{"question": "A 21-year-old sexually active male complains of fever, pain during urination, and inflammation and pain in the right knee. A culture of the joint fluid shows a bacteria that does not ferment maltose and has no polysaccharide capsule. The physician orders antibiotic therapy for the patient. The mechanism of action of action of the medication given blocks cell wall synthesis, which of the following was given?", "answer": "Ceftriaxone", "meta_info": "step1", "answer_idx": "C", "A": "Gentamicin", "B": "Ciprofloxacin", "C": "Ceftriaxone", "D": "Trimethoprim", "language": "en"}
{"question": "A 5-year-old girl is brought to the emergency department by her mother because of multiple episodes of nausea and vomiting that last about 2 hours. During this period, she has had 6–8 episodes of bilious vomiting and abdominal pain. The vomiting was preceded by fatigue. The girl feels well between these episodes. She has missed several days of school and has been hospitalized 2 times during the past 6 months for dehydration due to similar episodes of vomiting and nausea. The patient has lived with her mother since her parents divorced 8 months ago. Her immunizations are up-to-date. She is at the 60th percentile for height and 30th percentile for weight. She appears emaciated. Her temperature is 36.8°C (98.8°F), pulse is 99/min, and blood pressure is 82/52 mm Hg. Examination shows dry mucous membranes. The lungs are clear to auscultation. Abdominal examination shows a soft abdomen with mild diffuse tenderness with no guarding or rebound. The remainder of the physical examination shows no abnormalities. Which of the following is the most likely diagnosis?", "answer": "Cyclic vomiting syndrome", "meta_info": "step2&3", "answer_idx": "A", "A": "Cyclic vomiting syndrome", "B": "Gastroenteritis", "C": "Hypertrophic pyloric stenosis", "D": "Gastroesophageal reflux disease", "language": "en"}
{"question": "A 40-year-old woman presents with difficulty falling asleep, diminished appetite, and tiredness for the past 6 weeks. She says that, despite going to bed early at night, she is unable to fall asleep. She denies feeling anxious or having disturbing thoughts while in bed. Even when she manages to fall asleep, she wakes up early in the morning and is unable to fall back asleep. She says she has grown increasingly irritable and feels increasingly hopeless, and her concentration and interest at work have diminished. The patient denies thoughts of suicide or death. Because of her diminished appetite, she has lost 4 kg (8.8 lb) in the last few weeks and has started drinking a glass of wine every night instead of eating dinner. She has no significant past medical history and is not on any medications. Which of the following is the best course of treatment in this patient?", "answer": "Trazodone", "meta_info": "step1", "answer_idx": "D", "A": "Diazepam", "B": "Paroxetine", "C": "Zolpidem", "D": "Trazodone", "language": "en"}
{"question": "A 37-year-old female with a history of type II diabetes mellitus presents to the emergency department complaining of blood in her urine, left-sided flank pain, nausea, and fever. She also states that she has pain with urination. Vital signs include: temperature is 102 deg F (39.4 deg C), blood pressure is 114/82 mmHg, pulse is 96/min, respirations are 18, and oxygen saturation of 97% on room air. On physical examination, the patient appears uncomfortable and has tenderness on the left flank and left costovertebral angle. Which of the following is the next best step in management?", "answer": "Obtain a urine analysis and urine culture", "meta_info": "step2&3", "answer_idx": "B", "A": "Obtain an abdominal CT scan", "B": "Obtain a urine analysis and urine culture", "C": "Begin intravenous treatment with ceftazidime", "D": "No treatment is necessary", "language": "en"}
{"question": "A 19-year-old boy presents with confusion and the inability to speak properly. The patient's mother says that, a few hours ago, she noticed a change in the way he talked and that he appeared to be in a daze. He then lost consciousness, and she managed to get him to the hospital. She is also concerned about the weight he has lost over the past few months. His blood pressure is 80/55 mm Hg, pulse is 115/min, temperature is 37.2°C (98.9°F), and respiratory rate is 18/min. On physical examination, the patient is taking rapid, deep breaths, and his breath has a fruity odor. Dry mucous membranes and dry skin are noticeable. He is unable to cooperate for a mental status examination. Results of his arterial blood gas analysis are shown.\nPco2 16 mm Hg\nHCO3–  10 mEq/L\nPo2 91 mm Hg\npH 7.1\nHis glucose level is 450 mg/dL, and his potassium level is 4.1 mEq/L. Which of the following should be treated first in this patient?", "answer": "Hypoperfusion", "meta_info": "step1", "answer_idx": "A", "A": "Hypoperfusion", "B": "Hyperglycemia", "C": "Metabolic acidosis", "D": "Hypokalemia", "language": "en"}
{"question": "A 41-year-old woman presents to her primary care physician with complaints of fatigue and weakness. She denies any personal history of blood clots or bleeding problems in her past, but she says that her mother has had to be treated for breast cancer recently and is starting to wear her down. Her past medical history is significant for preeclampsia, hypertension, polycystic ovarian syndrome, and hypercholesterolemia. She currently smokes 1 pack of cigarettes per day, drinks a glass of wine per day, and currently denies any illicit drug use. Her vital signs include: temperature, 36.7°C (98.0°F); blood pressure, 126/74 mm Hg; heart rate, 111/min; and respiratory, rate 23/min. On physical examination, her pulses are bounding and irregular, complexion is pale, but breath sounds remain clear. On examination, the physician finds diffuse skin pallor and orders a complete blood count. Her laboratory data demonstrate a hematocrit of 27.1%, MCV of 79 fL, and a reticulocyte count of 2.0%. The patient is diagnosed with anemia. Which of the following represents the most likely etiology of her anemia.", "answer": "Iron deficiency", "meta_info": "step2&3", "answer_idx": "C", "A": "Vitamin B12 deficiency", "B": "Folate deficiency", "C": "Iron deficiency", "D": "Intravascular hemolysis", "language": "en"}
{"question": "A 59-year-old woman with stage IV lung cancer comes to the physician because of progressively worsening weakness in the past 3 months. She has had a 10.5-kg (23-lb) weight loss during this period. Her BMI is 16 kg/m2. She appears thin and has bilateral temporal wasting. Which of the following is the most likely primary mechanism underlying this woman's temporal muscle atrophy?", "answer": "Proteasomal degradation of ubiquitinated proteins", "meta_info": "step1", "answer_idx": "D", "A": "Cytochrome c-mediated activation of proteases", "B": "Lipase-mediated degradation of triglycerides", "C": "TNF-α-mediated activation of caspases", "D": "Proteasomal degradation of ubiquitinated proteins", "language": "en"}
{"question": "A 67-year-old man presents to the emergency department with a fever and altered mental status. The patient has a history of Alzheimer dementia and is typically bed bound. His son found him confused with a warm and flushed complexion thus prompting his presentation. The patient has a past medical history of dementia, diabetes, and hypertension and typically has a visiting home nurse come to administer medications. Prior to examination, he is given haloperidol and diphenhydramine as he is combative and will not allow the nurses near him. His temperature is 102.9°F (39.4°C), blood pressure is 104/64 mmHg, pulse is 170/min, respirations are 22/min, and oxygen saturation is 100% on room air. Physical exam is notable for dry and flushed skin and a confused man. There is no skin breakdown, and flexion of the patient’s neck elicits no discomfort. Laboratory studies are drawn as seen below.\n\nHemoglobin: 15 g/dL\nHematocrit: 45%\nLeukocyte count: 4,500/mm^3 with normal differential\nPlatelet count: 227,000/mm^3\n\nSerum:\nNa+: 139 mEq/L\nCl-: 100 mEq/L\nK+: 4.3 mEq/L\nHCO3-: 24 mEq/L\nBUN: 30 mg/dL\nGlucose: 97 mg/dL\nCreatinine: 1.5 mg/dL\nCa2+: 10.2 mg/dL\nAST: 12 U/L\nALT: 10 U/L\n\nUrine:\nColor: Yellow\nBacteria: Absent\nNitrites: Negative\nRed blood cells: Negative\n\nAn initial chest radiograph is unremarkable. The patient is given 3 liters of Ringer's lactate and an electric fan to cool off. Two hours later, his temperature is 99°F (37.2°C), blood pressure is 154/94 mmHg, pulse is 100/min, respirations are 17/min, and oxygen saturation is 100% on room air. The patient’s mental status is at the patient’s baseline according to the son. Which of the following is the most likely diagnosis?", "answer": "Non-exertional heat stroke", "meta_info": "step2&3", "answer_idx": "C", "A": "Exertional heat stroke", "B": "Neuroleptic malignant syndrome", "C": "Non-exertional heat stroke", "D": "Septic shock", "language": "en"}
{"question": "A 32-year-old man presents to a mission hospital in Cambodia because he has had difficulty walking from his village to the market. He says that he has always been healthy other than occasional infections; however, over the last year he has been having numbness in his hands and feet. Furthermore, he has noticed weakness, muscle wasting, and pain in his lower extremities. The only change he can remember is that after having a poor harvest last year, he and his family have been subsisting on white rice. Physical exam reveals normal skin color and decreased deep tendon reflexes. The most likely cause of this patient's symptoms is associated with which of the following enzymatic reactions?", "answer": "Alpha-ketoglutarate dehydrogenase", "meta_info": "step1", "answer_idx": "A", "A": "Alpha-ketoglutarate dehydrogenase", "B": "Acyl transferases", "C": "Glycogen phosphorylase", "D": "Homocysteine methyltransferase", "language": "en"}
{"question": "A 60-year-old woman presents to her primary care physician for a wellness checkup. She has a past medical history of hypertension and was discharged from the hospital yesterday after management of a myocardial infarction. She states that sometimes she experiences exertional angina. Her temperature is 99.5°F (37.5°C), blood pressure is 147/98 mmHg, pulse is 90/min, respirations are 17/min, and oxygen saturation is 98% on room air. Physical exam is within normal limits. Which of the following is the best next step in management?", "answer": "Atenolol", "meta_info": "step1", "answer_idx": "A", "A": "Atenolol", "B": "Furosemide", "C": "Hydrochlorothiazide", "D": "Nitroglycerin", "language": "en"}
{"question": "A 42-year-old male presents to his primary care physician complaining of abdominal pain. He reports a 5-month history of epigastric pain that improves with meals. He has lost 15 pounds since the pain started. His past medical history is significant for a prolactinoma for which he underwent transphenoidal resection. He drinks alcohol socially and has a 10 pack-year smoking history. His family history is notable for a maternal uncle with a parathyroid adenoma. His temperature is 98.8°F (37.1°C), blood pressure is 125/80 mmHg, pulse is 85/min, and respirations are 18/min. After further workup, the patient is started on octreotide, an analogue of an endogenously produced hormone. When this hormone is produced by the hypothalamus, it has which of the following effects?", "answer": "Decrease production of growth hormone", "meta_info": "step1", "answer_idx": "A", "A": "Decrease production of growth hormone", "B": "Decrease production of prolactin", "C": "Decrease production of gastrin", "D": "Decrease production of thyrotropin-releasing hormone", "language": "en"}
{"question": "A 28-year-old female reports that, for more days than not over the past 3 years, she has felt \"down\" and, at times, \"mildly depressed.\" Over this period, she also endorses feeling fatigued, difficulty concentrating, and often sleeping more than in the past. The patient denies any manic or hypomanic periods and also reports that she did not have any periods of extreme worsening of her depressed mood beyond that described above. She also denies any suicidal ideation. What is the minimum amount of time this patient must exhibit these symptoms in order to meet the diagnostic criteria for dysthymia?", "answer": "2 years", "meta_info": "step1", "answer_idx": "C", "A": "2 months", "B": "6 months", "C": "2 years", "D": "5 years", "language": "en"}
{"question": "A 42-year-old man is being treated by his female family medicine physician for chronic depression. Recently, he has been scheduling more frequent office visits. He does not report any symptoms or problems with his SSRI medication during these visits. Upon further questioning, the patient confesses that he is attracted to her and says \"You are the only one in the world who understands me\". The physician also manages his hypertension. Which of the following is the most appropriate next step in management?", "answer": "Ask closed-ended questions and use a chaperone for future visits", "meta_info": "step1", "answer_idx": "B", "A": "Re-evaluate this patient for borderline personality disorder", "B": "Ask closed-ended questions and use a chaperone for future visits", "C": "Immediately tell this patient that you can not continue to treat him and avoid any further communication", "D": "Increase the dosage of this patient’s SSRI", "language": "en"}
{"question": "A 51-year-old female presents with intermittent right upper quadrant discomfort. The physician suspects she is suffering from biliary colic and recommends surgery. Following surgery, brown stones are removed from the gallbladder specimen. What is the most likely cause of the gallstone coloring?", "answer": "E. coli infection; beta-glucoronidase release", "meta_info": "step1", "answer_idx": "A", "A": "E. coli infection; beta-glucoronidase release", "B": "Shigella infection; HMG-CoA reductase release", "C": "Shigella infection; beta-glucoronidase release", "D": "Bile supersaturated with cholesterol; beta-glucoronidase release", "language": "en"}
{"question": "A 56-year-old man with known coronary artery disease presents to the emergency department complaining of chest discomfort and palpitations for 2 hours. On arrival, the vital signs include blood pressure 122/76 mm Hg, heart rate 180/min, respiratory rate 22/min, temperature 37.0℃ (98.6℉), and blood oxygen saturation (SpO2) 98% on room air. A 12-lead electrocardiogram demonstrated ST-segment elevation in the anterolateral leads. The troponin level was 0.8 ng/mL (normal 0–0.4 ng/mL). The patient declined primary percutaneous intervention and was treated with antifibrinolytics in the coronary care unit. After 1 hour of treatment, the patient loses consciousness and the blood pressure falls to 60/40 mm Hg. Cardiac monitoring shows the electrocardiogram (ECG) pattern in lead 2 shown below. What is the most likely cause of his condition?", "answer": "Monomorphic ventricular tachycardia", "meta_info": "step1", "answer_idx": "A", "A": "Monomorphic ventricular tachycardia", "B": "Mitral regurgitation", "C": "Third-degree heart block", "D": "Acute pericarditis", "language": "en"}
{"question": "A 16-year-old female high school student is brought to the physician by her parents for her repeated behavioral problems at home and school during the past 10 months. Her teachers describe her behavior as uncooperative and disruptive as she persistently refuses to answer questions, insults her teachers, and annoys her classmates on a daily basis. At home, her parents try to address her frequent violations of curfew, but attempts at discussing the issue often result in their daughter losing her temper and screaming at her parents. Her grades have deteriorated over the past year. She has no history of psychiatric illness. On questioning, the patient refuses to answer and frequently disrupts the physician’s conversation with the parents. Which of the following is the most likely diagnosis in this patient?", "answer": "Oppositional defiant disorder", "meta_info": "step2&3", "answer_idx": "D", "A": "Reactive attachment disorder", "B": "Conduct disorder", "C": "Antisocial personality disorder", "D": "Oppositional defiant disorder", "language": "en"}
{"question": "A 22-year-old man is brought to the emergency room with a penetrating stab injury to his left chest. He appears pale, drowsy, and diaphoretic. His pulse is feeble, systolic blood pressure is 86 mm Hg, the respirations are 22/min with an oxygen saturation of 88% at room air, and the temperature is 36.6°C (98.0°F). His jugular vein is distended. Chest auscultation reveals equal breath sounds bilaterally, with muffled heart sounds. Immediate IV fluid resuscitation is initiated. Which of the following findings indicates that the cause of shock is cardiogenic?", "answer": "High central venous pressure (CPV)", "meta_info": "step2&3", "answer_idx": "B", "A": "Elevated serum creatinine", "B": "High central venous pressure (CPV)", "C": "Arterial blood gas (ABG) showing base deficit and metabolic acidosis", "D": "White blood cell (WBC) count < 4000/mm3", "language": "en"}
{"question": "A 56-year-old woman is brought to the physician by her husband because of a two-day history of fever, malaise, headaches, and confusion. She recently immigrated from rural China and her immunization status is unknown. Her temperature is 39.1°C (102.4°F). Physical examination shows nuchal rigidity and photophobia. Cerebrospinal fluid analysis shows a neutrophil count of 1,500/mm3. Cerebrospinal fluid cultured on Thayer-Martin agar and normal sheep blood agar shows no growth. However, when the sheep blood agar sample is heated, numerous non-hemolytic, opaque, cream-colored colonies grow. Which of the following characteristics best describes the most likely causal pathogen?", "answer": "Gram-negative coccobacillus", "meta_info": "step1", "answer_idx": "A", "A": "Gram-negative coccobacillus", "B": "Gram-positive, lancet-shaped diplococcus", "C": "Gram-negative diplococcus", "D": "Gram-positive, facultative intracellular bacillus", "language": "en"}
{"question": "A 35-year-old male presents to his primary care physician complaining of a one-month history of progressively worsening fatigue. He sought medical attention because this has affected his ability to complete his work as a graduate student. As a child, he was hospitalized for hemolytic uremic syndrome. His past medical history is also notable for diabetes mellitus and obesity. He takes metformin and glyburide. He does not smoke and drinks alcohol occasionally. His family history is notable for chronic lymphocytic leukemia in his paternal uncle and stroke in his father. His temperature is 99.9°F (37.7°C), blood pressure is 100/70 mmHg, pulse is 110/min, and respirations are 18/min. Physical examination reveals diffuse pallor. Hematologic labs are shown below:\n\nHemoglobin: 8.9 g/dL\nHematocrit: 24%\nLeukocyte count: 7,500 cells/mm^3 with normal differential\nPlatelet count: 180,000/mm^3\nMean corpuscular volume: 85 µm^3\nReticulocyte count: 0.4%\n\nHead and neck imaging is negative for neck masses. The pathogen associated with this patient’s condition is also known to cause which of the following?", "answer": "Erythema infectiosum", "meta_info": "step1", "answer_idx": "B", "A": "Kaposi’s sarcoma", "B": "Erythema infectiosum", "C": "Mononucleosis", "D": "Croup", "language": "en"}
{"question": "A 30-year-old man is brought to the doctor's office by his wife. She complains that over the past week there have been 3 episodes where he has fallen asleep while speaking with her. She mentioned that these events began a few months ago and have been increasing in frequency. She also says that his snoring has gotten to the point where she has a hard time sleeping next to him. When asked, the patient says that he frequently falls asleep while reading or watching television in the afternoons and feels refreshed after a short nap. The patient is worried because he sometimes hears people who aren’t in the room as he falls asleep. He is worried he might be “going crazy.” He has noticed that when his friends tell him a joke or he laughs at something on the TV, he drops whatever he’s holding and feels like his legs become weak. These episodes self-resolve in a few seconds. Examination shows a morbidly obese man in no acute distress. Which of the following is the best treatment for the most likely cause for this patient’s illness?", "answer": "Modafinil", "meta_info": "step1", "answer_idx": "A", "A": "Modafinil", "B": "Taking longer naps", "C": "Continuous positive airway pressure", "D": "Changing bedtime to earlier in the evening", "language": "en"}
{"question": "A 55-year-old homeless man presents to the emergency department acutely confused. The patient was found wandering the streets with an abnormal gait. The patient has a past medical history of alcohol and IV drug abuse. His temperature is 98.5°F (36.9°C), blood pressure is 103/61 mmHg, pulse is 120/min, respirations are 16/min, and oxygen saturation is 97% on room air. Physical exam is notable for a poorly kempt man with ataxic gait. Ophthalmoplegia is noted on cranial nerve testing, and he has decreased vibration sensation in the bilateral lower extremity. Dermatologic exam reveals perifollicular hemorrhages, bleeding gums, and many bruises along the patient’s upper and lower extremities. An initial ECG is notable for sinus tachycardia and the patient is given 2L of Ringer lactate. Laboratory values are ordered as seen below.\n\nHemoglobin: 8.0 g/dL\nHematocrit: 30%\nLeukocyte count: 3,500/mm^3 with normal differential\nPlatelet count: 192,000/mm^3\nMCV: 119 fL\n\nSerum:\nNa+: 139 mEq/L\nCl-: 100 mEq/L\nK+: 4.3 mEq/L\nHCO3-: 25 mEq/L\nBUN: 20 mg/dL\nGlucose: 47 mg/dL\nCreatinine: 1 mg/dL\nCa2+: 9.2 mg/dL\nMg2+: 1.2 mEq/L\nAST: 82 U/L\nALT: 70 U/L\n\nWhich of the following is the best next treatment for this patient?", "answer": "Thiamine", "meta_info": "step2&3", "answer_idx": "C", "A": "Folate", "B": "Magnesium", "C": "Thiamine", "D": "Vitamin C", "language": "en"}
{"question": "A 61-year-old woman is brought to the emergency department because of crushing substernal chest pain at rest for the past 2 hours. She is diaphoretic. Her temperature is 37.5°C (99.5°F), pulse is 110/min, respirations are 21/min, and blood pressure is 115/65 mm Hg. An ECG shows ST elevation in I, aVL, and V2–V4. Coronary angiography shows an 80% stenosis in the left anterior descending artery. Which of the following is the most likely initial step in the pathogenesis of this patient's coronary condition?", "answer": "Endothelial cell dysfunction", "meta_info": "step1", "answer_idx": "C", "A": "Intimal monocyte infiltration", "B": "Platelet activation", "C": "Endothelial cell dysfunction", "D": "Fibrous plaque formation", "language": "en"}
{"question": "A 4-year-old boy presents to the office with his mother. She states that the patient has been complaining of pain in his scrotum with swelling, abdominal pain, and nausea for the last 2 or 3 days. On exam, the abdomen is soft and nontender to palpation. The right scrotal sac is mildly enlarged without erythema. A tender mass is palpated in the right scrotal area. The mass does not transilluminate when a penlight is applied. The patient is afebrile and all vital signs are stable. What is the most likely etiology of this patient’s presentation?", "answer": "Patent processus vaginalis", "meta_info": "step1", "answer_idx": "A", "A": "Patent processus vaginalis", "B": "Collection of fluid in the tunica vaginalis", "C": "Infection of the epididymis", "D": "Neoplasm of the testicle", "language": "en"}
{"question": "A 59-year-old man presents to his primary care physician, accompanied by his wife, who requests treatment for his “chronic pessimism.” The patient admits to feeling tired and “down” most of the time for the past several years but insists that it is “just part of getting old.” His wife believes that he has become more self-critical and less confident than he used to be. Neither the patient nor his wife can identify any stressors or triggering events. He has continued to work as a librarian at a nearby college during this time and spends time with friends on the weekends. He sleeps 7 hours per night and eats 3 meals per day. He denies suicidal ideation or periods of elevated mood, excessive irritability, or increased energy. Physical exam reveals a well-dressed, well-groomed man without apparent abnormality. Basic neurocognitive testing and labs (CBC, BMP, TSH, cortisol, testosterone, and urine toxicology) are within normal limits. What is the most likely diagnosis?", "answer": "Dysthymia", "meta_info": "step1", "answer_idx": "D", "A": "Adjustment disorder with depressive features", "B": "Bipolar disorder", "C": "Cyclothymia", "D": "Dysthymia", "language": "en"}
{"question": "A 17-month-old girl was brought to the emergency department by her mom following a fall. The mom reports that the patient was playing in the playground when she tripped and fell onto the mulch. She had an uncomplicated birth history and has been meeting developmental goals except for language delay, for which she is to receive a hearing test for further evaluation next week. Physical exam reveals bruising along the left lateral thigh, knee, and elbow; all lab tests are within normal limits. Radiograph shows a fracture of the olecranon. Serum chemistry and liver panels were within normal limits. What is the most likely explanation for the patient’s presentation?", "answer": "Defective type 1 collagen gene", "meta_info": "step1", "answer_idx": "B", "A": "Child abuse", "B": "Defective type 1 collagen gene", "C": "Low levels of phosphate", "D": "Low levels of vitamin D", "language": "en"}
{"question": "ِA 62-year-old man comes to the emergency department because of colicky pain in the lower abdomen and abdominal distension for the past 12 hours. He has chronic constipation for which he takes lactulose and senna laxatives. His temperature is 37.1°C (98.7°F), blood pressure is 110/60 mm Hg and pulse is 85/min. On physical examination, there is diffuse abdominal distension and tenderness, and bowel sounds are faint. His plain abdominal radiograph is shown. Which of the following is the most likely diagnosis?", "answer": "Volvulus", "meta_info": "step2&3", "answer_idx": "C", "A": "Infectious colitis", "B": "Bowel adhesions", "C": "Volvulus", "D": "Acute diverticulitis", "language": "en"}
{"question": "A 73-year-old African American man comes to the physician for a routine health maintenance examination. He has type 2 diabetes mellitus, hypertension, hypercholesterolemia, and coronary artery disease. His current medications include metformin, hydrochlorothiazide, amlodipine, rosuvastatin, isosorbide mononitrate, aspirin, and dipyridamole. He is 180 cm (5 ft 11 in) tall and weighs 110 kg (242 lb); BMI is 34 kg/m2. His vital signs are within normal limits. His hemoglobin A1c concentration is 6.7%. Serum lipid studies show:\nCholesterol, total 302 mg/L\nHDL-cholesterol 39 mg/dL\nLDL-cholesterol 197 mg/dL\nTriglycerides 292 mg/dL\nThe physician prescribes a drug that inhibits intestinal cholesterol absorption. The addition of this drug is most likely to increase the risk of which of the following adverse effects?\"", "answer": "Hepatotoxicity", "meta_info": "step1", "answer_idx": "A", "A": "Hepatotoxicity", "B": "Hyperkalemia", "C": "Cutaneous flushing", "D": "Hyperuricemia", "language": "en"}
{"question": "A 15-year-old girl is brought to the clinic by her mother because she is worried the patient has not yet had her period. The patient’s older sister had her first period at age 14. The mother had her first period at age 13. The patient reports she is doing well in school and is on the varsity basketball team. Her medical history is significant for asthma and atopic dermatitis. Her medications include albuterol and topical triamcinolone. The patient’s temperature is 98°F (36.7°C), blood pressure is 111/72 mmHg, pulse is 65/min, and respirations are 14/min with an oxygen saturation of 99% on room air. Her body mass index (BMI) is 19 kg/m^2. Physical exam shows absent breast development and external genitalia at Tanner stage 1. Serum follicle stimulating hormone (FSH) level is measured to be 38 mIU/mL. Which of the following is the next best diagnostic step?", "answer": "Karotype", "meta_info": "step2&3", "answer_idx": "D", "A": "CYP17 gene work-up", "B": "Estrogen levels", "C": "Gonadotrophin-releasing hormone stimulation test", "D": "Karotype", "language": "en"}
{"question": "A 15-month-old girl is brought to the physician by her mother for grossly bloody diarrhea for 2 days. The girl has had a few episodes of blood-tinged stools over the past 3 weeks. She has not had pain, nausea, or vomiting. She is at the 55th percentile for height and 55th percentile for weight. Examination shows conjunctival pallor. The abdomen is soft and nontender. There is a small amount of dark red blood in the diaper. Her hemoglobin concentration is 9.5 g/dL, mean corpuscular volume is 68 μm3, and platelet count is 300,000/mm3. Further evaluation is most likely to show which of the following findings?", "answer": "Ectopic gastric mucosa on Technetium-99m pertechnetate scan", "meta_info": "step1", "answer_idx": "D", "A": "Neutrophil infiltrated crypts on colonic biopsy", "B": "Absent ganglionic cells on rectal suction biopsy", "C": "Target sign on abdominal ultrasound", "D": "Ectopic gastric mucosa on Technetium-99m pertechnetate scan", "language": "en"}
{"question": "A 3855-g (8-lb 8-oz) newborn is examined shortly after birth. She was delivered at 40 weeks' gestation by cesarean delivery because of breech presentation. Pregnancy was otherwise uncomplicated. Physical examination shows asymmetric thigh creases. The left leg is shorter than the right leg and positioned in external rotation. Which of the following is the most likely underlying cause of this patient's findings?", "answer": "Abnormal development of the acetabulum", "meta_info": "step1", "answer_idx": "C", "A": "Fracture of the femoral neck", "B": "Inflammation of the hip synovium", "C": "Abnormal development of the acetabulum", "D": "Displacement of the femoral epiphysis", "language": "en"}
{"question": "A 27-year-old G1P0 woman at 9 weeks estimated gestational age presents for a prenatal visit. She has no current complaints and takes no medications. She is vegetarian and emigrated from Nepal 7 years ago. She does not use tobacco, alcohol or recreational drugs. The patient’s vital signs include: blood pressure 111/95 mm Hg, temperature 36.7°C (98.6°F), pulse 88/min. Laboratory results are significant for the following:\nHemoglobin 10.2 g/dL\nErythrocyte count 5.5 million/mm3\nMean corpuscular volume 65 μm3\nMean corpuscular hemoglobin 21 pg/cell\nRed cell distribution width 13.5% (ref: 11.5–14.5%)\nSerum ferritin 170 ng/mL\nWhich of the following is the most likely cause of this patient's anemia?", "answer": "Thalassemia trait", "meta_info": "step2&3", "answer_idx": "D", "A": "Vitamin B12 deficiency", "B": "Zinc deficiency", "C": "Gestational anemia", "D": "Thalassemia trait", "language": "en"}
{"question": "A 31-year-old woman presents to your clinic with a persistent headache. She reports she has suffered from headaches since the age of 27 when she gained 12 kg (26.4 lb) after the birth of her second child. The headache is generalized and throbbing in nature. It worsens in the morning and is aggravated with coughing, laughing, and sneezing. The patient’s blood pressure is 130/85 mm Hg, heart rate is 90/min, respiratory rate is 14/min, and the temperature is 36.6℃ (97.9℉). The patient’s weight is 101 kg (222.7 lb), height is 165 cm (5.4 ft), and BMI is 36.7 kg/m2. Examination reveals papilledema. Head CT scan does not reveal any abnormalities. Lumbar puncture shows an opening pressure of 32 cm H2O. The patient is prescribed a carbonic anhydrase inhibitor, acetazolamide, for idiopathic intracranial hypertension. What will be the change in the kinetics of the reaction catalyzed by carbonic anhydrase under the influence of acetazolamide?", "answer": "Activation energy (Ea) will increase", "meta_info": "step1", "answer_idx": "A", "A": "Activation energy (Ea) will increase", "B": "Activation energy (Ea) will decrease", "C": "Free energy (G) of the reactants will increase", "D": "Increase reaction free energy change (∆G) by increasing free energy (G) of reactants and decreasing G of products", "language": "en"}
{"question": "A 55-year-old man comes to the emergency department because of a dry cough and severe chest pain beginning that morning. Two months ago, he was diagnosed with inferior wall myocardial infarction and was treated with stent implantation of the right coronary artery. He has a history of hypertension and hypercholesterolemia. His medications include aspirin, clopidogrel, atorvastatin, and enalapril. His temperature is 38.5°C (101.3°F), pulse is 92/min, respirations are 22/min, and blood pressure is 130/80 mm Hg. Cardiac examination shows a high-pitched scratching sound best heard while sitting upright and during expiration. The remainder of the examination shows no abnormalities. An ECG shows diffuse ST elevations. Serum studies show a troponin I of 0.2 ng/mL (N < 0.01). Which of the following is the most likely cause of this patient's symptoms?", "answer": "Dressler syndrome", "meta_info": "step2&3", "answer_idx": "D", "A": "Cardiac tamponade", "B": "Constrictive pericarditis", "C": "Reinfarction", "D": "Dressler syndrome", "language": "en"}
{"question": "A 27-year-old man presents to the physician with concern for pain in both of his knees that he is unable to attribute to any activities that he has recently performed. He had an acute episode of diarrhea 2 weeks ago, prior to the onset of symptoms. He has also been experiencing a burning sensation during urination for the past week. When questioned about any other symptoms, he notes that he has also noticed that his eyes occasionally feel irritated and painful, leading to bouts of blurry vision. On physical examination, the patient is afebrile and has conjunctival injection surrounding the iris. A synovial fluid aspiration of the knee is performed and reveals a white blood cell count of 51,000/µL. Which of the following is the most appropriate treatment for this patient’s condition?", "answer": "Indomethacin", "meta_info": "step2&3", "answer_idx": "C", "A": "Acetaminophen", "B": "Allopurinol", "C": "Indomethacin", "D": "Leflunomide", "language": "en"}
{"question": "A 22-year old active duty soldier presents to your clinic with complaints of intense fatigue, fevers, abdominal pain, and a nonproductive cough. Her symptoms began a few days ago, but she returned from a tour of duty in Malawi and Mozambique four weeks ago. She endorses sleeping outside, using minimal bug spray, and swimming in rivers during her tour. On physical exam, her temperature is 101.5, and she appears exhausted. She has a hive-like rash scattered over her body. Her abdominal exam is notable for hepatosplenomegaly, and her lung exam is notable for scattered crackles. Her CBC with diff is remarkable for marked eosinophilia, and she has an elevated IgE. Of the following organisms, infection with which one is most consistent with her symptoms?", "answer": "Schistosoma mansoni", "meta_info": "step1", "answer_idx": "B", "A": "Plasmodium falciparum", "B": "Schistosoma mansoni", "C": "Mycobacterium tuberculosis", "D": "Trypanosoma brucei rhodesiense", "language": "en"}
{"question": "A 72-year-old man comes to the emergency room because of a 4-day history of progressively worsening pain and swelling on the right side of his face. The patient was diagnosed with multiple myeloma 8 months ago and is currently undergoing treatment. His vital signs are within normal limits. Physical exam shows erythema and swelling over the right cheek and mandible. An orofacial fistula is present. Which of the following best describes the mechanism of action of the drug that is most likely responsible for this patient's symptoms?", "answer": "Binding to hydroxyapatite", "meta_info": "step1", "answer_idx": "D", "A": "Cross-linking DNA at guanine", "B": "Inhibition of proteosome activity", "C": "Stimulation of PTH receptor", "D": "Binding to hydroxyapatite", "language": "en"}
{"question": "A 12-month-old girl is brought to the physician because she is unable to sit and has not learned how to crawl. She keeps her hips and elbows flexed and her parents have to use considerable force to passively extend her joints. She attained neck control at 4 months and could roll from front to back at 5 months of age. She does not engage in play, reach for toys, or maintain eye contact. She babbles and does not mimic sounds. She does not follow simple instructions. She has difficulty swallowing solid foods and often coughs at meal times. Her maternal cousin has Down syndrome. Her vital signs are within normal limits. She is at the 25th percentile for length and 10th percentile for weight. Neurological examination shows increased muscle tone in all extremities. The ankle clonus and extensor plantar responses are present bilaterally. The Moro reflex is present. An MRI of the head shows periventricular leukomalacia. Which of the following is the most important risk factor for the development of this condition?", "answer": "Premature birth", "meta_info": "step2&3", "answer_idx": "A", "A": "Premature birth", "B": "Congenital rubella infection", "C": "Congenital CMV infection", "D": "Advanced maternal age", "language": "en"}
{"question": "A 31-year-old male presents with a 2-day history of watery diarrhea that began 8 days after his arrival from Africa. None of the other members of his family became ill. He reports symptoms of malaise, anorexia, and abdominal cramps followed by watery diarrhea. He denies tenesmus, urgency, and bloody diarrhea. His temperature is 98.6°F (37°C), respiratory rate is 15/min, pulse is 107/min, and blood pressure is 90/68 mm Hg. A physical examination is performed and is within normal limits. Intravenous fluids are started, and a stool sample is sent to the lab, which comes out to be negative for any ova/parasites, blood cells, or pus cells. What is the most likely diagnosis?", "answer": "Traveler’s diarrhea due to ETEC", "meta_info": "step2&3", "answer_idx": "D", "A": "Giardiasis", "B": "Irritable bowel syndrome (IBS)", "C": "Traveler’s diarrhea due to Norovirus", "D": "Traveler’s diarrhea due to ETEC", "language": "en"}
{"question": "A 46-year-old woman presents to the emergency department with progressive dyspnea and chest pain. She reports that her symptoms started 1 week ago and have gotten progressively worse. The chest pain is left-sided and is exacerbated by coughing or deep breaths. She also endorses a 6-month history of joint pains involving her knees, elbows, and digits. She does not have a significant medical or surgical history. She takes ibuprofen as needed. She works as a pre-school teacher. The patient’s temperature is 99°F (37.2°C), blood pressure is 120/78 mmHg, pulse is 89/min, and respirations are 17/min with an oxygen saturation of 93% on room air. On physical examination, a friction rub upon inspiration/expiration and crackles are appreciated at the base of the left lung. She has an erythematous rash that spans the bilateral cheeks and nose. There are also scattered ecchymoses on her arms and legs. A chest radiograph shows a small left-sided pleural effusion. A complete blood count is obtained, as shown below:\n\nHemoglobin: 9 g/dL\nHematocrit: 28%\nLeukocyte count: 1,500/mm^3 with normal differential\nPlatelet count: 80,000/mm^3\n\nA urinalysis shows elevated protein levels. Serologic antibodies are pending. Which of the following is the primary cause of the patient’s lab results?", "answer": "Immune-mediated destruction", "meta_info": "step2&3", "answer_idx": "B", "A": "Hematologic malignancy", "B": "Immune-mediated destruction", "C": "Mechanical shearing", "D": "Viral infection", "language": "en"}
{"question": "A 48-year-old patient is recovering from acute lung injury following a diffuse pulmonary viral infection. The cell type responsible for the regeneration of the patient's alveolar epithelium is also functions in:", "answer": "Surfactant secretion", "meta_info": "step1", "answer_idx": "C", "A": "Protease release", "B": "Phagocytosis", "C": "Surfactant secretion", "D": "Recruitment of neutrophils", "language": "en"}
{"question": "A 36-year-old woman comes to the physician because of fatigue for 4 months. She is unable to do her chores and complains of excessive sleepiness during the day. She has generalized itching. She has not had abdominal pain, fever, or weight loss. She has had chronic low back pain for 6 years. Her current medications include acetaminophen and vitamin supplements. Examination shows scratch marks over the trunk. The remainder of the examination shows no abnormalities. Laboratory studies show:\nHemoglobin 13.2 g/dL\nLeukocyte count 8,300/mm3\nPlatelet count 280,000/mm3\nESR 32 mm/h\nSerum\nGlucose 89 mg/dL\nCreatinine 0.7 mg/dL\nTSH 4.8 μU/ml\nBilirubin\nTotal 1.4 mg/dL\nDirect 0.9 mg/dL\nAlkaline phosphatase 480 U/L\nAspartate aminotransferase 62 U/L\nAlanine aminotransferase 32 U/L\nTotal cholesterol 288 mg/dL\nHDL-cholesterol 57 mg/dL\nLDL-cholesterol 189 mg/dL\nTriglycerides 212 mg/dL\nγ-Glutamyl transferase 92 U/L (N = 5–50)\nAntimitochondrial antibody (AMA) positive\nAntinuclear antibody (ANA) positive\nUrinalysis shows no abnormalities. Ultrasound of the abdomen shows gallbladder sludge. Which of the following is the most appropriate next step in management?\"", "answer": "Ursodeoxycholic acid", "meta_info": "step2&3", "answer_idx": "D", "A": "Liver biopsy", "B": "Atorvastatin", "C": "Cholestyramine", "D": "Ursodeoxycholic acid", "language": "en"}
{"question": "A 40-year-old woman presents to the physician with complaints of frequent headaches and fatigue for a month. Her headaches are mild and occur at random times. They are relieved by over the counter analgesics. Furthermore, she feels tired most of the time and sometimes gets short of breath with exertion. She denies low mood, loss of interest, inability to concentrate, sleep disturbance, or suicidal ideation. She was diagnosed with Crohn’s disease 20 years ago for which she currently takes methotrexate. Additionally, she takes a folic acid-containing multivitamin daily. Her medical history is otherwise insignificant and she does not smoke, drink, or use recreational drugs. She has a pulse rate of 110/min, respiratory rate of 20/min, and temperature of 37.0°C (98.6°F). Physical examination reveals pallor in her palms and lower palpebral conjunctiva. Which of the following arterial blood findings for the partial pressure of oxygen (PaO2), oxygen saturation (SaO2), and oxygen concentration (CaO2) are expected in this patient?", "answer": "Normal PaO2, normal SaO2, low CaO2", "meta_info": "step1", "answer_idx": "D", "A": "Normal PaO2, normal SaO2, normal CaO2", "B": "Low PaO2, low SaO2, low CaO2", "C": "Low PaO2, normal SaO2, normal CaO2", "D": "Normal PaO2, normal SaO2, low CaO2", "language": "en"}
{"question": "A 25-year-old woman complains of dyspnea and mild chest pain on exertion, which increases gradually with continued exertion. She had similar symptoms last year and her medical record included the following arterial blood gas findings:\npH 7.51\npO2 77 mm Hg\npCO2  32 mm Hg\nAn ECG last year demonstrated a right axis deviation. The current chest X-ray showed enlarged pulmonary arteries but no parenchymal infiltrates. A lung perfusion scan revealed a low probability for pulmonary thromboembolism. The current ECG showed right heart strain but no evidence of primary cardiac disease. What is the most logical diagnostic test for this patient?", "answer": "Echocardiography", "meta_info": "step1", "answer_idx": "A", "A": "Echocardiography", "B": "Holter monitoring", "C": "Lung biopsy", "D": "Transbronchial biopsy", "language": "en"}
{"question": "A 4-year-old boy is brought to the physician because of a progressive rash for 2 days. The rash started behind the ears and now involves the trunk and extremities. Over the past 4 days, he has had mild sore throat, red, itchy eyes, and headache. He was born at term and has been healthy except for recurrent episodes of tonsillitis and occasional asthma attacks. Two weeks ago, he was treated for tonsillitis that resolved with penicillin therapy. He immigrated with his family from Brazil 3 weeks ago. His immunization status is unknown. The patient appears weak and lethargic. His temperature is 38°C (100.4°F), pulse is 100/min, and blood pressure is 100/60 mm Hg. Examination shows postauricular and suboccipital lymphadenopathy. There is a non-confluent, pink maculopapular rash over the torso and extremities. His palms and soles show no abnormalities. Which of the following is the most likely diagnosis?", "answer": "Rubella", "meta_info": "step2&3", "answer_idx": "A", "A": "Rubella", "B": "Allergic drug reaction", "C": "Scarlet fever", "D": "Erythema infectiosum", "language": "en"}
{"question": "A 66-year-old man presents to the office complaining of fatigue. He reports that for the past year he has been experiencing a progressive decrease in energy. This week he began having some difficulty breathing while climbing the stairs. He denies chest pain or palpitations. He has no other chronic medical conditions and has had no prior surgeries. The patient is found to be anemic. A fecal occult blood test is positive, and a colonoscopy is obtained. The patient is subsequently diagnosed with colorectal cancer. He undergoes a partial colectomy and is started on 5-fluorouracil as adjuvant chemotherapy. Which of the following should be monitored as the patient continues treatment?", "answer": "Neutrophil count", "meta_info": "step1", "answer_idx": "C", "A": "Creatinine", "B": "Fecal leukocytes", "C": "Neutrophil count", "D": "Peak flow", "language": "en"}
{"question": "A 15-year-old girl comes to the physician for a follow-up evaluation. She has multiple erythematous pustules and nodules over her face, for which she has received erythromycin and topical benzoyl peroxide. She is concerned that the therapy is ineffective. The physician recommends a drug on the condition that the patient agrees to use oral contraceptives. The molecular structure of the drug most likely recommended by the physician closely resembles a drug used to treat which of the following conditions?", "answer": "Acute promyelocytic leukemia", "meta_info": "step1", "answer_idx": "B", "A": "EGFR-positive non-small cell lung cancer", "B": "Acute promyelocytic leukemia", "C": "BRAF-positive metastatic melanoma", "D": "Choriocarcinoma", "language": "en"}
{"question": "A 62-year-old female presents to her primary care provider complaining of a mass near her right jaw. She reports that the mass is painless and has grown very slowly over the past six months. She initially did not see a physician due to being very busy at her work as a lawyer. However, she reports that she noticed some right-sided facial weakness in the past week which prompted her to visit the physician. Her past medical history is notable for Hodgkins lymphoma as a child which required radiation therapy to the neck. She has a 20 pack-year smoking history and drinks alcohol socially. Her temperature is 98.6°F (37°C), blood pressure is 120/85 mmHg, pulse is 85/min, and respirations are 18/min. Physical examination reveals a painless firm mass at the angle of the right jaw. There is also a small palpable firm mass beneath the floor of the mouth. A right facial droop along with an inability to elevate her right eyebrow is noted. A biopsy of one of this lesion would most likely reveal which of the following?", "answer": "Cystic configurations of anaplastic squamous and mucoid cells", "meta_info": "step1", "answer_idx": "A", "A": "Cystic configurations of anaplastic squamous and mucoid cells", "B": "Non-infiltrative clusters of epithelial and mesenchymal cells", "C": "Epithelial cells with dense lymphoid stroma and germinal centers", "D": "Uniform spindle cells with scant cytoplasm and cigar-shaped nuclei", "language": "en"}
{"question": "A 29-year-old woman presents with low-grade fever, rash, and joint pain. She says her symptoms started gradually about 3 months ago and have progressively worsened. The patient describes her rash as pruritic, flat, and localized to her face. She reports a different type of rash on her shoulders and arms that are aggravated by exposure to sunlight. She describes her joint pain as moderate, dull and aching in character, and present mainly in the small bones of her wrists and hands, worse on the right than the left. She has no other relevant medical history and takes no current medications. Her family history is notable for her maternal grandmother, who had an unknown autoimmune condition. The patient denies any smoking history, alcohol use, or recreational drug use. Her temperature is 38.0℃ (100.3℉), pulse is 59/min, respiratory rate is 19/min, and blood pressure is 129/84 mm Hg. On physical examination, there is a macular, erythematous rash that involves both cheeks and the bridge of her nose, sparing the nasolabial folds. There is also a mild macular rash on the sun-exposed areas of her upper extremities and shoulders. She has moderate to severe point tenderness in the small joints of her wrists and hands, worse on the right, with minimal erythema and swelling. Multiple painless ulcers are present on the soft and hard palate. Which of the following additional findings would most likely be present in this patient?", "answer": "Swelling and proliferation of endothelial and mesangial cells in portions of each glomerulus with neutrophil infiltration", "meta_info": "step2&3", "answer_idx": "A", "A": "Swelling and proliferation of endothelial and mesangial cells in portions of each glomerulus with neutrophil infiltration", "B": "Immunologically mediated destruction of the salivary glands", "C": "Abnormal accumulation of fibrous tissue in the skin and multiple organs", "D": "Amyloid deposits within the myocardium between the muscle fibers", "language": "en"}
{"question": "A 3-year-old Cuban-American male has a history of recurrent Pseudomonas and Candida infections. Laboratory analysis reveals no electrolyte abnormalities. Examination of his serum shows decreased levels of IgG and CT scan reveals the absence of a thymus. The child likely has:", "answer": "Severe combined immunodeficiency syndrome", "meta_info": "step1", "answer_idx": "A", "A": "Severe combined immunodeficiency syndrome", "B": "DiGeorge syndrome", "C": "Isolated IgA deficiency", "D": "Common variable immunodeficiency", "language": "en"}
{"question": "A 7-year-old girl is brought to the physician for evaluation of recurrent epistaxis. Her mother reports that she bruises easily while playing. Her pulse is 89/min and blood pressure is 117/92 mm Hg. Examination shows multiple bruises in the upper and lower extremities. Laboratory studies show:\nPlatelet count 100,000/mm3\nProthrombin time 12 seconds\nPartial thromboplastin time 33 seconds\nBleeding time 13 minutes\nA peripheral blood smear shows enlarged platelets. Ristocetin assay shows no platelet aggregation. Which of the following is the most likely underlying cause of the patient's condition?\"", "answer": "Glycoprotein Ib deficiency", "meta_info": "step1", "answer_idx": "A", "A": "Glycoprotein Ib deficiency", "B": "Vitamin K deficiency", "C": "Von Willebrand factor deficiency", "D": "ADAMTS13 deficiency", "language": "en"}
{"question": "A 38-year-old woman comes to the emergency department because of progressive headache, blurry vision, and nausea for 1 day. Four days ago, she was diagnosed with a right middle ear infection. She appears lethargic. Her temperature is 39.1°C (102.3°F), and blood pressure is 148/95 mm Hg. Ophthalmologic examination shows bilateral swelling of the optic disc. The corneal reflex in the right eye is absent. Sensation to touch is reduced on the upper right side of the face. Serum studies show increased concentrations of fibrin degradation products. Which of the following is the most likely diagnosis?", "answer": "Cerebral venous thrombosis", "meta_info": "step1", "answer_idx": "A", "A": "Cerebral venous thrombosis", "B": "Hypertensive emergency", "C": "Subarachnoid hemorrhage", "D": "Viral meningitis", "language": "en"}
{"question": "A 35-year-old female presents to your office for a routine physical. She informs you that she is pregnant, and that the father of her child has Waardenburg’s syndrome. She asks you about common findings in Waardenburg’s syndrome. Which of the following features are not associated of Waardenburg’s syndrome?", "answer": "Conductive hearing loss", "meta_info": "step2&3", "answer_idx": "B", "A": "Heterochromia", "B": "Conductive hearing loss", "C": "Lateral displacement of inner canthi", "D": "Broad nasal root", "language": "en"}
{"question": "A 4-year-old boy is brought to the emergency department for evaluation after falling. He has fallen multiple times in the last year. His parents report that he did not walk until he was 18 months old. Examination shows a mildly swollen right ankle with no tenderness over the medial or lateral malleolus; range of motion is full with mild pain. He has marked enlargement of both calves. When standing up, the patient uses his hands against his knees and thighs to slowly push himself up into a standing position. Which of the following is the most likely underlying mechanism of this patient's fall?", "answer": "Absence of dystrophin protein", "meta_info": "step1", "answer_idx": "B", "A": "Loss of the ATM protein", "B": "Absence of dystrophin protein", "C": "Arylsulfatase A deficiency", "D": "SMN1 gene defect", "language": "en"}
{"question": "A 25-year-old man is brought to the emergency department with second- and third-degree burns covering 30% of the surface area of his body. He is alert and active. He has no personal or family history of serious illness. His temperature is 36.5°C (97.7°F), pulse is 62/min, respirations are 18/min, and blood pressure is 105/70 mm Hg. Pulse oximetry on 2 liters by nasal cannula shows an oxygen saturation of 98%. Intravenous fluids, intravenous and topical antibiotics, and intravenous pain medications are administered in the intensive care unit. Twenty-four hours later, the patient develops respiratory distress. Respirations are 30/min. There is an inspiratory stridor. The patient requires rapid sequence intubation. Administering succinylcholine during this procedure would most likely result in which of the following complications?", "answer": "Cardiac arrhythmia", "meta_info": "step2&3", "answer_idx": "C", "A": "Prolonged muscle weakness", "B": "Malignant hyperthermia", "C": "Cardiac arrhythmia", "D": "Respiratory depression", "language": "en"}
{"question": "A 32-year-old woman presents to the emergency department with 2 hours of left-sided weakness. Her husband reports that she had been complaining of pain and swelling in her right calf for several weeks prior to this event. The couple had recently returned from a vacation in Europe. What ausculatory finding would explain the mechanism by which her more recent complaint occurred?", "answer": "Wide, fixed splitting of S2", "meta_info": "step1", "answer_idx": "B", "A": "Holosystolic murmur radiating to the axilla", "B": "Wide, fixed splitting of S2", "C": "Crescendo-decrescendo murmur heard loudest at the right second intercostal space", "D": "An S2 that splits during expiration", "language": "en"}
{"question": "A 41-year-old woman presents with pain in her abdomen for the last couple of hours. She says pain is intermittent and localized to the right hypochondriac region. She admits to eating fatty foods this morning before the pain started. She also complains of nausea but has not vomited yet. She describes episodes with similar symptoms in the past after a fatty meal but were less severe. Past medical history is irrelevant. The vital signs include: heart rate 85/min, respiratory rate 16/min, temperature 37.6°C (99.6°F), and blood pressure 120/80 mm Hg. Physical examination is within normal limits. An abdominal ultrasound is pending. Which of the following hormones most likely is the cause of the postprandial aggravation of this patient's symptoms?", "answer": "Cholecystokinin", "meta_info": "step1", "answer_idx": "B", "A": "Somatostatin", "B": "Cholecystokinin", "C": "Gastrin", "D": "Secretin", "language": "en"}
{"question": "A 53-year-old man comes to the physician because of a 1-day history of fever and chills, severe malaise, and cough with yellow-green sputum. He works as a commercial fisherman on Lake Superior. Current medications include metoprolol and warfarin. His temperature is 38.5°C (101.3°F), pulse is 96/min, respirations are 26/min, and blood pressure is 98/62 mm Hg. Examination shows increased fremitus and bronchial breath sounds over the right middle lung field. An x-ray of the chest shows consolidation of the right upper lobe. Which of the following is the most likely causal pathogen?", "answer": "Streptococcus pneumoniae", "meta_info": "step1", "answer_idx": "D", "A": "Pseudomonas aeruginosa", "B": "Streptococcus pyogenes", "C": "Haemophilus influenzae", "D": "Streptococcus pneumoniae", "language": "en"}
{"question": "A 46-year-old man presents to his physician because of persistent pelvic and scrotal pain for the past month. He also has had occasional fevers, chills, dysuria, and increased urinary frequency over the last few months. He was prescribed trimethoprim and sulfamethoxazole for the urinary symptoms, but he is still having symptoms currently. He is sexually active with multiple male and female partners and uses condoms inconsistently. The patient has hypertension and takes lisinopril.  He also takes PrEP (Truvada, which contains tenofovir and emtricitabine). On physical exam, his temperature is 36.7℃ (98.1℉), the blood pressure is 115/70 mm Hg, the pulse is 74/min, and the respirations are 14/min. A digital rectal exam reveals a mildly tender and mildly enlarged prostate. Urine specimens are sent for culture and sensitivity testing. A urine sample taken after prostate massage shows a 10-fold increase in bacteria counts. The test results for antimicrobial sensitivity include ampicillin, cefepime, gentamicin, levofloxacin, and meropenem. The patient is prescribed tamsulosin. Which of the following is the most appropriate antibiotic to pair with the tamsulosin?", "answer": "Levofloxacin", "meta_info": "step2&3", "answer_idx": "C", "A": "Cefepime", "B": "Gentamicin", "C": "Levofloxacin", "D": "Trimethoprim and sulfamethoxazole", "language": "en"}
{"question": "A 29-year-old woman comes to the emergency department because of progressive numbness and weakness in her right arm and right leg for 1 day. Two months ago, she had blurry vision and headache for a week, which resolved without treatment. She does not smoke or drink alcohol. Her temperature is 37°C (98.6°F), pulse is 78/min, respirations are 14/min, and blood pressure is 115/71 mm Hg. Muscle strength is 3/5 in the right arm and leg and 5/5 on the left side. MRI of the brain shows gadolinium-enhancing lesions in the left central sulcus, cervical spinal cord, and optic nerve. Intravenous methylprednisolone therapy is started. This drug is most likely to result in which of the following laboratory changes?", "answer": "Eosinopenia", "meta_info": "step2&3", "answer_idx": "C", "A": "Monocytosis", "B": "Lymphocytosis", "C": "Eosinopenia", "D": "Granulocytopenia", "language": "en"}
{"question": "A 30-year-old male biology graduate student was dismissed from his PhD program after 8 years because he was not able to produce a thesis, claiming that his data was never exactly how he wanted it. He would spend weeks planning out a simple experiment, since everything had to be just right. For many experiments, he would start over because he felt he went out of order in adding the reagents to his media for his cells. He has had similar problems in his undergraduate courses, often failing to complete his assignments on time because he had to revise them until they were perfect. Which of the following disorders does this patient potentially suffer from?", "answer": "Obsessive compulsive personality disorder", "meta_info": "step1", "answer_idx": "C", "A": "Schizoid personality disorder", "B": "Narcissistic personality disorder", "C": "Obsessive compulsive personality disorder", "D": "Paranoid personality disorder", "language": "en"}
{"question": "A 62-year-old male presents to his primary care physician complaining of an unintended 10-pound weight loss over the last 4 months. He also reports vague abdominal discomfort, weakness, and occasional yellowing of his skin and eyes. He has a history of cirrhosis secondary to alcohol abuse and hepatitis C infection. Physical exam demonstrates hepatomegaly and abdominal distention. Which of the following serum markers is most strongly associated with this patient’s condition?", "answer": "Alpha-fetoprotein (AFP)", "meta_info": "step1", "answer_idx": "C", "A": "Carcinoembryonic antigen (CEA)", "B": "Cancer antigen 19-9 (CA 19-9)", "C": "Alpha-fetoprotein (AFP)", "D": "Beta-human chorionic gonadotropin (ß-HCG)", "language": "en"}
{"question": "A research group designed a study to investigate the epidemiology of syphilis in the United States. The investigators examined the total number of cases of syphilis and genitourinary chlamydia in the United States using a national health survey of a nationally representative sample of US citizens conducted in 2012. The investigators ultimately found that a history of genitourinary chlamydia infection is associated with syphilis. This study is best described as which of the following?", "answer": "Cross-sectional study", "meta_info": "step2&3", "answer_idx": "C", "A": "Single-blind clinical trial", "B": "Double-blind clinical trial", "C": "Cross-sectional study", "D": "Case-control study", "language": "en"}
{"question": "A 56-year-old African American male presents with altered mental status, abdominal pain, and a fever of 100.4F. His past medical history is significant for alcohol use and cirrhosis of the liver. Shifting dullness is noted on physical exam. Paracentesis demonstrates serum ascites albumen gradient of 1.3 g/dL, and the ascitic fluid polymorphonuclear cell count is 280 cells/mm^3. Which of the following is the best treatment for this patient’s condition while waiting for the ascitic fluid culture results?", "answer": "Cefotaxime", "meta_info": "step2&3", "answer_idx": "B", "A": "Nadolol", "B": "Cefotaxime", "C": "Penicillin", "D": "Gentamicin", "language": "en"}
{"question": "A 4-year-old boy who recently emigrated from Ghana is brought to the physician because of a 5-day history of pain and swelling in his hands. He has had similar episodes in the past. The patient appears distressed. His temperature is 38.1°C (100.5°F). Physical examination shows pallor. The dorsum of his hands and fingers are swollen, warm, and tender to palpation. Which of the following additional findings is most likely in this patient?", "answer": "Microhematuria", "meta_info": "step1", "answer_idx": "D", "A": "Coronary artery aneurysm", "B": "Hyperuricemia", "C": "Thickened heart valves", "D": "Microhematuria", "language": "en"}
{"question": "A 47-year-old woman is admitted to the hospital because of a 2-week history of low-grade fever, fatigue, and a 3-kg (6.6-lb) weight loss. Her temperature is 38°C (100.4°F). Physical examination shows pallor and a cardiac murmur. Her serum creatinine is 1.8 mg/dL. Urinalysis shows red cell casts and 2+ protein. A CT scan of the abdomen with contrast shows no abnormalities. Despite appropriate medical therapy, the patient dies. A photograph of the heart taken during autopsy is shown. Which of the following is the most likely explanation for the laboratory findings in this patient?", "answer": "Deposition of antigen-antibody complexes", "meta_info": "step1", "answer_idx": "B", "A": "Occlusion of renal arteries by cholesterol crystals", "B": "Deposition of antigen-antibody complexes", "C": "Intravascular fragmentation of red blood cells", "D": "Hypersensitivity to penicillin haptens", "language": "en"}
{"question": "A 36-year-old woman comes to the physician because of a 2-month history of progressively worsening lower back pain and weakness in the lower extremities. The pain is worse with movement and improves with lying down on a flat surface. She was diagnosed with pulmonary tuberculosis 6 months ago and is currently taking isoniazid and rifampin. Physical examination shows sensory loss over the lateral aspect of the mid-thigh, patella, and medial aspect of the right lower leg. Strength is 2/5 with right-sided dorsiflexion and the patellar reflex is absent. An x-ray of the spine shows a paravertebral opacity with anterior wedging of the vertebral body. Which of the following nerve roots is most likely to be affected in this patient?", "answer": "L4", "meta_info": "step1", "answer_idx": "D", "A": "S2", "B": "S1", "C": "L3", "D": "L4", "language": "en"}
{"question": "A 24-year-old primigravid woman at 8 weeks' gestation is brought to the emergency department because of a 5-day history of nausea and vomiting. She has not been able to tolerate much food or drink. Her symptoms are worse in the morning. She has tried multiple oral antiemetics with limited relief. She has not had fevers, chills, abdominal pain, urinary symptoms, or diarrhea. She appears tired. Her temperature is 37°C (98.6°F), pulse is 105/min, and blood pressure is 108/60 mm Hg. Examination shows dry mucous membranes and cool extremities, with delayed capillary refill time. Arterial blood gas analysis on room air shows:\npH 7.56\nPCO2 40 mm Hg\nPO2 94 mm Hg\nHCO3- 30 mEq/L\nMeasurement of which of the following is the most appropriate next step in diagnosis?\"", "answer": "Urine chloride concentration", "meta_info": "step2&3", "answer_idx": "D", "A": "Serum osmolal gap", "B": "Serum anion gap", "C": "Urine albumin to urine creatinine ratio", "D": "Urine chloride concentration", "language": "en"}
{"question": "A 34-year-old pregnant woman, gravida 2, para 0, at 28 weeks of gestation presents to the physician for a prenatal visit. She has not had regular prenatal care. Her most recent abdominal ultrasound was at 20 weeks of gestation, and it confirmed accurate fetal dates and appropriate fetal development. She takes levothyroxine for hypothyroidism. She used to work as a nurse before she emigrated from Brazil 13 years ago. She lost her immunization records during the move and cannot recall all of her vaccinations. She appears well. Her vital signs are within normal limits. The physical examination reveals a fundal height of 26 cm. No abnormalities are found during the physical exam. An ELISA test conducted for HIV is negative. Serology test results for hepatitis B surface antibody and hepatitis C antibody are positive for both. The laboratory test results for hepatitis B core antibody, hepatitis B surface antigen, and hepatitis A antibody are negative. The polymerase chain reaction analysis of hepatitis C RNA is positive for genotype 1. Which of the following is the most appropriate recommendation at this time?", "answer": "Hepatitis A vaccination", "meta_info": "step2&3", "answer_idx": "A", "A": "Hepatitis A vaccination", "B": "Plan to formula feed the newborn", "C": "Start combination therapy with interferon α and ribavirin", "D": "Undergo liver biopsy", "language": "en"}
{"question": "A 36-year-old man presents with a 3-week history of fever, enlarged lymph nodes, fatigue, and a dry cough. The patient’s wife says she has noticed that he lost a lot of weight over the last 6 months and seems very pale. Over the last week, he has noticed a worsening non-productive cough and night sweats. His blood count shows anemia and low lymphocyte count. He tells the physician that he had multiple unprotected sexual relationships with women other than his wife about 6 years ago and is fearful this may be related to his current health concerns. A test is performed which screens for the cause of this patient's immunodeficiency. Which of the following does this screening test detect?", "answer": "p24 antigen", "meta_info": "step1", "answer_idx": "C", "A": "Anti-HCV antigen", "B": "Lactic dehydrogenase", "C": "p24 antigen", "D": "CCR5 mutation", "language": "en"}
{"question": "Seven days after initiation of induction chemotherapy for acute myeloid leukemia, a 56-year-old man develops leukopenia. He feels well. He has no history of serious cardiopulmonary disease. His temperature is 36.7°C (98.1°F), blood pressure is 110/65 mm Hg, pulse is 72/min, and respiratory rate is 14/min. Examination of the skin, head and neck, heart, lungs, abdomen, and perirectal area reveals no abnormalities. Laboratory studies show:\nHemoglobin 9 g/dL\nLeukocyte count 1,500/mm3\nPercent segmented neutrophils 50%\nPlatelet count 85,000/mm3\nTo reduce the likelihood of complications, it is most appropriate to administer which of the following?", "answer": "Ciprofloxacin", "meta_info": "step2&3", "answer_idx": "A", "A": "Ciprofloxacin", "B": "Granulocyte colony-stimulating factor", "C": "Vancomycin", "D": "No pharmaco-prophylaxis at this time", "language": "en"}
{"question": "A 40-year-old man undergoes an elective cholecystectomy for repeated attacks of cholelithiasis over the last 5 years. In the operating room, rapid sequence intubation is performed using a certain muscle relaxant to prevent aspiration of gastric contents. During the procedure, atracurium is administered to maintain muscle relaxation and, 1.5 hours after the operation, the anesthesiologist administers neostigmine to reverse the paralysis. The patient, however, continues to remain paralyzed and cannot be extubated. Which of the following drugs most likely caused prolonged muscle paralysis in this patient?", "answer": "Succinylcholine", "meta_info": "step1", "answer_idx": "C", "A": "Midazolam", "B": "Pancuronium", "C": "Succinylcholine", "D": "Tubocurarine", "language": "en"}
{"question": "A 12-year-old boy is brought to the emergency department by ambulance after he was struck by a car while crossing the road. He is found to have a femur fracture and multiple bruises on presentation, but he is alert and hemodynamically stable. He says that the car \"came out of nowhere\" and that he has had multiple similar near misses in recent months. He has no past medical history but says that he has been having headaches that he describes as dull and continuous. He has also noticed that he has been waking up at night several times to go to the restroom. Otherwise, he has been healthy with no major concerns. A basic metabolic panel shows mild hypernatremia. The most likely pathology underlying this patient's symptoms is derived from which of the following embryonic layers?", "answer": "Surface ectoderm", "meta_info": "step1", "answer_idx": "D", "A": "Mesoderm", "B": "Neural crest", "C": "Neuroectoderm", "D": "Surface ectoderm", "language": "en"}
{"question": "A 40-year-old man presents with left hip pain. He says that symptoms started a month ago and have progressively worsened. He says the pain has rendered him unable to report to work for the last 2 weeks. The pain was initially 4/10 in intensity, dull with no radiation and was aggravated to 5/10 in intensity upon weight-bearing. Initially, it improved with rest and Tylenol. He initially attributed it to heavy work and took a few days off work, but he did not seek medical attention. However, it worsened over time to its present 8/10 intensity and does not respond to Tylenol anymore. The patient denies any history of injury, weight loss, change in appetite, or recent travel. His past medical history is significant for Crohn's disease, managed with a combination of prednisone and mesalamine and presently in remission. On physical examination, there is limited flexion and extension at the left hip. The rest of the examination, including a complete neurological examination, is unremarkable. On abdominal imaging of the left hip joint, a transcervical fracture is noted in the left hip with surrounding bony sclerosis. A DEXA scan shows a T-score of  -2.5 at the hips and -1.5 at the lumbar spine (normal T-score ≥ -1.0). Which of the following is most likely to be the underlying cause for the fracture in this patient?", "answer": "Chronic steroid use", "meta_info": "step1", "answer_idx": "B", "A": "Trauma", "B": "Chronic steroid use", "C": "Metastatic lesion", "D": "Sciatica", "language": "en"}
{"question": "A 78-year-old woman with a history of breast cancer, status-post bilateral mastectomy, presents to the emergency department with progressive difficulty breathing, worsening fatigue, and 5 pounds of unintended weight loss over the past month. A portable chest x-ray reveals a massive right pleural effusion. The ED resident performs thoracentesis with chest tube placement and admits her to the floor. Overnight, the patient requests multiple pain medications for right upper abdominal pain and is found to have increasingly sanguinous drainage. Where was the thoracentesis needle most likely placed?", "answer": "Lower border of the 10th rib at the right midaxillary line", "meta_info": "step1", "answer_idx": "A", "A": "Lower border of the 10th rib at the right midaxillary line", "B": "Lower border of the 9th rib at the right midaxillary line", "C": "Upper border of the 7th rib at the right midclavicular line", "D": "Upper border of the 10th rib at the right midaxillary line", "language": "en"}
{"question": "While studying the metabolism of a novel drug, the researcher identifies a molecule that inhibits its metabolism by binding with enzyme E. Molecule A inhibits the enzyme E by reversibly binding at the same active site on the enzyme where the drug binds. Which of the following statements best describes the effects of molecule A on Vmax and Km on the metabolic reactions of the novel drug?", "answer": "Value of Vmax is unchanged but value of Km is increased", "meta_info": "step1", "answer_idx": "A", "A": "Value of Vmax is unchanged but value of Km is increased", "B": "Value of Vmax is decreased but value of Km is unchanged", "C": "Values of both Vmax and Km are unchanged", "D": "Value of Vmax is unchanged but value of Km is decreased", "language": "en"}
{"question": "A 70-year-old man presents to a physician’s office with shortness of breath for 1 month. He is “easily winded” and is unable to keep up with his grandchildren when playing in the park. Over the last few weeks, he had to increase the number of pillows under his head to sleep comfortably. He denies a cough and fever. The medical history includes hypercholesterolemia and hypertension. His current medications are aspirin, carvedilol, and rosuvastatin. The vital signs are as follows: blood pressure 150/90 mm Hg, pulse 90/min, and respiratory rate 14/min. The physical examination reveals distended jugular veins, bilateral pitting edema of the lower limbs, and fine crackles at the base of the lungs. An echocardiogram reveals an ejection fraction of 40%. Inhibition of which of the following hormones would be most beneficial for this patient?", "answer": "Angiotensin II", "meta_info": "step1", "answer_idx": "A", "A": "Angiotensin II", "B": "Prostaglandin E1", "C": "Aldosterone", "D": "Epinephrine", "language": "en"}
{"question": "A 51-year-old man comes to the physician because of severe pain while urinating for 4 days. He has also had to urinate more often than usual. Three weeks ago, he underwent surgery for an incarcerated hernia. While recovering, he developed septic shock and was treated in the intensive care unit. He was discharged 6 days ago. He has a history of hypertension. Current medications include amlodipine and oxycodone. He appears anxious. His temperature is 37.8°C (100°F), pulse is 96/min, and blood pressure is 122/80 mm Hg. Examination shows tenderness to palpation in the suprapubic area; no guarding is present. There is a well-healed surgical scar in the right inguinal region. There is no costovertebral angle tenderness. Urinalysis shows:\nBlood 1+\nProtein 1+\nNitrite positive\nLeukocyte esterase positive\nRBC 1–2/hpf\nWBC 20–25/hpf\nWhich of the following would have most likely prevented this complication?\"", "answer": "Intermittent catheterization", "meta_info": "step2&3", "answer_idx": "A", "A": "Intermittent catheterization", "B": "Prophylactic oral ciprofloxacin", "C": "Topical mupirocin application", "D": "Screening for bacteriuria", "language": "en"}
{"question": "A 40-year-old woman with HIV infection comes to the emergency department because of a 4-week history of progressively worsening fatigue and headache. On mental status examination, the patient is somnolent and oriented only to person. Her CD4+ lymphocyte count is 80/mm3 (N ≥ 500). Analysis of this patient's cerebrospinal fluid (CSF) shows a leukocyte count of 30/mm3 (60% lymphocytes), a protein concentration of 52 mg/dL, and a glucose concentration of 37 mg/dL. An India ink stain of the CSF is shown. Which of the following is the most appropriate pharmacotherapy for this patient's neurological symptoms?", "answer": "Amphotericin B and flucytosine", "meta_info": "step1", "answer_idx": "C", "A": "Pyrimethamine, sulfadiazine, and folinic acid", "B": "Isoniazid, rifampin, pyrazinamide, and ethambutol", "C": "Amphotericin B and flucytosine", "D": "Fluconazole", "language": "en"}
{"question": "A 64-year-old man comes to the physician because of a 2-week history of intermittent epigastric discomfort. He reports that his urine has been very dark, and his stools have been pale for the past week. His appetite has decreased, and he has had a 4.5-kg (10-lb) weight loss during this period. He has smoked 1 pack of cigarettes daily for 30 years. He drinks a few shots of vodka daily. He has no history of severe illness. He has chronic left knee pain, for which he takes acetaminophen. Vital signs are within normal limits. Examination shows jaundice of the skin and scleral icterus. There are scratch marks on the extremities. Abdominal examination shows a nontender, palpable mass in the right upper quadrant. The remainder of the examination is normal. Laboratory studies show:\nHemoglobin 11.6 g/dL\nLeukocyte count 8,700/mm3\nPlatelet count 172,000/mm3\nSerum\nUrea nitrogen 17 mg/dL\nCreatinine 1.1 mg/dL\nBilirubin\nTotal 6 mg/dL\nDirect 5.2 mg/dL\nAlkaline phosphatase 220 IU/L\nUltrasonography shows dilated extrahepatic and pancreatic ducts and a distended gall bladder. Which of the following is the most likely cause of these findings?\"", "answer": "Malignant biliary tract obstruction", "meta_info": "step2&3", "answer_idx": "A", "A": "Malignant biliary tract obstruction", "B": "Acetaminophen-induced liver injury", "C": "Hemolysis", "D": "Chronic pancreatitis", "language": "en"}
{"question": "A 27-year-old woman is brought to the physician after passing out at home. Her husband reports that she suddenly lost consciousness for approximately 30 seconds while shoveling snow in the driveway. Immediately before the episode, she felt light-headed and short of breath. Two months ago, she experienced a similar episode while running in her yard with her children. She has no history of serious illness. Her father died of sudden cardiac death at the age of 44 years. Vital signs are within normal limits. Cardiac examination shows a systolic ejection murmur best heard along the left sternal border that decreases with hand grip. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate treatment for this patient?", "answer": "Metoprolol", "meta_info": "step2&3", "answer_idx": "D", "A": "Septal myectomy", "B": "Amlodipine", "C": "Cardiac pacemaker", "D": "Metoprolol", "language": "en"}
{"question": "A 7-month-old male infant is brought to the physician because of a 2-month history of fatigue and weakness. His mother reports that he has difficulty feeding. He is at the 20th percentile for height and 3rd percentile for weight. Physical examination shows an enlarged tongue. Crackles are heard at both lung bases. The liver is palpated 1 cm below the right costal margin. Neurologic examination shows decreased muscle tone in the extremities. Serum glucose is 105 mg/dL. An x-ray of the chest shows cardiomegaly. The patient most likely has a deficiency of which of the following enzymes?", "answer": "Acid maltase", "meta_info": "step1", "answer_idx": "A", "A": "Acid maltase", "B": "Iduronate sulfatase", "C": "Glucose-6-phosphatase", "D": "Alpha-galactosidase", "language": "en"}
{"question": "A 43-year-old man presents to a medical office for follow-up of hypertension. He was recently diagnosed and has been managing his condition with diet modification and moderate-intensity exercise. Today, he brings a list of his recent at-home morning blood pressure readings. The systolic blood pressure readings over the last 5 days are as follows:\nDay 1: 130 mm Hg\nDay 2: 132 mm Hg\nDay 3: 128 mm Hg\nDay 4: 132 mm Hg\nDay 5: 128 mm Hg\nWhat is the standard deviation for the systolic blood pressure readings?", "answer": "2 mm Hg", "meta_info": "step1", "answer_idx": "C", "A": "1 mm Hg", "B": "1.5 mm Hg", "C": "2 mm Hg", "D": "2.5 mm Hg", "language": "en"}
{"question": "An 11-year-old boy is brought to the physician by his mother because of worsening fatigue. His mother reports that he seems to have trouble keeping up with his older brothers when playing outside. Physical examination shows conjunctival pallor. A hemoglobin electrophoresis is performed. This patient's results are shown in comparison to those of a patient with known sickle cell anemia and a child with normal hemoglobin. Based on this electrophoresis, which of the following types of hemoglobin are dominant in this patient's blood?", "answer": "HbS and HbC", "meta_info": "step1", "answer_idx": "D", "A": "HbA and HbC", "B": "HbS only", "C": "HbA only", "D": "HbS and HbC", "language": "en"}
{"question": "A 55-year-old African American man presents to the emergency department with central chest pressure. His symptoms started 1 day before. The pain was initially intermittent in nature but has become constant and radiates to his jaw and left shoulder. He also complains of some difficulty breathing. The patient was diagnosed with essential hypertension 1 year ago, but he is not taking any medications for it. The patient denies smoking, alcohol, or drug use. Family history is unremarkable. His blood pressure is 230/130 mm Hg in both arms, the temperature is 36.9°C (98.4°F), and the pulse is 90/min. ECG shows diffuse T wave inversion and ST depression in lateral leads. Laboratory testing is significant for elevated troponin. Which of the following is the most likely diagnosis?", "answer": "Hypertensive emergency", "meta_info": "step2&3", "answer_idx": "B", "A": "Hypertensive urgency", "B": "Hypertensive emergency", "C": "Aortic aneurysm", "D": "Malignant hypertension", "language": "en"}
{"question": "A 38-year-old woman comes to the physician for the evaluation of progressive weakness and numbness for 3 months. The symptoms started in her lower legs and gradually moved to her upper legs and arms. During the last 5 days, she has also had bilateral facial weakness with headaches. She has hepatitis B and Graves' disease. She is sexually active with one male partner and they use condoms inconsistently. Her current medications include methimazole and a multivitamin. Vital signs are within normal limits. She is alert and fully oriented. She has bilateral upper and lower facial paralysis. There is generalized weakness of the muscles. Sensation to light touch is decreased throughout and is absent in her fingertips and toes. Deep tendon reflexes are 1+ bilaterally. Further evaluation of this patient is most likely to show which of the following findings?", "answer": "Positive GM1 ganglioside autoantibodies", "meta_info": "step2&3", "answer_idx": "A", "A": "Positive GM1 ganglioside autoantibodies", "B": "Positive Lyme ELISA test", "C": "Low vitamin B12 level", "D": "Elevated TSH and decreased FT4 levels", "language": "en"}
{"question": "A 32-year-old G2P1 at 32 weeks gestation presents to the emergency department with complaints of severe abdominal pain, fatigue, and nausea. Physical examination is significant for profound jaundice and tenderness to palpation of the right upper quadrant of the abdomen. The patient returned 2 weeks ago from a 1 month-long trip to India. She received sporadic pre-natal care while traveling and reports no known complications in her current pregnancy to date. She denies any past medical problems and states that her prior pregnancy proceeded as a normal vaginal birth without any complications. Infection with which of the following organisms would portend the worst prognosis with the highest mortality rate for this patient?", "answer": "Hepatitis E", "meta_info": "step2&3", "answer_idx": "D", "A": "Hepatitis A", "B": "Hepatitis B", "C": "Hepatitis D", "D": "Hepatitis E", "language": "en"}
{"question": "A 42-year-old woman comes to the physician because of an episode of coughing with bloody sputum. Over the past 5 months, she has had a persistent nonproductive cough, excessive fatigue, and a 5.6-kg (12.3-lb) weight loss. She does not smoke. Physical examination shows no abnormalities. An x-ray of the chest shows a 2.0-cm nodule with irregular borders at the upper lobe of the left lung. A CT-guided biopsy of the lung nodule is performed. Pathologic examination of the biopsy specimen is most likely to show which of the following?", "answer": "Adenocarcinoma", "meta_info": "step1", "answer_idx": "D", "A": "Small cell lung carcinoma", "B": "Large cell lung carcinoma", "C": "Bronchial carcinoid tumor", "D": "Adenocarcinoma", "language": "en"}
{"question": "A group of researchers is conducting a prospective study to examine if dietary fiber intake is protective against coronary heart disease. Specifically, they are looking at the frequency of coronary heart incidents in a group of middle-aged men taking various daily amounts of water-insoluble fiber. The Pearson correlation coefficient that was obtained regarding the relationship between the amount of daily water-insoluble fiber intake and the frequency of coronary heart incidents in their study was 0.11 with a p-value of 0.006. Which of the following statements is correct regarding this study result?", "answer": "There is no correlation between fiber intake and the frequency of coronary heart incidents because the correlation coefficient is significant.", "meta_info": "step1", "answer_idx": "D", "A": "There is a significant correlation between the daily fiber intake and the frequency of coronary heart incidents because the correlation coefficient is significant.", "B": "There is a significant correlation between fiber intake and the frequency of coronary heart incidents because the correlation coefficient is not significant.", "C": "There is a significant correlation between fiber intake and the frequency of coronary heart incidents because the value of the correlation coefficient shows a very good and robust correlation.", "D": "There is no correlation between fiber intake and the frequency of coronary heart incidents because the correlation coefficient is significant.", "language": "en"}
{"question": "A 24-year-old man comes to the physician because of a painful swelling above his buttocks for 1 week. He is unable to sit for extended periods because of the pain. He has obstructive sleep apnea and type 2 diabetes mellitus. His only medication is metformin. He appears anxious. He is 175 cm (5 ft 9 in) tall and weighs 114 kg (251 lb); BMI is 37 kg/m2. His temperature is 38.1°C (100.6°F), pulse is 96/min and blood pressure is 124/86 mm Hg. Examination shows facial acne. A cyst is seen above the natal cleft. There is tenderness to palpation at the cyst and surrounding tissue. The skin around the cyst is warm and erythematous. Which of the following is the most appropriate next step in management?", "answer": "Incision and drainage", "meta_info": "step2&3", "answer_idx": "B", "A": "Coccygectomy", "B": "Incision and drainage", "C": "Retinoid therapy", "D": "Surgical resection and primary wound closure", "language": "en"}
{"question": "A 17-year-old girl comes to the physician because of a 3-year history of acne on her face and chest. She has no itching or scaling. She is concerned about the possibility of facial scarring and has never sought treatment. She has no history of serious illness. She takes no medications. She is 160 cm (5 ft 3 in) tall and weighs 58 kg (130 lb); BMI is 23 kg/m2. Her vital signs are within normal limits. Examination shows several open comedones on the face and chest. Which of the following is the most appropriate initial treatment?", "answer": "Topical benzoyl peroxide", "meta_info": "step2&3", "answer_idx": "B", "A": "Oral antibiotics", "B": "Topical benzoyl peroxide", "C": "Topical antibiotic", "D": "Oral isotretinoin", "language": "en"}
{"question": "A 12-year-old boy is brought to the emergency department by his mother because he has been having difficulty breathing. He started having symptoms about 3 days ago when he started experiencing persistent coughing, runny nose, and a low grade fever. Since then he has been experiencing dyspnea that grew worse until he felt that he could no longer breathe. His mom says that this has happened many times before. On presentation, physical exam reveals an anxious, thin boy who is using his accessory muscles to breathe. Prolonged expiratory wheezes are heard on auscultation of his lungs bilaterally. During stabilization, he is prescribed a drug for treatment of his condition. The patient's mother recognizes the drug since her father, a 40-pack-year smoker, also takes the medication and she is told that the drug is able to beneficially inhibit a receptor on smooth muscle in both cases. Which of the following drugs most likely has a similar mechanism of action as the drug prescribed to this patient?", "answer": "Glycopyrrolate", "meta_info": "step1", "answer_idx": "B", "A": "Cortisol", "B": "Glycopyrrolate", "C": "Theophylline", "D": "Zileuton", "language": "en"}
{"question": "A 35-year-old taxi driver presents to his physician with complaints of itchy, watery eyes and excessive sneezing that have become more severe with the change of the seasons. He has previously taken an over-the-counter medication in the past with moderate relief of his symptoms, but it made him very drowsy. He asks to switch to a medication that will not cause drowsiness that may impair his driving. Which of the following medications would you prescribe for this patient?", "answer": "Cetirizine", "meta_info": "step1", "answer_idx": "A", "A": "Cetirizine", "B": "Chlorpheniramine", "C": "Diphenhydramine", "D": "Hydroxyzine", "language": "en"}
{"question": "A 19-year-old female college student comes to the physician for a sudden loss of visual acuity of her right eye. She noticed that she was unable to read the time on the alarm clock when she woke up in the morning. When she closes her right eye, she is able to see sharply. When she closes her left eye, she has blurry double vision. She does not recall trauma to her eye but has been working long nights on her honors thesis. She has a history of occasional shoulder luxation. She is 180 cm (5 ft 11 in) tall, and weighs 62 kg (136 lbs); her BMI is 19.1 kg/m2. Her vital signs are within normal limits. On physical examination, slender and long fingers are noted. She has several flat, demarcated brownish nevi on her left cheek. Ocular examination shows upward temporal subluxation of her right lens. Which of the following is the most likely diagnosis in this patient?", "answer": "Marfan syndrome", "meta_info": "step2&3", "answer_idx": "D", "A": "Joint hypermobility syndrome", "B": "Sturge-Weber syndrome", "C": "Ehlers-Danlos syndrome", "D": "Marfan syndrome", "language": "en"}
{"question": "A 62-year-old man presents to his primary care provider complaining of abdominal pain. He reports a 6-month history of gradually progressive epigastric pain and 10 pounds of unexpected weight loss. He has also noticed that his skin feels itchier than usual. His past medical history is notable for gout, hypertension, and diabetes mellitus. He takes allopurinol, enalapril, and glyburide. He has a 10-pack-year smoking history and a distant history of cocaine abuse. His temperature is 100.1°F (37.8°C), blood pressure is 135/85 mmHg, pulse is 100/min, and respirations are 20/min. On exam, he has notable hepatomegaly and a palpable gallbladder. A right upper quadrant ultrasound reveals an irregular extrahepatic mass originating from the gallbladder wall. Which of the following serum markers is most likely elevated in this patient?", "answer": "CA 19-9", "meta_info": "step1", "answer_idx": "C", "A": "Bombesin", "B": "CA-125", "C": "CA 19-9", "D": "S-100", "language": "en"}
{"question": "A 4-year-old girl from a recently immigrated family presents to the emergency department with episodes of severe coughing lasting up to several minutes followed by vomiting. She had a low grade fever and runny nose over the last 2 weeks but these coughing episodes just began one day prior to presentation. A complete blood count shows a lymphocytic infiltrate and Gram stain reveals a gram-negative coccobacillus. The emergency department physician explains that this organism causes disease by toxin-mediated inactivation of an inhibitory signaling molecule. Which of the following could be used to culture the most likely cause of this disorder?", "answer": "Regan-Lowe medium", "meta_info": "step1", "answer_idx": "D", "A": "Charcoal yeast with iron and cysteine", "B": "Eaton agar", "C": "Loffler medium", "D": "Regan-Lowe medium", "language": "en"}
{"question": "A 28-year-old man presents with episodic abdominal pain and bloody diarrhea for the past week. He says that the abdominal pain is diffusely localized to the periumbilical region and is dull and cramping in character. He also reports episodes of painful, bloody diarrhea up to 7 times per day. A colonoscopy is performed and shows continuous erythema, superficial ulcers, and pseudopolyps in the rectum and sigmoid colon. A biopsy is taken and sent for histological evaluation. One of the slides from the biopsy is shown in the image below. Which of the following histopathologic findings characteristic of this patient’s most likely diagnosis is marked by the yellow circle?", "answer": "Crypt abscess", "meta_info": "step1", "answer_idx": "C", "A": "Goblet cell hyperplasia", "B": "Paneth cells metaplasia", "C": "Crypt abscess", "D": "Enterocyte dysplasia", "language": "en"}
{"question": "A 14-year-old boy is brought to the emergency department because of a 2-day history of fatigue. He reports that during this time he has had occasional palpitations and shortness of breath. He has sickle cell disease. Current medications include hydroxyurea and folic acid. He appears fatigued. His temperature is 38.3°C (100.9°F), pulse is 120/min, respirations are 24/min, and blood pressure is 112/74 mm Hg. Examination shows pale conjunctivae. Cardiac examination shows a midsystolic ejection murmur. Laboratory studies show:\nHemoglobin 6.4 g/dl\nLeukocyte count 6,000/mm3\nPlatelet count 168,000/mm3\nMean corpuscular volume 84 μm3\nReticulocyte count 0.1%\nWhich of the following is the most likely underlying cause of these findings?\"", "answer": "Parvovirus B19", "meta_info": "step1", "answer_idx": "A", "A": "Parvovirus B19", "B": "Medication-induced hemolysis", "C": "Defect in erythrocyte membrane proteins", "D": "Hemolytic crisis", "language": "en"}
{"question": "A 44-year-old woman comes to the office because of 4 episodes of loss of consciousness over the past 2 weeks. She recovered immediately and was not confused following the episodes. For the past 6 months, she has also had increased shortness of breath, palpitations, and chest tightness that resolves with rest. She immigrated with her family from India 10 years ago. Pulse is 115/min and irregular and blood pressure is 108/70 mm Hg. Cardiac examination shows an accentuated and split S2. There is an opening snap followed by a low-pitched diastolic murmur in the fifth left intercostal space at the midclavicular line. An ECG shows atrial fibrillation and right axis deviation. Which of the following is the most likely underlying mechanism of these findings?", "answer": "Increased pulmonary capillary wedge pressure", "meta_info": "step1", "answer_idx": "A", "A": "Increased pulmonary capillary wedge pressure", "B": "Increased central venous pressure", "C": "Increased oxygenated blood in the right ventricle", "D": "Increased mean arterial pressure", "language": "en"}
{"question": "A 43-year-old woman is brought to the emergency department because of severe central chest pain, mild shortness of breath, and one episode of coughing up blood since waking up that morning. The pain worsens on inspiration, and she describes it as 8 out of 10 in intensity. Three months ago, she underwent a left modified radical mastectomy for invasive ductal carcinoma. Her temperature is 37.8°C (100°F), pulse is 103/min, respirations are 20/min, and blood pressure is 102/74 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 93%. The lungs are clear to auscultation. Cardiac examination shows no abnormalities. The left lower extremity is swollen and erythematous. Laboratory studies show a normal complete blood count, creatinine of 1.0 mg/dL, and a creatinine clearance of 81 mL/min (N = 75–115). Arterial blood gas analysis on room air shows:\npH 7.49\nPCO2 29 mm Hg\nPO2 69 mm Hg\nHCO3- 22 mEq/L\nAn x-ray of the chest shows no abnormalities. Which of the following is the most appropriate next step in management?\"", "answer": "Low molecular weight heparin therapy", "meta_info": "step2&3", "answer_idx": "D", "A": "CT pulmonary angiography", "B": "D-dimer levels", "C": "Catheter embolectomy", "D": "Low molecular weight heparin therapy", "language": "en"}
{"question": "A 58-year-old Caucasian male with a history of peripheral vascular disease is admitted to the hospital with a painful, pulseless foot. He is prescribed antiplatelet and anticoagulant drugs. Which of the following matches a drug with its correct characteristic?", "answer": "Heparin: activates antithrombin 3", "meta_info": "step1", "answer_idx": "B", "A": "Warfarin: directly inhibits thrombin", "B": "Heparin: activates antithrombin 3", "C": "Aspirin: reversibly inhibits COX-1", "D": "Prasugrel: reduced risk of bleeding compared to other drugs in its class", "language": "en"}
{"question": "A 64-year-old woman comes to the physician because of several episodes of dizziness during the last month. The episodes last between 30–40 seconds and during the episodes she feels as though she is spinning. Episodes usually occur immediately after lying down or suddenly sitting up from a reclined position. They also sometimes happen when she suddenly turns her head to look at something. She has no nausea. Last month, she had an upper respiratory tract infection that resolved spontaneously. She has hypertension treated with hydrochlorothiazide. Otoscopic examination shows no abnormalities. There is no lateralization when a vibrating 512 Hz tuning fork is placed in the middle of the forehead. Which of the following is the most likely diagnosis?", "answer": "Benign paroxysmal positional vertigo", "meta_info": "step2&3", "answer_idx": "A", "A": "Benign paroxysmal positional vertigo", "B": "Persistent postural-perceptual dizziness", "C": "Meniere disease", "D": "Acoustic neuroma", "language": "en"}
{"question": "A 31-year-old woman presents to her primary care physician because she has been experiencing diarrhea over the last several days. She returned from a cruise ship vacation 3 days ago and has recently been to many countries in Central and South America. After returning, she developed bloody diarrhea, nausea, and right-upper quadrant abdominal pain. Stool examination shows blood and neutrophils and imaging reveals abscesses in the liver. Which of the following findings would most likely be seen in this patient?", "answer": "Ulcers that are flask-shaped", "meta_info": "step1", "answer_idx": "D", "A": "Acid fast cysts", "B": "Motile bacteria", "C": "Non-invasive trophozoites", "D": "Ulcers that are flask-shaped", "language": "en"}
{"question": "A 35-year-old woman that is currently being treated for chronic hepatitis C comes to the physician because of progressive fatigue for 10 days. Examination shows pale conjunctivae. Her hemoglobin concentration is 10.1 g/dL, serum total bilirubin concentration is 1.9 mg/dL, and LDH is 259 U/L (N = 45–90 U/L). Which of the following mechanisms most likely contributes to the efficacy of this patient's pharmacotherapy?", "answer": "Decreased GMP synthesis", "meta_info": "step1", "answer_idx": "D", "A": "Activation of leukocytes", "B": "Inhibition of reverse transcriptase", "C": "Inhibition of RNA polymerase", "D": "Decreased GMP synthesis", "language": "en"}
{"question": "A 7-year-old boy is brought to a pediatrician by his parents. The parents say that the patient accidentally instilled a drop from a bottle of medicated eye drops into his right eye. According to them, the patient’s grandfather uses the eye drops which were prescribed for him by an ophthalmologist. The parents have brought the eye drops with them. The pediatrician notes that the eye drops contain an α1 adrenergic agonist drug. He examines the patient’s eye and finds that the eye drops have produced their expected effects. He reassures the parents about the self-limited effect of the drug and the absence of any risk of long-term complications. Which of the following effects are most likely to have occurred in this child’s eye from these eye drops?", "answer": "Contraction of the pupillary dilator muscle with no effect on the ciliary muscle", "meta_info": "step1", "answer_idx": "A", "A": "Contraction of the pupillary dilator muscle with no effect on the ciliary muscle", "B": "Relaxation of the pupillary dilator muscle with no effect on the ciliary muscle", "C": "Relaxation of the pupillary sphincter muscle with contraction of the ciliary muscle", "D": "Contraction of the pupillary dilator muscle with contraction of the ciliary muscle", "language": "en"}
{"question": "A 21-year-old female comes to the physician’s office because of insomnia. For the past 9 months, the patient has been having a hard time falling asleep because she “can’t turn her mind off.” She is a student in a nearby university and spends hours at the end of each day worrying about her classes as well as her upcoming tests. When she doesn’t have tests, she worries about her family and her boyfriend even though admits she has no specific concerns about them. This constant worrying has led to insomnia and an inability to focus in class. She has also been fatigued and hasn’t had the energy to go the gym as she usually does. The most effective medication for her disorder has what mechanism of action?", "answer": "Inhibit reuptake of serotonin", "meta_info": "step1", "answer_idx": "A", "A": "Inhibit reuptake of serotonin", "B": "Inhibition of monoamine oxidase", "C": "Increase norepinephrine and dopamine", "D": "Block dopamine receptors", "language": "en"}
{"question": "A 7-year-old girl is brought to the physician because of a slightly itchy rash that first appeared 3 days ago. Her mother says she has also been complaining of headaches and achy muscles since yesterday evening. The girl went on a camping trip for school 10 days ago. She recalls being bitten several times by mosquitoes. She has a history of atopic dermatitis. She lives in Massachusetts with both parents and her 4-year-old sister. Her temperature is 39°C (102.2°F). Physical examination shows a 3-cm, nontender rash on her left upper torso. A photograph of the rash is shown. There are also multiple 5 to 8-mm erythematous papules over the lower legs and forearms. Which of the following is the most appropriate pharmacotherapy?", "answer": "Amoxicillin", "meta_info": "step2&3", "answer_idx": "A", "A": "Amoxicillin", "B": "Ceftriaxone", "C": "Penicillin G", "D": "Azithromycin", "language": "en"}
{"question": "A 45-year-old man presents to the clinic for the third time in the past 3 weeks asking for an MRI of his lower back. He had initially gone to the gym as advised by his wife and had started doing some back exercises. The next day, he developed soreness in his lower back and spent the whole day online trying to figure out what was wrong with him. He has been to the emergency department a few times and subsequently has been redirected to the clinic where each time he was thoroughly examined and investigated for all the possible causes. The patient still exhibits worry and would like to get an MRI to make sure everything is ‘okay.’ Which of the following is the most likely diagnosis in this patient?", "answer": "Illness anxiety disorder", "meta_info": "step2&3", "answer_idx": "A", "A": "Illness anxiety disorder", "B": "Somatic symptom disorder", "C": "Factitious disorder", "D": "Munchausen syndrome", "language": "en"}
{"question": "A 25-year-old woman presents to the urgent care clinic for cough for the past five days. She recently moved to the area and has not yet established a primary care doctor. She has noticed worsening runny nose with congestion, sneezing, and tearing over the past few days. She initially thought that it was just due to dust from moving boxes into her new apartment, but her symptoms did not improve after cleaning her belongings and vacuuming her floor. She feels some relief after splashing her face with cold water, but her symptoms recur within ten minutes. She has no pets and does not take any medications. Her physical exam reveals examples of findings shown in Figures A-C. No rales or wheezes are appreciated on lung auscultation, but bronchial breath sounds are heard at the bases. The patient states that she will need to drive back home after this visit. What is the best initial step in management?", "answer": "Intranasal corticosteroids", "meta_info": "step2&3", "answer_idx": "B", "A": "Oral loratadine", "B": "Intranasal corticosteroids", "C": "Sublingual oseltamivir", "D": "Oral montelukast", "language": "en"}
{"question": "A 73-year-old woman with atrial fibrillation presents to your clinic to discuss the need for anticoagulation. Her PMH is significant for high blood pressure, diabetes mellitus type II, osteoporosis, and depression. She previously smoked but quit about 16 years ago. She has never had a stroke or TIA. Her physical examination is remarkable for an irregular heart rate. She has a blood pressure of 136/94 mm Hg and a heart rate of 74/min. What is her CHADS2 score?", "answer": "2", "meta_info": "step2&3", "answer_idx": "B", "A": "1", "B": "2", "C": "4", "D": "Too little information to tell", "language": "en"}
{"question": "A 26-year-old woman is admitted to the hospital because of a 3-day history of tingling and weakness in the lower extremities. Neurologic examination shows areflexia of the ankle and knee joints bilaterally. Motor strength is 1/5 in both lower legs. Over the next 3 weeks, the patient's condition progresses to involve both upper extremities, and she requires ventilatory support. Six weeks after admission, deep tendon reflexes are 1+ in the ankles, and she is able to wiggle her toes. Which of the following is most likely responsible for the improvement in this patient's neurological status?", "answer": "Remyelination of peripheral nerves", "meta_info": "step1", "answer_idx": "B", "A": "Synthesis of monoamine neurotransmitters", "B": "Remyelination of peripheral nerves", "C": "Replication of oligodendrocyte precursor cells", "D": "Lymphocytic infiltration in the endoneurium\n\"", "language": "en"}
{"question": "A 42-year-old woman presents to her primary care physician for fatigue and blurry vision. She is a refugee from Syria who arrived in the United States 1 week ago. She has lived for the last 8 months in a refugee camp. She worked at a grocery store in Syria before being displaced from her home. She has one son who is 9 years old and was seen by a pediatrician the day prior. She reports that while she was in the refugee camp, she ate very little and gave most of her food to her son to ensure that he stayed healthy. She denies any past medical history and takes no medications. She does not smoke or drink alcohol. Her temperature is 97.8°F (36.6°C), blood pressure is 108/68 mmHg, pulse is 102/min, and respirations are 18/min. On exam, she appears fatigued but is fully cooperative with the examination. There are fissures at the corners of her mouth. A funduscopic examination reveals corneal vascularization in both eyes. Her tongue is darkly erythematous. This patient is most likely deficient in a vitamin that has which of the following functions?", "answer": "Precursor to FAD and FMN", "meta_info": "step1", "answer_idx": "C", "A": "Cofactor for homocysteine methyltransferase", "B": "Cofactor for pyruvate dehydrogenase enzyme", "C": "Precursor to FAD and FMN", "D": "Constituent of NAD+ and NADP+", "language": "en"}
{"question": "A 70-year-old man was first evaluated for an enlarging neck mass with complaints of night sweats, fever, and weight loss. Excisional biopsy confirms the diagnosis of Burkitt lymphoma. The patient is started on a CODOX-M/IVAC chemotherapy regime. The physician notes a marked improvement, but is concerned about a common complication of chemotherapy. The patient is prescribed rasburicase in response to this complication. Which of the following statements describing the patient’s current state is most accurate?", "answer": "Rasburicase converts uric acid to allantoin, increasing its secretion", "meta_info": "step1", "answer_idx": "C", "A": "Rasburicase is a xanthine oxidase inhibitor", "B": "This complication only occurs in response to radiation", "C": "Rasburicase converts uric acid to allantoin, increasing its secretion", "D": "Hypophosphatemia is expected to develop in this patient", "language": "en"}
{"question": "A previously healthy 41-year-old man is brought to the emergency department 30 minutes after collapsing at home. Cardiopulmonary resuscitation is attempted for 10 minutes without success. A photograph of sections of the heart obtained at autopsy is shown. The patient's condition is most likely associated with which of the following pathophysiologic changes?", "answer": "Marked noncompliance of the left ventricular wall", "meta_info": "step1", "answer_idx": "C", "A": "Retrograde blood flow from the aorta into the left ventricle", "B": "Fixed obstruction of the left ventricular outflow tract", "C": "Marked noncompliance of the left ventricular wall", "D": "Severe narrowing of the left anterior descending artery", "language": "en"}
{"question": "A 68-year-old woman comes to the physician with increasing fatigue and shortness of breath for 2 weeks. She has only passed very small amounts of urine over the past few days. During this time, she has also noticed that her feet appear unusually puffy for a few hours every morning. Three weeks ago, she had a sore throat that resolved spontaneously after several days without antibiotic therapy. She has a 6-month history of lower back and thoracic pain, for which she takes ibuprofen daily. Her only other medication is a laxative for constipation, which she first experienced 8 months ago. Her sister has systemic lupus erythematosus. Her temperature is 37.9°C (98.9°F), pulse is 110/min, respirations are 22/min, and blood pressure is 150/100 mm Hg. Examination shows pedal edema and conjunctival pallor. There is tenderness to palpation over the lumbar spine and the 8th rib on the right. Cardiac examination shows no abnormalities. Laboratory studies show:\nHemoglobin 9.8 mg/dL\nSerum\nUrea nitrogen 50 mg/dL\nCreatinine 2.8 mg/dL\nCalcium 12.9 mg/dL\nUrine\nProtein negative\nBlood negative\nWhich of the following is the most likely underlying cause of this patient's symptoms?\"", "answer": "Immunoglobulin light chains", "meta_info": "step2&3", "answer_idx": "B", "A": "Renal deposition of AL amyloid", "B": "Immunoglobulin light chains", "C": "Decreased cardiac ejection fraction", "D": "Anti-streptococcal antibodies", "language": "en"}
{"question": "A 13-month-old male needs to have surgery for an undescended testicle. The child lives with his 16-year-old mother only. His 19-year-old father is not involved. From whom should the surgeon get consent for the procedure?", "answer": "The mother", "meta_info": "step1", "answer_idx": "A", "A": "The mother", "B": "The father", "C": "A grandparent", "D": "The hospital's medical ethics committee", "language": "en"}
{"question": "A 7-year-old boy is brought to the emergency department after he was bitten by a dog. The patient was at a friend's house, and he was bitten when he pulled the dog's tail while it was eating. The patient is currently doing well and has a dog bite on his right distal forearm. His temperature is 98.2°F (36.8°C), blood pressure is 100/60 mmHg, pulse is 123/min, respirations are 19/min, and oxygen saturation is 98% on room air. The wound is thoroughly irrigated in the emergency department. Which of the following is the best next step in management?", "answer": "Quarantine and observe the animal", "meta_info": "step2&3", "answer_idx": "C", "A": "Closure of the wound via sutures", "B": "Euthanasia of the animal", "C": "Quarantine and observe the animal", "D": "Rabies vaccine and rabies immunoglobulin", "language": "en"}
{"question": "A 35-year-old woman, otherwise healthy, presents with frequent nosebleeds and bruising on her legs. She says that her symptoms started about 6 months ago and have not improved. She remembers that her 8-year-old son had similar symptoms about a month ago following a viral respiratory infection, but his symptoms quickly resolved without treatment. No significant past medical history and no current medications. Family history is significant for her father dying at age 65 of myocardial infarction. Review of systems is significant for her last period 2 weeks ago being a bit heavier than usual. Her vital signs include: temperature 37.0°C (98.6°F), blood pressure 100/75 mm Hg, pulse 98/min, respirations 15/min, and oxygen saturation 99% on room air. On physical examination, the patient is alert and cooperative. Cardiac exam is normal. Lungs are clear to auscultation. There is non-palpable purpura present on the lower extremities bilaterally. Which of the following set of laboratory results and peripheral blood smear findings would most likely be seen in this patient?", "answer": "Platelets: Decreased | Bleeding time: Increased | PT: Normal| PTT: Normal| Blood smear: Schistocytes absent", "meta_info": "step2&3", "answer_idx": "D", "A": "Platelets: Decreased | Bleeding time: Increased | PT: Normal | PTT: Normal | Blood smear: Schistocytes present", "B": "Platelets: Decreased | Bleeding time: Increased | PT: Increased| PTT: Increased | Blood smear: Schistocytes present", "C": "Platelets: Increased | Bleeding time: Decreased| PT: Normal| PTT: Normal | Blood smear: Schistocytes absent", "D": "Platelets: Decreased | Bleeding time: Increased | PT: Normal| PTT: Normal| Blood smear: Schistocytes absent", "language": "en"}
{"question": "A 65-year-old woman comes to the physician because of urinary straining and delayed flow of urine for 1 month. She has a medical history significant for long-standing asthma. Recently, she has been taking albuterol more frequently on an as-needed basis. She was diagnosed with major depression last year. Currently, her symptoms of depression are under control. Her medications include inhaled salmeterol and fluticasone propionate and oral amitriptyline, the dose of which was increased recently due to uncontrolled depressive symptoms. The vital signs include: temperature 37.1°C (99.8°F), pulse rate 80/min, respiratory rate 14/min, and blood pressure 110/70 mm Hg. On examination, she has dry oral mucous membranes. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate modification in this patient’s drug therapy?", "answer": "Switching amitriptyline to fluoxetine", "meta_info": "step2&3", "answer_idx": "C", "A": "Adding ipratropium bromide inhaler", "B": "Reducing the dose of albuterol", "C": "Switching amitriptyline to fluoxetine", "D": "No change is required at this time", "language": "en"}
{"question": "An 8-year-old girl is brought by her mother to her pediatrician’s office for a follow-up visit. She was diagnosed with asthma about 4 years ago and has been on medications ever since. She came into the doctor’s office about a month ago with an escalation of her symptoms. She told her doctor that she has been struggling to breathe almost every single day. This difficulty increased when she played outdoors with her friends. She said that she used to wake up at least 3 times a week from sleep to use her inhaler. She uses a short-acting β-agonist inhaler to control her symptoms. At the previous visit, her doctor had started her on a small dose of fluticasone (inhaled) as well as a long-acting β-agonist inhaler. She has some improvement in her symptoms. On physical examination, she doesn’t seem to be in distress, and currently, the lungs are clear on auscultation. Her forced expiratory volume in one second is about 70% of the predicted value. Based on the description of these patients symptoms and current treatment regime, which of the following categories describes the severity of this child’s symptoms?", "answer": "Moderate persistent", "meta_info": "step2&3", "answer_idx": "C", "A": "Mild intermittent", "B": "Mild persistent", "C": "Moderate persistent", "D": "Severe persistent", "language": "en"}
{"question": "An 18-year-old woman presents with recurrent headaches. The pain is usually unilateral, pulsatile in character, exacerbated by light and noise, and usually lasts for a few hours to a full day. The pain is sometimes triggered by eating chocolates. These headaches disturb her daily routine activities. The physical examination was within normal limits. She also has essential tremors. Which drug is suitable in her case for the prevention of headaches?", "answer": "Propranolol", "meta_info": "step1", "answer_idx": "D", "A": "Ergotamine", "B": "Verapamil", "C": "Valproic", "D": "Propranolol", "language": "en"}
{"question": "A 26-year-old man is brought to the emergency department by the police after threatening to harm his roommate earlier today. He reports that someone on the radio told him to do so. His family reports that, during the past two years, the patient has become increasingly more withdrawn from family and friends. He states that he has spent the majority of the last year alone in his room “working on a project at home to save the earth from an evil alien power.” There is no family history of serious illness. He has smoked marijuana on a daily basis since he was thirteen. Vital signs are within normal limits. On mental status examination, he has a flat affect and his speech is disorganized. An MRI scan of the head is most likely to show which of the following?", "answer": "Enlarged cerebral ventricles", "meta_info": "step2&3", "answer_idx": "D", "A": "Periventricular plaques and white matter lesions", "B": "Ring-enhancing lesion", "C": "Hyperintense temporal lobe lesion", "D": "Enlarged cerebral ventricles", "language": "en"}
{"question": "A 46-year-old anesthesiologist is found placing several syringes of amobarbital in his backpack prior to leaving the hospital. When confronted, the anesthesiologist admits that he began abusing the medication the previous year, after his divorce was finalized. He has been using it on a daily basis since then, and his most recent usage was 8 hours ago. Which of the following is the most life-threatening complication of amobarbital withdrawal?", "answer": "Cardiovascular collapse", "meta_info": "step2&3", "answer_idx": "C", "A": "Internal bleeding", "B": "Respiratory depression", "C": "Cardiovascular collapse", "D": "Self-inflicted violence", "language": "en"}
{"question": "A 55-year-old man is brought to the emergency department for 1 episode of bloody emesis. He reports feeling lightheaded this morning and shortly after breakfast, he felt nauseous and had an episode of bloody emesis. He denies any trauma, fever, abnormal ingestions, or recent infections. He endorses black stools over the past few days. His past medical history is significant for alcohol abuse and cirrhosis. A physical examination demonstrates mild jaundice and ascites. What is the mechanism of action of the medication that can be used in the management of this patient’s condition?", "answer": "Somatostatin analog leading to constriction of the splanchnic vessels", "meta_info": "step1", "answer_idx": "C", "A": "Antagonists of ß1 and ß2 adrenergic receptors", "B": "Reversible block of histamine H2 receptors", "C": "Somatostatin analog leading to constriction of the splanchnic vessels", "D": "Stimulation of cGMP production leading to vascular smooth muscle relaxation", "language": "en"}
{"question": "Shortly after undergoing a bipolar prosthesis for a displaced femoral neck fracture of the left hip acquired after a fall the day before, an 80-year-old woman suddenly develops dyspnea. The surgery under general anesthesia with sevoflurane was uneventful, lasting 98 minutes, during which the patient maintained oxygen saturation readings of 96–100% on 8 L of oxygen. She has a history of hypertension, osteoporosis, and osteoarthritis of her right knee. Her medications include ramipril, naproxen, ranitidine, and a multivitamin. She appears cyanotic, drowsy, and is oriented only to person. Her temperature is 38.6°C (101.5°F), pulse is 135/minute, respirations are 36/min, and blood pressure is 155/95 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 81%. There are several scattered petechiae on the anterior chest wall. Laboratory studies show a hemoglobin concentration of 10.5 g/dL, a leukocyte count of 9,000/mm3, a platelet count of 145,000/mm3, and a creatine kinase of 190 U/L. An ECG shows sinus tachycardia. Which of the following is the most likely diagnosis?", "answer": "Fat embolism", "meta_info": "step2&3", "answer_idx": "A", "A": "Fat embolism", "B": "Thyrotoxic crisis", "C": "Malignant hyperthermia", "D": "Meningitis\n\"", "language": "en"}
{"question": "A 34-year-old woman presents to her primary care physician complaining of weakness and rash for the past 2 months. She says her symptoms had a gradual onset at first, but over the past 2 weeks she has grown more concerned as she now has difficulty going up and down the stairs in her apartment. Her rash is nonpruritic and confined to her knuckles. She denies fever, chills, and changes in bowel habits, cough, or shortness of breath. Up until the onset of her symptoms she had been an avid hiker in upstate New York. Temperature is 98.0°F (36.7°C) blood pressure is 110/72 mmHg, pulse is 88/min, and respirations are 20/min. Physical examination demonstrates 4-/5 strength in the proximal lower extremities. The patient's cutaneous findings are demonstrated in figure A. Laboratory studies will most likely demonstrate the following in this patient?", "answer": "Anti-histidyl tRNA synthetase antibodies", "meta_info": "step1", "answer_idx": "A", "A": "Anti-histidyl tRNA synthetase antibodies", "B": "Anti-histone antibodies", "C": "Anti-HMG CoA reductase antibodies", "D": "Anti-mitochondrial antibodies", "language": "en"}
{"question": "A 4-day-old, full-term infant born by uncomplicated vaginal delivery is brought to a pediatrician by his mother, who notes that her son's skin appears yellow. She reports that the child cries several times per day, but sleeps 7-8 hours at night, uninterrupted. She has been breastfeeding exclusively and feels that he has been feeding well. He has been having a bowel movement on average once every 3 days. Which of the following is the most likely etiology of the patient's presentation?", "answer": "Breastfeeding jaundice", "meta_info": "step2&3", "answer_idx": "A", "A": "Breastfeeding jaundice", "B": "Breast milk jaundice", "C": "Glucose-6-phosphate dehydrogenase deficiency", "D": "Hepatitis A", "language": "en"}
{"question": "A 23-year-old female comes to the office because of a 3-week history of vaginal discharge and itching despite cleaning her genitals with a vaginal douche. Her last menstrual period was one week ago. She is sexually active with her new boyfriend. She has an intrauterine device and does not use barrier protection. She was treated for a sore throat infection one month ago. Speculum examination shows erythema around the vaginal introitus and copious white discharge. Vaginal pH is 4.3 and a KOH test shows multiple pseudohyphae on microscopy. Which of the following is the strongest predisposing factor for this patient's condition?", "answer": "Suppression of vaginal bacterial flora", "meta_info": "step1", "answer_idx": "A", "A": "Suppression of vaginal bacterial flora", "B": "Increased vaginal pH", "C": "Intrauterine device", "D": "Unprotected sexual intercourse", "language": "en"}
{"question": "A 3-year-old boy who has no known past medical or family history is brought by his parents to his pediatrician for new symptoms. Specifically, his parents state that he has suffered from a fever associated with diarrhea and conjunctivitis over the past week or so. His parents note that he has never had an episode of diarrhea like this previously, but that several other children at his daycare had been ill recently. The blood pressure is 112/70 mm Hg, heart rate is 94/min, respiratory rate is 14/min, and temperature is 37.0°C (98.6°F). The physical exam is significant for preauricular adenopathy. Which of the following interventions would have been most effective to prevent this condition?", "answer": "Better hand-washing practices", "meta_info": "step2&3", "answer_idx": "B", "A": "Appropriate immunization", "B": "Better hand-washing practices", "C": "Keeping all food stored in the refrigerator", "D": "Avoiding undercooked seafood", "language": "en"}
{"question": "A 24-year-old woman with no past medical history presents to her PCP for a routine checkup. She feels generally healthy but has noticed a new vaginal discharge that has a strange odor. The patient has been in a long-term relationship and denies any new sexual partners. She denies vaginal itching, abnormal menstruation, or dyspareunia. Vital signs are within normal limits. The physical exam reveals thin, greyish-white vaginal discharge but is otherwise unremarkable. A sample of this discharge is collected. What would be the most likely finding on wet mount?", "answer": "Epithelial cells with stippling", "meta_info": "step1", "answer_idx": "C", "A": "Motile, flagellated protozoans", "B": "Long, branching filamentous structures", "C": "Epithelial cells with stippling", "D": "Large mucoid capsules", "language": "en"}
{"question": "A 50-year-old African-American woman comes to the physician because of right elbow pain for the past 12 hours. The pain is currently at 7 out of 10 in intensity. She has not had any trauma to the right elbow. She also reports general malaise. She had a miscarriage at the age of 37 years. One year ago, she had carpal tunnel syndrome that was treated with a volar splint. Three months ago, she was diagnosed with thrombophlebitis, which responded well to treatment with ibuprofen and compression therapy. She runs 5 km (3.1 miles) per week. She works as an accountant. She drinks 1–2 glasses of wine on weekends. She is 171 cm (5 ft 7 in) tall and weighs 70 kg (154 lbs); BMI is 23.9 kg/m2. Her pulse is 110/min, blood pressure is 130/80 mm Hg, and temperature is 38.3°C (101°F). On physical examination, the skin above her right elbow is erythematous and severely tender to palpation. Laboratory studies show:\nHemoglobin 13.5 g/dL\nLeukocyte count 9,520/mm3\nPlatelet count 853,000/mm3\nSerum\nNa+ 136 mEq/L\nK+ 3.7 mEq/L\nCl- 96 mEq/L\nCa2+ 11.0 mg/dL\nHCO3- 25 mEq/L\nGlucose 102 mg/dL\nCreatinine 1.0 mg/dL\nUric acid 10.5 mg/dL\nFurther evaluation of this patient is most likely to show which of the following?", "answer": "Mutation in Janus kinase 2 gene", "meta_info": "step2&3", "answer_idx": "A", "A": "Mutation in Janus kinase 2 gene", "B": "Howell-Jolly bodies", "C": "Antibodies against citrullinated peptides", "D": "Anti-phospholipid antibodies", "language": "en"}
{"question": "A 64-year-old man is brought to his primary care physician by his daughter for forgetfulness. The patient’s daughter reports that over the past 2 weeks the patient has become more confused. He did not remember to pick up his car from the body shop last week, and yesterday, he did not show up to his grandson’s birthday party. When she went over to the patient’s house to check on him, she noticed the mailbox was stuffed with unopened letters. The patient says “I’m fine. I just have a headache.” The patient’s daughter adds, “I just hope you’re not drinking again dad. Your neighbor saw you fall outside the house a few weeks ago, and the other day you said you were nauseous and vomited.” The patient’s medical history is significant for a history of alcohol abuse, hypertension, hyperlipidemia, and atrial fibrillation. He takes aspirin, amlodipine, metoprolol, atorvastatin, and warfarin. He smokes cigars, but denies alcohol use since he started psychotherapy 7 months ago. The patient’s temperature is 97°F (36.1°C), blood pressure is 144/92 mmHg, and pulse is 82/min. On physical examination, there is a 3 cm ecchymosis on the right scalp. No focal neurological deficits are appreciated. Gait is normal. An initial complete blood count shows normocytic anemia. The patient’s INR is 2.5. Imaging is pending. Which of the following is a treatment option for the patient’s most likely diagnosis?", "answer": "Burr hole", "meta_info": "step2&3", "answer_idx": "B", "A": "Alteplase", "B": "Burr hole", "C": "Donepezil", "D": "Thiamine supplementation", "language": "en"}
{"question": "A 60-year-old man presents to the physician for a follow-up examination. During the previous visit, splenomegaly was detected on the abdominal exam, which has been confirmed by abdominal ultrasound. He has no complaints other than fatigue for several months. There is no history of serious illness. His only medication is acetaminophen for knee pain. The temperature is 36.7℃ (98.1℉), pulse is 68, respirations are 12/min, and blood pressure is 125/70 mm Hg. On physical examination, the spleen size on percussion is 16 cm (6.2 in). Otherwise, the physical examination shows no abnormalities. The laboratory test results are as follows:\nHemoglobin 10 g/dL\nMean corpuscular volume 90 μm3\nLeukocyte count 80,000/mm3\nPlatelet count 450,000/mm3\nThe peripheral blood smear shows a predominance of neutrophils and the presence of band cells, myelocytes, promyelocytes, and blasts (< 5%). The cytogenetic study shows t(9;22). Which of the following is the most likely diagnosis?", "answer": "Chronic myeloid leukemia", "meta_info": "step2&3", "answer_idx": "B", "A": "Acute lymphoid leukemia", "B": "Chronic myeloid leukemia", "C": "Hairy cell leukemia", "D": "Burkitt lymphoma", "language": "en"}
{"question": "A 55-year-old man comes to the physician because of balance problems. He follows a vegan diet and does not eat meat, eggs, or dairy. Physical examination shows pale oral mucosa and conjunctivae. Neurologic examination shows normal strength in all extremities and decreased sense to vibration in his lower extremities bilaterally. A peripheral blood smear is shown. Which of the following enzymes is most likely impaired?", "answer": "Methylmalonyl-CoA mutase", "meta_info": "step1", "answer_idx": "D", "A": "Succinate dehydrogenase", "B": "Propionyl-CoA carboxylase", "C": "Pyruvate carboxylase", "D": "Methylmalonyl-CoA mutase", "language": "en"}
{"question": "A 32-year-old woman presents to her primary care physician for generalized fatigue. She states that she is doing well but that she always feels tired. She started exercising to have more energy, finds that she tires easily, and has not felt motivated to return to the gym. She is doing well and is excelling at her job. She recently started a vegan diet in order to try and become healthy. She is currently struggling with dating and is unable to find a compatible mate and feels hopeless about this. The patient has a past medical history of uterine leiomyomas. Her temperature is 99.5°F (37.5°C), blood pressure is 100/68 mmHg, pulse is 80/min, respirations are 14/min, and oxygen saturation is 98% on room air. Laboratory values are ordered as seen below.\n\nHemoglobin: 10 g/dL\nHematocrit: 32%\nMCV: 78 µm^3\nFerritin: 10 mg/mL\nTotal iron binding capacity: 620 mcg/dL\nLeukocyte count: 6,500/mm^3 with normal differential\nPlatelet count: 190,000/mm^3\n\nSerum:\nNa+: 141 mEq/L\nCl-: 102 mEq/L\nK+: 4.1 mEq/L\nHCO3-: 24 mEq/L\nBUN: 20 mg/dL\nGlucose: 99 mg/dL\nCreatinine: 1.1 mg/dL\nCa2+: 10.2 mg/dL\nTSH: 4.7 mIU/mL\nAST: 12 U/L\nALT: 10 U/L\n\nWhich of the following is the next best step in management?", "answer": "Iron", "meta_info": "step2&3", "answer_idx": "C", "A": "Vitamin B9", "B": "Vitamin B12", "C": "Iron", "D": "Assess for depression", "language": "en"}
{"question": "A 28-year-old woman, gravida 1, para 0, at 24 weeks' gestation comes to the physician for a prenatal visit. She feels well. She has no history of medical illness and takes no medications. Her fasting serum glucose is 91 mg/dL. One hour after drinking a concentrated glucose solution, her serum glucose concentration is 94 mg/dL. The hormone responsible for the observed laboratory changes most likely increases glucose transport into which of the following types of cells?", "answer": "Adipocytes", "meta_info": "step1", "answer_idx": "C", "A": "Spermatocytes", "B": "Islet cells", "C": "Adipocytes", "D": "Placental cells", "language": "en"}
{"question": "A 27-year-old woman presents to the emergency department with weakness of her legs which has progressed to an inability for her to stand. The patient works as a school teacher in Alaska and regularly goes hiking and camping. She recently returned from a camping trip where she hiked through tall brush and drank from mountain streams. The patient was also involved in a motor vehicle accident 2 days ago but did not seek treatment. The patient has a medical history that is unremarkable and is currently taking multivitamins and other than a recent bout of diarrhea is generally healthy. Her temperature is 99.5°F (37.5°C), blood pressure is 120/68 mmHg, pulse is 120/min, respirations are 17/min, and oxygen saturation is 98% on room air. Physical exam is notable for a very anxious woman with 1/5 strength of the patient’s lower extremities and 2/5 strength of her trunk muscles with diminished sensation. Laboratory studies are ordered as seen below.\n\nHemoglobin: 15 g/dL\nHematocrit: 43%\nLeukocyte count: 6,500/mm^3 with normal differential\nPlatelet count: 194,000/mm^3\n\nSerum:\nNa+: 138 mEq/L\nCl-: 102 mEq/L\nK+: 4.4 mEq/L\nHCO3-: 24 mEq/L\nBUN: 20 mg/dL\nGlucose: 120 mg/dL\nCreatinine: 1.0 mg/dL\nCa2+: 10.2 mg/dL\npH: 7.44\nPaCO2: 10 mmHg\nPaO2: 90 mmHg\nAST: 12 U/L\nALT: 10 U/L\n\nThe patient complains about difficulty breathing. Repeat laboratory values are notable for the findings below.\n\npH: 7.35\nPaCO2: 30 mmHg\nPaO2: 80 mmHg\n\nThe patient is intubated and sent to the MICU. Which of the following risk factors is associated with the most likely diagnosis?", "answer": "Consuming meats cooked over a campfire", "meta_info": "step2&3", "answer_idx": "C", "A": "Female sex living in a Northern latitude", "B": "Hiking in tick-infested woods", "C": "Consuming meats cooked over a campfire", "D": "Central cervical spine trauma", "language": "en"}
{"question": "An 18-year-old male presents to the emergency room smelling quite heavily of alcohol and is unconscious. A blood test reveals severe hypoglycemic and ketoacidemia. A previous medical history states that he does not have diabetes. The metabolism of ethanol in this patient's hepatocytes resulted in an increase of the [NADH]/[NAD+] ratio. Which of the following reaction is favored under this condition?", "answer": "Oxaloacetate to malate", "meta_info": "step1", "answer_idx": "C", "A": "Pyruvate to acetyl-CoA", "B": "Citrate to isocitrate", "C": "Oxaloacetate to malate", "D": "Oxaloacetate to phosphoenolpyruvate", "language": "en"}
{"question": "A previously healthy 7-year-old girl is brought to the physician for a well-child examination. She feels well. She emigrated from India 3 months ago. There is no family history of serious illness. Her immunizations are up-to-date. She is at 60th percentile for height and weight. Her temperature is 37°C (98.6°F), pulse is 90/min, and respirations are 26/min. Examination shows no abnormalities. Laboratory studies show:\nHemoglobin 13.2 g/dL\nLeukocyte count 8900/mm3\nPlatelet count 310,000/mm3\nSerum\nHepatitis B surface antigen negative\nHepatitis B antibody positive\nInterferon-γ release assay positive\nAn x-ray of the chest shows no abnormalities. Which of the following is the most appropriate next step in management?\"", "answer": "Administer isoniazid", "meta_info": "step2&3", "answer_idx": "B", "A": "Perform acid-fast stain on induced sputum", "B": "Administer isoniazid", "C": "Perform tuberculin skin test", "D": "Administer isoniazid, rifampin, ethambutol and pyrazinamide", "language": "en"}
{"question": "Please refer to the summary above to answer this question\nAn 8-year-old boy is brought to the physician by his mother for a well-child examination at a clinic for low-income residents. Although her son's elementary school offers free afterschool programming, her son has not been interested in attending. Both the son's maternal and paternal grandmothers have major depressive disorder. The mother is curious about the benefits of afterschool programming and asks for the physician's input. Based on the study results, which of the following statements best addresses the mother's question?\"", "answer": "High-quality afterschool programming for low-income 8-year-olds may correlate with decreased ADHD risk in adults.\n\"", "meta_info": "step2&3", "answer_idx": "D", "A": "The patient's family history of psychiatric illness prevents any conclusions from being drawn from the study.", "B": "High-quality afterschool programming for low-income 8-year-olds may correlate with decreased bipolar disorder risk in adults.", "C": "High-quality afterschool programming should be free of charge for low-income children to improve adult mental health.", "D": "High-quality afterschool programming for low-income 8-year-olds may correlate with decreased ADHD risk in adults.\n\"", "language": "en"}
{"question": "Two days after delivery, a 2450-g (5-lb 6-oz) male newborn has three episodes of green vomitus. He has passed urine twice a day, but has not yet passed stool. He was born at 34 weeks' gestation. He appears irritable. His temperature is 37.3°C (99.1°F), pulse is 161/min, respirations are 56/min, and blood pressure is 62/44 mm Hg. Examination shows a distended abdomen; there is diffuse tenderness to palpation over the abdomen. Bowel sounds are decreased. Digital rectal examination is unremarkable. The remainder of the examination shows no abnormalities. An x-ray of the abdomen shows dilated bowel loops. Contrast enema demonstrates inspissated meconium plugs in the distal ileum and microcolon. Which of the following is the child most likely to develop?", "answer": "Infertility", "meta_info": "step2&3", "answer_idx": "A", "A": "Infertility", "B": "Alzheimer's disease", "C": "Asthma", "D": "Necrotizing enterocolitis", "language": "en"}
{"question": "A 6-week-old boy is brought to see his pediatrician. His mother says that he has not been feeding well and forcefully vomited after every feed over the past 4 days. The infant was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccines and is meeting all developmental milestones. However, a week after delivery he developed a respiratory infection involving an aggressive cough followed by a high-pitched intake of breath. Respiratory cultures were positive for a gram-negative coccobacilli for which he received erythromycin. Since then he has remained healthy until now. On examination, the infant’s vitals are normal but he appears lethargic and mildly dehydrated with depressed fontanelles and decreased skin turgor. A firm non-tender mass is palpated in the epigastric region. Which of the following is most likely a cause of this baby’s symptoms?", "answer": "Antibiotic use", "meta_info": "step2&3", "answer_idx": "B", "A": "Deficiency of nitric oxide synthase", "B": "Antibiotic use", "C": "Inadequate myenteric plexus innervation", "D": "Telescoping of the proximal bowel into a distal segment", "language": "en"}
{"question": "A 67-year-old man presents to his primary care physician because he has been feeling increasingly short of breath. Specifically, after retirement he has been going on daily morning walks with his wife; however, over the last year he feels that his endurance has decreased. His medical history is significant for well-controlled hypertension but is otherwise unremarkable. When asked, he reveals that he worked in a variety of industries throughout his life. Testing demonstrates decreased forced vital capacity (FVC) and a normal forced expiratory volume (FEV) to FVC ratio. Pathology demonstrates changes primarily in the upper lobes where macrophages can be seen with dark round ingested particles. Which of the following is most likely associated with the cause of this patient's symptoms?", "answer": "Lung rheumatoid nodules", "meta_info": "step1", "answer_idx": "D", "A": "Increased risk of lung cancer", "B": "Increased risk of tuberculosis", "C": "Mesothelioma", "D": "Lung rheumatoid nodules", "language": "en"}
{"question": "A 75-year-old woman is brought to the emergency department because of vomiting, abdominal pain, and constipation for the past 2 days. She has urinated frequently over the past week and has become excessively thirsty during this time. She has no significant past medical history. She is a 30-pack-year smoker. She appears confused. Her blood pressure is 95/70 mm Hg, pulse is 110/min, respirations are 25/min, and temperature is 37.1°C (98.8°F). She has dry oral mucosa. Lung auscultation shows rhonchi and wheezing localized to the right middle lobe area. An electrocardiogram (ECG) shows a shortened QT interval. A computed tomography scan is shown. Which of the following is the most likely cause of this patient’s recent condition?", "answer": "Squamous cell carcinoma", "meta_info": "step2&3", "answer_idx": "D", "A": "Adenocarcinoma", "B": "Bronchoalveolar carcinoma", "C": "Large-cell carcinoma", "D": "Squamous cell carcinoma", "language": "en"}
{"question": "A 23-year-old woman comes to the physician because of a painless lesion on the arm that first appeared 5 days after she visited a petting zoo. The lesion began as a small papule and then became a blister that has since ulcerated. Her temperature is 38.3°C (101°F). Examination shows a black eschar with edematous borders on the left upper arm. There is axillary lymphadenopathy. The virulence factor responsible for the edema seen in this patient has a mechanism of action similar to which of the following enzymes?", "answer": "Adenylate cyclase", "meta_info": "step1", "answer_idx": "A", "A": "Adenylate cyclase", "B": "Catalase", "C": "Guanylate cyclase", "D": "SNARE protein", "language": "en"}
{"question": "A 54-year-old man with a history of hypertension presents 6 days after being admitted for new-onset atrial fibrillation with the rapid ventricular rate with a painful lesion on his left leg. He says his heart rate has been well-controlled since starting metoprolol and warfarin in the hospital but says he has developed a painful lesion on his left leg. His blood pressure is 114/78 mm Hg, the heart rate is 84/min, and the respiratory rate is 15/min. On physical examination, there is a large, dark lesion on his left leg that feels cold (see image). A genetic defect, in which of the following proteins is most likely responsible for this patient’s condition?", "answer": "Protein C", "meta_info": "step2&3", "answer_idx": "C", "A": "Factor V", "B": "Factor XII", "C": "Protein C", "D": "Factor VIII", "language": "en"}
{"question": "A 35-year-old patient presents to the dermatologist with a new skin rash. The patient has noticed new bumps on her arm over the past 1 month. The bumps are about 0.5 cm in diameter and are filled with a clear fluid. They extend on both arms but are not in her mouth or torso. The lesions do not pop with pressure but remain tense. Her skin does not slough off with rubbing. The patient denies any other symptoms including joint pain or fever. The patient has no other medical history. The patient’s condition is most likely caused by antibodies against which of the following compounds?", "answer": "Hemidesmosomes", "meta_info": "step1", "answer_idx": "B", "A": "Desmoglein", "B": "Hemidesmosomes", "C": "Double-stranded DNA", "D": "U1 ribonucleotide polypeptide", "language": "en"}
{"question": "A 59-year-old woman presents to the emergency department because of shortness of breath. She has been experiencing an increasing inability to breathe following strenuous activity. This includes climbing stairs and walking a few blocks down the street. During the day, her breathing becomes more pronounced when she takes her a nap or lies down to sleep at night. Another concerning symptom is the increased swelling in her legs. She has a history of few episodes of syncope. Her past medical history is otherwise unremarkable. The vital signs include: blood pressure 110/70 mm Hg, pulse 90/min, and respiratory rate 18/min. An electrocardiogram (ECG) shows low voltage. Echocardiography shows granular speckling with concentric thickening of the ventricular walls, more prominently of the right wall. Which of the following confirmatory tests is most appropriate?", "answer": "Biopsy of cardiac tissue", "meta_info": "step2&3", "answer_idx": "B", "A": "Pulmonary function test", "B": "Biopsy of cardiac tissue", "C": "Chest X-ray", "D": "No further testing required", "language": "en"}
{"question": "A 30-year-old previously healthy male presents to your office with complaints of facial pressure and rhinorrhea for the past 3 weeks. The patient reports that several weeks prior, he had a “common cold” which resolved. However, he has since developed worsening facial pressure, especially over his cheeks and forehead. He reports over 1 week of green tinged rhinorrhea. His temperature is 100.1 deg F (37.8 deg C), blood pressure is 120/70 mmHg, pulse is 85/min, and respirations are 15/min. Nasal exam reveals edematous turbinates and purulent discharge. What is the most likely diagnosis?", "answer": "Acute bacterial rhinosinusitis", "meta_info": "step2&3", "answer_idx": "B", "A": "Acute viral rhinosinusitis", "B": "Acute bacterial rhinosinusitis", "C": "Allergic rhinitis", "D": "Chronic rhinosinusitis", "language": "en"}
{"question": "A 25-year-old man is brought to the emergency department 30 minutes after he was involved in a motorcycle collision. Physical examination shows a deep laceration on the volar surface of the distal left forearm. Neurological examination shows loss of abduction and opposition of the left thumb. The radial and ulnar pulses are palpable. Based on these findings, which of the following nerves is most likely injured in this patient?", "answer": "Median nerve", "meta_info": "step1", "answer_idx": "C", "A": "Posterior interosseous nerve", "B": "Axillary nerve", "C": "Median nerve", "D": "Ulnar nerve", "language": "en"}
{"question": "A 70-year-old man presents to the emergency department after several episodes of bloody stools that started 6 hours ago. The patient denies nausea, vomiting, or diarrhea. On examination, he is pale and cachectic. The patient’s abdomen is nontender to palpation on the exam. His heart rate is 120/min and blood pressure is 80/60 mm Hg. A stool sample from the patient shows stools with bright red blood, and a hemoccult test is positive. Which of the following is the most likely location of his intestinal bleeding?", "answer": "Sigmoid colon", "meta_info": "step1", "answer_idx": "B", "A": "Ascending colon", "B": "Sigmoid colon", "C": "Stomach", "D": "Ileum", "language": "en"}
{"question": "A 48-year-old man comes to the physician because of a 4-month history of persistent cough productive of white phlegm. He coughs consistently throughout the day, and he has not noticed any particular triggers that make it worse. He has also recently experienced some shortness of breath with exertion. He has not had any weight loss, fever, or chills. He had similar symptoms last year, which lasted about 6 months. He has hypertension, for which he takes amlodipine. He has worked in construction for the past 10 years. He has smoked a pack of cigarettes per day for 30 years. Vital signs are within normal limits. Examination shows an end-expiratory wheeze throughout all lung zones. Which of the following is the most likely diagnosis?", "answer": "Chronic bronchitis", "meta_info": "step2&3", "answer_idx": "D", "A": "Asbestosis", "B": "Hypersensitivity pneumonitis", "C": "Asthma", "D": "Chronic bronchitis", "language": "en"}
{"question": "A 26-year-old female with no significant past medical history presents to the emergency department complaining of chest pain. She states that she was visiting her boyfriend in the hospital and, approximately 10 minutes ago, she developed chest pain associated with sweating, palpitations, nausea, and chills. She appears very nervous and states that she is scared that she is dying. Vital signs reveal tachycardia, hypertension, and tachypnea. An EKG is obtained that is unremarkable besides tachycardia. TSH and free T4 are within normal limits. A urine drug screen is obtained and it is negative. What is the best immediate treatment for this patient?", "answer": "Alprazolam, reassurance, encouraging patient to slow breathing", "meta_info": "step2&3", "answer_idx": "B", "A": "Morphine, oxygen, nitrogylcerin, aspirin, beta blockers, ACE inhibitor, and heparin", "B": "Alprazolam, reassurance, encouraging patient to slow breathing", "C": "Albuterol breathing treatment", "D": "Cognitive behavioral therapy", "language": "en"}
{"question": "A 36-year-old woman is brought to the emergency department by her sister 1 hour after she was found unconscious at home. She appears lethargic. Her temperature is 37°C (98.6°F), pulse is 80/min, respirations are 5/min, and blood pressure is 120/70 mm Hg. Urine toxicology screening is positive for alcohol, benzodiazepines, and barbiturates. The patient's condition improves with supportive treatment, and she is admitted for psychiatric evaluation. Three days later, a physician colleague approaches the physician who treated the patient in the lobby of the hospital and states, “I just want to know what happened. I'm her neighbor and childhood friend, and I'm worried about her.” Which of the following responses by the treating physician is the most appropriate?", "answer": "\"\"\"I understand your concern, but I am unable to provide information about this situation.\"\"\"", "meta_info": "step2&3", "answer_idx": "D", "A": "\"\"\"Why don't you go ahead and ask her directly? She is currently in the psychiatric ward.\"\"\"", "B": "\"\"\"Her urine toxicology screening was positive for alcohol, benzodiazepines, and barbiturates.\"\"\"", "C": "\"\"\"I'm not the right person to ask. Please ask her primary care physician.\"\"\"", "D": "\"\"\"I understand your concern, but I am unable to provide information about this situation.\"\"\"", "language": "en"}
{"question": "A 40-year-old man presents to a clinic for a regular follow-up. He was diagnosed with Wilson’s disease 20 years ago and underwent a human leukocyte antigen–matched liver transplant 15 years ago. Today he is feeling fine and has no complaints except for a new, mild jaundice that his wife noticed a few weeks ago. He denies any changes in stool or urine color and is not having any abdominal pain. On physical examination, his vital signs are within normal limits, and only mild scleral icterus is noticed. Which of the following best describes the mechanism of rejection that happened in this patient?", "answer": "Donor allogeneic MHC molecules are taken up by recipient APCs and processed into peptides, and then the peptides are presented by recipient MHC molecules to recipient T cells.", "meta_info": "step1", "answer_idx": "C", "A": "Donor allogeneic MHC molecules are taken up by recipient APCs and processed into peptides, and then the peptides are presented by recipient MHC molecules to donor T cells.", "B": "Donor allogeneic MHC molecules are taken up by donor APCs and processed into peptides, and then the peptides are presented by unprocessed donor allogeneic MHC molecules to recipient T cells.", "C": "Donor allogeneic MHC molecules are taken up by recipient APCs and processed into peptides, and then the peptides are presented by recipient MHC molecules to recipient T cells.", "D": "Recipient MHC molecules are taken up by donor APCs and processed into peptides, and then the peptides are presented by donor allogeneic MHC molecules to recipient T cells.", "language": "en"}
{"question": "A 6-year-old boy is brought to his pediatrician due to increased shortness of breath. His mother is particularly disturbed because her son wakes up breathless one or 2 nights every week. He was diagnosed with asthma 2 years ago. Over the past few months, he has not been able to participate in any sport and is also using his inhaler more than 3 times a week. On examination, the patient appears to be in slight distress and seems pale and fatigued. There are slight expiratory wheezes and crackles in both lungs. The pediatrician starts him on a low dose of another inhaler which needs to be taken once daily. She asks his mother to avoid any conditions that might aggravate her son’s symptoms and make it difficult for him to breathe. Three months later, the mother is back with her son at the same pediatrician’s office. She is concerned about a painless white plaque on his tongue. When the physician scrapes the lesion it reveals a red base with minimal bleeding. A photograph of the lesion is shown. Which of the following was most likely prescribed during the previous visit?", "answer": "Inhaled beclomethasone", "meta_info": "step2&3", "answer_idx": "A", "A": "Inhaled beclomethasone", "B": "Inhaled ipratropium bromide", "C": "Nebulized theophylline", "D": "Inhaled salmeterol", "language": "en"}
{"question": "A 25-year-old medical student enrolls in an exercise research study. Spirometry testing, along with arterial and venous blood gases, are performed immediately before and after 15 minutes of exercising on a stationary bicycle. How do you expect the venous pH, arterial pCO2, and venous pCO2 to respond?", "answer": "Venous pH decreases, arterial pCO2 stays the same, venous pCO2 increases", "meta_info": "step1", "answer_idx": "D", "A": "Venous pH decreases, arterial pCO2 decreases, venous pCO2 decreases", "B": "Venous pH increases, arterial pCO2 decreases, venous pCO2 increases", "C": "Venous pH increases, arterial pCO2 increases, venous pCO2 increases", "D": "Venous pH decreases, arterial pCO2 stays the same, venous pCO2 increases", "language": "en"}
{"question": "A 38-year-old imprisoned man is brought to the physician after going on a hunger strike for 36 hours. During this time, he has only had two cups of water. Physical examination shows dry mucous membranes. His serum glucose concentration is 70 mg/dL. Which of the following enzymes contributes most to maintaining a normal serum glucose level in this patient?", "answer": "Phosphoenolpyruvate carboxykinase", "meta_info": "step1", "answer_idx": "A", "A": "Phosphoenolpyruvate carboxykinase", "B": "Hydroxymethylglutaryl-CoA lyase", "C": "Glycogen phosphorylase", "D": "Phosphofructokinase-1", "language": "en"}
{"question": "A 27-year-old man presents to the emergency department with a chief concern of abdominal pain and diarrhea. The patient states that for the past 4 days he has experienced abdominal pain, diarrhea, weakness and a subjective fever. He also endorses a weight loss of 11 pounds during this time. The patient has a past medical history of celiac disease, constipation, and depression. His current medications include fish oil, a multivitamin, sodium docusate, and fluoxetine. His temperature is 98.5°F (36.9°C), blood pressure is 110/75 mmHg, pulse is 90/min, respirations are 13/min, and oxygen saturation is 98% on room air. Physical exam is notable for a young man in mild distress. Cardiac and pulmonary exams are within normal limits. Abdominal exam is notable for generalized tenderness and increased bowel sounds. Oral exam is notable for multiple shallow painful ulcers. Laboratory values are ordered as seen below:\n\nHemoglobin: 12 g/dL\nHematocrit: 36%\nLeukocyte count: 8,000 cells/mm^3 with normal differential\nPlatelet count: 227,500/mm^3\n\nSerum:\nNa+: 141 mEq/L\nCl-: 101 mEq/L\nK+: 4.5 mEq/L\nHCO3-: 24 mEq/L\nBUN: 17 mg/dL\nGlucose: 82 mg/dL\nCreatinine: 1.0 mg/dL\nCa2+: 10.1 mg/dL\nAST: 12 U/L\nALT: 11 U/L\n\nA stool guaiac test is performed which returns positive. The patient is started on IV fluids and morphine. Which of the following best describes the most likely diagnosis?", "answer": "ASCA positivity", "meta_info": "step2&3", "answer_idx": "B", "A": "ANCA positivity", "B": "ASCA positivity", "C": "Dilated vascular structure in the anal canal", "D": "Mucosal disruption", "language": "en"}
{"question": "A previously healthy 31-year-old man is rushed to the emergency department after an all-night binge that included smoking, alcohol, and cocaine. He complains of chest fluttering, fatigue, and lightheadedness. His past medical and family history are noncontributory. Social history is positive for occasional smoking and social drinking. At the hospital, the blood pressure is 110/70 mm Hg and the heart rate of 160/min and regular. The electrocardiogram (ECG) is shown. A physical maneuver involving massage of the neck is attempted without improvement. The patient is given the appropriate medication that improves his heart rate and returns his ECG to normal. Which of the following is the mechanism of action of the medication?", "answer": "Slowing of the atrioventricular (AV) node conduction time", "meta_info": "step2&3", "answer_idx": "B", "A": "Gamma-aminobutyric acid receptor agonist", "B": "Slowing of the atrioventricular (AV) node conduction time", "C": "Blocking of sodium/potassium adenosine triphosphatase pump", "D": "Prolongation of repolarization phase of cardiac action potential", "language": "en"}
{"question": "A scientist is studying how animals regulate their blood pressure in response to various stimuli. In particular, she is interested in how much a novel compound that binds to both alpha-1 and beta-1 adrenergic receptors will affect blood pressure. She studies this question in non-human primates, but finds that her results are confounded by the fact that the animals' heart rates start to decrease several minutes after administration of this novel compound. She therefore decides to pretreat these animals with a drug that is known to prevent this decrease in heart rate. Which of the following drugs would most likely achieve the desired effect?", "answer": "Hexamethonium", "meta_info": "step1", "answer_idx": "B", "A": "Dobutamine", "B": "Hexamethonium", "C": "Metoprolol", "D": "Scopolamine", "language": "en"}
{"question": "A hepatologist has learned about the survival benefit of Noxbinle (tumorolimus) in hepatocellular carcinoma (HCC) patients from a fellow physician. She is looking at a list of HCC patients on her hospital's hepatology consult service and trying to identify candidates who might derive more survival benefits from Noxbinle as opposed to Metalimus. Based on the information provided in the drug advertisement, which of the following patients with HCC would be an appropriate treatment candidate and benefit the most from treatment with Noxbinle 100 mg in comparison to Metalimus 100 mg?", "answer": "Patient with severe cirrhosis, history of hepatitis C, and asthma", "meta_info": "step2&3", "answer_idx": "D", "A": "Non-cirrhotic patient with a history of hepatitis B and alcohol dependence", "B": "Alcoholic patient with severe cirrhosis on immunosuppressive therapy", "C": "Patient with severe cirrhosis, history of hepatitis C, and kidney stones", "D": "Patient with severe cirrhosis, history of hepatitis C, and asthma", "language": "en"}
{"question": "An error occurs during the embryologic development of the kidney. It is found that the fetus lacks proper ureters, major and minor calyces, and renal pelvises. In this fetus, what other renal structure would be expected to be absent?", "answer": "Collecting ducts", "meta_info": "step1", "answer_idx": "A", "A": "Collecting ducts", "B": "Ductus deferens", "C": "Distal convoluted tubule", "D": "Bowman's capsule", "language": "en"}
{"question": "An investigator is studying the effects of tissue hypoxia on skeletal muscles. Skeletal muscle hypoxia is induced by decreasing oxygen delivery to peripheral tissues. Which of the following is most likely to achieve this desired effect?", "answer": "Decrease the serum 2,3-bisphosphoglycerate concentration", "meta_info": "step1", "answer_idx": "A", "A": "Decrease the serum 2,3-bisphosphoglycerate concentration", "B": "Increase the serum hydrogen ion concentration", "C": "Increase the arterial partial pressure of carbon dioxide", "D": "Increase the serum temperature", "language": "en"}
{"question": "A 48-year-old woman presents to the doctor’s office complaining of frequent episodes of severe heartburn and chest pain. It feels like food is getting stuck in her throat somewhere. She wakes up at night in fits of coughing and in pain. Antacids and other over the counter remedies do not improve the discomfort. The physician feels that the patient has acid reflux and recommends upper gastrointestinal endoscopy and a trial of omeprazole. Several biopsies are taken during the endoscopy: one from the distal esophagus, one from the gastroesophageal junction, and one from the body of the stomach. Which histological finding would place her at the highest risk of developing esophageal adenocarcinoma in the near future?", "answer": "The presence of high grade dysplasia at the Z line", "meta_info": "step1", "answer_idx": "D", "A": "The presence of inflammatory cells in the body of the stomach", "B": "The presence of metaplasia at the Z line", "C": "The presence of goblet cells at the Z line", "D": "The presence of high grade dysplasia at the Z line", "language": "en"}
{"question": "A 26-year-old man comes to the physician because of a 3-week history of malaise and recurrent fever. He has also had a 4.5-kg (10-lb) weight loss over the past 3 months. He came back from his honeymoon in Kenya 6 months ago. He appears ill. His temperature is 39°C (102.2°F). He is alert and oriented to person, time, and place. Physical examination shows generalized lymphadenopathy and hepatosplenomegaly. Laboratory studies show a hemoglobin concentration of 9.1 g/dL, leukocyte count of 2,900/mm3, and platelet count of 108,000/mm3. Which of the following is the most likely vector of this patient's condition?", "answer": "Sand fly", "meta_info": "step1", "answer_idx": "B", "A": "Tsetse fly", "B": "Sand fly", "C": "Freshwater snail", "D": "Anopheles mosquito", "language": "en"}
{"question": "A 68-year-old Caucasian male presents to your office complaining of urinary hesitancy and decreased urinary flow. His blood pressure is measured to be 168/95. You prescribe prazosin. Which best describes the principal action(s) of prazosin?", "answer": "Relaxation of urinary sphincter and reduction of peripheral vascular resistance", "meta_info": "step1", "answer_idx": "A", "A": "Relaxation of urinary sphincter and reduction of peripheral vascular resistance", "B": "Relaxation of urinary sphincter and suppression of renin release", "C": "Contraction of urinary bladder wall smooth muscle and suppression of renin release", "D": "Contraction of urinary bladder wall smooth muscle and reduction of peripheral vascular resistance", "language": "en"}
{"question": "A 4-year-old boy is referred to the infectious disease clinic for recurrent pneumonia. Although he has had several previous hospital admissions and received multiple courses of antibiotic therapy, he continues to get sick. On his most recent hospital admission, the boy presented with mild fever, right-sided chest pain, and yellow-colored sputum. He had difficulty breathing and diminished breath sounds on the right side of the chest. A CT scan of the thorax revealed multiple right-sided ground-glass opacities. Sputum cultures grew Aspergillus galactomannan. The boy’s medical history is significant for neonatal sepsis and recurrent episodes of pyoderma and otitis media. His younger brother had recurrent purulent skin infections before he died of an otogenic brain abscess at the age of 2. His mother says that skin infections are common in the male members of her family. The patient’s HIV status is negative and his complete blood count, T cell and B cell counts, immunoglobulin profile, and complement tests are within normal limits. Which of the following is the next best step in the management of this patient?", "answer": "Dihydrorhodamine (DHR) test", "meta_info": "step1", "answer_idx": "C", "A": "CD4+ cell count", "B": "Bone marrow biopsy", "C": "Dihydrorhodamine (DHR) test", "D": "Adenosine deaminase levels", "language": "en"}
{"question": "A 72-year-old man is being transported by emergency medical services to the emergency department for a stroke code. He was found on the ground by his daughter earlier today, and he was last known to be without neurological deficits two hours prior to presentation. His temperature is 99°F (37.2°C), blood pressure is 185/105 mmHg, pulse is 102/min, and respirations are 18/min. A non-contrast head CT is performed, which demonstrates a hypodense lesion affecting the left medial frontal and parietal lobe. Which of the following will most likely be found on physical exam?", "answer": "Contralateral lower extremity weakness", "meta_info": "step1", "answer_idx": "B", "A": "Contralateral hemiparesis", "B": "Contralateral lower extremity weakness", "C": "Hemineglect", "D": "Wernicke aphasia", "language": "en"}
{"question": "A 33-year-old G1P0 at 39 weeks gestation is admitted to the labor and delivery floor for induction of labor. She feels well and is no acute distress. She is accompanied by her husband. Her past medical history is notable for major depressive disorder and generalized anxiety disorder. She takes sertraline. Her temperature is 99.2°F (37.3°C), blood pressure is 120/75 mmHg, pulse is 95/min, and respirations are 18/min. To initiate labor induction, the obstetrician injects the patient with a hormone that is endogenously made in the hypothalamus and released by the posterior pituitary. This medication is associated with an increased risk of which of the following complications?", "answer": "Placental abruption", "meta_info": "step1", "answer_idx": "A", "A": "Placental abruption", "B": "Vasa previa", "C": "Placenta accreta", "D": "Preeclampsia", "language": "en"}
{"question": "A 57-year-old Caucasian male presents to your office with heart palpitations and shortness of breath. On exam, he is tachycardic and his rhythm is irregularly irregular. He fails standard pharmacologic therapy and you refer to cardiology, where he is started on an antiarrhythmic medication. The action of this agent results in a longer action potential duration, an increased effective refractory period, and a longer QT interval. Which drug has been prescribed?", "answer": "Sotalol", "meta_info": "step1", "answer_idx": "D", "A": "Flecanide", "B": "Mexiletine", "C": "Diltiazem", "D": "Sotalol", "language": "en"}
{"question": "A 2-year-old girl is brought to the physician because of abdominal distention and twitching of her feet, which her mother noticed a week ago. The patient has also had a low-grade fever for 5 days. She has not had a bowel movement in 3 days. She was born at term and has been healthy since. She is at the 40th percentile for height and 20th percentile for weight. Her temperature is 38.1°C (100.6°F), pulse is 128/min, and blood pressure is 135/82 mm Hg. Examination shows an irregular palpable mass that crosses the midline of the abdomen. The liver is palpated 3 cm below the right costal margin. There are erratic movements of the eyes. A 24-hour urine collection shows elevated homovanillic acid and vanillylmandelic acid levels. Which of the following is the most likely diagnosis?", "answer": "Neuroblastoma", "meta_info": "step2&3", "answer_idx": "D", "A": "Hodgkin lymphoma", "B": "Hepatoblastoma", "C": "Nephroblastoma", "D": "Neuroblastoma", "language": "en"}
{"question": "A 53-year-old man is brought to the emergency department by his wife after the sudden onset of dizziness, nausea, and left-sided weakness. His blood pressure is 165/95 mm Hg. Neurological examination shows decreased muscle tone and hyperreflexia in the right upper and lower extremities. His gait is unsteady, and he falls to the left when attempting to walk. Finger-to-nose testing shows dysmetria on the left side. A CT scan of the head shows a small lesion in the left lateral pons that involves the nucleus of a cranial nerve that exits the brain at the middle cerebellar peduncle. Which of the following additional findings is most likely in this patient?", "answer": "Difficulty chewing and deviation of the jaw to the left", "meta_info": "step1", "answer_idx": "C", "A": "Ptosis and inability to look up with the right eye", "B": "Winging of the left scapula and weakness turning the head to the right", "C": "Difficulty chewing and deviation of the jaw to the left", "D": "Inability to smell vanilla or coffee", "language": "en"}
{"question": "A 38-year-old African American female presents to her primary care physician with uveitis, cough, and arthralgias in her ankles and legs. Bloodwork reveals elevated angiotensin converting enzyme levels, and skin PPD testing shows no observable induration after 48 hours. The patient demonstrates reduced FEV1 and FVC upon spirometry. FEV1/FVC is 85%. Which of the following would you expect to see upon chest X-ray:", "answer": "Enlarged hilar lymph nodes", "meta_info": "step1", "answer_idx": "A", "A": "Enlarged hilar lymph nodes", "B": "Kerley B Lines", "C": "Bilateral diaphragmatic elevation.", "D": "Fluid in alveolar walls", "language": "en"}
{"question": "A previously healthy 41-year-old man comes to the physician for evaluation of a 1-month history of painless, intermittent bleeding on defecation, which he discovered while wiping. His younger sister was recently diagnosed with endometrial cancer, and his mother was diagnosed with gastric cancer at 58 years of age. Physical examination shows no abnormalities. Test of the stool for occult blood is positive. Colonoscopy shows a tumor in the ascending colon. Histopathologic examination of the tumor shows a mucinous, poorly-differentiated adenocarcinoma. A mutation of which of the following genes is most likely responsible for this patient's condition?", "answer": "MLH1", "meta_info": "step1", "answer_idx": "A", "A": "MLH1", "B": "TP53", "C": "DCC", "D": "KRAS", "language": "en"}
{"question": "A 49-year-old woman presents to her pulmonologist for a follow-up visit. She reports a longstanding history of chronic dyspnea and fatigue. Her past medical history is notable for asthma. She has a known mutation in the BMPR2 gene. She was recently trialed on nifedipine but stopped due to severe lower extremity edema. She does not smoke and does not drink alcohol. Her temperature is 99.4°F (37.4°C), blood pressure is 135/80 mmHg, pulse is 80/min, and respirations are 20/min. Physical examination reveals an increased P2 on cardiac auscultation. Her physician recommends starting a medication to slow the patient’s clinical worsening that requires regular monitoring of liver function tests. This medication has which of the following mechanisms of action?", "answer": "Endothelin-1 receptor antagonist", "meta_info": "step1", "answer_idx": "A", "A": "Endothelin-1 receptor antagonist", "B": "Beta-2-adrenergic receptor agonist", "C": "Phospholipase A2 antagonist", "D": "Phosphodiesterase type 5 antagonist", "language": "en"}
{"question": "A 14-year-old girl is brought to the physician by her mother for the evaluation of recurrent episodes of nose bleeding for several months. The episodes occur unexpectedly and stop after a few minutes by elevating the upper body and bending the head forward. Menses occur at regular 27-day intervals with heavy flow. Her last menstrual period was 3 weeks ago. Vital signs are within normal limits. Physical examination shows no abnormalities. Laboratory studies show:\nHemoglobin 11 g/dL\nHematocrit 34%\nLeukocyte count 7,000/mm3\nPlatelet count 180,000/mm3\nProthrombin time 13 sec\nPartial thromboplastin time 45 sec\nFibrin split products negative\nThe bleeding time is 10 minutes. Which of the following is the most appropriate next step in treatment?\"", "answer": "Desmopressin", "meta_info": "step2&3", "answer_idx": "D", "A": "Oral prednisone", "B": "Intravenous immunoglobulins", "C": "Tranexamic acid", "D": "Desmopressin", "language": "en"}
{"question": "A 29-year-old G3P2 undergoes a cesarean section at 38 weeks gestation and delivers a boy weighing 4570 g with Apgar scores of 5 and 8 at 1 and 5 minutes, respectively. The current pregnancy was complicated by gestational diabetes with poor glycemic control. The newborn’s heart rate is 122/min, the respiratory rate is 31/min, and the temperature 36.4℃ (97.5℉). On examination, the newborn is pale, lethargic, diaphoretic, and has poor muscular tone. The liver is 2 cm below the right costal margin. Which of the following is the most probable cause of the newborn’s condition?", "answer": "Hyperinsulinemia", "meta_info": "step2&3", "answer_idx": "B", "A": "Microangiopathy", "B": "Hyperinsulinemia", "C": "Hyperglycemia", "D": "Polycythemia", "language": "en"}
{"question": "A 19-year-old woman is brought to the emergency department by ambulance after experiencing a first-time seizure. She as preparing for an exam at her college’s library, in her normal state of health and collapsed. When she regained consciousness she was surrounded by students and staff. The emergency personnel assessed her condition and brought her in. Past medical history is significant for major depressive disorder. Her primary care physician prescribed a medication for her depression, but she has not taken it for several days because she was concerned about weight gain. Family medical history is insignificant for neurological disorders. Instead, for the past 10 days, she has been taking her roommate’s antidepressant medication instead. Today her blood pressure is 100/80 mm Hg, pulse 102/min, respirations 12/min and he BMI is 15 kg/m2. Physical examination reveals pale and dry mucosa and conjunctiva, and lanugo on her arms and legs. What medication is the patient most likely taking?", "answer": "Bupropion", "meta_info": "step1", "answer_idx": "A", "A": "Bupropion", "B": "Gabapentin", "C": "Selegiline", "D": "Amitriptyline", "language": "en"}
{"question": "A 59-year-old man with long-standing hypertension is brought to the emergency department because of vomiting and headache for 2 hours. He reports that he has been unable to refill the prescription for his antihypertensive medications. His blood pressure is 210/120 mm Hg. Fundoscopy shows bilateral optic disc swelling. An ECG shows left ventricular hypertrophy. Treatment with intravenous fenoldopam is begun. Which of the following intracellular changes is most likely to occur in renal vascular smooth muscle as a result of this drug?", "answer": "Increased production of cyclic adenosine monophosphate", "meta_info": "step1", "answer_idx": "C", "A": "Increased activity of protein kinase C", "B": "Increased activity of guanylate cyclase", "C": "Increased production of cyclic adenosine monophosphate", "D": "Increased intracellular concentration of calcium", "language": "en"}
{"question": "A 4-year-old boy is referred to the transfusion clinic with malaise, fever, bilateral conjunctivitis, erythema of the oral mucosa, macular rash of the trunk, and inguinal lymphadenopathy following several days of loose stool. The boy was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccines and is meeting all developmental milestones. Kawasaki’s disease is suspected and therapy with intravenous immunoglobulin and aspirin is initiated. Later that day, the patient develops trouble breathing, facial flushing, and rapidly evolving pruritic abdominal rash. He is rushed to the emergency department where his blood pressure is 85/48 mm Hg, heart rate is 120/min, respiratory rate is 26/min, and temperature is 37.0°C (98.6°F). On physical examination, the patient has severe facial edema and severe stridor, which can be heard without a stethoscope. A complete blood count is normal. Of the following options, which underlying condition could cause this reaction?", "answer": "IgA deficiency", "meta_info": "step2&3", "answer_idx": "B", "A": "Bruton's agammaglobulinemia", "B": "IgA deficiency", "C": "Hyper-IgM syndrome", "D": "Hyper-IgD syndrome", "language": "en"}
{"question": "A 19-year-old man presents to the physician due to progressively worsening weakness. He also notes that he has been getting tired easily and frequently feels short of breath. Additionally, he notes a protuberant belly that he cannot seem to reduce with diet and exercise. His past medical history is significant for easy bruising since he was very young, requiring at least one transfusion when he was younger. He takes no medications. His blood pressure is 125/92 mm Hg, pulse is 90/min, respiratory rate 12/min, and temperature is 36.6°C (97.9°F). Physical examination reveals hepatomegaly and splenomegaly. Several bruises can be seen on the inside of his arms and legs. Laboratory testing shows:\nHematocrit 23%\nErythrocyte count 2.2 million/mm3\nThrombocyte count  25,000/mm3\nA bone marrow biopsy shows decreased trilineage hematopoiesis and macrophages with a crinkled tissue-paper appearance. What is the mode of inheritance for this patient's disease?", "answer": "Autosomal recessive", "meta_info": "step1", "answer_idx": "C", "A": "Autosomal dominant", "B": "X-linked recessive", "C": "Autosomal recessive", "D": "X-linked dominant", "language": "en"}
{"question": "A 1-day-old boy is brought to the emergency room by his parents for difficulty breathing. He was delivered at home via vaginal birth with no complications. The mom received minimal prenatal care as she wanted the most natural process for her child. The mom reports that he has been relatively healthy expect for when he feeds he gets a little fussy. However, these episodes self-resolve after he curls up his legs. A physical examination demonstrates a baby in acute distress with subcostal retractions and cyanosis at the distal extremities. A 5/6 systolic ejection murmur is heard at the left upper sternal border. What is the best next step in terms of managing this patient?", "answer": "Give prostaglandin E1", "meta_info": "step1", "answer_idx": "B", "A": "Administer warming blankets", "B": "Give prostaglandin E1", "C": "Immediate surgical repair", "D": "Obtain lumbar puncture for CSF analysis", "language": "en"}
{"question": "A 40-year-old woman schedules an appointment for a routine medical check-up. She admits to being careless about her health, but is motivated to improve. She is working with a personal trainer at the gym and is following a weight reduction diet plan. Despite a 20 kg (44 lb) weight loss over the last year, she still feels that she is fat. She was a frequent binge drinker, but now she has reduced her alcohol consumption to a single glass of wine with dinner and an occasional beer on the weekend. She also has a 15 pack-year smoking history, but quit 6 months ago after she developed a cough and shortness of breath that later improved. She admits to trying various recreational drugs in the past. On her last visit, she was started on rosuvastatin for an elevated cholesterol level. She is sexually active with her partner and they have 2 children. She is uncertain about her family history as she was raised in foster care. The vital signs include: pulse 80/min, respirations 16/min, and blood pressure 122/80 mm Hg. The physical examination reveals a visibly overweight woman with a body mass index (BMI) of 34 kg/m2. The remainder of the examination yields no significant findings. An electrocardiogram (ECG) and chest X-ray are both normal. Lab tests show the following:\nSerum glucose (fasting) 95 mg/dL\n    Serum electrolytes:\nSodium 140 mEq/L\nPotassium 3.8 mEq/L\nChloride 101 mEq/L\nSerum creatinine 0.8 mg/dL\nBlood urea nitrogen 10 mg/dL\nCholesterol, total 180 mg/dL\nHDL-cholesterol 42 mg/dL\nLDL-cholesterol 70 mg/dL\nTriglycerides 365 mg/dL\n    Urinalysis:  \nGlucose negative\nKetones negative\nLeucocytes negative\nNitrites negative\nRBC negative\nCasts negative\nWhich medication would most likely further improve her lipid profile?", "answer": "Fenofibrate", "meta_info": "step1", "answer_idx": "C", "A": "Niacin", "B": "Orlistat", "C": "Fenofibrate", "D": "Ezetimibe", "language": "en"}
{"question": "A 59-year-old man presents to the emergency department with abdominal pain. He states that it seemed to come on abruptly, though he does endorse feeling pain the past several days. He has been experiencing bloody diarrhea as well as a subjective fever. His past medical history is notable for an ST elevation myocardial infarction (STEMI) treated 1 year ago, an abdominal aortic aneurysm (AAA) treated 1 week ago, chronic obstructive pulmonary disease (COPD), asthma, obesity, hypertension, stroke treated 5 years ago, an atrial arrhythmia, diabetes, constipation, and post-traumatic stress disorder (PTSD). His temperature is 102.0°F (39°C), blood pressure is 197/128 mmHg, pulse is 135/min, respirations are 22/min, and oxygen saturation is 92% on room air. On physical exam, you note an obese man in distress. Cardiopulmonary exam is notable for bilateral wheezes and a systolic murmur. There is bilateral lower extremity pitting edema and venous stasis ulcers. Abdominal exam reveals diffuse tenderness which the patient describes as 10/10 in severity. Laboratory values are ordered as seen below.\n\nHemoglobin: 14 g/dL\nHematocrit: 42%\nLeukocyte count: 15,500/mm^3 with normal differential\nPlatelet count: 199,000/mm^3\n\nSerum:\nNa+: 139 mEq/L\nCl-: 100 mEq/L\nK+: 4.4 mEq/L\nHCO3-: 22 mEq/L\nBUN: 32 mg/dL\nGlucose: 189 mg/dL\nCreatinine: 1.9 mg/dL\nCa2+: 10.2 mg/dL\nLactate: 4.5 mg/dL\nAST: 12 U/L\nALT: 10 U/L\n\nWhich of the following is the most likely explanation for this patient's presentation?", "answer": "Abdominal aortic aneurysm repair complication", "meta_info": "step2&3", "answer_idx": "A", "A": "Abdominal aortic aneurysm repair complication", "B": "Atrial fibrillation", "C": "Obstruction of the small bowel", "D": "Ruptured appendix", "language": "en"}
{"question": "An investigator is studying an experimental treatment for HIV infection that inhibits the maturation of new HIV virions. Patients who are taking the drug are observed for several years and side effects are recorded. A correlation is established between the drug and the development of impaired glucose tolerance. In addition, a significant portion of the patients who take the drug for several years shows increased fat accumulation in the neck with loss of subcutaneous fat in the face and extremities. Which of the following processes is most likely targeted by this drug?", "answer": "Viral polypeptide cleavage", "meta_info": "step1", "answer_idx": "B", "A": "Viral entry into host cell", "B": "Viral polypeptide cleavage", "C": "Viral budding from host cells", "D": "Reverse transcription of viral RNA", "language": "en"}
{"question": "A 30-year-old G1P1 woman gives birth to a healthy infant at 39 weeks gestation. The mother attended all her prenatal visits and took all her appropriate prenatal vitamins. Her past medical history is notable for diabetes mellitus, for which she takes metformin. Apgar scores were 8 and 9 at 1 and 5 minutes, respectively. The infant's temperature is 99.2°F (37.3°C), blood pressure is 65/40 mmHg, pulse is 110/min, and respirations are 22/min. On exam, the child has ambiguous genitalia. A karyotype analysis demonstrates the presence of a Y chromosome. Further workup reveals internal testes with normal levels of serum luteinizing hormone and testosterone. Which of the following additional findings would most likely be seen in this patient?", "answer": "Testosterone-to-dihydrotestosterone ratio > 20", "meta_info": "step1", "answer_idx": "D", "A": "Decreased androgen receptor responsiveness", "B": "Impaired sense of smell", "C": "Long extremities", "D": "Testosterone-to-dihydrotestosterone ratio > 20", "language": "en"}
{"question": "An investigator is studying the pharmacokinetic properties of two novel inhalational anesthetics and reports the following findings.\nBlood-gas partition coefficient Minimum alveolar concentration\nDrug A 0.42 3.20%\nDrug B 2.31 7.45%\nWhich of the following statements best describes the properties of drug A when compared to drug B?\"", "answer": "More lipid-soluble and faster recovery from anesthesia", "meta_info": "step1", "answer_idx": "C", "A": "More blood soluble and faster induction of anesthesia", "B": "More potent and slower recovery from anesthesia", "C": "More lipid-soluble and faster recovery from anesthesia", "D": "Less potent and faster induction of anesthesia", "language": "en"}
{"question": "A 56-year-old man presents to an initial visit to his primary care physician complaining of excessive fatigue, weight loss, and increased abdominal girth. He drinks about 2–4 glasses of wine with dinner and recalls having abnormal liver enzymes in the past. He has a remote history of intravenous drug use. Physical examination reveals shifting dullness, firm liver, and splenomegaly. The skin lesion in this photo is present in on the face, arms, and upper trunk of the patient. Which of the following best describes the mechanism of development of these skin lesions in this patient?", "answer": "Hormonal imbalance", "meta_info": "step2&3", "answer_idx": "B", "A": "Anastomoses between portal vein tributaries and the arterial system", "B": "Hormonal imbalance", "C": "Coagulation defects", "D": "Increase in serum ammonia", "language": "en"}
{"question": "A 44-year-old man presents to the emergency department due to sudden chest pain and difficulty breathing for the past 3 hours. The pain is felt in the retrosternal area and radiates up to his left shoulder and arm; it worsens on inspiration, and is relieved when he is leaning forward. His heart rate is 61/min, respiratory rate is 16/min, temperature is 36.5°C (97.7°F), and blood pressure is 115/78 mm Hg. Physical examination shows no abnormalities. Pericardial friction rub is heard on auscultation. Laboratory results show elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels. An ECG is performed. Which of the following is the most likely diagnosis?", "answer": "Acute pericarditis", "meta_info": "step1", "answer_idx": "A", "A": "Acute pericarditis", "B": "Aortic stenosis", "C": "Infective endocarditis", "D": "Myocardial infarction", "language": "en"}
{"question": "A 27-year-old woman comes to the physician because of a rash and headache. She recently returned from a camping trip in North Carolina. She has a severe allergy to doxycycline. Her temperature is 38.2°C (100.8°F). Physical examination shows a blanching erythematous rash and petechiae over both ankles and the soles of her feet. A drug is prescribed that can cause fatal aplastic anemia. The bacteriostatic effect of this drug is most likely due to which of the following mechanisms?", "answer": "Inactivation of bacterial peptidyltransferase at the 50S ribosomal subunit", "meta_info": "step1", "answer_idx": "D", "A": "Inhibition of initiation complex formation at the 30S ribosomal subunit", "B": "Inactivation of prokaryotic topoisomerase II and IV", "C": "Inhibition of tRNA binding site at the 30S ribosomal subunit", "D": "Inactivation of bacterial peptidyltransferase at the 50S ribosomal subunit", "language": "en"}
{"question": "The research of an academic physician helps to discover a novel small molecule that improves outcomes after myocardial infarction in animal models due to decreasing the severity of reperfusion injury. A pharmaceutical company then approached the university of this physician in order to sign an agreement allowing the molecule to proceed to clinical trials. After several years of work, the physician has obtained a wealth of new data from human trials and has published several high profile papers.\n\nA major national conference then invites this physician to give a keynote presentation on his work with the novel small molecule. In order to prepare for this speech, the pharmaceutical company offers:\n1. A speaking honorarium\n2. Compensation for travel expenses\n3. Help with preparing slides for the speech\n\nWhich of these benefits can the physician ethically accept?", "answer": "1 and 2", "meta_info": "step1", "answer_idx": "B", "A": "1 only", "B": "1 and 2", "C": "1 and 3", "D": "1, 2, and 3", "language": "en"}
{"question": "A 6-year-old boy is brought to the pediatrician with swelling around the eyes, lower extremity edema, and abdominal distension for the past 3 days. There is no history of hematuria or decreased urine output. His temperature is 36.9°C (98.4°F), pulse rate is 88/min, blood pressure is 98/70 mm Hg, and respiratory rate is 20/min. On physical examination, 2+ pitting edema is present in the lower limbs and the periorbital region. The abdomen is distended with a positive fluid wave. Laboratory studies show:\nSerum creatinine 0.8 mg/dL\nSerum albumin 1.5 g/dL\nSerum cholesterol 260 mg/dL\nSerum C3 and C4 Normal\nUrine protein/creatinine ratio 3.1 mg/mg\nThe patient is diagnosed with minimal change disease. Which of the following options best describes the pathogenesis of edema in this patient?", "answer": "Decreased oncotic pressure gradient across capillary", "meta_info": "step1", "answer_idx": "D", "A": "Increased capillary hydrostatic pressure", "B": "Increased capillary permeability", "C": "Increased interstitial oncotic pressure", "D": "Decreased oncotic pressure gradient across capillary", "language": "en"}
{"question": "A 73-year-old woman is brought to the physician by her son because of a 2-year history of increasing forgetfulness. She does not remember her children's names; she cannot go outside the house unaccompanied because she forgets where she is and what she is supposed to do. Her son reports that over the past year, she has withdrawn herself from social gatherings and avoids making conversation. Mental status examination shows both impaired short- and long-term memory. She is oriented only to person. Her abstract reasoning is impaired. She appears indifferent about her memory lapses and says this is normal for someone her age. This patient's condition is most likely associated with decreased production of which of the following substances?", "answer": "Acetylcholine", "meta_info": "step1", "answer_idx": "B", "A": "Gamma-aminobutyric acid", "B": "Acetylcholine", "C": "Norepinephrine", "D": "Dopamine", "language": "en"}
{"question": "During an emergency room shift, you encounter a disheveled looking man claiming that he is President Kennedy’s love child and the FBI is out to get him. He also endorses that the aliens are responsible for his fathers death and that the aliens implanted a chip in his head to constantly speak to him. Upon review of his medical record, you notice that he made a previous visit to the ER for a similar episode about 8 months ago. Besides his eccentric demeanor and disorganized speech, his vitals and physical exam are all within in normal range. No illicit substances were identified following a urinary toxicology screening. What type of medication would be best long-term for our patient?", "answer": "Quetiapine", "meta_info": "step2&3", "answer_idx": "A", "A": "Quetiapine", "B": "Lithium", "C": "Fluoxetine", "D": "Chlorpromazine", "language": "en"}
{"question": "A 20-year-old man presents to an outpatient clinic with complaints of fever and sweating for 2 months. He says that he does not have the same appetite as before. He lost 2.7 kg (6.0 lb) in the last 2 months. He also complains of pleuritic chest pain and difficulty breathing, which is not nocturnal and is unrelated to position. He has had a mild cough for several months. On examination, the patient is afebrile with normal auscultatory findings. A chest X-ray reveals a right upper lobe homogeneous density. Ziehl-Neelsen staining of sputum shows Mycobacterium tuberculosis. What is the most likely pathological process seen in this type of infection?", "answer": "Caseous necrosis", "meta_info": "step1", "answer_idx": "A", "A": "Caseous necrosis", "B": "Liquefactive necrosis", "C": "Fat necrosis", "D": "Fibrinoid necrosis", "language": "en"}
{"question": "A 19-year-old man presents with a 10-day history of progressive lower back pain and leg weakness, followed by severe lower abdominal pain for the past 12-hours. He describes the back pain as moderate in intensity which radiates to both legs. The weakness has progressively increased, and he cannot ambulate without support. He is also complaining of fever but never checks it. He is a captain of the college basketball team and the back pain and lower limb weakness is preventing him from participating in practices or games. Past medical history is significant for schizophrenia and a suicide attempt. His vital signs include: blood pressure 128/84 mm Hg, temperature 38.8°C (101.8°F). A mass is palpable in the lower abdomen. Strength is 5 out of 5 in the upper limbs bilaterally and 3 out of 5 in the lower limbs bilaterally. Deep tendon reflexes are 2+ in the upper limbs while they are reduced in the lower limbs. Sensitivity to pinprick is absent from below the umbilicus. 1270 mL of urine is collected after placing a Foley catheter. Which of the following is the next best step in the management of this patient?", "answer": "Spinal magnetic resonance imaging (MRI)", "meta_info": "step2&3", "answer_idx": "C", "A": "Nerve conduction studies", "B": "Psychiatric consultation", "C": "Spinal magnetic resonance imaging (MRI)", "D": "Ultrasound of kidneys, ureters, and bladder", "language": "en"}
{"question": "A 72-year-old man is diagnosed with multiple myeloma. His blood work shows mild anemia and urinalysis detects proteinuria at a level of 670 mg/24 h. A kidney biopsy is performed. Which of the following deposits would most likely be detected on the renal biopsy in this patient?", "answer": "AL amyloid", "meta_info": "step1", "answer_idx": "C", "A": "Аβ amyloid", "B": "Calcitonin", "C": "AL amyloid", "D": "Mutated transthyretin", "language": "en"}
{"question": "A 29-year-old woman, gravida 1, para 0 at 11 weeks' gestation, comes to the physician because of a 2-day history of left lower-extremity pain and swelling. Her temperature is 37.9°C (100.2°F). She denies any trauma but says she has not been ambulating due to swelling and the pain in her lower extremities. Physical examination shows diffuse pain on palpation and swelling of the left leg, as well as warmth and tenderness. Compression ultrasound shows poor compressibility of the femoral vein. Which of the following options would be most appropriate for the management of this patient?", "answer": "Heparin", "meta_info": "step2&3", "answer_idx": "C", "A": "Aspirin", "B": "Dipyridamole", "C": "Heparin", "D": "Warfarin", "language": "en"}
{"question": "A 65-year-old woman presents to the emergency department with a new-onset seizure. The patient was at home watching television when she suddenly began jerking her limbs and not responding according to her partner. The patient works as a gardener is often dehydrated but drinks large volumes of water to compensate for her work. She does not wear protective gear or sunscreen while working. She has smoked 1.5 packs of cigarettes per day for the past 40 years. She drinks liquor before bed every night. The patient has a past medical history of hypertension and diabetes and recently lost 9 pounds. Physical exam is within normal limits. Which of the following is the most likely underlying diagnosis in this patient?", "answer": "Small cell carcinoma of the lung", "meta_info": "step2&3", "answer_idx": "D", "A": "Glioblastoma multiforme", "B": "Infiltrating ductal carcinoma of the breast", "C": "Primary seizure disorder", "D": "Small cell carcinoma of the lung", "language": "en"}
{"question": "A 32-year-old man presents to the emergency department after puncturing his foot while working on his garage last week. His past medical history is significant for bronchial asthma and seasonal allergies. On examination, the patient’s jaw seems rigid, and his temperature is 38.3°C (100.9°F). The puncture on the sole of his foot is 2 cm deep and 0.5 cm long. The patient is immediately given tetanus immunoglobulin. What is inoculation of the tetanus vaccine able to stimulate the production of?", "answer": "Allotype antibodies", "meta_info": "step1", "answer_idx": "B", "A": "Anti-tetanus antibodies", "B": "Allotype antibodies", "C": "Hypersensitive reaction type III", "D": "Idiotype antibodies", "language": "en"}
{"question": "A 28-year-old woman presents to the clinic with 2 months of palpitations, tremor, heat intolerance, insomnia, and loose bowel movements. She has lost 20 kg (44 lb). A physical examination indicates that the body temperature is 37.8°C (100.0°F), the heart rate is 120/min, and the blood pressure is 130/80 mm Hg. The examination also reveals that a moderately-sized diffuse goiter and a bruit were present. She was agitated and experienced a fine tremor with warm moist palms; she also had increased deep tendon reflexes. No exophthalmos was noted. The laboratory tests revealed TSH < 0.01 mIU/L (normal: 0.5–4.0 mIU/L), T4: 57 pmol/L (normal: 10–25 pmol/L), T3: 24 pmol/L (normal 3.1–5.4 pmol/L). Complete blood count was normal. A thyroid scan demonstrated diffusely increased uptake. A high level of thyroid-stimulating immunoglobulin antibodies was detected. Which of the following explains these findings?", "answer": "Graves’ disease", "meta_info": "step1", "answer_idx": "B", "A": "Exogenous thyroxine intake", "B": "Graves’ disease", "C": "Hashimoto’s thyroiditis", "D": "Pregnancy", "language": "en"}
{"question": "A 45-year-old woman comes to the physician because of fatigue and irregular menstrual cycles for the past year. She also complains of recurrent sinus infections. During the past 6 months, she has had increased urinary frequency and swelling of her feet. She has also had difficulty lifting her 3-year-old niece for the past 3 weeks. She was recently diagnosed with depression. She works as a medical assistant. The patient has smoked one half-pack of cigarettes daily for 25 years and drinks four beers on the weekends. Her only medication is escitalopram. She is 160 cm (5 ft 3 in) tall and weighs 79 kg (175 lb); BMI is 31 kg/m2. She appears tired. Her temperature is 37°C (98.6°F), pulse is 80/min, respirations are 18/min, and blood pressure is 140/82 mm Hg. Physical examinations shows neck obesity and an enlarged abdomen. Examination of the skin shows multiple bruises on her arms and legs. There is generalized weakness and atrophy of the proximal muscles. Laboratory studies show:\nSerum\nNa+ 150 mEq/L\nK+ 3.0 mEq/L\nCl- 103 mEq/L\nHCO3- 30 mEq/L\nUrea nitrogen 19 mg/dL\nCreatinine 0.9 mg/dL\nGlucose 136 mg/dL\nA 1 mg overnight dexamethasone suppression test shows a serum cortisol of 167 nmol/L (N < 50) and a 24-hour urinary cortisol is 425 μg (N < 300 μg). Serum ACTH is 169 pg/mL (N = 7–50). Subsequently, a high-dose dexamethasone suppression test shows a serum cortisol level of 164 nmol/L (N < 50). Which of the following is the most likely underlying cause of this patient's symptoms?\"", "answer": "Small cell lung cancer", "meta_info": "step2&3", "answer_idx": "C", "A": "Adrenal carcinoma", "B": "Hypothyroidism", "C": "Small cell lung cancer", "D": "Adrenal adenoma", "language": "en"}
{"question": "A 39-year-old woman, gravida 3, para 2, at 39 weeks' gestation is admitted to the hospital with leakage of fluid and contractions. She noticed the fluid leak about an hour ago and has no associated bleeding. Contractions have been about 20 minutes apart. On admission, she is dilated 2 cm, 50% effaced, and at -2 station. Spontaneous rupture of membranes is confirmed and she is monitored by external tocodynamometer. Repeat evaluation after 2 hours shows dilation of 6 cm , 70% effacement, and -1 station. Four hours later, her pelvic exam shows no changes and she has 4 strong contractions every 10 minutes. The fetal heart rate is 120/min, with moderate accelerations and no late or variable decelerations. Which of the following is the most appropriate next step in management?", "answer": "Cesarean delivery", "meta_info": "step2&3", "answer_idx": "A", "A": "Cesarean delivery", "B": "Assisted vaginal delivery", "C": "Amnioinfusion", "D": "Intrauterine pressure catheter\n\"", "language": "en"}
{"question": "A 32-year-old homeless man presents to the emergency department with dyspnea, left-sided chest pain, chills, and a productive cough over the last week or so. He does not have medical insurance and has not seen a doctor for many years. His chest pain increases with inspiration. The pain does not radiate or worsen with movement. He states that has a productive cough with yellow sputum with flecks of blood. He drinks 6 beers a night and does not smoke or take illicit drugs. Temperature is 37.8°C (100.0°F), blood pressure is 124/90 mm Hg, pulse is 92/min, and respiration rate is 16/min. On physical examination, tactile fremitus is increased and there is a dullness to percussion over the lower part of the left lung. No murmurs are heard. Oral examination reveals poor dentition. Chest X-ray reveals a large left lobar opacification with extensive pleural effusion. Which of the following is the best initial management for this patient?", "answer": "IV antibiotics and thoracentesis", "meta_info": "step2&3", "answer_idx": "B", "A": "Supplemental oxygen", "B": "IV antibiotics and thoracentesis", "C": "Inhaled bronchodilators", "D": "Upper endoscopy", "language": "en"}
{"question": "A 43-year-old woman presents with left calf pain. She denies any previous episodes of such pain. Past medical history is significant for cervical carcinoma treated with cryosurgery with no evidence of recurrence. Current medications are an estrogen-containing oral contraceptive and a multivitamin. The patient reports a 40-pack-year smoking history, but no alcohol or recreational drug use. The patient is afebrile and her vital signs are within normal limits. On physical examination, her left calf is swollen, erythematous, and tender to palpation. A D-dimer level is positive. Which of the following is the most likely etiology of this patient’s condition?", "answer": "Oral contraceptives", "meta_info": "step1", "answer_idx": "B", "A": "Fibromyalgia", "B": "Oral contraceptives", "C": "Protein C deficiency", "D": "Protein S deficiency", "language": "en"}
{"question": "A 53-year-old woman with hypertension and hyperlipidemia comes to the physician because of a 3-month history of progressively worsening shortness of breath. Her pulse is 92/min, respirations are 22/min, and blood pressure is 110/70 mm Hg. Cardiac examination shows a grade 3/6 holosystolic murmur at the apex that radiates to the axilla and an extra heart sound during early diastole. Assuming all other parameters remain constant, which of the following is most likely to decrease the volume of retrograde blood flow in this patient?", "answer": "Decrease in systemic vascular resistance", "meta_info": "step1", "answer_idx": "C", "A": "Increase in atrioventricular orifice size", "B": "Increase in left ventricular inotropy", "C": "Decrease in systemic vascular resistance", "D": "Increase in left ventricular end-diastolic pressure", "language": "en"}
{"question": "A 66-year-old man presents to his primary care physician with abdominal pain in the setting of progressively worsening constipation. He complains of epigastric pain that waxes and wanes, and expressed concern that he has not defecated for the past 5 days. Upon further questioning, he relates that he has been taking three of his wife's multivitamins each day for the past three weeks to \"combat a cold.\" Vital signs are within normal limits. Physical exam reveals an abdomen with nonspecific tenderness to deep palpation without rebound tenderness, hyperpercussion, or flank tenderness. What is the most likely cause of his symptoms?", "answer": "Iron overdose", "meta_info": "step2&3", "answer_idx": "B", "A": "Magnesium overdose", "B": "Iron overdose", "C": "Potassium overdose", "D": "Folic acid overdose", "language": "en"}
{"question": "Two days after undergoing transsphenoidal removal of a pituitary macroadenoma, a 35-year-old woman reports increased thirst and frequent urination. The surgery was uncomplicated. Neurologic examination shows no abnormalities. Her serum sodium concentration is 153 mEq/L and serum glucose concentration is 92 mg/dL. Which of the following findings in the nephron best describes the tubular osmolality, compared with serum, in this patient?", "answer": "Collecting duct is hypotonic", "meta_info": "step1", "answer_idx": "C", "A": "Distal ascending loop of Henle is hypertonic", "B": "Proximal convoluted tubule is hypertonic", "C": "Collecting duct is hypotonic", "D": "Distal convoluted tubule is hypertonic", "language": "en"}
{"question": "A 67-year-old woman comes to the physician because of a 5-day history of episodic abdominal pain, nausea, and vomiting. She has coronary artery disease and type 2 diabetes mellitus. She takes aspirin, metoprolol, and metformin. She is 163 cm (5 ft 4 in) tall and weighs 91 kg (200 lb); her BMI is 34 kg/m2. Her temperature is 38.1°C (100.6°F). Physical examination shows dry mucous membranes, abdominal distension, and hyperactive bowel sounds. Ultrasonography of the abdomen shows air in the biliary tract. This patient's symptoms are most likely caused by obstruction at which of the following locations?", "answer": "Distal ileum", "meta_info": "step1", "answer_idx": "B", "A": "Third part of the duodenum", "B": "Distal ileum", "C": "Proximal jejunum", "D": "Pancreatic duct", "language": "en"}
{"question": "A 47-year-old man presents to his ophthalmologist for abnormal vision. The patient was discharged from the hospital 2 weeks ago after a motor vehicle accident where he was given 1L of blood. He also underwent several surgical procedures including enucleation of the right globe and exploratory abdominal laparotomy to stop internal bleeding. Currently, he states that he has noticed decreased vision in his left eye. The patient has a past medical history of poorly controlled diabetes, asthma, and atopic dermatitis. His temperature is 98.9°F (37.2°C), blood pressure is 167/108 mmHg, pulse is 90/min, respirations are 14/min, and oxygen saturation is 97% on room air. Physical exam is notable for 20/200 vision in the patient's left eye, which is worse than usual. The patient's left eye appears red and irritated. Which of the following is the most likely diagnosis?", "answer": "Sympathetic ophthalmia", "meta_info": "step2&3", "answer_idx": "D", "A": "Anterior uveitis", "B": "Normal post-operative visual adaptations", "C": "Seasonal allergies", "D": "Sympathetic ophthalmia", "language": "en"}
{"question": "A 26-year-old female presents to her primary care physician with several months of mood swings, which she feels are affecting her work and personal relationships. She states that on roughly a quarter of days each month, she feels highly irritable, sensitive to criticism and rejection, and easily saddened. She also feels that her appetite varies greatly, and on the days when she is particularly emotional, she also feels especially hungry. As a result of these symptoms, her performance at work has suffered, and her boyfriend has been complaining that she is difficult to live with. She is anxious that she cannot “get my mood under control.” The patient has no past medical history, regular periods every 28 days, and no obstetric history. She uses condoms for contraception. Her mother has major depressive disorder, and her father has hypertension and coronary artery disease. At this visit, the patient’s temperature is 98.4°F (36.9°C), pulse is 75/min, blood pressure is 130/76 mmHg, and respirations are 13/min. She appears slightly anxious but has overall normal affect and is pleasantly conversational. Physical exam is unremarkable. Which of the following is the best next step in management?", "answer": "Selective serotonin reuptake inhibitor", "meta_info": "step2&3", "answer_idx": "A", "A": "Selective serotonin reuptake inhibitor", "B": "Combined oral contraceptive therapy", "C": "Serotonin-norepinephrine reuptake inhibitor", "D": "Cognitive behavioral therapy", "language": "en"}
{"question": "A 63-year-old male presents to the emergency department complaining of worsening nausea. He reports that the nausea began several months ago and is accompanied by occasional bloating and heartburn. He reports that he frequently feels full even after eating only a little at each meal, and occasionally he will vomit if he eats too much. The vomit is non-bloody and contains bits of undigested food. A review of systems is notable for occasional headaches, tingling in his distal extremities, and constipation. His medical history is significant for Parkinson’s disease diagnosed 3 years ago, hypertension diagnosed 8 years ago, and type II diabetes mellitus diagnosed 10 years ago. The patient reports that he was given prescriptions for both his blood pressure and diabetes medications, but he has not taken either for months because one of them was causing erectile dysfunction. He reports he regularly takes his levodopa. An endoscopy is performed, which rules out cancer. In addition to restarting medications for his hypertension and diabetes, what of the following is most appropriate treatment for the patient’s symptoms?", "answer": "Erythromycin", "meta_info": "step2&3", "answer_idx": "D", "A": "Ondansetron", "B": "Scopolamine", "C": "Proton-pump inhibitor", "D": "Erythromycin", "language": "en"}
{"question": "A 27-year-old Japanese man presents to the emergency department with diarrhea. The patient states that whenever he goes out to eat he experiences bloating, flatulence, abdominal cramps, and watery diarrhea. Today, his symptoms started after he went out for frozen yogurt. The patient is otherwise healthy and is not currently taking any medications. His temperature is 98.0°F (36.7°C), blood pressure is 122/80 mmHg, pulse is 81/min, respirations are 13/min, and oxygen saturation is 99% on room air. Physical exam demonstrates a nontender abdomen and an unremarkable rectal exam with guaiac-negative stools. Which of the following is the most appropriate next step in management?", "answer": "Lactose-free diet", "meta_info": "step2&3", "answer_idx": "B", "A": "Hydrogen breath test", "B": "Lactose-free diet", "C": "Loperamide", "D": "Stool osmotic gap", "language": "en"}
{"question": "A 29-year-old woman presents to her primary care physician with worsening fatigue and lightheadedness over the past several months. She states that she has felt easily fatigued and has experienced several falls during this time frame as well. She drinks 5 to 8 drinks per day and works as a waitress. Her temperature is 98.2°F (36.8°C), blood pressure is 114/64 mmHg, pulse is 98/min, respirations are 12/min, and oxygen saturation is 98% on room air. Laboratory studies are ordered as seen below.\n\nHemoglobin: 9.0 g/dL\nHematocrit: 29%\nLeukocyte count: 6,700/mm^3 with normal differential\nPlatelet count: 199,400/mm^3\nMethylymalonic acid: 1.0 umol/L (normal < 0.40 umol/L)\n\nWhich of the following is the most likely etiology of this patient's symptoms?", "answer": "Vitamin B12 deficiency", "meta_info": "step2&3", "answer_idx": "D", "A": "Alcohol use", "B": "Folate deficiency", "C": "Iron deficiency", "D": "Vitamin B12 deficiency", "language": "en"}
{"question": "A 32-year-old man from the Czech Republic is brought to the emergency department by his girlfriend with a 2-day history of yellowing of the skin. His girlfriend also reports a several-week history of anorexia, nausea without vomiting, and diffuse low-grade abdominal pain. He is a frequent injection drug user. His temperature is 38.1°C (100.6°F). He is grossly confused and somnolent. Physical examination is notable for scleral icterus and diffuse jaundice; when asked to hold his hands in wrist extension, a flapping movement is observed. Liver function tests show alanine aminotransferase 1,830 U/L, aspartate aminotransferase 1,377 U/L, and direct bilirubin 15 mg/dL. Coagulation studies reveal an international normalized ratio of 3.8. On serological testing, HBsAg is positive, and HBsAb is negative. Which of the following laboratory tests should be performed in this patient prior to initiating treatment?", "answer": "Hepatitis D serologies", "meta_info": "step2&3", "answer_idx": "A", "A": "Hepatitis D serologies", "B": "HIV ELISA", "C": "PPD skin test", "D": "Lumbar puncture", "language": "en"}
{"question": "A 63-year-old woman with a history of adult polycystic kidney disease and COPD presents to her optometrist after having difficulty watching a movie. She has no other complaints. She is accompanied by her daughter, who notes that her mother hasn’t been able to look at her since the previous day. On exam, her right eye has full range of motion, but her left eye is fixed in a down and outward position. What is the most likely cause of her symptoms?", "answer": "Vascular abnormality", "meta_info": "step1", "answer_idx": "A", "A": "Vascular abnormality", "B": "Seizure", "C": "Demyelinating disease", "D": "Impaired dopaminergic neurons", "language": "en"}
{"question": "An 11-year-old boy presents to the office with his mother for the evaluation of weight loss, rash, and several weeks of bloating and diarrhea. The mother states that the patient’s father had similar symptoms at his age. On physical examination, the patient is pale with dry mucous membranes. There is a vesicular rash on the bilateral lower extremities which he says is ‘very itchy’. Which of the following laboratory findings would confirm the most likely diagnosis in this patient?", "answer": "Anti-tTG or gliadin antibodies", "meta_info": "step1", "answer_idx": "B", "A": "HLA-DQ2", "B": "Anti-tTG or gliadin antibodies", "C": "Anti-lactase antibodies", "D": "HLA-B27", "language": "en"}
{"question": "A 23-year-old African American G1P0 woman at 18 weeks estimated gestational age presents with fatigue and lethargy. She says the symptoms onset gradually about 1 week ago and have progressively worsened. She has been otherwise healthy. Past medical history is unremarkable. She denies smoking, drug or alcohol use. The patient is afebrile and vital signs are within normal limits. Her physical examination is unremarkable. Her blood count shows the following:\nHemoglobin 10.8 g/dL\nRed blood cell count 5.7 million/mm3\nMean corpuscular volume (MCV) 76 μm3\nRed cell distribution width 12.4% (ref: 11.5–14.5%)\nShe is empirically started on ferrous gluconate tablets. Five weeks later, she shows no improvement in her hemoglobin level. Hemoglobin electrophoresis is normal. Which of the following is the most likely diagnosis in this patient?", "answer": "Alpha-thalassemia trait", "meta_info": "step2&3", "answer_idx": "C", "A": "Iron deficiency anemia", "B": "Beta-thalassemia trait", "C": "Alpha-thalassemia trait", "D": "Folate deficiency anemia", "language": "en"}
{"question": "A 26-year-old woman comes to the physician for a follow-up examination 1 week after undergoing rotator cuff repair surgery. Physical examination of the right shoulder shows decreased sensation to pinprick and light touch over the lateral shoulder. There is normal passive range of motion of the shoulder, but she has difficulty externally rotating and abducting her right arm. Which of the following structures was most likely injured during the surgery?", "answer": "Axillary nerve", "meta_info": "step1", "answer_idx": "B", "A": "Upper trunk of the brachial plexus", "B": "Axillary nerve", "C": "Lower trunk of the brachial plexus", "D": "Long thoracic nerve", "language": "en"}
{"question": "A 25-year-old man presents to his primary care physician with complaints of coughing up blood in his sputum and dark-colored urine for 1 week. There are streaks of blood intermixed with phlegm. He also expresses concerns about his urine being grossly dark brown. He denies any history of major bleeding from minor injuries. He is currently not taking any medications. His family history is negative for bleeding disorders. The vital signs include blood pressure 160/100 mm Hg, pulse 88/min, temperature 36.8°C (98.2°F), and respiratory rate 11/min. On physical examination, there are no significant clinical findings. The urinalysis results are as follows:\npH 6.7\nColor dark brown\nRed blood cell (RBC) count 12–14/HPF\nWhite blood cell (WBC) count 3–4/HPF\nProtein absent\nCast RBC and granular casts\nGlucose absent\nCrystal none\nKetone absent\nNitrite absent \n24 hours of urine protein excretion 1 g\n    His renal function test showed:\nSodium 136 mEq/L\nPotassium 5.1 mEq/L\nChloride 101 mEq/L\nBicarbonate 22 mEq/L\nAlbumin 3.5 mg/ dL\nUrea nitrogen 28 mg/dL\nCreatinine 2.5 mg/dL\nUric Acid 6.8 mg/ dL\nCalcium 8.7 mg/ dL\nGlucose 111 mg/dL\nHPF: high-power field\nA kidney biopsy is obtained and the immunofluorescence shows linear immunoglobulin G (IgG) deposition in the glomeruli. Which of the following antibodies is most likely responsible for this patient’s condition?", "answer": "Anti-glomerular basement membrane antibody (anti-GBM)", "meta_info": "step1", "answer_idx": "C", "A": "Anti-neutrophil cytoplasmic antibody (c-ANCA)", "B": "Anti-phospholipid antibody", "C": "Anti-glomerular basement membrane antibody (anti-GBM)", "D": "Anti-dsDNA antibody", "language": "en"}
{"question": "The lung of a 45-year-old Caucasian male who died from Mycobacterium tuberculosis infection reveals the following at autopsy (Image A). Of the steps leading to the formation of this structure, which occurs first?", "answer": "Bacterium-mediated inhibition of phagosome-lysosome fusion", "meta_info": "step1", "answer_idx": "B", "A": "Th1 cell activation", "B": "Bacterium-mediated inhibition of phagosome-lysosome fusion", "C": "Formation of epithelioid cells", "D": "Formation of giant cells", "language": "en"}
{"question": "A 57-year-old man comes to the physician because of a 3-month history of bloating and nausea after eating food. He has also had episodic abdominal pain during this period. He has osteoarthritis of the left knee. There is no family history of serious illness. He has smoked one pack of cigarettes daily for 21 years. He drinks two to three beers daily. Current medications include ibuprofen. He is allergic to amoxicillin and latex. Vital signs are within normal limits. The lungs are clear to auscultation. Cardiac examination shows no abnormalities. The abdomen is soft; there is mild tenderness to palpation over the epigastrium. Rectal examination shows no abnormalities. An esophagogastroduodenoscopy is performed and shows 3 shallow ulcers of the gastric mucosa. Biopsy shows chronic inflammation of the gastric mucosa and Helicobacter pylori. He is prescribed a 2-week course of antibiotics and omeprazole to treat the H. pylori infection. Which of the following recommendations is most appropriate at this time?", "answer": "Avoid drinking alcohol for the next 2 weeks", "meta_info": "step2&3", "answer_idx": "A", "A": "Avoid drinking alcohol for the next 2 weeks", "B": "Begin prophylactic steroid therapy for anaphylaxis", "C": "Check liver enzymes in 2 weeks", "D": "Perform urea breath test in 2 weeks", "language": "en"}
{"question": "A 72-year-old man presents to his physician’s office with difficulty breathing and chronic fatigue. Over the past few months, he has felt that it is difficult to retain his energy throughout the day. He is disturbed because he has to skip many social events because of his inability to participate. He also says that lately, he has had difficulty catching his breath after walking for just a few blocks. Other than well-controlled diabetes, his past medical history is insignificant. On physical examination, moderate conjunctival pallor is noted. His recent blood count shows a hemoglobin level of 10.3 g/dl, hematocrit of 24%, serum ferritin level of 10 ng/ml, and a red cell distribution width of 16.5%. Which of the following would be the best next step in the management of this patient?", "answer": "Colonoscopy", "meta_info": "step2&3", "answer_idx": "A", "A": "Colonoscopy", "B": "Vitamin B12 levels", "C": "Endoscopy", "D": "Iron supplementation", "language": "en"}
{"question": "A 17-year-old rugby player limped into the emergency room and says he “rolled his ankle” while running during a game. You conclude that the mechanism involved ankle plantar flexion and inversion. There is no medial or lateral malleolus point tenderness. Anterior drawer test of the ankle is positive. Talar tilt test is negative. What is the most likely injury?", "answer": "Anterior talofibular ligament (ATFL) sprain", "meta_info": "step2&3", "answer_idx": "A", "A": "Anterior talofibular ligament (ATFL) sprain", "B": "Deltoid ligament sprain", "C": "Tibia fracture", "D": "Fibula fracture", "language": "en"}
{"question": "Which of the following statements concerning positive predictive value (PPV) is correct?", "answer": "PPV is the proportion of tests that are true positives; if disease prevalence is low, then PPV will be low.", "meta_info": "step1", "answer_idx": "A", "A": "PPV is the proportion of tests that are true positives; if disease prevalence is low, then PPV will be low.", "B": "PPV is the proportion of tests that are true positives; disease prevalence has no effect on PPV.", "C": "PPV is the proportion of tests that are false positives; if disease prevalence is low, then PPV will be low.", "D": "PPV is the proportion of tests that are false positives; if disease prevalence is high then PPV will be low.", "language": "en"}
{"question": "A 32-year-old man presents to the emergency department with fever, weight loss, and right upper quadrant pain. He says that he started experiencing nausea and fatigue after he returned from a honeymoon trip to Asia with his wife. Notably, she is 5 months pregnant with their first child. On presentation, his temperature is 100.8°F (38.2°C), blood pressure is 118/79 mmHg, pulse is 81/min, and respirations are 14/min. Physical exam reveals a jaundiced patient with a palpable liver edge as well as splenomegaly. Labs are sent in order to confirm the diagnosis. After confirmation, the patient's wife is immediately tested as well because she is at a much higher risk of fatal complications from this infection. The organism that is most likely responsible for this patient's symptoms has which of the following structures?", "answer": "Non-enveloped (+) RNA hepevirus", "meta_info": "step1", "answer_idx": "D", "A": "Enveloped dsDNA virus", "B": "Enveloped (-) RNA virus", "C": "Enveloped (+) RNA virus", "D": "Non-enveloped (+) RNA hepevirus", "language": "en"}
{"question": "A 59-year-old man presents to the emergency room with shortness of breath and swelling of his feet and legs. He denies any past medical problems, surgeries, medications, or illicit drug use. He reports drinking a few beers each night. He is diagnosed with a first episode of congestive heart failure and is admitted to the hospital. The next day, the nurse notices that his hands are shaky when he extends his arms. The patient says that he couldn’t sleep the night before and that he feels restless, anxious, and slightly nauseated. On the second night of admission the patient becomes agitated. He is disoriented, cannot remember where he is, and appears globally confused. His pulse is 125/min, blood pressure is 170/110 mmHg, and temperature is 101.7°F (38.7°C). He is diaphoretic and his hands are shaking at rest. He cries out in fear reporting voices whispering in his room and strange shadows passing over the walls. What medication should be administered to this patient?", "answer": "Benzodiazepines", "meta_info": "step1", "answer_idx": "B", "A": "Flumazenil", "B": "Benzodiazepines", "C": "Dantrolene", "D": "Fomepizole", "language": "en"}
