
-{"instruction": "A 5-year-old girl, weighing 20 kg, suffered from diabetic ketoacidosis, presented with lethargy and rapid breathing. She was brought to the emergency room by her family. Her blood pressure was 70/40 mmHg, heart rate was 120 beats/min, and blood glucose was 420 mg/dL. The emergency physician assessed that she was 10% dehydrated. Which of the following statements about her treatment and prognosis is incorrect? ", "input": "(A) Prioritize instillation of 200-400 ml of 0.9% saline solution to restore the capillary refilling time to normal. (B) If the child's consciousness improves and the perfusion is adequate after a single infusion of 400 ml of 0.9% saline, the infusion should not exceed 1.5 times the maintenance infusion volume within 48 hours. (C) Before giving 0.9% saline infusion, give an immediate regular insulin 2 units IV bolus and a continuous hourly regular insulin 2 units intravenous infusion. (D) If hyponatremia cannot be stabilized after blood sugar is corrected, it is one of the risk factors for cerebral edema. (E) Bicarbonate supplementation is usually not necessary. ", "output": "C"} 
-{"instruction": "A 56-year-old man is brought to the emergency room with a fever of 39.2°C for 1 day. The patient also has headache, general fatigue, nausea and vomiting. The doctor performs a lumbar puncture. Which of the following results of cerebrospinal fluid analysis does not match the manifestation of bacterial meningitis? ", "input": "(A) Sugar 80 mg/dL. (B) White blood cell count 1500/mm³. (C) White blood cell classification 85% neutrophils. (D) Open pressure 350 mmH2O. (E) Protein (total protein) 250 mg/dL. ", "output": "A"} 
-{"instruction": "A 56-year-old male construction worker from the flooded area in southern Taiwan went to the emergency room for about 3 days because of fever, headache, vomiting, loss of appetite, fatigue, and body aches. He had a history of diabetes and kidney disease. When he arrived at the hospital, his temperature was 39.2 °C, his heart rate was 120 beats/min, his respiratory rate was 22 breaths/min, and his blood pressure was 105/60 mmHg. Physical examination showed no conjunctival congestion, no jaundice, and no rash. Which of the following is a possible diagnosis? ", "input": "(A) Q fever. (B) dengue fever. (C) leptospirosis. (D) melioidosis. (E) All of the above. ", "output": "E"} 
-{"instruction": "A 57-year-old male committed suicide by taking a rodenticide containing an anticoagulant. Which of the following statements is incorrect? ", "input": "(A) Most rodenticides currently in use are superwarfarin. (B) The mechanism of action of superwarfarin is the same as that of warfarin, which is to inhibit the synthesis of coagulation factors II, VII, IX, and X. (C) The effect of superwarfarin starts slowly, and abnormal coagulation function may not appear until 1-2 days later. (D) For patients who take superwarfarin orally, it is better to use vitamin K1 as soon as possible before abnormal coagulation function appears. (E) If the patient 
-has severe bleeding, it is easier to restore coagulation function by using prothrombin complex concentrates than by using fresh frozen plasma."A 6-year-old boy was on his way to school in his father's car. The car was hit from the left by a taxi at a speed of 40 kilometers per hour. The child was sitting in the passenger seat without a safety seat. When the ambulance arrived at the scene, the paramedics initially assessed that which of the following conditions was the least likely to require transfer to a pediatric trauma center?", "input": "(A) The father died on the spot. (B) The right thigh was deformed. (C) Glass fragments were found in the right lower abdomen. (D) The pediatric trauma score was 7. (E) The boy was found about 1 meter away from the car.", "output": "B"}
-{"instruction": "A 60-year-old male patient was sent to the emergency room because of fever, chills, and altered consciousness for one day. The patient had a history of hypertension, diabetes, and bedridden due to stroke. On arrival, his temperature was 39.3 °C, heart rate was 116 beats/min, respiratory rate was 24 breaths/min, and blood pressure was 75/40 mmHg. Physical examination revealed a stiff neck, no jaundice, a soft abdomen, and no bedsores. White blood cell count was 16800/mm³, Segment 78%, Band 10%, Lactate 5.2 mmol/L. Which of the following treatments is wrong?", "input": "(A) First, assess whether the airway is open, whether the breathing and ventilation are appropriate, and whether intubation should be performed. (B) Central venous lines must be established quickly to monitor central venous pressure and central venous oxygen saturation. (C) Dopamine or norepinephrine should be administered intravenously immediately. (D) Broad-acting antibiotics should be administered within 1 hour. (E) Possible sites of infection should be identified within 6 hours and source control should be performed. ", "output": "C"} 
-{"instruction": "A 70-year-old male patient who had just undergone coronary artery bypass surgery was discharged from the hospital 3 days ago. The patient was sent back to the emergency room because he could not sleep at night, talked a lot, and had confused behavior. His laboratory test results were normal, his wounds were not infected, and his neurological examination did not show any focal neurological symptoms, but his mental status examination revealed severe intellectual disability. His family members said that the patient had shown signs of intellectual degeneration several years ago, did not remember his family, and had gone out on his own before, but he would not have confused behavior. Which of the following actions is the least appropriate? ", "input": "(A) Consider a head CT scan. (B) Ask the patient to avoid sleeping during the day as much as possible. (C) Further follow-up examinations should be performed. (D) Consider giving him antipsychotic drugs. (E) He should be transferred to a psychiatric ward for inpatient treatment immediately. ", "output": "E"} 
-{"instruction": "72 A 6-year-old male patient came to the emergency room with abdominal distension and shortness of breath. Physical examination showed distended cervical veins and shifting dullness in the abdomen. The results of ascites examination showed a white blood cell count of 280/mm³, 40% of which were polynuclear cells. The albumin in the ascites was 1.3 g/dL and the triglyceride was 300 mg/dL; the albumin in the blood was 2.6 g/dL. What is the most likely cause of his ascites? ", "input": "(A) Peritoneal tuberculosis. (B) Bacterial peritonitis. (C) Disseminated intraabdominal cancer. (D) Congestive heart failure. (E) Chylous ascites. ", "output": "D"} 
-{"instruction": "A vehicle carrying isotopes accidentally overturned. When the ambulance arrived, it was found that the radioactive isotope material had leaked. There was 1 A patient suspected of being contaminated by isotopes was sent to the emergency department of a hospital. Which of the following statements about emergency response is incorrect? ", "input": "(A) A decontamination area should be set up in the emergency room, and traffic control should be implemented to guide the patient to the decontamination area for treatment. (B) Workers in the decontamination area should wear waterproof full-body protective clothing, double-layer surgical latex gloves, and surgical masks for the mouth and nose. (C) Necessary emergency medical treatment (such as pressure to stop bleeding) should be performed before decontamination. (D) After the patient arrives at the decontamination area, he or she should take off his or her clothes and rinse the whole body vigorously with plenty of clean water. (E) Contaminated skin without wounds should not be scrubbed vigorously. ", "output": "D"} 
-{"instruction": "Which of the following is incorrect about the treatment of deep vein thrombosis (DVT)? ", "input": "(A) If there is no obvious contraindication to the medication, low molecular weight heparin can be used for initial treatment. (B) For patients with renal dysfunction (creatinine > 2 mg/dL), low molecular weight heparin can still be used, but the dose needs to be adjusted. (C) While using heparin, oral anticoagulant warfarin can be started. (D) For pregnant women, due to the obvious teratogenicity of low molecular weight heparin, only oral warfarin can be used. (E) If DVT is induced by tumor, lifelong use of anticoagulants is recommended. ", "output": "D"} 
-{"instruction": "Which of the following symptoms is most helpful in distinguishing anticholinergic toxicity from sympathomimetic toxicity? ", "input": "(A) Rapid heart rate. (B) Dry skin. (C) Confusion. (D) Dilated pupils. (E) Increased temperature. ", "output": "B"} 
-{"instruction": "Which of the following statements about hyperpotassium is incorrect? ", "input": "(A) Leukocytosis may lead to pseudohyperkalemia. (B) Calcium chloride should be given to severe cases of hyperpotassium. (C) Hyperkalemia may occur when insulin is used to treat hyperglycemia. (D) Kayexalate may not be effective for patients who have undergone colon resection. (E) Inhaled albuterol can treat hyperkalemia. ", "output": "C"} 
-{"instruction": "Which of the following statements about right ventricular myocardial infarction is incorrect? ", "input": "(A) Most of them are caused by lesions in the right coronary artery, so they are often combined with left ventricular inferior wall myocardial infarction in clinical practice. (B) The ST wave rise of V4R on the right electrocardiogram is its special change, but it may not always appear. (C) The clinical manifestations are often combined with low blood pressure and severe pulmonary edema. (D) Treatment can be achieved by infusion to increase left ventricular preload, and appropriate cardiotonic drugs can be considered. (E) If symptoms occur within 12 hours, primary percutaneous coronary intervention should be considered. ", "output": "C"} 
-{"instruction": "Which of the following statements about acute pulmonary embolism is incorrect? ", "input":"(A) Chest x-ray may show areas of oligoemia (Westermark's sign). (B) EKG may show sinus tachycardia, right bundle branch block, or an S1Q3T3 pattern. (C) Echocardiography may show right atrial, right ventricular, or main pulmonary artery enlargement with tricuspid regurgitation. (D) D-dimer is highly specific and, if elevated, almost always confirms the diagnosis. (E) If severe hypoxia or shock occurs, thrombolytic therapy should be considered and surgical referral should be sought.", "output": "D"}
-{"instruction": "Mr. Chen developed high fever, cough and shortness of breath on the third day of bed rest after a stroke. A chest X-ray confirmed pneumonia. Which of the following statements about aspiration pneumonia is incorrect?", "input": "(A) Recent studies have found that the main pathogens of aspiration pneumonia are anaerobic bacteria. (B) Rapid sequence intubation is one of the risk factors for aspiration pneumonia. (C) The typical X-ray distribution of aspiration pneumonia in bedridden patients is the posterior segments of the upper lobe and the superior segments of the lower lobe. (D) The peak of the inflammatory response caused by pulmonary aspiration occurs between 4 and 6 hours. (E) In healthy young people with pulmonary aspiration, if the amount of aspiration is small and there are no obvious symptoms, antibiotics do not necessarily need to be used.", "output": "A"} 
-{"instruction": "Which of the following statements about ventricular tachycardia (VT) and supraventricular tachycardia (SVT) is incorrect?", "input": "(A) If VT or SVT with aberrancy cannot be distinguished clinically, both should be treated as VT. (B) If atrioventricular dissociation is found on the electrocardiogram, it should be treated as VT. (C) If the patient's condition is stable, adenosine can be considered to distinguish the two. (D) When Wolff-Parkinson-White (WPW) syndrome is accompanied by atrial fibrillation, β-blockers and calcium channel blockers should not be given. Digoxin can be used for treatment. (E) WPW syndrome is accompanied by narrow QRS tachycardia adenosine is not an absolute contraindication for use in patients with traumatic intubation.", "output": "D"} 
-{"instruction": "Which of the following statements is incorrect about the choice of drugs to be used for rapid sequence intubation in trauma patients? ", "input": "(A) Fentanyl is used for patients with hypotension. (B) Ketamine is used for patients with brain trauma. (C) Lidocaine is used for patients with head trauma before intubation. (D) Rocuronium is used for patients with crush injuries. (E) Succinylcholine is used for patients with suspected brain trauma. ", "output": "B"} 
-{"instruction": "In a regional hospital near a disaster site, when the number of patients exceeds the hospital's capacity, a second triage is required. Which of the following methods is more appropriate? ", "input": "(A) No need for second triage. (B) JumpSTART (simple triage and rapid treatment). (C) PTT (pediatric triage tape). (D) SAVE (secondary assessment of victim endpoint). (E) START (simple triage and rapid treatment). ", "output": "D"} 
-{"instruction": "In the emergency room, when a perforated peptic ulcer is suspected, which of the following actions is least appropriate? ", "input": "(A) Urgently notify the surgeon. (B) If no extra-intestinal air is visible on the X-ray, air should be instilled into the stomach through a nasogastric tube to detect perforation. (C) Place a nasogastric tube for drainage. (D) Insert two large-bore tubes for intravenous infusion. (E) Administer broad-acting antibiotics. ", "output": "B"} { 
-"instruction": "While waiting for a flight at the airport, a middle-aged man suddenly falls to the ground and loses consciousness. You ask the terminal staff to notify the medical department and immediately perform cardiopulmonary resuscitation. A few minutes later, the airport medical staff arrives at the scene with a first aid kit and an automatic external defibrillator (AED). After examination, they find that the patient still has no pulse. What is the most appropriate next step? Which is correct? ", "input": "(A) Stop cardiac massage first, give the patient a chest shock, activate the AED power and apply the shock pad, and analyze the heart rhythm. (B) Resume cardiac massage first, activate the AED power and apply the shock pad without hindering cardiac massage, then stop cardiac massage and analyze the heart rhythm. (C) Stop cardiac massage first, immediately send the patient to the airport clinic, immediately activate the AED power and apply the shock pad while on the move, and analyze the heart rhythm. (D) First use a bag-valve-mask to assist in oxygen delivery for 2 minutes, then activate the AED power and apply the shock pad, and analyze the heart rhythm. (E) First establish a respiratory tract with a laryngeal mask airway and give oxygen for 2 minutes, then send the patient to the airport infirmary. Immediately activate the AED power supply and apply the defibrillator while on the move, and analyze the heart rhythm. ", "output": "B"} 
-{"instruction": "Which of the following descriptions of carbon monoxide (CO) poisoning is incorrect? ", "input": "(A) Hemoglobin's ability to bind carbon monoxide is 230-270 times that of oxygen, while myosin's ability to bind carbon monoxide is 20-25 times that of oxygen. (B) If the patient is exposed to moderate or severe carbon monoxide, pulse oximetry, carboxyhemoglobin (COHb), CK-MB and troponin-I, electrolytes, lactate and chest X-ray should be performed. (C) Pulse oximetry can be used to assess whether the blood oxygen concentration of patients with carbon monoxide poisoning is adequate. (D) If the patient has only mild symptoms, no unconsciousness, no cardiopulmonary symptoms, is conscious and cooperative, routine COHb testing and electrocardiogram examinations should still be performed to identify hidden cardiac hypoxia. (E) Carbon monoxide poisoning may cause lesions in the basal ganglia or hypothalamus, resulting in interval CO syndrome. ", "output": "C"}  
-{"instruction":"Which of the following is incorrect about the clinical features and related treatments of bradycardia?", "input": "(A) In patients with TypeⅡ second-degree atrioventricular (AV) block myocardial infarction, anterior wall myocardial infarction is common and can easily progress to complete AV block. (B) For severe poor blood perfusion, transcutaneous pacing (TCP) and atropine should be used first. Dopamine and epinephrine should not be used at the same time. (C) TCP should be used for unstable patients who have failed to respond to atropine or whose intravenous infusion has not been given. (D) For patients with third-degree AV block with poor blood perfusion, TCP is more effective than atropine. (E) Isoproterenol is not the first choice for the treatment of symptomatic bradycardia.", "output": "B"}
-{"instruction":"Which of the following statements about intussusception in children is incorrect?", "input": "(A) It can be caused by Meckel diverticulum, intestinal polyps, lymphoma, or foreign bodies. (B) It can be treated with barium enema, and after successful reduction, the child can be discharged home immediately. (C) The most common age is about three months to six years old, and the male to female ratio is about 4:1. (D) The common symptom is intermittent abdominal pain, and the appearance of currant jelly stool is a late manifestation. (E) The most common type is ileocolic intussusception.", "output": "B"} 
-{"instruction": "Which of the following statements about the straight leg raising test is not included?", "input": "(A) A positive straight leg raise test indicates that the nerve root is compressed. (B) The straight leg raise test only reproduces low back pain and posterior thigh pain, which is not enough to constitute a positive result of the test. (C) The patient lies on his back, extends his knee, and passively raises the affected lower limb. Sciatica radiates to below the knee joint within 70°, which is called a positive straight leg raise test on the same side. (D) The contralateral straight leg raise test has a higher specificity for diagnosing nerve root compression caused by intervertebral disc herniation. (E) The contralateral straight leg raise test has a higher sensitivity for diagnosing nerve root compression caused by intervertebral disc herniation.", "output": "E"} 
-{"instruction": "Which of the following statements about protective gear for toxic and chemical disasters is correct?", "input": "(A) Class A protective gear includes a self-contained air cylinder plus a full-body splashproof chemical protective suit. (B) Class B protective gear can protect personnel working in an oxygen-deficient environment. (C) Class C protective gear includes an N95 mask plus a full-body splashproof chemical protective suit. (D) Class B protective gear is what general medical personnel should wear when providing medical treatment to chemical disaster patients. (E) A fire suit plus a self-contained air cylinder is equivalent to Class B protective gear.", "output": "B"} 
-{"instruction": "Which of the following statements about the concept of using a nasogastric tube to treat gastrointestinal bleeding is correct?", "input": "(A) Patients suspected of lower gastrointestinal bleeding do not need a nasogastric tube. (B) Nasogastric tube placement is likely to cause varicose vein bleeding in patients and should be avoided if possible. (C) Bright red blood in the stool from the anus must be from the lower gastrointestinal tract. (D) Upper gastrointestinal bleeding cannot be ruled out even if the drainage from the nasogastric tube is normal. (E) In the case of upper gastrointestinal bleeding, the nasogastric tube should be flushed with ice water because evidence-based medicine shows that hypothermia can help stop bleeding.", "output": "D"} 
-{"instruction": "Which of the following statements about high-altitude syndromes is incorrect?", "input": "(A) Ginkgo biloba may be used to prevent acute mountain sickness. (B) The main treatment for acute mountain sickness is immediate descent and oxygen administration, along with oral acetazolamide 125 mg twice a day. (C) High-altitude pulmonary edema is a very serious complication and should be treated with oxygen and oral nifedipine. (D) If headache and vomiting occur when climbing a mountain quickly, acute mountain sickness should be highly suspected. (E) The pathogenesis of high-altitude syndrome may be low pressure and low blood oxygen in the mountains, which cause cerebral vasoconstriction, thereby reducing cerebral blood flow and finally causing high-altitude cerebral edema. ", "output": "E"} 
-{"instruction": "Which of the following descriptions of electric injury is incorrect? ", "input": "(A) When injured by AC electric shock, if the current reaches 18-30 milliamperes (mA), respiratory depression may occur. (B) When injured by AC current, if the current reaches 70 mA or more, it may cause ventricular fibrillation. (C) When injured by high-voltage AC current (600-70,000 volts), the first rhythm of cardiac arrest is more likely to be ventricular fibrillation. (D) When injured by lightning, the first rhythm of cardiac arrest is more likely to be asystole. (E) High-voltage electric shock is more likely to cause myosinuria and renal failure than lightning shock. ", "output": "C"} 
-{"instruction": "Which of the following statements about the indications for head computed tomography in mild traumatic brain injury (TBI) is incorrect? ", "input": "(A) Symptoms of amnesia. (B) Local neurological abnormalities. (C) Confusion or seizure. (D) Dizziness and nausea. (E) History of abnormal coagulation function. ", "output": "D"} 
-{"instruction": "Which of the following descriptions of diving emergencies is correct? ", "input": "(A) Generally speaking, recreational divers who carry a tank of pure oxygen on their backs when diving are statistically more likely to develop diving emergencies, such as decompression sickness, when diving multiple times a day than when diving once a day. (B) If you feel joint pain after diving and go to the hospital emergency room, and the X-ray examination shows no joint fractures or lesions, you may have type II decompression sickness. The most important treatment at this time is hyperbaric oxygen therapy. (C) If you conduct a single recreational dive per day, you should wait at least 12 hours after the last dive before flying. If you conduct multiple dives per day with unlimited depth, it is best to wait 24 hours after the last dive before flying. (D) Type I decompression sickness is more serious than type II and can easily cause damage to the spinal cord and brain. (E) The pathogenesis of decompression sickness is mainly due to the accumulation of oxygen in the tissues and vascular system, causing blockage and inflammatory reactions. ", "output": "C"} 
-{"instruction": "Which of the following statements about heatstroke is correct? ", "input":"(A) The typical definition of heat stroke is a core body temperature above 39°C, central nervous system dysfunction and no sweating (anhidrosis). (B) Heat stroke often causes liver damage, and liver enzymes may increase, which can help differentiate between heat stroke and heat exhaustion. (C) Heat stroke patients usually develop high blood potassium in the early stages and low blood potassium in the late stages. (D) Heat stroke can be treated by rapid cooling with ice water. (E) The clinical symptoms, signs and treatments of exercise and non-exertional heat stroke are different. The higher the body temperature, the higher the mortality rate caused by heat stroke.", "output": "B、D"} 
-{"instruction": "Which of the examination data for pleural effusion best supports empyema diagnosis?", "input": "(A) The ratio of total protein concentration between pleural effusion and serum is 0.6. (B) The ratio of lactate dehydrogenase concentration between pleural effusion and serum is 0.4. (C) The pH of pleural effusion is 6.5. (D) The white blood cell count of pleural effusion is 10000/mm³. (E) The red blood cell count of pleural effusion is 100000/mm³. ", "output": "C"}
-{"instruction": "A 65-year-old male with cirrhosis of the liver came to the emergency room because of limb redness, swelling and pain for one day. The patient had eaten raw fish two days ago. One day later, he developed diarrhea and general fatigue. Later, the skin of his right ankle became red and swollen, which quickly spread to his calf, accompanied by blisters and tissue necrosis. What is the most likely pathogen at this time?", "input": "(A) Non-typhoid salmonella. (B) Pseudomonas aeruginosa. (C) Staphylococcus aureus. (D) Streptococcus pyogenes. (E) Vibrio vulnificus.", "output": "E"} "(A)Non-typhoid salmonella。 (B)Pseudomonas aeruginosa。 (C)Staphylococcus aureus。 (D)Streptococcus pyogenes。 (E)Vibrio vulnificus。", "output": "E"} 
-{"instruction": "According to the "Emergency Medical Rescue Act", which of the following statements about the work of medical instructors is incorrect? ", "input": "(A)Education, training, supervision and assessment of junior rescue technicians in performing emergency rescue. (B)Setting quality indicators for rescue technicians at all levels and implementing quality monitoring. (C)Approving the record form of senior rescue technicians performing rescue in accordance with the established medical process. (D)Providing regular online guidance to rescue technicians in performing rescue work. (E) Education, training, supervision and assessment of senior rescue technicians in performing emergency rescue. ", "output": "D"}
-{"instruction": "The symptoms of child abuse are sometimes confused with other diseases. Regarding the situation of non-child abuse, which of the following statements is incorrect?", "input": "(A)Burns may be caused by accidents, most of which are caused by hot water splashing. They should not have strange shapes like cigarette burns. (B)Mongolian spots are purple spots similar to bruises. The difference from ordinary bruises is that Mongolian spots will change color (purple, green, blue, brown) over time. (C)Bruise of young children or school-age children that is not caused by child abuse usually appears on bone protrusions, such as the calves and forehead, and most of them are unilateral. (D)Neonatal fractures that are not caused by child abuse often occur in the clavicle and humerus. (E)Osteogenesis imperfecta is caused by a genetic defect and is often mistaken for child abuse.", "output": "B"} 
-{"instruction": "Which of the following is the least likely to occur in an acute myocardial infarction complicated by severe pulmonary edema?", "input": "(A) A large area of ​​ST-wave-band elevation myocardial infarction on the anterior wall of the left ventricle. (B) A large area of ​​non-ST-wave-band elevation myocardial infarction. (C) A myocardial infarction on the inferior wall of the left ventricle complicated by a right ventricular infarction. (D) A myocardial infarction on the anterior wall of the left ventricle complicated by rupture of the chordae tendineae or mastoid muscles of the mitral valve. (E) A rupture of the ventricular septum caused by an infarction of the anterior wall and septum of the left ventricle.", "output": "C"} 
-{"instruction": "For the following suspected victims of violence, in addition to medical care, treatment, and reporting, emergency physicians are also required to examine the injuries and issue various special diagnosis certificates. However, if you are only an emergency physician, which type of victims of violence can you not diagnose and issue special diagnosis certificates?", "input": "(A) Victims of domestic violence. (B) Abused children. (C) Elderly people who have been abused or subjected to domestic violence. (D) Victims of sexual violence. (E) None of the above.", "output": "D"} 
-{"instruction": "A fire broke out on campus and you are the first person to arrive at the scene. According to the START (simple triage and rapid treatment) process, which of the following injuries are classified as yellow? ", "input": "(A) 22-year-old female, rapid breathing, black carbon particles attached to mouth and nose, unconscious. (B) 21-year-old female, left thigh fracture, normal breathing and pulse, conscious. (C) 18-year-old female, panicked, running around, crying and shouting that classmates were 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": "According to the definition of mental illness as revised in July 2007, mental illness refers to abnormal mental states such as thinking, emotions, perception, cognition, and behavior, which cause impairment in the ability to adapt to life and require medical treatment and care. Which of the following is not included in its scope? ", "input": "(A) Mental illness. (B) Neurosis. (C) Alcohol addiction. (D) Drug addiction. (E) Antisocial personality disorder. ", "output": "E"} 
-{"instruction": "The patient is using oxygen at a concentration (FiO2) of 60%, and his PaO2 is 280 mmHg and PaCO2 is 40 mmHg. What is the estimated alveolar-arterial oxygen difference (Aa DO2) of the patient in mmHg? ", "input": "(A)50 (B)100 (C)150 (D)200 (E)250", "output": "B"} 
-{"instruction": "The patient has erythematous macules, papules, and vesicular rashes on the trunk and limbs. Many of the rashes are target-shaped. The patient also has oral ulcers and red and swollen conjunctivae. Which of the following diagnoses is most likely? ", "input": "(A)Stevens-Johnson syndrome. (B)bullous pemphigoid. (C)pustular psoriasis. (D)pemphigus vulgaris. (E)dermatitis herpertiformis. ", "output": "A"} 
-{"instruction": "Patients with ischemic stroke have different clinical symptoms depending on the area of ​​the brain affected. Which of the following statements is incorrect? ", "input": "(A) Cerebellar infarction often causes sudden inability to stand or walk, but no abnormalities in the brain nerves occur. (B) Middle cerebral artery infarction causes weakness in the contralateral limbs (the upper limbs are more serious than the lower limbs) and numbness. (C) Anterior cerebral artery infarction causes weakness in the contralateral limbs (the lower limbs are more serious than the upper limbs) and mild sensory loss. (D) Posterior cerebral artery infarction causes symptoms such as dizziness, vertigo, diplopia and movement disorders. (E) Basal artery infarction can cause severe limb paralysis, coma and locked-in syndrome. In patients with locked-in syndrome, all muscles in the body are paralyzed except for the eyes, which can move upward. ", "output": "A"} 
-{"instruction": "Which of the following is incorrect about the common location of avascular necrosis after fracture? ", "input":"(A) Scaphoid fracture. (B) Femoral head fracture. (C) Femoral neck fracture. (D) Patella fracture. (E) Talus neck fracture Hawkins classification type II and III.", "output": "D"} 
-{"instruction": "Which of the following is the most common cause of intestinal obstruction in pregnant women?", "input": "(A) Intussusception. (B) Cecal volvulus. (C) Sigmoid volvulus. (D) Sigmoid tumor. (E) Sigmoid bezoars.", "output": "B"}
-{"instruction": "Which of the following statements about first aid for a woman who is 26 weeks pregnant and has cardiac arrest is incorrect?", "input": "(A) Because her trachea is swollen and intubation is difficult, a half-size smaller endotracheal tube should be selected. (B) First aid should be performed in accordance with current advanced cardiac lifesaving guidelines. (C) To avoid affecting cardiac compression and airway establishment, a femoral venous catheter can be placed to provide intravenous infusion. (D) The patient's right hip and waist should be raised to avoid compression of the aorta and inferior vena cava. (E) The obstetrician, gynecologist and neonatologist should be notified urgently to perform an emergency cesarean section within 5 minutes of the mother's cardiac arrest.", "output": "C"} "(A) Because the trachea is swollen and intubation is difficult, a half-size smaller endotracheal tube should be selected. (B) Perform emergency treatment according to the current advanced cardiopulmonary resuscitation guidelines. (C) To avoid affecting cardiac compression and airway establishment, a femoral venous catheter can be placed to provide intravenous infusion. (D) Elevate the patient's right hip and waist to avoid compression of the aorta and inferior vena cava. (E) Urgently notify the obstetrician and neonatologist and perform an emergency cesarean section within 5 minutes of the mother's heart stopping.", "output": "C"} 
-{"instruction": "Which of the following statements about end-tidal CO2 is incorrect?", "input": "(A) In patients with COPD, this value is more different from PaCO2. (B) During CPR, this value will increase before the patient's pulse is restored. (C) After sodium bicarbonate is injected, this value will increase temporarily. (D) If the endotracheal tube is accidentally inserted into the esophagus during intubation, this value will be low. (E) In normal people, the value is approximately equal to PaCO2 but slightly higher.", "output": "E"}
-{"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 cerebral vascular 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 around 110/70 mmHg with drugs. (C) The choice of drug can achieve a faster blood pressure lowering effect by intravenous infusion of nitroprusside. (D) Angiotensin-converting enzyme inhibitor should be avoided in patients with poor renal function and pregnant women. (E) If the patient has aortic detachment, β-blocker should be used concurrently with intravenous infusion of nitroprusside to avoid reflex tachycardia. ", "output": "B"} 
-{"instruction": "Which of the following statements about the characteristics of neurogenic shock is incorrect? ", "input": "(A) Slow heartbeat. (B) Dry and warm skin. (C) Decreased blood pressure. (D) Warm limbs. (E) Narrowing of pulse pressure. ", "output": "E"} 
-{"instruction": "Which of the following statements about testicular torsion is incorrect? ", "input": "(A) Testicular torsion not only occurs after strenuous activities, but may also occur during sleep. (B) Testicular torsion occurs (C) Doppler ultrasound can be used to confirm the diagnosis, which can show decreased blood flow on the affected side. (D) In ​​the case of right-sided testicular torsion, manual repositioning of the affected testicle can be considered before surgery. The method is to stand in front of the patient's feet and twist the right testicle 540 degrees in a clockwise direction. (E) In the case of testicular torsion, the pain will not vary in degree with changes in the patient's posture. ", "output": "D"} 
-{"instruction": "Which of the following is incorrect about the diagnosis and treatment of sigmoid volvulus? ", "input": "(A) Colonoscopy can reveal a spiral sphincter-like twist in the colon mucosa. (B) A typical feature of a barium enema study is a bird's beak. (C) CT diagnosis is highly accurate and most diagnoses require CT. (D) If the intestine is healthy and not necrotic, endoscopic decompression can be used and the intestine can twist on its own (self-detorsion). (E) About 60% of cases will relapse. It is recommended to electively resection the excess sigmoid colon after the acute phase is relieved. ", "output": "C"} 
-{"instruction": "Which of the following statements about pneumonia caused by pathogens is incorrect? ", "input": "(A)Mycoplasma pneumoniae can cause gastrointestinal symptoms. (B)Pneumococcus is still the most common pathogen. (C)Staphylococcus aureus is more common in patients with chronic lung disease. (D)Streptococcus pneumoniae is more common in the elderly and children under 2 years old. (E)Klebsiella can form pulmonary cavitation and lobar infiltration. ", "output": "A"} 
-{"instruction": "Regarding the management of the oral anticoagulant warfarin, which of the following is more appropriate? ", "input": "(A)International normalized ratio(INR)2-3, continue to monitor activated partial thromboplastin time. (B)INR ＜5, no obvious bleeding, suspend the use of warfarin until the INR returns to the normal range. (C) INR 5-9, no obvious bleeding, transfuse fresh frozen plasma. (D) INR > 9, no obvious bleeding, repeated intravenous injection of vitamin K1. (E) INR > 20, no obvious bleeding, suspend the use of warfarin. ", "output": "B"} 
-{"instruction": "Which of the following statements about central and peripheral vertigo is incorrect? ", "input": "(A) Peripheral vertigo generally lasts for a shorter time, while central symptoms may last for weeks to months. (B) Generally speaking, the symptoms of peripheral vertigo are more affected by head posture, while those of central vertigo are less affected. (C) Symptoms of peripheral vertigo are usually milder, while those of central vertigo are more severe. (D) Nystagmus is usually unidirectional in peripheral vertigo, but may be horizontal, circular, or vertical in central vertigo. (E) Peripheral vertigo is not associated with other neurological symptoms, but central vertigo may be associated with other neurological symptoms. ", "output": "C"} 
-{"instruction": "Which of the following statements about pericardial effusion is incorrect? ","input": "(A)Possible causes include pericarditis, hypothyroidism, cancer, uremia, ventricular rupture, and trauma. (B)Typical clinical signs are low blood pressure, venous distension, and distant, muffled heart sounds. If these signs are absent, acute pericardial effusion can be ruled out. (C)If a patient with acute chest pain suddenly faints and his blood pressure suddenly becomes unmeasurable, and a moderate amount of pericardial effusion is found on bedside ultrasound, myocardial infarction with myocardial rupture or aortic detachment should be considered. (D)If the blood pressure is low, the first treatment should be intravenous infusion to increase the pressure of the right heart and overcome the pressure of the pericardial effusion. (E) If pericardial tamponade has occurred and needle aspiration fails to drain the effusion, surgical pericardiotomy should be considered. ", "output": "B"} 
-{"instruction": "Which of the following is incorrect about the diagnosis of aortic detachment? ", "input": "(A) Not all patients present with the classic symptom of chest pain that moves to the back. (B) Older patients with hypertension are often associated with atherosclerotic lesions in the aorta. If the patient is young, Marfan syndrome should be considered. (C) During physical examination, attention should be paid to whether the pulse strength of the four limbs is symmetrical. If it is not certain whether it is symmetrical, the blood pressure of the four limbs can be further measured to determine the difference between the left and right sides. (D) If a diastolic murmur is heard above the right side of the sternum during auscultation during physical examination, the aorta should be considered to be separated to the base of the aorta, resulting in aortic insufficiency. (E) Chest X-ray examination is the most important basis for judgment. If the thoracic longitudinal diaphragmatic cavity is not enlarged or widened, aortic separation can be ruled out. ", "output":"E"} 
-{"instruction": "Which of the following is not an indication for urgent thoracotomy for traumatic hemothorax?", "input": "(A) The chest tube drainage volume is greater than 1500 ml at a time. (B) The chest tube drainage volume is greater than 200 ml per hour and lasts for more than 3 hours. (C) The patient continues to have shock symptoms after intravenous transfusion therapy, and bleeding from other sites has been ruled out. (D) The patient's chest X-ray is combined with a large pneumothorax and tracheal deviation can be seen. (E) The patient's follow-up chest X-ray shows a significant increase in the amount of hemothorax, and the patient does not respond well to intravenous therapy.", "output": "D"} 
-{"instruction": "Which of the following statements is correct about the primary assessment of trauma patients and their corresponding treatment? ", "input": "(A) Protection of the airway includes opening the airway to make it unobstructed. If a foreign body is seen, it should be removed. There is no need to consider cervical spine fixation. (B) Patients who are conscious should be given an oropharyngeal airway to prevent tongue collapse. (C) If the patient has symptoms of tension pneumothorax, needle decompression should be performed immediately without waiting. (D) If the patient has symptoms of pericardial tamponade, treatment should be given during the secondary assessment after the primary assessment. (E) For patients with poor circulation, a central venous catheter should be established first to provide infusion. If infusion is not possible, two large-bore catheters should be used for intravenous infusion. ", "output": "C"} 
-{"instruction": "Which of the following statements is incorrect about the treatment of pregnant women with other diseases? ", "input": "(A) Pregnant women with hyperthyroidism are at risk of developing preeclampsia. (B) Pregnant women with thyroid storms should not be treated with radioactive iodine. (C) Pregnant women with hypertensive emergencies can use captopril (D) Pregnant women with paroxysmal supraventricular tachycardia can safely use verapamil for treatment. (E) Pregnant women with atrial fibrillation can be treated with low molecular weight heparin to prevent thrombosis. ", "output": "C"} { 
-"instruction": "Which of the following statements about the physiological changes in normal pregnancy is incorrect? ", "input": "(A) The number of white blood cells increases and the hemoglobin concentration decreases. (B) The total blood volume increases and the cardiac output increases. (C) Both systolic and diastolic pressures decrease, but the diastolic pressure decreases more. (D) The respiratory rate increases and the tidal volume increases. (E) Signs of peripheral insufficiency (shock) will appear only when the amount of blood lost is large. ", "output": "D"} 
-{"instruction": "Which of the following is not included in the timing of transarterial embolization treatment?", "input": "(A) Upper limb fracture combined with vascular injury. (B) Blunt abdominal contusion, unstable blood pressure, CT scan revealed extensive liver parenchymal damage, combined with contrast agent extravasation. (C) Blunt abdominal contusion, stable blood pressure, CT scan revealed contrast agent extravasation in the spleen. (D) Kidney injury with continuous bleeding and hematuria, the hematoma is limited to the perirenal space, and the collecting system is not damaged. (E) Patient with pelvic fracture, very unstable blood pressure, and local hematoma rapidly expanding. ", "output": "A"} 
-{"instruction": "Which of the following statements about the incident command system is correct? ", "input": "(A) The command structure can be divided into five major functions, including command, safety, execution, planning and logistics. (B) The recommended ratio of supervisors to subordinates is 1:8. (C) In addition to ensuring the safety of disaster rescuers and disaster victims, the safety officer must also release relevant information to the media on a regular basis. (D) It is not the task of the logistics department to make records of injuries or damage. (E) The commander must have a very professional understanding of all disasters, otherwise he cannot serve as a commander. ", "output": "D"} 
-{"instruction": "Which of the following statements about the management of viral croup in children is incorrect? ", "input": "(A) If the patient has idiopathic hypertrophic subaortic stenosis, monitor monitoring is required when the safety of L-epinephrine is of concern. (B) Patients receiving epinephrine nebulization should be observed in the emergency room for at least 3 hours after treatment. (C) Patients receiving epinephrine nebulization should also receive steroid treatment. (D) Oral dexamethasone is not recommended for the treatment of croup. (E) If the patient's overall appearance is relaxed and he or she only makes stridor sounds when he or she cries excitedly, epinephrine nebulization treatment is not necessary. ", "output": "D"} 
-{"instruction": "Which of the following statements about lung abscess is incorrect? ", "input": "(A) Pulmonary abscesses caused by anaerobic bacteria often contain more than one species of bacteria. (B) Pulmonary abscesses are mainly treated with surgery, and early resection can effectively shorten the course of antibiotics. (C) It is more likely to occur in the basal segments of the lower lung lobes. (D) Patients who are prone to pulmonary aspiration are also prone to pulmonary abscesses. (E) About 1/3 of patients with pulmonary ulcers will develop pleural effusion (empyema). ", "output": "B"} 
-{"instruction": "Which of the following statements about the diagnosis and treatment of acute pancreatitis is incorrect? ", "input":"(A)Amylase rises quickly and has a short half-life, so its sensitivity decreases after 36 hours. (B)Amylase and lipase levels have nothing to do with the severity of the disease. (C)After amylase returns to normal, elevated lipase levels can persist for several days. (D)If the Ranson score is ≥ 3 points, or APACHE II is ≥ 8 points, it indicates severe acute pancreatitis and a poor prognosis. (E)Abdominal CT can be used to assess severity. If the CT is normal, the diagnosis of acute pancreatitis can be ruled out.", "output": "E"} 
-{"instruction": "Which of the following statements about acute gout is incorrect?", "input": "(A)It is a crystal-induced synovitis. (B) Drugs that can induce gout include aspirin, diuretics, and cyclosporine. (C) High serum uric acid levels are a prerequisite for the diagnosis of gout. (D) Nonsteroidal anti-inflammatory drugs are the first choice for the treatment of acute gout. (E) Intravenous colchicine is not recommended for the treatment of gout, as its serious side effects include bone marrow suppression. ", "output": "C"}
-{"instruction": "Which of the following statements about acute epiglottis is incorrect?", "input": "(A) It may cause acute and unexpected airway obstruction. (B) If caused by bacteria, one of the most common bacteria is Haemophilus influenzae type A. (C) The patient often presents with a forward tilt, open mouth, and extended head posture. (D) A lateral neck X-ray may show an enlarged epiglottis in the shape of a thumbprint. (E) Steroids may be used to reduce airway inflammation and edema.", "output": "B"} "(A) It may cause acute and unexpected airway obstruction. (B) If it is caused by bacteria, one of the most common strains is Haemophilus influenzae type A. (C) The patient will often be tilted forward, with the mouth open and the head extended. (D) A lateral neck X-ray may reveal an enlarged, thumbprint-shaped neck. (E) Steroids may be used to reduce airway inflammation and edema.", "output": "B"} 
-{"instruction": "Which of the following is more appropriate in the management of an acute transfusion reaction?", "input": "(A) If urticaria occurs during a blood transfusion, no more transfusions should be given. (B) If a fever occurs during a blood transfusion, it must be a reaction to the transfusion and not caused by an infection. (C) In the event of acute intravascular hemolysis, blood transfusions must not be continued. (D) Because transfusion reactions are unpredictable, blood transfusions should be given as quickly as possible from the beginning. (E) If fever occurs during transfusion, it can be treated with diphenhydramine only. ", "output": "C"} 
-{"instruction": "Which of the following statements is correct about rapid visual deterioration? ", "input": "(A) Central retinal artery occlusion is usually accompanied by eye pain. (B) If optic neuritis is suspected, oral steroids should be given. (C) Acute angle-closure glaucoma often causes a constricted pupil that is unresponsive to light. (D) Fundus examination reveals cherry-red spots, which are characteristic of central retinal vein occlusion. (E) If the worsening vision is due to temporal artery inflammation, the vision in the other eye may also worsen over a few days to weeks. ", "output": "E"}
-{"instruction": "Which of the following statements about asthma in pregnant women is incorrect?", "input": "(A) About one-third of asthma patients will have worsening symptoms during pregnancy. (B) Peak expiratory flow values ​​do not change much during pregnancy and can be used to assess the severity of the disease and guide treatment. (C) In acute attacks, inhaled beta-adrenergic receptor agonists are the main treatment option. (D) The treatment prognosis of well-controlled asthma is the same as that of general patients and will not increase the risk to the fetus. (E) Pregnant women can use inhaled steroid preparations, but oral steroid drugs should not be used.", "output": "E"} 
-{"instruction": "Which of the following statements about the treatment of asthma is incorrect?", "input": "(A) Beta-adrenergic receptor agonists can cause bronchodilation. (B) Theophylline It is the first-line drug for the treatment of acute asthma. (C) Giving steroid treatment within 1 hour of hospitalization can reduce the rate of hospitalization. (D) Intravenous injection of magnesium sulfate can treat acute severe asthma. (E) The anti-inflammatory effect of steroids appears 4-8 hours after treatment. ", "output": "B"} 
-{"instruction": "Which of the following statements about alcohol withdrawal syndrome is incorrect? ", "input": "(A) Symptoms appear 6-24 hours after stopping drinking. (B) Symptoms may last about 2-7 days. (C) Visual and auditory hallucinations will occur. (D) Blood pressure rises and the heart rate becomes faster. (E) Changes in consciousness are mainly drowsiness. ", "output": "E"} 
-{"instruction": "Which of the following statements about common pesticide poisoning is incorrect?", "input": "(A) If a patient drinks an unknown pesticide and develops oral mucosal ulcers 1-2 days later, paraquat poisoning should be considered. (B) Carbamate poisoning rarely causes seizures because it cannot pass through the blood-brain barrier. (C) Pyrethrin acts on the sodium ion channels on the nerve cell membrane, repeatedly stimulating them and eventually causing conduction disorders. (D) The toxicity of glyphosate is mainly related to the surfactant it contains. (E) Paraquat poisoning can be removed by hemodialysis in the early stages. ", "output": "E"} 
-{"instruction": "Which of the following statements about eyeball rupture is incorrect? ", "input": "(A)BB bullets, firecracker debris, or small pieces of wood thrown by lawn mowers may penetrate the eyeball. (B)Common manifestations of eyeball rupture include shallow anterior chamber, blood accumulation, irregular pupil shape, and significant deterioration of vision. (C)When eyeball rupture is suspected, intraocular pressure should be measured. (D)When eyeball rupture is suspected, tetanus toxoid or immunoglobulin should be injected, and antibiotics should be injected intravenously. (E)When a foreign body is suspected to have penetrated the eyeball, Water's view or orbital CT should be performed. ", "output": "C"} 
-{"instruction": "For patients with minor head trauma, which of the following does not meet the Canadian CT head rule's recommendation for CT? ", "input": "(A) A 75-year-old man was riding a bicycle and tripped over a rock on the road and fell and hit his head. He had a 4-cm laceration on his scalp. He was conscious and his GCS was 15. (B) A 22-year-old college student was hit on the head while playing volleyball. There was no obvious hematoma on his scalp. He was conscious and his GCS was 15. He now feels dizzy but has not vomited. (C) A 2-year-old child rolled down the stairs (about 60 cm high). There was no obvious hematoma on his scalp. He vomited 5 times at home before coming to the emergency room and is now more sleepy. (D) A 45-year-old male drunkenly fell off his motorcycle. He was not wearing a helmet. He was conscious, GCS 15, and had a distinct raccoon eye in his right eye. (E) A 33-year-old female motorcycle passenger, wearing a helmet, was hit by a truck at 80 km/h and flew out. She had multiple abrasions all over her body. She was conscious, GCS 15. ", "output": "B"} 
-{"instruction": "Which of the following statements is correct about the treatment of lithium salt poisoning? ", "input": "(A) Forced diuresis can be used to increase the excretion of lithium salt. (B) If the patient has seizures, phenytoin can be used for treatment. (C) In case of acute poisoning, if hemodialysis is required, acetate dialysate is more effective. (D) The use of continuous dialysis is less likely to cause the problem of lithium salt concentration rebound. (E) Perform gastric lavage and use activated carbon to assist adsorption. ", "output": "D"} 
-{"instruction": "Which of the following statements about renal toxicity caused by intravenous injection of contrast agents is incorrect? ", "input": "(A) Diabetic patients, patients with well-controlled hypertension, and those aged 70 years and above are all high-risk groups. (B) Those with risk factors should use non-ionic contrast agents. (C) Asthmatic patients and patients with severe cardiopulmonary dysfunction should use non-ionic contrast agents. (D) Patients with blood creatinine > 3.0 mg/dL should not use ionic contrast agents. (E) Patients with blood urea nitrogen 60 mg/dL and blood creatinine 1.55 mg/dL should not use ionic contrast agents 
-."Wheezing sound is loud.", "output": "E"}
-{"instruction": "A 5-year-old boy complained of abdominal pain, fever, and diarrhea for two days. His family said that he had poor energy, a very poor appetite, and decreased urine output. Physical examination results showed no peritonitis symptoms or bloody stools, but mild dehydration. Emergency blood test results were as follows: Sugar 78 mg/dL, BUN 36 mg/dL, creatinine 3.0 mg/dL, Amylase 71 U/L, AST 51 U/L, CRP 18 mg/L, WBC 13100/mm³, Hb 9.6 g/dL, Platelet 89000/uL, HCO₃ 17 mmol/L. Which of the following diseases is this patient most likely to be diagnosed with?", "input": "(A) Ulcerative colitis. (B) Henoch-Schonlein purpura. (C)Hemolytic uremic syndrome. (D)Mesenteric lymphadenitis. (E)Salmonella enteritis. ", "output": "C"} "(A)Ulcerative colitis. (B)Henoch-Schonlein purpura. (C)Hemolytic uremic syndrome. (D)Mesenteric lymphadenitis. (E)Salmonella enteritis.", "output": "C"} 
-{"instruction": "Which of the following statements about alcohol withdrawal is incorrect?", "input": "(A)Patients with alcohol withdrawal often experience sweating, unsteady gait (ataxia) and hallucinations. (B)Symptoms of alcohol withdrawal are not related to the type of alcohol consumed. (C)Symptoms of alcohol withdrawal can be divided into four stages: autonomic hyperactivity, hallucination, dyskinesia and global confusion. (D)After stopping drinking, symptoms usually return within 24 hours. Symptoms of sweating, palpitations and hallucinations may occur within hours. (E) Treatment is mainly supportive therapy. ", "output": "C"}
-{"instruction": "Which of the following statements about antipsychotic drugs is incorrect? ", "input": "(A)The role of monoamine oxidase inhibitors (MAOIs) is to increase the concentration of norepinephrine and serotonin in the central nervous system. (B)When using monoamine oxidase inhibitors (MAOIs), be careful not to take them with foods containing tyramine, otherwise it will cause a drop in blood pressure. (C)The role of tricyclic antidepressant (TCA) drugs is to inhibit the presynaptic reaction to norepinephrine. (D) Side effects of tricyclic antidepressants (TCA) include anticholinergic effect and cardiotoxicity. (E) Combination of monoamine oxidase inhibitors (MAOI) and selective serotonin reuptake inhibitors (SRPI) can produce serotonin syndrome, which can cause central nervous system and gastrointestinal symptoms and may lead to death. ", "output": "B"} {" 
-instruction": "Which of the following statements about acute renal failure caused by radiocontrast agents is incorrect? ", "input": "(A) Radiocontrast agents can directly cause acute renal failure caused by direct tubular toxicity. (B) Contrast agents can reduce acute renal failure caused by reduction in renal perfusion. (C) Current studies have shown that acetylcysteine ​​has no effect on reducing the chance of acute renal failure in high-risk patients due to contrast agents. (D) Some studies have shown that fenoldopam (selective dopamine-1 receptor agonist) can reduce the chance of acute renal failure in patients with chronic renal insufficiency undergoing angiography. (E) Giving crystalloid infusion to patients using contrast agents can reduce the chance of acute renal failure. ", "output": "C"} 
-{"instruction": "A 25-year-old tall and thin male was admitted to the emergency room because of sudden chest pain while fighting monsters in an online game. The patient reported no external injuries and no history of other diseases. He occasionally smoked. Which of the following statements about this patient is incorrect? ", "input": "(A) Mitral valve prolapse may be accompanied by symptoms of dizziness, hyperventilation, anxiety, and palpitations. (B) Expiratory chest X-ray is much more sensitive than inspiratory chest X-ray in diagnosing pneumothorax and can provide a better assessment of lung parenchyma. (C) Based on clinical judgment, an electrocardiogram should still be performed if necessary to rule out acute coronary heart disease. (D) Pneumonia may also cause chest pain, usually accompanied by fever and cough. Rales may be heard during physical examination, and chest X-ray can help confirm the diagnosis. (E) Clinical symptoms and signs combined with chest X-ray cannot completely rule out aortic detachment. Further imaging examinations are required if necessary. ", "output": "B"} 
-{"instruction": "An 86-year-old man was sent to the emergency room by his family due to fever. According to the nurse, the patient often choked when eating recently. He has a history of Alzheimer's disease and hypertension. He usually lives at home and has not been to the hospital in the past two months. After examination, you found rales in the right lung and infiltration in the right lower lobe of the chest X-ray. Which of the following statements is incorrect when you want to treat a patient with a single antibiotic? ", "input": "(A)Clindamycin. (B)Ceftriaxone. (C)Ceftazidime. (D)Levofloxacin. (E)Piperacillin-tazobactam. ", "output": "A"} 
-{"instruction": "Which of the following statements about spontaneous pneumothorax is incorrect? ", "input": "(A)The most common cause in the neonatal age group is respiratory distress syndrome. (B)The most common cause in the 20 to 40 age group is rupture of subpleural bleb in the apex. (C) In patients over 40 years of age, the most common cause of secondary spontaneous pneumothorax is lung tumor. (D) Deep sulcus sign can sometimes be seen on chest X-ray. (E) Giving the patient 3-4 L/min of oxygen can increase pleural air absorption by 3 to 4 times. ", "output": "C"} 
-{"instruction":"One afternoon, a 50-year-old woman was sent to the emergency room. Her family said that the patient had a history of asthma. In the morning, she drank a soup made from asthma-curing herbs that she had picked in the mountains yesterday. In the afternoon, she began to talk nonsense and her whole body felt dry and hot. The patient's vital signs when she arrived at the emergency room were as follows: temperature 38.5℃, respiration 19 times/min, heart rate 120 beats/min, blood pressure 152/80 mmHg, confusion, restlessness, E2V2M5. Which treatment is the least appropriate for this patient?", "input": "(A) Give the patient adequate infusion and appropriate monitoring. (B) Give the patient physical restraints, but not for too long. (C) Give the patient a sedative, such as lorazepam or phenothiazines. (D) If the patient's electrocardiogram shows a widened QRS, consider using sodium bicarbonate. (E) Consider using physostigmine to treat the patient. ", "output": "C"} 
-{"instruction": "Which of the following statements about antidotes for poisoning treatment is incorrect? ", "input": "(A) Atropine is an antidote for organophosphate poisoning and should be used regardless of the presence of bradycardia, increased bronchial secretions, or spasms. (B) Dimercaprol (BAL) is an antidote for arsenic, mercury, or lead poisoning. Its side effects are nephrotoxic, causing nausea, vomiting, and urticaria. (C) Pralidoxime (PAM) is an antidote for organophosphate poisoning and is not used for carbamate poisoning. (D) Hypoglycemia caused by sulfonylurea poisoning can be treated with octreotide. (E) Calcium ions (CaCl2 or Ca gluconate) are used for poisoning by hydrofluoric acid, calcium ion blockers, oxalate, etc., but not for digitalis poisoning. ", "output": "A"} 
-{"instruction": "There is a 25-year-old male with a history of bipolar disorder. He has had diarrhea for 4 days due to gastroenteritis. He was taken to the emergency room by his family because of drowsiness and slurred speech. The medicine bag brought by the family contained lithium, valproate sodium and estazolam. Which of the following statements is incorrect? ", "input":"(A) If the patient's blood lithium concentration is 4 meq/L, hemodialysis should be used to remove the lithium, and repeated dialysis is often required. (B) If the patient has seizures, phenytoin should be used for treatment. (C) The blood concentrations of lithium, valproic acid, and benzodiazepine should be checked. (D) The patient should be asked about polyuria, which will help to diagnose lithium poisoning. (E) The patient should be given adequate fluid therapy, and normal saline is the preferred fluid.", "output": "B"}
-{"instruction": "A 21-year-old male presented to the emergency department with sudden onset of right-sided chest pain. A chest X-ray revealed a 10% pneumothorax on the right side. Which of the following statements is incorrect?", "input": "(A) The patient should be observed for at least 6 hours and then X-rayed. If there is no change in the X-ray, the patient can be discharged and scheduled for an outpatient appointment in 24 hours. (B) The air in the pleural cavity is absorbed at a rate of 1-2% per day. The use of oxygen 3-4 L/min can increase the absorption rate by about 4 times. (C) If this is the first attack, the possible subsequent recurrence rate is about 30%. (D) Both the use of a catheter for suction and the placement of a small-caliber chest tube are acceptable treatment strategies. (E) If catheter suction is used, the suction volume should be greater than 10 liters, there may be continuous air leakage. ", "output": "E"} 
-{"instruction": "A 3.5-year-old girl was brought to the emergency room by her family, complaining of fever and cold symptoms for five days. Physical examination revealed that the girl had stridor and stiff neck. The trauma station measured O2 saturation of 96%, and determined the trauma level to be level three. The girl seemed anxious and could still use sentences fluently, but was unwilling to lie down for examination. Which of the following treatments is more appropriate? ", "input": "(A) Immediately intramuscular injection of steroid dexamethasone 0.6mg/kg. (B) Intramuscular injection of epinephrine. (C) Lateral neck X-ray. (D) Immediately give her an IV drip and replenish the infusion. (E)Immediately place an endotracheal tube to maintain airway patency. ", "output": "C"} 
-{"instruction": "Which of the following statements about gastrointestinal bleeding is incorrect? ", "input": "(A)Proton-Pump inhibitor (PPI) can reduce the rebleeding rate of hemorrhagic gastric ulcers and reduce the need for blood transfusion and surgery. (B)Sengstaken-Blakemore tube (SB tube) is no longer recommended for the treatment of varicose vein bleeding due to too many complications. (C)Nasogastric tube placement can be considered for upper gastrointestinal bleeding, even for suspected esophageal varicose vein bleeding. (D)Angiography can be used as a diagnostic tool, but it can only be detected when the bleeding rate exceeds 0.5~2.0 ml/min. (E) The most common cause of lower gastrointestinal bleeding is hemorrhoidal bleeding, followed by angiodysplasia and diverticular disease. ", "output": "B"} 
-{"instruction": "Which of the following statements about emphysematous cholecystitis is incorrect? ", "input": "(A) Emphysematous cholecystitis occurs in about 1% of patients with acute cholecystitis. (B) 30% of patients with emphysematous cholecystitis do not have gallstones. (C) Abdominal tomographic scan is recommended to confirm emphysematous cholecystitis. (D) Emphysematous cholecystitis has a higher mortality rate than general acute cholecystitis. (E) Emphysematous cholecystitis is mostly caused by a single microbial infection. ", "output": "E"} 
-{"instruction": "Which of the following statements about complications of acute pancreatitis is incorrect? ", "input": "(A) Acute respiratory distress syndrome (ARDS). (B) Pericardiac effusion. (C) Portal vein thrombosis. (D) Sudden visual loss (Purtscher's retinopathy). (E) Hypercalcemia. ", "output": "E"} 
-{"instruction": "Common risk factors for acalculous cholecystitis do not include:", "input": "(A) Multiple trauma (B) Young obese women. (C) Bacterial infection of the gall bladder. (D) Gallbladder torsion. (E) A patient with severe burns and scalds.", "output": "B"} 
-{"instruction": "A 60-year-old male with a medical history of hypertension and diabetes was sent to the emergency room because of acute chest pain extending to the back. When he sought medical attention, his blood pressure was 220/110 mmHg, his heart rate was 98 beats/min, and his respiratory rate was 20 breaths/min. Chest X-ray showed mediastinum widening, and the electrocardiogram showed left ventricular hypertrophy. Regarding the diagnosis and clinical treatment of this patient, which of the following is incorrect? ", "input": "(A) Clinically, aortic dissection should be strongly suspected, and a CT examination should be arranged immediately. (B) Pulse deficit is helpful in diagnosis but has only 15-30% sensitivity. (C) Chest X-rays of patients with aortic detachment have 63-88% abnormal changes. (D) Aortic detachment sometimes involves the coronary arteries, most commonly the right coronary artery, which can cause inferior or posterior wall infarction. (E) Regarding blood pressure control in this patient, nitroprusside alone may be considered. ", "output": "E"}  
-{"instruction": "The patient has red maculopapular and vesicular rashes on the trunk and limbs, many of which are target-shaped rashes. He also has oral ulcers and conjunctival erythema. Which of the following diagnoses is most likely:", "input":"(A) Stevens-Johnson syndrome. (B) Bullous pemphigoid. (C) Pustular psoriasis. (D) Pemphigus vulgaris. (E) Dermatitis herpertiformis.", "output": "A"}
-{"instruction": "A 56-year-old female presents to the emergency department with unconsciousness. During screening, her temperature is 39.4℃, BP: 130/80 mmHg, heart rate 100 beats/min, respiration 16 breaths/min, and peripheral blood oxygen concentration (SpO2) is 98%. Many small hemorrhages (petechiae) are found on the skin. The white blood cells in the blood are: 10,000/mm³, hemoglobin: 8.5 g/dL, platelets 10,000/mm³, PT and PTT are normal, and schistocytes are found in the blood smear. Creatinine: 4.5 mg/dL. Which of the following statements is correct? ", "input": "(A) Platelets should be given immediately to avoid spontaneous bleeding. (B) Bone marrow aspiration and biopsy should be arranged. (C) The patient has disseminated intravascular coagulation. (D) Administration of fresh frozen plasma is an effective treatment. (E) Splenectomy is an effective treatment. ", "output": "D"} 
-{"instruction": "Which of the following symptoms can most confidently identify the patient as having peripheral vertigo?","input": "(A) Tinnitus and hearing loss. (B) Dysphagia. (C) Sudden onset. (D) Nystagmus of uncertain direction. (E) Visual fixation does not affect nystagmus.", "output": "A"} 
-{"instruction": "Which of the following best describes testicular torsion?", "input": "(A) Pain is relieved by changes in posture. (B) The testicle is horizontal when standing. (C) The pain is mild and not noticeable at first. (D) The pain is limited to the scrotum. (E) The cremasteric reflex is normal.", "output": "B"} 
-{"instruction": "A 29-year-old male receiving methadone treatment was shot in the left chest and was taken to the emergency room by his family. He was breathing more than 30 times per minute, and a weak pulse could be felt in the carotid artery. He was agitated. Physical examination revealed cold sweat all over the body, distended carotid veins, no breath sounds in the left chest, and tympanic sound on percussion. The bullet hole was at the intersection of the 6th intercostal space on the left and the midclavicular line. Which of the following treatments is most appropriate? ", "input": "(A) Give an endotracheal tube. tube) while protecting the cervical spine. (B) Perform abdominal ultrasound (FAST) examination to check whether there is bleeding in the abdomen. (C) Place a chest tube directly through the bullet hole for rapid drainage. (D) Rapidly administer 2 liters of fluid. (E) Insert a 14-gauge empty needle in the left midclavicular line and second intercostal space to reduce pressure. ", "output": "E"} 
-{"instruction": "A 21-year-old male was riding a motorcycle and collided with a small passenger car. When he arrived at the hospital, he had a right scoliosis and head injury, was unconscious, had obvious contusions on the chest and upper abdomen, and had weak breath sounds on the left chest. His blood pressure was 90/50 mmHg and his heart rate was 140/min. Which of the following treatment sequences is most appropriate? 1. Endotracheal tube tube) insertion. 2. CT of the brain. 3. Rapid infusion of 2 liters. 4. Abdominal ultrasound (FAST). 5. Left thoracic tube insertion (tube thoracostomy). ", "input": "(A)1->2->3->4->5. (B)1->3->5->4->2. (C)1->3->4->5->2. (D)5->1->3->2->4. (E)5->1->3->4->2. ", "output": "B"} 
-{"instruction": "A 50-year-old female fell from the 3rd floor and was sent to the emergency room. The patient was conscious and her vital signs were stable, but she had obvious pain in her lower back and paralysis of her lower limbs. Chest and abdominal X-rays revealed T12 fracture dislocation. Which of the following statements is wrong in the first-line assessment and treatment? ", "input": "(A) Immediately perform a physical examination to check for anus tone. (B) Arrange surgical reduction of dislocation as soon as possible. (C) Neurogenic shock presents with hypotension and tachycardia. (D) Consider the use of methylprednisolone. (E) Arrange a spine computer tomography examination immediately. ", "output": "C"} 
-{"instruction": "Which of the following descriptions is correct about diaphragmatic injury? ", "input": "(A) Emergency surgery is usually not required unless blood pressure drops. (B) It is usually more common on the right side than on the left. (C) It is more common in puncture wounds of the chest and abdomen. (D) The main threat to vital signs is hemorrhagic shock. (E) For smaller diaphragmatic injuries, the diagnosis rate of CT scan is very high. ", "output": "C"} 
-{"instruction": "Which of the following conditions is not an indication for brain CT scan in adult patients with mild head trauma? ", "input": "(A) Raccoon's eyes. (B) The GCS score was 13 two hours after the injury. (C) Scalp laceration and suspected open skull fracture. (D) Age 66. (E) Vomited once after the injury. ", "output": "E"} { 
-"instruction": "An 8-year-old boy was hit by a motorcycle on the way to school. The boy rolled over and fell to the ground. When he was sent to the emergency room by ambulance, his vital signs were body temperature 36.7°C, breathing 30 times/minute, heart rate 125 times/minute, and blood pressure 82/65 mmHg. The patient was unconscious and unable to express himself. Which of the following is the least appropriate first aid for pediatric trauma? ", "input": "(A) If peripheral blood vessels cannot be accessed, the intraosseous approach can be considered for this patient. If a tibia fracture is found, the distal femur on the same side can be accessed. (B) Give crytalloid at a dose of 20 ml/kg each time, with a target urine output of 1.5 ml/kg/hr. (C) Because the chest wall bones of children are more elastic, tension pneumothorax is less likely to occur in the event of chest contusion. (D) According to the patient's vital signs, the blood loss should be greater than 30%. (E) The first priority is to protect the airway. If an endotracheal tube is to be selected, a size 5~5.5 endotracheal tube with a cuff can be selected. ", "output": "C"} 
-{"instruction": "In recent years, Taiwan has successively held two large-scale events, the World Games and the Deaflympics. Which of the following statements about emergency medical care for mass gatherings is incorrect? ", "input": "(A) Definition: For the same purpose, the number of people gathered in a certain place exceeds 1,000. (B) The incidence of medical needs generated by sports gatherings is 0.12-17 / 1000 people. (C) The incidence of cardiac arrest at sports gatherings is 3-40 / 1000000 people. (D) Combines three major fields: emergency medicine, public health, and public safety. (E) Proper emergency medical planning is required. ", "output": "C"} 
-{"instruction": "Which of the following statements about our country's medical guidance system and medical guidance physicians is wrong? ", "input": "(A) Municipal and county (city) fire authorities should designate medical guidance physicians and establish a medical guidance system. (B) Responsible for the education, training, supervision, and assessment of emergency rescue technicians at all levels. (C) Establish quality indicators for rescue technicians at all levels and implement quality monitoring. (D) Approve the rescue record form of senior rescue technicians performing emergency rescue in accordance with the pre-established medical process. (E) The qualifications of medical supervisors are determined by the central fire department. ", "output": "E"}
-{"instruction": "Regarding the composition and tasks of the Regional Emergency Medical Response Center under the Emergency Medical Rescue Act, which of the following statements is incorrect?", "input": "(A) There are currently 6 Regional Emergency Response Centers in the country. (B) They can be entrusted to medical institutions to handle their operations. (C) When emergency hospitals transfer critically ill patients, they must assist in bed allocation and patient tracking. (D) They must regularly conduct annual major disaster emergency medical drills. (E) They must have a grasp of emergency medical information and resource status in the region.", "output": "C"}  
-{"instruction": "Which of the following is not a common abnormal manifestation in patients with myxedema? ", "input":"(A) Hypernatremia and water retention. (B) Hypoventilation and hypoxia. (C) Hypothermia. (D) Bradycardia. (E) Confusion, even lethargy or coma.", "output": "A"} 
-{"instruction": "Which of the following is incorrect about the treatment of jellyfish stings?", "input": "(A) Do not use fresh water for flushing, as it will stimulate the release of toxins from the remaining stinging cells in the skin. (B) 5% acetic acid is the first choice for reducing the activity of stinging cells. (C) Tetanus vaccination is required. (D) Prophylactic antibiotic use is not recommended. (E) Even if there are no systemic symptoms, the patient still needs to be observed for 8 hours to avoid delayed reactions. ", "output": "E"}
-{"instruction": "25 A 65-year-old male presents to the emergency department with a punch to the right eye. Physical examination reveals that the right eye cannot look up and has diplopia. He is suspected of having an orbital blow out fracture. What other physical examination findings would you expect, excluding the following? ", "input": "(A) Abnormal sensation of the right anterior cheek. (B) Enophthalmos. (C) Subcutaneous edema around the orbit. (D) Subconjunctival hemorrhage. (E) Cerebrospinal fluid rhinorrhea. ", "output": "E"} 
-{"instruction": "A 65-year-old postmenopausal woman with no past systemic illness had a normal CBC on physical examination six months ago. In the past three days, she has gradually developed pale complexion and shortness of breath after exercise, but has no other discomfort. Her CBC is as follows: Hb 8.6 gm/dL, MCV 80 fL, white blood cell count 9950/mm³, normal classification, platelet 145000/mm³, which of the following tests is most helpful for diagnosis? ", "input": "(A) Urine test. (B) Liver function test. (C) Kidney function test. (D) Stool test. (E) Bone marrow test. ", "output": "D"} 
-{"instruction": "Which of the following statements about antiphospholipid antibody syndrome is correct? ", "input": "(A) Abnormal bleeding is a common clinical manifestation. (B) Less than 3% of lupus erythematosus (SLE) patients have antiphospholipid antibody syndrome. (C) Venous thrombosis is rarely caused in clinical practice. (D) Antiphospholipid antibodies (antiphospholipid antibodies) appear in the blood. (A) If urticaria occurs 
-during a transfusion, the transfusion should not be continued. (B) If a fever occurs during a transfusion, it must be a reaction to the transfusion and not caused by infection. (C) If an acute intravascular hemolysis occurs, the transfusion should not be continued. (D) Because a post-transfusion reaction is unpredictable, the transfusion can be started as quickly as possible. (E) If a fever occurs during a transfusion, it only needs to be treated with antihistamines such as diphenhydramine. ", "output": "C"} 
-{"instruction": "A 78-year-old female patient has suffered from diabetes for 40 years and has poor blood sugar control. She came to the emergency department complaining that she had a ruptured wound on her right foot for two weeks, and the redness and swelling of the affected area gradually expanded. The infectious disease physician's clinical diagnosis was limb-threatening cellulitis. Please ask: In addition to surgical treatment, which of the following intravenous antibiotics is the least appropriate? ", "input": "(A)Ampicillin-sulbactam. (B)Aztreonam + clindamycin. (C)Cefoxitin. (D)Extended-spectrum fluroquinolone. (E)Piperacillin-tazobactam. ", "output": "D"} 
-{"instruction": "A 32-year-old male complains of weakness in his limbs, clear consciousness, proximal weakness compared to distal weakness, abnormal eye movement, poor pupillary light reflex, and normal sensation and reflex in his limbs. Which of the following diagnoses is most appropriate? ", "input": "(A) Botulism. (B) Myasthemia gravis. (C) Acute intermittent porphyria. (D) Lead poisoning. (E) Guillain-Barré syndrome. ", "output": "B"} 
-{"instruction": "Which of the following is incorrect about Guillain-Barré syndrome(GBS)? ", "input": "(A) It is the most common acute systemic neuropathy. Patients usually have a history of viral infection, such as gastroenteritis. (B) It mainly affects the motor nerves, manifested as asymmetric limb weakness, usually affecting the lower limbs first and then the upper limbs. (C) The most obvious neurological examination result is the absence of deep tendon reflex. (D) Although patients may have some complaints of abnormal sensation, neurological examination shows that the sensory nerves are normal. (E) The occurrence of Guillain-Barré syndrome is related to acute campylobacter jejuni infection. ", "output": "B"} 
-{"instruction": "A 27-year-old woman is sent to the emergency department because of an epileptic seizure. Her blood pressure is 165/90 mmHg and her Glasgow coma scale (GCS) is 10. She has no history of epilepsy and is 32 weeks pregnant. Physical examination reveals obvious lower limb edema. Which of the following treatments and dispositions for this patient is incorrect? ", "input": "(A) Give 6 g of magnesium sulfate intravenously over 15 minutes. (B) Liver function, kidney function, and complete blood count including platelets must be tested. (C) A CT scan of the brain must be arranged immediately. (D) If there is no obvious bleeding, intravenous infusion should be limited. (E) Administer furosemide diuretic to promote diuresis."E"} 
-{"instruction": "A 34-year-old female, who received gonadotropin treatment at an infertility clinic a week ago, gradually developed shortness of breath, abdominal pain combined with nausea and vomiting, and increased abdominal circumference and weight in recent days. On the day of consultation, her urine output decreased significantly. Which of the following statements is incorrect?", "input": "(A) About a quarter of patients who use gonadotropin to stimulate ovulation will develop mild symptoms, and less than 2% will develop severe symptoms like the above. (B) Continuous blood oxygen monitoring and electrocardiogram monitoring are required. (C) A detailed abdominal examination, especially deep palpation and pelvic examination, is required to identify serious lesions at an early stage. (D) Laboratory tests include electrolytes, renal function, complete blood count (CBC), coagulation function, and blood preparation. (E) Serious complications include pleural or peritoneal effusion, renal failure, ovarian torsion or cyst rupture, and adult respiratory distress syndrome. ", "output": "C"}
-{"instruction": "Which of the following statements about childhood epilepsy is incorrect?", "input": "(A) Nearly 50% of epilepsy are idiopathic. (B) Because epilepsy may cause brain damage, anti-epileptic drugs should be given immediately at the first attack. (C) For newborns, a brain ultrasound can rule out conditions such as bleeding or edema. (D) Hypoglycemia or hypocalcemia may also be the cause. (E) Febrile seizures often occur between 6 months and 5 years of age.", "output": "B"} { "B"} 
-{"instruction": "Which of the following statements is incorrect in the treatment of hemorrhagic shock in children?", "input": "(A) Give 20 ml/kg of Ringer's lactate first. (B) If blood pressure is still unstable, Ringer's lactate can be given one or two times. (C) If blood pressure is still unstable, 20 ml/kg of packed RBC can be given. (D) When intravenous drip cannot be established, venous cutdown or intraosseous injection can be performed. (E) Urine volume and urine specific gravity can provide important information on whether fluid is sufficient during emergency treatment.", "output": "C"}
-"instruction": "A 76-year-old man was brought to the emergency room because of shortness of breath. The patient had no history of other medical conditions except hypertension. Chest X-ray Only pleural effusion was found. The results of pleural effusion examination were: protein 1.5 g/dL, lactate dehydrogenase (LDH) 80 U/L. The protein in the blood was 3.6 g/dL, lactate dehydrogenase (LDH) 201 U/L. Based on the above test results, which of the following statements is correct about the most likely cause? ", "input": "(A) Autoimmune disease. (B) Primary or metastatic malignant tumor. (C) Bacterial pneumonia. (D) Interstitial pneumonia caused by amiodarone. (E) Congestive heart failure. ", "output": "E"} 
-{"instruction": "A 90 A year-old female was sent to the emergency room with fever. This patient has lived in a nursing home for a long time and has a history of dementia and diabetes. She has not been to the hospital in the past month. After your examination, you suspected that it was pneumonia. Which of the following statements about the pathogen of this patient's pneumonia is correct? ", "input": "(A) Mycoplasma pneumoniae and Legionella are common pathogens of pneumonia in these patients living in nursing homes. (B) Because these patients have less opportunities to go out and contact with people, they are not easily infected by influenza viruses. (C) If nursing home patients get pneumonia, the most common pathogen is Pseudomonas aeruginosa. (D) Giving influenza vaccines to these elderly people in nursing homes can achieve an 80% effectiveness in preventing postinfluenzal pneumonia. (E) The most common bacteria is Streptococcus pneumoniae, gram-negative bacilli and Haemophilius influenzae. ", "output": "E"} 
-{"instruction": "A 55-year-old male patient with long-term alcohol addiction was brought to the emergency room by his family. He complained of cough and fever for two weeks, weight loss and night sweats. Blood tests showed elevated white blood cell counts and inflammatory indexes. Chest X-ray showed a 5-centimeter hole with air-fluid level lesions in the left lower lung. Which of the following statements is correct? ", "input": "(A) Pulmonary abscesses are mainly caused by aerobic bacteria in immunocompetent patients, while they are mainly caused by anaerobic bacteria in immunocompromised patients. (B) In terms of treatment, the failure rate of antibiotic treatment alone is too high, and postural drainage or bronchoscopic drainage should be used to accelerate recovery. (C) Possible factors for failure of medical treatment include large cavities, thick cavitary walls, pustules, and blockage. (D) Chest X-ray is a good basis for tracking clinical progress. (E) About 50% of patients ultimately require surgical treatment. ", "output": "C"} 
-{"instruction": "Which of the following statements is incorrect about the treatment of hydrofluoric acid (HF)? ", "input": "(A) Calcium gluconate solution up to 33% can be used for local soaking until the pain is reduced. (B) Calcium gluconate solution or calcium chloride solution can be used for local injection at the exposed area. (C) Calcium gluconate solution can be used for continuous arterial infusion or local intravenous infusion. (D) If HF is ingested, milk, calcium solution, magnesium gastric emulsion, calcium tablets or magnesium gastric emulsion tablets can be given to bind toxic fluoride ions. (E) If there are systemic symptoms, the main treatment is to correct hypocalcemia, which can be supplemented with calcium gluconate or calcium chloride according to the free calcium value in the blood. ", "output": "B"} 
-{"instruction": "Which of the following statements about methemoglobinemia is incorrect? ", "input": "(A) There are many factors that can cause methemoglobinemia, such as congenital factors or certain drugs, such as nitrates, lidocaine, acetaminophen, etc. (B) The patient will have cyanosis. When the pulse oxymeter is used to measure the blood oxygen concentration, it can be found that the blood oxygen concentration is low. (C) When the patient's blood contains more than 10% hemoglobin, it will appear chocolate-brown. (D) The oxyhemoglobin dissociation curve of such patients will shift to the left. (E) When patients with severe G6PD deficiency use methylene blue to treat hemoglobinemia, it may cause hemolytic anemia. Patients and their families should be fully informed before use. ", "output": "B"} 
-{"instruction": "Two patients who were unconscious while cleaning the spa sink were taken to the emergency room. According to the EMT personnel, the scene was filled with the smell of rotten eggs. Which of the following statements about these two patients is incorrect? ", "input": "(A) Both patients may have been poisoned by hydrogen sulfide (H2S). (B) Rescuers are advised to carry self-contained breathing apparatus. (C) At the scene of the incident, if the patient is not breathing, give the patient mouth-to-mouth artificial respiration. (D) As an antidote, consider giving the patient amyl nitrite inhalation and intravenous sodium nitrite. (E) Hyperbaric oxygen therapy may be considered for the patient. ", "output": "C"} 
-{"instruction": "Which of the following statements about the toxic syndrome (toxidromes) of organophosphate poisoning is incorrect? ", "input":"(A) Caused by an increase in the number and activity of acetylcholine receptors. (B) The mnemonic for this is SLUDGE-BAM, which includes increased salivation and lacrimation. (C) The mnemonic for this is DUMBELS, which includes diarrhea, increased urination, and miosis. (D) This causes the so-called cholinergic crisis, with symptoms including abdominal discomfort and emesis. (E) Parasympathetic nervous system excitement, with bradycardia, increased bronchial secretion, and dyspnea being the most common causes of death, known as "killer B's." ", "output": "A"} 
-{"instruction": "A 35-year-old woman, depressed after an argument over her husband's affair, swallowed 50 tablets of extra-strength Tylenol brought back from the United States. Three hours later, she was found by a friend and sent to the emergency room. After a blood test, the acetaminophen concentration in her blood was 350 µg/mL 4 hours later. She complained of no discomfort and asked to go home. Which of the following statements is correct? ", "input": "(A) After explaining in detail the precautions after returning home and informing the patient to return to the emergency department if she feels any discomfort, the patient can be allowed to go home. (B) After observing the patient for 6 hours, if the patient still does not feel any discomfort, the patient can be allowed to go home. (C) Arrange the patient to be hospitalized for observation, because the symptoms caused by long-acting drugs may be delayed. (D) Arrange the patient to be admitted to a psychiatric ward to prevent the patient from committing suicide again. (E) Start treatment with N-acetylcysteine ​​and arrange for the patient to be hospitalized. ", "output": "E"} 
-{"instruction":"Which of the following statements about chain snake bites is correct?", "input": "(A) The wound is usually not swollen, but numb. (B) Kidney failure may occur very early. (C) The venom may cause skin ulcers if it is sprayed on the skin. (D) If not treated promptly, respiratory failure may cause death. (E) If the patient has a positive skin test for anti-chain snake antibodies, anti-chain snake antibody treatment should not be used.", "output": "B"}
-{"instruction": "Which of the following statements about the treatment of swallowed foreign bodies is incorrect?", "input": "(A) If a child swallows a button-type battery and it gets stuck in the esophagus, it must be removed as soon as possible. Otherwise, it may cause esophageal rupture even in less than 6 hours. (B) If a child swallows a button-type battery and it has passed through the esophagus and there are no symptoms, there is no urgency and weekly X-ray follow-up examinations are sufficient. (C) If cocaine in a condom package is swallowed and gets stuck in the esophagus, a gastroenterologist should be seen as soon as possible for endoscopic removal. (D) If the swallowed sharp object is greater than 5 cm in length and greater than 2 cm in width, the chance of it passing through the stomach is very low. (E) If a child swallows a coin and it gets stuck in the esophagus, consider using a Foley scissor within 24 hours. catheter removed. ", "output": "C"} 
-{"instruction": "Which of the following statements is correct regarding the use of a nasogastric tube to treat gastrointestinal bleeding? ", "input": "(A) Patients suspected of lower gastrointestinal bleeding do not need a nasogastric tube. (B) The placement of a nasogastric tube is likely to cause varicose vein rupture and bleeding in patients, and should be avoided as much as possible. (C) If bright red blood is discharged from the anus, the source of bleeding must be in the lower gastrointestinal tract. (D) Upper gastrointestinal bleeding cannot be ruled out even if the drainage of the nasogastric tube is normal. (E) In the case of upper gastrointestinal bleeding, the nasogastric tube should be flushed with ice water because evidence-based medicine shows that hypothermia can help stop bleeding. ", "output": "D"} 
-{"instruction": "A 35-year-old male patient with chronic alcoholism presented to the emergency department with upper abdominal pain. His temperature was 37.8℃ and his heart rate was 120. bpm, blood pressure 100/70 mmHg, white blood cell count 13000/mm³, segment 80%, band 5%, AST 60 U/L, lipase 1800 U/L. Which of the following treatments is most important for this patient at present? ", "input": "(A) Administration of first or second generation of cephalosporins. (B) Fluid resuscitation. (C) Intravenous injection of gabexate mesilate (protease inhibitor). (D) Intravenous or intramuscular injection of morphine analgesics (narcotics). (E) Nasogastric drainage (NG tube drainage). ", "output": "B"} 
-{"instruction": "A 5-year-old boy reported that he swallowed 5 A child was found with a plastic toy coin the size of a dollar. When the child was brought to the emergency room, his parents said they did not witness the incident. The child's breathing was normal and he had no chest or abdominal pain. However, the child was unable to swallow saliva. Neck soft tissue, CXR and KUB examinations showed no obvious foreign objects or abnormalities. Which of the following treatments is most appropriate? ", "input": "(A)Chest computer tomography. (B)Endoscopic removal. (C)Foley catheter removal. (D)Intravenous glucagon administration. (E)Sublingually nifedipine use. ", "output": "B"} 
-{"instruction": "Intussusception is a common abdominal emergency in children. Which of the following statements is incorrect? ", "input": "(A)When the disease occurs, the child will have sudden acute abdominal pain. (B) Currant jelly stool is a typical symptom. (C) Ultrasound may reveal a crescent sign. (D) Barium enema is one of the diagnostic methods. (E) It is most likely to occur in ileal intussusception. ", "output": "C"} 
-{"instruction": "A 4-day-old female infant was sent to the emergency room because of bloody stools and persistent abdominal distension. CT scan revealed pneumatosis intestinalis, suspected to be necrotizing enterocolitis. Which of the following statements is incorrect? ", "input": "(A) The most susceptible groups are premature infants and low-weight newborns. (B) Maternal cocaine use is a risk factor for necrotizing enteritis in full-term infants. (C) If diagnosed too late, it may lead to intestinal perforation and septic shock. (D) Laboratory diagnosis is not specific for necrotizing enteritis. (E) Regardless of whether there is intestinal perforation, patients with necrotizing enteritis require surgical treatment. ", "output": "E"} 
-{"instruction": "Which of the following statements about Boerhaave's syndrome is incorrect? ", "input": "(A) Epileptic seizures can cause. (B) It often invades the distal esophagus. (C) Men drinking alcohol is a risk factor. (D) It often leads to right-sided pleural effusion. (E) The pathogenesis is a transient high pressure in the esophagus, which leads to rupture of the entire esophagus. ", "output": "D"} 
-{"instruction": "Which of the following is not a common pathogen that causes fever and diarrhea in patients with acquired immune deficiency syndrome (AIDS)? ", "input": "(A) Cytomegalovirus. (B) Salmonella species. (C) Staphylococcus aureus. (D) Aeromonas hydrophila. (E) Cryptosporidium. ", "output": "C"} "(A) Cytomegalovirus. (B) Salmonella species. (C) Staphylococcus aureus. (D) Aeromonas hydrophila. (E) Cryptosporidium.", "output": "C"} 
-{"instruction": "Which of the following statements about the use of adenosine is incorrect?", "input": "(A) It can be used to stabilize WPW syndrome with narrow QRS complex regular tachycardia. (B) It can be used to stabilize supraventricular (C) For unstable supraventricular pulse, adenosine can be given once. (D) For stable wide QRS complex regular pulse (wide QRS complex regular tachycardia), adenosine can be given. (E) For unstable wide QRS complex regular pulse, adenosine can be given. ", "output": "E"}
-{"instruction": "Which of the following statements is correct about diagnostic tools used to assist in the diagnosis of pulmonary embolism? ", "input": "(A) The presence of S1Q3T3 on the electrocardiogram can confirm the diagnosis of pulmonary embolism. (B) A normal D-Dimer value can completely rule out pulmonary embolism. (C) In the absence of oxygen (room air), an arterial gas analysis PaO2>80mmHg can completely rule out pulmonary embolism. (D) Patient shock will affect the diagnostic rate of pulmonary embolism by CT. (E) Ventilation-perfusion lung scan can provide an accurate diagnosis and is a standard emergency examination for pulmonary embolism. ", "output":"D"} 
-{"instruction": "A 65-year-old man was taken to the hospital emergency room by a passerby because of chest tightness. In the emergency room, the patient complained of squeezing pain in the chin and left shoulder. He had been in good health in the past and had no history of heart-related diseases. The only medication he was currently taking was Levitra (Vardenafil). The electrocardiogram showed ST-segment elevation, and the blood test report showed elevated troponin-I and CK-MB, with normal D-Dimer values. The emergency physician initially diagnosed it as acute coronary syndrome. Which of the following statements is correct for the next treatment?", "input": "(A) Immediately give nitroglycerin (0.4mg sublingual tablet), and the maximum dose can be given three times (five minutes apart each time). (B) Unless there are contraindications such as hypotension, morphine (4 mg, IVP) should be routinely given to relieve chest tightness. (C) Even if the patient is allergic to aspirin, clopidogrel (300 mg) should be used instead. (D) ACE inhibitors should not be used in patients with normal LVEF (left ventricular ejection fraction). (E) For such patients, oxygen should be given. ", "output": "C"}
-{"instruction": "Which of the following statements is correct regarding the first aid and corresponding drug treatment pairing for drug-induced cardiovascular toxicity?", "input": "(A) Polymorphic ventricular tachycardia (VT) caused by antihistamines is treated with procainamide. (B) Ventricular dysrhythmias (VD) caused by tricyclic antidepressants are treated with sodium bicarbonate. (C) Hypertensive crisis (HH) caused by amphetamine is treated with propranolol. (D) Acute digitalis intoxication causes hyperkalemia leading to QRS widening, which is treated with calcium chloride. (E) In the case of acetylcholinesterase-inhibiting agents bradycardia caused by isoproterenol treatment. ", "output": "B"} 
-{"instruction": "A 45-year-old female with a history of breast cancer and lung metastasis collapsed after going to the toilet at home and was unconscious for about 2 minutes. When she arrived at the emergency room, she had chest tightness, pale face, cold sweats, and low blood pressure. Her electrocardiogram was as follows. Which of the following statements is incorrect? ", "input": "(A) The patient often has pulsus paradoxus. (B) It is cardiogenic shock, and water should be restricted. Do not use large amounts of infusion. (C) Ultrasound cardiography is a good diagnostic tool. (D) Emergency pericardiocentesis should be performed when necessary. (E) X-ray examination can reveal an enlarged heart image. ", "output": "B"} 
-{"instruction": "Which of the following is an indication for fibrinolytic therapy for acute pulmonary embolism?", "input": "(A) A mismatch between the perfusion scan and ventilation scan. (B) Severe disturbance of consciousness. (C) S1Q3T3 on the electrocardiogram. (D) Acute chest pain occurs within 3 hours. (E) Hemodynamic instability and severe hypoxia.", "output": "E"} 
-{"instruction": "A 50-year-old male with acute ST-segment elevation myocardial infarction was in the emergency room waiting to be sent to the cardiac catheterization room for examination. An intravenous infusion route had been established. He suddenly became unconscious, had no breathing or pulse, and the electrocardiogram monitor showed the following figure. Which of the following immediate emergency measures is the most correct? ", "input": "(A) Immediately provide artificial respiration or positive pressure oxygen. (B) Immediately provide epinephrine 1mg. (C) Immediately provide defibrillator once (chest compressions must be performed during the preparation of the defibrillator). (D) Perform a full 2 ​​minutes (or 5 30:2 cycles of CPR) before defibrillator. (E) Perform endotracheal intubation first. ", "output": "C"} 
-{"instruction": "A 30-year-old male complained of a history of depression and was sent to the emergency room due to an overdose of tricyclic antidepressants. When he arrived at the hospital, his temperature was 37℃, his respiratory rate was 26 times/min, his blood pressure was 84/60 mmHg, and he was unconscious (coma index E3M5V2). The electrocardiogram monitor showed the following figure. Which emergency treatment has the highest priority? ", "input": "(A)Amiodarone. (B)Lidocaine. (C)Biphasic synchronized cardioversion 200 joules. (D)Biphasic defibrillation 150-200 joules. (E)Sodium bicarbonate. ", "output": "D"} 
-{"instruction": "In the case of acute myocardial infarction complicated by severe pulmonary edema, which of the following is least likely? ", "input": "(A)ST elevation myocardial infarction in a large area of ​​the anterior wall of the left ventricle. (B)Non-ST elevation myocardial infarction with diffuse ST wave depression in multiple coronary artery basins. (C) Myocardial infarction of the inferior wall of the left ventricle complicated by right ventricular infarction. (D) Myocardial infarction of the anterior wall of the left ventricle complicated by chordae tendinae or papillary muscle rupture. (E) Infarction of the anterior wall of the left ventricle and septum leading to septal rupture. ", "output": "C"}  
-{"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": "Which of the following statements about intraosseous infusion is correct?", "input": "(A) For pediatric emergency treatment, intraosseous injection is the best choice for infusion. (B) For intraosseous infusion of solutions, only crystalloid solution can be used. (C) The value of the use of intraosseous injection needles is still unclear and has not been determined. (D) The intraosseous injection site and the injection site can continue to be used as an infusion route when there is swelling four weeks after the injection. (E) When the intraosseous injection needle is injected, bone marrow can be aspirated to confirm that the needle is in the correct position.", "output": "E"}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": "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 38-year-old male was taken to the emergency room because he suddenly had convulsions while chatting with a friend. He lost consciousness and had no spontaneous breathing or heartbeat when he arrived at the hospital. The EMT said that when he arrived at the scene, the AED had recommended a shock, and then continued CPR. After you determined that there was no need for another shock, you quickly put the endotracheal tube in and continued to give CPR first aid. At this time, the nurse reported: "end-tidal CO2 45 mmHg". Regarding the use and judgment of end-tidal CO2 during the first aid process, which of the following is wrong?", "input": "(A) During the CPR process, end-tidal CO2 should be continuously measured to monitor the quality of CPR. (B) If end-tidal CO2 If the value can be measured, it will change with the respiratory cycle and will not become unmeasurable after ambu bagging, the endotracheal tube should be placed in the trachea. (C) If the end-tidal CO2 is less than 10 mmHg, attempts should be made to improve the quality of CPR. (D) If the end-tidal CO2 suddenly and continuously increases (usually greater than or equal to 40 mmHg), it indicates restoration of spontaneous circulation (ROSC). (E) Auscultation and chest X-ray can more accurately confirm whether the endotracheal tube is placed in the trachea than end-tidal CO2. ", "output": "E"} 
-{"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": "Which of the following statements is incorrect? ", "input": "(A) Tension pneumothorax is a life threatening emergency and must be confirmed by X-ray before emergency treatment. (B) Thoracotomy for massive hemothorax must be performed by a qualified and experienced surgeon. (C) If the chest tube drains 1500 ml of blood at the beginning or 200 ml of blood every 2-4 hours, it is necessary to consider requesting a thoracotomy. (D) Chest tube placement is generally located between the fourth and fifth intercostal spaces, mid-axillary line. (E) About 15-30% of chest puncture injuries require thoracotomy. ", "output": "A"}"A"} 
-{"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": "In the Palliative Care Ordinance, if CPR is not performed, relevant regulations must be met. Which of the following statements is incorrect?", "input": "(A) The patient must be a terminally ill patient. (B) Two doctors are required to diagnose the patient as a terminally ill patient, but only one of them needs to be a relevant specialist. (C) A written consent form must be signed. (D) If the patient is under 20 years old, the consent of his or her legal representative should be obtained when signing the written consent form. (E) If the patient is unconscious or unable to clearly express his or her wish not to perform CPR, his or her closest relative may issue a written consent form instead.", "output": "B"} "(A) The patient must be a terminally ill patient. (B) Two doctors are required to diagnose the patient as a terminally ill patient, and only one of them needs to be a relevant specialist. (C) A written consent must be signed. (D) If the patient is under 20 years old, the consent of his legal representative should be obtained when signing the written consent. (E) If the patient is unconscious or unable to clearly express his wish not to undergo cardiopulmonary resuscitation, his closest relative may issue a written consent instead.", "output": "B"} 
-{"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 pregnant woman at 38 weeks' gestation gives birth to a male infant in the emergency department. You are assisting with the management of the newborn, who is lethargic, cyanotic, and inactive, with bradycardia. After positive pressure ventilation and oxygenation with a bag-mask, his heart rate is still only 40 beats per minute, and another colleague is preparing to intubate him; what is the most appropriate next step?", "input": "(A) Establish intravenous access and give sodium bicarbonate. (B) Establish intravenous access and give epinephrine. (C) Establish intraosseous injection and give epinephrine. (D) Establish intravenous access and give 10/kg of (E) Start chest compression. ", "output": "E"} "(A) Establish intravenous access and give sodium bicarbonate. (B) Establish intravenous access and give epinephrine. (C) Establish intraosseous injection and give epinephrine. (D) Establish intravenous access and give intravenous fluid therapy of 10 ml/kg of normal saline. (E) Start chest compression.", "output": "E"} 
-{"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": "According to the Department of Health's 2012-2013 healthcare quality and patient safety work goal 2: "Implementing infection control" implementation strategy, it is recommended to implement the concept of bundle care. For patients with central catheters, multiple measures should be taken simultaneously to reduce central line associated bloodstream infection (CLA-BSI). Which of the following statements is incorrect? ", "input": "(A) Central catheters should be removed immediately when they are no longer needed after routine assessment. (B) When a central catheter is placed, both the operator and the patient must use maximum coverage protection. (C) The skin must be thoroughly disinfected when a central catheter is placed. The best disinfectant is 2% chlorhexidine. (D) Carefully select the site for central line placement, using the groin as the placement site whenever possible. (E) Ensure hand hygiene. ", "output": "D"}
-{"instruction": "According to the World Health Organization (WHO) definition of disaster, which of the following statements does not meet the conditions of the definition of disaster?", "input": "(A) An accident at a nuclear power plant caused the residents within 30 kilometers of the power plant to evacuate urgently, but no one was immediately killed. (B) A small town with a population of about 1,000 people, about 80 kilometers away from a large city, was closed. (C) Due to an oil spill from an oil tanker, more than 1,000 kilometers of coastline was seriously polluted, and fishing operations had to be stopped. (D) The extent of the disaster's damage to life or ecology will exceed the scope of the basic structure (infrastructure) in the disaster area. (E) In a large city in North America, a school shooting occurred, killing more than 10 students and seriously injuring 5. ", "output": "E"} {" 
-instruction": "According to the Department of Health's "101 Annual Hospital Emergency Medical Capacity Grading Standard" for the quality of trauma treatment, which of the following statements is correct? ", "input": "(A) After the trauma team of a hospital responsible for severe emergency care is activated, the time to arrival should be less than 10 minutes. (B) After the trauma team of a hospital responsible for severe emergency care is activated, the time to arrival should be less than 30 minutes. (C) After the trauma team of a hospital responsible for moderate emergency care is activated, the time to arrival should be less than 60 minutes. (D) The trauma team should be activated for patients with level 1 trauma in a hospital responsible for moderate emergency care. (E) The trauma team should be activated for patients with level 1 trauma in a hospital responsible for severe emergency care. ", "output": "A"} 
-{"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": "Which of the following statements about radiation damage is incorrect?", "input": "(A) The amount of radiation absorbed multiplied by the quality factor is called the radiation equivalent dose. Under the international standard MKS system, the unit is Sievert (Sv). (B) The three elements of radiation protection are time, distance and shielding. (C) The effects of radiation on the human body can be roughly divided into three situations: external exposure, surface contamination and internal intake. (D) The extent of radiation damage can be initially assessed by drawing blood to test the polymorphonuclear nuclei (PMN) in the blood cells. (E) If radiation damage is combined with major trauma, the trauma should be treated first.", "output": "D"} "(A) The radiation absorbed dose multiplied by the quality factor is called the radiation equivalent dose. Under the international standard MKS system, the unit is Sievert (Sv). (B) The three elements of radiation protection are time, distance and shielding. (C) The effects of radiation on the human body can be roughly divided into three situations: external exposure, surface contamination and internal intake. (D) The extent of radiation damage can be initially assessed by drawing blood to test the polymorphonuclear neutrophils (PMN) in the blood cells. (E) If radiation damage is combined with major trauma, the trauma should be treated first.", "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": "Regarding the causes of postoperative fever, the "Five Ws" can be considered. Which of the following statements about the "Five Ws" is incorrect? ", "input": "(A) Wind: Atelectasis or Pneumonia. (B) Water: Dehydration. (C)Wound: Wound infection. (D)Walking: Deep Vein Thrombosis. (E)Wrong Drug: Drug fever or Pseudomembrane colitis. ", "output": "B"} 
-{"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": "Please choose the more correct statement about sigmoid volvulus?", "input": "(A) It is one of the most common causes of intestinal obstruction in children. (B) The probability of causing intestinal obstruction in the large intestine of adults is higher than that of malignant tumors and diverticulitis. (C) The typical "Coffee Bean Sign" can be seen on the plain abdominal X-ray. (D) It is mostly an acute attack, and a history of chronic constipation is rare. (E) Because the intestinal motility of mental patients is generally relatively fast, even if they take anticholine agents, they are less likely to develop this disease. ", "output": "C"}
-{"instruction": "A 25-year-old female was taken to the emergency room by her friends from a nightclub because of confusion and convulsions. Which of the following statements about methamphetamine poisoning is incorrect?", "input": "(A) Complications include cerebral hemorrhage. (B) Patients usually have a high body temperature and should be cooled, but the temperature is not related to the prognosis. (C) Severe patients may have symptoms of shock and renal failure. (D) Some patients may have myocardial ischemia or myocardial infarction. (E) If the patient has convulsions, the patient's airway should be protected to maintain appropriate oxygen concentration and ventilation function.", "output": "B"} {"25), intubation and ventilator treatment must be considered. Non-invasive ventilators (such as BiPAP, CPAP, etc.) are not recommended because they may increase viral spread. (E) The local area is not an epidemic area for drug-resistant viruses, and routine addition or switching to zanamivir is not encouraged. ", "output": "B"} 
-{"instruction": "A 30-year-old female with a history of anxiety disorder was sent to the emergency room because of unconsciousness. EMT found a bag of lorazepam, a sleeping pill, at the scene. When she arrived at the hospital, her heart rate was 130 beats/min, systolic blood pressure was 80 mmHg, respiratory rate was 8 times/min, and body temperature was 36.5 ℃. Which of the following emergency treatments is wrong? ", "input": "(A) Emergency treatment should prioritize the treatment of the respiratory tract and assess whether ventilation is adequate. (B) Vasopressors should be used to stabilize blood pressure and maintain peripheral tissue perfusion. (C) Any unconscious patient should be given the antidote flumazenil as soon as possible. (D) Coma cocktail treatment can be tried first (DONT: D50W, Oxygen, Narcan, Thiamine). (E) After stabilizing vital signs, a detailed medical history should be taken and gastric lavage can be given if necessary. ", "output": "C"}"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"} 
-{"instruction": "A 28-year-old young woman was sent to the emergency room and complained of gradual weakness in her limbs over the past 4 days. The muscle weakness progressed from the extremities to the proximal parts of the limbs. The patient was conscious and neurological examination showed normal cranial nerve function. The muscles in her limbs were weakened and could not resist gravity. She had symptoms of gastroenteritis such as diarrhea and abdominal pain 2 weeks before the onset of limb weakness. Which of the following statements about Guillain-Barré syndrome (GBS) is incorrect? ", "input": "(A) This disease is the most common acute systemic neuropathy and may be related to acute campylobacter jejuni infection. (B) It mainly affects the motor nerves, manifested as symmetrical limb weakness, usually affecting the lower limbs first and then the upper limbs. (C) The most obvious neurological examination is that the patient will lose deep tendon reflexes. (D) The patient will have some abnormal sensory complaints and abnormal sensory neurological examination. (E) Plasmapheresis treatment may be considered. ", "output": "D"} 
-{"instruction": "A 29-year-old healthy male with no history of any disease tested positive for influenza A in another hospital 2 days ago and started taking Tamiflu. He came to the clinic today because of persistent high fever and difficulty breathing. A chest X-ray shows bilateral pulmonary infiltrates. Which of the following actions is incorrect? ", "input": "(A) The patient should be reported to the Centers for Disease Control as a severe influenza patient. He or she may develop respiratory failure or even die, and hospitalization is necessary. (B) If the blood oxygen saturation is < 95%, oxygen must be given. A moist bottle should be used for oxygen administration, and bronchodilators should be given to make sputum easier to cough up. (C) If there are no symptoms of bacterial infection, intravenous antibiotics should not be used. (D) If hypoxia persists (PaO 2/FiO 2 < 200 and PaCO₂ > 50 mmHg or pH < 7.25), intubation and ventilator treatment must be considered. Non-invasive ventilators (such as BiPAP, CPAP, etc.) are not recommended because they may increase viral spread. (E) The local area is not an epidemic area for drug-resistant viruses, and routine addition or switching to zanamivir is not encouraged. ", "output": "B"}
-{"instruction": "A 30-year-old male came to the emergency room because he felt weak and unable to move when he got up in the morning. The patient described a similar attack 3 months ago. In the past six months, the patient has had symptoms such as palpitations and weight loss. When he arrived at the hospital, his blood pressure was 120/70 mmHg, heart rate was 110 beats/min, respiratory rate was 20 breaths/min, and body temperature was 37 ℃. Other physical examinations were normal except for symmetrical weakness in the limbs. Which of the following statements is incorrect?", "input": "(A) Biochemical examinations need to test changes in potassium ions, magnesium ions, calcium ions, etc. (B) The diagnosis may be hyperthyroidism combined with periodic paralysis. (C) The affected muscle groups are mostly distal muscles. The lower limbs are more susceptible to the effects than the upper limbs. They are symmetrical and often accompanied by abnormal sensations. (D) The patient is more likely to have an attack if he eats foods high in starch and salt. (E) The patient should not be given dextrose solution with KCL. ", "output": "C"} 
-{"instruction": "A 32-year-old female was sent to the emergency room after falling from a motorcycle accident. Her right thigh was deformed. An endotracheal tube was placed in the patient, and a ventilator was used to assist her breathing. Her initial blood pressure in the emergency room was 80/60 mmHg and her heart rate was 120 beats/min. After intravenous resuscitation and emergency treatment, her blood pressure returned to 120/80 mmHg. One hour later, her blood pressure dropped to 90/75 mmHg and her heart rate was 130 beats/min. , what is the top priority at this time? ", "input": "(A) Emergency placement of a chest tube. (B) Appropriate infusion therapy, find the bleeding point and stop the bleeding. (C) Give a large amount of infusion to rescue. (D) Conduct a secondary assessment from head to toe. (E) Repeated primary survey. ", "output": "E"} 
-{"instruction": "A 38-year-old male was drunk and fought with others. He was sent to the emergency room by EMT. It was found that the bleeding of the scalp laceration had stopped, the face and chin were deformed and swollen, the blood pressure was 86/56 mmHg, the heart rate was 126 times/min, the respiration was 24 times/min, and the consciousness was unclear. Which of the following treatments should be performed first? ", "input": "(A) Nasopharyngeal tube placement. (B) 2,000 ml of Ringer's solution infusion. (C) Vascular embolism therapy. (D) Brain CT scan. (E) Cricoid chondrotomy. ", "output": "E"} 
-{"instruction": "A 3-year-old girl was brought to the emergency room by her mother, complaining of a 1-day fever. After examining the skin and oral cavity, the initial diagnosis was hand, foot and mouth disease. The girl's vital signs were stable and she did not need to be hospitalized immediately. During health education, the mother should be informed of the serious conditions that require prompt medical attention, which of the following is not included? ", "input": "(A) Myoclonic jerk. (B) Continuous vomiting. (C) Continuous lethargy. (D) Continuous diarrhea. (E) Rapid breathing and heartbeat. ", "output": "D"} 
-{"instruction": "A 40-year-old female had headache, nausea and fever 5 days ago. She started to be confused and delirious 3 days ago. She became drowsy yesterday. She had convulsion today and came to the hospital. Her temperature was 38.5℃ when she was admitted to the hospital. There were no abnormalities in her chest and abdomen. Her neck was stiff and her cranial nerve examination was normal. Her tendon reflexes were normal. Babinski sign was negative. WBC was 9,000/mm3. The initial pressure of lumbar puncture was 180 mmH2O. The results of cerebrospinal fluid examination were white blood cells 193/mm3 (polynuclear cells 12, lymphocytes 141, monocytes 40), red blood cells 6,500/mm3, protein 92 mg/dL, glucose 40 mg/dL. Which of the following is the most likely diagnosis? ", "input": "(A) Subarachnoid hemorrhage. (B) Herpes simplex virus encephalitis. (C) Acute purulent meningitis. (D) Tuberculous meningitis. (E) Meningitis caused by parasites. ", "output": "D"} 
-{"instruction": "A 40-year-old male was injured by lightning on the golf course. Which of the following statements is correct? ", "input": "(A) Lightning injury can easily cause ventricular fibrillation due to the extremely high voltage. (B) If the patient survives the lightning injury, he or she is prone to neuropsychiatric complications, including schizophrenia. (C) Lightning injury causes a large number of casualties and requires on-site treatment. Patients with red labels in the injury classification should be given the first priority. (D) When heavy rain and lightning strike, people should evacuate to open areas to avoid being crushed by collapsed buildings. (E) The principles of intravenous fluid supplementation are the same for patients with electric shock and lightning injuries. ", "output": "B"} 
-{"instruction": "A 45-year-old patient with cirrhosis was hospitalized for fever and abdominal distension. Physical examination revealed ascites, abdominal tenderness and rebound pain. Which of the following statements about spontaneous bacterial peritonitis is incorrect? ", "input": "(A) Symptoms of fever, abdominal pain and leukocytosis are common. (B) White blood cells >1,000/mm3 and neutrophils >250/mm3 in ascites are a confirmed diagnosis. (C) It is recommended to use third-generation antibiotics. (D) Lactic acid should be tested. If it is severe sepsis, crystalloid 20 ml/kg should be given. (E) The most common bacteria in the country are Gram-negative bacteria, such as Escherichia coli. ", "output": "D"} 
-{"instruction": "A 45-year-old male came to the emergency room early in the morning because of crooked eyes and crooked mouth. Examination showed that the patient had right peripheral type facial palsy. Careful examination revealed that the patient also had right ear pain and vesicular rash on the right outer ear. Which of the following statements is incorrect? ", "input": "(A) This is Ramsay Hunt Syndrome, not Bell's palsy. (B) This is an infection with the varicella-zoster virus (VZV). (C) The initial clinical manifestations of Ramsay Hunt Syndrome may not include a rash. (D) Antiviral drugs such as acyclovir and steroids can be used as early as possible. (E) Ramsay Hunt Syndrome has a better recovery rate from facial nerve palsy than Bell's palsy. ","output": "E"}
-{"instruction": "After a 16-hour flight, a 48-year-old female patient suddenly felt shortness of breath, chest pain, and sweating. She was rushed to the emergency room from the airport and was in a coma when she arrived at the emergency room. The patient was discharged from the hospital due to a left femur fracture half a month ago and had no history of hypertension or heart disease. After evaluation, the blood pressure was 80/44 mmHg, the heart rate was 120 beats/min, the respiratory rate was 22 breaths/min, the blood oxygen saturation was 88%, the electrocardiogram showed sinus tachycardia, and the physical examination showed clear breath sounds. Which of the following statements about this patient is the least appropriate?", "input": "(A) If the electrocardiogram shows S1Q3T3, it can support the diagnosis of pulmonary embolism. (B) Due to unstable hemodynamics, it is not appropriate to use a fibrinolytic agent. (C) Ventilation-perfusion lung scan is ineffective and has low clinical value in emergency. (D) Consider immediate spiral chest CT. (E) Patient shock will affect the diagnostic rate of CT for pulmonary embolism. ", "output": "B"}"B"} 
-{"instruction": "A 5-year-old boy was hit by a reversing SUV. When he was sent to the emergency room, he was found to be unconscious, with cold skin, weak limbs and no tension. His blood pressure was 74/52 mmHg, heart rate was 142 beats/min, respiratory rate was 36 breaths/min, and blood oxygen saturation was 88%. Which of the following statements is incorrect?", "input": "(A) A size 4.5 endotracheal tube can be used. (B) The goal of infusion is a urine output of 1 ml/kg/hr. (C) The estimated blood loss for this patient should be greater than 20%. (D) Children are less likely to suffer from traumatic asphyxia when their chest is injured because their bones are soft and flexible. (E) The placement of a nasogastric tube and a urinary catheter will help assess abdominal injuries.", "output": "D"} 
-{"instruction": "A 4-year-old girl was brought to the emergency room by her father, complaining of poor appetite and fever for 1 day. When she arrived at the hospital, her respiratory rate was 32 times/min, her heart rate was 148 times/min, and her temperature was 39 ℃. The girl was reluctant to speak, and it was difficult to understand what she said when she opened her mouth, but she was sure that she did not have a runny nose or cough. During the physical examination, she looked very weak, but was unwilling to lie flat, had difficulty breathing and saliva flowed from the corners of her mouth, and stridor murmurs could be heard in the neck when she inhaled. Which of the following statements and treatments is the least appropriate? ", "input":"(A) Do not force the girl to lie down while she is awake. (B) Give her oxygen and monitor her oxygen saturation. (C) Avoid examining the throat to prevent acute airway obstruction. (D) If possible, a lateral neck X-ray may be taken, but an endotracheal tube must be available for emergency treatment. (E) When X-ray or endoscopy confirms significant swelling, antibiotics should be considered. The most common causative agent is Hemophilus influenzae type A.", "output": "E"} 
-{"instruction": "A 4-year-old boy has had a high fever for 5 days. The doctor suspects Kawasaki disease. Which of the following statements about the disease is incorrect?", "input": "(A) The main symptoms include red and cracked lips and strawberry tongue. (B) Unilateral non-purulent cervical lymphadenopathy. (C) Polymorphous exanthem. (D) Desquamation near the anus. (E) NSAIDs and aspirin are the first choice of drugs. ", "output": "E"}
-{"instruction": "A 50-year-old male had an argument with someone after drinking alcohol 5 days ago. He went to the doctor because of neck pain and swelling. During the examination, it was found that the lower end of the annular cartilage was swollen, his voice was normal, his right pupil was constricted, and his eyelids were drooping. Which of the following statements is incorrect?", "input": "(A) Symptoms of sympathetic cranial nerve damage appear. (B) A head CT scan can be arranged. (C) An arterial angiography can be arranged. (D) If the diagnosis is carotid artery injury, anticoagulants can be considered. (E) A bronchoscopy can be performed.", "output": "E"} 
-{"instruction": "50 A 50-year-old male patient comes to the emergency department with chest discomfort. He took 40 tablets of amlodipine (Norvasc 5 mg/tab) 30 minutes ago and is unconscious. His blood pressure is 60/30 mmHg, heart rate is 40 beats/min, respiratory rate is 20 breaths/min, and body temperature is 37 ℃. Based on current research evidence, which of the following treatments is the most effective? ", "input": "(A) Give 10% Ca gluconate 0.6 ml/kg. (B) Arrange hemodialysis to enhance elimination. (C) Perform gastric lavage as soon as possible and give activated charcoal. (D) Give 1.0 U/kg/hr insulin. (E) Give glucagon 5 mg. ", "output": "D"} 
-{"instruction": "A 50-year-old male patient comes to the emergency department with chest discomfort. On arrival, his vital signs are blood pressure 102/60 mmHg, heart rate 56 times/min, respiratory rate 22 times/min, blood oxygen saturation 95%. The electrocardiogram shows that Lead II, III and aVF all have obvious ST elevation. Which of the following statements is wrong? ", "input": "(A) A right EKG should be considered. (B) If V4R in the right EKG does not have obvious ST elevation, right ventricular myocardial infarction can be ruled out. (C) Regardless of whether V4R in the right EKG has obvious ST elevation, nitroglycerin and morphine should not be given. (D) The clinical manifestations of right ventricular myocardial infarction are hypotension, distended cervical veins and no pulmonary edema. (E) When appropriate intravenous fluids are given for suspected right ventricular myocardial infarction complicated by hypotension, it is not appropriate to use the central venous pressure value as a reference data. ", "output": "B"} 
-{"instruction": "A 50-year-old woman comes to the emergency department for medical treatment. After examination, she is diagnosed with terminal ovarian cancer. You decide to apply the "SPIKE" technique of breaking bad news. Which of the following statements about the "SPIKE" technique of breaking bad news is incorrect? ", "input": "(A) "S" refers to establishing an appropriate communication environment (setting up the interview). (B) "P" refers to assessing the patient's cognition and feelings (perception). (C) "I" refers to assessing the patient's own understanding of the disease (insight). (D)”K” refers to giving patients relevant knowledge and information (knowledge). (E)”E” refers to applying empathy to patients’ emotions and feelings (empathy). ", "output": "C"} 
-{"instruction": "A 50-year-old farmer collapsed beside a field after spraying pesticides. He was taken to the emergency room by EMT. When he arrived at the hospital, his temperature was 38.5℃, his blood pressure was 100/70 mmHg, his respiratory rate was 30 times/min, and his blood oxygen saturation was 88%. Which of the following statements about organophosphate intoxication is correct? ", "input": "(A)Organophosphate pesticides are commonly used herbicides that can cause excessive tracheal secretions and often lead to respiratory failure. (B) The antidote atropine mainly antagonizes nicotinic toxidromes. (C) Patients with convulsions can be treated with diazepam, and at the same time, attention must be paid to the patency of the patient's airway. (D) The toxic mechanism of organophosphate poisoning is mainly to cause a decrease in the secretion of acetylcholine at the nerve terminals. (E) The pupil size of patients with organophosphate poisoning is miosis, and the skin is warm and dry. ", "output": "C"} { 
-"instruction": "A 56-year-old female came to the emergency room because of unconsciousness. During examination, it was found that her body temperature was 39.4 ℃, blood pressure was 130/80 mmHg, heart rate was 100 beats/min, respiratory rate was 16 breaths/min, and blood oxygen saturation was 98%. Many small hemorrhages (petechiae) were found on the skin. The white blood cell count was 10,000/mm 3, the hemoglobin was 8.5 g/dL, and the platelet count was 10,000/mm 3. The PT and aPTT were normal. The blood smear showed schistocytes. The creatinine was 4.5 mg/dL. Which of the following statements is incorrect? ", "input": "(A) This disease is more common in women and adults aged 30-50 years. (B) The patient develops disseminated intravascular coagulation. (C) Restoring the normal platelet count is the goal of treatment. (D) Platelet transfusions should be avoided as much as possible. (E) Plasma exchange can treat most patients. ", "output": "B"} 
-{"instruction": "A 60-year-old woman developed blurred vision and limb paralysis after eating canned pickled oysters yesterday. Her blood pressure was 90/60 mm Hg, her heart rate was 110 beats/min, and her blood oxygen saturation was 85%. Which of the following statements about botulism is incorrect? ", "input": "(A) Normal light reflex of pupils. (B) Body temperature is usually higher than 38.5 ℃. (C) Descending paralysis. (D) Normal mental status. (E) The toxin includes A and B chains, and it is mainly the A chain that causes axonal nerve conduction abnormalities. ", "output": "B"} 
-{"instruction":"A 63-year-old male with a medical history of hypertension and diabetes was sent to the emergency room because of acute chest pain extending to the back. When he sought medical attention, his blood pressure was 220/110 mmHg, his heart rate was 102 beats/min, and his respiratory rate was 22 breaths/min. A chest X-ray showed mediastinum widening, and an electrocardiogram showed left ventricular hypertrophy. Which of the following is incorrect about the diagnosis and clinical treatment of this patient?", "input": "(A) Clinically, aortic dissection should be strongly suspected, and a CT scan should be arranged immediately. (B) Pulse deficit is helpful for diagnosis, but has low sensitivity. (C) Less than half of patients with aortic detachment have calcium signs on their chest X-rays. (D) Aortic detachment usually causes pericardial tamponade, which has a high mortality rate. (E) Regarding blood pressure control in this patient, nitroprusside alone should not be used to avoid reflex tachycardia. ", "output": "D"}
-{"instruction": "A 67-year-old male presented to the emergency department with an accidental left head injury. Physical examination revealed a left fronto-temporal scalp laceration and left orbital hematoma. The pupils were equal in size (2 mm) and the light reflex was normal. The patient was conscious and complained of blurred vision for 3 months. Visual field examination revealed left homonymous hemianopsia. What is the most likely diagnosis?", "input": "(A) Left supradural hemorrhage. (B) Fracture of the skull base and intracranial hemorrhage. (C) Right occipital infarct stroke. (D) Left cerebellar hemorrhage. (E) Pituitary tumor.", "output": "C"} 