{"question": "A 49-year-old woman otherwise healthy presents to the outpatient department with swelling of the neck. Family history is negative for any thyroid disorders. Physical examination shows a nontender thyroid gland with a nodule on the right side. The thyroid gland is mobile on deglutition. Cervical lymphadenopathy is present. Fine needle aspiration and cytology show empty appearing nuclei with central clearing, nuclear grooves and branching structures interspersed with calcific bodies. Which of the following is the most likely diagnosis in this patient?", "answer": "Papillary carcinoma", "meta_info": "step1", "answer_idx": "B", "A": "Follicular carcinoma", "B": "Papillary carcinoma", "C": "Anaplastic carcinoma", "D": "Follicular adenoma", "language": "en"}
{"question": "A 33-year-old woman comes to the physician because of a 2-year history of intermittent episodes of pain in all her fingers bilaterally. The episodes are worse during the winter. The fingers become white when exposed to cold weather, then severely painful and numb once they warm up. She has started wearing gloves at all times to prevent these episodes. She has generalized anxiety disorder. Her mother has systemic lupus erythematosus. Current medications include lorazepam and fluoxetine. She appears anxious. Her temperature is 37.3°C (99.1°F), pulse is 92/min, and blood pressure is 116/72 mm Hg. Examination of both hands shows no abnormalities. Allen's test is negative. Her hemoglobin concentration is 14.4 g/dL, leukocyte count is 9,800/mm3, and platelet count is 156,000/mm3. Serum electrolyte concentrations are within normal limits. Nailfold capillary microscopy is normal. Which of the following is the most appropriate pharmacotherapy?", "answer": "Oral nifedipine", "meta_info": "step2&3", "answer_idx": "B", "A": "Oral aspirin", "B": "Oral nifedipine", "C": "Oral epoprostenol", "D": "Oral prednisone", "language": "en"}
{"question": "A 43-year-old man comes to the physician because of redness and swelling of his right leg. He reports that it is very painful to touch. He has had fever and chills. He has no chest pain or shortness of breath. He has a history of type 2 diabetes mellitus and underwent saphenous vein stripping and ligation in his right leg 3 years ago. He works as a security guard. He does not smoke or drink alcohol. His medications include metformin and sitagliptin. His temperature is 38.7°C (101.7°F), pulse is 99/min, and blood pressure is 138/72 mm Hg. Examination shows an 8-cm, indurated, tender, warm, erythematous skin lesion with sharply demarcated margins. There is no inguinal lymphadenopathy. Toe web intertrigo is noted. Which of the following is the most appropriate next step in management?", "answer": "Intravenous cefazolin therapy", "meta_info": "step2&3", "answer_idx": "B", "A": "Oral cephalexin therapy", "B": "Intravenous cefazolin therapy", "C": "Intravenous ciprofloxacin therapy", "D": "Subcutaneous heparin injection", "language": "en"}
{"question": "A 52-year-old thoracic surgeon presents to his primary care physician with an eczematous dermatitis overlying his hands and forearms. He notes that he has recently started using a new type of surgical gloves. He notes that he washes his hands frequently, but he has never had issues with skin irritation before. On physical examination, there are erythematous plaques with areas of vesicles on his bilateral hands and dorsal forearms. Of the following options, which is the next best step in patient management?", "answer": "Patch testing", "meta_info": "step2&3", "answer_idx": "A", "A": "Patch testing", "B": "KOH examination", "C": "Skin biopsy", "D": "Radioallergosorbent test", "language": "en"}
{"question": "A 43-year-old woman presents to a new primary care physician complaining of anxiety. She has been worrying non-stop recently about the possibility that her husband will lose his job as a teacher. Her husband, who is present, assures the physician that his job is entirely secure and states that she has \"fretted\" for their entire marriage, though the exact topic causing her anxiety varies over time. She also worries excessively about everyday tasks, such as whether she will catch the train on time and whether their house in Southern California is sufficiently earthquake-proof. She has no way to overcome these worries. She endorses other symptoms including poor sleep (associated with racing thoughts about her various worries), fatigue, and impaired concentration at work, all of which have been present for at least the past year. Her vital signs are within normal limits and there are no abnormalities on physical exam. What is the most likely diagnosis?", "answer": "Generalized anxiety disorder", "meta_info": "step2&3", "answer_idx": "D", "A": "Social phobia", "B": "Agoraphobia", "C": "Posttraumatic stress disorder", "D": "Generalized anxiety disorder", "language": "en"}
{"question": "A 60-year-old woman comes to the physician because of palpitations and a 5.4-kg (11.9-lb) weight loss over the past 3 months. She appears anxious. Her pulse is 104/min and blood pressure is 148/101 mm Hg. Physical examination shows warm skin, mild tremor, and an enlarged thyroid gland. A thyroid scintigraphy scan shows several focal areas with increased uptake. A biopsy of one of these areas of affected thyroid tissue is most likely to show which of the following?", "answer": "Patches of enlarged follicular cells distended with colloid", "meta_info": "step1", "answer_idx": "C", "A": "Sheets of parafollicular cells surrounded by amyloid stroma", "B": "Follicle destruction with lymphocytic infiltrate and germinal center formation", "C": "Patches of enlarged follicular cells distended with colloid", "D": "Crowded follicular cells with scalloped colloid", "language": "en"}
{"question": "A 47-year-old man is brought to the emergency department 1 hour after his neighbor found him collapsed on his front porch in a pool of vomitus. On arrival, he is oriented only to self. His pulse is 103/min and respirations are 30/min. Neurologic examination shows muscle spasms in the arms and jaw. Serum studies show:\nNa+ 137 mEq/L\nCl- 99 mEq/L\nHCO3- 8 mEq/L\nOsmolality 328 mOsm/kg\nThe difference between the calculated and observed serum osmolality is 32 mOsm/kg. Urinalysis shows oxalate crystals. This patient is most likely experiencing toxicity from which of the following substances?\"", "answer": "Ethylene glycol", "meta_info": "step1", "answer_idx": "B", "A": "Methanol", "B": "Ethylene glycol", "C": "Parathion", "D": "Aspirin", "language": "en"}
{"question": "A 13-year-old boy presents to the clinic for evaluation of pain, swelling, and redness in the left knee. This began a month ago and has been progressively worsening. He thinks his pain is due to playing soccer. He is frustrated that the pain does not respond to Tylenol. History is non-contributory. The vital signs are unremarkable. On examination, there is tenderness and warmth present over the knee with limitation of movement. The laboratory values show a normal white blood cell (WBC) count and elevated alkaline phosphatase. A radiograph of the knee shows mixed lytic and blastic lesions. Which of the following is the most probable cause of his complaints?", "answer": "Osteosarcoma", "meta_info": "step2&3", "answer_idx": "B", "A": "Osteomyelitis", "B": "Osteosarcoma", "C": "Ewing’s sarcoma", "D": "Chondrosarcoma", "language": "en"}
{"question": "A 55-year-old woman presents to the emergency department because of palpitations and generalized weakness. She has a history of type 2 diabetes, for which she has been receiving medication for the past 15 years. Consequently, her recent medical history involves diabetic retinopathy as well as end-stage renal disease. She is advised dialysis; however, she does not attend her regular dialysis sessions. The physical examination shows motor strength of 3/5 in the upper limbs and 4/5 in the lower limbs. Cranial nerve capacity is intact. Her electrocardiogram (ECG) is shown. Medical management is initiated for the patient. Which of the following is the most likely explanation for this patient’s clinical findings?", "answer": "Skipped dialysis appointment", "meta_info": "step2&3", "answer_idx": "A", "A": "Skipped dialysis appointment", "B": "Insulin supplementation", "C": "Administration of α-agonist", "D": "Alkalosis", "language": "en"}
{"question": "A 59-year-old man presents to the emergency department with diffuse abdominal pain that radiates to his back, nausea, and vomiting. The vital signs include: temperature 36.7°C (98.0°F), blood pressure 126/74 mm Hg, heart rate 74/min, and respiratory rate 14/min. The laboratory evaluation on admission is significant for a serum glucose 241 mg/dL, aspartate aminotransferase (AST) 321 IU/dL, and leukocyte count 21,200/mL. Within 3 days of admission with supportive care in the intensive care unit, the patient’s clinical condition begins to improve. Based on Ranson’s Criteria, what is this patient’s overall risk of mortality, assuming all other relevant factors are negative?", "answer": "20%", "meta_info": "step2&3", "answer_idx": "A", "A": "20%", "B": "40%", "C": "80%", "D": "100%", "language": "en"}
{"question": "A 68-year-old male presents to your office for his annual physical exam. He has no complaints at this time and his chronic hypertension is well controlled. You notice a .5cm papule on the patient's eyelid that has a pink pearly appearance, rolled borders, and overlying telangiectasias. On further questioning, you find out the patient was a door-to-door salesman and spent a lot of time outdoors, and he did not wear sunscreen. He has fair skin and blonde hair. The patient states that he first noticed the lesion about 6 months prior, and it has grown slightly since then. What is the most likely diagnosis?", "answer": "Basal cell carcinoma", "meta_info": "step2&3", "answer_idx": "D", "A": "Squamous cell carcinoma", "B": "Keratoacanthoma", "C": "Verrucous carcinoma", "D": "Basal cell carcinoma", "language": "en"}
{"question": "A 67-year-old woman is brought to the emergency room after complaining of back pain with a gradual loss of sensation in her lower extremities. She was recently diagnosed with radiosensitive metastatic breast cancer and was scheduled to receive chemotherapy and palliative surgery. Her temperature is 99.0°F (37.2°C), blood pressure is 133/81 mmHg, pulse is 82/min, respirations are 15/min, and oxygen saturation is 98% on room air. Physical exam is notable for decreased sensation bilaterally over the patient's lower extremities. She demonstrates 2/5 strength of leg extension on the left and 1/5 on the right which is slightly worse than her baseline neurological exam taken 2 months ago. Pain to her lumbar region worsens with coughing. An initial CT scan of the spine does not demonstrate any unstable fractures of the spine. A MRI of the spine is ordered and pending. Which of the following is the most appropriate next step in management?", "answer": "Radiation therapy", "meta_info": "step2&3", "answer_idx": "C", "A": "Biopsy", "B": "Chemotherapy", "C": "Radiation therapy", "D": "Surgical decompression", "language": "en"}
{"question": "An obese 50-year-old woman presents to the emergency department of a rural hospital due to chest pain for the last 12 hours. The pain is substernal, crushing in nature, radiating into her neck, and accompanied by profuse sweating. Her history is significant for hypertension, and she admits poor compliance with her medications. An ECG done at the clinic confirmed the presence of STEMI, and the patient was given aspirin. The ambulance was in an accident on the way to the hospital and by the time the patient reached the angiography suite, the cardiologist decided intervention should be delayed due to the late presentation. Also, the patient’s pain has improved. The patient is admitted and is stable for 3 nights with no dyspnea or edema. Her blood pressure is kept under control while in the hospital. On the fourth night, the patient becomes quite agitated and soon thereafter she is unresponsive. Her pulse cannot be palpated. She has an elevated JVP and upon auscultation, heart sounds are distant. What is the most likely diagnosis for this patient?", "answer": "Left ventricular free wall rupture", "meta_info": "step2&3", "answer_idx": "B", "A": "Acute pericarditis", "B": "Left ventricular free wall rupture", "C": "Papillary muscle rupture", "D": "Pulmonary embolism", "language": "en"}
{"question": "A 20-year-old woman presents to the emergency department with painful swelling in the middle of her neck for the past 3 days. She is not experiencing pain during swallowing, difficulty in breathing, or changes in her voice. On examination, a red, 5 x 5 cm, exquisitely tender, non-pulsatile, fluctuating mass is present in the midline on the anterior aspect of the neck. The patient is prepared for an incision and drainage of the neck abscess. Which of the following is responsible for the exact mechanism of diapedesis that allows for inflammatory cells to enter the tissue space of this patient?", "answer": "Transmigration and chemotaxis", "meta_info": "step1", "answer_idx": "C", "A": "Adhesion", "B": "Margination", "C": "Transmigration and chemotaxis", "D": "Rolling", "language": "en"}
{"question": "A 45-year-old G2P2 presents with episodes of urgency accompanied by an involuntary passage of urine. These symptoms take place during the day and night. The symptoms are not linked with physical exertion, laughing, or coughing. Her occupation does not involve weight lifting, but she says that sometimes it is very stressful for her. She denies any other genitourinary symptoms. She had  1 vaginal delivery and 1 cesarean section. She does not have a history of genitourinary or neurologic disorders. The weight is 91 kg (200.6 lb) and the height is 172 cm (5 ft 60 in). The vital signs are as follows: blood pressure, 128/75 mmHg; heart rate, 77/min; respiratory rate, 13/min; and temperature, 36.6℃ (97.9℉). The physical examination shows no abdominal masses and no costovertebral angle or suprapubic tenderness. On gynecologic examination, there are no vulvar lesions. The external urethral orifice appears normal. A Q-tip test is negative. The cervix is normally positioned, non-tender, movable, and without visible lesions. The uterus is not enlarged and the ovaries are not palpable. A urinalysis, urine culture, and ultrasound examination of the bladder were all normal. Cystometric studies show the following findings:\n  Measured value Normal range\nResidual volume 10 ml < 50 ml\nSensation-of-fullness volume 190 ml 200–225 ml\nUrge-to-void volume 700 ml 400–500 ml\nInvoluntary contractions present absent\nWhich of the following treatment strategies would be most appropriate for this patient?", "answer": "Start her on a muscarinic antagonist", "meta_info": "step2&3", "answer_idx": "D", "A": "Instillation of the urethral mesh sling", "B": "Topical estrogen therapy", "C": "Augmentation cystoplasty", "D": "Start her on a muscarinic antagonist", "language": "en"}
{"question": "A 4-year-old girl is brought to the physician with progressively worsening fever, malaise, and a sore throat. Her parents say “Our daughter has not received vaccinations because her body has to learn how to fight infections.” Her temperature is 38.5˚C (101.3 F). Physical examination shows marked cervical lymphadenopathy. There are gray-white membranes over the tonsils and posterior pharynx that bleed when scraped off. The patient's symptoms are most likely caused by disruption of which of the following steps in protein synthesis?", "answer": "Translocation of the ribosome along the mRNA", "meta_info": "step1", "answer_idx": "B", "A": "Folding of completed proteins", "B": "Translocation of the ribosome along the mRNA", "C": "Binding of tRNA to the A site", "D": "Release of completed protein from ribosome", "language": "en"}
{"question": "A 56-year-old man presents to his family physician for issues with his back that have persisted since he was in his 20’s. For the last 6 months, his neck has been very stiff and he has been unable to tilt his head backwards. He also has severe kyphosis and feels limited in his range of motion. He tries to get at least 8 hours of sleep each night, but he says he rarely feels rested. On examination, the patient has no pain on active and passive movements. His cervical spine is moderately stiff; limitations are in extension, flexion, and rotation. There is also evidence of mild swelling of his wrist joints. The patient is sent for an X-ray of his lumbar spine. Unfortunately, he did not seek medical care for years due to financial hardships. Which of the following therapies would have been first line for improving this patient’s symptoms early in the course of this disease?", "answer": "Indomethacin", "meta_info": "step2&3", "answer_idx": "B", "A": "Infliximab", "B": "Indomethacin", "C": "Methotrexate", "D": "Sulfasalazine", "language": "en"}
{"question": "A 24-year-old woman visits the health services of her university for vaginal itching, dysuria, pelvic discomfort, and foul-smelling vaginal discharge. She states this is the eighth time she has had such symptoms within the last year, for which she and her sexual partners have received multiple courses of doxycycline and ceftriaxone or azithromycin and ceftriaxone. A pelvic examination showed a mucopurulent cervical discharge with cervical friability. A vaginal wet-mount showed an elevated number of polymorphonuclear leukocytes. What is the most likely cause of this patient’s cervicitis?", "answer": "Mycoplasma genitalium", "meta_info": "step1", "answer_idx": "C", "A": "Chlamydia trachomatis", "B": "Mycoplasma hominis", "C": "Mycoplasma genitalium", "D": "Neisseria gonorrhoeae", "language": "en"}
{"question": "A previously healthy 11-month-old boy is brought to the emergency department for the evaluation of abdominal pain and vomiting. His mother states that over the past 6 hours he has been having intermittent episodes of inconsolable crying, during which he “grabs his abdomen and draws up his legs.” These episodes have been accompanied by nonbloody, nonbilious vomiting and reddish, mucoid bowel movements. He appears sleepy. His temperature is 38.1°C (100.6°F), blood pressure 100/60 mm Hg, pulse is 110/min, and respirations are 24/min. He cries when his abdomen is palpated. The remainder of the examination shows no abnormalities. A complete blood count shows a leukocyte count of 12,000/mm3. Serum electrolyte levels are within normal limits. An abdominal x-ray shows no free air. An abdominal ultrasonography is shown. Which of the following is the most appropriate next step in management?", "answer": "Air enema", "meta_info": "step2&3", "answer_idx": "A", "A": "Air enema", "B": "Appendectomy", "C": "Technetium-99m pertechnetate scan", "D": "Pyloromyotomy", "language": "en"}
{"question": "A 68-year-old man comes to the physician because of a 4-month history of bad breath and progressive difficulty swallowing solid food. Physical examination shows no abnormalities. An upper endoscopy is performed and a photomicrograph of a biopsy specimen obtained from the mid-esophagus is shown. Which of the following best explains the findings in this patient?", "answer": "Neoplastic proliferation of squamous epithelium", "meta_info": "step1", "answer_idx": "C", "A": "Atrophy and fibrosis of the esophageal smooth muscle", "B": "Metaplastic transformation of esophageal mucosa", "C": "Neoplastic proliferation of squamous epithelium", "D": "Eosinophilic infiltration of the esophageal walls\n\"", "language": "en"}
{"question": "A 43-year-old woman comes to the physician because of a 2-month history of progressive muscle pain and stiffness that worsens with exercise. She also has difficulty climbing stairs, getting out of chairs, and putting things on shelves or in cupboards. She has had constipation, occasional headaches, and a 9-kg (20-lb) weight gain during the past year. She has hypertension controlled with atenolol and amlodipine. She has used calamine lotion for the past 6 months for dry skin. Her pulse is 80/min and her blood pressure is 138/76 mm Hg. Physical examination shows weakness of the proximal muscle groups. She has delayed tendon reflex relaxation, with a mounding of the muscle surface occurring just before relaxation. Creatine kinase level is 3,120 U/L. Which of the following is the most appropriate next step in diagnosis?", "answer": "Serum TSH levels", "meta_info": "step2&3", "answer_idx": "A", "A": "Serum TSH levels", "B": "Acetylcholine receptor antibody testing", "C": "Serum potassium levels", "D": "Temporal artery biopsy", "language": "en"}
{"question": "A 34-year-old woman comes to the physician because of a rapidly growing lump in her right breast. Eight months ago, she underwent excision of a liposarcoma from the dorsum of her right forearm. Her brother was diagnosed with osteosarcoma of the maxilla at the age of 22 years. Her mother died at the age of 43 years from complications of acute myeloid leukemia. She has smoked a pack of cigarettes daily for 7 years. Examination shows a fixed, firm mass in the right breast with axillary lymphadenopathy. A biopsy of the mass confirms the diagnosis of invasive ductal carcinoma. Which of the following genetic principles is most likely responsible for this patient's condition?", "answer": "Loss of heterozygosity in tumor suppressor gene", "meta_info": "step1", "answer_idx": "A", "A": "Loss of heterozygosity in tumor suppressor gene", "B": "Methylation of a previously normal gene copy", "C": "Oncogenic transformation of a previously normal gene", "D": "Chronic exposure to carcinogenic material", "language": "en"}
{"question": "A 31-year-old woman comes to the doctor because of episodic nosebleeds and gingival bleeding for the past 2 weeks. She has no history of serious illness and takes no medications. She is sexually active with two male partners and uses condoms inconsistently. Vital signs are within normal limits. Examination shows punctate, non-blanching macules on the chest. The remainder of the examination shows no abnormalities. The hemoglobin concentration is 13.1 g/dL, leukocyte count is 6600/mm3, and platelet count is 28,000/mm3. A peripheral blood smear shows reduced platelets with normal morphology. HIV test is negative. Which of the following is the most appropriate next step in management?", "answer": "Hepatitis C antibody testing", "meta_info": "step2&3", "answer_idx": "C", "A": "Blood cultures", "B": "D-dimer testing", "C": "Hepatitis C antibody testing", "D": "Anti-platelet antibody testing", "language": "en"}
{"question": "A 40-year-old woman presents to the clinic for hair loss. She was in her usual state of health until earlier this month when she started noticing more and more hair on her pillow in the morning. The problem has only been getting worse since then; she's even started pulling out clumps of hair when she shampoos in the morning. She has no other symptoms, and her past medical history is unremarkable. The physical exam is notable for smooth, circular, non-scarring, hairless patches across her scalp. A firm tug on a bundle of hair causes almost all of the hair to be removed. Which of the following is the most likely diagnosis?", "answer": "Alopecia areata", "meta_info": "step2&3", "answer_idx": "A", "A": "Alopecia areata", "B": "Secondary syphilis", "C": "Tinea capitis", "D": "Trichotillomania", "language": "en"}
{"question": "A 2-day-old girl born at 32 weeks gestation to a 42-year-old woman is being examined by a resident. The examination reveals a very small head circumference with low set ears, a prominent occiput, and a comparatively small mandible. A picture of the infant’s fist is given below. A bilateral foot deformity is present. Which of the following is the most likely karyotype abnormality in this infant?", "answer": "Trisomy 18", "meta_info": "step1", "answer_idx": "C", "A": "47, XXX", "B": "Trisomy 21", "C": "Trisomy 18", "D": "47, XXY", "language": "en"}
{"question": "A 44-year-old male is brought to the physician by his father. Over the past year, the patient has become progressively forgetful and withdrawn. He frequently has trouble remembering names of acquaintances, and has been requiring increasing amounts of assistance with getting dressed, cooking, and personal hygiene. He was diagnosed with a genetic disorder during infancy. Physical examination shows prominent epicanthal folds, low-set small ears, and a protruding tongue. Mental examination shows significant deficits in short- and long-term memory. This patient's cognitive symptoms are most likely the result of which of the following neuropathologic changes?", "answer": "Extracellular accumulation of amyloid plaques", "meta_info": "step1", "answer_idx": "D", "A": "Intracellular aggregations of alpha-synuclein", "B": "Multifocal deposition of excess copper", "C": "Synaptic build-up of abnormal prion protein", "D": "Extracellular accumulation of amyloid plaques", "language": "en"}
{"question": "A previously healthy 75-year-old man comes to the physician with a 6-month history of fatigue, weight loss, and abdominal pain. He drinks 2 oz of alcohol on the weekends and does not smoke. He is retired but previously worked in a factory that produces plastic pipes. Abdominal examination shows right upper quadrant tenderness; the liver edge is palpable 2 cm below the ribs. A liver biopsy specimen shows pleomorphic spindle cells that express PECAM-1 on their surface. Which of the following is the most likely diagnosis?", "answer": "Angiosarcoma", "meta_info": "step1", "answer_idx": "C", "A": "Cavernous hemangioma", "B": "Kaposi sarcoma", "C": "Angiosarcoma", "D": "Cholangiocarcinoma\n\"", "language": "en"}
{"question": "A 28-year-old man is brought to the emergency department 20 minutes after being involved in a bicycling accident. He complains of severe pain over the front of his right shoulder. He refuses to move his right arm. Physical examination shows supraclavicular swelling and bruising. The shoulder's range of motion is limited by pain. An x-ray of the shoulder shows a fracture of the middle third of the clavicle with complete superior displacement of the medial clavicular segment. Which of the following muscles is responsible for the displacement of this segment?", "answer": "Sternocleidomastoid", "meta_info": "step1", "answer_idx": "D", "A": "Trapezius", "B": "Subclavius", "C": "Pectoralis major", "D": "Sternocleidomastoid", "language": "en"}
{"question": "A 49-year-old woman presents to her oncologist with progressive difficulty breathing at rest, decreased exercise tolerance, and ankle swelling bilaterally for the past 2 weeks. She was diagnosed with breast cancer 4 years ago which was treated with radical mastectomy, radiation, and aggressive chemotherapy. She does not smoke or drink alcohol. Her family history is positive for breast cancer in her elder sister. Vital signs include: blood pressure 85/50 mm Hg, temperature 36.7°C (98.1°F), and a regular pulse of 110/min. The physician notices that, with inspiration, the radial pulse becomes weak. On physical examination, she looks anxious and tachypneic. Jugular venous pressure is 14 cm and heart sounds are distant. Lungs are clear and 1+ pedal edema is noted. Her chest X-ray is shown in the exhibit. Echocardiography of this patient will most likely show which of the following?", "answer": "Impairment of both early and late diastolic filling with respiratory variation of ventricular filling", "meta_info": "step2&3", "answer_idx": "B", "A": "Rapid early diastolic filling and impaired late diastolic filling", "B": "Impairment of both early and late diastolic filling with respiratory variation of ventricular filling", "C": "Abnormal myocardial texture, and restrictive diastolic dysfunction", "D": "Dilated left and/or right ventricle and low ejection fraction", "language": "en"}
{"question": "A 5-year-old boy is brought to the physician because of high-grade fever and generalized fatigue for 5 days. Two days ago, he developed a rash on his trunk. He returned from a family hiking trip to Montana 1 week ago. His immunization records are unavailable. His temperature is 39.8°C (103.6°F), pulse is 111/min, and blood pressure is 96/60 mm Hg. Examination shows injection of the conjunctivae bilaterally. The tongue and pharynx are erythematous. Tender cervical lymphadenopathy is present on the left. There is a macular rash over the trunk and extremities. Bilateral knee joints are swollen and tender; range of motion is limited by pain. Cardiopulmonary examination shows no abnormalities. Which of the following is the most likely diagnosis?", "answer": "Kawasaki disease\n\"", "meta_info": "step2&3", "answer_idx": "D", "A": "Staphylococcal scalded skin syndrome", "B": "Juvenile idiopathic arthritis", "C": "Granulomatosis with polyangiitis", "D": "Kawasaki disease\n\"", "language": "en"}
{"question": "A 61-year-old female presents to the emergency room for a headache and vision loss. She reports a 3-hour history of acute-onset dull headache. She also says she cannot see out of part of her eye. Her past medical history is notable for hypertension, hyperlipidemia, and a prior myocardial infarction. She takes enalapril, atorvastatin, aspirin, and metoprolol. On exam, she is alert and oriented to person, place, and time. She has 5/5 strength and full sensation to light touch in her bilateral upper and lower extremities. Her brachioradialis, triceps, patellar, and Achilles reflexes are symmetric and 2+ bilaterally. Fundoscopic examination reveals a normal retina. Visual field examination demonstrates an inability to see in the superior right visual field. This patient’s condition is likely due to a lesion in which of the following locations?", "answer": "Temporal lobe", "meta_info": "step1", "answer_idx": "D", "A": "Optic nerve", "B": "Pituitary gland", "C": "Parietal lobe", "D": "Temporal lobe", "language": "en"}
{"question": "A 37-year-old G2P1001 presents to her obstetrician’s office at 31 weeks gestation for decreased fetal movement over the last day. She states that although she occasionally feels some movement, it is decreased from baseline. She denies any gush of fluid, vaginal bleeding, or painful contractions. This pregnancy has been complicated by gestational diabetes for which the patient was prescribed insulin. She reports not always taking postprandial fingersticks; therefore, she infrequently uses her insulin. She also had a urinary tract infection in the first trimester that was successfully treated with nitrofurantoin. The patient has a past medical history of obesity and rosacea, and she had an uncomplicated spontaneous vaginal delivery six years ago. At this visit, the patient’s temperature is 98.6°F (37.0°C), blood pressure is 148/71 mmHg, pulse is 75/min, and respirations are 14/min. The patient appears comfortable and has a fundal height of 33 centimeters. An initial attempt with Doppler ultrasound is unable to detect fetal heart tones. Which of the following is the best next step in management?", "answer": "Non-stress test", "meta_info": "step2&3", "answer_idx": "A", "A": "Non-stress test", "B": "Biophysical profile", "C": "Contraction stress test", "D": "Cervical exam", "language": "en"}
{"question": "A 59-year-old man is brought to the emergency department by his wife because of fever, chills, night sweats, and generalized fatigue for 2 weeks. His temperature is 39.1°C (102.4°F). He appears ill. Physical examination shows a grade 3/6 mid-diastolic murmur at the left sternal border, and crackles at both lung bases. A transesophageal echocardiography shows a 12 mm vegetation on the aortic valve. Blood cultures show gram-positive, catalase-negative, gamma-hemolytic cocci in chains that are unable to grow in a 6.5% NaCl medium. Which of the following is the most likely predisposing factor for this patient’s current condition?", "answer": "Colon cancer", "meta_info": "step1", "answer_idx": "B", "A": "Periodontal disease", "B": "Colon cancer", "C": "Valve replacement", "D": "Urinary tract infection", "language": "en"}
{"question": "A 65-year-old woman presents to her family doctor to reestablish care since her retirement from her corporate job and loss of her employer-sponsored health insurance. She states that she has not had time for regular check-ups. She exercises 3-4 times a week and consumes red meat sparingly. She drank and smoked cigarettes socially with coworkers but never at home or on vacation. She wakes up with achy wrists and elbows that she suspects is from years of using a computer keyboard. She completed menopause at age 52. Her family history is notable for coronary artery disease on her father's side and colon cancer on her mother's side. She last had a colonoscopy 5 years ago that revealed no abnormal findings. Her vital signs are within normal limits and her physical exam is grossly unremarkable. What diagnostic test should this patient receive?", "answer": "Mammography", "meta_info": "step2&3", "answer_idx": "C", "A": "Chest radiograph", "B": "Colonoscopy", "C": "Mammography", "D": "Pelvic ultrasound", "language": "en"}
{"question": "A 52-year-old woman comes to the physician because of mild fatigue and dizziness for the past 2 days. She has not been to work since yesterday due to her symptoms. She says she has \"\"very high blood sugar” and has had similar episodes often in the past 2 years, for which she has visited multiple doctors around the city. She has also purchased a home glucose monitoring device, which she uses daily. Since the symptoms began, she has become socially withdrawn and spends much of her time at home researching diabetes on the internet. One week ago, she took a day off work because of her symptoms. She is not on any treatment. She has had 3 laboratory test reports that all show normal fasting and post-meal blood glucose levels. Her father and brother have diabetes mellitus type 2. She appears anxious. Vital signs are normal. Physical examination shows no abnormalities. Random serum glucose is 128 mg/dL. Which of the following is the most likely explanation for this patient's symptoms?\"", "answer": "Illness anxiety disorder", "meta_info": "step2&3", "answer_idx": "C", "A": "Somatic symptom disorder", "B": "Unipolar major depression", "C": "Illness anxiety disorder", "D": "Impaired glucose homeostasis", "language": "en"}
{"question": "A 4800 g (10.6 lb) male newborn is delivered at term to a 35-year-old woman, gravida 1, para 1. Significant lateral neck traction is required during delivery. Apgar scores are 9 and 9 at 1 and 5 minutes, respectively. Vital signs are within normal limits. At rest, his right shoulder is adducted and internally rotated. The baby cries with passive movement of the arm. Laboratory studies show:\nHematocrit 66%\nLeukocyte count 9000/mm3\nSerum\nNa+ 142 mEq/L\nCl- 103 mEq/L\nK+ 5.1 mEq/L\nHCO3- 20 mEq/L\nUrea nitrogen 8 mg/dL\nGlucose 34 mg/dL\nCreatinine 0.6 mg/dL\nWhich of the following is most likely to have prevented this infant's condition?\"", "answer": "Administration of insulin", "meta_info": "step2&3", "answer_idx": "B", "A": "Avoidance of soft cheeses", "B": "Administration of insulin", "C": "Abstinence from cocaine", "D": "Avoidance of cat feces", "language": "en"}
{"question": "A 30-year-old woman comes to the physician for evaluation of successful conception. She and her husband are trying to conceive, and they have had frequent sexual intercourse over the past month. Her menstrual cycles occur at regular 28-day intervals, and her last menstrual period began 25 days ago. Which of the following is the most sensitive test for diagnosing pregnancy at this time?", "answer": "Serum testing", "meta_info": "step1", "answer_idx": "A", "A": "Serum testing", "B": "Transvaginal ultrasound", "C": "Transabdominal Doppler ultrasound", "D": "Urine testing", "language": "en"}
{"question": "A 25-year-old healthy man presents to the physician for an annual checkup. He doesn’t have any concerns and feels completely healthy. He recently started a new job and has been working out at a gym regularly. He does not smoke cigarettes, drinks occasionally, and does not use illicit substances. His vital signs include: pulse 80/min, respirations 14/min, and blood pressure 120/80 mm Hg. Physical examination is significant for a splitting of the second heart sound heard on inspiration but not on expiration. Which of the following is also most likely associated with the auscultatory findings in this patient?", "answer": "Increased right ventricular output", "meta_info": "step1", "answer_idx": "C", "A": "Decreased venous return", "B": "Increased intrapleural pressure", "C": "Increased right ventricular output", "D": "Increased systemic blood pressure", "language": "en"}
{"question": "A 79-year-old man presents to his primary care physician complaining of progressive shortness of breath on exertion for the past 2 months. He was first aware of having to catch his breath while gardening, and he is now unable to walk up the stairs in his house without stopping. He has had type 2 diabetes mellitus for 30 years, for which he takes metformin and sitagliptin. His blood pressure is 110/50 mm Hg, the temperature is 37.1°C (98.8°F), and the radial pulse is 80/min and regular. On physical examination, there is a loud systolic murmur at the right upper sternal border with radiation to the carotid arteries. Which of the following will increase the intensity of this patient’s murmur?", "answer": "Squatting", "meta_info": "step2&3", "answer_idx": "A", "A": "Squatting", "B": "Standing up from a sitting position", "C": "Diuretics", "D": "Volume depletion", "language": "en"}
{"question": "A 47-year-old woman presents with intermittent throbbing headaches. She says that she has had at least 1–2 every week for the last 3 months. She describes the pain as severe, pulsatile, and localized to the right frontotemporal and periorbital areas. She says the headaches usually last for several hours and are made worse by the presence of light. She endorses nausea with occasional vomiting during the most severe episodes. She denies any seizures, loss of consciousness, or focal neurologic deficits. Her past medical history is significant for myocardial infarction (MI) 1 year ago, status post percutaneous transluminal coronary angioplasty complicated by residual angina, and severe asthma, managed medically. The patient is afebrile, and the vital signs are within normal limits. A physical examination is unremarkable. A noncontrast computed tomography (CT) scan of the head appears normal. Which of the following is the best prophylactic treatment for this patient’s most likely diagnosis?", "answer": "Valproic acid", "meta_info": "step2&3", "answer_idx": "B", "A": "Amitriptyline", "B": "Valproic acid", "C": "Propranolol", "D": "Ibuprofen", "language": "en"}
{"question": "A 37-year-old 11-week primigravida will soon undergo a prenatal evaluation. The doctor wants to exclude chromosomal abnormalities with a test. He tells her that the test includes extracting a blood sample to determine the chances of having certain genetic conditions. This process involves analyzing fetal DNA in the mother’s blood. What conditions can the given test predict?", "answer": "Trisomy 21, trisomy 13, trisomy 18, fetal sex", "meta_info": "step1", "answer_idx": "B", "A": "Trisomy 21, Ebstein anomaly", "B": "Trisomy 21, trisomy 13, trisomy 18, fetal sex", "C": "Trisomy 21, trisomy 13, spina bifida", "D": "Trisomy 21, spina bifida", "language": "en"}
{"question": "A 41-year-old man presents with progressive fatigue, pain in the front of the chest, and difficulty breathing with minimal exertion while trying to sleep. He reports having a flu-like illness consisting of fatigue, muscle pain, and cough 10 days ago that resolved spontaneously without seeking a medical help. He has no past medical history. He does not smoke cigarettes or drink alcohol. His vital signs include a blood pressure of 100/70 mm Hg, a temperature of 37.5°C (99.5°F), and a regular radial pulse of 105/min. On physical examination, the patient looks tired, the jugular venous pressure is elevated, pulmonary rales are present on both sides, and an S3 gallop is audible. His ECG shows nonspecific ST-segment and T-wave abnormalities. A 2-dimensional echocardiogram shows global left ventricular motion abnormalities and dilatation of the left ventricle. Troponin I  and Creatine Kinase-MB are elevated. Which of the following is the most likely mechanism of the patient illness?", "answer": "Viral-mediated inflammation with local and systemic immunological activation", "meta_info": "step2&3", "answer_idx": "B", "A": "Rupture of an atherosclerotic plaque in the coronary artery", "B": "Viral-mediated inflammation with local and systemic immunological activation", "C": "Infection of the endocardial surface of the heart with microembolization and immune complex deposition", "D": "Immune-mediated inflammation of the heart triggered by a preceding streptococcal infection", "language": "en"}
{"question": "A group of epidemiologists is studying the rates of cardiac surgeries performed in several Southeast Asian countries compared to the United States. Results show a significant increase in the number of mitral valve replacements performed in Vietnam in adults aged 30–50 years compared to the same age group in the United States. Which of the following public health interventions is most likely to decrease this number?", "answer": "Prompt antibiotic treatment for bacterial pharyngitis", "meta_info": "step1", "answer_idx": "A", "A": "Prompt antibiotic treatment for bacterial pharyngitis", "B": "Improved access to drug rehabilitation centers", "C": "Genetic screening program for FBN1 gene mutation", "D": "Screening echocardiography for prolapsed anterior mitral valve leaflets", "language": "en"}
{"question": "A 31-year-old male presents to his primary care physician complaining of low back pain and fevers. He reports a four-day history of intermittent fevers, chills, and low back pain. He denies trauma or recent illness. His past medical history is notable for recurrent renal stones, diabetes mellitus, and alcohol abuse. He takes metformin but admits to missing several doses. He has had multiple sexual partners and uses condoms intermittently. His temperature is 100.6°F (38.1°C), blood pressure is 110/70 mmHg, pulse is 110/min, and respirations are 21/min. On examination, he demonstrates mild tenderness to palpation along his lower back. Sensation to touch is intact in the bilateral lower extremities. Strength in leg and hip flexion and extension is 5/5 bilaterally. The physician is unable to perform a digital rectal examination due to pain. A urinalysis demonstrates leukocytes. Which of the following treatment regimens is most appropriate in this patient?", "answer": "Ceftriaxone and doxycycline", "meta_info": "step1", "answer_idx": "D", "A": "Ampicillin and gentamicin", "B": "Ciprofloxacin and trimethroprim-sulfamethoxazole", "C": "Terazosin", "D": "Ceftriaxone and doxycycline", "language": "en"}
{"question": "A 12-year-old boy is brought to his pediatrician in order to be medically cleared for playing baseball. On presentation, the boy’s only complaint is that he has never been able to completely keep up with his classmates during gym or on the playground because he feels fatigued and short of breath. A review of his prior medical history reveals that he hit all his developmental milestones as expected and has otherwise been healthy. He lives with his parents and eats a diet consisting of mostly fast food and soda. Physical exam reveals a thin, pale boy with decreased color under his eyelids. A panel of hematologic tests are obtained with the following results:\n\nHemoglobin: 11 g/dL\nLeukocyte count: 4,250/mm^3\nPlatelet count: 185,000/mm^3\nMean corpuscular volume: 116 µm^3\nBlood smear: neutrophils with extra lobes\n\nCrystals are also found within this patient's urine. Which of the following treatments would be effective for this patient’s most likely condition?", "answer": "Administration of uridine", "meta_info": "step1", "answer_idx": "A", "A": "Administration of uridine", "B": "Administration of purine", "C": "Cobalamin supplementation", "D": "Folate supplementation", "language": "en"}
{"question": "A 27-year-old woman presents to her primary care physician for a follow-up appointment. At her previous visit she had missed her previous two menses and also had a blood pressure of 147/100 mmHg. The patient has a past medical history of anxiety, depression, bulimia nervosa and irritable bowel syndrome. Her physician prescribed her an exercise program as well as started her on hydrochlorothiazide and ordered lab work. The results of the patient's lab work are below:\n\nSerum:\nNa+: 145 mEq/L\nK+: 2.9 mEq/L\nCl-: 100 mEq/L\nHCO3-: 30 mEq/L\nBUN: 18 mg/dL\nCa2+: 10.9 mg/dL\nMg2+: 2.0 mEq/L\nCreatinine: 1.2 mg/dL\nGlucose: 110 mg/dL\n\nThe patient's blood pressure at this visit is 145/100 mmHg and she has still not experienced her menses. Her cardiac, abdominal, and pulmonary exams are within normal limits. Inspection of the patient's oropharynx is unremarkable as is inspection of her extremities. The patient is started on furosemide and sent home. Which of the following is the most likely cause of this patient's presentation?", "answer": "Increased mineralocorticoid production", "meta_info": "step2&3", "answer_idx": "A", "A": "Increased mineralocorticoid production", "B": "Vomiting", "C": "Increased reabsorption at the collecting duct", "D": "Decreased renal artery blood flow", "language": "en"}
{"question": "A 59-year-old man is brought to the emergency room by his wife. Thirty minutes ago, he was carrying heavy moving boxes from his house to a truck when he felt short of breath and suddenly lost consciousness. His wife states that he fell to the ground and was unresponsive for 15 seconds before he regained consciousness. He was not confused after this episode. He does not have chest pain. On questioning, he recalls experiencing episodic shortness of breath and chest tightness while playing tennis over the past year. These symptoms resolved with rest. He has no personal history of serious illness and takes no medication. Vital signs are within normal limits. His temperature is 36.7°C (98°F), heart rate is 95/min and pulse is delayed but regular, respirations are 20/min, and blood pressure is 104/80 mm Hg. Which of the following is most likely to confirm the diagnosis?", "answer": "Echocardiogram", "meta_info": "step2&3", "answer_idx": "B", "A": "CT angiography", "B": "Echocardiogram", "C": "Cardiac enzymes", "D": "Electroencephalogram\n\"", "language": "en"}
{"question": "A previously healthy 2-year-old girl is brought to the physician by her mother because of a dry, harsh cough for 2 days that worsens at night. She has also had mild rhinorrhea and fever. Her older brother has asthma and had a cold last week. Immunizations are up-to-date. She appears to be in mild distress. Her temperature is 38.1°C (100.5°F), pulse is 140/min, respirations are 35/min, and blood pressure is 99/56 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 96%. Examination shows clear rhinorrhea and a dry, hoarse cough. There is mild inspiratory stridor upon agitation that resolves with rest. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate initial step in treatment?", "answer": "Cool mist and dexamethasone", "meta_info": "step2&3", "answer_idx": "D", "A": "Ceftriaxone", "B": "Bronchoscopy", "C": "Chest x-ray", "D": "Cool mist and dexamethasone", "language": "en"}
{"question": "A 78-year-old man comes to the physician for evaluation of progressive hearing loss in both ears over the past year. He has difficulties understanding conversations in crowded places and when more than one person talks at the same time. He has no dizziness, ear discharge, ringing noise, or ear pain. He has a history of hypertension, hypercholesterolemia, and type 2 diabetes mellitus. Medications include enalapril, metformin, and atorvastatin. Vital signs are within normal limits. Otoscopic examination shows pearly gray, translucent tympanic membranes with a normal light reflex. A vibrating 512 Hz tuning fork is placed on the left mastoid process. Once the patient no longer hears a tone, the fork is held over the ipsilateral ear and the patient reports to hear the tone again. The same test is repeated on the right side with similar results. There is no lateralization when a vibrating 512 Hz tuning fork is placed in the middle of the forehead. Which of the following is the most likely diagnosis?", "answer": "Presbycusis", "meta_info": "step2&3", "answer_idx": "D", "A": "Cerumen impaction", "B": "Ototoxicity", "C": "Vestibulocochlear nerve damage", "D": "Presbycusis", "language": "en"}
{"question": "A 35-year-old woman, gravida 3, para 2, at 37 weeks' gestation comes to the physician for a prenatal visit. She feels well. She states that she did not follow up with her gynecologist on a regular basis due to a busy work schedule. Pregnancy and delivery of her first two children were uncomplicated. Her blood pressure was 127/75 mm Hg at her initial obstetrics appointment. Her temperature is 37.2°C (99°F), pulse is 90/min, and blood pressure is 145/95 mm Hg. Pelvic examination shows a uterus consistent in size with a 37-week gestation. Physical examination shows 2+ edema in the lower extremities. Urinalysis shows:\nBlood negative\nProtein 3+\nRBC 1–2/hpf\nRBC casts negative\nAfter four hours of observation, her vital signs are unchanged. Which of the following is the most appropriate next step in management?\"", "answer": "Induce labor", "meta_info": "step2&3", "answer_idx": "A", "A": "Induce labor", "B": "Administration of methyldopa", "C": "Reassurance", "D": "Fetal monitoring with continuous cardiotocography", "language": "en"}
{"question": "A 31-year-old presents with self-described complaints of being \"fidgety and irritable\" that is unlike his \"calm personality a few years ago\". What is concerning to him is that his father was diagnosed with a similar condition at the age of 38. His father began a progressive decline - losing interest in his life and family, becoming messy, experiencing involuntary movements, and worsening dementia as he grew older. Genetic tests were performed on the patient which confirmed that he has a larger number of repeats than his father. He is concerned that the disease may begin earlier for him or may have already started. Which of the following trinucleotide repeats is found in this disease?", "answer": "CAG", "meta_info": "step1", "answer_idx": "A", "A": "CAG", "B": "CTG", "C": "GAA", "D": "UGA", "language": "en"}
{"question": "A 48-year-old woman comes to the physician because of a 3-month history of low-grade fever, unintentional weight loss, night sweats, and a right-sided neck mass. Examination shows pallor. There is a non-tender and immobile right-sided cervical mass and enlarged axillary and inguinal lymph nodes. The liver is palpated 4 cm below the right costal margin, and the spleen is palpated 3 cm below the left costal margin. Histopathologic examination of a cervical lymph node biopsy specimen shows a nodular proliferation of centrocytes and centroblasts that stain positive for CD20. Genetic analysis shows a reciprocal translocation of chromosomes 14 and 18. This patient's condition is most likely caused by mutation of an oncogene that encodes for a protein involved in which of the following cellular processes?", "answer": "Inhibition of programmed cell death", "meta_info": "step1", "answer_idx": "D", "A": "Hydrolysis of guanosine triphosphate", "B": "Upregulation of cytokine receptor binding", "C": "Transfer of phosphate from ATP to cellular protein", "D": "Inhibition of programmed cell death", "language": "en"}
{"question": "A 59-year-old man is brought to the emergency department for changes in mental status. His wife noticed that since lunch time today, he has been “zoning out” and forgetting simple things such as where the bathroom is. She decided to call the ambulance as he got uncharacteristically violent during dinner when he threw his plate to the floor. The patient denies fevers, weight loss, chills, chest pain, or shortness of breath, but reports mild abdominal discomfort and some dark stools that he attributes to iron supplements. A physical examination demonstrates a moderate fluid wave of the abdomen and shaking of the hands while the wrists are extended. What is the mechanism of action of the medication that can treat this patient’s condition?", "answer": "Trapping of ammonia in the colon", "meta_info": "step1", "answer_idx": "D", "A": "Antagonist against 5-HT3", "B": "Long-acting somatostatin analog", "C": "Mu-opioid receptor agonist", "D": "Trapping of ammonia in the colon", "language": "en"}
{"question": "An otherwise healthy 49-year-old man presents to his primary care doctor for routine screening. He does not have any symptoms and take no medications. He has smoked 15–20 cigarettes daily for the past 9 years. His father died of diabetes complications and his mother has been recently diagnosed with proliferative diabetic retinopathy. His blood pressure is 160/95 mm Hg, temperature is 36.9°C (98.4°F), pulse is 90/min, body mass index is 36 kg/m², fasting blood sugar 170 mg/dL, and A1c is 9%. Which of the following manifestations is more specific for this patient’s condition?", "answer": "Acanthosis nigricans", "meta_info": "step2&3", "answer_idx": "C", "A": "Kussmaul respiration", "B": "Unintentional weight loss", "C": "Acanthosis nigricans", "D": "Polyurea", "language": "en"}
{"question": "A 30-year-old woman is brought to the emergency department because of severe headache and vomiting that started after she was hiking in the mountains at high altitude. She normally lives in a city that is close to sea level. Therapy is initiated with a drug that alkalinizes the urine. Which of the following is the most likely site of action of this drug in the kidney?", "answer": "Proximal convoluted tubule", "meta_info": "step1", "answer_idx": "A", "A": "Proximal convoluted tubule", "B": "Ascending loop of Henle", "C": "Glomerulus", "D": "Early distal convoluted tubule", "language": "en"}
{"question": "A 35-year-old woman comes to employee health services 30 minutes after a work-related incident. She works as a phlebotomist and reports that blood splashed into her right eye when she was drawing blood from a 30-year-old male patient. Immediately following the incident, she flushed her eye with water for several minutes. The patient from whom she drew blood was admitted for hemoptysis, weight loss, and night sweats. He is an intravenous drug user and is sexually active with several male and female partners. The phlebotomist has no history of serious illness and takes no medications. Her immunizations are up-to-date. Physical examination shows no abnormalities. In addition to drawing her blood for viral serologies, which of the following is the most appropriate next step?", "answer": "Start raltegravir, tenofovir, and emtricitabine", "meta_info": "step2&3", "answer_idx": "A", "A": "Start raltegravir, tenofovir, and emtricitabine", "B": "Start zidovudine", "C": "Start tenofovir and emtricitabine", "D": "Administer hepatitis B immune globulin and vaccine", "language": "en"}
{"question": "A 65-year-old Asian woman comes to the physician for a routine health maintenance examination. On questioning, she has had occasional night sweats during the past 2 months. She has not had fevers or weight loss. Seven months ago, she had an acute myocardial infarction and was treated with percutaneous coronary intervention. She has hypertension, hyperlipidemia, and gastroesophageal reflux disease. She has smoked one pack of cigarettes daily for 37 years. Current medications include aspirin, atorvastatin, ramipril, metoprolol, and esomeprazole. She is 178 cm (5 ft 10 in) tall and weighs 89 kg (207 lbs); BMI is 29.7 kg/m2. Her temperature is 37.4°C (99.3°F), pulse is 84/min, respirations are 18/min, and blood pressure is 145/80 mm Hg. The lungs are clear to auscultation. Cardiac examination shows an S4. There is a nontender skin lesion near the right large toenail. A photograph of the lesion is shown. The remainder of the examination shows no abnormalities. Which of the following is the most likely diagnosis?", "answer": "Malignant melanoma", "meta_info": "step2&3", "answer_idx": "B", "A": "Traumatic subungual hemorrhage", "B": "Malignant melanoma", "C": "Onychomycosis", "D": "Squamous cell carcinoma", "language": "en"}
{"question": "A 12-year-old girl brought to the clinic by her mother has a 3-day history of fever and sore throat and hematuria since this morning. The patient’s mother says she had a fever up to 39.5℃ (103.1℉) for the last 3 days and a severe sore throat, which has improved slightly. The mother states that she noticed her daughter had red urine today. The patient’s temperature is 39.3℃ (102.8℉), pulse is 89/min, respiratory rate is 25/min, and blood pressure is 109/69 mm Hg. On physical examination, her pharynx is erythematous. There is significant swelling of the tonsils bilaterally, and there is a white exudate covering them. Ophthalmologic examination reveals evidence of conjunctivitis bilaterally. Otoscopic examination is significant for gray-white tympanic membranes bilaterally. The remainder of the exam is unremarkable. A urine dipstick is performed and shows the following results:\nUrine Dipstick\nSpecific Gravity 1.019\nGlucose None\nKetones None\nNitrites Negative\nLeukocyte Esterase Negative\nProtein None\nBlood 3+\n Which of the following microorganisms is the most likely cause of this patient’s symptoms?", "answer": "Adenovirus", "meta_info": "step2&3", "answer_idx": "B", "A": "Streptococcus pyogenes", "B": "Adenovirus", "C": "Escherichia coli O157:H7", "D": "Proteus mirabilis", "language": "en"}
{"question": "A 73-year-old woman with a past medical history of diabetes, hypertension, and hyperlipidemia presents to the emergency department with swelling in her left neck. The onset was a few months ago. She has lost 6.8 kg (15.0 lb) over the same duration. She denies any fever, night sweats or itching. Physical examination reveals a painless swelling in front of her left ear. There is painless lymphadenopathy below the ear. Biopsy of the lymph nodes reveals mucoepidermoid carcinoma of the parotid gland. Surgery is planned and the tumor is removed while trying to preserve a nerve that could be involved. What physical finding would suggest involvement of the nerve in its course through the parotid gland?", "answer": "Inability to smile on the left side", "meta_info": "step1", "answer_idx": "C", "A": "Loss of taste on the left anterior 2/3 of the tongue", "B": "Hypersensitivity to sound in the left ear", "C": "Inability to smile on the left side", "D": "Numbness of the left cheek", "language": "en"}
{"question": "A 43-year-old man is brought to the emergency department by his wife after a near-syncopal episode. He was doing yard work when he began feeling dizzy and had to lie down. Earlier in the day, he was started on lisinopril. On arrival, he is fully oriented. His pulse is 100/min and blood pressure is 92/60 mm Hg. Serum electrolytes are within normal limits. An ECG shows no evidence of ischemia. Concurrent treatment with which of the following agents most likely predisposed the patient to this episode?", "answer": "Hydrochlorothiazide", "meta_info": "step1", "answer_idx": "B", "A": "Ibuprofen", "B": "Hydrochlorothiazide", "C": "Lithium", "D": "Trimethoprim/sulfamethoxazole", "language": "en"}
{"question": "A 4-year-old Caucasian girl previously diagnosed with asthma presents with recurrent sinusitis, otitis media, and clubbing of the nail bed. Family history is significant for a distant cousin with cystic fibrosis. A \"sweat test\" is performed and comes back normal. What additional diagnostic test would be helpful in establishing a diagnosis?", "answer": "Nasal transepithelial potential difference", "meta_info": "step1", "answer_idx": "A", "A": "Nasal transepithelial potential difference", "B": "Skeletal survey", "C": "Complete blood cell count", "D": "Urinalysis", "language": "en"}
{"question": "A 35-year-old woman presents with a complaint of oral ulcers. It is the third recurrence of ulcers in the last 8 months. She is sexually active and complains of dyspareunia. Examination shows the presence of a uveitis. Which of the following would most likely be positive in this patient?", "answer": "HLA-B51", "meta_info": "step1", "answer_idx": "B", "A": "Anti-double stranded (Ds) DNA", "B": "HLA-B51", "C": "ANCA", "D": "HLA-B27", "language": "en"}
{"question": "A 22-year-old female software analyst presents to a medical clinic for evaluation of tingling and numbness in both hands for the past 2 months. Her symptoms are usually aggravated by the end of the work day and absent on most off days. She has been a type I diabetic for 2 years and is currently on insulin. She admits to being sexually active but has had irregular periods for the past 3 months. A urine pregnancy test is negative. What is the most likely cause of this patient’s symptoms?", "answer": "Hypothyroidism", "meta_info": "step1", "answer_idx": "A", "A": "Hypothyroidism", "B": "Acute intermittent porphyria", "C": "Amyotrophic lateral sclerosis", "D": "Multiple sclerosis", "language": "en"}
{"question": "A 60-year-old male presents to his primary care physician complaining of fatigue. He reports a six-month history of gradually worsening tiredness. More recently, he has experienced intermittent fevers and night sweats. His temperature is 99.5°F (37.5°C), blood pressure is 115/80 mmHg, pulse is 80/min, and respirations are 18/min. On examination, painless cervical lymphadenopathy is noted. A lymph node biopsy is performed and karyotypic analysis of the biopsy reveals an 11;14 translocation. What is the normal function of the protein that is overexpressed due to the translocation seen in this patient?", "answer": "Mediate cell cycle transition to S phase", "meta_info": "step1", "answer_idx": "D", "A": "Promote cell growth", "B": "Mediate cell cycle transition to mitosis", "C": "Mediate cell cycle transition to G2 phase", "D": "Mediate cell cycle transition to S phase", "language": "en"}
{"question": "An 8-year-old boy presents with abdominal pain and constipation. The patient’s mother says that the symptoms gradually onset 2 months ago. The patient describes the pain as moderate to severe, gnawing and diffusely localized. No significant past medical history and no current medications. The patient lives in a house built in the 1990s with his parents and has a sister who goes to daycare. His mother mentioned that he is a good student but has been irritable lately, and his homework has been full of careless mistakes. The vital signs include: temperature 37.0°C (98.6°F), blood pressure 100/65 mm Hg, pulse 82/min, respiratory rate 19/min, and oxygen saturation 99% on room air. On physical examination, the patient is alert and cooperative. The abdomen is diffusely tender to palpation with no rebound or guarding. There is a left wrist drop. A nontender, flat bluish line above the gums is noted. Laboratory results are significant for the following:\nSodium 141 mEq/L\nPotassium 4.1 mEq/L\nChloride 101 mEq/L\nBicarbonate 25 mEq/L\nBlood urea nitrogen (BUN) 27 mg/dL\nCreatinine 1.7 mg/dL\nGlucose (fasting) 80 mg/dL\n    White blood cell (WBC) count 8,700/mm3\nRed blood cell (RBC) count 4.20 x 106/mm3\nHematocrit 41.5%\nHemoglobin 10.3 g/dL\nPlatelet count 190,000/mm3\nMean corpuscular volume (MCV) 65 mm3\nLead 72 mcg/dL\nWhich of the following is the most appropriate next step in the management of this patient?", "answer": "Chelation therapy with dimercaprol and calcium disodium edetate (EDTA)", "meta_info": "step2&3", "answer_idx": "C", "A": "Chelation therapy with dimercaptosuccinic acid (succimer)", "B": "Chelation therapy with dimercaprol", "C": "Chelation therapy with dimercaprol and calcium disodium edetate (EDTA)", "D": "Plain abdominal radiographs", "language": "en"}
{"question": "Two days after undergoing a left total hip replacement, a 68-year-old man has increasing shortness of breath and chest pain for 30 minutes. He has type 2 diabetes mellitus and bilateral osteoarthritis of the hips. Prior to admission to the hospital, his medications were metformin and naproxen. His temperature is 37.8°C (100°F), pulse is 110/min, respirations are 30/min, and blood pressure is 106/70 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 89%. The lungs are clear to auscultation. Cardiac examination shows no abnormalities. The right lower extremity is swollen. Right foot flexion in an upward direction causes pain in the right calf. Pedal pulses are palpable. Supplemental oxygen and intravenous fluid resuscitation are begun. His hematocrit is 30%. Arterial blood gas analysis on room air shows:\npH 7.48\npCO2 27 mm Hg\npO2 68 mm Hg\nHCO3- 23 mEq/L\nAn electrocardiogram shows sinus tachycardia and right axis deviation. Which of the following is the most appropriate next step in management?\"", "answer": "Obtain a spiral CT angiogram", "meta_info": "step2&3", "answer_idx": "B", "A": "Administer alteplase", "B": "Obtain a spiral CT angiogram", "C": "Obtain an x-ray of the chest", "D": "Perfom an echocardiography", "language": "en"}
{"question": "An 11-month-old male presents to the emergency department with his father after “passing out” at home. His father reports that the patient started crying after his older brother took a toy away from him. The patient was difficult to soothe and then suddenly stopped breathing. His father reports that his lips turned slightly blue, and the patient’s entire body became limp. The episode lasted a few seconds, and the patient seemed to act normally afterwards. The patient’s father notes that the patient’s older brother had similar episodes as a child. He denies any family history of neurological disease. The patient’s temperature is 98.5°F (36.9°C), blood pressure is 86/64 mmHg, pulse is 98/min, and respirations are 26/min. On physical exam, the patient is in no acute distress playing on his father’s lap. The patient's neurological exam is unremarkable. Which of the following is the best next step in management?", "answer": "Observation and reassurance", "meta_info": "step2&3", "answer_idx": "D", "A": "Arterial blood gas", "B": "Echocardiogram", "C": "Electrocardiogram (ECG)", "D": "Observation and reassurance", "language": "en"}
{"question": "A 27-year-old woman presents to the emergency department for pain in multiple joints. She states that she has had symmetric joint pain that started yesterday and has been worsening. It is affecting her wrists, elbows, and shoulders. She also endorses a subjective fever and some fatigue but denies any other symptoms. The patient works as a schoolteacher and is generally healthy. She is currently sexually active with 2 male partners and uses condoms occasionally. Her temperature is 100°F (37.8°C), blood pressure is 122/85 mmHg, pulse is 88/min, respirations are 14/min, and oxygen saturation is 99% on room air. Her laboratory values are within normal limits. Physical exam is notable for joint stiffness and pain in particular of the metacarpophalangeal (MCP), proximal interphalangeal (PIP), and the wrist. The patient is discharged with ibuprofen. Four weeks later, the patient follows up at her primary doctor and notes that her symptoms have improved and she is no longer taking any medications for symptom control. Which of the following is the most likely diagnosis?", "answer": "Parvovirus B19", "meta_info": "step2&3", "answer_idx": "B", "A": "Gonococcal arthritis", "B": "Parvovirus B19", "C": "Rheumatoid arthritis", "D": "Transient synovitis", "language": "en"}
{"question": "A 57-year-old man with HIV and GERD comes to the emergency department because of productive cough with malodorous phlegm and night sweats for the past week. He has smoked 1 pack of cigarettes daily for 30 years and he drinks 8–10 beers daily. His temperature is 38.9°C (102.0°F). Physical examination shows coarse crackles and dullness to percussion at the right lung base. Scattered expiratory wheezing is heard throughout both lung fields. The CD4+ T-lymphocyte count is 280/mm3 (N ≥ 500). An x-ray of the chest is shown. Which of the following is the most likely cause of this patient's symptoms?", "answer": "Aspiration pneumonia", "meta_info": "step1", "answer_idx": "D", "A": "Bronchiectasis", "B": "Adenocarcinoma in situ", "C": "Tuberculosis", "D": "Aspiration pneumonia", "language": "en"}
{"question": "A 20-year-old woman is brought to the emergency department by her boyfriend for right arm and leg weakness, numbness, and tingling that has been resolving gradually. The symptoms started 4 hours ago after she had an argument with her boyfriend during which she slapped and kicked him. She says she has been limping and cannot use her right arm anymore. She has never had similar symptoms in the past. She has a history of genital herpes and trichotillomania. She is alert and oriented. Physical examination shows upper and lower face symmetry and normal speech. She has 5/5 strength in all extremities and 5/5 right ankle plantar flexion when lying down. She has 4/5 strength in the right arm and leg when ambulating. She cannot stand on her toes when asked. Her deep tendon reflexes are 2+ bilaterally. She has normal proprioception, light touch sensation, and two-point discrimination in all extremities. She has a negative Spurling test. CT of the head without contrast shows no abnormalities. Which of the following is the most appropriate next step in management?", "answer": "Provide patient education", "meta_info": "step2&3", "answer_idx": "B", "A": "Administer alteplase", "B": "Provide patient education", "C": "Prescribe aspirin", "D": "Start biofeedback therapy\n\"", "language": "en"}
{"question": "A 14-year-old female presents to her psychiatrist in hopes that she can find help in dealing with the sexual abuse that occurred in her childhood. While retelling her story of the numerous encounters the patient had with her abuser, the psychiatrist begins to feel protective and parental towards the client, wishing that he could have somehow helped the young girl. Which of the following best describes the feelings that the psychiatrist has for the patient?", "answer": "Countertransference", "meta_info": "step1", "answer_idx": "A", "A": "Countertransference", "B": "Identification", "C": "Sublimation", "D": "Projection", "language": "en"}
{"question": "Which of the following trinucleotide DNA sequences would initiate protein translation when converted to mRNA?\nNote: sequences are written 3'-->5'", "answer": "TAC", "meta_info": "step1", "answer_idx": "A", "A": "TAC", "B": "ATC", "C": "ATT", "D": "AAA", "language": "en"}
{"question": "A 47-year-old woman visits the emergency department due to painful, swollen fingers in both of her hands. She has worked as a bus driver for the county school system for the last 20 years. Her past medical history is significant for a transient ischemic attack 5 years ago. She reports that she has lost weight in the last 2 months although there have been no changes in her diet. She also says that she generally feels fatigued all day. On examination, nodules are seen over her Achilles tendon and both wrists are erythematous, swollen, and tender to touch. Laboratory tests are presented below:\nHemoglobin: 11.0 g/dL\nHematocrit: 40.5%\nLeukocyte count: 7400/mm3\nMean corpuscular volume: 80.1 μm3\nPlatelet count: 210,000/mm3\nErythrocyte sedimentation rate: 55 mm/h\nAnti-cyclic citrullinated peptide antibody: 45 (Normal reference values: < 20)\nWhich side-effect is associated with the drug of choice for the treatment of this patient’s condition?", "answer": "Pneumonitis", "meta_info": "step2&3", "answer_idx": "C", "A": "Retinopathy", "B": "Arterial hypertension", "C": "Pneumonitis", "D": "Reactivation of latent tuberculosis", "language": "en"}
{"question": "A 37-year-old man comes to the emergency room with fever, chills, and left lower leg pain for 2 days. He was recently discharged from the hospital after arthroscopic knee surgery. Physical examination shows an erythematous lesion with poorly defined margins over the left shin but no fluctuance. Treatment with an intravenous antibiotic is begun. Shortly after starting the infusion, the patient develops flushing, erythema, and pruritus of the upper body. The symptoms resolve after discontinuation of the infusion. Before the next dose with the same agent, the patient is given diphenhydramine and ranitidine and the antibiotic is subsequently given at a slower infusion rate without complications. The patient was most likely treated with an antibiotic that binds to which of the following?", "answer": "D-alanyl-D-alanine", "meta_info": "step1", "answer_idx": "D", "A": "Transpeptidase", "B": "Topoisomerase II", "C": "Dihydrofolate reductase", "D": "D-alanyl-D-alanine", "language": "en"}
{"question": "A 55-year-old man presents with worsening weakness of the left hand and progressive difficulty in walking for the last 2 months. He says he was previously healthy and active, hiking every weekend, but because of his increasing weakness and incoordination while walking, he stopped his weekly hiking excursion. His past medical history is unremarkable. Current medications are a daily multivitamin and occasional acetaminophen for headaches. He has no significant family history. The patient denies smoking, recreational drug use, or drinking. His vitals include: pulse 70/min, respirations 14/min, temperature 37.0°C (98.6°F), and blood pressure 130/80 mm Hg. Physical examination reveals fasciculations in the tongue and distal extremities. The left forearm shows significant atrophy, and mild lower limb muscle atrophy is also seen bilaterally. Hyporeflexia (1+) is present in the left arm, while hyperreflexia (3+) is seen in the legs bilaterally. Babinski’s sign is positive bilaterally. The patient's speech is notably slow but no evidence of productive or expressive aphasia is present. The cranial nerves are intact. Which of the following pathologies most likely underlies this patient’s condition?", "answer": "Loss of the pyramidal tract neurons and anterior horn cells of the spinal cord", "meta_info": "step1", "answer_idx": "D", "A": "Demyelination of neurons in various parts of the brain", "B": "Degeneration of the dorsal columns of the spinal cord", "C": "Infarction of the posterior limb of the internal capsule", "D": "Loss of the pyramidal tract neurons and anterior horn cells of the spinal cord", "language": "en"}
{"question": "A 14-year-old male who is a recent immigrant from India visits your office complaining of difficulty walking. Physical examination reveals weakness upon right leg extension and absent right patellar tendon reflex. PCR of a stool sample and a swab of the pharynx both yield viral RNA. Which of the following best describes the likely causal virus of this patient’s symptoms?", "answer": "Non-enveloped, positive stranded, icosahedral virus", "meta_info": "step1", "answer_idx": "A", "A": "Non-enveloped, positive stranded, icosahedral virus", "B": "Enveloped, positive stranded, icosahedral virus", "C": "Enveloped, negative stranded, helical virus", "D": "Non-enveloped, negative stranded, helical virus", "language": "en"}
{"question": "A 21-year-old woman is brought to the emergency department because of the sudden onset of left-sided back pain with radiation to the groin that began 2 hours ago. She has had similar episodes in the past. Her pulse is 103/min. Examination shows a soft and non-tender abdomen. Left costovertebral angle tenderness is present. Leukocyte count is 11,000/mm3. Urine dipstick is positive for blood and a urinary cyanide nitroprusside test is positive. An x-ray of the abdomen shows no abnormalities. Further evaluation of this patient's urine is most likely to show which of the following?", "answer": "Hexagon-shaped crystals", "meta_info": "step1", "answer_idx": "D", "A": "pH of 7.8", "B": "Urease-producing bacteria", "C": "High uric acid concentration", "D": "Hexagon-shaped crystals", "language": "en"}
{"question": "A 45-year-old man presents to the emergency department with sudden left lower back pain and bloody urine. The pain is dull and constant. He can not localize exactly where it is. Over the past 2 weeks, he has also gained 3 kg (7 lb) and his shoes feel tight. He denies a history of any chronic medical conditions, recent abdominal trauma or illness, and has never noticed blood in his urine before. In the hospital, his temperature is 36.8°C (98.2°F), the heart rate is 98/min, the respiratory rate is 15/min, and the blood pressure is 135/85 mm Hg. A review of medical records shows that his blood pressure was 115/75 mm Hg 6 months ago. On physical exam, he appears distressed. There are bruises on his left upper arm, chest, and right thigh. The patient does not remember when he got them. His heart has a regular rate and rhythm and his lungs are clear to auscultation bilaterally. He has 2+ pitting edema in both legs up to the knee and his hands appear edematous. A urine dipstick shows 3+ blood and 4+ protein. Additional specimens are sent to chemistry for analysis. What will be most helpful in diagnosing sequelae resulting from the patient’s underlying condition?", "answer": "CT angiogram with contrast", "meta_info": "step2&3", "answer_idx": "A", "A": "CT angiogram with contrast", "B": "Non-contrast CT", "C": "Cystoscopy", "D": "Renal biopsy", "language": "en"}
{"question": "A 21-year-old man visits his primary care provider complaining of visual disturbance in both eyes for a month and an episode of abnormal uncontrollable shaking that occurred twice last week. He was previously healthy and did not take any medication. His mother has intermittent muscle weakness and his maternal uncle developed hemiplegia at the age of 35. Neuroimaging shows bilateral occipital lobe infarcts and a skeletal muscle biopsy reveals atypical muscle fibers that stain positive for subsarcomelar structures. The physician suspects a maternally inherited genetic disorder. The difference in the level of severity of this disorder among family members in best explained by which of the following?", "answer": "Heteroplasmy", "meta_info": "step1", "answer_idx": "A", "A": "Heteroplasmy", "B": "Mosaicism", "C": "Anticipation", "D": "Uniparental disomy", "language": "en"}
{"question": "Your hospital administrators want to provide you with a tool to analyze the usage of emergency department visits by patients in your high-risk practice. The following graph is displayed on the dashboard of your electronic medical record to show you how often your patients utilize the ED so that you can provide higher quality and more cost-effective care. The X-axis indicates the number of times a patient has been to the ED in the last year. The Y-axis indicates the number of patients who fit into that category. How would you describe the data shown below?", "answer": "It is positively-skewed, with mean > median > mode.", "meta_info": "step1", "answer_idx": "A", "A": "It is positively-skewed, with mean > median > mode.", "B": "It is positively-skewed, with mode > median > mean.", "C": "It is positively-skewed, with median > mode > mean.", "D": "It is negatively-skewed, with mode > median > mean.", "language": "en"}
{"question": "A 27-year-old G1P0000 at 17 weeks of gestation is interested in participating in a clinical trial for nausea management during pregnancy. The trial will be evaluating the effects of moderate ginger consumption on nausea symptoms. Prior to enrolling in the trial, the investigators explain to the patient that they will be doing a full exam and some special testing to make sure she is experiencing a healthy pregnancy. Which of the following findings would most likely be abnormal during pregnancy?", "answer": "Hypertension", "meta_info": "step1", "answer_idx": "A", "A": "Hypertension", "B": "Increased cardiac output", "C": "Increase in factor VII", "D": "Respiratory alkalosis", "language": "en"}
{"question": "A 14-year-old Caucasian male of normal weight presents for a well-child checkup. During physical examination, his parents state that their son has been frequenting the bathroom more often than usual and his weight has decreased despite an increase in his caloric intake. Which of the following is most consistent with their son's symptoms?", "answer": "Self-reactive T-cells", "meta_info": "step1", "answer_idx": "A", "A": "Self-reactive T-cells", "B": "Amyloid deposits in pancreatic islet cells", "C": "Absence of leukocytic infiltrates in the pancreas", "D": "Hypoglycemia", "language": "en"}
{"question": "A 56-year-old woman with a history of stage IIA cervical cancer presents to your office after her 5th episode of a complicated urinary tract infection. She complains of easy fatigability, weakness, and has noted that her shoes no longer fit. The physical examination is unremarkable, except for a blood pressure of 165/90 mm Hg and mild pitting lower extremity edema. The rectovaginal exam revealed no masses. Given the patient’s medical history, the specialist makes a stage IIIB diagnosis; however, to confirm this, he orders abdominal and transvaginal ultrasounds and renal function tests. Which of the following findings would you most likely expect to be reported in the ultrasound?", "answer": "Hydronephrosis", "meta_info": "step1", "answer_idx": "D", "A": "Bladder or rectum mucosa invasion", "B": "Distant metastasis", "C": "Parametrial invasion by cancer", "D": "Hydronephrosis", "language": "en"}
{"question": "A 77-year-old man is brought to the physician because of a 2-day history of increasing shortness of breath and ankle swelling. He has type 2 diabetes mellitus, hypertension, coronary artery disease, and congestive heart failure. Current medications include lisinopril, metformin, and aspirin. He has smoked half a pack of cigarettes daily for 50 years. His temperature is 37.2°C (98.9°F), pulse is 100/min and regular, respirations are 20/min, and blood pressure is 100/65 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 91%. There are jugular venous pulsations 5 cm above the sternal angle. Crackles are heard at both lung bases. Cardiac examination shows an S3 gallop. There is edema from the mid-tibia to the ankle bilaterally. Laboratory studies show:\nHemoglobin 14.1 g/dL\nLeukocyte count 7100/mm3\nSerum\nNa+ 129 mEq/L\nCl- 99 mEq/L\nK+ 4.8 mEq/L\nUrea nitrogen 48 mg/dL\nGlucose 196 mg/dL\nCreatinine 2.1 mg/dL\nWhich of the following is the most appropriate next step in management?\"", "answer": "Discontinue metformin therapy", "meta_info": "step2&3", "answer_idx": "A", "A": "Discontinue metformin therapy", "B": "Begin vancomycin therapy", "C": "Begin nitroprusside therapy", "D": "Begin hydrochlorothiazide therapy", "language": "en"}
{"question": "A 32-year-old woman, gravida 2, para 1, at 40 weeks' gestation is admitted to the hospital 30 minutes after spontaneous rupture of membranes without labor pains. She delivered her first child vaginally at 38 weeks' gestation. Pregnancy was complicated by hypothyroidism. She has no other history of serious illness. Medications include levothyroxine and a multivitamin. Her pulse is 90/min, respirations are 16/min, and blood pressure is 134/76 mm Hg. Pelvic examination shows a uterus consistent in size with a 40 week gestation. A cardiotocography reading is shown. Which of the following is the most likely cause of the cardiotocography findings?", "answer": "Umbilical cord compression", "meta_info": "step2&3", "answer_idx": "A", "A": "Umbilical cord compression", "B": "Fetal head compression", "C": "Uteroplacental insufficiency", "D": "Fetal CNS depression", "language": "en"}
{"question": "A 55-year-old man presents for a routine check-up. He currently has no complaints, and his last physical and laboratory studies were unremarkable. His past medical history is significant for hypercholesterolemia, well managed with rosuvastatin, and hypertension, well managed with hydrochlorothiazide. His current medications also include aspirin. The patient is afebrile and his vital signs are within normal limits. Physical examination reveals some generalized lymphadenopathy. Laboratory findings are significant for the following:\nWBC 38,000/mm3\nRBC 4.20 x 106/mm3\nHematocrit 27.3%\nHemoglobin 8.3 g/dL\nPlatelet count 355,000/mm3\nA peripheral blood smear and differential shows 92% small normocytic lymphocytes.\nWhich of the following is the most likely diagnosis in this patient?", "answer": "Chronic lymphocytic leukemia", "meta_info": "step2&3", "answer_idx": "C", "A": "Acute myelogenous leukemia", "B": "Chronic myelogenous leukemia", "C": "Chronic lymphocytic leukemia", "D": "Asymptomatic multiple myeloma", "language": "en"}
{"question": "A 72-year-old man with a history of diabetes, dyslipidemia, and hypertension presents to the emergency department with sudden-onset right-sided facial paresthesia, word-finding difficulty, and lightheadedness. He was at a restaurant, in general good health, enjoying a dinner with friends when the 1st symptoms started. He takes atorvastatin, lisinopril, hydrochlorothiazide, and a multivitamin every day. A review of symptoms was negative. His symptoms spontaneously resolved after 5 minutes. In the emergency department, the vital signs included: blood pressure of 132/80 mm Hg, heart rate of 86/min, respiratory rate of 20/min, and oxygen saturation of 99% on room air. The laboratory results included:\nHemoglobin 11.3 g/dL\nHematocrit 33%\nWBC count 9,800/mm3\nPlatelet count 247,000/mm3\nInternational normalized ratio (INR) 1.1\nProthrombin time (PT) 11.5 seconds\nPartial thromboplastin time (PTT) 32 seconds\nHis electrocardiogram (ECG) and his head computed tomography (CT) scan were normal. A duplex ultrasound scan shows 70–89% stenosis in the left carotid artery and 50% in the right. In the course of evaluation, his aphasia recurred for 3 minutes. A brain magnetic resonance imaging (MRI) scan was negative for areas of ischemia or intracranial hemorrhage. His symptom recurrence prompted his hospital admission for inpatient care. What is the next step in management?", "answer": "Carotid endarterectomy", "meta_info": "step2&3", "answer_idx": "C", "A": "Enoxaparin", "B": "Thrombolysis", "C": "Carotid endarterectomy", "D": "Carotid artery stenting", "language": "en"}
{"question": "A 70-year-old woman visits her physician complaining of dry mouth and dry eyes. She states that she has recently been having difficulty wearing her dentures on account of her dry mouth. She also says that her tongue sticks to the roof of her mouth, making it difficult to speak and swallow food. Her eyes have also been burning, and she has had to use over the counter eye drops much more often. These symptoms have persisted for several months. On physical exam, mild bilateral enlargement of the parotid glands was noted, and an intraoral examination revealed a red, dry, and smooth mucosal surface on the dorsum of the tongue and buccal mucosa. The patient has a history of hypertension, for which she takes lisinopril. Which of the following is the best 1st step in this patient’s management?", "answer": "Perform a Schirmer test and obtain anti-Ro/anti-La titers", "meta_info": "step2&3", "answer_idx": "C", "A": "Administer prednisone", "B": "Obtain an electrocardiogram (ECG)", "C": "Perform a Schirmer test and obtain anti-Ro/anti-La titers", "D": "Perform a parotid gland biopsy", "language": "en"}
{"question": "A 61-year old obese nulliparous female presents to your office with right lower quadrant abdominal pain. Her medical history is significant for breast cancer and past use of postmenopausal estrogen replacement therapy. This patient most likely has elevated levels of which of the following?", "answer": "CA 125", "meta_info": "step1", "answer_idx": "D", "A": "hCG", "B": "AFP", "C": "CA 19-9", "D": "CA 125", "language": "en"}
{"question": "A 28-year-old man comes to the physician because of a swollen, tender left knee for the past 4 days. During this period, the patient has had pain with urination. The patient has no history of serious illness and takes no medications. He is sexually active with two male partners and they use condoms inconsistently. His older sister has systemic lupus erythematosus. He is 180 cm (5 ft 11 in) tall and weighs 98 kg (216 lb); BMI is 30.1 kg/m2. His temperature is 37°C (98.6°F), pulse is 83/min, and blood pressure is 140/75 mm Hg. Examination shows conjunctivitis bilaterally. The left knee is warm, erythematous, and tender to touch; range of motion is limited. Laboratory studies show an erythrocyte sedimentation rate of 62 mm/h. Urinanalysis shows WBCs. Further evaluation of this patient is most likely to reveal which of the following?", "answer": "HLA-B27 positive genotype", "meta_info": "step2&3", "answer_idx": "A", "A": "HLA-B27 positive genotype", "B": "Hiking trip two months ago", "C": "Positive anti-dsDNA antibodies", "D": "Intravenous drug use", "language": "en"}
{"question": "A 21-year-old man comes to the physician because of nervousness and difficulty sleeping over the past 2 weeks. Three months ago, he started a new team project at his job. He says that he has trouble falling asleep at night because he thinks about the project. He insists on checking the work of his teammates and spends several hours each week making elaborate lists and schedules. He refuses to let others take on more tasks because he thinks that only he can complete them satisfactorily. The project deadline has already been postponed once. He says, “My teammates never understand how important it is to do things the right way.” Ever since high school, he has used the majority of his time to plan out assignments and does not have time to regularly participate in social activities. Which of the following is the most likely diagnosis?", "answer": "Obsessive-compulsive personality disorder", "meta_info": "step1", "answer_idx": "A", "A": "Obsessive-compulsive personality disorder", "B": "Obsessive-compulsive disorder", "C": "Schizoid personality disorder", "D": "Adjustment disorder with mixed anxiety and depressed mood\n\"", "language": "en"}
{"question": "A 52-years-old man presents with a history of recurrent episodes of unilateral headaches. He says the episodes are short-lived (usually lasting for a few seconds to 3-4 minutes), and he describes them as a severe throbbing orbital headache, accompanied by ipsilateral conjunctival injection and lacrimation. He says that often the episodes seem to be triggered by a cutaneous stimulus touching the face or while chewing food. Sometimes, he says he experiences countless attacks during a single day. The headaches do not respond to indomethacin and any other non-steroidal anti-inflammatory drug (NSAID). Which of the following drugs is most likely to be effective as a preventive therapy in this patient?", "answer": "Lamotrigine", "meta_info": "step1", "answer_idx": "C", "A": "Ibuprofen", "B": "Acetaminophen", "C": "Lamotrigine", "D": "Amitriptyline", "language": "en"}
{"question": "A 55-year-old obese man presents to the emergency department with abdominal pain. His pain started 2 days ago and has been worsening steadily. His only current medication is allopurinol. His temperature is 101.0°F (38.3°C), blood pressure is 157/98 mmHg, pulse is 120/min, respirations are 17/min, and oxygen saturation is 98% on room air. Physical exam is notable for left lower quadrant abdominal tenderness and rectal exam is unremarkable. A CT scan is performed demonstrating inflamed outpouchings of the colonic mucosa with a 4-cm abscess. Which of the following is appropriate treatment of this patient?", "answer": "CT-guided percutaneous drainage", "meta_info": "step2&3", "answer_idx": "B", "A": "Ciprofloxacin and gentamicin", "B": "CT-guided percutaneous drainage", "C": "Laparoscopy and drainage", "D": "Piperacillin-tazobactam and vancomycin", "language": "en"}
{"question": "A 32-year-old G2P2 woman gives birth to a boy at 39 weeks gestation. The mother recently immigrated from Somalia and had no prenatal care. She refused all intrapartum medications. The boy’s Apgar scores were 7 and 9 at 1 and 5 minutes, respectively. His height and weight were in the 20th and 15th percentiles, respectively. Mother and child were discharged the day after birth. However, 7 days later, the mother presents to the pediatrician because she noticed redness and discharge in her baby's eyes. His temperature is 98.8°F (37.1°C), blood pressure is 105/65 mmHg, pulse is 120/min, and respirations are 22/min. On exam, the boy has scant non-purulent mucoid bilateral eye discharge and conjunctival hyperemia. Which of the following is the most appropriate treatment for this patient?", "answer": "Oral and topical erythromycin", "meta_info": "step1", "answer_idx": "B", "A": "Intravenous acyclovir", "B": "Oral and topical erythromycin", "C": "Sterile lubricant with artificial tear preparation", "D": "Topical bacitracin", "language": "en"}
{"question": "A 21-year-old woman presents to her physician for a regular follow-up visit. She was diagnosed with relapsing-remitting multiple sclerosis 2 months ago when she suffered a second episode of optic neuritis. She was successfully treated with methylprednisolone pulse therapy and discharged. Today, she only complains of slight fatigue with upper and lower extremity weakness. Her blood pressure is 120/80 mm Hg, her heart rate is 63/min, her respiratory rate is 14/min, and her temperature is 36.7°C (98.0°F). Neurological examination reveals brisk deep reflexes (3+ equal) and decreased strength (4/4) in the upper limbs. The rest of the examination is unremarkable. The patient is prescribed a drug that is an inhibitor of ɑ4-integrin (CD49d) for the prevention of relapses. She is concerned about the side effects of this drug, among which is increased susceptibility to the upper respiratory tract and urinary tract infections. Inhibition of which of the following processes is the best explanation for such adverse effects?", "answer": "Tight adhesion of leukocytes to the endothelial cells", "meta_info": "step1", "answer_idx": "A", "A": "Tight adhesion of leukocytes to the endothelial cells", "B": "Expression of selectins on the surface of endothelial cells", "C": "Formation of tight bounds between leukocytes and endothelial selectins", "D": "Inhibition of interaction between platelet endothelial cell adhesion molecules (PECAMs) on the surfaces of leukocytes and endothelial cells", "language": "en"}
{"question": "A 64-year-old man presents to the clinic complaining of low back pain. He was diagnosed with benign prostatic hypertrophy several years ago, which worsened last year. A hard nodule was felt on a digital rectal exam, which led to a prostate biopsy that revealed high-grade adenocarcinoma. A bone scan at that time showed small, focal abnormalities in the lumbar spine. He subsequently underwent radiation therapy to his prostate and pelvic lymph nodes. He was then placed on leuprolide and an anti-androgen. He was doing well until 2 months ago when he developed low back pain, which has worsened since then. He reports that the pain is 8/10 and nearly constant. He states that the pain not only affects his ability to fall asleep but also wakes him up at night. The pain is mildly alleviated by ibuprofen. In addition to prostate cancer, his medical history is significant for hypertension, hyperlipidemia, recurrent nephrolithiasis, and gastroesophageal reflux disease. He takes aspirin, lisinopril, rosuvastatin, and pantoprazole. Upon physical examination, there is midline tenderness within the lumbar region. Magnetic resonance imaging of the spine is obtained, which shows bony metastasis to the L2 and L3 spine without evidence of fracture or spinal cord compression. His prostate-specific antigen is 17.5 ng/mL. Which of the following is the best next step in management?", "answer": "External radiation therapy", "meta_info": "step2&3", "answer_idx": "B", "A": "Calcium and vitamin D supplementation", "B": "External radiation therapy", "C": "Flutamide", "D": "Kyphoplasty", "language": "en"}
{"question": "Two days after undergoing internal fixation of a displaced right femoral fracture sustained during a motor vehicle accident, a 34-year-old woman develops sudden shortness of breath. On examination, she is oriented only to person. Her temperature is 38.3°C (100.9°F), pulse is 122/min, respiratory rate is 31/min, and blood pressure is 152/90 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 83%. There are several scattered petechiae on the anterior chest wall. Her hemoglobin concentration is 10.3 g/dL, leukocyte count is 9,500/mm3, and platelet count is 140,000/mm3. Which of the following is the most likely cause of her current condition?", "answer": "Fat globules entering the circulation", "meta_info": "step1", "answer_idx": "A", "A": "Fat globules entering the circulation", "B": "Rupture of a coronary plaque", "C": "Damage to the alveolar capillary endothelium", "D": "Bacterial invasion of the pulmonary parenchyma", "language": "en"}
{"question": "A 15-year-old girl comes to the physician for the evaluation of a painless swelling under the left lower jaw for 5 months. Her 18-year-old sister has a history of acute lymphoblastic leukemia that has been in remission for 11 years. The patient's temperature is 37°C (98.6°F) Physical examination shows a 3 × 2 cm swelling on the left side, 4 cm below the base of the mandible and anterior to the sternocleidomastoid muscle. The swelling is soft and fluctuant. It does not move with swallowing, and forced exhalation against a closed glottis does not increase the size of the swelling. Ultrasound shows a round mass with uniform low echogenicity and no internal septations. Which of the following is the most likely diagnosis?", "answer": "Branchial cleft cyst", "meta_info": "step1", "answer_idx": "B", "A": "Lymphadenopathy", "B": "Branchial cleft cyst", "C": "Laryngocele", "D": "Infantile hemangioma", "language": "en"}
{"question": "A 70-year-old man is brought to the emergency department by staff of the group home where he resides because of fever, a productive cough, and blood-tinged sputum for 2 days. The staff report that he developed myalgia, headache, and rhinorrhea 7 days ago, which improved initially before worsening again. He has hypertension and Alzheimer disease. Current medications include enalapril and donepezil. On arrival, he is obtunded. His temperature is 39.8°C (103.6°F), pulse is 120/min, respirations are 22/min and shallow, and blood pressure is 100/60 mm Hg. Pulse oximetry on 10 L/min of oxygen via nasal cannula shows an oxygen saturation of 92%. Examination shows scattered crackles and rhonchi throughout both lung fields. An x-ray of the chest shows bilateral lung opacities and multiple small, thin-walled cystic spaces within the basal pulmonary parenchyma. Which of the following is the most likely cause of this patient’s current condition?", "answer": "Infection with Staphylococcus aureus", "meta_info": "step2&3", "answer_idx": "A", "A": "Infection with Staphylococcus aureus", "B": "Infection with Aspergillus fumigatus", "C": "Foreign body aspiration", "D": "Granulomatosis with polyangiitis", "language": "en"}
{"question": "A 55-year-old man presents to his primary care physician with ear pain. The patient states he has had worsening ear pain for the past 2 days. He describes his pain as 9/10. The patient has a past medical history of diabetes, obesity, and hypertension. His current medications include insulin, metformin, lisinopril, aspirin, and atorvastatin. His temperature is 100.5°F (38.1°C), blood pressure is 177/99 mmHg, pulse is 100/min, respirations are 19/min, and oxygen saturation is 98% on room air. Physical exam reveals a purulent drainage from the ear canal. Manipulation of the ear causes severe pain. Which of the following is the most likely infectious agent?", "answer": "Pseudomonas aeruginosa", "meta_info": "step2&3", "answer_idx": "C", "A": "Haemophilus influenzae", "B": "Moraxella catarrhalis", "C": "Pseudomonas aeruginosa", "D": "Staphylococcus aureus", "language": "en"}
{"question": "A 19-year-old male college student with no significant medical history presents to the emergency department with altered mental status. His girlfriend said that he drank multiple shots of vodka and gin throughout the weekend and was found slumped on the couch with some vomit on his shirt. He is afebrile, with a blood pressure of 128/60 mmHg, pulse of 100/min, respirations at 25/min, and SpO2 of 95% on room air. His pupils are equal and reactive to light bilaterally. He exhibits no tremors or myoclonus. The remainder of the physical exam is unremarkable. His basic metabolic panel is displayed below:\n\nSerum:\nNa+: 138 mEq/L\nCl-: 90 mEq/L\nK+: 4.0 mEq/L\nHCO3-: 20 mEq/L\nBUN: 30 mg/dL\nGlucose: 100 mg/dL\nCreatinine: 0.8 mg/dL\n\nAn arterial blood gas reveals the following:\n\npH: 7.32\npCO2: 34 mmHg\npO2: 89 mmHg\n\nThe girlfriend is concerned that the patient's breathing appears uncomfortable. How do you respond?", "answer": "His breathing suggests that he needs some fluids", "meta_info": "step2&3", "answer_idx": "B", "A": "His breathing is concerning for hepatic encephalopathy", "B": "His breathing suggests that he needs some fluids", "C": "His breathing suggests that he has major depression disorder", "D": "You are not his healthcare proxy and I cannot speak to you", "language": "en"}
{"question": "A 56-year-old man presents to his primary care provider for a check-up. His past medical history is significant for type 2 diabetes mellitus for 20 years and insomnia.  He takes metformin and insulin NPH. Both of his parents died in a car accident several years ago. He smokes a half of a pack of cigarettes every day and drinks 1-2 beers a day and more on the weekends. Today, his blood pressure is 130/80 mm Hg, pulse is 76/min, respiratory rate is 18/min, and temperature is 36.5°C (97.7°F). On physical exam, he appears obese. His heart has a regular rate and rhythm and his lungs are clear to auscultation bilaterally. A foot exam is performed and is unremarkable. A urinalysis reveals  glucose (++), and protein (+++). Which of the following explains these findings?", "answer": "Glomerular hyperfiltration", "meta_info": "step2&3", "answer_idx": "A", "A": "Glomerular hyperfiltration", "B": "Renal artery stenosis", "C": "Subendothelial immune-complex deposits", "D": "Interstitial atrophy", "language": "en"}
{"question": "A 64-year-old man comes to the physician because of a 1-month history of progressively worsening back pain that wakes him up at night. He also reports symptoms of urinary urgency and a weak urine stream. He has no history of serious illness and takes no medications. Rectal examination shows an enlarged and hardened prostate with a nodular surface. After further evaluation and confirmation of the diagnosis, he is started on a new drug. Initially, there is an increase in serum testosterone and dihydrotestosterone levels, followed by a sustained decrease in both serum hormone levels. Treatment with which of the following drugs was most likely initiated in this patient?", "answer": "Leuprolide", "meta_info": "step1", "answer_idx": "A", "A": "Leuprolide", "B": "Finasteride", "C": "Ketoconazole", "D": "Cyproterone acetate", "language": "en"}
{"question": "A 46-year-old man presents to a physician three days after arriving in Morocco. He endorses acute onset of painless, profuse watery diarrhea that appears white and cloudy. The patient denies bloody stool, vomiting, or subjective fevers. Vital signs are T 98.6, HR 120, RR 17, and BP 85/50. On physical exam, the patient has dry mouth, decreased skin turgor, and cold clammy skin. His peripheral pulse is rapid and thready. The toxin responsible for this clinical presentation has a mechanism of action that is most similar to which other toxin?", "answer": "Edema toxin", "meta_info": "step1", "answer_idx": "C", "A": "Diphtheria toxin", "B": "Exotoxin A", "C": "Edema toxin", "D": "Shiga-like toxin", "language": "en"}
{"question": "A 25-year-old woman presents to the urgent care center with a one month history of intermittent chest pain that occurs about 2-3 times per week in the early mornings. She does not smoke and has never suffered from chest pain before. She has no family history of early MI. A 12 lead ECG does not show any abnormalities. Creatine kinase and troponin I enzymes are within normal limits. What test will most likely be positive?", "answer": "Ergonovine", "meta_info": "step2&3", "answer_idx": "A", "A": "Ergonovine", "B": "Immediately repeat ECG", "C": "Exercise stress test", "D": "Kehr's sign", "language": "en"}
{"question": "A 28-year-old man is scheduled for skin grafting of the right leg. Four weeks earlier, he underwent open reduction and internal fixation of an open right tibial fracture. The postoperative period at that time was complicated by necrosis of the overlying skin. In the operating room, he is placed on continuous hemodynamic monitoring and anesthetized with intrathecal bupivacaine injected into the L3–L4 spinal interspace. Thirty minutes later, he has severe shortness of breath and lightheadedness and loses consciousness. His temperature is 37.1°C (98.8°F), pulse is 38/min, respirations are 24/min, and palpable systolic blood pressure is 58 mmHg. The skin is diaphoretic and flushed. He withdraws the upper extremities to painful stimuli above the navel. The lungs are clear to auscultation. Heart sounds are not audible. Which of the following is the most likely underlying cause of this patient's symptoms?", "answer": "Loss of sympathetic vascular tone", "meta_info": "step2&3", "answer_idx": "A", "A": "Loss of sympathetic vascular tone", "B": "Obstructive thrombus in the pulmonary artery", "C": "Intravascular volume depletion", "D": "Type I hypersensitivity reaction", "language": "en"}
{"question": "A 42-year-old man with no significant medical history presents to the emergency department with complaints of headache, nausea, and dizziness. He states that he was at home working on his car when he started to feel dizzy and experienced a headache. This progressed to him feeling nauseous. The patient states he went inside and drank some water and felt better; however, when he started working on his car again his symptoms returned. Upon presentation, he states his symptoms have mostly improved except for a persistent headache. His temperature is 98.1°F (36.7°C), blood pressure is 125/84 mmHg, pulse is 87/min, respirations are 18/min, and oxygen saturation is 98% on room air. Neurologic exam is unremarkable. Which of the following is the best next step in management?", "answer": "100% oxygen", "meta_info": "step2&3", "answer_idx": "A", "A": "100% oxygen", "B": "CT", "C": "Hydroxocobalamin", "D": "Ibuprofen and acetaminophen", "language": "en"}
{"question": "A 19-year-old woman comes to the physician because of severe headaches for the past 3 months. The headaches are pulsating in nature and she describes the pain as 8 out of 10 in intensity. She has visited the emergency department for headaches twice in the past month; during both visits, her blood pressure was elevated. She has polycystic ovarian disease. Her medications include metformin and an oral contraceptive pill. She is 162 cm (5 ft 4 in) tall and weighs 86 kg (190 lb); BMI is 32.8 kg/m2. Her temperature is 37°C (98.6°F), pulse is 99/min, and blood pressure is 168/98 mm Hg. Examination shows hirsutism. Cardiopulmonary examination shows no abnormalities. The abdomen is soft and nontender. An abdominal bruit is heard on the left side. Neurologic examination shows no focal findings. A complete blood count and serum concentrations of electrolytes, urea nitrogen, and creatinine are within the reference range. Plasma free metanephrines are within the reference range. An abdominal ultrasound shows an increased peak systolic velocity in the distal portion of the left renal artery. A contrast-enhanced CT scan of the abdomen shows alternating stenosis and dilation in an 8-mm distal segment of the left renal artery with approximately 75% reduction in the diameter of the vessel. A CT scan of the brain shows no abnormalities. Which of the following is the most appropriate next step in management?", "answer": "Ramipril and percutaneous transluminal angioplasty without stent placement", "meta_info": "step2&3", "answer_idx": "C", "A": "Combination therapy with captopril and valsartan", "B": "Percutaneous transluminal angioplasty without stent placement", "C": "Ramipril and percutaneous transluminal angioplasty without stent placement", "D": "Enalapril and aortorenal bypass with a vein graft", "language": "en"}
{"question": "A 28-year-old male is found to have 93% HbA, 2% HbF, and 5% HbA2 on hemoglobin electrophoresis. Which of the following is the most likely diagnosis?", "answer": "Beta-thalassemia minor", "meta_info": "step1", "answer_idx": "B", "A": "Alpha thalassemia major with Hb Bart's", "B": "Beta-thalassemia minor", "C": "Beta-thalassemia major", "D": "Diabetes mellitus", "language": "en"}
{"question": "A 76-year-old female is brought to the emergency department for altered mental status. She is accompanied by a nurse from her nursing home. The nurse says that usually the patient is interactive even though she is sometimes forgetful. In the last two days, the patient has been increasingly lethargic and doesn’t respond to the staff’s questions. She also has not been able to get up and use the restroom so the staff has had to change multiple soiled sheets. Her temperature is 102.1°F (38.9°C), blood pressure is 100/74 mmHg, pulse is 120/min, and respirations are 24/min. The patient is combative on arrival but can be subdued with reorientation by the care team. She is not oriented to person, place, or time. Urinalysis shows positive leukocyte esterase and nitrites. Urine culture grows >100,000 CFU of E. coli. The physician team would like to consent this patient for a Foley catheter. Which of the following is the best assessment of the patient’s capacity to make healthcare decisions?", "answer": "Capacity cannot be determined at this time", "meta_info": "step1", "answer_idx": "D", "A": "The patient does not have capacity to make decisions", "B": "The patient does have capacity to make decisions", "C": "The hospital ethics board should be consulted", "D": "Capacity cannot be determined at this time", "language": "en"}
{"question": "A 19-year-old woman is brought to the emergency department by ambulance 1 hour after a motor vehicle accident. She has no history of serious illness. She is on mechanical ventilation without any sedation. Her vital signs are within a normal range. Her Glasgow Coma Scale (GCS) is 3. Examination by the attending trauma surgeon and neurologist shows brain death. Laboratory studies show no abnormalities. A search on the state donor registry shows that she has registered as an organ donor. Her father is shocked at the suggestion of organ donation and says that “life is still circulating in her body because it is warm, and she has a normal heartbeat!” While the physician empathizes with the family, which of the following is the most appropriate response?", "answer": "“Brain death is considered legal death just as if her heart was not beating.”", "meta_info": "step2&3", "answer_idx": "B", "A": "“Only after your consent will her organs be removed.”", "B": "“Brain death is considered legal death just as if her heart was not beating.”", "C": "“She is very unlikely to recover.”", "D": "“She will be dead once she is disconnected from advanced life-support.”", "language": "en"}
{"question": "A 58-year-old male has had long-term involvement in the world of organized crime. He very recently retired from his post within this organization. This former mafia boss has now suddenly started making large contributions to several local charities. Which of the following ego defenses best characterizes this gentleman's behavior?", "answer": "Altruism", "meta_info": "step1", "answer_idx": "A", "A": "Altruism", "B": "Displacement", "C": "Sublimation", "D": "Atonement", "language": "en"}
{"question": "A 45-year-old man presents with a chronic productive cough that he has had for the past few years. He admits to having smoked 1 pack of cigarettes a day for the past 25 years. A chest radiograph reveals an enlarged heart. The patient's pulmonary function tests would be similar to that seen in a patient with:", "answer": "Emphysema", "meta_info": "step1", "answer_idx": "C", "A": "Asymptomatic asthma", "B": "Silicosis", "C": "Emphysema", "D": "Coal worker's pneumonitis", "language": "en"}
{"question": "A 69-year-old gentleman presents to his primary care physician for a general checkup. He states that overall he is doing well. Ever since he retired, he has been working on projects at home, and taking time to exercise every day. He eats a balanced diet, and has been spending time with his wife every evening. Despite this, the patient claims that he feels less well rested when he awakes in the morning. The patient states that he used to sleep nine hours a night in his youth and felt excellent. Now he sleeps seven hours a night and doesn’t feel as well rested as he used to. The patient’s wife states that he seems to sleep peacefully. On physical exam the patient’s neurological exam is within normal limits. The patient is muscular and has a healthy weight and has a pleasant demeanor. He denies feeling fatigued or tired currently. Which of the following physiological changes is most likely in this patient?", "answer": "Decreased melatonin", "meta_info": "step2&3", "answer_idx": "B", "A": "Decreased orexin", "B": "Decreased melatonin", "C": "Increased dopamine", "D": "Increased acetylcholine", "language": "en"}
{"question": "A 7-year-old boy with sickle cell disease is brought into the clinic by his mother for knee and hip pain. The child has been admitted several times in the past for pain crises managed with fluids and hydromorphone. He started complaining of worsening hip pain over the last several days and now walks with a limp. His temperature is 97.9°F (36.6°C), blood pressure is 84/54 mmHg, pulse is 100/min, respirations are 19/min, and oxygen saturation is 99% on room air. On physical exam, the hip appears normal and is cool to the touch. There is decreased range of motion at the hip and pain with ambulation. Which of the following is the most appropriate next step in management?", "answer": "Radiograph", "meta_info": "step2&3", "answer_idx": "D", "A": "CT", "B": "Ibuprofen and acetaminophen", "C": "MRI", "D": "Radiograph", "language": "en"}
{"question": "A 65-year-old asian man presents to his primary care physician because of abdominal distension, right upper quadrant (RUQ) abdominal pain, decreased appetite, and weight loss for several weeks. He denies smoking or excess alcohol intake. His temperature is 37.1°C (98.7°F), blood pressure is 120/80 mm Hg, and pulse is 85/min. Physical examination reveals a cachectic man with jaundice, palmar erythema, ascites, and a palpable mass in the RUQ. Abdominal ultrasound shows a 3 cm hypoechoic mass in the right lobe of the liver. Alpha fetoprotein (AFP) is 500 μg/L. Which of the following is a risk factor for this patient condition?", "answer": "Chronic hepatitis C infection", "meta_info": "step2&3", "answer_idx": "D", "A": "Exposure to nitrosamines  ", "B": "Cyclophosphamide use", "C": "Clonorchis sinensis infection", "D": "Chronic hepatitis C infection", "language": "en"}
{"question": "A 71-year-old man from Puerto Rico presents to the emergency department with a 2-week history of abdominal pain. He does not speak much English so his family explains that he has been complaining of intermittent pain that is not associated with any particular actions. Furthermore, his family is concerned because he has been having weight loss and blood in his stool for 3 months. The physician explains that there is a concern for colon cancer and that a colonoscopy is required to evaluate his condition further. The family is afraid that the news will upset the patient so they ask that they be allowed to make healthcare decisions on the patient's behalf. They explain that this is the way that their culture handles medical decisions. What should the physician do in this situation?", "answer": "Call for a Spanish-speaking interpreter to speak with the patient", "meta_info": "step1", "answer_idx": "B", "A": "Ask the family to translate the plan for the patient and ask for questions", "B": "Call for a Spanish-speaking interpreter to speak with the patient", "C": "Respect the family's cultural wishes and not discuss the plan with the patient", "D": "Speak directly with the patient in English to ascertain their wishes", "language": "en"}
{"question": "A 45-year-old man presents to a physician with recurrent episodes of palpitations over the last 3 months. The episodes are self-limiting but cause significant distress and discomfort to the patient. After a detailed electrophysiological workup, the physician concludes that the symptoms occur mainly due to abnormal function of the cardiac ion channels, which primarily produce the plateau phase of the action potential in cardiac myocytes in healthy patients. Which of the following ion channels is dysfunctional in this patient?", "answer": "L-type voltage-gated calcium channels", "meta_info": "step1", "answer_idx": "B", "A": "Fast sodium channels", "B": "L-type voltage-gated calcium channels", "C": "T-type voltage-gated calcium channels", "D": "Inward rectifier IK1 channels", "language": "en"}
{"question": "A 23-year-old man comes to the physician because of severe daytime sleepiness and random episodes of falling asleep during the day for short periods of time. When he wakes up from these episodes, he feels refreshed. He sleeps 6–7 hours at night. He reports that sometimes he is unable to move for a few minutes when he first wakes up in the morning. Last week, he suddenly “lost control” of his legs and neck for about 30 seconds after his classmate had told him a joke. An analysis of this patient's cerebral spinal fluid is most likely to show which of the following findings?", "answer": "Decreased orexin-A", "meta_info": "step1", "answer_idx": "A", "A": "Decreased orexin-A", "B": "Increased neuron-specific enolase", "C": "Increased 14-3-3 protein", "D": "Anti-ganglioside antibodies", "language": "en"}
{"question": "A 73-year-old man is brought to the emergency department 30 minutes after he lost consciousness for 5 minutes while watching a game of summer league football in a seat from the stands in the afternoon. On arrival, he is lethargic and oriented only to person. Three weeks ago, he was treated for hepatitis A. He has type 2 diabetes mellitus and hypothyroidism. Current medications include metformin and levothyroxine. His temperature is 41.5 °C (106.7 °F), pulse is 106/min, respirations are 26/min, and blood pressure is 128/70 mm Hg. Examination shows hot, dry skin. The pupils are equal and reactive to light. Neurologic examination shows no focal findings. Fundoscopy shows proliferative diabetic retinopathy. Cardiopulmonary examination shows no abnormalities. His abdomen is soft and nontender. There is no costovertebral angle tenderness. His serum glucose concentration is 160 mg/dL. An ECG shows a normal sinus rhythm. Which of the following is the most likely underlying cause of this patient's symptoms?", "answer": "Inadequate hypothalamic response", "meta_info": "step2&3", "answer_idx": "A", "A": "Inadequate hypothalamic response", "B": "Metabolic acidosis with ketosis", "C": "Elevation of serum thyroxine levels", "D": "Central dopamine receptor blockade", "language": "en"}
{"question": "A 3-year-old boy is brought to the physician for a well-child examination. He feels well. He was born at 38 weeks' gestation and weighed 2766 g (6 lb 2 oz). He now weighs 14 kg (31 lbs). There is no personal or family history of serious illness. His immunizations are up-to-date. He is at 60th percentile for height and 55th percentile for weight. Vital signs are within normal limits. The lungs are clear to auscultation. A grade 3/6 systolic ejection murmur is heard along the upper left sternal border. S2 is widely split and does not vary with respiration. There is a grade 2/6 mid-diastolic murmur along the lower left sternal border. The abdomen is soft and nontender; there is no organomegaly. Which of the following is the most likely diagnosis?", "answer": "Atrial septal defect", "meta_info": "step2&3", "answer_idx": "C", "A": "Patent ductus arteriosus", "B": "Benign heart murmur", "C": "Atrial septal defect", "D": "Pulmonary valve stenosis", "language": "en"}
{"question": "A 30-year-old man presents to the emergency department after being attacked by 2 men a few minutes ago. He was suddenly approached by 2 men holding knives while he was walking on the street nearby. While trying to escape, he was stabbed once in the neck. He is complaining of difficulty breathing and chest pain. He is in apparent distress. His temperature is 36.8°C (98.2°F), the blood pressure is 100/60 mm Hg, the pulse is 110/min, the respirations are 28/min, and the SaO2 is 85% on 4 L oxygen by nasal cannula. Examination of the neck reveals a deep penetrating injury on the right side and distended neck veins. The respiratory exam shows severe tenderness in the right chest, decreased inspiration in the right lung, and tracheal deviation to the left. What is the next best step in the management of this patient?", "answer": "Needle thoracostomy", "meta_info": "step1", "answer_idx": "D", "A": "Pericardiocentesis", "B": "Intravenous fluids", "C": "Dobutamine", "D": "Needle thoracostomy", "language": "en"}
{"question": "An 8-month-old male presents to your office with a 5-day history of blood in his stool. Abdominal pain is notably absent on history obtained from his parents. Past medical history and physical exam findings are not remarkable. Laboratory findings are significant for mild iron deficiency. Which of the following is characteristic of this patient’s diagnosis?", "answer": "Diagnostic studies localize ectopic gastric tissue.", "meta_info": "step2&3", "answer_idx": "D", "A": "It may affect neonates but is more common in adolescents.", "B": "It is rare, affecting less than 1% of the population.", "C": "Both males and females are equally affected.", "D": "Diagnostic studies localize ectopic gastric tissue.", "language": "en"}
{"question": "A 19-year-old man is brought to a psychiatrist by his mother. The patient’s mother has become increasingly concerned about him since his high school graduation. Although she says that he had been an excellent student in high school, his grades have begun slipping in his second year in college, and he no longer socializes with friends. When she asked him why he no longer talks to his friends, she states that he told her, “They already know where I am. They can see me. They watch me from my bedroom window, so they already know what I’m doing. We don’t need to talk.” She found this to be bizarre, as nearly all of his friends live hours away. The patient states that he feels fine and doesn’t understand why everyone thinks he is crazy. The psychiatrist notices reduced spontaneous movements while the patient is speaking and that he speaks in a monotone with a voice that is soft in volume. He also appears suspicious and defensive, asking the psychiatrist “why are you asking me that?” after each evaluative question. His mood is generally flat with little reactivity or engagement during the course of his interview, but he denies any symptoms of depression or psychosis. No significant past medical history. Family history is not available as he was adopted. Which of the following is the most likely diagnosis in this patient?", "answer": "Schizophrenia", "meta_info": "step2&3", "answer_idx": "B", "A": "Paranoid personality disorder", "B": "Schizophrenia", "C": "Drug abuse", "D": "Brain tumor", "language": "en"}
{"question": "A 26-year-old woman comes to the physician because of progressively worsening episodic pelvic pain for 2 years. The pain starts a few days before her menstrual period and lasts about 10 days. She has tried taking ibuprofen, but her symptoms do not improve. Menses have occurred at regular 29-day intervals since menarche at the age of 11 years and last for 5–7 days. The first day of her last menstrual period was 2 weeks ago. She is sexually active with her boyfriend and has noticed that intercourse is often painful; they use condoms inconsistently. Vital signs are within normal limits. Pelvic examination shows a normal vagina and cervix. Bimanual examination shows a normal-sized uterus and no palpable adnexal masses. Urine pregnancy test is negative. Which of the following is the most appropriate next step in management?", "answer": "Prescribe estrogen-progestin contraceptives", "meta_info": "step2&3", "answer_idx": "D", "A": "Perform MRI of the pelvis", "B": "Prescribe gonadotropin-releasing hormone agonists", "C": "Prescribe androgenic steroids", "D": "Prescribe estrogen-progestin contraceptives", "language": "en"}
{"question": "A research group has developed a new screening test for HIV that can detect infection 2 weeks earlier than the current gold standard. A rigorous clinical study of this new screening test involving n subjects yields a false-positive probability α, and a false-negative probability, β. Which of the following will most likely reduce the type II error of this screening test?", "answer": "Increasing α", "meta_info": "step2&3", "answer_idx": "B", "A": "Decreasing n", "B": "Increasing α", "C": "Increasing the specificity of the test", "D": "Decreasing the sensitivity of the test", "language": "en"}
{"question": "A 70-year-old female underwent a right total knee arthroplasty without complication. She was discharged to a rehab facility on post-operative day 3. Two days after her discharge from the hospital, she began experiencing pain and swelling of the right leg. Doppler ultrasound imaging at this time revealed a deep venous thrombosis in the right popliteal and tibial veins. The patient was re-admitted and started on an unfractionated heparin infusion. Five days later, doppler ultrasonography of the lower extremities revealed extension of the clot in the right lower extremity to include the common femoral, superficial femoral, popliteal, tibial, and saphenous veins. In addition, a thrombus was noted in the left common femoral vein as well. CBC showed a decrease in platelet count from 195,000/uL on admission to 83,000/uL. Which of the following is the pathophysiology of this patient's presentation?", "answer": "Formation of antibodies to heparin-platelet factor-4 complex", "meta_info": "step2&3", "answer_idx": "B", "A": "Excessive irreversible inactivation of the cyclo-oxygenase enzyme", "B": "Formation of antibodies to heparin-platelet factor-4 complex", "C": "Deposition of immune complex nuclear antigens in kidneys", "D": "Inherited mutation in clotting factor V, which cannot be degraded by activated protein C", "language": "en"}
{"question": "Three days after surgical repair of a distal right radius fracture, a 62-year-old man develops severe wound pain and fever. His temperature is 39.1°C (102.4°F). Physical examination shows erythema and edema of the right arm that extends up to the elbow. Yellow pus drains from the surgical wound. Cultures from the wound fluid grow gram-positive bacteria in grape-like clusters that are resistant to nafcillin. While treating the patient's condition, the hospital also wants to eradicate the causal pathogen in asymptomatic carriers. Which of the following measures would be most effective?", "answer": "Mupirocin nasal ointment", "meta_info": "step1", "answer_idx": "D", "A": "Permethrin hair wash", "B": "Colistin nebulized aerosol", "C": "Chlorhexidine hand disinfection", "D": "Mupirocin nasal ointment", "language": "en"}
{"question": "A research group from Europe is investigating a potential link between certain lifestyle risk factors and the development of potentially fatal renal disease. They designed a cohort study that included 68 individuals: 34 exposed and 34 unexposed to given risk factors, who were followed up for 4 years in total. During this time, the renal disease of interest was seen in 6 individuals among the exposed group and 6 individuals among the unexposed group; thus, the risk ratio (RR) of the disease development (exposed vs. unexposed) was 1. During the initial 2 years, there was 1 death in the exposed group, and another death in the unexposed group. A survey administered for the last 2 years of the study showed that the prevalence ratio of disease between exposed and unexposed individuals was in fact 0.5 (at 2 years of follow-up there was only 1 case of the disease in the 34 exposed individuals, with a resulting prevalence of 2.94%; and only 2 cases of the disease in the 34 unexposed individuals, with a resulting prevalence of 5.88%), a value that deviates from the true RR (i.e. 1). For this reason (and to accurately answer the research question), the risk of the disease should be estimated in terms of which of the following?", "answer": "Incidence", "meta_info": "step1", "answer_idx": "A", "A": "Incidence", "B": "Prevalence", "C": "Mortality", "D": "Survival rates", "language": "en"}
{"question": "A 55-year-old male with fever, fatigue, generalized weakness, and bleeding gums for the past 3 weeks presents to his family physician. On exam, he has bilateral submandibular lymphadenopathy and hepatosplenomegaly. CBC demonstrates decreased RBCs and mature WBCs. The patient is referred to an oncologist, and a bone marrow aspiration is performed, demonstrating >20% myeloblasts with Auer rods that are myeloperoxidase positive. What is the most likely chromosomal translocation that is responsible for this patient's clinical presentation and lab results?", "answer": "15;17", "meta_info": "step1", "answer_idx": "A", "A": "15;17", "B": "14;18", "C": "11;14", "D": "8;14", "language": "en"}
{"question": "A 59-year-old man with Parkinson disease is brought to the emergency department 1 hour after he had a syncopal episode. Over the past two weeks, the patient has felt light-headed upon standing and has noticed that his legs have been swollen. He was started on a medication for early symptoms of Parkinson disease one month ago. Vital signs show blood pressure 114/70 mm Hg when supine and 92/38 mm Hg upon standing. Examination of the lower extremities shows a lacy, purple rash and 2+ pitting edema. Neurologic examination shows an ataxic gait. The physician decreases the dose of medication. The patient is most likely experiencing adverse effects caused by a drug that works through which of the following mechanisms of action?", "answer": "Increased dopamine release from central neurons", "meta_info": "step1", "answer_idx": "A", "A": "Increased dopamine release from central neurons", "B": "Inhibition of acetylcholine activity in the basal ganglia", "C": "Selective inhibition of monoamine oxidase type B", "D": "Inhibition of central methylation of dopamine", "language": "en"}
{"question": "A 50-year-old woman presents to her primary care physician for muscle weakness. Her symptoms have progressively worsened over the course of several months, where she has experienced difficulty getting up from a chair, climbing the stairs, and placing her groceries on the top shelves of her kitchen. She also reports feeling tired lately and is unsure when this began. Physical examination is notable for muscle weakness in the deltoids and hip flexors with 2+ biceps, triceps, patellar, and ankle tendon reflexes. Laboratory testing demonstrates a creatine kinase level of 4,200 U/L (normal is 10-70 U/L), lactate dehydrogenase level of 150 U/L (normal is 45-90 U/L), and thyroid-stimulating hormone level of 1.5 µU/mL (normal is 0.5-5.0 µU/mL). Which of the following is the best initial treatment for this patient?", "answer": "Prednisone", "meta_info": "step2&3", "answer_idx": "C", "A": "Azathioprine", "B": "Intravenous immunoglobulin", "C": "Prednisone", "D": "Thyroxine", "language": "en"}
{"question": "A 22-year-old woman comes to the physician because of a 5-kg (11-lb) weight gain and hair loss over the past 4 months. Menarche occurred at the age of 12 years and menses occurred at irregular intervals until she stopped having periods 2 months ago. She is 165 cm (5 ft 5 in) tall and weighs 82 kg (180 lb); BMI is 30 kg/m2. Physical examination shows a receding hairline and hair loss over the vertex of the head. Serum studies show:\nThyroid-stimulating hormone 2 μU/mL\nLuteinizing hormone 32 mIU/mL\nProlactin 11 ng/mL\nUrine pregnancy test is negative. Withdrawal bleeding occurs after a progestin challenge test. The most likely cause of amenorrhea in this patient is an increase in production of which of the following hormones?\"", "answer": "Estrogen in adipose tissue", "meta_info": "step1", "answer_idx": "B", "A": "Progesterone in corpus luteum", "B": "Estrogen in adipose tissue", "C": "Follicle stimulating hormone in the adenohypophysis", "D": "Dopamine in the hypothalamus", "language": "en"}
{"question": "A 70-year-old man with chronic myopia comes to the physician because of a 4-month history of difficulty seeing distant objects, especially at night, despite wearing glasses. Examination shows bilateral narrowing of peripheral visual fields, cupping of the optic discs, and elevated intraocular pressure. Gonioscopy shows no abnormalities. He is prescribed a drug. At a follow-up examination several months later, intraocular pressure is normal, but darkening of the iris and an increase in the length of the eyelashes is observed. Which of the following drugs was most likely prescribed?", "answer": "Latanoprost", "meta_info": "step1", "answer_idx": "D", "A": "Timolol", "B": "Acetazolamide", "C": "Apraclonidine", "D": "Latanoprost", "language": "en"}
{"question": "A 3-week-old female presents with her parents to her pediatrician for a routine visit. The parents report that the child is sleeping in regular two-hour intervals and feeding and stooling well. They are concerned because they have on occasion noticed a “swelling of the belly button.” Cord separation occurred at seven days of age. The parents report that the swelling seems to come and go but is never larger than the size of a blueberry. They deny any drainage from the swelling. On physical exam, the child is in no acute distress and appears developmentally appropriate for her age. Her abdomen is soft and non-tender with a soft, 1 cm bulge at the umbilicus. The bulge increases in size when the child cries and can be easily reduced inside the umbilical ring without apparent pain.\n\nWhich of the following is the best next step in management?", "answer": "Expectant management", "meta_info": "step2&3", "answer_idx": "A", "A": "Expectant management", "B": "Histopathologic evaluation", "C": "Elective surgical management", "D": "Immediate surgical management", "language": "en"}
{"question": "A 25-year-old man presents to the emergency department after a motor vehicle collision. He is currently complaining of chest pain and shortness of breath and seems rather confused. His temperature is 97.7°F (36.5°C), blood pressure is 94/54 mmHg, pulse is 170/min, respirations are 12/min, and oxygen saturation is 90% on room air. A 14-gauge needle is placed in the 2nd intercostal space on the patient’s left, and his blood pressure increases to 104/74 mmHg and his pulse decreases to 100/min. Which of the following is the best next intervention for this patient?", "answer": "Tube thoracostomy", "meta_info": "step2&3", "answer_idx": "D", "A": "Chest radiograph", "B": "Pericardiocentesis", "C": "Thoracotomy", "D": "Tube thoracostomy", "language": "en"}
{"question": "A 13-year-old girl presents with a rash on her left hand and forearm. She went hiking with friends the day before yesterday and awoke this morning to find her hand and forearm red and itchy. She denies any swelling of the face or throat, difficulty breathing, dizziness, or palpitations. She has no significant past medical history or known allergies. She is afebrile and her vital signs are within normal limits. On physical examination, there are multiple erythematous papules and fluid-filled vesicles in a linear pattern on her left hand and forearm as shown in the exhibit (see image). Which of the following is the best course of treatment for this patient?", "answer": "Topical clobetasol", "meta_info": "step2&3", "answer_idx": "B", "A": "Oral prednisone", "B": "Topical clobetasol", "C": "Phototherapy", "D": "Azathioprine", "language": "en"}
{"question": "A 12-year-old boy is brought to the physician for multiple bruises. He has fallen multiple times over the past 4 months and has difficulty walking without assistance. His speech is slow and difficult to understand. Neurological examination shows bilateral nystagmus, decreased muscle strength, 1+ reflexes bilaterally, and a wide-based gait with irregular and uneven steps. His proprioception and vibration senses are absent. The remainder of the examination shows kyphoscoliosis and foot inversion with hammer toes. This patient is most likely to die from which of the following complications?", "answer": "Heart failure", "meta_info": "step1", "answer_idx": "B", "A": "Renal cell carcinoma", "B": "Heart failure", "C": "Posterior fossa tumors", "D": "Aspiration pneumonia\n\"", "language": "en"}
{"question": "A 28-year-old nulligravid woman comes to the physician for a routine health maintenance examination. Upon questioning, she reports that she and her husband have been trying to conceive for more than 1 year; they have unprotected sexual intercourse 3–4 times per week. Recently, she has not been enjoying sexual intercourse with her husband because of painful penetration. She also reports episodic back and pelvic pain over the past 6 months that lasts for 2–3 days; she has missed several days of work each month because of the pain. Menarche was at the age of 13 years, and menses occur at 26–28 day intervals. Pelvic examination shows a normal-appearing vulva and vagina. There is rectovaginal tenderness. Ultrasonography of the pelvis shows a retroverted normal-sized uterus. Further evaluation is most likely to show which of the following findings?", "answer": "Reddish-black peritoneal lesions on laparoscopy", "meta_info": "step1", "answer_idx": "C", "A": "Endometrial tisssue within the myometrium on biopsy", "B": "Multiple bilateral ovarian cysts on ultrasonography", "C": "Reddish-black peritoneal lesions on laparoscopy", "D": "Concentric, solid myometrial tumors on MRI", "language": "en"}
{"question": "A 2-year-old Caucasian male presents with recurrent diaper rash and oral thrush. He has also experienced recurrent episodes of otitis media from repeat Streptoccous pneumoniae. He notably has reduced T and B cell counts. What disease is the child suffering from?", "answer": "Severe combined immunodeficiency", "meta_info": "step1", "answer_idx": "C", "A": "X-linked agammaglobulinemia", "B": "Isolated IgA deficiency", "C": "Severe combined immunodeficiency", "D": "DiGeorge syndrome", "language": "en"}
{"question": "A 42-year-old primigravida woman presents to her gynecologist for a routine prenatal visit at 11 weeks of gestation. Her pregnancy has been uneventful so far. She denies smoking, using alcohol, or any illicit drugs. Past medical history is significant for Hashimoto’s thyroiditis which is well-controlled with levothyroxine. Her blood pressure is 110/70 mm Hg, a heart rate of 95/min, a respiratory rate of 20/min, and a temperature of 36.4°C (97.5°F). Physical examination is unremarkable. A transvaginal ultrasound reveals increased nuchal translucency. Laboratory studies show decreased levels of PAPP-A and increased levels of β-hCG. If the pregnancy is continued to term, the child is at an increased risk of developing which of the following conditions?", "answer": "Alzheimer’s disease", "meta_info": "step1", "answer_idx": "C", "A": "Vaginal adenosis", "B": "Huntington disease", "C": "Alzheimer’s disease", "D": "Ebstein anomaly", "language": "en"}
{"question": "An 18-month-old boy is brought to the emergency department by his babysitter because of lethargy and fever for 3 hours. He has not fully recovered from a middle ear infection that started a few days ago. The parents cannot be reached for further information. His temperature is 39.1°C (102.3°F). Physical examination shows nuchal rigidity. A pathogen is isolated from the patient's cerebrospinal fluid that does not grow on regular blood agar plate but produces colonies when cocultured with Staphylococcus aureus. Vaccination against the causal pathogen of this patient's current disease is most likely to also prevent which of the following conditions?", "answer": "Epiglottitis", "meta_info": "step1", "answer_idx": "B", "A": "Bacterial rhinosinusitis", "B": "Epiglottitis", "C": "Chancroid", "D": "Impetigo", "language": "en"}
{"question": "A 20-month-old boy is brought to the physician for the evaluation of intellectual and behavioral abnormalities and abnormal movements of his extremities. His mother reports that he often hits his head and limbs against furniture. He is unable to walk without support and speaks in unclear 2-word phrases. Examination shows multiple bruises on the forehead and several healing wounds over the fingers. There is increased muscle tone in all extremities. Laboratory studies show an increased serum uric acid concentration. The serum concentration of which of the following substances is most likely to also be increased in this patient?", "answer": "Phosphoribosyl pyrophosphate", "meta_info": "step1", "answer_idx": "C", "A": "Phenylalanine", "B": "Deoxyadenosine trisphosphate", "C": "Phosphoribosyl pyrophosphate", "D": "Cytosine monophosphate", "language": "en"}
{"question": "A 24-year-old man presents to the office for a physical exam and drug screening requested by his parole officer. He has a history of multiple run-ins with the law, including theft, destruction of property, and assault and battery. Patient confesses that he has always been the 'problem child' in his home and always got into trouble with authority figures. Past medical records reveal testimonies from his mother describing episodes of physically aggressive behavior in school starting at before 12. Although a single parent, his mother states there were no stressful changes or issues at home. Today's urine toxicology screens are negative. Which of the following is most likely this patient’s diagnosis?", "answer": "Antisocial personality disorder", "meta_info": "step1", "answer_idx": "C", "A": "Substance use-related aggression", "B": "Conduct disorder", "C": "Antisocial personality disorder", "D": "Borderline personality disorder", "language": "en"}
{"question": "A 47-year old woman is referred to a nephrologist due to hematuria over the last week and lower extremity edema. She first noticed her feet and legs would swell in the mornings about 2 weeks ago. Her past medical history is significant for systemic lupus erythematosus for the past 24 years. This causes her mild joint and muscle pain on most day and she manages her symptoms with ibuprofen and acetaminophen. Today, her heart rate is 90/min, the respiratory rate is 17/min, the blood pressure is 140/90 mm Hg, and the temperature is 37.1°C (98.8°F). Urine analysis shows 6-10 dysmorphic RBCs per high powered field and occasional cellular casts. Serum creatinine is 2.4 mg/dL and a 24 hour urine collection reveals 550mg of excreted protein. A kidney biopsy shows findings consistent with diffuse proliferative glomerulonephritis. Which of the following is the best initial therapy for this patient?", "answer": "Cyclophosphamide and prednisolone", "meta_info": "step2&3", "answer_idx": "D", "A": "Methotrexate and folic acid", "B": "Intravenous immunoglobulin", "C": "Plasmapheresis", "D": "Cyclophosphamide and prednisolone", "language": "en"}
{"question": "A 6-year-old girl presents to your clinic two weeks after receiving a routine immunization in preparation for a trip overseas. Periorbital edema is present on exam, and 24 hour urine collection shows excretion of 4.3 grams of protein/day. Which pathological change would likely be seen on microscopy?", "answer": "Podocyte effacement on electron microscopy", "meta_info": "step1", "answer_idx": "D", "A": "Linear IgG deposition on light microscopy", "B": "IgA-immune complexes in the mesangium on electron microscopy", "C": "Subepithelial deposits with “spike and dome” appearance on electron microscopy", "D": "Podocyte effacement on electron microscopy", "language": "en"}
{"question": "A 9-year-old girl is brought to the physician by her father for evaluation of intermittent muscle cramps for the past year and short stature. She has had recurrent upper respiratory tract infections since infancy. She is at the 5th percentile for weight and 10th percentile for height. Physical examination shows nasal polyps and dry skin. An x-ray of the right wrist shows osteopenia with epiphyseal widening. Which of the following sets of laboratory findings is most likely in this patient's serum?\n $$$ Calcium %%% Phosphorus %%% Parathyroid hormone %%% Calcitriol $$$", "answer": "↓ ↓ ↑ ↓", "meta_info": "step1", "answer_idx": "A", "A": "↓ ↓ ↑ ↓", "B": "↓ ↑ ↑ ↓", "C": "↑ ↓ ↑ ↑", "D": "Normal ↓ ↑ ↓", "language": "en"}
{"question": "A 24-year-old medical student presents to urgent care with cough and rhinorrhea. He has been learning about HIV and immunosuppression in medical school, and he is worried that he is seriously ill. He has no significant medical history, and he is sexually active with his girlfriend. He consumes alcohol on weekends but does not use tobacco or other recreational drugs. He candidly reports that, in microbiology lab, he cultured his own sputum on Sabouraud agar, and Candida grew on the agar. Examination of the oropharynx does not show any abnormalities. You perform a nasal viral swab, which confirms that he has a rhinovirus infection. Which of the following is the most likely explanation for his positive Candida culture?", "answer": "Benign Candida colonization", "meta_info": "step1", "answer_idx": "D", "A": "HIV virus infection", "B": "Xerostomia", "C": "Surreptitious drug use", "D": "Benign Candida colonization", "language": "en"}
{"question": "A 57-year-old woman comes to her physician with a persistent cough. She has observed an increase in the frequency of her cough over the past few months and also the production of yellowish sputum on several occasions. She says that sputum production is greater in the morning compared to the rest of the day. She has been a chain smoker for about 35 years now, smoking close to 3 packs a day. She has never had the will to quit. Over the last 2 years, she has had this cough and doesn't recall being free of it for 3 months at a stretch. On examination, there is a slight expiratory wheeze in the lower lung fields. Her respiratory rate is 18/min, pulse is 85/min, and blood pressure is 110/70 mm Hg. Her forced expiratory volume in the first second is 83% at this time. Her FEV1/FVC post-bronchodilator ratio is 0.65. Based on these findings, her physician recommends that she quit smoking. She is also advised to take pneumococcal and influenza vaccinations over the next few months. Which of the following medications would be most appropriate to assist the patient with her symptoms at this time?", "answer": "Albuterol", "meta_info": "step2&3", "answer_idx": "A", "A": "Albuterol", "B": "Fluticasone", "C": "Doxycycline", "D": "Prednisone", "language": "en"}
{"question": "A 56-year-old woman presents to her primary care physician for dizziness. She says that her symptoms began approximately 1 month prior to presentation and are associated with nausea and ringing of the ears. She describes her dizziness as a spinning sensation that has a start and end and lasts approximately 25 minutes. This dizziness is severe enough that she cannot walk or stand. Her symptoms are fluctuating, and she denies any tunnel vision or feelings of fainting. However, she has abruptly fallen to the ground in the past and denied losing consciousness. Medical history is significant for a migraine with aura treated with zolmitriptan, type 2 diabetes managed with metformin, and hypertension managed with lisinopril. Her blood pressure is 125/75 mmHg, pulse is 88/min, and respirations are 16/min. On physical exam, when words are whispered into her right ear, she is unable to repeat the whispered words aloud; however, this is normal in the left ear. Air conduction is greater than bone conduction with Rinne testing, and the sound of the tuning fork is loudest in the left ear on Weber testing. Which of the following is most likely the diagnosis?", "answer": "Meniere disease", "meta_info": "step2&3", "answer_idx": "B", "A": "Benign paroxysmal positional vertigo", "B": "Meniere disease", "C": "Migraine", "D": "Transient ischemic attack", "language": "en"}
{"question": "A 3086-g (6-lb) male newborn is delivered at 39 weeks' gestation to a 29-year-old woman. Initial examination shows micrognathia, a broad nasal bridge, short philtrum, and a cleft palate. Intermittent muscle spasms are seen predominantly in the hands and feet. A harsh systolic murmur is heard over the lower left sternal border. Which of the following is the most likely cause of this infant’s symptoms?", "answer": "Deletion in chromosome 22", "meta_info": "step1", "answer_idx": "B", "A": "Deletion in chromosome 7", "B": "Deletion in chromosome 22", "C": "Nondisjunction of chromosome 21", "D": "Nondisjunction of chromosome 13", "language": "en"}
{"question": "A 37-year-old woman comes to the emergency department because her eyes have had a yellow discoloration and she has had dark urine for the past 3 days. She has also had fever, itching, and severe fatigue. She reports having symptoms of the stomach flu a week ago, which resolved with over-the-counter medication. She does not have diarrhea but says her stools are whitish in appearance. She has no personal history of serious illness. She does not smoke and drinks an average of 2 beers on weekends. She does not use illicit drugs. She has been sexually active with the same partner for 12 years and uses condoms consistently. She works as a flight attendant for an international airline. She appears ill. Her temperature is 39.3°C (102.7°F), pulse is 64/min, and blood pressure is 132/82 mm Hg. Examination shows scleral icterus, excoriation marks over her extremities, and parched lips. The liver is tender on palpation; there is no splenomegaly. Cardiopulmonary examination is normal. Laboratory studies show:\nHemoglobin 11.6 g/dL\nLeukocyte count 10,300/mm3\nPlatelet count 256,000/mm3\nESR 19 mm/hr\nProthrombin time 13 seconds\nSerum\nUrea nitrogen 28 mg/dL\nGlucose 89 mg/dL\nCreatinine 0.7 mg/dL\nBilirubin\nTotal 8 mg/dL\nDirect 4 mg/dL\nALP 80 U/L\nAST 312 U/L\nALT 569 U/L\nAn ultrasound of the abdomen shows no abnormalities. Serum studies are most likely to show which of the following findings?\"", "answer": "Anti-HAV IgM", "meta_info": "step2&3", "answer_idx": "C", "A": "Anti-mitochondrial antibodies", "B": "Perinuclear anti-neutrophil cytoplasmic antibodies", "C": "Anti-HAV IgM", "D": "Anti-HEV IgG", "language": "en"}
{"question": "A 27-year-old man presents with diarrhea, fatigue and weight loss. He says he has been having occasional loose stools and abdominal pain for the past month, but he did not seek any medical attention because of work deadlines. He says the diarrhea is associated with cramping lower abdominal pain and an urgency to defecate. His stool is loose, occasionally blood-tinged, and contains mucus. He also says he feels fatigued and has lost 11 kg (24 lb) over the last 2 months. The patient denies any fever, sick contacts, or a history of recent travel. No significant past medical history. Family history is significant for colon cancer in his father, who died at the age of 50. On physical examination, the patient has generalized pallor. Abdominal exam reveals mild tenderness to palpation in the left lower quadrant. Laboratory investigations reveal microcytic anemia with an elevated ESR. A colonoscopy with biopsy is performed, which shows inflammation of the sigmoid colon and rectum. Biopsy shows a predominantly lymphoid infiltration of the mucosa and submucosa with multiple crypt abscesses. No evidence of granulomatous disease. What is the mechanism of action of the drug which typically induces remission of this patient’s most likely condition?", "answer": "Inhibition of prostaglandins and inflammatory cytokines", "meta_info": "step1", "answer_idx": "A", "A": "Inhibition of prostaglandins and inflammatory cytokines", "B": "Antibody against tumor necrosis factor", "C": "Inhibition of cellular metabolism", "D": "Suppression of polymorphonuclear cell migration", "language": "en"}
{"question": "A 61-year-old woman presents to your office complaining of mild fatigue and weight loss over the past 6 months. She states she has felt generally unwell and has had decreased appetite during this time frame. Her temperature is 98.1°F (36.7°C), blood pressure is 122/80 mmHg, pulse is 88/min, respirations are 16/min, and oxygen saturation is 98% on room air. Physical exam reveals splenomegaly and a nontender abdomen. A complete blood count with differential shows the following:\n\nHemoglobin: 10 g/dL\nHematocrit: 30%\nLeukocyte count: 166,500/mm^3\nSegmented neutrophils 92%\nLeukocyte alkaline phosphatase: Low\nPlatelet count: 92,000/mm^3\n\nA bone marrow biopsy is performed demonstrating infiltration with a large number of normal-appearing neutrophils. Which of the following translocations is likely to be seen in this patient?", "answer": "t(9;22)", "meta_info": "step2&3", "answer_idx": "B", "A": "t(8;14)", "B": "t(9;22)", "C": "t(12;21)", "D": "t(15;17)", "language": "en"}
{"question": "A 44-year-old homeless man is brought to the emergency department after he was arrested when found intoxicated in someone's garage. The patient is acutely altered and is covered in urine, stool, and vomit. His temperature is 97.6°F (36.4°C), blood pressure is 104/64 mmHg, pulse is 130/min, respirations are 19/min, and oxygen saturation is 98% on room air. The patient is aroused with pain and begins answering basic questions. He states his vision is blurry and he can't see anything. Laboratory values are ordered as seen below.\n\nSerum:\nNa+: 141 mEq/L\nCl-: 102 mEq/L\nK+: 4.4 mEq/L\nHCO3-: 14 mEq/L\nBUN: 25 mg/dL\nGlucose: 99 mg/dL\nCreatinine: 1.4 mg/dL\nCa2+: 10.2 mg/dL\n\nWhich of the following is the most appropriate initial treatment of this patient?", "answer": "Inhibition of alcohol dehydrogenase", "meta_info": "step2&3", "answer_idx": "B", "A": "Glutathione formation", "B": "Inhibition of alcohol dehydrogenase", "C": "Muscarinic antagonism", "D": "Removal via dialysis", "language": "en"}
{"question": "A 32-year-old construction worker is brought to the Emergency Department after a block of concrete crushed his right leg. His coworkers tried to remove the block, but it was not possible until firemen arrived on the scene 30 minutes after the incident. His personal medical history is unremarkable. Upon admission his vitals were stable. On physical examination the man is unconscious. His right leg is deformed with lacerations and hematomas. There are at least two fractures and several areas of the muscle appear pulpified. Distal right pulses are absent. An X-ray of the right leg reveals several displaced fractures of the tibia and fibula. Blood samples and a urine specimens are sent to the lab for analysis. Which of the following laboratory abnormalities would you expect to find in this patient?", "answer": "Fractional excretion of sodium (FeNa+) > 2%", "meta_info": "step2&3", "answer_idx": "A", "A": "Fractional excretion of sodium (FeNa+) > 2%", "B": "Urine osmolality > 500 mOsmol/kg", "C": "Red-tinted plasma", "D": "Elevated haptoglobin", "language": "en"}
{"question": "A 42-year-old primigravida woman goes into labor at 37 weeks. After several hours of labor, a boy is born with multiple physical abnormalities including cleft palate, micrognathia, and low-set ears. Imaging reveals an absence of the thymic shadow. Which of the following is the most likely cause of the patient’s condition?", "answer": "Microdeletion of the long arm of chromosome 22", "meta_info": "step1", "answer_idx": "A", "A": "Microdeletion of the long arm of chromosome 22", "B": "Microdeletion of the long arm of chromosome 7", "C": "Microdeletion of the short arm of chromosome 5", "D": "Adenosine deaminase deficiency", "language": "en"}
{"question": "A 20-year-old woman presents following a seizure 2 hours ago. The patient's roommate describes seeing the patient suddenly 'freeze', collapse, and start having jerky movements involving her entire body. The patient says she can not recall the episode but does remember 'seeing stars' before losing consciousness. She remembers being confused about where she was soon after the seizure and had urinated in her clothes when she regained consciousness. A persistent headache has troubled her since the seizure for which she took acetaminophen before coming to the hospital. Her past medical history is unremarkable. She denies alcohol and drug use. The physician starts her on an antiepileptic drug that acts in the motor cortex by blocking repeated activation of voltage-gated sodium channels and is also used in status epilepticus. When this drug is used long-term, which of the following complications can develop?", "answer": "Drug-induced SLE", "meta_info": "step1", "answer_idx": "B", "A": "Drug dependence", "B": "Drug-induced SLE", "C": "Renal failure", "D": "Liver failure", "language": "en"}
{"question": "A 68-year-old man presents to his primary care physician for pain in his feet. The patient states that it is very painful for him to walk around, and he has significant pain in his right and left toes. The patient has a past medical history of obesity, type II diabetes mellitus, anxiety, depression, COPD, and a 30 pack-year smoking history. The patient’s current medications include lisinopril, hydrochlorothiazide, insulin, metformin, fluoxetine, clonazepam, albuterol, home oxygen, varenicline, and fish oil and he is compliant with all medications. On physical exam, the patient’s toes appear pale and dirty. When inspecting his toes, shallow wounds with a pale base devoid of granulation tissue can be appreciated. The patient has decreased pinprick sensation in his lower extremities bilaterally. Pulmonary exam is notable for a prolonged expiratory phase. Which of the following findings is most likely to be found in this patient?", "answer": "Calf pain after walking moderate distance", "meta_info": "step2&3", "answer_idx": "D", "A": "Bipedal edema", "B": "Increased reflexes of the lower extremities", "C": "Loss of vibration sensation in the lower extremities", "D": "Calf pain after walking moderate distance", "language": "en"}
{"question": "A 16-year-old man is brought to the emergency department for left arm pain. Per the patient, he was playing at his high-school football game when a member of the opposing team tackled him from behind, which resulted in him landing on his left arm. He felt a “popping” sensation and immediate, sharp pain at his left shoulder. The patient is in mild distress and holds his arm against his abdomen. Physical examination demonstrates limited abduction secondary to pain and reduced muscle tone over the shoulder. What additional finding would you expect from this patient?", "answer": "Loss of sensation over the lateral arm", "meta_info": "step1", "answer_idx": "C", "A": "Loss of sensation over the dorsal hand", "B": "Loss of sensation over the lateral 3 1/2 fingers", "C": "Loss of sensation over the lateral arm", "D": "Loss of sensation over the lateral forearm", "language": "en"}
{"question": "A 68-year-old woman is brought to the emergency room because of pain in her right shoulder after falling down the stairs in her apartment. She has a history of postmenopausal osteoporosis. Her current medications are alendronate, vitamin D, and calcium supplementation. Physical examination shows shortening of the right arm as well as tenderness and swelling over the right shoulder. The range of motion of the right arm is limited by pain. An x-ray of the right shoulder shows a fracture of the surgical neck of the humerus. Which of the following movements is most likely to be impaired in this patient?", "answer": "Arm abduction", "meta_info": "step1", "answer_idx": "C", "A": "Wrist extension", "B": "Elbow flexion", "C": "Arm abduction", "D": "Thumb adduction", "language": "en"}
{"question": "A hematologist has found a historical hemocytometer used during the 1960s. Out of curiosity, he decides to obtain platelet counts from his brother, who has idiopathic thrombocytopenic purpura (ITP), with both the historical hemocytometer and a modern automated CBC analyzer. The platelet counts of repeated measurements are shown in ascending order:\nHistorical hemocytometer 55,000 57,000 62,000 76,000 77,000 82,000 92,000 Mean: 72,000\nModern automated CBC analyzer 71,000 71,000 72,000 72,000 73,000 74,000 74,000 Mean: 72,000\nIf the measurements on a modern automated CBC analyzer are considered accurate, which of the following conclusions can be drawn about the historical hemocytometer?\"", "answer": "Test lacks precision", "meta_info": "step2&3", "answer_idx": "D", "A": "Test lacks accuracy", "B": "Test lacks validity", "C": "Test lacks specificity", "D": "Test lacks precision", "language": "en"}
{"question": "A 9-year-old female child whose family recently emigrated from Afghanistan presents to the county hospital with difficulty swallowing and generalized muscle rigidity. Her parents note that although she is in severe pain she always appears to be smiling. After getting a detailed history from the parents, the residents comes to the conclusion that the child's clinical presentation is due to a lack of immunizations and a deep wound on her knee resulting from a fall six days ago. Which of the following is the mechanism of action of the toxin causing this child's symptoms?", "answer": "Preventing release of GABA by cleaving of synaptobrevin 2", "meta_info": "step1", "answer_idx": "D", "A": "Inhibiting protein synthesis via ADP-ribosylation of elongation factor 2", "B": "Overactivating adenylate cyclase by ADP-ribosylation of the Gs alpha subunit", "C": "Overactivating adenylate cyclase by disabling the Gi subunit", "D": "Preventing release of GABA by cleaving of synaptobrevin 2", "language": "en"}
{"question": "A 49-year-old obese man presents to the emergency department with a fever and a cough productive of bloody sputum. He has also been waking up at night frequently, which he attributes to sweating while asleep. He is also proud of recently losing some weight but denies actively trying to do so. He says that he has had these symptoms intermittently for the last several years but has not consistently sought treatment because his housing has been transient with periods of homelessness. He is started on a course of therapy and leaves against medical advice before his physician is able to explain the medications. He returns two days later because he is concerned that his eyes are bleeding. The area of the lung most likely affected by this patient's condition has which of the following characteristics?", "answer": "Low perfusion, low ventilation, high V/Q ratio", "meta_info": "step1", "answer_idx": "C", "A": "High perfusion, high ventilation, high V/Q ratio", "B": "High perfusion, high ventilation, low V/Q ratio", "C": "Low perfusion, low ventilation, high V/Q ratio", "D": "Low perfusion, low ventilation, low V/Q ratio", "language": "en"}
{"question": "A 66-year-old male presents to clinic for a blood glucose level of 169 mg/dL taken at a local pharmacy. He is a farmer in rural Alabama and has not seen a doctor for decades. He wants to be in excellent shape prior to his trip to visit his daughter at college. His past medical history and family history are unknown, and he does not take any medications. His diet consists of pork products and he does not smoke. His temperature is 99.5°F (37.5°C), pulse is 100/min, blood pressure is 169/90 mmHg, respirations are 18/min, and oxygen saturation is 97% on room air. The patient is started on metformin, lisinopril, and a guided exercise program. Lab results are below:\n\nSerum:\nNa+: 145 mEq/L\nCl-: 100 mEq/L\nK+: 4.9 mEq/L\nHCO3-: 24 mEq/L\nBUN: 18 mg/dL\nGlucose: 211 mg/dL\nCreatinine: 1.0 mg/dL\nCa2+: 10.0 mg/dL\n\nHe returns from his trip, complaining of cough. He denies any other symptoms. His temperature is 99.5°F (37.5°C), pulse is 101/min, blood pressure is 160/85 mmHg, respirations are 18/min, and oxygen saturation is 98% on room air. Repeat lab results are below:\n\nSerum:\nNa+: 145 mEq/L\nCl-: 100 mEq/L\nK+: 5.3 mEq/L\nHCO3-: 24 mEq/L\nBUN: 22 mg/dL\nGlucose: 169 mg/dL\nCreatinine: 1.2 mg/dL\nCa2+: 10.1 mg/dL\n\nWhat is the next best step in management?", "answer": "Switch blood pressure medication to losartan", "meta_info": "step2&3", "answer_idx": "A", "A": "Switch blood pressure medication to losartan", "B": "Switch blood pressure medication to hydrochlorothiazide", "C": "Azithromycin", "D": "Loratadine", "language": "en"}
{"question": "A 25-year-old woman presents to her primary care physician for her annual physical exam. Her prior medical history is significant for seasonal allergies and a broken arm at age 12 that was treated in a long arm cast. She has not had any major illnesses in the previous year and does not currently have any major complaints. On physical exam her blood pressure is found to be 152/95 mmHg. Laboratory findings reveal elevated levels of renin and aldosterone. Given her elevated blood pressure, she is prescribed captopril; however, 1 week later she presents to the emergency department with hypertensive urgency. At that point captopril is immediately stopped. Which of the following is the most likely cause of this patient's disorder?", "answer": "Bilateral fibromuscular dysplasia", "meta_info": "step1", "answer_idx": "A", "A": "Bilateral fibromuscular dysplasia", "B": "Conn syndrome", "C": "Renin secreting tumor", "D": "Unilateral fibromuscular dysplasia", "language": "en"}
{"question": "An investigator is analyzing the serum calcium and parathyroid hormone levels of 100 patients. A scatter plot of the findings is shown. Which of the following is a possible explanation for the group marked with the letter E?", "answer": "Lymphoma", "meta_info": "step1", "answer_idx": "A", "A": "Lymphoma", "B": "End-stage kidney disease", "C": "Thyroidectomy", "D": "Multiple endocrine neoplasia", "language": "en"}
{"question": "A 56-year-old male is admitted to the emergency department with sudden onset of pain, left-sided scrotal swelling, and nausea. The patient states that the symptoms started three hours ago after he lifted up a heavy pack. He says that the swelling had been intermittently present for several years already and was most prominent when physically straining or coughing, but it had never been painful. Past medical history is unremarkable. Patient reports a 26-pack-year history of smoking. Vital signs are as follows: blood pressure 150/90 mm Hg, heart rate 85/min, respiratory rate 14/min, and temperature 37.8℃ (100℉). BMI is 32.9 kg/m2. Patient’s respiratory and cardiovascular exams are within normal limits. The abdomen is moderately distended. There is a tender erythematous scrotal swelling on the left, which cannot be manually reduced. Which of the following tests should be performed to confirm the diagnosis in this patient?", "answer": "No further tests are needed", "meta_info": "step2&3", "answer_idx": "B", "A": "Ultrasonography", "B": "No further tests are needed", "C": "Fine needle biopsy", "D": "Laparoscopy", "language": "en"}
{"question": "A 6-year-old boy presents to a pediatrician for initial evaluation. He was recently adopted from abroad and his parents want to establish care in the United States. His medical history is unclear and there are no records on any family history. On presentation, he is found to fall below the 5th percentile in height for his age with shortened 4th and 5th digits. Physical exam reveals wrist spasms when his blood pressure is taken. Radiographs reveal decreased bone mineral density and several healing fractures. Which of the following mechanisms is most likely associated with this patient's presentation?", "answer": "Resistance to effects of parathyroid hormone", "meta_info": "step1", "answer_idx": "D", "A": "Decreased production of parathyroid hormone", "B": "Inadequate intake of vitamin D", "C": "Malabsorption of nutrients", "D": "Resistance to effects of parathyroid hormone", "language": "en"}
{"question": "A 12-year-old boy is brought to the emergency department with a 2-month history of increasing difficulty with physical activity. Specifically, he says that he gets short of breath quickly with exertion even though he used to participate in all activities without a problem. When asked, he endorses sometimes coughing up flecks of blood. His past medical history is unclear because he was recently adopted from abroad and has not yet established care. Physical exam reveals blue discoloration of his lips and fingernails as well as a holosystolic murmur best heard at the lower left sternal border. Which of the following physiologic mechanisms is primarily responsible for this patient's current presentation?", "answer": "Pulmonary artery hypertension", "meta_info": "step1", "answer_idx": "D", "A": "Increasing size of ventricular septal defect", "B": "Left ventricular outflow tract obstruction", "C": "New atrial septal defect", "D": "Pulmonary artery hypertension", "language": "en"}
{"question": "A scientist isolates the rough endoplasmic reticulum from HeLa cells. He performs a northern blot to isolate nucleic acid sequences of interest. Which of the following molecules make up part of the structure that was separated?", "answer": "Ribosomal RNA", "meta_info": "step1", "answer_idx": "C", "A": "RNA polymerase", "B": "Transfer RNA", "C": "Ribosomal RNA", "D": "Mitochondrial RNA", "language": "en"}
{"question": "A 14-month-old girl is brought to the pediatrician after her parents noticed her being increasingly irritable with frequent vomiting for the past 2 weeks. Parents deny any history of fever. They recently immigrated to the country and, unfortunately, the mother did not receive prenatal care during pregnancy due to a lack of health insurance. Physical examination is unremarkable except for a head circumference over 2 standard deviations larger than the mean for her age, and delay in meeting motor developmental milestones. A magnetic resonance imaging (MRI) of her brain shows an enlargement of the posterior fossa, cystic dilation of the 4th ventricle, and hypoplasia of the cerebellar vermis (see image). Which of the following is the most likely diagnosis in this patient?", "answer": "Dandy-Walker malformation", "meta_info": "step1", "answer_idx": "C", "A": "Chiari II malformation", "B": "Chiari III malformation", "C": "Dandy-Walker malformation", "D": "Klippel Feil syndrome", "language": "en"}
{"question": "A 28-year-old woman presents with a 3-year history of recurrent headaches. She says the episodes are typically triggered by hunger, mental stress, physical exertion, and lack of sleep, although many times the trigger is not known. She describes her headaches as unilateral, severe, throbbing, and aggravated by movement. The patient says that each episode usually lasts for 6–24 hours and is often accompanied by nausea, vomiting, and intolerance to light. Which of the following brain regions, if lesioned, would most likely result in no change in this patient’s symptoms?", "answer": "Red nucleus", "meta_info": "step1", "answer_idx": "A", "A": "Red nucleus", "B": "Locus coeruleus", "C": "Nucleus raphe magnus", "D": "Periaqueductal gray", "language": "en"}
{"question": "A 68-year-old man comes to the physician for a routine health maintenance examination. He has had increasing shortness of breath and a productive cough for the past 1 year. He can walk up a flight of stairs without stopping. He has hypertension and his only medication is amlodipine. He has a history of asthma during childhood. He smoked 1 pack of cigarettes daily for 30 years but quit 16 years ago. He used to work at a shipyard and retired 5 years ago. His pulse is 98/min, respirations are 25/min and blood pressure is 134/88 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 93%. Scattered expiratory wheezing and rhonchi are heard throughout both lung fields. Cardiac examination shows no murmurs, rubs, or gallops. Spirometry shows an FEV1:FVC ratio of 63% and an FEV1 of 65% of predicted. His diffusing capacity for carbon monoxide (DLCO) is 40% of predicted. Which of the following is the most likely cause of this patient's findings?", "answer": "Emphysema", "meta_info": "step2&3", "answer_idx": "C", "A": "Asthma", "B": "Congestive heart failure", "C": "Emphysema", "D": "Asbestosis\n\"", "language": "en"}
{"question": "A 9-year-old boy presents to his orthopedic surgeon for ongoing evaluation of his lower extremity deformities. Specifically, his hips have been dislocating over the last year despite bracing in hip-knee-ankle-foot orthoses. He is paralyzed from below the L2 nerve root and has difficulty with both bladder and bowel incontinence. He has had these abnormalities since birth due to a lower back lesion that required surgical closure during infancy. Which of the following substances was most likely elevated in his mother's serum during her pregnancy?", "answer": "Alpha-fetoprotein", "meta_info": "step1", "answer_idx": "A", "A": "Alpha-fetoprotein", "B": "Beta-human chorionic growth hormone", "C": "Estriol", "D": "Sphingomyelin", "language": "en"}
{"question": "Polymerase chain reaction (PCR) has revolutionized the molecular biology field. PCR allows for amplification of a single piece of genetic material to produce trillions of idential copies. Which of the following is NOT necessary for PCR?", "answer": "Reverse transcriptase", "meta_info": "step1", "answer_idx": "B", "A": "Taq polymerase", "B": "Reverse transcriptase", "C": "Primers", "D": "Target DNA strand", "language": "en"}
{"question": "An investigator is studying the efficacy of antiviral drugs in infected human cells. Harvested human cells are inoculated onto four cell culture plates. Live varicella-zoster virus (VZV) is administered to cells on two of the culture plates. One healthy and one infected cell set are set aside as controls. In comparison with the control plates, the subsequent application of a guanosine analog to the experimental cell sets induces cell death in the virally infected cells but not in the healthy cells. Which of the following is the most likely mechanism for these findings?", "answer": "Phosphorylation by virally-encoded thymidine kinase", "meta_info": "step1", "answer_idx": "C", "A": "Secretion of interferons by virally infected cells", "B": "Mutation of viral DNA polymerase", "C": "Phosphorylation by virally-encoded thymidine kinase", "D": "Inhibition of RNA-dependent DNA polymerase", "language": "en"}
{"question": "A 13-year-old boy is brought to the physician because of pain and redness on his back for 2 days. He returned yesterday from a vacation to East Africa with his parents, where he took multiple rides on hot air balloons. His vital signs are within normal limits. Examination shows a tender, nonpruritic, erythematous rash with edema covering the extensor surface of both forearms, the shoulders, and the upper back, with small patches of skin exfoliation. The rash becomes pale when pressed and then rapidly regains color. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in management?", "answer": "Apply aloe vera-based moisturizer\n\"", "meta_info": "step2&3", "answer_idx": "D", "A": "Dress wound with wet gauze", "B": "Administer 2 liters of intravenous fluids", "C": "Apply topical mupirocin", "D": "Apply aloe vera-based moisturizer\n\"", "language": "en"}
{"question": "A 55-year-old man comes to the emergency department because of headache, fever, chills, shortness of breath, and abdominal pain for 1 week. He also feels tired and nauseous. He returned from a trip to Botswana 2 weeks ago. He has type 2 diabetes mellitus. He has smoked one pack of cigarettes daily for the past 30 years and drinks a glass of beer daily. His only current medication is metformin. His temperature is 39.3°C (102.8°F), pulse is 122/min, respirations are 28/min, and blood pressure is 109/84 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 94%. Examination shows jaundice. A few scattered inspiratory crackles are heard in the thorax. The liver is palpated 2 cm below the right costal margin. Laboratory studies show:\nHemoglobin 9.2 g/dL\nLeukocyte count 9,400/mm3\nPlatelet count 90,000/mm3\nSerum\nNa+ 137 mEq/L\nCl- 102 mEq/L\nK+ 5.2 mEq/L\nHCO3- 13 mEq/L\nGlucose 69 mg/dL\nLactate dehydrogenase 360 U/L\nCreatinine 0.9 mg/dL\nBilirubin\n_ Total 4.2 mg/dL\n_ Direct 0.8 mg/dL\nAST 79 U/L\nALT 90 U/L\nUrine\nBlood 3+\nProtein trace\nRBC 0–1/hpf\nWBC 1–2/hpf\nArterial blood gas analysis on room air shows a pH of 7.31. Which of the following is the most appropriate next step in management?\"", "answer": "Blood smear", "meta_info": "step2&3", "answer_idx": "C", "A": "Coombs test", "B": "Blood culture", "C": "Blood smear", "D": "Serology", "language": "en"}
{"question": "A population study was conducted to evaluate coronary artery disease in the general population. A cohort of 700 patients underwent coronary angiography to evaluate the geographic distribution of coronary arteries throughout the heart. Which of the following was the most common finding in this cohort?", "answer": "Right coronary artery dominance", "meta_info": "step1", "answer_idx": "C", "A": "The SA node is supplied by a branch of the right coronary artery.", "B": "The AV node is supplied by a branch of the right coronary artery.", "C": "Right coronary artery dominance", "D": "A SA node is supplied by a branch of the left coronary artery.", "language": "en"}
{"question": "A 24-year-old woman comes to the physician because of intermittent episodes of stabbing facial pain for 4 months. The pain occurs over her left cheek, is 9 out of 10 in intensity, radiates towards her mouth, and lasts around half a minute before subsiding. These episodes commonly occur when she washes her face, brushes her teeth, or eats a meal. She does not have visual disturbances, weakness of her facial muscles, or hearing loss. She had a tooth extracted about 2 months ago, but the facial pain has persisted. She has hypothyroidism and vitiligo. Her mother has major depressive disorder. Current medications include levothyroxine and a herbal cream. She appears anxious. Vital signs are within normal limits. Cardiopulmonary examination shows no abnormalities. Neurologic examination shows no focal findings. Which of the following is the most appropriate next step in management?", "answer": "Carbamazepine", "meta_info": "step2&3", "answer_idx": "D", "A": "Microvascular decompression", "B": "Botulinum toxin injection", "C": "Radiofrequency rhizotomy", "D": "Carbamazepine", "language": "en"}
{"question": "A 67-year-old man is brought to the emergency department after the sudden onset of dizziness, blurry vision, and a raspy voice. He has type 2 diabetes mellitus, hypercholesterolemia, coronary artery disease, and hypertension. He has smoked two packs of cigarettes daily for 30 years. He drinks three to four beers daily. His current medications include metformin, atenolol, lisinopril, furosemide, and aspirin. His temperature is 36.6°C (98°F), pulse is 85/min, respirations are 18/min, and blood pressure is 142/90 mm Hg. He is alert and oriented to person, place, and time. The pupil on the left is pinpoint. There is ptosis of the left eye. Horizontal nystagmus is present. The gag reflex is diminished. When he stands without support, he falls towards his left side. There is loss of pain and temperature sensation over the left face and right trunk and limbs. Occlusion of which of the following arteries is the most likely cause of this patient's symptoms?", "answer": "Left posterior inferior cerebellar artery", "meta_info": "step2&3", "answer_idx": "B", "A": "Right middle cerebral artery", "B": "Left posterior inferior cerebellar artery", "C": "Right internal carotid artery", "D": "Left posterior cerebral artery", "language": "en"}
{"question": "A 67-year-old woman with a recently found hepatic carcinoma has been an inpatient for more than a week. During morning rounds, she was abnormally disoriented to time and place along with a shortened attention span. The overnight resident reports that she was coming in and out of this state for the past couple nights. The patient was known to drink often, but reported that she has not consumed alcohol in weeks leading up to her admission. She is not jaundiced and has no metabolic imbalance upon laboratory tests. What is the most likely cause of her recent mental impairment?", "answer": "Delirium", "meta_info": "step1", "answer_idx": "A", "A": "Delirium", "B": "Substance abuse", "C": "Brain metastasis", "D": "Delirium tremens", "language": "en"}
{"question": "A 51-year-old man comes to the physician because of recurrent episodes of dizziness, tinnitus, and hearing loss on the left side for 6 weeks. These episodes last for hours at a time and are associated with the sensation that the room is spinning. He has no history of major medical illness and takes no medications. Examination shows horizontal nystagmus to the left. Weber test shows lateralization to the right ear. The Rinne test is positive bilaterally. Which of the following is the most likely cause of this patient's symptoms?", "answer": "Endolymphatic hydrops", "meta_info": "step1", "answer_idx": "C", "A": "Dislodged otoliths", "B": "Acoustic neuroma", "C": "Endolymphatic hydrops", "D": "Posterior inferior cerebellar artery infarction", "language": "en"}
{"question": "A 37-year-old farmer presents to the emergency department with acute onset of complaints of diarrhea, excessive tearing, and increased saliva production. He is concerned that he is dehydrated, as he has also been urinating with increased frequency over the past several hours. His temperature is 97.6°F (36.4°C), blood pressure is 111/64 mmHg, pulse is 60/min, respirations are 10/min, and oxygen saturation is 98% on room air. Physical exam is significant for a moderately agitated and diaphoretic man who demonstrates pinpoint pupils. Which of the following is the most appropriate next step in management?", "answer": "Atropine", "meta_info": "step2&3", "answer_idx": "A", "A": "Atropine", "B": "Diphenhydramine", "C": "Naloxone", "D": "Physostigmine", "language": "en"}
{"question": "A 54-year-old woman comes to the emergency department because of sharp chest pain and shortness of breath for 1 day. She has been coughing intermittently, which worsens the pain. She has osteoporosis, for which she takes raloxifene. Arterial blood gas analysis on room air shows:\npH 7.52\nPCO2 25 mm Hg\nPO2 65 mm Hg\nO2 saturation 92%\nPhysical examination is most likely to show which of the following findings?\"", "answer": "Unilateral swelling of the leg", "meta_info": "step1", "answer_idx": "A", "A": "Unilateral swelling of the leg", "B": "Increased anteroposterior diameter of the thorax", "C": "Grouped vesicles on the right hemithorax", "D": "Absent left radial pulse", "language": "en"}
{"question": "A previously healthy 18-year-old woman comes to the emergency department because of diarrhea and abdominal cramps since the previous evening. She has had around 3–4 episodes of watery stools. She feels nauseous and has vomited twice. She recollects eating out 2 days ago. She has been on a vegan diet for 6 months. She takes no medications and has not traveled anywhere recently. Her temperature is 36.8°(98.2°F), pulse is 73/min, and blood pressure is 110/70 mm Hg. Examination shows dry mucous membranes. Abdominal examination is unremarkable. Which of the following is the most likely causal organism?", "answer": "Norovirus", "meta_info": "step2&3", "answer_idx": "B", "A": "Rotavirus", "B": "Norovirus", "C": "Vibrio vulnificus", "D": "Bacillus cereus", "language": "en"}
{"question": "A 6-year-old boy is brought to the physician for a well-child examination. He has no history of major medical illness. His mother says, “Sometimes when my son forgets to flush, his urine leaves dark stains in the toilet.” She is unconcerned because her son already had dark-colored urine as a baby and he has never had any health issues. His vital signs are within normal limits. Physical examination shows no abnormalities. The patient’s condition is most likely associated with impaired formation of which of the following?", "answer": "Maleylacetoacetate", "meta_info": "step1", "answer_idx": "D", "A": "Cystathionine", "B": "Methylmalonate", "C": "Tyrosine", "D": "Maleylacetoacetate", "language": "en"}
{"question": "A 72-year-old man presents with a recent episode of slurred speech and numbness in his left arm and left leg 2 hours ago that resolved completely within 45 minutes. He says he was having breakfast when he noticed that he had difficulty talking and the left side of his body was numb. The patient denies any past similar symptoms. Past medical history is significant for type 2 diabetes mellitus, hypertension, and ischemic heart disease. He had a coronary artery bypass graft 12 years ago and a percutaneous intervention 3 years ago. Current medications are aspirin, metformin, nitrates, and rosuvastatin. His vital signs include: blood pressure 143/97 mm Hg, pulse 80/min, oxygen saturation 98% on room air. On physical examination, the patient is alert and oriented. Higher mental functions are intact. Muscle strength is 5 out of 5l in both upper and lower limbs bilaterally. The sensation is intact. Cerebellar signs are absent and his gait is normal. Which of the following is the next best step in the management of this patient?", "answer": "Admit the patient for observation and workup", "meta_info": "step2&3", "answer_idx": "B", "A": "Add clopidogrel and discharge the patient", "B": "Admit the patient for observation and workup", "C": "Discharge now and ask him to visit again when symptoms reoccur", "D": "Start antiepileptic drugs", "language": "en"}
{"question": "A 29-year-old man is brought to the emergency department after being found unresponsive at home. The patient's roommate says that the patient had previously been feeling well. The patient and his roommate had a celebration the night before, where they drank homemade liquor. His temperature is 37°C (98.6°F), pulse is 126/min, respirations are 30/min and shallow, and blood pressure is 84/44 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 96%. He is unresponsive to painful stimuli. The pupils are 3 mm, equal, round, and reactive to light. The lungs are clear to auscultation. Cardiac examination shows a grade 2/6 systolic murmur along the left parasternal border. Laboratory studies show:\nSerum\nNa+ 146 mmol/L\nK+ 7.7 mmol/L\nCl- 111 mmol/L\nUrea nitrogen 5.8 mmol/L\nGlucose 83 mg/dL\nLactate 11.2 mmol/L\nSerum osmolality 379 mosm/kg\nArterial blood gas analysis shows:\npH 6.69\npCO2 53 mm Hg\npO2 84 mm Hg\nHCO3- 4.3 mmol/L\nThe patient is intubated and fluid resuscitation is begun. Which of the following is the most appropriate pharmacotherapy?\"", "answer": "Fomepizole", "meta_info": "step2&3", "answer_idx": "B", "A": "N-acetylcysteine", "B": "Fomepizole", "C": "Naloxone", "D": "Flumazenil", "language": "en"}
{"question": "A 22-year-old woman presents with an episodic history of swelling of the face, hands, and neck and a single episode of difficulty swallowing. She also has a history of frequent, severe abdominal pain. At the time of her visit, her blood pressure is 126/84 mm Hg, heart rate is 82/min, and respiratory rate is 15/min. Physical examination is unremarkable except for a swollen right hand as shown in the image below. Imaging studies are normal and do not reveal any cause of her pain. Her C1 inhibitor level is less than 6% of the reference value. Which of the following is the most likely diagnosis for this patient?", "answer": "Hereditary angioedema", "meta_info": "step1", "answer_idx": "B", "A": "DiGeorge syndrome", "B": "Hereditary angioedema", "C": "Paroxysmal nocturnal hemoglobinuria", "D": "Chediak-Higashi syndrome", "language": "en"}
{"question": "A 60-year-old man calls his hospital and asks to speak to his physician about laboratory test reports ordered because of a 3-month history of abdominal fullness and generalized fatigue. The referral note shows that he was constipated for the previous week. His abdominal examination had shown distention, and a 7-cm, hard, irregular, nontender mass was palpable on rectal examination. His colonoscopy report reveals a low anterior circumferential rectal lesion. An MRI of the pelvis shows a rectal mass with involvement of the prostate and seminal vesicles. A brief review of the results shows that an endoscopic biopsy confirms the clinical diagnosis of advanced rectal adenocarcinoma. His serum carcinoembryonic antigen concentration is 21.0 ng/mL (N < 2.5). The physician is tasked with delivering the diagnosis to the patient. Which of the following is the most appropriate statement by the physician at this time?", "answer": "\"\"\"I would like to meet later today at 4:00 PM so that we have enough time to discuss the lab results. If you'd like a friend or family member to accompany you, feel free to bring them along.\"\"\"", "meta_info": "step2&3", "answer_idx": "C", "A": "\"\"\"Your lab reports show that you have a locally advanced rectal adenocarcinoma\"\"\"", "B": "\"\"\"Would you like to know all the details of your diagnosis, or would you prefer I just explain to you what our options are?\"\"\"", "C": "\"\"\"I would like to meet later today at 4:00 PM so that we have enough time to discuss the lab results. If you'd like a friend or family member to accompany you, feel free to bring them along.\"\"\"", "D": "\"\"\"You must be be curious as to why all these tests were ordered, and you may even be anxious about the results.\"\"\"", "language": "en"}
{"question": "A 50-year-old man has a kidney transplantation for end-stage renal disease in the setting of long-standing polycystic kidney disease. His postoperative course is uncomplicated. He had smoked one pack of cigarettes daily for 20 years but quit 5 years ago. He does not drink alcohol or use illicit drugs. Current medications include basiliximab, mycophenolate mofetil, and prednisone. His vital signs are within normal limits. On physical examination, the surgical incisions appear clean and intact. Prior to discharge, administration of which of the following is most appropriate in this patient?", "answer": "Trimethoprim-sulfamethoxazole", "meta_info": "step2&3", "answer_idx": "B", "A": "Azithromycin", "B": "Trimethoprim-sulfamethoxazole", "C": "Acyclovir", "D": "Varicella vaccine", "language": "en"}
{"question": "A 28-year-old woman, gravida 1, para 0, at 32 weeks' gestation comes to the physician for a prenatal visit. She has had no prenatal care. She emigrated from China 5 years ago and cannot recall all of her vaccinations. She appears well. Physical examination shows a uterus consistent in size with a 32-week gestation. Serum studies show:\nAnti-hepatitis A IgM antibody negative\nAnti-hepatitis A IgG antibody positive\nHepatitis B surface antigen negative\nAnti-hepatitis B surface antibody positive\nHepatitis B core antigen negative\nAnti-hepatitis B core antibody negative\nWhich of the following is the most appropriate next step in management?\"", "answer": "Plan normal vaginal delivery at term", "meta_info": "step1", "answer_idx": "A", "A": "Plan normal vaginal delivery at term", "B": "Determine hepatitis B e antigen serum level", "C": "Administer hepatitis B vaccine to mother", "D": "Perform liver biopsy of mother", "language": "en"}
{"question": "A 58-year-old woman presents to her family physician for an annual checkup. During the visit, the patient asks her physician for help quitting smoking cigarettes. She has unsuccessfully tried quitting several times previously and has also failed prior attempts with meditation and exercise. The physician prescribes a partial agonist of the nicotinic receptor to aid the patient in cessation. Which of the following is a potential side effect of this medication?", "answer": "Suicidal ideation", "meta_info": "step2&3", "answer_idx": "C", "A": "Seizure", "B": "Sexual dysfunction", "C": "Suicidal ideation", "D": "Tachycardia", "language": "en"}
{"question": "A 57-year-old man with chronic obstructive pulmonary disease comes to the emergency department because of leg swelling for 2 weeks. He has smoked 2 packs of cigarettes daily for the past twenty years. His vital signs are within normal limits. Physical examination shows jugular venous distention, hepatomegaly, and pitting edema of both lower extremities. Cardiac examination shows a regular heart rate and normal heart sounds. Auscultation of the lungs shows scattered wheezing without crackles. Left ventricular ejection fraction is 60%. Which of the following is the most likely underlying cause of this patient's condition?", "answer": "Chronic hypoxic vasoconstriction", "meta_info": "step1", "answer_idx": "D", "A": "Left-sided systolic heart failure", "B": "Ventricular septal defect", "C": "Chronic occlusion of the pulmonary vessels", "D": "Chronic hypoxic vasoconstriction", "language": "en"}
{"question": "A young Mediterranean teen brings her 4-year-old little brother to the Emergency Room because of a high temperature. Their parents are on their way to the hospital, but, in the meantime, she provides some of the history. She explains that he has been running a fever and limping for the past week. This morning, she had trouble awakening him, and she noticed some swelling and redness around his right ankle. In terms of his past medical history, she knows he has something wrong with his blood. He had to receive extra vaccinations as an infant, and he takes an antibiotic everyday. On exam in the ED, his temperature is 102.4 deg F (39.1 deg C), blood pressure is 90/60 mmHg, pulse is 123/min, and respirations are 22/min. He is lethargic, and his exam is noteworthy for erythema and edema in an area surrounding his distal shin. What is the most likely diagnosis?", "answer": "Osteomyelitis", "meta_info": "step1", "answer_idx": "C", "A": "Dactylitis", "B": "Avascular necrosis", "C": "Osteomyelitis", "D": "Thrombophlebitis", "language": "en"}
{"question": "A 47-year-old man comes to the emergency department complaining of weight gain and abdominal discomfort. He states that over the past month he has gained 10 lbs. This week he began experiencing mild, diffuse abdominal discomfort. He denies nausea, vomiting, constipation, or diarrhea. The patient has not seen a physician in years and takes no medications. He is a truck driver. He states that he drinks a 6-pack of beer per night. On physical examination, there is jaundice, hepatomegaly, and a positive fluid wave. An abdominal ultrasound reveals cirrhosis, portal vein dilation, and moderate ascites. He undergoes a paracentesis that relieves his symptoms. Fluid analysis is shown below:\n\nSerum:\nAlbumin: 4.0 g/dL\n\nAscitic fluid:\nColor: Yellow\nLeukocyte count: 100/mm^3 with 50% neutrophils\nProtein: 2.3 g/dL\nAlbumin: 1.9 g/dL\n\nA culture is pending. He is discharged and instructed to follow-up with a gastroenterologist for an upper endoscopy. Upper endoscopy reveals multiple, small non-bleeding esophageal varices. Which of the following is the next best step in management of the patient’s condition?", "answer": "Propranolol", "meta_info": "step2&3", "answer_idx": "C", "A": "Atenolol", "B": "Ceftriaxone", "C": "Propranolol", "D": "Transjugular intrahepatic portosystemic shunt", "language": "en"}
{"question": "An 8-month-old boy is brought to the office by his mother for recurrent infections. Over the past 2 months, the boy had multiple visits to the urgent care clinic for respiratory, ear, and skin infections. His mother is concerned about the health of her child. Currently, the child had a runny nose for the last 2 days. There is no fever but the mother adds that the boy is not eating very well. His mother denies any history of infection during her pregnancy and was tested negative for HIV. The patient’s heart rate is 90/min, respiratory rate is 14/min, and temperature is 36.7°C (98.0°F). On physical exam, there are decreased lung sounds in the left lower lobe. A chest X-ray reveals an absent thymic shadow and fails to show any lung pathology. There is no history of similar symptoms in the families of either parent. What is the most likely cause of this patient’s condition?\n ", "answer": "Adenosine deaminase deficiency", "meta_info": "step1", "answer_idx": "A", "A": "Adenosine deaminase deficiency", "B": "Hypoxanthine-guanine phosphoribosyl transferase (HGPRT) deficiency", "C": "HIV infection", "D": "Purine nucleoside phosphorylase deficiency", "language": "en"}
{"question": "A 4-year-old girl is brought to the physician because of a nonpruritic, painless rash on her face for 5 days. She was born at term and has been healthy since. Her 62-year-old maternal grandmother has bullous pemphigoid. Her development is adequate for her age and immunizations are up-to-date. She appears healthy and well-nourished. Her temperature is 37°C (98.6°F) and pulse is 90/min. Examination shows a nontender rash on the right side of the patient's face. An image of the patient's lower face is shown. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in management?", "answer": "Topical mupirocin therapy", "meta_info": "step2&3", "answer_idx": "D", "A": "Potassium hydroxide preparation", "B": "Oral cephalexin therapy", "C": "Skin biopsy", "D": "Topical mupirocin therapy", "language": "en"}
{"question": "A 56-year-old man comes to the physician for a routine health maintenance examination. He has had mild pain in his left groin for 2 weeks. He was admitted to the hospital 1 month ago for myocardial infarction. Cardiac catheterization and angiography showed occlusion of the left anterior descending artery and he underwent placement of 2 stents. He has hypertension and hypercholesterolemia. There is no family history of serious illness. He has smoked 2 packs of cigarettes daily for 30 years. Current medications include aspirin, clopidogrel, rosuvastatin, and enalapril. His temperature is 36.7°C (98°F), pulse is 88/min, and blood pressure is 130/84 mm Hg. Examination shows a 3-cm (1.2-in), tender, pulsatile mass in the left thigh, below the inguinal ligament. There is mild erythema of the overlying skin. A loud murmur is heard on auscultation of the mass. Cardiopulmonary examination shows no abnormalities. There is no edema in the lower limbs. Femoral and pedal pulses are palpable bilaterally. Neurologic examination shows no focal findings. Which of the following is the most likely diagnosis?", "answer": "Femoral artery pseudoaneurysm", "meta_info": "step2&3", "answer_idx": "B", "A": "Femoral artery dissection", "B": "Femoral artery pseudoaneurysm", "C": "Femoral artery thrombosis", "D": "Femoral abscess", "language": "en"}
{"question": "A 1-year-old girl is brought to the physician because of fever and crying while passing urine for 2 days. She was born at term and has been healthy since. Three months ago, she was treated for a urinary tract infection with oral cefixime. Her temperature is 39°C (102.2°F), pulse is 144/min, and blood pressure is 85/40 mm Hg. Physical examination shows no abnormalities. Her leukocyte count is 14,000/mm3. Urine dipstick shows leukocyte esterase and nitrites; urinalysis shows WBCs and gram-negative rods. Urine culture results are pending. Renal ultrasonography shows hydronephrosis of the left kidney. Empirical antimicrobial therapy is initiated, following which the patient's symptoms improve. Which of the following is the most appropriate next step in diagnosis?", "answer": "Voiding cystourethrography", "meta_info": "step2&3", "answer_idx": "D", "A": "Intravenous pyelography", "B": "Dynamic renal scintigraphy", "C": "Urodynamic testing", "D": "Voiding cystourethrography", "language": "en"}
{"question": "A 69-year-old woman presents to her primary care physician complaining of a new-onset, left-sided, throbbing headache that has lasted for several days. She reports that the pain is worsened by eating. Which of the following is a complication of this condition if not treated promptly?", "answer": "Monocular blindness", "meta_info": "step1", "answer_idx": "C", "A": "Skin nodules", "B": "Intestinal ischemia", "C": "Monocular blindness", "D": "Ischemic stroke", "language": "en"}
{"question": "A 32-year old woman presents to the office complaining of progressively worsening shortness of breath for 2 months. She was seen multiple times in the past for complications of systemic lupus erythematosus that include anemia, pericarditis, and chronic interstitial lung disease. As she does not have medical insurance, she does not regularly follow up with her physician and also is not compliant with her medications. She does not drink alcohol, smoke cigarettes, or take illicit drugs. Her family history is positive for colon cancer in her father. Her temperature is 36.5°C (97.8°F), the blood pressure is 106/70 mm Hg, the pulse is 84/min, and the respirations are 16/min. Severe clubbing of her fingernails is noted. Which of the following best describes the pathogenesis of this patient's nail findings?", "answer": "Entrapment of megakaryocytes in the nail bed", "meta_info": "step2&3", "answer_idx": "C", "A": "Septic emboli", "B": "Atherosclerotic emboli", "C": "Entrapment of megakaryocytes in the nail bed", "D": "Chronic hypoxemia", "language": "en"}
{"question": "An otherwise healthy 27-year-old woman presents to the emergency department because of worsening headaches and nosebleeds. Her blood pressure is 185/115 mm Hg, pulse is 88/min and temperature is 36.9°C (98.4°F). She denies the use of nicotine, alcohol, or illicit drugs. Family history is irrelevant. Physical examination is only positive for abdominal bruits. She is given a calcium-channel blocker and a thiazide diuretic, but her blood pressure did not respond adequately. Aldosterone-to-renin ratio is < 20. Which of the following is the most likely cause of this patient’s condition?", "answer": "Renal artery stenosis", "meta_info": "step2&3", "answer_idx": "A", "A": "Renal artery stenosis", "B": "Essential hypertension", "C": "Coarctation of the aorta", "D": "Primary aldosteronism", "language": "en"}
{"question": "A 50-year-old farmer from Jamaica presents to his physician with a wart-like lesion on his left foot. He is a plantain farmer and often farms barefoot because of the pleasant climate. Physical examination reveals warty, cutaneous nodules that resemble the florets of cauliflower. On a KOH preparation, irregular, dark brown, yeast-like bodies with septae are noted. Culture on Sabouraud agar reveals sclerotic bodies. Which of the following is the most likely diagnosis?", "answer": "Chromoblastomycosis", "meta_info": "step1", "answer_idx": "D", "A": "Mycetoma", "B": "Sporotrichosis", "C": "Entomophthoromycoses", "D": "Chromoblastomycosis", "language": "en"}
{"question": "A 52-year-old man comes to the physician because of a 3.6-kg (8-lb) weight loss over the past 3 months and increasing fatigue. He was diagnosed with hepatitis C 6 years ago. His father died of colon cancer. He has smoked one pack of cigarettes daily for 35 years and drinks one beer daily. He used cocaine and heroin in the past but stopped 12 years ago. He is 176 cm (5 ft 8 in) tall and weighs 71 kg (156 lb); BMI is 22.9 kg/m2. His temperature is 37.0°C (98.6°F), pulse is 79/min, and blood pressure is 115/75 mm Hg. He appears weak and lethargic. Examination shows scleral icterus and scars on both cubital fossae. There is reddening of the palms bilaterally. There are several telangiectasias over the chest and back. The abdomen is soft and nontender. The liver is firm and of nodular consistency. Laboratory studies show:\nHemoglobin 11.6 g/dL\nMean corpuscular volume 88 μm3\nLeukocyte count 9,600/mm3\nPlatelet count 223,000/mm3\nUltrasonography of the liver shows a solitary lesion. Which of the following findings is most likely in this patient?\"", "answer": "Elevated α-fetoprotein", "meta_info": "step2&3", "answer_idx": "B", "A": "Positive blood cultures", "B": "Elevated α-fetoprotein", "C": "Elevated carcinoembryonic antigen", "D": "Spiculated lesion on chest CT", "language": "en"}
{"question": "A 63-year-old man comes to the physician for the evaluation of difficulty walking for the last 6 months. He reports weakness in his lower legs that improves with exercise and throughout the day. Three months ago, he started adding flax seeds to his breakfast because he is frequently constipated. He has hypertension and type 2 diabetes mellitus. He has smoked 2 packs of cigarettes daily for the last 45 years. His current medications include enalapril and metformin. Vital signs are within normal limits. Examination shows dry mucous membranes. Muscle strength in the lower extremities is decreased. Sensation to pinprick and light touch is normal. Deep tendon reflexes are 1+ bilaterally. Active muscle contraction or repeated muscle tapping increases reflex activity. Which of the following is most likely to confirm the diagnosis?", "answer": "Autoantibodies against voltage-gated calcium channels", "meta_info": "step2&3", "answer_idx": "B", "A": "Demyelinating plaques on a brain MRI", "B": "Autoantibodies against voltage-gated calcium channels", "C": "Decremental response following repetitive nerve stimulation", "D": "Fasciculations and positive sharp waves on EMG", "language": "en"}
{"question": "A 5-year-old boy is brought to the emergency department by his mother because of abdominal pain. His mother says that he has not had any fever, vomiting, diarrhea, or dysuria. His last bowel movement was 3 days ago and appeared normal. The boy is restless and clutches his abdomen. His temperature is 37.2°C (99°F), blood pressure is 108/76 mm Hg, pulse is 110/min, respirations are 20/min. The abdomen appears mildly distended. On auscultation, he has hyperactive bowel sounds. The remainder of the examination shows no abnormalities. An ultrasound of the abdomen shows no abnormalities. Which of the following is the most appropriate next step in management?", "answer": "Administer polyethyelene glycol", "meta_info": "step2&3", "answer_idx": "A", "A": "Administer polyethyelene glycol", "B": "Reassurance and observation", "C": "Perform a barium enema", "D": "Start empirical antibiotic therapy", "language": "en"}
{"question": "A 30-year-old woman presents to the emergency department with chest pain. She states that she was making coffee this morning when she suddenly developed sharp, 8/10, mid-sternal chest pain. The pain does not radiate and is constant. She is worried because she has a marathon next week that she has been training for. Her medical history is significant for seasonal allergies. She takes no medications except a multivitamin. Her mother has asthma. She works as a lawyer. She denies sick contacts or recent travel. She has a glass of wine with dinner but denies tobacco or recreational drug use. The patient’s initial temperature is 98°F (36.7°C), blood pressure is 122/78 mmHg, pulse is 89/min, and respirations are 14/min with an oxygen saturation of 98% on room air. A physical examination is within normal limits. Labs are pending. Which of the following is the best initial step in management?", "answer": "Electrocardiogram", "meta_info": "step2&3", "answer_idx": "C", "A": "Aspirin, oxygen, nitroglycerin, and morphine", "B": "Computerized tomography scan", "C": "Electrocardiogram", "D": "Heparin", "language": "en"}
{"question": "A 34-year-old woman, gravida 2, para 1, at 34 weeks' gestation comes to the physician because of a 10-day history of generalized pruritus and a 2-day history of jaundice, dark urine, and pale stools. She had developed pruritus at the end of her previous pregnancy, which disappeared after delivery. She has had standard prenatal care. Medications include folic acid and a multivitamin. Her blood pressure is 108/60 mm Hg. Examination shows scleral icterus, jaundice, and scratch marks on her upper and lower limbs. Pelvic examination shows a uterus consistent in size with a 30-week gestation.\nHemoglobin 11.5 g/dl\nPlatelet 350,000/mm3\nProthrombin time 11 seconds (INR=1)\nSerum\nTotal bilirubin 5 mg/dl\nDirect bilirubin 4.2 mg/dl\nBile acid\n25 μmol/l (N= 0.3 to 10 μmol/l)\nAspartate aminotransferase 55 U/L\nAlanine aminotransferase 45 U/L\nThere are no abnormalities on abdominopelvic ultrasonography. Which of the following is the most appropriate next step in management?\"", "answer": "Ursodeoxycholic acid", "meta_info": "step2&3", "answer_idx": "D", "A": "24-hour urine protein", "B": "Emergency endoscopic retrograde cholangiopancreatography and sphincterotomy", "C": "Immediate induction of labor", "D": "Ursodeoxycholic acid", "language": "en"}
{"question": "A mother brings her 17-year-old daughter to your office because of a recent onset dull unilateral pelvic pain that started last week. In addition, the daughter also complains of constipation for which she increased her fiber intake, but the dietary changes are not helping her. She began menstruating at the age of 13, and her menstrual cycles are regular (about 28 days). On physical examination, the patient has a large, non-tender, mobile adnexal mass in the left lower quadrant. The pelvic examination is normal except for the presence of the adnexal mass. The patient is advised to have an outpatient ultrasound, and then return to the clinic next week. After 2 weeks, you learned that the patient visited the emergency department for a sudden onset of abdominal pain that required observation after an abdominal ultrasound was performed. The ultrasound showed a large simple cystic mass with increased internal echoes, having a diameter of 10 cm and hyperechogenic vascular walls on the left ovary with a small intraperitoneal collection in the pouch of Douglas. What was the most likely diagnosis of this patient?", "answer": "Corpus luteum cyst", "meta_info": "step1", "answer_idx": "C", "A": "Follicular cyst", "B": "Endometrioma", "C": "Corpus luteum cyst", "D": "Dermoid cyst", "language": "en"}
{"question": "A 22-year-old woman comes to the clinic complaining of right anterior knee pain. She reports that the pain has been present for 3 months and has gradually worsened. She says the pain is exacerbated when climbing or descending the stairs. She also states the pain is sometimes worse with prolonged periods of sitting. She has tried over-the-counter aspirin and ibuprofen without relief. She is a soccer player and is worried that the pain is starting to affect her ability to play. She reports multiple minor lower extremity injuries due to soccer but denies significant trauma such as known fractures or torn ligaments. Her past medical history is unremarkable. She had a myringotomy in her left ear as a child. On examination, there is pain and crepitus on extension of the right knee with anterior patellar compression. Which of the following is the most appropriate management of the patient’s symptoms?", "answer": "Quadriceps exercises", "meta_info": "step2&3", "answer_idx": "D", "A": "Aspiration", "B": "Orthopedic surgery", "C": "Ossicle resection", "D": "Quadriceps exercises", "language": "en"}
{"question": "A 25-year-old woman is brought to the emergency department by her husband for abdominal pain. The husband answers all questions posed to the patient by the physician. Throughout the interview, the patient makes very little eye contact with the physician. Her husband asks the physician to prescribe “something for her abdominal pain” so that they can return home. Examination of the patient shows mild bruising in the left infraorbital area and a right periorbital hematoma. When asked about her injuries, she quietly states that she fell while walking down the stairwell of her apartment complex. The husband reluctantly leaves the examination room when asked to by the physician. While alone with the physician, the patient admits that her husband is responsible for her injuries. Which of the following immediate responses by the physician is most appropriate?", "answer": "\"\"\"Do you feel safe leaving the emergency department?\"\"\"", "meta_info": "step1", "answer_idx": "B", "A": "\"\"\"May I add some information about local domestic violence agencies to your discharge records?\"\"\"", "B": "\"\"\"Do you feel safe leaving the emergency department?\"\"\"", "C": "\"\"\"How often has your husband physically hurt you in the past?\"\"\"", "D": "“May I ask your husband to join us so we can talk about this matter together?”", "language": "en"}
{"question": "A 15-year-old girl comes to the physician because of a 2-month history of progressive fatigue and weakness. She also reports recurrent headaches for 2 years, which have increased in severity and frequency. Her blood pressure is 185/95 mm Hg. Serum studies show a morning renin activity of 130 ng/mL per hour (N=1–4), a morning aldosterone concentration of 60 ng/dL (N=5-30), and a potassium concentration of 2.9 mEq/L. Further evaluation is most likely to show which of the following?", "answer": "Pleomorphic modified smooth muscle cells in the renal cortex", "meta_info": "step1", "answer_idx": "C", "A": "ACTH-producing growth in the pituitary gland", "B": "Increased 17-hydroxyprogesterone levels", "C": "Pleomorphic modified smooth muscle cells in the renal cortex", "D": "Involution of zona glomerulosa of the adrenal gland", "language": "en"}
{"question": "A 15-year-old boy is brought to the emergency department by his mother because of severe left testicular pain for 1 hour. For the past week, he has also had mild testicular pain and pain on urination. He has not had nausea or vomiting. He is otherwise healthy. His temperature is 39.1°C (102.3°F), pulse is 114/min, and blood pressure is 120/76 mm Hg. Examination shows a high-riding, swollen, erythematous tender left testis; lifting the left testis relieves his pain. His hemoglobin concentration is 15.6 g/dL, leukocyte count is 14,600/mm3, and platelet count is 290,000/mm3. Testicular ultrasound shows increased blood flow to the left testicle when compared to the right and an enlarged left epididymis with decreased echogenicity. Further evaluation of this patient is most likely to show which of the following findings?", "answer": "Positive nucleic acid amplification testing", "meta_info": "step2&3", "answer_idx": "C", "A": "Reducible scrotal mass", "B": "Gram-negative rods in urethral swab", "C": "Positive nucleic acid amplification testing", "D": "Absent cremasteric reflex", "language": "en"}
{"question": "A 27-year-old female presents to the emergency department with complaints of acute-onset fatigue, blurred vision, and rash earlier today. Her husband rushed her to emergency department when he noted that she was exhibiting changes in her mental status and had trouble speaking. Her vital signs are as follows: T 38.4, HR 87, BP 110/85, RR 14, and SpO2 96%. Physical examination reveals petechiae, pallor, and left upper extremity weakness. Work-up reveals Hgb 8.5 g/dL, platelets 22,000 cells/uL, normal PT/INR and PTT, absent fibrin split products, elevated fibrinogen, a negative Coombs test, 3.7 mg/dL creatinine, 3.8 mg/dL indirect bilirubin, and LDH 1000 IU/L. Which of the following would be expected on a peripheral blood smear from this patient?", "answer": "Schistocytes", "meta_info": "step2&3", "answer_idx": "C", "A": "Spherocytes", "B": "Atypical lymphocytes", "C": "Schistocytes", "D": "Rouleaux formation", "language": "en"}
{"question": "A 67-year-old African American male presents to his primary care physician for routine follow-up. He has a history of poorly controlled hypertension, despite being on lisinopril, hydrochlorothiazide, amlodipine and metoprolol, which he takes regularly. His blood pressure during the visit is 170/80. He does not have kidney disease. His primary care physician decides to start him on methyldopa. What is the mechanism of action of methyldopa?", "answer": "Centrally acting alpha2 adrenergic receptor agonist", "meta_info": "step1", "answer_idx": "C", "A": "Direct vascular smooth muscle relaxation", "B": "Dopamine receptor agonist", "C": "Centrally acting alpha2 adrenergic receptor agonist", "D": "Inhibition of alpha1 adrenergic receptors", "language": "en"}
{"question": "A 2800-g (6-lb 3-oz), 3-day-old newborn is in the intensive care unit for fever, vomiting, tremors, cyanotic episodes, and seizures. She was born at 36 weeks to a 25-year-old primigravid woman. Spontaneous vaginal delivery was complicated by maternal fever and chorioamnionitis. Apgar scores were 6 at 1 minute and 7 at 5 minutes, respectively. Shortly after delivery, the child had seizures and high-grade fever with poor feeding and hypotonia. She was intubated for respiratory distress. Her temperature is 39°C (102.3°F), pulse is 180/min, and respirations are 60/min. Physical exam shows grunting breath sounds, an enlarged liver palpable 3 cm below the right costal margin, and lethargy. A CT scan of the chest, abdomen, and pelvis shows multiple pulmonary and hepatic granulomas. Which of the following would most likely have prevented this complication?", "answer": "Avoiding unpasteurized milk products", "meta_info": "step2&3", "answer_idx": "A", "A": "Avoiding unpasteurized milk products", "B": "Measles, mumps, rubella vaccination before pregnancy", "C": "Prophylactic penicillin", "D": "Delivery via cesarean section", "language": "en"}
{"question": "A 45-year-old woman presents to her primary care practitioner requesting a routine checkup for a job application. Her family history is negative for malignancies and inheritable diseases. She has been married for 15 years and has 2 healthy children. Her past medical history is negative for surgical procedures and cardiovascular disease; however, she used to work as a radiology technician. Her only complaints at the moment are neck pain and hoarseness. Physical examination is unremarkable except for a painless nodule in the right lobe of the thyroid gland with no inflammatory signs. In a follow-up appointment, the patient brings the results of her thyroid function tests, which are normal. She also brings the results of a fine-needle aspiration biopsy that report the pathology of the nodule as follicular neoplasia. After some discussion, the patient opts for surgical treatment. With a surgical pathology report that describes vascular invasion, which of the following additional features would you expect to find for this thyroid nodule?", "answer": "Capsular invasion", "meta_info": "step1", "answer_idx": "A", "A": "Capsular invasion", "B": "Cystic nature", "C": "Psammoma bodies", "D": "Pleomorphic cells without follicle development", "language": "en"}
{"question": "A 65-year-old man comes to the physician because of progressive shortness of breath and a worsening cough for the past month. He also reports occasional bloody sputum. He has lost about 7 kg (15.4 lb) of weight over the past 4 months despite having no change in appetite. He has smoked 2 packs of cigarettes daily for 15 years but stopped smoking at the age of 55. Physical examination shows reduced breath sounds throughout both lungs. An x-ray of the chest is shown. Which of the following is the most likely cause of the patient's symptoms?", "answer": "Pulmonary metastases", "meta_info": "step1", "answer_idx": "D", "A": "Squamous cell lung carcinoma", "B": "Small cell lung cancer", "C": "Lung adenocarcinoma", "D": "Pulmonary metastases", "language": "en"}
{"question": "A 67-year-old man comes to the physician due to exertional dyspnea and lower extremity swelling for the last 4 weeks. The patient has been a smoker for the last 45 years and has been diagnosed with COPD. He has no history of diabetes mellitus or ischemic heart disease. He is non-compliant with his medications for COPD. The patient is a retired social worker and spends most of his time at home. His temperature is 37.2°C (98.9°F), blood pressure is 135/115 mm Hg, pulse is 90/min, and respirations are 22/min. Oxygen saturation on room air is 92%. Physical examination reveals a barrel-shaped chest, distension of neck veins, and 3+ bilateral pitting edema of his lower extremities. The liver is palpated 6 cm below the costal margin and is tender to palpation. Application of pressure on the upper abdomen causes persistent distension of jugular veins. Lungs are clear to auscultation. Chest X-ray shows enlarged main pulmonary arteries. ECG shows right bundle branch block and right ventricular hypertrophy. Which of the following is the gold standard test for diagnosing this patient’s condition?", "answer": "Right heart catheterization", "meta_info": "step2&3", "answer_idx": "A", "A": "Right heart catheterization", "B": "Coronary angiography", "C": "Abdominal paracentesis", "D": "Ultrasound of liver", "language": "en"}
{"question": "A 13-year-old African-American girl is brought to the physician for right shoulder pain that has worsened over the past month. She has had many episodes of joint and bone pain and recurrent painful swelling in her hands and feet. Physical examination shows tenderness of the right anterior humerus without swelling or skin changes. Active and passive range of motion of the right shoulder is decreased and there is pain with movement. The leukocyte count is 4600/mm3. An x-ray of the right shoulder shows subchondral lucency of the humeral head with sclerosis and joint space narrowing. Which of the following is the most likely underlying cause of this patient's shoulder pain?", "answer": "Infarction of the bone trabeculae", "meta_info": "step1", "answer_idx": "C", "A": "Infection of the joint space", "B": "Crystal deposition within the joint", "C": "Infarction of the bone trabeculae", "D": "Infection of the bone", "language": "en"}
{"question": "A 4-month-old male presents to the emergency department with severe cough, wheezing, and cyanosis. You suspect bronchiolitis of viral etiology and you administer an anti-viral medication. This drug is often used to treat which one of these other infections?", "answer": "Hepatitis C", "meta_info": "step1", "answer_idx": "B", "A": "Hepatitis B", "B": "Hepatitis C", "C": "Rhinovirus", "D": "HSV", "language": "en"}
{"question": "A 43-year-old woman presents to the clinic complaining of “spotting.” She states that over the past 5 months she has had intermenstrual bleeding. Additionally, her menses last more than a week with the first 4 days consisting of heavy bleeding. She denies abdominal pain but reports feeling an increasing “pressure-like\" discomfort. She denies dysuria, dyspareunia, or dyschezia. Prior to 5 months ago, her menstrual periods were only 4 days long and consisted of moderate bleeding. Her periods normally occur every 28 days. She is frustrated because she feels like she needs to wear a pad all the time. The patient delivered 3 healthy children vaginally without complications, followed by a tubal ligation. Her last menstrual period was 1 week ago. She is sexually active with her husband and denies a history of sexually transmitted diseases. She has never had an abnormal pap smear. Her last pap smear and test for human papillomavirus was 4 years ago. The patient has hypothyroidism treated with levothyroxine. On physical examination, the thyroid is normal in size without masses or tenderness. Pelvic examination reveals a firm, mobile, enlarged, irregularly-shaped uterus without adnexal tenderness. Speculum exam is unremarkable. Which of the following is the most likely diagnosis?", "answer": "Leiomyoma", "meta_info": "step2&3", "answer_idx": "D", "A": "Adenomyosis", "B": "Cervical cancer", "C": "Endometriosis", "D": "Leiomyoma", "language": "en"}
{"question": "A 19-year-old woman comes to the physician because of a 1-week history of fatigue and yellow discoloration of her eyes. Four weeks ago, she had a sore throat and was diagnosed with a viral infection that self-resolved. She has no history of serious medical illness. Her only medication is an oral contraceptive. She appears tired. Her pulse is 94/min, and blood pressure is 125/75 mm Hg. Physical examination shows scleral icterus. The liver edge is palpable 2 cm below the right costal margin and the spleen tip is palpable 4 cm below the left costal margin. Skin examination shows no rashes. Her hemoglobin concentration is 9.5 g/dL, and the direct antiglobulin test is positive. Which of the following additional laboratory findings is most likely in this case?", "answer": "Decreased haptoglobin level", "meta_info": "step2&3", "answer_idx": "C", "A": "Increased serum C3 complement concentration", "B": "Increased direct bilirubin level", "C": "Decreased haptoglobin level", "D": "Decreased mean corpuscular volume", "language": "en"}
{"question": "A 67-year-old female is admitted to the hospital with enterococcus endocarditis and is treated with penicillin and gentamicin. During her admission, she develops worsening pulmonary edema secondary to valvular insufficiency and requires therapy with IV furosemide. This patient is most likely to experience which of the following adverse reactions to her current pharmacological treatment:", "answer": "Ringing in the ears and impaired hearing", "meta_info": "step1", "answer_idx": "A", "A": "Ringing in the ears and impaired hearing", "B": "Hyperkalemia leading to possible cardiac arrhythmia", "C": "Diffuse flushing and redness over body surface", "D": "Pseudomembranous colitis and diarrhea", "language": "en"}
{"question": "A 75-year-old male is brought to the emergency room by his daughter due to slurred speech and a drooping eyelid on the right side. This morning, he had difficulty eating his breakfast and immediately called his daughter for help. She says that his voice also seems different. His temperature is 99°F (37.2°C), blood pressure is 120/78 mmHg, pulse is 90/min, respirations are 21/min, and pulse oximetry is 98% on room air. On physical exam, he is oriented to time and place. There is right-sided nystagmus and he has difficulty with point-to-point movement. Where is the lesion responsible for his symptoms most likely located?", "answer": "Posterior inferior cerebellar artery", "meta_info": "step1", "answer_idx": "A", "A": "Posterior inferior cerebellar artery", "B": "Anterior cerebral artery", "C": "Anterior inferior cerebellar artery", "D": "Basilar artery", "language": "en"}
{"question": "You are conducting an experiment on a cell line in your laboratory. You introduce a molecule into the tissue culture dish containing the cell line that binds to a transmembrane protein. As a result, the affected cell initiates a process characterized by karyorrhexis, membrane blebbing, and pyknosis. What was the molecule that you introduced into the culture?", "answer": "FAS-ligand", "meta_info": "step1", "answer_idx": "C", "A": "Perforin", "B": "Granzyme B", "C": "FAS-ligand", "D": "BCL-2", "language": "en"}
{"question": "A 45-year-old woman comes to the physician because of a 6-month history of progressive irritability, palpitations, heat intolerance, frequent bowel movements, and a 6.8-kg (15-lb) weight loss. She also has a smooth, uniformly enlarged mass at the front of her neck and protuberant eyes with lid retraction. Laboratory investigations show undetectable levels of thyroid stimulating hormone, elevated levels of free T3 and T4, and a raised titer of TSH receptor autoantibodies (TRAbs). Therapy is initiated with radioactive iodine-131. This patient is at greatest risk for which of the following complications?", "answer": "Worsening exophthalomos", "meta_info": "step2&3", "answer_idx": "A", "A": "Worsening exophthalomos", "B": "Agranulocytosis", "C": "Vocal cord paralysis", "D": "Thyroid carcinoma\n\"", "language": "en"}
{"question": "A 56-year-old woman comes to the emergency department because of severe abdominal pain associated with nausea and vomiting for 12 hours. The pain extends from the epigastrium to the right upper quadrant and radiates to the right scapula. The patient has gastroesophageal reflux disease. She underwent total thyroidectomy for papillary thyroid carcinoma 3 years ago. She has smoked one pack of cigarettes daily for 35 years. Current medications include levothyroxine, omeprazole, and a multivitamin. The patient appears uncomfortable. Her temperature is 38.1°C (100.6°F), pulse is 93/min, and blood pressure is 140/85 mm Hg. Abdominal examination shows tenderness to deep palpation in the right upper quadrant. The patient's leukocyte count is 10,300/mm3. Abdominal ultrasonography shows thickening of the gallbladder wall, without dilatation of the intra- and extrahepatic bile ducts. Laparoscopic cholecystectomy is performed. Pathological examination shows acute cholecystitis. There is an ulcerated 1 x 1.5-cm mass in the fundus of the gallbladder with invasion of the gallbladder wall and lymphatic vessels. Which of the following is the most likely underlying condition?", "answer": "Cutaneous malignant melanoma", "meta_info": "step2&3", "answer_idx": "B", "A": "Adenocarcinoma of the sigmoid colon", "B": "Cutaneous malignant melanoma", "C": "Multiple endocrine neoplasia", "D": "Squamous cell carcinoma of the esophagus\n\"", "language": "en"}
{"question": "You are on your first day of a pathology rotation and the attending pathologist gives you a biopsy specimen to examine. She says it is from the antrum of the stomach of a 32-year-old man who has been complaining of abdominal pain for the past 6 months. The patient states the pain gets worse when eating. On endoscopy, there was a single ulcerated lesion with a 'punched out' appearance. What are the most likely histologic findings in this biopsy specimen?", "answer": "A urease-positive organism", "meta_info": "step1", "answer_idx": "C", "A": "Signet ring cells", "B": "An abundance of self reactive T cells", "C": "A urease-positive organism", "D": "Absence or evidence of destruction of parietal cells", "language": "en"}
{"question": "A 40-year-old man is brought into the emergency department by his wife complaining of intense lower right abdominal pain. An abdominal CT scan was performed which noted a dilated appendix with a thickened wall and the accumulation of extraluminal fluid. A quick history is taken while the OR is prepped for surgery. Past medical history is noncontributory and the patient takes no medications. Social history reveals a sedentary lifestyle. The patient admits to regularly drinking several beers and several shots of vodka every night. He had to stop drinking 2 days ago due to the intense abdominal pain. The patient is brought into the OR and the inflamed and necrotic appendix is removed. He is admitted to the hospital for overnight monitoring. Later that night, the patient begins to hallucinate. Which type of hallucination is this patient likely to experience?", "answer": "Tactile hallucination", "meta_info": "step1", "answer_idx": "D", "A": "Proprioceptive hallucinations", "B": "Olfactory hallucination", "C": "Gustatory hallucination", "D": "Tactile hallucination", "language": "en"}
{"question": "A 34-year-old woman presents with sudden onset flank pain for the past day. She describes the pain as intermittent and radiating to her groin. She denies any similar symptoms in the past. No significant past medical history. The patient currently does not take any medications. Family history is significant for her mother who died of a pancreatic tumor at the age of 53. Laboratory analysis reveals:\nSerum calcium 12 mg/dL\nSerum phosphorus 2.2 mg/dL\nSerum parathyroid hormone 105 pg/mL\nWhich of the following mutated gene products is most likely causing this patient’s symptoms?", "answer": "Menin", "meta_info": "step1", "answer_idx": "D", "A": "Receptor tyrosine kinase", "B": "Cytokine receptor", "C": "Threonine kinase", "D": "Menin", "language": "en"}
{"question": "As a public health practitioner, you are charged with choosing which blood test to use for the screening of a new infectious disease. You want to ensure that as many cases of this disease as possible are picked up by this initial screening test. Which of the following is the highest priority characteristic of this new test?", "answer": "Highly sensitive test", "meta_info": "step1", "answer_idx": "A", "A": "Highly sensitive test", "B": "Low false positive rate", "C": "High true positive rate", "D": "Low negative predictive value", "language": "en"}
{"question": "A 25-year-old man is brought into the hospital by his family because they are concerned that he has post-traumatic stress disorder. The patient is a marine and was deployed to Afghanistan 2 years ago. He was able to successfully reintegrate with society upon his return; however, for the last 2 weeks, he has been having recurrent nightmares and avoiding news coverage on the war. He has become more and more detached from his family and friends and, on the few times he does interact with them, he has angry outbursts. The patient is afebrile, and his vital signs are within normal limits. Physical examination is unremarkable. Which of the following findings is most important in correctly diagnosing this patient’s condition?", "answer": "Duration of symptoms", "meta_info": "step2&3", "answer_idx": "A", "A": "Duration of symptoms", "B": "State of hyperarousal", "C": "Avoidance of triggers", "D": "Negative Mood", "language": "en"}
{"question": "A 4-year-old girl is brought to the pediatrician because of throat pain for 2 days. She had frequent episodes of oral thrush as a baby and has been treated for vaginal yeast infection twice in the past year. Physical examination shows white patches on the tongue and palate. Scraping off the patches reveals erythematous oral mucosa with pinpoint bleeding. Leukocyte count is within normal range. Exposure to nitroblue tetrazolium turns the patient's neutrophils dark blue. A deficiency in which of the following enzymes is the most likely cause of this patient's recurrent infections?", "answer": "Myeloperoxidase", "meta_info": "step1", "answer_idx": "D", "A": "Adenosine deaminase", "B": "Pyruvate kinase", "C": "Glucose-6-phosphate dehydrogenase", "D": "Myeloperoxidase", "language": "en"}
{"question": "A 55-year-old male with chronic dyspnea is intubated and started on mechanical ventilation for respiratory failure. Pressure-volume scalars on the ventilator show decreased change in volume for each unit change in pressure as compared to normal values. Of the following options, which is the most likely cause of his respiratory failure?", "answer": "Pulmonary fibrosis", "meta_info": "step1", "answer_idx": "C", "A": "Asthma", "B": "Centriacinar emphysema", "C": "Pulmonary fibrosis", "D": "Alpha-1-antitrypsin deficiency", "language": "en"}
{"question": "A 6-year-old African-American boy presents with severe pain and swelling of both his hands and wrists. His symptoms onset 2 days ago and have not improved. He also has had diarrhea for the last 2 days and looks dehydrated. This patient has had two similar episodes of severe pain in the past. Physical examination reveals pallor, jaundice, dry mucous membranes, and sunken eyes. Which of the following mutations is most consistent with this patient’s clinical condition?", "answer": "Missense", "meta_info": "step1", "answer_idx": "C", "A": "Chromosomal deletion", "B": "Nonsense", "C": "Missense", "D": "Frame shift", "language": "en"}
{"question": "A 45-year-old woman presents to her primary care physician with complaints of weight loss and anxiety. She says that over the past 6 months she has lost 10 pounds even though she has had an increased appetite. In addition, she describes 3 episodes where it felt like her heart was \"pounding out of her chest.\" Her temperature is 99.3°F (37.4°C), pulse is 106/min and regular, blood pressure is 141/80 mmHg, and respirations are 18/min. Physical exam is significant for mild bilateral proptosis and 3+ deep tendon reflexes bilaterally. Which of the following is the best initial therapy for the patient's condition?", "answer": "Propranolol", "meta_info": "step2&3", "answer_idx": "C", "A": "Adenosine", "B": "Potassium iodide", "C": "Propranolol", "D": "Thyroidectomy", "language": "en"}
{"question": "A 58-year-old woman is brought to the emergency department by her husband because of increasing confusion and generalized fatigue over the past week. During this period, she has had muscle cramps, headaches, nausea, and vomiting. Six days ago, she underwent resection of a parasagittal meningioma. She tolerated the procedure well without complications and was discharged two days ago. She has hypercholesterolemia and hypertension. Current medications include oxycodone, acetaminophen, atorvastatin, and hydrochlorothiazide. She is oriented only to person and place. Her temperature is 37°C (98.6°F), pulse is 89/min, respiratory rate is 14/min, and blood pressure is 142/88 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 97%. The remainder of the examination shows no abnormalities. Serum studies show:\nSerum\nNa+ 126 mEq/L\nK+ 3.6 mEq/L\nCl- 107 mEq/L\nUrea nitrogen 16 mg/dL\nGlucose 87 mg/dL\nCreatinine 0.9 mg/dL\nOsmolality 255 mOsmol/kg H2O\nUrine\nOsmolality 523 mOsmol/kg H2O\nSodium 44 mEq/L\nWhich of the following is the most likely cause of this patient's symptoms?\"", "answer": "Syndrome of inappropriate antidiuretic hormone", "meta_info": "step2&3", "answer_idx": "B", "A": "Cerebral salt wasting syndrome", "B": "Syndrome of inappropriate antidiuretic hormone", "C": "Primary polydipsia", "D": "Mineralocorticoid deficiency", "language": "en"}
{"question": "A 55-year-old man comes to the emergency department because of left arm pain after falling from a ladder. Physical examination shows tenderness along the proximal left humerus. An x-ray of the left arm and shoulder shows a nondisplaced proximal humerus fracture. Which of the following cytokines is most likely to be involved in normal bone healing in this patient?", "answer": "Macrophage colony-stimulating factor", "meta_info": "step1", "answer_idx": "D", "A": "Interleukin-4", "B": "Interferon-α", "C": "Granulocyte colony-stimulating factor", "D": "Macrophage colony-stimulating factor", "language": "en"}
{"question": "A 62-year-old African American man is admitted to the emergency department with a 24-hour history of intense epigastric pain that radiates to the back with nausea and vomiting. His medical history is relevant for hypertension, heart failure (HF), chronic obstructive pulmonary disease (COPD), and radicular pain, all under control with amlodipine, furosemide, ipratropium, and gabapentin. He drinks occasionally at family gatherings and has never smoked cigarettes. His vital signs are recorded as follows: blood pressure of 130/80 mm Hg, a heart rate of 78/min, a respiratory rate of 18/min, and a body temperature of 36.6°C (97.9°F). Abdominal examination shows edema and bruising of periumbilical subcutaneous tissue and intense pain to touch but no signs of peritoneal irritation. Which of the following is the most likely responsible for this patient’s condition?", "answer": "Furosemide", "meta_info": "step2&3", "answer_idx": "A", "A": "Furosemide", "B": "Ipratropium", "C": "Gabapentin", "D": "Alcohol consumption", "language": "en"}
{"question": "A 62-year-old woman presents to the emergency department complaining of intense pain in her right knee that started 12 hours ago. Her past medical history is significant for hemochromatosis, managed with biweekly phlebotomy. Her vitals include: blood pressure of 130/70 mm Hg, pulse of 82/min, respiratory rate of 18/min, and temperature of 36.5°C (97.7°F). Physical examination reveals an erythematous, warm, and severely tender right knee with a restricted range of motion. An arthrocentesis is performed, and synovial fluid analysis is significant for a neutrophil count of 3,200 cells/μL, a negative Gram stain, and the following result under polarized light microscopy (see image). Which of the following additional findings would you also expect to observe in this patient?", "answer": "Chondrocalcinosis", "meta_info": "step2&3", "answer_idx": "A", "A": "Chondrocalcinosis", "B": "Urate tophi", "C": "Heberden's nodes", "D": "Rheumatoid nodules", "language": "en"}
{"question": "A 52-year-old man with a history of mild chronic obstructive pulmonary disease (COPD) has been using albuterol as needed to manage his COPD without any other maintenance medications. Recently, he has been experiencing a greater degree of shortness of breath, wheezing, and a productive cough. He denies any recent changes to his activities of daily living, exercise, or recent upper respiratory illnesses. The vital signs include: temperature 36.7°C (98.0°F), blood pressure 126/74 mm Hg, heart rate 74/min, and respiratory rate 14/min. His physical examination shows decreased breath sounds bilateral, and expiratory wheezes, a barrel-shaped chest, and a holosystolic murmur heard best at the 2nd intercostal space on the left. Pulmonary function tests demonstrate a forced expiratory volume-1 (FEV-1) which is 60% of the predicted value. What is the next best step for the management of his COPD?", "answer": "Add tiotropium to treatment regimen", "meta_info": "step2&3", "answer_idx": "B", "A": "Add rofilumast to treatment regimen", "B": "Add tiotropium to treatment regimen", "C": "Add tiotropium plus fluticasone to treatment regimen", "D": "Add carbocysteine to treatment regimen", "language": "en"}
{"question": "A 24 year-old male presented to his physician with a homogenous, painless testicular swelling that he noticed for the past two weeks. After ultrasound and blood tests, he subsequently underwent a radical inguinal orchiectomy and pathology was consistent with seminoma. Which of the following would you expect to see in a tissue sample from the patient’s orchiectomy?", "answer": "Lobules of large cells with prominent nuclei and watery cytoplasm", "meta_info": "step1", "answer_idx": "A", "A": "Lobules of large cells with prominent nuclei and watery cytoplasm", "B": "Schiller-Duval bodies", "C": "Tubular papillary architecture with necrosis", "D": "Mature derivatives of endoderm, mesoderm, and ectoderm", "language": "en"}
{"question": "A 31-year-old man comes to the physician because of diarrhea, bloating, nausea, and vomiting for the past week. He describes his stool as greasy, frothy, and soft; it is not red or darkened. The patient went on a hiking trip in Brazil 3 weeks ago. He has no history of serious illness and takes no medications. The patient appears dehydrated. His vital signs are normal. Examination shows dry mucous membranes and diffuse abdominal tenderness. Microscopy of the stool reveals egg-shaped cysts with prominent two-layered cell wall and multiple nuclei. Which of the following is the most appropriate treatment?", "answer": "Metronidazole therapy", "meta_info": "step1", "answer_idx": "C", "A": "Supportive treatment only", "B": "Trimethoprim-sulfamethoxazole therapy", "C": "Metronidazole therapy", "D": "Octreotide therapy", "language": "en"}
{"question": "A 48-year-old man presents to the clinic feeling depressed after a string of failed business projects. His team noticed that he seems less engaged than he once used to be and this is reflecting in his work. He has no previous psychiatric history and symptoms of depressed mood have been ongoing for the past 6 months. A patient health questionnaire 9 (PHQ-9) was administered and the patient scored 10. The patient is started on venlafaxine. The alteration in the normal functioning of which of the following is the mechanism of action for this therapy?", "answer": "Serotonin, norepinephrine, and dopamine", "meta_info": "step1", "answer_idx": "A", "A": "Serotonin, norepinephrine, and dopamine", "B": "Norepinephrine and dopamine", "C": "Serotonin receptor antagonism", "D": "Alpha-2 receptor antagonism", "language": "en"}
{"question": "A researcher is performing an experiment where she is using bacteria to clone copies of a mutated gene that she plans on introducing to cells. In order to perform this, she has created a small, circular segment of double-stranded DNA that includes the gene of interest as well as a gene for antibiotic resistance. After introducing this segment of DNA to competent bacteria, she plates the bacteria on media containing the antibiotic. Which of the following processes was necessary in order for the bacteria to survive on the plate and contain copies of the gene of interest?", "answer": "Transformation", "meta_info": "step1", "answer_idx": "D", "A": "Conjugation", "B": "Transduction", "C": "Transfection", "D": "Transformation", "language": "en"}
{"question": "A 27-year-old woman presents to the emergency department with altered mental status. Her parents found her in her room surrounded by pill bottles, alcohol, and illicit drugs 10 minutes ago and promptly brought her in. She was unconscious with lacerations on her wrists. The patient has a past medical history of depression, fibromyalgia, and multiple suicide attempts. Physical exam is notable for a somnolent young woman who responds to questions but is non-compliant in describing the history. She is currently vomiting and her gait seems ataxic. Initial laboratory values are unremarkable. An arterial blood gas analysis reveals the following findings.\n\nArterial blood gas\npH: 7.50\npO2: 105 mmHg\npCO2: 20 mmHg\nBicarbonate: 24 mEq/L\n\nWhich of the following is the most likely intoxication in this patient?", "answer": "Aspirin", "meta_info": "step1", "answer_idx": "C", "A": "Acetaminophen", "B": "Amitriptyline", "C": "Aspirin", "D": "Ethylene glycol", "language": "en"}
{"question": "A 33-year-old Asian American man presents to his primary care provider in February with pain in his fingers. His symptoms started 2 years ago and have gradually progressed. He initially attributed his symptoms to stress at work as a social worker. He has tried using ibuprofen, acetaminophen, and naproxen, but these medications did not improve his pain. He also reports that there have been at least 3 instances in the past 2 months in which his fingers became extremely painful and turned white before turning pale blue. These instances occurred when the patient was walking outside. His past medical history is notable for gastroesophageal reflux disease and gout. He takes omeprazole and allopurinol. His temperature is 99°F (37.2°C), blood pressure is 120/78 mmHg, pulse is 90/min, and respirations are 18/min. Physical examination reveals loss of skin fold wrinkles and indurated skin on the palmar side of the digits. Finger range of motion is limited. Which of the following medications is most appropriate to address this patient's concerns?", "answer": "Amlodipine", "meta_info": "step1", "answer_idx": "B", "A": "Ambrisentan", "B": "Amlodipine", "C": "Cilostazol", "D": "Lisinopril", "language": "en"}
{"question": "A 3-year-old boy is brought to the physician because of a 1-day history of abdominal pain and frequent urination. His mother reports that the patient has wet his bed overnight and that his urine smelled odd this morning. He has been toilet trained for 4 months and has had very few accidents since then. His last bowel movement was 3 days ago. He was born at term after a normal gestation and has reached all developmental milestones. His parents divorced 4 months ago and the patient's father has moved away. The patient began preschool 6 weeks ago. During this period, he has had two upper respiratory infections that resolved without treatment. His 12-year-old brother has type 1 diabetes mellitus. Vital signs are within normal limits. Physical examination of the abdomen shows mild suprapubic tenderness. Urine dipstick is positive for leukocyte esterase, nitrite, and blood; urinalysis shows white blood cells and gram-negative rods. Which of the following is the most likely predisposing factor for this patient's condition?", "answer": "Constipation", "meta_info": "step2&3", "answer_idx": "B", "A": "Social stressors", "B": "Constipation", "C": "Posterior urethral valves", "D": "Respiratory tract infection", "language": "en"}
{"question": "A 37-year-old male presents with difficulty eating solids and drinking water; which has been progressively worse over the past year. He has noticed that he is regurgitating food that appears undigested and has also been having difficulty belching. He said that lifting his neck seems to help him keep his food down. He is currently on omeprazole for his acid reflux; however, his heartburn still persists. An esophagogastroduodenoscopy (EGD) is performed that shows no evidence of mechanical obstruction or esophageal inflammation. If esophageal manometry is performed, which of the following will most likely be present in this patient?", "answer": "Aperistalsis in the distal two-thirds of the esophagus with incomplete lower esophageal relaxation", "meta_info": "step1", "answer_idx": "A", "A": "Aperistalsis in the distal two-thirds of the esophagus with incomplete lower esophageal relaxation", "B": "Normal amplitude, uncoordiated, simultaneous esophageal contractions", "C": "Excessive amplitude or duration of coordinated esophageal contractions", "D": "Hypotensive peristaltic contractions", "language": "en"}
{"question": "A 56-year-old man comes to the emergency department for chest pain that started 1 hour ago. He has a history of hypertension, hyperlipidemia, and type 2 diabetes mellitus. He appears diaphoretic and distressed. An ECG shows P waves independent of QRS complexes. The QRS interval is 0.11 seconds with normal morphology. Which of the following is the most likely trigger of this patient's ventricular contractions?", "answer": "Bundle of His", "meta_info": "step1", "answer_idx": "C", "A": "Sinoatrial node", "B": "Bachmann bundle", "C": "Bundle of His", "D": "Purkinje fibers", "language": "en"}
{"question": "A 29-year-old pregnant woman is brought to the emergency department complaining of the sudden onset of severe, sharp pelvic pain. She is at 6 weeks’ gestation. The patient is bleeding heavily from the vagina and feels very dizzy. Substantial pain is noted in the lower right quadrant, which intensified towards the end of the physical exam. On examination, there is evidence of abdominal and cervical motion tenderness. Her blood pressure is 71/37 mm Hg, respiratory rate is 21/min, pulse is 117/min, and temperature is 38.4°C (101.1°F). Which of the following is the most appropriate definitive step in the management of this patient?", "answer": "Surgery", "meta_info": "step2&3", "answer_idx": "A", "A": "Surgery", "B": "Methotrexate", "C": "Transvaginal ultrasound", "D": "Serial hCG", "language": "en"}
{"question": "A 24-year-old man presents to his primary care physician with heel pain that has been persistent for 3 weeks now. He is bothered by the feeling of significant pressure and swelling in his ankle. He is also having difficulty walking due to pain in his hip. Upon physical examination, there is evidence of swelling and warmth over his Achilles tendon. Imaging of his sacroiliac joint reveals soft tissue involvement and narrowing of the joint spaces. This patient also appears to have a low to moderate kyphosis of his spine. He has no family history of any bone or rheumatological diseases. This patient most likely presents with clinical features of which disease?", "answer": "Ankylosing spondylitis", "meta_info": "step2&3", "answer_idx": "A", "A": "Ankylosing spondylitis", "B": "Reactive arthritis", "C": "Osteoma", "D": "Fibromyalgia", "language": "en"}
{"question": "A 51-year-old man comes to his physician with chronic sinusitis and rhinorrhea for which he uses mometasone nasal spray. He is seeking a refill on this prescription, noting that, although it has not fully relieved his nasal symptoms over the past 2 years, it has helped minimize the severity of those symptoms. On auscultation, there are faint crackles in the bilateral lung fields and an indentation at the nasal bridge. The patient also notes occasional hemoptysis and hematuria. He has no significant medical history and takes no other medications. Family history is significant for rheumatoid arthritis. The physician is suspicious for granulomatosis with polyangiitis and a nasal mucosal biopsy is obtained which confirms the diagnosis. The patient is started immediately on prednisone and cyclophosphamide. Which of the following should also be added to this patient’s therapeutic regimen?", "answer": "Trimethoprim/sulfamethoxazole", "meta_info": "step2&3", "answer_idx": "D", "A": "Azithromycin", "B": "Ganciclovir", "C": "Doxycycline", "D": "Trimethoprim/sulfamethoxazole", "language": "en"}
{"question": "A 28-year-old man presents to a clinic for a health check-up. He says that he feels great and has not seen a physician for approximately 10 years. He is concerned about his health because his 3 older brothers have recently developed cardiac problems. His medical history is significant for an appendectomy 16 years ago. He works out twice a week and eats a low-salt, well-balanced diet. He drinks alcohol socially on the weekend, but does not use tobacco or drugs. The pulse is 80/min, respirations are 14/min, and the blood pressure is 129/80 mm Hg. The physical examination is unremarkable. Laboratory testing shows the following:\nSerum Glucose (fasting) 100 mg/dL\n  Sodium 142 mEq/L\n  Potassium 3.9 mEq/L\n  Chloride 101 mEq/L\nSerum Creatinine 0.8 mg/dL\nBlood Urea Nitrogen 10 mg/dL\nCholesterol, total 250 mg/dL\n  HDL-cholesterol 34 mg/dL\n  LDL-cholesterol 210 mg/dL\nTriglycerides 160 mg/dL\nThe patient is most likely started on a medication which acts by which of the following mechanism?", "answer": "Inhibition of HMG-CoA reductase", "meta_info": "step1", "answer_idx": "D", "A": "Blockage of beta-adrenergic receptors", "B": "Blockage of the angiotensin receptors", "C": "Increase loss of bile acids in the feces", "D": "Inhibition of HMG-CoA reductase", "language": "en"}
{"question": "A 17-year-old boy presents for a psychotherapy session after finding out that his girlfriend has been carrying on another relationship with someone else. He expresses rage and complains of difficulty focusing on his upcoming high school comedy club routines and upcoming track meet. His therapist, while explaining the concept of defense mechanisms, describes some hypothetical examples related to the situation. Which of the following potential actions by this patient would be an example of sublimation?", "answer": "Channeling his anger about the situation into training for his track meet", "meta_info": "step1", "answer_idx": "A", "A": "Channeling his anger about the situation into training for his track meet", "B": "Instigating a physical fight with his girlfriend’s other partner", "C": "Making jokes about the situation and incorporating them into his comedy routine", "D": "Not thinking about the upsetting situation until after his track meet, then confronting and processing his feelings about it", "language": "en"}
{"question": "A 39-year-old woman is brought to the emergency room by her fiancé for severe abdominal pain for the past 5 hours. She was watching TV after dinner when she felt a sudden, sharp, 10/10 pain at the epigastric region that did not go away. Ibuprofen also did not help. She reports recurrent abdominal pain that would self-resolve in the past but states that “this one is way worse.” Her past medical history is significant for diabetes and an appendectomy 2 years ago. The patient endorses nausea and 1 episode of emesis, but denies fevers, chills, chest pain, shortness of breath, diarrhea, constipation, urinary symptoms, paresthesia, or weakness. She used to smoke marijuana in college and drinks about 2 beers a week. A physical examination demonstrates an overweight woman in acute distress with diffuse abdominal tenderness. Her vitals are within normal limits. Laboratory values are shown below:\n\nHemoglobin: 12 g/dL\nHematocrit: 34%\nLeukocyte count: 4,900/mm^3 with normal differential\nPlatelet count: 160,000/mm^3\n\nSerum:\nNa+: 138 mEq/L\nCl-: 98 mEq/L\nK+: 4.8 mEq/L\nHCO3-: 25 mEq/L \nGlucose: 123 mg/dL\nCa2+:  6.9 mg/dL\nAST: 387 U/L\nALT: 297 U/L\nALP: 168 U/L\nLipase: 650 U/L (Normal 0 – 160 U/L)\n\nWhat is the best next step in the workup of this patient?", "answer": "Abdominal ultrasound", "meta_info": "step2&3", "answer_idx": "C", "A": "Abdominal computed tomography without IV contrast", "B": "Abdominal magnetic resonance imaging", "C": "Abdominal ultrasound", "D": "Upright chest and abdominal radiograph", "language": "en"}
{"question": "A 50-year-old man is evaluated for a 2-year history of intermittent, nonproductive, chronic cough, as well as mild dyspnea with exertion. He has a 20-pack-year history of smoking and is a current smoker. His medical history is significant for hypertension and type 2 diabetes mellitus, which he has controlled with diet and exercise. He also takes lisinopril. On physical examination, blood pressure is 125/76 mm Hg, pulse rate is 78/min, respiratory rate is 15/min, oxygen saturation is 98% (breathing room air), and his BMI is 25 kg/m2. There is no jugular venous distention. Heart sounds are normal, and there is no murmur. Auscultation of the lungs reveals faint, bilateral wheezing. No peripheral edema is noted. The remainder of the examination is normal. Which of the following is most likely to confirm the diagnosis for this patient?", "answer": "Spirometry", "meta_info": "step1", "answer_idx": "C", "A": "Chest CT scan", "B": "Measurement of protease inhibitor", "C": "Spirometry", "D": "Cardiac catheterization", "language": "en"}
{"question": "A 51-year-old woman presents with bilateral hand tremors. She has had these tremors for several years, and her symptoms have gradually worsened over time. The tremors are restricted to her hands and are most prominent when she is holding a cup of tea or a pen. The tremors get worse when she is under stress or exhausted, and they are starting to disrupt her work routine. She denies walking difficulties, speech problems, and weakness. Her past medical history is significant for a recent hospitalization for an asthma exacerbation. Current medications include salmeterol, medium-dose fluticasone, and a daily multivitamin. The patient denies smoking but drinks alcohol socially. The patient is afebrile and her vital signs are within normal limits. On physical examination, her hands have a noticeable tremor when in use and remain still while resting in her lap. Which of the following is the best course of treatment for this patient?", "answer": "Primidone", "meta_info": "step2&3", "answer_idx": "B", "A": "Baclofen", "B": "Primidone", "C": "Propranolol", "D": "Sodium valproate", "language": "en"}
{"question": "A 39-year-old female was involved in a head-on collision motor vehicle accident. If she was found to have a traumatic rupture of the aorta, where along the path of the aorta is the most common site of injury?", "answer": "Aortic isthmus", "meta_info": "step1", "answer_idx": "C", "A": "Ascending aorta", "B": "Site of attachment of ligamentum arteriosum", "C": "Aortic isthmus", "D": "Descending aorta - Thoracic aorta", "language": "en"}
{"question": "A previously healthy 2-month-old boy is brought to the physician because of a 10-day history of poor feeding. He used to feed for 20 minutes but now needs 40 minutes. He struggles to breathe and sweats while feeding. He was born at 38 weeks' gestation. He is at the 20th percentile for length and 10th percentile for weight. His vital signs are within normal limits. Pulse oximetry on room air shows an oxygen saturation of 98%. A grade 3/6 holosystolic murmur is heard at the left lower sternal border. An ECG shows left-axis deviation. An x-ray of the chest shows an enlarged left atrium and ventricle and increased pulmonary vascular markings. Doppler echocardiography confirms the presence of an intracardiac shunt. Which of the following is the most likely explanation for the direction of flow of blood across this shunt?", "answer": "Decrease in pulmonary vascular resistance", "meta_info": "step2&3", "answer_idx": "D", "A": "Communication between the right and left atria", "B": "Right ventricular outflow tract obstruction", "C": "Increase in pulmonary vascular resistance", "D": "Decrease in pulmonary vascular resistance", "language": "en"}
{"question": "A 14-year-old boy is brought to the physician for a follow-up examination. He has allergic rhinitis and his only medication is cetirizine. He is at the 60th percentile for height and above the 95th percentile for weight and BMI. Vital signs are within the normal limits. Examination shows a slightly tender, firm, 1-cm subareolar mass in the left breast. There are no changes in the skin or nipple. The right breast is unremarkable. There is no palpable axillary lymphadenopathy. Axillary and pubic hair is present. Examination of the penis and testis shows no abnormalities. Neurologic examination shows no focal findings. Which of the following is the most likely cause of this patient's findings?", "answer": "Physiological development", "meta_info": "step2&3", "answer_idx": "D", "A": "Adverse drug reaction", "B": "Leydig cell tumor", "C": "Ductal ectasia", "D": "Physiological development", "language": "en"}
{"question": "A 54-year-old woman presents to her primary care physician complaining of a lump in her right breast. She first noticed it 1 month ago. Now she is worried that it may have grown. She claims that the lump is not painful or itchy, and she denies any abnormal nipple bleeding or discharge. She has a family history of breast cancer, including both her mother and older sister. Physical examination reveals a firm, immobile lump in the upper right breast. A mammogram is performed, which identifies an irregular mass with a fibrotically stranded border. A biopsy is performed that is positive for invasive ductal carcinoma. The patient is started on radiation induction therapy and scheduled for a modified radical mastectomy. Following tumor gene testing, the patient is found to be positive or the HER-2/neu oncogene. Which of the following should be started post-mastectomy to improve the patient’s prognosis?", "answer": "Trastuzumab", "meta_info": "step2&3", "answer_idx": "D", "A": "Anastrozole", "B": "Corticosteroids", "C": "Leuprolide", "D": "Trastuzumab", "language": "en"}
{"question": "A 48-year-old man presents to his primary care physician concerned about his weight. He states he has been gaining weight though does not feel he has changed his diet. The patient also states he has felt fatigued lately and not himself. He denies taking any medications or using any illicit substances at baseline. His temperature is 99.2°F (37.3°C), blood pressure is 177/108 mmHg, pulse is 100/min, respirations are 18/min, and oxygen saturation is 98% on room air. Physical exam is notable for an obese man with striae on his abdomen. A 24-hour urine free cortisol is collected and demonstrates an elevated cortisol level; however, a high dose of dexamethasone when administered results in no attenuation of cortisol release. A CT scan of the abdomen is within normal limits. Which of the following is associated with the most likely diagnosis?", "answer": "History of smoking", "meta_info": "step2&3", "answer_idx": "D", "A": "Adrenal adenoma", "B": "Decreased ACTH level", "C": "Enlargement of the facial bones", "D": "History of smoking", "language": "en"}
{"question": "Advances in molecular biology have identified important factors and sequences required for transcription and translation of mRNA as well as multiple diseases associated with mutations. The Kozak sequence is one such finding from this research. What is the Kozak consensus sequence?", "answer": "An initiator of translation proximal to the start codon", "meta_info": "step1", "answer_idx": "C", "A": "A sequence box that binds to NF-1", "B": "An untranslated region downstream of the the stop codon", "C": "An initiator of translation proximal to the start codon", "D": "A site to which the 50S ribosome binds", "language": "en"}
{"question": "A 3-week-old male infant is brought to the physician by his parents because they noticed that his head has been tilted to the left since birth. Physical examination shows the head turned toward the left side and the chin rotated toward the right. He cries during an attempt to rotate the head to the right. There is a firm, well-circumscribed mass on the left lower side of the neck. Which of the following is the strongest predisposing factor for this patient's condition?", "answer": "Fetal macrosomia", "meta_info": "step1", "answer_idx": "A", "A": "Fetal macrosomia", "B": "Cesarean delivery", "C": "Intrauterine exposure to haloperidol", "D": "Preterm birth", "language": "en"}
{"question": "A 13-month-old boy was brought to the clinic due to failure-to-thrive and mental impairment. Retinal findings are shown in the picture. The parents are healthy, but they previously had a child who died at 14 months of age. What is the most likely cause for the underlying abnormalities?", "answer": "Lysosomal enzyme mutation", "meta_info": "step1", "answer_idx": "C", "A": "Structural protein mutation", "B": "Genomic imprinting", "C": "Lysosomal enzyme mutation", "D": "Mitochondrial gene mutation", "language": "en"}
{"question": "A 24-year-old woman who is 16 weeks pregnant comes to your office requesting a referral for an abortion. Upon questioning she states that she is scared that her baby will be \"deformed\" because on routine screening she was found to have an elevated level of alpha-fetoprotein. What is the most likely cause of this lab abnormality in this patient?", "answer": "Inaccurate gestational age", "meta_info": "step1", "answer_idx": "D", "A": "Trisomy 13", "B": "Trisomy 18", "C": "Trisomy 21", "D": "Inaccurate gestational age", "language": "en"}
{"question": "A previously healthy 45-year-old man is brought to the emergency department after being found by a search and rescue team in the mountains. He has been without food or water for 30 hours. His temperature is 37°C (98.6°F), pulse is 123/min, respirations are 20/min, and blood pressure is 90/55 mm Hg. Physical examination shows decreased skin turgor and dry mucous membranes. Evaluation of this patient's urine before treatment is initiated is most likely to show which of the following?", "answer": "Low urine sodium with hyaline casts", "meta_info": "step1", "answer_idx": "B", "A": "Low urine sodium and low urine osmolality", "B": "Low urine sodium with hyaline casts", "C": "High urine protein with fatty casts", "D": "Low urine osmolality with RBC casts", "language": "en"}
{"question": "A 14-year-old Caucasian male presents with painful erythematous and honey-colored crusted lesions around his mouth. Culture of the lesions reveals gram-positive cocci in clusters. Further analysis reveals bacteria that are beta-hemolytic, coagulase positive, catalase positive, and appear golden on the blood agar plate. Which of the following helps the bacterium in this infection bind to immunoglobulin and prevent phagocytosis when invading its host?", "answer": "Protein A", "meta_info": "step1", "answer_idx": "A", "A": "Protein A", "B": "Staphylokinase", "C": "Exfoliatin A", "D": "Neurotoxin", "language": "en"}
{"question": "A 70-year-old man comes to the physician for the evaluation of abdominal pain over the past month. The patient describes epigastric pain that radiates to the back. He also reports a 10-kg (22-lb) weight loss over the past 6 months. He has a history of untreated type 2 diabetes mellitus. He has not seen a doctor in 15 years. He is retired and spends most of his time at home watching TV. He rarely cooks and mainly eats fast food. He has smoked one pack of cigarettes daily for the past 50 years. He drinks 2–3 cans of beer per day. He appears pale. His temperature is 37°C (98.6°F), pulse is 80/min, and blood pressure is 150/90 mm Hg. Physical examination shows jaundice of the conjunctivae and the skin. The abdomen is soft, with no rebound or guarding. Laboratory studies show a serum glucose concentration of 260 mg/dL. Abdominal sonography shows enlargement of the gallbladder. Which of the following is most likely to have contributed to this patient's condition?", "answer": "Smoking history", "meta_info": "step2&3", "answer_idx": "A", "A": "Smoking history", "B": "Poor dietary habits", "C": "History of alcohol use", "D": "Diabetes mellitus", "language": "en"}
{"question": "A 63-year-old African American man with a history of hypertension and dyslipidemia presents to the emergency department with facial swelling and difficulty breathing. Symptoms began suddenly that morning and continued to worsen. He started taking lisinopril several weeks ago. His blood pressure is 110/74 mm Hg, heart rate is 94/min, and respiratory rate is 20/min. Physical examination is notable for swelling of his lips and inspiratory stridor. Clinical lab results suggest a normal C1 esterase inhibitor level. Of the following options, which is the most likely diagnosis?", "answer": "Drug-induced angioedema", "meta_info": "step2&3", "answer_idx": "C", "A": "Erysipelas", "B": "Facial lymphedema", "C": "Drug-induced angioedema", "D": "Contact dermatitis", "language": "en"}
{"question": "A 21-year-old female college student comes to the physician because of a two-week history of vaginal itching and burning. She also noticed white vaginal discharge despite cleaning her genital area daily using a \"\"soap-free, natural\"\" vaginal douche. She is worried that she might have contracted a sexually transmitted disease after meeting her new boyfriend around one month ago. She has type 1 diabetes mellitus. The patient swims for the college swimming team. She had an intrauterine device implanted 3 months ago and does not use barrier protection. She smokes one pack of cigarettes per day and does not drink alcohol. Speculum examination shows an erythematous vagina covered in copious white discharge. Her vaginal pH is 4.4 and the microscopic image of a KOH preparation shows multiple pseudohyphae. Which of the following is the greatest predisposing factor for this patient's condition?\"", "answer": "Diabetes mellitus", "meta_info": "step2&3", "answer_idx": "D", "A": "Frequent vaginal douching", "B": "Unprotected sexual intercourse", "C": "Intrauterine device", "D": "Diabetes mellitus", "language": "en"}
{"question": "A 72-year-old female recently fractured her hip in a fall. She suffers from regular joint pain in her fingers, and hip X-rays reveal low bone mineral density. She has a history of diabetes mellitus and was diagnosed 2 years ago with end-stage renal disease. Serum phosphate levels are markedly elevated. Which of the following likely contributes to her orthopedic problems?", "answer": "Increased serum parathyroid hormone", "meta_info": "step1", "answer_idx": "B", "A": "Decreased serum aldosterone", "B": "Increased serum parathyroid hormone", "C": "Increased serum glucose", "D": "Chronic hypertension", "language": "en"}
{"question": "A 52-year-old man presents to his primary care physician for his annual check-up. He says that he has no health concerns; however, his wife is concerned that he has become increasingly forgetful. For example, he has become forgetful during his daily activities and recently has been getting lost during errands like shopping. She says that these symptoms have been occurring for about a year. She says that she became alarmed when he started forgetting the names of their children. Finally, over the last month he has become more irritable, which has led to several confrontations at work. Based on the age of onset for his disease, the patient is referred for genetic testing. Which of the following chromosomes contain genes that may be mutated in this patient's disease?", "answer": "1", "meta_info": "step1", "answer_idx": "A", "A": "1", "B": "4", "C": "18", "D": "20", "language": "en"}
{"question": "A 23-year-old woman, gravida 2, para 1, at 13 weeks gestation, comes to the physician because of a 2-day history of burning pain during urination. She has been sexually active with different male partners during the pregnancy and did not use condoms. She has not had any fever, chills, or pelvic pain. Physical examination shows thick, purulent discharge from the urethra. Urine dipstick shows leukocyte esterase, urinalysis shows 10 WBCs/hpf, and Gram stain of the urethral swab shows polymorphonuclear leukocytes with intracellular gram-negative diplococci. Pelvic ultrasound shows a viable intrauterine pregnancy. Which of the following is the most appropriate treatment?", "answer": "Intramuscular ceftriaxone and oral azithromycin\n\"", "meta_info": "step1", "answer_idx": "D", "A": "Oral levofloxacin", "B": "Intramuscular ceftriaxone", "C": "Oral erythromycin", "D": "Intramuscular ceftriaxone and oral azithromycin\n\"", "language": "en"}
{"question": "A 20-year-old college student is brought to his primary care physician by his parents over the New Years holiday because they are concerned about his behavior since right after high school graduation in May the spring before. Prior to this year, he was generally an outgoing and social young man, who now reportedly has been spending the majority of his time alone in his dorm room and room at home, where his mother and father have overheard him talking to other people when he has no guests. When asked if anything was bothering him at school, he reports that at night the voice of the school's mascot encourages him to save the school from the large oak grove that will soon takeover the student union building by setting the trees on fire for all to see. On exam, his appears to be otherwise healthy and his urine toxicology screen is negative. What is the most likely diagnosis?", "answer": "Schizophrenia", "meta_info": "step1", "answer_idx": "C", "A": "Schizoaffective disorder", "B": "Major depression", "C": "Schizophrenia", "D": "Schizophreniform disorder", "language": "en"}
{"question": "A 58-year-old man comes to the physician for evaluation of an increasing left-sided cheek swelling and recurrent oral ulcers for 1 year. He has smoked a pack of cigarettes daily for 25 years. Examination shows a mild, nontender swelling above the angle of the left jaw. An ultrasound-guided biopsy of the mass confirms the diagnosis of parotid adenoid cystic carcinoma. A left-sided total parotidectomy is performed. This patient is at greatest risk for which of the following complications?", "answer": "Inability to wrinkle the left side of the forehead", "meta_info": "step1", "answer_idx": "D", "A": "Hyperesthesia of the left ear lobe", "B": "Impaired taste of the posterior 1/3 of the tongue", "C": "Flushing of the right cheek while eating", "D": "Inability to wrinkle the left side of the forehead", "language": "en"}
{"question": "A 34-year-old man comes to the physician for a routine health maintenance examination required for his occupation as a school bus driver. He feels well and healthy. Upon questioning, he reports that he has smoked 2 joints of marijuana every night after work for the past year for recreational purposes. He typically smokes 5 joints or more on weekends. Which of the following responses by the physician is the most appropriate?", "answer": "\"\"\"Have you ever experienced a situation in which you wished you smoked less marijuana?\"\"\"", "meta_info": "step1", "answer_idx": "B", "A": "\"\"\"Let me know when you are ready to stop smoking marijuana. We can talk about specific strategies to help you quit at that time.\"\"\"", "B": "\"\"\"Have you ever experienced a situation in which you wished you smoked less marijuana?\"\"\"", "C": "\"\"\"We have a great program to help patients with substance use disorder issues. Let me give you more information about specific details.\"\"\"", "D": "\"\"\"You should stop smoking marijuana because it is not good for your health.\"\"\"", "language": "en"}
{"question": "A 6-year-old girl of Moroccan descent is brought to the pediatrician by her father who is concerned about the child developing a body odor. He reports that she has started to smell “like a teenage boy” especially after physical activity. The child has had limited medical follow-up since being born in Morocco and immigrating to the United States at 3 years of age. Her temperature is 99°F (37.2°C), blood pressure is 150/90 mmHg, pulse is 85/min, and respirations are 18/min. On exam, she has hair in her axillary and pubic regions. Genital examination demonstrates clitoral enlargement and labioscrotal fusion. Which of the following metabolites is most likely elevated in this patient?", "answer": "11-deoxycorticosterone", "meta_info": "step1", "answer_idx": "C", "A": "Aldosterone", "B": "Cortisol", "C": "11-deoxycorticosterone", "D": "Leutenizing hormone", "language": "en"}
{"question": "A 25-year-old woman presents to the clinic for burning with urination. She is a newlywed and reports 3 similar episodes within the past 4 months. She claims that since yesterday she has noticed a burning sensation whenever she urinates, an increase in urinary frequency, and some clear vaginal discharge. She denies fever, chills, back pain, or chest pain. Her past medical history is significant for chlamydia that was adequately treated 3 years ago. She is currently sexually active with her husband and has an IUD. She is subsequently prescribed a course of nitrofurantoin for her symptoms. While getting up to leave, the patient asks “why is it that I always get these symptoms but my husband is fine?” What is the most appropriate answer to this patient’s question?", "answer": "The female urethra is shorter", "meta_info": "step2&3", "answer_idx": "C", "A": "Her partner is an asymptomatic carrier", "B": "Inadequate treatment of her prior episodes", "C": "The female urethra is shorter", "D": "The patient is experiencing recurrence of her past chlamydial infection", "language": "en"}
{"question": "A 17-year-old boy comes to the physician 1 week after noticing a lesion on his penis. There is no history of itching or pain associated with the lesion. He is sexually active with two female partners and uses condoms inconsistently. Five weeks ago, he returned from a trip to the Caribbean with some of his football teammates. He takes no medications. He has recently started an intense exercise program. His vital signs are within normal limits. Physical examination shows multiple enlarged, nontender lymph nodes in the inguinal area bilaterally. A photograph of the lesion is shown. Which of the following is the most likely pathogen?", "answer": "Treponema pallidum", "meta_info": "step2&3", "answer_idx": "C", "A": "Mycoplasma genitalium", "B": "Human papillomavirus", "C": "Treponema pallidum", "D": "Herpes simplex virus type 2", "language": "en"}
{"question": "A 36-year-old man presents to a physician for a post-transplant medical evaluation. He has been taking prednisone and azathioprine for the last 6 months after receiving a cadaveric renal transplant. He complains of fever, cough, and anorexia for the last 6-7 days. His cough is productive of thick sputum. His temperature is 38.5°C (101.5°F). The physical examination is significant for diminished breath sounds over the left lower lung with dullness on percussion and increased vocal resonance. A left lower lobe nodule, 5 cm (2 in) in diameter with eccentric central cavitation, is visible on the chest X-ray. A sputum analysis reveals branched, irregular, gram-positive filamentous rods. Which of the following constitutes the first-line therapy in this patient?", "answer": "Sulfisoxazole", "meta_info": "step1", "answer_idx": "D", "A": "Erythromycin", "B": "Ceftazidime", "C": "Penicillin", "D": "Sulfisoxazole", "language": "en"}
{"question": "A 54-year-old woman presents to her gynecologist complaining of incontinence. She reports leakage of a small amount of urine when she coughs or laughs as well as occasionally when she is exercising. She denies any pain with urination. She underwent menopause 2 years ago and noted that this problem has increased in frequency since that time. Her history is significant only for three uncomplicated pregnancies with vaginal births. Urinalysis, post-void residual, and cystometrogram are conducted and all show normal results. The patient's vital signs are as follows: T 37.5 C, HR 80, BP 128/67, RR 12, and SpO2 99%. Physical examination is significant for pelvic organ prolapse on pelvic exam. Which of the following is a reasonable first step in the management of this patient's condition?", "answer": "Kegel exercises", "meta_info": "step2&3", "answer_idx": "A", "A": "Kegel exercises", "B": "Bethanechol", "C": "Urethropexy", "D": "Tension-free vaginal tape", "language": "en"}
{"question": "Researchers from a public health institute located in the United States conducted a multicenter cohort study on a large number of elderly individuals in order to evaluate the protective effect of the new vaccine for herpes zoster (commonly known as shingles) reactivation. After a long follow-up period, the data shows that shingles developed in 15% of study participants who received the new vaccine compared to 20% of diseased study participants in the control group that did not receive the vaccine. If the new vaccine showed identical efficacy in groups with higher and lower risks of herpes zoster reactivation (e.g., 40% and 10% risk), the calculated protective proportion of 25% would be maintained, regardless of the different baseline risk for shingles development. What is this metric also known as?", "answer": "Relative risk reduction", "meta_info": "step1", "answer_idx": "C", "A": "Event rate", "B": "Risk difference", "C": "Relative risk reduction", "D": "Absolute risk reduction", "language": "en"}
{"question": "A 55-year-old gentleman has been working in a sand blasting factory for over 25 years. He presents to his primary care physician with what he describes as increasing shortness of breath. PFTs are performed describing a restrictive lung process. Which of the following has most likely been the long-term mechanism of his disease development?", "answer": "Phagocytosis of silica", "meta_info": "step1", "answer_idx": "B", "A": "Eosinophilic reaction", "B": "Phagocytosis of silica", "C": "Tuberculosis", "D": "Defective mucociliary transport", "language": "en"}
{"question": "A 37-year-old man presents to the emergency department with acute loss of vision, slurred speech, and agitation. Past medical history is significant for HIV and hepatitis C, diagnosed 10 years ago for which he is non-compliant with medication. A T1 MRI of the brain shows asymmetric, hypointense white matter lesions. Which of the following pathogens is most likely responsible for this patient’s opportunistic infection?", "answer": "JC virus", "meta_info": "step1", "answer_idx": "C", "A": "Herpes virus 8", "B": "Candida albicans", "C": "JC virus", "D": "Pneumocystis jirovecii", "language": "en"}
{"question": "A 4-year-old girl is brought to the physician for evaluation of a rash that her mother noticed 5 months ago. The rash is not painful or itchy but she notices that her daughter sometimes picks at the “spots.” The girl's 2-year-old brother has also started developing similar skin lesions over the past month. The patient has no history of serious illness and takes no medications. She is in the 75th percentile for height and 50th percentile for weight. A photograph of the patient's rash is shown. Which of the following infectious agents is the most likely cause of this patient's skin condition?", "answer": "Poxvirus", "meta_info": "step1", "answer_idx": "C", "A": "Human herpesvirus 8", "B": "Human papillomavirus", "C": "Poxvirus", "D": "Varicella-zoster virus", "language": "en"}
{"question": "A 51-year-old police officer is brought to the emergency room after being shot in the abdomen. His wound was packed and bandaged by emergency medical services before he was transported to the hospital. His past medical history is notable for hypertension and diabetes. He takes metformin and lisinopril. He has a 20-pack-year smoking history and does not drink alcohol. His temperature is 98.6°F (37°C), blood pressure is 142/86 mmHg, pulse is 120/min, and respirations are 24/min. On exam, he appears uncomfortable but is able to answer questions appropriately. He has a 1 cm x 1 cm wound in the left upper quadrant. There is an exit wound in the left lower back. After undergoing the appropriate laboratory and imaging tests, he undergoes a diagnostic laparotomy. No involvement of the colon or small intestine is noted intraoperatively. He is placed on the appropriate antibiotic and pain control regimens. Three days later, he experiences several episodes of non-bloody diarrhea. His temperature is 101°F (38.3°C). Sigmoidoscopy reveals multiple pseudomembranous plaques in the sigmoid and descending colon. This patient's symptoms are most likely due to taking an antibiotic that inhibits which of the following enzymes?", "answer": "50S ribosomal subunit", "meta_info": "step1", "answer_idx": "B", "A": "30S ribosomal subunit", "B": "50S ribosomal subunit", "C": "Dihydropteroate synthetase", "D": "DNA-dependent RNA polymerase", "language": "en"}
{"question": "A 3-year-old girl is brought to the physician by her parents for the evaluation of vaginal discharge for one month. The discharge is foul-smelling and contains some blood. The patient sometimes has pain with urination. She has not had increased urinary frequency or abdominal pain. Topical vaginal cream application did not improve the patient's symptoms. There is no personal or family history of serious illness. She lives with her parents and attends a local daycare center. Vital signs are within normal limits. Examination of the vulva and vaginal entrance shows an intact hymen, vaginal erythema with blood-tinged, foul-smelling discharge, and the tip of a white object. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in the management of this patient?", "answer": "Vaginal irrigation with warm saline", "meta_info": "step2&3", "answer_idx": "A", "A": "Vaginal irrigation with warm saline", "B": "Vacuum suction", "C": "Alert Child Protective Services", "D": "Administration of oral metronidazole", "language": "en"}
{"question": "A 60-year-old man comes to the physician because of a 3-month history of a slowly enlarging painless ulcer on his lower lip. One year ago he had a painful rash near his upper lip that resolved completely with acyclovir therapy. He has a 10-year history of type 2 diabetes mellitus treated with metformin. He has worked in construction for the past 33 years. He has smoked one pack of cigarettes daily for 35 years. Examination shows a 0.5 x 0.5 cm nontender ulcer with everted edges on the midline of his lower lip. The erythematous ulcer bleeds upon palpation. He has numerous moles of varying sizes all over his body. There are no palpable cervical lymph nodes. Which of the following is the most likely diagnosis?", "answer": "Squamous cell carcinoma", "meta_info": "step2&3", "answer_idx": "A", "A": "Squamous cell carcinoma", "B": "Aphthous stomatitis", "C": "Psoriasis", "D": "Seborrheic keratosis", "language": "en"}
{"question": "A 3-year-old girl is brought to the pediatrician by her father for fever and cough. The patient’s father states that she had a sore throat and runny nose 2 weeks ago. Then last night she developed a productive cough and a fever. The father is worried that this is pneumonia again, and reports that she has been hospitalized 5 times already with pneumonia. Her medical history is also significant for chronic diarrhea. The father reports that the patient has 2 older brothers who are both healthy. The patient’s temperature is 102°F (38.9°C), blood pressure is 102/60 mmHg, pulse is 110/min, and respirations are 28/min with an oxygen saturation of 94% on room air. On physical examination, decreased breath sounds are appreciated on the right. A chest radiography shows consolidation in the right upper lobe, consistent with pneumonia. An antibody panel and flow cytometry are obtained in the setting of the patient’s recurrent infections. The results show a normal lymphocyte count with low levels of IgA, IgG, and IgE and elevated levels of IgM. Which of the following is the patient most at risk for developing?", "answer": "Blurry vision", "meta_info": "step2&3", "answer_idx": "C", "A": "Ataxia", "B": "Atopic dermatitis", "C": "Blurry vision", "D": "Scant tonsils", "language": "en"}
{"question": "A 72-year-old man presents with urinary frequency resulting in frequent awakening to urinate at night. He is a retired elite runner and does not have a history of any chronic medical conditions. The patient denies weight loss, bone pain, or pain with urination. The patient is not in distress. Vitals show: temperature 36.8°C (98.2°F), heart rate 98/min, respiratory rate 15/min, and blood pressure 100/75 mm Hg. Physical exam is significant for a smooth, non-tender, uniformly enlarged prostate on digital rectal exam. There is no CVA tenderness. CBC, CMP, urinalysis, and abdominal ultrasound are ordered. Significant findings include: bilateral hydronephrosis on ultrasound, BUN/creatinine > 20:1, specific gravity > 1,020, FENa < 1%, urine Na < 20, and urine osmolality > 450 mOsm/kg. Furthermore, post-void residual volume is > 100 mL. Which type of patient would least likely have these same diagnostic findings?", "answer": "A 35-year-old woman with severe colicky pain radiating to the left flank", "meta_info": "step2&3", "answer_idx": "D", "A": "A 55-year-old Egyptian man with painless hematuria, 18.1 kg (40 lb) incidental weight loss and confirmed Schistosoma hematobium infection", "B": "A 27-year-old woman with waxing and waning internuclear ophthalmoplegia, scanning speech, and optic neuritis", "C": "An ICU patient with a kinked Foley catheter", "D": "A 35-year-old woman with severe colicky pain radiating to the left flank", "language": "en"}
{"question": "An 82-year-old man with Alzheimer disease is brought to the physician by his daughter because of extensive bruising on his arms. He lives in an assisted living facility. Physical examination shows large ecchymoses across both forearms and upper arms in varied stages of healing. His hemoglobin concentration is 11.7 g/dL, mean corpuscular volume is 78 μm3, and platelet count is 180,000/mm3. Coagulation studies are within normal limits. Which of the following is the most likely etiology of his bruises?", "answer": "Nonaccidental trauma", "meta_info": "step1", "answer_idx": "C", "A": "Platelet aggregation inhibition", "B": "Intravascular coagulation with fibrinolysis", "C": "Nonaccidental trauma", "D": "Vitamin K deficiency", "language": "en"}
{"question": "A 23-year-old woman presents to her gynecologist for a routine visit. She is nulliparous, does not report any gynecologic or systemic diseases, and has no complaints. She is sexually active with one partner and uses oral contraceptive pills. Her vital signs are as follows: blood pressure 125/70 mm Hg, heart rate 81/min, respiratory rate 12/min, and temperature 36.6℃ (97.9℉). The physical examination is within normal limits. The breast examination is normal. No pathology is noted in the external genitalia and a speculum examination reveals a normal cervix with a closed external os and no discharge. A specimen is obtained from the cervical portion for a Pap smear. On bimanual examination, the uterus is normal size, non-tender, and mobile adnexa is non-palpable.\nThe pap smear result is as follows:\nThe pap smear result is as follows:\nSpecimen adequacy: satisfactory for evaluation\nInterpretation: negative for intraepithelial lesion or malignancy\nNotes: absent transformation zone component\nHow should we proceed with the management of this patient?", "answer": "Repeat Pap test in 3 years as a usual screening schedule suggests", "meta_info": "step2&3", "answer_idx": "A", "A": "Repeat Pap test in 3 years as a usual screening schedule suggests", "B": "Repeat Pap test within 2 weeks and ensure proper sampling from the transformation zone", "C": "Perform a screening test for high-risk human papillomavirus (HPV)", "D": "Perform a HPV testing and Pap smear in one year", "language": "en"}
{"question": "A 57-year-old woman presents to the emergency department with acute pain in the left lower abdomen associated with nausea and vomiting for the past 24 hours. Prior to this episode, the patient did not have any significant gastrointestinal (GI) problems except for occasional constipation and indigestion after heavy meals. She has had hypertension and hypercholesterolemia for the past 7 years. Her family history is negative for GI disorders. Vital signs include a temperature of 38.0°C (100.4°F), blood pressure of 120/80 mm Hg, and pulse of 85/min. On physical examination, there is tenderness in the left lower abdominal quadrant. Abdominal CT scan shows thickening of the bowel wall and streaky mesenteric fat. Which of the following best describe the primary disorder in this patient?", "answer": "Herniation of mucosa and submucosa through the muscular layer of the colon", "meta_info": "step2&3", "answer_idx": "C", "A": "Obstruction of the lumen of the appendix", "B": "Inflammation of the renal parenchyma, calyces and pelvis", "C": "Herniation of mucosa and submucosa through the muscular layer of the colon", "D": "Inflammation of the upper genital tract", "language": "en"}
{"question": "A 35-year-old woman comes to the emergency department because of a 3-day history of pain in the left cheek. The pain occurs every few hours, lasts 30–60 seconds, and is aggravated by chewing and brushing. She has a history of pain with a vesicular rash in the right axillary area one year ago. She had an upper respiratory infection 2 weeks ago. Physical examination shows no abnormalities. Which of the following is the most likely diagnosis?", "answer": "Trigeminal neuralgia", "meta_info": "step1", "answer_idx": "B", "A": "Cluster headache", "B": "Trigeminal neuralgia", "C": "Postherpetic neuralgia", "D": "Temporal arteritis", "language": "en"}
{"question": "A 45 year old male presents to clinic complaining of a ringing in his ears. The patient's vitals are: BP 120/65, RR 16, 100% on room air, HR 78 bpm and he appears to be in no acute distress. Upon obtaining a history you learn that this patient also complains that at times the \"room feels like it's spinning.\" You also notice throughout the interview that you have to speak loudly as the patient has difficulty hearing. The patient is then lost to follow up for his current condition. The patient returns several years later with worsening symptoms and as part of this patient's workup a MRI is obtained (Image A). Which of the following chromosomes is most likely mutated in association with this patient's condition?", "answer": "Chromosome 22", "meta_info": "step2&3", "answer_idx": "C", "A": "Chromosome 13", "B": "Chromosome 17", "C": "Chromosome 22", "D": "The X chromosome", "language": "en"}
{"question": "A 35-year-old is brought into the emergency room after a bicycle vs motored vehicle accident. He was unconscious after hitting the side of his head on the road, but recovered consciousness after a few minutes. He started to ride his bicycle again, but then developed a severe headache with nausea and vomiting, at which time he called EMS. While in the hospital, the patient is confused and cannot provide a history. He quickly loses consciousness and his CT scan is displayed in Figure 1. What is the most likely diagnosis?", "answer": "Epidural hematoma", "meta_info": "step2&3", "answer_idx": "B", "A": "Subdural hematoma", "B": "Epidural hematoma", "C": "Subgaleal hematoma", "D": "Caput succedaneum", "language": "en"}
{"question": "A 39-year-old man comes to the physician because of a 2-month history of shortness of breath with exertion. He immigrated to the United States from Ghana 20 years ago. His pulse is 88/min, respirations are 18/min, and blood pressure is 120/80 mm Hg. Echocardiography shows thickened mitral valve leaflets with reduced motion and a narrowed mitral valve orifice diameter. Which of the following auscultation findings is most likely to correlate with the severity of this patient's valvular disease?", "answer": "Decreased time between S2 and opening snap", "meta_info": "step1", "answer_idx": "A", "A": "Decreased time between S2 and opening snap", "B": "Radiation of murmur to the axilla", "C": "Increased intensity of the murmur", "D": "Absence of A2 heart sound", "language": "en"}
{"question": "A 6-year-old boy is brought to the physician because of worsening fatigue for the past 4 weeks. Examination of the head and neck shows conjunctival pallor, grayish-brown spots on the irises, prominent epicanthal folds, and a broad nasal bridge. He has a single transverse palmar crease, and there are scattered petechiae over the chest. An ultrasound of the abdomen shows enlargement of the liver and spleen. Analysis of the bone marrow aspirate of this patient is most likely to show which of the following findings?", "answer": "CD10 positive cells", "meta_info": "step1", "answer_idx": "C", "A": "Translocation t(15;17)", "B": "Ringed sideroblasts", "C": "CD10 positive cells", "D": "Hypocellular bone marrow", "language": "en"}
{"question": "A 42-year-old female presents to the emergency department with two days of severe abdominal pain and fever. The patient has a history of gallstones, for which she was scheduled to have a cholecystectomy in two weeks. On physical exam, her abdomen is tender to palpation over the epigastrium, without rebound or guarding. The patient is noticeably jaundiced. Laboratory evaluation is notable for a leukocytosis and a total bilirubin of 6.4 mg/dL. What is the diagnosis in this patient?", "answer": "Acute cholangitis", "meta_info": "step2&3", "answer_idx": "C", "A": "Acute pancreatitis", "B": "Chronic pancreatitis", "C": "Acute cholangitis", "D": "Primary sclerosing cholangitis", "language": "en"}
{"question": "A 52-year-old woman presents to her primary care physician because she has been feeling pain in her right leg. Specifically, she says that an area on her right thigh has been feeling tender and swollen over the past few weeks. Her past medical history is significant for obesity, poorly controlled diabetes, and hypertension. She also has been taking estrogen replacement therapy and drinking alcohol to cope with her symptoms of menopause. Her family history is significant for cardiomyopathy. On physical exam, there is erythema and edema along a cord-like lesion in her thigh. This lesion feels thick and hardened on palpation and is tender to the touch. She is started on compression therapy as well as NSAIDs for pain management. Which of the following characteristics of this patient most likely increased her risk for this disorder?", "answer": "Estrogen therapy", "meta_info": "step1", "answer_idx": "C", "A": "Alcohol use", "B": "Diabetes", "C": "Estrogen therapy", "D": "Hypertension", "language": "en"}
{"question": "A 34-year-old woman presents to the clinic complaining of constipation and dry mouth. She had uncontrollable diarrhea for 1 day and took some medications afterwards. Patient denies any recent hospitalizations or antibiotic use. She also denies melena, hematochezia, nausea, or vomiting. Vitals are within normal limits. What medication did the patient take?", "answer": "Loperamide", "meta_info": "step1", "answer_idx": "A", "A": "Loperamide", "B": "Oral vancomycin", "C": "Sulfasalazine", "D": "Setraline", "language": "en"}
{"question": "A 25-year-old arrives at a gynecology clinic for a consult as she and her husband plan to conceive a baby soon. She is currently taking no medications, doesn’t smoke, and drinks alcohol socially. Her father passed away at the age of 51 due to heart failure. Her vital signs include blood pressure 150/100 mm Hg, heart rate 67/min, respiratory rate 16/min, and temperature 36.7°C (98.0°F). Physical examination is unremarkable. When asked about her high blood pressure, the patient says that her primary care physician once told her that her blood pressure was elevated on most of her visits; the physician emphasized that she should exercise and control her diet, but she never followed up with him as she always felt good. A number of tests are run to find out the etiology of her elevated blood pressure. Everything is within the normal range except for a renal angiogram shown in the picture. What is the most likely cause of this patient’s high blood pressure?", "answer": "Fibromuscular hyperplasia", "meta_info": "step1", "answer_idx": "C", "A": "Atherosclerosis", "B": "Adult polycystic kidney disease", "C": "Fibromuscular hyperplasia", "D": "Pheochromocytoma", "language": "en"}
{"question": "A 73-year-old man is found to have an early stage hepatocellular carcinoma in the left lobe of his liver. He decides to undergo surgery to remove the tumor through partial liver resection. During the procedure, a ligament is found that attaches the liver to the anterior abdominal wall. Since part of this ligament lies over the part of the liver that needs to be resected, the ligament is incised to allow for removal of the tumor. The free edge of the ligament is found to have a thickening with small remnant blood vessels. Which of the following embryonic structures most likely gave rise to the thickening described here?", "answer": "Left umbilical vein", "meta_info": "step1", "answer_idx": "B", "A": "Ductus venosus", "B": "Left umbilical vein", "C": "Right umbilical artery", "D": "Ductus arteriosus", "language": "en"}
{"question": "A researcher is conducting an experiment on the physiology of body fluids. He documents specific observations and plots some of them as a Darrow-Yannet diagram. In his study, some diagrams are normal, while most are abnormal. The abnormalities in the diagram are mostly in the form of changes in the x-axis, changes in the y-axis or changes in both axes of the diagram. Which of the following parameters are most likely to affect the x-axis in the diagram?\n ", "answer": "Fluid volume", "meta_info": "step1", "answer_idx": "D", "A": "Fluid osmolality", "B": "Fluid surface tension", "C": "Fluid viscosity", "D": "Fluid volume", "language": "en"}
{"question": "An 11-year-old girl is brought to a pediatrician by her parents with recurrent wheezing for the last 3 years. After a detailed history, complete physical examination, and thorough diagnostic evaluation, the pediatrician informs the parents that the girl has mild persistent asthma, which will be most effectively treated with inhaled corticosteroids (ICS). However, her parents firmly object to the use of corticosteroids in any form, despite being told that the side effects associated with ICS are negligible. Therefore, the pediatrician suggests the regular use of a drug that does not contain a corticosteroid. The pediatrician mentions that the drug is used as prophylaxis only and will not be useful to treat acute bronchospasm. Which of the following drugs is most likely suggested by the pediatrician?", "answer": "Inhaled cromolyn sodium", "meta_info": "step1", "answer_idx": "C", "A": "Subcutaneous terbutaline", "B": "Inhaled ipratropium bromide", "C": "Inhaled cromolyn sodium", "D": "Oral roflumilast", "language": "en"}
{"question": "A team of scientists is researching the synthesis of a drug that would potentially reduce blood pressure in hypertensive patients by a novel mechanism of action. The drug A is an inactive prodrug and enters hepatocytes, reacts with reactant B, a native material in the cell, and creates products C and D. D has a blood pressure lowering effects. The reaction requires the presence of enzyme E. The researcher observes that, for the above chemical reaction, Gibbs free energy change (ΔG) is less than zero in normal hepatocytes whereas, in hepatocytes of patients with fatty liver, ΔG is more than 0 due to some unknown reason. Based on this knowledge, provided the concentration and actions of reactant B and enzyme E are same in both normal hepatocytes and hepatocytes of fatty liver patients, which of the following is the most likely possibility if drug A is administered to hypertensive patients with fatty liver?", "answer": "Drug A will not decrease blood pressure, regardless of its dose or supplementation of B or E", "meta_info": "step1", "answer_idx": "C", "A": "Drug A will decrease blood pressure only if reactant B is also supplemented in necessary dose", "B": "Drug A will decrease blood pressure only if enzyme E is also supplemented in necessary dose", "C": "Drug A will not decrease blood pressure, regardless of its dose or supplementation of B or E", "D": "Drug A will decrease blood pressure in same dose as required for patients with a healthy liver", "language": "en"}
{"question": "A 70-year-old man comes to the physician because of a 4-month history of progressively worsening lower back pain. He describes the pain as a constant, dull ache that interferes with his sleep and is only partially relieved with ibuprofen. Two years ago, he was diagnosed with advanced prostate cancer, for which he underwent radiation therapy of the prostate and bilateral orchiectomy. One year postoperatively, serum prostate-specific antigen (PSA) was undetectable. He missed his previous follow-up visit. Current medications include over-the-counter ibuprofen. Vital signs are within normal limits. Physical examination shows tenderness of the spinous process of the third lumbar vertebra. Digital rectal examination shows a hard, nontender prostate. The remainder of the examination shows no abnormalities. The serum PSA concentration is 16 ng/mL (N<4). A technetium-99m bone scan shows increased uptake at the second and third lumbar vertebral bodies. In addition to analgesia, which of the following is the most appropriate next step in management?", "answer": "External beam radiotherapy to the lumbar vertebrae", "meta_info": "step2&3", "answer_idx": "A", "A": "External beam radiotherapy to the lumbar vertebrae", "B": "Leuprolide therapy", "C": "Finasteride therapy", "D": "Observation with no further treatment", "language": "en"}
{"question": "A 24-year-old woman presents complaining of a new onset vaginal odor. She reports that she is sexually active in a monogamous relationship with the same partner for two years. You perform a KOH prep, and notice an abnormal smell. On microscopy in your office, you observe the findings in figure A.\n\nWhat is the most likely causative organism?", "answer": "Gardnerella vaginalis", "meta_info": "step1", "answer_idx": "D", "A": "Trichomonas vaginalis", "B": "Candida albicans", "C": "Escherichia coli", "D": "Gardnerella vaginalis", "language": "en"}
{"question": "A 22-year-old woman is brought to the emergency department 4 hours after the ingestion of 25 tablets of an unknown drug in an attempt to commit suicide. Her temperature is 36.7°C (98°F), pulse is 41/min, respirations are 14/min, and blood pressure is 88/55 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 93%. She is confused and oriented only to person. The pupils are equal and reactive to light. Examination shows cold, clammy extremities. Scattered expiratory wheezing and rhonchi are heard throughout both lung fields. The abdomen is soft. Fingerstick blood glucose concentration is 65 mg/dL. ECG shows prolonged PR intervals and narrow QRS complexes. Two large bore cannulas are inserted and intravenous normal saline, dextrose, and atropine are administered. Five minutes later, pulse is 51/min and blood pressure is 95/61 mm Hg. In addition to securing the airway, which of the following is the most appropriate next step in management?", "answer": "Glucagon", "meta_info": "step2&3", "answer_idx": "A", "A": "Glucagon", "B": "Activated charcoal", "C": "Sodium bicarbonate", "D": "Hemodialysis", "language": "en"}
{"question": "A 56-year-old patient reports a history of recurrent dental caries. The bacteria causing this patient's dental problems most likely exhibits which of the following properties?", "answer": "Production of dextrans from glucose", "meta_info": "step1", "answer_idx": "B", "A": "Inhibition of growth on optochin sensitivity test", "B": "Production of dextrans from glucose", "C": "Presence of catalase enzyme", "D": "Soluble in bile", "language": "en"}
{"question": "A 40-year-old woman comes to the physician for a follow-up examination. She says she has felt fatigued for about 3 months. She does not have enough energy for her job as a physician's assistant and often has to lie down and rest during shifts. She no longer adheres to her usual exercise routine because of exhaustion. During this time, she has noticed that her stools are sometimes pale and foul smelling. She also has generalized itching. The patient does not have abdominal pain, fever, or weight loss. She takes levothyroxine for hypothyroidism. She has smoked one pack of cigarettes weekly for 20 years. Physical examination shows no abnormalities. Laboratory studies show:\nHemoglobin 14.1 g/dL\nLeukocyte count 7,200/mm3\nErythrocyte sedimentation rate 26 mm/h\nSerum\nThyroid-stimulating hormone 4.2 μU/ml\nBilirubin\nTotal 1.7 mg/dL\nDirect 1.0 mg/dL\nAlkaline phosphatase 370 U/L\nAspartate aminotransferase 80 U/L\nAlanine aminotransferase 46 U/L\nCholesterol 320 mg/dL\nGamma-glutamyl transferase 98 U/L (N = 5–50)\nMagnetic resonance cholangiopancreatography shows no gallstones and no evidence of extrahepatic biliary obstruction. Liver biopsy shows nonsuppurative destructive cholangitis with lymphocytic infiltration of portal areas and periductal granulomas. Which of the following autoantibodies is most likely to be present in this patient?\"", "answer": "Anti-mitochondrial antibodies", "meta_info": "step2&3", "answer_idx": "B", "A": "Anti-liver-kidney microsomal-1 antibodies", "B": "Anti-mitochondrial antibodies", "C": "Anti-smooth muscle antibodies", "D": "Perinuclear anti-neutrophil cytoplasmic antibodies", "language": "en"}
{"question": "A 73-year-old man seeks evaluation for difficulty developing and maintaining erections. He has recently made lifestyle modifications, such as losing 4.5 kg (10 lb) but his erectile symptoms have not improved. He was prescribed a drug by his physician. Inhibition of which of the following best describes this drug’s mechanism of action?", "answer": "cGMP phosphodiesterase", "meta_info": "step1", "answer_idx": "B", "A": "5-alpha reductase", "B": "cGMP phosphodiesterase", "C": "Estrogen receptors", "D": "Testosterone receptors", "language": "en"}
{"question": "A 65-year-old woman with hypertension comes to the emergency department because of sudden onset of a severe headache 2 hours ago. Her temperature is 35°C (95°F) and blood pressure is 189/115 mm Hg. A CT scan of the head shows a subarachnoid hemorrhage and she is started on appropriate pharmacotherapy. Which of the following regions of the brain is most likely affected?", "answer": "Preoptic nucleus", "meta_info": "step1", "answer_idx": "C", "A": "Ventral lateral thalamic nucleus", "B": "Pineal gland", "C": "Preoptic nucleus", "D": "Caudate nucleus", "language": "en"}
{"question": "A 35-year-old woman with a one-year history of auditory hallucinations and periods of anhedonia and amotivation is being seen by her psychiatrist. She was started on haloperidol at her last visit, but she was told to stop taking the medication since she developed muscle stiffness and spasms soon after taking the drug. Today, her temperature is 97.7°F (36.5°C), blood pressure is 132/76 mmHg, pulse is 98/min, and respirations are 12/min. The patient is now started on a new medication that will seek to avoid the same side effects as her previous one; however, she will need to come in for weekly testing. Which of the following should be tested weekly?", "answer": "White blood cell count", "meta_info": "step1", "answer_idx": "D", "A": "Electrocardiogram", "B": "Electrolytes", "C": "Gonadotropin releasing hormone", "D": "White blood cell count", "language": "en"}
{"question": "A 9-year-old boy is brought to the emergency room by his concerned mother after he \"urinated blood.\" The boy reports that, starting this morning, he experienced significant pain with urination and his urine appeared a bright red color. These symptoms were not present before today; however, he reports a cough, runny nose, and sore throat that started approximately 3 days ago. Vital signs are as follows: T 38.4 deg C, HR 101, BP 110/65, RR 14, SpO2 99%. Physical examination is significant for bilateral conjunctivitis, tenderness to suprapubic palpation, and a small amount of clotted blood is noted surrounding the urethral meatus. A urine sample is obtained, and urinalysis shows 3+ blood, and urine microscopy demonstrates gross blood with too many cells to count per high powered field. Which of the following is the most common viral cause of this child's condition?", "answer": "Adenovirus", "meta_info": "step1", "answer_idx": "C", "A": "Parvovirus B19", "B": "Coronavirus", "C": "Adenovirus", "D": "Coxsackie A virus", "language": "en"}
{"question": "A young researcher wants to develop a method of increasing oxygen delivery to the peripheral tissues. He brainstorms several ideas but is informed by his mentor that only one of his ideas will most likely help him achieve the desired result. Of the following proposed mechanisms, which one would best serve the researcher's purpose?", "answer": "Increase taut form hemoglobin in muscle capillaries", "meta_info": "step1", "answer_idx": "D", "A": "Decrease lactic acid production by skeletal muscle", "B": "Increase fetal hemoglobin concentration in circulation", "C": "Increase relaxed form hemoglobin in muscle capillaries", "D": "Increase taut form hemoglobin in muscle capillaries", "language": "en"}
{"question": "A 29-year-old man comes to the physician for a follow-up examination. He has had numbness and tingling of his legs for the past 10 days. Three months ago, he was diagnosed with pulmonary tuberculosis and started on antituberculosis therapy. Examination shows dry scaly lips and cracks at the corner of the mouth. Sensation to pinprick and light touch is decreased over the lower extremities. His hemoglobin concentration is 10.4 g/dL and mean corpuscular volume is 76 μm3. Administration of which of the following is most likely to have prevented this patient's current symptoms?", "answer": "Pyridoxine", "meta_info": "step1", "answer_idx": "D", "A": "Iron", "B": "Vitamin E", "C": "Folic acid", "D": "Pyridoxine", "language": "en"}
{"question": "A 36-year-old woman presents with a 2-month history of urinary incontinence, accompanied by urgency, nocturia, and occasional hematuria. Her symptoms are present day and night and have no known triggers. She was diagnosed with grade 2 pelvic organ prolapse (cystocele) 1 year ago, which is managed with pelvic floor training exercises and a vaginal pessary. She is otherwise healthy and does not take any medications. The blood pressure is 120/80 mm Hg, the heart rate is 67/min, the respiratory rate is 14/min, and the temperature is 36.8℃ (98.2℉). The physical examination is significant for suprapubic tenderness. No costovertebral angle tenderness is present. There are no signs of vulvar inflammation, and no urethral or vaginal discharge. The vaginal mucosa is normal and there is no cervical discharge. A vaginal pessary is placed. The cervix is non-tender and mobile, the uterus is not enlarged, and the adnexa have no masses.\nThe urinalysis shows the following findings:\n Color:  Pale yellow\n Clarity:  Clear\n pH:  6.2\n Specific gravity:  1.023\n Glucose:  Negative\n Ketones:  Negative\n Nitrites:  Positive\n Leukocyte esterase:  Positive\n Bilirubin:  Negative\n Urinary bilirubin:  Negative\n Protein: Negative\n RBCs:  47 RBCs/hpf\n WBCs:  21 WBCs/hpf\n Epithelial cells:  27 squamous epithelial cells/hpf\n Casts:  5 hyaline casts/lpf\n Crystals:  Occasional urates\n Bacteria:  None noted\n Yeast:  None noted\nThe urinary culture is negative. Which investigation should be performed next in this patient?", "answer": "Ultrasound examination", "meta_info": "step2&3", "answer_idx": "B", "A": "Cystoscopy", "B": "Ultrasound examination", "C": "Cystometry", "D": "Pelvic CT scan", "language": "en"}
{"question": "The incidence of red-green color blindness in males in a certain population is 1/100. Which of the following is closest to the probability of a female and a male with normal vision having a daughter with red-green color blindness?", "answer": "0", "meta_info": "step1", "answer_idx": "D", "A": "1/100", "B": "1/50", "C": "98/100", "D": "0", "language": "en"}
{"question": "A 31-year-old man comes to the physician for evaluation of chronic cough, sinus pain, and nasal discharge. He has a history of frequent upper respiratory infections and recurrent sinusitis since childhood. He is also concerned about fertility, as he and his wife have been trying to conceive for 5 years unsuccessfully. Pulmonary examination shows crackles and wheezing throughout both lung fields. A CT scan of the chest is shown. The most likely cause of this patient's condition is a defect in which of the following molecular structures?", "answer": "Dynein arm", "meta_info": "step1", "answer_idx": "D", "A": "IL-2R gamma chain", "B": "NADPH oxidase", "C": "CFTR protein", "D": "Dynein arm", "language": "en"}
{"question": "A 3-year-old boy is brought to the emergency department because of abdominal pain and watery diarrhea for the past 3 days. This morning he also had nausea and his stool had a red tint. Four days ago, he and his parents returned home from a vacation, during which they visited a petting zoo and consumed many new foods. He lives with his family and they have cats and dogs at home. The patient attends daycare. His immunizations are up-to-date. His temperature is 38°C (100.4°F), pulse is 140/min, and blood pressure is 80/45 mm Hg. Examination shows dry mucus membranes. The abdomen is soft, and there is tenderness to palpation of the right lower quadrant with rebound. Stool culture grows Yersinia enterocolitica. Which of the following is most likely to have prevented this patient's condition?", "answer": "Avoiding the consumption of undercooked pork", "meta_info": "step2&3", "answer_idx": "B", "A": "Hand-washing at daycare", "B": "Avoiding the consumption of undercooked pork", "C": "Avoiding the consumption of deli meats", "D": "Avoiding the consumption of unwashed vegetables", "language": "en"}
{"question": "A 61-year-old woman dies unexpectedly. She had not seen a physician in 10 years. Examination of the heart during autopsy shows hypertrophy of the left ventricular wall and enlargement of the left ventricular chamber. Microscopic examination shows lengthening of individual muscle fibers due to duplication of sarcomeres in series. Which of the following is the most likely underlying cause of these findings?", "answer": "Increased left ventricular end diastolic volume", "meta_info": "step1", "answer_idx": "D", "A": "Increased pulmonary arterial pressure", "B": "Decreased left ventricular contractility", "C": "Decreased left ventricular compliance", "D": "Increased left ventricular end diastolic volume", "language": "en"}
{"question": "A 57-year-old man with a history of hypertension, hyperlipidemia, type 2 diabetes mellitus, and obstructive sleep apnea presents to your office for routine screening. He reports compliance with his medications but admits to difficulty maintaining the diet and exercise routines discussed during his last visit. He does not have any other complaints. He drinks 3-4 beers on the weekends and does not smoke cigarettes. His current medications include metformin, atorvastatin, and hydrochlorothiazide. On physical examination, his temperature is 99°F (37.2°C), blood pressure is 130/85 mmHg, pulse is 85/min, and respirations are 18/min. Laboratory results are shown below:\n\nSerum:\nNa+: 138 mEq/L\nCl-: 100 mEq/L\nK+: 3.9 mEq/L\nHCO3-: 23 mEq/L\nBUN: 13 mg/dL\nGlucose: 160 mg/dL\n\nYou decide to start the patient on a medication that triggers insulin release. What is the mechanism of action of this drug?", "answer": "Close potassium channels", "meta_info": "step1", "answer_idx": "A", "A": "Close potassium channels", "B": "Increase insulin sensitivity", "C": "Delay gastric emptying", "D": "Increase ATP generation", "language": "en"}
{"question": "A 28-year-old woman presents to the emergency department with fever and abdominal pain for the past several days. She says she feels like she has a slight fever. She denies nausea or vomiting. Physical examination shows pain in the right upper quadrant to deep palpation with rebound tenderness and guarding. A laparoscopy is performed which shows string-like, fibrous scar tissue in the perihepatic recesses. Which of the following is the most likely organism responsible for the patient's condition?", "answer": "Neisseria gonorrhoeae", "meta_info": "step2&3", "answer_idx": "D", "A": "Giardia lamblia", "B": "Gardnerella vaginalis", "C": "Trichomonas vaginalis", "D": "Neisseria gonorrhoeae", "language": "en"}
{"question": "A 30-year-old woman comes to the emergency department because of a 1-day history of sharp chest pain radiating to the left shoulder. The pain worsens when she coughs, breathes deeply, or lies down. She has had a mild fever and a cough for the past 2 days. She takes ibuprofen for hip and knee pain, which started 4 months ago. Examination shows a symmetric, erythematous rash on her nose and cheeks, and erythematous patches with scaling and plugged follicles over her hands. Cardiovascular evaluation of this patient is most likely to show which of the following findings?", "answer": "Triphasic scratchy heart sound of varying intensity", "meta_info": "step1", "answer_idx": "C", "A": "Increased distension of jugular veins during inspiration", "B": "18 mm Hg decrease in systolic blood pressure during inspiration", "C": "Triphasic scratchy heart sound of varying intensity", "D": "Holosystolic blowing murmur heard best at the apex", "language": "en"}
{"question": "A 22-year-old man comes to the physician because he has been increasingly worried and stressed in recent weeks. He started a marketing job three months ago, which involves traveling between Washington and California several times a year. Two months ago, he was supposed to fly to Seattle, but he experienced nausea, palpitations, sweating, and shortness of breath and was unable to board the plane, causing him great embarrassment. He had never been on a plane before; his parents died in a plane crash when he was younger. A week ago, he called in sick when he was supposed to go on a business trip. He worries that he will lose his job. He is otherwise well and has no history of serious illness. He takes no medications. His temperature is 37.2°C (99°F), pulse is 85/min, respirations are 12/min, and blood pressure is 130/80 mm Hg. Physical examination shows no abnormalities. On mental status examination, he is alert and cooperative. His speech is normal and his thought process is organized. His memory, attention, and concentration are intact. Which of the following is the most appropriate next step in management of this patient's symptoms?", "answer": "Cognitive behavioral therapy", "meta_info": "step2&3", "answer_idx": "D", "A": "Oral paroxetine", "B": "Oral alprazolam", "C": "Observation", "D": "Cognitive behavioral therapy", "language": "en"}
{"question": "A 52-year-old man presents to the office complaining of a 2-week history of fatigue, progressively worsening shortness of breath, and swelling of his lower legs and feet. His past medical history is only significant for slightly elevated blood pressure. The patient denies tobacco use although he does admit to drinking 8-10 beers, daily, for the past 10 years. He takes a low dose of aspirin daily, ever since he had an anterior myocardial infarction 2 years ago. The patient works as a financial consultant and frequently travels for work. The current temperature is 36.8°C (98.3°F), the pulse rate is 68/min, the blood pressure is 152/84 mm Hg, and the respiratory rate is 16/min. His weight is 102 kg (224 lb) and height 180 cm (5 ft 9 in). Echocardiography demonstrates an ejection fraction of 35% and a thin left ventricular wall. What is the appropriate medication for this patient’s condition?", "answer": "Spironolactone", "meta_info": "step1", "answer_idx": "D", "A": "Nifedipine", "B": "Procainamide", "C": "Ibuprofen", "D": "Spironolactone", "language": "en"}
{"question": "A 70-year-old man comes to the physician for a follow-up evaluation. Eight months ago, he presented with a 6-month history of increased urinary frequency, difficulty to initiate urination, and straining to maintain the urinary stream. Digital rectal examination showed symmetrically enlarged, nontender prostate with rubbery texture. Laboratory studies showed a prostate-specific antigen (PSA) level of 2 ng/mL. Abdominal ultrasound showed a post-void residual urine volume of 250 ml and bladder wall thickening. The patient received appropriate treatment. His vital signs are within normal limits. Laboratory studies now show a PSA level of 1 ng/mL. Which of the following medications was most likely used to treat this patient's symptoms?", "answer": "Dutasteride", "meta_info": "step2&3", "answer_idx": "B", "A": "Oxybutynin", "B": "Dutasteride", "C": "Terazosin", "D": "Tadalafil", "language": "en"}
{"question": "A 53-year-old man presents to the office complaining of persistent abdominal pain. He states that he has gained 4.5 kg (10.0 lb) because the pain is only relieved by eating. The patient also admits that he has had numerous loose, foul-smelling stools over the last few weeks with associated nausea. He has taken some over the counter antacids without relief or change in symptoms. His blood pressure is 132/76 mm Hg, respiratory rate is 14/min, and heart rate is 75/min. Physical examination reveals mild tenderness to palpation of the upper abdomen. Which of the following is the most likely diagnosis?", "answer": "Zollinger-Ellison syndrome", "meta_info": "step1", "answer_idx": "D", "A": "H. pylori infection", "B": "Intestinal type gastric adenocarcinoma", "C": "NSAID induced peptic ulcer disease", "D": "Zollinger-Ellison syndrome", "language": "en"}
{"question": "A 68-year-old man with advanced dementia is brought to the preoperative unit prior to an elective cholecystectomy for biliary colic. He says he does not want the surgery anymore. He begins yelling at unit staff and requests to leave. His designated medical power of attorney, who had previously signed the surgery consent forms, is present. Which of the following is the most appropriate next step in management?", "answer": "Ask the patient about his concerns and try to address them", "meta_info": "step1", "answer_idx": "B", "A": "Cancel the surgery and allow the patient to leave", "B": "Ask the patient about his concerns and try to address them", "C": "Call family members and schedule a family meeting", "D": "Perform cognitive screening evaluation", "language": "en"}
{"question": "A 67-year-old man presents to his physician’s office with a progressive cough. It has been increasing in intensity over the past week. He has also been noticing an increase in the amount of sputum he usually produces, which is thick and yellow. He also complains of increased difficulty in breathing, more so than he previously experienced. He was diagnosed with chronic obstructive lung disease (COPD) about 3 years ago and has been on treatment for it since then. He doesn’t report any fever, chills, or night sweats. He has observed a foul smell to his sputum. His blood pressure is 100/65 mm Hg, the respirations are 23/min and the pulse is about 110/min. Currently, his FEV1 is around 48% of the normal predicted value. He is currently receiving a yearly influenza shot and has taken the pneumococcal vaccination at the time of his diagnosis. In spite of this, he has had acute exacerbations of his symptoms 4 times over the last year. His last episode was 2 months ago, for which he was treated with a short course of antibiotics. He is also currently receiving treatment for diabetes. Which of the following pathogens should be considered before initiating treatment for the current episode?", "answer": "P. aeruginosa", "meta_info": "step2&3", "answer_idx": "C", "A": "S. pneumonia", "B": "H. influenzae", "C": "P. aeruginosa", "D": "Syncytial virus", "language": "en"}
{"question": "A 27-year-old man who was involved in a motor vehicle collision is brought into the emergency room with a fractured skull. The paramedics report that the patient was conscious and lucid on the way to the hospital but now is unresponsive. His vitals are a blood pressure of 122/78 mm Hg, temperature of 37.0°C (98.6°F), pulse rate of 88/min, and respiratory rate of 14/min. A noncontrast CT scan of the head shows an epidural hematoma. Which of the following structures is involved in the development of an epidural hematoma?", "answer": "Middle meningeal artery", "meta_info": "step1", "answer_idx": "A", "A": "Middle meningeal artery", "B": "Bridging cortical veins", "C": "Arteriovenous malformation", "D": "Lenticulostriate vessels", "language": "en"}
{"question": "A 54-year-old woman presents to the emergency department due to recent onset of a high fever, accompanied by severe headache and neck stiffness. Her past medical history is significant for rapidly progressive glomerulonephritis. She is currently on immunosuppressants after a kidney transplant performed 6 months ago. On presentation, her temperature is 102.2°F (39°C), blood pressure is 112/71 mmHg, pulse is 107/min, and respirations are 22/min. Physical exam reveals severe pain with neck flexion and reciprocal knee flexion. Laboratory tests reveal a gram-positive organism with endotoxin. Which of the following characteristics is true of the most likely cause of this patient's disorder?", "answer": "Tumbling motility in broth", "meta_info": "step1", "answer_idx": "D", "A": "Anaerobic spore forming rods", "B": "Catalase-negative", "C": "Coagulase-positive", "D": "Tumbling motility in broth", "language": "en"}
{"question": "A 2-year-old boy is brought to see the pediatrician by his mother due to a “bad” cough. The mother reports that he has been coughing so hard that he threw up on several occasions. He is adopted and the mother does not know his vaccination history. He has no known allergies. His temperature is 38.5°C (100.5°F), pulse is 120/min, respirations are 33/min, blood pressure is 101/54 mm Hg, and oxygen saturation is 96% on room air. The boy looks unwell with mild difficulty breathing and a nonproductive cough multiple times followed by a “whoop” sound during the inhalation. He has scattered petechiae on his face. A nasopharyngeal swab is sent for culture and PCR. Which of the following antibiotics is recommended for this patient?", "answer": "Erythromycin", "meta_info": "step2&3", "answer_idx": "C", "A": "Ceftriaxone", "B": "Cefotaxime", "C": "Erythromycin", "D": "Ampicillin", "language": "en"}
{"question": "A 19-year-old man returns from travel in South America. He presents complaining of profuse, watery diarrhea. You suspect the causative organism to be Enterotoxigenic E. coli. What is the mechanism by which this organism causes diarrhea?", "answer": "Stimulates adenylate cyclase (increasing cAMP)", "meta_info": "step1", "answer_idx": "D", "A": "Blocks the release of inhibitory neurotransmitters GABA and glycine", "B": "Blocks the presynaptic release of acetylcholine at the neuromuscular junction", "C": "Stimulates release of cytokines", "D": "Stimulates adenylate cyclase (increasing cAMP)", "language": "en"}
{"question": "A 38-year-old man presents to the clinic for complaints of abdominal pain and diarrhea. He reports a long-standing history of the symptoms except for the time when he attempted a carbohydrate-free diet 5 years ago. The pain is described as stabbing, diffuse, 8/10, and is especially worse following food intake. Recently, he noticed some numbness and tingling of his feet but denies any bloody stool, nausea, vomiting, fevers, weight loss, or focal neurological deficits. What histopathological findings would you expect to find in this patient?", "answer": "Blunting of the intestinal villi at the ileum", "meta_info": "step1", "answer_idx": "A", "A": "Blunting of the intestinal villi at the ileum", "B": "Crypt abscesses at the descending colon", "C": "Noncaseating granulomas at the ileum", "D": "Normal gastric mucosa at the jejunum", "language": "en"}
{"question": "A 25-year-old male presents for a new primary-care visit. He has never been seen by a physician and reports that he has been in good health. You note a very tall, very thin male whose arm span is greater than his height. The patient reports that his father had a similar build but passed away suddenly in his 40s. You suspect a genetic disorder characterized by a defect in fibrillin-1. What is the histopathology of the most common large-artery complication of this disease?", "answer": "Cystic medial degeneration", "meta_info": "step1", "answer_idx": "D", "A": "Focal granulomatous inflammation with mural lymphocytes, macrophages, giant cells", "B": "Predominant neutrophilic infiltration with fibrinoid necrosis", "C": "Fibrinoid necrosis of blood vessel walls, endothelial swelling, and neutrophilic infiltrate in skin lesions", "D": "Cystic medial degeneration", "language": "en"}
{"question": "A group of investigators is evaluating the efficacy of intranasal ketamine in decreasing acute suicidality in teenagers admitted to inpatient psychiatric units. They conducted a pilot study in which 15 participants were randomized to receive intranasal ketamine while 15 participants were randomized to receive placebo. The investigators ultimately found no statistically significant difference in suicidality after 30 days of follow up with the level of significance fixed at 5%. They suspect inadequate statistical power. Assuming the investigators intend to keep the level of significance at 5%, which of the following changes would be most effective to increase the statistical power?", "answer": "Decrease the type II error rate", "meta_info": "step1", "answer_idx": "B", "A": "Decrease the sample size", "B": "Decrease the type II error rate", "C": "Increase beta", "D": "Increase the type I error rate", "language": "en"}
{"question": "A 56-year-old man presents with severe back pain for the past hour. He says the pain started about 1 hour ago and has not improved. The patient describes the pain as sharp, 10/10, and located between his scapula. Past medical history is significant for hypertension, which he is noncompliant with medication. His vital signs are a blood pressure of 180/95 mm Hg and a pulse of 108/min. On physical examination, there is a loss of pain and temperature sensation in the lower trunk and extremities bilaterally. Strength is 4 out of 5 in all muscle groups in the lower extremities bilaterally. A contrast CT of the chest reveals findings consistent with a type B aortic dissection. Which of the following etiologies is the most likely cause of this patient’s neurologic findings?", "answer": "Anterior cord syndrome", "meta_info": "step1", "answer_idx": "C", "A": "Brown-Séquard syndrome", "B": "Spinal cord compression", "C": "Anterior cord syndrome", "D": "Spinal epidural hematoma", "language": "en"}
{"question": "A 7-year-old girl is brought to the physician by her mother because of a 6-month history of worsening fatigue and frequent upper respiratory tract infections. She is at the 2nd percentile for height and 10th percentile for weight. Physical examination shows pallor, diffuse hyperpigmented macules, absence of the radial bones, and hypoplastic thumbs. Her hemoglobin concentration of 8.7 g/dL, leukocyte count is 2,500/mm3, and platelet count is 30,000/mm3. This patient's condition is most likely caused by a defect in a gene encoding a protein that is normally involved in which of the following processes?", "answer": "DNA interstrand crosslink repair", "meta_info": "step1", "answer_idx": "B", "A": "Hydrolysis of glucocerebroside", "B": "DNA interstrand crosslink repair", "C": "Maturation of erythroid progenitor cells", "D": "Ras signal transduction pathway", "language": "en"}
{"question": "A 36-year-old woman is brought to the emergency department because of loss of consciousness. Her husband says that she complained of vomiting and dizziness for 2 days, but did not seek medical care. She has a history of acral vitiligo. Her blood pressure is 90/60 mm Hg, temperature is 35.9°C (96.6°F), and pulse is 90/min. On physical examination, she is obtunded, skin turgor is reduced, and her oral mucosa is dry with hyperpigmented spots on the inner side of both cheeks. Lab results are shown:\nRandom plasma glucose 40 mg/dL\nSerum osmolarity 275 mOsm/kg H₂O\nSerum sodium 130 mEq/L\nSerum potassium 6 mEq/L\nUrine sodium level 30 mEq/L\nECG shows normal sinus rhythm without ST-T wave changes. Dextrose 5% is given and random plasma glucose becomes 60 mg/dL, but her blood pressure is still the same. Which of the following is the best next step in the management of this patient condition?", "answer": "Normal saline and intravenous dexamethasone", "meta_info": "step2&3", "answer_idx": "D", "A": "Intravenous calcium gluconate", "B": "ACTH stimulation test", "C": "Oral dehydroepiandrosterone (DHEA)", "D": "Normal saline and intravenous dexamethasone", "language": "en"}
{"question": "A 4-year-old girl is seen by her pediatrician for developmental delay. One year prior, the patient was able to ride a tricycle, stack 3 blocks, and speak in short sentences. Now, she is unable to feed herself and has recently started to point to objects she wants rather than asking. Physical exam reveals a well nourished child sitting in a stroller wringing her hands. Vital signs are normal. The patient's mother reports that her 7-year-old son is doing well, and that they have no family history of mental retardation or other cognitive disorders. What is the most likely diagnosis?", "answer": "Rett syndrome", "meta_info": "step1", "answer_idx": "B", "A": "Angelman syndrome", "B": "Rett syndrome", "C": "Prader-Willi syndrome", "D": "McCune-Albright syndrome", "language": "en"}
{"question": "A 49-year-old woman visits the emergency department with the acute onset of severe shortness of breath. She also reports right-sided calf pain that developed after a 22-hour flight from Beijing to Los Angeles, and that, several hours after she felt pain in her calf, she began to have trouble breathing. Currently, her shortness of breath is so severe that she is unable to speak clearly or quickly, but she manages to deny any recent surgery or history of recent bleeding. The vital signs include: blood pressure 111/69 mm Hg, pulse 142/min, and respiratory rate 33/min. On observation, she is using accessory muscles to breathe. On auscultation, her lungs are clear and her heart rate is rapid but regular. Her right calf is swollen, warm, and tender. The arterial blood gas test result reveals a pH of 7.5, partial pressure of carbon dioxide (PCO2) 22 mm Hg, and a partial pressure of oxygen (PaO2) 47 mm Hg on 6 L of oxygen by nasal cannula. Which of the following is the most appropriate next step in the management of this patient?", "answer": "Streptokinase", "meta_info": "step2&3", "answer_idx": "B", "A": "Unfractionated heparin", "B": "Streptokinase", "C": "Low molecular-weight heparin", "D": "Embolectomy", "language": "en"}
{"question": "A 37-year-old woman, gravida 4, para 3, at 35 weeks' gestation is admitted to the hospital in active labor. She has had no prenatal care. Her three children were delivered by lower segment transverse cesarean section. The patient appears in acute distress. Her pulse is 98/min, respirations are 15/min, and blood pressure is 130/80 mm Hg. The abdomen is nontender and contractions are felt. The fetus is in a cephalic presentation. The fetal heart rate is reactive with no decelerations. One hour following vaginal delivery, the placenta is not delivered. Manual separation of the placenta leads to profuse vaginal bleeding. A firm, nontender uterine fundus is palpated at the level of the umbilicus. Which of the following is the most likely diagnosis?", "answer": "Placenta accreta", "meta_info": "step2&3", "answer_idx": "C", "A": "Uterine rupture", "B": "Placenta previa", "C": "Placenta accreta", "D": "Abruptio placentae\n\"", "language": "en"}
{"question": "A 40-year-old man is brought to the clinic by his wife with a complaint of behavioral changes for the past few months. He is irritable and gets angry with trivial matters. He sometimes screams in the middle of the night and remains restless. His wife has recently noticed that he is forgetting things and repeats the same question multiple times. For the past few weeks, he is also having abnormal movements of his body, more prominent in the arms and hands. The past medical history is unremarkable. His father died at the age of 28 years old in a road traffic accident. His grandmother had similar symptoms after her retirement. He does not smoke, drinks alcohol, or uses illicit drugs. The physical examination reveals a restless ill-groomed man. He is having intermittent involuntary dance-like movements. The slit-lamp ophthalmic examination is normal. His mini-mental state examination (MMSE) score is 22/30. The complete blood count, basic metabolic profile, thyroid profile, liver profile, serum vitamin B12, and ceruloplasmin levels are within normal range. An MRI of the brain will reveal an atrophy of which of the following structure?", "answer": "Caudate nucleus", "meta_info": "step2&3", "answer_idx": "A", "A": "Caudate nucleus", "B": "Cerebellum", "C": "Diffuse cortex", "D": "Frontal and temporal lobes", "language": "en"}
{"question": "A researcher is studying the association between hemoglobin levels and BMI. He divides volunteers who wish to participate into 2 groups based on their BMI, a normal weight group and an overweight group. He then measures the hemoglobin level of all of the volunteers. His null hypothesis is that there is no association between hemoglobin levels and body weight. The mean hemoglobin level for the normal weight group is 13.4 g/dL and 13.8 g/dL for the overweight group. He obtains a mean difference of 0.4 g/dL between the 2 groups. He does an unpaired t-test and gets a p-value of 0.10. Which of the following statements best describes the study?", "answer": "If the null hypothesis is true, there is a 10% probability to get this difference of 0.4 g/dL or higher due to chance.", "meta_info": "step1", "answer_idx": "D", "A": "If the null hypothesis is not true, 10% or more of the volunteers would not show any association between hemoglobin level and weight.", "B": "If the null hypothesis is not true, there is still a 10% probability to not get this difference of 0.4 g/dL or higher due to chance.", "C": "If the null hypothesis is true, there is still a 10% probability of not getting this difference of 0.4 g/dL or higher due to chance.", "D": "If the null hypothesis is true, there is a 10% probability to get this difference of 0.4 g/dL or higher due to chance.", "language": "en"}
{"question": "A 51-year-old female with a history of papillary thyroid carcinoma who is two weeks status-post thyroidectomy presents to her surgeon complaining of difficulty with her voice. Following the operation, she developed immediate hoarseness and difficulty speaking. The hoarseness has not improved since the operation. Her past medical history is notable for hypertension and obesity. Her temperature is 99°F (37.2°C), blood pressure is 120/80 mmHg, pulse is 90/min, and respirations are 16/min. Physical examination reveals a healing surgical scar without evidence of infection or dehiscence. Which of the following embryologic structures most likely gave rise to the structure that was damaged in this patient?", "answer": "Sixth branchial arch", "meta_info": "step1", "answer_idx": "D", "A": "First branchial arch", "B": "Second branchial arch", "C": "Fourth branchial arch", "D": "Sixth branchial arch", "language": "en"}
{"question": "Six days after admission to the hospital for treatment of infective endocarditis, a 64-year-old woman develops persistent ringing in both ears, lightheadedness, and nausea. When she turns her head, she sees the light on the ceiling swinging from side to side. She has congestive heart disease, hypertension, and coronary artery disease. She was treated for a cerebrovascular accident 7 years ago and has no residual deficits. Current medications include intravenous vancomycin and gentamicin, as well as oral aspirin, atenolol, furosemide, and lisinopril. Her vital signs are within normal limits. Cardiac examination shows a grade 3/6 holosystolic murmur along the left lower sternal border. While the patient fixates on a target, administration of brisk, horizontal head rotations to both sides results in corrective saccades to refixate back to the target. She has an unsteady gait. Muscle strength and sensation are normal. Which of the following is the most likely cause of this patient's current symptoms?", "answer": "Medication toxicity", "meta_info": "step2&3", "answer_idx": "C", "A": "Decreased endolymph resorption", "B": "Suppurative labyrinthitis", "C": "Medication toxicity", "D": "Delirium", "language": "en"}
{"question": "A patient with congestive heart failure with viral myocarditis due to coxsackievirus infection presents to a local hospital for treatment and then returns home. Which of the following cardiac conditions are the most likely long-term consequence of the patient’s clinical presentation and hospitalization?", "answer": "Dilated cardiomyopathy", "meta_info": "step1", "answer_idx": "B", "A": "Concentric hypertrophy", "B": "Dilated cardiomyopathy", "C": "Endarteritis obliterans", "D": "Hypertrophic cardiomyopathy", "language": "en"}
{"question": "A 5-year-old male presents to the pediatrician with his mother for a well child visit. His mother has no complaints. The patient is doing well in preschool and appears to be ready for kindergarten. He can begin to sound out letters and write out his first name. He has many friends at school and enjoys playing with his older siblings. The patient’s past medical history is notable for birth weight in the 99th percentile and unexplained hypoglycemia in the first week of life. The patient’s mother denies any family history of genetic syndromes or malignancy. The patient’s height and weight are in the 99th percentile. On physical exam, the patient has an enlarged tongue with no other dysmorphic features. He also has the physical exam findings seen in Figures A and B. This patient should be screened for abnormalities in which of the following organs?", "answer": "Kidneys", "meta_info": "step2&3", "answer_idx": "D", "A": "Adrenal glands", "B": "Bone", "C": "Eyes", "D": "Kidneys", "language": "en"}
{"question": "A first-year medical student undergoes a surgical procedure involving a midline laporotomy incision. The patient presents back to the surgeon approximately 3 months later and asks the surgeon: \"What type of tissue is causing the scar to form on my abdomen?\" The physician promptly answers:", "answer": "Type 1 collagen", "meta_info": "step1", "answer_idx": "B", "A": "Keratin", "B": "Type 1 collagen", "C": "Type 2 collagen", "D": "Type 4 collagen", "language": "en"}
{"question": "A 40-year-old female complains of muscle weakness. Her blood pressure is 180/140 mm Hg, and serum potassium is 3.2 mEq/L. Plasma renin levels are abnormally low. A CT scan of her abdomen reveals a 3 cm lesion in her right adrenal gland. The patient’s lesion is likely composed of functional cells from which of the following regions:", "answer": "Zona glomerulosa", "meta_info": "step1", "answer_idx": "A", "A": "Zona glomerulosa", "B": "Zona fasciculata", "C": "Adrenal medulla", "D": "Posterior pituitary", "language": "en"}
{"question": "A 75-year-old woman is brought to the physician by her daughter because of a 1-month history of fatigue and a 3.5-kg (7-lb) weight loss. The patient has a history of hypertension, hyperlipidemia, and Alzheimer's dementia. She lives with her daughter and requires assistance with all of her banking and meal preparation. Her daughter has hypothyroidism but there is no other history of serious illness in the family. She does not remember the names of her medications but says she takes them every day. Her pulse is 114/min and blood pressure is 148/101 mm Hg. Physical examination shows warm skin and a tremor. The thyroid gland is not palpable. The serum thyroid stimulating hormone level is undetectable. Histological examination of a thyroid biopsy shows follicular atrophy. Which of the following is the most likely underlying cause of this patient's symptoms?", "answer": "Exogenous levothyroxine use", "meta_info": "step1", "answer_idx": "B", "A": "Graves disease", "B": "Exogenous levothyroxine use", "C": "Granulomatous thyroiditis", "D": "Iodine exposure", "language": "en"}
{"question": "A 42-year-old man is brought to the emergency department by EMS from the scene of an automobile accident, where he appeared to be an unrestrained passenger. The patient is confused and unable to answer questions. His temperature is 98.6°F (37°C), pulse is 120/min, blood pressure is 75/44 mmHg, and respiratory rate is 22/min. On physical exam, there is bruising over his sternum and left chest, with tenderness to palpation. Cardiac auscultation reveals normal heart sounds with no murmurs, rubs, or gallops. He has marked jugular venous distention and bibasilar crackles on pulmonary auscultation with equal air entry bilaterally. Abdominal and cranial nerve exams are within normal limits. His extremities are cool with prolonged capillary refill, and he is diaphoretic. The patient is admitted to the intensive care unit and hemodynamic monitoring is established, which reveals a pulmonary capillary wedge pressure (PCWP) of 22 mmHg (normal range 8-12 mmHg), central venous pressure (CVP) of 12 cmH2O (normal range 4-12 cmH2O), cardiac output (CO) of 2.2 L/min (normal range 4-8 L/min), and systemic vascular resistance (SVR) of 1800 dynes/seconds/cm^-5 (normal range 700–1600 dynes/seconds/cm^-5). Which of the following types of shock best describes this patient's condition?", "answer": "Cardiogenic", "meta_info": "step2&3", "answer_idx": "A", "A": "Cardiogenic", "B": "Anaphylactic", "C": "Neurogenic", "D": "Obstructive", "language": "en"}
{"question": "A 23-year-old man comes to the emergency department complaining of 10/10 abdominal pain. He describes the pain as sharp, stabbing, intermittent, and concentrated at the left lower quadrant. It started about 3 hours ago with no obvious precipitating factor. He reports multiple similar episodes in the past but they have all resolved within 1 hour or so. He denies fever, weight changes, headaches, nausea/vomiting, or gastrointestinal changes but endorses “red-colored urine” for the past day. He just returned from an extensive hiking trip in Colorado. A radiograph of the abdomen was unremarkable. What is the most likely explanation for this patient’s presentation?", "answer": "Hereditary defect of amino acid transporter in the kidney", "meta_info": "step1", "answer_idx": "A", "A": "Hereditary defect of amino acid transporter in the kidney", "B": "Infection with urease positive bacteria", "C": "Presence of antibodies to the glomerular basement membrane", "D": "Thinning and splitting of the glomerular basement membrane", "language": "en"}
{"question": "A 33-year-old African American woman presents to the emergency department due to diffuse pain and fatigue. The woman states that she feels like her bones and muscles diffusely hurt. She also has experienced some abdominal pain as well and states that she has trouble focusing. The patient has a past medical history of sickle cell disease for which she takes hydroxyurea. Her temperature is 98.1°F (36.7°C), blood pressure is 119/59 mmHg, pulse is 130/min, respirations are 16/min, and oxygen saturation is 98% on room air. Laboratory values are ordered and are currently pending. Which of the following is a side-effect of definitive treatment for this patient?", "answer": "Tetany", "meta_info": "step2&3", "answer_idx": "D", "A": "Dilute urine", "B": "Peaked T-waves on ECG", "C": "QT shortening on ECG", "D": "Tetany", "language": "en"}
{"question": "A 40-year-old man with psoriatic arthritis comes to the physician because of progressively worsening pain and stiffness in both of his hands and feet for the past 3 weeks. His psoriatic arthritis had been well-controlled with adalimumab for several years prior to this. His only other medication is omeprazole. Physical examination shows scaly plaques on both elbows and limited range of motion of most of the larger joints. Which of the following is the most likely underlying mechanism of the recurrence of this patient's symptoms?", "answer": "Formation of antidrug antibodies", "meta_info": "step1", "answer_idx": "C", "A": "Suppression of the bone marrow", "B": "Decreased ionization by the glomeruli", "C": "Formation of antidrug antibodies", "D": "Increased acetylation by the liver", "language": "en"}
{"question": "A 35-year-old African American female presents to the emergency department with a three day history of cough, chest pain, and fever. Upon presenting to the emergency department, her temperature is 101.4 °F (38.5 °C), blood pressure is 110/80 mmHg, pulse is 95/min, and respirations are 24/min. Lung auscultation reveals crackles over the left lung base. Chest radiograph reveals a dense consolidation in the left lower lung. The patient undergoes lab tests in the emergency department that demonstrate an elevated level of C-reactive protein. This abnormal lab finding was most likely caused by increased activity of which of the following mediators?", "answer": "IL-6", "meta_info": "step1", "answer_idx": "C", "A": "IL-12", "B": "IL-8", "C": "IL-6", "D": "IL-2", "language": "en"}
{"question": "A 50-year-old man comes to the physician after a fall on a flight of stairs earlier that day. He slipped, causing him to fall and hit the handrail with the lateral part of his chest. He has no shortness of breath. He returned from a 10-day trip to South Africa 4 weeks ago. He smoked one pack of cigarettes daily for 10 years but stopped 18 years ago. He drinks 1–2 beers a week. His temperature is 37.1°C (98.8°F), pulse is 78/min, and blood pressure is 126/72 mm Hg. Examination shows normal breath sounds bilaterally. The left lateral chest wall is tender to palpation. An x-ray of the chest shows no fracture; there is a 5-mm lesion in the right upper lung field. There are no previous x-rays of the patient available. Which of the following is the most appropriate next step in management?", "answer": "CT scan of the chest", "meta_info": "step2&3", "answer_idx": "C", "A": "Follow-up x-ray of the chest in 12 months", "B": "Positron emission tomography", "C": "CT scan of the chest", "D": "Reassurance", "language": "en"}
{"question": "A 62-year-old woman presents to a clinic with complaints of a worsening rash on her back, fevers with chills, and rigor for 2 days. She denies any headaches, nausea, or vomiting. She is currently on chemotherapy for multiple myeloma, which was diagnosed last year. On examination, there were multiple punched-out ulcers covered in crusts surrounded by raised, violaceous margins on her back. Some of the lesions have black necrotic centers. The vital signs include: temperature 38.8°C (102.0°F), respirations 24/min, pulse 110/min, and blood pressure 100/90 mm Hg. Laboratory studies show:\nHemoglobin 8.4 g/dL\nWhite blood cell (WBC) count  1,500/mm3\nPlatelets 300,000/mm3\nWhich of the following organisms is most likely responsible for this patient’s condition?", "answer": "Pseudomonas aeruginosa", "meta_info": "step1", "answer_idx": "A", "A": "Pseudomonas aeruginosa", "B": "Streptococcus pneumoniae", "C": "Haemophilus influenzae", "D": "Streptococcus pyogenes", "language": "en"}
{"question": "An 8-year-old boy developed nausea, abdominal pain, and watery diarrhea 6 hours after consuming homemade mushroom soup. The boy is rushed to the emergency department. He is severely dehydrated and his blood pressure is 60/40 mm Hg. He is managed with intravenous fluids and other supportive treatment. The mushrooms in the soup had been picked from his family's backyard, and samples of mushrooms were sent to the lab for analysis. The lab reports confirmed that the mushrooms contained some kind of toxin. Which of the following enzymes is most likely inhibited by this toxin?", "answer": "RNA polymerase II", "meta_info": "step1", "answer_idx": "B", "A": "DNA gyrase", "B": "RNA polymerase II", "C": "RNA polymerase I", "D": "RNA polymerase III", "language": "en"}
{"question": "A 6-year-old girl is brought to the physician because of generalized fatigue and dark urine for 4 days. Four weeks ago, she was treated with cephalexin for a skin infection. Her temperature is 37°C (98.6°F) and blood pressure is 132/89 mm Hg. Physical examination shows 1+ pretibial edema bilaterally. Her serum creatinine is 1.7 mg/dL. Urine studies show:\nBlood 2+\nProtein 2+\nRBC 12–14/hpf with dysmorphic features\nRBC casts numerous\nWhich of the following is the most likely cause of these findings?\"", "answer": "Granular subepithelial immune complex deposition", "meta_info": "step1", "answer_idx": "A", "A": "Granular subepithelial immune complex deposition", "B": "Systemic amyloid protein aggregation", "C": "Anti-type IV collagen antibody formation", "D": "DNA-anti-DNA antibody immune complex formation", "language": "en"}
{"question": "A 7-year-old girl is brought to the physician by her mother for a 6-month history of irritability. She has no history of significant illness and is up-to-date on her immunizations. She appears markedly lethargic. Her vital signs are within normal limits. Physical examination shows subconjunctival pallor. Her hemoglobin concentration is 9.2 g/dL and mean corpuscular volume is 76 μm3. A photomicrograph of a wet stool mount is shown. Which of the following infectious agents is the most likely cause of these findings?", "answer": "Necator americanus", "meta_info": "step1", "answer_idx": "A", "A": "Necator americanus", "B": "Enterobius vermicularis", "C": "Trichuris trichiura", "D": "Taenia solium", "language": "en"}
{"question": "A 15-year-old girl is brought to the physician by her mother because of a 3-day history of lower abdominal pain. Over the past 9 months, she has had multiple similar episodes of abdominal pain, each lasting for 4–5 days. Menarche has not yet occurred. Examination shows suprapubic tenderness to palpation. Pubic hair and breast development are Tanner stage 4. Pelvic examination shows bulging, bluish tissue 1 cm inside the vaginal introitus. Which of the following is the most likely diagnosis?", "answer": "Imperforate hymen", "meta_info": "step1", "answer_idx": "D", "A": "Labial adhesions", "B": "Androgen insensitivity", "C": "Endometriosis", "D": "Imperforate hymen", "language": "en"}
{"question": "A 6-year-old boy presents with high fever, sore throat, and cough for the past day. The patient’s mother also says he is complaining of generalized muscle aches and chills. Past medical history is significant for childhood asthma, managed with inhaled mometasone furoate. The patient’s temperature is 39.1°C (102.3°F), pulse is 120/min, and respiratory rate is 20/min. On physical examination, his oropharynx is erythematous with mild swelling of the pharyngeal tonsils. Chest auscultation reveals crepitus over the lung bases bilaterally. There are no signs of respiratory distress. Rapid diagnostic testing for influenza B infection in this patient is positive. In addition to symptomatic treatment, which of the following antiviral drugs would most likely benefit this patient?", "answer": "Oseltamivir", "meta_info": "step1", "answer_idx": "D", "A": "Amantadine", "B": "Ribavirin", "C": "Rimantadine", "D": "Oseltamivir", "language": "en"}
{"question": "A 38-year-old woman presents to the emergency department with nausea and progressive right upper quadrant abdominal pain for the past day. For the past year, she has had occasional pain in her right upper quadrant which is often relieved on its own after a few hours. She was recently diagnosed with multiple gallstones for which she underwent an elective uncomplicated endoscopic retrograde cholangiopancreatography (ERCP) 3 days ago. Past medical history is otherwise unremarkable. On physical examination, there is tenderness over the epigastrium with no guarding or rebound. Vital signs include blood pressure 110/68 mm Hg, pulse 98/min, temperature 36.2°C (97.2°F), and respiratory rate 11/min. Laboratory tests are pending. An imaging study of the abdomen confirms the most likely diagnosis. Which of the following is most likely to be below the normal range in her blood due to her current condition?", "answer": "Calcium", "meta_info": "step1", "answer_idx": "D", "A": "Trypsinogen", "B": "C-reactive protein", "C": "Glucose", "D": "Calcium", "language": "en"}
{"question": "A 42-year-old woman comes to the emergency department because of hematuria and pain in both flanks. She has a history of recurrent urinary tract infections. She also complains of swelling of both feet and facial puffiness. She has passed urinary stones twice before. Her mother also has a history of urinary stone and underwent a kidney transplant. Her temperature is 38.0°C (100.4°F), pulse is 110/min, and blood pressure is 150/98 mm Hg. Abdominal examination shows palpable, bilateral flank masses. Results of a complete blood count are within the reference range. Her serum creatinine concentration is 2.7 mg/dL. Which of the following additional findings is most likely to be seen in this patient?", "answer": "Multiple hepatic cysts", "meta_info": "step2&3", "answer_idx": "B", "A": "Osteolytic bone lesions", "B": "Multiple hepatic cysts", "C": "Mitral valve stenosis", "D": "Popliteal aneurysm", "language": "en"}
{"question": "A 51-year-old man with a past medical history of peptic ulcer disease currently treated via outpatient triple therapy presents to the urgent care center complaining of acute abdominal pain which began suddenly less than 2 hours ago. The physical examination shows his abdomen to be mildly distended, diffusely tender to palpation, and positive for rebound tenderness. Physical exam is unremarkable. The vital signs include: temperature 36.7°C (98.0°F), blood pressure 96/54 mm Hg, heart rate 112/min, and respiratory rate 19/min. Given the following options, what is the next best step in patient management?", "answer": "CT abdomen and pelvis", "meta_info": "step2&3", "answer_idx": "B", "A": "Abdominal radiographs", "B": "CT abdomen and pelvis", "C": "H. pylori testing", "D": "Serum gastrin level", "language": "en"}
{"question": "A 10-month-old boy is brought to the physician because of fever and a cough for 3 days. He was treated for otitis media 3 and 4 months ago. He was also treated for pneumococcal pneumonia and H. influenzae meningitis this past month. He was delivered at term. Pregnancy and neonatal period were uncomplicated. He was breast-fed until 6 months of age. He has a maternal uncle who died of recurrent respiratory tract infections at 28 years of age. He is at the 20th percentile for height and the 10th percentile for weight. His temperature is 39°C (102.2°F), pulse is 122/min, and respirations are 44/min. Examination shows crackles at the left lung base. Palatine tonsils are absent. An x-ray shows an infiltrate in the left lower lung lobe. Flow cytometry shows absence of B-cells. Which of the following is mostly responsible for this patient's late onset of symptoms?", "answer": "Maternal IgG decreases by 6 months", "meta_info": "step2&3", "answer_idx": "D", "A": "Reduced T-cell receptor excision circles by 6 months", "B": "Involution of the thymus begins at 6 months", "C": "Splenic dysfunction occurs by 6 months", "D": "Maternal IgG decreases by 6 months", "language": "en"}
{"question": "A 55-year-old right-handed woman is being evaluated for a long history of numbness and tingling in both of her hands, particularly in the third digits, that is worse at night. She works as a medical office assistant in a local travel medicine clinic. Her past medical history is significant for hypothyroidism, managed medically with thyroxine. Physical examination showed thenar eminence atrophy, decreased sensation in the 3 first digits of both hands that extends proximally, and weakness on thumb abduction and thumb opposition; deep tendon reflexes are normal. Phalen and Tinel tests are positive. Which of the following is the most inclusive list of spinal roots that contribute to the affected nerve in this patient?", "answer": "C5, C6, C7, C8, T1", "meta_info": "step2&3", "answer_idx": "D", "A": "C4, C5", "B": "C6, C7, C8", "C": "C3, C4, C5", "D": "C5, C6, C7, C8, T1", "language": "en"}
{"question": "A 7-year-old girl is referred to a pediatric cardiologist after a heart murmur was auscultated during a routine school health examination. The patient has not experienced any symptoms of shortness of breath, fatigue, chest pain, or palpitations. She is healthy, does not have any significant medical history, and had an uneventful birth without any complications. Her vital signs are as follows: T 37.2 C, HR 92, BP 104/62, RR 24, SpO2 99%. Physical examination is significant for a midsystolic ejection murmur heard best at the 2nd intercostal space near the left sternal border, a loud S1 heart sound, a widely fixed split S2 heart sound, and no evidence of cyanosis or clubbing. An echocardiogram is conducted and reveals a left-to-right shunt across the interatrial septum. Surgical correction of this patient's condition will most likely prevent which of the following from developing later in life?", "answer": "Pulmonary hypertension", "meta_info": "step1", "answer_idx": "C", "A": "Arteriovenous fistula", "B": "Pulmonary stenosis", "C": "Pulmonary hypertension", "D": "Aortic root dilation", "language": "en"}
{"question": "A 21-year-old man is brought to the emergency department by the police because of altered mental status. The police found him covering his ears and shouting near a highway rest area. Upon questioning, he was unable to look directly at the police and answer coherently. On the way to the hospital, he reported feeling nauseous and vomited twice. His temperature is 38.2°C (100.8°F), pulse is 100/min, respirations are 28/min, and blood pressure is 110/77 mm Hg. He is admitted to the hospital for evaluation. Three hours after admission, he has a tonic-clonic seizure. Laboratory studies show:\nSerum\nNa+ 140 mEq/L\nCl- 102 mEq/L\nArterial blood gas analysis on room air:\nOn admission Three hours later\npH 7.47 7.39\nPaCO2 24 mm Hg 31 mm Hg\nPO2 84 mm Hg 82 mm Hg\nHCO3- 20 mEq/L 18 mEq/L\nWhich of the following is the most likely explanation of the patient's laboratory findings?\"", "answer": "Salicylate toxicity", "meta_info": "step1", "answer_idx": "A", "A": "Salicylate toxicity", "B": "Diabetic ketoacidosis", "C": "Recurrent vomiting", "D": "Adrenal insufficiency", "language": "en"}
{"question": "A 58-year-old man makes an appointment with his nephrologist because he has been feeling weak and increasingly fatigued over the last month. Specifically, he has not been able to do activities of daily living independently because he feels short of breath after several minutes of activity. His past medical history is significant for rapidly progressive glomerulonephritis that led to kidney failure. He has been on hemodialysis for the last 6 months and has been compliant with attending every dialysis session. Physical exam reveals conjunctival pallor. Laboratory tests are obtained and results are shown below:\n\nHemoglobin: 8.9 g/dL (normal: 13.5-17.5 g/dL)\nPlatelet count: 198,000/mm^3 (normal: 150,000-400,000/mm^3)\nMean corpuscular volume: 87 µm^3 (normal: 80-100 µm^3)\nReticulocyte count: 0.1% (normal: 0.5-1.5%)\n\nBased on these findings, the patient is given appropriate treatment to address his symptoms. Which of the following is the most likely mechanism of action for this treatment?", "answer": "Activation of receptors on erythroid progenitor cells", "meta_info": "step1", "answer_idx": "A", "A": "Activation of receptors on erythroid progenitor cells", "B": "Chelation of heavy metals", "C": "Provision of finished blood products", "D": "Removal of red blood cell clearing organ", "language": "en"}
{"question": "A 33-year-old African American woman comes to the physician because of a 4-month history of progressive fatigue, shortness of breath, constipation, and a nonproductive cough. She returned from a trip to Nigeria 6 months ago. Physical examination is unremarkable. Serum calcium concentration is 11.7 mg/dL. An x-ray of the chest shows bilateral hilar lymphadenopathy with coarse, nodular opacities in both lower lobes. A photomicrograph of a biopsy specimen of the affected area of the lungs is shown. Which of the following best describes the pathogenesis of this patient's histopathological findings?", "answer": "TNF-α secretion by CD4+ T cells", "meta_info": "step1", "answer_idx": "C", "A": "MHC I binding to CD8+ T cells", "B": "Antigen binding to IgM", "C": "TNF-α secretion by CD4+ T cells", "D": "IL-5 secretion by Th2 cells", "language": "en"}
{"question": "A 15-day-old female newborn is brought to the physician for evaluation of red eyes with discharge for 3 days. She was born at 37 weeks' gestation to a 26-year-old woman. Pregnancy and delivery were uncomplicated. The mother received irregular prenatal care during the 3rd trimester of pregnancy. Examination of the newborn shows watery discharge in both eyes and mild eyelid swelling. Which of the following is the most likely cause of this patient's presentation?", "answer": "Chlamydia trachomatis", "meta_info": "step1", "answer_idx": "B", "A": "Staphylococcus aureus", "B": "Chlamydia trachomatis", "C": "Neisseria gonorrhoeae", "D": "Herpes simplex virus 2", "language": "en"}
{"question": "An investigator is studying central nervous system neurotransmitters in mice. He injects the spinal cord with a protease that cleaves SNARE proteins, thereby blocking the release of neurotransmitters from the Renshaw cells in the spinal cord. Which of the following consequences would be expected?", "answer": "Spastic paralysis", "meta_info": "step1", "answer_idx": "D", "A": "Disinhibited behavior", "B": "Hydrophobia", "C": "Positive Kernig sign", "D": "Spastic paralysis", "language": "en"}
{"question": "A 32-year-old G2P2 at 33 weeks and 4 days of gestation presents to the emergency room with low-grade fever, mild low back pain, and dysuria for 1 day. She has a history of urinary tract infections, including one during this current pregnancy that was treated successfully with cephalexin. On examination, she is nontoxic but mildly uncomfortable; she has CVA tenderness on her right side. Her urinalysis is positive for leukocyte esterase and nitrites, and she is admitted to the hospital for IV antibiotics with ceftriaxone. Her present condition places her at increased risk for which of the following:", "answer": "Preterm labor", "meta_info": "step2&3", "answer_idx": "D", "A": "Low birth weight", "B": "Pre-eclampsia", "C": "Postpartum hemorrhage", "D": "Preterm labor", "language": "en"}
{"question": "A 16-year-old African-American boy is brought to the physician because of a 2-month history of progressive right shoulder pain. He has had many episodes of joint and bone pain in the past, and as a child, had recurrent painful swelling of his hands and feet. His brother had a stroke at 6 years of age and now has an intellectual disability. The patient is at the 60th percentile for height and 55th percentile for weight. His vital signs are within normal limits. Physical examination shows tenderness of the right anterior humerus without noticeable swelling or skin changes. Active and passive range of motion of the right shoulder is decreased and there is pain with movement. The leukocyte count is 4600/mm3. An x-ray of the right shoulder shows subchondral lucency of the humeral head with sclerosis and joint space narrowing. Which of the following is the most likely explanation for this patient's symptoms?", "answer": "Infarction of the bone trabeculae", "meta_info": "step2&3", "answer_idx": "C", "A": "Infection of the dermis and subcutaneous tissue", "B": "Infection of the bone", "C": "Infarction of the bone trabeculae", "D": "Loss of bone mineral density", "language": "en"}
{"question": "A 50-year-old woman comes to the emergency department after waking up with facial swelling and with difficulties swallowing. She was recently diagnosed with hypertension and started on an antihypertensive drug. She follows a strict vegetarian diet. Her pulse is 110/min and blood pressure is 135/85 mm Hg. Physical examination shows marked edematous swelling of the face, lips, and tongue. There is no rash. Serum C4 levels are within the reference range. Which of the following is the most likely cause of this patient's symptoms?", "answer": "Impaired breakdown of kinins", "meta_info": "step1", "answer_idx": "D", "A": "Deficiency of C1 esterase inhibitor", "B": "Scombroid poisoning", "C": "Nonimmunologic release of histamine", "D": "Impaired breakdown of kinins", "language": "en"}
{"question": "An 82-year-old man presents to the primary care physician with complaints of urinary leakage over the last 2 months. The leakage occurred without any additional symptoms. He has a history of prostatic hyperplasia. The vital signs include: blood pressure 140/90 mm Hg, heart rate 84/min, respiratory rate 18/min, and temperature 36.6°C (98.0°F). Physical examination reveals a palpable and distended bladder. Urinalysis reveals:\nColor Yellow\nClarity/turbidity Clear\npH 5.5\nSpecific gravity 1.015\nNitrites Negative\nLeukocyte esterase Negative\nWhich of the following is the best initial management for this patient?", "answer": "Bladder catheterization", "meta_info": "step2&3", "answer_idx": "C", "A": "Anticholinergics", "B": "Surgery", "C": "Bladder catheterization", "D": "Pelvic floor muscle training", "language": "en"}
{"question": "A 25-year-old female presents to her geneticist due to the fear that she may have inherited her father's disease. He was diagnosed at the age of 41 when his symptoms of chorea, coordination problems, and cognitive decline begin to occur. He was diagnosed with a disease resulting from the expansion of CAG repeats on chromosome 4 and later developed severe dementia and died at the age of 56. The daughter was found to have double the amount of CAG repeats and was told by the geneticist that she may have an earlier onset with increased severity of disease. What phenomenon describes this?", "answer": "Anticipation", "meta_info": "step1", "answer_idx": "C", "A": "Variable expression", "B": "Incomplete penetrance", "C": "Anticipation", "D": "Heteroplasmy", "language": "en"}
{"question": "A 25-year-old man presents to the emergency department after being rescued from a house fire 30 minutes ago. He is conscious and in distress. On examination, he is noted to have 1st-degree burns involving 54% of his total body surface area. He has type 1 diabetes and takes insulin every day. He is admitted to the burn unit and treated appropriately. Ten days after admission, the physician notices blue-green pus oozing from the burn wounds. He is afebrile with a pulse of 90/min and a blood pressure of 130/80 mm Hg. A sample exudate is collected with a sterile swab and sent to the laboratory for culture, which yields the growth of aerobic gram-negative rods. Which of the following antibiotics will be most effective in treating this patient’s condition?", "answer": "Piperacillin with gentamicin", "meta_info": "step1", "answer_idx": "B", "A": "Azithromycin with rifampin", "B": "Piperacillin with gentamicin", "C": "Piperacillin", "D": "Ticarcillin", "language": "en"}
{"question": "A 67-year-old man with a past medical history of obesity and diabetes presents to the emergency department with fatigue. The patient has become more confused over the past several days and has been urinating profusely. His temperature is 99.0°F (37.2°C), blood pressure is 120/68 mmHg, pulse is 160/min, respirations are 19/min, and oxygen saturation is 98% on room air. Physical exam is notable for a confused man with dry mucous membranes. He is unable to answer simple questions and is moving all extremities spontaneously. Which of the following is also likely to be found in this patient?", "answer": "Blurred vision", "meta_info": "step2&3", "answer_idx": "A", "A": "Blurred vision", "B": "Meningeal symptoms", "C": "Seizures", "D": "Tremulousness", "language": "en"}
{"question": "A 42-year-old man presents with acute onset jaundice. Past medical history is significant for COPD diagnosed 4 years ago, managed medically, and admission for acute pancreatitis 6 months ago. The patient denies any history of smoking, alcohol use or recreational drugs. Which of the following is the most likely etiology of liver damage in this patient?", "answer": "α1-antitrypsin (AAT) deficiency", "meta_info": "step1", "answer_idx": "A", "A": "α1-antitrypsin (AAT) deficiency", "B": "Glucose-6-phosphate dehydrogenase deficiency (G6PD deficiency)", "C": "Dubin–Johnson syndrome", "D": "Hepatitis C", "language": "en"}
{"question": "An 8-year-old girl presents to the emergency department with respiratory distress, facial edema, and a skin rash after eating a buffet dinner with her family. Her parents say they were eating at a seafood buffet when, all of a sudden, the patient began to cough and feel short of breath. They say nothing like this has ever happened before. The patient has a history of seasonal allergies for which she occasionally takes cetirizine. Her blood pressure is 80/52 mm Hg; heart rate, 122/min; and respiratory rate, 22/min. On physical examination, the patient has severe edema over her face and audible stridor. Of the following options, which is the most appropriate next step in the management of this patient?", "answer": "Intramuscular epinephrine", "meta_info": "step2&3", "answer_idx": "A", "A": "Intramuscular epinephrine", "B": "Intravenous epinephrine", "C": "Extra-strength topical diphenhydramine", "D": "Inhaled sodium cromolyn", "language": "en"}
{"question": "A 33-year-old man presents to his physician complaining of a small mass he noticed in his scrotum about 1 month ago. The mass feels loosely attached to the right testicle and is firm, and not painful. He has no history of a serious illness and takes no medications. He is married with 2 children. His vital signs are within normal limits. Examination shows a 1-cm spherical mass in the superior part of the right testis that has a smooth border. It transilluminates with a flashlight. The mass does not enlarge when the patient coughs or bears down. Scrotal ultrasonography shows an extratesticular hypoechoic mass near the epididymal head of the right testicle with posterior acoustic enhancement and without internal shadows. Which of the following is the most appropriate next step in management?", "answer": "No therapy at this time", "meta_info": "step2&3", "answer_idx": "D", "A": "Ligation of processus vaginalis", "B": "Microsurgical varicocelectomy", "C": "Orchiectomy", "D": "No therapy at this time", "language": "en"}
{"question": "A 51-year-old asymptomatic woman undergoes colposcopy due to a high-grade intraepithelial lesion based on a Pap smear. Colposcopy shows a visible lesion 2 cm in diameter located on the posterior cervical lip and confined to the cervix with sharp borders, a coarse mosaic pattern after application of acetic acid, and contact bleeding. The histologic evaluation of the biopsy shows glandular epithelial cells with nuclear hyperchromasia and enlargement, increased mitoses, a fusion of glands, and stromal infiltration to 8 mm. The chest X-ray and abdominal ultrasound are negative for any additional findings. Which of the following interventions is a proper management strategy for the presented patient?", "answer": "Modified radical (Wertheim) hysterectomy", "meta_info": "step2&3", "answer_idx": "B", "A": "Loop electrosurgical excision procedure (LEEP)", "B": "Modified radical (Wertheim) hysterectomy", "C": "Platinum-based chemotherapy", "D": "Simple hysterectomy with bilateral salpingo-oophorectomy", "language": "en"}
{"question": "A 65-year-old man presents to the Emergency Department complaining of substernal chest pain. An acute coronary event is suspected and a coronary catheterization procedure reveals an atherosclerotic plaque in the patient's left anterior descending artery. In the formation of an atherosclerotic plaque, which of the following pairings is correct?", "answer": "Smooth muscle cells (SMC) -- extracellular matrix (ECM) deposition", "meta_info": "step1", "answer_idx": "B", "A": "Fibroblasts -- foam cells", "B": "Smooth muscle cells (SMC) -- extracellular matrix (ECM) deposition", "C": "Endothelial cells -- downregulation of VCAM-1", "D": "LDL chemical reduction -- endothelial dysfunction", "language": "en"}
{"question": "A 15-year-old boy is brought to the physician by his mother because of a 2-month history of pain in his left hip. The pain started suddenly and has worsened over the past 2 weeks. The pain radiates down the thigh and is aggravated by movement. He had a fall while cycling around a month ago. He had a urinary tract infection 3 months ago that resolved with trimethoprim/sulfamethoxazole. There is no family history of serious illness. His immunizations are up-to-date. He is 165 cm (5 ft 5 in) tall and weighs 85 kg (187 lb); BMI is 31.2 kg/m2. His temperature is 37.5°C (99.5°F), pulse is 65/min, and blood pressure is 104/70 mm Hg. Examination shows an antalgic gait. The left groin is tender to palpation and internal rotation is limited due to pain. Flexing the hip causes external rotation and abduction. His leukocyte count is 9,800/mm3 and erythrocyte sedimentation rate is 12 mm/h. An x-ray of the pelvis is shown. Which of the following is the most appropriate next step in management?", "answer": "Surgical pinning of femoral head", "meta_info": "step2&3", "answer_idx": "B", "A": "Long leg cast", "B": "Surgical pinning of femoral head", "C": "Intra-articular lidocaine", "D": "Proximal femoral osteotomy", "language": "en"}
{"question": "A 58-year-old man is hospitalized and treated with clindamycin for a pulmonary abscess. During his hospital stay he develops abdominal pain and bloody diarrhea, and has a WBC of 14,000; serum creatinine is 0.9 mg/dL. On teaching rounds, you learn that the responsible pathogen produces a multi-unit toxin that binds to the colonic mucosa, causing actin depolymerization that results in cell death and mucosal necrosis. What is the preferred treatment for this condition?", "answer": "Metronidazole", "meta_info": "step1", "answer_idx": "A", "A": "Metronidazole", "B": "Penicillin G", "C": "Tetracycline", "D": "Erythromycin", "language": "en"}
{"question": "A 61-year-old Caucasian woman presents to her physician for a routine checkup. She has primary hypertension and rheumatoid arthritis. She currently does not report any relevant symptoms, such as weight change, increased or decreased appetite, sleep or mood problems, gastrointestinal symptoms, fever, or night sweats. Her medications include valsartan 160 mg, hydrochlorothiazide 25 mg daily, and methylprednisolone 28 mg every other day. According to her diary, her blood pressure varies from 130/80 to 120/60 mm Hg. In the past year, she had humeral and tibial fractures from a self-height fall and stepping over a fence, respectively, that occurred 6 months apart. She is in menopause and is not on hormone replacement therapy. Currently, she does not smoke but has a 10-pack-year history of smoking. She consumes alcohol occasionally. She weighs 56 kg (123.5 lb), and her height is 169 cm (5 ft 7 in). She does not report a family history of any cancer. Her father died after a myocardial infarction at the age of 63. She performs daily household activities but is not engaged in either aerobic or strength training. She mainly consumes vegetables, cereals, and dairy products. Her blood pressure is 125/80 mm Hg, heart rate is 67/min, respiratory rate is 14/min, and temperature is 36.5°C (97.7°F). Her physical examination is unremarkable. Which result would you expect to find on her screening tests?", "answer": "T score –2.01 on DEXA scan", "meta_info": "step2&3", "answer_idx": "B", "A": "A score of 17 on PHQ-9 test", "B": "T score –2.01 on DEXA scan", "C": "Dilation of the abdominal aorta on ultrasound examination", "D": "Presence of focal hyperintensities on mammography", "language": "en"}
{"question": "A 24-year-old man is brought to the emergency department by his sister because she has noticed that he has been behaving differently over the past 4 weeks. Today, the patient attempted to set their house on fire while yelling that he was trying to “save us all.” The patient has a history of psychotic symptoms treated with aripiprazole. His sister states that he stopped taking his medications about 3 weeks ago. He works as a dishwasher but has not been to work for several days. His vital signs are within normal limits. Mental status examination shows a blunted affect. Throughout the interview, the patient continuously stares at the ceiling and makes little eye contact with the physician. When asked about the incident today, he states that he has been hearing the voice of “the great one” who has informed him that aliens are in his neighborhood in the form of rats and cockroaches that need to be “torched to prevent the alien invasion.” He is refusing treatment and insists on going home. Which of the following is the most appropriate next step in management?", "answer": "Involuntarily hospitalize the patient", "meta_info": "step2&3", "answer_idx": "C", "A": "Administer aripiprazole and follow-up after 24 hours", "B": "Refer the patient to a psychologist for cognitive behavioral therapy", "C": "Involuntarily hospitalize the patient", "D": "Ask the patient's sister to convince him to stay overnight", "language": "en"}
{"question": "A 13-year-old girl is brought to the emergency department by her father because of a severe nosebleed. She takes no medications and has no history of serious medical illness but has had frequent nosebleeds in the past. Physical examination shows brisk bleeding from the right nare and pooled blood in the posterior pharynx. Laboratory studies show:\nHemoglobin 8 g/dL\nPlatelet count 195,000/mm3\nProthrombin time 12 sec\nPartial thromboplastin time 49 sec\nFibrin split products negative\nThe bleeding time is 11 minutes. Which of the following is the most appropriate pharmacotherapy?\"", "answer": "Desmopressin", "meta_info": "step1", "answer_idx": "C", "A": "Prothrombin complex concentrate", "B": "Rituximab", "C": "Desmopressin", "D": "Intravenous immunoglobulin", "language": "en"}
{"question": "A 33-year-old man presents to the emergency department with joint pain. He states that since yesterday he has had joint pain, and today he noticed a rash. The patient does not have a significant past medical history. The patient smokes cigars, drinks 1 to 4 drinks per day, is sexually active, and uses cocaine occasionally. His temperature is 101°F (38.3°C), blood pressure is 125/65 mmHg, pulse is 80/min, respirations are 14/min, and oxygen saturation is 98% on room air. Physical exam reveals pustular skin lesions and an inflamed and painful right knee that is warm to the touch. Which of the following is the most appropriate treatment for the most likely diagnosis?", "answer": "Cefixime and azithromycin", "meta_info": "step2&3", "answer_idx": "A", "A": "Cefixime and azithromycin", "B": "Ceftriaxone", "C": "Ceftriaxone and vancomycin", "D": "Piperacillin and tazobactam", "language": "en"}
{"question": "A 20-year-old woman presents to a physician following unprotected coitus with her boyfriend about 10 hours ago. She tells the physician that although they usually use a barrier method of contraception, but this time they did not. She does not want to become pregnant. She also mentions that she has been diagnosed with major depression and does not want to take an estrogen-containing oral contraceptive pill. After counseling, the physician prescribes an enteric-coated pill containing 1.5 mg of levonorgestrel. Which of the following is the primary mechanism of action of levonorgestrel?", "answer": "Delayed ovulation through inhibition of follicular development", "meta_info": "step1", "answer_idx": "A", "A": "Delayed ovulation through inhibition of follicular development", "B": "Thickening of cervical mucus", "C": "Atrophy of endometrium", "D": "Reduction in motility of cilia in fallopian tubes", "language": "en"}
{"question": "A 4-year-old girl is brought to the emergency department because of colicky abdominal pain for 1 day. She has had two similar episodes in the past. Urinalysis shows red blood cells and hexagonal-shaped crystals. Urine sodium cyanide nitroprusside test is positive. Further evaluation of this patient is most likely to show which of the following findings?", "answer": "Impaired intestinal ornithine reabsorption", "meta_info": "step1", "answer_idx": "C", "A": "Increased stool fat content", "B": "Inability of intercalated cells to secrete H+", "C": "Impaired intestinal ornithine reabsorption", "D": "Urease-positive bacteria in the renal pelvis", "language": "en"}
{"question": "A 49-year-old woman, gravida 1, para 1, comes to the physician because of shorter and less frequent menstrual periods over the past year. During this time, she has also had frequent mood swings and a 2.5-kg (5-lb) weight loss. She occasionally wakes up at night because she is too warm and sweating profusely. These episodes are followed by chills and anxiety that subside within minutes. She has no history of abnormal Pap smears. She is sexually active with her husband, who had a vasectomy 10 years prior. She is 163 cm (5 ft 3 in) tall and weighs 70 kg (154 lb); BMI is 26 kg/m2. Her temperature is 37°C (98.6°F), pulse is 103/min, respirations are 16/min, and blood pressure is 129/84 mm Hg. Abdominal and genitourinary examination shows no abnormalities. Which of the following is the most appropriate next step in management?", "answer": "Measure serum TSH concentration", "meta_info": "step2&3", "answer_idx": "D", "A": "Perform transvaginal ultrasound", "B": "Measure serum β-hCG concentration", "C": "Obtain endometrial biopsy", "D": "Measure serum TSH concentration", "language": "en"}
{"question": "An 8-year-old boy is brought by his parents to the emergency department with a tender and swollen right leg. The boy said that he was playing soccer when he accidentally kicked a metal goal post. The boy was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccines and is meeting all developmental milestones. A review of his medical history reveals that he had a fracture of the left tibia at 4-years-old and a fracture of the right radius 6 months ago. Neither of the two was associated with major trauma and both healed well. At the hospital, his vital signs are stable and his sclerae are white-blue. There is no muscular hypotonia. His height and weight are normal for his age and sex and the skin is normal. A tender swelling is present over his right leg and he can not put weight on that leg. The radiograph of his right leg confirms a fracture of the shaft of the tibia at the junction of its upper one-third and lower two-thirds. The clinician suspects physical abuse and orders a skeletal survey. Which of the following findings is most likely to be detected in a skeletal survey?", "answer": "Wormian bones in the skull", "meta_info": "step2&3", "answer_idx": "D", "A": "A healed right scapular fracture", "B": "Ground-glass appearance of the cortices of the long bones", "C": "Widening and cupping of the metaphyses of the long bones", "D": "Wormian bones in the skull", "language": "en"}
{"question": "A previously healthy 34-year-old man comes to the physician because of loose stools for the past 4 months. On average, he has 1 episode of loose non-bloody bowel movement with abdominal cramps each day around noon. He has no diarrhea when he does not have breakfast in the morning. He also complains of excess flatus but no bowel incontinence or urgency. He has had no fever or weight loss. His symptoms are not associated with stress. He has had no overseas or mountainous trips over the past year. He takes no medications. His vital signs are within normal limits. Physical examination shows no abnormalities. Which of the following is the most appropriate initial recommendation?", "answer": "Elimination of all dairy products", "meta_info": "step2&3", "answer_idx": "B", "A": "Cholestyramine", "B": "Elimination of all dairy products", "C": "Empirical therapy with metronidazole", "D": "Loperamide", "language": "en"}
{"question": "A 37-year-old male with a history of diabetes is prescribed a drug that would decrease the risk of the patient developing glomerular renal capillary damage, nodular glomerular sclerosis, and eventual nephrotic syndrome. After some time being on this medication, the patient complains of a bad cough. Which of the following physiologic changes is most likely expected after being prescribed that medication?", "answer": "Decreased aldosterone, decreased GFR, increased renal plasma flow, increased bradykinin", "meta_info": "step1", "answer_idx": "C", "A": "Decreased aldosterone, decreased GFR, decreased renal plasma flow, increased bradykinin", "B": "Increased aldosterone, increased GFR, decreased renal plasma flow, increased bradykinin", "C": "Decreased aldosterone, decreased GFR, increased renal plasma flow, increased bradykinin", "D": "Increased aldosterone, increased GFR, increased renal plasma flow, increased bradykinin", "language": "en"}
{"question": "A 69-year-old woman presents with insomnia and altered mental status. The patient is accompanied by her husband who says her symptoms began acutely 4 days ago with no obvious trigger and have not improved. Before this point, she had been living independently with no signs of cognitive impairment. The patient’s husband says that the patient is often non-compliant with medication and eats and drinks little unless prompted. Past medical history is significant for hypertension, diabetes mellitus type 2, chronic pyelonephritis, and depression. Current medications are aspirin, metoprolol, hydrochlorothiazide, losartan, metformin, and trazodone. Vitals include: temperature 38.1℃ (100.6℉), blood pressure 130/70 mm Hg, pulse 91/min, respiratory rate 17/min, and oxygen saturation 99% on room air. On physical examination, the patient is agitated and easily distracted. Oriented x 1. She believes it is 1967, and she is at the bookstore. She talks to non-existent people and uses words inappropriately. Cardiac sounds are muffled but otherwise normal. Lungs are clear to auscultation. On abdominal examination, the tip of the urinary bladder can be palpated. Costovertebral angle tenderness is present bilaterally. Catheterization of the bladder yields cloudy, foul-smelling urine. Urinalysis is pending. Which of the following would be the best treatment for this patient’s change in mental status?", "answer": "Antibiotic therapy", "meta_info": "step2&3", "answer_idx": "B", "A": "Changing trazodone to amitriptyline", "B": "Antibiotic therapy", "C": "Discontinuation of metoprolol", "D": "Lifelong administration of memantine", "language": "en"}
{"question": "A 65-year-old man presents to the physician with a concern for several lumps on his jaw. He has a history of dental caries and admits to maintaining poor oral hygiene. On physical examination, he has 3 nontender and indurated masses at the angle of his jaw that are draining thick yellow pus. Microscopy of the drained pus reveals yellow granules filled with bacteria. Which of the following medical treatments is indicated for this patient’s condition?", "answer": "Penicillin", "meta_info": "step2&3", "answer_idx": "C", "A": "Amoxicillin-clavulanate", "B": "Dapsone and rifampin", "C": "Penicillin", "D": "Trimethoprim-sulfamethoxazole", "language": "en"}
{"question": "A 23-year-old man presents with severe right lower quadrant abdominal pain for the past 2 hours. He says the pain started in the periumbilical region and has now shifted to the lower right quadrant. He describes the pain as spasmodic. Past medical history is insignificant, and the patient denies any history of smoking, alcohol, or drug use. The patient’s vital signs show: pulse 88/min, respiratory rate 18/min, blood pressure 126/84 mm Hg, and temperature 38.4°C (101.0°F). On physical examination, there is severe tenderness to palpation in the right lower quadrant with rebound and guarding. The patient is rushed to the operating room for a laparoscopic appendectomy. The following preoperative laboratory tests are obtained:\nSerum glucose (random) 123 mg/dL\n  Serum electrolytes\nSodium 143 mEq/L\nPotassium 4.7 mEq/L\nChloride 102 mEq/L\n    Serum creatinine 1.7 mg/dL\nBlood urea nitrogen 32 mg/dL\n    Hemoglobin (Hb%) 12.5 g/dL\nMean corpuscular volume (MCV)  80 fl\nReticulocyte count 1%\nErythrocyte count 5.1 million/mm³\nLeukocyte count 14,000/mm³\nNeutrophils 80%\nDuring the induction of anesthesia, isoflurane and a second compound are administered. About 25 minutes after induction, the patient develops significant muscle rigidity and his temperature increases to 40.8°C (105.4°F). The patient’s blood pressure is now 158/94 mm Hg. Which of the following was most likely the second compound administered to this patient?", "answer": "Succinylcholine", "meta_info": "step1", "answer_idx": "D", "A": "Atracurium", "B": "Nitrous oxide", "C": "Neostigmine", "D": "Succinylcholine", "language": "en"}
{"question": "A 16-year-old boy is brought to the physician because of a 3-week history of loose stools. He has 2–3 episodes of loose stools a day that are occasionally bloody. During this period, he has also had crampy abdominal pain, generalized fatigue, and a 2-kg (5-lb) weight loss. His temperature is 37.1°C (98.8°F), pulse is 82/min, and blood pressure is 106/68 mm Hg. Examination shows mild lower abdominal tenderness to palpation. Test of the stool for ova and parasites is negative. His hemoglobin concentration is 11.8 g/dL, leukocyte count is 12,400/mm3, and erythrocyte sedimentation rate is 14 mm/h. A colonoscopy shows inflamed, friable mucosa extending just beyond the rectum that bleeds on contact with the endoscope. A biopsy confirms the diagnosis. Which of the following is the most appropriate therapy for this patient?", "answer": "Mesalamine therapy", "meta_info": "step2&3", "answer_idx": "C", "A": "Gluten-free diet", "B": "Proctocolectomy", "C": "Mesalamine therapy", "D": "Cyclosporine therapy\n\"", "language": "en"}
{"question": "A 26-year-old man presents with a 6-month history of headaches. Over the past 6 months, he has developed headaches that are 4/10 in intensity and occur every other day for 1–2 hours. The headaches are bilateral and feel like a ‘band is squeezing his head’. He denies photophobia, phonophobia, nausea, and vomiting. He has had no visual loss or photopsia. No significant past medical history. He is an avid weightlifter and works at a moving company, where he is constantly lifting heavy items. Additionally, he recently got his 21-year-old girlfriend and his other 23-year-old girlfriend pregnant, which he says is causing a lot of stress. Physical examination is unremarkable. Which of the following is the next best step in the management of this patient? ", "answer": "Ibuprofen", "meta_info": "step2&3", "answer_idx": "D", "A": "Amitriptyline", "B": "Magnetic resonance image (MRI) of the head", "C": "Ophthalmologic evaluation", "D": "Ibuprofen", "language": "en"}
{"question": "A histologic section is obtained from the central canal of the spinal cord. A special stain is used to identify a specific glial cell that makes up the lining of the central canal and ventricles in the central nervous system. Which of the following best describes the primary function that the cells highlighted in blue serve?", "answer": "Production and circulation of CSF", "meta_info": "step1", "answer_idx": "A", "A": "Production and circulation of CSF", "B": "Protective membrane surrounding spinal cord", "C": "Conduct voluntary muscle action potentials", "D": "Increasing action potential conduction velocity", "language": "en"}
{"question": "A 58-year-old man presents to the emergency department with a 4-hour history of severe abdominal pain. He has noted brief episodes of postprandial abdominal pain for the last 2 months, but this pain is much more severe and diffuse. He also reports nausea and has had several episodes of non-bloody, non-bilious emesis since the pain started. Past medical history is notable for hyperlipidemia diagnosed 10 years ago and managed with lifestyle modifications; he has never been hospitalized. Vital signs are unremarkable. Physical examination shows dry mucous membranes and a soft, non-distended abdomen that is diffusely tender. Laboratory tests are notable for a lipase level of 3,125 U/L. CT of the abdomen shows an enlarged gallbladder and peripancreatic fluid with dilation of the pancreatic and common bile ducts. Which of the following is the best next step in the management of this patient?", "answer": "Endoscopic retrograde cholangiopancreatography (ERCP)", "meta_info": "step2&3", "answer_idx": "C", "A": "Cholecystectomy", "B": "Colonoscopy", "C": "Endoscopic retrograde cholangiopancreatography (ERCP)", "D": "Esophagogastroduodenoscopy (EGD)", "language": "en"}
{"question": "A 55-year-old man presents to his primary care physician for his annual check-up. He says that he has generally been feeling well; however, he has noticed that he has had some intermittent very low grade fevers of unknown etiology. His past medical history is significant for well-controlled hypertension and diabetes. On physical exam he is found to have painless enlargement of a number of cervical and axillary lymph nodes. A biopsy of the enlarged nodes is obtained and genetic testing shows that part of chromosomes 14 and 18 are joined together. Which of the following would most likely be observed in cells with this genetic change?", "answer": "Decreased release of cytochrome c", "meta_info": "step1", "answer_idx": "C", "A": "Decreased activation of CD95", "B": "Decreased activity of p53", "C": "Decreased release of cytochrome c", "D": "Increased activation of Apaf-1", "language": "en"}
{"question": "A 75-year-old man is brought to the emergency room because of dizziness and palpitations for the past hour. His pulse is 185/min and blood pressure is 100/52 mm Hg. An ECG shows a narrow-complex, regular tachycardia without P waves. A drug is administered that activates cardiac potassium channels and causes transient atrioventricular block. Which of the following adverse effects is most likely to occur?", "answer": "Chest pain", "meta_info": "step1", "answer_idx": "A", "A": "Chest pain", "B": "Dry cough", "C": "Perioral paresthesia", "D": "Yellow vision", "language": "en"}
{"question": "A 70-year-old man is brought to the emergency department with painful discharge from his right ear with difficulty hearing for 3 days. His temperature is 39.5°C (103.1°F) and pulse is 120/minute. Physical examination shows mild facial asymmetry with the right corner of his mouth lagging behind the left when the patient smiles. There is severe ear pain when the right auricle is pulled superiorly. Otoscopic examination shows granulation tissue at the transition between the cartilaginous and the osseous part of the ear canal. Which of the following is most likely associated with this patient's condition?", "answer": "Glucose intolerance", "meta_info": "step1", "answer_idx": "B", "A": "Decreased intracranial perfusion", "B": "Glucose intolerance", "C": "Pus-filled mastoid air cells", "D": "Positive streptococcal culture", "language": "en"}
{"question": "A 24-year-old female with a history of recurrent infections, bipolar disorder, and no prenatal care gives birth to a male infant. On physical exam in the delivery room, you observe a tuft of hair over the infant's lumbosacral region. Which of the following drugs was this mother most likely taking during pregnancy?", "answer": "Valproate", "meta_info": "step1", "answer_idx": "C", "A": "Gentamicin", "B": "Lithium", "C": "Valproate", "D": "Folic acid", "language": "en"}
{"question": "A 25-year-old woman presents to the physician with the complaint of several episodes of headache in the past 4 weeks that are affecting her school performance. The episodes are getting progressively worse, and over-the-counter headache and migraine medication do not seem to help. She also mentions having to raise her head each time to look at the board when taking notes; she cannot simply glance up with just her eyes while facing her notes. She has no significant past medical or family history and was otherwise well prior to this visit. Ophthalmic examination shows an upward gaze palsy, convergence-retraction nystagmus, and papilledema. What structure is most likely to be affected by this patient's condition?", "answer": "Aqueduct of Sylvius", "meta_info": "step1", "answer_idx": "B", "A": "Third ventricle", "B": "Aqueduct of Sylvius", "C": "Tegmentum", "D": "Inferior colliculi", "language": "en"}
{"question": "A 75-year-old woman is brought to the emergency department because of a 6-hour history of severe headache, nausea, and 1 episode of vomiting. On arrival, she is lethargic and oriented only to self. Her pulse is 50/min, respirations are 8/min and shallow, and blood pressure is 150/96 mm Hg. Examination shows medial deviation of the left globe and ecchymoses of the upper eyelids. Appropriate pharmacotherapy with an intravenous drug is initiated, and the patient's urine output subsequently increases. The patient is at greatest risk of which of the following adverse effects?", "answer": "Pulmonary edema", "meta_info": "step1", "answer_idx": "D", "A": "Drug-induced hypersensitivity syndrome", "B": "Hyperuricemia", "C": "Tinnitus", "D": "Pulmonary edema", "language": "en"}
{"question": "A 31-year-old gravida 2 para 2 woman presents to her primary care physician for follow up. Two weeks ago, she gave birth via vaginal delivery to a 9.5 lb (4.3 kg) male infant. The delivery was complicated by a vaginal laceration that required extensive suturing once the infant was delivered. Immediately after delivery of the placenta she experienced intense shaking and chills that resolved within 1 hour. She has felt well since the delivery but admits to 6 days of malodorous smelling vaginal discharge that is tan in color. She has a history of vaginal candidiasis and is worried that it may be recurring. Her temperature is 98.8°F (37.1°C), blood pressure is 122/73 mmHg, pulse is 88/min, respirations are 16/min, and BMI is 33 kg/m^2. Speculum exam reveals a 1.5 cm dark red, velvety lesion on the posterior vaginal wall with a tan discharge. The pH of the discharge is 6.4. Which of the following is the most likely diagnosis?", "answer": "Rectovaginal fistula", "meta_info": "step2&3", "answer_idx": "B", "A": "Bacterial vaginosis", "B": "Rectovaginal fistula", "C": "Vaginal melanoma", "D": "Vesicovaginal fistula", "language": "en"}
{"question": "A 50-year-old male presents to the emergency room after getting hit by a car while biking. He complains of severe pain in both thighs. His thighs appear swollen, bruised, and angulated. Radiographic imaging demonstrates bilateral femoral shaft fractures. He subsequently undergoes surgical fixation of his fractures. Initially he has an uneventful post-operative course; however, on post-op day 4 he becomes confused and develops chest pain, tachypnea, and dyspnea. A new petechial rash is seen over his chest and neck. Electrocardiogram reveals normal sinus rhythm. Which of the following is the most likely cause of this patient’s respiratory symptoms?", "answer": "Occlusion of the pulmonary vessels by fat globules", "meta_info": "step1", "answer_idx": "C", "A": "Lobar lung consolidation", "B": "Aspiration of stomach contents", "C": "Occlusion of the pulmonary vessels by fat globules", "D": "Spontaneous pneumothorax", "language": "en"}
{"question": "A group of researchers is conducting a study to assess the validity and reliability of patient history in determining the amount and duration of drug abuse. In this study, 60 subjects with hepatitis were asked details of their history of drug abuse, such as the duration of drug abstinence, the amount and duration of drug abuse, and the treatment history. Additionally, a source close to or related to each of the study subjects (most often a spouse) was asked similar questions about the subject by a second researcher who was blinded to the subject’s drug abuse history. Results revealed that the duration of drug abstinence correlated highly between subjects and the source (Spearman’s r = 0.94, p-value < 0.001), as did the individual's score on the stimulant relapse risk scale (SRRS, Spearman’s r = 0.74, p-value < 0.001), a ranked metric of relapse risk. Which of the following statements regarding this results of this study is true?", "answer": "Spearman’s correlation coefficient reveals a strong association between the SRRS scores, as assessed by the study subject and their related source.", "meta_info": "step1", "answer_idx": "C", "A": "If the authors had conducted a study on larger sample size, Pearson’s correlation coefficient for these data would have been calculated.", "B": "There is a linear relationship between the duration of drug abstinence as assessed by the subject and their close/related source.", "C": "Spearman’s correlation coefficient reveals a strong association between the SRRS scores, as assessed by the study subject and their related source.", "D": "We can conclude that 88.4% (= 0.94 x 0.94) of the variability in the duration of drug abstinence (as assessed by the study subjects) can be 'explained' by the variability in the duration of drug abstinence as assessed by their sources.", "language": "en"}
{"question": "A 27-year-old man comes to the emergency department for progressive weakness and numbness in his legs for 5 days. Symptoms originally started with tingling in both feet and have progressed to involve the knees and hips; he is currently unable to walk without assistance. Two weeks ago, the patient had diarrhea that subsided without antibiotics. Neurologic examination shows weakness, decreased sensation, and absent patellar reflexes in both lower extremities. Lumbar puncture shows elevated CSF protein and no white blood cells. Which of the following structures is most likely affected in this patient?", "answer": "Schwann cells", "meta_info": "step2&3", "answer_idx": "C", "A": "Postsynaptic acetylcholine receptors", "B": "Muscle endomysium", "C": "Schwann cells", "D": "Cerebral white matter", "language": "en"}
{"question": "A 23-year-old man presents to the emergency department presenting with sudden-onset dyspnea and left-sided chest pain over the last hour. This event started when he was in class sitting for an exam. He reports that the pain is worse with inspiration and does not radiate. He says he has anxiety and takes alprazolam as needed. He smokes half a pack of cigarettes a day and drinks alcohol socially. The temperature is 36.7°C (98.0°F), the blood pressure is 130/80 mm Hg, the pulse is 82/min, and the respiratory rate is 14/min. Pulse oximetry shows 97% on room air. The patient’s weight is 63.5 kg (140 lb), height is 185 cm (6 ft 1 in), and he has a BMI of 18.5 kg/m2. A chest X-ray is taken (see exhibit). After an hour of supplemental oxygen, rest, and careful monitoring his dyspnea improves and chest pain resolves without medication. Which of the following is the most appropriate further management of this patient?", "answer": "Supplemental oxygen", "meta_info": "step2&3", "answer_idx": "C", "A": "Needle thoracostomy", "B": "IV antibiotics", "C": "Supplemental oxygen", "D": "CT angiogram of chest", "language": "en"}
{"question": "A 36-year-old male is brought to the emergency department by fire and rescue after being found down in his apartment by his wife. His wife reports that the patient had been complaining of chest pain for the last few hours but refused to go to the hospital. She went to the grocery store for about half an hour and found her husband unresponsive on the ground when she returned home. The patient’s wife reports that his past medical history is significant for a “heart murmur” and that the patient’s father died at age 32 for unknown reasons. In the trauma bay, the patient’s temperature is 98.8°F (37.1°C), blood pressure is 88/41 mmHg, pulse is 116/min, and respirations are 12/min. On physical exam, the patient has a Glascow Coma Score (GCS) of 7. He has a tall stature with long limbs and long, slender fingers. He is also noted to have a pectus deformity. On cardiac exam, the patient has a diastolic decrescendo murmur at the left third intercostal space. He has weak brachial and femoral pulses.\n\nWhich of the following is the most likely etiology of this patient’s presentation?", "answer": "Spontaneous separation in the arterial wall", "meta_info": "step2&3", "answer_idx": "D", "A": "Coronary atherosclerosis", "B": "Spontaneous rupture of the aorta", "C": "Spontaneous rupture of the mitral chordae tendinae", "D": "Spontaneous separation in the arterial wall", "language": "en"}
{"question": "A 44-year-old man comes to the physician because of severe lower back pain for 1 week. He has also had fatigue, weight gain, and episodic headaches during the past 3 months. He has no history of serious illness and takes no medications. His pulse is 88/min and blood pressure is 155/102 mm Hg. Physical examination shows facial plethora and truncal obesity. The skin appears stretched, with multiple ecchymotic patches over the upper and lower extremities bilaterally. Cardiopulmonary examination shows no abnormalities. There are bilateral paravertebral muscle spasms and severe tenderness over the second lumbar vertebra. An x-ray of the lumbar spine shows decreased bone density and a compression fracture of the L2 vertebra. Further evaluation of this patient is most likely to show which of the following findings?", "answer": "T-wave flattening on ECG", "meta_info": "step2&3", "answer_idx": "C", "A": "Low serum glucose levels", "B": "Suprasellar mass on cranial MRI", "C": "T-wave flattening on ECG", "D": "Positive Chvostek sign", "language": "en"}
{"question": "Two weeks after undergoing coronary artery bypass surgery for acute myocardial infarction, a 62-year-old man comes to the physician because of a 4-day history of fever, stabbing chest pain, and fatigue. Initially the pain was only present when he was lying supine, but now it is present all the time and only subsides when he is leaning forward. He has hypertension and mild mitral regurgitation. He has smoked one pack of cigarettes daily for 44 years but quit prior to surgery. Current medications include aspirin, clopidogrel, metoprolol, captopril, and atorvastatin. His temperature is 38.3°C (102°F), pulse is 84/min and regular, respirations are 16/min, and blood pressure is 132/86 mm Hg. During inspiration the blood pressure drops to 117/80 mm Hg. On physical examination there are jugular venous pulsations 4 cm above the sternal angle. Heart sounds are faint. There is 2+ edema in the lower extremities. Which of the following is the most likely cause of this patient's symptoms?", "answer": "Decreased left ventricular diastolic filling", "meta_info": "step2&3", "answer_idx": "B", "A": "Increase in mean aortic pressure", "B": "Decreased left ventricular diastolic filling", "C": "Supraventricular arrhythmia", "D": "Decreased right ventricular contractility\n\"", "language": "en"}
{"question": "A 28-year-old woman comes to the physician with her mother because of a 1-week history of feeling unusually energetic. The mother describes her state as “hyper” and reports that she often paces around her room. During this period, the patient has not slept. She had similar episodes 2 months and 5 months ago. The mother also states that, for the past 8 months, the patient has believed she is a famous singer and is going on a world tour next year. The patient does not have a partner and has only a few friends. She was working as a dental technician until 6 months ago, when she started to hear voices telling her to quit. She has not held a job since then. She does not use illicit drugs. Vital signs are within normal limits. Physical and neurological examinations show no abnormalities. On mental status examination, her speech is pressured, but she suddenly stops talking in the middle of sentences and does not finish them. She occasionally directs her attention to empty corners in the room, as if she were listening to someone. Which of the following is the most likely diagnosis?", "answer": "Schizoaffective disorder", "meta_info": "step2&3", "answer_idx": "A", "A": "Schizoaffective disorder", "B": "Schizotypal personality disorder", "C": "Delusional disorder", "D": "Mood disorder with psychotic features", "language": "en"}
{"question": "A 4-year-old boy presents the pediatrician with his parents for a consultation after his school teacher complained about his abnormal behavior and his inability to make friends in school. They mention that the boy does not interact well with others at home, school, or daycare. On physical examination, his vital signs are stable with normal weight, height, and head circumference for his age and sex. His general examination and systemic examination, including neurologic examination, are completely normal. His recent audiologic evaluation shows normal hearing, and intellectual disability has been ruled out by a clinical psychologist. Which of the following investigations is indicated as part of his diagnostic evaluation at present?", "answer": "No further testing is needed", "meta_info": "step2&3", "answer_idx": "D", "A": "Magnetic Resonance Imaging (MRI) of brain", "B": "Positron Emission Tomography (SPECT) Scanning of head", "C": "Electroencephalography", "D": "No further testing is needed", "language": "en"}
{"question": "A 57-year-old man comes to the physician because of a 5-day history of fever, joint pain, malaise, and a diffuse rash. Two months ago, he was diagnosed with latent tuberculosis and the appropriate treatment was administered. Examination shows a scaly, maculopapular rash over the chest, arms, and back. Which of the following is the most likely explanation for this patient's current condition?", "answer": "Decreased acetyltransferase activity", "meta_info": "step1", "answer_idx": "B", "A": "Decreased acetaldehyde dehydrogenase activity", "B": "Decreased acetyltransferase activity", "C": "Decreased cytochrome p450 activity", "D": "Decreased glucose-6-phosphate dehydrogenase activity", "language": "en"}
{"question": "A 40-hour-old baby girl is being evaluated for failure to pass meconium. She is the product of a full-term vaginal delivery to a G2P2 36-year-old mother. The pregnancy was uncomplicated, and the only medication that the mother took was a prenatal vitamin. The baby has been exclusively breastfed, and she has an adequate latch. On physical examination, the newborn’s abdomen is distended and on digital rectal examination, reveals that the rectum is empty. What is the most likely additional finding?", "answer": "Absence of ganglion cells in the submucosal plexus on suction biopsy of the rectum", "meta_info": "step2&3", "answer_idx": "A", "A": "Absence of ganglion cells in the submucosal plexus on suction biopsy of the rectum", "B": "Acid-producing mucosa visualized in a technetium scan", "C": "Abdominal ultrasound showing bowel-within-bowel", "D": "Inability to pass a 10-French catheter from the mouth into the stomach", "language": "en"}
{"question": "A 65-year-old man presents to the physician with a low-grade fever, fatigue, and anorexia for the past 10 days. The patient denies any chest pain, cough, or shortness of breath. He has been a smoker for the last 10 years and consumes alcohol occasionally. His past medical history is significant for colorectal carcinoma. His temperature is 38.3°C (101.0°F), the blood pressure is 130/90 mm Hg, and the pulse is 100/min. Physical examination shows reddish-brown spots under his nail bed (as shown in the exhibit) and tender erythematous fingers tips. Cardiac auscultation reveals a new holosystolic murmur best heard at the apex with no radiation. Chest X-ray, electrocardiogram, and urinalysis are normal. Which of the following is the best next step in diagnosing this patient’s condition?", "answer": "Obtain blood samples for blood culture", "meta_info": "step2&3", "answer_idx": "C", "A": "Obtain anti-CCP antibody titers", "B": "Echocardiography", "C": "Obtain blood samples for blood culture", "D": "Reassurance and symptomatic management", "language": "en"}
{"question": "A 27-year-old man presents for followup 3 months after starting an antiretroviral regimen consisting of efavirenz, tenofovir, and emtricitabine. Labs drawn just prior to presentation reveal an undetectable viral load and a T-lymphocyte count of 317/mm^3. By comparison, his viral load was 6100/mL and his T-lymphocyte count was 146/mm^3 at the time of treatment initiation. He reports that he is tolerating the medications well and is not experiencing any major side effects. Which of the following treatment regimens should be recommended for this patient given the fully suppressed viral load?", "answer": "Continue current regimen of efavirenz, tenofovir, and emtricitabine", "meta_info": "step1", "answer_idx": "A", "A": "Continue current regimen of efavirenz, tenofovir, and emtricitabine", "B": "Continue efavirenz and emtricitabine but discontinue tenofovir", "C": "Continue efavirenz and tenofovir but discontinue emtricitabine", "D": "Continue tenofovir and emtricitabine but discontinue efavirenz", "language": "en"}
{"question": "A 60-year-old male painter with severe chest pain is found to have atherosclerosis of his coronary arteries. What type of cells were most likely injured in the initial stage of his disease?", "answer": "Endothelial cells", "meta_info": "step1", "answer_idx": "C", "A": "Myocytes", "B": "Neutrophils", "C": "Endothelial cells", "D": "Smooth muscle cells", "language": "en"}
{"question": "A 27-year-old woman, gravida 1, at 26 weeks gestation presents to the physician during a prenatal visit. She feels well. Her pregnancy has been uncomplicated. Her initial laboratory tests at 8 weeks confirmed her blood type as B-. Her partner is blood type A+. At the clinic, her temperature is 37.2°C (99.0°F), and blood pressure is 108/60 mm Hg. Pelvic examination shows a uterus consistent in size with a 24-week gestation. Fetal heartbeats are normal. A sample of blood is collected for blood type screening and verification. Regarding Rh D immunoglobulin (RhoGam) administration, the most appropriate next step is which of the following?", "answer": "At 28 weeks gestation if anti-D screen is negative", "meta_info": "step2&3", "answer_idx": "A", "A": "At 28 weeks gestation if anti-D screen is negative", "B": "At 28 weeks gestation if anti-D screen is positive", "C": "Within 72 hours after birth if anti-D screen is negative", "D": "Rh D immunoglobulin (RhoGam) is not required in this patient regardless of test results", "language": "en"}
{"question": "A 32-year-old obese man visits your dermatology clinic after his barber saw a darkened area on the back of his neck. He has not seen his primary care physician in many years and does not know if he has diabetes. A rapid blood glucose test showed a normal glucose level. Otherwise, he reports recent loss of appetite with slight weight loss. What could be causing this patient’s newly-discovered dermatologic change?", "answer": "Gastric adenocarcinoma", "meta_info": "step2&3", "answer_idx": "A", "A": "Gastric adenocarcinoma", "B": "Diabetes insipidus", "C": "Diabetes mellitus", "D": "Barrett’s esophagus", "language": "en"}
{"question": "A 59-year-old man comes to the physician because of a 6-month history of progressive blurry vision in both eyes. His vision has not improved with the use of reading glasses. His blood pressure is 155/98 mm Hg. Physical examination shows his visual acuity to be 20/80 in the right eye and 20/60 in the left eye. A photograph of the fundoscopic examination of the right eye is shown. Which of the following is the most likely cause of this patient's symptoms?", "answer": "Diabetic retinopathy\n\"", "meta_info": "step1", "answer_idx": "D", "A": "Idiopathic intracranial hypertension", "B": "Open-angle glaucoma", "C": "Central retinal artery occlusion", "D": "Diabetic retinopathy\n\"", "language": "en"}
{"question": "A 16-year-old high school cheerleader is brought by her mother to the emergency department after falling on her back during a stunt. She strongly believes that the accident happened because the team couldn’t catch her ‘enormous and bloated’ body. Lately, she has been in a lot of stress as dance regionals are coming up soon and she wants to lose 6.8 kg (15 lb). She is also experiencing intermittent palpitations and dizziness, even during rest. The physical examination reveals a slender girl with bilateral swelling on her cheeks and abrasions on the dorsum of her right hand. When her mother left the room, she admitted to taking furosemide that she found in the medicine cabinet. The vital signs include: temperature 36.2°C (97.2°F), blood pressure 90/60 mm Hg, pulse rate 50/min, respiratory rate 12/min, height 162 cm (5 ft 4 in), and weight 40.9 kg (90 lb). A magnetic resonance image (MRI) of the thoracic spine shows a vertebral compression fracture. She is refusing to eat anything but ice. What is the most appropriate next step in the management of this patient’s symptoms?", "answer": "Admit and start parenteral nutrition", "meta_info": "step1", "answer_idx": "A", "A": "Admit and start parenteral nutrition", "B": "Stabilize the fracture with a brace and discharge patient", "C": "Switch furosemide to hydrochlorothiazide", "D": "Refer to psychiatrist for outpatient cognitive behavioral therapy", "language": "en"}
{"question": "A 44-year-old man presents to an oncologist after being diagnosed with small cell lung carcinoma confirmed with a biopsy last week. He worked as a plant technician in the metal processing unit at a factory for the last 14 years. Family history is unremarkable. It is concluded that this cancer is most likely mediated by mutations triggered by chronic chemical exposure at his work. Which of the following enzymes is primarily inhibited at the biochemical level by the chemical agent responsible for this patient’s condition?", "answer": "Pyruvate dehydrogenase", "meta_info": "step1", "answer_idx": "A", "A": "Pyruvate dehydrogenase", "B": "Phosphofructokinase", "C": "Dihydrofolate reductase", "D": "Glucose-6-phosphate dehydrogenase", "language": "en"}
{"question": "A 41-year-old woman presents to the emergency room with a 2-day history of flank pain, nausea, and vomiting. She denies any urinary frequency or urgency and denies any recent changes in her diet. Her temperature is 100.4°F (38°C), blood pressure is 152/96 mmHg, and pulse is 104/min. On physical exam, there is bilateral flank tenderness to palpation. In addition, neurologic testing reveals decreased strength in her left upper extremity and an inability to sustain lateral gaze with her right eye. An electrocardiogram reveals an irregularly irregular heart rhythm. Which of the following is associated with the most likely cause of this patient's symptoms?", "answer": "Hereditary thrombophilia", "meta_info": "step1", "answer_idx": "B", "A": "Drug allergy", "B": "Hereditary thrombophilia", "C": "Hypertension", "D": "Streptococcus infection", "language": "en"}
{"question": "A 20-year-old African American woman comes to the clinic after missing her last two periods. Her cycles are usually regular, occurring at 28-32 day intervals with moderate bleeding and some abdominal discomfort. She also complains of occasional diffuse and generalized headaches. She is a college student and works part-time as a bartender. Past medical history is insignificant. Blood pressure is 110/70 mm Hg, pulse rate is 80 /min, respiratory rate is 14 /min, and temperature is 36.5°C (97.7°F). Physical examination is significant for mild breast tenderness and some secretions from the nipple area. Urine pregnancy test is negative. Which of the following is the best initial step in her management?", "answer": "Serum prolactin levels", "meta_info": "step2&3", "answer_idx": "A", "A": "Serum prolactin levels", "B": "LH/FSH ratio", "C": "Ultrasound of abdomen and pelvis", "D": "Dopamine agonists", "language": "en"}
{"question": "A 25-year-old man comes to the physician because he and his wife have been unable to conceive a child despite having regular unprotected sexual intercourse. He is 187 cm (6 ft 1 in) tall and weighs 79 kg (174 lb). Examination shows long extremities, bilateral gynecomastia, and small, firm testes. A peripheral blood smear shows a dense, dark-staining spot at the periphery of the nucleus of a cell. Which of the following is the most likely explanation for the finding on this patient's peripheral blood smear?", "answer": "Methylation of cytosine nucleotides", "meta_info": "step1", "answer_idx": "B", "A": "Acetylation of histone lysine residues", "B": "Methylation of cytosine nucleotides", "C": "Aggregation of ribosomes", "D": "Precipitation of oxidized hemoglobin", "language": "en"}
{"question": "A 22-year-old woman college student presents with diarrhea and crampy abdominal pain that is relieved by defecation. She states that she has had a lot of ‘stomach issues’ in the past, especially during exam weeks. The past medical history is significant for major depressive disorder diagnosed 2 years ago that has been managed with Prozac. She does not have a family history of irritable bowel disease, autoimmune disease, or cancer. The symptoms do not seem to be worse with any particular food, though she admits to eating a lot of pizza and deli sandwiches with minimal fruits and vegetables. She denies recent travel and has not experienced fever, weight loss, nausea, or vomiting. She has not noticed blood in her stool. The physical exam and laboratory findings are unremarkable. Which of the following is a diagnostic criteria for the disorder that is most likely responsible for the patient’s presentation?", "answer": "Symptoms present at least 1 day per week for 3 consecutive months with symptom onset at least 6 months before diagnosis", "meta_info": "step2&3", "answer_idx": "C", "A": "Symptoms present at least 6 months", "B": "Symptoms not relieved with defecation", "C": "Symptoms present at least 1 day per week for 3 consecutive months with symptom onset at least 6 months before diagnosis", "D": "No change in stool consistency", "language": "en"}
{"question": "A 69-year-old female presents to the emergency department with crampy abdominal pain. She has a past medical history of hypertension, dyslipidemia, and cholelithiasis status post cholecystectomy. The patient states she has not passed stool or gas for 48 hrs. On physical exam vitals are T 98.4 F HR 105 bpm BP 155/101 mmHg RR 16 SpO2 96%, abdominal exam is notable for distension, tympany to percussion, and tenderness to palpation without rebound or guarding. Which of the following findings are most likely on radiograph?", "answer": "Ladder-like series of distended bowel loops with air-fluid levels on abdominal radiograph", "meta_info": "step2&3", "answer_idx": "C", "A": "Apple core defect after lower GI series", "B": "Multiple punctate mucosal outpouchings through the serosa on lower GI series", "C": "Ladder-like series of distended bowel loops with air-fluid levels on abdominal radiograph", "D": "Loss of haustral markings and \"lead pipe\" appearance to the descending colon on lower GI series", "language": "en"}
{"question": "A 56-year-old man comes to the physician because of a 2-month history of worsening pain in his left buttock. The pain is described as a deep, dull ache that is worse at night. He does not report any recent trauma. He has hyperlipidemia. He has smoked one pack of cigarettes daily for the past 30 years and drinks one beer every night. He does not use illicit drugs. His only medication is simvastatin. Physical examination shows tenderness over the left gluteal region. Neurologic examination shows no focal findings. An x-ray of the pelvis shows a 4-cm, poorly defined, osteolytic lesion in the left ilium with a moth-eaten pattern of bone destruction, multiple well-defined sclerotic lesions, and an aggressive periosteal reaction. The remainder of the physical examination, including rectal examination, shows no abnormalities. Chest x-ray and abdominal ultrasonography show no abnormalities. Which of the following is the most likely diagnosis?", "answer": "Chondrosarcoma", "meta_info": "step2&3", "answer_idx": "D", "A": "Giant cell tumor", "B": "Fibrosarcoma", "C": "Plasmacytoma", "D": "Chondrosarcoma", "language": "en"}
{"question": "An otherwise healthy 49-year-old man comes to the physician because of a 1-month history of worsening headaches and increasing irritability. Examination shows bilateral papilledema. An MRI of the brain shows a mass in the right temporal lobe with heterogeneous peripheral rim enhancement that crosses the midline. He undergoes surgical resection of the mass. Gross examination shows a poorly-demarcated mass with areas of hemorrhage and necrosis. Microscopic examination of the mass will most likely show which of the following?", "answer": "Pleomorphic cells forming pseudopalisades", "meta_info": "step1", "answer_idx": "B", "A": "Closely-packed capillaries and foamy stromal cells", "B": "Pleomorphic cells forming pseudopalisades", "C": "Cells with clear cytoplasm and central round nuclei", "D": "Areas of lamellated calcification", "language": "en"}
{"question": "A male newborn develops hyperammonemia, encephalopathy, and respiratory alkalosis 3 days after a normal delivery. He enters into a coma the next day and dies a week later. Family history is positive for parental consanguinity. Histopathologic examination of the liver shows diffuse microvesicular steatosis, distinct focal hepatocellular fibrosis, and Kupffer cell glycogenosis. Citrulline levels are low. What enzyme is most likely deficient in this patient’s case?", "answer": "Carbamoyl phosphate synthetase I", "meta_info": "step1", "answer_idx": "A", "A": "Carbamoyl phosphate synthetase I", "B": "Homogentisic acid dioxygenase", "C": "Ornithine transcarbamylase", "D": "Propionyl-CoA carboxylase", "language": "en"}
{"question": "A 48-year-old woman is brought to the emergency department immediately following a motor vehicle accident in an unconscious state. She is managed as per emergency treatment protocols with the airway, breathing, and circulation being appropriately managed by mechanical ventilation, intravenous fluids, and other supportive drugs. A complete diagnostic evaluation suggests a diagnosis of traumatic brain injury and rules out the presence of fractures and other visceral injuries. About 36 hours after the accident, pulse oximetry shows deteriorating oxygen saturation. Chest auscultation reveals widespread rales over bilateral lung fields. Her arterial blood gas analysis shows a PaO2 of 100 mm Hg at FiO2 of 60%. Her bedside echocardiogram is normal and suggests a pulmonary capillary wedge pressure of 11 mm Hg. Which of the following signs is most likely to be present in her chest radiogram?", "answer": "Bilateral asymmetric pulmonary infiltrates with peripheral distribution", "meta_info": "step2&3", "answer_idx": "C", "A": "Deep sulcus sign with radiolucency along the costophrenic sulcus", "B": "Lung collapse at the hilum on one side and shift of the mediastinum to the opposite side", "C": "Bilateral asymmetric pulmonary infiltrates with peripheral distribution", "D": "Abrupt tapering of a pulmonary artery", "language": "en"}
{"question": "A 58-year-old man with a history of heart failure is admitted to the hospital for a cardiac transplantation. Five years ago, the patient had a mitral valve replacement with a porcine valve, but since then his heart failure symptoms have not improved. He developed persistent New York Heart Association class IV symptoms and was placed on the transplant waiting list. The heart to be transplanted originated from a deceased donor and the family has given consent for the transplantation. The patient is subsequently started on cyclosporine, and the postoperative period is unremarkable. He is readmitted to the emergency department 10 months later due to chest pain and severe shortness of breath. What is true about the medication prescribed to this patient?", "answer": "Inhibits calcineurin", "meta_info": "step1", "answer_idx": "C", "A": "Inhibits IMP dehydrogenase", "B": "Binds FK506 binding protein", "C": "Inhibits calcineurin", "D": "Is a precursor of 6-mercaptopurine", "language": "en"}
{"question": "An investigator studying renal physiology uses para-aminohippuric acid (PAH) to estimate the renal plasma flow in a human volunteer. An intravenous infusion of 400 mg of PAH solution is administered to the subject; effective renal plasma flow is calculated to be 600 ml/min. Next, an intravenous infusion of 1000 mg of PAH solution is administered to the subject; effective renal plasma flow is calculated to be 400 mL/min. Which of the following explains the measured decline in the calculated effective renal plasma flow?", "answer": "Decreased PAH clearance", "meta_info": "step1", "answer_idx": "D", "A": "Decreased serum protein binding", "B": "Efferent arteriole dilation", "C": "Afferent arteriole dilation", "D": "Decreased PAH clearance", "language": "en"}
{"question": "A 55-year-old man presents to his primary care physician with a 2-month history of fatigue. He says that he has been feeling tired, even after mild exertion, and decided to be evaluated because it has begun interfering with his job as a construction worker. He reports that he has been feeling numbness and tingling in his feet and has been tripping more frequently. His past medical history is significant for hypertension and type 2 diabetes well-controlled on metformin. His surgical history is significant for weight-loss surgery 2 years ago. Physical exam reveals bilateral vibration sensory deficits as well as conjunctival pallor. Selected lab results are presented as follows:\n\nHemoglobin: 9.1 g/dL\nHematocrit: 27%\nPlatelet count: 265,000/mm^3\nMean corpuscular volume: 112 µm^3\nReticulocyte count: 0.19%\n\nWhich of the following findings would most likely also be seen in this patient?", "answer": "High methylmalonic acid and high homocysteine levels", "meta_info": "step1", "answer_idx": "B", "A": "Elevated bilirubin levels", "B": "High methylmalonic acid and high homocysteine levels", "C": "High transferrin levels", "D": "Low haptoglobin levels", "language": "en"}
{"question": "A 27-year-old woman is brought to the emergency department by her coworker after having a generalized seizure at work. Her coworker reports that she is at 30 weeks' gestation and has mentioned headache and right upper quadrant pain earlier that day. Her temperature is 37°C (98.6°F), pulse is 91/min, and blood pressure is 170/102 mm Hg. Pulmonary examination shows bilateral rales. There is diffuse edema in the lower extremities. Deep tendon reflexes are increased bilaterally. She is not oriented to person, place, and time. Which of the following is the most appropriate initial pharmacotherapy?", "answer": "Magnesium sulfate", "meta_info": "step1", "answer_idx": "D", "A": "Calcium gluconate", "B": "Aspirin", "C": "Phenytoin", "D": "Magnesium sulfate", "language": "en"}
{"question": "A 23-year-old woman presents to the emergency department because of nausea. She has been experiencing severe intermittent nausea and diarrhea for the last year and refuses to leave the emergency department until she is told what is causing her symptoms. She hates hospitals but has reluctantly undergone numerous workups and imaging studies in order to discern what is wrong. All of the studies have been normal. She says that these symptoms have been causing her severe distress and is impairing her ability to perform her job. She says that she feels as if the nausea is worse when she is trying to work but says that she will continue to work as an insurance agent despite the physical discomfort. She has started restricting her diet to only graham crackers because she thinks that helps her symptoms. She has also started avoiding eating lunch because of the nausea. Which of the following disorders is most consistent with this patient's presentation?", "answer": "Somatic symptom disorder", "meta_info": "step1", "answer_idx": "D", "A": "Conversion disorder", "B": "Factitious disorder", "C": "Malingering", "D": "Somatic symptom disorder", "language": "en"}
{"question": "A 37-year-old homeless man is brought in by ambulance to the emergency department after being found unresponsive. He was found in an area of IV drug use with drug paraphernalia including glassine envelopes with a white powder residue. There is no past medical history available. He is treated with intranasal naloxone and stabilized in the field. Upon arrival to the hospital, his blood pressure is 100/70 mm Hg, pulse rate is 90/min, respiratory rate is 18/min, and temperature is 38.9°C (102.0°F). On physical examination, the patient is jaundiced with white scrapable exudates on the oral mucosa. His arms are covered with stigmata of IV drug use. Heart auscultation reveals a holosystolic murmur that is loudest at the left sternal border. The lungs are clear to auscultation bilaterally. Laboratory work is performed which shows:\nHemoglobin 10.9 g/dL\nHematocrit 37.7%\nLeukocyte count 1,500/mm3\nNeutrophils 65%\nLymphocytes 30%\nMonocytes 5%\nMean corpuscular volume 82.2 μm3\nPlatelet count 190,000/mm3\nErythrocyte sedimentation rate 35 mm/h\nAspartate aminotransferase 2,400 U/L\nAlanine aminotransferase 3,200 U/L\nCD4 count 27 cells/mm3\nHIV-1 antibody positive\nHepatitis C virus antibody positive\nQuantiferon-gold test negative\nWhich of the laboratory findings will be found in this patient?", "answer": "Positive blood culture", "meta_info": "step1", "answer_idx": "B", "A": "Atypical lymphocytes on blood smear", "B": "Positive blood culture", "C": "Elevated levels of cardiac troponin I and T", "D": "Positive sputum culture", "language": "en"}
{"question": "A 35-year-old woman, gravida 6, para 5, at 35 weeks' gestation comes to the emergency department because of vaginal bleeding for 2 hours. This is her second episode in the past 2 days. She has had no prenatal care. Her children were delivered vaginally. Her pulse is 122/min, respirations are 20/min, and blood pressure is 88/59 mm Hg. The abdomen is nontender, and no contractions are felt. There is active bright red vaginal bleeding. The fetal heart rate is 110/min. Two large-bore peripheral intravenous cannulas are inserted and intravenous fluids are administered. Three units of blood are typed and cross-matched. Which of the following is the most appropriate step in management?", "answer": "Perform cesarean delivery", "meta_info": "step2&3", "answer_idx": "A", "A": "Perform cesarean delivery", "B": "Hospitalization and observation", "C": "Administer magnesium sulfate", "D": "Perform cervical cerclage", "language": "en"}
{"question": "A 2710-g (6-lb) male newborn is delivered at 38 weeks of gestation to a 26-year-old woman, gravida 2, para 2. The pregnancy, labor, and delivery were uncomplicated. Breastfeeding is initiated. Which of the following supplements is most important to prevent a potentially life-threatening condition in this newborn?", "answer": "Vitamin K", "meta_info": "step1", "answer_idx": "B", "A": "Vitamin B1", "B": "Vitamin K", "C": "Folic acid", "D": "Iron", "language": "en"}
{"question": "A 4-month-old adopted infant is brought to the pediatrician because of feeding problems and recurrent fungal and bacterial infections. Her family has almost no background information about the infant. They report that she is a little fragile and looks different compared to other infants her age. Physical evaluation reveals a cleft lip with intact hard and soft palate and mild jaw malformation. An echocardiogram reveals an interrupted aortic arch. Further investigation reveals leukopenia and mild hypocalcemia. These findings support a diagnosis of which of the following?", "answer": "DiGeorge syndrome", "meta_info": "step1", "answer_idx": "B", "A": "Chediak-Higashi syndrome", "B": "DiGeorge syndrome", "C": "Severe combined immunodeficiency (SCID)", "D": "Wiskott-Aidrich syndrome", "language": "en"}
{"question": "A 48-year-old homeless man presents to clinic complaining of fatigue and fevers that \"began recently.\" Cardiac exam reveals a holosystolic murmur, heard best over the left lower sternal border. The murmur increases on inspiration. He also has track marks on his arms bilaterally. This presentation is consistent with which defect?", "answer": "Tricuspid regurgitation", "meta_info": "step1", "answer_idx": "B", "A": "Ventricular septal defect", "B": "Tricuspid regurgitation", "C": "Mitral regurgitation", "D": "Pulmonary stenosis", "language": "en"}
{"question": "A 65-year-old diabetic man presents to the emergency department with severe retrosternal chest pain, vomiting, and diaphoresis for the last half hour. He has a history of diabetic chronic kidney disease. He is on insulin therapy. Oral medications include aspirin, losartan, and metformin. The vital signs include: temperature 36.8°C (98.2°F), pulse 88/min, respiration rate 14/min, and blood pressure 120/65 mm Hg. The weight is 78 kg (172.0 lb). The lungs are clear to auscultation. Cardiac examination shows no abnormalities. The electrocardiogram (ECG) shows ST-segment elevation in the precordial leads V-1–V-4. Left ventricular ejection fraction is estimated at 55%. The laboratory test results are as follows:\nLaboratory test\nHemoglobin 15 g/dL\nLeukocyte count 9,500/mm3\nSerum\nGlucose 215 mg/dL\nNa+ 140 mEq/L\nCl− 102 mEq/L\nK+ 4.1 mEq/L\nUrea nitrogen 22 mg/dL\nCreatinine 1.4 mg/dL\nCardiac troponin I 0.8 ng/mL\nThe patient is being considered for primary percutaneous coronary intervention. Which of the following management steps is most likely to decrease the risk for development of acute renal failure in this patient?", "answer": "Intravenous normal saline", "meta_info": "step2&3", "answer_idx": "A", "A": "Intravenous normal saline", "B": "Reduced intravenous contrast dose", "C": "Preemptive hemodialysis", "D": "Withholding losartan", "language": "en"}
{"question": "A 7-year-old boy is brought in to your clinic by his mother, who is complaining of her son’s “dry scalp and hair loss.” She reports a scaling spot on his scalp developed around 2 months ago, soon after moving to a new school, which then became a larger bald spot. She denies that anyone in the household is exhibiting similar symptoms, but does recall a note that came home from school warning of a lice outbreak. Thus far, she has only tried daily baths with little improvement. The patient denies pain or itchiness, but the mother reports she does notice him scratching his scalp. The mother also reports that since her son has started at the new school, she has noticed an increase in his tics including excessive blinking and clearing of his throat. The patient's medical history is significant for asthma, allergic rhinitis, and attention deficient hyperactivity disorder. His current medications include fluticasone, salmeterol, loratadine, and methylphenidate. Family history includes obsessive compulsive disorder in his older sister. The mother also reports her father had a debilitating skin and joint disorder. On examination, you note swollen lymph glands at the back of the patient's ears and neck, and there are residual black dots within a patch of alopecia. Which of the following is the most likely diagnosis?", "answer": "Tinea capitis", "meta_info": "step2&3", "answer_idx": "C", "A": "Nummular dermatitis", "B": "Psoriasis", "C": "Tinea capitis", "D": "Trichotillomania", "language": "en"}