-{"instruction": "68 A 60-year-old male was taken to the hospital for treatment because of weakness, nausea, and vomiting in recent days. The patient had a history of heart disease and kidney disease. The long-term medications he took include digitalis, aspirin, and diuretics. A blood test revealed WBC 4,800/mm 3 (band:0%, seg:70%), BUN 53 mg/dL, Creatinine 4.2 mg/dL, K⁺ 7.3 mEq/L, and Digoxin level 1.75 ng/ µL. Which of the following statements is correct? ", "input": "(A) Digoxin level 1.75 ng/ µL cannot rule out the possibility that the symptoms are caused by digitalis poisoning. (B) Emergency hemodialysis cannot quickly improve the condition. (C) If unstable VT occurs, synchronized cardioversion can be used, starting with a bidirectional 100 joule shock. (D) If the digoxin level is greater than 2.5 ng/ µL, digoxin-specific Fab antibody treatment is necessary. (E) Using digoxin-specific Fab antibody, it will be most beneficial to the patient if the digoxin level can be reduced to less than 0.5 ng/ µL. ", "output": "E"} 
-{"instruction": "A 74-year-old female patient suddenly had difficulty speaking and swallowing. Physical examination showed dysphonia, tongue deviation to the right, right face drooping, right facial sensory loss, right arm weakness and aphasia. Which part of the body is most likely to be affected by the above symptoms? ", "input": "(A) Left brain stem. (B) Cerebellum. (C) Left cerebrum. (D) Pons. (E) Right midbrain. ", "output": "C"} 
-{"instruction": "Which of the following is incorrect about the stages of acetaminophen poisoning? ", "input": "(A) Stage 1 (0-24 hours): Symptoms such as nausea, vomiting, and fatigue may occur, and low blood potassium may occur. (B) Stage 2 (24-48 hours): Symptoms usually worsen and right upper abdominal pain may occur, but liver function and prothrombin time are still normal. (C) Stage 3 (72-96 hours): There will be obvious liver cell necrosis, resulting in jaundice, vomiting, and obvious liver function, bilirubin, and PT abnormalities. In severe cases, acute liver and kidney failure, hepatic encephalopathy, hepatic coma, and hemorrhage may occur. (D) In ​​the fourth stage (5-14 days), if the poisoning is not severe, liver function may recover completely. (E) The antidote for acetaminophen poisoning is N-acetylcysteine. ", "output": "B"} 
-{"instruction": "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 emergencies, which of the following statements is incorrect? ", "input": "(A) Infection is the most common acute disease that induces hyperosmotic hyperglycemic state (HHS), especially pneumonia and urinary tract infection. (B) Diuretics, the use of lithium salts, beta-blockers, steroids, calcium ion blockers and other drugs may make patients more susceptible to HHS. (C) HHS patients often have blood glucose higher than 600 mg/dL, effective serum osmotic pressure greater than 315 mOsm/L, arterial pH>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. (D) The average body fluid deficit of HHS is about 20~25% of body weight or 8~12 liters, half of which must be replenished in the first 12 hours, and as far as possible balanced within one day. It is recommended to start with infusion of saline solution at 15-20 ml/kg/hr (first hour), and then 4-14 ml/kg/hr. (E) Insulin therapy for HHS begins with 0.1 units/kg/hr. Blood sugar is measured every hour. If blood sugar drops to 250 mg/dL, switch to infusion of saline solution containing 5% sugar solution to maintain blood sugar at 150-200 mg/dL. ", "output": "E"} { 
-"instruction": "During the emergency room suture of a forehead laceration on a 4-year-old boy, the boy was agitated and unable to cooperate with the suture. Which of the following statements is incorrect? ", "input": "(A) Intramuscular injection of ketamine can produce a combined sedative and analgesic effect. (B) Midazolam can be given because it is safe, effective, and has a short duration of action. (C) Ketamine can be used in combination with midazolam to reduce the occurrence of hallucinations. (D) Ketamine can be used in infants aged 3 months, but be careful about excessive saliva to prevent airway obstruction. (E) Chloral hydrate can be used, but the drug effect is slow and the duration of action is long. ", "output": "A"} 
-{"instruction": "Ideally, the decontamination steps for patients contaminated by chemical disasters should be carried out outside the hospital. Which of the following statements is incorrect? ", "input": "(A) Hot, warm, and cold zones should be established at the disaster site and the site should be sealed off for control. (B) In the hot zone, the main focus is to rescue contaminated patients as quickly as possible to avoid further aggravation of contamination exposure. (C) Contaminated patients in the warm zone should be thoroughly decontaminated and given medical treatment to stabilize their condition. (D) Patients who are transferred out of the cold zone are completely decontaminated. (E) Personnel between the warm zone and the cold zone can support each other in rescue work. ", "output": "E"} "Ideally, the decontamination of patients contaminated by chemical disasters should be carried out outside the hospital. Which of the following statements is incorrect?", "input": "(A) Hot, warm and cold zones should be established at the disaster site and the site should be sealed off for control. (B) In the hot zone, the main task is to rescue contaminated patients as quickly as possible to avoid further aggravation of contamination exposure. (C) In the warm zone, contaminated patients should be thoroughly decontaminated and treated with medical treatment to stabilize their condition. (D) Patients who are transferred out of the cold zone are already completely decontaminated. (E) Personnel between the warm and cold zones can support each other in rescue work.", "output": "E"} 
-{"instruction": "An earthquake victim was crushed by a collapsed house and was taken to the hospital 8 hours later. What is the least likely injury to occur at this time?", "input": "(A) Hypothermia. (B) Rhabdomyolysis. (C) Traumatic asphyxia. (D) Cardiac arrhythmia and sudden death due to tissue reperfusion. (E) Severe infection of the wound leading to sepsis.", "output": "E"}
-{"instruction":"There is a fire scene with a large number of casualties. The on-site medical examiner found a patient lying on the ground without breathing. After opening the airway, he still could not breathe on his own. According to the START (Simple Triage and Rapid Treatment) medical examination principle, which is the most appropriate next step?", "input": "(A) Give mouth-to-mouth artificial respiration. (B) Insert a laryngeal mask airway. (C) Check for pulse. (D) Give external cardiac massage. (E) Give up first aid.", "output": "E"} 
-{"instruction": "Regarding pediatric trauma, which of the following statements is correct?", "input": "(A) In order to achieve the sniffing position, the occiput should be raised during intubation. (B) Because of the placement of the intraosseous needle It may damage the growth plates, so it is recommended for children under 6 years old only when both intravenous catheters and central venous catheters cannot be established. (C) If a 6-year-old child has severe bleeding, give 10 ml/kg of fluid therapy. (D) If the chest X-ray does not show rib fractures, pneumothorax or hemothorax, the chance of pulmonary contusion is extremely low. (E) The normal urine output of infants under 1 year old should be greater than 2 ml/kg/hr. ", "output": "E"} 
-{"instruction": "Regarding the clinical use of antidotes for poisoned patients, which of the following is incorrect? ", "input": "(A) Tricyclic antidepressant (TCA)--sodium bicarbonate. (B) Benzodiazepine -- flumazenil. (C) Azides -- amyl & sodium nitrite, sodium thiosulfate. (D) Methemoglobinemia -- methylene blue. (E) Methanol -- fomepizole. ", "output": "C"} {"instruction": 
-"Which of the following statements about and treatments for eclampsia in pregnant women is incorrect? ", "input": "(A) The most effective drug for controlling seizures is MgSO 4, with a loading dose of 6 gm. (B) Diuretics should be given actively to control diastolic blood pressure to < 105 mmg/Hg and urine output to > 30 ml/hr , to reduce the edema. (C) If the patient continues to have seizures, a head CT scan is still required. (D) The patient must have proteinuria to meet the diagnosis. (E) Induction of labor should be arranged as soon as possible. ", "output": "B"} 
-{"instruction": "Which of the following descriptions of acute abdominal pain in pregnant women is incorrect? ", "input": "(A) In the early stages of pregnancy, the most common symptoms are ectopic pregnancy and threatened abortion. (B) In the late stages of pregnancy, the most common symptoms are early uterine contractions and placental abruption. (C) The incidence of gallstones increases during pregnancy, and it is the disease that most pregnant women need emergency surgery for. (D) The incidence of acute appendicitis remains the same in pregnant women, but the proportion of delayed diagnosis is higher. (E) Ultrasound is the preferred diagnostic tool for pregnant women with acute abdominal pain. ", "output": "C"} 
-{"instruction": "Regarding the 'Public places that should be equipped with automatic external cardiac defibrillators' announced by the Ministry of Health and Welfare in 2013, which of the following does not belong to the eight categories of public places stipulated in the regulations? ", "input": "(A) Taiwan Railway stations above second class. (B) Passenger aircraft with more than 19 seats and cabin crew members. (C) Movie theaters with an average of 3,000 people entering and leaving per day. (D) Schools above junior high school level. (E) Hotels, inns, and guest houses with more than 250 guest rooms (limited to those with dormitories). ", "output": "D"} 
-{"instruction": "Which of the following statements about acute appendicitis in children is incorrect? ", "input": "(A) Non-ruptured appendicitis is more common in boys, with the peak period being between 9 and 12 years old, and is less common in children under 2 years old. (B) Acute appendicitis may present with local peritoneal signs, but if the coccyx is located in the pelvic cavity, this sign is less likely to occur. (C) The patient will experience anorexia, vomiting, and right lower abdominal pain. Children with non-ruptured appendicitis may have a fever, but the fever of children with ruptured appendicitis is higher. (D) The chance of rupture of appendicitis in children over 10 years old is higher than that in children under 3 years old. (E) Non-ruptured appendicitis can progress to ruptured appendicitis within 8 to 24 hours after the onset of symptoms, so it is necessary to see a surgeon as soon as possible. ", "output": "D"} 
-{"instruction": "Which of the following statements about the diagnosis of roseola infantum is incorrect? ", "input": "(A) It is mainly caused by human herpes virus type 6. (B) The most common age is 6 months to 3 years old. (C) The fever subsides soon after the rash appears. (D) The rash mainly appears on the neck, trunk, buttocks and oral mucosa. (E) The chance of fever seizure is high. ", "output": "E"} 
-{"instruction": "Which of the following statements about the American Heart Association (AHA) emergency treatment for acute ischemic stroke patients is incorrect? ", "input": "(A) The National Institutes of Health Stroke Scale (NIHSS) assessment should be completed as soon as possible. (B) If the patient is not using oral anticoagulants, if time is urgent, r-tPA treatment can be given before the coagulation test results come out. However, if the test results later show that INR > 1.7 or prolonged aPTT time, treatment should be stopped. (C) If the regulations and indications are met, thrombolytic therapy can be performed with r-tPA. The recommended dose is 0.9 mg/kg, 10% intravenous push over 1 minute, and the remaining 90% intravenous drip over 1 hour. (D) When r-tPA is administered, aspirin should be given as soon as possible. (E) If r-tPA has been administered, it is not recommended to administer anticoagulants such as heparin. ", "output": "D"} 
-{"instruction": "Which of the following statements about the National Institutes of Health Stroke Scale (NIHSS) is incorrect? ", "input": "(A) Covers a complete neurological examination to assess acute stroke patients. (B) Can assess the clinical severity of stroke patients. (C) Scores range from 0 to 42. (D) Higher scores indicate more severe conditions. (E) Generally speaking, thrombolytic agents are not recommended for patients with scores greater than 25. ", "output": "A"}
-{"instruction": "Which of the following statements about the differential diagnosis of vertigo is incorrect?", "input": "(A) The symptoms of benign paroxysmal positional vertigo will subside with repeated inductions. (B) The age at which Ménière's disease first occurs is usually under 65 years old. (C) If gait disturbance, hearing loss and unilateral poor vision are combined, a cerebellopontine angle tumor should be considered. (D) Vestibular neuronitis usually lasts for a few days and usually does not recur. (E) Labyrinthitis is often associated with hearing loss. ", "output": "B"} 
-{"instruction": "Which of the following statements about out-of-hospital emergency response operations is incorrect? ", "input": "(A) Triage is done using simple triage and rapid treatment (START). (B) If there is a situation that endangers rescue workers at the disaster scene, the principle should be to reduce on-site treatment and transfer quickly. (C) Patients with minor injuries can be sent to a more distant hospital to avoid congestion in the local hospital's emergency department, which makes it impossible to effectively treat seriously ill patients. (D) In ​​order to rescue the disaster as quickly as possible, the commander should ask the nearest emergency hospital to send medical personnel to form a rescue team for rescue. (E) The response command center needs to keep in close contact with the local hospital and communicate the conditions of patients who need to be transferred to the hospital in order to achieve perfect coordination. ", "output": "D"} 
-{"instruction": "Which of the following statements about septic shock is wrong? ", "input": "(A) Septic shock is a complication of sepsis with an average arterial pressure of less than 65 mmHg, and it is still hypotension after rapid infusion of 30 ml/kg. (B) A central venous catheter (CVP) should be placed and the CVP level should be maintained at around 8-12 mmHg. (C) Most cases of community meningitis with septic shock are caused by S. pneumoniae or N. meningitidis. (D) If pressors are considered, dopamine should be used first. (E) Septic shock caused by soft tissue infection is often accompanied by bacteremia. ", "output": "D"} 
-{"instruction": "Which of the following statements about adrenal insufficiency is incorrect? ", "input": "(A)Addison disease is currently believed to be mostly related to people with immune diseases. (B)According to statistics worldwide, the most common infectious cause of adrenal insufficiency is tuberculosis. (C)One of the complications that patients may experience after pituitary surgery. (D)HIV can directly damage the adrenal glands and cause adrenal insufficiency. (E) Sheehan syndrome is a postpartum blood loss that causes necrosis of the anterior pituitary gland, leading to endocrine disorders, including adrenal insufficiency. ", "output": "D"} 
-{"instruction": "Which of the following statements about tumor lysis syndrome is incorrect? ", "input": "(A) It is mainly a malignant tumor that occurs in the blood. (B) The most likely ion imbalance to cause fatality in tumor lysis syndrome is high potassium. (C) High calcium is also common in tumor lysis syndrome. (D) Treatment of hyperuricemia includes alkalinizing urine, intravenous infusion, and administration of acetazolamide. (E) Intravenous infusion and the use of the uric acid-lowering drug allopurinol can reduce the occurrence of tumor lysis syndrome. ", "output": "C"} 
-{"instruction": "Which of the following statements is correct about emergency thoracotomy? ", "input": "(A) Blunt wound, no pulse, EKG is asystole. (B) Blunt wound, no pulse, EKG is pulseless electrical activity (PEA). (C) Puncture wound, no pulse, EKG is asystole. (D) Puncture wound, no pulse, EKG is PEA. (E) Puncture wound, pulse, obvious shock. ", "output": "D"} 
-{"instruction": "Which of the following statements is correct about decompression sickness caused by diving? ", "input": "(A) After diving to a depth of 30 meters, limb and joint pain is caused, which is Type II decompression sickness (Type II DCS). (B) After participating in diving tourism activities, if you want to take a plane back to Taiwan, you must wait at least 6 hours after the diving activity ends to avoid decompression sickness. (C) The most effective treatment for decompression sickness is to use hyperbaric oxygen (HBO) therapy directly in a pressurized chamber 3ATA. (D) For the adjuvant treatment of decompression sickness, heparin has not been effective in humans in empirical medical research. (E) The pathological mechanism of decompression sickness caused by diving is due to the supersaturation and accumulation of helium in the body. ", "output": "D"} 
-{"instruction": "Which of the following statements about diaphragm injuries is incorrect? ", "input": "(A) Puncture injuries are more common than blunt contusions. (B) Blunt contusions are more likely to occur on the left side. (C) Minor diaphragm injuries are difficult to detect on CT cross-sectional examinations. (D) They are easily misdiagnosed as unilateral hemothorax. (E) The main clinical manifestation is hemorrhagic shock. ", "output": "E"} 
-{"instruction": "Which of the following statements about status epilepticus is incorrect? ", "input":"(A) The definition of epileptic state is continuous or intermittent seizures lasting more than 30 minutes without recovery of consciousness. (B) Patients taking epileptic medications usually need to monitor the concentration of epileptic medications. (C) The common cause of the first epileptic seizure in the elderly is cerebral stroke. (D) Depakine is more suitable than phenytoin for patients with epileptic state with arrhythmia. (E) The recommended dose of phenytoin is 20 mg/kg. It should not be added to an infusion containing glucose, and the rate should not exceed 50 mg/min.", "output": "A"} 
-{"instruction": "You are treating a 3 Which of the following medical histories would be least helpful in helping you determine whether the infant is at high risk for sudden infant death syndrome (SIDS)? ", "input": "(A) The parents let the boy sleep on his stomach. (B) The boy was a premature baby. (C) The boy slept in a separate crib in the same room as his parents. (D) The parents let the baby sleep on a soft mattress. (E) The father is a smoker. ", "output": "C"} 
-{"instruction": "You are treating a 5-day-old newborn. The mother said that the baby girl was found to have blood stains when changing her diaper. Because she had found similar phenomena 3-4 times, the mother was very worried and took the baby to the emergency room for treatment. The baby girl is very active and is eating as she did in the nursery. Physical examination is unremarkable. Which of the following diagnoses is most appropriate? ", "input": "(A) False menstruation and vaginal discharge. (B) Infectious colitis. (C) Urinary tract infection. (D) Diaper rash. (E) Anal fissure. ", "output":"A"} 
-{"instruction": "You are caring for a 6-month-old febrile baby girl whose mother says she has Tetralogy of Fallot and has not yet undergone full surgical correction. On physical examination, you find that the baby is suddenly agitated, tachypneic, and cyanotic. Which of the following actions is least appropriate?", "input": "(A) Provide oxygen, with the baby in a knee-bent chest position. (B) Give digoxin (30-50 micrograms per kilogram). (C) Give propranolol (0.2 milligrams per kilogram). (D) Give morphine (0.1-0.2 milligrams per kilogram). (E) Give saline infusion therapy (20 milliliters per kilogram).", "output": "B"}
-{"instruction": "Based on the structure and content of the Taiwan Triage & Acuity Scale (TTAS), regarding child triage, which of the following statements is incorrect?", "input": "(A) If a child with a level 3 triage waits for more than 30 minutes, the triage staff must reassess the urgency of the child's condition. (B) If the triage staff determines the urgency based on the absolute heart rate of different ages, it is more likely to cause overtriage. (C) Pain is divided into peripheral pain and central pain. (D) Coagulation abnormalities are not included in the judgment criteria. (E) High-risk injury risk has been included in the judgment criteria.", "output": "C"} 
-{"instruction": "Child physical abuse Abuse) Common features, which does not include the following? ", "input": "(A) Spiral fracture. (B) Clavicle fracture in newborns. (C) Immersion burn. (D) Retinal hemorrhage. (E) The mechanism of injury does not match the description of the medical history. ", "output": "B"} { 
-"instruction": "An explosion at a petrochemical plant caused the leakage of toxic chemicals, resulting in casualties. The toxic chemical was found to be acrylonitrile. Which of the following is incorrect? ", "input": "(A) Acrylonitrile is a highly flammable toxic chemical that can be easily ignited by sparks and burning acrylonitrile will release nitrogen oxides and hydrocyanic acid. (B) Remove patients with inhalation exposure from the exposure source and provide appropriate ventilation and oxygen supply; patients with skin exposure to acrylonitrile will also be poisoned, so make sure that proper decontamination has been completed in the decontamination area. (C) Administer the antidote cyanide antidote kit or cyanokit (hydroxocobalamin) for acrylonitrile poisoning. (D) The detoxification mechanism of the antidote cyanide antidote kit is converted to the production of a complex, reducing the toxic effects of cyanide. (E) Acrylonitrile is a systemic asphyxiant. ", "output": "D"} 
-{"instruction": "Which of the following statements about the protective clothing of responders in nuclear, biological and chemical incidents is incorrect? ", "input": "(A) Level A protective clothing for toxic chemicals, including a self-contained air bottle (SCBA) plus a full-body airtight protective suit, provides the highest level of protection. (B) Level C protective clothing for toxic chemicals, including a full-face mask plus an appropriate filter canister, and a full-body splash-proof protective suit. (C) Medical personnel who come into contact with and treat chemical disaster patients in hospital emergency rooms must wear Level B protective clothing. (D) These protective suits do not protect against penetrating radiation. (E) Protective clothing commonly used in radiation disasters is mainly used to prevent personnel from being contaminated by radiation dust.", "output": "C"} 
-{"instruction": "According to the 2010 ILCOR and AHA/ACC ACLS guidelines, which of the following statements is incorrect? ", "input": "(A) For emergency treatment of patients with ventricular fibrillation, the first epinephrine should be given after the second defibrillation. (B) For unstable PSVT, you can try to give adenosine 6 mg once; if it fails, synchronize the shock. (C) For stable wide QRS complex tachycardia that is not sure whether it is VT, you can try to give adenosine 6 mg once; if it fails, switch to amiodarone or procainamide. (D) For unstable atrial fibrillation combined with WPW, synchronize the shock. (E) For unstable torsades de pointes, defibrillation shock should be used. ", "output": "D"} 
-{"instruction": "According to the new version of the Palliative Care Ordinance, which of the following statements is correct? ", "input": "(A) When a patient signs a consent form, there must be two witnesses. In an emergency, if family members are not available, hospital doctors, nurses and social workers can serve as witnesses. (B) A terminally ill cancer patient is intubated in the emergency room due to coma and respiratory failure. Although he has not signed a consent form to waive emergency treatment, life support equipment can still be removed after his spouse arrives and signs a consent form. (C) Two doctors are required to judge and sign for the diagnosis of terminally ill patients, at least one of whom must be a relevant specialist. (D) If a terminally ill cancer patient who has lost his spouse falls into a coma, and his father and adult son have different opinions on whether to intubate the patient, the father's opinion shall prevail according to the law. (E)Terminal cancer patients can only be recorded in the medical institution's medical records after signing a consent form, but they cannot be recorded in the health insurance card due to the Personal Information Act. ", "output": "B"} 
-{"instruction": "The patient's oxygen concentration (FiO 2) is 40%, and his PaO 2 is 185 mmHg, and PaCO₂ is 40 mmHg. What is the estimated alveolar-arterial oxygen difference (Aa DO 2) of the patient? ", "input": "(A)50. (B)100. (C)150. (D)200. (E)250. ", "output": "A"} 
-{"instruction": "Which of the following statements is incorrect about the patient's past medical history and the common pneumonia pathogens he has? ", "input": "(A) In healthy adults with influenza, the most common cause of pneumonia is Legionella species. (B) In COPD patients, the most common cause of pneumonia is Haemophilus influenzae. (C) In alcoholics, the most common cause of pneumonia is Klebsiella pneumoniae. (D) In ​​patients who have just been discharged from the hospital, the most common cause of pneumonia is Pseudomonas aeruginosa. (E) In AIDS patients, the most common cause of pneumonia is Pneumocystis carinii. ", "output": "A"} "(A) In healthy adults with influenza, the most common cause of pneumonia is Legionella species. (B) In patients with COPD, the most common cause of pneumonia is Haemophilus influenzae. (C) In patients with alcohol addiction, the most common cause of pneumonia is Klebsiella pneumoniae. (D) In ​​patients who have just been discharged from the hospital, the most common cause of pneumonia is Pseudomonas aeruginosa. (E) In patients with AIDS, the most common cause of pneumonia is Pneumocystis carinii.", "output": "A"} 
-{"instruction": "Intussusception is a common abdominal emergency in children. Which of the following statements is incorrect?", "input": "(A) Barium enema is one of the diagnostic methods. (B) Currant jelly stools are (C) Ultrasound may reveal a target sign. (D) If there is evidence of intestinal perforation, surgery should be recommended. (E) The most common type is ileo-colic. ", "output": "B"}
-{"instruction":"Which of the following statements is incorrect for a patient with suspected thoracic vertebral fracture and displacement?", "input": "(A) Arrange a spine CT scan immediately. (B) Perform a physical examination to check anal tone immediately. (C) There is insufficient literature to support the routine use of steroids. (D) If hypotension and tachycardia are present, neurological shock should be considered. (E) Arrange surgery as soon as possible to perform reduction and fixation.", "output": "D"}
-{"instruction": "The Ministry of Health and Welfare implemented the "Emergency and Referral Quality Improvement Plan" this year. Which of the following statements about referrals is incorrect?", "input": "(A) When a hospital makes a referral, it should inform the patient or his/her family of the reason and risk, and record it in the medical record. (B) When a hospital makes a referral, it should assist the patient in selecting and arranging appropriate rescue transportation tools and rescue personnel, and provide appropriate life-sustaining equipment, drugs, and medical materials. (C) When a hospital makes a referral (including voluntary discharge), it should fill out a referral form and deliver it together with a medical record summary to the accompanying rescue personnel; if necessary, it may first be sent to the hospital receiving the referral by fax or electronic document. (D) When a hospital makes a referral, it should first contact the hospital for secondary evacuation. The base hospital for secondary evacuation may refuse to accept the referral due to full beds. (E) If the patient's condition is still not stable after treatment, but the patient or his family requests to be discharged from the hospital, a discharge summary and referral form should still be submitted. ", "output": "D"} 
-{"instruction": "For a patient with head trauma and a coma index of 14 points, which of the following statements is incorrect for the indications of a head CT scan? ", "input": "(A) Only dizziness and nausea. (B) Symptoms of amnesia. (C) Local neurological abnormalities. (D) Confusion or seizure. (E) History of abnormal coagulation function. ", "output": "A"} 
-{"instruction": "Which of the following statements about testicular torsion is incorrect? ", "input": "(A) Testicular torsion often occurs after strenuous exercise. (B) The diagnostic rate of unilateral disappearance of the cremasteric reflex can reach 99%. (C) Doppler ultrasound can be used for diagnosis, and reduced blood flow on the affected side can be seen. (D) If the entire testicle is painful and swollen during testicular torsion, holding it with the hand will relieve testicular pain. (E) The golden treatment period is within 6 hours of onset. ", "output": "A"} 
-{"instruction": "Which of the following statements about bystander CPR and public access defibrillation (PAD) is incorrect? ", "input": "(A) If a patient with ventricular fibrillation (VF) is not defibrillated in time, the survival rate decreases by 7-10% per minute. (B) After the revision of Taiwan's Emergency Medical Rescue Act this year, it is stipulated that eight types of public places should be equipped with automated external defibrillators (AEDs) or other necessary emergency rescue equipment. (C) PADs must be used in conjunction with bystander CPR to effectively achieve the purpose of first-time rescue. (D) The aforementioned amendment stipulates that if a person other than a rescuer uses emergency rescue equipment or performs emergency measures to eliminate the imminent danger to the life of another person, the provisions of the Civil Code and the Criminal Code on emergency evacuation exemption shall apply. (E) Regardless of whether the patient is in the hospital when VF occurs and collapses, or whether an AED/defibrillator is present, CPR should be performed for 1.5 to 3 minutes before defibrillation. This will increase the patient's chance of survival and prognosis. ", "output": "E"} 
-{"instruction": "Which of the following statements about the clinical diagnosis and treatment of H7N9 influenza is incorrect? ", "input": "(A) There is currently no phenomenon of sustained human-to-human transmission, but limited human-to-human transmission cannot be ruled out. (B) Taiwan has classified this case as a Category 5 infectious disease. (C) The infectious period is within 7 days after onset of illness. (D) For acute respiratory tract infection, clinical symptoms must include at least fever (≧38 ℃) and cough as one of the clinical conditions. (E) One of the test conditions is the isolation and identification of H7N9 influenza virus in clinical specimen culture. ", "output": "C"} 
-{"instruction": "Regarding head trauma, if hyperventilation is used to temporarily reduce intracranial pressure, what range of PaCO₂ should be maintained? ", "input": "(A) Above 35 mmHg. (B) 30~35 mmHg. (C) 25~30 mmHg. (D) 20~25 mmHg. (E) < 20 mmHg. ", "output": "B"} 
-{"instruction": "Regarding cardiac tamponade, which of the following statements is incorrect? ", "input": "(A)Possible causes include pericarditis, hypothyroidism, cancer, uremia, ventricular rupture, and trauma. (B)Typical clinical manifestations are hypotension, jugular vein distension, and distant, muffled heart sounds. However, these symptoms are often absent in patients with trauma or combined bleeding. (C)If a patient with acute chest pain suddenly faints and his blood pressure cannot be measured, and bedside ultrasound reveals a moderate amount of pericardial effusion, myocardial infarction with myocardial rupture or aortic detachment should be considered. (D)For non-traumatic or non-mechanical pericardial tamponade, the first treatment to consider is norepinephrine. (E) For traumatic or nonmechanical pericardial tamponade, surgical pericardiotomy should usually be considered. ", "output": "D"} 
-{"instruction": "Which of the following statements is correct about the clinical manifestations and management of varicella-zoster virus? ", "input": "(A) The varicella rash extends from the face and scalp to the trunk and limbs, with more lesions on the covered than exposed parts of the body, and the rash changes at all stages can be seen at the same time. The smallpox rash is distributed eccentrically, and the rash evolves in a regular and uniform pattern. (B) Children infected with varicella should avoid using acetaminophen as a fever-reducing drug to prevent the occurrence of Reye syndrome. (C) Clinical infection is mostly self-limiting, and the antiviral drug acyclovir may cause teratogenicity. Therefore, it is not recommended to treat pregnant women with varicella infection with the antiviral drug acyclovir. (D) The main causes of death in adults are myocarditis and viral encephalitis, while in children they are mainly sepsis and primary viral pneumonia. (E) The mode of transmission is direct skin contact with varicella or herpes zoster scabs, respiratory droplets or airborne transmission. It is one of the most contagious diseases along with open tuberculosis and measles. ", "output":"(A) The varicella rash extends from the face and scalp to the trunk and limbs. There are more lesions on the covered parts of the body than on the exposed parts, and the rash changes at different stages can be seen at the same time. The smallpox rash is distributed eccentrically, and the rash evolves regularly and uniformly. (B) Children infected with varicella should avoid using acetaminophen as a fever-reducing drug to avoid the occurrence of Reye syndrome. (C) Clinical infections are mostly self-limiting, and the antiviral drug acyclovir may have the risk of causing teratogenicity. Therefore, it is not recommended to treat pregnant women with varicella infection with the antiviral drug acyclovir. (D) The main causes of death in adults are myocarditis and viral encephalitis, while in children, they are mainly septicemia and primary viral pneumonia. (E) The transmission mode is direct skin contact with varicella or herpes zoster scabs, respiratory droplets or airborne transmission. It is one of the most contagious diseases along with open pulmonary tuberculosis and measles. ", "output": "A"} 
-{"instruction": "Which of the following concepts about traumatic hemorrhagic shock and transfusion is most appropriate? ", "input": "(A) Massive transfusion usually refers to the administration of more than 5 units of concentrated red blood cells (PRBC) within 12 hours. (B) When massive transfusion is required, red blood cells, plasma, and platelets should be given as soon as possible, and large amounts of crystalloid transfusion should be avoided. (C) When normal temperature transfusion is given, the chance of survival can be increased. (D) The most common reason for poor response to transfusion emergency is uncontrolled bleeding. (E) Excessive transfusion does not cause coagulation abnormalities. ", "output": "B"}
-{"instruction": "Which of the following statements about thyroid storm is incorrect?", "input": "(A) For patients with hyperthyroidism, thyroid storm is a clinical diagnosis. (B) The most common triggering cause is infection. (C) When hyperthyroidism without complications turns into thyroid storm, free T4, T4 and T3 will increase significantly. (D) Patients may experience symptoms of the central nervous system such as drowsiness, convulsions and coma. (E) Patients may experience symptoms of the gastrointestinal system such as anorexia, jaundice and liver enlargement.", "output": "C"} 
-{"instruction": "Which of the following statements about elderly injuries is incorrect?", "input": "(A) Hemorrhagic shock usually does not cause rapid heartbeat. (B) In case of hypotension, crystalloid can be given once, 1-2 liters. Elderly people should be given blood transfusion earlier than the general population. (C) In case of head trauma, the elderly are more likely to have epidural hemorrhage than the general population. (D) Cervical fractures occur more frequently in the elderly and are more difficult to diagnose. (E) The most common sites of fractures in the elderly are the hip, humerus, and wrist.", "output": "C"} 
-{"instruction": "Which of the following statements about the treatment of gastrointestinal bleeding is incorrect?", "input": "(A) Proton pump inhibitor can reduce the rebleeding rate of hemorrhagic gastric ulcers and can also reduce the need for blood transfusions and surgery. (B) If there is obvious or large amounts of blood in the stool, a nasogastric tube should be placed to rule out upper gastrointestinal bleeding. (C) Angiography can be used as a diagnostic tool, but the bleeding rate must be at least 0.5 ml/min to be detected. (D) Sengstaken-Blakemore tube (SB tube) is no longer recommended for the treatment of esophageal varicose bleeding due to too many complications. (E) Nasogastric tube placement can be considered for upper gastrointestinal bleeding, even if esophageal varicose bleeding is suspected. ", "output": "D"} 
-{"instruction": "Regarding chest trauma, rib and scapula fractures, which of the following statements is incorrect? ", "input": "(A) Scapula fractures usually do not require surgical treatment. (B) Fractures of ribs 1 to 3 are prone to complications of major blood vessels or thoracic spinal cord injury, with a mortality rate of about 10%. (C) Fractures of the sternum or scapula are common in direct impacts. (D) Fractures of ribs 10 to 12 are often associated with liver and spleen damage. (E) Rib fractures require attention to the presence of pneumothorax, hemothorax, and subsequent pneumonia. ", "output": "B"} 
-{"instruction": "Which of the following statements about alcohol withdrawal syndrome is incorrect? ", "input": "(A) Symptoms appear 6-24 hours after stopping drinking. (B) Symptoms may last for about 2-7 days. (C) Patients with alcohol withdrawal often experience sweating, unsteady gait (ataxia), and hallucinations. (D) Blood pressure rises and the heart rate increases. (E)Consciousness changes are mainly characterized by drowsiness. ", "output": "E"} 
-{"instruction": "Which of the following statements about the treatment of paroxysmal supraventricular tachycardia is incorrect? ", "input": "(A)The vast majority of PSVT cases are narrow QRS complex, but a few are wide QRS complex. (B)In the emergency treatment of PSVT in the hospital, there is no need to perform carotid sinus massage first, and adenosine can be used directly. (C)In places where no drugs are available, carotid sinus massage should be performed on the right side of the PSVT patient to avoid more severe right-sided hemiplegia in case the patient suffers a stroke. (D)Adenosine can be used to treat PSVT in pregnant women. (E) Adenosine can be used for PSVT caused by WPW syndrome. ", "output": "C"} 
-{"instruction": "Which of the following statements about hydrofluoric acid is incorrect? ", "input": "(A) Hydrofluoric acid is a relatively weak acid. It dissociates hydrogen ions about 1000 times slower than strong acids such as hydrochloric acid, so it is not easy to cause chemical burns. (B) The severity of the injury depends on the concentration of hydrofluoric acid and the duration of exposure. (C) It destroys oxidative phosphorylation, glycolysis and other cellular metabolism. (D) It causes hypocalcemia, hypomagnesemia and hyperkalemia. (E) The main toxicity comes from fluoride ions. ", "output": "A"} 
-{"instruction": "Which of the following statements is correct about the diagnosis and treatment of dengue fever? ", "input": "(A) Both Aedes aegypti and Aedes albopictus are dengue vectors, the former prefers to live indoors, while the latter mostly lives outdoors. (B) It ranks second in the number of confirmed imported cases of legal infectious diseases in Taiwan, second only to amoebic dysentery in total number of cases. (C) The number of imported cases is greater than the number of local cases, especially Southeast Asia and Central and South America, which are high epidemiological risk areas. Local cases are currently limited to Tainan, Kaohsiung and Pingtung. (D) The period from 1 day before onset to 10 days after onset is the "infectious period" or "viremia period". During this period, if the infected person is bitten by a mosquito, the mosquito will be infected with the dengue virus and have the ability to further infect. Therefore, suspected dengue patients need to be treated and observed under a hanging mosquito net during this period to prevent the spread of the epidemic. (E) In addition to a decrease in platelets below 100,000, dengue hemorrhagic fever patients will also experience plasma leakage due to increased microvascular permeability, resulting in a relative blood concentration effect, causing the patient's hematocrit to increase by 20% and serum protein levels to increase. ", "output": "A"} 
-{"instruction": "Which of the following statements about abdominal aortic aneurysm is incorrect?", "input":"(A) Abdominal aortic aneurysms smaller than 4 cm have a low chance of rupture. (B) Most intact abdominal aortic aneurysms are painless. When they are painful, it indicates that the aneurysm may have ruptured. (C) Whether hypotension occurs is an important factor affecting the prognosis of ruptured abdominal aortic aneurysms. (D) If aortic rupture is accompanied by hypotension, a large amount of blood and fluid transfusion should be actively given to restore blood pressure to normal. The prognosis of surgery is better. (E) If hemodynamics is unstable and there is a high suspicion of abdominal aortic rupture, surgical treatment should be performed immediately and should not be delayed to wait for CT angiography.", "output": "D"} 
-{"instruction": "Which of the following statements about blunt abdominal injuries is incorrect?", "input": "(A) The most commonly injured organs are the spleen and liver. (B) If the vital signs of liver and spleen injuries are stable, non-surgical treatment can be adopted. (C) If the vital signs are unstable and ultrasound reveals a large amount of abdominal bleeding, surgery can be performed directly. (D) Intestinal injuries often have no symptoms in the early stages of abdominal trauma, and the patient's symptoms and physical examinations must be continuously observed. (E) Diaphragm injuries are more common on the right side.", "output": "E"}
-{"instruction": "Which of the following laboratory data is most supportive of pleural fluid examination for empyema?", "input": "(A) Pleural fluid culture is positive for bacteria. (B) Pleural fluid lactate dehydrogenase is greater than 1,000 IU/L. (C) Pleural fluid pH is less than 7.1. (D) Pleural fluid white blood cell count is greater than 10,000/mm3. (E) Pleural fluid glucose is less than 40 mg/dL.", "output": "D"} 
-{"instruction": "A 6-year-old girl weighing approximately 30 kg was brought to the emergency room by her family and was drowsy and had rapid breathing. Her blood pressure was 80/40 mmHg, her heart rate was 130 beats/min, and her blood sugar was 500 mg/dL. The emergency physician assessed that she had a 10% Regarding dehydration, which of the following statements is incorrect regarding treatment and prognosis? ", "input": "(A) It may be considered to give priority to infusing 600 ml of 0.9% saline solution to increase blood pressure. (B) If the child's consciousness improves and perfusion is appropriate after infusing 600 ml of 0.9% saline solution once, the infusion should not exceed 1.5 times the maintenance infusion within 48 hours. (C) After the saline solution infusion, regular insulin 0.1 unit/kg/hr is immediately given by continuous intravenous infusion. (D) If the hyponatremia still cannot be stabilized after blood sugar is corrected, it is considered one of the risks of cerebral edema. (E) Appropriate saline infusion, bicarbonate and regular insulin supplementation can reduce the occurrence of cerebral edema. ", "output": "E"} 
-{"instruction": "Which of the following statements about pregnant women's trauma is wrong?", "input": "(A) The best initial treatment for the fetus is to provide the best treatment for the mother's injuries and to conduct early assessment of the fetus. (B) The general priority of treatment is the same as that for non-pregnant women. (C) The best lying position for pregnant women is generally to raise the left side. (D) When the blood gas analysis PaCO2 is 40 mmHg, respiratory failure should be considered. (E) Tetanus toxoid can be used in early pregnancy. ", "output": "C"} 
-{"instruction": "Which of the following statements about traumatic diaphragmatic rupture is incorrect?", "input": "(A) It usually occurs on the left side. (B) Blunt injuries are more likely to cause large radial lacerations in the diaphragm, while puncture injuries cause small holes. (C) X-rays in the early stages of injury are often mistaken for elevated diaphragms or localized hemothorax. (D) When left-sided diaphragmatic rupture is suspected, a gastric tube can be placed. If a chest X-ray shows the gastric tube in the chest cavity, the diagnosis can be confirmed. (E) For smaller diaphragmatic injuries, the diagnosis rate of CT scan is very high. ", "output": "E"} 
-{"instruction": "Which of the following statements about scratches and bites from suspected rabid animals is incorrect?", "input": "(A) Avoid suturing the wound if possible. If suturing is necessary, it should be as loose as possible. (B) Antibiotics, tetanus vaccine, or tetanus immune globulin should be given as is the treatment for other scratches and bites. (C) Post-exposure vaccination is not recommended for scratches and bites from domestic dogs and cats. (D) Vaccination is recommended for stray dogs and cats if the exposure level is Category II or above. (E) For non-immunocompromised individuals, rabies immune globulin should be given if the exposure level is Category II. ", "output": "E"} 
-{"instruction": "Regarding shock, the human body uses a compensatory mechanism formed by the autonomic response to increase blood flow to important organs. Which of the following statements is incorrect?", "input": "(A) Small arteries located in the skin, muscles, kidneys and spleen contract. (B) Heart rate and cardiac contraction increase to increase cardiac output. (C) Promote the release of antidiuretic hormone to retain water and salt in the body and increase blood vessel volume. (D) Reduce the release of vasoactive hormones, such as dopamine and epinephrine. (E) Veins contract to increase blood return. ", "output": "D"} 
-{"instruction": "Which of the following statements about aeromedical transportation is incorrect?", "input": "(A) When transporting patients by helicopter, patients with poor consciousness should consider placing a nasogastric tube to reduce the risk of aspiration pneumonia. If the patient has been intubated, the cuff pressure should be maintained at the highest limit before boarding. (B) In terms of patient safety, fixed-wing aircraft is a better choice than helicopters. (C) Patients with blast injuries must be particularly careful about the deterioration of pneumothorax, hollow organ rupture, and arterial air embolism. (D) In ​​addition to meeting the indications for air ambulance, air transfer is limited to cases where the hospital in the area is unable to provide complete treatment due to its equipment and expertise, and if air transfer is not performed, the time limit for emergency medical treatment will be affected. (E) Taiwan has the National Aeromedical Counseling Center (NACC), which is responsible for reviewing applications for the use of publicly funded air transfers to transport injured patients in Taiwan. ", "output": "A"} 
-{"instruction": "A mother and daughter, aged 44 and 15 respectively, both began to experience symptoms such as vomiting, diarrhea, dizziness, drooping eyelids, muscle weakness, and difficulty swallowing and breathing two days ago. Both were admitted to the intensive care unit for further treatment due to respiratory failure. Which of the following diagnoses best fits the clinical presentation of the mother and daughter?", "input": "(A) Guillain-Barre syndrome. (B) Myasthenia Gravis. (C) Muscular dystrophy. (D) Botulism. (E) CO intoxication. ", "output": "D"} 
-{"instruction": "Which of the following antidotes is the least appropriate when used in the case of poisoning by a substance?", "input":"(A) Simple asphyxiant: 100% oxygen. (B) Carbon monoxide (CO): 100% oxygen. (C) Azide: Sodium thiosulfate. (D) Aniline: Methylene blue. (E) Datura: Physostigmine.", "output": "C"} 
-{"instruction": "Which of the following statements about the public version of the CPR+AED teaching materials published by the Ministry of Health and Welfare is incorrect?", "input": "(A) It is divided into three levels: the simple version, the complete version, and the AED administrator version. (B) The biggest difference between the teaching process of the three-level teaching materials and the professional version is that artificial respiration is not taught. (C) The teaching material contains a special paragraph that emphasizes the legal protection of kind rescuers. (D) The AED administrator course is a complete course with the AED setup process added. (E) The teaching materials at all three levels teach people how to identify agonal breathing. ", "output": "B"}
-{"instruction": "Which of the following statements about cancer patients developing febrile neutropenia after chemotherapy is incorrect?", "input": "(A) It may be an infection and a detailed medical history and physical examination are required. (B) Even if the patient's urine test results do not show pyuria, a urine culture is still required. (C) The patient's indwelling catheter should also be evaluated for the possibility of infection. (D) The physical examination should include the patient's oral and perianal areas, and a rectal examination should be performed before using antibiotics. (E) Two sets of blood culture tests are recommended.", "output": "D"}"input": "(A) There are many types of these organic phosphorus compounds, which are widely used in agriculture to kill insects, bacteria and mites. (B) These organophosphorus insecticides have low fat solubility and a garlicky odor. (C) They are easily absorbed from the gastrointestinal tract, skin, eyes or respiratory tract of the human body, causing local or systemic effects. (D) The severity of poisoning is related to the dose and the body's absorption and elimination rate of the poison. (E) The special symptoms of Muscarinic poisoning are increased glandular secretions, slow heartbeat, and constricted pupils.", "output": "B"} 
-{"instruction": "Which of the following statements about ectopic pregnancy is incorrect?", "input": "(A) The typical symptom of an ectopic pregnancy is the sudden onset of severe unilateral or bilateral abdominal pain, but usually there is little vaginal bleeding. (B) When an ectopic pregnancy occurs, the patient may still have normal menstruation before the disease occurs. (C) Only one β-hCG test cannot clearly distinguish whether the patient has an ectopic pregnancy or a normal pregnancy. (D) If the patient has previously undergone tubal surgery for sterilization, ectopic pregnancy should be considered first when pregnancy occurs. (E) More than half of the patients with ectopic pregnancy have no clear risk factors.", "output": "A"}"Which of the following statements about cancer patients developing febrile neutropenia after chemotherapy is incorrect?", "input": "(A) It may be an infection and a detailed medical history and physical examination are required. (B) Even if the patient's urine test results do not show pyuria, a urine culture is still required. (C) The patient's indwelling catheter should also be evaluated for the possibility of infection. (D) The physical examination should include the patient's oral and perianal areas, and the anus should be examined before using antibiotics. (E) Two sets of blood cultures are recommended.", "output": "D"} 
-{"instruction": "Which of the following is a wound that is susceptible to tetanus-prone?", "input": "(A) A second-degree burn. (B) A depth of 0.5 centimeters. (C) Glass cut. (D) Within 4 hours of injury. (E) Linear wound. ", "output": "A"}
-{"instruction": "Which of the following is not an internationally recognized biological warfare agent of Class A for bioterrorism?", "input": "(A) Smallpox. (B) Anthrax. (C) Hanta virus. (D) Ebola virus. (E) Botulinum toxin.", "output": "C"} {"instruction": "Which of the 
-following will not be transmitted from person to person?", "input": "(A) Pneumonic Plague. (B) Smallpox. (C) Viral Hemorrhagic Fever. (D) Inhalational Anthrax. (E) Coronavirus.", "output": "D"} {"instruction": "Which of the following is not a biological warfare agent of Class A for bioterrorism?", "input": "(A) Smallpox. (B) Anthrax. (C) Hanta virus. (D) Ebola virus. (E) Botulinum toxin.", "output": "D"} {" 
-instruction": "Which of the following is not a biological warfare agent of Class A for bioterrorism?", "input": "(A) Pneumonic Plague. (B) Smallpox. (C) Viral Hemorrhagic Fever. (D) Inhalational Anthrax. (E) Coronavirus ... Which of the following statements about necrotizing fasciitis is incorrect?", "input": "(A) Malignant otitis externa is a necrotizing infection that occurs in the external auditory canal, mastoid, and skull base. The main pathogen is Streptococcus pneumoniae. (B) Fournier gangrene is a type of necrotizing fasciitis that occurs in the perineum. Most cases are polymicrobial infections, with Escherichia coli being the most commonly isolated bacterium. (C) Type II necrotizing fasciitis often occurs in previously healthy patients. The most common sites of infection are the limbs, and Group A streptococcus is the most common pathogen. (D) When patients with cirrhosis develop necrotizing fasciitis of the limbs, the possibility of Vibrio vulnificus and Aeromonas hydrophilia as pathogens must be considered. (E) In Taiwan, Klebsiella pneumoniae is also a possible pathogen that causes necrotizing soft tissue infection. ", "output": "A"} 
-{"instruction": "Which of the following statements about pneumonia and pathogens is incorrect?", "input": "(A)MRSA, Mycoplasma pneumoniae and Legionella are all common pneumonia pathogens in nursing home residents. (B) In addition to fever and dry cough, Legionella pneumophila is also commonly seen in clinical practice with gastrointestinal symptoms such as diarrhea and vomiting. (C) Pseudomonas aeruginosa is a common pneumonia-causing bacterium in patients with a recent history of hospitalization and immunosuppression. (D) Staphylococcus aureus is a common pneumonia-causing bacterium following viral infection. (E) Klebsiella pneumoniae is an important pneumonia-causing bacterium in alcoholics, and one of the characteristics is the bulging fissure sign on chest X-ray. ", "output": "A"} 
-{"instruction": "Which of the following children with fever (temperature ≥ 38℃) has the highest chance of suffering from severe bacterial infection?", "input": "(A) A 2-month-old male infant with no other relevant symptoms, with a white blood cell count of 20,000/µL. (B) A 4-month-old male infant with no other relevant symptoms, with no abnormal findings on urine examination. (C) A 2-month-old female infant with no other relevant symptoms, with a white blood cell count of 8,200/µL. (D) A 4-month-old female infant with diarrhea, with no abnormal findings in stool examination. (E) A 6-month-old male infant with no other relevant symptoms, with no abnormal findings in urine examination. ", "output": "A"} 
-{"instruction": "For acute myocardial infarction with cardiogenic shock, which of the following treatments or medications is inappropriate?", "input": "(A) Aspirin 300 mg orally. (B) Captopril 25 mg orally. (C) Dopamine 5 mcg/kg/min intravenous infusion. (D) Intra-Aortic Balloon Counterpulsation. (E) Instruct the cardiologist to perform percutaneous coronary intervention. ", "output": "B"} 
-{"instruction": "A pregnant woman with a history of asthma at 26 weeks of gestation presents to the emergency department with dyspnea. Which of the following statements is incorrect?", "input": "(A) Even if there is no wheezing during auscultation, the possibility of an acute asthma attack cannot be ruled out. (B) Spirometry can be used to assess the severity of an acute asthma attack and the effectiveness of treatment. (C) Oxygen should be given to maintain a blood oxygen concentration > 95%, and a fetal monitor should be installed to closely observe whether there is fetal distress. (D) Inhaled β2 agonists are the first line of treatment for pregnant women with acute asthma attacks. (E) Systemic corticosteroids are not recommended for pregnant women with acute asthma attacks. ", "output": "E"} 
-{"instruction": "Which of the following statements about the characteristics of organophosphorus pesticide preparations is incorrect?", "input": "(A) There are many types of these phosphorus-containing organic compounds, which are widely used in agriculture to kill insects, bacteria and mites. (B) These organophosphorus pesticides have low fat solubility and a garlicky odor. (C) They are easily absorbed from the human gastrointestinal tract, skin, eyes or respiratory tract, causing local or systemic effects. (D) The severity of poisoning is related to the dose and the body's absorption and elimination rate of the poison. (E) The special symptoms of Muscarinic poisoning are increased glandular secretions, slow heartbeat, and constricted pupils. ", "output": "B"}
-{"instruction": "Which of the following statements about salicylate poisoning is incorrect?", "input": "(A) To accurately assess the severity, it is recommended to measure the blood concentration, compare the time of administration, and use the Done nomogram to make a judgment. (B) If a patient complains of tinnitus while taking salicylate drugs chronically, the possibility of poisoning should be considered. (C) In acute overdose in adults, the severity is closely related to the dosage of the drug. (D) Salicylate poisoning is mainly manifested as high anion gap metabolic acidosis, but if the blood draw shows normal anion gap metabolic acidosis, the possibility cannot be completely ruled out. (E) If the patient has renal failure, altered consciousness, or acute lung injury, emergency hemodialysis treatment should be considered.", "output": "A"} 
-{"instruction": "Which of the following statements about transfusion-related acute lung injury (TRALI) is incorrect?", "input": "(A) It is one of the main causes of transfusion-related death. (B) It usually occurs during or within 6 hours after transfusion. (C) It more often occurs after FFP or platelet transfusion and less often after packed RBC transfusion alone. (D) Because TRALI is accompanied by pulmonary edema, diuretics should be actively administered. (E) In most patients, lung injury will gradually improve on its own after supportive treatment.", "output": "D"} 
-{"instruction": "Which of the following statements about blunt chest injury in adults is incorrect?", "input": "(A) Most patients with aortic rupture caused by trauma die at the scene. The few survivors are mostly injured in the ligamentum arteriosum. (B) Tension pneumothorax is a clinical diagnosis. Usually, hypotension occurs first, followed by cyanosis. (C) If chest X-ray and ultrasound diagnose hemothorax, a chest tube should be placed. If more than 1,500 ml of blood is immediately drained, thoracotomy should be arranged to stop bleeding. (D) If air continues to be drained after the chest tube is placed, tracheobronchial injury should be considered, and bronchoscopy should be arranged for diagnosis. (E) For patients with blunt cardiac injury, blood tests for Troponin I should be performed. It is more useful for clinical emergency judgment and treatment than electrocardiogram. ", "output": "E"} 
-{"instruction": "Which of the following statements about spinal cord injury in adults is wrong?", "input": "(A) Anterior cord syndrome: Proprioception and vibration sensation will be lost below the injured site. (B) Central cord syndrome is more likely to occur in the elderly. The injury mechanism is usually hyperextension, and upper limb weakness is greater than lower limb weakness. (C) Cauda equina syndrome has a better prognosis, mainly because the injured nerves are peripheral nerves, which have a chance of regeneration. (D) Brown-Sequard syndrome is weakness and loss of body sensation on the same side, combined with loss of pain and temperature sensation on the opposite side. (E) Spinal cord injury causes neurogenic shock, usually with warmth in the limbs, low blood pressure but a relatively slow heartbeat (relative bradycardia). ", "output": "A"} 
-{"instruction": "Which of the following statements is incorrect about the comparison of typical symptoms of common causes of fatal chest pain and the evaluation of acute coronary heart disease?", "input": "(A) Angina pain is located behind the sternum or in the upper abdomen, with a stuffy or oppressive feeling; large-area pulmonary embolism is a heavy and tight feeling throughout the chest. (B) The pain of aortic detachment and esophageal rupture is mainly located below the sternum. The former is often tearing pain and transfers to the back between the shoulder blades, while the latter is often a sudden sharp pain after severe vomiting and transfers to the back. (C) Aortic detachment, respiratory failure, sepsis and burns may cause an increase in Troponin. (D) Acute stroke or subarachnoid hemorrhage will not cause an increase in Troponin. (E) In addition to acute coronary heart disease, chronic alcoholism, prostate cancer, and carbon monoxide poisoning are all related to elevated CK-MB. ", "output": "D"} 
-{"instruction": "Which of the following statements about compartment syndrome is correct?", "input": "(A) Tibial fractures are a common site of occurrence, and compartment syndrome can also occur in the hand. (B) When the chamber pressure exceeds 45 mmHg, tissue ischemia will occur. (C) The inability to feel the proximal arterial pulsation of the limb is an early sign of compartment syndrome. (D) The patient can be advised to raise the affected limb to reduce the chamber pressure. (E) Doppler ultrasound is a good diagnostic tool. ", "output": "A"} 
-{"instruction": "Which of the following statements about neck injury is wrong?", "input": "(A) For physical examination of neck trauma, hard signs usually represent more serious injuries relative to soft signs. (B) Physical examination found expanding hematoma and stridor/hoarseness, both of which are hard signs of neck trauma. (C) Zone II injuries of the neck are compared to Zones I and III. If necessary, direct surgical exploration can be considered, and conventional angiography is not necessary. (D) If the vital signs of the patient with a puncture injury of the neck are stable, CTA (CT angiography) can be arranged first to check for vascular damage. (E) Blunt neck injuries can cause carotid artery dissection. After diagnosis, anticoagulant therapy should be given to prevent stroke. ", "output": "B"} 
-{"instruction": "Which of the following statements is correct about avoiding the occurrence of decompression illness?", "input":"(A) Ascend quickly after diving into the deep sea. (B) Take a plane within 12 hours after diving. (C) Do strenuous exercise after diving. (D) Drink plenty of water after diving. (E) Take a car up the mountain after diving.", "output": "D"} 
-{"instruction": "Which of the following statements about glyphosate pesticide poisoning is incorrect?", "input": "(A) It is a kind of herbicide, and the common commercial herbicide Nipro is of this type. (B) The main ingredients are 41% of sugar phosphates and 15% of non-ionic surfactants (surfactant polyoxyethyleneamine). (C) It has a corrosive effect, so when ingested, it may cause irritation and erosion of the gastrointestinal and upper respiratory tract mucosa. (D) The main toxicity mechanism is related to the sugars and phosphates it contains. (E) Severe poisoning can cause cardiotoxicity, metabolic acidosis, and hyperkalemia. ", "output": "D"}
-{"instruction": "Which of the following statements about emergencies during pregnancy is incorrect?", "input": "(A) HELLP syndrome may lead to the fatal complication of subcapsular liver hematoma. (B) If a pregnant woman experiences painful vaginal bleeding near her due date, early placental separation (abruptio placentae) should be considered. (C) Treatment of postpartum hemorrhage focuses on promoting uterine contractions and correcting coagulation abnormalities. (D) Pregnant women who develop eclampsia should immediately use benzodiazepine drugs to control seizures. (E) Pregnant women who develop HELLP syndrome When the patient is in hospital, the administration of magnesium ions, the control of blood pressure and the stabilization of vital signs are very important. ", "output": "D"}"(A) The pathogen is the Gram-positive bacillus Clostridium tetani. (B) The toxin produced by it, Tetanospasmin, can act on skeletal muscle, spinal cord, brain and sympathetic nervous system. (C) The diagnosis is based on clinical symptoms. (D) If wound debridement is to be performed, tetanus immune globulin should be given first. (E) After debridement, it is recommended to inject Penicillin to treat systemic tetanus infection.", "output": "E"} 
-{"instruction": "Which of the following statements about Neuroleptic malignant syndrome is incorrect?", "input": "(A) The cause of the formation is not closely related to the overdose of antipsychotic drugs. It usually occurs when the drug is started or the dosage is adjusted. (B) To diagnose Neuroleptic malignant syndrome, there must be fever and muscle rigidity. (C) Severe cases with significant muscle rigidity require Dantrolene treatment. (D) If the patient has fever and muscle rigidity, intubation and muscle relaxants are strongly recommended to lower the patient's body temperature. (E) If the patient is intubated and needs muscle relaxants, depolarizing muscle relaxants are better than non-depolarizing muscle relaxants. ", "output": "E"}"(A) HELLP syndrome may lead to the fatal complication of subcapsular liver hematoma. (B) If a pregnant woman experiences painful vaginal bleeding near her due date, early placental abruption (abruptio placentae) should be considered. (C) The treatment of postpartum hemorrhage focuses on promoting uterine contractions and correcting coagulation abnormalities. (D) Pregnant women who develop eclampsia should immediately use benzodiazepine drugs to control seizures. (E) When a pregnant woman develops HELLP syndrome, it is very important to administer magnesium ions, control blood pressure, and stabilize vital signs.", "output": "D"} 
-{"instruction": "Which of the following statements about rhabdomyolysis is incorrect?", "input": "(A) When rhabdomyolysis occurs, the use of NSAIDs should be avoided. (B) When a urine dipstick test shows hematuria, but microscopic examination reveals no red blood cells in the urine, the patient should be considered to have myoglobinuria. (C) The acute renal failure caused by rhabdomyolysis is intrinsic acute renal failure. (D) Blood electrolyte abnormalities that may be caused by rhabdomyolysis include hyperkalemia, hypocalcemia, and hyperphosphatemia. (E) The diagnostic criteria for rhabdomyolysis are that the CK value in plasma is more than 10 times the upper limit of normal value after confirming that there is no damage to the heart and brain. ", "output": "E"}
-{"instruction": "Which of the following statements about patient selection for air medical treatment is incorrect?", "input": "(A) For patients with severe trauma (but not fatal) and those who are located farther away, air evacuation is more effective than ground transportation. (B) For patients with heart disease who need emergency bypass surgery or balloon pump support, air medical transfer can be considered. (C) Pregnant women with heart disease who are in premature labor or have early amniotic fluid rupture are not suitable for air medical transfer. (D) Patients with acute ischemic stroke are suitable for air medical transfer. (E) Premature newborns can still be transported by professionals for air medical transfer.", "output": "C"} 
-{"instruction": "Which of the following statements about the description and treatment of pelvic fractures is incorrect?", "input": "(A) Once a pelvic fracture is confirmed, the possibility of abdominal, retroperitoneal, reproductive and urinary system injuries must be ruled out. (B) For pelvic fractures with unstable hemodynamics, angiography and embolization should be arranged as soon as possible. (C) The mechanisms of pelvic fractures include: anterior posterior compression, lateral compression and vertical shear, among which lateral compression is the most common. (D) Pelvic fractures lead to retroperitoneal bleeding, the main sources of which are venous and fracture edge bleeding, and arterial bleeding accounts for only 10~15%. (E) In addition to embolization therapy, pelvic fixation can also control retroperitoneal bleeding, but it is more effective for venous and fracture edge bleeding.", "output": "B"} { 
-"instruction": "Which of the following statements about lithium poisoning is incorrect?", "input": "(A) If epilepsy occurs, phenytoin treatment is ineffective. (B) In acute lithium poisoning, patients primarily present with neurological symptoms, followed by gastrointestinal symptoms. (C) Long-term use often causes side effects such as polyuria, nausea, rash, and hand tremors. (D) Renal failure, cirrhosis, fluid depletion, and infection are all precipitating factors that lead to lithium poisoning. (E) For patients who acutely take lithium, if the serum concentration is greater than 1.5 mEq/L, even if there are no symptoms, the patient should be advised to be hospitalized for observation and treatment.", "output": "B"} 
-{"instruction": "Which of the following statements about trauma in the elderly is incorrect?", "input": "(A) It is usually not easy to see an increased heart rate in hemorrhagic shock. (B) In case of hypotension, a crystalloid can be used to give a 250-500 ml infusion first, and the patient can be closely evaluated and repeated if necessary. (C) In head trauma, the elderly are more likely to have epidural hemorrhage than the average person. (D) Cervical fractures are more likely to occur in the elderly and are more difficult to diagnose. (E) The most common locations for fractures in the elderly are the pelvis, hip, humerus and wrist. ", "output": "C"} 
-{"instruction": "Which of the following statements about epilepsy and epileptic seizures is incorrect?", "input": "(A) For patients with a history of epilepsy who are controlled by medication, relapses are often caused by forgetting to take medication, drinking alcohol, or lack of sleep. (B) For patients with a history of epilepsy who occasionally have epilepsy, the most important tests are blood sugar and anti-epileptic drug levels in the blood. (C) For pregnant women who suspect that eclampsia is causing epileptic seizures, magnesium sulfate 4-6 g IV can be given first, followed by 1-2 g/hr. (D) Epileptic seizures refer to continuous or intermittent seizures lasting more than 5 minutes without recovery of consciousness. (E) The anti-epileptic drug Phenytoin can be combined with sugar-containing drips or intramuscular injections. ", "output": "E"} 
-{"instruction": "Which of the following statements about Herpes simplex encephalitis is incorrect?", "input": "(A) It is more common in people under 20 years old and over 50 years old. (B) If untreated, the mortality rate is as high as 70%. (C) Survivors may have long-term neurological sequelae. (D) CT or MRI imaging examinations often show frontal lobe lesions. (E) If clinical symptoms are difficult to distinguish from bacterial meningitis, empirical antibiotics and antiviral drugs should be given. ", "output": "D"} 
-{"instruction": "Which of the following statements about the treatment of migraine is incorrect?", "input": "(A) Dihydroergotamine (DHE) may cause symptoms of nausea, vomiting, and diarrhea. (B) Ketorolac is not suitable for use in the third trimester of pregnancy. (C) Opioids are best used in patients with chronic and recurrent migraine. (D) Olanzapine can cause QT wave prolongation on the electrocardiogram. (E) Prochlorperazine also has an antiemetic effect. ", "output": "C"} 
-{"instruction": "Which of the following statements about tetanus is incorrect?", "input": "(A) The pathogen is the Gram-positive bacillus Clostridium tetani. (B) The toxin produced is Tetanospasmin, which can act on skeletal muscle, spinal cord, brain and sympathetic nervous system. (C) Diagnosis is based mainly on clinical symptoms. (D) If wound debridement is to be performed, tetanus immune globulin should always be given first. (E) After debridement, it is recommended to inject Penicillin to treat systemic tetanus infection. ", "output": "E"} 
-{"instruction": "Which of the following statements about the causes of peripheral vertigo is incorrect? ", "input": "(A) Benign paroxysmal positional vertigo. (B) Labyrinthitis. (C) Vestibular neuritis. (D) Migraine. (E) Meniere's disease. ", "output":"D"} 
-{"instruction": "According to the CURB-65 score, which of the following is not a risk factor for severe community-acquired pneumonia?", "input": "(A) New onset of confusion. (B) Blood urea nitrogen (BUN) ≥ 7 mmol/l (19 mg/dL). (C) Respiratory rate ≥ 30 times/min. (D) Body temperature ≥ 39 ℃. (E) Age ≥ 65 years old.", "output": "D"} 
-{"instruction": "According to the American College of Emergency Physicians guidelines and The San Francisco Syncope Rule, which of the following 5 patients with initially unexplained syncope is less likely to require hospitalization?", "input": "(A) Blood creatinine 5 mg/dl. (B) Hematocrit 28%. (C) The electrocardiogram shows a new atrioventricular block. (D) Has a family history of sudden cardiac death. (E) Age 85 years. ", "output": "A"} 
-instruction": "According to the 2012 North American Emergency Response Guidebook, which of the following statements about chemical hazards is incorrect?", "input": "(A) Approach the incident site from the upwind side to maintain your own safety. (B) It mentions the Hazard Classification System (C) If the sign indicating hazardous chemicals is red, it means flammability. (D) The so-called initial isolation zone refers to the area where people upwind may be exposed to hazardous chemicals at lethal concentrations. (E) The so-called Toxic Inhalation Hazard (TIH) substances refer to chemicals that can produce toxic gases and cause inhalation hazards when in contact with water. ", "output": "D"} {"instruction": "According 
-to the 2010 AHA guidelines for CPR and ECC, the ST-segment elevation meets the standards for STEMI, except for which of the following?", "input": "(A) For female patients, the J-point elevation is on leads other than leads V2 and V3. (A) For males aged 40 years and above, the J-point elevation exceeds 0.2 mV (2 mm) at leads V2 and V3. (B) For males aged 40 years and above, the J-point elevation exceeds 0.2 mV (2 mm) at leads V2 and V3. (C) For males aged 40 years and above, the J-point elevation exceeds 0.1 mV (1 mm) at leads other than leads V2 and V3. (D) For males aged 40 years and below, the J-point elevation exceeds 0.15 mV (1.5 mm) at leads V2 and V3. (E) For males aged 40 years and below, the J-point elevation exceeds 0.1 mV (1 mm) at leads other than leads V2 and V3. ", "output": "D"} 
-{"instruction": "Regarding the management of patients with severe sepsis and septic shock, according to the latest 2012 International Guidelines for Management of Severe Sepsis and Septic Shock (2012), which of the following statements is correct?", "input": "(A) Broad-acting antibiotics should be given within 2 hours of clinical diagnosis of septic shock or severe sepsis. (B) Severe sepsis refers to tissue hypoperfusion or organ dysfunction in the setting of suspected clinical infection. The definition of acute lung injury in organ dysfunction is that in the absence of pneumonia, the patient's PaO2/FiO2 < 200 mmHg. (C) The goal of emergency treatment in the first 6 hours is to maintain a central venous pressure (CVP) between 8 and 12 mmHg, a mean arterial pressure (MAP) ≧ 65 mmHg, urine output ≥ 0.5 mL/kg/hr, and a superior vena cava oxygen partial pressure (ScvO2) > 70 mmHg or mixed venous oxygen saturation (Sv O2) > 65 mmHg. Only after the emergency department achieves the above goals can the patient be transferred to the intensive care unit for continued treatment. (D) For patients who are in shock and do not respond to initial fluid therapy, the vasopressor dopamine should be used first, with the goal of raising the mean arterial pressure (MAP) to 65 mmHg. (E) For patients who do not have tissue perfusion insufficiency after fluid therapy and do not have severe hypoxia, acute hemorrhage or myocardial infarction, the patient's hemoglobin is recommended to be maintained at 7~9 g/dL. ", "output": "E"} 
-{"instruction": "For patients with pulmonary embolism, which of the following is an indication for the injection of fibrinolytic agents?", "input": "(A)Computed tomography revealed pulmonary emboli on both sides. (B)O2 needs to be above 6 L/min to maintain SaO2 greater than 90%. (C) Deep vein thrombosis in the lower extremities. (D) Systolic pressure less than 90 mmHg. (E) Chest pain and 12 leads EKG with S1Q3T3 pattern changes. ", "output": "D"} 
-{"instruction": "A 10-year-old girl with blunt abdominal injury was diagnosed with Grade III splenic laceration by CT scan. She was therefore admitted to the pediatric intensive care unit for close observation. Her vital signs are currently stable. Which of the following situations should require immediate laparotomy?", "input": "(A) Amylase was 400 U/L in a blood draw. (B) White blood cells were found to be 16,000/mm. (C) Extraperitoneal bladder rupture. (D) Due to abdominal pain, CT scan revealed intraperitoneal free air. (E) 24 hours later, hemoglobin dropped from 11 g/dL to 8.5 g/dL. ", "output": "D"} 
-{"instruction": "Which of the following statements about patients suspected of being infected with Ebola in Taiwan is incorrect?", "input":"(A) Ask the patient to go to the nearest quarantine hospital for medical treatment. (B) Ask the patient to call 1922 and a specialist will assist him in seeking medical treatment. (C) Patients infected with Ebola virus often have symptoms such as muscle pain, headache, vomiting, and diarrhea. (D) Ebola virus is a member of the Filoviridae family. (E) The mortality rate of patients infected with Ebola virus can be as high as 90%. ", "output": "A"} 
-{"instruction": "When the patient came to the hospital for chest pain, his blood pressure was 155/95 mmHg, his heart rate was 65 beats/min, and the electrocardiogram showed ST-segment elevation of lead V1-V3. He continued to have chest pain in the emergency room. The following treatments can be given at this time. Which of the following is the least appropriate?", "input": "(A) Atenolol 25 mg orally. (B) Dobutamine 5 mcg/kg/min (C) Morphine 3 mg intravenous injection. (D) NTG 0.6 mg sublingually. (E) Instruct the cardiologist to consider percutaneous coronary intervention. ", "output": "B"} 
-{"instruction": "The patient has a history of hypertrophic cardiomyopathy and complains of chest pain in the emergency room. Which of the following treatments should be considered first?", "input":"(A) Clopidogrel 300 mg orally. (B) Dobutamine 5 mcg/kg/min. (C) Nitroglycerin 5 mcg/min. (D) Norepinephrine 2 mcg/min. (E) Propanolol 10 mg orally.", "output": "E"} 
-{"instruction": "An 8-year-old boy accidentally swallowed a brand new button battery 3 hours ago and was accompanied to the emergency room by his mother. Which of the following treatments is wrong?", "input": "(A) If the button battery is stuck in the esophagus, it may cause esophageal rupture within 6 hours. (B) If the X-ray shows that the button battery is stuck in the esophagus, the first priority is to try foley balloon catheter technique to remove the foreign body. (C) For children younger than 6 Children aged 1-2 years need to be followed up with an X-ray every 48 hours to confirm that the battery has passed through the pylorus of the stomach. (D) If there are no symptoms, most button batteries can be discharged on their own after 48-72 hours. (E) If the battery has passed through the esophagus and stomach, but there are symptoms of gastrointestinal pain, a surgeon is still required to evaluate whether surgery is needed to remove the foreign body. ", "output": "B"} 
-{"instruction": "An 80-year-old male nursing home resident, accompanied by a caregiver, comes to the emergency department with complaints of unbearable itching all over his body in the middle of the night. His ear temperature is 37.0℃. Physical examination reveals multiple rashes and nail scratches on the lower abdomen, bilateral groin, and back. Which of the following diseases is the most likely cause?", "input": "(A) Urticaria. (B) Scabies. (C) Contact dermatitis. (D) Eczema. (E) Psoriasis.", "output": "B"} 
-{"instruction": "An 8-year-old boy was hit by a car while walking to school. He rolled over and fell to the ground. He was taken to the emergency room by ambulance. His temperature was 36.7℃, his respiratory rate was 30 times/min, his heart rate was 130 times/min, and his blood pressure was 80/65 mmHg. The patient was unconscious and unable to speak. Which of the following statements about first aid for pediatric trauma is incorrect?", "input": "(A) The first priority is to protect the airway. If you want to choose an endotracheal tube, you can choose a size 6 with a cuff. (B) If peripheral vascular access is not possible, this patient may consider intraosseous injection of a proximal tibia. (C) Give crystalloid 20 ml/kg each time, with a goal of urine output of 1 ml/kg/hr. (D) Because the chest wall bones of children are more flexible, tension pneumothorax is less likely to occur in the event of a chest contusion. (E) Based on this patient's vital signs, the blood loss should be greater than 30% of the total blood volume. ", "output": "D"} 
-{"instruction": "A 78-year-old patient presents to the emergency department with an acute exacerbation of chronic obstructive pulmonary disease (COPD). Which of the following statements about contraindications to the use of noninvasive positive pressure ventilation (NPPV) is incorrect?", "input": "(A) Respiratory rate > 25 bpm and using accessory muscles. (B) Unable to maintain airway patency. (C) Confusion. (D) Hemodynamic instability. (E) Extreme obesity. ", "output": "A"} 
-{"instruction": "A 70-year-old male chronic smoker presents to the emergency department with fever, cough, and dyspnea. The patient also has body aches, abdominal pain, and diarrhea. Vital signs are blood pressure 90/60 mmHg, respirations 30/min, heart rate 130/min, temperature 39°C, and oxygen saturation 90%. Chest X-ray shows bilateral pneumonia, and urine Legionella antigen test is positive. Which of the following statements about this disease is incorrect?", "input": "(A) Pancreatitis may occur. (B) This disease is not contagious. (C) Low sodium levels are common test abnormalities. (D) Third-generation cephalosporin or carbapenem antibiotics are the first choice for treatment. (E) Sputum cultures often fail to isolate the causative bacteria. ", "output": "D"} 
-{"instruction": "A 65-year-old female patient was admitted to the emergency department with complaints of sudden dyspnea, wheezing, and chest tightness. Physical examination showed symmetrical breath sounds without gurgling; no edema in either leg. Heart rate 120 beats/min, room air SpO₂ 93%. Past medical history is breast cancer, surgery and chemotherapy; she was discharged from the hospital 2 weeks ago for right hip fracture. You suspect that this patient is most likely to have pulmonary embolism. Which of the following statements is incorrect?", "input": "(A) This patient's AaDO2 (Alveolar-arterial gradient) may decrease. (B) This patient's Well's score is 7. (C) The electrocardiogram may show sinus tachycardia and S1Q3T3 pattern. (D) If the patient has sudden cardiac arrest, thrombolytic agents (Fibrinolysis), such as tPA, may be considered. (E) EKG and myocardial enzyme tests are still needed to rule out the possibility of acute coronary heart disease. ", "output": "A"} 
-{"instruction": "A 65-year-old female with a history of pancreatic cancer has had a swollen right foot for about a week. Which of the following statements is incorrect?", "input": "(A) When performed by an experienced scanner, the sensitivity and specificity of vascular ultrasound for diagnosing deep venous embolism can reach over 90%. (B) The more obese the patient is, the more difficult it is to correctly diagnose deep venous embolism using vascular ultrasound. (C) Patients with a history of deep venous embolism are not easy to distinguish new from old clots using the compressive properties of ultrasound. (D) If this patient's veins cannot be flattened on ultrasound, a diagnosis of deep venous embolism can be made. (E) A thrombus must be visible on ultrasound to diagnose deep venous embolism. ", "output": "E"} 
-{"instruction": "A 65-year-old man fell and was cut by broken glass in the garden. He then fell into a pile of dirt and branches. Which of the following statements is correct?", "input": "(A) The 5 cm facial wound has been injured for more than 12 hours. Considering the risk of infection, suture is not recommended. (B) Wounds on the thigh have a higher risk of wound infection than wounds on the scalp. (C) X-rays can detect more than 90% of broken glass or broken branches that are hidden under the skin. (D) The wound on the calf is deeper, so subcutaneous suture is recommended. (E) Choose 10% povidone-iodine solution without alcohol to clean the wound. ", "output": "B"}
-{"instruction": "A 65-year-old male, a regular smoker with a history of hypertension, came to the emergency department complaining of unilateral headache. His temperature was 37°C, his heart rate was 84 beats/min, his breathing was 16 breaths/min, and his blood pressure was 142/84 mmHg. Which of the following statements about emergency headache differential diagnosis is correct?", "input": "(A) If the patient has unilateral headache attacks in a short period of time, combined with unilateral tearing and runny nose, cluster headache should be suspected. Such patients may have neurological symptoms such as ptosis and miosis on the same side. (B) If the patient has severe unilateral, pulsatile headache that is more painful with movement, and is accompanied by nausea, vomiting, and photophobia, migraine should be suspected. Migraine does not present as bilateral headache. (C) If the patient has unilateral headache, tenderness in the temporal artery and increased pulse, normal ESR, and ptosis and miosis on the same side, it may be temporal arteritis. At the same time, attention should be paid to whether the patient has decreased vision and steroid treatment should be given as soon as possible. (D) Ischemic stroke may also present as headache, especially anterior cerebral artery stroke. (E) If the patient is taking anticoagulants, cerebral hemorrhage should be included in the differential diagnosis. If the CT scan shows no bleeding, a brain magnetic resonance imaging (MRI) should be arranged to exclude subarachnoid hemorrhage (SAH) if it is still strongly suspected clinically. ", "output": "A"} 
-{"instruction": "A 60-year-old male presented to the emergency department with dyspnea. His chest X-ray showed bilateral pleural effusion. After diagnostic pleural puncture, the laboratory analysis of the pleural effusion showed the following results: pH 7.57, pleural effusion/serum lactate dehydrogenase ratio (LDH ratio) 0.4, pleural effusion/serum protein ratio (Protein ratio) 0.2, cell count WBC 133 cells/µL (of which 65% are lymphocytes). Which of the following diagnoses is most appropriate?", "input": "(A) Heart failure. (B) Bacterial pneumonia. (C) Lymphoma. (D) Tuberculosis. (E) Lupus erythematosus. ", "output": "A"} 
-{"instruction": "A 50-year-old male presents to the emergency department with hemoptysis. Which of the following statements is incorrect?", "input": "(A) The priority should be to assess whether the airway is patent and whether the blood oxygen concentration is adequate. (B) The severity of the disease can be determined based on the amount of hemoptysis within 24 hours, where massive hemoptysis is defined as > 600 ml of hemoptysis within 24 hours. (C) Pulmonary embolism often causes massive hemoptysis. (D) Chest X-ray is a necessary examination, but there is a 15-30% chance that the chest X-ray will be normal. (E) If the color of the hemoptysis is dark red, it should be noted that the bleeding may come from the gastrointestinal tract. ", "output": "C"} 
-{"instruction": "A 48-year-old female is currently receiving Warfarin for deep venous embolism. One hour ago, she began to have massive bilateral epistaxis that could not be stopped by direct pressure. Her current blood pressure is 136/82 mmHg, heart rate is 110 beats/min, and blood draw results show platelets 170,000/µL, Hb 8 g/dL, Hct 23%, INR 8. Which of the following treatments is least appropriate?", "input": "(A) Give desmopressin acetate(ddAVP). (B) Give fresh frozen plasma. (C) Give prothrombin complex concentrate. (D) Give vitamin K. (E) Stop Warfarin. ", "output": "A"} 
-{"instruction": "A 47-year-old male patient was taken to the emergency room with nausea and vomiting accompanied by shortness of breath after a drinking binge the day before yesterday. Vital signs: temperature 36.5 ℃, pulse 124 beats/min, respiration 26 breaths/min, blood pressure 103/61 mmHg, SpO₂ 100%, test report: arterial blood gas analysis: pH 7.27, PCO₂ 25 mmHg, HCO₃- 11 mmol/L, blood glucose 102 mg/dL, blood sodium concentration 142 mmol/L, blood potassium concentration 3.5 mmol/L, blood chloride concentration 106 mmol/L, serum ketones were positive. Which of the following statements is wrong?", "input":"(A) This patient has high anion gap metabolic acidosis. (B) If alcoholic ketoacidosis is suspected, lactic acidosis caused by infection or drugs must be ruled out first. (C) Blood osmotic pressure and methanol concentration can be tested to rule out methanol or other organic acidosis. (D) If it is alcoholic ketoacidosis, the patient can be given a sugar solution to increase the glucose concentration in the body and replenish the fluid deficiency. (E) In alcoholic ketoacidosis, insulin supplementation is required to promote glucose utilization and reduce the production of ketoacids by fat breakdown.", "output": "E"}
-{"instruction": "A 5-year-old child weighing 20 kg was taken to the emergency room by ambulance accompanied by his mother for status epilepticus. He complained of convulsions for 30 minutes. Which of the following statements is incorrect?", "input": "(A) Ensuring airway patency and stabilizing vital signs are the first priority. (B) If emergency testing reveals hypoglycemia, 10% G/W 100 ml should be immediately injected intravenously. (C) If convulsions persist, Lorazepam 2 mg should be given intravenously, which can be repeated. (D) If convulsions persist and intravenous drips cannot be given, Diazepam 2 mg should be given through the rectum. (E) If convulsions persist, consider intravenous Midazolam 2 mg, plus Midazolam 1 mcg/kg/min continuous intravenous infusion.", "output": "D"} 
-{"instruction": "A 50-year-old male presents to the emergency department with right upper quadrant pain after lunch. His past medical history includes diabetes and hypertension. Which of the following statements is incorrect?", "input": "(A) Most cases of biliary colic pain resolve within 1 to 5 hours. (B) The sensitivity and specificity of emergency ultrasound in diagnosing acute cholecystitis are only about 70%. (C) If the thickness of the gallbladder on this patient's abdominal ultrasound is greater than 3 mm, acute cholecystitis should be suspected. (D) If this patient has cholecystitis, ultrasound may not have sonographic Murphy's sign. (E)Morphine-like analgesics used in this patient may increase bile duct pressure and induce contraction of the Sphincter of Oddi. ", "output": "B"} 
-{"instruction": "A 40-year-old female with thyroid disease who did not take medication regularly was sent to the emergency room due to yellowish skin, drowsiness and dyspnea. Examination revealed: body temperature 39.2 ℃, blood pressure 145/75 mmHg, irregular pulse of about 145 beats/min, electrocardiogram showed atrial fibrillation with rapid ventricular rate, and chest X-ray revealed bilateral pulmonary edema. Based on the clinical manifestations, which of the following treatment statements is correct?", "input": "(A) Supportive treatment, including oxygen and fluid replacement, is the main treatment. For fever, acetaminophen or aspirin can be given to help reduce fever. (B) Because the patient has atrial fibrillation with rapid ventricular rate, amiodarone can be given first to control the heart rate and prevent the symptoms of heart failure from worsening. (C) Propylthiouracil (PTU) and methimazole can both be used to inhibit thyroid hormone synthesis and inhibit the conversion of T4 to T3. (D) Lugol's solution contains iodine ions and must be used together with PTU to inhibit the production of thyroid hormone. (E) Glucocorticoids can inhibit the conversion of T4 to T3 and can improve the survival rate of patients with thyroid storm. ", "output": "E"} 
-{"instruction": "A 3-year-old child, who was healthy in the past, was complained by his family that he started to have diarrhea and intermittent abdominal pain two days ago. He received intravenous infusion treatment in the emergency department of a community hospital, but his condition did not improve and he even started to have bloody stools. The parents observed that the child was crying frequently and requested to be transferred to the emergency department of a evacuation hospital for treatment. The blood test results are as follows: WBC: 12,000/uL, Hb: 9 g/dL, PLT: 19,000/uL, glucose 75 mg/dL, BUN 50 mg/dL, Creatinine 5.5 mg/dL, AST 60 U/L, Na 125 mEq/L, K 4.8 mEq/L. Which of the following is correct?", "input": "(A) The child's condition is probably caused by intussusception. (B) A blood smear is not helpful for diagnosis. (C) Children's oliguria rarely lasts for a week. (D) Antibiotics are very helpful in such cases. (E) It is more likely that toxins damage the colon mucosal epidermis and enter the blood, causing the impact.", "output": "E"} 
-{"instruction": "A 38-year-old female with a history of hyperthyroidism was sent to the emergency room due to fever and shortness of breath. Her vital signs during examination were: temperature 39.5 ℃, pulse 143 beats/min, respiration 24 times/min, blood pressure 108/59 mmHg, SpO₂ 98%. Physical examination revealed: the patient was orthopnea with bilateral lower limb edema, bilateral breath sounds with wet rales, and the electrocardiogram showed sinus tachycardia. Which of the following statements is incorrect?", "input": "(A) It is necessary to assess the patient's consciousness to see if there are symptoms such as drowsiness, convulsions, coma, and whether there are manifestations of hepatobiliary and gastrointestinal dysfunction such as anorexia, abdominal pain, and jaundice. (B) Based on the patient's history of hyperthyroidism, fever, and tachycardia accompanied by heart failure, if there are clinical symptoms such as central nervous system and hepatobiliary and gastrointestinal dysfunction, it is possible to suspect whether it is a thyroid storm. (C) The patient's thyroid function can be tested to determine whether it is thyrotoxicosis or thyroid storm. (D) Possible causes of thyroid storm include infection, diabetic ketoacidosis, or discontinuation of antithyroid drugs. (E) Other possible differential diagnoses need to be considered, such as infection, fever emergency, or use of sympathomimetic agents. ", "output": "C"} 
-{"instruction": "A 35-year-old male patient came to the emergency department because he had a small amount of blood in his stool this morning. Upon questioning, he had no history of abdominal pain or syncope. Which of the following statements about lower gastrointestinal bleeding is incorrect?", "input": "(A) The most common cause of confirmed lower gastrointestinal bleeding is diverticular disease. (B) 10-14% of patients with bloody stools have bleeding spots from the upper gastrointestinal tract. (C) Patients with lower gastrointestinal bleeding without abdominal tenderness have a higher morbidity rate. (D) About 80% of patients with lower gastrointestinal bleeding will have spontaneous remission. (E) The Glasgow-Blatchford Bleeding score can be used as the only criterion for patients with lower gastrointestinal bleeding to be discharged from the outpatient clinic for follow-up treatment. ", "output":"E"} 
-{"instruction": "A 32-year-old female has received multiple packed RBC transfusions due to anemia caused by chronic menorrhagia. She had febrile nonhemolytic transfusion reactions during the last two transfusions. Her current Hb is 6.0 g/dL. After transfusion type and cross-matching, which of the following methods can reduce the possibility of a febrile nonhemolytic transfusion reaction occurring again?", "input": "(A) Whole blood transfusion. (B) Irradiated red blood cell transfusion. (C) Reduce the transfusion rate so that the transfusion time exceeds 4 hours. (D) Volume-reduced red blood cell transfusion. (E) Leukocyte-reduced red blood cell transfusion. ", "output": "E"} 
-{"instruction": "A 32-year-old female was accidentally injured by ignited gunpowder while watching the National Day fireworks 4 hours ago. About 50% of her body surface was covered with blisters or charred. The patient weighs 50 kgw, has a blood pressure of 110/89 mmHg, a heart rate of 120 beats/min, and has 100 ml of urine through an indwelling urinary catheter. He has been given 1,000 ml of lactated Ringer's solution since the injury. How many ml should be given per hour for the next 4 hours of infusion according to the Parkland formula?", "input": "(A)8,000 ml. (B)5,000 ml. (C)625 ml. (D)1,000 ml. (E)975 ml. ", "output": "D"} 
-{"instruction": "A 32-year-old male presents to the emergency department with symptoms of bilateral eye pain, photophobia, uncontrollable tearing, and blurred vision. He works as an electric welder. Today, he developed this symptom after working for 8 hours without wearing goggles. Which of the following drugs is most suitable for temporary pain relief?", "input": "(A)Nonsteroidal anti-inflammatory drug eye drop. (B)Steroid eye drop. (C)Decongestant eye drop. (D)Topical anesthetics. (E)Antihistamine eye drop. ", "output": "D"} 
-{"instruction": "A 30-year-old female who is 12 weeks pregnant comes to the clinic because of migraine combined with nausea and vomiting. Which of the following drugs can be considered the most appropriate? ", "input": "(A)Chlorpromazine. (B)Dihydroergotamine. (C)Metoclopramide. (D)Prochlorperazine. (E)Sumatriptan. ", "output": "C"} 
-{"instruction": "A 30-year-old male was in a car accident and arrived at the hospital with a chest contusion. He was conscious, with a blood pressure of 145/75 mmHg, a heart rate of 115 beats/min, and respirations of 30 times/min. He had hazy breath sounds on the right side. His chest wall bulged when he exhaled and sunken when he inhaled. Which of the following statements about the first aid of this patient is wrong?", "input":"(A) Examination of the right chest revealed pneumothorax, which required chest tube drainage. (B) This breathing pattern should raise the suspicion of flail chest. (C) The patient may be in shock. (D) Recommended examinations include 12-lead electrocardiogram and cardiac enzyme testing. (E) Typical pulmonary contusion changes often appear 6 hours after injury in radiographic examinations.", "output": "E"}
-{"instruction": "A 30-year-old male had been feeling weak for two days. This morning, he found that his limbs were becoming weaker and he had palpitations. He was taken to the emergency room by his family. The patient reported that he often had hand tremors and sweating, and he had also had limb weakness in the past. During the examination, his temperature was 36.2 ℃, his pulse was 65 times/min, his blood pressure was 128/79 mmHg, and his respiration was 16 times/min. Except for the symmetrical weakness in his limbs, there were no other abnormalities. A blood test revealed that the potassium concentration in his blood was 1.6 mmol/L, TSH was low, and T3 and Free T4 were high. Which of the following statements is incorrect?", "input": "(A) This patient may be suspected of having hypokalemic periodic paralysis caused by hyperthyroidism. (B) The patient may have an attack after drinking alcohol or eating a lot of sweets, and the symptoms are mainly symmetrical distal weakness of the limbs. (C) The electrocardiogram may show flattening of the T wave, depression of the ST segment and the appearance of U waves. (D) When potassium chloride (KCl) injection is given by peripheral venous route, the potassium ion concentration should not exceed 40 mEq/L. (E) When potassium ions are given by peripheral venous route, the supplementation rate should not exceed 40 mEq/hr. ", "output": "B"} 
-{"instruction": "A 28-year-old male was in a car accident 1 hour ago and suffered blunt abdominal injuries. Which of the following statements is incorrect?", "input": "(A) Go to the emergency department and immediately check amylase and lipase (A) The patient's right eye was red and had mucopurulent discharge after wearing contact lenses. (B) The patient was given a peritoneal lavage (DPL) immediately after arriving at the emergency department, which could exclude pancreatic damage. (C) An abdominal CT scan immediately after arriving at the emergency department could not exclude intestinal damage. (D) Blunt abdominal injuries are more common in the left diaphragm than in the right. (E) If the patient has only a simple liver laceration, non-surgical treatment may be used depending on the severity. ", "output": "B"}  
-{"instruction": "A 26-year-old female, 32 weeks pregnant and weighing 65 kg, was hit by a motorcycle while crossing a zebra crossing. When she was taken to the emergency room by ambulance, she was conscious, breathing 24 times/min, pulse 112 times/min, blood pressure 118/76 mmHg, and body temperature 36.5 ℃. The victim complained of lower abdominal pain and a small amount of vaginal bleeding. Physical examination revealed lower abdominal tenderness but no rebound pain. Which of the following statements about this pregnant woman is incorrect?", "input": "(A) Although the pregnant woman's blood pressure is within the normal range, her bleeding may still exceed 1,500 ml, so she should be given crystalloid fluid infusion therapy and blood transfusion should be considered. (B) Although the pregnant woman does not know her own blood type, she knows that the fetus's blood type is type O Rh(-). Therefore, no matter what the mother's blood type is, she does not need to be given RhO(D)immunoglobulin. (C) The pregnant woman should lie on her left side to prevent the uterus from compressing the inferior vena cava. (D) When the pH value of vaginal secretions is around 5, it indicates amniotic membrane rupture. (E) If the pregnant woman's heart stops after emergency treatment, an emergency cesarean section can be considered. ", "output": "D"} 
-{"instruction": "A 26-year-old male drank a lot of mineral water and drinks to replenish water after sweating a lot during a marathon. After resting, he still felt dizzy and had a headache, so he continued to drink a lot of water. Later, as the symptoms worsened, he was taken to the emergency room by a friend. His temperature was 36.5℃, pulse 61 beats/min, blood pressure 110/75 mmHg, respiration 19 breaths/min, consciousness E3V4M5. Blood tests revealed that the blood sodium concentration was 128 mmol/L and the plasma osmolality was 266 mOsm/L. Which of the following statements is incorrect?", "input": "(A) When evaluating a patient with hyponatremia, the status of the extracellular fluid must be evaluated first. (B) A patient with hyperglycemia may have pseudohyponatremia due to excessive blood sugar. (C) This patient may have hypoosmotic hyponatremia due to excessive drinking of water. (D) The speed of correction of low blood sodium should not exceed 0.5~1.0 mEq/L per hour. If the patient develops seizures, the speed can be doubled. (E) Correcting blood sodium too quickly may cause cerebral edema, which can be fatal in severe cases. ", "output": "E"}
-{"instruction": "A 25-year-old female developed right eyelid redness and mucopurulent discharge after wearing contact lenses. discharge) to the emergency room. The eyes do not hurt. Which of the following drugs is most suitable for treating this patient?", "input": "(A) Gentamicin/Betamethasone eye drops. (B) Tetracycline HCl eye ointment. (C) Rinderon-A eye ointment. (D) Erythromycin eye ointment. (E) Ciprofloxacin eye drops. ", "output": "E"} 
-{"instruction": "A 25-year-old male was riding a bicycle and was crushed by a truck. When he arrived at the hospital, he had a deformed abdomen and pelvic fracture and right thigh deformity. He was conscious, his blood pressure was 80/45 mmHg, his heart rate was 145 beats/min, his breath sounds were clear and symmetrical, and there were tire marks on the upper abdomen. Which of the following statements is correct about the first aid of this patient?", "input": "(A) Prioritize the two 22-Gauge (B) Use FAST (Focused Assessment Sonography in Trauma) ultrasound to check for potential bleeding in the posterior peritoneal cavity. (C) When the FAST ultrasound is negative, surgery can be ruled out. (D) Rapidly insert a large-caliber intravenous catheter to give blood transfusions, preferably from the femoral vein rather than the subclavian vein. (E) When the FAST ultrasound is negative, consider pelvic fixation and arrange emergency angiography. ", "output": "E"} 
-{"instruction": "A 25-year-old male was randomly stabbed with a knife while riding the subway. The wound was located at the 4th intercostal space on the left anterior chest. The victim's cardiopulmonary function stopped 1 minute before arriving at the hospital, and the EMT immediately performed CPR. After arriving at the hospital, the medical staff took over the first aid. At this time, the carotid artery pulse could not be felt, but a fast and narrow QRS wave pattern appeared on the EKG monitor. After emergency CPR and endotracheal intubation, it was found that the breath sounds on both sides were equal and not weakened. What is the most appropriate next step?", "input": "(A) Immediately give a large amount of fluid. (B) Immediately insert chest tubes into both sides of the chest. (C) Immediately perform pericardial puncture. (D) Immediately perform emergency thoracotomy (ED thoracotomy) in the emergency department. (E) Immediately give ACLS first aid and send to the operating room for thoracotomy. ", "output": "D"} 
-{"instruction": "A 1-year-old child has bloody and mucous stools and continues to have intermittent abdominal pain and crying. The emergency department arranges an abdominal X-ray and abdominal ultrasound examination, which reveals intestinal obstruction. You judge that it is very likely to be intussusception and explain the necessity of air reduction to the family. The family asks whether this technique has any contraindications. Which of the following is wrong?", "input": "(A) It should not be performed when there is blood in the stool, for fear that pressure may cause intestinal perforation. (B) If there are signs of intestinal perforation or peritonitis, surgery should be performed. (C) Patients with hypovolemia or septic shock need to consult a surgeon for surgery. (D) If lymphoma causes intussusception, nonsurgical reduction is not appropriate. (E) Nonsurgical reduction is not appropriate if symptoms persist for more than 24 hours. ", "output": "A"} 
-{"instruction": "A 1.5-year-old and a 3-year-old brother were riding a motorcycle with their father. Their mother was holding the children from the back seat without wearing a helmet. They fell off the motorcycle when turning. Both children had a perfect GCS score, but the younger brother had a hematoma on his left temporal side and the older brother had a hematoma on his occipital side. They were taken to the emergency room by ambulance. They did not vomit and could be comforted. After careful questioning about the accident process, it was found that the speed of the car was slow and they were not at high risk of injury. According to the Pediatric Emergency Care Applied Research Network (PECARN) recommendation for brain CT examination, which of the following is correct?", "input": "(A) Although the children are conscious, they both have hematoma at the back of their skull. Both should undergo a CT scan of the brain. (B) The elder brother's injury is at a high risk, so he should undergo a CT scan of the brain. (C) Both are conscious. Even if they lost consciousness for a few seconds, they should just be observed. (D) The younger brother is younger than 2 years old. If his parents are worried, they can arrange a CT scan of the brain. (E) The elder and younger brothers have the same principle in deciding to have a CT scan.", "output": "D"} 
-{"instruction": "A 10-year-old boy weighs 20 kilograms. He is conscious but has a slight wheezing breath. His family said that the child has been wanting to drink water recently and has intermittent abdominal pain and vomiting. Blood test showed acidemia (pH=7.10), ketone body 2+, blood sugar 911 mg/dL, diagnosed as diabetic ketoacidosis, which of the following treatments is wrong?", "input": "(A) 0.9% Normal Saline 200~400 ml should be given within 1~2 hours. (B) If blood pH < 6.9, combined with high potassium, bicarbonate treatment should be given. (C) Immediately give insulin 4U per hour. (D) After blood sugar drops to 300 mg/dL, start giving 5% G/W. (E) Supplementing bicarbonate will actually increase the risk of cerebral edema. ", "output": "C"}
-{"instruction": "An 18-year-old woman underwent a cesarean section 6 days ago and went to the emergency department complaining of abdominal pain and foul-smelling bloody vaginal discharge. Physical examination showed obvious lower abdominal tenderness, clean and intact surgical wounds, mild swelling and tenderness of both breasts but no fever, vital signs: blood pressure 155/79 mmHg, heart rate 110 beats/min, respiration 20 times/min, body temperature 39℃. Which of the following diagnoses best explains the cause of this fever?", "input": "(A) Endometritis. (B) Mastitis. (C) Pyelonephritis. (D) Intra-abdominal gauze retention. (E) Appendicitis.", "output": "A"}  
-{"instruction": "A 20-year-old, 50-kg female patient was taken to the emergency room from the gas explosion scene. On arrival, her GCS was E4M6V5, her temperature was 36oC, her heart rate was 120 beats/min, her respiratory rate was 20 breaths/min, and her blood pressure was 150/88mmHg. She had 2nd-3rd degree burns on her face, chest, back, and upper limbs, covering approximately 40% TBSA. Which of the following treatments is more appropriate? ", "input": "(A) If the patient is in pain, she can be given an analgesic injection. (B) Routine use of preventive antibiotic treatment is necessary. (C) If the chest X-ray is normal, she can be observed first without rushing to insert an endotracheal tube. (D) Ice cubes and ice water can be applied to the wound to reduce further tissue damage. (E) According to Modified Parkland Formula, 4,000ml of Ringer's lactate should be given in the first 24 hours 
-."A 23-year-old male went diving at Green Island. 20 minutes after landing, he suddenly felt weakness in his right leg. After preliminary evaluation, the patient was conscious, blood pressure was 130/80 mmHg, heart rate was 100 beats/min, breathing was 18 times/min, right leg strength was 3 points, and other limb strength was normal. If you want to transfer the patient to a hospital in western Taiwan at this time, which of the following methods is best?", "input": "(A) Take a boat to Taitung first, then take an ambulance via the Southern Cross-Island Highway to the west. (B) Take a helicopter directly over the Southern Cross-Island Highway to the west. (C) Take a boat to Taitung first, then take a general commercial passenger plane from Taitung Airport to the west. (D) Take a low-flying helicopter (less than 300 meters) around the southern tip of Taiwan to the west. (E) Take a helicopter directly over the Central Mountains to Taipei.", "output": "D"}
-{"instruction": "A 26-year-old female was 25 weeks pregnant when she was driving on the highway and had a car accident. The paramedics found that the airbag was deployed. She was conscious when she was transferred to the hospital but complained of lower abdominal pain. Her vital signs at the emergency room were: heart rate 88 beats/min, blood pressure 105/70 mmHg. Which of the following statements is incorrect?", "input": "(A) Pregnancy increases the mother's total blood volume, so it will present hypervolemic. Therefore, it is possible that blood loss of more than 30% will lead to abnormal vital signs. (B) At 12 weeks of pregnancy, the height of the uterine fundus is approximately at the pubic symphysis, and at 20 weeks it is approximately at the height of the navel. Thereafter, the uterine fundus rises by about 1 cm with each additional week. (C) To avoid affecting venous return, it is recommended to lie on the left side. If a long backboard is used, place something under the long backboard in the right hip area so that the patient is tilted about 30° with the left lower and the right higher. (D) Abdominal contusion often leads to fetal death due to uterine rupture and placental rupture. (E) If the pregnant woman is found to have right-sided hemothorax after examination, the position of the chest tube is the same as that of an ordinary adult. ", "output": "E"} 
-{"instruction": "A 28-year-old female was found unconscious at home by her family and sent to the emergency room. Her symptoms included dilated pupils, eye spasms, increased neuromuscular reflexes, muscle spasms, blood pressure 190/108 mmHg, heart rate 126 beats/min, respiration 32 times/min, and body temperature 39.5℃. Which of the following is the least likely diagnosis for the patient?", "input": "(A) Amphetamine. (B) Tricyclic antidepressants. (C) Serotonin syndrome. (D) Organophosphate pesticide poisoning. (E) Antipsychotic drug malignancy syndrome.", "output": "D"} 
-{"instruction": "A 28-year-old pregnant woman, 35 weeks pregnant, drove to her prenatal checkup by herself. Because the car in front of her braked suddenly and failed to react in time, she crashed into the car in front of her. When she arrived at the hospital, she was conscious, her blood pressure was 130/80 mmHg, her heart rate was 100 beats/min, and her breathing was 20 breaths/min. Physical examination revealed an obvious seat belt mark under her navel. Which of the following statements about the assessment and treatment of this patient is incorrect?", "input": "(A) Uterine rupture is a relatively rare complication. When uterine rupture occurs, the fetal mortality rate is greater than that of the mother. (B) Ultrasound examination can detect placental detachment better than fetal monitoring. (C) Placental detachment is the most common cause of fetal death after maternal death. (D) After the mother's condition stabilizes, she should be seen by the obstetrics and gynecology department as soon as possible to evaluate the fetus's condition, whether there is water rupture or vaginal bleeding. (E) Most obstetricians and gynecologists believe that if the number of contractions per hour in the first 4 hours of monitoring is less than 3, the pregnant woman can be discharged from the hospital and return home. ", "output": "B"} 
-{"instruction": "A 29-year-old female, 20 weeks pregnant, came to the emergency department complaining of right lower abdominal pain for 2 days. Before coming to the clinic, she had poor appetite and vomited several times, but no diarrhea. Vital signs: temperature 37℃, heart rate 108 beats/min, respiratory rate 20 times/min, blood pressure 112/76mmHg. Physical examination revealed obvious tenderness in the right lower abdomen and rebound tenderness. Laboratory examination revealed WBC 7,800/μL, Neutrophil 78%, Hb 13 g/dL, PLT 242,000/μL. Sugar 102mg/dL, Creatinine 0.8 mg/dL, AST 38 U/L. Which of the following statements is correct? ", "input": "(A) According to the modified Alvarado score, it can be estimated that the patient has a less than 10% chance of appendicitis. (B) If ultrasound examination finds that the appendix is ​​non-compressible and the diameter is greater than 3mm, appendicitis can be diagnosed. (C) If a pregnant woman undergoes abdominal CT, it is estimated that the fetus absorbs about 20~30 rad of radiation. (D) This patient can choose abdominal magnetic resonance imaging (MRI) to help with diagnosis. (E) Too many imaging examinations will greatly increase the chance of appendicitis perforation, and a surgeon should be consulted early for surgery. ", "output": "D"} 
-{"instruction": "A 2-year-old girl had a fever for 5 days, drooling, ulcers on the tongue, gums, and lips, bad breath, swollen lymph nodes in the neck, and red and swollen blisters on the right thumb. Examination of other parts of the body was normal. The clinic gave her oral Amoxicillin but she still had a fever. What is the most likely pathogen? ", "input": "(A) Group A streptococcus. (B) Coxsackievirus. (C) Staphylococcus aureus. (D) Herpes simplex virus. (E) Adenovirus. ", "output": "D"} 
-{"instruction": "A 30-year-old female was bitten by a stray cat and was accompanied by her family to the emergency room for treatment. The patient reported that she had not received a tetanus vaccine or a rabies vaccine since graduating from elementary school. Wound examination revealed a 3-cm laceration on the right forearm. Which of the following is correct about the treatment of cat bites? ", "input": "(A) Primary sutures increase the chance of infection, so preventive antibiotic treatment should be used. (B) Because it is a high-risk wound for tetanus infection, tetanus immunoglobulin should be administered. (C) Because rabies infection is possible, at least 3 doses of rabies vaccine should be administered. (D) For highly infected wounds, antibiotics are recommended, with Moxifloxacin being the preferred drug. (E) After wound treatment, if hospitalization is not arranged, it is recommended to return to the outpatient clinic for follow-up within 72 hours. ", "output": "C"} 
-{"instruction":"A 35-year-old male patient is HIV positive and has not taken medication as prescribed in the past 3 months. He comes to the emergency department complaining of fever and increasing breathlessness in the past 2 weeks. When he arrived at the emergency department, his vital signs were: heart rate 110 beats/min, blood pressure 135/75 mmHg, respiratory rate 22 breaths/min, blood oxygen concentration 92% (room air), and his body temperature is now normal; the blood test report is as follows: WBC 2,000/uL; chest X-ray found diffuse interstitial infiltrates on both sides. Which of the following drugs is not suitable for the treatment of his current condition?", "input": "(A) Pentamidine. (B) Prednisone. (C) Pyrimethamine. (D) Sulfamethoxazole. (E) Trimethoprim. ", "output": "C"} 
-{"instruction": "A 37-year-old male was treated in the outpatient clinic for Schizophrenia. The medication he took was Seroquel 100mg and Lexotan (bromazepam) 3mg (1 tablet each before bedtime). A few days later, he became unconscious and stiff and was sent to the hospital. The measured vital signs are as follows: GCS E4M4V1, blood pressure 85/51 mmHg, heart rate 168 beats/min, body temperature 40.2℃, respiration 22 times/min, SpO₂ 94%. The pupils on both sides are 3.5mm. Other physical examination findings include: DTR: hyporeflexia, Babinski sign (-), Rigidity: (+) similar limbs, sweating. CT scan showed no obvious abnormality, and the electrocardiogram showed a sinusoidal pulse. Blood test reference: CK 319 U/L, Cr 1.3 mg/dL, Na 122 mEq/L, AST 94 U/L, ALT 126 U/L. In the case of suspected poisoning, which of the following diagnoses is correct? ", "input":"(A)Cholinergic toxidrome. (B)Anticholinergic toxidrome. (C)Sympathomimetics. (D)Serotonin syndrome. (E)Neuroleptic malignant syndrome.", "output": "E"}
-{"instruction": "A 38-year-old female patient was taken to the emergency room by her family due to impaired consciousness. The patient presented with lethargy. Her blood sugar level was normal and she had no history of medication. According to her family, she was unable to breastfeed when she gave birth to her second child 6 years ago. Physical examination revealed pale complexion, blood pressure 90/60 mmHg, heart rate 64 beats/min, and respiration 14 times/min. She had decreased body hair. Laboratory examination revealed Hb 8.8 g/dL and Na 124 mEq/L. Which of the following treatments is most appropriate?", "input": "(A) After giving 3% NaCl drip, if the blood sodium level is normal and the patient is conscious, she can be discharged home. Encourage the patient to consume more salt. (B) Give a transfusion of two units of packed RBC. If there is no obvious source of bleeding and the hemoglobin level improves, she can be discharged home. (C) All the symptoms of the patient can be explained by adrenal hypofunction. After being given adrenal cortisol, he can be discharged home. (D) This patient may have Sheehan's syndrome and needs to be examined and treated for hypopituitarism. (E) Since this patient is in shock, he should be treated with Dopamine first. ", "output": "D"} 
-{"instruction": "A 39-year-old male with a long history of epilepsy was found to have an epileptic seizure at home by his family today. When the patient was taken to the emergency room, he was fully conscious. Which of the following statements about the treatment of this patient is incorrect? ", "input": "(A) Many patients like this one are caused by not taking anti-epileptic drugs regularly. (B) If the patient is suspected of not taking anti-epileptic drugs regularly, the concentration of anti-epileptic drugs in the serum should be tested before the initial dose of anti-epileptic drugs is administered. (C) If the concentration of anti-epileptic drugs in the patient's serum is appropriate, a supplemental dose should be considered to prevent the recurrence of epilepsy. (D) Even patients with epilepsy who are well controlled with anti-epileptic drugs may still have occasional epileptic attacks. (E) There is currently no evidence-based criterion to determine how long the patient should stay in the emergency department. ", "output": "C"} 
-{"instruction": "A 40-year-old woman hanged herself after suspected drug use. She was sent to the emergency room without any signs of life. Which of the following statements is incorrect?", "input": "(A) According to the method of hanging, if the body is in the air and the feet do not touch the ground, it is called complete, and all other methods are called incomplete. (B) Death is usually caused by three factors: damage to the spinal cord or brain stem, compression of the neck structure, or bradycardia leading to cardiac arrest. (C) If the height of the hanging is greater than or equal to the patient's height, the cause of death should be excessive pressure, resulting in compression of the internal blood vessels in the neck and brain death. (D) Bradycardia is caused by the pressure of hanging stimulating the carotid sinus and causing increased vagal tone. (E) If cervical spine injury cannot be ruled out, it is best to use a cervical collar for fixation. ", "output": "C"} 
-{"instruction": "A 77-year-old male was admitted to the outpatient clinic for Parkinsonism. He was taking Madopar (levodopa) 250mg 1# tid, Enzil (amantadine) 100mg ½ # bid. Past medical history: uremia receiving hemodialysis, heart bypass surgery. The patient was sent to the hospital due to unconsciousness, fever, and general stiffness. The measured vital signs were as follows: GCS E4M6V5 (but the correct location could not be determined), blood pressure 162/76 mmHg, heart rate 84 beats/min, body temperature 39.2℃, respiration 16 times/min, SpO₂ 96%. The pupil size was 3.0mm on both sides. Babinski sign(-), Rigidity:(+) All four limbs are similar. There are no obvious signs of infection, no obvious abnormalities in CT, and no obvious abnormalities in EKG. Blood test reference: CK 319U/L; Cr 1.3mg/dL; Na 142mEq/L; AST 20U/L; WBC 9,450 µ/L. In the case of suspected poisoning, which of the following diagnoses is correct? ", "input": "(A)Cholinergic toxidrome. (B)Anticholinergic toxidrome. (C)Sympathomimetics. (D)Serotonin syndrome. (E)Neuroleptic malignant syndrome. ", "output": "D"} 
-{"instruction": "A 9-month-old girl (weight 10 kg) continued to have intermittent abdominal pain and crying at home. She was sent to the emergency room because of bloody stools. An abdominal X-ray and abdominal ultrasound examination were urgently arranged. Intestinal obstruction was suspected. You judged that it was very likely to be intussusception. Which of the following is wrong? ", "input": "(A) If the symptoms are within 24 hours, non-surgical methods are recommended. (B) Air reduction should not be performed when there are signs of peritonitis, for fear that pressure will cause intestinal perforation. (C) If the amount of bleeding is large and there are symptoms of circulatory insufficiency, give 200 mL of Normal Saline as soon as possible and prepare for blood transfusion. (D) Bloody stools are a late symptom of intussusception and a contraindication to air reduction. (E) If air reduction fails, reassessment is required to determine if it is incarcerated hernia. ", "output": "D"} { "D"} 
-{"instruction": "EMT rescued a severely burned patient from a fire scene and sent him to the emergency department of a nearby critical care hospital. After first aid, the emergency doctor wanted to transfer the patient because the hospital did not have a burn intensive care unit. However, he could not find a nearby hospital with a burn intensive care unit. Later, the family insisted on transferring the patient to the emergency department of Medical Center A. Which of the following is correct?", "input": "(A) The emergency doctor should call the regional emergency medical response center (rROC) in the area and request assistance in the transfer. (B) Before transferring the patient, the doctor should fill out an emergency disease referral form. (C) This case should be considered an automatic discharge, and the doctor does not need to contact the emergency department of Medical Center A. (D) This is a critical case. The hospital is responsible for severe emergency treatment. It is inappropriate to transfer the patient to another hospital. (E) This case is a case where the family insisted on transferring the patient to another hospital. This case does not fall under the Emergency Medical Rescue Act. ", "output": "B"}
-"instruction": "An alcoholic with cirrhosis is admitted to the emergency department for esophageal varicose bleeding. He is fasting and receiving medication. 24 hours after admission, he develops agitation, sweating, hand tremors, headaches, elevated blood pressure, seizures, and visual hallucinations. Which of the following statements is incorrect about the management of this patient? ", "input": "(A) The diagnosis of alcohol withdrawal symptoms combined with epilepsy is met, but a detailed physical examination and differential diagnosis are still required. (B) Benzodiazepines are the first choice for the treatment of alcohol withdrawal symptoms combined with epilepsy. (C) Haloperidol can be used to treat hallucinations associated with alcohol withdrawal. (D) Anti-epileptic drugs (such as phenytoin) can be used to prevent the recurrence of alcohol withdrawal epilepsy. (E) The use of benzodiazepines can reduce the occurrence of alcohol withdrawal combined with delirium. ", "output": "D"} 
-{"instruction": "Which of the following statements about diarrhea is correct? ", "input":"(A) Most cases of diarrhea are non-infectious, while infectious diarrhea is usually caused by viruses. (B) Less than 10% of elderly people with mesenteric ischemia present with diarrhea, while persistent diarrhea in young people should be considered as a form of sexually transmitted infection. (C) Blood biochemistry tests and complete blood counts are often helpful in diagnosing diarrhea. (D) Wright stain is used to detect white blood cells in stool, and about 80% of positive tests can culture pathogens. (E) If the stool contains blood, it is usually not necessary to culture stool bacteria.", "output": "D"}
-{"instruction": "Which of the following ways to reach Yushan North Peak (3,850 meters) and stay at Yushan North Peak that night has the highest risk of developing severe high altitude illness?", "input": "(A) Take a helicopter directly to Yushan North Peak from the ground. (B) From Dongpu Hot Spring in Nantou County (1,100 meters), walk to Guangao (2,800 meters) via the Batongguan Ancient Trail, stay at Guangao the first night, and walk from Guangao to Yushan North Peak on the second day. (C) Depart from Taipei, take a night train to Tatajia in Yushan National Park, walk to Paiyun Villa (3,402 meters) from the Tatajia trailhead (2,600 meters) in the morning, and walk from Paiyun Villa to Yushan North Peak on the third day. (D) Depart from Taipei, take a bus and stay at the Alishan Youth Activity Center (2,000 meters above sea level) on the first night. In the morning, walk from the Tatajia trailhead to Paiyun Villa. On the third day, walk from Paiyun Villa to the North Peak of Yushan. (E) Depart from Taichung, take a bus and stay at Dongpu Villa (2,500 meters above sea level) on the first night. In the morning, walk from the Tatajia trailhead to Paiyun Villa. On the third day, walk from Paiyun Villa to the North Peak of Yushan. ", "output": "A"} 
-{"instruction": "Which of the following electrolyte abnormalities will not occur in patients with heat stroke? ", "input": "(A) High sodium. (B) High potassium. (C) High calcium. (D) Low sodium. (E) Low potassium. ", "output": "C"} 
-{"instruction": "Which of the following acidic liquid burns should be considered for treatment with calcium ion solution injection?", "input": "(A)Acetic acid (Acetic acid). (B)Chromic acid (Chromic acid). (C)Formic acid (Formic acid). (D)Nitric acid (Nitric acid). (E)Oxalic acid (Oxalic acid).", "output": "E"} 
-{"instruction": "Which of the following drug poisoning patients is not suitable for multidose activated charcoal therapy?", "input": "(A)Theophylline. (B)Carbamazepine. (C)Phenobarbital. (D)Quinine. (E)Acetaminophen.", "output": "E"} 
-{"instruction": "Which of the following antibiotics is more correct?", "input": "(A)33-year-old alcoholic male with pneumonia, given ceftriaxone 1g (B) A 7-year-old boy with acute pharyngitis was given tetracyclines 50 mg/kg orally every day. (C) A 5-year-old girl with acute meningitis was given azithromycin 10 mg/kg intravenously every day. (D) A 26-year-old male basketball player with mild pneumonia was given moxifloxacin 400 mg orally once a day. (E) A 28-year-old pregnant woman with urinary tract infection was given ciprofloxacin 500 mg orally twice a day. ", "output": "A"} 
-{"instruction": "Which of the following statements about hyponatremia is incorrect? ", "input": "(A) Hyponatremia will not have any special manifestations or effects on the patient's muscle tone and function. (B) In patients without seizure complications, the rate of correction of blood sodium should not exceed 0.5-1 mEq/L per hour. (C) If the patient has had an epileptic seizure, the rate of correction of blood sodium can be increased to 1-2 mEq/L per hour. (D) In ​​the treatment of patients with chronic hyponatremia, if the rate of increase is greater than 0.5 mEq/L per hour, central putamen myelinolysis and neurological dysfunction are likely to occur. (E) Clinical symptoms usually begin to appear when Na is less than 120 mEq/L, and epilepsy is more likely to occur when it is less than 113 mEq/L. ", "output": "D"} 
-{"instruction": "Which of the following statements about acute otitis media is incorrect? ", "input": "(A) Common pathogens are Streptococcus pneumoniae, Haemophilus influenzae (nontypeable) and Moraxella catarrhalis. (B) The diagnostic criterion is the detection of redness of the eardrum (erythema) during physical examination. (C) For children over two years old with acute otitis media, if they do not have severe symptoms, it may be considered to observe them for 48 hours before deciding whether to give them antibiotic treatment. (D) Antibiotic treatment includes amoxicillin or amoxicillin-clavulanate. (E) About half of the patients may still have middle ear effusion (OME) after treatment. ", "output": "B"}  