{"question": "A 68-year-old man is brought to the emergency department because of a 1-day history of fever and cloudy urine. He lives in a group home and has a chronic indwelling urinary catheter for benign prostatic hyperplasia. He has depression, for which he takes vilazodone. His temperature is 38.3°C (100.9°F), pulse is 89/min, and blood pressure is 110/74 mm Hg. Urine cultures grow Enterococcus faecium resistant to vancomycin, and therapy with intravenous linezolid is initiated. Eight hours later, he becomes agitated and starts to sweat profusely. His temperature is 39.6°C (103.3°F), pulse is 120/min, and blood pressure is 184/105 mm Hg. Neurologic examination shows increased deep tendon reflexes and clonus of the arms and legs. In addition to discontinuation of his current medication, administration of which of the following drugs is most appropriate in this patient?", "answer": "Cyproheptadine", "meta_info": "step1", "answer_idx": "D", "A": "Flumazenil", "B": "Dantrolene", "C": "Octreotide", "D": "Cyproheptadine", "language": "en"}
{"question": "A 54-year-old man is newly diagnosed with diabetes. As part of his clinical care, he undergoes testing to determine his kidney function. His glomerular filtration rate is found to be 80 mL/min. He is curious about how glomerular filtration occurs and which molecules are filtered the fastest and slowest. He is told that albumin is filtered less readily than sodium. Aside from size of the 2 molecules, which of the following features of the glomerular basement membrane accounts for this additional finding?", "answer": "Negative charge", "meta_info": "step1", "answer_idx": "C", "A": "Thickness", "B": "Positive charge", "C": "Negative charge", "D": "Presence of podocytes", "language": "en"}
{"question": "A 2-year-old boy with recurrent ear infections is brought to the pediatrician for a follow-up examination. He can walk with support and his vocabulary consists of approximately 50 words. His maternal uncle died in childhood from an unknown disease. Physical examination shows coarse facial features with an enlarged tongue. The abdomen is distended and both the liver and spleen tip are palpable. Laboratory studies show elevated total urinary glycosaminoglycan levels and an absence of plasma iduronate-2-sulfatase. Which of the following additional findings is most likely in this patient?", "answer": "Aggressive behavior", "meta_info": "step1", "answer_idx": "D", "A": "Optic atrophy", "B": "Cherry-red macula", "C": "Corneal clouding", "D": "Aggressive behavior", "language": "en"}
{"question": "A 29-year-old woman presents to a physician at 16 weeks gestation with fevers and a cough for 2 days. The cough is productive and occurs more often in the morning. Her medical history is not significant. Physical and laboratory evaluations suggest a diagnosis of community-acquired pneumonia. The physician explains to her that she needs to be treated with antibiotic therapy. She asks the physician if she can take levofloxacin because she tolerates levofloxacin. The physician explains that levofloxacin should be avoided during pregnancy because fetal exposure may increase the risk of a specific medical condition. Which of the following medical conditions is the physician referring to?", "answer": "Arthropathy", "meta_info": "step1", "answer_idx": "A", "A": "Arthropathy", "B": "Congenital heart defect", "C": "Deafness", "D": "Neural tube defect", "language": "en"}
{"question": "A large, multicenter study is conducted to assess the prevalence and mortality rate of pneumonia requiring hospitalization caused by various pathogens in 3 states over the past year. The study encompassed 250,000 adults between 45–79 years of age. The results for five different pathogens are shown:\nAll cases Fatal cases\nPathogen Number Percentage Number Percentage\nS. aureus 460 34.8 69 50.3\nInfluenza virus 288 21.8 12 8.8\nP. aeruginosa 136 10.3 17 12.4\nS. pneumoniae 338 25.5 27 19.7\nKlebsiella spp. 101 7.6 12 8.8\nTotal 1323 100 137 100\nA journalist would like to report the yearly case fatality rate of the pneumonia pathogen responsible for most hospitalizations in these states. Based on the study results, which of the following responses by the investigator is most accurate?\"", "answer": "15.0%", "meta_info": "step1", "answer_idx": "C", "A": "10.4%", "B": "34.8%", "C": "15.0%", "D": "12.5%", "language": "en"}
{"question": "A 52-year-old woman is admitted to the surgical unit after a laparoscopic hysterectomy for uterine leiomyomas performed 2 days ago. The surgery was performed under general anesthesia, blood loss was minimal, and there were no intraoperative complications. The patient reports lower abdominal pain and discomfort. Medical history is significant for multiple sclerosis that is well-controlled with ocrelizumab. Her last multiple sclerosis flare was approximately 7 years ago and presented with paresthesias and weakness of the upper extremities. Her temperature is 99°F (37.2 °C), blood pressure is 125/85 mmHg, pulse is 99/min, and respirations are 19/min. On physical exam, the patient appears restless and uncomfortable. The surgical incision sites are mildly erythematous and without discharge. There is tenderness with deep suprapubic palpation. Neurologic exam is unremarkable. Laboratory studies show:\n\nSerum:\nNa+: 144 mEq/L\nCl-: 100 mEq/L\nK+: 4.3 mEq/L\nHCO3-: 26 mEq/L\nGlucose: 105 mg/dL\nCreatinine: 3.1 mg/dL\n\nWhich of the following is the best next step in management?", "answer": "Bladder scan", "meta_info": "step2&3", "answer_idx": "B", "A": "Bethanechol administration", "B": "Bladder scan", "C": "Intravenous fluids", "D": "Urodynamic studies", "language": "en"}
{"question": "A 38-year-old female visits your office complaining of several years of joint swelling and stiffness that is worse in the morning and improves throughout the day. Physical examination reveals bilateral deformities at her proximal interphalangeal and metacarpophalangeal joints. The presence of which of the following in this patient’s serum would most help 'rule in' a diagnosis of rheumatoid arthritis:", "answer": "Anti-citrullinated protein antibody", "meta_info": "step1", "answer_idx": "B", "A": "Anti-nuclear antibody", "B": "Anti-citrullinated protein antibody", "C": "Anti-centromere antibody", "D": "Anti-smooth muscle antibody", "language": "en"}
{"question": "A 3-week-old infant presents to the emergency department with thick white discharge from his eyes that has persisted for the past 24 hours. The patient's birth was not complicated, and he was born at home vaginally with a mid-wife supervising the birth. The patient has a documented allergy to penicillin which caused anaphylaxis after it was given secondary to a maternal syphilis infection. His temperature is 97.6°F (36.4°C), blood pressure is 75/40 mm Hg, pulse is 130/min, respiratory rate is 24/min, and oxygen saturation is 98% on room air. The patient is currently sleeping. Physical exam is notable for bilateral purulent drainage from the eyes. Which of the following is a complication associated with the best treatment for this patient?", "answer": "Non-bilious projectile vomiting", "meta_info": "step2&3", "answer_idx": "B", "A": "Damage to the lacrimal ducts", "B": "Non-bilious projectile vomiting", "C": "Possible anaphylaxis and urticaria", "D": "Sedation and increased sleepiness", "language": "en"}
{"question": "A 10-year-old boy initially presented with a runny nose, fever, and watery eyes. His parents gave him aspirin. Over the next few days, the boy developed jaundice, became irritable, lethargic, and had seizures. The hepatic transaminases were significantly raised. The blood ammonia levels were also increased. A liver biopsy is performed. Which of the following histopathological findings will most likely be seen on the liver biopsy in this patient?", "answer": "Cytoplasmic fatty vacuolization in hepatocytes and swollen mitochondria", "meta_info": "step1", "answer_idx": "D", "A": "Hepatic granulomas", "B": "Iron accumulation and proliferation of smooth endoplasmic reticulum", "C": "Hepatocytes proliferation", "D": "Cytoplasmic fatty vacuolization in hepatocytes and swollen mitochondria", "language": "en"}
{"question": "An 18-year-old woman presents with a dry cough for the past 2 weeks. She also says that she is tired all the time and feels feverish and chilly at times. She is a college student and lives in a dormitory and says that her roommate has a similar cough. Past medical history is unremarkable. The patient denies any smoking history, alcohol or recreational drug use. Her vitals signs include: temperature 36.8°C (98.2°F), pulse 72/min, blood pressure 118/63 mm Hg, and respiratory rate 15/min. Physical examination is unremarkable. A chest radiograph reveals interstitial infiltrates that look worse than her symptoms. A nasopharyngeal swab is sent to the lab for a bacterial culture which shows colonies having fried-egg appearance on Eaton’s agar. Cold agglutinins are positive. Which of the following antibiotics would be best to administer to this patient?", "answer": "Erythromycin", "meta_info": "step1", "answer_idx": "C", "A": "Penicillin", "B": "Ceftriaxone", "C": "Erythromycin", "D": "Aztreonam", "language": "en"}
{"question": "A 9-year-old boy comes to the physician because of pain with swallowing and a burning sensation in his mouth for the past 10 days. Over the past 3 weeks, he has had increasing fatigue and runs out of breath easily. His father had gallstones, for which he underwent a cholecystectomy at the age of 30 years. The boy appears weak and lethargic. His temperature is 37.7°C (99.8°F), blood pressure is 110/68 mm Hg, pulse is 105/min, and respirations are 28/min. Examination shows pallor of the mucosal membranes, mild scleral icterus, and a swollen, red tongue. His spleen is enlarged and palpable 2–3 cm below the left costal margin. A complete blood cell count shows a hemoglobin concentration of 9.8 g/dL, mean corpuscular volume of 102 μm3, and a reticulocyte count of 0.4%. His peripheral blood smear shows erythrocytes without central pallor. Which of the following could have prevented this patient's chief complaints?", "answer": "Folic acid supplementation", "meta_info": "step2&3", "answer_idx": "A", "A": "Folic acid supplementation", "B": "Cholecystectomy", "C": "Gluten-free diet", "D": "Vitamin B12 injections", "language": "en"}
{"question": "A 62-year-old man is brought to the hospital because of a 6-hour history of worsening upper abdominal pain, nausea, and vomiting. He is diagnosed with acute calculous cholecystitis and scheduled for cholecystectomy the next day. He has congestive heart failure, hyperlipidemia, and hypertension. Physical examination shows no abnormalities. Current medications include metoprolol and simvastatin. One month ago, spironolactone was added to his medication regimen. Preoperative serum studies show:\nNa+ 138 mEq/L\nK+ 6.1 mEq/L\nCl- 100 mEq/L\nHCO3- 22 mEq/L\nUrea nitrogen 13 mg/dL\nCreatinine 1.0 mg/dL\nAn ECG shows normal sinus rhythm. In addition to discontinuation of spironolactone, which of the following is the most appropriate next step in management of this patient's hyperkalemia?\"", "answer": "Administer intravenous saline with furosemide", "meta_info": "step2&3", "answer_idx": "A", "A": "Administer intravenous saline with furosemide", "B": "Administer intravenous sodium bicarbonate", "C": "Order dietary modification", "D": "Administer intravenous calcium gluconate", "language": "en"}
{"question": "A 48-year-old woman comes to the physician for a follow-up examination. She has a history of type 2 diabetes mellitus and coronary artery disease. Current medications include metformin, aspirin, pravastatin, and losartan. Her body mass index is 30 kg/m2. Physical examination shows no abnormalities. Her hemoglobin A1c concentration is 8%. She does not want to start insulin injection therapy and is afraid that a new medication is going to cause weight gain. Empagliflozin is added to her diabetes regimen. This patient is at greatest risk for which of the following adverse effects of this new drug?", "answer": "Vaginal candidiasis", "meta_info": "step1", "answer_idx": "B", "A": "Localized lipodystrophy", "B": "Vaginal candidiasis", "C": "Hypoglycemia", "D": "Lactic acidosis", "language": "en"}
{"question": "A 62-year-old man with coronary artery disease and type 2 diabetes mellitus comes to the emergency department because of frequent episodes of palpitations for 4 days. His pulse is 165/min and blood pressure is 98/70 mm Hg. An ECG shows monomorphic ventricular tachycardia. Intravenous pharmacotherapy is begun with a highly lipophilic drug that prolongs the duration of the myocardial action potential and refractory period and inhibits adrenergic stimulation of the myocardium. The patient's ventricular tachycardia converts to normal sinus rhythm. He is discharged home with an oral formulation of the same drug. Which of the following adverse effects is most commonly associated with long-term use of this medication?", "answer": "Hyperthyroidism", "meta_info": "step1", "answer_idx": "C", "A": "Priapism", "B": "Angle-closure glaucoma", "C": "Hyperthyroidism", "D": "Hepatic adenoma", "language": "en"}
{"question": "A 45-year-old woman presents to her primary care physician complaining of weight gain. She states that for the past few months she has gained 10 pounds, especially around her abdomen. She says that this is despite going to kickboxing classes 5 days a week. She reports mild fatigue and muscle soreness, which she attributes to her exercise classes. She also complains of dry skin and hair, but feels that this might be due to showering twice a day. Her medical history is significant for major depressive disorder. She takes citalopram and a multivitamin. She smokes a half pack of cigarettes a day. She drinks 1 glass of red wine every night after dinner, and 3-4 drinks mixed with hard liquor on the weekend with friends. Her temperature is 98°F (36.7°C), blood pressure is 122/75, and pulse is 65/min. Her physical examination is unremarkable, except for xerosis. Labs are obtained, as shown below:\n\nSerum:\nNa+: 130 mEq/L\nK+: 4.1 mEq/L\nCl-: 101 mEq/L\nBUN: 16 mg/dL\nGlucose: 125 mg/dL\nCreatinine: 0.9 mg/dL\nAspartate aminotransferase (AST): 56 U/L\nAlanine aminotransferase (ALT): 70 U/L\nCreatine kinase (CK): 223 U/L (normal 22 to 198 U/L)\n\nHemoglobin A1c: 5.3\nTotal cholesterol: 264 mg/dL (normal < 200 mg/dL)\nLow-density lipoprotein (LDL) cholesterol: 117 mg/dL (normal < 100 mg/dL)\nHigh-density lipoprotein (HDL) cholesterol: 48 (normal > 50 mg/dL)\nTriglycerides: 163 mg/dL (normal < 150 mg/dL)\n\nWhich of the following is the most appropriate next step in management?", "answer": "Thyroxine", "meta_info": "step2&3", "answer_idx": "D", "A": "Fludrocortisone", "B": "Liver biopsy", "C": "Muscle biopsy", "D": "Thyroxine", "language": "en"}
{"question": "A 31-year-old woman comes to the physician because of white lesions in her mouth that she first noticed 5 days ago. The lesions are not painful or itchy. She has asthma treated with theophylline, inhaled β-adrenergic agonists, and corticosteroids. She smokes half a pack of cigarettes daily. She appears healthy. Vital signs are within normal limits. Oral examination shows white plaques on the buccal mucosa and hard palate that are firmly adherent and cannot be scraped off. She has no cervical or axillary lymphadenopathy. Which of the following is the most appropriate next step in the management of this patient?", "answer": "Biopsy of the lesions", "meta_info": "step2&3", "answer_idx": "B", "A": "Topical nystatin", "B": "Biopsy of the lesions", "C": "Smoking cessation", "D": "Culture of the lesions", "language": "en"}
{"question": "An 11-year-old male is brought to his pediatrician for continuing management of a chronic lung infection. He has had many lung infections throughout childhood, and current sputum samples show oxidase positive, non-lactose fermenting gram-negative rods that produce a blue-green pigment. Physical exam shows nasal polyps and nail clubbing. He has also recently been experiencing floating foul smelling diarrhea, so he is prescribed enzymes and vitamin supplementation tablets. Which of the following chromosomes most likely contains the gene mutation responsible for this patient's symptoms?", "answer": "7", "meta_info": "step1", "answer_idx": "A", "A": "7", "B": "17", "C": "22", "D": "X", "language": "en"}
{"question": "A 16-year-old girl is brought to the physician for a routine health maintenance examination. Her last visit was over a year ago. Menarche was at the age of 12 years; her last menstrual period was 4 months ago. She is on the school's gymnastics team and is currently preparing for an important competition. She is 165 cm (5 ft 5 in) tall and weighs 45 kg (99 lbs); BMI is 16.5 kg/m2. Her temperature is 36.8°C (98.2°F), pulse is 53/min, and blood pressure is 98/64 mm Hg. Examination shows yellowish discoloration of the skin. There are bilateral soft symmetric masses below her mandible. The skin over the dorsal side of her right hand is thickened. The patient is most likely to develop which of the following complications?", "answer": "Fractures", "meta_info": "step2&3", "answer_idx": "C", "A": "Recurrent infections", "B": "Ovarian cancer", "C": "Fractures", "D": "Hyperthyroidism", "language": "en"}
{"question": "A 32-year-old female is seeing an endocrinologist for the first time after a recently-diagnosed illness by her primary care physician. Her temperature is 99.7 °F (37.6 °C), blood pressure is 110/65 mmHg, pulse is 89/min, and respirations are 11/min. Prior to starting medical management, the patient is cautioned to alert her providers if she becomes pregnant, as this medication crosses the placenta and is known to cause aplasia cutis. Which of the following activities is inhibited by this medication?", "answer": "Coupling of iodine with tyrosine residues", "meta_info": "step1", "answer_idx": "A", "A": "Coupling of iodine with tyrosine residues", "B": "Production of TRH", "C": "Response of peripheral tissues to thyroid hormone", "D": "Sensitivity of anterior pituitary to TRH", "language": "en"}
{"question": "A 62 year old woman presents to her doctor complaining of painful tingling and burning in her feet for the past year. Careful physical exam demonstrates that she has poor position sense in her bilateral lower extremities. Lab results reveal elevated urine and plasma methylmalonic acid concentrations. What vitamin deficiency is this woman most likely suffering from?", "answer": "Vitamin B12", "meta_info": "step1", "answer_idx": "C", "A": "Vitamin C", "B": "Vitamin B1", "C": "Vitamin B12", "D": "Biotin", "language": "en"}
{"question": "A 52-year-old man visits his psychiatrist saying he feels sad most of the time. 5 months ago, he lost his daughter in a motor vehicle accident and since then has been unable to cope with this loss. He spends most of his day thinking about her and this often distracts him from his daily activities. He also admits to hearing his daughter’s voice in his sleep and sometimes has dreams about her. During the day, he sometimes gets brief glimpses of her. He believes this is because he was not able to do anything to help her during the last moments of her life. Other than this, he is able to get along his daily life and has never contemplated suicide. But he often wishes he could be close to his daughter again. Which of the following best describes the symptoms this patient is expressing?", "answer": "Normal grief reaction", "meta_info": "step2&3", "answer_idx": "C", "A": "Brief psychotic disorder", "B": "Major depressive disorder", "C": "Normal grief reaction", "D": "Post-traumatic stress disorder", "language": "en"}
{"question": "A 68-year-old woman with hypertension and congestive heart failure is brought to the emergency department because of a 2-day history of shortness of breath and confusion. Her pulse is 112/min, respirations are 22/min, and blood pressure is 73/45 mm Hg. Examination shows cool extremities, jugular venous distention, and diffuse crackles in the lungs. Treatment with intravenous dobutamine is begun. Which of the following is the primary mechanism of action of this drug?", "answer": "β1-adrenergic agonism", "meta_info": "step1", "answer_idx": "C", "A": "α2-adrenergic agonism", "B": "β2-adrenergic antagonism", "C": "β1-adrenergic agonism", "D": "α1-adrenergic antagonism", "language": "en"}
{"question": "A 58-year-old man comes to the physician for a follow-up examination dressed in a vampire costume. He is on his way to a Halloween party at an assisted-living facility, where he works as a patient care attendant. He feels well. He has a history of hypertension that is well controlled. He was also diagnosed with type 2 diabetes two months ago during a routine check up. His current medications include lisinopril and metformin. His father died of colon cancer at 52 years of age. His screening colonoscopy at age 55 was normal. He used to smoke half a pack of cigarettes daily for 10 years but quit 15 years ago. His temperature is 37°C (98.6°F), pulse is 90/min, respirations are 14/min, and blood pressure is 138/90 mm Hg. Physical examination shows no abnormalities. His hemoglobin A1c two months ago was 7.6%. Which of the following health maintenance recommendations is most appropriate at this time?", "answer": "Influenza vaccine", "meta_info": "step2&3", "answer_idx": "B", "A": "Hemoglobin A1c measurement", "B": "Influenza vaccine", "C": "Prostate-specific antigen measurement", "D": "Colonoscopy", "language": "en"}
{"question": "A 33-year-old homeless man presents to the emergency department with an altered mental status. The patient was found minimally responsive at a local mall and was brought in by police. The patient has a past medical history of polysubstance abuse, anxiety, depression, and panic disorder. His current medications include sertraline, clonazepam, and amitriptyline. His temperature is 98.7°F (37.1°C), blood pressure is 117/68 mmHg, pulse is 80/min, respirations are 10/min, and oxygen saturation is 98% on room air. Physical exam is notable for a somnolent man. Neurological exam reveals 4 mm pupils, which are equal and reactive to light, and a patient who responds incoherently to questions when stimulated. The patient has normoactive bowel sounds and is non-tender in all 4 quadrants. Laboratory values are ordered as seen below.\n\nSerum:\nNa+: 139 mEq/L\nCl-: 100 mEq/L\nK+: 4.3 mEq/L\nHCO3-: 25 mEq/L\nBUN: 20 mg/dL\nGlucose: 99 mg/dL\nCreatinine: 1.1 mg/dL\nCa2+: 10.2 mg/dL\nEthanol: negative\n\nAn initial ECG is unremarkable. Which of the following is the best treatment for this patient?", "answer": "Observation", "meta_info": "step2&3", "answer_idx": "C", "A": "Flumazenil", "B": "Fomepizole", "C": "Observation", "D": "Sodium bicarbonate", "language": "en"}
{"question": "A 6-month-old boy is brought to her pediatrician for a checkup and vaccines. He was born at 39 weeks gestation via spontaneous vaginal delivery. He is meeting all the developmental milestones. His prenatal history was complicated with maternal diabetes. He is being breastfed exclusively and has 3–4 wet diapers a day. On physical exam, the vital signs include: temperature 37.0°C (98.6°F), blood pressure 85/45 mm Hg, pulse 140/min, and respiratory rate is 31/min. On physical examination, the patient is alert and responsive. Height, weight, and head circumference are above the 90th percentile. Which of the following vaccines should be administered for this patient at this visit?", "answer": "RV, DTaP, PCV, Hib, IPV", "meta_info": "step2&3", "answer_idx": "B", "A": "RV, Tdap, PCV, Hib", "B": "RV, DTaP, PCV, Hib, IPV", "C": "Hep B, DTaP, Influenza", "D": "RV, Hep B, Hep A", "language": "en"}
{"question": "A 23-year-old woman is brought to the emergency department 20 minutes after being involved in a high-speed motor vehicle collision where she was the unrestrained driver. She was found thrown across the dashboard of the car. On arrival, she appears lethargic. She is unable to provide a history. Her pulse is 133/min, respirations are 23/min, and blood pressure is 90/60 mm Hg. Examination shows a 2-cm laceration over the right upper extremity. The pupils are equal and reactive to light. There are multiple bruises over the chest and abdomen. The lungs are clear to auscultation. Cardiac examination shows no abnormalities. The abdomen is soft and not distended. Neurologic examination shows no focal findings. 0.9% saline infusion is begun. Which of the following is the most appropriate next step in management?", "answer": "Ultrasonography", "meta_info": "step2&3", "answer_idx": "D", "A": "Observation", "B": "Exploratory laparotomy", "C": "CT scan of the abdomen", "D": "Ultrasonography", "language": "en"}
{"question": "Three days after starting a new medication, a 66-year-old woman with resistant hypertension and hyperlipidemia comes to the doctor because of decreased urination. She denies dysuria, fevers, or chills. Blood pressure is 133/67 mm Hg. Physical examination shows no abnormalities. Compared to measurements from one week ago, the glomerular filtration rate is markedly decreased and plasma renin activity is elevated. A duplex ultrasound of the kidneys shows increased systolic flow velocity in both renal arteries when compared to the aorta. Which of the following drugs is the most likely cause of this patient's worsening renal function?", "answer": "Enalapril", "meta_info": "step1", "answer_idx": "C", "A": "Furosemide", "B": "Spironolactone", "C": "Enalapril", "D": "Atenolol", "language": "en"}
{"question": "An investigator is conducting an experiment to develop a new drug against HIV infection. HIV-infected and uninfected CD4 T-cell lines are mixed in-vitro with a chemically modified synthetic peptide triazole complex. The complex is found to have a high binding affinity to the gp120 protein, irreversibly inhibiting its function and reducing CD4 T cell infection. Inhibition of which of the following steps of HIV infection is the most likely therapeutic effect of this experimental drug?", "answer": "Attachment to host CD4 T-cells", "meta_info": "step1", "answer_idx": "D", "A": "Incorporation of viral genome into host cell DNA", "B": "Transcription of the viral genome", "C": "Fusion and entry into CD4 T-cells", "D": "Attachment to host CD4 T-cells", "language": "en"}
{"question": "A 35-year-old man presents to the physician for a medical evaluation necessary before joining the armed force services. He is a healthy man with no history of smoking or substance abuse. His past medical history is not significant. His vital signs are stable and his systemic examination is within normal limits. Examination of his respiratory system, including auscultation of his chest, does not reveal any abnormality. His laboratory investigations are within normal limits but his chest radiogram shows a solitary pulmonary nodule (SPN), size 9 mm (0.35 in) in diameter, in the middle zone of his right lung. The physician compares the radiogram with a radiogram obtained 3 years back for pre-employment medical evaluation. The physician notes that a similar SPN with the same size was present in the previous radiogram at the same location. Which of the following is the next best step in his evaluation?", "answer": "No further workup", "meta_info": "step2&3", "answer_idx": "A", "A": "No further workup", "B": "Thin-section computed tomography (CT) scan", "C": "Positron emission tomography (PET) scan", "D": "Follow-up after 12 months; if unchanged, no further follow-up", "language": "en"}
{"question": "A 32-year-old man presents to his primary care physician because he has been experiencing fatigue and back pain over the last 2 days. He suffered from malaria after going on vacation 5 years ago and recently started taking a medication to deal with a latent form of this infection. He started developing these symptoms 36 hours after taking the first dose and noticed his urine became progressively darker during that time. On physical exam he is found to have scleral icterus and skin jaundice. Labs are obtained with the following results:\n\nHematocrit: 32% (Normal: 41%-53%)\nHemoglobin: 10.6 g/dL (Normal: 13.5-17.5 g/dL)\nLeukocyte count: 8500/mm3 (Normal: 4500-11,000/mm3)\nPlatelet count: 273,000/mm3 (Normal: 150,000-400,000/mm3)\n\nWhich of the following would most likely be seen on a peripheral blood smear in this patient?", "answer": "Small round inclusions of denatured hemoglobin", "meta_info": "step1", "answer_idx": "B", "A": "Helmet-shaped red blood cells", "B": "Small round inclusions of denatured hemoglobin", "C": "Small round inclusions of nuclear remnants", "D": "Target-shaped red blood cells", "language": "en"}
{"question": "A 30-year-old woman presents to the office for routine examination. She has no medical complaints except for mild burning sensation in her eyes and an occasional dry cough. She denies fever, headache, or any recent illnesses. Past medical history is unremarkable and she takes no medications. She does not smoke cigarettes or drinks alcohol. Her temperature is 37.0°C (98.6°F), the blood pressure is 110/70 mm Hg, the pulse is 78/min, and the respirations are 12/min. Physical examination is normal except for bilateral conjunctival injection. Laboratory results and chest X-ray is shown below:\nSerum chemistry\n  Sodium 145 mEq/L\n  Potassium 4.1 mEq/L\n  Chloride 98 mEq/L\n  Calcium 13 mEq/L\n  Bicarbonate 20 mEq/L\n  Blood urea nitrogen 8 mEq/L\n  Creatinine 0.7 mEq/L\n  Glucose 96 mEq/L\nUrine toxicology Negative\nWhich of the following abnormalities would most likely be seen in this patient?", "answer": "Increased ACE levels", "meta_info": "step2&3", "answer_idx": "A", "A": "Increased ACE levels", "B": "Increased ADH levels", "C": "Presence of anti-dsDNA antibodies", "D": "Caseating granulomas in lung tissue biopsy", "language": "en"}
{"question": "A 60-year-old man presents to a physician with the complaint of a persistent cough for a year. He has visited multiple physicians to date, but there has been no conclusive diagnosis. He has been a smoker since the age of 30. There is no history of significant expectoration, blood in sputum, wheezing, or breathing difficulty, but he has lost approx. 6.35 kg (14 lb) of weight over the last 9 months. On physical examination, his vital signs are stable, and examination of the chest reveals decreased breath sounds over the left infrascapular region. His chest radiogram suggests atelectasis in the left lower lobe. A detailed evaluation confirms a diagnosis of non-small cell lung carcinoma involving the left main bronchus, which is 4 cm in size and is located 3.8 cm (1.5 in) from the carina. Ipsilateral hilar lymph nodes, ipsilateral subcarinal lymph nodes, and ipsilateral scalene lymph nodes are involved in metastasis with no distant metastasis. Investigations also suggest that the patient does not have any comorbidity that contraindicates any anti-cancer treatment modality and that his performance status is good. Which of the following is the initial treatment of choice for the patient?", "answer": "Concurrent chemoradiotherapy", "meta_info": "step2&3", "answer_idx": "C", "A": "Surgery followed by adjuvant chemotherapy", "B": "Chemotherapy only", "C": "Concurrent chemoradiotherapy", "D": "Radiation therapy only", "language": "en"}
{"question": "A previously healthy 25-year-old woman comes to the physician because of a 3-week history of fever, recurrent headaches, and anorexia. One month ago, she returned from a camping trip in Chile. Her temperature is 39.3°C (102.8°F). Examination shows a swelling in the left periorbital region and axillary, cervical, and inguinal lymphadenopathy. A blood sample is obtained. Processing of the sample with which of the following methods is most likely to confirm the diagnosis?", "answer": "Staining with Giemsa dye", "meta_info": "step1", "answer_idx": "B", "A": "Staining with India ink", "B": "Staining with Giemsa dye", "C": "Staining of glycogen", "D": "Staining with silver", "language": "en"}
{"question": "A 57-year-old man presents to the emergency department with chest and back pain. He states that his symptoms started suddenly 1 hour ago and have persisted. He has a past medical history of hypertension and diabetes. His temperature is 98.5°F (36.9°C), blood pressure is 168/111 mmHg, pulse is 95/min, respirations are 14/min, and oxygen saturation is 99% on room air. Physical exam is notable for an uncomfortable man but is otherwise within normal limits. An initial ECG is unremarkable. Laboratory values are ordered as seen below.\n\nHemoglobin: 15 g/dL\nHematocrit: 45%\nLeukocyte count: 6,300/mm^3 with normal differential\nPlatelet count: 222,000/mm^3\n\nSerum:\nNa+: 141 mEq/L\nCl-: 103 mEq/L\nK+: 4.5 mEq/L\nHCO3-: 24 mEq/L\nBUN: 42 mg/dL\nGlucose: 129 mg/dL\nCreatinine: 1.9 mg/dL\nCa2+: 10.2 mg/dL\n\nWhich of the following is the best next step in management?", "answer": "Transesophageal echocardiography", "meta_info": "step2&3", "answer_idx": "D", "A": "CT angiogram of the chest", "B": "D-dimer", "C": "Esmolol", "D": "Transesophageal echocardiography", "language": "en"}
{"question": "A 2-week-old infant is brought to the pediatrician for the first time by his parents. His mother received regular prenatal care and the child was born at home under the guidance of a midwife and a doula. The child appears well. The parents tell you they do not plan to have their child receive any vaccines. After a discussion regarding the risks and benefits of vaccines, the parents are still adamant in their wishes to forgo. Which of the following is the most appropriate course of action?", "answer": "Document the visit, specifically the detailing of risks and benefits and the parents' refusal of treatment", "meta_info": "step1", "answer_idx": "D", "A": "Call child protective services", "B": "Refuse to continue to care for the child", "C": "Give any scheduled vaccines during that visit against the will of the parents", "D": "Document the visit, specifically the detailing of risks and benefits and the parents' refusal of treatment", "language": "en"}
{"question": "A 15-year-old boy is brought in to his pediatrician's office by his step-mother for uncontrollable behavior. She reports he has an extensive history of detention for outbursts in class. He recently got expelled from school for fist fighting. At home, he punches his younger brother when he’s angry. The family had to give their cat away to a neighbor because the patient tried to set it on fire. The patient’s medical history is significant for bed-wetting until he was 11. His father has adult attention deficit disorder. The patient states that he thinks school is a “joke.” He denies having close friends and says “the kids in my town are stupid anyway.” He calmly describes how he would like to burn down all their houses. He admits to trying alcohol and cocaine but denies any other illicit drugs. Which of the following is the patient’s most likely diagnosis?", "answer": "Conduct disorder", "meta_info": "step2&3", "answer_idx": "C", "A": "Antisocial personality disorder", "B": "Attention deficient hyperactivity disorder", "C": "Conduct disorder", "D": "Substance abuse", "language": "en"}
{"question": "A 30-year-old female complains of heat intolerance, excessive sweating, and recent unintentional weight loss. She denies alcohol, tobacco, and other drug use and does not take any medications. Laboratory analysis reveals elevated serum T4 and decreased serum TSH. You elect to manage the patient’s condition pharmacologically with methimazole. Methimazole interferes with the function of which of the following proteins?", "answer": "Thyroid peroxidase", "meta_info": "step1", "answer_idx": "B", "A": "Sex-hormone binding globulin", "B": "Thyroid peroxidase", "C": "5’-deiodinase", "D": "Sodium/iodide symporter", "language": "en"}
{"question": "A 40-year-old woman presents to her primary care physician with complaints of worsening muscle aches and diffuse weakness over the past several months. She states that she now has difficulty climbing stairs and extending her neck. Ultimately, she became more concerned when she began having trouble swallowing and experienced shortness of breath last night which has resolved. Her temperature is 98.5°F (36.9°C), blood pressure is 120/84 mmHg, pulse is 70/min, respirations are 12/min, and oxygen saturation is 98% on room air. Physical exam is notable for 2/5 strength of the proximal muscles of the upper and lower extremities. Dermatologic, cardiac, and pulmonary exam are unremarkable. The patient is tolerating oral secretions and has no difficulty swallowing or protecting her airway currently. Laboratory studies are notable for an elevated CRP and aldolase. Which of the following is the most appropriate treatment for this patient?", "answer": "Prednisone", "meta_info": "step2&3", "answer_idx": "D", "A": "Intravenous immunoglobulin", "B": "Methotrexate", "C": "Naproxen", "D": "Prednisone", "language": "en"}
{"question": "A 50-year-old woman visits her primary care practitioner with the complaints of generalized weakness, lightheadedness, and fatigability for the past month. She also claims to have epigastric pain, heartburn, and a sensation of a lump in her throat. Her family history is irrelevant, but her medical history is significant for a Pap smear that reported atypical squamous cells of undetermined significance (ASCUS), which was followed up with a cervical biopsy negative for malignancy. She occasionally takes over-the-counter medicines to cope with the heartburn, and recently her hemoglobin was found to be 11 g/dL, for which she received iron and vitamin B12 supplementation. Physical examination is unremarkable, except for pale skin, and a pulse of 120/min. Which of the following is the next best step in the management of this patient?", "answer": "Endoscopy", "meta_info": "step2&3", "answer_idx": "C", "A": "Proton pump inhibitor", "B": "Anti-H2 agent", "C": "Endoscopy", "D": "Diet and lifestyle recommendations", "language": "en"}
{"question": "A 67-year-old man presents to a primary care clinic to establish care after moving from another state. According to his prior medical records, he last saw a physician 4 years ago and had no significant medical problems at that time. Records also show a normal EKG and normal colonoscopy results at that time. The patient reports feeling well overall, but review of systems is positive for 1 year of mild cough productive of clear sputum and 2 years of increased urinary frequency. He denies fever, chills, dyspnea, dysuria or hematuria. He denies illicit drug use but has been drinking approximately 1-2 beers per night and smoking 1 pack of cigarettes per day since age 20. Physical exam is unremarkable. Which of the following tests is indicated at this time?", "answer": "Abdominal ultrasound", "meta_info": "step2&3", "answer_idx": "A", "A": "Abdominal ultrasound", "B": "Bladder ultrasound", "C": "Serum prostate specific antigen (PSA) testing", "D": "Sputum culture", "language": "en"}
{"question": "An 8-year-old boy is brought to the physician for evaluation of an excessive bleeding after undergoing a dental procedure. Laboratory studies show a platelet count of 195,000/mm3, a partial thromboplastin time of 44 sec, and a prothrombin time of 12 sec. A one-stage clotting assay shows a decreased factor VIII. Therapy with a drug that acts on endothelial cells is initiated. This drug is most likely to result in which of the following?", "answer": "Increased permeability to urea in the collecting duct", "meta_info": "step1", "answer_idx": "C", "A": "Decreased cAMP in renal tubular cells", "B": "Increased tubular fluid osmolarity in the loop of Henle", "C": "Increased permeability to urea in the collecting duct", "D": "Increased bleeding time", "language": "en"}
{"question": "A young girl is brought to the physician by her mother for a well-child examination. She is at the 55th percentile for height and at the 40th percentile for weight. Vital signs are within normal limits. Physical examination shows no abnormalities. She is able to follow simple commands, such as “close your eyes, then stick out your tongue,” but she is unable to follow 3-step commands. She knows approximately 75 words, and half of her speech is understandable. She can say 2-word phrases, and she is able to name many parts of the body. Assuming normal development, which of the following milestones would be expected in a patient this age?", "answer": "Kicks a ball", "meta_info": "step2&3", "answer_idx": "B", "A": "Separates easily from parents", "B": "Kicks a ball", "C": "Pedals a tricycle", "D": "Hops on one foot", "language": "en"}
{"question": "An investigator is studying the association between exclusive breastfeeding and body weight in infants. The body weights of 15 exclusively breastfed infants at the age of 6 months are measured. Results are shown:\nPatient Body weight (kg)\n1 7.0\n2 6.0\n3 6.1\n4 6.8\n5 7.2\n6 6.4\n7 6.2\n8 6.8\n9 6.5\n10 7.3\n11 6.3\n12 8.5\n13 6.9\n14 6.6\n15 5.2\nOne of the computed measures of central tendency is 6.8 kg. Which of the following characteristics is generally true about this measurement?\"", "answer": "It is resistant to outliers.", "meta_info": "step1", "answer_idx": "B", "A": "It is not applicable for qualitative data analysis.", "B": "It is resistant to outliers.", "C": "Its value only occurs once in a data set.", "D": "It is useful to assess the extent of data variability.", "language": "en"}
{"question": "A 32-year-old man presents to his primary care provider with right leg weakness and numbness. He reports a 2-day history of “clumsiness” in his right lower extremity after playing in his company’s annual weekend-long charity baseball tournament. He says a similar episode happened 1 year ago during the same tournament. He has a history of major depressive disorder and right distal radius fracture status post-closed reduction and casting after falling 2 years ago. He takes fluoxetine. He also reports that he several years ago he had an isolated episode of decreased vision and inability to move his right eye that resolved on its own. He has a 15-pack-year smoking history and drinks 3-4 beers per week. His temperature is 98.4°F (36.9°C), blood pressure is 115/65 mmHg, pulse is 85/min, and respirations are 18/min. On exam, hip flexion, knee extension, and ankle dorsiflexion are all 3/5 on his right and 5/5 on his left. Right Achilles and patellar reflexes are 1+ on the right and 2+ on the left. He has decreased sensation to light touch throughout the right leg especially below the knee. Additional questioning would most likely reveal which of the following additional features about this patient’s current symptoms?", "answer": "Symptom exacerbation in the heat", "meta_info": "step1", "answer_idx": "C", "A": "Concomitant hyperreflexia", "B": "Symptom improvement in the heat", "C": "Symptom exacerbation in the heat", "D": "Symptom exacerbation with repetitive muscle contractions", "language": "en"}
{"question": "A 56-year-old man comes to the physician because of throat pain and increasing difficulty swallowing food for the past 5 months. He has also had episodic left ear pain for the past 3 months. He has hypertension. His only medication is amlodipine. His father died of laryngeal cancer at the age of 55 years. He has smoked one pack of cigarettes daily for 36 years. He drinks 2–3 beers daily. Vital signs are within normal limits. Examination shows left cervical lymphadenopathy. Oropharyngeal examination shows a 3-cm ulcerating left tonsillar mass. Examination of both auditory canals is unremarkable. Which of the following is the most appropriate initial step in management?", "answer": "Panendoscopy", "meta_info": "step2&3", "answer_idx": "B", "A": "Nasopharyngoscopy", "B": "Panendoscopy", "C": "Barium swallow", "D": "Laryngoscopy\n\"", "language": "en"}
{"question": "A 23-year-old woman presents to the emergency department with abdominal pain. The patient states that she has pain in her back that radiates to her abdomen. The pain started yesterday and is episodic. She describes the pain as a 10/10 when it occurs. The patient has a past medical history of asthma, anxiety, and chlamydia that was appropriately treated. Her current medications include fluoxetine. The patient's lab values are ordered as seen below.\n\nHemoglobin: 14 g/dL\nHematocrit: 40%\nLeukocyte count: 8,500 cells/mm^3 with normal differential\nPlatelet count: 225,000/mm^3\n\nSerum:\nNa+: 140 mEq/L\nCl-: 100 mEq/L\nK+: 4.9 mEq/L\nHCO3-: 24 mEq/L\nBUN: 22 mg/dL\nGlucose: 89 mg/dL\nCreatinine: 1.2 mg/dL\nCa2+: 10.0 mg/dL\nAST: 11 U/L\nALT: 11 U/L\n\nUrine:\nColor: amber\nNitrites: negative\nNa+: 12 mmol/24 hours\nBeta-hCG: positive\nRed blood cells: 11/hpf\n\nWhich of the following is the best test for this patient's most likely diagnosis?", "answer": "Renal ultrasound", "meta_info": "step2&3", "answer_idx": "D", "A": "Abdominal CT", "B": "Transvaginal ultrasound", "C": "Abdominal ultrasound", "D": "Renal ultrasound", "language": "en"}
{"question": "A baby is delivered via cesarean section on the 31st gestational week. The child has tachypnea, nasal flaring, and subcostal, and intercostal retraction. Nasogastric tube was positioned without problems. Chest radiography shows bilateral, diffuse, ground-glass appearance, air bronchograms, and poor lung expansion. What is the best treatment plan in the present case?", "answer": "Surfactant administration and oxygen therapy", "meta_info": "step1", "answer_idx": "B", "A": "No therapy right away, only observation", "B": "Surfactant administration and oxygen therapy", "C": "Antibiotics", "D": "Emergency surgical repair of tracheoesophageal fistula", "language": "en"}
{"question": "A previously healthy 38-year-old man comes to the emergency department for evaluation of several hours of severe, right-sided, colicky flank pain that radiates to the groin. He drinks 2–3 energy drinks daily. An x-ray of the abdomen shows a 4-mm radiopaque mass in the right ureter. Microscopic examination of the urine shows biconcave, dumbbell-shaped crystals. Which of the following is most likely to prevent future episodes of flank pain?", "answer": "Maintain adequate hydration", "meta_info": "step1", "answer_idx": "C", "A": "Begin loop diuretic", "B": "Maintain acidic urine", "C": "Maintain adequate hydration", "D": "Start high-dose vitamin C", "language": "en"}
{"question": "A 45-year-old woman presents for evaluation of mild painless postcoital bleeding for the past 6 months. Recently, she started to note irregular intermenstrual bleeding. She has a regular menstrual cycle that lasts 30 days. She has no history of genital infections or any other major gynecologic diseases. She has 1 sexual partner and uses barrier contraception for birth control. The pelvic examination shows an erosive necrotizing lesion (6 cm in diameter) that involves the posterior lip of the cervix and extends to the cervical canal and posterior vaginal apex. Cervical mobility is decreased. The uterus is not enlarged and the ovaries are non-palpable. A colposcopy is performed and a biopsy is obtained. The histologic evaluation shows irregularly-shaped nests of squamous epithelium cells with large pleomorphic nuclei, inconspicuous nucleoli, a clear cytoplasm, and increased mitoses that infiltrate the stroma for greater than 10 mm. Which of the following investigations is the main method for staging the patient’s condition?", "answer": "Clinical examination", "meta_info": "step2&3", "answer_idx": "B", "A": "Pelvic MRI", "B": "Clinical examination", "C": "Pelvic CT", "D": "PET-CT", "language": "en"}
{"question": "A 69-year-old man presents for surgery due to chronic painful diverticula in the sigmoid colon. The patient is a Jehovah's witness and refuses a transfusion of blood products even in an emergency. Which artery should be briefly clamped to prevent bleeding during the partial sigmoidectomy?", "answer": "Inferior mesenteric artery", "meta_info": "step1", "answer_idx": "B", "A": "Superior mesenteric artery", "B": "Inferior mesenteric artery", "C": "Celiac trunk", "D": "Inferior rectal artery", "language": "en"}
{"question": "A thymic sample from a fetus is examined. One cell type found was double-positive for the CD4 and CD8 receptors. What is the identity of these double-positive cells?", "answer": "Immature T-cells of the thymic cortex", "meta_info": "step1", "answer_idx": "B", "A": "B-cells", "B": "Immature T-cells of the thymic cortex", "C": "Immature T-cells of the thymic medulla", "D": "Macrophages", "language": "en"}
{"question": "An investigator is studying the antimicrobial resistance profile of a bacterial pathogen using disk diffusion testing. The pathogen is isolated onto agar plates and antibiotic wafers are added to the plates. The inhibitory zone diameters are then recorded and used to define susceptibility thresholds. The results of the testing for the pathogen shown:\nDrug Susceptibility\nPenicillin G Resistant\nCefazolin Resistant\nDoxycycline Susceptible\nImipenem Resistant\nAzithromycin Susceptible\nVancomycin Resistant\nWhich of the following is most likely the organism being studied?\"", "answer": "Ureaplasma urealyticum", "meta_info": "step1", "answer_idx": "D", "A": "Staphylococcus aureus", "B": "Clostridioides difficile", "C": "Borrelia burgdorferi", "D": "Ureaplasma urealyticum", "language": "en"}
{"question": "A 30-year-old man comes to the physician for evaluation of infertility. He does not smoke, drink, or take any medications. Physical examination shows no abnormalities. Serum analysis shows anti-sperm antibodies. What is the most likely cause of this patient's serum finding?", "answer": "Defect in Sertoli cell function", "meta_info": "step1", "answer_idx": "C", "A": "Increase in testicular temperature", "B": "Dysgenesis of vas deferens", "C": "Defect in Sertoli cell function", "D": "Defect in GnRH production\n\"", "language": "en"}
{"question": "A mother calls the psychiatrist, saying that she is concerned about her 18-year-old son who has become quite emaciated over the past several months. She has noticed that his pupils are enlarged, he has frequent nose bleeds, and he wears long sleeve shirts even in warm weather. His personality has changed quite dramatically as well, as he repeatedly steals from her and sells anything valuable in the house. He also has become overconfident, aggressive, and paranoid. Which of the following is a risk of the drug that the son is most likely using?", "answer": "Sudden cardiac arrest", "meta_info": "step1", "answer_idx": "B", "A": "Serotonin syndrome", "B": "Sudden cardiac arrest", "C": "CNS white matter lesions", "D": "Increased risk of schizophrenia in predisposed patients", "language": "en"}
{"question": "A 48-year-old man is brought to the physician by his wife because he has become increasingly restless and anxious. His wife says that he has seemed sad and irritable for the past 4 months. He lost his job as a store clerk because he often lied to avoid work, and spent most of his days on the phone placing bets on football games. He avoids all family-related events because he has borrowed money from most of his relatives. He is hopeful that his symptoms will improve once he is able to win some of his money back. He previously smoked 8–10 cigarettes daily but quit 1 month ago. He drinks beer on the weekends. On examination, he is uncooperative and dismissive. He is mildly tremulous. Neurologic examination is normal. He is oriented to person, place, and time. Which of the following is the most likely diagnosis?", "answer": "Gambling disorder", "meta_info": "step2&3", "answer_idx": "A", "A": "Gambling disorder", "B": "Alcohol withdrawal", "C": "Bipolar II disorder", "D": "Adjustment disorder", "language": "en"}
{"question": "A 28-year-old man comes to the emergency department because of an excruciating headache that started 30 minutes ago. The pain is located around the right eye and it awoke him from sleep. Over the past two weeks, he has had similar headaches around the same time of the day, and he reports pacing around restlessly during these episodes. Physical examination shows conjunctival injection and tearing of the right eye. In addition to supplemental oxygen therapy, administration of which of the following drugs is most likely to provide acute relief in this patient?", "answer": "Sumatriptan", "meta_info": "step1", "answer_idx": "A", "A": "Sumatriptan", "B": "Amitriptyline", "C": "Prednisone", "D": "Oxycodone", "language": "en"}
{"question": "A 27-year-old woman presents with loss of consciousness at work. The patient’s colleagues say that she had been complaining of a headache all day. Her past medical history is significant for diabetes mellitus type 1. Her blood pressure is 70/60 mm Hg, pulse is 105/min, temperature is 37.2°C (99.0°F), and her respiratory rate is 28/min and shallow. On physical examination, there is a black eschar formation on her nose and her breath has a fruity odor. Laboratory findings are significant for serum glucose of 750 mg/dL, potassium of 3.3 mmol/L, and blood pH of 7.1. Which of the following diabetic complications is most likely the cause of this patient’s presenting symptoms?", "answer": "Diabetic ketoacidosis", "meta_info": "step1", "answer_idx": "A", "A": "Diabetic ketoacidosis", "B": "Hyperosmolar coma", "C": "Lactic acidosis", "D": "Hypoglycemic coma", "language": "en"}
{"question": "A 61-year-old male presents to his primary care doctor with a six-month history of progressively worsening cough, shortness of breath, and 15-pound weight loss. Over the same time period, he has also started to notice occasional weakness in his legs that has made it difficult for him to stand up from his chair and climb stairs. The weakness appears to improve when he exercises at his local aerobics class. His past medical history is notable for hypertension and hyperlipidemia. He has smoked 2 packs of cigarettes per day for 35 years. Chest radiographs demonstrate a perihilar mass in his right lung. A biopsy of the lung lesion is shown. Which of the following is most likely true about this patient?", "answer": "His weakness improves when calcium builds up in the presynaptic nerve terminal", "meta_info": "step1", "answer_idx": "D", "A": "His weakness is due to a type III hypersensitivity reaction", "B": "He is at high risk of developing extraocular weakness", "C": "His weakness is due to antibodies directed against post-synaptic, voltage-gated ion channels", "D": "His weakness improves when calcium builds up in the presynaptic nerve terminal", "language": "en"}
{"question": "A 45-year-old man with a history of hypertension, IV drug use, and type 1 diabetes is brought to the emergency room due to nausea, vomiting, and altered consciousness. He was brought in by his sister who found him asleep on her couch. He is difficult to arouse and does not respond to questions. His sister does not know his medications; however, he has a known history of medication noncompliance. On physical exam his temperature is 99°F (37.2°C), blood pressure is 100/70 mmHg, pulse is 112/min, respirations are 26/min, and pulse oximetry is 99% on room air. He is arousable but is not cooperative with the exam. His breaths are deep and you notice a fruity-smell coming from his mouth. Exam is otherwise unremarkable. Which of the following findings would you also expect to see in this patient?", "answer": "Decreased total body potassium", "meta_info": "step1", "answer_idx": "A", "A": "Decreased total body potassium", "B": "Increased bicarbonate concentration", "C": "Decreased hydrogen ion concentration", "D": "Decreased free fatty acid concentration", "language": "en"}
{"question": "A 31-year-old woman and her 32-year-old husband come to the physician because they have not been able to conceive since they married 1.5 years ago. They are sexually active and have not used any form of contraception during this period. She was diagnosed with cervicitis due to Chlamydia trachomatis infection 4 years ago, which was treated with oral azithromycin. The wife reports that she has regular menses and is otherwise healthy. Her last menstrual bleeding was 2 weeks ago. Neither partner shows abnormalities on physical examination. Which of the following is the most appropriate next step in management?", "answer": "Semen analysis", "meta_info": "step2&3", "answer_idx": "D", "A": "Chromosomal karyotyping", "B": "Postcoital testing", "C": "Post-ejaculatory urinalysis", "D": "Semen analysis", "language": "en"}
{"question": "A 66-year-old man comes to the physician with a 4-month history of recurrent crusty lesions on the dorsal surface of his hands. When he scrapes off the crusts, they reappear after a few days. The lesions are mildly pruritic and occasionally burn. He works as a landscaper. A photograph of his right hand is shown. Which of the following is the most likely diagnosis?", "answer": "Actinic keratosis", "meta_info": "step1", "answer_idx": "C", "A": "Sporotrichosis", "B": "Basal cell carcinoma", "C": "Actinic keratosis", "D": "Seborrheic keratosis\n\"", "language": "en"}
{"question": "A 50-year-old woman presents to the emergency department with severe abdominal pain and discomfort for several hours. She says that the pain started suddenly and rates it as an 8/10 pain. There are no exacerbating factors but the pain gets relieved by leaning forward. She also complains of nausea and vomiting. She has vomited 4 times in the last 2 hours. Her past medical history is significant for HIV, diabetes, asthma, depression, and acute angle glaucoma. She states that she is very diligent with her medications and has never missed a pill. She says that she does not smoke or drink alcohol. Her temperature is 37°C (98.6°F), respirations are 15/min, pulse is 97/min, and blood pressure is 102/98 mm Hg. On examination, she is pale, diaphoretic, and in extreme discomfort. She does not allow an abdominal exam. Laboratory results show a serum amylase of 456 U/L and a serum lipase of 562 U/L. Treatment of which of the following conditions most likely led to this patient's current condition?", "answer": "Acquired immunodeficiency syndrome", "meta_info": "step2&3", "answer_idx": "B", "A": "Asthma", "B": "Acquired immunodeficiency syndrome", "C": "Depression", "D": "Diabetes", "language": "en"}
{"question": "A 66-year-old man is brought to the emergency department after 3 consecutive days of nausea and multiple episodes of vomiting every day. He has been receiving cisplatin as part of treatment for small cell lung carcinoma diagnosed about a year ago. Upon admission, he is found to be drowsy with muscle weakness. The patient’s vital signs are as follows: blood pressure is 98/60 mm Hg, heart rate is 120/min, respiratory rate is 14/min, and body temperature is 36.5°C (97.7°F). Physical examination reveals a mildly cachectic male with mild abdominal tenderness to palpation. The following tests are performed:\nLaboratory test\nSerum Na+ 136 mEq/L\nSerum Cl- 78 mEq/L\nSerum K+ 3.0 mEq/L\nSerum creatinine (SCr)  1.0 mg/dL\n    Arterial blood gas\npH 7.58\nPO2 95 mm Hg\nPCO2 49 mm Hg\nSO2% 98%\nHCO3- 44.4 mEq/L\nWhich of the following is the most likely cause of this patient’s acid-base abnormality?", "answer": "Excessive hydrogen ion loss", "meta_info": "step1", "answer_idx": "B", "A": "Increased potassium secretion", "B": "Excessive hydrogen ion loss", "C": "Carbon dioxide retention", "D": "Decreased bicarbonate excretion", "language": "en"}
{"question": "A 30-year-old woman presents with a white patch on her tongue that she noticed a few weeks ago. She denies any changes in taste sensation or pain, weight loss, or night sweats. Past medical history is significant for a 10-year history of type 1 diabetes mellitus, managed currently on insulin therapy. Her last HbA1c a month ago was 9%. On physical examination, there are white patches present over the dorsum of her tongue (as seen in the image) that can easily be scraped off. Microscopic examination of KOH treated scrapings shows pseudohyphae. The patient is advised to have better blood glucose control and is prescribed a drug for these oral patches, which she is instructed to swish in her mouth for several minutes and then swallow. Which of the following best describes the mechanism of action of this drug?", "answer": "Disruption of cell membrane integrity", "meta_info": "step1", "answer_idx": "C", "A": "Inhibition of synthesis of lanosterol", "B": "Inhibit of synthesis of ergosterol", "C": "Disruption of cell membrane integrity", "D": "Inhibition of nucleic acid synthesis", "language": "en"}
{"question": "A 34-year-old African-American woman comes to the physician because of a 6-month history of fatigue, increasing shortness of breath on exertion, and a dry cough. She also has chronic constipation with bowel movements once every two to three days. She has not had fevers, night sweats, or weight loss. She has a history of hypertension and arthritis of both ankle joints. Current medications include hydrochlorothiazide and daily multivitamins. Her vital signs are within normal limits. Her serum sodium is 138 mEq/L, potassium is 3.9 mEq/L, and calcium is 11.5 mg/dL. An x-ray of the chest shows bilateral hilar lymphadenopathy and normal lung parenchyma. Which of the following is the most likely cause of this patient's hypercalcemia?", "answer": "Elevated 1,25-dihydroxyvitamin D3 levels", "meta_info": "step2&3", "answer_idx": "A", "A": "Elevated 1,25-dihydroxyvitamin D3 levels", "B": "PTH-related protein production", "C": "Thiazide-induced renal calcium reabsorption", "D": "Chronic kidney disease", "language": "en"}
{"question": "A 78-year-old man comes to the physician because of difficulty swallowing and regurgitation of undigested food for the past several months. The patient reports that his symptoms have gotten progressively worse. Physical examination shows severe halitosis and a gurgling sound after he swallows a small amount of water. Results of fluoroscopic barium esophagography are shown. The nerve responsible for motor innervation of the affected muscle is also responsible for which of the following functions?", "answer": "Parasympathetic innervation of the AV node", "meta_info": "step1", "answer_idx": "A", "A": "Parasympathetic innervation of the AV node", "B": "Sensory innervation of the posterior tongue", "C": "Visceral sensory innervation of the carotid sinus", "D": "Motor innervation of the ventral tongue", "language": "en"}
{"question": "A 1-day-old boy is brought to the emergency department by ambulance after his parents found him to be increasingly lethargic. He was born at home with inconsistent prenatal care. Since then, his parents report that his head appears to be getting bigger over the past few hours. He also feeds poorly and has had a few episodes of vomiting. On presentation, he is found to have limb spasticity with adducted thumbs. His head circumference is bigger than expected and he appears to be unable to look up when following objects. Which of the following findings would most likely also be seen in this patient?", "answer": "Obstruction of the cerebral aqueduct", "meta_info": "step1", "answer_idx": "C", "A": "Abnormally large posterior fossa", "B": "Downwardly displaced cerebellum", "C": "Obstruction of the cerebral aqueduct", "D": "Tuft of hair on the spine", "language": "en"}
{"question": "A 48-year-old woman presents to the emergency department with a 2-day history of chest pain. The patient’s symptoms started gradually after moving heavy objects during packing. The pain is constant and nagging but intensifies with lateral movement. The patient has no history of serious illness and takes no medications, currently. She does not smoke. Her vitals are as follows: blood pressure 125/75 mm Hg; pulse 75/min; respiratory rate 14/min; and temperature 36.9℃ (98.4℉). Examination of the anterior chest wall shows the absence of swelling, erythema, or warmth. The 3rd and 4th left rib bones are tender anteriorly near the sternum. An electrocardiogram is shown. The test for cardiac troponin I is negative. Which of the following is the most appropriate initial step in the management of this patient?", "answer": "Ibuprofen", "meta_info": "step2&3", "answer_idx": "A", "A": "Ibuprofen", "B": "Intercostal nerve block", "C": "Serial ECG for 12 hours", "D": "Sublingual nitroglycerin", "language": "en"}
{"question": "A 28-year-old woman who recently immigrated from Kenya presents with fatigue, shortness of breath, and palpitations for a few weeks. Review of systems is significant for a painful swollen knee. The patient is afebrile, and her vital signs are within normal limits. On physical examination, her voice seems hoarse, although her pharynx does not show signs of an inflammatory process. Cardiopulmonary auscultation is significant for a loud first heart sound with a split second heart sound and a mid-diastolic rumbling murmur with an opening snap best heard over the cardiac apex. Transthoracic echocardiography shows a calcified mitral valve with an opening area of 1.5 cm2 (normal: 3.0–3.5 cm2). The patient is recommended to have her mitral valve replaced because of the risk for complications such as atrial fibrillation which may lead to the formation of a life-threatening blood clot that can travel to other parts of the body. Which of the following organs is most likely to be spared in this patient?", "answer": "Lungs", "meta_info": "step1", "answer_idx": "A", "A": "Lungs", "B": "Spleen", "C": "Brain", "D": "Small bowel", "language": "en"}
{"question": "A 14-year-old girl with a BMI of 17 complains of frequent urination, excessive thirst, and abdominal pain. Her parents have noticed that she appears to have lost some weight. Her past medical history is significant for celiac disease. A random plasma blood glucose is 267 mg/dL. Which of the following is a property of the hormone that is deficient in this patient?", "answer": "Enhances potassium uptake", "meta_info": "step1", "answer_idx": "B", "A": "Up-regulates glycogen phosphorylase activity", "B": "Enhances potassium uptake", "C": "Downregulates HMG-CoA reductase", "D": "Crosses the placenta to affect the fetus", "language": "en"}
{"question": "A 37-year-old woman presents to her primary care physician with a 6-month history of fatigue. She denies any recent history of fevers, chills or headaches. She does not smoke or drink alcohol. A CBC demonstrates a microcytic anemia. Iron studies are ordered and demonstrate the following:\nSerum iron: 40 µg/dL (normal 50–170 µg/dL);\nTIBC: 230 µg/dL (normal 250–370 µg/dL);\nTransferrin saturation: 10% (normal 15–50%);\nSerum ferritin: 180 µg/L (normal 15-150 µg/L);\nWhich of the following is a likely cause of this patient's iron studies findings?", "answer": "Rheumatoid arthritis", "meta_info": "step1", "answer_idx": "D", "A": "Lead poisoning", "B": "Dysfunctional uterine bleeding", "C": "Splenic sequestration of RBCs", "D": "Rheumatoid arthritis", "language": "en"}
{"question": "A 32-year-old man presents with epigastric gnawing pain occurring after meals. Occasionally, dull pain awakens him at night. He also complains of bloating and occasional constipation. He has been having these symptoms for almost 2 years and uses antacids and castor oil for relief. Recently, he began to note that these remedies provide less relief than in the past. He reports no significant weight loss, night sweats, or a change in stool color. He has no family history of peptic ulcer disease or gastrointestinal malignancies. The patient does not smoke cigarettes but drinks alcohol occasionally. He rarely uses NSAIDs for symptomatic treatment. His blood pressure is 120/80 mm Hg, heart rate is 85/min, respiratory rate is 14/min, and temperature is 36.6°C (97.9°F). A physical examination revealed epigastric tenderness on palpation and the abdomen was distended. A urea breath test was performed, which was positive. Which of the following statements regarding the test results in this patient is true?", "answer": "The causative agent possesses urease; thus, it is possible to detect urease by giving the patient urea with labeled C-14 orally and then measuring the carbon dioxide content in the exhaled breath.", "meta_info": "step1", "answer_idx": "C", "A": "The test detected products of increased cellular breakdown by the causative agent induced by urea ingestion.", "B": "The causative agent possesses urease; thus, it is possible to detect urease by giving the patient urease with labeled N-14 orally and then measuring the ammonia content in the exhaled breath.", "C": "The causative agent possesses urease; thus, it is possible to detect urease by giving the patient urea with labeled C-14 orally and then measuring the carbon dioxide content in the exhaled breath.", "D": "The causative agent possesses urease; thus, it is possible to detect urease by giving the patient urease and then measuring the pH of the exhaled breath to determine whether or not there was an increased breakdown of ammonia.", "language": "en"}
{"question": "A 45-year-old man is brought into the emergency department after he was found collapsed in a housing development stairwell. He was found in a pool of vomit, barely breathing. Used syringes and a tourniquet were found near the patient. His blood pressure is 100/70 mm Hg, pulse is 65/min, and respiratory rate is 6/min. Physical examination reveals a thin and disheveled man with track marks on both arms. The appropriate reversal agent is administered. Which of the following findings would be most likely seen in this patient as a result of administering  this reversal agent?", "answer": "Yawning", "meta_info": "step2&3", "answer_idx": "A", "A": "Yawning", "B": "Miosis", "C": "Smooth skin", "D": "Tremulousness", "language": "en"}
{"question": "A 33-year-old woman comes to the physician because of a 1-year history of irregular menses and infertility. She has a history of an eating disorder and has received dietary and behavioral therapy over the past 6 months with minimal improvement in her symptoms. She is 170 cm (5 ft 7 in) tall and weighs 49 kg (104 lb); her BMI is 17 kg/m2. Physical examination is significant for pallor and thin, soft, depigmented hair on the arms and back. After an extensive workup, the physician recommends pulsatile GnRH therapy. One week after initiating therapy, a pelvic ultrasound shows a 24-mm hypoechogenic cavity in the right ovary. The patient subsequently receives a drug that results in the resumption of meiosis and the loss of gap junctions between the cumulus granulosa cells and the oocyte. This patient most likely received which of the following drugs?", "answer": "Human chorionic gonadotropin", "meta_info": "step1", "answer_idx": "C", "A": "Follicle-stimulating hormone", "B": "Mifepristone", "C": "Human chorionic gonadotropin", "D": "Cyproterone citrate", "language": "en"}
{"question": "A 52-year-old woman visits her primary care practitioner, who has been following her closely after she was diagnosed with peptic ulcer disease. She tested positive for H. pylori in a urea breath test, which was later confirmed by an endoscopic biopsy. Her family history is significant for colorectal carcinoma, as well as ovarian cancer. Her past medical history is relevant for cigarette smoking and peptic ulcer disease, which has been under treatment twice, initially with a clarithromycin-containing regime. This was followed by a bismuth-containing regime after a fecal antigen test was positive 4 weeks later. A recent endoscopy and fecal antigen test detected H. pylori in her stomach mucosa. In addition to a protein pump inhibitor (PPI), which of the following should be added to the treatment regime of this patient?", "answer": "Levofloxacin, amoxicillin", "meta_info": "step2&3", "answer_idx": "B", "A": "Bismuth subsalicylate, metronidazole, tetracycline", "B": "Levofloxacin, amoxicillin", "C": "Clarithromycin, amoxicillin", "D": "Rifabutin, amoxicillin", "language": "en"}
{"question": "An 8-year-old boy is brought to the pediatrician’s office with his mother for a routine check-up. Although her son is doing well, the mother has some concerns with regards to his overall health. He was born at 39 weeks gestation via spontaneous vaginal birth. He is up to date on all vaccines and has met most of developmental milestones. She reports that he is shorter than his classmates and seems less developed physically than his older brother and sister when they were his age. Additionally, the boy’s teacher has some concerns regarding his learning capability not being at the level of his peers. His height and weight are at the 10th and 15th percentile respectively. He has a heart rate of 90/min, respiratory rate of 22/min, blood pressure of 110/65 mm Hg, and temperature of 37.0°C (98.6°F). At physical exam the child appears cheerful, well developed, and well nourished. He is small for his age. with upslanting palpebral fissures, flat occiput, low set ears, and a flat nose. Which of the following techniques would most likely identify the cause of this patient’s presentation?", "answer": "Karyotype", "meta_info": "step1", "answer_idx": "B", "A": "Punnett square", "B": "Karyotype", "C": "Polymerase chain reaction", "D": "Gene mapping", "language": "en"}
{"question": "A 55-year-old woman visits her primary care provider for concerns of frequent headaches. She complains of recurrent headaches and involuntary weight loss, which she attributes to a constant pain along the right side of her jaw that occasionally radiates to her right eye. Her past medical history includes diabetes mellitus type 2 and chronic glomerulonephritis resulting in stage II chronic kidney disease. Her mother passed away in her 70s and had been diagnosed with multiple sclerosis at the age of 50. Today, her blood pressure is 135/90 mm Hg, heart rate is 88/min, respiratory rate is 15/min, and temperature is 36.6°C (97.9°F). The right side of her face is painful to palpation from her jaw to the right side of her scalp. Which of the symptoms below is most commonly associated with the patient’s condition?", "answer": "Neck stiffness", "meta_info": "step2&3", "answer_idx": "B", "A": "Limb muscle weakness", "B": "Neck stiffness", "C": "Diplopia", "D": "Shock-like pain in face", "language": "en"}
{"question": "A 66-year-old man presents to his primary care provider for a routine checkup. He says that he feels well overall but has experienced some intermittent back pain and vague epigastric pain over the past 6 months. He also has experienced cramping in both legs that is worse whenever he walks for long periods of time. He has a history of poorly controlled hypertension, diabetes mellitus, recurrent renal stones, and major depressive disorder. He takes lisinopril, nifedipine, metformin, glyburide, and fluoxetine. He has a 55-pack-year smoking history and drinks alcohol socially. His temperature is 98.4°F (36.9°C), blood pressure is 155/85 mmHg, pulse is 92/min, and respirations are 16/min. On exam, he is well-appearing and in no acute distress. A normal S1 and S2 are heard on auscultation. He has no abdominal tenderness to palpation. A light pulsatile mass is felt in the mid-epigastrium. Achilles and patellar reflexes are 2+ bilaterally. His gait is normal. Which of the following additional findings is most strongly associated with this patient’s condition?", "answer": "Abdominal bruit", "meta_info": "step1", "answer_idx": "A", "A": "Abdominal bruit", "B": "Asymmetric upper extremity pulses", "C": "Continuous machine-like murmur", "D": "Costovertebral tenderness", "language": "en"}
{"question": "A 17-year-old male collapses 25 minutes into a soccer game. He is unresponsive and pulseless. Despite adequate resuscitation by a bystander, the patient is pronounced dead when the ambulance arrives. The patient had no past medical history other than a heart murmur as a child and he took no medications. His family history is notable for an uncle who died suddenly of unknown causes at the age of 25. A mutation in which of the following proteins most likely contributed to this patient’s condition?", "answer": "Myosin heavy chain", "meta_info": "step1", "answer_idx": "A", "A": "Myosin heavy chain", "B": "Dystrophin", "C": "Fibrilin", "D": "Elastin", "language": "en"}
{"question": "A 36-year-old woman, gravida 3, para 2, at 31 weeks' gestation comes to the emergency department because of painless, bright red vaginal bleeding for one day. She has not felt any contractions. Her other children were delivered by Cesarean section because of breech position. Fetal heart rate is reactive with no decelerations. Which of the following findings is most likely on ultrasound?", "answer": "Placenta over the cervical os", "meta_info": "step1", "answer_idx": "C", "A": "Retroplacental hematoma", "B": "Adnexal bleeding", "C": "Placenta over the cervical os", "D": "Gestational sac in a dilated cervix", "language": "en"}
{"question": "A 24-year-old man is brought to the emergency department for bowling at a local bowling alley while inappropriately dressed. The patient refused to speak with police and was seen conversing with inanimate objects in the back of the police car. The patient states that his clothes were contaminated by assassins who have been tracking him for years. The patient refuses to answer any further questions, and continues to whisper toward someone else. The patient has a past medical history of homelessness, alcohol abuse, marijuana use, and cocaine abuse. Physical exam is notable for a healthy young man who seems mistrustful of all hospital personnel. The patient is started on a medication and is transferred to the psychiatric inpatient unit. The patient’s condition improves, but he still often speaks of a contamination that is on his clothes and skin that is coming from external parties. The patient is started on a new medication. He is then sent to group therapy, followed by physical activity in the yard. The physician is called over when the patient is found down in the recreation yard while he was exercising. The patient is not responsive, and his limbs seem to resist passive force. His temperature is 104°F (40°C), pulse is 112/min, blood pressure is 140/90 mmHg, respirations are 18/min, and oxygen saturation is 95% on room air. Which of the following best describes the most likely diagnosis?", "answer": "Dopamine blockade", "meta_info": "step2&3", "answer_idx": "B", "A": "Dehydration", "B": "Dopamine blockade", "C": "Inadequate evaporative cooling", "D": "Infection", "language": "en"}
{"question": "A 23-year-old male presents to the emergency department after he was found naked wandering his neighborhood. The patient is disheveled and has not bathed in months. The patient has a past medical history of alcohol abuse and schizophrenia that is well controlled with haloperidol. The patient is started on haloperidol and most of his symptoms improve dramatically; however, he continues to refuse to eat food from the hospital as he believes it to be contaminated. The patient stays on the inpatient psychiatric unit and lab values are drawn and return as follows:\n\nSerum:\nNa+: 135 mEq/L\nK+: 3.0 mEq/L\nCl-: 92 mEq/L\nHCO3-: 22 mEq/L\nBUN: 7 mg/dL\nCa2+: 8.4 mg/dL\nCreatinine: 0.6 mg/dL\nGlucose: 70 mg/dL\n\nThat patient is started on an intravenous solution containing potassium chloride and is closely monitored. His oral intake also seems to be improving. Lab values are ordered again the following day and return as follows:\n\nSerum:\nNa+: 137 mEq/L\nK+: 2.9 mEq/L\nCl-: 95 mEq/L\nHCO3-: 22 mEq/L\nBUN: 8 mg/dL\nCa2+: 9.0 mg/dL\nCreatinine: 1.0 mg/dL\nGlucose: 77 mg/dL\n\nThe patient is continued on IV fluids and his clinical symptoms seem to further improve. Repeat labs the following three days remains largely unchanged. The patient's symptoms improve and he is determined to be at his baseline in terms of functioning. Which of the following is the best next step in management?", "answer": "IV fluids containing magnesium", "meta_info": "step2&3", "answer_idx": "C", "A": "Discharge the patient on IM haloperidol", "B": "IV fluids containing potassium", "C": "IV fluids containing magnesium", "D": "Increase oral intake", "language": "en"}
{"question": "A 2-year-old girl is brought to the physician because of high-grade fever and crying while passing urine. Four months ago, she was treated for a febrile urinary tract infection with cefixime. There is no family history of serious illness. Her temperature is 39.2°C (102.6°F) and pulse is 123/min. Physical examination shows no abnormalities. Urine dipstick shows leukocyte esterase; urinalysis shows WBCs. Urine culture shows Escherichia coli sensitive to cefixime. A voiding cystourethrogram is shown. Without treatment, which of the following is this patient most likely to develop?", "answer": "Renal scarring", "meta_info": "step2&3", "answer_idx": "C", "A": "Renal cell carcinoma", "B": "Hypotension", "C": "Renal scarring", "D": "Nephrotic syndrome", "language": "en"}
{"question": "A 37-year-old man presents to his primary care physician with a chief complaint of diarrhea. The patient states that his symptoms have worsened recently. He works as a farmer and is dressed in tattered and old denim. He lives alone, and this is the first time he has come to town in years. The patient’s diet is mostly dairy products and some meat products. He denies any systemic symptoms and states that diarrhea tends to occur right after a meal. He also claims that at times he struggles to fall asleep, and sometimes he feels he lacks energy. The patient is instructed to avoid consuming dairy products for a week and to return with a report of his symptoms. As you set up the return appointment with this patient you notice that he is rather emotionless. He also states that he lacks anybody that he can list as an emergency contact so he leaves that section of his medical forms blank. What is the most likely diagnosis?", "answer": "Schizoid personality disorder", "meta_info": "step2&3", "answer_idx": "C", "A": "Avoidant personality disorder", "B": "Major depressive disorder", "C": "Schizoid personality disorder", "D": "Schizotypal personality disorder", "language": "en"}
{"question": "A 77-year-old man presents to the emergency department with a change in his mental status. The patient’s daughter states that he can cook and clean up after himself and only needs help paying bills. Yesterday the patient seemed fine; however, this morning she noticed that he struggled to perform simple tasks and was forgetful while cooking, leaving the stove on. They recently returned from a trip to Mexico and admit to drinking unfiltered water and eating local cuisines while abroad. The patient has a past medical history of hypertension and diabetes. His temperature is 97.5°F (36.4°C), blood pressure is 187/118 mmHg, pulse is 90/min, respirations are 16/min, and oxygen saturation is 100% on room air. Which of the following is the most likely diagnosis?", "answer": "Vascular dementia", "meta_info": "step2&3", "answer_idx": "D", "A": "Alzheimer dementia", "B": "Lewy body dementia", "C": "Normal pressure hydrocephalus", "D": "Vascular dementia", "language": "en"}
{"question": "A 65-year-old male with a past medical history of left ventricular hypertrophy presents to the emergency room because of a history of progressive shortness of breath and a cough productive of frothy pink sputum. Physical examination reveals crackles at the lung bases bilaterally. The patient denies fever, chills, or any recent infection. A radiograph of the chest shows septal lines and areas of opacification in both lung fields (see image).\nWhich of the following most likely accounts for this patient’s dyspnea?", "answer": "Alveolar and interstitial fluid accumulation", "meta_info": "step1", "answer_idx": "D", "A": "Destruction of interalveolar septa", "B": "Excess mucous production in bronchiolar epithelium", "C": "A collection of air in the pleural space", "D": "Alveolar and interstitial fluid accumulation", "language": "en"}
{"question": "A 42-year-old man is brought to the emergency department because of several episodes of black, tarlike stool and lightheadedness over the past couple of days. He underwent an appendectomy at the age of 16. He has hypertension and tension headaches. He drinks 4 beers daily. Current medications include amlodipine and naproxen. His temperature is 36.7°C (98°F), pulse is 100/min, and his blood pressure is 100/70 mm Hg. The lungs are clear to auscultation bilaterally. The abdomen is soft, nondistended, and nontender. The liver is palpated 3 cm below the right costal margin. His hemoglobin concentration is 10 g/dL. Intravenous fluid resuscitation is begun. An esophagogastroduodenoscopy is performed, which does not show bleeding. Which of the following is the most appropriate next step in management?", "answer": "Colonoscopy", "meta_info": "step2&3", "answer_idx": "B", "A": "Double-balloon enteroscopy", "B": "Colonoscopy", "C": "Laparotomy", "D": "Angiography\n\"", "language": "en"}
{"question": "A 68-year-old man comes to the physician because of constipation and decreased appetite during the past several months. In the past 2 weeks, he has also noticed an increasing frequency of urination. He has not had any dysuria or flank pain. He has a history of hypertension, calcium pyrophosphate crystal arthritis, and alcoholic cirrhosis. Current medications include hydrochlorothiazide, rifaximin, lactulose, and naproxen as needed for the joint pain. He quit drinking 5 years ago. He does not smoke cigarettes. His vital signs are within normal limits. Physical examination shows decreased bowel sounds but is otherwise unremarkable. Serum studies show:\nCreatinine 1.1 mg/dL\nCalcium 11.8 mg/dL\nPhosphorus 2.1 mg/dL\nMagnesium 1.6 mg/dL\nTotal protein 6 g/dL\nAlbumin 3.1 g/dL\nAST 53 U/L\nALT 43 U/L\nWhich of the following is the most appropriate next step in diagnosis?\"", "answer": "Serum parathyroid hormone level", "meta_info": "step2&3", "answer_idx": "C", "A": "Serum parathyroid-related protein level", "B": "Urine and serum protein electrophoresis", "C": "Serum parathyroid hormone level", "D": "X-ray of the chest", "language": "en"}
{"question": "A 68-year-old African American male presents to his primary care provider complaining of progressively worsening back pain. The pain is localized to the lower back and sometimes wakes him up from sleep. He has a history of hypertension and admits to a 50 pack-year smoking history. Further questioning reveals that he has also experienced fatigue and an unintentional weight loss of 18 pounds over the past year. Laboratory analysis is notable for an elevated alkaline phosphatase. A radiograph of the patient’s spine demonstrates multiple sclerotic lesions in the lumbar vertebral bodies. Which of the following tests would most likely confirm the diagnosis in this patient?", "answer": "Transrectal ultrasound-guided prostate biopsy", "meta_info": "step1", "answer_idx": "C", "A": "Renal biopsy", "B": "Fine needle aspiration of the thyroid", "C": "Transrectal ultrasound-guided prostate biopsy", "D": "Chest radiograph", "language": "en"}
{"question": "A 75-year-old man presents to his primary care physician because he has been experiencing increasing muscle and joint pain over the last 3 months. He says that he also feels increasingly fatigued and weak despite no change to his daily routine. His past medical history is significant for an infection when he was 12 years of age that led to 2 months of paralysis and mechanical ventilation through a tracheostomy tube. At the time, he developed the paralysis after 3 days of fever and sore throat. He recalls that he was still able to feel everything and was embarrassed that his daily activities had to be performed for him by caregivers. The most likely cause of this patient's symptoms is associated with which of the following structures?", "answer": "Naked (+) stranded RNA virus", "meta_info": "step1", "answer_idx": "C", "A": "DNA virus", "B": "Enveloped (-) stranded RNA virus", "C": "Naked (+) stranded RNA virus", "D": "Naked (-) stranded RNA virus", "language": "en"}
{"question": "A 2-year-old boy was rushed to the emergency department in the early morning by his mother because he was unresponsive to deep pain stimuli. The patient’s mother said that he has been suffering from a fever, cough and runny nose for the last 10 days. 2 days ago, they visited a free clinic and received medication. When she gave him the medication yesterday, the patient had 3 episodes of vomiting and his condition rapidly worsened. This morning, the patient did not wake up, even after multiple attempts. On physical examination, the patient is febrile, hypotensive, and tachycardic. Peripheral pulses are 1+, and his extremities are pale and cool to touch. Pupils are equal and slowly reactive to light. Significant hepatomegaly is noted. Which of the following is the most likely etiology of this patient’s symptoms?", "answer": "Decrease in beta-oxidation", "meta_info": "step1", "answer_idx": "A", "A": "Decrease in beta-oxidation", "B": "Increase in gluconeogenesis", "C": "Increase in beta-oxidation", "D": "Increase in glycolysis", "language": "en"}
{"question": "A 24-year-old patient presents to your gastroenterology practice on a referral from her primary care provider. The patient has been experiencing postprandial bloating and abdominal pain for one year. Symptoms occur following the ingestion of milk products. Which of the following drugs has a mechanism of action that is similar to the pathophysiology of this patient's disease?", "answer": "Magnesium hydroxide", "meta_info": "step1", "answer_idx": "D", "A": "Omeprazole", "B": "Bismuth", "C": "Octreotide", "D": "Magnesium hydroxide", "language": "en"}
{"question": "In which location is dimeric IgA most likely to be found in highest concentrations?", "answer": "Colostrum", "meta_info": "step1", "answer_idx": "A", "A": "Colostrum", "B": "Blood from the fetus", "C": "Blood from the mother", "D": "Fetal bone marrow", "language": "en"}
{"question": "A 25-year-old man presents to the ER after a street fight. His girlfriend reports that he was struck with a bat in the head. After the initial hit, she reported that he briefly lost consciousness but then was normal for several hours. Since then, he has been rapidly decompensating. He is grabbing his head in pain and his mental status is altered. Vital signs are stable. Neurological exam reveals that his right pupil is dilated and his right lid is drooping. If this patient's symptoms are allowed to progress without intervention, which of the following would be expected to occur?", "answer": "Right sided hemiparesis", "meta_info": "step1", "answer_idx": "A", "A": "Right sided hemiparesis", "B": "Down and in gaze of the right pupil", "C": "Right sided homonymous hemianopsia.", "D": "Right eye with an inability to abduct", "language": "en"}
{"question": "A 7-year-old girl is brought to the emergency department because of diffuse abdominal pain and multiple episodes of vomiting for 2 hours. She started developing fever, headache, and neck pain 3 days ago. On arrival, she is unresponsive. Her temperature is 40.3°C (104.5°F) and palpable blood pressure is 45 mm Hg. Physical examination shows diffuse purpuric skin lesions. In spite of all appropriate therapy, she dies shortly thereafter. Autopsy shows massive parenchymal hemorrhage of the adrenal glands. Which of the following was the portal of entry for the most likely causal organism?", "answer": "Nasopharynx", "meta_info": "step1", "answer_idx": "A", "A": "Nasopharynx", "B": "Genital mucosa", "C": "Choroid plexus", "D": "Gastrointestinal tract", "language": "en"}
{"question": "A 50-year-old female comes to the emergency department with sudden onset left-sided calf pain starting 20 minutes ago. Her past medical history is notable for diabetes, hypertension, and chronic atrial fibrillation controlled on an anti-arrhythmic. Upon arrival to the emergency department, her blood pressure is 150/91 mmHg, pulse is 100/min, and respirations of 22/min. Examination of the leg reveals a pale left calf with diminished dorsalis pedis and posterior tibial pulses. Prompt intervention relieves the patient’s symptoms. Which of the following, if seen microscopically, would indicate that her calf myocytes are more likely to recover without permanent damage?", "answer": "Cellular swelling", "meta_info": "step1", "answer_idx": "A", "A": "Cellular swelling", "B": "Mitochondrial vacuolization", "C": "Nuclear pyknosis", "D": "Fragmented cells and debris", "language": "en"}
{"question": "A 56-year-old man comes to the physician because of progressive worsening of vision in both his eyes over the past 6 months. He reports that he first noticed some blurring of his vision and glare in the evenings, which have both gotten worse in this period. He works as a tower crane operator and spends most of his day outdoors. Ophthalmologic examination shows visual acuity of 20/100 in both eyes. A photograph of the eye is shown. Damage to which of the following structures is most likely responsible for this patient's current symptoms?", "answer": "Lens", "meta_info": "step1", "answer_idx": "C", "A": "Aqueous humor", "B": "Vitreous body", "C": "Lens", "D": "Retina", "language": "en"}
{"question": "A 25-year-old man presents to the clinic with the complaint of yellow discoloration of his skin. He reports that the discoloration appeared gradually over the past 5 days. He does not have any other complaints. He never had similar symptoms before. Past medical history is only significant for a recent flu infection that was so bad that he missed work for a week. Physical exam is significant for yellow sclera and slight yellowish discoloration of the skin over the face and neck. Liver function tests reveal:\nTotal bilirubin level 5 mg/dL\nDirect bilirubin level 0.4 mg/dL\nAspartate aminotransferase (AST) 25 U/L\nAlanine aminotransferase (ALT) 15 U/L\nWhat is the most likely pathology giving rise to this patient’s condition?", "answer": "Decreased conjugation of bilirubin by uridine-diphosphate glucuronyltransferase", "meta_info": "step1", "answer_idx": "A", "A": "Decreased conjugation of bilirubin by uridine-diphosphate glucuronyltransferase", "B": "Bile duct obstruction", "C": "Hemolysis", "D": "Decreased transport of bile into the bile canaliculi", "language": "en"}
{"question": "A 17-year-old girl is brought to the physician by her father because of concerns about her behavior. She worries excessively about her weight and body image, and has frequent diarrhea. She is 170 cm (5 ft 7 in) tall and weighs 63.5 kg (140 lb); BMI is 22 kg/m2. She appears anxious but well. Vital signs are within normal limits. Physical examination shows calluses on the knuckles of her right hand. Further evaluation of this patient is most likely to show which of the following findings?", "answer": "Parotid gland swelling", "meta_info": "step1", "answer_idx": "A", "A": "Parotid gland swelling", "B": "Elevated blood pressure", "C": "Right upper quadrant tenderness", "D": "Jugular venous distention", "language": "en"}
{"question": "A 36-year-old woman comes to the emergency department because of left wrist pain and swelling that started immediately after a fall. She was walking her dog when the dog abruptly pulled away, causing her to fall forward onto both hands. Physical examination shows left wrist pain with pinching and grasping, moderate swelling, and mild tenderness. Her left thumb is placed in a thumb immobilization splint. An x-ray of the wrist 2 days later is shown. The most likely cause of these findings is a fracture of which of the following bones?", "answer": "Scaphoid", "meta_info": "step1", "answer_idx": "A", "A": "Scaphoid", "B": "Ulna", "C": "Lunate", "D": "Hamate", "language": "en"}
{"question": "A 2200-g (4-lb 14-oz) newborn is delivered at term to a 37-year-old primigravid woman. Apgar scores are 6 and 8 at 1 and 5 minutes, respectively. Examination in the delivery room shows that he is at the 2nd percentile for head circumference and at the 10th percentile for length. He has a small jaw, small eyes, and low-set ears. There is a keyhole-shaped defect in the iris of the left eye. He has seven fingers on each hand. There is an opening in the roof of the mouth extending into the soft and hard palate bilaterally. Cleft lip and cleft palate are present. A 3/6 holosystolic murmur is heard at the left lower sternal border. The heels are prominent, with convex-shaped deformity of the plantar surface of the feet. Which of the following is the most likely cause of these findings?", "answer": "Trisomy 13", "meta_info": "step2&3", "answer_idx": "D", "A": "Fragile X syndrome", "B": "Trisomy 18", "C": "Fetal alcohol syndrome", "D": "Trisomy 13", "language": "en"}
{"question": "A 55-year-old woman is rushed to the emergency department after being found lying unconscious in a burning house by a firefighter. No history can be obtained. Her vital signs include pulse 130/min and respirations 16/min. Physical examination reveals soot all over her face. Scattered wheezes can be heard on auscultation of the chest. A thorough survey of the body shows no evidence of any burn injuries. Which of the following changes in the oxygen-hemoglobin curve would most likely be expected in this patient?", "answer": "The curve would be shifted left due to an increased oxygen binding affinity by hemoglobin.", "meta_info": "step1", "answer_idx": "A", "A": "The curve would be shifted left due to an increased oxygen binding affinity by hemoglobin.", "B": "The curve would be shifted left due to metabolic acidosis in peripheral tissues.", "C": "The curve would be unchanged because the partial pressure of oxygen is unchanged.", "D": "The curve would be shifted right due to decreased hemoglobin affinity for oxygen.", "language": "en"}
{"question": "A 73-year-old man with a past medical history significant for high blood pressure, hypothyroidism, and diabetes presents to the outpatient clinic. He complains of joint pain, muscle pain, and fatigue that has been present for the last several weeks. On examination, you notice a butterfly-shaped rash across the bridge of his nose and cheeks. He has a blood pressure of 124/72 mm Hg and heart rate of 64/min. Of the following, which medication is most likely responsible for his presentation?", "answer": "Hydralazine", "meta_info": "step2&3", "answer_idx": "C", "A": "Verapamil", "B": "Clonidine", "C": "Hydralazine", "D": "Terazosin", "language": "en"}
{"question": "A 65-year-old woman with a 6-month history of acute promyelocytic leukemia managed with all-trans-retinoic acid presents with severe abdominal pain, nausea, vomiting, and bloody urine. The patient states her symptoms onset acutely a few hours ago and has not improved. She describes the pain as severe, sharp and stabbing in character, and diffusely localized to the umbilical region, accompanied by nausea and vomiting. The patient also states that she noticed blood in her urine last time she urinated. No additional significant past medical history. Her vitals signs include: temperature 37.0°C (98.6°F), blood pressure 95/75 mm Hg, pulse 115/min, respiratory rate 23/min, and oxygen saturation 99% on room air. On physical examination, the patient is ill-appearing and in severe distress. The cardiac exam is normal. Lungs are clear to auscultation. The abdomen is severely tender and out of proportion with physical exam findings. There are diffuse petechiae present over the entire body. Laboratory results are pending. A peripheral blood smear is shown in the exhibit. A contrast CT of the abdomen shows findings consistent with acute mesenteric ischemia. Which of the following set of laboratory findings would most likely be seen in this patient?", "answer": "PT: ↑ | PTT ↑ | Bleeding time: ↑ | Fibrin split products: ↑ | D-dimer: ↑| Fibrinogen: ↓ | Platelet count: ↓", "meta_info": "step2&3", "answer_idx": "C", "A": "PT: ↑ | PTT ↑ | Bleeding time: ↑ | Fibrin split products: ↑ | D-dimer: ↑| Fibrinogen: ↑ | Platelet count: ↓", "B": "PT: ↓ | PTT ↓ | Bleeding time: ↑ | Fibrin split products: ↑ | D-dimer: ↑| Fibrinogen: ↓ | Platelet count: ↓", "C": "PT: ↑ | PTT ↑ | Bleeding time: ↑ | Fibrin split products: ↑ | D-dimer: ↑| Fibrinogen: ↓ | Platelet count: ↓", "D": "PT: ↓ | PTT ↓ | Bleeding time: ↓ | Fibrin split products: ↓ | D-dimer: ↓| Fibrinogen: ↓ | Platelet count: ↓", "language": "en"}
{"question": "A 32-year-old woman comes to the physician because of a throbbing left-sided headache that started 3 hours ago. Two hours ago, she took ibuprofen with no relief. She has been vomiting every 20 minutes since the start of the headache. She reports that she could not see very well for a few minutes this morning. A similar episode occurred last week. She is otherwise healthy and has recently started taking an oral contraceptive. Her vital signs are within normal limits. Physical examination shows no abnormalities except mild sensitivity to light. Visual acuity is 20/20. Which of the following is the most appropriate initial pharmacotherapy in this patient?", "answer": "Intravenous prochlorperazine", "meta_info": "step2&3", "answer_idx": "C", "A": "Intranasal dihydroergotamine and subcutaneous sumatriptan", "B": "Oral tramadol", "C": "Intravenous prochlorperazine", "D": "Oral ketorolac and oral ergotamine\n\"", "language": "en"}
{"question": "A 66-year-old man presents with palpitation, syncope, and difficulty breathing. He has a past medical history of stroke and his current medications include warfarin. Physical examination is unremarkable. An ECG is performed and shows ventricular tachycardia. The patient is treated successfully with amiodarone. At the time of discharge, his medications include warfarin and amiodarone, and he is cautioned that his PT might be prolonged. Which of the following mechanisms best explains the effect of amiodarone on the coagulation profile of this patient?", "answer": "Amiodarone inhibits CYP2C9 leading to an increased risk of bleeding", "meta_info": "step1", "answer_idx": "B", "A": "Amiodarone induces CYP3A4 leading to a decreased effectiveness of warfarin", "B": "Amiodarone inhibits CYP2C9 leading to an increased risk of bleeding", "C": "Amiodarone causes hepatotoxicity which requires monitoring of the prothrombin time", "D": "Inorganic iodine from amiodarone decreases the effectiveness of warfarin", "language": "en"}
{"question": "A 55-year-old woman presents to the emergency department with recent onset confusion and photophobia. Upon questioning her husband, you discover the patient has been sick over the past week with fevers and productive sputum. Her vital signs are Temperature 102.6 Pulse 80 Respirations 18 Blood Pressure 110/70. The physical exam is significant for lethargy and nuchal rigidity. A lumbar puncture is performed and demonstrates cloudy fluid with an opening pressure of 35 cm H20, cell count of 1500 cells/uL (neutrophil predominant), protein level of 50 mg/dL and glucose of 30 mg/dL. Computed tomography scan demonstrates no space-occupying lesions. What is the most appropriate initial treatment for this patient?", "answer": "Vancomycin, ceftriaxone, ampicillin and dexamethasone", "meta_info": "step2&3", "answer_idx": "C", "A": "Acyclovir", "B": "Ceftriaxone and dexamethasone", "C": "Vancomycin, ceftriaxone, ampicillin and dexamethasone", "D": "Vancomycin, ceftriaxone and ampicillin", "language": "en"}
{"question": "A 58-year-old male presents to his primary care physician complaining of a painless bump on his penis. He first noticed the lesion 1 year ago but was too embarrassed to mention the issue at his last annual physical exam. The lesion has since grown in size and has recently become more erythematous. He has hypertension treated with lisinopril. At age 45, he was successfully treated for phimosis with a steroid cream. He first engaged in sexual intercourse at age 14 and has had “too many sexual partners to count” in his lifetime. He smoked one pack of cigarettes daily for 30 years but quit 10 years ago. He drinks one alcoholic beverage daily. Physical examination shows a nontender 5 mm x 5 mm ulcerated lesion with an erythematous base on the dorsum of the glans. There is no inguinal lymphadenopathy. Excisional biopsy of the lesion is performed. Which of the following pathological findings is most likely to be seen on the biopsy specimen?", "answer": "Atypical squamous cells with varying degrees of mitotic activity", "meta_info": "step2&3", "answer_idx": "A", "A": "Atypical squamous cells with varying degrees of mitotic activity", "B": "Spirochetes on dark-field microscopy", "C": "Nonspecific inflammatory features with C. trachomatis amplification on PCR", "D": "Safety pin-shaped intracellular inclusions that appear purple on Giemsa stain", "language": "en"}
{"question": "A 54-year-old man comes to the physician for a follow-up appointment. Three weeks ago he underwent emergent cardiac catheterization because of a myocardial infarction and had to stay at the hospital longer than expected because of decreased kidney function. He says his symptoms have since improved greatly and he now produces even more urine than before the procedure. His serum creatinine concentration is 1.6 mg/dL and blood urea nitrogen concentration is 20 mg/dL.This patient is at increased risk for which of the following complications?", "answer": "Hypokalemia", "meta_info": "step1", "answer_idx": "D", "A": "Hypermagnesemia", "B": "Metabolic alkalosis", "C": "Hypernatremia", "D": "Hypokalemia", "language": "en"}
{"question": "A 35-year-old woman visits her primary care provider with complaints of easy fatigability, breathlessness on exertion, and altered sensations in her lower limbs. Past medical history is positive for hypertension. She takes hydrochlorothiazide and lisinopril, ethinyl estradiol-progestin, and a multivitamin every day. Family history is noncontributory. She drinks alcohol almost every day and smokes cigarettes when she drinks. Today her heart rate is 95/min, respiratory rate is 17/min, blood pressure is 130/92 mm Hg, and temperature of 37.0°C (98.6°F). Overall, she has marked pallor with slight bluing of her lips and distal fingertips. Her heart has a regular rate and rhythm and her lungs are clear to auscultation bilaterally. Additionally, she has loss of touch, and vibration sense in both of her lower limbs. Her CBC is as follows:\nHemoglobin 8.0 g/dL\nMCV 112 fL\nWBC 2,500/mm3\nPlatelets 95,000/mm3\nWhat is the most likely diagnosis?", "answer": "Vitamin B12 deficiency", "meta_info": "step1", "answer_idx": "A", "A": "Vitamin B12 deficiency", "B": "Folic acid deficiency", "C": "Vitamin C deficiency", "D": "Vitamin A deficiency", "language": "en"}
{"question": "A 40-year-old man is brought by his wife with nausea and vomiting. He had been working for four hours on repairing his car with the garage shutter closed and the car running but did not lose consciousness. The patient’s blood pressure is 120/70 mmHg, respirations are 28/min, pulse is 120/min, and SaO2 is 98% on room air. The patient has no medical history and is not taking any medications. The patient has 1 alcoholic drink/week and does not use any other illicit drugs. Ophthalmologic exam reveals bilateral retinal hemorrhages. The compound responsible for this patient’s clinical presentation has what mechanism of action?", "answer": "Inhibits the electron transport chain", "meta_info": "step1", "answer_idx": "A", "A": "Inhibits the electron transport chain", "B": "Inhibits acetylcholine esterase", "C": "Prevents acetylcholine release", "D": "DNA alkylation", "language": "en"}
{"question": "A 54-year-old man is hospitalized after a left hemicolectomy for colon cancer. On postoperative day 1, his hemoglobin is noted on routine labs to have dropped overnight from 7.1 g/dL to 5.3 g/dL. The patient does not report feeling any differently. On exam, his temperature is 100.4°F (38.0°C), blood pressure is 102/80 mmHg, pulse is 95/min, and respirations are 14/min. The patient’s urine output in his Foley bag has been 1.0 cc/kg/hr for the last 8 hours. Prior to the operation, the patient had a temperature of 98.8°F (37.1°C), blood pressure of 122/70 mmHg, and a pulse of 65/min. Which of these findings is most concerning regarding the severity of his hypovolemia?", "answer": "Decreased systolic blood pressure", "meta_info": "step1", "answer_idx": "B", "A": "Decreased pulse pressure", "B": "Decreased systolic blood pressure", "C": "Increased heart rate", "D": "Increased temperature", "language": "en"}
{"question": "An obese 45-year-old female presents to the emergency room complaining of abdominal pain. She reports a 4-hour history of severe right upper quadrant pain following a fatty meal. She has a history of multiple similar episodes over the past year. An ultrasound of the right upper quadrant reveals gallstones. Due to the recurrent nature of her disease, she undergoes an elective laparoscopic cholecystectomy. While in the operating room, the surgeons use the laparoscope to visualize a structure connecting the liver to the anterior wall of the abdominal wall. Which of the following embryologic structures eventually ends up within the visualized structure?", "answer": "Umbilical vein", "meta_info": "step1", "answer_idx": "C", "A": "Ductus venosus", "B": "Umbilical artery", "C": "Umbilical vein", "D": "Vitelline duct", "language": "en"}
{"question": "A 28-year-old woman presents with a recent history of severe headaches. The patient states that the headaches came on gradually about 1 week ago and have steadily worsened. She describes the headaches as severe, diffuse, and frequently causing nausea and vomiting, especially in the mornings. Past medical history is significant for bacterial meningitis, approx. one month ago, that was successfully treated. Current medications are combined oral contraceptives and fluoxetine. A review of systems is significant for fatigue and daytime sleepiness. Family history is significant for her mother and aunt who suffer from migraines with aura. Her temperature is 37.0°C (98.6°F), the blood pressure is 110/70 mm Hg, the pulse is 70/min, the respiratory rate is 16/min, and the oxygen saturation is 99% on room air. The cardiac exam is normal. Lungs are clear to auscultation. The neurological exam is normal. The ophthalmic exam reveals the indistinct margins of the optic disc, bilaterally. Which of the following is the most likely cause of the headaches in this patient?", "answer": "Hydrocephalus", "meta_info": "step2&3", "answer_idx": "B", "A": "Genetics", "B": "Hydrocephalus", "C": "Intracranial mass", "D": "Infection", "language": "en"}
{"question": "A 72-year-old presents to the Emergency Room with hemoptysis. He has smoked 1 pack of cigarettes a day for the past 30 years. Physical examination of the face is shown in Image A and is accompanied by left upper extremity edema. Of the following, which is the most likely cause of the patient’s symptoms:", "answer": "Superior sulcus tumor", "meta_info": "step1", "answer_idx": "B", "A": "Pleural effusion", "B": "Superior sulcus tumor", "C": "Pulmonary embolus", "D": "Mass in the thoracic region of the spinal cord", "language": "en"}
{"question": "A 59-year-old man who was recently diagnosed with renal cell carcinoma comes to the physician for a follow-up evaluation. The physician recommends starting treatment with a chemotherapeutic agent that is also used to treat neovascular age-related macular degeneration. A recent history of which of the following conditions would discourage the use of this drug?", "answer": "Gastrointestinal bleeding", "meta_info": "step1", "answer_idx": "D", "A": "Interstitial lung disease", "B": "Chronic kidney disease", "C": "Platinum allergy", "D": "Gastrointestinal bleeding", "language": "en"}
{"question": "A 36-year-old woman presents with a persistent cough productive of blood-streaked sputum, night sweats, and weight loss. No significant past medical history. She denies any history of smoking, alcohol consumption, or recreational drug use. She works as a nurse at a local hospital and lives in an apartment with her extended family. Her vital signs are a blood pressure of 100/80 mm Hg, heart rate of 94/min, respiratory rate of 17/min, and temperature of 35.9℃ (96.6℉). Physical examination reveals dullness to percussion and diminished breath sounds over the upper lobe of the left lung. During the discussion regarding the required workup, the patient tells the physician about recent contact with a patient with tuberculosis. She asks the physician not to report her case because she is concerned she will lose her job. Which of the following statements is correct?", "answer": "If this patient is diagnosed with active pulmonary tuberculosis, it should be reported even without the patient’s consent, and the patient should receive isolation and treatment.", "meta_info": "step1", "answer_idx": "A", "A": "If this patient is diagnosed with active pulmonary tuberculosis, it should be reported even without the patient’s consent, and the patient should receive isolation and treatment.", "B": "The patient has a right to privacy, so, without her consent, the physician can not report her case even if she is diagnosed with active pulmonary tuberculosis.", "C": "If this patient turns out to have active pulmonary tuberculosis, her case can stay unreported only if she agrees to stay home from work and remain isolated at home for her entire treatment period.", "D": "Only active pulmonary tuberculosis is a reportable disease.", "language": "en"}
{"question": "A 33-year-old woman gravida 2, para 1, at 35 weeks gestation is admitted to the hospital with fever and active labor. She reports a 2-day history of fluid leakage from the vagina without pain or vaginal bleeding. Her pregnancy has otherwise been uncomplicated. She has attended many prenatal appointments and followed the physician's advice about screening for diseases, laboratory testing, diet, and exercise. Her previous pregnancy was complicated by a preterm delivery at 34 weeks gestation. The patient reports a 10-pack-year history of smoking before pregnancy and smoked 4 cigarettes daily during pregnancy. At the hospital, her temperature is 39.6°C (103.3°F), blood pressure is 108/60 mm Hg, and pulse is 125/min. Her BMI is 18.2 kg/m2. Uterine palpation reveals tenderness. Cervical examination indicates 100% effacement and 10 cm dilation. Her lungs are clear to auscultation. The baseline fetal heart rate is 180/min. Which of the following is the most appropriate next step in management?", "answer": "Ampicillin and gentamicin", "meta_info": "step2&3", "answer_idx": "B", "A": "Amnioinfusion", "B": "Ampicillin and gentamicin", "C": "Intravenous betamethasone", "D": "Ritodrine hydrochloride", "language": "en"}
{"question": "A 49-year-old man, with a history of alcohol abuse over the last 2 decades, presents with a complaint of epigastric pain for about a year. He previously had one episode of acute pancreatitis for which he was hospitalized. He continued to drink 4–5 beers/day after he was discharged. His appetite is good, but he has a history of weight loss. He also complains of oily and bulky stools. He takes aluminum hydroxide gel and ranitidine for partial pain relief. Vital signs are stable. Routine physical exam and blood work are normal except for mild hypocalcemia. Abdominal CT scan is shown below. Which of the following tests is comparatively less useful in assessing the function of the organ involved in this condition?", "answer": "Serum amylase and lipase levels", "meta_info": "step1", "answer_idx": "B", "A": "Secretin stimulation test", "B": "Serum amylase and lipase levels", "C": "Fecal elastase level", "D": "Magnetic resonance cholangiopancreatography (MRCP)", "language": "en"}
{"question": "A 34-year-old woman presents to the office due to a pulmonary embolism confirmed by computed tomography (CT) chest angiogram, which she was recently hospitalized for. She does not have any recent surgical trauma or travel history. She complains of having episodes where her fingers become white and then blue, and they are usually accompanied by pain in the same region. These episodes tend to happen more frequently during winter and have been ongoing for about 2 years now. She also had a spontaneous abortion at 12 weeks of gestation last year. She does not have a family history of venous thromboembolic disease. The vital signs include heart rate 76/min, respiratory rate 18/min, temperature 37.2°C (99.0°F), and blood pressure 120/80 mm Hg. Physical examination is non-contributory. The complete blood count (CBC) results are as follows:\nHemoglobin 14.2 g/dL\nHematocrit 39%\nLeukocyte count 4,950/mm3\nNeutrophils 59%\nBands 3%\nEosinophils 1%\nBasophils 0%\nLymphocytes 31%\nMonocytes 4%\nPlatelet count 120,000/mm3\nThe coagulation test results are as follows:\nPartial thromboplastin time (activated) 56 seconds\nProthrombin time 15 seconds\nReticulocyte count 1.0%\nThrombin time < 2 seconds deviation from control\nWhich of the following diagnostic tests would be the most appropriate?", "answer": "Lupus anticoagulant", "meta_info": "step1", "answer_idx": "C", "A": "Protein C", "B": "Factor-V-Leiden", "C": "Lupus anticoagulant", "D": "Protein S", "language": "en"}
{"question": "A 36-year-old woman, gravida 3, para 2, at 34 weeks' gestation is brought to the emergency department for the evaluation of continuous, dark, vaginal bleeding that started one hour ago. She also reports severe lower abdominal pain. Her current pregnancy was complicated by preeclampsia. Her first two children were delivered vaginally. Current medications include methyldopa and a multivitamin. Her pulse is 100/min, respirations are 16/min, and blood pressure is 90/60 mm Hg. The abdomen is tender, and hypertonic contractions are felt. There is blood on the vulva and on the medial aspect of both thighs bilaterally. The fetus is in a cephalic presentation. The fetal heart rate is 170/min with several decelerations. Which of the following is the most appropriate next step in the management of this patient?", "answer": "Emergency cesarean delivery", "meta_info": "step2&3", "answer_idx": "A", "A": "Emergency cesarean delivery", "B": "Elective cesarean delivery", "C": "Administration of terbutaline", "D": "Administration of oxytocin and normal vaginal birth", "language": "en"}
{"question": "A 16-year-old boy is brought to the emergency department because of severe left flank pain and nausea for 3 hours. The pain is colicky and radiates towards his groin. He drinks multiple glasses of iced tea every day. He has had similar episodes of abdominal pain in the past. His maternal uncle has a similar history of abdominal pain. His temperature is 37.1°C (98.8°F), pulse is 103/min, and blood pressure is 108/72 mm Hg. Examination shows a soft and nontender abdomen. Left costovertebral angle tenderness is present. An x-ray of the abdomen shows no abnormalities. A urinary cyanide nitroprusside test is positive. Further evaluation of this patient is most likely to show which of the following?", "answer": "Hexagon-shaped crystals on urinalysis", "meta_info": "step2&3", "answer_idx": "D", "A": "Rhomboid crystals on urinalysis", "B": "Urinary pH of 7.8", "C": "Serum anti-Saccharomyces cerevisiae antibodies", "D": "Hexagon-shaped crystals on urinalysis", "language": "en"}
{"question": "A 57-year-old woman comes to the emergency department because of severe dyspnea, cough, and pleuritic chest pain for 20 minutes. Three weeks ago, she underwent surgery for a total right knee replacement. The patient appears distressed. Her pulse is 112/min, respirations are 24/min, and blood pressure is 88/55 mm Hg. Examination shows jugular venous distention. There is a mildly tender surgical scar on her right knee. A CT scan of the chest is shown. Which of the following is the most appropriate treatment for this patient's condition?", "answer": "Alteplase", "meta_info": "step1", "answer_idx": "B", "A": "Endovascular stent-grafting", "B": "Alteplase", "C": "Coronary angioplasty", "D": "Pericardiocentesis", "language": "en"}
{"question": "A group of multidisciplinary researchers from a tertiary hospital decides to investigate whether there is an association between splenectomy and pulmonary tuberculosis. From the hospital database, they identify 19,000 patients over the age of 20 with newly diagnosed pulmonary tuberculosis, as well as 72,000 patients without pulmonary tuberculosis for comparison purposes. Both of these groups are matched for age, gender, and an index year when the condition was initially diagnosed. The odds of pulmonary tuberculosis development associated with splenectomy and other comorbidities is estimated. After controlling for all relevant confounders, the results show that splenectomy is associated with a two-fold higher incidence of pulmonary tuberculosis development. There is also a synergistic effect between splenectomy and other comorbid conditions in the development of pulmonary tuberculosis. What type of study has been used by the researchers in this example?", "answer": "Case-control study", "meta_info": "step1", "answer_idx": "B", "A": "Cohort study", "B": "Case-control study", "C": "Ecological study", "D": "Intervention study", "language": "en"}
{"question": "A 53-year-old woman presents to the clinic with complaints of fatigue. She reports that over the past several months she has been lethargic and tired. She has gained 10 pounds over the past month but attributes it to her menopause. Her last menstrual period (LMP) was 1 year ago. Past medical history is significant for asthma and seasonal allergies, and medications include a rescue inhaler and cetirizine as need. Review of systems is negative except for cold intolerance and constipation. What is the best next step in evaluating this patient?", "answer": "TSH levels", "meta_info": "step1", "answer_idx": "D", "A": "Beta-hCG levels", "B": "FSH levels", "C": "Thyroid peroxidase antibody titer", "D": "TSH levels", "language": "en"}
{"question": "A 33-year-old man presents to his primary care physician for fatigue, weight loss, and diffuse pruritus. The patient has a past medical history of multiple admissions for severe abdominal pain and bloody diarrhea as well as several episodes of ascending cholangitis which were successfully treated. He is currently a member of Alcoholics Anonymous. His temperature is 98.2°F (36.8°C), blood pressure is 124/75 mmHg, pulse is 100/min, respirations are 13/min, and oxygen saturation is 99% on room air. Urinalysis is notable only for a dark urine sample with no red blood cells present. A rectal exam reveals pale stool and grossly visible blood. Physical exam is otherwise notable for pruritis, jaundice, and scleral icterus. Which of the following is the most likely underlying diagnosis?", "answer": "Cholangiocarcinoma", "meta_info": "step2&3", "answer_idx": "B", "A": "Ascending cholangitis", "B": "Cholangiocarcinoma", "C": "Cirrhosis", "D": "Colon cancer", "language": "en"}
{"question": "A 43-year-old female presents with several years of pain and stiffness in her wrists and hands. Her symptoms have been getting progressively worse. She reports that her hands feel stiff for an hour or more after awaking in the morning. She undergoes subsequent testing, and is found to have anti-citrullinated protein antibodies. Her physician is concerned for rheumatoid arthritis, and discusses treatment with a biologic disease-modifying anti-rheumatic agent.\n\nWhich of the following must be done before beginning treatment with a TNF inhibitor?", "answer": "Test for latent mycobacterial infection", "meta_info": "step1", "answer_idx": "C", "A": "Confirm diagnosis with a test for rheumatoid factor", "B": "Confirm diagnosis with elevated ESR and CRP", "C": "Test for latent mycobacterial infection", "D": "Obtain a radiograph demonstrating osteophytes", "language": "en"}
{"question": "A 65-year-old man is brought to the emergency department with a complaint of right-sided numbness for 5 hours. The numbness started in the right-side of the face and has progressed to the same side arm and leg within 30 minutes. He denies limb weakness, walking difficulty, vision problem, or vertigo. He had similar symptoms 5 months ago that were resolved within 10 minutes. The past medical history includes type 2 diabetes mellitus, hypertension, dyslipidemia, and hyperuricemia. The medication list includes allopurinol, amlodipine, aspirin, glimepiride, lisinopril, and rosuvastatin. The blood pressure is 165/102 mm Hg, and the rest of the vital signs are within normal limits. On examination, there are no facial droop and slurring of the speech noted. The muscle strength is normal in all 4 limbs with a normal tone and deep tendon reflexes. There is a decreased pinprick sensation and proprioception on the right arm and leg. The gait is normal. The blood sugar is 221 mg/dL. The CT scan of the head is normal. The MRI of the head with diffusion-weighted imaging reveals a 15 mm diffusion restriction in the left thalamus. Which of the following is the most crucial in the development of this patient’s condition?", "answer": "Lipohyalinosis of small penetrating arteries due to chronic hypertension", "meta_info": "step2&3", "answer_idx": "C", "A": "Emboli from deep leg veins with a patent foramen ovale", "B": "Leakage of blood from intracranial vessel due to uncontrolled hypertension", "C": "Lipohyalinosis of small penetrating arteries due to chronic hypertension", "D": "Significant stenosis of the left carotid artery", "language": "en"}
{"question": "A 23-year-old man presents to a psychiatrist for evaluation of situational anxiety. He reports that he recently started a new job that involves regular public speaking and is very stressed before every public speaking event. He describes developing a rapid heart rate and diaphoresis that interferes with his ability to speak well. He has no past medical history and takes no medications. He does not smoke or drink alcohol. His temperature is 98.6°F (37°C), blood pressure is 110/65 mmHg, pulse is 85/min, and respirations are 17/min. On exam, he is well-appearing and appropriately conversational. He is alert and fully oriented. The patient is prescribed propranolol to take before major public speaking events. Which of the following physiologic changes will occur when the patient takes this medication?", "answer": "Decreased cardiac output and increased peripheral resistance", "meta_info": "step1", "answer_idx": "B", "A": "Decreased cardiac output and decreased peripheral resistance", "B": "Decreased cardiac output and increased peripheral resistance", "C": "Increased cardiac output and decreased peripheral resistance", "D": "Increased cardiac output and increased peripheral resistance", "language": "en"}
{"question": "A 69-year-old woman is brought into the emergency room by family members after they noted that she had become increasingly lethargic over the past 3 days. Her temperature is 39.5°C (103.1°F), the blood pressure is 75/40 mm Hg, the heart rate 130/min, the respiratory rate 24/min, and the oxygen saturation is 89% on room air. On examination, she is severely ill, drowsy, and unable to speak. Her skin is warm to the touch. White blood cell count is 15,000/mm3 and her urinalysis is positive for nitrites and leukocyte esterase. Which of the following is the best initial step in the management of this patient's condition?", "answer": "Assessment of airway, breathing, and circulation", "meta_info": "step2&3", "answer_idx": "C", "A": "Intramuscular adrenaline", "B": "Intravenous hydrocortisone", "C": "Assessment of airway, breathing, and circulation", "D": "Intravenous noradrenaline", "language": "en"}
{"question": "A 28-year-old G2P1 woman at 29 weeks gestation presents to the obstetrician after noticing red spots on her undergarments over the past week. Her vaginal bleeding has not been painful; however, she is concerned that it has persisted. Her previous child was born by cesarean section and she is currently taking folate and a multivitamin. She endorses feeling fetal movements. Her temperature is 98.9°F (37.2°C), blood pressure is 120/84 mmHg, pulse is 88/min, respirations are 17/min, and oxygen saturation is 99% on room air. Physical exam is notable for a gravid uterus and non-tender abdomen. Speculum exam reveals a closed cervical os and a small amount of blood. Which of the following is the most likely diagnosis?", "answer": "Placenta previa", "meta_info": "step2&3", "answer_idx": "B", "A": "Placenta percreta", "B": "Placenta previa", "C": "Placental abruption", "D": "Uterine rupture", "language": "en"}
{"question": "A 57-year-old woman comes to the emergency department 1 hour after experiencing a distressing 10-minute episode of stuttering during a business meeting. She has hypertension. She has smoked 2 packs of cigarettes daily for 30 years. Current medications include fosinopril and hydrochlorothiazide. Her temperature is 37°C (98.6°F), pulse is 90/min, respirations are 16/min, and blood pressure is 134/88 mm Hg. She is oriented to person, place, and time. Her speech is clear. When she is asked to hold both arms fully extended at shoulder level with palms upwards and eyes closed, her right palm turns inwards and downwards. Which of the following is the most likely cause of this patient's physical findings?", "answer": "Upper motor neuron lesion", "meta_info": "step2&3", "answer_idx": "C", "A": "Cerebellar lesion", "B": "Inferior frontal gyrus lesion", "C": "Upper motor neuron lesion", "D": "Thalamus lesion", "language": "en"}
{"question": "A 40-year-old man comes to the physician because of a 5-kg (11-lb) weight loss over the past month and easy bruising. He has not changed his diet significantly. He also noticed that his arms now bruise more easily. He appears pale. His pulse is 70/min, his blood pressure is 125/75 mm Hg, and his temperature is 38°C (100.4°F). Examination shows a palm-sized hematoma on his right arm. His spleen is palpable 5 cm below the costal margin. His liver is enlarged. Laboratory results show:\nLeukocytes 10,500/mm3\nHemoglobin 10.2 g/dL\nPlatelets 52,000/mm3\nFibrinogen 110 mg/dL (Reference: 150-400 mg/dL)\nCytogenetic analysis shows leukocytes with a reciprocal translocation of chromosomes 15 and 17. Which of the following is the most appropriate treatment for this patient at this time?\"", "answer": "All-trans retinoic acid", "meta_info": "step2&3", "answer_idx": "B", "A": "Cyclophosphamide", "B": "All-trans retinoic acid", "C": "Cryoprecipitate transfusion", "D": "Imatinib", "language": "en"}
{"question": "At a routine exam, a 68-year-old female patient is discovered to have a serum calcium level of 11.5 mg/dL. Follow-up laboratory tests show a high parathyroid hormone with low phosphorus and mildly elevated alkaline phosphatase. 24-hour urine calcium level is elevated. Review of symptoms includes complaints of fatigue, constipation, and diffuse bone pain for which she takes vitamin D. Past medical history is significant for type 2 diabetes mellitus for 25 years and essential hypertension for 15 years. The patient has a history of kidney stones. Family history is irrelevant. Which of the following is the most likely etiology of this patient's condition?", "answer": "Solitary parathyroid adenoma", "meta_info": "step2&3", "answer_idx": "C", "A": "Vitamin D intoxication", "B": "Familial hypocalciuric hypercalcaemia", "C": "Solitary parathyroid adenoma", "D": "Thyrotoxicosis", "language": "en"}
{"question": "A 27-year-old man and his wife present to an infertility clinic for evaluation after they tried unsuccessfully to conceive for 2 years. He has no prior medical history and does not currently take any medications. On evaluation, he is found to have long extremities and gynecomastia. In addition, he has testicular atrophy and very little body hair, which is distributed primarily in the pubic region. Further analysis reveals azoospermia, and appropriate tests confirming the diagnosis are performed. The couple is told about the cause of their inability to conceive and given further options to pursue. Which of the following is associated with the pathophysiology underlying this patient's disorder?", "answer": "Increased aromatase activity", "meta_info": "step1", "answer_idx": "C", "A": "Abnormal signaling through androgen receptors", "B": "Abnormal conversion of testosterone", "C": "Increased aromatase activity", "D": "Increased production of prolactin", "language": "en"}
{"question": "A 32-year-old GP2 presents to an outpatient clinic for a routine gynecologic examination. The patient appears well, although she mentions that during the past 6 months she has noticed small amounts of vaginal bleeding in the middle of her menstrual cycles. Her last pregnancy was 3 years ago. Her subsequent menstrual cycles have been regular, lasting about 2–3 days. She mentions that she is up to date with her Pap smear; all of her Pap smears have been normal. She denies any recent travel or history of trauma. The patient is sexually active with her husband and they use condoms consistently. She does not smoke, drinks alcohol occasionally, and has never used illicit drugs. The physical examination is essentially normal. An ultrasound reveals a fleshy mass with a pedunculated stalk deep in the cervical canal. The uterine lining measures 5 mm in thickness and is homogeneous. Multiple small leiomyomas are also observed. The patient is otherwise asymptomatic and has no other complaints. The rest of the physical examination is unremarkable. Which of the following is the next best step in management?", "answer": "Removal of the lesion with a ring forceps", "meta_info": "step2&3", "answer_idx": "D", "A": "No further intervention with follow-up in 6 months", "B": "Electrocautery and cryofreezing", "C": "Cervical brush biopsy", "D": "Removal of the lesion with a ring forceps", "language": "en"}
{"question": "An 11-year-old girl presents to her pediatrician with complaints of headache and rapid leg fatigue with exercise. Her vital signs are: HR 77, BP in left arm 155/100, RR 14, SpO2 100%, T 37.0 C. On palpation, her left dorsalis pedis pulse is delayed as compared to her left radial pulse. Her lower extremities feel slightly cool. Blood pressure obtained on the left lower extremity is 120/80. Which of the following is the most likely underlying pathology?", "answer": "Coarctation of the aorta", "meta_info": "step2&3", "answer_idx": "C", "A": "Peripheral arterial disease", "B": "Vasospasm", "C": "Coarctation of the aorta", "D": "Tetralogy of Fallot", "language": "en"}
{"question": "A 34-year-old woman comes to the gynecologist complaining of vaginal swelling and discomfort. She states that over the past 2 weeks she has noticed swelling of her right labia. The swelling continued to grow in size and now causes her discomfort when walking. She denies abnormal discharge or bleeding from the swelling or from the vulva. She normally shaves the area, but with the recent pain, she has been unable to. She denies any history of known trauma. The patient is relatively healthy and takes only a multivitamin. She never received the vaccine for human papillomavirus (HPV). On physical exam, there is a fluctuant, swelling of the right labia, most prominently at the posterior vestibule. Which of the following is the most likely diagnosis?", "answer": "Bartholin gland cyst", "meta_info": "step2&3", "answer_idx": "A", "A": "Bartholin gland cyst", "B": "Folliculitis", "C": "Granuloma inguinale", "D": "Vulvar cancer", "language": "en"}
{"question": "A 4-month-old boy is brought to the physician because of noisy breathing for 2 months that has progressively become louder. The noisy breathing improves when he is in the prone position. It is worse when he is agitated, feeding, or lying on his back. He was born at term and has been healthy since. His temperature is 37.1°C (98.8°F), pulse is 120/min, and respirations are 50/min. Pulse oximetry on room air shows an oxygen saturation of 98%. Examination shows inspiratory stridor. Which of the following is the most appropriate treatment?", "answer": "Observation", "meta_info": "step2&3", "answer_idx": "A", "A": "Observation", "B": "Surgical division", "C": "Ceftriaxone therapy", "D": "Supraglottoplasty", "language": "en"}
{"question": "A 16-year-old girl comes to the physician with a 4-day history of painful vulvar lesions, generalized fatigue, and malaise. During this period, she has also had dysuria. She is sexually active with 2 male partners and uses condoms inconsistently. Her immunizations are up-to-date; she completed the vaccination course for human papilloma virus 2 months ago. Her temperature is 38.1°C (100.6°F), pulse is 100/min, respirations are 12/min, and blood pressure is 110/70 mm Hg. Pelvic examination shows several shallow ulcers on an erythematous base over the labia majora and minora. There is bilateral, tender inguinal lymphadenopathy. Which of the following is the most appropriate treatment for this patient's condition?", "answer": "Acyclovir therapy", "meta_info": "step2&3", "answer_idx": "A", "A": "Acyclovir therapy", "B": "Azithromycin therapy", "C": "Doxycycline therapy", "D": "Penicillin therapy", "language": "en"}
{"question": "A 57-year-old man comes to the physician because of progressively worsening epigastric pain and 6.8-kg (15-lb) weight loss for the past 2 months. Two weeks ago, he noticed painful, red blotches on the medial aspect of his right calf. He has smoked one pack of cigarettes daily for the last 35 years. He appears thin. Physical examination shows tender erythematous nodules on the right ankle and left antecubital fossa. Endoscopy shows a large mass in the antrum of the stomach. A biopsy specimen of the gastric mass shows disorganized mucin-secreting cells with surrounding fibrosis. These cells most likely originated from which of the following structures?", "answer": "Exocrine ducts in the body of the pancreas", "meta_info": "step1", "answer_idx": "C", "A": "Lymphoid tissue in the terminal ileum", "B": "Mature hepatocytes in the liver", "C": "Exocrine ducts in the body of the pancreas", "D": "Squamous epithelium in the proximal esophagus", "language": "en"}
{"question": "A 62-year-old woman comes to the emergency department because of painful and difficult swallowing. Her voice has also become muffled. She has been well until last night and reports having intermittent fevers at home. The patient has smoked a pack of cigarettes a day since age 19 but is otherwise healthy. Her temperature is 39°C (102.2°F), blood pressure is 142/93 Hg/mm, heart rate is 109/min, and respiratory rate is 18/min. On examination, the patient's head is extended and she appears anxious. Her voice is muffled and there is inspiratory stridor. There is tender bilateral cervical lymphadenopathy and pain upon palpation of the hyoid. The remainder of the examination shows no abnormalities. Laboratory studies show a leukocyte count of 18,000/mm3 with 83% neutrophils. Which of the following is the most likely cause of this patient's presentation?", "answer": "Haemophilus influenzae type b", "meta_info": "step2&3", "answer_idx": "D", "A": "Pseudomonas aeruginosa", "B": "Corynebacterium diphtheriae", "C": "Parainfluenza virus", "D": "Haemophilus influenzae type b", "language": "en"}
{"question": "A 56-year-old woman is brought to the emergency department by her husband 30 minutes after a generalized tonic-clonic seizure. Over the past 3 months, she has had recurrent headaches and worsening early-morning vomiting. She has no personal or family history of a seizure disorder. An MRI of the brain shows a central mass; surgical resection is planned. One day before the surgery, the patient has another generalized seizure and, despite resuscitative efforts, she dies. Gross examination of the brain at autopsy is shown. Which of the following was the most likely cause of this patient's symptoms?", "answer": "Glioblastoma", "meta_info": "step1", "answer_idx": "B", "A": "Oligodendroglioma", "B": "Glioblastoma", "C": "Schwannoma", "D": "Meningioma", "language": "en"}
{"question": "A 29-year-old woman (gravida 2, para 1) presents at 32 weeks gestation for routine follow-up care. Her previous pregnancy was complicated with preeclampsia, and she delivered at 35 weeks via cesarean delivery. Four years ago, she was diagnosed with arterial hypertension. Prior to pregnancy, she took amlodipine and hydrochlorothiazide; after she found out she was pregnant, she switched to methyldopa. The course of her current pregnancy has been unremarkable with normal laboratory values at each checkup. According to her blood pressure diary, her systolic blood pressure varies between 120 and 130 mm Hg, and her diastolic blood pressure is usually normal. At presentation, the blood pressure is 140/80 mm Hg, heart rate is 76/min, respiratory rate is 15/min, and temperature is 36.9°C (98.4°F). The fetal heart rate is 143/min. Examination shows a 1+ pitting lower leg edema. Dipstick test shows 2+ protein. 24-hour urine assessment demonstrates urinary protein excretion of 1 g/L. Which of the following laboratory values should be assessed next in this patient?", "answer": "Liver transaminases", "meta_info": "step2&3", "answer_idx": "B", "A": "Coagulogram", "B": "Liver transaminases", "C": "Total bilirubin", "D": "Urinalysis", "language": "en"}
{"question": "Following a colonoscopy performed on a 63-year-old man, the gastroenterologist identifies a firm tumor approx. 80 cm (31.4 in) from the entry site. He also performs an endoscopic polypectomy and tattooing at 50 cm (19.6 in) from the entry site. A pathologic report shows a benign polyp. One week later, the surgeon in the operating room is erroneously preparing to perform partial colectomy of the tattooed site. After confirming the patient’s name and before surgery, the surgical team reviews the patient’s history and medical documents orally based on institutional protocols. The surgery resident points out that the resected polyp is benign and the tumor lies 30 cm (11.8 in) distal to the tattooed area. The attending surgeon performs a partial colectomy on the correct site. Which of the following best describes this approach to the prevention of medical errors?", "answer": "Preoperative time-out", "meta_info": "step2&3", "answer_idx": "B", "A": "Closed-loop communication", "B": "Preoperative time-out", "C": "Primordial prevention", "D": "Sentinel event", "language": "en"}
{"question": "A 28-year-old G2P1001 presents for a routine obstetric visit in her 36th week of pregnancy. She has a history of type I diabetes controlled by insulin and delivered 1 child by normal spontaneous vaginal delivery 2 years ago. Earlier in this pregnancy, she had 2 episodes of burning with urination and frequent urination. Urinalysis each time confirmed a urinary tract infection, and both urine cultures isolated organisms sensitive to nitrofurantoin. Her symptoms resolved with 10-day courses of nitrofurantoin. She has no complaints today. Urinalysis is positive for leukocyte esterase and nitrites. Which of the following is the best next step in management?", "answer": "Treat with oral nitrofurantion for 10 days then continue for prophylaxis until delivery", "meta_info": "step2&3", "answer_idx": "D", "A": "Admit to the hospital and treat with intravenous ceftriaxone", "B": "Treat with oral trimethroprim-sulfamethoxazole for 10 days then continue for prophylaxis until delivery", "C": "Treat with oral nitrofurantion for 10 days", "D": "Treat with oral nitrofurantion for 10 days then continue for prophylaxis until delivery", "language": "en"}
{"question": "A 3-year-old boy is brought to the physician by his parents because of clumsiness and multiple falls over the past 4 months. He started walking at the age of 18 months and could walk up steps by the time he was 27 months old but now struggles to walk at all without assistance. When standing up from a lying position, he crawls onto his knees and slowly walks himself up with his hands. There is bilateral calf enlargement. Analysis of a left calf biopsy specimen from this patient is most likely to show which of the following?", "answer": "Degeneration of muscle fibers with fibrofatty replacement", "meta_info": "step1", "answer_idx": "B", "A": "Proliferation of mitochondria within muscle fibers", "B": "Degeneration of muscle fibers with fibrofatty replacement", "C": "Atrophic muscle fibers interspersed among hypertrophic muscle fibers", "D": "Necrotic muscle fibers with lymphocytic infiltrate", "language": "en"}
{"question": "A 60-year-old man presented to the hospital with right upper quadrant abdominal pain. He has a history of hepatitis B. He underwent a CT of his abdomen which revealed a large mass (11.3 cm x 7.2 cm in diameter) with a metastatic retroperitoneal lymph node. He was diagnosed with hepatocellular carcinoma and initially received radiotherapy while on the transplant list to prevent local expansion of his malignancy. 3 months after radiotherapy, the patient experienced hematemesis and melena. He was admitted to the emergency department for evaluation. His vitals were: blood pressure 84/56 mmHg, heart rate 92/min, and respiratory rate 20/min. Laboratory evaluation revealed severe anemia with a hemoglobin level of 5.7 g/dL, INR 1.8 and platelets of 68,000 cells/mm3. He received a blood transfusion. An endoscopic examination demonstrated diffuse edematous hyperemic mucosa and multiple hemorrhagic patches with active oozing in the antrum. What is the most likely diagnosis for the lesions seen in endoscopy?", "answer": "Intrinsic apoptotic pathway", "meta_info": "step1", "answer_idx": "A", "A": "Intrinsic apoptotic pathway", "B": "Coagulative necrosis", "C": "Overexpression of BcL-2 gene", "D": "Cytotoxic CD8 T cells pathway", "language": "en"}
{"question": "A 49-year-old Caucasian woman presents to your office for elevated blood pressure. She is a nurse and checks her blood pressure regularly while working in the wards. She presents with readings ranging between 163/101 and 156/94 mm Hg. After some research she conducted on her own, she has been exercising and following a low-fat, low-salt diet for the past 3 months. Her past medical history includes laparoscopic cholecystectomy for acute cholecystitis 2 years previously. Her mother and father have hypertension and her father had myocardial infarction at the age of 68 years. She takes no medications and denies smoking. She drinks 3 glasses of wine a week. Her blood pressure in the office after more than 10 minutes of rest was 153/89 mm Hg in her left arm and 145/90 mm Hg in her right arm. A review of her medical record reveals that her blood pressure was 142/92 mm Hg at her visit 1 year ago. Which of the following is the best next step in management?", "answer": "Blood glucose", "meta_info": "step2&3", "answer_idx": "D", "A": "Liver function tests", "B": "Urine microalbumin", "C": "Hemoglobin A1C", "D": "Blood glucose", "language": "en"}
{"question": "A 55-year-old man presents to his primary care physician for back pain. The patient states that his back pain is worse in the morning and improves with certain activities. He does not experience pain when cycling but notices the pain when standing or walking. 2 months prior to presentation he was lifting heavy boxes and furniture into his daughter's new home. He is requesting pain medication and a doctor's note to take off work for the week as his symptoms are disrupting his life. Which of the following is most likely to be seen in this patient?", "answer": "Narrowing of the lumbar spinal canal on MRI", "meta_info": "step2&3", "answer_idx": "D", "A": "Bamboo appearance of the spine on radiography", "B": "Muscular tenderness with perispinal palpation", "C": "Multiple doctors visits for other unrelated problems", "D": "Narrowing of the lumbar spinal canal on MRI", "language": "en"}
{"question": "A 75-year-old man presents to the emergency department from his doctor’s office with a 2-day history of urinary hesitancy, fever, and chills. He additionally notes that he has been getting up frequently during the night to urinate. For the last 2 years, it has taken him longer than usual to initiate urination and his stream has gotten weaker. He has a history of hypertension for which he takes losartan. His blood pressure is 128/84 mm Hg, heart rate is 84/min, respiratory rate is 14/min, and temperature is 38.2°C (100.8°F). No costovertebral angle tenderness is present on physical examination. The patient declines rectal examination. Significant laboratory results are as follows:\nWBC 15.2 x  10°/L\nHemoglobin 13.4 g/dL\nPlatelets 185 x 109/L\nProstate-specific antigen (PSA) 10 ng/mL\nWhat is the most likely cause of the patient’s symptoms?", "answer": "Prostatitis", "meta_info": "step2&3", "answer_idx": "D", "A": "Prostate cancer", "B": "Pyelonephritis", "C": "Nephrolithiasis", "D": "Prostatitis", "language": "en"}
{"question": "A 6-year-old boy is brought to the physician for evaluation of bilateral erythematous skin lesions on the flexures of the elbows and knees. He has been scratching the areas frequently. He has had similar lesions intermittently for the last 2 years. A photograph of the lesions on the back of the knees is shown. This patient's skin lesions are most likely associated with which of the following?", "answer": "Reversible decrease in FEV1/FVC ratio", "meta_info": "step1", "answer_idx": "A", "A": "Reversible decrease in FEV1/FVC ratio", "B": "IgA anti-tissue transglutaminase antibodies", "C": "Hepatocyte infection with hepatitis C virus", "D": "Pencil-in-cup deformity of the fingers", "language": "en"}
{"question": "An important step in the formation of thyroid hormones is the formation of I2 via oxidation of I-. Which of the following molecules is responsible for this reaction?", "answer": "Thyroid peroxidase", "meta_info": "step1", "answer_idx": "B", "A": "Thyroid deiodinase", "B": "Thyroid peroxidase", "C": "Perchlorate", "D": "Propylthiouracil", "language": "en"}
{"question": "A 29-year-old woman presents to her primary care provider for a normal check-up at the prompting of her mother. When asked how she is doing, she replies that she feels depressed. Upon further questioning, she states that she feels “worthless” now that her ex-boyfriend left her 2 days ago. She has been sitting in his bed all day trying to call him but he is not answering her calls. She says that she will never find another man like him and feels like she should just “disappear” rather than continue living without him. She also reports that she can hear his voice when he’s not around, especially at night before she goes to bed. She denies having any other friends and has some social anxiety, particularly in large groups of people. A review of her medical record indicates that she has endured several episodes of verbal and physical abuse from her prior relationships which she suggested “were all her fault.” She has had 4 prior serious relationships and reports that she has not been single for more than a few days in the last 10 years. On exam, she is unkempt with poor self-care. This patient’s history is most consistent with which of the following conditions?", "answer": "Dependent personality disorder", "meta_info": "step1", "answer_idx": "B", "A": "Avoidant personality disorder", "B": "Dependent personality disorder", "C": "Histrionic personality disorder", "D": "Paranoid personality disorder", "language": "en"}
{"question": "A 65-year-old man presents to the emergency department with confusion and chest pain. He states his symptoms started after he landed on a return flight from Brazil. Since then, the patient states that he feels anxious, short of breath, and has pleuritic chest pain. The patient has a past medical history of diabetes and chronic kidney disease. His medications include insulin, lisinopril, aspirin, and atorvastatin. His temperature is 101°F (38.3°C), blood pressure is 154/94 mmHg, pulse is 90/min, respirations are 17/min, and oxygen saturation is 96% on room air. Physical exam is notable for a confused man. The patient’s laboratory studies are ordered as seen below.\n\nSerum:\nNa+: 140 mEq/L\nCl-: 103 mEq/L\nK+: 5.3 mEq/L\nHCO3-: 25 mEq/L\nBUN: 33 mg/dL\nGlucose: 168 mg/dL\nCreatinine: 1.8 mg/dL\nCa2+: 10.0 mg/dL\nTroponin: < 0.05 mcg/L\n\nA chest CT angiogram, an echocardiogram (ECG), and a second troponin are ordered and are all unremarkable. The patient’s chest pain resolves with diazepam. A lumbar puncture is performed and based on the results the patient is subsequently started on acyclovir. Which of the following is the best next step in management?", "answer": "Bolus of IV fluids", "meta_info": "step2&3", "answer_idx": "A", "A": "Bolus of IV fluids", "B": "Calcium gluconate", "C": "Hemodialysis", "D": "No further interventions needed", "language": "en"}
{"question": "A 52-year-old homosexual man presents to the emergency department because of sudden right loin pain accompanied by nausea and vomiting. He has essential hypertension for 3 years for which he takes bisoprolol. He has a remote history of intravenous drug use. His temperature is 36.9°C (98.4°F), the blood pressure is 137/92 mm Hg, and the pulse is 95/min. Physical examination reveals right flank tenderness and 2+ edema of both legs up to the knees. Doppler ultrasonography shows an enlarged, echogenic right kidney with the absent venous signal. Laboratory results are shown:\nSerum creatinine 2.2 mg/dL\nUrine dipstick 4+ protein\nUrine analysis 20–25 red cells/high power field\nWhich of the following is the most likely underlying etiology of this patient's condition?", "answer": "Membranous nephropathy", "meta_info": "step2&3", "answer_idx": "C", "A": "Acute pyelonephritis", "B": "Hypertensive kidney disease", "C": "Membranous nephropathy", "D": "Penile cancer", "language": "en"}
{"question": "A 53-year-old woman is brought to the emergency department for a 2-hour history of balance problems. She was gardening when she suddenly felt very dizzy and she quickly called for her husband. When he arrived, she was sitting on the ground, swaying back and forth but overall leaning to the right. When she tried to stand up they found she was very unsteady and unbalanced, so her husband carried her to the car. In the emergency department, while lying in bed, she complains of a room-spinning sensation; when she sits up, she sways to the right. She is unable to walk more than 3 steps without falling. Finger-nose-finger and heel-knee-shin testing are abnormal. She has a past medical history of hypertension, polycystic ovarian syndrome, and type 2 diabetes mellitus. All of her vital signs are all within normal limits. Angiography would most likely show a dissection in which of the following vessels?", "answer": "Vertebral artery", "meta_info": "step2&3", "answer_idx": "C", "A": "Anterior cerebral artery", "B": "Middle cerebral artery", "C": "Vertebral artery", "D": "Anterior spinal artery", "language": "en"}
{"question": "A 65-year-old man with squamous cell carcinoma of the lung presents with a sodium of 118 and an altered mental status. He is started on 3% normal saline over the next several hours. The patient’s mental status improves and and a repeat sodium six hours later is 129. Three days after treatment he demonstrates quadriparesis and dysarthria. Which of the following best describes this cause of the patients symptoms after treatment?", "answer": "Osmotic demyelination syndrome", "meta_info": "step2&3", "answer_idx": "C", "A": "Lateral medullary syndrome", "B": "Medial medullary syndrome", "C": "Osmotic demyelination syndrome", "D": "Hypercalcemia", "language": "en"}
{"question": "A 27-year-old woman presents to the emergency department with severe wheezing, which started an hour ago. She informs the doctor that she has had mild persistent asthma for the last 2 years and is on inhaled corticosteroids, and uses them regularly. She has not experienced asthma symptoms for the last 2 months and there is no history of non-compliance. She mentions that her present symptoms came on about 20 minutes after her last meal. When the doctor makes specific inquiries, she recollects items in her lunch, which included canned milk product, commercially available roasted peanuts, homemade celery salad, and wine. She also mentions that she took a tablet of acetaminophen immediately after the meal because her legs were aching since morning, which she attributes to her morning walk at 6 am the same day. She has never developed respiratory symptoms in response to milk protein, peanuts, or acetaminophen until now. Skin prick testing for food allergens, performed a month back, was negative for all the common food allergens, including milk and peanuts. Which of the following is the most likely trigger for her current episode?", "answer": "Food additive", "meta_info": "step2&3", "answer_idx": "B", "A": "Ara-h-1 protein", "B": "Food additive", "C": "Acetaminophen", "D": "Exercise", "language": "en"}
{"question": "A 30-year old African-American woman comes into your office for pregnancy counseling with her husband. She states that both she and her husband have family histories of sickle cell disease. Based on previous genetic testing, they both also have a copy of the sickle cell gene from their parents, but neither of them has ever manifested symptoms associated with the disease. They want to conceive and are concerned about the chances that their child might have the disease. What is the chance the offspring will be a child WITHOUT sickle cell anemia?", "answer": "3/4", "meta_info": "step2&3", "answer_idx": "B", "A": "1/2", "B": "3/4", "C": "1/4", "D": "2/3", "language": "en"}
{"question": "A 52-year-old man presents to the clinic complaining of blood in his urine. He had a mild respiratory illness 3 weeks ago. Urinalysis reveals a high red blood cell count and casts in the urine. A diagnosis of post-streptococcal glomerulonephritis is made. The physician explains that the treatment is supportive and that the patient needs to follow up with him every two weeks. Six weeks later, the patient returns to the clinic because he does not feel well; he has been experiencing malaise and fatigue. On examination, his pulse is 98/min, blood pressure is 135/85 mm Hg, temperature is 36.6°C (98.0°F), and respiratory rate is 16/min. He has a mildly distended abdomen. Blood tests reveal that the patient’s creatinine level has increased from 1.2 mg/dL to 3.0 mg/dL over the last month. He is referred to a nephrologist who diagnoses him with rapidly progressive glomerulonephritis (RPGN) and starts him on hemodialysis, as his potassium level has risen to 7 mEq/dL. The patient is advised to undergo renal transplantation. His human leukocyte antigen (HLA) genotype is A7/A5, B2/B9, C8/C3. The first allele in each locus is the maternal form; the second is paternal. Several potential donors are available for the renal graft. Which of the following would be the closest match?", "answer": "Donor A: tA7/A5, ttB8/B2, ttC3/C8", "meta_info": "step1", "answer_idx": "B", "A": "Donor B: tA5/A12, tB22/9, ttC4/C3", "B": "Donor A: tA7/A5, ttB8/B2, ttC3/C8", "C": "Donor E: tA7/A8, ttB9/B27, tC3/C4", "D": "Donor D: tA4/A7, ttB1/B8, ttC8/C3", "language": "en"}
{"question": "An investigator is studying determinants of childhood obesity by observing a cohort of pregnant women with obesity. After delivery, he regularly records the height and weight of the cohort's children. The results of the correlation analysis between mean childhood BMI at 4 years of age and mean maternal BMI before pregnancy are shown. Based on these findings, which of the following is the most likely correlation coefficient?", "answer": "0.45", "meta_info": "step1", "answer_idx": "B", "A": "-0.45", "B": "0.45", "C": "0", "D": "-1.80", "language": "en"}
{"question": "A 25-year-old woman comes to the physician for a routine examination. She is a recreational runner and for the past 3 months she has been training for a marathon. Yesterday she ran 17 km (10.5 mile). Menses occur at regular 28-day intervals and last 6 days. She drinks three to five beers when going out with friends. She follows a vegan diet. She appears well. Her temperature is 36.6°C (98.0°F), blood pressure is 110/72 mm Hg, pulse is 70/min, and respirations are 14/min. Physical examination shows no abnormalities. Laboratory studies show:\nHemoglobin 9.8 g/dL\nMean corpuscular volume 91 fL\nLactate dehydrogenase 400 U/L\nPlatelet count 250,000/mm3\nReticulocyte count 3%\nHaptoglobin 23 mg/dL (N=41–165 mg/dL)\nSerum\nIron 90 μg/dL\nFerritin 170 ng/mL\nTotal iron binding capacity (TIBC) 220 μg/dL (N=251–406 μg/dL)\nUrinalysis shows trace blood but no RBCs. Which of the following is the most likely cause of this patient's anemia?\"", "answer": "Intravascular hemolysis", "meta_info": "step2&3", "answer_idx": "C", "A": "Extravascular hemolysis", "B": "Vitamin B12 deficiency", "C": "Intravascular hemolysis", "D": "Impaired heme synthesis", "language": "en"}
{"question": "A 45-year-old man comes into the ED after a car accident. After waiting an hour in the waiting room, he begins to berate the receptionist and demands to be seen by a doctor. During the exam, the patient brags that he recently had to quit his job because they did not appreciate his talent and drive. After a medical student declines his invitation for a date, he becomes very angry and throws supplies across the room. The physician manages the patient's physical injuries and begins to suspect the patient has a personality disorder. Which personality disorder is most likely?", "answer": "Narcissistic personality disorder", "meta_info": "step1", "answer_idx": "A", "A": "Narcissistic personality disorder", "B": "Avoidant personality disorder", "C": "Histrionic personality disorder", "D": "Obsessive-compulsive personality disorder", "language": "en"}
{"question": "A 61-year-old man comes to the physician because of weight loss and a non-productive cough for 4 months. He has smoked 2 packs of cigarettes daily for 42 years. A CT scan of the chest shows an irregular mass at the right hilum and axillary lymphadenopathy. A biopsy of the mass obtained on bronchoscopy confirms the diagnosis of metastatic non-small cell lung cancer. Results of a molecular diagnostic test show a microdeletion on the short arm of chromosome 7. The physician recommends chemotherapy with erlotinib. The beneficial effect of this drug is most likely due to arrest in which of the following phases of the cell cycle?", "answer": "G1 phase", "meta_info": "step1", "answer_idx": "B", "A": "G2 phase", "B": "G1 phase", "C": "G0 phase", "D": "S phase", "language": "en"}
{"question": "A 52-year-old woman comes to the physician because of a 4-day history of painful swallowing and retrosternal pain. She was diagnosed with HIV infection 2 months ago; her medications include tenofovir, emtricitabine, and raltegravir. Vital signs are within normal limits. Physical examination of the oral cavity shows no abnormalities. The patient's CD4+ T-lymphocyte count is 70/mm3 (N ≥ 500). Empiric treatment is started. Two weeks later, she reports no improvement in symptoms. Esophagogastroduodenoscopy is performed and shows multiple round superficial ulcers in the distal esophagus. Which of the following is the most likely underlying cause of this patient's symptoms?", "answer": "Infection with herpes simplex virus", "meta_info": "step1", "answer_idx": "C", "A": "Adverse effect of medication", "B": "Degeneration of ganglion cells within the myenteric plexuses", "C": "Infection with herpes simplex virus", "D": "Infection with Candida species", "language": "en"}
{"question": "An 18-year-old girl comes to the emergency room with abdominal pain. She states that the pain started 6 hours ago, is 8/10, and localizes to the right lower abdomen. She recalls a similar episode last month. Her older brother was hospitalized 2 years ago for perforated appendicitis. Her mother has diverticulitis. The patient got her first menstrual period at age 14. Her periods occur regularly every 28 days. Her last menstrual period was 2 weeks ago. She is sexually active with multiple partners and uses condoms inconsistently. The patient’s temperature is 99°F (37.2°C), blood pressure is 110/74 mmHg, pulse is 89/min, and respirations are 14/min with an oxygen saturation of 98% on room air. On physical exam, the patient is in moderate distress. There is lower abdominal tenderness with guarding. A pelvic examination reveals clear mucous in the vaginal introitus, a mobile uterus, and tenderness of the right adnexa. Labs are obtained, as shown below:\n\nLeukocyte count: 10,000/mm^3 with normal differential\nHemoglobin: 13.5 g/dL\nPlatelet count: 200,000/mm^3\nBeta-human chorionic gonadotropin: Pending\n\nA pelvic ultrasound demonstrates a small fluid collection in the cul-de-sac posterior to the uterus. Which of the following is the most likely diagnosis?", "answer": "Midcycle pain", "meta_info": "step2&3", "answer_idx": "C", "A": "Appendicitis", "B": "Endometriosis", "C": "Midcycle pain", "D": "Ruptured ectopic pregnancy", "language": "en"}
{"question": "In a suburban town in Virginia, epidemiologists are alarmed by the increasing number of squamous cell lung cancer cases. Further investigation reveals that most people in the area work in a glass factory, the region’s main source of employment. A researcher is interested in studying the role of immunosurveillance in the pathogenesis of this lung cancer. He postulates that tumor infiltration by natural killer (NK) cells has a better prognosis since they play a major role in immunosurveillance. NK cells also kill tumor cells by the perforin-mediated destruction of cancerous cells. The researcher is interested in studying tumor infiltration by NK cells in the resected specimen from patients within the cohort who have been diagnosed with stage 1 lung cancer. Which of the following cluster of differentiation markers will he need to use to identify these cells in the resected specimens?", "answer": "CD56", "meta_info": "step1", "answer_idx": "D", "A": "CD20", "B": "CD3", "C": "CD34", "D": "CD56", "language": "en"}
{"question": "A 26-year-old man presents to the office complaining of persistent back pain for the past 3 months. You saw the patient previously and prescribed NSAIDs and rest, but he has not improved. The patient states that his maternal grandfather had ‘back problems his whole life’, and he worries that he might have the same issues. An X-ray is performed and shows squaring of the vertebrae with longitudinal fibrous bands. What is the most likely diagnosis?", "answer": "Ankylosing spondylitis", "meta_info": "step1", "answer_idx": "C", "A": "Ehlers-Danlos syndrome", "B": "Osteosarcoma", "C": "Ankylosing spondylitis", "D": "Osteopetrosis", "language": "en"}
{"question": "A regional hospital system has decided to institute a new task group for quality improvement and patient safety. The task group would like to begin by decreasing the number of days given for narcotic pain medication prescriptions in the emergency department to at most 7 days instead of the hospital average of 21 days per prescription. Which of the following interventions would be most successful at achieving the task group’s mission?", "answer": "Changing the electronic medical record to only allow a maximum of 7 days per prescription", "meta_info": "step1", "answer_idx": "D", "A": "Educating patients about appropriate narcotics dosing", "B": "Printing out and posting handouts detailing the dangers of narcotics", "C": "Sending an email to all providers notifying them of narcotics prescribing best practices", "D": "Changing the electronic medical record to only allow a maximum of 7 days per prescription", "language": "en"}
{"question": "A 57-year-old man comes to the clinic complaining of nausea and 1 episode of vomiting during the past day. He denies any precipitating event except for a headache for which he took some acetaminophen yesterday. The headache is described as bilateral, dull, and 8/10 in severity. He has never had such symptoms before. His past medical history is significant for hypertension, biliary colic, and a past hospitalization for delirium tremens when he “tried to quit alcohol cold turkey.” When asked about his current alcohol intake, the patient looks away and mutters “just a couple of drinks here and there.” The patient reports mild abdominal pain that began this morning but denies vision changes, bowel changes, fever, or weight loss. Physical examination demonstrates tenderness at the right upper quadrant (RUQ) that does not worsens with inhalation. What is the most likely explanation for this patient’s symptoms?", "answer": "Accumulation of N-acetyl-p-benzoquinone imine in the liver", "meta_info": "step1", "answer_idx": "A", "A": "Accumulation of N-acetyl-p-benzoquinone imine in the liver", "B": "Impaction of a gallstone in the ileus", "C": "Malignant overgrowth of glial cells in the brain", "D": "Obstruction of the cystic duct by gallstone", "language": "en"}
{"question": "A 48-year-old patient comes to the physician because of a 4-day history fever, headaches, loss of appetite, and myalgia. Two weeks ago, the patient went on a camping trip to Wisconsin. His temperature is 39.5°C (103.1°F). Physical examination shows no rash or joint swelling. Laboratory studies show:\nHemoglobin 14.1 g/dL\nLeukocyte count 3,800/mm3\nPlatelet count 85,000/mm3\nSerum\nAST 48 U/L\nALT 52 U/L\nTreatment with doxycycline is begun and the patient recovers. A paired acute and convalescent indirect fluorescent antibody test confirms that the patient had anaplasmosis. The patient's condition was most likely transmitted by which of the following vectors?\"", "answer": "Ixodes tick", "meta_info": "step1", "answer_idx": "B", "A": "Lone star tick", "B": "Ixodes tick", "C": "Dog tick", "D": "Flea", "language": "en"}
{"question": "A 42-year-old woman comes to the clinic complaining of upper abdominal pain. Her symptoms started 1 month ago with vague abdominal discomfort following a meal at a steakhouse. Since then the pain has progressed to the point that she has more than 5 episodes a week. The pain is worse with eating but has not affected her appetite. She also reports a burning sensation in her chest when she lies down at night after dinner. She denies weight loss or dysphagia. She takes no medications except daily calcium supplements. She drinks 2 glasses of wine per week and denies tobacco use. Her blood pressure is 110/78, pulse is 72/min, and respirations are 13/min. On physical examination, the patient’s abdomen is soft and non-distended. Normal bowel sounds are appreciation. There is mild epigastric tenderness but no guarding and no rebound. Fecal occult blood is negative. Which of the following is the next best step in management?", "answer": "Start omeprazole", "meta_info": "step1", "answer_idx": "B", "A": "Start antibiotic therapy", "B": "Start omeprazole", "C": "Surgical fundiplication", "D": "Upper gastrointestinal endoscopy", "language": "en"}
{"question": "A 3-year-old boy presents to the pediatrician crying with ear pain and his temperature has been 101°F (38.3°C) for several days. His mother states that other children at his daycare center have been having similar symptoms. She further describes that he was fed formula and was not breastfed. The mother admits that she smokes cigarettes daily. On exam, the boy is irritable and crying, and frequently tugs on his left ear. Both tympanic membranes appear erythematous, and the left appears opaque and bulging with decreased mobility on pneumatic otoscopy. Which of the following is the best next step in management?", "answer": "Amoxicillin", "meta_info": "step2&3", "answer_idx": "A", "A": "Amoxicillin", "B": "TMP-SMX", "C": "Tympanocentesis", "D": "Supportive therapy", "language": "en"}
{"question": "A 47-year-old G3P2 woman presents to her endocrinologist for a follow-up appointment. Her last menstrual period was at the age of 35 years. She now feels fatigued and cannot concentrate on her work or type properly on the keyboard because of an onset of tremor in her hands. Her symptoms are taking a toll on her quality of life. The patient’s blood pressure is 124/83 mm Hg, pulse is 91/min, respirations are 17/min, and temperature is 36.7°C (98.1°F). On physical examination, there is a mild enlargement of the thyroid; the gland is minimally firm in texture and is nontender. Which of the following pathologic findings is she most likely to have?", "answer": "Silent thyroiditis", "meta_info": "step2&3", "answer_idx": "B", "A": "Follicular thyroid neoplasia  ", "B": "Silent thyroiditis", "C": "Chronic lymphocytic thyroiditis", "D": "Fibrous thyroiditis", "language": "en"}
{"question": "A 44-year-old woman is brought to the emergency department after she was found lying in the park mumbling to herself. She is lethargic and disoriented. She has a 2-week history of increasing weakness, nausea, and vomiting. She denies any recent alcohol or drug use. She has a history of systemic lupus erythematosus but stopped taking methotrexate many years ago. Her temperature is 37.3°C (99.1°F), pulse is 89/min, and blood pressure is 154/91 mm Hg. On mental status examination, she is confused and only oriented to person, but not to place or time. She is unable to name the days of the week backwards. She exhibits moderate generalized weakness. Physical exam shows jugular venous distention and pitting edema in the lower extremities. Laboratory studies show:\nSerum\nNa+ 137 mEq/L\nK+ 5.5 mEq/L\nCl- 120 mEq/L\nBicarbonate 15 mEq/L\nUrea nitrogen 94 mg/dL\nCreatinine 5.5 mg/dL\nGlucose 92 mg/dL\nWhich of the following is the most appropriate next step in management?\"", "answer": "Hemodialysis", "meta_info": "step2&3", "answer_idx": "B", "A": "Administer lactulose", "B": "Hemodialysis", "C": "Restart methotrexate", "D": "Fluid restriction", "language": "en"}
{"question": "An investigator is studying the secretion of gastrointestinal hormones before and after food intake. She isolates a hormone that accelerates the emptying of gastric contents into the duodenal bulb. The isolated hormone is most likely which of the following?", "answer": "Gastrin", "meta_info": "step1", "answer_idx": "B", "A": "Glucagon-like peptide", "B": "Gastrin", "C": "Cholecystokinin", "D": "Vasoactive intestinal peptide", "language": "en"}
{"question": "A 45-year-old woman presents to the office with a chief complaint of a cough that has persisted for a month and a half. She also has night fevers and has lost 5 kg (11 lb) in the last 2 months. She recently returned from a 6-month trip to Peru. Her vitals include: heart rate 82/min, respiratory rate 17/min, temperature 38.0°C (100.4°F), and blood pressure 107/80 mm Hg. On auscultation, she has diminished respiratory sounds at the base of the right lung. Chest radiography shows an opacity in the right apex. What is the most likely cause of her presentation?", "answer": "Tuberculosis", "meta_info": "step1", "answer_idx": "B", "A": "Echinococcosis", "B": "Tuberculosis", "C": "Pulmonary thromboembolism", "D": "Heart failure", "language": "en"}
{"question": "A 52-year-old homeless man is brought to the urgent care clinic with altered mental status and disorientation for the last day. Past medical records are unavailable. His temperature is 37°C (98.6°F), the respiratory rate is 15/min, the pulse is 107/min, and the blood pressure is 92/67 mm Hg. He has a flapping tremor of the wrists during attempted extension. He is started on intravenous D5 1/2NS and blood is drawn for further testing. His condition deteriorates overnight. On re-examination the next morning, he has developed visual disturbances with a new horizontal nystagmus and a staggering gait. His blood tests show: \nSerum\nAlbumin 3.2 gm/dL\nAlkaline phosphatase 150 U/L\nAlanine aminotransferase 76 U/L\nAspartate aminotransferase 155 U/L\nGamma-glutamyl transpeptidase 202 U/L\nWhat is the most likely diagnosis?", "answer": "Wernicke's encephalopathy", "meta_info": "step2&3", "answer_idx": "D", "A": "Alcohol-related dementia", "B": "Hepatic encephalopathy", "C": "Delirium", "D": "Wernicke's encephalopathy", "language": "en"}
{"question": "A 27-year-old woman comes to the emergency department at 14 weeks gestation with abdominal pain. She states she has passed a large amount of blood from her vagina in the past 2 hours. Her vitals are within normal limits and she describes her abdominal pain as a 4/10. Physical exam is notable for a dilated cervix. The patient states she does not want any invasive procedures in her workup but is accepting to necessary medical interventions. Which of the following is the best next step in management?", "answer": "Expectant management", "meta_info": "step2&3", "answer_idx": "C", "A": "Admission and external fetal monitoring", "B": "Dilation and curettage", "C": "Expectant management", "D": "Transvaginal ultrasound", "language": "en"}
{"question": "A 25-year-old female is admitted to the hospital for an intrauterine fetal demise (IUFD) during her 30th gestational week. The patient did not receive any prenatal care or screenings. The baby is delivered via C-section and the family wishes to conduct an autopsy to understand the reason for the IUFD and to better prepare for future pregnancies. On autopsy, the fetus is discovered to have severe facial abnormalities as well as a brain lacking the normal sagittal fissure. Which of the following genes was most likely mutated in this fetus?", "answer": "Sonic hedgehog", "meta_info": "step1", "answer_idx": "C", "A": "Hox", "B": "Wnt-7", "C": "Sonic hedgehog", "D": "BMP", "language": "en"}
{"question": "A healthy 32-year-old woman enrolls in a study investigating kidney function. Her renal plasma flow (RPF) is 600 mL/min. She is administered an intravenous substance that does not undergo tubular reabsorption. The following sets of measurements are taken every 10 minutes:\nPlasma concentration of substance Excretion rate of substance\nSet 1 0.1 mg/mL 60 mg/min\nSet 2 0.15 mg/mL 90 mg/min\nSet 3 0.2 mg/mL 104 mg/min\nSet 4 0.25 mg/mL 110 mg/min\nSet 5 0.3 mg/mL 116 mg/min\nThis patient was most likely administered which of the following substances?\"", "answer": "Para-aminohippurate", "meta_info": "step1", "answer_idx": "C", "A": "Cystatin C", "B": "Glucose", "C": "Para-aminohippurate", "D": "Iohexol", "language": "en"}
{"question": "A 6-year-old girl is brought to the physician for a well-child examination. She has no history of serious illness. Her temperature is 37°C (98.6°F), pulse is 95/min, and blood pressure is 96/52 mm Hg. Examination shows a 2/6 continuous, low-pitched murmur over the left upper sternal border that radiates towards the neck. The murmur disappears when she flexes her neck. The remainder of the examination shows no abnormalities. Which of the following is the most likely diagnosis?", "answer": "Venous hum", "meta_info": "step2&3", "answer_idx": "B", "A": "Patent ductus arteriosus", "B": "Venous hum", "C": "Coronary artery fistula", "D": "Aortic stenosis", "language": "en"}
{"question": "A 72-year-old man with a history of hypertension and hyperlipidemia presents to the emergency department with three-days of fever, cough, and shortness of breath. On physical exam, temperature is 101.3 deg F (38.5 deg C), pulse is 106/min, blood pressure is 148/92 mmHg, and respiratory rate is 24/min. Crackles are auscultated on the right lower lobe. Chest radiograph demonstrates right lower lobe opacities concerning for consolidation. Sodium level is 118 mEq/L. He is admitted to the hospital on empiric antibiotics. What is the most appropriate management of this patient’s hyponatremia?", "answer": "Fluid restriction", "meta_info": "step2&3", "answer_idx": "B", "A": "Hypertonic saline", "B": "Fluid restriction", "C": "Salt tablets", "D": "Demeclocycline", "language": "en"}
{"question": "A 75-year-old man presents to the physician for a follow-up examination. Over the last several months, he reports dyspnea when walking during his daily exercise routine. He feels tired most of the time. He has no fever or weight loss. He has no history of severe illness and takes no medications. He does not smoke, drinks alcohol, or follow a particular diet. The vital signs are within normal limits. The physical examination reveals pale conjunctiva. The examination of the heart, lungs, abdomen, and extremities shows no abnormalities. No lymphadenopathy is palpated. The laboratory studies show the following:\nHemoglobin 8.5 g/dL\nMean corpuscular volume 105 μm3\nLeukocyte count 4,500/mm3\nPlatelet 160,000/mm3\nAbdominal ultrasonography shows no organomegaly or other pathologic findings. The peripheral blood smear shows large and hypogranular platelets and neutrophils with hypo-segmented or ringed nuclei. No blasts are seen. Bone marrow aspiration shows hypercellularity. In addition, ring sideroblasts, hypogranulation, and hyposegmentation of granulocyte precursors, and megakaryocytes with disorganized nuclei are present. Marrow myeloblasts are 4% in volume. Which of the following best explains these findings?", "answer": "Myelodysplastic syndrome", "meta_info": "step2&3", "answer_idx": "C", "A": "Acute myeloid leukemia", "B": "Aplastic anemia", "C": "Myelodysplastic syndrome", "D": "Primary myelofibrosis", "language": "en"}
{"question": "A 37-year-old man comes to the physician because of a 1-month history of a burning sensation in his chest. The sensation is most prominent when he is lying in bed, but it is also present after eating heavy meals. He also states his breath has an unpleasant odor in the morning. He has not lost any weight during this period. He has hypothyroidism. His father died of colon cancer and his mother has hypertension. He has smoked one pack of cigarettes daily for 15 years and drinks 2–3 beers on weekends. His medications include levothyroxine and an over-the-counter multivitamin. He is 170 cm (5 ft 7 in) tall and weighs 95 kg (210 lb); BMI is 32.9 kg/m2. Vital signs are within normal limits. Physical examination shows no abnormalities. Which of the following is the next best step in management?", "answer": "Proton-pump inhibitor", "meta_info": "step2&3", "answer_idx": "B", "A": "Urea breath test", "B": "Proton-pump inhibitor", "C": "H2 receptor blocker", "D": "Barium swallow", "language": "en"}
{"question": "A 36-year-old man presents with right upper quadrant pain, fatigue, and pruritus. His past medical history is significant for ulcerative colitis diagnosed 5 years ago, which is well-managed medically. He is vaccinated against hepatitis A and B and denies any recent travel abroad. On physical examination, mild jaundice of the skin is present. An abdominal examination reveals significant hepatosplenomegaly. A percutaneous liver biopsy is performed. Which of the following histopathologic findings would most likely be seen on the liver biopsy of this patient?", "answer": "Onion skin fibrosis (concentric periductal fibrosis)", "meta_info": "step1", "answer_idx": "D", "A": "Small drops of fat throughout the liver parenchyma", "B": "Normal histologic findings", "C": "Mononuclear cell infiltrate and apoptotic hepatocytes", "D": "Onion skin fibrosis (concentric periductal fibrosis)", "language": "en"}
{"question": "A 26-year-old man is brought to the emergency department because he has had abdominal pain, nausea, and vomiting for the past 2 hours. He ate a sandwich and coleslaw from a deli about 1 hour before the symptoms began. He has no history of serious illness and takes no medications. His temperature is 99.6°F (37.6°C), pulse is 80/min, respirations are 18/min, and blood pressure is 122/68 mm Hg. The lungs are clear to auscultation. Cardiac examination shows no abnormalities. Abdominal examination shows diffuse mild tenderness with no rigidity, rebound, or guarding. The remainder of the examination shows no abnormalities. Which of the following is the most likely causal organism?", "answer": "Staphylococcus aureus", "meta_info": "step2&3", "answer_idx": "B", "A": "Shigella dysenteriae", "B": "Staphylococcus aureus", "C": "Enterotoxigenic Escherichia coli", "D": "Bacillus cereus", "language": "en"}
{"question": "A 12-year-old girl is brought to the emergency department because of severe pain and swelling of her right eye for 3 days. Over the past two weeks, she had nasal congestion and a constant, mild headache. She did not visit a doctor and instead took over-the-counter naproxen and phenylephrine. Her nasal congestion has since improved, but the headache persists. She underwent a dental procedure for caries about ten days ago. She does not recollect any recent insect bites or trauma. Her immunizations are up-to-date. She appears ill and reports occasional chills. Her temperature is 38.3°C (101°F), pulse is 89/min, and blood pressure is 110/70 mm Hg. Examination shows proptosis of the right eye. Vision is impaired in the affected eye. Her right upper and lower eyelid are erythematous, swollen, and tender to touch. Ocular movements cause severe pain. Her headache is worsened by leaning forward and improves when the patient is lying on her back. Which of the following is the most likely cause of the patient's symptoms?", "answer": "Bacterial infection from ethmoidal sinus", "meta_info": "step2&3", "answer_idx": "D", "A": "Cavernous sinus thrombosis", "B": "Suppurative spread of dacrocystitis", "C": "Bacterial infection from sphenoid sinus", "D": "Bacterial infection from ethmoidal sinus", "language": "en"}
{"question": "A 45-year-old man presents to the emergency room with fever and headache. He recently had a middle ear infection. On physical examination, when the head is passively flexed towards the chest, then flexion of the knee is observed. In addition, he reports that his headache increases after rotating his head horizontally. Lumbar puncture and CSF analysis were done. Which of the following laboratory findings would best represent your suspected diagnosis?", "answer": "Glucose: ↓, Proteins: ↑, Cells: 90% neutrophils, Lactic Acid (mmol/l): 4.5", "meta_info": "step1", "answer_idx": "D", "A": "Glucose: ↑, Proteins: ↑, Cells: 10% lymphocytes, Lactic Acid (mmol/l): 3.0", "B": "Glucose: ↓, Proteins: normal, Cells: 10% lymphocytes, Lactic Acid (mmol/l): 2.8", "C": "Glucose: ↑, Proteins: ↓, Cells: 90% neutrophils , Lactic Acid (mmol/l): 4.3", "D": "Glucose: ↓, Proteins: ↑, Cells: 90% neutrophils, Lactic Acid (mmol/l): 4.5", "language": "en"}
{"question": "A 6-day-old female infant is brought to the emergency department because of poor feeding and irritability for two days. She was born at 39 weeks' gestation, and the pregnancy and delivery were uncomplicated. Her temperature is 39.2°C (102.6°F). She appears lethargic and makes occasional twitching movements in both upper extremities. The anterior fontanelle is soft and full. A lumbar puncture is performed and analysis of the cerebrospinal fluid shows increased protein and decreased glucose. Cerebrospinal fluid culture shows gram-positive, intracellular rods with tumbling motility. Infection of a healthy adult with the pathogen affecting this infant would most likely present with which of the following clinical conditions?", "answer": "Gastroenteritis", "meta_info": "step1", "answer_idx": "D", "A": "Cystitis", "B": "Pelvic inflammatory disease", "C": "Meningitis", "D": "Gastroenteritis", "language": "en"}
{"question": "A 64-year-old man has complaints of scrotal pain and swelling for the past 2 weeks. The pain is so severe that he is now unable to even sit comfortably for more than 5 minutes. Additionally, he complains of an inability to hold urine when he has an urge to urinate and of mild discomfort during urination. His medical history is significant for hypertension that is well-controlled with losartan. He smokes 1 pack of cigarettes every day and has been doing so for the past 25 years. On physical examination, swelling and erythema of the right hemiscrotal sac are evident, accompanied by intense tenderness with palpation of an indurated epididymis. What is the most likely infectious agent responsible for this patient’s condition?", "answer": "Escherichia coli", "meta_info": "step1", "answer_idx": "D", "A": "Chlamydia trachomatis", "B": "Neisseria gonorrhoeae", "C": "Mumps virus", "D": "Escherichia coli", "language": "en"}
{"question": "A 65-year-old female is diagnosed with invasive ductal carcinoma of the breast. After a lumpectomy with a negative axillary lymph node dissection and subsequent radiation therapy, the patient is started on adjuvant chemotherapy with anastrozole. Which of the following is an expected side effect of this medication?", "answer": "Increased risk for osteoporosis", "meta_info": "step1", "answer_idx": "C", "A": "Increased risk for endometrial carcinoma", "B": "Decreased LDL and increased HDL levels", "C": "Increased risk for osteoporosis", "D": "Excessive weight loss", "language": "en"}
{"question": "An 18-year-old man comes to the physician because of fatigue, back pain, and dark-colored urine for two days. He has no history of serious illness. He recently sprained his ankle playing basketball and has been taking ibuprofen as needed for pain. Physical examination shows scleral icterus. Laboratory studies show a hemoglobin concentration of 9.2 g/dL and serum lactate dehydrogenase concentration of 254 U/L. A photomicrograph of a peripheral blood smear with Wright's stain is shown. Which of the following is the most likely mode of inheritance for this patient's condition?", "answer": "X-linked recessive\n\"", "meta_info": "step1", "answer_idx": "D", "A": "Autosomal recessive", "B": "X-linked dominant", "C": "Autosomal dominant", "D": "X-linked recessive\n\"", "language": "en"}
{"question": "A 32-day-old boy is brought to the pediatrician with complaints of purulent discharge from the umbilicus and perianal ulceration for the past few days. A detailed developmental history reveals that he was born to a couple who had a non-consanguineous marriage. He was born by normal delivery at 39 weeks of gestation and his neonatal period was uneventful. His birth weight was 2.9 kg (6.3 lb) and he is exclusively breastfed. His parents also report that he has had 25–30 episodes of loose stools per day since his seventh day of life. His umbilical cord fell off on the 25th day of life. His temperature is 38.6ºC (101.4°F), pulse is 110/min, and respiratory rate is 35/min. On physical examination, erythema and induration are noted around the umbilicus and mild hepatosplenomegaly is present. His laboratory studies show:\nHemoglobin 12.9 gm/dL\nLeukocyte count 73,000/mm3\nPlatelet count 170,000/mm3\nPeripheral smear Hypersegmented polymorphs, toxic granules\nStool pH 6\nWhich of the following tests is most likely to yield an accurate diagnosis?", "answer": "Flow cytometry", "meta_info": "step2&3", "answer_idx": "B", "A": "Ultrasonography of the abdomen and pelvis", "B": "Flow cytometry", "C": "Magnetic resonance imaging", "D": "Complete blood count", "language": "en"}
{"question": "A 1-hour-old newborn male is evaluated in the delivery room. The infant was born at 37 weeks gestation to a 39-year-old G3. The mother initially labored at home with a midwife but was transferred to the hospital for failure to progress. The infant was eventually delivered via Caesarean section. The mother declined all prenatal screening during this pregnancy. Upon delivery, the infant is found to have a 3 cm full-thickness defect in the abdominal wall to the right of the umbilicus with evisceration of a loop of bowel. His Apgar scores were 7 and 8 at 1 and 5 minutes, respectively. His weight is 3.0 kg (6.6 lb), and his height and head circumference are in the 30th and 40th percentiles, respectively. The abdominal defect is immediately covered in sterile saline dressings, and an orogastric tube and two peripheral intravenous lines are placed.\n\nThis condition is associated with which of the following additional cardiac defects?", "answer": "No cardiac defects", "meta_info": "step2&3", "answer_idx": "A", "A": "No cardiac defects", "B": "Bicuspid aortic valve", "C": "Tetralogy of Fallot", "D": "Ventricular septal defect", "language": "en"}
{"question": "A 17-year-old girl is brought to the physician for a well-child examination. She is worried about gaining weight. She frequents buffet restaurants but feels guilty soon after. She has a history of burning her extremities with cigarettes. Her last menstrual period was 3 weeks ago. She attends high school and plays field hockey on the school team. She is at the 25th percentile for height, 12th percentile for weight, and 17th percentile for BMI. Examination shows bilateral parotid gland enlargement. Oropharyngeal examination shows perimolysis. The remainder of the examination shows no abnormalities. Which of the following is the most likely diagnosis?", "answer": "Bulimia nervosa", "meta_info": "step2&3", "answer_idx": "B", "A": "Major depressive disorder", "B": "Bulimia nervosa", "C": "Body dysmorphic disorder", "D": "Anorexia nervosa\n\"", "language": "en"}
{"question": "A 37-year-old man with a history of depression has a two-year history of slowly worsening movement abnormalities characterized by rapid, involuntary, nonrepetitive movements involving his face, trunk, and limbs presents to clinic. He has also noted worsening of his depression, along with symptoms of increased anxiety and irritability. During the interview, his wife explains that he has suffered cognitive decline, most notably in the realm of executive function. On family history, you discover that his father suffered from a similar illness before dying at the age of 44. What would be the expected findings on brain MRI?", "answer": "Atrophy of the caudate nucleus", "meta_info": "step2&3", "answer_idx": "B", "A": "Normal brain MRI", "B": "Atrophy of the caudate nucleus", "C": "Periventricular high-signal intensity lesions on FLAIR sequence", "D": "Atrophy of the hippocampi", "language": "en"}
{"question": "A 55-year-old man with a history of diabetes and hypertension presents to the emergency department when he found half of his face paralyzed this morning. The patient was last seen normal the night before by his wife and woke up with these symptoms. He has a past medical history of diabetes and hypertension and is not currently taking any medications for these conditions. His temperature is 98.5°F (36.9°C), blood pressure is 177/118 mmHg, pulse is 90/min, respirations are 15/min, and oxygen saturation is 99% on room air. Physical exam is notable for an inability for the patient to move any part of his face on the right side. The rest of his neurological exam is within normal limits. Which of the following is the next best step in management for the most likely diagnosis?", "answer": "Topical lubricants and discharge", "meta_info": "step2&3", "answer_idx": "D", "A": "Elevation of the head of the bed and intubation", "B": "MRI of the head", "C": "Tissue plasminogen activator", "D": "Topical lubricants and discharge", "language": "en"}
{"question": "A newborn boy develops excessive bilious vomiting 4 hours after delivery. The infant was born vaginally to a 29-year-old mother (gravida 2, para 1) at 38 weeks gestation. History was significant for polyhydramnios detected at 32 weeks and monitored for the duration of gestation. He was put to the breast right after birth and sucked actively. He still has not passed meconium. The patient’s vital signs include: blood pressure 77/50 mm Hg, heart rate 128/min, respiratory rate 37/min, and temperature 36.4℃ (97.5℉). On physical examination, the newborn appears fussy and mildly dehydrated. His abdomen appears rounded, soft and nontender on palpation, with no palpable organomegaly or masses. What is the most probable site of obstruction?\n   ", "answer": "Duodenum, distal to Vater’s papilla", "meta_info": "step1", "answer_idx": "C", "A": "Esophagus", "B": "Gastric pylorus", "C": "Duodenum, distal to Vater’s papilla", "D": "Sigmoid colon", "language": "en"}
{"question": "The patient is counselled about her risk of thyroid malignancy. Serum studies show:\nNa+ 138 mEq/L\nK+ 4.1 mEq/L\nCl- 101 mEq/L\nTSH 0.03 μU/mL\nCalcium 9 mg/dL\nWhich of the following is the most appropriate next step in management?\"", "answer": "Thyroid scintigraphy scan", "meta_info": "step2&3", "answer_idx": "D", "A": "Free T4 and T3 levels", "B": "Fine-needle aspiration biopsy", "C": "Open biopsy", "D": "Thyroid scintigraphy scan", "language": "en"}
{"question": "An 18-month-old girl is brought to her pediatrician because of swelling in her hands and feet. Her mother is concerned because she has been inconsolable for the last 8 hours. The mother adds that the girl has been getting tired easily recently. The vital signs include: temperature 38.0°C (100.4°F), blood pressure 90/55 mm Hg, and pulse 122/min. Gentle palpation of the metacarpal and metatarsal bones causes the infant to scream. The laboratory evaluation is remarkable for mild anemia, leukocytosis, and increased reticulocyte count. Her peripheral blood smear is shown in the picture. Which of the following best represents the etiology of this infant condition?", "answer": "Abnormal globin chain structure", "meta_info": "step2&3", "answer_idx": "C", "A": "Red cell enzymatic deficiency", "B": "Abnormal heme synthesis", "C": "Abnormal globin chain structure", "D": "Abnormal globin chain synthesis", "language": "en"}
{"question": "A 34-year-old gravida-1 at 8 weeks gestation seeks evaluation for a fever and sore throat for 3 days. She also reports generalized body pain and fatigue over this period. She was diagnosed with Graves’ disease 6 months ago. Before conception, methimazole was switched to propylthiouracil. She appears ill. The vital signs include: axillary temperature 38.0℃ (100.4℉), pulse 88/min, respiratory rate 12/min, and blood pressure 120/80 mm Hg. A 1 × 1 cm ulcer is seen on the side of the tongue. The ulcer is tender with surrounding erythema. Examination of the neck, lungs, heart, and abdomen shows no abnormalities. The laboratory studies show the following:\nHemoglobin 13.5 g/dL\nMean corpuscular volume 90 μm3\nLeukocyte count 2,500/mm3\nSegmented neutrophils 5%\nLymphocytes 88%\nPlatelet count 240,000/mm3\nAlanine aminotransferase 18 U/L\nAspartate transaminase 16 U/L\nWhich of the following is the most appropriate next step in management?", "answer": "Discontinuation of propylthiouracil", "meta_info": "step2&3", "answer_idx": "B", "A": "Acetaminophen for fever control", "B": "Discontinuation of propylthiouracil", "C": "Oral ampicillin", "D": "Rectal temperature measurement", "language": "en"}
{"question": "A 27-year-old man comes to the physician because of a 1-week history of fever and pain with urination. His temperature is 39°C (102.2°F). Physical examination shows no abnormalities. A photomicrograph of a urine sample is shown. This patient's findings indicate damage to which of the following structures?", "answer": "Renal interstitium", "meta_info": "step1", "answer_idx": "C", "A": "Urethra", "B": "Ureter", "C": "Renal interstitium", "D": "Glomerulus", "language": "en"}
{"question": "Twelve hours after undergoing uncomplicated total knee replacement, a 55-year-old man develops increasing anxiety, agitation, hand tremor, and nausea. He told the nurse he saw a bear in his room. His pain has been controlled with intravenous morphine. He has a history of advanced liver disease. He drinks 7 cans of beer daily. He is diaphoretic. His temperature is 37.6°C (99.7°F), pulse is 118/min, respirations are 18/min, and blood pressure is 146/92 mm Hg. Administration of which of the following drugs is the most appropriate next step in management?", "answer": "Lorazepam", "meta_info": "step1", "answer_idx": "B", "A": "Chlordiazepoxide", "B": "Lorazepam", "C": "Dantrolene", "D": "Carbamazepine", "language": "en"}
{"question": "A 45-year-old woman comes to the physician’s office with complaints of jaw pain. When she eats, yawns, or rubs her jaw, she gets intense, shooting pains down the left side of her jaw, including her lower lip and chin. These episodes last about 30 seconds and have recurred about 10 times per day for the last month. She finds these episodes extremely distressing and comes to the physician’s office in hope of finding a treatment. The patient denies any locking of her jaw. Physical exam is not notable for any tenderness to palpation over the jaw. She has no crepitus in her temporomandibular joint. The patient is able to open and close her jaw without pain. The nerve involved in this patient’s clinical presentation exits the skull through which of the following brain structures?", "answer": "Foramen ovale", "meta_info": "step1", "answer_idx": "B", "A": "Superior orbital fissure", "B": "Foramen ovale", "C": "Foramen spinosum", "D": "Jugular foramen", "language": "en"}
{"question": "A 64-year-old woman presents to the hospital for chemotherapy. She has newly diagnosed acute myeloid leukemia. She is due to receive treatment with bendamustine for 2 days. On day 2 of her treatment, the patient complains of intense pain in her right great toe. On physical exam, the metatarsophalangeal joint of the 1st toe is warm, erythematous, swollen, and tender to both movement and palpation. An arthrocentesis is performed that reveals negatively birefringent needle-shaped crystals under polarized light. A Gram stain of the synovial fluid is negative. In addition to adequate intravenous hydration, which of the following if given would have most likely prevented the patient’s symptoms?", "answer": "Allopurinol", "meta_info": "step2&3", "answer_idx": "B", "A": "Acetazolamide", "B": "Allopurinol", "C": "Colchicine", "D": "Corticosteroids", "language": "en"}
{"question": "A 29-year-old woman comes to the physician with complaints of fever, headache, and rash, which have gradually worsened over the past 6 days. The patient informs the physician that the rash appeared after 2 days of fever. The rash started at the wrists and ankles and then gradually spread to the trunk, palms, and soles. On examination, the physician notes a maculopapular rash as shown in the image below. Vital signs show a temperature of 39.4°C (103.0°F), a blood pressure of 110/70 mm Hg, and a pulse rate of 86/min. Which of the following is the most likely diagnosis?", "answer": "Rocky Mountain spotted fever", "meta_info": "step2&3", "answer_idx": "C", "A": "Endemic typhus", "B": "Lyme disease", "C": "Rocky Mountain spotted fever", "D": "Q fever", "language": "en"}
{"question": "A 25-year-old man presents to the emergency department after paramedics picked him up from an electronic music festival. His temperature is 103°F (39.4°C), blood pressure is 167/105 mmHg, and pulse is 122/min. On physical exam, the patient is highly alert, agitated, and diaphoretic. Laboratory testing is significant for a serum sodium concentration of 130 mEq/L. Which of the following was most likely ingested by the patient?", "answer": "3,4-methylenedioxymethamphetamine", "meta_info": "step1", "answer_idx": "C", "A": "Heroin", "B": "Ketamine", "C": "3,4-methylenedioxymethamphetamine", "D": "Lysergic acid diethylamide", "language": "en"}
{"question": "A 1-day-old male is seen in the neonatal intensive care unit for respiratory distress. He was born at 37 weeks to a 24-year-old G3P11011 Rh- mother who had no prenatal care. On physical examination, temperature is 99°F (37.2°C), blood pressure is 120/85 mmHg, pulse is 120/min, respirations are 26/min, and pulse oximetry is 92% on room air. There is abdominal distention with a positive fluid wave. Laboratory results are as follows:\n\nSerum:\nAlkaline phosphatase: 80 U/L\nALT: 33 U/L\nAST: 32 U/L\nBilirubin (total): 10 mg/dL\nBilirubin (conjugated): 0.2 mg/dL\nAmylase: 76 U/L\n\nLeukocyte count: 5,000/mm^3 with normal differential\nHemoglobin: 8 g/dL\nPlatelet count: 200,000/mm^3\nMean corpuscular volume: 80 µm^3\nReticulocyte count: 3%\n\nWhat is the most likely diagnosis?", "answer": "Erythroblastosis fetalis", "meta_info": "step1", "answer_idx": "D", "A": "Dubin-Johnson syndrome", "B": "Gilbert syndrome", "C": "Breast feeding jaundice", "D": "Erythroblastosis fetalis", "language": "en"}
{"question": "Study X examined the relationship between coffee consumption and lung cancer. The authors of Study X retrospectively reviewed patients' reported coffee consumption and found that drinking greater than 6 cups of coffee per day was associated with an increased risk of developing lung cancer. The same study in lab mice; however, did not come to a similar conclusion. Which of the following most likely explains the difference between these 2 studies?", "answer": "Confounding", "meta_info": "step2&3", "answer_idx": "A", "A": "Confounding", "B": "Lead time bias", "C": "Observer bias", "D": "Selection bias", "language": "en"}
{"question": "A 2-day-old boy was born at 38 weeks gestation to a 37-year-old woman by vaginal delivery. Since birth, the boy has had difficulty latching onto the breast but has not vomited or passed meconium. Examination reveals a flat facial profile with epicanthal eyelids, low-set earlobes, and a transverse crease on each palm. The abdomen is distended with absent breath sounds in the hypogastric region. A digital rectal examination shows a patent anal canal and is followed by a projected expulsion of gas and stool. What is the most likely mechanism underlying this patient’s findings?", "answer": "Failure of neural crest cell migration during embryologic development", "meta_info": "step2&3", "answer_idx": "C", "A": "Hypertrophic pylorus causing retrograde flow of gastric contents", "B": "Inspissated meconium causing intestinal obstruction", "C": "Failure of neural crest cell migration during embryologic development", "D": "Telescoping of 2 parts of the intestine into each other", "language": "en"}
{"question": "An otherwise healthy 23-year-old newly-married woman comes to the physician because of a 6-day history of discomfort in her vaginal area during and after sexual intercourse. Her last menstrual period was 3 weeks ago. Two years ago, she was diagnosed with genital herpes which was treated with acyclovir. She has been in a monogamous relationship for the past year and has been using an intrauterine device for contraception for the past month. Examination shows a 4-cm, mildly tender mass in the inferior aspect of the left labium minus with no signs of inflammation. Speculum examination causes her discomfort but shows no abnormalities. Which of the following is the most likely cause of these findings?", "answer": "Obstructed orifice of the Bartholin duct", "meta_info": "step2&3", "answer_idx": "A", "A": "Obstructed orifice of the Bartholin duct", "B": "Reactivation of the genital herpes", "C": "Squamous cell carcinoma of the vulva", "D": "Allergic reaction to the intrauterine device", "language": "en"}
{"question": "A 22-year-old professional softball player is undergoing an annual check-up. Her medical history is significant for hallux valgus and scoliosis. She additionally notes that she frequently has bumps and bruises from playing softball, but she has no injuries today. Her family history is significant for heart disease. The patient's blood pressure is 110/70 mm Hg, heart rate is 78/min, and respiratory rate is 15/min. A physical examination is unremarkable except for an indurated palpable mass on her left breast. A biopsy of the mass is performed. Which biopsy findings are most likely to be present in this patient?", "answer": "Necrotic fat with calcifications and giant cells", "meta_info": "step1", "answer_idx": "B", "A": "Chronic inflammation with plasma cells", "B": "Necrotic fat with calcifications and giant cells", "C": "Leaf-like projections", "D": "Abundant extracellular mucin", "language": "en"}
{"question": "A 5-month-old male infant is brought to the physician by his parents for the evaluation of a progressive enlargement of his head circumference. His parents report that he has been healthy except for an episode of tonsillitis 3 months ago treated with penicillin. The patient was born at term by a lower segment transverse cesarean section because of a transverse lie. He has met all developmental milestones. His immunizations are up-to-date. The patient is at the 50th percentile for length, 50th percentile for weight, and 95th percentile for head circumference. He appears well-nourished. His temperature is 37°C (98.6°F), pulse is 120/min, and blood pressure is 90/60 mm Hg. Physical examination shows a tense anterior fontanelle. The eyes deviate inferiorly and the eyelids are retracted. Which of the following is the most appropriate next step in the management of this patient?", "answer": "Ultrasound of the head", "meta_info": "step2&3", "answer_idx": "D", "A": "Serial lumbar punctures", "B": "CT scan of the head", "C": "Place a CSF shunt", "D": "Ultrasound of the head", "language": "en"}
{"question": "A 37-year-old G1P1001 delivers a male infant at 9 pounds 6 ounces after a C-section for preeclampsia with severe features. The mother has a history of type II diabetes with a hemoglobin A1c of 12.8% at her first obstetric visit. Before this pregnancy, she was taking metformin, and during this pregnancy, she was started on insulin. At her routine visits, her glucose logs frequently showed fasting fingerstick glucoses above 120 mg/dL and postprandial values above 180 mg/dL. In addition, her routine third trimester culture for group B Streptococcus was positive. At 38 weeks and 4 days gestation, she was found to have a blood pressure of 176/103 mmHg and reported a severe headache during a routine obstetric visit. She denied rupture of membranes or vaginal bleeding. Her physician sent her to the obstetric triage unit, and after failure of several intravenous doses of labetalol to lower her blood pressure and relieve her headache, a C-section was performed without complication. Fetal heart rate tracing had been reassuring throughout her admission. Apgar scores at 1 and 5 minutes were 7 and 10. After one hour, the infant is found to be jittery; the infant's temperature is 96.1°F (35.6°C), blood pressure is 80/50 mmHg, pulse is 110/min, and respirations are 60/min. When the first feeding is attempted, he does not latch and begins to shake his arms and legs. After 20 seconds, the episode ends and the infant becomes lethargic. Which of the following is the most likely cause of this infant’s presentation?", "answer": "ß-cell hyperplasia", "meta_info": "step2&3", "answer_idx": "A", "A": "ß-cell hyperplasia", "B": "Neonatal sepsis", "C": "Inborn error of metabolism", "D": "Neonatal encephalopathy", "language": "en"}
{"question": "A 65-year-old male presents to his cardiologist to discuss increasing episodes of dyspnea after climbing stairs. He also now needs three pillows at night to sleep. Physical examination reveals an early diastolic murmur best appreciated at the left sternal border with bounding peripheral pulses. The cardiologist is very concerned and immediately refers the patient for a surgical workup. What is the most likely diagnosis?", "answer": "Aortic regurgitation", "meta_info": "step1", "answer_idx": "B", "A": "Mitral valve insufficiency", "B": "Aortic regurgitation", "C": "Mitral stenosis", "D": "Aortic stenosis", "language": "en"}
{"question": "A 42-year-old overweight restaurant waiter develops excruciating pain in the heel of his right foot. Symptoms are most intense after getting out of bed but get better after walking. On physical examination, both feet have a flat medial arch. There is tenderness to palpation along the inner aspect of the right heel bone, minimal active dorsiflexion, and pain at passive dorsiflexion. X-ray films reveal a bone spur at the level of the attachment of the right plantar fascia. The spur is also present in the comparison film of the left foot. He is diagnosed with plantar fasciitis and is told to lose weight, rest, use ice, and take anti-inflammatory medications. Which of the following is most accurate?", "answer": "This was caused by excessive strain on the medial fascicle.", "meta_info": "step1", "answer_idx": "C", "A": "The central fascicle is the thinnest and the most likely to rupture.", "B": "The patient's windlass mechanism remains intact.", "C": "This was caused by excessive strain on the medial fascicle.", "D": "The pain in the right foot is caused by the bone spur.", "language": "en"}
{"question": "A 7-year-old boy is brought to the physician because of decreased vision, hearing, and speaking over the past 3 months. During this time, he has also had difficulty walking, concentrating, drawing, and feeding himself. His maternal male cousin had similar complaints and died at the age of 5 years. Examination shows hyperpigmented skin and nails. His speech is dysarthric. Neurologic examination shows an ataxic gait, spasticity, and decreased muscle strength in all extremities. Fundoscopy shows optic atrophy. Which of the following is the most likely cause of this patient's symptoms?", "answer": "Dysfunction of ATP-binding cassette transporter", "meta_info": "step1", "answer_idx": "B", "A": "Deficiency of β-glucocerebrosidase", "B": "Dysfunction of ATP-binding cassette transporter", "C": "Deficiency of arylsulfatase A", "D": "Deficiency of lysosomal galactocerebrosidase", "language": "en"}
{"question": "A 55-year-old man comes to the physician because of a 4-month history of nocturia. He wakes up twice each night to urinate. He has no history of serious illness. He takes no medication. His younger brother was diagnosed with testicular cancer at the age of 35 years. Rectal examination shows a smooth, symmetrical prostate without nodules. The physician offers to discuss the advantages and limitations of the prostate specific antigen (PSA) test in diagnosing prostate cancer. He mentions that a a serum PSA of 4 ng/mL is generally used as a cutoff value. At this cutoff, the test has a sensitivity of 21% for detecting any prostate cancer and 51% for detecting high-risk prostate cancer, with a specificity of 91%. In patients without urinary retention, hematuria, back pain, or incontinence, the positive predictive value for PSA > 4 ng/mL is estimated at 30% and the negative predictive value for PSA ≤ 4 ng/mL at 85%. Based on this information, what is the probability that this patient does not have prostate cancer if his PSA is 4.3 ng/mL?", "answer": "70%", "meta_info": "step2&3", "answer_idx": "C", "A": "79%", "B": "15%", "C": "70%", "D": "9%", "language": "en"}
{"question": "A 23-year-old woman presents to the emergency department for vomiting and abdominal pain. The patient states that she has been unable to eat or drink for the past 24 hours without vomiting. She also complains of worsening abdominal pain that started 3 days ago. The patient has a past medical history of IV drug abuse and alcohol abuse. She is not on any current medications. Her temperature is 99.5°F (37.5°C), blood pressure is 127/68 mmHg, pulse is 120/min, respirations are 17/min, and oxygen saturation is 98% on room air. On physical exam, tenderness is elicited when the right lower quadrant of her abdomen is palpated. Deep palpation and release of the left lower quadrant of her abdomen also causes severe pain. Rectal exam reveals normal tone and stool is Guiac negative. Laboratory studies are ordered as seen below.\n\nHemoglobin: 12 g/dL\nHematocrit: 36%\nLeukocyte count: 11,500/mm^3 with normal differential\nPlatelet count: 197,000/mm^3\n\nSerum:\nNa+: 139 mEq/L\nCl-: 100 mEq/L\nK+: 4.3 mEq/L\nHCO3-: 27 mEq/L\nBUN: 20 mg/dL\nGlucose: 67 mg/dL\nCreatinine: 1.1 mg/dL\nCa2+: 10.2 mg/dL\nAST: 12 U/L\nALT: 15 U/L\n\nUrine:\nCocaine: positive\nAmphetamines: positive\nß-hCG: positive\nMarijuana: positive\nHeroin: negative\nPCP: negative\nMDMA: positive\nGlucose: negative\nKetones: negative\n\nWhich of the following is the next best step in management?", "answer": "Ultrasound", "meta_info": "step2&3", "answer_idx": "C", "A": "Chest radiograph", "B": "Abdominal CT", "C": "Ultrasound", "D": "Colonoscopy", "language": "en"}
{"question": "A 75-year-old man was brought in by his daughter since he was having increased incidences of forgetting things. His daughter said that he becomes increasingly frustrated searching for his glasses and keys most of the time. He was helped out a couple of times in the supermarket for forgetting the way out. He recently lost his driving license when he was spotted by the cops driving in the wrong direction on the interstate. Which of the following is the most likely pathology for this presentation?", "answer": "Abnormal cleavage of amyloid precursor protein", "meta_info": "step1", "answer_idx": "D", "A": "Prion infection", "B": "α-synuclein defect", "C": "Depigmented substantia nigra and locus cerulus", "D": "Abnormal cleavage of amyloid precursor protein", "language": "en"}
{"question": "A 7-month-old male child is brought into your office for recent rhinorrhea and cough. The mother states that the child has had mild fevers of up to 100.7 F over the last three days along with clear nasal discharge, and a nonproductive cough, but the child has been working harder to breathe over the last day. The mother states the child was vaccinated for the flu one month ago. His vitals are significant for a temperature of 100.9F and his physical exam is significant for intercostal retractions along with expiratory wheezing. What is the most likely organism responsible?", "answer": "Respiratory syncytial virus", "meta_info": "step2&3", "answer_idx": "C", "A": "Parainfluenza virus", "B": "Adenovirus", "C": "Respiratory syncytial virus", "D": "Echovirus", "language": "en"}
{"question": "A 56-year-old man comes to the physician because of increasing generalized fatigue for 1 month. He also has had a 5.4 kg (12 lb) weight loss over the past 6 months. He has hypertension and type 1 diabetes mellitus. His father died of colon cancer at the age of 65 years. He has smoked one pack of cigarettes daily for 32 years and drinks one alcoholic beverage per week. He has numerous tattoos, several of which were acquired when he went backpacking through Southeast Asia as a young man. Current medications include enalapril and insulin. He is 180 cm (5 ft 11 in) tall and weighs 78 kg (172 lb); BMI is 24.1 kg/m2. His temperature is 37.0°C (98.6°F), pulse is 86/min, and blood pressure is 140/90 mm Hg. The abdomen is soft and nontender. The liver is palpated 3 cm below the right costal margin. Laboratory studies show:\nHemoglobin 12.6 g/dL\nMean corpuscular volume 86 μm3\nLeukocyte count 8800/mm3\nPlatelet count 282,000/mm3\nHemoglobin A1C 6.3 %\nSerum\nGlucose 113 mg/dL\nCreatinine 1.1 mg/dL\nAlbumin 4.1 mg/dL\nTotal bilirubin 1.1 mg/dL\nAlkaline phosphatase 66 U/L\nAST 100 U/L\nALT 69 U/L\nFerritin 180 ng/mL\nα-fetoprotein\n410 ng/mL (N < 10 ng/mL)\nCT scan of the abdomen shows a 3.5 x 2 x 1.5 cm mass in segment 6 of the liver. Which of the following interventions most likely would have prevented this patient's condition?\"", "answer": "Hepatitis B vaccination", "meta_info": "step2&3", "answer_idx": "B", "A": "Regular phlebotomies", "B": "Hepatitis B vaccination", "C": "Penicillamine therapy", "D": "Antitrypsin replacement therapy", "language": "en"}
{"question": "A 6-year-old girl with polycystic kidney disease is started on a new medication after receiving a kidney transplant from a matched, unrelated donor. Two days after starting the medication, laboratory studies show a leukocyte count of 17,500/mm3 (90% segmented neutrophils, 4% bands, 1% eosinophils, 3% lymphocytes, and 1% monocytes). Which of the following drugs is the most likely cause of these laboratory findings?", "answer": "Methylprednisolone", "meta_info": "step1", "answer_idx": "A", "A": "Methylprednisolone", "B": "Abciximab", "C": "Erythropoietin", "D": "Tacrolimus", "language": "en"}
{"question": "A clinical trial is conducted to investigate the efficiency of a new glucagon receptor antagonist in the treatment of type 2 diabetes mellitus. After 12 weeks of treatment with this drug, all participants in the study achieved statistically significant reductions in fasting and postprandial serum glucose. Three individuals reported symptoms of hypoglycemia while exercising. The activity of which of the following cellular enzymes is most likely to be decreased in response to treatment with this drug?", "answer": "Protein kinase A", "meta_info": "step1", "answer_idx": "C", "A": "Mitogen-activated protein kinase", "B": "Guanylate cyclase", "C": "Protein kinase A", "D": "Phospholipase C", "language": "en"}
{"question": "A 19-year-old man is admitted to the medical intensive care unit with suspected sepsis. Blood cultures grow Gram-negative cocci containing lipooligosaccharide in their cell wall. Which of the following would you expect to find on a detailed history and physical examination of this patient?", "answer": "Petechial rash", "meta_info": "step1", "answer_idx": "A", "A": "Petechial rash", "B": "Ascending paralysis", "C": "History of exposure to rabbit hides", "D": "Rice water stools", "language": "en"}
{"question": "A 25-year-old male rugby player presents to the emergency room complaining of a severe headache. He is accompanied by his teammate who reports that he had a head-to-head collision with another player and briefly passed out before regaining consciousness. His past medical history is significant for a pilocytic astrocytoma as a child treated successfully with surgery. His family history is notable for stroke in his father. His temperature is 98.9°F (37.2°C), blood pressure is 160/90 mmHg, pulse is 60/min, and respirations are 20/min. On examination, he is lethargic but oriented to person, place, and time. The affected vessel in this patient directly branches from which of the following vessels?", "answer": "Maxillary artery", "meta_info": "step1", "answer_idx": "A", "A": "Maxillary artery", "B": "Internal carotid artery", "C": "Superficial temporal artery", "D": "Anterior cerebral artery", "language": "en"}
{"question": "A 4-year-old boy presents with 3 days of fever, crampy abdominal pain, vomiting, and loose, bloody bowel movements containing mucus. The patient’s mother says that other children from his daycare class have also developed similar symptoms. The patient’s temperature is 39.0°C (102.2°F). On physical examination, the patient is irritable and inconsolable, and his abdomen is distended. Intravenous fluid resuscitation is initiated. Histopathologic analysis of his stool reveals numerous red and white blood cells. Which of the following is characteristic of the most likely microorganism responsible for this patient’s symptoms?", "answer": "Inactivation of the 60S ribosome subunit", "meta_info": "step1", "answer_idx": "A", "A": "Inactivation of the 60S ribosome subunit", "B": "Permanent activation of Gs alpha subunit", "C": "Overactivation of guanylate cyclase", "D": "Disabling Gi alpha subunit", "language": "en"}
{"question": "A 23-year-old man develops a seizure on the medical floor. He was admitted 2 days ago with high-grade fever and severe headache. At the time of admission, he had photophobia, neck rigidity, and the following vital signs: temperature 39.5°C (103.1°F), blood pressure 130/70 mm Hg, and heart rate 120/min. A cerebral spinal fluid analysis was ordered, and he was started on intravenous antibiotics. The patient’s seizure terminates without any medication or intervention. An MRI is performed which reveals dilation of all the ventricles of the brain. Which of the following is the most likely cause of his abnormal radiologic findings?", "answer": "Arachnoid granulation adhesions", "meta_info": "step1", "answer_idx": "C", "A": "Blood clot in the foramen of 3rd ventricle", "B": "Aqueductal stenosis", "C": "Arachnoid granulation adhesions", "D": "Mega cisterna magna", "language": "en"}
{"question": "A 27-year-old unconscious man is brought to the ED by EMS. He was found face down in the middle of the sidewalk at 2AM. The patient is disheveled and smells of alcohol. Physical exam reveals bruising and ecchymosis at the right temple and 1-mm pupils bilaterally. His temperature 97.1°F (36.3°C), blood pressure is 84/58 mmHg, pulse is 71/min, respirations are 8/min. Following initial stabilization and respiratory support, what is the best next step for this patient?", "answer": "Naloxone", "meta_info": "step1", "answer_idx": "C", "A": "Flumazenil", "B": "Glucose", "C": "Naloxone", "D": "Warming blankets", "language": "en"}
{"question": "A 43-year-old man presents to the clinic for pain with swallowing for a month. He says that the pain has gotten worse over the past few weeks. His past medical history is significant for AIDS. He states that he has not been able to afford his highly active antiretroviral therapy, so he is not currently taking any medications. His temperature is 98.6°F (37°C), respirations are 15/min, pulse is 70/min, and blood pressure is 100/84 mm Hg. Physical examination reveals no mucosal lesions. Evaluation of the blood reveals:\nHb%: 11 gm/dL\nTotal count (WBC): 2,400 /mm3\nDifferential count:\nNeutrophils: 70%\nLymphocytes: 25%\nMonocytes: 5%\nCD4+ cell count: 51/mm3\nWhat is the best pharmacotherapy for this patient's current symptom?", "answer": "Oral fluconazole", "meta_info": "step2&3", "answer_idx": "A", "A": "Oral fluconazole", "B": "Oral nystatin liquid suspension", "C": "Intravenous amphotericin B", "D": "Oral acyclovir", "language": "en"}
{"question": "A 25-year-old man is brought by his roommate to the emergency department with chest pain, which began 90 minutes ago. His roommate says that he has not slept within the past 24 hours and has been taking pills to help him study longer for his upcoming national dental board exam. On examination, he is diaphoretic, extremely agitated, and attempts to remove his IV lines and ECG leads. His temperature is 38.9°C (102.2°F), pulse is 115/min, and blood pressure is 160/102 mmHg. His pupil size is 7 mm bilaterally. The lungs are clear to auscultation. The most appropriate next step in management is administration of which of the following?", "answer": "Lorazepam", "meta_info": "step2&3", "answer_idx": "A", "A": "Lorazepam", "B": "Dantrolene", "C": "Ketamine", "D": "Haloperidol\n\"", "language": "en"}
{"question": "A 65-year-old female presents to her primary care physician for a routine check-up. She reports feeling well but has noticed occasional weakness and constipation over the past few months. A complete blood count is within normal limits. Serum calcium is 11.9 mg/dL and serum phosphate is 2.4 mg/dL. Urine calcium output is 400 mg/24 h. A sestamibi scan demonstrates increased uptake near the inferior left pole of the thyroid gland. Which of the following mechanisms is most likely involved in this patient’s symptoms?", "answer": "Increased RANK-L expression", "meta_info": "step1", "answer_idx": "C", "A": "Increased osteoprotegerin expression", "B": "Decreased RANK-L expression", "C": "Increased RANK-L expression", "D": "Increased ß-adrenergic receptor synthesis", "language": "en"}
{"question": "A 35-year-old male presents to his physician with a small mass that he found in the anterior of his neck a few days ago. The mass is not painful and does not affect his swallowing. He noticed no change in his weight. His history is significant for radiation exposure for treating his neuroblastoma at the age of 15. On examination, a nodule around the size of 2.2 cm is palpated in the right thyroid lobule; the nodule is firm and non-tender. There is cervical lymphadenopathy. His blood pressure is 118/75 mm Hg, respirations are 17/min, pulse is 67/min, and temperature is 37.5°C (99.5°F). Laboratory findings include serum Na+ of 136 mmol/L, K+ of 4.2 mmol/L, Cl– of 90 mmol/L, and bicarbonate of 24 mmol/L. Which of the following factors will most likely make the prognosis worse in this patient?", "answer": "Bone metastases", "meta_info": "step2&3", "answer_idx": "B", "A": "Age", "B": "Bone metastases", "C": "Follicular histological variant", "D": "Hurthle cell variant", "language": "en"}
{"question": "An 18-year-old man is referred to a psychiatrist for evaluation after a recent suicide attempt. On questioning him, he says that he did it because he got fed up with life and feels that he is worthless. The patient’s father informs the doctor that his son has been gloomy most of the time over the last 2 months, and his academic performance has declined significantly. His father further adds that his son’s appetite has decreased significantly over the last 3 months, leading to a 5.0 kg (11.0 lb) weight loss.  The patient denies any history of manic or hypomanic episodes. Physical examination is unremarkable. Routine laboratory tests, including thyroid hormone and cortisol levels, are within normal limits. Which of the following patterns of abnormal brain activity would most likely be present in this patient?", "answer": "Decreased norepinephrine levels in the cortical and limbic areas", "meta_info": "step2&3", "answer_idx": "C", "A": "Increased dopaminergic activity in the limbic system", "B": "Increased glutamatergic activity in the subthalamic nucleus", "C": "Decreased norepinephrine levels in the cortical and limbic areas", "D": "Decreased cholinergic activity in the hippocampus and amygdala", "language": "en"}
{"question": "A 10-year-old girl is evaluated for a suspected primary deficiency. She is the first child in a consanguineous marriage. She was born vaginally at full term after an uncomplicated pregnancy and was breastfed for 9 months. The patient has had an episode of meningococcal meningitis, recurrent bronchiolitis, and multiple bouts of pneumococcal pneumonia over the past 5 years. She has also suffered from chronic otitis media since the age of 5. After a thorough examination, the child is found to have a partial CD19 deficiency. Which of the following proteins is heavily involved with this pathogenesis?", "answer": "CD21", "meta_info": "step1", "answer_idx": "C", "A": "CD8", "B": "CD16", "C": "CD21", "D": "CD25", "language": "en"}
{"question": "A 24-year old woman is brought to the emergency department after a motor vehicle collision. She was a restrained passenger at the time of impact. On examination, the patient is pale and in moderate distress. She complains of a sharp pain in the posterior aspect of the left shoulder. Vitals include temperature is 37.0°C (98.6°F), right arm blood pressure is 94/63 mm Hg, left arm blood pressure is 90/61 mm Hg, pulse is 122/min, and respirations are 24/min. Cardiopulmonary auscultation reveals normal heart sounds and clear lungs. Neck veins are not distended. Several, large ecchymoses are visible over the chest and abdomen in a seatbelt pattern. Her abdomen is tender on superficial palpation with mild rebound tenderness and rigidity. Her range of motion is normal with 5/5 motor strength in all extremities. Wrist drop is absent. A FAST scan is pending. Based on the patient’s current presentation, which organ is most likely affected?", "answer": "Spleen", "meta_info": "step1", "answer_idx": "C", "A": "Pancreas", "B": "Heart", "C": "Spleen", "D": "Appendix", "language": "en"}
{"question": "A 68-year-old woman presents to her primary care physician with complaints of fatigue, difficulty breathing upon exertion, and crampy lower abdominal pain. She also notices that her stools are dark. She has had essential hypertension for 20 years for which she takes bisoprolol. Her family history is positive for type 2 diabetes mellitus. On physical examination, she looks pale. Complete blood count shows the following:\nHemoglobin 10 g/dL\nMean corpuscular volume (MCV) 70 fL\nMean corpuscular hemoglobin (MCH) 25 pg/cell\nMean corpuscular hemoglobin concentration (MCHC) 27 g/dL\nRed cell distribution width 16%\nPlatelet count 350,000/mm3\nSerum ferritin is 9 ng/mL. The patient is referred to a gastroenterologist and conventional colonoscopy reveals a polypoid mass in the ascending colon. Biopsy shows poorly differentiated adenocarcinoma. A preoperative staging is performed and a laparoscopic cancer resection with postoperative chemotherapy are planned. Which of the following tests can be used for postoperative follow up of this patient?", "answer": "Carcinoembryonic antigen (CEA)", "meta_info": "step2&3", "answer_idx": "A", "A": "Carcinoembryonic antigen (CEA)", "B": "Pelvic magnetic resonance imaging (MRI)", "C": "Transrectal endoscopic ultrasound (TRUS)", "D": "Cancer antigen 125 (CA 125)", "language": "en"}
{"question": "A 34-year-old man comes to the physician because of a 2-day history of progressively blurred vision. He also reports seeing flashing lights in his visual field. He does not have any pain. The patient has not been examined by a physician in several years. He appears emaciated. Examination shows right conjunctival injection. Visual acuity is 20/20 in the left eye and 20/100 in the right eye. Fundoscopic examination of the right eye is shown. His CD4+ T-lymphocyte count is 46/mm3. Which of the following is the most appropriate pharmacotherapy for this patient's eye condition?", "answer": "Valganciclovir", "meta_info": "step1", "answer_idx": "A", "A": "Valganciclovir", "B": "Penicillin G", "C": "Sulfadiazine and pyrimethamine", "D": "Trimethoprim-sulfamethoxazole", "language": "en"}
{"question": "A 42-year-old man comes to the physician because of several episodes of rectal bleeding over 2 weeks. He has had pain around the anal area for the past month. Six months ago, he was diagnosed with esophageal candidiasis and was treated with oral fluconazole. He is HIV-positive. He has had 9 male sexual partners over his lifetime and uses condoms inconsistently. The patient's current medications include dolutegravir, tenofovir, and emtricitabine. He is 179 cm (5 ft 10 in) and weighs 66 kg (146 lb); BMI is 20.9 kg/m2. Vital signs are within normal limits. Digital rectal examination and anoscopy show a hard 2-cm mass palpable 0.5 cm above the anal verge that bleeds on contact. There is no inguinal lymphadenopathy. The abdomen is soft and nontender. The CD4+ T-lymphocyte count is 95/mm3(N ≥ 500/mm3). A biopsy confirms the diagnosis. This patient is most likely to benefit from which of the following interventions?", "answer": "Radiochemotherapy", "meta_info": "step2&3", "answer_idx": "A", "A": "Radiochemotherapy", "B": "Local 5-fluorouracil therapy", "C": "Injection sclerotherapy", "D": "Submucosal hemorrhoidectomy\n\"", "language": "en"}
{"question": "A 19-month-old boy comes into the emergency department with his parents. He has burns on his buttocks and perineal area. The patient’s mother says she was at home with the patient when she heard him screaming from the kitchen. She says she ran to the room to find that the patient had pulled down a container of hot water on himself. Which of the following burn patterns would be most indicative of child abuse in this patient?", "answer": "Circular burns of equal depth restricted to the buttocks, with sparing of the hands and feet", "meta_info": "step1", "answer_idx": "D", "A": "Burns to flexor and anterior surfaces", "B": "Burns with irregular borders, uneven depth of burns, and splash pattern", "C": "Burns with some areas blistering but with others not blistering", "D": "Circular burns of equal depth restricted to the buttocks, with sparing of the hands and feet", "language": "en"}
{"question": "A 44-year-old woman presents to the physician for evaluation of recurrent episodes of pounding headache, palpitations, excessive sweating, anxiety, tremors, and pallor, with occasional vomiting for the last 2 weeks. She has presented to the same physician with similar complaints in the past; however, she is frustrated with the lack of proper diagnosis and now insists on a detailed workup. She does not take any medications. She has a history of progressively increasing thyroid swelling as well as multiple bone pain for the past 2 months. On physical examination, she is very lean and appears anxious and apprehensive. She has clammy and moist hands. Her temperature is 37.1°C (98.9°F), the pulse is 110/min, the blood pressure is 176/94 mm Hg, and the respiratory rate is 27/min. Her weight is 43 kg (94.8 lb), height is 145 cm (4 ft 7 in), and body mass index (BMI) is 20.4 kg/m2. A firm thyroid nodule is palpable in the right lobe. Physical examination is otherwise normal. What is the most appropriate initial management for this patient?", "answer": "24-h urine catecholamine by-products (vanillylmandelic acid (VMA), metanephrine, and normetanephrine)", "meta_info": "step2&3", "answer_idx": "C", "A": "Serum epinephrine and norepinephrine", "B": "Clonidine test", "C": "24-h urine catecholamine by-products (vanillylmandelic acid (VMA), metanephrine, and normetanephrine)", "D": "Serum calcium and PTH", "language": "en"}
{"question": "A 54-year-old male is involved in a high speed motor vehicle collision and is brought to the emergency department. On arrival, his vitals are temperature 98.6 °F (37 °C), blood pressure 110/70 mmHg, pulse 100/min, and respirations are 20/min. His Glasgow Coma Score (GCS) is 13 (eye opening 3, verbal response 5, and motor response 5). Physical exam is notable for a rapid and thready pulse, and a rigid and distended abdomen with positive rebound tenderness. FAST exam reveals a large hypoechoic stripe in the hepatorenal recess. Two large bore IV's are started and the patient is given a 1L bolus of normal saline. The patient’s mental status rapidly deteriorates and he becomes unresponsive. His pulse is 149/min and blood pressure is 70/40 mmHg. The patient is started on a medication while additional fluids are administered. Subsequently his vitals, his pulse is 80/minute and blood pressure is 120/80 mmHg. While the patient is being taken to the operating room, he develops pain in all four distal extremities. His digits appear blue and are cool to the touch. Which medication is most likely responsible for this complication?", "answer": "Norepinephrine", "meta_info": "step2&3", "answer_idx": "B", "A": "Epinephrine", "B": "Norepinephrine", "C": "Vasopressin", "D": "Ephedrine", "language": "en"}
{"question": "A 20-year-old man with a history of cystic fibrosis presents to his pulmonologist for a regular checkup. He generally feels well but noticed that he has had an increase in stool frequency. He describes his stools as loose and “greasy”, often staining the toilet bowl. He regularly uses albuterol and budesonide inhalers and has chest physical therapy several times a month. Physical exam is unremarkable. Serum level of which of the following coagulation factors is likely abnormal in this patient?", "answer": "II", "meta_info": "step2&3", "answer_idx": "A", "A": "II", "B": "V", "C": "VIII", "D": "XI", "language": "en"}
{"question": "A 6-year-old boy is brought to the physician by his father for an annual health maintenance examination. His father notes that he has several pigmented areas on his skin and a few fleshy bumps. He has also had some blurred vision in his left eye. He has no history of serious medical illness. He lives at home with both parents and is up-to-date on all his immunizations. His father has similar skin findings. His mother has epilepsy and glaucoma. Vital signs are within normal limits. Visual acuity testing shows 20/50 in the left eye and 20/20 in the right eye. Slit-lamp examination shows pigmented iris nodules. Examination of his skin shows eight brownish macules and numerous soft, non-tender, pedunculated lesions on the back, chest, and abdomen. Which of the following is the most appropriate next step in management?", "answer": "MRI of the brain", "meta_info": "step2&3", "answer_idx": "A", "A": "MRI of the brain", "B": "Electroencephalogram", "C": "B-scan ultrasound", "D": "Gonioscopy", "language": "en"}
{"question": "A 43-year-old man is brought to the emergency department because of a fever, cough, pleuritic chest pain, and dyspnea. Two days ago, he returned from a construction site along the Mississippi River. Abdominal examination shows a palpable spleen. An x-ray of the chest shows diffuse reticulonodular infiltrates. Therapy with a drug that binds ergosterol is initiated. This patient is most likely to experience which of the following adverse effects?", "answer": "Hypomagnesemia", "meta_info": "step1", "answer_idx": "A", "A": "Hypomagnesemia", "B": "Histamine release", "C": "Leukopenia", "D": "Cytochrome P450 induction", "language": "en"}
{"question": "A 49-year-old African man presents to the physician with a 3-month history of fatigue, shortness of breath, and abdominal distention. He immigrated to the US approximately 6 months ago. He has no other medical problems and is currently not on medication. He previously worked as a farmer but stopped due to his inability to keep up with the work. His blood pressure is 112/58 mm Hg, pulse is 90/min, respiratory rate is 19/min, and temperature is 37.8°C (100.0°F). Physical examination reveals bilateral pedal edema up to the knees, jugular venous distention, and abdominal distention with free fluid. Chest auscultation reveals the following sound. Jugular venous pressure tracing reveals prominent ‘x’ and ‘y’ descents. Radial pulse is absent during inspiration bilaterally. Which of the following is the primary underlying cause of this patient’s presentation?", "answer": "Tuberculosis", "meta_info": "step2&3", "answer_idx": "B", "A": "Coxsackie A virus", "B": "Tuberculosis", "C": "Protozoan infection", "D": "Tricuspid endocarditis", "language": "en"}
{"question": "A 25-year-old primigravida is admitted to the hospital at 35 weeks gestation with lower leg edema. She denies any other symptoms. Prior to admission, the antepartum course was unremarkable and she was compliant with recommended  prenatal care. The vital signs were as follows: blood pressure, 155/90 mm Hg; heart rate, 84/min; respiratory rate, 16/min; and temperature, 36.6℃ (97.9℉). The fetal heart rate was 142/min. The physical examination shows 2+ pitting edema. A 24-hour urine assessment showed proteinuria (1.2 g). An ultrasound examination showed a normally developing fetus without structural abnormalities. The placental margin was located 3 cm away from the internal os. Which of the following options describes the  proper management in this patient assuming that no deterioration occurs up to the time of delivery?", "answer": "Induction of vaginal delivery at 37 weeks’ pregnancy if not begin spontaneously earlier", "meta_info": "step2&3", "answer_idx": "A", "A": "Induction of vaginal delivery at 37 weeks’ pregnancy if not begin spontaneously earlier", "B": "Cesarean delivery after a course of a corticosteroid treatment", "C": "Vaginal delivery induction after a course of corticosteroid treatment", "D": "Watch for a spontaneous vaginal delivery at any term from the moment of presentation", "language": "en"}
{"question": "A 12-year-old female presents to the emergency room difficult to arouse and occasionally vomiting. On physical exam, her oral mucosa looks dry, her breath has a fruity odor, and her breathing is slow, deep and labored. What is the most likely primary metabolic disturbance?", "answer": "Anion gap metabolic acidosis", "meta_info": "step2&3", "answer_idx": "A", "A": "Anion gap metabolic acidosis", "B": "Non-anion gap metabolic acidosis", "C": "Metabolic alkalosis", "D": "Respiratory alkalosis", "language": "en"}
{"question": "A 36-year-old man presents to the emergency room with subacute worsening of chronic chest pain and shortness of breath with exertion. The patient is generally healthy, lifts weights regularly, and does not smoke. His temperature is 97.8°F (36.6°C), blood pressure is 122/83 mm Hg, pulse is 80/min, respirations are 13/min, and oxygen saturation is 98% on room air. Cardiac auscultation reveals a crescendo-decrescendo murmur heard right of the upper sternal border with radiation into the carotids. An ECG shows left axis deviation and meets criteria for left ventricular hypertrophy. An initial troponin is < 0.01 ng/mL. Which of the following is the most likely diagnosis?", "answer": "Bicuspid aortic valve", "meta_info": "step2&3", "answer_idx": "B", "A": "Bacterial endocarditis", "B": "Bicuspid aortic valve", "C": "Cardiac myxoma", "D": "Senile calcific changes", "language": "en"}
{"question": "A 66-year-old man is admitted to the intensive care unit for management of laboratory-confirmed septic shock. His current plan includes appropriate management of airway and breathing, intravenous antibiotics, fluid resuscitation, and supportive care. After the administration of adequate intravenous isotonic fluids, his temperature is 37.2°C (99.0°F), the pulse rate is 120/min, the blood pressure is 90/50 mm Hg, and the respiratory rate is 22/min. His extremities are warm and capillary refill time is normal. The patient is started on vasopressor therapy, and norepinephrine is chosen over epinephrine. Which of the following characteristics of norepinephrine best explains this choice in this patient?", "answer": "Norepinephrine has more α1-adrenergic effects compared to epinephrine", "meta_info": "step1", "answer_idx": "D", "A": "Norepinephrine has less α1-adrenergic effects compared to epinephrine", "B": "Norepinephrine has more β2-adrenergic activity compared to epinephrine", "C": "Norepinephrine has similar α1-adrenergic effects compared to epinephrine", "D": "Norepinephrine has more α1-adrenergic effects compared to epinephrine", "language": "en"}
{"question": "A 67-year-old man comes to the physician because of a worsening tremor that began one year ago. The tremor affects his left hand and improves when he uses his hand to complete a task. He also reports feeling stiffer throughout the day, and he has fallen twice in the past year. He has not noticed any changes in his cognition or mood. He has not had difficulty sleeping, but his wife says that he would kick and punch while dreaming for almost a decade. He drinks two cans of beer daily. He takes no medications. He appears healthy and well nourished. His vital signs are within normal limits. He maintains a blank stare throughout the visit. Further evaluation is most likely to show which of the following?", "answer": "Reduced amplitude on foot tapping", "meta_info": "step2&3", "answer_idx": "A", "A": "Reduced amplitude on foot tapping", "B": "Extensor plantar response", "C": "Choreiform movements", "D": "No abnormalities\n\"", "language": "en"}
{"question": "A 25-year-old African American man comes to the emergency department for “red urine.” Patient reports that he just returned from a skiing trip in the Rocky Mountains and developed the reddish urine today. He denies upper respiratory infection symptoms, chest pain, fever, or chills but does endorse some right flank pain that developed 3 days ago. Physical examination was unremarkable except for some tenderness upon palpation at the right flank. Laboratory findings are as follows:\n\nSerum:\nNa+: 137 mEq/L\nK+: 4.9 mEq/L\nCl-: 100 mEq/L\nHCO3-: 25 mEq/L\nOsmolality: 275 Osm/kg\n\nUrine:\nColor: Red\nProtein: 3+\nRBC: 4 cells/hpf\nOsmolality: 214 Osm/kg\nSpecific gravity: 1.004\n\nWhich finding would you most likely expect with this patient?", "answer": "HbS on hemoglobin electrophoresis", "meta_info": "step1", "answer_idx": "B", "A": "Cystic mass of the right kidney on CT abdomen/pelvis", "B": "HbS on hemoglobin electrophoresis", "C": "Renal stones on CT abdomen/pelvis", "D": "Segmental sclerosis and hyalinosis of renal glomeruli on light microscopy", "language": "en"}
{"question": "A 62-year-old man presents to his primary care physician because of lower back pain and radiating leg pain. He says that the pain is searing and goes from the buttock into the posterior thigh and lateral leg. It is moderate in intensity and he has noticed that it worsens with sitting and improves with standing. His past medical history is significant for well controlled hypertension, but he has otherwise been healthy. He works as a laborer loading packages in a warehouse and is concerned because the pain does not allow him to work. On physical exam, he is found to have pain and paresthesia while performing a straight leg raise. Radiographs show loss of disk height and MRI shows significant degeneration and posterolateral herniation of the disk in between the L5 and S1 vertebrae. Adjacent disks appear to be relatively normal without notable herniation. Which of the following sets of findings would most likely be seen in this patient?", "answer": "Weak ankle plantarflexion and diminished Achilles reflex", "meta_info": "step1", "answer_idx": "C", "A": "Weak ankle dorsiflexion and diminished Achilles reflex", "B": "Weak ankle dorsiflexion and hallucis extension", "C": "Weak ankle plantarflexion and diminished Achilles reflex", "D": "Weak ankle plantarflexion and diminished patellar reflex", "language": "en"}
{"question": "A 46-year-old woman presents to her primary care provider with pain in both of his hands and wrists. She notes that it is hard for her to prepare breakfast or wash dishes in the morning due to stiffness. It seems to subsides later in the day. She also complains of a constant fatigue and unintentional weight loss during the last few months. The past medical history is significant for hypertension. She takes captopril and aspirin daily, and occasional ibuprofen for the pain in her hands. Her mother developed similar symptoms in her hands resulting in hand deformity. The blood pressure is 140/90 mm Hg, heart rate is 67/min, respiratory rate is 13/min, and temperature is 37.0°C (98.6°F). Physical examination shows redness, edema, and tenderness on palpation at the metacarpophalangeal and proximal interphalangeal joints of both hands. The blood tests show the following findings:\nRed blood cell count 3.3 million/mm3\nHb 12.1 mg/dL\nLeukocyte count 10,101/mm3\nESR 48 mm/h\nC-reactive protein 3.9 mg/L\nAnti-cyclic citrullinated peptide 45 μ/mL\nWhich of the following medications is first-line therapy to slow disease progression?", "answer": "Methotrexate", "meta_info": "step2&3", "answer_idx": "B", "A": "Intra-articular corticosteroid injections", "B": "Methotrexate", "C": "Meloxicam", "D": "Etanercept", "language": "en"}
{"question": "A 27-year-old woman presents to her primary care physician’s office complaining of trouble sleeping. She reports that for the past 10 months she has experienced difficulty falling asleep due constant worrying. The content of her worry include items such as whether or not her child will feel lonely in day care and the health of her parents. These worrying episodes typically begin toward the end of the day and last for several hours. She states that she has trouble concentrating at work as well and describes her heart as \"racing\" during these episodes. She denies any alcohol or illicit drug use. Which of the following neurotransmitters is most likely decreased in this patient?", "answer": "GABA", "meta_info": "step1", "answer_idx": "C", "A": "Acetylcholine", "B": "Dopamine", "C": "GABA", "D": "Norepinephrine", "language": "en"}
{"question": "A 10-year-old boy is brought to the physician because of fever and bloody diarrhea for the past few days. His parents report that he has become increasingly lethargic and irritable. His temperature is 38.6°C (101.4°F), pulse is 102/min, and respirations are 22/min. He has no significant past medical history. His parents say that he mostly only eats a diet of chicken, hamburgers, fries, cheese, and milk. On physical examination, pallor and edema in both legs are present. His laboratory studies show:\nHemoglobin 8.9 gm/dL\nLeukocyte count 9,300/mm3\nPlatelet count 67,000/mm3\nBlood urea nitrogen 43 mg/dL\nSerum creatinine 2.46 mg/dL\nCoombs test Negative\nWhich of the following is the most likely diagnosis?", "answer": "Escherichia-induced hemolytic uremic syndrome", "meta_info": "step2&3", "answer_idx": "D", "A": "Thrombotic thrombocytopenic purpura", "B": "Genetic form of hemolytic uremic syndrome", "C": "Hemolytic uremic syndrome associated with systemic disease", "D": "Escherichia-induced hemolytic uremic syndrome", "language": "en"}
{"question": "A 50-year-old white male who works in construction comes to your office because of pain in his upper arm. He states that over the last few months, he has been having pain in his upper arm that worsens with raising objects overhead. He states that he also recently fell on his outstretched hand and that seemed to worsen his pain. His vital signs are within normal limits. He has no pain on internal or external rotation. He also had no pain with the lift off test, but does have significant pain with the empty can test and the arm drop test. Which structure has he most likely injured?", "answer": "Supraspinatus tendon", "meta_info": "step2&3", "answer_idx": "C", "A": "Pectoralis major tendon", "B": "Deltoid muscle", "C": "Supraspinatus tendon", "D": "Subscapularis tendon", "language": "en"}
{"question": "A 76-year-old man presents to the physician with a severe, pruritic rash as shown in the image. He has lost sleep over the past week because of itchiness and discomfort. He has not noticed any insect bites. He is not experiencing any pain. He currently lives in an elderly home where several other residents are experiencing a similar problem. He has no history of a serious illness and does not take any medications. His vital signs are within normal limits. A similar rash is seen on his face and below the knees on both sides. The skin of the groin, genital and perianal area, buttocks, and thighs show no abnormalities. The remainder of the physical examination is unremarkable. Which of the following pathogens is the most likely cause of this patient’s condition?", "answer": "Cimex lectularius", "meta_info": "step2&3", "answer_idx": "A", "A": "Cimex lectularius", "B": "Dermatobia hominis", "C": "Varicella zoster", "D": "Sarcoptes scabiei", "language": "en"}
{"question": "A 6-month-old girl is brought to the hospital by her parents for evaluation due to poor feeding for the last month. Her parents say that she has not been eating well over the last two months, yet her abdomen has grown larger. Physical exam shows a thin female infant with an enlarged liver and palpable spleen. Eye exam reveals a red spot on the retina. She has an intact muscle tone and reflexes. Which of the following enzymes is deficient in this patient?", "answer": "Sphingomyelinase", "meta_info": "step1", "answer_idx": "C", "A": "Hexosaminidase A", "B": "α-galactosidase A", "C": "Sphingomyelinase", "D": "Galactocerebrosidase", "language": "en"}
{"question": "A 24-year-old female is brought to the ED from a nearby nightclub by the local police due to aggressive and violent behavior over the past hour. A friend accompanying the patient reports that the patient smoked marijuana that \"seemed different\" approximately one hour ago. The patient has never had this kind of reaction to marijuana use in the past. On examination, the patient is combative with slurred speech and active visual hallucinations; eye examination shows prominent vertical nystagmus. This patient's presentation can be best explained by intoxication with a substance that acts at which of the following receptors?", "answer": "NMDA", "meta_info": "step1", "answer_idx": "C", "A": "Serotonin", "B": "Cannabinoid", "C": "NMDA", "D": "Norepinephrine", "language": "en"}
{"question": "A 2-month-old infant comes to the clinic because of progressive weakness and fatigue over the past 4 weeks. He is his mother’s first-born boy. She was in Mexico during the delivery and says that she had a regular 39-week gestation. She took folic acid during her pregnancy. The infant was born through vaginal delivery with no complications. Apgar scores were 10 and 9 at 1 and 5 minutes, respectively. The neonate did not go through a newborn screening process. His pulse is 130/min, respiratory rate is 43/min, temperature is 37.2°C (99.0°F), and blood pressure is 90/60 mm Hg. Physical examination shows lethargy, hypotonia, and a weak response to primitive reflexes. There is a “honey-like” odor around his diaper which the mother says has been present since birth. Which of the following enzymes is most likely deficient in this patient?", "answer": "Branched-chain alpha-ketoacid dehydrogenase", "meta_info": "step1", "answer_idx": "A", "A": "Branched-chain alpha-ketoacid dehydrogenase", "B": "Cystathionine synthase deficiency", "C": "Phenylalanine hydroxylase", "D": "Propionyl-CoA carboxylase", "language": "en"}
{"question": "A 35-year-old engineer is told by his boss that his team will need to work extra evening hours in the coming week in order to meet a project deadline. This frustrates the engineer, who already feels he is working too many hours. Instead of discussing this directly with his boss, the engineer calls in sick and leaves his work for his boss to finish. Which of the following psychological defense mechanisms is this individual demonstrating?", "answer": "Passive aggression", "meta_info": "step2&3", "answer_idx": "C", "A": "Displacement", "B": "Acting out", "C": "Passive aggression", "D": "Blocking", "language": "en"}
{"question": "A 29-year-old woman comes to the physician because of a 4-month history of fever, progressive shortness of breath, and a dry cough. During this time, she has also had a 5-kg (11-lb) weight loss. Two months ago, she was in Kenya for several weeks to visit her family. Physical examination shows fine crackles and wheezing over both lung fields. Her serum calcium concentration is 11.8 mg/dL. An x-ray of the chest shows reticular opacities in both lungs and bilateral hilar lymphadenopathy. Which of the following is the most likely underlying mechanism of this condition?", "answer": "Granulomatous inflammation", "meta_info": "step1", "answer_idx": "B", "A": "Necrotizing inflammation", "B": "Granulomatous inflammation", "C": "Monoclonal plasma cell production", "D": "Neoplastic transformation\n\"", "language": "en"}
{"question": "A 58-year-old man undergoes coronary angiography that demonstrates a 90% stenosis of the left anterior descending coronary artery. The circumflex branch of the left coronary artery is not significantly obstructed. Prior to the angiogram, he underwent a pharmacologic cardiac stress test. When administered, the pharmacologic agent caused the left circumflex artery to vasodilate, with resulting increased blood supply to its supplied myocardium that was already well-perfused at baseline. This increased flow through the circumflex artery shunted blood flow away from the myocardium supplied by the stenosed left anterior descending artery, resulting in ischemia that manifested as a perfusion defect on radionuclide imaging. Which of the following agents is most strongly associated with this phenomenon described above?", "answer": "Dipyridamole", "meta_info": "step1", "answer_idx": "D", "A": "Metoprolol", "B": "Verapamil", "C": "Diltiazem", "D": "Dipyridamole", "language": "en"}
{"question": "A 51-year-old woman comes to the physician because of a 3-week history of fatigue, non-productive cough, and worsening shortness of breath while walking. She was diagnosed with HIV 11 years ago. Two years ago, she was treated for esophageal thrush with fluconazole. She takes no medications because she does not feel like she needs them. She occasionally uses intravenous illicit drugs and has smoked a pack of cigarettes daily for 35 years. She appears ill. Her temperature is 38.4°C (101.1°F), respiratory rate is 25/min, pulse is 116/min, and blood pressure is 115/70 mm Hg. Pulse oximetry shows an oxygen saturation of 89% on room air. Inspiratory crackles are heard over bilateral lung fields. Cardiac examination shows no abnormalities. Laboratory studies show a CD4 count of 67/mm3 (N ≥ 500/mm3) and an elevated HIV viral load. An x-ray of the chest shows diffuse interstitial infiltrates bilaterally. In addition to starting antiretroviral therapy, the appropriate treatment for her current illness is initiated. Maintaining the patient on this medication to prevent recurrence of her current illness will also prevent infection with which of the following pathogens?", "answer": "Toxoplasmosa gondii", "meta_info": "step2&3", "answer_idx": "B", "A": "Varicella zoster virus", "B": "Toxoplasmosa gondii", "C": "Cryptococcus neoformans", "D": "Candida albicans", "language": "en"}
{"question": "A 37-year-old man presents with right lower extremity weakness and low back pain. The patient states that he has had chronic mild to moderate low back pain for several years, but, 3 days ago after lifting a box, the pain increased in intensity and spread to his right leg. He describes the pain as severe, electrical in character, and descending from his right gluteal region along his right posterior thigh and leg to his right lateral ankle and foot. The patient also says that he has been having difficulty walking due to stumbling over his right foot. His temperature is 37.0℃ (98.6℉), the blood pressure is 125/80 mm Hg, the pulse is 72/min, the respiratory rate is 16/min, and the oxygen saturation is 98% on room air. On physical examination, the patient is alert and cooperative. Musculoskeletal examination of the lower extremities shows the following results:\nFunctional Muscle Group/DTR Tested Right Side Left Side\n               Strength\nHip extension 5/5 5/5\nHip abduction 4/5  5/5\nHip adduction  5/5  5/5\nHip flexion 5/5 5/5\nKnee flexion 5/5 5/5\nKnee extension 5/5 5/5\nFoot plantar flexion 5/5 5/5\nFoot dorsiflexion 4/5 5/5\nFoot inversion 4/5 5/5\nFoot eversion 4/5 5/5\nToe extension 3/5 5/5\n              Reflexes\nKnee 3+ 3+\nAchilles 1+ 3+\nPlantar 2+ 3+\n               Sensory\nSensation Decreased on the lateral aspect of the lower leg and dorsum of the foot Normal over all the surface\nLassegue test Positive at 30 deg. Negative\nWhich of the following is the most likely mechanism giving rise to this patient’s condition?", "answer": "Protrusion of the L4/L5 intervertebral disk", "meta_info": "step2&3", "answer_idx": "A", "A": "Protrusion of the L4/L5 intervertebral disk", "B": "Entrapment of the femoral nerve in the femoral canal", "C": "Inflammation of the S2-3 spinal roots", "D": "Herniation of the L2/3 intervertebral disk", "language": "en"}
{"question": "A 21-year-old woman comes to the physician because of a 5-day history of pain with urination and vaginal itching. She is sexually active with multiple partners and uses condoms inconsistently. Pelvic examination shows erythema of the vulva and vaginal mucosa, punctate hemorrhages on the cervix, and green-yellow, malodorous discharge. A photomicrograph of the discharge is shown. Which of the following is the most likely causal organism?", "answer": "Trichomonas vaginalis", "meta_info": "step1", "answer_idx": "D", "A": "Neisseria gonorrhoeae", "B": "Treponema pallidum", "C": "Candida albicans", "D": "Trichomonas vaginalis", "language": "en"}
{"question": "A 9-year-old girl has recently begun having daily staring-spells in which she becomes unresponsive for several seconds. Following these episodes, she rapidly returns to normal with no recollection of the event. Her performance in school has begun to deteriorate. The child's pediatrician refers her to a pediatric neurologist, and, after an appropriate neurological work-up, the child is diagnosed with absence seizures. Her neurologist recommends initiating an anti-seizure medication, but the patient adamantly refuses due to fear of side effects and her belief that the condition is not affecting her quality of life. Which of the following is the most appropriate next step?", "answer": "Obtain consent from one parent before initiating therapy", "meta_info": "step1", "answer_idx": "C", "A": "Prescribe a long acting depot medication", "B": "Discuss the patient's school performance with her teachers", "C": "Obtain consent from one parent before initiating therapy", "D": "Obtain consent from both parents before initiating therapy", "language": "en"}
{"question": "A 44-year-old woman comes to the physician because of pain and swelling below her left eye for 3 days. She has also had excessive watering from her eyes during this period. She has no history of serious illness and takes no medications. Her temperature is 37°C (98.6°F), pulse is 90/min, and blood pressure is 110/70 mm Hg. Examination shows erythema, tenderness, warmth, and swelling below the medial canthus of the left eye. There is purulent discharge from the lower lacrimal punctum on palpation of the swelling. The remainder of the examination shows no abnormalities. The discharge is sent for cultures. Which of the following is the most appropriate next step in management?", "answer": "Oral amoxicillin-clavulanate therapy", "meta_info": "step2&3", "answer_idx": "C", "A": "Topical ciprofloxacin", "B": "Irrigation of lacrimal cannaliculi", "C": "Oral amoxicillin-clavulanate therapy", "D": "CT scan of the orbit\n\"", "language": "en"}
{"question": "A 40-year-old man comes to the physician because of decreased sexual arousal and erectile dysfunction that has put strain on his marriage for the last year. He has also had fatigue and generalized weakness for the past 9 months. He has noticed his bowel movements have not been as frequent as usual. He has occasional dry coughing and back pain. He has not had fever, headache, or changes in vision. One year ago, he traveled to South Africa with his wife. He looks fatigued. He is 168 cm (5 ft 6 in) tall and weighs 89 kg (196 lb); BMI is 31.6 kg/m2. His temperature is 36.5°C (97.7°F), pulse is 50/min, and blood pressure is 125/90 mm Hg. Physical examination shows dry skin and a distended abdomen. Neurological examination reveals delayed deep tendon reflexes. Laboratory studies show:\nHemoglobin 11.0 g/dL\nPlatelet count 380,000/mm3\nSerum\nNa+ 130 mEq/L\nCl- 97 mEq/L\nK+ 4.5 mEq/L\nHCO3- 25 mEq/L\nGlucose 95 mg/dL\nTSH 0.2 μU/mL\nWhich of the following is the most likely cause of these findings?\"", "answer": "Pituitary adenoma", "meta_info": "step2&3", "answer_idx": "B", "A": "Hemochromatosis", "B": "Pituitary adenoma", "C": "Graves disease", "D": "Hashimoto thyroiditis", "language": "en"}
{"question": "A 52-year-old man with limited, unresectable small cell lung cancer comes to the emergency department because of fever for the past 2 days. He has been on numerous chemotherapy regimens. His last round of treatment was with cisplatin and etoposide and ended 10 days ago. He feels fatigued but has not had nausea or vomiting. His temperature is 38.5°C (101.3°F), blood pressure is 100/60 mm Hg, and pulse is 115/min. The lungs are clear to auscultation. Examination shows a soft, nontender abdomen. Laboratory studies show:\nHemoglobin 10.2 g/dL\nLeukocyte count 4,000/mm3\nTotal neutrophils 8%\nEosinophils 2%\nLymphocytes 80%\nMonocytes 10%\nUrinalysis shows no abnormalities. Blood culture samples are obtained. Which of the following is the most appropriate next step in management?\"", "answer": "Cefepime", "meta_info": "step2&3", "answer_idx": "A", "A": "Cefepime", "B": "Piperacillin", "C": "Clindamycin", "D": "High-resolution chest CT", "language": "en"}
{"question": "A 28-year-old woman presents in respiratory distress. Auscultation of the lungs reveals bilateral crepitations and a friction rub. Lab findings show pancytopenia, proteinuria, and a false-positive test for syphilis. A chest X-ray shows bilateral pleural effusions. Which of the following findings are most likely?", "answer": "Photosensitivity", "meta_info": "step1", "answer_idx": "A", "A": "Photosensitivity", "B": "Urethritis", "C": "Xerostomia", "D": "Esophageal dysmotility", "language": "en"}
{"question": "A 2-month-old infant is brought in by his mother for runny nose and cough. She reports he had an ear infection 2 weeks ago, and since then he has had a productive cough and nasal congestion. His medical history is significant for multiple ear infections and eczematous dermatitis. He has also been hospitalized for 2 episodes of severe viral bronchiolitis. The mother reports that the infant has a good appetite but has had intermittent, non-bloody diarrhea. The patient is at the 20th percentile for weight. On physical examination, the patient has widespread, dry, erythematous patches, mucopurulent nasal drip, and crusting of the nares. His tongue is coated by a thick white film which is easily scraped off. Crackles are heard at the left lung base. Labs are drawn, as shown below:\n\nHemoglobin: 12.8 g/dL\nPlatelets: 280,000/mm^3\nLeukocytes: 7,500/mm^3\nNeutrophils: 5,500/mm^3\nLymphocytes: 2,000/mm^3\n\nSerum:\nNa+: 138 mEq/L\nCl-: 96 mEq/L\nK+: 4.3 mEq/L\nHCO3-: 23 mEq/L\nUrea nitrogen: 18 mg/dL\nGlucose: 90 mg/dL\nCreatinine: 1.0 mg/dL\nCa2+: : 9.2 mg/dL\n\nWhich of the following is the most likely cause of this patient’s presentation?", "answer": "Adenosine deaminase deficiency", "meta_info": "step2&3", "answer_idx": "B", "A": "22q11.2 deletion", "B": "Adenosine deaminase deficiency", "C": "Defective leukocyte adhesion", "D": "WAS gene mutation", "language": "en"}
{"question": "A 51-year-old inmate was released from prison 1 month ago and visits his general practitioner for evaluation of a positive HIV diagnosis he received from a local free clinic a week ago. The patient states that he had spent the last 2 years in prison and that, during that time, he had engaged in multiple unprotected sexual acts with fellow male inmates. When he was released from prison recently, he decided to get tested for HIV and was diagnosed positive. He is currently married with 2 children and has been paroled back to the home he shares with them. He has not told either his wife or his children of his diagnosis. He adamantly states that he is not homosexual, but that his wife would assume that he is if she found out he had contracted HIV while in prison. He states that he is terrified his wife will leave him or possibly keep his children from seeing him if she finds out about his HIV status.  He wants to be treated without the threat of his wife finding out. He insists that he will use the proper precautions to ensure his wife and children don’t contract HIV from him and reiterates the importance of keeping his diagnosis a secret. He continues and states that “they are all I have. If they leave me, I have no one.” Which of the following is the most appropriate response in this patient’s case?", "answer": "Advise the patient the positive diagnosis will be reported to the public health office, but you would also encourage him to have a discussion with his family.", "meta_info": "step2&3", "answer_idx": "D", "A": "Honor the patient’s wishes and treat him without telling his wife or reporting him to the Department of Health", "B": "Tell the patient you will honor his wishes, but report him to the Department of Health so they can tell his wife", "C": "Consult an ethics committee to determine whether or not to report him to the Department of Health", "D": "Advise the patient the positive diagnosis will be reported to the public health office, but you would also encourage him to have a discussion with his family.", "language": "en"}
{"question": "A 62-year-old man with end-stage renal disease is brought to the emergency department because of fever, severe abdominal pain, and shaking chills for 4 hours. His last hemodialysis was 2 days ago. On arrival, he appears ill and is poorly responsive. Blood cultures grow gram-positive, catalase-positive cocci that express mecA. Intravenous antibiotic therapy is begun with an agent that disrupts cell membranes by creating transmembrane channels. Which of the following adverse events is associated with the use of this agent?", "answer": "Rhabdomyolysis", "meta_info": "step1", "answer_idx": "B", "A": "Photosensitivity", "B": "Rhabdomyolysis", "C": "Ototoxicity", "D": "QT prolongation", "language": "en"}
{"question": "A 25-year-old woman comes to the physician because of pain and weakness in her left leg that started 2 days ago while running a marathon. Physical examination shows impaired flexion of the left knee joint and impaired extension of the left hip joint. An MRI of the left lower extremity shows injury to the long head of the biceps femoris muscle and the semitendinosus muscle. Which of the following is the most likely origin of the injured muscles?", "answer": "Ischial tuberosity", "meta_info": "step1", "answer_idx": "A", "A": "Ischial tuberosity", "B": "Anterior superior iliac spine", "C": "Greater trochanter", "D": "Linea aspera", "language": "en"}
{"question": "A 32-year-old man and his 29-year-old wife come to the physician because they have been unable to conceive despite regular unprotected sexual intercourse for 13 months. The woman reports regular menstrual cycles since the age of 13. Menses occur at regular 28-day intervals and last 5–7 days. Ovulation predictor kits consistently turn positive around day 14. The man has a negative history of mumps. They each smoked one pack of cigarettes per day until one year ago. The man works in construction and his wife is a secretary for a law firm. Examination of the scrotum in a standing position shows soft bands palpated in the upper pole of the left scrotum with an intact left testicle. Following Valsalva maneuver, the patient reports a dull, aching pain in his left hemiscrotum. A light held behind the scrotum does not shine through. The right scrotum appears normal. Semen studies show normal sperm count with moderately decreased motility and abnormal morphology. Which of the following is most likely to improve the patient's ability to conceive?", "answer": "Ligation of dilated pampiniform venous plexus", "meta_info": "step2&3", "answer_idx": "A", "A": "Ligation of dilated pampiniform venous plexus", "B": "Conservative management with scrotal support", "C": "Surgical excision of the hydrocele sac", "D": "Administration of ceftriaxone and doxycycline", "language": "en"}
{"question": "A 29-year-old man comes into his primary care physician's office with a chief complaint of a cough. The patient states that the cough started yesterday and he is asking if he needs antibiotics. While conversing with the patient, you note that he seems cold, mistrustful, and does not display much emotion. The patient worked for a software company but recently took a different position that allows him to work from home. The patient states that he switched positions because while at the office he made a mistake during a presentation. He felt that afterwards, his fellow workers thought less of him and he was embarrassed to show his face around the office. The patient wishes he could have related better to his coworkers. He currently lives in a barn on the outskirts of town with his many cats. On physical exam you note a healthy young man, adorned in overalls and denim shoes. His physical exam is notable for erythema of the posterior pharynx. The patient is informed that he has a viral upper respiratory infection and is sent home with instructions to rest and hydrate himself. Which of the following personality disorders best characterizes this patient?", "answer": "Avoidant", "meta_info": "step2&3", "answer_idx": "A", "A": "Avoidant", "B": "Schizoid", "C": "Schizotypal", "D": "Paranoid", "language": "en"}
{"question": "A 49-year-old man is undergoing an elective hernia repair. No significant past medical history or current medications. The patient has been working as a cardiovascular surgeon in the same hospital for the past 15 years. In obtaining informed consent, the patient’s doctor has described all the available options for the procedure with their pros and cons, has offered different materials for the hernioplasty, and described the exact procedure. He has not focused too much on the possible complications and the risks and benefits of not performing the operation, because the patient insists he already knows everything that can happen since he is a surgeon himself. The patient has given his consent, but on the day of the operation, he changes his mind regarding the material of the synthetic mesh to be used for the hernioplasty. Which of the following is true about informed consent in this case?", "answer": "The patient’s doctor should have included possible complications of the given operation and risks and benefits of not performing it, regardless of the patient’s education or prior experience.", "meta_info": "step1", "answer_idx": "C", "A": "The informed consent obtained from this patient in this hospital is invalid because he works in the hospital.", "B": "There is no need to receive an informed consent from a patient who is a doctor himself.", "C": "The patient’s doctor should have included possible complications of the given operation and risks and benefits of not performing it, regardless of the patient’s education or prior experience.", "D": "Even though the patient has changed his mind about the type of mesh material, since the basic procedure is still the same, informed consent does not need to be obtained from the patient again.", "language": "en"}
{"question": "A 55-year-old man presents to his primary care provider complaining of blood clots in his urine. On further questioning, he also reports suprapubic discomfort and a feeling of bladder fullness with difficulty voiding. The patient reports recently starting treatment for a newly diagnosed non-Hodgkin lymphoma. Vital signs are within normal limits. Physical exam reveals pain on palpation of the suprapubic region. What is the mechanism of action of the drug most likely responsible for the patient’s complaints?", "answer": "Alkylating agent", "meta_info": "step1", "answer_idx": "A", "A": "Alkylating agent", "B": "Intercalating agent", "C": "Reverse transcriptase inhibitor", "D": "Microtubule inhibitor", "language": "en"}
{"question": "A 25-year-old man presents to his primary care physician with lower back pain. He states that he has had the pain for the past two years. The patient works as a butcher, and recently was moving heavy meat carcasses. The patient states that his pain is worse in the morning and that nothing improves it aside from swimming. The patient has a past medical history of anabolic steroid abuse, acne, hypertension and obesity. His current medications are hydrochlorothiazide, ibuprofen, topical benzoyl peroxide, and acetaminophen. On physical exam there is no tenderness upon palpation of the spine. There is limited range of motion of the spine in all 4 directions. Which of the following is most likely to confirm the most likely diagnosis in this patient?", "answer": "MRI of the sacroiliac joint", "meta_info": "step2&3", "answer_idx": "C", "A": "Radiograph of the spine", "B": "The straight leg test and the clinical presentation", "C": "MRI of the sacroiliac joint", "D": "HLA typing", "language": "en"}
{"question": "A 42-year-old African American female presents to your clinic complaining of excessive thirst and urination. She reports that these symptoms began one week ago, and they have been affecting her ability to work as a schoolteacher. Labs are drawn and are listed below.\n\nSerum:\nNa+: 145 mEq/L\nCl-: 101 mEq/L\nK+: 4.4 mEq/L\nHCO3-: 25 mEq/L\nUrea nitrogen: 24 mg/dL\nGlucose: 115 mg/dL\nCreatinine: 0.7 mg/dL\nHemoglobin: 10.5 g/dL\nHematocrit: 25%\nLeukocyte count: 11,000/mm^3\nPlatelets: 200,000/mm^3\n\nUrine:\nSpecific gravity: 1.006\nEpithelial cells: 5/hpf\nGlucose: negative\nProtein: 20 mg/dL\nRBC: 6/hpf\nWBC: 1/hpf\nLeukocyte esterase: negative\nNitrites: negative\nBacterial: none\n\nA water deprivation test is performed with the following results:\n\nSerum osmolality: 305 mOsm/kg\nUrine osmolality: 400 mOsm/kg\nUrine specific gravity: 1.007\n\nDesmopressin is administered, and the patient's urine osmolality increases to 490 mOsm/kg. The patient's antidiuretic hormone is measured and is within normal limits. Which of the following may be associated with this patient’s condition?", "answer": "Dactylitis", "meta_info": "step2&3", "answer_idx": "D", "A": "Coarse tremor", "B": "Auditory hallucinations", "C": "Amenorrhea", "D": "Dactylitis", "language": "en"}
{"question": "A 42-year-old male with a history of schizophrenia presents to his psychiatrist for a normal follow-up visit. He is accompanied by his case manager. The patient was diagnosed with schizophrenia at the age of 27. After being trialed on two different medications, he was deemed to be stable on a third medication which he has been taking for the past 10 years. He reports that he occasionally hears voices. He lives in supportive housing, and his caretakers report that he prefers to be alone but is not disruptive. His temperature is 99°F (37.2°C), blood pressure is 130/90 mmHg, pulse is 105/min, and respirations are 18/min. On exam, he demonstrates a flattened affect and disorganized speech. A funduscopic examination reveals pigmented plaques at the retinal periphery. No deposits are seen in the cornea or anterior lens. This patient has most likely been treated with which of the following medications?", "answer": "Thioridazine", "meta_info": "step1", "answer_idx": "D", "A": "Fluphenazine", "B": "Olanzapine", "C": "Chlorpromazine", "D": "Thioridazine", "language": "en"}
{"question": "A 6-month-old girl is brought to the emergency department because her lips turned blue for several minutes earlier during feeding. Her father reports that the patient had similar episodes while playing that resolved quickly. During the examination, she sits calmly in her father's lap. When her ears are examined, the patient begins to cry and her lips and fingers begin to turn blue. Further evaluation of this patient is most likely to show which of the following?", "answer": "Right axis deviation on ECG", "meta_info": "step1", "answer_idx": "D", "A": "Diminutive left ventricle on echocardiogram", "B": "Decreased blood pressure in both lower extremities", "C": "Pulmonary vascular congestion on chest x-ray", "D": "Right axis deviation on ECG", "language": "en"}
{"question": "A 52-year-old female presents to clinic complaining of sudden onset of flank tenderness that was fluctuating and radiating into her groin. Laboratory analysis reveals a serum calcium of 12.4 (normal 8.4-10.2) and a serum phosphorous of 2.5 (normal 2.7-4.5) and a chloride:phosphorous ratio >33. You suspect primary hyperparathyroidism. Which of the following mechanisms is responsible for the patient’s current condition?", "answer": "Increased RANK-L production", "meta_info": "step1", "answer_idx": "C", "A": "PTH binding to receptors on osteoclasts", "B": "Parafollicular, or C-cell, synthesis of calcitonin", "C": "Increased RANK-L production", "D": "Decreased M-CSF production", "language": "en"}
{"question": "A 53-year-old man comes to the physician because of a 2-week history of fatigue, generalized itching, and yellowing of the eyes and skin. He underwent a liver transplantation because of acute liver failure following α-amanitin poisoning 1 year ago. Physical examination shows scleral icterus and abdominal distention with shifting dullness. A liver biopsy specimen shows decreased hepatic duct density. Further histological examination of the liver biopsy specimen is most likely to show which of the following findings?", "answer": "Interstitial fibrosis", "meta_info": "step1", "answer_idx": "C", "A": "Graft vessel vasculitis", "B": "Fibrinoid necrosis", "C": "Interstitial fibrosis", "D": "Viral inclusions\n\"", "language": "en"}
{"question": "A 23-year-old man comes to the emergency department because of a 5-day history of progressively worsening dyspnea. He has had intermittent episodes of chest pain, which was 4/10 in intensity and increased on inspiration. He does triathlons and has not been able to train because of the discomfort. He has had no fever or syncopal episodes. He had an upper respiratory tract infection 3 weeks ago. His father died of heart disease at the age of 55 years. His temperature is 36.8°C (98.2°F), pulse is 113/min, and blood pressure is 100/70 mm Hg. Examination shows jugular venous distention. Inspiratory crackles are heard throughout the thorax. Cardiac examination shows an S3 gallop. Laboratory studies show:\nHemoglobin 14.8 g/dL\nLeukocyte count 9200/mm3\nPlatelet count 230,000/mm3\nESR 41 mm/hr\nSerum\nCreatinine 1.1 mg/dL\nGlucose 92 mg/dL\nLDH 120 U/L\nTroponin I 0.204 ng/mL (N< 0.1 ng/mL)\nAn x-ray of the chest shows an enlarged cardiac silhouette and prominent vascular markings in both lung fields. An ECG shows diffuse T-wave inversions. Which of the following echocardiographic findings is most likely in this patient?\"", "answer": "Left ventricular dilation and global hypokinesis", "meta_info": "step2&3", "answer_idx": "C", "A": "Swinging heart with compression of the left heart chambers", "B": "Mitral valve stenosis with left atrial enlargement", "C": "Left ventricular dilation and global hypokinesis", "D": "Vegetations on the mitral valve", "language": "en"}
{"question": "Two days after undergoing abdominal surgery for lysis of adhesions, a 52-year-old man has nausea and one episode of bilious vomiting. The patient's nausea is somewhat alleviated in the prone position. The patient has had a 70-kg (154-lb) weight loss since undergoing bariatric surgery 1 year ago. Physical examination shows abdominal distention. Sudden movement of the patient elicits a sloshing sound on auscultation of the abdomen. An upper gastrointestinal series of the abdomen with oral contrast shows no passage of contrast past the third segment of the duodenum. The obstruction in this patient is most likely caused by which of the following structures?", "answer": "Superior mesenteric artery", "meta_info": "step1", "answer_idx": "A", "A": "Superior mesenteric artery", "B": "Common bile duct", "C": "Portal vein", "D": "Inferior vena cava", "language": "en"}
{"question": "A 16-year-old girl is brought to the physician because her mother is concerned about her lack of appetite and poor weight gain. She has had a 7-kg (15-lb) weight loss over the past 3 months. The patient states that she should try to lose more weight because she does not want to be overweight anymore. She maintains a diary of her daily calorie intake. Menarche was at the age of 13 years, and her last menstrual period was 3 months ago. She is on the high school track team. She is sexually active with 2 male partners and uses condoms inconsistently. She is at 50th percentile for height and below the 5th percentile for weight and BMI. Her temperature is 37°C (98.6°F), pulse is 58/min and blood pressure is 96/60 mm Hg. Examination shows fine hair over the trunk and extremities. Which of the following is the most likely diagnosis?", "answer": "Anorexia nervosa", "meta_info": "step2&3", "answer_idx": "D", "A": "HIV infection", "B": "Type 1 diabetes mellitus", "C": "Hyperthyroidism", "D": "Anorexia nervosa", "language": "en"}
{"question": "A 25-year-old male presents with progressively worsening headaches over the past two months. He also feels that he has been losing his balance more often over the past week, but he denies any motor weakness or sensory impairment. His neurological exam reveals impaired upward gaze, pupils that constrict poorly to light but react to accommodation, and bilateral upper eyelid retraction. On tandem walking, he tends to fall on both sides. The remainder of the physical examination is unremarkable. What is the most likely diagnosis in this patient?", "answer": "Pineal tumor", "meta_info": "step1", "answer_idx": "C", "A": "Multiple sclerosis", "B": "Pituitary mass", "C": "Pineal tumor", "D": "Craniopharyngioma", "language": "en"}
{"question": "A 32-year-old woman presents to an urgent care facility after having sustained a deep cut 8 hours ago while hiking in the Appalachian mountains. Immediately after she sustained the injury she rinsed out the dirt with a bottle of saline from her first aid kit. She immigrated to the United States at age 20 and was unvaccinated upon arrival. Her medical records indicate that she has since received one dose of Tdap and one Td booster 3 years ago. She is afebrile, well appearing, and her wound appears clean without signs of infection at this time. What is the next best step in management?", "answer": "Tetanus toxoid and tetanus immunoglobulin", "meta_info": "step2&3", "answer_idx": "C", "A": "Tetanus immunoglobulin only", "B": "Tetanus titers and if negative, tetanus toxoid and immunoglobulin within 48 hours", "C": "Tetanus toxoid and tetanus immunoglobulin", "D": "Tetanus toxoid and tetanus immunoglobulin today; tetanus toxoid again on days 3, 7, and 14 after exposure", "language": "en"}
{"question": "A 39-year-old woman presents to the emergency department with a chief concern of abdominal pain. She states that her symptoms occurred shortly after she began eating dinner that evening. She states that the pain is in the right side of her abdomen and travels to her right shoulder. She has a past medical history of polycystic ovarian syndrome, obesity, type II diabetes mellitus, and hypertension. Her current medications include metformin, insulin, atorvastatin, aspirin, and lisinopril. Her temperature is 99.5°F (37.5°C), blood pressure is 110/75 mmHg, pulse is 90/min, respirations are 13/min, and oxygen saturation is 99% on room air. On abdominal exam, the patient demonstrates tenderness in the right upper quadrant. The patient is started on IV fluids and morphine. Four hours later, she states that the pain has abated. Which of the following is associated with this patient's most likely diagnosis?", "answer": "Cholecystokinin", "meta_info": "step2&3", "answer_idx": "B", "A": "Acetylcholine", "B": "Cholecystokinin", "C": "Gastrin", "D": "Secretin", "language": "en"}
{"question": "A 12-year-old girl is brought to the primary physician because of severe ear pain and yellow discharge from her left ear for the past 2 days. It is also mildly pruritic. The pain started during her last day of summer camp, where she spent a lot of time outdoors hiking, horseback riding, and swimming. Her temperature is 37°C (98.6°F), pulse is 76/min, and blood pressure is 110/75 mm Hg. Examination shows tragal tenderness and a red and edematous external auditory canal. A diagnostic tuning fork is placed in the middle of the patient's forehead. The patient reports hearing the sound more loudly in the left ear. To complete the workup, the tuning fork is placed on the mastoid process of the left ear. Once she can no longer hear the sound, the tuning fork is placed in front of the auricle, and she reports no longer hearing the sound. On the right side, once the sound from the mastoid process subsides and the tuning fork is placed in front of the right ear, she reports hearing the sound again. Which of the following is the most likely cause of the patient's symptoms?", "answer": "Infection with Pseudomonas aeruginosa", "meta_info": "step2&3", "answer_idx": "C", "A": "Infection with Aspergillus species", "B": "Abnormal squamous epithelial growth", "C": "Infection with Pseudomonas aeruginosa", "D": "Pleomorphic replacement of normal bone\n\"", "language": "en"}
{"question": "A 50-year-old man comes to the emergency department because of severe lower chest pain for the past hour. The pain radiates to the back and is associated with nausea. He has had two episodes of non-bloody vomiting since the pain started. He has a history of hypertension and type 2 diabetes mellitus. He has smoked one pack of cigarettes daily for 30 years. He drinks five to six beers per day. His medications include enalapril and metformin. His temperature is 38.5°C (101.3°F), pulse is 110/min, and blood pressure is 90/60 mm Hg. The lungs are clear to auscultation. Examination shows a distended abdomen with epigastric tenderness and guarding but no rebound; bowel sounds are decreased. Laboratory studies show:\nHemoglobin 14.5 g/dL\nLeukocyte count 5,100/mm3\nPlatelet count 280,000/mm3\nSerum\nNa+ 133 mEq/L\nK+ 3.5 mEq/L\nCl- 98 mEq/L\nTotal bilirubin 1.0 mg/dL\nAmylase 160 U/L\nLipase 880 U/L (N = 14–280)\nAn ECG shows sinus tachycardia. Which of the following is the most likely diagnosis?\"", "answer": "Acute pancreatitis", "meta_info": "step2&3", "answer_idx": "D", "A": "Acute mesenteric ischemia", "B": "Peptic ulcer disease", "C": "Myocardial infarction", "D": "Acute pancreatitis", "language": "en"}
{"question": "A 29-year-old woman presents to the physician’s office complaining of swollen hands for the past 3 weeks. It is associated with stiffness in the morning, which lasts about 10 minutes. The patient’s medical history is significant for hypothyroidism that is managed with levothyroxine. She has no recent travel history. Vital signs are normal. On examination, the patient has a butterfly-shaped, non-blanching rash on her face with mild cervical lymphadenopathy. The metacarpophalangeal and proximal interphalangeal joints are tender and appear swollen. Cardiopulmonary examination reveals a grade 2/6 holosystolic murmur heard best at the apex. Which of the following tests is the best next step in evaluating this patient?", "answer": "Antinuclear antibody", "meta_info": "step2&3", "answer_idx": "C", "A": "Anti-double-stranded-DNA antibody", "B": "Anti-U1 ribonucleoprotein antibody", "C": "Antinuclear antibody", "D": "Anti-histone antibody", "language": "en"}
{"question": "A 61-year-old male dies in a motor vehicle accident. Autopsy of the heart reveals dilatation of the left atrium and expansion of the left ventricular cavity with associated eccentric hypertrophy. The structural changes in this patient's heart are most likely associated with which of the following?", "answer": "Mitral insufficiency", "meta_info": "step1", "answer_idx": "B", "A": "Pulmonic stenosis", "B": "Mitral insufficiency", "C": "Chronic hypertension", "D": "Congenital atrial septal defect", "language": "en"}
{"question": "A 52-year-old business executive presents to his physician with complaints of intermittent chest pain which started 2 months ago. He describes his pain as crushing, centrally located, and typically lasting about 5 minutes but never more than 10 minutes. The pain radiates to his left arm and jaw, occurs only when he climbs the stairs or runs on a treadmill, and is relieved by rest. He has been hypertensive and diabetic for the last 10 years and has been compliant with his medications. His physical exam findings are within normal limits. Lab tests are normal except for a significantly elevated LDL-cholesterol level. A stress ECG shows ST-segment depression in the anterior chest leads when his heart rate and blood pressure increase to over 40% from their baseline values. The physician decides to initiate a medication to relieve his symptoms. Which of the following changes best describes the direct effect of the prescribed medication on his cardiovascular physiology in the cardiac output/venous return versus right atrial pressure graph?", "answer": "iv", "meta_info": "step1", "answer_idx": "C", "A": "i", "B": "iii", "C": "iv", "D": "vi", "language": "en"}
{"question": "A 34-year-old man comes to the physician for a follow-up appointment. He was diagnosed with HIV 6 years ago and has been on highly active antiretroviral therapy with emtricitabine, tenofovir, and darunavir. He reports that he has been compliant with his medication regimen. His last CD4+ T-lymphocyte count was 520/mm3 (N > 500) and HIV viral load was undetectable. Today, his CD4+ T-lymphocyte count is 410/mm3 and his HIV viral load is 240 copies/mL. Further evaluation shows resistance to emtricitabine and tenofovir. Mutations in which of the following genes are most likely responsible for these findings?", "answer": "pol", "meta_info": "step1", "answer_idx": "B", "A": "tat", "B": "pol", "C": "rev", "D": "env", "language": "en"}
{"question": "A 61-year-old woman with a history of stage IV pancreatic cancer comes to the emergency department with insomnia due to intractable midepigastric pain. The pain had been constant for months but has worsened over the past few weeks despite the fact that she is already taking hydrocodone 10 mg and ibuprofen 400 mg. She has a past medical history of chronic pain and major depressive disorder. In the past month, she has been taking her pain medications with increasing frequency, going from twice a day to four times a day. Her other medications include venlafaxine and eszopiclone. She describes her mood as low, but states she does not have any suicidal thoughts. She appears fatigued and slightly cachectic. Her temperature is 36°C (96.8°F), pulse is 100/min, and blood pressure is 128/65 mm Hg. Physical examination shows a mass in the midepigastric region. Which of the following is the most appropriate next step in management?", "answer": "Switch from hydrocodone to hydromorphone", "meta_info": "step2&3", "answer_idx": "B", "A": "Discontinue hydrocodone and ibuprofen, and start IV ketorolac", "B": "Switch from hydrocodone to hydromorphone", "C": "Switch from eszopiclone to zolpidem", "D": "Allow the patient to take hydrocodone and ibuprofen up to every four hours\n\"", "language": "en"}
{"question": "Two days into hospitalization for pyelonephritis and sepsis, a 48-year-old woman develops severe sudden-onset dyspnea. She has no history of serious cardiopulmonary disease. She is fatigued and pale. Her blood pressure is 115/65 mm Hg, the pulse is 120/min, the respiratory rate is 36/min, and the temperature is 39.7°C (103.5°F). Her oxygen saturation is 80% on 60% FiO2. She has severe nasal flaring, supraclavicular and intercostal respiratory retractions, and paradoxical abdominal movements. Inspiratory crackles are heard over both lung fields. Cardiac examination shows no murmurs. A chest X-ray, taken before orotracheal intubation, is shown. Which of the following is the most appropriate next step in management?", "answer": "Low tidal volume ventilation", "meta_info": "step2&3", "answer_idx": "D", "A": "Broad-spectrum antibiotics", "B": "High-dose glucocorticoids", "C": "Intravenous fluids", "D": "Low tidal volume ventilation", "language": "en"}
{"question": "A 48-year-old man presents to the physician with a cough with expectoration and breathlessness on exertion for the last 4 years. There is no history of any other medical conditions. He has been a smoker for the last 10 years. He recently immigrated from a developing country and his immunization status is unknown. After a complete physical examination of the patient, the physician orders a chest radiogram which shows increased bronchovascular markings and flattening of the diaphragm. His spirometry findings include an FEV1 of 82% of predicted, which increases to 88% of predicted at 15 minutes after the administration of inhaled albuterol. The FEV1/FVC ratio is 0.66. The physician explains the diagnosis to the patient and emphasizes the importance of smoking cessation. He also offers him specific vaccinations. However, the patient mentions that he does not have medical insurance and due to his poor financial situation, he can afford only 1 of the suggested vaccines. In such a situation, which of the following vaccines should definitely be recommended to this patient?", "answer": "Influenza vaccine", "meta_info": "step2&3", "answer_idx": "C", "A": "23-valent pneumococcal polysaccharide vaccine", "B": "Haemophilus influenzae type b vaccine", "C": "Influenza vaccine", "D": "Pertussis vaccine", "language": "en"}
{"question": "A five-year-old female presents to the pediatrician for a well visit. The patient’s parents report that she recently entered kindergarten and her teacher expressed concern that the patient is not meeting developmental milestones. She struggles to name colors and has not expressed any interest in learning to read. The patient’s parents have also noticed that the patient is not completing tasks that her older siblings were doing by this age, including dressing herself independently and going to the bathroom by herself. The patient rolled over at 9 months, sat without support at 12 months, and walked at 20 months. Her parents also report that the patient is very social, and that adults frequently comment on her friendly personality. The patient is in the 15th percentile for weight and 5th percentile for height. On physical exam, the patient has a broad forehead, flat nasal bridge, long philtrum, and a wide mouth. She has a strabismus on neurological exam, and her cardiac exam is significant for a heart murmur. Laboratory testing is below:\n\nSerum:\nNa+: 145 mEq/L\nK+: 3.9 mEq/L\nCl-: 100 mEq/L\nHCO3-: 24 mEq/\nUrea nitrogen: 11 mg/dL\nGlucose: 76 mg/dL\nCreatinine: 0.9 mg/dL\nCa2+: 11.9 mg/dL\n\nWhich of the following cardiac abnormalities is associated with this condition?", "answer": "Supravalvular aortic stenosis", "meta_info": "step2&3", "answer_idx": "C", "A": "Bicuspid aortic valve", "B": "Coarctation of the aorta", "C": "Supravalvular aortic stenosis", "D": "Tetralogy of Fallot", "language": "en"}
{"question": "A 20-year-old male comes to the physician because of a 1-week-history of a painless ulceration on his penis. The patient is sexually active with multiple partners and does not use barrier protection. Physical examination shows a shallow, firm ulcer with a smooth base along the shaft of the penis and nontender bilateral inguinal adenopathy. Which of the following is most likely to confirm the diagnosis in this patient?", "answer": "Dark field microscopy", "meta_info": "step1", "answer_idx": "C", "A": "Tzanck preparation", "B": "Culture swab", "C": "Dark field microscopy", "D": "Serologic detection of antibodies", "language": "en"}
{"question": "A 31-year-old man presents to the clinic as a follow-up visit after recently being diagnosed with medullary thyroid cancer. Last year, he was diagnosed with a pheochromocytoma that was successfully resected. His family history is positive for medullary thyroid cancer in his father and paternal grandmother with a mucosal neuroma in his brother. What additional finding is most likely to be present in this patient on physical examination?", "answer": "Marfanoid habitus", "meta_info": "step2&3", "answer_idx": "D", "A": "Ash leaf spot", "B": "Pituitary adenoma", "C": "Neurofibromas", "D": "Marfanoid habitus", "language": "en"}
{"question": "Digestion begins in the mouth by breaking food up into smaller particles through mastication and mixing it with saliva containing amylase. Food then enters the stomach, where gastric acid and pepsin initiate protein digestion. The resulting chyme is then expelled into the duodenum where pancreatic enzymes, such as lipase and phospholipase-A2, digest lipids. These digested lipids are then ready for absorption across the gastrointestinal mucosa. Resection of which of the following segments of the gastrointestinal tract would prevent the absorption of these digested lipids?", "answer": "Jejunum", "meta_info": "step1", "answer_idx": "A", "A": "Jejunum", "B": "Ileum", "C": "Descending colon", "D": "Rectum", "language": "en"}
{"question": "A group of investigators is studying hemodynamic regulatory mechanisms in a human volunteer subject. The volunteer is administered a stimulant drug, and a sudden increase in blood pressure is observed. It is hypothesized that the increase in blood pressure causes stretching of the atria. Increased atrial stretch would most likely lead to which of the following changes?", "answer": "Decreased reabsorption of sodium", "meta_info": "step1", "answer_idx": "B", "A": "Vasodilation and decreased platelet aggregation", "B": "Decreased reabsorption of sodium", "C": "Increased reabsorption of solute-free water", "D": "Vasoconstriction and stimulation of thirst", "language": "en"}
{"question": "A 26-month-old boy is presented to the outpatient clinic by his parents complaining of a productive cough for the last 5 days. His mother reports a history of recurrent chest infections during the past year. He also has a history of chronic bloody diarrhea and pronounced bleeding after his circumcision. The vital signs are as follows: blood pressure 100/60 mm Hg, pulse 100/min, temperature 38.0°C (100.4°F), and respiratory rate 27/min. On examination, there are purpuric eruptions over the extremities as well as eczematous patches on the flexural surfaces of his elbows and knees. Chest auscultation reveals crepitus over the base of the right lung. Chest radiography is suggestive of consolidation in the right lower lobe. Blood test results show anemia, thrombocytopenia with small platelets, and leukopenia. With a suspicion of a congenital immunodeficiency, flow cytometry is ordered which reveals a Wiskott-Aldrich syndrome protein (WASP) mutation. Which of the following would be the definitive treatment of this patient’s condition?", "answer": "Early hematopoietic stem cell transplantation (HSCT)", "meta_info": "step1", "answer_idx": "A", "A": "Early hematopoietic stem cell transplantation (HSCT)", "B": "Intravenous immunoglobulin (IVIG)", "C": "Rituximab", "D": "Chemotherapy", "language": "en"}
{"question": "Four hours after undergoing an open emergency surgery under general anesthesia for a bleeding abdominal aortic aneurysm, a 55-year-old man is unable to move both his legs. During the surgery, he had prolonged hypotension, which was corrected with IV fluids and vasopressors. He has a history of hypertension and hyperlipidemia. He has smoked one pack of cigarettes daily for 35 years. Prior to admission, his medications were hydrochlorothiazide and atorvastatin. The patient is conscious and oriented to place and person. His temperature is 37.7°C (99°F), pulse is 74/min, and blood pressure is 100/70 mm Hg. Examination shows muscle strength of 1/5 in the lower extremities. Further evaluation of this patient is most likely to show which of the following?", "answer": "Normal proprioception in the extremities\n\"", "meta_info": "step2&3", "answer_idx": "D", "A": "Babinski's sign present bilaterally", "B": "Normal bulbocavernosus reflex", "C": "Bilaterally increased knee and ankle jerk", "D": "Normal proprioception in the extremities\n\"", "language": "en"}
{"question": "A 30-year-old woman seeks evaluation at a local walk-in clinic with a week-long history of lightheadedness and palpitations. She also complains of fatigability and shortness of breath of the same duration. The past medical history is significant for menarche at 9 years of age, heavy menstrual bleeding for the past several years and abdominal pain that worsens during menses. She stopped trying to conceive a child after 2 spontaneous abortions in the past 4 years and has been on iron oral supplementation for the last 2 years. She adds that she feels a dull pressure-like discomfort in her pelvis and constipation. The physical examination is significant for pale mucous membranes and a grade 2/6 ejection systolic murmur in the area of the pulmonic valve. Pelvic examination reveals an enlarged, mobile uterus with an irregular contour. The hemoglobin level is 10 g/dL and the hematocrit is 27%. Based on these findings, which of the following is the most likely diagnosis?", "answer": "Uterine leiomyoma", "meta_info": "step1", "answer_idx": "A", "A": "Uterine leiomyoma", "B": "Endometrial hyperplasia", "C": "Endometrial carcinoma", "D": "Endometrial polyp", "language": "en"}
{"question": "A study is conducted in a town with a population of 225,000, where the people are followed-up for the development of emphysema. A total of 1,000 smokers are selected and followed-up, out of which 200 actually develop the disease. A control group of 1,000 non-smokers is formed, out of which 20 develop emphysema. The prevalence of smoking in the general population is 40%. The researcher calculates all possible risk estimates, including the odds ratio. What percentage of the risk of developing emphysema can be attributed to smoking?", "answer": "18%", "meta_info": "step1", "answer_idx": "D", "A": "40%", "B": "20%", "C": "10%", "D": "18%", "language": "en"}
{"question": "A medical student is performing clinical research by analyzing the aggregated data of all patients from a national database. In performing the study, she uses all the data collected from patients who had an appendectomy and analyzes the risk factors that are associated with readmission after discharge. She first excludes some of the data based on previously determined exclusion criteria and then performs analysis on the rest. She performs a multiple regression on all variables and finds that one of the risk factors demonstrates a < 5% probability of being the same between groups. She takes this result and presents it to faculty; however, they respond that the finding is meaningless. Which of the following faults to this study most likely explains why the result was considered meaningless?", "answer": "Failure to consider clinical significance versus statistical significance", "meta_info": "step1", "answer_idx": "B", "A": "Data should not have been aggregated", "B": "Failure to consider clinical significance versus statistical significance", "C": "Single rather than multiple regression should have been performed", "D": "Usage of the wrong threshold for significance", "language": "en"}
{"question": "A 60-year-old man presents to the emergency department with ‘discomfort’ in his chest and a ‘squeezing’ sensation in his neck. The symptoms started 45 minutes ago while he was washing the dishes. He also complains of nausea. He has been a regular smoker for 45 years, averaging a pack of cigarettes each day. He also drinks heavily on weekends. His medical history is significant for a stroke 3 months ago, but the patient admits he has not been taking his medications. Vital signs show: pulse 62/min, respiratory rate 20/min, blood pressure 176/94 mm Hg, and temperature 36.9°C (98.4°F). Physical examination reveals a visibly distressed man who is sweating profusely. The chest is clear to auscultation and a 4th heart sound can be heard. Aspirin was administered upon arrival. His ECG is shown in the picture. Which of the following features is a contraindication for thrombolytic therapy in this patient?", "answer": "Stroke 3 months ago", "meta_info": "step2&3", "answer_idx": "D", "A": "Aspirin administration", "B": "Elevated blood pressure", "C": "History of smoking", "D": "Stroke 3 months ago", "language": "en"}
{"question": "A 3-year-old girl is brought by her parents to the office for bloody diarrhea and a seizure. The parents say she started having fever, abdominal pain, and diarrhea about 3 days ago, but the bloody diarrhea started 12 hours ago. The seizure was the last symptom to appear 3 hours ago, and it consisted of repetitive movement of arms and legs with loss of consciousness. Her 4-year-old brother had a similar case with bloody diarrhea 2 weeks ago. Her vital signs include: blood pressure is 130/85 mm Hg, her respiratory rate is 25/min, her heart rate is 120/min, and her temperature is 39.2°C (102.6°F). On physical examination, she looks pale and sleepy, the cardiopulmonary auscultation is normal, the abdomen is painful on palpation, and the skin assessment reveals the presence of disseminated pinpoint petechiae. The urinalysis show hematuria. The Coombs test is negative. The complete blood count results are as follows:\nHemoglobin 7 g/dL\nHematocrit 25 %\nLeukocyte count 17,000/mm3\nNeutrophils 70%\nBands 2%\nEosinophils 1%\nBasophils 0%\nLymphocytes 22%\nMonocytes 5%\nPlatelet count 7,000/mm3\nHer coagulation tests are as follows:\nPartial thromboplastin time (activated) 30 seconds\nProthrombin time 12 seconds\nReticulocyte count 1 %\nThrombin time < 2 seconds deviation from control\nWhat is the most likely diagnosis?", "answer": "Hemolytic-uremic syndrome", "meta_info": "step1", "answer_idx": "D", "A": "Disseminated intravascular coagulation", "B": "Henoch-Schonlein purpura", "C": "Systemic vasculitis", "D": "Hemolytic-uremic syndrome", "language": "en"}
{"question": "A 68-year-old woman presents to the emergency room with productive cough and fever. She has a chronic cough that has been getting progressively worse over the last 2 weeks. Last night she developed a fever and vomited. She smoked one pack of cigarettes per day for 40 years and recently quit. Her past medical history includes COPD and her medications include ipratropium and fluticasone. On physical exam her temperature is 102.2°F (39°C), blood pressure is 131/78 mmHg, pulse is 110/min, respirations are 22/min, and oxygen saturation is 95% on room air. She has decreased breath sounds bilaterally with diffuse crackles. You obtain a sputum sample and identify an organism that grows selectively on medium containing factors V and X. Which of the following organisms is the most likely cause of this patient's symptoms?", "answer": "Haemophilus influenzae", "meta_info": "step1", "answer_idx": "A", "A": "Haemophilus influenzae", "B": "Streptococcus pneumoniae", "C": "Mycoplasma pneumoniae", "D": "Fusobacterium species", "language": "en"}
{"question": "A 36-year-old man comes to the physician because of progressive fatigue and night sweats for 2 months. During this time, he has also had a 10-kg (22-lb) weight loss. Physical examination shows painless swelling of the cervical, axillary, and inguinal lymph nodes. Examination of the abdomen shows hepatosplenomegaly. Histologic examination of a lymph node biopsy specimen shows Reed-Sternberg cells. A diagnosis of Hodgkin lymphoma is made. The patient is started on a chemotherapeutic regimen that includes bleomycin. The mechanism of action of this drug is most similar to that of which of the following?", "answer": "Metronidazole", "meta_info": "step1", "answer_idx": "C", "A": "Trimethoprim", "B": "Sulfamethoxazole", "C": "Metronidazole", "D": "Chloramphenicol", "language": "en"}
{"question": "An 7-year-old girl is brought to the pediatrician by her concerned mother, because she is \"more physically matured\" than the rest of the girls in her class. On physical exam, she is noted to have breast development and pubic hair. On gonadotropin reseasing hormone (GnRH) stimulation, she has an increase in leutienizing hormone (LH) levels. Thyroid function tests and an MRI of the head are both within normal limits. Which of the following is the most appropriate treatment for this condition?", "answer": "Leuprolide", "meta_info": "step2&3", "answer_idx": "A", "A": "Leuprolide", "B": "Finasteride", "C": "Octreotide", "D": "Anastrozole", "language": "en"}
{"question": "A 45-year-old woman presents to the emergency department with hematemesis. Her son said that the patient had complained of gnawing abdominal pain that worsened before and improved after meals for the past 3 weeks. She frequently travels for work and is often stressed. She drinks alcohol socially and does not smoke tobacco or marijuana. She has not had anything to eat or drink for the past 24 hours due to the pain, but coughed up \"several cup of\" frank red blood before arrival. Her temperature is 98°F (37°C), blood pressure is 80/50 mmHg, pulse is 140/min, respirations are 23/min, and oxygen saturation is 96% on room air. Gastric ultrasound reveals high gastric residual volume. The patient is empirically started on 3 units of uncrossmatched O-negative blood transfusion and pantoprazole. The patient's initial laboratory data return in the meantime:\n\nHemoglobin: 5 g/dL\nHematocrit: 18 %\nLeukocyte count: 8,000/mm^3 with normal differential\nPlatelet count: 400,000/mm^3\n\nSerum:\nNa+: 140 mEq/L\nCl-: 115 mEq/L\nK+: 3.2 mEq/L\nHCO3-: 26 mEq/L\nBUN: 60 mg/dL\nGlucose: 104 mg/dL\nCreatinine: 1.1 mg/dL\n\nBlood type: AB\nRhesus status: negative\n\nAfter bedside esophageogastroduodenoscopy with stapling of several peptic ulcers, repeat labs are obtained in 2 hours. The patient now complains of feeling hot with intermittent shivering. She denies any other symptoms. Her temperature is 101°F (38.3°C), blood pressure is 100/55 mmHg, pulse is 100/min, respirations are 20/min, and oxygen saturation is 99% on room air. Her lungs are clear to auscultation bilaterally, and no accessory respiratory muscle use is observed. No rash is seen. What is the most likely diagnosis?", "answer": "Febrile nonhemolytic reaction", "meta_info": "step2&3", "answer_idx": "B", "A": "Febrile hemolytic reaction", "B": "Febrile nonhemolytic reaction", "C": "Transfusion related bacterial contamination", "D": "Transfusion related acute lung injury", "language": "en"}
{"question": "A 66-year-old man comes to the physician because of a 3-week history of shortness of breath with exertion. He has hypertension, hyperlipidemia, and type 2 diabetes mellitus. Current medications include aspirin, losartan, simvastatin, and insulin. His temperature is 37.1°C (98.8°F), pulse is 74/min, and blood pressure is 150/84 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 96%. Cardiac examination is shown. Further evaluation of this patient is most likely to show which of the following?", "answer": "Elevated serum brain natriuretic peptide levels", "meta_info": "step2&3", "answer_idx": "B", "A": "Earlier onset of abnormal cardiac sound with standing", "B": "Elevated serum brain natriuretic peptide levels", "C": "Left-to-right shunt through the atrial septum", "D": "Bounding pulses of peripheral arteries", "language": "en"}
{"question": "A 27-year-old gravida 2, para 2 woman presents to her OB/GYN’s office concerned that she may be pregnant. She and her husband use condoms for contraception. The night before, the condom broke during intercourse. She has 2 children under the age of 3 and does not want another child at this time. She says she cannot take “the pill” because she had a blood clot in her leg after her last cesarean section successfully treated with 6 months of anticoagulation. She smokes cigarettes and drinks alcohol regularly. Which of the following would be the most appropriate recommendation for this patient?", "answer": "Recommend copper IUD", "meta_info": "step2&3", "answer_idx": "D", "A": "Reassure her that she is likely not pregnant", "B": "Refer her to an abortion clinic", "C": "Recommend etonogestrel implant", "D": "Recommend copper IUD", "language": "en"}
{"question": "A 25-year-old Ashkenazi Jewish man presents to his primary care physician for a follow-up visit. One week ago, he presented with a chief complaint of priapism while engaging in intercourse with two of his partners. During that visit, it was determined that his blood pressure was 175/100 mmHg. He returns this week to have his vitals rechecked. His temperature is 99.5°F (37.5°C), pulse is 80/min, blood pressure is 182/100 mmHg, respirations are 10/min, and oxygen saturation is 98% on room air. Bloodwork is drawn and is shown below.\n\nSerum:\nNa+: 139 mEq/L\nK+: 3.7 mEq/L\nCl-: 100 mEq/L\nHCO3-: 28 mEq/L\nUrea nitrogen: 9 mg/dL\nGlucose: 122 mg/dL\nCreatinine: 1.0 mg/dL\nCa2+: 9.8 mg/dL\nMg2+: 1.7 mg/dL\n\nAfter a physical exam is performed, which of the following is the best initial step in management for this patient's underlying condition?", "answer": "Duplex ultrasound", "meta_info": "step2&3", "answer_idx": "D", "A": "Begin lifestyle modification and weight loss program", "B": "Begin lifestyle modification, weight loss program, and hydrochlorothiazide", "C": "24-hour urinary cortisol", "D": "Duplex ultrasound", "language": "en"}
{"question": "A 63-year-old man is brought to the emergency department after having 8–9 episodes of red watery stool. He has no abdominal pain or fever. He underwent an angioplasty 4 years ago and received 2 stents in his left main coronary artery. He has hypertension, hypercholesterolemia, coronary artery disease, and chronic constipation. Current medications include aspirin, metoprolol, and simvastatin. He drinks one beer daily. He is in distress. His temperature is 37.3°C (99.1°F), pulse is 110/min, respirations are 14/min, and blood pressure is 86/58 mm Hg. Examination shows pale conjunctivae. The abdomen is soft and nontender. Bowel sounds are increased. The lungs are clear to auscultation. Cardiac examination shows an S4 gallop. Rectal examination shows frank blood. Laboratory studies show:\nHemoglobin 9.8 g/dL\nLeukocyte count 7,800/mm3\nPlatelet count 280,000/mm3\nProthrombin time 14 seconds (INR=0.9)\nSerum\nNa+ 135 mEq/L\nK+ 4.1 mEq/L\nCl- 101 mEq/L\nUrea nitrogen 16 mg/dL\nGlucose 96 mg/dL\nCreatinine 0.7 mg/dL\nTwo large bore intravenous catheters are inserted and 0.9% saline infusions are administered. A nasogastric tube is inserted. Aspiration shows clear gastric content containing bile. Directly afterwards, his pulse is 133/min and blood pressure is 80/54 mm Hg. Which of the following is the most appropriate next step in management?\"", "answer": "Angiography", "meta_info": "step2&3", "answer_idx": "A", "A": "Angiography", "B": "Laparotomy", "C": "Esophagogastroduodenoscopy", "D": "Enteroscopy", "language": "en"}
{"question": "A 15-month-old boy with Down syndrome is brought to the physician for a well-child examination. The mother is concerned about giving the child any more vaccinations, as she reports he had a fever of 38.7°C (101.7°F) soon after his vaccinations at 12-months of age. He has had a runny nose for 2 days. He has a seizure disorder with a seizure lasting 1–2 minutes a few times a week that has not been controlled by medications. He was treated for intussusception at 6 months of age. His father was diagnosed with HIV 2 years ago. His medications include phenytoin, levetiracetam, and vitamin supplements. He is allergic to amoxicillin and has previously developed localized urticaria after consumption of eggs. His immunizations are up-to-date. Vital signs are within normal limits. Examination shows low-set ears, hypertelorism, and a flat head. The remainder of the examination shows no abnormalities. Which of the following is a relative contraindication for administering one or more routine vaccinations in this patient at this time?", "answer": "Uncontrolled seizure disorder\n\"", "meta_info": "step2&3", "answer_idx": "D", "A": "Egg protein allergy", "B": "Fever of 38.7°C (101.7°F) after previous vaccination", "C": "Current upper respiratory tract infection", "D": "Uncontrolled seizure disorder\n\"", "language": "en"}
{"question": "A 1-year-old boy is brought to his pediatrician’s office due to regression of development. She has observed that he is not progressing as he did during the 1st year of his life. There seems to be a regression in some behavioral and other milestones. She is also concerned about his facial development. On examination, the vital signs are normal. He has coarse facial features with a bulging frontal bone. Additionally, his lips are enlarged and corneal clouding is observed. Urine studies show an increase in dermatan sulfate. Which of the following genetic conditions is most likely related to these clinical features?", "answer": "Hurler syndrome", "meta_info": "step2&3", "answer_idx": "C", "A": "Morquio syndrome", "B": "Tay-Sachs disease", "C": "Hurler syndrome", "D": "Fabry disease", "language": "en"}
{"question": "A 6-year-old African American girl is brought to the physician by her mother because she has recently developed axillary and pubic hair. She also has multiple pustules on her forehead and has had oily skin for 3 months. Her mother reports that she recently bought some deodorant for the girl because of her body odor. Her mother has hypothyroidism. She is at the 95th percentile for height and the 99th percentile for weight and BMI. Her vital signs are within normal limits. She has no palpable glandular breast tissue. There is coarse hair under both axilla and sparse dark hair on the mons pubis and along the labia majora. Which of the following is the most likely explanation for this patient's examination findings?", "answer": "High levels of insulin", "meta_info": "step2&3", "answer_idx": "A", "A": "High levels of insulin", "B": "Adrenal enzyme deficiency", "C": "Pituitary tumor", "D": "Ovarian cyst", "language": "en"}
{"question": "A 45-year-old woman comes to the physician for a health maintenance examination. Her father has a history of type 2 diabetes mellitus. She has gained 18-kg (40-lb) since the birth of her son 6 years ago. Her BMI is 31 kg/m2. Physical examination shows hyperpigmented plaques in the axillae and posterior neck. Laboratory studies show a hemoglobin A1c of 6.4% and an elevated serum insulin level. Which of the following factors is most likely involved in the pathogenesis of this patient's condition?", "answer": "Increased levels of serum fatty acids", "meta_info": "step1", "answer_idx": "B", "A": "Increased serum levels of glucagon-like peptide-1", "B": "Increased levels of serum fatty acids", "C": "Decreased levels of serum cortisol", "D": "Positive HLA-DR4 serotype", "language": "en"}
{"question": "An 89-year-old woman presents with worsening dyspnea on exertion and generalized fatigue. She has fainted once. Exam reveals a crescendo-decrescendo systolic ejection murmur that radiates to the carotids. What pathological step preceded calcification in her condition?", "answer": "Cellular injury and necrosis", "meta_info": "step1", "answer_idx": "D", "A": "Commissural fibrosis", "B": "Congenital bicuspid valve", "C": "Fibrillin-1 deficiency", "D": "Cellular injury and necrosis", "language": "en"}
{"question": "A 22-year-old man presents to the emergency department for chest pain. He says that the chest pain began a few hours prior to presentation and is associated with nausea, abdominal discomfort, and sweating. He has experienced similar symptoms multiple times in the past, which brings him great concern because he believes he may be having a heart attack. This concern has persisted for 2 months. This has caused him to avoid taking long train rides or driving on divided highways. Approximately 7 months ago his parents divorced. Medical history is significant for obesity. He denies any medications or illicit drug use. Physical examination is unremarkable. An electrocardiogram demonstrates sinus tachycardia with a pulse of 110/min. Which of the following is most likely the diagnosis?", "answer": "Panic disorder", "meta_info": "step1", "answer_idx": "C", "A": "Adjustment disorder", "B": "Illness anxiety disorder", "C": "Panic disorder", "D": "Specific phobia", "language": "en"}
{"question": "An investigator is developing a new vaccine. Eukaryote ribosomes are utilized to create a novel protein. After the aminoacyl-tRNA binds to the A site, which of the following is the next step in protein formation?", "answer": "Catalysis of peptide bond", "meta_info": "step1", "answer_idx": "A", "A": "Catalysis of peptide bond", "B": "Recognition of UAG codon by release factor", "C": "Assembly of 40s subunit with tRNA", "D": "Advancement of ribosome in 3' direction", "language": "en"}
{"question": "A 70-year-old Caucasian woman presents with a 2-week history of blood-tinged sputum. Her past medical history is significant for peptic ulcer disease for which she underwent triple-drug therapy. She is a lifetime non-smoker and worked as a teacher before retiring at the age of 60 years. A review of systems is significant for a weight loss of 6.8 kg (15 lb) over the last 5 months. Her vitals include: blood pressure 135/85 mm Hg, temperature 37.7°C (99.9°F), pulse 95/min, and respiratory rate 18/min. Physical examination is unremarkable. A contrast CT scan of the chest shows an irregular mass in the peripheral region of the inferior lobe of the right lung. A CT-guided biopsy is performed and reveals malignant tissue architecture and gland formation with a significant amount of mucus. Which of the following is the most significant risk factor for this patient’s most likely diagnosis?", "answer": "Sex", "meta_info": "step1", "answer_idx": "D", "A": "Medications", "B": "Occupational history", "C": "Race", "D": "Sex", "language": "en"}
{"question": "Four days after admission to the hospital for community-acquired pneumonia, a 68-year-old woman has abdominal pain and multiple episodes of loose stools. They are watery, foul-smelling, and occasionally streaked with blood. She has approximately 6 episodes daily. She feels tired. She is currently being treated with intravenous ceftriaxone and oral azithromycin. She underwent a laparoscopic cholecystectomy 5 years ago. She returned from a trip to Bolivia 4 weeks ago. Her temperature is 37.5°C (99.5°F), pulse is 98/min, and blood pressure is 138/80 mm Hg. Bronchial breath sounds are heard over her right lung. Abdominal examination shows mild diffuse tenderness throughout the lower quadrants. The abdomen is not distended. The remainder of her examination shows no abnormalities. Her hemoglobin concentration is 12 g/dL, leukocyte count is 14,100/mm3, and erythrocyte sedimentation rate is 37 mm/h. Which of the following is the most appropriate next step in management?", "answer": "Enzyme immunoassay for glutamate dehydrogenase antigen", "meta_info": "step2&3", "answer_idx": "C", "A": "Stool for ova and parasites", "B": "Fecal lactoferrin", "C": "Enzyme immunoassay for glutamate dehydrogenase antigen", "D": "Stool acidity test", "language": "en"}
{"question": "An otherwise healthy 52-year-old man comes to the physician because of a 2-month history of palpitations. He says that he can feel his heart beat in his chest all the time. For the past 3 weeks, he has shortness of breath on exertion. He has not had chest pain, orthopnea, or nocturnal dyspnea. He emigrated from Nepal at the age of 25 years. He does not take any medications. His temperature is 36.5°C (97.7°F), pulse is 103/min, and blood pressure is 138/56 mm Hg. The lungs are clear to auscultation. Cardiac examination is shown. Which of the following is the most likely diagnosis?", "answer": "Aortic valve regurgitation", "meta_info": "step2&3", "answer_idx": "B", "A": "Pulmonary valve stenosis", "B": "Aortic valve regurgitation", "C": "Tricuspid valve regurgitation", "D": "Mitral valve prolapse", "language": "en"}
{"question": "A 55-year-old male presents to the emergency department after he was seen having a seizure. On presentation he is comatose and very jaundiced despite having no previous medical history and dies shortly thereafter. Over the next several hours 5 more patients present to the ER with severe diarrhea, abdominal pain, and bleeding abnormalities. They all recently returned from a several day camping trip where they slept in the woods and cooked with ingredients they were able to find in the wild. The original patient was also part of this camping trip. Postmortem analysis reveals massive hepatic necrosis. Which of the following activities was most likely inhibited by the cause of this patient's presentation?", "answer": "Transcription of mRNA", "meta_info": "step1", "answer_idx": "A", "A": "Transcription of mRNA", "B": "Transcription of rRNA", "C": "Transcription of tRNA", "D": "Translation of mRNA", "language": "en"}
{"question": "A 46-year-old woman is brought to the emergency department for respiratory depression. Routine urine toxicology screening is positive for alcohol, fentanyl, and benzodiazepines. Blood glucose is 80 mg/dL. Naloxone, flumazenil, and lactated Ringer's solution are administered intravenously. Two hours later, the woman has a tonic-clonic seizure lasting for one minute. Her pulse is 100/min, blood pressure is 145/90 mm Hg, and respiratory rate is 24/min. Pulse oximetry on room air shows an oxygen saturation of 98%. The patient appears drowsy and diaphoretic. She is not oriented to place or time but responds to her name. Examination shows a hematoma on her left temple. Neurological examination shows stiff extremities and a tremor in both hands. The remainder of the examination shows no abnormalities. Which of the following is the most likely cause of this patient's seizure?", "answer": "Benzodiazepine withdrawal", "meta_info": "step2&3", "answer_idx": "B", "A": "Hypoglycemia", "B": "Benzodiazepine withdrawal", "C": "Alcohol withdrawal", "D": "Subdural hemorrhage", "language": "en"}
{"question": "A 22-year-old man comes to the emergency department because of sudden onset of facial swelling, abdominal pain, and nausea 1 hour after eating some trail mix. He does not have shortness of breath or hoarseness. He has never had a similar episode before. He has asthma treated with an albuterol inhaler, which he uses less than once a month. His pulse is 90/min, respirations are 25/min, and blood pressure is 125/80 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 99%. Physical examination shows perioral swelling and scattered urticaria over the face and the fingers of his right hand. There is no swelling of the oropharynx and no audible stridor. The lungs are clear to auscultation bilaterally. Treatment with intravenous diphenhydramine is begun. Shortly after, the abdominal pain and nausea have resolved, the swelling has improved, and the rash has started to fade. Which of the following is the most appropriate next step in management?", "answer": "Prescribe epinephrine autoinjector", "meta_info": "step2&3", "answer_idx": "C", "A": "Recommend avoidance of peanuts", "B": "Perform patch test", "C": "Prescribe epinephrine autoinjector", "D": "Administer oral prednisone", "language": "en"}
{"question": "A 2-year-old boy is referred by his primary care physician to a geneticist because of prolonged and recurrent infections. Specifically, he has had an abnormally large number of upper respiratory and gastrointestinal infections over the last year. He was born with a defect in the cardiac septum that was repaired right after birth and has remained asymptomatic since then. On evaluation, the patient appears to have hyperactive reflexes and his arm twitches upon blood pressure measurement. The regions of this patient's lymph nodes that is likely abnormal also contains which of the following?", "answer": "High endothelial venules", "meta_info": "step1", "answer_idx": "B", "A": "Efferent sinuses", "B": "High endothelial venules", "C": "Plasma cell cords", "D": "Primary follicles", "language": "en"}
{"question": "A 45-year-old woman presents with a 2-year history of fatigue, paresthesia, diarrhea, and abdominal pain. She says she experiences 2–3 episodes of non-bloody diarrhea per month associated with crampy abdominal pain. She also has the bilateral tingling sensation of her upper and lower limbs in a glove and stocking pattern which is sometimes associated with the burning sensation of her hands and legs. Past medical history is unremarkable. The patient denies smoking, alcohol consumption, illicit drug use. Her vital signs include: blood pressure 100/60 mm Hg without postural changes, heart rate 92/min, respiratory rate 16/min, temperature 37.0℃ (98.6℉). Laboratory findings are significant for the following:\nHgb 7.2 gm/dL\nMCV 110 fL\nRBC 3.6 X109/L\nPlatelets 10,000/mm3\nTotal count  4,200/mm3\nReticulocyte 0.8%\nA peripheral blood smear demonstrates hypersegmented neutrophils. Anti-intrinsic factor and anti-tissue transglutaminase antibodies were negative. An upper GI series with small bowel follow-through is performed which shows a narrowing of the barium contrast in the lumen of the terminal ileum to the width of a string. Which of the following is the most likely diagnosis in this patient?", "answer": "Crohn's disease", "meta_info": "step2&3", "answer_idx": "B", "A": "Celiac disease", "B": "Crohn's disease", "C": "Bacterial overgrowth", "D": "Hypothyroidism", "language": "en"}
{"question": "A 15-month-old boy is brought to his pediatrician by his mother with a swollen and painful right elbow. She reports that he stumbled and fell on the carpeted floor of their living room, hitting his right elbow on the ground. The mother reports that he did not appear to be in a great deal of pain after the fall, and that she noted the swelling of the joint a few hours after the fall. He recently started walking approximately 2 weeks ago. He does not have any known medical issues, and he is not currently on medication. The mother's pregnancy was without complications and the boy was delivered vaginally without complications at 40 weeks. Aspiration of the right elbow joint reveals frank blood. Which of the following should be included in the work-up of this patient?", "answer": "Prothrombin time/partial thromboplastin time", "meta_info": "step2&3", "answer_idx": "C", "A": "Peripheral blood smear", "B": "Creatinine level and percutaneous kidney biopsy", "C": "Prothrombin time/partial thromboplastin time", "D": "24 hour urine collection for porphyrin levels", "language": "en"}
{"question": "A 45-year-old male comes into your office one week after he was tackled playing football with his friends. The patient states that the medial aspect of his knee collided with another player's knee. Since then, he has been taking ibuprofen for knee pain. On exam, the patient's right knee appears larger than his left knee with a small effusion. The patient has intact sensation and strength in both lower extremities. The patient's right knee has no laxity on valgus stress test, but is very lax on varus stress test. Lachman's test and posterior drawer test both have firm endpoints without laxity. McMurray's test is positive and the patient states he feels catching and locking during the test. Which of the following structures has this patient injured in addition to the meniscus?", "answer": "Lateral collateral ligament", "meta_info": "step2&3", "answer_idx": "D", "A": "Anterior cruciate ligament", "B": "Posterior cruciate ligament", "C": "Medial collateral ligament", "D": "Lateral collateral ligament", "language": "en"}
{"question": "A 19-month-old girl is brought for a well-child examination. She was born at term and has been healthy. On physical examination, the child is alert and active. Her temperature is 37.3 °C (99.1 °F), pulse is 102/min, respirations are 24/min, and blood pressure is 102/54 mm Hg. She is at the 75th percentile for height and 80th percentile for weight. Cardiac examination shows a normal S1 and a split S2 during inspiration. A grade 2/6 soft mid-systolic murmur is heard maximally at the lower left sternal border. A contrast echocardiogram is performed and reveals a mild transient right-to-left interatrial shunt that becomes apparent when the child coughs. Which of the following is the most appropriate next step in management?", "answer": "No intervention", "meta_info": "step2&3", "answer_idx": "A", "A": "No intervention", "B": "Aspirin therapy", "C": "Surgical closure", "D": "Regular echocardiographies", "language": "en"}
{"question": "A 6-year-old girl is brought to the emergency department because of right knee pain for the past 3 days. During this period, the girl has refused to walk. Her mother reports that her symptoms began after she fell down while playing. Three weeks ago, the patient had a sore throat and was treated with penicillin V. Her father has hemophilia A and has had repeated episodes of joint pain and swelling following minor injury. The patient's immunizations are up-to-date. Her temperature is 38.1°C (100.6°F), pulse is 120/min, and respirations are 21/min. The right knee joint is warm and erythematous. The girl starts to cry as soon as the physician tries to flex the knee joint. Further evaluation of this patient is likely to show which of the following findings?", "answer": "Gram-positive cocci in synovial fluid", "meta_info": "step2&3", "answer_idx": "A", "A": "Gram-positive cocci in synovial fluid", "B": "Prolonged prothrombin time", "C": "Increased antistreptolysin O titers", "D": "Rhomboid crystals in synovial fluid", "language": "en"}
{"question": "A 35-year-old man attempted to climb Mount Everest. At an altitude of 7,000 meters, he became short of breath and developed a dusky blue tinge around his face and lips. A physician in the climbing party performs a rudimentary physical exam which reveals a respiratory rate of 30/min, blood pressure of 130/90 mm Hg, heart rate of 108/min, and temperature of 36.4°C (97.5°F), with few basal crackles on the right side of chest. No jugular venous distension or dependent edema is noted. With this information, the mountain climber is sent down the mountain for further evaluation. Investigation reveals a normal chest X-ray with a normal heart size. What is the most likely cause of this patient’s condition?", "answer": "Hypoxemic hypoxia", "meta_info": "step1", "answer_idx": "D", "A": "Diffusion defect", "B": "Anemic hypoxia", "C": "Ischemic hypoxia", "D": "Hypoxemic hypoxia", "language": "en"}
{"question": "A 28-year-old man who was involved in a motorcycle accident presents to the nearest trauma center to get his wounds treated. After the initial evaluation and resuscitation by the emergency trauma team, a CT scan shows a skull base fracture. Which of the following clinical features can be seen as a long-term complication of posterior pituitary dysfunction?", "answer": "Polydipsia", "meta_info": "step1", "answer_idx": "C", "A": "Erectile dysfunction", "B": "Decreased lean body mass", "C": "Polydipsia", "D": "Cold intolerance", "language": "en"}
{"question": "A 19-year-old woman comes to the physician for a follow-up examination. She has a history of type 1 diabetes mellitus and is compliant with her medications. After reviewing the patient's recent blood sugar levels, the physician changes the patient's antidiabetic regimen by changing the dosage of an insulin that does not produce an observable peak in serum insulin concentration. The dosage of which of the following types of insulin was most likely changed in this patient's medication regimen?", "answer": "Insulin glargine", "meta_info": "step1", "answer_idx": "A", "A": "Insulin glargine", "B": "Insulin glulisine", "C": "Regular insulin", "D": "Insulin lispro", "language": "en"}
{"question": "A 31-year-old woman visits her local walk-in clinic for 2 days of dysuria, increased voiding frequency, urgency, and intense suprapubic pain. She just came back a day ago from a short honeymoon trip to Prague. On physical examination, the patient is found with exquisite suprapubic pain. Costovertebral tenderness is absent and pelvic examination is normal. Her vital signs are: temperature 36.5°C (97.7°F), heart rate 78/min, respiratory rate 15/min. Which of the following organisms would be most likely isolated in this patient?", "answer": "Staphylococcus saprophyticus", "meta_info": "step1", "answer_idx": "D", "A": "Streptococcus agalactiae", "B": "Enterococcus faecalis", "C": "Klebsiella pneumoniae", "D": "Staphylococcus saprophyticus", "language": "en"}
{"question": "A 14-year-old boy is brought to the physician by his mother because of a 1-week history of fever, fatigue, and throat pain. He appears lethargic. His temperature is 38.5°C (101.3°F). Physical examination shows bilateral cervical lymphadenopathy. Oral examination shows the findings in the photograph. A peripheral blood smear shows lymphocytosis with atypical lymphocytes. A heterophile antibody test is positive. Which of the following is the most appropriate recommendation by the physician?", "answer": "Avoid contact sports", "meta_info": "step1", "answer_idx": "C", "A": "Start antiretroviral therapy", "B": "Schedule bone marrow biopsy", "C": "Avoid contact sports", "D": "Avoid crowded places", "language": "en"}
{"question": "A 62-year-old carpenter presents to your clinic complaining of worsening joint pain in her hands. She states that the pain is present in all of her fingers, but is worse in the right hand and that it gets better when she has a few days off from work. She notes no paresthesias, fever, or fatigue. On examination, the patient is afebrile and all vital signs are stable. She has hard, non-tender lesions overlying the proximal interphalangeal joints of the 2nd and 3rd fingers on the right hand and all 5 digits on this hand have a decreased range of motion. An X-ray of her hands is shown. What is the most likely pathogenesis leading to the X-ray findings?", "answer": "Repetitive movement injury", "meta_info": "step1", "answer_idx": "A", "A": "Repetitive movement injury", "B": "Overgrowth of a gram-positive bacteria", "C": "Deposition of monosodium urate crystals", "D": "Production of rheumatoid factor and other autoantibodies", "language": "en"}
{"question": "A 7-year-old girl presents to the emergency department with a bloody nose that spontaneously started bleeding 20 minutes ago. On physical examination, she appears well and has no lymphadenopathy. Her heart has a regular rate and rhythm, her lungs are clear to auscultation bilaterally, and her abdomen is soft without hepatosplenomegaly, but she does have petechiae over her lower extremities. A complete blood count is obtained and reveals a leukocyte count of 11,300 cells/mcL, hemoglobin 12.1 g/dL, hematocrit 36%, and platelets 15,000/mcL. A peripheral smear shows a few morphologically normal platelets. Her mother reports that she had a viral infection 2 weeks ago but has been otherwise healthy. Which of the following is the next best step?", "answer": "Start intravenous immunoglobulin", "meta_info": "step2&3", "answer_idx": "A", "A": "Start intravenous immunoglobulin", "B": "Perform a splenectomy", "C": "Perform a bone marrow aspiration", "D": "Observation", "language": "en"}
{"question": "A 2-year-old boy is brought to the physician by his parents because their son frequently avoids eye contact and has no friends in daycare. He was born at term and has been healthy except for an episode of otitis media 6 months ago. His immunizations are up-to-date. He is at the 95th percentile for height, 20th percentile for weight, and 95th percentile for head circumference. Vital signs are within normal limits. Examination shows elongated facial features and large ears. The patient is shy and does not speak or follow instructions. He continually opens and closes his mother's purse and does not maintain eye contact. Which of the following is the most likely cause of this patient's presentation?", "answer": "CGG trinucleotide repeat expansion on X-chromosome", "meta_info": "step1", "answer_idx": "A", "A": "CGG trinucleotide repeat expansion on X-chromosome", "B": "Deletion of the long arm on chromosome 7", "C": "Genomic imprinting on chromosome 15", "D": "An additional X chromosome", "language": "en"}
{"question": "A 78-year-old man is admitted to hospital for treatment of a severe attack of pneumonia he has been experiencing for the past three days. A week earlier, he had been feeling well until he developed what he describes as a mild cold. Over the next few days, he began to have difficulty breathing and developed a productive cough and fever. As his condition worsened despite antibiotic therapy at home, he was admitted for intravenous antibiotics and observation. He has a 50-pack-year history of smoking and has been diagnosed with chronic obstructive pulmonary disease (COPD). Prior to admission, the man was taking inhaled formoterol, budesonide, and oxygen at home. He has been drinking 3 alcoholic drinks daily for the last 60 years and smoked marijuana during his 20s. His lab results from 1 week ago and from his day of admission to hospital are as follows:\n7 days ago\nOn admission to hospital\nSerum glucose (random)  130 mg/dL\nSerum electrolytes\nSodium 142 mEq/L\nPotassium 3.9 mEq/L\nChloride 101 mEq/L\nSerum creatinine 0.8 mg/dL\nBlood urea nitrogen 9 mg/dL\nCholesterol, total 170 mg/dL\nHDL-cholesterol 42 mg/dL\nLDL-cholesterol 110 mg/dL\nTriglycerides 130 mg/dL\nSerum glucose (random)  100 mg/dL\nSerum electrolytes\nSodium 140 mEq/L\nPotassium 4.0 mEq/L\nChloride 100 mEq/L\nSerum creatinine 0.9 mg/dL\nBlood urea nitrogen 11 mg/dL\nCholesterol, total 130 mg/dL\nHDL-cholesterol 30 mg/dL\nLDL-cholesterol 80 mg/dL\nTriglycerides 180 mg/dL\nWhat best explains the change in this patient’s lipid profile over this time period?", "answer": "Physiological response", "meta_info": "step1", "answer_idx": "C", "A": "COPD exacerbation", "B": "Drug side effect", "C": "Physiological response", "D": "Undiagnosed dyslipidemia", "language": "en"}
{"question": "A 42-year-old woman comes to the physician because of a 4-week history of progressive difficulty swallowing solid foods. The patient reports feeling like food gets stuck in her throat, and that she has to drink a lot of water to swallow her meals. Over the past 3 months, she has had progressive fatigue and occasional dyspnea while performing her daily activities. Her pulse is 104/min, respirations are 19/min, and blood pressure is 110/70 mm Hg. Physical examination shows conjunctival pallor, erythema around the corners of the mouth, and dry, scaly lips. Her fingernails appear spoon-shaped and brittle. Auscultation of the heart shows a grade 1/6 systolic murmur best heard at the second left intercostal space. Esophagogastroduodenoscopy shows thin membranes that are protruding into the upper third of the esophagus. Further evaluation of the patient is most likely to show which of the following?", "answer": "Craving for non-nutritive substances", "meta_info": "step1", "answer_idx": "D", "A": "Altered sense of smell", "B": "Intolerance to cold temperatures", "C": "Thickening of the skin", "D": "Craving for non-nutritive substances", "language": "en"}
{"question": "A 27-year-old nullipara makes an appointment with her gynecologist to discuss the results of her cervical cancer screening. She is not vaccinated against HPV and has a single sexual partner. She and her partner are planning pregnancy, so she recently discontinued oral contraception and began to take folate and iron supplements. She has no history of gynecologic diseases. Her first Pap smear showed atypical squamous cells of undetermined significance, but 2 subsequent Pap smears had normal results. The most recent Pap smear was reported as a high-grade squamous intraepithelial lesion. Colposcopy was performed at the next visit and a biopsy was obtained from a small patch of the acetowhite epithelium at the cervical transformation zone. The pathologic assessment shows CIN 3. Which of the following statements regarding the management of this patient is correct?", "answer": "Close follow-up with cytology and colposcopy may be considered in this patient.", "meta_info": "step2&3", "answer_idx": "B", "A": "The annual rate of progression of CIN 3 to cancer is > 10%, so the patient should be treated as soon as possible.", "B": "Close follow-up with cytology and colposcopy may be considered in this patient.", "C": "Additional HPV testing would be useful to guide the therapy.", "D": "Pregnancy is not recommended in women with high-grade cervical lesions, so treatment is reasonable.", "language": "en"}
{"question": "A 47-year-old woman comes to the physician because of a 3-month history of recurrent episodes of nausea and feeling like the room is spinning. Each episode lasts less than a minute and usually occurs when she gets out of bed in the morning or suddenly turns her head. She has not vomited and does not have headaches. She is asymptomatic between episodes. Which of the following findings most closely correlates with this patient's symptoms?", "answer": "Nystagmus", "meta_info": "step1", "answer_idx": "B", "A": "Intention tremor", "B": "Nystagmus", "C": "Abnormal Rinne test", "D": "Orthostatic hypotension", "language": "en"}
{"question": "A 56-year-old man is brought to the emergency department by his wife because of increasing confusion and lethargy for the past 12 hours. He is oriented only to person. His temperature is 37.3°C (99.1°F), pulse is 109/min, respirations are 18/min, and blood pressure is 108/67 mm Hg. Examination shows abdominal distention and several erythematous, lacy lesions on the chest that blanch with pressure. His hands make a flapping motion when they are dorsiflexed. Which of the following is the most likely precipitating factor for this patient's symptoms?", "answer": "Presence of hemoglobin in the intestine", "meta_info": "step1", "answer_idx": "C", "A": "Elevated systemic vascular resistance", "B": "Destruction of gut anaerobes", "C": "Presence of hemoglobin in the intestine", "D": "Low protein consumption", "language": "en"}
{"question": "A 63-year-old man comes to the physician because of a 4-hour history of severe pain in the right knee. His temperature is 38.0°C (100.1°F). Examination shows erythema, edema, and warmth of the right knee; range of motion is limited by pain. Arthrocentesis of the knee joint yields cloudy fluid with a leukocyte count of 24,000/mm3 (74% segmented neutrophils). Polarized light microscopy shows needle-shaped, negatively birefringent crystals. Five hours after treatment with a drug is begun, he develops abdominal cramp, diarrhea, and vomiting. The patient was most likely treated with a drug that predominantly acts on which of the following parts of the cell?", "answer": "Cytoskeleton", "meta_info": "step1", "answer_idx": "D", "A": "Cell wall", "B": "Cytosolic enzyme", "C": "Nucleus", "D": "Cytoskeleton", "language": "en"}
{"question": "A 1-year-old boy presents to the emergency department for several days of irritability and poor feeding. His parents are very concerned that he has been acting differently. The patient has an unremarkable past medical history and has been followed by a pediatrician. His temperature is 102°F (38.9°C), blood pressure is 57/38 mmHg, pulse is 170/min, respirations are 35/min, and oxygen saturation is 99% on room air. During the exam the infant is irritable and is crying. Musculoskeletal exam reveals that the patient's knee can not be extended while the patient's hip is in a flexed position without significant patient irritation. Fundoscopy is within normal limits. Abdominal, cardiac, and pulmonary exam are within normal limits. Which of the following is the next best step in management?", "answer": "Lumbar puncture", "meta_info": "step2&3", "answer_idx": "B", "A": "Blood and urine cultures", "B": "Lumbar puncture", "C": "Vancomycin and ceftriaxone", "D": "Vancomycin, ceftriaxone, and prednisone", "language": "en"}
{"question": "A 74-year-old man comes to the physician because of a 2-month history of shortness of breath and leg swelling. He has trouble climbing one flight of stairs due to dyspnea. He has hypertension and was diagnosed with multiple myeloma 6 months ago. Current medications include hydrochlorothiazide. Cardiopulmonary examination shows jugular venous distention, bibasilar crackles, and pitting edema in the lower extremities. Transthoracic echocardiography shows a thickened myocardium with elevated diastolic filling pressures. Which of the following is the most likely underlying mechanism of this patient's cardiomyopathy?", "answer": "Amyloid deposition", "meta_info": "step1", "answer_idx": "C", "A": "Chronic vasoconstriction", "B": "Myosin gene mutation", "C": "Amyloid deposition", "D": "Chronic hypercalcemia", "language": "en"}
{"question": "A 47-year-old man is brought to the emergency department 30 minutes after he was involved in a motor vehicle collision. On arrival, he is unconscious and unresponsive to painful stimuli. His pulse is 120/min, respirations are 10/min, and his blood pressure is 88/60 mm Hg. Infusion of 0.9% saline is begun, and intubation is attempted without success. Pulse oximetry on 20 L/min of oxygen via bag mask shows an oxygen saturation of 78%. The next appropriate step in the management of this patient involves passing a tube through an incision through which of the following structures?", "answer": "Investing layer of deep cervical fascia", "meta_info": "step1", "answer_idx": "A", "A": "Investing layer of deep cervical fascia", "B": "Annular ligament", "C": "Cricotracheal ligament", "D": "Prevertebral layer of deep cervical fascia", "language": "en"}
{"question": "Parents bring an 11-month-old baby to the clinic because the baby has a fever of 39.0°C (102.2°F). The baby is irritated and crying constantly. She is up to date on immunizations. A complete physical examination reveals no significant findings, and all laboratory tests are negative. Five days after resolution of her fever, she develops a transient maculopapular rash. What is the most likely diagnosis?", "answer": "Roseola", "meta_info": "step1", "answer_idx": "A", "A": "Roseola", "B": "Erythema infectiosum", "C": "Rubella", "D": "Kawasaki disease", "language": "en"}
{"question": "A 67-year-old man is brought to his primary care practitioner by his daughter who has noticed a ‘pill-rolling’ tremor in his right hand, along with a progressively slow, shuffling gait. The patient’s daughter says that these symptoms gradually started 2 weeks ago and have progressively worsened. His past medical history is significant for hypertension, which is well-controlled with losartan. He does not take any other medications. Physical examination reveals a slow shuffling gait, difficulty initiating movements, a resting tremor in his right hand that decreases in intensity with voluntary movement, and cogwheel-like rigidity in the right arm. The primary care practitioner decides to prescribe levodopa and carbidopa. Which of the following statements would best explain the mechanism of action of these drugs?", "answer": "Increased dopamine synthesis", "meta_info": "step1", "answer_idx": "D", "A": "Inhibition of the enzyme monoamine oxidase (MAO) B", "B": "Blockade of muscarinic receptors", "C": "Inhibition of dopamine reuptake", "D": "Increased dopamine synthesis", "language": "en"}
{"question": "A 79-year-old man with a long-standing history of hypertension and diabetes presents to the emergency department with sudden-onset of loss of motor function on the left side of his body. Neurologic exam shows normal sensation throughout the body. MRI of the brain is obtained and shows a small sub-cortical infarct involving a perforating vessel. Which of the following is the most likely underlying pathogenesis?", "answer": "Lipohyalinosis of small vessels", "meta_info": "step1", "answer_idx": "C", "A": "Embolism originating from the left atrium", "B": "Berry aneurysm", "C": "Lipohyalinosis of small vessels", "D": "Fibromuscular dysplasia", "language": "en"}
{"question": "A cardiology specialist working in the university hospital center noticed that a large number of his patients who had myocardial infarctions also had some sort of malignancy in their medical history. In order to determine whether a relationship existed between myocardial infarction and malignant processes, he decided to pursue a case-control study. His selected cases consisted of a sample of patients hospitalized in an internal ward with a history of a myocardial infarction, while control cases were patients on the same ward without a history of a myocardial infarction. Their charts and medical documentation were then reviewed for a history of any type of malignancy. The results of the study led the cardiologist to conclude that, for patients with malignancy, the odds of having a myocardial infarction were 3.2 times higher when compared to patients without malignancy. If the cardiologist was aware of Berkson’s bias (also known as the admission rate bias), he could minimize it by which of the following?", "answer": "Recruiting the controls from different wards to increase disease variability", "meta_info": "step1", "answer_idx": "C", "A": "Including the diagnoses negatively related to the risk factor being studied", "B": "Excluding controls that present a probability of hospital admission similar to cases", "C": "Recruiting the controls from different wards to increase disease variability", "D": "Excluding those patients with preferential recollection of exposures", "language": "en"}
{"question": "A 27-year-old woman presents to her primary care physician’s office with fatigue, headaches, and concentration difficulties. Her symptoms began approximately 7 months prior to presentation. Throughout this time, she reports problems with initiating and remaining asleep, has noticed periods of muscle soreness, and has feelings of restlessness. She states that she is very concerned about whether she will be able to pay her monthly expenses and if her parents are satisfied with her career choices. She is also worried about how her colleagues and supervisor think of her performance at work. She denies any significant past medical history besides occasional palpitations. She takes a daily multivitamin. Family history is significant for panic disorder in her mother. She currently lives alone and at times socializes with friends. She occasionally drinks alcohol during social gatherings, does not smoke, and denies any illicit drug use. Her temperature is 99°F (37.2 °C), blood pressure is 110/75, pulse is 101/min, and respirations are 18/min. Physical examination is unremarkable. Which of the following is the most appropriate pharmacologic treatment for this patient?", "answer": "Buspirone", "meta_info": "step2&3", "answer_idx": "A", "A": "Buspirone", "B": "Mirtazapine", "C": "Olanzapine", "D": "Trazodone", "language": "en"}
{"question": "A 73-year-old man comes in to the emergency department because of nausea and severe pain in his upper abdomen and right shoulder blade for the past day. He was able to eat a little for breakfast but vomited up the meal a couple of hours later. He has type 2 diabetes mellitus treated with metformin. He has smoked half a pack of cigarettes daily for 40 years and drinks 4 beers every week. He appears acutely distressed. His temperature is 38.8°C (102°F), pulse is 124/min, and blood pressure is 92/68 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 95%. The abdomen is soft and there is tenderness to palpation of the right upper quadrant with soft crepitus. The remainder of the examination shows no abnormalities. Laboratory studies show:\nHemoglobin 14.3 g/dL\nLeukocyte count 18,100/mm3\nPlatelet count 216,000/mm3\nSerum\nAspartate aminotransferase (AST, SGOT) 41 U/L\nAlanine aminotransferase (ALT, SGPT) 19 U/L\nAlkaline phosphatase 110 U/L\nTotal bilirubin 0.9 mg/dL\nDirect bilirubin 0.2 mg/dL\nAlbumin 4.1 g/dL\nUltrasonography of the right upper quadrant shows a gallbladder with an air-filled, thickened wall and no stones in the lumen. Which of the following is the most likely diagnosis?\"", "answer": "Emphysematous cholecystitis", "meta_info": "step2&3", "answer_idx": "B", "A": "Chronic pancreatitis with pseudocyst rupture", "B": "Emphysematous cholecystitis", "C": "Gallstone ileus", "D": "Primary sclerosing cholangitis", "language": "en"}
{"question": "A 26-year-old man presented with a headache and fatigue for the past few months. On presentation to the clinic, the blood pressure is 190/110 mm Hg; the femoral pulse is reduced compared to the radial pulse, and an ejection click is heard. There was no murmur. Which of the following is associated with his condition?", "answer": "Coarctation of the aorta", "meta_info": "step1", "answer_idx": "C", "A": "Ventricular septal defect (VSD)", "B": "Wolff-Parkinson-White syndrome", "C": "Coarctation of the aorta", "D": "Atrial septal defect (ASD)", "language": "en"}
{"question": "A 57-year-old man with a history of diabetes and stage 3 chronic kidney disease is admitted to the hospital for elective coronary angiography. The senior resident admitting the patient to the ward is concerned about his chronic renal impairment and the scheduled angiography, which will require the use of intravenous contrast. Which of the following strategies is most likely to decrease the likelihood that the procedure will exacerbate the patient’s renal failure?", "answer": "Use non-iodinated contrast medium", "meta_info": "step2&3", "answer_idx": "C", "A": "Intravenous mannitol before and during the procedure", "B": "Intravenous N-acetyl cysteine before and during the procedure", "C": "Use non-iodinated contrast medium", "D": "Forced diuresis with furosemide", "language": "en"}
{"question": "A 17-year-old girl is brought in a wheelchair because of gradually progressive difficulty in walking, incoordination, and frequent falls. Her symptoms started at 9 years old with clumsiness while walking. She later experienced difficulties with coordination, which later involved her arms and trunk. She was born at term with normal developmental milestones. The physical examination reveals severely ataxic gait, nystagmus, absent deep tendon reflexes, and loss of vibration and proprioception. Presuming it is an inherited condition, what is the most likely genetic pathophysiology of this disorder?", "answer": "GAA trinucleotide repeats", "meta_info": "step2&3", "answer_idx": "A", "A": "GAA trinucleotide repeats", "B": "Mitochondrial DNA mutation", "C": "NOTCH3 mutation", "D": "PMP22 gene duplication", "language": "en"}
{"question": "A previously healthy 51-year-old man is brought to the emergency department because of confusion for 2 hours. His wife reports that he fell and hit his head while changing a ceiling light the previous evening. On arrival, he is unconscious. His temperature is 37.1°C (98.8°F), pulse is 54/min, respirations are 8/min and irregular, and blood pressure is 198/106 mm Hg. The right pupil is dilated and fixed; the left pupil is round and reactive to light. There is extension of the extremities to painful stimuli. He is intubated and mechanically ventilated. A mannitol infusion is begun. A noncontrast CT scan of the brain shows herniation of the right medial temporal lobe. Which of the following is the most likely additional finding in this patient?", "answer": "Right-sided hemiplegia", "meta_info": "step1", "answer_idx": "A", "A": "Right-sided hemiplegia", "B": "Left-side facial nerve palsy", "C": "Bilateral spasticity", "D": "Multifocal myoclonus", "language": "en"}
{"question": "A 1-year-old female presents to the emergency department with 2 days of fever up to 103ºF. During the course of her work-up, a urine culture reveals gram negative rods and a urinary tract infection (UTI) is diagnosed. She is placed on ceftriaxone and quickly defervesces. Follow-up of the urine culture reveals the causal bacteria was E. coli, without any concerning resistance patterns and was susceptible to ceftriaxone. This is her first UTI and there is no family history of renal abnormalities or vesicourethral reflux. In addition to her current therapy, what additional steps should be taken during the management of this child's UTI?", "answer": "Renal bladder ultrasound", "meta_info": "step2&3", "answer_idx": "C", "A": "Prophylactic antibiotic therapy to prevent future UTIs", "B": "Voiding cystourethrogram", "C": "Renal bladder ultrasound", "D": "Repeat urine culture", "language": "en"}
{"question": "A 22-year-old woman presents to her primary care physician because she has been having severe pruritus on her left leg. She says the symptoms started 1 week ago after she went on a hiking trip with her friends. She wore shorts during the hike and felt as if something brushed her skin on the front of her leg just below the knee. She has no past medical history and no family history of autoimmune diseases. On physical exam, she has red pruritic papules and vesicles on her left leg. Which of the following mechanisms was most likely involved in the development of this patient's symptoms?", "answer": "Cytotoxicity due to T-cells", "meta_info": "step1", "answer_idx": "C", "A": "Activation of cell surface receptors by antibodies", "B": "Cross-linking of IgE antibodies", "C": "Cytotoxicity due to T-cells", "D": "Immune complex deposition", "language": "en"}
{"question": "An adopted 7-year-old boy is brought to a pediatrician with a history of progressive muscular weakness, intellectual impairment, and speech problems. The adoptive parents say that the patient was normal at birth, but as he grew older, his muscular weakness increased. Physical examination reveals the wasting of muscles of the dorsal forearm and the anterior compartment of the lower legs. Thenar and hypothenar eminences are also flattened. However, deep tendon reflexes are 2+ bilaterally. His face has an atypical appearance with thin cheeks and temporal wasting. When he was asked to make a tight fist and open his hands quickly, he could not open them immediately, and relaxation of the contracted muscles was very slow. The pediatrician suspects genetic muscular dystrophy. Which of the following is the trinucleotide repeat linked to this patient’s most likely condition?", "answer": "CTG", "meta_info": "step1", "answer_idx": "A", "A": "CTG", "B": "CGG", "C": "GAA", "D": "CGT", "language": "en"}
{"question": "A 36-year-old woman presents to her primary care physician for her yearly physical exam. She says that she has been experiencing some mild shortness of breath, but otherwise has no medical complaints. Her past medical history is significant for allergies and asthma as a child, but she is not currently taking any medications or supplements. She does not smoke and drinks about 2 glasses of wine per week as a social activity. On physical exam she is asked to take deep breaths during cardiac auscultation. The physician notices that the splitting of S2 decreases during inspiration. Which of the following is most consistent with this physical exam finding?", "answer": "Left bundle branch block", "meta_info": "step1", "answer_idx": "C", "A": "Asthma recurrence", "B": "Atrial septal defect", "C": "Left bundle branch block", "D": "Pulmonary stenosis", "language": "en"}
{"question": "A 47-year-old woman presents to the emergency department with calf pain and swelling that has persisted for the past 24 hours. She recently had an elective cholecystectomy performed 3 days ago that was complicated intraoperatively by bleeding requiring a transfusion of 1 unit of packed red blood cells. The patient is otherwise healthy, and her vitals are within normal limits. Physical exam is notable for an enlarged and tender right calf. Ultrasound with doppler reveals non-compressible veins of the affected leg. Which of the following is appropriate initial management of this patient?", "answer": "Heparin", "meta_info": "step2&3", "answer_idx": "B", "A": "CT angiogram of the chest", "B": "Heparin", "C": "Inferior vena cava filter", "D": "Warfarin", "language": "en"}
{"question": "A 24-year-old primigravida is admitted to the hospital at 36 weeks gestation with a headache and blurred vision. The vital signs are as follows: blood pressure, 170/95 mm Hg; heart rate, 88/min; respiratory rate, 15/min; and temperature, 36.6℃ (97.9℉). The physical examination is significant for pitting edema of the lower extremity. Meningeal signs are negative. The ophthalmoscopic exam shows vascular narrowing and a cotton-like fundal exudate. The dipstick test shows 1+ proteinuria. While the blood is being drawn, the patient has a generalized tonic-clonic seizure. Which of the following options describe the most likely mechanism underlying the patient’s seizure?", "answer": "Failure of cerebral vasoregulation", "meta_info": "step2&3", "answer_idx": "B", "A": "Increase in the extracellular sodium concentration", "B": "Failure of cerebral vasoregulation", "C": "Inhibition of brain GABA-signaling", "D": "Increased activation of NMDA receptors", "language": "en"}
{"question": "A 12-month-old girl is brought in by her mother to the pediatrician for the first time since her 6-month checkup. The mother states that her daughter had been doing fine, but the parents are now concerned that their daughter is still not able to stand up or speak. On exam, the patient has a temperature of 98.5°F (36.9°C), pulse is 96/min, respirations are 20/min, and blood pressure is 100/80 mmHg. The child appears to have difficulty supporting herself while sitting. The patient has no other abnormal physical findings. She plays by herself and is making babbling noises but does not respond to her own name. She appears to have some purposeless motions. A previous clinic note documents typical development at her 6-month visit and mentioned that the patient was sitting unsupported at that time. Which of the following is the most likely diagnosis?", "answer": "Rett syndrome", "meta_info": "step1", "answer_idx": "B", "A": "Language disorder", "B": "Rett syndrome", "C": "Fragile X syndrome", "D": "Trisomy 21", "language": "en"}
{"question": "A 55-year-old man comes to the emergency department because of cramps and left-sided flank pain, nausea, and urinary frequency for 3 hours. He has no history of serious illness and takes no medications. He drinks 2–3 alcoholic beverages daily. His temperature is 37.2°C (99.0°F), pulse is 107/min, and blood pressure is 145/80 mm Hg. Examination of the back shows left costovertebral angle tenderness. An x-ray of the abdomen shows no abnormalities. Abdominal ultrasound shows a 4-mm stone in the distal left ureter and a scatter of small stones in the left renal pelvis. Urinalysis shows RBCs and needle-shaped crystals, but no WBCs. Pain medication and intravenous fluids are administered. In addition to adequate hydration, the patient is most likely to benefit from which of the following?", "answer": "Potassium citrate", "meta_info": "step2&3", "answer_idx": "B", "A": "Probenecid", "B": "Potassium citrate", "C": "High-protein diet", "D": "Hydrochlorothiazide", "language": "en"}
{"question": "A 4-year-old boy is brought to the physician because of a 1-month history of generalized fatigue. During the past week, he has also had fever and severe leg pain that keeps him awake at night. Examination shows cervical and axillary lymphadenopathy. His liver is palpated 4 cm below the right costal margin and the spleen is palpated 3 cm below the left costal margin. His hemoglobin concentration is 10.2 g/dL, leukocyte count is 64,500/mm3, and platelet count is 29,000/mm3. A bone marrow aspirate predominantly shows immature cells that stain positive for CD10, CD19, and TdT. Which of the following is the most likely diagnosis?", "answer": "Acute lymphoblastic leukemia", "meta_info": "step1", "answer_idx": "C", "A": "Idiopathic thrombocytopenic purpura", "B": "Acute myeloid leukemia", "C": "Acute lymphoblastic leukemia", "D": "Hodgkin lymphoma", "language": "en"}
{"question": "A 41-year-old man comes to the physician because of a 10-day history of generalized weakness. He has also had headaches and night sweats and is a known user of illicit intravenous drugs. His temperature is 39.1°C (102.4°F), pulse is 110/min, respirations are 17/min, and blood pressure is 127/78 mm Hg. There are several track marks on his forearms. A holosystolic murmur that increases on inspiration is heard along the left sternal border. Laboratory studies show a leukocyte count of 13,900/mm3 and an erythrocyte sedimentation rate of 58 mm/h. Which of the following is the most likely consequence of this patient's condition?", "answer": "Pulmonary embolism", "meta_info": "step1", "answer_idx": "C", "A": "Hematuria", "B": "Rupture of nail-bed capillaries", "C": "Pulmonary embolism", "D": "Painful nodules on pads of the fingers", "language": "en"}
{"question": "A 17-year-old girl presents to the emergency department with a painful rash on her head. She says that she started noticing a rash 2 weeks ago that has gotten worse over time. In addition, she says that she has been very thirsty over the same time period and often needs to urgently use the restroom during the day, which has been disrupting her ability to pay attention in school. Otherwise she says that she has some headaches, but attributes this to migraines that run in her family. She does not take any medications, doesn't smoke, and drinks socially with her friends. On physical exam, a disfiguring red scalp rash is observed and radiographs reveal lytic appearing skull lesions. Further examination and testing would most likely reveal which of the following findings in this patient?", "answer": "Granules with tennis racket shape on electron microscopy", "meta_info": "step1", "answer_idx": "B", "A": "Anti-nuclear antibodies on serology", "B": "Granules with tennis racket shape on electron microscopy", "C": "HLA-B27 gene variant on genetic testing", "D": "Noncaseating granulomas with multinucleated giant cells on histology", "language": "en"}
{"question": "A 57-year-old man presents to the emergency department with a change in his mental status. His wife noticed he was particularly somnolent this evening which prompted her to bring him in. The patient has a past medical history of congestive heart failure, diabetes, and hypertension. His temperature is 99.5°F (37.5°C), blood pressure is 97/58 mmHg, pulse is 40/min, respirations are 17/min, and oxygen saturation is 95% on room air. A fingerstick blood glucose is notable for a value of 47 mg/dL. Which of the following is the best treatment for this patient?", "answer": "Glucagon", "meta_info": "step2&3", "answer_idx": "C", "A": "Calcium chloride", "B": "Dextrose", "C": "Glucagon", "D": "Transcutaneous pacing", "language": "en"}
{"question": "A 16-year-old boy comes to his primary care clinic for a sports physical. He states that he wants to try out for his high school’s football team this year. He's \"trying to get in better shape.” The patient has no complaints except for occasional headaches when he is stressed about exams. The patient also mentions that he is embarrassed of his “small penis” and asks if there is something he can take for that. The patient’s temperature is 98°F (36.7°C), blood pressure is 118/76 mmHg, and pulse is 79/min. On physical examination, the patient is obese and has no visible facial hair. His testes are less than 20 mL in volume, and his phallus measures less than 8 cm. Initial labs show testosterone levels of 95 ng/dL and a low follicle stimulating hormone/luteinizing hormone ratio. Which of the following is the next best diagnostic step?", "answer": "Thyroid-stimulating hormone and prolactin levels", "meta_info": "step2&3", "answer_idx": "D", "A": "Adrenocorticotrophic hormone stimulation test", "B": "Semen analysis", "C": "Spectral karyotype", "D": "Thyroid-stimulating hormone and prolactin levels", "language": "en"}
{"question": "A 72-year-old man presents to the hospital with retrosternal chest pain and shortness of breath. The pain started 5 hours prior to arrival and has not changed after sublingual nitroglycerin intake. The patient has a history of long-standing persistent atrial fibrillation but had not been taking anticoagulants at the time of presentation. He had also been diagnosed with iron-deficiency anemia 3 months before admission and is taking 120 mg of elemental iron daily. He has no history of ischemic heart disease. Clinical investigation confirms inferior ST-elevation myocardial infarction with occlusion of the right coronary artery. The patient is managed with percutaneous coronary intervention (PCI). Six hours after the PCI, the patient develops cardiogenic shock; 8 hours after presentation, he dies, despite intensive care management. The autopsy reveals widespread inferior-posterior myocardial infarction and thrombotic occlusion of the left circumflex artery. The microscopic image depicts a macroscopically intact myocardium. Which of the following statements regarding this patient’s myocardial tissue is true?", "answer": "This slide shows changes in the myocardial tissue that result from lipid peroxidation during the patient's lifetime.", "meta_info": "step1", "answer_idx": "A", "A": "This slide shows changes in the myocardial tissue that result from lipid peroxidation during the patient's lifetime.", "B": "The changes shown on this slide are a result of iron overload.", "C": "The slide shows cardiac steatosis.", "D": "The microscopic image reveals cardiac tissue hypertrophy.", "language": "en"}
{"question": "A 3-year-old boy is brought in by his parents for placement of a tracheostomy tube in order to allow for better ventilator support of his breathing. At birth, he was flaccid with a poor sucking reflex. Since then, his weakness has progressively worsened such that he is unable to sit, eat, or breathe independently. Family history reveals that his grandfather was affected by a degenerative disorder at age 50, and his father had the same degenerative disorder at age 30. Examination is significant for tongue fasciculations and absent deep tendon reflexes. Which of the following forms of inheritance is associated with the most likely cause of this patient's disorder?", "answer": "Autosomal recessive on chromosome 5", "meta_info": "step1", "answer_idx": "B", "A": "Autosomal dominant on chromosome 19", "B": "Autosomal recessive on chromosome 5", "C": "Autosomal recessive on chromosome 9", "D": "X-linked dominant", "language": "en"}
{"question": "A 73-year-old man is brought to the emergency department 30 minutes after the sudden onset of right-sided body weakness. His wife reports that he does not seem to understand simple questions. He has type 2 diabetes mellitus and has smoked 1 pack of cigarettes daily for 45 years. The patient speaks fluently, but he answers questions with nonsensical phrases and cannot repeat single words. Which of the following is the most likely diagnosis?", "answer": "Wernicke aphasia", "meta_info": "step1", "answer_idx": "C", "A": "Conduction aphasia", "B": "Global aphasia", "C": "Wernicke aphasia", "D": "Transcortical sensory aphasia", "language": "en"}
{"question": "A 23-year-old woman comes to physician for an annual health maintenance examination. She feels well. She is 155 cm (5 ft 1 in) tall and weighs 79 kg (174 lb); BMI is 33 kg/m2. Examination shows a skin rash over both axillae. A photograph of her left axilla is shown. This patient's skin finding is most likely associated with which of the following conditions?", "answer": "Polycystic ovarian syndrome", "meta_info": "step1", "answer_idx": "C", "A": "Niacin deficiency", "B": "Primary adrenal insufficiency", "C": "Polycystic ovarian syndrome", "D": "Hashimoto thyroiditis", "language": "en"}
{"question": "A 72-year-old female is brought in by ambulance after being found down in her home. Her daughter discovered her after returning from work and does not know how long she has been down. Physical exam reveals right sided paralysis with a positive babinski sign. She is also found to produce strained stuttering speech with no perceivable meaning. She is unable to follow any instructions and cannot repeat speech. An MRI is obtained showing a left MCA infarct. Damage to which of the following structures is most likely to be responsible for her language deficits?", "answer": "Arcuate fasciculus + Inferior frontal gyrus + superior temporal gyrus", "meta_info": "step1", "answer_idx": "D", "A": "Arcuate fasciculus", "B": "Inferior frontal gyrus", "C": "Inferior frontal gyrus + superior temporal gyrus", "D": "Arcuate fasciculus + Inferior frontal gyrus + superior temporal gyrus", "language": "en"}
{"question": "A 66-year-old male with a history of diabetes and knee osteoarthritis presents to his primary care provider in July complaining of headaches and blurry vision. He reports a 6-month history of occasional dull diffuse headaches and blurry vision. He notes that the episodes have increased in severity since the weather got warmer and that he occasionally feels extremely itchy when he spends time outdoors. The patient lives in southern Arizona. Moreover, he has felt chronically fatigued and has lost 10 pounds without dieting or changing his appetite. He currently takes metformin and his most recent hemoglobin A1c was 6.5%. Physical examination reveals multiple bruises on the bilateral upper and lower extremities and hepatosplenomegaly. Fundoscopic examination demonstrates enlarged retinal veins. Multiple laboratory tests are pending. At steady state, which of the following sets of findings is most likely in this patient?", "answer": "Increased plasma volume, increased RBC mass, decreased EPO, normal SaO2", "meta_info": "step1", "answer_idx": "A", "A": "Increased plasma volume, increased RBC mass, decreased EPO, normal SaO2", "B": "Normal plasma volume, increased RBC mass, increased EPO, normal SaO2", "C": "Decreased plasma volume, normal RBC mass, normal EPO, normal SaO2", "D": "Increased plasma volume, decreased RBC mass, decreased EPO, normal SaO2", "language": "en"}
{"question": "A 25-year-old woman is brought to the emergency department for the evaluation of severe abdominal pain for the last hour. Abdominal ultrasound shows a non-compressible and enlarged appendix. The patient is diagnosed with acute appendicitis. While obtaining informed consent from the patient for appendectomy, the patient reports that she does not want to undergo surgery because she does not trust doctors. She states that all doctors are “bad” and all they think about is money. She adds that she thinks that nurses are “angels” and that they should take care of her instead of the “arrogant” doctors. This patient's behavior is characteristic of a condition that is most typically associated with which of the following?", "answer": "Self-injurious behavior", "meta_info": "step2&3", "answer_idx": "D", "A": "Repeated performance of certain routines", "B": "Substance use disorder", "C": "Fear of social situations", "D": "Self-injurious behavior", "language": "en"}
{"question": "A 20-year-old woman presents with persistent sadness for the last 2 months. She says that she is always feeling tired and nothing seems to cheer her up. Although previously a top student at her college, she did not register for classes this term, because she does not feel like going to school anymore. She says her friends complain that she does not want to ‘hang out’ with them anymore. She is sleeping more than usual and often does not want to leave the bed in the morning. The patient denies any suicidal ideation or preoccupation with death. Her past medical history is unremarkable. She currently takes a daily multivitamin. The vital signs include pulse 64/min, respiratory rate 12/min, blood pressure 110/70 mm Hg, and temperature 36.9°C (98.5°F). Her body mass index (BMI) is 17.5 kg/m2. On physical examination, the patient is pale. Mucous membranes and oral cavity are dry with poor dentition. Multiple calluses are present on the knuckles of her left hand. Which of the following medications is the best course of treatment in this patient?", "answer": "Mirtazapine", "meta_info": "step1", "answer_idx": "A", "A": "Mirtazapine", "B": "Lorazepam", "C": "Bupropion", "D": "Amitriptyline", "language": "en"}
{"question": "A 31-year-old man presents to the clinic with complaints of sudden onset of fever, headache, chills, and a painful “bump” in his right groin. He recently spent three months working as a park ranger in New Mexico. His physical exam is notable for an enlarged lymph node in the inguinal region that is extremely tender to palpation. The patient is promptly treated with antibiotics, and his case is reported to the Centers for Disease Control and Prevention. Which of the following was the most likely vector that transmitted the disease to this for patient?", "answer": "Flea", "meta_info": "step1", "answer_idx": "B", "A": "Armadillo", "B": "Flea", "C": "Rat", "D": "Tick", "language": "en"}
{"question": "As the only full-time inpatient endocrinologist at your hospital, you have been tasked with deciding which blood glucose measuring device to use on the wards. A medical device representative presents you with the data in Image A. All readings were performed on the same individual whose blood glucose was known to be 125 mg/dL at the time. Which of the devices has the best precision?", "answer": "Device D", "meta_info": "step1", "answer_idx": "C", "A": "Device B", "B": "Device C", "C": "Device D", "D": "Not enough information provided", "language": "en"}
{"question": "A 21-year-old male comes to the physician’s office with complaints of fatigue. The patient is a college intramural athlete and has noticed that during hard workouts with his team, he gets severe muscle pain and weakness to the point where he has to stop and rest. Usually he is able to recover and the cramps subside after rest. After strenuous workouts he has also noticed that his urine is dark. On exam, the patient has no acute symptoms and appears to be sitting comfortably with a completely normal exam. The patient does not have any tenderness to palpation of his muscles. Which of the following enzymes is most likely defective in this patient?", "answer": "Glycogen phosphorylase", "meta_info": "step1", "answer_idx": "C", "A": "Glucose-6-phosphatase", "B": "Debranching enzyme", "C": "Glycogen phosphorylase", "D": "Acid maltase", "language": "en"}
{"question": "A 78-year-old man comes to the physician because of a 3-week history of dyspnea, chest pain, dry cough, painful swallowing, and a feeling of fullness in his head. The symptoms were initially mild but have progressively worsened. He has a history of gastroesophageal reflux disease treated with esomeprazole. He does not smoke cigarettes. His pulse is 99/min and blood pressure is 95/66 mm Hg. Examination shows swelling and redness of the face and neck. There is distention of the superficial veins of his neck and upper thorax. Plain radiographs of the chest show a widened mediastinum and unremarkable lung fields. Which of the following is the most likely underlying cause of this patient's symptoms?", "answer": "Mediastinal lymphoma", "meta_info": "step1", "answer_idx": "D", "A": "Pancoast tumor", "B": "Constrictive pericarditis", "C": "Descending aortic aneurysm", "D": "Mediastinal lymphoma", "language": "en"}
{"question": "A 52-year-old man is brought to the emergency department 30 minutes after his farmhand found him on the ground sweating profusely. On arrival, he is lethargic and unable to provide any history. His temperature is 37.5°C (99.5°F), pulse is 42/min, and blood pressure is 95/60 mm Hg. Physical examination shows diaphoresis and excessive salivation. The pupils are constricted. There is scattered expiratory wheezing throughout both lung fields. His clothes are soaked with vomit, urine, and feces. A drug with which of the following mechanisms of action is most appropriate for this patient?", "answer": "Muscarinic acetylcholine receptor antagonism", "meta_info": "step1", "answer_idx": "C", "A": "Non-selective α adrenergic receptor antagonism", "B": "β2 adrenergic receptor agonism", "C": "Muscarinic acetylcholine receptor antagonism", "D": "Nicotinic acetylcholine receptor agonism", "language": "en"}
{"question": "A 40-year-old woman is admitted to the hospital about four hours after her husband discovered that she ingested a bottle of acetaminophen in an attempted suicide. The patient denies any symptoms at this time. Vital signs include a blood pressure of 115/80 mmHg and pulse of 85/min. Physical exam is unremarkable. AST and ALT levels are approximately 2500 U/L. APAP level is 160 mcg/mL, and INR is 1.7. The patient refuses N-acetyl-cysteine (NAC) treatment. What is the best next step in management?", "answer": "Involve the patient's husband to guide medical care", "meta_info": "step1", "answer_idx": "C", "A": "Administer NAC", "B": "Cancel the NAC order", "C": "Involve the patient's husband to guide medical care", "D": "Force the patient to accept NAC", "language": "en"}
{"question": "An 11-month-old baby boy is brought to the emergency room by his parents for vomiting. His mom reports that he has had a cold for the past week with a runny nose and low-grade fevers. However, his condition worsened today when he began coughing and struggling to breathe. During one of his coughing spells he threw up his milk as well. The parents deny any sick contacts, changes in diet, or bowel changes but endorse fatigue and decreased appetite. A physical examination demonstrates a healthy-looking baby with an intense cough and significant inspiratory stridor. What is the pathophysiology of this patient’s condition?", "answer": "Toxin that inactivates Gi protein", "meta_info": "step1", "answer_idx": "C", "A": "Generation of reactive oxygen species", "B": "Production of IgA proteases", "C": "Toxin that inactivates Gi protein", "D": "Toxin that permanently activates Gs protein", "language": "en"}
{"question": "A 56-year-old male undergoes a pancreaticoduodenectomy for resection of a tumor of the head of the pancreas. His medical history is otherwise insignificant except for a series of minor respiratory and gastrointestinal infections since childhood that were effectively treated with antibiotics. Before today, he has not had any prior surgeries or required a blood transfusion. In the post anesthesia care unit, his hemoglobin is measured and found to be 5.2 g/dL. A transfusion of 2 units of packed red blood cells is ordered. Minutes after the transfusion is initiated, the patient reports severe itching, nausea, and shortness of breath. His vital signs show a drop in blood pressure from 138/88 to 92/47 and an increase in heart rate from 94 to 118. The patient's nurse stops the transfusion immediately. Which of the following underlying conditions most likely predisposed this patient to develop this reaction?", "answer": "Selective IgA deficiency", "meta_info": "step1", "answer_idx": "D", "A": "Severe combined immunodeficiency disorder", "B": "Bruton's agammaglobulilnemia", "C": "Wiskott-Aldrich syndrome", "D": "Selective IgA deficiency", "language": "en"}
{"question": "A 5-year-old girl is brought to the emergency department after sustaining an atraumatic tibial fracture while playing with her friends. This patient has a history of fractures in her upper and lower extremities. Children's services have investigated the family several times in the past and found no abuse. She was born at 39 weeks gestation via spontaneous vaginal delivery which resulted in several mild fractures. She is up to date on all vaccines and is meeting all developmental milestones. The mother has a brother with a similar history that is still living. Her vital signs show a heart rate of 90/min, respiratory rate of 22/min, blood pressure of 110/65 mm Hg, and temperature of 37.0°C (98.6°F). Physical exam reveals a regular heart rate, and her lungs are clear to auscultation bilaterally. The sclera of both eyes are blue. Additionally, her teeth are brown and distorted. Her leg is swollen, erythematous, and tender to palpation. An X-ray reveals a tibia fracture, while multiple fractures at various stages of healing are also seen on her arms. The physician suspects this is a genetic condition. Which of the inheritance patterns can be attributed to the girl’s condition?", "answer": "Locus heterogeneity", "meta_info": "step1", "answer_idx": "C", "A": "Pleiotropy", "B": "Anticipation", "C": "Locus heterogeneity", "D": "De novo mutation", "language": "en"}
{"question": "A 72-year-old woman presents to her primary care physician because she is coughing pink sputum and has difficulty breathing. She says that she was feeling pretty good until she traveled to her grandson's wedding last week. Since then she has had increasing difficulty sleeping and walking due to her shortness of breath. Physical exam reveals swollen ankles, basilar crackles bilaterally, and a murmur best heard in the left lateral decubitus position. She is already taking several medications for this condition; however, given the recent worsening of symptoms she is started on an additional medication. Which of the following is the most likely mechanism of action for the medication that was started in this patient?", "answer": "Inhibition of Na-K-Cl cotransporter", "meta_info": "step1", "answer_idx": "D", "A": "Competitive inhibition of hormonal signaling", "B": "Decrease in adenylyl cyclase activity", "C": "Inhibition of Na-Cl symporter", "D": "Inhibition of Na-K-Cl cotransporter", "language": "en"}
{"question": "A 37-year-old woman is brought to the emergency department for acute abdominal pain for the past 2 hours. She reports that the pain is constant, 10/10, and is diffusely spread across her stomach. She reports nausea and 1 episode of vomiting 1 hour ago, painless bloody urine, and paresthesias in her hands bilaterally. The patient claims similar episodes in the past following the use of alcohol, though with milder pain. Her past medical history is significant for pelvic inflammatory disease that was adequately treated 5 years ago. She is currently sexually active with her husband without contraceptive use. Her temperature is 98.6°F (37°C), blood pressure is 148/98 mmHg, pulse is 103/min, respirations are 18/min, and oxygen saturation is 99% on room air. A physical examination demonstrates a patient in acute distress with diffuse abdominal tenderness and decreased sensation of the hands bilaterally. What is the most likely explanation for this patient’s symptoms?", "answer": "Mutation of the porphobilinogen deaminase enzyme", "meta_info": "step1", "answer_idx": "C", "A": "Implantation of the embryo outside of the uterus", "B": "Inflammation of the appendix", "C": "Mutation of the porphobilinogen deaminase enzyme", "D": "Obstruction of the cystic duct and subsequent inflammation of the gallbladder", "language": "en"}
{"question": "A medical research study is being conducted to evaluate the specificity of a novel blood test for rheumatoid arthritis. Of the 300 patients enrolled, half are diagnosed with RA. The remaining patients are age-matched controls. In the subgroup of patients with RA, 125 are found positive for the novel blood test. In the control group, 45 are found positive. Which of the following represents the overall specificity of this novel test?", "answer": "105 / (105 + 45)", "meta_info": "step2&3", "answer_idx": "C", "A": "105 / (105 + 25)", "B": "125 / (125 + 105)", "C": "105 / (105 + 45)", "D": "125 / (125 + 25)", "language": "en"}
{"question": "A 58-year-old man comes to the emergency department because of multiple episodes of coughing up blood over the past 2 hours. He says that he has coughed up approximately half a cup of bright-red blood each time. He has had progressively worsening shortness of breath on exertion and a productive cough with occasionally blood-tinged sputum for the past 6 months. He has a history of hypertension and chronic obstructive pulmonary disease. He has worked in a car manufacturing company for over 20 years. He drinks 2 to 3 beers every evening. He has smoked 1 pack of cigarettes daily for the past 30 years. His medications include amlodipine, tiotropium, and an albuterol inhaler as needed. His temperature is 37.2 °C (99.0 °F), blood pressure is 102/68 mm Hg, pulse is 108/min, and respirations are 22/min. Pulse oximetry on room air shows an oxygen saturation of 89%. He appears anxious and cachectic. Examination of the lung shows decreased breath sounds bilaterally. There is no cervical or axillary lymphadenopathy. His hemoglobin is 11.5 g/dL, leukocyte count is 8,800/mm3, and a platelet count is 160,000/mm3. His coagulation parameters are within normal limits. Serum studies and urine analysis show no abnormalities. He is intubated and mechanically ventilated, and infusion of 0.9% saline is begun. An x-ray of the chest shows hyperinflation of the lung fields and a 2-cm nodule in the right lower lobe. In addition to placing the patient in the right lateral decubitus position, which of the following is the most appropriate next step in management?", "answer": "Bronchoscopy", "meta_info": "step2&3", "answer_idx": "D", "A": "Radionuclide scan", "B": "Upper endoscopy", "C": "Arteriography", "D": "Bronchoscopy", "language": "en"}
{"question": "A previously healthy 3-year-old girl is brought to the physician because she refuses to use her left arm after “tripping over a stone” that morning on the way to the supermarket while holding her mother's hand. She did not hit the ground. Development has been normal for her age. She appears anxious. Her vital signs are within normal limits. The left forearm is held close to her body in partial extension and pronation. There is no swelling or bruising of the elbow or the forearm. Palpation of the proximal radius produces pain. The child cries on attempting to passively supinate the forearm. Which of the following is the most appropriate next step for the physician?", "answer": "Forced hyperpronation of the arm", "meta_info": "step2&3", "answer_idx": "B", "A": "Administer ibuprofen and ice packs", "B": "Forced hyperpronation of the arm", "C": "Notify child protective services", "D": "Perform nerve conduction studies and electromyography\n\"", "language": "en"}
{"question": "A previously healthy 29-year-old woman comes to the physician because of a 3-day history of low-grade fever, muscle aches, and a rash. She has had 4 male sexual partners over the past year and uses condoms inconsistently. Examination shows a diffuse maculopapular rash that includes the palms and soles. Testing for nonspecific anticardiolipin antibodies is positive. Which of the following is the most appropriate next step in management?", "answer": "Test for fluorescent treponemal antibody absorption", "meta_info": "step1", "answer_idx": "D", "A": "Assess for double-stranded DNA antibodies", "B": "Administer penicillin G", "C": "Analyze rash with darkfield microscopy", "D": "Test for fluorescent treponemal antibody absorption", "language": "en"}
{"question": "A 59-year-old man with New York Heart Association Class II heart failure presents to your outpatient clinic for routine follow-up. His blood pressure is 134/89 mm Hg and heart rate is 75/min. Physical examination reveals clear lung sounds bilaterally with normal S1 and S2 heart sounds. He currently takes captopril, bisoprolol, and furosemide. You would like to add on spironolactone. Of the following, which is true regarding aldosterone antagonists in patients with heart failure?", "answer": "Aldosterone antagonists decrease morbidity and mortality in heart failure patients", "meta_info": "step2&3", "answer_idx": "C", "A": "Aldosterone antagonists do not require renal dosing", "B": " Aldosterone antagonists are indicated for patients in all stages of heart failure", "C": "Aldosterone antagonists decrease morbidity and mortality in heart failure patients", "D": "Aldosterone antagonists can cause visual disturbances", "language": "en"}
{"question": "A 32-year-old man comes to the physician because of a 1-week history of fever, nausea, headache, and confusion. Three weeks ago, he had an episode of a sore throat, diarrhea, and generalized lymphadenopathy. He is sexually active with a new partner that he met 2 months ago and they use condoms inconsistently. He appears ill. Physical examination shows nuchal rigidity. Further evaluation shows infection with a single-stranded, positive-sense RNA virus. The cells most likely affected in this patient’s current condition are analogous to which of the following cell types?", "answer": "Langerhans cells", "meta_info": "step1", "answer_idx": "D", "A": "Osteoblasts", "B": "Mast cells", "C": "Schwann cells", "D": "Langerhans cells", "language": "en"}
{"question": "A 64-year-old man presents for a routine physical. He states that he has felt abnormally weak during this time and has had trouble focusing in the setting of losing 5 pounds. The patient states he has a decreased appetite and also has not had a bowel movement in the past 5 days and feels uncomfortable. On review of system, he endorses abdominal pain. His temperature is 97.5°F (36.4°C), blood pressure is 132/83 mmHg, pulse is 115/min, respirations are 15/min, and oxygen saturation is 98% on room air. Physical exam is notable only for the patient being able to recall 1 of 3 objects. His cranial nerve exam is unremarkable and his gait is stable. Urinalysis is initially notable for a clear and voluminous sample with a low specific gravity. Which of the following tests is most likely abnormal in this patient?", "answer": "Calcium level", "meta_info": "step2&3", "answer_idx": "A", "A": "Calcium level", "B": "Lead level", "C": "Potassium level", "D": "TSH level", "language": "en"}
{"question": "Ten days after a motor vehicle collision, a 28-year-old man develops jaundiced skin. Upon initial presentation for his injuries, the patient was taken for an emergency laparotomy, which revealed significant internal hemorrhage from blunt abdominal trauma to the spleen. He required rapid transfusion with a total of 7 units of packed red blood cells. He has recovered well from the procedure until this morning, when he began to develop jaundiced skin and sclerae. He does not have pruritus. He has had no prior surgeries and takes no other medications. He is sexually active with one female partner. Prior to the accident, he drank 4 beers per day. His vital signs are within normal limits. Abdominal examination is limited due to pain. There are no palpable abdominal masses. There is a midline surgical scar with no erythema, purulence, or drainage. He has healing abrasions on the upper left side of his face and bruises over the anterior abdomen. CT scans show a resolving hematoma in the peritoneal cavity. Laboratory studies show:\nHemoglobin 9.7 g/dL\nHematocrit 30%\nLeukocyte count 7,000/mm3\nPlatelet count 135,000/mm3\nSerum\nTotal bilirubin 3.9 mg/dL\nIndirect bilirubin 3.7 mg/dL\nDirect bilirubin 0.2 mg/dL\nAspartate aminotransferase (AST) 60 U/L\nAlanine aminotransferase (ALT) 92 U/L\nWhich of the following is the most likely cause of this patient's jaundice?\"", "answer": "Increased formation of bilirubin", "meta_info": "step2&3", "answer_idx": "C", "A": "Biliary obstruction", "B": "Hepatocellular injury", "C": "Increased formation of bilirubin", "D": "Decreased hepatic uptake of unconjugated bilirubin\n\"", "language": "en"}
{"question": "A 69-year-old man comes to the physician because of a cough for the past 3 months. The cough is mostly dry, but the patient recalls a recent episode in which he coughed up mucus with dark red streaks. He has felt tired for the past few months. Over the past month, he has had poor appetite and a 5-kg (11-lb) weight loss. He also has occasional back pain, which has worsened in recent weeks. He has no recent travel history. He has smoked a pack of cigarettes daily for 30 years. He does not drink alcohol. His vitals are within normal limits. Auscultation of the lungs reveals wheezing in the lower right lung field. There is no peripheral lymphadenopathy. The liver is of normal size, and the spleen is not palpable. Laboratory studies show a hemoglobin concentration of 13.5 g/dL, serum calcium concentration of 12.3 mg/dL, and a total serum protein of 7.0 g/dL. X-rays of the chest are shown. Which of the following is the most likely diagnosis?", "answer": "Squamous cell lung carcinoma\n\"", "meta_info": "step2&3", "answer_idx": "D", "A": "Tuberculosis", "B": "Lobar pneumonia", "C": "Small cell lung carcinoma", "D": "Squamous cell lung carcinoma\n\"", "language": "en"}
{"question": "A 37-year-old man comes to the physician because of a 3-month history of worsening painful swallowing, hoarseness, and bilateral otalgia. He has had a 10-kg (22-lb) weight loss during this period. He does not smoke or drink alcohol. Laryngoscopic examination shows an abnormal mass located on the right true vocal cord. Immunohistochemistry of the mass shows expression of HPV-16 DNA. This neoplasm most likely derived from which of the following types of epithelial tissue?", "answer": "Stratified squamous epithelium with submucosal glands", "meta_info": "step1", "answer_idx": "A", "A": "Stratified squamous epithelium with submucosal glands", "B": "Simple columnar epithelium with cilia", "C": "Pseudostratified columnar epithelium with cilia", "D": "Pseudostratified columnar epithelium with cartilage", "language": "en"}
{"question": "An investigator is studying patients with an autosomal dominant mutation in the long arm of chromosome 10. This mutation alters the structure of CD95 receptors and impairs the binding of a ligand to this receptor. These patients are at greatest risk for which of the following complications?", "answer": "Autoimmune cytopenia", "meta_info": "step1", "answer_idx": "B", "A": "Partial albinism", "B": "Autoimmune cytopenia", "C": "Acute myeloid leukemia", "D": "Diabetes mellitus", "language": "en"}
{"question": "An investigator is studying cardiovascular changes during exercise. He is following a 25-year-old female volunteer who is training for a marathon. Her training consists of running on a treadmill for increasing amounts of time. During her training sessions, laboratory studies show increased concentrations of adenosine and lactate in the active muscles. Which of the following is most likely a direct effect of these metabolites?", "answer": "Decreased systemic vascular resistance", "meta_info": "step1", "answer_idx": "B", "A": "Decreased capillary pressure", "B": "Decreased systemic vascular resistance", "C": "Increased venous return", "D": "Increased mixed venous oxygen saturation", "language": "en"}
{"question": "A previously healthy 16-year-old girl is brought to the physician by her parents because of behavior changes and involuntary limb movements over the past 2 days. She also has a 2-week history of fever, headache, and fatigue. Her temperature is 38°C (100.4°F), pulse is 110/min, respirations are 20/min, and blood pressure is 102/72 mm Hg. Mental status examination shows impaired speech and a disorganized thought process. Muscle strength is 5/5 in all extremities. Urine toxicology screening is negative. Cerebrospinal fluid analysis shows a leukocyte count of 70 cells/mm3 (90% lymphocytes) and a protein concentration of 51 mg/dL. Abdominal ultrasound shows a large right adnexal mass. The patient's symptoms are most likely caused by antibodies against which of the following?", "answer": "Glutamate receptors", "meta_info": "step1", "answer_idx": "D", "A": "Purkinje cell Yo antigens", "B": "GM1 ganglioside", "C": "Neuronal Hu antigens", "D": "Glutamate receptors", "language": "en"}
{"question": "A 7-year-old boy is brought to the physician by his mother because of low-grade fevers and a cough lasting for 2 weeks. He has vomited several times after fits of coughing. He has no history of serious illness and has not received any routine childhood vaccinations. His temperature is 38.3°C (101°F). Physical examination shows erythema of the nasal and oral mucosa. While in the exam room, he has a long series of consecutive coughs, during which he appears diaphoretic. The coughing is followed by a loud inspiratory gasp. Laboratory studies show a leukocyte count of 16,300/mm3 (67% lymphocytes). The pathogen most likely responsible for this patient's presentation contains a toxin that acts by which of the following mechanisms?", "answer": "Increases intracellular cAMP", "meta_info": "step1", "answer_idx": "A", "A": "Increases intracellular cAMP", "B": "Increases intracellular cGMP", "C": "Inactivates host elongation factor", "D": "Inactivates host 60S ribosome", "language": "en"}
{"question": "A 21-year-old college student is rushed to the ER because of a high-grade fever that started this morning. She vomited several times last night. She is complaining of a severe, unremitting headache. Her temperature is 38.9°C (102.0°F), respiratory rate is 20/min, pulse is 112/min, and blood pressure is 105/78 mm Hg. She is highly sensitive to light. Her neck feels stiff on passive flexion, with positive Kernig’s and Brudzinski’s signs. There is a non-blanching maculopapular rash all over the body. Cerebrospinal fluid (CSF) samples are sent to the lab for analysis and she is started on intravenous fluids and antibiotics. The CSF analysis will most likely reveal which of the following?", "answer": "Polymorphonuclear leukocytosis", "meta_info": "step1", "answer_idx": "D", "A": "Eosinophils", "B": "Decreased protein concentration", "C": "Lymphocytosis", "D": "Polymorphonuclear leukocytosis", "language": "en"}
{"question": "A 58-year-old man with chronic obstructive pulmonary disease and hypertension comes to the physician because of shortness of breath 3 days after starting propranolol. His temperature is 36.7°C (98.1°F), pulse is 64/min, respirations are 20/min, and blood pressure is 138/88 mm Hg. Auscultation of the lungs shows diffuse expiratory wheezes. In addition to discontinuing the propranolol, which of the following drugs should be administered?", "answer": "Albuterol", "meta_info": "step1", "answer_idx": "A", "A": "Albuterol", "B": "Prednisone", "C": "Tiotropium bromide", "D": "Theophylline", "language": "en"}
{"question": "A 6-year-old boy is admitted with a one-week history of diarrhea, which was sometimes bloody and originally began after a birthday party. He has become lethargic and has not been eating or drinking. His vital signs are as follows: T 38.5 C, HR 135, BP 82/54. Physical examination is significant for petechiae on his legs and diffuse abdominal tenderness to palpation. Lab-work shows BUN 72 mg/dL, creatinine 8.1 mg/dL, and platelet count < 10,000. PT and PTT are within normal limits. Which of the following would be expected on a peripheral blood smear?", "answer": "Fragmented red blood cells", "meta_info": "step2&3", "answer_idx": "B", "A": "Rouleaux formation", "B": "Fragmented red blood cells", "C": "Spur cells", "D": "Giant platelets", "language": "en"}
{"question": "A microbiology student is studying the different types of cell surface markers on immune cells. He is interested in the human major histocompatibility complex (MHC) and human leukocyte antigens (HLAs). While studying, he learns that both class I and class II MHC molecules are expressed on specific types of cells. Currently, he is studying the HLA-DP, HLA-DQ, HLA-DRα, and HLA-DRβ genes. Which of the following cells express molecules encoded by these genes?", "answer": "Thymic epithelial cells", "meta_info": "step1", "answer_idx": "D", "A": "Eosinophils", "B": "Mesenchymal cells", "C": "Platelets", "D": "Thymic epithelial cells", "language": "en"}
{"question": "A 10-year study of 1,000 residents in a small US town is conducted to determine the risk of developing lung cancer. The study assesses each subject with a comprehensive physical exam and chest X-ray at 3-time points: at baseline, at the 5-year point, and at the conclusion of the study. At each time point, the total number of cases of lung cancer in the population is recorded. The data gathered from the study are given in the table below:\nTime point Total cases of lung cancer\nt = 0 years 100\nt = 5 years 500\nt = 10 years 600\nWhich of the following is the incidence of lung cancer per 1,000 people per year?", "answer": "87", "meta_info": "step2&3", "answer_idx": "C", "A": "104", "B": "0.6", "C": "87", "D": "125", "language": "en"}
{"question": "A 7-year-old boy suffers from generalized edema. Urine protein excretion is 5.2 g over 24 hours, and serum analysis reveals hyperlipidemia. The patient responds to treatment with prednisone, and, 8 weeks later, his urine does not contain measurable protein. If a kidney biopsy had been performed while the patient’s condition was pathologic, which of the following would you expect to find upon glomerular electron microscopy?", "answer": "Effacement of podocyte foot processes", "meta_info": "step1", "answer_idx": "A", "A": "Effacement of podocyte foot processes", "B": "Subepithelial ‘spike and dome’ deposits", "C": "Subepithelial humps", "D": "Subendothelial thickening", "language": "en"}
{"question": "A previously healthy 3-month-old girl is brought to the emergency department because her lips turned blue while passing stools 20 minutes ago. She has not stopped crying since then. She was born at 38 weeks' gestation. She is at the 50th percentile for length and below the 30th percentile for weight. She is alert and agitated. Her temperature is 36.6°C (98°F), pulse is 180/min, respirations are 50/min, and blood pressure is 70/50 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 70%, which increases to 81% on administration of 100% oxygen. Physical examination shows perioral cyanosis and retractions of the lower ribs with respiration. Cardiac examination shows a harsh grade 2/6 systolic crescendo-decrescendo murmur at the left upper sternal border. Which of the following would most likely improve this patient's symptoms?", "answer": "Knee-chest positioning", "meta_info": "step2&3", "answer_idx": "A", "A": "Knee-chest positioning", "B": "Supine positioning", "C": "Lower limb elevation", "D": "Prone positioning", "language": "en"}
{"question": "An 8-year-old girl of Asian descent is brought to the physician because of fatigue. She is not able to keep up with the rest of her classmates in gym class because she tires easily. Physical examination shows pale conjunctivae. Laboratory studies show:\nHemoglobin 11.0 g/dL\nMean corpuscular volume 74 μm3\nRed cell distribution width 14 (N=13-15)\nSerum ferritin 77 ng/mL\nPeripheral blood smear shows small, pale red blood cells. Hemoglobin electrophoresis is normal. Which of the following best describes the pathogenesis of the disease process in this patient?\"", "answer": "Cis deletion of α-globin genes", "meta_info": "step1", "answer_idx": "C", "A": "Decreased production of β-globin proteins", "B": "Amino acid substitution in the β-globin protein", "C": "Cis deletion of α-globin genes", "D": "Acquired inhibition of heme synthesis", "language": "en"}
{"question": "A 52-year-old postmenopausal woman comes to the physician with a 6-month history of difficulty biting down and chewing that is becoming progressively worse. She has been taking acetaminophen for headaches and nonspecific pain in her hips and back. She also complains that her hearing has been deteriorating as she gets older. Vital signs are within normal limits. Examination shows a mildly tender, 1-cm, bony, immobile swelling in the left side of her forehead. Intraoral examination shows bilateral expansion of the maxillary alveolus and malocclusion. Audiometry shows bilateral mixed conductive and sensorineural hearing loss. Laboratory studies show:\nHemoglobin 14.6 g/dL\nLeukocyte count 9,000/mm3\nPlatelet count 256,000/mm3\nSerum\nAlkaline phosphatase 1100 U/L\nVitamin D 40 ng/ml (N = 20–100 ng/mL)\nCalcium 9.5 mg/dL\nParathyroid hormone 300 pg/mL\nA plain x-ray of the skull is shown. Which of the following is the most appropriate next step in management?\"", "answer": "Intravenous zoledronate", "meta_info": "step2&3", "answer_idx": "C", "A": "Hematopoietic cell transplantation", "B": "Transsphenoidal hypophysectomy", "C": "Intravenous zoledronate", "D": "Estrogen replacement therapy", "language": "en"}
{"question": "A 66-year-old man is brought to the emergency department because of worsening shortness of breath and progressive swelling of his legs for 1 week. He has hypertension and hyperlipidemia. Current medications include amlodipine and pravastatin. His temperature is 37.5°C (99°F), pulse is 95/min, respirations are 12/min, and blood pressure is 113/70 mm Hg. Pulmonary examination shows bilateral coarse crackles. An S3 gallop is heard on auscultation. There is jugular venous distension and pitting edema of both ankles. He is admitted to the hospital and treatment with intravenous bumetanide is initiated. Serum studies obtained 5 days after admission show:\nNa+ 138 mEq/L\nCl− 101 mEq/L\nMg2+ 1.3 mEq/L\nUrea nitrogen 42 mg/dL\nCreatinine 1.8 mg/dL\nArterial blood gas analysis on room air:\npH 7.51\nPCO2 52 mm Hg\nPO2 60 mm Hg\nHCO3- 33 mmol/L\nFurther evaluation of this patient is most likely to show which of the following findings?\"", "answer": "Elevated serum aldosterone", "meta_info": "step2&3", "answer_idx": "A", "A": "Elevated serum aldosterone", "B": "Decreased urine chloride", "C": "Decreased serum renin", "D": "Elevated serum potassium", "language": "en"}
{"question": "A 16-year-old boy is brought to the emergency department by his parents after collapsing at home. He was resting at home after an uneventful dental procedure that involved the extraction of several teeth. He became drowsy and then unconscious and was unrousable. At the hospital, his temperature is 37.0° C (98.6° F), respiratory rate is 15/min, pulse rate is 67/min, and blood pressure is 122/98 mm Hg. Oxygen saturation is 85% on room air. The patient is deeply cyanosed despite a good respiratory effort and a clear airway. His lungs are clear to auscultation, bilaterally. Even though an endotracheal tube is introduced and assisted ventilation is induced, his condition does not improve. A review of dental records reveals the details of the procedure where the local anesthetic pilocarpine was administered. What is the most likely cause of this patient’s condition?", "answer": "Methemoglobinemia", "meta_info": "step1", "answer_idx": "B", "A": "Cyanide poisoning", "B": "Methemoglobinemia", "C": "Sulfhemoglobinemia", "D": "Carbon monoxide poisoning", "language": "en"}
{"question": "Please refer to the summary above to answer this question\nWhich of the following is the most likely underlying cause of this patient's upper extremity symptoms?\"\n\"Patient Information\nAge: 1 day\nSex: F\nEthnicity: Hispanic\nSite of Care: office\nHistory\nReason for Visit/Chief Concern: brought in by her parents because “her arm looks funny”\nHistory of Present Illness:\nmother had no prenatal care\nlabor was spontaneous with rupture of membranes yielding fluid with dark green streaks\nthe infant was delivered vaginally 1 day ago at home at approximately 39 weeks' gestation\nthe delivery was complicated by shoulder dystocia, which was managed with suprapubic pressure and the McRoberts maneuver\nfather reports that the infant's right arm “just hangs by the side” and that she never bends her right elbow\nthe infant is breastfeeding, stooling, and voiding without complication\nPast Medical History:\nnone\nFamily History:\nmother has type 2 diabetes mellitus\nMedications:\nnone\nImmunizations:\nhas not received any routine vaccinations\nAllergies:\nno known drug allergies\nSocial History:\nthe infant lives with her mother, father, and paternal grandmother\nno one in the residence smokes\nPhysical Examination\nTemp Pulse Resp BP O2 Sat Ht Wt Head circumference\n37.1°C\n(98.8°F)\n154/min 45/min 87/49 mm Hg\n99%\n50 cm\n(20 in; 69th percentile)\n4,400 g\n(9 lb 11 oz; 99th percentile)\n35 cm\n(13.8 in; 82nd percentile)\nAppearance: well-appearing; crying during the examination\nHEENT: red reflex is seen bilaterally; there is a fluctuant area over the left parietal bone that crosses suture lines\nPulmonary: clear to auscultation\nCardiac: regular rate and rhythm; normal S1 and S2; no murmurs, rubs, or gallops\nAbdominal: no tenderness, masses, or hepatosplenomegaly; bowel sounds normal; umbilical stump is intact and clamped\nExtremities: hips are stable bilaterally\nMusculoskeletal: clavicles are intact bilaterally; the right upper extremity hangs limply from the shoulder in full extension, adduction, and fixed internal rotation; the hand is pronated, and the wrist and fingers are flexed\nSkin: dry, warm; no jaundice\nNeurologic: normal suck and grasp reflexes; the Moro reflex is normal in the left upper extremity and absent in the right upper extremity; deep tendon reflexes are 2+ bilaterally\"", "answer": "Damage to the upper trunk of the brachial plexus", "meta_info": "step2&3", "answer_idx": "B", "A": "Injury to the median nerve", "B": "Damage to the upper trunk of the brachial plexus", "C": "Damage to the lower trunk of the brachial plexus", "D": "Aspiration of meconium", "language": "en"}
{"question": "A 34-year-old man presents with severe left inguinal pain and swelling since last night. He has just returned from a summer trip to the southwestern United States where he spent most of his time working with homeless and unemployed people in an area that straddles New Mexico and Utah. Upon further inquiry, he denies any contact with wild or domestic animals including pets, but he does remember occasionally seeing mice in his motel room and found their droppings on the floor. On physical exam his temperature is 38.5°C (101.3°F), pulse is 95/min, respiration rate is 18/min, and blood pressure is 130/85 mm Hg. The left inguinal area is swollen. There is no skin erythema and it is not warm to palpation. There are several enlarged and soft lymph nodes with a hard underlying core. The area is very tender and surrounded by edema. A localized rash is found in the ipsilateral inner thigh above the knee (see image). Examination of the heart, lungs, abdomen, and other limbs shows no abnormalities. Which of the following pathogens is the most likely cause of this patient’s condition?", "answer": "Yersinia pestis", "meta_info": "step2&3", "answer_idx": "D", "A": "Hantavirus", "B": "Rhabdovirus", "C": "Borrelia burgdorferi", "D": "Yersinia pestis", "language": "en"}
{"question": "A 10-year-old unvaccinated girl presents to her pediatrician with a rash. Her mother reports that she has had a fever, “red eyes,” sore throat, and rash on her face for the last day. On physical examination, the girl appears sick but not toxic, and has nonpurulent conjunctivitis and an erythematous posterior pharynx without exudate or tonsillar hypertrophy. She has lymphadenopathy bilaterally. Her heart has a regular rate without murmurs, her lungs are clear to auscultation bilaterally, and her abdomen is soft without hepatosplenomegaly. She has red cheeks with circumoral pallor and no other skin findings. Which of the following is the most appropriate advice for this patient’s mother?", "answer": "She will likely develop a maculopapular truncal rash in a few days that will fade to become a lacy rash.", "meta_info": "step2&3", "answer_idx": "C", "A": "This infection could have been prevented with a vaccine.", "B": "Her symptoms were caused by human herpesvirus type 6 (HHV-6) or human herpesvirus type 7 (HHV-7).", "C": "She will likely develop a maculopapular truncal rash in a few days that will fade to become a lacy rash.", "D": "She should be started on oral valacyclovir.", "language": "en"}
{"question": "A 42-year-old woman presents to the clinic for worsening fatigue and difficulty breathing for the last 6 months. Previously, she could routinely walk 3 miles after dinner, but now she can no longer walk more than 2 blocks without being short of breath. She also reports being tired soon after starting any type of physical activity. On further questioning, she recalls having on and off fevers, occasional night sweats, and losing 5 kg (11 lb) over the last 6 months. Her past medical history reveals 2 cesarean deliveries in her twenties and a hospitalization for acute appendicitis in her teens. She currently takes no medications and also denies smoking and recreational drug use. She drinks half a glass of wine with her evening meals. Her vitals include a respiratory rate of 14/min, a pulse rate of 87/min, a blood pressure of 110/89 mm Hg, and a temperature of 36.7°C (98.0°F). Physical examination is normal. A chest X-ray shows bilateral hilar lymphadenopathy. Which of the following changes in forced expiratory volume (FEV1) and forced vital capacity (FVC) are expected if she takes a pulmonary function test?", "answer": "FEV1: decrease and FVC: decreased", "meta_info": "step1", "answer_idx": "A", "A": "FEV1: decrease and FVC: decreased", "B": "FEV1: decreased and FVC: no change", "C": "FEV1: decreased and FVC: increased", "D": "FEV1: no change and FVC: no change", "language": "en"}
{"question": "A 42-year-old woman is brought to the emergency department because of a severe, throbbing, occipital headache for 2 hours. She also reports nausea, photophobia, and chest tightness. The symptoms developed shortly after she had a snack consisting of salami and some dried fruits at a wine tasting event. The patient has recurrent migraine headaches and depression, for which she takes medication daily. She is mildly distressed, diaphoretic, and her face is flushed. Her temperature is 37.2°C (98.9 F), pulse is 88/min, respirations are 19/min, and blood pressure is 190/128 mmHg. Deep-tendon reflexes are 2+ bilaterally. This patient's symptoms are most likely caused by a side effect of which of the following medications?", "answer": "Tranylcypromine", "meta_info": "step1", "answer_idx": "A", "A": "Tranylcypromine", "B": "Almotriptan", "C": "Topiramate", "D": "Doxepin", "language": "en"}
{"question": "A 70-year-old man is brought to the emergency department because of severe back pain that began when he was lifting a box 1 hour ago. He also has a 2-year history of increasingly severe right hip pain. Physical examination shows tenderness to palpation of the lower spine as well as erythema of the skin over the right hip. Neurologic examination shows decreased hearing in the left ear; the Weber test localizes to the left side. Serum studies show an alkaline phosphatase concentration of 410 U/L, calcium concentration of 9.5 mg/dL, and parathyroid hormone level of 322 pg/mL. An x-ray of the spine shows a fracture of the L4 vertebra. Which of the following is the most likely diagnosis?", "answer": "Osteitis deformans", "meta_info": "step1", "answer_idx": "C", "A": "Osteoporosis", "B": "Osteomalacia", "C": "Osteitis deformans", "D": "Osteonecrosis", "language": "en"}
{"question": "A study investigating the use of adalimumab for the relief of peripheral arthropathy in patients with psoriatic arthritis was conducted. The study utilizes a crossover design in which half of the study participants are given adalimumab for a month while the other half takes placebo. After a 2 week washout period in which no one takes any adalimumab, the group that was originally on adalimumab is given placebo for a month while the group that was originally taking placebo is given adalimumab for a month. Pain in all affected joints is assessed clinically by follow-up visits every two weeks for the duration of the study. Which of the following is true about cross-over study designs?", "answer": "1 and 2", "meta_info": "step1", "answer_idx": "D", "A": "Crossover studies avoid the ethical issue of not giving all participants access to a novel therapeutic agent", "B": "Crossover studies minimize the effects of differences between participants", "C": "The purpose of the washout period is to increase the length of the study to gather more data", "D": "1 and 2", "language": "en"}
{"question": "A 64-year-old woman presented to the community health clinic complaining of nausea, bloating, pain in both knees, and a burning sensation in her feet. She has recently immigrated to the United States and was previously diagnosed with diabetes mellitus, hypertension, and osteoarthritis but no medical records are currently available. She has stopped taking her medication since immigrating; however, she does recall being on insulin but cannot recall the dosage or the specific type. She has a blood pressure of 172/120 mm Hg, heart rate of 95/min, respiratory rate of 15/min, and temperature of 37.0°C (98.6°F). Her random serum glucose is 364 mg/dL. She is started on atorvastatin, amlodipine, ramipril, aspirin, duloxetine, metoclopramide, acetaminophen, and insulin detemir. Three weeks later, she presents with generalized weakness, walking difficulty, and hand tremors. Physical examination reveals bilateral hand tremors, cogwheel rigidity, and bradykinesia. She is walking with small narrow steps and reduced arm swing. Today her random serum glucose is 150 mg/dL. Her symptoms are presumed to be caused by a drug. Which medication is likely responsible for these symptoms?", "answer": "Metoclopramide", "meta_info": "step2&3", "answer_idx": "B", "A": "Atorvastatin", "B": "Metoclopramide", "C": "Ramipril", "D": "Acetaminophen", "language": "en"}
{"question": "A 51-year-old man presents to the emergency room after being the victim of a robbery and assault. He was walking down an alley when he was approached by a stranger with a knife. Upon resisting, the stranger stabbed the patient’s right distal forearm before stealing his wallet and evading the scene. The patient was able to call an ambulance and has remained conscious despite mild bleeding from the injury site. He reports severe pain in his forearm and an inability to move his 2nd and 3rd fingers. He has no medical conditions and takes no medications. He is allergic to penicillin and ibuprofen. On exam, the patient is able to flex the proximal interphalangeal (PIP) joints of his 2nd through 5th fingers. When the PIP joints of his 2nd through 5th fingers are restrained by the examiner, flexion is noted at the DIP joints of the 4th and 5th fingers but not the 2nd and 3rd digits. Thumb flexion at the metacarpophalangeal (MCP) joint and interphalangeal (IP) joint is preserved. Sensation is intact over the palmar and dorsal aspects of the radial and ulnar hand. This patient most likely has an injury to which of the following muscle tendons?", "answer": "Flexor digitorum profundus", "meta_info": "step1", "answer_idx": "B", "A": "Flexor digitorum longus", "B": "Flexor digitorum profundus", "C": "Flexor digitorum superficialis", "D": "Flexor pollicis longus", "language": "en"}
{"question": "Researchers develop a drug X that acts on the loop of Henle but discover that it does not reach its intended site of action within the nephron. It is freely filtered but rapidly disappears from the proximal tubule. They modify several of the chemical properties of drug X to produce drug Y, which cannot be reabsorbed from the proximal tubule. Which of the following natural substances are most similar to the concentration profiles of drug X and drug Y in the proximal tubule?", "answer": "Drug X: glucose; Drug Y: creatinine", "meta_info": "step1", "answer_idx": "B", "A": "Drug X: creatinine; Drug Y: glucose", "B": "Drug X: glucose; Drug Y: creatinine", "C": "Drug X: glucose; Drug Y: potassium", "D": "Drug X: potassium; Drug Y: creatinine", "language": "en"}
{"question": "A 66-year-old woman comes to the emergency department because of fever and difficulty swallowing for 5 hours. She appears anxious. Her temperature is 39.1°C (102.4°F). Physical examination shows an extended neck and excessive drooling. Her voice is muffled and there is inspiratory stridor. There is tender bilateral cervical lymphadenopathy and pain upon palpation of the hyoid. Laboratory studies show a leukocyte count of 18,800/mm3 with 85% neutrophils. Which of the following is the most likely causal organism?", "answer": "Haemophilus influenzae type b", "meta_info": "step1", "answer_idx": "A", "A": "Haemophilus influenzae type b", "B": "Streptococcus pyogenes", "C": "Corynebacterium diphtheriae", "D": "Parainfluenza virus\n\"", "language": "en"}
{"question": "A 65-year-old man with a history of coronary artery disease presents to your office complaining of ongoing chest pain with exertion. The patient has had a recent cardiac work-up that showed no areas of acute ischemia. At the last visit, the patient was prescribed sublingual nitroglycerin for symptom relief of stable angina. On further questioning, the patient states that he has been swallowing the tablet whole instead of allowing it to dissolve because he “does not like the taste”. What is the cause of the persistent symptoms?", "answer": "First pass metabolism of nitroglycerin", "meta_info": "step1", "answer_idx": "C", "A": "Nitroglycerin tolerance", "B": "Unstable angina", "C": "First pass metabolism of nitroglycerin", "D": "Concomitant use of sildenafil", "language": "en"}
{"question": "A 5-year-old boy is brought to the physician by his mother because of a 3-day history of low-grade fever and sore throat. This morning, she noticed a rash on his buttocks, hands, and feet. He does not have pruritus. His temperature is 38.3°C (100.9°F), pulse is 99/min, and blood pressure is 123/78 mm Hg. Physical examination shows oral vesicles. A photograph of the rash on the feet is shown. Which of the following is the most likely pathogen?", "answer": "Coxsackie A virus", "meta_info": "step1", "answer_idx": "B", "A": "Herpes simplex virus 1", "B": "Coxsackie A virus", "C": "Parvovirus B19", "D": "Epstein-Barr virus", "language": "en"}
{"question": "An 8-year-old African-American male is found to have a holosystolic, harsh-sounding murmur upon physical examination. The murmur is best appreciated at the left sternal border, and is found to be louder when the patient squats. Which of the following is the most likely diagnosis?", "answer": "Ventricular septal defect", "meta_info": "step1", "answer_idx": "A", "A": "Ventricular septal defect", "B": "Patent ductus arteriosus", "C": "Atrial septal defect", "D": "Tricuspid atresia", "language": "en"}
{"question": "A 29-year-old G1P0 woman at 32 weeks of gestation comes to the emergency department complaining of vaginal bleeding for the past hour. She noticed some blood on the toilet paper when she went to the bathroom an hour ago, but now she is bleeding through her underwear. She denies any trauma, pain, abnormal discharge or odor, fever, or recent infections. The patient mentioned that that during her last ultrasound, the doctor told her that, “there’s an abnormality but not to worry,” but she can’t remember the name of the condition. Her temperature is 100.1°F (37.8°C), blood pressure is 120/70 mmHg, pulse is 86/min, and respirations are 15/min . A fetal heart tracing is obtained and shows a fetal heart rate of 130-140, long-term variability, and appropriate accelerations. What is the most likely explanation for this patient’s presentation?", "answer": "Attachment of the placenta to the lower placental segment over the internal os", "meta_info": "step1", "answer_idx": "B", "A": "Abnormal placental spiral artery development", "B": "Attachment of the placenta to the lower placental segment over the internal os", "C": "Cystic swelling of chorionic villi and trophoblast proliferation", "D": "Fetal vessels in close proximity to the cervical os", "language": "en"}
{"question": "A 55-year-old woman comes to the office complaining of a dry mouth for the past few months. She has to drink water more frequently, as she finds it difficult to chew and swallow solid foods. She has to wake up 3–5 times each night to drink due to intense thirst. She also complains of a foreign body sensation in both the eyes for the past month. She has had no joint pain, fever, weight loss, or urinary or bowel changes. She does not smoke cigarettes but drinks alcohol socially. Her mother has rheumatoid arthritis for which she takes methotrexate, and her father died of prostatic carcinoma 7 years ago. Her temperature is 36.7°C (98°F), blood pressure is 130/75 mm Hg, pulse is 80/min, respirations are 14/min, and BMI is 28 kg/m2. On examination, the eyes and oral cavity appear dry, and dental caries are present. No lymphadenopathy is noted. Cardiopulmonary and abdominal examinations are negative. Laboratory results are shown below:\nComplete blood count:\nHemoglobin 10 g/dL\nLeukocytes   13,500/mm3\nPlatelets 170,000/mm3\nESR 65 mm/hr\n   Antinuclear antibody Positive\nRheumatoid factor Positive\nAnti dsDNA Negative\nAnti Ro Positive\nAnti-CCP Negative\nAnti Jo 1   Negative\nWhich of the following is the most likely diagnosis?", "answer": "Primary Sjogren’s syndrome", "meta_info": "step2&3", "answer_idx": "C", "A": "Rheumatoid arthritis", "B": "Systemic lupus erythematosus", "C": "Primary Sjogren’s syndrome", "D": "Polymyositis", "language": "en"}
{"question": "A 42-year-old woman presents to the physician with chronic abdominal pain. She was initially diagnosed with an ulcer in the 2nd part of the duodenum and severe esophagitis 6 years ago. Despite confirmed H. pylori eradication and long-term therapy with pantoprazole, she has had frequent recurrences of duodenal and gastric ulcers. The medical history is otherwise unremarkable. She is a 10 pack-year smoker and consumes alcohol regularly. Her father had severe gastric ulcer disease. The vital signs are within normal limits. The body mass index is 19 kg/m2. Mild epigastric tenderness is noted on deep palpation of the epigastrium. The laboratory studies show the following:\nLaboratory test\nHemoglobin 10 g/dL\nMean corpuscular volume 75 μm3\nLeukocyte count 7500/mm3 with a normal differential\nSerum  \nNa+ 145 mEq/L\nK+ 4.5 mEq/L\nCa+ 9.5 mg/dL\nPhosphorus 4 mg/dL\nUrea nitrogen 18 mg/dL\nCreatinine 1.0 mg/dL\nWhich of the following is the most likely underlying cause of this patient’s condition?", "answer": "Gastrin-secreting tumor", "meta_info": "step2&3", "answer_idx": "B", "A": "Chronic alcohol consumption", "B": "Gastrin-secreting tumor", "C": "Primary hyperparathyroidism", "D": "Tobacco use", "language": "en"}
{"question": "A 33-year-old woman comes to the emergency department for severe abdominal pain for the past hour. The pain is 10/10, stabbing, and concentrated around the epigastric region with radiation to the back. She had 2 episodes of emesis and complains of nausea. She has had multiple similar episodes over the past 3 months which are not correlated with oral intake. She denies fever, weight changes, headaches, palpitations, bowel changes, or chest pain, but endorses nausea and stool that is hard to flush. Her medical history is significant for diabetes that is controlled with metformin. Her surgical history is significant for an elective cesarean section 5 years ago. She is currently sexually active with contraceptive use. What imaging finding would you expect in this patient?", "answer": "Multiple pancreatic calcifications on CT", "meta_info": "step1", "answer_idx": "D", "A": "Gallbladder thickening and presence of cholelithiasis on ultrasound", "B": "Increase in appendicular diameter and fat stranding on computer tomography (CT)", "C": "Lack of an intrauterine pregnancy on ultrasound", "D": "Multiple pancreatic calcifications on CT", "language": "en"}
{"question": "A 37-year-old female presents to her primary care provider for a normal follow-up visit. Her past medical history is notable for poorly controlled type II diabetes mellitus despite good treatment adherence to oral medications. She has been trialed on metformin and glyburide but stopped them due to rapid weight gain, respectively. She was started on a new oral diabetes medication three months ago. Since starting the new medication, she has noticed slowly progressive swelling in her lower extremities. Her temperature is 99.2°F (37.3°C), blood pressure is 120/75 mmHg, pulse is 105/min, and respirations are 22/min. She has gained 10 pounds since her last visit. Physical examination reveals 1+ pitting edema in the bilateral legs. A hemoglobin A1c lab test is drawn. This patient’s symptoms are most likely attributable to which of the following medications?", "answer": "Pioglitazone", "meta_info": "step1", "answer_idx": "C", "A": "Glipizide", "B": "Exenatide", "C": "Pioglitazone", "D": "Acarbose", "language": "en"}
{"question": "A 21-year-old woman comes to the physician for a follow-up examination. Four months ago, she underwent posterior arthrodesis for thoracolumbar scoliosis. She has recovered well from the surgery but noticed difficulties combing her hair with her right hand. A photograph of the patient's back is shown. The nerve that was most likely injured in the surgery originates from which of the following spinal roots?", "answer": "C5–C7", "meta_info": "step1", "answer_idx": "D", "A": "C6-C8", "B": "C1-C3", "C": "T2-T5", "D": "C5–C7", "language": "en"}
{"question": "A 45-year-old female is brought by ambulance to your emergency room after complaining of shortness of breath along with profuse sweating at a company social function. Her vitals were notable for elevated blood pressure with a normal exam and a stable electrocardiogram. She has been seeing a psychiatrist recently for her depression and was prescribed phenelzine after failing treatment with a first-line antidepressant therapy. What must she have been exposed to at the party that led to such a dramatic side effect?", "answer": "Tyramine", "meta_info": "step1", "answer_idx": "B", "A": "Norepinephrine", "B": "Tyramine", "C": "Gluten", "D": "Dopamine", "language": "en"}
{"question": "A 3-day-old female infant is brought by her mother to the pediatrician’s office. The patient’s mother says she has been noticing bruising on her child’s arms and some blood in her diapers. The infant was born at home after the mother received normal prenatal care. The patient has been exclusively breastfed since birth and is gaining weight appropriately. On exam, multiple ecchymoses are noted throughout the patient’s torso and extremities. The patient is lethargic with a large, full anterior fontanelle. On examination of the diaper, some dried blood mixed with a small amount of stool is noted. Which of the following would most likely be expected for this patient's prothrombin time (PT), partial thromboplastin time (PTT), and bleeding time?", "answer": "PT increased, aPTT normal, bleeding time normal", "meta_info": "step1", "answer_idx": "B", "A": "PT normal, aPTT normal, bleeding time normal", "B": "PT increased, aPTT normal, bleeding time normal", "C": "PT normal, aPTT normal, bleeding time increased", "D": "PT normal, aPTT increased, bleeding time normal", "language": "en"}
{"question": "A 53-year-old woman comes to see her primary care physician because she has had fever and malaise for two days. She was in her usual state of health until three days ago when she began to feel tired in the evening and decided to go to bed early. The next day she developed a fever, productive cough, chills, and malaise. She is otherwise healthy with no chronic conditions and lives by herself with two cats. She smokes one pack of cigarettes per day and drinks alcohol socially. On physical exam, she is found to have increased dullness to percussion at the lung bases and blood work is obtained showing elevated levels of C-reactive protein and hepcidin. The signal responsible for the elevated levels of these proteins was most likely secreted by which of the following cells?", "answer": "Macrophages", "meta_info": "step1", "answer_idx": "A", "A": "Macrophages", "B": "Neutrophils", "C": "Regulatory T-cells", "D": "Type 2 helper T-cells", "language": "en"}
{"question": "Three weeks after undergoing transurethral prostate resection for benign prostatic hyperplasia, a 70-year-old man has fever, malaise, and pain in his extremities. Physical examination shows subungal petechiae and tender red papules on his fingers and toes. A new holosystolic murmur is heard on chest auscultation. A photomicrograph of a Gram stain of an isolate from blood culture is shown. The organism does not cause hemolysis on blood agar. Addition of pyrrolidonyl-β-naphthylamide gives the bacterial colonies a cherry red color. Which of the following is the most likely causal organism?", "answer": "Enterococcus faecalis", "meta_info": "step1", "answer_idx": "A", "A": "Enterococcus faecalis", "B": "Streptococcus gallolyticus", "C": "Cardiobacterium hominis", "D": "Staphylococcus epidermidis", "language": "en"}
{"question": "An 85-year-old woman is brought to her primary care provider by her son for a checkup. She is feeling well with no major complaints. Her son is concerned that she has been bruising much more easily over the last week or two. Past medical history is significant for hypertension, hyperlipidemia, and a urinary tract infection that was successfully treated with an extended course of oral cephalexin 3 weeks ago. Family history is noncontributory. Today, her heart rate is 90/min, respiratory rate is 17/min, blood pressure is 125/85 mm Hg, and temperature is 36.7°C (98.1°F). On physical exam, her heart has a regular rate and rhythm and her lungs are clear to auscultation bilaterally. She has some poorly demarcated purple-yellow bruising and areas of dark purple bruising as well. Further analysis reveals a prolonged PT that corrects with mixing, normal liver function tests, and a stool test that is guaiac positive. The physician administers an injection that should improve her condition and recommends further testing and a follow-up exam. What is the mechanism of action of the medication received by the patient?", "answer": "γ-carboxylation of liver enzymes", "meta_info": "step1", "answer_idx": "D", "A": "γ-carboxylation of pancreatic enzymes", "B": "Protein C deficiency", "C": "Activation of 7-dehydrocholesterol by UV light", "D": "γ-carboxylation of liver enzymes", "language": "en"}
{"question": "A 35-year-old man presents with loose stools and left lower quadrant abdominal pain. He says he passes 8–10 loose stools per day. The volume of each bowel movement is small and appears mucoid with occasional blood. The patient reports a 20-pack-year smoking history. He also says he recently traveled abroad about 3 weeks ago to Egypt. The vital signs include: blood pressure 120/76 mm Hg, pulse 74/min, and temperature 36.5°C (97.8°F). On physical examination, mild to moderate tenderness to palpation in the left lower quadrant with no rebound or guarding is present. Rectal examination shows the presence of perianal skin ulcers. Which of the following is the most likely diagnosis in this patient?", "answer": "Amebiasis", "meta_info": "step1", "answer_idx": "A", "A": "Amebiasis", "B": "Crohn’s disease", "C": "Salmonellosis", "D": "Diverticulosis", "language": "en"}
{"question": "Hepatocyte nuclear factor 4 alpha (HNF4a) is a transcription factor that is found in the liver, pancreas, kidney, and intestines. The gene is composed of 11 exons and depending on the tissue there are different isoforms of the protein being expressed. Which of the following is responsible for producing the different isoforms of HNF4a?", "answer": "Alternative splicing", "meta_info": "step1", "answer_idx": "C", "A": "Addition of 7-methylguanosine cap", "B": "Addition of polyadenylated (poly-A) tail", "C": "Alternative splicing", "D": "DNA methylation", "language": "en"}