-{"instruction": "Which of the following statements about epistaxis is incorrect? ", "input":"(A)The most common bleeding site is Kiesselbach's plexus (or Little's area) on the anterior and inferior side of the nasal septum. (B)Children's nasal bleeding is also prone to occur in Kiesselbach's plexus (or Little's area). (C)Hypertension is an important cause of epistaxis. When patients with nasal bleeding are also measured with high blood pressure, the blood pressure should be lowered as soon as possible. (D)Available treatments include oxymetazoline spray and pledgets. (E)Silver nitrate chemically cauterizes is not recommended for bilateral anterior nasal bleeding at the same time.", "output": "C"}
-{"instruction": "Lower back pain is a common chief complaint in emergency departments. Which of the following statements about the common causes of lower back pain is correct? ", "input": "(A)Neurogenic claudication is relieved by rest but is aggravated by forward flexion of the spine. (B)The most common symptom of cauda equina syndrome is decreased anal sphincter tension, not urinary retention. (C)When epidural compression syndrome is suspected to be caused by a tumor, steroid treatment should be given before MRI confirmation. (D)To diagnose spinal epidural abscess, the three symptoms of severe back pain, fever, and neurological deficits must be present at the same time. (E)X-ray manifestations of spinal osteomyelitis often show bone hyperplasia and intervertebral disc stenosis. ", "output": "C"} 
-{"instruction": "Among the various intrinsic factors that cause acute renal failure (intrinsic renal failure), which of the following is wrong? ", "input":"(A)Acute interstitial nephritis. (B)Hemorrhagic shock. (C)Ischemic acute tubular necrosis (ATN). (D)Rapid progressive glomerulonephritis. (E)Rhabdomyolysis.", "output": "B"} 
-{"instruction": "Which of the following statements is correct when a pregnant woman dies suddenly and cardiopulmonary resuscitation is required?", "input": "(A)When using mask ventilation, if the resistance is large and the tidal volume is insufficient, the ventilation rate can be increased to compensate. (B)When performing rapid sequence intubation, succinylcholine should be avoided when using muscle relaxants. (C)Emergency cesarean section is not considered for fetuses under 28 weeks. (D)Inguinal central venous catheter placement should be the first choice during chest compression. (E)Amiodarone can have serious adverse effects on the fetus and should be avoided in pregnant women. ", "output": "E"}
-{"instruction": "Young children are admitted to the emergency room due to trauma. Which of the following injuries is most likely to be caused by accidental injury or child abuse?", "input": "(A) The caregiver reported that the 1.5-year-old child played with his own genitals and caused a laceration. (B) The caregiver reported that the 1.5-year-old child fell while running, and an examination revealed a fractured clavicle. (C) The caregiver reported that the 2-year-old child fell while running, and an examination revealed a lacerated chin. (D) The caregiver reported that the 10-month-old child fell while learning to walk, and an examination revealed a fractured thigh. (E) The caregiver reported that the 10-month-old child fell from the bed, and an examination revealed multiple rib fractures.", "output": "C"} 
-{"instruction": "In the emergency room, a 5-year-old child was undergoing a forehead laceration suture surgery. The child was emotionally agitated and unable to cooperate. Even after appropriate comfort, he was still unable to cooperate. Which of the following statements is incorrect:", "input": "(A) Chloral hydrate can be used, but the effect is slow and the duration of action is long. It is not an ideal sedative for emergency invasive treatment. (B) Ketamine can be injected intramuscularly to produce a combined sedative and analgesic effect. (C) Midazolam can be given because it is safe, effective and has a short duration of action. (D) Ketamine can be used in combination with midazolam to reduce the occurrence of hallucinations. (E) Ketamine can also be used in infants under 3 months old, but be careful about excessive saliva to prevent airway obstruction.", "output": "B"} 
-{"instruction": "Which of the following ultrasound signs has the highest specificity for the diagnosis of pneumothorax?", "input": "(A)Comet-tail artifacts. (B)Lung point sign. (C)Lung pulse sign. (D)Seashore sign. (E)Stratosphere sign.", "output": "B"} 
-{"instruction": "An AIDS patient comes to the emergency department complaining of general weakness, weight loss, poor appetite, pigmentation on the teeth, and physical examination reveals hypotension. What complications should be highly suspected in this patient?", "input": "(A)Sepsis. (B)Adrenal insufficiency. (C)Kaposi's sarcoma. (D)Heart failure. (E)Malnutrition.", "output": "B"} 
-{"instruction": "Which of the following statements about cardiac tamponade is incorrect?", "input": "(A) The electrocardiogram may show electrical alternans. (B) Possible causes include pericarditis, hypothyroidism, cancer, uremia, trauma, etc. (C) There may be Kussmaul signs, where the patient's carotid veins become more dilated when he or she exhales deeply. (D) Typical clinical manifestations of Beck triad include: low blood pressure, venous distension, and distant, muffled heart sounds. (E) At the end of diastole, the right and left atrial pressures are similar or equal. ", "output": "C"} 
-{"instruction": "Which of the following statements about the clinical manifestations of common venomous snake bites in Taiwan is incorrect? ", "input": "(A) Hemorrhagic venomous snake bites will cause tooth marks and local swelling and pain, and subcutaneous hemorrhage, blisters or blood blisters may be seen. (B) Hemorrhagic venomous snake bites may have complications such as hemolysis, rhabdomyolysis, and diffuse intravascular coagulation (DIC). (C) In the case of a serpentine bite, tooth marks (small tooth marks) are not easily found. (D) Cobra venom contains cytotoxins, which can cause local swelling and pain, hemorrhagic subcutaneous hemorrhage, blisters or blood blisters, and in severe cases, skin necrosis. (E) After being bitten by a cobra, the patient will experience nausea, vomiting, abdominal pain, diarrhea, and severe neuromuscular blockade. ", "output": "E"} 
-{"instruction": "Which of the following descriptions of botulism is incorrect? ", "input": "(A) It is caused by the toxin secreted by Clostridium botulinum, and symptoms occur 6 to 48 hours after ingestion. (B) First, double vision, drooping eyelids, eye movement disorders, slurred speech, and difficulty swallowing occur. (C) Then, muscle strength decreases from the upper limbs to the lower limbs, and respiratory distress gradually occurs, and finally respiratory failure occurs. (D) Abnormal sensory function and tendon reflex function will occur. (E) Symptoms usually include urine retention, blurred vision, and dry skin and eyes. ", "output": "D"} 
-{"instruction": "Which of the following is incorrect about the description, antidote use, and treatment of methanol poisoning? ", "input": "(A) The half-life of formic acid, the main toxic metabolite, is about 20 hours. (B) Late-stage symptoms are mainly metabolic acidosis and optic nerve edema, which produce permanent neurological sequelae. (C) The treatment goal of using Fomepizole as an antidote for methanol poisoning is to achieve a methanol concentration of less than 20 mg/dL. (D) When using ethanol to treat methanol poisoning, the loading dose is 1 g per kilogram of body weight for oral or intravenous administration. (E) Ethanol is used to treat methanol poisoning. If hemodialysis is required, the amount of ethanol given should be reduced. ", "output": "E"}"B"} 
-{"instruction": "Which of the following statements about marine toxins is correct?", "input": "(A) Pufferfish toxins can be destroyed by frying, marinating, or cooking. (B) Pufferfish poisoning symptoms usually develop 24 hours after ingestion. (C) The formation of toxins in coral reef fish is related to the biological chain. (D) Histamine in fish is destroyed by cooking, so if the fish is cooked, it will not cause poisoning. (E) Jellyfish stings often present on the skin as red lines with a special lymphatic distribution. Flushing with large amounts of clean water can inactivate the stinging cells.", "output": "C"} 
-{"instruction": "Which of the following statements about the occurrence and symptoms of vertebral artery dissection is incorrect?", "input": "(A) Usually occurs in people older than 65 years. (B) Usually presents with severe unilateral headache in the back of the neck. (C) Neurological symptoms usually involve the brain stem and cerebellum. (D) Patients may experience neck pain, numbness of the face and limbs, vertigo, ataxia, and dysarthria. (E) Vertebral artery dissection may result from neck injury.", "output": "A"}"E"} 
-{"instruction": "What is wrong with air medical treatment?", "input": "(A) Safety is the primary guiding principle of air medical treatment. (B) The captain needs to fully understand the aircraft and weather conditions before departure, and also needs to understand the patient's information and condition. (C) Air medical nurses usually have experience in intensive care units or emergency medical care. (D) About 50% of air medical medical instructors have an emergency background. (E) The physical condition and stress of the crew will affect flight safety.", "output": "B"}
-{"instruction": "Which of the following statements about patients with acute heart failure and pulmonary edema is incorrect?", "input": "(A) Natriuretic peptide is recommended for diagnosing or excluding heart failure, but routine testing is still controversial. (B) If the patient's blood pressure is greater than 150/100 mmHg, nitroglycerin can be used. The maximum dose is 100 mg/min. The end point of adjusting the dose is the improvement of blood pressure or symptoms. (C) Diuretics must be used in combination with vasodilators. If diuretics are used alone, they may increase mortality. (D) Non-invasive ventilators can be used in patients with acute heart failure or pulmonary edema. (E) Non-invasive respirators can be used in patients with moderate to severe acute heart failure and respiratory failure, and blood circulation stabilization is required. ", "output": "B"} 
-{"instruction": "Which of the following statements about resuscitation treatment for patients injured in dust explosions is incorrect? ", "input": "(A) A 60 kg adult with second- and third-degree burns covering 40% of the body surface area requires 8 hours of infusion of 3,600 ml of lactated Ringer solution. (B) Patients with full-thickness burns on the face require immediate endotracheal intubation. (C) The particulate matter contained in smoke is usually less than 0.5 micrometer in size, which is formed by the incomplete combustion of organic materials. (D) Small particles in smoke can reach the terminal bronchioles, causing an inflammatory response and leading to bronchial spasm and edema. (E) When inhalation injury exists, fluid resuscitation should be performed with caution to avoid aggravating pulmonary edema and acute respiratory distress syndrome. It is recommended to establish hemodynamic monitoring at an early stage. ", "output": "A"} 
-{"instruction": "Which of the following statements is incorrect about the emergency clinical treatment of severe hemoptysis (life-threatening hemoptysis)? ", "input": "(A) Bleeding lung down is often used in clinical practice, which may cause a more serious ventilation-perfusion mismatch. (B) If the patient has respiratory failure or unstable vital signs, intubation should be given immediately. The diameter of the endotracheal tube should be as large as possible, preferably 8 mm or more. (C) If the patient is taking wafarin, coagulation function should be tested, and fresh frozen plasma (FFP) should be transfused after the report is released. (D) Emergency bronchoscopy should be performed as soon as possible, which is the first-line choice for diagnosis and treatment. (E) If the bleeding continues to be uncontrolled, BAE (bronchial artery angiography and embolization) or surgery should be considered. ", "output": "C"} 
-{"instruction": "You are treating an 8-year-old boy with left knee pain and fever for 3 days. After initial evaluation, you highly suspect that the boy has acute septic arthritis. Which of the following is the least likely pathogen to cause the boy's septic arthritis? ", "input": "(A)Methicillin-resistant Staphylococcus aureus. (B)Methicillin-sensitive Staphylococcus aureus. (C)Streptococcus sepcies. (D)H. Influenzae. (E)Gram-negative bacilli. ", "output": "D"} 
-{"instruction": "You are treating a 7-year-old boy with suspected lower gastrointestinal bleeding. Rectal examination revealed blood on the gloves, and other physical examinations were normal. Which of the following is the most likely cause of this boy's gastrointestinal bleeding? ", "input": "(A)Henoch-Schonlein purpura. (B)Intussusception. (C)Polyp. (D)Milk protein allergy. (E)Meckel's diverticulum. ", "output": "C"} { 
-"instruction": "Systemic autoimmune diseases are often accompanied by various complications. Which of the following statements is incorrect? ", "input": "(A)Patients with Behcet's disease are more likely to have deep venous thrombosis. (B)Patients with temporal arteritis are more likely to have optic nerve damage. (C) Patients with rheumatoid arthritis are more likely to suffer atlantoaxial subluxation due to minor trauma. (D) Patients with ankylosing spondylitis are often accompanied by cauda equina syndrome. (E) Systemic sclerosis increases the risk of arrhythmia. ", "output": "D"} 
-{"instruction": "Two motorcycles were involved in a car accident. EMTs were notified and rushed to the scene. There were one EMT-P, one EMT-II, and one Phoenix volunteer EMT-I in the ambulance. One patient was not breathing or having a heartbeat at the scene. A passerby was giving CPR. Phoenix volunteers immediately inserted a laryngeal mask airway into the patient, EMT-P gave the patient an IV drip, and after EMT-II connected the AED, the AED voice said: Electric shock recommended. In this process, who violated the current regulations for the management of emergency technicians? ", "input": "(A) No one violated the regulations. (B) Phoenix volunteer EMT-I. (C) EMT-II. (D) EMT-P. (E) Passersby. ", "output": "B"} 
-{"instruction": "The operation of air medical transfer is related to altitude. Which of the following statements is correct? ", "input":"(A) Boyle's Law: The higher the altitude → the lower the pressure → the larger the bubble volume. (B) Henry's Law: At a constant temperature, the amount of gas dissolved in a liquid is inversely proportional to the partial pressure of the gas above the liquid. (C) The patient has an endotracheal tube, and the cuff does not need to be replaced with liquid, such as saline. (D) The patient has a urinary catheter, and the liquid in the balloon should be replaced with gas. (E) For a 10% pneumothorax, there is no need to insert a chest tube to reduce pressure before air transfer.", "output": "A"} 
-{"instruction": "The severity of acute pancreatitis is very important for the subsequent treatment and prognosis of patients. According to the Atlanta criteria , the following are indicators that can predict severe pancreatitis, except which one? ", "input": "(A)APACHE II score ≤ 8. (B)Ranson score ≧ 3. (C)Serum creatinine > 2mg/dL, before fluid resuscitation. (D)Serum calcium ≦ 7.5 mg/dL. (E)Presence of pancreatic pseudocyst. ", "output": "C"}
-{"instruction": "According to the World Health Organization (WHO) 2009 dengue case classification, which of the following is not a diagnostic condition for severe dengue fever?", "input": "(A) Severe bleeding. (B) Severe plasma leakage leading to shock. (C) GOT or GPT ≧ 1000 IU/L. (D) Severe plasma leakage leading to fluid accumulation and respiratory distress. (E) Liver enlargement exceeds 2 cm below the ribs.", "output": "E"} "E"} 
-{"instruction": "A patient complained of coughing up blood and went to the emergency department. Which of the following statements is incorrect?", "input": "(A) Coughing up more than 600 mL of blood within 24 hours is called massive hemoptysis. (B) Bronchial artery embolization has a 1.4-6.5% risk of spinal artery obstruction, leading to unilateral paralysis. (C) Computed tomography with contrast agent and bronchoscopy have similar accuracy in diagnosing bleeding points. (D) 15-30% of patients with hemoptysis have normal chest X-rays. (E) Pulmonary blood flow is supplied by two sets of vascular systems (Bronchial and pulmonary vessels), and coughing up blood that requires emergency treatment is mostly bleeding from bronchial vessels. ", "output": "B"}
-{"instruction": "Which of the following statements is incorrect regarding pediatric trauma treatment?", "input": "(A) The principles of first aid treatment for pediatric trauma are the same as those for adults. (B) For traumatic massive hemothorax in children, the definition of recommended surgery is that the amount of immediate bleeding after chest tube placement is greater than 15mL/kg or greater than 4mL/kg/h. (C) If signs of shock appear, 20mL/kg of normal saline can be given three times. If the signs of shock still cannot be improved, 10mL/kg of blood transfusion can be given. (D) If there is cerebral hemorrhage and the patient is suspected of having an injury with increased intracranial pressure, hyperventilation can be given appropriately, and PaCO₂ should ideally be controlled between 30 and 34mmHg. (E) In pediatric trauma, if vital signs are stable and there is suspected blunt renal contusion, urine tests can be performed. If it is greater than 5 RBCs/HPF, further examination and treatment should be arranged. ", "output": "E"} 
-{"instruction": "For incomplete spinal cord injury, which of the following statements is correct?", "input": "(A) Central cord syndrome will cause complete paralysis below the lesion and loss of pain and temperature sensation. (B) Anterior cord syndrome will cause paralysis of the limbs, some of which may lead to decreased pain and temperature sensation, and the symptoms in the upper limbs are greater than those in the lower limbs. (C) Brown-sequard syndrome will cause weakness of the limbs below the lesion, loss of proprioception, and loss of pain and temperature sensation on the opposite side. (D) Cauda equina is a central nerve injury, which is accompanied by incontinence. (E) Brown-sequard syndrome has the worst prognosis among the above four.", "output": "C"} 
-{"instruction": "For acute appendicitis (Acute Which of the following statements is incorrect about the examination of acute appendicitis? ", "input": "(A) CRP doubles every 8 hours and peaks at 36 to 50 hours. (B) If the modified Alvarado score is greater than 6 points, you can directly consult a surgeon without imaging examination. (C) Even if the ultrasound examination is negative, it cannot rule out acute appendicitis. (D) The abdominal CT is negative, which should rule out acute appendicitis. (E) Laparoscopy can be used for diagnosis and treatment. ", "output": "D"} 
-{"instruction": "Septic arthritis is a problem that needs to be ruled out for acute joint pain. In the adolescent population, gonococci are the most common pathogens. Which of the following statements is correct regarding gonococcal septic arthritis? ", "input": "(A) Repeated aspiration of joint fluid increases the chance of infection, and daily aspiration of joint fluid is not recommended. (B) Septic arthritis caused by gonococci can be treated with third-generation cephalosporins. (C) After the onset of arthritis, patients often develop tenosynovitis. (D) Rheumatic arthritis, alcohol abuse, and steroid treatment are all common risk factors. (E) Bacterial cultures of joint fluid are usually positive, and there is no need to culture the cervix or urethra. ", "output": "B"} 
-{"instruction": "Deep venous thrombosis (DVT) refers to the symptoms of the affected limb caused by the blockage of blood flow in the deep veins. Which of the following is correct? ", "input": "(A) This disease often occurs in the lower limbs. More than 50% of patients will have symptoms such as redness, swelling, pain and temperature rise in the affected limb. (B) In severe cases, it will cause blue phlebitis (Phlegmasia cerulea dolens), which may cause blood circulation obstruction, causing compartment syndrome and ischemic necrosis of the affected limb. If it is not treated in time, it may even lead to amputation. (C) Homan sign means that the calf will feel extreme pain when the dorsum of the foot is flexed forcefully. It has good sensitivity for diagnosing deep venous embolism. (D) Because duplex ultrasonography is greatly affected by the examiner's technique, it is not a recommended option for deep venous embolism examination of the lower extremities. (E) Outpatient patients taking the anticoagulant drug Warfarin should frequently monitor the international normalized ratio (INR) value, which is recommended to be maintained at 1.0-2.0. ", "output": "B"} 
-{"instruction": "Which of the following statements is correct for the treatment of snake bites? ", "input": "(A) Open the wound and suck out the toxin. (B) Apply pressure with a tourniquet to collapse the artery and prevent the artery from transporting toxins throughout the body. (C) Inject antivenom serum directly from the snake species identified by the patient. (D) Do not soak in ice water. (E) Establish an intravenous line in the affected limb so that antivenom can be injected later. ", "output": "D"} 
-{"instruction": "Many diseases present with shoulder and neck pain as clinical symptoms. Which of the following statements is correct? ", "input": "(A) When neck pain is accompanied by neurological symptoms, if there is no abnormality in the X-ray, an electromyogram or nerve conduction test should be arranged instead of an MRI. (B) Central cord syndrome will cause the lower limbs to be weaker than the upper limbs. (C) The most common cancer metastases of the cervical spine are gastric cancer and colorectal cancer. (D) Thoracic outlet syndrome is more common in pregnant women. (E) The most common cause of shoulder transfer pain is myocardial infarction. ", "output": "D"} 
-{"instruction": "The differential diagnosis of infectious diseases often requires consideration of exposure to specific epidemiological risk factors. Which of the following statements about epidemiological risk factors related to infectious diseases is incorrect? ", "input":"(A) West Nile encephalitis ←→ Eastern Europe, Kazakhstan, Russia. (B) Ebola virus infection ←→ Travel history to West African countries. (C) Leptospirosis ←→ Local typhoons or flooding areas in Taiwan. (D) Meningococcal Meningitis ←→ Sub-Saharan African countries. (E) Malaria ←→ Travel history to Southeast Asia, Africa, and Oceania.", "output": "A"}
-{"instruction": "Which of the following is incorrect in the assessment and consideration of post-traumatic circulation in the elderly?", "input": "(A) A blood pressure of 100/60 mmHg in the elderly may indicate shock. (B) As they age, cardiac output (cardiac index) and maximal heart rate decrease. (C) If elderly trauma patients with severe trauma develop hypotension and metabolic acidemia, the mortality rate is extremely high. (D) Because elderly trauma patients have reduced cardiac function, the threshold for pRBC transfusion should be lowered. (E) For elderly trauma patients with blunt intra-abdominal solid organ injuries, early surgical treatment has a lower risk than conservative treatment.", "output": "D"}"output": "C"} 
-{"instruction": "Which of the following is wrong about the treatment of chemical splashes into the eyes?", "input": "(A) Alkaline agents often cause more serious damage than acidic agents. (B) From the first moment, flush with large amounts of water until the pH value returns to normal. (C) Avoid using anesthetic analgesics during the flushing process to avoid affecting the assessment of the injury. (D) If the eyelids are stuck in their normal position due to the 3-second glue spray, consider observation and treatment. (E) All unknown solvents should be treated as acid-base sprays and flushed with large amounts of water.", "output": "C"} 
-{"instruction":"Which of the following treatments is wrong for patients with eye pain or red eyes?", "input": "(A) Persistent blurred vision requires immediate referral to an ophthalmologist. (B) Topical analgesics and steroids can be given first, and if symptoms do not improve after more than 48 hours, referral to an ophthalmologist should be made. (C) Non-traumatic red eyes without visual changes or severe pain can be given medication first and observed for 48 hours. (D) If the red eye and pain are unilateral and accompanied by headache and vomiting, glaucoma should be considered even if there are no visual changes. (E) Patients who wear contact lenses should be referred to an ophthalmologist.", "output": "B"}
-{"instruction": "Evaluation and comparison of typical symptoms of common causes of potentially life-threatening chest pain. Which of the following statements is incorrect?", "input": "(A) Aortic detachment mainly causes severe tearing pain below the sternum and transfers to the back between the shoulder blades. Chest X-rays may show widening of the diaphragm and calcium sign. (B) A young man comes to the clinic with sudden severe pleuritic chest pain, combined with respiratory distress and shock. Physical examination reveals unilateral jugular vein distension and unilateral decreased breath sounds. Needle decompression should be considered at this time. (C) If the patient comes to the clinic with a sudden sharp pain that moves to the back after violent vomiting after drinking alcohol 30 minutes ago, clinically, esophageal rupture should be suspected. If the upper esophageal perforation occurs, diaphragmatic emphysema is rarely seen on chest X-rays. (D) Clinically, Westermark's sign or Hampton hump may occasionally be seen on chest X-rays of pulmonary embolism. (E) Typical acute coronary heart disease is dull pain or pressure behind the sternum or in the upper abdomen, which may be accompanied by nausea, vomiting, cold sweats, and wheezing. ", "output": "C"} 
-{"instruction": "A 26-week pregnant woman was taken to the emergency room by 119 personnel after her motorcycle collided with a car. Which of the following statements is correct regarding the assessment and treatment of the pregnant woman's injuries?", "input": "(A) Even minor injuries may have a significant impact on the fetus, so the fetus should be treated first, and then the pregnant woman's injuries should be assessed. (B) When the pH value of vaginal secretions is around 5, it indicates amniotic membrane rupture. (C) The most common cause of fetal death is placental detachment (abruptio placentae), with a mortality rate of 50-80%. (D) Regardless of the severity of the injury, pregnant women are absolutely contraindicated for radiation examinations such as X-rays and CT. (E) Fetal monitoring should be arranged. At least 4 to 6 hours. If the patient has symptoms such as vaginal bleeding and contractions, the patient should be monitored for 24 hours. ", "output": "E"} 
-{"instruction": "Regarding Alcoholic Ketoacidosis, which of the following statements is incorrect? ", "input": "(A) The patient has a large anion gap because of high serum ketones. (B) The patient's blood alcohol level is usually very high. (C) The patient is in a state of starvation and dehydration. (D) Treatment can be given with glucose and saline infusion. (E) Thiamine 50 to 100 mg should be given before glucose to prevent the induction of Wernicke's disease. ", "output": "B"} 
-{"instruction": "Regarding Nerve gases (nerve poison gas), which of the following statements and treatments are correct? ", "input": "(A)2-PAM can be used to counteract the muscarinic effects of neurotoxins. (B)Atropine can be used to counteract the nicotinic effects of neurotoxins. (C)Benzodiazepines can be used to treat seizures. (D)GA, GB, GD, and VF are all well-known neurotoxins and are organophosphate poisons. (E)SLUD syndrome is caused by salivation, lacrimation, urination, and desaturation. ", "output": "C"} 
-{"instruction": "Which of the following statements is correct about Thyroid Storm? ", "input": "(A)A daily dose of 300 mg of hydrocortisone steroid supplement can be given. (B) Agitation and abnormal liver function are common manifestations of non-thyroid storm. (C) Thyroid storm may cause high body temperature, and acetaminophen or salicylate (salicylic acid) must be given to reduce the body temperature as quickly as possible. (D) Iodine is used to reduce the thyroid hormone T4 in the peripheral blood and convert it into the more active T3 form. (E) Propranolol can not only control tachycardia, but also reduce the release of thyroid hormone from the thyroid gland. ", "output": "A"} 
-{"instruction": "Which of the following statements about the diagnosis of lower gastrointestinal bleeding is incorrect? ", "input": "(A) Angiography can only diagnose bleeding when the bleeding volume is greater than 0.5mL/min. (B) Tc-99m-labeled RBC Scintigraphy can diagnose bleeding as long as the bleeding volume is greater than 0.1 mL/min. (C) Computed tomography is not helpful in the diagnosis of lower gastrointestinal bleeding. (D) In ​​general, the diagnostic rate of endoscopy is higher than that of angiography and scintigraphy. (E) If small intestinal bleeding is suspected, the patient can be recommended to be referred to a hospital equipped with capsule endoscopy. ", "output": "C"} 
-{"instruction": "Which of the following is incorrect about the various risk factors for preeclampsia? ", "input": "(A) Chronic kidney disease. (B) Multiple pregnancy. (C) Multiparous women. (D) Chronic hypertension. (E) Pre-pregnancy diabetes. ", "output": "C"} 
-{"instruction": "Which of the following statements about natural disasters is incorrect? ", "input": "(A) After an earthquake, the majority of casualties in hospitals are those with fractures or crush injuries. (B) Acute stress disorder often occurs during the recovery period. (C) After a disaster, traumatic injuries usually occur during the acute and recovery periods. (D) After a disaster, vector-borne diseases (such as dengue fever) usually occur during the recovery period. (E) Usually, a large number of deaths occur within the first three hours after a major earthquake. ", "output":"B"} 
-{"instruction": "Which of the following statements about blunt cardiac trauma is incorrect?", "input": "(A) If the ST-T segment is elevated on the electrocardiogram, coronary artery dissection should be considered. (B) When cardiac enzymes are normal, blunt cardiac trauma cannot be ruled out. (C) Transthoracic echocardiography is more sensitive than transesophageal echocardiography (TEE) in diagnosing blunt cardiac trauma. (D) Blunt cardiac trauma is most likely to cause sudden arrhythmia within 24 hours. (E) If the patient suffers from cardiogenic shock, it is necessary to consider whether the patient's heart structure is damaged and surgical treatment is required if necessary. ", "output": "C"}
-{"instruction": "Which of the following is incorrect about the treatment of aortic stripping?", "input": "(A) An intravenous line should be established immediately and vital signs such as blood pressure, pulse, and heart rhythm should be closely monitored. (B) The patient's blood pressure is usually very high, and the first priority is to lower the blood pressure as quickly as possible with antihypertensive drugs such as labetalol. This should be given as soon as possible before the patient is sent for a CT scan. (C) If the patient's blood pressure is low, necessary infusion or even blood transfusion should be performed, and bedside ultrasound should be used to confirm the possibility of complications such as pericardial tamponade or hemothorax. (D) If Stanford type B (E) If the patient's blood pressure is undetectable and pulseless electrical activity (PEA) is present, mechanical adjuvant therapy such as intra-aortic balloon pump (IABP) or extracorporeal membrane oxygenation (ECMO) should be considered, and the patient should be quickly connected to surgical treatment. ", "output": "E"} 
-{"instruction": "Which of the following is incorrect about ear diseases and treatment? ", "input": "(A) Although aminoglycoside is ototoxic, it is a local treatment for otitis externa with a very low chance of absorption causing systemic or local side effects, making it a cheap and safe drug. (B) The main clinical manifestation of Ramsay Hunt syndrome is otalgia. (C) When ear pain (otalgia) occurs, mandibular impacted molars or molar abscesses should also be included in the common differential diagnosis. (D) NSAID drugs including aspirin are common causes of drug-induced tinnitus. (E) Mumps infection may lead to hearing loss as a complication. ", "output": "A"} 
-{"instruction": "Which of the following statements about the Tourniquet Test is incorrect? ", "input": "(A) The pressure of the blood pressure cuff is the average of the systolic and diastolic pressures. (B) Place a blood pressure cuff on the upper arm for 10 minutes and observe the number of punctate hemorrhages within a 1-inch square on the forearm. (C) A positive reaction is considered if 20 or more punctate hemorrhages are present per square inch (6.25 square centimeters). (D) The test can be repeated if the previous test was negative or there was no bleeding. (E) This test is helpful in the clinical diagnosis of dengue fever. ", "output": "B"} 
-{"instruction": "Which of the following statements is correct regarding the use of medications during rapid sequence intubation? ", "input": "(A) Fentanyl should not be used in patients with coronary artery disease. (B) Lidocaine should not be used in patients with asthma attacks. (C) Ketamine can be used in patients with low blood pressure. (D)diazepam is suitable for induction. (E)rocuronium has a sedative effect, so it is not necessary to use an induction drug at the same time. ", "output": "C"} 
-{"instruction": "Which of the following statements about rabies and rabies vaccine injection is incorrect? ", "input": "(A)Rabies is a Class I notifiable infectious disease. (B)Rabies vaccine may not be given temporarily if bitten by a domestic dog. (C)If bitten by a wild dog, the first dose of rabies vaccine should be injected immediately. If possible, the wild dog should be observed for 10 days. If there are no symptoms, vaccination can be stopped. (D)If bitten by a wild dog, if the wound exposure level is Class II, it is recommended to inject rabies immunoglobulin at the same time. (E) The number of rabies vaccines injected after the first exposure is 5 times, and the second dose of vaccine is injected on the 3rd day after the first dose. ", "output": "D"} 
-{"instruction": "Which of the following statements about children's rash diseases is correct? ", "input": "(A) To avoid complications of bacterial infection, local steroids should be avoided in the treatment of neonatal atopic dermatitis. (B) If a child has a persistent high fever due to varicella, consider alternating the use of acetaminophen and aspirin to enhance the antipyretic effect. (C) Measles, enterovirus, and herpes simplex virus may all cause lesions on the mucosa. (D) A 12-year-old child who develops a rash all over his body 3 days after having a headache and fever and whose cuff test is positive should report dengue fever to the CDC within 1 week. (E) Scarlet fever is a common Staphylococcus aureus infection in school-age children and can be treated with Oxacillin. ", "output": "C"} 
-{"instruction": "Which of the following statements is incorrect about the treatment of children who swallow foreign objects? ", "input": "(A) If a button battery is swallowed and confirmed to be in the stomach by X-ray and the child has no symptoms, he can be sent home for observation and arranged for outpatient follow-up. (B) If a sharp object is swallowed and has passed through the duodenum, the most common site of intestinal perforation is the ileocecal valve. (C) If a blunt object (such as a coin) is stuck in the esophagus, the patient can observe it for 48 hours without symptoms. If it is still in the esophagus, it needs to be removed. (D) If a button battery is stuck in the esophagus, it may cause esophageal perforation within 6 hours and must be removed as soon as possible. (E) If an X-ray confirms that a sharp object is in the stomach after accidental swallowing, and the patient has no symptoms, it must still be removed as soon as possible. ", "output": "C"}  
-{"instruction":"Which of the following statements about syncope is correct?", "input": "(A) A temporary loss of consciousness and muscle tone. When arriving at the emergency room, patients often recover spontaneously. In half of cases, the cause may not be found. (B) The causes are all benign, such as vasovagal event, so patients should not worry. (C) Vasovagal event is caused by excessive sympathetic excitement, resulting in excessive heart rate. (D) Common causes of carotid sinus hypersensitivity include: boys shaving, tight collars, and turning heads. It is common in young patients. (E) San Francisco Syncope Rules Rule) can screen out patients who are prone to complications and need hospitalization within a short period of time after syncope, and the subsequent examination must focus on neurology. ", "output": "A"}
-{"instruction": "Which of the following statements about the treatment of acute coronary heart disease is incorrect?", "input":"(A) According to the American Heart Association treatment guidelines, if the onset time is less than 12 hours, and the ST wave of the precordial leads V1 to V5 on the electrocardiogram shows a 3mm decrease, and only the aVR lead shows an ST wave increase of more than 1mm, immediate cardiac catheterization and coronary intervention should be considered. (B) If the ST wave of V1 to V4 rises by 3mm and the patient still has severe chest pain, but it has been 14 hours since the onset, coronary intervention should not be considered. (C) If the patient has severe acute pulmonary edema, emergency cardiac catheterization surgery should be performed even if the onset time has exceeded 12 hours. (D) If the patient presents with severe cardiogenic shock, emergency cardiac catheterization should be considered regardless of the time since the onset of the attack. (E) If the patient has an ST-segment elevation myocardial infarction (STEMI) with an onset within 12 hours, your hospital cannot perform coronary intervention, and the patient is not suitable for thrombolytic therapy because of a history of cerebral hemorrhage, then even if the transfer takes 1 hour, you should try to transfer to another hospital for coronary intervention. ", "output": "B"} 
-{"instruction": "Which of the following statements about the emergency assessment and treatment of acute asthma is incorrect? ", "input": "(A) FEV1 less than 40% is a severe asthma attack. (B) Give oxygen therapy to maintain SaO 2≧ 90%. (C) After treatment, FEV1 has reached 50%, indicating that the treatment is effective and the patient can be considered to go home without hospitalization. (D) Low socioeconomic class or chronic mental illness history are risk factors for death from asthma. (E) Arterial blood gas analysis of pregnant women with asthma PaCO₂ within the normal range often indicates that carbon dioxide has begun to accumulate in the blood. ", "output": "C"} 
-{"instruction": "Which of the following statements about acute abdominal pain is incorrect?", "input": "(A) A blood test of a patient with acute abdominal pain revealed a normal white blood cell count, and it is not possible to rule out the need for surgery. (B) A young woman with lower abdominal pain comes to the clinic. She has a history of pelvic inflammation in the past, and the possibility of ectopic pregnancy should be considered. (C) Diverticulitis is more common in men and its incidence increases with age. It is often located in the sigmoid colon. (D) Severe upper abdominal pain accompanied by nausea, vomiting, and cold sweats requires consideration of an electrocardiogram. (E) X-ray findings of patients with intestinal perforation show free air in most cases, except for a small number of 5% of patients.", "output": "E"} 
-{"instruction": "Which of the following statements about traumatic aortic injury is incorrect?", "input": "(A) The most common site of injury is the proximal descending aorta. (B) Measuring blood pressure in the limbs may reveal high blood pressure in the upper limbs and low blood pressure in the lower limbs. (C) Typical chest X-ray findings include a nasogastric tube that is positioned to the left. (D) Typical chest X-ray findings include a widening of the diaphragmatic cavity that is greater than 8 cm. (E) If a significant left-sided hemothorax is present at the same time, surgical treatment should be arranged immediately.", "output": "C"} { 
-"instruction": "Which of the following is incorrect in diagnosing myocardial infarction?", "input": "(A) ST-segment elevation myocardial infarction (STEMI) is defined as the clinical symptom of myocardial hypoxia, with a continuous ST-segment elevation on the electrocardiogram, which continuously releases biomarkers of myocardial necrosis. (B) Two or more consecutive ST-segment depressions in the anterior leads V4 to V6 may indicate transmural posterior injury. (C) In patients with left anterior descending coronary artery occlusion, multiple ST-segment depressions combined with aVR ST-segment elevations will be seen on the electrocardiogram, which must be considered as ST-segment elevation myocardial infarction (STEMI) with active reperfusion of the coronary arteries. (D) Transthoracic echocardiography will show poor local ventricular wall activity, so it can be used as an auxiliary diagnosis. (E) Troponin (cardiac troponin, cTn) released by the myocardium is the preferred biological indicator for diagnosing myocardial infarction. ", "output": "B"} 
-{"instruction": "Which of the following statements about severe enterovirus disease is incorrect? ", "input": "(A) Enterovirus 71 is the main cause in Taiwan. (B) The direct cause of death is renal failure. (C) Most patients with severe complications have brain stem encephalitis. (D) Persistent lethargy, persistent vomiting and myoclonic jerks are the three major precursors of severe illness. (E) The mortality rate of critically ill patients is about 3% to 20%. ", "output": "B"} 
-{"instruction": "Which of the following statements about peritonitis in peritoneal dialysis is incorrect? ", "input": "(A) Antibiotics can be given first with the first-generation cephalosporin. (B) In terms of treatment, antibiotics can be added to the dialysate and do not need to be given intravenously. (C) The most common bacteria causing peritonitis is Staphylococcus aureus, accounting for about 40%. (D) The recommended treatment period is 7 to 10 days. (E) The white blood cell count in the dialysate is usually greater than 100/mm³, and the neutrophil count is greater than 50%. ", "output": "C"} 
-{"instruction": "Which of the following statements about bladder rupture is incorrect? ", "input": "(A) Extraperitoneal rupture is more likely to cause infection and intra-abdominal ulcer formation than intraperitoneal rupture. (B) Extraperitoneal rupture is more common than intraperitoneal rupture. (C) Extraperitoneal rupture of the bladder is treated with catheter drainage. (D) Intraperitoneal rupture of the bladder requires surgical exploration and bladder repair. (E) The gold standard for diagnosis is retrograde cystogram. ", "output": "A"} 
-{"instruction": "Which of the following statements about diabetic ketoacidosis is correct? ", "input": "(A) It only occurs in patients with insulin-dependent type. (B) The diagnostic criteria are blood glucose greater than 400 mg/dL, anion gap greater than 10, bicaronate less than 15 mEq/L, and pH less than 7.3. (C) As the patient is dehydrated, it is recommended to start with 0.45% normal saline. (D) The course of the disease is usually longer than that of hyperosmotic non-ketoacid coma. (E) The patient is about 5 to 10 liters of water short. ", "output": "E"} 
-{"instruction": "Which of the following statements and treatments is wrong about radiation damage? ","input": "(A) For systemic radiation injuries, the patient's body excretions, including sputum, urine, feces, and vomitus, should be collected for radioisotope analysis. (B) For patients with only internal radiation contamination, the onset time of all symptoms should be recorded just like patients with systemic radiation injuries. (C) Even if the patient is only externally contaminated, CBC/DC and urinalysis should still be obtained from the patient. (D) The patient was exposed to a high whole-body dose of 30Gy and died after 3 days of severe shock and circulatory system collapse. (E) The patient was exposed to a whole-body dose of 4Gy and developed acute hematopoietic syndrome after a 3-week latent period. Infection and bleeding may occur.", "output": "D"}
-{"instruction": "Which of the following is incorrect in the ultrasound diagnosis of appendicitis?", "input": "(A) Ultrasound shows a tubular structure, which usually has no intestinal peristalsis and cannot be flattened. (B) The diagnosis can be confirmed if the cross-sectional diameter of the tubular structure is greater than 3mm. (C) Faecoliths can sometimes be seen in the appendix. (D) If there is fluid accumulation or ulcer formation around the tubular structure, it may be a ruptured appendicitis. (E) The cross-sectional view usually shows a more echogenic mucosal layer and a more hypoechoic edematous muscle layer around it.", "output": "B"}"output": "C"} 
-{"instruction": "A 32-year-old female was sent to the hospital for suicide by taking pesticides. The patient seemed to be in pain, vomiting, spitting out light blue-green foam from the mouth, and wheezing. Blood pressure 92/60 mmHg, respiratory rate 26 times/min, pulse 114 times/min, body temperature 36℃, blood oxygen concentration 88%, and the patient's oral mucosa had burn marks. Which of the following statements is most appropriate?", "input": "(A) Give oxygen as soon as possible to reduce alveolar fiber production. (B) Hemodialysis within 6 hours is helpful. (C) It is well absorbed through normal skin and is easily poisoned after skin contact. (D) The concentration in the blood is an important basis for judging the prognosis. (E) Give antioxidants, such as superoxide dismutase It can inhibit substances from entering alveolar cells. ", "output": "D"} 
-{"instruction": "Which of the following statements about blast injuries is incorrect?", "input":"(A) It may cause arterial gas embolism and produce neurological symptoms. (B) The most common cause of death in victims of primary blast injuries is intraperitoneal hemorrhage. (C) Primary blast injuries are likely to affect the victim's auditory system, respiratory system, and gastrointestinal system. (D) Primary blast injuries may cause delayed gastrointestinal rupture in victims, so the victim may even need to be observed for 48 hours to confirm. (E) Victims with isolated tympanic membrane rupture caused by the explosion should usually still undergo a chest X-ray examination.", "output": "B"} 
-{"instruction": "Which of the following statements about epilepsy is incorrect?", "input": "(A) Status epilepticus (status (B) Epilepsy caused by alcohol withdrawal usually does not require long-term antiepileptic drug treatment. (C) Antiepileptic drugs are teratogenic and are not recommended for continued use in pregnant women with a history of epilepsy or epileptic symptoms. (D) Patients with epilepsy who do not respond well to lorazepam and phenytoin may also not respond to barbiturates. (E) Patients suspected of bacterial meningitis should be started on empirical antibiotics. ", "output": "C"}
-{"instruction": "An 18-year-old female with a history of autoimmune hemolytic anemia seeks medical attention because of paleness and shortness of breath over the past 5 days. Which of the following statements about the management of this patient is incorrect?", "input": "(A) The first-line treatment is high-dose corticosteroids. (B) Anti-immune drugs such as azathioprine 2~4mg/kg/day or cyclosporine can be used to reduce the steroid dose. (C) After splenectomy, the patient can be cured and will never relapse. (D) To prevent overwhelming post-splenectomy infection after splenectomy, the patient should be vaccinated with streptococcal vaccine. (E) In the acute phase, in addition to replenishing concentrated red blood cells (PRBC), plasma dialysis or exchange transfusion can also effectively remove autologous antibody concentrations. ", "output": "C"} 
-{"instruction": "A 1-year-old infant has a fever with no obvious source of infection. Which of the following statements is correct? ", "input": "(A) Routine urinalysis is not required. (B) For those at risk of urinary tract infection, bacterial culture is not required if the urinalysis is negative. (C) The sensitivity and specificity of Gram's staining of urine for bacterial identification in diagnosing urinary tract infection is less than 60%. (D) The accuracy of bag collection specimen in diagnosing urinary tract infection is very low. (E) Antibiotics should be used immediately without waiting for the receipt of urine specimens. ", "output": "D"} 
-{"instruction": "A 23-year-old male returned to Taiwan from Sao Tome and Principe, Africa, one week ago. He went to the emergency room complaining of a high fever of 40.2℃, tremors, general weakness, and abdominal pain. His pulse was 122 beats/min and his respirations were 24 breaths/min. There was no obvious rash on his body and no joint pain. Laboratory tests revealed total bilirubin 4.9mg/dL, direct bilirubin 1.1mg/dL, SGPT (ALT) 247 U/L, and SGOT (AST) 236 U/L. Ultrasound examination revealed an enlarged liver, but no gallstones or bile duct enlargement, nor liver abscesses. Which of the following tests is most helpful for diagnosis?", "input": "(A) Blood smear. (B) Hepatitis markers. (C) Leptospiral microscopic agglutination test. (D) Abdominal CT. (E) Stool examination for parasites and eggs. ", "output": "A"} 
-{"instruction": "A 27-year-old male was stung by a stonefish on his left palm while diving. The local redness and swelling gradually extended to the arm and the pain was unbearable, so he sought medical attention. His vital signs were stable, and he had no shortness of breath or heart discomfort. Which of the following statements is correct? ", "input": "(A) Local soaking in hot water. (B) Antidote serum (antivenom) should be used. (C) Antibiotics should be injected. (D) Common hemorrhagic poisoning reaction. (E) Use large amounts of intravenous infusion for treatment. ", "output": "A"} 
-{"instruction": "A 28-year-old female, 26 weeks pregnant, was hit by a bus while crossing the road. When she was taken to the emergency room by ambulance, she was conscious, with a respiration rate of 26 breaths/min, a pulse of 140 beats/min, a blood pressure of 80/50 mmHg, and a body temperature of 36°C. The patient complained of abdominal pain and a small amount of vaginal bleeding. Which of the following statements about this patient is incorrect? ", "input": "(A) She can lie on her left side to avoid the uterus compressing the inferior vena cava. (B) The height of the fundus of this patient's uterus should be above the height of her belly button. (C) The amount of blood loss in this patient may have reached more than 30% of her total blood volume. (D) The pH of the vaginal secretions was 7.0, which should highly suspect amniotic membrane rupture. (E) The patient's blood type is Rh negative, and the fetus's father's blood type is also Rh negative, so the dose of Rh0(D) immunoglobulin needs to be doubled. ", "output": "E"} 
-{"instruction": "A 28-year-old male computer repairman was accidentally sprayed with hydrofluoric acid on the back of his hand and arm while working. The area was red, swollen and painful. He immediately sought medical attention after rinsing. After examination, the back of the hand and arm showed a local corrosive appearance and unbearable pain. Vital signs were measured: blood pressure 127/51 mmHg, respiration 16 times/min, pulse 52 times/min, body temperature 36.2℃, and clear consciousness. Which of the following statements is correct? ", "input": "(A) Rinse with plenty of clean water until the pain disappears. (B) Apply magnesium oxide ointment topically and inject calcium gluconate solution. (C) Severe pain and swelling, perform fasciotomy. (D) Use preventive antibiotics. (E) Hypercalcemia, hypermagnesium, and hypokalemia occur. ", "output": "B"} 
-{"instruction": "A 30-year-old female was sent to the emergency room due to high fever, cough, and weakness. In the emergency room, her temperature was 38.5℃, blood pressure was 110/70mmHg, pulse was 105 beats/min, and blood oxygen concentration was 95%. Physical examination revealed multiple pinholes in the patient's arms and heart murmurs. Lung X-ray and urine test were normal. Which of the following statements is wrong? ", "input": "(A) This patient needs to be referred to the cardiology department for a cardiac ultrasound. (B) If two blood cultures show bacteria, it can be considered a major criterion for the diagnosis of infective endocarditis. (C) A fever above 38°C is also a major criterion for diagnosis. (D) Use Vancomycin + Gentamicin + Nafcillin for treatment. (E) Some patients may see painless bleeding spots on their palms and soles. ", "output": "C"} 
-{"instruction": "A 36-year-old 8-month pregnant woman with a history of diabetes was seen collapsing while waiting for a prenatal check-up. You are the first medical staff to arrive at the scene. According to the 2015 AHA ACLS guidelines, you begin first aid. Which of the following actions is incorrect? ", "input":"(A) If the patient is unresponsive and unrespirable, ask the clinic nurse to activate the hospital emergency response system to obtain a defibrillator and support. (B) Tilt the patient to 27-30 degrees to the side to facilitate high-quality CPR. (C) If the patient's heart stops beating for 4 minutes, consider performing a perimortem cesarean delivery (PMCD). (D) There is no need to use Vasopressin instead of the second dose of Epinephrine. (E) If the patient's heartbeat and breathing are restored, consider hypothermia treatment for the patient.", "output": "B"} 
-{"instruction": "A 38-year-old male complained of numbness and weakness in his limbs after a car accident. His vital signs are as follows: pulse 88 beats/min, blood pressure 70/40 mmHg. Which of the following statements is incorrect?", "input": "(A) Neurogenic shock should be suspected only after other possible causes of shock have been ruled out. (B) Clinical signs of neurogenic shock are low blood pressure, slow pulse and cold extremities. (C) If neurogenic shock is suspected, pressors can be used after giving appropriate fluids. (D) Spinal cord injury above the fifth cervical vertebra may cause phrenic nerve injury in patients. (E) The use of high-dose steroids for spinal cord injury caused by contusion is still controversial.", "output": "B"}
-{"instruction": "A 39-week-old female baby was born with cyanosis, poor motility, and a pulse of 40 beats/min. After 60 seconds of bag-valve-mask positive pressure ventilation and chest compression, the pulse is still less than 60 beats/min. Which of the following procedures is more appropriate?", "input": "(A) Place an endotracheal tube and inject Epinephrine intravenously. (B) Continue chest compression and ventilation at a ratio of 30:2 for 1 minute. (C) Place an endotracheal tube and inject Atropine intravenously. (D) Stop chest compression and start ventilation with oxygen. (E) Stop chest compression and place an endotracheal tube and ventilate with air.", "output": "A"} 
-{"instruction": "A 40-year-old male was taken to the emergency room for two days of unexplained wheezing and was later diagnosed with pulmonary embolism. Which of the following statements is incorrect?", "input": "(A) Common symptoms of pulmonary embolism are low blood oxygen, rapid heartbeat, rapid breathing, coughing up blood, cold sweats, and fever. (B) There is about a 50% chance of finding a deep vein thrombosis (DVT) in a patient. (C) If the emergency physician responsible for the diagnosis believes that the patient's risk of pulmonary embolism is extremely low and all of the Pulmonary Embolism Rule-Out Criteria (PERC Rule) are met, it is reasonable not to arrange any more tests for pulmonary embolism. (D) The severity of the symptoms is related to the size of the embolism in the pulmonary artery. (E) The patient's blood pressure dropped to 80/50 mmHg, which can be defined as massive pulmonary embolism (massive PE). ", "output": "D"} 
-{"instruction": "A 42-year-old male was treated in a mainland China hospital for 3 days due to acute illness and his vital signs are currently stable. Which of the following situations is more suitable for air transfer back to Taiwan for treatment? ", "input": "(A) Duodenal perforation, post-surgery. (B) Retina peeling, post-laser surgery. (C) Bloody stool, pancolonic endoscopy combined with polypectomy. (D) Femoral fracture surgery. (E) 10% pneumothorax. ", "output": "B"} 
-{"instruction": "A 45-year-old female traveled to Tibet and developed difficulty breathing and coughed up frothy, bloody sputum at the Everest Base Camp (5,200 meters). Which of the following treatments is least recommended?", "input": "(A) Give oxygen. (B) Descend. (C) Use Viagra (Sildenafil). (D) Use Nifedipine. (E) Use the diuretic Lasix.", "output": "E"} 
-{"instruction": "A 45-year-old male with a history of diabetes. He underwent weight loss surgery (gastric bypass, Roux-en-Y gastric bypass) one month ago. The patient is undergoing a bypass surgery. He reports that he had just had dinner with friends. One hour after eating, he developed nausea, vomiting, abdominal cramps, abdominal distension, and diarrhea, accompanied by cold sweats. His blood pressure was 95/62 mmHg, his pulse was 106 beats/min, his respirations were 18 breaths/min, his temperature was 36.5°C, and his finger-stick blood glucose was 45 mg/dL. Which of the following postoperative complications is most likely? ", "input": "(A) Bowel obstruction. (B) Anastomotic leakage. (C) Enteric leak. (D) Cholelithiasis. (E) Dumping syndrome. ", "output": "E"} 
-{"instruction": "A 45-year-old male alcoholic with jaundice and ascites goes to the emergency room due to low blood pressure and general weakness. Which of the following statements is correct? ", "input": "(A) If there is no fever and abdominal pain, spontaneous peritonitis can be ruled out in most cases. (B) The annual incidence of spontaneous peritonitis in patients with ascites is about 70%. (C) The six-month survival rate of the first spontaneous peritonitis is about 70%. (D) Most pathogens are Enterobacteriaceae. (E) A white blood cell count >250/mm³ in ascitic fluid analysis can diagnose spontaneous peritonitis. ", "output": "D"} 
-{"instruction": "A 47-year-old male was prescribed Seroquel (Quetiapine) and Lexotan (Bromazepam) to treat his mental illness. His family found him unconscious with stiff and shaking limbs and sent him to the hospital. Vital signs measured: blood pressure 147/51 mmHg, respiration 21 times/min, pulse 162 times/min, coma index: E4M1V1, temperature 39.2℃. Physical examination revealed that the patient was sweating, his pupils were equal and reactive to light, and his limbs were stiff. Blood draw results showed no obvious abnormalities in liver and kidney function. What syndrome is the patient most likely to have? ", "input": "(A)Cholinergic toxidrome. (B)Anticholinergic toxidrome. (C)Sympathomimetics. (D) Serotonin syndrome. (E) Neuroleptic malignant syndrome. ", "output": "E"} 
-{"instruction":"A 50-year-old male presented to the emergency department with sudden onset of left upper abdominal pain and vomiting. His past medical history included hiatal hernia and gastroesophageal reflux disease. Vital signs on physical examination were blood pressure 86/40 mmHg, pulse 121 beats/min, temperature 37°C, respiration 20 breaths/min, and blood oxygen concentration 98%. The main abnormalities on physical examination were epigastric distension and pain, tympanic percussion, and decreased breath sounds in the left lower lung. Attempts to insert a nasogastric tube were unsuccessful and could not be inserted. Laboratory reports found lactate 28mg/dL, pH 7.13, HCO₃- 8.1, Hb 12 g/dL. Chest X-ray revealed a distended stomach above the diaphragm. In addition to appropriate fluid therapy, which of the following is more appropriate? ", "input": "(A) Consult for surgical treatment. (B) Arrange for gastroscopy. (C) Transfuse PRBC. (D) Intravenous injection of sodium bicarbonate. (E) Insert an orogastric tube. ", "output": "A"} 
-{"instruction": "A 4-year-old girl accidentally swallowed an unknown object. Which of the following statements is incorrect? ", "input":"(A) If an X-ray reveals an opened paper clip in the stomach, regardless of its size, the child should be taken to a pediatric gastroenterologist for immediate removal. (B) If a mother recalls that a button battery is missing from the table, an X-ray should be taken immediately. (C) If the child has congenital esophageal atresia and has undergone surgery, an esophagogram or endoscopy should be performed if the child is feeling unwell. (D) If a small, smooth, round, non-corrosive object is lodged in the middle of the esophagus, it can be observed for 36 hours. (E) If you are concerned about whether the foreign body in the stomach has been expelled from the body, an X-ray can be taken every 3 to 5 days.", "output": "D"}
-{"instruction": "A 50-year-old female traveled to Vietnam and had a history of contact with poultry. After returning home, she developed flu-like symptoms such as fever (over 38°C), sore throat, muscle aches, headache, cough, and general fatigue and weakness, and went to the emergency room for treatment. Regarding the suspected new influenza A, which of the following statements is incorrect?", "input": "(A) Currently, the new influenza A subtypes that have been confirmed to have infected humans include H5N1, H6N1, H7N2, H7N9, H9N2, H10N7, H10N8, etc. (B) H7N9 is an avian influenza virus, belonging to the influenza A virus genus (Influenza virus A) of the Orthomyxoviridae family. (C) Currently, there is a vaccine available for prevention of H5N1 influenza. (D) The antiviral drug amantadine or rimantadine has good effects on the treatment of new influenza A virus and is recommended. (E) New influenza A is a fifth-category infectious disease and must be reported within 24 hours. ", "output": "D"} {" 
-instruction": "A 55-year-old female with no history of overseas travel complained of progressive unilateral headache, fatigue, and sudden left-sided vision loss. Examination showed optic neuritis. Which of the following diagnoses is more likely? ", "input": "(A)Lyme disease. (B)Carotid dissection. (C)Giant cell arteritis. (D)Cerebral sinus thrombosis. (E)Antiphospholipid syndrome. ", "output": "C"} 
-{"instruction": "A 5-year-old, 20-kg boy was hit by a car that ran a red light while crossing the road. He was taken to the emergency room by ambulance. His temperature was 35°C, his respiratory rate was 30 breaths/min, his pulse was 160 beats/min, his blood pressure was 70/40 mmHg, and his GCS was E1V2M4. Bedside ultrasound revealed hemothorax and a small amount of intraperitoneal bleeding. Which of the following statements about the first aid of this patient is incorrect?", "input": "(A) Considering endotracheal intubation to protect the airway, a No. 5 cuffed endotracheal tube can be used. (B) After the right chest tube was placed, 150 ml of blood was immediately drained, and an immediate operative thoracotomy was required. (C) Rapid infusion of saline solution can be repeated 3 times, 400 ml each time. If the blood pressure is still low, another 200 ml of PRBC can be transfused. (D) If peripheral blood vessels cannot be injected, consider placing an intraosseous injection in the proximal tibia and drawing blood with the bone needle for blood preparation. (E) The infusion for this patient needs to be warmed first and hypothermia should be avoided. ", "output": "B"} 
-{"instruction": "A 5-year-old child fell from a height of about 60 cm 1 hour ago and has a 2*2 cm hematoma on the scalp. Which of the following statements is most appropriate? ", "input": "(A) If there is no neurological abnormality, a head CT examination should still be performed to rule out intracranial hemorrhage. (B) If a 5-year-old child has a scalp hematoma, the risk of fracture or intracranial hemorrhage is higher than that of a child under 2 years old. (C) If there are no neurological symptoms, no imaging examination is required and the patient can be sent home immediately. (D) After 4 hours of observation in the emergency department, if there are no neurological symptoms, the patient can be sent home without imaging examination. (E) The CT examination results are normal. 20% of patients will develop delayed neurological symptoms. ", "output": "D"} 
-{"instruction": "A 60-year-old male suddenly developed chest pain, which was as sharp as a knife in the front of the chest and cold sweats on the back. The blood pressure was 200/100 mmHg and the pulse was 100 beats/min. Ultrasound showed a dissection flap in the aorta. Which of the following statements is wrong? ", "input": "(A) When a young person is diagnosed with this disease, other causes should be sought, such as congenital cardiovascular disease, trauma or pregnancy. (B) The Stanford classification system is used to distinguish between type A and type B, with the brachiocephalic artery as the basis for classification. (C) The location of pain usually cannot reflect the location of the lesion, and the location of pain will change. (D) It often manifests as hypertension. When hypotension or shock occurs, pericardial tamponade, aortic hemorrhage, severe aortic regurgitation or myocardial infarction should be considered. (E) The best choice for controlling blood pressure is β-blockers, and the goal is to reduce the heart rate to 60-70 beats/min. ", "output": "A、B、C、D、E"} 
-{"instruction": "A 60-year-old male presents with OHCA. The electrocardiogram shows PEA (pulseless electrical activity). Echocardiography reveals significant right ventricular enlargement. Which of the following diagnoses is most likely? ", "input": "(A) Pericardial tamponade. (B) Hypovolemia. (C) Acute myocardial infarction. (D) Pulmonary embolism. (E) Tension pneumothorax. ", "output": "D"} 
-{"instruction": "A 60-year-old chronic alcoholic patient did not drink in the morning. In the evening, he went to the emergency room complaining of palpitations, nausea, and vomiting. Blood tests showed: pH 7.2, sodium bicarbonate: 6 mmol/L, sodium: 135 mmol/L, potassium: 4.0 mmol/L, chloride: 105 mmol/L, ketone body positive reaction, blood sugar: 110 mg/dL, lactate: 2.0 mmol/L. Which of the following descriptions is correct? ", "input": "(A) Methanol poisoning does not produce ketone bodies, and the acidosis caused by methanol poisoning is more serious. (B) The most common complication after massive infusion treatment of this disease is cerebral edema. (C) Infusions containing sugar should not be used to treat this disease. (D) Insulin can reduce the production of ketone bodies and is very beneficial for the treatment of this disease. (E) If the blood pH is less than 7.2, sodium bicarbonate should be given routinely to treat acidosis. ", "output": "A"} 
-{"instruction": "A 62-year-old male with prostate cancer is undergoing radiation therapy. He has had occasional fecal incontinence and tenesmus in the past 3 days and has started to have diarrhea with bloody stools today. Vital signs are blood pressure 136/78 mmHg, pulse 84 beats/min, and temperature 37.2℃. Physical examination shows that the abdomen is soft to the touch. Anal examination revealed diffuse tenderness, blood, and intact anal tone. Muscle strength, deep tendon reflexes, and sensation in both lower limbs were symmetrical and intact. Which of the following treatments is the most appropriate? ","input": "(A) Empirically administer ceftriaxone and doxycycline. (B) Analgesics and oral sucralfate. (C) Intravenous pantoprazole. (D) Consult a surgeon for surgery. (E) Insert an anal cannula for decompression.", "output": "B"} 
-{"instruction": "A 64-year-old female, who used to take unidentified pain medications, came to the clinic recently with loss of appetite and general weakness. Her vital signs were: temperature 36.9℃, pulse 68 beats/min, respiration 14 times/min, blood pressure 86/54mmHg, SpO₂: 98%, blood sugar 126mg/dL. Which of the following statements is incorrect? ", "input": "(A)Adrenal crisis may occasionally present with acute abdominal pain as a clinical manifestation. (B)Adrenal insufficiency may also present with clinical symptoms such as headache, confusion, visual changes, or gastrointestinal symptoms. (C)If serum cortisol is greater than 18mg/dL, adrenal insufficiency can generally be ruled out. (D)Primary adrenal insufficiency is easily found to have low potassium and low sodium levels in blood tests. (E)If the patient has hypotension, he can be given fluid supplements according to the emergency procedures for shock. If there is no response, consider giving hydrocortisone (100mg iv bolus). ", "output": "D"} 
-{"instruction": "A 65-year-old female with a history of hypertension and atrial fibrillation presented to the emergency department with dizziness and vomiting. Which of the following statements about this case is incorrect? ", "input":"(A) If there is unsteady gait, weakness of the ipsilateral facial muscles and loss of corneal reflex, a cerebellopontine angle tumor should be considered. (B) If the vertigo is sudden and accompanied by hearing loss, labyrinthitis should be considered. (C) If it is Meniere's Disease, the symptoms may last up to 12 hours and the frequency may range from several times a week to several times a month. (D) The clinical symptoms of peripheral vertigo are mainly treated with H2 antihistamines. (E) The use of calcium channel blockers can relieve the clinical symptoms of peripheral vertigo.", "output": "D"}
-{"instruction": "A 70-year-old male received general anesthesia and surgery for a femoral neck fracture 10 days ago. He now goes to the emergency room for unilateral leg pain and dyspnea. His vital signs are blood pressure 110/60 mmHg, pulse 130 beats/min, respiration 30 times/min, and temperature 37°C. Which of the following statements is correct?", "input": "(A) Chest X-ray Westermark sign or Hampton hump has a high specificity for diagnosing pulmonary embolism. (B) When the right ventricular pressure is greater than 40 mmHg, inverted T waves can be found in V5 and V6 of the electrocardiogram. (C) D-dimer may show higher values ​​due to hyperlipidemia or symptoms lasting more than five days. (D) Arterial blood gas analysis can reveal a decrease in alveolar-arterial oxygen tension gradient. (E) At this point, the patient will do better with thrombolytic therapy than heparin. ", "output": "A"} 
-{"instruction": "A 70-year-old male presented to the emergency department with blurred vision and left-sided head injury. Physical examination revealed left fronto-temporal scalp and orbital hematoma. Both pupils were equal in size, 3 mm. Both had normal light reflexes, normal limb movements and deep tendon reflexes, and a steady gait, but he was prone to bumping into objects on the left side. Visual field examination revealed left homonymous hemianopsia. Which of the following is the most likely diagnosis? ", "input": "(A) Pituitary tumor. (B) Right epidural hemorrhage. (C) Left subdural hemorrhage. (D) Right occipital infarction. (E) Right central retinal artery occlusion.", "output": "D"} {"instruction" 
-: "A 74-year-old man began to have testicular pain a few days ago, and the pain has become increasingly severe. Emergency physiology examination showed testicular tenderness, but the scrotum looked normal and there was no discharge from the urethra. Which of the following treatments is the most appropriate?", "input": "(A) Ceftriaxone. (B) Cephalexin. (C) Doxycycline. (D) Levofloxacin. (E) Amoxicillin. ", "output": "D"} 
-{"instruction": "A 75-year-old female, who had been bedridden for a long time due to a stroke, is usually cared for in a nursing home and has a nasogastric tube. She vomited and coughed after a feeding at noon. She also had dyspnea and persistent cough at night and was sent to the emergency room from the nursing home for treatment. Which of the following statements about the patient's clinical treatment is correct? ", "input": "(A) Antibiotics should be used preventively as long as there is a cough. (B) The use of steroids can prevent lung injury. (C) If aspiration pneumonia occurs, the most common pathogen is S. aureus. (D) The broad-spectrum antibiotic Levofloxacin can be used. (E) For patients whose condition is stable, they can be transferred back to the nursing home for care if they remain stable after 24 hours of observation. ", "output": "E"} 
-{"instruction": "A 76-year-old male sought medical attention due to unconsciousness. He has recently complained of diarrhea and abdominal pain. Vital signs are: temperature 39℃, pulse 140 beats/min, respiratory rate 20 times/min, blood pressure 148/98mmHg, SpO₂: 92%. Breath sounds were wet during auscultation, and blood tests revealed that the patient had hyperthyroidism. Which of the following statements is incorrect? ", "input": "(A) In differential diagnosis , in addition to infectious diseases, other diseases such as drugs, thyroid diseases, malignant neuroleptic syndrome or pheochromocytoma should be considered. (B) Thyroid storm is mainly diagnosed through clinical symptoms, and Burch and Wartofsky's Diagnostic Parameters and Scoring Points can also be used as a basis for diagnosis. (C) Symptoms of heart failure can be seen in thyroid storm. (D) Patients with high fever during thyroid storm should not use aspirin to reduce fever to avoid Reye syndrome. (E) This patient should be treated with methimazole first, and then iodine such as Lugol solution 1 to 2 hours later. ", "output": "D"}  
-{"instruction": "An 88-year-old male was hit by a car while crossing the road. His family said that he usually has mild dementia and takes medication. He also took anticoagulants for heart valve surgery. When he was sent to the emergency room, he had abrasions on his face, chest and abdomen, and a hematoma on the back of his brain. His vital signs were as follows: pulse 88 beats/min, blood pressure 105/70mmHg. The patient could not answer questions correctly. Which of the following statements is wrong? ", "input":"(A) Although there is no increased heart rate, the blood pressure may still be lower than usual, so we should inquire carefully. (B) The family members said that the consciousness is not much different from usual, so there is no suspicion of cerebral hemorrhage. (C) Blood gases and lactate can be used to assess the prognosis of patients in shock. (D) Be very careful when using contrast agents to examine elderly people in shock, as it may worsen the patient's renal function. (E) The probability of subdural hemorrhage (SDH) in elderly people with head trauma is higher than that of epidural hemorrhage (EDH). ", "output": "B"}
-{"instruction": "An 8-month-old infant with Tetralogy of Fallot was taken to the emergency room by his mother because he developed systemic cyanosis after a bout of crying. After evaluation, the doctor believed that it was a blue spell and prescribed intravenous morphine, but due to the urgency of the situation, the nurse gave 10 times the therapeutic dose. Which of the following statements is least appropriate? ", "input": "(A) The treatment of this patient is mainly based on the following five principles: provide supportive treatment, prevent or reduce the absorption of toxins, increase the excretion of toxins, consider giving antidotes and prognosis assessment. (B) The pupil may shrink to the size of a pinpoint. (C) If the infant has impaired consciousness, consider giving intravenous injection of flumazenil. It can improve the infant's consciousness. (D) If the infant has symptoms such as coma and respiratory depression, give intravenous injection of naloxone antidote to improve the infant's symptoms. (E) When acute morphine poisoning causes respiratory depression, consider endotracheal intubation and use of a ventilator to maintain airway patency and respiratory function. ", "output": "C"} 
-{"instruction": "Which of the following is incorrect about the advantages of Cricothyroidotomy over emergency tracheostomy? ", "input": "(A) It is easier to operate. (B) It is less likely to bleed. (C) More suitable for providing emergency surgical airway. (D) Can be used for children under 12 years old. (E) The operation time is short 
-."An adult patient develops one-sided facial immobility, drooping of the corners of the mouth, and disappearance of forehead wrinkles over a few days, but limb movement and sensation are normal. Which of the following treatments is correct?", "input": "(A) It is generally believed to be caused by a viral infection, so antiviral drugs should be given. (B) If there is severe ear pain, antiviral drugs should be considered. (C) If the cornea is damaged, antibiotics should be considered. (D) The combined use of steroids and antiviral drugs has a better therapeutic effect and reduces complications than the use of steroids alone. (E) A CT or MRI should be arranged to rule out the possibility of a stroke.", "output": "B, C"}
-{"instruction": "Which of the following most needs an emergency thoracotomy (resuscitative thoracotomy) in the emergency department?", "input": "(A) A 25-year-old male driver was not wearing a seat belt and hit a street light. His steering wheel was deformed. When he arrived at the hospital, his cardiopulmonary function stopped and his electrocardiogram showed pulseless electrical activity (PEA). (B) A 60-year-old male was stabbed in the left anterior chest with a sharp knife. When he arrived at the hospital, his cardiopulmonary function stopped and his electrocardiogram showed PEA. (C) A 16-year-old male fell from a tree and was pierced through the chest by a branch. When he arrived at the hospital, his blood pressure was 80/40 mmHg. (D) A 40-year-old female was stabbed in the left anterior chest with a sharp knife. When she arrived at the hospital, her cardiopulmonary function stopped and her pupils had no light reflex. (E) A 20-year-old male was hit in the chest by a baseball and fell to the ground. When he arrived at the hospital, he was in cardiopulmonary arrest and his electrocardiogram showed ventricular fibrillation. ", "output": "B"} 
-{"instruction": "Which of the following patients is not at high risk for cervical spine injury? ", "input": "(A) A 30-year-old male pickup driver overturned on the highway. He was conscious and able to walk. One of his passengers died. (B) A 35-year-old female pedestrian was hit by a high-speed car that ran a red light while crossing the road. She now has neck pain. (C) A 40-year-old male worker fell from a 6-meter-high scaffold. He had no obvious neurological symptoms. (D) A 50-year-old male driver was hit by a car behind him when he stopped at a red light 1 day ago. He now has back neck pain. (E) An 80-year-old male fell and hit his head while walking. He was conscious, and a CT scan of his head revealed subdural hemorrhage. ", "output": "D"} 
-{"instruction": "Which of the following descriptions and treatments for pelvic fractures is incorrect? ", "input": "(A) Once a pelvic fracture is confirmed, the possibility of abdominal, retroperitoneal, reproductive and urinary system injuries must be ruled out. (B) Pelvic fracture injuries with unstable hemodynamics should be promptly arranged for angiography and embolization therapy. (C) Lateral compression is the most common mechanism leading to pelvic fractures. (D) Pelvic fractures lead to retroperitoneal bleeding, the main sources of which are venous and fracture edge bleeding, and arterial bleeding accounts for only 10-15%. (E) In addition to embolization, pelvic fixation can also control retroperitoneal bleeding, but it is more effective for venous and fracture edge bleeding. ", "output": "B"} 
-{"instruction": "Which of the following statements about intestinal obstruction is incorrect? ", "input": "(A) In developed countries, the most common cause is postoperative adhesions, followed by tumors and hernias. (B) In children aged 6 to 36 months, intussusception is the most common cause of obstruction. (C) The chance of recurrence of small bowel obstruction increases with the number of previous small bowel obstructions caused by postoperative adhesions. (D) Closed-loop intestinal obstruction has a higher risk of causing strangulation. (E) Bacterial translocation is common in simple intestinal obstruction. Routine antibiotic treatment is recommended for patients treated conservatively. ", "output": "E"} 
-{"instruction": "Which of the following statements about hospital emergency response and hazard vulnerability analysis for emergency disasters is correct? ", "input": "(A) Only regional hospitals and district hospitals need to conduct hazard vulnerability analysis for emergency disasters in the hospital emergency response plan. (B) According to the current international situation, regardless of the hospital level and geographical location, terrorist attack-related disasters are the top priority planning in the hospital emergency response plan. (C) When facing chemical disasters, hospitals need to prepare decontamination equipment and antidote plans, and other equipment does not need to be considered. (D) When facing earthquake hazards, urban hospitals should consider the surge capacity of seriously ill patients and the increased demand for hemodialysis. (E) The hospital emergency response plan of the medical center should plan for all emergency disaster responses, so there is no need to conduct an emergency disaster hazard vulnerability analysis. ", "output": "D"} {" 
-instruction": "When there are a large number of casualties, according to the principle of simple triage and rapid treatment, the order of assessing patients is:", "input": "(A) Breathing → circulation → consciousness. (B) Breathing → consciousness → circulation. (C) Circulation → breathing → consciousness. (D) Circulation → consciousness → breathing. (E) Consciousness → breathing → circulation. ", "output": "A"} 
-{"instruction": "Colon ischemia is common in people over 60 years old. Which of the following statements is incorrect? ", "input": "(A) Colon ischemia in most patients is self-limited and improves with conservative treatment. (B) Typical symptoms are left lower abdominal cramps and abdominal distension. Most patients have bloody stools. (C) Only some patients have thumbprinting on plain radiographs, but it is not diagnostically specific. (D) Colonoscopy can provide direct observation of mucosal ischemia, and biopsy and other causes should be performed when necessary. (E) Computed tomography angiography (CT angiography) can provide an accurate diagnosis of colon ischemia. ", "output": "E"} "(A) In most patients, colorectal ischemia is self-limited and improves with conservative treatment. (B) Typical symptoms are left lower abdominal cramps and abdominal distension, and most patients have bloody stools. (C) Only some patients have thumbprinting on plain radiographs, but it is not diagnostically specific. (D) Colonoscopy can provide direct observation of mucosal ischemia, and biopsy and other causes must be performed when necessary. (E) Computed tomography angiography can provide an accurate diagnosis of colorectal ischemia.", "output": "E"} 
-{"instruction": "A middle-aged man sought medical attention for abdominal pain after heavy drinking. Examination revealed low blood pressure and a high anion gap (high anion gap) metabolic acidosis, which of the following statements is incorrect? ", "input": "(A) The absence of ketone in the blood does not rule out the diagnosis of alcoholic ketoacidosis. (B) First, give a normal saline solution containing 5% sugar water as an infusion, then change to half saline containing 5% sugar water as a maintenance infusion until oral intake is restored, and supplement potassium and magnesium. (C) The blood sugar of patients with alcoholic ketoacidosis may be slightly higher or lower than normal. (D) If the patient's arterial blood pH is lower than 7.2, consider supplementing with sodium bicarbonate to avoid fatal arrhythmias caused by acidemia. (E) Large amounts of fluids should be given and vitamin B1 (thiamine) should be used regularly. ", "output": "D"}
-{"instruction": "A middle-aged man went to the emergency room due to fever and cough for several days. Chest X-ray showed pulmonary abscess. Which of the following statements is correct? ", "input": "(A) Lemierre's syndrome can occur after tonsillitis. (B) Multiple pulmonary abscesses are very common and are mostly caused by hematogenous infection. (C) The common pathogens in patients with normal immunity are aerobic bacteria, while those in patients with low immunity are anaerobic bacteria. (D) Seventy percent of patients require surgical drainage. (E) The incidence of this disease has increased dramatically in the past 40 years. ", "output": "A"} 
-{"instruction": "When a jellyfish stings you, you need to clean the wound. Which of the following is the wrong way to treat the wound? ", "input":"(A) Clean water. (B) Seawater. (C) Soak in 45℃ hot water. (D) 5% acetic acid. (E) Apply lidocaine.", "output": "A"} 
-{"instruction": "Which of the following carbon monoxide poisoning patients is most in need of hyperbaric oxygen therapy?", "input": "(A) The carbon monoxide concentration in the blood of pregnant women is 5%. (B) The carbon monoxide concentration in the blood of ordinary people is 15%. (C) Has experienced syncope or loss of consciousness. (D) The patient has symptoms of dizziness. (E) Face and hands become numb after poisoning.", "output": "C"}
-{"instruction": "Traumatic aortic injury is one of the most difficult and fatal injuries to diagnose in emergency. Which of the following statements about this injury is incorrect?", "input": "(A) Most of them are caused by puncture injuries or deceleration injuries. (B) 90% of patients with blunt aortic injuries will die on the spot and will not be able to be sent to the hospital in time. (C) High rib fractures, asymmetric blood pressure in both upper limbs, and weak pulse in the lower limbs should all be considered as signs of aortic injury. (D) In ​​most patients, chest X-rays may show widening of the diaphragm and left tracheal deviation. (E)For patients with stable vital signs, CT angiogram with contrast should be arranged if aortic injury is suspected. ", "output": "D"} 
-{"instruction": "This patient has chest pain and acute coronary syndrome caused by cocaine abuse. His pulse is 120 beats/min, blood pressure is 168/96 mmHg, and temperature is 37.2℃. Which drug is the first choice for treating this patient? ", "input": "(A)Diazepam. (B)Labetolol. (C)Phetolamine. (D)Tissue plasminogen activator (t-PA). (E)Verapamil. ", "output": "A"} 
-{"instruction": "Due to a major earthquake, many buildings collapsed and there were a large number of injured patients. The Department of Health dispatched your hospital to perform emergency medical rescue missions. You are responsible for the classification of patients on site. According to the Simple Triage and Rapid Treatment (START) principle of triage, which of the following statements is wrong?", "input": "(A) Anonymous, male, no breathing and pulse, head and neck separated (black). (B) A 50-year-old male without breathing, breathing after opening the airway (red). (C) A 30-year-old female, breathing about 25 times/min, radial artery cannot be felt, right thigh deformity and combined wound with heavy bleeding (yellow). (D) An 18-year-old male, running around on the scene, with multiple abrasions on his right hand and feet (green). (E) A 21-year-old female with a left thigh fracture, normal breathing and pulse, and conscious color is yellow. ", "output": "C"} 
-{"instruction": "Which of the following treatments for incarcerated hernia is less appropriate in the emergency room? ", "input": "(A) If reduction is unsuccessful, fasting is required. (B) Give intravenous analgesics. (C) Apply hot compresses to the hernia to make reduction easier. (D) If reduction fails 1 to 2 times, consider seeking treatment from a surgeon. (E) After successful reduction, observation is still required for a period of time. ", "output": "C"} 
-{"instruction": "In the Hospital Incident Command System structure, which of the following departments does not belong to the Operation section? ", "input": "(A)Hazmat Branch. (B)Infrastructure Branch. (C)Medical Care Branch. (D)Security Branch. (E)Situation Branch. ", "output": "E"} {" 
-instruction": "During an earthquake disaster, a 60-year-old male patient was trapped by a wardrobe and his lower limbs were pinned to the ground for 10 hours before he was rescued. Which of the following should be considered harmful in the emergency treatment? ", "input": "(A)Injection of large amounts of saline solution. (B)Supplementation of potassium ions. (C)Supplementation of sodium bicarbonate. (D)Supplementation of calcium ions. (E)Supplementation of mannitol. ", "output": "B"} 
-{"instruction": "A young male with no medical history was sent to the emergency room due to altered consciousness while participating in a marathon. He was unconscious on arrival, with a temperature of 42°C and dry, hot skin. Blood tests for white blood cells and CRP were both within normal ranges, with no evidence of meningitis. CT and chest X-rays were also normal. Which of the following statements is correct? ", "input": "(A) Patients with parasympathetic stimulant overdose will also have similar clinical manifestations. (B) The patient should be cooled quickly to below 37°C to reduce the damage to the nerves caused by high body temperature. (C) During the cooling process, if the patient shivers, he can be treated with short-acting benzodiazepine. (D) After adequate fluid therapy, if hypotension persists, Norepinephrine should be used as a pressor. (E) Because the patient is dehydrated, typical hyperkalemia and hypernatremia can be seen in the blood. ", "output": "C"} 
-{"instruction": "A 35-year-old male working in a tunnel was unconscious after sweating profusely. The room temperature on site was 40℃ and the heat dissipation was poor. Which of the following statements is wrong? ", "input": "(A) In addition to fever, patients with heat stroke will mainly have symptoms of central nervous system such as epilepsy or mental confusion. (B) The body temperature of patients with heat exhaustion may not exceed 40℃. (C) When treating heat stroke, if the patient's physical condition allows, the infusion rate can be started at 250 ml/hr. (D) Using 4°C saline solution for cooling is a better auxiliary cooling treatment than using an ice pillow. (E) The primary goal of cooling heat stroke is to reduce the core body temperature to 39°C. ", "output": "D"}"(A) Risk factors for primary pneumothorax include smoking, male sex, mitral valve prolapse and heredity. (B) Diagnosis can be made through chest X-ray, chest CT or ultrasound, all of which have a sensitivity and specificity of more than 90%. (C) Under room air, the oxygen saturation is 91%, which meets the criteria of a stable patient. (D) Clinically, if tension pneumothorax is highly suspected, it must be treated immediately and a chest X-ray cannot be waited for to confirm the diagnosis. (E) If the area of ​​spontaneous pneumothorax is less than 20%, oxygen therapy and observation can be used in stable healthy adults without immediate chest tube placement.", "output": "B"} 
-{"instruction": "About the effect of blood product therapy on improving von Willebrand factor Which of the following has the best effect if the factor is deficient? ", "input": "(A) Whole blood. (B) Platelet phoresis. (C) Washed red blood cells. (D) Fresh-frozen plasma. (E) Cryoprecipitate. ", "output": "E"}"D"} 
-{"instruction": "Which of the following statements about lower limb ligament injuries is correct?", "input": "(A) When a patient is suspected of having anterior cruciate ligament rupture, the sensitivity of the physical examination Lachman test is higher than that of the anterior drawer sign. (B) Posterior cruciate ligament rupture is more likely to occur than anterior cruciate ligament rupture. (C) Long-term use of steroids or third-generation cephalosporins are risk factors for spontaneous tendon rupture. (D) Spontaneous posterior tibialis tendon rupture often occurs during strenuous exercise, so young male patients are more likely to suffer from it. (E) When joint hematoma occurs, the probability of posterior cruciate ligament rupture is higher than that of anterior cruciate ligament rupture. ", "output": "A"}
-{"instruction": "Which of the following statements about the diagnosis and treatment of spontaneous pneumothorax is incorrect?", "input": "(A) Risk factors for primary pneumothorax include smoking, male sex, mitral valve prolapse, and heredity. (B) Diagnosis can be made through chest X-ray, chest CT, or ultrasound, all of which have a sensitivity and specificity of more than 90%. (C) Under room air, the oxygen saturation is 91%, which meets the criteria for a stable pneumothorax patient. (D) Once a tension pneumothorax is highly suspected clinically, it must be treated immediately without waiting for a chest X-ray to confirm the diagnosis. (E) If the area of ​​spontaneous pneumothorax is less than 20%, a stable healthy adult can be treated with oxygen and observed without immediate chest tube placement. ", "output": "B"}"output": "E"} 
-{"instruction": "According to the Emergency Medical Rescue Act, regarding the emergency medical rescue information reporting method, which of the following statements is incorrect?", "input": "(A) When the local disaster relief and rescue command center receives a report and initially determines that it is a mass casualty incident, it should notify the local health, fire authorities and related agencies (institutions). A "disaster incident file" should be established in the emergency medical management system. (B) In the case of non-mass casualty incidents, the local health authorities may establish a "disaster incident file" in the emergency medical management system after becoming aware of and determining it to be a "special incident." (C) Regional emergency medical response centers may assist local health authorities and emergency hospitals in collecting and registering relevant data. (D) Emergency hospitals should provide preliminary data on the number of injured patients admitted to the hospital within 60 minutes, and provide a single contact window and telephone number. They are responsible for contacting health and fire authorities and updating the treatment data of injured patients until the emergency treatment of injured patients is completed. (E) Emergency medical rescue information reporting operations, if the communication transmission is interrupted by a fault, may be reported in other ways first, and the reporting information registration operation shall be completed within 24 hours after the fault is eliminated. ", "output": "D"}
-{"instruction": "Which of the following statements about Antiphospholipid Syndrome is incorrect?", "input": "(A) It is more common in women. (B) When acute thrombosis is suspected, D-dimer is an important test to determine the risk of this disease. (C) Patients with positive reaction to Lupus anticoagulant have a 50% chance of developing arteriovenous embolism within 20 years. (D) This disease is treated with Warfarin, and the International Normalized Ratio (INR) should be maintained at 3. (E) Pregnant women with Antiphospholipid Syndrome can be treated with low molecular weight heparin or low-dose aspirin.", "output": "B"} 
-{"instruction": "Which of the following statements about Gout is incorrect?", "input": "(A) It often occurs in the first metatarsophalangeal joint of the big toe, but it may occur in joints throughout the body. (B) The diagnosis must be confirmed by testing the crystal composition of the joint fluid. (C) If it cannot be differentiated from septic arthritis, hospitalization is the safest approach. (D) Generally speaking, pain is relieved in about 2 days after administration of NSAIDs. (E) Intravenous colchicine is often associated with serious side effects, such as bone marrow suppression, so it is rarely used.", "output": "D"} 
-{"instruction": "Which of the following statements about acute sinusitis is incorrect?", "input": "(A) The top three common pathogens are the same as the common pathogens of otitis media. (B) Clinical manifestations include yellow-green thick nasal discharge, nasal congestion, fullness of the nose and face, and even decreased sense of smell. (C) For patients with yellow-green thick nasal discharge, the possibility of bacterial infection must be highly suspected and antibiotic treatment must be given. (D) For patients who are allergic to penicillin, Cefuroxime is a reasonable alternative to antibiotics. (E) The diagnostic value of X-ray examination is not high and is not routinely recommended for all patients with acute sinusitis. ", "output": "C"} 
-{"instruction": "Which of the following statements about myasthenia gravis is incorrect? ", "input": "(A) Most patients present with general weakness, especially in the proximal limb muscle groups. (B) Elderly patients with new facial muscle weakness are easily misdiagnosed as having a stroke. (C) Patients often have worsening respiratory failure due to infection, surgery, or discontinuation of medication. (D) If a patient requires intubation for respiratory failure, pancuronium is the first choice. (E) Patients with heart disease may experience bradycardia when treated with edrophonium. ", "output": "D"} 
-{"instruction": "Which of the following is incorrect about the management of complications after receiving Fibrinolytic therapy? ", "input": "(A) After starting Fibrinolytic therapy, check hemoglobin every 4 to 6 hours. When hemoglobin drops > 1 to 2 g/dL, bleeding should be suspected. (B) When a patient has intra-abdominal or intracranial bleeding, thrombolytic drugs, antiplatelet drugs and heparin should be stopped immediately. (C) If a patient has bleeding at the injection site, protamine should be injected immediately. (D) If bleeding occurs after receiving heparin, protamine can be injected. (E) In case of massive bleeding, blood coagulation factor cryoprecipitate or FFP should be transfused. ", "output": "C"} 
-{"instruction": "Which of the following factors is less relevant to inducing acute angle-closure glaucoma? ", "input": "(A) Use ocular antihistamines. (B) Use pseudoephedrine for patients with nasal congestion. (C) Use inhaled ethylenediamine sympathetic stimulants for patients with asthma. (D) Bright light environment. (E) Emotional stress. ", "output": "D"} 
-{"instruction": "From December to March of the following year, influenza is prevalent. Emergency rooms in major hospitals are crowded with patients with fever. Which of the following statements about severe complications of influenza is incorrect? ", "input": "(A) The reporting condition is that the patient needs to be treated in the intensive care unit or dies within one week due to complications such as pneumonia after the onset of influenza-like symptoms. (B) It is currently a Category 4 infectious disease and must be reported within one week. (C) Both type A and type B influenza can be treated with Zanamivir. (D) Zanamivir mainly reduces the severity of infection by inhibiting neuraminidase. (E) Since 2016, the seasonal influenza A types in Taiwan are mainly H1N1 and H3N2. ", "output": "A"} 
-{"instruction": "According to the Regulations on the Management of Necessary Emergency Rescue Equipment in Public Places, regarding the use of Automated External Defibrillators (AEDs) in public places, which of the following does not belong to the eight categories of public places specified in the regulations? ", "input": "(A) Taoyuan Chiang Kai-shek International Airport. (B) Guanxi Rest Area of ​​Taipei Second High School. (C) Taiwan Railway stations above second-class stations. (D) Schools above high school. (E) A ferry that can carry 90 people from Tamsui to Bali. ", "output": "E"} 
-{"instruction": "According to the Guideline of the Wilderness Medical Society in December 2014, regarding the emergency treatment of frostbite, which of the following is not recommended? ", "input": "(A) Rapidly rewarm the frozen sore limb with warm water at 37-39℃. (B) For blisters containing clear fluid, consider draining the fluid with a needle. (C) For hemorrhagic blisters, use a needle to drain the fluid from the blister. (D) For those at risk of amputation, consider giving thrombolytic agent (tPA) treatment. (E) Consider giving tetanus prophylaxis. ", "output":"C"} 
-{"instruction": "According to the 2015 new version of the AHA ACLS guidelines for tachycardia (≥150 beats/min), a 50-year-old male has sudden palpitations, no chest tightness or nausea, and the electrocardiogram shows regular monomorphic wide QRS tachycardia, and it is unclear whether it is VT. The pulse is about 180 beats/min, and the blood pressure is 106/76mmHg. There are no symptoms such as hypotension, shock, and ischemic chest pain. Which of the following treatments should be prioritized?", "input": "(A) Adenosine, initial dose of 6mg intravenous push over 1~3 seconds, plus 20ml of normal saline for rapid administration. (B) Amiodarone, initial dose of 300mg intravenous push. (C) Synchronous rectification 100J. (D) Synchronous rectification, bi-phase wave 120~200 J or single-phase wave 200 J. (E) Synchronous rectification 50 J. ", "output": "A"}
-{"instruction": "According to the 2015 new AHA ACLS guidelines for tachycardia (≥150 beats/min), which of the following statements about the treatment of symptoms such as hypotension, shock, and ischemic chest pain is incorrect?", "input": "(A) For narrow, regular QRS complexes, the dose is 50~100J synchronous rectification. (B) For narrow, irregular QRS complexes, the dose is 120~200J (biphasic) or 200J (monophasic) synchronous rectification. (C) For wide, regular QRS complexes, the dose is 100J synchronous rectification. (D) For wide, irregular QRS complexes, the dose is 120~200J (biphasic) or 200J (monophasic) synchronous rectification. (E) Paroxysmal supraventricular tachycardia (PSVT) can be treated by rapid intravenous injection of Adenosine 6mg. If it is effective, no electric shock is needed. ", "output": "D"} 
-{"instruction": "According to the classification and reporting regulations of emerging infectious disease cases (including suspected cases) in Taiwan, which of the following is not included in the reporting within 24 hours? ", "input": "(A) Acute viral hepatitis A. (B) Severe complications of influenza. (C) Human immunodeficiency virus infection. (D) Rabies. (E) Middle East respiratory syndrome coronavirus infection. ", "output": "B"} 
-{"instruction": "For a patient with cardiopulmonary arrest whose initial rhythm is pulseless electrical activity and has not been cured after 10 minutes of first aid, which of the following treatments is the least appropriate? ", "input": "(A) A pulsatile blood test can differentiate hypoxia, acidosis, and hyperkalemia/hypokalemia. (B) The medical history and the setting where the patient was found, or measuring body temperature, can help determine the possibility of hypothermia. (C) Bedside ultrasound can help determine cardiac tamponade, acute pulmonary embolism, tension pneumothorax, and hypovolemia, etc. (D) The medical history, the patient's medication history, or the setting where the patient was found, can help determine the possibility of drug or toxin poisoning. (E) Bedside X-ray can help determine the possibility of tension pneumothorax.", "output": "E"} 
-{"instruction": "For patients with acute ischemic stroke, with onset within less than 3 hours, NIHSS is 20. In which of the following cases can intravenous thrombolytic drugs (tPA) still be used? ", "input": "(A) Blood sugar level is 460mg/dL. (B) Oral anticoagulant Warfarin is being used, and INR is 2.0. (C) Platelet level is 110,000/mm³. (D) There was a seizure when the stroke occurred. (E) Blood pressure at the time was 210/115 mmHg. ", "output": "C"} { 
-"instruction": "A taxi crashed into another car, resulting in an injury to a 3-year-old child passenger in the back seat of the taxi, who was subsequently taken to the emergency room by ambulance. The child has a laceration on his forehead, a pulse of 120 beats/min, and a blood pressure of 86/48 mmHg. He is hugging his mother. If he gradually develops respiratory distress and mental coma, which of the following statements is most appropriate: ", "input": "(A) The child's breathing is mainly based on diaphragmatic movement, so drug-assisted intubation should not be considered. (B) For endotracheal intubation in children, oral intubation should be given priority. (C) Children are tolerant to tension pneumothorax and are less likely to go into shock. (D) Children do not respond well to bag-mask ventilation, so surgical tracheotomy should be considered. (E) The respiratory structure of children is different from that of adults, so they should be hyperextensioned when lying on their backs to prevent airway obstruction. ", "output": "B"} 
-{"instruction": "When facing patients with in-hospital cardiac arrest (IHCA), the first priority is to prevent it from happening. Therefore, we advocate the establishment of rapid response teams (RRTs) or medical emergency teams (METs). Which of the following descriptions of RRTs/METs is incorrect? ", "input": "(A) The establishment of RRTs/METs is mainly to ensure that a team can work together to provide emergency treatment to patients after IHCA occurs, thereby increasing the patient's chance of recovery. (B) The establishment of RRTs/METs can improve the survival rate of hospitalized patients. (C) Through Early Warning Sign Systems, we can identify dangerous hospitalized patients and prevent the occurrence of IHCA. (D) In ​​addition to first aid skills, RRTs/METs training also includes the establishment of a teamwork concept. (E) In addition to helping adult patients, the establishment of RRTs/METs may also be helpful for pediatric patients. ", "output": "A"} 
-{"instruction": "According to the annual epidemic period and severe data of pediatric enterovirus compiled by the Taiwan Centers for Disease Control, which of the following statements is correct? ", "input": "(A) Common severe enterovirus cases occur in children over 5 years old. (B) Coxsackie virus does not cause hand, foot and mouth disease. (C) There are two peaks in the annual epidemic period, from April to June and from September to October. (D) Enterovirus 71 is the most common type of enterovirus that induces acute myocarditis in infants. (E) Severe enterovirus is a Category 5 infectious disease and must be reported. ", "output": "C"} "C"} 
-{"instruction": "According to the Management Regulations for Rescue Technicians, the rescue items that can be performed by intermediate rescuers do not include the following:", "input": "(A) Operate a manual defibrillator. (B) Give an intravenous injection. (C) Deliver an emergency baby. (D) Assist with the use of inhaled bronchodilators. (E) Use a laryngeal mask airway (LMA).", "output": "A"}
-{"instruction": "According to the recommendations of the Centers for Disease Control of the Ministry of Health and Welfare, which of the following statements is correct regarding the treatment of suspected rabies when a person is scratched or bitten by an animal and has skin wounds or saliva contact? ", "input":"(A) If you are exposed by scratches or bites from stray dogs or cats, seek medical attention immediately and get vaccinated. If the stray dogs or cats are asymptomatic after 7 days of observation, you can stop vaccinating. (B) If you are exposed by scratches or bites from domestic dogs or cats, do not give the vaccine for the time being. Observe the domestic dogs or cats. If suspected rabies symptoms appear after one month, give the vaccine. (C) When the wound needs to be injected with immunoglobulin at the same time, it is recommended to suture it after a few hours (≧2 hours). (D) When rabies immunoglobulin is needed, intravenous injection is better than wound infiltration injection. Immunoglobulin can be administered at the same time as the first dose of vaccine after exposure. (E) The dosage of human rabies immunoglobulin (HRIG) is 20 IU/kg. Perform a skin sensitivity test before administration.", "output": "C"} 
-{"instruction": "Which of the following statements is correct in treating respiratory failure in a 1-year-old infant?", "input": "(A) The vocal cord is the narrowest part of the respiratory tract. (B) The infectious cause of lower respiratory tract obstruction is croup. (C) Non-depolarizing neuromuscular blocking agents should be given before rapid-sequence intubation. (D) Before intubation, the headrest should be raised to facilitate the sniffing position. (E) When intubating, the length of the laryngeal lobe should be selected by measuring the distance from the upper incisor to the mandible.", "output": "E"}
-{"instruction": "There are several injured in a series of car accidents. Given limited medical resources, the nearest trauma hospital can only treat four patients at a time. Which of the following patients would you recommend being sent to the nearest non-critical emergency hospital for evaluation?", "input": "(A) A 55-year-old male car driver suffered facial contusion and chest puncture wound. He was breathing 30 times/min at the scene. (B) A 30-year-old male motorcycle driver was thrown 3 meters away at the scene of the accident. His right upper arm and right thigh were deformed. He was conscious and had no head injury. His pulse was 80 beats/min and his blood pressure was 120/80 mmHg. (C) A 40-year-old female passenger in a car with an airbag that exploded, suffered burns on about 25% of her body, complained of numbness and weakness in her limbs, was conscious, had a pulse of 70 beats/min, and a blood pressure of 80/40 mmHg. (D) A 25-year-old pregnant pedestrian was hit by a motorcycle at 60 km/hr. She was conscious and had stable vital signs. She had only abrasions on her limbs and complained of abdominal pain. (E) A 40-year-old male riding a bicycle was hit by a car at 20 km/hr. He was conscious and had stable vital signs. His right forearm was deformed and had an open wound, but his peripheral circulation was normal. ", "output": "E"} 
-{"instruction": "Which of the following statements about the treatment of patients with traumatic shock is incorrect?", "input": "(A) The goal is to control bleeding and restore adequate circulatory volume. (B) When clinical assessment shows that the amount of bleeding is more than 30% of the total blood volume, crystalloid fluid and blood products should be given as soon as possible. (C) When treating patients with crystalloid fluid and blood products, hypothermia and coagulopathy should be carefully monitored. (D) In ​​the treatment of patients with traumatic hypovolemic shock, pressors should be given as soon as possible to provide sufficient blood pressure to achieve adequate peripheral tissue perfusion. (E) In addition to giving infusion therapy as soon as possible, the bleeding site should also be found as soon as possible to achieve the goal of early control of bleeding.", "output": "D"} 
-{"instruction": "Which of the following vascular emergencies is most easily diagnosed using ultrasound?", "input": "(A) Pulmonary embolism. (B) Deep vein thrombosis. (C) Basilar artery thrombosis. (D) Aortic dissection. (E) Superior vena cava syndrome (SVCS).", "output": "B"} { 
-"instruction": "Which of the following statements about chemical disaster scenes and treatment is incorrect?", "input": "(A) Primary stabilization is possible in the cold zone. (B) Carry out decontamination in the warm zone and determine the order of evacuation. (C) In the hot zone, only search and rescue of the injured should be carried out and they should be transferred out of the contaminated area. (D) Usually, cyanide antidote kit is given on the scene for its medical effect. (E) An incident command system should be established on the scene, and hot, warm and cold zones should be divided. ", "output": "B"} 
-{"instruction": "Which of the following statements about spinal cord injury in adults is incorrect? ", "input": "(A) The prognosis of Anterior cord syndrome is better than that of other spinal cord syndromes. (B) Upper limb weakness in Central cord syndrome is more severe than that in lower limbs. (C) Cauda equina syndrome may present with symptoms of abnormal bowel and bladder function and loss of perineal pain. (D) Thrombosis of anterior spinal artery may cause anterior cord syndrome. (E) The most common cause of Brown-Sequard syndrome is spinal puncture. ", "output": "A"} 
-{"instruction": "Which of the following statements about spinal trauma in children is incorrect? ", "input": "(A) If X-rays cannot rule out cervical spine injury, a tomographic scan may be considered. (B) X-rays are recommended to be taken in at least three directions: anterior-posterior, lateral, and odontoid view. (C) Most children who develop SCIWORA (spinal cord injury without radiographic abnormality) are paralyzed at the time of the injury. (D) Children with multiple injuries should all be suspected of spinal trauma. (E) For children under 12 years old, cervical spine injuries mostly occur between the occiput and the second cervical vertebra. ", "output": "C"} { 
-"instruction": "Which of the following statements is correct about the treatment of cyanide poisoning in chemical disasters? ", "input": "(A) At the scene of a chemical disaster, because antidotes must be given actively, an intravenous line must be established for the patient. (B) Even though sodium nitrite can be given intravenously immediately, inhaled amyl nitrite is still required. (C) Nitrites are relatively contraindicated in patients with cyanide poisoning and carbon monoxide poisoning because they produce methemoglobinemia and further reduce oxygen delivery. (D) When the diagnosis is uncertain, nitrites and sodium thiosulfate are safer empirical treatments because of their relatively low toxicity. (E) When treating patients in a hospital after a chemical disaster has been decontaminated, level B protective clothing must be worn to avoid incomplete decontamination of the scene. ", "output": "C"}aeruginosa. (E)S. aureus is a common pathogen in nursing home residents with pneumonia. ", "output": "C"} 
-{"instruction": "Which of the following statements about orbital fracture is incorrect? ", "input": "(A)The most common orbital fractures are inferior and medial orbital fractures. (B)Even if there is no limitation of muscle movement or diplopia, an ophthalmologist should be consulted to evaluate the eye injury. (C)Blow-out fracture If there is limitation of eye muscle movement, the most common one is the inferior rectus muscle. (D)Antibiotics may be considered. (E)Blow-out fracture often causes diplopia when the patient looks down. ", "output": "E"}"(A) In a chemical disaster, an intravenous line must be established because antidotes must be given aggressively. (B) Even though sodium nitrite can be given intravenously immediately, inhaled amyl nitrite must still be used. (C) Nitrites are relatively contraindicated in patients with cyanide poisoning and carbon monoxide poisoning because they will produce methemoglobinemia and further reduce oxygen delivery. (D) When the diagnosis is unclear, nitrites and sodium thiosulfate are safer empirical treatments because of their relatively low toxicity. (E) In order to avoid incomplete decontamination when treating patients in a hospital after a chemical disaster, Class B protective clothing must be worn. ", "output": "C"} 
-{"instruction": "Regarding influenza, some patients have a higher risk of complications. Which of the following is not included? ", "input": "(A) 3-year-old children. (B) Diabetic patients. (C) 28-year-old woman one week postpartum. (D) 16-year-old male, long-term use of Aspirin. (E) 50-year-old male, BMI (body mass index) is 29. ", "output": "E"}
-{"instruction": "Which of the following statements about the diagnosis and management of pneumonia in special groups is correct?", "input": "(A) P. aeruginosa is a common pathogen in alcoholics. (B) H. influenzae is a common pathogen in diabetics. (C) Pregnant women with respiratory symptoms and a history of varicella exposure should have a chest X-ray to rule out pneumonia. (D) P. aeruginosa is a common pathogen in influenza-associated bacterial pneumonia in the elderly. (E) S. aureus is a common pathogen in nursing home residents.", "output": "C"} 
-{"instruction": "Which of the following statements about the diagnosis and management of diabetic patients in the emergency department is incorrect?", "input": "(A) An 8-hour fasting blood glucose level greater than 126 mg/dL (7.0 mmol/L) or any blood sugar level greater than 200 mg/dL (11.1 mmol/L) can confirm diabetes. (B) Diabetic patients are more likely to experience atypical chest pain, and may even experience myocardial infarction without chest pain. (C) For diabetic patients with hypertension, Angiotensin II receptor blockers or Angiotensin-converting enzyme inhibitors should be used to control blood pressure first. (D) Even if there is no hypertension, Angiotensin-converting enzyme inhibitors can prevent or slow down kidney disease (diabetic nephropathies) caused by diabetes. (E) If the patient's renal function is not ideal, Metformin should not be used as the first-line blood sugar-lowering drug. ", "output": "A"} 
-{"instruction": "About Increased Intracranial Pressure in Patients with Head Trauma (Increased Intracranial Pressure (IICP), which of the following statements is incorrect? ", "input": "(A) Intracranial pressure greater than 20 mmHg will increase mortality. (B) If uncal transtentorial herniation occurs, it may cause dilation of the patient's ipsilateral pupil and weakness of the contralateral limb. (C) It is recommended to maintain PaCO₂ at 25~30 mmHg. Too low PaCO₂ may cause cerebral ischemia. (D) Elevating the patient's head of the bed 30 degrees can promote the outflow of cerebrospinal fluid from the skull, thereby reducing intracranial pressure. (E) In addition to reducing intracranial pressure, Mannitol can also help scavenge free radicals. ", "output": "C"} 
-{"instruction": "Regarding crush injury, which of the following statements is incorrect? ", "input": "(A) It may cause compartment syndrome at the injured site, usually with compartment pressure greater than 30 mmHg. (B) It may cause the injured to suffer from hypovolemia, hyperkalemia, hypercalcemia, and acidemia. (C) It may cause the injured to suffer from disseminated intravascular coagulation and severe complications of renal failure. (D) Before being rescued, 1~2 L of saline and bicarbonate treatment can be given. (E) The injured may receive fasciotomy or hyperbaric oxygen treatment. ", "output": "B"} 
-{"instruction": "A 35-year-old female presented to the emergency department with fever and body aches for 5 days. She had upper abdominal pain, nausea, and loss of appetite. Physical examination revealed abdominal tenderness. Blood tests showed white blood cell count of 2,500/mm³, hematocrit of 15.6 g/dL, platelet count of 45,000/mm³, GOT of 176 IU/L, and GPT of 180 IU/L. Which of the following statements is correct? ", "input": "(A) The dengue NS1 rapid test can be used to assist in the diagnosis. The test detects IgM antibodies in the blood, but its sensitivity and specificity are not high. (B) Dengue fever may be complicated by acute cholecystitis, and treatment should still include surgery or percutaneous transhepatic gallbladder drainage. (C) The patient should be given platelet transfusion to avoid bleeding. (D) For fever, acetaminophen should be given. If nausea and inability to eat occur, ketoprofen injection should be used instead. (E) If the patient's vital signs are stable and there is no obvious bleeding, he belongs to group B and should be hospitalized for observation and treatment. ", "output": "E"} 
-{"instruction": "Which of the following conditions will increase the risk of onset or aggravation in the mountains compared to on the plains, excluding the following? ", "input": "(A) Chronic kidney disease. (B) Heart failure. (C) Asthma. (D) Gastrointestinal bleeding. (E) Epilepsy. ", "output": "C"} 
-{"instruction": "Which of the following common imaging manifestations of diaphragmatic injury is wrong? ", "input": "(A) A collar sign appears on chest CT images. (B) A chest X-ray shows an elevated diaphragm on the affected side. (C) A chest X-ray shows that the longitudinal diaphragm cavity is shifted toward the affected side. (D) A chest X-ray shows an air-fluid level in the chest cavity. (E) A chest X-ray shows a nasogastric tube curled up in the chest cavity. ", "output": "C"} 
-{"instruction": "Which of the following diseases that can cause acute visual impairment or visual loss can cause eye pain? ", "input": "(A) Central retinal artery occlusion. (B) Central retinal vein occlusion. (C) Cytomegalovirus retinitis. (D) Methanol intoxication. (E) Optic neuritis. ", "output":"E"} 
-{"instruction": "Which of the following statements is incorrect about the treatment of patients with hypertensive acute heart failure?", "input": "(A) If a patient develops hypotension after using Nitroglycerin, he or she needs to be treated with fluid infusion immediately. (B) Non-invasive ventilators may be considered for patients with stable blood circulation. (C) Diuretics need to be used in combination with vasodilators. Using diuretics alone may increase mortality. (D) Long-term use of Nitroprusside may cause cyanide toxicity. (E) In the acute phase, if the blood pressure is greater than 150/100 mmHg, high doses of Nitroglycerin can be used and adjusted according to symptoms and blood pressure.", "output": "A"} 
-{"instruction": "A pregnant woman is in the emergency room and has an emergency delivery. The previous prenatal checkup revealed polyhydramnios. After the baby was born in the emergency room, the emergency doctor found that the body was ruddy but all four limbs were cyanotic and paralyzed. When the respiratory secretions were suctioned, the face was responsive, the breathing was weak, and the heart rate was 90 beats/min. What is the APGAR score calculation result? ", "input": "(A) 3. (B) 4. (C) 5. (D) 6. (E) 7. ", "output": "B"} 
-{"instruction":"According to the latest recommendations of the 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, which of the following statements is incorrect?", "input": "(A) For full-term or premature infants, if emergency treatment is not required, delaying clamping of the umbilical cord for 30 seconds after birth may be beneficial for the newborn. (B) Preterm newborns are given emergency treatment, and it is recommended to use 100% oxygen first, and then reduce it depending on the situation. (C) The recommendation for the use of atropine for bradycardia remains unchanged. (D) The pressure-to-inflation ratio for neonatal cardiopulmonary resuscitation is 3:1. If it is of cardiac origin, the pressure-to-inflation ratio can be 15:2. (E) When tracheal intubation cannot be successfully established, laryngeal mask can be used for full-term newborns or premature infants over 34 weeks. This recommendation is Class I.", "output": "B"} 
-{"instruction": "A long-term bedridden patient in a nursing home was sent to the emergency room for treatment. The doctor found that the patient had multiple itches on his body, especially on the navel, armpits and genitals. He was diagnosed with scabies. Which of the following suggestions for the treatment of scabies is the least appropriate?", "input": "(A) Use Ivermectin for treatment. (B) Use Lindane for treatment. (C) Use Permethrin for treatment. (D) Contacts need to be treated together. (E) Applying Cortisone after deworming can improve skin itching.", "output": "B"} 
-{"instruction": "A 70-year-old woman is brought to the emergency department. Physical examination reveals unilateral eyelid ptosis, miosis, and anhydrosis on the same side of the face. Which of the following is not included in the clinical differential diagnosis?", "input": "(A) Herpes zoster. (B) CN3 palsy. (C) Internal carotid artery dissection. (D) Cerebral infarction. (E) Lung cancer.", "output": "B"} 
-{"instruction": "A 75-year-old woman has cervical spondylosis. Past medical history: A patient was sent to the emergency room for neck pain due to a car accident. Emergency examination revealed that the patient had obvious weakness in both upper limbs and loss of pain and temperature sensation. What is the possible diagnosis for this patient? ", "input": "(A) Brown-Séquard syndrome. (B) Carotid dissection. (C) Central cord syndrome. (D) Posterior cord syndrome. (E) Vertebral artery dissection. ", "output": "C"} 
-{"instruction": "Which of the following statements about myocardial infarction is incorrect? ", "input": "(A) The mortality rate of combined cardiogenic shock can reach 80%. (B) Dressler's syndrome can occur within 2-10 weeks after myocardial infarction. (C) Patients with persistent sinus tachycardia have a poor prognosis. (D) The most common arrhythmia in the early stage is VPCs (ventricular premature contractions). (E) Patients with AIVR (accelerated idioventricular rhythms) have a poor prognosis and need active treatment. ", "output": "E"} 
-{"instruction": "Which of the following statements about the use of painkillers for acute abdominal pain is incorrect? ", "input": "(A) Opioids relieve pain and will not affect abdominal physical examination, delay diagnosis, or lead to increased morbidity and mortality. (B) Ketorolac is an NSAID and a pure analgesic that will not mask early symptoms of peritoneal inflammation. (C)Nasogastric suction can help diagnose upper gastrointestinal bleeding, and nasogastric drainage can also be used to reduce pressure in cases of intestinal obstruction. (D)Administering antiemetics such as Metoclopramide can improve abdominal pain caused by postoperative vomiting, but headache is a possible side effect. (E)The intravenous dose of Metoclopramide is 10 mg, and slow administration can reduce extra pyramidal side effects. ", "output": "B"} 
-{"instruction": "A 46-year-old female went to the emergency department because of sudden stiffness on the left side of her face, crooked face and mouth, and facial nerve palsy. Which of the following symptoms does not require brain imaging? ", "input": "(A) Limb weakness. (B) Facial plegia sparing the forehead. (C) Unable to look out. (D) Difficulty swallowing, drooling. (E) Abnormal taste in the front two-thirds of the tongue. ", "output": "E"} 
-{"instruction": "A 47-year-old ranger was bitten by a badger in the mountains of Taitung. His right calf was lacerated 2 cm and bleeding. Which of the following was wrong in the treatment after he went to the emergency room? ", "input": "(A) The patient should be asked whether he had ever received a rabies vaccine injection in the past. If the patient had not received the injection, he should be given a rabies vaccine and immunoglobulin injection this time. (B) Rabies immunoglobulin should be injected by soaking around the wound to avoid intravenous injection. (C) The patient had received a rabies vaccine three years ago, so he does not need to be given a rabies vaccine this time. (D) The patient should be asked whether he has ever received a tetanus shot in the past. If he has not, he should be given a tetanus shot this time. (E) If the patient had received a tetanus shot three years ago, he does not need to be given a tetanus shot this time. ", "output": "C"} 
-{"instruction": "Which of the following statements about the possible complications of early rhabdomyolysis is incorrect? ", "input": "(A)Acute renal failure. (B)Disseminated intravascular coagulation. (C)Hypercalcemia. (D)Hyperkalemia. (E)Hyperuricemia. ", "output": "C"} 
-{"instruction": "Which of the following statements about the clinical manifestations of patients with migraine is inappropriate? ","input": "(A) The intensity of the headache often reaches above the moderate level on the pain scale. (B) Its symptoms can generally last up to 72 hours (average is about 4-72 hours). (C) The most common precursors are lightheadedness and visual blind spots (scotoma). (D) It is characterized by unilateral, pulsatile headaches that worsen with activity. (E) Symptoms rarely occur in childhood and usually peak around age 40.", "output": "E"} 
-{"instruction": "A 50-year-old woman was sent to the emergency room and complained of weakness. Her blood sodium level was 126 meq/L. The patient had no obvious edema. Subsequent examination revealed that her urine sodium was 30 (normal value: 27-287) meq/L, which of the following diseases is the most likely diagnosis? ", "input": "(A) liver cirrhosis. (B) SIADH. (C) heart failure. (D) nephrotic syndrome. (E) severe GI loss. ", "output": "B"} 
-{"instruction":"Which of the following statements about esophageal corrosive injury is incorrect?", "input": "(A) Endoscopic examination should be performed as soon as possible to assess the extent of mucosal damage. (B) Strong acid causes shallow coagulation necrosis, more severe gastric damage, stenosis of the vestibule pylorus, and acidosis, with a lower mortality rate than strong alkali. (C) Strong alkali causes deeper liquefaction necrosis, more severe esophageal damage, and stenosis of the esophagus. (D) If a child accidentally swallows a button-type battery and suspects it is stuck in the esophagus, endoscopic examination should be completed within 6 hours. (E) If a child accidentally swallows a button-type battery and suspects it is stuck in the esophagus, and the child's vital signs are stable but endoscopic examination cannot be performed immediately, if it is confirmed that the battery was ingested within two hours, then Foley Balloon catheter technique can be considered for removal. ", "output": "B"}
-{"instruction": "When a hazardous substance is discovered, as an emergency medical worker, you should respond accordingly. Which of the following statements is incorrect?", "input": "(A) Assess the risk of hazardous substances to community safety (community risk assessment). (B) Confirm the occurrence of a hazardous substance incident (recognition of an event). (C) Identify what type of hazardous substances are involved in this incident (identification of the substances involved). (D) Isolate and perform on-site hazardous substance control (isolation and scene control). (E) Decontaminate, stabilize the patient's vital signs and establish triage (decontamination, stabilization and triage). The first step in decontamination is to immediately flush the patient with large amounts of clean water in the hot zone (hot zone).", "output": "E"} 
-{"instruction": "About acute pericarditis (acute pericarditis), which of the following statements is correct? ", "input": "(A)The severity of chest pain symptoms is usually unrelated to posture. (B)If there is a large pericardial effusion, the electrocardiogram may show electrical alternans. (C)Computed tomography is more sensitive than ultrasound for diagnosing pericardial effusion. (D)The electrocardiogram may show PR elevation. (E)Viral pericarditis often requires hospitalization to drain the pericardial effusion. ", "output": "B、D"} 
-{"instruction": "Regarding the differential diagnosis of patients with arthritis in the emergency department, which of the following is more often manifested in a monoarticular manner? ", "input": "(A)Gonococcal arthritis. (B)Lyme disease. (C)Gout. (D) Reactive arthritis. (E) Viral arthritis. ", "output": "C"} 
-{"instruction": "A 30-year-old woman is 36 weeks pregnant (G4P1AA0SA2) and is clinically suspected of acute pulmonary embolism. Which of the following treatments is correct? ", "input": "(A) r-tPA will cross the placenta and is contraindicated during pregnancy. (B) If pulmonary vascular computed tomography (CT-PA) is not suitable, magnetic resonance imaging (MRI) can be considered. (C) Wells' Criteria can be used to predict the possibility of pulmonary embolism in pregnant women. (D) If ultrasound reveals DVT, unfractionated heparin or low-molecular-weight heparin can be used directly for anticoagulant therapy. (E) A V/Q scan should be arranged to reduce the radiation dose to the fetus. ", "output": "D"} 
-{"instruction": "Which of the following statements about severe asthmaticus attacks is incorrect? ", "input": "(A) Inhaled bronchodilators and steroids usually do not improve the condition. (B) Injection or inhalation of magnesium sulfate can be used as an adjunctive treatment for severe asthma, but it can easily cause hypotension and neuromuscular blockade. (C) If intubation is required, Ketamine is a good adjunctive drug during the process and after ventilation is started. (D) In ​​refractory situations, adults can be given epinephrine SC or IM, 0.5 mg. (E) The use of a ventilator does not reduce airway obstruction caused by asthma, but it only reduces the patient's work of breathing and improves oxygenation. ", "output": "B"} 