{"question": "A 50-year-old man presents for a routine examination. Past medical history is significant for cirrhosis secondary to hepatitis C virus (HCV) infection diagnosed 4 years ago and complicated by ascites. Current medications include furosemide 40 mg orally daily. Physical examination is unremarkable. Laboratory findings are significant for the following:\nLaboratory test\nAspartate Aminotransferase (AST) 80 U/L\nAlanine Aminotransferase (ALT) 50 U/L\nTotal bilirubin 2.5 mg/dL\nDirect bilirubin 1.8 mg/dL\nAlkaline phosphatase (ALP) 140 U/L\nInternational normalized ratido (INR) 1.9\nSerum creatinine 1 mg/dL\nUrinalysis\nSodium 200 mmol/24h\nPotassium 60 mmol/24h\nProtein Nil\nRBCs Nil\nRBC casts Nil\nWBCs Nil\nUrea 13 g/24h\nCreatinine 6 mmol/24h\n  Abdominal and renal ultrasound reveals no interval change over the past 6 months. Moderate ascites is present. Upper GI endoscopy reveals esophageal varices with a hepatic venous pressure gradient measuring 14 mm Hg. Diagnostic paracentesis is performed and yields a clear liquid with an absolute polymorphonuclear neutrophil (PMN) count of 75 cells/mm3. Which of the following is the most likely etiology of this patient’s condition?", "answer": "Portal hypertension", "meta_info": "step1", "answer_idx": "B", "A": "Hepatocellular carcinoma", "B": "Portal hypertension", "C": "Spontaneous bacterial peritonitis", "D": "Hepatorenal syndrome", "language": "en"}
{"question": "A 45-year-old man with HIV comes to the physician because of multiple lesions on his lower extremity. The lesions are increasing in size and are not painful or pruritic. He does not have lymphadenopathy. He works at a garden center. He lives in Mississippi. Medications include abacavir, dolutegravir, and lamivudine. His temperature is 37.7°C (98.8°F), pulse is 75/min, and blood pressure is 125/80 mm Hg. Examination shows multiple lesions on both heels; some are elevated. There are two similar lesions on the chest. An image of the patient's right heel is shown. His CD4+ T-lymphocyte count is 450/mm3 (normal ≥ 500/mm3). A skin biopsy shows multiple spindle-shaped cells and leukocyte infiltration. Which of the following is the most likely causal organism?", "answer": "Human herpesvirus 8", "meta_info": "step2&3", "answer_idx": "B", "A": "Mycobacterium avium complex", "B": "Human herpesvirus 8", "C": "Coccidioides immitis", "D": "Epstein-Barr virus", "language": "en"}
{"question": "A 32-year-old woman presents to the office complaining of pain, numbness, and discoloration of her fingers over the past 6 months. She notices that cold temperatures worsen these symptoms, turning the tip of her fingers white and sometimes blue. Her vital signs show her temperature is 37.5°C (99.5°F), blood pressure is 124/86 mm Hg, pulse is 80/min, and respirations are 10/min. On physical examination, the patient has a pale malar rash spread across her face with tender cervical and axillary lymphadenopathy. Examination of her hands reveal tenderness and shiny sclerodactyly. Antinuclear and anti-U1 ribonucleoprotein antibodies are positive. A diagnosis of mixed connective tissue disease is confirmed. What is the next best step in management?", "answer": "Echocardiogram", "meta_info": "step2&3", "answer_idx": "A", "A": "Echocardiogram", "B": "Arthrocentesis", "C": "Bone marrow transplant", "D": "Upper GI series", "language": "en"}
{"question": "A 58-year-old woman presents with difficulty moving her right shoulder. She underwent a right radical mastectomy with lymph node dissection 3 weeks ago. Her surgery went well with no complications. She has undergone some physical therapy which has not been effective. A few days ago, she started to notice brief periods of painful shoulder instability, especially while opening or closing doors. On physical examination, there is normal active and passive range of motion in the right shoulder. Strength is 5 out of 5 in all muscles of the right shoulder and upper extremity. Sensation is intact. When the patient is asked to push against the wall, her right shoulder blade moves backward (see image). Which of the following nerves is most likely injured in this patient?", "answer": "Long thoracic nerve", "meta_info": "step1", "answer_idx": "C", "A": "Axillary nerve", "B": "Suprascapular nerve", "C": "Long thoracic nerve", "D": "Ulnar nerve", "language": "en"}
{"question": "A 40-year-old man comes to the physician because he is concerned about the amount of breast tissue he has recently developed. His wife has noticed that he has been irritable for the past month. He was recently treated for tinea capitis. In preparation for an upcoming bodybuilding competition, he has been eating a lot of chicken breast. He drinks 2 beers everyday. He smokes marijuana 3–4 times a week but does not smoke cigarettes. He weighs 90 kg (198 lb) and is 175 cm (5 ft 8 in) tall; BMI is 30.1 kg/m2. Physical examination shows bilateral gynecomastia and small, firm testes. There is no hepatosplenomegaly or abdominal tenderness. Laboratory studies show:\nHematocrit 60%\nPlatelet count 400,000/mm3\nSerum\nNa+ 135 mEq/L\nCl- 97 mEq/L\nK+ 4.5 mEq/L\nHCO3- 25 mEq/L\nGlucose 100 mg/dL\nWhich of the following is the most likely cause of his symptoms?\"", "answer": "Anabolic steroid use", "meta_info": "step2&3", "answer_idx": "A", "A": "Anabolic steroid use", "B": "Normal aging", "C": "Erythropoietin use", "D": "Marijuana use", "language": "en"}
{"question": "A 35-year-old woodsman from local forestry presents to a clinic for counseling regarding his contact with a wild fox that occurred 5 days ago. He says that the fox was not aggressive, allowed him to caress it, and even licked his forearm where he had an open wound. Two days ago, in the same forest, foresters shot a group of foxes who had attacked them, and the fox corpses were handed over to a local veterinary laboratory for testing. Two locals also reported they were attacked by foxes, so the patient became concerned about his exposure. At the time of presentation, the patient had no complaints. His vital signs are as follows: the blood pressure is 125/80 mmHg, the heart rate is 81/min, the respiratory rate is 14/min, and the temperature is 36.8°C (98.2°F). Physical examination reveals 2 healing lacerations, 2 × 3 cm, with a depth of 1 mm each, and multiple scratches on the flexor surface of his right arm. The patient is unaware of his immunization status. Which of the following statements is correct?", "answer": "If rabies immunoglobulin is not available immediately, it can be administered within 7 days of the first vaccine dose.", "meta_info": "step1", "answer_idx": "D", "A": "The patient does not need immunoglobulin to be administered since he was not bitten by the animal.", "B": "Before initiating post-exposure prophylaxis, results of laboratory testing of the fox's corpses should be obtained.", "C": "There is no need to treat the patient’s wounds before administering post-exposure prophylaxis because the wounds are already healing; thus, they do not pose a threat to the patient’s health.", "D": "If rabies immunoglobulin is not available immediately, it can be administered within 7 days of the first vaccine dose.", "language": "en"}
{"question": "A 14-year-old boy presents to his primary care physician for a general check up. The patient's parents refuse to allow the boy to join the school basketball team. The patient has attended two practices, and both times during conditioning, he has fainted. Otherwise, the child is performing well in school. The patient has a past medical history of obesity, elevated fasting blood glucose, and high blood pressure. He is not currently taking any medications. The patient's parents want the patient to be cleared medically before he goes back to playing basketball again. His temperature is 99.5°F (37.5°C), blood pressure is 130/87 mmHg, pulse is 81/min, and respirations are 11/min. Physical exam is notable for an obese child who is pleasant and conversational. Pulmonary exam reveals lungs that are clear to auscultation bilaterally. Cardiovascular exam reveals a murmur heard loudest along the left sternal border. Neurological exam reveals 5/5 strength in the upper and lower extremities with 2+ reflexes. Further diagnostic exams are ordered. Which of the following is appropriate management in this patient?", "answer": "Metoprolol", "meta_info": "step2&3", "answer_idx": "B", "A": "Metformin", "B": "Metoprolol", "C": "Suggest the patient exercise more before joining a competitive team", "D": "Clear the patient to participate in sports", "language": "en"}
{"question": "A 65-year-old man with chronic obstructive pulmonary disease is admitted to the hospital for the treatment of worsening shortness of breath and productive cough. Three days later, he complains of weakness in the lower limbs. His muscle strength is 4/5 at both hips but normal elsewhere. The drug that is most likely responsible for this patient's muscle weakness inhibits which of the following?", "answer": "Nuclear factor-κB", "meta_info": "step1", "answer_idx": "D", "A": "Adenosine receptor", "B": "5-lipoxygenase", "C": "Myosin light-chain kinase", "D": "Nuclear factor-κB", "language": "en"}
{"question": "A 64-year-old woman is brought to the emergency department after a syncopal episode 2 hours ago while grocery shopping. She has been feeling fatigued and lightheaded for the past couple of days. She has hypertension. Current medications include carvedilol. She appears diaphoretic. She is oriented to person but not to place or time. Her blood pressure is 102/65 mm Hg. An ECG is shown. Which of the following is the most appropriate next step in management?", "answer": "Placement of transcutaneous pacemaker", "meta_info": "step2&3", "answer_idx": "C", "A": "Observation", "B": "Administration of dopamine", "C": "Placement of transcutaneous pacemaker", "D": "Administration of amiodarone\n\"", "language": "en"}
{"question": "A 42-year-old morbidly obese woman presents to the emergency room for evaluation of a rash that started 3 days ago. The rash appeared under the patient’s breasts as well as in the abdominal folds, and the patient describes it as being very itchy. The rash is bright red with scaling and a few scattered purulent areas of skin breakdown. The patient is afebrile and is in no apparent distress, besides being uncomfortable from the itching. What is the most likely causative agent of this rash?", "answer": "A commensal yeast that is catalase-positive", "meta_info": "step1", "answer_idx": "D", "A": "A heavily encapsulated, urease-positive yeast", "B": "A gram-negative rod that produces pyocyanin", "C": "An acid-fast bacillus", "D": "A commensal yeast that is catalase-positive", "language": "en"}
{"question": "A 47-year-old man comes to the physician because of severe retrosternal chest pain and shortness of breath for 45 minutes. He has dyslipidemia, hypertension, and type 2 diabetes mellitus. Current medications include hydrochlorothiazide, lisinopril, metformin, and atorvastatin. He has smoked 1 pack of cigarettes daily for 20 years. He appears pale and diaphoretic. His temperature is 37°C (98.6°F), pulse is 115/min, and blood pressure is 140/70 mm Hg. Breath sounds are normal. The remainder of the examination shows no abnormalities. An ECG shows left ventricular hypertrophy with ST-segment elevation in leads I, aVL, and V1–V6. High-dose aspirin, clopidogrel, metoprolol, sublingual nitroglycerin, and unfractionated heparin are administered. As the patient awaits transport to the nearest emergency room, he collapses and becomes unresponsive. His pulse and blood pressure cannot be detected. Despite resuscitative efforts, the patient dies. Which of the following is the most likely cause of death in this patient?", "answer": "Ventricular fibrillation", "meta_info": "step2&3", "answer_idx": "B", "A": "Papillary muscle rupture", "B": "Ventricular fibrillation", "C": "Septal wall rupture", "D": "Pulmonary embolism\n\"", "language": "en"}
{"question": "A 4-year-old boy presents to a clinic with intermittent fevers and a rash for 6 days. According to his mother, he is also complaining of pain all over his body. She adds that the rash 1st appeared on his face within 12 hours of the onset of fever, and later spread to his trunks and limbs. The patient denies any itchiness over the rash. There is no history of a sore throat or recent use of medication for symptom relief. The temperature is 37.2°C (99.9°F) and the pulse is 88/min. On examination, there is a maculopapular rash on the face and the trunk, including the limbs, but sparing the palms and soles. The pediatrician reassures the mother that this is most likely a viral infection and will resolve spontaneously. After 7–10 days, the boy is brought back to the clinic for a follow-up visit. The areas affected by the rash appear to have a central clearing giving a lacy or reticular appearance, especially on the cheeks and it looks like someone slapped him on the cheeks. Immunoglobulin M (IgM) antibody detection by the enzyme-linked immunoassay (ELISA) will most likely detect antibodies against which of the following pathogens?", "answer": "Parvovirus B19", "meta_info": "step1", "answer_idx": "D", "A": "Measles virus", "B": "Human herpesvirus 6", "C": "Rubella virus", "D": "Parvovirus B19", "language": "en"}
{"question": "A 25-year-old woman comes into your office with complaints of heavy bleeding. She states that her mother also has heavy bleeding during her menstrual cycle. She has had a heavy flow as long as she can remember and had her first menstrual cycle at age 12. She states during her cycle, she has to change pads every 2 hours for at least 3 days. She also states that she gets bruised easily just like her mother. She denies any past medical history other than her heavy menstrual flow and denies taking any medications. She also denies any medical history in her father and says he is \"perfectly healthy.\" Her vitals are HR 85, T 98.8 F, RR 13, BP 125/75. Her CBC is significant for Hgb 10.5, WBC 5.8, Plts 250, Hct 33. On coagulation studies, her PT is 14 seconds and her PTT is 43 seconds. Her INR is 1.1. What is the most likely cause of this patient's menorrhagia?", "answer": "Von Willebrand's disease", "meta_info": "step2&3", "answer_idx": "B", "A": "Factor V Leiden", "B": "Von Willebrand's disease", "C": "Hemophilia B", "D": "Antiphospholipid antibody syndrome", "language": "en"}
{"question": "A 30-year-old woman comes to the physician because of numbness, fatigue, and blurry vision for 1 week. The symptoms are worse after a hot shower or bath. She had an episode of right arm weakness 2 years ago that resolved without intervention. She recently returned from a hiking trip in upstate New York. Her temperature is 37.1°C (100°F) and blood pressure is 100/66 mm Hg. Physical examination shows decreased sensation to light touch in the left hand, right thigh, and right flank. Strength is normal. There is left-sided photophobia and pupillary constriction in the left eye is decreased compared to the right eye. Which of the following best describes the pathogenesis of the disease process in this patient?", "answer": "Th1 cell-mediated nerve sheath damage", "meta_info": "step1", "answer_idx": "C", "A": "Spirochete protein cross-reactivity in the meninges", "B": "Osmotically-mediated Schwann cell damage", "C": "Th1 cell-mediated nerve sheath damage", "D": "Lymphocytic infiltrate of the endoneurium", "language": "en"}
{"question": "A 30-year-old man visits his physician with thoughts that he ‘is not real’ which occurred suddenly and have persisted for weeks. The patient states that, 3 weeks ago, he witnessed an armed robbery in which he saw a person get shot in the chest. The patient states that at the time the shot was fired, he felt as though he ‘wasn’t in the room’ and as if he was ‘floating above watching it all happen’ below him. Ever since the event, he has been having similar experiences without provocation. He states that now, seemingly out of nowhere, he will have a sudden feeling that he is ‘perceiving life as a dream’. He now seeks help to control these feelings of depersonalization. Which of the following would be the best course of treatment for this patient?", "answer": "Psychotherapy", "meta_info": "step2&3", "answer_idx": "D", "A": "Amantadine", "B": "Butorphanol", "C": "Dextromethorphan", "D": "Psychotherapy", "language": "en"}
{"question": "A 9-year-old boy presents with recent onset worsening performance in school and facial lesions that look like acne. Past medical history is significant for developmental delays and infantile spasm. No current medications. On physical examination, there are facial papulonodular lesions (as shown in the image), pitting of dental enamel, and multiple hypomelanotic oval macules over the torso. Which of the following genes is most likely impaired in this patient?", "answer": "TSC", "meta_info": "step1", "answer_idx": "B", "A": "VHL", "B": "TSC", "C": "NF1", "D": "GNAQ", "language": "en"}
{"question": "A 14-year-old girl is brought to the emergency department because of occipital headache, nausea, and vomiting for the last 2 hours. She has a multi-year history of frequent left ear infections and discharge, with poor response to antimicrobial therapy. She has muffled hearing in the left ear. Her blood pressure is 134/78 mm Hg, the pulse is 83/min, the respiratory rate is 16/min, and the temperature is 36.5°C (97.7°F). She is alert and oriented. Physical examination of the left ear shows perforation of the tympanic membrane, granulation tissue, and white keratinaceous debris in the posterosuperior quadrant of the tympanic membrane. An MRI shows evidence of sigmoid sinus thrombosis on the left side and a hyperintense area in the middle ear on. Which of the following is the most likely underlying cause of this patient’s current condition?", "answer": "Cholesteatoma", "meta_info": "step2&3", "answer_idx": "B", "A": "Acoustic neuroma", "B": "Cholesteatoma", "C": "Chronic serous otitis media", "D": "Chronic suppurative otitis media", "language": "en"}
{"question": "An otherwise healthy 8-year-old boy is brought to the emergency department by his mother 2 hours after the sudden onset of scrotal pain. Physical examination shows nontender testes and a tender, 5-mm, bluish nodule at the superior pole of the left testis. The patient undergoes urgent surgical exploration of the scrotum. During the operation, the nodule on the superior pole of the testis is found to be necrotic. In the process of embryologic development, this nodule forms as a result of the activity of which of the following?", "answer": "Sertoli cells", "meta_info": "step1", "answer_idx": "D", "A": "Leydig cells", "B": "Estradiol", "C": "Luteinizing hormone", "D": "Sertoli cells", "language": "en"}
{"question": "A 23-year-old woman comes to the physician for a 6-month history of dry cough, hoarseness, and chest pain. She does not smoke and has not lost weight. Laboratory studies show no abnormalities. An x-ray of the chest shows a mass that projects across the right hilum. A CT scan of the chest is shown. Which of the following is the most likely diagnosis?", "answer": "Neurofibroma", "meta_info": "step1", "answer_idx": "B", "A": "Rhabdomyosarcoma", "B": "Neurofibroma", "C": "Sarcoma", "D": "Aortic aneurysm", "language": "en"}
{"question": "A 4-year-old is brought into the emeregency room by his mother. The mother states that the child had a slight cough one week ago that has since worsened. The mother states the child's cough sounds like someone barking and states that he has also had mild fevers along with rhinorrhea. The patient's vitals are significant for a fever of 100.8 F, and his physical exam reveals inspiratory stridor. What is the most likely organism responsible?", "answer": "Parainfluenza virus", "meta_info": "step2&3", "answer_idx": "A", "A": "Parainfluenza virus", "B": "Respiratory syncytial virus", "C": "Adenovirus", "D": "Ebstein barr virus", "language": "en"}
{"question": "A researcher interested in the relationship between vaccination and autism sends a survey to parents of children who are active patients at a large primary care practice. The survey asks several questions, including whether their children received their childhood vaccines on-time, and whether their children currently have a diagnosis of an autism spectrum disorder. Which of the following correctly identifies the study design used by the researcher?", "answer": "Cross-sectional", "meta_info": "step1", "answer_idx": "A", "A": "Cross-sectional", "B": "Cohort", "C": "Randomized controlled trial", "D": "Case-control", "language": "en"}
{"question": "A 6-month-old boy is brought to the physician for a well-child examination. He was born at term, and pregnancy was complicated by prolonged labor. There is no family history of serious illness. He can sit upright without support and can roll over from the prone to the supine position. He cannot pull himself to stand. He can grasp his rattle and cannot transfer it from one hand to the other. He babbles. He cries if anyone apart from his parents holds him or plays with him. He touches his own reflection in the mirror. Vital signs are within normal limits. He is at 40th percentile for head circumference, 30th percentile for length and at 40th percentile for weight. Physical examination shows no abnormalities. Which of the following developmental milestones is delayed in this infant?", "answer": "Fine motor", "meta_info": "step2&3", "answer_idx": "A", "A": "Fine motor", "B": "Social", "C": "Gross motor", "D": "Cognitive", "language": "en"}
{"question": "A 28-year-old woman is admitted to the hospital for treatment of a displaced fracture of the femoral neck following a high-speed motor vehicle collision. She is given pentazocine for pain relief. This drug binds to heptahelical transmembrane receptors. Which of the following is the most likely effect of this drug?", "answer": "Opening of postsynaptic K+ channels", "meta_info": "step1", "answer_idx": "D", "A": "Release of presynaptic acetylcholine", "B": "Release of presynaptic norepinephrine", "C": "Opening of postsynaptic Na+ channels", "D": "Opening of postsynaptic K+ channels", "language": "en"}
{"question": "A 70-year-old man comes to the physician because of fatigue and intermittent epigastric pain. The symptoms began about one year ago. He describes the pain as diffuse and 3 out of 10 in intensity. Recently, he has had unusually large black stools. He appears pale. His pulse is 72/min and his blood pressure is 110/70 mm Hg. Physical examination shows epigastric tenderness. A urea breath test is positive. Upper gastrointestinal endoscopy reveals an ulcerating mass in the gastric antrum. Biopsies of the mass show diffuse infiltrates of small lymphoid cells that are positive for CD20 antigen. A CT scan of the chest and abdomen shows normal regional lymph nodes. Which of the following is the most appropriate therapy with curative intent at this time?", "answer": "Amoxicillin, clarithromycin, and omeprazole", "meta_info": "step2&3", "answer_idx": "D", "A": "Rituximab, cyclophosphamide, adriamycin, and vincristine", "B": "Imatinib", "C": "External beam radiation therapy", "D": "Amoxicillin, clarithromycin, and omeprazole", "language": "en"}
{"question": "A 42-year-old woman approaches your office complaining of a 1-year long persistent dysuria, increasing discomfort with bladder filling and voiding, and suprapubic pain. She further comments that she has been presenting with abdominal cramps, and alternating periods of diarrhea and constipation for the past 4 months. Her family medical history is negative for malignancies and hereditary disorders. Her personal history is relevant for various visits to the general practitioners for similar complaints that resulted in multiple antimicrobial treatments for urinary tract infection. At the moment, she is not taking any medication. Physical examination shows suprapubic tenderness as well as tender areas in the pelvic floor. The vital signs include: temperature 37.0°C (98.6°F), heart rate 68/min, blood pressure 120/58 mm Hg, and respiratory rate 13/min. Vaginal examination is normal. No adnexal masses are detected and no vaginal secretions are noticed.\nShe brings a urinalysis and a urine culture from 1 week ago that show the following:\nTest Result Normal Range\nUrine culture Negative < 100,000 CFU/mL to no bacterial growth in asymptomatic patients\nUrinalysis Density: 1.030; Leukocyte esterase (-); Nitrites (-); pH: 6.0, Presence of 4 RBCs per high power field. Density: 1.030 - 1.060; Leukocyte esterase (-), Nitrites (-), pH: 4.5 - 8.0\nWhat is the most appropriate step in this case?", "answer": "Self-care and behavior modification", "meta_info": "step1", "answer_idx": "A", "A": "Self-care and behavior modification", "B": "Admission to the ER for intravenous antibiotic administration", "C": "Urinary analgesia with phenazopyridine", "D": "Conjugated estrogens", "language": "en"}
{"question": "A 27-year-old man comes to the physician for a routine health maintenance examination. He says he feels well, but is worried because his 32-year-old brother recently had to start hemodialysis because of kidney disease. He reports that his grandfather had \"\"bad kidneys” as well. The patient does not have dysuria, hematuria, or flank pain. He has no history of serious illness. His vital signs are within normal limits. Physical examination shows no abnormalities. An ultrasound of his right kidney is shown. Which of the following is the most appropriate next step in management?\"", "answer": "Reassurance", "meta_info": "step2&3", "answer_idx": "B", "A": "Percutaneous aspiration", "B": "Reassurance", "C": "Abdominal CT scan", "D": "Partial nephrectomy", "language": "en"}
{"question": "A 45-year-old man is following up with his primary care doctor for follow up of his essential hypertension. This is his annual check-up, and he reports that he has been doing well since his appointment last year. He denies any negative side effects from his amlodipine or metformin. His physical examination is within normal limits, and his vital signs are all within normal limits, other than his blood pressure being 142/84 mm Hg. Which of the following best describes the mechanism of action for his blood pressure medication?", "answer": "Dihydropyridine calcium channel blockers preferentially bind to a vascular smooth muscle", "meta_info": "step1", "answer_idx": "A", "A": "Dihydropyridine calcium channel blockers preferentially bind to a vascular smooth muscle", "B": "Calcium channel blockers only bind to channels on cardiac muscles", "C": "Non-dihydropyridine calcium channel blockers preferentially bind to a vascular smooth muscle", "D": "Calcium channel blockers only bind to channels on the sarcoplasmic reticulum", "language": "en"}
{"question": "A 50-year-old male visits his primary care physician with skin lesions on his knees and elbows. He reports joint pain, and physical examination reveals severe swelling of the fingers on both hands. Tests for serum rheumatoid factor are negative. Which of the following pairs of adjectives most likely characterize the patient’s skin lesions:", "answer": "Silver, scaly", "meta_info": "step1", "answer_idx": "C", "A": "Honey-colored, crusting", "B": "Irregular, depigmented", "C": "Silver, scaly", "D": "Non-blanching, hemorrhagic", "language": "en"}
{"question": "A 42-year-old woman comes to the physician because of a low-grade fever and generalized fatigue for a week. During this period, she has passed decreased amounts of urine. Two months ago, she underwent a renal allograft transplant because of reflux nephropathy. There is no family history of serious illness. Her current medications include prednisone, cyclosporine, and azathioprine. Her temperature is 37.8°C (100°F), pulse is 99/min, and blood pressure is 160/94 mm Hg. Examination shows several white patches within the oral cavity. There is a well-healed surgical incision over the right lower abdomen. The remainder of the examination shows no abnormalities. Laboratory studies show:\nHemoglobin 12.1 g/dL\nLeukocyte count 6,000/mm3\nPlatelet count 156,000/mm3\nSerum\nUrea nitrogen 89 mg/dL\nGlucose 76 mg/dL\nCreatinine 3.9 mg/dL\nDonor-specific antibodies negative\nA biopsy of the allograft shows mononuclear infiltrates with tubulitis and arteritis. C4d staining is negative. Oral fluconazole is administered. Which of the following is the most appropriate next step in the management of this patient?\"", "answer": "Methylprednisolone therapy", "meta_info": "step2&3", "answer_idx": "B", "A": "Intravenous immunoglobulin therapy", "B": "Methylprednisolone therapy", "C": "Removal of graft", "D": "Plasmapheresis", "language": "en"}
{"question": "A 55-year-old woman is brought to your office for evaluation of 6 months of anal discomfort, vaginal pruritus, and soreness that worsened in the last several months. The past medical history is significant for hypertension and smoking. The family history is negative for malignancies. The physical examination is unremarkable, except for the presence of white, atrophic papules merging into an ulcerated plaque, with some of the white lesions extending and surrounding the anus (see image). You order biopsies of the lesions and a follow-up appointment. 2 weeks later, the histology evaluation reports hyperkeratosis, significant epidermal thinning, and plugging of infundibular follicles. Which of the following lesions is the patient at risk to develop?", "answer": "Differentiated squamous cell carcinoma (SCC)", "meta_info": "step1", "answer_idx": "C", "A": "Basal cell carcinoma (BCC)", "B": "Vulvar low-grade squamous intraepithelial lesion (LSIL)", "C": "Differentiated squamous cell carcinoma (SCC)", "D": "Vulvar high-grade squamous intraepithelial lesion (HSIL)", "language": "en"}
{"question": "A 32-year-old male presents to his primary care physician with complaints of chronic headaches that have developed and increased in frequency and severity over the last several months. Additionally, the patient has noted he has been less coordinated over the last few weeks, stumbling and tripping often when he is walking. Physical examination is significant for notably reduced hand grip strength bilaterally as well as decreased pain and temperature sensation along the upper back and down both arms to the hands. A referral to the appropriate specialist is made, and an MRI of the brain and neck is obtained. Results of the MRI are show in Figures A and B. Which of the following is the most likely diagnosis in this patient?", "answer": "Arnold-Chiari malformation type 1", "meta_info": "step1", "answer_idx": "A", "A": "Arnold-Chiari malformation type 1", "B": "Arnold-Chiari malformation type 2", "C": "Arnold-Chiari malformation type 3", "D": "Arnold-Chiari malformation type 4", "language": "en"}
{"question": "After hospitalization for urgent chemotherapy to treat Burkitt’s lymphoma, a 7-year-old boy develops paresthesias of the fingers, toes, and face. Blood pressure is 100/65 mm Hg, respirations are 28/min, pulse is 100/min, and temperature is 36.2°C (97.2°F). Inflating a blood pressure cuff on the boy’s arm produces carpal spasm. He has excreted 20 mL urine in the past 6 hours. Laboratory studies show the following:\nHemoglobin 15 g/dL\nLeukocyte count 6,000/mm3 with a normal differential serum\nK+ 6.5 mEq/L\nCa+ 6.6 mg/dL\nPhosphorus 5.4 mg/dL\nHCO3− 15 mEq/L\nUric acid 12 mg/dL\nUrea nitrogen 54 mg/dL\nCreatinine 3.4 mg/dL\nArterial blood gas analysis on room air:\npH 7.30\nPCO2 30 mm Hg\nO2 saturation 95%\nFebuxostat is initiated. Which of the following is the most appropriate next step in management?", "answer": "Hemodialysis", "meta_info": "step2&3", "answer_idx": "A", "A": "Hemodialysis", "B": "Intravenous 0.9% saline", "C": "Sodium bicarbonate", "D": "Orotracheal intubation", "language": "en"}
{"question": "An 84-year-old woman with an indwelling urinary catheter and a history of recurrent nephrolithiasis is brought to the emergency department from her nursing home because of increasing confusion over the past day. On arrival, she is oriented only to person. Her temperature is 38.3°C (100.9°F). Examination shows dry mucous membranes. Urine studies show:\npH 8.3\nWBC 40/hpf\nBacteria moderate\nNitrites positive\nThe urine has an ammonia odor. Which of the following is most likely to be present on this patient's urine culture?\"", "answer": "Gram-negative, oxidase-negative rods", "meta_info": "step1", "answer_idx": "D", "A": "Gram-negative, oxidase-positive rods", "B": "Gram-positive, novobiocin-resistant cocci", "C": "Gram-positive, gamma-hemolytic cocci", "D": "Gram-negative, oxidase-negative rods", "language": "en"}
{"question": "A 28-year-old woman who was recently hired at a new company feels intense physical attraction towards her supervisor. She feels he is exceptionally kind to her and finds herself fantasizing about him during work. While talking to her co-workers, she ardently raises complaints about her supervisor and declares that she finds him to be extremely repulsive, rude, and arrogant. Which of the following ego defenses is this patient most closely exhibiting?", "answer": "Reaction formation", "meta_info": "step2&3", "answer_idx": "C", "A": "Denial", "B": "Isolation of affect", "C": "Reaction formation", "D": "Repression", "language": "en"}
{"question": "An 11-year-old boy presents to his pediatrician with his mother for a sore throat. His symptoms began approximately a few days ago after attending a birthday party with his friends. His symptoms are accompanied by nausea, vomiting, and a mild headache. He also has mild discomfort in his throat when eating food or drinking water. The patient denies rhinorrhea, conjunctivitis, cough, myalgias, or a rash. His mother said his temperature last night was 101°F (38.3°C). On physical exam, the patient has tender and enlarged anterior cervical lymph nodes. Upon oral inspection, there is pharyngeal inflammation and exudates with petechial lesions on the soft palate. Which of the following is the best next step in management?", "answer": "Rapid antigen detection test", "meta_info": "step2&3", "answer_idx": "D", "A": "Azithromycin", "B": "Observation", "C": "Penicillin V", "D": "Rapid antigen detection test", "language": "en"}
{"question": "A 52-year-old male with follicular non-Hodgkin lymphoma undergoes chemotherapy. He develops suprapubic pain and hematuria. Which of the following compounds is most likely responsible for this patient's symptoms?", "answer": "Cyclophosphamide", "meta_info": "step1", "answer_idx": "A", "A": "Cyclophosphamide", "B": "Mesna", "C": "Bleomycin", "D": "Carmustine", "language": "en"}
{"question": "A 68-year-old man comes to the physician because of a 1-week history of difficulty with urination. Two weeks ago, he was hospitalized for treatment of a cerebrovascular accident; his symptoms began after he was discharged. His vital signs are within normal limits. Neurologic examination shows mild dysarthria, right facial droop, and right hemiparesis. Rectal examination shows a normal prostate. The patient produces 70 mL of urine for a sample. Placement of a Foley catheter yields an additional 500 mL of urine. Which of the following is the most appropriate pharmacotherapy for this patient?", "answer": "Muscarinic agonist", "meta_info": "step1", "answer_idx": "A", "A": "Muscarinic agonist", "B": "Muscarinic antagonist", "C": "Alpha-1 receptor agonist", "D": "5-alpha-reductase inhibitor", "language": "en"}
{"question": "A 61-year-old woman presents with painless vaginal bleeding. Patient says the bleeding has been occurring occasionally for the past 3 years. Past medical history is significant for diabetes mellitus type 2 and hypertension, both managed medically. Current medications are atorvastatin, lisinopril, hydrochlorothiazide, and metformin. Patient has not been sexually active since the death of her husband 9 years ago. Menopause occurred 8 years ago, and she denies taking hormone replacement therapy or estrogen-containing oral contraceptives. Her last Pap smear 1 year ago was normal. Vital signs are temperature 37.0℃ (98.6℉), blood pressure 130/85 mm Hg, pulse 82/min, respiratory rate 13/min, and oxygen saturation 99% on room air. BMI is 33.8 kg/m2. On physical examination, patient is alert and cooperative. Cardiac exam is normal. Lungs are clear to auscultation. Abdomen is soft and non-tender with no masses or hepatosplenomegaly. Examination of the perineum shows pale, atrophic vaginal mucosa. Speculum examination shows no vaginal or cervical lesions. The cervix is movable and non-tender. There is trace blood in the vaginal vault and mild bleeding from the cervical os. The uterus is not enlarged but softened on palpation. Adnexa is non-palpable. Which of the following is the next best diagnostic step in this patient?", "answer": "Endometrial biopsy", "meta_info": "step2&3", "answer_idx": "C", "A": "Hysteroscopy", "B": "Pap test", "C": "Endometrial biopsy", "D": "Pelvic MRI", "language": "en"}
{"question": "A 20-year-old African American woman presents to the clinic after missing her last 2 periods. Her cycles are usually regular, occurring at 28–32 day intervals with moderate bleeding and some abdominal discomfort. She also complains of occasional diffuse and generalized headaches. She is a college student and works part-time as a bartender. The past medical history is benign. The blood pressure is 110/70 mm Hg, the pulse is 80/min, the respiratory rate is 14/min, and the temperature is 36.5°C (97.7°F). The physical examination is significant for mild breast tenderness and secretions from the nipple area. A urine pregnancy test is negative. Which of the following is the best initial step in her management?", "answer": "Serum prolactin levels", "meta_info": "step2&3", "answer_idx": "B", "A": "MRI of the brain", "B": "Serum prolactin levels", "C": "LH:FSH ratio", "D": "Dopamine agonists", "language": "en"}
{"question": "A 50-year-old man comes to the physician because of an 8-month history of intermittent watery diarrhea and abdominal pain. He has had a 12-kg (26-lb) weight loss during this period. He has also had episodic pain of the ankle, wrist, and knee joints during the past 5 years. An endoscopy with small bowel biopsy is performed. Histopathologic examination of a tissue specimen shows foamy macrophages in the lamina propria with periodic acid-Schiff (PAS)-positive inclusions. Further evaluation is most likely to show which of the following?", "answer": "Intracellular, gram-positive bacilli", "meta_info": "step1", "answer_idx": "C", "A": "Anti-tissue transglutaminase antibodies", "B": "Anti-cyclic citrullinated peptide antibody", "C": "Intracellular, gram-positive bacilli", "D": "Low serum TSH and high free T4 concentrations", "language": "en"}
{"question": "A 49-year-old woman comes to the physician because of a growing lump in the right breast that she first noticed 1 month ago. Physical examination of the right breast shows a 3.5-cm firm, fixed mass in the right upper quadrant. There is dimpling of the overlying skin. A mammogram shows a mass with poorly-defined margins and microcalcifications. Immunohistochemical analysis of a biopsy specimen from the mass shows malignant cells that stain negative for estrogen and progesterone receptors and positive for human epidermal growth factor receptor 2. The drug that most specifically targets this patient's tumor is also used in the treatment of which of the following conditions?", "answer": "Gastric cancer", "meta_info": "step1", "answer_idx": "B", "A": "Multiple sclerosis", "B": "Gastric cancer", "C": "Osteoporosis", "D": "Rheumatoid arthritis", "language": "en"}
{"question": "A 17-year-old girl is brought to the physician because her mother is concerned about her lack of appetite. She has had a 4-kg (8.8-lb) weight loss over the past 4 months. The patient states that she does not “feel like eating so much”. Over the last year her academic performance in school has decreased and she has had a lot of disputes with her parents concerning her future. Her mother says that she has also become more nervous and restless. Her grandmother had a problem with her thyroid. She is sexually active with two male partners and uses condoms inconsistently. She is at 60th percentile for height and at 15th percentile for weight. She appears thin. Her temperature is 37°C (98.6°F), pulse is 104/min, and blood pressure is 135/80 mm Hg. The pupils are 9 mm large, round and minimally reactive to light. Deep tendon reflexes are 2+ bilaterally. There is fine tremor of her hands. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in diagnosis?", "answer": "Obtain toxicology screening", "meta_info": "step2&3", "answer_idx": "C", "A": "Measure serum electrolytes", "B": "Perform abdominal ultrasound", "C": "Obtain toxicology screening", "D": "Obtain HIV screening test", "language": "en"}
{"question": "An 11-year-old male presents to the pediatrician to be evaluated for learning difficulties. His parents report that the patient’s grades have been falling since he started middle school this year. The patient previously attended a smaller elementary school that focused more on the arts and creative play. His parents report that at home the patient bathes and dresses himself independently but requires help with more difficult tasks, such as packing his backpack and making a schedule for homework. He enjoys reading comic books and playing video games. The patient’s parents report that he said his first word at 19 months and walked at 21 months. His mother notes that she herself struggled to pay attention in her classes and completed college in six years after taking a reduced course load. On physical exam, the patient has a long, narrow face with large ears. His testicles are larger than expected for his age. Which of the following additional findings is most likely to be found in this patient’s history?", "answer": "Poor reciprocal emotional behavior", "meta_info": "step2&3", "answer_idx": "D", "A": "Compulsive completion of rituals", "B": "Cruelty to animals or fire-setting", "C": "Difficulty seeing the board at school", "D": "Poor reciprocal emotional behavior", "language": "en"}
{"question": "A 17-year-old girl comes to the primary care clinic with her father complaining of right knee pain. She reports that the pain started about a month ago, and since then it has gotten progressively worse. The knee pain is not constant but becomes most noticeable when going up or down the stairs. She also endorses that her knee becomes uncomfortable towards the end of class. Her father is worried because the pain is affecting her ability to play basketball, and she has college scouts coming to watch her play. The patient has no chronic medical conditions. She had a tonsillectomy as a child. She takes a multivitamin and uses ibuprofen as needed for the pain. On physical examination, there is tenderness at the inferior pole of the patella, without swelling or overlying skin changes. Which of the following is the most likely diagnosis?", "answer": "Patellar tendonitis", "meta_info": "step2&3", "answer_idx": "C", "A": "Osgood-Schlatter disease", "B": "Patellar stress fracture", "C": "Patellar tendonitis", "D": "Patellofemoral syndrome", "language": "en"}
{"question": "A 60-year-old man presents to the physician for his 10-year colonoscopy screening. He has no complaints except for occasional diarrhea and dribbling of urine. He says that he is on a healthy diet and exercises 3 days a week. He quit smoking 5 years ago after smoking 1 pack of cigarettes per day for 20 years. He has hypertension and dyslipidemia. He has benign prostatic hyperplasia that was diagnosed last year. On physical examination, his abdomen is lax with no tenderness or rigidity. Rectal examination reveals no blood in the rectal vault. Colonoscopy reveals a 4 x 3 cm polyp in the sigmoid colon. Multiple biopsies are obtained and sent for pathologic examination. Genetic testing reveals a mutation in the KRAS gene. Which of the following pathological type of polyp does this patient most likely have that also puts him at higher risk of malignancy?", "answer": "Villous adenomatous polyps", "meta_info": "step1", "answer_idx": "B", "A": "Hamartomatous polyps", "B": "Villous adenomatous polyps", "C": "Tubular adenomatous polyps", "D": "Hyperplastic polyps", "language": "en"}
{"question": "A 20-year-old healthy female volunteer is enrolled in a study involving renal perfusion. The medical history is unremarkable and she takes no medications. She denies smoking, drinking, and drug use. The family history is unremarkable. The physical examination reveals no abnormal findings. A drug which is known to selectively act on a segment of the renal vasculature is administered and the glomerular filtration rate (GFR) and filtration fraction (FF) both increase. Which of the following could be the mechanism of action of the administered drug?", "answer": "Efferent arteriole constriction", "meta_info": "step1", "answer_idx": "A", "A": "Efferent arteriole constriction", "B": "Renal artery constriction", "C": "Increased peritubular capillary permeability", "D": "Afferent arteriole constriction", "language": "en"}
{"question": "A 3-year-old male is brought to the emergency room by his mother for a rash and fever. The mother reports that the child first developed a cough and malaise three days ago. Over the last 24 hours, a rash developed and the patient had a temperature up to 101.4°F (38.6°C) the night prior to presentation. The child’s medical history is notable for a prior hospitalization at the age of 2 for fever, vomiting, and lethargy. During that hospitalization, a cerebrospinal fluid sample demonstrated gram-negative diplococci. His current temperature is 100.9°F (38.3°C), blood pressure is 130/85 mmHg, pulse is 115/min, and respirations are 22/min. Physical examination reveals a lethargic male child with a diffuse petechial skin rash that is most prominent on the trunk and legs. This patient most likely has a deficiency in which of the following factors?", "answer": "C5", "meta_info": "step1", "answer_idx": "D", "A": "C1q", "B": "C3", "C": "C4", "D": "C5", "language": "en"}
{"question": "A 13-month-old boy is brought to the physician for the evaluation of rectal bleeding that occurred earlier that morning. The patient has also had several itchy and red skin lesions that started on his scalp and spread downwards. The parents report that their son has had six episodes of bilateral otitis media since birth. His immunizations are up-to-date. He is at the 3rd percentile for height and weight. His vital signs are within normal limits. Examination shows several eczematous lesions over the scalp, neck, and upper and lower extremities, as well as multiple red spots that do not blanch on pressure. The remainder of the physical examination shows no abnormalities. Laboratory studies show:\nHemoglobin 9.4 g/dL\nLeukocyte count 11,500/mm3\nPlatelet count 30,000/mm3\nProthrombin time 14 sec\nPartial thromboplastin time 33 sec\nWhich of the following is the most likely diagnosis?\"", "answer": "Wiskott-Aldrich syndrome", "meta_info": "step2&3", "answer_idx": "D", "A": "Chronic granulomatous disease", "B": "DiGeorge syndrome", "C": "Chediak-Higashi syndrome", "D": "Wiskott-Aldrich syndrome", "language": "en"}
{"question": "A 28-year-old woman, gravida 3, para 2, at 34 weeks' gestation comes to the physician because of a 1-day history of dyspnea, dry cough, and chest pain. Her pulse is 112/min, respirations are 24/min, and blood pressure is 108/78 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 90%. Examination shows jugular venous distention and bilateral pitting edema below the knees that is worse on the right side. There is dullness to percussion over the right lung base. Which of the following is the most likely diagnosis?", "answer": "Pulmonary embolism", "meta_info": "step1", "answer_idx": "A", "A": "Pulmonary embolism", "B": "Panic attack", "C": "Bacterial pneumonia", "D": "Acute pericarditis", "language": "en"}
{"question": "A 55-year-old man comes to the physician for a follow-up examination. One month ago, he underwent a right-sided kidney transplantation due to severe polycystic kidney disease. Following the procedure, he was started on transplant rejection prophylaxis. He has had some chest and back pain as well as frequent coughing. He has also had 5–6 bowel movements per day of loose stool and occasional vomiting. He appears pale. Temperature is 37°C (98.6°F), pulse is 80/min, and blood pressure is 155/90 mm Hg. Physical examination shows lower extremity pitting edema. Laboratory studies show:\nHemoglobin 10 g/dL\nLeukocyte count 2,500/mm3\nPlatelet count 80,000/mm3\nSerum\nUrea nitrogen 30 mg/dL\nGlucose 150 mg/dL\nWhich of the following is the most likely underlying cause of this patient's symptoms?\"", "answer": "Mycophenolate mofetil", "meta_info": "step2&3", "answer_idx": "C", "A": "Tacrolimus", "B": "Daclizumab", "C": "Mycophenolate mofetil", "D": "Azathioprine", "language": "en"}
{"question": "A 2-year-old boy with a history of multiple hospitalizations for fever and infection undergoes immunologic evaluation. Serum CH50 assay shows inappropriately low erythrocyte lysis and further workup confirms C8 deficiency. This patient is at increased risk for recurrent infections with which of the following pathogens?", "answer": "Neisseria species", "meta_info": "step1", "answer_idx": "A", "A": "Neisseria species", "B": "Giardia species", "C": "Pneumocystis species", "D": "Mycobacterium species\n\"", "language": "en"}
{"question": "A 55-year-old man is brought to the emergency department because of cough and poor appetite for the past week. Since it began, he has been coughing up small amounts of malodorous phlegm. During the past two nights, he has also had night sweats. He was diagnosed with HIV infection 5 years ago. He has hypertension, type 2 diabetes mellitus, and severe heartburn. The patient is homeless and does not take any medication. He has smoked a pack of cigarettes daily for 30 years. He drinks 8–10 beers daily. His temperature is 38.9°C (102.0°F), pulse is 101/min, respirations are 25/min and blood pressure is 145/92 mm Hg. The patient appears intoxicated. Physical examination shows crackles and dullness to percussion at the right lung base. Scattered expiratory wheezing is heard throughout both lung fields. A grade 2/6 mid-systolic ejection murmur is heard along the upper right sternal border. His CD4+T-lymphocyte count is 280/mm3 (Normal ≥ 500). An x-ray of the chest shows a hazy infiltrate in the right lower lung field. Which of the following is the most likely cause of this patient's symptoms?", "answer": "Aspiration pneumonia", "meta_info": "step2&3", "answer_idx": "B", "A": "Pneumocystis pneumonia", "B": "Aspiration pneumonia", "C": "Mitral valve regurgitation", "D": "Pharyngoesophageal diverticulum\n\"", "language": "en"}
{"question": "A 2-year-old boy is brought in to his pediatrician for his annual exam, flu vaccination, and to evaluate a diaper rash. The itchy pink rash has been bothering the boy for about 1 week and over the counter, remedies are not helping. He was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccines and is meeting all developmental milestones. During the discussion, his parents are frustrated by his behavior and inability to follow directions. Today, his vital signs are stable and normal for his age. On physical examination, the boy appears uncomfortable. His heart has a regular rate and rhythm and his lungs are clear to auscultation bilaterally. There is a pink-red, raised rash in the anogenital region and medial thighs. Additionally, there are multiple bruises on the boy’s buttocks and the back of his thighs. Some are healing and some are fresh. When questioned about the bruising, the parents become evasive and end the discussion. Which of the following is the next best step in the management of the child?", "answer": "To report to Child Protective Services", "meta_info": "step2&3", "answer_idx": "A", "A": "To report to Child Protective Services", "B": "To order patch testing for allergic contact dermatitis", "C": "To obtain skin scrapings for examination by light microscopy", "D": "Mupirocin cream", "language": "en"}
{"question": "A 62-year-old woman comes to the physician for the evaluation of a palpable mass in the left breast that she noticed 3 weeks ago. During this period, she has also had some left-sided blood-tinged discharge. She has hypertension, type 2 diabetes mellitus, and hypercholesterolemia. She has no children. The patient's menopause occurred at 57 years of age. Her mother died of colon cancer at the age of 65 years. The patient had smoked one pack of cigarettes daily for 30 years but quit 15 years ago. She does not drink alcohol. Her current medications include enalapril, metformin, atorvastatin, and a multivitamin. She is 165 cm (5 ft 5 in) tall and weighs 84 kg (187 lb); BMI is 30.9 kg/m2. She appears well. Her temperature is 37°C (98.6°F), pulse is 78/min, and blood pressure is 135/80 mm Hg. Examination of the breasts shows a left-sided single, nontender, firm mass with poorly defined margins in the upper outer quadrant. Biopsy of the mass confirms the diagnosis of pleomorphic lobular carcinoma in situ (LCIS) that is estrogen-receptor (ER) positive. The patient undergoes lumpectomy of the left breast and treatment with tamoxifen is started. The patient's therapy increases her risk of which of the following conditions?", "answer": "Endometrial cancer", "meta_info": "step2&3", "answer_idx": "C", "A": "Myelosuppression", "B": "Osteoporosis", "C": "Endometrial cancer", "D": "Ovarian cancer", "language": "en"}
{"question": "A confused and disoriented 32-year-old man is brought to the emergency department by his wife. He was in his usual state of health until yesterday, when he started complaining of fever and headache. This morning he was complaining of worsened headache and was acting odd, prompting his wife to bring him to the hospital. His past medical history is unremarkable. At the hospital, his temperature is 39.2°C (102.5°F), pulse is 116/min, and blood pressure is 96/64 mm Hg. Physical examination is notable for neck stiffness and a large scar across his abdomen that his wife says is from a splenectomy operation following a car accident a few years ago. He has not seen a doctor since that time. A lumbar puncture shows elevated protein, low glucose, and 1,200 WBCs with 95% polymorphonuclear cells; gram staining shows gram-positive diplococci. Which of the following is the most likely risk factor contributing to this patient's underlying diagnosis?", "answer": "Dysfunction of a single organ", "meta_info": "step2&3", "answer_idx": "B", "A": "Congenital humoral immunodeficiency", "B": "Dysfunction of a single organ", "C": "Dysfunction of multiple organs", "D": "Undiagnosed viral infection", "language": "en"}
{"question": "A group of scientists is verifying previous research on DNA replication. The diagram illustrates the theoretical DNA replication process in bacteria such as Escherichia coli. What does the letter ‘a’ represent in this process?", "answer": "Okazaki fragments", "meta_info": "step1", "answer_idx": "B", "A": "RNA Primers", "B": "Okazaki fragments", "C": "The leading strand", "D": "Replication fork", "language": "en"}
{"question": "A physician is involved in a research collaboration with a pharmaceutical company. The company invites her to give a lecture series for other physicians on new therapies in her field of expertise at a retreat center in the Caribbean. Which of the following is acceptable for the physician to accept?:\nA) Compensation for travel expenses\nB) An honorarium for speaking\nC) Assistance with preparing her presentations", "answer": "A and B", "meta_info": "step1", "answer_idx": "D", "A": "A only", "B": "B only", "C": "C only", "D": "A and B", "language": "en"}
{"question": "A 15-year-old teenager is brought to a pediatrician by his parents. They are concerned about his performance at school and have received several letters from his school noting that the adolescent has difficulty with reading and writing compared to his classmates and often misbehaves during class. A physical exam reveals some atypical findings. A Wechsler Intelligence Scale for Children (WISC) shows that the boy has a mild intellectual disability with an IQ of 84. Complete blood count and serum TSH levels are normal. After a careful review of all findings the pediatrician suspects the teenager may have a numerical chromosomal disorder and orders karyotype (see image). Which of the following set of findings were most likely found during the physical exam?", "answer": "Tall Stature and gynecomastia", "meta_info": "step1", "answer_idx": "D", "A": "Arachnodactyly, scoliosis and aortic root dilation", "B": "Short stature, broad chest and thick skin folds in neck", "C": "Short stature, hypotonia and obesity", "D": "Tall Stature and gynecomastia", "language": "en"}
{"question": "Ten days after delivery, a 1500-g (3.3-lb) male newborn is feeding poorly. He was born at 32 weeks' gestation. He has had frequent episodes of vomiting for the past 2 days. He has no fever, diarrhea, or hematemesis. He appears lethargic and is difficult to arouse. His temperature is 37°C (98.6°F), pulse is 145/min, respirations are 65/min, and blood pressure is 78/55 mm Hg. The lungs are clear to auscultation. The abdomen is hard with rebound tenderness. The patient is responsive only to painful stimuli. His hemoglobin concentration is 13.0 g/dL, leukocyte count is 10,900/mm3, and platelet count is 90,000/mm3. Arterial blood gas analysis on room air shows:\npH 7.31\nPCO2 30 mm Hg\nPO2 80 mm Hg\nO2 saturation 98%\nAn x-ray of the abdomen is shown. Which of the following is the most appropriate treatment?\"", "answer": "Exploratory laparotomy", "meta_info": "step2&3", "answer_idx": "B", "A": "Nasogastric tube gut decompression", "B": "Exploratory laparotomy", "C": "Administration of ampicillin, gentamicin, and metronidazole", "D": "Barium enema\n\"", "language": "en"}
{"question": "A 45-year-old man who underwent liver transplantation 3 months ago for chronic liver failure presents to the physician because of a backache following a fall from sitting. He is currently on immunosuppressive therapy with glucocorticoids and cyclosporine. He has no comorbidities. On physical examination, his vitals are within normal limits. He has tenderness over his lumbar spine. An X-ray of the lumbar spine shows a wedge compression fracture of the L1 vertebra. His serum testosterone and serum creatinine levels are normal. Bone mineral densitometry shows a T-score of –3.0. What is the most likely diagnosis?", "answer": "Transplantation-related osteoporosis", "meta_info": "step2&3", "answer_idx": "D", "A": "Renal osteodystrophy", "B": "Osteopenia", "C": "Osteomalacia", "D": "Transplantation-related osteoporosis", "language": "en"}
{"question": "A 56-year-old woman presents to the emergency department with acute onset of pain and redness of the skin of her right arm for the past 3 days. She has had type 2 diabetes mellitus for the past 22 years, but she is not compliant with her medications. Her temperature is 38.0°C (100.4°F), pulse is 105/min, and blood pressure is 116/74 mm Hg. On physical examination, her forearm is tender and erythematous. She is diagnosed with acute cellulitis, and intravenous clindamycin is started. On the 6th day of antibiotic therapy, the patient complains of severe watery diarrhea, fever, and abdominal tenderness without rigidity. Which of the following is the best initial diagnostic test for her current complaint?", "answer": "Polymerase chain reaction", "meta_info": "step2&3", "answer_idx": "D", "A": "Complete blood count with differential", "B": "Sigmoidoscopy or colonoscopy", "C": "Fecal occult blood test", "D": "Polymerase chain reaction", "language": "en"}
{"question": "A group of researchers attempts to determine the mean fasting triglyceride levels in patients between the ages of 30 and 60 in a suburb of Tampa, FL. Over the course of several years, the team manages to obtain the blood levels of a random sample of 10,000 volunteers who fit their inclusion criteria. The blood levels are measured and demonstrate a standard deviation of 5. Which of the following correlates with the estimated standard error of the mean for this population?", "answer": "0.05", "meta_info": "step2&3", "answer_idx": "B", "A": "0.02", "B": "0.05", "C": "0.10", "D": "0.15", "language": "en"}
{"question": "A 14-year-old girl is brought to the physician by her mother for evaluation of several bruises on her lower extremities. She has had these bruises for about 6 weeks, and the mother is concerned that she might be bullied at school. The patient has had increasing fatigue and paleness over the past several days. She has a history of recurrent generalized tonic-clonic seizures treated with carbamazepine. She appears pale and ill. Her temperature is 37.8°C (100.1°F), pulse is 115/min, and blood pressure is 100/60 mm Hg. The lungs are clear to auscultation. Examination shows a soft, nontender abdomen with no organomegaly. There are several subcutaneous purple spots on her legs bilaterally. Her hemoglobin concentration is 8.4 g/dL, leukocyte count is 2,600/mm3, platelet count is 18,000/mm3, and reticulocyte count is 0.3%. Serum electrolyte concentrations are within normal limits. Which of the following is the most likely underlying cause of this patient's symptoms?", "answer": "Adverse effect of medication", "meta_info": "step2&3", "answer_idx": "D", "A": "Immune thrombocytopenic purpura", "B": "Sickle cell disease", "C": "Systemic lupus erythematosus", "D": "Adverse effect of medication", "language": "en"}
{"question": "A 51-year-old man comes to the emergency department because of a 3-day history of shortness of breath, fever, and chills. He has no history of serious illness. His temperature is 39.5°C (103.1°F). Physical examination shows a grade 4/6, holosystolic, blowing murmur over the apex that radiates to the axilla. Crackles are heard in both lower lung fields. Examination of the extremities shows several non-tender, non-blanching, erythematous macules on the palms and soles. Histopathologic examination of these macules is most likely to show which of the following?", "answer": "Microabscesses with neutrophil infiltration of capillaries", "meta_info": "step1", "answer_idx": "A", "A": "Microabscesses with neutrophil infiltration of capillaries", "B": "Epithelioid cells with surrounding multinucleated giant cells", "C": "Cleft-like vacuoles within the arterioles", "D": "Spiral-shaped bacteria with axial filaments in the epidermis", "language": "en"}
{"question": "An investigator is studying the maternal and fetal consequences of a recent spike in benzodiazepine addiction in Ireland. She is particularly interested in whether benzodiazepine use contributes to oral cleft deformities in newborns exposed to alprazolam, clonazepam, or lorazepam during the first trimester. The investigator uses statistical data from the local demographic institute to calculate the number of newly diagnosed cases of oral cleft deformities in Ireland over the past 5 years. Which of the following terms describes the investigator's statistical measure of interest?", "answer": "Cumulative incidence", "meta_info": "step1", "answer_idx": "C", "A": "Mortality rate", "B": "Relative risk", "C": "Cumulative incidence", "D": "Attributable risk", "language": "en"}
{"question": "A 55-year-old woman comes to the office for preventive health care. She has recently migrated to the United States from Hong Kong. Her past medical history is noncontributory. She denies smoking cigarettes or drinking alcohol. She last saw a doctor at the age of 14 when she was diagnosed with appendicitis and underwent an appendectomy. Her father died of a stroke at 59 years old and her mother died of a heart attack at 66 years old. She has 2 daughters who are in good health. Temperature is 37°C (98.7°F), blood pressure is 113/85 mm Hg, pulse is 69/min, respiratory rate is 14/min, and BMI is 24 kg/m2. Cardiopulmonary and abdominal examinations are negative.\nLaboratory test\nComplete blood count\nHemoglobin 12.5 g/dL\nMCV 88 fl\nLeukocytes 5,500/mm3\nPlatelets 155,000/mm3\nBasic metabolic panel\nSerum Na+ 135 mEq/L\nSerum K+ 3.7 mEq/L\nSerum Cl- 106 mEq/L\nSerum HCO3- 25 mEq/L\nBUN 10 mg/dL\nSerum creatinine 0.8 mg/dL\nLiver function test\nSerum bilirubin 0.8 mg/dL\nAST 30 U/L\nALT 35 U/L\nALP 130 U/L (20–70 U/L)\nWhat is the next best step in management of this patient?", "answer": "Gamma glutamyl transferase", "meta_info": "step2&3", "answer_idx": "C", "A": "Bone scan", "B": "Ultrasonography of the abdomen", "C": "Gamma glutamyl transferase", "D": "Anti mitochondrial antibody", "language": "en"}
{"question": "A 33-year-old man presents to his primary care practitioner, complaining about the presence of white spots in both of his hands. He states that the white spots have expanded in the last few months; they are not tender nor ulcerated. His past medical history is relevant for hypothyroidism. Upon physical examination, the patient shows hypopigmented macules on both hands and on the back and shoulders adjacent to a patch of skin, with signs of excoriation and scratching. Under the Wood’s lamp, the skin lesions on the hands, back, and shoulders show fluorescence. There are no signs of inflammation in any of the skin lesions. The vital signs of the patient are within normal limits. Which is the most likely diagnosis of this condition?", "answer": "Vitiligo", "meta_info": "step2&3", "answer_idx": "A", "A": "Vitiligo", "B": "Tinea versicolor", "C": "Pityriasis alba", "D": "Halo nevus", "language": "en"}
{"question": "A 3-year-old boy is brought to the emergency department by his mother. He started violently coughing, wheezing, and having difficulty breathing about 10 minutes ago. She had briefly left him lying on his back playing with toys and when she returned he was choking. She attempted the Heimlich maneuver with no improvement. He has a heart rate is 120/min, respiratory rate is difficult to evaluate, blood pressure of 110/65 mm Hg, and temperature of 37.0°C (98.6°F). A respiratory exam reveals wheezing and decreased breath sounds on the right side. A stat chest X-ray is ordered. Which of the following is the most likely site where the aspirated foreign body is lodged?", "answer": "Posterior segment of the right upper lobe", "meta_info": "step1", "answer_idx": "B", "A": "Basilar segment of the right upper lobe", "B": "Posterior segment of the right upper lobe", "C": "Basilar segment of the left lower lobe", "D": "Basilar segment of the right lower lobe", "language": "en"}
{"question": "A 38-year-old man presents with weakness, loss of appetite, headaches, and irritability. He developed these symptoms gradually over the past 4 months. He was diagnosed with Crohn’s disease, which was moderate at the time of diagnosis 6 months ago. He takes methotrexate 15 mg, which effectively controls his symptoms. The patient’s vital signs include: blood pressure 105/70 mm Hg, heart rate 102/min, respiratory rate 16/min, and temperature 36.4℃ (97.5℉). On physical examination, the patient is pale. His lungs are clear to auscultation. His heart sounds are rhythmic; a short early systolic murmur can be heard over the apex of the heart. The rest of the exam is unremarkable. The patient’s blood test shows the following findings:\nErythrocytes 2.7 x 109/mm3\nHb 9.3 g/dL\nHct 37%\nMean corpuscular hemoglobin  45.2 pg/cell (2.8 fmol/cell)\nMean corpuscular volume 122 µm3 (122 fL)\nReticulocyte count 0.4%\nTotal leukocyte count 3050/mm3\nNeutrophils 62%\nLymphocytes 32%\nEosinophils 1%\nMonocytes 5%\nBasophils 0%\nPlatelet count 199,000/mm3\nWhich of the following drugs should be prescribed to this patient?", "answer": "Folic acid", "meta_info": "step1", "answer_idx": "D", "A": "Riboflavin", "B": "Niacin", "C": "Pyridoxine", "D": "Folic acid", "language": "en"}
{"question": "A 75-year-old man with coronary artery disease and mitral valve stenosis status-post coronary artery bypass graft and mitral bioprosthetic valve replacement is evaluated in the intensive care unit. His postsurgical course was complicated by ventilator-associated pneumonia and bilateral postoperative pleural effusions requiring chest tubes. He has been weaned from the ventilator and has had his chest tubes removed but has required frequent suctioning to minimize aspirations. He has been dependent on a percutaneous gastrostomy tube for enteral nutrition for the past four weeks. He is currently on aspirin, carvedilol, atorvastatin, ceftazidime, and pantoprazole. He has a history of prostate cancer status post radical prostatectomy. His temperature is 96°F (35.6°C), blood pressure is 95/55 mmHg, pulse is 50/min, and respirations are 20/min. On physical exam, he is not alert and oriented but responds with moans when stimulated. His laboratory data are listed below:\n\nSerum:\nNa+: 145 mEq/L\nCl-: 110 mEq/L\nK+: 3.4 mEq/L\nHCO3-: 26 mEq/L\nBUN: 10 mg/dL\nGlucose: 112 mg/dL\nCreatinine: 1.4 mg/dL\nThyroid-stimulating hormone: 10 µU/mL\nCa2+: 11.1 mg/dL\nPO4-: 1.0 mg/dL\nAST: 6 U/L\nALT: 10 U/L\nAlbumin: 2.5 mg/dL\nLactate dehydrogenase: 200 U/L (140-280 U/L)\nHaptoglobin: 150 mg/dL (30-200 mg/dL)\n1,25-(OH)2 D3: 10 pg/mL (15-75 pg/mL)\nParathyroid hormone: 9 pg/mL (10-60 pg/mL)\n\nLeukocyte count: 10,000 cells/mm^3 with normal differential\nHemoglobin: 9 g/dL\nHematocrit: 30 %\nPlatelet count: 165,000 /mm^3\n\nHis electrocardiogram and chest radiograph are shown in Figures A and B. What is the most likely cause of his hypercalcemia?", "answer": "Immobilization", "meta_info": "step2&3", "answer_idx": "B", "A": "Euthyroid sick syndrome", "B": "Immobilization", "C": "Malignancy", "D": "Primary hyperparathyroidism", "language": "en"}
{"question": "A 35-year-old woman presents for a follow-up. The patient was diagnosed with major depressive disorder 16 months ago and has tried multiple medications with no improvement, namely bupropion, fluoxetine, sertraline, and imipramine. Upon inquiry, she assures the psychiatrist that she has been fully compliant with her medications so far but stopped her current medications a few weeks back as they did not help either. Her husband suggested her to try a herbal preparation for improving her mood. She also noted that she felt temporarily better while attending her sister’s wedding last weekend, but she still remains depressed most of the times. Which of the following would be the next best step in the treatment of this patient’s depression?", "answer": "Phenelzine", "meta_info": "step1", "answer_idx": "C", "A": "St John’s Wort", "B": "Selegiline", "C": "Phenelzine", "D": "Electroconvulsive therapy", "language": "en"}
{"question": "A 17-year-old boy is brought in by paramedics to the emergency department. He was found down at a family picnic. The boy's parents state that he tried many new foods at the picnic. Additionally, because it is springtime, many insects were out while he was playing football. His temperature is 99.5°F (37.5°C), blood pressure is 127/68 mmHg, pulse is 120/min, respirations are 33/min, and oxygen saturation is 84% on room air. Physical exam is notable for tachycardia and very minimal breath sounds bilaterally. No jugular venous distention is noted and an abdominal exam is within normal limits. Which of the following best describes an effect of the next best step in management?", "answer": "Decreased serum potassium", "meta_info": "step1", "answer_idx": "A", "A": "Decreased serum potassium", "B": "Equilibration of environmental and chest cavity pressure", "C": "Hypoglycemia", "D": "Increased systemic vascular resistance", "language": "en"}
{"question": "A 45-year-old woman comes to the emergency department with her 17-year-old son because she believes she has been poisoned by her ex-husband. She reports that her coffee tasted “strange” this morning. After breakfast, she then saw a black car drive by the house, which she concludes must have been her ex-husband, who also drives a black car. She says that since the divorce 3 years ago, her ex-husband has been seeking revenge and thinks that he has installed cameras in her apartment to spy on her and their son. She has never seen any of these cameras but when she is alone in the apartment, she can sometimes hear them beeping and feel them recording her. The son also reports his mother's coffee mug smelled of bitter almonds, which he suspects was cyanide. He agrees with the mother's distrust towards his father and reports that he has also occasionally heard a camera beeping but has not been able to find any cameras yet. The mother's vital signs are within normal limits. Physical examination shows no abnormalities. Arterial blood gas analysis on room air shows a pH of 7.4. Toxicology screening is negative. Which of the following is the best initial step in management?", "answer": "Examine mother and son separately", "meta_info": "step2&3", "answer_idx": "C", "A": "Ziprasidone therapy", "B": "Repetitive transcranial magnetic stimulation", "C": "Examine mother and son separately", "D": "Report the case to the authorities", "language": "en"}
{"question": "A 2-year-old boy is brought to the physician after his adoptive mother observed jerking movements of his arms and legs earlier that morning. He was adopted from an orphanage in Albania at 4 months of age. He has a history of intellectual disability. Examination shows pale skin and light blue eyes. There is a dry, eczematous, scaly rash on the extensor surfaces of the extremities. This patient is most likely deficient in which of the following enzymes?", "answer": "Phenylalanine hydroxylase", "meta_info": "step1", "answer_idx": "A", "A": "Phenylalanine hydroxylase", "B": "α-ketoacid dehydrogenase", "C": "Cystathionine synthase", "D": "Homogentisate oxidase", "language": "en"}
{"question": "A 45-year-old man comes to the physician because of a 4-month history of increased frequency of urination. He wakes up several times a night to urinate and feels fatigued during the day. He also complains of increased thirst; he drinks multiple liters of water and soda daily and still feels thirsty. Vital signs are within normal limits. Physical examination shows patches of velvety hyperpigmentation in the axilla and on the posterior neck. Laboratory evaluation in this patient is most likely to show which of the following?", "answer": "Elevated glycated hemoglobin concentration", "meta_info": "step1", "answer_idx": "B", "A": "Elevated serum thyroxine concentration", "B": "Elevated glycated hemoglobin concentration", "C": "Positive urinary leukocyte esterase", "D": "Low urine osmolality", "language": "en"}
{"question": "A 69-year-old man comes to the physician with a 9-month history of worsening shortness of breath on exertion and need to urinate at night. He occasionally has palpitations but does not have chest pain. The patient had a transient ischemic attack 5 years ago for which he underwent right-sided carotid endarterectomy. He has hypertension and type 2 diabetes mellitus. Current medications include metformin, lisinopril, aspirin, and simvastatin. He appears fatigued. His pulse is 61/min, blood pressure is 120/75 mmHg, and respirations are 25/min. Pulse oximetry shows an oxygen saturation of 96%. Examination shows cold extremities. There are no murmurs or rubs on cardiac auscultation. Fine, bilateral crackles are heard at the lung bases. There is 2+ lower extremity edema. An ECG shows sinus rhythm and known T wave inversions in leads V1 to V4. Which of the following agents is most likely to improve the patient's long-term survival?", "answer": "Eplerenone", "meta_info": "step2&3", "answer_idx": "A", "A": "Eplerenone", "B": "Ivabradine", "C": "Verapamil", "D": "Digoxin", "language": "en"}
{"question": "A 22-year-old woman presents to her primary care provider complaining of a facial rash. She says the rash began 3 weeks ago after hiking in the White Mountains of New Hampshire this summer. Since that time she has also experienced pain in her hands and wrists that is worse in the morning and accompanied by subjective fevers. She denies chest pain, shortness of breath, nausea, or vomiting. Vital signs are 99.6°F (37.6°F), blood pressure is 134/82 mmHg, pulse is 88/min, and respirations are 18/min. Examination demonstrates a rash on the patient's face that spares the nasolabial folds along with oral ulcers. The metacarpophalangeal joints are tender to palpation, and range of motion is limited by pain. Complete blood count demonstrates normocytic anemia with thrombocytopenia. Which of the following is the next best step in diagnosis?", "answer": "Anti-nuclear antibodies", "meta_info": "step2&3", "answer_idx": "C", "A": "Anti-cardiolipin antibodies", "B": "Anti-dsDNA antibodies", "C": "Anti-nuclear antibodies", "D": "Anti-Smith antibodies", "language": "en"}
{"question": "A 54-year-old man presents with fever and a painful jaw mass with a yellowish discharge. He says that he first noticed the jaw mass 6 weeks ago and that the mass has been progressively increasing in size. He reports a history of chronic alcoholism and currently takes more than 6 drinks daily. His temperature is 37.9°C (100.2°F). On physical examination, there is a 7 × 7 cm mass at the tip of the jaw bone with significant surrounding edema and sclerosis The mass is severely tender on light palpation and has a yellowish malodorous discharge. The oral cavity shows signs of very poor dentition. Laboratory analysis of the discharge reveals gram-positive anaerobic filamentous bacteria. Which of the following organisms is the most likely cause of this patient’s condition?", "answer": "Actinomyces israelii", "meta_info": "step1", "answer_idx": "B", "A": "Peptostreptococcus magnus", "B": "Actinomyces israelii", "C": "Nocardia asteroides", "D": "Eikenella corrodens", "language": "en"}
{"question": "A 57-year-old homosexual man presents to the emergency department with epigastric pain. He has presented multiple times for the same complaint in the past. The patient has a past medical history of alcoholism and is homeless. He states that his symptoms at this time are constant and occur at all times of the day and are near his baseline. He also endorses fatty and foul smelling diarrhea during this time frame. Which of the following is the best initial diagnostic test for this patient’s condition?", "answer": "CT scan", "meta_info": "step2&3", "answer_idx": "A", "A": "CT scan", "B": "Lipase", "C": "Secretin stimulation test", "D": "Stool ova and parasite analysis", "language": "en"}
{"question": "A 6-year-old boy is rushed to the emergency department after being involved in a motor vehicle accident. He has abrasions on his left knee and left elbow. His wounds are cleaned and a pressure bandage is applied. Typically, neutrophils and macrophages are attracted toward the site of injury by various chemical mediators. Which of the following cells is responsible for the initial cascade by the release of TGF-β and PDGF?", "answer": "Platelets", "meta_info": "step1", "answer_idx": "C", "A": "Mast cells", "B": "Fibroblasts", "C": "Platelets", "D": "Basophils", "language": "en"}
{"question": "A 70-year-old man comes to the emergency department after briefly losing consciousness and collapsing when rising from a chair. He did not sustain any injuries from his collapse. He has had a two-week history of dizziness upon standing. He has smoked one pack of cigarettes daily for 55 years. He drinks three beers and two glasses of whiskey daily. He currently takes dutasteride and tamsulosin for benign prostatic hyperplasia. His blood pressure is 120/80 mm Hg supine and 100/70 mm Hg one minute after standing with no change in pulse rate. Physical examination shows conjunctival pallor. On cardiac auscultation, there is a plopping sound followed by a low-pitched, rumbling mid-diastolic murmur heard best at the apex. Which of the following is the most likely cause of this patient's presentation?", "answer": "Cardiac tumor", "meta_info": "step1", "answer_idx": "C", "A": "Stokes-Adams attack", "B": "Constricted aortic valve orifice", "C": "Cardiac tumor", "D": "Left ventricular dilation", "language": "en"}
{"question": "A 6-month-old infant is brought to a pediatrician for his scheduled immunizations. The parents deny any specific current complaints, but his facial features differ from those of other children in the family. During the physical examination, the pediatrician notes that the infant’s vital signs are stable. His facial features include a medial epicanthic fold, a face that appears flat, and a flat occiput with low-set ears. The pediatrician also notes a single transverse palmar crease on both hands. An echocardiogram is performed which suggests that the infant has a congenital heart disease which is the most common form of congenital heart disease seen in children with this particular genetic disorder. Which of the following congenital heart diseases does this infant most likely present with?", "answer": "Atrioventricular septal defect", "meta_info": "step2&3", "answer_idx": "D", "A": "Supravalvar aortic stenosis", "B": "Tetralogy of Fallot", "C": "Atrial septal defect", "D": "Atrioventricular septal defect", "language": "en"}
{"question": "A 32-year-old white woman comes to the physician because of fatigue, lethargy, and swelling of the lower legs for 2 months. She reports recurrent episodes of pain in both wrists, her right knee, and her right ankle in the past year. She has had skin problems that are aggravated by exposure to sunlight for the past 18 months. She has smoked one pack of cigarettes daily for 13 years and drinks one alcoholic beverage daily. Her temperature is 37°C (98.6°F), pulse is 92/min, and blood pressure is 115/75 mm Hg. Examination shows 2+ pretibial edema bilaterally and periorbital edema. There are erythematous patches with scaling on both cheeks. Laboratory studies show:\nHemoglobin 11.2 g/dL\nLeukocyte count 8500/mm3\nPlatelet count 130,000/mm3\nSerum\nUrea nitrogen 36 mg/dL\nGlucose 77 mg/dL\nCreatinine 0.9 mg/dL\nAlbumin 2.6 mg/dL\nTotal cholesterol 275 mg/dL\nTriglycerides 180 mg/dL\nUrine\nBlood negative\nGlucose negative\nProtein 4+\nWBC 0–1/hpf\nFatty casts numerous\nA renal biopsy specimen is most likely to show which of the following?\"", "answer": "Thickened capillary loops", "meta_info": "step2&3", "answer_idx": "A", "A": "Thickened capillary loops", "B": "Segmental sclerosis", "C": "Crescent formation", "D": "Hypercellular glomeruli", "language": "en"}
{"question": "A 60-year-old man presents to the clinic with his wife for “weird breathing” during the night. The patient’s wife says that his breathing pattern is irregular but he does not snore. The patient says he is not aware of these symptoms. Past medical history is remarkable for an NSTEMI when he was 50 years old. He spends a night at the sleep lab where his tidal volume is monitored overnight and a tracing is shown in the image below. Which of the following is most likely responsible for this patient’s breathing pattern?", "answer": "Left ventricular heart failure", "meta_info": "step1", "answer_idx": "C", "A": "Diabetic ketoacidosis", "B": "Hypothyroidism", "C": "Left ventricular heart failure", "D": "Obesity", "language": "en"}
{"question": "A 72-year-old man with a history of chronic kidney disease presents to his primary care physician complaining of recurrent chest pain with activity. The patient used to have chest pain when he mowed his lawn. Now he gets chest pain whenever he walks short distances such as to get his mail. The pain resolves on its own when the patient sits and rests. His temperature is 98.2°F (36.8°C), blood pressure is 157/98 mm Hg, pulse is 80/min, respirations are 15/min, and oxygen saturation is 98% on room air. Physical exam is notable for an obese man who is in no distress. An initial ECG is unchanged from a previous ECG. The patient's first troponin is 0.06 ng/mL which is unchanged from previous troponins. Which of the following is the most likely diagnosis?", "answer": "Unstable angina", "meta_info": "step2&3", "answer_idx": "C", "A": "NSTEMI", "B": "Stable angina", "C": "Unstable angina", "D": "Variant angina", "language": "en"}
{"question": "A 55-year-old woman presents to the surgical oncology clinic as a new patient for evaluation of recently diagnosed breast cancer. She has a medical history of hypertension for which she takes lisinopril. She denies any surgical history. Her family history is notable for breast cancer in her maternal grandmother. She is visibly anxious during the encounter, but physical examination is otherwise unremarkable. Her primary concern today is which surgical approach will be chosen to remove her breast cancer. Which of the following procedures involves the removal of an entire breast?", "answer": "Mastectomy", "meta_info": "step2&3", "answer_idx": "B", "A": "Vasectomy", "B": "Mastectomy", "C": "Lumpectomy", "D": "Arthroplasty", "language": "en"}
{"question": "A 14-year-old female is seeing her pulmonologist in clinic after a recent asthma exacerbation. She has been adherent to her original controller medication so the physician prescribes an additional new drug which prevents IgE binding to mast cells. Which of the following did the physician add?", "answer": "Omalizumab", "meta_info": "step1", "answer_idx": "C", "A": "Theophylline", "B": "Albuterol", "C": "Omalizumab", "D": "Beclamethasone", "language": "en"}
{"question": "A 24-year-old man is brought in to the emergency room after being retrieved by firefighters from a burning building. The patient is responding coherently to questions but reports pain secondary to a burn on his leg. He states he also has a headache and feels dizzy. His temperature is 98.5°F (36.9°C), blood pressure is 129/66 mmHg, pulse is 126/min, respirations are 14/min, and oxygen saturation is 99% on room air. Physical exam is notable for a confused young man with dry and flushed skin. Cardiopulmonary exam reveals a normal S1 and S2 as well as clear breath sounds bilaterally. The patient’s neurological exam is within normal limits. Towards the end of his exam, the patient begins vomiting. Dermatologic exam reveals a superficial burn covering 1% of the patient’s body over his right leg. Which of the following is the best next step in management for this patient?", "answer": "100% oxygen", "meta_info": "step2&3", "answer_idx": "A", "A": "100% oxygen", "B": "Hydroxocobalamin", "C": "Normal saline", "D": "Ondansetron", "language": "en"}
{"question": "A 29-year-old female presents to her psychiatrist with concerns that she may be \"OCD.\" She explains that she has become extremely obsessed with making sure that her fruits and vegetables are completely sanitized by first rinsing with water for exactly 60 seconds and then boiling for exactly 60 minutes. She refuses to eat any fruits or vegetables that did not undergo this process, which she began doing about 3 months ago. Which of the following vitamin deficiencies is she most likely to develop?", "answer": "Vitamin C", "meta_info": "step1", "answer_idx": "C", "A": "Vitamin A", "B": "Vitamin K", "C": "Vitamin C", "D": "Vitamin E", "language": "en"}
{"question": "A 73-year-old male is brought to his family practitioner by his daughter with the complaints of a spinning sensation for the past 4 weeks. He says that the room appears to be continuously spinning. This has progressively worsened over the last 4 weeks to the point that he has become bed bound and cannot walk without support. These spinning sensations are present throughout the day and do not change with position. They are associated with nausea and vomiting. He denies ear pain, ear discharge, ringing in the ear, hearing disturbances, ear fullness, head trauma, fever, or recent flu-like illness. He has a blood pressure of 133/80 mm Hg, heart rate of 80/min, respiratory rate of 12/min, and temperature of 36.7°C (98.2°F). His extraocular eye movements are normal in all directions, but a vertical nystagmus is present that does not disappear despite repetitive testing. Hearing tests are within normal limits. What is the most likely diagnosis?", "answer": "Cerebellar tumor", "meta_info": "step2&3", "answer_idx": "C", "A": "Acute labyrinthitis", "B": "Benign paroxysmal positional vertigo", "C": "Cerebellar tumor", "D": "Meniere's disease", "language": "en"}
{"question": "A 79-year-old man presents to the emergency room after a syncopal event. The patient has a history of hyperlipidemia for which he is taking atorvastatin. On physical examination, his vital signs are stable, but on cardiac auscultation, you detect a crescendo-decrescendo systolic murmur loudest on the right upper sternal border radiating to the neck. On physical exam, one would also expect:", "answer": "Palpation of the carotid pulse would be weak and late relative to the patient’s heart sounds", "meta_info": "step1", "answer_idx": "D", "A": "That the murmur would best be heard in the lateral left decubitus position", "B": "The character of the murmur would be machine-like", "C": "The murmur would also have a mid-systolic click loudest before S2", "D": "Palpation of the carotid pulse would be weak and late relative to the patient’s heart sounds", "language": "en"}
{"question": "A researcher is designing a study to examine a possible correlation between exposure to a particular pesticide and chronic bronchitis. The researcher gathers all records of patients presenting with bronchitis for the past 10 years from the local hospital and contacts the qualifying subjects to ask them about exposure to the particular pesticide. Using the data he compiles, he is able to calculate an estimate for the relative and absolute risk for developing chronic bronchitis in people who have been exposed to that pesticide. Which of the following best describes this type of study design?", "answer": "Cross-sectional study", "meta_info": "step2&3", "answer_idx": "B", "A": "Case-control study", "B": "Cross-sectional study", "C": "Cohort study", "D": "Double-blind, randomized, placebo-controlled clinical trial", "language": "en"}
{"question": "A 49-year-old woman presents to her primary care physician due to fatigue and shortness of breath. She finds herself being short of breath when climbing the stairs or walking uphill. Approximately 1 year ago, she was able to partake in long-distance running and weightlifting. Two weeks ago she noticed blood-tinged sputum after severely coughing during sleep. She emigrated from Mexico to the United States 3 years ago. Her temperature is 98°F (36.7°C), blood pressure is 100/62 mmHg, pulse is 135/min and irregularly irregular, and respirations are 21/min. On physical exam her speech is hoarse. She has bilateral crackles heard in the lung bases. Which of the following will most likely be found on cardiac auscultation?", "answer": "Opening snap with a mid-to-late diastolic murmur", "meta_info": "step2&3", "answer_idx": "D", "A": "Crescendo-decrescendo systolic ejection murmur", "B": "High-pitched, early diastolic decrescendo murmur", "C": "Holosystolic, high-pitched murmur loudest at the left lower sternal border", "D": "Opening snap with a mid-to-late diastolic murmur", "language": "en"}
{"question": "A 60-year-old man presents to the physician for a follow-up examination. During the previous visit, splenomegaly was detected on the abdominal exam, which has been confirmed by abdominal ultrasound. He has no complaints other than fatigue for several months. He has no history of serious illness and takes no medications. The vital signs are within the normal range. On percussion, spleen size is 15 cm (5.9 in). Otherwise, the physical examination shows no abnormalities. The laboratory test results are as follows:\nHemoglobin 10 g/dL\nMean corpuscular volume 88 μm3\nLeukocyte count 65,000/mm3\nPlatelet count 500,000/mm3\nThe peripheral blood smear shows a predominance of neutrophils and the presence of band cells, myelocytes, promyelocytes, and blasts (< 5%). The molecular studies document the BCR-ABL1 rearrangement. Which of the following is the most appropriate pharmacotherapy at this time?", "answer": "Imatinib", "meta_info": "step2&3", "answer_idx": "C", "A": "All-trans retinoic acid", "B": "Aspirin", "C": "Imatinib", "D": "Hydroxyurea", "language": "en"}
{"question": "A 45-year-old man presents to the outpatient unit with a complaint of lower extremity edema for the past few weeks. He has also been observing puffiness of the face lately. The urinalysis shows 4+ proteinuria. The serum creatinine is 3.5 mg/dL, and antinuclear antibodies are absent. The biopsy findings are given in the picture. What is the most likely cause of the following findings?", "answer": "Membranous glomerulonephritis", "meta_info": "step1", "answer_idx": "D", "A": "Membranoproliferative glomerulonephritis", "B": "Rapidly progressive glomerlonephritis", "C": "Postinfectious glomerulonephritis", "D": "Membranous glomerulonephritis", "language": "en"}
{"question": "A 2-year-old male is brought to his pediatrician by his parents because of a lack of testes in his scrotum. Physical examination confirms that testes are absent from the scrotal sac and palpable masses are found bilaterally around the inguinal canal. If the child’s condition is left untreated, levels of which of the following hormones is most likely to be decreased most when the child reaches sexual maturity?", "answer": "Inhibin", "meta_info": "step1", "answer_idx": "C", "A": "FSH", "B": "LH", "C": "Inhibin", "D": "Prolactin", "language": "en"}
{"question": "A 23-year-old man presents to the emergency department by ambulance after being rescued from a burning house. The patient was intubated in the field and is maintaining his oxygen saturation above 98%. Physical exam reveals partial or full-thickness burns across an estimated 30% of his total body surface area. His weight is 70 kg. Which of the following is the volume of isotonic fluid that should be given to this patient over the next 24 hours?", "answer": "8,400 mL", "meta_info": "step2&3", "answer_idx": "C", "A": "1,100 mL", "B": "4,200 mL", "C": "8,400 mL", "D": "16,800 mL", "language": "en"}
{"question": "A 28-year-old G1P0 primigravida woman at 28 weeks estimated gestational age presents for routine prenatal care. She has no complaints and says she can feel her baby move and respond to outside sounds. The patient has no significant past medical or family history. Currently, she is taking a prenatal multivitamin which contains iron and folic acid. Her blood type is A (-) negative, and her husband is A (+) positive. The patient says she stopped drinking alcohol 2 years ago and denies any history of smoking or recreational drug use. Her pulse is 90/min, blood pressure is 114/68 mm Hg, and respiratory rate is 18/min. She has gained 9.0 kg (19.8 lb) over the course of the pregnancy. Physical examination shows a gravid uterus, extending 28 cm above the pubic symphysis. Occasional movements are observed in the abdomen. There is no guarding or tenderness to palpation. Fetal heart sounds can be auscultated. The remainder of the examination is unremarkable. The patient is administered an injection of RhO(D) immunoglobulin (RhoGAM). Which of the following statements best describes the rationale for administering RhO(D) immunoglobulins (RhoGAM) in this patient?", "answer": "RhO(D) immunoglobulins will prevent anti-D antibody formation in the mother.", "meta_info": "step1", "answer_idx": "C", "A": "RhO(D) immunoglobulin will prevent hemolytic disease in this pregnancy.", "B": "The father requires RhO(D) immunoglobulin administration rather than the patient.", "C": "RhO(D) immunoglobulins will prevent anti-D antibody formation in the mother.", "D": "RhO(D) immunoglobulins will prevent anti-D antibody formation in the fetus.", "language": "en"}
{"question": "A 51-year-old man comes to the physician for evaluation of inability to attain an erection during sexual activity for 6 months. He has had an active sexual life in the past. He reports that early morning erections are present every other day. He has a history of hypertension and diabetes mellitus. His wife recently filed for divorce. He has smoked one pack of cigarettes daily for 25 years. His only medications are enalapril and metformin. Physical examination shows no abnormalities. The underlying cause of this patient's condition is best classified as which of the following?", "answer": "Psychogenic", "meta_info": "step1", "answer_idx": "C", "A": "Hormonal", "B": "Neurogenic", "C": "Psychogenic", "D": "Vascular", "language": "en"}
{"question": "A 49-year-old G4P4 woman comes to the clinic complaining of repeated leakage of fluid from her vagina for the past 5 months. She noticed an increase in episodes following her cold last week when she was coughing and sneezing a lot. Her past medical history is significant for Crohn disease, which is well controlled with sulfasalazine. Her last menstrual period was 1 year ago. She is currently sexually active with multiple partners with inconsistent condom use. She denies any vaginal itching, abnormal discharge, pain, subpubic pressure, urinary urges, or odors. Physical examination is significant for a bulge at the anterior vaginal wall. What is the most likely explanation for this patient’s symptoms?", "answer": "Prolapse of the bladder", "meta_info": "step1", "answer_idx": "A", "A": "Prolapse of the bladder", "B": "Detrusor muscle overactivity", "C": "Genitourinary syndrome of menopause", "D": "Rectovaginal fistula", "language": "en"}
{"question": "A 24-year-old woman presents to a physician with recurrent episodes of palpitations, shortness of breath, and perspiration. The episodes are self-limited and are usually preceded by specific social circumstances that she does not enjoy. There is no significant past medical history. After a complete history and physical examination, the physician diagnoses an anxiety disorder. He explains that anxiety is associated with the stimulation of the sympathetic nervous system which produces several symptoms related to anxiety such as tachycardia. Which of the following cellular mechanisms best explains the effects of stimulation of sympathetic cardiac nerves on the pacemaker cells in the sinoatrial node?", "answer": "Facilitation of If currents through HCN channels", "meta_info": "step1", "answer_idx": "C", "A": "Decreased intracellular cyclic adenosine monophosphate (cAMP) level in the sinoatrial node", "B": "Inactivation of L-type voltage-gated calcium channels", "C": "Facilitation of If currents through HCN channels", "D": "Opening of G-protein activated potassium channels", "language": "en"}
{"question": "A 14-year-old boy is brought to the office by his parents because he states that for the past 2 months he has been feeling constantly tired, and also noticed a dull pain in the pit of his stomach. The patient has no relevant family history. The vital signs include a heart rate of 105/min, a respiratory rate of 16/min, a temperature of 37.0°C (98.6°F), and a blood pressure of 111/66 mm Hg. On physical exam, the abdomen is distended with hepatomegaly 5 cm underneath the xiphoid process. The complete blood count results are as follows:\nHemoglobin 17.6 g/dL\nHematocrit 64%\nRBC 6.02 x 1012/L\nLeukocyte count\n26,300/mm3\nNeutrophils 55%\nBands 2%\nEosinophils 1%\nBasophils 0%\nLymphocytes 29%\nMonocytes 2%\nPlatelet count 480,000/mm³\nErythropoietin < 1.0 mU/mL\nThe coagulation test results are as follows:\nPartial thromboplastin time (activated) 30.9 s\nProthrombin time 14.0 s\nThe abdominal Doppler ultrasound imaging is shown in the picture. What is the most likely etiology of this patient’s diagnosis?", "answer": "Polycythemia vera", "meta_info": "step1", "answer_idx": "D", "A": "Behçet's syndrome", "B": "Protein C deficiency", "C": "Factor V Leiden mutation", "D": "Polycythemia vera", "language": "en"}
{"question": "A 17-year-old girl is presented to the clinic by her mom for hair loss. Both the girl and her mom have noted random patches of hair loss across the girl's scalp, eyebrows, and eyelashes, 1st appearing several months ago. The girl has noticed no other symptoms, though the spots of hair loss are sometimes sore. On further questioning, the girl shares that she has been very stressed lately about getting good grades and applying to colleges. She knows she needs to do well on all of her homework in order to get into a good college, so she has sometimes had to stay up late into the night to rewrite her homework over and over again so that they are 'absolutely perfect'. The physical exam shows an anxious-appearing, somewhat quiet girl. There is diffuse hair loss and thinning across her scalp, with many different hair shafts of different lengths. There is no discernible pattern to the hair loss. Which of the following is the best treatment for this patient?", "answer": "Cognitive-behavioral therapy", "meta_info": "step2&3", "answer_idx": "A", "A": "Cognitive-behavioral therapy", "B": "Intralesional steroids", "C": "Oral griseofulvin", "D": "Systemic steroids", "language": "en"}
{"question": "In a town with a hepatitis B prevalence of 4%, a new screening test is introduced as part of a study. The first round of the study detects cases of hepatitis B using the new test, which has a sensitivity of 99% and a specificity of 77%. In the second round of the study, the same test is used again in a different population with a hepatitis B prevalence of 29%. Which of the following best describes the findings obtained from the study?", "answer": "The positive predictive value would increase in the second round.", "meta_info": "step1", "answer_idx": "A", "A": "The positive predictive value would increase in the second round.", "B": "The sensitivity would decrease in the second round.", "C": "The negative predictive value would increase in the second round.", "D": "The positive likelihood ratio would increase in the second round.", "language": "en"}
{"question": "A 5-year-old girl is brought to the physician for a well-child examination. Her mother says she has been having trouble sleeping for 3 weeks because of pruritus in her genital area. The girl has otherwise been feeling well. She is at the 45th percentile for height and 51st percentile for weight. Vital signs are within normal limits. Pelvic examination shows erythema of the vulva and perianal region. There is no vaginal discharge. Which of the following is the most appropriate next step in management?", "answer": "Perianal cellophane-tape examination", "meta_info": "step2&3", "answer_idx": "B", "A": "Potassium hydroxide preparation", "B": "Perianal cellophane-tape examination", "C": "Cultures for chlamydia and gonorrhea", "D": "Stool microscopy", "language": "en"}
{"question": "A 25-year-old man comes to the emergency department because of left flank pain for 2 hours. The pain is colicky in nature and he describes it as 8 out of 10 in intensity. He has nausea and has vomited once. He had a similar episode 6 months ago for which he took naproxen. There is no personal or family history of serious illness. He is a second-year medical student and has been consuming more coffee and energy drinks than normal to stay awake and study for the past 2 days. He does not smoke or drink alcohol. He takes no medications. His temperature is 37.3°C (99.1°F), pulse is 98/min, and blood pressure is 124/78 mm Hg. The abdomen is soft and nontender. Examination of the back shows no costovertebral angle tenderness. The remainder of the examination shows no abnormalities. Urinalysis is unremarkable. Which of the following is the most likely underlying cause of this patient's symptoms?", "answer": "Ureteropelvic junction obstruction", "meta_info": "step2&3", "answer_idx": "C", "A": "Bilateral renal cysts", "B": "Glomerular IgA deposits", "C": "Ureteropelvic junction obstruction", "D": "Ascending urinary tract infection\n\"", "language": "en"}
{"question": "An otherwise healthy 6-year-old boy presents for a follow-up visit to his pediatrician's office for persistent nocturnal enuresis. He has never been dry at night and throughout the last year the pediatrician has seen him multiple times for this issue. He and his family have tried not drinking liquids 2 hours before bed, bed wetting alarms, and a reward sticker chart with limited success. His 2 older brothers had nocturnal enuresis that resolved on its own when they were 8 years of age, but the patient often sleeps over at a friend's house and is very bothered by this problem. He has 1 soft stool a day, denies abdominal pain, dysuria, or frequency, and has been continent during the day since 3 years of age. He has a completely normal physical exam, urinalysis, and basic metabolic panel. What is the next best step in management?", "answer": "Desmopressin", "meta_info": "step2&3", "answer_idx": "B", "A": "Cognitive behavioral therapy", "B": "Desmopressin", "C": "Imipramine", "D": "Oxybutynin", "language": "en"}
{"question": "A 41-year-old woman presents with acute right flank pain for the past 6 hours. She says the pain is severe, colicky, ‘comes in waves’, and is localized to the right flank. She also has associated nausea and vomiting. The patient is afebrile, and her vital signs are within normal limits. On physical examination, she is writhing in pain and moaning. There is severe right costovertebral angle tenderness. Gross hematuria is present on urinalysis. A noncontrast CT of the abdomen and pelvis reveals a 4-mm-diameter radiopaque stone obstructing the right ureteropelvic junction. Aggressive IV fluid hydration is started, and ondansetron is administered. Which of the following is the next best step in the management of this patient?", "answer": "Hydrocodone/acetaminophen", "meta_info": "step2&3", "answer_idx": "D", "A": "Renal ultrasound", "B": "24-hour urine chemistry", "C": "Potassium citrate", "D": "Hydrocodone/acetaminophen", "language": "en"}
{"question": "A 36-year-old female presents with a 6-month history of stiffness in her joints. She reports bilateral knee pain that is worse in the morning prior to activity and stiffness of the fingers in both hands. Anti-CCP antibody tests are positive. Over several months, the patient's symptoms prove unresponsive to NSAIDs and methotrexate, and the decision is made to begin infliximab. Which of the following drugs has the most similar mechanism to inflixmab?", "answer": "Trastuzumab", "meta_info": "step1", "answer_idx": "C", "A": "Imatinib", "B": "Cyclophosphamide", "C": "Trastuzumab", "D": "Allopurinol", "language": "en"}
{"question": "A 55-year-old man presents to the emergency department with chest pain that started 1 hour ago and has not been improving. He has a past medical history of diabetes, hypertension, and obesity. His temperature is 98.5°F (36.9°C), blood pressure is 147/68 mmHg, pulse is 130/min, respirations are 13/min, and oxygen saturation is 100% on room air. Physical exam is notable for jugular venous distension and bilateral lower extremity pitting edema. The patient is given nitroglycerin, and his chest pain improves. Which of the following is the best explanation for this patient’s improvement in symptoms?", "answer": "Preload reduction", "meta_info": "step2&3", "answer_idx": "D", "A": "Coronary artery vasodilation", "B": "Decreased adrenergic tone", "C": "Mu receptor agonism", "D": "Preload reduction", "language": "en"}
{"question": "An investigator is studying energy metabolism in athletes. Baseline serum lactate levels at rest are recorded and repeat levels are obtained directly after a 1000-meter sprint. Compared to the baseline measurements, the serum lactate levels are significantly increased after the sprint. This increase in serum lactate is necessary to regenerate an essential cofactor for which of the following enzymes?", "answer": "Glyceraldehyde-3 phosphate dehydrogenase", "meta_info": "step1", "answer_idx": "B", "A": "Glycogen phosphorylase", "B": "Glyceraldehyde-3 phosphate dehydrogenase", "C": "Phosphofructokinase-1", "D": "Pyruvate carboxylase", "language": "en"}
{"question": "A scientist is studying the development of CD8+ T cells. In his experiments, he uses a radioactive isotope to mark a population of T cells. Once injected into the thymus, these cells bind tightly to MHC I self-antigen complexes. Later in the experiment, the scientist cannot find any marked cells in the peripheral blood. Which of the following processes is responsible for the loss of these marked CD8+ cells?", "answer": "Negative selection", "meta_info": "step1", "answer_idx": "B", "A": "Positive selection", "B": "Negative selection", "C": "APC antigen presentation", "D": "IL-2 stimulation", "language": "en"}
{"question": "A 65-year-old woman who has smoked 2 packs per day for forty years comes to your practice complaining of a chronic cough, dyspnea, hemoptysis, and difficulty rising from a chair. Based on CXR and biopsy slides shown, you feel that all of the following would be consistent with her diagnosis EXCEPT?", "answer": "Decreasing muscle strength with repetitive stimulation", "meta_info": "step1", "answer_idx": "A", "A": "Decreasing muscle strength with repetitive stimulation", "B": "Antibodies to presynaptic calcium channels", "C": "Dry mouth", "D": "Orthostatic hypotension", "language": "en"}
{"question": "A 16-month-old boy is brought to the pediatrician after his parents noticed the appearance of a rash on his face, torso, and limbs. The boy has been ill for almost 2 weeks, initiating with fever, malaise, coryza, headache, nausea, diarrhea, and a rash on both of his cheeks. Physical examination is unremarkable except for an erythematous maculopapular rash on the face, trunk, and extremities with a reticular pattern (as shown in the photograph). What is the most likely diagnosis?", "answer": "Erythema infectiosum", "meta_info": "step1", "answer_idx": "C", "A": "Measles", "B": "Chickenpox", "C": "Erythema infectiosum", "D": "Roseola infantum", "language": "en"}
{"question": "A 27-year-old woman presents to a neurologist complaining of facial pain. She reports that over the past 6 months, she has developed intermittent burning unilateral facial pain that happens over 10 seconds to 3 minutes. The pain is severe enough to completely stop her from her activities. She is worried whenever she goes out that another attack will happen and she is sad that this has limited her ability to work as a lawyer. Her past medical history is notable for irritable bowel syndrome and polycystic ovarian syndrome. She takes an oral contraceptive pill. Her temperature is 98.6°F (37°C), blood pressure is 130/75 mmHg, pulse is 75/min, and respirations are 18/min. On exam, she is a well-appearing woman who is alert, oriented, and appropriately interactive. Her pupils are 2 mm and reactive to light bilaterally. Fundoscopic examination is unremarkable. Her strength and range of motion are full and symmetric in her upper and lower extremities. This patient’s symptoms are likely due to irritation of a nerve that passes through which of the following foramina?", "answer": "Foramen rotundum", "meta_info": "step1", "answer_idx": "A", "A": "Foramen rotundum", "B": "Inferior orbital fissure", "C": "Jugular foramen", "D": "Superior orbital fissure", "language": "en"}
{"question": "A 26-year-old man comes to the physician because of high-grade fever, fatigue, nausea, and headache for 4 days. The headache is constant and feels like a tight band around his head. He also reports that his eyes hurt while looking at bright lights. He has been taking acetaminophen and using cold towels to help relieve his symptoms. He works as an assistant for a nature camp organization but has been unable to go to work for 3 days. His immunization records are unavailable. His temperature is 38.5°C (101.3°F), pulse is 92/min, and blood pressure is 108/74 mm Hg. He is oriented to time, place, and person. There is no rash or lymphadenopathy. Flexion of the neck results in flexion of the knee and hip. A lumbar puncture is done; cerebrospinal fluid analysis shows an opening pressure of 80 mm H2O, leukocyte count of 93/mm3 (78% lymphocytes), a glucose concentration of 64 mg/dL, and a protein concentration of 50 mg/dL. Which of the following is the most likely causal organism?", "answer": "Coxsackievirus", "meta_info": "step2&3", "answer_idx": "D", "A": "Borrelia burgdorferi", "B": "Mycobacterium tuberculosis", "C": "Herpes simplex virus 1", "D": "Coxsackievirus", "language": "en"}
{"question": "A 4-year-old girl presents to the pediatrician’s office for a physical examination prior to starting preschool. She was born at 39 weeks gestation via spontaneous vaginal delivery. She is up to date on all vaccines and is meeting all developmental milestones. Past medical history is noncontributory. She takes no medications but does take a chewable vitamin daily. She lives with her parents and older brother in a house. Today, her blood pressure is 110/65 mm Hg, heart rate is 90/min, respiratory rate is 22/min, and temperature of 37.0°C (98.6°F). On physical exam, she appears well developed and pleasant. She sits listening to the conversation and follows directions. Palpation of the heart reveals a mild parasternal heave. Auscultation reveals a normal S1 but the S2 is split and remains split during inhalation and exhalation. Additionally, there is a medium pitched midsystolic murmur that is loudest between ribs 2 and 3 on the left side and a very soft diastolic rumble. Which of the following congenital defects is the most likely cause of these findings?", "answer": "Atrial septal defect", "meta_info": "step1", "answer_idx": "A", "A": "Atrial septal defect", "B": "Coarctation of the aorta", "C": "Patent ductus arteriosus", "D": "Tetralogy of Fallot", "language": "en"}
{"question": "A 24-year-old man is brought to the emergency department after his head was hit with a bat during a baseball game. His teammates state that he was unresponsive after the incident but regained consciousness after 15 minutes. The patient initially refused to go to the hospital and sat on the bench for the remainder of the game. He initially appeared fine but became increasingly confused. He appears lethargic but opens his eyes to loud verbal commands. He is oriented to person and place. His temperature is 37.1 (98.8°F), pulse is 78/min, respiratory rate is 16/min, and blood pressure is 148/87 mm Hg. Examination shows an area of soft-tissue swelling over the left temporal region. A complete blood count and serum concentrations of electrolytes, urea nitrogen, and creatinine are within the reference range. A CT scan of the head is shown. After returning from the CT scan, the patient only opens his eyes to painful stimuli and responds to questions with incomprehensible sounds. He withdraws from painful stimuli. On repeat examination, the left pupil is 6 mm in diameter and reacts minimally to light. The right pupil is 3 mm in diameter and reacts normally to light. His respiratory rate is 10/min and he is intubated in the emergency department. Which of the following is the most appropriate next step in management?", "answer": "Perform craniotomy", "meta_info": "step2&3", "answer_idx": "C", "A": "Adminster hypotonic saline", "B": "Administer dexamethasone", "C": "Perform craniotomy", "D": "Perform brain MRI", "language": "en"}
{"question": "A 58-year-old woman comes to the physician for a routine follow-up examination. She has a history of type 2 diabetes mellitus, hypertension, and asthma. Last year, she received laser photocoagulation for proliferative retinopathy. Her current medications include metformin, lisinopril, and an albuterol inhaler. Her mother died of complications from diabetes. She drinks 1 glass of wine daily with dinner and does not smoke. Her temperature is 37.2°C (99°F), pulse is 92/min, respirations are 14/min, and blood pressure is 152/98 mm Hg. Cardiopulmonary examination is unremarkable. There is decreased sensation to monofilament testing of the plantar surfaces of both feet. Laboratory studies show:\nToday 6 months ago\nHemoglobin A1c 6.2% 6.4%\nSerum\nCreatinine 1.3 mg/dL 1.1 mg/dL\nUrine\nAlbumin:creatinine ratio (N < 30) 470 mg/g 260 mg/g\nThe addition of which of the following medications is most likely to have prevented this patient's progressively worsening renal function?\"", "answer": "Amlodipine", "meta_info": "step2&3", "answer_idx": "D", "A": "Losartan", "B": "Aspirin", "C": "Atorvastatin", "D": "Amlodipine", "language": "en"}
{"question": "A 4-year-old boy is brought to the physician by his mother because of a rash on his hands and feet for the past two weeks. It is intensely pruritic, especially at night. He has not had fever, headache, or diarrhea. His mother has a history of eczema. The child was due for an appointment later in the week to follow up on any potentially missing vaccinations. His temperature is 37.8°C (100.1°F). Examination shows a maculopapular rash with linear patterns affecting the interdigital spaces of the fingers and toes. The remainder of the examination shows no abnormalities. Which of the following is the most effective intervention for this patient's skin lesion?", "answer": "Topical permethrin", "meta_info": "step2&3", "answer_idx": "C", "A": "Oral acyclovir", "B": "Supportive care", "C": "Topical permethrin", "D": "Topical clotrimazole", "language": "en"}
{"question": "A 32-year-old man comes with his wife to the primary care physician because she is concerned about his drinking behavior. Specifically, he drinks 7 drinks every day and has abandoned many social activities that he previously enjoyed. In addition, he starts drinking in the morning because he feels shaky when he does not have a drink. When asked about his behavior, the man says that he knows that he probably should drink less but feels that he is not motivated enough to change. He says that perhaps the topic should be addressed again next year. Which of the following stages does this patient's behavior most likely represent?", "answer": "Contemplation", "meta_info": "step1", "answer_idx": "A", "A": "Contemplation", "B": "Precontemplation", "C": "Preparation", "D": "Relapse", "language": "en"}
{"question": "An 18-month-old boy is brought to the emergency department 25 minutes after an episode of loss of consciousness. The child began crying after his 4-year-old brother snatched a toy from him. The brief shrill cry was followed by a period of expiration; he then turned blue, became unconscious, and briefly lost his muscle tone, before he stiffened and had jerky movements of his arms and legs for 15 seconds. After this episode, he immediately regained consciousness. He had a similar episode 2 weeks ago when his father refused to give him a juice box. He has been healthy and has met all his developmental milestones. Vital signs are within normal limits. He is alert and active. Cardiopulmonary examination shows no abnormalities. Neurologic examination shows no focal findings. Which of the following is the most appropriate next step in management?", "answer": "Reassurance", "meta_info": "step2&3", "answer_idx": "C", "A": "CT scan of the head", "B": "Echocardiography", "C": "Reassurance", "D": "Tilt table test", "language": "en"}
{"question": "A 67-year-old woman presents to the ophthalmologist with complaints of worsening visual loss. She states that her vision is blurry. Driving has become difficult, particularly at night, as she experiences substantial glare and sees halos around lights. On physical examination, there is absence of a red reflex. What is the most likely cause of this patient’s visual loss?", "answer": "Cataracts", "meta_info": "step2&3", "answer_idx": "B", "A": "Age-related macular degeneration", "B": "Cataracts", "C": "Open-angle glaucoma", "D": "Refractive error", "language": "en"}
{"question": "A 30-year-old woman comes to the physician because of headaches and nausea for the past 3 weeks. The headaches are holocranial and last up to several hours. During this period, she has also had a swishing sound in both ears, which decreases when she turns her head to either side. She has had multiple episodes of blurring of vision and double vision for the past 2 weeks. She has vomited twice in the past week. She has nodular cystic acne and polycystic ovarian disease. Current medications include an oral contraceptive, metformin, and isotretinoin. She is 163 cm (5 ft 4 in) tall and weighs 89 kg (196 lb); BMI is 33.5 kg/m2. Her temperature is 37.3°C (99.1°F), pulse is 70/min, and blood pressure is 128/82 mm Hg. She is oriented to time, place, and person. Examination shows acne over her cheeks and back. Hirsutism is present. Visual acuity is 20/20 in both eyes. There is esotropia of the left eye. Further evaluation of this patient is most likely to show which of the following findings?", "answer": "Bilateral optic disc swelling", "meta_info": "step2&3", "answer_idx": "B", "A": "Hyperpigmentation of palmar creases", "B": "Bilateral optic disc swelling", "C": "Raised intra-ocular pressure", "D": "Weakness of left upper and lower extremities", "language": "en"}
{"question": "A 64-year-old woman with knee osteoarthritis comes to the physician for a follow-up examination. She reports significantly improved pain control since starting celecoxib 1 month ago. A history involving which of the following conditions is most likely to explain the administration of this drug instead of another nonsteroidal anti-inflammatory drug?", "answer": "Glanzmann thrombasthenia", "meta_info": "step1", "answer_idx": "C", "A": "Reye syndrome", "B": "Sulfa drug allergy", "C": "Glanzmann thrombasthenia", "D": "Gout", "language": "en"}
{"question": "A 48-year-old woman is admitted to the hospital and requires anticoagulation. She is administered a drug that binds tightly to antithrombin III. Which of the following drugs was administered?", "answer": "Enoxaparin", "meta_info": "step1", "answer_idx": "D", "A": "Aspirin", "B": "Warfarin", "C": "Dabigatran", "D": "Enoxaparin", "language": "en"}
{"question": "A 20-year-old woman comes to the physician because of a 2-day history of low-grade fever and painful lesions on her left index finger. Two weeks ago, she had a painful rash on the right labia majora that resolved without treatment. Physical examination shows tender lymphadenopathy of the left epitrochlear and right inguinal region. A photograph of the left index finger is shown. Which of the following best describes the properties of the most likely virus involved?", "answer": "Enveloped virus with a double-stranded, linear DNA structure", "meta_info": "step1", "answer_idx": "C", "A": "Naked virus with a double-stranded, circular DNA structure", "B": "Naked virus with a single-stranded, positive sense, linear RNA structure", "C": "Enveloped virus with a double-stranded, linear DNA structure", "D": "Enveloped virus with a partially double-stranded, circular DNA structure", "language": "en"}
{"question": "A 37-year-old man comes to the emergency department because of unsteady gait that started after waking up that morning. He has no fever, chills, headache, or myalgia. He works as a logger in Washington. His younger sister has multiple sclerosis. The patient appears pale. He is alert and responsive. His temperature is 37°C (98.9°F), pulse is 100/min, respirations are 11/min, and blood pressure is 136/86 mm Hg. Examinations shows intact cranial nerves. There is bilateral flaccid paralysis of his lower extremities. Lower extremity deep tendon reflexes are absent. The patient develops tachypnea and is admitted to the intensive care unit. Assisted breathing is started because of respiratory weakness. Which of the following is the most appropriate next step in management?", "answer": "Locate and remove tick", "meta_info": "step2&3", "answer_idx": "D", "A": "Perform enzyme‑linked immunosorbent assay", "B": "Administer doxycycline", "C": "Administer botulism antitoxin", "D": "Locate and remove tick", "language": "en"}
{"question": "A 43-year-old man presents requesting a sleep aid for long-standing insomnia. He says he has been having trouble falling asleep for as long as he can remember, but it has become increasingly worse after he and his wife moved to their new house. He claims that his new neighbors are jealous of his huge swimming pool and are trying to sabotage it while he sleeps. His wife even had to cancel the housewarming party that was planned for the neighbors because of her husband’s behavior. When probed further on this topic, the patient accuses the physician of being angry and hostile. What is the next best step in the management of this patient?", "answer": "Respond in a straightforward manner, be honest and non-threatening", "meta_info": "step2&3", "answer_idx": "A", "A": "Respond in a straightforward manner, be honest and non-threatening", "B": "Encourage the patient to inform the police", "C": "Set rules and be firm with adhering to them", "D": "Refer this patient to another physician", "language": "en"}
{"question": "A 22-year-old man presents to the emergency room after an altercation with the police. The police were called because the man was acting erratically in public. On physical examination, the patient is disoriented, does not respond to questioning, and appears to be reacting to internal stimuli. Laboratory tests are performed, which are all within normal limits, including a toxicology screen. The patient becomes aggressive and is given a medication to address his acute psychotic episode. An hour later, he is found in a sustained rigid posture in his bed, with his eyes in a fixed upward gaze. Which of the following medications was most likely given to this patient?", "answer": "Haloperidol", "meta_info": "step1", "answer_idx": "B", "A": "Citalopram", "B": "Haloperidol", "C": "Phenelzine", "D": "Alprazolam", "language": "en"}
{"question": "A 42-year-old man is brought to the emergency department by his wife with chills and a temperature of 38.5°C (101.3°F) for the past 2 days. The patient’s wife mentions that he recently injured his leg 5 days ago, after which she noticed that his calf was swollen, red, and painful. She says there was no pus, but that her husband was in excruciating pain. His vital signs include: temperature 38.9°C (102.1°F), blood pressure 110/75 mm Hg, and  respiratory rate 18/min. On physical examination, there is a tender mass over the left calf which is red and inflamed. Blood and wound cultures are taken. The patient is started on empiric antibiotics with vancomycin, but shows no improvement. Culture results reveal that the causative organism is resistant to the current antibiotic as well as penicillin. Which of the following antibiotic therapies would be most suitable for this patient?", "answer": "IV daptomycin", "meta_info": "step1", "answer_idx": "C", "A": "IV nafcillin", "B": "Dicloxacillin", "C": "IV daptomycin", "D": "Doxycycline", "language": "en"}
{"question": "A 63-year-old man presents to the emergency department with the sudden onset of excruciating chest pain, which he describes as a tearing sensation. He was diagnosed with essential hypertension 20 years ago, but he is not compliant with his medications. On physical examination, the temperature is 37.1°C (98.8°F), heart rate is 95/min, and blood pressure is 195/90 mm Hg in the right arm and 160/80 mm Hg in the left arm. The pulses are absent in his right leg and diminished in his left leg. A chest X-ray shows a widened mediastinum. Which of the following is the next best step?", "answer": "CT scan", "meta_info": "step2&3", "answer_idx": "A", "A": "CT scan", "B": "Surgery", "C": "D-dimer", "D": "Intravenous ultrasound", "language": "en"}
{"question": "在病人接受全身麻醉施行胸腰脊椎側彎（scoliosis）矯正手術時，下列何方法對脊椎神經功能監測最可靠？", "answer": "wake-up test", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "motor evoked potentials", "B": "somato-sensory evoked potentials", "C": "electromyography", "D": "wake-up test", "language": "tw"}
{"question": "人體站立時，肺部那一區域的換氣／灌流比（ventilation/perfusion）為最高？", "answer": "肺尖", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "肺底", "B": "肺尖", "C": "肺中央處", "D": "肺各處均有相若之換氣／灌流比", "language": "tw"}
{"question": "一位 75 歲的男性，主訴最近 6 個月來快走會有心悸和胸悶的現象，身體檢查時，血壓 140/50 mmHg，心跳規律，胸骨右側上方可聽到心舒期雜音，心臟超音波檢查有嚴重的主動脈瓣逆流，但左心室收縮內徑（left ventricular end systolic dimension）為 58 mm，舒張內徑為 80 mm，此時最好的治療方式為何？", "answer": "用豬心瓣膜置換主動脈瓣", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "用金屬性瓣膜置換主動脈瓣", "B": "用豬心瓣膜置換主動脈瓣", "C": "使用抗心律不整藥劑", "D": "使用抗心衰竭藥劑", "language": "tw"}
{"question": "關於停經後的荷爾蒙療法，下列敘述何者錯誤？", "answer": "女性荷爾蒙有降低 LDL 的效果，所以可用於預防心血管疾病", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "對於萎縮性陰道炎，可使用局部荷爾蒙療法", "B": "女性荷爾蒙有降低 LDL 的效果，所以可用於預防心血管疾病", "C": "荷爾蒙療法對於骨質疏鬆所造成的骨折有預防的效果", "D": "若子宮未切除，使用女性荷爾蒙者需合併服用黃體素", "language": "tw"}
{"question": "下列何者不是路易氏體失智症（dementia with Lewy bodies, DLB）的主要症狀？", "answer": "舞蹈症", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "認知功能時好時壞", "B": "視幻覺", "C": "舞蹈症", "D": "巴金森氏症狀", "language": "tw"}
{"question": "「動作單位（motor unit）」指的是：", "answer": "單一運動神經元加上它支配的所有肌肉纖維", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "單一運動神經元加上它支配的所有肌肉纖維", "B": "一條肌肉纖維加上所有支配它的動作神經元", "C": "供應單一肌肉的所有動作神經元", "D": "一組拮抗肌群", "language": "tw"}
{"question": "下列何者並非神經內分泌瘤的組織免疫標記？", "answer": "CD7", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "neuron-specific enolase", "B": "synaptophysin", "C": "chromogranin A  \t", "D": "CD7", "language": "tw"}
{"question": "左側第九到十一後肋間靜脈血直接回流入下列何者？", "answer": "半奇靜脈（hemiazygos vein）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "奇靜脈（azygos vein）", "B": "半奇靜脈（hemiazygos vein）", "C": "左鎖骨下靜脈（left subclavian vein）", "D": "內胸靜脈（internal thoracic vein）", "language": "tw"}
{"question": "利用配對方式選擇病例對照研究，下列何者錯誤？", "answer": "無法控制配對因子之干擾作用", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "需事先決定干擾因子", "B": "可降低已知干擾因子的影響", "C": "無法控制配對因子之干擾作用", "D": "需做配對分析", "language": "tw"}
{"question": "24 此時下列那些治療方式對此男嬰有幫助？①Blalock-Taussig 分流術 ②心房中隔氣球造口術（balloon atrial septostomy） ③前列腺素靜脈注射（PGE1 infusion） ④肺動脈環縮術（PA banding） ", "answer": "②③", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "①②", "B": "②③", "C": "①③", "D": "①④", "language": "tw"}
{"question": "39 一位 55 歲停經後女性，發現乳房右側有一 2.5 公分腫塊，經詳細檢查後，接受改良型全乳房根除術 （modified radical mastectomy），病理診斷為乳癌（T2N0M0）, ER(+), PR(+), Her2(-)。術後輔助治療何者適當？ \n", "answer": "荷爾蒙拮抗治療 \t", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "化學治療 \t", "B": "荷爾蒙拮抗治療 \t", "C": "化學治療合併放射治療", "D": "放射治療", "language": "tw"}
{"question": "73.32歲男性病人右下腹痛2天，來到急診，身體檢查有明顯局部壓痛，白血球在正常值內但略偏高，C-reactive  protein上升。未注射顯影劑的電腦斷層如圖示，下列何項診斷最有可能？ \n", "answer": "epiploic appendagitis", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "epiploic appendagitis", "B": "acute ileus", "C": "ascending colon intusussception", "D": "colon cancer with perforation", "language": "tw"}
{"question": "一位60歲男性因突然大量吐血而被送至急診，呈休克狀態，經緊急輸液治療後，病情改進。發病前並未喝酒及嘔吐，也沒有服用非類固醇消炎止痛藥（NSAID, non-steroidal anti-inflammatory drugs），最近也無特殊壓力。他是B型肝炎病毒慢性感染者。這位病人最可能是下列那種病灶出血？", "answer": "食道靜脈曲張破裂出血", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "食道靜脈曲張破裂出血", "B": "胃癌出血", "C": "出血性胃炎", "D": "十二指腸第二部分出血", "language": "tw"}
{"question": "一位 2 歲的小孩，2 天前出現輕度發燒及皮膚病灶，並注意到全身出現紅斑，檢查時 Nikolsky sign 呈陽性，下列敘述何者正確？", "answer": "葡萄球菌皮膚燙傷樣症候群（staphylococcal scalded skin syndrome）為可能診斷", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "葡萄球菌皮膚燙傷樣症候群（staphylococcal scalded skin syndrome）為可能診斷", "B": "一定會侵犯黏膜組織", "C": "使用類固醇治療有良好療效", "D": "會留下永遠的皮膚病灶", "language": "tw"}
{"question": "一位50歲男性主訴胸部不適與行動時氣促，無高血壓病史，血壓130/80 mmHg，心跳規則每分鐘76次，聽診上有第四心音，但並無明顯雜音，胸部X光片無明顯異常，心電圖呈現左心室肥厚合併ST-T波變化，而心臟超音波呈現嚴重左心尖部肥厚與正常左心室收縮功能。下列何種藥物最不適當？", "answer": "digitalis", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "digitalis", "B": "beta blockers", "C": "diltiazem", "D": "verapamil", "language": "tw"}
{"question": "一位 50 歲男性病人，因為皮膚出現紅疹且有劇癢來診，病人無發燒。三天前因為被診斷出有甲狀腺功能亢進，目前正服用抗甲狀腺藥物中。病人之白血球數為 4,500/μL，最適當的處置為下列那一項？", "answer": "給予抗組織胺、換用另外一種抗甲狀腺藥物", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "立即停用抗甲狀腺藥物、建議開刀", "B": "給予抗組織胺、換用另外一種抗甲狀腺藥物", "C": "加入大量類固醇、立即安排放射性碘治療", "D": "加入抗生素、給予 Lugol's solution", "language": "tw"}
{"question": "30.一位45歲自小罹患慢性B型肝炎的男性病患，主訴一個多月前覺得右上腹疼痛，有時疼痛會延伸到右邊的肩 膀。最近一週至門診追蹤腹部超音波顯示有多顆肝臟腫瘤，分別是一顆2.2公分大小在S2的位置，和另一顆6.6\n 公分大小在 S5的位置，有觀察到低迴音（hypoechoic）的腫塊。進一步安排腹部電腦斷層之後，發現在相同位置有同樣大小的腫塊，並且已經侵犯到右側肝門靜脈。其他部位的腹部超音波和電腦斷層結果皆屬正常。抽血結果發現胎兒蛋白值（AFP）為230 ng/mL，AST 53 U/L，ALT 68 U/L。則這位病人最可能的診斷為何？\n", "answer": "hepatocellular carcinoma with portal vein thrombosis", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "liver abscess with necrosis", "B": "hepatocellular carcinoma with portal vein thrombosis", "C": "multiple cavernous hemangioma", "D": "acute-on-chronic hepatitis", "language": "tw"}
{"question": "關於先天性肺部呼吸道畸形（congenital pulmonary airway malformation）的治療，下列何者比較正確？", "answer": "新生兒胸部X光發現右上肺葉有大囊泡狀病灶，出生後即因呼吸衰竭插管治療，應緊急進行開胸手術", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "新生兒胸部X光發現右上肺葉有大囊泡狀病灶，出生後即因呼吸衰竭插管治療，應緊急進行開胸手術", "B": "新生兒產前懷疑右下肺葉有實質狀病灶，出生後呼吸平穩，應立即接受肺部電腦斷層檢查", "C": "新生兒產前懷疑左上肺葉有小囊泡狀病灶，於出生後6個月大時接受電腦斷層確診，應於2歲之後再手術", "D": "3個月大男嬰因呼吸急促，經X光及電腦斷層檢查發現左下肺葉多囊泡狀病灶，應安排磁振造影（MRI）確定血管走向", "language": "tw"}
{"question": "王先生，56 歲農夫，有長期吸菸與嚼檳榔習慣，近 1 個月有喉嚨異物感、吞嚥不適、左耳疼痛、左前頸部腫大、雙側頸部中段各有一顆最大徑超過 2 公分腫瘤，聲音稍啞但無呼吸困難，經醫師檢查後可能的診斷是罹患下咽癌，王先生此時之臨床分期應該是多少？", "answer": "T4N2c", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "T3N2a", "B": "T3N2b", "C": "T4N2b", "D": "T4N2c", "language": "tw"}
{"question": "36 26 歲不孕女性，主訴月經稀少，經檢查如圖 A、圖 B、圖 C 所示，欲治療圖 A 所呈現疾患，下列藥物何者最不適當？  圖 A：多毛  \t 圖 B：後頸黑色素棘皮症 \t圖 C：陰道超音波 \n", "answer": "danazol", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "medroxyprogesterone acetate", "B": "antiandrogen", "C": "5α-reductase inhibitor", "D": "danazol", "language": "tw"}
{"question": "下列有關人體寄生蟲成蟲形態的敘述，何者錯誤？", "answer": "廣節裂頭絛蟲（Diphyllobothrium latum）具有圓形吸盤（sucker）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "十二指腸鉤蟲（Ancylostoma duodenale）具有兩對齒鉤", "B": "蟯蟲（Enterobius vermicularis）具有頭翼（cephalic alae）", "C": "牛羊肝吸蟲（Fasciola hepatica）具有頭錐（cephalic cone）", "D": "廣節裂頭絛蟲（Diphyllobothrium latum）具有圓形吸盤（sucker）", "language": "tw"}
{"question": "傳染登⾰熱的病媒蚊是下列何者？", "answer": "埃及斑蚊、⽩線斑蚊", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "熱帶家蚊、⽩腹叢蚊", "B": "埃及斑蚊、⽩線斑蚊", "C": "⽩腹叢蚊、⼩⿊蚊", "D": "中華瘧蚊、熱帶家蚊", "language": "tw"}
{"question": "核子醫學 technetium pertechnetate scan 對診斷下列何種疾病有幫助？", "answer": "梅克耳憩室（Meckel's diverticulum）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "梅克耳憩室（Meckel's diverticulum）", "B": "水腎", "C": "骨髓病變 \t", "D": "腎上腺腫瘤", "language": "tw"}
{"question": "下列各病症與其病原蟲之配對中，何者錯誤？", "answer": "Megaesophagus－杜氏利什曼原蟲（Leishmania donovani）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "Romaña's sign－枯西氏錐蟲（Trypanosoma cruzi）", "B": "Winterbottom's sign－岡比亞錐蟲（Trypanosoma brucei gambiense）", "C": "Megaesophagus－杜氏利什曼原蟲（Leishmania donovani）", "D": "Espundia－巴西利什曼原蟲（Leishmania braziliensis）", "language": "tw"}
{"question": "在blood coagulation pathway的最後一步，促使fibrinogen轉化成fibrin的物質為何？", "answer": "thrombin", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "von Willebrand factor", "B": "factor V", "C": "thrombin", "D": "plasminogen", "language": "tw"}
{"question": "39.58歲男性，近半年感到腹部不適，某日就診時發現有兩側頸部、腋下與腹股溝淋巴結腫大。病人體溫 38.8℃，血壓90/50mmHg，並有畏寒與疲累的症狀，血球檢查數據如下（括弧內是正常參考數值）：RBC  4.12 M/μL（4～5.52），Hb 12.4 g/dL（13.2～17.2），Retic. 1.48%（0.5～2），PLT 261 k/μL（148～339）， WBC 9.74 k/μL（3.54～9.06），Blast 0% ，Promyel. 0%，Myelo. 0%，Meta 0%，Band 0%，Seg 5.0%，Eos.  3.0%，Baso. 1.0%，Mono. 8.0%，Lym. 83.0%，Aty.Lym. 0.0%，Plasma cell 0.0%，Normobl. 0.0/100 WBC。以 下那個敘述錯誤？\n", "answer": "因為白血球總數正常，只需要症狀治療", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "因為白血球總數正常，只需要症狀治療", "B": "應該要做詳細的身體檢查，以找出可能的感染來源", "C": "應該要接受血液細菌培養", "D": "應該要儘早投與靜脈注射的廣效性抗生素", "language": "tw"}
{"question": "一位 24 歲男性病人主訴下背疼痛已半年。症狀時好時壞。嚴重時，可能半夜或清晨會痛醒。該病人最不可能同時有下列那一種症狀或徵兆？", "answer": "皮下結節（subcutaneous nodule）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "虹彩炎（iritis） \t", "B": "香腸趾（sausage toe）", "C": "皮下結節（subcutaneous nodule）", "D": "足底筋膜炎（plantar fasciitis）", "language": "tw"}
{"question": "依據赫爾辛基宣言（Declaration of Helsinki），當使用可辨識之人體組織或資料進行研究時，須遵守的規定。下列何者錯誤？", "answer": "在不可能或無法取得同意之情況，或取得同意後將造成研究無效時，可在免除同意書之情況下進行", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "通常醫師必須取得同意後，方可收集、分析、儲存和再利用", "B": "在不可能或無法取得同意之情況，或取得同意後將造成研究無效時，可在免除同意書之情況下進行", "C": "在不可能或無法取得同意之情況，或取得同意後將造成研究無效時，此種研究需經研究倫理委員會審議和批准後，方可在免除同意書之情況下進行", "D": "醫師應避免受試者在壓力或脅迫下取得同意", "language": "tw"}
{"question": "根據世界衛生組織宣佈，下列何種疾病因為病毒疫苗之使用而絕跡？", "answer": "天花（smallpox）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "天花（smallpox）", "B": "流行性感冒", "C": "小兒麻痺", "D": "水痘", "language": "tw"}
{"question": "醫師法所稱之醫師不包括下列那一項？", "answer": "獸醫師", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "中醫師", "B": "獸醫師", "C": "醫師", "D": "牙醫師", "language": "tw"}
{"question": "下列那一種組織結構不被外淋巴液（perilymph）所包圍？", "answer": "鎚骨（malleus）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "橢圓囊（utricle）", "B": "耳蝸管（cochlea duct）", "C": "鎚骨（malleus）", "D": "球囊（saccule）", "language": "tw"}
{"question": "下列何者是亞急性皮膚紅斑性狼瘡 （subacute cutaneous lupus erythematosus；SCLE）常見的皮膚表現形式？", "answer": "papulosquamous 與 annular lesions", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "malar rash 與 papulosquamous lesions", "B": "papulosquamous 與 annular lesions", "C": "malar rash 與 discoid rash", "D": "discoid rash 與 annular lesions", "language": "tw"}
{"question": "一位 84 歲男性病患，過去曾在金礦坑內工作長達 30 年，6 個星期前因為咳嗽加劇、黃痰，及下午發燒送醫，痰液抹片檢查發現 AFB（Acid-fast bacilli）(+++)，醫生當時開立第一線治療之標準四種抗結核藥物。如今結核菌培養呈現 MDR（multidrug resistant）TB，檢驗結果顯示對下列那些藥物產生抗藥性？", "answer": "Rifampin+Isoniazid \t", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "Rifampin+Isoniazid \t", "B": "Rifampin+Isoniazid+Ethambutol", "C": "Isoniazid+Ethambutol", "D": "Isoniazid+Pyrazinamide", "language": "tw"}
{"question": "感染下列何種病毒，若自行服用阿司匹靈（Aspirin）等水楊酸類（salicylates）退燒藥物後，最易增加兒童罹患雷氏症候群（Reye syndrome）的風險？", "answer": "流感病毒（Influenza virus）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "德國麻疹病毒（Rubella virus）", "B": "麻疹病毒（Measles virus）", "C": "流感病毒（Influenza virus）", "D": "狂犬病病毒（Rabies virus）", "language": "tw"}
{"question": "有關治療產後大量出血之血管內栓塞術的敘述，下列何者最正確？", "answer": "栓塞的目標是止血並盡量保存子宮", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "血管內栓塞術是唯一的治療方法", "B": "栓塞的目標是止血並盡量保存子宮", "C": "栓塞兩側子宮靜脈對止血的效果最好", "D": "栓塞兩側子宮動脈的後遺症是會造成卵巢壞死", "language": "tw"}
{"question": "高血壓的預防和控制指引，不包括下列何者？", "answer": "增加鈉鹽攝取", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "體重控制", "B": "增加鈉鹽攝取", "C": "增加體能活動", "D": "飲酒適量", "language": "tw"}
{"question": "關於重積癲癇（status epilepticus）治療，下列何者錯誤？", "answer": "癲癇發作時應立即給與抗癲癇藥物如phenytoin，並避免給予苯二氮類藥物（benzodiazepines）如", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "癲癇發作時應立即給與抗癲癇藥物如phenytoin，並避免給予苯二氮類藥物（benzodiazepines）如", "B": "抗癲癇藥物應使用靜脈注射類而不是口服類", "C": "若使用抗癲癇藥物後仍持續發作，進入頑固性重積癲癇（refractory status epilepticus），應再加上麻醉類藥物如propofol", "D": "腦波監控是必要檢查", "language": "tw"}
{"question": "下列何者與味蕾感覺訊號的傳遞，較不相關？", "answer": "trigeminal nerve", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "trigeminal nerve", "B": "facial nerve", "C": "glossopharyngeal nerve", "D": "vagus nerve", "language": "tw"}
{"question": "有關骨骼肌和平滑肌的比較，下列敘述何者錯誤？", "answer": "骨骼肌可經有絲分裂增殖，平滑肌則否", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "骨骼肌是多核細胞，平滑肌是單核細胞", "B": "骨骼肌細胞核位在細胞的周邊，平滑肌細胞核位在中央", "C": "骨骼肌具有橫紋，平滑肌則無", "D": "骨骼肌可經有絲分裂增殖，平滑肌則否", "language": "tw"}
{"question": "下列何者為管理學 SWOT 分析中與外部環境相關之面向？", "answer": "機會（opportunity）和威脅（threat）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "機會（opportunity）和威脅（threat）", "B": "優勢（strength）和劣勢（weakness）", "C": "機會（opportunity）和劣勢（weakness）", "D": "優勢（strength）和威脅（threat）", "language": "tw"}
{"question": "下列有關白喉毒素（diphtheria toxin）的敘述，那一項錯誤？", "answer": "是一種endotoxin", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "是一種endotoxin", "B": "可結合至細胞表面之heparin-binding epidermal growth factor", "C": "可結合至心臟及神經細胞導致受損", "D": "A subunit會使細胞內的elongation factor 2（EF-2）失去活性", "language": "tw"}
{"question": "一位 6 個月大的嬰兒患有神經母細胞瘤，原腫瘤已完全切除，但腫瘤已轉移到肝臟，則該疾病算是那一期？", "answer": "4S", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "2B", "B": "3", "C": "4", "D": "4S", "language": "tw"}
{"question": "一位 25 歲喜好運動之男性，於三年前因車禍造成膝後十字韌帶斷裂，雖經積極復健，但走路膝關節內側疼痛，理學檢查呈現向後不穩定大於 10 毫米，他應接受何種治療？", "answer": "手術重建（reconstruction）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "繼續復健（rehabilitation）", "B": "石膏固定（casting）", "C": "手術修補（direct repair）", "D": "手術重建（reconstruction）", "language": "tw"}
{"question": "臨床上成功應用於breast cancer免疫療法的單株抗體trastuzumab（Herceptin）是針對下列那一個分子？", "answer": "Her-2/neu", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "Her-2/neu", "B": "MAG-1", "C": "MUC-1", "D": "CD-20", "language": "tw"}
{"question": "足月產之嬰兒，第一天血紅素（Hb）濃度為 12 g/dL，平均紅血球體積（MCV）為 110 fL，則下列判讀何者為真？", "answer": "正紅血球性貧血（normocytic anemia）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "完全正常 \t", "B": "小紅血球性貧血（microcytic anemia）", "C": "正紅血球性貧血（normocytic anemia）", "D": "大紅血球性貧血（macrocytic anemia）", "language": "tw"}
{"question": "下列何者最有可能引起血壓下降？", "answer": "增加小動脈一氧化氮（NO）的量", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "活化小動脈血管平滑肌β1 腎上腺素型受器（β1 adrenergic receptors）", "B": "開啟小動脈血管平滑肌細胞上鈣離子通道（calcium channel）", "C": "增加小動脈一氧化氮（NO）的量", "D": "活化血管張力素轉換酶（angiotensin-converting enzyme）", "language": "tw"}
{"question": "在成年男性，下列何種病毒性疾病最易侵犯睪丸？", "answer": "腮腺炎（mumps） \t", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "麻疹（measles） \t", "B": "德國麻疹（rubella）", "C": "腮腺炎（mumps） \t", "D": "疱疹（herpes）", "language": "tw"}
{"question": "有關Toxic shock syndrome的敘述，下列何者錯誤？", "answer": "主要致病機轉為Pseudomonas 製造的exfoliative toxin所引起", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "臨床上表現包括⼤⾯積⽪膚紅腫疼痛或是膿皰、以及⽪膚廣泛性脫屑現象", "B": "初期會出現⽪膚疼痛現象，⼤部分是因為術後傷⼝感染或是腹腔感染引起", "C": "病患會出現發燒、喉嚨痛、肌⾁痠痛、嘔吐或是腹瀉，嚴重時會造成低⾎壓以及多重器官衰竭", "D": "主要致病機轉為Pseudomonas 製造的exfoliative toxin所引起", "language": "tw"}
{"question": "在靜脈注射一個大劑量的短效胰島素製劑造成低血糖時，下列何種狀況最不會造成血糖回升延遲的現象？", "answer": "副甲狀腺素分泌不足", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "腎上腺髓質發育不全", "B": "升血糖素（glucagon）分泌缺乏", "C": "甲狀腺功能低下", "D": "副甲狀腺素分泌不足", "language": "tw"}
{"question": "30 歲男性，數年來有反覆發作之全身銀灰色鱗屑性紅色斑塊，3 個月前這些病灶集中在指（趾）尖及指（趾）甲周圍，且合併脊椎及手指末端關節炎，又 HLA-B27(+)。下列何者為首選口服治療藥物？", "answer": "methotrexate", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "retinoids", "B": "methotrexate", "C": "cyclosporine", "D": "glucocorticoids", "language": "tw"}
{"question": "35.婦科手術後，若有\t血症（septicemia）引起alveolar-capillary membrane的微血管側受損，使肺部微血管通透 性增加，而造成肺部的併發症，稱為：\n", "answer": "Acute respiratory distress syndrome", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "Pulmonary edema", "B": "Pulmonary hypertension", "C": "Respiratory permeability defect", "D": "Acute respiratory distress syndrome", "language": "tw"}
{"question": "下列何種周邊視網膜變性與視網膜剝離關係最密切？", "answer": "格子狀變性（lattice degeneration）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "囊狀視網膜變性（cystoid degeneration） \t", "B": "格子狀變性（lattice degeneration）", "C": "萎縮性視網膜裂孔（atrophic retinal hole） \t", "D": "卵石狀視網膜變性（paving stone degeneration）", "language": "tw"}
{"question": "下列何種疾病不可使用 GnRH（gonadotropin-releasing hormone）agonist 治療？", "answer": "肢端肥大症（acromegaly）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "無月經（amenorrhea）", "B": "前列腺癌症（prostate cancer）", "C": "乳癌（breast cancer）", "D": "肢端肥大症（acromegaly）", "language": "tw"}
{"question": "使用下列那一種麻醉劑時，最需要再合併給予肌肉鬆弛劑？", "answer": "Nitrous oxide", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "Halothane", "B": "Benzodiazepines", "C": "Isoflurane", "D": "Nitrous oxide", "language": "tw"}
{"question": "7 歲小男生因下肢及臀部出現紅色點狀物（如附圖），其血小板數目正常，同時有膝蓋關節痛與陣發性腹痛之情形，尿液檢查發現其同時有血尿的情形，請問最有可能之診斷為何？", "answer": "Henoch-Schönlein purpura", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "Henoch-Schönlein purpura", "B": "Ig A nephropathy", "C": "scarlet fever", "D": "juvenile rheumatoid arthritis", "language": "tw"}
{"question": "⿐咽癌的⾎液測試中，下列何者⽬前被認為準確度最好？", "answer": "Serum/Plasma free EBV DNA copies", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "EBV anti-VCA IgG", "B": "EBV anti-VCA IgA", "C": "EBV anti-EA IgA", "D": "Serum/Plasma free EBV DNA copies", "language": "tw"}
{"question": "有關頭部神經或血管路徑的敘述，下列何者正確？", "answer": "顏面神經（facial nerve）穿過莖乳孔（stylomastoid foramen）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "眼動脈（ophthalmic artery）穿過眶上裂（superior orbital fissure）", "B": "顏面神經（facial nerve）穿過莖乳孔（stylomastoid foramen）", "C": "三叉神經上頜支（maxillary division of trigeminal nerve）穿過卵圓孔（foramen ovale）", "D": "前庭耳蝸神經（vestibulocochlear nerve）穿過頸靜脈孔（jugular foramen）", "language": "tw"}
{"question": "關於Noonan syndrome之敘述，下列何者錯誤？", "answer": "主動脈狹窄（aortic stenosis）為其最常見的心臟病變", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "身材矮小", "B": "蹼狀頸（webbed neck）", "C": "正常染色體核型（normal karyotype）", "D": "主動脈狹窄（aortic stenosis）為其最常見的心臟病變", "language": "tw"}
{"question": "一位 63 歲長期抽菸的男性喉癌病人（鱗狀上皮細胞）；手術一年後發現肺部廣泛轉移。於 cisplatin/5-FU 化學治療結束後第二天出院。但隔天其太太發現病人意識不清，於是送病人至急診。呼吸及血壓均正常，但心跳 112/分。何者是最適當之處置？", "answer": "檢驗血中 calcium", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "血液細菌培養，使用選擇性抗綠膿桿菌之抗生素 \t", "B": "檢驗血中 calcium", "C": "檢驗血液中NH3", "D": "腦部核磁共振", "language": "tw"}
{"question": "下列有關 E. coli 修補 O6-methylguanine 的敘述，何者正確？", "answer": "利用甲基轉移酶將甲基送到甲基轉移酶本體", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "利用甲基轉移酶（methyltransferase）將甲基送到四氫葉酸（tetrahydrofolate）", "B": "利用甲基轉移酶將甲基送到甲基轉移酶本體", "C": "利用 DNA 去甲基酶（DNA demethylase）送到四氫葉酸", "D": "利用 DNA 去甲基酶送到水中", "language": "tw"}
{"question": "一中年女性主訴手指會麻，下列那一部位的感覺缺失可使醫師確認受傷的神經是尺神經（ulnar nerve）？", "answer": "小指的掌面（palmar surface of the 5th finger）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "大拇指的掌面（palmar surface of thumb）", "B": "前臂掌面的尺側（ulnar side of the volar surface of forearm）", "C": "小指的掌面（palmar surface of the 5th finger）", "D": "手背近虎口處（dorsum of hand between the thumb and the 2nd finger）", "language": "tw"}
{"question": "一名40多歲男性右眼紅痛，經診斷為急性前部葡萄膜炎（acute anterior uveitis），並伴有多年下背痛病史，則下列何者錯誤？", "answer": "常雙眼同時發作", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "好發於男性", "B": "X光可能發現竹狀脊椎（bamboo spine）", "C": "常雙眼同時發作", "D": "與HLA-B27相關", "language": "tw"}
{"question": "21 歲大學生準備前往某開發中國家旅遊，該地是 A 型肝炎疫區，他沒有免疫力，希望不要得到感染，下列敘述何者錯誤？", "answer": "A 型肝炎疫苗與免疫球蛋白不能同時施打", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "應接種 A 型肝炎疫苗或施打免疫球蛋白（immune serum globulin, ISG）", "B": "A 型肝炎疫苗與免疫球蛋白不能同時施打", "C": "如果 2 週內即將前往，應施打免疫球蛋白（ISG）較具保護力", "D": "如果計劃多次到開發中國家旅遊，施打 A 型肝炎疫苗較合成本效益", "language": "tw"}
{"question": "78.曼森裂頭絛蟲（Spirometra mansonoides）那些發育時期的蟲體可以感染人？①六鈎幼蟲卵 ", "answer": "③④", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "①②", "B": "①③", "C": "②④", "D": "③④", "language": "tw"}
{"question": "下列何者會因胃擴張（Distension）之刺激而分泌？", "answer": "胃泌素（Gastrin） \t", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "膽囊收縮素（Cholecystokinin）", "B": "胃抑素（Gastric inhibitory peptide）", "C": "胃泌素（Gastrin） \t", "D": "體抑素（Somatostatin）", "language": "tw"}
{"question": "承上題，依Parkland formula，下列敘述何者正確？", "answer": "輸液前8小時給crystalloid溶液2160 mL", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "輸液前8小時給crystalloid溶液4320 mL", "B": "輸液前12小時給crystalloid溶液4320 mL", "C": "輸液前8小時給crystalloid溶液2160 mL", "D": "輸液前12小時給crystalloid溶液2160 mL", "language": "tw"}
{"question": "腋神經（axillary nerve）受損時，會造成下列那一塊旋轉\t（rotator cuff）肌肉無力？", "answer": "小圓肌（teres minor）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "棘上肌（supraspinatus muscle）", "B": "棘下肌（infraspinatus muscle）", "C": "肩胛下肌（subscapularis muscle）", "D": "小圓肌（teres minor）", "language": "tw"}
{"question": "與大部分血管新生（angiogenesis）關係最密切的生長因子（growth factor）為何？", "answer": "VEGF（vascular endothelial growth factor）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "PDGF（platelet-derived growth factor）", "B": "IGF-1（insulin-like growth factor-1）", "C": "VEGF（vascular endothelial growth factor）", "D": "TGF-β（transforming growth factor-β）", "language": "tw"}
{"question": "下列何者與先天性白內障無關？", "answer": "丁氣體；12", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "甲氣體；2.4", "B": "乙氣體；0.42", "C": "丙氣體；1.9", "D": "丁氣體；12", "language": "tw"}
{"question": "一名 6 歲女孩因為手臂骨折而住院，身體診查發現乳房已有發育，皮膚呈現咖啡牛奶斑（café-au-lait spots），甲狀腺機能亦有亢進現象，影像檢查顯示骨骼纖維性發育不良（fibrous dysplasia），骨齡判讀為 9 歲，最可能的診斷是：", "answer": "McCune-Albright syndrome", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "Fanconi syndrome \t", "B": "McCune-Albright syndrome", "C": "neurofibromatosis \t", "D": "Peutz-Jeghers syndrome", "language": "tw"}
{"question": "下列何者不是Bishop score的評分項目之一？", "answer": "生產次數（parity）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "生產次數（parity）", "B": "子宮頸擴張程度（dilatation）", "C": "子宮頸軟化程度（effacement）", "D": "胎頭於骨盆的位置（station）", "language": "tw"}
{"question": "下列有關骨髓（bone marrow）的敘述，何者正確？", "answer": "具有竇狀系統（sinusoidal system），是一個封閉型的循環系統，新生的血球細胞必須穿透內皮（endothelium），才能進入循環", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "具有竇狀系統（sinusoidal system），是一個封閉型的循環系統，新生的血球細胞必須穿透內皮（endothelium），才能進入循環", "B": "黃骨髓（yellow bone marrow）是活化的骨髓，負責製造各種血球細胞", "C": "在長骨（long bone）內的非造血空間，會被纖維母細胞（fibroblast）占據", "D": "巨核細胞（megakaryocyte）釋放的血小板（platelet），必須藉由網狀細胞（reticular cell）的協助，才能進入竇狀系統（sinusoidal system）", "language": "tw"}
{"question": "一位 50 歲女性，發現右側甲狀腺腫大 1 個月，於門診理學檢查及超音波檢查發現右側甲狀腺有 1 個 3 公分腫瘤，無頸淋巴腫大，細針抽吸細胞學檢查為乳突性甲狀腺癌，該病人接受甲狀腺全切除，手術後發生呼吸困難。關於病人發生呼吸困難之問題，下列敘述何者錯誤？", "answer": "手術後 2 小時發生呼吸困難，可能為副甲狀腺受損，導致低血鈣進而全身麻木，呼吸不適", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "手術後一拔管立刻發生呼吸困難，可能為雙側喉返神經受損造成聲帶麻痺，導致呼吸道阻塞", "B": "手術後當天晚上發生呼吸困難，可能為頸部血腫壓迫氣管，造成氣管軟化及呼吸道阻塞", "C": "手術後 2 小時發生呼吸困難，可能為副甲狀腺受損，導致低血鈣進而全身麻木，呼吸不適", "D": "可能因為傷口疼痛精神緊張造成過度換氣症候", "language": "tw"}
{"question": "當疑有 submandibular duct 的結石時，下列何者為最恰當的影像診斷方式？", "answer": "dental occlusal view", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "skull basal view", "B": "dental occlusal view", "C": "skull lateral view", "D": "Caldwell view", "language": "tw"}
{"question": "下列那種細菌以家禽、家畜為其貯存宿主（reservoir）？", "answer": "空腸彎曲菌（Campylobacter jejuni）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "空腸彎曲菌（Campylobacter jejuni）", "B": "霍亂弧菌（Vibrio cholerae）", "C": "百日咳桿菌（Bordetella pertussis）", "D": "腦膜炎奈瑟氏菌（Neisseria meningitidis）", "language": "tw"}
{"question": "有關low-molecular-weight heparin（LMWH）特點的敘述，何者錯誤？", "answer": "一般可以用凝血時間的檢\t做監測，維持約正常值的兩倍左右", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "LMWH的使用劑量一般可依體重決定就好", "B": "一般可以用凝血時間的檢\t做監測，維持約正常值的兩倍左右", "C": "必要時可以監測Factor Xa activity看LMWH的藥量是否恰當", "D": "LMWH主要由腎臟代謝排出", "language": "tw"}
{"question": "一個 2 歲 8 個月大的女孩，來診發現肝脾極度腫大，分別在肋骨下 3 公分及 8 公分摸到，其血色素（Hb）為 6.5 g/dL，血小板（platelets）數目低為 88,000/mm3，檢查無缺鐵，血色素電泳分析（hemoglobin electrophoresis）Hb A 為 93.0%，Hb A2 為 5.1%，Hb F 為 1.9%，骨髓檢查無惡性細胞浸潤，但有貯積細胞，周邊血白血球測定之β-glucosidase 酵素活性甚低，下列何者為最可能診斷？", "answer": "高雪氏病（Gaucher disease）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "重型乙型海洋性貧血（β-thalassemia）", "B": "重型甲型海洋性貧血（α-thalassemia）", "C": "重度再生不良性貧血（Severe aplastic anemia）", "D": "高雪氏病（Gaucher disease）", "language": "tw"}
{"question": "有關肝細胞癌（hepatocellular carcinoma，即HCC）的臨床評估及診治，以下敘述何者錯誤？", "answer": "正子攝影（FDG-PET）已被證實是診斷HCC最敏感的影像檢查方式", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "理學檢查時，應注意是否有jaundice、ascites、spider angioma、palmar erythema等可能指出有chronic liver disease或liver cirrhosis的signs", "B": "血清AFP是常用的tumor marker；但並非所有的HCC患者，血清AFP皆會升高", "C": "ultrasound，triphasic CT及gadolinium-enhanced MRI皆是可應用來協助診斷HCC的影像檢查方式", "D": "正子攝影（FDG-PET）已被證實是診斷HCC最敏感的影像檢查方式", "language": "tw"}
{"question": "承上題，下列那項是該嬰兒最可能之 blood gas 檢查結果？", "answer": "metabolic alkalosis and respiratory acidosis", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "metabolic alkalosis and respiratory acidosis", "B": "metabolic acidosis and respiratory alkalosis", "C": "metabolic acidosis and respiratory acidosis", "D": "metabolic alkalosis and respiratory alkalosis", "language": "tw"}
{"question": "21 急診常有受傷需縫合的傷口，關於拆線時間，下列敘述何者正確？①頭皮 6～8 天 ②眼皮 10～14 天  ③背部 12～14 天 ④四肢 12～14 天 \n", "answer": "①③④", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "①②④", "B": "①②③", "C": "②③④", "D": "①③④", "language": "tw"}
{"question": "29 歲女性經門診醫師診斷甲狀腺單邊有一結節，有關診斷之敘述，下列何者錯誤？", "answer": "做 CT 及 MRI 檢查", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "應有發生時間及症狀、家族史的資料", "B": "做超音波及 FNA（小針切片細胞學檢查）", "C": "做 TSH 檢查 \t", "D": "做 CT 及 MRI 檢查", "language": "tw"}
{"question": "心臟超音波檢查是下列何種疾病的最佳診斷利器？", "answer": "心包囊積水", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "急性心肌梗塞", "B": "心包囊積水", "C": "心房中隔缺損", "D": "心室中隔缺損", "language": "tw"}
{"question": "54 歲女性失足從 3 公尺高度跌下，嚴重呼吸困難及右胸壁血腫。被送到急診身體檢查，意識昏昏欲睡，血壓測不到，發紺、心動過速與右側呼吸聲減少。你是值班醫生，你的及時處理為何？", "answer": "插胸管 \t", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "胸部 X 光及電腦斷層掃描", "B": "插 CVC 用全速靜脈輸液", "C": "插胸管 \t", "D": "給予 inotropics", "language": "tw"}
{"question": "95 國民健康局想進行世代研究（cohort study），探討運動是否可減少發生冠心症的危險。這個世代必 須是建立在： \n", "answer": "沒有罹患冠心症的人", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "已經罹患了冠心症的人", "B": "沒有罹患冠心症的人", "C": "已經有運動習慣的人 \t", "D": "沒有運動習慣的人", "language": "tw"}
{"question": "下列有關肺臟移植的敘述，何者錯誤？", "answer": "肺功能檢查若是有 FVC 數據顯著下滑的情形，可作為診斷排斥作用發生之 criteria", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "常見之 surgical indicatoins 為 COPD、pulmonary fibrosis 及 pneumoconiosis 等疾病所造成之肺部永久性傷害 \t", "B": "prednisolone、cyclosporine 與 azathioprine 為常併用之免疫抑制藥物", "C": "急性排斥發生時，病患常出現 dyspnea、leukocytosis 及 mild fever 等症狀", "D": "肺功能檢查若是有 FVC 數據顯著下滑的情形，可作為診斷排斥作用發生之 criteria", "language": "tw"}
{"question": "你的門診診間進來一位初診病人，23 歲的阿凱是研究所一年級的學生。他的主訴為昨晚開始發燒、咳嗽、流鼻水，你問診及做完身體檢查，診斷他的問題為上呼吸道感染。正要開藥時，他要求你為他開一張診斷證明書，因為學校後天要期末考，他擔心感冒影響考試的準備，希望你在診斷證明書上註明他需要在家休息 3 天。下列何種作法最為恰當？", "answer": "經說明後，僅開給他當天之就醫證明", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "打電話給他的父或母親", "B": "問他是否得到老師的許可", "C": "經說明後，僅開給他當天之就醫證明", "D": "轉介給另一位門診醫師處理", "language": "tw"}
{"question": "下列何者不屬於美國精神醫學會「精神疾患診斷及統計手冊第四版」之焦慮性疾患（anxiety disorders）？", "answer": "適應障礙合併焦慮", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "創傷後壓力疾患", "B": "恐慌症", "C": "適應障礙合併焦慮", "D": "社交畏懼症", "language": "tw"}
{"question": "有關病人在不同壓力下所需的營養需求敘述，下列何者錯誤？", "answer": "燒傷病人每天所需的蛋白質攝取量為 2.0 g/kg/day", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "mild stress 下，病人所需的熱量為 25～30 kcal/kg/day", "B": "燒傷病人每天所需的蛋白質攝取量為 2.0 g/kg/day", "C": "燒傷病人每天的熱量攝取為 35～40 kcal/kg", "D": "moderate malnutrition 的病人，非蛋白質的熱量攝取與氮素比為 150：1", "language": "tw"}
{"question": "承上題，關於乳癌的改良式根治性乳房切除手術（modified radical mastectomy）治療，下列何者錯誤？", "answer": "前哨淋巴結切片（sentinel lymph node biopsy）無法避免腋下淋巴結清除手術的合併症，通常用於縮短手術時間", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "改良式根治性乳房切除包含清除腋下的淋巴結，通常清除level 1 與 level 2的範圍", "B": "腋下淋巴結清除的解剖位置，上界為腋靜脈（axillary vein），內界為胸壁，外界為背闊肌", "C": "腋下淋巴清除手術的合併症包括疼痛、減少關節活動範圍、淋巴水腫等", "D": "前哨淋巴結切片（sentinel lymph node biopsy）無法避免腋下淋巴結清除手術的合併症，通常用於縮短手術時間", "language": "tw"}
{"question": "一糖尿病中年婦女，突然頭部劇痛、左眼瞼下垂、複視、瞳孔放大，來急診求治，神智清楚，腦部電腦斷層如附圖，下列處置何者最恰當？", "answer": "住院，馬上安排腦部血管攝影", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "住院，馬上安排腦部血管攝影", "B": "抽血密切注意血糖的變化", "C": "住院，檢\t是否有重症肌無力（myasthenia gravis）", "D": "安排腦部核磁共振，再決定是否要住院", "language": "tw"}
{"question": "張太太的女兒現年 10 歲，自上學期中就開始經常口渴，有消瘦現象。有一天昏倒送醫之後，診斷得到第一型糖尿病，胰臟之β（beta）細胞破壞嚴重，缺乏胰島素，血糖過高。這個疾病的成因為何？", "answer": "產生自體免疫反應 T 細胞，破壞胰臟β（beta）細胞所致的自體免疫疾病", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "感染症破壞胰臟腺體，引起胰臟功能過高 \t", "B": "攝取糖份過多，引起胰臟功能衰竭", "C": "產生自體免疫反應 T 細胞，破壞胰臟β（beta）細胞所致的自體免疫疾病", "D": "電解質代謝失常，引起胰臟功能衰竭", "language": "tw"}
{"question": "蛋白質最常經下列何種轉譯後修飾（post-translational modification），再送到溶酶體（lysosome）？", "answer": "糖基化（glycosylation）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "糖基化（glycosylation）", "B": "磷酸化 （phosphorylation）", "C": "蘇素化（sumoylation）", "D": "乙醯化（acetylation）", "language": "tw"}
{"question": "一位 28 歲 AIDS 患者，主訴為大腿內側突然出現數顆 2-4 mm 的丘疹，其中心具有 umbilication 的現象。其皮膚切片如圖示，最可能的診斷是：", "answer": "傳染性軟疣（molluscum contagiosum） \t", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "尋常疣（verruca vulgaris） \t", "B": "扁平疣（verruca plana）", "C": "傳染性軟疣（molluscum contagiosum） \t", "D": "尖端濕疣（condyloma acuminata）", "language": "tw"}
{"question": "1 一位五十歲病患術後小便減少，其小便的鈉離子低於 20 mOs/L，小便和血漿的 creatinine 比值大於 40 ，則小便減少的原因是何種的問題？ \n", "answer": "Prerenal", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "Prerenal", "B": "Renal", "C": "Postrenal", "D": "不一定", "language": "tw"}
{"question": "承上題，檢查結果最可能合併的畸形為下列何者？", "answer": "Neural tube defect", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "Down syndrome", "B": "Trisomy 13", "C": "Trisomy 18", "D": "Neural tube defect", "language": "tw"}
{"question": "患者長期服用抗癲癇藥物時，下列何種情況最不需要做血中藥物濃度監測？", "answer": "合併使用無交互作用之藥物", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "懷疑病人服藥不確實", "B": "癲癇發作呈現重積狀態", "C": "病人本身有肝腎疾病", "D": "合併使用無交互作用之藥物", "language": "tw"}
{"question": "75.⼀位46歲男性，胸部遭攻擊造成⾎胸合併休克，胸管引流出700 ml⾎液後，⾎壓為118/82 mmHg，⼼跳90 \t下/分，幾分\t後⾎壓下降為84/62 mmHg，⼼跳126下/分，下列處置何者最優先？\n", "answer": "重新評估病⼈", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "立即氣管插管", "B": "緊急開胸", "C": "立即輸⾎", "D": "重新評估病⼈", "language": "tw"}
{"question": "在光學顯微鏡下觀察下列何種型式的血管，其內彈性板（internal elastic lamina）最明顯且呈波浪狀？", "answer": "肌性動脈（muscular artery） \t", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "彈性動脈（elastic artery）", "B": "肌性動脈（muscular artery） \t", "C": "微血管（capillary） \t", "D": "小靜脈（venule）", "language": "tw"}
{"question": "一鼻咽癌病患抱怨雙側手臂與大腿疼痛，下列何者是最適當的檢查工具？", "answer": "同位素骨骼掃描", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "超音波", "B": "電腦斷層掃描", "C": "核磁共振造影", "D": "同位素骨骼掃描", "language": "tw"}
{"question": "一位 82 歲的骨癌末期併肺部移轉的病人在安寧病房中，並已簽署 DNR，主訴呼吸困難，下列何者是最不適宜的處置？", "answer": "安排胸部電腦斷層攝影檢查", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "安排胸部電腦斷層攝影檢查", "B": "給予 lorazepam", "C": "給予氧氣治療 \t", "D": "給予 codeine", "language": "tw"}
{"question": "下列有關使用心臟節律器（pacemaker）的病人，進行麻醉前評估與準備之敘述，何者錯誤？", "answer": "置放磁鐵於麻醉中的病人之胸前pacemaker上，即可完全避免術中電燒的干擾與危害", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "進行非心臟常規手術前，應重新檢查心臟節律器的功能", "B": "置放磁鐵於麻醉中的病人之胸前pacemaker上，即可完全避免術中電燒的干擾與危害", "C": "術中應關閉心電圖監視器上filter的功能，以免偵測不到節律放電波形（pacing spikes）", "D": "術中除使用心電圖監視器外，應配合使用脈動式血氧飽和監測儀（pulse oximetry）", "language": "tw"}
{"question": "下列有關腦部偽腫瘤（pseudotumor cerebri）的敘述，何者錯誤？", "answer": "常伴隨腦室變大", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "常伴隨腦室變大", "B": "腦壓增高，作腰椎穿刺壓力往往超過200 mmH2O", "C": "會有視乳突水腫（papilledema）", "D": "內科治療以類固醇及利尿劑為主", "language": "tw"}
{"question": "下列關於功能性腸胃道疾患（functional gastrointestinal disorders）敘述，何者錯誤？", "answer": "在與功能性腸胃道疾患共病的焦慮疾患中，創傷後壓力症候群（posttraumatic stress disorder）是最常出現的", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "具有腸胃道收縮異常以及功能性食道症狀的病人經常合併有精神疾病", "B": "焦慮症為功能性腸胃道疾患常見的精神科共病", "C": "在與功能性腸胃道疾患共病的焦慮疾患中，創傷後壓力症候群（posttraumatic stress disorder）是最常出現的", "D": "恐慌發作的症狀亦包含了腸胃道症狀", "language": "tw"}
{"question": "病理診斷狂⽝病（Rabies）的最主要依據是觀察到：", "answer": "Negri body", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "Lewy body", "B": "Kuru plaque", "C": "Negri body", "D": "Stress granules", "language": "tw"}
{"question": "20 歲孕婦，G1P0，妊娠 31 週，主訴：頭痛，視力模糊有一天之久。血壓 200/140 mmHg，下肢水腫（+++），蛋白尿（++++），深部肌腱反射（+++），GOT 上升，血小板下降，有溶血現象。請問最可能的診斷為何？", "answer": "HELLP 症候群", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "肝昏迷", "B": "腎衰竭", "C": "子癇症", "D": "HELLP 症候群", "language": "tw"}
{"question": "結膜的杯狀細胞（goblet cells），可以分泌淚液的那一種成分？", "answer": "黏液（mucin） \t", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "脂肪（lipid） \t", "B": "水（aqueous）", "C": "黏液（mucin） \t", "D": "電解質（electrolytes）", "language": "tw"}
{"question": "一位病人因為單純性闌尾炎（simple appendicitis）接受闌尾切除術，術中並無腸內容物外漏，屬於下列何種手術傷口分類？", "answer": "clean-contaminated", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "clean", "B": "clean-contaminated", "C": "contaminated", "D": "dirty and infected", "language": "tw"}
{"question": "有關於hiatal hernia之描述，下列何者正確？", "answer": "sliding hiatal hernia（type I）常伴隨胃酸逆流之症狀", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "sliding hiatal hernia（type I）常伴隨胃酸逆流之症狀", "B": "paraesophageal hiatal hernia指的是腹部的大腸、小腸等herniation to the chest", "C": "paraesophageal hiatal hernia與sliding hiatal hernia是不同的兩種情形，不會同時出現", "D": "絕大部分的sliding hiatal hernia須接受手術治療", "language": "tw"}
{"question": "張小弟目前是小學六年級學生，大約 3 年前開始，他會不自主的皺眉頭、眼睛亂飄、扮鬼臉以及發出聲音等動作，因此常常被老師糾正。最近更加上時常口出穢語，自己無法控制。除此之外，身體理學以及神經學檢查正常，也沒有慢性疾病。下列臨床診斷何者最有可能？", "answer": "妥瑞氏症（Tourette's disorder）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "過動兒（hyperkinetic child）", "B": "全肌張力不全症（generalized dystonia）", "C": "妥瑞氏症（Tourette's disorder）", "D": "亨丁頓氏舞蹈症（Huntington's chorea）", "language": "tw"}
{"question": "造成攝護腺手術中併發 TURP 症候群之可能原因，下列何者錯誤？", "answer": "失血過多", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "循環體液過多", "B": "水中毒", "C": "沖洗液內溶物毒性", "D": "失血過多", "language": "tw"}
{"question": "電腦斷層檢查發現廣泛頭骨增厚（diffuse skull thickening），下列何者最不會發生？", "answer": "水腦症（hydrocephalus）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "肢端肥大症（acromegaly）", "B": "地中海型貧血（thalassemia）", "C": "水腦症（hydrocephalus）", "D": "小腦症（microcephaly）", "language": "tw"}
{"question": "免疫系統能夠偵查出腫瘤細胞的存在，並且盡力消滅它。免疫系統與腫瘤互動的階段依先後次序為何？", "answer": "消滅期→平衡期→逃避期", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "逃避期（escape phase）→平衡期（equilibrium phase）→腫瘤之免疫調節期（immunoediting）", "B": "逃避期→消滅期（elimination phase）→平衡期", "C": "平衡期→逃避期→消滅期", "D": "消滅期→平衡期→逃避期", "language": "tw"}
{"question": "與醫療資源耗用和配置較有關係的健康指標為何？", "answer": "疾病盛行率", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "疾病盛行率", "B": "疾病發生率", "C": "有效接觸率", "D": "平均餘命", "language": "tw"}
{"question": "當一個病人被診斷出有右側的輸尿管結石合併右腎積水，同時又有左側腎結石但無左腎積水；你覺得下列敘述中何者是最適當的治療步驟？", "answer": "先以體外震波碎石術或輸尿管鏡碎石術來治療右側的輸尿管結石，等結石廓清、腎積水消除後再處理左腎結石", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "先將左腎結石用體外震波碎石術來治療，等結石廓清後再處理右側輸尿管結石", "B": "同時為兩側的結石施行體外震波碎石術治療", "C": "先以體外震波碎石術或輸尿管鏡碎石術來治療右側的輸尿管結石，等結石廓清、腎積水消除後再處理左腎結石", "D": "先將右側輸尿管結石推回腎臟，再施予兩側的體外震波碎石術治療", "language": "tw"}
{"question": "一位 55 歲男性糖尿病病患發生水腫及蛋白尿超過每日 6 克，該病患合併增生性視網膜病變，下列何種處置不需立即執行？", "answer": "腎臟組織切片", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "利尿劑", "B": "腎臟組織切片", "C": "限鹽飲食", "D": "血管張力素接受體阻斷劑（angiotensin receptor blocker）", "language": "tw"}
{"question": "Sulfonylureas類治療糖尿病藥物的主要作用機轉為何？", "answer": "促進胰島素的分泌", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "抑制胰島素被肝臟代謝分解", "B": "促進胰島素的生合成及敏感性", "C": "增加細胞的胰島素受體數目", "D": "促進胰島素的分泌", "language": "tw"}
{"question": "兒童嚴重型再生不良性貧血的治療選項中，下列何種治療方式之治癒率較高？", "answer": "血液幹細胞移植", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "放射治療", "B": "化療", "C": "輸血", "D": "血液幹細胞移植", "language": "tw"}
{"question": "下列那一種血漿蛋白不是以肝臟為主要的製造場所？", "answer": "γ 球蛋白（γ-globulin）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "白蛋白（albumin） \t", "B": "β 球蛋白（β-globulin）", "C": "γ 球蛋白（γ-globulin）", "D": "纖維蛋白原（fibrinogen）", "language": "tw"}
{"question": "一位腦中風（stroke）患者，其身體檢查發現有一側肢體的軀體感覺（somatosensory）功能缺損，而肌力（muscle power）正常。腦中風病灶最有可能位於：", "answer": "視丘（thalamus） \t", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "大腦額葉（frontal lobe）", "B": "大腦顳葉（temporal lobe）", "C": "視丘（thalamus） \t", "D": "大腦枕葉（occipital lobe）", "language": "tw"}
{"question": "有關急性呼吸窘迫症（acute respiratory distress syndrome；ARDS）病人的臨床處理原則的敘述，下列何者錯誤？", "answer": "在 ARDS 病人使用較高的呼吸末期正壓（positive end-expiratory pressure，PEEP）提升血氧的臨床策略，目前已經確認為最適當壓力與方法，可有效改善 ARDS 病人死亡率", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "在 ARDS 病人使用較高的呼吸末期正壓（positive end-expiratory pressure，PEEP）提升血氧的臨床策略，目前已經確認為最適當壓力與方法，可有效改善 ARDS 病人死亡率", "B": "趴姿（prone position）可以有效改善 ARDS 病人血氧，但沒有影響死亡率", "C": "趴姿（prone position）目前建議應用在持續血氧過低 ARDS 病人", "D": "使用吸入性一氧化氮（Inhaled NO）目前可以應用在持續血氧過低 ARDS 病人，但對於死亡率沒有影響 9 下列關於中心視網膜動脈阻塞（central retinal artery occlusion）之敘述，何者錯誤？", "language": "tw"}
{"question": "有關檢查脊髓受傷病患之敘述，下列何者錯誤?", "answer": "患者僅下肢麻痺，上肢肌力正常，可完全排除頸椎受傷", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "患者若上、下肢完全麻痺，但腦神經系統正常，通常表示頸椎受傷", "B": "患者僅下肢麻痺，上肢肌力正常，可完全排除頸椎受傷", "C": "患者於外傷後 48～72 小時內還能保留肢體運動或感覺，通常表示有較佳之預後", "D": "對任何脊椎受傷之患者，首要考量為不可任意移動頸部", "language": "tw"}
{"question": "使用下類那一種治療巴金森氏症藥物時，尿液及唾液經常會呈現褐色的狀況？", "answer": "levodopa", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "selegiline", "B": "levodopa", "C": "amantadine", "D": "bromocriptine", "language": "tw"}
{"question": "一位 15 歲女童主訴過去幾個月有間歇性的發燒、手腕及踝關節痛。尿液檢查發現有血尿（hematuria）、蛋白尿（proteinuria）及膿尿（pyuria）。下列何種檢驗對診斷最有幫助？", "answer": "雙股 DNA（dsDNA）抗體 \t", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "雙股 DNA（dsDNA）抗體 \t", "B": "喉頭 A 群 beta 溶血性鏈球菌（group A beta-hemolytic streptococcus）培養", "C": "小便培養", "D": "紅血球沈澱速率（erythrocyte sedimentation rate）", "language": "tw"}
{"question": "第二頸髓完全損傷的患者，需要下列輔具，何者不包括在內？", "answer": "握柄加粗湯匙", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "口控電動輪椅", "B": "聲控電腦", "C": "握柄加粗湯匙", "D": "呼吸器", "language": "tw"}
{"question": "35歲男性，家住山上，在颱風之後清掃自家附近水溝，當時注意到有很多死老鼠，一週後因黃疸、茶色尿及發高燒被送到急診，最可能的致病菌是：", "answer": "鉤端螺旋體（Leptospira species）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "鉤端螺旋體（Leptospira species）", "B": "腸病毒（enterovirus）", "C": "流感病毒（influenza virus）", "D": "登革熱病毒（dengue virus）", "language": "tw"}
{"question": "腎臟移植手術一個月之內比較少見的感染為何？", "answer": "BK virus（polyoma）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "BK virus（polyoma）", "B": "泌尿道感染 \t", "C": "oral candidiasis \t", "D": "herpesvirus", "language": "tw"}
{"question": "下列何種藥物可作為墮胎藥？", "answer": "Dinoprostone", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "Alprostadil", "B": "Dinoprostone", "C": "Epoprostenol", "D": "Iloprost", "language": "tw"}
{"question": "承上題，在治療結束後，病人突然發生單側下肢腫脹，膚色略為暗紅，觸壓時沒有凹陷（non-pitting），無局部發熱現象，病人並無凝血功能異常也無栓塞的紀錄，則下列診斷及治療何者較正確？", "answer": "Trousseau's syndrome，給予抗凝血劑及抗癌藥物", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "下肢靜脈栓塞，給予抗凝血劑 heparin", "B": "下肢水腫，給予利尿劑", "C": "Trousseau's syndrome，給予抗凝血劑及抗癌藥物", "D": "下肢靜脈栓塞，給予血栓溶解劑 recombinant tissue plasminogen activator", "language": "tw"}
{"question": "下列那一種症狀不是由克沙奇 A 型病毒（Coxsackie A virus）所引起的？", "answer": "胸膜痛（pleurodynia）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "疹性咽峽炎（herpangina）", "B": "心臟炎（carditis）", "C": "胸膜痛（pleurodynia）", "D": "腦膜炎（meningitis）", "language": "tw"}
{"question": "76.7歲男童因突發性高燒、吞嚥困難就醫，在對比劑注射後，接受電腦斷層掃描檢查如圖示，箭號所指病灶最可能診斷為何？  ", "answer": "咽喉後膿瘍", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "扁桃腺炎", "B": "咽喉後膿瘍", "C": "咽喉癌", "D": "甲狀腺水囊", "language": "tw"}
{"question": "下列何種疾病引起的低血鈉（hyponatremia）與血液稀釋無關？", "answer": "抗利尿激素不適當分泌症候群（syndrome of inappropriate antidiuretic hormone secretion）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "肝硬化（liver cirrhosis）", "B": "鬱血性心臟衰竭（congestive heart failure）", "C": "抗利尿激素不適當分泌症候群（syndrome of inappropriate antidiuretic hormone secretion）", "D": "腎病症候群（nephrotic syndrome）", "language": "tw"}
{"question": "承上題，上述診斷之最佳手術治療方法為：", "answer": "下視丘刺激術（subthalamic stimulation）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "蒼白球切開術（pallidotomy）或燒灼術", "B": "視丘刺激術（thalamic stimulation）", "C": "下視丘刺激術（subthalamic stimulation）", "D": "大腦皮質刺激術（cortical stimulation）", "language": "tw"}
{"question": "下列有關Clostridium difficile及其導致之腹瀉疾病之敘述，何者錯誤？", "answer": "治療後的復發率（recurrence rate）常低於5%", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "健康新生兒無症狀腸道帶菌（asymptomatic fecal carriage）並不罕見", "B": "通常為醫療照護相關之感染", "C": "抗微生物製劑的使用是誘發本疾病的主因", "D": "治療後的復發率（recurrence rate）常低於5%", "language": "tw"}
{"question": "利用視網膜雷射（laser photocoagulation）治療糖尿病視網膜病變的功效，不包括下列何者？", "answer": "可防止微血管瘤（microaneurysms）之發生", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "可防止微血管瘤（microaneurysms）之發生", "B": "可促使視網膜新生血管（neovascularization）之消退", "C": "可減緩牽引型視網膜剝離（tractional retinal detachment）之惡化", "D": "可減少玻璃體出血（vitreous hemorrhage）之機會", "language": "tw"}
{"question": "21歲男性因上頸部硬塊求診，接受對比劑注射後的電腦斷層掃描如圖⽰，則最可能診斷為何？", "answer": "⿐咽癌", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "⿐咽癌", "B": "淋巴管瘤", "C": "上呼吸道感染", "D": "深頸部感染症", "language": "tw"}
{"question": "下列何種神經肌肉阻斷劑的作用是直接抑制骨骼肌細胞內鈣離子自肌漿網釋出而使骨骼肌鬆弛？", "answer": "Dantrolene", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "Baclofen", "B": "Dantrolene", "C": "Pancuronium", "D": "Atracurium", "language": "tw"}
{"question": "下列何種疾病是性聯遺傳（sex-linked recessive）？", "answer": "裘馨氏肌肉失養症（Duchenne muscular dystrophy）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "肢帶型肌肉失養症（limb-girdle muscular dystrophy）", "B": "肌強直症（myotonic dystrophy）", "C": "裘馨氏肌肉失養症（Duchenne muscular dystrophy）", "D": "低鉀週期性麻痺（hypokalemic periodic paralysis）", "language": "tw"}
{"question": "下列何者不是 Framingham Heart Study 用來估算心血管疾病十年風險的指標？", "answer": "舒張壓 \t", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "總膽固醇 \t", "B": "高密度脂蛋白膽固醇值（HDL）", "C": "舒張壓 \t", "D": "抽菸習慣", "language": "tw"}
{"question": "下列何種降血壓藥物的作用機轉是經由 NO-cGMP pathway？", "answer": "Nitroprusside", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "Verapamil", "B": "Trimethaphan", "C": "Diazoxide", "D": "Nitroprusside", "language": "tw"}
{"question": "下列那一硬腦膜靜脈竇（dural venous sinuses）的血液直接注入內頸靜脈（internal jugular vein）？", "answer": "乙狀竇（sigmoid sinus）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "乙狀竇（sigmoid sinus）", "B": "上岩竇（superior petrosal sinus）", "C": "橫竇（transverse sinus）", "D": "枕竇（occipital sinus）", "language": "tw"}
{"question": "關於眼瞼惡性腫瘤的敘述，下列何者錯誤？", "answer": "⽪脂腺癌⼀般好發在下眼瞼", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "基底細胞癌（basal cell carcinoma）發⽣率最⾼", "B": "鱗狀細胞癌（squamous cell carcinoma）⼀般預後較基底細胞癌差", "C": "⽪脂腺癌（sebaceous gland carcinoma）臨床上易被誤診為慢性眼瞼炎或霰粒腫（chalazion）", "D": "⽪脂腺癌⼀般好發在下眼瞼", "language": "tw"}
{"question": "下列有關出血性腦中風之敘述，何者錯誤？", "answer": "高血壓所導致之出血性腦中風最常發生於頂葉之大腦皮質", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "不正常之腦內血管可以造成出血性腦中風 \t", "B": "不正常之血液凝集功能可以造成出血性腦中風", "C": "出血性腦中風亦可發生於年輕人", "D": "高血壓所導致之出血性腦中風最常發生於頂葉之大腦皮質", "language": "tw"}
{"question": "45.某勞工於甲、乙、丙場所分別工作2.5、3、2.5小時，若其甲苯濃度分別為40、150、20 ppm，其時量平均濃度 （TWA）為何？\n", "answer": "75 ppm", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "70 ppm", "B": "74 ppm", "C": "75 ppm", "D": "80 ppm", "language": "tw"}
{"question": "一位 21 歲男性患者，因胸痛及呼吸困難前來就診，胸部 X 光片如圖所示，下列何種處置最為適當？", "answer": "插胸管引流 \t", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "即時給予抗生素治療", "B": "給予支氣管擴張劑吸入治療", "C": "插胸管引流 \t", "D": "給予氧氣治療，並觀察病情", "language": "tw"}
{"question": "有關決定能力，下列敘述何者錯誤？", "answer": "根據「安寧緩和醫療條例」，末期病人意識昏迷或無法清楚表達意願時，由醫護人員根據病患最大利益進行代理", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "一個人可能有能力決定住處的選擇，卻沒有能力決定接受何種治療", "B": "根據「安寧緩和醫療條例」，末期病人意識昏迷或無法清楚表達意願時，由醫護人員根據病患最大利益進行代理", "C": "「病患自主」和「尊重人格」的倫理原則要求讓有決定能力的人對醫療行使知情同意", "D": "一個人可能因為精神錯亂而暫時失去決定能力，但之後又恢復這能力", "language": "tw"}
{"question": "法洛氏四合症（Tetralogy of Fallot）完全矯正後，長期追蹤若有嚴重的肺動脈瓣逆流，右心室擴大，及右心室功能失效，此時最好的處理方式為何？", "answer": "肺動脈瓣置換", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "心房中隔造口（creation of atrial septal defect）", "B": "肺動脈瓣置換", "C": "三尖瓣置換 \t", "D": "使用降肺高壓藥物", "language": "tw"}
{"question": "下列何者不是愛滋病毒（human immunodeficiency virus）傳播的方式？", "answer": "共用餐具 \t", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "性行為未全程使用保險套", "B": "共用針頭施打毒品", "C": "共用餐具 \t", "D": "被愛滋病毒感染的母親哺餵母乳", "language": "tw"}
{"question": "16.3歲男童，因為咽喉疼痛伴隨吞嚥與呼吸困難送至急診室，經醫師檢查，發現他在每次吸氣時都出現明顯阻塞 的聲音，側頸X光（lateral neck x-ray）報告顯示會厭軟骨腫脹（swollen epiglottis），此最有可能是下列何種細菌感染所造成？ \n", "answer": "b型流感嗜血桿菌（Haemophilus influenzae type b）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "b型流感嗜血桿菌（Haemophilus influenzae type b）", "B": "無乳鏈球菌（Streptococcus agalactiae）", "C": "奈瑟氏腦膜炎球菌（Neisseria meningitidis）", "D": "單核球增多性李斯特菌（Listeria monocytogenes）", "language": "tw"}
{"question": "大部份血管瘤（hemangioma）在多少歲開始退化？", "answer": "12～18個月", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "1個月", "B": "3～6個月", "C": "6～9個月", "D": "12～18個月", "language": "tw"}
{"question": "19 一位 40 歲男性，曾經因肝功能異常接受血液檢查，被告知結果為 anti-HDV 呈現陽性反應，這位病人最可能當時還有以下何種病毒感染？（HDV 表示 D 型肝炎病毒） ", "answer": "B 型肝炎病毒", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "A 型肝炎病毒", "B": "B 型肝炎病毒", "C": "C 型肝炎病毒", "D": "E 型肝炎病毒", "language": "tw"}
{"question": "Pyrazinamide 在酸性環境中可有效對抗結核桿菌的活性，故常與其他藥物合併使用以治療結核病患，但該抗生素真正有活性的形式是必須被水解成 pyrazinoic acid。此水解反應需在何器官進行？", "answer": "肝臟", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "心臟", "B": "肝臟", "C": "腎臟", "D": "脾臟", "language": "tw"}
{"question": "1歲以上正常小孩應仍保有下列那一種反應或反射？", "answer": "parachute reaction", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "palmar grasp reflex", "B": "parachute reaction", "C": "rooting reflex", "D": "symmetric tonic neck reflex（STNR） 72.", "language": "tw"}
{"question": "下列有關遲發型性腺功能低下症（late onset hypogonadism）的敘述，何者正確？", "answer": "有臨床症狀時才須治療", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "睪固酮於晚上 8 至 10 點分泌達最高峰", "B": "睪固酮由睪丸內曲細精管內皮細胞分泌", "C": "有臨床症狀時才須治療", "D": "前列腺增生（BPH）病人可以補充睪固酮", "language": "tw"}
{"question": "不產芽孢厭氧菌（non-sporeforming anaerobes）感染人體，最常造成下列那種形式的病變？", "answer": "組織壞死和膿瘍（abscess）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "食物中毒（food poisoning）", "B": "溶血性貧血（hemolytic anemia）", "C": "組織壞死和膿瘍（abscess）", "D": "自體免疫病（autoimmune diseases）", "language": "tw"}
{"question": "18 75 歲王先生，因高血壓服藥控制，血壓為 130/70 mmHg。三天前因攝護腺肥大，併服泌尿科開予的 α-blocker，早上起床時發生昏厥（syncope），2 分鐘後自然甦醒。家屬並未發現有尿、糞失禁現象。 病人昏厥最可能的原因為何？ \n", "answer": "姿勢性低血壓（orthostatic hypotension）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "姿勢性低血壓（orthostatic hypotension）", "B": "心室顫動（ventricular fibrillation）", "C": "心因性休克（cardiogenic shock）", "D": "癲癇發作（seizure）", "language": "tw"}
{"question": "⼀位61歲男性⻑期使⽤diazepam每天50～60毫克達15年，若立即停⽌服⽤後，下列何者為最正確的描述？", "answer": "抽搐發作為較嚴重之戒斷症狀", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "⼼搏變慢", "B": "戒斷症狀不會在停⽤5天後才出現", "C": "抽搐發作為較嚴重之戒斷症狀", "D": "戒斷症狀不致於產⽣譫妄", "language": "tw"}
{"question": "73.15歲車禍傷患主訴左上腹部劇痛，而且逐漸呈現休克狀態。電腦斷層檢查如附圖。箭頭所指之異常最符合下列那一項診斷？  ", "answer": "spleen laceration", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "spleen laceration", "B": "pancreas laceration", "C": "kidney laceration", "D": "diaphragm laceration", "language": "tw"}
{"question": "免疫球蛋白重鏈（immunoglobulin heavy chain）基因之胚原序列（germline sequence）可存在於下列那種細胞中？", "answer": "T 細胞", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "成熟之 B 細胞", "B": "活化之 B 細胞", "C": "漿細胞（plasma cell）", "D": "T 細胞", "language": "tw"}
{"question": "Celiac disease及Crohn's disease是二種腸道發炎疾病，下列有關二者之比較何者正確？", "answer": "IFN-γ所引起的發炎反應，在這二種疾病都扮演重要角色", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "前者是對腸內共生菌有強烈發炎反應，後者是因為對麥類食物過敏所引起", "B": "前者可能與NOD-2分子失去功能有關，後者主要與HLA-DQ2分子的表現有關", "C": "IFN-γ所引起的發炎反應，在這二種疾病都扮演重要角色", "D": "利用廣泛性抗生素去掉大部分共生菌，皆可治療這二種疾病", "language": "tw"}
{"question": "77.下列有關單胞絛蟲（Echinococcus granulosus）感染人體的敘述，共有幾項敘述錯誤？①人為終宿主（final host） ②最容易在肌肉形成包生囊（hydatid cyst） ③因誤食未熟帶蟲之牛肉而感染 ④感染後數週即迅速發病 ", "answer": "4項", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "1項", "B": "2項", "C": "3項", "D": "4項", "language": "tw"}
{"question": "58 35 歲之女性病人，主訴心悸，容易緊張，體重在半年內減輕 10 公斤。理學檢查發現手易發抖、冒汗。 頸部甲狀腺吞嚥時易見。甲促素（TSH）測不到。下列何者是確定本病例病因之最重要檢查？\n", "answer": "甲狀腺碘 131 攝取影像檢查", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "甲狀腺超音波", "B": "甲狀腺碘 131 攝取影像檢查", "C": "細針穿刺細胞學檢查", "D": "頸部斷層攝影", "language": "tw"}
{"question": "下列口服降血糖藥物中，不會引起體重增加的是那一種？", "answer": "metformin", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "glyburide", "B": "metformin", "C": "pioglitazone", "D": "repaglinide", "language": "tw"}
{"question": "乳癌最常見轉移部位為下列何者？", "answer": "骨骼", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "腦部", "B": "骨骼", "C": "肺部", "D": "肝臟", "language": "tw"}
{"question": "腰椎椎間盤突出，90%發生在那個地方？", "answer": "L4-5 and L5-S1", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "L1-2 and L2-3", "B": "L2-3 and L3-4", "C": "L3-4 and L4-5", "D": "L4-5 and L5-S1", "language": "tw"}
{"question": "單純以加氯消毒飲用水，對下列那一種病原體效果不佳？", "answer": "梨型鞭毛蟲（Giardia）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "梨型鞭毛蟲（Giardia）", "B": "沙門桿菌（Salmonella）", "C": "志賀桿菌（Shigella）", "D": "大腸桿菌（Esherichia Coli）", "language": "tw"}
{"question": "下列有關白血病（leukemia）各器官病理變化之敘述，何者錯誤？", "answer": "慢性淋巴球性白血病（chronic lymphoid leukemia）之肝臟浸潤在於肝竇狀隙內", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "急性骨髓性白血病（acute myeloid leukemia）中單核球分化之亞型較可能浸潤皮膚及其附屬構造", "B": "急性淋巴球性白血病（acute lymphoid leukemia）比急性骨髓性白血病較常見有中樞神經", "C": "綠色瘤（chloroma）多會進展為急性骨髓性白血病", "D": "慢性淋巴球性白血病（chronic lymphoid leukemia）之肝臟浸潤在於肝竇狀隙內", "language": "tw"}
{"question": "有關心電圖PR間距（PR interval），最不可能代表下列心跳週期的那一部分？", "answer": "心室去極化（ventricular depolarization）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "心房去極化（atrial depolarization）", "B": "心房再極化（atrial repolarization）", "C": "房室間細胞延遲（atrioventricular delay）", "D": "心室去極化（ventricular depolarization）", "language": "tw"}
{"question": "下列何者非葡萄球菌菌種（Staphylococcus species）所造成的主要疾病？", "answer": "胃潰瘍（gastric ulcer）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "食物中毒（food poisoning）", "B": "膿皰瘡（impetigo）", "C": "皮膚燙傷樣綜合徵狀（scalded skin syndrome）", "D": "胃潰瘍（gastric ulcer）", "language": "tw"}
{"question": "關於梅毒的敘述，下列何者正確？", "answer": "二期梅毒皮疹典型發生在chancre出現的3~12週後，但在HIV病患出現的時間可能與chancre有所重疊", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "梅毒螺旋體（Treponema pallidum）可以利用鏡檢與其他nonvenereal diseases的treponemes做鑑別診斷", "B": "二期梅毒皮疹經治療後，皮疹通常在4~12週後消褪", "C": "二期梅毒皮疹典型發生在chancre出現的3~12週後，但在HIV病患出現的時間可能與chancre有所重疊", "D": "血液專一性treponemal test是監測梅毒治療效果的最佳指標", "language": "tw"}
{"question": "77 在治療注意力缺損過動疾患（attention-deficit/hyperactivity disorder）之患者，常使用中樞神經刺激劑 （central stimulants），下列何者不屬此類藥物？ \n", "answer": "Nortriptyline \t", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "Dextroamphetamine \t", "B": "Methylphenidate", "C": "Nortriptyline \t", "D": "Pemoline", "language": "tw"}
{"question": "塵肺病中與惡性間皮瘤（malignant mesothelioma）最相關的物質是：", "answer": "石綿", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "碳", "B": "鉛", "C": "矽", "D": "石綿", "language": "tw"}
{"question": "下列那個現象最能顯示 DNA 為遺傳物質？", "answer": "DNA 的轉化作用（transformation）能改變細菌的表型（phenotype） \t", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "RNA 的生物合成必須以單股 DNA 做為模版 \t", "B": "DNA 的轉化作用（transformation）能改變細菌的表型（phenotype） \t", "C": "DNA 存在於原核生物中 \t", "D": "DNA 存在於所有的真核的細胞核中", "language": "tw"}
{"question": "下列有關抗癲癇藥物oxcarbazepine的敘述，何者錯誤？", "answer": "其比carbamazepine具有較強的誘發肝臟細胞色素P450活性的作用", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "主要靠其代謝物10-hydroxy-carbazepine（MHD）來產生抗癲癇作用", "B": "其藥理學作用方式與carbamazepine相似，但相對嚴重的副作用較少發生", "C": "其比carbamazepine具有較強的誘發肝臟細胞色素P450活性的作用", "D": "使用oxcarbazepine較carbamazepine容易發生低鈉血症（hyponatremia）", "language": "tw"}
{"question": "老化過程中會發生許多生理變化，在 80 歲以上之正常老人，下列何種變化不正確或較罕見？", "answer": "腎素（renin）與腎上腺皮質醛固酮（aldosterone）分泌增加", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "心臟竇房結（sino-atrial node）之節律細胞（pacemaker cells）數量減少可達 90%", "B": "腎素（renin）與腎上腺皮質醛固酮（aldosterone）分泌增加", "C": "約有 50%可在腸道發現憩室（diverticula）", "D": "動脈血氧分壓約 70-75 毫米汞柱 21 \t下列何者在老年病患最不常見？", "language": "tw"}
{"question": "下列何者會因小腸中出現酸性食糜而分泌？", "answer": "胰泌素（secretin）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "胃抑素（gastric inhibitory polypeptide）", "B": "胃泌素（gastrin）", "C": "飢餓素（ghrelin） \t", "D": "胰泌素（secretin）", "language": "tw"}
{"question": "下列何者不屬於深筋膜（deep fascia）的構造？", "answer": "半月板（meniscus）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "闊筋膜（fascia lata）", "B": "半月板（meniscus）", "C": "髂脛束（iliotibial tract）", "D": "足底筋膜（plantar aponeurosis）", "language": "tw"}
{"question": "S-D 序列（Shine-Dalgarno sequence）是位於 mRNA 轉譯起點（translation initiation site）上游的 AG 豐富序列（AG rich sequence），其功能為何？", "answer": "可與 16S 核糖體 RNA 的 3'端序列結合，使 mRNA 的轉譯起點作正確排列以利轉譯表現的進行", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "可與 23S 核糖體 RNA（ribosomal RNA）的 3'端序列結合，使 mRNA 上的啟動子區域（promoter region）作正確排列以利轉譯表現的進行 \t", "B": "可與 16S 核糖體 RNA 的 3'端序列結合，使 mRNA 上的啟動子區域作正確排列以利轉譯表現的進行", "C": "可與 23S 核糖體 RNA 的 3'端序列結合，使 mRNA 的轉譯起點作正確排列以利轉譯表現的進行", "D": "可與 16S 核糖體 RNA 的 3'端序列結合，使 mRNA 的轉譯起點作正確排列以利轉譯表現的進行", "language": "tw"}
{"question": "34.以下有關hereditary nonpolyposis colon cancer（HNPCC；或稱Lynch's syndrome）常見的臨床病理及基因分子 變異，何者錯誤？\n", "answer": "HNPCC大腸直腸癌患者診斷的中位年齡，較其他一般民眾大腸直腸癌診斷的中位年齡來得較年長", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "HNPCC大腸直腸癌患者診斷的中位年齡，較其他一般民眾大腸直腸癌診斷的中位年齡來得較年長", "B": "HNPCC患者的家屬也好發卵巢癌、子宮內膜癌或其他的腸胃道癌症", "C": "HNPCC與germline mutations of hMSH2或hMLH1相關", "D": "hMSH2或hMLH1之基因變異將導致細胞內DNA mismatch repair機制的缺損", "language": "tw"}
{"question": "下列何者不是腹膜（peritoneum）的衍生物？", "answer": "卵巢韌帶", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "闊韌帶", "B": "卵巢繫膜", "C": "卵巢韌帶", "D": "輸卵管繫膜", "language": "tw"}
{"question": "有關溺水病人之急救，下列何者正確？", "answer": "最重要的病理性結果是缺氧 \t", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "最重要的病理性結果是缺氧 \t", "B": "應儘早清除呼吸道的水分，儘速實施哈姆立克急救", "C": "應使用提下巴法打開呼吸道，且常規使用頸圈於每位溺水病患", "D": "急救溺水的病人，應從水中就開始做 CPR，然後一面游向岸邊", "language": "tw"}
{"question": "抑制單純疹病毒之藥物 acyclovir，其標的為何？", "answer": "病毒胸腺激酶（thymidine kinase） \t", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "直接破壞病毒的組成，造成病毒結構解離 \t", "B": "阻止病毒從寄主細胞中釋放出來", "C": "病毒胸腺激酶（thymidine kinase） \t", "D": "抑制病毒 RNA 合成酶（RNA polymerase）的作用", "language": "tw"}
{"question": "下列甲狀腺結節（thyroid nodule）的檢查，應不優先考慮何者？", "answer": "正子攝影檢查", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "超音波及細針穿刺細胞檢查", "B": "胸骨下甲狀腺瘤作CT或 MRI", "C": "正子攝影檢查", "D": "甲狀腺核醫掃描（scanning）用於濾泡瘤且甲狀腺刺激素（TSH）低者", "language": "tw"}
{"question": "比較第一型和第二型骨骼肌纖維時，下列何者錯誤？", "answer": "第一型纖維較易疲乏", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "第一型纖維的粒線體含量較豐富", "B": "第一型纖維較易疲乏", "C": "第一型纖維的肌球蛋白含量較豐富", "D": "第一型纖維的微血管含量較豐富", "language": "tw"}
{"question": "這位病人可能是因下列何構造被血塊擠壓，進而壓迫腦幹而引起上述症狀？", "answer": "鉤（uncus）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "小腦扁桃體（cerebellar tonsil）", "B": "鉤（uncus）", "C": "胼胝體（corpus callosum）", "D": "下視丘（hypothalamus）", "language": "tw"}
{"question": "78 一位 72 歲男性在周邊血液出現有核紅血球。病人之直接及間接抗球蛋白測試（direct and indirect  Coombs test）均為陰性。下列何者為最可能之原因？ \n", "answer": "癌症骨髓轉移", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "癌症骨髓轉移", "B": "慢性酒精中毒", "C": "腸胃吸收不良", "D": "慢性失血", "language": "tw"}
{"question": "23 一位 15 歲女孩來到門診，主訴發燒 3 週、體重減輕、全身倦怠，身體診查發現雙側臉頰紅斑。在懷疑 systemic lupus erythematosus 情形下，下列何種檢查結果符合美國風濕病學院（ACR）公布的十一 項診斷準則之一？ \n", "answer": "positive anticardiolipin IgG and IgM", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "淋巴球 2200/mm3 \t", "B": "24 小時肌酐廓清率（creatinine clearance rate）45 ml/min/1.73 m2", "C": "positive anticardiolipin IgG and IgM", "D": "補體 C3：60 mg/dL, C4：9.87 mg/dL", "language": "tw"}
{"question": "下列對於「脾臟之紅髓（red pulp）」的敘述，何者正確？", "answer": "富含血液 \t", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "由淋巴小結（lymphatic nodule）組成", "B": "位於皮質區", "C": "富含血液 \t", "D": "主要功能是過濾淋巴液", "language": "tw"}
{"question": "病人發生代謝性酸血症（Metabolic acidosis）合併下列何種臨床情境，則可能為Inborn errors of metabolism 的機率最高？", "answer": "3週大新生兒，一直嘔吐、無法進食、活力差。血液Anion gap與Lactic acid增加；尿液Ketones 4+", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "3週大新生兒，一直嘔吐、無法進食、活力差。血液Anion gap與Lactic acid增加；尿液Ketones 4+", "B": "10個月大男嬰持續腹瀉3天。血液呈現氯高而Anion gap正常", "C": "3歲大男童高燒5天且食慾差。血液白血球增高", "D": "8歲女童多吃、多喝、多尿但體重下降。血糖410 mg/dL，血液呈現Anion gap增加", "language": "tw"}
{"question": "45歲孕婦，G5P4，妊娠週數不明，接受產科超音波檢查，正在測量標的的名稱（雙十\t之間）為何？", "answer": "FL（femur length）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "BPD（biparietal diameter）", "B": "AC（abdominal circumference）", "C": "FL（femur length）", "D": "NT（nuchal translucency）", "language": "tw"}
{"question": "⼤部分⼈體內成熟T細胞上之TCR為α-chain及β-chain所組成，故稱為αβ T cells。當比對TCR α-chain及βchain的DNA序列時，發現β-chain比α-chain多出了下列何種基因片段？", "answer": "D", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "V", "B": "D", "C": "J", "D": "C", "language": "tw"}
{"question": "下列何者直接位於子宮的後方？", "answer": "輸卵管", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "卵巢", "B": "膀胱", "C": "直腸", "D": "輸卵管", "language": "tw"}
{"question": "65 下列何者為心臟復健的目的？①治療心臟病 ②增進心臟功能 ③減少殘障發生 ④找出並改善危 險因子\n", "answer": "①②③④", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "只有①和②", "B": "只有③和④", "C": "只有①②③", "D": "①②③④", "language": "tw"}
{"question": "下列有關房水（aqueous humour）之敘述，何者錯誤？", "answer": "房水在前房形成，經瞳孔，流入後房排出", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "房水是血漿在睫狀體（cilicary body）處分泌（secretion）形成", "B": "大約90%的房水經小樑網（trabecular meshwork）排出眼睛", "C": "大約10%的房水經葡萄膜鞏膜路徑（uveoscleral route）排出眼睛", "D": "房水在前房形成，經瞳孔，流入後房排出", "language": "tw"}
{"question": "α-胺基酸中的胺基（-NH2）與羧基（-COOH），其 pKa 值分別為 10 和 2，當 pH 接近中性時，胺基會接受一個質子（proton），而羧基則失去一個質子，這種狀態或現象稱為：", "answer": "兩性離子（zwitterions）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "異構現象（isomerization）", "B": "中和現象（neutralization）", "C": "兩性離子（zwitterions）", "D": "立體異構現象（stereoisomerization）", "language": "tw"}
{"question": "關於兒童失神癲癇 （childhood absence epilepsy）的敘述，下列何者正確？", "answer": "屬於良性的原發性全面性癲癇（idiopathic generalized epilepsy）之一", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "好發於1至3歲", "B": "常伴有智力損傷或神經學檢查異常", "C": "每秒4到6次的棘波-慢波複合波（4-to 6-Hz spike-and-wave complexes）為其特徵性之腦電圖（EEG）表現", "D": "屬於良性的原發性全面性癲癇（idiopathic generalized epilepsy）之一", "language": "tw"}
{"question": "鐵硫蛋白（iron-sulfur protein）為一種電子傳遞蛋白質，下列相關敘述何者不正確？", "answer": "有 3Fe-3S cluster", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "屬於 non-heme iron protein", "B": "其鐵硫簇（iron-sulfur cluster）的配體（ligand）大多是 cysteine", "C": "Rieske protein 屬於此類的蛋白", "D": "有 3Fe-3S cluster", "language": "tw"}
{"question": "下列何者是食道異物（esophageal foreign body）最容易卡住的部位？", "answer": "環咽括約肌（cricopharyngeal sphincter）狹窄區", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "環咽括約肌（cricopharyngeal sphincter）狹窄區", "B": "主動脈跨過食道造成狹窄區", "C": "食道中三分之一處", "D": "下食道括約肌（lower esophageal sphincter）狹窄區", "language": "tw"}
{"question": "73.13歲女性病患，月經未來且下腹痛，故接受電腦斷層檢查，結果如下圖。其最有可能的診斷為何？  ", "answer": "子宮融合異常合併處女膜未穿孔（uterine fusion abnormality with imperforated hymen）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "子宮肌瘤（uterine myoma）", "B": "子宮內膜癌（endometrial cancer）", "C": "輸卵管卵巢膿瘍（tubo-ovarian abscess）", "D": "子宮融合異常合併處女膜未穿孔（uterine fusion abnormality with imperforated hymen）", "language": "tw"}
{"question": "有關肝醣合成酶（glycogen synthase）參與肝醣合成之敘述，下列何者正確？", "answer": "將葡萄糖殘基以（α1→4）鍵結⾄肝醣鏈（glycogen chain）之非還原端", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "此酵素被磷酸化後可被活化", "B": "此酵素只存在於肝臟", "C": "利⽤glucose-6-phosphate做為葡萄糖單元的供給者", "D": "將葡萄糖殘基以（α1→4）鍵結⾄肝醣鏈（glycogen chain）之非還原端", "language": "tw"}
{"question": "處理急性胸痛病患時，下列何項應為第一優先執行？", "answer": "呼吸、脈搏、血壓", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "呼吸、脈搏、血壓", "B": "病史", "C": "身體檢查", "D": "心電圖", "language": "tw"}
{"question": "48 如圖示，未施打顯影劑之電腦斷層橫切面影像，於右大腦半球額頂葉處，有一大範圍之低密度病灶 ，並使中線構造左移，最可能的診斷為下列何者？ \n", "answer": "腦梗塞（cerebral infarct）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "腦炎（encephalitis）", "B": "腦梗塞（cerebral infarct）", "C": "腦挫傷（brain contusion）", "D": "腦瘤（brain tumor）", "language": "tw"}
{"question": "下列那一項不是影響子宮內膜癌的不良預後因子？", "answer": "年輕", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "深部子宮肌肉層侵襲", "B": "grade 3 腫瘤", "C": "年輕", "D": "淋巴血管空間侵襲（lymph-vascular space invasion）", "language": "tw"}
{"question": "依照衛生福利部國民健康署的乳癌篩檢建議，健康年齡 55 歲的停經女性，定期追蹤項目為下列何者？", "answer": "每兩年乳房 X 光攝影", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "每半年執行乳房超音波檢查", "B": "每年乳房 X 光攝影", "C": "每一年乳房超音波檢查", "D": "每兩年乳房 X 光攝影", "language": "tw"}
{"question": "治療慢性腎病（chronic kidney disease）合併之高血壓時，首選藥物為：", "answer": "血管張力素轉化酶阻斷劑（angiotensin-converting enzyme inhibitors）或血管張力素接受器阻斷劑（angiotensin receptor blockers）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "利尿劑（diuretics）", "B": "鈣離子阻斷劑（calcium channel blockers）", "C": "β-阻斷劑（β-blockers）", "D": "血管張力素轉化酶阻斷劑（angiotensin-converting enzyme inhibitors）或血管張力素接受器阻斷劑（angiotensin receptor blockers）", "language": "tw"}
{"question": "急性膽管炎指的是膽道系統細菌性感染，臨床症狀從輕微自癒到危及生命都有可能，何者非Charcot's  triad？", "answer": "意識譫妄（delirium）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "發燒（fever）", "B": "黃疸（jaundice）", "C": "腹痛（abdominal pain）", "D": "意識譫妄（delirium）", "language": "tw"}
{"question": "關於腎小管對於腎小球過濾液中鈉離子再吸收的描述，下列何者錯誤？", "answer": "亨氏管上行段粗枝的基底外側細胞膜會利用鈉-鉀-氯協同轉運蛋白（Na-K-2Cl cotransporter）再吸收 30%腎小球過濾液中的鈉離子", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "60%腎小球過濾液中的鈉離子在近曲小管被再吸收", "B": "亨氏管上行段粗枝的基底外側細胞膜會利用鈉-鉀-氯協同轉運蛋白（Na-K-2Cl cotransporter）再吸收 30%腎小球過濾液中的鈉離子", "C": "遠曲小管（distal convoluted tubule）會利用頂膜（apical membrane）的鈉-氯協同轉運蛋白（Na-Cl cotransporter）再吸收 7%腎小球過濾液中的鈉離子", "D": "集尿管（collecting duct）會利用頂膜的上皮鈉離子通道（epithelial sodium channel）再吸收 3%腎小球過濾液中的鈉離子", "language": "tw"}
{"question": "下列那一個胺基酸可以代謝成α-ketoglutarate，然後進入 citric acid cycle？", "answer": "Proline", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "Glycine", "B": "Proline", "C": "Alanine", "D": "Tyrosine", "language": "tw"}
{"question": "神經傳遞中下列那一項可能最直接促使神經末梢之乙醯膽鹼（acetylcholine）釋放？", "answer": "電壓門控鈣離子通道（voltage-gated calcium ion channel）打開", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "電壓門控鈉離子通道（voltage-gated sodium ion channel）打開", "B": "電壓門控鉀離子通道（voltage-gated potassium ion channel）打開", "C": "電壓門控鈣離子通道（voltage-gated calcium ion channel）打開", "D": "電壓門控鎂離子通道（voltage-gated magnesium ion channel）打開 50 請指出何者不是核糖核酸（ribonucleic acid, RNA）的特性？", "language": "tw"}
{"question": "根據世界醫學會所制定的赫爾辛基宣言（Declaration of Helsinki），對兼顧醫療照護的醫學研究，下列建議何者最為適當？", "answer": "醫師可以結合醫學研究與醫療照護，但此情況僅止於此研究有潛在的預防、診斷或治療的價值", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "應清楚區分醫療照護與醫學研究，以避免責任不清，確保病患權益", "B": "研究是提升醫療照護水準所必需，因此在教學醫院，所有的醫療照護都應包含某種程度之醫學研究", "C": "醫師可以結合醫學研究與醫療照護，但此情況僅止於此研究有潛在的預防、診斷或治療的價值", "D": "無相關建議", "language": "tw"}
{"question": "如果以員工「對工作的自主控制」（control）及「工作負荷」（demand）來分類，以下何種組合的職業壓力最高？", "answer": "低控制、高負荷", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "高控制、高負荷", "B": "高控制、低負荷", "C": "低控制、低負荷", "D": "低控制、高負荷", "language": "tw"}
{"question": "甲狀腺上皮細胞內將碘化甲狀腺球蛋白（iodinated thyroglobulin）分解成甲狀腺素的胞器是：", "answer": "溶酶體（lysosomes）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "溶酶體（lysosomes）", "B": "過氧化酶體（peroxisomes）", "C": "粒線體（mitochondria）", "D": "高爾基氏體（Golgi complex）", "language": "tw"}
{"question": "22 一位 16 歲男性，體檢時發現胸部 X 光肺動脈血管陰影擴大，心臟大小正常，理學檢查聽診在左邊第 肋間有 2/6 度收縮期心雜音，第 2 心音呈固定分裂音（fixed splitting），則最可能的診斷是：", "answer": "心房中隔缺損", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "肺動脈瓣狹窄", "B": "主動脈瓣狹窄", "C": "心室中隔缺損", "D": "心房中隔缺損", "language": "tw"}
{"question": "77.一位56歲女性，由美國紐約返回臺北的飛機途中發生暈厥（syncope），下了飛機後因呼吸不順至急診就 診，她以前不曾發生類似狀況，平常亦無特殊疾病，身體檢查發現血壓120/70 mmHg，心跳126次/分，呼吸 28次/分，體溫37.2℃，呼吸音及心音皆正常，四肢活動自如，無腫脹現象，在給予40％氧氣五分鐘後，動脈氣體分析為pH=7.48，PaO2 =70mmHg，PaCO2 =28mmHg，O2 saturation=92%，此時應安排下列那一項檢查最適當？ \n", "answer": "注射顯影劑的螺旋快速胸部電腦斷層檢查", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "心臟超音波檢查", "B": "靜脈杜卜勒超音波檢查", "C": "注射顯影劑的螺旋快速胸部電腦斷層檢查", "D": "主動脈血管攝影", "language": "tw"}
{"question": "外傷評分系統（Injury Severity Score, ISS）是對外傷病患嚴重度評估常⽤的評分⽅式；下列對於外傷評分系統的敘述何者錯誤？", "answer": "Injury Severity Score（ISS）是⼀種⽣理性評分系統（physiological scoring system）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "Abbreviated Injury Scale（AIS），於1971年提出，將受傷部位嚴重程度，分為從第1級（minimal severity）⾄第6級（presumably fatal）", "B": "Injury Severity Score（ISS）是⼀種⽣理性評分系統（physiological scoring system）", "C": "ISS分數區域為1分⾄75分，minor injury是指ISS<9分", "D": "Glasgow Coma Scale（GCS）能評量外傷病患意識狀態，分數區域為3分⾄15分", "language": "tw"}
{"question": "有關氣喘病患呼吸道過度反應性（airway hyperresponsiveness）之敘述，下列何者錯誤？", "answer": "某病患methacholine PC20<8 mg/mL即可診斷為氣喘", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "常以支氣管激發試\t中使FEV1下降20%之methacholine濃度（PC20）或劑量（PD20）來表示", "B": "如果某病患methacholine劑量-反應曲線在高劑量時未出現平原（plateau）現象也代表呼吸道高反應性之存在", "C": "某病患methacholine PC20<8 mg/mL即可診斷為氣喘", "D": "methacholine PC20值越低代表呼吸道高反應性越高", "language": "tw"}
{"question": "主動脈瓣狹窄的病患容易發生心絞痛（angina pectoris）的原因為何？", "answer": "左心室壓增加但是主動脈壓卻下降", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "左心室壓增加而且主動脈壓也增加", "B": "左心室壓增加但是主動脈壓卻下降", "C": "左心室壓下降而且主動脈壓也下降", "D": "左心室壓下降但是主動脈壓卻增加", "language": "tw"}
{"question": "對於肝硬化的敘述，下列何者錯誤？", "answer": "預防肝硬化所引起的食道靜脈瘤的首選藥物為非選擇性α-blockers", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "經頸靜脈肝內門體靜脈分流術TIPS（transjugular intrahepatic portosystemic shunt） 會使得肝性腦病變", "B": "預防肝硬化所引起的食道靜脈瘤的首選藥物為非選擇性α-blockers", "C": "不論是否伴隨\t出血，末期肝衰竭病患都需考慮肝臟移植", "D": "食道靜脈瘤出血處置需要外科介入的情況，包含內視鏡處理失\t，胃靜脈瘤出血和TIPS治療失", "language": "tw"}
{"question": "下列何者不是綠膿桿菌（Pseudomonas aeruginosa）的特徵？", "answer": "會發酵葡萄糖和乳糖", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "好棲息於潮濕的環境中", "B": "會發酵葡萄糖和乳糖", "C": "生長時會發出葡萄般的香味", "D": "對大部分的抗生素具抗藥性", "language": "tw"}
{"question": "當偏頭痛患者出現噁⼼、嘔吐等症狀時，下列何者是最佳的治療藥物？", "answer": "sumatriptan", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "acetaminophen", "B": "allopurinol", "C": "sumatriptan", "D": "sulindac", "language": "tw"}
{"question": "肺炎退伍軍人桿菌（Legionella pneumophila）初次分離培養（primary culture）時，需要添加下列那種成分？", "answer": "L-半胱胺酸（L-cysteine）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "甘油（glycerol）", "B": "橄欖油（olive oil）", "C": "L-半胱胺酸（L-cysteine）", "D": "菸鹼酸（nicotinic acid）", "language": "tw"}
{"question": "相較於年輕人，老年人之甲狀腺機能亢進，比較容易以下列何種徵象來表現？", "answer": "心房纖維顫動（atrial fibrillation）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "凸眼（exophthalmos）", "B": "心房纖維顫動（atrial fibrillation）", "C": "甲狀腺腫（goiter） \t", "D": "震顫（tremor）", "language": "tw"}
{"question": "色素性視網膜炎（retinitis pigmentosa）的典型三特徵（classical triad）不包含：", "answer": "黃斑部水腫（macular edema）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "骨刺狀黑色素沉積（retinal bone-spicule pigmentation）", "B": "視神經蒼白化（waxy pallor of the optic disc）", "C": "小動脈變細（arteriolar attenuation）", "D": "黃斑部水腫（macular edema）", "language": "tw"}
{"question": "下列何項是分辨高位無肛病（high type imperforate anus）或低位無肛病（low type imperforate anus）最重要的方法？", "answer": "肉眼觀察", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "倒位攝影（invertogram）", "B": "電腦斷層", "C": "核磁造影 \t", "D": "肉眼觀察", "language": "tw"}
{"question": "有關免疫抑制劑的敘述，下列何者錯誤？", "answer": "Sirolimus（Rapamycin）和 Cyclosporine 都屬於 Calcineurin inhibitors", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "Tacrolimus 造成的 PTDM（Post-transplant diabetes mellitus）機會比 Cyclosporine 高", "B": "Cyclosporine 會有牙齦增生（Gingival hyperplasia）和多毛症（Hirsutism）的副作用", "C": "Sirolimus（Rapamycin）和 Cyclosporine 都屬於 Calcineurin inhibitors", "D": "Tacrolimus 和 Cyclosporine 都是常用於腎臟移植術後的藥物，但是同時也具有腎毒性的副作用", "language": "tw"}
{"question": "關於蕁麻疹（urticaria）的敘述，下列何者錯誤？", "answer": "病灶的組織病理變化主要是血管炎", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "肥胖細胞（mast cell） 是主要作用細胞", "B": "特定病灶存在時間通常小於24小時", "C": "部分慢性蕁麻疹患者的病因是自體免疫（autoimmunity）", "D": "病灶的組織病理變化主要是血管炎", "language": "tw"}
{"question": "一位 55 歲男性主訴解黑便 3 天，內視鏡檢查發現為十二指腸潰瘍，除了制酸藥劑 Omeprazole 外，有醫師建議給予口服 Clarithromycin 250 mg 及 Amoxicillin 1000 mg 每天兩次。服用幾天是最佳選擇？", "answer": "14 天", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "3 天", "B": "14 天", "C": "30 天", "D": "90 天", "language": "tw"}
{"question": "上頜 Le Fort 式骨折一共有幾種？", "answer": "三", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "一", "B": "二", "C": "三", "D": "四", "language": "tw"}
{"question": "下列何者是臨床上已廣泛用來抑制攝護腺肥大及治療雄性禿之 5α-reductase type 2 inhibitor？", "answer": "Finasteride", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "Finasteride", "B": "Dutasteride", "C": "Megestrol acetate", "D": "Leuprolide", "language": "tw"}
{"question": "在昏暗的環境下，視網膜桿狀細胞（rod cell）外部區段（outer segment）產生的鈉離子內流（influx）電流主要是因為下列那一物質的作用？", "answer": "cGMP", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "cAMP", "B": "cGMP", "C": "傳導素（transducin）", "D": "all-trans retinal", "language": "tw"}
{"question": "頸脊髓空洞症（cervical syringomyelia）最典型的臨床症狀是：", "answer": "區段分離性的感覺異常症候群（segmental sensory dissociation）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "區段分離性的感覺異常症候群（segmental sensory dissociation）", "B": "分離性感覺與運動障礙症候群（sensory motor dissociation deficit）", "C": "聯合性後柱及側柱障礙症候群（combined posterior and lateral column deficit） \t", "D": "聯合性前柱及側柱障礙症候群（combined anterior and lateral column deficit）", "language": "tw"}
{"question": "下列有關腎臟（kidney）組織結構之敘述，何者錯誤？", "answer": "緻密斑（macula densa）是由近直小管（proximal straight tubule）的上皮細胞所特化", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "腎絲球微血管（glomerular capillary）之內皮細胞（endothelial cell）屬於穿孔型（fenestrated type）", "B": "緻密斑（macula densa）是由近直小管（proximal straight tubule）的上皮細胞所特化", "C": "近腎絲球細胞（juxtaglomerular cell）主要是由入球小動脈（afferent arteriole）之管壁平滑肌細胞（smooth muscle cell）所特化", "D": "皮質和髓質交接處有弓形動脈（arcuate artery）", "language": "tw"}
{"question": "下列關於 calcitonin 的敘述，何者錯誤？", "answer": "和血漿蛋白（plasma protein）結合能力強，所以在肝臟以及腎臟代謝緩慢", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "由 32 個胺基酸組成", "B": "主要由甲狀腺（thyroid）分泌", "C": "和血漿蛋白（plasma protein）結合能力強，所以在肝臟以及腎臟代謝緩慢", "D": "可用來治療 Paget 氏疾病（Paget's disease of bone）", "language": "tw"}
{"question": "如何辨識位於頸部的頸內動脈與頸外動脈？", "answer": "頸內動脈無分支，頸外動脈有分支", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "頸內動脈有分支，頸外動脈無分支 \t", "B": "頸內動脈與頸外動脈皆有分支，但分支數目不同", "C": "頸內動脈無分支，頸外動脈有分支", "D": "由兩者之口徑不同判別", "language": "tw"}
{"question": "35 歲的吳先生擔任警衛，這兩週因為感冒沒有上班；3 天前開始下肢無力，並逐漸加重到今天已全身無力、呼吸困難，並且兩側手腳發麻。理學檢查發現肌腱反射（tendon reflex）消失，腳趾對音叉震動及關節角度變化沒有感覺。神經傳導檢查發現傳導速度變慢；腦脊髓液中蛋白質升高，但白血球數目正常。下列那一項診斷有可能？", "answer": "急性發炎性多發性周邊神經病變（Guillain-Barré syndrome）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "腦膜炎（meningitis）", "B": "運動神經元疾病（motor neuron disease）", "C": "急性發炎性多發性周邊神經病變（Guillain-Barré syndrome）", "D": "多發性硬化症（multiple sclerosis）", "language": "tw"}
{"question": "小明平常偶爾吃一點花生後就會很不舒服，有一天不小心吃了以花生油炸過的芝麻球，幾分鐘後就喘不過氣來。小明體內對花生的特異性抗體，最可能是那一種？", "answer": "IgE", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "IgM", "B": "IgG", "C": "IgE", "D": "IgA", "language": "tw"}
{"question": "有關轉譯之敘述，下列何者錯誤？", "answer": "每一種 t-RNA 均只能辨認一種 codon", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "每一種 t-RNA 均只能辨認一種 codon", "B": "ATG 是一種起始 codon \t", "C": "UAA 是一種終止 codon", "D": "不需透過特定之 t-RNA 終止轉譯 35 \t有關真核細胞之 mRNA 之轉錄後修飾，下列敘述何者錯誤？", "language": "tw"}
{"question": "下列有關人類唾液腺結構之敘述，何者錯誤？", "answer": "頜下腺（submandibular gland）的分泌腺泡主要為黏液性，舌下腺（sublingual gland）則主要為漿液性", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "耳下腺（parotid gland）為純漿液腺，而頜下腺（submandibular gland）與舌下腺（sublingual gland）則是混合腺體", "B": "耳下腺（parotid gland）內的閏管（interealated duct）長度，在三大唾液腺中最長", "C": "頜下腺（submandibular gland）的分泌腺泡主要為黏液性，舌下腺（sublingual gland）則主要為漿液性", "D": "唾液腺之葉間泌管（interlobar duct）上皮主要為偽複層柱狀上皮（pseudostratified columnar epithelium）或複層立方上皮", "language": "tw"}
{"question": "何種感染後最容易造成急性腎絲球腎炎（Glomerulonephritis）？", "answer": "鏈球菌", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "大腸桿菌", "B": "葡萄球菌", "C": "鏈球菌", "D": "綠膿桿菌", "language": "tw"}
{"question": "下列有關糖尿病腎病變之敘述，何者錯誤？", "answer": "蛋白尿或微蛋白尿不會出現於新診斷第二型糖尿病病人", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "蛋白尿或微蛋白尿不會出現於新診斷第二型糖尿病病人", "B": "病理上的變化如腎絲球基底膜變厚及腎小球內基質（mesangium）擴張是常見的", "C": "使用腎素－血管張力素系統（renin-angiotensin system）阻斷劑", "D": "國內目前每年進入透析的新病人其原發病因以糖尿病腎病變占第一位", "language": "tw"}
{"question": "下列胸部影像中的病變最可能為：", "answer": "左肺下葉塌陷（left lower lobe collapse） \t", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "左肺下葉塌陷（left lower lobe collapse） \t", "B": "局限性左肋膜積水（localized left pleural effusion）", "C": "左橫膈膜赫尼亞（left diaphragmatic hernia）", "D": "縱膈腔腫瘤（mediastinal tumor）", "language": "tw"}
{"question": "39 一位 50 歲女性最近一個月胃口不佳、比較累、且有噁心，晚上小便次數增加，血壓為 175/100 mmHg。 血液生化檢查：BUN 40 mg/dL，creatinine 2.3 mg/dL，Na+ 142 mmol/L，K+ 3.5 mmol/L，Cl- 91 mmol/L， free Ca 3.0 mmol/L。在詢問病史時，下列何者對於鑑別診斷上較無幫助？ \n", "answer": "有無使用類固醇", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "有無服用 thiazide 類利尿劑", "B": "有無尿道結石病史", "C": "有無使用維生素 D \t", "D": "有無使用類固醇", "language": "tw"}
{"question": "肩難產最容易發生的問題是：", "answer": "臂神經叢受傷", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "膈神經受傷", "B": "臂神經叢受傷", "C": "鎖骨骨折", "D": "肱骨骨折", "language": "tw"}
{"question": "下列何種形式之核酸重複（nucleotide repeat），與遺傳疾病如 fragile X syndrome, Huntington's disease 等有關？", "answer": "三核酸重複（triple nucleotide repeat）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "雙核酸重複（double nucleotide repeat）", "B": "三核酸重複（triple nucleotide repeat）", "C": "四核酸重複（quadruple nucleotide repeat）", "D": "隨意核酸重複（random nucleotide repeat）", "language": "tw"}
{"question": "右眼外展神經（abducens nerve）麻痺病人，以右眼固視（fixation）時，斜視角度會呈現下列何種情況？", "answer": "內斜視角度大於用左眼固視", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "內斜視角度大於用左眼固視", "B": "內斜視角度小於用左眼固視", "C": "外斜視角度大於用左眼固視", "D": "外斜視角度小於用左眼固視", "language": "tw"}
{"question": "下列何者最可能是癌前病變？", "answer": "日照性角化症（actinic keratosis）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "化膿性肉芽腫（pyogenic granuloma）", "B": "日照性角化症（actinic keratosis）", "C": "脂漏性角質化（seborrheic keratosis）", "D": "皮纖維瘤（dermatofibroma）", "language": "tw"}
{"question": "UDP-glucose 參與下列那個代謝路徑？", "answer": "半乳糖轉變為葡萄糖（epimerization of galactose to glucose）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "五碳糖磷酸途徑（pentose phosphate pathway）", "B": "肝醣分解（glycogen degradation）", "C": "糖解作用（glycolysis）", "D": "半乳糖轉變為葡萄糖（epimerization of galactose to glucose）", "language": "tw"}
{"question": "下列那一個分子在嘌呤代謝中直接水解成尿酸？", "answer": "xanthine", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "xanthine", "B": "hypoxanthine", "C": "inosine", "D": "IMP", "language": "tw"}
{"question": "一位 50 歲男性，肝功能異常有 15 年，GOT 值及 GPT 值都維持 150 U/L 左右（兩項正常值均為 0-35 U/L），C 型肝炎抗體陽性，B 型肝炎表面抗原陰性反應，表面抗體陽性反應，核心抗體陽性反應，接受肝穿刺檢查，病理報告顯示中等度纖維化及發炎。請問以下之治療藥物何者是最佳選擇？", "answer": "Interferon + Ribavirin", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "Interferon + Ribavirin", "B": "Interferon + Lamivudine", "C": "Interferon + Adefovir", "D": "Interferon + Entecavir", "language": "tw"}
{"question": "與淋病球菌（gonococci）異性帶菌者一次性接觸後，得到感染的危險性程度為何？", "answer": "女高於男", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "女高於男", "B": "男高於女", "C": "男女均為 0％", "D": "男女均為 100％", "language": "tw"}
{"question": "72.57歲女士主訴下樓梯時，突然左腳後跟劇烈疼痛，隔天至骨科門診，接受腳後跟超音波檢查矢狀切面如圖，最可能之診斷為何？  ", "answer": "Achilles tendon rupture", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "Achilles tendinitis", "B": "Achilles tendon fibroma", "C": "Achilles tendon rupture", "D": "retro-calcaneal bursitis", "language": "tw"}
{"question": "11 一位 56 歲的男性病人因半夜發生端坐呼吸至急診就診，理學檢查發現血壓為 164/98 mmHg，不規則心跳 120/min，兩側肺部有囉音，心尖部有III/VI之全收縮期雜音及S3奔馬音，抽血檢查Na+: 120 mEq/L,  5 mEq/L, Cl- : 92 mEq/L。下列何種處置最不適當？", "answer": "立即給予靜脈滴注 3% saline以矯正其血中Na+濃度", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "再驗其尿中Na+濃度以釐清病因 \t", "B": "立即給予靜脈滴注 3% saline以矯正其血中Na+濃度", "C": "立即給予靜脈注射 furosemide", "D": "立即給予靜脈注射 digoxin", "language": "tw"}
{"question": "下列敘述何者錯誤？", "answer": "Flumazenil 是苯二氮平（benzodiazepine）的拮抗劑，可維持作用達數十小時", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "Flumazenil 是苯二氮平（benzodiazepine）的拮抗劑，可維持作用達數十小時", "B": "苯二氮平戒斷症狀有焦慮及激躁，也可能引起幻覺", "C": "苯二氮平緩解焦慮症狀快速，當其為治療泛焦慮症時，使用時間宜越短越好", "D": "苯二氮平使用會影響記憶力及專注力", "language": "tw"}
{"question": "52歲男性主訴雙手漸進性肌肉萎縮及無力，之後伴隨言語及吞嚥困難，神經學檢查發現舌頭及手腳肌肉萎縮、肌束震顫（fasciculation）和深部肌腱反射增強，但感覺系統並無異常。下列何者為最可能之診斷？", "answer": "肌萎縮性側索硬化（amyotrophic lateral sclerosis）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "肌萎縮性側索硬化（amyotrophic lateral sclerosis）", "B": "多發性硬化症（multiple sclerosis）", "C": "多發性神經病變（polyneuropathy）", "D": "肌肉性失養症（muscular dystrophy）", "language": "tw"}
{"question": "除 Barrett's esophagus 外，食道癌病理絕大部分為：", "answer": "鱗狀上皮癌（Squamous cell carcinoma）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "鱗狀上皮癌（Squamous cell carcinoma）", "B": "類表皮癌（Carcinoid） \t", "C": "腺癌（Adenocarcinoma）", "D": "小細胞癌（Small cell carcinoma）", "language": "tw"}
{"question": "白血球的附著分子（adhesion molecule）缺乏時，最可能導致下列何種情形？", "answer": "白血球的趨化作用（chemotaxis）會出現問題", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "白血球附著缺乏（leukocyte adhesion deficiency; LAD）的患者會出現明顯的中性白血球降低", "B": "白血球的骨髓氧化酶（myeloperoxidase）出現缺損", "C": "這類患者容易得到病毒感染", "D": "白血球的趨化作用（chemotaxis）會出現問題", "language": "tw"}
{"question": "承上題，下列何者為該女性最可能之診斷？", "answer": "乳腺囊腫（breast cyst）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "乳腺癌（breast carcinoma）", "B": "乳腺囊腫（breast cyst）", "C": "良性纖維腺瘤（fibroadenoma）", "D": "乳腺膿瘍（breast abscess）", "language": "tw"}
{"question": "一位35歲的病人接受子宮肌瘤切除手術，術後6週回診時發現骨盆腔膿瘍而再次手術，取出一塊大紗布，術後醫師的處理方式，下列那一個的方式是最不適當的？", "answer": "要求開刀房的護理長負起責任", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "要求開刀房的護理長負起責任", "B": "主動通報院內病人安全委員會", "C": "誠懇與病人討論當時開刀的實況", "D": "爭取減免第2次手術的費用", "language": "tw"}
{"question": "王太太某日在果園工作時被一隻蜜蜂叮咬，約10幾分鐘後，出現全身蕁麻疹（urticaria），接\t呼吸困難，家人連忙將她送到急診室求診。抵達急診室時血壓為88/54 mmHg，心跳110 BPM。對王太太目前的狀況，應以下列何項優先給藥？", "answer": "epinephrine 0.5 mg肌肉注射", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "methylprednisolone 60 mg靜脈注射", "B": "diphenhydramine 50～100 mg靜脈注射", "C": "albuterol 5 mg吸入", "D": "epinephrine 0.5 mg肌肉注射", "language": "tw"}
{"question": "50歲健康男性，因牙結石進行相關治療，過去病史有penicillin過敏，下列建議何者最恰當？", "answer": "不需給與預防性抗生素", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "給與clindamycin預防心內膜炎", "B": "給與vancomycin預防心內膜炎", "C": "給與tetracycline預防心內膜炎", "D": "不需給與預防性抗生素", "language": "tw"}
{"question": "52.\n", "answer": "慢性胰臟炎併胰臟鈣化及胰管內結石", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "慢性胰臟炎併胰臟鈣化及胰管內結石", "B": "急性胰臟炎", "C": "胰臟癌", "D": "膽結石", "language": "tw"}
{"question": "下列何者不屬於心臟復健的有氧訓練方式？", "answer": "舉重", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "踩固定式腳踏車", "B": "跑步機運動", "C": "游泳", "D": "舉重", "language": "tw"}
{"question": "下列丘腦內之何結構跟邊緣系統沒有直接的聯繫？", "answer": "前腹側核（Ventral anterior nucleus）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "背外側核（Lateral dorsal nucleus）", "B": "前核（Anterior nucleus）", "C": "中線核（Midline nucleus）", "D": "前腹側核（Ventral anterior nucleus）", "language": "tw"}
{"question": "取卵的時機一般是在絨毛性腺激素（human chorionic gonadotropin）注射後幾小時？", "answer": "34～36", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "20～24", "B": "34～36", "C": "40～44", "D": "48～52", "language": "tw"}
{"question": "下列何種病患不宜使用可傾斜靠背（recline back support）輪椅？", "answer": "薦椎部患有壓瘡（pressure sore）的病人", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "不能獨立移動身體重量（shift weight）的病人 \t", "B": "長時間坐立造成腰痛或臀痛的病人", "C": "薦椎部患有壓瘡（pressure sore）的病人", "D": "常發生姿勢性低血壓（postural hypotension）的病人", "language": "tw"}
{"question": "一位70歲男性，意識清楚，因咳嗽、黃痰和發燒來醫院就診，胸腔科門診的胸部X光片顯示右上葉肺炎，患者的vital signs：", "answer": "一般病房住院治療", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "門診治療", "B": "一般病房住院治療", "C": "加護病房住院治療", "D": "立即施打肺炎疫苗", "language": "tw"}
{"question": "一位 32 歲女性，有靜脈注射毒品的習慣，因發燒及寒顫 3 天至急診求診。理學檢查有貧血、口腔有潰瘍、心臟聽診有心雜音。下列敘述何者最不恰當？", "answer": "安排胸前心臟超音波（transthoracic echocardiography），檢查結果為陰性即可排除感染性心內膜炎的診斷", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "應做三套血液培養，每次抽血時間至少相隔 1 小時", "B": "最可能的致病菌為金黃色葡萄球菌（Staphylococcus aureus）", "C": "眼底鏡檢查可能會發現有 Roth's spots，而病患四肢可能會出現疼痛的 Osler's node", "D": "安排胸前心臟超音波（transthoracic echocardiography），檢查結果為陰性即可排除感染性心內膜炎的診斷", "language": "tw"}
{"question": "下列何者為糖尿病多發性神經病變（diabetic polyneuropathy）病患的特徵之一？", "answer": "Areflexia", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "Babinski sign \t", "B": "Areflexia", "C": "Grasp reflex \t", "D": "Exaggerated stretch reflex 21 造成耳蝸（cochlea）內 hair cell 去極化的機轉為何？", "language": "tw"}
{"question": "下列何者位於心臟的隔緣肉柱（septomarginal trabecula, moderator band）中？", "answer": "房室束右支（right branch of atrioventricular bundle）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "發出左右分支前的房室束（atrioventricular bundle）", "B": "房室束右支（right branch of atrioventricular bundle）", "C": "房室束左支（left branch of atrioventricular bundle）", "D": "普金斯纖維（Purkinje fibers）", "language": "tw"}
{"question": "下列有關疝氣（hernia）的敘述，何者錯誤？", "answer": "以腹股溝疝氣發生率而言，女性多於男性", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "75%的疝氣發生在腹股溝區域（inguinal region）", "B": "以腹股溝疝氣（inguinal hernia）而言，三分之二屬於間接型疝氣（indirect hernia）", "C": "以腹股溝疝氣發生率而言，女性多於男性", "D": "以股疝氣（femoral hernia）發生率而言，女性多於男性", "language": "tw"}
{"question": "下列何種情況，導致遺傳疾病半乳糖血症（galactosemia）的發生？", "answer": "缺少 UDP-glucose:galactose 1-phosphate uridylyltransferase", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "缺少 fructokinase", "B": "缺少 UDP-glucose:galactose 1-phosphate uridylyltransferase", "C": "無法分解 lactose", "D": "過度攝取 galactose", "language": "tw"}
{"question": "一位 20 歲女性，過去因蝴蝶斑被懷疑是全身性紅斑性狼瘡，病患現因發燒及下肢水腫住院。尿液檢驗顯示血尿與嚴重之蛋白尿，下列何者自體抗體檢查與病患目前之症狀最有相關性？", "answer": "anti-double strand DNA", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "anti-Sm \t", "B": "anti-RNP \t", "C": "anti-double strand DNA", "D": "anti-histone", "language": "tw"}
{"question": "有關疾病篩檢之敘述，下列何者正確？", "answer": "選取一個切點（cut-off point）來決定標準值所在時，若增加敏感度（sensitivity），則特異度（specificity）常會下降", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "鑑別力好的 Receiver Operating Characteristics（ROC）曲線應該是接近對角線", "B": "診斷糖尿病的飯前血糖值標準若由 110 降到 105，偽陽性個案數會減少", "C": "若以系列性檢查（tests in series），篩檢一種疾病，則第一個檢查通常會使用特異度（specificity）較高者", "D": "選取一個切點（cut-off point）來決定標準值所在時，若增加敏感度（sensitivity），則特異度（specificity）常會下降", "language": "tw"}
{"question": "承上題，下列何種處置方式可行？", "answer": "剖腹探查", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "經\t性抗生素治療", "B": "血管攝影檢查", "C": "胃鏡檢查", "D": "剖腹探查", "language": "tw"}
{"question": "59 楊小姐今年 27 歲，最近每天晚上服用巴比妥鹽類藥物（Barbiturate）幫助睡覺，幾天之後開始肚子劇痛，且偶爾會有幻覺產生，今天因為癲癇發作而被送至急診。她的血壓 172/116 mmHg、心跳每分鐘 134 次，一直喊肚子痛；兩腳不斷的踢來踢去掙扎，但兩手卻垂在床緣不太會動。楊小姐接受了腹部超音波、腹部電腦斷層、腦脊髓液檢查都完全正常，但神經傳導速度檢查顯示週邊神經有明顯之軸突病變（axonopathy）。家屬表示楊小姐的媽媽也曾經因為吃巴比妥鹽類藥物而產生類似的症狀。 下列何者診斷最有可能？ \n", "answer": "紫質症（porphyria）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "蜱麻痺（tick paralysis）", "B": "混合型冷凝蛋白血症（mixed cryoproteinemia）", "C": "急性發炎性脫髓鞘型多發神經病變（acute inflammatory demyelinating polyneuropathy）", "D": "紫質症（porphyria）", "language": "tw"}
{"question": "下列何種藥物最常用於預防早產？", "answer": "Ritodrine", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "Isoproterenol", "B": "Albuterol", "C": "Salmeterol", "D": "Ritodrine", "language": "tw"}
{"question": "77.一位28歲已婚女性病人，性生活正常，有左側輸卵管發炎的病史，平常月經相當不規則，有時候兩至三個月才來一次，上次月經來已經是九週前的事了。此病人從昨天早上開始，下腹疼痛合併陰道有少許出血，另外還有冒冷 、頭暈、心悸的症狀，故來求診。到達急診時意識清楚，臉色蒼白，無外傷。生命徵象如下：呼吸22次/min、心跳 102次/min、體溫", "answer": "腹部X光檢查", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "給予靜脈輸液（fluid hydration）", "B": "持續性監測血壓", "C": "腹部X光檢查", "D": "懷孕測試（pregnancy test）", "language": "tw"}
{"question": "下列有關降血糖藥物作用機轉的描述，何者錯誤？", "answer": "rosiglitazone 具有減少胰島素抗性（insulin resistance）的作用，主要針對第一型糖尿病使用", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "glipizide 具有促進胰島素分泌的作用", "B": "metformin 具有抑制肝臟製造過多葡萄糖的作用", "C": "rosiglitazone 具有減少胰島素抗性（insulin resistance）的作用，主要針對第一型糖尿病使用", "D": "acarbose 具有抑制腸道內負責分解雙醣、寡醣及多醣的酵素，進而延遲及減少醣類的分解吸收", "language": "tw"}
{"question": "下列何者不屬於復發性短期憂鬱性疾患（Recurrent brief depressive disorder）之治療？", "answer": "激素治療", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "心理治療 \t", "B": "激素治療", "C": "抗憂鬱劑治療 \t", "D": "情緒穩定劑治療", "language": "tw"}
{"question": "下列何種視神經盤凹杯與視神經盤直徑比例（cup-disk ratio），比較不會被懷疑有青光眼：", "answer": "0.2", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "0.2", "B": "0.5", "C": "0.8", "D": "兩眼視神經盤凹杯與視神經盤直徑比例（cup-disk ratio）極不對稱", "language": "tw"}
{"question": "89 一位 60 歲男性因上腹悶痛來求診，內視鏡發現潰瘍性病灶，病理切片發現在黏膜層有大量單形性 （monomorphous）淋巴球浸潤，且有淋巴上皮性病灶（lymphoepithelial lesion），則下列何者是最有可能的致病原？ \n", "answer": "幽門螺旋桿菌", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "巨細胞病毒", "B": "葡萄球菌", "C": "沙門氏桿菌", "D": "幽門螺旋桿菌", "language": "tw"}
{"question": "承上題，此時會選擇何種藥物治療？", "answer": "口服 metronidazole 或 vancomycin", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "注射 clindamycin \t", "B": "口服 asacol", "C": "注射 ampicillin \t", "D": "口服 metronidazole 或 vancomycin", "language": "tw"}
{"question": "許多藥物的合成乃是結合分子生物學與合成化學而得，抗愛滋病的藥物 3'-Azido-2',3'-dideoxythymidine （AZT）即為其中一項，下列關於 AZT 的敘述，何者錯誤？", "answer": "人類 T 淋巴球的 DNA 複製酶對 AZT triphosphate 有高親和力，所以會帶來許多副作用", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "AZT 由易被 HIV 病毒感染的 T 淋巴球所吸收而轉變為三磷酸根 AZT（AZT triphosphate）", "B": "HIV 病毒的反轉錄酶對於 AZT triphosphate 有極高的親和力", "C": "HIV 病毒的 DNA 進行複製時若 3'端加入 AZT triphosphate 則會終止複製反應", "D": "人類 T 淋巴球的 DNA 複製酶對 AZT triphosphate 有高親和力，所以會帶來許多副作用", "language": "tw"}
{"question": "催產素（oxytocin）的主要作用為何？", "answer": "促進排乳作用（milk ejection）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "促進子宮鬆弛（uterine relaxation）", "B": "促進排乳作用（milk ejection）", "C": "抑制黃體分解（luteolysis）", "D": "抑制前列腺素 F2α（PGF2α）的分泌", "language": "tw"}
{"question": "判別食道閉鎖的病嬰有無食道氣管瘻管，可由一般胸部 X 光片那一種變化看出？", "answer": "有無腸胃空氣的影像", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "有無腸胃空氣的影像", "B": "橫膈膜位置", "C": "食道盲端的位置 \t", "D": "氣管分支的位置", "language": "tw"}
{"question": "三個月大的嬰兒，患有右側斜頸症（torticollis），下列的醫療建議何者正確？", "answer": "應該教導向右側上方注視的姿勢", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "如果沒有治療，左臉會有扁平化的現象", "B": "容易合併左側髖關節發育不良（hip dysplasia）", "C": "應該加強右側頸部的肌力訓練", "D": "應該教導向右側上方注視的姿勢", "language": "tw"}
{"question": "當吸入過敏原後，過敏原經由抗原呈現細胞（antigen presenting cell, APC），將其處理後呈現給 T 細胞而引起一連串的過敏反應。以下何者不屬於抗原呈現細胞？", "answer": "嗜伊紅性細胞（eosinophil）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "嗜伊紅性細胞（eosinophil）", "B": "樹突細胞（dendritic cell）", "C": "單核球（monocyte） \t", "D": "巨噬細胞（macrophage）", "language": "tw"}
{"question": "有關前列腺癌之敘述，下列何者錯誤？", "answer": "腫瘤侵犯至貯精囊時屬T3a期", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "每年PSA升高超過0.75 ng/mL者，潛伏癌症之機率增高", "B": "經直腸超音波檢查比指診更能精確定出局部腫瘤期別", "C": "格里森分數（Gleason score）高於7分者較易發生癌症進展", "D": "腫瘤侵犯至貯精囊時屬T3a期", "language": "tw"}
{"question": "當我們為病患進行麻醉誘導時，下列何項因子並不會增加麻醉氣體的誘導速率？", "answer": "高麻醉機通路氣體容量（high anesthetic-circuit volume）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "減少再吸入（rebreathing）", "B": "高麻醉機通路氣體容量（high anesthetic-circuit volume）", "C": "高腦血流量（cerebral blood flow）", "D": "肺泡中的溶解度（solubility）降低", "language": "tw"}
{"question": "下列有關急性發炎性脫髓鞘多發性神經病變症候群（Guillain-Barré syndrome）之敘述，何者錯誤？", "answer": "糖尿病病人大部分會發生此病", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "可能引起顏面神經病變", "B": "呼吸困難常是致命的主因", "C": "會有自主神經功能異常（autonomic dysfunction）的症狀", "D": "糖尿病病人大部分會發生此病", "language": "tw"}
{"question": "下列那種酶在肌細胞中含量較低，無法有效進行糖合成作用（gluconeogenesis）？", "answer": "葡萄糖6-磷酸酶（glucose 6-phosphatase）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "丙酮酸脫氫酶（pyruvate dehydrogenase）", "B": "磷酸果糖磷激酶-1（phosphofructokinase-1）", "C": "肝醣合成酶（glycogen synthase）", "D": "葡萄糖6-磷酸酶（glucose 6-phosphatase）", "language": "tw"}
{"question": "下列何者是分辨肌⾁病變與神經病變最有⽤的電學診斷⽅法？", "answer": "肌電圖檢查（EMG study）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "神經傳導檢查（nerve conduction study）", "B": "肌電圖檢查（EMG study）", "C": "連續電刺激神經檢查（repetitive nerve stimulation test）", "D": "肌⾁激發電刺激檢查（muscle excitability test）", "language": "tw"}
{"question": "一位 60 歲心肌梗塞患者，經運動功能測試後，有關其心臟復健之有氧運動的處方，下列敘述何者最正確？", "answer": "每週運動 3 次以上 \t", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "每週運動 3 次以上 \t", "B": "每次持續運動時間應超過 60 分鐘", "C": "以上肢運動為主 \t", "D": "運動強度不得低於心跳每分鐘 130 次", "language": "tw"}
{"question": "單精細胞質內注射術（ICSI）其遺傳物質不可由何處取得？", "answer": "原精細胞（Spermatogonia）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "活動精蟲（Spermatozoon）", "B": "副睪（Epididymis）的精蟲（Spermatozoon）", "C": "精小管（Seminiferous tubules）的精細胞（Spermatids）", "D": "原精細胞（Spermatogonia）", "language": "tw"}
{"question": "為避免早產兒於出生後發生玻璃腺樣病（hyaline membrane disease），可於產前給予孕婦下列何種藥物？", "answer": "glucocorticoids", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "aspirin", "B": "glucocorticoids", "C": "magnesium sulfate", "D": "thyrotropin", "language": "tw"}
{"question": "關於嗜伊紅性白血球和嗜中性白血球的異同，下列敘述何者正確？", "answer": "IL-5主要促進嗜伊紅性白血球的生成", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "嗜中性白血球含有過氧化酶，但嗜伊紅性白血球不含此酶", "B": "IL-5主要促進嗜伊紅性白血球的生成", "C": "真核寄生蟲感染時嗜中性白血球反應較強", "D": "CCR3在嗜中性白血球表現較多", "language": "tw"}
{"question": "一位 45 歲紅斑性狼瘡女性患者，近半年來數度因為突發性眼皮與嘴唇皮下組織水腫合併有呼吸困難，前往急診就醫。下列何者與患者的急性症狀最為相關？", "answer": "補體系統", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "抗核抗體", "B": "補體系統", "C": "免疫球蛋白", "D": "血中白蛋白", "language": "tw"}
{"question": "下列氣管（trachea）和支氣管（bronchus）管壁構造之比較，何項正確？", "answer": "兩者都有彈性纖維（elastic fiber）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "兩者都有彈性纖維（elastic fiber）", "B": "兩者的上皮（epithelium）高度相同", "C": "兩者都有纖維軟骨（fibrous cartilage）", "D": "兩者都沒有平滑肌細胞（smooth muscle cells）", "language": "tw"}
{"question": "一位 7 歲男孩，3 星期以來，下肢出現很多膿癤（furunculosis），2 天前出現紅色血尿及蛋白尿，因此至門診就診；血壓明顯升高（160/105 mmHg），並發現全身水腫，體重比平時重了 3 kg，血清白蛋白/球蛋白比值（A/G）為 3.2/3.1 mg/dL。下列何者最不可能出現？", "answer": "尿液培養常長出 A 群鏈球菌", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "經檢驗，此病童血中C3補體降低", "B": "癤內膿（pus）培養，長出 A 群鏈球菌，但 ASO（antistreptolysin O）titer 正常", "C": "腎絲球基底膜可發現免疫複合體（immune complex）沈澱", "D": "尿液培養常長出 A 群鏈球菌", "language": "tw"}
{"question": "下頜下腺（submandibular gland）位於下列何處？", "answer": "二腹肌三角（digastric triangle）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "肌三角（muscular triangle）", "B": "頸動脈三角（carotid triangle）", "C": "二腹肌三角（digastric triangle）", "D": "頦下三角（submental triangle）", "language": "tw"}
{"question": "有關抗癲癇藥物作用的敘述，下列何者錯誤？", "answer": "topiramate透過阻斷glutamate轉運子（transporter）的作用來產生抗癲癇作用", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "ethosuximide主要透過阻斷T-type鈣離子通道來產生抗癲癇作用", "B": "tiagabine主要透過阻斷GABA轉運子（transporter）的作用來產生抗癲癇作用", "C": "topiramate透過阻斷glutamate轉運子（transporter）的作用來產生抗癲癇作用", "D": "valproic acid可透過阻斷鈉離子通道來產生抗癲癇作用", "language": "tw"}
{"question": "一位 23 歲女性病人主訴心悸，心跳每分鐘 160 下，血壓為 110/80 mmHg，心電圖為 paroxysmal supra- ventricular tachycardia（PSVT），可優先考慮下列何種治療？", "answer": "頸動脈竇按摩", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "Adenosine 靜脈快速注射", "B": "Lidocaine 靜脈注射", "C": "Verapamil 靜脈緩慢注射", "D": "頸動脈竇按摩", "language": "tw"}
{"question": "關於Zollinger-Ellison syndrome的敘述，下列何者錯誤？", "answer": "70～90%的腫瘤會分布於總膽管、胃與胰臟頸及胰臟體之間", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "病因為胃泌細胞瘤（gastrinoma）⼤量分泌胃泌激素後，造成胃酸分泌過量", "B": "70～90%的腫瘤會分布於總膽管、胃與胰臟頸及胰臟體之間", "C": "必須排除有無第⼀型多發性內分泌腫瘤症候群（MEN I）的可能，因為有四分之⼀的患者會合併有MEN I，", "D": "病⼈會有淋巴及肝臟轉移之風險，所以應將這個腫瘤視為惡性腫瘤", "language": "tw"}
{"question": "最常見的偏頭痛預兆是：", "answer": "視覺症狀", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "感覺異常", "B": "視覺症狀", "C": "半側偏癱", "D": "語言障礙", "language": "tw"}
{"question": "23 一位 50 歲男性患者有高血壓病史約 5 年，20 分鐘前發生未曾經歷過的劇烈頭痛，接著出現兩下肢無 力，最可能的病變為： \n", "answer": "前交通動脈（anterior communicating artery）之動脈瘤破裂", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "前交通動脈（anterior communicating artery）之動脈瘤破裂", "B": "後交通動脈（posterior communicating artery）之動脈瘤破裂", "C": "脊髓梗塞（spinal cord infarct） \t", "D": "兩側前大腦動脈阻塞", "language": "tw"}
{"question": "臨床上有關不同類型休克（shock）的成因，下列何者正確？", "answer": "Hypovolemic shock 可出現於大量失血（hemorrhage）時", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "燒燙傷（burns）可造成 distributing shock", "B": "心包膜填塞（cardiac tamponade）會造成 cardiogenic shock", "C": "Obstructive shock 常出現於外科手術（surgery）後", "D": "Hypovolemic shock 可出現於大量失血（hemorrhage）時", "language": "tw"}
{"question": "5 歲男孩，並無發燒或高血壓病史，突然發生右側肢體無力，經腦部電腦斷層檢查，發現左側前腦動脈供應區呈現缺血性梗塞，核磁共振動脈攝影（MRA）及腦血管攝影顯示兩側前腦動脈及中腦動脈供應區出現不正常毛玻璃樣血管叢。下列四項診斷中，那一項最符合？", "answer": "毛毛樣腦血管症（Moyamoya Disease）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "左側前腦動脈瘤破裂，併發血管收縮", "B": "基底核區之動靜脈畸形", "C": "毛毛樣腦血管症（Moyamoya Disease）", "D": "腦動脈炎併發血管阻塞", "language": "tw"}
{"question": "與子宮頸腺癌相關性最強的人類乳突病毒是：", "answer": "HPV 18", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "HPV 16", "B": "HPV 18", "C": "HPV 31", "D": "HPV 33", "language": "tw"}
{"question": "關於原發性肺癌的敘述，何者錯誤？", "answer": "鱗狀上⽪癌（squamous cell carcinoma）是⽬前最常⾒的組織型態", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "鱗狀上⽪癌（squamous cell carcinoma）是⽬前最常⾒的組織型態", "B": "腺癌（adenocarcinoma）會有腺泡（acinar）、乳突（papillary）、⿂鱗（lepidic）、固態（solid）等的型態", "C": "跟吸菸相關性⾼的是鱗狀上⽪癌、⼩細胞癌（small-cell carcinoma）", "D": "表⽪⽣⻑因⼦受體（epidermal growth factor receptor）突變常出現於腺癌", "language": "tw"}
{"question": "21 承上題，如果你採用帶莖橫式腹直肌肌皮瓣（pedicled transverse rectus abdominis myocutaneous （TRAM）flaps）來重建，最大的缺點為何？ \n", "answer": "腹肌無力，甚至出現腹部疝氣", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "腹部疤痕不美觀 \t", "B": "腹肌無力，甚至出現腹部疝氣", "C": "重建的乳房不自然 \t", "D": "皮瓣體積不夠", "language": "tw"}
{"question": "下列有關癤（furuncle）的敘述，何者正確？", "answer": "較常發生於年輕人 \t", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "癤是一種急性的汗腺感染症", "B": "外用抗生素是治療首選", "C": "較常發生於年輕人 \t", "D": "常見的病原菌是 haemolytic streptococci", "language": "tw"}
{"question": "軟斑（malacoplakia）是一種什麼樣的病灶？", "answer": "細菌性感染", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "良性的膀胱腫瘤 \t", "B": "膀胱上皮的癌前病灶", "C": "病毒性感染 \t", "D": "細菌性感染", "language": "tw"}
{"question": "過量neostigmine中毒，不會產生下列何種作用？", "answer": "散瞳", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "腹瀉", "B": "流\t", "C": "散瞳", "D": "排尿", "language": "tw"}
{"question": "新生兒室一位新生兒的右側足踝部有明顯變形如下圖，圖片顯示的足踝先天畸形，不包括下列何者？", "answer": "扁平足（pes planus）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "前足內翻（metatarsal adductus）", "B": "扁平足（pes planus）", "C": "足跟內翻（heel varus）", "D": "馬蹄足（ankle equinus）", "language": "tw"}
{"question": "下列何種尿路結石，其成分含鎂？", "answer": "struvite", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "struvite", "B": "whewellite", "C": "weddellite", "D": "hydroxyapatite", "language": "tw"}
{"question": "有關老人 hip fracture 的敘述，下列何者錯誤？", "answer": "術後應儘量不要讓病人下床活動", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "常見於骨質疏鬆的病人", "B": "一般而言，手術是較好的處理方式", "C": "骨折手術後一年內 mortality rate 仍會上升", "D": "術後應儘量不要讓病人下床活動", "language": "tw"}
{"question": "一名個9個月大嬰兒因突發性右側陰囊腫大來急診，經臆斷可能是嵌閉性腹股溝疝氣、睪丸扭轉、睪丸或副睪發炎、或急性陰囊水腫。下列敘述何者錯誤？", "answer": "如果是嵌閉性腹股溝疝氣，無論多久，應儘速在急診就徒手復位", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "可做陰囊超音波檢查幫助鑑別診斷", "B": "如果是睪丸扭轉，應儘速在扭轉後6小時內手術，約有90%可成功恢復血流", "C": "如果是嵌閉性腹股溝疝氣，無論多久，應儘速在急診就徒手復位", "D": "急性陰囊水腫可以觀察，不用急\t手術", "language": "tw"}
{"question": "一位 16 歲重型地中海型貧血病患，長期輸血且排鐵劑使用不足，致罹患鐵質沈積症。下列那一種情況與其病情無關？", "answer": "智力測驗顯示重度智障", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "肝臟切片有纖維化的現象", "B": "心臟超音波檢查舒張功能有缺陷", "C": "智力測驗顯示重度智障", "D": "葡萄糖耐受試驗（glucose tolerance test）異常", "language": "tw"}
{"question": "下列關於新生兒淋病性結膜炎（neonatal gonococcal conjunctivitis）的敘述，何者錯誤？", "answer": "膿狀分泌物大約在出生後第三周至第四周間開始出現", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "常是由母親經產道感染給新生兒", "B": "須同時給予局部及全身抗生素治療", "C": "膿狀分泌物大約在出生後第三周至第四周間開始出現", "D": "最好要對其分泌物作抹片及細菌培養等檢查", "language": "tw"}
{"question": "一位 35 歲女性主訴：畏寒、水腫、無月經、且時有乳汁分泌。血液分析發現甲狀腺激素數值過低，則此病患之無月經及泌乳現象最可能由於下列何種激素之影響？", "answer": "下視丘所分泌之甲釋素（TRH）刺激腦下垂體分泌泌乳素", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "下視丘所分泌之多巴胺（dopamine）刺激腦下垂體分泌泌乳素（prolactin）", "B": "下視丘所分泌之性釋素（GnRH）刺激腦下垂體分泌促黃體素（LH）", "C": "下視丘所分泌之甲釋素（TRH）刺激腦下垂體分泌泌乳素", "D": "下視丘所分泌之多巴胺刺激腦下垂體分泌促黃體素", "language": "tw"}
{"question": "副交感神經之節後纖維與下列何者伴行？", "answer": "腭大神經（Greater palatine nerve）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "岩小神經（Lesser petrosal nerve）", "B": "腭大神經（Greater palatine nerve）", "C": "岩大神經（Greater petrosal nerve）", "D": "鼓索神經（Chorda tympani nerve）", "language": "tw"}
{"question": "下列關於medullary thyroid carcinoma的敘述，何者錯誤？", "answer": "約80%的medullary carcinoma與MEN 2A或MEN 2B有關", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "源⾃於parafollicular或C cells", "B": "約80%的medullary carcinoma與MEN 2A或MEN 2B有關", "C": "可分泌calcitonin，亦可能分泌carcinoembryonic antigen（CEA）", "D": "若同時合併pheochromocytoma，則必須先處理pheochromocytoma", "language": "tw"}
{"question": "士兵參與戰爭後，最可能產生的精神疾病為何？", "answer": "創傷後壓力症（post traumatic stress disorder）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "創傷後壓力症（post traumatic stress disorder）", "B": "強迫症（obsessive compulsive disorder）", "C": "妄想症（delusional disorder）", "D": "恐慌症（panic disorder）", "language": "tw"}
{"question": "下列何者是診斷糖尿病神經病變（diabetic neuropathy）最有用的電學診斷方法？", "answer": "神經傳導（nerve conduction）檢查", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "神經傳導（nerve conduction）檢查", "B": "肌電圖（electromyography）檢查", "C": "肌肉激發電刺激（muscle excitability）檢查", "D": "神經連續電刺激（repetitive nerve stimulation）檢查", "language": "tw"}
{"question": "55 下列何種藥物應在病人感染瘧疾數天之後給予，以便清除病人肝臟中裂殖蟲（schizonts）及靜止蟲體 （hypnozoites）？ \n", "answer": "primaquine", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "primaquine", "B": "artemisinin", "C": "proguanil", "D": "sulfadoxine", "language": "tw"}
{"question": "承上題，電腦斷層顯示如下圖，抽血檢 睪固酮（testosterone）為250 ng/dL，DHEAS為800 µg/dL，則診斷最有可能為：", "answer": "腎上腺腫瘤", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "分泌男性素的卵巢腫瘤", "B": "多囊性卵巢腫瘤", "C": "腎上腺腫瘤", "D": "庫欣氏症（Cushing syndrome）", "language": "tw"}
{"question": "臺灣常見的貝他型海洋性貧血症（β thalassemia），其致病基因是位於第幾對染色體上？", "answer": "11", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "9", "B": "11", "C": "13", "D": "15", "language": "tw"}
{"question": "一位 45 歲男性病人，曾有高尿酸血症及血脂異常之病史，求診時主訴最近兩週體重急遽下降 8 公斤，有口渴頻尿之現象，理學檢查發現病人身高 165 公分，體重 80 公斤，血壓 160/90 mmHg，呼吸每分鐘 15 次，脈搏每分鐘 100 次，頸部有黑色素沈積之現象，病人最可能的診斷為何？", "answer": "糖尿病", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "甲狀腺功能亢進", "B": "嗜鉻細胞瘤", "C": "糖尿病", "D": "尿崩症", "language": "tw"}
{"question": "對於血液與消化系統之間的關係敘述，下列何者錯誤？", "answer": "肝臟合成之免疫球蛋白（immunoglobulin）在血液中具殺菌作用", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "紅血球被摧毀之後，血基質（heme）被分解成膽紅素（bilirubin）進入肝臟成為膽汁的一部分", "B": "肝臟合成之免疫球蛋白（immunoglobulin）在血液中具殺菌作用", "C": "大腸常生菌（normal flora）合成之維他命K對凝血因子的生成很重要", "D": "消化道吸收的鐵可供給紅血球進行氧氣攜帶", "language": "tw"}
{"question": "42.產婦生產會陰部裂傷（perineal laceration）共分四度，第四度裂傷最為嚴重。第四度裂傷代表深度到達下列何 種解剖位置？\n", "answer": "直腸黏膜層（rectal mucosa）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "陰道黏膜層（vaginal mucosa）", "B": "外層肛門括約肌（external anal sphincter）", "C": "內層肛門括約肌（internal anal sphincter）", "D": "直腸黏膜層（rectal mucosa）", "language": "tw"}
{"question": "構成手腕（wrist）的骨頭中，那兩塊骨頭會直接與橈骨遠端（distal end of radius）相關節？", "answer": "舟狀骨（scaphoid）與月狀骨（lunate）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "大多角骨（trapezium）與小多角骨（trapezoid）", "B": "頭狀骨（capitate）與鉤狀骨（hamate）", "C": "舟狀骨（scaphoid）與月狀骨（lunate）", "D": "三角骨（triquetrum）與豆狀骨（pisiform）", "language": "tw"}
{"question": "RU-486（mifepristone）可以用在人工流產，是因為其主要拮抗下列何種受體？", "answer": "progesterone", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "glucocorticoid", "B": "androgen", "C": "estrogen", "D": "progesterone", "language": "tw"}
{"question": "70歲女性，左側耳後有如左圖之腫瘤，數年之久，病理組織切片結果如右圖；下列何者為最適當的診斷？", "answer": "基底細胞癌（basal cell carcinoma ）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "狀細胞癌（squamous cell carcinoma）", "B": "基底細胞癌（basal cell carcinoma ）", "C": "惡性黑色素細胞癌（malignant melanoma）", "D": "脂漏性角化症（seborrheic keratosis）", "language": "tw"}
{"question": "16 35 歲男性主訴發燒五天，發病前三天從印尼旅遊一週回來，其他症狀包括：眼窩後酸痛、背部肌肉酸痛、食慾減退、軟便及下肢和腹部紅疹（如圖所示）。血壓 130/85 mmＨg；額溫 38.9℃；脈搏 88/分；呼吸 18/分；血液檢驗：白血球 2,350/mm3；血球容積比（hematocrit）49%；血小板：43,000/mm3；\n GOT/GPT: 84/67 U/L。病人最可能是那種感染症？ \n", "answer": "登革熱（Dengue fever）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "流行性感冒（influenza）", "B": "梅毒（Syphilis）", "C": "登革熱（Dengue fever）", "D": "肺炎黴漿菌（Mycoplasma pneumoniae）感染 17 下列有關肺水腫的敘述，何者正確？", "language": "tw"}