-{"instruction": "A 32-year-old male auto repair shop worker committed suicide by drinking 100 mL of plating solution. He went to the emergency department with sore throat and abdominal pain. The patient reported that the plating solution contained a high concentration of chromic acid. Which of the following treatments and dispositions is inappropriate? ", "input": "(A) Arrange emergency gastroscopy. (B) Give succimer (DMSA) chelation therapy. (C) Give Vitamin C. (D) Give Acetylcysteine. (E) Perform endotracheal intubation. ", "output": "B"} 
-{"instruction": "A 23-year-old female is sent to the emergency department with complaints of fever and confusion. Her past medical history is unknown. Blood test results, arterial blood gas analysis (ABG): pH 7.39, PCO₂ 24 mmHg, PaO 2 89 mmHg, HCO₃ 14 meq/L; Na 130 meq/L, K 5.0 meq/L, Cl 96 meq/L, BUN 20 mg/dL, Cr 1.3 mg/dL, Glucose 300 mg/dL. Which of the following is not included in the differential diagnosis of acidosis in this patient? ", "input": "(A) Ketoacidosis. (B) Renal tubular acidosis. (C)Metformin poisoning. (D)Salicylates poisoning. (E)Lactic acidosis. ", "output": "B"} 
-{"instruction":"Which of the following is incorrect about Extended Focused Assessment with Sonography for Trauma (E-FAST)?", "input": "(A) FAST can detect intra-abdominal bleeding. (B) E-FAST can detect hemothorax. (C) E-FAST can detect pneumothorax. (D) FAST can detect pericardial effusion. (E) E-FAST can detect aortic aneurysm.", "output": "E"}"B"} 
-{"instruction": "Which of the following statements about antiphospholipid syndrome (APS) is incorrect?", "input": "(A) It is more common in women and often causes venous thrombosis in clinical practice. (B) Catastrophic APS can cause small blood vessel obstruction in multiple organs. (C) The clinical course of catastrophic APS progresses rapidly, and the mortality rate can be as high as 50%. (D) Considering the possibility of miscarriage, pregnant women with antiphospholipid syndrome should avoid the use of low molecular weight heparin or aspirin for treatment. (E) Healthy patients with positive antiphospholipid antibodies who have no history of thrombosis do not need to be given prophylactic antithrombotic treatment.", "output": "D"}
-{"instruction": "A 54-year-old male with a history of alcoholic cirrhosis presents to the emergency room with massive vomiting of blood. He is diagnosed with acute esophageal venous aneurysm bleeding. Which of the following statements is incorrect?", "input": "(A) Because esophageal venous aneurysm bleeding is suspected, a nasogastric tube should not be placed. (B) At this time, the priority should be to stabilize vital signs and arrange endoscopic treatment as soon as possible. (C) Vasoactive drugs can reduce portal blood flow and thus portal pressure, achieving the effect of hemostasis. (D) When cirrhotic patients have esophageal venous aneurysm bleeding, quinolone or ceftriaxone can be used to prevent infection. (E) If the patient's vital signs are unstable and endoscopic treatment cannot be provided in time, placement of a Sengstaken-Blakemore tube should still be considered. ", "output": "A"}"(A) Patients with significantly elevated BUN or Creatinine levels after urinary retention may be considered for hospitalization. (B) Routine use of antibiotics is recommended to prevent urinary tract infections. (C) Bedside ultrasound can diagnose whether there is acute urinary retention. (D) The retention balloon of the catheter expands in the urethra, which may cause urethral injury. (E) If acute urinary retention causes pain, suprapubic catheter insertion can be performed after several failed attempts at catheterization, as long as there is no obvious pelvic trauma or abnormal anatomical structure in the lower abdomen.", "output": "B"} 
-{"instruction": "A 2.5-month-old full-term boy was brought to the emergency department by his parents because of vomiting for four days. Which of the following statements is correct?", "input": "(A) It should be gastroesophageal reflux. No further examination is needed. Antiemetics should be given. (B) Upper GI tract contrast study can help with differential diagnosis. (C) If the vomitus has bile color, congenital pyloric stenosis should be considered. (D) If it is congenital pyloric stenosis, the patient is prone to dehydration and acidemia in the early stages of the disease. (E) If abdominal ultrasound reveals congenital pyloric stenosis, the patient should be referred to the surgical department for emergency surgery.", "output": "B"}
-{"instruction": "Which of the following statements is incorrect regarding the training of first aid technicians?", "input": "(A) The teaching staff for first aid training and continuing education courses at all levels are limited to doctors, nurses, or senior and intermediate first aid technicians who have been engaged in emergency medical rescue work for more than three years. (B) Civil groups or foundations under the jurisdiction of the Ministry of Health and Welfare that have established a purpose related to emergency medical rescue and whose directors and board members meet the requirements may conduct primary and intermediate first aid technician training after applying for permission. (C) General-level and above emergency hospitals may conduct primary first aid technician training after applying for permission. (D) Hospitals with intermediate or higher emergency responsibilities may conduct intermediate rescue technician training after applying for permission. (E) Hospitals with severe emergency responsibilities may conduct advanced rescue technician training after applying for permission. ", "output": "E"} 
-{"instruction": "Which of the following is incorrect about the agencies (institutions) that can set up ambulances as stipulated in the "Emergency Medical Rescue Act"? ", "input": "(A) Firefighting agencies. (B) Health agencies. (C) Military agencies. (D) Religious institutions. (E) Ambulance business institutions. ", "output": "D"} 
-{"instruction": "Which of the following statements about pseudomembranous colitis is incorrect? ", "input": "(A) Most cases occur in the large intestine, and yellow pseudomembranes can be seen under endoscopy. (B) Diagnosis includes stool culture, stool toxins, and colonoscopy. (C) The third-generation cephalosporins antibiotics are the most effective for this disease, and it can be cured in about a week. (D) The most common clinical manifestations include diarrhea, fever, elevated white blood cells, and abdominal pain. (E) The most common bacteria causing this disease is Clostridium difficile.", "output": "C"} 
-{"instruction": "A 20-year-old male developed unsteady gait and mental changes (GCS E3V4M6) at 10 pm at Pai Yun Villa (3,402 meters) in Yushan. Which of the following treatments is inappropriate?", "input": "(A) Consider descending the mountain immediately. (B) Give oxygen. (C) Use a hyperbaric bag. (D) Give an injection of dexamethasone. (E) Give Viagra, Sildenafil.", "output": "E"} 
-{"instruction": "Which of the following statements about sinusitis is correct?", "input": "(A) Most infections are bacterial. (B) Use of intranasal corticosteroid sprays may prolong the course of the disease. (C) The first-line antibiotic for treatment is a sulfonamide. (D) Orbital cellulitis is most often caused by infection of the ethmoid sinus. (E) Confirmation of uncomplicated sinusitis requires CT. ", "output": "D"} 
-{"instruction": "Which of the following chest trauma patients is less likely to require surgery? ", "input": "(A) Two fractures in three consecutive ribs. (B) Left-sided hemopneumothorax without rib fractures. (C) X-ray shows a nasogastric tube in the chest cavity. (D) More than 1,500 mL of blood comes out after the chest tube is placed. (E) After the pneumothorax is drained through the chest tube, there is still a lot of gas leakage. ", "output": "A"} 
-{"instruction": "A 65-year-old female with a history of heart failure, chronic renal failure, and bipolar disorder was taken to the emergency room by her family for confusion and involuntary hand shaking. Her blood pressure was 150/75 mmHg, heart rate was 88 beats/min, respiration was 25 times/min, body temperature was 36.5°C, coma index was E3V3M5, blood test results showed creatinine 5.6mg/dL, lithium concentration was 3.5 mEq/L. Which of the following is the best treatment and management? ", "input": "(A) Hemodialysis. (B) Intravenous administration of large amounts of saline. (C) Intravenous injection of diuretics. (D) Gastric lavage. (E) Administer sodium bicarbonate intravenously. ", "output": "A"} 
-{"instruction": "Which of the following interpretations of pleural effusion is incorrect? ", "input": "(A) Esophageal rupture may cause an increase in amylase in pleural effusion. (B) Pleural effusion caused by pulmonary embolism may be transudates. (C) Pleural effusion caused by rheumatoid arthritis will have increased glucose. (D) When the pH value is less than 7.1, thoracotomy can be diagnosed and chest tube drainage is an indication. (E) Pleural effusion caused by cancer will have a predominantly lymphocyte white blood cell classification. ", "output": "C"} 
-{"instruction": "An 82-year-old male with a history of hypertension, heart disease, and prostate hypertrophy complained of difficulty in defecation and urination and general discomfort and went to the emergency room for treatment. Physical examination revealed a mass in the lower abdomen. Blood tests: BUN 30 mg/dL, Creatinine 2.0 mg/dL; routine urine examination WBC/PUS: 3-5/HPF, RBC: 15-20/HPF. Which of the following statements is incorrect? ", "input": "(A) Patients with significantly elevated BUN or Creatinine after urinary retention can be considered for hospitalization. (B) Routine use of antibiotics is recommended to prevent urinary tract infections. (C) Bedside ultrasound can diagnose whether there is acute urinary retention. (D) The retention balloon of the catheter expands in the urethra, which may cause urethral injury. (E) If acute urinary retention causes pain, after several failed attempts at catheterization, suprapubic catheterization can be performed as long as there is no obvious pelvic trauma or abnormal anatomical structure in the lower abdomen. ", "output": "B"} 
-{"instruction": "A young man was beaten with a baseball bat and sent to the emergency room. Physical examination revealed: weakness in the lower limbs, and normal muscle strength in the upper limbs except for problems with abduction of the little finger; numbness in the chest approximately below the clavicle and the inner side of the upper arm. Which segment of the spinal cord should be suspected to be damaged clinically? ", "input":"(A)C4. (B)T1. (C)T4. (D)T8. (E)L3.", "output": "B"} 
-{"instruction": "A 28-year-old HIV-positive patient complained that he had not been taking medication regularly for the past six months. He felt increasingly short of breath and had a fever in the past week. When he arrived at the emergency room, his vital signs were: blood pressure 105/75 mmHg, respiratory rate 32 times/min, heart rate 120 times/min, blood oxygen concentration 89%. Chest X-ray revealed diffuse interstitial infiltrates on both sides. Pneumocystis pneumonia infection was suspected. Which of the following statements and treatments is wrong?", "input": "(A) Pneumocystis pneumonia pneumonia) is the most common opportunistic infection in AIDS patients. (B) Trimethoprim-sulfamethoxazole antibiotics can be given for treatment. (C) Pentamidine can also be considered as a treatment drug. (D) Steroids should be avoided at this time to avoid increasing the risk of systemic infection. (E) For patients with CD4+ T-cell counts less than 200 cells/mm³, antibiotics should be given prophylactically to prevent recurrence. ", "output": "D"}
-{"instruction": "Which of the following statements about qSOFA is correct?", "input": "(A) There are three items in qSOFA. As long as two of them are met, the patient can be diagnosed with sepsis. (B) Total bilirubin (T-bilirubin) in the blood is greater than 2.0 mg/dL, which is one of the qSOFA assessment items. (C) Platelet count is less than 10,000/mm³, which is one of the qSOFA assessment items. (D) Respiratory rate ≧20 times/min is one of the qSOFA assessment items. (E) Systolic blood pressure is less than or equal to 100 mmHg, which is one of the qSOFA assessment items.", "output": "E"} 
-{"instruction": "During a sarin gas terrorist attack, a 70-year-old woman was sent to the emergency room for suspected poisoning. Which of the following symptoms does not include:", "input": "(A) Tears (lacrimation). (B) Muscle fasciculations. (C) Slow heartbeat (bradycardia). (D) Seizures. (E) Anhidrosis.", "output": "E"} 
-{"instruction": "According to the regulations of our country's Palliative Care Act, the public can sign advance directives such as "Advance Notice for Palliative Care", "Advance Notice Not to Perform Cardiopulmonary Resuscitation", and "Consent to Not Perform Life Support". Which of the following is a necessary condition for the signatory? ", "input": "(A) Aged 18 or above. (B) Fully competent. (C) Medical institution. (D) Terminal illness. (E) Appointment of an agent. ", "output": "B"} 
-{"instruction": "Which of the following statements about intraocular pressure and eye-related emergencies is incorrect? ", "input": "(A) Intraocular pressure should not be measured when there is a suspected rupture of the eyeball. (B) Normal intraocular pressure is between 10 and 20 mmHg. (C) Hyphema generally causes an increase in intraocular pressure. (D) An eyeball rupture generally causes a decrease in intraocular pressure. (E) Uveitis generally causes an increase in intraocular pressure. ", "output": "E"} 
-{"instruction": "A 65-year-old man is brought to the emergency room after being assaulted by a club. Which of the following conditions may affect the performance or interpretation of a focused assessment with sonography for trauma (FAST)? ", "input": "(A) Subcutaneous emphysema. (B) Long-term peritoneal dialysis. (C) Prior abdominal surgery. (D) Obesity. (E) Cirrhosis without ascites. ", "output": "E"} 
-{"instruction": "Which of the following statements about airway management of a pregnant patient is incorrect? ", "input": "(A) During preoxygenation, high-flow oxygen of 15 L/min can be continuously given through a nasal cannula until paralysis to prevent the patient from hypoxia. (B) If intubation fails, bronchoscopic intubation should be considered, because laryngeal mask airway is not suitable for pregnant women. (C) The use of a video laryngoscope can increase the success rate of the first-pass. (D) The pregnant woman should be intubated in a supine position, and an assistant should be asked to push the pregnant uterus to the left. (E) Standard doses of RSI drugs should be used. ", "output": "B"} 
-{"instruction": "A 58-year-old male with a history of nasopharyngeal carcinoma is currently undergoing radiation therapy. He has had a loss of appetite and general weakness for nearly a week. A blood test revealed Ca2+ of 15.5 mg/dL and Albumin of 3.0 g/dL. Which of the following statements is incorrect? ", "input": "(A)Corrected Ca2+ = 16.3 mg/dL. (B)The electrocardiogram may show ST segment depression and QT segment shortening. (C)1,000 mL of normal saline can be given by drip for two hours. (D)Hemodialysis can effectively reduce calcium ions in the blood. (E)Bisphospho nates is more effective and faster than Calcitonin and is the first choice. ", "output": "E"} 
-{"instruction": "Which of the following is wrong about the landing zone for helicopter takeoffs and landings? ", "input": "(A) The landing zone is a dangerous area during helicopter takeoffs and landings because the helicopter blades are drooping but still have a minimum speed. (B) Crew members should be more than 100 feet away from the landing zone during helicopter takeoffs and landings, and medical personnel should be more than 200 feet away. Both should have proper eye and ear protection. (C) All medical supplies (IV stands, etc.) should be kept below shoulder height. (D) It is safer for ground staff to operate the helicopter door. (E) Do not approach or leave from the rear of the helicopter. When approaching or leaving, you must crouch facing the rear door of the helicopter and keep your head down. ", "output": "D"} 
-{"instruction": "In mass casualty events, the JumpSTART Pediatric MCI Triage© system is currently used to triage pediatric patients. Which of the following statements about this system is wrong? ", "input": "(A) The assessment is: whether the patient can move or walk → whether he or she is breathing → respiratory rate → whether there is a pulse → consciousness. (B) The triage is divided into four categories: death, immediate evacuation, delayed evacuation, and mild illness. (C) The modified Glasgow Coma Scale is used to assess consciousness. (D) Each injured person should receive a detailed secondary assessment. (E) In principle, cardiac compression should not be performed on patients in cardiac arrest during the triage process of mass casualty incidents. ", "output":"In mass casualty events, the JumpSTART Pediatric MCI Triage© system is currently used for triage of pediatric patients. Which of the following statements about this system is incorrect?", "input": "(A) The assessment is: ability to move or walk → presence of breathing → respiratory rate → presence of pulse → consciousness status. (B) Triage is divided into four categories: death, immediate evacuation, delayed evacuation, and mild illness. (C) The modified Glasgow Coma Scale is used for consciousness status. (D) Each patient should receive a detailed secondary assessment. (E) In principle, cardiac compression is not performed on patients with cardiac arrest during the triage process of mass casualty events.", "output": "C"} 
-{"instruction": "A 30-year-old female was rescued from a fire. She weighed 60 kg and had burns covering 40% of her body surface area. There was carbon deposition in her oropharynx. Which of the following treatments is correct?", "input": "(A) SpO₂ 98%, normal breathing, no need for intubation. (B) Place a nasogastric tube to relieve pressure, but generally glucose infusion is not required for the first 24 hours. (C) Give morphine for pain relief. To reduce the risk of respiratory depression, intramuscular injection is better than intravenous injection. (D) Give steroids to reduce laryngeal edema. Hydrocortisone 100mg STAT+Q8H IV. (E) According to Parkland Formula, drip Ringer's solution at 150 ml per hour for the first 8 hours and 75 ml per hour for the next 16 hours.", "output": "B"}
-{"instruction": "A 5-year-old boy with sickle cell anemia was brought to the emergency room by his nanny because of a high fever and inability to walk. Physical examination revealed a red, hot and painful left knee, with no other respiratory or urinary tract symptoms. Which of the following statements about pediatric septic arthritis is correct?", "input": "(A) Based on the patient's age, Haemophilus influenzae is also among the top three most common bacterial species in purulent arthritis, in addition to MSSA and MRSA. (B) Knee X-rays cannot diagnose septic arthritis in the early stages, so they are not necessary. (C) If septic arthritis is suspected during clinical diagnosis, it is necessary to wait for the blood test results before performing arthrocentesis. (D) Because one-third of the bacterial culture results of joint fluid are negative, when there is a high degree of clinical suspicion, turbid joint fluid can help diagnose suspected cases. (E) This patient has no other symptoms, so there is no need to collect urine, skin wounds, throat, and rectum for bacterial culture. ", "output": "D"} 
-{"instruction": "To distinguish between Anticholinergic toxidromes and Sympathomimetic toxidromes, which of the following clinical symptoms is most likely to distinguish the two? ", "input": "(A) Confusion. (B) Rapid heartbeat. (C) High blood pressure. (D) High body temperature. (E) Sweating.", "output": "E"} 
-{"instruction": "A 37-year-old male drank a large amount of chemical liquid and was taken to the emergency room by his family because of confusion. Which of the following situations would not be recommended for treatment with Fomepizole?", "input": "(A) Serum methanol concentration greater than 20 mg/dL. (B) Unexplained osmolar gap greater than 10 mOsm/L. (C) Serum isopropyl alcohol concentration greater than 100 mg/dL. (D) Unexplained metabolic acidosis (pH less than 7.3). (E) Serum ethylene glycol concentration greater than 20 mg/dL.", "output": "C"} 
-{"instruction": "A 42-year-old woman went to the emergency room with a fever for 3 days. Physical examination revealed an eschar on her thigh and suspected scrub typhus. Which of the following statements is correct?", "input": "(A) Ciprofloxacin is the first choice of antibiotic. (B) It is a Category IV infectious disease and requires infectious disease notification and hospitalization for isolation. (C) Most patients have a history of travel and were infected abroad. (D) The pathogen is Orientia tsutsugamushi, and the incubation period is usually 9 to 12 days. (E) Without treatment, the mortality rate can reach 80%.", "output": "D"} 
-{"instruction": "Which of the following is correct about the symptoms of spinal cord injury syndrome? ", "input": "(A) Spinal shock: low blood pressure, but warm extremities and slow heartbeat. (B) Central cord syndrome: limb weakness accompanied by decreased partial pain and temperature sensation, with the lower limbs more severe than the upper limbs. (C) Brown-Séquard syndrome: limb weakness, proprioception and vibration sensation on the same side of the injury, and disappearance of pain and temperature sensation on the opposite side. (D) Anterior cord syndrome: proprioception and vibration sensation below the injury site disappear, but pain and temperature sensation are retained. (E) Cauda equina syndrome: loss of bowel and bladder function, weakness in the lower body, with only the perineum, buttocks and inner thighs feeling normal. ", "output": "C"} 
-{"instruction": "Which of the following statements about transfusion-related complications is correct? ", "input": "(A) If the patient has had a febrile transfusion reaction in the last few transfusions, irradiated blood should be used for this transfusion. (B) If the patient has an allergic transfusion reaction during transfusion, diphenhydramine can be given for treatment, and transfusions can be continued after evaluation. (C) Transfusion-related acute lung injury (TRALI) often occurs after PRBC transfusion and less frequently after FFP or Platelet transfusion. (D) Transfusion-related acute lung injury (TRALI) can cause pulmonary edema, and diuretics should be given as soon as possible. (E) Regarding extravascular hemolytic transfusion reactions, hemolysis usually occurs in the liver and bone marrow, and less often in the spleen. ", "output": "B"} 
-{"instruction": "A 77-year-old male drank a large amount of Dimethoate 44% and committed suicide. He was taken to the emergency room by his family because of vomiting, coma and seizures. Which of the following treatments is most likely to improve the patient's prognosis? ", "input": "(A) Gastric lavage. (B) Give activated charcoal. (C) Urinary alkalinization. (D) Give atropine. (E) Give Pralidoxime. ", "output": "D"} 
-{"instruction": "A 60-year-old male went to the emergency department complaining of two days of right facial pain and herpes, and right eye redness, pain and photophobia. The diagnosis was Herpes Zoster Ophthalmicus. Which of the following statements about this disease is incorrect? ", "input":"(A) Most cases involve the upper eyelid on the same side. (B) Some patients may develop optic neuritis. (C) The dosage of antiviral drugs should be adjusted according to the patient's renal function. (D) Oral valacyclovir may be considered for treatment. (E) If herpes appears on the tip of the nose, it is called Hutchinson sign, and the prognosis is better.", "output": "E"} 
-{"instruction": "A 65-year-old woman was sent to the emergency room due to a car accident. At the time of the accident, she was sitting in the passenger seat of the car and had fastened her seat belt. Physical examination revealed a seat belt sign on her abdomen and she complained of left shoulder pain. However, the patient's left shoulder joint movement was normal. Based on the above symptoms, which of the following injuries is the patient most likely to have?", "input": "(A) T12 chance fracture. (B) T10 compression fracture. (C) Splenic rupture. (D) Liver laceration. (E) Duodenum hematoma. ", "output": "C"}
-{"instruction": "A 2-year-old girl was admitted to the emergency room. Her mother said that she had a congenital respiratory disease and had just suddenly become wheezing and had poor response. Initial assessment in the emergency room showed that she was labored in breathing and had a pale complexion. After airway suction and oxygen administration with a resuscitation ball, her vital signs were as follows: blood pressure 55/32 mmHg, respiration 42 times/min, heart rate 56 times/min (regular), and body temperature 35°C. Which of the following was not included in the initial emergency treatment?", "input": "(A) Use bronchodilator therapy. (B) Use epinephrine inhalation therapy. (C) During intubation, the best choice of sedative is ketamine. (D) Use steroid injection. (E) Perform chest compression and oxygen 15:2 first aid.", "output": "E"}  
-{"instruction":"A 10-year-old boy weighs 25 kg, is in poor spirits, has slow reactions, BT 38℃, HR 140 beats/min, RR 32 beats/min, BP 80/50 mmHg, and O 2 Sat 96%. Blood test results show that glucose is greater than 500 mg/dL. Which of the following statements is incorrect?", "input": "(A) An ABG should be ordered and the ketone body concentration in the blood should be tested. (B) Because the symptoms of shock are obvious, IV 250-500 mL normal saline should be given first to restore the capillary refilling time to normal. (C) IV bolus insulin 2.5 IU should be given as soon as possible. (D) IV infusion 2.5 IU/hr should be maintained continuously. (E) The rate of blood glucose decrease should be less than 50-100 mg/dL per hour.", "output": "C"}
-{"instruction": "Computed tomography without contrast injection has a higher sensitivity for diagnosing subarachnoid hemorrhage in the head as the time after symptom onset:", "input": "(A) 6-12 hours. (B) 12 to 23 hours. (C) 24 to 47 hours. (D) 48 to 71 hours. (E) Greater than 72 hours.", "output": "A"} 
-{"instruction": "A 40-year-old male is referred to the emergency department with a suspected diagnosis of thrombotic thrombocytopenic purpura. Which of the following clinical manifestations is not included?", "input": "(A) Fever. (B) Prolonged prothrombin time. (C) Thrombocytopenia. (D) Neurological findings. (E) Hemolytic anemia. ", "output": "B"} 
-{"instruction": "A 48-year-old male hemophilia A patient fell yesterday and developed obvious hematoma in his left elbow joint and swelling and pain in his left forearm. X-ray examination showed no obvious fracture. Which of the following statements is wrong? ", "input": "(A) Factor VIII 15-30 IU/kg can be given for treatment. (B) Clinical tests of hemophilia patients show abnormal APTT (activated partial thromboplastin time). (C) If the patient has swelling in the left forearm accompanied by severe pain and numbness, compartment syndrome should be considered. syndrome), after replenishing the coagulation factors, the chamber pressure can be measured. (D) To avoid hematoma caused by intravenous injection, NSAID can be given intramuscularly for pain relief. (E) Severe hemophilia patients often present with spontaneous bleeding or uncontrolled bleeding after trauma. ", "output": "D"} 
-{"instruction": "Regarding unexplained syncope, which of the following is not a risk factor that requires hospitalization for evaluation and examination? ", "input": "(A) History of heart failure. (B) Hematocrit is less than 30%. (C) Family history of sudden cardiac death. (D) The patient is 40 years old. (E) Systolic arterial pressure is less than 90 mmHg. ", "output": "D"} 
-{"instruction": "When facing patients with in-hospital cardiac arrest (IHCA), the first priority is to prevent it from happening. Therefore, we advocate the establishment of rapid response teams (RRTs) or medical emergency teams (METs). Which of the following descriptions of RRTs/METs is incorrect? ", "input": "(A) The establishment of RRTs/METs is mainly to ensure that a team can work together to provide emergency treatment to patients after IHCA occurs, thereby increasing the patient's chance of recovery. (B) The establishment of RRTs/METs can improve the survival rate of hospitalized patients. (C) Through Early Warning Sign Systems, we can identify dangerous hospitalized patients and prevent the occurrence of IHCA. (D) In ​​addition to first aid skills, RRTs/METs training also includes the establishment of a teamwork concept. (E) Current research shows that the establishment of RRTs/METs may be helpful to pediatric patients in addition to adults. ", "output": "A"} 
-{"instruction": "Which of the following statements about epilepsy caused by alcohol withdrawal is most appropriate? ", "input": "(A) Localized epileptic seizures are more common. (B) Most patients will only have one seizure. (C) About two-thirds of patients will experience delirium after an epileptic seizure. (D) About 90% of patients will have an seizure within 48 hours after stopping drinking. (E) A small number of patients with multiple seizures will have multiple seizures within 12 hours, but will not have another seizure afterwards. ", "output": "D"} 
-{"instruction": "A 35-year-old male was found unconscious during an ultra-marathon and was taken to the emergency room. In the emergency room, GCS E3V3M5, blood pressure 100/50 mmHg, pulse 110 beats/min, respiration 22 breaths/min, body temperature 37℃, blood glucose 100 mg/dL, brain CT scan was normal, and blood sodium 115 meq/L. Which of the following is the most appropriate treatment for this low blood sodium? ", "input": "(A) 500 mL of 3% NaCl intravenous drip (IV drip) for 24 hours. (B) 500 mL of 3% NaCl intravenous drip (IV drip) for 48 hours. (C) 100 mL of 3% NaCl as an IV bolus. (D) 500 mL of 3% NaCl as an IV bolus. (E) 500 mL of 0.9% NaCl as an IV bolus. ", "output": "C"} 
-{"instruction": "Which of the following statements about gout and pseudogout (also known as calcium pyrophosphate deposition) in crystal induced synovitis is incorrect?","input": "(A) Gout and pseudogout, like most septic arthritis, are monoarthritis. (B) Acute gout attacks are common in middle-aged men over 40 years old. Attacks in women of childbearing age may be related to gestational diabetes. (C) Yellow uric acid crystals can be seen in Gout's joint fluid under a polarizing microscope, while calcium pyrophosphate in pseudogout is blue. (D) Uric acid, calcium, and phosphorus in the blood cannot be used as a basis for diagnosing gout or pseudogout. (E) Colchicine can treat acute gout and pseudogout attacks, but intravenous injection may lead to serious side effects such as bone marrow suppression and death.", "output": "C"}
-{"instruction": "Which of the following statements about pneumonia is correct?", "input": "(A) Legionnaires' disease has a distinct seasonal pattern, with most cases occurring in the summer. (B) Streptococcus pneumoniae most often follows a viral infection. (C) Staphylococcus aureus is the most common cause of pneumonia in alcoholics. (D) Mycoplasma pneumoniae often presents with extrapulmonary symptoms, such as a rash or gastrointestinal symptoms. (E) If the patient is discharged from the hospital within seven days, the antibiotic chosen should cover the treatment of Pseudomonas aeruginosa.", "output": "E"}  
-{"instruction": "Which of the following statements about lung abscess is incorrect? ", "input":"(A) The mortality rate of secondary cases is higher than that of primary cases. (B) Eighty percent of cases are secondary cases, which are more common in patients with cancer or weakened immune system. (C) Multiple lesions are not common, but Lemierre's syndrome can be seen with multiple lesions in the lungs. (D) When the pathogen is an anaerobic bacterium, the infection route is usually inhalation. (E) Generally speaking, drug treatment can control this disease. The reasons for the failure of drug treatment include bronchial obstruction or non-bacterial infection sources.", "output": "B"} 
-{"instruction": "A 29-year-old male patient with depression. According to his friends, the patient took an unknown type of sleeping pill (Benzodiazepine) and tricyclic antidepressants (Tricyclic antidepressants, TCA) in total of 40 tablets, and the coma index when he arrived at the hospital was E2V2M4. Which of the following statements is incorrect? ", "input": "(A) Patients poisoned by tricyclic antidepressants have dry skin. (B) Considering airway protection, after endotracheal intubation, gastric lavage and activated charcoal are performed. (C) The electrocardiogram has a high R wave in aVR (i.e., right axis deviation in the last 40 milliseconds), which indicates TCA poisoning. (D) Flumazenil (Anexate) can be given as an antidote for Benzodiazepine poisoning in this patient. (E) 1 mEq/kg of NaHCO₃ can be given as an antidote for TCA poisoning in this patient. ", "output": "D"}
-{"instruction": "An 11-month-old boy, weighing about 10 kg, has persistent paroxysmal abdominal pain and cries at home. His parents are the primary caregivers. Bloody stools were found in his diapers. The bedside abdominal ultrasound image showed a high probability of intussusception. Which of the following is wrong?", "input": "(A) Children of this age usually cannot find the leading point. (B) When there are signs of peritonitis, the pressure of air reduction must be reduced to avoid intestinal perforation. (C) The presence of bloody stools is not a contraindication to air reduction. (D) The incidence rate varies in different seasons and may be related to viral infection. (E) If air reduction fails, reassessment is needed to determine whether it is incarcerated hernia.", "output": "B"} 
-{"instruction": "A 25-year-old male patient with schizophrenia came to the emergency room 30 minutes ago because of dyspnea and neck and jaw stiffness. His companion said that his psychiatrist had changed his prescription for him 2 days ago. There were no special abnormalities in his vital signs. Physical examination revealed stiffness in the mandible and neck and stridor in the upper respiratory tract. The patient did not have skin rash, tongue swelling, or wheezing. Which of the following treatments is more appropriate?", "input": "(A) Diazepam 5 mg intravenous injection. (B) Diphenhydramine 50 mg intravenous injection. (C) Intubation after direct visualization of the airway through a fiberoptic endoscope. (D) Methylprednisolone 125 mg Intravenous injection. (E) Rapid sequence intubation with oral endotracheal tube intubation. ", "output": "B"} 
-{"instruction": "A 42-year-old female with a history of hyperthyroidism and no regular outpatient follow-up has been feverish and wheezing for two days. When she was sent to the emergency department, her coma index was E2V2M4, her temperature was 42.1℃, her heart rate was 180 beats/min, her electrocardiogram showed atrial fibrillation, her blood oxygen saturation was 76%, her lungs were auscultated with bilateral humours, her lung ultrasound showed extensive and numerous B lines, and her blood pressure was 70/40 mmHg. Which of the following is more appropriate for the treatment of this patient? ", "input": "(A) After the TSH and Free T4 test values ​​are confirmed, give Methimazole or Propythiouracil. (B) Give Amiodarone 150 mg to correct arrhythmia. (C) Give Acetylsalicylic acid to reduce fever. (D) Give NTG drip to reduce preload. (E) Give Propylthiouracil 600 mg orally, and then give Lugol solution 10 drops one hour later. ", "output": "E"} 
-{"instruction": "A 1-year-old child returned to Taiwan for medical treatment after developing fever and systemic rash symptoms in Guangdong, China. Which of the following statements is correct? ", "input": "(A) If Koplik spots are found during oral examination, the patient should be advised to be hospitalized in a negative pressure isolation ward. (B) In differential diagnosis, measles usually develops a rash the day after the fever subsides. The rash usually first appears on the hands and feet, then spreads to the trunk and face, and the oral mucosa is usually not affected. (C) In differential diagnosis, German measles is not a legal infectious disease. Those with mild symptoms can be discharged from the hospital and go home for observation. (D) Scarlet fever is caused by a single-stranded DNA virus that can be transmitted through droplets. It is recommended to be hospitalized in a single ward. (E) The rash of infantile roseola appears together with the fever, and disappears after the fever subsides. ", "output": "A"} 
-{"instruction": "A 30-year-old male was found unconscious while running a marathon and was sent to the emergency room. In the emergency room, GCS E3V3M5, blood pressure 100/50 mmHg, pulse 120 beats/min, respiration 22 times/min, body temperature 41℃, blood sugar 100 mg/dL, which of the following treatments is most appropriate? ", "input": "(A) The patient should be wet with cold tap water and given an electric fan. (B) The patient's sweat should be wiped off as soon as possible. (C) The patient's body temperature should be lowered to below 37℃ as soon as possible. (D) The patient should be allowed to undergo a brain CT scan first. (E) The patient should be given a sports drink to replenish water. ", "output": "A"} 
-{"instruction": "Which of the following statements about metabolic acidosis is incorrect? ", "input": "(A) It can be caused by rapid infusion of large amounts of normal saline. (B) When the blood pH is lower than 7.1, respiratory physiological compensation function will deteriorate. (C) If the blood potassium concentration is normal, the intracellular potassium ion may be severely low. (D) Ethanol is often the main cause of severe metabolic acidosis. (E) Potassium-sparing diuretics can cause normal anion gap metabolic acidosis. ", "output": "D"} 
-{"instruction": "Which of the following descriptions about epidural hematoma is correct? ", "input": "(A) Epidural hematoma is more common in the elderly and children under 2 years old. (B) Epidural hematoma most often occurs in the frontal region. (C) If the patient with epidural hematoma is in coma, the mortality rate is high, up to 80%. (D) Epidural hematoma usually looks crescent-shaped on brain CT images. (E) On brain CT images, epidural hematoma usually does not extend beyond the suture line. ", "output":"E"} 
-{"instruction": "According to the latest recommendations of the 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, which of the following statements is incorrect?", "input": "(A) Atropine is not recommended for routine use in critically ill children and newborns for preintubation to prevent bradycardia caused by emergency intubation. (B) The atropine dose is 0.02 mg/kg, and the minimum dose used each time is 0.1 mg. (C) Evidence-based medicine shows that atropine can be used for patients with bradycardia. (D) Both amiodarone and lidocaine can be used for shock-refractory VF or pulseless VT. (E) In clinical settings where critical care resources (e.g., ventilators, pressors) are not readily available, administering large volumes of fluids to children in septic shock may be harmful. ", "output": "B"} 
-{"instruction": "A 5-year-old girl was admitted to the emergency room. Her mother said that she had a congenital respiratory disease. She had just had 3 convulsions, each lasting about 5 minutes, and was accompanied by cyanosis. She was taken to the hospital by ambulance. When she arrived at the emergency room, the girl still had opisthotonos, eyes drooping, clenched teeth, and cyanotic lips. Which of the emergency treatments is correct, airway intubation or epilepsy treatment? ", "input": "(A) Ketamine 4 mg/kg IM injection. (B) Midazolam 0.1 mg/kg IM injection. (C) Phenytoin 20 mg/kg IM infusion. (D) Succinylcholine 1.5 mg/kg IM injection. (E)Valium 5 mg IM injection. ", "output": "B"} 
-{"instruction": "For various acute poisoning-induced cardiac arrests, in addition to giving ACLS first aid, which of the following antidotes is less effective? ", "input": "(A)Digoxin poisoning is treated with Digoxin Fab. (B)Organophosphates poisoning is treated with Atropine. (C)Sodium channel blocker poisoning is treated with Sodium bicarbonate. (D)Calcium channel blocker poisoning is treated with Glucagon. (E)Local anesthetic agents poisoning is treated with IV lipid emulsion. ", "output": "D"}
-{"instruction": "According to the American Burn Association, major burns should be admitted to a burn center. Which of the following does not require admission to a burn center?", "input": "(A) 40-year-old male, no past medical history, second-degree burns on the extremities, 29% BSA. (B) 40-year-old male, no past medical history, third-degree burns on the back, 11% BSA. (C) 70-year-old male, no past medical history, second-degree burns on the extremities, 17% BSA. (D) 4-year-old girl, no past medical history, third-degree burns on the perineum and buttocks, 3% BSA. (E) 30-year-old female, no past medical history, second-degree burns on the anterior chest, 4% BSA, combined with carbon deposits in the oropharynx and gradual hoarseness of the voice.", "output": "A、B、C、D、E"} 
-{"instruction": "Which of the following statements about hypoxemia is correct?", "input": "(A) In the case of right-to-left shunt, the oxygen in the artery (PaO 2) will increase significantly as long as the oxygen supply is increased. (B) Hypoventilation alone will only increase PaCO₂, but the Aa O 2 gradient is normal, which is unrelated to the oxygen supply. (C) In the case of ventilation-perfusion mismatch, the oxygen in the artery (PaO 2) will not increase significantly even if the oxygen supply is increased, but the Aa O 2 gradient will increase. (D) In ​​the case of diffusion impairment, the oxygen in the artery (PaO 2) will increase as long as the oxygen supply is increased, but the Aa O 2 gradient will not change significantly. (E) When the oxygen partial pressure in the atmosphere decreases, as long as the oxygen supply is increased, the oxygen in the artery (PaO 2) will increase significantly, but the Aa O 2 gradient will decrease. ", "output": "B"} 
-{"instruction": "A 28-year-old male is a type 1 diabetes patient. He is currently using an insulin pump to control blood sugar. He has been vomiting and diarrhea and has a poor appetite since the day before yesterday. This morning, he suddenly developed slurred speech and felt weaker in his right limbs. When he went to the emergency room, his blood sugar was 40 mg/dL. Which of the following is wrong about the treatment of this patient? ", "input": "(A) Hypoglycemia can cause symptoms suspected of stroke, so it is better to treat hypoglycemia first. (B) Sugar-containing infusions are more effective than glucagon and should be used first. (C) Temporarily stop using insulin pump for at least 24 hours. (D) Infection, worsening renal function, and acute coronary heart disease may all lead to hypoglycemia. (E) Blood glucose test strips may be inaccurate for peritoneal dialysis patients, and blood should be drawn again to confirm blood glucose levels. ", "output": "C"} 
-{"instruction": "According to the 2007 ABCD2 score, which of the following factors is most likely to cause a subsequent stroke in patients with a transient ischemic attack? ", "input": "(A) Age younger than 60 years old. (B) Anemia. (C) Attack duration greater than 10 minutes. (D) Family history of coronary heart disease. (E) Symptoms associated with vision during the attack. ", "output": "C"} 
-{"instruction": "Which of the following is not a location scanned by Focused Assessment with Sonogra phy for Trauma, FAST? ", "input": "(A) The junction between the liver and the right kidney (hepatorenal recess). (B) The junction between the spleen and the left kidney (splenorenal recess). (C) The aorta. (D) The pelvic cavity (pelvic view). (E) The subxiphoid process (subxiphoid view). ", "output": "C"} 
-{"instruction": "Which of the following statements about Fresh frozen plasma (FFP) is correct? ", "input": "(A) Type AB can be a universal donor. (B) Patients who need urgent gastroscopy and have coagulopathy should first receive FFP. (C) FFP can be used to treat coagulation disorders caused by Dabigatran. (D) Patients must undergo ABO-type and Rh compatible testing before receiving FFP transfusion. (E) After thawing, FFP must be used within 48 hours. ", "output": "A"} 
-{"instruction": "A 60-year-old male patient, weighing 60 kg, complained of nosebleeds for one week. His respiratory rate was 21 breaths/min, pulse was 74 beats/min, blood pressure was 158/90 mmHg, body temperature was 36.7℃, blood oxygen was 98%, he had a history of chronic kidney disease, and a left forearm arteriovenous catheter had been established one week ago. Blood tests showed BUN 280 mg/dL, Cr 23.5 mg/dL, HCO₃- 11.4 mEq/L. Which of the following statements is incorrect? ", "input": "(A) Desmopressin 0.3 mg SC or IV can increase von Willebrand factor and improve symptoms. (B) The tendency to bleed easily may be caused by the direct effect of uremic toxins. (C) If the massive bleeding continues, cryoprecipitate should be considered. (D) Platelet transfusion should be performed routinely. (E) The bleeding time of blood test will be prolonged. ", "output": "D"} "D"} 
-{"instruction": "Which of the following statements about possible side effects of laparoscopic Roux-en-Y gastric bypass surgery in obese patients is incorrect?", "input": "(A) Fentanyl and Benzodiazepines are lipophilic drugs, and their half-lives are prolonged in obese patients. (B) Acute intestinal obstruction immediately after laparoscopic Roux-en-Y gastric bypass surgery is a surgical emergency and must be treated immediately. (C) Postoperative intestinal obstruction after laparoscopic Roux-en-Y gastric bypass surgery includes internal hernia and rotation of the Roux end. (D) Acute intestinal obstruction after laparoscopic Roux-en-Y gastric bypass surgery will not cause vomiting of bile. (E) Dumping syndrome syndrome) is caused by rapid postprandial gastric emptying, release of gastric hormones, and visceral vasodilation. ", "output": "D"}
-{"instruction": "A 4-year-old girl, weighing 20 kg, has cold symptoms, lethargy, fever, fatigue, and loss of appetite for many days. Her blood pressure is 70/40 mmHg, her heart rate is 120 beats/min, O2 Sat 95%, and her breathing is about 24 times/min. Which of the following statements is incorrect? ", "input": "(A) The patient can be given 400 mL of 0.9% saline or lactated Ringer's solution for 5-10 minutes. (B) If myocarditis or cardiogenic shock is suspected, 0.9% saline or lactated Ringer's solution 100-200 mL can be given for 10-20 minutes. (C) If the treatment effect is not ideal, you can consider consulting a specialist. (D) If the child's urine output is 20 mL per hour, it means that the treatment response is not ideal. (E) If the child's blood pressure reaches 80/50 mmHg during treatment, the infusion should be stopped to avoid excessive administration. ","output": "E"} 
-{"instruction": "A 28-year-old pregnant woman was sent to the emergency room after a car accident. She was unconscious, with a coma index of E3V4M5, a heart rate of 110 beats/min, and a blood pressure of 80/50 mmHg. She complained of abdominal pain and pain in the right thigh. Physical examination revealed rebound pain when pressing the lower abdomen, a uterine fundus approximately near the navel, clear fluid secretions from the vagina, a deformed right thigh, and a 15-centimeter laceration. Which of the following statements is correct?", "input": "(A) Tetanus is not recommended for pregnant patients. (B) X-rays cannot be taken to confirm whether the right thigh is fractured. (C) Judging from vital signs, the amount of blood loss is approximately 15-30% of the total blood volume. (D) If the pH value of the vaginal secretions is 7, it may be amniotic fluid leaking out of the ruptured amniotic membrane. (E) The fetus is initially judged to be about 12 weeks old. Fetal heart rate and contraction monitor (cardiotochodynamometry) cannot be used yet. Only Doppler ultrasound can be used to evaluate fetal heart rate. ", "output": "D"} 
-{"instruction": "A 55-year-old female patient went directly to the emergency room from the airport after a 16-hour flight because of sudden difficulty breathing, chest pain, and sweating. When she arrived at the hospital, her blood pressure was 80/44 mm/Hg, her heart rate was 120 beats/min, her respiration was 22 times/min, her blood oxygen saturation was 88%, and the electrocardiogram monitor showed sinus tachycardia. The patient had no history of hypertension or heart disease, and after evaluation, pulmonary embolism was highly suspected. Which of the following related examinations of this patient is wrong? ", "input": "(A) This patient's chest X-ray may be completely normal. (B) A lower extremity venous ultrasound may reveal deep venous embolism. (C) A patient with pulmonary embolism may have an ECG with T wave inversion in V1-V4. (D) In ​​patients with symptomatic pulmonary embolism, abnormal D-dimer values ​​will not persist for more than 3 days. (E) Chest CT angiography is more difficult to diagnose pulmonary embolism in obese patients or patients with extremely rapid breathing.", "output": "D"} 
-{"instruction": "A 1-year-old girl is admitted to the emergency department. Her parents say that she is developing normally. The patient has had a fever for 2 days, has a hoarse cough and hoarse speech, has a slightly wheezing breath, poor appetite, and slightly poor response. Initial assessment shows that the patient has shallow and rapid breathing, normal skin color, suprasternal retraction, and the following vital signs: blood pressure 96/58 mmHg, respiration 34 times/min, heart rate 116 times/min, body temperature 38℃, and blood oxygen 92%. Which of the following descriptions and treatments is incorrect? ", "input": "(A) Epinephrine inhalation therapy. (B) Heliox inhalation therapy. (C) Draw blood and arrange for neck and chest X-rays. (D) Inject steroids. (E) This patient has upper airway obstruction and should be intubated immediately. ", "output": "E"} 
-{"instruction": "About adrenal insufficiency (adrenal (A) It is common in chronic steroid users after discontinuation of medication or in tumor patients. (B) It can cause adrenal hemorrhage due to meningococcal infection. (C) CMV infection is the main cause of adrenal insufficiency in HIV patients. (D) Gastrointestinal infection is one of the common causes of adrenal crisis. (E) Secondary adrenal insufficiency will not cause a lack of Cortisol in the blood. ", "output": "E"} 
-{"instruction": "Which of the following statements about NOAC (novel oral anticoagulants) is incorrect? ", "input": "(A) Dabigatran is a direct thrombin inhibitor. (B) Rivaroxaban is a direct Factor Xa inhibitor. (C) Even if the Thrombin clotting time is normal, it cannot be ruled out that the patient's current coagulation abnormality is caused by Dabigatran. (D) Hemodialysis can remove Dabigatran from the blood. (E) When a patient using Rivaroxaban has a major bleeding event, an antifibrinolytic agent (such as tranexamic acid) can be given. ", "output": "C"} 
-{"instruction": "A 6-year-old girl presented to the emergency department with an itchy maculopapular rash and fever and malaise. Examination revealed white discharge from her tonsils, enlarged cervical lymph nodes, and enlarged liver and spleen. Which of the following is the most likely causative pathogen? ", "input": "(A) Group A Streptococcus. (B) Epstein-Barr virus. (C) Coxsackie virus. (D) Staphylococcus aureus. (E) Influenza virus. ", "output": "B"} 
-{"instruction": "Which of the following statements about malignant external otitis, which can cause life-threatening skull base osteomyelitis, is more appropriate? ", "input": "(A) Most cases can be treated with antibiotics. (B) The clinical stage can be determined by a lateral cranial X-ray. (C) An elevated inflammatory index such as C-reactive protein is required for diagnosis. (D) The most common pathogen is Streptococcus pneumoniae. (E) It most often causes lesions in the fifth cranial nerve. ", "output": "A"} 
-{"instruction": "Which of the following statements about acute epiglottitis is less appropriate?", "input":"(A) Steroids should not be given to avoid aggravating the infection. (B) Antibiotics include cefotaxime plus vancomycin. (C) Common pathogens include Streptococcus and Staphylococcus, but they may also be cultured negative. (D) The typical clinical symptoms are the so-called three Ds, namely drooling, dysphagia, and distress. (E) CT scans are not required to confirm the diagnosis.", "output": "A"} 
-{"instruction": "A 22-year-old female patient went to the emergency department because her eyes became red, swollen and painful after falling asleep with contact lenses. Examination revealed corneal ulcers. What is the most likely pathogen causing the infection?", "input": "(A) Varicella zoster virus (Varicella zoster virus). (B) Staphylococcus aureus. (C) Streptococcus pneumoniae. (D) Herpes simplex virus. (E) Pseudomonas aeruginosa. ", "output": "E"}
-{"instruction": "Which of the following descriptions of the use of antithrombotics to treat venous embolism combined with pulmonary embolism is less appropriate?", "input": "(A) Oral NOACs (novel oral anticoagulants) such as rivaroxaban can be used to treat venous embolism in patients undergoing dialysis. They are more convenient and safer than traditional treatments. (B) A platelet count below 100,000/mm³ is an absolute contraindication to the use of fibrinolytic therapy. (C) Anticoagulants are more effective than antiplatelets in preventing venous thromboembolism. (D) If the patient's blood pressure drops to 75/55 mmHg, fibrinolytic therapy may be considered. (E) Warfarin The initial 24-36 hours of treatment may increase thrombogenesis, which can be alleviated by combined intravenous heparin treatment for 3-5 days. ", "output": "A"} 
-{"instruction": "Which of the following statements about massive transfusion is less appropriate? ", "input": "(A) Giving at least 10 units of PRBCs (packed red blood cells) within 24 hours can be called massive transfusion. (B) For patients who receive massive transfusions, the commonly recommended ratio of FFP (fresh frozen plasma): platelets: PRBCs is 2:1:1. (C) During massive transfusions, if the platelet count is less than 50,000/mm³, platelet transfusion is recommended. (D) During massive transfusions, if the monitored INR is greater than 1.5, FFP (fresh frozen plasma) is recommended. (E) During massive blood transfusion, if the fibrinogen level is less than 1 g/L or 100 mg/dL, cryoprecipitate or fibrinogen concentrate can be given. ", "output": "B"} 
-{"instruction": "Which of the following statements about systemic lupus erythematosus (SLE) is more appropriate? ", "input": "(A) When pericardial effusion occurs, high-dose glucocorticoid can reduce the need for pericardiocentesis. (B) When pericarditis occurs, NSAIDs (non-steroidal anti-inflammatory drugs) should be avoided. (C) When SLE patients who have been taking glucocorticoids for a long time develop pneumonia, second-generation cephalosporins are the first choice for treatment. (D) SLE patients do not have a significantly increased risk of developing coronary artery disease. (E) Erythrocyte sedimentation rate (ESR) can be used to differentiate between lupus enteritis and other causes of abdominal pain. ", "output": "A"} 
-{"instruction": "Which of the following statements about toxic epidermal necrolysis is less appropriate? ", "input": "(A) The mortality rate of toxic epidermal necrolysis may be as high as 30%. (B) When toxic epidermal necrolysis affects more than 30% of body surface area (BSA), it is called Stevens-Johnson syndrome. (C) Treatment is mainly based on hydration, prevention of secondary infection and wound care. (D) Fever, sore throat and muscle pain are often the initial symptoms. (E) Skin rashes may appear all over the body, especially on the limbs. ", "output": "B"} 
-{"instruction": "According to the publicity of the Taiwan Centers for Disease Control to the public, when the following symptoms appear, it may represent a severe case of enterovirus, except which one? ", "input": "(A) Crying incessantly. (B) Rapid heartbeat. (C) Continuous vomiting. (D) Drowsiness. (E) Muscle twitching. ", "output": "A"} 
-{"instruction": "A 60-year-old male patient is sent to the emergency room. He seems to be unconscious. Neurological examination reveals that his limbs cannot move in response to any stimulation, and he cannot make any sound. However, you observe that the patient's eyes occasionally open and close on their own. Where is his lesion most likely to be? ", "input": "(A) Pons. (B) Cerebellum. (C) Hypothalamus. (D) Midbrain. (E) Medulla. ", "output": "A"} 
-{"instruction": "Which sign of bedside ultrasound examination of trauma patients would make you suspect that the patient has pneumothorax? ", "input": "(A) A-lines. (B) B-lines. (C) Lung point sign. (D)Lung sliding. (E)Tissue-like sign. ", "output": "C"} 
-{"instruction": "A 21-year-old male was taken to the emergency department with dyspnea after falling off his bicycle. He was very agitated and grabbed his clavicle. BP: 170/92 mmHg, HR: 140 times/min, RR: 31 times/min. Initial assessment found tachypnea with stridor, no trachea deviation, and decreased and symmetrical breath sounds on both sides. Which of the following diagnoses is most likely? ", "input": "(A)Tension pneumothorax. (B)Flail chest. (C)Posterior dislocation of clavicular head. (D)Massive hemothorax. (E)Hyperventilation. ", "output":"C"} 
-{"instruction": "Which of the following patients can be considered for emergency thoracotomy (resuscitative thoracotomy) in the emergency department?", "input": "(A) A 35-year-old male fell from a height and had no breath sounds on the right side of his chest. He presented with asystole when he arrived at the hospital. (B) A 20-year-old male was stabbed in the left chest after a fight. He had no breath or heartbeat and presented with asystole when he arrived at the hospital. (C) A 19-year-old female was in a car accident and her chest hit the steering wheel. She had no breath or heartbeat when she arrived at the hospital. She presented with pulseless electrical activity (PEA). (D) A 25-year-old male suffered a gunshot wound to the left chest. He had no breath or heartbeat when he arrived at the hospital. He presented with PEA. (E) A 30-year-old male fell from a scaffold. His chest was deformed. He had no breath or heartbeat when he arrived at the hospital. He presented with asystole.", "output": "D"} 
-{"instruction": "According to the latest version of neonatal resuscitation recommendations jointly released by the American Heart Association and the American Academy of Pediatrics in 2016, which of the following statements is more appropriate? ", "input": "(A) During the first aid process, the recommended site for measuring blood oxygen concentration is the left upper limb of the newborn. (B) After clearing the airway and providing positive pressure breathing for 30 seconds, if the heart rate is measured at 50 beats per minute, it is recommended to perform ventilation correction steps, including adjusting the mask, repositioning, suctioning the mouth and nose, opening the mouth, increasing ventilation pressure, and considering alternative airways. (C) During positive pressure ventilation (but not chest compression), do not use pure oxygen for ventilation; it should be set to 21-30% for those over 35 weeks old and 21% for those under 35 weeks old. (D) In ​​the first golden minute, the rescue sequence is to maintain body temperature, assess medical history, and open the airway. (E) For chest compression, it is recommended to compress the chest 3 times and blow one breath every 3 seconds. ", "output": "B"} 
-{"instruction":"Which of the following statements about measles is more appropriate?", "input": "(A) In addition to fever, the initial symptoms often include nausea, vomiting, abdominal pain, diarrhea and loss of appetite. (B) The rash starts on the body, then spreads upward to the neck and head, and finally to the limbs, palms and soles. (C) Before the rash appears, it cannot be transmitted to other people. (D) This disease is a Class II notifiable infectious disease and must be reported within 24 hours. (E) It can be transmitted through droplets and oral and nasal secretions, but not through the air.", "output": "D"} 
-{"instruction": "A 3-year-old boy complained of abdominal pain for more than a day, and his family said that he was not energetic and had a very poor appetite. He cried and was restless as soon as he was approached, and was unable to cooperate with physical examinations. Regarding pediatric abdominal pain, which of the following statements is less appropriate? ", "input": "(A) The first step in evaluating any child with poor activity and poor appetite is to check the bedside glucose. (B) If this child is ultimately diagnosed with appendicitis, it may have ruptured and complicated by peritonitis. (C) If there is arthritis and a generalized rash that is unevenly distributed, especially if the rash appears more frequently and earlier on the legs and buttocks than on the arms, chest, and abdomen, Henoch-Scholein purpura should be considered first. (D) If this child continues to have severe vomiting, weight loss, and signs of dehydration, pyloric stenosis should be considered first. (E) This child may also have intussusception, and should also be examined for other lesions such as lymphoma or Meckel's diverticulum. ", "output": "D"} 
-{"instruction": "Which of the following statements about pediatric seizures is less appropriate? ", "input": "(A) Febrile convulsion is the most common cause of pediatric seizures. (B) Evidence shows that it is not recommended to give anti-epileptic drugs to children with febrile convulsions. (C) Actively giving antipyretic drugs to children with febrile convulsions can reduce the chance of another seizure. (D) The first occurrence of afebrile convulsion under the age of 3 years (E) If a child with status epilepticus is finally treated with propofol infusion, attention should be paid to complications such as metabolic acidosis, rhabdomyolysis, renal failure, or heart failure. ", "output": "C"} { 
-"instruction": "Which of the following descriptions of acute pericarditis in children is less appropriate? ", "input": "(A) The most common cause is infection, the most common virus being Coxsackie virus. (B) Typical symptoms are chest pain and respiratory distress. (C) Physical examination may reveal distended cervical veins, edema of the limbs, enlarged liver and spleen, pulsus paradoxus, and pericardial friction rub on auscultation. (D) The gold standard for confirming the diagnosis is the presence of at least two of the following three conditions: multi-lead ST segment elevation on 12-lead electrocardiogram, cardiomegaly on chest X-ray, and elevated troponin-I in the blood. (E) Some surviving children will later develop constrictive peri carditis due to thickening of the pericardium. ", "output": "D"} 
-{"instruction": "Which of the following common side effects of anti-dizziness and anti-emetic drugs is less appropriate? ", "input": "(A)Antihistamines (e.g., diphenhydramine) have a common side effect of drowsiness. (B)Benzodiazepines (e.g., lorazepam) have a common side effect of sedation. (C)Benzamides (e.g., metoclopramide) have a common side effect of extrapyramidal symptoms. (D)Phenothiazines (e.g., prochlorperazine) have a common side effect of extrapyramidal symptoms. (E)Serotonin antagonists (e.g., ondansetron, granisetron) have a common side effect of extrapyramidal symptoms. ", "output": "E"} 
-{"instruction": "Which of the following is less appropriate when performing a stool examination on a patient with acute diarrhea? ", "input": "(A) Patients with acute diarrhea lasting more than 3 days should have a stool culture. (B) Immunocompromised patients with acute diarrhea should have a stool culture. (C) Stool cultures of patients with acute diarrhea often isolate pathogens. (D) Diarrhea suspected to be related to antibiotic use should be tested for Clostridium difficile toxin. (E) Stool cultures for Salmonella should be considered in patients with Reiter's syndrome with acute diarrhea. ", "output": "C"} 
-{"instruction": "An 88-year-old male is a type 2 diabetic. He is currently using metformin and glypizide to control his blood sugar. He was found unconscious by his family in the morning. When he went to the emergency room, his blood sugar was 36 mg/dL. He regained consciousness after being given 80mL of D50W. Which of the following statements is less appropriate? ", "input":"(A) If the patient's renal function deteriorates, attention should be paid to whether there is lactic acidosis. (B) If CT contrast agent is administered, metformin should be discontinued for 48 hours. (C) The patient should be kept in the hospital for observation until blood sugar is stable and there are no other reasons requiring treatment. The patient should be allowed to eat before leaving the hospital. (D) Metformin is more likely to cause hypoglycemia than glypizide. It is not recommended for elderly patients to use metformin. (E) Because glypizide is a long-acting drug, hypoglycemia may occur again. It is recommended to observe in the emergency department for a longer period of time.", "output": "D"} 
-{"instruction": "Which of the following statements about rhabdomyolysis is less appropriate?", "input": "(A) The diagnostic criterion is creatine kinase in plasma. (CK) value is more than 5 times the upper limit of normal value, but heart and brain diseases must be ruled out first. (B) Blood CK value can effectively predict the risk of acute kidney damage. (C) It can be combined with electrolyte abnormalities such as high potassium, high phosphorus and low calcium. (D) Treatment requires large amounts of infusion and alkaline urine, and it is best to maintain urine volume greater than 300 mL/hr. (E) Blood myoglobin has a shorter half-life than CK and is not recommended for diagnosing rhabdomyolysis after 24 hours. ", "output": "B、D"}
-{"instruction": "An emergency newborn weighs about 2 kg. After initial warming, drying and stimulation, the newborn has difficulty breathing and mild cyanosis. His heart rate is 80 beats/min. Which of the following treatments is more appropriate?", "input": "(A) Continue to keep warm and assess blood sugar. (B) Inject epinephrine. (C) Provide positive pressure ventilation. (D) Intubate using a laryngeal mask airway (LMA). (E) Start chest compression and provide ventilation.", "output": "C"} {  
-{"instruction":"A 40-year-old male has unexplained syncope. Which of the following is less likely to be at high risk for hospitalization?", "input": "(A) Left bundle branch block on electrocardiogram. (B) History of heart failure. (C) Complaint of dyspnea. (D) Systolic blood pressure less than 90 mmHg. (E) Asystole lasting more than 3 seconds after carotid massage.", "output": "E"}
-"instruction": "Regarding the clinical manifestations of hypertrophic cardiomyopathy, which of the following is less appropriate?", "input": "(A) Nitroglycerin is not effective in improving chest pain. (B) Atrial fibrillation can aggravate symptoms. (C) Valsalva maneuver can weaken heart murmurs. (D) The severity of symptoms is related to age. (E) Dyspnea on exertion is the most common early symptom. ", "output": "C"} 
-{"instruction": "Which of the following is less appropriate for the treatment of aortic dissection? ", "input": "(A) For patients with Stanford type B, surgery can be performed if they continue to have severe chest pain. (B) Medications should be used to control heart rhythm before using vasodilators. (C) Ultrasound can be used to assess the presence of cardiac tamponade so that early treatment can be provided. (D) Calcium ion blockers are the first choice for lowering blood pressure. (E) Actively control systolic blood pressure to 100-120 mmHg. ", "output": "D"} 
-{"instruction": "Which of the following statements about antiplatelet drugs used in myocardial infarction is less appropriate? ", "input": "(A) Aspirin can reduce the mortality rate of patients with ST-segment elevation myocardial infarction by more than 20%. (B) Abciximab is not recommended for patients with coronary heart disease who do not undergo percutaneous coronary intervention. (C) Clopidogrel and omeprazole can enhance the effect when used together. (D) Prasugrel should not be used in patients with a history of transient ischemic attack. (E) Patients using ticagrelor are advised to stop taking the drug for at least 3 days before surgery. ", "output": "C"} 
-{"instruction": "Which of the following descriptions of psoas muscle abscess is less appropriate? ", "input": "(A) Symptoms are often manifested by latent fever, abdominal pain and lameness. (B) Pathogens can easily spread infection from distant sites via the bloodstream. (C) Pressing the patient's thigh on the affected side and asking the patient to lift his leg with force can induce pain. (D) It is most commonly caused by streptococcal infection. (E) The principle of treatment is antibiotics and percutaneous drainage surgery. ", "output": "D"} 
-{"instruction": "Which of the following descriptions of psoas muscle abscess is less appropriate? ", "input": "(A) A positive crossed straight leg raise test on the nonsymptomatic side has high specificity but low sensitivity for the diagnosis of a herniated disc. (B) In suspected dural compression caused by a tumor, dexamethasone should be used before definitive testing. (C) Neuropathic claudication due to lumbar spinal stenosis is aggravated by flexion of the spine and relieved by extension. (D) Cerebrospinal fluid examination in transverse myelitis often shows lymphocytosis and elevated protein. (E) In a blood test for vertebral osteomyelitis, white blood cells may be normal, but the erythrocyte sedimentation rate and C-reactive protein are almost always elevated. ", "output": "C"} 
-{"instruction": "The patient has pain and swelling in the prepatellar bursa of his right knee. Which of the following statements is less appropriate? ", "input": "(A) Bursitis most commonly occurs in the elbows and knees. (B) It may be caused by repeated trauma or gout. (C) Septic bursitis is most common in the prepatellar bursa and olecranon bursa. (D) The ratio of bursal fluid blood glucose to serum blood glucose is greater than 50%, which can be diagnosed as septic bursitis. (E) Staphylococcus aureus is the most common bacterial species in bursitis. ", "output": "D"} 
-{"instruction": "A 45-year-old male with no history of trauma developed gradual pain in his right knee joint a few hours ago. Which of the following statements is more appropriate? ", "input": "(A) Gout attacks are mainly characterized by inflammation of multiple joints. (B) Pseudogout is caused by the accumulation of calcium oxalate in the synovial bursa of the joints. (C) During an acute gout attack, the patient's blood uric acid level will rise. (D) Gout can be diagnosed if blue needle-shaped crystals are seen in the joint aspirate under a polarizing microscope. (E) Patients with renal dysfunction should consider treatment with colchicine. ", "output": "D"} 
-{"instruction": "The emergency medical technician brought a 19-year-old student from school. The school nurse and teacher said that he had an epileptic seizure in class. The seizure stopped before getting on the ambulance, but he had another seizure on the way to the hospital and it has continued until now. This seizure lasted for more than five minutes. The ambulance technician said that the blood sugar level measured in the car was 102 mg/dL, and the intravenous line was established before the seizure. Which of the following treatments is most appropriate? ","input": "(A) Emergency endotracheal tube insertion. (B) Intravenous injection of lorazepam. (C) Intravenous injection of phenobarbital. (D) Intravenous injection of propofol. (E) Intravenous injection of fentanyl.", "output": "B"} 
-{"instruction": "A 72-year-old woman was brought to the emergency room by her husband at 6:20 in the morning. The husband said that everything was normal when he went to bed last night. When he got up at around 6 o'clock this morning, he found that his wife had difficulty moving on the right side and could not speak clearly. Physical examination revealed right-sided limb weakness accompanied by aphasia and abnormal body sensation, and blood pressure of 170/100 mmHg, blood test showed no abnormalities, no bleeding risk factors, head CT scan showed no signs of cerebral hemorrhage, but the boundary between gray matter and white matter in the left median cerebral artery basin was unclear. The current time is 7:15. Which of the following treatments is most appropriate? ", "input": "(A)Aspirin. (B)Heparin. (C)Labetalol. (D)Nimodipine. (E)Thrombolysis. ", "output": "A"}
-{"instruction": "A 35-year-old female complained of seeing two shadows when looking at things today. The medical history was found to have diarrhea and fever 3 weeks ago. In the past week, she had difficulty walking and the symptoms became more and more obvious. There was no past medical history, no substance abuse, and the patient was conscious. Clinical examination revealed ocular muscle paralysis and limb movement disorders, symmetrical weakness and sensory loss in the lower limbs, and weakened tendon reflexes. There were no signs of insect bites on the skin. Cerebrospinal fluid examination showed a protein content of 75mg/dL and a white blood cell count of less than 10 cells per cubic millimeter. There were no other findings. Which of the following diagnoses is most appropriate?", "input": "(A) Guillain-Barre syndrome. (B) myasthenia gravis gravis). (C) Multiple sclerosis. (D) Tick paralysis. (E) Wernicke's encephalopathy. ", "output": "A"} "A 35-year-old female complained of seeing two shadows when looking at things today. The medical history was found to have diarrhea and fever 3 weeks ago. In the past week, she had difficulty walking and the symptoms became more and more obvious. There was no past medical history, no substance abuse, and the patient was conscious. Clinical examination revealed ocular muscle paralysis and limb movement disorders, symmetrical weakness and sensory loss in the lower limbs, and weakened tendon reflexes. There were no signs of insect bites on the skin. Cerebrospinal fluid examination showed a protein content of 75mg/dL and a white blood cell count of less than 10 cells per cubic millimeter. There were no other findings. Which of the following diagnoses is most appropriate?", "input": "(A)Guillian-Barre syndrome. (B)Myasthenia gravis. (C) Multiple sclerosis. (D) Tick paralysis. (E) Wernicke's encephalopathy. ", "output": "A"} 
-{"instruction": "A 25-year-old female with an autoimmune disease presents to the emergency department with increasing weakness. You suspect she has myasthenia gravis. Which of the following neurological tests would be most helpful in establishing a diagnosis? ", "input": "(A) Toe strength. (B) Eyelid movement. (C) Walking gait. (D) Joint reflexes. (E) Vibration sensation. ", "output": "B"}
-{"instruction": "A 46-year-old male was brought to the emergency room by ambulance. His family said that the patient had a fever, headache, and confusion within a day. The ambulance technician said that the patient's consciousness deteriorated significantly during the transportation. When he arrived at the emergency room, his temperature was 40℃, his heart rate was 130 beats/min, his blood pressure was 110/60 mmHg, his respiratory rate was 20 times/min, and his blood oxygen concentration was 95%. His neck was slightly stiff. Which of the following treatments is the most priority? ", "input": "(A) Blood culture and antibiotic treatment. (B) Arrange a contrast-enhanced head CT scan. (C) Administer 10 mg of dexamethasone intravenously. (D) Perform a lumbar puncture to obtain cerebrospinal fluid (CSF). (E) Arrange an urgent MRI scan. ", "output": "A"} 
-{"instruction": "Which of the following statements is inappropriate when using succinylcholine as a muscle relaxant to assist in intubation? ", "input": "(A) The use of succinylcholine may cause bradycardia in the patient. (B) The use of succinylcholine may cause increased intragastric and intracranial pressure in the patient. (C) In premedication, it is recommended to use a low-dose nondepolarizing muscle relaxant to avoid muscle tremors. (D) Succinylcholine Do not use in patients with known hyperkalemia, neuromuscular disease, or myasthenia gravis. (E) If a patient develops unexplained fever and muscle stiffness after administration of succinylcholine, consider administering dantrolene sodium. ", "output": "C"} 
-{"instruction": "Which of the following descriptions is more appropriate for the treatment of asthma severities? ", "input": "(A) Endotracheal intubation does not relieve bronchoconstriction. (B) Ketamine is contraindicated when a patient requires intubation because it increases intrathoracic pressure. (C) For intubated patients, the goal is to immediately correct respiratory acidemia to normal limits. (D) Administration of Heliox can reduce intubation rates, intensive care unit admissions, and length of hospital stay. (E) Magnesium sulfate can be given intravenously for treatment, but attention should be paid to the side effects of hypertension and neuromuscular blockade. ", "output": "A"} 
-{"instruction": "Which of the following statements about pneumonia in specific groups of patients is less appropriate? ", "input": "(A) M. pneumoniae and Legionella are more common pathogens in nursing home residents. (B) Gram-negative bacilli (P. aeruginosa), S. aureus and Legionella are common species in patients after liver transplantation in the first three months. (C) Pregnant women who have been exposed to chickenpox and have cough and respiratory symptoms should be recommended to have a chest X-ray. (D) The most common pathogen in alcoholics is S. pneumoniae, but Klebsiella species are also important pathogens. (E) Atypical pneumonia is more common in younger people. ", "output": "A"} 
-{"instruction": "Which of the following statements is more appropriate for the diagnosis and treatment of spontaneous pneumothorax? ", "input": "(A) If the patient has tracheal deviation, decreased blood pressure and blood oxygen, and decreased breath sounds on one side, a chest X-ray should be performed first. (B) When the patient's chest ultrasound shows a comet tail sign, it can help diagnose pneumothorax. (C) According to the American College of Chest Physicians, if the distance from the top of the chest cavity to the top of the lung (apex-cupola) is less than 5 cm on a standing chest X-ray, it can be classified as a small pneumothorax and observation and treatment can be considered. (D) Oxygen can be given to the patient, which helps absorb the pneumothorax. (E) If the patient's pneumothorax requires drainage, the only drainage method is chest tube placement. ", "output": "D"} 
-{"instruction": "A 77-year-old male stroke patient has been bedridden for a long time. He is sent to the emergency department because of fever and shortness of breath. Blood tests show elevated white blood cells and C-reactive protein. Chest X-ray shows a 5-cm cavitary lesion in the right lower lung. Which of the following statements is less appropriate? ", "input": "(A) Pulmonary abscesses are associated with aspiration pneumonia. (B) Pulmonary abscesses are more commonly infected by anaerobic bacteria. (C) Pulmonary abscesses usually do not require drainage. (D) Anaerobic infections have a worse prognosis than aerobic infections. (E) The antibiotic ampicillin- sulbactam is a reasonable initial empirical medication. ", "output": "D"} 
-{"instruction": "Which of the following statements about a patient who is coughing up blood is more appropriate? ", "input": "(A) For a small amount of hemoptysis, since it is mostly caused by acute bronchitis, there is no need for X-rays. (B) For all cases of hemoptysis, hospitalization for observation and examination should be arranged. (C) For a large amount of hemoptysis, the vital signs are stable, and since the diagnostic rate of X-rays is low, a CT scan should be arranged directly. (D) For a large amount of hemoptysis, the airway should be maintained, and the use of rapid sequence intubation should be avoided during intubation. (E) For a large amount of hemoptysis, the vital signs are unstable, and direct intubation and bronchoscopy should be considered. ", "output": "E"} 
-{"instruction":"A 75-year-old male patient is brought to the emergency room because of emotional agitation and violent behavior. On examination, his blood pressure is 165/104 mmHg, his respiratory rate is 16 breaths/min, his heart rate is 105 beats/min, and his temperature is 37.2℃. The patient has a history of hypertension and dementia and is being followed up in the neurology clinic. In recent days, the patient has begun to suspect that family members have stolen his money or that someone is trying to hurt him. Which of the following statements is less appropriate?", "input": "(A) The differential diagnosis should include delirium. (B) Causes of delirium include medications, electrolyte imbalance, infection, etc. (C) If the patient is agitated, physical restraints are usually the first choice. (D) If the patient is agitated, non-pharmacological treatments may include providing a quiet, comfortable environment and family companionship. (E) If the patient is agitated and non-pharmacological treatments fail, oral risperidone may be considered. ", "output": "C"}
-{"instruction": "A 35-year-old male presents to the emergency department with runny nose, tearing eyes, nausea, vomiting, diarrhea, and abdominal cramps. During the history, he denies any past medical conditions, but his medical record shows a history of heroin abuse. Physical examination reveals dilated pupils and goosebumps on the skin. Which of the following statements is less appropriate?", "input": "(A) This patient may be experiencing heroin withdrawal syndrome. (B) Most heroin withdrawal syndromes occur 36-72 hours after discontinuation of the drug and can last 7-10 days. (C) The opioid with the longest-lasting withdrawal symptoms is methadone. (D) The most severe opioid withdrawal syndrome is heroin. (E) For mild opioid withdrawal syndrome, buprenorphine or naloxone can be considered. ", "output": "B"}  
-{"instruction":"A 30-year-old male is brought to the emergency department with general rigidity, confusion, and a high fever. The patient is prescribed antipsychotics as a rule in the psychiatric clinic. The initial diagnosis is neuroleptic malignant syndrome (NMS). Which of the following statements about NMS is less appropriate?", "input": "(A) General rigidity can be treated with dentrolene sodium or bromocriptine. (B) Autonomic dysfunction may occur, such as rapid heart rate, sweating, and abnormal blood pressure. (C) Mortality rate may be as high as 20%. (D) Antipsychotics must be discontinued. (E) Anticholinergic medications are usually helpful.", "output": "E"}
-{"instruction": "Which of the following statements about alcohol withdrawal syndrome is less appropriate? ", "input": "(A) Alcohol withdrawal seizures are usually diffuse tonic-clonic seizures. (B) For alcohol withdrawal seizures, benzodiazepines are the first choice for drug treatment. (C) For alcohol withdrawal seizures, phenytoin is also a commonly used drug. Repeated initial doses (repeated (D) Alcohol withdrawal delirium, which often occurs within 3 to 5 days after the last drink and can last 48 to 72 hours or even longer. (E) Alcohol withdrawal hallucinations, which are often treated with antipsychotics. ", "output": "C"} 
-{"instruction": "Which of the following statements is more appropriate about peritoneal dialysis catheter (PD catheter) infection? ", "input": "(A) Fever is usually present, but there is rarely local redness, swelling or pain at the catheter exit site. (B) Streptococcus viridans is the most common species. (C) If the patient can be followed up in the outpatient clinic, first-generation oral cephalosporins can be used as empirical antibiotic treatment. (D) If ascites is drawn for testing, the leukocyte count must be greater than 250/mm³ and the neutrophil count must be greater than 50% for diagnosis to be confirmed. (E) All patients with PD catheter infection should be hospitalized. ", "output": "C"} 
-{"instruction": "A 17-year-old male came to the clinic because of unbearable testicular pain. The clinic doctor suspected that it was acute testicular torsion and referred the patient to the emergency department. Which of the following descriptions of this disease is less appropriate? ", "input": "(A) There will be local tenderness in the testicle on the affected side. (B) During physical examination, the cremasteric reflex on the affected side may be normal or absent. (C) During physical examination, lifting the affected testicle will relieve pain, and it is quite sensitive in distinguishing testicular torsion from epididymitis. (D) This is a urinary emergency and should be treated with an urgent urologist, who should consider manual detorsion. (E) If pain is relieved after manual detorsion, Doppler ultrasound can be used to confirm whether blood flow to the testicle has been restored. ", "output": "C"} 
-{"instruction": "A 25-year-old male complained of progressive left lower abdominal pain for 3 days, painful urination, and yellowish discharge from the urethra. His vital signs are as follows: blood pressure 135/80 mmHg, heart rate 110 beats/min, respiration 22 times/min, and body temperature 38.4°C. Urine laboratory examination: RBC 0-3/HPF, WBC 50-99/HPF. Which of the following statements about this patient is less appropriate? ", "input": "(A) If left-sided tenderness is found upon palpation of the scrotum, epididymitis may be present. (B) If this patient is diagnosed with epididymitis, the common pathogens are mainly Gram-negative bacilli such as E. coli and K. pneumoniae. (C) The left lower abdominal pain in this patient may be referral pain. (D) If combined with testicular and epididymitis, under color Doppler ultrasound, it can be seen that the blood flow of the left testis is slightly increased compared with the right testis. (E) The first choice of antibiotics is a single intramuscular injection of ceftriaxone 250mg and oral doxycycline for 10 days. ", "output": "B"} 
-{"instruction": "A 45-year-old male went to the emergency department because of left-sided low back pain. The urine test results were as follows: RBC >100/HPF, WBC 0-3/HPF, Bacteria (-). Ultrasound examination revealed a 0.8 cm left ureteral stone. Which of the following statements is less appropriate? ", "input": "(A) The ureteropelvic junction is one of the common sites of ureteral stone. (B) 10%-15% of patients will not have hematuria. (C) There is a 98% chance that the stone will be discharged spontaneously with urine within one month. (D) NSAIDs are the first choice for pain control in acute attacks. (E) Non-contrast CT is a more sensitive diagnostic tool than ultrasound. ", "output": "C"} 
-{"instruction": "A 35-year-old female patient comes to the hospital with dizziness and vomiting. Examination reveals that the patient is agitated, has horizontal nystagmus, diplopia, unsteady gait (ataxia), and gingival hyperplasia. Which of the following is the most likely diagnosis? ", "input": "(A) Amphetamine intoxication. (B) Hyperthyroidism. (C) Opioid withdrawal syndrome. (D) Phenytoin intoxication. (E) Rabies. ", "output": "D"} 
-{"instruction": "A 65-year-old female collapsed at home and was brought to the emergency room by her family. BT: 35.5℃, HR: 50 times/min, RR: 16 times/min, BP: 80/50mmHg, GCS: E3V5M6, the patient complained of a recent cold, general weakness, loss of appetite for nearly a month, constipation, but no weight loss, hair loss, multiple joint pain, swollen eyelids, dry skin. Which of the following is the most likely diagnosis? ", "input": "(A)Angiostrongylus cantonensis infection. (B)Digoxin intoxication. (C)Hepatic encephalopathy. (D)Lead poisoning. (E)Myxedema coma. ", "output": "E"}
-{"instruction": "A 50-year-old woman came to the clinic because of fatigue and facial cramps in recent days. She complained of numbness in the fingertips and around the mouth, but her vital signs were normal. The examining nurse said that the patient had "lotus fingers" (extension of interphalangeal joints, bending of metacarpophalangeal joints, and flexion of wrists) when taking her blood pressure. She was suspected of hyperventilation. Which of the following tests is most necessary? ", "input": "(A)Arterial blood gas. (B)Calcium. (C)Glucose. (D)Potassium. (E)Troponin. ", "output": "B"} 
-{"instruction": "Which of the following statements about diarrhea is less appropriate? ","input": "(A) Most patients with diarrhea are caused by viruses. (B) Clostridium difficile infection is common in hospitals 7 to 10 days after the use of antibiotics. (C) Pseudomembranous colitis mostly occurs in the large intestine, and yellow-white pseudomembranous membranes can be seen under endoscopy. (D) Traveler's diarrhea is mostly caused by bacterial infection. (E) Patients with infectious diarrhea should not use loperamide to relieve symptoms.", "output": "E"} 
-{"instruction": "A 70-year-old male complained of sudden headache and right-sided vision loss 1 hour ago. Examination revealed that he could not see the right half of both eyes. The pupils of both eyes were equal in size, the light response was normal, and the muscle strength of the limbs was normal. Which of the following is the most likely differential diagnosis? ", "input":"(A) Glaucoma. (B) Left occipital lobe infarction. (C) Pituitary apoplexy. (D) Right occipital lobe arteriovenous malformation. (E) Right optic neuritis.", "output": "B"} 
-{"instruction": "Which of the following statements about the symptoms of intestinal obstruction is more appropriate?", "input": "(A) Only about half of the patients have abdominal pain. (B) Proximal obstruction rarely causes vomiting. (C) The pain is mostly continuous, and rarely paroxysmal colic. (D) Adynamic intestinal obstruction is usually more painful than mechanical obstruction. (E) Large intestinal obstruction often causes pain in the hypogastric region.", "output": "E"}
-{"instruction": "A 32-year-old female was sent to the emergency room after taking a large amount of drugs for depression and became unconscious. Her coma index was E2V3M4, blood pressure was 70/45 mmHg, heart rate was 115 beats/min, respiration was 25 times/min, body temperature was 36.5°C, and the electrocardiogram showed prolonged QRS and terminal R wave in aVR. Which of the following drugs is least likely to cause poisoning?", "input": "(A) Trazodone. (B) Diphenhydramine. (C) Carbamazepine. (D) A mitriptyline. (E) Hydroxyzine.", "output": "A 
-" } "A 25-year-old woman drinks a 3-day-old soup and goes to the emergency room with headache, shortness of breath, and general weakness. When blood is drawn, it is found that the patient's blood is the color of chocolate brown. Which of the following statements is inappropriate?", "input": "(A) Arterial gas analysis shows a methemoglobin concentration of 9%. (B) Pulse oximetry may overestimate the true arterial blood oxygenation status. (C) The patient's nails will show gray-blue discoloration. (D) Methylene blue treatment is required. (E) The 4-substance soup may contain sodium nitrite.", "output": "A"} 
-{"instruction": "A 55-year-old woman drank a large amount of herbicide two hours ago and was sent to the emergency room because of continuous vomiting and confusion. The patient's clothes were covered with blue-green liquid. Her coma index was E1V2M5, her blood pressure was 100/65 mmHg, her heart rate was 105 beats/min, her respiration was 26 times/min, and her SpO₂ was 86%. Which of the following statements is less appropriate?", "input": "(A) The patient needs endotracheal intubation. (B) It is paraquat poisoning. (C) The patient's liver function index may be elevated. (D) There is currently no antidote. (E) The main treatment is supportive therapy.", "output": "B"} 
-{"instruction": "According to Lake Louise Acute Mountain Sickness (Lake Louise Acute Mountain Sickness Sickness) diagnosis, which of the following clinical symptoms must be present to diagnose acute mountain sickness? ", "input": "(A) Headache. (B) Gastrointestinal symptoms such as loss of appetite, nausea or vomiting. (C) Fatigue or weakness. (D) Dizziness. (E) Insomnia. ", "output": "A"} 
-{"instruction": "A 25-year-old male climbed Yushan Mountain. On the first night, he stayed at Paiyun Villa (3,402 meters above sea level). On the second day, after climbing the main peak of Yushan Mountain, he reached the North Peak of Yushan Mountain (3,850 meters above sea level) in the afternoon. At night, he developed difficulty breathing at the North Peak of Yushan Mountain and coughed up foamy and bloody sputum. Which of the following treatments is the least appropriate? ", "input": "(A) Give oxygen. (B) Descend altitude. (C) Treatment with a hyperbaric chamber. (D) Treatment with nifedipine. (E) Treatment with Diamox (acetazolamide). ", "output": "E"} 
-{"instruction": "Which of the following is less appropriate for the prevention and treatment of decompression sickness? ", "input": "(A) Decompression sickness is caused by nitrogen accumulation in tissues or blood vessels. (B) The deep joint pain caused by Type I decompression sickness most often occurs in the knee or shoulder joints. (C) For severe symptoms of decompression sickness, recompression therapy should be used as soon as possible. (D) Intravenous injection is recommended to increase tissue perfusion. (E) For patients with arterial gas embolism, it is not recommended to transport them in a supine position. ", "output": "E"} 
-{"instruction": "A 55-year-old woman, slightly overweight, came to the emergency department because of upper abdominal pain combined with nausea and vomiting. The blood test results were as follows: WBC 18,000/mm³ (normal range <10,000/mm³), GOT (AST) 150 IU/L (normal value: 8-40 IU/L), Total Bilirubin 1.2 mg/dL (normal value: 0.4-1.2 mg/dL), Direct bilirubin 0.4 mg/dL (normal range: <0.4 mg/dL). Which of the following statements is most appropriate? ", "input": "(A)Acute acalculous cholecystitis is more common than calculous cholecystitis. (B)Emphysematous cholecystitis is more common in young people and patients with diabetes. (C)Murphy's sign is to press the right upper abdomen, and the patient will stop exhaling due to pain. (D)Abdominal ultrasound examination shows gallbladder wall thickness > 2mm plus pericholecystic fluid, which can diagnose cholecystitis. (E)Abdominal ultrasound examination is the preferred imaging diagnostic tool for this patient. ", "output": "E"} 
-{"instruction": "Which of the following statements about spontaneous bacterial peritonitis is less appropriate? ", "input": "(A)The annual incidence of spontaneous bacterial peritonitis in patients with cirrhosis and ascites is about 30%. (B) The diagnostic criteria are white blood cell count>250/mm³, or neutrophil count>50/mm³. (C) The most common pathogens are Escherichia coli, Klebsiella pneumoniae, and Streptococcal pneumoniae. (D) The use of third-generation cephalosporins is a reasonable choice for treatment. (E) When diagnosing spontaneous bacterial peritonitis, giving albumin 1.5g/kg and giving albumin 1g/kg on the third day can help reduce the chance of acute renal failure. ", "output":"B"} 
-{"instruction": "An 18-year-old male young man went on a binge drinking spree and developed chest pain due to violent vomiting. Which of the following statements is less appropriate?", "input": "(A) The pain caused by esophageal rupture is often acute and radiates to the back. (B) The patient may have symptoms such as dysphagia, dyspnea, vomiting blood, and cyanosis. (C) If mediastinal emphysema is not found on the initial X-ray examination, a rupture of the lower esophagus cannot be ruled out. (D) If the rupture is located in the high esophagus (cervical perforations), it is often complicated by pleural effusion. (E) Esophageal rupture often occurs on the left side of the distal esophagus.", "output": "D"} 
-{"instruction": "Which of the following statements about acute pancreatitis is less appropriate?", "input": "(A) About 80% of patients have only mild inflammation, and the mortality rate is less than 1%. (B) Most patients do not require antibiotic treatment. (C) Common causes include gall stones, alcohol, etc. (D) You must wait until the abdominal pain disappears before trying a liquid diet. (E) When the patient's clinical manifestations and various test data are consistent with the diagnosis of acute pancreatitis, it is not necessarily necessary to arrange an abdominal CT examination.", "output": "D"} 
-{"instruction": "A 5-year-old girl complained of mild cold symptoms starting 3 days ago. Two days ago, he started to have intermittent abdominal pain. He went to the emergency room because of the worsening abdominal pain. At that time, he had obvious pain in both knee joints and lower limbs. There were red spots and bruise-like lesions in his lower limbs. There was blood in his stool. He had no fever, vomiting, or history of trauma. He had no chronic diseases or allergies in the past. The results of emergency blood tests were as follows: sugar 78 mg/dL, BUN 18 mg/dL, amylase 51 U/L, AST 45 U/L, CRP 0.85 mg/L, WBC 12,100/uL, Hb 11.8 g/dL, Hct 36.5%, platelet 389 k/uL, urine test results: WBC 5/HPF, RBC 40/HPF. Which of the following is the most likely diagnosis for this patient? ", "input": "(A)Immune thrombocytopenic purpura (ITP). (B)Hemophilia. (C)Henoch-Schonlein purpura. (D)V on Willebrand disease. (E)Meningocococemia. ", "output": "C"} 
-{"instruction": "A 27-week pregnant woman had an emergency delivery in the emergency room and underwent an amputation by the emergency physician. Examination revealed no cyanosis, rosacea, and limbs. The body was bent. The face responded when respiratory secretions were suctioned. The cry was weak and the heart rate was 88 beats/min. What is the APGAR score calculation result? ", "input": "(A)3. (B)4. (C)5. (D)6. (E)7. ", "output": "D"} 
-{"instruction": "A 9-month-old girl weighing 10 kg, her family reported that she had convulsions 20 minutes ago. The clinical manifestations were eyes drooping, loss of consciousness, stiffness of both limbs and subsequent twitching, which lasted for 15-20 minutes. She was drowsy when she arrived at the emergency room. Her family said that she had cold symptoms recently and had a poor appetite. The vital signs were as follows: breathing 26 times/min, heart rate 162 times/min, blood oxygen saturation 97% without the use of supplementary oxygen, capillary refilling time <2 seconds. The child cries occasionally, breathes shallowly but not laboredly, has rosy skin, and is soft and tender to the touch. He has no hepatosplenomegaly, normal lung sounds, and no heart murmurs. Which of the following statements is inappropriate? ", "input": "(A) The first priority is to ensure a patent airway and stabilize vital signs. (B) If hypoglycemia is the cause, 100 mL of 10% glucose water should be immediately administered intravenously. (C) If convulsions persist, consider giving 1 mg of lorazepam intravenously. (D) If convulsions persist and intravenous drips are not possible, 5 mg of diazepam should be administered through the rectum. (E) If the convulsion persists, consider intravenous injection of midazolam 2mg load, plus continuous intravenous injection of midazolam 1mcg/kg/min.", "output": "B"} 
-{"instruction": "Which of the following descriptions of the causes, symptoms and treatments of diseases related to acute limb artery occlusion is less appropriate? ", "input": "(A) Embolism is caused by atrial fibrillation, rheumatic heart disease, etc., and the symptom is intermittent claudication. It should be treated with drugs first, and then interventional treatment should be considered. (B) Raynaud's disease is caused by spasm of small arteries due to cold or pressure, resulting in pain, pallor, cyanosis, etc., and is treated with rewarming and medications such as calcium blockers or beta blockers. (C) Trash foot or blue toe syndrome is caused by cholesterol/platelet aggregation embolism, resulting in pain and cyanosis in part of the foot, while the rest of the foot is warm. (D) Buerger's disease is common in smokers, and is an inflammation of small and medium-sized blood vessels without atherosclerosis, resulting in painful nodules, ulcers or gangrene. (E) Hypothenar hammer syndrome is caused by the use of vibrating tools, which leads to the degeneration and narrowing of the ulnar artery or aneurysm, resulting in pain and discoloration of the ulnar fingers (one or more) except the thumb. ", "output": "A"} 
-{"instruction": "Which of the following is not included in the causes of QT prolongation leading to Torsades de Pointes? ", "input": "(A) Stroke (including subarachnoid hemorrhage). (B) Severe bradycardia or atrioventricular block. (C) Drugs such as organophosphorus and antihistamines. (D) Antibiotics, especially third-generation cephalosporins. (E) Class IA and IC antiarrhythmic drugs. ", "output": "D"} 
-{"instruction": "According to the American Heart Association's 2015 guidelines for cardiopulmonary resuscitation, which of the following descriptions of basic life-saving techniques for adults is more appropriate? ", "input":"(A) If the patient is suspected of opioid intoxication and has cardiac arrest, consider giving the antidote naloxone before performing CPR. (B) According to the few empirical studies currently available, the location of chest compression is no different for patients, whether it is the center of the chest or the lower half of the sternum, so the lower half of the sternum is recommended as the chest compression location. (C) The chest compression speed is set at 100-120 times/minute because studies have shown that too fast a chest compression speed will cause rescuers to quickly become overworked and affect the quality of chest compression. (D) The chest compression depth is set at 5-6 cm because studies have shown that a depth of more than 6 cm can easily cause patient injury, and professional rescuers often compress too deep. (E) For chest massage, be sure to try not to interrupt it for more than 10 seconds and chest compression fraction (CCF) At least 50%. ", "output": "B"}
-{"instruction": "An 80-year-old man with a history of asthma needs to be intubated immediately due to pneumonia, sepsis and multiple organ failure. His blood pressure is 60/40 mmHg, heart rate is 110 beats/min, renal function creatinine is 12.6mg/dL, and potassium is 7.0 mmol/L. When performing rapid sequence intubation, which of the following statements is inappropriate?", "input": "(A) High-concentration oxygen should be given before intubation to maintain the blood oxygen concentration at 100% before intubation as much as possible. (B) Premedication, lidocaine can be given to reduce adverse physiological reactions caused by intubation. (C) A large amount of fluid should be given quickly to treat hypotension. (D) Propofol can be preferred as a sedative. (E) Rocuronium can be selected as a muscle relaxant. ", "output": "D"}  
-{"instruction": "A 26-week pregnant woman went to the emergency room with palpitations and cold sweats. Her blood pressure was 60/40 mmHg, her heart rate was 170 beats/min, and her breathing was 30 breaths/min. Which of the following statements is more appropriate for emergency resuscitation of the pregnant woman? ", "input":"(A) According to the 2015 AHA ACLS guidelines, during the resuscitation process, a long backboard and a bed blanket should be used to assist in raising the bed and keep the pregnant woman lying on her left side to maintain the return of body fluids. (B) If endotracheal intubation is required, rapid-sequence intubation drugs can still be used as usual, and the drug dosage is no different from that of ordinary adults. (C) The intravenous injection route should give priority to the inguinal central venous catheter. (D) There is no need to consider emergency cesarean section for fetuses under 28 weeks. (E) Adenosine can have serious adverse effects on the fetus and should be avoided in pregnant women.", "output": "B"}
-{"instruction": "A 60-year-old male with a history of smoking and diabetes suddenly collapsed and lost consciousness at work this afternoon. He was sent to the emergency room by 119. He had no vital signs before arriving at the hospital. After CPR and defibrillation, his spontaneous circulation was restored. According to the 2015 AHA standard treatment process for post-cardiac arrest care, which of the following statements is more appropriate? ", "input": "(A) If the patient continues to be comatose, hypothermia may be required, with the goal of maintaining a body temperature of 31-33℃. (B) If the patient's blood pressure is too low, dopamine 5-10mcg/kg/min should be given to maintain mean arterial pressure≥90mmHg. (C) The patient does not need to be given 100% oxygen throughout the whole process. Adjust FiO2 until the patient's SpO₂ ≥94%. (D) If the patient is still not conscious within 12 hours after resuscitation, it can be judged as a poor neurological prognosis, and it is necessary to discuss with the family about giving up emergency treatment. (E) If the electrocardiogram does not show STEMI, there is no need to consider coronary reperfusion treatment. Other causes should be found as soon as possible. ", "output": "C"} 
-{"instruction": "Which of the following statements about ovarian torsion is more appropriate? ", "input": "(A) Most torsion occurs on the left side because the left uterine-ovarian ligament is longer. (B) The typical presentation is progressive unilateral lower abdominal pain after exercise. (C) Torsion is almost always associated with ovarian enlargement. (D) Transabdominal Doppler ultrasound is the diagnostic tool of choice. (E) It is caused by thrombotic blockage of the artery, resulting in local ischemia and necrosis of the ovary. ", "output": "C"} { 
-"instruction": "A 30-year-old woman complained of right lower abdominal pain for one day, accompanied by dizziness, nausea and vomiting. When she was seen in the emergency department, her vital signs were blood pressure 90/50 mmHg, heart rate 115 beats/min, respiration 20 times/min, body temperature 37.5℃, physical examination shows tenderness and rebound pain in the entire lower abdomen, the last menstruation was 5 weeks ago, but the patient said that she had undergone vasectomy and it was impossible for her to be pregnant, and her menstruation was irregular. The blood test report showed that the white blood cell count was 18,000/mL and the hemoglobin was 7.8g/dL. Which of the following statements is more appropriate? ", "input": "(A) She has undergone vasectomy and does not need a pregnancy test. An imaging examination should be arranged as soon as possible to rule out diseases that require surgery. (B) A Modified Alvarado score of 5 points is low risk and can rule out the diagnosis of acute appendicitis. (C) Abdominal ultrasound reveals ascites in the Douglas pouch, and the value of β-hCG in serum can determine whether it is an ectopic pregnancy. (D) For patients with suspected ectopic pregnancy, when ultrasound and blood tests cannot confirm the diagnosis, magnetic resonance imaging is the first choice for diagnosis. (E) When ultrasound shows intrauterine pregnancy, ectopic pregnancy can be ruled out unless the patient has a high risk of heterotopic pregnancy. ", "output": "E"} 
-{"instruction": "Which of the following statements about spontaneous abortion is more appropriate? ", "input": "(A) According to the WHO definition, it is before 20 weeks of gestation or the fetus is less than 800 grams. (B) Most cases occur before 8 weeks of pregnancy. (C) The most common symptom is abdominal pain plus vaginal bleeding. (D) The most common cause is infection. (E) Most cases of threatened abortion result in the loss of the fetus. ", "output": "B"} 
-{"instruction": "Which of the following statements about hyperemesis gravidarum is more appropriate? ", "input": "(A) It is defined as persistent vomiting accompanied by weight loss, dehydration, and high sodium levels. (B) Evidence shows that ketonemia caused by dehydration is harmful to the fetus. (C) Serial measurements of urine ketones can be used to determine the success of treatment. (D) It is often accompanied by abdominal pain, so be careful to differentiate it from other diseases. (E) It can be treated with vitamin B12. ", "output": "C"} 
-{"instruction": "Which of the following statements is inappropriate regarding receiving radiological imaging examinations during pregnancy? ", "input": "(A) A dose of less than 50 mGy is safe. (B) It is unsafe to receive an abdominal CT scan. (C) A dose of more than 100 mGy may be teratogenic. (D) A CT scan for pulmonary embolism is safe. (E) Pelvic X-rays have no effect on the fetus. A 40-year-old woman who 
-has given birth to two children and is currently 33 weeks pregnant complained of right upper abdominal pain for one week; blood pressure 160/110 mmHg; blood test report: hemoglobin 7.0 g/dL (12-15g/dl), platelets 90,000/μL (160,000-400,000/μL), ALT 120 U/L (5-25 U/L), AST 230 U/L (5-35 U/L), total bilirubin 3.2 mg/dL (0.2-1.2 mg/dL), INR 4 (0.8-1.2), APTT 70 seconds (28.0-39.0 seconds) ; Abdominal ultrasound showed no gallstones, gallbladder wall swelling, renal abnormalities, or ascites. Which of the following statements is less appropriate? ", "input":"(A) May occur in women with abdominal pain > 20 weeks gestation or within 7 days postpartum. (B) Diagnosis is a variant of preeclampsia. (C) Initial treatment is similar to eclampsia; intravenous magnesium, blood pressure control, hospitalization. (D) Definitive treatment is delivery, especially at ≥ 28 weeks gestation. (E) For women who are not yet ready for delivery, corticosteroids can help delay delivery and improve fetal outcomes.", "output": "D"} 
-{"instruction": "Which of the following is less appropriate regarding the side effects or complications of cathinones?", "input": "(A) Compartment syndrome. (B) Retrograde amnesia amnesia). (C) acute kidney injury. (D) hyperthermia. (E) delirium. ", "output": "B"} 
-{"instruction": "A town was attacked by a plane carrying poison gas bombs, and many people were killed or injured. The symptoms of poisoning are increased bronchial secretions, pupil constriction, nausea and vomiting, and abdominal cramps. Which of the following poisonous gases is less likely to be the cause? ", "input": "(A)Sarin (GB). (B)Tabun (GA). (C)Sulfur mustard (HD). (D)Cyclosarin (GF). (E)Soman (GD). ", "output":"C"} 
-{"instruction": "Which of the following is less appropriate in the assessment and treatment of rib fractures in elderly patients with chest trauma?", "input": "(A) The conditions for hospitalization should be lenient and the observation time should be sufficient. (B) Arterial oxygen saturation should be continuously monitored and oxygen should be supplied to maintain >95%. (C) The patient can only be discharged after the expectoration ability and pain control have been stabilized. (D) When flail chest, pulmonary contusion, or hemothorax occurs after injury, the elderly are more likely to lose their compensation ability, regardless of their original lung function. (E) The elderly have a reduced tolerance to opium analgesics, which can easily lead to respiratory failure and hypotension.", "output": "D"} 
-{"instruction": "A trauma patient, unconscious after a car accident (GCS E2V3M4), vital signs are stable. The 1st and 2nd ribs on the right and the 9th and 10th ribs on the left are segmental fractures. There is no pneumothorax in the first chest X-ray. Which of the following descriptions is less appropriate?", "input": "(A) This patient does not meet the diagnosis of pneumothorax. (B) Chest X-rays often underestimate the extent of chest trauma. (C) Ultrasound is more sensitive and accurate in diagnosing pneumothorax than chest X-rays. (D) CT is much more accurate in diagnosing potential pneumothorax than ultrasound. (E) When ninth and tenth rib fractures are combined with unexplained hypotension, liver and spleen bleeding should be considered.", "output": "D"} { 
-"instruction": "Which of the following statements about the examination of patients with acute heart failure is less appropriate?", "input": "(A) A B-type natriuretic peptide value greater than 500 pg/mL should lead to a high suspicion of heart failure. (B) Atrial fibrillation is often found on an electrocardiogram. (C) The presence of bilateral B lines on ultrasound can confirm the presence of pulmonary edema. (D) A chest X-ray has a 20% chance of being normal. (E) Auscultation may reveal S3 gallop. ", "output": "C"} 
-{"instruction": "Which of the following statements about spontaneous nosebleeds (epistaxis) is less appropriate? ", "input": "(A) It occurs more often in dry seasons. (B) It occurs more often in middle-aged people between the ages of 30 and 50. (C) Bleeding occurs more often in the anterior than in the posterior nasal cavity. (D) Bleeding in the anterior nasal cavity most often originates from the Kiesselbach plexus. (E) Bleeding in the posterior nasal cavity most often originates from the sphenopalatine artery. ", "output": "B"} 
-{"instruction": "A trauma patient from an outlying island needs to be transferred to the main island by air. Which combination of medical personnel on board will give the patient the best prognosis?", "input": "(A) Nurse and paramedic. (B) Nurse and nurse. (C) Nurse and doctor. (D) Nurse and respiratory therapist. (E) No special difference.", "output": "E"} 
-{"instruction": "Which of the following is not an indication for air ambulance in Taiwan?", "input": "(A) Two or more long bone fractures. (B) Burns to the perineum. (C) Third-degree burns covering 10% of the area. (D) Trauma that has caused limb paralysis. (E) Broken fingers. ", "output": "E"} 
-{"instruction": "A 35-year-old male was injured in a car accident and was sent to the emergency room with paraplegia of the lower body. Examination revealed that his spinal cord injury level was approximately T10. In addition to paraplegia, the patient lost pain and temperature sensation below the T10 level, but still retained touch. What type of spinal cord injury does this patient have? ", "input": "(A)Anterior cord syndrome. (B)Brown-Séquard syndrome. (C)Cauda-Equina syndrome. (D)Central cord syndrome. (E)Posterior cord syndrome. ", "output": "A"} 
-{"instruction": "A 2-year-old boy was brought to the emergency room by his parents. He weighed 13 kg, had a heart rate of 160 beats/min, a blood pressure of 84/38 mmHg, and an oxygen saturation of 90%. X-ray examination showed left hemopneumothorax, rib fractures, and a rotational fracture of the humerus. Which of the following statements is less appropriate? ", "input": "(A) This fracture strongly suggests child abuse and should be reported to the child protection agency within 48 hours. (B) The heart rate is too fast, but the blood pressure is still above the lower limit of blood pressure for that age. (C) Give 260 mL of normal saline as soon as possible. (D) The chest tube needs to be inserted higher than that of an adult because a child's diaphragm is higher than that of an adult. (E) After the left chest tube is placed, if the bleeding continues to exceed 130 mL per hour, the large blood vessels may be injured. ", "output": "A"} 
-{"instruction": "You are on duty in the emergency department of a general emergency hospital today. There is no surgical doctor on duty that day. The ambulance brings in a 28-year-old male who fell off a motorcycle. He is conscious, with a heart rate of 128 beats/min and a blood pressure of 78/42 mmHg. He complains of severe pelvic and right thigh pain, no obvious cervical spine tenderness, free movement of both upper limbs and no numbness or pain. The right thigh is deformed and the femur is exposed. Pelvic displacement and obvious tenderness are found on palpation. No ascites is found on ultrasound. Which of the following statements is more appropriate? ", "input": "(A) It is not possible to decide whether cervical spine imaging is necessary based on the NEXUS criteria. (B) The patient has lost approximately 750mL-1,500mL of blood, so Ringer's solution and blood transfusion should be given immediately. (C) Ultrasound cannot rule out intra-abdominal bleeding, so a CT scan should be completed before transfer. (D) A urinary catheter should be placed as soon as possible in case of suspected unstable pelvic fracture. (E) The open 
-fracture of the right thigh should be cleaned as soon as possible to reduce the risk of infection. ", "output": "A"} {"instruction": "Which of the following descriptions of acute epiploic appendagitis is less appropriate? ", "input":"(A) Most cases do not require surgery. (B) Most cases do not cause fever or vomiting. (C) Most cases require antibiotics. (D) Most cases heal within 1-2 weeks. (E) Epiploic appendages are most commonly found near the sigmoid colon and cecum.", "output": "C"} 
-{"instruction": "A 25-year-old female, 8 months pregnant, suddenly felt right chest pain and difficulty breathing, which became more severe during physical activity. She was conscious when she was examined in the emergency room, with a heart rate of 120 beats/min, a respiration rate of 30 breaths/min, a blood pressure of 85/50 mmHg, a temperature of 37.5℃, and a blood oxygen concentration of 90%. Auscultation revealed clear lung sounds on both sides, with no obvious heart murmurs. ECG There are extensive T wave inversions. The compression test of the lower extremity venous ultrasound is normal. Which of the following treatments is more appropriate? ", "input": "(A) Consider subcutaneous injection of low molecular weight heparin and oral warfarin at the same time. (B) Give oxygen first and arrange for chest CT to confirm the diagnosis. (C) Give inhaled bronchodilators first and start steroids. (D) Antibiotics should be given, and amoxicillin/clavulanate and clarithromycin can be used. (E) The risk of progression to septic shock is high, and the initiation of a sepsis bundle should be considered. ", "output": "B"}
-{"instruction": "A 56-year-old male patient complained of vomiting blood and had a history of liver cirrhosis. His vital signs showed a temperature of 37.3℃, respiratory rate of 26 breaths/min, heart rate of 124 beats/min, and blood pressure of 86/60 mmHg. Which of the following statements is more appropriate for the management of this patient?", "input": "(A) The cause of bleeding is almost always rupture of esophageal venous aneurysm, with very few exceptions. (B) The purpose of nasogastric lavage is to provide a clearer view during gastroscopy. (C) The patient's family members indicated that he had an allergic reaction to blood transfusion before. If a blood transfusion is required, the use of leukocyte-poor PRBC can prevent this from happening again. (D) This patient should be treated with antibiotics such as ciprofloxacin as soon as possible to reduce the mortality rate. (E) If the patient's hemoglobin is 8.0 g/dL, there is no need to use the massive transfusion protocol. ", "output": "D"} "(A) The cause of bleeding is almost always rupture of esophageal venous aneurysm, with very few exceptions. (B) The purpose of nasogastric lavage is to make the field of vision clearer during gastroscopy. (C) The family members said that the patient had an allergic reaction to blood transfusion before. If a blood transfusion is required, the use of leukocyte-poor PRBC can prevent this from happening again. (D) This patient should be given antibiotics such as ciprofloxacin as soon as possible to reduce the mortality rate. (E) If this patient's hemoglobin is 8.0 g/dL, there is no need to use a massive transfusion protocol.", "output": "D"} 
-{"instruction": "According to the National Health Insurance Medical Service Benefit Items and Payment Standards, after a patient with cardiac arrest recovers spontaneous circulation, which of the following is suitable for the use of targeted temperature management (TTM) management)？ ", "input": "(A)Resumption of spontaneous circulation for more than 12 hours. (B)Systolic blood pressure 100 mmHg. (C)Computed tomography of the brain shows intracranial hemorrhage. (D)Consciousness GCS 9 after resuscitation after cardiac arrest. (E)There is a large amount of active internal bleeding. ", "output": "B"}
-{"instruction": "Which of the following actions, if performed on a patient with right neck and shoulder pain, is more likely to be a muscle strain? ", "input": "(A) The patient tilts his head back and rotates to the side. The examiner stands behind him and presses the top of the patient's forehead with both hands. The patient experiences radiating pain or numbness in the upper limb. (B) The patient raises his right palm and places it on the top of his head to relieve the pain on the affected side. (C) When the patient bends his neck and touches his chin to his chest, it will induce an electric shock sensation or paresthesias in the right upper arm. (D) The pain is worse when the patient turns his head to the left. (E)Continued breath-holding will increase pain in the right neck and shoulder. ", "output": "D"} 
-{"instruction": "Which of the following statements about massive hemoptysis is more appropriate? ", "input": "(A)The pulmonary artery is responsible for 99% of the blood flow to the lungs and is therefore often the main cause of hemoptysis. (B)Rasmussen's aneurysm is often caused by Aspergillus infection. (C)For patients with massive hemoptysis and instability, bronchoscopy after intubation is the first line of diagnosis and treatment. (D)In order to avoid the difficulty of intubation, a smaller endotracheal tube is usually selected for the treatment of patients with massive hemoptysis. (E)If a tracheotomy patient has a trachea-innominate fistula, it is usually impossible to temporarily stop the bleeding by applying pressure, and surgical treatment should be requested immediately. ", "output": "C"} 
-{"instruction": "A 70-year-old male with a history of diabetes underwent right thoracotomy two weeks ago. He presented to the emergency department today with fever, dyspnea, and severe chest pain on inspiration. A chest X-ray showed a moderate right pleural effusion, which was aspirated with a fine needle and revealed purulent material. Which of the following statements is more appropriate for the diagnosis and management of this patient?", "input": "(A) The most common possible pathogen in this patient is S. pneumococcus. (B) The diagnostic criteria for empyema include a pleural fluid glucose level greater than 40 mg/dL and an LDH level greater than 1,000 U/L. (C) The pH value of the pleural fluid is 6.9, which can strengthen the diagnosis. (D) The preferred antibiotics are amoxicillin/clavulanate. (E) The disease is in the organizational stage and can be cured by antibiotics and chest tube drainage. ", "output": "C"} 
-{"instruction": "A 67-year-old male is currently taking rivaroxaban regularly in the cardiology department. He suffered pelvic and femoral neck fractures in a car accident. Which of the following statements about this patient is more appropriate? ", "input": "(A) Reversal agents can be used to avoid major bleeding. (B) If you want to understand the coagulation status, the aPTT time will be more accurate than the PT time. (C) This patient should regularly track coagulation factors. (D) Poor renal function will lead to a decrease in the excretion rate of rivaroxaban. (E) If the patient has massive bleeding, emergency hemodialysis is recommended to metabolize the drugs. ", "output": "D"} 
-{"instruction": "A 30-year-old female, 32 weeks pregnant, weighing 60kg, came to the emergency room with convulsions at home. Her family said that the patient had no history of seizures. The patient had several more seizures in the emergency room, and her blood pressure was 180/90 mmHg. Which of the following drugs should be considered first? ", "input": "(A)Lorazepam 6mg iv. (B)Labetalol 10mg iv. (C)Magnesium sulfate 4g iv. (D)Midazolam 10mg im. (E)Propofol 60mg iv. ", "output": "C"} 
-{"instruction": "A 5-year-old girl was brought to the emergency room by her mother for suspected abnormal behavior in the kindergarten. The teacher found that the girl often bit her lips for up to 10 minutes recently, her eyes were dull, she was not interactive, there were no bruises on her body, and she would occasionally turn her head to respond when called. The mother said that she also found similar situations at home. The emergency room measured vital signs and found blood pressure of 106/55 mmHg, heart rate of 96 beats/min, respiration of 20 times/min, body temperature of 36.3℃, and no fever or cough recently. During the physical examination, the girl had no errors in communication. Which of the following statements is more appropriate? ", "input": "(A) The girl's behavior is abnormal and she is suspected of being mentally stimulated. The child prevention and protection process (domestic violence or sexual assault) should be initiated. (B) The girl's eyes were dull, which was suspected to be an infection. Blood tests and blood sugar tests were performed. (C) The girl's behavior was recurrent, which was suspected to be a brain tumor. A CT scan was performed. (D) The girl often bit her lips and had recurrent seizures. She was suspected of epilepsy. An EEG test was arranged. (E) The girl's interaction was poor, which was suspected to be developmental delay. An evaluation was performed. ", "output": "D"} 
-{"instruction": "Regarding the renal injury scale (Grade IV), which of the following statements is more appropriate? ", "input": "(A) Grade III and above recommends surgical exploration. (B) Injuries to the medulla are at least Grade III. (C) Most renal gunshot and puncture injuries require surgical exploration. (D) Urinary extravasation on imaging is an indication for surgical exploration. (E) Sequential complications of kidney injury may include delayed bleeding, urinoma, and hypertension. ","output": "E"} 
-{"instruction": "A male patient complained of chest tightness and shortness of breath and came to the emergency department. After the first-line resident gave the patient nitroglycerin via intravenous pump infusion, the patient's blood pressure dropped severely. You took over the treatment. Which of the following causes is less likely?", "input": "(A) Hypertrophic obstructive cardiomyopathy. (B) Right ventricular infarction. (C) Aortic stenosis. (D) Anaphylaxis. (E) Mitral regurgitation.", "output": "E"}
-{"instruction": "Which description of acute kidney injury is less appropriate?", "input": "(A) Most patients with community-based acute kidney injury suffer from prerenal (insufficient renal perfusion), and fluid replacement (crystalloid) is the main treatment. (B) Most patients with hospital-based acute kidney injury suffer from renal ischemic tubular necrosis. (C) Patients who use angiotensin-converting enzyme (ACE) inhibitors and whose renal function deteriorates rapidly are likely to have bilateral renal artery stenosis. (D) If the patient has very poor renal function but is stable and contrast is necessary, arranging for an MRI with gadolinium-based contrast may avoid renal damage. (E) Post-obstructive renal damage from complete obstruction can result in permanent renal impairment after 10-14 days. ", "output": "D"} "(A) Most patients with community-based acute renal injury have prerenal (insufficient renal perfusion) and are primarily treated with crystalloid fluid replacement. (B) Most patients with hospital-based acute renal injury have renal ischemic tubular necrosis. (C) Patients taking angiotensin-converting enzyme (ACE) inhibitors are likely to have bilateral renal artery stenosis if their renal function rapidly deteriorates. (D) If the patient's renal function is extremely poor but the condition is stable and the use of contrast agents is necessary, arranging an MRI with gadolinium-based contrast can avoid renal injury. (E) Post-obstructive lesions caused by complete occlusion Kidney damage can cause permanent renal impairment after 10-14 days. ", "output": "D"} 
-{"instruction": "A 2-year-old boy was taken to the emergency room with fever and wheezing three days ago. In the emergency room, you decide to perform endotracheal intubation. Which of the following statements is more appropriate? ", "input": "(A) When performing endotracheal intubation, if the glottis cannot be seen, it is advisable to place a pillow behind the boy's neck to align the trachea and oropharynx. (B) If difficult intubation occurs, surgical cricothyroidotomy should be performed urgently. (C) If oral endotracheal intubation fails multiple times, nasal intubation can be tried. (D) If a 4.5 mm endotracheal tube is used for endotracheal intubation, a cuffed endotracheal tube should be used and the cuff pressure should be continuously monitored. (E) When performing endotracheal intubation, a curved laryngoscope blade should be used. ", "output": "D"}
-{"instruction": "A 50-year-old female patient who has been on peritoneal dialysis for many years presents to the emergency department with vomiting, abdominal pain, and a 2-day history of fever. Analysis of the peritoneal dialysis fluid reveals: WBC 90/mm³, of which 40% are neutrophils. Which of the following is more appropriate? ", "input": "(A) It is likely peritonitis, and a general surgeon should be consulted immediately. (B) It is likely peritonitis related to peritoneal dialysis, and IV antibiotics should be given immediately. (C) It is very likely peritoneal dialysis-related peritonitis. IP antibiotics should be given immediately (antibiotics are added to the dialysate). (D) It is unlikely to be peritoneal dialysis-related peritonitis. Peritoneal dialysis should be stopped immediately and a nephrology consultation will be conducted. (E) It is unlikely to be peritoneal dialysis-related peritonitis. Other tests should be arranged immediately to confirm the diagnosis. ", "output": "E"} 
-{"instruction": "A 3-year-old boy came to the emergency department because of difficulty breathing for three days and the symptoms became increasingly severe. The family said that the boy had been vaccinated on time in the past. In the past few days, his breathing has been more rapid and labored, and he has been less energetic. Physical examination findings: Chest auscultation revealed obvious stridor when the boy was resting, and the boy kept coughing, and the sound was like a barking cough. ; Appearance: There is chest retraction when breathing. Which of the following actions is more appropriate? ", "input": "(A) Give antibiotic treatment. (B) Immediately give steroid (dexamethasone) treatment, and it should be given intravenously, not orally. (C) Inhaled Beta-agonist drugs are not recommended because this action may aggravate the upper airway obstruction. (D) Immediately give inhaled Epinephrine treatment, which will not help the boy's condition. (E) Use a thicker endotracheal tube for endotracheal intubation. ", "output": "C"} 
-{"instruction": "To perform a Dix-Hallpike examination, what position do you need to arrange to start? ", "input": "(A) The patient is sitting on the examination bed. (B) The patient lies supine on the examination bed with the head facing upward. (C) The patient lies supine on the examination bed with the head tilted to one side. (D) The patient lies supine with the head tilted back outside the headboard and the head facing upward. (E) The patient lies supine with the head tilted back outside the headboard and the head tilted to one side. ", "output": "A"} 
-{"instruction": "Which of the following statements is more appropriate for patients with intestinal obstruction? ", "input": "(A) Postoperative adhesions rarely lead to large intestinal obstruction. (B) Anticonvulsant drugs such as Buscopan (hyoscine butylbromide) should be used as soon as possible to relieve the patient's abdominal pain. (C) Incarcerated groin hernia is the most common cause of small intestinal obstruction. (D)Nasogastric tube placement is often necessary and should be used early. (E)Severe intestinal obstruction leads to intestinal ischemic necrosis, with a mortality rate of about 50%. ", "output": "A"} 
-{"instruction": "Which of the following statements about Toxic epidermal necrolysis is more appropriate? ", "input": "(A)The average mortality rate of Toxic epidermal necrolysis is 60-70%. (B)When Toxic epidermal necrolysis affects more than 30% of the body surface area (BSA), it is called Stevens-Johnson syndrome. (C)Toxic epidermal necrolysis does not invade the conjunctiva and cornea. (D)The initial symptoms are often fever, sore throat, and muscle pain. (E)Skin rashes may appear all over the body, especially on the trunk. ", "output": "D"} 