{"question": "關於嬰兒異位性皮膚炎的敘述，下列何者正確？", "answer": "分布範圍主要為臉部、頭皮以及四肢的伸側（extensor side）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "分布範圍主要為臉部、頭皮以及四肢的伸側（extensor side）", "B": "若患者合併thrombocytopenia以及免疫功能異常，需懷疑是hyper-IgE syndrome", "C": "臨床上不須與脂漏性皮膚炎做鑑別診斷", "D": "為避免局部類固醇造成的副作用，FDA建議首選外用藥物為0.03% tacrolimus或1% pimecrolimus", "language": "tw"}
{"question": "74.61歲男性突發性的胸痛、呼吸困難，其胸部X光如圖示，最主要的診斷為何？  ", "answer": "氣胸", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "肺氣腫", "B": "肺挫傷出血", "C": "氣胸", "D": "肺炎", "language": "tw"}
{"question": "下列關於操縱子（operon）的敘述，何者錯誤？", "answer": "只在真核生物上發現", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "只在真核生物上發現", "B": "包含promoter", "C": "包含operator", "D": "包含structural genes", "language": "tw"}
{"question": "尺神經（ulnar nerve）受損時，拇指無法進行何種動作？", "answer": "內收（adduction）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "屈曲（flexion）", "B": "伸直（extension）", "C": "內收（adduction）", "D": "外展（abduction）", "language": "tw"}
{"question": "下列有關內臟型利什曼症（visceral leishmaniasis）之敘述，何者錯誤？", "answer": "此類病人脾臟穿刺是禁忌 \t", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "臨床上易誤診為再生不能性貧血（aplastic anemia） \t", "B": "病人以藥物治療後，可能產生黑熱病後皮膚利什曼症（post kala-azar dermal leishmaniasis）", "C": "此類病人脾臟穿刺是禁忌 \t", "D": "病人會出現高球蛋白血症（hyperglobulinemia）", "language": "tw"}
{"question": "下列有關 Crohn's 大腸炎及潰瘍性大腸炎（Ulcerative colitis）的鑑別之敘述，何者錯誤？", "answer": "潰瘍性大腸炎有較高比率之肛裂，肛門潰瘍、管及膿瘍", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "臨床症狀 Crohn's 大腸炎比潰瘍性大腸炎有較高比率可摸到腹部腫塊及較多肛門問題 \t", "B": "放射線學檢查，Crohn's 大腸炎較多迴腸疾病，且較多跳躍式病灶", "C": "潰瘍性大腸炎有較高比率之肛裂，肛門潰瘍、管及膿瘍", "D": "潰瘍性大腸炎的潰瘍較表淺及普遍化，而 Crohn's 大腸炎較多直線性、深且散在性的潰瘍", "language": "tw"}
{"question": "68.酮酸中毒患者體內酮體（ketone body）是由下列那些物質構成？①乙醯乙酸（acetoacetate） ②β-羥丁酸 （β-hydroxybutyrate） ③丙酮（acetone） ④α-酮戊二酸（α-ketoglutarate） \n", "answer": "僅①②③", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "①②③④", "B": "僅①②④", "C": "僅①②③", "D": "僅③④", "language": "tw"}
{"question": "下列何種鹼基不存於一般 RNA 分子？", "answer": "胸腺嘧啶（thymine）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "腺嘌呤（adenine） \t", "B": "尿嘧啶（uracil）", "C": "胸腺嘧啶（thymine）", "D": "胞嘧啶（cytosine）", "language": "tw"}
{"question": "64.懷孕婦女因輸尿管結石產生腰痛求醫處理時，下列何者較不合適？      ", "answer": "必須立即以IVU（intravenous urography）找出石頭位置，加以碎石處理免得繼續妊娠時症狀加劇", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "必須立即以IVU（intravenous urography）找出石頭位置，加以碎石處理免得繼續妊娠時症狀加劇", "B": "利用雙J輸尿管導管（double-J ureter stent）以解除輸尿管之阻塞 \t", "C": "局部麻醉下超音波定位置放經皮腎造廔管（percutaneous nephrostomy tube insertion）", "D": "在懷孕的第一個trimester時應該盡量避免X光照射", "language": "tw"}
{"question": "下列何種黴菌為主要病原菌（primary pathogen）？", "answer": "Paracoccidioides brasiliensis", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "Aspergillus niger \t", "B": "Cryptococcus neoformans", "C": "Candida albicans \t", "D": "Paracoccidioides brasiliensis", "language": "tw"}
{"question": "成熟的B細胞可以同時表現IgD與IgM兩種免疫球蛋白於細胞表面上，其主要的分子機制為何？", "answer": "RNA多樣裁接（alternative splicing）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "RNA多樣裁接（alternative splicing）", "B": "對偶基因排除（allelic exclusion）", "C": "V", "D": "J片段重組（recombination）", "language": "tw"}
{"question": "一位 50 歲女性，因為發燒、腹瀉、脫水，在一家醫院注射點滴治療，病患突然意識障礙、煩躁，而且陷入半昏迷狀態，轉到醫學中心緊急做了 MRI 檢查，根據此二張 MRI T2WI 及 DWI 影像，最適當的診斷是：", "answer": "Pontine myelinolysis", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "Pontine myelinolysis", "B": "Acute pontine infarction", "C": "Japanese encephalitis", "D": "Pontine glioma", "language": "tw"}
{"question": "膽固醇是下列何種維生素（Vitamin）合成的前驅物？", "answer": "D", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "A", "B": "D", "C": "E", "D": "K", "language": "tw"}
{"question": "一位 55 歲男性，因黃疸轉診，在檢驗所初步血清生化檢查顯示 Bilirubin total/direct＝7.8/4.0 mg/dL（normal ＜1.0/0.3），GOT 247 U/L（normal＜35），GPT 176 U/L（normal＜35），血漿 prothrombin time 延長，轉診醫師注意到注射 vitamin K 可明顯改善 prothrombin time，以下那一診斷方向最可能？", "answer": "阻塞性黃疸", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "慢性肝炎加急性發作", "B": "肝硬化", "C": "阻塞性黃疸", "D": "急性肝衰竭", "language": "tw"}
{"question": "下列何者不是視網膜黃斑部中央小凹（foveola）之結構特徵？", "answer": "僅含有神經節細胞（ganglion cells）及錐狀細胞（cones）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "完全無桿狀細胞（rods）之分布", "B": "僅含有神經節細胞（ganglion cells）及錐狀細胞（cones）", "C": "是視網膜最薄之處", "D": "完全無視網膜血管之分布", "language": "tw"}
{"question": "下列何者不是罹患乳癌的危險因子？", "answer": "嬸嬸罹患乳癌", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "一等親姊妹罹患乳癌", "B": "40歲懷孕生第一胎", "C": "停經後服用10年的女性荷爾蒙取代劑", "D": "嬸嬸罹患乳癌", "language": "tw"}
{"question": "下列有關治療甲狀腺功能低下症（hypothyroidism）藥物levothyroxine的藥理作用描述，何者錯誤？", "answer": "Levothyroxine對於藥物如amiodarone所引起的甲狀腺功能低下症治療效果不佳", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "Levothyroxine不能同時與鈣和含鋁類的制酸劑合併使用", "B": "Levothyroxine對於藥物如amiodarone所引起的甲狀腺功能低下症治療效果不佳", "C": "Levothyroxine可以使用於懷孕的甲狀腺功能低下症婦女", "D": "黏液性水腫昏迷（myxedema coma）可以利用levothyroxine來治療", "language": "tw"}
{"question": "有關乳房 X 光攝影（mammography）檢查的敘述，何者正確？", "answer": "乳房脂肪比例會影響 mammography sensitivity", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "小於 30 歲的年輕婦女懷疑乳房有硬塊，應先排乳房 X 光攝影", "B": "50 歲以上婦女 mammography sensitivity 較 50 歲以下婦女差", "C": "乳房脂肪比例會影響 mammography sensitivity", "D": "mammography 會因不同檢查者而影響檢查結果，亦即 operator-dependent", "language": "tw"}
{"question": "19歲女性，因為腳扭傷而貼敷酸痛藥布，兩天後，出現如圖所示會癢之皮膚病變，下列何種檢查最有助於診斷？", "answer": "貼膚試\t（patch test）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "KOH鏡檢（KOH examination）", "B": "貼膚試\t（patch test）", "C": "針刺試\t（prick test）", "D": "Tzanck抹片檢查（Tzanck test）", "language": "tw"}
{"question": "有關遺傳學與基因檢測在肝臟疾病的研究，下列敘述何者錯誤？", "answer": "在威爾森症（Wilson's disease）方面，最常見突變點發生在ATP7B基因，且只有一種突變會發生", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "在肝臟酒精代謝方面，酒精氧化代謝成乙醛（acetaldehyde）後，藉由乙醛脫氫酶（aldehyde", "B": "在自體免疫性肝炎（autoimmune hepatitis）方面，遺傳背景與HLA-B1, -B8, -DR3和-DR4有相關", "C": "在遺傳性鐵質沉\t症（hereditary hemochromatosis）方面，以HFE基因相關C282Y與H63D突變最常見", "D": "在威爾森症（Wilson's disease）方面，最常見突變點發生在ATP7B基因，且只有一種突變會發生", "language": "tw"}
{"question": "一位漁夫出海捕魚時，不慎足背被魚鰭刺傷，數小時後因小腿腫脹、疼痛並有深紫色水泡浮現，請問下列那一種致病菌最有可能？", "answer": "Vibrio vulnificus \t", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "Aeromonas hydrophilia", "B": "Staphylococcus aureus", "C": "Vibrio vulnificus \t", "D": "Streptococcus pyogenes", "language": "tw"}
{"question": "14 歲女孩出現惡性高血壓（200/130 mmHg），腹部影像學檢查顯示一腎上腺腫瘤，尿中兒茶酚胺（catecholamine）以及血清腎素（serum renin）均升高。下列腎臟血管變化中，何者與此腫瘤有最密切的關係？", "answer": "Hyperplastic arteriolosclerosis", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "Hyaline arteriolosclerosis", "B": "Hyperplastic arteriolosclerosis", "C": "Atherosclerosis", "D": "Thromboembolism", "language": "tw"}
{"question": "下視丘（hypothalamus）的那一個核區為人體生物時鐘（biological clock）之主要節律點（pacemaker）？", "answer": "suprachiasmatic nucleus", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "paraventricular nucleus", "B": "preoptic nucleus", "C": "ventromedial nucleus", "D": "suprachiasmatic nucleus", "language": "tw"}
{"question": "一位病人因肺部腫瘤，施行經支氣管切片，其組織學變化如圖二所示，下列何者為最合適的描述？", "answer": "具腺體樣結構（glandular structure）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "呈現乾酪狀壞死（caseous necrosis）變化", "B": "有角質珠（keratin pearl）的存在", "C": "具腺體樣結構（glandular structure）", "D": "以神經性上皮（neuroepithelium）為主", "language": "tw"}
{"question": "在臨床上有一部分的小孩因類胰島素成長因子（insulin-like growth factor; IGF-1）的缺乏，因此造成生長發育遲緩的現象，下列何種藥物可以用來促進其生長發育？", "answer": "Mecasermin", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "重組人類生長激素（recombinant human growth hormone）", "B": "Octreotide", "C": "Mecasermin", "D": "Pegvisomant", "language": "tw"}
{"question": "一位 63 歲糖尿病患者因大葉性肺炎伴隨敗血症及腎衰竭住院，接受抗生素治療 3 週後出現腹脹拉肚子，糞便有少許血絲以及黏液，大腸鏡檢查發現大腸黏膜上覆蓋黃色膜樣的斑塊，糞便 Clostridium difficile toxin 呈陽性反應，下列何者為最有可能之診斷？", "answer": "偽膜性結腸炎（pseudomembranous colitis）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "毒性巨結腸症（toxic megacolon）", "B": "偽膜性結腸炎（pseudomembranous colitis）", "C": "輻射小腸結腸炎（radiation enterocolitis）", "D": "腸套疊（intussusception）", "language": "tw"}
{"question": "胃賁門部（cardiac portion）上皮那類細胞最多？", "answer": "表面黏膜細胞（surface mucous cells）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "表面黏膜細胞（surface mucous cells）", "B": "腸內分泌細胞（enteroendocrine cells）", "C": "壁細胞（parietal cells）", "D": "再生幹細胞（regenerative stem cells）", "language": "tw"}
{"question": "王君，男性 25 歲，第一次搭摩天大樓的電梯時，恐慌發作，以後王君不敢再搭任何密閉式電梯，但王君搭飛機來往國內外多趟，並未發生恐慌發作，也可勝任密閉式實驗室的工作，逛百貨公司搭扶手電梯也都沒有問題。王君最適合的診斷是什麼？", "answer": "電梯畏懼症（specific phobia of elevator）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "恐慌症（panic disorder）", "B": "懼高症（acrophobia）", "C": "電梯畏懼症（specific phobia of elevator）", "D": "懼曠症（agoraphobia）", "language": "tw"}
{"question": "原始致癌基因（proto-oncogenes）能夠透過下列機制轉變為致癌基因（oncogenes），何者除外？", "answer": "其啟動區（promoter region）發生突變導致該蛋白質合成量下降", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "化學性誘導突變（chemical-induced mutation）", "B": "染色體重組 \t", "C": "病毒感染", "D": "其啟動區（promoter region）發生突變導致該蛋白質合成量下降", "language": "tw"}
{"question": "一位患有尋常天瘡（Pemphigus vulgaris）的孕婦，剛剛平安產下 3000 公克的小男嬰，但是隨即發現小男嬰身上及四肢分布有紅斑，有些紅斑上有小水，因此迅速被送入新生兒加護病房治療。他的病因為何？", "answer": "母親的自體免疫疾病之抗體，抗 desmoglein 3 抗體（anti-desmoglein 3 antibody）通過胎盤，暫時引起之病徵", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "母親的自體免疫疾病之抗體，抗 desmoglein 3 抗體（anti-desmoglein 3 antibody）通過胎盤，暫時引起之病徵", "B": "母親的自體免疫疾病之抗體，抗 dsDNA 抗體（anti-dsDNA antibody）通過胎盤，引起之胎兒皮膚系統之自體免疫病", "C": "母親治療自體免疫疾病的用藥，在他身上引起不良反應", "D": "母親的自體免疫疾病之遺傳，而且他一出生即發病", "language": "tw"}
{"question": "Rotenone 會抑制粒線體電子傳遞鏈的那一個步驟？", "answer": "NADH→coenzyme Q", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "NADH→coenzyme Q", "B": "Cyt b→Cyt c1", "C": "Cyt c1→Cyt c", "D": "Cyt c→Cyt (a+a3)", "language": "tw"}
{"question": "第三顱神經受損，最可能影響下列何種動作？", "answer": "上眼瞼上抬", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "咀嚼", "B": "臉龐流汗", "C": "緊閉眼睛", "D": "上眼瞼上抬", "language": "tw"}
{"question": "下列那一位腦死病患，最不適合成為腎臟移植的捐贈者？", "answer": "20 歲，HIV 陽性", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "43 歲，糖尿病病患 \t", "B": "35 歲，腎結石病史者", "C": "37 歲，十二指腸潰瘍病史", "D": "20 歲，HIV 陽性", "language": "tw"}
{"question": "承上題，有關上述病人在縫合後的應注意事項，下列何者錯誤？", "answer": "給予灌腸", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "給予灌腸", "B": "給予軟便劑", "C": "給予冰敷", "D": "給予抗生素", "language": "tw"}
{"question": "44 52 歲女性病患，因左側腰痛到泌尿科求診，經身體檢查只發現以前因子宮肌瘤行子宮切除術及膽囊結石接受腹腔鏡手術的傷痕，尿液分析 RBC：2-5/HPF，WBC：2-5/HPF，Sugar(- )，Protein(- )， BUN：19.1 mg/dL，Cr：0.58 mg/dL，Uric acid：5.1 mg/dL，安排 IVU（靜脈注射尿路攝影）檢查 （如圖），可能的診斷是： \n", "answer": "左腎盞結石", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "腎外的鈣化", "B": "左腎盞結石", "C": "左腎血管鈣化", "D": "兩側輸尿管結石", "language": "tw"}
{"question": "47 25 歲女性，G1P0，月經規則，週期 42 天，產前超音波呈現胎兒頭臀徑（CRL, crown-rump length） 1 公分，請問懷孕週數為：", "answer": "12 週", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "6 週", "B": "8 週", "C": "10 週", "D": "12 週", "language": "tw"}
{"question": "Beckwith-Wiedemann syndrome 可能合併何種腫瘤？", "answer": "Wilms' tumor", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "lymphoma", "B": "neuroblastoma", "C": "Wilms' tumor", "D": "hepatoblastoma", "language": "tw"}
{"question": "下列有關背部的敘述，何者錯誤？", "answer": "位在枕下三角內的動脈為枕下動脈（suboccipital artery）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "豎脊肌（erector spinae）為脊柱的主要伸肌群", "B": "背部菱形肌（rhomboid muscle）的外型在上臂平舉時方為易見", "C": "位在枕下三角內的動脈為枕下動脈（suboccipital artery）", "D": "構成枕下三角頂部的肌肉為頭半脊肌（semispinalis capitis）", "language": "tw"}
{"question": "82 下列敘述中，何者是神經母細胞（Neuroblast）相關腫瘤之特點？  ", "answer": "有可能自行消退（Spontaneous regression） \t", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "有可能自行消退（Spontaneous regression） \t", "B": "神經節神經細胞瘤（Ganglioneuroma）中會有不少神經母細胞之存在", "C": "嬰兒罹患神經母細胞瘤（Neuroblastoma）一旦有皮膚之轉移，預後極差", "D": "所有神經節神經母細胞瘤（Ganglioneuroblastomas）都屬良性腫瘤", "language": "tw"}
{"question": "下列何者不是雄性素（androgen）過度刺激所引起之可能副作用？", "answer": "Weight loss", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "Priapism", "B": "Polycythemia", "C": "Prostate enlargement", "D": "Weight loss", "language": "tw"}
{"question": "下圖所示嬰兒頭部經常維持在向右傾斜的姿勢，並在右側頸部摸到一個鴿蛋大的硬塊，則下列何種方向的頭部活動會受限？", "answer": "頭部轉向右側", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "頭部前屈", "B": "頭部後仰", "C": "頭部轉向右側", "D": "頭部轉向左側", "language": "tw"}
{"question": "25 歲機車騎士遭到時速 60 公里汽車撞擊後被送入急診，到院時意識清楚，下列情境對於頸部 X 光檢查之敘述何者錯誤？", "answer": "外傷病人若側面頸椎 X 光片正常，就可以將頸圈取下", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "無神經理學症狀者，仍可能有頸椎損傷 \t", "B": "側面頸椎 X 光片須包括 7 節頸椎及第一節胸椎", "C": "外傷病人若側面頸椎 X 光片正常，就可以將頸圈取下", "D": "若側面頸椎 X 光片無法看到第 7 頸椎，就要加照 swimmer's view", "language": "tw"}
{"question": "一位罹患惡性腫瘤的 5 歲男童在作完第五次化療後發現尿中有蛋白。單次小便的 protein/creatinine<1.0。同時尿液中發現有糖分、磷酸及碳酸（glycosuria，phosphaturia，bicarbonate loss）。下列何種組織構造是其受傷部位？", "answer": "近端腎小管（proximal tubules）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "腎絲球（glomerulus）", "B": "近端腎小管（proximal tubules）", "C": "亨利氏環（Henle's loop）", "D": "遠端腎小管（distal tubules）", "language": "tw"}
{"question": "下列那一種抗結核菌用藥不適合使用於孕婦？", "answer": "streptomycin", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "isoniazid", "B": "streptomycin", "C": "rifampin", "D": "ethambutol", "language": "tw"}
{"question": "以下何者不屬於水銀（汞）中毒最常見的症狀？", "answer": "腕垂症 \t", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "性情變化，暴躁易怒 \t", "B": "步履不穩", "C": "腕垂症 \t", "D": "顫抖", "language": "tw"}
{"question": "使用成人呼吸器 \"volume-cycled\" 通氣模式時，降低吸氣流量（flow rate）之設定，而維持其他設定，會產生下列何種現象？", "answer": "延長吸氣時間（Ti）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "延長吸氣時間（Ti）", "B": "增加潮氣容積（VT）", "C": "增加尖峰吸氣壓（PIP）", "D": "增加呼吸次數（RR）", "language": "tw"}
{"question": "根據American Society for Reproductive Medicine Revised Classification of Endometriosis，若病患手術中評估之score為28 分，其子宮內膜異位嚴重度為那一個stage？", "answer": "Stage III", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "Stage I", "B": "Stage II", "C": "Stage III", "D": "Stage IV", "language": "tw"}
{"question": "關於人工生殖技術（assisted reproductive technology）之敘述，下列何者正確？", "answer": "所謂人工生殖技術是指經過取卵過程之相關治療", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "為增加懷孕率，植入的胚胎數越多越好", "B": "所謂人工生殖技術是指經過取卵過程之相關治療", "C": "預防FSH surge是人工生殖技術中很重要的一環", "D": "誘導排卵時，GnRH-antagonist可抑制FSH surge", "language": "tw"}
{"question": "帶有下列何種染色體或基因異常的急性骨髓性白血病之預後最壞？", "answer": "FLT3 internal tandem duplication", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "FLT3 internal tandem duplication", "B": "NPM1 mutation", "C": "t(15;17) \t", "D": "inv(16)", "language": "tw"}
{"question": "承上題，該患者在手術前發現血中β-HCG 值為 1,050 1U/L（正常＜2.5），α-fetoprotein（AFP）值為 330 ng/mL（正常＜6），手術後五天再追蹤一次，假使病人現在已經完全沒有腫瘤存在，則下列何種結果最有可能？", "answer": "β-HCG：25；AFP：160", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "β-HCG：＜2.5；AFP＜6", "B": "β-HCG：800；AFP：80", "C": "β-HCG：30；AFP：10", "D": "β-HCG：25；AFP：160", "language": "tw"}
{"question": "Bowen's disease是那一個部位的疾病？", "answer": "外陰", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "子宮體", "B": "子宮頸", "C": "陰道", "D": "外陰", "language": "tw"}
{"question": "一名媽媽發現她10個月大，一向很健康的女嬰腹部腫脹且一整天未解便而就醫。身體檢查發現女嬰腹部有明顯壓痛且腸音幾乎消失。腹部X光檢查發現小腸明顯擴張，但無游離空氣的存在。下列何種情況最可能發生在女嬰身上？", "answer": "腸\t疊（intussusception）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "十二指腸閉鎖（duodenal atresia）", "B": "赫希普氏病（Hirschsprung disease）", "C": "腸\t疊（intussusception）", "D": "梅克爾氏憩室（Meckel diverticulum）", "language": "tw"}
{"question": "乳暈皮膚在哺乳時能分泌潤滑液保護乳暈及乳頭，其腺體的屬性是：", "answer": "皮脂腺", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "皮脂腺", "B": "汗腺", "C": "乳腺", "D": "毛囊腺", "language": "tw"}
{"question": "51.有關兒童腹股溝疝氣（inguinal hernia）的敘述，下列何者正確？①早產兒發生率較高 ②多為直接型疝氣（direct type） ③ 手術以疝氣袋高位結紮為主 ④手術年齡需大於一歲 ", "answer": "僅①③", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "②④", "B": "僅①③", "C": "①③④", "D": "①②③", "language": "tw"}
{"question": "一人因胃部疼痛而求診，內視鏡檢查發現是胃潰瘍，經採胃部切片檢驗後發現為幽門桿菌感染，因此醫師開了三種抗生素給患者服用，其一是 clarithromycin。此抗生素之主要作用機轉為何？", "answer": "抑制該菌之蛋白質合成", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "抑制該菌之細胞壁合成", "B": "抑制該菌之核酸合成", "C": "抑制該菌之蛋白質合成", "D": "抑制該菌之細胞膜合成", "language": "tw"}
{"question": "佩佩第一次產檢抽血結果發現她的紅血球比較小，MCV 67 fL，MCH 21 pg，血紅素 Hb 12.3 g/dL，產前諮詢時，下列敘述何者錯誤？", "answer": "如果夫妻雙方一個是甲型帶因，一個是乙型帶因，可能會生下重症的小孩，須靠終生輸血", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "佩佩有可能是地中海型貧血帶因（carrier）或者是缺鐵性貧血", "B": "應該請佩佩的先生也回門診抽血驗全血球計數（CBC），如果先生的 MCV 也小於 80 fL，要請夫妻雙方一起作地中海型貧血的基因檢測", "C": "地中海型貧血分為 thalassemia major, thalassemia minor 以及 thalassemia intermedia", "D": "如果夫妻雙方一個是甲型帶因，一個是乙型帶因，可能會生下重症的小孩，須靠終生輸血", "language": "tw"}
{"question": "勃起功能障礙（erectile dysfunction）最常見的原因是？", "answer": "混合因素（mixed factors）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "精神因素（psychogenic factor）", "B": "荷爾蒙因素（hormonal factor）", "C": "動脈因素（arterial factor）", "D": "混合因素（mixed factors）", "language": "tw"}
{"question": "新藥上市前，在臨床試\t階段，其受試對象在1000～3000名，屬於第幾階段的臨床試\t？", "answer": "第三階段", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "第四階段", "B": "第三階段", "C": "第二階段", "D": "第一階段", "language": "tw"}
{"question": "下列何者不是因胚胎發育異常造成的甲狀腺組織位置變異？", "answer": "迷路甲狀腺（lateral aberrant thyroid）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "舌後甲狀腺（lingual thyroid）", "B": "異位性甲狀腺（ectopic thyroid）", "C": "迷路甲狀腺（lateral aberrant thyroid）", "D": "甲狀腺舌骨囊腫（thyroglossal duct cyst）", "language": "tw"}
{"question": "自動吐氣末正壓現象（Auto-PEEP），最容易出現於下列何種病患身上？", "answer": "重度慢性阻塞性肺疾", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "迷漫性大腦病變", "B": "兩側廣泛性肺炎", "C": "重度慢性阻塞性肺疾", "D": "嚴重呼吸肌無力", "language": "tw"}
{"question": "下列有關 Basal ganglia 的神經訊息傳導之敘述，何者正確？", "answer": "Corpus striatum（包含 caudate 與 putamen）為接收來自 cerebral cortex 的運動計畫訊息之主要結構", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "Corpus striatum（包含 caudate 與 putamen）為接收來自 cerebral cortex 的運動計畫訊息之主要結構", "B": "Substantia nigra 為接收來自 cerebral cortex 的運動計畫訊息之主要結構", "C": "Globus pallidus 為接收來自 cerebral cortex 的運動計畫訊息之主要結構", "D": "Basal ganglia 的傳出訊息由 caudate 發出，傳入 thalamus，再由 thalamus 傳至 cerebral cortex 的運動區", "language": "tw"}
{"question": "發生急性心肌梗塞的患者，其心肌梗塞區的心肌細胞出現帶狀收縮（contraction band）及心肌間質出血所代表的意義為：", "answer": "血栓溶解治療導致梗塞區血液再灌流", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "血栓擴展造成冠狀動脈完全阻塞及梗塞區擴大", "B": "血栓溶解治療導致梗塞區血液再灌流", "C": "非血栓性冠狀動脈阻塞所導致的心肌梗塞", "D": "非完全阻塞性冠狀動脈狹窄所導致的心內膜下心肌梗塞", "language": "tw"}
{"question": "有關腦下垂體細胞（pituicytes），下列敘述何項正確？", "answer": "此細胞屬神經膠細胞（neuroglial cell）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "此細胞位於腦下垂體前葉（pars distalis）", "B": "此細胞分泌催產素（oxytocin）與抗利尿激素（ADH/vasopressin）", "C": "此細胞具有 Herring 小體（Herring bodies）", "D": "此細胞屬神經膠細胞（neuroglial cell）", "language": "tw"}
{"question": "女性骨盆腔最小的徑線為何？", "answer": "中骨盆腔橫徑", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "骨盆腔入口前後徑", "B": "中骨盆腔前後徑", "C": "中骨盆腔橫徑", "D": "骨盆腔出口橫徑", "language": "tw"}
{"question": "72 歲女性由其女兒陪同就診。女兒告訴醫師她母親罹患失智症已五年，無法跟人溝通，平日由她照顧。三個小時前母親跌倒致右肩腫痛。理學檢查發現手臂、腳、腹部及背部有多處深淺不一之瘀青，頭及右上臂有壓痛點。X 光檢查顯示右肱骨頭骨折。下列處置何者較適當？", "answer": "需懷疑是老人虐待，必要時尋求資源予以安置", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "安排全血球計數（CBC），凝血時間（clotting time）及其它檢查以排除血液疾病", "B": "打石膏，固定止痛後，請女兒帶回家，並請他們要注意跌倒的預防", "C": "照會骨科，做完內固定後，回家療養即可", "D": "需懷疑是老人虐待，必要時尋求資源予以安置", "language": "tw"}
{"question": "29.治療發紺性先天性心臟病常用的外科Blalock-Taussig分流術式（Blalock-Taussig shunt），主要是連接下列那二 條血管，以達到改善缺氧的效果？\n", "answer": "鎖骨下動脈和同側肺動脈（Subclavian artery and pulmonary artery of the same side）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "鎖骨下動脈和同側肺靜脈（Subclavian artery and pulmonary vein of the same side）", "B": "升主動脈和肺動脈（Ascending aorta and main pulmonary artery）", "C": "頸動脈和同側肺動脈（Carotid artery and subclavian artery of the same side）", "D": "鎖骨下動脈和同側肺動脈（Subclavian artery and pulmonary artery of the same side）", "language": "tw"}
{"question": "有關情感性疾患混合發作（mixed episode），係指躁症與鬱症之混合症狀迅速交替出現，時間至少持續多少天？", "answer": "七", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "一", "B": "四", "C": "七", "D": "十四", "language": "tw"}
{"question": "聲音由空氣傳經人體中耳，依鎚骨與鉆骨之槓桿原理，聲音增加了幾分貝？", "answer": "3", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "3", "B": "10", "C": "15", "D": "20", "language": "tw"}
{"question": "62.在下背痛的篩選中，下列何種症狀代表病人可能是罹患一種嚴重的病變（所謂 red flag），須轉介至相關科別", "answer": "夜間疼痛且愈來愈嚴重", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "夜間疼痛且愈來愈嚴重", "B": "病人身體質量指數（BMI）高", "C": "合併下肢疼痛", "D": "曾有腰椎手術病史", "language": "tw"}
{"question": "Penicillamine常用來治療下列何種結石？", "answer": "胱氨酸結石（cystine stone）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "草酸鈣結石（calcium oxalate stone）", "B": "尿酸結石（uric acid stone）", "C": "腎石灰沈\t症（nephrocalcinosis）", "D": "胱氨酸結石（cystine stone）", "language": "tw"}
{"question": "一名 38 歲女性，最近 1 個月來黃疸現象愈來愈明顯，過去幾年來，她曾有過幾次右上腹絞痛的經驗，她接受肝臟切片檢查，顯微鏡檢查可見明顯膽管增生及膽管內膽汁滯留的現象，但肝臟細胞沒有發炎或壞死的變化。下列何者是引起她黃疸最可能的原因？", "answer": "肝外膽管阻塞（Extrahepatic biliary obstruction）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "急性 C 型病毒性肝炎（Acute viral hepatitis C）", "B": "原發性膽道性肝硬化（Primary biliary cirrhosis）", "C": "肝外膽管阻塞（Extrahepatic biliary obstruction）", "D": "威爾森氏症（Wilson disease）", "language": "tw"}
{"question": "一位 55 歲男性，有長年抽菸、嚼檳榔與酗酒習慣。因口腔鱗狀上皮細胞癌接受手術前合併化學與放射線治療，之後發生吞嚥疼痛現象。內視鏡檢查發現食道下三分之一處有一直徑約 1.5 公分不規則形潰瘍，病理切片檢查如圖所示。最可能的診斷為：", "answer": "單純疱疹病毒（herpes simplex virus）感染", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "念珠菌（Candida）感染", "B": "口腔鱗狀上皮細胞癌轉移至食道", "C": "合併食道鱗狀上皮細胞癌", "D": "單純疱疹病毒（herpes simplex virus）感染", "language": "tw"}
{"question": "72.病人主訴右下腹逐漸悶痛、腹脹、反胃一整天。腹部電腦斷層檢查呈現如附圖。箭號所指之異常最符合下列那一項初診斷？  ", "answer": "acute appendicitis", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "cecal diverticulitis", "B": "acute appendicitis", "C": "mesenteric adenitis", "D": "colon cancer", "language": "tw"}
{"question": "一位36歲女性因車禍跌倒時，右臂受到直接撞擊，造成右前臂腫痛及變形，經X光檢查發現遠端橈骨骨折併遠端橈尺骨關節脫位，此病患最可能的診斷為何？", "answer": "Galeazzi氏骨折", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "Galeazzi氏骨折", "B": "Smith氏骨折", "C": "Monteggia氏骨折", "D": "Essex-Lopresti氏骨折", "language": "tw"}
{"question": "下列有關慢性心衰竭的敍述，何者錯誤？", "answer": "內頸靜脈的壓力能完全反應左心室的功能", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "在聽診方面，收縮性左心衰竭病患可聽到第三心音，在舒張性左心衰竭常聽到第四心音", "B": "內頸靜脈的壓力能完全反應左心室的功能", "C": "身體診察（physical examination）可發現最大心尖搏動點（point of maximal impulse）由原本位置（第5肋間及左鎖骨中線）向左及向下偏離", "D": "左心室射出分量（left ventricular ejection fraction）為評估心臟收縮功能的指標", "language": "tw"}
{"question": "viridans streptococci 感染所造成之心內膜炎，不能單獨使用 aminoglycosides 類的藥物，而必須合併 penicillin 的使用才能發揮其殺菌的效果，其主要原因為何？", "answer": "aminoglycosides 類的藥物無法穿過 viridans streptococci 之細胞壁", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "aminoglycosides 類的藥物無法穿過 viridans streptococci 之細胞壁", "B": "aminoglycosides 無法與 viridans streptococci 的核糖體結合", "C": "viridans streptococci 沒有細胞壁結構", "D": "aminoglycosides 類的藥物無法穿過 viridans streptococci 之細胞膜", "language": "tw"}
{"question": "心臟細胞的休息膜電位（resting membrane potential）主要是因為細胞膜內外的什麼離子濃度差所導致？", "answer": "鉀", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "鈉", "B": "鉀", "C": "鈣", "D": "鎂", "language": "tw"}
{"question": "關於下列四種疾病的主要致病機轉，那兩種疾病的免疫過度反應（hypersensitivity reaction）最為接近？", "answer": "①④", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "①②", "B": "②④", "C": "①④", "D": "②③", "language": "tw"}
{"question": "當酸性食糜（pH＜3）進入十二指腸內產生之生理反應，下列敘述何者正確？", "answer": "增加富含碳酸氫根（bicarbonate）的胰液分泌", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "增加胃酸分泌 \t", "B": "降低膽汁的生成", "C": "增加富含碳酸氫根（bicarbonate）的胰液分泌", "D": "抑制富含酵素之胰液分泌", "language": "tw"}
{"question": "下列那種分子組合屬於調節 T 細胞（regulatory T cell）的標記？", "answer": "CD4/CD25", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "CD3/CD28", "B": "CD4/CD25", "C": "CD3/CD8", "D": "CD16/CD56", "language": "tw"}
{"question": "33 歲女性，G4P2A1，妊娠 33 週，依胎兒生物生理計分法（biophysical profile, BPP）得分為 4 分，最佳處置為何？", "answer": "當天重複 BPP 試驗，若是小於或等於 6，立即分娩", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "立即分娩", "B": "當天重複 BPP 試驗，若是小於或等於 6，立即分娩", "C": "三天後重複 BPP 試驗，若是小於或等於 8，立即分娩", "D": "七天後重複 BPP 試驗，若是小於或等於 8，立即分娩", "language": "tw"}
{"question": "一位 12 歲男童因陰莖太短而就診，身體檢查發現陰莖 3 公分長，陰囊較小，未摸到睪丸，無尿道下裂且無陰毛發育，血液檢查顯示血清濾泡促素（FSH）及黃體促素（LH）值均高於正常範圍，睪固酮（testosterone）值＜0.2 ng/mL。下列那一項檢查對診斷的幫助最少？", "answer": "腦垂體功能檢查", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "染色體檢查 \t", "B": "腦垂體功能檢查", "C": "hCG 刺激試驗 \t", "D": "血清 antimüllerian hormone 濃度", "language": "tw"}
{"question": "一位52歲男性病患因長期胃痛至某醫學中心求診。醫師安排做胃鏡檢查，發現該病人在胃幽門處有潰瘍，並採取若干胃黏膜組織，送細菌室培養。針對這些檢體，最適合的氣體培養環境為何？", "answer": "低氧環境（含約5%氧氣）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "大氣環境（含約20%氧氣）", "B": "無氧環境", "C": "高氧環境（含約50%氧氣）", "D": "低氧環境（含約5%氧氣）", "language": "tw"}
{"question": "78.張先⽣是⼀位⽊⼯，和妻⼦住在⼀起，每天都會抽⼀包菸且下班後會喝⼀點酒。有⼀次暈倒⼜很快醒來，檢查後發現他有左側頸動脈明顯狹窄，腦⾎管攝影發現狹窄⾼達90%。⾎管外科主治醫師建議他做頸動脈內膜刮除術或置放⽀架等治療，但告知張先⽣接受⼿術有立即死亡或中風的風險，張先⽣對⼿術感到遲疑，並說", "answer": "和張先⽣充分討論後，先給予內科藥物治療，並安排戒菸計畫及定期追蹤", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "和張先⽣充分討論後，先給予內科藥物治療，並安排戒菸計畫及定期追蹤", "B": "臨床不需考慮治療疾病以外的事，張先⽣的退休⾦不該影響你的醫療決策", "C": "張先⽣可能受到疾病的壓⼒無法做正確的判斷，應聯絡其家屬討論治療⽅向", "D": "先安排⼿術爭取治療時效性，進開⼑房再向張先⽣解釋此⼿術的風險即可", "language": "tw"}
{"question": "對 chronic ulcerative colitis 的病人而言，下列何者非促成其形成癌症的因素之一？", "answer": "潰瘍之深度", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "潰瘍之深度", "B": "發病年齡", "C": "罹病之期限", "D": "病變範圍", "language": "tw"}
{"question": "下列何者不是大麻的藥理作用？", "answer": "降低食慾", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "緩解疼痛", "B": "降低食慾", "C": "欣快感（euphoria）和放鬆", "D": "減少噁心", "language": "tw"}
{"question": "39 一位 41 歲健康女士，公司提供年度健康檢查發現血中 CA 19-9 數值為 42.6 U/mL，高於正常值（＜ U/mL），因此到醫院求助；其它項目皆無異狀。下列何者是比較合理的做法？", "answer": "解釋並安慰 \t", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "解釋並安慰 \t", "B": "安排大便潛血，胃鏡、大腸鏡", "C": "安排腹部超音波 \t", "D": "直接做電腦斷層攝影", "language": "tw"}
{"question": "在DNA複製中，下列何酵素功能主要是用以增加DNA複製之準確度？", "answer": "3'→5'外切核酸酶", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "單股DNA結合蛋白", "B": "3'→5'外切核酸酶", "C": "DNA連接酶", "D": "DNA解螺旋酶", "language": "tw"}
{"question": "周全性老年評估可以發現老年人之潛在性可治療的健康問題，使老年人獲得較好的健康照顧。下列何種狀況最不適合作周全性老年評估？", "answer": "疾病末期病人或有嚴重失智者", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "疾病末期病人或有嚴重失智者", "B": "有多重疾病、服用多種藥物的老年人", "C": "日常生活活動功能不全的老年人，尤其在最近有惡化的情形者", "D": "最近多次住院，且原因未明確者", "language": "tw"}
{"question": "74.\n 病人主訴胸骨後和上腹部疼痛且食慾不佳，胸部X光檢查呈現如圖，下列那一項診斷最正確？  \n", "answer": "hiatal hernia", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "hiatal hernia", "B": "aortic dissection", "C": "myocardial infarction", "D": "pneumomediastinum", "language": "tw"}
{"question": "有關糖尿病慢性併發症的敘述，下列何者錯誤？", "answer": "糖尿病的腎臟病變在早期就會有肌酸酐上升的現象", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "糖尿病慢性併發症的發生與糖尿病的罹病期及血糖控制有關", "B": "病人最好能定期接受糖尿病慢性併發症的篩檢", "C": "病人可能有腹瀉或便秘的現象", "D": "糖尿病的腎臟病變在早期就會有肌酸酐上升的現象", "language": "tw"}
{"question": "一位 21 歲大學女生出現不斷檢查門窗，認為家中桌椅不乾淨，不斷擦拭，碰過桌椅的手需以水及肥皂反覆沖洗，且其腦中常有揮之不去「明知不可能是事實」的意念。請問此患者最有可能之臨床診斷為何？", "answer": "強迫症（obsessive compulsive disorder）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "慮病症（hypochondriasis）", "B": "妄想症（delusional disorder）", "C": "強迫症（obsessive compulsive disorder）", "D": "恐慌症（panic disorder）", "language": "tw"}
{"question": "6 臺灣地區腎病比率偏高，王先生為腎功能受損（GFR 25～40 mL/min）的病人，將進行全髖關節置換 手術，下列有關麻醉的考量，何者錯誤？ \n", "answer": "腎功能不佳，故應絕對限制水分給予", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "術中低血容為手術後腎衰竭的重要因素", "B": "腎功能不佳，故應絕對限制水分給予", "C": "mannitol 與利尿劑（furosemide）對急性腎衰竭病人之幫助不大", "D": "應放置導尿管，並監測術中尿輸出，使之大於 0.5 mL/kg/h", "language": "tw"}
{"question": "26 六歲女童到兒科急診求診，主訴為尿液呈現紅色。急診室醫師幫女童安排尿液檢查，沒有看到紅血球。 下列何者最不可能是致病的原因？ \n", "answer": "尿路外傷（urinary tract trauma）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "肌球蛋白尿（myoglobinuria）", "B": "血紅素尿（hemoglobinuria）", "C": "尿路外傷（urinary tract trauma）", "D": "藥物（如 rifampin，sulfasalazine）", "language": "tw"}
{"question": "一位70歲老先生沒繫妥安全帶，開小轎車撞上電線桿，顏面直接撞擊前面擋風玻璃，到達急診時顏面嚴重腫脹，口腔內有血絲，主訴頭部疼痛，下列敘述何者錯誤？", "answer": "老年人外傷的預後，與罹患之慢性病無關", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "治療老年外傷的傷患，病患的評估順序與一般外傷病患相同", "B": "老年人如有頭部外傷，症狀常延遲出現", "C": "隨\t年齡增加，老年人的生理代償功能降低", "D": "老年人外傷的預後，與罹患之慢性病無關", "language": "tw"}
{"question": "一位年輕人因車禍受傷被送到急診，病人意識不清但亟需立即開刀，不過一時之間又找不到他的家人來簽同意書，醫師應該如何處理？", "answer": "雖然沒有病人同意，醫師仍應進行開刀", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "沒有病人同意、因此醫師不應開刀", "B": "先找一找有沒有護理人員願意代理決定，再進行開刀", "C": "雖然沒有病人同意，醫師仍應進行開刀", "D": "通報警局再決定是否開刀", "language": "tw"}
{"question": "下列有關胃腸藥之服用方式，何者錯誤？", "answer": "omeprazole 和制酸劑一起同時給與", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "制酸劑（antacid）於飯後 1 小時口服", "B": "omeprazole 和制酸劑一起同時給與", "C": "sucralfate 在飯前給與", "D": "H2 blocker 在睡前給與", "language": "tw"}
{"question": "一位 40 週出生體重 4100 公克經自然生產出生之男嬰，於出生後 8 小時發現他有間歇性兩側手腳抽動與眼神直視的現象。在懷疑新生兒抽搐（neonatal seizure）的考慮下，下列那一項措施錯誤？", "answer": "先安排 EEG 檢查再給予抗癲癇藥物", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "先安排 EEG 檢查再給予抗癲癇藥物", "B": "立即抽血檢查血糖值及血鈣值", "C": "檢查是否有顱內出血 \t", "D": "確定母親是否有 gestational diabetes", "language": "tw"}
{"question": "下列何者不屬於粒線體腦病變？", "answer": "雷特氏症候群（Rett syndrome）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "Leigh 氏病 \t", "B": "雷特氏症候群（Rett syndrome）", "C": "雷氏症候群（Reye syndrome）", "D": "具 ragged-red fiber 之肌躍性癲癇（MERRF）", "language": "tw"}
{"question": "有關毛地黃使用於治療兒童心臟衰竭之敘述，何者不正確？", "answer": "心電圖上 PR interval 延長就要停藥", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "口服後 30 分鐘有初步效果，2~6 小時達最高效果 \t", "B": "60~85%能從胃腸道吸收", "C": "心電圖上 PR interval 延長就要停藥", "D": "低血鉀病人會加劇毛地黃中毒", "language": "tw"}
{"question": "39歲女性經診斷有十二指腸潰瘍及幽門螺旋桿菌感染，接受第一線殺菌藥物治療後，評估是否殺菌成功，下列何種檢查最簡便正確？", "answer": "C13-urea breath test", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "C13-urea breath test", "B": "血清幽門螺旋桿菌抗體檢查", "C": "經胃鏡切片組織學檢查", "D": "尿液幽門螺旋桿菌抗體檢查", "language": "tw"}
{"question": "一位 28 歲未曾懷孕的病人主訴，在兩次月經間有出血，而且月經量增大，在過去 9 個月間，她接受了兩次子宮內膜刮搔術，但症狀並未緩解，口服避孕藥和抑前列腺素（antiprostaglandins）也沒有減少異常出血。下列何種處置最恰當？", "answer": "子宮鏡檢查", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "子宮切除 \t", "B": "子宮鏡檢查", "C": "子宮內膜破壞術（endometrial ablation）", "D": "給予促性腺釋放激素刺激劑（GnRH agonist）", "language": "tw"}
{"question": "下列抗心律不整藥物中，何者較不會引起 Torsade de pointes 的副作用？", "answer": "Amiodarone", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "Amiodarone", "B": "Sotalol", "C": "Dofetilide", "D": "Quinidine", "language": "tw"}
{"question": "乳房根除手術（Radical mastectomy）後有翼狀肩（Winged scapula）之現象，是因那一條神經損傷之故？", "answer": "長胸神經（Long thoracic nerve）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "長胸神經（Long thoracic nerve）", "B": "胸背神經（Thoracodorsal nerve） \t", "C": "肋間神經（Intercostal nerve）", "D": "橈神經（Radial nerve）", "language": "tw"}
{"question": "下列何者能外展手臂？", "answer": "棘上肌（supraspinatus）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "棘下肌（infraspinatus）", "B": "棘上肌（supraspinatus）", "C": "肩胛下肌（subscapularis）", "D": "小圓肌（teres minor）", "language": "tw"}
{"question": "下列何者最容易造成代謝性酸中毒（metabolic acidosis）？", "answer": "嚴重腹瀉（severe diarrhea）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "嚴重嘔吐（severe vomiting）", "B": "嚴重腹瀉（severe diarrhea）", "C": "過度換氣（hyperventilation）", "D": "消化性潰瘍（peptic ulcer）", "language": "tw"}
{"question": "關於總膽管囊腫（choledochal cyst）的敘述，下列何者錯誤？", "answer": "很少有黃疸（jaundice）的現象", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "女性的比例較高", "B": "手術的方法以囊腫全切除併Roux-en-Y膽管空腸吻合", "C": "很少有黃疸（jaundice）的現象", "D": "若不全切除囊腫，日後有惡性變化的可能", "language": "tw"}
{"question": "導管燒灼術（catheter ablation）對於下列那一種不整脈，往往沒有良好的治療效果？", "answer": "冠心症導致的心室頻脈\t", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "冠心症導致的心室頻脈\t", "B": "房室結再進入之上心室性頻脈（atrioventricular nodal reentrant supraventricular tachycardia）", "C": "心房撲動（atrial flutter）", "D": "WPW 症候群相關之上心室性頻脈", "language": "tw"}
{"question": "下列對於情感性疾患（mood disorders）之敘述，何者錯誤？", "answer": "第一型雙極性疾患（bipolar I disorder）之盛行率，男性與女性差不多，但女性比男性會有較多躁症之發作", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "重度憂鬱症之盛行率，女性通常是男性的兩倍", "B": "第一型雙極性疾患（bipolar I disorder）之盛行率，男性與女性差不多，但女性比男性會有較多躁症之發作", "C": "第一型雙極性疾患之發作年齡較重度憂鬱症早", "D": "重度憂鬱症之平均發作年齡約為 40 歲", "language": "tw"}
{"question": "我國全民健康保險之預防保健服務不包括：", "answer": "預防職業病健康檢查", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "成人預防保健服務", "B": "預防職業病健康檢查", "C": "孕婦產前檢查", "D": "兒童預防保健服務", "language": "tw"}
{"question": "關於膽色素（bile pigment）之敘述，下列何者正確？", "answer": "為血紅素分解之產物 \t", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "為血紅素分解之產物 \t", "B": "參與脂肪的消化作用", "C": "全部由糞便排出 \t", "D": "在肝細胞中與白蛋白（albumin）結合", "language": "tw"}
{"question": "一位24歲病人被發現有血紅蛋白H疾病（hemoglobin H disease），下列何種血紅蛋白在此病人特別多？", "answer": "β4", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "α2γ2", "B": "α2δ2", "C": "β4", "D": "γ4", "language": "tw"}
{"question": "有關梅氏神經叢（Meissner's plexus）的敘述，何者正確？", "answer": "調節黏膜層蠕動與腺體之分泌", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "調節黏膜層蠕動與腺體之分泌", "B": "分布在消化道肌肉層中", "C": "類似交感神經有刺激括約肌的功能", "D": "在漿膜層常見", "language": "tw"}
{"question": "蘇先生，65 歲，過去兩年來由於重症肌無力一直在神經內科接受藥物治療。最近一星期來呼吸逐漸急促，因而至急診就醫，理學檢查並無發燒，呼吸速率 32/分鐘，胸部聽診並無雜音。胸部 X 光並無異常，且動脈血氧氣飽和度為 98%，則下列何者為最適當處置步驟？", "answer": "肺功能檢查（FVC 和 Pimax）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "肺功能檢查（FVC 和 Pimax）", "B": "動脈血氣體分析", "C": "追蹤胸部 X 光攝影", "D": "肺部電腦斷層攝影", "language": "tw"}
{"question": "一位 70 歲男性過去有糖尿病、高血壓、高血脂及常年抽菸的病史。4 週前因冠狀動脈狹窄，接受經 femoral artery 之 PTCA（percutaneous transluminal coronary angioplasty）治療。目前主訴尿量減少，全身倦怠，輕微發燒住院。檢查結果顯示血壓偏高 180/100 mmHg，下肢有網狀斑（livedo reticularis）及水腫，血中 creatinine 由 4 週前之 1.2 mg/dL 上升到 5.7 mg/dL。則其初步診斷是：", "answer": "atheroembolic renal disease（cholesterol emboli syndrome）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "contrast nephropathy \t \t", "B": "systemic vasculitis", "C": "atheroembolic renal disease（cholesterol emboli syndrome）", "D": "acute interstitial nephritis", "language": "tw"}
{"question": "下列何者進入腎上腺髓質（suprarenal medulla），與嗜鉻細胞（chromaffin cell）形成突觸?", "answer": "經小內臟神經（lesser splanchnic nerve）來的節前神經纖維（preganglionic fiber）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "經小內臟神經（lesser splanchnic nerve）來的節前神經纖維（preganglionic fiber）", "B": "經腹腔神經節（celiac ganglion）來的節後神經纖維（postganglionic fiber）", "C": "經主動脈腎神經節（aorticorenal ganglion）來的節後神經纖維（postganglionic fiber）", "D": "經下腹下神經叢（inferior hypogastric plexus）來的節前神經纖維（preganglionic fiber）", "language": "tw"}
{"question": "解剖病例在基底核發現 Alzheimer 第二型星狀細胞，病人多半是罹患了：", "answer": "肝性昏迷", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "Alzheimer 氏病", "B": "腦脫疝", "C": "肝性昏迷", "D": "Prion 引發的疾病", "language": "tw"}
{"question": "北洛尼氏病症（Peyronie's disease）經常和下列那一種病有相關？", "answer": "手肌腱的 Dupuytren's contracture", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "手肌腱的 Dupuytren's contracture", "B": "多發性硬化症（multiple sclerosis）", "C": "骨骼系統的 von Recklinghausen's disease", "D": "纖維性囊腫（cystic fibrosis）", "language": "tw"}
{"question": "缺乏抗體及補體時，容易遭受下列何者感染？", "answer": "Pyogenic bacteria \t", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "Mycobacterium species", "B": "Herpes virus \t", "C": "Pyogenic bacteria \t", "D": "Pneumocystis carinii", "language": "tw"}
{"question": "根據下述聽力圖，則下列敘述何者正確？", "answer": "右耳傳導性重聽，左耳感音性重聽", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "右耳傳導性重聽，左耳傳導性重聽", "B": "右耳傳導性重聽，左耳感音性重聽", "C": "右耳感音性重聽，左耳傳導性重聽", "D": "右耳感音性重聽，左耳感音性重聽", "language": "tw"}
{"question": "73.56歲女性，15個月前被診斷為卵巢癌接受化學治療，最近主訴有噁心、嘔吐及食慾不振 （anorexia）。半年前開始體重逐漸下降，已減輕20公斤，感覺越來越虛弱。檢查發現呼吸每分鐘約25次，結膜蒼白，腹部鼓脹，有腹水且有一10×30 cm之腫塊。治療此病人之惡病質（cachexia）與食慾不振，下列那一種藥物較適當？ \n", "answer": "corticosteroid", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "corticosteroid", "B": "prochlorperazine", "C": "morphine sulfate", "D": "cyproheptadine", "language": "tw"}
{"question": "傷口重建的原則及方法有①skin graft ②myocutaneous flap ③free flap ④linear closure ⑤skin flap，重建的思考順序是：", "answer": "④①⑤②③", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "①②③④⑤", "B": "④⑤①③②", "C": "④①⑤②③", "D": "④⑤③①②", "language": "tw"}
{"question": "有關 arginine vasopressin（AVP）之敘述，下列何者錯誤？", "answer": "AVP 的抗利尿（antidiuretic）作用主要是經由凝血因子 VI 的受體（receptor）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "AVP 又稱為抗利尿激素（antidiuretic hormone）", "B": "AVP 的抗利尿（antidiuretic）作用主要是經由凝血因子 VI 的受體（receptor）", "C": "AVP 會增加循環中凝血因子Ⅷ（Factor Ⅷ）的濃度", "D": "AVP 具有血管收縮（vasoconstriction）的作用", "language": "tw"}
{"question": "三尖瓣置換時，在那一部分下針時，必須很注意以免傷及傳導組織，造成術後傳導阻滯（heart block）？", "answer": "中隔葉（septal leaflet）環部", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "前葉與後葉交界處 \t", "B": "前葉環部", "C": "中隔葉（septal leaflet）環部", "D": "後葉環部", "language": "tw"}
{"question": "一位 62 歲的男性患有輕微重症肌無力，經電腦斷層檢查發現有約 2 公分大小的前縱膈腔腫瘤，如果你要向家屬解釋病情，開刀前預測術後病理報告最可能是什麼？", "answer": "胸腺瘤（Thymoma）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "畸形瘤（Teratoma） \t", "B": "胸腺瘤（Thymoma）", "C": "淋巴瘤（Lymphoma）", "D": "神經原性腫瘤（Neurogenic tumor）", "language": "tw"}
{"question": "關於梅克爾憩室（Meckel diverticulum），下列敘述何者錯誤？", "answer": "年紀小的幼童比年紀大的孩童，更易發生憩室炎（diverticulitis）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "最常見的臨床表現為無痛性出血，其次為腸阻塞", "B": "通常位於離迴盲瓣（ileocecal valve）50～75公分內的迴腸端", "C": "可能含有異位性組織（ectopic tissue），胃組織比胰組織常見", "D": "年紀小的幼童比年紀大的孩童，更易發生憩室炎（diverticulitis）", "language": "tw"}
{"question": "下列有關焦慮性疾患（anxiety disorders）的敘述，何者錯誤？", "answer": "針對特定畏懼症（specific phobia）的治療，目前被認為最有效者仍是藥物治療", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "針對特定畏懼症（specific phobia）的治療，目前被認為最有效者仍是藥物治療", "B": "焦慮症常併有物質使用疾患，必須小心釐清焦慮症狀是否和物質有關", "C": "廣泛性焦慮症（generalized anxiety disorder）患者以女性較多", "D": "近期酒精過度飲用及支持系統不佳，均為創傷後壓力症候群的危險因子", "language": "tw"}
{"question": "10.一位52歲在魚市場送貨的張先生，之前每週一到週六清晨5時載貨到某魚市場工作時，能扛10公斤為一箱的海 鮮穿梭於市場約10來趟，勝任愉快。上週日參加喜宴，多喝了一些酒，第二天在同一魚市場進行相同工作時發覺走了5趟就覺得喘，需要休息10分鐘才能再搬貨。他原以為前一晚沒睡好，只要回家休息就可恢復，沒想\n 到接下來3天皆是如此，因此前來醫院就醫。醫師的初步診斷為心衰竭。請問根據紐約心臟協會的功能分類\n （NYHA functional classification），應屬於：\n", "answer": "第二級", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "第一級", "B": "第二級", "C": "第三級", "D": "第四級", "language": "tw"}
{"question": "75.一位體重50公斤有C型肝炎及憂鬱症病史之中年婦人，與丈夫吵架後服用36顆", "answer": "保守觀察，不需進一步處理", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "考慮給予acetylcysteine", "B": "口服活性碳（activated charcoal）", "C": "檢測血中鉀離子濃度", "D": "保守觀察，不需進一步處理", "language": "tw"}
{"question": "97 一位 18 歲女性，因為這幾個月來覺得下腹部不適而就醫。骨盆腔檢查發現她左側卵巢有一個 10 公分大的腫瘤，右側卵巢及子宮大小正常。她接受腫瘤切除手術。肉眼觀察發現這是一個實體灰白色的腫瘤。顯微鏡下可見腫瘤大多數是由不分化的間質細胞組成，部分細胞有軟骨或神經上皮分化。 有關此腫瘤的敘述，下列何者正確？ \n", "answer": "是一種惡性腫瘤 \t", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "是一種惡性腫瘤 \t", "B": "腫瘤細胞源自卵巢的間質細胞", "C": "此腫瘤常伴隨子宮內膜增生", "D": "此腫瘤與 BRCA1 基因異常有關", "language": "tw"}
{"question": "下列何者沒有發出分支構成膝關節動脈吻合網（genicular anastomosis）？", "answer": "腓動脈（fibular artery）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "股動脈（femoral artery）", "B": "膕動脈（popliteal artery）", "C": "腓動脈（fibular artery）", "D": "脛前動脈（anterior tibial artery）", "language": "tw"}
{"question": "人體試驗開始進行前，計畫書須先通過人體試驗委員會（IRB）之審查。若需變更計畫書內容，需經人體試驗委員會通過，方可改變作業方式。但在什麼情況下，不需經人體試驗委員會通過，可直接不照計畫書內容執行？", "answer": "為及時避免受試者遭受傷害者", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "僅修正受試者同意書之文字，未變更作業內容", "B": "經人體試驗委員會以簡易審查（expedited procedures）的程序審查通過之計畫書", "C": "為及時避免受試者遭受傷害者", "D": "降低受試者的藥物劑量，使得風險改變", "language": "tw"}
{"question": "在職業肺部疾病之檢查中，一氧化碳擴散速率（DLco）的異常下降，較常見於下列何者？", "answer": "矽肺症 \t", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "矽肺症 \t", "B": "棉花肺症 \t", "C": "職業性氣喘 \t", "D": "慢性阻塞性肺病", "language": "tw"}
{"question": "下列何者不屬於精神分裂症患者所出現之思考「內容」障礙？", "answer": "思考聯結鬆弛（loosening of associations）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "被害妄想（delusion of persecution）", "B": "關係意念（idea of reference）", "C": "被跟蹤妄想（delusion of being followed）", "D": "思考聯結鬆弛（loosening of associations）", "language": "tw"}
{"question": "一段抗原蛋白片段被 T 細胞辨識時，不會與下列那一個分子直接接觸？", "answer": "CD3 複合體分子 \t", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "CD3 複合體分子 \t", "B": "主要組織相容性複合體（MHC）分子", "C": "T 細胞受體（TCR）α 鏈", "D": "T 細胞受體（TCR）β 鏈", "language": "tw"}
{"question": "依照International Continence Society所提出Pelvic Organ Prolapse Quantification system（POP-Q）不同部位缺陷之定量測量，其數值之呈現可用另一種方式：以一條直線數 串方式來表示，如-3, -4, -8, -10, -3, -3, 11, 4, 3。但是，此列數值於何測量部位是不合情理？", "answer": "Point Ba", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "Point Aa", "B": "Point Ba", "C": "Point C", "D": "Point D", "language": "tw"}
{"question": "在下列四種神經元受損情況下，那一種最容易產生痙攣型構音障礙（spastic dysarthria）？", "answer": "雙側上運動神經元（bilateral upper motor neuron）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "單側上運動神經元（unilateral upper motor neuron）", "B": "單側下運動神經元（unilateral lower motor neuron）", "C": "雙側上運動神經元（bilateral upper motor neuron）", "D": "雙側下運動神經元（bilateral lower motor neuron）", "language": "tw"}
{"question": "下列有關痲瘋的敘述，何者錯誤？", "answer": "在癩瘤型痲瘋，是由於細胞性及體液性（humoral）免疫反應兩者均有缺失的緣故", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "癩瘤型痲瘋（lepromatous leprosy）病變組織中可以發現有極多的痲瘋桿菌", "B": "在癩瘤型痲瘋，是由於細胞性及體液性（humoral）免疫反應兩者均有缺失的緣故", "C": "在類結核型痲瘋（tuberculoid leprosy），是由於細胞性免疫反應太強的緣故，其肉芽腫中較難發現細菌", "D": "痲瘋桿菌經由人與人之間散布，可能由呼吸傳染", "language": "tw"}
{"question": "有關⼼臟⾎管系統的⾝體檢查與評估，下列何者錯誤？", "answer": "⾺凡⽒症（Marfan's syndrome）除了⾝形瘦⻑之外，在牙齦上的表現常常是有較低的牙腭⼸（low-arched", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "所謂differential cyanosis指的是發紺現象單獨出現在下肢，要考慮有從右到左的⾎液分流（shunting）病態", "B": "當⽪膚看起來有點像青銅⾊的⾊素沉積之際，⼼衰竭的鑑別診斷要考量⾎⾊素沈著病（hemochromatosis）", "C": "⾺凡⽒症（Marfan's syndrome）除了⾝形瘦⻑之外，在牙齦上的表現常常是有較低的牙腭⼸（low-arched", "D": "所謂的杵狀指（clubbing finger）是暗⽰著病患可能有從右到左的⾎液分流（shunting）病態⽣理現象", "language": "tw"}
{"question": "承上題，阻塞性位置最常發生在：", "answer": "迴腸", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "十二指腸", "B": "空腸", "C": "迴腸", "D": "升結腸", "language": "tw"}
{"question": "威爾遜氏病（Wilson's disease）是一種銅代謝的先天性異常，角膜會有 Kayser-Fleischer ring，下列敘述何者正確？", "answer": "色素沈積於 Descemet's membrane 該層", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "該環狀銅質色素沈積於角膜中心", "B": "該色素沈積位於角膜上皮層", "C": "相同的環狀銅質色素，也會出現於圓錐角膜（keratoconus）的病人", "D": "色素沈積於 Descemet's membrane 該層", "language": "tw"}
{"question": "下列有關失語症的相關敘述，何者錯誤？", "answer": "全面性失語症的病患其聽說能力異常，但讀寫能力是正常的", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "如中風發生位置在優勢大腦中腦動脈的主幹（middle cerebral artery main stem），病患有可能呈現全面性失語症（global aphasia） \t", "B": "全面性失語症的病患其聽說能力異常，但讀寫能力是正常的", "C": "交叉性失語症（crossed aphasia）係指慣用手為右手的病患，當右側腦部有病變時產生典型失語症之症狀", "D": "命名性失語症（anomic aphasia）常由其他類型失語症轉變而來", "language": "tw"}
{"question": "一位 19 歲大學女生，因骨盆腔巨大腫瘤接受手術治療，發現是左側卵巢不成熟型畸胎瘤（immature teratoma），有關她的治療預後因子為：", "answer": "amount of undifferentiated neural tissue \t", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "amount of undifferentiated neural tissue \t", "B": "degree of glandular differentiation", "C": "presence of solid parts more than cystic parts \t", "D": "presence of sexual pseudoprecocity", "language": "tw"}
{"question": "一位 30 歲男性因車禍造成頸椎損傷，右側肢體無力但左側溫痛覺異常。這最可能是何種脊髓損傷？", "answer": "Brown-Séquard syndrome", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "anterior cord syndrome", "B": "Brown-Séquard syndrome", "C": "central cord syndrome", "D": "complete spinal cord injury", "language": "tw"}
{"question": "下列那一種情形最不適合接種注射型非活性流感疫苗？", "answer": "罹患輕度心室中隔缺損的 3 個月嬰兒", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "罹患糖尿病的 70 歲老人", "B": "懷孕 32 週的孕婦", "C": "罹患輕度心室中隔缺損的 3 個月嬰兒", "D": "罹患發紺性心臟病的 6 歲兒童", "language": "tw"}
{"question": "一位 28 歲女性抱怨說做了流產手術後，月經不來。她最可能的診斷是：", "answer": "Asherman's syndrome", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "Gonadal dysgenesis", "B": "Sheehan syndrome", "C": "Kallmann syndrome", "D": "Asherman's syndrome", "language": "tw"}
{"question": "將檢體貯存於 4℃兩週以上，再進行細菌分離的冷藏增殖法（cold enrichment），適用於下列何種菌屬的病菌？", "answer": "亞辛氏菌屬（Yersinia） \t", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "沙門氏菌屬（Salmonella）", "B": "亞辛氏菌屬（Yersinia） \t", "C": "幽門桿菌屬（Helicobacter）", "D": "霍亂弧菌屬（Vibrio）", "language": "tw"}
{"question": "下列何者是屬於補體的 C3 轉化酶（C3 convertase）？", "answer": "C3bBb", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "C5b67", "B": "C3a", "C": "C3b", "D": "C3bBb", "language": "tw"}
{"question": "下列關於小兒麻痺病毒（Poliovirus）之敘述，何者為錯？", "answer": "感染後大部分人出現中樞神經症狀，少部分人為無症狀感染", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "分類上屬於小 RNA 病毒科（Picornaviridae），包括三種血清型 \t", "B": "其疫苗有沙克疫苗及沙賓疫苗，均為包含三種血清型之混合疫苗", "C": "感染後大部分人出現中樞神經症狀，少部分人為無症狀感染", "D": "麻痺性脊髓灰白質炎（paralytic poliomyelitis）主要是因為此病毒感染脊髓前角細胞（anterior horn cell）所致", "language": "tw"}
{"question": "小學 3 年級的李小弟最近功課退步，老師說他上課時常常發呆，有時嘴巴還動來動去，不知在吃什麼；事後問他，他總是很無辜的說：「沒有啊！」在門診時請李小弟連續深呼吸 3 分鐘，結果做了一半他又開始發呆。下列那一個檢查最能診斷出李小弟的病？", "answer": "腦電圖", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "心理測驗", "B": "24 小時心電圖", "C": "腦電圖", "D": "生長激素測定", "language": "tw"}
{"question": "59 某病患發生車禍造成脊髓損傷，肚臍以下完全沒有感覺，下肢肌肉力量也完全喪失。根據美國脊髓 損傷協會（ASIA）的分類標準，其狀況應表示為下列何者？\n", "answer": "ASIA：A, level：T10", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "ASIA：A, level：T4", "B": "ASIA：E, level：T4", "C": "ASIA：A, level：T10", "D": "ASIA：E, level：T10", "language": "tw"}
{"question": "15 一位 25 歲男性病人，平日身體健康，喜歡野外旅遊，10 天前剛從澎湖旅遊回到臺中，2 天前開始出現發燒、倦怠感及頭痛，前往某診所就診後，服用一些感冒藥但並未退燒，於是到某醫院就診，血液檢查 發現白血球：3600/μL、AST：120 IU/L、ALT：80 IU/L，於右側腋窩附近發現有一焦痂（eschar）。請問最有可能的致病原為何？ \n", "answer": "Orientia tsutsugamushi", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "Orientia tsutsugamushi", "B": "Hantavirus", "C": "Burkholderia pseudomallei", "D": "Coxiella burnetii", "language": "tw"}
{"question": "腎臟髓質的高滲透度環境主要是因為氯化鈉與下列那一種物質累積所造成？", "answer": "尿素", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "尿酸", "B": "銨離子", "C": "尿素", "D": "蛋白質", "language": "tw"}
{"question": "34歲婦女，不孕症5年，經檢查發現雙側輸卵管水腫（hydrosalpinx），卵巢功能正常，先生精液檢查正常，下一步應建議她做何治療？", "answer": "腹腔鏡輸卵管整型、造口或切除手術", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "人工授精", "B": "打排卵針增加懷孕機會", "C": "吃排卵藥增加懷孕機會", "D": "腹腔鏡輸卵管整型、造口或切除手術", "language": "tw"}
{"question": "脊髓刺激（spinal cord stimulation）可以有效降低慢性神經性疼痛，下列何者並非常見的適應症？", "answer": "癌症痛（cancer pain）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "脊椎術後症候群（failed back syndrome）", "B": "脊髓損傷相關疼痛（pain associated spinal cord injury）", "C": "癌症痛（cancer pain）", "D": "截肢後疼痛（postamputation limb pain）", "language": "tw"}
{"question": "關於臺灣之 B 型肝炎疫苗注射，下列何者錯誤？", "answer": "若母親為 e 抗原陽性的 B 型肝炎帶原者，新生兒除接受疫苗注射外，需於出生 24 小時內注射 B 型肝炎免疫球蛋白", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "臺灣已施行新生兒全面 B 型肝炎疫苗注射", "B": "青少年之帶原率已由疫苗接種前 15%，降低到目前之 5%", "C": "兒童肝癌的年發生率已有顯著下降", "D": "若母親為 e 抗原陽性的 B 型肝炎帶原者，新生兒除接受疫苗注射外，需於出生 24 小時內注射 B 型肝炎免疫球蛋白", "language": "tw"}
{"question": "下列關於細胞週期蛋白質（cyclin）之敘述何者錯誤？", "answer": "能直接催化蛋白質的磷酸化的一種激酶（kinase）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "在細胞週期中能被活化和分解", "B": "是催化蛋白質磷酸化酵素的調控因子", "C": "能與泛肽素（ubiquitin）連結", "D": "能直接催化蛋白質的磷酸化的一種激酶（kinase）", "language": "tw"}
{"question": "當某種離子在細胞膜兩側達成電化學平衡（electrochemical equilibrium）時，下列敘述何者正確？", "answer": "此時之膜電位即為該種離子之平衡電位（equilibrium potential） 2 下列關於階梯電位（graded potentials）的敘述，何者正確？", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "細胞膜電位（membrane potential）等於 0", "B": "該種離子在細胞膜兩側之濃度相等", "C": "細胞膜內側之正電荷總數等於細胞膜外側之負電荷總數", "D": "此時之膜電位即為該種離子之平衡電位（equilibrium potential） 2 下列關於階梯電位（graded potentials）的敘述，何者正確？", "language": "tw"}
{"question": "人類與小鼠的腸道中，寄生有上千種的共生菌，但是正常個體並不會對這些共生菌產生免疫反應，下列敘述何者錯誤？", "answer": "腸道的免疫系統主要會產生IgA與共生菌結合，而後引起補體的活化清除共生菌", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "共生菌不像致病菌會利用毒性因子，破壞上皮細胞或是引起發炎細胞激素之分泌", "B": "與共生菌存在的上皮細胞會分泌TGF-β等細胞激素", "C": "腸道的免疫系統主要會產生IgA與共生菌結合，而後引起補體的活化清除共生菌", "D": "腸道的上皮細胞在接觸共生菌的表面，並不會表現Toll-like receptors及CD14，因此較不易產生發炎反應", "language": "tw"}
{"question": "關於21-羥酶缺乏（21-hydroxylase deficiency）所致之先天性腎上腺增生（congenital adrenal hyperplasia）的敘述，下列何者正確？", "answer": "大多數患兒會出現電解質失調（electrolyte disturbance）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "男嬰的外陰部會出現性器混淆（ambiguous genitalia）", "B": "大多數患兒會出現電解質失調（electrolyte disturbance）", "C": "男童比女童易罹患此症", "D": "臨床上常以21-羥酶酵素活性（enzyme activity）的測定作為診斷的依據", "language": "tw"}
{"question": "下列有關 DNA 複製（DNA replication）的敘述，何者錯誤？", "answer": "DNA 合成（DNA synthesis）由 3'往 5'端進行", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "DNA 複製以半保留（semiconservative）模式進行", "B": "DNA 複製過程中會產生引導股（leading strand）與落後股（lagging strand）", "C": "DNA 合成（DNA synthesis）由 3'往 5'端進行", "D": "DNA 複製後，原始模版（parental strand）與新合成模版（newly synthesized strand）兩股以反向平行（antiparallel）形成雙股結構", "language": "tw"}
{"question": "戴奧辛在各項環境介質中的污染及其對國人健康造成的影響深受關注。下列何者為國內戴奧辛排放量最高之污染來源？", "answer": "金屬冶煉業", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "廢棄物焚化爐", "B": "金屬冶煉業", "C": "農田露天燃燒", "D": "有機氯農藥製造", "language": "tw"}
{"question": "年輕的主動脈瓣狹窄的病人接受 Ross 手術式時，其主動脈瓣用下列何種瓣膜來置換？", "answer": "自體之肺動脈瓣（autograft）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "機械性人工瓣膜（mechanical prosthesis）", "B": "生物性人工瓣膜（bioprosthesis）", "C": "同種之生物瓣膜（homograft）", "D": "自體之肺動脈瓣（autograft）", "language": "tw"}
{"question": "一位27歲的男性，因手肘關節部位疼痛而來求診，經病史詢問及身體檢查發現，懷疑為肱骨外上髁炎（lateral epicondylitis），下列何者錯誤？", "answer": "肱骨外上髁炎又稱為高爾夫球肘（golfer's elbow）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "肱骨外上髁是前臂、手腕、以及手指的伸肌（extensor）肌腱附\t處（origin）", "B": "肱骨外上髁炎又稱為高爾夫球肘（golfer's elbow）", "C": "身體檢查可以發現肱骨外上髁處有壓痛", "D": "病患作前臂伸展（extension）及外旋（supination）抗阻力的動作時會有疼痛", "language": "tw"}
{"question": "下列何者不是 gene transfer 所使用的 vectors？", "answer": "naked RNA", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "adenovirus", "B": "retrovirus", "C": "liposome-DNA", "D": "naked RNA", "language": "tw"}
{"question": "一位 24 歲女性至急診主訴突然發作之左下腹劇烈疼痛且有盜汗及嘔吐情形，正常月經剛結束十天，懷孕檢測為陰性，下列何者是最可能之臨床診斷？", "answer": "卵巢扭轉（ovarian torsion）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "闌尾炎（appendicitis）", "B": "子宮內膜異位（endometriosis）", "C": "子宮外孕（ectopic pregnancy）", "D": "卵巢扭轉（ovarian torsion）", "language": "tw"}
{"question": "下列那一個胺基酸在蛋白質的α螺旋（α-helix）結構中很少出現？", "answer": "脯胺酸（proline） \t", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "脯胺酸（proline） \t", "B": "甲硫胺酸（methionine）", "C": "色胺酸（tryptophan）", "D": "組胺酸（histidine）", "language": "tw"}
{"question": "1 歲小女生被帶至急診，家屬陳述 4 天前即開始有鼻塞、流鼻涕，今日開始出現如「狗吠」般的咳嗽，偶爾會仰頭呼吸且有喘鳴，下列敘述何者錯誤？", "answer": "立刻以壓舌板檢查喉嚨是否有感染的徵象", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "立刻以壓舌板檢查喉嚨是否有感染的徵象", "B": "主要病變處應在聲門下區，而聲門上區與聲門區可能正常", "C": "胸部 X 光片可見氣管影像成尖塔狀（steeple sign）", "D": "較可能為病毒感染，不建議立即使用抗生素", "language": "tw"}
{"question": "71 一位 74 歲患有攝護腺癌並且已經發生轉移，兩年前他已接受睪丸切除手術，此外他未曾接受其他治療，而且一直都保持很健康。直到最近他發現右側髖關節劇痛，全身性骨頭掃描發現彌漫性多處骨 頭轉移，骨盆 X 光檢查顯示右側髖關節被腫瘤所浸潤破壞，試問接下來應如何處理？ \n", "answer": "局部放射治療右側髖關節", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "給予男性荷爾蒙 \t", "B": "給予 LH-RH analog", "C": "以止痛劑控制疼痛 \t", "D": "局部放射治療右側髖關節", "language": "tw"}
{"question": "評估醫療品質，常用 Donabedian 所提出的三個構面來檢視，其中，落實醫事人員證照制度，是在改善那一個構面？", "answer": "結構", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "背景", "B": "結構", "C": "過程", "D": "結果", "language": "tw"}
{"question": "77.一位35歲女性癲癇患者，近5日來出現全身倦怠、食慾不佳和發燒症狀，至急診時生命徵象如下：血壓 95/60 mmHg，心跳 125次/分鐘，呼吸 20次/分鐘，體溫39.5℃，全身多處皮膚疼痛異常且出現如圖的病灶。下列敘述何者錯誤？   ", "answer": "Nikolsky Sign為陰性", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "可能的診斷為toxic epidermal necrolysis 或是 Stevens-Johnson syndrome", "B": "藥物史必須詳盡，將藥物不良反應列入考慮", "C": "Nikolsky Sign為陰性", "D": "比照燒傷病患的處理原則，大量給予輸液，避免低血容性休克", "language": "tw"}
{"question": "50 歲男性，因右肩持續疼痛至復健科求診。檢查時發現：右肩肌力減弱，右眼眼皮下垂，瞳孔較左眼為小。下列敘述何者正確？", "answer": "需進行胸部 X 光檢查", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "身體診查時，應發現右眼眼球外突", "B": "需進行胸部 X 光檢查", "C": "僅需進行右肩膀 X 光檢查", "D": "為頸椎病變，需進行頸椎 X 光檢查", "language": "tw"}
{"question": "50歲男性，無明顯症狀，影像檢查如圖所示，請選出最合適的描述：", "answer": "需考慮手術的可能", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "肝臟有一囊腫，位於肝門附近", "B": "有一腫瘤位於後縱膈腔", "C": "超音波抽吸可改善其壓迫症狀", "D": "需考慮手術的可能", "language": "tw"}
{"question": "下列何者不會導致非感染性角膜炎？", "answer": "第二條腦神經麻痺", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "類風濕性關節炎", "B": "第二條腦神經麻痺", "C": "第五條腦神經麻痺", "D": "第七條腦神經麻痺", "language": "tw"}
{"question": "有關手術中輸血的敘述，下列何者錯誤？", "answer": "輸血反應在手術麻醉下，不會發生", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "血液成分輸血治療（blood component therapy）原則於手術中仍適用", "B": "大量輸血（massive transfusion）時，必須適量補充新鮮冷凍血漿", "C": "輸血反應在手術麻醉下，不會發生", "D": "耶和華見證人（Jehovah's Witnesses）病患在術前應與他們討論輸血問題", "language": "tw"}
{"question": "根據Hunt and Hess SAH classification，一個蜘蛛膜下腔出血（SAH）病人，臨床上只有輕微頭痛及輕微頸部僵硬，且無其他神經學檢查異常（focal neurological deficit），其grade應為下列何者？", "answer": "1", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "1", "B": "2", "C": "3", "D": "4", "language": "tw"}
{"question": "下列有關 paleospinothalamic system 之敘述，何者錯誤？", "answer": "傳導路徑不經過網狀系統（reticular formation）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "與意識狀態有關 \t", "B": "可傳導痛覺", "C": "傳導路徑不經過網狀系統（reticular formation）", "D": "此體感覺傳導系統較缺乏定位功能", "language": "tw"}
{"question": "下列有關譫妄（delirium）的敘述，何者最適當？", "answer": "失智症（dementia）是譫妄最主要的前置因子（predisposing factor）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "老年人住院時譫妄的發生率，平均約為1.0～5.0 %", "B": "失智症（dementia）是譫妄最主要的前置因子（predisposing factor）", "C": "鴉片類藥物（opioids）或是抗膽鹼劑（anti-cholinergics）的使用，可有效幫助患者減少譫妄的發生", "D": "身體約束（physical restraint）及benzodiazepines注射，目前被建議用於譫妄的治療", "language": "tw"}
{"question": "位於下視丘（hypothalamus）之 osmoreceptor 為：", "answer": "Chemoreceptor", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "Mechanoreceptor", "B": "Chemoreceptor", "C": "Nociceptor", "D": "Stress receptor", "language": "tw"}
{"question": "37.⼀位46歲女性因為常常頭暈，爬樓梯時感到很喘⽽來醫院求診。⾝體檢查除臉⾊與結膜蒼⽩之外，並無其他明顯異常。患者⾎壓106/76 mmHg，脈搏每分 72次，規則⼼跳，無發燒，亦無體重減輕或是食慾降低的現象。⾎液數據顯⽰⾎紅素7.6 g/dL，⽩⾎球4,030/μL，無異常分類，⾎⼩板418,000/μL，MCV 74.8 fL（參考區間80～100），ferritin 3.84 ng/mL（參考區間28～365），serum iron 10 μg/dL（參考區間51～209）， TIBC（total iron binding capacity）459 μg/dL（參考區間268～593）。⾎液抹片如下圖所⽰。有關這位病⼈最可能的疾病之描述，下列何者錯誤？\n", "answer": "此類病⼈的紅⾎球中的protoporphyrin 量常是降低的", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "此類病⼈的⾎液中的reticulocyte counts常是降低的", "B": "此類病⼈的骨髓中的sideroblast比例常是降低的", "C": "此類病⼈的紅⾎球中的protoporphyrin 量常是降低的", "D": "此類病⼈的red cell distribution width（RDW）index常是增加的", "language": "tw"}
{"question": "下列有關乳房發炎或膿瘍（abscess）之敘述，何者錯誤？", "answer": "在嚴重慢性乳房感染，單純乳房切除（simple mastectomy）是絕對禁止的", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "膿瘍通常發生在剛餵母奶時的前幾週", "B": "葡萄球菌感染（Staphylococcus infection）較容易引起乳房局部性、深部之膿瘍", "C": "鏈球菌感染（Streptococcus infection）較容易引起乳房全面性蜂窩組織炎（cellulitis）", "D": "在嚴重慢性乳房感染，單純乳房切除（simple mastectomy）是絕對禁止的", "language": "tw"}
{"question": "1.2個月大女嬰，咳嗽已有3個星期之久，近幾天甚至偶爾咳至唇色發紫，這陣子並無發燒現象。血液檢查WBC為", "answer": "Bordetella pertussis", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "adenovirus", "B": "Bordetella pertussis", "C": "enterovirus", "D": "Streptococcus pneumoniae", "language": "tw"}
{"question": "做視⼒檢測時，只能看到藍道爾（Landolt）⽒視⼒表上的0.4視標，表⽰：", "answer": "相當於史奈倫（Snellen）⽒視⼒表檢查的20/50視⼒", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "要向前⾛到距離視⼒表四公尺處，才能看到1.0的視標", "B": "對應之最⼩視⾓（minimal angle of resolution）為五分之⼆分⾓（minute of arc）", "C": "該眼只剩下40%的視覺效能（visual efficiency）", "D": "相當於史奈倫（Snellen）⽒視⼒表檢查的20/50視⼒", "language": "tw"}
{"question": "下列何者最容易造成 photosensitivity 的副作用？", "answer": "Promethazine", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "Hydralazine", "B": "Diphenhydramine", "C": "Promethazine", "D": "Penicillin", "language": "tw"}
{"question": "下列何者細菌不是急性鼻竇炎常見菌種？", "answer": "Staphylococcus aureus", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "Staphylococcus aureus", "B": "Streptococcus pneumoniae", "C": "Haemophilus influenzae", "D": "Moraxella catarrhalis", "language": "tw"}
{"question": "一位 24 歲男性，準備出國旅遊而至門診諮詢，他擔心旅遊期間在國外生病的問題。下列何者是國際旅遊者最常見的疾病？", "answer": "旅遊者腹瀉", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "旅遊者腹瀉", "B": "性傳染病", "C": "寄生蟲感染", "D": "瘧疾", "language": "tw"}
{"question": "生產時第一產程後期及第二產程的疼痛傳導是經由：", "answer": "T10-L1", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "T10-L1", "B": "T12-S2", "C": "S2-S4", "D": "L1-L5", "language": "tw"}
{"question": "關於心包填塞（cardiac tamponade），下列敘述何者錯誤？", "answer": "常有 Kussmaul's sign", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "頸靜脈鼓脹 \t", "B": "低血壓 \t", "C": "奇脈（paradoxical pulse）", "D": "常有 Kussmaul's sign", "language": "tw"}
{"question": "下列有關血紅素（hemoglobin）與氧氣的結合與釋放之敘述，何者正確？", "answer": "高濃度的 2,3-二磷酸甘油酸（2,3-bisphosphoglycerate）能降低血紅素對氧氣的親和力", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "高濃度的 2,3-二磷酸甘油酸（2,3-bisphosphoglycerate）能降低血紅素對氧氣的親和力", "B": "pH 值的下降可增強血紅素對氧氣的親和力", "C": "當血紅素中鐵與氧氣結合時會被氧化成三價鐵離子", "D": "氧氣結合在任何一個血基質（heme）皆不會受另外其他三個血基質的影響", "language": "tw"}
{"question": "一位 25 歲的婦人來到門診，她罹患系統性紅斑性狼瘡（systemic lupus erythematosus, SLE）已有五年，控制良好，最近她懷孕三個月，很怕胎兒會受 SLE 的影響發生新生兒狼瘡（neonatal lupus erythematosus, NLE），請問若此媽媽血中測得下列何種物質，則胎兒容易發生 NLE？", "answer": "Anti-Ro antibodies", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "A low C4 concentration", "B": "Anti-Ro antibodies", "C": "Anti-Smith antibodies", "D": "Thrombocytopenia", "language": "tw"}
{"question": "右圖為何種胞器（organelle）？", "answer": "粗糙內質網（Rough endoplasmic reticulum）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "高基氏體（Golgi apparatus）", "B": "粗糙內質網（Rough endoplasmic reticulum）", "C": "平滑內質網（Smooth endoplasmic reticulum）", "D": "粒線體（Mitochondria）", "language": "tw"}
{"question": "一位40歲病患突發心悸、臉色蒼白、冒冷\t、意識模糊，血壓70/30 mmHg，其心電圖如下，應做何處置較適當？", "answer": "同步心臟整流（cardioversion）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "施予頸動脈竇按摩", "B": "注射atropine", "C": "同步心臟整流（cardioversion）", "D": "注射adenosine", "language": "tw"}
{"question": "補體 C5-C9 形成之胞膜破壞結構體（membrane attack complex）有缺乏時，會產生下列何種現象？", "answer": "無法防範細胞內細菌如 Neisseria meningitidis 之感染", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "易有免疫複合體疾病（immune complex disease）", "B": "易有自體免疫疾病（autoimmune disease）", "C": "對於傳統補體路徑（classical complement pathways）之活化大有影響，因此凋亡細胞之清除受到影響", "D": "無法防範細胞內細菌如 Neisseria meningitidis 之感染", "language": "tw"}
{"question": "18個月大的男孩，因昏迷被送到急診室，腦部電腦斷層攝影發現右顳部有硬腦膜下出血，身體診察無外傷。據母親敘述此男孩從小頭圍比正常小孩大，曾有醫師懷疑有水腦。下列那種先天性代謝疾病最為可能的診斷？", "answer": "戊二酸尿症第一型（glutaric aciduria type I）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "苯酮尿症（phenylketonuria）", "B": "中鏈脂肪酸去氫酶缺乏症（medium chain acyl CoA dehydrogenase deficiency）", "C": "戊二酸尿症第一型（glutaric aciduria type I）", "D": "異戊酸血症（isovaleric acidemia）", "language": "tw"}
{"question": "6 一位 43 歲男性病人因工作關係，7 天前發生燒傷達全身 35%表面積，外科醫師安排常規清創與植皮手 術，下列敘述何者錯誤？ \n", "answer": "燒傷病人進行手術時，手術室室溫應儘量降低，以避免傷口術後感染", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "若有吸入性燒傷時，需仔細評估病人之氣道情形，必要時須讓病人在清醒狀況下進行光纖內視鏡插入氣管內管", "B": "切除壞死組織有時會伴隨大量失血，大管徑的靜脈導管置入是必要的", "C": "燒傷病人進行手術時，手術室室溫應儘量降低，以避免傷口術後感染", "D": "燒傷 24 小時後，使用肌肉鬆弛劑 succinylcholine 會使體內鉀離子濃度上升，應避免使用", "language": "tw"}
{"question": "80 A 君在求診時被診斷有 AIDS。基於個人因素，A 君希望主治醫師不要將他的病情透露給其配偶知道。 下列主治醫師的處置何者不適當？ \n", "answer": "若 A 君拒絕向配偶說明病情，可私下將實情告知 A 君的親友", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "依法通報衛生主管單位", "B": "與 A 君溝通，說服他向他的配偶說明病情", "C": "若 A 君拒絕向配偶說明病情，可私下將實情告知 A 君的親友", "D": "可請社工或心理師對 A 君提供諮詢或輔導", "language": "tw"}
{"question": "有關狂犬病（rabies）之敘述，下列何者正確？", "answer": "最好的預防策略是對動物施打疫苗", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "是被感染了狂犬病細菌的病狗咬傷所引起的", "B": "最初的入侵部位為肌肉；最終之感染部位為心臟", "C": "最好的預防策略是對動物施打疫苗", "D": "病原細菌入侵僅數天即嚴重發病", "language": "tw"}
{"question": "何種生殖細胞腫瘤（germ cell tumor）對放射線治療效果之反應最好且可能根治？", "answer": "胚組織瘤（germinoma）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "絨毛膜癌（choriocarcinoma）", "B": "胚胎癌（embryonal carcinoma）", "C": "胚組織瘤（germinoma）", "D": "內胚層竇腫瘤（endodermal sinus tumor）", "language": "tw"}
{"question": "關於鈉-鉀離子唧筒（Na+-K+pump）的機制，下列敘述何者錯誤？", "answer": "磷酸化的鈉-鉀離子唧筒對鉀離子的親和力低於對鈉離子的親和力", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "每運送三莫耳（moles）鈉離子至細胞外需水解一莫耳ATP", "B": "與鈉離子結合後會導致鈉-鉀離子唧筒的磷酸化", "C": "Cardiotonic steroid，如洋地黃（digitalis）會結合並抑制心臟細胞之鈉-鉀離子唧筒的功能", "D": "磷酸化的鈉-鉀離子唧筒對鉀離子的親和力低於對鈉離子的親和力", "language": "tw"}
{"question": "50歲男性，患有高血壓與尋常性乾癬，下列那一類抗高血壓藥物會惡化乾癬，宜避免處方？", "answer": "β-blocker", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "diuretics", "B": "β-blocker", "C": "calcium channel blocker", "D": "α-blocker 42.", "language": "tw"}
{"question": "下列那一類型膠原蛋白（collagen）纖維是彈性（elastic）軟骨與透明（hyaline）軟骨的基質中都有的？", "answer": "Type II", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "Type I", "B": "Type II", "C": "Type III", "D": "Type IV", "language": "tw"}
{"question": "一位 8 歲小男孩，因為牙齦發黑，檢查發現 cortisol 下降，ACTH 上升，診斷為 Addison 病。患童定時補充 cortisone acetate，但是在治療一年半後，發現學習上有退步的現象，而且走路也不太穩。下列的後續診斷發現，何者最不合理？", "answer": "家族史分析中發現父系親屬中也有一位男孩發病", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "腦部核磁共振檢查發現有白質退化的現象", "B": "血液超長鏈脂肪酸分析結果不正常", "C": "小男孩 4 歲的弟弟也罹病", "D": "家族史分析中發現父系親屬中也有一位男孩發病", "language": "tw"}
{"question": "有關肺傳導區（conducting zone）之功能，下列敘述何者錯誤？", "answer": "分泌表面作用素（surfactant）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "分泌黏液（mucus） \t", "B": "形成無效腔（dead space）", "C": "分泌表面作用素（surfactant）", "D": "調控呼吸道阻力（airway resistance）", "language": "tw"}
{"question": "Nitric oxide（NO）可以直接活化下列何種酵素？", "answer": "Cytosolic guanylyl cyclase", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "Adenylate cyclase", "B": "Membrane-bound guanylyl cyclase", "C": "Cytosolic guanylyl cyclase", "D": "Protein kinase C", "language": "tw"}
{"question": "下列關於阿茲海默症（Alzheimer disease）的敘述，何者正確？", "answer": "病理特徵為老年斑（senile plaques）和神經纖維糾結（neurofibrillary tangles）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "意識障礙是首發症狀", "B": "為持續性、進行性、可逆性病程", "C": "病理特徵為老年斑（senile plaques）和神經纖維糾結（neurofibrillary tangles）", "D": "疾病早期不會有人格改變", "language": "tw"}
{"question": "下列有關靜脈竇型（sinus venosus）心房中隔缺損（atrial septal defect，ASD）之敍述，何者錯誤？", "answer": "可以使用導管手術來關閉缺損", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "常合併肺靜脈回流異常", "B": "缺損的位置，有時是在心房中隔底部接近下腔靜脈開口", "C": "手術修補時，一般需使用布塊（patch）修補", "D": "可以使用導管手術來關閉缺損", "language": "tw"}
{"question": "格雷夫斯病（Graves' disease）可以選擇下列何種藥物來治療？", "answer": "Methimazole", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "Levothyroxine", "B": "Methimazole", "C": "Propranolol", "D": "Octreotide", "language": "tw"}
{"question": "在處理⼀個困難的傷⼝時，我們常以肌⾁⽪瓣（muscle flap）來重建缺損，根據 Mathes & Nahai 的分類，以下敘述何者正確？", "answer": "適合取較⼤肌⾁來重建缺損的是屬於type I、III、V", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "臀⼤肌（gluteus maximus）和腹直肌（rectus abdominis）⽪瓣都屬於type II", "B": "闊背肌（latissimus dorsi）由單⼀⾎管莖供應，屬於type I", "C": "適合取較⼤肌⾁來重建缺損的是屬於type I、III、V", "D": "股薄肌（gracilis）是屬於type IV，所以只能取⼀⼩部分肌⾁來重建缺損", "language": "tw"}
{"question": "切除腮腺後，顏面神經主幹可追溯至顱底何處？", "answer": "莖乳突孔（stylomastoid foramen）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "卵圓孔（foramen ovale）", "B": "蝶腭孔（sphenopalatine foramen）", "C": "莖乳突孔（stylomastoid foramen）", "D": "眼眶下裂（infraorbital fissure）", "language": "tw"}
{"question": "一位 85 歲男性，三個月來發生運動時嚴重呼吸困難，一週前昏厥來門診就醫，聽診發現收縮期射出型心雜音（systolic ejection murmur）並延伸至右頸部，下列敘述何者正確？", "answer": "本病人如未積極治療，存活率大約一年半至兩年", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "本病人發生此疾病的原因，最常見的是風濕性心臟病", "B": "心臟超音波測量二尖瓣開口面積，可評估本病人心臟疾病的嚴重程度", "C": "本病人如未積極治療，存活率大約一年半至兩年", "D": "心臟瓣膜氣球擴張術是本病人治療的首選方法", "language": "tw"}
{"question": "在⼤腸桿菌中，下列何者為Dam甲基化酶（Dam methylase）所扮演的功能？", "answer": "對DNA模板股（template strand）的修飾，以便DNA修復系統的辨認", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "甲基化尿嘧啶（uracil），使之轉化為胸腺嘧啶（thymine）", "B": "對DNA模板股（template strand）的修飾，以便DNA修復系統的辨認", "C": "去除模板股（template strand）上的錯誤配對", "D": "修復編碼股（coding strand）上的錯誤配對", "language": "tw"}
{"question": "有關 aphasia 之病徵與可能受損部位的敘述，何者正確？", "answer": "語言理解能力正常，說話困難，慢且不流暢，可能受損部位是 Broca's area \t", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "語言理解能力正常，說話困難，慢且不流暢，可能受損部位是 Broca's area \t", "B": "語言理解能力正常，說話困難，慢且不流暢，可能受損部位是 angular gyrus", "C": "語言理解能力正常，說話流暢，但無意義，可能受損部位是 angular gyrus", "D": "語言理解能力正常，說話流暢，但無意義，可能受損部位是 Wernicke's area", "language": "tw"}
{"question": "下列何者對於預防外傷病人發生破傷風（tetanus）和氣性壞疽（gas gangrene）均極重要？", "answer": "清除壞死組織", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "給予抗毒素", "B": "送入高壓氧艙", "C": "清除壞死組織", "D": "給予疫苗", "language": "tw"}
{"question": "關於此疾病的治療，下列何者具有最佳療效？", "answer": "波長694 nm的雷射", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "塗抹hydroquinone", "B": "塗抹tretinoin", "C": "波長532 nm的雷射", "D": "波長694 nm的雷射", "language": "tw"}
{"question": "有一位研究者想了解抽菸和肥胖間的相關，肥胖程度用身體質量指數測量，身體質量指數（BMI）＝體重（公斤）÷身高2（公尺），此研究者想描述抽菸者和非抽菸者的BMI集中趨勢，下列何者統計量最適合？", "answer": "平均值", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "平均值", "B": "全距", "C": "百分比", "D": "眾數", "language": "tw"}
{"question": "55 一名護士被感染愛滋病人血液的針頭刺到，這名病人血液中含有 viral RNA 濃度（107 copies/mL）。 下列何者為治療該名護士之首選方法？ \n", "answer": "連續性給予 zidovudine 和 lamivudine 四星期", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "診測護士的血液是否含有 HIV", "B": "連續性給予 zidovudine 四星期", "C": "連續性給予 zidovudine 和 lamivudine 四星期", "D": "連續性給予 acyclovir 和 zidovudine 四星期", "language": "tw"}
{"question": "一位足月男嬰出生時很順利，但是第三天大時開始出現黃疸，下列那一項最不可能是此嬰兒的黃疸原因？", "answer": "Rh 血型不合", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "生理性黃疸", "B": "Rh 血型不合", "C": "哺育母乳黃疸", "D": "泌尿道感染", "language": "tw"}
{"question": "在 Tetralogy of Fallot 病患的正面胸部 X 光中，下列何者為誤？", "answer": "心尖朝下", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "心臟的大小（size）可為正常", "B": "J 左心上緣可呈凹面狀（concavity）", "C": "肺的血管分布狀態可減少", "D": "心尖朝下", "language": "tw"}
{"question": "胺醯-tRNA合成酶（aminoacyl-tRNA synthetases）是一種活化胺基酸的酵素，其特徵為何？", "answer": "能辨認特定的tRNA及胺基酸，促進胺醯-tRNA的合成", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "能辨認特定的tRNA及胺基酸，促進胺醯-tRNA的合成", "B": "需要會同其他酵素將胺基酸結合到特定的tRNA上", "C": "需要以GTP活化胺基酸後，始能進行胺醯-tRNA的合成", "D": "可以將胺基酸直接與tRNA 3'-端結合而形成胺醯-tRNA", "language": "tw"}
{"question": "細胞被病毒感染後，在短時間內會分泌何種物質，來防止病毒進一步感染其他細胞？", "answer": "干擾素（Interferons）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "抗體（Antibodies） \t", "B": "化學介質（Chemokines）", "C": "干擾素（Interferons）", "D": "腫瘤壞死因子（Tumor necrosis factor）", "language": "tw"}
{"question": "下列因素當中，那一項影響受孕的程度最小？", "answer": "肌層內子宮肌瘤（intramural myoma）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "輸卵管阻塞（tubal obstruction）", "B": "肌層內子宮肌瘤（intramural myoma）", "C": "子宮腔中隔（septum）", "D": "子宮內沾黏（intrauterine synechiae）", "language": "tw"}
{"question": "51.梅克耳憩室（Meckel's diverticulum）所造成的下消化道出血，可利用下列何者做診斷？①99mTc-pertechnetate放射線同位素檢查 ②腹部超音波檢查 ③腹腔鏡探查 ④下消化道鋇劑攝影 ⑤大腸鏡檢查 ", "answer": "①③", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "①③", "B": "②⑤", "C": "④⑤", "D": "②④", "language": "tw"}
{"question": "下列那種陰道感染與早產的關聯性最高？", "answer": "Bacterial vaginosis  \t", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "Bacterial vaginosis  \t", "B": "Trichomonas vaginalis", "C": "Candidiasis \t", "D": "Herpes simplex infection", "language": "tw"}
{"question": "罕見遺傳疾病 Medium-chain acyl-CoA dehydrogenase 基因突變，可能造成脂肪肝、低血糖、Octanoic acid 在血液中堆積、嗜睡、嘔吐及昏迷。下列有關該酶之功能敘述，何者正確？", "answer": "該酶之作用是將脂肪酸逐步轉化為 Acetyl-CoA 31 \t下列關於 Lesch-Nyhan syndrome 的敘述，何者錯誤？", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "該酶之作用是將脂肪酸運入粒線體", "B": "該酶作用於 ω-oxidation", "C": "該酶之作用是將脂肪酸逐步轉化為 Pyruvate", "D": "該酶之作用是將脂肪酸逐步轉化為 Acetyl-CoA 31 \t下列關於 Lesch-Nyhan syndrome 的敘述，何者錯誤？", "language": "tw"}
{"question": "在因全⾝性免疫疾病造成的⾓膜邊緣潰瘍（marginal ulcer）病患中，最常⾒的全⾝性免疫疾病是：", "answer": "類風濕性關節炎（rheumatoid arthritis）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "全⾝性紅斑性狼瘡（systemic lupus erythematosus）", "B": "類風濕性關節炎（rheumatoid arthritis）", "C": "結節性多動脈炎（polyarteritis nodosa）", "D": "Wegener⽒⾁芽腫（Wegener granulomatosis）", "language": "tw"}
{"question": "請在下列各原核細胞 RNA 聚合酶（RNA polymerase）次單元（subunit）中配對出其專一的功能？", "answer": "a-II, b-III, c-I", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "a-I, b-II, c-III", "B": "a-III, b-II, c-I", "C": "a-III, b-I, c-II", "D": "a-II, b-III, c-I", "language": "tw"}
{"question": "如圖所示之皮疹，下列敘述何者錯誤？", "answer": "勤於用熱水及肥皂洗澡，才能避免其發生", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "是缺脂性濕疹（asteatotic eczema）", "B": "常在秋冬季發生", "C": "主要發生於老人", "D": "勤於用熱水及肥皂洗澡，才能避免其發生", "language": "tw"}
{"question": "55 歲甲狀腺功能低下病人，主訴呼吸困難，胸部 X 光如附圖，則最正確的診斷應為：", "answer": "大量心包膜積液（massive pericardial effusion）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "鬱血性心衰竭（congestive heart failure）", "B": "二尖瓣閉鎖不全（mitral regurgitation）", "C": "大量心包膜積液（massive pericardial effusion）", "D": "主動脈瓣閉鎖不全（aortic regurgitation）", "language": "tw"}
{"question": "依據DSM-IV-TR診斷標準，下列有關自閉症的敘述何者正確？", "answer": "與典型自閉症比較，亞斯柏格症也有社交互動困難和侷限且重複的行為與興趣，但語言溝通常無困難", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "與典型自閉症比較，亞斯柏格症也有社交互動困難和侷限且重複的行為與興趣，但語言溝通常無困難", "B": "半數以上的自閉症兒童具有別人沒有的特殊才能（例如記憶超凡），而少數具有智能障礙", "C": "半數以上的自閉症患者一生中會癲癇發作", "D": "抗精神病藥物能改善其核心症狀", "language": "tw"}
{"question": "一位懷孕 25 週的年輕孕婦，騎機車不慎撞擊前方小轎車而到急診就醫。她有兩側手掌及膝蓋擦傷，她很擔心的請問急診室王醫師有關她胎兒的情況。請問王醫師針對胎兒的檢查中，何者最為恰當？", "answer": "胎兒心跳監測", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "腹部電腦斷層掃描 \t", "B": "Kleihauer-Betke 試驗", "C": "骨盆腔內診 \t", "D": "胎兒心跳監測", "language": "tw"}
{"question": "鼻毛囊炎（folliculitis）最常見的致病菌為：", "answer": "金黃色葡萄球菌", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "鏈球菌", "B": "綠膿桿菌", "C": "金黃色葡萄球菌", "D": "大腸桿菌", "language": "tw"}
{"question": "玻尿酸（hyaluronic acid）是關節滑液的組成之一，是下列何種雙醣分子（disaccharide unit）的聚合物？", "answer": "D-glucuronic acid及N-acetylglucosamine", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "galactose及glucose", "B": "glucose及N-acetylglucosamine", "C": "D-glucuronic acid及fructose", "D": "D-glucuronic acid及N-acetylglucosamine", "language": "tw"}
{"question": "錐鼻蟲（Triatoma / kissing bug）可以傳播下列何種寄生蟲？", "answer": "枯西氏錐蟲（Trypanosoma cruzi）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "杜氏利什曼原蟲（Leishmania donovani）", "B": "熱帶利什曼原蟲（Leishmania tropica）", "C": "岡比亞錐蟲（Trypanosoma brucei gambiense）", "D": "枯西氏錐蟲（Trypanosoma cruzi）", "language": "tw"}
{"question": "關於介白素（interleukins）之訊息傳遞何者正確？", "answer": "活化轉錄因子STATs（signal transducers and activators of transcription）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "其受體主要是絲胺酸激酶型受器（receptor serine kinase）", "B": "活化轉錄因子STATs（signal transducers and activators of transcription）", "C": "主要是活化cAMP", "D": "主要由G protein參與反應", "language": "tw"}
{"question": "腹股溝管（Inguinal canal）的前壁由下列何者組成？", "answer": "腹外斜肌腱膜（Aponeurosis）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "腹外斜肌腱膜（Aponeurosis）", "B": "腹橫肌膜（Fascia transversalis）", "C": "腹內斜肌 \t", "D": "腹橫肌", "language": "tw"}
{"question": "下列何者是配體管制型離子通道（ligand-gated ion channel）如菸鹼性乙醯膽鹼受體（nicotinic acetylcholine receptor）的特性？", "answer": "碰到特定的配體時才允許離子通過細胞膜", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "在脂雙層中允許離子通透的帶電脂質", "B": "碰到特定的離子時才允許配體通過細胞膜", "C": "碰到特定的配體時才允許離子通過細胞膜", "D": "配體與細胞膜上相對應受體結合需依賴特定離子存在", "language": "tw"}
{"question": "造成早發性（early-onset）新生兒感染的細菌中，最常見的格蘭氏陽性菌為：", "answer": "B群鏈球菌 \t", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "金黃色葡萄球菌", "B": "B群鏈球菌 \t", "C": "肺炎雙球菌", "D": "大腸桿菌", "language": "tw"}
{"question": "抗甲狀腺藥物之副作用，下列何者最常見？", "answer": "皮疹（rash） \t", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "肝炎（hepatitis） \t", "B": "白血球過低（agranulocytosis）", "C": "皮疹（rash） \t", "D": "類紅斑狼瘡（SLE-like syndrome）", "language": "tw"}
{"question": "承上題，那位病人給予生理食鹽水後可以矯正其電解質和酸鹼的不平衡？", "answer": "乙病人", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "甲病人", "B": "乙病人", "C": "丙病人", "D": "丁病人", "language": "tw"}
{"question": "一位 51 歲的女病人因罹患下 1/3 的直腸癌而直接進行低前位切除術治療，術後病理報告為Dukes' C2，術後第 5 天排氣，且小便自解無礙，逐步開始恢復進食，術後第 7 天順利排放大便，術後第 9 天出院。出院後隔天晚上，病人在家發現有多量的黃濁具臭味之液體自陰道口排出，病人又回醫院急診室就醫，則最可能是何種診斷？", "answer": "直腸陰道瘻管", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "尿路感染", "B": "月經週期來了", "C": "直腸陰道瘻管", "D": "偽膜性結腸炎", "language": "tw"}
{"question": "常見的 glycogen storage disease 是因為病人缺乏 glucose-6-phosphatase 所造成，下列敘述何者正確？", "answer": "病人血中 glucose 濃度可能偏低", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "glycogen synthesis 增加  \t", "B": "glucose-6-phosphate 無法轉化成 glucose-1-phosphate \t", "C": "病人血中 glucose 濃度可能偏低", "D": "glycolysis 異常", "language": "tw"}
{"question": "因尿路阻塞產生腎水腫（hydronephrosis）變化時，最早期的變化通常可見於下列何者？", "answer": "renal calices", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "renal pelvis", "B": "ureter", "C": "renal calices", "D": "renal papillae", "language": "tw"}
{"question": "有關 C 型肝炎病毒的敘述，何者錯誤？", "answer": "已經有疫苗可以預防感染", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "屬於 Flaviviridae \t", "B": "具有 envelope", "C": "已經有疫苗可以預防感染", "D": "與肝癌有關", "language": "tw"}
{"question": "下列血清學診斷項目中，何者對於全身性紅斑性狼瘡（SLE）診斷的特異性最高？", "answer": "抗雙鏈去氧核糖核酸抗體（anti-ds DNA）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "紅斑性狼瘡細胞（LE cell）", "B": "類風濕因子（rheumatoid factor）", "C": "抗單鏈去氧核糖核酸抗體（anti-ss DNA）", "D": "抗雙鏈去氧核糖核酸抗體（anti-ds DNA）", "language": "tw"}
{"question": "下列有關「利他主義」（Altruism）、「公平」（Equity）、「正義」（Justice）、「效率」（Efficiency）的敘述，何者錯誤？", "answer": "有「效率」的醫療體系運作結果，自然會導致「公平」的資源配置", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "「利他主義」的思考邏輯和個人偏好有關，因為具有利他思想的人會偏好生病者可以獲得適當的醫療服務", "B": "「公平」與「正義」的思考邏輯和個人偏好無關，因為公平正義的概念來自於一套特定價值標準的推導", "C": "有「效率」的醫療體系運作結果，自然會導致「公平」的資源配置", "D": "「利他主義」的思考邏輯和「效率」的概念均與個人偏好有關", "language": "tw"}
{"question": "24歲女性，主訴半年無月經，雙側乳房有白色分泌物，病患主訴無性經\t。下列檢查何者最不適當？", "answer": "FSH（follicle stimulating hormone）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "TSH（thyroid stimulating hormone）", "B": "prolactin", "C": "詳細的藥物史", "D": "FSH（follicle stimulating hormone）", "language": "tw"}
{"question": "原本健康的 20 歲原住民小華，十年前隨家人遷往臺北，已 5 年沒到山上。清晨坐車由臺北出發，早上 10 點就到達合歡山，白天無明顯不舒服，晚餐胃口不佳，晚上 10 點後在山上（高度 3050 公尺）有頭痛、頭暈、嘔吐、虛弱等症狀，下列敘述何者正確？", "answer": "坐車快速上山，比慢慢走路上山，更容易發生高山症", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "原住民對高度適應良好，不會得高山症", "B": "坐車快速上山，比慢慢走路上山，更容易發生高山症", "C": "給小華氧氣治療，通常無法改善症狀", "D": "小華晚上失眠，有坐著睡比躺著睡舒服現象時，建議給予 Benzodiazepam 治療以幫助睡眠", "language": "tw"}
{"question": "Neuraminidase 是某些流感病毒的重要酵素之一，此酵素可以切除宿主細胞膜上醣複合物上的那一種糖基？", "answer": "galactose", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "N-acetylglucosamine", "B": "gluconic acid", "C": "galactose", "D": "sialic acid", "language": "tw"}
{"question": "對於單純頭部外傷病人，當你發現下列何者時應懷疑顱內壓力（ICP）異常升高？", "answer": "呼吸和脈搏變慢，且血壓上升時", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "呼吸和脈搏變慢，且血壓下降時", "B": "呼吸和脈搏是不規則的，且血壓上升時", "C": "呼吸和脈搏變慢，且血壓上升時", "D": "呼吸是快速與淺的，脈搏是快速的，且血壓下降時", "language": "tw"}
{"question": "45.一名5歲大的女童因為頸部中線腫塊，經檢查為甲狀舌骨囊腫（thyroglossal duct cyst）。有關其手術方式 （Sistrunk procedure）之描述，下列何者最正確？ \n", "answer": "切除囊腫、舌骨中段及相連至舌底部之管道", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "切除囊腫及舌骨中段", "B": "切除囊腫、舌骨中段及相連至舌底部之管道", "C": "切除囊腫、甲狀腺及相連至舌底部之管道", "D": "切除囊腫、舌骨中段及甲狀腺", "language": "tw"}
{"question": "下列何者是周邊型眩暈症（peripheral vertigo）發生時，最可能的臨床徵象？", "answer": "耳鳴", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "吞嚥困難", "B": "複視", "C": "臉麻", "D": "耳鳴", "language": "tw"}
{"question": "下列何者收縮，可使舌頭變窄？", "answer": "舌內在橫肌（intrinsic transverse muscle）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "舌內在橫肌（intrinsic transverse muscle）", "B": "舌內在垂直肌（intrinsic vertical muscle）", "C": "頦舌肌（genioglossus muscle）", "D": "舌骨舌肌（hyoglossus muscle）", "language": "tw"}
{"question": "當病患使用tetracycline治療時，併用下列何種藥物最會干擾其吸收？", "answer": "Al(OH)3", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "CaCO3", "B": "Al(OH)3", "C": "Mg(OH)2", "D": "NaHCO3", "language": "tw"}
{"question": "當尿液排空，下列何者最可能緊貼於膀胱的上方？", "answer": "子宮", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "子宮", "B": "陰道", "C": "直腸", "D": "輸精管", "language": "tw"}
{"question": "子宮頸錐狀切除後的病理檢查，發現癌細胞侵襲深度介於 3~5 mm 之間，寬度小於 7 mm，則此病人屬於子宮頸癌的那一期？", "answer": "stage Ia2", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "stage Ia1", "B": "stage Ia2", "C": "stage Ib1", "D": "stage Ib2", "language": "tw"}
{"question": "有關人類截肢後所發生的幻痛（phantom pain）現象，下列何者敘述最為正確？", "answer": "拍打殘肢端（stump）或使用經皮神經刺激（TENS）是相當有效的止痛方式", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "截肢後延遲裝置義肢可減輕幻痛", "B": "成人發生率比兒童低", "C": "幻痛與冷天氣和情緒有關，入睡後仍會存在", "D": "拍打殘肢端（stump）或使用經皮神經刺激（TENS）是相當有效的止痛方式", "language": "tw"}
{"question": "對於⾁毒桿菌（Clostridium botulinum）的敘述，下列何者錯誤？", "answer": "⾁毒素（Botulinum toxin）主要使細胞內的Rho-GTPase失去活性", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "⾁毒素（Botulinum toxin）主要使細胞內的Rho-GTPase失去活性", "B": "食入受此菌汙染的罐頭食品會造成⾁毒症", "C": "嬰兒食入受到此菌芽胞污染的食物會造成⾁毒症", "D": "⾁毒素可做為⽣化武器，造成吸入性⾁毒症（inhalation botulism）", "language": "tw"}
{"question": "45 一位 25 歲的男子因感覺胸部有壓迫感求診。胸部 X 光檢查顯示縱隔腫塊，血清腫瘤標誌包括 AFP （alpha fetoprotein）、β- HCG 及 LDH 均顯著升高。最可能的診斷是： \n", "answer": "生殖細胞腫瘤", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "生殖細胞腫瘤", "B": "肝癌", "C": "何杰金氏淋巴瘤（Hodgkin's lymphoma）", "D": "淋巴母細胞淋巴瘤（lymphoplasmacytic lymphoma）", "language": "tw"}
{"question": "若在為病患抽血時不慎發生針扎事件，並且發現病患的愛滋病毒（HIV）抗體為陽性時，被針扎的醫護人員，應在發生針扎後儘快開始服用抗病毒藥物，以預防 HIV 感染（post-exposure prophylaxis），一般建議服用多久？", "answer": "4 週", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "24 小時", "B": "7 天", "C": "4 週", "D": "6 個月", "language": "tw"}
{"question": "77 一位懷孕 32 週的 40 歲婦女，因嚴重頭痛與視力模糊而至急診就醫，來急診時，血壓 165/115 mmHg， 身體診查發現下肢嚴重水腫，下列處理何者不適當？ \n", "answer": "可給予 ACE inhibitor 處理高血壓的問題", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "處理方式比照子癎症（eclampsia），需緊急會診婦產科醫師", "B": "可給予 ACE inhibitor 處理高血壓的問題", "C": "可給予MgSO4（magnesium sulfate）", "D": "考慮將胎兒生出來是治療的重要關鍵", "language": "tw"}
{"question": "精子（spermatozoa）具有粒線體鞘（mitochondria sheath）的部位是：", "answer": "尾部中節（middle piece）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "頭部（head） \t", "B": "尾部主節（principal piece） \t", "C": "尾部中節（middle piece）", "D": "尾部終節（end piece）", "language": "tw"}
{"question": "下列何者有助於減少卵巢癌的發生？", "answer": "口服避孕藥", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "口服避孕藥", "B": "素食", "C": "裝置子宮內避孕器", "D": "初經早（early menarche）", "language": "tw"}
{"question": "64 一位到復健科門診求診的腦中風病人，發病已經 1 個月，但仍有患側肩關節脫位（subluxation）現象。 下列復健處置，何者最為重要？ \n", "answer": "維持被動性肩關節活動與加強肩外展運動", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "以肩帶（shoulder sling）固定", "B": "維持被動性肩關節活動與加強肩外展運動", "C": "腋下放置軟墊，增加肩外展角度", "D": "肩關節以膠布貼紮（taping）固定", "language": "tw"}
{"question": "下列有關人類禽流感（avian flu）之敘述，何者錯誤？", "answer": "病毒通常為H3亞型（hemagglutinin type）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "目前發生在一些東南亞國家，死亡率極高", "B": "病毒通常為H3亞型（hemagglutinin type）", "C": "早期使用 oseltamivir 可能有效", "D": "有發生全球大流行（pandemic）之可能", "language": "tw"}
{"question": "下列何者是steroidogenic acute regulatory protein的主要功能？", "answer": "促使膽固醇送入粒線體內", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "促使膽固醇轉變成妊烯醇酮（pregnenolone）", "B": "促使膽固醇進入細胞內", "C": "促使膽固醇送入粒線體內", "D": "促使膽固醇轉變成低密度脂蛋⽩（low density lipoprotein）", "language": "tw"}
{"question": "下列有關磺胺劑之敘述，何者錯誤？", "answer": "單獨使用可抑制人體 folic acid 之生合成，因此有貧血（anemia）之不良作用", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "可抑制細菌 folic acid 之生合成", "B": "可與 trimethoprim 合用產生加乘（synergistic）抑菌作用", "C": "單獨使用可抑制人體 folic acid 之生合成，因此有貧血（anemia）之不良作用", "D": "不良作用有過敏反應，Stevens-Johnson syndrome", "language": "tw"}
{"question": "關於消化道壁內神經叢myenteric plexus（Auerbach's plexus）的敘述，下列何者正確？", "answer": "迷走神經（vagus nerve）為主要的刺激性訊息提供者", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "位於消化道的黏膜下層", "B": "迷走神經（vagus nerve）為主要的刺激性訊息提供者", "C": "除接受交感神經和副交感神經支配外，本身功能無法自行運作", "D": "主要功能為局部消化道的分泌、吸收和血流供應", "language": "tw"}
{"question": "一位 65 歲因陳舊性腦中風臥病在床之養護機構女性住民，她長期放置導尿管，過去有幾次無症狀菌尿症（asymptomatic bacteriuria）病史，例行性尿液檢查發現有白血球及細菌，此時她未有發燒及泌尿道感染症狀，最合適之處理為下列何者？", "answer": "先行觀察，若有發燒或泌尿道感染症狀再處理", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "馬上給予口服抗生素治療 \t", "B": "馬上送至醫院急診室做進一步診治", "C": "尿液送細菌培養，如果陽性給予靜脈抗生素治療", "D": "先行觀察，若有發燒或泌尿道感染症狀再處理", "language": "tw"}
{"question": "陣發性夜間血色素尿（paroxysmal nocturnal hemoglobinuria）的病人發生溶血的原因，是因為紅血球上缺乏何種抗原？", "answer": "CD55, CD59", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "CD55, CD59", "B": "CD16, CD66", "C": "CD15, CD25", "D": "CD11, CD14", "language": "tw"}
{"question": "下列何構造不會出現在肝門管區（portal area）？", "answer": "中央靜脈（central vein）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "門小靜脈（portal venule）", "B": "中央靜脈（central vein）", "C": "肝小動脈（hepatic arteriole）", "D": "膽管（bile duct）", "language": "tw"}
{"question": "下列對慢性阻塞性肺病（COPD）治療的敘述，何者錯誤？", "answer": "以降階（step down）方式：先用上多種藥物，然後視情況逐漸減少種類", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "以降階（step down）方式：先用上多種藥物，然後視情況逐漸減少種類", "B": "若仍有抽菸習慣，必須戒菸", "C": "以升階（step up）方式：先從單一或少量藥物開始，然後視情況逐漸增加藥物種類", "D": "肺的復健可改善 COPD 患者的生活品質", "language": "tw"}
{"question": "下列何者為屈戌（樞紐）關節？", "answer": "肘關節", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "肩關節", "B": "肘關節", "C": "近端尺橈關節", "D": "遠端尺橈關節", "language": "tw"}
{"question": "多發性骨髓瘤病患出現高鈣血症時，下列何種藥物治療不能達到治療目的？", "answer": "fluoride", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "bisphosphonate", "B": "fluoride", "C": "corticosteroid", "D": "calcitonin", "language": "tw"}
{"question": "關於兒童次發性消化性潰瘍（Secondary peptic ulcers），下列敘述何者錯誤？", "answer": "Nonsteroidal anti-inflammatory drugs（NSAIDs）造成的潰瘍位置，最常見於十二指腸（duodenum）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "Nonsteroidal anti-inflammatory drugs（NSAIDs）藉由抑制prostaglandin，而造成黏膜損傷", "B": "Nonsteroidal anti-inflammatory drugs（NSAIDs）造成的潰瘍位置，最常見於十二指腸（duodenum）", "C": "壓力性潰瘍（Stress ulcer）通常在事件開始後的24小時內發生", "D": "氫離子幫浦抑制劑（Proton pump inhibitors），可用於治療嚴重潰瘍出血的病患", "language": "tw"}
{"question": "下面有關假說檢定之型一錯誤（type I error）與型二錯誤（type II error）的敘述何者正確？", "answer": "固定型一錯誤的機率，增加樣本數可以降低型二錯誤發生的機率", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "型一錯誤發生的機率加上型二錯誤發生的機率等於 1", "B": "檢定力（power）= 1-型一錯誤的機率", "C": "型一錯誤與型二錯誤有可能會同時發生", "D": "固定型一錯誤的機率，增加樣本數可以降低型二錯誤發生的機率", "language": "tw"}
{"question": "有一位 27 歲男子，因有輕度胸痛接受胸部 X 光檢查，發現前縱膈腔有 15 公分大的腫瘤，而血清檢查發現α-fetoprotein 有異常升高，試問此病人最好之治療為何？", "answer": "先化學治療後，看情況再追加手術切除", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "手術切除腫瘤，再追加化學治療", "B": "手術切除腫瘤，再追加放射線治療", "C": "先化學治療後，看情況再追加手術切除", "D": "先放射線治療後，看情況再追加化學治療或手術切除", "language": "tw"}
{"question": "一位25歲之健康男性，以潮氣容積（tidal volume）1,500毫升，呼吸頻率25次／分的方式持續呼吸30秒，下列敘述何者錯誤？", "answer": "血液中的氧氣總量（total oxygen content）大幅增加", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "( Paco )", "B": "血紅素氧飽和度（hemoglobin saturation;Sa 。2 ）變化不大 \t", "C": "血液中的氧氣總量（total oxygen content）大幅增加", "D": "呈現呼吸性鹼中毒（respiratory alkalosis）", "language": "tw"}
{"question": "有關睪丸之 Immature teratoma 的敘述，何者是正確的？", "answer": "為一種惡性腫瘤 \t", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "為一種惡性腫瘤 \t", "B": "通常只含一種胚胎層的組織", "C": "通常出現成熟的骨頭組織", "D": "通常出現明顯的 Trophoblast", "language": "tw"}
{"question": "下列有關下頜齒（mandibular teeth）根管中之感覺神經纖維的敘述，何者正確？", "answer": "穿過下頜孔（mandibular foramen）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "其細胞本體（cell body）位於下頜下神經節（submandibular ganglion）", "B": "穿過下頜孔（mandibular foramen）", "C": "穿過圓孔（foramen rotundum）", "D": "與舌神經（lingual nerve）伴行", "language": "tw"}
{"question": "使⽤以下何種食物材質刺激最易促進吞嚥反射？", "answer": "較冰的食物", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "較冰的食物", "B": "較甜的食物", "C": "溫度適中的食物", "D": "較為堅硬的食物", "language": "tw"}
{"question": "兒童的腎絲球濾過速率（glomerular filtration rate, GFR）何時可以達到和成人一般的數值？", "answer": "出生後第二年至第三年", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "出生後第二年至第三年", "B": "出生後第四年至第五年", "C": "出生後第七年至第八年", "D": "青春期", "language": "tw"}
{"question": "46 一位 58 歲男性，過去無全身性疾病之病史，最近在例行之健康檢查中發現其血液相如下：血紅素 14.7 g/dL，血比容 46%，白血球數 12,350/μL，血小板數 725,000/μL。其他生化、心電圖及胸部 X 光 檢查均無異常，病人亦無自述症狀。下列何者是目前對此病人最適當的治療？ \n", "answer": "Observation", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "Plateletpheresis", "B": "Hydroxyurea", "C": "Anagrelide", "D": "Observation", "language": "tw"}
{"question": "下列有關治療類精神疾病藥物所產生之副作用及其作用可能機制的配對，何者錯誤？", "answer": "直立型低血壓：乙型腎上腺素性受體阻斷作用", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "體重增加：組織胺及血清素受體阻斷作用", "B": "直立型低血壓：乙型腎上腺素性受體阻斷作用", "C": "錐體外毒性症狀：多巴胺受體阻斷作用", "D": "口乾及尿液滯留：毒蕈素性受體阻斷作用", "language": "tw"}
{"question": "下列那一種 Staphylococcal enterotoxin 型最易引發食物中毒？", "answer": "Staphylococcal enterotoxin A", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "Staphylococcal enterotoxin A", "B": "Staphylococcal enterotoxin B", "C": "Staphylococcal enterotoxin C", "D": "Staphylococcal enterotoxin D", "language": "tw"}
{"question": "依據「安寧緩和醫療條例」之規定，末期病人無簽署意願書且意識昏迷或無法清楚表達意願時，由其最近親屬出具同意書代替之。有①配偶 ②成年孫女 ③父 ④弟弟，四位最近親屬，意見不一時，優先次序為：", "answer": "①②③④", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "①③②④", "B": "①④③②", "C": "①③④②", "D": "①②③④", "language": "tw"}
{"question": "一位52歲停經後的婦女，除了主訴頻尿、尿急和急迫性尿失禁外，看起來身體狀況還算健康，針對她的主訴你會建議她接受何種治療最適合？", "answer": "膀胱訓練（bladder training）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "放鬆的技巧（relaxation techniques）", "B": "抗乙醯膽鹼藥物（anticholinergic medication）", "C": "白天每小時解小便一次", "D": "膀胱訓練（bladder training）", "language": "tw"}
{"question": "60 歲男性，主訴近幾個月來痰中帶血，左耳聽力下降，MRI 影像如下，最有可能的診斷是：", "answer": "鼻咽癌（nasopharyngeal carcinoma）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "咽喉血管瘤（hemangioma in nasopharynx）", "B": "口腔癌（oral cancer）", "C": "鼻咽癌（nasopharyngeal carcinoma）", "D": "聽神經瘤（acoustic schwannoma）", "language": "tw"}
{"question": "40.38歲女性，主訴在最近6個月運動時有愈來愈嚴重的呼吸困難（exertional dyspnea）。血球檢查數據如下（括弧內是正常參考數值）：RBC 3.91 M/µL（3.78～4.99），HB 7.0 g/dL（10.8～14.9），HCT 26.2% （35.6～45.4），MCV 67.0 fL（80～100），MCH 17.9 pg（26～34），MCHC 26.7 g/dL（31～37），\n k/µL（150～361），WBC 6.07 k/µL（3.54～9.06）。以下那個檢查對這個病人之診斷較無相關？", "answer": "血清中銅的濃度", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "血清中鐵蛋白（ferritin）", "B": "糞便潛血檢查", "C": "血清中鐵的濃度", "D": "血清中銅的濃度", "language": "tw"}
{"question": "有關單獨二尖瓣狹窄（isolated mitral stenosis）之敘述，何者正確？", "answer": "臨床症狀除運動時呼吸困難外，有時會出現咳血、肺栓塞或肺炎等", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "大多數病患狹窄愈嚴重，第一心音（S1）愈弱", "B": "opening snap如果聽得見，是在心收縮期", "C": "感染性心內膜炎在單獨二尖瓣狹窄病患的機率與合併二尖瓣閉鎖不全病患相同", "D": "臨床症狀除運動時呼吸困難外，有時會出現咳血、肺栓塞或肺炎等", "language": "tw"}
{"question": "關於penicillins之藥物動力學的敘述，下列何者正確？", "answer": "benzathine penicillin相對其他penicillin藥物有較長的半衰期，約可長達 14 天", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "ticarcillin可以經腸胃道吸收，因此可以口服方式治療感染", "B": "probenecid可以抑制 penicillins由腎小管過濾方式排至尿中", "C": "benzathine penicillin相對其他penicillin藥物有較長的半衰期，約可長達 14 天", "D": "amoxicillin口服吸收效果易受食物干擾而降低藥效", "language": "tw"}
{"question": "55歲女性，長期有搔癢，疲倦和腹部不適。身體檢查發現病人有黃疸，皮膚有黃色瘤（xanthoma），肝臟切片檢查發現肝內小膽管被破壞，並在門脈區發現有非乾酪性肉芽腫（noncaseating granuloma），她血清中最可能出現下列何種抗體？", "answer": "抗粒線體抗體（anti-mitochondrial antibody）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "抗平滑肌抗體（anti-smooth muscle antibody）", "B": "抗粒線體抗體（anti-mitochondrial antibody）", "C": "抗可溶性肝抗原／肝胰抗體（anti-soluable liver antigen/liver pancreas antigen antibody）", "D": "抗肝腎微小體-1抗體（anti-liver kidney microsome-1 antibody）", "language": "tw"}
{"question": "一位 70 歲女性，有高血壓、糖尿病病史，早上起床時，突然發生口語不清，右側肢體無力，在急診室神經學檢查發現：意識清楚，語言表達尚可，右側上下肢肌力皆約 2 分，感覺功能皆正常，下列敘述之病灶，何者最不可能？", "answer": "左側丘腦外側（lateral thalamus）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "左側內囊（internal capsule）附近", "B": "左側放射冠（corona radiata）附近", "C": "左側丘腦外側（lateral thalamus）", "D": "左側橋腦（pons）附近", "language": "tw"}
{"question": "使用年齡標準化死亡率（Age-adjusted death rates）的目的在：", "answer": "比較不同年齡結構族群間的死亡水準", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "控制因年齡登記錯誤所造成的誤差 \t", "B": "精確計算某特定年齡層的死亡人數", "C": "校正因年齡訊息遺漏所造成死亡率計算的誤差", "D": "比較不同年齡結構族群間的死亡水準", "language": "tw"}
{"question": "42 一位 25 歲年輕女性，因臉上蝴蝶斑、頸部淋巴腺腫大及時有高燒而求診。以往常會頭痛，冬季時兩手有Raynaud's現象及手指關節疼痛。血液檢查所見：血色素 9.8 g/dL，白血球 3,100/mm3，血小板", "answer": "anti-double-stranded DNA antibodies 陽性", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "anti-double-stranded DNA antibodies 陽性", "B": "elevated complement level", "C": "eosinophilia \t", "D": "depressed γ-globulin level", "language": "tw"}
{"question": "28 10 歲女童過去身體狀況良好，最近發現眼皮浮腫，下肢水腫，體重急速增加而住院。入院後之實驗室檢查呈現 serum albumin 2.5 g/dL（正常 4.0 - 5.3 g/dL），cholesterol 290 mg/dL（正常 125 - 240 mg/dL）， triglyceride 350 mg/dL（正常 15 - 114 mg/dL），BUN 14 mg/dL（正常 7 - 18 mg/dL），creatinine 0.7 mg/dL 5 - 1.0 mg/dL），24 小時尿蛋白為 80 mg/m2/hr，下列那一項敘述最不正確？", "answer": "此病人有 90 %以上的機會是微小變化型腎病變（minimal-change nephropathy）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "診斷為腎病症候群 \t \t", "B": "需檢測抗核抗體（ANA）及補體（C3, C4）", "C": "臨床上常合併有易凝血傾向（hypercoagulation status）", "D": "此病人有 90 %以上的機會是微小變化型腎病變（minimal-change nephropathy）", "language": "tw"}
{"question": "下列有關眼球運動的敘述，何者錯誤？", "answer": "調節性會聚（accommodative convergence）屬於一種強直性會聚（tonic convergence）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "duction是指單眼的運動，包括眼球的內旋（intorsion）和外旋（exotorsion）", "B": "version是指雙眼的同向運動，包括看右上（dextro-elevation）或左下（levo-depression）等", "C": "vergence是指雙眼的異向運動，包括會聚（convergence）或散開（divergence）等", "D": "調節性會聚（accommodative convergence）屬於一種強直性會聚（tonic convergence）", "language": "tw"}
{"question": "下列何項構造位於枕下三角內？", "answer": "枕下神經", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "頸內動脈", "B": "枕下神經", "C": "枕大神經", "D": "枕動脈", "language": "tw"}
{"question": "有關兒童白血病的敘述，下列何者錯誤？", "answer": "和慢性骨髓性白血病（CML）相反，急性淋巴性白血病（acute lymphoblastic leukemia, ALL）患童，若有 t（9；22） 的染色體易位，會有較佳的預後", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "慢性骨髓性白血病（chronic myelogenous leukemia，CML）在兒童發生的比率，相對於成人是非常低的", "B": "兒童慢性骨髓性白血病（CML）大部分都有 t（9；22）（q34；q11）的染色體易位，因而產生了費城染色體（Philadelphia chromosome）", "C": "過去兒童慢性骨髓性白血病（CML）的預後並不好，必需盡早接受幹細胞移植，但自從有了基利克（imatinib, gleevec(r)）的問世，預後已顯\t改善", "D": "和慢性骨髓性白血病（CML）相反，急性淋巴性白血病（acute lymphoblastic leukemia, ALL）患童，若有 t（9；22） 的染色體易位，會有較佳的預後", "language": "tw"}
{"question": "一位 25 歲罹患 AIDS 的男性呼吸衰竭致死。解剖時在肺臟見到的變化如圖所示。則其病理診斷應是：", "answer": "病毒包涵體（viral inclusion body）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "類澱粉病（amyloidosis）", "B": "病毒包涵體（viral inclusion body）", "C": "瀰漫性肺泡傷害（diffuse alveolar damage）", "D": "黴菌感染（fungal infection）", "language": "tw"}
{"question": "有一位住加護病房之 10 歲男童，昏迷但有自發性呼吸，醫師叫他沒反應，理學檢查四肢鬆軟無力，痛刺激手部時眼睛會張開、手會縮回，此時之葛式昏迷指數（Glasgow Coma Scale）為多少分？", "answer": "7 分", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "6 分", "B": "7 分", "C": "8 分", "D": "9 分", "language": "tw"}
{"question": "下列有關抗癲癇藥物的描述，何者正確？", "answer": "孕婦於懷孕期間服用抗癲癇藥物如 Phenytoin，其胎兒常會發現 Vitamin K-dependent 的凝血因子減少的現象", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "Oxcarbazepine 的體內半衰期較 Carbamazepine 短", "B": "Felbamate 具有阻斷 GABAA型受體之功能", "C": "Tiagabine 具有促進神經元或神經膠細胞 GABA 再回收的作用", "D": "孕婦於懷孕期間服用抗癲癇藥物如 Phenytoin，其胎兒常會發現 Vitamin K-dependent 的凝血因子減少的現象", "language": "tw"}
{"question": "關於腦垂體的發育，下列敘述何者正確？", "answer": "腺垂體（adenohypophysis）來自口腔外胚層", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "垂體漏斗（infundibulum）屬於腺體部分", "B": "神經垂體（neurohypophysis）為中腦衍生而來", "C": "神經外胚層發育為腦垂體前葉（anterior lobe）", "D": "腺垂體（adenohypophysis）來自口腔外胚層", "language": "tw"}
{"question": "下列胞器，何者不具有膜（membrane）的構造？", "answer": "核仁（nucleolus）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "核仁（nucleolus）", "B": "胞內體（endosome）", "C": "過氧化質體（peroxisome）", "D": "內質網（endoplasmic reticulum）", "language": "tw"}
{"question": "34歲的吳先生因多話，三天三夜沒睡，覺得自己能力很好可以選總統，一個月花了50萬買電視購物的產品，被家人送至急診室，醫師診斷為躁症發作（manic episode），此時不應給予何種藥物？", "answer": "fluoxetine", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "fluoxetine", "B": "olanzapine", "C": "lithium", "D": "aripiprazole", "language": "tw"}
{"question": "20歲男性因急性腹痛、⾼燒求診，接受對比劑注射後之電腦斷層掃描檢查如圖，最可能之診斷為何？", "answer": "急性闌尾炎", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "急性闌尾炎", "B": "⼤腸憩室炎", "C": "尿路結⽯", "D": "胰臟炎", "language": "tw"}
{"question": "關於過敏性支氣管肺麴黴菌病（allergic bronchopulmonary aspergillosis），下列何種影像學徵象最少見？", "answer": "明顯的肋膜積液 （pleural effusion）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "肺擴張不全（atelectasis）", "B": "支氣管囊腫（bronchocele）", "C": "肺實質化（consolidation）", "D": "明顯的肋膜積液 （pleural effusion）", "language": "tw"}
{"question": "41 一位 45 歲女士，20 年前即發現有慢性 B 型肝炎，最近體檢發現血紅素 11.5 gm/dL，白血球 3,350/μL，血小板 95,000/μL。病人無自覺症狀。回顧過去五年來的抽血檢查，血紅素多在 11.5 gm/dL 至 12.5 gm/dL 之間，白血球數目多在 3,500/μL 至 4,000/μL 之間，血小板 100,000/μL 至 120,000/μL 之間。下列何項 是最可能的診斷？ \n", "answer": "脾臟功能過旺", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "再生不良性貧血 \t", "B": "自體免疫性疾病造成的血球低下症", "C": "藥物造成的血球低下 \t", "D": "脾臟功能過旺", "language": "tw"}
{"question": "承上題，若經過一天之靜脈營養和輸液、注射抗生素及大腸減壓等療法後，病況仍未見改善，則該如何緊急處理較好？", "answer": "全大腸切除及迴腸造口術，加上 Hartmann's pouch", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "全大腸切除及迴腸直腸吻合術 \t", "B": "全大腸切除及迴腸造口術，加上 Hartmann's pouch", "C": "大腸直腸肛門全切除及迴腸造口術 \t", "D": "全大腸切除及迴腸袋肛門吻合術（Ileal pouch-anal anastomosis）一次完成", "language": "tw"}
{"question": "64.40歲病⼈因劇烈頭痛發燒來到急診，之前沒有⽤過抗⽣素，腦脊髓液檢查發現腦壓（opening pressure） 300 mmH2O，⽩⾎球100/mL（Lymphocyte：Neutrophil＝90：10），Protein level：45 mg/dL，最不可能 的致病菌為何？\n", "answer": "Klebsiella pneumoniae", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "herpes simplex virus", "B": "Mycobacterium tuberculosis", "C": "Cryptococcus neoformans", "D": "Klebsiella pneumoniae", "language": "tw"}
{"question": "下列何者為膀胱過動症最合理的藥物治療？", "answer": "抗膽鹼激性劑（anticholinergic agent）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "膽鹼激性劑（cholinergic agent）", "B": "抗膽鹼激性劑（anticholinergic agent）", "C": "腎上腺性劑（adrenergic agent）", "D": "抗腎上腺性劑（antiadrenergic agent）", "language": "tw"}
{"question": "視丘性疼痛症候群（thalamic pain syndrome）不常伴隨下列何症狀？", "answer": "偏癱（hemiplegia） \t", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "半側偏盲（homonymous hemianopia）", "B": "分離性感覺喪失（dissociated sensory loss）", "C": "偏癱（hemiplegia） \t", "D": "半側感覺喪失（hemihypesthesia）", "language": "tw"}
{"question": "下列有關肺臟移植後使用免疫抑制藥物之敘述，何者正確？", "answer": "Cyclosporine 無 myelosuppression 的副作用，常與 prednisolone 併用，以減少 cyclosporine 所引起之腎毒性", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "Prednisolone 屬於 adrenal corticosteroid 類，長期使用會有高血壓（hypertension）與低血糖（hypoglycemia）之副作用", "B": "Azathioprine 屬於 antiproliferative agents，最常見之副作用為白血球過多症（leukocytosis）", "C": "Mycophenolate mofetil（MMF）為 calcineurin inhibitor，在體內由肝臟之 cytochrome p450 enzymes 負責代謝", "D": "Cyclosporine 無 myelosuppression 的副作用，常與 prednisolone 併用，以減少 cyclosporine 所引起之腎毒性", "language": "tw"}
{"question": "下列何種情況最容易導致下肢水腫（Edema）？", "answer": "血中蛋白濃度下降（Decreased plasma protein concentration）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "細小動脈收縮（Arteriolar constriction） \t", "B": "小靜脈擴張（Venular dilatation）", "C": "靜脈壓下降（Decreased venous pressure） \t", "D": "血中蛋白濃度下降（Decreased plasma protein concentration）", "language": "tw"}
{"question": "下列有關於甲狀舌管囊腫（thyroglossal duct cyst）之敘述，何者錯誤？", "answer": "治療方式主要是將囊腫切除即可，少有復發情形", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "是最常見的先天性頸部腫瘤，也是兒童第二常見的頸部腫瘤", "B": "理學檢查可發現此囊腫隨伸舌與吞嚥動作而移動", "C": "甲狀腺掃描及功能測定是治療前的必要檢查項目", "D": "治療方式主要是將囊腫切除即可，少有復發情形", "language": "tw"}
{"question": "下列何者最不可能是卵巢過度刺激症候群（ovarian hyperstimulation syndrome）的危險因子？", "answer": "Antral follicle count小於4", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "年輕病患", "B": "BMI小於18.5", "C": "Antral follicle count小於4", "D": "當次週期成功懷孕", "language": "tw"}
{"question": "36 一位 70 歲男性病人，皮膚有超過體表面積 90%以上的脫屑及泛紅，經診斷為紅皮症（erythroderma）。 下列相關敘述何者錯誤？ \n", "answer": "應注意是否有低心輸出量（low cardiac output）心臟衰竭之徵候", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "乾癬（psoriasis）惡化為常見病因之一", "B": "易導致血中低白蛋白（low serum albumin）及電解質不平衡", "C": "藥物之不良反應亦可能導致此症", "D": "應注意是否有低心輸出量（low cardiac output）心臟衰竭之徵候", "language": "tw"}
{"question": "37.一位女性體檢時，意外發現有高血鈣，進一步檢查證實為原發性副甲狀腺功能亢進（primary  hyperparathyroidism），根據目前的治療指引，有些原發性副甲狀腺功能亢進患者即使無臨床症狀亦建議應接受手術，但下列何者除外？ \n", "answer": "年齡大於60歲", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "骨密度檢查T-score小於-2.5", "B": "肌酸酐廓清率（creatinine clearance）小於60 mL/min", "C": "血鈣超過正常值上限1.0 mg/dL以上", "D": "年齡大於60歲", "language": "tw"}
{"question": "人類乳頭狀瘤病毒（Human Papillomavirus）分型方法是利用：", "answer": "基因體 DNA 序列相似度（sequence homology）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "抗體辨識", "B": "基因體 DNA 序列相似度（sequence homology）", "C": "病毒顆粒之大小", "D": "病毒基因之表現", "language": "tw"}
{"question": "關於缺鐵性貧血（iron-deficiency anemia, IDA）的敘述，下列何者錯誤？", "answer": "足月兒的缺鐵性貧血常發生在出生後前3個月", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "低體重早產兒為好發族群", "B": "青春期後的女性罹患慢性缺鐵性貧血應考慮月經過多", "C": "患者血清中（serum）ferritin 是下降的", "D": "足月兒的缺鐵性貧血常發生在出生後前3個月", "language": "tw"}
{"question": "25 楓糖尿症是一種支鏈胺基酸代謝異常疾病。患者因為支鏈胺基酸以及其副產物堆積而引起腦病變。 臺灣發現這一項疾病在原住民發生率特別的高，後續的研究發現，下列那一項敘述最不合理？ \n", "answer": "在蒙古可以看到和臺灣原住民相同的突變", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "大部分的原住民患者可以看到一個相同的突變，稱作 founder effect", "B": "在蒙古可以看到和臺灣原住民相同的突變", "C": "臺灣漢人患者的突變種類變異性比原住民大", "D": "臺灣原住民表兄妹結婚相當普遍", "language": "tw"}
{"question": "用以治療廣泛性焦慮症（generalized anxiety disorder）之抗焦慮藥物中，buspirone 之主要藥理作用機轉為下列何者？", "answer": "血清素 1A受體部分作用劑（5HT1A receptor partial agonist）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "血清素 1A受體部分作用劑（5HT1A receptor partial agonist）", "B": "血清素 1A受體拮抗劑（5HT1A receptor antagonist）", "C": "血清素 2A受體部分作用劑（5HT2A receptor partial agonist）", "D": "血清素 2A受體拮抗劑（5HT2A receptor antagonist）", "language": "tw"}
{"question": "下列何種藥物，可用來治療思覺失調症（schizophrenia）？", "answer": "serotonin dopamine antagonists", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "serotonin dopamine agonists", "B": "serotonin dopamine antagonists", "C": "serotonin norepinephrine reuptake inhibitors", "D": "serotonin dopamine reuptake inhibitors", "language": "tw"}
{"question": "醫療費⽤的成⻑率跟下列那⼀個因素關聯性較⼩？", "answer": "醫病資訊不對稱", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "⼈⼝老化", "B": "所得增加", "C": "醫療科技進步", "D": "醫病資訊不對稱", "language": "tw"}
{"question": "有關橈骨神經之敘述，下列何者錯誤？", "answer": "如果posterior interosseous nerve受傷，只會侵犯到手臂之伸肌", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "主要支配triceps、brachioradialis、supinator及extensors of the fingers等肌肉", "B": "神經主要源自頸椎第6～8節神經根", "C": "如果posterior interosseous nerve受傷，只會侵犯到手臂之伸肌", "D": "在鉛中毒患者常見本神經之侵犯", "language": "tw"}
{"question": "產生腸毒素的大腸桿菌，其對熱穩定的毒素，有下列何種作用機制？", "answer": "活化次級信號分子", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "溶解脂肪，打破細胞膜", "B": "抑制蛋白質的合成", "C": "活化發炎反應（inflammation）", "D": "活化次級信號分子", "language": "tw"}
{"question": "6.56歲的男性，腎病症候群病史，最近2天嘔吐因此沒有吃利尿劑。身體診察有中度的全身水腫，動脈血氣體pH 7.48，PaCO2  47 mmHg，HCO3- 34 mEq/L，血液osmolality 255 mOsmol/kg H2O，BUN 30 mg/dL，肌酸酐1.5 mg/dL，Na 120 mmol/L。 尿液Na+ 30 mmol/L，尿液Cl- 8 mmol/L。下列敘述何者錯誤？ \n", "answer": "病人的有效血液容量增加", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "病人的細胞外液量增加", "B": "病人的細胞內液量增加", "C": "病人的有效血液容量增加", "D": "病人的有效血液容量減少", "language": "tw"}
{"question": "下\t何者藥物不會有引起急性尿滯留（acute urinary retention）的副作用？", "answer": "膽鹼作用劑（cholinergic agents）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "α-腎上腺素作用劑（α- adrenergic agents）", "B": "抗組織胺（antihistamines）", "C": "治療鼻塞的感冒藥", "D": "膽鹼作用劑（cholinergic agents）", "language": "tw"}
{"question": "有關醫療錯誤的告知，下列敘述何者錯誤？", "answer": "只要承認醫療錯誤，就等於有醫療過失", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "通常對醫師而言，坦承自己的醫療錯誤是一件困難的事", "B": "最好是率先告知醫療錯誤，不要等病人問了再說", "C": "對於病人或家屬強烈的情緒反應，要有心理準備", "D": "只要承認醫療錯誤，就等於有醫療過失", "language": "tw"}
{"question": "下列何者不是胰臟癌（carcinoma of the pancreas）的臨床表現？", "answer": "膽囊萎縮變小", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "阻塞性黃疸、灰白色糞便", "B": "膽囊萎縮變小", "C": "上腹部疼痛、後背痛 \t", "D": "體重減輕", "language": "tw"}
{"question": "下列何種藥物為一種選擇性高之 antithrombin-dependent factor Xa 抑制劑？", "answer": "Fondaparinux", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "Heparin", "B": "Clopidogrel", "C": "Fondaparinux", "D": "Aspirin", "language": "tw"}
{"question": "28.會陰體（perineal body）受傷後，下列何者的作用最可能不受影響？ ①球海綿體肌（bulbospongiosus  muscle） ②會陰深橫肌（deep transverse perineal  muscle） ③會陰淺橫肌（superficical transverse perineal  muscle） ④坐骨海綿體肌（ischiocavernosus muscle） ⑤尿道外括約肌（external urethral sphincter muscle）\n", "answer": "④⑤", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "①③", "B": "②④", "C": "①⑤", "D": "④⑤", "language": "tw"}
{"question": "下列有關神經性梅毒（neurosyphilis）之敘述，何者錯誤？", "answer": "治療方法為經肌肉注射盤尼西林（penicillin）每週一次共三次", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "10%沒有接受治療的早期梅毒的患者會罹病", "B": "因為AIDS的盛行，神經性梅毒的發生率增高", "C": "腦脊髓液的螺旋菌抗體（treponemal antibody）陽性反應有助於診斷", "D": "治療方法為經肌肉注射盤尼西林（penicillin）每週一次共三次", "language": "tw"}
{"question": "以下方法均可減少植體抗宿主疾病（graft-versus-host disease, GVHD），下列何者除外？", "answer": "將預植入的造血幹細胞實行淋巴球混合作用（mixed lymphocyte reaction），以減低T淋巴球的數目", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "以alemtuzumab處理預植入的造血幹細胞，經由拮抗CD52的作用，使得成熟的T淋巴球數目減少", "B": "將預植入的造血幹細胞實行淋巴球混合作用（mixed lymphocyte reaction），以減低T淋巴球的數目", "C": "選擇MHC class I及MHC class II配合的植體，以降低植入後成熟T淋巴球的抗宿主反應", "D": "使用抗胸腺球蛋白（anti-thymoglobulin）預處理植入的細胞，減低T淋巴球及白血球的數目", "language": "tw"}
{"question": "19 一位肝硬化患者因為大量吐血至急診處接受緊急上消化道內視鏡檢查，發現胃及食道靜脈曲張 （varices）出血，此患者之門脈壓（portal pressure，以 wedge-to-free gradient 測量）最有可能為： \n", "answer": "13～15 mmHg", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "5～7 mmHg", "B": "8～10 mmHg", "C": "10～12 mmHg", "D": "13～15 mmHg", "language": "tw"}
{"question": "4 一位 10 歲男孩，主訴 1 星期前感冒，來診前 1 天相當疲倦，今天突然暈倒，蒼白盜汗，心跳約 多次/分，心電圖如附圖，最可能的診斷為何？", "answer": "Wolff-Parkinson-White 症候群", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "感冒藥副作用 \t", "B": "心肌炎合併完全房室傳導障礙", "C": "先天性心臟病 \t", "D": "Wolff-Parkinson-White 症候群", "language": "tw"}
{"question": "那一種荷爾蒙經由 JAK-STAT 訊號途徑產生作用？", "answer": "泌乳素（prolactin）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "性釋素（GnRH）", "B": "促濾泡素（FSH）", "C": "泌乳素（prolactin）", "D": "動情素（estrogen）", "language": "tw"}
{"question": "下列有關心律不整之機轉（mechanism），何者正確？", "answer": "Early afterdepolarization（EAD）主要之原因為動作電位間期（action potential duration）過長", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "Delayed afterdepolarization（DAD）主要原因為細胞內鉀離子過多", "B": "Early afterdepolarization（EAD）主要之原因為動作電位間期（action potential duration）過長", "C": "Torsades des pointes 之主要原因為 delayed afterdepolarization", "D": "細胞外鉀離子過高，易引起 early afterdepolarization", "language": "tw"}
{"question": "73 依據 DSM-IV-TR 診斷標準，下列何者會出現在典型自閉症但不在亞斯柏格症（Asperger's disorder） 的核心症狀之中？\n", "answer": "語言能力與認知發展遲緩", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "社交互動缺損", "B": "智能障礙", "C": "語言能力與認知發展遲緩", "D": "侷限、反覆、固著的行為／興趣／活動", "language": "tw"}
{"question": "下列有關腎⼩管葡萄糖再吸收的描述，何者正確？", "answer": "近端腎⼩管頂膜（apical membrane）主要利⽤第⼆型鈉依賴性葡萄糖運輸蛋⽩（sodium-dependent glucose transporter 2）再吸收葡萄糖", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "遠端腎⼩管頂膜（apical membrane）利⽤第⼀型葡萄糖運輸蛋⽩（glucose transporter 1）再吸收葡萄糖", "B": "遠端腎⼩管基底外側膜（basolateral membrane）利⽤第⼀型鈉依賴性葡萄糖運輸蛋⽩（sodiumdependent glucose transporter 1）再吸收葡萄糖", "C": "近端腎⼩管頂膜（apical membrane）主要利⽤第⼆型鈉依賴性葡萄糖運輸蛋⽩（sodium-dependent glucose transporter 2）再吸收葡萄糖", "D": "近端腎⼩管基底外側膜（basolateral membrane）主要利⽤第⼀型葡萄糖運輸蛋⽩（glucose transporter", "language": "tw"}
{"question": "下列有關各種血管炎臨床特徵的描述，何者最為正確？", "answer": "Churg-Strauss syndrome-asthmatic attack", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "granulomatosis with polyangiitis-urticaria", "B": "microscopic polyangiitis-chronic sinusitis", "C": "Churg-Strauss syndrome-asthmatic attack", "D": "polyarteritis nodosa-severe migraine", "language": "tw"}
{"question": "開心手術後的病人，在加護病房照顧時，發現心包腔引流管出血量相當多，第 1 個小時約 300 毫升（病人體重 60 公斤），第 2 個小時約 400 毫升，醫護人員會依流出之量給予靜脈輸血及血小板或新鮮血漿。會造成這麼厲害出血的原因，下列何者最不可能？", "answer": "體外循環會造成溶血", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "體外循環會破壞血小板", "B": "體外循環會造成溶血", "C": "體外循環時，殘餘之肝素", "D": "可能有出血點沒有查到", "language": "tw"}
{"question": "威而剛（Viagra）主要是藉由何種作用促進勃起（erection）？", "answer": "抑制磷酸雙酯酶（phosphodiesterase）的活性", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "抑制磷酸雙酯酶（phosphodiesterase）的活性", "B": "促進磷酸雙酯酶（phosphodiesterase）的活性", "C": "抑制一氧化氮合成酶（NO synthase）的活性", "D": "抑制腺苷酸環化酶（adenylate cyclase）的活性", "language": "tw"}
{"question": "下列何者最少見於 Klinefelter syndrome？", "answer": "身材矮小", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "最常見的核型（karyotype）為 47,XXY", "B": "很少在青春期以前被診斷", "C": "青春期發育可能遲延 \t", "D": "身材矮小", "language": "tw"}
{"question": "下列關於肩難產（shoulder dystocia）的敘述，何者錯誤？", "answer": "西元 2002 年美國婦產科醫學會（ACOG）建議非糖尿病產婦之胎兒預估體重大於 4000 克時，施行預防性剖腹生產手術是適當的", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "胎兒出生體重的增加會提高肩難產的發生", "B": "母體常會出現因子宮乏力或產道裂傷造成的產後大出血", "C": "西元 2002 年美國婦產科醫學會（ACOG）建議非糖尿病產婦之胎兒預估體重大於 4000 克時，施行預防性剖腹生產手術是適當的", "D": "自然生產時可利用 McRoberts maneuver 或 Woods corkscrew maneuver 來協助胎兒娩出", "language": "tw"}
{"question": "8.⼀個G1P1 / 39週出⽣體重3,200公克的新⽣兒，出⽣後哺餵全⺟乳。第19個⼩時⼤時檢測總膽紅素值為12  mg/dL、直接型膽紅素值為0.22 mg/dL。⺟親為O型Rh陽性、⽗親B型Rh陽性⾎型。⺟親之前未曾接受過任何\n ⾎品輸注。⽗親有⼄型海洋性貧⾎、⺟親則無海洋性貧⾎。下列何者為最可能之診斷？\n", "answer": "ABO⾎型不合（ABO incompatibility）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "Rh其他⾎型不合（Rh minor group incompatibility）", "B": "ABO⾎型不合（ABO incompatibility）", "C": "⺟乳性黃疸（Breast milk jaundice）", "D": "⼄型海洋性貧⾎（ß-Thalassemia）", "language": "tw"}
{"question": "恙（Leptotrombidium spp.）能傳染人類致病的時期是：", "answer": "幼蟲", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "幼蟲", "B": "前稚蟲期", "C": "稚蟲期", "D": "成蟲期", "language": "tw"}
{"question": "Model for End-Stage Liver Disease（MELD）scale是評估hepatic functional reserve的好方法，其內容不包括下列何者？", "answer": "serum albumin level", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "serum albumin level", "B": "INR（international normalized ratio）", "C": "serum bilirubin level", "D": "serum creatinine level", "language": "tw"}
{"question": "下列有關內側縱束（medial longitudinal fasciculus）之敘述，何者錯誤？", "answer": "參與瞳孔光反射之傳導", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "含有由內側前庭神經核（medial vestibular nucleus）發出之神經纖維", "B": "參與瞳孔光反射之傳導", "C": "位於第四腦室或大腦導水管之腹面靠中線處", "D": "與眼球上下垂直共軛運動（vertical conjugate movement）有關", "language": "tw"}
{"question": "68 60 歲女性病人就診前三個月因子宮頸癌切除子宮，手術後曾經發生急性尿滯留。其後，須用力排尿， 且常發生膀胱炎及恥骨上方疼痛。什麼檢查可給予診斷或治療最大之幫助？ \n", "answer": "尿路動力學檢查 \t", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "核子醫學檢查 \t", "B": "尿路動力學檢查 \t", "C": "膀胱放射攝影 \t", "D": "靜脈注射尿路攝影", "language": "tw"}
{"question": "77.一位35歲懷孕28週婦女，因血壓過高至急診就診，經評估後懷疑是子癲前症（pre-eclampsia）。下 列何者不是此病之臨床表現？\n", "answer": "癲癇（seizure）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "高血壓（hypertension）", "B": "蛋白尿（proteinuria）", "C": "寡尿（oliguria）", "D": "癲癇（seizure）", "language": "tw"}
{"question": "49 李小姐今年 36 歲，已婚，育有 2 個各為 7 歲與 5 歲小孩。李小姐於一週前開始有左側乳房下方，接近乳暈處的疼痛現象，這兩天疼痛部位可摸到一約兩公分大小的硬塊，硬塊表面皮膚並且出現紅腫 的現象。李小姐曾經自行服用止痛藥，但是情況未能改善。下列何者是最適當的進一步處置？ \n", "answer": "乳房超音波檢查", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "乳房超音波粗針（core needle）穿刺檢查", "B": "乳房超音波檢查", "C": "乳房 X 光攝影檢查 \t", "D": "乳房腫瘤切除術", "language": "tw"}
{"question": "病毒感染引起發炎時，下列那一種發炎細胞最多？", "answer": "淋巴球", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "嗜中性球", "B": "嗜酸性球", "C": "淋巴球", "D": "漿細胞", "language": "tw"}
{"question": "3.48歲女性主訴胸悶，偶有眩暈並有運動時呼吸困難，身體診察脈搏64/min, 心臟大小正常，有 S4 gallop，在胸骨右緣第三及四肋間有Grade IV/VI射出型心縮期雜音, 向頸部放散\n （radiation to neck）。血行動力學壓力（mmHg）如下：右心房平均壓：6；右心室43/8；肺動脈：43/18（平均壓28）；肺動脈楔壓：平均壓22；左心室227/33；主動脈139/72（平均壓98），病人之心臟病為： \n", "answer": "主動脈瓣狹窄 \t", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "僧帽瓣狹窄", "B": "僧帽瓣閉鎖不全", "C": "主動脈瓣狹窄 \t", "D": "主動脈瓣閉鎖不全", "language": "tw"}
{"question": "下列何項危險因子不會影響陰莖海綿體血流量（penile blood flow，PBF）？", "answer": "心因性（psychogenic）勃起功能障礙", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "抽菸 \t", "B": "糖尿病", "C": "高血壓 \t", "D": "心因性（psychogenic）勃起功能障礙", "language": "tw"}
{"question": "關於老人自殺相關的敘述，下列何者錯誤？", "answer": "和其他族群相較之下，老人自殺者較常合併酒精濫用", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "65歲以上之老年族群自殺風險性比其他族群高", "B": "老人往往採取較激烈的自殺方式，而且男性自殺身亡者比例較高", "C": "和其他族群相較之下，老人自殺者較常合併酒精濫用", "D": "失落和身體疾病纏身是老人自殺最常見的促使因素（precipitants）", "language": "tw"}
{"question": "橫紋肌裡的 T 小管是下列何者形成的？", "answer": "細胞膜內陷形成 \t", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "細胞膜內陷形成 \t", "B": "平滑內質網特化形成", "C": "微小管特化形成 \t", "D": "神經末梢特化形成", "language": "tw"}
{"question": "下列有關腎臟的逆流機制（countercurrent mechanism）的敘述，何者錯誤？", "answer": "亨氏管上升段粗枝會利用鈉-氯協同運輸蛋白（Na+-Cl+ cotransporter）將鈉、氯離子分泌至腎小管管腔", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "主要是為了形成並維持腎臟髓質垂直性的滲透壓梯度", "B": "所需要的能量由亨氏管上升段粗枝（thick ascending limb of loop of Henle）的鈉-鉀腺苷三磷酸酶（Na+-K+ ATPase）提供", "C": "亨氏管上升段粗枝會利用鈉-氯協同運輸蛋白（Na+-Cl+ cotransporter）將鈉、氯離子分泌至腎小管管腔", "D": "直管（vasa recta）利用逆流交換（countercurrent exchange）的作用維持腎臟髓質垂直性的滲透壓梯度", "language": "tw"}
{"question": "一位 30 歲原本健康狀況良好的年輕人，三天內產生步態不穩，雙下肢無力，病情逐漸加重，無力範圍往上昇到胸腹部，神經學檢查顯示胸部以下肌力減退為 1-2 分（5 分為正常），感覺功能正常，肌腱反射無反應，則最可能的診斷是：", "answer": "急性週邊神經或神經根炎（Guillain-Barré syndrome）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "重症肌無力（myasthenia gravis） \t", "B": "急性週邊神經或神經根炎（Guillain-Barré syndrome）", "C": "頸脊髓腫瘤（cervical cord tumor）", "D": "多發性肌炎（polymyositis）", "language": "tw"}
{"question": "會製造睪固酮（testosterone）的細胞是：", "answer": "萊迪氏細胞（Leydig cell）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "萊迪氏細胞（Leydig cell）", "B": "塞托利氏細胞（Sertoli cell）", "C": "管周邊細胞（peritubular cell）", "D": "產精細胞（spermatogenic cell）", "language": "tw"}
{"question": "下列敘述，何者較為正確？", "answer": "高度近視患者比正常人容易得青光眼、白內障、視網膜剝離、黃斑部出血等眼疾", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "高度近視患者比正常人容易得青光眼、白內障、視網膜剝離、黃斑部出血等眼疾", "B": "小朋友睡前點阿托品（atropine）眼藥水，可以治好近視眼", "C": "近視度數七、八百度，用雷射屈光手術即可治癒近視所導致的眼球病變", "D": "給小朋友角膜塑形術，可以使近視眼球變化不再進行", "language": "tw"}
{"question": "34.下列那一個病例最不符合所列之動脈血氣體分析和血清電解質的檢查結果［pH：7.49，PaO2：90 mmHg， mmHg，HCO3-：28；Na+ 139，K+ 3.0，Cl- 89（電解質的單位是mmol/L）］？", "answer": "急性腹瀉三天", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "長期使用利尿劑", "B": "急性腹瀉三天", "C": "原發性皮質醛酮症", "D": "噁心嘔吐兩天", "language": "tw"}
{"question": "下列有關 colon motility 之敘述何者為非？", "answer": "right colon 的 motility 以 peristaltic wave 為主", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "left colon 的 motility 型式以 tonic contraction 為主", "B": "進食後會有 gastrocolic reflex 之產生", "C": "一次 mass peristalsis 之收縮，將大腸內容物推進的長度約占整條大腸的三分之一", "D": "right colon 的 motility 以 peristaltic wave 為主", "language": "tw"}
{"question": "有關鞏膜炎（scleritis）的處理，下列敘述何者錯誤？", "answer": "使用 10% phenylephrine 點眼，依照鞏膜血管的收縮與否，可與上鞏膜炎（episcleritis）鑑別診斷", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "常需照會風濕次專科醫師，評估潛在的病因（underlying disease）", "B": "使用 10% phenylephrine 點眼，依照鞏膜血管的收縮與否，可與上鞏膜炎（episcleritis）鑑別診斷", "C": "應給予大量廣效性抗生素作第一線治療 \t", "D": "當鞏膜炎有導致眼球破裂之虞時，可予縫補性移植片（patch graft）治療", "language": "tw"}
{"question": "何小姐，56 歲女姓，微胖。最近兩個月在深夜有偶發性的上腹劇痛，疼痛發作時痛的感覺會傳導到右後背，尤其是肩胛骨下方的地方。疼痛經常持續 4~5 小時即自動緩解，何小姐注意到發作的當日往往是吃的很豐盛、油膩或很飽。綜合上述的病史，您認為腹痛最可能的診斷是：", "answer": "膽結石併膽絞痛", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "急性胃炎", "B": "十二指腸潰瘍", "C": "急性胰臟炎", "D": "膽結石併膽絞痛", "language": "tw"}
{"question": "下列何者主要是負責細胞還原生合成（reductive biosynthesis）反應之輔？", "answer": "NADPH", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "NADH", "B": "NADPH", "C": "FADH2", "D": "FMNH2", "language": "tw"}
{"question": "下列有關glutathione（GSH）的敘述，何者錯誤 ？", "answer": "glutathione reductase利⽤ATP可直接將GSSG還原成2個GSH", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "由Glu、Cys及Gly三種胺基酸組成", "B": "某些種類的leukotriene的⽣合成需要glutathione的參與", "C": "GSH被氧化時，經由雙硫鍵的形成產⽣glutathione disulfide（GSSG）", "D": "glutathione reductase利⽤ATP可直接將GSSG還原成2個GSH", "language": "tw"}
{"question": "下列何種疾病常合併下肢無力、感覺異常及大小便失禁？", "answer": "脊神經管閉合不全（spinal dysraphism）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "脊髓肌肉萎縮症（spinal muscular atrophy） \t", "B": "脊神經管閉合不全（spinal dysraphism）", "C": "恰克-馬利-杜斯氏症（Charcot-Marie-Tooth disease）", "D": "裘馨氏肌失養症（Duchenne muscular dystrophy）", "language": "tw"}
{"question": "下列何處損傷最可能導致病人有異常高的肌肉張力（hypertonia）？", "answer": "upper motor neurons", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "α motor neurons", "B": "γ motor neurons", "C": "upper motor neurons", "D": "skeletal muscles", "language": "tw"}
{"question": "23.一名30歲女性，近2個月血清肌酸酐從1.0升至3.0 mg/dL，其血清anti-neutrophil cytoplasmic抗體呈陰性反應，血清C3降低，C4正常，經腎臟切片檢查確定為新月型腎絲球腎炎，電鏡檢查發現有subepithelial electron-dense 沉積，glomerular basement membrane厚度正常，下列診斷何者正確？\n", "answer": "poststreptococcal glomerulonephritis", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "membranous nephropathy", "B": "membranoproliferative glomerulonephritis, type II", "C": "lupus nephritis", "D": "poststreptococcal glomerulonephritis", "language": "tw"}
{"question": "下列何者位於會陰淺隙（superficial perineal pouch）？", "answer": "陰莖腳", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "陰莖腳", "B": "膜部尿道", "C": "會陰深橫肌", "D": "陰莖背側神經", "language": "tw"}
{"question": "有關二尖瓣嚴重狹窄（severe mitral stenosis）之治療，下列何者錯誤？", "answer": "有無徵狀的嚴重二尖瓣狹窄（mitral stenosis）都應該接受介入性的手術治療", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "有無徵狀的嚴重二尖瓣狹窄（mitral stenosis）都應該接受介入性的手術治療", "B": "嚴重的二尖瓣狹窄大都以風濕性心臟病（rheumatic heart disease）為主", "C": "利用體外循環之下行二尖瓣膜連合處切開術（open mitral commissurotomy, OMC）是手術選項之一", "D": "當無法實行二尖瓣膜連合處切開術時，二尖瓣膜置換手術（mitral valve replacement）也是外科治療選項之一", "language": "tw"}
{"question": "P 先生對蝦蟹過敏，每次吃了海鮮大餐都會產生蕁麻疹。在 K 先生的主動提議下，K 先生將 P 先生的血清注射到自己的皮下後 1 週，K 先生吃了海鮮大餐後半小時也在注射的皮膚出現明顯的皮膚疹，但吃其他的食物並不會出現反應，身體其他地方也無特別病狀。下列敘述何者正確？", "answer": "血清中具抗原特異性的 IgE 已經黏附在皮下的過敏細胞", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "P 先生的反應是被動免疫，K 先生的反應是主動免疫", "B": "血清中具抗原特異性的 IgE 已經黏附在皮下的過敏細胞", "C": "P 先生的血清已經在 K 先生的身上引起免疫容忍", "D": "P 先生和 K 先生的反應都是被動免疫", "language": "tw"}
{"question": "下圖為一孩童之 X 光素片，下列相關敘述何者錯誤？", "answer": "為確立診斷，必須進一步做小腸鋇劑攝影", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "有呈現腸道異常之徵象", "B": "要考慮左側腹股溝疝氣（left inguinal hernia）", "C": "為確立診斷，必須進一步做小腸鋇劑攝影", "D": "應以外科手術治療", "language": "tw"}
{"question": "71 32 歲女性曾做兩次流產手術，主訴痛經，經血量減少，經子宮輸卵管攝影檢查（見圖 A）及子宮鏡檢（見圖 B），下列診斷何者最適當？圖 A \t圖 B", "answer": "Asherman's Syndrome", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "Sheehan's Syndrome", "B": "Asherman's Syndrome", "C": "Swyer's Syndrome", "D": "Klinefelter Syndrome", "language": "tw"}
{"question": "下列何者是視網膜最前端的組織構造？", "answer": "鋸齒緣（ora serrata）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "玻璃體基底部（vitreous base）", "B": "鋸齒緣（ora serrata）", "C": "皺摺部（pars plicata）", "D": "平坦部（pars plana）", "language": "tw"}
{"question": "一位 18 歲男性病患兩年來有漸行性的動作性手抖、僵硬、手指徐動症（athetosis），說話有點不清晰，並無家族史。其肝功能不正常，腹部超音波顯示有肝硬化。目前對診斷最有幫忙的檢查為：", "answer": "血液中銅及藍胞漿素（ceruloplasmin）之濃度", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "血液中銅及藍胞漿素（ceruloplasmin）之濃度", "B": "血液中維他命 B12濃度", "C": "基因測試 \t", "D": "血液中阿摩尼亞（ammonia）的濃度", "language": "tw"}
{"question": "小王由於白血病必須進行骨髓移植，他只有一位親弟弟，他這位弟弟進行 HLA 檢驗，則 HLA 完全與他符合的機會大約為多少%？", "answer": "25", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "100", "B": "75", "C": "50", "D": "25", "language": "tw"}
{"question": "下列關於蕁麻疹（urticaria）的敘述，何者錯誤？", "answer": "急性和慢性蕁麻疹的定義，臨床上以是否持續 6 個月當分界", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "個別病灶通常在 24 小時內會消失，但可能會有新的病灶產生", "B": "dermographism 是因機械刺激造成 mast cell degranulation 而產生皮膚浮腫", "C": "急性和慢性蕁麻疹的定義，臨床上以是否持續 6 個月當分界", "D": "陽光或冷熱刺激亦可能會造成蕁麻疹", "language": "tw"}
{"question": "關於tetracyclines類抗生素之敘述，下列何者正確？", "answer": "治療立克次體感染的首選藥物", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "可結合至細菌之50S核醣體，而干擾蛋白質合成", "B": "常與制酸劑併用，以預防胃部不適", "C": "治療立克次體感染的首選藥物", "D": "doxycycline口服時，易受食物干擾吸收", "language": "tw"}
{"question": "子宮內膜（Endometrium）的發育，與卵泡的逐漸成熟相一致並受卵巢雌性素（estrogen）分泌影響的是那一時期？", "answer": "增殖期（Proliferative phase）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "增殖期（Proliferative phase）", "B": "分泌期（Secretory phase）", "C": "缺血期（Ischemic phase）", "D": "月經期（Menstrual phase）", "language": "tw"}
{"question": "下列何者不直接與子宮相連？", "answer": "懸韌帶（suspensory ligament of ovary） \t", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "闊韌帶（broad ligament）", "B": "懸韌帶（suspensory ligament of ovary） \t", "C": "卵巢韌帶（ligament of ovary）", "D": "子宮圓韌帶（round ligament of uterus）", "language": "tw"}
{"question": "直腸癌最常見的症狀是那一項？", "answer": "便血（hematochezia）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "裡急後重感（tenesmus）", "B": "便血（hematochezia）", "C": "解粘液便（mucus discharge）", "D": "大便習慣改變（change in bowel habit）", "language": "tw"}
{"question": "酶具有高效率的化學反應催化作用（catalysis），原因為何？", "answer": "可降低化學反應的活化能（activation energy, ΔG‡）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "可抑制酶促反應（enzymatic catalytic reaction）的逆反應", "B": "可增加催化反應的平衡常數（equilibrium constant）", "C": "可降低化學反應的活化能（activation energy, ΔG‡）", "D": "可增加化學反應的活化能（activation energy, ΔG‡）", "language": "tw"}
{"question": "慢性心房振顫（Atrial fibrillation）的病人，可以用下列那一種手術術式來治療，使其恢復竇律（Sinus rhythm）？", "answer": "迷宮手術（Maze operation）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "植入式心室振顫自動去除器（Automatic internal cardioverter defibrillator）", "B": "心律調整器（VVI pacemaker）", "C": "迷宮手術（Maze operation）", "D": "心房轉換手術（Atrial switch）", "language": "tw"}
{"question": "有關血液中二氧化碳之運輸，下列敘述何者正確？", "answer": "在周邊微血管（peripheral capillary）中，碳酸氫根離子（HCO3-）自紅血球流出（efflux）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "在肺泡微血管（alveolar capillary）中，碳酸氫根離子（HCO3-）自紅血球流出（efflux）", "B": "在周邊微血管（peripheral capillary）中，碳酸氫根離子（HCO3-）自紅血球流出（efflux）", "C": "主要依賴氯-碳酸氫根共同轉運蛋白（Cl-- HCO3- cotransporter）之協助", "D": "血液中二氧化碳主要以碳酸根離子（CO32-）之形式存在", "language": "tw"}
{"question": "霍亂弧菌（Vibrio cholerae）之血清型別是依據下列何者的抗原性予以區分？", "answer": "脂多醣體（lipopolysaccharides）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "鞭毛蛋白（flagellin）", "B": "莢膜多醣體（capsular polysaccharides）", "C": "脂多醣體（lipopolysaccharides）", "D": "外膜蛋白（outer membrane proteins）", "language": "tw"}
{"question": "下列有關犬心絲蟲（Dirofilaria immitis）感染的敘述，何者錯誤？", "answer": "人體被狗身上的蝨子及跳蚤叮咬而感染", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "狗是該蟲的終宿主（final host） \t \t", "B": "人體被狗身上的蝨子及跳蚤叮咬而感染", "C": "在人體感染很少能發育為成蟲 \t", "D": "大多數被感染的病人都在肺臟或皮下組織形成結節（nodules）", "language": "tw"}
{"question": "關於腎病症候群（nephrotic syndrome）的敘述，下列何者錯誤？", "answer": "高蛋白飲食為治療腎病症候群的必要方式之一", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "腎病症候群的特點為重度蛋白尿，低白蛋白血症，高脂血症和水腫", "B": "高蛋白飲食為治療腎病症候群的必要方式之一", "C": "膜性腎病變（membranous glomerulonephritis）腎絲球腎炎容易發生腎靜脈血栓", "D": "腎病症候群患者其血漿滲透壓降低，可刺激肝臟脂蛋白合成而造成高脂血症，其中以低密度脂蛋白及膽固醇之增加為最常見", "language": "tw"}
{"question": "接合黴菌綱（zygomycetes）通常不具下列那一種構造？", "answer": "phialides", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "columella", "B": "sporangium", "C": "phialides", "D": "coenocytic hyphae 59 \t下列有關新型隱球菌（Cryptococcus neoformans）黑色素（melanin）之敘述何者錯誤？", "language": "tw"}
{"question": "42 一位 38 歲男性過去未曾關節腔出血，但因拔牙後流血不止而就醫。抽血檢查發現血小板數目 2 秒，aPTT 75.3 秒。下列診斷何者最應優先考慮？", "answer": "第十一凝血因子缺乏（Factor XI deficiency）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "嚴重型類血友病（type 3 von Willebrand disease） \t", "B": "血小板無力症（Glanzmann's thrombasthenia）", "C": "第十凝血因子缺乏（Factor X deficiency）", "D": "第十一凝血因子缺乏（Factor XI deficiency）", "language": "tw"}
{"question": "當妊娠期間的婦女出現有異食症（pica syndrome）時，應該懷疑與下列何種情況最有相關性？", "answer": "缺鐵性貧血（iron deficiency anemia）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "家暴、暴力虐待（domestic abuse）", "B": "蛔蟲感染（ascariasis）", "C": "缺鐵性貧血（iron deficiency anemia）", "D": "精神分裂症（schizophrenia）", "language": "tw"}
{"question": "49 一位 48 歲婦女，主訴不正常子宮出血，子宮內膜搔刮手術報告為 atypical complex hyperplasia，下列 何者為最適當之治療？\n", "answer": "子宮切除", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "子宮切除", "B": "黃體素給予", "C": "雌激素給予", "D": "子宮鏡指引下，再次切除病灶", "language": "tw"}
{"question": "巴拉松屬於那一種農藥？", "answer": "有機磷", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "有機氯", "B": "有機磷", "C": "氨基甲酸鹽", "D": "天然產物", "language": "tw"}
{"question": "一位 38 歲女性，過去無重大疾病史，至門診要求減重。理學檢查發現其血壓 138/94 mmHg，心跳 78 次/分，體重 68 公斤，腰圍 88 公分，身體質量指數（BMI）為 26.6 kg/m2。家族病史顯示母親有糖尿病。下列處置何者最適當？", "answer": "病人屬體重過重，先以飲食與運動治療即可", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "因合併有高血壓，應立即使用 sibutramine 或 orlistat 等藥物減重 \t", "B": "家族病史有糖尿病，因此應給予 metformin 以減重並降血糖", "C": "腰圍大於 80 公分，屬中央型肥胖（central obesity），應進行腹部脂肪之抽脂手術", "D": "病人屬體重過重，先以飲食與運動治療即可", "language": "tw"}
{"question": "某病毒可引起孩童之急性下呼吸道疾病，經由鼻腔分泌物分離出該病毒，發覺其不具血球凝集作用，但可使感染之細胞融合（syncytia）。該病毒可能為下列何者？", "answer": "呼吸道細胞融合病毒（Respiratory syncytial virus）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "流行性感冒病毒A型（Influenza virus A）", "B": "副流行性感冒病毒（Parainfluenza virus）", "C": "呼吸道細胞融合病毒（Respiratory syncytial virus）", "D": "麻疹病毒（Measles virus）", "language": "tw"}
{"question": "48歲男性B型肝炎患者，腹部超音波發現一大型肝臟腫瘤，且主要肝門靜脈也有腫瘤栓塞，顯微鏡下腫瘤細胞含有膽色素，則下列敘述何者為最有可能的診斷？", "answer": "肝細胞癌", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "膽管癌", "B": "肝臟血管瘤", "C": "肝細胞癌", "D": "轉移性膽囊癌", "language": "tw"}
{"question": "B 群鏈球菌（GBS）常菌集落（colonization）於健康婦女之陰道，易造成新生兒之感染，如敗血症、肺炎及腦膜炎等。新生兒 GBS 感染可分早期（early onset，出生後 7 天內）及晚期（late onset，出生後 7~90 天），則下列敘述何者錯誤？", "answer": "生產期間給予母親抗生素或疫苗接種，兩種方法均可預防早期及晚期新生兒 GBS 感染", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "在生產開始前（before labor）使用抗生素（penicillin）無法可靠地清除陰道之 GBS 菌落，因此無法預防新生兒 GBS 感染", "B": "生產期間（intrapartum）給予母親抗生素可阻斷新生兒 GBS 之 colonization，預防新生兒 GBS 感染", "C": "在懷孕前或懷孕期間給予母親 GBS 疫苗，產生之保護性抗體可通過胎盤，保護新生兒不受 GBS 感染", "D": "生產期間給予母親抗生素或疫苗接種，兩種方法均可預防早期及晚期新生兒 GBS 感染", "language": "tw"}
{"question": "39 歲男性，一個月前開始出現嚴重搔癢性皮疹，皮疹主要分布於指間、手腕及肘窩屈側、肚臍周圍、外陰部、臀部等處。病灶處 KOH 法顯微鏡檢查如圖所示，下列問診項目中，何者與本症之診斷較無關係？", "answer": "糖尿病的病史", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "嚴重搔癢的時間", "B": "糖尿病的病史", "C": "家人是否有類似症狀", "D": "最近的婚外性行為", "language": "tw"}
{"question": "57.一位79歲女性兩星期前不慎滑倒，造成下背痛，無法起立。現在背痛已漸改善，且可用四腳拐杖輔助走路。 X光檢查顯示第二腰椎壓迫性骨折（compression fracture），椎體高度喪失約20%，腰椎前凸（lordosis）仍保持，沒有椎莖破壞（pedicle destruction）。下列何者是病患現在最適當的治療？ \n", "answer": "背架保護加止痛藥物保守治療", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "背架保護加止痛藥物保守治療", "B": "經皮椎體成型手術（percutaneous vertebroplasty）治療", "C": "第一腰椎至第三腰椎後位骨釘固定骨融合手術治療", "D": "椎板切除（laminectomy）神經減壓，加第一腰椎至第三腰椎骨釘固定治療", "language": "tw"}
{"question": "熱帶肺部嗜酸性白血球增多症（tropical pulmonary eosinophilia）的病患常呈現下列特徵，何者除外？", "answer": "大量微絲蟲（microfilaria）會出現在末梢血液中", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "血清中呈現高效價抗絲蟲抗體", "B": "除肺部外，末梢血液中之嗜酸性白血球也增多", "C": "大量微絲蟲（microfilaria）會出現在末梢血液中", "D": "用diethylcarbamazine治療有效", "language": "tw"}
{"question": "有關巴金森氏症（Parkinson's disease），下列敘述何者錯誤？", "answer": "通常會直接投予（口服或注射）多巴胺（dopamine）治療", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "為大腦黑質（substantia nigra）及基底核（basal ganglia）中神經元的多巴胺（dopamine）分泌不足所造成", "B": "患者腦中之退化神經元中常含有由神經絲（neurofilaments）與特定蛋白質交織而成的內含體（Lewy bodies）", "C": "通常會直接投予（口服或注射）多巴胺（dopamine）治療", "D": "腦神經元退化後，通常會有明顯的神經膠樣變性（gliosis）", "language": "tw"}
{"question": "有關鈣離子阻斷劑（calcium channel blocker）治療高血壓，下列敘述何者錯誤？", "answer": "短效的 dihydropyridines 比長效的 dihydropyridines 治療高血壓，更能達到保護心血管效果 15 有關膽管癌（cholangiocarcinoma）的敘述，下列何者錯誤？", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "dihydropyridines（如 nifedipine）易造成 reflex tachycardia", "B": "diltiazem 或 verapamil 可造成房室傳導時間（atrioventricular conduction）延長", "C": "dihydropyridines 易造成下肢水腫", "D": "短效的 dihydropyridines 比長效的 dihydropyridines 治療高血壓，更能達到保護心血管效果 15 有關膽管癌（cholangiocarcinoma）的敘述，下列何者錯誤？", "language": "tw"}
{"question": "承上題，下列關於王女士所需醫療照顧之敘述，何者錯誤？", "answer": "如王女士在急診時仍持續有睡眠障礙，可用長效之 benzodiazepines 治療", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "王女士之精神病症狀可投與 haloperidol 治療 \t", "B": "如王女士在急診時仍持續有睡眠障礙，可用長效之 benzodiazepines 治療", "C": "應避免時常更換不同之照顧者", "D": "王女士於此病改善後，不需長期住院", "language": "tw"}
{"question": "下列何者不適於斷指重接（replantation）？", "answer": "多層（multiple levels）截斷", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "全手掌（complete plam）截斷", "B": "部份大拇指（partial thumb）截斷", "C": "多層（multiple levels）截斷", "D": "多指（multiple digits）截斷", "language": "tw"}
{"question": "臀部肌肉注射時，外上四分之一象限（upper lateral quadrant）是安全部位，下列何者位於此部位？", "answer": "臀中肌（gluteus medius）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "股四方肌（quadratus femoris）", "B": "臀中肌（gluteus medius）", "C": "闊筋膜張肌（tensor fasciae latae）", "D": "髂腰肌（iliopsoas）", "language": "tw"}
{"question": "根據American Burn Association所訂，須到灼傷中心住院的情況，下列敘述何者錯誤？", "answer": "5歲以下，50歲以上，二及三度燒傷大於5% TBSA", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "二及三度燒傷大於10% TBSA", "B": "三度燒傷", "C": "inhalation injury", "D": "5歲以下，50歲以上，二及三度燒傷大於5% TBSA", "language": "tw"}
{"question": "一位 28 歲女性因為長時間杵狀指與肢端發紺到院求治。動脈血氣體分析為：pH 7.45，PaO2 50 mmHg， PaCO2 35 mmHg，HCO3- 24 mmol/L（未使用氧氣），血比容為 65%。給予純氧呼吸 30 分鐘後，再分析動脈血氣體結果為：pH 7.4，PaO2 195 mmHg，PaCO2 39 mmHg，HCO3- 24 mmol/L，胸部X光與肺功能檢驗都正常。最可能造成此病人低血氧的機制為何？", "answer": "血液分流", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "通氣不足", "B": "通氣灌流比異常", "C": "血液分流", "D": "肺部瀰散障礙", "language": "tw"}
{"question": "50 20 歲年輕男性有嚴重頭痛 1 天，身體檢查發現頸部僵硬，體溫 38.8℃，呼吸 26，脈搏 98，血壓 95/45 。腦的肉眼變化如附圖。最可能造成該變化的微生物是： \n", "answer": "Neisseria meningitidis", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "Cryptococcus neoformans", "B": "Mycobacterium tuberculosis", "C": "Toxoplasma gondii \t", "D": "Neisseria meningitidis", "language": "tw"}
{"question": "使用 lamivudine 治療慢性 B 型肝炎，容易使 B 型肝炎病毒產生何種基因之突變？", "answer": "DNA 聚合酶（polymerase）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "B 型肝炎病毒抗原 HBxAg", "B": "B 型肝炎病毒抗原 HBsAg", "C": "B 型肝炎病毒抗原 HBcAg", "D": "DNA 聚合酶（polymerase）", "language": "tw"}
{"question": "一位 70 歲男性，因咳嗽而至門診就診時，發現痰液 acid-fast stain 為陽性。下列的致病菌何者不會呈現 acid-fast stain 陽性？", "answer": "Legionella pneumophila", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "Mycobacterium avium complex", "B": "Legionella pneumophila", "C": "Mycobacterium tuberculosis", "D": "Nocardia asteroides", "language": "tw"}
{"question": "關於先天性免疫力（innate immunity）相關的基因突變會導致嚴重的原發性免疫缺損疾病的敘述，下列何者正確？", "answer": "白血球黏著分子缺損可能會導致新生兒臍帶傷口延遲癒合", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "NEMO 的突變不會影響先天性免疫力", "B": "慢性肉芽腫病的病患易受肝炎病毒感染", "C": "白血球黏著分子缺損可能會導致新生兒臍帶傷口延遲癒合", "D": "Toll-like receptor 的缺損不會導致對病毒的免疫缺損", "language": "tw"}
{"question": "倒生性乳頭瘤（inverted papilloma）最常發生於鼻腔之何處？", "answer": "鼻側壁", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "鼻中隔", "B": "鼻前庭", "C": "鼻側壁", "D": "鼻底部", "language": "tw"}
{"question": "下列何種材料是目前最常被用來修補耳膜破孔？", "answer": "自體顳肌膜（temporalis fascia）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "自體顳肌膜（temporalis fascia）", "B": "自體皮瓣（pedicle flap）", "C": "自體全層皮膚移植片（full thickness skin graft）", "D": "自體分層皮膚移植片（split thickness skin graft）", "language": "tw"}
{"question": "27 下列關於粒線體（mitochondria）的敘述，何者錯誤？  ", "answer": "mitochondrial genome mutation 通常遺傳自母親", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "含有自己的 genome", "B": "電子傳遞鍊（electron transport system）之基因，全位於 mitochondrial genome", "C": "mitochondrial genome mutation 常造成先天神經肌肉或內分泌疾病", "D": "mitochondrial genome mutation 通常遺傳自母親", "language": "tw"}
{"question": "目前所訂定的鉛中毒標準，對小孩族群之保護遠比對成人嚴格，主要來自下列那一系統或器官的毒性效應？", "answer": "造血系統", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "呼吸系統", "B": "周圍神經系統", "C": "造血系統", "D": "肝", "language": "tw"}
{"question": "輪狀病毒（Rotavirus）和挪瓦克病毒（Norwalk virus）屬於不同病毒，但它們共同具有下列何種特性？", "answer": "可經由糞-口傳播", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "可經由糞-口傳播", "B": "均是雙股 RNA", "C": "均是單股 RNA", "D": "可經由游泳傳播", "language": "tw"}
{"question": "被下列那一種人體寄生蟲嚴重感染後，患者會出現腸阻塞（bowel obstruction）的臨床症狀？", "answer": "蛔蟲（Ascaris lumbricoides）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "橫川氏吸蟲（Metagonimus yokogawai）", "B": "旋毛蟲（Trichinella spiralis）", "C": "蛔蟲（Ascaris lumbricoides）", "D": "棘顎口線蟲（Gnathostoma spinigerum）", "language": "tw"}
{"question": "下列那一種麻醉劑，在可產生外科麻醉的濃度下，所需要的誘導時間最短？", "answer": "nitrous oxide", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "nitrous oxide", "B": "benzodiazepines", "C": "methoxyflurane", "D": "halothane", "language": "tw"}
{"question": "下列有關頭痛的現象之中，何者最需要讓病人接受腦部磁振造影或電腦斷層攝影？", "answer": "最近常在凌晨因頭痛而醒過來，且常伴隨噁心嘔吐", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "頭痛通常發生在單側  \t", "B": "頭痛已經十年，型態及嚴重度都沒有變化", "C": "最近常在凌晨因頭痛而醒過來，且常伴隨噁心嘔吐", "D": "頭痛之前常有閃光性的視野缺損（scintillating scotoma）", "language": "tw"}
{"question": "乳房X光攝影之篩檢報告為breast imaging reporting and data system（BI-RADS）category 0，下列的處置何者最適當？", "answer": "加做乳房超音波", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "一年後再追蹤", "B": "直接手術切片", "C": "細胞針刺檢查", "D": "加做乳房超音波", "language": "tw"}
{"question": "朱女士，45 歲，20 年前因開刀輸血感染 C 型肝炎，目前 AST 60 U/L，ALT 85 U/L，肝生檢（biopsy）顯示為第二期（Metavir F2）之肝纖維化。下列敘述何者錯誤？", "answer": "朱女士可接受抗病毒治療", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "朱女士應定期接受肝癌篩檢，包括腹部超音波和甲型胎兒蛋白", "B": "朱女士可接受抗病毒治療", "C": "目前 C 型肝炎之標準治療為長效型干擾素（pegylated interferon）合併雷巴威林（ribavirin）和蛋白酵素抑制劑（protease inhibitor）", "D": "若能清除 C 型肝炎病毒，可減少肝硬化和肝癌之風險", "language": "tw"}
{"question": "有關Trisomy18（Edwards syndrome）的敘述，下列何者錯誤？", "answer": "經過良好治療，90%可存活至成年", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "容易早產", "B": "窄及外展受限的髖關節（Narrow hips with limited abduction）", "C": "經過良好治療，90%可存活至成年", "D": "存活者有嚴重的神經學發展遲緩", "language": "tw"}
{"question": "60 歲女性病人，20 年前有右側乳癌做過 irradiation，發現右側甲狀腺硬塊約二個月，則應建議做何檢查？", "answer": "超音波定位細胞學檢查", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "T3, T4, TSH", "B": "超音波定位細胞學檢查", "C": "核磁共振", "D": "血管攝影", "language": "tw"}
{"question": "咖啡因（caffeine）戒斷之最常見症狀為何？", "answer": "頭痛", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "入睡困難", "B": "頭痛", "C": "心搏過速", "D": "手抖", "language": "tw"}
{"question": "有關脂漏性⽪膚炎（seborrheic dermatitis）的敘述，下列何者錯誤？", "answer": "外⽤抗黴菌藥物不能有效治療脂漏性⽪膚炎", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "好發在頭⽪、眉⽑、⿐⼦兩側、⽿朵後⾯", "B": "常發於嬰兒和成⼈", "C": "外⽤抗黴菌藥物不能有效治療脂漏性⽪膚炎", "D": "若是病程頑固且臨床表現不尋常，需留意HIV感染", "language": "tw"}
{"question": "能引起體內產生較強抗體反應的蛋白質抗原，一般具有何特性？", "answer": "與反應個體的體內分子差異大", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "分子量很小（MW < 2500）", "B": "結構簡單、複雜度不高", "C": "與反應個體的體內分子差異大", "D": "進入體內可以很快完全釋放", "language": "tw"}
{"question": "老化過程中會發生許多生理變化，下列何種變化在正常老人最常見？", "answer": "心房利鈉激素（atrial natriuretic hormone）分泌增加", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "腎素（renin）分泌增加 \t", "B": "腎上腺皮質醛酮（aldosterone）分泌增加", "C": "心房利鈉激素（atrial natriuretic hormone）分泌增加", "D": "抗利尿激素（antidiuretic hormone）分泌減少", "language": "tw"}
{"question": "有關精索靜脈曲張（varicocele）的敘述，下列何者錯誤？", "answer": "精子的濃度和運動力可不受影響", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "年紀大的人突然發生精索靜脈曲張，有時是腎臟腫瘤的表現", "B": "精子的濃度和運動力可不受影響", "C": "進行 valsalva maneuver 時精索靜脈曲張會更明顯", "D": "外科手術是結紮 internal spermatic veins", "language": "tw"}
{"question": "⼦宮外孕病患選擇內科單⼀化學藥物methotrexate（葉酸拮抗劑）治療後，第4天⾄第7天抽⾎檢驗⾎清⼈類絨⽑膜性腺激素值（human chorionic gonadotropin），根據美國⽣殖醫學會2013年建議，若下降幅度沒有達到多少百分比，可以考慮接受追加第⼆劑methotrexate治療？", "answer": "15%", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "45%", "B": "35%", "C": "25%", "D": "15%", "language": "tw"}
{"question": "有關長期照護與醫療照護之比較，下列敘述何者錯誤？", "answer": "長期照護以機構式照顧為主", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "長期照護主要的對象為慢性病患或身心障礙之失能或失智者", "B": "醫療照護對象包括急性病患與慢性病患", "C": "長期照護以機構式照顧為主", "D": "醫療照護之照顧概念主要為治\t疾病", "language": "tw"}
{"question": "下列何者不屬於大腸的特徵？", "answer": "環狀皺襞（plicae circulares）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "環狀皺襞（plicae circulares）", "B": "結腸袋（haustrae coli） \t \t", "C": "腸脂垂（appendices epiploicae）", "D": "結腸帶（taeniae coli）", "language": "tw"}
{"question": "承上題，經過一系列臨床檢查後，發現她患有子宮頸癌第 Ib 期，她住院檢查並接受根除性子宮切除手術及骨盆腔淋巴結摘除手術。但是手術後病患自覺大腿無法內收，大腿內側感覺變差，且症狀並沒有慢慢好轉。請問最有可能的原因為何？", "answer": "手術中傷到 obturator nerve", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "手術後淋巴水腫，壓迫骨盆神經", "B": "手術中傷到 pudendal nerve", "C": "手術中下肢使用彈性繃帶過久，導致神經壓迫損傷 \t", "D": "手術中傷到 obturator nerve", "language": "tw"}
{"question": "一位 23 歲男性，主訴下背疼痛且傳導至右下肢已數月之久。理學檢查發現兩側肌力 5 分，straight leg raising test（SLRT）右側 20°，左側 70°；雙側深部肌腱反射（DTR）正常，疼痛位置約在第五腰椎神經根支配處。則最有可能的診斷是：", "answer": "腰椎椎間盤突出", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "腰椎腫瘤", "B": "腰椎椎間盤突出", "C": "腰椎滑脫", "D": "腰椎肌肉肌腱炎", "language": "tw"}
{"question": "陳先生，60 歲，每天均要喝酒，尤其晚餐還常不吃飯，由媳婦預備小菜下酒，同時吹吹年輕時的英雄故事，三天前腹痛住院，醫生懷疑腸胃有問題，因此一切飲食均由醫院嚴格管制，陳先生剛開始出現失眠、發抖的症狀，從昨天開始出現視幻覺，看到滿身爬滿蟲子，不停大叫並往外衝。陳先生最可能的診斷為：", "answer": "酒精戒斷", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "鎮靜劑服用過量中毒", "B": "酒精戒斷", "C": "妄想症", "D": "老年性痴呆", "language": "tw"}
{"question": "醫療法規定下列何種醫療機構應提撥年度結餘的百分之二十以上作為營運基金？", "answer": "社團法人醫療機構", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "公立醫療機構", "B": "財團法人醫療機構", "C": "社團法人醫療機構", "D": "教學醫院", "language": "tw"}
{"question": "一位 60 歲礦工，主訴乾咳及胸痛，組織切片顯示有黑色的色素沈積在肺、肋膜及淋巴結，其最可能的病理診斷為：", "answer": "碳沈積症", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "碳沈積症", "B": "矽沈積症", "C": "肺癌", "D": "黑色素癌", "language": "tw"}
{"question": "在長期使用類精神疾病治療藥物時，常會伴隨著錐體外症狀（extrapyramidal syndrome）的發生，其主要的原因係下列那種受體被阻斷所產生的結果？", "answer": "dopamine", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "muscarinic", "B": "dopamine", "C": "α-adrenergic", "D": "serotonin", "language": "tw"}
{"question": "下列何者不屬於豎脊肌（erector spinae）？", "answer": "半棘肌（semispinalis）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "半棘肌（semispinalis）", "B": "棘肌（spinalis）", "C": "最長肌（longissimus）", "D": "髂肋肌（iliocostalis）", "language": "tw"}
{"question": "門診來了一位52歲男性進行體檢，身高167公分，體重87公斤，平日沒有不適。身體診察發現血壓132/84毫米汞柱，心跳每分鐘72次，身體質量指數（BMI）31 kg/m2，其他身體檢查正常。在目前的血壓值所處的範圍，考慮前面的敘述，下列那一種生活型態修正對於降低血壓數值的效果最明顯？", "answer": "減重大約九公斤", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "每天慢走十分鐘，每週四次", "B": "每天作息正常", "C": "減重大約九公斤", "D": "每日限鹽小於六公克", "language": "tw"}
{"question": "57 歲男性，由其女兒送至急診室，外觀衣衫襤褸、步態不穩，面無表情不回答問題。據其女兒所述，病患每天酗酒不太進食，最近視力漸差，急診的第一步處置應為：", "answer": "靜脈注射 thiamine，再給予靜脈輸液", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "靜脈注射含葡萄糖輸液", "B": "會診神經內科醫師", "C": "靜脈注射 MgSO4", "D": "靜脈注射 thiamine，再給予靜脈輸液", "language": "tw"}
{"question": "關於糖尿病（diabetes mellitus）診斷之敘述，下列何者錯誤？", "answer": "餐後兩小時血漿葡萄糖濃度大於等於 180 mg/dL", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "空腹血漿葡萄糖濃度大於等於 126 mg/dL", "B": "餐後兩小時血漿葡萄糖濃度大於等於 180 mg/dL", "C": "糖化血紅素（hemoglobin A1c）大於 6.5%", "D": "有口渴多尿及不明原因體重減輕時，隨機血漿葡萄糖濃度大於等於 200 mg/dL", "language": "tw"}
{"question": "李先生參加農耕隊服務於巴西，回國後腳部皮膚有出疹現象，診斷為泳者之癢（swimmer's itch），請問下列敘述何者正確？", "answer": "止癢劑（antipruritic）及抗組織胺（antihistamine）可舒緩症狀", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "止癢劑（antipruritic）及抗組織胺（antihistamine）可舒緩症狀", "B": "使用 mebendazole 可治療痊癒", "C": "在皮下組織一段時間後會在骨骼肌中形成包囊", "D": "是因人類血吸蟲尾動幼蟲（cercaria）感染而引起", "language": "tw"}
{"question": "物理治療常常使用熱療來治療疼痛或是肌肉骨骼的問題。下列有關熱療的敘述，何者錯誤？", "answer": "降低代謝", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "增加血流量", "B": "降低代謝", "C": "減少關節僵直程度", "D": "增加神經傳導速度", "language": "tw"}
{"question": "一個40週出生2,000公克的新生兒，在出生後第2小時出現呼吸喘快、有肋骨下凹陷、全身發紅但嘴唇為紫紅色的現象，體溫脈博正常，檢測血糖值為30 mg/dL。接下來應做何種檢\t最為重要？", "answer": "血球血比容（Hematocrit）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "C反應蛋白（CRP）", "B": "血球血比容（Hematocrit）", "C": "心臟超音波（Heart ultrasound）", "D": "血液鈉離子濃度（Serum sodium concentration）", "language": "tw"}
{"question": "如圖所示之皮疹發生於頭皮、軀幹、手肘及膝蓋處，下列敘述何者正確？", "answer": "311 nm 窄波紫外線 B 光是有效的治療方法", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "是一種黴菌感染", "B": "311 nm 窄波紫外線 B 光是有效的治療方法", "C": "無同形現象（isomorphic phenomenon）", "D": "口服類固醇是最佳處置", "language": "tw"}
{"question": "37歲孕婦，G1P0，妊娠39週，生產後如圖所示：", "answer": "fourth-degree laceration", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "first-degree laceration", "B": "second-degree laceration", "C": "third-degree laceration", "D": "fourth-degree laceration", "language": "tw"}
{"question": "病人雙眼顳側偏盲（bitemporal hemianopia），其病灶位於何處？", "answer": "視交叉（optic chiasma）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "視神經（optic nerve）", "B": "眼窩（orbital fossa）", "C": "視神經管（optic canal）", "D": "視交叉（optic chiasma）", "language": "tw"}
{"question": "下列有關兒童生長與兒童發展的描述，何者最為完整？", "answer": "兒童的發展涵蓋了動作發展、語言發展、認知發展、社會情緒發展及自我照顧發展", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "生長（growth）是指一些技巧的成熟與功能的獲得", "B": "發展（development）是指兒童生理性的變化，如身高、體重及頭圍的變化", "C": "兒童的發展涵蓋了動作發展、語言發展、認知發展、社會情緒發展及自我照顧發展", "D": "丹佛發展篩檢量表（Denver II）是評估 6 歲以上兒童的發展", "language": "tw"}
{"question": "當抗原侵入血液循環時，B 及 T 細胞免疫反應在何處發生？", "answer": "脾臟", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "血液", "B": "肝臟", "C": "脾臟", "D": "淋巴結", "language": "tw"}
{"question": "maple syrup urine disease 是因為下列那個胺基酸無法代謝，造成 α-keto acids 在血液裡累積？", "answer": "leucine", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "leucine", "B": "alanine", "C": "glycine", "D": "histidine", "language": "tw"}
{"question": "股動脈閉塞一段時間後將導致血管舒張之代謝產物生成，其原因為何？", "answer": "氧供應低於氧需求 \t", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "氧供應高於氧需求 \t", "B": "氧供應低於氧需求 \t", "C": "氧供應與氧需求達到新平衡", "D": "與氧供應對氧需求之比值無關", "language": "tw"}
{"question": "李小姐習慣長時間於電腦前工作，她有雙眼近視，右眼約一千五百度，左眼一千九百度，日常生活和近距離工作時配戴一般眼鏡。她注意到有些漂浮物在視線周邊已有一段時間。一週前，李小姐開始覺得左眼的視野裡漂浮物越來越多，偶爾還伴有閃光。三天前，她的左眼在下鼻側漸漸變成像窗簾一般遮住她的視線。今天早上，她覺得症狀越來越嚴重，到醫院求診後住院做進一步的檢查和處置。住院當時，她的右眼以一千五百度鏡片矯正後的最佳矯正視力為 6/12，左眼以一千三百度鏡片矯正後的最佳矯正視力為 6/12，她的角膜狀態，瞳孔光反射，水晶體及眼壓都是正常的。視網膜檢查較可能的發現為何？", "answer": "左眼外上側視網膜剝離", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "兩眼外上側視網膜下出血", "B": "左眼外上側視網膜剝離", "C": "兩眼內下側之脈絡膜腫瘤", "D": "左眼內下側視網膜靜脈血管阻塞", "language": "tw"}
{"question": "一個一歲 6 個月的男童，剛出生時，在胸骨左側上緣可以聽到心縮期雜音，慢慢地嘴唇及指端有發紺的現象，發育尚稱良好，但在玩耍至某一程度，發紺會更厲害，無法繼續玩下去，必須在旁邊蹲坐一陣子再回去玩，胸部 X 光檢查及心電圖如圖示，則此病童最可能有何種疾病？", "answer": "一定是有肺動脈血流不足的先天性心臟病", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "大動脈血管轉位症，體動脈接受缺氧血所造成的", "B": "一定是有肺動脈血流不足的先天性心臟病", "C": "可能是肺囊狀纖維化（Cystic fibrosis）之疾病", "D": "可能是先天性肺動脈高壓症", "language": "tw"}
{"question": "一位 6 歲的女生，罹患彌漫增生型狼瘡性腎炎（diffuse proliferative lupus nephritis），已接受每天 30 mg 口服 prednisolone 2 個月，最近學校通知要施打疫苗（vaccination），下列何者易發生嚴重副作用，不宜施打？", "answer": "Measles, mumps 及 rubella vaccine", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "Haemophilus influenza type b conjugate vaccine", "B": "Influenza vaccine", "C": "Measles, mumps 及 rubella vaccine", "D": "Tetanus 及 diphtheria toxoid vaccine", "language": "tw"}
{"question": "一位 61 歲男性主訴倦怠，四個月以來逐漸嚴重。病人血清肌酸酐及尿素氮明顯增加，尿液試紙檢驗，無血尿、尿蛋白或尿糖情形，但本斯瓊司氏蛋白（Bence Jones proteins）測試陽性。腎切片檢查如下圖所示。病人之基本病因為何？", "answer": "多發性骨髓瘤（Multiple myeloma）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "風濕熱（Rheumatic fever）", "B": "多發性骨髓瘤（Multiple myeloma）", "C": "僵直性脊椎炎（Ankylosing spondylitis）", "D": "系統性硬化症（Systemic sclerosis）", "language": "tw"}
{"question": "舌癌最容易發生在那一部位？", "answer": "舌頭側邊", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "舌頭前端", "B": "舌根部", "C": "舌頭側邊", "D": "舌頭中間部位", "language": "tw"}
{"question": "一位 2 歲大的男童，自出生 6 個月後反覆有中耳炎、細菌性鼻竇炎及肺炎，雖然施打卡介苗，直至目前並無任何關於卡介苗的併發症，除了一般常規的 CBC/DC 檢查之外，你認為下列何種檢測最能查出病因？", "answer": "Immunoglobulins level（IgG, A, M, E）& lymphocyte subsets", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "Lymphocyte proliferation test including antigens and mitogens stimulation", "B": "Immunoglobulins level（IgG, A, M, E）& lymphocyte subsets", "C": "PMN function tests, including chemotaxis, nitroblue tetrazolium test, CD11/CD18 expression及phagocytosis", "D": "HIV 1+2 Ab", "language": "tw"}
{"question": "16.一35歲過去無特殊病史之已婚女性，因兩天的發燒、頻尿、左腰痛求診。急診所做血液培養：Staphylococcus epidermidis （只在一瓶需氧血液培養瓶長出；另一瓶厭氧瓶及另一\t血液培養，則無細菌生長）; 尿液常規有膿尿症，尿液培養：\n", "answer": "依尿液培養報告選擇抗生素，治療E. coli泌尿道感染", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "安排心臟超音波，尋找感染性心內膜炎之證據", "B": "依血液培養報告選擇抗生素，積極治療S. epidermidis菌血症", "C": "依尿液培養報告選擇抗生素，治療E. coli泌尿道感染", "D": "依血液與尿液培養報告選擇抗生素，同時治療S. epidermidis菌血症與E. coli泌尿道感染", "language": "tw"}
{"question": "49 一位 39 歲男性，因為持續 3 週的血痰與呼吸喘促到院求治。胸部 X 光與胸部電腦斷層顯示兩側多發性實質化與毛玻璃樣浸潤。尿液檢查有許多紅血球。理學檢查發現後鼻腔有黏膜增厚，疑似腫塊。 下列那種檢驗對於確立診斷效益最低？ \n", "answer": "anti-cardiolipin antibody", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "cytoplasmic antineutrophil cytoplasmic antibody（c-ANCA）", "B": "anti-glomerular basement membrane（GBM）antibody", "C": "anti-cardiolipin antibody", "D": "鼻腔腫塊活體切片", "language": "tw"}
{"question": "46歲生過四胎之婦女，於第四胎生產時接受輸卵管結紮手術。現因不正常陰道出血而就醫，經陰道診視發現子宮頸表面平滑，血液自子宮頸口處流出，觸診發現子宮大小正常無觸痛之情形。經陰道超音波掃瞄子宮大小正常無內膜增生之情形，然而於子宮附屬物區發現有香腸般水囊狀物，最長部位為9.5公分而最寬部位為3.9公分，此水囊狀物最適合之診斷為：", "answer": "輸卵管水腫（hydrosalpinx）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "尿道憩室（urethral diverticulum）", "B": "盲腸炎（appendicitis）", "C": "輸尿管水腫（hydroureter）", "D": "輸卵管水腫（hydrosalpinx）", "language": "tw"}
{"question": "40歲女性，患蜘蛛膜下腔出血（subarachnoid hemorrhage），檢查發現囊狀動脈瘤出血，下列敘述何者正確？", "answer": "若該血管瘤為剝離性動脈瘤（dissecting aneurysm）而非囊狀動脈瘤，它的臨床表現通常是大腦梗塞（cerebral infarct）而非出血", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "該血管瘤在病人出生時即已存在", "B": "主要的缺損是血管的內膜（intima）", "C": "病人的一等親患此病的機率與一般人相同 \t", "D": "若該血管瘤為剝離性動脈瘤（dissecting aneurysm）而非囊狀動脈瘤，它的臨床表現通常是大腦梗塞（cerebral infarct）而非出血", "language": "tw"}
{"question": "一名 13 歲 9 個月男童因為身材矮小而就診，他出生時體重 3 公斤。他的父親身高 162 公分，第二性徵發育始於 14 歲；母親身高 152 公分，初經年齡為 13 歲。此孩童身體檢查顯示身高 137 公分（低於第三百分位），體重 32 公斤（第十百分位），左右睪丸均為 2 毫升，無陰毛發育，其他器官亦未發現異常。下列那一項檢查就此個案言最不適切？", "answer": "單次空腹抽血測生長激素（growth hormone）值", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "骨齡（bone age）X 光檢查", "B": "單次空腹抽血測生長激素（growth hormone）值", "C": "單次空腹抽血測第一型似胰島素生長因子（insulin-like growth factor）值", "D": "腦部影像醫學檢查（image study）", "language": "tw"}
{"question": "下列何者引起血小板增加的可能性最小？", "answer": "肝硬化", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "慢性骨髓性白血病", "B": "肝硬化", "C": "脾臟切除", "D": "缺鐵性貧血", "language": "tw"}
{"question": "阻塞性肥厚型心肌病症患者之聽診，所聽到的收縮期心雜音，可因下列何項操作而減輕甚至消失？", "answer": "蹲踞", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "蹲踞", "B": "站立", "C": "使用毛地黃", "D": "含舌下硝化甘油含片", "language": "tw"}
{"question": "關於腕隧道症候群（carpal tunnel syndrome），下列何者錯誤？", "answer": "在小指（第五指）有麻痺感", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "在小指（第五指）有麻痺感", "B": "在晚上（或不工作）時，大拇指和第二、第三指有痛感", "C": "嚴重時手部的肌肉萎縮", "D": "患者中女性較男性為多", "language": "tw"}
{"question": "下列何者不是造成新生兒先天性感染之重要病原體？", "answer": "麻疹病毒", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "巨細胞病毒", "B": "梅毒螺旋體", "C": "弓蟲症", "D": "麻疹病毒", "language": "tw"}
{"question": "cyclosporine-A（CsA）是異體造血幹細胞移植（allogeneic hematopoietic stem cell transplantation）用來預防移植物反宿主疾病（graft-versus-host disease）的重要免疫抑制劑，下列何者不是CsA常見的副作用？", "answer": "hyperglycemia", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "hypertension", "B": "hyperlipidemia", "C": "hyperglycemia", "D": "nephrotoxicity", "language": "tw"}
{"question": "一位長期喝酒之 40 歲男性患者因急性胰臟炎住院治療，不料第二天開始出現顫抖、流汗、血壓增高、心跳變快、焦慮不安、煩躁失眠、有視幻覺及被害妄想，之後並出現癲癇發作及意識混亂，亂拔點滴，下列敘述何者正確？", "answer": "應給予大劑量苯二氮平類（benzodiazepines）的抗焦慮劑，但不需給予抗癲癇藥", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "應立即予以肢體約束，並注射鎮靜效果強的傳統抗精神病藥物", "B": "應給予大劑量苯二氮平類（benzodiazepines）的抗焦慮劑，但不需給予抗癲癇藥", "C": "胰臟炎與酒精性譫妄（alcohol withdrawal delirium）的產生沒有關聯", "D": "正子斷層造影（positron emission tomography）可能顯示左頂葉及右額葉代謝明顯增加", "language": "tw"}
{"question": "風濕性心臟病（rheumatic heart disease）最常侵犯：", "answer": "二尖瓣膜（mitral valve）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "主動脈瓣膜（aortic valve）", "B": "二尖瓣膜（mitral valve）", "C": "肺動脈瓣膜（pulmonary valve）", "D": "三尖瓣膜（tricuspid valve）", "language": "tw"}
{"question": "林先生主訴看東西影像會晃動，經檢查為雙側對稱性水晶體上顳側脫位（supero-temporal subluxation），會建議他作何種遺傳性疾病檢查？", "answer": "馬凡氏症候群（Marfan syndrome）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "半乳糖血症（galactosemia）", "B": "威爾遜氏病（Wilson's disease）", "C": "馬凡氏症候群（Marfan syndrome）", "D": "愛伯氏症候群（Alport syndrome）", "language": "tw"}
{"question": "下列何者不是 cAMP 媒介之藥理作用？", "answer": "norepinephrine 促進血管收縮", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "vasopressin 促進腎臟對水分之再吸收", "B": "norepinephrine 促進血管收縮", "C": "epinephrine 促進肝醣分解", "D": "epinephrine 促進脂肪細胞分解三酸甘油酯", "language": "tw"}
{"question": "對於細菌莢膜（capsule）之敘述，下列何者正確？", "answer": "能幫助細菌抵抗吞噬作⽤（phagocytosis）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "主要成分為胜肽聚醣（peptidoglycan）", "B": "所有細菌皆有多醣類莢膜", "C": "導致⾰蘭⽒染⾊（Gram stain）反應的主要原因", "D": "能幫助細菌抵抗吞噬作⽤（phagocytosis）", "language": "tw"}
{"question": "FAP（Familial adenomatous polyposis）病人之形成大腸直腸癌與下列何者有關？", "answer": "Tumor suppressor gene mutation", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "Tumor suppressor gene mutation", "B": "DNA mismatch repair gene mutations", "C": "myc oncogene \t", "D": "erb B2 oncogene", "language": "tw"}
{"question": "38 在有慢性溶血疾病的病人，下列何種病毒感染會導致暫時性的再生不良性貧血（transient aplastic  crisis）？ \n", "answer": "Parvovirus B19", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "human immunodeficiency virus（HIV）", "B": "Parvovirus B19", "C": "Coxsackievirus \t", "D": "Enterovirus 39 \t下列何種藥物會使 Lambert-Eaton 肌無力症候群症狀惡化？", "language": "tw"}
{"question": "79 大維因車禍昏迷不醒至今已三年多，其同卵雙胞胎弟弟國明因上星期發生猛爆性肝炎而危在旦夕。雖然大維的肝功能正常且與國明有相同基因，但醫師並沒有提出要摘取大維肝臟來救國明的建議。 在倫理上，下列各項中何者是醫師不提這項建議最為重要的理由？ \n", "answer": "大維無法同意捐贈肝臟給國明", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "國明並未同意接受大維的捐贈", "B": "為免大維的父母陷入兩難選擇", "C": "成功機率過低而不應貿然提出", "D": "大維無法同意捐贈肝臟給國明", "language": "tw"}
{"question": "食用未熟之海水魚類，會感染下列何種寄生蟲？", "answer": "海獸胃線蟲（Anisakis simplex）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "海獸胃線蟲（Anisakis simplex）", "B": "美洲鈎蟲（Necator americanus）", "C": "廣東住血線蟲（Angiostrongylus cantonensis）", "D": "中華肝吸蟲（Clonorchis sinensis）", "language": "tw"}
{"question": "下運動神經元（lower motor neurons）的損傷會導致下列那一種疾病？", "answer": "amyotrophic lateral sclerosis", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "Parkinson's disease", "B": "Huntington's disease", "C": "amyotrophic lateral sclerosis", "D": "myasthenia gravis", "language": "tw"}
{"question": "踝關節受傷機轉以下列何者最多？", "answer": "旋後外轉（Supination-External rotation）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "旋前外轉（Pronation-External rotation）", "B": "旋前外展（Pronation-Abduction）", "C": "旋後內收（Supination-Adduction）", "D": "旋後外轉（Supination-External rotation）", "language": "tw"}
{"question": "針對衛生教育計畫本身執行過程給予評核，如教學活動安排時間是否合適、教學者能否熟用教學法、學習者是否全程參與教學活動等，是屬於下列那一種衛生教育的評價？", "answer": "過程評價", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "結果評價", "B": "過程評價", "C": "衝擊評價", "D": "成效評價", "language": "tw"}
{"question": "所謂「健康工人效應（healthy worker effect）」是指會造成何種偏差（bias）？", "answer": "選樣上偏差（selection bias）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "選樣上偏差（selection bias）", "B": "資料上偏差（information bias）", "C": "干擾（confounding）", "D": "測量上偏差（measurement error）", "language": "tw"}
{"question": "瘦素（leptin）會抑制食慾，使得體重得以維持恆定，是因為其促進下列何種傳導物質，進而抑制進食中樞所致？", "answer": "α-melanocyte stimulating hormone（α-MSH）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "α-melanocyte stimulating hormone（α-MSH）", "B": "neuropeptide Y（NPY）", "C": "orexin", "D": "agouti-related peptide（AgRP）", "language": "tw"}
{"question": "下列何者是不可改善的心臟疾病危險因子？", "answer": "家族史", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "高血壓", "B": "家族史", "C": "吸煙", "D": "靜態（sedentary）生活", "language": "tw"}
{"question": "下列何者非 schizophrenia 病人到急診的常見原因？", "answer": "失眠", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "藥物未按時服用", "B": "服藥產生之副作用", "C": "自殺行為", "D": "失眠", "language": "tw"}
{"question": "16 歲男孩，主訴鼻塞、濃稠鼻涕已經超過一年。根據此張 plain CT 片，最可能的診斷是：", "answer": "Chronic paranasal sinusitis", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "Chronic rhinitis", "B": "Chronic paranasal sinusitis", "C": "Fungal infection in the paranasal sinuses", "D": "Tumors in the paranasal sinuses", "language": "tw"}
{"question": "關於轉化症（conversion disorder〔functional neurological symptom disorder〕）的敘述，何者錯誤？", "answer": "最佳的治療方式為告知患者其症狀是想像出來的", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "常見於戲劇型人格（histrionic personality disorder）", "B": "癱瘓（paralysis）、視盲（blindness）、不語（mutism）是最常見的症狀", "C": "在男性患者中，與反社會型人格障礙症（antisocial personality disorder）相關", "D": "最佳的治療方式為告知患者其症狀是想像出來的", "language": "tw"}
{"question": "下列何者不是蕈毒鹼受體阻斷劑（muscarinic receptor-blocking drugs）之臨床用途？", "answer": "青光眼（glaucoma）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "青光眼（glaucoma）", "B": "動暈症（motion sickness）", "C": "支氣管擴張（bronchodilation）", "D": "帕金森氏症（Parkinson's disease）", "language": "tw"}
{"question": "有關發紺（cyanosis）之敘述，下列何者錯誤？", "answer": "血紅素蛋白（hemoglobin）異常或病變會造成貧血，但不會引起 central cyanosis", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "週邊血管收縮是造成 peripheral cyanosis 最常見的原因", "B": "動脈血氧濃度過低，是造成 central cyanosis 的原因", "C": "血紅素蛋白（hemoglobin）異常或病變會造成貧血，但不會引起 central cyanosis", "D": "central cyanosis 有時會造成杵狀指（clubbing fingers）", "language": "tw"}
{"question": "下列何者不是人工膝關節置換手術後復健計畫的重點？", "answer": "臥床休息以預防人工關節過早磨損", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "減少疼痛 \t", "B": "恢復關節活動度", "C": "恢復及增加肌力 \t", "D": "臥床休息以預防人工關節過早磨損", "language": "tw"}
{"question": "李女士在健康檢查時血液中的 antinuclear antibody（ANA）價數達到 1：8（titer 1：8），她沒有身體不適，也沒有其他的檢驗值異常。出現 ANA 自體抗體的意義為何？", "answer": "某種低程度的自體免疫性是身體正常免疫功能運作的一部分", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "應是檢驗錯誤，需重新抽血再測一次 \t", "B": "李女士已得到紅斑性狼瘡", "C": "李女士即將於近期發病，得到紅斑性狼瘡", "D": "某種低程度的自體免疫性是身體正常免疫功能運作的一部分", "language": "tw"}
{"question": "評估支氣管哮喘病患急性發作時，下列何種理學檢查結果不能作為哮喘嚴重度指標？", "answer": "使用噘嘴呼吸（pursed-lip breathing）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "使用輔助肌吸氣（accessory muscle）", "B": "使用噘嘴呼吸（pursed-lip breathing）", "C": "胸腔過度充氣（hyperinflation）", "D": "有奇異脈（paradoxical pulse）", "language": "tw"}
{"question": "在⼼臟無異常的病⼈置放flow-directed pulmonary artery catheter錄肺動脈楔壓（wedge pressure）時，其肺動脈楔壓最接近下列何種⾎壓？", "answer": "left ventricular end-diastolic pressure", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "aortic diastolic pressure", "B": "central venous pressure", "C": "left ventricular end-diastolic pressure", "D": "pulmonary artery systolic pressure", "language": "tw"}
{"question": "有關嗜鉻細胞瘤（Pheochromocytoma）的治療，下列那一項敘述正確？", "answer": "病人雖然血壓高低不定，仍應給予 alpha adrenergic blocker", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "病人已有高血壓，應避免給予輸液", "B": "需首先給予 beta adrenergic blocker，以改善流汗頭痛等症狀", "C": "病人雖然血壓高低不定，仍應給予 alpha adrenergic blocker", "D": "絕對禁用 calcium-channel blocker 以避免血壓變化太大", "language": "tw"}
{"question": "有關中耳（middle ear）的敘述，下列何者正確？", "answer": "中耳腔又稱鼓室（tympanic cavity）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "聽管（auditory or Eustachian tube）平時是開的，僅在吞嚥或喊叫才關閉", "B": "三塊聽骨為透明軟骨", "C": "中耳腔又稱鼓室（tympanic cavity）", "D": "聽小骨間藉由韌帶聯合而形成關節", "language": "tw"}
{"question": "目前治療晚期（advanced）上皮性卵巢癌化學療法的第一線藥物為何？", "answer": "carboplatin＋paclitaxel", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "cisplatin＋5FU", "B": "carboplatin＋paclitaxel", "C": "cisplatin＋cyclophosphamide", "D": "carboplatin＋cyclophosphamide", "language": "tw"}
{"question": "小腦天幕（cerebellar tentorium）不附著於：", "answer": "顴骨（zygomatic bone）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "蝶骨（sphenoid bone）", "B": "枕骨（occipital bone）", "C": "顳骨（temporal bone）", "D": "顴骨（zygomatic bone）", "language": "tw"}
{"question": "下列何種病原體通常引起非典型肺炎（atypical pneumonia）？", "answer": "Mycoplasma pneumoniae", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "Streptococcus pneumoniae", "B": "Mycobacterium avium-intracellulare", "C": "Mycoplasma pneumoniae", "D": "Nocardia", "language": "tw"}
{"question": "⼀研究想比較抽菸者與非抽菸者的⾎膽固醇濃度，下列敘述何者錯誤？", "answer": "型⼀錯誤加型⼆錯誤的機率和為1", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "檢定時犯下型⼀錯誤（type I error）的機率，即為研究者設定的顯著⽔準", "B": "若顯著⽔準不變，欲增加統計檢定⼒，可以增加樣本數", "C": "型⼀錯誤是抽菸者與非抽菸者的⾎膽固醇濃度沒差異，但檢定時卻誤判有差異的情形", "D": "型⼀錯誤加型⼆錯誤的機率和為1", "language": "tw"}
{"question": "下列有關矽肺症（silicosis）的敘述，何者錯誤？", "answer": "患者感染結核病的機率與一般人相近", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "盛行率最高的塵肺症", "B": "即使患者停止接觸二氧化矽疾病仍可以持續進展", "C": "患者感染結核病的機率與一般人相近", "D": "疾病晚期可見進展性大量纖維化（progressive massive fibrosis）", "language": "tw"}
{"question": "在產前染⾊體檢查分析的20個⽺⽔細胞中，發現5個細胞有46條正常染⾊體，15個細胞多了⼀條第21號染⾊體。下列何者為最可能的診斷？", "answer": "異常細胞鑲嵌（mosaicism）型唐⽒症候群（Down syndrome）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "無分離（nondisjunction）型唐⽒症候群（Down syndrome）", "B": "無分離（nondisjunction）型愛德華⽒症候群（Edwards syndrome）", "C": "轉位（translocation）型愛德華⽒症候群（Edwards syndrome）", "D": "異常細胞鑲嵌（mosaicism）型唐⽒症候群（Down syndrome）", "language": "tw"}
{"question": "下列那些麻醉相關監視器對靜脈空氣栓塞（venous air embolism）偵測之敏感度（sensitivity），由高至低排列順序為何？", "answer": "④②①③", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "①②③④", "B": "②①③④", "C": "②③①④", "D": "④②①③", "language": "tw"}
{"question": "下列何種降血壓藥物最適合用於姙娠性高血壓的病人？", "answer": "α-Methyldopa", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "Clonidine", "B": "α-Methyldopa", "C": "Captopril", "D": "Propranolol", "language": "tw"}
{"question": "目前在醫療上常使用肉毒桿菌毒素（botulinum toxin）注射來治療肌肉痙攣，主要作用的機轉為下列何者？", "answer": "讓乙醯膽鹼無法由終板（end plate）釋出，阻斷神經肌肉交接處的功能", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "讓肌肉細胞膜鈣離子阻斷作用，導致肌肉無法收縮", "B": "破壞乙醯膽鹼接受器（acetylcholine receptor）", "C": "讓乙醯膽鹼無法由終板（end plate）釋出，阻斷神經肌肉交接處的功能", "D": "使神經軸細胞質（axon plasma）流動停止，造成神經傳導異常", "language": "tw"}
{"question": "下列有關HDV的描述，何者錯誤？", "answer": "interferon（或pegylated interferon）是目前唯一被證實有效治療HDV的藥物，根治率極高（＞80%）且不容易復發", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "HDV可以與HBV急性共同感染（coinfection），或是重覆感染（superinfection）於HBV帶原者", "B": "重覆感染HDV，對原本慢性HBV帶原者有不好的影響，可能促使肝臟疾病快速惡化或造成猛爆性肝衰竭", "C": "HDV與HBV急性共同感染之後演變成慢性D型肝炎的機會較低", "D": "interferon（或pegylated interferon）是目前唯一被證實有效治療HDV的藥物，根治率極高（＞80%）且不容易復發", "language": "tw"}
{"question": "成年人的踝關節急性創傷，可以根據 Ottawa ankle rules 來判斷是否需要接受 X 光檢查。下列何者不是 Ottawa ankle rules 的判斷準則？", "answer": "受傷後足踝背屈活動受限（limited dorsiflexion of ankle）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "受傷後內踝有壓痛（tenderness at tip of medial malleolus）", "B": "受傷後外踝有壓痛（tenderness at tip of lateral malleolus）", "C": "受傷後無法負重（inability to bear weight）", "D": "受傷後足踝背屈活動受限（limited dorsiflexion of ankle）", "language": "tw"}
{"question": "下列關於預防院內泌尿道感染之原則，何者錯誤？", "answer": "尿液中本來就有細菌，因此放置留置型導尿管不須採取無菌技術", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "尿液中本來就有細菌，因此放置留置型導尿管不須採取無菌技術", "B": "放置留置型導尿管須採取無菌技術，以預防泌尿道感染", "C": "不應該為了照顧者之方便而放置留置型導尿管", "D": "留置型導尿管不需要時應儘早拔除", "language": "tw"}
{"question": "承上題，如果病患是原發性副甲狀腺高能症（Primary Hyperparathyroidism），則那一項描述最正確？", "answer": "手術切除副甲狀腺病灶", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "肝臟腫瘤絕不是惡性的", "B": "異位性副甲狀腺腺瘤，頸部超音波 100%可以偵測", "C": "T1-201-Tc99m subtraction scan 定位優於 Tc99m sestamibi scan", "D": "手術切除副甲狀腺病灶", "language": "tw"}
{"question": "活體肝移植捐贈者於部分肝切除後剩下的肝臟變化，下列敘述何者正確？", "answer": "肝細胞與庫弗氏細胞（Kupffer's cells）及內皮細胞同步複製", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "被切除的肝葉重新長出", "B": "剩下的肝臟至少需半年以上才能長大一倍", "C": "肝細胞與庫弗氏細胞（Kupffer's cells）及內皮細胞同步複製", "D": "肝臟切除後的代償性生長主要是由於肝內幹細胞（intrahepatic stem cells）之生長 77 下列有關細胞凋亡（apoptosis）的敘述，何者正確？", "language": "tw"}
{"question": "關於兒童腸\t疊（intussusception）的敘述，下列何者錯誤？", "answer": "大多數病人都需要手術治療", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "好發的年齡為三個月到兩歲", "B": "大多數病人都需要手術治療", "C": "好發部位在迴腸盲腸部（ileocecal region）", "D": "若診斷時已有腹膜炎的現象，則以手術治療較為恰當", "language": "tw"}
{"question": "下列有關 danazol 的藥理學作用描述，何者錯誤？", "answer": "具有抑制芳香環轉化酶（aromatase）的活性，進而抑制雌激素的合成", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "一種經人工合成的睪固酮（testerone）", "B": "主要用於子宮內膜異位症（endometriosis）及良性乳房纖維囊腫（fibrocystic breast", "C": "具有抑制芳香環轉化酶（aromatase）的活性，進而抑制雌激素的合成", "D": "具有肝毒性", "language": "tw"}
{"question": "手肘彎曲時，尺骨頭（head of ulna）與下列何者接觸？", "answer": "尺骨切迹（ulnar notch）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "尺骨切迹（ulnar notch）", "B": "冠狀窩（coronoid fossa）", "C": "橈骨窩（radial fossa）", "D": "鷹嘴窩（olecranon fossa）", "language": "tw"}
{"question": "下圖為一位 41 歲女性腰椎之磁振造影矢狀面 T1 及 T2 影像。第四及第五腰椎體內中央部分有橫向之高訊號變化。請問此高訊號的骨髓變化為何？", "answer": "fatty replacement of central aspect of vertebral bodies", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "infectious spondylitis", "B": "transverse fracture of vertebral bodies", "C": "metastases", "D": "fatty replacement of central aspect of vertebral bodies", "language": "tw"}
{"question": "75 歲男性病人腹痛兩天至急診，體溫 38.5℃、血壓 80/60 mmHg、脈搏 120/min，理學檢查發現上腹壓痛及僵硬有反彈痛（rebound pain）懷疑有消化性潰瘍並穿孔，此時最適宜之 X 光檢查為：", "answer": "胸部 X 光（chest X-ray）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "胸部 X 光（chest X-ray）", "B": "KUB X-ray", "C": "上消化道 X 光（upper G-I series）", "D": "腹部電腦斷層（abdominal CT scan）", "language": "tw"}
{"question": "下列有關胱胺酸結石（cystine stone）的敘述，何者錯誤？", "answer": "尿中的鎂離子是胱胺酸結石的 inhibitor", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "典型的 cystinuria 是 autosomal recessive 遺傳 \t", "B": "尿中的鎂離子是胱胺酸結石的 inhibitor", "C": "內科療法包括每天喝水超過 3 公升，和尿液的鹼性化", "D": "penicillamine 可以降低尿中胱胺酸的 level", "language": "tw"}
{"question": "許多蛋白質須與金屬離子結合後才能展現正確的功能，下列何種胺基酸的側鏈具備與金屬離子直接結合的能力？", "answer": "半胱胺酸（cysteine）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "半胱胺酸（cysteine）", "B": "丙胺酸（alanine）", "C": "苯丙胺酸（phenylalanine）", "D": "脯胺酸（proline） 27\t維生素 lipoic acid 及 biotin 是與酶分子中那個胺基酸結合？", "language": "tw"}
{"question": "21.67歲男性本身有糖尿病，目前以口服降血糖藥物控制，前一天晚上11點左右喝了2瓶啤酒後，忽然發生心悸，一直到今日上午 5℃，心跳每分鐘140次，血壓150/80毫米汞柱，呼吸每分鐘24次。心電圖如下。下列處置何者最恰當？", "answer": "給予amiodarone靜脈注射治療", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "給予coumadin口服", "B": "立即胸前電擊100J", "C": "給予amiodarone靜脈注射治療", "D": "給予heparin靜脈注射治療", "language": "tw"}
{"question": "當巴金森氏病病人在晚期開始出現運動阻滯（motor block）時，進行下列何種運動比較不受影響？", "answer": "上樓梯", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "上樓梯", "B": "在狹窄的走廊步行", "C": "過馬路", "D": "進出電梯門", "language": "tw"}
{"question": "下列何者不是造成產婦出血（obstetrical hemorrhage）致死的常見原因？", "answer": "子癇症（eclampsia）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "胎盤早期剝離（abruption of placenta）和前置胎盤（placenta praevia）", "B": "植入性胎盤（placenta accreta/increta）和胎盤存留", "C": "子宮破裂和子宮無力（uterine atony）", "D": "子癇症（eclampsia）", "language": "tw"}
{"question": "43.一位35歲女性因為月經流量太大應診，抽血檢查發現血紅素為11.2 gm/dL，白血球 7550/µL，血小板196500/µL，前凝血酵素時間（PT）INR 1.0，活化之部分凝血激素時間\n （aPTT）56秒（control:28\"-35\"），下列何種檢查對此病人的診斷不是必要的？ \n", "answer": "factor XIII activity", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "factor VIII activity", "B": "factor IX activity", "C": "factor XIII activity", "D": "von Willebrand factor activity", "language": "tw"}
{"question": "下列有關陰道滴蟲及其病症的敘述，何者正確？", "answer": "人是其唯一的宿主", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "患者之白帶呈白色乳酪狀", "B": "夫妻中男性通常沒有症狀，只需治療出現症狀的妻子即可", "C": "人是其唯一的宿主", "D": "感染型（infective form）為囊體", "language": "tw"}
{"question": "34 某位 39 歲孕婦，G6P2A3，妊娠 35 週，產科史前二次妊娠皆因骨盆狹窄行剖腹產，此次妊娠採人工受孕，主訴突然陰道大出血，然而並無下腹痛或其他疼痛，急診送院後行緊急剖腹產。胎兒娩出後 ，胎盤無法完全剝離，子宮收縮疲軟出血不止，不得已行子宮全切除術。則上述病例最可能的診斷是： \n", "answer": "植入性胎盤", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "胎盤早期剝離", "B": "雙角子宮", "C": "植入性胎盤", "D": "雙葉胎盤", "language": "tw"}
{"question": "33 28 歲女性最近半年來臉頰部有紅斑（如附圖）及手指、手腕和肩膀有偶發性疼痛。曾經被醫師懷疑為紅斑性狼瘡。請問下列那些檢查對疾病的診斷最有幫助？ skin biopsy  anti-nuclear antibodies  serum complements C3 and C4 level rheumatoid factors complete \n blood routine  anti-dsDNA antibodies  anti-SS-A/anti-SS-B \n", "answer": "", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": " \t- -", "B": "", "C": "", "D": "", "language": "tw"}
{"question": "陳小妹是一位國中 2 年級學生，7 天前，左手突然發生不自主的亂動，她無法拿碗吃飯，尤其是雙手平舉時，整隻手臂一直舞動不停無法控制，但是左手力量不減，感覺也無異常，理學及神經學檢查無其他異常。另外她的心臟超音波也顯示瓣膜不正常，紅血球沉降速率（ESR）也升高。最有可能的臨床臆斷是：", "answer": "辛登南氏舞蹈症（Sydenham's chorea）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "亨丁頓氏舞蹈症（Huntington's chorea）", "B": "辛登南氏舞蹈症（Sydenham's chorea）", "C": "高甲狀腺性舞蹈症 \t", "D": "中風性半邊舞蹈症", "language": "tw"}
{"question": "下列何種副作用與長期使用抗心律不整藥物 amiodarone 最無關？", "answer": "Depression", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "Hyperthyroidism", "B": "Pulmonary fibrosis", "C": "Depression", "D": "Photosensitivity", "language": "tw"}
{"question": "64.一位55歲男性這兩天意識變化被送至急診處。病人一個月前診斷為肺癌，但他拒絕任何進一步治療。家人敘述病人這個月情緒低落，但進食情況尚可，無嘔吐或發燒。身體檢查：體溫36.8℃，血壓130/78 mmHg，脈搏每分80次，呼吸每分19次。病人對時空有錯亂情形，以及嗜睡；其他神經學檢查無異常；右上鎖骨窩有一拇指大的淋巴結，下肢無水腫。初步檢查血比容 mg/dL，ALT 30 U/L，血糖156 mg/dL。血清電解質，Na+ 122，K+ 5.5，Cl- 86（電解質單位mmol/L）。有關此病人的可能診斷，下列那一個最適當？", "answer": "肺癌併發抗利尿激素分泌不當", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "肺癌併發阻塞性肺炎", "B": "肺癌併發腦部轉移", "C": "肺癌併發厭食", "D": "肺癌併發抗利尿激素分泌不當", "language": "tw"}
{"question": "下列何者是真核細胞組蛋⽩去⼄醯酶（histone deacetylase）之主要功能？", "answer": "調節基因之轉錄", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "調節基因之轉錄", "B": "增加組蛋⽩之濃度", "C": "減少mRNA轉譯之作⽤", "D": "增加真核起始因⼦2（eIF2）蛋⽩質之穩定性", "language": "tw"}
{"question": "一個正在接受手術後放射線治療的病人，發生嘔吐、食慾不佳、腹瀉及輕微腹痛之症狀。下列何者為最有可能之診斷？", "answer": "放射線後腸炎（radiation enteritis）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "放射線後膀胱炎（radiation cystitis）", "B": "放射線後腸炎（radiation enteritis）", "C": "放射線後直腸炎（radiation proctitis）", "D": "腸道陰道瘻管（enterovaginal fistula）", "language": "tw"}
{"question": "關於小孩子外傷，下列敘述何者錯誤？", "answer": "小孩子急救時之優先順序與成人不相同", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "小孩子胸部外傷雖未見肋骨骨折，但已有肺部挫傷現象", "B": "小孩子較常見脊椎沒有骨折但有脊髓受傷（spinal cord injury without radiologic abnormality）之現象", "C": "小孩子急救時之優先順序與成人不相同", "D": "小孩子因皮下脂肪（subcutaneous tissue）較少，急救時易導致低體溫（hypothermia）", "language": "tw"}
{"question": "28 王女士 38 歲，接受機械性僧帽瓣置換手術後，術後使用 warfarin sodium，則下列何者正確？①若王女士須服用 thyroxine，應定期監測 prothrombin time，適當減少 warfarin 的劑量 ②若王女士須服用當歸、銀杏等中藥，應定期監測 aPTT，適當減少 warfarin 的劑量 ③若王女士須服用口服避孕藥，應定期監測 prothrombin time，適當增加 warfarin 的劑量 ④若王女士嗜食菠菜，應定期監測 aPTT，適當增加 warfarin 的劑量 ", "answer": "①③", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "①②", "B": "①③", "C": "②④", "D": "④", "language": "tw"}
{"question": "對於急性胰臟炎（acute pancreatitis）的可能併發症（complications），下列敘述何者錯誤?", "answer": "高鈣血症合併抽搐（hypercalcemia with seizure）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "低血容合併急性腎衰竭（hypovolemia with acute renal failure）", "B": "低血氧合併成人呼吸窘迫症（hypoxemia with adult respiratory distress syndrome）", "C": "高鈣血症合併抽搐（hypercalcemia with seizure）", "D": "血管栓塞合併小腸缺血症（vascular thrombosis with ischemic bowel disease）", "language": "tw"}
{"question": "1.1歲女童高燒3天並有輕微咳嗽，懸壅垂與舌顎交界處（Uvulopalatoglossal junction）有紅色小斑或出血點 （Nagayama spots），第4天開始出現紅疹後不再發燒，同時出現輕微腹瀉，此女童最可能是被下列何種病原體感染？\n", "answer": "人類疱疹病毒第六型（Human Herpesviruses 6）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "麻疹病毒（Measles）", "B": "呼吸道融合病毒（Respiratory syncytial virus）", "C": "人類疱疹病毒第六型（Human Herpesviruses 6）", "D": "輪狀病毒（Rotavirus）", "language": "tw"}
{"question": "對於痘科病毒（Poxvirus）的敘述，下列何者正確？", "answer": "痘科病毒感染細胞後的複製過程在細胞質內進⾏，不需要宿主的DNA複製系統協助", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "天花的撲滅，是因為全⾯接種猴痘科（monkeypox）病毒的死毒疫苗", "B": "天花的撲滅，是因為全⾯接種天花病毒（variola virus）的減毒疫苗", "C": "猴痘科病毒對動物的感染⽬前仍然流傳於非洲，但不會感染⼈類", "D": "痘科病毒感染細胞後的複製過程在細胞質內進⾏，不需要宿主的DNA複製系統協助", "language": "tw"}
{"question": "下圖為一個顏面部創傷來急診的病人，急診醫師安排臉部電腦斷層，顏面骨有骨折的狀況，其受傷的情形分類為：", "answer": "右側Le Fort I + III，左側Le Fort II", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "右側Le Fort I + II，左側Le Fort III", "B": "右側Le Fort II + III，左側Le Fort I", "C": "右側Le Fort I + III，左側Le Fort II", "D": "右側Le Fort I + II，左側Le Fort IV", "language": "tw"}
{"question": "為了解決家庭醫學常見的急慢性疾病、未分化問題及身心疾病達到全人照顧的目的，臨床診治宜採用何種模式？", "answer": "生物心理社會模式", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "生物醫學模式", "B": "心理醫學模式", "C": "社會醫學模式", "D": "生物心理社會模式", "language": "tw"}
{"question": "酸性藥物中毒時，給與NaHCO3的主要原因為何？", "answer": "減少藥物在腎小管的再回收", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "增加酸性藥物在肝臟代謝的速率", "B": "改變酸性藥物在血液中的穩定度", "C": "增加藥物在血液中的free form，利於腎絲球的過濾", "D": "減少藥物在腎小管的再回收", "language": "tw"}
{"question": "一位 25 歲年輕女性來到門診，主訴 2 天前即覺得解小便時，尿道口有疼痛及燒灼的感覺，隨後並有頻尿和尿急之現象，今天早上則發現尿液呈粉紅色，兩天來下腹部偶有不適，但是並沒有發燒或寒顫之情形。最適當之臆斷（Impression）會是什麼？", "answer": "急性膀胱炎", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "泌尿道結石 \t", "B": "急性膀胱炎", "C": "膀胱腫瘤 \t", "D": "急性腎盂腎炎", "language": "tw"}
{"question": "叢林斑疹傷寒（scrub typhus）的病媒是：", "answer": "紅（red mite）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "跳蚤（flea）", "B": "紅（red mite）", "C": "體蝨（louse）", "D": "硬蜱（hard tick）", "language": "tw"}
{"question": "一位 5 歲男童，因為先天性之雙側膀胱輸尿管逆流導致慢性腎病變。身體檢查發現：男童身高 100 公分，體重 20 公斤。抽血測得之血中尿素氮（BUN）值為 56 mg/dL；血清肌酸酐值 1.2 mg/dL。請估算其腎絲球過濾率，並根據慢性腎病之分期，判斷目前男童的腎功能屬於慢性腎病第幾期？", "answer": "第三期", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "第一期", "B": "第二期", "C": "第三期", "D": "第四期", "language": "tw"}
{"question": "下列敘述何者錯誤？", "answer": "對於大多數輕度智能障礙的兒童來說，5 歲之前常常無法發展出社交和溝通技能", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "評估兒童青少年的發展，須評估已具有的能力和生理年齡應有的發展程度之間的差距", "B": "大多數輕度智能障礙的成年人，能發展出自我支持（self-support）的社交和職業技能", "C": "大多數兒童在 1 歲時已會發出近似語言但不若語言清楚的聲音", "D": "對於大多數輕度智能障礙的兒童來說，5 歲之前常常無法發展出社交和溝通技能", "language": "tw"}
{"question": "水中那一個物質的存在最能代表最近剛受到糞便的污染？", "answer": "NH3-N", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "NH3-N", "B": "NO2--N", "C": "NO3--N", "D": "N2O5-N", "language": "tw"}
{"question": "王小姐是子宮頸癌患者，理學檢查發現她的子宮頸癌病灶大小約 3 公分，且有侵犯到上 1/3 的陰道和右側子宮旁組織（parametrium），但未達到骨盆壁。其他檢查像是膀胱鏡檢查、下消化道攝影以及泌尿道攝影等均無發現腫瘤組織，則王小姐的子宮頸癌分期為：", "answer": "Stage IIb \t", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "子宮頸癌採用手術分期，須手術完才能確定", "B": "Stage IIa", "C": "Stage IIb \t", "D": "Stage IIIb", "language": "tw"}
{"question": "脂肪栓塞症候群（Fat embolism syndrome）是長骨或骨盆骨折的併發症，死亡率高。手術中及手術後如果有下列變化，要懷疑可能發生脂肪栓塞症候群，下列敘述何者錯誤？", "answer": "潮氣容積末二氧化碳（ETCO2）上升", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "潮氣容積末二氧化碳（ETCO2）上升", "B": "動脈血氧濃度下降", "C": "肺動脈壓上升 \t", "D": "心電圖可能顯現類似缺血般的 ST-segment 變化", "language": "tw"}
{"question": "下列何種癲癇發作時，病人的意識是清醒的？", "answer": "單純型部分發作（simple partial seizures）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "全身強直陣攣型發作（generalized tonic-clonic seizures）", "B": "複雜型部分發作（complex partial seizures）", "C": "單純型部分發作（simple partial seizures）", "D": "熱痙攣（febrile convulsion）", "language": "tw"}
{"question": "關於硬皮症（morphea）的敘述，下列何者錯誤？", "answer": "常有雷諾氏現象（Raynaud phenomenon）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "硬皮症之皮膚病灶和全身性硬化症（systemic sclerosis）的皮膚病灶可明顯區分", "B": "極少見影響內臟器官，預後良好", "C": "常有雷諾氏現象（Raynaud phenomenon）", "D": "線形硬皮症（linear morphea）好犯於兒童之四肢", "language": "tw"}
{"question": "最常見的先天性心臟病為：", "answer": "心室中隔缺損", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "心室中隔缺損", "B": "心房中隔缺損", "C": "法洛氏四合症", "D": "肺動脈瓣閉鎖", "language": "tw"}
{"question": "停經後婦女的卵巢腫瘤多半來自？", "answer": "卵巢表皮（ovarian epithelium）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "卵巢表皮（ovarian epithelium）", "B": "卵巢實質（ovarian stroma）", "C": "卵巢生殖細胞（ovarian germ cell）", "D": "他處轉移而來", "language": "tw"}
{"question": "下列有關雙極性疾患（bipolar disorder）的敘述，何者錯誤？", "answer": "第1次發病（onset）大部分是躁症", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "多數個案會再復發", "B": "可能合併妄想或幻覺", "C": "第1次發病（onset）大部分是躁症", "D": "2次發病間可完全緩解（full remission）", "language": "tw"}
{"question": "對於慢性不癒合傷口的敘述，下列何者錯誤？", "answer": "Vitamin B12缺乏會妨礙單核細胞的活化和fibronectin沉積，然後影響細胞的黏\t和妨礙TGF-β receptors", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "最常見的原因是傷口感染", "B": "放射線的暴露會造成內皮細胞（endothelial cell）的傷害和endarteritis，導致組織萎縮，纖維化和癒合延緩", "C": "Vitamin B12缺乏會妨礙單核細胞的活化和fibronectin沉積，然後影響細胞的黏\t和妨礙TGF-β receptors", "D": "糖尿病會影響傷口癒合的每一個步驟", "language": "tw"}
{"question": "一位 77 歲女性因為最近 8 個月來體重減輕 7 公斤而就診。她在 2 年前先生過世後就一個人獨居。最近一年因為心臟衰竭及膝關節炎，無法自我照料而住在長期照護機構。照顧者表示：她最近記憶力變差且情緒低落。下列敘述何者錯誤？", "answer": "社會網絡（social network）對個人健康的影響是間接的", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "根據 Holmes & Rahe 的社會再適應量表，配偶死亡比父母親死亡的壓力更大", "B": "人口統計資料顯示鰥寡者的死亡率比有配偶者高", "C": "評估社會心理對健康的影響時，社會資源（social resource）是很重要的項目", "D": "社會網絡（social network）對個人健康的影響是間接的", "language": "tw"}
{"question": "下列有關肝臟解剖學之敘述，何者錯誤？", "answer": "即使在門脈高壓的情況底下，門脈循環與系統靜脈循環彼此之間仍然沒有聯繫（connection）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "通常膽囊動脈源自於右肝動脈", "B": "最常見的膽道構造為右前枝與右後枝膽管會合後，再與左膽管會合成總肝管（common hepatic duct）", "C": "尾狀葉（caudate lobe）指的是Couinaud分類中的第一節葉（segment 1）", "D": "即使在門脈高壓的情況底下，門脈循環與系統靜脈循環彼此之間仍然沒有聯繫（connection）", "language": "tw"}
{"question": "下列何者非鬆脆類桿菌（Bacteroides fragilis）之特徵？", "answer": "能產生芽胞（spore）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "能水解七葉苷（esculin）", "B": "能生長於含20%膽鹽（bile salt）的培養基", "C": "能產生芽胞（spore）", "D": "屬革蘭氏陰性桿菌", "language": "tw"}
{"question": "15 有關世界衛生組織（WHO）與臺灣衛生福利部疾病管制署目前在推動之手部衛生運動中，所謂洗手 5 時機，包括下列那些情形？①幫病人做身體檢查前 ②只接觸病人身體體表之一般檢查之後 ③預期接觸到病人血液或體液才須洗手 ④執行侵入性檢查戴無菌手套之前 ⑤進入病人房間，只觸碰到床欄桿就離開病人房間 ", "answer": "僅①①①①", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "①①①①①", "B": "僅①①①①", "C": "僅①①①", "D": "僅①①①", "language": "tw"}
{"question": "使用傳統抗精神病藥物的個案若出現錐體外症候群（extrapyramidal syndrome）的副作用時，下列處理何者錯誤？", "answer": "併用鋰鹽（lithium）來降低錐體外症候群", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "降低傳統抗精神病藥物的劑量", "B": "併用鋰鹽（lithium）來降低錐體外症候群", "C": "併用抗膽鹼性藥物（anticholinergics）", "D": "考慮換成新一代的抗精神病藥物", "language": "tw"}
{"question": "幼兒罹患「先天性鼻淚管阻塞」的原因及處理原則，何者錯誤？", "answer": "十二個月以內的幼兒，可施以淚囊鼻腔吻合術來治療", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "此病是由於鼻淚管的末端薄膜（valve of Hasner）未完全打開", "B": "六個月以內的幼兒，可施以局部按摩合併點抗生素眼藥水", "C": "十二個月以內的幼兒，可施以淚囊鼻腔吻合術來治療", "D": "在保守療法治療一段時間後仍無法成功的患者，可施以淚囊灌洗術及探針術", "language": "tw"}
{"question": "承上題，上述病人若術前懷疑髓質癌（Medullary cancer）淋巴未轉移，最好之手術方法是：", "answer": "雙側甲狀腺全切除術及中央淋巴廓清術（total thyroidectomy＋central lymph node dissection）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "雙側甲狀腺全切除術及中央淋巴廓清術（total thyroidectomy＋central lymph node dissection）", "B": "雙側甲狀腺全切除術及雙側廣泛性頸淋巴廓清術（total thyroidectomy＋bilateral radical neck dissection）", "C": "甲狀腺次全切術（subtotal thyroidectomy）", "D": "患側甲狀腺全葉切除術（one side lobectomy）", "language": "tw"}
{"question": "下列何者是頸動脈海綿竇管（Carotid-cavernous fistula）的典型徵候？", "answer": "結膜血管曲張", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "眼壓降低", "B": "結膜血管曲張", "C": "眼球內陷", "D": "水晶體混濁", "language": "tw"}
{"question": "一位 70 歲有肝硬化病史的老先生，近幾週因生蠔盛產，自己剝生蠔來吃，到急診時，主訴發燒已兩天，今天皮膚出現下圖之水泡，到急診時血壓 90/50 mmHg，老先生最可能感染的病原菌為下列何者？", "answer": "Vibrio vulnificus", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "Staphylococcus aureus", "B": "Vibrio vulnificus", "C": "group A streptococcus", "D": "Klebsiella pneumoniae", "language": "tw"}
{"question": "輸卵管及副睪丸之 adenomatoid tumor 之細胞的來源是：", "answer": "mesothelial cell", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "epithelial cell", "B": "squamous cell", "C": "mesothelial cell", "D": "endothelial cell", "language": "tw"}
{"question": "32 35 歲 70 公斤男性被高壓電電傷，燒傷面積佔總體表面積 40%，以 Parkland Formula 來計算，傷後前 小時每小時應輸入體液多少 mL？", "answer": "700", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "350", "B": "460", "C": "700", "D": "1050", "language": "tw"}
{"question": "下列何種雷射適用於治療血管擴張？", "answer": "染料雷射（Dye laser）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "染料雷射（Dye laser）", "B": "鉺雅鉻雷射（Er-YAG laser）", "C": "紅寶石雷射（Ruby laser）", "D": "銣雅鉻雷射（Nd-YAG laser）", "language": "tw"}
{"question": "下列有關sevoflurane的敘述，何者錯誤？", "answer": "遇到瓶子或麻醉機管路中的雜質會降解出HCl，也叫做路易士酸", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "遇到瓶子或麻醉機管路中的雜質會降解出HCl，也叫做路易士酸", "B": "需要特殊塑膠瓶來包裝", "C": "如果降解出酸性物質，則有可能灼傷病患的呼吸黏膜", "D": "通常製造的成品中會加一些水以防降解", "language": "tw"}
{"question": "人類免疫不全病毒（HIV）感染的孕婦服用合併抗反轉錄病毒治療，若偵測不到血漿HIV病毒量（＜20 copies/mL），則生下嬰兒感染HIV機會大約多少？", "answer": "＜1%", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "25%", "B": "15%", "C": "7%", "D": "＜1%", "language": "tw"}
{"question": "下列何種惡性增生最不常見於兒童接受骨髓移植後的次發性惡性疾病（secondary malignancy）？", "answer": "腎癌（renal cell cancer）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "腦瘤（brain tumor） \t", "B": "甲狀腺瘤（thyroid tumor）", "C": "腎癌（renal cell cancer）", "D": "非何杰金氏淋巴瘤（non-Hodgkin lymphoma）", "language": "tw"}
{"question": "下列有關膽固醇合成之敘述，何者錯誤？", "answer": "從飲食中攝取的膽固醇是不會影響到肝細胞中膽固醇的合成", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "胰島素可刺激 HMG-CoA reductase \t", "B": "細胞內高濃膽固醇可以刺激膽固醇脂（cholesterol ester）的形成", "C": "從飲食中攝取的膽固醇是不會影響到肝細胞中膽固醇的合成", "D": "一些膽固醇的中間代謝產物會抑制 HMG-CoA reductase", "language": "tw"}
{"question": "79.下列疾病中，何者致病機轉主要跟自體抗體（autoantibody）的產生有關？①尋常型天皰瘡（pemphigus  vulgaris） ②多發性結節性動脈炎（polyarteritis nodosa） ③惡性貧血（pernicious anemia）\n", "answer": "僅①③", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "①②③", "B": "僅①②", "C": "僅②③", "D": "僅①③", "language": "tw"}
{"question": "下列關於腺病毒（adenovirus）的敘述，何者錯誤？", "answer": "具有外套（envelope）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "為 DNA 病毒 \t", "B": "引起結膜炎（conjunctivitis）", "C": "可以潛伏於淋巴組織中", "D": "具有外套（envelope）", "language": "tw"}
{"question": "醫師為一位過重的糖尿病患開立 1500 Kcal 飲食，下列營養師所列之處方何者較接近？", "answer": "190 公克碳水化合物、50 公克脂肪、75 公克蛋白質", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "210 公克碳水化合物、60 公克脂肪、100 公克蛋白質", "B": "190 公克碳水化合物、50 公克脂肪、75 公克蛋白質", "C": "250 公克碳水化合物、70 公克脂肪、90 公克蛋白質、6 公克 NaCl", "D": "300 公克碳水化合物、80 公克脂肪、75 公克蛋白質、8 公克綜合維他命丸", "language": "tw"}
{"question": "一位64歲男性，突然發生右半身癱瘓，無法言語，意識不清，此CT影像是症狀發生後第7天所照，最可能的診斷是：", "answer": "hemorrhagic infarction", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "contusion hemorrhage", "B": "hypertensive hemorrhage", "C": "hemorrhagic infarction", "D": "hemorrhage due to bleeding tendency", "language": "tw"}
{"question": "下列有關主動脈閉鎖不全身體診察的敍述，何者錯誤？", "answer": "聽診主動脈閉鎖不全的心雜音，請病人左側臥姿（left decubitus position）最清楚", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "可聽到 Austin Flint murmur", "B": "可聽到 mid-systolic murmur", "C": "可聽到 decrescendo diastolic murmur", "D": "聽診主動脈閉鎖不全的心雜音，請病人左側臥姿（left decubitus position）最清楚", "language": "tw"}
{"question": "下列有關潛在性器官捐贈者（potential donor）的照顧之敘述，何者錯誤？", "answer": "尿崩症（diabetes insipidus）並不常見，故尿量變多時，只須減少給予的水分即可", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "平均動脈血壓（mean arterial blood pressure）須大於 60 mmHg", "B": "每小時尿量最好大於 1.0 mL/kg", "C": "尿崩症（diabetes insipidus）並不常見，故尿量變多時，只須減少給予的水分即可", "D": "高血鈉症是常見的電解質不平衡", "language": "tw"}
{"question": "王先生因為急性胰臟炎入院，下列何者最不像是他該有的症狀或檢查結果？", "answer": "血鈣上升", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "腹痛位於上腹並且輻射到背部", "B": "持續性嘔吐", "C": "血鈣上升", "D": "發燒", "language": "tw"}
{"question": "下列有關慢性發炎性脫髓鞘型多發性神經病變（chronic inflammatory demyelinating polyneuropathy）之陳述，何者錯誤？", "answer": "類固醇（prednisolone）治療常無效", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "慢慢出現 \t \t", "B": "可以逐漸（progressive）也可以階梯式（step-wise）進行", "C": "早期可以有不對稱性", "D": "類固醇（prednisolone）治療常無效", "language": "tw"}
{"question": "關於Q熱（Q fever）致病菌之相改變（phase transition）現象的敘述，下列何者正確？", "answer": "急性期時，病人體內產生的IgM及IgG抗體主要是對抗第二相的抗原", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "相改變是因為此菌的鞭毛（flagellum）基因發生突變所造成", "B": "當此菌處於第一相（phase I）時，其細胞壁（cell wall）不含O抗原醣（O-antigen sugars）", "C": "當此菌處於第二相（phase II）時，能抑制吞噬體（phagosome）與溶小體（lysosome）的融合", "D": "急性期時，病人體內產生的IgM及IgG抗體主要是對抗第二相的抗原", "language": "tw"}
{"question": "下列那一種血管炎，c-ANCA（c-antineutrophil cytoplasmic autoantibodies）呈陽性的比例最高？", "answer": "Wegener granulomatosis", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "microscopic polyangiitis", "B": "Wegener granulomatosis", "C": "Henoch-Schönlein purpura", "D": "Churg-Strauss syndrome", "language": "tw"}
{"question": "下列有關脊髓白質（white matter）的敘述，何者正確？", "answer": "前外側系統（anterolateral system）傳遞痛、溫和粗觸覺", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "前外側系統（anterolateral system）傳遞痛、溫和粗觸覺", "B": "腹側皮質脊髓徑（ventral corticospinal tract）為已交叉的神經纖維", "C": "薄束（fasciculus gracilis）存在於前索（anterior funiculus）中", "D": "楔狀束（fasciculus cuneatus）存在於全段脊髓白質", "language": "tw"}
{"question": "發生賈克森氏癲癇（jacksonian seizure），最可能的病灶位在何處？", "answer": "額葉", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "顳葉", "B": "枕葉", "C": "額葉", "D": "頂葉", "language": "tw"}
{"question": "一位 52 歲男性病患因為車禍大量出血，有關此時的生理現象之描述，下列何者錯誤？", "answer": "會刺激副交感神經系統導致心跳加速", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "會刺激副交感神經系統導致心跳加速", "B": "心輸出量（cardiac output）會下降", "C": "四肢會冰冷同時冒冷汗", "D": "回到右心房之體靜脈血量會降低", "language": "tw"}
{"question": "一位 80 歲男性，1 週來在臉部、四肢末端長出如圖所示的暗褐色斑、水、合併糜爛。患者發疹前幾天曾服用過磺胺類（sulphonamide）藥物，幾年前也曾在服用類似藥物後在身體同樣的部位也會發出類似的疹子。最可能診斷為：", "answer": "固定性藥物疹（fixed drug eruption）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "多形性紅斑（erythema multiforme）", "B": "麻疹樣藥物疹（morbilliform drug eruption）", "C": "固定性藥物疹（fixed drug eruption）", "D": "單純性疹（herpes simplex）", "language": "tw"}
{"question": "有關直腸癌的術前放射線治療之敘述，何者錯誤？", "answer": "無法減輕對小腸之傷害", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "可以增加 Resectability rate", "B": "可以減少術中之 Tumor seeding", "C": "可增加保留肛門的機會", "D": "無法減輕對小腸之傷害", "language": "tw"}
{"question": "上斜肌（superior oblique muscle）本身的作用，並不會使眼球做下列何種運動？", "answer": "內轉（adduction）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "看下（depression）", "B": "內旋（intorsion）", "C": "內轉（adduction）", "D": "外轉（abduction）", "language": "tw"}
{"question": "腹膜覆蓋下腹壁動脈（inferior epigastric artery）會形成下列何結構？", "answer": "臍外側襞（lateral umbilical fold）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "臍正中襞（median umbilical fold）", "B": "臍內側襞（medial umbilical fold）", "C": "臍外側襞（lateral umbilical fold）", "D": "臍旁襞（paraumbilical fold）", "language": "tw"}
{"question": "41.胎心無壓力試\t（non-stress test）20分鐘檢查結果，有二次胎心加速大於基線胎心搏（baseline）15 bpm （beat per minute）以上，且持續15秒以上，可以判讀為： \n", "answer": "正常反應（reactive）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "正常反應（reactive）", "B": "不正常反應（nonreactive）", "C": "爭議性（equivocal）", "D": "無法判讀（unsatisfactory）", "language": "tw"}
{"question": "心尖相對於第幾個肋間？", "answer": "五", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "三", "B": "五", "C": "七", "D": "九", "language": "tw"}
{"question": "71.78歲陳先生由親人陪同就診，主訴最近一週有尿失禁及倦怠無力。病人長期失眠，經常服用安眠藥。最近失眠加重，增加劑量仍未見效，而且血壓也上升。病人又自行購買高血壓藥物服用。身體檢查病人生命徵象穩 定，意識清楚，行動正常且無局部神經異常症狀。對該病人的處置方式，下列何者最為適當？\n", "answer": "作老人周全性評估", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "安排病人入住護理之家接受照顧", "B": "轉介精神神經專科檢查及調整安眠藥", "C": "作老人周全性評估", "D": "即刻安排病人住院治療", "language": "tw"}
{"question": "下列那一種情形，可以不用得到病人的告知後同意？", "answer": "病人在診間似乎語多保留，調閱該病人五年前在本院由 A 醫師主治時的住院病歷，看是否曾經罹患性病，以確認本次處方藥物的正確性", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "開立我國行政院衛生署已經核准上市的處方藥物給一個非仿單所載適應症的病人，因為國外最知名的期刊剛剛才登載了這種標籤外使用對這類病人有非常好的療效", "B": "在病人例行回診驗血時，順便多抽 5 ml 的血，來作一項國科會所贊助的研究計畫", "C": "病人在診間似乎語多保留，調閱該病人五年前在本院由 A 醫師主治時的住院病歷，看是否曾經罹患性病，以確認本次處方藥物的正確性", "D": "為了保護新生兒免於垂直感染，在產婦例行產檢時，作 AIDS 的篩檢", "language": "tw"}
{"question": "下表為三種不同雙螺旋 DNA 結構（A form; B form; Z form）的特性，請指出代號 W、X、Y 的結構型式（structural form）名稱：", "answer": "W = Z form DNA; X = A form DNA; Y = B form DNA \t", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "W = Z form DNA; X = A form DNA; Y = B form DNA \t", "B": "W = Z form DNA; X = B form DNA; Y = A form DNA", "C": "W = A form DNA; X = Z form DNA; Y = B form DNA", "D": "W = A form DNA; X = B form DNA; Y = Z form DNA", "language": "tw"}
{"question": "粒線體疾病（mitochondrial disease）的遺傳是：", "answer": "母系遺傳", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "父系遺傳 \t", "B": "母系遺傳", "C": "孟德爾定律 \t", "D": "無定律可循", "language": "tw"}
{"question": "下列有關眼部病變之敘述，何者錯誤？", "answer": "葛雷氏症（Graves' disease）是突眼症最常見的原因", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "突眼症（Exorbitism）是眼窩體積減少（Decreased bony orbital volume）造成", "B": "葛雷氏症（Graves' disease）是突眼症最常見的原因", "C": "赫特氏眼外測量計（Hertel exophthalmometer）是用來量側眼緣（Lateral orbital rim）到角膜頂端（Corneal apex）的距離", "D": "外科治療外傷後眼球內陷（Post-traumatic enophthalmos）並不能完全解決複視（Diplopia）的問題", "language": "tw"}
{"question": "下列何者在下視丘分泌減少時會引起泌乳激素（prolactin）分泌增加？", "answer": "多巴胺（dopamine）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "乙醯膽鹼（acetylcholine）", "B": "腎上腺素（epinephrine）", "C": "多巴胺（dopamine）", "D": "血清素（serotonin）", "language": "tw"}
{"question": "傷寒沙門氏菌（Salmonella typhi）菌體的何種成分可以作為疫苗抗原，以產生保護性免疫力？", "answer": "莢膜多糖體（capsular polysaccharides）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "鞭毛蛋白（flagellin）", "B": "莢膜多糖體（capsular polysaccharides）", "C": "菌毛蛋白（pilin） \t", "D": "脂多糖體（lipopolysaccharides）", "language": "tw"}
{"question": "Stridor 最常見於下列何種患者？", "answer": "上呼吸道阻塞", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "氣喘症", "B": "慢性阻塞性肺疾", "C": "上呼吸道阻塞", "D": "肺結核", "language": "tw"}
{"question": "想了解台灣地區有多少比率的小朋友最近幾年曾經被腸病毒感染過，應該檢查：", "answer": "血清中的抗體力價（titer）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "血清中的病毒培養（virus culture）", "B": "血清中的病毒抗原濃度", "C": "血清中的抗體力價（titer）", "D": "血清中具有特異性的聚合鏈反應（polymerase chain reaction, PCR）", "language": "tw"}
{"question": "有位曾患腎盂腎炎的孕婦，因細菌引起嚴重上呼吸道感染，下列何者為治療該孕婦的首選藥物？", "answer": "Azithromycin", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "Clarithromycin", "B": "Erythromycin", "C": "Azithromycin", "D": "Tetracycline", "language": "tw"}
{"question": "王老先生於 2 年前因罹患中風後即長期臥床，近日家屬發現其臀部有一個 4 公分傷口，經整形外科醫師診斷為褥瘡，建議手術治療；術中發現傷口壞死範圍深及骨頭，則此褥瘡的深度分級為何？最好的重建方法是清創（debridement）後再作何種處置？", "answer": "Grade IV；局部臀大肌皮瓣重建術（local gluteal maximus flap reconstruction）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "Grade III；換藥即可（dressing change）", "B": "Grade III；植皮（skin grafting）", "C": "Grade IV；顯微皮瓣重建術（microsurgical free flap reconstruction）", "D": "Grade IV；局部臀大肌皮瓣重建術（local gluteal maximus flap reconstruction）", "language": "tw"}
{"question": "尿路感染最常見的菌種是下列何者？", "answer": "E. Coli", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "Klebsiella spp.", "B": "Proteus spp.", "C": "E. Coli", "D": "Enterobacter spp.", "language": "tw"}
{"question": "下列何種藥物口服可治療鐵中毒？", "answer": "deferasirox", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "deferoxamine", "B": "deferasirox", "C": "D-dimethylcysteine", "D": "Prussian blue", "language": "tw"}
{"question": "下列何者不是上皮性卵巢癌？", "answer": "Granulosa cell tumor", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "Mucinous adenocarcinoma", "B": "Serous adenocarcinoma", "C": "Endometrioid adenocarcinoma", "D": "Granulosa cell tumor", "language": "tw"}
{"question": "下咽癌病患接受根除性手術治療後，下列何者不是常使用之音聲復健方式？", "answer": "腹語（abdominal voice）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "氣動式人造喉（pneumatic artificial larynges）", "B": "食道語（esophageal voice）", "C": "腹語（abdominal voice）", "D": "氣管食道語（tracheo-esophageal speech）", "language": "tw"}
{"question": "下列有關一氧化氮（nitric oxide）之敘述，何者正確？", "answer": "由 L-arginine 與氧分子作用形成", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "是化學性（chemical）傳遞物質（messenger）可活化 adenylate cyclase", "B": "由 L-arginine 與氧分子作用形成", "C": "可導致血管壁收縮（constriction of blood vessels）", "D": "是極安定之氣體分子", "language": "tw"}
{"question": "78.65歲男性長期有高血壓，持續用藥控制中，幾天前門診醫師幫他換藥，這幾天就常感覺腹脹，而且 有便秘現象，病人最可能用了下列何種藥？\n", "answer": "Amlodipine", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "Valsartan", "B": "Renitec", "C": "Labetalol", "D": "Amlodipine", "language": "tw"}
{"question": "尿路結石的發生和下列何種狀況較少有關連？", "answer": "腎移植", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "腎移植", "B": "懷孕", "C": "肥胖", "D": "馬蹄腎", "language": "tw"}
{"question": "有關體內鈣質的描述何者錯誤?", "answer": "98%的鈣會被腎臟再吸收，主要是在遠端腎小管 \t", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "骨骼系統儲存體內99%的鈣，血鈣則佔略少於1%", "B": "鈣質的來源主要為飲食攝取，大多於十二指腸（duodenum）及空腸（jejunum）吸收", "C": "98%的鈣會被腎臟再吸收，主要是在遠端腎小管 \t", "D": "1,25-(OH)2 vitamin D可增加腸道的鈣結合蛋白（calcium binding protein）來增進鈣質吸收", "language": "tw"}
{"question": "李小姐，50歲已婚的臺灣人，體重96公斤，目前還有性生活。在三年前時，因為有子宮肌瘤而接受經腹部全子宮切除術（total abdominal hysterectomy）。她沒有抽煙，在某一所護理之家當護理助手，並且此份工作和提重物有關。她本身因為有氣喘（asthma）的病史而有慢性咳嗽（chronic cough）。她目前有兩位小孩，年紀為20及23歲，兩位都是經由陰道生產，其中出生體重最重的為4.0公斤。最近10個月來，她感覺到腹部有下墜感以及頭痛的症狀，當她站立整天，下墜感越大，她也抱怨尿的流量不好以及感覺膀胱無法完全排空，而她自述並沒有小便失禁或是腸道症狀。下列關於造成她形成陰道脫垂（prolapse）的危險因子，何者最不相關？", "answer": "目前還有性生活", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "經陰道生產的過大胎兒", "B": "肥胖", "C": "曾經接受子宮切除", "D": "目前還有性生活", "language": "tw"}
{"question": "正常情況下，心臟後方大都由下列何者構成？", "answer": "左心房（left atrium）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "右心室（right ventricle）", "B": "左心室（left ventricle）", "C": "右心房（right atrium）", "D": "左心房（left atrium）", "language": "tw"}
{"question": "關於人類免疫缺陷病毒（Human immunodeficiency virus, HIV）致病機轉之敘述，下列何者錯誤？", "answer": "感染B淋巴球，造成免疫功能下降", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "可造成巨噬細胞（macrophage）功能變差", "B": "會引起CD4 T淋巴球（lymphocyte）減少", "C": "感染B淋巴球，造成免疫功能下降", "D": "CD8 T淋巴球/CD4 T淋巴球比例上升", "language": "tw"}
{"question": "31.\n 一位62歲女性於50歲時停經，這一年多來常有頻尿、夜尿、尿急及急迫性尿失禁之情形，因此造成日常生活困擾而就醫。理學檢查發現有第三度膀胱脫垂之現象，尿液分析無菌尿、血尿或尿路感染之情形。解尿日記發現白天解尿次數超過八次以上，晚上夜尿（nocturia）情\n 形超過3至5次以上。尿路動力學檢查於膀胱灌注期發現如下圖之情形，其初次解尿感覺\n （first desire to void）之容積為116 c.c.、膀胱最大容積（maximum bladder capacity）為\n c.c.。據此尿動力學之發現，此患者最適合之診斷為：", "answer": "逼尿肌不穩定（detrusor instability）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "逼尿肌不穩定（detrusor instability）", "B": "間質性膀胱炎（interstitial cystitis）", "C": "尿道症候群（urethral syndrome） \t", "D": "尿動力學應力性尿失禁（urodynamic stress incontinence）", "language": "tw"}
{"question": "一位 68 歲男性COPD病患，去年已有兩次因為acute exacerbation住院放置氣管內管使用呼吸器治療。最近一星期明顯咳嗽加劇，痰量增加，顏色變黃，伴有輕微發燒及嚴重呼吸困難，急診室的血液檢查呈現輕度leukocytosis，動脈血檢查PaO2 = 58 mmHg，PaCO2 = 68 mmHg，胸部X光片並未出現新的浸潤。下列敘述何者錯誤？", "answer": "應該給予oxygen，並且儘量維持PaO2在 90 mmHg，以避免加重heart failure", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "應該給予 empirical intravenous antibiotics 治療，antibiotics 應該要能 cover Gram(-) bacilli", "B": "應該給予oxygen，並且儘量維持PaO2在 90 mmHg，以避免加重heart failure", "C": "應該要小心排除合併 left side heart failure 的情形，必要時要安排 echocardiography", "D": "病人穩定後出院給予口服 prednisolone，會減少 relapse rate", "language": "tw"}
{"question": "下列何者不是食物引起的肉毒桿菌毒素中毒（food-born botulism）的症狀？", "answer": "角弓反張（opisthotonus）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "瞳孔放大（pupil dilatation）", "B": "吞嚥困難（dysphagia）", "C": "構音障礙（dysarthria）", "D": "角弓反張（opisthotonus）", "language": "tw"}
{"question": "注意力缺失過動症（attention-deficit/hyperactivity disorder）所使用之治療藥物中，下列何者不是中樞神經刺激劑？", "answer": "Wellbutrin", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "methylphenidate", "B": "dextroamphetamine", "C": "dexmethylphenidate", "D": "Wellbutrin", "language": "tw"}
{"question": "有一肺腫瘤病人，併有腹部絞痛、腹瀉、氣管痙攣及皮膚潮紅，其組織診斷最有可能是：", "answer": "支氣管類癌（bronchial carcinoid）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "支氣管類癌（bronchial carcinoid）", "B": "乳癌肺轉移（metastatic breast cancer）", "C": "肺非小細胞癌（non-small cell lung carcinoma）", "D": "大腸癌肺轉移（metastatic colon cancer）", "language": "tw"}
{"question": "48 歲女性因倦怠、膚色變黑來診。病人主訴食慾不振，3 個月來已減輕 4 公斤。病人年輕時曾患甲狀腺機能亢進症，接受 131I 治療，現已甲狀腺機能低下，規則服用甲狀腺素。抽血檢查：Na+ 125 mmol/L， K+ 5.0 mmol/L，Ca2+ 2.7 mmol/L，Hb 10.5 g/dL，WBC 8000/mm3。請問下一步最有診斷價值的檢查是：", "answer": "ACTH，cortisol", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "free T4，hsTSH", "B": "anti-dsDNA，ANA", "C": "ACTH，cortisol", "D": "PET（正子掃描）", "language": "tw"}
{"question": "醣蛋白（N-linked glycoprotein）的生成中，攜帶寡醣（oligosaccharide moiety）的分子為下列何者？", "answer": "dolichol phosphate \t", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "isoprene \t", "B": "dolichol phosphate \t", "C": "Coenzyme A \t", "D": "thiamine pyrophosphate", "language": "tw"}
{"question": "具有前期B細胞抗原接受器（pre-B cell receptor）之B型細胞具有下列那一項生物特性？", "answer": "快速細胞分裂", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "輕鏈基因重組（light chain gene rearrangement）", "B": "細胞表面具IgM分子", "C": "快速細胞分裂", "D": "接受專一性抗原刺激", "language": "tw"}
{"question": "10.8歲氣喘男童，最近3個月內，於白天出現氣喘症狀的次數平均一星期少於1次，一個月內半夜因咳嗽而醒來也少於2次，其", "answer": "吸入型短效支氣管擴張劑（inhaled short-acting β2 agonist）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "吸入型短效支氣管擴張劑（inhaled short-acting β2 agonist）", "B": "吸入型長效支氣管擴張劑（inhaled long-acting β2 agonist）", "C": "吸入型類固醇（inhaled corticosteroid）", "D": "吸入型類固醇倂用口服白三烯素受體結抗劑（inhaled corticosteroid + oral leukotriene receptor antagonist）", "language": "tw"}
{"question": "翼腭窩（pterygopalatine fossa）與其周邊之連通經由：", "answer": "圓孔（foramen rotundum）接受第五顱神經之第二支", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "上頜孔（maxillay foramen）進入硬腭黏膜", "B": "翼管（pterygoid canal）接受交感神經節前纖維", "C": "圓孔（foramen rotundum）接受第五顱神經之第二支", "D": "翼腭孔（pterygopalatine foramen）進入鼻腔", "language": "tw"}
{"question": "具有毒性的有機危害性物質大部分可在燃燒過程中分解或減量，但也有在燃燒過程中產生新的有害物質，其中最引人注意的就是毒性高，具致癌作用，在環境中可持久不易分解的焚化後新生物是：", "answer": "多氯戴奧辛（polychlorinated dioxins）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "多氯聯苯（polychlorinated biphenyls）", "B": "多氯戴奧辛（polychlorinated dioxins）", "C": "滴滴涕（dichlorodiphenyl-trichloroethane, DDT）", "D": "氯仿（chloroform）", "language": "tw"}
{"question": "下列那一條肌肉不是由正中神經（median nerve）所支配？", "answer": "尺側屈腕肌（Flexor carpi ulnaris）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "橈側屈腕肌（Flexor carpi radialis）", "B": "掌長肌（Palmaris longus）", "C": "屈拇長肌（Flexor pollicis longus）", "D": "尺側屈腕肌（Flexor carpi ulnaris）", "language": "tw"}
{"question": "以下何者不屬於構成鼻中隔的部分？", "answer": "鼻骨", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "中隔軟骨", "B": "鼻骨", "C": "犁骨", "D": "垂直板", "language": "tw"}
{"question": "一個曾經被流感病毒感染過的人，其體內最具中和性保護力的抗體，應具有辨識那一種病毒蛋白質的能力？", "answer": "血球凝集素（hemagglutinin, HA）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "血球凝集素（hemagglutinin, HA）", "B": "基質（matrix, M）蛋白", "C": "核套蛋白（nucleocapsid, NP）", "D": "非結構（nonstructural, NS）蛋白", "language": "tw"}
{"question": "下列有關使用經心肌雷射血管再造術（Transmyocardial laser revascularization）治療無法以傳統冠狀動脈繞道手術治療的末期冠狀動脈疾病病人之敘述，何者錯誤？", "answer": "其作用機轉，乃經由心肌打洞，使帶氧血能直接由左心室流入心肌，供應氧氣及養份", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "6 個月後之追踪，約有 60~80%病人症狀有改善", "B": "其作用機轉可能和心臟神經被去除作用（Cardiac denervation）有關", "C": "其作用機轉可能是心肌局部血管新生（Local neovascularization）有關", "D": "其作用機轉，乃經由心肌打洞，使帶氧血能直接由左心室流入心肌，供應氧氣及養份", "language": "tw"}
{"question": "有關痘病毒（Poxvirus）的敘述，下列何者錯誤？", "answer": "動物的痘病毒不會傳給人", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "是最大的人類DNA病毒", "B": "完全在細胞質中複製", "C": "自己攜帶核醣核酸聚合酶（RNA polymerase），供基因轉錄", "D": "動物的痘病毒不會傳給人", "language": "tw"}
{"question": "承上題，病患尋求另類醫學治療，約三個月後雙腿幾乎癱瘓，故又來接受外科治療，經手術將脊椎前後的腫瘤切除，並植入自體骨移植，再用鈦合金屬內固定，病理報告是 aneurysmal bone cyst，病理組織是：", "answer": "良性（benign） \t", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "良性（benign） \t", "B": "低度惡性（low malignancy）", "C": "高度惡性（high malignancy）", "D": "非典型骨瘤（atypical bone tumor）", "language": "tw"}
{"question": "一位 25 歲男性晚餐後酒後駕車，發生車禍被送入急診室，診斷腹腔內出血，需緊急進行剖腹探查手術。車禍後二小時，病患送入手術室，此時血壓為 80/46 mmHg，心跳每分鐘 120 下。下列敘述何者錯誤？", "answer": "麻醉誘導時應持續壓住 thyroid cartilage，直到氣管內管的氣囊充完氣，以防止胃內容物吐出", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "麻醉誘導時，應進行 rapid sequence induction \t", "B": "麻醉誘導時應持續壓住 thyroid cartilage，直到氣管內管的氣囊充完氣，以防止胃內容物吐出", "C": "可考慮使用 ketamine 做為 induction agent，以防止血壓再下降", "D": "麻醉誘導前，必須做足夠時間的 preoxygenation", "language": "tw"}
{"question": "有關骨盆橫膈（pelvic diaphragm）的敘述，下列何者錯誤？", "answer": "排便時其肌肉收縮，幫助排出糞便", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "外形呈現漏斗狀", "B": "位於會陰（perineum）的頂部", "C": "由提肛肌（levator ani muscle）和尾骨肌（coccygeus）及其筋膜組成", "D": "排便時其肌肉收縮，幫助排出糞便", "language": "tw"}
{"question": "常有癌症患者家屬不願病人知道病情，要求醫師不要告訴病人，但基於「尊重自主」的原則醫師卻應該告知病人真相，因而產生進退兩難的困境。這種臨床上常見的倫理兩難，通常經由下列何種方法或步驟，可以獲得妥善解決？", "answer": "溝通技巧", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "醫療法律", "B": "道德良知", "C": "溝通技巧", "D": "衛生教育", "language": "tw"}
{"question": "66 歲男性，已知高血壓多年但未控制，突發頭痛、意識不清與癲癇，至急診時血壓為 240/130 mmHg，神經學檢查意識混沌，但無局部肢體無力現象，腦部磁振照影檢查最可能的發現為何？", "answer": "大腦枕葉部（occipital lobe）水腫", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "小腦（cerebellum）出血", "B": "視丘（thalamus）出血", "C": "大腦枕葉部（occipital lobe）水腫", "D": "中腦（midbrain）梗塞", "language": "tw"}
{"question": "有一新生兒出生後有嘔吐，嘔吐液為黃色。腹部 X 光顯示\"double-bubble sign＂，遠端腸道無腸氣。則下一步處置為何？", "answer": "腹部超音波檢查是否有幽門肥厚情形", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "腹部超音波檢查是否有幽門肥厚情形", "B": "上消化道攝影，以確定阻塞位置及程度", "C": "下消化道攝影，看是否有 microcolon", "D": "安排開腹手術", "language": "tw"}
{"question": "鈉離子（Na）以不同濃度分布於細胞膜兩側，此時驅使鈉離子依單純擴散（simple diffusion）作用由高濃度之一側向低濃度之一側移動之能量梯度是屬於一種：", "answer": "化學能（chemical potential energy）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "熱能（thermal energy）", "B": "化學能（chemical potential energy）", "C": "電位能（electrical potential energy）", "D": "機械能（mechanical energy）", "language": "tw"}
{"question": "58歲婦女，停經2年，無婦科開刀病史，無熱潮紅，心悸症狀，但會有陰部乾澀，性交疼痛的困擾，其最適當的治療為：", "answer": "陰部雌激素局部使用", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "口服大豆異黃酮", "B": "口服雌激素與黃體素", "C": "口服雌激素", "D": "陰部雌激素局部使用", "language": "tw"}
{"question": "一般細菌中能產生芽胞的桿菌，革蘭氏染色結果為：", "answer": "深紫色", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "紅色", "B": "綠色", "C": "深紫色", "D": "黃色", "language": "tw"}
{"question": "有關 Fluconazole，下列敘述何者正確？", "answer": "抑制 lanosterol 的去甲基化", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "有效治療 Aspergillosis", "B": "抑制 lanosterol 的去甲基化", "C": "無法通過腦部血管 \t", "D": "易誘發肝臟藥物代謝酵素的合成", "language": "tw"}
{"question": "在手腕處，正中神經（median nerve）位於下列何者肌腱的深層？", "answer": "尺側屈腕肌（flexor carpi ulnaris）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "掌長肌（palmaris longus）", "B": "橈側屈腕肌（flexor carpi radialis）", "C": "尺側屈腕肌（flexor carpi ulnaris）", "D": "屈指淺肌（flexor digitorum superficialis） 15 下列何者不支配肘關節（elbow joint）的運動？", "language": "tw"}
{"question": "自從SARS之後，醫護人員的職業性感染問題受到很大的關注。請依院內感染控制的觀念，對於職業性肺結核的認定，下列何者正確？", "answer": "員工就職時的肺部X光檢查是職業性肺結核認定的重要比較資料之一", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "員工就職時的肺部X光檢查是職業性肺結核認定的重要比較資料之一", "B": "由於肺結核也屬於法定傳染病，因此依據勞工保險條例，不得同時加以認定為職業病，因此也得不到勞保給付", "C": "由於患者四處走動，醫院中各部門員工感染肺結核的危險性皆相同", "D": "醫護人員得到肺結核都是職業病", "language": "tw"}
{"question": "16.25歲男性病人因騎機車車禍而顏面部受傷，主要症狀為右側鼻翼撕裂傷（avulsion injury）、流鼻血 （epistaxis）和腫痛，送至急診室，下列敘述何者錯誤？\n", "answer": "經會診耳鼻喉科醫師，發現右側鼻中膈有血腫情形（septal hematoma），應保守治療，待其自行吸收", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "要高度懷疑可能有鼻骨骨折的發生，可安排X-ray檢查", "B": "經會診耳鼻喉科醫師，發現右側鼻中膈有血腫情形（septal hematoma），應保守治療，待其自行吸收", "C": "鼻部主要組成可分為皮膚覆蓋（skin cover）、結構支撐（structural support）及黏膜內襯（mucosal lining），治療時可以根據缺損的範圍，做不同的重建考量", "D": "鼻唇皮瓣（nasolabial flaps）和前額旁正中皮瓣（paramedian forehead flaps）為鼻部重建時，最常用的兩種局部皮瓣", "language": "tw"}
{"question": "3 歲小孩在定期健康檢查時，聽到心雜音，強度 II/VI，位於胸骨緣左側中間之短暫收縮期雜音。該雜音並未輻射至頸部，沒有震顫（thrill），小孩過去無重大病史，身高及體重在五十百分位，生長發育正常，血壓 90/70 mmHg。脈搏 84 次/分，且規律，其它理學檢查均正常。接下來該如何處置？", "answer": "告訴小孩的母親，這種心雜音在小孩很常見，定期觀察追蹤即可", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "立即照會小兒心臟科醫師", "B": "不要告訴小孩的母親有關心雜音的事，以免引起緊張", "C": "告訴小孩的母親，這種心雜音在小孩很常見，定期觀察追蹤即可", "D": "告訴小孩的母親，所有的心雜音都必須進一步做心臟超音波檢查", "language": "tw"}
{"question": "14.28歲婦女產下健康男嬰2個月後，因體重增加、倦怠、怕冷、便秘來就診，目前仍哺乳中。病人自訴產前體檢皆為正常，但產後感覺力不從心，身體檢查除臉部圓大、皮膚略微乾燥外並無特殊發現。血壓150/100 mmHg mmHg），脈搏60/min 規則，抽血檢查Na：132 mM，K：3.5 mM，Ca：2.3 mM。下列那項檢查最具診斷價值：", "answer": "freeT4，hsTSH", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "ACTH，cortisol", "B": "Blood glucose", "C": "freeT4，hsTSH", "D": "憂鬱量表", "language": "tw"}
{"question": "人類免疫缺乏病毒（HIV）經由 CD4 分子進入白血球時，經常利用下列何者當作共同接受體？", "answer": "CXCR4", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "CD40", "B": "CD40 ligand", "C": "CXCR4", "D": "CCR4", "language": "tw"}
{"question": "B細胞發育過程中第一個表現之抗體蛋白是：", "answer": "µ重鏈（µ heavy chain）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "δ重鏈（δ heavy chain）", "B": "µ重鏈（µ heavy chain）", "C": "κ輕鏈（κ light chain）", "D": "λ輕鏈（λ light chain）", "language": "tw"}
{"question": "一個小於 1 公分的 colorectal tubular adenoma，其 risk of cancer 約有多少？", "answer": "<5%", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "絕對不可能有 cancer \t", "B": "<5%", "C": "5-10% \t", "D": "10-20%", "language": "tw"}
{"question": "凝血蛋白之麩胺酸基之γ-羧化（γ-carboxylation）修飾，需要何種維生素參與？", "answer": "Vitamin K", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "Vitamin A", "B": "Vitamin D", "C": "Vitamin E", "D": "Vitamin K", "language": "tw"}
{"question": "下列何者連接股骨與髖臼窩？", "answer": "內收大肌（adductor magnus）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "內收長肌（adductor longus）", "B": "內收短肌（adductor brevis）", "C": "內收大肌（adductor magnus）", "D": "恥骨肌（pectineus）", "language": "tw"}
{"question": "最常用來重建下頷骨的骨皮瓣包括腓骨（fibula）、髂骨（iliac）、肩胛骨（scapula），下列敘述何者錯誤？", "answer": "髂骨皮瓣（iliac osteocutaneous flap）對皮瓣提供處的後遺症最小，所能帶的血管根蒂（pedicle）較短", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "腓骨皮瓣（fibula osteocutaneous flap）由腓動脈（peroneal artery）供應血流，對皮瓣提供處的後遺症最小", "B": "髂骨皮瓣（iliac osteocutaneous flap）對皮瓣提供處的後遺症最小，所能帶的血管根蒂（pedicle）較短", "C": "肩胛骨皮瓣（scapula osteocutaneous flap）由肩胛下動脈（subscapular artery）供應血流，可以連同周圍的骨頭、肌肉和皮膚一起取，形成複合式皮瓣", "D": "對良性的下頷骨缺損，腓骨皮瓣（fibula osteocutaneous flap）可以合併牙科植體手術（osseointegrated implantation for dentition or prosthetic anchors）", "language": "tw"}
{"question": "肱骨外科頸（surgical neck of humerus）骨折，最可能傷及那⼀條神經？", "answer": "腋神經（axillary nerve）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "肌⽪神經（musculocutaneous nerve）", "B": "正中神經（median nerve）", "C": "尺神經（ulnar nerve）", "D": "腋神經（axillary nerve）", "language": "tw"}
{"question": "90 一名 61 歲男性病人主訴骨骼疼痛，並有腎衰竭及肺炎球菌感染導致之肺炎（Pneumococcal pneumonia）。 骨髓活檢切片中最可能並且最重要的發現為： \n", "answer": "漿細胞（Plasma cell）之病變", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "肉芽腫（Granuloma）", "B": "漿細胞（Plasma cell）之病變", "C": "淋巴球（Lymphocyte）之病變", "D": "立德-史登堡氏細胞（Reed-Sternberg cell）", "language": "tw"}
{"question": "抗利尿激素（anti-diuretic hormone）不適當分泌症候群（SIADH），會造成下列何種電解質異常？", "answer": "低鈉血症", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "高鈉血症", "B": "低鈉血症", "C": "高鉀血症", "D": "低鉀血症", "language": "tw"}
{"question": "77.⼀位66歲糖尿病合併腎病變病⼈，有胸悶、咳嗽無痰、呼吸急促、意識昏睡，⽣命徵象顯⽰⾎壓 80/40 mmHg，⼼跳每分 40下，呼吸每分 26次，體溫36℃。經抽⾎檢查發現鉀離⼦7.7 mmol/L、⾎糖300  mg/dL、動脈⾎：pH=7.20，HCO3- =12 mEq/L，BE= -12 mEq/L。下列何者治療不適當？\n", "answer": "經靜脈快速灌注⽣理食鹽⽔1000 mL，治療低⾎壓及稀釋鉀離⼦", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "經靜脈給予碳酸氫鈉，可將鉀離⼦由細胞外移入細胞內", "B": "經靜脈給予葡萄糖⽔及胰島素，可將鉀離⼦由細胞外移入細胞內", "C": "經靜脈快速灌注⽣理食鹽⽔1000 mL，治療低⾎壓及稀釋鉀離⼦", "D": "經靜脈給予氯化鈣，以拮抗鉀離⼦對⼼臟細胞膜電位的影響", "language": "tw"}
{"question": "下列那一個臨床症狀與心電圖變化的配對是最相符合的？", "answer": "普金杰系統阻斷（Purkinje system block）：延長的 QRS 綜合波", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "第一級心阻斷（first-degree heart block）：QT 延長症候群（long QT syndrome）", "B": "普金杰系統阻斷（Purkinje system block）：延長的 QRS 綜合波", "C": "心肌鉀離子通道突變，功能降低：PR（或 PQ）間期異常的延長", "D": "左心室肥大或擴張：高而尖的T波", "language": "tw"}
{"question": "有關簡單型熱痙攣（simple febrile seizure）的描述，下列何者正確？", "answer": "常有家族病史", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "常有家族病史", "B": "通常到成人階段仍會發生", "C": "腦波檢查常發現不正常", "D": "常伴隨腦部病變", "language": "tw"}
{"question": "莖突咽肌（stylopharyngeal muscle）由下列何者支配？", "answer": "第九顱神經 \t", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "第九顱神經 \t", "B": "第七顱神經 \t", "C": "下頜神經（mandibular nerve）", "D": "交感神經（sympathetic nerve）", "language": "tw"}
{"question": "下列何者受損會影響肱骨（humerus）的內收（adduct）、內旋（medially rotate）及屈曲（flex）功能？", "answer": "胸大肌（pectoralis major）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "胸大肌（pectoralis major）", "B": "胸小肌（pectoralis minor）", "C": "鎖骨下肌（subclavius）", "D": "前鋸肌（serratus anterior）", "language": "tw"}
{"question": "7 歲男孩，三天前開始發高燒、倦怠，同時在臉部、軀幹及四肢出現網狀紅斑，臉部的病灶如圖所示，則男孩最可能之診斷為：", "answer": "傳染性紅斑（erythema infectiosum）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "麻疹（measles） \t", "B": "川崎氏症（Kawasaki's disease）", "C": "猩紅熱（scarlet fever）", "D": "傳染性紅斑（erythema infectiosum）", "language": "tw"}
{"question": "70歲男性，機械性人工二尖瓣瓣膜置換手術後，術後三小時，胸腔引流管之流量逐漸減少，但是中心靜脈壓逐漸上升，尿量逐漸減少，心跳逐漸加快，動脈壓逐漸下降。此時要鑑別診斷是心包填塞（cardiac tamponade）或是術後心臟失能（myocardial dysfunction），最好的診斷工具為下列何者？", "answer": "心臟超音波", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "心臟超音波", "B": "胸部X光", "C": "胸動脈導管（swan ganz catheter）", "D": "動脈血氣體分析", "language": "tw"}
{"question": "下列何症狀與 achalasia 無關？", "answer": "胃酸逆流", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "胃酸逆流", "B": "吞嚥困難", "C": "體重減輕", "D": "吸入性肺炎", "language": "tw"}
{"question": "反轉錄病毒嵌入宿主的染色體中，其基因上那一個片段具有啟動子（promoter）序列可以調控病毒的轉錄（transcription）？", "answer": "LTR", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "LTR", "B": "gag", "C": "pol", "D": "env", "language": "tw"}
{"question": "下列有關Meckel's diverticulum之敘述，何者錯誤？", "answer": "通常長在mesenteric border", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "通常是由vitelline duct退化而成", "B": "是造成小孩下消化道出血的原因之一", "C": "通常長在mesenteric border", "D": "掉入腹股溝疝氣袋內時，又稱為Littre's hernia", "language": "tw"}
{"question": "憂鬱症患者常見的快速動眼期睡眠（rapid eye movement sleep）之潛期（latency）變化為何？", "answer": "縮短", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "不變", "B": "縮短", "C": "延長", "D": "不會出現潛期", "language": "tw"}
{"question": "A 型主動脈剝離症，須緊急手術，手術死亡率相當高，最常見的死亡原因為：", "answer": "血管吻合處出血不止", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "心臟衰竭", "B": "呼吸衰竭", "C": "血管吻合處出血不止", "D": "腦中風", "language": "tw"}
{"question": "陳先生，19 歲，最近到南美洲遊學兩星期，回國後出現類流感症狀，癒後仍出現關節痛達數十天之久。請問最可能感染下列何種病毒？", "answer": "基孔肯雅病毒（Chikungunya virus）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "登革熱病毒（dengue virus）", "B": "塞姆利基森林病毒（Semliki Forest virus）", "C": "黃熱病毒（yellow fever virus）", "D": "基孔肯雅病毒（Chikungunya virus）", "language": "tw"}
{"question": "下列何者是掌控與維持姿勢相關的中軸肌肉（axial muscles）收縮的最主要運動路徑？", "answer": "網狀脊髓路徑（reticulospinal tract）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "側皮質脊髓路徑（lateral corticospinal tract）", "B": "腹皮質脊髓路徑（ventral corticospinal tract）", "C": "網狀脊髓路徑（reticulospinal tract）", "D": "紅核脊髓路徑（rubrospinal tract）", "language": "tw"}
{"question": "52 下列那些疾病發生呼吸衰竭時，會以高二氧化碳性（hypercarbic）而非低血氧性（hypoxemic）呼吸衰竭為主？①極重度慢性阻塞性肺病 ②肺炎併急性肺損傷 ③原發性肺纖維化（idiopathic pulmonary fibrosis） ④心臟衰竭併肺水腫 ⑤重症肌無力（myasthenia gravis） ⑥頸椎外傷 ", "answer": "①⑤⑥", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "①③④", "B": "②③④", "C": "①⑤⑥", "D": "③⑤⑥", "language": "tw"}
{"question": "蛋白質結構中的β-摺板（β-sheet）與α-螺旋（α-helix）在結構分類上屬於：", "answer": "二級結構（secondary structure）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "一級結構（primary structure）", "B": "二級結構（secondary structure）", "C": "三級結構（tertiary structure）", "D": "四級結構（quaternary structure）", "language": "tw"}
{"question": "下列何種檢查，最無法確定目前胃中有幽門桿菌（Helicobacter pylori）感染？", "answer": "血中抗幽門桿菌抗體陽性", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "胃切片組織培養陽性", "B": "血中抗幽門桿菌抗體陽性", "C": "碳-13尿素吹氣檢查陽性", "D": "糞便幽門桿菌抗原檢\t陽性", "language": "tw"}
{"question": "下列何種抗癲癇藥物在達到其治療上需要之濃度（therapeutic concentration）後，在人體內之排除是屬於非線性排除（nonlinear elimination）？", "answer": "Phenytoin \t", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "Phenytoin \t", "B": "Carbamazepine", "C": "Valproate \t", "D": "Gabapentin", "language": "tw"}
{"question": "日本血吸蟲（Schistosoma japonicum）那一發育時期的蟲體會感染人？", "answer": "尾動幼蟲（cercaria）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "蟲卵 \t", "B": "纖毛幼蟲（miracidium）", "C": "尾動幼蟲（cercaria）", "D": "囊狀幼蟲（metacercaria）", "language": "tw"}
{"question": "下列何種藥物廣泛地使用於抑制細胞免疫的反應，也會抑制 prostaglandins 及 leukotrienes 的合成及促進 IgG 的合成作用？", "answer": "Prednisone", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "Cyclosporine", "B": "Prednisone", "C": "Cyclophosphamide", "D": "Mercaptopurine", "language": "tw"}
{"question": "下列有關如何培養嬰幼兒及兒童良好飲食習慣的敘述，何者最為適當？", "answer": "3歲後可以開始規定一些簡單的餐桌禮儀", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "2歲半到3歲之間為黃金訓練期", "B": "3歲後可以開始規定一些簡單的餐桌禮儀", "C": "2至4歲可以使用脫脂鮮奶", "D": "少喝含糖飲料，補充水分以稀釋果汁為宜", "language": "tw"}
{"question": "下列有關 Arthus 反應的描述，何者錯誤？", "answer": "這種過敏免疫反應常是全身性反應 \t", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "這種過敏免疫反應常是全身性反應 \t", "B": "抗體和補體系統活化都是重要的致病因子", "C": "嗜鹼性球（basophils）的活化是重要的致病因子", "D": "屬於第三型的過敏免疫（hypersensitivity）反應", "language": "tw"}
{"question": "依據2005年Starfield等人的研究報告，美國地區每10,000人口多增加一位家庭醫師，對死亡人數的影響為何？", "answer": "每100,000人口減少70人死亡", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "每100,000人口增加700人死亡", "B": "每100,000人口增加70人死亡", "C": "每100,000人口減少70人死亡", "D": "每100,000人口減少700人死亡", "language": "tw"}
{"question": "在醫院工作時發現有不符合醫學倫理但不違法的事情，如果想採取行動，下列那一項最不適當？", "answer": "向檢察官告發", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "提報到醫學倫理委員會討論", "B": "向上級報告", "C": "尋求同儕意見 \t", "D": "向檢察官告發", "language": "tw"}
{"question": "人類是下列何種病毒中，最明確的天然宿主？", "answer": "基孔肯雅病毒（Chikungunya virus）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "辛德畢斯病毒（Sindbis virus）", "B": "塞姆利基森林病毒（Semliki Forest virus）", "C": "西尼羅腦炎病毒（West Nile encephalitis virus）", "D": "基孔肯雅病毒（Chikungunya virus）", "language": "tw"}
{"question": "張先生目前 50 餘歲，最近出現多個關節腫脹、疼痛，主要在雙手近端指間關節、雙手腕關節、膝關節等，檢查結果為類風濕性關節炎（rheumatoid arthritis）。醫師表示目前張先生體內的類風濕性因子（rheumatoid factor）價數頗高，需積極治療。此因子是下列那一項？", "answer": "自體抗體（autoantibody）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "細胞激素（cytokine）", "B": "自體抗體（autoantibody）", "C": "調節性T細胞（Treg細胞）產生之調控因子", "D": "補體複合體（complement complex）", "language": "tw"}
{"question": "氣喘病人應避免使用 aspirin，是因為使用 aspirin 後下列何種物質產生可能增加，而易導致氣管收縮？", "answer": "leukotriene \t", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "thromboxane \t", "B": "prostaglandin D2", "C": "leukotriene \t", "D": "PAF（platelet-activating factor）", "language": "tw"}
{"question": "下列何者非目前國內所推動本土化家庭醫師制度的特色？", "answer": "由基層醫師組織聯合門診", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "由基層醫師組織聯合門診", "B": "建置家庭檔案的資訊管理系統", "C": "合作醫院成立共同照護門診", "D": "提供 24 小時的諮詢服務專線", "language": "tw"}
{"question": "65 歲男性病患，長期患有下足疼痛及腫脹，其足部之 X 光素片如圖，呈現軟組織腫大及鄰近骨骼變化，最可能的臨床診斷為？", "answer": "痛風關節炎（gouty arthritis）及痛風石沉澱（tophi）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "退化性關節炎（degenerative arthritis）併發囊膜積水", "B": "感染性（infection）骨骼及軟組織病變", "C": "痛風關節炎（gouty arthritis）及痛風石沉澱（tophi）", "D": "外傷性之骨骼軟組織病變", "language": "tw"}
{"question": "7.26歲女性病人，最近一週有多喝和多尿。體重50公斤，血液osmolality 290 mOsmol/kg H2O，Na 140 mmol/L，K 3.8  mmol/L。尿液osmolality 200 mOsmol/kg H2O，限水試\t2小時之體重47公斤，尿液osmolality 290 mOsmol/kg H2O，給予\n ADH（DDAVP）後2小時內最高的尿液osmolality 320 mOsmol/kg H2O。下列敘述何者最正確？ \n", "answer": "治療使用thiazides", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "最可能的診斷是原發性多飲症（primary polydipsia）", "B": "治療使用限水", "C": "治療使用thiazides", "D": "最可能的診斷是中樞型尿崩症（central diabetes insipidus）", "language": "tw"}
{"question": "一位 60 歲先生騎車車禍受傷前額著地，送至急診室時仍可自行步行進入急診。雙手疼痛無力抬起，經雙手 X 光檢查後並無任何手部骨折情形。則這位先生最可能是何種脊椎損傷？", "answer": "中央脊髓症候群（central cord syndrome）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "前脊髓症候群（anterior cord syndrome）", "B": "布朗塞卡氏症候群（Brown-Séquard syndrome）", "C": "中央脊髓症候群（central cord syndrome）", "D": "馬尾束症候群（cauda equina syndrome）", "language": "tw"}
{"question": "下列何者屬耳蝸內淋巴液（endolymph）組成成分的特色，以便產生動作電位？", "answer": "低鈉離子，高鉀離子", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "高鈉離子，高鉀離子", "B": "高鈉離子，低鉀離子", "C": "低鈉離子，高鉀離子", "D": "低鈉離子，低鉀離子", "language": "tw"}
{"question": "承上題，引發上述現象的解釋，有一種學說是有關左腎靜脈的胡桃鉗效應（nutcracker effect）；請問這個胡桃鉗指的是那兩條血管？", "answer": "superior mesenteric artery and aorta", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "celiac trunk and aorta \t", "B": "superior mesenteric artery and aorta", "C": "inferior mesenteric artery and aorta", "D": "right renal artery and aorta", "language": "tw"}
{"question": "某研究為分析降血壓藥的效果，採用病例對照設計（case-control study），欲分析病例對照兩組樣本服降血壓藥 3 個月前後測量之血壓值差異是否有明顯不同，研究者應該使用何種統計方法最合適？", "answer": "獨立樣本 t 檢定（Independent t-test）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "配對 t 檢定（Paired t-test）", "B": "單一樣本 Z 檢定（One sample Z-test）", "C": "Pearson 卡方檢定（Pearson Chi-square test）", "D": "獨立樣本 t 檢定（Independent t-test）", "language": "tw"}
{"question": "一個8個月大的男童因第一次尿道感染住院，膀胱尿道攝影檢查（voiding cystourethrogram）顯示如附圖，你會如何給父母親建議？", "answer": "建議使用抗生素預防感染", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "接受外科手術治療", "B": "建議接受局部玻尿酸注射治療", "C": "建議使用抗生素預防感染", "D": "建議只要觀察有無復發性感染，暫不需任何治療", "language": "tw"}
{"question": "下列何者是治療慢性淚囊炎（chronic dacryocystitis）的最佳方法？", "answer": "淚囊鼻腔吻合術 \t", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "淚囊切除 \t", "B": "淚囊切開排膿 \t", "C": "淚囊鼻腔吻合術 \t", "D": "結膜淚囊鼻腔吻合術", "language": "tw"}
{"question": "有關兒童急性闌尾炎（appendicitis）的敘述，下列何者最恰當？", "answer": "小於 2 歲其常見的症狀為腹痛、嘔吐、腹瀉、發燒", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "小於 2 歲其常見的症狀為腹痛、嘔吐、腹瀉、發燒", "B": "大於 2 歲其臨床表現與大人相似", "C": "白血球上升是診斷的重要指標", "D": "超音波檢查診斷率較電腦斷層高", "language": "tw"}
{"question": "一位 19 歲少女，來門診求診，主訴下腹痛合併陰道點狀出血。她敘述 1 個禮拜前曾在家裡自行驗孕，驗孕試劑呈現陽性反應。醫師安排陰道超音波檢查並沒有發現子宮腔內的妊娠囊。抽血檢查血清 beta-hCG 數值為 1800 mIU/mL。相隔 4 天之後，再次檢查血清 beta-hCG 數值為 2100 mIU/mL。這位少女的臨床症狀及實驗室數據最符合下列那一個臨床診斷？", "answer": "子宮外孕（ectopic pregnancy）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "自然流產（spontaneous abortion）", "B": "多重懷孕（multiple gestation）", "C": "子宮外孕（ectopic pregnancy）", "D": "不完全流產（incomplete abortion）", "language": "tw"}
{"question": "可以用手術矯正之男性不孕症病因最常見的（the most common correctable cause of male infertility）為何？", "answer": "Varicocele", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "Varicocele", "B": "Testicular torsion", "C": "Testicular tumor", "D": "Hydrocele", "language": "tw"}
{"question": "民國 94 年間國軍 A 上尉於軍事操練中意外死亡，其未婚妻要求婦產科醫師進行屍體取精以作人工生殖，在當時引起社會很大爭議，下列何者非為本案醫學倫理上的主要爭議？", "answer": "撫卹金公平分配的問題", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "死者意願的問題 \t", "B": "家屬權利的問題", "C": "未來兒女權利的問題", "D": "撫卹金公平分配的問題", "language": "tw"}
{"question": "下列何者不是給予全靜脈營養治療（Total Parenteral Nutrition）的併發症？", "answer": "Non-essential fatty acid deficiency", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "Non-essential fatty acid deficiency", "B": "Iron deficiency anemia", "C": "Hyperglycemia \t", "D": "Pancreatitis", "language": "tw"}
{"question": "陳姓老翁1個月前因為罹患胰臟癌末期而簽署了安寧緩和醫療意願書，希望病危的時候可以放棄急救。3天前，陳老先生出現發燒、頻尿的情況，而被送往醫院救治，經過醫師的診察確認陳老先生為尿路感染合併\t血症，陳老先生於住院中因為血壓不穩，經過輸液治療而導致肺水腫，醫師建議進行氣管插管併用呼吸器治療，以緩解其肺水腫。此時是否應同意陳老先生接受插管？", "answer": "贊成，雖然陳老先生為胰臟癌末期，也簽署了安寧緩和醫療意願書，但本次住院的原因為  \t泌尿道感染合併\t血症，並非不可治癒的疾病，醫師應該為其插管治療 \t", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "反對，因為陳老先生已經簽署了安寧緩和醫療意願書，不應該違反其意願而為其插管", "B": "反對，因為陳老先生為胰臟癌末期，不要再進行過於侵入性的治療，免得增加其痛苦", "C": "贊成，雖然陳老先生為胰臟癌末期，也簽署了安寧緩和醫療意願書，但本次住院的原因為  \t泌尿道感染合併\t血症，並非不可治癒的疾病，醫師應該為其插管治療 \t", "D": "贊成，雖然陳老先生為胰臟癌末期，也簽署了安寧緩和醫療意願書，但只要屬於病危的患者，均應該依醫師法定急救義務而加以急救", "language": "tw"}
{"question": "化膿性肝膿瘍在臺灣地區，以下列何種致病菌為最常見？", "answer": "Klebsiella pneumoniae", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "Escherichia coli \t", "B": "Klebsiella pneumoniae", "C": "Anaerobic bacteria \t", "D": "Streptococci", "language": "tw"}
{"question": "有關心臟血管系統的身體診查（physical examination），下列敘述何者錯誤？", "answer": "正常右內頸動脈的壓力應小於 12 cm H2O", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "正常右內頸動脈的壓力應小於 12 cm H2O", "B": "第三心音可在正常兒童或年輕人聽到", "C": "第三心音與心室的血容量增加有關（volume overload）", "D": "第四心音與心室的順應性（compliance）下降有關", "language": "tw"}
{"question": "保險的基本原理有三個要件，下列何者不是要件之一？", "answer": "供需平衡", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "危險共同分攤", "B": "大多數法則", "C": "供需平衡", "D": "避免引導道德危險", "language": "tw"}
{"question": "一位12歲女孩因身材矮小就診，父親身高160公分，母親身高152公分。去年曾發生一次全身性痙攣（generalized convulsion），身體檢查顯示身高133公分（低於第3百分位），體重47公斤（第 90百分位），圓臉、輕微智障，實驗室檢查顯示血清鈣值1.53 nmol/L，血清磷值6.4 mg/dL，血清鎂1.1 mmol/L，血清副甲狀腺素（intact PTH）值245 pg/mL（正常值12-72 pg/mL），此女童最可能的診斷為：", "answer": "pseudohypoparathyroidism", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "hyperparathyroidism", "B": "hypoparathyroidism", "C": "pseudohypoparathyroidism", "D": "pseudopseudohypoparathyroidism", "language": "tw"}
{"question": "下列有關蛋白質激酶 C（protein kinase C）的敘述，何者正確？", "answer": "可在細胞膜上被二醯甘油（diacylglycerol）活化", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "可在細胞膜上被二醯甘油（diacylglycerol）活化", "B": "可對二醯甘油進行磷酸化", "C": "可活化 p53 抑癌基因", "D": "可被 cylic AMP 活化", "language": "tw"}
{"question": "下列何種人體寄生蟲感染需要全家集體投藥治療？", "answer": "蟯蟲（Enterobius vermicularis）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "蟯蟲（Enterobius vermicularis）", "B": "有鉤絛蟲（Taenia solium）", "C": "旋毛蟲（Trichinella spiralis）", "D": "中華肝吸蟲（Clonorchis sinensis）", "language": "tw"}
{"question": "復健病房值班時，有頸椎損傷患者，頭痛、冒汗、起雞皮疙瘩，下列處置何者最適當？", "answer": "檢查是否有膀胱過漲現象，必要時緊急導尿", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "檢查喉嚨是否發紅，是否發燒，給予感冒、退燒藥", "B": "詢問是否有習慣性偏頭痛，給予止痛藥", "C": "檢查是否有膀胱過漲現象，必要時緊急導尿", "D": "可能是緊張過度，給予鎮定劑", "language": "tw"}
{"question": "鑑定皮癬菌（Dermophyton）的主要依據，不包括下列那一特性？", "answer": "生化特性", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "生化特性", "B": "菌落特性", "C": "菌絲特性", "D": "孢子特性", "language": "tw"}
{"question": "臀皺褶（Gluteal fold）附近的皮膚感覺主要由下列何者支配？", "answer": "股後皮神經（Posterior femoral cutaneous nerve）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "臀下神經（Inferior gluteal nerve） \t", "B": "坐骨神經（Sciatic nerve）", "C": "股外側皮神經（Lateral femoral cutaneous nerve）", "D": "股後皮神經（Posterior femoral cutaneous nerve）", "language": "tw"}
{"question": "社區健康營造不鼓勵的做法是：", "answer": "由上而下（top-down）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "充能或增能（empowerment）", "B": "夥伴關係（partnership）", "C": "由上而下（top-down）", "D": "合作或結盟（alliance）", "language": "tw"}
{"question": "下列何者非為透納氏症候群Turner syndrome之特徵？", "answer": "青春痘增生", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "身材短小", "B": "無月經", "C": "不孕症", "D": "青春痘增生", "language": "tw"}
{"question": "耳下腺管（parotid duct）開口處口腔黏膜的痛覺，由下列何者傳導？", "answer": "頰神經（buccal nerve）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "舌神經（lingual nerve）", "B": "頰神經（buccal nerve）", "C": "顴面神經（zygomaticofacial nerve）", "D": "面神經（facial nerve）之頰支（buccal branch）", "language": "tw"}
{"question": "下列何者是目前市場上的抗膽鹼藥物（anti-cholinergic medications）治療尿急性失禁（urge incontinence）時，最常見的副作用（adverse effect）？", "answer": "口乾（dry mouth） \t", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "肌肉無力（muscle weakness）", "B": "尿液滯留（urinary retention）", "C": "口乾（dry mouth） \t", "D": "頻尿（urinary frequency）", "language": "tw"}
{"question": "一位男童於 9 個月大因罹患川崎病接受 2 gm/kg 的靜脈注射免疫球蛋白治療，現已痊癒。15 個月大來診要求注射麻疹-腮腺炎-德國麻疹疫苗與第一劑日本腦炎疫苗，下列那一種處置最適當？", "answer": "可接種日本腦炎疫苗，麻疹-腮腺炎-德國麻疹疫苗必須延後接種", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "可立即接種注射麻疹-腮腺炎-德國麻疹疫苗與日本腦炎疫苗", "B": "可接種日本腦炎疫苗，麻疹-腮腺炎-德國麻疹疫苗必須延後接種", "C": "可接種麻疹-腮腺炎-德國麻疹疫苗，日本腦炎疫苗必須延後接種", "D": "日本腦炎疫苗與麻疹-腮腺炎-德國麻疹疫苗均必須延後接種", "language": "tw"}
{"question": "關於胃酸（gastric acid) 分泌之敘述，何者錯誤？", "answer": "D細胞（D cell）所分泌的somatostatin會增加組織胺（histamine）及胃泌素（gastrin）的分泌，進而增加胃酸的分泌", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "受到乙醯膽鹼（acetylcholine），胃泌素（gastrin）及組織胺（histamine）的調控", "B": "胃酸的分泌可分為頭期（cephalic phase），胃期（gastric phase）及腸期（intestinal", "C": "胃期（gastric phase）所分泌的胃酸佔所有胃酸分泌的 60%～70%", "D": "D細胞（D cell）所分泌的somatostatin會增加組織胺（histamine）及胃泌素（gastrin）的分泌，進而增加胃酸的分泌", "language": "tw"}
{"question": "從遭到愛滋病毒感染，到以檢測試劑可偵測到感染的這一個月左右的時間內，檢測結果可能出現偽陰性。這段期間稱為什麼期？", "answer": "空窗期（window period）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "空窗期（window period）", "B": "潛伏期（incubation period）", "C": "恢復期（recovery period）", "D": "發病期（developing period）", "language": "tw"}
{"question": "下列有關足底筋膜炎（plantar fasciitis）的敘述，何者錯誤？", "answer": "足部 X 光片常可見到骨刺（spur），此為診斷最重要的根據", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "足底筋膜可幫助維持內側足弓（plantar arch）", "B": "當大腳趾做過度背屈動作（hyper-dorsiflexion）時可引發疼痛", "C": "足部 X 光片常可見到骨刺（spur），此為診斷最重要的根據", "D": "很少需要以手術方式治療", "language": "tw"}
{"question": "91 氣喘篩檢計畫調查兩所國中的學生，共檢出氣喘學生人數如下：  \t男生 \t女生金城國中\t315 \t270 山城國中\t480 \t420 合  計\t795 \t690  試問下列敘述何者正確？ \n", "answer": "這些數字無法進行任何推論", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "這項調查顯示男生有氣喘的危險性高", "B": "山城國中的氣喘盛行率較高", "C": "山城國中的氣喘發生率較高", "D": "這些數字無法進行任何推論", "language": "tw"}
{"question": "外展聲帶，打開聲門最主要的是下列何種肌肉之作用？", "answer": "後環杓肌", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "側環杓肌", "B": "環甲肌", "C": "杓間肌", "D": "後環杓肌", "language": "tw"}
{"question": "使用 ACE 抑制劑（angiotensin converting enzyme inhibitor）要注意那一種副作用？", "answer": "高血鉀（Hyperkalemia）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "高血鈉（Hypernatremia）", "B": "低血鈣（Hypocalcemia）", "C": "高血鉀（Hyperkalemia）", "D": "低血鈉（Hyponatremia）", "language": "tw"}
{"question": "有關穩定型心絞痛（stable angina）之藥物治療，下列何者最不適當？", "answer": "合併使用 aspirin 及 warfarin 優於單獨使用 aspirin", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "使用交感神經乙型阻斷劑，除非病人有該藥物之禁忌症", "B": "若病人有使用交感神經乙型阻斷劑之禁忌症，則建議使用鈣離子阻斷劑", "C": "若合併糖尿病或左心室收縮功能不良，則建議使用血管張力素轉換酶抑制劑（angiotensin-converting", "D": "合併使用 aspirin 及 warfarin 優於單獨使用 aspirin", "language": "tw"}
{"question": "一位 70 歲抽菸患者，其肺功能顯示 FEV1/FVC = 60%，FEV1 只有預期值的 56%；下列何者非長期治療的處方？", "answer": "口服低劑量類固醇", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "吸入長效型支氣管擴張劑", "B": "口服低劑量類固醇", "C": "戒菸 \t", "D": "肺部復健", "language": "tw"}
{"question": "下列有關骶尾畸胎瘤（sacrococcygeal teratoma）之敘述，何者正確？", "answer": "原條（primitive streak）閉鎖不全所造成", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "由外胚層和中胚層的細胞組成", "B": "原條（primitive streak）閉鎖不全所造成", "C": "產前的超音波檢查不易發現", "D": "常發生於男性新生兒", "language": "tw"}
{"question": "透明膜（hyaline membrane）這種疾病與胎兒肺部在下列何時期發育不良有關？", "answer": "末囊期（terminal sac period）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "偽腺期（pseudoglandular period）", "B": "小管期（canalicular period）", "C": "末囊期（terminal sac period）", "D": "肺泡期（alveolar period）", "language": "tw"}
{"question": "下列何者較不可能是因為上運動神經元（upper motor neuron）損傷所呈現的病徵？", "answer": "肌束抽搐（Fascicular twitching）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "肌無力（Weakness）", "B": "肌束抽搐（Fascicular twitching）", "C": "深部腱反射（Deep tendon reflex）增加", "D": "伸蹠反射（Extensor plantar reflex） 61 \t巨細胞動脈炎（Giant cell arteritis）的主要治療是：", "language": "tw"}
{"question": "一位 52 歲女性，主訴咳嗽痰多，胸部 X 光片和 CT 影像如下圖，則最可能的診斷為下列何者？", "answer": "囊狀支氣管擴張（cystic bronchiectasis）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "囊狀支氣管擴張（cystic bronchiectasis）", "B": "膿胸（empyema）", "C": "橫膈疝脫（diaphragmatic hernia）", "D": "空洞性肺癌（cystic lung carcinoma）", "language": "tw"}
{"question": "一位 43 歲病人，偶然間摸到頸部淋巴結腫大，但無其他不適。經淋巴結切片及病理檢查證實為 B 細胞瀰漫型大細胞淋巴瘤，CD20 抗原陽性。電腦斷層攝影顯示腹部大動脈旁及鼠蹊部淋巴結腫大。對這位病人最適當的治療為何？", "answer": "給予化學治療 CHOP 加 rituximab", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "密切觀察待有症狀時再治療", "B": "給予化學治療 COP（cyclophosphamide, vincristine 及 prednisolone）", "C": "給予化學治療 CHOP（COP 加 adriamycin）", "D": "給予化學治療 CHOP 加 rituximab", "language": "tw"}
{"question": "下列何者不會引起脂肪肝？", "answer": "胃食道逆流", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "肥胖", "B": "糖尿病", "C": "高血脂症", "D": "胃食道逆流", "language": "tw"}
{"question": "承上題，在急診處對該病人的處置，下列何者最為適當？", "answer": "尿液滲透壓測定，並給予0.9% NaCl", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "腦部電腦斷層攝影，並給予口服kayexalate 60 mg", "B": "尿液滲透壓測定，並給予0.9% NaCl", "C": "動脈血氣體分析，並作血液的細菌培養", "D": "腦脊髓液檢查，並給予5%葡萄糖溶液，加入5單位的短效胰島素", "language": "tw"}
{"question": "下列狀況何者為最可能的診斷？", "answer": "排卵期的子宮頸黏液", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "使用口服排卵藥 \t", "B": "排卵期的子宮頸黏液", "C": "早發性停經 \t", "D": "接受子宮頸錐狀切除術後", "language": "tw"}
{"question": "一男嬰足月出生活動力正常，但產後 4 天發現臍帶結紮處有滲出血水，背部有局部瘀血斑，嬰兒最有可能缺乏下列何種營養素？", "answer": "維生素 K", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "維生素 K", "B": "維生素 B12", "C": "葉酸", "D": "鐵", "language": "tw"}
{"question": "9 張先生 56 歲，因嚴重心臟衰竭至急診處，胸部 X 光及臨床診察變化為：肺充血（lung congestion）   Kerley B line 腹水、肝腫大 下肢水腫（edema），則下列何者是最確切的右心衰竭特點？ \n", "answer": "", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "", "B": "", "C": "", "D": "", "language": "tw"}
{"question": "下列有關肉毒桿菌毒素（botulinum neurotoxin）局部肌肉注射以治療腦性麻痺肌肉痙攣的敘述，何者最正確？", "answer": "有效期間 3 至 6 個月，需要重複注射", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "其作用是使周邊神經去髓鞘（demyelination），造成肌肉無力", "B": "作用快速，注射後 20 分鐘就出現肌肉無力及痙攣消失", "C": "有效期間 3 至 6 個月，需要重複注射", "D": "其缺點是可能造成局部感覺異常", "language": "tw"}
{"question": "一般標準之純音聽力檢查（pure tone audiometry）所測\t之最高音頻為下列何者？", "answer": "8000 Hz", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "4000 Hz", "B": "6000 Hz", "C": "8000 Hz", "D": "10000 Hz", "language": "tw"}
{"question": "下列何種細胞是專業化的抗原呈現細胞（professional antigen-presenting cell）？", "answer": "巨噬細胞（macrophage）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "CD4+ T 細胞 \t", "B": "嗜中性白血球（neutrophil）", "C": "巨噬細胞（macrophage）", "D": "肥胖細胞（mast cell）", "language": "tw"}
{"question": "下列細胞中，何者的主要功能是產生抗體？", "answer": "漿細胞（plasma cells）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "巨噬細胞（macrophages）", "B": "肥大細胞（mast cells）", "C": "漿細胞（plasma cells）", "D": "T淋巴細胞（T lymphocytes）", "language": "tw"}
{"question": "在急性心肌梗塞後，會發生各種併發症，下列何種併發症發生後必須考慮儘速手術治療，以免病人病情惡化而死亡？", "answer": "壞死性心室中隔缺損", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "呼吸窘迫症候群（Acute Respiratory Distress Syndrome）", "B": "壞死性心室中隔缺損", "C": "低心輸出量合併寡尿（Oliguria）", "D": "細菌性心內膜炎", "language": "tw"}
{"question": "下列有關平滑肌收縮時之 cross-bridge activation 的敘述，何者錯誤？", "answer": "該激活作用是因肌動蛋白（actin）磷酸化所致", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "該激活作用是因肌動蛋白（actin）磷酸化所致", "B": "troponin 不參與此激活作用", "C": "細胞質內之鈣離子（cytosolic calcium）與調鈣蛋白（calmodulin）結合，參與此激活作用", "D": "在平滑肌內的 ATPase 酵素活性速率比在骨骼肌內來的慢", "language": "tw"}
{"question": "84 有關醫療社會化（medical socialization）之可能結果，請由下列選項中選出最適當的組合關係？①造成醫療價格高漲 ②非醫療需求者亦需負擔醫療費用 ③易引起醫療供給者之反彈 ④易引起高所得者之不滿與不安 ", "answer": "②③④", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "①②③④", "B": "②③④", "C": "①②③", "D": "①②④", "language": "tw"}
{"question": "一位病人於理學檢查時被發現有肩膀外展（abduction）無力，下列那一部分的神經損傷不會造成此種現象？", "answer": "肌皮神經（musculocutaneous nerve）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "腋窩神經（axillary nerve）", "B": "臂神經叢上幹（upper trunk）", "C": "肌皮神經（musculocutaneous nerve）", "D": "臂神經叢後索（posterior cord）", "language": "tw"}
{"question": "關於人類單核細胞艾利希體症（human monocytic ehrlichiosis）的敘述，下列何者錯誤？", "answer": "以青黴素（penicillin）、氨基糖苷（aminoglycosides）、大環內酯（macrolides）等類藥物治療有效", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "以青黴素（penicillin）、氨基糖苷（aminoglycosides）、大環內酯（macrolides）等類藥物治療有效", "B": "其致病菌可在血液單核球（monocyte）和巨噬細胞（macrophage）內進行繁殖", "C": "多數病患會有血清轉胺酶（serum transaminase）升高及血小板減少（thrombocytopenia）的情況", "D": "臨床主要以核酸增幅法（nucleic acid amplification）或血清學檢\t（serological test）確認此疾病", "language": "tw"}
{"question": "下列何者非會厭炎（epiglottitis）典型之症狀？", "answer": "哮鳴（wheezing）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "喘鳴（stridor）", "B": "吞嚥困難（dysphagia）", "C": "哮鳴（wheezing）", "D": "流涎（drooling）", "language": "tw"}
{"question": "腦中核酸分解所形成之氨（ammonia），主要轉化為下列何種物質，再經由血液運送至肝臟或腎臟？", "answer": "麩胺醯胺（glutamine）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "尿酸（uric acid）", "B": "尿素（urea）", "C": "天冬醯胺（asparagine）", "D": "麩胺醯胺（glutamine）", "language": "tw"}
{"question": "下列何者受損時最可能影響提睪肌（cremasteric muscle）的收縮？", "answer": "生殖股神經（genitofemoral nerve）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "股神經（femoral nerve）", "B": "陰部神經（pudendal nerve）", "C": "生殖股神經（genitofemoral nerve）", "D": "髂腹股溝神經（ilioinguinal nerve）", "language": "tw"}
{"question": "此時昏迷指數最可能為幾分？", "answer": "3", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "1", "B": "3", "C": "5", "D": "7", "language": "tw"}
{"question": "下列何種細胞不屬於永久性組織（nondividing or permanent tissues）?", "answer": "平滑肌細胞（smooth muscle cells）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "神經元（neurons）", "B": "骨骼肌細胞（skeletal muscle cells）", "C": "平滑肌細胞（smooth muscle cells）", "D": "心肌細胞（cardiac muscle cells）", "language": "tw"}
{"question": "兒童總膽管囊腫（choledochal cyst）的症狀，下列何者最少見？", "answer": "膽道結石（gallstone）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "腹痛（abdominal pain）", "B": "黃疸（jaundice）", "C": "膽道結石（gallstone）", "D": "腹部腫塊（abdominal mass）", "language": "tw"}
{"question": "34歲男性，因中樞神經系統症狀住院，腦部切片顯示多個髓鞘脫失（demyelination）病灶，其內之神經軸索（axons）數目略減，病灶邊緣之寡樹突膠質細胞核呈玻璃狀雙染的包涵物（glassy amphophilic inclusions），亦見到奇異且巨大的星狀膠原細胞（bizarre giant astrocytes），其診斷為何？", "answer": "進行性多病灶腦白質病（progressive multifocal leukoencephalopathy）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "人類免疫力不足病毒腦炎（human immunodeficiency virus encephalitis）", "B": "進行性多病灶腦白質病（progressive multifocal leukoencephalopathy）", "C": "亞急性硬化性全腦炎（subacute sclerosing panencephalitis）", "D": "第二型單純疱疹病毒腦炎（herpes simplex virus type 2 encephalitis）", "language": "tw"}
{"question": "50 歲婦女上門求診，因左側腋下有腫塊 3 週，經醫師檢查發現，左側腋下淋巴結腫大且硬，但不痛，請問該婦女最有可能罹患下列何種疾病？", "answer": "乳房腺管癌", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "急性乳腺炎合併化膿", "B": "乳房腺管癌", "C": "乳房惡性淋巴瘤", "D": "肺部小細胞癌", "language": "tw"}
{"question": "一位 16 歲的高中生打籃球後左膝蓋一直疼痛不癒。國術館推拿後反而漸漸腫脹。骨科檢查，X 光發現遠端股骨有異常；切片診斷為惡性骨肉瘤。下列敘述何者錯誤？", "answer": "胸部 X 光檢查發現有一個可能是轉移的腫瘤，此階段已無法治療", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "X 光檢查可能發現 Codman's triangle \t", "B": "胸部 X 光檢查發現有一個可能是轉移的腫瘤，此階段已無法治療", "C": "胸部電腦斷層檢查是必要的", "D": "化學治療是不可缺少的", "language": "tw"}
{"question": "控制下列心血管因子，何者對缺血性心臟病之預後影響最不顯著？", "answer": "控制血糖", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "戒菸 \t", "B": "控制血壓 \t", "C": "控制血脂異常（dyslipidemia）", "D": "控制血糖", "language": "tw"}
{"question": "肺炎黴漿菌（Mycoplasma pneumoniae）感染會引起原發性非典型肺炎（primary atypical pneumonia），在鑑定培養時通常會加入下列何種抗生素於培養基中，以利黴漿菌的分離與生長？", "answer": "青黴素（penicillin） \t", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "青黴素（penicillin） \t", "B": "紅黴素（erythromycin）", "C": "四環素（tetracycline）", "D": "磺胺劑（sulfonamide）", "language": "tw"}
{"question": "下列那一種真核細胞調控蛋白質（eukaryotic regulatory proteins）會與增強子（enhancer）結合，以促進基因轉錄？", "answer": "轉錄活化子（transcription activators）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "轉錄活化子（transcription activators）", "B": "輔活化子（coactivators）", "C": "TATA-結合蛋白（TATA-binding proteins; TBP）", "D": "基準轉錄因子（basal transcription factors）", "language": "tw"}
{"question": "胚胎發育時，下列那一咽溝（pharyngeal groove）會持續存在，並且衍生形成外聽道（external acoustic meatus）？", "answer": "第一", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "第一", "B": "第二", "C": "第三", "D": "第四", "language": "tw"}
{"question": "一位 5 歲大 20 kg 的兒童送醫途中，身體評估顯示兒童無反應、無脈搏，且無自發性呼吸。護送兒童的緊急救護員敘述護送途中持續給予正壓呼吸及胸部按壓，貼上自動體外電擊器貼片，心電圖顯示如下，此時，下列何種治療對小朋友最合適？", "answer": "使用兒童電擊貼片，給予 50 焦耳雙相電擊一次", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "建立血管通路，給予 Amiodarone 100 mg 注射", "B": "建立血管通路，給予 Adenosine 2 mg 注射", "C": "使用兒童電擊貼片，給予 50 焦耳雙相電擊一次", "D": "建立血管通路，給予 Epinephrine 0.2 mg 注射，並繼續 CPR", "language": "tw"}
{"question": "胰臟之腺泡中央細胞（centroacinar cells）的來源是什麼？", "answer": "閏管（intercalated duct）細胞", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "產酵素細胞（zymogenic cells）", "B": "蘭氏小島（islet of Langerhans）細胞", "C": "小葉間管（interlobular duct）細胞", "D": "閏管（intercalated duct）細胞", "language": "tw"}
{"question": "20歲男性，因右膝受傷接受X光攝影。附圖為X光攝影影像，最可能的診斷為何？", "answer": "hereditary multiple exostoses", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "fibrous dysplasia", "B": "hereditary multiple exostoses", "C": "osteogenic sarcoma", "D": "eosinophilic granuloma", "language": "tw"}
{"question": "年輕女性引起急性輸卵管炎之最常見的致病原因為何？", "answer": "Chlamydia trachomatis", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "gonorrhea \t", "B": "Chlamydia trachomatis", "C": "Ureaplasma urealyticum", "D": "bacterial vaginitis", "language": "tw"}
{"question": "有關幼兒異物吞食之敘述，下列何者錯誤？", "answer": "即使病人無臨床症狀，blunt objects and coins lodged in the esophagus 也必須儘早取出，以避免食道破裂", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "至少 30% of children with esophageal foreign bodies 無症狀", "B": "誤食 foreign body 者，大部分（約 80%）為 6 個月到 3 歲之間的嬰幼兒", "C": "若有 sharp objects in the esophagus, disc button batteries 或異物合併呼吸道症狀者，應立即取出", "D": "即使病人無臨床症狀，blunt objects and coins lodged in the esophagus 也必須儘早取出，以避免食道破裂", "language": "tw"}
{"question": "35歲女性主述於2年前，手部遇冷會出現指端變紫黑色的情形，另外也抱怨顏面紅斑及多發性關節痛。最近1 年，工作時容易疲勞，實\t室檢查Anti-U1 RNP抗體為1:1280。最可能的診斷為：", "answer": "混合性結締組織病（mixed connective tissue disease）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "全身性硬化症（systemic sclerosis）", "B": "系統性紅斑狼瘡（systemic lupus erythematosus）", "C": "皮膚肌炎（dermatomyositis）", "D": "混合性結締組織病（mixed connective tissue disease）", "language": "tw"}
{"question": "出生體重低於1000公克的早產兒發生腦性麻痺（cerebral palsy）機率較高，是因為這類嬰兒較易有何種腦部病變發生？", "answer": "peri-ventricular leukomalacia", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "brain malformation", "B": "subdural hematoma", "C": "congenital meningitis", "D": "peri-ventricular leukomalacia", "language": "tw"}
{"question": "因感染結核分枝桿菌（Mycobacterium tuberculosis）而在肺部形成的肉芽腫（granuloma）中，主要可以觀察到下列那一種細胞？", "answer": "蘭氏巨細胞（Langhans giant cell）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "滋養細胞（trophocyte）", "B": "小膠質細胞（microglial cell）", "C": "空泡細胞（koilocyte）", "D": "蘭氏巨細胞（Langhans giant cell）", "language": "tw"}
{"question": "左胃網膜動脈（left gastro-omental artery）源自下列何者？", "answer": "脾動脈（splenic artery）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "右胃網膜動脈 \t", "B": "肝動脈（hepatic artery）", "C": "胃十二指腸動脈（gastroduodenal artery）", "D": "脾動脈（splenic artery）", "language": "tw"}
{"question": "一位 72 歲病患，服用口服降血糖藥物多年，最近五天因\"感冒\"變得嗜睡，由家人送來急診求醫，抵院時，血壓為 120/80 mmHg，神經學檢查無異常所見，實驗室數據如下：WBC：14,500/mm3、尿酮：", "answer": "0.9% NaCl 3000 mL 靜脈輸注", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "NPH insulin 20 單位皮下注射", "B": "0.9% NaCl 3000 mL 靜脈輸注", "C": "抗生素治療 \t", "D": "7% sodium bicarbonate 40 mL 靜脈注射", "language": "tw"}
{"question": "克流感（oseltamivir）主要藉由干擾流感病毒的那種蛋白的功能，以達到抑制病毒的功效？", "answer": "Neuraminidase", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "M1 protein", "B": "Hemagglutinin", "C": "M2 protein", "D": "Neuraminidase", "language": "tw"}
{"question": "附圖為描述糖尿病發病過程的一些生理變化，甲、乙及丙三條曲線分別描述那些變化？", "answer": "甲：血糖變化；乙：胰島素分泌量；丙：胰島素敏感度", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "甲：血糖變化；乙：胰島素分泌量；丙：胰島素敏感度", "B": "甲：胰島素分泌量；乙：胰島素敏感度；丙：血糖變化", "C": "甲：血糖變化；乙：胰島素敏感度；丙：胰島素分泌量", "D": "甲：胰島素敏感度；乙：胰島素分泌量；丙：血糖變化", "language": "tw"}
{"question": "下列有關馬尾症候群（cauda equina syndrome）的敘述，何者正確？", "answer": "球海綿體肌反射（bulbocavernosus reflex）消失", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "以上運動神經元（upper motor neuron）表徵為主", "B": "通常臨床症狀是左右兩側對稱", "C": "深部肌腱反射增強", "D": "球海綿體肌反射（bulbocavernosus reflex）消失", "language": "tw"}
{"question": "五個月大男嬰，因哭鬧不停及出現粉紅色果凍樣大便（currant jelly stool）就醫，影像學檢查發現有腸套疊。病人最可能出現下列何種病理變化？", "answer": "腸道壞死", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "腸道壞死", "B": "腸壁平滑肌肥厚", "C": "腸黏膜細胞增生", "D": "腸道血管增生", "language": "tw"}
{"question": "左肺門（hilum）正上方的溝（或切跡）是由何結構造成的？", "answer": "動脈弓", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "食道", "B": "動脈弓", "C": "奇靜脈", "D": "上腔靜脈", "language": "tw"}
{"question": "下列有關第一型神經纖維瘤（type 1 neurofibromatosis）的描述，何者錯誤？", "answer": "此病為體染色體隱性遺傳（autosomal recessive）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "此病為體染色體隱性遺傳（autosomal recessive）", "B": "有將近一半的病人均是因為新的基因突變造成（de novo mutation）", "C": "有可能會伴發視神經瘤（optic glioma）", "D": "身上有六個以上之咖啡斑（café-au-lait spots）", "language": "tw"}
{"question": "48 歲男性，連續發生胸痛並延伸至左肩之情形已持續 3 天。來到急診時表現為呼吸困難、頭暈與冒冷汗持續 1 小時；病人一到急診血壓無法測得，而心電圖呈現如下變化。下列處置何者正確？", "answer": "直流電電擊整流術（direct current cardioversion）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "舌下甘油片可緩解此病人之疼痛", "B": "可針對病人之呼吸困難使用 morphine 肌肉注射", "C": "以靜脈注射 amiodarone 速效劑量，再以靜脈連續輸注維持劑量", "D": "直流電電擊整流術（direct current cardioversion）", "language": "tw"}