-{"instruction": "Which description of symptom treatment for palliative care is more appropriate? ", "input": "(A) The biggest concern with actively using opioids to control pain is that it will cause sudden respiratory depression. (B) For terminal patients with shortness of breath, in addition to treating the underlying condition, the starting dose of morphine is twice the dose used to treat pain. (C) For persistent nausea and vomiting, morphine can be used at half the dose used to treat pain. (D) When prescribing opium to treat terminal pain, a stimulant or osmotic laxative should be prescribed at the same time to prevent constipation. (E) For terminally agitated patients, there is evidence that the use of antipsychotics, hypnotics, or opioids can hasten death. ", "output": "D"} 
-{"instruction": "A 25-year-old male drowned in a river with transient unconsciousness and was brought to the emergency department with a Glasgow Coma Scale score of 15 and SaO2 of 95%. Which of the following is less appropriate? ", "input": "(A) Often associated with head trauma or excessive neck extension, routine use of a cervical collar is recommended. (B) Observation for 4-6 hours is recommended, and follow-up chest X-rays are not necessary if physical examination shows normal lungs. (C) Blood tests for low sodium and low potassium are uncommon. (D) Prophylactic antibiotics are not routinely required. (E) If SaO2 drops to 91%, in addition to chest X-ray and routine blood tests, drug screening should be considered. ", "output": "A"} 
-{"instruction":"A 25-year-old female accidentally ingested about 120 ml of an unknown chemical. 14 hours later, she went to the emergency room for dizziness and nausea. The patient said that the drug tasted sweet. At the time of consultation, her temperature was 36.8℃, her breathing was 18 times/min, her heart rate was 92 times/min, her blood pressure was 169/85 mmHg, Na was 142 mmol/L, Cl was 109 mmol/L, BUN was 7 mg/dL, glucose was 131 mg/dL, ketone body: negative, Ethanol was 3 mg/dL, blood osmolality was 319 mOsm/Kg, and arterial blood gas analysis showed pH 7.29, PCO₂ 25.4 mmHg, HCO₃ 12.5 mmol/L, urine analysis was Calcium oxalate crystals were detected. Which of the following substances is the patient most likely to have ingested? ", "input": "(A) Methanol. (B) Toluene. (C) Ethylene glycol. (D) 2-chloroethanol. (E) Isopropyl alcohol. ", "output": "C"}
-{"instruction": "A 6-year-old boy was walking across the street when he was hit by a car traveling at 35 km/h. Which of the following statements is more appropriate regarding the care of this victim?", "input": "(A) Because of the large impact on the thorax, flail chest is common. (B) The likelihood of symptomatic cardiac contusion is higher than in adults. (C) The chance of tension pneumothorax is higher than in adults. (D) The chance of transection of the thoracic aorta is higher than in adults. (E) Rib fractures are common in children with this mechanism of injury.", "output": "C"}  
-{"instruction": "Which of the following statements about the use of thrombolytic agents (r-tPA) to treat ischemic stroke is less appropriate? ", "input":"(A) If the patient is suffering from epileptic seizure and unconsciousness, thrombolytic therapy should not be considered. (B) If all conditions are met, r-tPA can be considered for brain tumors that have been cured for more than three months. (C) The patient's blood pressure should be maintained at less than 185 mmHg systolic and less than 110 mmHg diastolic before medication. (D) It should never be used in patients with unclear symptom onset. (E) If the patient is eligible for arterial embolectomy, r-tPA can still be given before embolectomy.", "output": "B"} 
-{"instruction": "A 50-year-old male driver was hit by a truck. When he arrived at the emergency room, his vital signs were as follows: temperature 36.2℃, respiration 40 times/min, heart rate 140 times/min, blood pressure 70/40 mmHg, blood oxygen 80%, confusion, and coma index 14. Primary assessment showed that his airway was patent and free of foreign objects, his trachea was deviated to the left, his cervical veins were distended, and there was subcutaneous edema on the right chest wall. Which of the following treatments is more appropriate?", "input": "(A) Emergency thoracotomy on the right side. (B) Bag-valve-mask ventilation. (C) Non-invasive positive pressure ventilator. (D) A tube thoracotomy was placed in the fifth intercostal space on the right side. (E) A needle decompression was placed in the fifth intercostal space on the right side. ", "output": "E"}
-{"instruction": "A six-year-old child weighing 20 kg was sent to the emergency room with abdominal contusion during a kindergarten trip. There were no abnormal findings in the respiratory tract or breathing. There was abdominal tenderness with rebound tenderness. The blood pressure was 70/30 mmHg with symptoms of shock. Which of the following statements is more appropriate for emergency treatment?", "input": "(A) 1,000 ml of isotonic crystalloid solution should be given for fluid resuscitation and reassessed. (B) 400 ml of isotonic crystalloid solution should be given for fluid resuscitation. (C) If the child is still in shock after the first infusion, 10 ml of isotonic crystalloid solution per kilogram can be given for the second or third infusion. (D) Because the child has a lower tolerance to shock, direct blood transfusion can be given as a priority. (E) Transfusion therapy is 20 ml packed RBC per kg. ", "output": "B"} 
-{"instruction": "You are preparing to extract knee joint fluid. Which of the following statements is more appropriate? ", "input": "(A) It is best to extract in a sitting position. (B) It is best to extract with the knees bent. (C) The two finger widths (about 3 cm) just below the patella are used as the reference point. (D) The needle is inserted on the inside or outside of the reference point and moves horizontally toward the midpoint of the posterior side of the patella. (E) When extracting, avoid milking the joint cavity at the same time to avoid bleeding in the joint cavity. ", "output": "D"} 
-{"instruction": "Which of the following options is more appropriate for the description of migraine? ", "input": "(A) Combination use of antihistamines and nonsteroidal anti-inflammatory drugs (NSAIDs) can help migraines, but antihistamines alone are not helpful. (B) The most common age of onset is around 40 years old, and the prevalence is greater in men than in women. (C) The use of steroids does not reduce the risk of recurrence of headaches after emergency department discharge. (D) Initial treatment recommends the use of morphine combined with antiemetics. (E) It is usually unilateral and pulsatile, and there may be phobia of light and sound.", "output": "A"} 
-{"instruction": "A 75-year-old woman with a history of rheumatic heart disease and hypertension recently complained of chest tightness and shortness of breath. I was sent to the emergency room today because of syncope. When I arrived at the hospital, my blood pressure was 108/76 mmHg, my heart rate was 135 beats/min, my respiration rate was 25 breaths/min, and my SpO₂ was 89%. I heard humming sounds on both sides of my chest, and S4 gallop was heard on my heart sounds. My chest X-ray showed bilateral pulmonary edema, and my electrocardiogram showed atrial fibrillation. Which of the following statements is more appropriate? ", "input": "(A) Beta-blockers or calcium ion blockers can be given, which have a good effect on controlling heart rhythm. (B) This lesion is often caused by endocarditis, so routine preventive antibiotics are required. (C) If the lesion is severe, surgery is often required. If surgery is not performed, the mortality rate within one year is high. (D) Give oxygen, sublingual NTG and furosemide, and sometimes positive pressure breathing to treat pulmonary edema. (E) Give aspirin and clopidogrel, check for troponin, and arrange for cardiac catheterization immediately. ", "output": "C"} 
-{"instruction": "Which of the following recommendations for post-cardiac arrest care for patients with cardiac arrest is more appropriate? ", "input": "(A) Cooling the patient with ice water before arrival at the hospital helps the patient's neurological prognosis and survival rate to discharge. (B) If the patient is unconscious and unable to follow verbal commands after resuscitation, consider targeted temperature management of 32-36℃ for 48-72 hours. (C) Emergency coronary angiography and percutaneous coronary intervention (PCI) after resuscitation have been shown to help patients' prognosis. (D) Complications such as bradycardia, coagulation abnormalities, hyperkalemia and QT prolongation are more likely to occur during cooling. (E) If a patient develops fever after rewarming, it should be actively controlled. ", "output": "E"} 
-{"instruction": "Which of the following is more appropriate for the diagnosis and treatment of acute pancreatitis? ", "input": "(A) Laboratory tests must include both amylase and lipase for a correct diagnosis. (B) The level of lipase can represent the severity of the disease. (C) Abdominal CT is a good diagnostic tool and this imaging examination can be arranged early. (D) To avoid worsening of the condition, the patient must be prohibited from taking food orally and should be given intravenous fluids instead. (E) Antibiotics do not help prevent complications of infection. ", "output": "E"} 
-{"instruction": "A 27-year-old male with fever and sore throat for two days went to the emergency room due to continued worsening pain, difficulty swallowing, and difficulty breathing. His temperature was 38.3℃, his respiratory rate was 20 times/min, his heart rate was 108 times/min, and his blood pressure was 123/76 mmHg. Which of the following statements about this patient is more appropriate? ", "input":"(A) Patients with acute anaphylaxis often present with drooling, dysphagia, and respiratory distress. (B) According to the original Centor criteria: tonsillar exudate, anterior cervical lymphadenopathy, no cough, and fever, if two or more of the four criteria are met, Group A β-hemolytic Streptococcus (GABHS) pharyngitis may be suspected and antibiotic treatment may be considered. (C) Ludwig's angina often originates from infection of the retropharyngeal space, which then spreads to the sublingual and submental spaces. (D) When the patient has stridor and difficulty swallowing, the patient can be asked to lie down and given epinephrine nebulization inhalation to relieve the symptoms. (E) Retropharyngeal abscess, in addition to sore throat, is often accompanied by neck swelling and muffled voice. ", "output": "B"}
-{"instruction": "Typical symptoms of Kawasaki disease include fever >39 to 40°C for at least 5 days. In addition to fever, there are 5 other typical diagnostic factors, at least 4 of which must be present, but not including?", "input": "(A) Chapped lips, erythema, strawberry tongue, redness and congestion of the mouth and pharynx. (B) Bilateral conjunctival congestion without discharge. (C) Rash: maculopapular rash, diffuse erythroderma, or multiforme erythema. (D) Redness and swelling of the hands and feet in the acute phase, and or peeling of the nail ends of the limbs in the subacute phase. (E) Cervical lymphadenopathy (usually bilateral and ≥1.5 cm in diameter).", "output": "E"}  
-{"instruction": "A 30-year-old male patient with schizophrenia is taking medication to control his condition. However, he has been seeing doctors and taking medications frequently due to depression in recent days. He was taken to the emergency room by his family. He complained of confusion and body stiffness starting this morning. GCS E3V3M3, blood pressure 187/78 mmHg, heart rate 120 beats/min, respiration 30 times/min, body temperature 39°C, no distension of the jugular vein, clear lung auscultation without wet sounds, irregular heart rhythm, no heart murmurs, soft abdomen, abnormal stiffness of limbs, unable to flex. Initial laboratory examination: WBC 20,600/μL, Hb 13.9 g/dL, platelet 160,000/μL, CRP 1.9 mg/dL, BUN 50 mg/dL, Cr 2.0 mg/dL, GOT 40 U/L, Na 140 mmol/L, K 4.2 mmol/L, CK 1,250 U/L, arterial blood gas: metabolic acidosis. Based on the current test results, which of the following diagnostic options is more appropriate? ", "input": "(A)Epilepsy. (B)Meningitis. (C)Neuroleptic malignant syndrome. (D)Serotonin syndrome. (E)Thyroid storm. ", "output": "C"}
-{"instruction": "Which of the following statements is more appropriate for the primary assessment and resuscitation of traumatic injuries in the elderly?", "input": "(A) During rapid sequence intubation, the drug dosage remains unchanged. (B) When hypoxia is imminent and respiratory failure is imminent, the heart rate will significantly increase. (C) The following auxiliary methods are recommended to identify the early symptoms of shock, including base deficit, serum lactamase, shock index, etc. (D) For patients with traumatic shock, early placement of advanced monitoring such as central venous pressure is not helpful. (E) To avoid potential and undetected spinal injuries, the neck collar and long back fixation should not be removed prematurely.", "output": "C"} 
-{"instruction": "Which of the following is less appropriate regarding the clinical manifestations of anaphylaxis?", "input": "(A) Typical initial symptoms are itching and urticaria. (B) Vocal cord paralysis and hoarseness are common. (C) The faster the symptoms develop, the more severe the condition. (D) About half of deaths occur within 60 minutes of the onset of symptoms. (E) There is still a risk of recurrence after the symptoms disappear.", "output": "B"} 
-{"instruction": "An 82-year-old male was sent to the emergency department because of fever, wheezing, and use of accessory muscles, obvious wheezing, and altered consciousness. On arrival, his temperature was 39°C, his heart rate was 120 beats/min, his respirations were 28 breaths/min, and his blood pressure was 132/84 mmHg, blood oxygen concentration 85%. Arterial blood gas analysis PaCO₂ 80 mmHg. Which of the following treatments is less appropriate for this patient? ", "input": "(A) Oxygen therapy should be given to maintain a blood oxygen concentration of at least 90%. (B) A non-invasive positive pressure ventilator should be given, and a nasogastric tube should be used to reduce pressure to prevent aspiration events. (C) Inhaled treatment with type II sympathomimetic agents and anticholinergics should be given. (D) If the cough is accompanied by thick sputum, broad-spectrum antibiotics should be given, covering Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis species. (E) Endotracheal intubation should be considered. ", "output": "B"} 
-{"instruction": "Which is the first priority when conducting a complete eye examination? ", "input": "(A) Test intraocular pressure. (B) Test vision. (C) Test pupil size. (D) Test the eyelid and conjunctiva. (E) Test the activity of the extraocular muscles. ", "output": "B"} 
-{"instruction": "A 75-year-old woman was found lying at home by her family, vomiting green objects, suspected of intoxication from ingesting an unknown liquid. The vital signs measured after emergency intubation are as follows: E1V TM4, blood pressure 85/51 mmHg, heart rate 148 beats/min, body temperature 35.4℃, respiration 32 times/min, SpO₂ 83%, and both pupils are 3mm without light reflex. The patient was restless and sweating all over. The brain CT scan showed no obvious abnormality, and the electrocardiogram showed a sinus rhythm. Arterial blood oximetry: pH 7.35, PCO₂ 36.7 mmHg, PO 2 314.8 mmHg, HCO₃ 19.8 mm/L, SBE-5.8 mm/L, Sat 99.7%, P(Aa)O 2 341.0 mmHg, FiO 2 100%. In the case of suspected poisoning, which of the following is the most likely diagnosis? ", "input": "(A) Caustics intoxication. (B) Cyanide intoxication. (C) Methanol intoxication. (D) Methemoglobinemia. (E) Paraquat intoxication. ", "output": "D"} 
-{"instruction": "A 36-year-old male presents with multiple painful ulcers on his penis and purulent nodules in the bilateral inguinal clefts. Which of the following treatments is appropriate? ", "input": "(A) Ceftriaxone. (B) Doxycycline. (C) Metronidazole. (D) Pencillin-G benzathine. (E) Valacyclovir. ", "output": "A"} 
-{"instruction": "A 60-year-old male presents to the emergency department with right calf pain and intermittent claudication for approximately 7 days. Physical examination reveals a weak right dorsalis pedis artery, right arm BP of 160/100 mmHg, and right ankle BP of 100/60 mmHg. Which statement about this patient is more appropriate? ", "input": "(A) The pain is difficult to localize and is usually not relieved by rest. Elevation of the limb is often required to improve symptoms. (B) This patient most likely has a lesion in the right common femoral artery. (C) This patient's ankle-brachial index is 0.625. (D) Treatment Low molecular weight heparin (LMWH) is the first-line treatment. (E) Even if treatment is successful, the ankle-brachial index will not return to the normal range. ", "output": "C"} 
-{"instruction":"A 30-year-old male who often drinks alcohol for social events. One month ago, he went to the urology clinic because of stinging and burning sensations when urinating. After examination, he was diagnosed with chlamydial urethritis. He recovered after a course of antibiotic treatment. Recently, he began to feel stiffness and pain in his lower back, and even a dull pain in his right knee. He went to the pharmacy to buy a topical pain-relieving patch, but it did not relieve the pain. Instead, his ankle joints on both sides and his right toes became swollen and painful, making him unable to walk. He also had red and swollen eyes. What is the most likely diagnosis for this patient?", "input": "(A) Behcet's disease. (B) Psoriatic arthritis. (C) Reiter's syndrome). (D) Gonococcal arthritis. (E) Ankylosing spondylitis. ", "output": "C"}
-{"instruction": "Which of the following descriptions of sonographic B lines in pulmonary ultrasound is more appropriate?", "input": "(A) They can be used in conjunction with vena cava ultrasound to assist in the diagnosis of heart failure. (B) They occur in patients with acute respiratory distress syndrome, pulmonary fibrosis, pneumonia, and massive pneumothorax. (C) They run parallel to the pleura. (D) If the patient does not have sonographic B lines in the lungs, heart failure can be ruled out. (E) If the patient has sonographic B lines on both sides of the lungs, heart failure can be diagnosed.", "output": "A"} 
-{"instruction": "28-year-old female, vital signs are blood pressure 132/84 mmHg, heart rate 85 beats/min, respiration 18 times/min, body temperature 36.4℃; in the emergency department, she complained of lower abdominal pain and abnormal vaginal bleeding. She said that her last menstrual period was about two weeks ago. She has no past medical history, G0P0. Physical examination revealed tenderness in the left lower abdomen and pelvic cavity without rebound tenderness; blood test results were as follows: white blood cells 9,300/μL, hemoglobin 10.3 g/dL, platelets 263,000 /μL; β-hCG 3,600 mIU/mL; abdominal ultrasound showed no abnormal ascites, and no gestational sac was found in the uterus. Which of the following inferences is more appropriate? ", "input":"(A) If the estimated gestational period is about two weeks, and the β-hCG level rises smoothly after two days, it may be diagnosed as threatened abortion. (B) If the estimated gestational period is about two weeks, and the β-hCG level drops after two days, it may be diagnosed as missed abortion. (C) If the estimated gestational period is more than five weeks, and the transvaginal ultrasound does not find the gestational sac in the uterus, it may be diagnosed as threatened abortion. (D) If the estimated gestational period is more than five weeks, and the transvaginal ultrasound does not find the gestational sac in the uterus, it may be diagnosed as ectopic pregnancy. (E) If the estimated gestational period is more than five weeks and no intrauterine gestational sac is found by transvaginal ultrasound, it may be implantation bleeding. ", "output": "D"} 
-{"instruction":"Which of the following statements about the treatment of acute heart failure is more appropriate?", "input": "(A) Compared with drug therapy alone, the combination of noninvasive ventilation and drug therapy does not reduce the chance of intubation. (B) If a patient with acute heart failure develops hypotension, adequate fluids should be given before using cardiotonic drugs, such as norepinephrine. (C) The use of acetaminophen to relieve headaches caused by nitroglycerin is often ineffective. (D) The use of morphine to treat acute heart failure can reduce the patient's anxiety, but it will prolong hospital stay and increase mortality. (E) Late-stage heart failure is caused by pulmonary microvascular wedge pressure. pressure) is high, chest X-ray will almost always show typical pulmonary edema. ", "output": "D"}
-{"instruction": "A 20-year-old male just returned from Kenya, Africa a week ago. He developed fever, headache, nausea, and vomiting two days ago. When he went to the emergency room, his vital signs were consciousness E2M4V2, blood pressure 120/70 mmHg, body temperature 39.1℃, heart rate 110 beats/min, and respiration 20 times/min. Physical examination revealed no other abnormalities except neck stiffness. Blood test results showed WBC 17,000/μL and creatinine 1.0 mg/dL. Chest X-ray and brain CT scan showed no abnormalities. Initial cerebrospinal fluid pressure was 180mmH 2O and turbid cerebrospinal fluid (turbid) , Gram-negative diplococci (+), which of the following statements is more appropriate? ", "input": "(A) Because the patient has been to the "Meningitis belt" countries, bacterial meningitis is suspected. A brain CT scan and a lumbar puncture should be performed before antibiotics are given. (B) The patient's initial cerebrospinal fluid pressure was too high, and the turbidity of the cerebrospinal fluid indicates that the white blood cell count is >200 cells/mm³, so bacterial meningitis is suspected. (C) To prevent this bacterial infection, vaccination can be given three days before travel. (D) Ceftriaxone plus vancomycin is usually used, and the steroid hydrocortisone 50 mg iv is recommended. (E) The students who shared the same dormitory with this patient may be infected. It is recommended that they take rifampin 600 mg Q12H for four times in total. ", "output": "E"} 
-{"instruction": "A 32-year-old male went to the emergency department because of intermittent fever and oral ulcers for two weeks. He had herpes zoster two months ago. Because of clinical suspicion of human immunodeficiency virus (HIV) infection, which of the following statements is more appropriate? ", "input": "(A) Currently, HIV 1+2 ELISA test is often used as a preliminary test to detect HIV virus antigens. (B) Most Taiwanese patients are infected with HIV-2. (C) If HIV is diagnosed, the patient is not suitable for tetanus vaccine in the future. (D) For lesions in the mouth, suspected Candida infection can be treated first with amphotericin B. (E) Lymphoma is the most common tumor in HIV-infected patients and can also cause fever in patients. ", "output": "E"} 
-{"instruction": "A 60-year-old male complained of a brief fainting spell 30 minutes ago and is now wheezing and having chest pain. Auscultation of the heart sounds revealed systolic murmurs; when palpating his right pulse, a significant brachioradial delay was found. Which of the following statements is more appropriate for the diagnosis and treatment of this patient? ", "input": "(A) Electrocardiograms can often reveal left ventricular hypertrophy, and oxygen should be given for treatment. (B) The patient's chest X-ray may show pulmonary edema. At this time, positive pressure respiration should be avoided and nitroglycerin is the first choice for treatment. (C) This disease usually does not require surgical treatment. (D) If atrial fibrillation occurs during the treatment observation period, the use of beta-blockers for heart rate control should be considered first. (E) Endocarditis is a very common complication of this disease, so prophylactic antibiotics should be given. ", "output": "A"} 
-{"instruction": "A young woman suffered severe head injuries when her motorcycle hit a telegraph pole and her helmet flew off. In the emergency room, her GCS was 6 points, her blood pressure was 140/90 mmHg, and her heart rate was 80 beats/min. After receiving endotracheal intubation and ventilator ventilation, the pupils were equal to 3mm, both sides reacted to light, and there were no other obvious injuries. What is the most important treatment principle for this patient? ", "input": "(A) Avoid hypotension. (B) Give osmotic diuretics. (C) Actively treat hypertension. (D) Increase the metabolic rate of brain tissue. (E) Differentiate between intracranial hematoma and cerebral edema. ", "output": "A"} 
-{"instruction": "A 27-year-old pregnant woman had frequent contractions and ruptured membranes. She was 38 weeks pregnant and was expecting her second child. She gave birth in the emergency room shortly after arriving at the hospital. The mother is emaciated and pale (Hb 5.0 g/dL). The emergency department measures her vital signs: clear consciousness, blood pressure 126/75 mmHg, heart rate 130 beats/min, respiration 20 times/min, body temperature 36.3℃. The mother is suspected to be a drug addict. The newborn is not very active, has shallow breathing, and a heart rate of 75 beats/min. After back stimulation, there is still no improvement. Which of the following statements is more appropriate for the emergency treatment of this newborn? ", "input": "(A) The newborn is not very active and the mother has broken water. Antibiotics should be injected immediately if sepsis is suspected. (B) The newborn is not very active and the mother is severely anemic. The newborn needs blood transfusion. (C) If there is still no improvement after stimulation, give the newborn chest compression first aid and inject epinephrine. (D) Suspected withdrawal syndrome, injection of sugar solution and administration of antidote. (E) No improvement after stimulation, airway clearance and positive pressure oxygen breathing. ", "output": "E"} 
-{"instruction": "A 3-year-old boy suffered a facial laceration due to a fall. Ketamine was used for sedation during suture. Which of the following statements is more appropriate? ", "input": "(A) Intramuscular or intravenous injection is acceptable, and the sedative effect lasts for the same period of time. (B) The intramuscular injection dose is 1 mg/kg. (C) After the drug takes effect, the patient may still have movements and muscle tension. (D) The additional dose is mainly used to increase the depth of anesthesia, not to prolong the duration of action. (E) Compared with other sedatives, it is more likely to have respiratory depression and blood pressure effects. ", "output": "C"} 
-{"instruction": "Which statement about urinary tract infection is less appropriate?", "input":"(A) Visual inspection or assessment of urine odor is usually not helpful in determining infection. (B) Fluoroquinolones are recommended as empirical antibiotics for patients with HIV/AIDS. (C) A positive urine nitrogen test (urine nitrite) combined with a positive leukocyte esterase test can improve the diagnosis of urinary tract infection. (D) Pseudomonas converts nitrates in the urine to nitrites, which will result in a positive urine nitrogen test (urine nitrite). (E) Pregnant women and those who are about to undergo invasive urinary tract surgery should still be treated for asymptomatic bacteriuria.", "output": "D"} 
-{"instruction": "A 60-year-old male with a history of hypertension and diabetes mellitus was sent to the emergency department with complaints of acute chest pain extending to the back. On examination, his blood pressure was 220/110 mmHg, heart rate 98 beats/min, respiration 20 times/min, chest X-ray shows mediastinum widening, and the electrocardiogram shows no special changes. Which of the following is more appropriate for the diagnosis and clinical treatment of this patient? ", "input": "(A) If the laboratory test D-dimer is normal, the possibility of pulmonary embolism and aortic detachment can be ruled out. (B) The sensitivity of pulse deficits in patients with aortic detachment is high. (C) 80-90% of patients with aortic detachment will have abnormal chest X-rays. (D) Aortic stripping sometimes affects coronary perfusion, and the most commonly affected coronary artery is the left coronary artery, which can cause anterior wall myocardial infarction. (E) Nitroglycerin or nicardipine should be used first to control blood pressure. ", "output": "C"} 
-{"instruction": "A non-traumatic adult female who was in shock upon arriving at the emergency department was immediately evaluated by bedside ultrasound. The diameter of the patient's inferior vena cava was measured to be approximately 2.4 cm below the sphenoid process (subxiphoid), and the change in the diameter of the inferior vena cava was <50% during breathing. The apical four chamber view of cardiac ultrasound evaluation found that the RV/LV end-diastolic diameter ratio was >1. Which of the following is the most likely cause of shock in this patient? ", "input": "(A) Massive upper gastrointestinal bleeding. (B) Acute pulmonary embolism. (C) Acute heart failure with pulmonary edema. (D) Septic shock. (E) Rupture of abdominal aortic aneurysm.", "output": "B"} 
-{"instruction": "Which of the following statements is more appropriate for the diagnosis of patients with acute appendicitis?", "input": "(A) Alvarado score is the gold standard for clinical diagnosis. (B) Many empirical data show that abdominal ultrasound can improve the diagnosis rate of acute appendicitis. (C) Early appendicitis usually presents with epigastric pain. (D) Up to 50% of patients present with atypical symptoms. (E) Patients with simple right lumbar pain should be able to reasonably rule out acute appendicitis. ", "output": "D"} 
-{"instruction": "Which of the following tests can help diagnose lumbar disc herniation syndrome and has the highest specificity? ", "input": "(A)Straight leg raise test. (B)Lhermitte's sign. (C)Spurling's sign. (D)Abductor sign. (E)Cr ossed straight leg raise test. ", "output": "E"} 
-{"instruction": "A 17-year-old female was sent to the emergency room after she developed confusion and agitated behavior in a nightclub with a temperature of 39°C and a blood pressure of 150/96 mmHg. Her friend said that the patient had taken ecstasy. Which of the following statements is more appropriate? ", "input": "(A)Patients often have high fever, high blood pressure, dehydration, and high sodium levels. (B) Giving activated charcoal will not help much. (C) If the patient has a fever over 40℃, the prognosis is poor, but cooling should not be too rapid to avoid epilepsy. (D) If the patient still has a high fever after cooling, consider using dantrolene. (E) If the patient has symptoms similar to serotonin syndrome, consider using serotonin agonist drugs. ", "output": "D"} 
-{"instruction": "An 88-year-old male resident of a nursing home went to the emergency department with cough, fever, and shortness of breath. Chest X-ray showed right-sided pneumonia, and the doctor recommended hospitalization. Which of the following is less suitable as his choice of empirical antibiotic? ", "input": "(A) Vancomycin. (B) Tazocin (Piperacillin/Tazobactam). (C)Levofloxacin. (D)Cefepime. (E)Cef uroxime. ", "output": "E"} 
-{"instruction": "Which of the following statements about the use of antiplatelet and antithrombotic drugs in the treatment of acute stroke is less appropriate? ", "input": "(A) In patients with ischemic stroke and acute atrial fibrillation, antithrombotic drugs should be used as early as possible in the emergency department to prevent worsening of stroke or secondary stroke. (B) Antiplatelet or antithrombotic drugs should not be used within 24 hours of thrombolytic treatment. (C) Antiplatelet drugs should be given within 24 to 48 hours after the onset of stroke symptoms. (D) Patients with transient ischemic attack can use two different antiplatelet drugs in combination. (E) The ABCD2 score is not effective in identifying patients at high risk of transient ischemic attack. ", "output": "A、B、C、D"} 
-{"instruction": "A 30-year-old male with asthma attacks went to the emergency room for treatment. He had no fever and no special findings on chest X-ray. He had inhaled albuterol and ipratropium three times in the emergency room and had been given IV steroids. After tracking, SpO₂ 90%, arterial PCO₂ 45 mmHg, blood pressure 102/75 mmHg, heart rate 145 beats/min, respiratory rate 35 breaths/min, combined with the use of respiratory auxiliary muscles, which of the following descriptions and treatments is more appropriate for this patient? ","input": "(A) If there is no wheezing breath sound during the second auscultation, giving bronchodilators at this time is unlikely to be helpful. (B) Salmeterol xinafoate and formoterol are better than albuterol in binding to the β 2-receptor and can be considered for use in patients. (C) Magnesium 2 grams IV drip can be considered, but nebulized magnesium should not be considered. (D) If there is no pneumothorax, non-invasive positive pressure ventilator (NIPPV) has the potential to increase airflow, but it will not reduce the chances of intubation and hospitalization. (E) If intubation is necessary, ketamine is a good choice, but intubation cannot solve the problem of airflow obstruction.", "output": "E"}
-{"instruction": "A 23-year-old woman who was 12 weeks pregnant had sudden palpitations, shortness of breath, and sweating during a prenatal checkup. When she was sent to the emergency department, her temperature was 38.8°C, her heart rate was 148 beats/min, her respiratory rate was 25 breaths/min, and her blood pressure was 145/100 mmHg. She had no past or family medical history. Physical examination showed a slightly enlarged thyroid gland. Especially when the thyroid gland was palpated, the patient's heart rate was 160 beats/min. Which of the following treatments is less appropriate?", "input": "(A) Give supportive treatment including oxygen, intravenous infusion; if necessary, give oral acetaminophen 325-650 mg to help reduce fever. (B) Give methimazole 40 mg orally, 25 mg every 4 hours; total daily dose 120 mg. (C) One hour after the above treatment steps are completed; give 8-10 drops of Lugol solution every 6-8 hours until the desired effect is achieved. (D) Give propranolol 1-2 mg slowly intravenously, repeat every 10 to 15 minutes, until the desired effect is achieved. (E) Give hydrocortisone 100 mg intravenously, repeat 100 mg 3 times within 24 hours, until the desired effect is achieved. ", "output": "B"} 
-{"instruction": "A 46-year-old female with no history of illness. She usually runs a food stall in Kinmen Traditional Market. She recently traveled to the Hualien Mountains. She complained of intermittent fever, headache, soreness in both calf muscles, mild cough, and non-suppurative conjunctivitis in both eyes about 10 days ago. The above symptoms subsided after 5 days, but she began to have darker urine and decreased urine volume 3 days ago. Blood pressure 125/78 mmHg, heartbeat 100 beats/min, respiration 25 breaths/min, and body temperature 38°C. WBC 12,500/μL (Seg. 89%, Lym. 9%), Hb 11.8 g/dL, Platelet 230,000/μL, AST 658 U/L, ALT 586 U/L, T-Bil. 3 mg/dL, creatinine 4.5 mg/dL, no obvious changes on chest X-ray. Which of the following pathogens is most likely? ", "input": "(A) Hepatitis A virus. (B) Rickettsia tsutsugamushi. (C) Measles virus. (D) Leptospirosis. (E) Dengue virus. ", "output": "D"} 
-{"instruction": "A factory employee accidentally entered an industrial irradiation room and was irradiated by the radiation source above. He was taken to the emergency room with general discomfort. Which of the following statements is more appropriate? ", "input": "(A) By asking the patient about the time when vomiting occurred after being exposed to the radiation source, the radiation exposure dose can be estimated. (B) A decrease in the absolute neutrophil count is more often used to estimate the exposure dose than a decrease in the absolute lymphocyte count. (C) Colony-stimulating factor (CSF) is not very effective when the patient's blood cell count is reduced. (D) When handling patients, emergency medical staff should wear Class B protective clothing to avoid inhaling radioactive materials. (E) When patients are decontaminated, they need to be quickly rinsed with large amounts of clean water to avoid worsening injuries. ", "output": "A"} 
-{"instruction": "A 14-day-old boy was brought to the emergency room by his family today because of tea-colored urine, grayish-white stools, and yellow sclera and skin. The family pointed out that the child had been breastfed since birth. On the second day, the child developed yellow skin and sclera, and had anorexia and poor activity, which has not improved so far. In the emergency room, the rectal temperature was measured at 37.4℃. What is the most likely cause of the child's jaundice? ", "input": "(A) Physiological jaundice. (B) Breast milk jaundice. (C) Biliary atresia. (D) Septic jaundice. (E) Hemolysis jaundice. ", "output": "C"} 
-{"instruction": "Which of the following statements about the cause of shoulder pain is more appropriate? ", "input": "(A) The most serious vascular injury is acute thrombosis of the axillary artery. (B) Thoracic outlet syndrome is a possible differential diagnosis for shoulder pain, which often occurs in middle-aged men. (C) Patients with splenic injury may have symptomatic right shoulder pain due to diaphragm irritation. (D) Nerve compression in the neck often causes shoulder pain, such as C7-C8 disc herniation. (E) Brachial plexus neuritis is a possible cause of shoulder pain, which usually begins with weakness and then pain. ", "output": "A"} 
-{"instruction": "A 70-year-old female patient developed sudden dizziness when she got up. Which of the following statements is more appropriate? ", "input": "(A) The patient experienced rotation and horizontal nystagmus, which are often manifestations of central nervous system disease. (B) The patient opened her eyes, was able to stand steadily on both feet, and her hands did not tremble, indicating that the cerebellum functioned normally. (C) Because water flowed out of the corners of the patient's mouth when she rinsed her mouth, and she easily choked when she drank water, the clinical diagnosis was peripheral facial nerve palsy (Bell's palsy). (D) If the diagnosis was left lateral medullary infarction, the symptoms should be right facial numbness, loss of corneal reflex, Horner's syndrome, and dysphagia. (E) If dizziness is caused by postural hypotension, do not use prochlorperazine and chlorpromzine for antiemetic purposes. ", "output": "E"} 
-{"instruction": "Which of the following statements about acute limb weakness is more appropriate? ", "input":"(A) If the patient's weakness first develops in the upper limbs and then progresses to the lower limbs, tick paralysis should be considered. (B) When the patient's weakness is greater in the distal limbs than in the proximal limbs, myasthenia gravis should be considered first. (C) Guillain-Barre syndrome can lead to autonomic dysfunction. (D) Multiple sclerosis is a demyelinating disease, and clinically, symptoms may improve with temperature rise. (E) From the symptom perspective, whether it is a central nervous system or peripheral nervous system problem can be distinguished by whether there is diplopia or dysphagia.", "output": "C"} 
-{"instruction": "Which of the following statements about airway management principles for pregnant women is more appropriate?", "input": "(A) The more the pregnant woman gains weight, the lower the Mallampati Class index will be before intubation. (B) Upper airway edema is more common in late pregnancy, so the use of a laryngeal mask airway (LMA) is not recommended for pregnant women who have difficulty intubating. (C) For pregnant women who are assessed to have difficulty in intubation, it is recommended to try non-microscopic nasotracheal intubation first. (D) When rapid drug-guided intubation is to be used, the drugs and dosage considerations used by pregnant women are no different from those for general patients. (E) After intubation is completed, the frequency of ventilation can be increased to create a mild respiratory alkaline state to increase uteroplacental blood flow.", "output": "D"}
-{"instruction": "A 35-year-old male with no past medical history complained of anal pain for three days. After physical examination, he was diagnosed with perianal abscess. Which of the following statements is more appropriate?", "input": "(A) The patient's main complaint is fever combined with anal pain. (B) A small number of patients also have anal fistula. (H) Staphylococcus aureus and Escherichia coli are common pathogens. (C) Treatment is local drainage and oral antibiotics. (D) Drainage followed by the use of the WASH (warm water, analgesics, stool softeners, high-fiber diet) regimen no longer helps improve symptoms.", "output": "C"}  (D) Using 
-the
-{"instruction": "A 65-year-old male drank an unknown pesticide and went to the emergency room a few hours later for gastrointestinal discomfort. He immediately developed changes in consciousness and soon even had a seizure and respiratory failure. The blood test report showed hyperammonemia. Although he was actively rescued and his consciousness gradually recovered after a few days, he continued to have anterograde and retrograde amnesia. Which type of pesticide poisoning is most likely?", "input": "(A) Paraquat poisoning. (B) Organophosphate poisoning. (C) Securitol poisoning. (D) Pyrethrin poisoning. (E) Glyphosate poisoning.", "output": "C"} 
-{"instruction": "A 15-year-old female student had sex with her boyfriend four days ago and was taken to the emergency room by her family, who requested that the sexual assault process be carried out. After private questioning, the girl said that this was a consensual relationship. Which of the following statements is more appropriate?", "input": "(A) According to the Convention on the Rights of the Child, the best interests of the child should be given priority, so the parents were tactfully informed to respect their daughter's wishes and to reach a consensus before informing the doctor whether to carry out the sexual assault process. (B) According to the injury classification regulations, this is a second-level condition. (C) In order to determine whether there has been any violent injury, it is necessary to remove the clothes and take photos, and carefully check for wounds, bruises, and tenderness, especially on the limbs, neck, and perineum. (D) Internal examination or use colposcopy to check if there are any wounds on the vagina and cervix, and use Wood's lamp to check if there is any semen residue on the body surface. (E) Blood test for complete blood count, liver function, hepatitis B/C, syphilis and HIV virus, and urine test for pregnancy and drug-facilitated rape. ", "output": "D"} 
-{"instruction": "A 40-year-old male has pain in the third molar of the right mandible for a week. Today he has a fever and cannot lie flat. Saliva keeps overflowing from the corners of his mouth. There is obvious stridor when breathing. Physical examination found redness and swelling on the right side of the face, which extends to the chin and neck, and clenched teeth. Use simple mask 6L/min The subsequent blood oxygen concentration was 95%. Which follow-up treatment is more appropriate? ", "input": "(A) Rapid sequence intubation should be used as soon as possible to establish an advanced airway. (B) Rocuronium injection can relieve the problem of lockjaw. (C) Succinylcholine injection will worsen the problem of lockjaw. (D) When using a bag-valve mask to actively administer oxygen, jaw thrust can effectively open the patient's airway. (E) Awake intubation should be arranged as soon as possible. ", "output": "E"} 
-{"instruction": "Which of the following is not a common complication caused by high-voltage electrical injuries? ", "input": "(A) Aspiration pneumonia. (B) Delayed cataract. (C) Hearing loss. (D) Delayed thrombosis in the injured limb. (E) Bone necrosis. ", "output": "E"} 
-{"instruction": "Taiwan is located in an earthquake zone and may experience large-scale Richter earthquakes every year. According to the operating guidelines of the Central Disaster Response Center, which of the following statements is more appropriate? ", "input": "(A) If a first-level disaster response center is established by the central government, the highest authority should be the Presidential Office, and the then-president will usually be the commander of the disaster response center. (B) The timing of the opening of the response center is determined to be when the magnitude of the earthquake announced by the Central Weather Bureau reaches 7 or above. (C) If rescue teams from other counties and cities want to assist in rescue, they should go directly to the scene after assembling to facilitate dispatch by local commanders. (D) If a foreign search and rescue team wishes to assist in the rescue, the Ministry of the Interior's Fire Department should assess the manpower needs and coordinate the command. (E) In the event of a radiation disaster caused by an earthquake, the Director of the Atomic Energy Commission of the Executive Yuan shall serve as the commander. ", "output": "D"} 
-{"instruction": "A 20-year-old female pedestrian was hit by a car at a speed of 70 kilometers per hour. When she arrived at the emergency room, her vital signs were as follows: body temperature 36.4℃, respiration 12 times/min, heart rate 120 times/min, blood pressure 88/60 mmHg, blood oxygen 96%, coma index 15, primary assessment showed that the airway was open and free of foreign objects, breathing was normal and effortless, there was no tracheal deviation, lung sounds on both sides were normal, and heart sounds were normal. Abdominal tenderness and pelvic instability, ultrasound shows posterior peritoneal fluid accumulation. Which of the following treatments should be prioritized? ", "input": "(A) Arrange CT of the abdomen and pelvis. (B) Inform the orthopedic surgeon to prepare external fixation of the pelvis. (C) Inform the surgeon to prepare for emergency laparotomy. (D) Inform the radiologist to prepare angiography. (E) Inject two 18-gauge IVs, give 1,000 ml of warm saline, prepare blood products, and fix with a pelvic fixation belt. ", "output": "E"} 
-{"instruction": "Which statement about heat stroke is more appropriate? ", "input":"(A) The diagnosis must meet the three clinical symptoms of body temperature greater than 40℃, altered consciousness and anhidrosis. (B) Because the cerebellum is sensitive to high body temperature, unsteady gait (ataxia) may be an early clinical symptom of heat stroke. (C) Epileptic seizures are common in heat stroke, especially when the patient's body temperature is highest. (D) During cooling therapy, no matter what method is used, the body temperature must be lowered to the target temperature of 37℃ as soon as possible, and hypothermia should be avoided. (E) Clinically, cooling with cold water gastric lavage and urinary bladder lavage is safe and effective, but water intoxication should be noted.", "output": "B"}
-{"instruction": "Which of the following statements is appropriate regarding neonatal resuscitation?", "input": "(A) For term and premature infants who do not require resuscitation at birth, delaying umbilical cord clamping for approximately 20 seconds is appropriate. (B) When tracheal intubation cannot be successfully established, laryngeal mask is not recommended for term neonates or premature infants older than 34 weeks. (C) If the infant is born with meconium-stained amniotic fluid and has poor muscle tone and inappropriate labored breathing, he or she should be placed under a radiation warmer and positive pressure ventilation should be initiated if necessary. (D) In ​​neonatal cardiac arrest, chest compression as early as possible is the focus of initial resuscitation. (E) Resuscitation of premature newborns of less than 35 weeks' gestation should start with a high oxygen concentration close to 100% and then adjust the oxygen to achieve preductal oxygen saturation close to that of healthy full-term newborns. ", "output": "C"} 
-{"instruction": "A 20-year-old female presented to the emergency department with lower abdominal pain for several days. Her vital signs were normal. Pelvic examination revealed tenderness in the patient's lower abdomen, uterus, bilateral adnexa, and cervix, and mucopurulent vaginal discharge. Urine pregnancy test was negative, and urine analysis showed no special findings. Which of the following treatments is more appropriate? ", "input":"(A) Arrange CT scan to confirm pelvic inflammation before treatment. (B) Arrange vaginal ultrasound to confirm pelvic inflammation before treatment. (C) Draw blood for Procalcitonin test. If the value is <0.5 ng/mL, no antibiotics are needed. (D) Wait for the cervical culture report and then decide on the most effective treatment. (E) Direct antibiotic treatment.", "output": "E"} 
-{"instruction": "Which of the following statements is more appropriate for the management of trauma in women at 28 weeks of gestation? ", "input":"(A) Loss of 10-15% of total blood volume will cause shock symptoms. (B) Pelvic examination takes precedence over ultrasound in secondary assessment. (C) The pH value can be used to distinguish whether it is ruptured amniotic fluid or vaginal discharge: neutral for amniotic fluid, acidic for vaginal discharge. (D) The sensitivity and specificity of transabdominal ultrasound in diagnosing ascites are lower than those of non-pregnant patients. (E) If there is no obvious abdominal trauma, ultrasound examination shows no evidence of internal bleeding and the fetal heart rate is greater than 120 beats/min, the pregnant woman can be discharged from the hospital after appropriate health education.", "output": "C"}
-{"instruction": "A 50-year-old female patient was sent to the emergency department due to general weakness. On examination, she was unconscious, with a blood pressure of 100/70 mmHg, a sinus rhythm on the electrocardiogram, a heart rate of 54 beats/min, a body temperature of 34℃, and a respiration rate of 10 breaths/min. The serum sodium level was 128 meq/L and the blood glucose level was 90 mg/dL. The face and lower limbs showed non-pitting edema. Which of the following descriptions of differential diagnosis and treatment is more appropriate?", "input": "(A) Diagnosed as adrenal crisis, hydrocortisol was given. (B) Diagnosed as hypoglycemic coma, D50W was given intravenously. (C) Diagnosed as water intoxication, 3% saline was given Correct hyponatremia. (D) Diagnose bradycardia and cardiogenic shock, give dopamine. (E) Diagnose myxedema coma, give thyroxine. ", "output": "E"} 
-{"instruction": "A 58-year-old male reported that he was bitten on the right forearm by a white-nosed croaker trapped in a hunting trap while hunting in the mountains of Nantou about a day ago. The wound had obvious deep teeth marks and dried blood, and the area around the wound was red. The captured white-nosed croaker was also brought in in a cage and seemed calm. According to the treatment guidelines and the latest national policies, after the wound is cleaned and tetanus vaccine is injected, which of the following treatments is more appropriate? ", "input": "(A) Give a complete course of rabies vaccination and immediately administer rabies immunoglobulin infiltration around the wound. (B) Give a single injection of rabies vaccine and submit the white nose to the agricultural department for testing for rabies. If the test is positive, complete the subsequent vaccination course. (C) Give a single injection of rabies vaccine and submit the white nose to the agricultural department for testing for rabies. If the test is negative, stop the subsequent vaccination course. (D) Give a complete course of rabies vaccination. (E) Administer oral antibiotic therapy.", "output": "A"} 
-{"instruction": "Which of the following statements is more appropriate regarding upper gastrointestinal bleeding?", "input": "(A) BUN and creatinine (B) Routine abdominal radiograph should be arranged as soon as possible. (C) Nasogastric tube placement does not increase the chance of bleeding from esophageal varicose veins. (D) The nasogastric tube aspirate is negative for occult blood, which should reasonably rule out upper gastrointestinal bleeding. (E) Emergency endoscopic examination should not be used on high-risk patients after emergency treatment. ", "output": "C"} 
-{"instruction": "Which of the following antithrombotic treatments is less appropriate? ", "input": "(A) The advantage of low molecular weight heparin is that it does not require blood monitoring. (B) Warfarin overdose can consider transfusing fresh frozen plasma. (C) Antiplatelet drugs are more effective than anticoagulants for venous embolism. (D) The new anticoagulant drug rivaroxaban is an inhibitor of coagulation factor X. (E) The antiplatelet drug aspirin has an anticoagulant effect that lasts for 7 days. ", "output": "C"} 
-{"instruction": "The San Francisco Syncope Rule is a tool used to assess the risk of syncope. It requires the assessment of five indicators. Which of the following statements about the five indicators is more appropriate? ", "input": "(A) History of coronary artery disease. (B) Hemoglobin less than 9.0 g/dL indicates that the patient may have acute bleeding. (C) EEG indicates that the patient may have epilepsy. (D) Sick sinus syndrome, caused by bradycardia leading to syncope. (E) Systolic pressure. A systolic pressure less than 90 mmHg is a high-risk factor. ", "output": "E"} 
-{"instruction": "A 63-year-old male went to the emergency department of Hospital A and complained of persistent chest pain that began one hour ago. The electrocardiogram showed ST segment elevation in leads II, III, and aVF. If Hospital A cannot provide primary percutaneous coronary intervention (PCI) treatment, which of the following actions is less appropriate? ", "input": "(A) The emergency physician at Hospital A should immediately contact the base hospital of the emergency patient referral network to confirm the time when the patient can receive primary PCI treatment. (B) Hospital A's emergency department should send the patient to the base hospital as soon as possible, preferably within 30 minutes. (C) If the base hospital assesses that the patient cannot receive primary PCI treatment within 120 minutes, it should inform Hospital A. (D) If primary PCI is not possible within 120 minutes, Hospital A should transfer the patient to the base hospital as soon as possible for thrombolytic treatment. (E) For thrombolytic treatment, the injection of thrombolytics should be started within 30 minutes of arrival. ", "output": "D"} 
-{"instruction": "A 26-year-old male was taken to the emergency department by EMT and police escort, with his limbs restrained on a stretcher. According to his family, he had not slept for five or six days and was mumbling all day. He had a conflict with his family today and behaved violently. When he saw the patient, he was still emotional and kept yelling that he wanted to fight the police. He also kept twisting and turning to break free from the restraints. He even had to be supported by the EMT to be stable when he was stretched on the bed. You are the doctor in charge of the patient. What is the most reasonable next step? ", "input": "(A) Give oral olanzapine FC 5 mg (film-coated tablets). (B) In order to quickly suppress symptoms and protect patients and medical staff, lorazepam 2 mg and haloperidol 5 mg should be injected intravenously. (C) The patient's current symptoms are related to whether he can be hospitalized involuntarily. No medication should be given to avoid the psychiatric consultation doctor being unable to obtain evidence. (D) Intramuscular injection of olanzapine 5 mg. (E) Inject ketamine 5 mg intramuscularly to temporarily dissociate the patient, but monitor his breathing. ", "output": "D"} 
-{"instruction": "Which of the following statements about valvular heart disease is less appropriate? ", "input":"(A) If the patient has symptoms at rest and a diastolic murmur is detected, an urgent echocardiogram is recommended, even if vital signs are stable. (B) If the patient experiences syncope, it is necessary to identify whether it is aortic stenosis. Hospitalization and observation and arrangement of echocardiogram are recommended. (C) If the chest X-ray shows that the heart is normal in size but there is severe pulmonary edema, it is necessary to identify whether it is acute mitral regurgitation. (D) The typical symptoms of aortic stenosis are wheezing, chest pain, and dizziness. However, many patients with severe aortic stenosis have no symptoms. (E) If the diagnosis is aortic detachment with acute aortic regurgitation, β-blocker treatment is recommended. ", "output": "E"}
-{"instruction": "Which of the following patient's behavioral symptoms is more consistent with functional (Psychiatric)psychosis?", "input": "(A) Aged over 40, with alcoholism, sometimes irritable and abnormal behavior, sometimes normal. (B) Occasional hallucinations, drowsiness, often not knowing the time, not recognizing places and people. (C) Sudden confusion, inability to speak, only sounds, weakness in hands and feet. (D) Unable to do simple calculations, poor recent memory, but good long-term memory, unable to feed himself. (E) Delusions, flat expression, incoherent speech, auditory hallucinations, occasionally maintaining a rigid posture.", "output": "E"} 
-{"instruction": "A 35-year-old male patient complained of a sudden nosebleed while resting. Examination revealed persistent bleeding from the right nostril. Which of the following statements is more appropriate?", "input": "(A) When using a nasal speculum to examine the nostrils, they must be spread horizontally so that the nasal septum can be examined. (B) The most common site of anterior epistaxis is the inferior nasal concha. (C) When bleeding persists, the use of silver nitrate chemical cautery is a better way to stop the bleeding. (D) If nasal packing is used, antibiotics must be prescribed to prevent toxic shock syndrome. (E) Patients with nosebleeds may consider injection of tranexamic acid.", "output": "E"} 
-{"instruction": "A 50-year-old male had cardiac arrest before arriving at the hospital. He was sent to the emergency department and returned to spontaneous circulation (ROSC) after CPR. Which of the following statements about the current assessment and targeted temperature management (TTM) is more appropriate?", "input": "(A) TTM may cause side effects such as hyperkalemia, increased coagulopathy, and tremors. (B) TTM can improve both survival and neurological outcomes. (C) If the patient is conscious, sedatives can be given before TTM. (D) Brain damage and edema will stop worsening after ROSC. (E) Clinical neurological reflex deficits or abnormalities can predict poor outcomes.", "output": "B"} 
-{"instruction": "A 32-week pregnant woman fell off her motorcycle. She was conscious, with a heart rate of 100 beats/min, blood pressure of 120/80 mmHg, respiration rate of 18 breaths/min, multiple abrasions on her limbs, and a tightness in her abdomen without obvious external injuries. Abdominal ultrasound showed no intra-abdominal bleeding, and the fetal heart rate was about 140 beats/min. Which of the following statements is more appropriate for this pregnant patient?", "input": "(A) She needs to be hospitalized immediately for a cesarean section. (B) Even if there is no obvious abdominal injury, it is recommended to use tocodynamometry for observation for 2 hours before discharge. (C) The patient's blood type is Rh negative, and giving Rho(D) immune globulin can prevent the occurrence of pre-eclampsia. (D) Antibodies produced by the injection of tetanus toxoid can cross the placenta and reduce the possibility of neonatal tetanus. (E) If vaginal secretions increase and the pH is equal to 5, amniotic membrane rupture should be highly suspected. ", "output": "D"} 
-{"instruction": "In a fire accident, if you want to follow the simple triage and rapid treatment (START) rule, which of the following scenarios is more appropriate? ", "input": "(A) A four-year-old girl has a deformed left leg and keeps crying and looking for her mother. The triage is green. (B) A man in his sixties has carbon particles in his mouth and nose. He still does not breathe after opening his airway. The triage is red. (C) The young woman rescued from the stairwell had only a scratch on her forehead and her vital signs were stable. When her identity was confirmed, she answered questions irrelevantly and was unable to follow simple instructions. Her injury was red. (D) A woman in her thirties had extensive burns on her limbs and ran anxiously to call her daughter. Her injury was yellow. (E) A middle-aged man fell to the ground. His pulse could not be felt in his limbs. His breathing was shallow and rapid. His injury was yellow. ", "output": "C"} 
-{"instruction": "Which of the following substances has a more appropriate description of the poisoning mechanism? ", "input": "(A) Pufferfish poisoning: It can increase the permeability of nerve axons and muscle cells to sodium ions, thereby changing the balance of ions inside and outside the cells. (B) Organophosphate poisoning: mainly related to the surface expander POEA (polyoxyethylene-amine) it contains. (C) Strong acid: produces liquefaction necrosis of the exposed part, which can damage blood vessels, cells, and subcutaneous tissue, leading to deep tissue damage. (D) Cyanide poisoning: cyanide ions combine with trivalent iron ions of mitochondrial cytochrome oxidase (cytochrome oxidase aa3), causing it to lose its function, inhibiting the use of oxygen by tissues, causing intracellular hypoxia, and causing metabolic acidosis. (E) Coral reef fish toxin poisoning: can inhibit the permeability of cell membranes to sodium ions, and can also inhibit cholinergic receptors on central nervous system or ganglia. ", "output": "D"}  
-{"instruction":"A 9-month-old girl, weighing 10 kg, complained that she had paroxysmal abdominal pain and crying since 6 hours ago. She vomited once at the checkpoint. Her family opened her diaper and found no blood in her stool. Which of the following diagnoses is less likely?", "input": "(A)Midgut volvulus. (B)Pyloric stenosis. (C)Intussusception. (D)Incarcerated hernia. (E)Vir al enterocolitis.", "output": "B"}
-{"instruction": "Which of the following statements about peripheral vertigo and central vertigo is less appropriate? ", "input": "(A) Peripheral vertigo is generally shorter-lived, while central vertigo symptoms may last weeks to months. (B) Symptoms of peripheral vertigo are more likely to be affected by head position than those of central vertigo. (C) Horizontal head impulse test will produce abnormal reactions in patients with peripheral vertigo. (D) Nystagmus in peripheral vertigo is usually direction-changing horizontal nystagmus, while in central vertigo it may be horizontal, circular, or vertical. (E) Vertigo combined with hearing loss or tinnitus is more likely to be peripheral vertigo, while headache or neck pain should be considered central vertigo. ", "output": "D"} 
-{"instruction": "Which of the following patients is more likely to experience non-classic chest pain? ","input": "(A) Middle-aged male. (B) Hypertension. (C) Hyperlipidemia. (D) Mental illness.", "output": "D"} 
-{"instruction": "A 57-year-old female patient was sent to the emergency room because of unconsciousness. Her family mentioned that the patient had been taking an unknown drug purchased from a radio station for long-term joint pain, but had recently stopped taking the drug due to gastrointestinal discomfort. Her blood pressure was 90/60 mmHg, blood glucose was 65 mg/dL, and blood sodium was 123 mEq/L. Which of the following treatments is more appropriate?", "input": "(A) Lumbar puncture followed by antibiotic Ceftriaxone. (B) Hydrocortisol. (C) Thyroxine. (D) 3% Saline.", "output": "B"}
-{"instruction": "A 28-year-old male had headaches, lower abdominal pain, and red eyes for about 10 days. He went to the clinic for a checkup and was told that he had a cold. After the symptoms were slightly relieved, he developed fever, muscle soreness, jaundice, and oliguria. A week before the onset of symptoms, he had gone mountain climbing for several days, swam in the river, and drank river water. Results of an emergency blood test: WBC 10,600/µL, 70.0% PMN, platelets 100,000/µL, AST 157 IU/L, ALT 57 IU/L, bilirubin 4.0 mg/dL, BUN 47 mg/dL, Cr 5.7 mg/dL. Which of the following statements is more appropriate?", "input": "(A) This patient has a mild case, accounting for 10~20%, and most cases can heal on their own. (B) This patient should be considered for reporting a Category IV notifiable infectious disease and be isolated. (C) A rapid screening test kit for this disease is already available in the country and can be used as a confirmation. (D) Intravenous Penicillin or third-generation Cephalosporins are recommended for treatment. ", "output": "D"} 
-{"instruction": "A 14-year-old junior high school student developed acute respiratory distress and altered consciousness two days after a right femur fracture. Several small petechiae appeared on the patient's chest. Vital signs were blood pressure 95/45 mmHg, heart rate 130 beats/min, respiration 36 times/min, body temperature 38.6°C, and SpO₂ 80% under a 100% oxygen mask. Which of the following treatments should be given priority? ", "input": "(A)1L (A) Lung abscesses are usually located in the basal segments of lower lobes or posterior segment of upper lobes. (B) Heparin bolus 80 Units/kg. (C) Intravenous lipid emulsion. (D) Endotracheal intubation with rapid sequence intubation. ", "output": "D"} 
-{"instruction": "A 75-year-old nursing home resident was taken to the emergency department with complaints of fever, cough, and shortness of breath. A chest X-ray showed suspected left lung abscess with pleural effusion. Which of the following statements is less appropriate? ", "input": "(A) Lung abscesses are often located in the basal segments of lower lobes or posterior segment of upper lobes. (B) If pulmonary abscesses appear in multiple lobes at the same time, endocarditis or Lemierre's syndrome should be suspected. (C) For this patient, the choice of piperacillin-tazobactam is a reasonable empirical medication. (D) If the development of empyema is only in the first stage of exudative stage and has not yet developed into the fibrinopurulent stage, appropriate antibiotic treatment is very important, and chest tube drainage is usually not required. ", "output": "D"} 
-{"instruction": "Regarding diaphragmatic injury, which of the following descriptions is more appropriate? ", "input": "(A) Usually more on the right side than on the left side. (B) More common in puncture wounds in the chest and abdomen. (C) The threat to vital signs is mainly hemorrhagic shock. (D)Computed tomography (CT scan) has a high diagnostic rate for minor diaphragm injuries. ", "output": "B"} 
-{"instruction": "Which of the following statements about diabetic ketoacidosis (DKA) and hyperosmotic state (HHS) is more appropriate? ", "input": "(A)The treatment of both focuses on fluid resuscitation. (B)Both can cause severe acidemia due to increased blood ketones. (C)The blood sugar level in DKA is often higher than that in HHS. (D)DKA is common in the elderly, while HHS is common in young people. ", "output": "A"} 
-{"instruction": "Which of the following statements is more appropriate regarding craniofacial nerve palsy? ", "input": "(A) The presence of ptosis, pupil constriction, and neck pain at the same time requires consideration of vertebral artery dissection. (B) When the third cranial nerve is palsied due to compression by a hemangioma, the pupil appears constricted. (C) When the third cranial nerve is palsied due to hypertension and diabetes, the pupil size is not affected. (D) When the facial nerve is combined with the sixth cranial nerve on the same side, viral infection should be considered first. ", "output": "C"} 
-{"instruction": "Which of the following statements is more appropriate regarding intussusception in children? ", "input": "(A) Most types of intussusception are one colon invaginated into the other. (B) In most children, the exact cause of intussusception can be identified, such as Meckel's diverticulum, intestinal polyps, congenital duplications, lymphoma and Henoch-Schönlein purpura. (C) Abdominal CT scan is a common diagnostic tool. (D) If the child presents with clinical symptoms of peritonitis or shock, air-contrast enema reduction should be avoided and direct surgical treatment may be considered. ", "output": "D"}"(A)Median nerve. (B)M usculocutaneous nerve. (C)Radial nerve. (D)U lnar nerve.", "output": "D"} 
-{"instruction": "A 40-year-old woman was stabbed in the left lower back with a knife. Her vital signs are stable. Which of the following statements about follow-up treatment is more prioritized and appropriate?", "input": "(A) A CT scan with contrast should be performed. (B) The wound can be explored and the injury can be assessed under appropriate light and local anesthesia. (C) If FAST is negative, the patient should not be seriously injured. (D) The patient should be hospitalized for hemoglobin tracking.", "output": "A"} 
-{"instruction": "For patients in shock, a lung ultrasound scan with limited infusion (FALLS protocol), In the process of eliminating various types of shock, which of the following should be given the highest priority? ", "input": "(A) Obstructive shock. (B) Cardiogenic shock. (C) Hypovolemic shock. (D) Distributive shock. ", "output": "A"}"D"} 
-{"instruction": "Which of the following descriptions of the treatment of hemorrhagic shock in trauma patients is more appropriate?", "input": "(A) Patients with bilateral hip fractures and hypotension should first be infused with crystalloid fluid, with the goal of restoring the patient's blood pressure to normal. (B) For trauma patients, rapid and adequate infusion treatment is far more important than controlling bleeding. (C) Tranexamic acid given within 3 hours can improve the survival rate of trauma patients. (D) Massive transfusion is defined as the transfusion of more than 10 units of red blood cells and plasma within 24 hours.", "output": "C"}
-{"instruction": "Which of the following statements about the clinical manifestations of systemic lupus erythematosus (SLE) is less appropriate?", "input": "(A) It increases the risk of coronary artery disease and venous embolism. (B) An increase in C-reactive protein (CRP) should give priority to infection rather than disease activity. (C) An increase in prothrombin time (PT) alone should be considered as antiphospholipid antibodies. (D) All organ systems are affected by this disease.", "output": "C"} 
-{"instruction": "A 12-year-old female dislocated her right elbow after a fall. She was unable to abduct her fingers and had numbness on the palm of her little finger. Which of the following nerves was damaged?", "input": "(A) Median nerve. (B) M usculocutaneous nerve. (C)Radial nerve. (D)U lnar nerve. ", "output": "D"} 
-{"instruction": "A 56-year-old male with recurrent syncope went to the emergency room and was diagnosed with subclavian steal syndrome. Which of the following descriptions is more appropriate? ", "input": "(A)This lesion is a neurological syncope. (B)This lesion often occurs in the right upper limb. (C)This lesion can cause transient frontal ischemia. (D)The blood pressure on the affected side is usually higher, and the pulse on the affected upper limb feels stronger. ", "output": "A"} 
-{"instruction": "An 8-year-old boy was rushed to the emergency room after a 2-day fever and a second seizure within 30 minutes. He was no longer seizure-free when he arrived at the checkpoint. His blood pressure was 70/50 mmHg. Laboratory tests revealed WBC 21,000/µL, blood glucose 45mg/dL, and blood sodium 120 mEq/L. Cerebrospinal fluid examination results were as follows: glucose 37 mg/dL, protein 300 mg/dL, WBC 1,120/µL. Which of the following treatments is more appropriate?", "input": "(A) It may be bacterial meningitis. Ampicillin and Gentamicin are recommended. (B) Correct low blood sugar and low blood sodium first, then treat epilepsy. (C) First stabilize vital signs, then perform lumbar puncture, and then CT scan of the head. (D) It is recommended to give Dexamethasone treatment to reduce inflammation of the central nervous system. It should be given after the use of antibiotics. ", "output": "B"} 
-{"instruction": "Which of the following respiratory infectious diseases has a shorter incubation period than the latent period? ", "input": "(A) Severe specific infectious pneumonia (Coronavirus disease 2019, COVID-19). (B) Seasonal influenza. (C) Severe acute respiratory syndrome (SARS). (D) Measles. ", "output": "C"} 
-{"instruction": "Which of the following statements is more appropriate for diagnosing patients with acute abdominal pain? ", "input": "(A) Abdominal X-rays are a commonly used screening tool for various causes of abdominal pain. (B) The severity of abdominal pain is proportional to the severity of the disease. (C) Opioid analgesics can delay diagnosis of the disease. (D) Malnutrition can affect the clinical manifestations of abdominal pain in patients. ", "output": "D"} 
-{"instruction": "A 1 year and 10 month old boy complains of difficulty eating and coughing. His family suspects that there may be a foreign body blocking his throat but cannot confirm it. Which of the following treatments is more appropriate? ", "input": "(A)If the X-ray examination is normal, esophageal foreign bodies can be ruled out and other diagnoses should be considered. (B)Esophagogram can also be used as one of the diagnostic tools. (C)If the X-ray shows that a coin is blocking the upper esophagus, a Foley catheter can be used directly to remove the foreign body in the emergency room. (D)If the foreign body is a button battery and has been swallowed for more than 2 hours, it must be removed immediately with an endoscope. ", "output": "D"} {" 
-instruction": "60-year-old male, suddenly right limb weakness 1 hour ago, blood pressure 200/120 mmHg, blood oxygen concentration 95%, body temperature 38.1℃. The CT scan showed no intracranial hemorrhage. After consulting with a neurologist, the patient was diagnosed with acute ischemic stroke. Which of the following statements is more appropriate? ", "input": "(A) If the patient agrees to receive thrombolytic therapy, he or she must first be given antihypertensive drugs. If the systolic blood pressure continues to be >185mmHg, thrombolytics cannot be given. (B) After the patient receives thrombolytic therapy, Aspirin should be given within 24 hours to reduce the chance of another stroke in the short term. (C) Fever is a normal physiological reaction and does not need to be reduced, but it is necessary to look for potential infection and give antibiotics if necessary. (D) Oxygen should be given through a nasal cannula, and the blood oxygen concentration should be actively maintained above 98% to avoid further brain hypoxia. ", "output": "A"} 
-{"instruction": "A 25-year-old female with no past medical history complained of chest tightness and wheezing for a day when walking or lying down. She began to have cold symptoms such as body aches and cough 4 days ago. When she arrived at the hospital, her blood pressure was 78/56mmHg, heart rate 128 beats/min, respiratory rate 30 times/min, body temperature 37.7℃, SpO₂ 90%, auscultation showed bilateral gurgling sounds, CXR showed increased bilateral lung patterns, and electrocardiogram showed rapid heartbeat and diffuse T wave inversion. Which of the following treatments is more appropriate? ", "input": "(A) Give β-blocker and check for hyperthyroidism. (B) Give Aspirin and Levophed, check troponin, and consult the cardiology department to prepare for cardiac catheterization. (C) Give appropriate infusion, ultrasound examination, and activate ECMO if necessary. (D) Check D-dimer and arrange chest CT immediately. ", "output":"C"} 
-{"instruction": "A 35-year-old male underwent bariatric surgery two weeks ago and came to the hospital tonight with severe abdominal pain, nausea, and vomiting. Which of the following statements is more appropriate?", "input": "(A) Common surgical procedures include band gastrectomy, sleeve gastrectomy, Roux-en-Y gastric bypass, and jejunal shortening. (B) Gastrointestinal obstruction must be considered first. An abdominal X-ray or abdominal CT scan can be performed directly for diagnosis. (C) Except for band gastrectomy, other surgical procedures will remove most of the stomach and then reconstruct it. Therefore, leakage or bleeding at the sutures must be ruled out first. (D) Banding the stomach often causes the proximal gastric pouch and esophagus to expand due to being tied too tightly, which requires emergency upper gastrointestinal endoscopy for diagnosis. ", "output": "C"} 
-{"instruction": "When auricular never block is necessary due to auricular suture, where is the anesthetic needle injected on the auricle? ", "input": "(A) Above and below. (B) Front and back. (C) Above and back. (D) Below and front. ", "output": "A"} 
-{"instruction":"A 45-year-old male was diagnosed with AIDS (Acquired Immunodeficiency Syndrome) two years ago. He took antiviral drugs irregularly. Last month, his CD4+ was 450 cells/µL. After five days of fever, headache, and fatigue, he was sent to the emergency room due to persistent high fever. Chest X-ray and brain CT scan showed no abnormalities. The patient was lying on his side for a spinal puncture. The initial cerebrospinal fluid pressure was 280 mmH 2O. 12 ml of cerebrospinal fluid was collected and sent for testing: white blood cells 40 /µL, sugar 87mg/dL, protein 27 mg/dL, acid-fast stain, Gram stain, and India ink stain were all negative. Which of the following statements is more appropriate?", "input": "(A) The patient's spinal tap results suggest bacterial meningitis is the most likely cause. (B) Spinal taps performed in the lateral position are more reliable than those performed in the sitting position in measuring cerebrospinal fluid pressure. (C) The negative India ink stain rule out cryptococcal meningitis. (D) The sensitivity of acid-fast staining for diagnosing tuberculous meningitis using >10 ml of cerebrospinal fluid is about 80%. ", "output": "B、D"}
-{"instruction": "Which clinical symptom is more appropriate for bee stings and anaphylactic shock?", "input": "(A) Anaphylactic shock usually occurs within 15 minutes after a bee sting. The more stings there are, the greater the chance of shock. (B) If a rash appears on the whole body and there is persistent abdominal pain and vomiting, give Epinephrine 0.3mg IM injection. (C) A large number of bee stings (>100 stings) often cause heart failure, as well as liver and kidney failure. (D) Symptoms such as urticaria, lymphadenitis and arthritis often occur 72 hours after a bee sting.", "output": "B"} 
-{"instruction": "According to the 2019 American Heart Association guidelines for pediatric emergency care, which of the following statements is less appropriate?", "input": "(A) During prehospital cardiac arrest, advanced airway devices (endotracheal tubes or supraglottic airway devices) are more appropriate than bag-valve-mask ventilation for children. (B) For term and late preterm newborns (35 weeks of gestation or more) who receive respiratory support at birth, the initial use of 21% oxygen is a reasonable approach. (C) For OHCA patients younger than 18 years who remain unconscious after spontaneous breathing and heartbeat are restored, hypothermia is recommended. (D) For children with cardiac disease and in-hospital cardiac arrest, extracorporeal CPR (ECPR) can be considered if experienced ECMO staff are available.", "output": "A"} 
-{"instruction": "Which of the following treatments for patients with acute respiratory distress syndrome (ARDS) has been shown to reduce mortality?", "input": "(A) Early administration of broad-acting antibiotics. (B) Using a low tidal volume setting on the ventilator. (C) Administering packed red blood cell transfusions. (D) Administering prophylactic steroids.", "output": "B"} 
-{"instruction": "Regarding seizures in children, which of the following is more appropriate?", "input": "(A) Early use of anti-epileptic drugs has no significant difference in the treatment of epilepsy and gravitational syndrome. (B) Ketamine can be considered as a second-line drug for epilepsy and gravitational syndrome, and there is no need to worry about it causing increased intracranial pressure. (C) About 50% of patients with simple febrile seizures over 1 year old will have a second febrile seizure. (D) For children with complex febrile seizures, routine blood draws and imaging examinations are recommended. ", "output": "B"} 
-{"instruction": "Three patients in the emergency room ate mackerel lunch together and developed symptoms about 1 hour later, including headache, dizziness, diarrhea, and upper abdominal pain. The patients' vital signs were stable and they had no fever. Physical examination revealed that two patients had flushing on their faces and chests, while the rest of their bodies were normal. Which of the following treatments is more appropriate? ", "input": "(A) Symptoms appeared quickly, and the most likely pathogen was Staphylococcal enterotoxin. (B) Collect stool samples from the patient and give supportive treatment and oral antibiotics. (C) Give supportive treatment and antihistamines. (D) Cooking food at high temperatures can prevent this type of food poisoning. ", "output": "C"} 
-{"instruction": "When a seizure occurs after using Flumazenil, which of the following drugs is the best choice to stop the seizure? ", "input": "(A)Benzodiazepine. (B)Phenytoin. (C)Propofol. (D)Sodium Valproate. ", "output": "C"} 
-{"instruction": "Which of the following statements about measles is less appropriate? ", "input": "(A) It can be transmitted through air, droplets or contact with nasopharyngeal secretions of patients, but after infection, one will have lifelong immunity. (B) Symptoms such as cough, rhinitis, conjunctivitis, high fever, and fatigue will appear first, followed by white spots on the mucosa of the inner cheek opposite the lower molars in the mouth, called Koplik spots. (C) The typical maculopapular rash will appear in an eccentric shape, first appearing on the trunk, and then gradually spreading to the entire back of the ear, face and limbs. (D) Although the MMR vaccine in childhood can produce active immunity, if an adult wants to travel to a measles-endemic area, it is recommended to get a dose of MMR vaccine before going there. ", "output": "C"} 
-{"instruction": "During the summer vacation, Xiao Ming participated in a marathon competition. During the process, Xiao Ming felt thirsty, weak and dizzy, so he went to the medical station to sit down and rest. The medical station staff found that Xiao Ming's temperature was 39.5℃, E4V5M6, and he could answer clearly. Which of the following statements is more appropriate? ", "input": "(A) Because it is hot in summer, Xiao Ming may have suffered heat stroke. (B) The medical station let Xiao Ming lie down and replenish water, and also gave him Acetaminophen 500mg to assist in cooling down. (C) If Xiao Ming's consciousness gradually becomes confused during the rest process, an intravenous line can be established to give him physiological saline. (D) The medical station should not wait until Xiao Ming's consciousness changes, and should consider using 4℃ intravenous injection to quickly cool him down. ", "output": "C"} 
-{"instruction": "Which of the following statements is more appropriate regarding the steps of central cervical venous catheterization and ultrasound guidance? ","input": "(A) There are three approaches for insertion: central, posterior, and superior. (B) When using the central approach, the needle is inserted toward the contralateral nipple on the patient's side. (C) Under ultrasound, the internal jugular vein is located on the outside of the internal jugular artery, has a flatter shape, and will not be deformed by pressure. (D) The internal jugular vein, internal jugular artery, and thyroid gland must be identified under ultrasound before the needle can be inserted.", "output": "D"}"(A) Because it is hot in summer, Xiao Ming may have suffered from heat stroke. (B) The medical station let Xiao Ming lie down, replenish water, and also gave him 500mg of Acetaminophen to help cool him down. (C) If Xiao Ming's consciousness gradually becomes confused during the rest, an intravenous line can be established to give him normal saline. (D) The medical station should not wait until Xiao Ming's consciousness changes, but should consider using 4℃ drip injection to quickly cool him down.", "output": "C"} 
-{"instruction": "Which of the following statements about hematuria is more appropriate?", "input": "(A) The severity of kidney damage caused by trauma is closely related to the amount of hematuria. (B) Urine examination found red blood cell cylinders (red cell (C) Hematuria in children does not need to be considered a tumor. (D) Hematuria caused by glomerulonephritis is more common in middle-aged and elderly people. ", "output": "B"}
-{"instruction": "A 4-year-old boy was sent to the emergency room because of fever, cough, dyspnea and lethargy. Vital signs: blood pressure 70/55mmHg, heart rate 149 beats/min, respiration 28 times/min, cold limbs, mottled skin, capillary refill of 5 seconds, blood test white blood cell count 21,000/µ L, X-ray showed right-sided pneumonia. Which of the following judgments and treatments is less appropriate?", "input": "(A) It may be cold septic shock. (B) The preferred pressor drug is Norepinephrine rather than Dopamine or Epinephrine. (C) The infection may be Gram-positive bacteria. (D) Broad-acting antibiotics and 30ml/kg infusion are required within 1 hour for recovery.", "output": "B, D"} 
-{"instruction": "A 65-year-old male patient complained of fainting and loss of consciousness for about 3 minutes. His blood pressure was 167/88 mmHg, his heart rate was 77 beats/min, and his EKG showed ST depression over lead II, III, and aVF. His troponin level was elevated and his D-dimer level was 300 ng/mL. Which of the following statements is less appropriate?", "input": "(A) The patient had a non-ST-band elevation myocardial infarction, which has a mortality rate higher than that of ST elevation MI. (B) The patient had cardiac-related syncope, which has a mortality rate of more than 10% in half a year and is the most dangerous type of syncope. (C) The patient underwent percutaneous coronary intervention (PCI) within 24 to 48 hours, which did not reduce the mortality rate or recurrent MI. (D) Troponin peaked at about 48 hours and could remain elevated for up to 10 days.", "output": "C"} 
-{"instruction": "A 30-year-old male found himself weak and unable to move when he got up in the morning and went to the emergency room. The patient described a similar attack 3 months ago. In the past six months, the patient has had symptoms such as palpitations and weight loss. When he arrived at the hospital, his blood pressure was 120/70 mmHg, heart rate was 110 beats/min, respiratory rate was 20 breaths/min, and body temperature was 37℃. Other physical examinations were normal except for symmetrical weakness in the limbs. Which of the following statements is less appropriate?", "input": "(A) The diagnosis may be hyperthyroidism combined with periodic paralysis. (B) The affected muscles are mostly distal muscles. The lower limbs are more susceptible to the impact than the upper limbs. There is symmetry and they are often accompanied by abnormal sensations. (C) The patient is more likely to have an attack if he eats foods high in starch and salt. (D) Do not give the patient dextrose solution with KCL. ", "output": "B"} 
-{"instruction": "Which of the following statements is more appropriate for the primary assessment and resuscitation of elderly trauma? ", "input": "(A) Gauze can be inserted between the gums and cheeks to increase the tightness of the mask during BVM. (B) Dentures should be removed before using BVM to give oxygen to prevent them from falling off and causing airway obstruction. (C) A rapid heartbeat is an early sign of ischemic shock. (D) Shock is only considered when the required systolic pressure is less than 100 mmHg. ", "output": "A"} 
-{"instruction": "A 25-year-old female has had left lower abdominal pain and excessive vaginal discharge for about one week. The patient came to the emergency department with a fever. Internal examination revealed purulent vaginal discharge, cervical tenderness, and ultrasound showed a mass on the left side of the uterus. Which of the following statements is more appropriate for this patient? ", "input": "(A) If left untreated, the mass may rupture and cause peritonitis. (B) Cervical tenderness during internal examination is highly specific for diagnosing pelvic infection. (C) The diagnosis is Fitz-Huge-Curtis syndrome. (D) If the pus culture is not Neisseria gonorrhoeae, Neisseria gonorrhoeae infection can be ruled out. ", "output": "A"} 
-{"instruction": "A 60-year-old male has had left upper arm pain for one week. Which of the following neurological examination descriptions is less appropriate? ", "input": "(A) If accompanied by abnormal nerve sensation, it is a sign of radiculopathy. (B) Performing the Valsalva maneuver will increase the pain, which may be a radiculopathy. (C) Abduction will increase the pain in the left neck, which may be a symptom of nerve root compression. (D) When the neck is flexed and the chin is brought close to the chest wall, the upper arm will produce pain like electrical stimulation, which may be a symptom of cervical spinal cord compression. ", "output": "C"} 
-{"instruction": "A 55-year-old female presented to the emergency department with a high fever of 39.5°C and right upper abdominal pain. She was drowsy, with a heart rate of 95 beats/min, a blood pressure of 98/56 mmHg, yellow skin and sclera, and a white blood cell count of 16,000/µL. The initial diagnosis was acute cholangitis. Which of the following statements is more appropriate? ", "input": "(A) According to the 2016 Sepsis-3 guideline, a qSOFA score of 2 is calculated based on a high fever of ≥39°C and a systolic blood pressure of ≤100 mmHg. The patient is suspected to have an infection with sepsis. (B) Give at least 30 mL/kg of crystalloid intravenously within the first 3 hours of treatment. (C) When pressor therapy is needed, norepinephrine is the first choice. It has only an α-adrenergic effect that causes peripheral vasoconstriction, but is less likely to affect heart rate. (D) If blood pressure remains low after massive infusion and pressor therapy, corticosteroids should be injected as soon as possible. ", "output": "B"} 
-{"instruction": "Which of the following patients who were successfully resuscitated after cardiac arrest is suitable for targeted temperature management? ", "input": "(A) A 60-year-old male has hypertension. A CT scan of his head revealed approximately 10 cc of hemorrhage in the brain stem. (B) A 29-year-old female died after arriving at the hospital after a car accident. After recovery, a large amount of intra-abdominal blood was found. (C) A 70-year-old male had no medical history and 30 cc of coffee-colored gastric fluid was drained through a nasogastric tube. (D) A 35-year-old male was able to nod after first aid, and the electrocardiogram showed an increase in ST-segment. ", "output": "C"} 
-{"instruction":"Which of the following statements about Bell's palsy is more appropriate?", "input": "(A) It is more common in the elderly and preschool children with poor immunity. (B) Imaging examination is the diagnostic standard. (C) Incision and drainage and needle aspiration have the same therapeutic effect. (D) Tonsillectomy is the first choice of treatment.", "output": "C"} 
-{"instruction": "Which of the following statements about Bell's palsy is more appropriate?", "input": "(A) If the facial nerve (cranial nerve VII) is affected, the patient may experience symptoms of hyperacusis. (B) If the glossopharyngeal nerve (cranial nerve IX), the patient may have decreased taste in the back third of the tongue. (C) Since ear infections are rare, routine ear examinations are not necessary and oral steroids can be given first. (D) Giving antiviral drugs and steroids to patients at the same time will cause more side effects, so it is not recommended to use them together. ", "output": "A"} 
-{"instruction": "A 19-year-old male was taken to the emergency room in a state of agitation and confusion after allegedly taking an unknown hallucinogen in a nightclub. Which of the following statements is more appropriate? ", "input":"(A) Tachycardia and hypotension are common symptoms of hallucinogen intoxication, so the patient's vital signs must be monitored more closely. (B) Supportive therapy is the most commonly used method, which requires gastric lavage and the use of activated carbon to remove drugs. (C) Urinalysis must be done immediately to detect what type of hallucinogen the patient has taken and to give the corresponding antidote. (D) If the patient shows symptoms of extreme agitation or palpitations, most of them can be treated with BZD.", "output": "D"} 
-{"instruction": "Which of the following statements about graft versus host disease (GVHD) is less appropriate?", "input": "(A) Acute GVHD occurs within 100 days after transplantation. (B) The most common symptoms of Acute GVHD are fever and diarrhea. (C) Acute GVHD After recovery, patients are prone to chronic GVHD. (D) Currently, drugs commonly used to prevent GVHD include Tacrolimus and Methotrexate. ", "output": "B"}
-{"instruction": "A 20-year-old male hits his head on the bottom of a swimming pool while diving. The patient is conscious and complains that he cannot move his hands and feet at all. He cannot feel pain from the clavicle down, but proprioception and vibration sensation in his limbs are normal. An X-ray of the cervical spine shows no fractures. What diagnosis is most likely for this patient?", "input": "(A) Central cord syndrome. (B) Anterior cord syndrome. (C) Cauda equina syndrome. (D) Brown-Séquard syndrome.", "output": "B"} 
-{"instruction": "A 25-year-old male presents to the emergency department with right-sided headache accompanied by nausea and photophobia. Which of the following statements is more appropriate?", "input": "(A) Typical migraine symptoms include unilateral, persistent, non-throbbing pain, accompanied by photophobia and phonophobia. (B) Antihistamines alone (such as intravenous diphenhydramine) can also relieve migraine pain. (C) After excluding life-threatening diseases, nonsteroidal anti-inflammatory drugs and antiemetics can be used in combination to treat migraine. (D) Steroids are not helpful in reducing the recurrence of migraine.", "output": "C、D"} 
-{"instruction": "Which of the following statements about the physical examination and clinical symptoms of abdominal emergencies is more appropriate?", "input": "(A) Bruising and bleeding around the navel of a patient with pancreatitis is a Grey Turner's sign. (B) Compared with morphine, the use of nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief is less likely to conceal clinical symptoms and delay diagnosis. (C) Low risk modified Alvarado score (0-4 points) has low sensitivity and should not be used as the main tool for exclusion diagnosis. (D) Fitz-Curtis-Hugh syndrome pain is mainly located in the left upper abdomen. ", "output": "C"} 
-{"instruction": "Which of the following major or minor criteria for the diagnosis of infective endocarditis is less appropriate? ", "input": "(A) Two separate sets of blood cultures grow typical bacteria. (B) Cardiac ultrasound shows floating organisms or abscesses on the valve. (C) New onset of right bundle branch block (RBBB). (D) Fever greater than 38°C. ", "output": "C"} 
-{"instruction": "Which of the following descriptions of sedatives for acute agitation is more appropriate? ", "input": "(A) Benzodiazepines can cause electrocardiographic changes such as QTc prolongation. (B) First-generation antipsychotics such as Haloperidol do not cause respiratory depression. (C) Second-generation antipsychotics such as Quetiapine do not cause electrocardiographic changes such as QTc prolongation. (D) Second-generation antipsychotics such as Risperidone do not cause extrapyramidal symptoms. ", "output": "B"} 
-{"instruction": "A 66-year-old female patient presented with upper lip and tongue swelling three days ago. She had no fever, rashes, or signs of local tissue infection. She had hypertension and hyperlipidemia and had been treated with Enalapril 10mg qd and Atorvastatin 10mg qd a week ago. She had not taken any other medications. Which of the following treatments is inappropriate? ", "input": "(A) The pathogenesis is related to bradykinin. (B) Attention should be paid to the presence of airway obstruction. (C) Current treatment should be based on oral steroids and antihistamines. (D) If other antihypertensive drugs are used, angiotensin II receptor-blocking agents should be avoided. ", "output": "C"} 
-{"instruction": "A 65-year-old male with a history of epilepsy and mental illness was sent to the emergency room after taking an overdose of Phenytoin and becoming unconscious. Which of the following statements is more appropriate? ", "input": "(A) Nystagmus is related to the dose of the patient's poisoning. If the nystagmus is relieved, the possibility of severe poisoning can be ruled out. (B) Phenytoin's cardiotoxicity is common with intravenous medication and rarely occurs with oral medication. (C) Hemodialysis is helpful in removing Phenytoin, but has limited effect on improving symptoms of neurological poisoning. (D) Usually, once the serum concentration of phenytoin drops below normal, the patient can be discharged from the hospital for observation at home after a psychiatric consultation. ", "output": "B"} 
-{"instruction": "Which of the following statements is more appropriate for the treatment of dissemi nated intravascular coagulation (DIC)? ", "input": "(A) If the platelet count is <100,000/µL, platelet transfusion should be considered. (B) If the aPTT is prolonged by more than 1.5 times, consider transfusing fresh frozen plasma (FFP). (C) Consider giving prophylactic tranexamic acid to elderly patients. (D) Consider giving vitamin K to patients with prolonged PT. ", "output": "D"} "D"} 
-{"instruction": "Which of the following statements about qSOFA is more appropriate for evaluating patients with infectious diseases?", "input": "(A) There are three qSOFA assessment items in total. As long as two of them are met, the patient can be diagnosed with sepsis. (B) Platelet count less than 10,000/µL is one of the qSOFA assessment items. (C) Respiratory rate ≥ 20 times/min is one of the qSOFA assessment items. (D) Systolic blood pressure less than or equal to 100 mmHg is one of the qSOFA assessment items.", "output": "D"}
-{"instruction": "A 3-year-old boy with no significant past medical history was taken to the emergency room with a rash and dyspnea after eating a cake 30 minutes ago. He was restless, dyspnea, hoarse voice, pale skin, capillary refill time > 3 seconds, temperature 37.1°C, heart rate 150 beats/min, respiration 40 breaths/min, and blood pressure 70/45 mmHg. Which of the following is less appropriate in the management and description of this child? ", "input": "(A) The first-line emergency treatment for anaphylactic shock includes airway, oxygen, decontamination, adrenaline and fluids, but does not include steroids and antihistamines. (B) If the allergy is confirmed to be caused by food, gastric lavage can be arranged. (C) 0.01 mg/kg (0.01cc/kg, 1:1,(A) Nitroglycerin infusion dose is adjusted based on the 
-degree of blood pressure reduction as the treatment target, rather than the degree of chest pain relief. (B) Early administration of Clopidogrel does not reduce the mortality of NSTEMI. Clopidogrel is used as an alternative drug for patients who are allergic to aspirin. (C) Aspirin combined with H2 blockers will affect the efficacy of antiplatelet therapy. (D) Treatment with beta blockers can reduce the incidence of cardiogenic shock. ", "output": "A"}
-{"instruction": "A 24-year-old male had 3-second glue dropped into his right eye 10 minutes ago. The main ingredient of the product is cyanoacrylate. Examination revealed that a small part of the upper and lower eyelashes were stuck and could not be opened. The sclera was slightly congested, the eyeball moved freely, and the vision was normal. There is no ophthalmologist in the hospital. Which of the following treatments should be prioritized?", "input": "(A) Apply acetone with a cotton swab to the stuck area to dissolve the stickiness of the 3-second glue. (B) You can try to remove the stuck eyelashes with your bare hands. (C) Inform the patient that it may cause cataracts in the future. (D) You must be transferred to a hospital with an ophthalmologist on duty immediately.", "output": "B"} 
-{"instruction": "A 61-year-old female with breast cancer has been receiving chemotherapy for about a month. She started to have mild cough, nausea, poor appetite, abdominal distension and other symptoms two or three days ago. Today, she became unconscious and had a fever. When she went to the hospital, her GCS was E2M4V1, her blood pressure was 140/68 mmHg, her heart rate was 126 beats/min, her respirations were 26 breaths/min, SpO₂ was 96%, and her temperature was 38.3℃. Which of the following is more appropriate for this patient?", "input": "(A) Based on the consciousness of the Taiwan Emergency Examination Urgency Scale, the examination level is 2. (B) The patient's breath sounds are normal, her blood oxygen is normal, and her chest X-ray shows no signs of pneumonia, which excludes the diagnosis of pneumonia. (C) WBC 1,000/ µL, Segment 30%, when there is no obvious source of infection, an anal examination should be performed as soon as possible to determine whether there is a rectal ulcer. (D) Blood calcium is 15.2 mg/dL (3.8 m Eq/L), and infusion therapy must be given immediately to accelerate the excretion of calcium ions from the urine. ", "output": "D"} 
-{"instruction": "Which of the following descriptions of the physiological changes and emergency treatment during pregnancy is more appropriate? ", "input": "(A) Cardiac output and blood volume will increase, so blood pressure can be higher than when not pregnant. (B) Respiratory secretions decrease, which does not affect intubation. (C) Prolonged gastric emptying time and more relaxed ventricular dilator muscles require prevention of aspiration pneumonia. (D) Tidal volume increases due to hormonal factors, making pregnant women less likely to suffer from hypoxia. ", "output": "C"} 
-{"instruction": "According to the announcement of the Taiwan Centers for Disease Control, which of the following statements is more appropriate regarding home quarantine measures related to the novel coronavirus infection epidemic? ", "input": "(A) People under home quarantine can go out after reporting when they need to purchase daily necessities. (B) The head of the village or the village official is responsible for the health care of the self-health manager. (C) For people under home quarantine, the responsible unit is the local health authority. (D) For people under home quarantine, the responsible unit is the local health authority. ", "output": "C"} 
-{"instruction": "A 22-year-old female suddenly developed severe pain in the lower abdomen and went to the emergency room for medical treatment. She was conscious and her vital signs were stable. She had no trauma and no fever. Her last menstruation was about 2 weeks ago. Her menstruation is regular, about 30-32 days in cycle. She suffered abdominal pain when walking. Her hemoglobin was 12.4 g/dL and her pregnancy test was negative. An abdominal CT scan showed a cystic mass of about 3.8 cm on the right ovary, which contained a high-density content, a non-calcified cyst, and pelvic effusion. Which of the following diagnoses or treatments is more appropriate? ", "input": "(A) Ovary torsion. Contact the obstetrics and gynecology department and arrange surgery immediately. (B) Rupture of appendicitis , contact the surgical department and arrange surgery. (C) Rupture of corpus luteum cyst , contact the obstetrics and gynecology department and follow up with abdominal ultrasound. (D) Complicated nephrolithiasis , pain relief and observation. ", "output": "C"} 
-{"instruction": "A 65-year-old male was sent to the emergency room by a passerby because of chest tightness. The patient complained of squeezing pain in the chin and left shoulder. He had been in good physical condition in the past and had no history of heart-related diseases. The only medicine he was currently taking was Levitra (Vardenafil). The electrocardiogram showed ST-segment elevation, and the blood test report showed elevated troponin-I and CK-MB, and normal D-Dimer values. The emergency physician initially diagnosed the patient with acute coronary syndrome. Which of the following is the more appropriate treatment? ", "input": "(A) Immediately give nitroglycerin (0.4mg sublingual tablet), up to three doses (5 minutes apart each time). (B) Unless there are contraindications such as hypotension, morphine (4mg, IVP) should be given routinely to relieve chest tightness. (C) Even if the patient is allergic to aspirin, clopidogrel (300mg) should be used instead. (D) ACE inhibitors should not be used in patients with normal LVEF (left ventriculo lar ejection fraction). ", "output": "C"} 
-{"instruction": "A 28-year-old woman, who was about 32 weeks pregnant, was hit by a motorcycle while crossing the road and was sent to the hospital. She was conscious and her vital signs were: blood pressure 132/84 mmHg, pulse 85 beats/min, respiration 15 times/min, and body temperature 36.4℃. The patient complained of lower abdominal discomfort and fluid flowing from the vagina. Physical examination found no obvious tenderness in the lower abdomen. Which treatment and judgment is more appropriate for this pregnant woman? ", "input": "(A) If it is confirmed that the fluid is amniotic fluid, this patient still has a more than 50% chance of entering labor after 3 days. (B) Based on the patient's gestational age, it can be estimated that the fetal lungs are mature, and giving corticosteroids will only increase the risk of maternal and neonatal sepsis. (C) Wear sterile gloves and perform a vaginal examination to confirm whether the cervix is ​​dilated. (D) Use nitrazine paper to test the fluid flowing out of the vagina. If it is mixed with blood, there may be concerns about false positives. ", "output": "D"} "(A) If the fluid is confirmed to be amniotic fluid, this patient still has a more than 50% chance of not going into labor until 3 days later. (B) Based on the patient's gestational age, it can be estimated that the fetal lungs are mature. Giving corticosteroids will only increase the risk of maternal and neonatal sepsis. (C) Wear sterile gloves to perform a vaginal examination to confirm whether the cervix is ​​dilated. (D) Use nitrazine paper to test the fluid flowing out of the vagina. If it is mixed with blood, there may be concerns about false positives.", "output": "D"} 
-{"instruction": "Which of the following statements about lightning injuries is more appropriate?", "input": "(A) Lightning injuries are usually fatal. (B) Lightning will not strike the same place twice. (C) Mobile phones and electronic products can attract lightning. (D) Lightning injuries can cause neurological deficits and sequelae. ", "output": "D"}
-{"instruction": "A 63-year-old male complained of dyspnea and chest tightness, orthopnea and edema of both feet. His body temperature was 36.8ºC, his heart rate was 143 beats/min, his respirations were 23 times/min, and his blood pressure was 187/110mmHg. The 12-lead electrocardiogram showed atrial fibrillation and left ventricular hypertrophy. Which of the following treatments is more appropriate? ", "input":"(A) Use Diltiazem to lower the heart rate. (B) Use Labetalol to lower blood pressure. (C) Use Dobutamine to relieve lung congestion. (D) Use Captopril to lower blood pressure.", "output": "D"} 
-{"instruction": "Which of the following descriptions of the diagnosis of urinary tract infection (UTI) is more appropriate?", "input": "(A) Urine culture and blood culture are important for the diagnosis and management of UTI. (B) The patient's chief complaint and description of symptoms can correctly diagnose UTI. (C) Urine test for WBC count is not helpful for diagnosis. (D) Urine test for nitrite reaction has high specificity for diagnosing UTI.", "output": "D"}
-{"instruction": "A 21-year-old male came to the emergency department complaining of right chest pain and dyspnea. On arrival, his heart rate was 140 beats/min, blood pressure was 76/50 mmHg, respiratory rate was 34 breaths/min, and blood oxygen concentration was 86%. Physical examination showed no breath sounds on the right side, and percussion showed excessive reflex on the right side. Which of the following statements is inappropriate?", "input": "(A) This patient should have tension pneumothorax and should undergo needle decompression immediately. (B) An ultrasound examination of the right chest cavity should show a positive sliding sign. (C) Oxygen therapy with an oxygen fraction (FiO2) greater than 28% will increase pleural air absorption by 3 to 4 times. (D) This patient requires a 24-36 French chest tube after acupuncture for chest decompression. ", "output": "B"} 
-{"instruction": "A healthy 3-year-old boy who was born at term and received vaccinations, including pneumococcal vaccine, complained of right ear pain due to a 2-day fever. Examination revealed a bulging, red, and secretory right eardrum. Which of the following is more appropriate? ", "input": "(A) Penicillin V is a safe and effective first-line drug of choice. (B) If the patient is allergic to Penicillin, Clindamycin is the drug of choice. (C) The patient must be re-evaluated within 3 days. (D) Antihistamines and steroids are also important therapeutic drugs. ", "output": "C"} 
-{"instruction": "A 40-year-old worker was doing pipe maintenance in a factory. A pipe containing aniline ruptured and caused splashing. Four hours later, he felt unwell and went to the emergency room on his own. Which treatment is more appropriate for the patient?", "input": "(A) If there is contamination on the body, perform decontamination, gastric lavage and use activated carbon. (B) If blood pressure is low, give fluids and pressors (Dopamine or Norepinephrine). (C) If consciousness changes, give methylene blue (1% solution) 5~10 mg/kg intravenous drip. (D) If cyanosis of the extremities occurs, give oxygen and monitor with a pulse oximeter.", "output": "B"} 
-{"instruction": "Which of the following statements is more appropriate about the differences between the respiratory structure of 5-year-old children and adults?", "input": "(A) The epiglottic ligament is harder, so it is difficult to lift the laryngoscope during intubation. (B) The epiglottis is narrower in children and its angle with the trachea is more vertical. (C) The larynx of children is located approximately at the fourth to fifth cervical vertebrae. (D) The chest has more cartilage, so the chest has greater elastic recoil. ", "output": "B"} 
-{"instruction": "A 40-year-old male, weighing 60 kg, with a history of asthma and no heart disease, has been admitted to the emergency room for 3 days with high fever and shortness of breath. The diagnosis is that he may have acute asthma with pneumonia. His heart rate is 118 beats/min and his blood pressure is 92/45 mmHg. He needs intubation, rapid-sequence intubation (RSI). What is your top choice of drug combination? ", "input": "(A) 20 mg Etomidate, 50 mg Rocuronium. (B) 100 mg Ketamine, 50 mg Rocuronium. (C) 100 mg Lidocaine, 20 mg Etomidate. (D) 100 mg Lidocaine, 10 mg Midazolam, 20 mg Etomidate. ", "output": "B"} 
-{"instruction": "Regarding emergency wound treatment, which tetanus toxoid prophylaxis injection is more appropriate? ", "input": "(A) Infants under 1 year old with wounds should be injected with toxoid 0.01ml/kg. (B) The dose for people over 65 years old should be 0.5mL. (C) Pregnant women should avoid toxoid injection during the first trimester. (D) Toxoid injection should not be used concurrently with Tetanus Immune Globulin (TIG) to avoid neutralization of the toxoid. ", "output": "B"} 
-{"instruction": "According to the recommendations of the Taiwan Centers for Disease Control and the WHO, which treatment is more appropriate for patients suspected of novel coronavirus infection? ", "input": "(A) Ibuprofen is recommended as an antipyretic drug, and Acetaminophen is not recommended. (B) When using a closed-end suction tube, the endotracheal tube must be clamped when disconnecting the breathing tube. (C) When the patient is still breathing on his own, a resuscitation ball can be used for compression ventilation. (D) To avoid splashing during intubation, a video-assisted laryngoscope should not be used. ", "output": "B"} 
-{"instruction": "Which of the following is one of the risk factors for sudden death caused by asthma attacks? ", "input": "(A) Hospitalized for asthma attacks in the past year but not hospitalized for asthma in the past month. (B) Currently using systemic corticosteroids. (C) The patient feels that the current asthma attack is severe. (D) Currently using over-the-counter (OTC) medications. ", "output": "B"}"(A)20 mg/dL. (B)40 mg/dL. (C)70 mg/dL. (D)150 mg/dL.", "output": "C"} 
-{"instruction": "A 35-year-old healthy male went to the gym to train actively for 1.5 hours every day. After 2 consecutive days, he had muscle soreness and weakness all over his body. The color of his urine changed to "cola" color. The diagnosis was rhabdomyolysis. Which of the following is more appropriate? ", "input": "(A) The patient will have hypophosphatemia in the early stage of the disease. (B) The patient was given NSAID analgesia and anti-inflammatory drugs for muscle soreness and inflammation all over his body. (C) Lactate infusion (Lactate Ringer) should be given immediately before going to the hospital. (D) No prospective study has confirmed that giving sodium bicarbonate to alkaline urine is helpful for prognosis. ", "output": "D"} 
-{"instruction":"A patient with a history of overseas travel comes to the emergency room with a fever. According to the 2019 CDC case statistics, which of the following statements is more appropriate?", "input": "(A) Dengue fever is the most common imported case of legally contagious diseases in Taiwan. (B) Acute viral hepatitis A infection is mainly seen in patients returning from Vietnam and Indonesia. (C) If a patient returns from Singapore with fever and skin rash, dengue fever or measles infection should be highly suspected. (D) Amebic dysentery is often seen in patients returning from Africa with fever, abdominal pain, and diarrhea.", "output": "A"}
-{"instruction": "A 50-year-old male drank home-brewed rice wine and went to the emergency room 10 hours later due to dizziness, nausea, and blurred vision. Vital signs: temperature 36.8℃, respiration 18 times/min, heart rate 92 times/min, blood pressure 169/85 mmHg, laboratory test report: Na 142 mEq/L, Cl 109 mEq/L, BUN 14 mg/dL, Glu 126 mg/dL, Ketone body: negative, Ethanol 9 mg/dL, Blood osmolality 320 mOsm/Kg, and arterial blood ABG pH 7.29, PCO₂ 25.4 mmHg, HCO₃ 12.5 m Eq/L, based on the above data, it is judged that the case may have accidentally ingested methanol. What is the most likely methanol concentration in the case's blood at this time? ", "input": "(A) 20 mg/dL. (B) 40 mg/dL. (C) 70 mg/dL. (D) 150 mg/dL. ", "output": "C"}"Which of the following is more appropriate for the treatment of agitation?", "input": "(A) Agitation caused by amphetamine intoxication should be treated with 5-10mg Olanzapine. (B) Agitation caused by alcohol intoxication should be treated with 2-10mg Haloperidol. (C) Patients with alcohol withdrawal syndrome should be treated with 2mg Risperidone. (D) Patients with complex and difficult to differentiate agitation should not be treated with drugs.", "output": "B"} 
-{"instruction": "Which of the following is more appropriate for the description of gallstones and their complications?", "input": "(A) Abdominal CT scan has a higher sensitivity than ultrasound examination in diagnosing gallstones. (B) Nonsteroidal anti-inflammatory drugs (NSAIDs) can be used as the first choice of analgesics when colic attacks. (C) Testing for C-reactive protein is not helpful in diagnosing acute cholecystitis. (D) Ultrasound has a high specificity in diagnosing cholecystitis and detecting thickening of the gallbladder wall and peri-gallbladder effusion. ", "output": "B"}
-{"instruction": "Which of the following steps is more appropriate to diagnose unexplained shock using the Rapid Ultrasound in Shock (RUSH) protocol?", "input": "(A) IVC → Aorta → Heart → Intraperitoneum (Morison's Pouch, EFAST) → Lungs. (B) Heart → Aorta → IVC → Intraperitoneum (Morison's Pouch, EFAST) → Lungs. (C) Aorta → Heart → IVC → Intraperitoneum (Morison's Pouch, EFAST) → Lungs. (D) Heart → IVC → Intraperitoneum (Morison's Pouch, EFAST)→ aorta→ lungs. ", "output": "D"} 
-{"instruction": "A 36-year-old middle-aged man who reeked of alcohol was sent to the emergency room by EMT and police because of domestic violence. His wife said that the patient had been drinking for a long time. The EMT described that there was an attack at the scene, so he had been restrained. You quickly checked the pupils and muscle strength of the hands and feet and found no abnormalities, and there was no obvious trauma to the head. Which of the following treatments is more appropriate? ", "input": "(A) Olanzapine 5 mg + Loraze pam 1 mg intramuscular injection. (B) Haloperidal 10 mg intravenous injection. (C) Lorazepam will cause excessive sedation for such patients and is not recommended. (D) If the patient wishes, Olanzapine fast-dissolving tablets 5 mg can be given orally. ", "output": "D"} 
-{"instruction": "A 21-year-old male presents with a 14-day history of intermittent fever and sore throat. The patient has multiple sexual partners. Physical examination reveals several small blisters on the upper lip, multiple ulcers on the oral mucosa, swollen tonsils with white discharge on both sides, painful cervical lymph nodes, slightly enlarged liver, and no skin rash. Which pathogen is most likely to cause the above symptoms?", "input": "(A) HIV. (B) Cytomegalovirus. (C) Epstein-Barr virus. (D) Herpes simplex virus.", "output": "D"} 
-{"instruction": "If a spinal fracture affects breathing and the diaphragm, which segment (or more) of damage would require the use of advanced airway?", "input": "(A) C5. (B) C6. (C) C7. (D) T1. ", "output": "A"} 
-{"instruction": "Which of the following statements about PD-related peritonitis is less appropriate? ", "input": "(A) The cell count of ascitic fluid is usually greater than 500 WBC/µL and greater than 50% PMN. (B) Common pathogens are S. epidermidis, S. aureus, Streptococcus species and gram-negative bacteria. (C) Common symptoms are abdominal pain, which may sometimes be accompanied by fever. (D) Antibiotics are given first-generation Cephalosporin plus Gentamycin intraperitoneally first. ", "output": "A"} 
-{"instruction": "A 65-year-old woman presents to the emergency department with two days of lower back pain and right calf pain. Which of the following statements is more appropriate? ", "input": "(A) For suspected disc herniation, a CT scan of the relevant parts should be arranged to confirm the diagnosis. (B) For suspected sciatica, no diagnostic examination is required in the emergency department unless there is a risk of other serious diseases. (C) Steroid treatment of disc herniation can improve neurological function, but it cannot reduce the possibility of requiring surgery. (D) The patient should be advised to rest in bed for 2 weeks and avoid continuous daily activities to reduce pain symptoms. ", "output": "B"} 
-{"instruction": "Which of the following oral anti-epileptic drugs is most likely to require electrocardiogram monitoring in the event of an overdose? ", "input": "(A)Carbamazepine. (B)Levetiracetam. (C)Phenytoin. (D)Valproic acid. ", "output": "A"} 
-{"instruction": "A 4-year-old boy has a barking cough and fever for 2 days. He was treated with epinephrine vapor in the emergency room yesterday but did not improve. Today, he was found to have a hoarse voice and progressive dyspnea. Physical examination revealed stridor on both inspiration and expiration, drowsiness, facial cyanosis, use of accessory muscles for breathing, and a capillary refill time of 2 seconds. Which of the following is the most likely diagnosis? ", "input": "(A) Bacterial tracheitis. (B) Croup. (C) Epiglottis. (D) Retropharyngeal abscess. ", "output": "A"} 
-{"instruction": "Which treatment is more appropriate for agitation? ", "input": "(A) Agitation caused by amphetamine intoxication should be treated with 5-10mg Olanzapine. (B) Agitation caused by alcohol intoxication should be treated with 2-10mg Haloperidol. (C) Patients with alcohol withdrawal syndrome should be treated with 2mg Risperidone. (D) Patients with complex and difficult to differentiate agitation should not be treated with drugs. ", "output": "B"} conversation with others. Which of the following statements is more appropriate for the patient's clinical management? ", "input":"(A) Based on the patient's description of symptoms, it is predicted that her peak expiratory flow (PEF) should be moderate, which is the severity of an acute asthma attack. (B) Based on the severity of this patient's asthma attack, arterial blood gas analysis is unlikely. (C) Consider using a long-acting β2 agonist with Ipratropium inhaler to rapidly dilate the bronchoconstriction. (D) Based on this patient's symptoms, oral steroids can be used. The earlier they are used, the less likely they are to need hospitalization.", "output": "D"} 
-{"instruction": "A 36-year-old female who has no exercise habits signs up for a marathon. After several weeks of practice, she often feels pain in the front of her knee when walking and climbing stairs. Which of the following statements is more appropriate?", "input": "(A) It is more common in women with weak quadriceps and Q angle less than 20 degrees. (B) Symptoms often occur in both feet at the same time and are gradual pain. (C) If you feel discomfort in your knees during activities, you should keep your knees bent and rest. (D) Arthroscopic surgery may promote the release of calcium pyrophosphate, causing severe synovitis.", "output": "D"}
-{"instruction": "A 45-year-old female with a history of asthma and long-term follow-up in the thoracic medicine clinic went to the emergency room for dyspnea. The patient was carefully asked about her dyspnea and said that she would have dyspnea even when she was resting. Although she was not so dyspneic that she could not speak, it would affect her 
-breathing. {"instruction": "Which of the following diagnostic criteria for schizophrenia is more appropriate? ", "input": "(A) There must be two negative symptoms. (B) There must be rigid behavior. (C) There must be one of delusions, hallucinations, or nonsense. (D) Active symptoms are associated with depressive episodes. ", "output": "C"} 
-{"instruction": "An 82-year-old male was sent to the emergency room of a nursing home with symptoms such as difficulty concentrating, mood swings, and cognitive abnormalities. He had a history of dementia. Which of the following statements is more appropriate? ", "input": "(A) The patient should be provided with a comfortable isolation environment as soon as possible, and the hospital should send staff to guard the patient to reduce the stimulation of family contact with the patient. (B) If the patient becomes agitated, it is recommended to give Benzodiazepines drugs first to help relieve symptoms. (C) Physical restraints are recommended to be used on agitated patients as early as possible to prevent the patient from self-harm. (D) Symptoms of patients with depression may resemble those of hypoactive dementia, but symptoms of patients with depression are less likely to fluctuate rapidly. ", "output": "D"} 
-{"instruction": "Which of the following is a condition listed in the Ottawa knee rule that requires an X-ray? ", "input": "(A)Fibular head tenderness. (B)Tibial condyle tenderness. (C)Age older than 65 years. (D)Ability to bear weight and walk 2 steps. ", "output": "A"} 
-{"instruction": "Which of the following drugs does not reduce the occurrence of major adverse cardiac events after acute myocardial infarction? ", "input": "(A)Aspirin and Clopidogrel. (B)Bisoprolol. (C)Captopril. (D)Dilitazem. ", "output": "D"} 
-{"instruction": "A 70-year-old male was transferred from another hospital with traumatic pneumothorax, pelvic fracture and pelvic hemorrhage. He has received 10 units of packed red blood cells (RBC) transfusions. Which of the following statements is more appropriate for this patient? ", "input": "(A) According to the definition of massive transfusion, this patient has not yet received massive transfusion. (B) It would be best if the patient could receive platelet and plasma transfusions in the next blood transfusion. Empirical evidence shows that the ratio of the three should be 1:1:1. (C) Attention should be paid to whether the patient has hypothermia, coagulation abnormalities, and transfusion-induced pulmonary edema. These three events are called the fatal triangle of trauma. (D)Continuous blood transfusions require attention to hypocalcemia caused by the combination of citric acid and calcium ions in the blood. ", "output": "D"} 
-{"instruction": "A 54-year-old healthy woman has traveled abroad in the past 14 days. She began to have fever, muscle aches, cough and abnormal taste and smell 3 days ago. She went to the emergency room due to persistent high fever, general fatigue and wheezing. Chest X-ray showed patchy interstitial infiltrates in the bilateral lower lobes. Which of the following statements is more appropriate? ", "input": "(A)It may be COVID-19 (2019 novel coronavirus disease), the pathogen is an alpha coronavirus. (B) The patient meets the reporting conditions of the CDC's fifth category of statutory infectious diseases, severe specific infectious pneumonia, and needs to collect throat swab fluid, sputum and serum. (C) If this patient is a confirmed case, her husband who lives with her and has no symptoms needs to manage his own health. (D) COVID-19 is diagnosed based on a positive nucleic acid test PCR, and virus culture is not easy. ", "output": "D"} 
-{"instruction": "Which of the following statements about the treatment of acute pulmonary edema is less appropriate? ", "input": "(A) Reducing cardiac afterload can reduce the chance of intubation. (B) Compared with the simultaneous use of vasodilators, the use of intravenous injection of Furosemide alone does not reduce the chance of intubation. (C) Treatment with morphine-like drugs may increase hospitalization time and mortality. (D) Non-invasive positive pressure ventilation will increase cardiac afterload. ", "output": "D"} 
-{"instruction": "A 28-year-old female, 24 weeks pregnant, rear-ends the car in front of her. She is wearing her seat belt, the airbag did not deploy, her vital signs are normal, her abdominal pain is 5/10, and an ultrasound examination in the emergency department shows no ascites, no uterine or placental abnormalities, normal amniotic fluid volume and a clearly visible fetal heart rate of 150 beats/min. Which of the following actions should be prioritized? ", "input": "(A) Perform diagnostic peritoneal lavage (DPL) by open supra-umbilical. (B) Arrange an abdominal MRI scan. (C) See the obstetrics department for fetal tocodynamometry monitoring. (D) Follow up ultrasound examination after 4-6 hours of observation. ", "output": "C"} 
-{"instruction": "A 55-year-old male suddenly developed dizziness, vomited twice, turned pale, and had weakness in his limbs. His family took him to the emergency room. During the triage, his blood pressure was 180/110 mmHg, his heart rate was 95 beats/min, and his temperature was 37℃. Which of the following statements is more appropriate? ", "input": "(A) Severe vertigo and vomiting are central vertigo. (B) Immediately arrange a CT scan of the brain. (C) The head impulse test was normal, which is common in peripheral vertigo. (D) If the Dix-Hallpike test is positive, the patient has benign paroxysmal positional vertigo. ", "output":"C、D"} 
-{"instruction": "A patient on hemodialysis was transferred to the emergency department because his blood pressure dropped to 80/40 mmHg. Bedside ultrasound revealed pericardial effusion and the right ventricle was equal in size to the left ventricle. Under the parasternal short axis view of ultrasound, the left ventricle showed the D sign of the ventricular septum deviating toward the left ventricle. Which of the following is the most likely diagnosis?", "input": "(A) Air embolism. (B) Cardiac tamponade. (C) Sepsis. (D) Myocardial ischemia.", "output": "A"}
-{"instruction": "A 40-year-old male was injured in the left calf by a heavy object at a construction site. He was freed and sent to the emergency room two hours later. He complained of abnormal pain and numbness in the left calf, which was swollen and deformed. His vital signs are currently stable. Which of the following descriptions of this patient is more appropriate?", "input": "(A) It is necessary to evaluate the distal pulse of the injured area as soon as possible, because the presence or absence of a pulse is one of the necessary conditions for diagnosing compartment syndrome. (B) Although tissue pressure exceeding 30 mmHg is one of the diagnostic conditions for compartment syndrome, it is not necessary to measure pressure to confirm the diagnosis. (C) Capillary refill time (capillary refill time time) is a highly reliable physical examination for diagnosing compartment syndrome. (D) Give the patient bone traction and plaster fixation to relieve the pain caused by the fracture. ", "output": "B"} 
-{"instruction": "A 32-year-old male was sent to the emergency room. His companions described that the patient surfaced from a depth of 50 meters in the sea during a diving activity and lost consciousness 10 minutes after landing. After arriving at the hospital, his vital signs were stable but his coma index was E2V3M3. The results of blood arterial gas analysis (room air) were pH 7.236, PaO 2 82.3mmHg, PCO₂ 48.2mmHg, and HCO₃ 20mM/L. Which of the following statements is more appropriate? ", "input": "(A) The patient has type I decompression syndrome (type I (A) Drug-assisted intubation is recommended for respiratory treatment. Ketamine is not recommended for patients with head trauma and intracranial hypertension because it may worsen cerebral blood circulation. (B) 100% oxygen, intravenous fluids, and hyperbaric oxygen therapy should be given immediately. (C) The patient should be placed in a Trendelenburg position as much as possible. (D) Intubation and respirator therapy should be given priority over hyperbaric oxygen therapy. ", "output": "B"} 
-{"instruction": "Which of the following is more appropriate for the treatment of pediatric trauma? ", "input": "(A) Drug-assisted intubation is recommended for respiratory treatment. Ketamine is not recommended for patients with head trauma and high intracranial pressure because it may worsen cerebral blood circulation. (B) For the choice of infusion for patients with hemorrhagic shock, crystalloid solution can be used for infusion therapy at a rate of 20 ml per kilogram of body weight to achieve permissive hypotension. (C) Focused assessment with sonography for trauma (FAST) has a better negative predictive value for the assessment of intra-abdominal solid organ damage in children than in adults. (D) For patients with multiple blunt injuries, whole-body CT examination rarely affects subsequent management decisions. Based on the harm of radiation to children, focused CT examination is recommended. ", "output": "D"} { 
-"instruction": "Which of the following acute drug poisonings is not suitable for removal by hemodialysis to reduce toxicity? ", "input": "(A)Diclofenac. (B)Metformin. (C)Theophylline. (D)Valproic acid. ", "output": "A"} 
-{"instruction": "Which of the following statements is more appropriate for the steps of cricothyroidotomy? ", "input": "(A)Right-handed people should stand on the patient's right side to perform the operation. (B)The cricothyroid membrane is located at the midpoint between the chin and the sternal notch. (C)After locating the cricothyroid membrane, the skin is incised with a horizontal incision. (D)After the cricothyroid membrane is incised, a No. 6 endotracheal tube is inserted and fixed at a depth of about 10 cm. ", "output": "A"} 
-{"instruction": "A 44-year-old male experienced cardiac arrest with return of spontaneous circulation. Which of the following statements regarding follow-up care is inappropriate? ", "input": "(A) Targeted temperature management (TTM) can help reduce neurological damage. (B) Performing a brain CT scan can assess the severity of intracerebral hemorrhage and brain edema. (C) TTM exclusion criteria include being conscious and able to follow instructions and having poor neurological performance to begin with. (D) During the TTM cooling period, attention should be paid to electrolyte imbalances, mainly the manifestations of high potassium and magnesium levels. ", "output": "D"} 
-{"instruction": "Regarding blood pressure control (blood pressure 190/110 mmHg) in various hypertensive emergencies, which of the following is more appropriate? ", "input": "(A) For acute stroke patients who are not suitable for thrombolytic agents, Labetalol should be used. (B) For aortic detachment, Nicardipine should be used first. (C) For amphetamine poisoning, Benzodiazepine should be used first. (D) For acute renal failure, Nitroprusside should be used first. ", "output": "C"} 
-{"instruction": "Regarding the description of abdominal aortic aneurysms, which of the following is more appropriate? ", "input": "(A) If the diameter is greater than 5 cm, the chance of rupture increases greatly. (B) It is more common in women than in men. (C) If the aneurysm ruptures, it can be observed first if the hemodynamics are stable. (D) After endovascular repair, there is no risk of rupture. ", "output": "A"} 
-{"instruction": "Which of the following statements about cirrhosis and spontaneous peritonitis is more appropriate? ", "input": "(A) The patient has no fever, so spontaneous bacterial peritonitis can be ruled out. (B) Leukocyte esterase test strips for ascites can be used as a quick reference for diagnosis. (C) Ascites analysis reveals that neutrophils are greater than 100/µL, which can be diagnosed. (D) Up to 70% of patients with cirrhosis and ascites will have spontaneous peritonitis. ", "output": "B"} 
-{"instruction":"While decontaminating toxic substances, in accordance with the fire department's cooperation in the implementation of hazardous chemical disaster rescue guidelines, which of the following statements is more appropriate?", "input": "(A) The principle of hazardous chemical disaster treatment is to control the fire and prevent the spread of fire. If there is no risk of human life at the scene, hazardous disaster relief operations must still be carried out. (B) The initial on-site response commander is generally the first rescue personnel to arrive at the accident scene. If they are firefighters, the fire brigade leader will take on the role. (C) The warm zone is a buffer zone between the hot zone and the cold zone. Its main function is to provide first aid to patients. (D) In ​​the process of hazardous chemical disaster treatment, "fast" treatment is more important than "correct" treatment. ", "output": "B"}
-{"instruction": "A 9-year-old boy with a history of asthma, who was not taking medication to control his condition and had not had an attack for a year, had an upper respiratory tract infection two days ago, which led to an acute asthma attack and he was sent to the emergency room. When he arrived at the hospital, his temperature was 37.2ºC, his heart rate was 112 beats/min, his blood pressure was 110/72 mmHg, his respiratory rate was 33 breaths/min, his blood oxygen concentration was 93%, and he had wheezing when he exhaled and inhaled. The rest of the examination showed no obvious abnormalities. Which of the following statements is less appropriate?", "input": "(A) According to the Pediatric Respiratory Assessment Measure (PRAM) classification, the patient had a mild asthma attack. (B) Treatment with type II sympathetic nerve stimulants and steroids is recommended. (C) If the blood oxygen saturation is <92%, it is recommended to give oxygen and maintain the blood oxygen saturation at 93~98%. (D) Inhaled magnesium sulfate (MgSO 4) is not helpful for children with asthma of any grade. ", "output": "B"} "(A) According to the Pediatric Respiratory Assessment Measure (PRAM) classification, the child has a mild asthma attack. (B) Treatment with alpha-2 sympathetic nerve stimulants and steroids is recommended. (C) If the blood oxygen saturation is <92%, it is recommended to give oxygen and maintain the blood oxygen saturation at 93-98%. (D) Inhaled magnesium sulfate (MgSO 4) is not helpful for children with asthma of any grade.", "output": "B"} 
-{"instruction": "A 33-year-old female developed fever symptoms yesterday, combined with redness, swelling, pain and inability to bend the left knee joint. Which of the following statements is more appropriate?", "input": "(A) Migratory arthritis often occurs after Staphylococcus aureus infection. (B) Use ESR >30mm/h is highly specific for assessing septic arthritis and is a better diagnostic tool. (C)Neisseria gonorrhoeae infection, this species can be cultured in >60% of the joint fluid. (D)Salmonella is the most common cause of septic arthritis in patients with sickle-type erythrocytes. ", "output": "D"} 
-{"instruction": "A 74-year-old female patient suddenly developed difficulty speaking and swallowing. Physical examination showed dysarthria, tongue deviation to the right, left soft palate paralysis, left face drooping, loss of left facial sensation, and right arm weakness. Which lesion is most likely to be the above symptoms? ", "input": "(A)Left brain stem. (B) Right cerebellum. (C) Left cerebrum. (D) Right midbrain. ", "output": "A"}
-{"instruction": "A 30-year-old male seeks medical attention for fever, headache, and neck stiffness for 3 days. Which of the following statements is more appropriate? ", "input": "(A) If bacterial meningitis is clinically suspected, antibiotics can be used directly before performing brain imaging and lumbar puncture. (B) When bacterial meningitis is suspected, Dexamethasone should not be used to avoid affecting the patient's immune function. (C) In meningitis caused by diabetes combined with sinus infection, the cerebrospinal fluid examination is WBC 300/ µL, 65% PMN, Aspergillus infection should be considered first. (D) Patients diagnosed with herpes simplex virus encephalitis have typical MRI images showing invasion of the gray matter of the occipital lobe, resulting in mental and behavioral abnormalities. ", "output": "A"} 
-{"instruction": "An 8-year-old girl came to the pediatric emergency department complaining of a 3-day fever. During physical examination, it was found that the girl had slapped-cheek appearance on her cheeks and lacy, reticulated appearance on her limbs. The rash did not itch. What is the most likely diagnosis? ", "input": "(A) Scarlet fever. (B) Erythema infectiosum. (C) Kawasaki disease disease). (D) Roseola. ", "output": "B"} 
-{"instruction": "According to the announcement of the Taiwan Centers for Disease Control, which of the following descriptions is more appropriate regarding the personal protective equipment of medical caregivers in response to novel coronavirus infection? ", "input": "(A) Paramedics who assist in the transfer of patients must wear surgical masks for respiratory protection. (B) N95 masks and surgical masks must be fit-checked before use. (C) When removing an N95 mask, the lower elastic band should be removed first, followed by the upper elastic band. (D) When the emergency department nurse inquires about the chief complaint and TOCC, she must wear a one-piece isolation suit. ", "output": "C"} 
-{"instruction": "A 35-year-old female patient presented with fever for 4 days. She had traveled to Southeast Asia last week. She had a temperature of 39℃ and body aches. She also had nausea, vomiting, upper abdominal pain and tenderness. Blood tests showed white blood cell count of 2,500/μl, hemoglobin of 14g/dl, platelet count of 85,000/μl, AST/ALT of 135/110 U/L. Chest X-ray and urine tests were normal. Which of the following statements is less appropriate? ", "input": "(A) The patient meets the CDC's dengue reporting clinical criteria. (B) If the patient tests positive for dengue NS1 (non-structural protein 1) antigen, she is a confirmed case. (C) If the patient is dengue-positive, then he/she meets the diagnosis of severe dengue fever (2009 WHO case classification definition). (D) If the patient is dengue-positive and abdominal imaging reveals gallbladder wall edema, suspected of acute cholecystitis, invasive treatment should be avoided. ", "output": "C"} 
-{"instruction": "After an earthquake, a person was trapped for 16 hours under the crush of a collapsed beam. Which of the following matters should be noted by on-site search and rescue and medical rescue personnel? ", "input": "(A) The crushed limbs may develop compartment syndrome, the most common symptom of which is numbness and weakness. (B) The victim may develop high potassium and high calcium levels, which may further induce fatal arrhythmias. (C) As long as there is no renal failure, large-volume intravenous infusion with lactated Ringer's solution is recommended. (D) Fasciotomy is not a routine treatment because it increases the chances of infection and amputation. ", "output": "D"} 
-{"instruction": "Which of the following clinical symptoms and signs of acute appendicitis has the highest positive likelihood ratio? ", "input": "(A) Vomiting occurs before abdominal pain symptoms appear. (B) The obturator sign is positive. (C) The psoas sign is positive. (D) The abdominal pain shifts from the upper abdomen or around the umbilicus to the right lower abdomen. ", "output": "D"} 
-{"instruction": "A 35-year-old female, receiving treatment for infertility. She came to the emergency room today with sudden left lower abdominal pain. The urine pregnancy test is positive, and the urinalysis is normal. The bedside ultrasound shows an intrauterine pregnancy of about 6 weeks, with moderate ascites. Which of the following is more appropriate? ", "input": "(A) The patient is diagnosed with ovarian hyperstimulation syndrome (OHSS) and a pelvic examination should be performed to fully assess the patient's condition. (B) The patient is diagnosed with OHSS and diuretics can be given to relieve symptoms. (C) The patient may have a heterotopic pregnancy. (D) The patient has been confirmed to have an intrauterine pregnancy. If the fetal heartbeat can be further observed, ectopic pregnancy can be ruled out. ", "output": "C"} 
-{"instruction": "Which of the following is more appropriate for the emergency treatment of patients with acute psychosis?", "input":"(A) A psychiatric diagnosis should be established to help the emergency physician decide the patient's subsequent disposition. (B) Fever or rapid heartbeat are usually caused by the patient's high emotions or agitation, and no special tests are needed. (C) Auditory hallucinations are more likely to be caused by physiological reasons than visual hallucinations. (D) If the patient admits to drinking or taking illegal drugs when he is sober, further examination is not necessary to confirm it.", "output": "D"} 
-{"instruction": "Which of the following statements is more appropriate regarding the primary assessment and resuscitation of elderly people with trauma?", "input": "(A) To avoid potential undetected spinal damage, it is not advisable to remove the collar too early. (B) Due to the high severity of traumatic brain injuries in the elderly, the mortality rate is also high. (C) Fractures in the elderly, such as pelvic fractures and hip fractures, are mostly caused by car accidents. (D) The sequence and items of primary assessment of trauma in the elderly are different from those in young people. ", "output": "A"}
-{"instruction": "Which of the following descriptions of the clinical manifestations of common venomous snake bites in Taiwan is less appropriate?", "input": "(A) Hemorrhagic venomous snake bites will cause tooth marks and local swelling and pain, subcutaneous bruises, blisters or blood blisters may be seen. (B) Hemorrhagic venomous snake bites may have complications such as hemolysis, rhabdomyolysis, and diffuse intravascular coagulation (DIC). (C) Cobra venom contains cytotoxins that can cause local swelling and pain, hemorrhagic subcutaneous bruises, blisters or blood blisters, and in severe cases, skin necrosis. (D) Patients bitten by cobras will experience nausea, vomiting, abdominal pain, diarrhea, and severe neuromuscular blockade.", "output": "D"} "D"} 
-{"instruction": "Which of the following statements about pulmonary embolism is less appropriate?", "input": "(A) Massive pulmonary embolism is characterized by systolic blood pressure below 90 mmHg for more than 15 minutes; pulse cannot be felt; or heart rate is less than 40 beats/min, combined with symptoms of shock. (B) When the troponin concentration in the blood is elevated, or the NT-proBNP concentration in the blood exceeds 900 pg/ml, it indicates that the patient's pulmonary embolism has caused right ventricular strain. (C) If cardiac arrest, hypotension, respiratory failure, or right ventricular strain occurs, intravenous thrombolytic therapy should be considered. (D) Compared with intravenous injection of thrombolytic agents, thrombolytic effects of thrombolytic agents injected into the pulmonary artery are better. ", "output": "D"} 
-{"instruction": "Which of the following is not a Pulmonary Embolism Rule-Out Criteria for pulmonary embolism? ", "input": "(A)Age < 50 years old. (B)No hormone use. (C)No hemoptysis. (D)Oxygen saturation > 90%. ", "output": "D"}
-{"instruction": "Which of the following statements about the treatment of sepsis is more appropriate?", "input": "(A) Sepsis treatment begins with giving the patient a large amount of fluid, and then giving pressor drugs after the body has enough water. (B) Giving too much fluid to a Sepsis patient will cause the patient's prognosis to deteriorate. (C) The preferred fluid for Sepsis is colloid, which is less likely to cause acute kidney injury or require hemodialysis than normal saline. (D) Blood transfusion should be given to keep the patient's Hb>8 g/dL to maintain tissue oxygen supply and perfusion.", "output": "B"} 
-{"instruction": "Which of the following statements about acute pericarditis is more appropriate?", "input": "(A) The typical electrocardiogram change is ST-segment depression, especially in leads I, V5, and V6. (B) The increased troponin concentration in the blood in the laboratory diagnostic data indicates the possibility of myocarditis. (C) The sensitivity of CT for diagnosing pericardial effusion is much higher than that of echocardiography. (D) Treatment drugs include non-steroidal anti-inflammatory drugs (NSAIDs), steroids, and colchicine. The patient must be hospitalized for treatment and observation.", "output": "B"} 
-{"instruction": "Which of the following statements about hematuria in children is less appropriate?", "input": "(A) If hematuria is accompanied by proteinuria, acute renal function damage, edema, hypertension and joint disease, it may be glomerulonephritis. (B) If hematuria occurs after an upper respiratory tract infection, the serum ANA is negative and C3 is normal, it is highly suspected to be IgA nephropathy. (C) If there are combined symptoms of gastrointestinal abdominal pain, skin petechiae and renal function damage, Henoch-Schönlein purpura (HSP) should be considered. The use of corticosteroids can relieve abdominal pain symptoms and improve renal function damage. (D) Urinary tract infection is the most common cause of hematuria in adolescents. Patients often have fever and local lower urinary tract symptoms, such as frequent urination, urgency, and difficulty urinating. Urinary tract infection should be considered. ", "output": "C"} 
-{"instruction": "Which of the following statements is more appropriate for the diagnosis of necrotizing soft tissue infection? ", "input": "(A) Due to the severe necrotizing inflammation of deep tissues, the patient's disproportionately severe pain is a necessary condition for diagnosis. (B) Due to deep fascial infection causing skin vascular necrosis and thrombosis (thrombosis), the patient's skin in the affected area will develop hemorrhagic blisters in the early stage. (C) If the MRI with contrast shows no abnormalities in the intermuscular fascia of the affected area, this diagnosis can be ruled out. (D) The patient must have comorbidities that impair immune function, such as old age, diabetes, cirrhosis, or chemotherapy or immunosuppressive drugs, so the course of infection often worsens rapidly. ", "output": "C"} 
-{"instruction": "Which of the following statements is more appropriate regarding upper gastrointestinal bleeding? ", "input": "(A) Bright red blood in the stool can rule out the possibility that the bleeding point comes from the upper gastrointestinal tract. (B) For elderly people with many comorbidities, it is recommended that blood transfusion be considered only when the hemoglobin is ≤ 7 g/dL. (C) If a gastroscopy is to be performed, the use of drugs that promote gastrointestinal motility, such as metoclopramide, is contraindicated. (D) The patient also has a history of cirrhosis. Consider giving the antibiotic Ceftriaxone 1 gram IV. ", "output": "D"} 
-{"instruction": "Which of the following descriptions of common conjunctivitis in the emergency department is more appropriate? ", "input": "(A) Corneal foreign body is painful and accompanied by widespread congestion, and is less photophobia. (B) Allergic conjunctivitis is itchy and painful, but is less photophobia. (C) Acute angle-closure glucoma is often accompanied by blurred vision, photophobia, and headache. (D) Subconjunctival hemorrhage is neither painful nor itchy, and often affects vision. ", "output": "A"} 
-{"instruction": "There was heavy snow on the mountain. Xiao Ming carried his weak friend from the top of the mountain to the circle valley to rest. The snow on the road was very deep. It would take an estimated 4 hours to descend to the mountain resort. The preparations would start in 1 hour. Which of the following statements is less appropriate? ", "input": "(A) Xiao Ming has local clear blisters on his feet. After removing the wet shoes and socks, he can soak them in 37℃ warm water to slowly warm them up. (B) His friend's ear temperature is 34℃ and he is shivering all over. After removing the wet coat, he uses a blanket and warm drinks to warm him up. (C) Xiao Ming's hands are painful and itchy. After removing the wet gloves, he rubs his hands to keep warm. (D) Xiao Ming complains of pain in his feet and hands. The rescuer gives Xiao Ming the painkillers they carry with them. ", "output": "A"} 
-{"instruction": "A 40-year-old female, 34 weeks pregnant, came to the emergency room because of swollen feet and abdominal pain. Blood pressure 180/100mmHg, urine protein 3+. After using MgSO 4 and Hydralazine, the urine volume is still very small, the edema cannot be eliminated, and the symptoms have not improved. Which of the following treatments is more appropriate? ", "input":"(A) 25% Albumin 1g/kg iv. (B) Furosemide 40mg iv. (C) Mannitol 0.5mg/kg iv. (D) Continue to give IV fluid slowly and carefully.", "output": "D" 
-} {"instruction": "For cavitary lung lesions, which of the following differential diagnoses is less likely, except for lung abscess?", "input": "(A) Wegener's granulomatosis. (B) Pulmonary embolism. (C) Pulmonary aspergillosis. (D) Cryptococcus.", "output": "B"}
-{"instruction": "A 60-year-old male presented to the emergency department with dyspnea. His chest X-ray showed bilateral pleural effusions. After diagnostic pleural puncture, laboratory analysis of the pleural effusions showed the following results: pH 7.57, pleural effusion/serum lactate dehydrogenase ratio (LDH ratio) 0.4, pleural effusion/serum protein ratio (Protein ratio) 0.2, and WBC count 133/µL (65% of which were lymphocytes). Which of the following diagnoses is more appropriate?", "input": "(A) Heart failure. (B) Bacterial pneumonia. (C) Pulmonary tuberculosis. (D) Lupus erythematosus.", "output": "A"} 2. Cell count WBC 133/µL (65% of which are lymphocytes). Which of the following diagnoses is more appropriate? ", "input": "(A) Heart failure. (B) Bacterial pneumonia. (C) Pulmonary tuberculosis. (D) Lupus erythematosus. ", "output": "A"} 
-{"instruction": "Which of the following diagnoses and treatments is more appropriate for mandibular dislocation? ", "input": "(A) Anterior dislocation is common, while posterior dislocation is rare. (B) The patient can only be positioned in a sitting position during reduction. (C) The direction of the reduction force is to push the patient's chin upward and backward. (D) An X-ray is usually required immediately after reduction to confirm that the reduction is successful. ", "output": "A"}
-{"instruction": "Which of the following statements is appropriate regarding infectious diarrhea?", "input": "(A) If there are no contraindications, ciprofloxacin may be considered. (B) Loperamide does not improve outcomes. (C) If the diarrhea is bloody or inflammatory diarrhea is suspected, concomitant use of an antimotility agent is recommended. (D) Probiotics are not helpful in treating infectious diarrhea.", "output": "A"} 
-{"instruction": "A 25-year-old male presents to the emergency department with multiple facial lacerations and cheek burns caused by a boiler explosion. Which of the following is appropriate?", "input": "(A) All tongue lacerations should be sutured to prevent upper airway obstruction from hematomas. (B) Wounds within 0.6~0.8cm from the inner canthus of the eye need to be referred to the ophthalmologist. (C) Nasal tear duct rupture needs to be repaired by the ophthalmologist within 12 hours. (D) Silver sulfadiazine ointment can be used for cheek burns. ", "output": "B"} 
-{"instruction": "A 30-year-old male fell from a height of 6 meters and was sent to the emergency department. Physical examination revealed obvious right flail chest, tachypnea, 26 breaths/min, symmetrical breath sounds on both sides on auscultation, no dullness or hyperresonance on percussion, and oxygen mask at 6 L/min was given. Afterwards, arterial blood oximetry (ABG) showed: PaO2 45 mmHg, PCO₂ 28 mmHg, pH 7.47. Which of the following injuries is most likely the cause of this ABG abnormality? ", "input": "(A) Massive hemothorax. (B) Pulmonary contusion. (C) Hypoventilation. (D) Tension pneumothorax. ", "output": "B"} 
-{"instruction": "Which of the following is an indication for thrombolytic therapy in acute pulmonary thromboembolism? ", "input": "(A) Acute chest pain occurs within three hours. (B) The electrocardiogram shows S1Q3T3 pattern. (C) Hemodynamic instability and severe hypoxia. (D) There is a mismatch between the lung perfusion scan and ventilation scan.", "output": "C"} 
-{"instruction": "A 2-year-old boy (11 kg) was in a car accident. His vital signs when he was sent to the emergency room were: temperature 37.8℃, respiration 50 times/min, heart rate 150 times/min, blood pressure 90/60 mmHg, blood oxygen 89%, and he kept crying. Which of the following trauma treatments for this boy is more appropriate? ", "input": "(A) Place an oropharyngeal airway to avoid upper airway obstruction due to head trauma. (B) Manually fix the cervical spine, open the airway, clear oral and nasal secretions and foreign objects, and then give oxygen to maintain appropriate blood oxygen. (C) Place a soft cushion under the head of the head to maintain an open airway when lying flat. (D) Select a size 4.5 endotracheal tube and perform nasotracheal intubation. ", "output": "B"} 
-{"instruction": "A 2-year-old boy was brought to the emergency department for 5 days of persistent fever and respiratory symptoms. Physical examination revealed bilateral conjunctival congestion without discharge, chapped lips, strawberry tongue, and red maculopapular rash on the trunk, but no cervical lymphadenopathy and no redness, swelling, or desquamation of the extremities. Which of the following is more appropriate for this patient? ", "input": "(A) This boy has typical Kawasaki disease. Intravenous immunoglobulin (IVIG) and high-dose aspirin should be considered for treatment. (B) This boy has atypical Kawasaki disease. Auxiliary diagnostic criteria include: white blood cells (WBC), hemoglobin (Hb), platelets (PLT), albumin, glutathione transaminase (ALT), and creatinine. (C) Ibuprofen can be used to reduce fever in case of high fever. (D) Aspirin should be avoided if infected with influenza at the same time. ", "output": "D"} 
-{"instruction": "A 60-year-old male was injured in a car accident and went to the emergency room for treatment. The emergency medical staff had already given him a collar and a long back board for fixation. The patient is conscious and complains of neck pain, but has no other obvious abrasions or contusions. Blood pressure is 60/30 mmHg, heart rate is 80 beats/min, and skin is warm to the touch. Which of the following assessments and treatments is more appropriate for this patient? ", "input": "(A) Based on the history and initial physical examination, hypotension caused by intra-abdominal organ injury can be ruled out. (B) This patient should have lower limb paralysis and increased deep reflexes. (C) Such symptoms may occur in patients with injuries to the fourth thoracic vertebra. (D) Vasopressors are of no benefit to this patient and will increase the risk of tissue insufficiency. ", "output": "C"} 
-{"instruction": "A 67-year-old male was taken to the emergency room by his family because he had a sudden whole-body convulsion half an hour ago and could not be awakened. The family said that the patient had a history of epilepsy, but it was unclear whether he took medication regularly to control it. The convulsion lasted about 15 minutes. Which of the following statements is more appropriate? ", "input":"(A) When the patient is sent to the emergency room, he continues to have symptoms of convulsions. Phenytoin can be given as the first-line medication in the early stage. (B) After using two anti-epileptic drugs for 1 hour, the symptoms still do not improve. Barbiturates will not help much at this time. (C) Barbiturates are used to treat patients with persistent epileptic seizures. Because the drug half-life is shorter, it helps to extubate intubated patients earlier. (D) Valproic acid should be used in combination with Phenytoin to achieve a better therapeutic effect, but be careful that Valproic acid may cause side effects such as liver failure and pancreatitis.", "output": "B"} 
-{"instruction": "A 27-year-old woman was sent to the emergency room after swallowing a large amount of analgesics due to a bad mood. Which of the following statements is more appropriate?", "input": "(A) Regardless of which NSAID is used, the proportion of side effects is roughly the same, and treatment is mainly supportive. (B) Oral activated charcoal 1 gram per kilogram of body weight can be considered, but if convulsions occur, the use of BZD is ineffective. (C) Once the patient has symptoms of discomfort, the prognosis is usually poor. (D) Most patients have no symptoms after 4 hours of observation and can go home for observation after a psychiatric consultation.", "output": "A、B、C、D"}
-{"instruction": "A 4-year-old girl was a rear-seat passenger in a high-speed car accident. She was sitting in a safety seat. Physical examination revealed obvious seatbelt marks on her abdomen, as well as tenderness around her navel. FAST showed a small amount of pelvic fluid accumulation. Urinalysis showed hematuria. Her blood pressure was 110/70 mmHg and her heart rate was 85 beats/min. Which of the following is more appropriate to evaluate the hematuria?", "input": "(A) CT scan of the abdomen and pelvis. (B) Cystoscopy. (C) Renal ultrasound. (D) Retrograde urethrography.", "output": "A"}"(A)Acute angle-closure glaucoma. (B)Endophthalmitis. (C)Orbital cellulitis. (D)Viral conjunctivitis.", "output": "B"} 
-{"instruction": "Which of the following statements about hepatoencephalopathy is less appropriate?", "input": "(A)Treatment with Flumazenil may be effective. (B)Asterixis often appears in the first stage of hepatoencephalopathy. (C)The severity of hepatoencephalopathy is closely related to the glutamine concentration in the cerebrospinal fluid. (D)Glutamine and tryptophan, which are formed after blood ammonia crosses the blood-brain barrier, play an important role in the manifestation of hepatoencephalopathy.", "output": "B"}"A 4-year-old girl was a rear-seat passenger in a high-speed car accident. She was sitting in a safety seat. Physical examination revealed obvious seatbelt marks on her abdomen and tenderness around her navel. FAST showed a small amount of pelvic fluid accumulation. Urinalysis showed hematuria. At this time, her blood pressure was 110/70 mmHg and her heart rate was 85 beats/min. Which of the following treatments is more appropriate for evaluating hematuria?", "input": "(A) CT scan of the abdomen and pelvis. (B) Cystoscopy. (C) Renal ultrasound. (D) Retrograde urethrography.", "output": "A"} 
-{"instruction": "Which of the following metabolic abnormalities is less likely to cause shock in children?", "input": "(A) Hypoglycemia. (B) Hypercalcemia. (C)Hyperkalemia. (D) Metabolic acidosis. ", "output": "B"}
-{"instruction": "When an open wound is suspected of having radiation syndrome, which of the following statements is more appropriate?", "input": "(A) The victim on the scene had brown vomitus, and it can be estimated that the radiation dose he received was 3~4 Gray. (B) Cytogenetic dosimetry can be used in the hospital to assess the severity of the injury and the prognosis. (C) The victim's clinical manifestations include nausea, vomiting, hypotension and upper gastrointestinal bleeding. Antiemetics should not be given. (D) The number of lymphocytes will decrease significantly after exposure to radiation. Therefore, continuous testing of the lymphocyte count for 48 hours can estimate the victim's exposure dose.", "output": "B"} 
-{"instruction": "Which of the following statements about thyroid storm is more appropriate?", "input": "(A) Burch & Wartofsky score ≧45 points may be thyroid storm, but clinical differential diagnosis is still required. (B) Because thyroid storm is a persistent high fever, active cooling with Acetaminophen and Aspirin is necessary. (C) Long-acting beta-blockers can bring better control of rapid heart rate and are more suitable for patients with heart failure. (D) Lithium salt can be used to inhibit the conversion of peripheral T4 to T3 in severe thyroid storm.", "output": "A"} {" 
-instruction": "Syncope is a temporary lack of cerebral perfusion. Which of the following statements is more appropriate?", "input": "(A) Vasovagal syncope is often accompanied by precursors such as feeling cold, dizzy and nausea. (B) Postural hypotension in the elderly may be caused by the use of drugs, such as antiparkinsonism drugs. (C) Neuogenic syncope is usually caused by insufficient blood supply to the carotid artery or cerebral vascular detachment. (D) Aortic valve stenosis is one of the most common causes of syncope in the elderly.", "output": "B"} 
-{"instruction": "Which of the following is more appropriate for the identification and treatment of delirium in elderly patients?", "input": "(A) The characteristics are acute onset, recurrent symptoms, possible hallucinations, but attention is not affected. (B) Urinary retention can lead to delirium, but an indwelling urinary catheter can also increase the chance of delirium. (C) Benzodiazepines are the first choice for drug treatment. (D) Antihistamine is a safer treatment for patients who are agitated due to delirium. ", "output": "B"} 
-{"instruction": "You are preparing to perform a Rapid Sequence Intubation (RSI) on a 6-year-old girl with respiratory distress. Which of the following drugs is most likely to cause masseter muscle spasm in this patient, resulting in difficult intubation? ", "input": "(A) Fentanyl. (B) Ketamine. (C) Succinylcholine. (D) Vecuronium. ", "output": "C"} 
-{"instruction": "Which of the following is less appropriate regarding antithrombotic therapy? ", "input": "(A) Antiplatelet drugs are more effective than anticoagulants for venous embolism. (B) Warfarin acts on the vitamin K-related coagulation pathway. (C) Dabigatran, a new anticoagulant, is a direct inhibitor of thrombin. (D) Rivaroxaban, a new anticoagulant, is an inhibitor of coagulation factor X. ", "output": "A"} 
-{"instruction": "A 72-year-old male patient presented to the emergency department with abdominal distension and shortness of breath. Physical examination revealed distended cervical veins and shifting dullness in the abdomen. Ascites examination revealed a white blood cell count of 280/µL, with 40% polymorphonucleated cells. The albumin in the ascites is 1.3 g/dL, and the triglyceride is 300 mg/dL; the albumin in the blood is 2.6 g/dL. What is the most likely cause of the ascites? ", "input": "(A) Bacterial peritonitis. (B) Disseminated cancer in the abdomen. (C) Congestive heart failure. (D) Chylous ascites. ", "output": "C"} 
-{"instruction": "Which of the following is more appropriate for the diagnosis and treatment of influenza? ", "input": "(A) During the epidemic period, in order to control the epidemic, patients must be quickly screened and diagnosed before taking medication. (B) Treatment of uncomplicated influenza patients with Tamiflu should be started within 72 hours to help with recovery. (C) If severe pneumonia occurs, antibiotics should be administered, which must cover drug-resistant Staphylococcus aureus. (D) People aged 5 to 50 who contract influenza are more likely to develop complications such as pneumonia and meningitis. ", "output": "C"} 
-{"instruction": "A 70-year-old female with a history of diabetes went to the emergency department with blurred vision on her left side for 2 days combined with pain and photophobia. Physical examination showed that her vital signs were stable, her temperature was 37.7℃, her left conjunctiva was congested without discharge, her cornea was normal, there were suspended cells in the anterior chamber, her left eye intraocular pressure was 22mmHg, and her fundus could not be assessed due to cataracts. Which of the following is the most likely diagnosis? ", "input": "(A) Acute angle-closure glaucoma. (B) Endophthalmitis. (C) Orbital cellulitis. (D) Viral conjunctivitis. ", "output": "B"} 
-{"instruction": "Which of the following statements about priapism is more appropriate? ", "input":"(A) The most common cause of low blood flow type is penile and perineal trauma, which causes blood flow to the cavernous artery of the penis to be blocked. (B) High blood flow type and low blood flow type often present with symptoms of penile pain. (C) One of the methods to distinguish between high blood flow type and low blood flow type is to draw blood from the cavernous body of the penis for blood gas analysis. (D) Children with priapism often suffer from blood diseases.", "output": "C、D"} 
-{"instruction": "A 12-year-old boy, weighing 60 kg, has type 1 diabetes. He complains of general weakness, wheezing, and clear consciousness. His blood pressure is 80/50 mm Hg, heart rate is 145 beats/min, respiration is 28 breaths/min, blood sugar is 613 mg/dL, pH is 7.04, HCO₃ 2.1 mEq/L, Na is 134 mEq/L, K is 2.8 mEq/L. After 6 hours of infusion and insulin treatment, his current blood sugar is 180 mg/dL, pH is 7.283, HCO₃ is 13.8 mEq /L, Na is 144 mEq/L, K is 3.0 mEq/L. Which of the following is less appropriate?", "input": "(A) After 6 hours, the infusion therapy can be 5% glucose plus 0.45% saline solution. (B) Hypokalemia after 6 hours is mainly caused by insulin therapy and improvement of metabolic acid. At this time, 0.2~0.3 mEq KCL/kg/hr can be used for treatment. (C) Sodium bicarbonate treatment is not required initially and after 6 hours. (D) The initial infusion therapy sequence is to give 6U RI (Regular Insulin) intravenous push first, and then give 1,200ml of saline solution within 1 hour after maintaining 6U drip every hour.", "output": "D"} 
-{"instruction": "Regarding bleeding constitution, which of the following is less appropriate?", "input": "(A) Problems with thrombocytopenia are more likely to cause punctate bleeding, hematuria or gum bleeding. (B) Problems with coagulation factors are more likely to cause deep bleeding, such as retroperitoneal bleeding and joint bleeding. (C) Platelet transfusion is not suitable for immune-induced thrombocytopenia (ITP) because it will cause further platelet destruction. (D) Steroid and immunoglobulin injections can be considered for ITP.", "output": "C"} 
-{"instruction": "Which of the following statements is more appropriate regarding the symptoms and clinical manifestations of low calcium levels?", "input": "(A) The symptoms of low calcium levels are unrelated to the rate at which calcium levels decrease. (B) Low calcium levels will not cause hallucinations. (C) Low calcium levels may cause changes in consciousness. (D) Clinically, the Chvostek sign is highly specific for diagnosing hypocalcemia. ", "output": "C"} 
-{"instruction": "Which of the following statements about diabetic ketoacidosis (DKA) in children is more appropriate? ", "input": "(A) Sodium bicarbonate can be used for treatment. (B) Sepsis is the main cause of death in children with DKA. (C) IV loading bolus Regular Insulin 0.1 units/kg should be given for treatment. (D) Age less than 5 years old is a risk factor for DKA complicated by cerebral edema. ", "output": "D"} 
-{"instruction": "Which of the following statements about drowning is more appropriate? ", "input": "(A) Cervical spine injury only occurs in a small number of drowning cases, and the main mechanisms are diving, falling from heights, and drowning after a car accident. (B) If the drowning case arrives at the emergency room with a full GCS score and normal breathing, a neck collar and head CT examination are still required. (C) If the drowning case arrives at the emergency room with OHCA and a body temperature of only 20℃, it can be determined as obvious death and the family members are advised to give up first aid. (D) In ​​cases of OHCA caused by drowning, the cause of death is classified as trauma in the Utstein templates. ", "output": "A"} 
-{"instruction": "A 65-year-old male with no past medical history and normal vital signs complains of progressive limb weakness for about 4 weeks. Physical examination reveals symmetrical proximal muscle weakness, normal sensation, reflexes, and eye muscles. Which of the following differential diagnoses is least likely? ", "input": "(A) Dermatomyositis. (B) Polymyositis. (C) Myasthenia gravis. (D) Lambert-Eaton syndrome. ", "output": "C"} 
-{"instruction": "Which of the following statements about non-traumatic diseases of the hands is more appropriate? ", "input": "(A) Paronychia can be caused by minor trauma or nail biting. The most common infection is Gram-negative bacteria. (B) Kanavel's signs are all negative, which can rule out the diagnosis of flexor tenosynovitis. (C) For deep space infection, press the palm surface to check for pain, lumps or effusion. (D) Herpetic whitlow often produces vesicles and effusions, and treatment often requires incision and drainage. ", "output": "C"} 
-{"instruction": "A primipara has severe postpartum hemorrhage. She has received about 2,000 ml of blood transfusion and injected with Oxytocin. Her current vital signs are: blood pressure 76/32 mmHg, heart rate 132 beats/min, respiration 28 times/min, body temperature 36.0℃, SpO₂ 95% (room air), GCS E3M6V5. Which of the following treatments is effective and appropriate? ", "input": "(A) Emergency massive transfusion of FFP and platelets. (B) Massive blood transfusion, supplemented by vitamin K injection. (C) Notify the obstetrician and gynecologist to arrange a hysterectomy. (D) Notify the radiologist to arrange pelvic vessel embolization. ", "output":"D"} 
-{"instruction": "Which of the following statements about headaches is more appropriate?", "input": "(A) The incidence of migraines, cluster headaches, and tension headaches decreases with age. (B) Headaches are a common symptom of fever, but fever is not a red flag sign for headaches. (C) Cerebral vasoconstriction and rebound vasodilation are common causes of migraines. (D) Primary hypertension often causes thunderclap headaches.", "output": "A"} 
-{"instruction": "Which of the following statements about transfusion-related acute lung injury is less appropriate?", "input": "(A) Mostly associated with transfusions of fresh frozen plasma and platelets. (B) Also common with transfusions of packed RBCs alone. (C) Often causes bilateral pulmonary infiltrates. (D) Often occurs within 6 hours of transfusion.", "output": "B"}
-{"instruction": "Regarding rabies vaccine and immunoglobulin injection, which of the following is more appropriate?", "input": "(A) A woman in Chiayi County was slightly bitten by a badger that broke into her backyard. If it is judged to be a Class II wound, she will be vaccinated with immunoglobulin after the badger is tested and found to be virus-positive. (B) The wound needs to be injected with immunoglobulin at the same time. If sutures are required, it is recommended to do so within 30 minutes to prevent the immunoglobulin from leaking out with secretions. (C) If bitten by stray cats and dogs, do not give the vaccine for the time being. The dogs and cats should be observed for 7 days. If they show symptoms that are highly suspected of rabies, they should be given the vaccine. (D) Rabies immunoglobulin can be administered at the same time as the first dose of rabies vaccine after exposure to the same part of the body.", "output": "A"} 
-{"instruction": "A 10-year-old boy swallowed 25 tablets of Acetaminophen 500mg/tab 4 hours ago. His vital signs were normal in the emergency room. The blood Acetaminophen level was immediately tested to be 300mg/mL. Which of the following statements is more appropriate?", "input": "(A) This is a drug poisoning dose and he needs to be treated with N-acetylcysteine ​​immediately. (B) There is a risk of hepatic coma within 24 hours. (C) He can be treated with activated carbon first through a nasogastric tube or orally, and then the blood Acetaminophen level can be determined after 4 hours before deciding on N-acetylcysteine ​​treatment. (D) If poisoning occurs, he should be given a single dose of 160mg/kg of N-acetylcysteine, followed by 70mg/kg every 4 hours. The dose was given 17 times in a row. ", "output": "A、C"} 
-{"instruction": "What is the sensitivity of upright chest X-ray for detecting free air in the abdomen? ", "input": "(A)1 0%. (B)30%. (C)50%. (D)70%. ", "output": "B"} 
-{"instruction": "A patient presents to the emergency department with hemoptysis. Which description of his diagnosis and management is more appropriate? ", "input": "(A) Massive hemoptysis is more commonly defined as coughing up more than 1,500 mL of blood within 24 hours. (B) The first-line imaging diagnostic tool for patients with hemoptysis is chest X-ray, and it can obtain a preliminary possible diagnosis in 50% of patients. (C) Fiberoptic bronchoscope (fiberoptic bronchoscope (D) For patients with massive hemoptysis who need intubation because their airways cannot be kept open, it is recommended to use a small endotracheal tube, which is less likely to injure the tracheal mucosa. ", "output": "B"} { 
-"instruction": "Which of the following statements about esophageal rupture is less appropriate? ", "input": "(A) Blunt injuries to the neck rarely cause esophageal rupture. (B) Foreign body obstruction increases the risk of esophageal rupture. (C) Boerhaave's syndrome is mainly seen in ruptures of the upper esophagus. (D) Boerhaave's syndrome is caused by a sudden increase in esophageal pressure. ", "output": "C"} 
-{"instruction": "A 35-year-old male fell off a bicycle and lost his upper right front tooth. Which of the following treatments is more appropriate? ", "input": "(A) Just clean the wound. No tetanus vaccine is needed. (B) Before implanting the lost tooth into the alveolus, the entire tooth must be cleaned with saline and gauze. (C) Oral Doxycycline is the first choice of treatment. (D) There is a 2 cm laceration on the inner side of the upper lip. Rinse the wound clean and make sure there is no foreign body left. Then apply pressure to stop the bleeding. No suture is needed. ", "output": "C"} 
-{"instruction": "Which of the following is less appropriate in the treatment of acute aortic regurgitation? ", "input": "(A) Immediate surgical intervention should be considered. (B) β-blockers can be used to reduce the heart's oxygen demand. (C) Nitroprusside combined with Dobutamine can be used for the above patients. (D) Diuretics and Nitrates are usually ineffective for the above patients. ", "output": "B"} 
-{"instruction": "A middle-aged female who took a large amount of unknown drugs about 20 hours ago and was sent to her by a friend. It is only known that she had mental illness in the past. Clinical manifestations: body temperature of 41℃, confusion, agitation, sweating, dilated pupils, increased reflexes and muscle twitches (myoclonus). Which of the following treatments is more appropriate? ", "input": "(A) Give activated charcoal to reduce drug absorption. (B) Give Dantrolene to control muscle spasms. (C) Give Acetaminophen to control body temperature. (D) If intubation is required, Succinylcholine is not recommended. ", "output": "D"} 
-{"instruction": "Which of the following descriptions of alcohol withdrawal syndrome is more appropriate? ", "input": "(A) It is likely to occur as soon as 24 hours after stopping or reducing drinking. (B) If an epileptic seizure occurs, fewer than half of patients will have another seizure. (C) To prevent epileptic seizures, consider giving the anti-epileptic drug Phenytoin. (D) Among the therapeutic drugs, Lorazepam 1mg is equivalent to Midazolam 2mg, which is also equivalent to Diazepam 5mg. ", "output": "D"} 
-{"instruction": "Which of the following statements is less appropriate regarding the basic treatment of acute asthma? ", "input":"(A) High-dose corticosteroid therapy can relieve symptoms better than low-dose therapy. (B) Patients can be given inhaled adrenergic agents. (C) Oxygen therapy is given to maintain SaO 2 ≥ 90%. (D) Adding Ipratropium to a short-acting selective beta-agonist can help improve bronchodilation.", "output": "A" 
-} {"instruction": "The patient complains of double vision. Which of the following statements is more appropriate regarding assessment and diagnosis?", "input": "(A) Monocular double vision that persists even when the other eye is closed is rarely a problem with the visual light pathway. (B) Miller-Fisher syndrome , which is related to autoimmune antibodies. The distinguishing features are ocular motor paralysis, akinesia, and areflexia. (C) Ophthalmoplegic migraine is an inflammatory cranial neuropathy, a self-limiting disease, usually paralysis of the sixth cranial nerve. (D) Arterial tumor enlargement will directly compress the cranial nerves and cause diplopia. The distinguishing features are compression of the sixth cranial nerve and impact on the pupil. ", "output": "B"} 
-{"instruction": "A 30-year-old female, 32 weeks pregnant, seeks medical attention for wheezing. She is conscious and has vital signs: blood pressure 126/72 mmHg, heart rate 110 beats/min, respiration 28 times/min, temperature 36.0℃, SpO₂ 85% (room air), and normal breath sounds. The examination and testing meet the diagnostic benefit and cause the least harm to the fetus. Which of the following is more appropriate? ", "input":"(A)Chest radiography. (B)Chest CT pulmonary angiography (CTPA). (C)P ulmonary perfusion scan. (D)C hest magnetic resonance imaging with gadolinium contrast enhancement.", "output": "B"} 
-{"instruction": "A 70-year-old male with a history of asthma and heart failure has chest pain, cold sweats, and shortness of breath at home. When he goes to the emergency room, his blood pressure is 220/130 mmHg, his respiratory rate is 26 breaths/min, his heart rate is 114 beats/min, his body temperature is 36℃, and his blood oxygen concentration is 92%. The diagnosis is acute aortic detachment. Which of the following statements is more appropriate?", "input": "(A) This is a hypertensive urgency. (B) The blood pressure of the upper limbs may be different, usually by 5 to 10 mmHg. (C) Urgent antihypertensive medication is required, with Labetalol intravenous injection being the preferred medication. (D) Systolic blood pressure should be controlled between 100 and 140 mmHg, and heart rate should be controlled to less than 60 beats/min. ", "output": "D"} 
-instruction": "Emergency bedside lung ultrasound scan (BLUE protocol) , multiple features require consideration of the diagnosis of pneumonia. Which of the following is less appropriate? ", "input": "(A) Pulmonary sliding, C-profile(+). (B) Pulmonary sliding, A/B profile(+). (C) Pulmonary sliding, A-profile(+), DVT(-), PALPS(-). (D) No lung sliding, B'-profile(+). ", "output": "C"} 
-{"instruction": "Which of the following statements is more appropriate regarding the possible complication of local anesthetic systemic toxicity (LAST) during nerve block surgery? ", "input": "(A) Generally speaking, the longer-acting local anesthetic is, the less likely it is to develop LAST. (B) When LAST occurs, local muscle twitching occurs earlier than tongue numbness. (C) When a patient has cardiac arrest due to LAST, intravenous lipid emulsion should be used for treatment. (D) When seizures occur, magnesium sulfate (MgSO 4) treatment should be considered first. ", "output": "C"} 
-{"instruction": "Computed tomography revealed ascending colon diverticulitis with a 3-cm surrounding abscess. Which of the following statements is less appropriate? ", "input": "(A) Liquid food can be used. (B) Abscess drainage surgery is usually not required. (C) Large-volume infusion therapy is used to replenish water. (D) Broad-spectrum antibiotics are given. ", "output": "A"} 
-{"instruction": "Regarding Guillain-Barré syndrome (GBS), which of the following statements is less appropriate? ", "input": "(A) The motor nerves are mainly affected, which manifests as asymmetric limb weakness, usually affecting the lower limbs first and then the upper limbs. (B) The most obvious finding on neurological examination is the absence of deep tendon reflex. (C) Although the patient may have some complaints of abnormal sensations, neurological examinations show that the sensory nerves are normal. (D) The occurrence of Guillain-Barré syndrome is related to acute Campylobacter jejuni infection. ", "output": "A"} 
-{"instruction": "A 1-year-old boy has bruises and hemorrhages all over his body, no other symptoms, good mental energy and appetite, blood test results: WBC 13,900/µL (segment 40%, lymphocyte 52%, monocyte 8%), Hb 11g/dL, Platelets <5,000/µ L. Which of the following statements is more appropriate? ", "input": "(A) Idiopathic thrombocytopenic purpura (ITP) Generally, low platelets will become chronic and last for more than 6 months. (B) The diagnosis of ITP is mainly based on medical history, physical examination, complete blood count and peripheral blood smear examination. Shrunken platelets can be seen in the smear. (C) Bone marrow examination is not an immediately necessary test. (D) Steroid treatment can be used and platelet transfusions must be given quickly to prevent possible bleeding. ", "output": "C"} 
-{"instruction": "Which of the following statements about tracheobronchial injury is more appropriate? ", "input": "(A) The most common cause is a puncture wound to the neck. (B) About 1/3 of patients have mild or no symptoms. (C) Most intrathoracic tracheobronchial injuries occur 2 cm below the cricoid cartilage. (D) Bronchial lacerations that are larger than 1/3 of the bronchial circumference require surgical repair. ", "output": "D"} 
-{"instruction": "According to WHO guidelines, which of the following invasive treatments is less likely to cause an aerosol-generating effect and increase infectiousness? ", "input": "(A) External chest compression. (B) Tracheal intubation. (C) Manual bag-valve-mask ventilation. (D) Biphasic positive airway pressure (BiPAP). ", "output": "A"} { 
-"instruction": "Which of the following statements about radiation injury is less appropriate? ", "input": "(A) When taking a medical history, the dose of radiation exposure can be estimated by the time of vomiting. (B) Checking absolute lymphocytes can be used to estimate the radiation dose of exposure. (C) Decontamination is considered complete when the reading on the radiation detector is equal to or less than five times the background value. (D) If infection is suspected, preventive antibiotics can be given appropriately. ", "output": "C"} 
-{"instruction":"A 75-year-old male with a history of myocardial infarction and cerebral infarction, who takes anticoagulants regularly, was admitted to the hospital after falling from a bicycle. A head CT scan revealed right subdural hemorrhage. Which of the following treatments is more appropriate?", "input": "(A) Prothrombin concentrate complex, plasma, and Vitamin K can be given. (B) If the patient is taking new anticoagulants such as Xarelto, reversal drugs can be given. (C) A blood test can be performed to confirm whether the patient has coagulation abnormalities caused by taking antithrombotic drugs. (D) If the patient is taking Coumadin, Protamine sulfate can be given.", "output": "A"} 
-{"instruction": "Which of the following statements about complications of the neck in systemic rheumatic immune disease is less appropriate?", "input": "(A) Ankylosing spondylitis is more likely to cause cervical instability than rheumatoid arthritis. (B) Rheumatoid arthritis patients should maintain cervical stability even with minor injuries. (C) Ankylosing spondylitis patients should avoid flexion and extension during intubation to prevent cervical spinal cord disease caused by atlantoaxial joint instability. (D) Rheumatoid arthritis patients should be suspected of cervical instability when they experience severe neck pain radiating to the occipital region and abnormal sensations in the upper limbs.", "output": "A"} 
-{"instruction": "A 60-year-old woman has had right neck and shoulder pain for a week. Which of the following physical examinations is more likely to indicate a muscle strain? ", "input":"(A) Continuous breath-holding and exertion (Valsalva) will increase pain in the right neck and right shoulder. (B) The patient can reduce the pain on the affected side by abduction of the right upper arm. (C) When the neck is flexed and the chin is close to the chest wall, the upper arm will produce pain like electrical stimulation. (D) The pain will be worse when the patient turns his head to the left.", "output": "D"} 
-{"instruction": "A patient with lung cancer (non-small cell carcinoma), brain, liver, adrenal glands and multiple bone metastases, received Ipilimumab immunotherapy last month. He had a high fever, diarrhea, and worsening mental state in the past three days. He was taken to the emergency room. Which of the following descriptions or treatments is more appropriate?", "input": "(A)This drug is a synthetic monoclonal antibody that stimulates specific white blood cell anti-PD-1 antigens to enhance the ability of T lymphocytes and NK cells to kill tumor cells. (B)Patients with advanced cancer have poor immunity and are often infected. Even if the source of infection cannot be found in the initial evaluation, broad-spectrum antibiotics, antiviral and antifungal drugs can be given first. (C)If immune-related adverse events are suspected, methylprednisolone, 1-2 mg/kg/day, is given first, and the dose is reduced after three days. (D)Common side effects of Ipilimumab immunotherapy are pulmonary fibrosis or myocarditis.", "output": "C"}
-{"instruction": "Which of the following statements is more appropriate regarding the diagnosis and treatment of acute abdominal pain?", "input": "(A) Patients with unexplained abdominal pain should not be given analgesics. (B) Use Metoclopramide, sometimes in combination with Diphenhydramine to prevent the occurrence of dystonia. (C) Normal lipase values ​​exclude acute pancreatitis. (D) Normal Serum Lactate levels exclude mesenteric ischemia.", "output": "B"} {" 
-instruction": "An 80-year-old male complained of progressive wheezing for one week, combined with bilateral lower limb edema. His vital signs are as follows: temperature 36.3℃, heart rate 80 beats/min, respiration 26 breaths/min, blood pressure 180/155 mmHg, SpO₂ 90%. According to POCUS Blue Protocol found that both lungs showed B Profile. Which of the following statements is more appropriate? ", "input": "(A) Early administration of Morphine can reduce the length of hospital stay and mortality. (B) Transdermal NTG can be given before intravenous injection is established. (C) If the patient has a history of obstructive hypertrophic cardiomyopathy, NTG should be avoided. (D) The use of diuretics alone can reduce the patient's mortality rate. ", "output": "C"} 
-{"instruction": "Which of the following statements about MDMA is more appropriate? ", "input": "(A) The mechanism of action is to inhibit cytochrome P-450 2D6 to reduce the concentration of serotonin, dopamine, and norepinephrine, thereby exerting its effect. (B) It will cause excessive secretion of antidiuretic hormone (ADH), which will lead to hypernatremia. (C) When acute poisoning occurs, there will be changes in consciousness, respiratory depression, mydriasis, etc. (D) The treatment of poisoning is mainly supportive therapy, and there is currently no specific antidote available. ", "output": "D"} 
-{"instruction": "Which of the following statements is more appropriate for the treatment of asthma severe disease (status asthmaticus)? ", "input": "(A) When the patient's blood oxygen concentration decreases and consciousness changes, intubation should be performed as soon as possible to reduce airflow obstruction in the trachea. (B) Intravenous injection of Aminophylline is downgraded to a second-line drug and used after inhaled drug treatment and steroids. (C) Use noninvasive positive-pressure respiration (noninvasive positive-pressure (A)Children's rib fractures or metaphyseal fractures should be highly suspected of child abuse. (B)Child 
-abuse fractures often occur in children younger than 18 months old and are the most common clinical sign of physical abuse. (C)If a femur fracture is found, the probability of the infant being caused by child abuse is higher than that of a 2-3 year old child. (D)Toddler's fractures between 9 months and 4 years old are mainly caused by accidents. ", "output": "B"} 
-{"instruction": "Which of the following statements about medications used for eclampsia and preeclampsia is more appropriate? ", "input": "(A) When controlling blood pressure, Hydralazine works faster than Labetalol, so it is the first-line medication. (B) When epilepsy occurs, the first-line medication is Diazepam or Lorazepam. (C) Avoid using antiplatelet drugs in pregnant women to prevent preeclampsia or HELLP syndrome. (D) If side effects of high magnesium levels occur during treatment, Calcium gluconate can be administered. ", "output": "D"} 
-{"instruction": "Which of the following statements about REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) is less appropriate? ", "input": "(A) REBOA may be considered for patients with subdiaphragmatic trauma and hemorrhagic shock that are life-threatening. (B) Arterial dissection, extreme ischemia, and spinal cord injury are all possible complications of REBOA. (C) If used for patients with severe intra-abdominal bleeding, retroperitoneal bleeding, or even traumatic cardiac arrest, the balloon should be placed in Zone 2, i.e., the distal thoracic aorta. (D) If used for patients with severe proximal lower limb trauma and hypovolemic shock, the balloon should be placed in Zone 3, i.e., the distal abdominal aorta. ", "output": "C"} 
-{"instruction": "A 24-year-old female is found unconscious and brought to the emergency department with dilated pupils, nystagmus, increased neuromuscular reflexes, diarrhea and sweating, blood pressure 190/108 mmHg, heart rate 126 beats/min, and temperature 39℃. Which of the following diagnoses is less likely? ", "input": "(A)Cholinergic toxidrome s. (B)Sympathomimetics. (C)Serotonin toxidrome s. (D)Neuroleptic Malignant Syndrome. ", "output": "A"} 
-{"instruction": "Which of the following is not helpful in assisting the diagnosis of atypical Kawasaki disease? ", "input": "(A)Creatinine. (B)Urine analysis. (C)C-reactive protein. (D)Albumin. ", "output": "A"}  
-{"instruction": "Which of the following is a risk factor for post–lumbar puncture headache?", "input": "(A)Draining too much cerebrospinal fluid. (B)Using a larger needle (>22 gauge). (C)Not lying down after the procedure. (D)High opening pressure of cerebrospinal fluid.", "output": "B"}
-{"instruction":"A 30-year-old female accidentally ingested Datura stramonium and began to talk nonsense. Her entire body felt dry and hot. Her temperature was 38.5°C, her breathing was 25 breaths/min, her heart rate was 120 beats/min, her blood pressure was 162/105 mmHg, and her GCS was E4V2M5. Which of the following treatments is less appropriate?", "input": "(A) Give the patient appropriate fluids and monitoring. (B) Sedate the patient with Lorazepam. (C) Cool the patient with Acetaminophen. (D) Hemodialysis will not improve this patient's prognosis.", "output": "C"} 
-{"instruction": "Which of the following statements about surgical airway is more appropriate?", "input": "(A) For children under 8 years of age, cricothyrotomy is recommended. (B) When the trachea or larynx is injured, cricothyrotomy is recommended. (C) Cricothyrotomy can easily cause airway stenosis, and tracheostomy is usually performed within 24 hours. (D) Good jet ventilation can provide adequate ventilation, and it is not necessary to immediately reestablish other types of airways.", "output": "D"}
-{"instruction": "A 65-year-old male patient went to the clinic for treatment due to right ear pain and hearing loss. He was diagnosed with otitis media. After 3 days of oral antibiotics (Amoxicillin 1g TID), his condition did not improve and he went to the emergency room. Which of the following treatments is more appropriate?", "input": "(A) If there is no middle ear effusion, the patient can continue to take the antibiotics prescribed by the clinic. (B) If there is middle ear effusion, an otolaryngologist should be consulted to perform tympanic membrane puncture and drainage. (C) Hearing loss problems usually improve as the middle ear effusion is absorbed. (D) Facial nerve palsy is a common complication and can be treated with steroids.", "output": "C"} 
-{"instruction": "56-year-old male patient, with a history of diabetes, takes medication regularly. He traveled to Hualien and played in the stream 10 days ago. He complained of recurrent chills with fever, headache and muscle aches 5 days ago. Mild jaundice and decreased urine volume have occurred in the past three days. Emergency vital signs include blood pressure 106/62 mmHg, body temperature 37.8℃, heart rate 122 beats/min, respiration 20 times/min, SpO₂ 96%, and no heart murmurs. The total white blood cell count in the blood is 12,600/μL, liver function is abnormal, and there is mild jaundice and kidney function abnormality. Regarding diagnosis and treatment, which of the following statements is less appropriate?", "input": "(A) Leptospirosis, bacterial endocarditis, obstructive jaundice complicated with cholangitis, and hepatic abscess are all possible differential diagnoses. (B) Abdominal ultrasound or CT is an important diagnostic tool for diagnosing hepatic abscess and obstructive jaundice complicated with cholangitis. (C) Blood culture can be used to diagnose the above three infections, but if bacterial endocarditis caused by HACEK bacteria is suspected, a longer blood culture period is required. (D) For empirical antibiotic treatment, third-generation cyclosporin may be considered, combined with intravenous penicillin-G or oral doxycycline.", "output": "C"} 
-{"instruction": "Which of the following statements about blood transfusion is less appropriate?", "input": "(A)Reduces red blood cell concentrates are less likely to cause allergic fever during transfusion. (B)The platelet count should be maintained above 50,000/µL before performing a lumbar puncture. (C)Cryoprecipitate may be considered for bleeding caused by uremia. (D)Acute lung injury caused by blood transfusion should be treated with diuretics.", "output": "D"} 
-{"instruction": "Which of the following statements about urinary tract infection is more appropriate?", "input": "(A)Urinary tract infection requires antibiotic treatment for at least 1 week before it can be cured. (B) For patients infected with human immunodeficiency virus and complicated with urinary tract infection, sulfonamides are preferred for empirical antibiotic use. (C) Studies have shown that urinating after sexual intercourse does not prevent cystitis in young women. (D) Avoid drug or antibiotic abuse. Patients with asymptomatic bacteriuria should not be given antibiotic treatment. ", "output": "C"} { 
-"instruction": "An 8-year-old boy with a history of asthma was hit in the right chest and had tenderness and swelling in the lower limbs in a car accident. He had asthma attacks, restlessness, and cold sweats. Blood pressure 82/58 mmHg, heart rate 120 beats/min; chest X-ray: suspected rib fracture on the right side. Arterial gas analysis: pH 7.35, PaCO₂ 30 mmHg, PaO 2 80mmHg, HCO₃ 22 mEq/L, potassium 5.8 mEq/L. If the patient needs intubation, which of the following is more appropriate? ", "input": "(A) Ketamine has sedative, analgesic and cardiovascular stimulatory effects and is the first choice of induced anesthesia for this patient. (B) E tomidate has stable hemodynamics and is the first choice of induced anesthesia for this patient when used in combination with morphine. (C) Ketamine is used in combination with Propofol. Because Propofol reduces the toxicity of Ketamine, it is more suitable as the first choice of induced anesthesia for this patient. (D) After induction of anesthesia, the patient is still restless and has muscle contraction. Succinylcholine can be used to relax the muscles before intubation. ", "output": "A"} 
-{"instruction": "Which of the following descriptions is more appropriate regarding the complications of acute coronary heart disease? ", "input": "(A) The electrocardiogram shows accelerated idioventricular rhythms, which has a poor prognosis. (B) Cardiomastoid muscle rupture, which occurs more commonly in anterior wall infarcts. (C) If the patient is complicated by primary ventricular fibrillation, the prognosis will not be affected as long as it is treated promptly. (D) If Dressler's syndrome occurs, aspirin 100 mg should be taken daily. ", "output": "C"} 
-{"instruction": "A 3-year-old boy was in a car accident while sitting in a safety seat at the back of the car. He suffered a 3-cm scalp laceration and abdominal bruising, with a blood pressure of 100/65 mmHg. The child hugged his mother tightly, sometimes crying loudly, with his eyes tightly closed, and only opened his eyes when his mother called him. Which of the following is more appropriate? ", "input": "(A) It is mandatory to use a rear-facing safety seat according to regulations. (B) Ultrasound can be used to rule out solid organ damage in the abdomen. (C) If the child develops into shock, the scalp laceration should not be the main cause. (D) This child scored 14 points on the Modified Pediatric Glasgow Coma Scale. ", "output": "D"} 
-{"instruction": "Which of the following is inappropriate for the clinical consideration of giving antiviral drugs for herpes zoster? ", "input": "(A) It can shorten the course of the disease. (B) It can reduce the occurrence of new varicella. (C) It can reduce the severity of postherpetic neuralgia. (D) Antiviral drugs should also be given to immunocompromised patients if their symptoms persist for more than 72 hours. ", "output": "C"}"output": "D"} 
-{"instruction": "Which of the following statements about Shigella spp and the diarrheal illness they cause is less appropriate?", "input": "(A) Children in day care centers are a susceptible group. (B) Azithromycin can be used for treatment. (C) The course of disease can be self-limited. (D) Symptoms caused by S. sonnei are more severe than in other subgroups.", "output": "D"} 
-{"instruction": "A 38-year-old male presents to the emergency department with bleeding from a gum wound in the middle of the night after a tooth was extracted in the afternoon. Which of the following is less appropriate?", "input": "(A) Use gauze to hold the wound and apply local pressure to the bleeding area for 20 minutes. (B) Gelfoam or gauze soaked in tranexamic acid can be used to stop bleeding. (C) If gauze fails to stop bleeding, sutures can be used to tightly suture the gum wound. (D) If the above methods are ineffective, Lidocaine + Epinephrine can be injected locally around the wound. ", "output": "C"}"output": "C"} 
-{"instruction": "A 38-week pregnant woman was sent to the emergency room after a motorcycle accident. She had GCS E3V4M5, abrasions on her left face, subcutaneous edema on her left chest, bruises on her left abdomen, and a little blood on her underwear. Her blood pressure was 87/45 mmHg, her heart rate was 146 beats/min, her respirations were 23 breaths/min, and her SpO₂ was 95%. Which of the following statements is more appropriate?", "input": "(A) Stabilizing the pregnant woman first will give the fetus a better prognosis. The fetal condition should be assessed after the pregnant woman has been stabilized and secondary assessment has been performed. (B) The arterial blood showed PaO 2 91mmHg and PaCO₂ 38mmHg. The pregnant woman should be considered to be in imminent respiratory failure. (C) In addition to pushing the uterus to the left or lying on the left side, fluid infusion, blood transfusion, and pressor drugs should be started as soon as possible to prevent fetal hypoxia. (D) The vaginal fluid was tested with a test strip and the pH value was 5. There should be a high suspicion of amniotic membrane rupture and obstetrics and gynecology should be consulted as soon as possible. ", "output": "B"}
-{"instruction": "A 24-year-old male patient presents to the emergency department with bloody stools for 2 days. Clinically, infectious gastroenteritis is suspected. Possible bacterial species include Salmonella, Shigella, Yersinia, Vibrio and E. coli. Which of the following is the most appropriate first-line antibiotic choice?", "input": "(A)Trimethoprim-sulfamethoxazole. (B)Metronidazole. (C)Erythromycin. (D)Ciprofloxacin.", "output": "D"} 
-{"instruction": "Four children with a day-long fever are admitted to the emergency pediatric department. All four are active, have no obvious respiratory or gastrointestinal symptoms, and have been vaccinated on time. Which one does not need a urine test initially?", "input": "(A)A 3-month-old boy with a temperature of 38.5℃. (B)1.5 6-year-old boy, uncircumcised, temperature 38.0℃. (C) 1.5-year-old girl, temperature 38.0℃. (D) 4-year-old girl, temperature 38.0℃. ", "output": "D"} 
-{"instruction": "While performing traditional laryngoscope endotracheal intubation on an adult non-traumatic patient, when only half of the glottal triangle can be seen with the laryngoscope, which of the following is more appropriate? ", "input": "(A) Reposition the patient to a supine nodding position. (B) Reposition the patient with the head raised approximately 10 cm under the occipital area. (C) Apply cricoid pressure using the BURP maneuver. (D) Apply cricoid pressure using the Sellick maneuver. ", "output": "B"} 
-{"instruction": "Which of the following statements about pneumonia in patients infected with human immunodeficiency virus (HIV) is less appropriate?", "input": "(A) Bacterial pneumonia still has the highest incidence compared to other pathogens. (B) The most prominent feature of pneumocystic pneumonia is hypoxemia. (C) The typical chest X-ray findings of tuberculosis infection are not common in terminally ill patients. (D) Cytomegalovirus pneumonia is common in the early stages of HIV infection.", "output": "D"} 
-{"instruction": "Which of the following statements about JumpSTART for the assessment of massive casualties in children is more appropriate?", "input": "(A) As with adult assessment, the first step is to assess the presence of breathing. (B) AV PU is a tool for assessing awareness in JumpSTART. The first A is airway. (C) The order of assessment: whether the patient can walk → pulse → breathing. (D) As long as the patient can walk, it is minor and the patient should proceed to the second round of examination. ", "output": "D"} 
-{"instruction": "A 35-year-old male was injured in a car accident. MRI examination revealed that the spinal cord injury was located at approximately T10. In addition to weakness in both lower limbs, the patient also lost pain and temperature sensation in the lower body, but still retained proprioception. Which of the following statements is more appropriate? ", "input": "(A) The chance of neurological shock is high. (B) Light touch sensation in both lower limbs will not disappear completely. (C) The range of temperature sensation loss may begin below T6. (D) Neurological examination of the lower limbs will show decreased deep tendon reflexes and Barbinski's sign (positive). ", "output": "B"} 
-{"instruction": "Which of the following statements about blood transfusion in trauma patients is more appropriate? ", "input": "(A) Transfusion of more than 8 units of blood within 24 hours meets most definitions of massive transfusion. (B) Massive transfusions must be accompanied by calcium supplementation to prevent hypocalcemia. (C) PRBCs that match blood type and are crossmatched should be given as soon as possible, but this may be an exception in cases of massive injuries. (D) Type O PRBCs and fresh frozen plasma can be given in an emergency, while platelets are not considered based on blood type. ", "output": "C"} 
-{"instruction": "Which of the following statements about the management of acute ischemic stroke is more appropriate? ", "input": "(A) Systolic blood pressure must be actively controlled to below 120 mmHg before intravenous thrombolytics can be administered. (B) After the administration of intravenous thrombolytics, if the diastolic blood pressure exceeds 140 mmHg, consider using nitroprusside intravenous drip to control blood pressure. (C) 12 hours after the administration of intravenous thrombolytics, oral Aspirin should be started to reduce the risk of blood vessel re-blockage. (D) If the blood sugar is less than 50 mg/dL, but the clinical manifestations resemble a stroke, intravenous thrombolytics should still be administered first. ", "output": "B"} 
-{"instruction": "Regarding valproic acid poisoning, which of the following is more appropriate? ", "input": "(A) Slow-release valproic acid poisoning only requires a single dose of activated charcoal. (B) In poisoned patients, blood concentrations are strongly correlated with the occurrence of seizures. (C) Hemodialysis cannot be used to increase excretion. (D) It will cause an increase in ammonia in the blood and can be treated with L-carnitine. ", "output": "D"} 
-{"instruction": "Which is more appropriate for intubation using video laryngoscopes (VL) or direct laryngoscopes (DL)? ", "input": "(A) The blade curvature of VL and DL laryngoscopes is usually the same. (B) When inserting VL and DL, a tongue sweep must be performed from the corner of the mouth. (C) After the VL and DL are inserted, the front end of the blade targets the vallecula. (D) The first intubation success rate using VL is significantly higher than that using DL, and the complication rate is lower. ", "output":"C"} 
-{"instruction": "Which of the following statements about blood products is more appropriate?", "input": "(A) Fresh frozen plasma (FFP) can be directly thawed by heating in emergency transfusion situations, and it can remain active for five days after thawing. (B) Fresh frozen plasma does not need to be matched with blood type before it is released from storage. (C) The indications for cryoprecipitate include bleeding in patients with severe liver disease with fibrinogen less than 100 mg/dL. (D) Fresh frozen plasma is recommended for treatment of patients with excessive bleeding from novel oral anticoagulants.", "output": "C"} 
-{"instruction": "A 50-year-old male with myasthenia gravis comes to the emergency department with shortness of breath. Which of the following statements is more appropriate?", "input": "(A) If intubation is required, avoid administering depolarizing or nondepolarizing paralytic agents. (B) Neck symptoms are more pronounced in flexor weakness than in extensor weakness. (C) Distal limb weakness is the most common symptom in this patient population. (D) Patients with respiratory symptoms, even mild ones, should be admitted to the ICU for observation.", "output": "A"}
-{"instruction": "A 45-year-old female with a history of breast cancer and brain metastasis complained of wheezing that began 1 hour ago. Her temperature was 37.5℃, her heart rate was 130 beats/min, her breathing was 30 breaths/min, her blood pressure was 80/50 mmHg, and her SpO₂ was 88%. Physical examination showed no abnormalities in bilateral lung auscultation. She also had redness, swelling, and tenderness below the right calf. Which of the following statements is more appropriate?", "input": "(A) Ultrasound revealed a D-shaped left ventricle, which can be diagnosed as acute pulmonary embolism. (B) If the diagnosis of severe pulmonary embolism is met, thrombolytic therapy should be given. (C) Ultrasound sensitivity for pulmonary embolism is about 70%. (D) Low molecular weight heparin can be used for treatment.", "output": "D"} "A 45-year-old female with a history of breast cancer and brain metastasis complained of wheezing that began 1 hour ago. Her temperature was 37.5℃, her heart rate was 130 beats/min, her breathing was 30 breaths/min, her blood pressure was 80/50 mmHg, and her SpO₂ was 88%. Physical examination showed no abnormalities in both lungs. She also had redness, swelling, and tenderness below her right calf. Which of the following statements is more appropriate?", "input": "(A) Ultrasound revealed a D-shaped left ventricle, which can be diagnosed as acute pulmonary embolism. (B) If the diagnosis of severe pulmonary embolism is met, thrombolytic therapy should be given. (C) Ultrasound sensitivity for pulmonary embolism is about 70%. (D) Low molecular weight heparin can be used for treatment.", "output": "D"} 
-{"instruction": "About Crohn's disease Which of the following statements is more appropriate? ", "input": "(A) The most common site of disease is the jejunum. (B) Anemia is not a common symptom of this disease. (C) It is more common in Asians. (D) Prednisolone (60 mg per day) can be given when symptoms are severe. ", "output": "D"}
-{"instruction": "Which of the following is less appropriate when a nurse draws blood from a patient and then pricks him with a needle?", "input": "(A) If the nurse has never received the hepatitis B vaccine and it is unknown whether the patient is infected with HBV, hepatitis B immune globulin should be given. (B) If the nurse is eligible for hepatitis B immune globulin, it should be given within 24 hours of the prick. (C) If the patient has acquired immune deficiency syndrome, the nurse's chance of contracting HIV is approximately 0.3%. (D) Post-exposure prophylaxis for HIV is recommended to be given as soon as possible.", "output": "A"} 
-{"instruction": "Which of the following is more appropriate when describing heat stroke?", "input": "(A) Differentiate between exertional and non-exertional heat stroke (A) Because the endotracheal tube is more suitable for long-term ventilation, patients who use a laryngeal mask airway (LMA) before hospitalization should be replaced with an endotracheal tube immediately after arrival. (B) Compared with the endotracheal tube with an air cuff 
-, the supraglottic airway causes aspiration. and hypopharyngeal mucosal damage. (C) Laryngeal mask airway can be placed without visual inspection of the glottis, and in Taiwan it can be performed by an EMT-I. (D) After placement of a supraglottic airway, it is not advisable to use end-tidal carbon dioxide concentration to confirm position. ", "output": "B"} 
-{"instruction": "Which of the following statements about acute viral hepatitis is less appropriate? ", "input": "(A) Hepatitis A rarely develops into chronic hepatitis. (B) Acute infection with hepatitis C is usually asymptomatic. (C) 75% of adults infected with hepatitis B will develop chronic hepatitis. (D) Repeated infection with hepatitis B and hepatitis D can easily develop into fulminant hepatitis. ", "output": "C"} 
-{"instruction": "A 35-year-old female, 38 weeks pregnant, fell off her motorcycle and was sent to the hospital. She was conscious, with blood pressure of 100/50 mmHg, heart rate of 120 beats/min, respiration of 20 breaths/min, and body temperature of 36℃. She complained of lower abdominal discomfort. Physical examination revealed lower abdominal tenderness but no obvious signs of peritonitis. Which of the following statements is more appropriate? ", "input": "(A) The uterus has sufficient blood flow but is relatively small in size. Injury will not cause shock to the pregnant woman. (B) Because the enlarged uterus pulls on the peritoneum, there may be no obvious signs of peritonitis after intra-abdominal bleeding. (C) At this stage, the fetal head has descended into the pelvic cavity. Even if the pelvis is fractured, it will not directly injure the fetal head. (D) The total blood volume is the highest during pregnancy, and shock symptoms will only appear when the blood loss reaches more than 30% of the total blood volume. ", "output": "B"} 
-{"instruction": "From a medicolegal & ethical perspective, which of the following actions is less appropriate? ", "input": "(A) Requesting treatment for a long-standing "sarcoma" on the face on a holiday. The doctor examined it and found that it was not an emergency. He was instructed to go to the surgical outpatient clinic on weekdays and then left without recording it. (B) A patient who was injured in a drunken fight left without saying goodbye after the wound was treated. He must be found and asked to come back and recorded in accordance with hospital procedures. (C) Should a pregnancy test be requested or a basic assessment be performed to determine whether there is a medical emergency? Those who are unwilling to cooperate can be advised to obtain this request at an appropriate location. (D) If a doctor from another department asks the patient to go to the emergency room and wait for him to treat the patient, he should still conduct a basic assessment first and provide necessary treatment if there is an emergency. ", "output": "A"} 
-{"instruction": "Which of the following statements about forensic toxicology is less appropriate? ", "input": "(A) Blood after death is a colloid that looks like hemolysis. (B) The correlation between the concentration of the sample measured in urine and the effect of the drug in the body at the time is very weak. (C) The determination of the alcohol concentration in the eyeball fluid is an important basis for determining whether the deceased drank alcohol before his death. (D) The concentration of poisons measured in bile is not affected by enterohepatic circulation. ", "output": "D"} 
-{"instruction": "A woman was sent to the emergency room because of wrist cutting. Her thumb could not do the palm-to-palm (opposition) movement. Which of the following injuries should be suspected? ", "input": "(A) median nerve. (B) palmar digital nerve. (C) radial nerve. (D) ulnar nerve. ", "output": "A"} 
-{"instruction": "What is the most common cause of fetal death due to trauma to pregnant women, except for maternal shock or maternal death? ", "input":"(A)Abruptio placentae。 (B)Premature rupture of membranes。 (C)Rh blood type incompatibility。 (D)Uterine rupture。", "output": "A"} 
-{"instruction": "Which of the following statements is less appropriate for the diagnosis and treatment of patients with nosebleeds?", "input": "(A)The most likely site of bleeding is Kiesselbach's plexus. (B)The initial hemostatic treatment can be to ask the patient to tilt his head forward and pinch the nose with his fingers. (C)You can consider using NSAIDs to enhance vasoconstriction and achieve better hemostasis. (D)If nasal packing is placed for more than 48 hours, antibiotics should be used in combination.", "output": "C"}
-{"instruction": "Which of the following statements is more appropriate regarding the treatment of genitourinary injuries?", "input": "(A) Posterior urethral injuries caused by male pelvic fractures require immediate surgical treatment. (B) Ureteral injuries combined with urine leakage can be treated conservatively without surgery. (C) Intraperitoneal ruptures of the bladder combined with pelvic fractures can be treated conservatively. (D) Extraperitoneal ruptures of the bladder should be treated surgically if the catheter cannot properly drain the urine.", "output": "D"}"Which of the following statements is more appropriate when narrow-QRS complex PEA persists during emergency treatment of adults with cardiac arrest?", "input": "(A) It usually represents a metabolic disorder of the circulation. (B) Common causes include hyperkalemia, acidemia, or sodium channel blocker poisoning. (C) Ultrasound examination of the heart often reveals a hyperdynamic left ventricle. (D) Compared with wide-QRS complex PEA, ultrasound examination is less likely to reveal the cause in this type of patient. ", "output": "C"} 
-{"instruction": "Which of the following statements about epididymitis or orchitis is less appropriate? ", "input": "(A) In older men, epididymitis often results from a urinary tract infection caused by bacteria. (B) Urinalysis without purulent urine can rule out epididymitis or orchitis. (C) Orchitis alone is very rare and usually presents with other systemic infections such as mumps or other viral illnesses. (D) For sexually active men, antibiotics should include treatment for Gonorrhea and Chlamydia. ", "output": "B"}"(A) Posterior urethral injuries caused by male pelvic fractures require immediate surgical treatment. (B) Ureteral injuries combined with urine leakage can be treated conservatively without surgery. (C) Intraperitoneal ruptures of the bladder combined with pelvic fractures can be treated conservatively. (D) Extraperitoneal ruptures of the bladder should be considered for surgical treatment if the catheter cannot properly drain the urine.", "output": "D"} 
-{"instruction": "Which of the following statements about thyrotoxic hypokalemic periodic paralysis is more appropriate?", "input": "(A) Renal loss is the cause of hypokalemia. (B) Spot urinary potassium UK⁺> 10 Eq/L. (C) Transtubular K⁺ gradient value>3 mEq/L. (D) Urine calcium/phosphate ratio>1.7 has high sensitivity and specificity for the diagnosis of this disease. ", "output": "D"} 
-{"instruction": "Which of the following statements is more appropriate for the treatment of asthma? ", "input": "(A) Rapid-onset β1-adrenergic agonist is the first choice for the treatment of bronchoconstriction. (B) Giving steroids within one hour of arriving at the emergency department may reduce the chance of hospitalization. (C) After the acute attack is relieved, the amount of inhaled steroids prescribed should be minimized at the time of discharge. (D) Intravenous MgSO 4 can be given for severe asthma, but steam inhalation is not recommended. ", "output": "B"}
-{"instruction": "A 1.5-year-old boy was brought to the emergency room after having bloody stools for 3 days. The boy had no fever, abdominal pain, vomiting, ascites, joint pain, or hematuria. His blood test results, including hemoglobin, platelets, and coagulation function, were all normal. What is the most likely diagnosis for this boy?", "input": "(A) Intussusception. (B) Meckel's diverticulum. (C) Henoch-Schönlein purpura. (D) Hemolytic-uremic syndrome.", "output": "B"} 
-{"instruction": "A 16-year-old teenager had a dull look in his eyes and was unable to talk after attending a party. His friends confessed that he used laughing gas. Which of the following treatments or tests is more appropriate?", "input": "(A) An MRI of the head may reveal abnormalities. (B) Vitamin B12 injections can relieve symptoms. (C) Urine screening can confirm the diagnosis. (D) Blood tests can confirm the diagnosis. ", "output": "B"} 
-{"instruction": "Which of the following statements about Guillain-Barre' syndrome is more appropriate? ", "input": "(A) Neurological examination can reveal increased deep tendon reflexes and mild sensory abnormalities. (B) It may occur after a viral or bacterial infection, usually starting in the lower limbs and progressing upward. (C) The main method of diagnosis is a lumbar puncture. (D) Steroid treatment can shorten the time it takes for symptoms to recover. ", "output": "B"} 
-{"instruction": "Which of the following vitamins should we be more concerned about toxicity when taking large amounts? ", "input": "(A) Vitamin B1. (B) Vitamin B2. (C) Vitamin B3. (D) Vitamin B12. ", "output": "C"} 
-{"instruction": "A patient with hemophilia who lacks factor VIII comes to the hospital with sudden onset of left hip pain and left leg numbness. His vital signs are stable and he has no fever. Which of the following statements is more appropriate? ", "input": "(A) Assist the patient to straighten his left thigh. The patient's pain symptoms should improve. (B) Ultrasound examination shows no effusion in the hip joint, so there is no need to consider coagulation factor supplementation. (C) If shock occurs, retroperitoneal bleeding should be considered. (D) In ​​case of shock, it is recommended to immediately establish a central venous line to administer coagulation factors. ", "output": "C"} 
-{"instruction": "Regarding the principles of handling foreign bodies in the pediatric digestive tract, which of the following is less appropriate?", "input": "(A) If a button battery with a diameter of 1.5 cm is swallowed, an abdominal X-ray will show that it is in the stomach, and an upper gastrointestinal endoscopy should be arranged urgently. (B) If a suture needle of about 3 cm is swallowed, an abdominal X-ray will show that it is in the small intestine. If there are no symptoms, a series of follow-up X-rays are required to observe clinical symptoms and whether it is expelled. (C) If a NT$50 coin (diameter 2.8 cm) is swallowed, it is difficult for it to pass through the pylorus and needs to be removed endoscopically as soon as possible. (D) If multiple magnets are swallowed, an endoscopic examination and consultation with a pediatric surgeon should be performed as soon as possible. ", "output": "A"} 
-{"instruction": "Which of the following statements about blast and crush injuries is more appropriate? ", "input": "(A) The most common cause of death from primary blast injury is barotrauma of the lungs. (B) Bleeding from wounds caused by exsanguination can be stopped by applying pressure, but the use of tourniquets is not recommended. (C) Among the 5P symptoms of compartment syndrome, the most common is numbness. (D) Crush syndrome may cause high blood potassium and high blood calcium, which may further cause cardiac arrest. ", "output": "A"} 
-{"instruction": "A 28-year-old AIDS patient who had not taken medication regularly for half a year was sent to the emergency room due to fever and shortness of breath. When he arrived at the emergency room, he was conscious, with blood pressure of 107/73 mmHg, respiratory rate of 32 times/min, heart rate of 120 times/min, SpO₂ 85%, and CXR showed pulmonary consolidation. Which of the following statements is less appropriate? ", "input": "(A) Pulmonary tuberculosis should be considered, and the patient can be placed in an isolation room first. (B) β-lactam antibiotics plus Macrolides can be given for the most common pathogens. (C) Testing CD4 counts can help infer the pathogen. (D) The most common pathogen is Pneumocystis jirovecii. ", "output": "D"} 
-{"instruction": "Which of the following statements is less appropriate regarding the use of ophthalmic ultrasound in emergency situations? ", "input": "(A) Low-energy ultrasound should be used. (B) Increased intracranial pressure can be determined from ocular ultrasound. (C) Ultrasound can assist in the diagnosis of vitreous hemorrhage. (D) Suspected eyeball rupture should be confirmed with ultrasound. ", "output": "D"} 
-{"instruction": "Which of the following statements is more appropriate when narrow-QRS complex PEA persists during emergency treatment of adults with cardiac arrest? ", "input": "(A) It usually indicates metabolic causes of circulation. (B) Common causes include hyperkalemia, acidemia, or sodium channel blocker poisoning. (C) Ultrasound examination of the heart often reveals a hyperdynamic left ventricle. (D) Compared with wide-QRS complex PEA, ultrasound examination is less likely to reveal the cause in this patient. ", "output": "C"} 
-{"instruction":"Which of the following descriptions of HELLP syndrome in a 32-week pregnant woman is less appropriate?", "input": "(A) This syndrome is more common in multiparas than primiparas. (B) High doses of Labetalol may cause neonatal hyperglycemia. (C) Renal function may be normal. (D) Steroid therapy may improve fetal outcomes.", "output": "B"} 
-{"instruction": "Which of the following descriptions of laboratory tests and diagnostic tools for acute pancreatitis is less appropriate?", "input": "(A) Lipase is more sensitive to alcoholic pancreatitis than amylase. (B) Amylase begins to rise within hours of symptom onset and peaks within 48 hours. (C) Acute pancreatitis is already evident Symptoms and laboratory test reports require early arrangement of abdominal CT to assess the severity of the disease. (D) ALT greater than 150 U/L within 48 hours has a greater than 85% positive predictive rate of gallstone pancreatitis. ", "output": "C"}
-{"instruction": "Which of the following descriptions of Acute coronary syndrome is less appropriate?", "input": "(A) If the electrocardiogram shows LBBB and the V1-V3 discordant ST elevation>5 mm is used according to the Sgarbossa criteria, STEMI equivalent can be diagnosed. (B) Aspirin ≥ 162 mg should be given. If the patient has not used Aspirin before, 325 mg should be given. (C) When IV NTG is required, if the chest pain symptoms are relieved, the dosage should be adjusted according to the blood pressure. (D) Oral β-blocker drugs can be considered within 24 hours for STEMI/NSTEMI patients without contraindications.", "output": "A"} 
-{"instruction": "The Internet is already a part of life. Which of the following will do the most harm to patient privacy and medical confidence?", "input": "(A) A motorcycle rider was run over by a truck. He took a photo of the abdominal indentation with his personal mobile phone and synchronized it to his personal cloud drive for future teaching purposes. (B) Posted a photo of a man who was accidentally shot in the head while hunting on Facebook and shared it publicly to remind everyone to pay attention to safety and first aid. (C) An Internet celebrity used his mobile phone to live broadcast his emergency medical treatment. Immediately remind him that it is absolutely not allowed. Photograph other patients, family members and staff. (D) When encountering difficult and complicated diseases, immediately post text and image data without personal information to professional groups to seek opinions from other professionals. ", "output": "B"} 
-{"instruction": "A fisherman was cut by a shipboard 4 days ago. He started to have difficulty opening his mouth yesterday. Today, he came to the hospital for treatment because of facial spasm (risus sardonicus), abdominal stiffness and muscle spasms. He is conscious. Which of the following statements about this disease is more appropriate?", "input": "(A) The mortality rate is about 40%. It is a Gram-negative bacillus infection and can be treated with ceftriaxone. (B) The incubation period can be shorter than one day or longer than one month. The longer the incubation period, the worse the prognosis of the patient. (C) Consider debridement of the wound before administering immunoglobulin. The dose of immunoglobulin for adults is 250 units IM injection. (D) Reduce environmental stimulation during care. If respiratory failure occurs, succinylcholine can be used to assist in intubation.", "output": "D"} 
-{"instruction": "Which of the following statements about bacterial meningitis is more appropriate?", "input": "(A) Antibiotics should not be given before a lumbar puncture is completed. (B) If pneumococcal meningitis is suspected, dexamethasone is recommended. (C) Analysis of cerebrospinal fluid often reveals high opening pressure, elevated white blood cells, and hyperglycemia. (D) Empirical antibiotics include ceftriaxone and levofloxacin.", "output": "B"} 
-{"instruction": "Which of the following patient's behavioral symptoms is more consistent with functional (psychiatric)psychosis?", "input": "(A) Occasional visual hallucinations, drowsiness, often not knowing the time, and not recognizing people in places. (B) Sudden onset of confusion, inability to speak, only sounds, and weakness in hands and feet. (C) Unable to do simple calculations, poor recent memory but good long-term memory, unable to feed himself. (D) Delusions, flat expression, incoherent speech, auditory hallucinations, occasionally maintaining a rigid posture. ", "output": "D"} 
-{"instruction": "For patients with suspected pulmonary embolism, which of the following conditions is most likely to cause a false-negative D-dimer test value? ", "input": "(A) Pregnancy. (B) Hyperlipidemia. (C) Rheumatoid arthritis. (D) Underwent liposuction and breast augmentation surgery three days ago. ", "output": "B"} 
-{"instruction": "Which of the following statements about influenza is more appropriate? ", "input": "(A) Amantadine is no longer recommended for the treatment of influenza due to severe drug resistance. (B) Zanamivir (Relenza®) is an inhaled formulation and is not suitable for patients with renal dysfunction. (C) If a patient has pneumonia and needs to be hospitalized, he or she should immediately report the fourth category of infectious diseases - influenza complicated with severe illness. (D) According to the latest regulations, family members who are close contacts of critically ill patients can be directly given publicly funded preventive anti-influenza drugs. ", "output": "A"} 
-{"instruction": "Which of the following symptoms is more common in patients over the age of 85 with myocardial infarction? ", "input": "(A) Chest pain. (B) Dyspnea. (C) Fainting. (D) Altered consciousness. ", "output": "B"} 
-{"instruction": "Which of the following descriptions of sedatives for acute agitation is more appropriate? ", "input": "(A)Benzodiazepines can cause ECG changes such as QTc prolongation. (B)First-generation antipsychotics such as Haloperidol do not cause respiratory depression. (C)Second-generation antipsychotics such as Quetiapine do not cause ECG changes such as QTc prolongation. (D)Second-generation antipsychotics such as Risperidone do not cause extrapyramidal symptoms. ", "output": "B"} 
-{"instruction": "An 18-year-old female, weighing 45 kg, committed suicide by taking 30 tablets of Acetaminophen (500 mg/tablet). She was sent to the emergency department 4 hours later and complained of nausea and upper abdominal pain. She was conscious and her vital signs were stable. A blood test revealed GPT 28 IU/L, GOT 32 IU/L, T-Bil 0.8 mg/dL, and blood Acetaminophen concentration of 250 mg/L. Which of the following statements is more appropriate? ", "input":"(A) After 24 hours, the liver index is still normal, indicating that the poisoning is not serious and the patient can return home for observation. (B) After 5 days, renal failure occurs, which is unlikely to be caused by acetaminophen poisoning. Other causes should be sought. (C) N-acetylcysteine ​​treatment is started and the patient is hospitalized. (D) The patient is hospitalized for observation. N-acetylcysteine ​​can be temporarily withheld. The liver index is closely monitored and antidotes are given if it is elevated.", "output": "C"} "An 18-year-old female, weighing 45 kg, committed suicide by taking 30 tablets of Acetaminophen (500 mg/tablet). She was sent to the emergency room 4 hours later and complained of nausea and upper abdominal pain. She was conscious and her vital signs were stable. A blood test revealed GPT 28 IU/L, GOT 32 IU/L, T-Bil 0.8 mg/dL, and blood Acetaminophen concentration of 250 mg/L. Which of the following statements is more appropriate?", "input": "(A) After 24 hours, the liver index is still normal, indicating that the degree of poisoning is not serious and she can return home for observation. (B) After 5 days, renal failure occurs, which is unlikely to be caused by Acetaminophen poisoning. Other causes should be sought. (C) N-acetylcysteine ​​is started (D) Arrange the patient to be hospitalized for observation. N-acetylcysteine ​​can be temporarily withheld. Liver indexes should be closely monitored. If elevated, antidotes should be given. ", "output": "C"} 
-{"instruction": "Which of the following statements about cerebral venous thrombosis is more appropriate? ", "input": "(A) It is a rare and dangerous cause of headaches, with an average age of onset of over 60 years. (B) It is more common in men, especially those with a recent history of surgery. (C) About 80% of cases will develop into cerebral hemorrhage. (D) Clinical manifestations may include thunderclap headache. ", "output": "D"}
-{"instruction": "Which of the following statements about syncope is less appropriate?", "input": "(A) In addition to heart failure and arrhythmia, if the patient faints while lying on his back or without prodromal symptoms, hospitalization for observation should be considered. (B) If the symptoms are reproduced during carotid sinus massage and the ECG shows an asystole greater than 3 seconds, carotid sinus sensitivity can be diagnosed. (C) If the ECG shows left fascicular block, whether new or old, the mortality rate increases significantly. (D) The most common cause is psychogenic syncope. ", "output": "D"} 
-{"instruction": "Which of the following statements about diabetic ketoacidosis (DKA) in children is more appropriate?", "input": "(A) The standard diagnosis is blood pH less than 7.3, Bicarbonate less than 15 mEq/L, blood glucose greater than 250 mg/dL, and blood ketone bodies. (B) If blood glucose is greater than 500 mg/dL, insulin therapy can be given with a loading bolus of 0.1 unit/kg. (C) If blood pH is 7.1 combined with hemodynamic instability, sodium bicarbonate 0.5-2 mEq/kg can be given. (D) More than 60% of the causes of death in children with diabetic ketoacidosis are related to cerebral edema.", "output": "D"} 
-{"instruction": "A 23-year-old male returned to Taiwan from Africa a week ago. The patient complained of high fever of 40.2℃, tremors, general weakness, and abdominal pain. Heart rate was 122 beats/min, and respiration was 24 breaths/min. There was no obvious rash on the body and no joint pain. Laboratory examination revealed total bilirubin 4.9 mg/dL, direct bilirubin 1.1 mg/dL, ALT 247 U/L, and AST 236 U/L. Ultrasound examination revealed an enlarged liver, but no gallstones, bile duct enlargement, or liver abscess. Which of the following tests is most helpful in diagnosis? ", "input": "(A) Blood smear. (B) Hepatitis markers. (C) Leptospiral microscopic agglutination test. (D) Check the stool for parasites and eggs. ", "output": "A"} 
-{"instruction": "Neck lesions often cause pain that transfers to the shoulder. Which of the following statements is more appropriate? ", "input": "(A) Thoracic outlet syndrome is more common in women and is often caused by compression of the brachial nerve plexus and blood vessels. (B) In addition to causing shoulder pain, Pancoast's tumor may also cause Horner syndrome, with symptoms of unilateral constriction, ptosis, and sweating. (C) Brachial plexus neuritis is mostly characterized by weakness, and most cases are not accompanied by pain. (D) Symptoms of cervical compression caused by a herniated C3-C4 disc are similar to those of a rotator cuff tear. ", "output": "A"} 
-{"instruction": "A 79-year-old female patient was brought to the emergency room by her family and complained of being sleepy for the past three days, but sometimes she could be awake and behave normally. She had no fever or head trauma in the past month, and she had to be shaken vigorously when talking to her. Which of the following statements is more appropriate for this patient? ", "input": "(A) Infection can cause the above situation, the most common source of infection is meningitis. (B) Urinary retention may contribute to or cause the above situation. (C) If the patient is agitated, the preferred medication is an anti-histamine. (D) Avoid the patient using hearing aids to avoid excessive stimulation. ", "output": "B"} 
-{"instruction": "A 4-month-old boy developed constipation and poor appetite after consuming a honey-containing food supplement yesterday. He was found to have limb weakness and a temperature of 38.3℃ when he was admitted to the emergency department. Physical examination revealed dilated pupils and no response to light. Which of the following statements is more appropriate about the boy's possible illness? ", "input": "(A) The muscles innervated by the cranial nerves are the last to be affected. (B) Nausea, vomiting, abdominal cramps and diarrhea or constipation may occur, which can easily be misdiagnosed as acute gastroenteritis. (C) Sympathomimetic symptoms may occur. (D) Typical cases present with symmetrical ascending paralysis without sensory loss or pain. ", "output": "B"} 
-{"instruction": "A 50-year-old male presented to the emergency department with sudden onset of left upper abdominal pain and vomiting. Past medical history included diaphragmatic hernia and gastroesophageal reflux. Blood pressure 86/40 mmHg, heart rate 121 beats/min, temperature 37°C, respiratory rate 20 breaths/min, SpO₂ 98%. The main abnormalities on physical examination were epigastric bloating, tympanic percussion, and decreased breath sounds in the left lower lung. Laboratory reports revealed lactate 28 mg/dL, pH 7.13, HCO₃-8.1 m Eq/L, and Hb 12 g/dL. A chest X-ray shows that the stomach is distended and located above the diaphragm. In addition to appropriate infusion therapy, which of the following is more appropriate? ", "input": "(A) Consult for surgical treatment. (B) Arrange for a gastroscopy. (C) Transfuse red blood cell concentrates (PRBCs). (D) Intravenous injection of sodium bicarbonate. ", "output": "A"} 
-{"instruction": "Fournier's gangrene is a type of necrotizing fasciitis that occurs in the perineum. Which of the following statements is more appropriate? ", "input": "(A) Women are more likely to develop it than men. (B) Hyperbaric oxygen therapy before and after surgery can improve the patient's mortality rate. (C) About 40% of patients initially have no obvious local symptoms of redness and swelling except pain. (D) Risk factors include alcohol abuse and risky sexual behavior. ", "output": "C"} 
-{"instruction": "58-year-old male, began to have difficulty breathing 2 hours ago, SpO₂ 86%, respiratory rate 35 times/min, blood pressure 108/76 mmHg, heart rate 122 times/min. The condition worsened and he was intubated. Which of the following statements is more appropriate? ","input": "(A) The ventilator mode should be volume-targeted mode because pressure-targeted mode is more likely to cause harm. (B) When the patient is given 100% oxygen, the patient's blood oxygen analysis PaO2 is 96 mmHg. According to the definition of acute respiratory distress syndrome, the patient should be in moderate respiratory distress. (C) When the patient uses volume-targeted mode, a tidal volume of 10 mL/kg ideal body weight will have better results. (D) When the patient's condition improves and he can breathe on his own, the volume-targeted mode can be changed to pressure support mode, and the patient will be more comfortable.", "output": "D"} 
-{"instruction": "Regarding patients with diverticulitis, which of the following statements is less appropriate?", "input": "(A) The incidence rate increases with age. Under 40 years old, men are more likely to be affected than women. (B) Half of the patients report having experienced similar abdominal pain in the past. (C) The most common sites of the disease are the transverse colon, sigmoid colon, and ascending colon, respectively. (D) Abdominal CT is the preferred diagnostic tool.", "output": "C"}
-{"instruction": "Which of the following coagulation tests is less appropriate?", "input": "(A) Prolonged INR can be seen in patients using Cefoperazone. (B) Heparin can cause prolonged aPTT. (C) Elevated D-dimer may be a sign of pulmonary embolism or liver disease. (D) Elevated Protein C and Protein S are common in patients under 50 years of age with thrombotic stroke.", "output": "D"}"B"} 
-{"instruction": "A facial trauma patient was found to have an orbital fracture and intraorbital ecchymosis on CT scan. The patient complained of blurred vision, swollen and painful eyes, tight eyelids that were difficult to close, and significantly elevated intraocular pressure. Which treatment option is more appropriate?", "input": "(A) Canthotomy. (B) Canthotomy + cantholysis. (C) Ice packing. (D) Mannitol 20% 1g/kg bolus.", "output": "B"}
-{"instruction": "Which of the following statements about intercostal nerve block is less appropriate?", "input": "(A) Rib fractures are one of the indications. (B) It has a good analgesic effect on thoracic herpes zoster. (C) If long-acting local anesthetics (such as Bupivacaine) are used, the analgesic effect can last for more than 8 hours. (D) After the local injection is completed, a chest X-ray is required to detect whether there is a complication of pneumothorax.", "output": "D"} 
-{"instruction": "Which of the following statements about lightning injuries is more appropriate?", "input": "(A) It is easy to cause ventricular fiber fibrillation. (B) For unconscious patients, pupil dilation is a sign of poor prognosis. (C) The damage is mostly to the superficial tissue, and fasciotomy is rarely required. (D) Acute kidney damage often occurs. ", "output": "C"} 
-{"instruction": "Which of the following statements about urinary tract stones is more appropriate? ", "input": "(A) Alpha-blockers cannot promote the excretion of urinary tract stones, so they are not recommended for patients with urinary tract stones. (B) Uric acid stones often do not show up on X-rays, and the pH value of urine is mostly acidic. (C) There are many risk factors for kidney stones, including obesity, a diet low in salt and meat, gout, and hyperthyroidism. (D) Giving large amounts of intravenous fluids can help control pain or increase the rate of stone excretion. ", "output": "B"} 
-{"instruction": "Which of the following statements is more appropriate for a peritoneal dialysis patient to present to the emergency department with abdominal pain and cloudy dialysate?", "input": "(A) Hospitalization is required as long as there is a fever. (B) Peritonitis can only be diagnosed when the leukocyte count in the ascitic fluid is at least 250/mm³ and the neutrophil count is greater than 50%. (C) Antibiotics should be first-generation cephalosporins (Cefazolin) administered intravenously. (D) The most common pathogen is Staphylococcus epidermidis.", "output": "D"} 
-{"instruction": "Which of the following statements is more appropriate for a corneal abrasion?", "input": "(A) The cornea should be stained with blue fluorescein before slit-lamp examination. (B) When operating the slit lamp, a yellow-green light source is used to illuminate the surface of the cornea for examination. (C) If a corneal abrasion is confirmed, it is usually recommended to give the patient antibiotic eye ointment. (D) Corneal cells grow slowly, and superficial abrasions usually take more than five days to heal. ", "output": "C"} 
-{"instruction": "78-year-old male, long-term smoker. Sudden onset of right chest pain and wheezing, the pain worsened with deep breathing, but there was no significant increase in coughing and sputum. SpO₂ 90%, blood pressure and heart rate are within normal range. Which of the following statements is more appropriate? ", "input": "(A) If tension pneumothorax is strongly suspected, a CXR should be performed as soon as possible for confirmation. (B) If deep sulcus sign is found on CXR AP view, pneumothorax should be suspected. (C) If seashore sign is found on ultrasound examination, pneumothorax should be suspected. (D) COPD is the most common cause of primary pneumothorax. ", "output": "B"} 
-{"instruction": "When testicular torsion occurs, there is usually severe scrotal pain. Which of the following statements is more appropriate? ", "input": "(A) Testicular pain after scrotal trauma is not related to testicular torsion. (B) If the affected testicle is lifted, the pain will be relieved. This is called a positive Prehn's sign. This sign can be used to differentiate epididymitis from the diagnosis. (C) If surgical treatment can be performed within 12 hours, the chance of testicle salvage is as high as 80%. (D) Patients with cryptic testis are also prone to testicular torsion. ", "output": "D"} 
-{"instruction": "A 60-year-old male with a history of bronchiectasis went to the emergency department for hemoptysis (about 30 mL) and wheezing. Blood pressure 120/80 mmHg, heart rate 85 beats/min, respiration 19 times/min, SpO₂ 96%. Which of the following statements is more appropriate regarding the patient's assessment and treatment? ", "input": "(A) This patient's vital signs are stable and the amount of blood coughed up in a single cough is small, which meets the clinical definition of minor hemoptysis. (B) Most patients with a small amount of hemoptysis need to be hospitalized for observation for a few days because of the risk of rebleeding. They can go home only after they are stable. (C) While waiting for the test, the patient continues to cough up 200 mL of blood. At this time, the basal hemoglobin may be falsely normal. (D) For early hemostasis treatment of patients with massive hemoptysis, it is recommended to use flexible fiberoptic bronchoscopy for local hemostasis. ", "output": "C"} 
-{"instruction": "A 30-year-old male went to the emergency room because of severe headache. He had no recent head trauma. Which of the following statements is more appropriate? ", "input": "(A) If the patient complains that he has never had such pain in his life, more than 50% of him has subarachnoid hemorrhage. (B) The headache has not lasted for more than 6 hours, and the CT scan will have a positive predictive value of nearly 100% for subarachnoid hemorrhage. (C) The headache has lasted for more than 24 hours, and a normal CT scan can rule out subarachnoid hemorrhage. (D) The brain MRI is normal, which can rule out subarachnoid hemorrhage. ", "output": "B"} 
-{"instruction": "A 50-year-old female has undergone artificial heart valve replacement surgery for rheumatic heart disease and has a high fever and shortness of breath. The body temperature is 38.7°C, the blood pressure is 105/65 mmHg, the heart rate is 105 beats/min, and the SpO₂ is 95%. The patient has grade III systolic murmur. Both CXR and urine tests are normal. Which of the following statements is less appropriate? ", "input":"(A) To meet the Duke criteria for infective endocarditis, abnormal findings on cardiac ultrasound are necessary. (B) If Coxiella burnetii is cultured in the blood, the condition of possible infective endocarditis is met. (C) If this patient is suspected of infective endocarditis, it is reasonable to use antibiotics combined with gentamycin. (D) If this patient is suspected of infective endocarditis, the patient can continue to use the original anticoagulant.", "output": "A"} 
-{"instruction": "A 25-week pregnant woman, sitting in the passenger seat of a car, was sent to the emergency room because of a car accident. Her blood pressure is normal, but there is obvious tenderness in the abdomen. Which of the following statements is more appropriate?", "input": "(A) It is still recommended to use seat belts, but it is not recommended to sit in seats equipped with airbags. (B) The first aid and monitoring of fetuses are better than those of pregnant women. (C) Traumatic ultrasound shows ascites, and CT is not recommended to determine the injury. (D) It is recommended to arrange fetal heart rate monitoring and obstetric ultrasound as soon as possible without affecting first aid.", "output": "D"} 
-{"instruction": "Which of the following statements is less appropriate regarding the steps of ultrasound-guided central jugular vein catheterization? ", "input": "(A) The internal jugular vein, internal jugular artery, and thyroid gland must be identified under ultrasound before the needle can be inserted. (B) There are three routes of insertion: central, posterior, and anterior. (C) When using the central route, the direction of needle insertion is toward the patient's xiphoid process. (D) When using the posterior approach, the direction of the needle is toward the patient's sternal notch. ", "output": "C"} 
-{"instruction": "Which of the following statements about Takotsubo cardiomyopathy is less appropriate? ", "input": "(A) It may be a cardiomyopathy caused by the use of cocaine. (B) Most patients are postmenopausal women. (C) It often causes apical ballooning of the left ventricle. (D) It causes permanent damage to the myocardial sympathetic nerves. ", "output": "D"} 
-{"instruction": "Which of the following statements about systemic rheumatic diseases is more appropriate? ", "input": "(A) Takayasu's arteritis occurs mostly in young men and is often accompanied by symptoms such as fever and abdominal pain. (B) Livedo reticularis accompanied by thrombocytopenia is an important clue for diagnosing Catastrophic antiphospholipid syndrome. The lungs are usually the first organ affected, and the mortality rate is 50%. (C) Raynaud phenomenon is common in patients with systemic sclerosis. Treatment includes rewarming, oral calcium blockers and nitroglycerin ointment. (D) Giant cell arteritis generally occurs in the elderly and is often accompanied by headaches, difficulty opening the mouth (jaw claudication) and hearing loss. ", "output": "C"} 
-{"instruction": "Which of the following statements about Taiwan's emergency medical rescue system is more appropriate? ", "input": "(A) It is a Franco-German EMSS system, in which trained EMTs send injured patients to the hospital. (B) Priority Dispatch means that when the dispatcher receives a report, he or she should act quickly. The sooner the ambulance is dispatched, the better. (C) According to the EMT Management Regulations, EMT-I, EMT-II and EMT-P can all perform pre-hospital emergency deliveries. (D) According to the EMT Management Regulations, EMT-I, EMT-II and EMT-P can all measure fingertip blood glucose for patients. ", "output": "C"} 
-{"instruction": "Which of the following statements is more appropriate for the differential diagnosis of delirium, dementia and psychiatric disorder? ", "input": "(A) The course of delirium symptoms is usually slower than that of dementia. (B) Dementia and mental illness usually cause hallucinations, but delirium is less likely to occur. (C) Dementia is more likely to cause asterixis, but delirium and mental illness are less likely to occur. (D) Dementia and mental illness are usually alert, while patients with delirium are more likely to be confused or hyperalert. ", "output": "D"} 
-{"instruction": "When a 2-year-old boy needs intubation for emergency treatment, which of the following statements is more appropriate? ", "input": "(A) A size 3.5 uncuffed endotracheal tube can be selected. (B) The endotracheal tube is inserted to a depth of approximately 12 cm. (C) It is advisable to use a curved laryngoscope for intubation. (D) If difficult intubation occurs, needle cricothyrotomy should be performed immediately. ", "output": "D"} 
-{"instruction": "Which of the following statements about rapid sequence intubation is more appropriate? ", "input": "(A) Ketamine should not be used in patients with severe asthma. (B) Succinylcholine should not be used in patients with myasthenia gravis. (C) For patients with cholinersterase deficiency, succinylcholine should be the first choice of neuromuscular blocking agents. (D) Sugammadex can reverse the effects of depolarizing neuromuscular blocking agents. ", "output": "B"} 
-{"instruction": "Which of the following statements about the use of local anesthetics is more appropriate? ", "input":"(A) Adding sodium bicarbonate (NaHCO₃) can prolong the duration of anesthesia. (B) Adding epinephrine can make the effect take effect more quickly. (C) When poisoning causes epilepsy, the first choice of treatment is Levetiracetam. (D) When poisoning causes cardiac arrest, consider using 20% ​​lipid emulsion intravenous injection for treatment.", "output": "D"} 
-{"instruction": "A 32-year-old female suffers from Graves' disease and recently stopped taking the medication due to side effects; she is confused, has a temperature of 40.1℃, an irregular heartbeat of 172 beats/min, respirations of 30 breaths/min, and a blood pressure of 177/76 mmHg, physical examination revealed yellowish sclera, wet sounds in the lower lungs and edema in both feet. Which of the following treatments is more appropriate? ", "input": "(A) Give Amiodarone to treat tachycardia. (B) Combine Acetaminophen and Aspirin to reduce fever. (C) Give diuretics and Nitroglycerine to treat high-output heart failure. (D) Give Methimazole orally first and then Lugol solution 1 hour later. ", "output": "D"}
-{"instruction": "Which of the following descriptions of inferior wall myocardial infarction is less appropriate?", "input": "(A) It may be caused by obstruction of the left circumflex artery or right coronary artery. (B) Lead II ST-segment elevation is greater than lead III, tending to block the right coronary artery. (C) Right side EKG V4R shows ST-segment elevation, indicating combined right ventricular infarction. (D) The mortality rate of inferior wall combined with right ventricular infarction is higher than that of inferior wall infarction alone.", "output": "B"} {"instruction":"input": "(A) Arrange bed rest in a quiet and dark environment. (B) Intramuscular injection of antihistamine. (C) Connect to 2-4 L/minute oxygen therapy. (D) Give intranasal lidocaine 10% solution 1 mL.", "output": "D"} 
-{"instruction": "According to the Emergency Medical Rescue Act, regarding the emergency medical rescue information reporting method, which of the following statements is less appropriate?", "input": "(A) In the case of a communication transmission failure, the emergency medical rescue information reporting process may be reported in advance by other means, and the reporting information must be logged within 24 hours after the failure is eliminated. (B) In the event of a non-mass casualty incident, the local health authority may establish a "disaster incident file" in the emergency medical management system after being informed and determined to be a "special incident". (C) The regional emergency medical response center may assist the local health authority and the responsible emergency hospital in collecting and recording relevant data. (D) The responsible emergency hospital shall provide the preliminary number of injured patients admitted within 60 minutes. ", "output": "D"}"B"} 
-{"instruction": "Which of the following statements about acute radiation syndrome is more appropriate?", "input": "(A) If leukopenia, superficial burns, and gastrointestinal symptoms occur, a preliminary diagnosis of acute radiation syndrome can be made. (B) When the dose exceeds 2Gy, persistent and persistent hypotension, prostration, nausea, vomiting, and explosive bloody diarrhea will occur. (C) The latent duration is independent of the dose received and may last 1 to 3 weeks. (D) The morbidity and mortality depend on the resulting pancytopenia, immunosuppression, and bleeding.", "output": "D"} 
-{"instruction": "Which of the following clinical manifestations and physical examinations is more appropriate for lower extremity venous thrombosis (DVT)?", "input": "(A) The diameter difference between the left and right legs is measured 10 cm below the tibial tuberosity. If the difference is ≥ 2 cm, the possibility of DVT doubles. (B) DVT of the large occipital vein is less likely to cause phlebitis. (C) About three-quarters of DVT patients have tenderness and redness in the limb swelling, which is often misdiagnosed as cellulitis. (D) DVT of the calf vein may cause a positive Homan's sign, which has a high sensitivity but a low specificity.", "output": "A"}
-{"instruction": "Which of the following is less appropriate for differential diagnosis and assessment of cyanosis in full-term newborns?", "input": "(A) If the blood oxygen concentration cannot be increased after 100% oxygen is given for 10 minutes, it may be a congenital heart disease. If necessary, prostaglandin E1 can be used for treatment. (B) If the respiratory rate increases and intercostal retractions are found, and the breath sounds are rhonchi, it may be caused by pulmonary reasons, and meconium aspiration syndrome should be considered. (C) The newborn has hypoglycemia, which is also one of the causes of cyanosis. It needs to be treated with 2 ml per kg of 10% glucose solution intravenously. (D) Except for the abnormal blood oxygen concentration, the newborn's other vital signs such as blood pressure, respiratory rate and heartbeat are normal. The cyanosis is central cyanosis.", "output": "D"} 
-{"instruction": "Which of the following pediatric patients with normal activity levels is most in need of prophylactic antibiotic treatment?", "input": "(A) A 5-year-old boy who returned from a visit to Southeast Asia with his parents had multiple episodes of uncontrollable watery rice water stools during quarantine, but no obvious abdominal cramps. (B) A 4-year-old girl who developed a fever and abdominal cramps after eating raw eggs, and whose stool contained blood and mucus, but no arthralgia. (C) A 6-year-old boy who developed a fever, abdominal pain, and diarrhea after eating undercooked chicken, but no cramps. (D) A 5-year-old boy drank raw water while camping with his parents and developed a fever, right lower abdominal pain, and diarrhea with blood and mucus, but no chest tightness. ", "output": "A"} 
-{"instruction": "Which of the following is more appropriate regarding cardiac trauma? ", "input": "(A) Cardiac punctures are most likely to occur in the right ventricle. (B) If blunt cardiac arrest does not resume heartbeat after 20 minutes of first aid, resuscitative thoracotomy may be considered. (C) The diagnostic sensitivity of Troponin for blunt cardiac injury is approximately 70%. (D) Cardiac ruptures caused by blunt cardiac injury are most likely to occur in the right ventricle. ", "output": "A"} 
-{"instruction": "Which of the following treatments is more appropriate for the treatment of croup?", "input": "(A) A single dose of steroids is sufficient, and no maintenance dose is required. (B) Intravenous steroids are more effective than oral steroids. (C) Patients with mild severity do not need to be given steroids. (D) Dexamethasone is not recommended for steroids.", "output": "A"} 
-{"instruction": "A 35-year-old male developed headaches, persistent coughing with bloody sputum, and dyspnea while climbing Mount Yushan. Which of the following statements is more appropriate?", "input": "(A) Give acetazolamide. (B) Give dexamethasone. (C) Give acetaminophen. (D) Give nifedipine. ", "output": "D"} 
-{"instruction": "Which of the following descriptions of Atypical Pneumonia is less appropriate? ", "input": "(A)Chlamydia infection Chest X-ray often shows patchy subsegmental infiltration. (B)Mycoplasma sometimes causes extrapulmonary symptoms, such as arthritis, rash, and neurological symptoms. (C)Long-term smokers, transplant recipients, and immunocompromised people are more susceptible to Legionella infection. (D)Empirical antibiotic treatment should at least select second-generation β-lactam antibiotics Cephalosporins or Penicillins. ", "output": "D"} 
-{"instruction": "Which of the following statements is less appropriate about the circulatory component of the primary assessment of pediatric trauma? ", "input": "(A) Decompensated hemorrhagic shock should be treated with transfusion as soon as possible. (B) For patients who require transfusion, tranexamic acid should be given as soon as possible within 3 hours. (C) For patients with multiple traumatic injuries, permissive hypotension is recommended. (D) Trauma to the infant's scalp can cause significant blood loss and bleeding should be stopped as soon as possible. ", "output": "C"} {" 
-instruction": "A 65-year-old male with a history of atrial fibrillation who is taking Warfarin goes to the emergency department with left-sided headache and right-sided weakness. Which of the following statements is more appropriate? ", "input": "(A) Taking warfarin is a risk factor for cerebral hemorrhage, but the degree of risk is not related to the INR value. (B) Compared with warfarin, novel oral anticoagulants have a lower risk of causing cerebral hemorrhage. (C) Treatment includes avoiding fever, monitoring blood pressure, correcting coagulation abnormalities, and using steroids to reduce brain inflammation if intracranial pressure rises. (D) Actively controlling systolic blood pressure between 110-139 mmHg can significantly reduce mortality and disability rates compared to systolic blood pressure between 140-179 mmHg. ", "output": "B"} 
-{"instruction": "A 30-year-old male reported left temporal headache, accompanied by tears and runny nose on the same side. He had a similar condition 2 months ago. Which of the following treatments is more appropriate? ", "input": "(A) Arrange him to lie down and rest in a quiet and dark environment. (B) Inject antihistamine intramuscularly. (C) Continue oxygen therapy at 2-4 L/minute. (D) Give intranasal lidocaine 10% solution 1 mL. ", "output": "D"}000 mL. (B) Ultrasound showing bilateral B lines and inferior vena cava greater than 2 cm can diagnose acute heart failure. (C) Non-invasive positive pressure ventilation can reduce the chance of intubation and improve respiratory distress. (D) The use of diuretics alone may increase mortality. ", "output": "B"} 
-{"instruction": "A 62-year-old female patient came to the emergency department because of left lower abdominal pain. Clinically, acute sigmoid diverticulitis was suspected. Which of the following accompanying symptoms is more common? ", "input": "(A) Vomiting. (B) Dysuria. (C) Changes in bowel habits. (D) Anorexia. ", "output": "C"} 
-{"instruction": "Which of the following is the main difference between spontaneous pneumomediastinum and spontaneous pneumothorax? ", "input": "(A) Cough. (B) Occurring during strenuous exertion. (C) Chest pain. (D) Tachycardia. ", "output": "B"}
-{"instruction": "Which of the following statements about acute heart failure is inappropriate?", "input": "(A) If hypotension is found after using Nitroglycerin, consider giving 250-1,000 mL of normal saline solution. (B) Acute heart failure can be diagnosed by ultrasound showing bilateral B lines and inferior vena cava greater than 2 cm. (C) Non-invasive positive pressure respiration can reduce the chance of intubation and improve respiratory distress. (D) Using diuretics alone may increase mortality.", "output": "B"} 
-{"instruction": "Which of the following is a high-risk group for successful suicide?", "input": "(A) Took 24 tablets of Nitroglycerin last month. (B) Do not like to accept help from others. (C) Loss of self-control ability. (D) Patients with substance abuse. ", "output": "C"} 
-{"instruction": "Which of the following statements about the use of lipid emulsions to treat drug poisoning is more appropriate? ", "input": "(A) Lipid emulsions are ineffective in treating local anesthetic poisoning. (B) They can be considered for use in cases of fat-soluble drug poisoning (such as beta-blockers) that are ineffective with other treatments. (C) They are not recommended for patients with low blood pressure. (D) They cannot be given as bolus because of common side effects, such as acute allergies, hyperlipidemia, pancreatitis, and fat embolism. ", "output": "B"} 
-{"instruction": "An 88-year-old male has had fever, wheezing, and confusion for the past two days. He was hospitalized four times for COPD-related infections and was just discharged home two weeks ago. Which of the following is less appropriate for this patient's condition?", "input": "(A) Common bacterial species in patients with acute COPD exacerbation are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. (B) In addition to infections, other causes should still be considered, such as pneumothorax and pulmonary embolism. (C) Considering that the patient was hospitalized two weeks ago, Pseudomonas aeruginosa should be included in the antibiotic selection. (D) Arterial blood test: pH 7.01, PCO₂ 90 mmHg, and then evaluate the patient to find that GCS E2V2M4, BiPAP should be used as soon as possible to improve the clinical condition. ", "output": "D"} 
-{"instruction": "According to the International Dental Federation tooth position representation method adopted by the National Health Insurance Administration of Taiwan, what should be the number of the "upper left canine"? ", "input": "(A)13. (B)23. (C)33. (D)43. ", "output": "B"} 
-{"instruction": "A 30-year-old healthy male developed fever and general malaise and altered consciousness one day ago. His wife brought him to the emergency room. The patient's cerebrospinal fluid Gram stain showed Gram-positive diplococci. Which of the following drug preventive treatments for his wife is more appropriate? ", "input": "(A)Ciprofloxacin 500 mg PO × 1 dose. (B) Rocephin 250 mg IM × 1 dose. (C) Rifampin 600 mg PO Q12H for two days. (D) No preventive medication is required. ", "output": "D"} 
-{"instruction": "A 26-year-old female patient comes to the emergency department and complains of frequent binge eating behavior in the past year. She often induces vomiting to eliminate the food she eats. The patient's BMI is 21. Based on the above situation, which of the following statements is more appropriate? ", "input": "(A) According to DSM-V, people with normal BMI do not meet the diagnosis of eating disorder. (B) People who frequently induce vomiting may have painless parotid enlargement and calluses on the backs of their fingers. (C) When giving injections to patients with long-term malnutrition, special attention should be paid to whether it will cause hyperphosphatemia. (D) Inducing vomiting too vigorously may cause Boerhaave syndrome, combined with right thoracic abscess. ", "output": "B"} 
-{"instruction": "Which of the following is not included in the general characteristics of organic psychosis in children? ", "input": "(A) Delirium. (B) Visual hallucinations. (C) Auditory hallucinations. (D) Acute onset. ", "output": "C"} 
-{"instruction": "A 50-year-old female fell from a height and was unconscious. She was suspected of intracranial hemorrhage. Her blood pressure was 105/71 mmHg, her heart rate was 95 beats/min, and her SpO₂ was 92%. Which of the following statements is more appropriate? ", "input": "(A) Ketamine is the preferred induction agent. (B) The cervical collar can be opened first during intubation and then continued after insertion. This process requires the cooperation of at least two people. (C) Permissive hypotension is also suitable for this patient. (D) Mannitol has been proven to be ineffective for this patient and is not recommended for use even when blood pressure is normal. ", "output": "B"} 
-{"instruction": "A 55-year-old male with a history of chronic pulmonary hypertension complained of wheezing without activity for 1 day, with a temperature of 36.1℃, a heart rate of 140 beats/min, respirations of 35 breaths/min, a blood pressure of 115/80 mmHg, and SpO₂ of 75%. He was immediately intubated with an endotracheal tube and a ventilator upon arrival. Which of the following treatments is more appropriate? ", "input": "(A) Use Dopamine for treatment, because its β-agonist effect can improve RCA perfusion, and its inotropic effect can relieve right heart failure. (B) The blood oxygen target is to maintain SpO₂>90%, and the positive end-expiratory pressure (PEEP) should be increased as much as possible to avoid airway collapse. (C) Avoid using Norepinephrine, because its β-agonist effect will increase pulmonary artery pressure. (D) Milrinone can be used for treatment, but close monitoring is required to avoid hypotension. ", "output":"D"} 
-{"instruction": "Which of the following statements about pulmonary embolism is less appropriate?", "input": "(A) The reference value of D-dimer should be adjusted upward with age, and the most commonly used method is (age x 10 ng/mL). (B) D-dimer has sufficient sensitivity and specificity, and still has sufficient reliability and validity 6 days after pulmonary embolism. (C) POCUS can show RV/LV ratio>1 and dilated IVC. (D) Common ECG abnormalities include sinus tachycardia, V1-4 T wave inversion and RBBB.", "output": "B"} 
-{"instruction": "Which of the following statements about hypertrophic cardiomyopathy is less appropriate?", "input": "(A) Clinical manifestations include shortness of breath combined with chest pain, palpitations, and syncope during activity. (B) Chest pain is best treated with nitroglycerin. (C) Diagnosis can be made with cardiac MRI or echocardiography. (D) Hypertrophic cardiomyopathy with syncope requires hospitalization.", "output": "B"}
-{"instruction": "A 35-year-old female complained of severe lower abdominal pain and nausea for about one day, with blood pressure of 132/84 mmHg, heart rate of 65 beats/min, respiration of 22 times/min, and body temperature of 36.4℃. She recently received IVF treatment in the clinic, underwent egg retrieval surgery 2 weeks ago, and 2 embryos were implanted 3 days after egg retrieval. Physical examination revealed obvious tenderness in the lower abdomen and pelvic cavity without rebound pain; white blood cell count of 14,600/mm³, Cr 0.78 mg/dL, Na 132 m Eq/L, β-hCG 453 mIU/mL; abdominal ultrasound revealed swollen ovaries and ascites, and no gestational sac was found in the uterus. Which of the following treatments and judgments is less appropriate?", "input": "(A) Inform the obstetrician and gynecologist and conduct a bimanual pelvic examination. (B) Ectopic pregnancy must be included in the differential diagnosis, and the β-hCG index can be tracked after 48 hours. (C) Forced abortion must be taken into consideration and progesterone should be given intramuscularly. (D) Appropriate intravenous infusion and NSAIDs should be given for pain relief.", "output": "A"} 
-{"instruction": "Which of the following descriptions of lower limb tendon injuries is less appropriate?", "input": "(A) Achilles tendon rupture often presents with sudden pain and inability to stand on tiptoe. (B) A small number of people with complete Achilles tendon rupture are able to walk, and are easily misdiagnosed as ankle sprains. (C) Rupture of the anterior tibialis tendon is very rare and generally not very painful. Most cases do not require surgery. (D) Rupture of the posterior tibialis tendon has a slower and less obvious course of disease and often occurs in young men under 40 years old. ", "output": "D"} 
-{"instruction": "A 30-year-old male patient suffers from temporomandibular dislocation after laughing. Which of the following statements is less appropriate for the treatment of this patient? ", "input": "(A) The patient can be discharged directly after emergency reduction. (B) Before reduction, consider injecting a local anesthetic into the preauricular temporomandibular joint. (C) It is more common to have a posterior dislocation, and attention should be paid to whether the external auditory canal is damaged. (D)The most commonly used reduction method is to have the patient sit up and apply downward and backward force to the patient's lower molars on both sides. ", "output": "C"} 
-{"instruction": "Which of the following statements about diverticulitis is more appropriate? ", "input": "(A)Patients with recurrences require surgical treatment. (B)The use of antibiotics can prevent complications and recurrence rates. (C)Patients without complications can be considered for discharge from the emergency department and oral medication. (D)Confirmed patients need to fast. ", "output": "C"} 
-{"instruction": "For patients with acute respiratory distress, an emergency bedside lung ultrasound scan (BLUE protocol) is performed. Which of the following statements is less appropriate? ", "input": "(A)A-profile, the most likely diagnosis is pneumothorax. (B) B-profile, most likely diagnosis is pulmonary edema, but also possible interstitial pneumonia and pulmonary fibrosis. (C) A/B-profile, most likely diagnosis is pneumothorax. (D) B' or C-profile, most likely diagnosis is pneumonia. ", "output": "C"} 
-{"instruction": "A 76-year-old male with no history of chronic diseases and no use of anticoagulants. He presented to the emergency department with hemoptysis and normal vital signs. Which of the following statements is more appropriate? ", "input": "(A) The more common definition of massive hemoptysis is coughing up more than 1,000 ml of blood within 48 hours. (B) The first-line imaging diagnostic tool is chest X-ray, and nearly 50% of patients receive a preliminary possible diagnosis. (C)Fiberoptic bronchoscopy is more convenient than rigid bronchoscopy to stop bleeding in cases of massive hemoptysis. (D)When intubation is required, it is recommended to use a small endotracheal tube to avoid injuring the tracheal mucosa. ", "output": "B"} 
-{"instruction": "Which of the following statements is more appropriate when using a tourniquet for trauma? ", "input": "(A)If there is massive bleeding from a limb, it should be used immediately. (B)If the tourniquet is placed in the groin or axilla, a second tourniquet can be used if necessary. (C)Tourniquets placed on the upper limbs require greater pressure to stop bleeding than those placed on the lower limbs. (D)It has been shown that prolonged use may increase nerve or muscle damage. ", "output": "B"} 
-{"instruction": "A 30-year-old female was rescued from a fire. She weighed 60 kg and had burns covering 40% of her body surface area. There was carbon deposition in her oropharynx. Which of the following treatments is more appropriate? ", "input": "(A) According to the Parkland Formula, drip Ringer's solution at a rate of 150 ml per hour for the first 8 hours. (B) Place a nasogastric tube to reduce pressure, but glucose infusion is generally not required for the first 24 hours. (C) Give morphine for analgesia. To reduce the risk of respiratory depression, intramuscular injection is preferred to intravenous injection. (D) Give steroids to reduce laryngeal edema. Hydrocortisone 100mg STAT+Q8H IV. ", "output": "B"} 
-{"instruction": "A 77-year-old male with a history of myocardial infarction presents to the emergency department with labored breathing, orthopnea, and bilateral edema over the past two weeks. Which of the following statements is more appropriate? ", "input": "(A) If hypotension occurs after nitroglycerin treatment, the drug should be stopped first. If hypotension persists, cardiotonic drugs should be used. (B) If shock and hypertrophic obstructive cardiomyopathy occur, phenylephrine treatment is a good choice. (C) If a non-invasive positive pressure ventilator is used in combination with drug treatment, the in-hospital mortality rate can be significantly reduced. (D) When performing focused care ultrasound, E-point septal separation and fractional shortening are highly reliable indicators of left ventricular function. ", "output": "B"} 
-{"instruction": "Which of the following statements about toxic epidermal necrolysis is more appropriate? ", "input":"(A) It manifests as large areas of painful erythema, blisters and epidermal peeling on the skin, and does not invade the mucous membranes. (B) Early use of prophylactic antibiotics is recommended to prevent wound infection. (C) Such skin lesions are less likely to show Nikolsky sign. (D) Drugs are the most common cause of this disease.", "output": "D"} 
-{"instruction": "A 3-year-old boy, weighing 15 kg, has been vomiting and diarrhea for 2 days. He is drowsy and has low activity, blood pressure 80/60 mmHg, heart rate 130 beats/min, respiratory rate 25 times/min, and body temperature 37.5℃. Which of the following statements is more appropriate?", "input": "(A) The estimated amount of dehydration is 0.45 kg. (B) The first-line treatment is oral rehydration. (C) The initial dose of water replenishment is 1,000 cc of normal saline. (D) The maintenance dose of water replenishment is 1,250 cc of 0.9% normal saline or D5S glucose saline per day. ", "output": "D"} 
-{"instruction": "Which of the following statements about patients with mood disorders is more appropriate? ", "input": "(A) Depression is more likely to be inherited than bipolar disorder. (B) Manic patients' symptoms of racing thoughts can last for more than seven days. (C) Antidepressants should be given as early as possible to patients who may develop agitation. (D) Parkinson's disease is less related to depression. ", "output": "B"} 
-{"instruction":"A 26-year-old female patient has a history of deep venous embolism (DVT). She took warfarin for a long time before pregnancy and has stopped taking it because of pregnancy. She has difficulty breathing and is suspected of having a large-scale pulmonary embolism. Which of the following is more appropriate?", "input": "(A) After the patient is stabilized by emergency treatment, she can continue to take warfarin to prevent the recurrence of thromboembolism. (B) If the patient does not have an acute bleeding tendency, there is no need to wait for a definitive diagnosis. Heparin can be given directly intravenously. (C) If the patient has renal failure, it is better to use low molecular weight heparin than unfractionated heparin. (D) Low molecular weight heparin can cross the placenta and cause teratogenicity, so it can only be given subcutaneously.", "output": "B"} 
-{"instruction": "Which of the following statements about hypoglycemia is more appropriate?", "input": "(A) The clinical manifestations of hypoglycemia can be divided into neuroglycopenic and autonomic symptoms; the manifestations of neuroglycopenic include anxiety, tremors, sensory abnormalities, and sweating. (B) Hypoglycemia caused by sulfonylurea overdose should be treated routinely with hemodialysis and activated carbon hemoperfusion. (C) For recurrent hypoglycemia caused by sulfonylurea, after glucose treatment, octreotide can be considered to reduce the risk of recurrent hypoglycemia. (D) Glucagon treatment of patients with hypoglycemia can increase blood sugar by 200 mg/dL.", "output": "C"}
-{"instruction": "Regarding ovarian torsion, which of the following statements is less appropriate?", "input": "(A) Ovarian torsion is more likely to occur on the right side, and most patients experience nausea and vomiting. (B) The twisted ovary or mass is usually larger than 4 or 5 cm, but ovarian torsion that occurs before the onset of menstruation is usually normal size. (C) Torsion during pregnancy is common in the first trimester and early second trimester. (D) Ovarian torsion can be ruled out if there is a signal of ovarian blood flow on Doppler ultrasound.", "output": "D"} 
-{"instruction": "Regarding diving-related diseases, which of the following statements is more appropriate?", "input": "(A) Diving in shallow water will not cause pulmonary bronchitis. (B) After shallow water diving, it is relatively safe to stop diving and fly 2 days later. (C) Symptoms of decompression often develop gradually a few days after diving. (D) Complaining of shoulder pain after diving is a common symptom of type II decompression. ", "output": "B"} 
-{"instruction": "Which of the following descriptions of complications of head trauma is more appropriate? ", "input": "(A) Post-concussion syndrome has a good prognosis, and its prevalence rate is less than 5% one year after injury. (B) Chronic traumatic encephalopathy is more common in the elderly and often occurs after multiple head injuries. (C) Subdural hemorrhage (D) Second impact syndrome is caused by cerebral edema that occurs rapidly after a head impact, and the mortality rate can be as high as 60%. ", "output": "D"} 
-{"instruction": "A 26-year-old man complained of fever, dysuria with white discharge, and erythematous pain and swelling in the right knee joint for 3 days. Fluid from the right knee joint showed a white blood cell count of 68,000/mm³ and 92% neutrophils. Which treatment is less appropriate for this patient? ", "input": "(A) The first choice drug is Ceftriaxone, with a dose of 1 gm QD. (B) If the treatment is combined with Chlamydia For comorbid infection of trachomatis, Azithromycin can be used at a dose of 1 gm orally once. (C) An alternative drug is Doxycycline at a dose of 100 mg orally BID. (D) Joint fluid glucose and protein are helpful in the clinical diagnosis of this disease. ", "output": "D"} 
-{"instruction": "Which of the following clinical manifestations of aneurysm is more appropriate? ", "input": "(A) Popliteal artery aneurysm is defined as a tumor larger than 3 cm or 200% of the normal blood vessel diameter. It is the most common peripheral hemangioma. Clinical manifestations include swelling behind the knee and discomfort. (B) If the patient has upper limb pain, weakness, and non-segmental sensory changes, subclavian artery aneurysm should be considered. (C) The clinical manifestations of hepatic artery aneurysm may include biliary colic and upper gastrointestinal bleeding. If it ruptures and enters the common bile duct, biliary bleeding (hemobilia) may occur, but it will not manifest as jaundice. (D) Renal artery aneurysm may clinically present with low back pain and hematuria. Once ruptured, it may cause shock, but it will not cause obstruction of the urinary collecting system. ", "output": "B"} 
-{"instruction": "According to the AHA 2020 ACLS guidelines, which of the following statements is inappropriate for the care of patients after cardiac arrest and resuscitation? ", "input": "(A) For patients using ventilators, it is recommended to maintain SpO₂ at 92%-98%, and try to avoid prolonged hyperoxia PaO 2>300 mmHg. (B) It is recommended to maintain the partial pressure of carbon dioxide in the blood PaCO₂ at 35-45 mmHg. (C) If there is acute respiratory distress syndrome (ARDS), the ventilator tidal volume should be maintained at 4-8 mL/kg of predictive body weight. (D) The incidence of pneumonia in patients after resuscitation is high, and the prognosis of those who develop pneumonia is poor. It is recommended to routinely give broad-acting antibiotics for prevention. ", "output": "D"} 
-{"instruction": "Which of the following statements about acute myocardial infarction (AMI) and troponin (TnI) is more appropriate? ", "input": "(A) Six hours after AMI, the specificity of TnI is about 95%. (B) Six hours after AMI, the sensitivity of TnI is about 95%. (C) The value of TnI reaches its peak at about 36 hours after AMI. (D) The value of TnI returns to its original value (baseline) within about 72 hours after AMI. ", "output": "A"} 
-{"instruction": "Which of the following statements about the assessment and management of patients with dyspnea is more appropriate? ", "input": "(A) Cyanosis is a specific and sensitive indicator of patients with hypoxemia. (B) The inability to increase arterial oxygen concentration after oxygen administration is an important indicator for determining right-to-left shunt. (C) For all patients with chronic lung disease who have hypercapnia, avoid oxygen administration to stimulate ventilation. (D) In ​​patients with carbon monoxide poisoning, the oxygen in the hemoglobin is replaced, and the value measured by the blood oximeter decreases. ", "output": "B"} "output": "B"} 
-{"instruction": "Which of the following statements is less appropriate for a 32-week pregnant woman who presents to the emergency department with regular and increasingly frequent contractions and bloody vaginal discharge?", "input": "(A) The fetal monitor shows a fetal heart rate of 103 beats/min, which is fetal distress. (B) If a digital vaginal examination is to be performed, a bedside ultrasound should be performed first to rule out placenta previa. (C) If the patient's water has broken, do not perform a digital vaginal examination to detect cervical dilation to avoid infection. (D) If an emergency vaginal delivery is to be performed, use an umbilical cord clamp to secure the fetus and cut the umbilical cord immediately after delivery to facilitate neonatal assessment and management.", "output": "D"}
-{"instruction": "Which of the following descriptions of genital ulcers is less appropriate? ", "input":"(A) Genital painless chancres can be a manifestation of primary syphilis and may result in a Jarisch-Herxheimer reaction during treatment. (B) The pathogen of syphilis is Treponena pallidum, and Penicillin is still the first choice for antibiotic treatment. (C) When painless chancres occur, testing VDRL/RPR (Venereal Disease Research Laboratory/Rapid Plasma Reagin) can diagnose syphilis. (D) HSV (Herpes simplex virus) can cause painful genital ulcers. Currently, HSV-2 accounts for the majority, but the number of HSV-1 infections continues to increase.", "output": "C"} 
-{"instruction": "Which of the following is less appropriate for patients considering hospice and palliative care?", "input": "(A) Lung cancer with metastases to the lungs, brain, and multiple bones. After trying targeted therapy and immunotherapy, the disease persists. ) The patient's condition worsened. He started tube feeding last month and his mental state gradually deteriorated. (B) An 80-year-old man had multiple myocardial infarctions and had 9 vascular stents installed. He was hospitalized four times in three months for heart failure and his discharge days were getting shorter and shorter. (C) After surgery for colorectal and bladder cancer, he had been on hemodialysis for eight years for terminal kidney disease. Recently, he expressed that he did not want to continue dialysis due to multiple blockages in the dialysis vessels. (D) A 40-year-old man trapped in a fire was intubated after escaping from smoke inhalation. When he arrived at the hospital, he had E2M5Vt and second- to third-degree burns except for the perineum. ", "output": "C"} 
-{"instruction": "Which of the following descriptions of Wellens' syndrome is less appropriate? ", "input": "(A) The patient's cardiac enzyme test is likely within the normal range. (B) When the patient has chest pain, the ECG may not show abnormal changes. (C) Deep and symmetrical inverted T waves may be found in some of the extremities of the ECG. (D) 25% of patients will have biphasic T waves on the ECG. ", "output": "C"} 
-{"instruction": "A 1-year-old infant vomits 5 times and has diarrhea 5 times. His vital signs are stable. There are no obvious abnormalities in physical and blood tests. He is not dehydrated. Which of the following treatments is more appropriate? ", "input": "(A) Loperamide can be used. (B) The BRAT diet (Banana, Rice, Applesauce, and Toast diet) is recommended. (C) The child's symptoms are still mild, so he can fast for four to six hours first. (D) Dopamine receptor agonists should not be used. ", "output": "D"} 
-{"instruction": "Which of the following statements about bacterial tracheitis in children is more appropriate? ", "input": "(A) Tenderness in the tracheal area is less common. (B) Neck X-rays may reveal supraglottic stenosis and irregular tracheal margins. (C) After intubation, bronchoscopy may aid in diagnosis and treatment. (D) Standard treatment requires the use of broad-spectrum antibiotics and steroids. ", "output": "C"} 
-{"instruction": "Which of the following statements about diabetic ketoacidosis (DKA) is more appropriate? ", "input": "(A) The initial blood glucose level in pregnant women with DKA is higher than that in normal patients. (B) The rate of blood sugar decline needs to be controlled at 50-75 mg/dL per hour. (C) Cerebral edema is a complication of DKA treatment and is more common in the elderly. (D) If the initial blood sugar is below 270 mg/dL, the possibility of DKA can be ruled out. ", "output": "B"} 
-{"instruction": "Which of the following is more appropriate for the examination and diagnosis of facial trauma? ", "input": "(A) When the eye is injured, if binocular diplopia occurs, it may be caused by lens dislocation. (B) The tongue blade test can assess whether the patient has an orbital bone fracture. (C) When the eye reacts to light with a Marcus Gunn pupil, optic nerve damage should be considered. (D) When the patient's nasal secretions are suspected to be cerebrospinal fluid leakage, beta-2 microglobulin in the secretions can be detected as a differential diagnosis. ", "output": "C"} 
-{"instruction": "Which of the following statements is more appropriate for the treatment of deep vein embolism or pulmonary embolism in pregnant women? ", "input": "(A) Wells score is applicable to pregnant women to evaluate deep vein embolism. (B) MRI/MRV with contrast agent has been shown to be effective in diagnosing pelvic deep vein embolism and is safe for pregnant women and fetuses. (C) Pregnant women with pulmonary embolism and unstable hemodynamics should be treated with Warfarin. (D) For pregnant women with stable hemodynamics, if ultrasound reveals deep venous embolism, anticoagulant therapy can be used if pulmonary embolism is clinically suspected. ", "output": "D"} 
-{"instruction": "A 26-year-old female patient with schizophrenia and no history of alcohol abuse is sent to the emergency department. The patient is roaring and agitated on the stretcher. Which next step is more appropriate? ", "input": "(A) Benzodiazepine should be the first choice of medication, such as intramuscular injection of Lorazepam. (B) Considering the medical history, Olanzapine IM can be chosen as the first choice at this time. (C) Use a constriction band as soon as possible to protect the patient and reduce the use of injections to avoid respiratory depression. (D) If the patient is pregnant, it is recommended that Haloperidol be used first. ", "output": "B"} 
-{"instruction": "A 40-year-old female with a history of asthma who takes medication regularly presents to the emergency department with labored breathing. Which statement is more appropriate for this patient? ", "input": "(A) After the endotracheal tube is inserted, the patient's tracheal obstruction pressure can be improved through a ventilator. (B) If this patient requires intubation, Ketamine will cause a significant increase in catecholamine and is contraindicated in such patients. (C) Patients hospitalized for acute asthma attacks should undergo CXR because there is a 50% chance of abnormality. (D) The combination of short-acting β-agonist and multi-dose Ipratropium can reduce the hospitalization rate of patients with moderate to severe acute asthma attacks. ","output": "D"} 
-{"instruction": "Which of the following statements about sore throat is less appropriate?", "input": "(A) Patients with dysphagia and shortness of breath should undergo immediate neck CT. (B) Group A β-hemolytic Streptococcus acute pharyngitis, with Penicillin as the first line of treatment. (C) Most deep neck infections are odontogenic, mostly in mandibular teeth. (D) When performing fine needle aspiration of tonsil abscesses, the needle should not be inserted more than 1 cm deep.", "output": "A"} 
-{"instruction": "Which of the following statements is more appropriate regarding care after post-cardiac arrest syndrome? ", "input":"(A) Immediately after return of spontaneous circulation (ROSC), loss of bilateral pupillary light reflexes predicts a low chance of recovery of consciousness. (B) Targeted temperature management is not recommended for patients with prehospital OHCA who initially have a non-shockable rhythm. (C) For patients who are unconscious after resuscitation from cardiac arrest, routine use of anti-epileptic drugs is recommended to reduce the risk of non-convulsive status epilepticus. (D) Consciousness and neurological examination results after ROSC should not be used to determine whether a patient should undergo emergency cardiac catheterization. ", "output": "D"} 
-{"instruction": "A 60-year-old male patient began to have upper abdominal pain 2 hours ago, and had severe nausea and multiple bilious vomiting 1 hour ago. The patient has no history of heart disease and the electrocardiogram is normal. Which of the following is the most likely cause of the patient's vomiting? ", "input": "(A) Achalasia. (B) Gastric outlet obstruction. (C) Large bowel obstruction. (D) Small bowel obstruction. ", "output": "D"}
-{"instruction": "Which of the following is less appropriate for the examination and management of an emergency patient with low back pain?", "input": "(A) A positive crossed straight leg raise test on the nonsymptomatic side is highly specific but has low sensitivity for the diagnosis of a herniated disc. (B) For suspected dural compression caused by a tumor, dexamethasone should be used before definitive testing. (C) Neuropathic claudication due to lumbar spinal stenosis is aggravated by flexion of the spine and relieved by extension. (D) Cerebrospinal fluid examination in transverse myelitis often shows lymphocytosis. phocytosis) and elevated protein. ", "output": "C"} 
-{"instruction": "Which of the following statements about catastrophic antiphospholipid syndrome is more appropriate? ", "input": "(A) Only in a minority of patients can a precipitating factor be identified, such as infection, surgery, trauma, and exposure to exogenous estrogens. (B) The lungs are the most important organ affected, followed by the kidneys, central nervous system, heart, and skin. (C) Livedo reticularis may be found in the abdomen, and a minority of patients may develop thrombocytopenia. (D) Because unfractionated heparin has anti-inflammatory properties and is safe and effective, anticoagulant therapy is recommended for this population. ", "output": "D"} 
-{"instruction": "A pregnant woman with acute abdominal pain is diagnosed as acute appendicitis. Which of the following statements is more appropriate?", "input": "(A) The incidence of appendicitis in pregnant women is about twice that of non-pregnant women. (B) Even in the third trimester, most pregnant women still experience appendicitis pain in the right lower abdomen. (C) Due to changes in the anatomical position of pregnant women, acute appendicitis most often occurs in the third trimester. (D) The incidence of fetal miscarriage in pregnant women with acute appendicitis and perforation is about 50%. ", "output": "B"} 
-{"instruction": "Regarding carbon monoxide poisoning, which of the following statements is more appropriate?", "input": "(A) If epileptic symptoms occur, hyperbaric oxygen therapy is not yet indicated. (B) If the woman is pregnant, conscious, and has a COHb level of 10%, she is eligible for hyperbaric oxygen therapy. (C) If the SpO₂ measured by a pulse oximeter is > 94%, oxygen therapy is not necessary. (D) If severe metabolic acidosis occurs, she is eligible for hyperbaric oxygen therapy. ", "output": "D"} 
-{"instruction": "Which of the following statements is more appropriate for the treatment of foreign bodies in the esophagus? ", "input": "(A) If a child accidentally swallows a button battery, conservative treatment is usually safer. (B) Sharp foreign bodies often cause intestinal perforation after passing through the stomach. (C) Patients with esophageal obstruction will not experience dyspnea clinically. (D) Lithium batteries have a lower voltage and therefore cause less damage.", "output": "B"} 
-{"instruction": "A 44-year-old male with a history of diabetes has had redness and swelling of the right lower limb for 3 days and a fever and went to the emergency room. Which of the following statements is more appropriate? ", "input": "(A) If he has been in contact with seawater, Vibrio vulnificus infection should be considered, and Vancomycin is the first choice for treatment. (B) The skin in the red and swollen area is intact without wounds and blisters, so necrotizing fasciitis can be ruled out. (C) Blisters appear in the red and swollen skin, and a CT scan is required to confirm necrotizing fasciitis. (D) Computed tomography revealed air in the soft tissue, which can be diagnosed as necrotizing fasciitis. ", "output": "D"} 
-{"instruction": "A 9-year-old child weighing 30 kg was sent to the emergency room due to abdominal contusion. He was conscious but had rapid breathing and cold sweats. He had abdominal tenderness combined with rebound pain, blood pressure of 100/50 mmHg, and heart rate of 130 beats/min. Which of the following treatments is more appropriate? ", "input": "(A) After evaluation, if there is internal bleeding, the bleeding grade is moderate (blood volume loss 30-45%). (B) Give 10 mL/kg isotonic crystalloid solution for the first infusion and re-evaluate. (C) If shock persists after the first infusion, a second or third 20 mL/kg isotonic crystalloid solution can be given. (D) If transfusion therapy is performed with 20 mL/kg PRBCs transfusion therapy. ", "output": "C"} 
-{"instruction": "According to the latest recommendations of the 2020 version of AHA Pediatric Advanced Lifesaving Techniques (AHA-PALS), which of the following is less appropriate? ", "input": "(A) The pediatric chain of survival has added a sixth link "recovery" and the IHCA chain of survival. (B) For infants and children who have a pulse but no breathing or abnormal breathing, it is reasonable to perform artificial respiration every 2-3 seconds. (C) When performing CPR on infants and children with advanced airways, the respiratory rate target is set to ventilation every 2-3 seconds. (D) Children should give priority to endotracheal intubation without a cuff. If a cuffed inner tube is used, attention should be paid to the inflation pressure. ", "output": "D"} 
-{"instruction": "For patients with terminal cancer who are receiving palliative care, if they have severe pain that cannot be relieved and come to the emergency department, which of the following analgesics is more appropriate? ", "input":"(A) Use oral Morphine. If the effect is not good after 60 minutes, add intravenous Morphine. (B) Use subcutaneous Morphine. If the effect is not good after 30 minutes, add intravenous Morphine. (C) Use intravenous Morphine. Inject it again after 15 minutes until the pain is relieved. (D) Use intramuscular Morphine. Inject it again after 20 minutes until the pain is relieved.", "output": "C"} 
-{"instruction": "Which of the following statements is less appropriate for the treatment of post-tonsillectomy bleeding?", "input": "(A) Vascular embolization is not suitable for this area. (B) If the bleeding point is visible, it can be cauterized with silver nitrate after local anesthesia. (C) Epinephrine gauze can be used for packing, and the position can be sutured to fix it. (D) In ​​severe cases, consider using aerosolized Epinephrine or Tranexamic acid. ", "output": "A"}"(A) The pediatric chain of survival adds a sixth link, "recovery", and the IHCA chain of survival. (B) For infants and children with a pulse but no breathing or abnormal breathing, it is reasonable to perform artificial respiration every 2-3 seconds. (C) When performing CPR on infants and children with advanced airways, the respiratory rate target is set at ventilation every 2-3 seconds. (D) Children should be given priority for endotracheal intubation without a cuff. If a cuffed endotracheal tube is used, attention should be paid to the inflation pressure. ", "output": "D"} 
-{"instruction": "For pain caused by fractures in different parts, when performing ultrasound-guided nerve blocks in the emergency department for analgesia, which of the following pairs is less appropriate? ", "input": "(A) Mid-clavicular fracture → supraclavicular brachial plexus nerve block. (B) Right shoulder dislocation and humeral neck fracture → interscalene brachial plexus nerve block. (C) Left chest wall rib fracture → paravertebral nerve block. (D) Femoral neck fracture → fascia iliaca nerve block. ", "output": "A"}
-{"instruction": "A 25-year-old male uses a substance for a long time. After use, he will feel euphoric and relieve anxiety. When the concentration is too high, it may cause headaches, convulsions, arrhythmias, low blood pressure, and even death. Long-term chronic abuse may cause spinal cord neuropathy, pancytopenia, etc. Which substance is more likely to be used in this case?", "input": "(A) Ecstasy. (B) K-drug. (C) Bath salts. (D) Laughing gas.", "output": "D"}2 mg/dL, Glu 780 mg/dL. Which of the following statements is more appropriate for the priority treatment of this patient? ", "input": "(A)Normal Saline 3L stat in 1 hour. (B)3% Saline 100 mL stat in 15-20 mins. (C)Regular Insulin 7U IV bolus. (D)Administer Normal Saline 1L + KCl 40 mEq stat in 1 hour from the central vein. ", "output": "D"} 
-{"instruction": "Which of the following statements is more appropriate for the treatment of snake bites in children? ", "input": "(A)The amount of serum administered to children should be reduced according to body weight. (B)If an intravenous line cannot be established, intraosseous injection can be used. (C) Start with a small dose and increase it as needed. (D) When there is limb swelling, fasciotomy should be considered. ", "output": "B"}
-{"instruction": "A 38-year-old female with a history of depression and long-term alcohol consumption, but no history of epilepsy, was found unconscious and convulsing for 2 minutes by her family and sent to the emergency room. She was still in a coma when she arrived at the hospital. Which of the following treatments is less appropriate?", "input": "(A) Arrange a brain CT. (B) Give Thiamine. (C) Give Flumazenil. (D) Arrange an EEG examination.", "output": "C"} 
-{"instruction": "A 4-year-old boy was sent to the emergency room because of cardiac arrest. According to the 2020 Advanced Cardiovascular Lifesaving Procedures Guidelines provided by the American Heart Association (AHA), which description of the patient's emergency resuscitation is more appropriate?", "input": "(A) Prioritize intubation with a cuffed endotracheal tube and straight blades. (B) Consider cricoid compression, which increases the chances of successful intubation and decreases the chances of gastroesophageal reflux. (C) If intubated, ventilate at a rate of approximately 1 breath every 6 seconds without interrupting chest compressions. (D) If a palpable pulse is present but breathing is not normal after first aid, perform artificial respiration at a rate of approximately 12-20 breaths per minute.", "output": "A"} 
-{"instruction": "Which of the following statements about Henoch-Schönlein purpura is less appropriate?", "input": "(A) Prone to diffuse abdominal pain or colic with vomiting. (B) It is easy to affect the knee or ankle joints, causing swelling and pain. (C) The typical rash often occurs on the face, buttocks and soles of the feet. (D) Hematuria can be seen with the naked eye, indicating that the kidneys are affected. ", "output": "C"} 
-{"instruction": "Which of the following statements about epididymitis is less appropriate? ", "input": "(A) Urine examination may show purgation. (B) Viral infection is one of the causes. (C) Ultrasound shows increased blood flow to the epididymis. (D) Lifting the affected testicle upward will make it more painful due to pulling. ", "output": "D"} 
-{"instruction": "A 60-year-old patient with a tracheostomy tube tube) for 1 month and comes to the emergency department with heavy bleeding from his tracheostomy. Which of the following is a more appropriate initial measure to stop the bleeding? ", "input": "(A)Utley maneuver. (B)Esophageal pressure with a catheter balloon. (C)Local injection or ligation of the blood vessel with a bronchoscope. (D)Inflate the balloon of the tracheostomy tube a little more. ", "output": "D"} 
-{"instruction": "A 40-year-old male with no past medical history presents with sudden onset of severe upper abdominal pain. Which of the following treatment and management considerations is more appropriate? ", "input": "(A)Intravenous morphine is less likely to affect the diagnosis than nonsteroidal anti-inflammatory analgesics. (B) Studies have shown that an abdominal pain panel can be established and used in the emergency department. It can be performed quickly and has clinical benefits. (C) Abdominal X-rays (plain radiographs) have a screening effect in most abdominal emergencies and can be included in routine examinations. (D) When an abdominal aortic aneurysm is found on bedside ultrasound and the creatinine level is 3 mg/dL, magnetic resonance imaging should be arranged urgently. ", "output": "A"} 
-{"instruction": "A 30-year-old male accidentally ingested about 150 mL of an unknown chemical three hours ago. He was sent to the hospital for drowsiness, vomiting, and restlessness. His temperature was 36.5℃, his breathing was 14 times/min, his heart rate was 70 times/min, his blood pressure was 140/80 mmHg, and his blood tests showed Na 135 meq/L, Cl 100 meq/L, BUN 28 mg/dL, ethanol <0.2 mg/dL, glucose 90 mg/dL, blood ketone 6 mmol/L, blood osmolality 320 mOsm/Kg. Arterial blood gas analysis showed pH 7.40, PCO₂ 42 mmHg, HCO₃- 23 meq/L. The most likely cause of substance poisoning is substance poisoning. Which is the most appropriate? ", "input": "(A) Methanol. (B) Ethylene glycol. (C) Propylene glycol. (D) Isopropanol. ", "output": "D"} 
-{"instruction": "An 82-year-old male was sent to the emergency department with fever, wheezing, use of accessory muscles, obvious wheezing, and altered consciousness. On arrival, his temperature was 39°C, his heart rate was 120 beats/min, his respirations were 28 breaths/min, his blood pressure was 132/84 mmHg, and his blood oxygen concentration was 85%. Arterial blood gas analysis PaCO₂ was 80 mmHg. Which of the following treatments is less appropriate for this patient? ", "input": "(A) Oxygen therapy should be given to maintain a blood oxygen concentration of at least 90%. (B) A non-invasive positive pressure ventilator should be given, and nasogastric tube decompression should be used to prevent inhalation events. (C) E2V3M4 and anticholinergic therapy should be given. (D) Endotracheal intubation should be considered. ", "output": "B"} 
-{"instruction": "A 55-year-old male was found by his family to have altered consciousness. In addition, he began to become weak and his appetite decreased in the past week. He was also a little confused. Examination revealed dry oral mucosa and poor skin elasticity. E2V3M4, weight 70 Kg. Blood tests show: pH 7.30, PCO₂ 40 mmHg, HCO₃ 22 meq/L, Na 118 meq/L, K 3.0 meq/L, Cl 96 meq/L, BUN 50 mg/dL, Cr 2.2 mg/dL, Glu 780 mg/dL. Which of the following statements is more appropriate for the priority treatment of this patient? ", "input": "(A)Normal Saline 3L stat in 1 hour. (B)3% Saline 100 mL stat in 15-20 mins. (C)Regular Insulin 7U IV bolus. (D)Administer Normal Saline 1L + KCl 40 mEq stat in 1 hour from the central vein. ", "output": 
-{"instruction": "Regarding shoulder dystocia, which of the following statements is more appropriate?", "input": "(A) Gaskin maneuver will increase the difficulty of this delivery. (B) Consider McRoberts maneuver and apply pressure to the fundus of the uterus. (C) Insert fingers into the birth canal and press the front shoulder of the newborn as close to the chest as possible. (D) The mother should be asked to bend her legs as much as possible and turn her knees outward.", "output": "D"}
-{"instruction": "A 65-year-old male with multiple metastatic lung adenocarcinoma has recently developed lower back pain and weakness in both legs. He went to the emergency department this morning because he was completely unable to walk, had loss of sensation in both legs, and had fecal incontinence. Which of the following assessments and interventions is more appropriate?", "input": "(A) Give 10 mg of dexamethasone intravenously before performing spinal MRI. (B) This patient has a good chance of regaining lower limb function with emergency spinal decompression surgery. (C) Perform a complete neurological assessment to determine the area of ​​the spine that needs to be imaged for MRI. (D) Urgently arrange for a spinal MRI with gadolinium-based contrast agents.", "output": "A"} 
-{"instruction": "Which of the following statements about hypertensive emergency is more appropriate?", "input": "(A) If it is combined with aortic stripping, blood pressure needs to be controlled to below 120 mmHg systolic as soon as possible, and heart rate should be controlled to no more than 100 beats/min. (B) For patients with infarct stroke, if thrombolytic drugs are to be administered, blood pressure must be controlled to below 185 mmHg systolic. (C) If it is caused by acute sympathetic crisis, the first-line antihypertensive drug is calcium channel blocker. (D) Hypertensive encephalopathy , is a clinical diagnosis after excluding infarction or hemorrhagic stroke. MRI can show frontal lobe edema. ", "output": "B"} 
-{"instruction": "A 26-year-old male accidentally injured his right hand while operating a machine. Which of the following treatments is less appropriate? ", "input": "(A) For finger lacerations with no exposed bone or injuries to the finger bed, wounds less than 1 cm can be considered for wound dressing change and outpatient follow-up. (B) For finger lacerations, if the fingertip flap continues to bleed, consider using a tourniquet tied to the proximal knuckle to stop bleeding and treat the wound. (C) If a patient is suspected of having a vascular injury in the right forearm, and if there is a small, stable hematoma, consider continuing to observe the hematoma. (D) If the right radial artery cannot be palpated, consider immediately consulting a vascular surgeon. ", "output": "C"} 
-{"instruction": "In mass casualty events, the JumpSTART Pediatric MCI Triage© system is currently used to triage pediatric patients. Which of the following statements about this system is less appropriate? ", "input": "(A) Assessment is: ability to move or walk → presence of breathing → respiratory rate → presence of pulse → consciousness. (B) The triage is divided into four categories: death, immediate evacuation, delayed evacuation, and mild illness. (C) The modified Glasgow Coma Scale is used for consciousness status. (D) In ​​principle, cardiac compression is not performed on patients with cardiac arrest during the triage process of mass casualty incidents. ", "output": "C"} 
-{"instruction": "A 61-year-old female with breast cancer has been receiving chemotherapy for about a month. Two or three days ago, she began to have mild cough, nausea, poor appetite, abdominal distension and other symptoms. Today, she has become unconscious and has a fever. When the patient sought medical attention, GCS E2M4V1, blood pressure 140/68 mmHg, heart rate 126 beats/min, respiration 26 times/min, SpO₂ 96%, body temperature 38.3℃. Which assessment and treatment is more appropriate for this patient? ", "input": "(A) Based on the consciousness performance of the Taiwan Emergency Examination Urgency Scale, the examination level is 2. (B) The patient's breath sounds are normal, blood oxygen is normal, and there is no pneumonia on the chest X-ray, which can rule out the diagnosis of pneumonia. (C) When WBC is 1,000/µL, Segment is 30%, and there is no obvious source of infection, an anorectal examination should be performed as soon as possible to determine whether there is a rectal ulcer. (D) When the blood calcium is 15.2 mg/dL (3.8 mEq/L), fluid therapy should be given immediately to accelerate the excretion of calcium ions from the urine. ", "output": "D"} 
-{"instruction": "A 40-year-old woman developed pain in the right sole after practicing marathon running. Which of the following statements is more appropriate? ", "input": "(A) Tenderness on the anterior and medial side of the calcaneus may be calcaneus bursitis. (B) If a bone spur is clearly seen in the heel area on X-ray, plantar fasciitis can be diagnosed. (C) Local injection of steroid drugs has long-term effects, but has more side effects. (D) Dorsiflexion and foot massage can help improve symptoms. ", "output": "D"} 
-{"instruction": "Which of the following respiratory infectious diseases has a shorter incubation period than the latent period? ", "input": "(A) Coronavirus disease 2019, COVID-19. (B) Seasonal influenza. (C) Severe acute respiratory syndrome (SARS). (D) Measles. ", "output": "C"} 
-{"instruction": "Which of the following is less appropriate in terms of drug treatment options for status epilepticus? ", "input": "(A) The use of Lorazepam may cause respiratory depression and hypotension. (B) The infusion rate of Phenytoin should not be too fast, and it should not be used with glucose drip. (C) The use of Valproic acid may cause liver damage or pancreatic inflammation. (D) The use of Propofol should be noted that it may cause side effects such as hypokalemia and rhabdomyolysis. ", "output": "D"} 
-{"instruction": "A 60-year-old female patient had diabetes and hypertension in the past. This time, she was treated in the emergency department for urinary tract infection and septic shock. She has been given NS 1,000 mL, dry oral mucosa, no urine in the past 2 hours, and the blood sugar level is 380 mg/dL. Which of the following statements is more appropriate for the treatment of this patient? ", "input": "(A) Give regular Insulin from IV. (B) The blood sugar goal is to control it at 200-250 mg/dL. (C) Give IV hydration first, and do not give hypoglycemic drugs for the time being. (D) Give the drugs prescribed in the outpatient clinic (Glyburide and Repaglinide). ", "output": "A"} 
-{"instruction": "A worker had his finger crushed by a factory machine. Which of the following statements is less appropriate? ", "input": "(A) Contraindications to finger amputation (including relative) include children, crush injuries, and hypoxia of the amputated part for more than 12 hours. (B) If it is a soft tissue amputation of the distal fingertip, the area is less than 1 square centimeter, and there is no exposed bone or nail bed, conservative treatment with daily dressing changes can be performed. (C) If the fingertip amputation has exposed bone but is less than 0.5 cm and the soft tissue defect is less than 1 square centimeter, the bone can still be trimmed back and the dressing can be changed for conservative treatment. (D) If the two-point discrimination sensation of the volar pad on the affected side is significantly larger on one side than the other, or exceeds 10 mm, suspect digital nerve damage. ", "output": "A"} 
-{"instruction": "Which of the following descriptions of the autonomic response to shock is less appropriate? ", "input":"(A) Arteriolar vasodilation, leading to redistribution of blood flow in the body. (B) Increased cardiac output, increasing heart rate and contractility. (C) Venous capacitance vasoconstriction, increasing venous return. (D) Release of vasoactive hormones to increase arteriolar and venous tone.", "output": "A"} 
-{"instruction": "Which of the following statements about the clinical manifestations of urinary tract stones is more appropriate?", "input": "(A) X-ray and CT measurements of the stone will show it to be smaller than the actual size. (B) Rebound pain and muscle stiffness (guarding) may be present. (C) More than 95% of patients have hematuria. (D) If acute obstruction causes unilateral hydronephrosis, most patients will have elevated creatinine.", "output": "B"} 
-{"instruction": "Which of the following statements about lightning and electrical injuries is more appropriate?", "input": "(A) Compared with low-voltage AC, lightning is more likely to cause ventricular fibrillation. (B) Injuries caused by lightning often affect the patient's eyes, and the most common sequelae is retinal damage. (C) Lightning is more likely to cause deep muscle damage and require fasciotomy than high-voltage AC. (D) In ​​a comatose patient struck by lightning, anisocoria does not necessarily mean a poor prognosis.", "output": "D"}
-{"instruction": "For a patient with head trauma, blood pressure is 228/132 mmHg and intracranial pressure (ICP) is 86 mmHg. Which of the following statements is more appropriate?", "input": "(A) The patient's mean arterial pressure (MAP) is 164 mmHg and cerebral perfusion pressure (CPP) is 78 mmHg. (B) The patient's mean arterial pressure is 180 mmHg and cerebral perfusion pressure is 94 mmHg. (C) Under normal circumstances, autoregulation can be adjusted to accommodate a CPP of 50-120 mmHg. CPP < 50 mmHg is considered to be the lower limit of human autoregulation. (D) Increased intracranial pressure can cause a Cushing's reflex. reflex), including high blood pressure, bradycardia, and shallow tachypnea. ", "output": "A"} 
-{"instruction": "A 59-year-old HIV-infected male with a chronic mild cough has a pleural effusion on chest X-ray. Which of the following is least likely to occur, other than pneumonia? ", "input": "(A) Non-Hodgkin lymphoma. (B) Kaposi sarcoma. (C) Adenocarcinoma. (D) Squamous cell carcinoma. ", "output": "D"} 
-{"instruction": "A 38-year-old male with a history of type 1 diabetes. Two weeks ago, the patient underwent partial gastrectomy and Roux-en-Y gastrojejunostomy due to obesity. Today, he was diagnosed with fever, abdominal pain, nausea and vomiting. Which of the following statements is more appropriate? ", "input": "(A) If physical examination reveals redness, swelling and exudation at the surgical wound, oral antibiotics can be prescribed and the patient can be sent home for follow-up. (B) If clinical suspicion of anastomotic leak is present at the anastomotic site, fasting and conservative treatment with intravenous antibiotics are required. (C) Anastomotic leaks are more common at the esophagus and colon surgery site. (D) The most common source of infection at this time point is pneumonia or urinary tract infection. ", "output": "C"} 
-{"instruction": "Regarding the drug treatment of acute agitation in the elderly, which of the following is more appropriate?", "input": "(A) Antihistamine drugs can relieve delirium. (B) Benzodiazepine is the preferred drug. (C) Ziprasidone is more likely to cause QTc prolongation. (D) Olanzapine and Benzodiazepine drugs are recommended to be used simultaneously.", "output": "C"} 
-{"instruction": "A 32-year-old male was taken to the emergency room by ambulance due to sudden chest tightness, chest pain, and shortness of breath. The patient was sitting on the sofa when the symptoms occurred, and then he had tingling in the fingertips, abdominal pain, and diarrhea. When the EMT arrived at the scene, the patient's vital signs were a heart rate of 118 beats/min and a respiration of 24 breaths/min; when he arrived at the emergency room, the patient's heart rate was 92 beats/min and respiration was 16 breaths/min. According to the medical records, the patient has visited the doctor several times for similar symptoms within a month. Relevant blood tests, electrocardiograms, and chest X-rays showed no significant abnormalities. Which of the following diagnoses is more appropriate? ", "input": "(A)Agoraphobia. (B)Acute stress disorder. (C)Munchausen syndrome. (D)Panic disorder. ", "output": "D"} 
-{"instruction": "Which of the following statements about pneumonia in pregnant women is more appropriate? ", "input": "(A)Pregnancy prolongs the course of bacterial pneumonia. (B)The prognosis of viral pneumonia during pregnancy is as severe as that of non-pregnant patients. (C)Giving acyclovir to patients with varicella pneumonia as early as possible will improve the prognosis. (D)Antiviral drugs should be given as early as possible for influenza viral pneumonia, especially H1N1. ", "output": "D"} 
-{"instruction": "A 45-year-old male was clearly intoxicated and was agitated and uncooperative when he arrived at the hospital. Which of the following drugs is more appropriate to treat his agitation? ", "input": "(A) Flumazenil. (B) Haloperidol. (C) Lorazepam. (D) Thiamine. ", "output": "B"} 
-{"instruction": "A 22-year-old male was diagnosed with schizophrenia last month and began taking antipsychotic drugs. Recently, he has developed facial and back muscle spasms, neck twisting, and eyes drooping. These symptoms are most likely to be side effects induced by antipsychotic drugs? ", "input": "(A) Neuroleptic-Induced Akathisia. (B) Neuroleptic-Induced Parkinsonism. (C) Neuroleptic-Induced dystonia. (D) Neuroleptic-Induced Tardive Dyskinesia. ", "output": "C"} 
-{"instruction": "Which of the following statements is more appropriate for a patient with cardiac arrest before arrival at the hospital and spontaneous circulation after CPR in the emergency department and targeted temperature management (TTM)? ", "input": "(A) When maintaining low temperature, attention should be paid to high blood potassium because potassium ions move out of cells. (B) Because low temperature can cause abnormal coagulation function, patients who are receiving anticoagulant therapy or are bleeding should be excluded. (C) If the patient is conscious but trembling all over, sedatives should be given before proceeding. (D) Hypothermia often induces bradycardia, which usually does not require medication. ", "output": "D"} "(A) When maintaining hypothermia, because potassium ions move out of cells, high blood potassium should be paid attention to. (B) Because hypothermia can cause abnormal coagulation function, patients who are receiving anticoagulant therapy or are bleeding should be excluded. (C) If the patient is conscious and easily trembles, sedatives should be given before proceeding. (D) Hypothermia often induces bradycardia, which usually does not require drug treatment.", "output": "D"} 
-{"instruction": "A 65-year-old female underwent surgery for esophageal cancer 6 weeks ago and had a jejunostomy tube placed for feeding. This time she came to the emergency room because the jejunostomy tube slipped. Which of the following statements is more appropriate?", "input": "(A) The stoma is not yet mature, so the stoma tube should not be put back immediately. The surgeon must be consulted first. (B) Jejunal stoma tubes are usually smaller and should be placed with a 8-14 French dedicated tube or urinary catheter. (C) If the surgeon recommends putting a urinary catheter back into the stoma, a 5-10 mL water balloon should be used after placement to prevent it from slipping. (D) If the area around the stoma is red, swollen, and purulent, a larger stoma tube can be placed instead.", "output": "B"}
-{"instruction": "Which of the following statements about the establishment of a surgical airway is more appropriate? ", "input":"(A) Surgical cricothyroidotomy is suitable for patients over 10 years old. (B) In an emergency, tracheostomy can establish a secure airway more quickly than cricothyroidotomy. (C) In recent years, percutaneous tracheostomy has been proven to be more suitable for emergency trauma patients than traditional tracheotomy. (D) Surgical cricothyroidotomy can use an endotracheal tube with an inner diameter of 5 mm to 7 mm.", "output": "A、D"} 
-{"instruction": "Which of the following is more appropriate for the treatment of lower gastrointestinal bleeding?", "input": "(A) The most common cause is colorectal polyps. In about 80% of cases, bleeding will stop on its own. (B) Ischemic colitis usually requires surgical intervention as soon as possible. (C) Generally speaking, patients with bloody stools and hemoglobin levels below 8 g/dL should be given a blood transfusion. (D) Patients with stable blood flow, no persistent bloody stools, and no related comorbidities can be followed up in the outpatient clinic.", "output": "D"} 
-{"instruction": "A 65-year-old male drank an unknown pesticide and went to the emergency room a few hours later for gastrointestinal discomfort. He immediately developed changes in consciousness and soon even had a seizure and respiratory failure. The blood test report showed hyperammonemia. Although he was actively rescued and his consciousness gradually recovered after a few days, he continued to have anterograde and retrograde amnesia. Which type of pesticide poisoning is most likely?", "input": "(A) Paraquat poisoning. (B) Organophosphate poisoning. (C) Weed poisoning. (D) Pyrethrum poisoning.", "output": "C"} 
-{"instruction": "Which of the following statements is more appropriate for fracture fixation in the emergency department?", "input": "(A) For clavicle fracture fixation, a shoulder strap is better than an arm sling. (B) A cock-up wrist splint is effective for wrist fracture fixation. (C) A thumb splint is used to fix the wrist in an OK position, retaining the pinching function. (D) For Achilles tendon rupture, the ankle should be placed perpendicular to the calf and fixed with a short-leg cast.", "output": "C"} 
-{"instruction": "A 53-year-old male with chronic alcoholism has been receiving regular wound care for chronic wounds on both feet for the past 3 months. He complains of cough with fever and chills for 3 days. Auscultation reveals a rhonchi in the right chest, and chest X-ray shows a right lobar infiltrate. Which of the following statements is less appropriate?", "input": "(A) It meets the definition of healthcare-associated pneumonia. (B) The most common pathogen is Klebsiella pneumoniae. (C) The patient's risk of bacteremia should also be considered when arranging follow-up examinations and treatment. (D) The pneumonia severity index assessment is less appropriate for this patient. ", "output": "B"} 
-{"instruction": "A 65-year-old male presents to the emergency department with sudden, persistent upper abdominal pain that moves to the back. Pain is relieved by bending forward. Pain index is 9 points, vital signs are stable, Chvostek's and Trousseau's signs: negative. WBC 18,000/mm³, Glucose 220 mg/dL, AST 270 IU/L, Lipase 200 U/L (13- 60 U/L), Calcium 7.5 mg/dL(8.5 to 10.2 mg/dL)Which of the following is more appropriate? ", "input": "(A) Early administration of fluid resuscitation therapy is important because it can reduce the mortality rate. (B) Lactated Ringer's solutions are recommended for intravenous administration because they have a better prognosis. (C) Quinolone and Metronidazole can reduce the need for future surgical intervention and lower mortality. (D) Hypocalcemia may be due to hypoalbuminemia, and calcium ion supplementation should be given during intravenous therapy. ", "output": "B"} 
-{"instruction": "Which of the following statements about natural disasters is less appropriate? ", "input": "(A) Hurricanes often cause more injuries and deaths in the acute phase than in the recovery phase. (B) Deaths caused by earthquakes often occur within the first 3 hours. (C) Infectious diseases caused by floods often appear after the acute phase. (D) Carbon monoxide poisoning from natural disasters such as blizzards is likely to increase during and after the disaster. ", "output": "A"} 
-{"instruction": "Which of the following is less appropriate for the management of a patient with unstable abdominal aortic aneurysms? ", "input": "(A) Give two large IVs and give large amounts of fluid to control blood pressure above 120 mmHg. (B) Call a cardiac surgeon to arrange emergency repair surgery. (C) If the patient's vital signs are stable after the treatment, a CT scan can be arranged. (D) Ultrasound can be used to examine and measure the diameter of the aorta as a preliminary diagnosis. ", "output": "A"} 
-{"instruction": "Which of the following is less appropriate for the concept of neonatal emergency care? ", "input": "(A) Neonatal bradycardia is often caused by hypoxia or respiratory failure. The first step is to give oxygen and re-treat the airway instead of using drugs to treat the slow heart rate. (B) If the neonate's bradycardia is still < 60 times/min after 30 seconds of positive pressure respiration, CPR should be started immediately. (C) The ratio of chest compression to airflow in neonatal CPR is 15:2. (D) When the heart rate exceeds 60 times/min, CPR should be stopped immediately and positive pressure respiration should be started at a rate of about 40-60 times/min. ", "output": "C"} 
-{"instruction": "Which of the following is more appropriate for the diagnosis of acute heart failure? ", "input":"(A) The most sensitive symptom is dyspnea on exertion. (B) More than 90% of patients will have pulmonary congestion on chest X-ray. (C) BNP (B-type natriuretic peptide) greater than 500 pg/mL is the gold standard for diagnosis. (D) Ultrasound imaging shows that the inferior vena cava is larger than 2 cm and collapses less than 50% with breathing, which can be diagnosed.", "output": "A"} 
-{"instruction": "A 30-year-old male doctor was suturing a patient's wound when his right index finger was pierced by the needle used for suturing. The wound was bleeding. The patient's blood test showed that the HIV antibody test was positive and the HBsAg is positive, Anti-HCV is positive; the doctor's blood draw shows anti-HBs is positive. Which of the following is more appropriate regarding the subsequent treatment of this doctor's occupational exposure? ", "input": "(A) This doctor should use disinfectants to clean the wound. (B) This doctor should receive HIV post-exposure prophylaxis (PEP). (C) This doctor should receive hepatitis B immune globulin (HBIG) treatment. (D) This doctor should receive hepatitis C antiviral drug treatment. ", "output": "B"}
-{"instruction": "Which of the following statements about hemoptysis is more appropriate?", "input": "(A) 75% of hemoptysis originates from the branches of the bronchial arteries, and the other 25% of hemoptysis originates from the branches of the pulmonary arteries. (B) Diseases of the respiratory tract, lung parenchyma, and cardiovascular systems may all cause hemoptysis. Large amounts of hemoptysis often originate from cardiovascular lesions. (C) Rasmussen's aneurysm is a pseudoangioma on the opening of a chronic tuberculosis lesion. (D) A patient with bronchiectasis, coughing and hemoptysis, with stable vital signs and no need for oxygen, meets the definition of small amounts of hemoptysis.", "output": "C"} "(A) 75% of hemoptysis originates from the branches of the bronchial arteries, and the other 25% of hemoptysis originates from the branches of the pulmonary arteries. (B) Diseases of the respiratory tract, lung parenchyma, and cardiovascular systems may all cause hemoptysis. Large amounts of hemoptysis often originate from cardiovascular lesions. (C) Rasmussen's aneurysm is a pseudoangioma on the opening of a chronic tuberculosis lesion. (D) A patient with bronchiectasis, coughing and hemoptysis, has stable vital signs and does not require oxygen, which meets the definition of small amounts of hemoptysis.", "output": "C"} 
-{"instruction": "A 7-year-old boy accidentally fell 10 minutes ago and avulsed his upper right front teeth. His mother brought him and his intact teeth to the emergency room. Which of the following statements is less appropriate?", "input": "(A) First determine whether it is a permanent tooth. If it is just a deciduous tooth, it cannot be reimplanted. (B) If you want to reimplant, first brush the dirt off the tooth with a toothbrush and rinse it with saline. (C) If it can be reimplanted, first store the tooth in ice milk and try to reimplant it as soon as possible. (D) If the tooth reimplantation time is delayed for more than 1 hour after the incident, the probability of successful reimplantation is almost zero.", "output": "B"}
-{"instruction": "An earthquake caused a building to collapse. A man's right foot was pinned by an overturned closet for 14 hours before he was found by rescuers. Before he was rescued, which of the following actions would be more appropriate?", "input": "(A) Only in shock should a large amount of fluid be infused to avoid excessive swelling of the limbs. (B) Lactated Ringer's solution is also a good choice for large-scale fluid infusion on site. (C) NaHCO₃ combined with a large amount of physiological saline for infusion. (D) Tourniquets will increase the patient's pain and are not recommended for routine use.", "output": "C"} 
-{"instruction": "In a series of car accidents with heavy casualties, which of the following patients would need to be sent to the hospital first?", "input": "(A) A middle-aged male with bleeding from the mouth and nose, and still not breathing after opening the airway. (B) A young woman with a deformed left thigh, constantly shouting for help. She breathes 20 times/min and her radial pulse can be felt. (C) A young man with pain and bruises on the right chest, anxiously looking for his daughter's whereabouts. (D) A middle-aged female with hematoma on the right forehead answered questions irrelevantly and was unable to follow the doctor's instructions. Respiration rate 20 times/min, capillary refill time 2 seconds. ", "output": "D"} 
-{"instruction": "Which of the following statements about vertigo is more appropriate? ", "input": "(A) Patients with vestibular neuritis have symptoms such as ear pain, hearing loss, and tinnitus. (B) Patients with stroke are often misdiagnosed with peripheral vestibular disorder in the emergency department. (C) Both peripheral and central vertigo will cause symptoms to worsen due to movements that change the position of the head. (D) When evaluating patients with vertigo in the emergency department, Dix-Hallpike testing and HINT plus testing should be performed simultaneously. ", "output": "C"} 
-{"instruction": "Which of the following descriptions and treatments for acute renal injury is less appropriate?", "input": "(A) Community-type acute renal injury is often reversible, but the 3-year mortality rate associated with it is as high as 45% to 66%. (B) Electrocardiogram can quickly screen for high blood potassium. When K > 6.5 meq/L, it will often cause high-pitched T waves, and its sensitivity can reach 80%. (C) Giving low-dose (renal-dose) Dopamine will not promote the recovery of renal function, nor will it reduce mortality. (D) Patients with a glomerular filtration rate ≤ 30 mL/min/1.73 m2 who receive contrast injection should stop using metformin for 48 hours. ", "output": "B"} 
-{"instruction": "Which of the following conditions is more appropriate for platelet transfusion therapy? ", "input": "(A) For patients with hemophilia (V on Willebran's disease) with gastrointestinal bleeding, platelet 40,000/mm³. (B) For patients with uremia before central venous catheter placement, platelet 25,000/mm³. (C) For patients with suspected meningitis before lumbar puncture, platelet 60,000/mm³. (D) For patients with idiopathic thrombocytopenic purpura without bleeding symptoms, platelet 6,000/mm³. ", "output": "A"} 
-{"instruction": "A 60-year-old male ate wild mushrooms 30 minutes ago and had vomiting and diarrhea, accompanied by sweating and incontinence. Physical examination revealed cold and wet skin and wet gurgling in both lungs. Which of the following statements is more appropriate? ", "input": "(A) In addition to toxin poisoning, it may also be caused by enteric invasive pathogens, such as intestinal amoeba and Vibrio cholerae infections. (B) Do not give antiemetics to avoid prolonging the course of poisoning. (C) This toxic syndrome is usually relieved within 12 hours after treatment. (D) This is cholinergic toxidrome. Give the antidote Pralidoxime 1g. ", "output": "C"} 
-{"instruction": "Which of the following statements about purulent chest is more appropriate? ", "input": "(A) The diagnostic criteria for purulent chest include a thoracentesis fluid pH < 7.35. (B) In tuberculous purulent chest, the number of lymphocytes in the thoracentesis fluid will be significantly increased. (C) POCUS can distinguish pleural effusion from purulent chest. (D) Fibrinolytics can improve the drainage of purulent chest and significantly reduce the mortality rate or the need for surgery. ", "output": "B"} 
-{"instruction": "Which of the following statements about bacterial pneumonia is less appropriate? ", "input": "(A)Pneumococcal pneumonia Laboratory test results may show elevated serum bilirubin or hyponatremia. (B)Klebsiella pneumonia is commonly seen in clinical practice as currant jelly sputum. (C)Haemophilus influenzae pneumonia is more common in the elderly, and pleural effusions and multilobar infiltrations are common. (D)Patients at risk of aspiration pneumonia should consider Staphylococcus aureus infection. ", "output": "B"} 
-{"instruction": "Which of the following statements is least likely to be caused by violence by a close partner? ", "input": "(A)Injuries with violent characteristics, such as nail scratches and bites. (B)Multiple injuries on the body from different periods of time, distributed in the center of the body (head, trunk). (C) The injured part is on the palm, knee or other parts of the body that are easily movable. (D) Delay in seeking medical treatment and suicidal tendency. ", "output":"C"} 
-{"instruction": "Which of the following is less appropriate when distinguishing between delirium, dementia, and mental illness?", "input": "(A) All three levels of concentration are impaired, with dementia being the more obvious. (B) Asterixis is more common in patients with delirium. (C) Delirium is more likely to be accompanied by visual or auditory hallucinations, which is less common in patients with dementia. (D) Dementia and mental illness are usually conscious, while patients with delirium are more likely to be in reduced consciousness or hyperalert.", "output": "A"} 
-{"instruction": "A 25-year-old male comes to the emergency department with an Ixodes tick bite on his left calf that was unable to be removed several hours ago. Which of the following is more appropriate?", "input": "(A) Lidocaine jelly can be applied to paralyze the tick before removal. (B) The tick body should be destroyed before removal with tweezers to prevent Borrelia burgdorferi from being secreted into the saliva through the tick body. (C) The removed tick should be kept in alcohol for identification. (D) The patient should take doxycycline orally to prevent Lyme disease.", "output": "C"}"A"} 
-{"instruction": "Which of the following statements about orbital fracture is less appropriate?", "input": "(A) When the bridge of the nose is hit hard, tear gland injury should be considered. (B) Blunt eye injuries The most common orbital fractures are fractures of the inferior and medial walls. (C) When the orbital floor is fractured, the patient often has double vision when looking down. (D) Patients with orbital fractures should use prophylactic antibiotics to avoid pathogenic bacteria infection of the nasal sinuses.", "output": "C"} {" 
-instruction": "A 28-year-old female was bitten by a badger in the mountains on her right forearm, with a 3-cm laceration. After treating the wound, I consult you about rabies-related health education. Which health education is more appropriate?", "input": "(A) The incubation period of rabies is about 1 to 3 months, but it may also remain latent for several years. (B) If it invades the central nervous system, it often manifests as meningitis. (C) Headache, fever, restlessness, and unconsciousness are common. (D) If there are any suspicious symptoms, it is recommended that the patient return for steroid treatment.", "output": "A"} 
-{"instruction": "A 2-year-old boy is sent to the emergency department because of a seizure. After two doses of Lorazepam, the seizure cannot be controlled. Which medication to give next time is less appropriate?", "input": "(A) Fosphenytoin. (B) Levetiracetam. (C)Phenobarbital. (D)Propofol. ", "output": "D"} 
-{"instruction": "A 48-year-old female with a history of asthma was rushed to the emergency room with sudden dyspnea. Examination revealed that the patient's SpO₂ was 80%, and her skin was pale and cyanotic. She was diagnosed with acute asthma. After treatment, her symptoms improved and she asked to go home. Regarding the increased risk of death after discharge, which one is more appropriate? ", "input": "(A)She used up a bottle of Fenoterol metered spray last month. (B)The β2-agonists she used three times in this emergency room. (C)She came to the emergency room for acute asthma attacks four times in the past year. (D)She still has wheezing when breathing. ", "output": "C"} 
-{"instruction": "Which of the following statements about the physical examination of a patient with spinal cord injury who was injured in a car accident is more appropriate?", "input": "(A) If the patient's residual urine volume is greater than 100-200 mL, spinal cord compression is highly suspected. (B) Patients with spinal cord injury may have hyperactive reflexes but no clonus. (C) If there is no hyperactive reflex within 1 hour after the injury, spinal cord injury can be ruled out. (D) Babinski's sign will not appear.", "output": "A"} 
-{"instruction": "Which of the following statements about emergency medical documents is less appropriate?", "input": "(A) If the patient is discharged voluntarily, the patient's condition at the time of discharge, the reason for discharge, and possible future events must be recorded. (B) Emergency medical records should be focused rather than systematically collecting and recording all information. Complete grammatical sentences are not necessary. (C) Special situations such as domestic violence and child abuse require detailed records in the medical records and the relevant reporting procedures to the competent authorities must be completed. (D) The diagnosis is a legal document and can only be issued by the attending physician in the emergency department.", "output": "D"} { 
-"instruction": "Which of the following statements about pharyngitis caused by Group A β-hemolytic Streptococcus is more appropriate?", "input": "(A) Symptoms include fever, cough, and sore throat. (B) Because family members have about a 10% chance of infection, prophylactic antibiotics are recommended. (C) Antibiotics should be given as soon as possible, within 3 days, to effectively prevent major nonsuppurative sequelae. (D) There is no clear evidence that giving appropriate antibiotics can prevent glomerulonephritis. ", "output": "D"} 
-{"instruction": "Which of the following situations is more likely to be a bioterrorism incident involving exposure to a biotoxin? ", "input": "(A) Patients with typical risk factors develop similar diseases. (B) Epidemiological investigations trace back to many different sources of infection. (C) Animals and humans in the same area develop the same disease. (D) A large number of people with multiple chronic diseases die suddenly in a short period of time. ", "output": "C"} 
-{"instruction": "Regarding virus pericarditis, which of the following statements is less appropriate? ", "input": "(A) The electrocardiogram may show multi-lead ST segment elevation and PR segment depression. (B) NSAIDs and Colchicine can be given for treatment. (C) If NSAIDs are not well tolerated, corticosteroid treatment can be considered. (D) Most patients require hospitalization. ", "output": "D"} 
-{"instruction": "Regarding arthrocentesis in the emergency department, which of the following statements is more appropriate? ", "input": "(A) For patients taking oral anticoagulants, routine coagulation function tests should be performed before arthrocentesis. (B) When performing arthrocentesis for suspected septic arthritis, local anesthetics can be injected into the joint cavity to reduce pain. (C) When extracting elbow joint fluid, the inner side of the elbow is the preferred choice for needle insertion. (D) When extracting wrist joint fluid, the needle should be inserted between the ulnar radial tuberosity and the tendons of the extensor pollicis longus and the common extensor tendons of the index finger. ", "output": "D"} 
-{"instruction": "Which of the following statements about selective serotonin reuptake inhibitors (SSRIs) is less appropriate? ", "input": "(A) Common side effects include nausea, vomiting, drowsiness, and headache. (B) It may increase suicidal ideation, especially in patients under 25 years of age. (C) Symptoms that occur after sudden discontinuation are often fatal and require emergency treatment. (D) When taking concomitant drugs that may increase serotonin, be aware of serotonin syndrome. ", "output": "C"} 
-{"instruction":"Regarding angioedema caused by angiotensin converting enzyme inhibitors, which of the following statements is more appropriate?", "input": "(A) Tranexamic acid is the first choice for treatment. (B) High-dose corticosteroids are effective in treating laryngeal edema. (C) When therapeutic drugs are in short supply, cryoprecipitate infusion can be given. (D) If treatment of hypertension is required, angiotensin receptor blockers can be given instead.", "output": "A"} 
-{"instruction": "Regarding abdominal diseases in the elderly, which of the following statements is more appropriate?", "input": "(A) Viral enteritis is more common in the elderly than bacterial enteritis. (B) Intestinal obstruction is the most common reason for abdominal surgery in the elderly. (C) The elderly may consider using imaging tests to rule out unexplained abdominal pain. (D) Elderly people rarely need surgery for abdominal pain, and symptoms are often subtle and difficult to diagnose.", "output": "C"} 
-{"instruction": "Which of the following is more common in lightning injuries?", "input": "(A) Eye injury. (B) Kidney failure. (C) Rhabdomyolysis. (D) Ventricular arrhythmia.", "output": "A"}
-{"instruction": "Which of the following statements is more appropriate regarding the decision-making of computed tomography (CT) of the brain, the description of the New Orleans Criteria and the Canadian CT Head Rule?", "input": "(A) The New Orleans Criteria is for patients with mild head trauma and a GCS score of 13 to 15. (B) The Canadian CT Head Rule is for patients with a GCS score of 15. Those with a GCS score of less than 15 are not applicable. (C) Based on the New Orleans Criteria, the following are included: headache, vomiting, persistent amnesia, evidence of trauma above the clavicle, signs of cranial fracture, and epileptic seizures. (D) Based on the Canadian CT Head Rule, the following are included: 2 Hours of GCS <15 points, vomiting more than 1 time, retrograde amnesia >30 minutes. ", "output": "D"} 
-Which of the following statements about syncope is more appropriate? ", "input":"(A) About 20% of patients cannot find the exact cause after emergency examination. (B) Urinary incontinence is very useful information in helping to distinguish epileptic seizures from syncope. (C) An 18-year-old female with no past medical history was witnessed to lose consciousness for about 1 minute. After the emergency department, she was conscious but had abdominal pain. The electrocardiogram showed a sinus rhythm. The patient refused to stay for observation. Priority was given to arranging outpatient follow-up in the cardiology department. (D) A 65-year-old male with no past medical history suddenly lost consciousness for about 1 minute while sitting. After the emergency department, he was conscious and had no physical discomfort. The electrocardiogram showed first-degree atrioventricular block. Hospitalization is still recommended.", "output": "D"}
-{"instruction": "Which of the following is inappropriate for the treatment of a patient with spontaneous intracranial hemorrhage?", "input": "(A) If Heparin is used within 3 hours, Protamine should be given. (B) If Warfarin is used, Vit-K and Prothrombin complex concentrate should be given regardless of the INR value on the blood test. (C) If an anti-platelet agent is used, platelets should be transfused and Desmopressin should be given. (D) If Dabigatran is used, Idarucizumab should be given.", "output": "C"} 
-{"instruction": "Which of the following is inappropriate for the evaluation and management of acute gastroenteritis in children?", "input": "(A) C-reactive protein can be used to distinguish between bacterial and viral gastroenteritis. (B) Those with severe dehydration should have their blood sugar and blood electrolytes checked. (C) BUN values ​​cannot easily distinguish those with mild dehydration, and bicarbonate (HCO₃-) values ​​can be used to exclude those without dehydration. (D) Continuing to eat can alleviate dehydration and promote recovery of the intestinal mucosa. ", "output": "A"} 
-{"instruction": "For multiple lacerations on the hands, during emergency assessment and preparation for suture, which of the following statements is less appropriate? ", "input": "(A) If examination reveals that the patient cannot make a "thumbs-up" gesture with his thumb, the median nerve may be damaged. (B) It is unsafe to use local anesthetics containing adrenaline when performing a digital nerve block in the emergency department. (C) For fingertip lacerations, two-point discrimination can be used to test for sensory loss. Normal two-point discrimination is < 6 mm. (D) If the wound is deep and the joint cavity is suspected to be damaged, the saline load test can be used, but the addition of methylene blue is not recommended. ", "output": "B"} 
-{"instruction": "Which of the following statements about spinal trauma is more appropriate? ", "input": "(A) The thoracic spine is relatively less likely to be injured because of the articulation protection formed with the ribs. (B) Injury to the third lumbar vertebra can affect the terminal nerves of the spinal cord and cause bladder function damage. (C) Compression fractures are often caused by excessive extension (hyperextension) squeezing the front of the spine during the injury. (D) Compression fractures with 20% collapse of the lumbar vertebral body height may require outpatient treatment. ", "output": "D"} 
-{"instruction": "Which of the following statements about the treatment of anaphylactic shock is more appropriate? ", "input": "(A) Albumin can be used for fluid resuscitation to reduce the problems caused by large amounts of crystalloid fluid. (B) For patients who usually take beta-blockers, treatment with Epinephrine may cause severe hypertension. (C) The deltoid muscle has a thinner fat layer, which can ensure that the EpiPen® is completely injected into the muscle layer, making it the most appropriate injection site. (D) The efficacy of an expired EpiPen® declines rapidly, and it is not recommended for use in this situation. ", "output": "B"} 
-{"instruction": "Which of the following statements about wrist fractures is less appropriate? ", "input": "(A)Scaphoid fracture is the most common fracture of the wrist. Clinically, it can be seen as tenderness in the snuffbox of the affected side and pain when moving the thumb of the affected side. (B)Capitate fracture often occurs together with scaphoid bone fracture and is prone to avascular necrosis. (C)Lunate fracture is often caused by falling on the hand or hyperextension of the wrist. (D)Triquetrum fracture is relatively rare and is easier to diagnose in the frontal view (AP view) of the wrist X-ray. ", "output": "D"} 
-{"instruction": "Which of the following statements about amniotic fluid embolism is less appropriate? ", "input": "(A) A blood test may reveal DIC. (B) A cardiac ultrasound may show left ventricular dysfunction. (C) A cardiac ultrasound may show right ventricular dysfunction. (D) Patients have a high survival rate after aggressive blood transfusion. ", "output": "D"} 
-{"instruction": "Which is the best predictor of repeated emergency room visits or hospitalizations in elderly patients? ", "input": "(A) The presence or absence of cancer. (B) The presence or absence of dementia. (C) The number of chronic diseases. (D) Acute functional decline. ", "output": "D"} 
-{"instruction": "What is the appropriate treatment for organophosphate poisoning? ", "input":"(A) If Succinylcholine is used during intubation, the onset of the drug's effect will be delayed. (B) Intermediate syndrome, which often occurs 1-4 days after acute poisoning, is mainly characterized by weakness in the distal limbs. (C) For the antidote Atropine, the dosage is adjusted according to the heart rate. (D) For the antidote Pralidoxime, the sooner the drug is given, the better the effect.", "output": "D"} 
-{"instruction": "Which of the following descriptions of rash symptoms and fever in children is less appropriate?", "input": "(A) Measles starts with fever, and a few days later the rash begins to spread from the face. (B) In German measles, fever is followed by rash, which begins to spread from the face. (C) Scarlet fever rash appears one or two days after the onset of fever, starting from the limbs and spreading to the trunk and face. (D) Roseola infantum rash appears after the onset of fever, and there is no obvious difference in the direction of spread. ", "output": "C"}
-{"instruction": "A 23-year-old woman who was 12 weeks pregnant had sudden palpitations, shortness of breath, and sweating during a prenatal checkup. When she was sent to the emergency department, her temperature was 38.8°C, her heart rate was 148 beats/min, her respiratory rate was 25 breaths/min, and her blood pressure was 145/100 mmHg. She had no past or family medical history. Physical examination revealed a slightly enlarged thyroid gland. The patient's heart rate was 160 beats/min, especially when the thyroid gland was palpated. Which of the following treatments is less appropriate?", "input": "(A) Give hydrocortisone 100 mg intravenously, 100 mg in 3 divided doses over 24 hours until the desired effect is achieved. (B) Give methimazole 40 mg orally, 25 mg every 4 hours; total daily dose 120 mg. (C) One hour after the above treatment steps are completed; give 8-10 drops of Lugol solution every 6-8 hours until the desired effect is achieved. (D) Give propranolol 1-2 mg slowly by intravenous injection, repeat every 10 to 15 minutes until the desired effect is achieved. ", "output": "B"}"output": "C"} 
-{"instruction": "Which of the following descriptions of the pathophysiology and clinical manifestations of traumatic shock is less appropriate?", "input": "(A) Trauma damages the endothelium, stimulating the expression of thrombomodulin on the endothelium to increase its binding to thrombin, thereby activating protein C. (B) Early trauma causes coagulopathy, which regulates anticoagulation and hyperfibrinolysis through the protein C pathway. (C) The percentage of blood loss is estimated based on systolic pressure, heart rate, and GCS to classify the severity of bleeding. This classification is very reliable and can be used to guide resuscitation. (D) Patients with intra-abdominal hemorrhage may experience bradycardia or a normal heart rate due to increased vagal tone caused by the accumulation of blood in the peritoneum. ", "output": "C"}
-{"instruction": "Which of the following is less appropriate for monitoring common adverse reactions to psychiatric drugs?", "input": "(A) Aripiprazole If a patient has a fever, severe muscle stiffness, and unconsciousness, blood sugar levels should be monitored. (B) Carbamazepine It is recommended to undergo HLA-B 1502 gene testing before use. (C) Clozapine If a patient has chest pain, dyspnea, or fever, an electrocardiogram should be monitored. (D) Olanzapine Patients should monitor prolactin regularly.", "output": "D"} 
-{"instruction": "A 30-year-old female with no medical history complained of coughing with sputum for about a week. The patient's temperature was 37.1℃, blood pressure was 114/72 mmHg, and respiratory rate was 16 times/min, blood oxygen concentration is 96%. Chest X-ray does not show obvious pneumonia, and breath sounds are normal. Which of the following descriptions of this patient is more appropriate? ", "input": "(A) β2-agonists are routinely used to relieve symptoms. (B) Atypical bacteria are also possible pathogens. (C) If the sputum is yellow-green, it can be inferred that it is a bacterial infection. (D) The forced expiratory volume in the first second (FEV1) can help with differential diagnosis. ", "output": "B"} 
-{"instruction": "Patients with hypertrophic cardiomyopathy may hear a systolic heart murmur at the apex of the heart. Which of the following actions can increase the intensity of this heart murmur? ", "input": "(A) Stand up from a squatting position. (B) Make fists with both hands. (C) Maintain a squatting position. (D) Passively raise the legs.", "output": "A"} 
-{"instruction": "Which of the following statements about sudden hearing loss is more appropriate?", "input": "(A) It can be divided into sensorineural and conductive hearing loss. About 70% of patients can find the cause of hearing loss. (B) Viral infection is one of the common causes of hearing loss, among which the herpes simplex virus is the most common. (C) Use a tuning fork placed on the patient's forehead to perform a Weber test , if the right ear can hear clear sounds, it means that the right ear has conductive hearing loss, or the left ear has sensorineural hearing loss. (D) Use a tuning fork to perform a Rinne test on the right mastoid and external auditory canal. If the sound is clearer at the mastoid, it means that the right ear has sensorineural hearing loss. ", "output": "C"} 
-{"instruction": "Which of the following statements about ischemic stroke syndrome related to specific diseases is more appropriate? ", "input": "(A) Type B aortic detachment may manifest as ischemic stroke and myocardial infarction at the same time. (B) If contraindications are excluded, thrombolytic agents can also be injected when ischemic stroke and myocardial infarction are combined at the same time. (C) For ischemic stroke associated with sickle cell anemia, thrombolytic injection is not recommended. (D) Patients with a recent history of trauma should be cautious about vertebral artery dissection in young stroke patients, but this diagnosis is usually only considered for severe cervical trauma. ", "output": "B"} 
-{"instruction": "A 30-year-old woman who is 35 weeks pregnant suddenly has a large amount of clear fluid flowing out of her vagina. Which of the following statements is more appropriate? ", "input": "(A) If necessary, digital examination can be performed. (B) Lubricants should not be used when using a speculum examination. (C) The pH value of the fluid is usually between 4.5 and 5.5. (D)When the liquid is immediately placed under a microscope, fern-like crystals can be seen (ferning test). ", "output": "B"} 
-{"instruction": "Regarding urinary tract infection in infants and young children, which of the following is not a possible cause of urine culture-negative pyuria? ", "input": "(A)Kawasaki's disease. (B)Appendicitis. (C)Chlamydia Sexually Transmitted Disease. (D)Balanitis. ", "output": "D"} 
-{"instruction": "Regarding tetanus, which of the following statements is more appropriate? ", "input": "(A)The shorter the incubation period of tetanus, the less severe the disease and the better the prognosis. (B) Local tetanus usually causes stiffness of the muscles distal to the injury and fully recovers after weeks to months. (C) General tetanus usually begins with the shorter axonal nerves being affected, resulting in descending paralysis. (D) Cephalic tetanus usually results from head trauma and will result in dysfunction of the fifth cranial nerve. ", "output": "C"} 
-{"instruction": "Which of the following statements is more appropriate regarding the diagnosis and treatment of pneumothorax? ", "input": "(A) A deep sulcus sign is seen in the costophrenic angle on the affected side, more often when the patient is sitting for the X-ray. (B) Giving the patient a non-rebreathing mask can accelerate the absorption of pneumothorax more quickly than giving oxygen through a nasal cannula. (C) If the patient has symptoms such as tracheal deviation and hypotension, acupuncture decompression should be performed as soon as possible above the ribs in the fourth intercostal space of the mid-axillary line. (D) The safe position for chest tube insertion is between the fifth intercostal space, the pectoralis major muscle and the latissimus dorsi muscle. ", "output": "D"} 
-{"instruction":"A 70-year-old male has been on long-term dialysis. He is prone to bruising and bleeding when his hands and feet collide. This time he vomited blood and went to the emergency room for treatment. The blood test data were normal except for anemia and poor renal function. Gastroscopy found that the digestive ulcer was difficult to stop bleeding and continued to ooze blood on the surface of the ulcer. Which of the following is less appropriate?", "input": "(A)Cryoprecipitate, 10 units over 30 mins. (B)Conjugated estrogens, 25 mg IV. (C)Desmopressin, 0.3 μg/kg IV. (D)Vitamin K1, 10mg slow IV.", "output": "D"} 
-{"instruction": "Which of the following descriptions of genitourinary emergencies is less appropriate?", "input": "(A) Testicular torsion can be manually restored in a manner similar to turning the pages of a book, rotating approximately 360 degrees on the affected side. (B) Blood gas analysis of the corpus cavernosum can distinguish between ischemic and non-ischemic priapism. (C) Paraphimosis can be treated with an elastic bandage wrapped around the glans for 5 minutes to help reduce edema. (D) Prostate massage is usually not necessary to confirm suspected acute prostatitis and may cause bacteremia or sepsis.", "output": "A"}
-{"instruction": "A 65-year-old male patient presents to the emergency department with sudden chest pain and dyspnea. Physical examination shows mid-diastolic murmur at the apex of the heart, Corrigan pulse, Duroziez sign, de Musset sign, and Quincke sign while lying on the left side. Cardiovascular CT scan shows Stanford Type A aortic dissection. Which of the following treatments is less appropriate?", "input": "(A) Give oxygen therapy. (B) Give Labetalol. (C) Give Nitroglycerin. (D) Arrange for surgical treatment.", "output": "B"} 
-{"instruction": "A 60-year-old male is injured in a car accident and presented to the emergency department. The paramedics have applied a collar and a long back board. He is conscious and complains of neck pain. He has no other obvious abrasions or contusions. His blood pressure is 60/30 mmHg, his heart rate is 80 beats/min, and his skin is warm to the touch. Which of the following assessments and treatments is appropriate for this patient?", "input": "(A) Based on the history and initial physical examination, hypotension due to intra-abdominal organ injury can be ruled out. (B) This patient should have lower extremity paralysis and increased deep reflexes. (C) This presentation may occur in a patient with an injury to the fourth thoracic vertebra. (D) Vasopressors are of no benefit to this patient and may increase the risk of tissue hypoperfusion. ", "output": "C"} 
-{"instruction": "Which of the following statements about the management of frostbite is more appropriate? ", "input": "(A) When hemorrhagic blisters form, debridement should be performed. (B) There is no evidence to support the use of prophylactic antibiotics and tetanus. (C) Aloe vera ointment may promote wound repair. (D) Consider early surgical intervention. ", "output": "C"} 
-{"instruction": "A 40-year-old male with alcoholic cirrhosis presents to the emergency department with vomiting blood. Which of the following treatments is more appropriate? ", "input": "(A) It may be esophageal varicose vein bleeding. Do not place a nasogastric tube. (B) Give preventive antibiotics as soon as possible. (C) Endoscopic examination must be performed only after the patient is able to cooperate. (D) Tranexamic acid is of no benefit to this patient.", "output": "B"} 
-{"instruction": "A shelter was hit by a missile. The building was slightly damaged but did not catch fire. Dozens of people had no obvious external injuries but were convulsing, foaming at the mouth and falling to the ground. Which of the following statements is more appropriate?", "input": "(A) If the patient is comatose, has weak breathing, and has a lot of oral and nasal secretions, immediately protect the cervical spine with bare hands and perform endotracheal intubation and suction to maintain a patent airway. (B) Give patients with nasal discharge 0.5-1.0 mg of Atropine intravenously or subcutaneously until the oral and nasal secretions are reduced to a controllable level or the total dose has reached 0.1 mg/Kg. (C) For patients with obvious systemic symptoms, slowly inject Prolidoxime 1-2 g intravenously as soon as possible. When the number of patients exceeds the drug supply, the dose can be reduced by half to allow more people to receive treatment. (D) In ​​addition to protecting the airway of patients with convulsions, any Benzodiazepines should be injected intravenously as soon as possible, and Phynetoin should be dripped intravenously at an initial dose of 20 mg/Kg. ", "output": "C"} 
-{"instruction": "Which of the following statements about pain and its treatment is more appropriate? ", "input": "(A) Changes in vital signs and the patient's facial expressions and movements are highly correlated with the patient's perceived pain index. (B) Patients with major trauma should be given nonsteroidal anti-inflammatory drugs first due to musculoskeletal pain. (C) Regardless of the severity of acute pain, a tiered approach to analgesia is required. (D) If a patient with abdominal pain improves after treatment, it does not necessarily mean that the condition has improved. ", "output": "D"} 
-{"instruction": "Which of the following descriptions of reactive arthritis is more appropriate? ", "input": "(A) It often occurs within one week after an infectious disease. (B) The joints of the upper limbs are more easily invaded than those of the lower limbs. (C) Conjunctivitis is less common in reactive arthritis following intestinal infection. (D) Chlamydia is a common bacterial infection in reactive arthritis. ", "output": "D"} 
-{"instruction": "Which of the following is more appropriate for the treatment of pulmonary hypertension? ", "input": "(A) Dobutamine can be used for right heart failure combined with shock symptoms. (B) High doses of Norepinephrine may increase pulmonary vascular resistance and worsen the condition. (C) When using a ventilator, low tidal volume and high positive end-expiratory pressure settings are required. (D) When shock is combined with insufficient left ventricular perfusion, 1L of fluid can be infused first to maintain blood pressure. ", "output": "B"} 
-{"instruction": "A 65-year-old diabetic patient (outpatient medication: Metformin, Glipizide, Pioglitazone) was sent to the emergency room due to hypoglycemia. After treatment, the patient regained consciousness and it was found that the patient ate less due to poor appetite. Which of the following statements is inappropriate for the treatment of this patient? ", "input": "(A) Check liver and kidney function to rule out poor drug metabolism. (B) If hypoglycemia still occurs repeatedly during treatment, Octreotide can be used for treatment. (C) Check for infection, including lung infection, urinary tract infection, skin infection, etc. (D) If infection and liver and kidney abnormalities are ruled out and blood sugar levels are normal for three consecutive Q1H, the patient can be discharged from the hospital and followed up in the outpatient clinic. ", "output": "D"} Pioglitazone), this time he was sent to the emergency department due to hypoglycemia and coma. After treatment, the patient regained consciousness and it was learned that the patient ate less due to poor appetite. Which of the following statements is less appropriate for the treatment of this patient? ", "input": "(A) Check liver and kidney function to rule out the possibility of poor drug metabolism. (B) If hypoglycemia still occurs repeatedly during treatment, Octreotide can be used for treatment. (C) Check for infection, including lung infection, urinary tract infection, skin infection, etc. (D) If infection and liver and kidney abnormalities are ruled out, and blood sugar levels are normal for 3 consecutive Q1H, the patient can be discharged from the hospital and followed up in the outpatient clinic. ", "output": "D"} 
-{"instruction": "Regarding the placement of bone needles in the emergency department, which of the following is more appropriate? ", "input": "(A) Bone needles have more complications than central venous catheters, with extravasation being the most common. (B) The pH value, bicarbonate, and carbon dioxide partial pressure in the bone marrow blood are well correlated with the venous blood. (C) When inserting a bone needle into a child's distal tibia, it should be inserted vertically into the center of the medial malleolus to avoid injuring the great occlusal vein. (D) If pain occurs when instilling saline into the bone needle, 2% Lidocaine 0.5 mg/Kg can be given through the bone needle. ", "output": "D"}
-{"instruction": "A 21-year-old male complained of fever and altered consciousness. A lumbar puncture diagnosed him with bacterial meningitis. On the same day, his family member also developed fever. Which of the following statements is less appropriate? ", "input":"(A) Bacterial meningitis is mainly transmitted through droplets and is highly contagious to close contacts. (B) If the culture result is N. meningitidis or S. pneumoniae, the contact needs to be given preventive antibiotics. (C) Preventive antibiotics given as early as within 24 hours of contact can achieve a higher protective effect. (D) Preventive medication can consider oral Rifampin, Ciprofloxacin, or intramuscular injection of Ceftriaxone.", "output": "B"} 
-{"instruction": "Which of the following statements about Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is less appropriate?", "input": "(A)REBOA The intravascular balloon is inserted and inflated into the proximal aorta through the common femoral artery. (B) The balloon is inflated in zone 1 to control bleeding from below the diaphragm to above the renal arteries. (C) Zone 2 extends from the diaphragm to the renal arteries and is recommended for bleeding from renal injury. (D) The balloon can be inflated in zone 3 if the bleeding source is below the renal arteries, including severe pelvic, inguinal, or proximal lower extremity bleeding. ", "output": "C"}
-{"instruction": "Which of the following statements about acute otitis media in children is more appropriate?", "input": "(A) The most common pathogens are Streptococcus pneumoniae and Haemophilus influenzae. (B) Otitis media can be diagnosed by the specific symptom of red eardrum. (C) Antibiotic treatment is necessary, but analgesia is not recommended because it will delay the diagnosis of the disease and may even affect the course of the disease. (D) If the initial oral amoxicillin antibiotic treatment is repeatedly ineffective, it is necessary to switch to amoxicillin-clavulanate or ceftriaxone. Clindamycin is not recommended for patients with a history of penicillin allergy.", "output": "A"} 
-{"instruction": "A 20-year-old female presented to the emergency department with abdominal pain, nausea, and bloody diarrhea two days ago after consuming undercooked chicken. Which of the following options is more appropriate for this patient's most likely pathogen?", "input": "(A)Vibrio cholerae. (B)Campylobacter. (C)Clostridium botulinum. (D)Giardia.", "output": "B"} 
-{"instruction": "Which of the following is more appropriate for controlling blood pressure in patients after myocardial infarction?", "input": "(A)Labetalol + Captopril. (B)Thiazide + Captopril. (C)Nifedipine + Captopril. (D)Metoprolol + Nifedipine.", "output": "A"} 
-{"instruction": "Which of the following is less appropriate for the diagnosis and treatment of a UTI?", "input": "(A) In a young woman whose sex partner has a UTI and whose urine test shows mild purulent urine but no bacteria, a Chlamydia infection should be suspected. (B) In an inpatient whose urine test is positive for nitrite, a Pseudomonas or Acinetobacter species should be suspected. (C) In a young man whose centrifuged urine specimen shows bacteria and 2 WBCs/HPF, a drug for UTI should be given. (D) Fluoroquinolones would be a better choice than Trimethoprim-Sulfamethoxazole for an HIV patient with a UTI. ", "output": "B"} 
-{"instruction": "A 20-year-old student hit his right shoulder during judo class and complained of pain and inability to move. Which of the following statements is less appropriate? ", "input": "(A) If the right palm cannot touch the left shoulder, anterior dislocation is suspected. (B) X-ray examination of the shoulder should include AP view and scapular lateral view. (C) The most common complication of shoulder dislocation is rotator cuff tears. (D) Neuropraxia may occur, with motor and sensory abnormalities, but usually recovers on its own. ", "output": "C"} 
-{"instruction": "Which of the following statements is more appropriate for the patient's neurological examination? ", "input": "(A) When checking both eyes with a penlight, if the patient's pupil is dilated on one side, it may be a problem with the second pair of cranial nerves on one side. (B) For comatose patients, the doctor can hold the patient's forearm and observe whether it is adducted or sunken to assess whether there is a problem with upper limb weakness. (C) If there is a problem with the peripheral seventh pair of cranial nerves, the corner of the mouth on the same side will be crooked, the eyes will not close tightly, but there will still be forehead wrinkles. (D) If there is a problem with the central seventh pair of cranial nerves, the upper and lower parts of the opposite face will be affected, including the disappearance of forehead wrinkles and crooked corners of the mouth. ", "output": "B"} 
-{"instruction": "In a patient with head trauma who presents with bilateral pinpoint pupils, bilateral Babinski's sign, and increased muscle tone, which of the following types of herniation is more likely? ", "input": "(A) Uncal transtentorial herniation. (B) Central transtentorial herniation. (C) Cerebellar tonsillar herniation. (D) Upward posterior fossa herniation. ", "output": "B"} 
-{"instruction": "In a patient with scleroderma who presents with an acute renal crisis, which of the following medications is more appropriate? ", "input": "(A) Angiotensin-converting enzyme inhibitor. (B) Beta-blocker. (C) Methotrexate. (D) High-dose corticosteroid. ", "output": "A"} {"instruction" 
-: "A 62-year-old male with a history of diverticulitis in the descending colon presents with left lower abdominal pain and is suspected of having a recurrence of diverticulitis. Vital signs are normal. Which of the following statements is more appropriate? ", "input": "(A) Arrange a CT scan. (B) Give routine antibiotic treatment. (C) The antibiotics available are Metronidazole plus Ciprofloxacin. (D) Long-term use of opioid analgesics does not increase the risk of diverticulitis perforation. ", "output": "C"}  
-{"instruction": "Which of the following descriptions of the labor process in pregnant women is more appropriate?", "input": "(A) Active labor (active (B) The first stage is from the time the water breaks until the cervix is ​​fully dilated. (C) The third stage is from the time the cervix is ​​fully dilated until the baby is born. The average time for primiparas is more than twice that of multiparas. (D) The latent phase is when the uterus contracts irregularly and the cervix begins to soften and thin. It is the preparation period before delivery. ", "output": "D"}
-{"instruction":"29-year-old male with a history of drug abuse. He started to have dyspnea more than a month ago, which gradually worsened and was accompanied by loss of appetite, occasional dyspnea when standing, cough, and eventually edema of both feet and decreased urine output. Blood pressure 102/64 mmHg, heart rate 140 beats/min, body temperature 38.5℃, respiration 37 times/min, anemia and wet gurgling in both lungs, heart murmurs and S3 on heart auscultation, and X-ray showed enlarged heart. There was no hepatosplenomegaly in the abdomen, edema of both feet, cold sweat on the skin, purple spots and hemorrhagic spots. Blood bacterial culture showed: Viridans streptococci. According to Duke Criteria What is the basis for diagnosing acute endocarditis? ", "input": "(A)2 major criteria. (B)5 minor criteria. (C)1 major criterion & 3 minor criteria. (D)2 major criteria & 2 minor criteria. ", "output": "C"} 
-{"instruction": "Which of the following statements is more appropriate regarding airway management in the emergency department? ", "input": "(A)When intubating an adult, the shoulder should be raised by 10 cm and the external ear should be aligned with the sternal notch to obtain the best view of the glottis. (B)When intubating an adult, BURP (backward-upward-rightward pressure) can be used to apply pressure to the cricoid cartilage. The Sellick method should be avoided to avoid obstructing the view of the glottis. (C) The infant has a larger head, smaller tongue, smaller mandible, and more anterior larynx, so the shoulders need to be raised to obtain the best view of the glottis. (D) A 9-year-old boy, weighing 30 kg, was clinically diagnosed with epiglottitis and acute respiratory failure. After needle cricothyrotomy, he was connected to 15 psi oxygen ventilation. ", "output": "D"} 
-{"instruction": "40-year-old patient with neck tumor, A patient had a tracheostomy 5 days ago. The tracheostomy tube slipped due to coughing. Blood oxygen concentration is 95%. Breathing is smooth but there is a little sputum. Which of the following approaches to replace the tracheostomy tube is more appropriate? ", "input": "(A) Replace it using a bronchoscope. (B) Have an experienced surgeon replace it. (C) Use an obturator and prepare a smaller tracheostomy tube. (D) Use a modified Seldinger technique (using a nasogastric tube or a sputum suction tube as a guidewire). ", "output": "B"} 
-{"instruction": "Which of the following approaches to pericardiocentesis is less appropriate? ", "input": "(A)Apical approach: Because it is closest to the left atrium and is most likely to cause ventricular puncture, you need to be careful about the risk of pneumothorax, but the advantage is that it is closest to the pericardium and has the shortest path. (B)Parasternal approach: The needle is inserted into the fifth intercostal space close to the sternal margin, so you need to be careful about puncturing internal thoracic vessels and the risk of pneumothorax. (C)Subxiphoid approach: The path is longer. If the hand-held angle is too vertical to the skin, it is easy to puncture the peritoneal cavity. If the direction is too biased to the midline, it will increase the risk of right atrium puncture. However, the advantage is that the risk of pneumothorax is relatively small. (D)If you don't have an ultrasound, you can connect the needle end of the V4 lead of the electrocardiogram machine. If a wide QRS suddenly appears, you must be careful that the needle tip has punctured the myocardium. ", "output": "D"} 
-{"instruction": "A 9-year-old boy was brought to the emergency room by his parents because of acute abdominal pain and related symptoms. Which of the following statements is more appropriate? ", "input": "(A) If it is acute appendicitis, about 70% of patients of this age will initially feel pain around the umbilicus, and then the pain will move to the right lower abdomen, with fever and vomiting. (B) If there is vomiting and diarrhea, the possibility of acute appendicitis can basically be ruled out. (C) Asking the child to cough hard or walk or jump will not help to diagnose peritonitis. (D) If the ultrasound shows that the appendix has a diameter of 7 mm, a wall thickness of 3 mm and is non-compressible, appendicitis can basically be diagnosed. ", "output": "D"} 
-{"instruction": "A 40-year-old woman has had upper abdominal pain, chest pain, vomiting and dysphagia for 2 days. Today she came to the emergency room because of a sudden fever (38.5℃). Physical examination revealed subcutaneous edema in the neck. Which of the following statements is more appropriate? ", "input": "(A) This patient does not have Macckler's triad. (B) First do a chest or upright abdominal X-ray. (C) An endoscopic examination can be arranged. (D) First arrange a chest CT scan, then consider an esophageal scintigraphy. ", "output": "B"} 
-{"instruction": "A 76-year-old woman has been sleepy for 3 days. She sometimes wakes up, but talks to herself, answers irrelevant questions, and stumbles day and night. Today, his condition became worse. He refused to get up to eat breakfast and was taken to the emergency room by his family. Which of the following assessment methods is more appropriate for this patient? ", "input": "(A) Confusion Assessment Methods. (B) Mini-Mental State Examination. (C) Identification of Seniors at Risk. (D) Clinical Dementia Rating. ", "output": "A"} 
-{"instruction": "Which of the following is less appropriate for the use of Amiodarone? ", "input": "(A) The total daily dose should not exceed 2.2 g. (B) The drug needs to be prepared with 5% dextrose water. (C) The dosage needs to be adjusted according to kidney function. (D) When used in combination with Warfarin, the dosage needs to be reduced. ", "output": "C"} 
-{"instruction": "Which of the following statements is more appropriate regarding the placement of tubes in the emergency department? ", "input": "(A) Nasogastric tubes can be routinely placed to treat patients with intestinal obstruction (i leus). (B) When replacing the jejunostomy tube with a urinary catheter, the balloon can be inflated to prevent slippage. (C) When acupuncture is performed to relieve pressure in tension pneumothorax, the needle can be inserted at the midclavicular line of the second intercostal space where the chest wall is thinnest. (D) If the patient's clinical condition worsens after a chest tube is inserted, the chest tube can be clamped and the patient can be sent to the operating room for emergency thoracotomy. ", "output": "D"}
-{"instruction": "A 40-year-old woman presents to the emergency department with complaints of abdominal distension and discomfort. She received an ovulation injection a week ago for infertility. Which of the following statements is more appropriate?", "input": "(A) Consider a bimanual pelvic examination. (B) Symptoms may include polyuria, abdominal distension, shortness of breath, and weight gain. (C) If the abdominal distension is accompanied by a large amount of ascites, transvaginal ultrasound drainage of the ascites may be considered. (D) In ​​severe cases, the ovaries are usually enlarged to no more than 8 cm.", "output": "C"}  
-{"instruction": "Which of the following statements about neurological examination of shoulder and neck pain is less appropriate? ", "input":"(A) Cervical disc herniation usually occurs at C5/6 and C6/7. (B) Increased pain with the Valsalva maneuver is more likely to be musculoskeletal pain. (C) Left arm muscle stiffness or increased pain with abduction and lifting is more likely to be musculoskeletal pain. (D) Pain in the right arm caused by flexing the neck and chin to the chest wall is more likely to be nerve root compression.", "output": "B"} 
-{"instruction": "An 18-year-old female, weighing 45 kg, committed suicide by taking 30 tablets of Acetaminophen (500 mg/tablet). She was sent to the emergency room 4 hours later and complained of nausea and epigastric pain. She was conscious and her vital signs were stable. Blood tests revealed GPT 28 IU/L, GOT 32 IU/L, T-Bil 0.8 mg/dL, and the acetaminophen concentration in the blood is 250 mg/L. Which of the following statements is more appropriate? ", "input": "(A) The liver index is still normal 24 hours after taking the drug, indicating that the poisoning is not serious and the patient can return home for observation. (B) Renal failure occurs 5 days later, which is unlikely to be caused by acetaminophen poisoning. Other causes should be sought. (C) Start treatment with N-acetylcysteine ​​and arrange for hospitalization. (D) Arrange for the patient to be hospitalized for observation. N-acetylcysteine ​​can be temporarily withheld. The liver index is closely monitored and antidotes are given if it is elevated. ", "output": "C"}
-{"instruction": "When considering carbon monoxide poisoning, which of the following interpretations of the COHb test results is more appropriate?", "input": "(A) Carbon monoxide poisoning is diagnosed clinically. (B) < 2% Carbon monoxide poisoning can be ruled out. (C)>15% is severe poisoning. (D) For smokers, it should not exceed 5%. ", "output": "A"} 
-{"instruction": "A 7-year-old child was in a car accident, weighing 16 kg, with an open airway, breathing 24 times/min, systolic pressure 84 mmHg, drowsiness, eyes open when stimulated by pain, incoherent speech, limb retraction when stimulated by pain, large open lacerations on the left shoulder and left chest, and an open fracture on the left calf. What are his Pediatric Trauma Score (PTS) and Revised Trauma Score (RTS)? ", "input": "(A)PTS is 4 points and RTS is 10 points. (B)PTS is 3 points and RTS is 10 points. (C)PTS is 3 points, RTS is 9 points. (D)PTS is 2 points, RTS is 9 points. ", "output": "B"} 
-{"instruction": "Which of the following statements about enterovirus infection is less appropriate? ", "input": "(A) To relieve throat pain, topical Lidocaine can be given. (B) There may be complications of viral encephalitis and myocarditis. (C) It is mainly clinical diagnosis, and PCR (polymerase chain reaction) can also be used for diagnosis. (D) Common viruses include Coxsackievirus A16. ", "output": "A"} 
-{"instruction": "A 32-year-old male was sent to the emergency room. His companions described that the patient surfaced from a depth of 50 meters in the sea during a diving activity and lost consciousness 10 minutes after landing. After arriving at the hospital, his vital signs were stable but his coma index was E2V3M3. The results of blood arterial gas analysis (room air) were pH 7.236, PaO 2 82.3 mmHg, PCO₂ 48.2 mmHg, HCO₃ 20mM/L. Which of the following statements is more appropriate?", "input": "(A) The patient has type I decompression sickness combined with arterial gas embolism. (B) 100% oxygen, intravenous infusion, and hyperbaric oxygen therapy should be given immediately. (C) Patients should be placed in the Trendelenburg position whenever possible. (D) Endotracheal intubation and mechanical ventilation should be given priority over hyperbaric oxygen therapy. ", "output": "B"} 
-{"instruction": "Which of the following is inappropriate for common important differences between cervical spine X-rays in children and adults? ", "input": "(A) Normal lordosis may disappear when children are in the supine position or wearing a rigid neck collar. (B) The posterior arch of the first cervical vertebra (C1) fuses at about 3 years of age, and the anterior arch fuses at about 10 years of age. (C) In a 10-year-old child, posterior wedging of the vertebra caused by the secondary growth center may be mistaken for a compression fracture. (D) In ​​a 4-year-old child, a lateral cervical X-ray may show pseudo-subluxation at the C2-C3 position. ", "output": "C"} 
-{"instruction": "Which of the following descriptions and treatments for acute renal cholangitis is less appropriate? ", "input": "(A) If creatinine rises, the patient should be considered to have chronic renal failure or a single kidney, rather than the current obstruction. (B) Nonsteroidal anti-inflammatory drugs, morphines, or Lidocaine IV can all achieve analgesic or symptom relief. (C) The use of Tamsulosin can shorten the time it takes for stones to pass, especially those larger than 5 mm. (D) If a pregnant woman has back pain but ultrasound cannot explain her clinical symptoms, she should be referred to a urologist and obstetrician and gynecologist and have a KUB examination arranged. ", "output": "D"} 
-{"instruction": "A middle-aged male suffers a puncture wound to the neck. His vital signs are stable. Examination reveals that the injury is deep to the cervical dilator muscle (platysma). He has hoarseness, neck tenderness, and subcutaneous emphysema. Computed tomography angiography shows no obvious vascular damage, but laryngotracheal injury is suspected. Which of the following further examinations and treatments is more appropriate? ", "input": "(A) Esophagectomy or esophagoscopy. (B) Upper gastrointestinal tract panendoscopy. (C) Interventional angiography. (D) Color Doppler. ", "output": "B"} 
-{"instruction": "A 30-year-old male returned to Taiwan from Nigeria, West Africa, 14 days ago. He came to the emergency room with persistent fever and headache. The nucleic acid of the new coronavirus was negative. The blood test report showed anemia, jaundice and low platelets. Which of the following treatments is more appropriate? ", "input": "(A) Even if it is not confirmed, combined with clinical symptoms and travel history, the fourth category of legal infectious diseases should be reported within 24 hours. (B) A brain CT should be arranged to correct the low platelet count to more than 20,000/mm³, and a lumbar puncture should be performed. (C) Both thick and thin blood smears should be arranged, of which thin blood smears are more able to confirm the type of infection. (D) Because treatment drugs all have serious side effects, drugs should not be used rashly before a confirmed diagnosis. ", "output": "C"} 
-{"instruction":"A 50-year-old woman goes to the emergency room with vomiting and diarrhea. She says that her food was poisoned with arsenic (arsenic trioxide) a few hours ago. Which of the following statements is less appropriate?", "input": "(A) The most common causes of death from arsenic poisoning are low blood pressure and arrhythmia. (B) An abdominal X-ray may reveal metallic flecks of arsenic. (C) A blood test to measure serum arsenic concentration can determine whether to give the chelating agent Dimercaprol. (D) If a physical examination reveals horizontal lines on the nails - Mees' lines - chronic poisoning should be suspected.", "output": "C"}
-{"instruction": "A 60-year-old male has a history of hypertensive heart disease. He has had exercise-related heart discomfort for 6 years and has had fainting episodes in the past 2 years. He suddenly developed difficulty breathing and gurgling sounds on both sides of the chest. The heart sounds showed Gr. III systolic murmur over right upper sternal border with carotid transmission and paradoxical splitting of S2. Chest X-ray and ECG are shown in the figure. What is the most likely diagnosis for the patient?", "input": "(A) Mitral regurgitation. (B) Aortic stenosis. (C) Hypertrophic obstructive cardiomyopathy. (D) Aortic regurgitation.", "output": "B"} "(A) Mitral regurgitation. (B) Aortic stenosis. (C) Hypertrophic obstructive cardiomyopathy. (D) Aortic regurgitation.", "output": "B"} 
-{"instruction": "A 30-year-old female, 34 weeks pregnant, is brought to the emergency department after a car accident. Ultrasound shows right-sided pneumothorax. Which of the following statements is more appropriate for the management of this patient?", "input": "(A) If a chest tube is considered, choose a 24F or 28F size. (B) The location of the chest tube should be considered at the intersection of the third or fourth intercostal space and the anterior axillary line. (C) When placing a chest tube, it is recommended to make a 1-2 cm skin incision parallel to and at the same level as the target intercostal space. (D) The path of the chest tube should be along the lower edge of the ribs. ", "output": "B"}
-{"instruction": "A 20-year-old woman is about 20 weeks pregnant and has not had regular prenatal checkups. She comes to the hospital with persistent vomiting. Which of the following statements is less appropriate?", "input": "(A) If the diagnosis is hyperemesis gravidarum, it is recommended to give her plenty of water to replenish her body fluids. (B) If the blood glucose level is 180 mg/dL, the possibility of ketoacidosis can be ruled out and she should be treated for hyperemesis gravidarum. (C) If the diagnosis is diabetic ketoacidosis, the insulin pump treatment is similar to that of non-pregnant women. (D) For intractable hyperemesis gravidarum, steroid treatment may be considered.", "output": "B"} 
-{"instruction": "According to research, which of the following risk factors for the elderly becoming victims of abuse or the next generation becoming perpetrators is less appropriate?", "input": "(A) The next generation with high socioeconomic status and busy work are more likely to become perpetrators. (B) Women and elderly people who cannot move independently are more likely to become victims of abuse. (C) The next generation with financial difficulties are more likely to become perpetrators. (D) Elderly residents of nursing homes are more likely to become victims of abuse.", "output": "A"} 
-{"instruction": "Xiao Ming plans to climb Yushan Mountain and is worried about altitude sickness. Which of the following suggestions is more appropriate?", "input": "(A) Dexamethasone can prevent altitude sickness. (B) Acetazolamide can be taken 24 hours before climbing. (C) Acetaminophen has no effect on headaches caused by altitude sickness. (D)Nifedipine is required for high altitude cerebral edema. ", "output": "B"} 
-{"instruction": "Which of the following compounds has the most similar mechanism of action for sarin poisoning? ", "input": "(A)Cyanide. (B)Halothane. (C)Organophosphate. (D)Phosphine. ", "output": "C"} 
-{"instruction": "Which of the following drugs is more likely to cause a false positive urine opioid screen? ", "input": "(A)Chlorpromazine. (B)Levofloxacin. (C)Ibuprofen. (D)Verapamil. ", "output": "B"} 
-{"instruction": "A 50-year-old male with no past medical history presents to the emergency department with fever for several days and upper abdominal pain, nausea and vomiting. Vital signs: temperature 39℃, blood pressure 110/83 mmHg, heart rate 100 beats/min, respiration 20 times/min. Physical examination revealed abdominal tenderness and gum bleeding. Blood test revealed platelet count 70,000/μL, GPT 200 IU/L. If dengue fever is suspected, which of the following is more appropriate? ", "input": "(A) NSAIDs should be used to reduce fever as soon as possible. (B) Ultrasound revealed edema of the gallbladder wall and some effusion next to the gallbladder. A surgeon should be consulted to arrange surgery. (C) Hospitalization is recommended and attention should be paid to whether it develops into a serious condition. If appropriate supportive treatment is not received, the mortality rate can reach 10-20%. (D)Dengue fever is a Category II infectious disease and should be reported within 1 week, and specimens should be collected for testing. ", "output": "C"} 
-{"instruction": "Which of the following statements about odontogenic infection is more appropriate? ", "input": "(A)It is often accompanied by multiple bacterial infections, mainly aerobic infections, and anaerobic infections are uncommon. In addition to antibiotic treatment, surgical drainage and debridement are often required. (B)Manibuli often cause masticator space infection, and the main clinical symptoms are facial pain and clenched jaw. Infections in the masticator space are not easy to spread to other deep neck spaces. (C) Infection of the submandibular, sublingual and submental spaces caused by the mandibular molars is called Ludwig's Angina. The tongue often moves backward due to infection, causing airway obstruction. (D) Ludwig's Angina progresses rapidly. In addition to antibiotic treatment, rapid sequence intubation should be used as soon as possible to establish an airway. ", "output": "C"} 
-{"instruction": "Which of the following causes of hypercoagulable state during pregnancy is less appropriate? ", "input": "(A) Uterine pressure causes venous obstruction. (B) The right iliac vein crosses the right iliac artery. (C) Increased platelet activation. (D) Protein C deficiency. ", "output": "B"} 
-{"instruction": "Which of the following statements most likely represents a patient with hernia combined with strangulation?", "input":"(A) The patient has severe nausea and vomiting. (B) Ultrasound shows thickened intestinal wall and free fluid in the bulge. (C) Doppler ultrasound shows arterial flow in the bulge. (D) Ultrasound shows rapid peristalsis in the bulge.", "output": "B"} 
-{"instruction": "Which of the following CT images is most common in traumatic aortic injury?", "input": "(A) Aortic pseudoaneurysm. (B) Blood clot in the lumen at the site of intimal disruption. (C) Aortic transection. (D) Active bleeding from the aorta to the septal cavity.", "output": "A"} 
-{"instruction": "A 26-year-old woman who is 28 weeks pregnant comes to the clinic because of pain in the lower right side of her belly button. The patient says that she has a persistent feeling of nausea today, but has no fever. Which of the following statements about this patient is more appropriate?", "input": "(A) The incidence of appendicitis in pregnant women is 1.4 times higher than that of ordinary women, and it is easy to be misdiagnosed. (B) In terms of the number of weeks and the location of abdominal pain, the vast majority of appendicitis pain is on the upper right side. (C) If the right kidney is edematous and the white blood cell count in the urine is elevated, it can be treated as a urinary tract infection. (D) If an ultrasound examination is performed and the typical manifestations of appendicitis are seen, surgery is recommended.", "output": "D"} 
-{"instruction": "Which of the following statements about the pathogens of pediatric pneumonia is less appropriate? ", "input":"(A) Mycoplasma pneumoniae: There will be a hacking dry cough. Extrapulmonary manifestations may include central nervous system diseases, joint pain, rash and other skin diseases. (B) Chlamydia trachomatis: Usually the course of the disease is fast and there will be high fever. It may even cause lung abscesses. It often occurs as a secondary infection after influenza infection. (C) Whooping cough pneumonia: Children cough for more than two weeks. Be careful of the risk of whooping cough. (D) Mycobacterium tuberculosis pneumonia: Persistent long-term cough and fever with extrapulmonary manifestations. Children with tuberculosis may not have symptoms of coughing up blood.", "output": "B"} 
-{"instruction": "A 48-year-old male complained of cough, dyspnea and fever for several days. He also had recurrent chronic sinusitis, joint pain, proteinuria and subcutaneous nodules of unknown cause. Chest X-ray showed infiltrations and nodules of varying degrees in both lungs. Which of the following is the more likely diagnosis?", "input": "(A)Hypersensitivity pneumonitis. (B)Sarcoidosis. (C)Wegener's granulomatosis. (D)Goodpasture's syndrome.", "output": "C"}
-{"instruction": "A 30-year-old homosexual male chef had his last sexual intercourse about a month ago. He went to the outpatient clinic for a checkup 2 days ago because of general malaise and loss of appetite. Today, he came to the emergency room because of a sudden fever (38.5℃), vomiting, nausea, and abdominal discomfort. Blood test report from the outpatient clinic: Bilirubin 9.2 mg/dL, AST 2238 U/L, ALT 3806 U/L, Anti-H AV I g M: positive, Anti-H AV I g G: Negative, the following HBcAb IgM, IgG, HBsAb, Anti-HCV are all negative. Which of the following statements is more appropriate?", "input": "(A) It is unlikely that this patient was infected through male-to-male sexual intercourse. (B) According to CDC regulations, this patient can be released from isolation and resume work 14 days after the onset of jaundice. (C) It is recommended that this patient also undergo tests for STDs such as HIV, syphilis, and gonorrhea. (D) When this patient is reported as a "confirmed case", there is no need to collect a stool sample for testing. ", "output": "C"} 
-{"instruction": "Which of the following statements is more appropriate for a patient with severe headache and suspected subarachnoid hemorrhage? ", "input": "(A) The preferred test is a brain CT without contrast, which gradually increases in sensitivity after 24 hours and can reach 98% around the third day. (B) If the CT is normal but the suspicion is still high, MRI can replace lumbar puncture to confirm whether there is subarachnoid hemorrhage. (C) Xanthochromia is caused by the degradation of hemoglobin into bilirubin. Light should be avoided before testing. (D) Within 1 hour after the rupture and bleeding of a brain aneurysm, the CT scan is normal, and the cerebrospinal fluid may show xanthochromia. ", "output": "C"} 
-{"instruction": "A 7-year-old girl went to the emergency department with wheezing, abdominal pain, polyuria, and altered consciousness. During the examination, she was found to be drowsy, pale, with a microvascular refill time of >3 seconds, a body temperature of 37.1℃, a heart rate of 152 beats/min, a respiration rate of 42 breaths/min, a blood pressure of 78/46 mmHg, a K of 4.5 mEq/L, a glucose of 450 mg/dL, a pH of 7.18, and a ketone body of 3.2mmol/L. Which of the following treatments and statements is more appropriate? ", "input": "(A) Insulin 0.1 unit/kg should be given immediately by intravenous injection to correct hyperglycemia. (B) Consider giving 20 mL/kg of 0.9% saline solution rapidly in the first hour. (C) After giving adequate saline infusion, give Insulin 0.04 unit/kg/hr immediately to eliminate ketoacids. (D) The current potassium level in the blood is within the normal range and no potassium supplement is needed. ", "output": "B"} 
-{"instruction": "Which of the following interpretations of pleural effusion is less appropriate? ", "input": "(A) Esophageal rupture may cause an increase in amylase in pleural effusion. (B) Pleural effusions caused by pulmonary embolism may be transudates. (C) Pleural effusions caused by rheumatic arthritis will have elevated glucose. (D) When the pH is less than 7.1, abscesses can be diagnosed and chest tube drainage is an indication. ", "output": "C"} 
-{"instruction": "Which of the following statements about gastrointestinal bleeding is more appropriate? ", "input": "(A) The patient has black stools (melena), and visual observation of nasogastric tube aspirates is coffee-ground, which is not enough to diagnose upper gastrointestinal bleeding. (B) The patient has black stools, which may be slow lower gastrointestinal bleeding. (C) The patient has bloody stools (hematochezia), if hemorrhoids are found during rectal examination and vital signs are stable, he can be referred to the colorectal department for outpatient treatment. (D) The most common cause of vomiting blood in patients with cirrhosis is peptic ulcer bleeding, followed by esophageal varicose vein bleeding. ", "output": "B"} 
-{"instruction": "Which of the following descriptions of the clinical characteristics and diagnostic treatment of elderly trauma is less appropriate? ", "input": "(A) For elderly patients with cervical spine injury, it is recommended to skip X-ray examination and directly arrange CT examination. (B) Excessive extension injury in the elderly may cause central cord syndrome, and motor dysfunction in the upper limbs is more common than in the lower limbs. (C) Cervical and lumbar fractures account for almost half of all osteoporotic fractures, and the second cervical and second lumbar vertebrae are the most common. (D) For elderly patients with mild head trauma and no symptoms who are taking Warfarin or Plavix, contrast-free brain CT will be recommended. ", "output": "C"} 
-{"instruction": "A 50-year-old female complained of weakness in both lower limbs 1 week ago, which then gradually progressed to weakness in the upper limbs and slurred speech. Her vital signs included blood pressure 100/60 mmHg, heart rate 110 beats/min, respiration 30 times/min, SpO₂ 96%. Physical examination revealed decreased deep tendon reflexes (DTR) in all four limbs. Which of the following treatments is less appropriate? ", "input": "(A) If the measured vital capacity is < 15 mL/Kg, endotracheal intubation should be considered. (B) During endotracheal intubation, because muscle relaxants are easily ineffective, it is necessary to consider increasing the dose of succinylcholine to 2-3 mg/Kg. (C) Intravenous immunoglobulin can reduce the course of the disease, but it may increase the risk of thrombosis. (D) The evidence for steroid therapy for this type of disease is weak and may even be harmful. Routine use is not recommended. ", "output": "B"} "(A) If the measured vital capacity is < 15 mL/Kg, endotracheal intubation should be considered. (B) Because muscle relaxants are easily ineffective during endotracheal intubation, it is necessary to consider increasing the succinylcholine dose to 2-3 mg/Kg. (C) Intravenous immunoglobulin can reduce the course of the disease, but it may increase the risk of thrombosis. (D) There is weak evidence for steroid therapy for this type of disease and it may even be harmful. Routine use is not recommended.", "output": "B"} 
-{"instruction": "Which of the following statements about acute exacerbation of chronic obstructive pulmonary disease is more appropriate?", "input": "(A) Antibiotics should be given for increased sputum volume and sputum color change. Sputum bacterial culture is helpful in the selection of emergency antibiotics. (B) A short-term course of steroids for 3 days can shorten recovery time. (C) Oxygen supplementation can help reverse pulmonary vasoconstriction. (D) Gastroesophageal reflux is a risk factor for worsening of COPD, and treating it can reduce worsening of the disease. ", "output": "C"}
-{"instruction": "A 6-day-old newborn is sent to the emergency room because of high fever, lethargy and poor spirits. Which of the following statements is more appropriate? ", "input": "(A) It may be related to maternal or perinatal factors, such as early rupture of membranes, and the course of the disease is usually slower. (B) The threshold for septic workup, such as blood draw, urine test and lumbar puncture, is the same as that for older infants. (C) Antibiotic treatment should be started as early as possible, covering Gram-positive bacteria and intestinal bacteria, but ceftriaxone should be avoided. (D) Clinical manifestations may also include shortness of breath, poor appetite and even vomiting, and Kernig and Brudzinski signs are often present. ", "output": "C"} 
-{"instruction":"Regarding heparin-induced thrombocytopenia, which of the following statements is more appropriate?", "input": "(A) Protamine can be used for treatment after the occurrence. (B) Fondaparinux should not be used for anticoagulation after the occurrence, as the mechanism is similar. (C) A small number of patients will have an allergic reaction within 30 minutes after intravenous injection of Heparin. (D) There is a high bleeding tendency after the occurrence, and platelet transfusions should be given prophylactically.", "output": "C"} 
-{"instruction": "Regarding acute chest pain, which of the following statements is more appropriate?", "input": "(A) An 18-year-old male who used cocaine and had chest pain for 2 days is less likely to have acute coronary heart disease. (B) 64 (C) A 70-year-old woman with diabetes has upper abdominal pain combined with soreness in both arms, which is unlikely to be a heart problem. (D) A 70-year-old man with cirrhosis and long-term alcoholism has chest pain after severe vomiting, so Boerhaave's syndrome should be considered. (D) Acute stroke patients do not affect the heart, so the myocardial index will not rise. ", "output": "C"} 
-{"instruction": "A 45-year-old female with a history of diabetes has had low back pain and lower abdominal distension for 2 days. She has frequent urination but it is not smooth. She has to strain to urinate and she also urinates stool. She also has numbness in the buttocks and inner thighs near the anus. Ultrasound estimates that the residual urine volume is 900 mL and there is mild edema on both sides. Which of the following statements or treatments is less appropriate?", "input": "(A) A urinary catheter should be placed and blood drawn to test kidney function and electrolytes. (B) A check should be performed to see if there is a gynecological mass or pelvic inflammation causing obstruction. (C) If a tumor is suspected to be compressing the nerve, dexamethasone should be given first, and then a lumbar magnetic resonance imaging should be arranged. (D) More than 95% of patients will have reduced anal sphincter tension.", "output": "D"} 
-{"instruction": "A 70-year-old male was transferred to our emergency department one month ago due to atrial fibrillation and infarct stroke. He is expected to stay in hospital for one month for rehabilitation treatment. The patient still needs to be given intravenous medication. Because peripheral intravenous catheters are difficult to place, it is recommended to place a central intravenous catheter. For this patient, the emergency physician chooses the location of the central intravenous catheter. Which one is more appropriate?", "input": "(A) Right internal jugular vein. (B) Right external jugular vein. (C) Right subclavian vein. (D) Right femoral vein.", "output": "A"} 
-{"instruction": "A 15-month-old boy presents to the emergency department with cough, runny nose, and shortness of breath. He is currently afebrile. Physical examination reveals intercostal retractions in the chest and wheezing on auscultation. Which of the following statements regarding the treatment of this patient is inappropriate?", "input": "(A) Administer oxygen therapy if necessary to maintain blood oxygen concentration greater than 90%. (B) Combination therapy with the steroid dexamethasone and epinephrine may reduce hospitalization rates. (C) Treatment with β2 agonists may help reduce hospitalization rates and length of stay. (D) If respiratory distress is present, use of non-invasive positive pressure ventilation (NIPPV) may reduce or delay the need for intubation. ", "output": "C"} 
-{"instruction": "Which of the following statements is more appropriate for performing a spinal tap on a patient suspected of bacterial meningitis? ", "input": "(A) If there is no obvious abnormality in the blood test report and no obvious neurological symptoms, a spinal tap can be performed without a brain CT scan. (B) Spinal tap should be performed after antibiotics are used to avoid affecting bacterial culture. (C) Bacterial meningitis can easily cause an increase in cerebrospinal fluid pressure. It is advisable to perform a brain CT scan as a routine procedure before performing a spinal tap. (D) If the patient is unable to lie on his side, consider doing a spinal tap in a sitting position. The measured cerebrospinal fluid pressures will not differ much. ", "output": "A"} 
-{"instruction": "According to the Interim Guidelines for Clinical Management of Novel Coronavirus (SARS-CoV-2) Infection (17th Edition, April 19, 2022) issued by the Taiwan Centers for Disease Control, which of the following adults infected with the novel coronavirus can be classified as having severe pneumonia? ", "input": "(A) Fever or respiratory infection, combined with a respiratory rate of 26 times/min. (B) Fever or respiratory infection, combined with a blood oxygen saturation of 94% under room air. (C) Fever or respiratory infection, combined with a chest X-ray lung infiltration of 40%. (D) Fever or respiratory infection, combined with severe respiratory distress PaO 2/FiO 2=350. ", "output": "B"} 
-{"instruction": "A 70-year-old male patient has a history of diabetes. His anus has been swollen and itchy in the past few days. Whenever he defecates, the swollen material comes out of his anus, but he can push it back by himself. Fresh blood is found on the toilet paper. Which of the following statements is more appropriate? ", "input": "(A) This patient may have anal varicose veins. Pay attention to whether he has portal hypertension. (B) This patient can be advised to take a warm water (30℃) sitz bath and give him a laxative before leaving the emergency room. (C) This patient can be advised to use local Nifedipine (0.3%) and Lidocaine (1.5%) gel to relieve symptoms. (D) This patient can be advised to drink more water and eat low-fiber foods to make defecation easier. ", "output": "C"} 
-{"instruction": "Which of the following drugs is less likely to interact with grapefruit juice? ", "input": "(A)Amiodarone. (B)Calcium channel blocker. (C)Carbamazepine. (D)Theophylline. ", "output": "D"} 
-{"instruction": "An 82-year-old male presented with widespread abdominal pain that began 2 hours ago and did not radiate to the back, along with severe nausea and multiple episodes of bilious vomiting. The patient had no history of heart disease and his electrocardiogram was normal. Which of the following statements is more appropriate? ", "input": "(A)The most likely diagnosis for this patient is large bowel obstruction. (B) Due to the patient's age, the criteria for evaluating whether to accept imaging examinations should be stricter to avoid excessive contrast agents and radiation damage. (C) The patient's serum Lactate value is normal, but the possibility of acute mesenteric ischemia cannot be ruled out. (D) Opioid analgesics can reduce gastrointestinal motility, leading to an increase in the patient's mortality rate. ", "output": "C"} 
-{"instruction":"Which of the following descriptions of common symptoms of vision loss is less appropriate?", "input": "(A) Acute angle-closure glaucoma is sudden vision change and unilateral eye pain and headache. (B) Uveitis is gradual vision change and pain. (C) Vitreous hemorrhage is sudden painless vision change. (D) Central retinal artery occlusion (CRAO) is ischemic pain and sudden vision change.", "output": "D"} 
-{"instruction": "A 70-year-old male sought emergency treatment for general weakness. Blood tests revealed BUN 84 mg/dL, Creatinine 2.5 mg/dL, Na 143 mEq/L, and K 4.0 mEq/L. Which of the following statements about this patient is inappropriate? ", "input": "(A) The cause of the disease may be low blood volume, low blood pressure, high blood calcium, and microvascular thrombosis. (B) Improper use of NSAIDs, ACEIs, ARBs, etc. may also aggravate this condition. (C) The size of the kidney measured by ultrasound is about 12 cm, and it is speculated that the patient may be a CKD patient. (D) For fluid replenishment, lactate ringer may be more suitable than normal saline. ","output": "C"} 
-{"instruction": "Which of the following statements about postoperative complications in urology is more appropriate?", "input": "(A) Urinary tract infection is the most common complication of transurethral resection of the prostate. (B) After transurethral resection of the prostate, if blood clots block the prostate and cause acute urinary retention, it is almost always necessary to contact the urology department and arrange for the patient to be hospitalized. (C) After transurethral resection of the prostate, if blood clots block the prostate and the patient uses saline for bladder irrigation, blood tests are required to check for low sodium levels. (D) If acute urinary retention occurs after artificial urinary sphincters, a urethral catheter should not be placed.", "output": "D"}
-{"instruction": "A 70-year-old male with a history of diabetes underwent right thoracotomy two weeks ago. He went to the emergency department today with fever, dyspnea, and severe chest pain on inspiration. A chest X-ray showed a moderate right pleural effusion, which was aspirated with a fine needle and found to be purulent material. Which of the following statements is more appropriate for the diagnosis and management of this patient?", "input": "(A) The most common possible pathogen in this patient is S. pneumococcus. (B) The diagnostic criteria for empyema include a pleural fluid glucose level greater than 40 mg/dL and an LDH level greater than 1,000 U/L. (C) The pH value of pleural fluid is 6.9, which can strengthen the diagnosis. (D) The preferred antibiotics are amoxicillin/clavulanate. ", "output": "C"} 
-{"instruction": "A 26-year-old doctor was pierced on his index finger by the suture needle while suturing a wound for a patient. The patient's blood test showed: HIV antibody test was positive, HBsAg was negative, and anti-HCV was positive. The doctor has never been vaccinated against hepatitis B. Regarding the occupational exposure treatment of this doctor, which of the following is more appropriate? ", "input": "(A) Disinfectants should be used to disinfect the wound. (B) Condoms should be used during sexual intercourse within six to twelve weeks. (C) He should receive hepatitis B immune globulin (HBIG) treatment. (D) Should receive antiviral treatment for hepatitis C. ", "output": "B"} 
-{"instruction": "A 4-year-old boy was brought to the emergency room in kindergarten because of frequent diarrhea, poor appetite, and decreased mental activity. Which of the following statements is more appropriate? ", "input": "(A) In case of hypoglycemia, ketone bodies in blood or urine should be checked. (B) Oral fluid replenishment is not effective in reducing mortality. (C) Oral fluid replenishment should be diluted by half because sports drinks have high sugar content. (D) If dehydration and shock occur, 20 ml/kg of normal saline can be given by drip for 1 hour, repeated three times until there is an initial response. ", "output": "A"} 
-{"instruction": "A 50-year-old male presents to the emergency department with 3 days of redness and swelling around a wound on his left lower limb, combined with fever. The patient has no past medical history and is a farmer by occupation. 7 days ago, he accidentally injured his left foot while working, resulting in a 2-cm laceration. The patient did not take it seriously and continued to work and soaked the wound in wet soil. Which of the following options is more appropriate regarding the bacterial species that infected this patient?", "input": "(A) Vibrio vulnificus. (B) Aeromonas hydrophila. (C) Pseudomonas aeruginosa. (D) Pasteurella species.", "output": "B"} 
-{"instruction": "Which of the following options is less appropriate regarding the identification and management of acute agitation? ", "input": "(A) Elderly patients with acute agitation need to be carefully assessed for their state of consciousness. If their consciousness and cognitive functions change rapidly, their course fluctuates, their attention is poor, and their alert level of consciousness or disorganized thinking is poor, then they meet the diagnosis of delirium in the Confusion Assessment Methods. (B) If the agitated patient has a long-term habit of drinking strong alcohol and suddenly stops drinking in the past two days for some reason, and the agitation is also manifested by sympathetic nervous system overexcitement and tremors, alcohol withdrawal should be considered, and adequate doses of benzodiazepines should be given to prevent the occurrence of delirium tremens. (C) If an acutely agitated patient also exhibits psychotic symptoms, such as visual hallucinations, auditory hallucinations, or persecutory delusions, an antipsychotic may be used as an acute sedative; if there are no obvious psychotic symptoms but the patient is agitated or irritable, benzodiazepines may be considered. (D) The primary treatment principle for elderly patients with delirium is to identify and treat the cause of the delirium, and sedatives should be selected from benzodiazepines, antihistamines, or muscle relaxants as much as possible. ", "output": "D"} 
-{"instruction": "A young person used a laughing gas (N2O) balloon for the first time at a party and was sent to the emergency room with delirium, agitation, and inability to calm down. Which of the following treatments is more appropriate? ", "input": "(A)Benzodiazepines (BZD) can be given to reduce delirium. (B)Vitamin B 12 treatment is not necessary. (C)If hypoxemia persists after oxygen administration, hyperbaric oxygen therapy should be considered. (D)If hypotension occurs, norepinephrine drip should be given as a priority. ", "output": "B"} 
-{"instruction": "Which of the following pathogens is more likely to cause pneumonia in patients within three months after liver transplantation? ", "input": "(A)Haemophilus influenzae. (B)Moraxella catarrhalis. (C)Staphylococcus aureus. (D)Streptococcus pneumoniae. ", "output": "C"} "output": "C"} 
-{"instruction": "A middle-aged male was found lying at the entrance of a subway station for an unknown period of time. His fingertip blood sugar level was 130 mg/dL. He had a distinct smell of alcohol, but no needle marks. He was unable to focus on answering questions. GCS E3V4M5, blood alcohol concentration was 150 mg/dL. Which of the following statements is more appropriate?", "input": "(A) ABG pH 7.10, HCO₃ 10 mmol/L, Ketone 3 +, Lactate negative, insulin treatment was given. (B) ABG pH 7.10, HCO₃ 10 mmol/L, Ketone negative, Lactate negative, intravenous infusion treatment was given. (C) After being observed in the emergency department for 24 hours, a seizure suddenly occurred and Lorazepam injection treatment was given. (D) If the patient has not regained consciousness after 24 hours of observation in the emergency department, intravenous infusion therapy should be given. ", "output": "C"}
-{"instruction": "Which of the following descriptions of enterovirus is more appropriate? ", "input": "(A)The virus that causes herpetic pharyngitis is mainly coxsackie B virus. (B)Children are less at risk of enterovirus infection than adults, so most children have mild enterovirus disease. (C)Patients are contagious before they show symptoms, but they will not excrete the virus for a long time after infection. (D)Enterovirus can pass through the placenta and cause vertical transmission from mother to fetus. ", "output": "D"} 
-{"instruction": "Which of the following descriptions of foreign bodies in the ears, nose and throat are more appropriate? ", "input":"(A) If the foreign body in the ear is a button battery, it is recommended to go directly to the ENT. (B) If a large bug gets into the ear canal, you can first try to remove it with an instrument. (C) If 
-there is inflammation after removal, oral antibiotics can be used. (D) Intravenous injection of Midazolam in children facilitates the removal of foreign bodies.", "output": "A"} {"instruction": "Which of the following medications has adverse effects on pregnant women and fetuses?", "input": "(A) Lithium salts can cause fetal brain neurological abnormalities. (B) Tetracyclines can cause fetal bone abnormalities. (C) Fluoroquinolones can cause fetal cartilage abnormalities. (D) Angiotensin-converting enzyme inhibitors can cause oligohydramnios.", "output": "A"}
-{"instruction": "A 68-year-old male with a history of alcoholic cirrhosis and diabetes mellitus is admitted to the emergency department with a large mouthful of blood (approximately 500 ml). Which of the following related treatments is more appropriate?", "input": "(A) It is unreliable to quickly determine that there is upper gastrointestinal bleeding based on the presence of blood-red or brown liquid in the vomitus. (B) The blood test shows hemoglobin of 8.0 g/dL. No blood transfusion is required at this time. Vital signs and the amount of bleeding can be observed first. (C) Antibiotic treatment should be given as soon as possible to prevent infection and reduce recurrence of bleeding. (D) The use of balloon tamponade is only a temporary treatment for varicose vein bleeding and is no longer recommended for emergency use.", "output": "C"} 
-{"instruction": "A 37-year-old female with a history of mental illness who was taking medication to control her condition was sent to the emergency room because of confusion. When she arrived at the hospital, she was found to have high temperature, high blood pressure, rapid heartbeat, sweating, muscle twitching (myoclonus), and increased reflexes (hyperreflexia). Based on the patient's condition, which of the following is more appropriate?", "input": "(A) The patient should be taking antipsychotic drugs to cause neuroleptic malignant syndrome. (B) Bromocriptine can be used to reduce fever and body stiffness, but it may cause high blood pressure. (C) Most patients may recover after 24 hours, and the most common cause of death is severe hyperthermia. (D) Dantrolene can be used to reduce temperature and treat muscle stiffness, reducing the mortality rate.", "output": "C"} 
-{"instruction": "Which of the following interpretations of pleural effusion is less appropriate?", "input": "(A) Esophageal rupture may cause elevated amylase in pleural effusion. (B) Pleural effusion caused by pulmonary embolism may be transudates. (C) Pleural effusion caused by rheumatoid arthritis will have elevated glucose. (D) Pleural effusion caused by cancer will have mainly lymphocytes.", "output": "C"} 
-{"instruction": "Regarding neck trauma, which of the following is less appropriate?", "input": "(A) Coughing is not a hard sign of neck strangulation. (B) Up to 20% of puncture wounds of the neck are accompanied by pneumothorax or hemothorax. (C) If the neck is overstretched due to sudden acceleration and deceleration, be careful of esophageal injury. (D) Neck puncture wounds that do not penetrate the cervical platysma are usually not life-threatening. ", "output": "A"} 
-{"instruction": "Which of the following oral hypoglycemic drugs is more likely to cause euglycemic ketoacidosis? ", "input": "(A) Biguanides, such as Metformin. (B) Sulfonylureas, such as Glimepiride. (C) DPP4 Inhibitors (Dipeptidyl peptidase-4 inhibitor), such as Sitagliptin. (D) SGLT2 Inhibitors (Sodium-Glucose Cotransporter 2 Inhibitors), such as Dapagliflozin. ", "output": "D"} 
-{"instruction": "A 37-year-old American male with a history of conservatively treated diverticulitis of the descending colon presents with fever and left lower abdominal pain. His vital signs are stable, and he has no vomiting, diarrhea, or urinary discomfort. Physical examination is characterized by local tenderness in the left lower abdomen, without rebound tenderness or signs of peritonitis. Laboratory tests show WBC 8,300/µL, Hb 13.5 g/dL, creatinine 0.8 mg/dL, and CRP 12 mg/d L. Which of the following is inappropriate regarding this patient's description? ", "input": "(A) Because the patient's symptoms are similar to those of previous diverticulitis, imaging studies are not necessary. (B) The location of the patient's diverticulitis is consistent with current worldwide epidemiological statistics. (C) Metronidazole plus Aztreonam is one of the reasonable antibiotic options. (D) The role of procalcitonin in guiding the use of antibiotics for diverticulitis is still unclear. ", "output": "C"} 
-{"instruction": "Which of the following drugs commonly used by transgender people and their side effects is more appropriate? ", "input": "(A) Testosterone users do not need to take a pregnancy test during clinical examinations because of its contraceptive properties. (B) 17-β-Estradiol increases the production of coagulation factors, leading to an increased risk of venous thromboembolism. (C) Adult female transgender people often use the drug spironolactone, which may cause side effects such as high blood potassium, low blood pressure, and increased urination. (D) Testosterone use can cause leukocytosis, which in turn increases the risk of cerebrovascular disease and thrombotic disease. ", "output": "B"} 
-{"instruction": "Which of the following statements about pediatric headaches is more appropriate? ", "input": "(A) Children's brain tumors most often grow in the midcranial fossa, and MRI can provide a better diagnosis. (B) Children's migraines are more often pulsating than adults'. (C) Children's cluster headaches occur more often than adults'. (D) Ketorolac, Prochlorperazine and Diphenhydramine can be used in combination with cocktail therapy for migraines. ", "output": "D"}"(A)APACHE II score ≤ 8. (B)Ranson score ≧ 3. (C)Serum creatinine > 2mg/dL, before fluid resuscitation. (D)Serum calcium ≦ 7.5 mg/dL.", "output": "C"} 
-{"instruction": "A 19-year-old female complained of being sexually assaulted in a bar 3 days ago. Which of the following is more appropriate?", "input": "(A)Syphilis, hepatitis B, hepatitis C, and HIV should be tested. (B)The antibiotics Ceftriaxone and doxycycline should be used prophylactically. (C)Levonorgestrel is more effective than Ulipristal acetate for contraception. (D)Antiemetics do not need to be used concurrently with emergency contraceptives.", "output": "A"}"output": "D"} 
-{"instruction": "A 25-year-old male patient with acquired immune deficiency syndrome developed fever and fatigue. He later went to the emergency room with a rash and blisters on his genitals and perineum and enlarged inguinal lymph nodes. Which of the following statements is more appropriate?", "input": "(A) It may be caused by an infection with an orthopoxvirus. This case is unlikely to become a serious illness. (B) The infectious period of this disease is from 5 days before the rash appears until all lesions have crusted over. (C) The principle for handling suspected cases of this disease is to admit them to a single room with an independent bathroom in the hospital. (D) According to the recommendation of the CDC, antiviral drugs are not required in this case.", "output": "C"}
-{"instruction": "The severity of acute pancreatitis is very important for the subsequent treatment and prognosis of patients. According to the Atlanta criteria, the following indicators can all predict severe pancreatitis, except which one?", "input": "(A)APACHE II score ≤ 8. (B)Ranson score ≧ 3. (C)Serum creatinine > 2mg/dL, before fluid resuscitation. (D)Serum calcium ≦ 7.5 mg/dL.", "output": "C"} 
-{"instruction":"An 84-year-old male was brought to the emergency room by his family. He complained of inattention, incoherent speech, nighttime hyperactivity and daytime sleepiness over the past two days. His temperature was 37.6℃, his heart rate was 115 beats/min, and his blood pressure was 154/96 mmHg. Which of the following statements is more appropriate?", "input": "(A) Delirium can be divided into hyperactive, hypoactive and mixed types, of which hyperactive is the most common. (B) Compared with dementia, delirium is less likely to produce visual and auditory hallucinations. (C) Avoid using antihistamines on this patient to prevent worsening of symptoms. (D) The patient continues to be agitated and exhibits disorganized behavior in the emergency room. Short-acting benzodiazepines are the first choice for treatment. ", "output": "C"}
-{"instruction": "Which of the following statements about early arrhythmias after acute myocardial infarction is more appropriate?", "input": "(A) The presence of sinus bradycardia is associated with a higher mortality rate. (B) When complete AV block occurs, the use of temporary pacing can reduce mortality. (C) Persistent sinus tachycardia is associated with a poor prognosis. (D) The presence of ventricular tachycardia indicates a poor prognosis.", "output": "C"} 
-{"instruction": "A 55-year-old male patient was transferred to our hospital after emergency intubation at another hospital due to massive hemoptysis and respiratory failure. He was found to have a temperature of 36°C, heart rate of 110 beats/min, blood pressure of 120/80 mmHg, and blood oxygen concentration of 86%. He was also found to have persistent respiratory bleeding. Bedside X-ray showed obvious infiltration of the left lung, and the tip of the endotracheal tube was 3 cm above the tracheal carina. Which of the following treatments is less appropriate?", "input": "(A) Place the patient on his right side. (B) Continue to push the endotracheal tube into the right main bronchus. (C) Arrange bronchoscopy to locate the bleeding site. (D) If bronchoscopy fails to stop the bleeding, arrange bronchial artery embolization.", "output": "A"} 
-{"instruction": "A 60-year-old male with a history of hepatitis B and cirrhosis who has not been followed up regularly presents with fever, abdominal distension, and delayed reactions. Laboratory tests show WBC 6,700/µL, Hb 11.5 g/dL, ALT 47 U/L, creatinine 3.7 mg/dL, T-bil 3.7 mg/dL, and Ammonia 130 µg/dL. Bedside ultrasound shows signs of ascites. Which of the following statements about this patient is inappropriate?", "input": "(A) Runyon criteria can help identify the source of infection in this patient. (B) HBeAg and HBV DNA can be tested to detect viral replication. (C) Albumin and vasoactive drugs can be used for treatment. (D) In ​​addition to Lactulose, oral Neomycin can also be used as an adjuvant treatment. ", "output": "D"} 
-{"instruction": "A 45-year-old male patient underwent cardiac catheterization for myocardial infarction one month ago. Today he went to the emergency room for fever, weakness, and chest pain. Body temperature 38℃, blood pressure 100/60mmHg, heart rate 120 beats/min. Echocardiogram showed some pericardial effusion, electrocardiogram showed no new changes, and chest X-ray showed some pleural effusion but no pneumonia. Which of the following treatments is more appropriate? ", "input": "(A) Perform pericardial aspiration. (B) Give antibiotics immediately. (C) Arrange cardiac catheterization. (D) Give high doses of Aspirin and Colchicine. ", "output": "D"} 
-{"instruction": "Which of the following statements about thyroid storm is less appropriate? ", "input": "(A) According to Burch and Wartofsky's diagnostic criteria, six major items need to be scored, including body temperature, central nervous system assessment, gastrointestinal symptom assessment, heart rate, degree of heart failure and whether there is atrial fibrillation. (B) Continuing from the above description, as long as the total score is greater than 8 points, thyroid storm can be suspected. (C) In terms of treatment, Propylthiouracil (PTU) or Methimazole can be used to reduce the synthesis of thyroid hormone. Methimazole should be avoided in the first trimester. (D) Treatment with iodine, such as Lugol solution, must be given after giving Thionamides. ", "output": "B"} 
-{"instruction": "A 26-week pregnant woman has proteinuria during prenatal check-up, complains of dizziness, blurred vision, and convulsions. Her current consciousness is GCS E3V5M5, blood pressure 197/115 mmHg, heart rate 105 beats/min, respiration 20 times/min, SpO₂ 99%. Which of the following is less appropriate? ", "input": "(A) Give Magnesium sulfate 4~6 g, and continue 2 g every hour for 24 hours. (B) Arrange a brain CT scan. (C) Give Labetalol 5 mg IV, re-evaluate and repeat the medication after 20 minutes. (D)Administering corticosteroids can help delay delivery and improve fetal outcomes. ", "output": "C"} 
-{"instruction": "A 33-week pregnant woman has sudden lower abdominal cramps and bloody transparent vaginal discharge. Which of the following is inappropriate? ", "input": "(A)The fetal heart rate is 103 beats/min, which is already fetal distress. The woman should lie on her left side, receive intravenous fluids, and be given oxygen. (B)Before doing a bimanual pelvic examination, ultrasound should be used to rule out placenta previa. (C)When using a speculum examination, lubricants should not be used to avoid affecting the test results. (D)The vaginal fluid was tested with a test strip and the pH value was 5, which is suspected to be amniotic fluid rupture. ", "output": "D"} 
-{"instruction": "Using the National Emergency X-radiography Utilization Study (NEXUS) criteria to evaluate patients with cervical spine injuries, in which of the following cases would the patient's collar be considered for removal? ", "input": "(A) Pain caused by neck movement. (B) Injury caused by high-speed impact. (C) Injury caused by toxic substances and alcohol reactions. (D) Altered mental status. ", "output": "B"} 
-{"instruction": "Requesting a medical evacuation of an intubated and chest-tubed trauma patient, which of the following pre-flight actions would be inappropriate? ", "input":"(A) The endotracheal tube's cuff is deflated before it is lifted into the air. (B) The FiO2 of the ventilator is set to 100%. (C) A chest tube is drained using a Heimlich valve or connected to a suction. (D) A nasogastric or orogastric tube is placed for drainage.", "output": "A"} 
-{"instruction": "A 24-year-old female returned to Taiwan 2 days ago after a honeymoon trip to Southeast Asia. She presented with symptoms of nausea, diarrhea, and bloody stools. Vital signs were examined: temperature 37.7℃, heart rate 110 beats/min, respiration 18 breaths/min, blood pressure 105/75 mmHg. After preliminary questioning and physical examination, the patient was unable to determine the last menstrual period. Which of the following is more appropriate?", "input": "(A) Oral rehydration with an electrolyte solution containing glucose and lactose is recommended. (B) Loperamide can be used in combination with antibiotics to improve the condition and is suitable for patients with diarrhea, mucus and bloody stools. (C) Probiotics and Proton pump inhibitors are safe and beneficial when used together with supplemental infusion therapy. (D) After confirming that there are no other contraindications, the first choice of antibiotic is Azithromycin 1,000mg taken once. ", "output": "D"}
-{"instruction": "A 55-year-old male patient with no past medical history has right-sided pneumonia on chest X-ray. Based on the risk assessment of pneumonia severity, which of the following statements is less appropriate?", "input": "(A) Pneumonia Severity Index is superior to CURB-65 rule in assessing risk and recommending hospitalization. (B) CURB-65 assesses BUN in the blood, while Pneumonia Severity Index assesses creatinine. (C) If the calculated CURB-65 rule score is 1, outpatient treatment can be considered. (D) If the calculated Pneumonia Severity Index is class II, outpatient treatment is recommended.", "output": "B"} 
-{"instruction": "The patient was unconscious after a severe blow to the head. He had large hematomas on his forehead and top of the head, and blood in his ears and nose. Neurological examination revealed bilateral pinpoint pupils, decorticate rigidity, and positive Babinski's signs on both sides. Which of the following is the most likely cause of this injury?", "input": "(A) Central transtentorial herniation. (B) Cerebellotonsillar herniation. (C) Uncal transtentorial herniation. (D) Upward posterior fossa herniation.", "output": "A"} 
-{"instruction": "A tourist was bitten on the right lower limb by an unknown fish while diving in Kenting. Which of the following treatments is less appropriate?", "input": "(A) Apply topical Lidocaine for pain relief. (B) Soak the affected limb in room temperature water at 20℃ to 30℃. (C) Wash the wound with seawater. (D) Take Fluoroquinolone orally.", "output": "B"} 
-{"instruction": "A 2.5-month-old male baby, born at full term, was brought to the emergency department by his parents because of vomiting for four days. Which of the following statements is more appropriate?", "input": "(A) Upper GI tract contrast study can help with differential diagnosis. (B) If the vomitus has bile color, congenital pyloric stenosis should be considered. (C) If it is congenital pyloric stenosis, the patient is prone to dehydration and is prone to acidosis in the early stages of the disease. (D) If abdominal ultrasound reveals congenital pyloric stenosis, the patient should be referred to the surgical department for emergency surgery. ", "output": "A"} 
-{"instruction": "Which of the following statements is more appropriate for the treatment of acute groinitis? ", "input": "(A) If an abscess needs to be drained, routine bacterial culture is required. (B) It contains both aerobic and anaerobic bacteria, and antibiotics must be given routinely. (C) Routine X-rays are required to rule out foreign bodies or fractures. (D) During drainage, the nail does not need to be completely removed, partial removal is sufficient. ", "output": "D"} 
-{"instruction": "Which of the following statements is less appropriate for acute lower back pain? ", "input": "(A) If the patient's medical history and physical examination do not show obvious risk factors, conservative treatment can be used and no diagnostic tests are required in the emergency department. (B) If the patient has urinary retention of more than 500 ml, he or she should be referred to a neurosurgeon for follow-up examinations. (C) Neurogenic claudication will improve with extending the spine and worsen with forward flexing. (D) If symptoms of Cauda equina syndrome are present, urinary retention is most common. ", "output": "C"} 
-{"instruction": "Which of the following is more suitable for emergency thoracotomy? ", "input": "(A) A 75-year-old male was stabbed in the left chest with a utility knife by a neighbor. He was sent to the hospital and had an asystole. E-FAST showed no pericardial effusion. (B) A 39-year-old female, 24 weeks pregnant, was stabbed in the left chest with a kitchen knife. She became PEA after entering the emergency room. (C) A 57-year-old male was thrown out of the car in a car accident. He had a deep laceration on his chest and bubbles continued to come out of the wound. The scene was an asystole. (D) A 25-year-old female was in a motorcycle accident. She had an obvious large right chest contusion. She had no spontaneous heartbeat and breathing from the scene to 20 minutes after being sent to the hospital. ", "output": "B"} 
-{"instruction": "The patient has long-term hip pain and may suffer from Paget's Disease. Which of the following tests is more appropriate? ", "input": "(A) Serum calcium concentration. (B) Serum vitamin D concentration. (C) Serum alkaline phosphatase concentration. (D) Serum parathyroid hormone concentration. ", "output": "D"} 
-{"instruction": "Which of the following statements is less appropriate for the treatment of acute exacerbations in patients with asthma? ", "input": "(A) Rapid-onset β2-adrenergic agonists are recommended for the treatment of all severe cases of acute bronchospasm. (B) Inhaled ipratropium bromide is used for patients with moderate to severe exacerbations to reduce their likelihood of hospitalization. (C) Giving corticosteroids injections in the emergency department can reduce the hospitalization rate of patients with seizures. (D) After the first-line treatment fails, intravenous injection or inhalation of epinephine can be used as a second-line treatment. ", "output": "D"}"(A) This patient's mean arterial pressure (MAP) is 164 mmHg and his cerebral perfusion pressure (CPP) is 78 mmHg. (B) This patient's mean arterial pressure is 180 mmHg and his cerebral perfusion pressure is 94 mmHg. (C) Under normal circumstances, autoregulation can be adjusted to accommodate a CPP of 50-120 mmHg. CPP < 50 mmHg is considered to be the lower limit of human autoregulation. (D) Increased intracranial pressure can cause the Cushing reflex, which includes hypertension, bradycardia, and shallow tachypnea.", "output": "A"} 
-{"instruction": "Which of the following statements about pericardial tamponade and pericardiotomy is more appropriate?", "input": "(A) Blunt heart rupture is rare. Traumatic tamponade is best treated with apical pericardiocentesis. (B) The most typical sign on cardiac ultrasound is right heart collapse. During diastole, the right atrium presses inward, and during systole, the right ventricle presses inward. (C) Right atrial collapse is more sensitive to cardiac tamponade than right ventricular collapse, and left atrial collapse is the latest finding. (D) Characteristics of different pericardiocentesis methods. The apical method is less likely to cause pneumothorax than the subcostal method.", "output": "C"}"(A) Rapid-onset β2-adrenergic agonists are recommended for the treatment of all severe cases of acute bronchospasm. (B) Inhaled ipratropium bromide is used for patients with moderate to severe exacerbations to reduce their likelihood of hospitalization. (C) Corticosteroids given in the emergency department can reduce the hospitalization rate of patients with exacerbations. (D) Epinephine intravenous injection or inhalation can be used as a second-line treatment after first-line treatment fails.", "output": "D"} 
-{"instruction": "A 10-year-old boy is brought to the emergency department by his parents because of right scrotal pain. You suspect it is appendage torsion. Which of the following statements does not support your diagnosis?", "input": "(A) The "blue dot" is seen on the right side of the scrotum. (B) High riding testis on the right side. (C) Testicular blood flow is normal under Color Doppler ultrasound. (D) Physical examination revealed that the pain point is limited to the upper part of the right testis. ", "output": "B"}
-{"instruction": "A patient with head trauma has a blood pressure of 228/132 mmHg and an intracranial pressure (ICP) of 86 mmHg. Which of the following statements is more appropriate?", "input": "(A) The patient's mean arterial pressure (MAP) is 164 mmHg and the cerebral perfusion pressure (CPP) is 78 mmHg. (B) The patient's mean arterial pressure is 180 mmHg and the CPP is 94 mmHg. (C) Under normal circumstances, autoregulation can be adjusted to accommodate a CPP of 50-120 mmHg. CPP < 50 mmHg is considered to be the lower limit of human autoregulation. (D) Increased intracranial pressure will cause the Cushing reflex. , including high blood pressure, bradycardia and shallow breathing. ", "output": "A"} 
-{"instruction": "A 70-year-old man was bitten on his right foot by an unknown snake while picking bamboo shoots in the mountains. Which of the following treatments is less appropriate? ", "input": "(A) If there is no local swelling, but there is local numbness or muscle weakness, you can consider injecting antivenom. (B) If there is local swelling, tissue necrosis or neurological symptoms, you can consider injecting antivenom. (C) If there is local swelling, obvious bruising, a small amount of blood blisters, and the coagulation function is generally normal, you can consider injecting antivenom. (D) If there is local swelling, obvious bruising, multiple blood blisters, PT and APTT is prolonged, and platelets are significantly decreased. Consider administering snake venom serum. ", "output": "C"} 
-{"instruction": "A 25-year-old HIV male has coughed for a week and has a mild fever. He comes to the hospital for treatment. X-ray shows infiltration of the right upper lung, which is suspected of pulmonary tuberculosis. Which of the following treatment statements is more appropriate? ", "input": "(A) Interferon γ release assays (IGRAs) are helpful for diagnosis. (B) Patients are more likely to see tuberculosis bacteria in sputum smears due to immunodeficiency. (C) The diagnostic sensitivity of the nuclear acid amplification test (NAAT) is higher than that of sputum smears. (D) No diagnosis is required. Empirical anti-tuberculosis drugs should be given in the emergency department first, and then outpatient follow-up should be arranged. ", "output": "C"} 
-{"instruction": "A 78-year-old male with a history of hypertension and arrhythmia complained of blood-streaked cough for the past two days and coughed up about 600 mL of blood half an hour before visiting the emergency department. The patient was conscious but weak, with 22 breaths/min, blood pressure 86/46 mmHg, and heart rate 137 beats/min but irregular. Chest X-ray showed infiltration in the left lower lung field. Which of the following statements is more appropriate?", "input": "(A) Give continuous positive pressure oxygen to correct hypoxia. (B) Inform the thoracic surgeon to perform an emergency thoracotomy. (C) Insert a large-caliber endotracheal tube deep into the right mainstem bronchus. (D) A fiberoptic bronchoscope is more suitable for hemostasis than a rigid bronchoscope. ", "output": "C"} 
-{"instruction": "In summer, the beach is always full of people playing in the water. Which of the following emergency patients should be treated appropriately? ", "input": "(A) An 8-year-old boy fell on a reef and suffered a 5-cm laceration on his left calf. He was sutured in the emergency room. (B) A 24-year-old woman was stung by a jellyfish on her right calf. She was first given ice to relieve the pain. (C) A 30-year-old man stepped on a sea urchin and had several spines inserted into the sole of his foot. He was given local anesthesia to remove the spines. (D) A 42-year-old woman was stung by a jellyfish on her left forearm. She applied glacial acetic acid to the local wound. ", "output": "C"} 
-{"instruction": "Which of the following is more appropriate for the treatment of trauma during pregnancy? ", "input": "(A)Because pregnant women may begin to show signs of shock when their fluid loss is relatively small, the amount of fluid infusion for resuscitation should be reduced to 50-75% of the normal level. (B)If a pregnant woman's heart stops for more than 7 minutes and the fetus is older than 24 weeks, an emergency cesarean section should be considered. (C)The order of primary assessment for pregnant women is different from that for non-pregnant women, and circulation should be placed first. (D)If the pH value of vaginal secretions of a pregnant woman is 7 at the time of trauma, it is reasonable to suspect that the pregnant woman has broken water. ", "output": "D"} 
-{"instruction": "A gangster attacked passers-by with a sharp knife. Four stabbed victims with stable vital signs were sent to the emergency room. Which of the following is less appropriate? ", "input": "(A) A puncture wound on the back of the neck, no neurological symptoms, do not use a neck collar to fix the neck to avoid covering up changes in the neck injury. (B) A puncture wound next to the navel, it is recommended not to explore the wound in the emergency department. (C) Two puncture wounds on the back of the waist, it is not recommended to explore the posterior waist wound in the emergency department. (D) A puncture wound on the right chest, the wound leaks gas with breathing, it is not recommended to place a chest tube for drainage from the wound. ", "output": "B"} 
-{"instruction": "A 4-year-old girl developed a persistent foreign body sensation after eating chicken. The parents tried to let the patient drink water, but it caused severe coughing. Which of the following statements is more appropriate? ", "input": "(A) If there is food obstruction in the esophagus, the esophageal wall can secrete mucus, which can relieve the obstruction by itself after lubrication. There is no need to force yourself to drink water to avoid choking. (B) In the physiological and anatomical structure of the esophagus, adults have three strictures; children are smaller and have four strictures. (C) If the medical history clearly shows that it is a protein obstruction, consider taking protein enzymes to soften the meat mass. (D) If imaging examinations reveal suspected small amounts of bone fragments in the esophageal food mass, a gastroscopy should be arranged within 24 hours. ", "output": "D"} 
-{"instruction": "A 38-year-old woman presents to the emergency department with a one-week history of pain in the anterior right thigh that is aggravated by tight clothing and exercise. She denies any trauma or surgery to the area. Which of the following is the most likely diagnosis? ", "input": "(A) Lateral femoral cutaneous nerve entrapment. (B) Obturator nerve entrapment. (C) Ilioinguinal nerve entrapment. (D) Piriformis syndrome. ", "output": "A"} 
-{"instruction":"A 66-year-old male with a history of rheumatoid arthritis and a mitral valve replacement presents to the emergency department with fever, malaise, and painless erythema on his hands. He has no history of injecting drugs. His temperature is 38.5°C, his blood pressure is 130/80 mmHg, and his heart rate is 95 beats/min. Echocardiography shows no specific abnormalities, and one of three blood cultures showed Streptococcus bovis. Which of the following statements is more appropriate?", "input": "(A) According to the Modified Duke diagnostic criteria, this is definite endocarditis. (B) Streptococcus bovis is the most common endocarditis. (C) This patient's rash is an immunologic phenomenon called Osler's nodes. (D) Vancomycin can be used in combination , Gentamicin and Rifampin. ", "output": "D"} 
-{"instruction": "Which of the following statements about children swallowing foreign bodies is less appropriate? ", "input": "(A) X-rays are usually unable to detect foreign bodies in the respiratory tract, so routine irradiation is still necessary. (B) If a button battery is swallowed and is already in the stomach without any symptoms, it can be observed and followed up first. (C) If the anteroposterior film shows a coin and the coin is shown on the disc side instead of the side, the coin is presumed to beIt is stuck in the esophagus rather than the trachea. (D) If it is found that the esophagus is blocked by a piece of meat and there are no obvious complications, it can be observed first. If there is no improvement after more than 12 hours, proteolytic enzymes can be fed. ", "output": "D"}  
-{"instruction": "The right forearm was sprayed with 50% hydrofluoric acid (HF) about 3% of the body surface area. Which of the following treatments is more appropriate? ", "input": "(A) Calcium chloride (CaCl 2) injection is given through a central venous catheter. (B) Directly immerse the right arm in a calcium gluconate solution. (C) Calcium gluconate is dripped into the right elbow vein. (D) Inject calcium chloride (CaCl 2) solution into the exposed area for infiltration therapy. ", "output": "A"}
-{"instruction": "Which of the following descriptions of compartment syndrome is less appropriate? ", "input": "(A) Patients over 35 years old are less likely to develop compartment syndrome. (B) If there is no history of trauma, this diagnosis can be ruled out. (C) When the difference between diastolic blood pressure and compartment pressure is less than 30 mmHg, fasciotomy should be performed. (D) If compartment syndrome has occurred for more than 48 hours, fasciotomy should not be performed. ", "output": "B"} 
-{"instruction": "A 51-year-old male with a history of colorectal cancer sought medical attention due to painful defecation and fever. Physical examination revealed tenderness in the perianal tissues. Which of the following statements is more appropriate? ", "input": "(A) First confirm whether the patient's immunity has been weakened by chemotherapy. It is not recommended to rashly perform anal examination. (B) Anorectal abscesses are commonly infected by a single bacterial species, and most of them are anaerobic bacteria. (C) The location of anorectal abscesses varies, among which pelvirectal abscesses are the most common. (D) If the patient is found to have a simple peripheral rectal abscess, drainage can be performed in the emergency department. A puncture drainage should be arranged in the emergency department. ", "output": "A"} 
-{"instruction": "Which of the following treatments for patients with salicylic acid poisoning and severe metabolic acidosis is more appropriate? ", "input": "(A) Oral sodium bicarbonate (NaHCO₃) is as effective as intravenous injection. (B) Hemodialysis and hemoperfusion can both remove salicylic acid. (C) For patients with endotracheal intubation, hyperventilation is given to achieve respiratory alkalinity to maintain normal blood pH. (D) Clinically, it is easy to cause hyperglycemia, so supplementation with glucose intravenous drips should be avoided. ", "output": "B"} 
-{"instruction": "Which of the following descriptions of trauma to pregnant women is less appropriate? ", "input": "(A) Pregnant women will only experience shock symptoms when their overall circulating blood volume increases and bleeding exceeds 30% of their circulatory volume. (B) The most effective way to diagnose placental abruption is when fetal heart rate monitoring shows uterine contractions > 3 times/min. (C) Ultrasound can be used to diagnose uterine rupture. (D) For pregnant women older than 20 weeks, it is recommended to conduct fetal heart rate monitoring for 4 to 6 hours continuously. ", "output": "C"} 
-{"instruction": "A 45-year-old male presents with asthma. He is conscious and afebrile. His SpO₂ is 89% on examination. He is breathing 32 times/min with accessory muscles. Chest X-ray shows no obvious abnormalities. He has been treated with albuterol and ipratropium inhalers but with poor results. His symptoms have not improved after IV methylprednisolone. Which of the following treatments is more appropriate? ", "input": "(A)Aminophylline 250 mg IV infusion for about 20 minutes. (B)Combined use of nebulized magnesium has a good effect. (C)Magnesium sulfate 10 g IV infusion for about 30 minutes. (D)Formoterol has a better affinity for β2 receptors and should be considered. ", "output": "B"} 
-{"instruction": "A 65-year-old male comes to the clinic for swallowing difficulties for several hours. Double tongue sign can be seen in the mouth. Which of the following descriptions is more appropriate? ", "input": "(A) The disease may progress rapidly, so early intubation should be considered. (B) Sedatives and muscle relaxants should be given appropriately during intubation to relieve patient discomfort and increase the success rate. (C) If there is no respiratory distress, consider not intubating first and use antibiotics for 3 days. (D) If there is difficulty in expectoration, consider giving expectorant inhalants first and then observe whether there is improvement. ", "output": "A"} 
-{"instruction": "A pregnant woman with eclampsia needs intubation. Which of the following descriptions is more appropriate? ", "input": "(A)The ventilator settings are the same as those for non-pregnant women, with PaCO₂ set at 28~35 mmHg. (B)The choice of endotracheal tube is similar to that for general patients. (C)Due to the weight gain of pregnant women, the dosage of drugs should be adjusted when using RSI. (D)After pre-oxygenation, it is not necessary to continue to use a nasal cannula for oxygen administration. ", "output": "A"} 
-{"instruction": "Which of the following descriptions of patients with vertigo is more appropriate? ", "input": "(A)The HINTS (Head Impulse test, Nystagmus, and Test of Skew deviation) test is applicable when the vertigo stops and there is no nystagmus. (B)New onset of hearing loss is more likely to be peripheral vertigo. (C) The Epley maneuver can diagnose benign paroxysmal positional vertigo. (D) When performing the Head Impulse Test, patients with peripheral vertigo often experience catch up saccades. ", "output": "D"} 
-{"instruction": "Which of the following descriptions is less appropriate regarding the use of ultrasound to measure the optic nerve sheath to monitor intracranial pressure? ", "input": "(A) Because ultrasound imaging is better at 5 mm behind the eyeball, the diameter of the nerve sheath is measured at this location. (B) When the diameter of the optic nerve sheath reaches 6 mm, the patient's intracranial pressure is more than 70% greater than 20 mmHg. (C) Eyeball trauma, optic neuritis, etc. may cause the diameter of the optic nerve sheath to increase. (D) This examination is not recommended for patients with suspected eyeball rupture. ", "output":"A"} 
-{"instruction": "A 45-year-old female with a medical history of myasthenia gravis seeks emergency treatment for shortness of breath. Which of the following statements and treatments is less appropriate?", "input": "(A) The most common complaints may be weakness of the limb muscles, neck extensors, and facial muscles. (B) Considering whether there is a myasthenic crisis, acetylcholinesterase inhibitors such as pyridostigmine should be given as soon as possible. (C) If pneumonia is present, aminoglycosides or quinolone should be avoided as antibiotics to avoid worsening of the condition. (D) If the patient has respiratory failure and requires intubation, succinylcholine should be avoided and rocuronium can be used.", "output": "D"}
-{"instruction": "Which of the following statements is more appropriate regarding the mechanism of action of anticoagulants, which can be divided into intrinsic, extrinsic, and common pathways?", "input": "(A) Enoxaparin has a more specific site of action than heparin, and its main site of action is the same as that of Dabigatran. (B) Heparin acts on the extrinsic pathway, and aPTT should be routinely monitored during use. (C) Rivaroxaban and Dabigatran act on the common pathway. (D) Warfarin acts on a single pathway, and PT/INR should be routinely monitored during use.", "output": "C"} "(A) Enoxaparin has a more specific site of action than heparin, and its main site of action is the same as that of Dabigatran. (B) Heparin acts on the extrinsic pathway, and aPTT should be routinely monitored during use. (C) Rivaroxaban and Dabigatran act on a common pathway. (D) Warfarin acts on a single pathway, and PT/INR should be routinely monitored during use.", "output": "C"} 
-{"instruction": "A 33-year-old female, married with children, was transferred to the emergency department due to unexplained vaginal bleeding. Which of the following is more appropriate?", "input": "(A) The possibility of pregnancy should be considered for all women of childbearing age, unless the patient has a uterine contraceptive device. (B) If the patient is pregnant, vaginal bleeding is less related to pregnancy and other causes should be considered. (C) If the bleeding occurs between menstrual periods, taking birth control pills may be a common cause. (D) NSAIDs can relieve pain during menstrual bleeding, but they cannot reduce bleeding. ", "output": "C"}
-{"instruction": "An 80-year-old male has a history of prostatic hypertrophy and has been using a long-term silicone urinary catheter for more than a year. He has been changing it regularly, and the last time he changed the catheter was 30 days ago. Which of the following statements is less appropriate?", "input": "(A) If this patient comes to the clinic with a complaint of upper abdominal pain, without fever or other symptoms, a urine test showing pyuria and a urine culture showing gram-positive cocci would diagnose a urinary tract infection. (B) When a patient with a long-term urinary catheter develops a urinary tract infection, multiple bacterial species can usually be cultured. (C) If this patient is diagnosed with a urinary tract infection, Morganella morganii and Proteus mirabilis are common pathogens. (D) If the patient is diagnosed with a urinary tract infection, it is recommended to remove the catheter or replace it with a new one. ", "output": "A"} 
-{"instruction": "Regarding the use of medications during recovery, which of the following has the highest risk of pregnancy? ", "input": "(A) Epinephrine. (B) Lidocaine. (C) Dobutamine. (D) Magnesium sulfate. ", "output": "D"} 
-{"instruction": "A 36-year-old female has a history of lupus erythematosus, which is controlled by regular medication in the outpatient clinic. Today, she had a severe headache and blurred vision. She was later sent to the emergency room because of a seizure. Her blood pressure was 210/100. mmHg, fundus examination showed no mastoid edema, and CT of the brain showed no special abnormalities. Which of the following is more appropriate for differential diagnosis? ", "input": "(A)Intracranial hypotension. (B)Occipital neuralgia. (C)Posterior reversible encephalopathy syndrome. (D)Pseudotumor cerebri syndrome. ", "output": "C"} 
-{"instruction": "A 35-year-old female with no history of hypertension or coronary artery disease. She has had symptoms such as malaise, fatigue, fever, loss of appetite, and nausea for 3 months. She has limb weakness during activities, which is more obvious in the upper limbs; heart auscultation is normal, but the pulsation of one brachial artery is weakened. Which of the following diagnoses of arterial ischemia is more appropriate? ", "input": "(A)Thromboangiitis obliterans (Buerger's disease). (B)Takayasu's arteritis. (C)Hypothenar hammer syndrome. (D)Raynaud's disease. ", "output": "B"} 
-{"instruction": "Which of the following fracture scenarios is least likely to be child abuse? ", "input": "(A)A four-year-old boy has a left humeral metaphyseal fracture. His father says it was caused by crossing the street while holding hands. (B)An 11-month-old baby has a right femur fracture. His mother says it was caused by accidentally falling from the crib. (C)A three-year-old boy has a non-displaced spiral fracture of the right distal tibia. His father cannot explain the cause. (D) A five-year-old boy fractured the 7th and 8th ribs on his left back. His mother said it was caused by a fall while running. ", "output": "C"} 
-{"instruction": "Which of the following statements is more appropriate regarding the GRIEV_ING protocol for informing of death? ", "input": "(A) G stands for Gathering, which means gathering family members in a quiet environment for discussion. (B) R stands for Respect, which means respecting the opinions of each family member during communication with family members. (C) E stands for Empathy, which means considering the emotions of family members and showing empathy. (D) V stands for Vacancy, which means stopping talking and giving family members some time to deal with grief. ", "output": "A"} 
-{"instruction": "According to the SALT triage algorithm, which of the following is less appropriate? ", "input": "(A) First, divide the patients into three categories and distinguish the assessment priorities. (B) Patients who cannot walk but can wave their arms are the first priority for assessment. (C) If tension pneumothorax is found, chest puncture and decompression should be performed as soon as possible. (D) If the patient is in poor consciousness but may survive, the patient's triage is red. ", "output": "B"} 
-{"instruction": "Which of the following descriptions of chest trauma is less appropriate? ", "input": "(A) About 50% of rib fractures are not obvious on chest X-ray. (B) When the first and second rib fractures are found, attention should be paid to whether there is combined heart, trachea, or aorta injury. (C) Tracheal injury usually occurs near the carina. (D) Severe chest trauma is often accompanied by aspiration pneumonia, and antibiotics are recommended to prevent infection. ", "output": "D"} 
-{"instruction": "A 62-year-old male with a history of alcoholic cirrhosis and ascites, and normal renal function in the past, has a fever for 5 days accompanied by nausea, vomiting, and oliguria, and seeks treatment in the emergency department. The body temperature is 38.8℃, and the blood test report shows that the renal function has significantly deteriorated. The creatinine value is 3 times the upper limit of the normal value of the test. Which of the following statements is more appropriate? ", "input":"(A) This patient may be diagnosed with hepatorenal syndrome, which is often associated with spontaneous bacterial peritonitis. (B) If the patient has no abdominal pain or tenderness, spontaneous bacterial peritonitis can be ruled out. (C) Renal cytology usually shows abnormal findings. (D) Ascitic fluid analysis with WBC > 100/mm³ and neutrophils > 50% is diagnostic of spontaneous peritonitis.", "output": "A"} 
-{"instruction": "A 46-year-old woman receiving peritoneal dialysis presents to the emergency department with acute abdominal pain. The peritoneal dialysis fluid analysis is as follows: WBC count 182/mm³, Neutrophil 64%, Mononuclear 36%, Protein <0.1 g/dL. Which of the following statements is less appropriate?", "input": "(A) Physical examination should pay attention to whether there is abdominal wall hernia, and surgical treatment is required if necessary. (B) Consider adding heparin to the peritoneal dialysis fluid to reduce the production of fibrin clot. (C) The most common bacterial species cultured in peritoneal dialysis fluid is Streptococcus species. (D) If the Gram stain of the peritoneal dialysis fluid shows GNB, the third-generation cephalosporin or amionoglycoside drugs are selected for empirical antibiotic treatment.", "output": "C"}
-{"instruction": "An 80-year-old woman was hospitalized for 2 weeks due to cholecystitis and sepsis. She came to the emergency department again 3 days after being discharged. She complained that she had not had a bowel movement for many days. Physical examination revealed that the patient had obvious abdominal distension. Anal examination did not find hard stool blocking the rectum. Abdominal X-ray showed that the large intestine was obviously enlarged with a diameter of 10 cm, but there was no abnormality in blood electrolytes. CT scan also did not find any lesions causing obstruction. Which is the most likely diagnosis?", "input": "(A)Ischemic colitis. (B)Ogilvie's syndrome. (C)Pseudomembranous colitis. (D)Sigmoid volvulus.", "output": "B"} "input": "(A)Ischemic colitis. (B)Ogilvie's syndrome. (C)Pseudomembranous colitis. (D)Sigmoid volvulus.", "output": "B"} 
-{"instruction": "Which of the following statements about conjunctivitis in children is less appropriate?", "input": "(A)Swelling of the preauricular lymph nodes is common in viral infections. (B)Bacterial conjunctivitis can be treated without oral antibiotics. (C)If combined with otitis media, it is often caused by H. influenza. (D)Bacterial infections often involve Staphylococcus aureus (S. aureus) and Pseudomonas aeruginosa (P. aeruginosa).", "output": "D"}
-{"instruction": "Based on the 2020 AHA Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Regarding pediatric airway oxygen resuscitation, which of the following is less appropriate? ", "input": "(A) For pediatric resuscitation in all situations, the recommended rate of auxiliary ventilation is increased to 1 ventilation every 2-3 seconds (20-30 ventilations per minute). (B) Cricocartilage compression is no longer recommended for routine intubation. (C) For patients of any age who require intubation, the use of cuffed endotracheal tubes (ETTs) is no longer recommended to reduce the frequency of tracheal compression injuries. (D) For patients with arterial catheters, the feedback generated by continuous measurement of arterial blood pressure can improve the quality of CPR. ", "output": "C"} 
-{"instruction": "Which of the following statements about ophthalmic emergencies is less appropriate?", "input": "(A) For patients suspected of having open-globe injury, the initial treatment should be to cover the eyeball to protect it, and avoid forcibly opening the patient's eyes for examination if the patient is unable to cooperate. (B) For patients suspected of having open-globe injury, if the eyelids are swollen and a detailed ophthalmic examination cannot be performed, the examination can be postponed until the surgery. (C) For patients with intraocular foreign bodies, CT is a necessary examination. (D) Among intraocular foreign bodies, copper is the most toxic and should be removed surgically as soon as possible.", "output": "C"} 
-{"instruction": "A 36-year-old male has a steel bar puncture wound in the right thigh. Which of the following is less appropriate?", "input": "(A) During the primary assessment, if the wound is bleeding, the first thing to consider is local pressure to stop the bleeding or use a tourniquet. (B) During the secondary assessment, the patient should be assessed for signs of arterial injury, such as absent pulse, cold distal limbs, etc. (C) If the ankle-brachial index is > 0.9, vascular injury should be considered. (D) If the femoral nerve is injured, knee extension can be tested to assess function.", "output": "C"} 
-{"instruction": "Which of the following statements about urinary tract stones is less appropriate? ", "input": "(A)The size measured on the X-ray image is mostly smaller than the actual size, and the difference may be up to 20%. (B)Urinary tract stones are the most commonly misdiagnosed diagnosis of ruptured abdominal aortic aneurysms. (C)Urinary tract stones, acute pyelonephritis, and acute renal infarction may all present with back pain and hematuria. (D)Hypertension, diabetes, unilateral nephrectomy, and renal transplantation are all risk factors for acute renal failure in patients with urinary tract stones. ", "output": "A"} 
-{"instruction": "The patient complains of stumbling while walking. If it is suspected to be a sign of intimate partner violence, which of the following is less appropriate? ", "input": "(A)Causes multiple bruises on the body and trunk. (B) Bruising and hematoma of both knees. (C) Chronic pelvic pain with multiple visits to the emergency room. (D) Multiple bruises on the neck and forearms. ", "output": "B"} 
-{"instruction": "Which of the following is the most important feature of adhesive capsulitis? ", "input": "(A) Localized tingling in the shoulder. (B) Limited range of active and passive motion. (C) Complete loss of sensation in the upper arm. (D) Ultrasound shows increased blood flow. ", "output": "B"} 
-{"instruction": "Which of the following is less appropriate for trauma in the elderly? ", "input": "(A) Rib fractures are more likely to occur due to chest trauma, followed by pneumonia and respiratory failure, and hospitalization should be recommended. (B) If the X-ray is normal but a hip fracture is suspected, further imaging examination is recommended. (C) People with head trauma are more likely to have epidural hemorrhage than young people. (D) If a person taking anticoagulants has a head trauma and has symptoms or not, it is recommended to arrange a head CT scan. ", "output": "C"} 
-{"instruction": "A 65-year-old male underwent tracheotomy for hypopharyngeal cancer 2 weeks ago. Today, he was hospitalized for mild bleeding in the tracheotomy tube. During the observation period, he suddenly had heavy bleeding. Which of the following descriptions is less appropriate? ", "input": "(A) If bleeding continues, you can apply pressure on the trachea and slowly pull the tracheotomy tube outward to stop the bleeding. (B) If bleeding continues, you can consider removing the tracheotomy tube, inserting an endotracheal tube through the mouth, and placing the balloon as low as possible below the bleeding point. (C) If bleeding continues, a finger can be placed along the tracheotomy and pressed on the innominate artery behind the sternum to help stop the bleeding. (D) The patient may have a tracheoinnominate artery fistula due to excessive cuff pressure. The cuff should be deflated immediately. ", "output": "D"} 
-{"instruction": "A 65-year-old male was sent to the emergency department 30 minutes ago because of right upper limb weakness, headache, and slurred speech. On admission, his temperature was 36°C, his heart rate was 85 beats/min, his respirations were 20 breaths/min, and his blood pressure was 201/145 mmHg. Which of the following statements is less appropriate? ", "input":"(A) PCA infarction is suspected when the patient has a concurrent neurological symptom of contralateral homonymous hemianopia. (B) Before a thrombolytic is administered, the patient's blood pressure must be controlled to SBP ≤ 185 mmHg and DBP ≤ 110 mmHg. (C) Regardless of whether the patient receives a thrombolytic, an antiplatelet agent such as aspirin should be given immediately. (D) Intra-arterial embolectomy should be performed within 6 hours of symptom onset.", "output": "C"} 
-{"instruction": "Which statement about acute otitis externa is more appropriate?", "input": "(A) Ofloxacin ear drops are safe for patients with a ruptured tympanic membrane. (B) Methicillin-resistant S. aureus is a common cause of malignant otitis externa. externa) is the most common infecting bacteria. (C) Acetic acid ear drops are contraindicated in otitis externa. (D) Antifungal ear drops are not recommended if fungal infection is suspected. ", "output": "A"} 
-{"instruction": "Which of the following statements is more appropriate regarding the treatment of nasal bone fractures? ", "input":"(A) Routine X-rays are performed to assist in diagnosis, and CT scans are performed in combination with other facial fractures. (B) Hematoma of the nasal septum can be observed first, and then drained if it has not been absorbed. (C) The treatment principles for nasal bone fractures combined with lacerations are different from those for other open fractures. (D) Nose deformity requires consultation with an ENT department, and evaluation is conducted after the swelling subsides within 6 to 10 days.", "output": "D"} 
-{"instruction": "Which of the following descriptions of blast injuries is more appropriate?", "input": "(A) If the patient's injured eye initially has poor vision, the prognosis is poor. (B) The condition of the eardrum injury can be used to assess the severity of the blast injury. (C) Patients with intra-abdominal organ injuries due to explosions are very close to the source of the blast. (D) Cardiac arrhythmia is the most common cause of death in blast injuries. ", "output": "C"} 
-{"instruction": "Which of the following statements about gallbladder disease is more appropriate? ", "input": "(A) Nonsteroidal anti-inflammatory drugs (NSAIDs) can be used as the first choice of analgesics during biliary colic attacks. (B) Ultrasound diagnosis of cholecystitis has a high specificity for the detection of gallbladder wall thickening and peri-gallbladder effusion. (C) The mortality rate of emphysematous cholecystitis is lower than that of general cholecystitis. (D) Acalculous cholecystitis is less likely to have complications than calculous cholecystitis. ", "output": "A"}
-{"instruction": "Which of the following statements about transfusion-associated graft-versus-host disease is less appropriate?", "input": "(A) If this disease occurs, the mortality rate is extremely high. (B) The use of leukocyte-reduces products can reduce the chance of occurrence. (C) Patients with congenital immunodeficiency are at high risk for this disease. (D) Patients with Hodgkin's disease who have remitted are still at high risk.", "output": "B"} 
-{"instruction": "Which of the following statements about aortic stenosis is less appropriate?", "input": "(A) EKG may show left ventricular hypertrophy. (B) If the patient develops pulmonary edema, the patient's blood pressure should be closely monitored when using nitrates or diuretics. (C) Classic triad aortic stenosis is characterized by wheezing, chest pain, and syncope. (D) It is often accompanied by endocarditis, and prophylactic antibiotics are required. ", "output": "D"} 
-{"instruction": "Which of the following tools is inappropriate for pregnant women or postpartum women to diagnose or rule out pulmonary embolism and venous embolism? ", "input": "(A) Breastfeeding does not need to be stopped after a standard pulmonary artery computed tomography. (B) Breastfeeding must be stopped for 12 hours after a ventilation-perfusion scan. (C)Magnetic resonance imaging without contrast has reliable sensitivity and specificity for diagnosing pelvic venous embolism. (D)Pulmonary perfusion examination can reduce fetal radiation exposure compared with standard pulmonary artery computed tomography. ", "output": "D"} 
-{"instruction": "Which of the following descriptions of hip trauma in the elderly is less appropriate? ", "input": "(A)Shenton line is an unreliable imaging basis for diagnosing femoral neck fractures. (B)For femoral neck fractures, skeletal traction can be used to stabilize the affected area first. (C)If the X-ray is normal but the patient is still in pain and unable to move, CT or MRI should be arranged. (D)MRI The sensitivity for diagnosing hip fractures is close to 100%. ", "output": "B"} 
-{"instruction": "An 80-year-old female with a history of arrhythmia, hypertension, and heart failure is now seen in the emergency department with wheezing and orthopnea. Which is more appropriate? ", "input": "(A)Chest ultrasound with more than one B line in the same image is highly specific for diagnosing pulmonary edema. (B)High-dose nitroglycerin is helpful for the acute treatment of hypertensive heart failure, but may cause hypotension in the presence of aortic insufficiency. (C)Morphine is used in patients with acute heart failure to dilate blood vessels, reduce the chance of endotracheal intubation, and reduce mortality. (D)β-Blockers can reduce sympathetic nerve activity, lower heart rate, and reduce mortality in patients with acute heart failure. ", "output": "D"} 
-{"instruction": "Which of the following emergency treatments is less appropriate for patients with mood disorders? ", "input": "(A)For patients with mild depression who do not require hospitalization, SSRI (selective serotonin reuptake inhibitors) drug treatment may be considered. (B) A suicide risk assessment is required to determine the appropriate next steps. (C)When a patient is agitated, treating the agitation takes precedence over fully identifying its cause. (D)For acute mania, atypical antipsychotics such as Ziprasidone cannot be used as a single prescription and must be used in combination with other mood stabilizers (Lithium, Valproic acid). ", "output": "D"} 
-{"instruction": "Which of the following descriptions of spinal cord injury is less appropriate? ", "input": "(A) Anterior cord syndrome is common in direct anterior spinal cord compression or cervical flexion. Motor function and thermal and pain sensation below the injured site disappear, but proprioception and vibration sensation are retained. Even with appropriate treatment, the prognosis is still poor. (B) Central cord syndrome is common in cervical degeneration combined with hyperextension. It mainly manifests as upper limb pain, decreased temperature sensation, and decreased limb strength, with mild lower limb symptoms. After appropriate treatment, the prognosis is good. (C) Brown-Séquard syndrome is common in spinal puncture or lateral compression. Symptoms include loss of proprioception and vibration sensation, limb weakness on the same side below the injured site, and loss of pain and temperature sensation on the opposite side. Even after appropriate treatment, the prognosis is still poor. (D) Cauda equina syndrome is common in transverse fractures of the sacral vertebra. The clinical manifestations are mainly abnormal bowel and bladder function, abnormal sensation in the perineum and inner thigh of the buttocks, combined with varying degrees of abnormal sensation and limb weakness in the lower limbs. ", "output": "C"} 
-{"instruction": "Which of the following statements is more appropriate for chemical factory workers who inhale unknown gases? ", "input": "(A) Gas is a chemical asphyxiant, and treatment mainly involves administering high concentrations of oxygen. (B) Ammonia is highly water-soluble and will dissolve in water in the lower respiratory tract, causing irritation. (C) In addition to affecting hemoglobin oxygen transport, carbon monoxide will also interfere with oxygen utilization within cells. (D) In ​​addition to irritating the respiratory tract and mucous membranes, hydrogen fluoride will also bind to magnesium ions and cause cardiac arrhythmias. ", "output": "C"}"(A) Ask whether the patient has headache, neck pain, or other neurological symptoms. (B) Consider giving diphenhydramine. (C) Consider performing otolith repositioning. (D) Consider performing HINTS plus testing.", "output": "D"} 
-{"instruction": "A 64-year-old male with a history of diabetes developed left eye socket redness, eye pain, and diplopia a few days after a cold, cough, and nasal congestion. Which of the following descriptions and treatments is more appropriate?", "input": "(A) The most common cause is maxillary sinusitis combined with perforation of the inferior orbital wall, leading to infection of the tissues around the eyeball. (B) For patients with diabetes and low immunity, fungal infection should be considered, the most common of which is Aspergillus. (C) If the patient has no fever, normal vision and pupil reflexes, oral antibiotics and analgesics can be prescribed and the patient can be referred to an outpatient clinic for follow-up. (D) If the patient has headache, fever, and abnormalities of the third, fourth, and sixth cranial nerves, cavernous sinus thrombosis should be considered. ", "output": "D"}"C"} 
-{"instruction": "A 50-year-old female syncope occurred at work. She is now fully conscious but has no recollection of the event. Which of the following statements is more appropriate for the patient's assessment?", "input": "(A) If there is no complete loss of consciousness, the risk is lower. (B) Neurological, cardiac, and reflex mediated syncope have a higher risk of death. (C) Patients with prodromal symptoms such as dizziness, cold sweats, and paleness before syncope have a lower risk than patients with unexplained syncope. (D) Most drug-induced syncope is caused by suppression of consciousness.", "output": "C"}
-{"instruction": "A 50-year-old male with no chronic diseases found himself dizzy and nauseous when he got up. The symptoms worsened with activity and were relieved by lying down and resting for a while. His temperature was 36°C, heart rate was 70 beats/min, blood pressure was 160/90 mmHg, and blood oxygen concentration was 99%. Initial examination showed no nystagmus. Which of the following treatments is less appropriate?", "input": "(A) Ask whether he has headache, neck pain, or other neurological symptoms. (B) Consider giving Diphenhydramine. (C) Consider performing otolith repositioning. (D) Consider performing HINTS plus testing.", "output": "D"} 
-{"instruction": "An 80-year-old man was sent to the emergency room because he forgot that he had not eaten recently and thought someone had taken his things. His calculation ability deteriorated, he got lost, and had auditory and visual hallucinations. Which of the following assessments and treatments is less appropriate?", "input": "(A) Lewy body dementia often has hallucinations and Parkinson's-like symptoms. (B) Mini-cog screening assessment, after 3 minutes, he recalled the three fruits just mentioned and could only name one, which indicates cognitive impairment. (C) Abnormal behavior is a common reason for dementia patients to be sent to the emergency room. (D) Before diagnosing dementia, it is necessary to first assess whether it affects independent daily activities or is due to delirium, depression and schizophrenia.", "output": "B"} 
-{"instruction": "A 55-year-old male worked in Africa and was bitten by mosquitoes. He returned home 10 days ago and has had fever, chills, headache, and muscle aches for 3 days. COVID-19 and dengue antigen rapid screening were negative. Physical examination revealed an enlarged spleen. Which of the following statements is more appropriate?", "input": "(A) When the thin-layer blood smear is negative for malaria parasites, a thick-layer blood smear must be performed because the density of malaria parasites may be lower than 100/μL. (B) Because the thin-layer blood smear is negative, if the thick-layer blood smear is negative for malaria parasites, malaria can be ruled out. (C) In more than 90% of cases, the first blood smear test result is positive. (D) The World Health Organization issued a certificate of malaria eradication in Taiwan in 1965, but Anopheles minimus is still prevalent in the mountainous areas of various counties and cities in Taiwan. ", "output": "C"} 
-{"instruction": "A 67-year-old male with a history of hypertension has no history of hospitalization within a year. He complained of coughing with sputum and intermittent high fever of 39°C in the past two days. He was conscious but weak when he went to the emergency room. His respiratory rate was 26 times/min, his blood pressure was 110/80 mmHg, and his SpO₂ was 96%. Blood tests showed WBC 12,900/uL, CRP 16.88 mg/dL, BUN 34 mg/dL, Creatinine 1.6 mg/dL, and chest X-ray showed consolidation in the right lower lung field. , which of the following statements is less appropriate? ", "input": "(A) This patient is a case of community pneumonia. (B) Common pathogens are S. pneumoniae, S. aureus, H. influenzae. (C) According to the severity assessment of the CURB-65 index, this patient has moderate pneumonia and is recommended to be hospitalized for observation and treatment. (D) According to the 2018 Taiwan Pneumonia Guidelines, this patient is recommended to be treated with Aztreonam antibiotics. ", "output": "D"} 
-{"instruction": "Regarding thunderclap headache, which of the following statements is more appropriate? ", "input": "(A) If it occurs at rest, carotid artery detachment should be highly suspected. (B) It is defined as a severe headache that occurs suddenly and reaches its maximum intensity within 1 minute. (C) If it is associated with Valsalva maneuve, the most likely diagnosis is acute glaucoma. (D) Cerebral venous thrombosis will not cause this type of headache. ", "output": "B"} 
-{"instruction": "Which of the following is more appropriate for the treatment of pulmonary abscesses? ", "input": "(A) Metronidazole, which is mainly used to treat anaerobic bacteria, is the first choice of antibiotic. (B) More than 30% of patients require surgical or percutaneous drainage. (C) Transbronchial drainage is less likely to affect the healthy lung. (D) When antibiotic treatment is ineffective, consider percutaneous, transbronchial or open drainage. ", "output": "D"} 
-{"instruction": "Which of the following statements is inappropriate for the treatment of urinary tract stones? ", "input": "(A) Giving large amounts of intravenous fluids will not accelerate the passage of urinary tract stones. (B) If the patient is not suitable for nonsteroidal anti-inflammatory drugs (NSAIDs), Narcotics can be used for pain relief, but these drugs cannot promote the passage of urinary tract stones. (C) Calcium channel blockers and alpha blockers can both be used to promote the passage of urinary tract stones. (D) If urinary tract stones are combined with acute urosepsis, hospitalization should be considered. ", "output": "C"} 
-{"instruction": "In mass casualty events, the JumpSTART Pediatric MCI Triage© system is currently used to triage pediatric patients. Which of the following statements about this system is less appropriate? ", "input": "(A) The assessment is: ability to move or walk → breathing → respiratory rate → pulse → consciousness. (B) Triage is divided into four categories: death, immediate evacuation, delayed evacuation, and mild illness. (C) The modified Glasgow Coma Scale is used to assess consciousness. (D) Each patient should receive a detailed secondary assessment. ", "output": "C"} 
-{"instruction": "10-year-old boy, abdominal pain combined with abilious vomiting. Blood pressure 85/60 mmHg, heart rate 130 beats/min; arterial gas analysis: pH 7.20, PaCO₂ 30 mmHg, HCO₃ 12 mEq/L, blood biochemistry results: sodium 140 mEq/L, potassium 2.0 mEq/L, chloride 108 mEq/L, glucose 360 ​​mg/dL, BUN 28 mg/dL, ketone bodies in urine. Which of the following descriptions is more appropriate? ", "input": "(A) The anion-gap is 22 mEq/L. (B) The effective osmolality is 300 mOsm/kg. (C) The most common fatal complication of this disease is pulmonary edema. (D) It is recommended to immediately give 20 mL/kg bolus normal saline plus 0.1 unit/kg bolus insulin. ", "output": "B"}
-{"instruction": "Which of the following statements about the treatment of subarachnoid hemorrhage is less appropriate?", "input": "(A) Systolic blood pressure should be controlled at 120-160 mmHg. Nicardipine can be considered first. (B) Nitroglycerin can be considered as a second-line drug for patients with high blood pressure that is poorly controlled. (C) Nimodipine can be considered to prevent subsequent vasospasm. (D) Some patients may experience epilepsy, which can be prevented with anti-epileptic drugs.", "output": "B"}  
-{"instruction": "Traumatic cerebral hemorrhage is often complicated by brain herniation syndrome. Which of the following statements about this syndrome is more appropriate? ", "input":"(A) The most common is uncal herniation, which is often caused by a blood clot in the midline of the brain, such as a blood clot in the frontal lobe or occipital lobe. (B) Uncal herniation often compresses the trochlear nerve, blocking the pupillary parasympathetic nerve signal, and clinically manifests as unilateral or bilateral pupil dilation. (C) The clinical symptoms of central herniation are mainly bilateral pupil dilation, bilateral Babinski's positivity and increased muscle tension. (D) The clinical symptoms of cerebellar tonsillar herniation are often bilateral pupil constriction, limb paralysis or sudden death.", "output": "D"} 
-{"instruction": "Which of the following is not included in the criteria for determining a stable pneumothorax patient?", "input": "(A) Not complicated with hemothorax. (B) Respiratory rate less than 24 times/min. (C) PaCO₂ less than 45 mmHg. (D) Room air oxygen concentration greater than 90%.", "output": "C"}
-{"instruction": "Traumatic shock requires consideration of emergency REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) placement. Which of the following statements is more appropriate?", "input": "(A) If chest X-ray shows widening of the diaphragm, REBOA should be placed in zone 3. (B) If pelvic bleeding is suspected, REBOA should be placed in zone 2. (C) If intra-abdominal bleeding is suspected, REBOA should be placed in zone 3. (D) The depth of placement can be referred to the distance from the needle insertion site to the scrotum and navel.", "output": "D"} 
-{"instruction": "A 40-year-old male feels dizzy, ear discomfort, and joint pain 2 hours after diving. Which of the following statements is more appropriate?", "input": "(A) Ascent may cause barotitis, which may lead to rupture of the eardrum. (B) Using the San Diego Diving and Hyperbaric Organizations Criteria assessment, a score of 3 or above can be diagnosed as arterial gas embolism. (C) Type I decompression sickness can cause joint pain, and in severe cases, limb weakness or numbness. (D) Alternobaric vertigo is usually temporary and does not require special treatment. ", "output": "D"} 
-{"instruction": "Which of the following statements is more appropriate for the management of patients with temporomandibular dislocation? ", "input": "(A) Routine X-rays are performed to rule out fractures. (B) Wrist rotation is most commonly used. (C) Temporomandibular dislocation is often posterior. (D) Wrist rotation is more effective than traditional reduction. ", "output": "D"} 
-{"instruction": "Upper limb trauma is often accompanied by nerve damage. Which of the following statements is less appropriate? ", "input": "(A) Anterior dislocation is often associated with axillary nerve damage, and the main clinical manifestations are weakness in shoulder abduction and paresthesia. (B) Humerus shaft fracture is often associated with radial nerve damage, and the main symptoms are wrist drop and paresthesia in the dorsal part of the thumb and index finger. (C) Supracondylar fracture is often associated with posterior interosseous nerve damage, which is derived from the median nerve. (D) Olecranon fracture is often associated with ulnar nerve damage, and the main symptoms are inability to abduct the fingers and paresthesia in the ring and little fingers. ", "output": "C"} 
-{"instruction": "Which of the following should receive a tetanus toxoid injection? ", "input": "(A) An 8-year-old child with a complete vaccination history suffered multiple abrasions and bruises on his limbs while riding a bicycle. (B) A 78-year-old man suffered minor burns, but had received a tetanus toxoid injection 6 years ago. (C) A 28-week pregnant woman was bitten by a dog, but had received a tetanus toxoid injection 1 year ago. (D) A 23-year-old worker accidentally cut his hand on a piece of glass while cleaning sewage, but had received a tetanus toxoid injection 1 year ago. ", "output": "C"} 
-{"instruction": "Which of the following statements is more appropriate? ", "input": "(A) The most common cause of sudden cardiac death in young athletes is coronary artery disease. (B) In Brugada syndrome, abnormalities in the limb leads are common. (C) In patients with hereditary channelopathies, sudden death often occurs during exercise. (D) Severe left ventricular dysfunction combined with an ejection fraction ≤ 35% requires consideration of implantable cardioverter-defibrillator placement. ", "output": "D"} 
-{"instruction": "A 50-year-old male drank home-brewed rice wine and went to the emergency room 10 hours later due to dizziness, nausea, and blurred vision. Vital signs: temperature 36.8℃, breathing 18 times/min, heart rate 92 times/min, blood pressure 169/85 mmHg, test report: Na 142 mEq/L, Cl 109 mEq/L, BUN 14 mg/dL, Glu 126 mg/dL, Ketone body: negative, Ethanol 9 mg/dL, Blood osmolality 320 mOsm/Kg, and arterial blood ABG pH 7.29, PCO₂ 25.4 mmHg, HCO₃ 12.5 mEq/L , Based on the above data, it is judged that the case may have accidentally ingested methanol. What is the most likely methanol concentration in the case's blood at this time? ", "input": "(A)20 mg/dL. (B)40 mg/dL. (C)70 mg/dL. (D)150 mg/dL. ", "output": "C"} 
-{"instruction": "A 68-year-old male was diagnosed with acute exacerbation of chronic obstructive pulmonary disease and hypercapnic respiratory failure. He was admitted to the intensive care unit after emergency intubation. The PCR test for COVID-19 was negative. After three days of staying in the emergency room, the patient developed intermittent decreases in blood oxygen concentration and increased endotracheal tube secretions. Follow-up chest X-ray showed new infiltration in the right lower lobe. Which of the following antibiotics is more appropriate? ", "input":"(A)Ceftriaxone and metronidazole. (B)Cefepime and vancomycin. (C)Levofloxacin and metronidazole. (D)Piperacillin-tazobactam.", "output": "B"} 
-{"instruction": "A 25-year-old male was found unconscious at home by his family. The last time he was normal was unclear. His past medical history included schizophrenia, and he took medication at the clinic. When he arrived at the hospital, his consciousness was E1M4V1, his temperature was 39℃, and the rest of his vital signs were normal. Which of the following statements is more appropriate?", "input": "(A) This patient may have symptoms caused by infection or drugs, and there is no need to rule out organic lesions. (B) The most important treatment for neuroleptic malignant syndrome is to give the BZD antagonist Flumazenil. (C) If the patient is taking Clozapine , clinical manifestations show muscle rigidity, and the patient is more likely to have serotonin syndrome. (D) For this patient, a nondepolarizing muscle relaxant should be preferred for intubation. ", "output": "D"} 
-{"instruction": "Which of the following descriptions of disseminated intravascular coagulation (DIC) is less appropriate? ", "input":"(A) The primary goal is to treat the underlying cause of DIC. (B) If there is no evidence of bleeding, low molecular weight heparin should be used to prevent thrombosis. (C) It causes a decrease in platelet count and an increase in fibrinogen/D-dimer/FDP. (D) The difference from severe liver disease is that D-dimer in patients with liver disease will not increase significantly.", "output": "C"} 
-{"instruction": "For obese patients with BMI ≧ 30 kg/m2, the patient's weight should be considered when administering the drug to adjust the appropriate drug dosage. For which of the following drugs, the actual body weight (total body weight) of the patient should be used to calculate the dosage?", "input": "(A) Enoxaparin. (B) Gentamicin. (C) Hydrocortisone. (D) Levofloxacin.", "output": "A"}
-{"instruction": "A 55-year-old female fainted while working and lost consciousness briefly. She was taken to the emergency room by a colleague. Which of the following judgments based on the medical history is less appropriate?", "input": "(A) If the fainting is caused by arrhythmia, it is usually sudden and there are no premonitory symptoms. (B) If it occurs slowly and gradually, combined with specific circumstances, vasovagal syncope should be suspected. (C) Postural hypotension causes fainting that only occurs within 3 minutes after standing up from a changed position. (D) When symptoms such as tongue biting and urinary incontinence occur, it should be considered an epileptic seizure rather than a simple fainting.", "output": "C"} 
-{"instruction": "A pedestrian is hit by a car from the side. He is conscious when he arrives at the hospital, and his blood pressure is 75/45 mmHg. Physical examination reveals pelvic tenderness. E-FAST examination shows no pneumothorax, no pericardial effusion, and no peritoneal effusion. X-ray shows a lateral compression fracture of the left pelvis. Which of the following is inappropriate?", "input": "(A) The use of a pelvic fixation belt will help reduce the amount of blood loss for this injury. (B) After active fluid resuscitation and blood transfusion, the blood pressure is 80/50 mmHg. The next step is to perform angiographic embolization. (C) The pelvic fracture is more likely to cause shock due to bleeding from the superior gluteal or obturator arteries. (D) In ​​conscious patients, physical examination has a sensitivity of greater than 90% for diagnosing pelvic fractures. ", "output": "A"} 
-{"instruction": "A 75-year-old male. His family said that the patient had just fallen to the ground while sitting on a chair to rest and lost consciousness for about 1 minute. After waking up, he complained of pain in his lower back and back of the head. The patient said that he had palpitations before losing consciousness. The body temperature was 36℃, the heart rate was 80 beats/min, the blood pressure was 120/80 mmHg, and the blood oxygen concentration was 98%. Which of the following statements is more appropriate? ", "input": "(A) A 12-lead electrocardiogram should be arranged, which has about a 50% chance of obtaining a clear diagnosis. (B) A brain CT should be arranged to check for cerebral hemorrhage. (C) The blood test report shows that the hematocrit is 35% and the myocardial enzyme (troponin) is normal. The patient belongs to the low-risk group and can be discharged. (D) During the observation period, the patient suddenly has his eyes hanging and his limbs tremble. Diazepam 5mg should be injected intravenously immediately and the effect of the drug should be observed. ", "output": "B"} 
-{"instruction": "A 65-year-old patient came to the emergency room because of headache. He was conscious and his vital signs were stable. Which of the following assessments of this disease is less appropriate? ", "input": "(A) According to the Ottawa Subarachnoid Hemorrhage Rule, people over 65 years old are risk factors. It is recommended to arrange a head CT examination. (B) The patient describes unilateral headache, which is the most common symptom of carotid artery or vertebral artery dissection. It is advisable to consider arranging a CTA examination. (C) MRI examination has high sensitivity and a negative test can be ruled out. (D) If the diagnosis is SAH, in addition to controlling SBP to 120-160 mmHg, preventive anti-epileptic drugs can also be considered. ", "output": "C"} 
-{"instruction": "Regarding hypoglycemia caused by sulfonylurea, which of the following treatments is less appropriate? ", "input": "(A) 50% Dextrose. (B) Diazoxide. (C) Glucagon. (D) Octreotide. ", "output": "C"} 
-{"instruction": "A 68-year-old male was discharged from the hospital one week ago and received high-dose steroid treatment during hospitalization. He now goes to the emergency department for fever, dyspnea, and unconsciousness. After examination, he is diagnosed with bacterial pneumonia. Chest X-ray shows bilateral lower lobe infiltration. Which of the following pathogens is most likely to be the cause? ", "input": "(A) Klebsiella pneumoniae. (B) Pseudomonas aeruginosa. (C) Staphylococcus aureus. (D) Streptococcus pneumoniae. ", "output": "B"} 
-{"instruction": "Due to abnormal operation, a large amount of radioactive pollutants leaked from the No. 3 nuclear power plant. Regarding emergency preparation and patient treatment, which of the following statements is less appropriate? ", "input": "(A) Emergency medical staff in contaminated areas must wear waterproof isolation clothing, hats, shoes and double gloves to avoid contamination. (B) The method for cleaning contaminated wounds is the same as that for general wounds, but the spread of contamination during the cleaning process must be prevented. (C) All patients should first be decontaminated until the radiation value is less than 2 times the background value before medical treatment. (D) If vomiting and diarrhea occur, the number of lymphocytes should be monitored every 6 hours. ", "output": "C"} 
-{"instruction": "Which of the following is more appropriate when a pregnant woman is in labor? ", "input": "(A) For pregnant women whose water has broken, perform an internal examination to determine the progress of labor. (B) Mediolateral episiotomy is easier to perform and causes less discomfort to pregnant women during the recovery period; while median episiotomy can reduce the possibility of birth canal laceration to the anus. (C) After the fetus is delivered, if the fetus is stable, do not cut the umbilical cord immediately. Umbilical cord cutting can be delayed 1 to 3 minutes regardless of whether the baby is premature or full-term. (D) If the umbilical cord has fallen out of the vagina before the fetus is fully delivered (umbilical cord prolapse), the umbilical cord should be pushed back into the uterus and the fetal head should be lifted with fingers to prevent the blood flow of the umbilical cord from being compressed. ", "output": "C"}"(A) The diagnosis of typical pancreatitis must meet three elements, including clinical symptoms, laboratory tests, and imaging examinations. (B) If the patient has no history of pancreatitis, a CT scan should be arranged as soon as possible because ultrasound is sometimes easily interfered with by bowel gas. (C) If pancreatitis is diagnosed, because the patient needs to fast for a long time, preventive antibiotics should be used to prevent intestinal bacterial metastasis. (D) Treatment is mainly supportive therapy, among which early active fluid therapy can improve the prognosis, and lactated Ringer's solution is the first choice.", "output": "D"} 
-{"instruction": "Which of the following descriptions of vulvovaginitis in women is more appropriate?", "input": "(A) Samples collected during internal examination should be collected to the depth of the posterior fornix, because the secretions from the anterior vagina may affect the pH value, resulting in inaccurate results. (B) Pseudohyphae and buds can be seen under microscopy. If the Whiff test has a fishy odor, it is more likely to be a Candida infection. (C) If the side effects of oral medications cannot be tolerated, Metronidazole gel or Clindamycin cream can be considered. (D) N.gonorrhoeae is the most common pathogen of Bartholin cyst and abscess.", "output": "C"}"(A) For pregnant women whose water has broken, perform an internal examination to determine the progress of labor. (B) Mediolateral episiotomy is easier to perform and causes less discomfort to pregnant women during the recovery period; median episiotomy can reduce the possibility of birth canal lacerations to the anus. (C) After the fetus is delivered, if the fetus is stable, do not cut the umbilical cord immediately. Umbilical cord cutting can be delayed for 1 to 3 minutes regardless of premature or full-term babies. (D) If the umbilical cord has fallen out of the vagina before the fetus is fully delivered (umbilical cord prolapse), the umbilical cord should be pushed back into the uterus and the fetal head should be lifted with fingers to prevent compression of the blood flow in the umbilical cord.", "output": "C"} 
-{"instruction": "A 20-week pregnant woman presented to the emergency department with sudden onset of shortness of breath and chest pain two hours ago. Her vital signs were temperature 36.5°C, heart rate 170 beats/min, respiration 24 breaths/min, and blood pressure 125/86 mmHg. Which of the following is more appropriate?", "input": "(A) If it is unstable ventricular tachycardia, a 100-joule synchronized shock can be given without reducing the dose. (B) If it is a myocardial infarction, the most likely cause is coronary spasm. (C) If pulmonary embolism is suspected, an MRI should be arranged, and a pulmonary V/Q scan should be avoided because the radiation dose may cause permanent damage to the fetus. (D) If it is severe asthma (status asthmaticus), MgSO 4 should not be given because it crosses the placenta and can cause neurological damage. ", "output": "A"}
-{"instruction": "A 44-year-old male was hospitalized for left upper abdominal pain. Examination revealed that his lipase was approximately 10 times the normal value. He is now fasting in the emergency room, awaiting follow-up imaging examinations. Which of the following statements is more appropriate?", "input": "(A) The diagnosis of typical pancreatitis must meet three criteria, including clinical symptoms, laboratory tests, and imaging examinations. (B) If the patient has no history of pancreatitis, a CT scan should be arranged as soon as possible, as ultrasound is sometimes easily interfered with by intestinal gas. (C) If pancreatitis is diagnosed, the patient needs to fast for a longer period of time, and preventive antibiotics should be used to prevent intestinal bacterial metastasis. (D) Treatment is mainly supportive, among which early and active fluid therapy can improve the prognosis. Lactated Ringer's solution is the first choice. ", "output": "D"} 
-{"instruction": "A 1-year-old child returned to Taiwan for medical treatment after developing fever and systemic rash in Guangdong, China. Which of the following statements is more appropriate? ", "input": "(A) If Koplik spots are found during oral examination, the patient should be advised to be hospitalized in a negative pressure isolation ward. (B) In differential diagnosis, measles usually develops a rash the day after the fever subsides. The rash usually appears on the hands and feet first, and then spreads to the trunk and face. The oral mucosa is usually not affected. (C) The pathogen of scarlet fever is a single-stranded DNA virus that can be transmitted through droplets. It is recommended to be hospitalized in a single ward. (D) The rash of roseola infantum appears with fever, and the rash disappears after the fever subsides. ", "output": "A"} 
-{"instruction": "A 58-year-old male was in a serious car accident 30 minutes ago and suffered severe laryngeal trauma and was sent to the emergency room. Physical examination revealed no obvious wounds on the front neck but large bruises and swelling. The cartilage structures in the throat could not be identified by finger palpation. The patient had moderate respiratory distress and biphasic stridor. Which of the following methods of upper airway protection is more appropriate? ", "input": "(A) Give the patient humidified air and intravenous steroids. (B) After giving the patient muscle relaxants and sedatives, perform oral endotracheal intubation to protect the airway. (C) The ENT department performs a tracheostomy under local anesthesia to protect the airway. (D) Perform a cricothyroidotomy to protect the airway. ", "output": "C"} {" 
-instruction": "An 82-year-old male patient has suddenly developed psychiatric symptoms such as emotional irritability, suspicion that his family has poisoned his food, and seeing deceased relatives coming back to see him in the past two days. Which differential diagnosis should be prioritized? ", "input": "(A) Delusional disorder. (B) Mental illness caused by physical illness. (C) Schizophrenia. (D) Bipolar disorder. ", "output": "B"} 
-{"instruction": "Which assessment and medical treatment is more appropriate for patients with acute psychosis who are prone to violent injury? ", "input": "(A) Atypical antipsychotics such as Olanzapine are specific for dopamine receptors and are better than typical antipsychotics in reducing the side effect of QTc prolongation. (B) Physical examination findings are specific to acute mental illness, and abnormal appearance or disorganized behavior are not the primary basis for judgment. (C) The evaluation principle is to first rule out the existence of medical or traumatic problems and secondly to reduce the patient's potential harm. (D) Both sedatives (Benzodiazepines) and alcohol intoxication or withdrawal can cause acute psychosis. ", "output": "A"} 
-{"instruction": "A 50-year-old male rapidly develops respiratory failure due to viral pneumonia within 3 days. His PaO2 is 90 mmHg on 100% oxygen. He is intubated and uses a ventilator. Which of the following statements is more appropriate? ", "input": "(A) It is a severe Acute Respiratory Distress Syndrome (ARDS). (B) Respiratory alkalosis may occur, but it is acceptable if it is mild. (C) During treatment, respiratory monitoring can set the blood oxygen target SpO2 greater than 95%. (D) Low tidal volume and Positive end expiratory pressure (PEEP) should be used. ", "output": "A"} 
-{"instruction": "A 50-year-old male seeks emergency treatment due to sudden pain in the left upper abdomen and vomiting. Past medical history includes diaphragmatic hernia and gastroesophageal reflux. Blood pressure 86/40 mmHg, heart rate 121 beats/min, body temperature 37℃, respiration 20 times/min, SpO₂ 98%. The main abnormalities of physical examination are epigastric bloating and pain, tympanic percussion, and decreased breath sounds in the left lower lung. Laboratory reports found lactate 28 mg/dL, pH 7.13, HCO₃- 8.1 mEq/L, and Hb 12 g/dL. Chest X-ray found that the stomach was distended and located above the diaphragm. In addition to appropriate infusion therapy, which of the following is more appropriate? ", "input": "(A) Consult for surgical treatment. (B) Arrange for gastroscopy. (C) Transfusion of concentrated red blood cells (PRBCs). (D) Intravenous injection of sodium bicarbonate. ", "output": "A"} 
-{"instruction": "Which of the following statements is more appropriate regarding a bioterrorism attack? ", "input": "(A) In biological warfare, infectious pathogens are usually used that have properties similar to those of chemical warfare agents. (B) The initial symptoms of most biological warfare agents are easily distinguishable from those of common infectious diseases. (C) In the absence of obvious symptoms or confirmed exposure, preventive vaccination or treatment is not required. (D) Use the highest transmission precautions until the pathogen is understood and its mode of transmission is determined. ", "output": "D"} 
-{"instruction": "A 70-year-old male with no chronic diseases went to the emergency room within 1 hour of onset of acute left limb weakness. His left upper and lower limbs could only move in bed but could not be raised to resist gravity. After examination, he had no other neurological symptoms, and his vital signs and blood tests were normal. He was diagnosed with ischemic stroke. Which of the following treatment statements is less appropriate? ", "input":"(A) This patient currently meets the indications for intravenous thrombolytics in our country. (B) This patient currently meets the indications for intra-arterial embolectomy in our country. (C) Asians can use lower doses of thrombolytics to reduce complications. (D) Patients receiving intravenous thrombolytics can still receive intra-arterial embolectomy.", "output": "B"} 
-{"instruction": "Which of the following is more appropriate regarding vascular lines that are placed in the emergency department?", "input": "(A) Chylothorax is sometimes seen as a complication of right cervical central venous catheter placement. (B) When inserting a central venous catheter from the femoral vein, if the needle is placed above the inguinal ligament, intraperitoneal bleeding may occur. (C) For patients with severe orthopnea, inserting a central venous catheter from the clavicle is a feasible method. (D) If there is local pain, redness or swelling at the insertion site of the arterial catheter, the first step is to apply local pressure for 3 to 5 minutes before removing the needle. ", "output": "C"}
-{"instruction": "Due to a gas pipeline leak, a series of explosions occurred on the road, and several injured were sent to the emergency room. Which of the following statements is less appropriate?", "input": "(A) Emergency intubation due to hemoptysis and respiratory failure, the ventilator is set to volume-control mode, and the tidal volume is controlled at 10 ml/kg. (B) The left ear is deaf, and an otoscope examination found a ruptured eardrum. There is no other discomfort. The patient is arranged to have a CXR. (C) A wound on the right arm continues to pulsate. After applying pressure to stop the bleeding, the bleeding still does not stop. A tourniquet is used to stop the bleeding. (D) The right knee is slightly abraded. Other physical examinations are normal. Vital signs are stable. Stay in the hospital for observation for 4~6 hours.", "output": "A"} "(A) Emergency intubation due to respiratory failure caused by hemoptysis. The ventilator was set to volume-control mode and the tidal volume was controlled at 10 ml/kg. (B) Hearing loss in the left ear. Otoscopic examination revealed a ruptured eardrum. The patient had no other discomfort and was arranged to have a CXR. (C) There was continuous pulsatile bleeding from a wound on the right arm. After applying pressure to stop the bleeding, the bleeding still did not stop. A tourniquet was used to stop the bleeding. (D) There was a slight abrasion on the right knee. Other physical examinations were normal. The vital signs were stable. The patient was kept in the hospital for observation for 4 to 6 hours.", "output": "A"} 
-{"instruction": "45-year-old with systemic sclerosis (systemic A male patient with sclerosis who was taking steroids and had normal renal function last month came to the emergency department with progressive headaches, nausea, and shortness of breath for three weeks. His vital signs were: blood pressure 250/150 mmHg, heart rate 95 beats/min, respiration 14 breaths/min, SpO₂ 95%, GCS E4V5M6. The blood values ​​were as follows: Cr 21.73 mg/dL. Which of the following statements is more appropriate about this patient's condition? ", "input": "(A) About half of these patients will develop a scleroderma renal crisis within four years of onset. (B) Steroid treatment is not a precipitating factor. (C) First-line use of angiotensin-coverting enzyme inhibitors is not recommended. (D) After hemodialysis treatment, only about 10% of patients may recover their kidney function. ", "output": "A"}
-{"instruction": "70-year-old female, nursing home resident, hospitalized for pneumonia for 2 weeks, discharged 3 days ago, started to have 10 large yellow watery stools yesterday, poor appetite, no history of contact or gathering, temperature 38℃, heart rate 120 beats/min, blood pressure 90/60 mmHg, blood oxygen concentration 94%, blood WBC 16,000/mm³, stool toxin A and toxin B positive, which of the following treatments is more appropriate?", "input": "(A) Give Vancomycin orally. (B) Give Vancomycin intravenously and transrectally. (C) Wait for the results of stool culture for Clostridium difficile (C. difficile) before deciding whether to give antibiotic treatment. (D) Before the report of C. difficile stool culture comes out, give Ciprofloxacin orally. ", "output": "B"} 
-{"instruction": "After the patient with unknown substance poisoning used a ventilator in the trachea, the ABG results were: pH 7.2, PaCO₂ 20 mmHg, PaO 2 300 mmHg, HCO₃- 10 mEq/L, but obvious cyanosis was still visible in the body appearance. Which of the following substances is more likely to be poisoning? ", "input": "(A) Carbon monoxide (CO). (B) Hydrogen cyanide (HCN). (C) Hydrogen sulfide (HS). (D) Sodium nitrite. ", "output": "D"} 
-{"instruction": "Which of the following statements is more appropriate regarding acute exacerbations of COPD?", "input": "(A) Treating gastroesophageal reflux can reduce acute exacerbations. (B) Giving oxygen can help improve pulmonary vasoconstriction. (C) Acute exacerbations of COPD are caused by limited expiratory airflow. (D) Most patients have no evidence of viral or bacterial infection during an acute exacerbation.", "output": "B"} 
-{"instruction": "Which of the following statements is more appropriate regarding the use of the Ottawa Subarachnoid Hemorrhage Rule?", "input": "(A) It has a diagnostic specificity of 100%. (B) The diagnostic criteria include limited neck flexion. (C) The diagnostic criteria include unconsciousness. (D) Diagnostic conditions include age 45 years old. ", "output": "B"} 
-{"instruction": "Which of the following statements is less appropriate for emergency treatment of patients with left ventricular assist devices in the emergency department? ", "input": "(A) During CPCR (Cardio-Pulmonary-Cerebral-Resuscitation) of such patients, chest compression may cause left ventricular rupture. (B) If the patient's vital signs are unstable, auscultation must be performed immediately. If there is no machine sound, the battery or controller function must be confirmed. (C) When performing CPCR chest compression, the depth of chest compression must be deeper than that of normal patients. (D) If ventricular pulse is present, the shock dose is the same as that for normal patients. ", "output": "C"} 
-{"instruction": "Patients with systemic rheumatic diseases may have difficulty intubating due to the following reasons. Which of the following statements is less appropriate? ", "input": "(A) Patients with ankylosing spondylitis should be careful about incomplete dislocation of the atlas and the vertebrae. (B) Granulomatosis with polyangiitis may cause subglottic stenosis. (C) Scleroderma may affect the elasticity of the skin and the caliber of the oral opening. (D) Systemic lupus erythematosus may invade the temporomandibular joint. ", "output": "D"} 
-{"instruction": "A 40-year-old male is sent to the emergency room due to a car collision. The victim complains of abdominal pain. Which of the following is less appropriate? ", "input": "(A) Vital signs are unstable. Abdominal trauma is the focus. Ultrasound examination shows ascites. Emergency laparotomy should be prepared. (B) Vital signs are stable. CT scan shows spleen damage. The first-line treatment is splenectomy. (C) There is no obvious trauma, vital signs are stable, and CT scan shows no obvious bleeding, but there is persistent tenderness and peritoneal signs in the abdomen. Laparotomy is still recommended. (D) There is a suspected puncture wound on the anterior abdominal wall. Vital signs are stable. CT scan is recommended. ", "output": "B"} 
-{"instruction": "The patient complained of vomiting and diarrhea 3 days ago, but no fever. Yesterday, he began to have coughing and symmetrical upper limb weakness. Today, he went to the emergency room because of weakness in both lower limbs and urinary incontinence. Which of the following diseases is more likely? ", "input": "(A) Japanese encephalitis. (B) Guillain-Barre syndrome. (C) Botulinum toxin poisoning. (D) Myasthenia gravis. ", "output": "C"} 
-{"instruction": "Which of the following syndromes and diseases is more appropriate? ", "input":"(A)Boerhaave syndrome refers to rupture of the gastric fundus. (B)Ehlers-Danlos syndrome is a disease that is prone to aortic detachment. (C)Precordial catch syndrome is chest pain caused by myocardial contusion. (D)Tietze's syndrome refers to chest pain caused by tension pneumothorax.", "output": "B"} 
-{"instruction": "Which of the following descriptions of traumatic hip dislocation is less appropriate?", "input": "(A)Clinically, posterior dislocation is the most common, and it often occurs when the knee hits the dashboard in a car accident. Physical examination shows that the thigh is shortened, everted, and externally rotated. (B) It is often accompanied by pelvic, acetabulum, thigh fractures and knee ligament injuries, and CT is required to further evaluate the injury. (C) Detailed evaluation of nerve and vascular function is required. The sciatic nerve is the most common nerve injury. (D) It is an orthopedic emergency and hip reduction should be completed within 6 hours. Delayed reduction increases the risk of ischemic necrosis of the femoral head. ", "output": "A"}
-{"instruction": "Which of the following hypertensive emergencies and corresponding treatment drugs and treatment goals is less appropriate?", "input": "(A) Aortic detachment, use Labetalol to control systolic pressure at 100-120 mmHg. (B) Amphetamine poisoning, use Benzodiazepine to control systolic pressure below 140 mmHg. (C) Preeclampsia, use ACE inhibitors to control systolic pressure below 140 mmHg. (D) Subarachnoid hemorrhage, use Nicardipine to control systolic pressure below 160 mmHg.", "output": "C"} 
-."According to the 2020 American Heart Association recommendations, which of the following descriptions of advanced lifesaving techniques for children is more appropriate?", "input": "(A) Unstable tachycardia with a regular, monomorphic, and wide QRS can be treated directly with adenosine. (B) For unstable bradycardia, suitable infusion drugs include dopamine, atropine, and epinephrine. (C) When a 20 kg child requires synchronous rectification of the heart due to unstable tachycardia, 10 joules is a reasonable starting dose. (D) Unstable bradycardia that requires initiation of CPR refers to a heart rate of less than 50 beats/min.", "output": "C"}"(A) Aortic artery detachment, use Labetalol to control systolic pressure at 100-120 mmHg. (B) Amphetamine intoxication, use Benzodiazepine to control systolic pressure below 140 mmHg. (C) Preeclampsia, use ACE inhibitors to control systolic pressure below 140 mmHg. (D) Subarachnoid hemorrhage, use Nicardipine to control systolic pressure below 160 mmHg.", "output": "C"} 
-{"instruction": "Which of the following statements is more appropriate regarding the targeted temperature management (TTM) management of post-cardiac arrest care?", "input": "(A) Inclusion criteria include: ROSC and GCS motor score <6, no other causes of coma, no DNR or DNI status, etc. (B) Exclusion criteria include: cardiac arrest due to trauma or severe bleeding, patients taking anticoagulants, etc. (C) Potential adverse reactions include: coagulation disorders with prolonged PTT, hyperkalemia during cooling, and hypokalemia during rewarming. (D) Reduce core body temperature to 32-36°C as soon as possible within 2 hours after restoration of spontaneous circulation. ", "output": "A"}
-{"instruction": "A 25-year-old male with no past medical history presents with dyspnea and shock after a contrast injection CT scan. Breath sounds are wheezing on both sides and significant use of accessory muscles. Vital signs are 80/45 mmHg, heart rate 120 beats/min, respiration 36 breaths/min, temperature 38.3℃, blood oxygen 85%, GCS E4V5M6. Which of the following assessments and treatments is less appropriate?", "input": "(A) Epinephrine 0.3 mg injected intramuscularly into the upper arm is preferred. (B) Administer large amounts of saline 1,000~2,000 cc intravenous infusion. (C) Administer high-concentration oxygen to maintain arterial oxygen concentration greater than 90%. (D) Give inhaled bronchodilators and intravenous injection of 2 g of magnesium sulfate. ", "output": "A"} 
-{"instruction": "Three patients in the emergency room ate mackerel lunch together and developed symptoms about 1 hour later, including headache, dizziness, diarrhea, and upper abdominal pain. The patients' vital signs were stable and they had no fever. Physical examination revealed that two patients had flushing on their faces and chests, while the rest of the body parts were normal. Which of the following treatments is more appropriate? ", "input": "(A) Symptoms appeared quickly, and the most likely pathogen is Staphylococcal enterotoxin. (B) Collect stool samples from the patients and give supportive treatment and oral antibiotics. (C) Provide supportive therapy and antihistamines. (D) Cooking food at high temperatures can prevent this type of food poisoning. ", "output": "C"} 
-{"instruction": "A 35-year-old female was admitted to the hospital for fever and unconsciousness. A brain CT scan showed no cerebral hemorrhage. Tests revealed WBC 3,700 /µL, Hb 5.0 g/dL, Platelet 15,000 /μL, Creatinine 3.5 mg/dL, T-Bil 5.3 mg/dL, D-Bil 1.2 mg/dL, INR 0.9, aPTT ratio 1.1, Heptoglobin 12 mg/dL (reference value 30~200 mg/dL) , which of the following statements about this patient is more appropriate? ", "input": "(A) The pathological mechanism is the overactivity of the protease ADAMTS-13. (B) Treatment includes plasma replacement and replenishment of red blood cells and platelets. (C) Differential diagnosis of human immunodeficiency virus (HIV) infection is required. (D) The prognosis after treatment is excellent and the recurrence rate is also very low. ", "output": "C"} 
-{"instruction": "You are preparing to draw fluid from the knee joint. Which of the following statements is more appropriate? ", "input": "(A) When drawing fluid, avoid milking the joint cavity at the same time to avoid bleeding in the joint cavity. (B) It is best to be in a bent knee position when drawing fluid. (C) The positioning point is two finger widths (about 3 cm) just below the patella. (D) The needle is inserted on the inside or outside of the positioning point and moves horizontally toward the midpoint of the posterior side of the patella. ", "output": "D"} 
-{"instruction": "A 32-year-old male has recently experienced upper abdominal pain and nausea. He went to another county for medical treatment two days ago and had a gastroscopy. He was told that he had a suspected bacterial infection in the stomach. Because the symptoms persisted after taking the medication, he went to the emergency room for medical treatment. Regarding proton pump inhibitors (PPIs), which of the following statements is more appropriate? ", "input": "(A) Compared with H2 receptor antagonists, PPIs have better therapeutic effects, but they are slower in treating ulcers. (B) They have the effect of inhibiting Helicobacter pylori. (C) Long-term use may increase the risk of pneumonia, fractures, and high magnesium levels. (D) It is not part of the three-in-one drug treatment combination for Helicobacter pylori, but can be prescribed together to improve symptoms and prognosis. ", "output": "B"} 
-{"instruction": "Which of the following drugs for the prevention and treatment of high-altitude disorders is less appropriate? ", "input": "(A) Acetazolamide can be used to prevent altitude sickness. It should be taken one day before climbing. It should be taken orally twice a day, 125-250 mg. (B) Nifedipine can be used to treat high-altitude pulmonary edema. It should be taken orally in an extended-release form, 30 mg every 12 hours. (C) Tadalafil can be used to prevent high-altitude pulmonary edema. It should be taken one day before climbing. It should be taken orally twice a day, 10 mg. (D)Dexamethasone can be used to prevent altitude sickness. It should be started when climbing a mountain, and should be taken orally at a rate of 4 mg every 6 hours. ", "output": "D"} 
-{"instruction": "An 11-month-old boy, weighing about 10 kg, has persistent episodes of abdominal pain and crying at home. His parents are the primary caregivers. Bloody stools were found in his diapers. Bedside abdominal ultrasound showed a high possibility of intussusception. Which of the following is less appropriate? ", "input": "(A)Children of this age usually cannot find the leading point. (B)When there are signs of peritonitis, the pressure of air reduction must be reduced to avoid intestinal perforation. (C)The presence of bloody stools is not a contraindication to air reduction. (D) If air repositioning fails, reassessment is required to determine whether it is incarcerated hernia. ", "output": "B"} 
-{"instruction": "Which of the following descriptions of Multisystem inflammatory syndrome in children (MIS-C) is less appropriate? ", "input": "(A) Age 0-12 years and fever ≥ 3 days are the current World Health Organization (WHO) diagnostic criteria for MIS-C. (B) Myocardial function is often impaired, combined with shock. (C) Evidence of SARS-CoV-2 infection is required, such as positive nucleic acid (RT-PCR) serology or recent contact with an infected person. (D) Commonly used treatment drugs are immunoglobulin and steroids. ", "output": "A"}
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