{"question": "患者因肛門嚴重搔癢就診，並出現脫肛（rectal prolapse）症狀時，你應懷疑受到下列何種寄生蟲感染？", "answer": "鞭蟲（Trichuris trichiura）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "蛔蟲（Ascaris lumbricoides）", "B": "美洲鈎蟲（Necator americanus）", "C": "鞭蟲（Trichuris trichiura）", "D": "蟯蟲（Enterobius vermicularis）", "language": "tw"}
{"question": "單一靜脈注射thiopental在人體內的作用時間非常短暫，其主要原因是具有下列何項性質？", "answer": "易由大腦再到脂肪組織重新分布", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "在腸胃道之吸收緩慢", "B": "不經由肝臟代謝而直接由腎臟排出", "C": "易由大腦再到脂肪組織重新分布", "D": "在肝臟很快被代謝成不活性物質", "language": "tw"}
{"question": "下列低血鉀之成因何者不是因鉀離子移入細胞內？", "answer": "庫欣氏症（Cushing's syndrome）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "代謝性鹼中毒（metabolic alkalosis）", "B": "合成代謝階段（anabolic state）", "C": "庫欣氏症（Cushing's syndrome）", "D": "低血鉀週期性無力症（hypokalemic periodic paralysis）", "language": "tw"}
{"question": "健康行為改變的PRECEDE-PROCEED模式中，下列那一項是屬於增強因素（reinforcing factor）？", "answer": "重要他人支持", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "資源整合運用", "B": "重要他人支持", "C": "態度信念改變", "D": "支持環境的重建", "language": "tw"}
{"question": "下列何者屬於衍生性空氣污染物？", "answer": "臭氧", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "二氧化硫", "B": "一氧化碳", "C": "一氧化氮", "D": "臭氧", "language": "tw"}
{"question": "承上題，下列有關這類患者之藥物治療，何者錯誤？", "answer": "使用 hydroxychloroquine 主要是抑制發炎細胞的增生", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "使用 hydroxychloroquine 主要是抑制發炎細胞的增生", "B": "急性期可以使用類固醇來緩解症狀", "C": "Sulfasalazine 主要是抑制發炎性細胞激素之表現", "D": "Methotrexate 是有效之第二線藥物", "language": "tw"}
{"question": "承上題，若此男童骨齡檢查結果為 12 歲 9 個月，優先考慮下列那一項診斷？", "answer": "體質性生長遲延（constitutional growth delay）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "家族性身材矮小（genetic short stature）", "B": "營養不良（malnutrition）", "C": "體質性生長遲延（constitutional growth delay）", "D": "腦垂體低能症（hypopituitarism）", "language": "tw"}
{"question": "一位 21 歲雙極性疾患（bipolar disorder）急性躁症發作（acute manic episode）的患者，被送到醫院急診室時，下列那一種症狀應較不會出現？", "answer": "罪惡妄想", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "情緒高亢", "B": "精力旺盛", "C": "意念飛躍", "D": "罪惡妄想", "language": "tw"}
{"question": "下列關於自發性氣胸（spontaneous pneumothorax）的手術適應症敘述，何者錯誤？", "answer": "細針穿刺引流無效者", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "第一次發作經插胸管引流後仍持續漏氣超過 72 小時", "B": "同側氣胸第二次或以上之復發", "C": "併發血胸、膿胸或慢性氣胸者", "D": "細針穿刺引流無效者", "language": "tw"}
{"question": "45 歲男性病人在接受心臟移植 10 年後發生冠狀動脈狹窄，最可能的冠狀動脈病變是：", "answer": "Intimal fibrosis \t", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "Intimal fibrosis \t", "B": "Medial fibrosis", "C": "Periarterial fibrosis \t", "D": "Medial calcification", "language": "tw"}
{"question": "目前國內接種的 B 型肝炎疫苗是屬於：", "answer": "基因重組次單位疫苗（subunit vaccine）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "死病毒（Killed virus）", "B": "活減毒疫苗（Live attenuated virus）", "C": "活病毒（Live virus）", "D": "基因重組次單位疫苗（subunit vaccine）", "language": "tw"}
{"question": "30 歲少婦，已婚，婚後 6 年來並無節育計畫，但並未生小孩，月經時有時無，最近因乳房分泌乳汁，至一般外科看診，再轉診至婦科，經抽血檢查，發現血中某數值增高，醫師隨即安排腦部核磁共振造影，結果在顱底鞍凹（sella turcica）處，發現約 1 公分大小之腦瘤。請問此患者抽血檢查數值偏高的是下列那一項？", "answer": "prolactin \t", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "HCG（human chorionic gonadotropin）", "B": "growth hormone", "C": "prolactin \t", "D": "α-fetoprotein", "language": "tw"}
{"question": "3.2 g/dL ", "answer": "因急性十二指腸潰瘍穿孔接受腹腔鏡十二指腸修補縫合術，術後第三天，鼻胃管仍留置，每日引流量約為六百毫升", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "因急性十二指腸潰瘍穿孔接受腹腔鏡十二指腸修補縫合術，術後第三天，鼻胃管仍留置，每日引流量約為六百毫升", "B": "因胃癌住院準備接受手術，手術後體重由七十公斤降為六十五公斤，抽血檢查血清白蛋白濃度為", "C": "因上腸繫膜動脈血栓併腹膜炎切除大部分小腸，術後第八天", "D": "因胃及小腸胃腸間質瘤（gastrointestinal stroma tumor, GIST）接受半胃切除術及小腸部分切除術，約切除二十公分小腸，術後第三天仍未排氣，持續禁食中", "language": "tw"}
{"question": "下列何種激素扮演促進胎兒時期中樞神經發育的關鍵角色？", "answer": "甲狀腺素（thyroxine）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "生長激素（growth hormone）", "B": "甲狀腺素（thyroxine）", "C": "腎上腺皮質醇（cortisol）", "D": "泌乳素（prolactin）", "language": "tw"}
{"question": "23.65歲女性病⼈因⻑期糖尿病腎病變，接受規則⾎液透析治療已5年，透析前⾎中磷（PO43-）6.8 mg/dL、鈣", "answer": "使⽤磷結合劑（phosphate binder）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "使⽤磷結合劑（phosphate binder）", "B": "使⽤維他命D3（vitamin D3）", "C": "使⽤擬鈣劑（calcimimetic）", "D": "使⽤鈣濃度3.0 mEq/L透析液", "language": "tw"}
{"question": "43.有一 32歲男性主訴兩三個月來易倦，腹脹。理學檢查發現體溫正常，結膜蒼白，脾臟在左肋下沿可觸診；血液常規檢查：WBC 120,000/uL， blast/promyelocyte/myelocyte/metamyelocyte/neutrophil/monocyte/eosinophil/ basophil/lymphocyte = \n metaphases 。目前學界共識第一線治療為何？", "answer": "tyrosine kinase inhibitor", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "hydroxyurea", "B": "interferon-alpha", "C": "tyrosine kinase inhibitor", "D": "allogeneic hematopoietic stem cell transplantation", "language": "tw"}
{"question": "大腦大靜脈（great cerebral vein of Galen）注入：", "answer": "直竇（straight sinus）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "岩上竇（superior petrosal sinus）", "B": "橫竇（transverse sinus）", "C": "直竇（straight sinus）", "D": "上矢狀竇（superior sagittal sinus）", "language": "tw"}
{"question": "62.張先生到醫院進行各項肺容積之測量，測量結果顯示總肺容量（total lung capacity）為5000毫升，肺餘容積 （residual volume）為300毫升，兩者之間的差值稱之為何？\n", "answer": "肺活量（vital capacity）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "肺活量（vital capacity）", "B": "吸氣儲備容積（inspiratory reserve volume）", "C": "潮氣容積（tidal volume）", "D": "功能性肺餘容量（functional residual capacity）", "language": "tw"}
{"question": "52 一位 60 歲男性，病人主訴便秘，大便有血，並有痔瘡。病人要求手術治療痔瘡以改善便秘，下列有 關臨床醫師之應對處置何者錯誤？ \n", "answer": "改善便秘需切除痔瘡", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "檢查痔瘡嚴重度", "B": "安排大腸鏡檢查", "C": "肛門收縮力檢查", "D": "改善便秘需切除痔瘡", "language": "tw"}
{"question": "復甦後的照護，有關體溫部分之敘述，下列何者正確？", "answer": "復甦後體溫若高於正常，要積極降溫", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "復甦後體溫於略低狀態（33-35℃），則要小心的回溫至正常", "B": "復甦後將體溫控制於 32-34℃，維持 12-24 小時，於原始為 ventricular fibrillation（VF）心律者，為 classⅡb 位階", "C": "復甦後將體溫控制於 32-34℃，維持 12-24 小時，於原始為 Asystole 心律者，為 classⅡa 位階", "D": "復甦後體溫若高於正常，要積極降溫", "language": "tw"}
{"question": "一位 50 歲中年婦女到門診主訴右手食指、中指、無名指麻痺，理學檢查魚際肌（thenar muscle）有明顯萎縮，她最可能發生下列那條神經的病變？", "answer": "正中神經（median nerve）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "橈神經（radial nerve）", "B": "正中神經（median nerve）", "C": "尺神經（ulnar nerve）  \t", "D": "後骨間神經（posterior interosseous nerve）", "language": "tw"}
{"question": "結核病及類肉瘤病（sarcoidosis）的共同特徵是：", "answer": "都有肉芽腫 \t", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "都是傳染性疾病 \t", "B": "都有乾酪狀壞死", "C": "都有肉芽腫 \t", "D": "常引起肺臟的瀰漫性間質纖維化", "language": "tw"}
{"question": "有一位12歲的男童因兩邊淋巴腺腫大到醫院求診，經血液及切片檢查，發現有細胞型態正常的組織球增生與血液細胞吞噬現象。細胞免疫檢\t發現CD1a陰性，而有CD8陽性之T細胞。下列何者為最正確診斷？", "answer": "infection-associated hemophagocytic syndrome", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "Langerhans cell histiocytosis", "B": "infection-associated hemophagocytic syndrome", "C": "malignant histiocytosis", "D": "acute monocytic leukemia", "language": "tw"}
{"question": "以下何者容易出現病毒相關性腫瘤？", "answer": "AIDS 患者", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "Leishmaniasis 患者 \t", "B": "Legionella pneumonia 患者", "C": "IgA nephropathy 患者", "D": "AIDS 患者", "language": "tw"}
{"question": "⼈⼯⽿蝸（cochlear implants）是利⽤電極，刺激極重度聽損病⼈內⽿中之何種細胞？", "answer": "螺旋神經節細胞（spiral ganglion cells）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "外⽑細胞（outer hair cells）", "B": "內⽑細胞（inner hair cells）", "C": "⾎管紋細胞（striae vascularis cells）", "D": "螺旋神經節細胞（spiral ganglion cells）", "language": "tw"}
{"question": "62.假設其它條件不變，慢性阻塞性肺臟疾病（chronic obstructive pulmonary disease）患者若要達到與正常人相同之通氣量（ventilation），則其每次呼吸時肋膜內壓（intrapleural pressure, Pip）的變化與正常人相比較應為下 列何者？\n", "answer": "較大", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "較大", "B": "較小", "C": "相等", "D": "可能較大也可能較小，視病情而定", "language": "tw"}
{"question": "一位 37 歲女性因為容易疲倦應診，血液相檢查顯示血紅素 8.0 gm/dL，紅血球數 3.65×106 /µL，血比容（Hct）24%，白血球數 8,150 /µL，血小板 385,000 /µL，網狀紅血球 2.5%。此病人之網狀紅血球生成指數（reticulocyte production index）最接近多少 %？", "answer": "0.7", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "2.5", "B": "2", "C": "1.25", "D": "0.7", "language": "tw"}
{"question": "一位 25 歲女性，無特殊過去病史，因右腋下有一硬塊以及一個月內體重減輕 5 公斤而至醫院求診，自述並無發燒、盜汗、咳嗽、呼吸困難或腹痛等症狀，理學檢查除了右側腋下有一 5×6 cm、固定、無痛性硬塊以外其餘皆正常，亦無可觸性的乳房腫塊。切片報告（incisional biopsy）為 poorly differentiated carcinoma，下一步該如何處理最適當？", "answer": "針對病理切片和病理科醫師討論，並安排進一步相關免疫染色基因檢測之檢查", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "抽血檢驗 CEA、CA-125、AFP 及 PSA", "B": "針對病理切片和病理科醫師討論，並安排進一步相關免疫染色基因檢測之檢查", "C": "儘快安排右側乳房切除術及腋下淋巴結切除術", "D": "立即給予 cyclophosphamide、adriamycin 及 5-fluorouracil", "language": "tw"}
{"question": "有關甲狀腺功能調節之敘述中，下列何者錯誤？", "answer": "甲狀腺釋放之荷爾蒙，大部份是三碘甲狀腺素（T3）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "腦下垂體分泌的 TSH，可刺激甲狀腺荷爾蒙之合成 \t", "B": "甲狀腺可自動調節其對碘離子的回收", "C": "甲狀腺荷爾蒙之合成，會受本身的負回饋調節", "D": "甲狀腺釋放之荷爾蒙，大部份是三碘甲狀腺素（T3）", "language": "tw"}
{"question": "正常生理範圍下，preload 與 afterload 對於心搏量（stroke volume）之影響分別為何？", "answer": "preload 增加心搏量；afterload 降低心搏量", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "preload 增加心搏量；afterload 降低心搏量", "B": "preload 降低心搏量；afterload 增加心搏量", "C": "皆增加心搏量 \t", "D": "皆降低心搏量", "language": "tw"}
{"question": "33.60歲何女士有高血壓10年，每日服用losartan 50 mg與hydrochlorothiazide 12.5 mg，血壓一直控制在理想範圍。 2個月前因為肺結核開始服用四合一抗結核藥物，一週前何女士開始出現發燒及手部多發性小關節腫痛現象，\n \t抽血檢\t發現抗核抗體（ANA）1：1280陽性，anti-histone antibody陽性，但anti-dsDNA antibodies為陰性。下\n 列處置何者最為適當？\n", "answer": "停掉isoniazid", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "停掉losartan", "B": "停掉isoniazid", "C": "停掉hydrochlorothiazide", "D": "原有用藥都不停，加上prednisolone 0.5 mg/kg/day", "language": "tw"}
{"question": "多發性內分泌腫瘤第Ⅰ型（MENⅠ），不包括下列何者？", "answer": "甲狀腺髓質瘤", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "副甲狀腺增生", "B": "胰島素瘤", "C": "甲狀腺髓質瘤", "D": "胃泌素瘤", "language": "tw"}
{"question": "右側視神經束（optic tract）受損的患者，下列有關其視野（visual field）檢查結果的敘述，何者正確？", "answer": "患者無法偵測投射在右眼右半視網膜（retina）的物體影像", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "左眼視覺功能缺失，而右眼正常", "B": "患者無法偵測投射在右眼右半視網膜（retina）的物體影像", "C": "患者可以偵測投射在左眼右半視網膜（retina）的物體影像", "D": "兩眼均無法偵測右側視野（visual field）的物體", "language": "tw"}
{"question": "下列有關破骨細胞（osteoclasts）的敘述何者正確？", "answer": "是多核細胞 \t", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "是多核細胞 \t", "B": "位於骨膜內（periosteum）", "C": "分泌骨基質 \t", "D": "細胞質為強嗜鹼性", "language": "tw"}
{"question": "派亞氏斑（Peyer's patch）具有下列何種特徵？", "answer": "是淋巴球聚集形成的構造", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "是微血管聚集形成的構造", "B": "是內分泌細胞聚集形成的構造", "C": "是淋巴球聚集形成的構造", "D": "是神經細胞聚集形成的構造", "language": "tw"}
{"question": "因⾞禍⽽急需輸⾎患者的⾎型為AB型，在場三⼈中，⼩李⾎型是A型，⼩吳是B型，⼩何是O型，下列敘述何者正確？", "answer": "三⼈均可捐⾎給患者", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "只有⼩李及⼩吳可捐⾎給患者", "B": "只有⼩何可捐⾎給患者", "C": "三⼈均可捐⾎給患者", "D": "三⼈均不可捐⾎給患者", "language": "tw"}
{"question": "陳小姐被發現有意識不清及黃疸而被送到急診就醫，檢查結果為total bilirubin：7.2 mg/dL（正常值：0.2～1.6 mg/dL）、direct bilirubin：4 mg/dL（正常值：0～0.3 mg/dL）、AST：478 U/L（正常值：5～45 U/L）、 ALT：356 U/L（正常值：0～40 U/L）、alkaline phosphatase：102 U/L（正常值：10～100 U/L）、 prothrombin time（INR）：3.1、albumin：3.6 g/dL（正常值：4.3～5.4 g/dL），下列之敘述何者錯誤？", "answer": "此病人之最可能病因為急性膽管炎", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "此病患可能發生hepatocellular jaundice", "B": "腹部超音波檢查膽管應無異常", "C": "此病患黃疸的病因，可能包括virus, autoimmune, toxin and metabolic disorder等", "D": "此病人之最可能病因為急性膽管炎", "language": "tw"}
{"question": "41 一位腎臟病患經異體腎臟移植後服用免疫抑制劑控制排斥反應。最近發現在左側足背皮膚有一些不 痛、不規則之斑塊（如圖），病理切片下呈現許多梭狀細胞（spindle cell）和血管樣間隙（slit-like vascular space）。有關此病的敘述何者錯誤？ \n", "answer": "免疫抑制劑中，glucocorticoid 比 cyclosporine A 更易導致此病發生", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "此為卡波西氏肉瘤（Kaposi's sarcoma） \t", "B": "免疫抑制劑中，glucocorticoid 比 cyclosporine A 更易導致此病發生", "C": "Human immunodeficiency virus（HIV）感染可能與此病之發生有關", "D": "Human herpesvirus-8 與此病相關", "language": "tw"}
{"question": "有位病人因下肢趾頭關節處腫脹疼痛無法行走，被送至醫院急診室，經抽血檢查發現是xanthine oxidase活性極高所引起的痛風，醫師做了緊急處理緩解後，建議病人服用下列何種藥物控制尿酸濃度最為合適？", "answer": "allopurinol", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "ibuprofen", "B": "indomethacin", "C": "allopurinol", "D": "aspirin", "language": "tw"}
{"question": "12.一位50歲女性肺結核病患，已服第一線4種抗結核藥物一個月，病人主訴食慾較差，稍微倦怠，但小便更深黃，肝功能檢查發現bilirubin T/D 15/8 mg/dL，AST：68 U/L，ALT：70  U/L。最不可能是那一種抗結核藥物引起？ \n", "answer": "ethambutol", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "isoniazid", "B": "rifampin", "C": "ethambutol", "D": "pyrazinamide", "language": "tw"}
{"question": "下列何種胺基酸為合成甲狀腺素T3 & T4的前驅物？", "answer": "arginine", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "arginine", "B": "tryptophan", "C": "lysine", "D": "tyrosine", "language": "tw"}
{"question": "一位 53 歲男性，主訴腹部疼痛及嘔吐。患者於 3 年前曾因大腸腫瘤接受右側結腸切除術，半年前病患亦有一次相似的腹部疼痛，於急診室處理後症狀改善而出院。此次病患仰臥腹部 X 光片顯示於左上腹部及左下腹部出現充滿氣體之脹大空腸腸管，6 小時後追蹤之腹部 X 光片仍顯示脹大的腸管，但是腸管內之氣體消失明顯，被腸腔內液體所取代。身體診查發現病患腸音靜止，患者無排氣無排便。下列何者與患者的病情變化最不相符？", "answer": "小腸阻塞轉變為部分性（small bowel partial obstruction）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "小腸阻塞轉變為部分性（small bowel partial obstruction）", "B": "電腦斷層顯示腸壁變厚，出現氣體", "C": "血中白血球數可能無升高", "D": "體溫可能無上升", "language": "tw"}
{"question": "顱內腦動脈瘤（cerebral aneurysm），破裂後第幾天，血管痙攣為最嚴重？", "answer": "3~10 天", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "1~3 天", "B": "3~10 天", "C": "10~15 天", "D": "15~21 天", "language": "tw"}
{"question": "在人體中，胺基酸不能作為下列何種生物分子生合成的前驅物？", "answer": "氰鈷胺（cobalamin）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "腎上腺素（epinephrine）", "B": "紫質（porphyrin）", "C": "腺嘌呤（adenine） \t", "D": "氰鈷胺（cobalamin）", "language": "tw"}
{"question": "甲醫師受邀到藥廠所贊助的研討會擔任講師，支領鐘點費5,000元，擔心有利益衝突的問題。有關利益衝突的敘述與處理，下列何者錯誤？", "answer": "利益衝突本身就不道德，應全面禁止", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "有效處理利益衝突第一個要件，就是察覺其存在", "B": "公開是處理利益衝突的金科玉律", "C": "核准與審核，也是處理利益衝突的方式之一", "D": "利益衝突本身就不道德，應全面禁止", "language": "tw"}
{"question": "下列何種抗生素不經由肝臟代謝或膽汁排出，因此不會干擾其他藥物的代謝作用？", "answer": "gentamicin", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "chloramphenicol", "B": "erythromycin", "C": "gentamicin", "D": "rifampin", "language": "tw"}
{"question": "57 一位 75 歲女性有高血壓病史一直用藥物控制，主訴心悸、呼吸困難來診。身體檢查發現心跳 108 次/min 而且不規則，有輕微心臟叩音變大，心跳呈心房顫動、心室搏動快速；心臟超音波呈 ejection fraction ", "answer": "測定free T4、TSH \t", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "使用 amiodarone 控制心跳", "B": "測定 troponin", "C": "測定free T4、TSH \t", "D": "以cardioversion治療心房顫動", "language": "tw"}
{"question": "Jacob 和 Monod 在研究大腸桿菌中乳糖代謝時發現：一些突變株不管有沒有誘導物（乳糖等）的存在下，皆 可 表現 大 量半 乳 糖 苷酶（β-galactosidase），是因為：", "answer": "此\t突\t變\t株\t的\t半\t乳\t糖\t苷酶操\t縱\t子 （operon）無法受其抑止子（Lac repressor）所調控", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "此突變株影響到半乳糖苷酶 mRNA 的轉譯表現", "B": "此突變株影響到半乳糖苷酶 mRNA 的轉錄後修飾表現", "C": "此\t突\t變\t株\t的\t半\t乳\t糖\t苷酶操\t縱\t子 （operon）無法受其抑止子（Lac repressor）所調控", "D": "此突變造成 Lac repressor 的 DNA 結合能力變強", "language": "tw"}
{"question": "影響台灣地區民眾死亡的因素中，何者最為重要？", "answer": "生活型態的因素", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "醫療體系的因素", "B": "生物的因素", "C": "環境的因素", "D": "生活型態的因素", "language": "tw"}
{"question": "某32歲女子，離開勒戒所不久，又施打來路不明的海洛因，因純度提高導致中毒出現意識不清，送至醫院後處置之原則，下列何者正確？", "answer": "若瞳孔放大與呼吸速率增加，顯示中毒程度正逐漸改善", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "因個案體溫會下降，所以保溫是海洛因中毒最重要的救護措施", "B": "以靜脈注射methadone為主要藥物治療", "C": "若瞳孔放大與呼吸速率增加，顯示中毒程度正逐漸改善", "D": "因鴉片類拮抗劑（opioid antagonist）多為長效，所以通常給予單次劑量即可", "language": "tw"}
{"question": "下列何者是腦部病變造成的下半身癱瘓（cerebral paraplegia）最常見的原因？", "answer": "大腦鐮腦膜瘤（falx meningioma）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "前腦動脈梗塞性腦中風（stroke）", "B": "一氧化碳中毒腦病變（encephalopathy）", "C": "腦膜炎（meningoencephalitis）", "D": "大腦鐮腦膜瘤（falx meningioma）", "language": "tw"}
{"question": "下列有關人工關節的敘述，何者正確？", "answer": "人工關節墊片及內襯磨損的問題直接關係其使用年限，目前髖關節陶瓷內襯及陶瓷股骨頭問世，大大減少磨損率", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "人工關節最大的問題在於與人體組織相容性，裝入人體內日積月累，容易產生異物反應（foreign body reaction），故要定期翻修", "B": "糖尿病或免疫力差的病人不是人工關節感染的高危險群", "C": "人工關節墊片及內襯磨損的問題直接關係其使用年限，目前髖關節陶瓷內襯及陶瓷股骨頭問世，大大減少磨損率", "D": "人工關節感染最常見菌種為綠膿桿菌（Pseudomonas aeruginosa）", "language": "tw"}
{"question": "下列細菌何者與食入受汙染的米飯而引起的食物中毒最為相關？", "answer": "臘狀桿菌（Bacillus cereus）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "腸炎沙門氏菌（Salmonella enterica）", "B": "創傷弧菌（Vibrio vulnificus）", "C": "臘狀桿菌（Bacillus cereus）", "D": "大腸桿菌（Escherichia coli）", "language": "tw"}
{"question": "下列有關掌內肌群（intrinsic muscles）之敘述，何者錯誤？", "answer": "掌短肌（palmaris brevis）是由正中神經（median nerve）所支配的", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "外展拇肌（abductor pollicis）是由正中神經（median nerve）所支配的", "B": "掌短肌（palmaris brevis）是由正中神經（median nerve）所支配的", "C": "背側掌骨間肌（dorsal interossei）是由尺神經（ulnar nerve）所支配的", "D": "蚓狀肌（lumbricals）是由正中神經（median nerve）和尺神經（ulnar nerve）共同支配的", "language": "tw"}
{"question": "19.有關肺癌的描述，下列何者正確？①adenocarcinoma是最常見的細胞型 ②squamous cell carcinoma 的發生與抽菸最有關聯 ③squamous cell carcinoma常位於靠近肺門中央的位置 ④小細胞肺癌常可以經由手術切除得到治療 ", "answer": "①②③", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "①③④", "B": "①②③", "C": "①②④", "D": "②③④", "language": "tw"}
{"question": "26.6歲大的兒童因為突然暈倒被送到醫院，心電圖顯示如圖，心跳頻率約為200/min。病童的血壓經測量為50/25  mmHg，可以摸到微弱的脈搏但週邊循環不佳，接下來應做的處置為何？\n", "answer": "使用同步整流術（Synchronized DC cardioversion）治療", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "靜脈快速給與Adenosine治療", "B": "使用冰袋輕輕壓迫前額（Valsalva maneuver）", "C": "使用同步整流術（Synchronized DC cardioversion）治療", "D": "靜脈給與Amiodarone治療", "language": "tw"}
{"question": "遺傳性非息肉症大腸癌（hereditary nonpolyposis colon cancer-HNPCC）可由 hMSH2 或 hMLH1 基因變異，而影響下列何種 DNA 修復途徑所造成？", "answer": "錯誤配對修復（mismatch repair）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "錯誤配對修復（mismatch repair）", "B": "鹼基切除修復（base excision repair）", "C": "核酸切除修復（nucleotide excision repair）", "D": "雙股斷裂修復（double strand break repair）", "language": "tw"}
{"question": "胎盤對於胎兒之生長發育極為重要，此乃由於其能提供猶如成人除了下列何者以外重要器官之功能？", "answer": "外分泌腺體", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "腎臟", "B": "腸胃道", "C": "肺臟", "D": "外分泌腺體", "language": "tw"}
{"question": "在美國精神醫學會之精神疾患診斷及統計手冊中，下列那一種人格疾患所屬的族類（cluster）與其他三者不同？", "answer": "妄想型", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "邊緣型", "B": "反社會型", "C": "妄想型", "D": "戲劇型", "language": "tw"}
{"question": "下列眼振圖所代表的臨床意義，最可能的診斷是：", "answer": "右側小腦橋腦角腫瘤（cerebellopontine angle tumor）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "右側美尼爾病（Ménière's disease）", "B": "左側美尼爾病（Ménière's disease）", "C": "右側小腦橋腦角腫瘤（cerebellopontine angle tumor）", "D": "左側小腦橋腦角腫瘤（cerebellopontine angle tumor）", "language": "tw"}
{"question": "下列何者為 ampicillin 與 piperacillin 合併治療 Pseudomonas aeruginosa 感染時誘發抗藥性的原因？", "answer": "ampicillin 誘發 beta-lactamase 的產生", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "piperacillin 抑制 ampicillin 與 penicillin 結合蛋白接觸", "B": "ampicillin 誘發 beta-lactamase 的產生", "C": "piperacillin 抑制 autolytic enzyme 的活性", "D": "ampicillin 係一種 bacteriostatic 作用劑", "language": "tw"}
{"question": "有關呼吸系統，下列敘述何者錯誤？", "answer": "鼻腔內之上皮組織屬於過渡性上皮（transitional epithelium）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "鼻腔內之黏膜（mucosa）可以溫暖，濕潤及過濾吸入之空氣", "B": "Bowman's 腺可分泌漿液（serous），以去除已被偵測過之殘餘氣味物質", "C": "鼻腔內之上皮組織屬於過渡性上皮（transitional epithelium）", "D": "嗅上皮（olfactory epithelium）是偽複層柱狀上皮", "language": "tw"}
{"question": "下列何種激素主要是由腎臟所生成？", "answer": "紅血球生成素（erythropoietin）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "降鈣素（calcitonin） \t", "B": "血管張力素原（angiotensinogen）", "C": "醛酮素（aldosterone）", "D": "紅血球生成素（erythropoietin）", "language": "tw"}
{"question": "一位 24 歲女性，因排尿困難合併外生殖器有疼痛性病灶，臨床診斷為疱疹，這些病灶已融合成皮膚潰瘍。同時有發燒、倦怠、肌肉酸痛及頭痛等症狀。過去並無類似的症狀。下列有關此病人之敘述，何者錯誤？", "answer": "此疾病預後良好，以後不會復發", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "最有可能之診斷是第二型單純疱疹（herpes simplex）", "B": "此疾病預後良好，以後不會復發", "C": "以 acyclovir 治療可以縮短癒合所需時間", "D": "以 acyclovir 治療可以減少復發的嚴重度與頻率", "language": "tw"}
{"question": "當微血管前小動脈（precapillary arterioles）收縮時，會產生下列何種顯\t變化？", "answer": "微血管的濾過速率（filtration rate）下降", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "微血管的靜水壓（hydrostatic pressure）增加", "B": "微血管的濾過速率（filtration rate）下降", "C": "微血管的血漿膠體滲透壓（colloid osmotic pressure）增加", "D": "組織間液膠體滲透壓（colloid osmotic pressure）上升", "language": "tw"}
{"question": "下列有關單純性疱疹角膜炎（Herpes simplex keratitis）的敘述，何者較正確？", "answer": "病情緩解後，未來仍可能復發", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "大多因植物性外傷所造成", "B": "與配戴隱形眼鏡有關", "C": "病情緩解後，未來仍可能復發", "D": "抹片檢查，可以看見有革蘭氏染色（Gram's stain）陰性之桿菌", "language": "tw"}
{"question": "下列那一條神經常在穿過鼠蹊韌帶（inguinal ligament）時受到壓迫，造成病患大腿外側感覺麻痛？", "answer": "股骨側皮表神經（lateral femoral cutaneous nerve）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "股神經（femoral nerve）", "B": "股骨側皮表神經（lateral femoral cutaneous nerve）", "C": "閉孔神經（obturator nerve）", "D": "陰部神經（pudendal nerve）", "language": "tw"}
{"question": "下列那三塊肌肉的肌腱一起附\t於脛骨粗隆的內側（medial side of tibial tuberosity）？", "answer": "股薄肌（gracilis）、縫匠肌（sartorius）、半腱肌（semitendinosus）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "股薄肌（gracilis）、縫匠肌（sartorius）、半膜肌（semimembranosus）", "B": "股薄肌（gracilis）、縫匠肌（sartorius）、半腱肌（semitendinosus）", "C": "股二頭肌（biceps femoris）、半膜肌（semimembranosus）、半腱肌（semitendinosus）", "D": "內收長肌（adductor longus）、內收短肌（adductor brevis）、內收大肌（adductor magnus）", "language": "tw"}
{"question": "根據統計，全球僅次於 Candida albicans 造成念珠菌菌血症（candidemia）之病原菌為何？", "answer": "Candida glabrata", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "Candida krusei", "B": "Candida glabrata", "C": "Candida parapsilosis", "D": "Candida tropicalis", "language": "tw"}
{"question": "86 下列有關補體系統的凝集路徑（lectin pathway）中的關鍵分子 mannan-binding lectin（MBL）的描述 ，何者錯誤？ \n", "answer": "其所參與的凝集路徑和替代路徑（alternative pathway）的作用機制較相似", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "可和細菌表面的醣蛋白或碳水化合物結合 \t", "B": "是發炎反應中產生的一種急性蛋白（acute phase protein）", "C": "其功能在補體系統中和 Clq 分子相似 \t", "D": "其所參與的凝集路徑和替代路徑（alternative pathway）的作用機制較相似", "language": "tw"}
{"question": "其診斷為何？", "answer": "腹部主動脈瘤 \t", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "腸繫膜囊腫 \t", "B": "腹部主動脈瘤 \t", "C": "胰臟尾部腫瘤 \t", "D": "下腔靜脈血栓", "language": "tw"}
{"question": "承上題，再經心導管檢查，確定了診斷，對此病患，下列何種手術治療最不適合？", "answer": "肺動脈環縮術", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "體動脈至肺動脈分流術", "B": "肺動脈瓣氣球擴張術 \t", "C": "在體外循環下，作直視下心內修補手術", "D": "肺動脈環縮術", "language": "tw"}
{"question": "有關海馬系統（hippocampal formation）之最主要傳出纖維（efferent fiber），可形成下列何構造？", "answer": "穹束（fornix）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "穹束（fornix）", "B": "胼胝體（corpus callosum）", "C": "終紋（stria terminalis）", "D": "丘腦髓紋（stria medullaris thalami）", "language": "tw"}
{"question": "與人類子宮頸癌相關性最強的病毒為人類乳頭瘤病毒（human papillomavirus）第幾型？", "answer": "16 及 18", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "16 及 18", "B": "1 及 2", "C": "6 及 2", "D": "25 及 38", "language": "tw"}
{"question": "下列何種作用與低劑量 Aspirin 預防栓塞型中風（Stroke）有關？", "answer": "抑制血小板的 COX-1", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "抑制血管內皮細胞的 COX-2", "B": "抑制血球細胞的 Lipoxygenase", "C": "抑制血小板的 COX-1", "D": "抑制血小板的 Thromboxane A2 受體", "language": "tw"}
{"question": "一位 21 歲大學女生，兩側小腿紅疹、痛感，已有 3 天。檢查看似紅疹，觸診則為結節、稍熱如下圖所示。最可能的臨床診斷為：", "answer": "結節性紅斑（Erythema nodosum）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "多型性紅斑（Erythema multiforme）", "B": "結節性紅斑（Erythema nodosum）", "C": "蜂窩性組織炎（Cellulitis）", "D": "遊走性紅斑（Erythema migrans）", "language": "tw"}
{"question": "細胞缺氧時，最不可能出現下列何種變化？", "answer": "鈣離子由細胞內流出", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "鈉和水進入細胞", "B": "細胞內pH值下降", "C": "鈣離子由細胞內流出", "D": "細胞內ATP下降", "language": "tw"}
{"question": "一位 65 歲女性病人，主訴 3 年來右膝關節日益疼痛，以致行動困難，本次就診之右膝關節 X 光攝影及 MRI 影像如圖，最可能的診斷為何？", "answer": "自發性骨壞死併膝關節炎（spontaneous osteonecrosis with arthritis）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "類風濕關節炎併骨囊腫（rheumatoid arthritis with bone cyst）", "B": "自發性骨壞死併膝關節炎（spontaneous osteonecrosis with arthritis）", "C": "感染性關節炎併骨囊腫（septic arthritis with bone cyst）", "D": "痛風性關節炎併骨囊腫（gouty arthritis with bone cyst）", "language": "tw"}
{"question": "下列何者是腦中風病患使用足踝部副木（splints）的最主要目的？", "answer": "矯正步態 \t", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "促進足踝部功能的恢復", "B": "防止踝關節腫痛", "C": "矯正步態 \t", "D": "動態副木可以取代癱瘓無力的肌肉", "language": "tw"}
{"question": "下列①⾄④項中那些物質運輸⽅向是由⾼濃度到低濃度？", "answer": "②④", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "①③", "B": "②③", "C": "②④", "D": "①②", "language": "tw"}
{"question": "有關家族性高膽固醇症（familial hypercholesterolemia）最主要的致病原因為何？", "answer": "LDL receptor 基因變異", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "飲食中過度高油脂食物的攝取", "B": "HMG-CoA reductase 基因變異", "C": "正常 LDL receptor 蛋白表現量過高", "D": "LDL receptor 基因變異", "language": "tw"}
{"question": "Dexmedetomidine可提供鎮靜、安眠及止痛作用，其作用機轉為何？", "answer": "α2-adrenergic agonist", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "γ-amino-butyric acid inhibition", "B": "α2-adrenergic agonist", "C": "µ receptor agonist", "D": "N-methyl-D-aspartate receptor inhibition", "language": "tw"}
{"question": "出生三日之嬰兒發生結膜充血、分泌物劇增，且其父母曾有性病史，下列敘述何者錯誤？", "answer": "由於僅為結膜炎，無失明之虞", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "分泌物的抹片檢查，可能有革蘭氏陰性雙球菌 \t", "B": "與產道感染有關", "C": "由於僅為結膜炎，無失明之虞", "D": "治療方針應予 Penicillin G，局部點眼及肌肉注射", "language": "tw"}
{"question": "下列有關前哨淋巴結切片術（sentinel lymph node biopsy）的敘述，何者錯誤？", "answer": "外科醫師執行前哨淋巴結切片術之經\t中，前百例若有偽陰性，不應再執行前哨淋巴結切片術", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "可減少腋下淋巴廓清（axillary lymph node dissection）造成手臂淋巴水腫的發生", "B": "外科醫師執行前哨淋巴結切片術之經\t中，前百例若有偽陰性，不應再執行前哨淋巴結切片術", "C": "乳房全切除（total mastectomy）者亦可做前哨淋巴結切片術", "D": "理學檢查若摸到腋下淋巴結者，不適合做前哨淋巴結切片術", "language": "tw"}
{"question": "下列有關器官移植之分配原則，何者最不適宜？", "answer": "受贈病患生活型態或行為 \t", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "受贈病患醫療需求的迫切程度 \t", "B": "受贈病患於名單上的等候時間", "C": "受贈病患生活型態或行為 \t", "D": "受贈病患與捐贈者組織配對相容性", "language": "tw"}
{"question": "腹式呼吸通常要配合節奏性的呼吸速率（paced breathing），下列何者是最理想的呼吸節奏？", "answer": "吐氣：吸氣＝4秒：2秒", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "吐氣：吸氣＝4秒：2秒", "B": "吐氣：吸氣＝1秒：2秒", "C": "吐氣：吸氣＝1秒：1秒", "D": "吐氣：吸氣＝2秒：4秒", "language": "tw"}
{"question": "老年病人發生吸入性肺炎最不可能之病原菌為：", "answer": "Legionella pneumophila", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "Entoerobacteriaceae \t", "B": "Staphylococcus aureus", "C": "Anaerobic bacteria \t", "D": "Legionella pneumophila", "language": "tw"}
{"question": "下列那一項不是世代追蹤研究偏差的來源？", "answer": "稀有暴露 \t", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "追蹤漏失率 \t", "B": "暴露組與非暴露組資料蒐集的完整性不同", "C": "稀有暴露 \t", "D": "研究對象不回應者", "language": "tw"}
{"question": "那兩個克氏循環（TCA cycle）的中間產物皆可直接經由一次轉胺反應（transamination）合成胺基酸？", "answer": "草醯乙酸（oxaloacetate）與α-酮基戊二酸（α-ketoglutarate）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "草醯乙酸（oxaloacetate）與α-酮基戊二酸（α-ketoglutarate）", "B": "檸檬酸（citrate）與琥珀酸（succinate）", "C": "琥珀酸（succinate）與蘋果酸（malate）", "D": "α-酮基戊二酸（α-ketoglutarate）與異檸檬酸（isocitrate）", "language": "tw"}
{"question": "下列何病症是早產兒出生數日內特有的腦部病變？", "answer": "核黃疸（Kernicterus）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "玻璃質膜病（Hyaline membrane disease）", "B": "核黃疸（Kernicterus）", "C": "Hirschsprung 氏病 \t", "D": "Pick 氏病", "language": "tw"}
{"question": "48歲男性，患有multiple endocrine neoplasia type 1（MEN type 1） 合併hyperparathyroidism，於10年前接受副甲狀腺切除⼿術，之後⾎鈣及iPTH皆正常，惟最近追蹤抽⾎檢查顯⽰：iPTH為132 pg/mL，⾎鈣為10.8 mg/dL，則最適宜的診斷為：", "answer": "recurrent hyperparathyroidism", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "secondary hyperparathyroidism", "B": "tertiary hyperparathyroidism", "C": "persistent hyperparathyroidism", "D": "recurrent hyperparathyroidism", "language": "tw"}
{"question": "消化道中那一部分其黏膜下層具有分泌黏液的腺體？", "answer": "十二指腸", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "十二指腸", "B": "直腸", "C": "胃", "D": "結腸", "language": "tw"}
{"question": "上頸神經節（superior cervical ganglion）相對於下列何脊椎骨高度？", "answer": "第一、二頸椎", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "第一、二頸椎", "B": "第四頸椎", "C": "第六頸椎", "D": "第一胸椎", "language": "tw"}
{"question": "一位再生不良性貧血病人，雖經過多種治療，病情仍無法改善，經常需要輸注濃縮紅血球，最近抽血檢查發現血鐵質（ferritin）為 3,750 ng/mL，肝功能變差。下列何者是最適當的治療藥物？", "answer": "Deferoxamine", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "Dimercaprol", "B": "Penicillamine", "C": "Deferoxamine", "D": "Charcoal", "language": "tw"}
{"question": "下列那一種病媒，性喜產卵於流水中，且其卵呈三角形？", "answer": "蚋（blackfly）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "虻（deer fly）", "B": "蚋（blackfly）", "C": "采采蠅（tsetse fly）", "D": "蠓（biting midges）", "language": "tw"}
{"question": "關於肺腺癌基因突變及標靶治療，下列敘述何者正確？", "answer": "ALK translocation的肺腺癌病⼈年紀中位數（median age），較整體肺腺癌患者的年紀中位數年輕", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "在東亞肺腺癌，EGFR突變率約10～20%", "B": "有EGFR突變的第四期肺腺癌，可⽤EGFR tyrosine kinase inhibitor治癒（cure）", "C": "ALK translocation的肺腺癌病⼈年紀中位數（median age），較整體肺腺癌患者的年紀中位數年輕", "D": "ALK translocation之肺腺癌，經標靶治療產⽣抗藥性後，約50～60%產⽣exon 20 T790M突變", "language": "tw"}
{"question": "錐鼻蟲（reduviid bug）可以媒介下列何種寄生蟲病？", "answer": "查加斯氏病（Chagas' disease）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "查加斯氏病（Chagas' disease）", "B": "利什曼症（Leishmaniasis）", "C": "睡眠病（Sleeping sickness）", "D": "黑熱病（Kala-azar）", "language": "tw"}
{"question": "旋股內側動脈（medial circumflex femoral artery）穿過下列何者，至大腿後面？", "answer": "髂腰肌（iliopsoas）和恥骨肌（pectineus）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "髂腰肌（iliopsoas）和恥骨肌（pectineus）", "B": "恥骨肌和內收短肌（adductor brevis）", "C": "內收短肌和內收長肌（adductor longus）", "D": "內收長肌和內收大肌（adductor magnus）", "language": "tw"}
{"question": "此病人若接受外科手術治療，下列何項步驟不正確？", "answer": "股動脈至膝動脈繞道手術", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "股動脈至膝動脈繞道手術", "B": "經皮下血管擴張整形術合併血管內人工彌補物（endovascular prosthesis）之置換", "C": "主動脈至兩側股動脈繞道手術", "D": "腋動脈至股動脈繞道手術", "language": "tw"}
{"question": "有關血栓性栓塞（thromboembolism）於懷孕婦女的敘述，下列何者錯誤？", "answer": "對於懷孕婦女深部靜脈栓塞或肺栓塞，建議使用 warfarin 治療，以維護胎兒安全", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "年齡大（尤其是 35 歲以上）的懷孕婦女發生靜脈栓塞較高", "B": "深部靜脈栓塞與肺栓塞在懷孕及剛生產後的婦女，發生率比未懷孕婦女高", "C": "Technetium-99m 肺灌注和肺換氣檢查（V/Q scan），一般而言，對胎兒是安全的", "D": "對於懷孕婦女深部靜脈栓塞或肺栓塞，建議使用 warfarin 治療，以維護胎兒安全", "language": "tw"}
{"question": "升結腸（ascending colon）部位之大腸癌病人最常表現下列何種臨床症狀？", "answer": "貧血", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "便血（hematochezia）", "B": "大便習慣改變", "C": "裏急後重（tenesmus）", "D": "貧血", "language": "tw"}
{"question": "新生兒紅斑性狼瘡（Neonatal lupus erythematous）由母體內何種自體抗體，經胎盤傳給胎兒所引起？", "answer": "anti-Ro/SS-A", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "ANA", "B": "anti-ds-DNA", "C": "anti-Sm", "D": "anti-Ro/SS-A", "language": "tw"}
{"question": "先天性遺傳代謝疾病患童常散發出特異性體味，下列之對應組合中何者最不正確？", "answer": "酪胺酸血症（tyrosinemia）- 泳池消毒水味（swimming pool odor）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "苯酮尿症（phenylketonuria）- 霉臭味（musty odor）", "B": "異戊酸血症（isovaleric acidemia）- 腳\t臭味（sweaty feet odor）", "C": "酪胺酸血症（tyrosinemia）- 泳池消毒水味（swimming pool odor）", "D": "三甲基胺尿症（trimethylaminuria）- 腐魚味（rotten fish odor）", "language": "tw"}
{"question": "腹部受傷機轉不同，可能有不同器官傷害，且受傷頻率不一，路人甲發生車禍造成腹部鈍傷（blunt injury）和路人乙腹部遭受槍擊傷（gunshot injury）時，他們最常受傷的器官分別是：", "answer": "鈍傷時為脾臟；槍擊傷時是小腸", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "鈍傷時為脾臟；槍擊傷時是肝臟", "B": "鈍傷時為肝臟；槍擊傷時是脾臟", "C": "鈍傷時為脾臟；槍擊傷時是小腸", "D": "鈍傷時為小腸；槍擊傷時是胰臟", "language": "tw"}
{"question": "下列何者是診斷卵黃囊瘤（yolk sac tumor）最常用的血清標記？", "answer": "甲型胎兒蛋白（alpha-fetoprotein）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "甲型胎兒蛋白（alpha-fetoprotein）", "B": "癌胚抗原（carcinoembryonic antigen）", "C": "人類絨毛膜促性腺激素（ human chorionic gonadotropin）", "D": "胎盤鹼性磷酸酶（ placental alkaline phosphatase）", "language": "tw"}
{"question": "一位20歲的陳姓大學生，參加露營活動，平日健康狀況良好。在搬一箱20公斤重的飲料，突然覺得腰痛，當天晚上腰痛加劇，且蔓延至右腳也呈現酸麻、無力，隔天他到門診求助。其最可能的診斷為何？", "answer": "右側腰椎神經根病變", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "右脛骨神經（tibial nerve）病變", "B": "右腓骨神經（peroneal nerve）病變", "C": "右股神經（femoral nerve）病變", "D": "右側腰椎神經根病變", "language": "tw"}
{"question": "下列藥物可用於治療急性無機汞鹽（inorganic mercury salts）中毒，何者錯誤？", "answer": "D-dimethylcysteine", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "unithiol", "B": "dimercaprol", "C": "succimer", "D": "D-dimethylcysteine", "language": "tw"}
{"question": "承上題，檢查報告診斷為胃食道逆流（GERD）合併裂孔疝氣（Hiatal hernia），以下何種治療不會考慮在內？", "answer": "螺旋桿菌治療（H.P. eradication）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "減重 \t", "B": "床頭墊高 15 度", "C": "投與 PPI（Proton pump inhibitor）治療", "D": "螺旋桿菌治療（H.P. eradication）", "language": "tw"}
{"question": "下列何種腫瘤最少見於前縱隔腔？", "answer": "節細胞神經母細胞瘤（ganglioneuroblastoma）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "何杰金氏淋巴瘤（Hodgkin lymphoma）", "B": "生殖細胞腫瘤（germ cell tumor）", "C": "副甲狀腺瘤（parathyroid adenoma）", "D": "節細胞神經母細胞瘤（ganglioneuroblastoma）", "language": "tw"}
{"question": "HIV-1 經由黏膜感染進入人體時，主要藉由何種細胞攜帶進入淋巴結？", "answer": "Dendritic cell", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "NK cell", "B": "CD8 T cell", "C": "Dendritic cell", "D": "CD4 T cell", "language": "tw"}
{"question": "一位 30 歲女性，胰臟尾部有一個 7 公分大的囊狀腫瘤而接受腫瘤切除手術。手術時發現腫瘤並未與胰管相通。切除標本切面外觀可見其為一個多囊狀腫瘤，內含黏稠液體。顯微鏡下可見腫瘤囊壁由一單層柱狀上皮覆蓋，在上皮下有一層緻密的間質細胞存在。上皮細胞的細胞核位於細胞底部並不濃染，且無明顯多形性存在。下列何者是最可能的診斷？", "answer": "Mucinous cystadenoma", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "Pseudocyst \t", "B": "Serous cystadenoma", "C": "Mucinous cystadenoma", "D": "Intraductal papillary mucinous neoplasm", "language": "tw"}
{"question": "下列藥物之主要作用為降低血漿 triglyceride，何者除外？", "answer": "cholestyramine", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "niacin", "B": "fenofibrate", "C": "cholestyramine", "D": "gemfibrozil", "language": "tw"}
{"question": "32 24 歲男性的右手腕關節疼痛腫脹有二個月之久。他本人不記得右手有受傷過，經服用消炎片雖有止痛效果，但是該關節越來越惡化而無法彎曲。X 光檢查如附圖。抽取關節液檢查發現：WBC  mg/dL，顯微鏡觀察無結晶物發現。最適切的診斷為何？", "answer": "Infectious arthritis", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "Rheumatoid arthritis \t \t", "B": "Calcium pyrophosphate dihydrate deposition disease", "C": "Infectious arthritis", "D": "Complex regional pain syndrome", "language": "tw"}
{"question": "下列何者不是熱療（heat therapy）的治療效果？", "answer": "疼痛閾值降低", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "血管擴張", "B": "肌肉韌帶鬆弛", "C": "代謝率增加", "D": "疼痛閾值降低", "language": "tw"}
{"question": "一位 42 歲婦女主訴頭痛，喉嚨痛和鼻充血帶有綠色黏狀分泌液已三天。但否認有發燒，胃腸症狀以及季節性過敏，或與病人接觸史。身體檢查：體溫 36.8℃，脈搏 82 次/分，呼吸 16 次/分，血壓 124/76 毫米汞柱，後口咽部呈現輕度發紅及腫脹，頸部柔軟，無淋巴節腫大，呼吸聲正常。被診斷為鼻竇炎（rhinosinusitis），其最常見的原因為何？", "answer": "鼻病毒（rhinovirus）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "鼻病毒（rhinovirus）", "B": "肺炎鏈球菌（Streptococcus pneumoniae）", "C": "流行感冒嗜血桿菌（Haemophilus influenzae）", "D": "卡他莫拉克氏菌（Moraxella catarrhalis）", "language": "tw"}
{"question": "下列何種 DNA 病毒可在感染人體之後，建立\"潛伏性感染＂（latent infection）？", "answer": "EB 病毒（Epstein-Barr virus）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "EB 病毒（Epstein-Barr virus）", "B": "反轉錄病毒（Retrovirus）", "C": "冠狀病毒（Coronavirus）", "D": "呼吸道腸道病毒（Reovirus）", "language": "tw"}
{"question": "小威的媽媽問醫生小威的氣喘病那時候才會好，醫生回答氣喘病是呼吸道組織持續的發炎反應，臨床不一定會有明顯症狀，但組織的發炎反應可能持續幾天甚至好幾年。下列何者不是造成慢性持續發炎的原因？", "answer": "介白質-5（IL-5）會誘使肥大細胞（mast cell）前驅物分化，而使肥大細胞增生，進而破壞局部組織", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "反覆的過敏原接觸刺激過敏反應細胞如肥大細胞（mast cell），嗜伊紅性細胞（eosinophil）產生反應", "B": "第二型輔助T細胞（Th2）分泌細胞素如介白質-13（interleukin-13, IL-13），IL-5等而使上述的過敏反應細胞存活更久", "C": "介白質-5（IL-5）會誘使肥大細胞（mast cell）前驅物分化，而使肥大細胞增生，進而破壞局部組織", "D": "組織的重模組化（remodeling）造成氣管不可逆的組織變化而使疾病成慢性且持續", "language": "tw"}
{"question": "關於化學性灼傷（chemical burn），下列敘述何者錯誤？", "answer": "水泥灼傷是酸性化學灼傷", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "所有的化學性灼傷都應該立即除去患處衣物並大量沖水", "B": "嚴重酸性化學灼傷若引起血中酸鹼值異常及呼吸困難，可能需要氣管內插管及使用呼吸機（ventilator）協助呼吸", "C": "氫氟酸（hydrofluoric acid）灼傷應立即以2.5%葡萄糖酸鈣凝膠（calcium gluconate gel）局部患處治療", "D": "水泥灼傷是酸性化學灼傷", "language": "tw"}
{"question": "6.75歲男性病人，抽菸10年以上，使用calcium channel blocker 治療高血壓10年，胸痛接受顯影劑注射冠狀動脈攝影，檢查前血液肌酸酐1.0 mg/dL，檢查結果發現嚴重冠狀動脈硬化，3 天後的血液肌酸酐1.1 mg/dL，7天後發生加速型的高血壓（accelerated hypertension）及少尿而住院。住院當天的理學檢查，高血壓視網膜病變、心臟擴大、下肢脈搏正常，但有皮膚 網狀青斑（livedo reticularis），血液嗜伊紅性白血球增加、補體下降、肌酸酐3.0 mg/dL，尿液紅血球6～10/HPF，蛋白質1+。最可能的診斷是： \n", "answer": "腎臟粥狀樣栓塞（atheroembolic renal disease） \t", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "顯影劑腎病變（contrast nephropathy）", "B": "腎臟粥狀樣栓塞（atheroembolic renal disease） \t", "C": "腎動脈狹窄（renal artery stenosis）", "D": "腎靜脈栓塞（renal vein thrombosis）", "language": "tw"}
{"question": "有關膽汁中之菌落的敘述，下列何者為誤？", "answer": "慢性膽囊炎的患者膽汁中培養出細菌的比率較急性膽囊炎者高", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "在沒有膽結石或其他病灶存在的情況下，膽囊中的膽汁一般是無菌的", "B": "慢性膽囊炎的患者膽汁中培養出細菌的比率較急性膽囊炎者高", "C": "有症狀之膽結石患者，膽汁中最常培養出之細菌為 E. coli 及 Klebsiella 等格蘭氏陰性菌", "D": "膽結石合併總膽管結石者，膽汁中培養出細菌的比率較不合併總膽管結石者高", "language": "tw"}
{"question": "維持喉部氣道功能最重要之肌肉為何？", "answer": "後環杓肌（Posterior cricoarytenoid muscle）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "甲狀杓骨肌（Thyroarytenoid muscle）", "B": "後環杓肌（Posterior cricoarytenoid muscle）", "C": "外環杓肌（Lateral cricoarytenoid muscle）", "D": "環甲肌（Cricothyroid muscle）", "language": "tw"}
{"question": "一對夫婦來看不孕症門診，檢查結果唯一不正常的是精液；精蟲數 14,000,000/mL，活動力 25%，正常形態 23%。你會建議先做什麼治療？", "answer": "intrauterine insemination with washed husband's sperm", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "clomiphene citrate \t \t", "B": "in vitro fertilization（IVF）", "C": "intrauterine insemination with washed husband's sperm", "D": "insemination with donor sperm", "language": "tw"}
{"question": "40 歲女性罹患混合型尿失禁（mixed incontinence），病人主訴急迫性尿失禁的程度比應力性尿失禁嚴重，初步的治療選擇應該是：", "answer": "修正飲水習慣，並教導與鼓勵做骨盆底肌運動", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "使用甲型交感神經拮抗劑（α-adrenergic antagonist）", "B": "膠原蛋白（collagen）注射於尿道", "C": "施行恥骨陰道吊帶術（pubovaginal sling），因為此手術是治療混合型尿失禁最理想的手術方法", "D": "修正飲水習慣，並教導與鼓勵做骨盆底肌運動", "language": "tw"}
{"question": "下列那一項對足月新生兒清醒時是不正常的？", "answer": "心跳每分鐘72下", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "心跳每分鐘72下", "B": "呼吸每分鐘40次", "C": "體溫37.5℃", "D": "前囟門平坦", "language": "tw"}
{"question": "42 歲女性，G5P4，妊娠 18 週，其胎兒腦部超音波檢查發現「香蕉徵」（banana sign），請問下列診斷中何者最為可能？", "answer": "神經管缺損", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "唐氏症 \t", "B": "神經管缺損", "C": "無腦兒 \t", "D": "透納氏徵候群（45, X）", "language": "tw"}
{"question": "當最大的光線強度刺激時，會使視網膜上的光感受細胞（photoreceptor cells）膜電位趨近於下列何者？", "answer": "鉀離子的平衡電位", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "鈉離子的平衡電位", "B": "鉀離子的平衡電位", "C": "鈣離子的平衡電位", "D": "0 mV", "language": "tw"}
{"question": "依現行身心障礙者權益保護法，下列敘述何者錯誤？", "answer": "身心障礙者進入收費之公營風景區、康樂場所或文教設施，憑身心障礙證明應予半價優待", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "各級政府機關及公營事業機構員工總人數在34人以上者，進用具有就業能力之身心障礙者人數，不得低於員工總人數3%", "B": "公共停車場應保留2%停車位，作為行動不便之身心障礙者專用停車位", "C": "身心障礙者進入收費之公營風景區、康樂場所或文教設施，憑身心障礙證明應予半價優待", "D": "各級政府應至少每五年舉辦身心障礙者之生活狀況、保健醫療、特殊教育、就業與訓練等需求評估及服務調查研究", "language": "tw"}
{"question": "一位 45 歲女性，G3P2，妊娠 30 週，急診就醫，主訴突然大量陰道出血合併劇烈下腹部疼痛，無任何內外科疾病史，血壓 180/110 mmHg，子宮劇痛硬如木板，最可能的診斷為：", "answer": "胎盤早期剝離", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "葡萄胎", "B": "胎盤早期剝離", "C": "植入性胎盤", "D": "子宮外孕", "language": "tw"}
{"question": "下列關於真核生物 RNA 的敘述，何者錯誤？", "answer": "mRNA 之 3' poly（A）序列是依循模板（template）DNA 上 poly（T）而來", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "5'-cap 可保護 mRNA 的端點，增加其穩定性", "B": "rRNA 及 tRNA 均無 5'-cap", "C": "mRNA 之 3' poly（A）序列是依循模板（template）DNA 上 poly（T）而來", "D": "histone 的 mRNA 沒有 3' poly（A）序列", "language": "tw"}
{"question": "有關以公權力推動強制性的衛生政策之倫理原則，下列敘述何者錯誤？", "answer": "即使某些衛生政策可能犧牲個人自由，但為了當事人的健康，也為了國民健康，衛生主管機關仍然應該毫無例外地推動這些政策", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "所採用的手段必須能夠達到政策目的", "B": "所要達成的公共利益與所犧牲的個人利益之間要符合比例", "C": "即使必須犧牲個人利益，仍應採取最小侵害手段", "D": "即使某些衛生政策可能犧牲個人自由，但為了當事人的健康，也為了國民健康，衛生主管機關仍然應該毫無例外地推動這些政策", "language": "tw"}
{"question": "下列何種反應條件，酵素可達到其催化之最高速度？", "answer": "所有酵素均與反應物結合", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "反應物濃度＜Km \t", "B": "反應物濃度＝Km \t", "C": "所有酵素均與反應物結合", "D": "溫度達到 100℃", "language": "tw"}
{"question": "橈神經（radial nerve）在大圓肌（teres major）下方處受到傷害，通常也會傷及與其伴行的那一條血管？", "answer": "深肱動脈（deep brachial artery）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "肱動脈（brachial artery）", "B": "深肱動脈（deep brachial artery）", "C": "前迴旋肱動脈（anterior circumflex humeral artery）", "D": "後迴旋肱動脈（posterior circumflex humeral artery）", "language": "tw"}
{"question": "關於中央靜脈導管置放術（central venous catheterization）的敘述，下列何者錯誤？", "answer": "一般就成功率而言，經外頸靜脈置放的成功率遠比經內頸靜脈置放的成功率高", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "一般就成功率而言，經外頸靜脈置放的成功率遠比經內頸靜脈置放的成功率高", "B": "若需要長期使用考量，則經鎖骨下靜脈置放中央靜脈導管比經由股靜脈置放要來的適當", "C": "置放中央靜脈導管時，以頭低腳高的姿勢（Trendelenburg position），可使內頸靜脈血管較易鼓脹、較易成功置放，且可以減少發生空氣栓塞的機會", "D": "中央靜脈導管置放術可能產生氣胸（pneumothorax）、乳糜胸（chylothorax）等併發症", "language": "tw"}
{"question": "關於非小細胞肺癌之治療敘述，下列何者錯誤？", "answer": "bronchoalveolar cell carcinoma 不適合手術", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "Stage I 之肺癌以外科手術為主", "B": "Stage II 之肺癌以外科手術為主，可考慮化學及放射治療為輔", "C": "Stage IIIb 之肺癌以化學及放射治療為主", "D": "bronchoalveolar cell carcinoma 不適合手術", "language": "tw"}
{"question": "一位 24 歲女性月經不規則來門診求診，懷孕試驗呈陰性反應，荷爾蒙檢查發現甲狀腺、泌乳激素正常，但是黃體激素大於濾泡激素 2 倍，超音波發現為多囊性卵巢，要如何治療？", "answer": "服用避孕藥 \t", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "服用避孕藥 \t", "B": "給予性腺刺激素（gonadotropin）", "C": "給予皮下注射降血糖藥物", "D": "做子宮擴刮術（D & C）", "language": "tw"}
{"question": "下列早期胰臟腺癌症狀之敘述，何者最常見？", "answer": "無症狀", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "無症狀", "B": "腹痛", "C": "發燒", "D": "黃疸", "language": "tw"}
{"question": "下列有關胃部分切除（partial gastrectomy）病人之敘述，何者正確？", "answer": "餐後易發生虛弱、暈眩及盜\t現象", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "餐後四小時易引起血糖過高現象", "B": "餐後易發生虛弱、暈眩及盜\t現象", "C": "餐後易發生血壓上升現象", "D": "甜食可避免餐後的不適", "language": "tw"}
{"question": "正常情況下，水分的通透性（permeability）在下列何處最大？", "answer": "亨利氏彎管的細下降枝（thin descending limb）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "亨利氏彎管的細下降枝（thin descending limb）", "B": "亨利氏彎管的細上升枝（thin ascending limb）", "C": "亨利氏彎管的粗上升枝（thick ascending limb）", "D": "集尿管（collecting duct）的髓質部（inner medullary portion）", "language": "tw"}
{"question": "80 李先生因為家人有癌症病史，所以到 A 醫院的健康檢查中心作全身健康檢查，檢查項目除了抽血之 外還有胃鏡和大腸鏡的檢查，依照醫療法規定，李先生需不需要寫同意書？ \n", "answer": "需要，侵入性檢查需要書面同意", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "不需要，只有在手術和麻醉時才要", "B": "需要，侵入性檢查需要書面同意", "C": "不需要，侵入性檢查只需要口頭同意即可", "D": "不需要，侵入性檢查只需要事後同意即可", "language": "tw"}
{"question": "有關慢性腎臟病的治療，下列何者正確？", "answer": "患有蛋白尿之第4期慢性腎臟病患者，應採用低蛋白飲食療法", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "若患者合併高血壓，其降血壓藥物首選為乙型阻斷劑（β-blocker）", "B": "若患者合併退化關節炎，可使用非類固醇類抗發炎藥物（NSAID）來止痛", "C": "患有重度蛋白尿之糖尿病慢性腎臟病患，最好合併使用血管張力素轉化酶抑制劑（ACEi）和血管張力素II型受體拮抗劑（ARB）來治療", "D": "患有蛋白尿之第4期慢性腎臟病患者，應採用低蛋白飲食療法", "language": "tw"}
{"question": "一位 56 歲女性，軀幹及四肢出現靶心狀病灶（target lesions），口腔糜爛、眼結膜紅腫、會陰部糜爛、身體發燒，最有可能之診斷為何？", "answer": "史蒂芬-強森症候群（Stevens-Johnson syndrome）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "疱疹性皮膚炎（dermatitis herpetiformis）", "B": "史蒂芬-強森症候群（Stevens-Johnson syndrome）", "C": "尋常性天疱瘡（pemphigus vulgaris）", "D": "膿疱性乾癬（pustular psoriasis）", "language": "tw"}
{"question": "下列何者是骨盆底（pelvic floor）最主要的支撐（support）構造？", "answer": "提肛肌（levator ani muscle）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "子宮薦骨韌帶（uterosacral ligaments）", "B": "提肛肌（levator ani muscle）", "C": "骨盆（bony pelvis） \t", "D": "圓韌帶（round ligaments）", "language": "tw"}
{"question": "有關小胖威利症候群（Prader-Willi Syndrome）的敘述，下列何者錯誤？", "answer": "母源性（maternal）染色體15q11-q13缺失", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "母源性（maternal）染色體15q11-q13缺失", "B": "新生兒及嬰兒期會有嚴重低張力與餵食困難", "C": "小手與小腳（small hands and feet）", "D": "性腺機能不足（hypogonadism）", "language": "tw"}
{"question": "承上題，下列對霍亂弧菌的敘述，何者正確？", "answer": "人類是此菌唯一的天然宿主", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "對酸的耐受性高 \t", "B": "所產生的神經毒素會刺激腸道的蠕動", "C": "人類是此菌唯一的天然宿主", "D": "無法生長於未添加鹽的培養基", "language": "tw"}
{"question": "下列何種細胞表面辨識抗原的受體（receptor）為免疫球蛋白？", "answer": "B 淋巴細胞", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "T 淋巴細胞", "B": "B 淋巴細胞", "C": "巨噬細胞", "D": "自然殺手細胞", "language": "tw"}
{"question": "有關老年病人的評估，下列敘述何者正確？", "answer": "Timed up-and-go test用於評估行走與平衡能力", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "Mini-Mental State Examination主要用來篩檢憂鬱症（depression）", "B": "Mini-Cog test包括「倒背數\t」與「系列減法」兩部分", "C": "Timed up-and-go test用於評估行走與平衡能力", "D": "備餐、沐浴、移位、服藥等能力皆是基本日常生活活動功能（basic activities of daily living）的評估項目", "language": "tw"}
{"question": "運動測試可以用來評估心肌梗塞後病患能否回到工作崗位。如果受試者想重回辦公室工作、不須負重或頻繁走動，則運動測試時其最大攝氧量至少須達多少代謝當量（Metabolic Equivalents, METs）？", "answer": "5-7", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "3-4", "B": "5-7", "C": "8-10", "D": "11-13", "language": "tw"}
{"question": "40歲男性，在右大腳趾出現如圖所示之表徵，有一年之久，最適切之診斷為：", "answer": "subungual melanoma", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "subungual hematoma", "B": "subungual melanoma", "C": "subungual pigmented nevus", "D": "friction induced melanonychia", "language": "tw"}
{"question": "3 歲右撇子男孩，剛學自己用餐，家人卻發現他左手固定於輕度內旋而無法外旋捧碗就口，右前臂卻活動自如，於醫院照左前臂 X 光如下圖，最可能的診斷是：", "answer": "先天性橈尺骨黏合（congenital radioulnar synostosis）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "先天性橈骨頭脫臼（congenital radial head dislocation）", "B": "先天性尺骨杵狀手（congenital ulnar club hand）", "C": "先天性橈尺骨黏合（congenital radioulnar synostosis）", "D": "創傷後肘內翻（post-traumatic cubitus varus deformity）", "language": "tw"}
{"question": "下列各種感覺及其受器，何者最不容易因持續刺激而發生傳導適應現象（adaptation）？", "answer": "本體感覺；muscle spindles", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "壓覺；pacinian corpuscles", "B": "本體感覺；muscle spindles", "C": "嗅覺；olfactory receptor cells", "D": "聽覺；hair cell receptors", "language": "tw"}
{"question": "Limbic system 中與恐懼情緒（fear）關係密切之結構為何？", "answer": "amygdaloid nuclei", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "thalamus", "B": "hippocampus", "C": "fornix", "D": "amygdaloid nuclei", "language": "tw"}
{"question": "77.一位30歲的男性工人從6公尺高的鷹架墜落，身體檢查顯示收縮壓120 mmHg，右胸有明顯的連迦胸（flail  chest），嚴重的呼吸窘迫（severe respiratory distress），右胸呼吸聲音稍微降低，叩診時則左右兩側類似。給予非再呼吸型面罩氧氣15 L/min後，其動脈氣體分析為pH：7.47，PaO2：65 mmHg，PaCO2：28 mmHg；下列何者最可能解釋他的異常動脈氣體分析之原因？ \n", "answer": "肺挫傷", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "疼痛", "B": "合併腹部創傷", "C": "心包膜積血", "D": "肺挫傷", "language": "tw"}
{"question": "下列何構造損傷，最可能導致感覺型失語症（sensory aphasia）？", "answer": "渥尼克區(Wernicke area)", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "上丘（superior colliculus）", "B": "弓狀束（arcuate fasciculus）", "C": "渥尼克區(Wernicke area)", "D": "前聯合（anterior commissure）", "language": "tw"}
{"question": "13 一位 73 歲纖瘦婦女，腹部反覆絞痛 3 個月，最近 3 天逐漸腹脹及無排氣、無大便。過去病史：多年前子宮頸癌根治性子宮卵巢切除術及化放療後。住院生命徵象：血壓 110 / 70 mmHg、心跳 130/分、寡尿。理學檢查：脫水、腹脹、腸蠕動加劇且聽診發現有金屬音（metallic sound），腹部呈瀰漫性壓痛。實驗室數據：Hb 13.2 gm/dL、WBC 12000/mm3、血清 amylase 600 U/L、Na 127 mEq/L。腹部 X 光顯示小腸擴大且無大腸氣。則其最可能的診斷為何？ \n", "answer": "機械性腸阻塞（mechanical obstruction）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "機械性腸阻塞（mechanical obstruction）", "B": "麻痺性腸阻塞（paralytic ileus）", "C": "急性胰臟炎（acute pancreatitis）", "D": "上腸繫動脈阻塞（SMA occlusion）", "language": "tw"}
{"question": "一位三個月大男嬰因為咳嗽一週住院，呼吸道分泌物檢驗出有砂眼披衣菌（Chlamydia trachomatis）抗原，這位男嬰最可能也有下列那一種臨床表現？", "answer": "曾有新生兒結膜炎 \t", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "肝脾腫大 \t", "B": "曾有新生兒結膜炎 \t", "C": "持續高燒七天 \t", "D": "胸部 X 光有實質化（consolidation）變化", "language": "tw"}
{"question": "下列何者是骨重新塑形過程後殘存的構造？", "answer": "間骨板（Interstitial lamellae）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "外環周骨板（Outer circum ferential lamellae）", "B": "哈維氏管（Haversian canal）", "C": "間骨板（Interstitial lamellae）", "D": "內環周骨板（Inner circum ferential lamellae）", "language": "tw"}
{"question": "下列何者不會抑制甲促素（TSH）之分泌？", "answer": "乳促素", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "糖皮素", "B": "體抑素", "C": "乳促素", "D": "多巴胺", "language": "tw"}
{"question": "一位 74 歲女性由家人陪同入急診求醫。主訴為一天前開始腹瀉，約有 10 次，黏液狀（mucoid）糞便。家人無同樣症狀。腹部偶爾會有絞痛感，無嘔吐，無發燒。病人 10 天前因為肺炎住院，前二天才出院，帶回家口服使用的藥物有 Augmentin（amoxicillin with clavulanic acid）與 acetaminophen，除此以外無使用其他藥物。依以上病史，你認為以下何者是最有可能造成此次腹瀉的病原？", "answer": "Clostridium difficile", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "Staphylococcus aureus", "B": "Clostridium difficile", "C": "Pseudomonas aeruginosa", "D": "Norwalk virus", "language": "tw"}
{"question": "Infliximab 單株抗體可用於 Crohn's disease 之緩解，其主要作用之標的為何？", "answer": "TNF-α", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "interferon", "B": "IL-2", "C": "TNF-α", "D": "LTB4", "language": "tw"}
{"question": "承上題，如第一步檢查是正常，肛門指診帶有暗紅色的血便，接下來要作：", "answer": "直腸鏡", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "血管攝影", "B": "直腸鏡", "C": "大腸鋇劑攝影", "D": "插鼻胃管", "language": "tw"}
{"question": " 下列何者是活化態維生素D的分子結構？", "answer": "1, 25-dihydroxycholecalciferol", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "1, 25-dihydroxycholecalciferol", "B": "7-dehydrocholesterol", "C": "25-hydroxycholecalciferol", "D": "cholecalciferol", "language": "tw"}
{"question": "關於藥物動力學的敘述，下列何者錯誤？", "answer": "藥物可藉由細胞與細胞之間的水性孔（aqueous pores）進行被動滲透，可容許的最大分子量為不超過", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "親脂性藥物較親水性藥物容易被身體快速吸收", "B": "藥物可藉由細胞與細胞之間的水性孔（aqueous pores）進行被動滲透，可容許的最大分子量為不超過", "C": "藥物可藉由與細胞膜上特定載體結合而通過細胞膜進入細胞", "D": "藥物可以藉由胞吞作用（endocytosis）進入細胞", "language": "tw"}
{"question": "下列有關「腫瘤細胞逃避宿主CD8淋巴細胞攻擊」的敘述，那一項錯誤？", "answer": "腫瘤細胞抑制本身MHC（major histocompatibility complex）class II分子的表現", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "腫瘤細胞抑制本身MHC（major histocompatibility complex）class II分子的表現", "B": "腫瘤細胞不表現可引發免疫反應的抗原", "C": "腫瘤細胞可分泌抑制T細胞活化的細胞激素", "D": "腫瘤細胞群能形成特殊環境不讓CD8淋巴細胞浸潤", "language": "tw"}
{"question": "44 \n 3 \n 陰性 \n 0 \n 98 \n", "answer": "94%", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "84%", "B": "94%", "C": "97%", "D": "100%", "language": "tw"}
{"question": "下列情況使用angiotensin-converting enzyme inhibitor（ACEI）比較容易發生急性腎衰竭，但何者例外？", "answer": "合併使用鈣離子阻斷劑", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "雙側腎動脈狹窄", "B": "合併使用鈣離子阻斷劑", "C": "使用大量利尿劑治療鬱血性心衰竭", "D": "合併使用非類固醇消炎劑", "language": "tw"}
{"question": "下列何者不是學者Jonsen等⼈⽤來解決臨床醫學個案問題的四主題法或四象限法（four topics or four boxes method）的內容？", "answer": "不傷害原則（nonmaleficience）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "不傷害原則（nonmaleficience）", "B": "醫療適應症（medical indications）", "C": "病⼈偏好（patient preferences）", "D": "⽣活品質（quality of life）", "language": "tw"}
{"question": "下列那一項處置最不會增加住院病人醫療照護相關感染肺炎（healthcare-associated pneumonia）的風險？", "answer": "使用口服sucralfate藥物治療胃炎", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "儘量讓病人平躺以維持住院的舒適度", "B": "給與麻醉藥物（narcotics）全天止痛", "C": "為方便抽痰延長使用氣管內插管（endotracheal intubation）", "D": "使用口服sucralfate藥物治療胃炎", "language": "tw"}
{"question": "Methenamine 被用於預防尿道細菌感染之藥劑，但其缺乏全身性抗菌作用，原因為何？", "answer": "在低 pH 值尿液中才能轉化成 formaldehyde", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "口服無法吸收進入血液循環", "B": "迅速被肝臟酵素代謝", "C": "在低 pH 值尿液中才能轉化成 formaldehyde", "D": "大量與血漿蛋白結合", "language": "tw"}
{"question": "下列對於透納氏症（Turner syndrome）的敘述，何者錯誤？", "answer": "透納氏症女性的特徵為蹼頸、盾狀胸、主動脈瓣膜缺損以及嚴重智力障礙", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "透納氏症女性身材矮小，成人身高一般不超過 150 公分", "B": "透納氏症女性於 1959 年被證實為細胞染色體核型（karyotype）45X，或嵌合型（mosaic）", "C": "透納氏症的發生率為 1/2500", "D": "透納氏症女性的特徵為蹼頸、盾狀胸、主動脈瓣膜缺損以及嚴重智力障礙", "language": "tw"}
{"question": "有關葡萄胎（hydatidiform mole）的敘述，下列何者錯誤？", "answer": "完全性葡萄胎因轉為絨毛膜癌機會很高，治療應以全子宮切除手術為佳", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "在超音波檢查下，常見子宮腔內呈暴風雪（snow storm）樣影像", "B": "母親年齡較大懷孕是危險因子", "C": "患者有時會有嚴重噁心、嘔吐現象，血液中 hCG 值很高", "D": "完全性葡萄胎因轉為絨毛膜癌機會很高，治療應以全子宮切除手術為佳", "language": "tw"}
{"question": "下列何者不是氧氣治療（oxygen therapy）引起的併發症？", "answer": "在COPD的病人容易引起hyperventilation", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "absorption atelectasis", "B": "在COPD的病人容易引起hyperventilation", "C": "bronchopulmonary dysplasia", "D": "在新生兒常引起retinopathy of prematurity（ROP）", "language": "tw"}
{"question": "67 面對一位外籍勞工因病來診，在醫病間之認知及溝通有所困難時，Berlin 及 Fowker 提出有用之溝通 方式\"LEARN＂Model，有關 LEARN Model 之敘述，下列何者錯誤？ \n", "answer": "A 代表 ask，要求病人多提供資料", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "L 代表 listen，傾聽病人之敘述", "B": "E 代表 explain，解釋給病人聽", "C": "A 代表 ask，要求病人多提供資料", "D": "R 代表 recommend，綜合病人敘述及醫師意見提出建議", "language": "tw"}
{"question": "一位微生物實驗室助理吳小姐 25 歲，右手食指指甲發展成類似灰指甲（Onychomycosis）症狀有 6 個月，但感染指甲周邊皮膚並沒有脫皮、起水泡或搔癢。吳小姐自小學起就有咬指甲之習慣，最近發現指甲變得很醜，於是到醫院皮膚科就診。皮膚科醫師以指甲剪取樣，其中一部分在門診以 10% KOH 處理並且以顯微鏡觀察，結果顯示指甲中有酵母菌（Yeast）、及長短不一之菌絲（Hyphae）。兩星期後指甲培養之結果出來，感染之病原菌很可能是一種平滑（Smooth）菌落、乳白色（Creamy）、出芽型酵母菌（Budding yeast）；有假菌絲（Pseudohyphae）及芽管（Germ tube）產生，PCR 分析也證明該菌之種類。於是醫師就開 Terbinafine 口服處方，兩個月後吳小姐的指甲也就復原。該菌最可能是下列那一病原？", "answer": "Candida albicans", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "Trichophyton rubrum \t", "B": "Epidermophyton floccosum", "C": "Microsporum canis \t", "D": "Candida albicans", "language": "tw"}
{"question": "29.下列選項中，心臟科醫師會優先選擇，由何處進入施行心臟冠狀動脈的氣球擴張術（percutaneous  transluminal coronary angioplasty）？ \n", "answer": "股動脈（femoral artery）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "股動脈（femoral artery）", "B": "股靜脈（femoral vein）", "C": "大隱靜脈（great saphenous vein）", "D": "小隱靜脈（small saphenous vein）", "language": "tw"}
{"question": "下列何者受坐骨神經（sciatic nerve）支配？", "answer": "內收大肌（adductor magnus）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "內收長肌（adductor longus）", "B": "恥骨肌（pectineus）", "C": "股薄肌（gracilis） \t", "D": "內收大肌（adductor magnus）", "language": "tw"}
{"question": "在臺灣引起肝膿瘍最常見的細菌為何？", "answer": "克雷白氏肺炎桿菌（K. pneumoniae）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "幽門螺旋桿菌（H. pylori）", "B": "大腸桿菌（E. coli）", "C": "金黃色葡萄球菌（S. aureus）", "D": "克雷白氏肺炎桿菌（K. pneumoniae）", "language": "tw"}
{"question": "無精蟲症是男性不孕症原因之一，如精液檢\t發現無精蟲症時，下列何者為最佳做法？", "answer": "解釋無精蟲症可能原因之後，休息數星期後再次檢\t精液或抽血檢查", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "解釋無精蟲症可能原因之後，休息數星期後再次檢\t精液或抽血檢查", "B": "安排睪丸切片，用以分析阻塞性或非阻塞性無精蟲症", "C": "安排單一精蟲注射試管嬰兒", "D": "告知領養小孩是唯一選擇", "language": "tw"}
{"question": "大部分小兒外科醫師建議隱睪症兒童在什麼年齡接受手術？", "answer": "1 歲", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "1 個月", "B": "6 個月", "C": "1 歲", "D": "3 歲", "language": "tw"}
{"question": "下列何種毒物，會阻斷鈉離子通道而抑制神經動作電位之傳導？", "answer": "tetrodotoxin", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "botulinum toxin", "B": "ω-conotoxin GVIA", "C": "α-latrotoxin", "D": "tetrodotoxin", "language": "tw"}
{"question": "B細胞被抗原刺激後，細胞膜上之免疫球蛋白可轉變成分泌型抗體，其機制為何？", "answer": "RNA剪接（RNA splicing）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "DNA重組（DNA recombination）", "B": "RNA剪接（RNA splicing）", "C": "蛋白分解酶（protease）切割", "D": "蛋白激酶（protein kinase）修飾", "language": "tw"}
{"question": "下列何種狀況可促進周邊組織中氧氣和血紅素的解離？", "answer": "運動", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "運動", "B": "pH 值 7.6", "C": "二氧化碳分壓降低", "D": "溫度下降", "language": "tw"}
{"question": "下列那一項是最能證明愛滋病預防教育執行成功的指標？", "answer": "民眾從事安全性行為（使用保險套）的比率提高", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "民眾從事安全性行為（使用保險套）的比率提高", "B": "愛滋病患的病情在臨床上獲得有效控制", "C": "醫院發出愛滋病預防教育單張的數量增加", "D": "參加愛滋病衛生教育活動的人數增多", "language": "tw"}
{"question": "單內醯胺（monobactam）屬於β-內醯胺類的抗生素，但與其他同類藥物相較，其抗菌範圍較為狹窄只可對抗何類細菌？", "answer": "革蘭氏陰性嗜氧菌", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "革蘭氏陰性厭氧菌", "B": "革蘭氏陽性厭氧菌", "C": "革蘭氏陰性嗜氧菌", "D": "革蘭氏陽性嗜氧菌", "language": "tw"}
{"question": "77 一位 55 歲男性至急診就醫，主訴 3 天來感覺頭暈，站立時較嚴重，躺臥時可緩解。除此以外無任何不適。平日偶爾會服用非類固醇類消炎止痛藥治療關節痠痛。理學檢查無明顯腹部壓痛，腸音蠕動正常。肛門檢查發現有血便，在急診安排胃灌洗（gastric lavage）、胃鏡以及大腸鏡檢查皆無發現異 常。住院後進行血管攝影也無異常。然而病人的血便仍持續。以下何者為最適合的下一步檢查？ \n", "answer": "核醫閃爍造影術（scintigraphy）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "核醫閃爍造影術（scintigraphy）", "B": "鋇劑對比檢查（barium contrast study）", "C": "超音波（sonography）", "D": "電腦斷層（computed tomography）", "language": "tw"}
{"question": "女孩進入青春期，一般最先開始發育的部位為：", "answer": "乳房（breast）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "陰毛（pubic hair）", "B": "乳房（breast）", "C": "快速生長（height spurt）", "D": "初經（menarche）", "language": "tw"}
{"question": "在肝臟細胞膜（plasma membrane）中，下列何種脂質含量最低？", "answer": "心磷脂（cardiolipin）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "膽鹼磷脂（phosphatidylcholine）", "B": "鞘磷脂（sphingolipids）", "C": "心磷脂（cardiolipin）", "D": "膽固醇（cholesterol）", "language": "tw"}
{"question": "下列何者不是高陰離子間隙代謝性酸中毒（high-anion-gap metabolic acidosis）的原因？", "answer": "diarrhea", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "lactic acidosis", "B": "ketoacidosis", "C": "diarrhea", "D": "salicylate intoxication", "language": "tw"}
{"question": "幼稚園中班的小恩，前年和去年皆施打過流行性感冒疫苗，半個月前被診斷得了流行性感冒，而服用了克流感（oseltamivir）治療。有關小恩後續的流感防範措施，下列何者是最佳的選擇？", "answer": "今年施打一劑流感疫苗", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "今年施打一劑流感疫苗", "B": "年齡未達8歲且打過疫苗又得病，今年應施打兩劑流感疫苗", "C": "已服用過克流感，今年不必施打流感疫苗", "D": "流感疫苗無效，明年不要施打", "language": "tw"}
{"question": "鑒於青少年憂鬱症的重要，有研究人員想要發展一份簡易的篩檢問卷。為了檢驗該篩檢問卷的效度，他一共邀請某一學校之 500 位學生填寫篩檢問卷。其中 50 人被判定為陽性，其餘為陰性。然後他請精神科醫師親自對這 500 人問診，結果發現在 50 名陽性者當中，只有 35 人真正有病，但是 450 名陰性者當中，卻還有 10 人有病。請問篩選問卷的敏感度（sensitivity）為何？", "answer": "35／45", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "50／500", "B": "35／50", "C": "35／45", "D": "40／450", "language": "tw"}
{"question": "一位 68 歲病人因為深頸部嚴重感染引起敗血性休克，他的呼吸道受到膿瘍壓迫而變狹窄，耳鼻喉科醫師判斷需要插呼吸管以搶救生命，下列何者考量正確？", "answer": "緊急狀態，應逕行插管搶救", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "若病人意識不清楚，須經家屬同意再進行插管 \t", "B": "即使病人意識清楚，仍應等候家屬到來再決定", "C": "緊急狀態，應逕行插管搶救", "D": "依病況決定要不要救", "language": "tw"}
{"question": "病患的左眼可以看向左方但無法同時上抬，下列何者最可能損傷？", "answer": "左眼之上直肌", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "左眼之上斜肌", "B": "左眼之上直肌", "C": "左眼之內直肌", "D": "左眼之下斜肌", "language": "tw"}
{"question": "由於體超突變機轉（somatic hypermutation）使得在發育中心（germinal center）的B淋巴球能產生出對抗原結合性更高的抗體，但是此過程之中也偶而會有產生自體抗體的B淋巴球，這時免疫系統如何處理？", "answer": "這些產生自體抗體的B淋巴球，在缺乏T細胞幫助之下凋亡，因而被清除", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "這些產生自體抗體的B淋巴球，停留於發育中心並不離開，以便於將來遇到自體抗原時再產生自體抗體", "B": "這些產生自體抗體的B淋巴球，因與補體結合而活化增生 \t", "C": "這些產生自體抗體的B淋巴球，會遇到巨噬細胞而被清除", "D": "這些產生自體抗體的B淋巴球，在缺乏T細胞幫助之下凋亡，因而被清除", "language": "tw"}
{"question": "2.麻醉藥物的效應可以大致分為催眠（hypnotic）以及止痛（analgesic）兩大方面來獨立考量，前者是麻醉深度監測 （monitoring of the depth of anesthesia）的主要範疇。下列關於麻醉深度監測的敘述，何者錯誤？ \n", "answer": "手術過程中麻醉深度不足，可能導致病患術中清醒（intraoperative awareness） ，低體溫時，其發生率較高", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "麻醉的深度可以用腦波圖（electroencephalogram, EEG）或由腦波圖計算出來的相關指標進行監測，主要是因為這些指標和", "B": "手術過程中麻醉深度不足，可能導致病患術中清醒（intraoperative awareness） ，低體溫時，其發生率較高", "C": "越來越多的證據顯示，術中進行麻醉深度監測，有助於降低病患術中清醒的發生率。但是，進行此項監測，並不能保證病患完全不會發生術中清醒", "D": "在病患可以承受的範圍內，儘量維持適當而且穩定的吸入性麻醉氣體濃度，有助於減少病患術中清醒的發生", "language": "tw"}
{"question": "下列何種致癌物最容易引起白血病及惡性淋巴瘤？", "answer": "Benzene", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "Asbestos", "B": "Cadmium compounds", "C": "Vinyl chloride", "D": "Benzene", "language": "tw"}
{"question": "治療幽門桿菌引起之消化性潰瘍，下列敘述何者錯誤？", "answer": "Clarithromycin 於酸性環境相當穩定，所以單獨使用 clarithromycin 之效果極佳", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "目前標準治療為 proton pump inhibitor，加上 clarithromycin 及 amoxicillin", "B": "Clarithromycin 於酸性環境相當穩定，所以單獨使用 clarithromycin 之效果極佳", "C": "若有抗藥性產生可以使用其他抗菌劑取代，如 metronidazole 或 tetracycline", "D": "對於十二指腸潰瘍患者，將幽門桿菌清除，可以降低一年之潰瘍復發率", "language": "tw"}
{"question": "8.⻑期禁食後再重新給與營養時，為避免造成再餵食症後群（refeeding syndrome），於早期餵食時，應注意下 列那些離⼦的補充？\n", "answer": "鉀、磷、鎂", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "鉀、磷、鎂", "B": "鈉、磷、鈣", "C": "鉀、磷、鈣", "D": "鉀、鈉、鎂", "language": "tw"}
{"question": "主胰管（major pancreatic duct）與膽管（common bile duct）共同開口於十二指腸何處？", "answer": "下行段（descending part）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "上段（superior part）", "B": "下行段（descending part）", "C": "下段（inferior part）", "D": "上行段（ascending part）", "language": "tw"}
{"question": "一位 48 歲男性病患發生一側上肢肢體乏力症狀，接著同側下肢肢體乏力，隨後再發生異側下肢肢體乏力，腦部電腦斷層掃描發現有一個腦膜瘤（meningioma），該腦膜瘤最有可能長在那個位置？", "answer": "枕骨大孔（foramen magnum）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "枕骨斜坡（clivus） \t", "B": "大腦鐮（falx）", "C": "枕骨大孔（foramen magnum）", "D": "嗅溝（olfactory groove）", "language": "tw"}
{"question": "有一病人因久咳且痰中帶有血絲及膿液而就診，經醫師採集其痰液進行細菌培養檢測後，發現其痰檢體中出現結核分枝桿菌，是為肺結核之患者。下列那一種抗生素不會出現在醫師的處方箋中？", "answer": "Vancomycin", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "Isoniazid", "B": "Ethambutol", "C": "Rifampin", "D": "Vancomycin", "language": "tw"}
{"question": "最常見兒童急性淋巴性白血病的白血病細胞免疫表現型（immunophenotype）為：", "answer": "early pre-B cell, CD10+", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "early pre-B cell, CD10+", "B": "pro-B cell, CD10-", "C": "pre-B cell \t", "D": "T cell", "language": "tw"}
{"question": "當胃內胃酸分泌 pH 值＜3 時，會分泌下列何種胜肽至胃腔中，抑制胃泌素（gastrin）之分泌？", "answer": "體抑素（somatostatin）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "膽囊收縮素（cholecystokinin）", "B": "胃抑素（gastric inhibitory polypeptide）", "C": "胰泌素（secretin） \t", "D": "體抑素（somatostatin）", "language": "tw"}
{"question": "23 一位 50 歲乳癌病患，她同時患有慢性 B 型肝炎及肝硬化。於五年前接受右側乳房切除後，健康情況一直穩定。最近一星期有咳嗽及右胸疼痛現象，胸部 X 光檢查顯示右側有中等程度肋膜腔積水。經安排胸腔超音波及抽水（thoracentesis），共抽出 500 mL 黃褐色之液體，送實驗室檢查獲得以下結 果：glucose：105 mg/dL、LDH：350 U/L、total protein：4.5 g/dL、WBC：1,000/uL。 \n 請問下列敘述何者錯誤？ \n", "answer": "應直接注入黏連劑至病患的肋膜腔內，以減少肋膜腔積水", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "肝硬化是引起肋膜腔積水的原因之一，靜脈補充白蛋白（albumin）可以改善肋膜腔積水", "B": "病患肋膜腔積水可能來自於乳癌肋膜轉移，必須檢驗肋膜腔積水是否有乳癌細胞", "C": "病患肋膜腔積水可能來自於肺部感染，必須進行肋膜腔積水及痰液之細菌培養", "D": "應直接注入黏連劑至病患的肋膜腔內，以減少肋膜腔積水", "language": "tw"}
{"question": "下列何者伴行小隱靜脈（small saphenous vein），且傳遞小腿後外側與小腳趾的皮膚感覺？", "answer": "腓腸神經（sural nerve）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "隱神經（saphenous nerve）", "B": "腓腸神經（sural nerve）", "C": "腓深神經（deep fibular nerve）", "D": "腓淺神經（superficial fibular nerve）", "language": "tw"}
{"question": "74歲男性，發燒咳嗽，右下肺葉有⼀個圓形病灶，內含很多中性球、壞死細胞的黏稠液，此病灶最可能為：", "answer": "膿瘍（abscess）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "肥厚性瘢痕（hypertrophic scar）", "B": "膿瘍（abscess）", "C": "⾎腫（hematoma）", "D": "結核（tuberculosis）", "language": "tw"}
{"question": "下列構造何者不經過superior orbital fissure？", "answer": "maxillary branch of trigeminal nerve", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "trochlear nerve", "B": "abducens nerve", "C": "superior ophthalmic vein", "D": "maxillary branch of trigeminal nerve", "language": "tw"}
{"question": "在右上腹觸摸到長形（香腸狀）硬塊是那一疾病的特徵？", "answer": "腸套疊", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "水腎", "B": "膽管囊腫", "C": "肥大性幽門狹窄", "D": "腸套疊", "language": "tw"}
{"question": "80 下列何種疾病可以出現有脂質或蛋白質等物質過度儲積於神經元（neuron）細胞內？①尼曼－匹克症 （Niemann-Pick disease） ②黏多醣儲積症（mucopolysaccharidoses） ③戴－薩克斯症（Tay-Sachs \n disease） \n", "answer": "①②③", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "僅①②", "B": "僅②③", "C": "僅①③", "D": "①②③", "language": "tw"}
{"question": "正常人對下列何種味覺具有最低的感受閾值（the lowest stimulation threshold）？", "answer": "苦", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "酸", "B": "甜", "C": "苦", "D": "鹹", "language": "tw"}
{"question": "8.5，尿液通常會培養出變形桿菌屬細菌，如Proteus mirabilis  下列有關Wegener's granulomatosis之敘述，何者最正確？", "answer": "黑人較白人常見", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "血中可測到antiproteinase-3抗體", "B": "黑人較白人常見", "C": "腎切片＞50%組織，可見到肉芽組織（granuloma）", "D": "此病在眼部不會造成結膜炎及鞏膜炎（scleritis）", "language": "tw"}
{"question": "16 個月男嬰，因排便後突然發生呼吸急促，發紺加劇而送至急診。此孩童以往即被發現有發紺及心雜音，其胸部 X 光片顯示肺血管減少，心臟形狀似\"馬靴\"（boot-shaped）。下列何種處理較不適當？", "answer": "避免孩童躁動而更消耗氧氣，給予 benzodiazepam 鎮靜", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "馬上將孩童置膝抱胸（knee-chest）姿勢，並給予氧氣", "B": "給予碳酸氫鈉（NaHCO3）以矯正酸血症", "C": "避免孩童躁動而更消耗氧氣，給予 benzodiazepam 鎮靜", "D": "給予靜脈注射 propranolol，減緩肺動脈下漏斗體（infundibulum）之收縮", "language": "tw"}
{"question": "一位 2 歲男孩，被家屬發現四肢冰冷、意識不清及發作（seizure）。當時血壓為 62/44 mmHg，其心電圖（EKG）如下圖所示。下列何者為最適當之處理？", "answer": "電擊休克（DC shock）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "給與靜脈注射 amiodarone", "B": "給與靜脈注射 lidocaine", "C": "放置暫時性心律調節器（temporary pacemaker）", "D": "電擊休克（DC shock）", "language": "tw"}
{"question": "下列何項治療可以減輕慢性阻塞性肺病之惡化？", "answer": "戒菸與氧氣治療", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "支氣管擴張劑", "B": "類固醇", "C": "戒菸與氧氣治療", "D": "復健", "language": "tw"}
{"question": "引起蛛網膜下出血最多的動脈瘤是那一種？", "answer": "Berry", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "Atherosclerotic", "B": "Mycotic", "C": "Traumatic", "D": "Berry", "language": "tw"}
{"question": "一位機車騎士，車禍撞擊造成右膝受傷，身體檢查發現右膝正前方有撞擊傷，合併輕微膝關節腫脹，膝後拉測試（posterior drawer test）呈陽性，X 光顯示無骨折，表示他何處韌帶損傷？", "answer": "膝後十字韌帶", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "膝內側韌帶", "B": "膝外側韌帶", "C": "膝前十字韌帶", "D": "膝後十字韌帶", "language": "tw"}
{"question": "心臟傳導系統的蒲金氏纖維（Purkinje fibers）為下列何者特化而成？", "answer": "心肌細胞（cardiac muscle cell）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "心肌細胞（cardiac muscle cell）", "B": "神經細胞（nerve cell）", "C": "纖維母細胞（fibroblast）", "D": "內皮細胞（endothelial cell）", "language": "tw"}
{"question": "下列何者是原發性副甲狀腺功能亢進的患者，最可能出現的電解質變化？", "answer": "高血鈣、低血磷", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "高血鈣、低血磷", "B": "低血鈣、高血磷", "C": "低血鈣、低血磷", "D": "高血鈣、高血磷", "language": "tw"}
{"question": "在下列何種疾病會聽到全收縮期雜音（holo-systolic murmur）？", "answer": "心室中隔缺損（ventricular septal defect）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "心房中隔缺損（atrial septal defect）", "B": "心室中隔缺損（ventricular septal defect）", "C": "肺動脈瓣狹窄（pulmonary stenosis）", "D": "開放性動脈導管（patent ductus arteriosus）", "language": "tw"}
{"question": "霍亂弧菌毒素會刺激小腸絨毛分泌細胞產生 cyclic AMP，接著引發下列何種離子大量釋出，導致分泌性腹瀉？", "answer": "氯離子", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "鈉離子", "B": "氯離子", "C": "鈣離子", "D": "鎂離子", "language": "tw"}
{"question": "承上題，下列何者是最適當優先安排的檢查工具？", "answer": "腹部電腦斷層攝影", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "大腸鋇劑灌腸攝影", "B": "大腸鏡", "C": "腹部電腦斷層攝影", "D": "腹部超音波", "language": "tw"}
{"question": "偵測自然殺手細胞（NK cells）可以下列那種分子組合作為標記？", "answer": "CD16/CD56", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "CD3/CD4", "B": "CD4/CD25", "C": "CD16/CD56", "D": "CD19/CD21", "language": "tw"}
{"question": "非典型胸痛的年輕女子接受運動心電圖檢查，下列敘述何者最正確？", "answer": "若呈陰性反應，則最終診斷為冠狀動脈疾病的機率極低", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "若呈陽性反應，則最終診斷為冠狀動脈疾病（coronary heart disease）的機率高", "B": "若呈陽性反應，則最終診斷為二尖瓣脫垂（mitral valve prolapse）的機率高", "C": "若呈陰性反應，則最終診斷為冠狀動脈疾病的機率極低", "D": "若呈陰性反應，則最終診斷為二尖瓣脫垂的機率極低", "language": "tw"}
{"question": "夢遊症（sleepwalking disorder）通常發生在睡眠腦波圖（EEG）的那一個時期？", "answer": "stage III & IV", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "stage I", "B": "stage II", "C": "stage III & IV", "D": "REM（rapid eye movement）sleep", "language": "tw"}
{"question": "糖尿病診斷標準之一為空腹血漿糖 ≥ 126 mg/dL，此處空腹之定義為沒有攝取熱量達至少多少小時？", "answer": "8", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "6", "B": "8", "C": "12", "D": "16", "language": "tw"}
{"question": "下列那種細胞最不可能與維持 oral tolerance 有關？", "answer": "第十七型輔助性 T 細胞（TH17）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "第三型輔助性 T 細胞（TH3）", "B": "調節性 T 細胞（regulatory T cell）", "C": "第十七型輔助性 T 細胞（TH17）", "D": "第二型輔助性 T 細胞（TH2）", "language": "tw"}
{"question": "下列何者現在臨床上適合用來治療嚴重敗血症？", "answer": "Activated protein C", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "Interleukin-1 receptor antagonist", "B": "Soluble receptor for tumor necrosis factor-α", "C": "Lipopolysaccharide antagonist", "D": "Activated protein C", "language": "tw"}
{"question": "關於配對的描述，下列何者錯誤？", "answer": "配對主要有頻率配對（frequency matching）與個人配對（individual matching）兩種，頻率配對需要較大的成本", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "在病例對照研究中，若採用配對，是避免研究所關注的危險因子外的暴露在病例組與對照組的分布有差異", "B": "配對主要有頻率配對（frequency matching）與個人配對（individual matching）兩種，頻率配對需要較大的成本", "C": "假設對性別與年齡進行配對，則無法再探討這兩個變項對疾病的影響", "D": "以病例對照研究為例，一個病例可配對多個對照，以增加檢力（power）", "language": "tw"}
{"question": "抗癌藥合併療法ABVD治療何杰金氏淋巴瘤（Hodgkin's lymphoma），其中何者可以明顯抑制癌細胞之topoisomerase II，而產生細胞毒殺作用？", "answer": "doxorubicin", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "bleomycin", "B": "doxorubicin", "C": "vincristine", "D": "dacarbozine", "language": "tw"}
{"question": "下列何種病毒具有E1A與E1B這兩種促進細胞生長的活化因子？", "answer": "Adenovirus", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "Adenovirus", "B": "Papillomavirus", "C": "Epstein-Barr virus", "D": "Cytomegalovirus", "language": "tw"}
{"question": "葡萄糖分子在腎小管近端上皮細胞的再吸收，最主要是透過何種機制進行？", "answer": "次級主動運輸（secondary active transport）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "次級主動運輸（secondary active transport）", "B": "二價鐵離子媒介之轉化作用（Fe2+-mediated conversion）", "C": "胞噬作用（phagocytosis）", "D": "氧化磷酸化作用（oxidative phosphorylation）", "language": "tw"}
{"question": "在某些例外的情況下，無需病患的同意即可進行醫療行為，惟下列何者不屬於這些例外的情況？", "answer": "有利於患者的人體試驗", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "緊急開刀或緊急侵入性檢查", "B": "有利於患者的人體試驗", "C": "精神疾病患者的強制治療", "D": "法定傳染病患者的隔離治療", "language": "tw"}
{"question": "4 歲男孩，母親主訴 4 天前開始出現輕微咳嗽，3 天前開始發燒，溫度皆在 39℃以上，且合併有寒顫（chill），入院前 2 天咳嗽更加劇烈，且有腹痛現象，身體檢查顯示一急性病容的小孩，右側胸部呼吸音下降且有囉音，胸部 X 光片如附圖，血液檢查顯示無貧血，但 WBC = 24,000/μL。則此病人最可能的致病菌為：", "answer": "Streptococcus pneumoniae", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "Haemophilus influenzae type b \t", "B": "Staphylococcus aureus", "C": "Streptococcus pneumoniae", "D": "Mycoplasma pneumoniae", "language": "tw"}
{"question": "下列何者不是聽覺傳導路徑中的構造？", "answer": "內側蹄系（medial lemniscus）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "斜方體（trapezoid body）", "B": "上橄欖核群（superior olivary complex）", "C": "內側蹄系（medial lemniscus）", "D": "下丘（inferior colliculus）", "language": "tw"}
{"question": "下列有關胸管的敘述，何者錯誤？", "answer": "胸管直接匯入上腔靜脈", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "乳糜池（chyle cistern）的大小、外型是不固定的", "B": "下六對肋間的淋巴亦下行匯入乳糜池（chyle cistern）", "C": "胸管位在後縱隔腔（posterior mediastinum）", "D": "胸管直接匯入上腔靜脈", "language": "tw"}
{"question": "紅斑性狼瘡（lupus erythematosus）之皮膚盤狀病灶（discoid lesion），較不會出現在下列那一部位之皮膚？", "answer": "腹部（abdomen）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "顏面（face）", "B": "頭部（scalp）", "C": "腹部（abdomen）", "D": "手前臂（forearm）", "language": "tw"}
{"question": "承上題，下列何者不是檢查胸腔出口症候群的方法？", "answer": "Breath test", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "Adson（scalene）test", "B": "Halsted（costoclavicular） test", "C": "Wright（hyperabduction）test", "D": "Breath test", "language": "tw"}
{"question": "一位 69 歲男性病患呈現嚴重的高血壓。影像學檢查發現他右腎臟的動脈進口處發生狹窄。下列疾病中那一個是造成這類腎臟動脈狹窄最常見的原因？", "answer": "Atherosclerosis", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "Fibromuscular dysplasia", "B": "Takayasu arteritis", "C": "Polyarteritis nodosa \t", "D": "Atherosclerosis", "language": "tw"}
{"question": "平靜吸氣（quiet inspiration）過程中，不會發生下列何種現象？", "answer": "內肋間肌（internal intercostal muscle）收縮", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "膈神經（phrenic nerve）興奮", "B": "內肋間肌（internal intercostal muscle）收縮", "C": "肋膜內壓（intrapleural pressure, Pip）下降", "D": "肺臟之彈性回復力（elastic recoil）增加", "language": "tw"}
{"question": "下列有關非特異性間質肺炎（non-specific interstitial pneumonia）的敘述，何者正確？", "answer": "可分細胞性（cellular）和纖維化（fibrosing）兩種型態", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "可分細胞性（cellular）和纖維化（fibrosing）兩種型態", "B": "時間異質性（temporal heterogeneity）明顯", "C": "可見纖維母細胞增生病灶（fibroblastic focus）", "D": "可見蜂巢狀纖維化（honeycomb fibrosis）", "language": "tw"}
{"question": "承上題，若病患請教醫師對其該腎臟腫瘤處置之見解時，則會建議：", "answer": "應為良性腫瘤，但當有症狀或體積超過 4 公分時再進行手術", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "應為良性腫瘤，不論大小都不必理會", "B": "應為良性腫瘤，但當有症狀或體積超過 4 公分時再進行手術", "C": "應為惡性腫瘤，並建議立刻行腎臟切除手術", "D": "應為惡性腫瘤，但可行腎臟部分切除手術（nephron sparing surgery）即可", "language": "tw"}
{"question": "一位 19 歲大學男生，自小即患有突發性心悸。住院當中，病患突感心悸，你立即作了心電圖，從此心電圖的結果中，你認為病人的不整脈最可能為何？", "answer": "paroxysmal supraventricular tachycardia（PSVT）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "sinus tachycardia \t", "B": "atrial fibrillation with rapid ventricular response", "C": "paroxysmal supraventricular tachycardia（PSVT）", "D": "ventricular tachycardia（VT）", "language": "tw"}
{"question": "80.老王是退休的單身男性，78歲，有心臟病、高血壓、糖尿病，只有間斷服藥，在一家工廠擔任倉庫管理員，最近一年半來走路容易跌倒，因此住院檢查，發現罹患了小腦萎縮症，醫師也告之此病症的預後不佳，因此曾拜託老闆，如果有什麼重病突發時，不要再急救。他並且留下書面的不予急救（DNR）意願書。某日晚上，在大門值班時突然昏迷，緊急送往醫院急救，發現有左前腦及中腦動脈阻塞之大片梗塞，又病人的實 室檢查發現有慢性腎功能衰竭，宜進行透析治療。病人在急診處呼吸逐漸不規則，血中二氧化碳分壓升高。\n 如果不施行氣管插管，可能危及生命，則下列的處理何者最適切？\n", "answer": "只進行一般之支持療法，但不安排透析，也不進行氣管插管，以尊重病人的意願", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "請工廠負責人代為簽署同意書，進行氣管插管，因醫師以救命為第一職責", "B": "請醫院之警衛或社工人員當見證人簽同意書，進行氣管插管，因醫師以救命為第一職責", "C": "直接進行氣管插管，並安排腹膜透析", "D": "只進行一般之支持療法，但不安排透析，也不進行氣管插管，以尊重病人的意願", "language": "tw"}
{"question": "藥物在血漿中的濃度以\"一次級的動力學＂下降，則表示：", "answer": "大約等於其半衰期", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "只經由一種藥物的代謝途徑", "B": "大部份在肝臟中代謝", "C": "藥物只存在血液循環內", "D": "大約等於其半衰期", "language": "tw"}
{"question": "安非他命所引起的激動不安，要使用何種藥物治療？", "answer": "安神藥（benzodiazepines）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "安神藥（benzodiazepines）", "B": "抗精神病藥物（antipsychotics）", "C": "抗憂鬱劑（antidepressants）", "D": "情緒穩定劑（mood stablizers）", "language": "tw"}
{"question": "急性期的腦動脈瘤破裂合併蜘蛛網膜下腔出血，則下述何者是快速及確定診斷的檢查？", "answer": "電腦斷層血管掃描（CT angiography）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "核磁共振血管掃描（MR angiography）", "B": "電腦斷層血管掃描（CT angiography）", "C": "電腦斷層掃描（CT brain）", "D": "腰椎穿刺（lumbar puncture）", "language": "tw"}
{"question": "醫院策略性管理（strategic management）的意義，是在導引醫院依據內外在環境的變動，做出重大的變革。其首要工作是要確認醫院的：", "answer": "使命與目標", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "處境", "B": "使命與目標", "C": "策略選擇", "D": "策略執行評估", "language": "tw"}
{"question": "根據衛生福利部民國95年公告之「研究用人體檢體採集與使用注意事項」，有關「去連結」之定義，下列何者正確？", "answer": "於檢體編碼後，將代碼與檢體提供者可供辨識個人資訊之對照資料完全永久消除之作業方式", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "將檢體編碼，以代碼取代姓名或其他可供辨識個人資訊，致無法辨識檢體提供者之作業方式", "B": "於檢體編碼後，將代碼與檢體提供者可供辨識個人資訊之對照資料，和檢體分開保存之作業方式", "C": "於檢體編碼後，將代碼與檢體提供者可供辨識個人資訊之對照資料再編碼方式處理之作業方式", "D": "於檢體編碼後，將代碼與檢體提供者可供辨識個人資訊之對照資料完全永久消除之作業方式", "language": "tw"}
{"question": "當你接收到一位嚴重創傷已插有氣管內管插管（endotracheal tube）的轉診病人時，於下列所有情況都需懷疑有氣管插管誤入食道（esophageal intubation），那項除外？", "answer": "可見到氣管內管內有霧氣進出", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "end-tidal CO2值近乎零", "B": "擠甦醒球(bag-valve-mask)時聽不到呼吸聲", "C": "聽得見胃有雜聲（borborygmus）", "D": "可見到氣管內管內有霧氣進出", "language": "tw"}
{"question": "承上題，為了要確定診斷，有各種方式可用，但下列何者錯誤？", "answer": "人工關節手術後第三天，其 d-dimer test 結果若為陽性，有百分之九十的機會可以排除此診斷", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "人工關節手術後第三天，其 d-dimer test 結果若為陽性，有百分之九十的機會可以排除此診斷", "B": "人工關節手術後第三天，Homans' sign 陰性，也不能排除此診斷", "C": "血管攝影雖比較具侵襲性，但卻是最正確的診斷方式", "D": "超音波及都卜勒（duplex）檢查最方便且無侵襲性，但正確度和操作者經驗有關", "language": "tw"}
{"question": "承上題，為防止這類病人的肌肉萎縮，下列何種復健治療最合適？", "answer": "功能性電刺激（functional electrical stimulation）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "功能性電刺激（functional electrical stimulation）", "B": "經皮神經電刺激（transcutaneous electrical nerve stimulation）", "C": "低能量雷射治療（low level laser therapy）", "D": "超音波熱療法（ultrasound diathermy）", "language": "tw"}
{"question": "如眼底視網膜照片所示，此位患者最可能之診斷為何？", "answer": "糖尿病視網膜病變 \t", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "糖尿病視網膜病變 \t", "B": "急性視網膜中心動脈阻塞", "C": "急性視網膜中心靜脈阻塞", "D": "早產兒視網膜病變", "language": "tw"}
{"question": "使用下列那一類治療憂鬱症的藥物時，必須限制含乳酪食品的攝取，否則會引起血壓上升的危險？", "answer": "Tranylcypromine", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "Fluoxetine", "B": "Imipramine", "C": "Bupropion", "D": "Tranylcypromine", "language": "tw"}
{"question": "下列何者不是引起術後 Hypoventilation 常見的原因？", "answer": "Hyperkalemia \t", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "Hyperkalemia \t", "B": "Hypothermia", "C": "使用 Opioids \t", "D": "使用 Neuromuscular blocking agents", "language": "tw"}
{"question": "下列有關膿胸（empyema thoracis）之敘述，何者錯誤？", "answer": "診斷依據為胸水檢驗中，白血球數目超過 2500/mm3 \t", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "診斷依據為胸水檢驗中，白血球數目超過 2500/mm3 \t", "B": "常見的致病菌包括 Streptococcus、Anaerobes、Klebsiella spp.", "C": "常見的症狀為胸痛、發燒", "D": "胸管引流與合宜的抗生素使用，為主要的治療方式", "language": "tw"}
{"question": "下列何者不屬於椎前交感神經節？", "answer": "腰交感神經節（Lumbar sympathetic ganglia）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "腹腔神經節（Celiac ganglia）", "B": "腸繫膜上神經節（Superior mesenteric ganglia）", "C": "腸繫膜下神經節（Inferior mesenteric ganglia）", "D": "腰交感神經節（Lumbar sympathetic ganglia）", "language": "tw"}
{"question": "在長期無法進食之受傷病人，其體內營養之補充途徑，已經證明以腸道營養（enteral nutrition）優於非腸道營養（parenteral nutrition），下列原因何者錯誤？", "answer": "易引發吸入性肺炎（aspiration pneumonia）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "價格較低 \t", "B": "合併症較少", "C": "腸道黏膜（intestinal mucosa）較不易萎縮", "D": "易引發吸入性肺炎（aspiration pneumonia）", "language": "tw"}
{"question": "1 歲 5 個月的男童因為高燒不退 5 天，躁動不安及不愛動左腳，被帶至急診室評估，身體診察發現左膝紅腫合併壓痛及關節活動受限，下列何者是最重要的檢查來確診敗血性關節炎（septic arthritis）？", "answer": "左膝關節液檢查（Gram stain and culture）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "左膝關節 X 光", "B": "紅血球沉降速率（ESR）", "C": "左膝關節液檢查（Gram stain and culture）", "D": "血球計數及分類", "language": "tw"}
{"question": "下列何者為已開發國家，50 歲以上造成不可逆視力喪失最常見之原因？", "answer": "視網膜黃斑部退化", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "視網膜黃斑部退化", "B": "白內障", "C": "青光眼", "D": "視網膜剝離", "language": "tw"}
{"question": "下列何者未矯正，是引起所謂的經線性（Meridional）弱視的原因？", "answer": "散光（Astigmatism）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "不等視（Anisometropic）", "B": "散光（Astigmatism）", "C": "遠視（Hypermetropia）", "D": "上斜視（Hypertropia）", "language": "tw"}
{"question": "臀上動脈（superior gluteal artery）發生阻塞，下列何者最不受影響？", "answer": "上孖肌（superior gemellus muscle）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "臀大肌（gluteus maximus muscle）", "B": "臀小肌（gluteus minimus muscle）", "C": "梨狀肌（piriformis muscle）", "D": "上孖肌（superior gemellus muscle）", "language": "tw"}
{"question": "下列何種指標與腦傷（traumatic brain injury）病人的預後關聯性最低？", "answer": "腦傷後癲癇（seizure）發生頻率", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "腦傷後癲癇（seizure）發生頻率", "B": "格拉司哥昏迷指數（Glasgow coma scale）", "C": "腦傷後失憶症（amnesia）時間的長短", "D": "腦傷造成意識失常（comatose）時間的長短", "language": "tw"}
{"question": "下列有關藥品安全監視的項目，屬於我國獨有而一般醫藥先進國家比較不常監視者？", "answer": "中藥摻西藥的監視 \t", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "中藥摻西藥的監視 \t", "B": "疫苗副作用的監視", "C": "新藥安全的監視 \t", "D": "偶發藥品品質安全副作用事件的監視", "language": "tw"}
{"question": "你正面對一位剛被診斷有第二型糖尿病的62歲女性，她懷疑自己也有骨質健康的問題，下列何者最能正確說明糖尿病和骨鬆症的相關性？", "answer": "第二型糖尿病患者相對於第一型糖尿病患者有較高的骨質密度", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "第二型糖尿病患者相對於第一型糖尿病患者有較高的骨質密度", "B": "第二型糖尿病患相對於一般人較少發生骨折", "C": "第二型糖尿病患相對於第一型糖尿病患有較高的骨折風險", "D": "血糖控制不良會降低骨質密度", "language": "tw"}
{"question": "下列有關惡性高溫（malignant hyperthermia）的敘述，何者錯誤？", "answer": "主要因為肌肉無法進行收縮作用", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "與鈣離子的 homeostasis 失調有關", "B": "可能與 ryanodine receptor 蛋白的基因缺損有關", "C": "可能與肌漿網（sarcoplasmic reticulum）受器蛋白的基因缺損有關", "D": "主要因為肌肉無法進行收縮作用", "language": "tw"}
{"question": "下列那項肺臟疾病，最有可能出現嗜中性白血球滲出物？", "answer": "細菌性肺炎", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "病毒性肺炎", "B": "肺氣喘", "C": "細菌性肺炎", "D": "肺癌", "language": "tw"}
{"question": "下列何者為嬰兒感染先天性德國麻疹（congenital rubella）後，最常合併之心臟病？", "answer": "開放性動脈導管（patent ductus arteriosus）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "心室中隔缺損（ventricular septal defect）", "B": "心房中隔缺損（atrial septal defect）", "C": "法洛式四合症（tetralogy of Fallot）", "D": "開放性動脈導管（patent ductus arteriosus）", "language": "tw"}
{"question": "有關 Achalasia 與 Pseudoachalasia 之敘述，何者錯誤？", "answer": "大部分 Achalasia 於內視鏡下，可發現食道黏膜之破壞與病變", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "Achalasia 起於食道蠕動功能不足 \t", "B": "Pseudoachalasia 起於 GE junction 附近的腫瘤壓迫", "C": "大部分 Achalasia 於內視鏡下，可發現食道黏膜之破壞與病變", "D": "兩者皆可發現食道擴張的現象", "language": "tw"}
{"question": "下列有關注意力缺損過動症（attention-deficit/hyperactivity disorder, ADHD）的敘述，何者錯誤？", "answer": "第一線治療為行為治療", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "第一線治療為行為治療", "B": "3 歲之前很難診斷注意力缺損過動症，因正常小孩也可能有相同行為", "C": "約一半的人到青春期或成人仍有症狀", "D": "第一線藥物治療為中樞神經刺激劑（stimulant），其主要副作用為食慾降低及失眠", "language": "tw"}
{"question": "38歲女性，到婦產門診就診，主訴有下列典型症狀 dysuria、dribbling、dyspareunia，同時臨床骨盆檢查發現前陰道壁有一腫塊，下列何者被公認為最佳診斷之影像工具？", "answer": "核磁共振（magnetic resonance imaging）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "靜脈腎盂攝影（intravenous pyelography）", "B": "解尿膀胱尿道攝影（voiding cystourethrography）", "C": "腎臟輸尿管膀胱攝影（kidney, ureter, bladder, KUB）", "D": "核磁共振（magnetic resonance imaging）", "language": "tw"}
{"question": "下列何者不是評估健康服務的指標？", "answer": "ethnicity", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "efficacy", "B": "ethnicity", "C": "effectiveness", "D": "efficiency", "language": "tw"}
{"question": "有關「失用症」（apraxia）的敘述，下列何者最為正確？", "answer": "言語功能也可能發生失用症", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "言語功能也可能發生失用症", "B": "病人因不了解指令所以無法執行動作", "C": "病人多伴有感覺神經功能缺失", "D": "多因小腦受傷引起", "language": "tw"}
{"question": "EB病毒（Epstein-Barr virus）主要感染B淋巴球；它是以該細胞表面的何種分子為受體（receptor）？", "answer": "CR2", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "CR2", "B": "CD4", "C": "CD8", "D": "醣蛋白（glycoprotein）", "language": "tw"}
{"question": "關於真核細胞蛋白質合成的啟始階段（initiation stage），下列敘述何者錯誤？", "answer": "核糖體的大與小兩個次單元（large and small subunits）必須形成完整的核糖體（ribosome）才能與mRNA結", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "需要mRNA、核糖體（ribosome）與aminoacyl-tRNA的參與", "B": "mRNA必須具有5'端帽結構（5'cap structure）或internal ribosome entry site（IRES）才能參與啟始作用", "C": "核糖體的大與小兩個次單元（large and small subunits）必須形成完整的核糖體（ribosome）才能與mRNA結", "D": "啟始階段需要的aminoacyl-tRNA是Met-tRNAiMet", "language": "tw"}
{"question": "T細胞受器多樣化（T cell receptor diversity）之原因很多，但不包含下列那一項？", "answer": "N-核苷酸添加（N-nucleotides addition）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "V", "B": "J基因片段連接[V", "C": "J gene segments joining]", "D": "N-核苷酸添加（N-nucleotides addition）", "language": "tw"}
{"question": "一位 28 歲女性，已婚但多年未生育，最近月經疼痛惡化，超音波檢查發現卵巢附近有一個囊腫，最可能的原因是：", "answer": "子宮內膜異位症", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "骨盆腔發炎", "B": "子宮內膜異位症", "C": "子宮肌瘤", "D": "子宮內膜癌", "language": "tw"}
{"question": "張先生因罹患大腸癌而來找此方面權威的邢主任看診，邢主任決定為張先生開刀治療。在手術前邢主任和張先生一番寒暄鼓勵，在麻醉生效後邢主任便將手術交給資深住院醫師執行，自己先行離去，直到最後才進開刀房將大腸癌段摘除，病患完全不知情，只聽邢主任說手術過程順利。有關邢主任的作為，下列那一個敘述最為恰當？", "answer": "應於術前向張先生說明參與手術的是那一些人，並告知他在適當的情況下會教導資深住院醫師開刀的技術", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "是一位好的老師，給予年輕醫師如此的磨練機會以獲取更多的經驗，用心良苦", "B": "工作負荷重，需要用這段時間做行政、教學及研究工作，情有可原", "C": "應全程參與開刀並親自執刀，只讓資深住院醫師縫合皮膚", "D": "應於術前向張先生說明參與手術的是那一些人，並告知他在適當的情況下會教導資深住院醫師開刀的技術", "language": "tw"}
{"question": "下列風濕病主要侵犯的組織之解剖構造（anatomic structures）之配對中，那一項錯誤？", "answer": "Ankylosing spondylitis；bony end plate", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "Rheumatoid arthritis；synovium", "B": "Ankylosing spondylitis；bony end plate", "C": "Osteoarthritis；cartilage", "D": "Gout；joint space 31 \t下列有關 Henoch-Schönlein purpura 的敘述，何者最不正確？", "language": "tw"}
{"question": "49 某日，一位 69 歲女性 A 在健身俱樂部被游泳池員工帶往服務台，建議 A 的先生帶 A 到醫院檢查。原來，A 不斷地問同樣的問題「我現在在那裡？我在做什麼？」很快地，他們來到醫學中心急診部，病人血壓偏高，意識清楚，手腳活動與感覺正常，步態平穩。54 小時後安排了 Brain MRI 結果如下， A 有可能的狀況為： \n", "answer": "暫時性失憶症（transient global amnesia）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "暫時性失憶症（transient global amnesia）", "B": "阿茲海默症（Alzheimer disease）", "C": "失憶性中風（amnestic stroke）", "D": "癲癇發作（epileptic seizures）", "language": "tw"}
{"question": "一位 50 歲已婚女性，主訴 1 個月以來，有失眠、疲倦、胃口不佳、便秘、體重下降、胸悶等症狀，懷疑自己可能有重大身體疾病，曾看過胃腸科、心臟科、家醫科。檢查均屬正常，最後被轉介到精神科治療，經詢問病史發現：病患有嚴重情緒低落及毫無生活情趣並有自殺想法。以上這些症狀在過去二年以來均持續存在，只是過去程度較輕，此次發作乃因股票暴跌所導致。您的診斷最可能是：", "answer": "重疊性憂鬱症（double depression）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "輕鬱症（dysthymic disorder）", "B": "重鬱症（major depression disorder）", "C": "重疊性憂鬱症（double depression）", "D": "雙極型情感性疾病（bipolar disorder）", "language": "tw"}
{"question": "一位 36 歲婦女因發燒倦怠及手部多處關節炎而住院，理學檢查有貧血、口腔有潰瘍、背部有多處紅斑、兩手關節有多處腫脹及壓痛感覺，實驗室檢查白血球 2,100/mm3（淋巴球占 40%、中性白血球占 57%）、血紅素（Hgb）10.5 gm/dL、紅血球沈降速度（ESR）92 mm/hr、24 小時尿蛋白為 1.2 gm，下列那一項檢查對診斷此病最重要？", "answer": "抗核抗體（ANA）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "C-反應蛋白（CRP）", "B": "抗核抗體（ANA）", "C": "血清免疫球蛋白", "D": "全身電腦斷層掃描檢查", "language": "tw"}
{"question": "下列何者不是正常老年人在泌尿功能上因老化造成的影響？", "answer": "未抑制之膀胱逼尿肌收縮（uninhibited detrusor contraction）增加", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "膀胱容量變小", "B": "尿流速率變慢", "C": "最大尿道閉鎖壓（maximal urethral closure pressure）降低", "D": "未抑制之膀胱逼尿肌收縮（uninhibited detrusor contraction）增加", "language": "tw"}
{"question": "壓力（stress）會促使內分泌系統那一個軸線（axis）活化？", "answer": "下視丘－腦下腺－腎上腺皮質", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "下視丘－腦下腺－睪丸", "B": "下視丘－腦下腺－卵巢", "C": "下視丘－腦下腺－甲狀腺", "D": "下視丘－腦下腺－腎上腺皮質", "language": "tw"}
{"question": "下列何者不是脫離呼吸器（weaning from ventilator）的條件？", "answer": "每分鐘通氣量（minute ventilation）> 9 L / minute", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "呼吸速率 < 25 / minute", "B": "動脈血氧氣分壓（ PaO2）> 70 mmHg（FiO2 40%）", "C": "潮氣量（tidal volume）5～6 mL/kg", "D": "每分鐘通氣量（minute ventilation）> 9 L / minute", "language": "tw"}
{"question": "下列何種寄生蟲曾經廣泛流行於我國離島之金門及澎湖地區？", "answer": "班氏絲蟲（Wuchereria bancrofti）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "班氏絲蟲（Wuchereria bancrofti）", "B": "馬來亞絲蟲（Brugia malayi）", "C": "蟠尾絲蟲（Onchocerca volvulus）", "D": "羅阿絲蟲（Loa loa）", "language": "tw"}
{"question": "下列何項與胃幽門桿菌感染無關？", "answer": "胃賁門癌", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "胃炎", "B": "胃賁門癌", "C": "十二指腸潰瘍", "D": "胃 MALToma", "language": "tw"}
{"question": "一位 58 歲的女性病患每日規律運動，最近一個月注意到每天傍晚下肢就會出現水腫，早上起床時水腫會消失，門診的身體檢查發現頸靜脈壓力正常，心臟大小正常，心跳規律無雜音，兩側肺野呼吸音正常，兩側下肢有可凹陷水腫（pitting edema），則以下的檢查，對鑑別診斷價值最低的是：", "answer": "核子醫學左心室射出率（ejection fraction）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "BUN, creatinine \t", "B": "serum albumin", "C": "肝功能檢查（ALT, AST）", "D": "核子醫學左心室射出率（ejection fraction）", "language": "tw"}
{"question": "某抑制劑會使酵素反應的 Km上升，但是不影響 高反應速率（即 Vmax不變），此抑制劑應屬於下列何者？", "answer": "競爭型抑制劑（competitive inhibitor）", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "競爭型抑制劑（competitive inhibitor）", "B": "不競爭型抑制劑（uncompetitive inhibitor）", "C": "非競爭型抑制劑（noncompetitive inhibitor）", "D": "混合型抑制劑（mixed inhibitor）", "language": "tw"}
{"question": "91 李先生是一退休農耕隊隊員，早年曾派駐中南美洲等地。近日因胸悶、心悸、吞嚥困難及胃腸不適就醫。李先生陳述當年駐外住在茅草房時，半夜常被小蟲叮咬，以致睡眠品質不好，曾引發心臟病。 依此病史，叮咬李先生最可能的是下列何者？ \n", "answer": "錐鼻蟲（reduviid bug）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "白蛉子（sandfly） \t", "B": "采采蠅（tsetse fly）", "C": "錐鼻蟲（reduviid bug）", "D": "臭蟲（bedbug）", "language": "tw"}
{"question": "一位病人被發現有白血病，他的周邊血液及骨髓抹片中可看到很多不成熟的細胞（如圖所示）。這位病人的血球細胞內最可能出現那種染色體異常？", "answer": "t(15;17)", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "t(15;17)", "B": "t(9;22)", "C": "t(8;21)", "D": "t(4;11)", "language": "tw"}
{"question": "52 歲家庭主婦，主訴雙手指末端關節痛有 1 年，常在使用手工作後疼痛加劇，休息後會改善，理學檢查發現手指遠端指間關節（distal interphalangeal joints）皆有小結節，具壓痛感，此病人最有可能罹患的疾病為何？", "answer": "退化性關節炎 \t", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "退化性關節炎 \t", "B": "類風濕性關節炎", "C": "結晶沈積引發關節炎 \t", "D": "感染性關節炎", "language": "tw"}
{"question": "細胞內DNA複製過程中，為何需要RNA引子（primer）？", "answer": "提供DNA聚合酶合成反應所需要的3'-端羥基（OH）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "提供DNA聚合酶合成反應所需要的3'-端磷酸基", "B": "提供DNA聚合酶合成反應所需要的3'-端羥基（OH）", "C": "提供DNA聚合酶合成反應所需要的5'-端羥基（OH）", "D": "提供DNA聚合酶合成反應所需要的5'-端磷酸基", "language": "tw"}
{"question": "80.34歲的葉小姐是位老師，身體健康無特殊病史，近日因為右側鼠蹊部腫脹來門診，經診斷為腹股溝疝氣，醫師向葉小姐建議進行疝氣修補術治療，在解釋病情及手術細節後，葉小姐卻要求術後要補充白蛋白，因為她 聽說白蛋白對腹部手術術後恢復有幫助，但醫師的專業判斷認為並不需要，此情境下，如何處理較適當？\n", "answer": "經過專業判斷不需要補充白蛋白，與病人多溝通後婉拒病人的要求，不給與術後白蛋白補充", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "經過專業判斷不需要補充白蛋白，與病人多溝通後婉拒病人的要求，不給與術後白蛋白補充", "B": "答應病人補充白蛋白，且以健保支付", "C": "即使判斷補充白蛋白不是恰當的醫療處置，但是病人要求了，補充之也無傷大雅", "D": "補充白蛋白是醫療專業判斷，由醫師決定即可，不需再與病人溝通", "language": "tw"}
{"question": "5 下列何種先天構造異常之新生兒會在安靜時呈現呼吸窘迫及發紺（cyanosis）的症狀，而張口大哭之 後發紺情況則得以緩解？\n", "answer": "雙側後鼻孔閉鎖（bilateral choanal atresia）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "先天性橫膈疝氣（congenital diaphragmatic hernia）", "B": "氣管食道瘻管（tracheo-esophageal fistula）", "C": "皮耳羅賓症候群（Piérre-Robin syndrome）", "D": "雙側後鼻孔閉鎖（bilateral choanal atresia）", "language": "tw"}
{"question": "大多數先天性代謝異常疾病（Inborn errors of metabolism）的遺傳模式（Mode of inheritance）為Autosomal recessive，下列何種代謝異常除外？", "answer": "Ornithine transcarbamylase deficiency（OTC deficiency）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "Phenylketonuria（PKU）", "B": "Ornithine transcarbamylase deficiency（OTC deficiency）", "C": "Methylmalonic acidemia（MMA）", "D": "Maple syrup urine disease（MSUD）", "language": "tw"}
{"question": "有關nesiritide用於治療急性代償性功能失常之心衰竭病人之藥理作用敘述，下列何者錯誤？", "answer": "使cyclic AMP增加", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "使cyclic AMP增加", "B": "活化brain natriuretic peptide（BNP）receptor", "C": "使血管放鬆", "D": "產生利尿作用", "language": "tw"}
{"question": "何種功能性腦下垂體腫瘤，對口服藥物治療反應最好，包括激素降低及腦瘤體積縮小？", "answer": "泌乳素瘤（prolactinoma）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "肢端肥大症（acromegaly）", "B": "庫欣氏症（Cushing's disease）", "C": "泌乳素瘤（prolactinoma）", "D": "甲促素分泌瘤（TSH-secreting adenoma）", "language": "tw"}
{"question": "雙眼外側視野二分之一缺損（bilateral temporal hemianopia），最可能的損傷部位是：", "answer": "視交叉（optic chiasm）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "視神經（optic nerve）", "B": "外側膝狀體（lateral geniculate body）", "C": "視徑（optic tract） \t", "D": "視交叉（optic chiasm）", "language": "tw"}
{"question": "下列那一種感染症最易於組織中見到厚壁、棕色之硬化體（sclerotic bodies）？", "answer": "產色芽生黴菌症（Chromoblastomycosis）", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "黑癬（Tinea nigra）", "B": "孢子絲菌病（Sporotrichosis）", "C": "產色芽生黴菌症（Chromoblastomycosis）", "D": "皮下黑化真菌病（Subcutaneous phaeohyphomycosis）", "language": "tw"}
{"question": "一位 18 歲男孩，患有腎病症候群，雙手掌心被發現有 discoid-like 的皮疹並有脫皮如下圖，腎臟切片檢查結果為 membranous nephropathy，下列那一項感染是最可能的診斷？", "answer": "梅毒（syphilis）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "B 型肝炎（hepatitis B）", "B": "巨細胞病毒（cytomegalovirus）感染", "C": "鉤端螺旋體症（Leptospirosis）", "D": "梅毒（syphilis）", "language": "tw"}
{"question": "麻醉風險之評估系統，現行的方法叫：", "answer": "ASA physical status classification", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "APACHE \t", "B": "ASA physical status classification", "C": "Apgar score \t", "D": "RISK", "language": "tw"}
{"question": "大腸內容物中最常見的 aerobic bacteria 是下列何者？", "answer": "Escherichia coli", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "Enterococcus", "B": "Proteus", "C": "Escherichia coli", "D": "Pseudomonas", "language": "tw"}
{"question": "喉返神經（recurrent laryngeal nerve）受傷切斷時，何者錯誤？", "answer": "不宜縫補受傷之神經", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "聲帶麻痺，處於近中央位置（paramedian）", "B": "聲音沙啞", "C": "不宜縫補受傷之神經", "D": "環狀甲狀腺肌肉（cricothyroid muscle）不會麻痺", "language": "tw"}
{"question": "一位 20 歲的年輕人發生車禍，造成肩胛骨翼狀外翻（scapular winging），下列敘述何者錯誤？", "answer": "大多為肩胛下肌（subscapularis）無力所致", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "可能因背肩胛神經（dorsal scapular nerve）受損所致", "B": "大多為前鋸肌（serratus anterior muscle）無力所致", "C": "大多為肩胛下肌（subscapularis）無力所致", "D": "大多為長胸神經（long thoracic nerve）受損所致", "language": "tw"}
{"question": "10 一位 28 歲男性病人的血壓值為：右上肢血壓 200/120 mmHg，左上肢血壓 190/115 mmHg，下肢 膝窩動脈（popliteal artery）血壓 110/60 mmHg，上背部有收縮期雜音，下列何者為最可能的診斷？ \n", "answer": "原發性高血壓（essential hypertension）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "腎動脈狹窄（renal artery stenosis）", "B": "原發性高血壓（essential hypertension）", "C": "主動脈縮窄（coarctation of aorta）", "D": "嗜鉻細胞瘤（pheochromocytoma）", "language": "tw"}
{"question": "18.巨噬細胞（macrophage）和嗜中性球（neutrophil）是體內最主要的吞噬細胞，它們都具有吞噬 （phagocytosis）並殺死病原的能⼒，有關這兩群細胞的敘述何者錯誤？\n", "answer": "這兩群細胞在受到細菌刺激後都會進⾏所謂的呼吸爆發（respiratory burst）的現象，這是因為胞內酵素的", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "當嗜中性球被細菌活化後，會進⾏⼀種特殊的細胞死亡的過程，把核內的染⾊質（chromatin）釋放到細胞", "B": "這兩群細胞在受到細菌刺激後都會進⾏所謂的呼吸爆發（respiratory burst）的現象，這是因為胞內酵素的", "C": "巨噬細胞在各個器官及組織都存在，比如在肝臟的庫⽒細胞（Kupffer cell）及神經組織中的⼩神經膠質細", "D": "如果NADPH氧化酶（oxidase）的基因發⽣突變⽽失去功能，會導致這兩群主要的吞噬細胞不能有效地殺", "language": "tw"}
{"question": "下列那一類壞死最常見於心臟的缺血性傷害？", "answer": "凝固性壞死", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "液化性壞死", "B": "凝固性壞死", "C": "乾酪狀壞死", "D": "脂肪壞死", "language": "tw"}
{"question": "您至隔壁病房協助一位猝死病患的急救，根據2010年心肺復甦術指引，下列何者錯誤？", "answer": "使用進階呼吸道（advanced airway）裝置人工通氣（ventilation）時，成人每6至8秒吹氣一次，與胸部按壓同步進行", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "若需檢查脈搏，不超過10秒鐘", "B": "避免中斷胸部按壓，如有需要中斷，不超過10秒鐘", "C": "使用進階呼吸道（advanced airway）裝置人工通氣（ventilation）時，成人每6至8秒吹氣一次，與胸部按壓同步進行", "D": "若需實施去顫電擊，在每次電擊後立即實施胸部按壓", "language": "tw"}
{"question": "下列女性均為 35 歲，何者最容易罹患子宮內膜癌？", "answer": "患有多囊性卵巢症候群（polycystic ovarian syndrome）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "青少年期卵巢便已切除", "B": "卵巢發育不全（ovarian agenesis）", "C": "曾經多次生育", "D": "患有多囊性卵巢症候群（polycystic ovarian syndrome）", "language": "tw"}
{"question": "病人車禍瀕臨死亡，他已簽署器官捐贈同意書，其所捐贈的器官該分配給那位受贈者，是應依據下列何醫學倫理原則？", "answer": "正義原則（justice）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "行善原則（beneficence）", "B": "尊重自主原則（respect for autonomy）", "C": "不傷害原則（non-maleficence）", "D": "正義原則（justice）", "language": "tw"}
{"question": "2個月大的女嬰，因為最近一個月餵食越來越困難而住院，身體診察發現神智清楚，低肌肉張力，四肢無力，無深部肌腱反應，腹式呼吸以及舌頭顫動（fasciculation）。最可能的診斷是：", "answer": "脊髓肌肉萎縮症（spinal muscular atrophy）", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "缺氧缺血性腦病變（hypoxic ischemic encephalopathy）", "B": "脊髓肌肉萎縮症（spinal muscular atrophy）", "C": "先天性重症肌無力（congenital myasthenia gravis）", "D": "先天性肌肉失養症（congenital muscular dystrophy）", "language": "tw"}
{"question": "一名 72 歲男性因猝死接受病理解剖。顯微鏡下檢查發現在胃部黏膜、腎臟間質、肺臟肺泡壁及動脈旁皆有形態不一、非結晶性鈣鹽沈積。下列何種情況最能解釋上述變化？", "answer": "末期腎疾病", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "正常老化過程", "B": "末期腎疾病", "C": "全身性結核菌感染", "D": "動脈硬化症", "language": "tw"}
{"question": "primary hyperparathyroidism造成的併發症中，下列何者無關？", "answer": "tetany", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "osteoporosis, osteopenia", "B": "tetany", "C": "depression, anxiety", "D": "kidney stone", "language": "tw"}
{"question": "林醫師最近亟需發表學術論文，於是想找高中同學陳教授合作，陳教授任職醫學院的基礎醫學學科，林醫師說他作癌症手術時，會取下病人的組織，而且為了有安全範圍，都會多取一些周邊的正常組織，他可以提供這些組織來作研究，陳教授很有意願合作，不過擔心是否要取得病人同意，林醫師說又不會有人知道，不用取得病人同意，這樣的說法對嗎？", "answer": "不對，因為我國目前對於以剩餘檢體供研究使用規定需要取得病人同意", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "對，因為我國目前對於以剩餘檢體供研究使用並無特殊規定", "B": "對，因為這是促進科學進步", "C": "不對，因為我國目前對於以剩餘檢體供研究使用規定需要取得病人同意", "D": "不對，因為我國目前規定不能以剩餘檢體供研究使用", "language": "tw"}
{"question": "Cardiac tropnin T，α-tropomyosin，myosin-binding protein C，β-myosin heavy chain 等基因突變與下列何種心肌症（cardiomyopathy）最有關？", "answer": "hypertrophic type", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "restrictive type", "B": "hypertrophic type", "C": "dilated type", "D": "mixed type", "language": "tw"}
{"question": "下列何者受損，最可能造成前臂（forearm）無法伸直（extension）？", "answer": "橈神經（radial nerve）", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "肌皮神經（musculocutaneous nerve）", "B": "正中神經（median nerve）", "C": "尺神經（ulnar nerve）", "D": "橈神經（radial nerve）", "language": "tw"}
{"question": "關於細菌基因傳遞的敘述，下列何者錯誤？", "answer": "Plasmid 不能經由 conjugation 傳遞", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "Conjugation 是由細菌與細菌接觸進行", "B": "Plasmid 不能經由 conjugation 傳遞", "C": "在某些細菌是可直接將外來 DNA 帶入菌體內", "D": "Transduction 通常由噬菌體造成", "language": "tw"}
{"question": "下列何種non-steroidal anti-inflammatory drugs (NSAIDs)藥物，同時具有抑制cyclooxygenase和lipoxygenase的作用？", "answer": "ketoprofen", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "aspirin", "B": "etodolac", "C": "ketoprofen", "D": "naproxen", "language": "tw"}
{"question": "大多數女童，最先出現的青春期發育表徵（visible sign of puberty）為：", "answer": "乳房發育", "meta_info": "taiwanese_test_Q", "answer_idx": "A", "A": "乳房發育", "B": "陰毛發育", "C": "腋毛發育", "D": "初經", "language": "tw"}
{"question": "下列何者不是妄想症（delusional disorder）發病之危險因子？", "answer": "移民經過數代後 \t", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "耳聾或視力衰退 \t", "B": "社會孤立", "C": "移民經過數代後 \t", "D": "社會經濟剝奪", "language": "tw"}
{"question": "以帕金森氏病症狀與自主神經障礙為主要表現的神經症候群為：", "answer": "Shy-Drager syndrome", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "Wernicke-Korsakoff syndrome", "B": "Shy-Drager syndrome", "C": "acquired immunodeficiency syndrome", "D": "Guillain-Barré syndrome", "language": "tw"}
{"question": "位於腸道底層免疫組織中之M細胞的主要免疫功能為：", "answer": "捕捉及轉運腸道中的抗原至下層的淋巴組織", "meta_info": "taiwanese_test_Q", "answer_idx": "C", "A": "直接殺菌", "B": "製造抗體", "C": "捕捉及轉運腸道中的抗原至下層的淋巴組織", "D": "保護周邊的腸道表皮細胞", "language": "tw"}
{"question": "謝小姐，25 歲，至門診主訴最近體重增加，希望能減重。經理學檢查及病史詢問後，資料如下：身高 160 cm，體重 64 kg，腰圍 76.5 cm，臀圍 80.5 cm，最近一年體重增加約 5 kg，月經規則。血壓 138/88 mmHg，心跳 76/min，其他無明顯異常。依行政院衛生署之體位標準，請問下列的評估及治療方式何者較適當？", "answer": "屬體重過重，並無中央性肥胖，應先予以飲食指導及運動諮詢", "meta_info": "taiwanese_test_Q", "answer_idx": "D", "A": "屬重度肥胖，應馬上予以減重手術治療", "B": "屬中度肥胖，且為中央性肥胖，應馬上給予藥物治療", "C": "屬輕度肥胖，應給予適當的飲食控制及運動治療，並輔以藥物治療", "D": "屬體重過重，並無中央性肥胖，應先予以飲食指導及運動諮詢", "language": "tw"}
{"question": "下列有關多發性骨髓瘤（Multiple myeloma），何者正確？", "answer": "常引起蝕骨性病灶", "meta_info": "taiwanese_test_Q", "answer_idx": "B", "A": "常好發於 45 歲以下的成年人", "B": "常引起蝕骨性病灶", "C": "發生率占原發性骨骼惡性腫瘤的第三位", "D": "好發部位包括脊椎、腓骨、手指骨及顱骨", "language": "tw"}
{"question": "男，50岁。吃海鲜后夜间突发左足第一跖趾关节剧烈疼痛1天。查体：关节局部红肿，", "answer": "非甾体抗炎药", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "苯溴马隆", "B": "抗生素", "C": "非甾体抗炎药", "D": "甲氟蝶呤", "language": "zh"}
{"question": "关于肽聚糖不正确的是（　　）。", "answer": "为真核细胞所特有", "meta_info": "医学微生物学", "answer_idx": "B", "A": "是G+和G-菌的共有组分", "B": "为真核细胞所特有", "C": "占G-菌细胞壁干重的5%～20%", "D": "G-菌的肽聚糖由聚糖骨架和四肽侧链组成", "language": "zh"}
{"question": "下列关于意志说法错误的是（　　）。", "answer": "意志是绝对自由的", "meta_info": "医学心理学", "answer_idx": "C", "A": "克服困难是意志行动的核心", "B": "目的是意志行动的前提", "C": "意志是绝对自由的", "D": "意志是自觉地确定目的", "language": "zh"}
{"question": "关于良、恶性肿瘤的区别，下列哪项错误？（　　）", "answer": "良性肿瘤异型性大，恶性肿瘤异型性小", "meta_info": "病理学", "answer_idx": "C", "A": "良性肿瘤生长慢，恶性肿瘤生长快", "B": "良性肿瘤不转移，恶性肿瘤转移", "C": "良性肿瘤异型性大，恶性肿瘤异型性小", "D": "良性肿瘤无病理核分裂象，恶性肿瘤可见病理核分裂象", "language": "zh"}
{"question": "4．对D群结核分枝杆菌最敏感的抗结核药物是（　　）。", "answer": "以上都不正确", "meta_info": "第1篇　呼吸系统", "answer_idx": "C", "A": "利福平", "B": "吡嗪酰胺", "C": "以上都不正确", "D": "以上均正确", "language": "zh"}
{"question": "某糖代谢途径终产物有磷酸己糖，也有CO2；虽有脱氢氧化，但不产生NADH+H+，一般也不产生ATP；其中间产物有的参与核苷酸合成，有的参与脂类合成。该代谢途径是（　　）。", "answer": "磷酸戊糖途径", "meta_info": "生物化学", "answer_idx": "B", "A": "糖有氧氧化", "B": "磷酸戊糖途径", "C": "糖异生", "D": "糖原分解", "language": "zh"}
{"question": "女性，30岁，头部受伤后昏迷半小时，清醒后左侧肢体力弱，腰穿见血性脑脊液，以后逐渐好转，最可能为（　　）。", "answer": "脑挫伤", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "急性硬膜外血肿", "B": "脑挫伤", "C": "急性硬膜下血肿", "D": "脑内血肿", "language": "zh"}
{"question": "肱骨中下l／3骨折，最易发生的并发症是（　　）。", "answer": "桡神经损伤", "meta_info": "第四部分　运动系统疾病", "answer_idx": "B", "A": "肱动脉损伤", "B": "桡神经损伤", "C": "尺神经损伤", "D": "正中神经损伤", "language": "zh"}
{"question": "3．呼吸链多数成分位于（　　）。", "answer": "线粒体内膜", "meta_info": "生物化学", "answer_idx": "A", "A": "线粒体内膜", "B": "线粒体膜间腔", "C": "线粒体基质", "D": "线粒体内膜F1-F0复合体", "language": "zh"}
{"question": "18岁未婚女孩，2个月来感觉消瘦、乏力。1个月来发现腹部增大迅速，原来的裤子全穿不下，而且月经稀少半年。妇科检查：腹部增大如足月妊娠，叩诊不满意。肛查：子宫正常大小，其余触诊不清。为辨别巨大卵巢囊肿与腹水，下列哪种辅助检查方法不适宜？（　　）", "answer": "经腹壁穿刺检查", "meta_info": "第5篇　女性生殖系统", "answer_idx": "D", "A": "腹部X线平片", "B": "肿瘤标志物检查", "C": "CT检查", "D": "经腹壁穿刺检查", "language": "zh"}
{"question": "下列哪项是形成动脉血压的基本因素?（　　）", "answer": "心脏射血和外周阻力", "meta_info": "生理学", "answer_idx": "C", "A": "血管容量和血量", "B": "心脏射血和静脉回心血量", "C": "心脏射血和外周阻力", "D": "外周静脉压和静脉血流阻力", "language": "zh"}
{"question": "尿渗透压降低常见于（　　）。", "answer": "中枢性尿崩症", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "中枢性尿崩症", "B": "甲状腺功能亢进症", "C": "糖尿病", "D": "原发性醛固酮增多症", "language": "zh"}
{"question": "2．血管平滑肌松弛作用最强的钙拮抗药是（　　）。", "answer": "硝苯地平", "meta_info": "药理学", "answer_idx": "C", "A": "地尔硫卓", "B": "尼莫地平", "C": "硝苯地平", "D": "维拉帕米", "language": "zh"}
{"question": "下列情形中，属于医疗事故的是（　　）。", "answer": "医生对解剖关系辨认不清，误伤邻近重要器官，造成患者功能障碍", "meta_info": "卫生法规", "answer_idx": "A", "A": "医生对解剖关系辨认不清，误伤邻近重要器官，造成患者功能障碍", "B": "因患者体质特殊而发生难以防范的后果", "C": "诊疗护理存在过失，虽未造成死亡、残疾等身体损害，但延长了患者的治疗时间", "D": "无过错输血造成患者感染", "language": "zh"}
{"question": "患者男性，36岁，呕血不止，烦躁、出冷汗。曾有胃溃疡史，呕血的原因是（　　）。", "answer": "胃溃疡", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "胃溃疡", "B": "十二指肠球溃疡", "C": "胃癌", "D": "十二指肠球炎", "language": "zh"}
{"question": "碘解磷定解救有机磷农药中毒的药理学基础是（　　）。", "answer": "生成磷酰化碘解磷定", "meta_info": "第八部分　其他疾病", "answer_idx": "C", "A": "生成磷酰化胆碱酯酶", "B": "具有阿托品样作用", "C": "生成磷酰化碘解磷定", "D": "促进ACh重摄取", "language": "zh"}
{"question": "由A、G、C、U四种核苷酸能组成（　　）种密码子。", "answer": "64", "meta_info": "生物化学", "answer_idx": "C", "A": "16", "B": "32", "C": "64", "D": "61", "language": "zh"}
{"question": "1．洋地黄中毒所致室性心动过速首选（　　）。", "answer": "苯妥英钠", "meta_info": "第2篇　心血管系统", "answer_idx": "A", "A": "苯妥英钠", "B": "异搏定（维拉帕米）", "C": "胺碘酮", "D": "溴苄胺", "language": "zh"}
{"question": "1岁时头围、身高是（　　）。", "answer": "头围46cm；身高75cm", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "头围34cm；身高50cm", "B": "头围46cm；身高75cm", "C": "头围50cm；身高105cm", "D": "头围35cm；身高140cm", "language": "zh"}
{"question": "2．负强化（　　）。", "answer": "行为出现的频率增加，撤销负性强化物", "meta_info": "医学心理学", "answer_idx": "C", "A": "行为出现的频率增加，给予正性强化物", "B": "行为出现的频率增加，给予负性强化物", "C": "行为出现的频率增加，撤销负性强化物", "D": "行为出现的频率减少，给予负性强化物", "language": "zh"}
{"question": "不属于地塞米松药理作用的是（　　）。", "answer": "抑制体内环氧化酶", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "抑制毛细血管和成纤维细胞增生", "B": "增强机体对细胞内毒素的耐受力", "C": "抑制体内环氧化酶", "D": "稳定溶酶体膜", "language": "zh"}
{"question": "4．肠伤寒（　　）。", "answer": "溃疡长轴与肠轴平行", "meta_info": "病理学", "answer_idx": "A", "A": "溃疡长轴与肠轴平行", "B": "溃疡呈环形与肠轴垂直", "C": "溃疡呈地图状", "D": "溃疡边缘呈堤状隆起", "language": "zh"}
{"question": "1．能抵御化脓性细菌入侵的细胞为（　　）。", "answer": "中性粒细胞", "meta_info": "生理学", "answer_idx": "A", "A": "中性粒细胞", "B": "嗜碱粒细胞", "C": "嗜酸粒细胞", "D": "血小板", "language": "zh"}
{"question": "关于预防应用抗生素的指征，错误的是（　　）。", "answer": "65岁以上的患者", "meta_info": "第八部分　其他疾病", "answer_idx": "C", "A": "肠道手术", "B": "污染的创面行清创术", "C": "65岁以上的患者", "D": "切口邻近感染区域的手术", "language": "zh"}
{"question": "当需要补钾时，100ml液体中含钾量不能超过（　　）。", "answer": "3ml", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "3ml", "B": "4ml", "C": "6ml", "D": "7ml", "language": "zh"}
{"question": "混合微团成分中，不包括（　　）。", "answer": "三脂酰甘油", "meta_info": "生物化学", "answer_idx": "B", "A": "脂肪酸", "B": "三脂酰甘油", "C": "溶血磷脂", "D": "一脂酰甘油", "language": "zh"}
{"question": "1．可与核蛋白体50S亚基结合，抑制蛋白质合成的是（　　）。", "answer": "氯霉素", "meta_info": "生物化学", "answer_idx": "A", "A": "氯霉素", "B": "GTP酶", "C": "转肽酶", "D": "蛋白激酶", "language": "zh"}
{"question": "治疗胆绞痛应首选（　　）。", "answer": "阿托品+哌替啶", "meta_info": "药理学", "answer_idx": "C", "A": "阿托品", "B": "阿司匹林", "C": "阿托品+哌替啶", "D": "阿托品+阿司匹林", "language": "zh"}
{"question": "一小儿体重7kg，身高65cm，头围42cm，乳牙2枚，能独坐一会，不能听懂自己的名字，此小儿的年龄最可能是（　　）。", "answer": "6个月", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "9个月", "B": "8个月", "C": "6个月", "D": "5个月", "language": "zh"}
{"question": "2．上述哪项为医务人员的道德义务？（　　）", "answer": "对病人义务和对社会义务的统一", "meta_info": "医学伦理学", "answer_idx": "B", "A": "具有独立做出诊断和治疗的权利及特殊干涉权", "B": "对病人义务和对社会义务的统一", "C": "自主选择医院、医护人员", "D": "保持和恢复健康，积极配合医疗，支持医学科学研究", "language": "zh"}
{"question": "1．最易与输卵管妊娠破裂相混淆的疾病是（　　）。", "answer": "卵巢黄体破裂", "meta_info": "第5篇　女性生殖系统", "answer_idx": "D", "A": "急性阑尾炎", "B": "输卵管卵巢囊肿", "C": "稽留流产", "D": "卵巢黄体破裂", "language": "zh"}
{"question": "具有调理作用的是（　　）。", "answer": "抗体和补体", "meta_info": "医学免疫学", "answer_idx": "B", "A": "抗原和补体", "B": "抗体和补体", "C": "补体", "D": "抗体", "language": "zh"}
{"question": "女，17岁。因学习压力大，成绩下降，近1个月每天上学至校门口时感到紧张、害怕，发生喷射性呕吐，将早餐尽数呕吐出，消化科检查未发现异常，体重无明显下降，请病假在家时从不呕吐，进食亦无异常。该患者最可能的诊断是（　　）。", "answer": "特定恐惧症", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "应激相关障碍", "B": "神经性呕吐", "C": "特定恐惧症", "D": "社交恐惧症", "language": "zh"}
{"question": "慢性化脓性骨髓炎，如大部分病灶已愈合，只有小块死骨存在，死骨不大的应采取的治疗方法是（　　）。", "answer": "死骨摘除窦道刮除碟形手术", "meta_info": "第四部分　运动系统疾病", "answer_idx": "D", "A": "单纯窦道刮除术", "B": "切开引流术", "C": "单纯死骨摘除术", "D": "死骨摘除窦道刮除碟形手术", "language": "zh"}
{"question": "关于风湿热的预后下列哪一项不正确？（　　）", "answer": "伴发心包炎者预后良好", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "首次发作累及心脏者，预后较差", "B": "反复发作累及心脏者预后不良", "C": "并发心功能不全者预后不良", "D": "伴发心包炎者预后良好", "language": "zh"}
{"question": "有机磷杀虫药中毒的原理是（　　）。", "answer": "胆碱酯酶失活", "meta_info": "第八部分　其他疾病", "answer_idx": "A", "A": "胆碱酯酶失活", "B": "交感神经兴奋", "C": "胆碱酯酶活性增强", "D": "肝功能受损", "language": "zh"}
{"question": "血液中H＋浓度变化调节呼吸运动的主要刺激部位是（　　）。", "answer": "颈动脉体和主动脉体", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "颈动脉体和主动脉体", "B": "支气管壁内肺牵张感受器", "C": "肺毛细血管旁感受器", "D": "延髓腹侧面化学感受器", "language": "zh"}
{"question": "患者复视，查体右眼向外侧视受限，双瞳孔等大同圆，对光反射存在，病变位于（　　）。", "answer": "右外展神经", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "右动眼神经", "B": "右视神经", "C": "右外展神经", "D": "右三叉神经眼支", "language": "zh"}
{"question": "3．小儿神经系统发育的规律是（　　）。", "answer": "先快后慢", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "先快后慢", "B": "先达高峰后下降", "C": "先近端后远端", "D": "年龄越小发育越快", "language": "zh"}
{"question": "1．携带编码毒素的基因使无毒的白喉棒状杆菌产生白喉毒素（　　）。", "answer": "溶源性转换", "meta_info": "医学微生物学", "answer_idx": "C", "A": "接合", "B": "转化", "C": "溶源性转换", "D": "原生质体融合", "language": "zh"}
{"question": "3．青春期胸腺退化（　　）。", "answer": "生理性萎缩", "meta_info": "病理学", "answer_idx": "B", "A": "全身性萎缩", "B": "生理性萎缩", "C": "神经性萎缩", "D": "内分泌性萎缩", "language": "zh"}
{"question": "男性，3l岁。因失眠长期服药治疗，突然停药12h后，出现头痛、虚弱无力及肢体颤抖，所服药物最可能是（　　）。", "answer": "巴比妥类", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "巴比妥类", "B": "苯二氮类", "C": "吩噻嗪类", "D": "三环类抗抑郁药", "language": "zh"}
{"question": "5．逆行性疝（　　）。", "answer": "疝内容物为多个肠袢", "meta_info": "第3篇　消化系统", "answer_idx": "C", "A": "疝环位于腹壁下动脉的内侧", "B": "疝环位于腹壁下动脉的外侧", "C": "疝内容物为多个肠袢", "D": "疝囊位于股管内", "language": "zh"}
{"question": "当样本含量固定时，第一类错误α和第二类错误β的关系有（　　）。", "answer": "α愈大，β可能愈小", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "α＞β", "B": "α＜β", "C": "α愈大，β可能愈小", "D": "α＝β", "language": "zh"}
{"question": "某孕妇为Rh-，第一胎分娩Rh+胎儿，为防止再次妊娠的Rh+胎儿产生溶血症，应给Rh-母亲注射（　　）。", "answer": "抗Rh抗体", "meta_info": "医学免疫学", "answer_idx": "A", "A": "抗Rh抗体", "B": "Rh抗原", "C": "免疫增强剂", "D": "以上都不是", "language": "zh"}
{"question": "2．严重革兰阴性杆菌感染的首选药（　　）。", "answer": "庆大霉素", "meta_info": "药理学", "answer_idx": "D", "A": "妥布霉素", "B": "奈替米星", "C": "大观霉素", "D": "庆大霉素", "language": "zh"}
{"question": "女性，42岁，因皮肤紫癜入院，血小板计数65×109/L血块收缩不良，其血小板减少与下述哪一项无关？（　　）", "answer": "大量出血如月经过多，痔疮出血等", "meta_info": "第一部分　血液系统疾病", "answer_idx": "D", "A": "病毒感染", "B": "电离辐射", "C": "自身免疫性疾病如SLE", "D": "大量出血如月经过多，痔疮出血等", "language": "zh"}
{"question": "女性，27岁，皮肤反复出紫癜半年来诊。体检：巩膜无黄染，胸骨无压痛，肝脾未触及，血红蛋白100g/L，白细胞3.8×109/L，分类淋巴细胞占60%，中性粒细胞40%，血小板40×109/L，骨髓象增生活跃，粒系占28%，红系占10%，淋巴系占52%，成熟浆细胞7%，组织嗜碱细胞3%，巨核细胞2个，无病态造血，Ham试验（－），网织红细胞0.8%。2．治疗上应首选（　　）。", "answer": "雄性激素结合中医中药", "meta_info": "第一部分　血液系统疾病", "answer_idx": "C", "A": "糖皮质激素", "B": "脾切除", "C": "雄性激素结合中医中药", "D": "以上都不对", "language": "zh"}
{"question": "服务人员特别是护理人员最常见的安全事件是（　　）。", "answer": "锐器伤", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "化学伤害", "B": "锐器伤", "C": "生物伤害", "D": "中毒", "language": "zh"}
{"question": "引起过敏反应的主要血液成分是（　　）。", "answer": "血浆", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "红细胞", "B": "血浆", "C": "血小板", "D": "中性粒细胞", "language": "zh"}
{"question": "对确定结核分枝杆菌感染最有价值的检查是（　　）。", "answer": "痰结核杆菌培养", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "血清结核菌抗体", "B": "γ干扰素释放实验", "C": "痰结核杆菌培养", "D": "PPD试验", "language": "zh"}
{"question": "体液平衡中，细胞外液里最重要的阴离子是（　　）。", "answer": "Cl-", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "C", "A": "HCO3_", "B": "HPO4-", "C": "Cl-", "D": "蛋白质", "language": "zh"}
{"question": "食物特殊动力作用效应最大的食物是（　　）。", "answer": "蛋白质", "meta_info": "生理学", "answer_idx": "B", "A": "糖类", "B": "蛋白质", "C": "维生素", "D": "混合食物", "language": "zh"}
{"question": "2．氯丙嗪抗精神病作用机制是（　　）。", "answer": "阻断中枢多巴胺D2受体", "meta_info": "药理学", "answer_idx": "B", "A": "阻断中枢5-HT受体", "B": "阻断中枢多巴胺D2受体", "C": "抑制中枢PG合成", "D": "抑制外周PG合成", "language": "zh"}
{"question": "3．属于医师执业规则的是（　　）。", "answer": "医师应当使用经国家有关部门批准使用的药品、消毒药剂和医疗器械", "meta_info": "卫生法规", "answer_idx": "C", "A": "医师在执业活动中，人格尊严、人身安全不受侵犯", "B": "对医学专业技术有重大突破，作出显著贡献的医师，应当给予表彰或者奖励", "C": "医师应当使用经国家有关部门批准使用的药品、消毒药剂和医疗器械", "D": "对考核不合格的医师，可以责令其接受培训和继续医学教育", "language": "zh"}
{"question": "由于肺血管病变产生肺动脉高压最常见的原因是（　　）。", "answer": "慢性肺血栓栓塞症", "meta_info": "第1篇　呼吸系统", "answer_idx": "C", "A": "胸廓畸形", "B": "弥漫性肺纤维化", "C": "慢性肺血栓栓塞症", "D": "慢性阻塞性肺疾病", "language": "zh"}
{"question": "男，55岁。因低位直肠癌行Dixon术，术后吻合口位于齿状线上1cm。患者术后最可能出现的情况是（　　）。", "answer": "排便功能基本保持正常", "meta_info": "第3篇　消化系统", "answer_idx": "C", "A": "排便前无明显便意，排便控制不理想", "B": "性功能障碍", "C": "排便功能基本保持正常", "D": "排尿功能障碍", "language": "zh"}
{"question": "最易发生血栓并发症的肾病综合征病理类型是（　　）。", "answer": "膜性肾病", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "微小病变肾病", "B": "系膜增生性肾炎（非IgA肾病）", "C": "膜性肾病", "D": "局灶节段性肾小球硬化", "language": "zh"}
{"question": "2．高血压伴双侧肾动脉狭窄的患者不宜使用的降压药是（　　）。", "answer": "ACEI", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "α受体拮抗剂", "B": "钙通道阻滞剂", "C": "利尿剂", "D": "ACEI", "language": "zh"}
{"question": "患者长期大量使用糖皮质激素时，下列哪种变化正确？（　　）。", "answer": "血中促肾上腺皮质激素减少", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "血中促肾上腺皮质激素减少", "B": "血中肾上腺皮质激素增加", "C": "血中TSH增加", "D": "血中GH减少", "language": "zh"}
{"question": "男，56岁。饮酒史30余年。20年前下岗后饮酒量渐增加，每天白酒1斤，从未间断。进食少，体型消瘦。能间断外出打零工，生活基本正常。10年前常无故怀疑妻子有外遇。近2年记忆力明显下降，易忘事。4天前患者被摩托车撞伤致胫骨骨折，住院拟行手术治疗，故停酒3天。昨晚患者看见地板上有各种虫子在爬，大喊大叫称床底下着火了，紧张害怕。不认识爱人，不知道自己在什么地方。2．对患者的治疗不正确的是（　　）。", "answer": "大剂量抗精神病药物治疗", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "补充大量B族维生素", "B": "大剂量抗精神病药物治疗", "C": "给予保护性约束", "D": "苯二氮䓬类药物替代治疗", "language": "zh"}
{"question": "男，45岁。右足底外伤5小时，伤口深，及时彻底清创后，TAT（破伤风抗毒素）皮试阳性。首先考虑给予注射（　　）。", "answer": "破伤风抗毒素（脱敏注射）", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "人体破伤风免疫球蛋白", "B": "破伤风抗毒素（脱敏注射）", "C": "青霉素", "D": "白喉、百日咳、破伤风三联疫苗", "language": "zh"}
{"question": "2．不合并骨折的髋关节后脱位的复位方法是（　　）。", "answer": "Allis法", "meta_info": "第四部分　运动系统疾病", "answer_idx": "C", "A": "骨牵引复位法", "B": "切开复位法", "C": "Allis法", "D": "无需牵引，仅用旋转法", "language": "zh"}
{"question": "一岁小儿未接种过卡介苗，PPD阳性表示（　　）。", "answer": "体内有活动结核", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "近2～3周感染结核", "B": "体内已有免疫力，不会再感染结核", "C": "体内有活动结核", "D": "对结核无免疫力，需立即接种卡介苗", "language": "zh"}
{"question": "糖原合成时每增加一个葡萄糖单位需要消耗的ATP数目为（　　）。", "answer": "2", "meta_info": "生物化学", "answer_idx": "A", "A": "2", "B": "1", "C": "4", "D": "5", "language": "zh"}
{"question": "女性，37岁，1年前诊断为再生障碍性贫血，经治疗好转；2个月来乏力、头晕加重，间有酱油色尿。查：血红蛋白60g/L，白细胞4×109/L，血小板60×109/L，网织红细胞84%，骨髓增生活跃，细胞外铁阴性。1．对该患者下述检查最有意义的是（　　）。", "answer": "酸溶血试验", "meta_info": "第一部分　血液系统疾病", "answer_idx": "A", "A": "酸溶血试验", "B": "冷热溶血试验", "C": "高铁血红蛋白还原试验", "D": "异丙醇试验", "language": "zh"}
{"question": "分泌降钙素的细胞是（　　）。", "answer": "甲状腺滤泡旁细胞", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "甲状旁腺细胞", "B": "甲状腺滤泡细胞", "C": "甲状腺滤泡旁细胞", "D": "成骨细胞", "language": "zh"}
{"question": "男性，18岁学生，不出门怕见人，不去上课，纠缠父母出钱给自己做美容手术半年。原因是半年来反复照镜子发现自己的鼻子比以前变大了，难看了。说班上的同学都讥笑他，出门就感觉别人在说他，别人的眼光看他时很特别，能使他头痛。父母不愿意出钱就说父母不关心他，父母不是亲生的，曾说要去做亲子鉴定。1．该患者的精神症状中不存在的是（　　）。", "answer": "夸大妄想", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "关系妄想", "B": "物理影响妄想", "C": "非血统妄想", "D": "夸大妄想", "language": "zh"}
{"question": "下述阿司匹林作用中哪项是错误的？（　　）", "answer": "抗胃溃疡作用", "meta_info": "药理学", "answer_idx": "B", "A": "解热镇痛作用", "B": "抗胃溃疡作用", "C": "抗风湿作用", "D": "抑制前列腺素合成", "language": "zh"}
{"question": "57岁男性确诊为慢性粒细胞白血病，最合适的首选治疗是（　　）。", "answer": "羟基脲", "meta_info": "第一部分　血液系统疾病", "answer_idx": "B", "A": "马利兰", "B": "羟基脲", "C": "骨髓移植", "D": "γ-干扰素", "language": "zh"}
{"question": "下列哪项为医德修养的根本途径?（　　）", "answer": "坚持在医疗卫生保健实践中修养", "meta_info": "医学伦理学", "answer_idx": "C", "A": "不断地学习医德理论知识", "B": "创造一个良好的医德修养氛围", "C": "坚持在医疗卫生保健实践中修养", "D": "坚持有的放矢的医德修养", "language": "zh"}
{"question": "女，35岁。与家人吵架后服敌百虫100ml，30分钟后被急送医院。查体：昏迷状态，呼吸困难，皮肤湿冷，双瞳孔如针尖大小。正确的紧急处理是（　　）。", "answer": "气管插管气道保护后硫酸铜溶液洗胃＋导泻", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "气管插管气道保护后硫酸铜溶液洗胃＋导泻", "B": "直接应用大量生理盐水洗胃＋导泻", "C": "直接应用硫酸铜溶液洗胃＋导泻", "D": "气管插管气道保护后2％碳酸氢钠溶液洗胃", "language": "zh"}
{"question": "男，62岁。慢性上腹痛、腹胀20余年，腹痛无规律，10年前胃镜诊为慢性萎缩性胃炎。2个月来上腹痛加重，早饱，偶有呕吐，体重下降7kg。查体：贫血貌。最可能的诊断是（　　）。", "answer": "胃癌", "meta_info": "第3篇　消化系统", "answer_idx": "D", "A": "肝癌", "B": "胆囊癌", "C": "十二指肠溃疡伴幽门梗阻", "D": "胃癌", "language": "zh"}
{"question": "关于新生儿败血症的病原及传染途径，不正确的是（　　）。", "answer": "产时感染最常见", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "国内有些地方表皮葡萄球菌感染占首位", "B": "美国70年代后以B群链球菌感染占首位", "C": "产时感染最常见", "D": "近年来医源性产后感染增多", "language": "zh"}
{"question": "2．男性，38岁。受凉后出现发热，咳嗽、痰少3天.查体：口周疱疹，右下肺叩浊，可闻及支气管呼吸音，最可能的诊断是（　　）。", "answer": "肺炎", "meta_info": "第1篇　呼吸系统", "answer_idx": "A", "A": "肺炎", "B": "肺脓肿", "C": "支气管扩张症", "D": "肺癌", "language": "zh"}
{"question": "发生肺血栓栓塞时，应首先考虑溶栓的情况是（　　）。", "answer": "持续低血压", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "剧烈胸痛", "B": "严重低氧血症", "C": "持续低血压", "D": "明显咯血", "language": "zh"}
{"question": "男性，40岁，因发热、便秘、食欲缺乏10天入院。查体：体温39.8℃，脉搏98次/分，肝大肋下1.0cm，质软，脾肋下及边。血常规：白细胞2.7×109/L，中性粒细胞0.52，淋巴细胞0.44，血清ALT 100U/L；肥达反应“0”1：160，“H”1：160。2．为进一步确定诊断，需做何检查？（　　）", "answer": "血细菌培养", "meta_info": "第八部分　其他疾病", "answer_idx": "C", "A": "便常规", "B": "尿常规", "C": "血细菌培养", "D": "骨髓象检查", "language": "zh"}
{"question": "可协助诊断急性阑尾炎的体征中，哪项错误？（　　）", "answer": "结肠充气试验阴性可排除阑尾炎诊断", "meta_info": "第3篇　消化系统", "answer_idx": "D", "A": "右下腹固定压痛是阑尾炎的主要体征", "B": "腰大肌试验阳性提示阑尾位置较深", "C": "闭孔内肌试验阳性提示阑尾位置较低", "D": "结肠充气试验阴性可排除阑尾炎诊断", "language": "zh"}
{"question": "女，14岁，初潮后月经周期紊乱，经期长短不一已有5个月。肛门检查：子宫发育正常，双侧附件未见异常。首选的辅助检查是（　　）。", "answer": "B型超声检查", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "B型超声检查", "B": "基础体温测定", "C": "X线检查", "D": "血雌激素水平测定", "language": "zh"}
{"question": "肝硬化患者发生原发性腹膜炎的原因是（　　）。", "answer": "肠道屏障作用减弱，下消化道细菌经淋巴系统进入腹腔", "meta_info": "第3篇　消化系统", "answer_idx": "D", "A": "脾功能亢进", "B": "肝脏合成白蛋白的能力降低", "C": "腹水形成", "D": "肠道屏障作用减弱，下消化道细菌经淋巴系统进入腹腔", "language": "zh"}
{"question": "上消化道出血的特征性表现是（　　）。", "answer": "呕血与黑粪", "meta_info": "第3篇　消化系统", "answer_idx": "B", "A": "发热", "B": "呕血与黑粪", "C": "氮质血症", "D": "单纯便血", "language": "zh"}
{"question": "被乙型肝炎病人血液污染针头刺破皮肤后主要宜采取（　　）。", "answer": "注射高效价免疫血清", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "D", "A": "注射干扰素", "B": "局部碘酒、酒精消毒", "C": "注射干扰素诱生剂", "D": "注射高效价免疫血清", "language": "zh"}
{"question": "女孩，12岁，经常患感冒和肺炎。查体：心前区隆起，无震颤，胸骨左缘第2肋间可闻及2级喷射性杂音，P2＞A2伴有固定分裂，心电显示电轴右偏，V1呈rsR'波形，14mm，2mm，P-R间期0.16秒。2．该患儿的超声心动图改变是（　　）。", "answer": "右房增大，右室流出道增宽，室间隔与左室后壁呈矛盾运动", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "左心房，左心室内径增宽，主动脉内径增宽", "B": "右房增大，右室流出道增宽，室间隔与左室后壁呈矛盾运动", "C": "左心房，右心房，右心室内径增宽，室间隔活动正常", "D": "主动脉骑跨于室间隔之上，内径增宽", "language": "zh"}
{"question": "急性硬膜外血肿最常合并的颅脑损伤是（　　）。", "answer": "颅骨骨折", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "颅骨骨折", "B": "脑积水", "C": "脑挫伤", "D": "脑干损伤", "language": "zh"}
{"question": "患者，男，55岁。反复腹痛、发热、黄疸2年，近4天上述症状加重，高热黄疸不退。入院体温40℃，脉搏130次/分，血压70/50mmHg。该患者首选的治疗为（　　）。", "answer": "积极抗休克同时及早手术", "meta_info": "第2篇　心血管系统", "answer_idx": "C", "A": "大剂量抗生素治疗感染后择期手术", "B": "大量输液", "C": "积极抗休克同时及早手术", "D": "应用血管收缩剂，血压升至正常后及早手术", "language": "zh"}
{"question": "给病人输血200ml，病人感觉头痛、恶心、寒战、呼吸困难，可能发生（　　）。", "answer": "溶血反应", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "溶血反应", "B": "细菌污染反应", "C": "过敏反应", "D": "发热反应", "language": "zh"}
{"question": "贫血伴轻度黄疸，最可能的诊断为（　　）。", "answer": "溶血性贫血", "meta_info": "第一部分　血液系统疾病", "answer_idx": "D", "A": "脾功能亢进", "B": "再生障碍性贫血", "C": "特发性血小板减少性紫癜", "D": "溶血性贫血", "language": "zh"}
{"question": "急性有机磷农药中毒最主要的死因是（　　）。", "answer": "呼吸衰竭", "meta_info": "第八部分　其他疾病", "answer_idx": "C", "A": "急性肾功能衰竭", "B": "中毒性休克", "C": "呼吸衰竭", "D": "脑水肿", "language": "zh"}
{"question": "测定肺通气效率较好的指标是（　　）。", "answer": "时间肺活量", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "潮气量", "B": "时间肺活量", "C": "通气/血流比值", "D": "肺扩散容量", "language": "zh"}
{"question": "哪项是最常见的早期输血并发症？（　　）", "answer": "发热反应", "meta_info": "第一部分　血液系统疾病", "answer_idx": "B", "A": "酸中毒", "B": "发热反应", "C": "细菌污染反应", "D": "溶血反应", "language": "zh"}
{"question": "脑血栓形成发病的重要危险因素是（　　）。", "answer": "短暂性脑出血发作史", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "抽烟史", "B": "蛛网膜下腔出血史", "C": "脑出血史", "D": "短暂性脑出血发作史", "language": "zh"}
{"question": "男，55岁。饮酒后不能自行排尿4小时急诊住院，体检见耻骨上包块，有轻压痛。2．要确诊病因，最简便的影像学检查是（　　）。", "answer": "B超", "meta_info": "第4篇　泌尿系统", "answer_idx": "C", "A": "CT", "B": "MBI", "C": "B超", "D": "KUB", "language": "zh"}
{"question": "关于应对的说法错误的是（　　）。", "answer": "应对都能消除自己的紧张", "meta_info": "医学心理学", "answer_idx": "C", "A": "应对是一种心理现象", "B": "应对是人面对应激源时的一种反应", "C": "应对都能消除自己的紧张", "D": "应对过程是通过努力克服困难的过程", "language": "zh"}
{"question": "早期诊断化脓性关节炎，以下哪项检查最有确诊价值？（　　）", "answer": "关节穿刺及关节液检查", "meta_info": "第四部分　运动系统疾病", "answer_idx": "D", "A": "血细胞计数及分类", "B": "血培养", "C": "血沉", "D": "关节穿刺及关节液检查", "language": "zh"}
{"question": "男，8岁，发热1天，体温39.8℃，头痛、呕吐、浅昏迷，Babinski征阳性。血象：白细胞18.5×109/L，中性粒细胞0.85。已确诊为流行性乙型脑炎。1．该患者临床类型属于（　　）。", "answer": "普通型", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "B", "A": "轻型", "B": "普通型", "C": "重型", "D": "暴发型", "language": "zh"}
{"question": "女，38岁。发热、皮疹、脱发和口腔溃疡6个月。查体：T 39.0℃，面部有充血性红斑，双手近端指间关节压痛，轻度肿胀，双下肢凹陷性水肿。实验室检查：尿蛋白（＋＋＋），尿红细胞（＋＋＋），24小时尿蛋白3.8g，血PLT 88×109/L，ANA 1:640，抗SSA抗体（＋），抗双链DNA抗体（＋），补体C3低下。2．最佳治疗方案是泼尼松1mg/（kg·d）联合（　　）。", "answer": "环磷酰胺", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "血浆置换", "B": "环磷酰胺", "C": "青霉素", "D": "柳氮磺吡啶", "language": "zh"}
{"question": "当患儿发热、呕吐同时伴有颈项强直，出血性皮疹与休克，最可能的诊断是（　　）。", "answer": "脑膜炎双球菌性脑膜炎", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "绿脓杆菌性脑膜炎", "B": "肺炎双球菌性脑膜炎", "C": "脑膜炎双球菌性脑膜炎", "D": "葡萄球菌性脑膜炎", "language": "zh"}
{"question": "骨折治疗的基本原则是（　　）。", "answer": "复位后固定，并开始功能锻炼", "meta_info": "第四部分　运动系统疾病", "answer_idx": "D", "A": "复位后固定，给予促进骨折愈合", "B": "手法复位，外固定，给予活血化瘀药物", "C": "切开复位，内固定，给予抗生素", "D": "复位后固定，并开始功能锻炼", "language": "zh"}
{"question": "钩端螺旋体病的主要传染源是（　　）。", "answer": "猪、鼠、犬", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "D", "A": "猫、鼠、兔", "B": "猪、牛、马", "C": "鸡、鸭、鹅", "D": "猪、鼠、犬", "language": "zh"}
{"question": "患者，1岁，以面色苍白1个月入院。查体：心率138次/分，心尖区闻及Ⅳ级收缩期杂音。血象：Hb50g/L，RBC2.54×1012/L。临床诊断为缺铁性贫血，该患儿的贫血程度该如何判定？（　　）", "answer": "重度贫血", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "轻度贫血", "B": "正常血象", "C": "中度贫血", "D": "重度贫血", "language": "zh"}
{"question": "2．新生儿败血症的产时感染的途径是（　　）。", "answer": "黏膜破损", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "阴道细菌上行", "B": "脐部感染", "C": "消化道入侵", "D": "黏膜破损", "language": "zh"}
{"question": "男性，18岁，学生，近1年来出现反复洗手，每次洗手时间可达30min，对做过的题目不放心，反复检查，以致耽搁考试时间，明知无需如此，却不能自控，为此苦恼不堪，当被阻止其洗手或检查时，即出现烦躁不安。1．该病人的诊断考虑（　　）。", "answer": "强迫症", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "神经衰弱", "B": "精神分裂症", "C": "强迫症", "D": "焦虑症", "language": "zh"}
{"question": "女，28岁。阴道分泌物增多5天。有不洁性交史。检查：右侧大阴唇可见1.0cm×1.0cm、硬韧、无痛隆起物。本例最可能的诊断是（　　）。", "answer": "梅毒", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "巨细胞病毒感染", "B": "淋病", "C": "生殖器疱疹", "D": "梅毒", "language": "zh"}
{"question": "肾病综合征出现大量蛋白尿的主要机制是（　　）。", "answer": "肾小球滤过膜电荷屏障受损", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "肾小球滤过膜电荷屏障受损", "B": "肾小球上皮细胞足突裂隙增大", "C": "肾血流增加", "D": "肾静脉回流障碍", "language": "zh"}
{"question": "对病原菌不明确的化脓性脑膜炎的治疗首选（　　）。", "answer": "青霉素+氨苄西林", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "青霉素+氨苄西林", "B": "氯霉素", "C": "红霉素+氯霉素", "D": "青霉素", "language": "zh"}
{"question": "7岁小儿，持续发热伴有咽痛、游走性大关节炎，抗链球菌抗体阳性，心肺听诊阴性，神经系统阴性，诊断为风湿热，抗风湿治疗应选用的药物是（　　）。", "answer": "阿司匹林", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "大剂量青霉素", "B": "糖皮质激素", "C": "阿司匹林", "D": "洋地黄制剂", "language": "zh"}
{"question": "不是产气荚膜梭菌致病物质的为（　　）。", "answer": "内毒素", "meta_info": "医学微生物学", "answer_idx": "D", "A": "胶原酶", "B": "透明质酸酶", "C": "肠毒素", "D": "内毒素", "language": "zh"}
{"question": "男，68岁。持续胸痛2小时。既往体健。查体：BP 110／65mmHg，双肺呼吸音清，心率94次/分，心音低钝，A2＞P2。心电图：V1～V6导联ST段弓背向上抬高0.3～0.5mV。实验室检查：血清肌钙蛋白I水平正常。该患者最可能的诊断是（　　）。", "answer": "急性心肌梗死", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "急性心肌梗死", "B": "肺血栓栓塞", "C": "急性心包炎", "D": "急性心肌炎", "language": "zh"}
{"question": "男，21岁，左小腿因外伤手术后经常自伤口处流脓3年余，伤口愈合后无任何症状，破溃流脓时发热、局部肿胀，反复多次发作，现发热、局部流脓，有时流出小碎骨片。2．最合理的进一步检查是（　　）。", "answer": "拍X线平片", "meta_info": "第四部分　运动系统疾病", "answer_idx": "A", "A": "拍X线平片", "B": "核素扫描", "C": "B超", "D": "局部血管造影", "language": "zh"}
{"question": "男，48岁。进行性贫血，消瘦、乏力半年，有时右腹隐痛，无腹泻。查体：右中腹部扪及肿块，肠鸣音活跃。1．可明确诊断的检查是（　　）。", "answer": "结肠镜", "meta_info": "第3篇　消化系统", "answer_idx": "A", "A": "结肠镜", "B": "CT", "C": "MRI", "D": "全消化道钡餐", "language": "zh"}
{"question": "降血糖作用最弱，作用持续时间最短的是（　　）。", "answer": "甲苯磺丁脲", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "甲苯磺丁脲", "B": "氯磺丙脲", "C": "格列本脲", "D": "胰岛素", "language": "zh"}
{"question": "消化性溃疡发病机制中最重要的攻击因子是（　　）。", "answer": "胃酸、胃蛋白酶", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "胃酸、胃蛋白酶", "B": "胰酶", "C": "胆汁", "D": "精神、心理因素", "language": "zh"}
{"question": "男性患者，35岁，阵发性头痛、心悸出汗3年，此次因情绪激动发作剧烈头痛心悸、大汗来急诊，检查发现面色苍白，血压26.7/17.3kPa（200/130mmHg），心136次/分。4．如果此时能除外瘤内出血、心衰和心律失常，对患者应采取的急救措施是（　　）。", "answer": "心得安静脉注射", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "D", "A": "哌唑嗪静脉注射", "B": "胰高血糖素静脉注射", "C": "酚妥拉明静脉注射", "D": "心得安静脉注射", "language": "zh"}
{"question": "胆囊动脉最多来源于（　　）。", "answer": "肝右动脉", "meta_info": "第3篇　消化系统", "answer_idx": "D", "A": "肝总动脉", "B": "肝固有动脉", "C": "腹腔干", "D": "肝右动脉", "language": "zh"}
{"question": "女，29岁。右乳红肿3个月。查体：右乳皮肤红肿，呈橘皮样改变，未触及肿块，右腋窝可触及多个肿大、质硬、融合淋巴结。皮肤活检在真皮淋巴管内查见癌栓，ER、PR阳性，C-erbB2（HER-2）阴性。2．最佳综合治疗措施是（　　）。", "answer": "手术、化疗、放疗、内分泌治疗", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "化疗、手术、放疗、内分泌治疗", "B": "放疗、手术、化疗、内分泌治疗", "C": "手术、化疗、放疗、内分泌治疗", "D": "内分泌治疗、手术、放疗、化疗", "language": "zh"}
{"question": "5—羟色胺主要来源于（　　）。", "answer": "肥大细胞", "meta_info": "病理学", "answer_idx": "C", "A": "血管内皮细胞", "B": "巨噬细胞", "C": "肥大细胞", "D": "淋巴细胞", "language": "zh"}
{"question": "属于感染性心内膜炎主要诊断标准的是（　　）。", "answer": "超声心动图发现赘生物", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "发热，体温≥38℃", "B": "细菌性动脉瘤", "C": "超声心动图发现赘生物", "D": "Osler结节", "language": "zh"}
{"question": "细菌性肝脓肿的主要治疗是（　　）。", "answer": "抗生素治疗", "meta_info": "第3篇　消化系统", "answer_idx": "A", "A": "抗生素治疗", "B": "切开引流", "C": "理疗", "D": "肝切除", "language": "zh"}
{"question": "急性肾炎患者在病程早期突然发生惊厥，可能性最大的是（　　）。", "answer": "高血压脑病", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "高热惊厥", "B": "低钙惊厥", "C": "低钠综合征", "D": "高血压脑病", "language": "zh"}
{"question": "新生儿溶血病最常见的是（　　）。", "answer": "ABO血型不合", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "葡萄糖6-磷酸脱氢酶缺乏症", "B": "MN血型不合", "C": "Rh血型不合", "D": "ABO血型不合", "language": "zh"}
{"question": "男性，65岁。下楼时不慎摔伤右髋部，查体右下肢短缩，外旋50°畸形，右髋肿胀不明显，但有叩痛。3．该患者最易发生的并发症是（　　）。", "answer": "股骨头缺血性坏死", "meta_info": "第四部分　运动系统疾病", "answer_idx": "D", "A": "脂肪栓塞", "B": "坐骨神经损伤", "C": "髋内翻畸形", "D": "股骨头缺血性坏死", "language": "zh"}
{"question": "关于脑膜炎奈瑟菌的特点，下列各项中正确的是（　　）。", "answer": "内毒素是其重要致病因素", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "C", "A": "革兰阳性双球菌", "B": "我国流行菌群以B群为主", "C": "内毒素是其重要致病因素", "D": "本菌在外界抵抗力强", "language": "zh"}
{"question": "下述疾病中，哪项不属于心身疾病?（　　）", "answer": "抑郁症", "meta_info": "医学心理学", "answer_idx": "B", "A": "癌症", "B": "抑郁症", "C": "十二指肠溃疡", "D": "支气管哮喘", "language": "zh"}
{"question": "患者，18岁，务农，于8月5日以发冷、发热起病，2天后入院，伴有头痛、肌肉酸痛、乏力、皮肤有出血点。入院1天后突然出现心慌、气短，心率快，咳血痰。X线胸片示双肺广泛片状阴影。4．钩端螺旋体病治疗早期最可能出现的症状是（　　）。", "answer": "赫氏反应", "meta_info": "第八部分　其他疾病", "answer_idx": "B", "A": "溶血反应", "B": "赫氏反应", "C": "中毒反应", "D": "二重感染", "language": "zh"}
{"question": "一足月新生儿，生后第6天，因少吃、少哭、少动2天入院，体检：体温38.2℃，精神差，前囟饱满，皮肤黄染。呼吸50次/分，心肺（-），腹稍胀，肝肋下2cm，脾肋下刚及，拥抱反射迟钝，已抽血培养。进一步检查应先考虑（　　）。", "answer": "腰椎穿刺，脑脊液常规及培养", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "腰椎穿刺，脑脊液常规及培养", "B": "颅脑CT检查", "C": "膀胱穿刺，尿液培养", "D": "血清胆红素测定", "language": "zh"}
{"question": "接种卡介苗后PPD试验有逐年减弱倾向，一般逐渐消失时间是（　　）。", "answer": "3～5年", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "1～2年", "B": "3～5年", "C": "5～10年", "D": "10年以上", "language": "zh"}
{"question": "雌、孕激素序贯试验阴性提示为（　　）。", "answer": "子宫性闭经", "meta_info": "第5篇　女性生殖系统", "answer_idx": "C", "A": "卵巢性闭经", "B": "下丘脑性闭经", "C": "子宫性闭经", "D": "内分泌异常", "language": "zh"}
{"question": "女，45岁。腹泻10年。精神紧张时加剧，排便前腹痛，排便后腹痛可缓解。大便为糊状，发病以来体重无明显变化。既往体健，平素进食好，睡眠差。查体：T 36.5℃，P 80次/分，R 18次/分，BP 120/80mmHg，未见皮疹，双肺呼吸音清，未闻及干湿性啰音，心律齐。腹软，无压痛。3．适宜的治疗措施是（　　）。", "answer": "微生态制剂", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "微生态制剂", "B": "抗结核治疗", "C": "手术治疗", "D": "抗生素", "language": "zh"}
{"question": "1．革兰染色后镜检衣原体的形态是（　　）。", "answer": "革兰阴性圆形体", "meta_info": "医学微生物学", "answer_idx": "D", "A": "始体", "B": "内基小体", "C": "革兰阳性圆形体", "D": "革兰阴性圆形体", "language": "zh"}
{"question": "下述哪项是人体的主要散热部位?（　　）", "answer": "皮肤", "meta_info": "生理学", "answer_idx": "A", "A": "皮肤", "B": "消化道", "C": "呼吸道", "D": "肺循环", "language": "zh"}
{"question": "婴儿5个月时应添加的辅食是（　　）。", "answer": "强化铁的米粉", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "强化铁的米粉", "B": "鱼类", "C": "蛋类", "D": "面", "language": "zh"}
{"question": "炎症的概念是（　　）。", "answer": "具有血管系统的活体组织对损伤因子所发生的防御反应", "meta_info": "病理学", "answer_idx": "B", "A": "具有血管系统的活体组织的损伤反应", "B": "具有血管系统的活体组织对损伤因子所发生的防御反应", "C": "具有血管系统的活体组织发生防御反应", "D": "具有血管系统的活体组织对致炎因子反应", "language": "zh"}
{"question": "手部创口清创处理，一般不迟于（　　）。", "answer": "8h", "meta_info": "第四部分　运动系统疾病", "answer_idx": "A", "A": "8h", "B": "10h", "C": "11h", "D": "12h", "language": "zh"}
{"question": "真菌孢子的主要作用是（　　）。", "answer": "进行繁殖", "meta_info": "医学微生物学", "answer_idx": "B", "A": "抗吞噬", "B": "进行繁殖", "C": "引起炎症反应", "D": "引起变态反应", "language": "zh"}
{"question": "男，15岁。全身水肿1周。查体：BP 120/70mmHg，腹部移动性浊音阳性。尿蛋白定量6.5g/d，沉渣RBC 0～2/HP。血白蛋白22g/L，胆固醇8mmol/L，BUN 6.5mmol/L，Scr 98μmol/L，ASO升高，血补体C3 0.88g/L（正常值0.8～1.5g/L），1．最可能的临床诊断是（　　）。", "answer": "原发性肾病综合征", "meta_info": "第4篇　泌尿系统", "answer_idx": "A", "A": "原发性肾病综合征", "B": "狼疮性肾炎", "C": "急进性肾小球肾炎", "D": "急性肾小球肾炎", "language": "zh"}
{"question": "男性，20岁。因甲状腺功能亢进症行甲状腺大部分切除术。术后第二天出现手足抽搐。3．该病人发作性手足抽搐1个月未缓解，且逐渐加重，最有效的治疗方法是（　　）。", "answer": "口服维生素", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "静脉注射10％氯化钙", "B": "口服乳酸钙", "C": "口服双氢速甾醇油剂", "D": "口服维生素", "language": "zh"}
{"question": "新生儿败血症的感染途径最常见的为（　　）。", "answer": "产后感染", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "母孕期血内有细菌时经胎盘血行感染胎儿", "B": "产时胎儿通过产道时吸入", "C": "产后感染", "D": "羊水穿刺", "language": "zh"}
{"question": "下列哪项是可诱导初始T细胞分化为Th1的细胞因子?（　　）", "answer": "IL-12", "meta_info": "医学免疫学", "answer_idx": "C", "A": "IL-4", "B": "IL-10", "C": "IL-12", "D": "IL-6", "language": "zh"}
{"question": "哪项是急性乳腺炎的主要致病菌？（　　）", "answer": "金黄色葡萄球菌", "meta_info": "第八部分　其他疾病", "answer_idx": "A", "A": "金黄色葡萄球菌", "B": "绿脓杆菌", "C": "溶血性链球菌", "D": "大肠杆菌", "language": "zh"}
{"question": "坐位乘车时，急刹车，右膝前方受到撞击，出现右髋剧痛，髋关节运动障碍，处于屈曲、内收、内旋畸形状态。4．该病人治疗4周后，自行下地负重行走活动，预计可能发生的情况是（　　）。", "answer": "股骨头缺血性坏死", "meta_info": "第四部分　运动系统疾病", "answer_idx": "C", "A": "关节周围组织损伤", "B": "习惯性关节脱位", "C": "股骨头缺血性坏死", "D": "髋关节周围创伤性骨化", "language": "zh"}
{"question": "男，45岁。间断咳嗽2年，每年均于秋季出现，干咳为主，夜间明显，伴憋气，常常影响睡眠，白天症状常不明显，使用多种药物抗感染治疗无效，持续l～2个月后症状可自行消失。本次入秋后再次出现上述症状，体格检查未见明显异常，胸部X线片未见明显异常，通气功能正常。为明确诊断，宜采取的进一步检查措施是（　　）。", "answer": "支气管激发试验", "meta_info": "第1篇　呼吸系统", "answer_idx": "C", "A": "睡眠呼吸监测", "B": "胸部CT", "C": "支气管激发试验", "D": "血气分析", "language": "zh"}
{"question": "男，28岁。车祸后昏迷3周。查体：昏迷，压眶反射消失，颈后仰伸，四肢强直性伸直，上肢内收、过度旋前和下肢内收、内旋、踝跖屈。该患者的损害水平在（　　）。", "answer": "脑干", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "脊髓", "B": "脑干", "C": "大脑皮层", "D": "基底节", "language": "zh"}
{"question": "尿中发现大量透明管型时，说明病变在（　　）。", "answer": "肾小管和肾小球", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "肾小管和膀胱", "B": "肾小管和肾盂", "C": "肾小管和肾小球", "D": "肾小管和输尿管", "language": "zh"}
{"question": "细菌的生长繁殖方式是（　　）。", "answer": "二分裂", "meta_info": "医学微生物学", "answer_idx": "B", "A": "孢子生殖", "B": "二分裂", "C": "复制", "D": "断裂", "language": "zh"}
{"question": "对伴有低血钾的高血压，其病因首先考虑（　　）。", "answer": "原发性醛固酮增多症", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "原发性醛固酮增多症", "B": "嗜铬细胞瘤", "C": "慢性肾炎", "D": "肾动脉狭窄", "language": "zh"}
{"question": "急性肾炎，正确的治疗方案是（　　）。", "answer": "青霉素治疗7～10天", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "卧床休息8周以上", "B": "无盐饮食至尿蛋白消失", "C": "青霉素治疗7～10天", "D": "血压正常后，可恢复上学及正常活动", "language": "zh"}
{"question": "女性，30岁。在颈丛麻醉下施行了甲状腺瘤切除术，手术顺利。3．病人的拆线时间为术后（　　）。", "answer": "4～5天", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "2～3天", "B": "4～5天", "C": "8～9天", "D": "10～12天", "language": "zh"}
{"question": "患者，4岁，既往接种卡介苗，做“OT”试验1：2000。下列哪一项结果不是接种卡介苗后的反应（　　）。", "answer": "阳性反应变化少，无减弱倾向，持续终身", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "硬结直径多为5～9mm", "B": "硬结边缘不整", "C": "试验阳性持续时间较短", "D": "阳性反应变化少，无减弱倾向，持续终身", "language": "zh"}
{"question": "病毒性心肌炎的确诊有赖于（　　）。", "answer": "心肌组织内病毒的检出", "meta_info": "第2篇　心血管系统", "answer_idx": "C", "A": "血肠道病毒核酸阳性", "B": "血清柯萨奇B组病毒IgG 1:640以上", "C": "心肌组织内病毒的检出", "D": "血清柯萨奇B组病毒IgM 1:320以上", "language": "zh"}
{"question": "女性，31岁，痛经，近1年加重。结婚3年，未避孕，未孕。月经规则，量中，子宫正常大小.左附件触及5cm囊肿。2．本例不孕原因可能为以下哪种？（　　）", "answer": "盆腔有子宫内膜异位病灶", "meta_info": "第5篇　女性生殖系统", "answer_idx": "D", "A": "输卵管不通", "B": "男方异常", "C": "盆腔广泛粘连", "D": "盆腔有子宫内膜异位病灶", "language": "zh"}
{"question": "对于无家属签字的无自主意识患者的紧急输血，经治医师应上报下列哪个部门同意、备案，并记入病历？（　　）", "answer": "医院职能部门", "meta_info": "卫生法规", "answer_idx": "A", "A": "医院职能部门", "B": "检验科", "C": "输血科", "D": "麻醉科", "language": "zh"}
{"question": "消化性溃疡慢性穿孔的最常见部位是（　　）。", "answer": "十二指肠后壁", "meta_info": "第3篇　消化系统", "answer_idx": "C", "A": "胃小弯", "B": "十二指肠前壁", "C": "十二指肠后壁", "D": "幽门管", "language": "zh"}
{"question": "1．子宫内膜癌浸润肌层2/3，属于（　　）。", "answer": "ⅠB期", "meta_info": "第5篇　女性生殖系统", "answer_idx": "B", "A": "ⅠA期", "B": "ⅠB期", "C": "Ⅱ期", "D": "ⅢB期", "language": "zh"}
{"question": "4岁患儿，明显浮肿，血压12/8kPa，尿蛋白（+++），尿红细胞0～2/HP，血浆白蛋白22g/L。1．此患儿首选的治疗是（　　）。", "answer": "激素中、长程疗法", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "激素中、长程疗法", "B": "环孢霉素A口服", "C": "雷公藤多苷口服", "D": "环磷酰胺冲击疗法", "language": "zh"}
{"question": "活动期佝偻病，长骨X线检查中，错误的是（　　）。", "answer": "干骺端增宽，骨密度增高", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "干骺端增宽，骨密度增高", "B": "骨骺与干骺端的距离加大", "C": "骨质普遍稀疏", "D": "临时钙化带消失", "language": "zh"}
{"question": "女，38岁。于高处取物时不慎摔下，呈骑跨式，伤及外阴部位，疼痛难忍，外阴血肿最易发生的部位是（　　）。", "answer": "大阴唇", "meta_info": "第二部分　模拟试题", "answer_idx": "A", "A": "大阴唇", "B": "阴阜部", "C": "阴蒂部", "D": "会阴部", "language": "zh"}
{"question": "患者，男，19岁。约2周前曾咳嗽、流涕，近3天感心悸。查体：心界不大，P2＞A2，心率96次/分，可闻及频发期前收缩，心脏各瓣膜区未闻及杂音和附加音。心电图示室性期前收缩，血清肌钙蛋白升高。该患者最可能的诊断是（　　）。", "answer": "病毒性心肌炎", "meta_info": "第2篇　心血管系统", "answer_idx": "D", "A": "感染性心内膜炎", "B": "扩张型心肌病", "C": "急性心包炎", "D": "病毒性心肌炎", "language": "zh"}
{"question": "下列乙类传染病应按甲类传染病处理的是（　　）。", "answer": "肺炭疽", "meta_info": "卫生法规", "answer_idx": "C", "A": "流行性出血热", "B": "流行性乙型脑炎", "C": "肺炭疽", "D": "流行性脑脊髓膜炎", "language": "zh"}
{"question": "男性，50岁，体重50kg，上腹隐痛不适，并不思进食已3月，胃镜检查证实为胃体癌。化验：血红蛋白80g/L，血浆白蛋白30g/L，血清钠130mmol/L、钾4.5mmol/L，动脉血pH为7.35。1．该病人可能存在（　　）。", "answer": "低渗性脱水", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "C", "A": "等渗性脱水", "B": "高渗性脱水", "C": "低渗性脱水", "D": "高钾血症", "language": "zh"}
{"question": "伸直型肱骨髁上骨折，常见的并发症是（　　）。", "answer": "血管神经损伤", "meta_info": "第四部分　运动系统疾病", "answer_idx": "B", "A": "肱骨下端缺血性坏死", "B": "血管神经损伤", "C": "脂肪栓塞", "D": "损伤性休克", "language": "zh"}
{"question": "适宜治疗等渗性脱水的液体是（　　）。", "answer": "平衡盐溶液", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "B", "A": "5%碳酸氢钠", "B": "平衡盐溶液", "C": "5%葡萄糖液", "D": "低分子右旋糖酐", "language": "zh"}
{"question": "男婴。娩出1分钟时，心率为104次/分，呼吸不规则而且慢，四肢活动好，青紫，弹足底有反应，躯干皮肤粉红。1分钟Apgar评分可评为（　　）。", "answer": "7分", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "9分", "B": "7分", "C": "6分", "D": "5分", "language": "zh"}
{"question": "男，74岁。反复咳嗽、咳痰30年，近5年来长期夜间家庭氧疗。1周前因受凉后出现喘息。夜间入睡困难。昨夜自服“舒乐安定”（艾司唑仑）”2片，并将吸氧流量提高至4L/min，自觉喘息症状有所改善。今晨家属发现其呼之不应。入院查体：轻度昏迷。球结膜水肿，口唇无发绀。双肺呼吸音低。双侧Babinski征（＋）。该患者最可能出现的问题是（　　）。", "answer": "肺性脑病", "meta_info": "第1篇　呼吸系统", "answer_idx": "B", "A": "氧中毒", "B": "肺性脑病", "C": "镇静剂中毒", "D": "脑梗死", "language": "zh"}
{"question": "下列哪一种分子不存在于T细胞表面？（　　）", "answer": "CD80", "meta_info": "医学免疫学", "answer_idx": "D", "A": "CD2", "B": "CD28", "C": "TCR", "D": "CD80", "language": "zh"}
{"question": "动机强度与解决问题的效率密切相关，解决问题效率最佳的动机强度应是（　　）。", "answer": "适中", "meta_info": "医学心理学", "answer_idx": "B", "A": "最强", "B": "适中", "C": "较弱", "D": "无动机", "language": "zh"}
{"question": "急进性肾小球肾炎Ⅱ型最常见的检测异常是（　　）。", "answer": "循环免疫复合物阳性", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "循环免疫复合物阳性", "B": "血抗肾小球基底膜抗体阳性", "C": "血单克隆免疫球蛋白升高", "D": "血冷球蛋白阳性", "language": "zh"}
{"question": "2．主要分布在肝脏（　　）。", "answer": "谷丙转氨酶", "meta_info": "生物化学", "answer_idx": "D", "A": "碱性磷酸酶", "B": "单胺氧化酶", "C": "乳酸脱氢酶", "D": "谷丙转氨酶", "language": "zh"}
{"question": "患者，男，70岁。40年前行胃大部分切除术。发现贫血1年。粪便隐血试验（－）。胃镜：吻合口炎症。与患者贫血无明显关系的因素是（　　）。", "answer": "胃蛋白酶缺乏", "meta_info": "第3篇　消化系统", "answer_idx": "B", "A": "维生素岛B12缺乏", "B": "胃蛋白酶缺乏", "C": "胃酸缺乏", "D": "铁缺乏", "language": "zh"}
{"question": "1．上述哪项智力水平为平常的智商范围？（　　）", "answer": "80～119", "meta_info": "医学心理学", "answer_idx": "B", "A": "≥130", "B": "80～119", "C": "70～79", "D": "＜70", "language": "zh"}
{"question": "一小儿身高85cm，头围48cm，乳牙20枚，能跳，能表达自己的意愿。2．按公式计算此小儿的体重约是（　　）。", "answer": "12kg", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "16kg", "B": "14kg", "C": "12kg", "D": "8kg", "language": "zh"}
{"question": "男，52岁。乏力、食欲减退12年，间断丙氨酸氨基转移酶升高。1个月来尿少，双下肢水肿，腹胀逐渐加重，3天前腹泻，黄稀水样便3次，2天来腹痛、发热，T 38.5℃。该患者最可能的诊断是（　　）。", "answer": "肝硬化并原发性腹膜炎", "meta_info": "第3篇　消化系统", "answer_idx": "A", "A": "肝硬化并原发性腹膜炎", "B": "结核性腹膜炎", "C": "急性细菌性痢疾", "D": "肝癌破裂", "language": "zh"}
{"question": "青春期自我意识中的主要矛盾不包括（　　）。", "answer": "本我与超我", "meta_info": "医学心理学", "answer_idx": "C", "A": "理想与现实", "B": "学习与恋爱", "C": "本我与超我", "D": "独立与依赖", "language": "zh"}
{"question": "男，36岁。右侧腹股沟区发现可复性肿块3年。6小时前患者发现肿块突然增大、剧烈疼痛。查体：右侧腹股沟区有6cm×5cm椭圆形肿块，触痛明显，腹部无压痛、反跳痛、腹肌紧张。首选的有效治疗是（　　）。", "answer": "急诊手术", "meta_info": "第3篇　消化系统", "answer_idx": "D", "A": "禁食、补液", "B": "手法复位", "C": "观察", "D": "急诊手术", "language": "zh"}
{"question": "某县人口50万，约80%居民以河水为饮用水，该县设有一传染病科的综合医院，城市污水未经处理直接排入河水中。该县1986年1～11月份伤寒发病人数达1063例，超过该县历史(1958～1985年)同期平均发病人数的6.9倍。初步调查，发现患者集中于河水排污口的下游地带。3．这一地区应采取何种以下哪种措施？（　　）", "answer": "迅速切断污染源", "meta_info": "预防医学", "answer_idx": "C", "A": "加强饮用水的净化", "B": "对饮用水迅速采取氯化消毒", "C": "迅速切断污染源", "D": "停止供水", "language": "zh"}
{"question": "具有杀菌作用的紫外线波长是（　　）。", "answer": "200～300nm", "meta_info": "医学微生物学", "answer_idx": "C", "A": "50～90nm", "B": "150～190nm", "C": "200～300nm", "D": "400～490nm", "language": "zh"}
{"question": "省级人民政府接到突发事件，应当向国务院卫生行政部门报告的时限为（　　）。", "answer": "1小时", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "1小时", "B": "2小时", "C": "6小时", "D": "立即", "language": "zh"}
{"question": "白细胞分类中，中性粒细胞与淋巴细胞的比例大致相等的时间是（　　）。", "answer": "生后4～6天及4～6岁", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "生后2～4天及2～4个月", "B": "生后4～6个月及4～6岁", "C": "生后4～6个月及6～8岁", "D": "生后4～6天及4～6岁", "language": "zh"}
{"question": "男，49岁，近一年逐渐出现失眠、记忆力下降、话少、淡漠、反应迟钝，有时出现不由自主哭笑，行走时步态不稳，大小便失禁，生活不能自理。觉得家里总丢东西。脑脊液无异常。CT示轻度脑萎缩，脑室扩大，中线结构异常。首先要考虑的诊断是（　　）。", "answer": "阿尔兹海默病", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "阿尔兹海默病", "B": "癫痫", "C": "老年痴呆", "D": "帕金森病", "language": "zh"}
{"question": "关于头皮裂伤，下列哪项是错误的？（　　）", "answer": "创口有脑组织外溢，须立即缝合头皮，变开放为闭合损伤", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "创口有脑组织外溢，须立即缝合头皮，变开放为闭合损伤", "B": "处置时着重检查有无颅骨和脑损伤", "C": "尽早清创缝合", "D": "清创时限放宽至24小时", "language": "zh"}
{"question": "介导Ⅳ型超敏反应的免疫细胞是（　　）。", "answer": "T细胞", "meta_info": "医学免疫学", "answer_idx": "A", "A": "T细胞", "B": "B细胞", "C": "嗜酸性粒细胞", "D": "中性粒细胞", "language": "zh"}
{"question": "下列哪项是在DTH对造成小静脉内皮细胞损伤的主要细胞因子?（　　）", "answer": "α-TNF", "meta_info": "医学免疫学", "answer_idx": "A", "A": "α-TNF", "B": "γ-IFN", "C": "PGI2", "D": "IL-2", "language": "zh"}
{"question": "维生素D治疗佝偻病的剂量应为（　　）。", "answer": "依病情不同而剂量不同", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "依病情不同而剂量不同", "B": "不同病期，剂量相同", "C": "先用小剂量，逐渐加大剂量", "D": "剂量越大越好", "language": "zh"}
{"question": "中年期心理卫生重点主要在于帮助中年人（　　）。", "answer": "保持家庭与婚姻的稳定", "meta_info": "医学心理学", "answer_idx": "C", "A": "保持良好生活习惯", "B": "自尊自立保持良好的社会功能", "C": "保持家庭与婚姻的稳定", "D": "维持良好的家庭关系", "language": "zh"}
{"question": "1．常见输血后肝炎是哪型病毒引起？（　　）", "answer": "丁型肝炎病毒", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "C", "A": "乙型肝炎病毒", "B": "丙型肝炎病毒", "C": "丁型肝炎病毒", "D": "戊型肝炎病毒", "language": "zh"}
{"question": "子宫内膜癌的首选治疗方法是（　　）。", "answer": "手术治疗", "meta_info": "第二部分　模拟试题", "answer_idx": "A", "A": "手术治疗", "B": "放射治疗", "C": "激素治疗", "D": "化学治疗", "language": "zh"}
{"question": "11个月婴儿发热、剧烈呕吐，嗜睡、烦躁交替出现，惊厥1次。前囟膨隆，右侧鼻唇沟变浅，颈项强直。其母患有肺结核。6．结核性脑膜炎强化治疗阶段最常见的联合用药是：（　　）。", "answer": "异烟肼+链霉素+利福平+吡嗪酰胺", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "异烟肼+链霉素+利福平+吡嗪酰胺", "B": "异烟肼+链霉素+乙胺丁醇+吡嗪酰胺", "C": "异烟肼+链霉素+利福平+乙胺丁醇", "D": "异烟肼+乙酰唑胺+利福平+吡嗪酰胺", "language": "zh"}
{"question": "有关血管性痴呆（VD）的描述，以下哪项是错误的？（　　）", "answer": "血管舒张剂治疗VD有效", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "是指由于脑血管病变导致的痴呆", "B": "发病率与年龄有关", "C": "男性多于女性", "D": "血管舒张剂治疗VD有效", "language": "zh"}
{"question": "痉挛性偏瘫步态为（　　）。", "answer": "划圈样步态", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "醉汉步态", "B": "跨阈步态", "C": "划圈样步态", "D": "剪刀样步态", "language": "zh"}
{"question": "女，45岁，确诊为子宫内膜癌。手术切除后病理示癌细胞局限在子宫内膜，该患者的手术病理分期为（　　）。", "answer": "ⅠA", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "ⅠA", "B": "ⅠC", "C": "ⅡA", "D": "ⅢA", "language": "zh"}
{"question": "病毒性肝炎，肝细胞的灶状坏死属于（　　）。", "answer": "液化性坏死", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "液化性坏死", "B": "干酪性坏死", "C": "固缩性坏死", "D": "坏疽", "language": "zh"}
{"question": "骨折后最易发生骨缺血性坏死的部位是（　　）。", "answer": "股骨头", "meta_info": "第四部分　运动系统疾病", "answer_idx": "A", "A": "股骨头", "B": "桡骨远端", "C": "锁骨远端", "D": "胫骨内髁", "language": "zh"}
{"question": "女，35岁。双手第2、3、5近端指间关节，双腕和双肘关节肿痛1年，伴晨僵1小时。查体：上述关节肿胀、压痛。实验室检查：ESR 48mm/h，CRP升高。双手X线片：双手骨质疏松，第2近端指间关节可见骨质破坏。对诊断最有意义的实验室检查是（　　）。", "answer": "类风湿因子", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "血尿酸", "B": "类风湿因子", "C": "抗核抗体", "D": "抗链“O”", "language": "zh"}
{"question": "血浆中能与铁结合的转铁蛋白称为（　　）。", "answer": "总铁结合力", "meta_info": "第一部分　血液系统疾病", "answer_idx": "D", "A": "未饱和铁结合力", "B": "转铁蛋白饱和度", "C": "转铁蛋白", "D": "总铁结合力", "language": "zh"}
{"question": "偏头痛的防治，哪一项不正确？（　　）", "answer": "发作后可用血管扩张药", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "不要过饥、过饱", "B": "避免过度疲劳和精神紧张", "C": "不饮酒和摄进高脂肪食物", "D": "发作后可用血管扩张药", "language": "zh"}
{"question": "男性，30岁。头痛，时有呕吐，逐渐加重1个月，近期嗜睡，反应迟钝，时有头晕、猝倒，无头部外伤及急性炎症病史，血压正常。检查见视神经乳头水肿，血常规、血沉正常。2．根据以上的初步诊断，其首选的辅助检查应是（　　）。", "answer": "脑CT", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "头颈X线摄片", "B": "脑血管造影", "C": "脑CT", "D": "脑MRI", "language": "zh"}
{"question": "成年人受到持续寒冷刺激时，产热量大为增加的主要方式是（　　）。", "answer": "骨骼肌代谢增强", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "肝脏代谢增强", "B": "基础代谢增强", "C": "肌紧张产热", "D": "骨骼肌代谢增强", "language": "zh"}
{"question": "X线检查吞钡观察食道有无压迹，采取（　　）。", "answer": "右前斜位", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "左侧位", "B": "右侧位", "C": "左前斜位", "D": "右前斜位", "language": "zh"}
{"question": "甲亢术前准备用硫脲类抗甲状腺药的主要目的是（　　）。", "answer": "使甲状腺功能恢复或接近正常，防止术后发生甲状腺危象", "meta_info": "药理学", "answer_idx": "C", "A": "减少手术出血", "B": "使甲状腺腺体缩小变韧，有利于手术进行", "C": "使甲状腺功能恢复或接近正常，防止术后发生甲状腺危象", "D": "防止手术后甲状腺功能低下", "language": "zh"}
{"question": "继发性肺结核临床病理特征不包括（　　）。", "answer": "肺门淋巴结显著肿大", "meta_info": "病理学", "answer_idx": "C", "A": "病变多从肺尖开始", "B": "病程较长，渗出、增生、坏死病变并存", "C": "肺门淋巴结显著肿大", "D": "多见于成人", "language": "zh"}
{"question": "能引起转移性脓肿的细菌是（　　）。", "answer": "葡萄球菌", "meta_info": "第八部分　其他疾病", "answer_idx": "A", "A": "葡萄球菌", "B": "铜绿假单胞菌", "C": "链球菌", "D": "变形杆菌", "language": "zh"}
{"question": "3．判断糖尿病控制程度的指标是（　　）。", "answer": "糖化血红蛋白", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "D", "A": "空腹血糖", "B": "胰岛素释放试验", "C": "葡萄糖耐量试验", "D": "糖化血红蛋白", "language": "zh"}
{"question": "关于霍乱下列各项中不正确的是（　　）。", "answer": "排出粪便为低渗，故血钠多在正常范围", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "D", "A": "剧烈吐泻引起脱水及电解质紊乱", "B": "每日大便排出1000～3000ml，可无或轻度脱水", "C": "每日大便排出10000ml以上可有重度脱水", "D": "排出粪便为低渗，故血钠多在正常范围", "language": "zh"}
{"question": "主要由肾脏细胞产生的细胞因子是（　　）。", "answer": "EPO", "meta_info": "医学免疫学", "answer_idx": "A", "A": "EPO", "B": "IL-2", "C": "1L-15", "D": "IL-5", "language": "zh"}
{"question": "急性普通型肝炎的病变特点是（　　）。", "answer": "肝细胞广泛变性，坏死轻微", "meta_info": "病理学", "answer_idx": "A", "A": "肝细胞广泛变性，坏死轻微", "B": "肝细胞广泛变性，坏死严重", "C": "肝细胞广泛变性，炎细胞浸润明显", "D": "肝细胞广泛变性，淤胆明显", "language": "zh"}
{"question": "A型行为性格与下列（　　）有关。", "answer": "冠心病", "meta_info": "第二部分　模拟试题", "answer_idx": "C", "A": "溃疡病", "B": "风湿性心脏病", "C": "冠心病", "D": "癌症", "language": "zh"}
{"question": "血中直接调节胰岛素分泌而且经常起调节作用的重要因素是（　　）。", "answer": "血糖浓度", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "A", "A": "血糖浓度", "B": "游离脂肪酸", "C": "胃肠道激素", "D": "血酮体浓度", "language": "zh"}
{"question": "关于兴奋在同一细胞内传导的叙述，下列哪项是错误的？（　　）", "answer": "呈电紧张性扩布", "meta_info": "生理学", "answer_idx": "D", "A": "是由局部电流引起的逐步兴奋过程", "B": "有髓神经纤维传导方式为跳跃式", "C": "局部电流强度数倍于阈强度", "D": "呈电紧张性扩布", "language": "zh"}
{"question": "可以全面描述正态分布资料特征的两个指标是（　　）。", "answer": "均数和标准差", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "均数和中位数", "B": "均数和标准差", "C": "均数和极差", "D": "几何均数和标准差", "language": "zh"}
{"question": "肝硬化的实验室检查项目中，诊断意义较大的是（　　）。", "answer": "AFP", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "癌胚抗原", "B": "碱性磷酸酶", "C": "谷氨酰转肽酶", "D": "AFP", "language": "zh"}
{"question": "男性，65岁。皮肤巩膜黄染进行性加重1个月来诊。自述尿色深黄，大便灰白色，查体：扪诊胆囊无肿大，Murphy征阴性，腹部未扪及肿块，诊断首选考虑为（　　）。", "answer": "胰头癌", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "胰头癌", "B": "胆总管下段癌", "C": "肝门部胆管癌", "D": "十二肠腺癌", "language": "zh"}
{"question": "结缔组织玻璃样变的错误描述是（　　）。", "answer": "纤维母细胞增多", "meta_info": "病理学", "answer_idx": "C", "A": "常见于瘢痕组织", "B": "常见于纤维化肾小球", "C": "纤维母细胞增多", "D": "常见于粥样硬化斑块", "language": "zh"}
{"question": "出生后主要的造血器官是（　　）。", "answer": "骨髓", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "肝脏", "B": "骨髓", "C": "髓外", "D": "淋巴结", "language": "zh"}
{"question": "8个月男孩，母乳喂养，未加辅食，生后6个月内生长发育良好，2个月来面色黄、反应呆滞。查体：面色蜡黄，嗜睡，舌震颤，心肺无异常，肝肋下3cm，腱反射亢进，踝阵挛阳性。2．此患儿的发病原因为（　　）。", "answer": "喂养不当", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "喂养不当", "B": "营养物质吸收障碍", "C": "生长发育过快，需要增多", "D": "慢性感染", "language": "zh"}
{"question": "女性，29岁，分娩时大出血，出现淡漠、呆滞、话少、思维迟钝、活动减少，闭经，乳房萎缩，阴毛、腋毛脱落，诊断为席汉病（Sheehandis—Ease）。2．该患者的治疗哪一项是主要的?（　　）", "answer": "激素替代法", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "慎用奋乃静", "B": "禁用氯丙嗪", "C": "激素替代法", "D": "防止感染", "language": "zh"}
{"question": "患者颈椎外伤截瘫。查体：双上肢屈肘位，屈肘动作存在，伸肘功能丧失。损伤部位是在（　　）。", "answer": "5～6颈椎之间", "meta_info": "第四部分　运动系统疾病", "answer_idx": "C", "A": "2～3颈椎之间", "B": "4～5颈椎之间", "C": "5～6颈椎之间", "D": "6～7颈椎之间", "language": "zh"}
{"question": "吗啡戒断症状的产生主要是由于（　　）。", "answer": "去甲肾上腺能神经活性增强", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "去甲肾上腺能神经活性增强", "B": "胆碱能神经活性增强", "C": "多巴胺神经活性增强", "D": "脑啡肽能神经活性增强", "language": "zh"}
{"question": "一种可靠的DNA诊断学方法必须符合的条件中，不包括（　　）。", "answer": "仅用于检测内源基因", "meta_info": "生物化学", "answer_idx": "B", "A": "能正确扩增靶基因", "B": "仅用于检测内源基因", "C": "能准确区分单个碱基的差别", "D": "便于完全自动化操作，适合大面积、大人群普查", "language": "zh"}
{"question": "男，60岁，右髋部疼痛2年余，加重伴跛行1个月，既往有“慢性肾炎史”，长期口服“激素”治疗。体检：右髋关节“4”字试验阳性。3．如果明确诊断为右股骨头缺血性坏死，应该首选的治疗措施是（　　）。", "answer": "人工髋关节置换术", "meta_info": "第四部分　运动系统疾病", "answer_idx": "D", "A": "长期口服止痛药", "B": "外敷活血化淤类药物", "C": "局部封闭治疗", "D": "人工髋关节置换术", "language": "zh"}
{"question": "29岁女性发病1周，巩膜重度黄染，肝界缩小，神志不清，躁动不安。血清总胆红素310μmol/L，ALT200单位，凝血酶原活动变为19%。诊断最可能为（　　）。", "answer": "急性重型肝炎", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "B", "A": "亚急性重型肝炎", "B": "急性重型肝炎", "C": "淤胆型肝炎", "D": "中毒性肝炎", "language": "zh"}
{"question": "哪项是肩关节前脱位病人的首选治疗方法？（　　）", "answer": "手法复位外固定", "meta_info": "第四部分　运动系统疾病", "answer_idx": "D", "A": "悬吊牵引", "B": "手术切开复位内固定", "C": "骨牵引", "D": "手法复位外固定", "language": "zh"}
{"question": "惊厥持续状态是指惊厥持续时间（　　）。", "answer": "＞30分钟", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "＞20分钟", "B": "＞30分钟", "C": "＞40分钟", "D": "＞50分钟", "language": "zh"}
{"question": "以下哪项是尿素在肝的合成部位？（　　）", "answer": "胞浆和线粒体", "meta_info": "生物化学", "answer_idx": "B", "A": "微粒体和高尔基体", "B": "胞浆和线粒体", "C": "胞浆和微粒体", "D": "胞浆和高尔基体", "language": "zh"}
{"question": "唯一能通过胎盘进入胎儿体内的免疫球蛋白是（　　）。", "answer": "IgG", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "IgM", "B": "IgG", "C": "IgA", "D": "IgE", "language": "zh"}
{"question": "极重症营养性贫血的患儿，需输血治疗时，其输血量应如何掌握？（　　）", "answer": "每次输血5～10ml/kg", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "每次输血1～5ml/kg", "B": "每次输血5～10ml/kg", "C": "每次输血15～20ml/kg", "D": "每次输血20～25ml/kg", "language": "zh"}
{"question": "下列各项肺外器官结核病均是由血源播散所致，除了（　　）。", "answer": "肠结核", "meta_info": "病理学", "answer_idx": "A", "A": "肠结核", "B": "肾结核", "C": "结核性脑膜炎", "D": "全身粟粒性结核病（除肺脏病变）", "language": "zh"}
{"question": "关于非条件反射的叙述，错误的是（　　）。", "answer": "它的建立必须有大脑皮质的参与", "meta_info": "生理学", "answer_idx": "C", "A": "生来就有", "B": "数量有限", "C": "它的建立必须有大脑皮质的参与", "D": "对于个体生存和种系生存具有重要意义", "language": "zh"}
{"question": "1．哪项是树突状细胞的表面分子？（　　）", "answer": "MHC-Ⅱ", "meta_info": "医学免疫学", "answer_idx": "C", "A": "CD3", "B": "KIR", "C": "MHC-Ⅱ", "D": "CD19", "language": "zh"}
{"question": "等渗性缺水病人，大量输入生理盐水治疗可导致（　　）。", "answer": "高氯血症", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "D", "A": "低钾血症", "B": "低氯血症", "C": "高钙血症", "D": "高氯血症", "language": "zh"}
{"question": "有限的器官供体与大量需要移植器官的病人之间存在供不应求的矛盾。因此，对有限器官供体的分配存在着尖锐的伦理问题，在下列争论的问题中哪项是绝大多数国家明确反对的？（　　）", "answer": "使器官供体商品化，以扩大移植器官的来源", "meta_info": "医学伦理学", "answer_idx": "C", "A": "有限的器官供体应根据什么原则进行分配", "B": "由谁做出裁决", "C": "使器官供体商品化，以扩大移植器官的来源", "D": "根据什么原则裁决", "language": "zh"}
{"question": "肝硬化的主要病理变化是（　　）。", "answer": "假小叶的形成", "meta_info": "病理学", "answer_idx": "C", "A": "肝细胞大片坏死", "B": "网状纤维支架的塌陷", "C": "假小叶的形成", "D": "肝内纤维组织增生", "language": "zh"}
{"question": "患者腰痛多年，时轻时重，伴双下肢痛。l0天前搬重物后腰腿痛加剧，并出现麻木与排尿困难。查体：腰运动受限，椎旁压痛向下肢放散，直腿高举与足背屈附加试验阳性，马鞍区痛觉减退。3．最主要的治疗措施是（　　）。", "answer": "手术", "meta_info": "第四部分　运动系统疾病", "answer_idx": "C", "A": "牵引", "B": "卧硬床休息", "C": "手术", "D": "激素，非甾体类抗炎剂", "language": "zh"}
{"question": "输血时发生细菌污染反应，其诊断方法较简捷的是（　　）。", "answer": "血袋内血液离心后直接涂片检查", "meta_info": "第一部分　血液系统疾病", "answer_idx": "A", "A": "血袋内血液离心后直接涂片检查", "B": "患者血液和输血袋内血液同时行细菌培养", "C": "患者血液细菌培养", "D": "采用有效抗生素抗感染性休克治疗性诊断", "language": "zh"}
{"question": "急性再障感染最多见于（　　）。", "answer": "呼吸道", "meta_info": "第一部分　血液系统疾病", "answer_idx": "A", "A": "呼吸道", "B": "皮肤黏膜", "C": "肛周感染", "D": "肠道", "language": "zh"}
{"question": "不属于胆红素脑病后遗症的是（　　）。", "answer": "偏瘫", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "手足徐动", "B": "智力落后", "C": "眼球运动障碍", "D": "偏瘫", "language": "zh"}
{"question": "1．人体防御能力与病原体处于相持状态，无临床症状而能排出病原体（　　）。", "answer": "病原携带状态", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "C", "A": "病原体被消灭或排出体外", "B": "隐性感染", "C": "病原携带状态", "D": "潜伏性感染", "language": "zh"}
{"question": "3．CO2从肺毛细血管进入肺泡属于（　　）。", "answer": "单纯扩散", "meta_info": "生理学", "answer_idx": "A", "A": "单纯扩散", "B": "通道介导的易化扩散", "C": "载体介导的易化扩散", "D": "原发性主动转运", "language": "zh"}
{"question": "2．8岁小儿重度贫血的诊断指标是（　　）。", "answer": "Hb＜30g/L", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "Hb～120g/L", "B": "Hb～90g/L", "C": "Hb～60g/L", "D": "Hb＜30g/L", "language": "zh"}
{"question": "在下述氨基酸中碱性氨基酸是（　　）。", "answer": "赖氨酸", "meta_info": "生物化学", "answer_idx": "B", "A": "谷氨酸", "B": "赖氨酸", "C": "丝氨酸", "D": "苏氨酸", "language": "zh"}
{"question": "患儿3岁，近1年多哭甚时出现青紫。查体：心前区隆起，胸骨左缘第3～4肋间可闻及4级收缩期杂音，可触及震预。X线检查示：左右心室及左房增大，肺血管影增多，肺动脉段凸出。3．此患儿如出现了永久性青紫，说明（　　）。", "answer": "形成艾森曼格综合征", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "形成艾森曼格综合征", "B": "合并了肺水肿", "C": "静脉系统淤血", "D": "合并了心力衰竭", "language": "zh"}
{"question": "提出克隆选择学说的是（　　）。", "answer": "Burnet", "meta_info": "医学免疫学", "answer_idx": "A", "A": "Burnet", "B": "Jerne", "C": "Watson", "D": "Crick", "language": "zh"}
{"question": "下列疾病不属于乙类传染病的是（　　）。", "answer": "风疹", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "风疹", "B": "肺炭疽", "C": "传染性非典型肺炎", "D": "肺结核", "language": "zh"}
{"question": "不出现管型尿的疾病是（　　）。", "answer": "急性膀胱炎", "meta_info": "第4篇　泌尿系统", "answer_idx": "D", "A": "急性肾小球肾炎", "B": "急进性肾小球肾炎", "C": "急性肾盂肾炎", "D": "急性膀胱炎", "language": "zh"}
{"question": "巨细胞病毒常引起（　　）。", "answer": "先天性畸形", "meta_info": "医学微生物学", "answer_idx": "C", "A": "带状疱疹", "B": "病毒型脑炎", "C": "先天性畸形", "D": "传染性单核细胞增多症", "language": "zh"}
{"question": "患儿，1岁，发热3天，流涕，咳嗽，咽部及眼结膜充血，在下眼睑边缘见Stimson线，口腔粘膜充血，既往未接种麻疹疫苗。1．该患儿诊断麻疹，属于麻疹病程哪一期？（　　）", "answer": "前驱期", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "潜伏期", "B": "前驱期", "C": "出疹期", "D": "恢复期", "language": "zh"}
{"question": "外周血管痉挛性疾病应选用（　　）。", "answer": "酚妥拉明", "meta_info": "药理学", "answer_idx": "C", "A": "异丙肾上腺素", "B": "山莨菪碱", "C": "酚妥拉明", "D": "间羟胺", "language": "zh"}
{"question": "患者饭后尿糖（++），空腹尿糖阴性，可诊断为（　　）。", "answer": "食后糖尿", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "C", "A": "糖耐量低减", "B": "轻型糖尿病", "C": "食后糖尿", "D": "非葡萄糖糖尿", "language": "zh"}
{"question": "2．每次哺乳时，母乳中呈先低后高变化的营养成分是（　　）。", "answer": "脂肪", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "矿物质", "B": "维生素", "C": "脂肪", "D": "碳水化合物", "language": "zh"}
{"question": "5．震颤麻痹是由于（　　）。", "answer": "黑质致密区含黑色素的神经元缺失", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "中枢神经系统脱髓鞘疾病", "B": "周围神经系统脱髓鞘疾病", "C": "血清钾低", "D": "黑质致密区含黑色素的神经元缺失", "language": "zh"}
{"question": "人体实验应该得到受试者完全知情同意、并在没有任何压力和自愿的状态下进行。这一原则最早出自何种国际性法典、宣言或协议？（　　）", "answer": "《纽伦堡法典》", "meta_info": "医学伦理学", "answer_idx": "A", "A": "《纽伦堡法典》", "B": "《赫尔辛基宣言》", "C": "《悉尼宣言》", "D": "日内瓦协议", "language": "zh"}
{"question": "男，42岁。高血压1年，乏力1周，未服药。查体：BP 150／100mmHg。心率76次/分。实验室检查：血钾2.9mmol/L，腹部B超示左侧肾上腺结节1.5cm×1.5cm。该患者最有助于明确诊断的筛查指标是（　　）。", "answer": "血浆醛固酮/血浆肾素活性比值", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "血促肾上腺皮质激素水平", "B": "血浆游离间苄肾上腺素水平", "C": "血浆醛固酮/血浆肾素活性比值", "D": "血浆肾素水平", "language": "zh"}
{"question": "下列方法中，下列哪项为精神分析治疗的常用方法？（　　）", "answer": "自由联想", "meta_info": "医学心理学", "answer_idx": "D", "A": "系统脱敏法", "B": "厌恶治疗", "C": "消退法", "D": "自由联想", "language": "zh"}
{"question": "患者，女，35岁。因尿频、尿急、尿痛2天就诊。体检：体温38.5℃。右肾区叩痛明显，尿常规：蛋白（＋＋），白细胞满视野，红细胞10～15个/HP。4．[假设信息]若追问病史，本例在1个月前有相似发作，中段尿培养为变形杆菌，菌落计数＞105/ml，本次培养结果尚未报告。此时应考虑的诊断是（　　）。", "answer": "复发", "meta_info": "第4篇　泌尿系统", "answer_idx": "D", "A": "慢性肾盂肾炎", "B": "慢性间质性肾炎", "C": "再感染", "D": "复发", "language": "zh"}
{"question": "男性60岁，腰痛3周，无明湿外伤史，X线片示第3腰椎椎体破坏，压缩楔形变，椎间隙正常，最可能的诊断（　　）。", "answer": "脊椎肿瘤", "meta_info": "第四部分　运动系统疾病", "answer_idx": "B", "A": "脊椎结核", "B": "脊椎肿瘤", "C": "强直性脊柱炎", "D": "化脓性脊椎炎", "language": "zh"}
{"question": "高钾血症的病因不包括（　　）。", "answer": "应用袢利尿剂", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "慢性肾衰竭", "B": "应用袢利尿剂", "C": "应用螺内酯", "D": "挤压综合征", "language": "zh"}
{"question": "下列治疗军团菌病的首选药物是（　　）。", "answer": "红霉素", "meta_info": "药理学", "answer_idx": "B", "A": "青霉素G", "B": "红霉素", "C": "四环素", "D": "氯霉素", "language": "zh"}
{"question": "28岁不孕妇女，痛经3年且逐渐加重。妇科检查：子宫后壁有2个触痛性硬韧结节，右侧附件区扪及超鸭卵大、活动不良的囊性肿物，压痛不明显。1．为进一步确诊，最有价值的辅助检查方法是（　　）。", "answer": "腹腔镜检查", "meta_info": "第二部分　模拟试题", "answer_idx": "D", "A": "盆腔B超检查", "B": "诊断性刮宫活组织检查", "C": "子宫输卵管碘油造影", "D": "腹腔镜检查", "language": "zh"}
{"question": "下述形成心室肌细胞动作电位的离子基础，哪一项是错误的？（　　）", "answer": "1期主要是Cl-外流", "meta_info": "生理学", "answer_idx": "B", "A": "0期主要是Na+内流", "B": "1期主要是Cl-外流", "C": "3期主要是K+外流", "D": "4期有K+内流", "language": "zh"}
{"question": "1岁小儿患麻疹后5周，低热，食欲不振，消瘦，盗汗。查体：两肺无湿罗音。OT试验1:2000浓度结果为阴性。下列哪一项检查最重要？（　　）", "answer": "胸部X线摄片", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "血培养", "B": "白细胞计数及分类", "C": "胸部X线摄片", "D": "痰培养", "language": "zh"}
{"question": "2．肝细胞脂肪变的病变是（　　）。", "answer": "肝细胞体积增大，胞质大小不等的空泡，苏丹（＋）", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "肝细胞体积增大，双核，核仁明显", "B": "肝细胞体积增大，胞质大小不等的空泡，苏丹（＋）", "C": "肝细胞体积增大，胞质疏松，淡染，透明度增加", "D": "肝细胞体积缩小，胞质疏松，透明度增加", "language": "zh"}
{"question": "特发性血小板减少性紫癫做骨髓穿刺的目的是（　　）。", "answer": "了解巨核细胞数量及有无成熟障碍", "meta_info": "第一部分　血液系统疾病", "answer_idx": "C", "A": "证明有血小板减少", "B": "了解有无合并缺铁性贫血", "C": "了解巨核细胞数量及有无成熟障碍", "D": "证明有血小板抗体存在", "language": "zh"}
{"question": "2．传导速度最快的是（　　）。", "answer": "浦肯野纤维", "meta_info": "生理学", "answer_idx": "D", "A": "窦房结", "B": "心室肌", "C": "房室交界", "D": "浦肯野纤维", "language": "zh"}
{"question": "4岁幼儿，摔倒后肩部疼痛。检查发现患肩下沉，患肢活动障碍，头向患侧偏斜，杜加（Dugas）征阴性。最可能的诊断是（　　）。", "answer": "锁骨骨折", "meta_info": "第四部分　运动系统疾病", "answer_idx": "B", "A": "肩关节脱位", "B": "锁骨骨折", "C": "肱骨外科颈骨折", "D": "桡骨小头半脱位", "language": "zh"}
{"question": "男，32岁。发热，T 39.5℃，腹痛，腹泻，全身乏力，询问病史常在街边小摊进食，查体：精神淡漠，P 88次/分。患者的病理变化不包括（　　）。", "answer": "黏膜下有凹空细胞", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "大量浆液分泌亢进", "B": "黏膜水肿", "C": "黏膜下有凹空细胞", "D": "中性粒细胞浸润", "language": "zh"}
{"question": "深Ⅱ度烧伤，若无感染等并发症，通常愈合时间为（　　）。", "answer": "3～4周", "meta_info": "第八部分　其他疾病", "answer_idx": "C", "A": "2～3日", "B": "2周", "C": "3～4周", "D": "5周以上", "language": "zh"}
{"question": "6个月，男婴，人工喂养。平时易惊、多汗、睡眠少，近2日来咳嗽、低热，今晨突然双眼凝视，手足抽动。查体：枕后有乒乓球感。1．患儿最可能是（　　）。", "answer": "血清钙降低", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "血清钙降低", "B": "血清镁降低", "C": "血清钠降低", "D": "脑脊液细胞数增多", "language": "zh"}
{"question": "黄某于2001年10月因医疗事故受到吊销医师执业证书的行政处罚，2002年9月向当地卫生行政部门申请重新注册。卫生行政部门经过审查决定对黄某不予注册，理由是黄某的行政处罚自处罚决定之日起至申请注册之日止不满（　　）。", "answer": "2年", "meta_info": "第二部分　模拟试题", "answer_idx": "A", "A": "2年", "B": "3年", "C": "4年", "D": "5年", "language": "zh"}
{"question": "小儿腹泻是指（　　）。", "answer": "多病原，多因素引起的腹泻为主的综合征", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "病毒性肠炎", "B": "喂养不当引起的腹泻", "C": "多病原，多因素引起的腹泻为主的综合征", "D": "肠道外感染引起的腹泻", "language": "zh"}
{"question": "男，21岁，右利，突然癫痫发作并伴头痛、呕吐、颈项强直、低热、命名性失语。2．查体时，下述哪项检查如有阳性发现对定性诊断最有帮助？（　　）", "answer": "头颅听诊", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "心脏听诊", "B": "眼底检查", "C": "头颅听诊", "D": "瞳孔检查", "language": "zh"}
{"question": "2．婴儿痉挛症首选（　　）。", "answer": "ACTH", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "卡马西平", "B": "乙琥胺", "C": "苯妥英钠", "D": "ACTH", "language": "zh"}
{"question": "2．脑性瘫痪（　　）。", "answer": "痉挛性瘫痪", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "不对称性迟缓性瘫痪，有感觉障碍", "B": "不对称性迟缓性瘫痪，无感觉障碍", "C": "对称性迟缓性瘫痪，无感觉障碍", "D": "痉挛性瘫痪", "language": "zh"}
{"question": "患儿，男，7月，因发热、腹泻2天于10月16日入院。2天前开始发热，呕吐2次，继之出现腹泻，稀水样便6～8次/天，量多，次日热退吐止，腹泻加重，尿量减少，精神萎靡，前囟眼窝凹陷，皮肤弹性差，心肺听诊阴性。4．如果第1天补液后明显好转，排尿2次，脱水纠正，晚上突然发生全身性抽搐，应考虑下列哪项（　　）。", "answer": "低钙血症", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "低镁血症", "B": "低钙血症", "C": "低钾血症", "D": "低钠血症", "language": "zh"}
{"question": "女性，45岁。右乳1.5cm×1.0cm肿块，活动度大。穿刺细胞学诊断为：乳腺癌。右侧腋窝扪及多枚肿大、质硬、整合的淋巴结，锁骨上、颈部未扪及淋巴结，检查未发现远处转移征象。该病人的临床分期为（　　）。", "answer": "T1N2M0", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "T1N1M0", "B": "T1N2M0", "C": "T2N2M0", "D": "T1N3M0", "language": "zh"}
{"question": "断肢在行再植手术之前应保存在（　　）。", "answer": "用无菌或清洁敷料包扎后干燥冷藏", "meta_info": "第四部分　运动系统疾病", "answer_idx": "C", "A": "乳酸林格液", "B": "75％酒精", "C": "用无菌或清洁敷料包扎后干燥冷藏", "D": "置于37℃恒温箱中", "language": "zh"}
{"question": "5岁男，浮肿7天，体检有高度浮肿，血压120/75mmHg，尿蛋白（+++），24小时尿蛋白定量2500mg，尿沉渣RBC 2～3/HP，BUN 5.4mmol/L。最可能的诊断是（　　）。", "answer": "肾病综合征", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "急性肾炎", "B": "肾病综合征", "C": "肾炎性肾病", "D": "迁延性肾炎", "language": "zh"}
{"question": "下列哪项为栓塞中最常见的类型？（　　）", "answer": "血栓栓塞", "meta_info": "病理学", "answer_idx": "A", "A": "血栓栓塞", "B": "气体栓塞", "C": "羊水栓塞", "D": "脂肪栓塞", "language": "zh"}
{"question": "男，68岁，吸烟、饮酒40多年。有高血压病史。某年冬天晨起时发现左下肢不能动，入院后诊断为脑卒中。以下医生的建议不合理的是（　　）。", "answer": "告知患者天气太冷是引发该病的直接因素", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "不良生活方式是疾病原因之一，应戒烟限酒", "B": "控制血压，预防再发", "C": "告知患者定期来医院检查身体", "D": "告知患者天气太冷是引发该病的直接因素", "language": "zh"}
{"question": "2．患者男性，32岁，Ⅲ度烧伤40%，伤后10天，体温40℃，心率140次/分，呼吸36次/分，创面湿，灶性积脓，创周炎症明显。血白细胞为20×109/L，血培养无菌生长，考虑为（　　）。", "answer": "创面脓毒症", "meta_info": "第八部分　其他疾病", "answer_idx": "C", "A": "败血症", "B": "菌血症", "C": "创面脓毒症", "D": "真菌败血症", "language": "zh"}
{"question": "以下有关中毒型痢疾的描述正确的是（　　）。", "answer": "结肠局部病变很轻，仅有充血水肿，很少有溃疡", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "C", "A": "以腹痛、腹泻、脓血便为首发及主要表现", "B": "常引起败血症", "C": "结肠局部病变很轻，仅有充血水肿，很少有溃疡", "D": "其中休克型表现最凶险", "language": "zh"}
{"question": "属于非典型抗精神病药物的是（　　）。", "answer": "氯氮平", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "氯氮平", "B": "氯丙咪嗪", "C": "卡马西平", "D": "阿扑吗啡", "language": "zh"}
{"question": "3．由交感缩血管神经末梢释放的主要神经递质是（　　）。", "answer": "去甲肾上腺素", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "普萘洛尔", "B": "去甲肾上腺素", "C": "酚妥拉明", "D": "肾上腺素", "language": "zh"}
{"question": "下列哪支血管病变可引起延髓脊外侧综合征？（　　）", "answer": "椎动脉或小脑后下动脉", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "大脑前动脉", "B": "大脑后动脉", "C": "椎动脉或小脑后下动脉", "D": "前交通动脉", "language": "zh"}
{"question": "某乳癌患者，病检发现癌实质多，间质成分少，癌细胞呈片状或巢状，中央有坏死，间质无淋巴细胞浸润，应诊为（　　）。", "answer": "髓样癌", "meta_info": "病理学", "answer_idx": "B", "A": "单纯癌", "B": "髓样癌", "C": "小叶原位癌", "D": "导管内原位癌", "language": "zh"}
{"question": "男性，24岁，突然意识不清，跌倒，全身强直数秒钟后抽搐，咬破舌。2分钟后抽搐停止。醒后活动正常。1．首先应考虑的疾病是（　　）。", "answer": "癫痫", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "脑出血", "B": "脑血栓", "C": "癫痫", "D": "脑栓塞", "language": "zh"}
{"question": "格林–巴利征不常有的表现是（　　）。", "answer": "胸4以下传导束性痛温觉障碍", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "四肢弛缓性瘫", "B": "双侧周围性面瘫", "C": "肌肉萎缩", "D": "胸4以下传导束性痛温觉障碍", "language": "zh"}
{"question": "女，35岁，初产妇。妊娠34＋1周，头痛1天。查体：BP 170/110mmHg，胎心率150次/分，胎儿大小相当于32周，羊水深度2.0cm。尿蛋白（＋＋＋）。该患者正确的处理原则是（　　）。", "answer": "硫酸镁解痉后剖宫产", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "解痉降压后羊膜腔内药物引产", "B": "硫酸镁解痉后剖宫产", "C": "对症处理继续妊娠", "D": "降压的同时宫缩素引产", "language": "zh"}
{"question": "1．上述哪项最能体现保护病人隐私的准则？（　　）", "answer": "医生使用艾滋病患者病情资料时，应做隐去姓名等处理", "meta_info": "医学伦理学", "answer_idx": "C", "A": "医生为患者选用疗效相当但价格低廉的药物", "B": "医生为患者提供完全、真实的信息，供其选择表态", "C": "医生使用艾滋病患者病情资料时，应做隐去姓名等处理", "D": "医生治疗时应努力使病人受益", "language": "zh"}
{"question": "下列哪一个脏器通常不发生凝固性坏死？（　　）", "answer": "脑", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "脑", "B": "肠", "C": "子宫", "D": "肺", "language": "zh"}
{"question": "淤血不会引起（　　）。", "answer": "实质细胞增生", "meta_info": "病理学", "answer_idx": "D", "A": "水肿", "B": "血栓形成", "C": "变性、坏死", "D": "实质细胞增生", "language": "zh"}
{"question": "男，38岁。车祸致胸部损伤，出现严重呼吸困难。查体：BP 80/60mmHg，脉细速，皮肤完整，气管左移，颈静脉充盈，颈部及右胸部皮下气肿，右胸饱满，肋间隙增宽，叩诊鼓音，右肺呼吸音消失。2．其主要的病理生理紊乱为（　　）。", "answer": "患侧胸膜腔正压", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "静脉回心血量增加", "B": "纵隔扑动", "C": "患侧胸膜腔正压", "D": "急性肺水肿", "language": "zh"}
{"question": "关于审慎，下述提法中错误的是（　　）。", "answer": "审慎与个人性格有关，是与生俱来的", "meta_info": "医学伦理学", "answer_idx": "C", "A": "审慎是一种处世态度", "B": "审慎是一种智慧表现", "C": "审慎与个人性格有关，是与生俱来的", "D": "审慎是以知识技能和冷静客观分析甚至丰富的经验为基础的", "language": "zh"}
{"question": "股骨转子间骨折与股骨颈骨折临床主要不同点是（　　）。", "answer": "远折骨折段处于极度外旋位", "meta_info": "第四部分　运动系统疾病", "answer_idx": "D", "A": "功能严重丧失", "B": "肿胀不明显", "C": "骨摩擦音，骨擦感不明显", "D": "远折骨折段处于极度外旋位", "language": "zh"}
{"question": "现代医学模式要求医务人员既要维护患者的利益，又要兼顾社会公益。下列几点中，错误的是（　　）。", "answer": "保护患者无损害的权利", "meta_info": "医学伦理学", "answer_idx": "C", "A": "尊重病人的知情同意的权利", "B": "尊重病人知情选择的权利", "C": "保护患者无损害的权利", "D": "尊重医生的行医权利", "language": "zh"}
{"question": "保存期内的全血最主要的有效成分是（　　）。", "answer": "红细胞", "meta_info": "第二部分　模拟试题", "answer_idx": "A", "A": "红细胞", "B": "白细胞", "C": "血小板", "D": "免疫球蛋白", "language": "zh"}
{"question": "45岁男性，经理，送来急诊，自述半小时前突然感到气紧、胸闷、心悸、头晕、出汗，认为生命垂危，要求紧急处理。近1个月来，这种情况发生过3次，每次持续约0.5～1小时，发病间隙期一切正常，发病与饮食无明显关系。2．最有助于鉴别诊断的项目是（　　）。", "answer": "追问起病诱因", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "追问起病诱因", "B": "心电图", "C": "脑电图", "D": "脑CT", "language": "zh"}
{"question": "1．《医疗事故处理条例》规定，残疾生活补助费应根据伤残等级，自定残之月起最长赔偿（　　）。", "answer": "30年", "meta_info": "卫生法规", "answer_idx": "D", "A": "5年", "B": "10年", "C": "20年", "D": "30年", "language": "zh"}
{"question": "男性，23岁，24小时前因车祸引起左下肢胫骨及腓骨开放性、粉碎性骨折，入院清除固定后12小时，出现左小腿及左足青紫、肿胀，患者出现发热和全身不适。次日肿胀加剧，累及左大腿，伤口流出伴有气泡的恶臭脓汁，肿胀区按之有捻发音。左小腿的坏死为（　　）。", "answer": "气性坏疽", "meta_info": "病理学", "answer_idx": "B", "A": "湿性坏疽", "B": "气性坏疽", "C": "液化性坏死", "D": "干酪样坏死", "language": "zh"}
{"question": "哪项是结核性肉芽肿的特异性诊断？（　　）", "answer": "中央为干酪样坏死，可见郎汉斯巨细胞", "meta_info": "病理学", "answer_idx": "C", "A": "增生的上皮样细胞", "B": "大量的淋巴细胞浸润", "C": "中央为干酪样坏死，可见郎汉斯巨细胞", "D": "境界清楚的肉芽肿", "language": "zh"}
{"question": "具有亲细胞作用的抗体是（　　）。", "answer": "IgE", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "IgM", "B": "IgD", "C": "IgE", "D": "IgA", "language": "zh"}
{"question": "男，50岁，被发现昏倒在煤气热水器浴室内。查体：浅昏迷，血压160/90mmHg，口唇樱红色，四肢无瘫痪，尿糖（++），尿酮体（－），诊断最可能是（　　）。", "answer": "急性一氧化碳中毒", "meta_info": "第八部分　其他疾病", "answer_idx": "C", "A": "脑出血", "B": "急性心肌梗死", "C": "急性一氧化碳中毒", "D": "糖尿病酮症酸中毒", "language": "zh"}
{"question": "男，70岁。急性前壁心肌梗死7小时，就诊时突然心悸，无头晕，查体：BP 100／70mmHg，双肺呼吸音清，心率88次/分，律不齐。心电监测示：频发室性期前收缩。2．患者心悸进行性加重，伴喘憋，不能平卧。查体：BP 90／60mmHg，端坐位，急性病容，双下肺可闻及湿性啰音，心率105次/分，律不齐，心电监测提示频发室性期前收缩。该患者喘憋的最可能原因是（　　）。", "answer": "急性左心衰", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "急性肺部感染", "B": "急性左心衰", "C": "气胸", "D": "支气管哮喘", "language": "zh"}
{"question": "女性，24岁，发热腰痛3天，体温38.0℃，巩膜黄染，肝肋下，1.0cm，脾肋下4cm，尿胆原（++），血清胆红素25μmol/L，血红蛋白80g/L，白细胞13.0×109/L，血象可见晚幼红细胞，骨髓增生明显活跃，中晚幼细胞增多，粒红比0.8:l。诊断为（　　）。", "answer": "自身免疫性溶血性贫血", "meta_info": "第一部分　血液系统疾病", "answer_idx": "D", "A": "慢性肝炎急性发作", "B": "急性黄疸型肝炎", "C": "急性红白血病", "D": "自身免疫性溶血性贫血", "language": "zh"}
{"question": "2．上述哪项引起下颌偏斜？（　　）", "answer": "三叉神经损害", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "外展神经损害", "B": "三叉神经损害", "C": "面神经损害", "D": "舌下神经损害", "language": "zh"}
{"question": "麻疹合并肺炎者应隔离至（　　）。", "answer": "出疹后10天", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "出疹后5天", "B": "出疹后10天", "C": "出疹后15天", "D": "出疹后3天", "language": "zh"}
{"question": "贫血定义是指单位容积血液内（　　）。", "answer": "红细胞计数、血红蛋白浓度和（或）红细胞压积低于正常", "meta_info": "第一部分　血液系统疾病", "answer_idx": "B", "A": "红细胞数低于正常", "B": "红细胞计数、血红蛋白浓度和（或）红细胞压积低于正常", "C": "红细胞计数及血红蛋白浓度低于正常", "D": "红细胞计数及红细胞压积低于正常", "language": "zh"}
{"question": "确诊流行性脑脊髓膜炎最可靠的根据是（　　）。", "answer": "以上都不是", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "D", "A": "皮肤有瘀点及瘀斑", "B": "高热、头痛、呕吐", "C": "脑脊液符合化脓性脑膜炎改变", "D": "以上都不是", "language": "zh"}
{"question": "哪项是最易引起血管神经损伤的股骨干骨折部位？（　　）", "answer": "下1/3", "meta_info": "第四部分　运动系统疾病", "answer_idx": "B", "A": "上1/3", "B": "下1/3", "C": "上中1/3交界处", "D": "以上都不是", "language": "zh"}
{"question": "3．常伴有先天性心脏病的是（　　）。", "answer": "21-三体综合征", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "21-三体综合征", "B": "苯丙酮尿症", "C": "佝偻病", "D": "糖尿病", "language": "zh"}
{"question": "某患者近期发现肝大（肋下4cm），质硬，有大小不等的结节，伴低热、纳差，轻度黄疸。HBsAg（＋），ALT 40U/L，AFP 800μg/L。最可能的诊断是（　　）。", "answer": "原发性肝癌", "meta_info": "第3篇　消化系统", "answer_idx": "C", "A": "急性黄疸型肝炎", "B": "大结节性肝硬化", "C": "原发性肝癌", "D": "胆汁性肝硬化", "language": "zh"}
{"question": "我国现在引起慢性肾功能不全的病因最常见的是（　　）。", "answer": "慢性肾小球肾炎", "meta_info": "第4篇　泌尿系统", "answer_idx": "D", "A": "肾小动脉硬化", "B": "急进性肾小球肾炎", "C": "慢性肾盂肾炎", "D": "慢性肾小球肾炎", "language": "zh"}
{"question": "1．肝细胞内Malloy小体（　　）。", "answer": "玻璃样变性", "meta_info": "病理学", "answer_idx": "B", "A": "水变性", "B": "玻璃样变性", "C": "纤维素样变性", "D": "钙化", "language": "zh"}
{"question": "钩端螺旋体病稻田型的传染源是（　　）。", "answer": "鼠", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "A", "A": "鼠", "B": "犬", "C": "牛", "D": "猪", "language": "zh"}
{"question": "胃癌最主要的转移途径是（　　）。", "answer": "淋巴道转移", "meta_info": "病理学", "answer_idx": "B", "A": "血行转移", "B": "淋巴道转移", "C": "直接蔓延", "D": "种植转移", "language": "zh"}
{"question": "下列关于肉芽组织的描述，哪项是错误的？（　　）", "answer": "肉芽组织鲜红色颗粒状、质韧", "meta_info": "病理学", "answer_idx": "C", "A": "肉芽组织由新生的毛细血管及成纤维细胞构成", "B": "肉芽组织可抗感染保护创面", "C": "肉芽组织鲜红色颗粒状、质韧", "D": "其中常有大量渗出液及炎细胞", "language": "zh"}
{"question": "男性，26岁，突然大喊大叫：“不得了啦，我爸爸被刺得稀烂，这儿净是戴铜帽子的人，你们看，他们正在刺我爸爸。”患者异常恐惧。此症状为（　　）。", "answer": "真性幻视", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "焦虑", "B": "思维障碍", "C": "假性幻视", "D": "真性幻视", "language": "zh"}
{"question": "男性，34岁，诊断急性粒细胞白血病M3，化疗时突发DIC，并迅速发展到消耗性低凝期，下述检查结果，哪一项不正确（　　）。", "answer": "凝血酶原时间缩短", "meta_info": "第一部分　血液系统疾病", "answer_idx": "B", "A": "纤维蛋白原浓度降低", "B": "凝血酶原时间缩短", "C": "血小板因子4水平增高", "D": "抗凝血酶Ⅲ水平减低", "language": "zh"}
{"question": "患者，男，60岁。因肝硬化一次排放腹水3000ml而无尿，诊断应首先考虑为（　　）。", "answer": "肾前性肾衰竭", "meta_info": "第二部分　模拟试题", "answer_idx": "B", "A": "急性心力衰竭", "B": "肾前性肾衰竭", "C": "肾后性肾衰竭", "D": "肾性肾衰竭", "language": "zh"}
{"question": "3．两端开口的通道样坏死缺损（　　）。", "answer": "瘘管", "meta_info": "病理学", "answer_idx": "C", "A": "糜烂", "B": "溃疡", "C": "瘘管", "D": "空洞", "language": "zh"}
{"question": "1．肺外结核最常引起的形态改变是（　　）。", "answer": "回盲部肠腔狭窄", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "直肠息肉形成", "B": "脾脏白色锥形病灶", "C": "回盲部肠腔狭窄", "D": "胃壁溃疡形成", "language": "zh"}
{"question": "关于动脉粥样硬化症的描述，哪项是正确的？（　　）", "answer": "氧化低密度脂蛋白具有细胞毒性", "meta_info": "病理学", "answer_idx": "C", "A": "主动脉脂纹仅见于中年以上人群", "B": "粥瘤内泡沫细胞均来自单核细胞", "C": "氧化低密度脂蛋白具有细胞毒性", "D": "粥瘤内胶原由纤维母细胞形成", "language": "zh"}
{"question": "患儿，男，8个月，咳嗽、发热1周，喘憋3天，逐渐加重，今日开始嗜睡，抽搐2次，体温不退，高达39.5℃。查体：呼吸急促，呼吸56次/分，心率100次/分，双肺广泛的中小水泡音，肝肋下1cm。血白细胞4×109/L；脑脊液检查提示压力升高，糖、氯化物正常，细胞数个，蛋白质定性阴性。2．该患儿最可能的诊断是（　　）。", "answer": "腺病毒肺炎合并中毒性脑病", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "腺病毒肺炎合并中毒性脑病", "B": "病毒性脑炎", "C": "瑞氏综合征", "D": "金黄色葡萄球菌肺炎合并中毒脑病", "language": "zh"}
{"question": "医师在执业活动中除正当治疗外，不得使用（　　）。", "answer": "麻醉药品", "meta_info": "卫生法规", "answer_idx": "D", "A": "保健药品", "B": "消毒药剂", "C": "有禁忌证的药", "D": "麻醉药品", "language": "zh"}
{"question": "女婴，足月顺产，出生体重3200g，生后48小时，血清总胆红素297.5μmol/L。在检查黄疸的原因时，首选的治疗方法是（　　）。", "answer": "光照疗法", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "光照疗法", "B": "清蛋白输注", "C": "换血", "D": "输血浆", "language": "zh"}
{"question": "男，35岁。左股骨干骨折内固定术后2天，突发右胸痛，咳嗽，氧饱和度显示92％，心肺查体未见明显异常。应首先考虑的诊断是（　　）。", "answer": "脂肪栓塞", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "脂肪栓塞", "B": "急性呼吸窘迫综合征", "C": "肺血栓栓塞", "D": "胸膜炎", "language": "zh"}
{"question": "患者，男，47岁。突然神志丧失，呼吸不规则，即刻进行心脏按压。判断其是否有效的主要方法（　　）。", "answer": "扪股动脉搏动", "meta_info": "第2篇　心血管系统", "answer_idx": "C", "A": "呼喊患者看其是否清醒", "B": "扪桡动脉搏动", "C": "扪股动脉搏动", "D": "观察末梢循环状况", "language": "zh"}
{"question": "男，68岁。间断发热1个月，咯血伴进行性少尿10天。查体：BP 165／100mmHg，双中下肺可闻及湿性啰音，双下肢水肿。尿常规：RBC 40～50/HP，蛋白（＋＋）。血Cr 455μmol/L，BUN 18.5mmol/L，B超示双肾增大。ANA（－），抗中性粒细胞胞质抗体阳性。最可能的诊断是（　　）。", "answer": "急进性肾小球肾炎Ⅲ型", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "急进性肾小球肾炎Ⅱ型", "B": "急进性肾小球肾炎Ⅲ型", "C": "急进性肾小球肾炎", "D": "急进性肾小球肾炎Ⅰ型", "language": "zh"}
{"question": "3．医疗器械（　　）。", "answer": "红外线", "meta_info": "医学微生物学", "answer_idx": "C", "A": "烧灼", "B": "干烤", "C": "红外线", "D": "巴氏消毒", "language": "zh"}
{"question": "下列各项进行底物磷酸化的反应是（　　）。", "answer": "琥珀酰CoA一琥珀酸", "meta_info": "生物化学", "answer_idx": "B", "A": "丙酮酸一乙酰辅酶A", "B": "琥珀酰CoA一琥珀酸", "C": "葡萄糖一6-磷酸葡萄糖", "D": "3-磷酸甘油醛一1，3-二磷酸甘油醛", "language": "zh"}
{"question": "以下对支气管扩张症最有诊断意义的是（　　）。", "answer": "薄层CT示肺野外1/3可见支气管", "meta_info": "第1篇　呼吸系统", "answer_idx": "D", "A": "咳大量脓痰", "B": "杵状指", "C": "X线胸片示卷发征", "D": "薄层CT示肺野外1/3可见支气管", "language": "zh"}
{"question": "1．阻塞性肺气肿（　　）。", "answer": "以阻塞性通气障碍为主", "meta_info": "第1篇　呼吸系统", "answer_idx": "A", "A": "以阻塞性通气障碍为主", "B": "以限制性通气障碍为主", "C": "以弥漫性障碍为主", "D": "以上都不是", "language": "zh"}
{"question": "作为医学伦理学基本范畴的权利，其重点内容是（　　）。", "answer": "病人的权利", "meta_info": "医学伦理学", "answer_idx": "C", "A": "医师的权利", "B": "医院的权利", "C": "病人的权利", "D": "病人家属的权利", "language": "zh"}
{"question": "2．大叶性肺炎少数可合并发生（　　）。", "answer": "肺肉质变", "meta_info": "病理学", "answer_idx": "A", "A": "肺肉质变", "B": "支气管扩张", "C": "肺结核病", "D": "支气管哮喘", "language": "zh"}
{"question": "下列哪项属于良性肿瘤？（　　）", "answer": "软骨母细胞瘤", "meta_info": "病理学", "answer_idx": "B", "A": "神经母细胞瘤", "B": "软骨母细胞瘤", "C": "无性细胞瘤", "D": "骨髓瘤", "language": "zh"}
{"question": "长期应用氯丙嗪的病人停药后易出现（　　）。", "answer": "迟发性运动障碍", "meta_info": "药理学", "answer_idx": "B", "A": "静坐不能", "B": "迟发性运动障碍", "C": "急性肌张力障碍", "D": "直立性低血压", "language": "zh"}
{"question": "哪项是缺铁性贫血早期最可靠的依据？（　　）", "answer": "血清铁蛋白降低", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "运铁蛋白饱和度降低", "B": "血清铁蛋白降低", "C": "血清铁减少", "D": "红细胞内原卟啉增高", "language": "zh"}
{"question": "下列关于Osserman分型的描述正确的是（　　）。", "answer": "眼肌型仅眼肌受累", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "轻度全身型对药物不敏感", "B": "迟发重症型是在数周内发展而来", "C": "重症急进型多不伴有胸腺瘤", "D": "眼肌型仅眼肌受累", "language": "zh"}
{"question": "心肌的等长调节，通过改变下列哪个因素来调节心脏的泵血功能？（　　）", "answer": "心脏收缩能力", "meta_info": "生理学", "answer_idx": "C", "A": "肌小节的初长度", "B": "横桥联结的数目", "C": "心脏收缩能力", "D": "心室舒张末期容积", "language": "zh"}
{"question": "29岁经产妇，停经10周，下腹阵发性剧烈疼痛8小时伴多量阴道流血，超过月经量，检查宫口开大近2cm。应采取的恰当的治疗是（　　）。", "answer": "行负压吸宫术", "meta_info": "第5篇　女性生殖系统", "answer_idx": "D", "A": "肌内注射黄体酮", "B": "肌内注射硫酸镁", "C": "口服硫酸舒喘灵", "D": "行负压吸宫术", "language": "zh"}
{"question": "患儿，11个月，生后反复患肺炎，2天前开始发热咳嗽、气促、烦躁不安。查体：口唇发绀，呼吸48次/分，心率198次/分，心音低钝，胸骨左级第3、4肋间可闻及3级收缩期杂音，双肺中、小水泡音，肝肋下3.0cm，双足背轻度水肿。3．该病治疗原则哪一项不正确？（　　）", "answer": "慎用洋地黄，不能长时间用", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "积极防治感染", "B": "按时预防接种", "C": "手术治疗大多能根治", "D": "慎用洋地黄，不能长时间用", "language": "zh"}
{"question": "5个月女孩，因发热3天，呕吐2天伴惊厥2次就诊。平时体健，已接种卡介苗，否认结核接触史。1．查体中特别应该注意的体征是（　　）。", "answer": "前囟膨隆", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "克氏征", "B": "巴氏征", "C": "腹壁反射", "D": "前囟膨隆", "language": "zh"}
{"question": "甲亢病人突然出现下肢不能动，最可能的是下述哪一种疾病？（　　）", "answer": "周期性麻痹", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "B", "A": "周围神经炎", "B": "周期性麻痹", "C": "重症肌无力", "D": "肌营养不良症", "language": "zh"}
{"question": "下列哪项为周围性瘫痪的肌张力改变特点？（　　）", "answer": "肌张力减低", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "铅管样增高", "B": "肌张力减低", "C": "齿轮样增高", "D": "肌张力时高时低", "language": "zh"}
{"question": "初产妇第一产程潜伏期延长是指潜伏期超过（　　）。", "answer": "16小时", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "8小时", "B": "10小时", "C": "12小时", "D": "16小时", "language": "zh"}
{"question": "男，56岁。因“肺部感染、休克”入监护室治疗。血气分析提示该患者“代谢性酸中毒，Ⅰ型呼吸衰竭”。为保护患者组织，此时不宜快速纠正酸中毒。其主要原因在于酸中毒时（　　）。", "answer": "氧离曲线右移", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "组织氧摄取能力增加", "B": "肺部获得更多的氧", "C": "组织氧耗量减少", "D": "氧离曲线右移", "language": "zh"}
{"question": "女，25岁，低热，腹痛1个月，尿少，腹围增加1周，查体腹部弥漫压痛（＋），揉面感，移动性浊音阳性。2．如考虑腹腔结核感染，对于确诊最有意义的是（　　）。", "answer": "腹水结核杆菌培养", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "腹水结核杆菌培养", "B": "腹部B型超声检查", "C": "胸腹部CT", "D": "PPD试验", "language": "zh"}
{"question": "男，48岁。间歇性水肿10余年，伴恶心、呕吐2周。血红蛋白70g/L，血压20.7/14.7kPa（155/110mmHg），尿蛋白（＋＋），颗粒管型2～4/HP，尿比重1.010～1.012。1．可能的诊断是（　　）。", "answer": "慢性肾小球肾炎", "meta_info": "第4篇　泌尿系统", "answer_idx": "C", "A": "肝炎后肝硬化", "B": "慢性肾盂肾炎", "C": "慢性肾小球肾炎", "D": "急性肾炎综合征", "language": "zh"}
{"question": "男，38岁。右上臂刀割伤3小时，查体：T 36.9℃，P 102次/分，BP 120/70mmHg，双肺呼吸音清，未闻及干湿性啰音，心律齐，未闻及杂音，腹软，无压痛，右小指及环指的小指半侧感觉明显减退，手指内收障碍。损伤的神经是（　　）。", "answer": "尺神经", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "肌皮神经", "B": "正中神经", "C": "尺神经", "D": "腋神经", "language": "zh"}
{"question": "实验设计的对照原则是为了（　　）。", "answer": "控制非实验因素的干扰，显现实验因素效应", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "控制非实验因素的干扰，显现实验因素效应", "B": "提高实验效应", "C": "提高组间均衡性", "D": "保证组间均衡性", "language": "zh"}
{"question": "女，75岁。胸痛5小时。心电图示V1～V5导联ST段抬高0.5mV。2．对改善预后最有效的措施是（　　）。", "answer": "静脉注射瑞替普酶（rt-PA）", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "卧床休息", "B": "静脉注射瑞替普酶（rt-PA）", "C": "静脉滴注丹红注射液", "D": "静脉滴注极化液", "language": "zh"}
{"question": "2．急性肾小球肾炎的病理类型是（　　）。", "answer": "毛细血管内增生性肾小球肾炎", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "微小病变型肾病", "B": "硬化性肾小球肾炎", "C": "系膜增生性肾小球肾炎", "D": "毛细血管内增生性肾小球肾炎", "language": "zh"}
{"question": "“入芝兰之室，久而不闻其香；入鲍鱼之肆，久而不闻其臭。”说明的是（　　）。", "answer": "感觉适应", "meta_info": "医学心理学", "answer_idx": "A", "A": "感觉适应", "B": "感觉相互作用", "C": "感觉减退", "D": "感受性补偿", "language": "zh"}
{"question": "35岁已婚妇女，停经50天阴道少量出血，3天后止，未就诊。现停经5个月，未觉胎动，伴阴道少量出血7天。1．查体最可能的发现是（　　）。", "answer": "子宫未增大", "meta_info": "第5篇　女性生殖系统", "answer_idx": "A", "A": "子宫未增大", "B": "多普勒可闻及胎心", "C": "宫底脐上一指", "D": "腹部膨隆", "language": "zh"}
{"question": "2．含胆固醇及其酯最多的血浆脂蛋白是（　　）。", "answer": "LDL", "meta_info": "生物化学", "answer_idx": "D", "A": "CM", "B": "VLDL", "C": "IDL", "D": "LDL", "language": "zh"}
{"question": "女孩，10岁，干咳4天，伴胸痛、发热3天。体温37.5℃，双肺未闻及中小水泡音。血常规：白细胞9.0×109/L，中性粒细胞占0.65。X线正位片示右下肺片状阴影。为明确诊断应首选哪一项检查？（　　）", "answer": "冷凝集试验", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "ESR", "B": "OT试验", "C": "血常规", "D": "冷凝集试验", "language": "zh"}
{"question": "可以诊断胎儿窘迫的依据是（　　）。", "answer": "破膜见羊水粪染", "meta_info": "第5篇　女性生殖系统", "answer_idx": "B", "A": "胎心150/分", "B": "破膜见羊水粪染", "C": "胎动40次/24小时", "D": "胎心监测示“早期减速”", "language": "zh"}
{"question": "某种心理测验在某一人群中测查结果的标准量数为（　　）。", "answer": "常模", "meta_info": "医学心理学", "answer_idx": "A", "A": "常模", "B": "量表", "C": "信度", "D": "效度", "language": "zh"}
{"question": "某镇卫生院3名医务人员违反《献血法》规定，将不符合国家规定标准的血液用于患者。由于患者家属及时发现，经治医师采取果断措施，幸好未给受血者健康造成损害。根据《献血法》规定，当地县卫生局应对3名医务人员给予的行政处理是（　　）。", "answer": "责令改正", "meta_info": "卫生法规", "answer_idx": "A", "A": "责令改正", "B": "警告", "C": "暂停执业活动6个月以上1年以下", "D": "吊销其医师执业证书", "language": "zh"}
{"question": "男，56岁，陈旧前壁心肌梗死1年，糖尿病病史3年，无高血压病史，有吸烟史，查体：BP 130/80mmHg，心率67次/min，律齐。该患者血低密度脂蛋白胆固醇的治疗目标值是低于（　　）。", "answer": "2.07mmol/L", "meta_info": "第2篇　心血管系统", "answer_idx": "D", "A": "3.37mmol/L", "B": "2.59mmol/L", "C": "1.40mmol/L", "D": "2.07mmol/L", "language": "zh"}
{"question": "患者，男，28岁。反复腹痛、腹泻7个月就诊，腹痛以右下腹为主，腹泻每日2～3次，糊状，无黏液及脓血。体检：右下腹轻度压痛，无反跳痛，肛周有瘘管。粪常规（－），胃肠钡餐造影见回盲部有线样征。2．本病的病因可能是（　　）。", "answer": "免疫反应", "meta_info": "第3篇　消化系统", "answer_idx": "C", "A": "结核杆菌感染", "B": "病毒感染", "C": "免疫反应", "D": "螺旋杆菌感染", "language": "zh"}
{"question": "伤寒病理学的主要特点是（　　）。", "answer": "全身单核一吞噬细胞系统的增生性反应", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "C", "A": "心肌坏死", "B": "骨髓受抑制", "C": "全身单核一吞噬细胞系统的增生性反应", "D": "肝细胞广泛坏死", "language": "zh"}
{"question": "患者，女，48岁。反复发生尿急、尿频、尿痛伴腰痛与低热10余年。曾查尿蛋白（＋＋），近1年来出现无力，纳差、清晨恶心，偶尔呕吐。近日症状再现，尿蛋白（＋），尿沉渣镜检白细胞20～30个/HP、红细胞偶见，血尿素氮13.6mmol/L，血肌酐353.6μmol/L，血红蛋白90g/L。1．患者肾功能不全的临床分期为（　　）。", "answer": "肾功能不全失代偿期", "meta_info": "第4篇　泌尿系统", "answer_idx": "A", "A": "肾功能不全失代偿期", "B": "肾功能不全代偿期", "C": "肾功能正常", "D": "肾衰竭终末期", "language": "zh"}
{"question": "5．烧伤后形成黑绿色痂见于（　　）。", "answer": "硫酸烧伤", "meta_info": "第八部分　其他疾病", "answer_idx": "A", "A": "硫酸烧伤", "B": "氢氟酸烧伤", "C": "生石灰烧伤", "D": "磷烧伤", "language": "zh"}
{"question": "男，70岁。吞咽困难半个月。查体无明显阳性体征。上消化道钡餐造影示食管中段黏膜紊乱，管壁僵硬，管腔狭窄。该患者最可能的初步诊断是（　　）。", "answer": "食管癌", "meta_info": "第3篇　消化系统", "answer_idx": "D", "A": "反流性食管炎", "B": "食管憩室", "C": "贲门失弛缓症", "D": "食管癌", "language": "zh"}
{"question": "4．供应脑桥血液的血管是（　　）。", "answer": "基底动脉", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "大脑中动脉", "B": "大脑后动脉", "C": "大脑前动脉", "D": "基底动脉", "language": "zh"}
{"question": "冠状动脉粥样硬化，最常受累的动脉分支是哪条？（　　）", "answer": "左冠状动脉前降支", "meta_info": "病理学", "answer_idx": "D", "A": "右冠状动脉主干", "B": "右冠状动脉回旋支", "C": "左冠状动脉回旋支", "D": "左冠状动脉前降支", "language": "zh"}
{"question": "急性哮喘发作首选（　　）。", "answer": "沙丁胺醇吸入", "meta_info": "药理学", "answer_idx": "B", "A": "色甘酸钠吸入", "B": "沙丁胺醇吸入", "C": "麻黄碱口服", "D": "倍氯米松口服", "language": "zh"}
{"question": "男，72岁。排便时突然跌倒，意识丧失，呼吸断续。有陈旧心肌梗死和糖尿病病史，无高血压病史，诊断为心脏骤停。2．心电图示心脏停搏，此时首选的药物是（　　）。", "answer": "肾上腺素", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "普鲁卡因胺", "B": "肾上腺素", "C": "胺碘酮", "D": "碳酸氢钠", "language": "zh"}
{"question": "男性，27岁，外地打工，近2个月来整日卧床发呆，不愿工作，诉每日脑子里听到一男一女的激烈辩论，其内容都是与他有关的，感到工友们背后取笑他，给他“穿小鞋”，个别工友企图陷害他。体检及神经系统无异常。1．该病人的精神症状主要是（　　）。", "answer": "争论性幻听，被害妄想", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "争论性幻听、被洞悉感", "B": "关系妄想", "C": "争论性幻听，被害妄想", "D": "被害妄想，物理影响妄想", "language": "zh"}
{"question": "5．营养不良患儿发生低血糖的表现是（　　）。", "answer": "突然面色苍白，神志不清", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "体重明显下降，全身消瘦", "B": "心音低钝，血压下降", "C": "突然面色苍白，神志不清", "D": "皮肤发花，四肢冰凉", "language": "zh"}
{"question": "医学心理学的研究途径有（　　）。", "answer": "心理学、生物学、社会学途径", "meta_info": "医学心理学", "answer_idx": "C", "A": "生物学途径", "B": "社会学途径", "C": "心理学、生物学、社会学途径", "D": "以上都不是", "language": "zh"}
{"question": "下列哪项为癔症发作最有效的治疗方法？（　　）", "answer": "暗示治疗", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "行为治疗", "B": "暗示治疗", "C": "抗精神病药", "D": "物理治疗", "language": "zh"}
{"question": "患儿，4岁，发现左上腹包块如拳头大小，质硬，可活动，无压痛，小便正常，应首先考虑（　　）。", "answer": "左肾母细胞瘤", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "左肾积水", "B": "左肾母细胞瘤", "C": "脾肿大", "D": "胰腺囊肿", "language": "zh"}
{"question": "中心静脉压的高低决定于下述哪一项因素?（　　）", "answer": "心脏射血能力和静脉回心血量", "meta_info": "生理学", "answer_idx": "B", "A": "血管容量和血量", "B": "心脏射血能力和静脉回心血量", "C": "心脏射血能力和外周阻力", "D": "外周静脉压", "language": "zh"}
{"question": "子宫颈原位癌累及腺体指的是（　　）。", "answer": "子宫颈原位癌沿基膜伸入腺体内至腺管上皮为癌细胞所取代，腺体基膜完整", "meta_info": "病理学", "answer_idx": "D", "A": "子宫颈腺体充满癌细胞", "B": "子宫颈表面和腺体先后发生了原位癌，并侵及腺体周围间质", "C": "子宫颈原位癌突破基膜侵及腺体", "D": "子宫颈原位癌沿基膜伸入腺体内至腺管上皮为癌细胞所取代，腺体基膜完整", "language": "zh"}
{"question": "2．血吸虫肝硬化所致的门静脉高压症的主要阻塞部位在（　　）。", "answer": "窦前", "meta_info": "第3篇　消化系统", "answer_idx": "A", "A": "窦前", "B": "窦旁", "C": "肝前", "D": "肝后", "language": "zh"}
{"question": "女性，33岁，l年来乏力，发热、关节痛，面颊部有蝶形红斑，口腔鼻腔黏膜溃疡，为无痛性。2个月来，病人兴奋、躁动，幻听、幻视，被害妄想，关系妄想。1．下列哪一项检查对诊断最有帮助?（　　）", "answer": "抗核抗体", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "Coombs试验", "B": "抗核抗体", "C": "血沉", "D": "抗“O”", "language": "zh"}
{"question": "对于强心苷，哪项是不正确的？（　　）", "answer": "有正性心肌舒张功能", "meta_info": "药理学", "answer_idx": "B", "A": "有负性频率作用", "B": "有正性心肌舒张功能", "C": "安全范围小", "D": "用于治疗心衰，也可治疗室上性心动过速", "language": "zh"}
{"question": "佝偻病后遗症期的小儿多见于（　　）。", "answer": "2岁以后", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "6个月以后", "B": "1岁以内", "C": "2岁以后", "D": "3岁以后", "language": "zh"}
{"question": "1．支配心脏的迷走神经释放的递质是（　　）。", "answer": "乙酰胆碱", "meta_info": "生理学", "answer_idx": "D", "A": "肾上腺素", "B": "去甲肾上腺素", "C": "γ-氨基丁酸", "D": "乙酰胆碱", "language": "zh"}
{"question": "医务人员收受药品生产企业的财物，情节尚不严重时，依法应对其给予的处罚是（　　）。", "answer": "没收违法所得", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "没收违法所得", "B": "罚款", "C": "吊销执业证书", "D": "警告", "language": "zh"}
{"question": "1．骨软骨瘤可见到（　　）。", "answer": "局部肿块，无触痛，多偶然发现", "meta_info": "第四部分　运动系统疾病", "answer_idx": "A", "A": "局部肿块，无触痛，多偶然发现", "B": "表面静脉怒张", "C": "多发生于扁平骨及不规则骨", "D": "发病后迅速出现瘫痪", "language": "zh"}
{"question": "氯霉素抗菌谱广，但仅限于伤寒、立克次体病及敏感菌所致严重感染，是因为（　　）。", "answer": "对造血系统严重的不良反应", "meta_info": "药理学", "answer_idx": "C", "A": "影响骨、牙生长发育", "B": "对肝脏严重损害", "C": "对造血系统严重的不良反应", "D": "二重感染", "language": "zh"}
{"question": "结核分枝杆菌敏感的理化因素是（　　）。", "answer": "紫外线", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "碱", "B": "酸", "C": "紫外线", "D": "寒冷", "language": "zh"}
{"question": "女性，28岁，妊娠35周，重度子痫前期，胎动消失半天。检查NST无反应，胎心音140次/min。最恰当的处理是（　　）。", "answer": "立即剖宫产", "meta_info": "第5篇　女性生殖系统", "answer_idx": "A", "A": "立即剖宫产", "B": "镇静、解痉、降压治疗24小时后终止妊娠", "C": "继续观察", "D": "综合处理48小时后根据病情终止妊娠", "language": "zh"}
{"question": "患者，女，28岁，农民，头昏、心悸、颜面苍白5年，并感吞咽困难，血红蛋白45g/L，红细胞2.0×1012/L，白细胞及血小板正常，血片见红细胞大小不均，以小细胞为主，中心染色过浅，首选抗贫血制剂为（　　）。", "answer": "口服铁剂", "meta_info": "第一部分　血液系统疾病", "answer_idx": "B", "A": "叶酸", "B": "口服铁剂", "C": "雄激素", "D": "维生素B12", "language": "zh"}
{"question": "下列哪项是最易引起输血后肝炎的病毒？（　　）", "answer": "HCV", "meta_info": "医学微生物学", "answer_idx": "C", "A": "HAV", "B": "HBV", "C": "HCV", "D": "HDV", "language": "zh"}
{"question": "1．肾小球呈弥漫性增生性炎症及渗出性病变多见于（　　）。", "answer": "急性肾小球肾炎", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "急性肾小球肾炎", "B": "原发性单纯性肾病综合征", "C": "腺病毒感染", "D": "肾炎性肾病", "language": "zh"}
{"question": "患者用力加腹压时，子宫颈及部分子宫体脱出阴道外口，诊断为（　　）。", "answer": "子宫脱垂Ⅱ度重", "meta_info": "第5篇　女性生殖系统", "answer_idx": "B", "A": "子宫脱垂Ⅱ度轻", "B": "子宫脱垂Ⅱ度重", "C": "子宫脱垂Ⅲ度", "D": "以上都不是", "language": "zh"}
{"question": "男，40岁。1小时前游泳时溺水送来急诊。查体：P 120次/分，R 34次/分，BP 90/60mmHg，神志尚清，烦躁不安，口唇发绀，两肺可闻及广泛湿性啰音，动脉血气分析（FiO2＝50%）：pH 7.52，PaCO2 30mmHg，PaO2 60mmHg。2．为改善其呼吸衰竭，应首选的措施是（　　）。", "answer": "无创通气", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "纯氧面罩吸氧", "B": "无创通气", "C": "快速利尿", "D": "静脉滴注糖皮质激素", "language": "zh"}
{"question": "下列应当被注销执业医师注册的是（　　）。", "answer": "构成医疗事故罪而被判处刑罚的", "meta_info": "卫生法规", "answer_idx": "D", "A": "中止医师执业活动满一年的", "B": "受罚款行政处罚的", "C": "受暂停执业6个月行政处罚的", "D": "构成医疗事故罪而被判处刑罚的", "language": "zh"}
{"question": "女性，l8岁，近1年来认为自己过胖，每日专注于自己的体重、体形，严格限制每日进食量，偶有贪食情况，但饱餐之后，立即自行呕吐，或服泻剂，现出现畏寒体温偏低，月经停止，比标准体重减轻25％，既往无躯体疾病病史，最可能的诊断是（　　）。", "answer": "神经性厌食症", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "神经性厌食症", "B": "癌症", "C": "神经性贪食症", "D": "甲状腺功能不全", "language": "zh"}
{"question": "阵发性室上性心动过速首选的药物是（　　）。", "answer": "维拉帕米", "meta_info": "药理学", "answer_idx": "D", "A": "利多卡因", "B": "苯妥英钠", "C": "普鲁卡因胺", "D": "维拉帕米", "language": "zh"}
{"question": "慢性粒细胞白血病下述哪一项错误？（　　）", "answer": "中性粒细胞碱性磷酸酶慢性期增多，急性期下降", "meta_info": "第一部分　血液系统疾病", "answer_idx": "A", "A": "中性粒细胞碱性磷酸酶慢性期增多，急性期下降", "B": "晚期骨髓内纤维组织增多", "C": "血清维生素B12浓度增高", "D": "周围血中中性粒纽胞比例增多", "language": "zh"}
{"question": "男性，49岁。平素健康，突然发热、畏冷、咳嗽，用青霉素后热不退，10天后咳大量脓臭痰，诊断可能为（　　）。", "answer": "急性肺脓肿", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "肺结核", "B": "支气管扩张症", "C": "急性肺脓肿", "D": "支气管胸膜瘘", "language": "zh"}
{"question": "女，34岁。孕24周，自觉无力。面色苍白。实验室检查：Hb 80g/L，RBC 2.8×1012/L。该孕妇应开始进行胎儿健康状况评估的时间为（　　）。", "answer": "孕32～34周", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "孕20～24周", "B": "孕40～42周", "C": "孕26～28周", "D": "孕32～34周", "language": "zh"}
{"question": "女孩，2岁。发热、流涕、咳嗽3天，皮疹6小时。查体：精神萎靡，前额及耳后有浅红色斑丘疹，眼结膜充血，口腔黏膜粗糙，两肺呼吸音粗。最可能的诊断是（　　）。", "answer": "麻疹", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "麻疹", "B": "幼儿急疹", "C": "川崎病", "D": "咽结合膜热", "language": "zh"}
{"question": "女性，10岁，阵发性腹痛、黑便2天，双下肢散在出血点，双膝关节肿胀，腹软，右下腹压痛。白细胞12.5×109/L，血小板200×109/L，血红蛋白lll319/L。尿常规：蛋白质（+），红细胞（+）/HP，颗粒管型0—3个/HP。1．诊断可能是（　　）。", "answer": "过敏性紫癜", "meta_info": "第一部分　血液系统疾病", "answer_idx": "C", "A": "肠套叠", "B": "风湿性关节炎", "C": "过敏性紫癜", "D": "急性肾小球肾炎", "language": "zh"}
{"question": "某人血浆中含有抗A，抗B凝集素，则此人的血型可能是（　　）。", "answer": "O型", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "A1型", "B": "AB型", "C": "A2B型", "D": "O型", "language": "zh"}
{"question": "肋骨骨折多发生于（　　）。", "answer": "4～7肋", "meta_info": "第1篇　呼吸系统", "answer_idx": "C", "A": "1～3肋", "B": "3～4肋", "C": "4～7肋", "D": "5～8肋", "language": "zh"}
{"question": "正常人尿中的主要色素是（　　）。", "answer": "胆色素", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "胆红素", "B": "胆色素", "C": "胆绿素", "D": "血红素", "language": "zh"}
{"question": "DNA以半保留复制方式进行复制，一完全被放射性核素标记的DNA分子置于无放射性标记的溶液中复制两代，其放射性状况如何？（　　）", "answer": "仅2个分子的DNA有放射性", "meta_info": "生物化学", "answer_idx": "A", "A": "仅2个分子的DNA有放射性", "B": "4个分子的DNA均有放射性", "C": "4个分子的DNA双链中仅其一条链有放射性", "D": "以上都不是", "language": "zh"}
{"question": "病儿跌伤，X线摄片为左肱骨下端骨骺分离。3周后到市医院就诊，接诊医生填X线申请单时将左写成右，放射科发现错后，拍了左手，却将一个“右”字铅号贴在X线片上。入院后主治医师在主诉中写左，诊断上又写右，手术通知单上也写右。术前备皮时，病儿提到左臂受伤.护士仍在右臂备皮。手术医生术前曾去查看患者，检查了左臂，第二天手术时竟仍按病志在右臂上开了刀，暴露到关节囊未见异常时，经再次询问病儿，方发现开错了手术部位。2．该事件的主要责任者是（　　）。", "answer": "手术医师", "meta_info": "卫生法规", "answer_idx": "D", "A": "放射科医师", "B": "经治医师", "C": "备皮护士", "D": "手术医师", "language": "zh"}
{"question": "在治疗过程中，心理治疗师让患者将脑子里想到的东西都说出来，不管有没有价值，然后对患者讲出来的内容进行阐释。2．该治疗师所使用的技术是（　　）。", "answer": "自由联想", "meta_info": "医学心理学", "answer_idx": "B", "A": "移情", "B": "自由联想", "C": "释梦", "D": "共情", "language": "zh"}
{"question": "3．上述哪项是决定Ig类和亚类的部位？（　　）", "answer": "CH", "meta_info": "医学免疫学", "answer_idx": "C", "A": "VL+VH", "B": "铰链区", "C": "CH", "D": "CL", "language": "zh"}
{"question": "不符合保泰松的是（　　）。", "answer": "大剂量也不易引起胃肠道反应", "meta_info": "药理学", "answer_idx": "C", "A": "血浆t1/2约2～3天", "B": "关节腔中的药物浓度维持时间长", "C": "大剂量也不易引起胃肠道反应", "D": "能诱导肝药酶，加速其自身代谢", "language": "zh"}
{"question": "7岁的男孩，眼睑浮肿4天，伴头痛、眼花，尿呈深茶色2天，儿科就诊，2周前曾患扁桃体炎，经用青霉素治疗好转。4．如果此患儿出现呼吸困难，颈静脉怒张，吐粉红色泡沫痰，两肺满布湿啰音，错误的治疗是（　　）。", "answer": "快速洋地黄化", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "静注呋塞米", "B": "静滴硝普钠", "C": "快速洋地黄化", "D": "腹膜透析", "language": "zh"}
{"question": "不是胆色素的是（　　）。", "answer": "血红素", "meta_info": "生物化学", "answer_idx": "A", "A": "血红素", "B": "胆素原族", "C": "胆绿素", "D": "胆素族", "language": "zh"}
{"question": "女，22岁。右手及前臂沸水烫伤1小时。查体：右手及前臂红肿明显，有水疱，部分水疱皮脱落，可见创面红白相间，疼痛迟钝。1．理论上判断该患者烧伤面积占体表面积的百分比是（　　）。", "answer": "5.5%", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "5.5%", "B": "4.5%", "C": "3%", "D": "6.5%", "language": "zh"}
{"question": "1．突出体现医德良心作用的为（　　）。", "answer": "某地一些临床名家自发组织了X俱乐部，其活动宗旨是：定期聚会，坦诚交待自己误诊误治的情况并互相交流体会", "meta_info": "医学伦理学", "answer_idx": "A", "A": "某地一些临床名家自发组织了X俱乐部，其活动宗旨是：定期聚会，坦诚交待自己误诊误治的情况并互相交流体会", "B": "一位急诊病人被送到医院，因其满身血污，其他病人及其家属见了忙掩鼻躲开，而应诊医护人员则顾不得脏不脏，出于责任心赶紧给病人做检查和处置", "C": "某科室常常针对所要解决的医德医风问题向住院病人做出改善服务的承诺", "D": "医师保证不泄露病人隐私，终于使病人放心地述说了全部病情信息", "language": "zh"}
{"question": "女，21岁。1型糖尿病8年，平素4次（R-R-R-N）胰岛素皮下注射治疗，定期查糖化血红蛋白7.5%～8%，2日前患者受凉后发热，体温37.5℃～38℃，因食欲不佳，自行停用胰岛素，改用阿卡波糖治疗。渐出现恶心、食欲不振，呕吐少量胃内容物，尿中有异味。查体：P 102次/分。BP 90/60mmHg，体重55kg，轻度脱水貌，精神萎靡，实验室检查：随机血糖25.6mmol/L，血钾4.8mmol/L，血糖（＋＋＋＋），尿酮体（＋＋＋＋）；动脉血气分析pH值7.25。3．患者入院后尿量约60ml/h，复查血钾4.0mmol/L。关于补钾治疗应采取（　　）。", "answer": "开始静脉补钾", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "每2小时测定血钾，低于3.5mmol/L，开始补钾", "B": "开始静脉补钾", "C": "两次检测血钾均正常，不需要补钾", "D": "观察尿量如果有进一步的增加，则补钾", "language": "zh"}
{"question": "关于结核菌素试验，下列正确的是（　　）。", "answer": "检出结核分枝杆菌感染", "meta_info": "第1篇　呼吸系统", "answer_idx": "D", "A": "检出结核病", "B": "HIV感染后可强阳性，结核病越重越易呈强阳性", "C": "Ⅲ型变态反应", "D": "检出结核分枝杆菌感染", "language": "zh"}
{"question": "每张中成药处方可以开具的药品种类最多是（　　）。", "answer": "5种", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "5种", "B": "3种", "C": "6种", "D": "2种", "language": "zh"}
{"question": "男，41岁。2周前搬重物时出现腰部疼痛，排便时加重，并向左下肢放射，逐渐出现左小腿皮肤感觉减退。查体：腰部活动受限，左侧支腿抬高40°出现左下肢放射性疼痛，腰椎X线片未见异常。最可能的诊断是（　　）。", "answer": "腰椎间盘突出症", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "腰椎间盘突出症", "B": "腰椎肿瘤", "C": "强直性脊柱炎", "D": "腰扭伤", "language": "zh"}
{"question": "导致肺气肿最常见的原因是（　　）。", "answer": "慢性阻塞性细支气管炎", "meta_info": "病理学", "answer_idx": "C", "A": "空气污染", "B": "重度吸烟", "C": "慢性阻塞性细支气管炎", "D": "尘肺", "language": "zh"}
{"question": "惊厥持续状态的处理，错误的是（　　）。", "answer": "禁用甘露醇", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "吸氧", "B": "禁用甘露醇", "C": "首先地西泮止惊", "D": "积极降温", "language": "zh"}
{"question": "人体内氨最主要的代谢去路是（　　）。", "answer": "在肝中合成尿素", "meta_info": "生物化学", "answer_idx": "B", "A": "渗入肠道", "B": "在肝中合成尿素", "C": "经肾脏泌氨随尿排出", "D": "生成谷氨酰胺", "language": "zh"}
{"question": "患者自诉看不见左侧物体，查体双眼左侧视野同向偏盲，对光反射消失，其病变位于（　　）。", "answer": "右侧视束", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "视交叉", "B": "右侧视束", "C": "左侧视束", "D": "左侧视辐射", "language": "zh"}
{"question": "1．男性，58岁，高血压病史，左偏身痛觉减退1周来诊，头CT示右基底节小低密度灶（0.5cm），诊断为（　　）。", "answer": "腔隙性脑梗死", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "腔隙性脑梗死", "B": "短暂性脑缺血发作", "C": "壳核出血", "D": "脑栓塞", "language": "zh"}
{"question": "黄体萎缩不全患者月经5～6天刮宫的病理表现（　　）。", "answer": "增殖期与分泌期并存", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "增殖期与分泌期并存", "B": "复杂型增生", "C": "分泌期内膜", "D": "增殖期内膜", "language": "zh"}
{"question": "对于启动子的叙述下述哪项是恰当的？（　　）", "answer": "开始结合RNA聚合酶的DNA序列", "meta_info": "生物化学", "answer_idx": "B", "A": "开始被翻译的DNA序列", "B": "开始结合RNA聚合酶的DNA序列", "C": "阻遏蛋白结合的DNA序列", "D": "产生阻遏物的基因", "language": "zh"}
{"question": "一新生儿室暴发脓毒血症，脓汁标本经涂片革兰染色镜检发现葡萄球菌。试问为确定该菌是否有致病力，应检查哪种酶？（　　）", "answer": "血浆凝固酶", "meta_info": "医学微生物学", "answer_idx": "A", "A": "血浆凝固酶", "B": "尿素酶", "C": "触酶", "D": "卵磷脂酶", "language": "zh"}
{"question": "一个tRNA反密码子为5＇-IGC-3＇，它可以识别的密码为（　　）。", "answer": "5＇-GCA-3＇", "meta_info": "生物化学", "answer_idx": "A", "A": "5＇-GCA-3＇", "B": "5＇-ACG-3＇", "C": "5＇-CCG-3＇", "D": "5＇-GCG-3＇", "language": "zh"}
{"question": "蜂窝织炎是指（　　）。", "answer": "一种弥漫性化脓性炎症", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "发生于皮下组织及阑尾的炎症", "B": "一种弥漫性化脓性炎症", "C": "由链球菌感染引起的局限性化脓性炎症", "D": "没有明显坏死的渗出性炎症", "language": "zh"}
{"question": "哪项是肺通气的原动力？（　　）", "answer": "呼吸肌的舒缩活动", "meta_info": "生理学", "answer_idx": "C", "A": "肺泡的表面张力", "B": "肺内压与大气压之差", "C": "呼吸肌的舒缩活动", "D": "肺的扩张和回缩", "language": "zh"}
{"question": "免疫指（　　）。", "answer": "机体识别排除抗原性异物的功能", "meta_info": "医学免疫学", "answer_idx": "A", "A": "机体识别排除抗原性异物的功能", "B": "机体清除自身衰老、死亡细胞的功能", "C": "机体抗感染的功能", "D": "机体对病原微生物的防御能力", "language": "zh"}
{"question": "给家兔静脉小剂量的肾上腺素后，心率增快，心缩力增强，但平均动脉压变化不大，这是因为肾上腺素（　　）。", "answer": "通过β受体扩张骨骼肌血管", "meta_info": "生理学", "answer_idx": "B", "A": "强烈兴奋降压反射", "B": "通过β受体扩张骨骼肌血管", "C": "无缩血管效应", "D": "不影响血管收缩", "language": "zh"}
{"question": "慢性丙型肝炎，抗HCV（+），HCVPCR（+），ALT120U/L，肝肋下1.0cm，脾界不大，侧卧未触及，下列哪项为此患根本的治疗？（　　）", "answer": "抗病毒应用干扰素治疗", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "D", "A": "护肝治疗", "B": "应用促肝细胞生长因子", "C": "调节免疫治疗", "D": "抗病毒应用干扰素治疗", "language": "zh"}
{"question": "女婴，2天，因高胆红素血症做血清学检查，抗人球蛋白试验直接法阳性，释放试验释放出抗E、C抗体，其母的Rh血型可能是（　　）。", "answer": "cCDEe", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "ocDEE", "B": "cCdee", "C": "cCDEe", "D": "CCDEE", "language": "zh"}
{"question": "上体前屈时腹痛明显，直立位时减轻，提示何种疾病？（　　）", "answer": "反流性食管炎", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "十二指肠淤滞症", "B": "胰腺体部癌", "C": "反流性食管炎", "D": "胃溃疡", "language": "zh"}
{"question": "女，20岁。双下肢及颜面水肿，尿蛋白定量4.2g/d，尿RBC 0～2/HP，血清蛋白28g/L，Scr 78μmol/L，肾活检病理诊断为微小病变肾病。该患者应用糖皮质激素治疗的最主要机制为（　　）。", "answer": "抑制细胞免疫", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "抑制体液免疫", "B": "抑制细胞免疫", "C": "抑制补体活化", "D": "抑制蛋白合成", "language": "zh"}
{"question": "卡托普利常见的不良反应是（　　）。", "answer": "刺激性干咳", "meta_info": "药理学", "answer_idx": "A", "A": "刺激性干咳", "B": "直立性低血压", "C": "阳痿", "D": "反射性心率加快", "language": "zh"}
{"question": "男，35岁。1年来反复出现腹泻，粪便糊状。结肠镜检查发现病变主要位于回肠末段，表现为多发的纵行溃疡.溃疡间黏膜正常。最可能的诊断是（　　）。", "answer": "克罗恩病", "meta_info": "第3篇　消化系统", "answer_idx": "C", "A": "溃疡性结肠炎", "B": "细菌性痢疾", "C": "克罗恩病", "D": "肠结核", "language": "zh"}
{"question": "成年患者输注1单位红细胞估计可提高的血红蛋白数量是（　　）。", "answer": "5", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "3", "B": "10", "C": "7", "D": "5", "language": "zh"}
{"question": "对病人保密的要求不包括（　　）。", "answer": "病人所需特殊检查", "meta_info": "医学伦理学", "answer_idx": "B", "A": "病人不良的病情诊断", "B": "病人所需特殊检查", "C": "医师同事的医疗差错", "D": "医师同事的个人隐私", "language": "zh"}
{"question": "男性，22岁，右膝内侧肿块5年，生长缓慢，无明显疼痛，X线片显示股骨下端内侧干骺端杵状肿块，边缘清楚。应首先考虑的是（　　）。", "answer": "骨软骨瘤", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "骨肉瘤", "B": "软骨肉瘤", "C": "骨软骨瘤", "D": "骨样骨瘤", "language": "zh"}
{"question": "确诊为女性生殖器尖锐湿疣，不正确的治疗是（　　）。", "answer": "口服红霉素", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "C", "A": "50%三氯醋酸", "B": "激光", "C": "口服红霉素", "D": "微波", "language": "zh"}
{"question": "1．27岁初孕妇，妊娠38周，患重度妊娠高血压综合征，昨晚突然出现阴道出血伴下腹痛，最可能的诊断应是（　　）。", "answer": "胎盘早剥", "meta_info": "第二部分　模拟试题", "answer_idx": "B", "A": "前置胎盘", "B": "胎盘早剥", "C": "先兆子宫破裂", "D": "子宫破裂", "language": "zh"}
{"question": "男婴，胎龄38周出生，宫内窘迫。Apgar评分1分钟3分。经抢救10分钟评分9分。生后6小时出现抽搐。首选的药物是（　　）。", "answer": "苯巴比妥", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "呋塞米", "B": "苯妥英钠", "C": "地塞米松", "D": "苯巴比妥", "language": "zh"}
{"question": "2．女，20岁，因腹痛服用硫酸阿托品0.6mg每天3次，1周后感到口干，便秘，这属于药物的（　　）。", "answer": "副作用", "meta_info": "药理学", "answer_idx": "A", "A": "副作用", "B": "毒性反应", "C": "后遗效应", "D": "停药反应", "language": "zh"}
{"question": "病人权利不包括（　　）。", "answer": "保管病志权", "meta_info": "医学伦理学", "answer_idx": "D", "A": "自我决定权", "B": "基本医疗权", "C": "知情同意权", "D": "保管病志权", "language": "zh"}
{"question": "3．防治尿酸性肾病（　　）。", "answer": "口服别嘌呤醇", "meta_info": "第一部分　血液系统疾病", "answer_idx": "C", "A": "VP方案", "B": "HAP方案", "C": "口服别嘌呤醇", "D": "鞘内注射甲氨蝶呤", "language": "zh"}
{"question": "关于酶共价修饰调节的叙述，错误的是（　　）。", "answer": "酶只发生从无活性到有活性的变化", "meta_info": "生物化学", "answer_idx": "D", "A": "需要另外酶的催化", "B": "是一种快速调节方式", "C": "酶活性可增强或减弱", "D": "酶只发生从无活性到有活性的变化", "language": "zh"}
{"question": "女性，29岁，贫血病史1年，浅表淋巴结不肿大，肝脾未触及，血象呈现全血细胞减少，若诊断再障，哪一项意义最大？（　　）", "answer": "骨髓增生低下，造血细胞减少", "meta_info": "第一部分　血液系统疾病", "answer_idx": "B", "A": "骨髓非造血细胞增多，NAP增加", "B": "骨髓增生低下，造血细胞减少", "C": "网织红细胞减少", "D": "铁粒幼血细胞消失", "language": "zh"}
{"question": "下列哪项指的是依据心理学的理论和方法对人的心理品质及水平做出鉴定？（　　）", "answer": "心理评估", "meta_info": "医学心理学", "answer_idx": "D", "A": "心理诊断", "B": "心理测验", "C": "心理测量", "D": "心理评估", "language": "zh"}
{"question": "4．T细胞产生的能活化T、B、N、Mφ的为（　　）。", "answer": "IL-4", "meta_info": "医学免疫学", "answer_idx": "C", "A": "IL-1", "B": "IL-2", "C": "IL-4", "D": "IL-5", "language": "zh"}
{"question": "轻微病变性肾小球肾炎的病变特点是（　　）。", "answer": "肾小球正常，肾小管脂质沉积", "meta_info": "病理学", "answer_idx": "C", "A": "内皮细胞增生", "B": "系膜细胞增生", "C": "肾小球正常，肾小管脂质沉积", "D": "肾小球纤维化，硬化", "language": "zh"}
{"question": "男，18岁。发热伴颈部淋巴结进行性无痛性肿大3个月。最高体温38.7℃。血常规：WBC 8.0×109/L，N 0.70，L 0.30；骨髓细胞学检查未见异常；淋巴结活检可见里-斯（R-S）细胞。最可能的诊断为（　　）。", "answer": "霍奇金淋巴瘤", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "霍奇金淋巴瘤", "B": "非霍奇金淋巴瘤", "C": "急性淋巴细胞白血病", "D": "急性粒细胞白血病", "language": "zh"}
{"question": "人的知觉是（　　）。", "answer": "人脑对事物整体的反映", "meta_info": "医学心理学", "answer_idx": "B", "A": "多种感觉的叠加", "B": "人脑对事物整体的反映", "C": "思维的结果", "D": "对知识认识和了解", "language": "zh"}
{"question": "三种不同来源的DNA（A、B和C），它们的Tm值依次为83℃、71℃和85℃，由此推出它们的分子组成为（　　）。", "answer": "GC%C＞A＞B", "meta_info": "生物化学", "answer_idx": "D", "A": "AT%A＜B＜C", "B": "GC%A＞C＞B", "C": "AT%C＞B＞A", "D": "GC%C＞A＞B", "language": "zh"}
{"question": "变异最易出现在（　　）。", "answer": "稳定期", "meta_info": "医学微生物学", "answer_idx": "B", "A": "迟缓期", "B": "稳定期", "C": "衰亡期", "D": "以上均可", "language": "zh"}
{"question": "IgG功能区不包括（　　）。", "answer": "CH4", "meta_info": "医学免疫学", "answer_idx": "A", "A": "CH4", "B": "VH", "C": "CH1", "D": "VL", "language": "zh"}
{"question": "药物治疗泌尿系统感染的最终目的是（　　）。", "answer": "达到尿液无菌，尿培养阴性", "meta_info": "第4篇　泌尿系统", "answer_idx": "D", "A": "使症状消失", "B": "尿培养菌落计数被抑制在500/ml", "C": "尿培养菌落计数被抑制在5000/ml", "D": "达到尿液无菌，尿培养阴性", "language": "zh"}
{"question": "RNA聚合酶催化转录的底物是（　　）。", "answer": "ATP、GTP、UTP、CTP", "meta_info": "生物化学", "answer_idx": "D", "A": "ATP、GTP、UTP、TTP", "B": "dAMP、dGMP、dCMP、dTMP", "C": "dATP、dGTP、dCTP、dTTP", "D": "ATP、GTP、UTP、CTP", "language": "zh"}
{"question": "患者孙某，女，40岁。因患溃疡性结肠炎入院治疗。住院后，主管医生告知有一种治疗溃疡性结肠炎的新药，需要一部分患者做临床疗效实验。主管医生还告诉患者自愿参加，但希望溃疡性结肠炎患者都参加。孙某原来不想参加这项实验，但抱着试一试的态度便参加了。用药一个星期后，自觉效果不好，便中途退出了实验。主管医生对她的做法很不满意。该案例中，该医生明显违背了下列说法的哪一项？（　　）", "answer": "《赫尔辛基宣言》中规定的“病人对某项科学实验研究工作拒绝参加时，绝对不能使医生和病人之间的关系受到影响或妨碍”", "meta_info": "医学伦理学", "answer_idx": "D", "A": "病人利益第一的道德原则", "B": "人体实验中知情同意的原则", "C": "主管医生不能出面劝说让他的患者参与到某人体实验中", "D": "《赫尔辛基宣言》中规定的“病人对某项科学实验研究工作拒绝参加时，绝对不能使医生和病人之间的关系受到影响或妨碍”", "language": "zh"}
{"question": "关于心动周期的叙述，哪一项是错误的?（　　）", "answer": "心动周期缩短时，收缩期与舒张期均等缩短", "meta_info": "生理学", "answer_idx": "D", "A": "如心率为75次／分，心动周期历时0.8s", "B": "房缩期为0.1s，室缩期为0.3s，全心舒张期为0.4s", "C": "心率增快，心动周期缩短", "D": "心动周期缩短时，收缩期与舒张期均等缩短", "language": "zh"}
{"question": "能抑制胰液分泌，又能抑制胰酶合成的药物是（　　）。", "answer": "生长抑素", "meta_info": "第3篇　消化系统", "answer_idx": "C", "A": "胰升糖素", "B": "降钙素", "C": "生长抑素", "D": "奥美拉唑", "language": "zh"}
{"question": "8岁男孩，右小腿轻微外伤后发冷、发热（39.5℃）5天，右小腿上端肿胀、剧痛，局部皮温高，肤色正常，白细胞计数25×109/L，X线片未见明显变化，局部穿刺，针达骨膜下时抽出黄色脓汁，首先应考虑为（　　）。", "answer": "化脓性骨髓炎", "meta_info": "第四部分　运动系统疾病", "answer_idx": "B", "A": "化脓性膝关节炎", "B": "化脓性骨髓炎", "C": "滑囊炎感染", "D": "胫骨上端骨结核转变为膝关节全关节结核", "language": "zh"}
{"question": "2．肥达试验O、H凝集效价均低于正常（　　）。", "answer": "肠热症可能性小", "meta_info": "医学微生物学", "answer_idx": "A", "A": "肠热症可能性小", "B": "肠热症早期或交叉反应", "C": "预防注射或回忆反应", "D": "细胞免疫功能低下", "language": "zh"}
{"question": "1．肠伤寒的肠溃疡特征（　　）。", "answer": "溃疡呈长椭圆形与肠的长轴平行", "meta_info": "病理学", "answer_idx": "B", "A": "溃疡呈环形与肠的长轴垂直", "B": "溃疡呈长椭圆形与肠的长轴平行", "C": "溃疡边缘呈堤状隆起", "D": "溃疡表浅呈地图状", "language": "zh"}
{"question": "3．DIC继发性纤溶亢进期（　　）。", "answer": "3P试验（+）", "meta_info": "第一部分　血液系统疾病", "answer_idx": "D", "A": "血小板增加", "B": "纤维蛋白原降低", "C": "PT缩短", "D": "3P试验（+）", "language": "zh"}
{"question": "怀疑甲状腺癌最主要的依据是（　　）。", "answer": "结节质硬、固定或合并压迫症状", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "C", "A": "同位素扫描为冷结节", "B": "结节突然增大", "C": "结节质硬、固定或合并压迫症状", "D": "疼痛", "language": "zh"}
{"question": "患儿，女，4岁，其母患结核性胸膜炎，故来体检。双肺听诊呼吸音粗，胸部透视未见异常，欲做“OT”试验。1．1：20000T稀释液0.1ml，内含结素单位为（　　）。", "answer": "5单位", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "1单位", "B": "0.1单位", "C": "5单位", "D": "7单位", "language": "zh"}
{"question": "2．仅浸润黏膜层及黏膜下层的胃肠癌称（　　）。", "answer": "早期癌", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "交界性肿瘤", "B": "早期癌", "C": "良性肿瘤", "D": "恶性肿瘤", "language": "zh"}
{"question": "女，76岁。跌倒后左髋部疼痛，不能站立行走，既往高血压、肺病、糖尿病20余年，一般状态差。查体：BP 190／110mmHg，左髋部压痛，左下肢呈短缩及外旋畸形。X线检查示股骨头下骨折，Pauwels角55°，GardenⅢ型。2．如果该患者后期出现股骨头坏死，最主要的原因是（　　）。", "answer": "旋股内侧动脉损伤", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "股深动脉损伤", "B": "旋股内侧动脉损伤", "C": "闭孔动脉损伤", "D": "旋股外侧动脉损伤", "language": "zh"}
{"question": "建筑工人不慎坠楼，腰剧痛，双下肢感觉运动障碍，大小便功能障碍。2．经X线平片检查，诊断为胸腰段屈曲性压缩骨折并脊髓损伤，为进一步明确骨折片向脊椎管内的移动情况，下列哪项检查是最有价值的？（　　）", "answer": "CT", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "MRI", "B": "CT", "C": "ECT", "D": "X线断层摄影", "language": "zh"}
{"question": "体内合成脂肪酸的原料乙酰CoA主要来自（　　）。", "answer": "葡萄糖氧化分解", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "氨基酸氧化分解", "B": "葡萄糖氧化分解", "C": "脂肪酸氧化分解", "D": "酮体氧化分解", "language": "zh"}
{"question": "男孩，15个月，单纯母乳喂养，不愿进辅食，其母不吃肉类、鱼类食品，近1个月面色渐苍黄，目光呆滞，肝肋下2.5cm，脾未及，伸手时手有震颤，Hb 90g/L，RBC 2.05×1012/L。2．要想确诊应做什么检查（　　）。", "answer": "骨髓穿刺", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "血胆红素测定", "B": "MCV、MCH、MCHC", "C": "骨髓穿刺", "D": "血清叶酸测定", "language": "zh"}
{"question": "40岁男性，头痛，伴恶心、呕吐3个月，近3天来头痛剧烈，呕吐呈喷射性，全身无力，不能站立。查体：患者嗜睡，痛苦病容，眼底见视神经乳头高度水肿，边缘有火焰状出血，体温37℃。2个月前当时脑脊液检查WBC 0.01×109/L。3．首先要作的辅助检查是（　　）。", "answer": "CT扫描", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "腰椎穿刺", "B": "全脑血管造影", "C": "CT扫描", "D": "核素脑扫描", "language": "zh"}
{"question": "3．tRNA反密码第1位上的I与mRNA密码第3位上的A、C、U均可配对，属于（　　）。", "answer": "摆动性", "meta_info": "生物化学", "answer_idx": "A", "A": "摆动性", "B": "通用性", "C": "连续性", "D": "特异性", "language": "zh"}
{"question": "先天性风疹综合征(CRS)即胎儿或新生儿患先天性白内障(失明)、心脏病、耳聋等缘由孕妇（　　）。", "answer": "在孕期1～5个月患风疹", "meta_info": "医学微生物学", "answer_idx": "A", "A": "在孕期1～5个月患风疹", "B": "在孕期6～7个月患风疹", "C": "分娩时患风疹", "D": "缺乏血清特异性风疹抗体", "language": "zh"}
{"question": "2．使慢性粒细胞白血病达到血液学缓解首选的治疗是（　　）。", "answer": "应用羟基脲", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "应用全反式维A酸", "B": "应用干扰素-α", "C": "放射治疗", "D": "应用羟基脲", "language": "zh"}
{"question": "原发性肝癌定位诊断，下述最敏感的方法是（　　）。", "answer": "CT肝动脉碘油造影", "meta_info": "第3篇　消化系统", "answer_idx": "B", "A": "X线肝血管造影", "B": "CT肝动脉碘油造影", "C": "放射性核素肝显像", "D": "X线门静脉造影", "language": "zh"}
{"question": "男，28岁。肛门周围胀痛，伴畏寒、发热2天。检查：肛门周围皮肤发红，压痛明显。最可能的诊断是（　　）。", "answer": "肛门旁皮下脓肿", "meta_info": "第3篇　消化系统", "answer_idx": "A", "A": "肛门旁皮下脓肿", "B": "混合痔", "C": "直肠癌", "D": "肛瘘", "language": "zh"}
{"question": "2．选择性阻断β1受体的为（　　）。", "answer": "美托洛尔", "meta_info": "药理学", "answer_idx": "D", "A": "普萘洛尔", "B": "拉贝洛尔", "C": "阿托品", "D": "美托洛尔", "language": "zh"}
{"question": "患儿，女，4岁，反复咳嗽2个月。查体：体温正常，浅表淋巴结（-）。咽（-），两肺布满哮鸣音，无水泡音，反复抗生素治疗不愈，以往无呛咳病史，有过敏性鼻炎。2．首选哪项检查？（　　）", "answer": "胸片", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "胸片", "B": "血培养", "C": "气道分泌物病毒分离", "D": "气管镜", "language": "zh"}
{"question": "女性，48岁。右颈部包块伴发热1个月入院，活检诊断为弥漫性大细胞型，B细胞来源，脾肋下5cm，骨髓穿刺涂片内有12%淋巴肉瘤细胞。3．治疗应采取（　　）。", "answer": "联合化疗", "meta_info": "第一部分　血液系统疾病", "answer_idx": "C", "A": "脾切除", "B": "放射治疗", "C": "联合化疗", "D": "颈淋巴结切除", "language": "zh"}
{"question": "女性青春期最早出现的是（　　）。", "answer": "乳房发育", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "月经来潮", "B": "乳房发育", "C": "体格发育", "D": "脂肪蓄积", "language": "zh"}
{"question": "心肌梗死后附壁血栓引起的脑血管疾病最常见的是（　　）。", "answer": "脑栓塞", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "蛛网膜下腔出血", "B": "脑血栓形成", "C": "脑栓塞", "D": "脑动脉炎", "language": "zh"}
{"question": "肥皂刷手法中需将上肢浸泡在70％乙醇内，浸泡范围是手至肘上（　　）。", "answer": "6cm", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "2cm", "B": "4cm", "C": "6cm", "D": "10cm", "language": "zh"}
{"question": "男，45岁，湖北人。3年前发现肝硬化、脾大，多次乙、丙型肝炎病毒学指标均阴性。结合流行病学、病史及血清学检查诊断为晚期血吸虫病。下列哪项不是晚期血吸虫病肝硬化的临床表现（　　）。", "answer": "溃疡性结肠炎", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "B", "A": "肝功损害", "B": "溃疡性结肠炎", "C": "巨脾", "D": "腹水", "language": "zh"}
{"question": "患儿，女，2岁半。自幼牛乳喂养，未按要求添加辅食，有时腹泻，逐渐消瘦。体检：身高80cm，体重7000g，皮下脂肪减少，腹壁皮下脂肪厚度<0.4cm，皮肤干燥、苍白，肌张力明显减低，肌肉松弛，脉搏缓慢，心音较低钝。1．对该患儿的主要诊断目前最可能是（　　）。", "answer": "营养不良", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "营养性缺铁性贫血", "B": "营养不良", "C": "婴幼儿腹泻", "D": "先天性甲状腺功能减低症", "language": "zh"}
{"question": "PPD试验假阴性常见于（　　）。", "answer": "急性粟粒性肺结核", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "患麻疹3个月后", "B": "急性粟粒性肺结核", "C": "患支气管肺炎时", "D": "未接种卡介苗", "language": "zh"}
{"question": "女婴，5天，发热昏迷入院，皮肤黄染，囟门饱满，病理反射阳性，脑脊液有大量中性粒细胞，应首选（　　）。", "answer": "氯霉素", "meta_info": "药理学", "answer_idx": "A", "A": "氯霉素", "B": "头孢哌酮", "C": "磺胺嘧啶", "D": "青霉素G", "language": "zh"}
{"question": "下列哪一项表现是由T3、T4分泌增多直接所致？（　　）", "answer": "心率增快", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "B", "A": "甲状腺肿大", "B": "心率增快", "C": "胫前黏液性水肿", "D": "甲状腺血管杂音", "language": "zh"}
{"question": "1．急性重型肝炎的病理特点是（　　）。", "answer": "肝细胞大片坏死", "meta_info": "病理学", "answer_idx": "D", "A": "肝细胞点灶状坏死", "B": "肝细胞亚大片坏死", "C": "肝细胞桥接坏死", "D": "肝细胞大片坏死", "language": "zh"}
{"question": "氯丙嗪抗精神病的作用机制是阻断（　　）。", "answer": "中脑-边缘系和中脑，皮质通路D2受体", "meta_info": "药理学", "answer_idx": "B", "A": "中枢α-肾上腺素能受体", "B": "中脑-边缘系和中脑，皮质通路D2受体", "C": "黑质-纹状体通路中的5-HT1受体", "D": "结节-漏斗通路的D2受体", "language": "zh"}
{"question": "一新生儿生后不到24小时出现黄疸，很快加重，皮肤重度黄染。3．最紧急的治疗是（　　）。", "answer": "光照治疗", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "抗感染", "B": "光照治疗", "C": "保肝治疗", "D": "灌肠促胎粪排出", "language": "zh"}
{"question": "男，35岁，外伤后腰痛伴右下肢麻木1周。查体：腰部活动受限，右小腿外侧感觉减退，疑有腰椎间盘突出症，最有诊断价值的检查方法是（　　）。", "answer": "CT", "meta_info": "第四部分　运动系统疾病", "answer_idx": "B", "A": "X线片", "B": "CT", "C": "核素骨扫描", "D": "肌电图", "language": "zh"}
{"question": "IQ＝[15（X－M）/S]＋100称为（　　）。", "answer": "离差智商", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "比率智商", "B": "离差智商", "C": "百分位智商", "D": "人格智商", "language": "zh"}
{"question": "对生长介素的叙述，错误的是（　　）。", "answer": "生长素通过它促进脂肪代谢", "meta_info": "生理学", "answer_idx": "D", "A": "是在生长素诱导下由肝脏产生的", "B": "生长素通过它促进软骨生长", "C": "生长素通过它促进蛋白质合成", "D": "生长素通过它促进脂肪代谢", "language": "zh"}
{"question": "5．ⅡB期淋巴瘤（　　）。", "answer": "病变累及右锁骨上淋巴结和左腋下，并伴有高热", "meta_info": "第一部分　血液系统疾病", "answer_idx": "C", "A": "病变仅限于一个解剖部位", "B": "病变累及右侧颈、腋下和腹股沟淋巴结", "C": "病变累及右锁骨上淋巴结和左腋下，并伴有高热", "D": "病变累及左颈及纵隔淋巴结", "language": "zh"}
{"question": "关于道德权利，下述提法中正确的是（　　）。", "answer": "道德权利与道德义务是对应的", "meta_info": "医学伦理学", "answer_idx": "D", "A": "道德权利都是法律权利", "B": "道德权利是依法行使的权力和应享受的利益", "C": "道德权利是法律权利的后盾", "D": "道德权利与道德义务是对应的", "language": "zh"}
{"question": "女，30岁，1年来乏力，易疲倦，腰部不适，有时下肢浮肿，未检查。2个月来加重，伴纳差，血压增高为150／100mmHg，下肢轻度浮肿。尿蛋白（＋），沉渣RBC 5～10/HP，偶见颗粒管型，血化验Hb 90g/L，血肌酐400ug/L。最可能的诊断是（　　）。", "answer": "慢性肾小球肾炎", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "慢性肾盂肾炎", "B": "慢性肾小球肾炎", "C": "肾病综合征", "D": "急性肾炎", "language": "zh"}
{"question": "男孩，10岁，近1周来夜间入睡2～3小时后常起床在房间内来回走动，目光呆滞，对问话不作答，数分钟后可自行回床睡觉。次日对夜间所发生的事不能回忆。患者既往体健，无精神疾病史。该患者的诊断首先考虑（　　）。", "answer": "睡行症", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "癔症", "B": "睡行症", "C": "精神分裂症早期", "D": "痴呆", "language": "zh"}
{"question": "女，55岁。急性胰腺炎，静脉应用广谱抗生素非手术治疗2周后，腹痛、腹胀加重，体温再度升高。2．若腹腔穿刺涂片查出大肠杆菌，应选择的治疗措施是（　　）。", "answer": "急诊行剖腹外引流手术", "meta_info": "第3篇　消化系统", "answer_idx": "B", "A": "甲硝唑和广谱抗生素腹腔灌洗", "B": "急诊行剖腹外引流手术", "C": "急诊行剖腹内引流手术", "D": "西药静脉滴注＋中药胃管内滴注", "language": "zh"}
{"question": "女，42岁。突发上腹剧痛6天，加重伴发热2天。查体：T 38℃，BP 76／50mmHg。面色苍白，嗜睡，脉搏细速，尿少。中上腹压痛（＋），伴反跳痛。上腹部可触及肿块，不活动。B超示胰腺周围液性包块，直径10cm。尿淀粉酶10000U/L（Somogyi法），血WBC 18×109/L，引起该患者感染的致病菌最可能是（　　）。", "answer": "大肠埃希菌", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "结核杆菌", "B": "大肠埃希菌", "C": "白色念珠菌", "D": "肠球菌", "language": "zh"}
{"question": "蛋白质二级结构是指分子中（　　）。", "answer": "局部主链的空间构象", "meta_info": "生物化学", "answer_idx": "B", "A": "每一氨基酸侧链的空间构象", "B": "局部主链的空间构象", "C": "氨基酸的排列顺序", "D": "每一原子的相对空间位置", "language": "zh"}
{"question": "女，80岁。高血压病史20年。间断头晕。既往有痛风史，查体：BP 180/90mmHg，心率52次/分，律齐，心脏各瓣膜听诊区未闻及杂音。实验室检查，血肌酐100μmo1/L，血钾正常，该患者的最适宜降压治疗方案是（　　）。", "answer": "缬沙坦与氨氯地平", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "氨氯地平与美托洛尔", "B": "缬沙坦与氢氯噻嗪", "C": "氨氯地平与氢氯噻嗪", "D": "缬沙坦与氨氯地平", "language": "zh"}
{"question": "外界轻微的刺激就容易引起情绪的强烈波动，或多愁善感，或兴奋激动，该症状是（　　）。", "answer": "情感脆弱", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "情感幼稚", "B": "病理性激情", "C": "情感脆弱", "D": "环性情绪", "language": "zh"}
{"question": "患者，男，64岁。因阵发性胸闷9年，持续胸痛7小时收入院。入院时血压为150/90mmHg，诊断急性前壁心肌梗死。1．支持诊断的心电图改变为（　　）。", "answer": "V1～V4出现异常Q波，伴ST段弓背向上抬高", "meta_info": "第2篇　心血管系统", "answer_idx": "B", "A": "Ⅱ、Ⅲ、aVF出现异常Q波，伴ST段弓背向上抬高", "B": "V1～V4出现异常Q波，伴ST段弓背向上抬高", "C": "Ⅰ、aVL出现肺性P波", "D": "浅而宽的Q波，ST段降低，T波抬高", "language": "zh"}
{"question": "哪一种疾病不易发生玻璃样变性？（　　）", "answer": "支气管炎", "meta_info": "病理学", "answer_idx": "D", "A": "动脉粥样硬化", "B": "肾小球肾炎", "C": "高血压病", "D": "支气管炎", "language": "zh"}
{"question": "女，65岁。经常出现头晕、四肢麻木感，注意力不易集中，自感记忆力下降半年，近2周突然加重。常半夜起床翻东西，怀疑家中被窃，易哭泣，对一些物品不能命名。既往高血压病史15年。头颅CT示：多发性脑梗死。最可能的诊断是（　　）。", "answer": "血管性痴呆", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "阿尔茨海默病", "B": "血管性痴呆", "C": "轻度认知功能损害", "D": "高血压病伴精神障碍", "language": "zh"}
{"question": "关于胆固醇在体内的主要生理功能的叙述，正确的是（　　）。", "answer": "控制膜的流动性", "meta_info": "生物化学", "answer_idx": "D", "A": "合成磷脂的前体", "B": "影响基因表达", "C": "控制胆汁分泌", "D": "控制膜的流动性", "language": "zh"}
{"question": "男，30岁，约1年时间孤僻、寡言，近期由于被上级批评后出现失眠，不上班并紧闭门窗，声称有人监视自己，在家中不敢谈话，说家中已被安装窃听器，公安局也要逮捕自己，不吃妻子做的饭食，认为妻子已同他人合伙在饭菜中放了毒药。因此殴打妻子。1．本病例的诊断最可能是（　　）。", "answer": "精神分裂症偏执型", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "精神分裂症偏执型", "B": "抑郁症", "C": "反应性精神病", "D": "躁狂症", "language": "zh"}
{"question": "1．属于Ⅰ类切口的手术是（　　）。", "answer": "腹腔镜疝修补术", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "化脓性阑尾炎手术", "B": "腹腔镜疝修补术", "C": "结肠脾曲癌引起的急诊肠梗阻手术", "D": "胃后壁穿孔手术", "language": "zh"}
{"question": "2．毛细血管壁增厚呈车轨状或分层状见于（　　）。", "answer": "弥漫性膜性增生性肾小球肾炎", "meta_info": "病理学", "answer_idx": "C", "A": "弥漫性系膜增生性肾小球肾炎", "B": "弥漫性新月体性肾小球肾炎", "C": "弥漫性膜性增生性肾小球肾炎", "D": "轻微病变性肾小球肾炎", "language": "zh"}
{"question": "3．治疗慢性心功能不全和逆转心肌肥厚并能降低病死率的药物是（　　）。", "answer": "卡托普利", "meta_info": "药理学", "answer_idx": "C", "A": "美西律", "B": "利多卡因", "C": "卡托普利", "D": "强心苷", "language": "zh"}
{"question": "7个月患儿，发热3天，体温39℃，流涕，咳重。皮肤出现红色斑丘疹，体温升至40℃。颊粘膜粗糙，可见白色斑点。1．最可能的诊断是（　　）。", "answer": "麻疹", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "风疹", "B": "水痘", "C": "麻疹", "D": "幼儿急疹", "language": "zh"}
{"question": "4岁女孩，反复发生支气管肺炎，消瘦，平时安静，不爱活动，稍活动后气急。胸骨左缘上方可闻及连续性的“机器”样杂音，占全收缩期和舒张期，杂音向左锁骨下、颈部和背部传导。超声心动图检查证实为先天性心脏病，动脉导管未闭。6．该患儿临床上出现下半身青紫，下列哪种情况是不正确的？（　　）", "answer": "胸骨左缘第二肋间可闻及粗糙响亮的连续性“机器”样杂音", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "肺动脉瓣区第二心音增强", "B": "闻及股动脉枪击音", "C": "胸骨左缘第二肋间可闻及粗糙响亮的连续性“机器”样杂音", "D": "胸骨左缘第二肋间可闻及全收缩期杂音", "language": "zh"}
{"question": "下列哪项主要表现病人角色所具有的特征？（　　）", "answer": "以上都包括", "meta_info": "医学心理学", "answer_idx": "D", "A": "求医行为", "B": "有疾病行为", "C": "与医疗系统发生关系", "D": "以上都包括", "language": "zh"}
{"question": "男，36岁，心悸、怕热、手颤乏力一年，大便不成形，日3～4次，体重下降11公斤，查体：脉搏90次/分，血压128／90mmHg，皮肤潮湿，双手细颤，双眼突出，甲状腺弥漫Ⅱ度肿大，可闻及血管杂音，心率104次/分，律不齐，心音强弱不等，腹平软，肝脾肋下未及，双下肢无水肿。2．本例心律不齐最可能是（　　）。", "answer": "心房颤动", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "窦性心律不齐", "B": "心房颤动", "C": "心房扑动", "D": "二度房室传导阻滞", "language": "zh"}
{"question": "一产妇分娩时产道出血400ml，血压100/65mmHg，Hb 110g/L。因平时身体虚弱，其家属要求输血以补充营养和加快恢复体力，此时正确的处理是（　　）。", "answer": "加强饮食营养，但不输注任何血液制品", "meta_info": "第二部分　模拟试题", "answer_idx": "C", "A": "输注全血2U", "B": "输注红细胞悬液2U", "C": "加强饮食营养，但不输注任何血液制品", "D": "输注人血清蛋白", "language": "zh"}
{"question": "关于癌基因的叙述，下述哪一项是正确的（　　）。", "answer": "是致癌病毒具有的某些核苷酸序列", "meta_info": "生物化学", "answer_idx": "A", "A": "是致癌病毒具有的某些核苷酸序列", "B": "为RNA病毒所特有", "C": "不需要活化即能表达", "D": "也称细胞癌基因", "language": "zh"}
{"question": "2．前有悬崖，后有追兵属于（　　）。", "answer": "双避冲突", "meta_info": "医学心理学", "answer_idx": "B", "A": "双趋冲突", "B": "双避冲突", "C": "多重趋避冲突", "D": "双重趋避冲突", "language": "zh"}
{"question": "男，15岁。全身水肿1周。查体：BP 120／70mmHg，腹部移动性浊音阳性。尿蛋白定量6.5g/d，沉渣RBC 0～2/HP。血清蛋白22g/L，胆固醇8mmol/L，BUN 6.5mmol/L，Scr 98μmol/L。AS2．最可能的肾脏病理类型是（　　）。", "answer": "微小病变肾病", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "新月体性肾炎", "B": "微小病变肾病", "C": "重度系膜增生性肾炎", "D": "系膜毛细血管性肾炎", "language": "zh"}
{"question": "3岁男孩，因自幼活动后气促，多汗，乏力来诊。体检：身高102cm，胸骨左缘第2～3肋间闻及收缩期杂音。心电图示：电轴右偏，不完全右束支传导阻滞。最可能的诊断是（　　）。", "answer": "房间隔缺损", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "房间隔缺损", "B": "室间隔缺损", "C": "肺动脉狭窄", "D": "法洛四联症", "language": "zh"}
{"question": "下述哪项是链球菌感染证据？（　　）", "answer": "抗“O”＞500U", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "抗“O”＞500U", "B": "CRP阳性", "C": "血沉增快", "D": "白细胞增高", "language": "zh"}
{"question": "关于电烧伤，错误的是（　　）。", "answer": "出口处较入口处重", "meta_info": "第八部分　其他疾病", "answer_idx": "A", "A": "出口处较入口处重", "B": "入口处常炭化", "C": "损伤范围常外小内大", "D": "烧伤常达肌肉、骨", "language": "zh"}
{"question": "男性，30岁，腹痛、腹泻、间断低热3年。结肠镜见回肠末段病变呈跳跃性，见纵行溃疡，溃疡周围黏膜呈鹅卵石样。最可能的诊断是（　　）。", "answer": "克罗恩病", "meta_info": "第3篇　消化系统", "answer_idx": "D", "A": "溃疡性结肠炎", "B": "溃疡型肠结核", "C": "肠伤寒", "D": "克罗恩病", "language": "zh"}
{"question": "患儿，男，12天。拒奶、少尿、体温不升10小时急诊入院。查体：重病容，面色苍白，前囟平，颈软，心音低钝，双肺未闻及啰音，腹胀，肝右肋下3.5cm，脐有少许分泌物。实验室检查：血WBC 5.0×109/L，N 0.70，L 0.30。最可能的诊断是（　　）。", "answer": "新生儿败血症", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "新生儿化脓性脑膜炎", "B": "新生儿肺炎", "C": "新生儿颅内出血", "D": "新生儿败血症", "language": "zh"}
{"question": "3．可兴奋细胞受刺激后，首先出现（　　）。", "answer": "局部电位", "meta_info": "生理学", "answer_idx": "C", "A": "锋电位", "B": "负后电位", "C": "局部电位", "D": "正后电位", "language": "zh"}
{"question": "男，26岁，饱餐后剧烈运动时腹痛2小时，阵发性加剧，脐周伴腰背痛，呕吐频繁，吐后症状无缓解，腹肌紧张，脐周有压痛及反跳痛，肠鸣音亢进，有气过水声。2．该病人需要首先静脉输入（　　）。", "answer": "等渗糖盐水", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "血浆", "B": "代血浆", "C": "全血", "D": "等渗糖盐水", "language": "zh"}
{"question": "某位病人患了性传播疾病，接受治疗。医生把此事告诉了病人单位里的其他人。单位里人得知此事后，都回避病人，和他断绝了一切来往。此现象表明病人下列哪项权利受到侵犯（　　）。", "answer": "被尊重和保守个人秘密的权利", "meta_info": "医学心理学", "answer_idx": "C", "A": "免除健康时的社会责任", "B": "病人的经济利益", "C": "被尊重和保守个人秘密的权利", "D": "以上都不是", "language": "zh"}
{"question": "2．急性脊髓炎（　　）。", "answer": "尿便障碍出现早", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "尿便障碍出现早", "B": "尿便障碍出现晚", "C": "分离性感觉障碍", "D": "无尿便障碍", "language": "zh"}
{"question": "重症肌无力常与哪一种病合并存在？（　　）", "answer": "胸腺肥大或胸腺瘤", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "甲状腺功能亢进", "B": "小细胞肺癌", "C": "多发性肌炎", "D": "胸腺肥大或胸腺瘤", "language": "zh"}
{"question": "医学伦理学最古老，最有生命力的医德范畴是（　　）。", "answer": "医疗保密", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "医疗保密", "B": "医疗公正", "C": "医疗权利", "D": "医疗荣誉", "language": "zh"}
{"question": "关于高血压脑出血，下列哪项不正确（　　）。", "answer": "外科治疗的目的是止血", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "出血是因粟粒状微动脉瘤破裂所致", "B": "出血50％～60％发生在壳核，其余为皮层下、丘脑、脑桥和小脑", "C": "CT为首选的检查方法", "D": "外科治疗的目的是止血", "language": "zh"}
{"question": "2．患者，女，60岁。进行性吞咽困难半年。食管吞钡X线钡餐检查示：颈段食管长5cm充盈缺损.左锁骨上窝有2枚肿大淋巴结，粘连固定，病理学为转移癌。其治疗应为（　　）。", "answer": "放射治疗", "meta_info": "第3篇　消化系统", "answer_idx": "A", "A": "放射治疗", "B": "术前放疗，放疗后3周内手术", "C": "化学疗法", "D": "中医中药治疗", "language": "zh"}
{"question": "下述哪一项结果对诊断缺铁性贫血最有意义？（　　）", "answer": "血清铁降低", "meta_info": "第一部分　血液系统疾病", "answer_idx": "D", "A": "红细胞平均血红蛋白浓度降低", "B": "红细胞平均体积降低", "C": "红细胞平均直径变小", "D": "血清铁降低", "language": "zh"}
{"question": "1．新生儿出血宜选用（　　）。", "answer": "维生素K", "meta_info": "药理学", "answer_idx": "A", "A": "维生素K", "B": "氨甲环酸", "C": "硫酸亚铁", "D": "尿激酶", "language": "zh"}
{"question": "1．营养性巨幼细胞贫血的检查结果为（　　）。", "answer": "MCV＞94fl，MCH＞32pg，MCHC 32％～38％", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "MCV＞94fl，MCH＞32pg，MCHC＞38％", "B": "MCV 80～94fl，MCH 28～32pg，MCHC 32％～38％", "C": "MCV＜80fl，MCH＜28pg，MCHC＜32％", "D": "MCV＞94fl，MCH＞32pg，MCHC 32％～38％", "language": "zh"}
{"question": "2．参与氧化脱氨的维生素是（　　）。", "answer": "维生素PP", "meta_info": "生物化学", "answer_idx": "B", "A": "维生素B1", "B": "维生素PP", "C": "叶酸", "D": "泛酸", "language": "zh"}
{"question": "急性胃炎的临床表现不包括（　　）。", "answer": "黄疸", "meta_info": "第3篇　消化系统", "answer_idx": "A", "A": "黄疸", "B": "消化道出血", "C": "呕吐", "D": "恶心", "language": "zh"}
{"question": "下列哪项是心理测量工具好坏的最基本标志?（　　）", "answer": "信度和效度", "meta_info": "医学心理学", "answer_idx": "B", "A": "代表性", "B": "信度和效度", "C": "标准化", "D": "以上都不是", "language": "zh"}
{"question": "1．甲肝感染（　　）。", "answer": "抗HAV阳性", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "B", "A": "抗HIV阳性", "B": "抗HAV阳性", "C": "抗EBV阳性", "D": "抗“O”阳性", "language": "zh"}
{"question": "肖某，女性，23岁，近一月来躺在床上常感到有人在给自己按摩，胃肠内有异物插入，非常难受，有时感到胃中有一个像乒乓球样的东西。该症状属于（　　）。", "answer": "内脏幻觉", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "错觉", "B": "妄想", "C": "内脏幻觉", "D": "感觉倒错", "language": "zh"}
{"question": "突然停止治疗全面强直-阵挛发作的药物可引起（　　）。", "answer": "癫痫持续状态", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "精神萎靡", "B": "抗癫痫用药量增加", "C": "失神发作", "D": "癫痫持续状态", "language": "zh"}
{"question": "不符合小儿生长发育的一般规律的是（　　）。", "answer": "由远到近", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "由上到下", "B": "由远到近", "C": "由粗到细", "D": "由低级到高级", "language": "zh"}
{"question": "患者突然出现右口角抽搐，后出现右侧上肢，下肢抽动，继而出现四肢抽搐，病变部位在（　　）。", "answer": "左侧中央前回下部", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "左侧中央前回下部", "B": "右侧中央前回下部", "C": "右侧中央前回上部", "D": "右侧中央后回", "language": "zh"}
{"question": "寄生虫感染时，浸润的炎症细胞主要为（　　）。", "answer": "嗜酸性粒细胞", "meta_info": "病理学", "answer_idx": "D", "A": "中性粒细胞", "B": "单核细胞", "C": "淋巴细胞", "D": "嗜酸性粒细胞", "language": "zh"}
{"question": "患者，男，28岁。7个月前缓慢出现左胸电击样疼痛，夜间加重。4个月前左下肢进行性无力，近1个月右下肢无力，排尿困难。查体：双上肢正常，左下肢肌力3级、右下肢4级，肌张力增高，腱反射亢进，双Babinski征（+），T4以下感觉减退。诊断最可能是下列哪项？（　　）", "answer": "脊髓压迫症", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "脊髓压迫症", "B": "多发性神经病", "C": "运动神经元病", "D": "急性脊髓炎", "language": "zh"}
{"question": "重视环境与个体的相互影响、人类身心全面发展以及社会适应良好的医学模式是（　　）。", "answer": "生物－心理－社会医学模式", "meta_info": "医学伦理学", "answer_idx": "D", "A": "自然医学模式", "B": "机械医学模式", "C": "生物医学模式", "D": "生物－心理－社会医学模式", "language": "zh"}
{"question": "1．哪项是5-羟色胺的前体？（　　）", "answer": "色氨酸", "meta_info": "生物化学", "answer_idx": "C", "A": "组氨酸", "B": "谷氨酸", "C": "色氨酸", "D": "苏氨酸", "language": "zh"}
{"question": "哪项为确诊霍乱的主要依据？（　　）", "answer": "吐泻物检查霍乱弧菌", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "D", "A": "“米泔水”样泻吐物", "B": "无痛性腹泻", "C": "霍乱血清凝集反应", "D": "吐泻物检查霍乱弧菌", "language": "zh"}
{"question": "痈的急性化脓性感染分布在（　　）。", "answer": "邻近多个毛囊及其所属皮脂腺", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "单个毛囊及其所属皮脂腺", "B": "邻近多个毛囊及其所属皮脂腺", "C": "全身广泛的皮肤毛囊及其所属皮脂腺", "D": "皮肤网状淋巴管", "language": "zh"}
{"question": "强心苷对下列哪种心衰的疗效最好？（　　）", "answer": "高血压或瓣膜病引起的", "meta_info": "药理学", "answer_idx": "D", "A": "严重二尖瓣狭窄引起的", "B": "肺源性心脏病引起的", "C": "严重贫血引起的", "D": "高血压或瓣膜病引起的", "language": "zh"}
{"question": "2岁以内乳牙的数目约为（　　）。", "answer": "月龄减4～6", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "月龄减2～4", "B": "月龄减4～6", "C": "月龄减6～8", "D": "月龄减10～12", "language": "zh"}
{"question": "1．导致支气管平滑肌舒张的肾上腺素能受体是（　　）。", "answer": "β2受体", "meta_info": "生理学", "answer_idx": "C", "A": "α受体", "B": "β1受体", "C": "β2受体", "D": "N受体", "language": "zh"}
{"question": "碳酸锂的下述不良反应中哪项是错误的？（　　）", "answer": "胰岛素分泌减少加重糖尿病症状", "meta_info": "药理学", "answer_idx": "D", "A": "恶心、呕吐", "B": "口干、多尿", "C": "肌无力、肢体震颤", "D": "胰岛素分泌减少加重糖尿病症状", "language": "zh"}
{"question": "1．将玩具从一手换入另一手的月龄是（　　）。", "answer": "7个月", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "7个月", "B": "9个月", "C": "12个月", "D": "15个月", "language": "zh"}
{"question": "男，46岁。有上腹隐痛不适伴嗳气、反酸3年余，加重3个月。行上消化道气钡双重造影检查，其结果见胃黏膜紊乱，有大小不一的龛影，周围皱襞中断，胃壁僵硬、蠕动减弱。4．下列情况中，不能行胃癌根治手术的是（　　）。", "answer": "子宫直肠窝转移", "meta_info": "第3篇　消化系统", "answer_idx": "A", "A": "子宫直肠窝转移", "B": "肝十二指肠韧带内淋巴结转移", "C": "癌组织浸润胰尾部时", "D": "癌组织浸润横结肠时", "language": "zh"}
{"question": "下列哪种药物是选择性钙拮抗药？（　　）", "answer": "拉西地平", "meta_info": "药理学", "answer_idx": "B", "A": "哌克昔林", "B": "拉西地平", "C": "氟桂利嗪", "D": "桂利嗪", "language": "zh"}
{"question": "5．由肥大细胞和嗜碱性粒细胞参与（　　）。", "answer": "Ⅰ型超敏反应", "meta_info": "医学免疫学", "answer_idx": "A", "A": "Ⅰ型超敏反应", "B": "Ⅲ型超敏反应", "C": "Ⅳ型超敏反应", "D": "以上均不是", "language": "zh"}
{"question": "小儿脊柱出现胸椎后突的时间是（　　）。", "answer": "出生后6个月", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "出生后3个月", "B": "出生后6个月", "C": "出生后10个月", "D": "1岁", "language": "zh"}
{"question": "哪种偏头痛最常见？（　　）", "answer": "普通偏头痛", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "血管性头痛", "B": "普通偏头痛", "C": "丛集型偏头痛", "D": "特殊型偏头痛", "language": "zh"}
{"question": "女，65岁。胆结石术后8天突发呼吸困难2小时，有COPD史20余年。查体：血压110/80mmHg，端坐呼吸，烦躁不安，大汗，口唇发绀，双肺可闻及少量干、湿啰音，心率130次/分。该患者呼吸困难最可能的原因是并发（　　）。", "answer": "自发性气胸", "meta_info": "第1篇　呼吸系统", "answer_idx": "B", "A": "急性左心衰竭", "B": "自发性气胸", "C": "继发肺部感染", "D": "急性呼吸窘迫综合征", "language": "zh"}
{"question": "对于Ml正确的为（　　）。", "answer": "骨髓增生活跃，原粒细胞占未分化细胞的比例>90%", "meta_info": "第一部分　血液系统疾病", "answer_idx": "A", "A": "骨髓增生活跃，原粒细胞占未分化细胞的比例>90%", "B": "NAP升高", "C": "Ph1多阳性", "D": "最易发生DIC及中枢神经系统白血病", "language": "zh"}
{"question": "3．主要作用于髓袢升支粗段皮质部和髓质部的是（　　）。", "answer": "呋塞米", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "呋塞米", "B": "螺内酯", "C": "氨苯蝶啶", "D": "甘露醇", "language": "zh"}
{"question": "5．主张人格的形成主要是通过对社会环境的适应（　　）。", "answer": "社会学习理论", "meta_info": "医学心理学", "answer_idx": "C", "A": "精神分析理论", "B": "人本主义理论", "C": "社会学习理论", "D": "人格特质理论", "language": "zh"}
{"question": "38岁经产妇，2次不良产史，现足月妊娠。阵发性腹痛7小时住院待产。检查子宫收缩20～30秒/5～6分钟，宫口开大2cm，头先露S－3，估计胎儿4000g。诊断为子宫收缩乏力。其诱因可能与下列哪项无关？（　　）", "answer": "子宫过度膨胀", "meta_info": "第5篇　女性生殖系统", "answer_idx": "C", "A": "头盆不称", "B": "精神因素", "C": "子宫过度膨胀", "D": "潜伏期延长", "language": "zh"}
{"question": "脑栓塞的临床表现中，下列哪一项是错误的？（　　）", "answer": "多有脑膜刺激征", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "年龄多较轻", "B": "多有脑膜刺激征", "C": "常见局限性抽搐、偏瘫、失语", "D": "多有风湿性心脏病", "language": "zh"}
{"question": "35岁，女性，双胎妊娠，胎膜早破，规律宫缩15小时，子宫颈口开大2cm，行剖宫产术，术后静脉点滴抗生素预防感染。第4天出现发冷、发热和腹痛，乳房胀，体温39.5℃，持续4小时。检查子宫底平脐，压痛阳性，恶露污浊有臭味。3．下列处理哪项不正确？（　　）", "answer": "诊断性刮宫", "meta_info": "第5篇　女性生殖系统", "answer_idx": "D", "A": "宫腔分泌物细菌培养和药敏试验", "B": "产妇采用半卧位、乳房热敷", "C": "选用对需氧菌和厌氧菌有效的抗生素联合治疗", "D": "诊断性刮宫", "language": "zh"}
{"question": "1．吗啡（　　）。", "answer": "可引起呼吸抑制", "meta_info": "药理学", "answer_idx": "B", "A": "可引起瞳孔扩大", "B": "可引起呼吸抑制", "C": "可引起共济失调", "D": "可引起急性心力衰竭", "language": "zh"}
{"question": "1．低剂量TD-Ag（　　）。", "answer": "引起T细胞免疫耐受", "meta_info": "医学免疫学", "answer_idx": "A", "A": "引起T细胞免疫耐受", "B": "引起B细胞免疫耐受", "C": "不引起免疫耐受", "D": "引起免疫抑制", "language": "zh"}
{"question": "经产前检查，医师发现或者怀疑胎儿异常的，应当对孕妇进行（　　）。", "answer": "产前诊断", "meta_info": "卫生法规", "answer_idx": "A", "A": "产前诊断", "B": "母婴保健", "C": "孕妇保健", "D": "胎儿保健", "language": "zh"}
{"question": "一眼静止时处于外展位并有瞳孔扩大，被损害的脑神经是（　　）。", "answer": "动眼神经", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "动眼神经", "B": "展神经", "C": "面神经", "D": "支配瞳孔的交感神经", "language": "zh"}
{"question": "语音震颤减弱常见于（　　）。", "answer": "肺气肿", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "肺炎", "B": "肺梗死", "C": "肺气肿", "D": "空洞型肺结核", "language": "zh"}
{"question": "Pratt试验的目的是（　　）。", "answer": "检查交通静脉瓣膜", "meta_info": "第2篇　心血管系统", "answer_idx": "D", "A": "检查深静脉", "B": "检查浅静脉", "C": "检查大隐静脉", "D": "检查交通静脉瓣膜", "language": "zh"}
{"question": "对于输血的原则，不正确的为（　　）。", "answer": "紧急情况下O型血可少量缓慢接受其他型血液", "meta_info": "生理学", "answer_idx": "C", "A": "输同型血经交叉配血试验主、次侧均不凝集为首选", "B": "必须保证ABO血型相合", "C": "紧急情况下O型血可少量缓慢接受其他型血液", "D": "AB型的人可少量缓慢接受其他型血液", "language": "zh"}
{"question": "女，35岁，被人用铁棒击伤头部，当时昏迷，送医院途中曾与家人谈话，但头痛，呕吐明显。查体：呈昏迷状态，左瞳孔直径0.5cm，右侧0.2cm，右侧肢体无自主运动。1．首先考虑的诊断是（　　）。", "answer": "急性硬脑膜外血肿", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "脑挫裂伤", "B": "原发性脑干损伤", "C": "急性硬脑膜外血肿", "D": "急性脑内血肿", "language": "zh"}
{"question": "下列哪项为精蛋白锌胰岛素引起的低血糖反应症状？（　　）", "answer": "精神情绪及运动障碍", "meta_info": "药理学", "answer_idx": "D", "A": "饥饿", "B": "肌肉震颤", "C": "心悸", "D": "精神情绪及运动障碍", "language": "zh"}
{"question": "2．人人享有卫生保健是贯彻了什么原则？（　　）", "answer": "公正原则", "meta_info": "医学伦理学", "answer_idx": "D", "A": "保守秘密原则", "B": "互相协作原则", "C": "诚实原则", "D": "公正原则", "language": "zh"}
{"question": "卫生服务需求的正确描述是（　　）。", "answer": "由需要转化而来的需求和没有需要的需求", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "由需要转化而来的利用和没有需要的需求", "B": "由需要转化而来的利用和没有需要的利用", "C": "由需要转化而来的需求和没有需要的需求", "D": "由需要转化而来的利用和没有利用的需求", "language": "zh"}
{"question": "患者，男，28岁，自8米高处坠落2小时后送至医院。自述胸背部疼痛，双下肢不能活动。3．CT显示胸11椎体爆裂骨折，胸11椎体压缩1/2，椎管内有较大骨折块，同时伴关节突交锁，最佳的治疗方案应是（　　）。", "answer": "手术减压，脊柱内固定术", "meta_info": "第四部分　运动系统疾病", "answer_idx": "A", "A": "手术减压，脊柱内固定术", "B": "手术切除相应椎板使脊髓得以减压", "C": "颅骨牵引并使用激素及脱水药物", "D": "手法复位并行推拿治疗", "language": "zh"}
{"question": "反映体内储备铁的指标是（　　）。", "answer": "血清铁蛋白", "meta_info": "第一部分　血液系统疾病", "answer_idx": "A", "A": "血清铁蛋白", "B": "总铁结合力", "C": "血红蛋白", "D": "转铁蛋白", "language": "zh"}
{"question": "对游离胆红素的描述，错误的是（　　）。", "answer": "能经肾随尿排出", "meta_info": "生物化学", "answer_idx": "D", "A": "与血浆清蛋白亲和力大", "B": "易透过细胞膜对脑的毒性怍用大", "C": "与偶氮试剂反应呈间接反应", "D": "能经肾随尿排出", "language": "zh"}
{"question": "女性，74岁，1周前因股骨颈骨折卧床行保守牵引治疗。8小时前在睡眠中突发心前区疼痛，持续伴阵发加重，出汗，口含硝酸甘油不缓解。既往有高血压、糖尿病病史。入院查体：P 62次/min，BP 110/70mmHg，双肺（－），心脏不大，心律齐，A2＞P2，双侧脉搏对称。患者心电图如下所示。2．为明确诊断，最有价值的检查是（　　）。", "answer": "肌钙蛋白T（cTnT）", "meta_info": "第2篇　心血管系统", "answer_idx": "B", "A": "D-二聚体（D-dimer）", "B": "肌钙蛋白T（cTnT）", "C": "脑钠肽（BNP）", "D": "肌酸激酶", "language": "zh"}
{"question": "3．淋巴干细胞分化成熟为T淋巴细胞的场所在（　　）。", "answer": "胸腺", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "肠腔", "B": "免疫球蛋白G", "C": "胸腺", "D": "骨髓", "language": "zh"}
{"question": "确诊伤寒最常用的检测方法是（　　）。", "answer": "血培养", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "粪便培养", "B": "血培养", "C": "骨髓培养", "D": "胆汁培养", "language": "zh"}
{"question": "以下诊断癫痫的首选辅助检查是（　　）。", "answer": "脑电图检查", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "诱发电位", "B": "脑电图检查", "C": "CT扫描", "D": "脑脊液检查", "language": "zh"}
{"question": "3．与激动药竞争同一受体并使激动药剂量-效应曲线右移，但最大效应不变（　　）。", "answer": "竞争性拮抗药", "meta_info": "药理学", "answer_idx": "C", "A": "激动药", "B": "部分激动药", "C": "竞争性拮抗药", "D": "非竞争性拮抗药", "language": "zh"}
{"question": "男婴，8个月。腹泻伴呕吐3天，无尿6小时。大便10～15次/天，呈蛋花汤样伴黏液，有腥臭味。查体：T 37.8℃，表情淡漠，前囟、眼窝明显凹陷，皮肤弹性差，可见花纹，四肢厥冷，双肺呼吸音清，心率120次/分，腹软，无明显压痛。实验室检查：粪镜检偶见白细胞，血钠134mmol/L。1．病原学诊断最可能是（　　）。", "answer": "产毒性大肠埃希菌肠炎", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "产毒性大肠埃希菌肠炎", "B": "金黄色葡萄球菌肠炎", "C": "轮状病毒肠炎", "D": "白色念珠菌肠炎", "language": "zh"}
{"question": "胆管癌的主要表现是（　　）。", "answer": "无痛性黄疸", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "厌食，恶心呕吐", "B": "腹痛，黄疸和寒战高热", "C": "无痛性黄疸", "D": "体重明显减轻", "language": "zh"}
{"question": "产后出血是指在胎儿娩出后24小时内阴道流血量超过（　　）。", "answer": "500mL", "meta_info": "第5篇　女性生殖系统", "answer_idx": "B", "A": "600mL", "B": "500mL", "C": "400mL", "D": "300mL", "language": "zh"}
{"question": "符合经典内分泌概念的激素是（　　）。", "answer": "泌乳素", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "B", "A": "生长抑素", "B": "泌乳素", "C": "胰高血糖素", "D": "促红细胞生成素", "language": "zh"}
{"question": "下列说法错误的是（　　）。", "answer": "心理能客观地反映事物", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "心理是脑的功能", "B": "心理是对事物的主观反映", "C": "客观现实是心理的源泉", "D": "心理能客观地反映事物", "language": "zh"}
{"question": "脑器质性精神障碍的高发年龄阶段是（　　）。", "answer": "老年", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "老年", "B": "少年", "C": "青年", "D": "儿童", "language": "zh"}
{"question": "下列哪项是原核生物参与转录起始的酶?（　　）", "answer": "RNA聚合酶全酶", "meta_info": "生物化学", "answer_idx": "D", "A": "引物酶", "B": "解链酶", "C": "RNA聚合酶Ⅲ", "D": "RNA聚合酶全酶", "language": "zh"}
{"question": "6个月婴儿，诊为化脓性脑膜炎，经抗感染治疗后，脑脊液化验正常，但体温持续不退，并出现惊厥。最可能的情况为（　　）。", "answer": "化脓性脑膜炎合并硬膜下积液", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "化脓性脑膜炎合并脑室管膜炎", "B": "化脓性脑膜炎合并硬膜下积液", "C": "化脓性脑膜炎恶化", "D": "化脓性脑膜炎合并脑脓肿", "language": "zh"}
{"question": "2周岁正常小儿血象白细胞分类以（　　）。", "answer": "淋巴细胞占优势", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "杆状核细胞占优势", "B": "分叶粒细胞占优势", "C": "淋巴细胞占优势", "D": "幼稚淋巴细胞占优势", "language": "zh"}
{"question": "已婚妇女，25岁。停经49天，阵发性下腹痛伴阴道少量出血3天，妇科检查宫口未开，子宫大小与停经天数相符合，最可能的诊断是（　　）。", "answer": "先兆流产", "meta_info": "第5篇　女性生殖系统", "answer_idx": "B", "A": "葡萄胎", "B": "先兆流产", "C": "难免流产", "D": "不全流产", "language": "zh"}
{"question": "关于心身疾病，不正确的说法是（　　）。", "answer": "遗传因素可以作为发病的基础", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "一般均出现器质性病变", "B": "情绪障碍在发病中是重要的中介", "C": "遗传因素可以作为发病的基础", "D": "疾病的症状波动与心理因素密切相关", "language": "zh"}
{"question": "肝硬化肝性脑病时，患者血氨升高，下列用于降血氨的是（　　）。", "answer": "L-鸟氨酸-L-门冬氨酸", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "L-鸟氨酸-L-门冬氨酸", "B": "氟马西尼", "C": "亮氨酸", "D": "缬氨酸", "language": "zh"}
{"question": "女，19岁。因发热伴头痛、烦躁2天，于1月28日入院。查体：BP 130／80mmHg，精神差，神志清楚，全身散在瘀点、瘀斑，颈抵抗阳性，Kernig征及Babinski征均阳性。实验室检查：腰穿脑脊液压力240mmH2O，外观混浊，WBC 1200×106/L，蛋白质1.5g/L，糖2.5mmol/L，氯化物100mol/L。本病蛛网膜切片的病理改变不包括（　　）。", "answer": "可见大量淋巴细胞、单核细胞", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "血管扩张充血", "B": "可见大量中性粒细胞", "C": "可见大量淋巴细胞、单核细胞", "D": "可见纤维素", "language": "zh"}
{"question": "张某，胃癌晚期，极度痛苦。但自认是胃溃疡，有望治疗。每当有不适和要求时，都按铃要求医务人员能解决。但医护人员总是勉强应付，使病人十分失望。一次，病人疼痛又发作，要求止痛，遭到拒绝，理由是：你的用药，医嘱已全了。面对类似病人，我们在医学道德选择上最佳方法是（　　）。", "answer": "征得家属同意后告诉病人实情，尽量满足病人要求，减轻痛苦", "meta_info": "医学伦理学", "answer_idx": "D", "A": "适当满足病人要求，减轻痛苦", "B": "实情交代，无法治疗", "C": "继续隐瞒病情，被动治疗", "D": "征得家属同意后告诉病人实情，尽量满足病人要求，减轻痛苦", "language": "zh"}
{"question": "1．能处理及递呈抗原的是（　　）。", "answer": "树突状细胞", "meta_info": "医学免疫学", "answer_idx": "D", "A": "嗜酸性粒细胞", "B": "中性粒细胞", "C": "淋巴细胞", "D": "树突状细胞", "language": "zh"}
{"question": "4个月小儿，患有维生素D缺乏性佝偻病，在开始VitD治疗时，突然出现惊厥，应立即采取的措施为（　　）。", "answer": "静脉点滴钙剂", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "静脉点滴钙剂", "B": "肌注鲁米那", "C": "气管插管", "D": "静脉推注脱水药", "language": "zh"}
{"question": "下列疾病中，哪一项不是衣原体引起的？（　　）", "answer": "大叶性肺炎", "meta_info": "医学微生物学", "answer_idx": "A", "A": "大叶性肺炎", "B": "性病淋巴肉芽肿", "C": "新生儿肺炎", "D": "包涵体性结膜炎", "language": "zh"}
{"question": "女性，47岁，半年来逐渐出现坐立不安，搓手顿足，惶惶不可终日，心情忧郁，悲观厌世，无大脑迟钝，无行动迟缓，近1年来月经无规律，手足发热，有时出汗，全身不适。此症状是（　　）。", "answer": "更年期抑郁", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "老年性抑郁", "B": "精神分裂症后抑郁", "C": "躯体病伴发抑郁", "D": "更年期抑郁", "language": "zh"}
{"question": "中度慢性肝炎镜下具有两种特征是（　　）。", "answer": "碎片状坏死及桥接坏死", "meta_info": "病理学", "answer_idx": "A", "A": "碎片状坏死及桥接坏死", "B": "纤维性炎及化脓性炎", "C": "假小叶及干酪样坏死", "D": "以上都不对", "language": "zh"}
{"question": "幽门梗阻病人呕吐10d，血压90/75mmHg，血钾3.1mmol/L，pH 7.5，应诊断为（　　）。", "answer": "代谢性碱中毒", "meta_info": "第二部分　模拟试题", "answer_idx": "D", "A": "呼吸性酸中毒", "B": "呼吸性碱中毒", "C": "代谢性酸中毒", "D": "代谢性碱中毒", "language": "zh"}
{"question": "男性，30岁，2天前曾与剧烈腹泻米泔水样物病人共同进餐。1天前突然剧烈呕吐、腹泻，清水样，无腹痛。血压90/60mmHg，脉搏100次/分，体温36.8℃，脱水外观，腓肠肌痉挛性痛。化验发现血液浓缩，便常规见少量黏液和白细胞。最可能的诊断是（　　）。", "answer": "霍乱", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "B", "A": "菌痢", "B": "霍乱", "C": "食物中毒", "D": "病毒性胃肠炎", "language": "zh"}
{"question": "男，30岁，拟在硬膜外麻醉下行胃大部切除术，为预防麻醉过程中出现血压下降，术前应采用何种药物？（　　）", "answer": "麻黄碱", "meta_info": "药理学", "answer_idx": "D", "A": "肾上腺素", "B": "间羟胺", "C": "多巴胺", "D": "麻黄碱", "language": "zh"}
{"question": "1．溃疡性结肠炎的病变大多位于（　　）。", "answer": "直肠、乙状结肠", "meta_info": "第3篇　消化系统", "answer_idx": "D", "A": "回盲部", "B": "末段回肠", "C": "全结肠", "D": "直肠、乙状结肠", "language": "zh"}
{"question": "腹腔空腔脏器破裂引起的腹膜炎的主要表现是（　　）。", "answer": "腹膜刺激征", "meta_info": "第3篇　消化系统", "answer_idx": "A", "A": "腹膜刺激征", "B": "胃肠道症状", "C": "气腹症", "D": "全身感染", "language": "zh"}
{"question": "认为医技人员从属于医师、服务于医师的观点，不符合下列哪条道德原则?（　　）", "answer": "彼此平等、互相尊重", "meta_info": "医学伦理学", "answer_idx": "B", "A": "正当竞争", "B": "彼此平等、互相尊重", "C": "不伤害", "D": "社会主义医学人道主义", "language": "zh"}
{"question": "病人在意识清晰时出现幻视多见于（　　）。", "answer": "精神分裂症", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "神经症", "B": "精神分裂症", "C": "抑郁症", "D": "躁狂症", "language": "zh"}
{"question": "2．上述哪项是不能做全身应用，而只能外用的糖皮质激素？（　　）", "answer": "氟轻松", "meta_info": "药理学", "answer_idx": "C", "A": "地塞米松", "B": "可的松", "C": "氟轻松", "D": "甲泼尼松", "language": "zh"}
{"question": "下列属于淋病奈瑟菌的特征的是（　　）。", "answer": "为革兰染色阴性双球菌", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "离开人体可存活4小时", "B": "为革兰染色阴性双球菌", "C": "一般消毒剂不易将其杀灭", "D": "对复层鳞状上皮有亲和力", "language": "zh"}
{"question": "关于T、B细胞免疫耐受的特点正确的叙述是（　　）。", "answer": "低剂量TD-Ag仅能使T细胞产生耐受，不能使B细胞产生耐受", "meta_info": "医学免疫学", "answer_idx": "C", "A": "诱导T细胞耐受维持时间短，B细胞长", "B": "高剂量TD-Ag不能使T、B细胞产生耐受", "C": "低剂量TD-Ag仅能使T细胞产生耐受，不能使B细胞产生耐受", "D": "低剂量的TI-Ag能使T、B细胞均产生耐受", "language": "zh"}
{"question": "下列哪项是近球小管对葡萄糖重吸收的关键动力？（　　）", "answer": "管腔膜上的同向转运", "meta_info": "生理学", "answer_idx": "A", "A": "管腔膜上的同向转运", "B": "基侧膜上的Na+泵", "C": "管腔膜上的电中性转运", "D": "管腔膜上的生电性转运", "language": "zh"}
{"question": "2．血清钾2.9mmol/L，心音低钝、腹胀、膝腱反射未引出（　　）。", "answer": "低钾血症", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "低渗性脱水", "B": "等渗性脱水", "C": "低钾血症", "D": "代谢性酸中毒", "language": "zh"}
{"question": "男，15岁，上感后2周出现肉眼血尿，BP 150／95mmHg，临床诊断为急性肾小球肾炎，控制血压应首选（　　）。", "answer": "利尿剂", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "血管紧张素Ⅱ受体拮抗剂", "B": "钙拮抗剂", "C": "α受体阻断剂", "D": "利尿剂", "language": "zh"}
{"question": "T细胞的生物学功能不包括（　　）。", "answer": "介导ADCC效应", "meta_info": "医学免疫学", "answer_idx": "D", "A": "直接杀伤靶细胞", "B": "参与对病毒的免疫应答", "C": "诱导抗体的类别转换", "D": "介导ADCC效应", "language": "zh"}
{"question": "有一名45岁女患者，车祸头部受伤，伤后即昏迷，1小时后入院。入院时中度昏迷，右侧瞳孔散大，光反射消失，左上下肢病理征（+）。1．首先采取措施是（　　）。", "answer": "20％甘露醇250ml静脉滴注", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "给予抗生素预防感染", "B": "20％甘露醇250ml静脉滴注", "C": "给予止血药物", "D": "地塞米松20mg静脉滴注", "language": "zh"}
{"question": "2．反映两变量间相关关系可绘制（　　）。", "answer": "散点图", "meta_info": "预防医学", "answer_idx": "B", "A": "圆图", "B": "散点图", "C": "直条图", "D": "线图", "language": "zh"}
{"question": "最容易发生变异的呼吸道病毒是（　　）。", "answer": "甲型流感病毒", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "甲型流感病毒", "B": "麻疹病毒", "C": "腮腺炎病毒", "D": "呼吸道合胞病毒", "language": "zh"}
{"question": "慢性支气管炎患者发生阻塞性通气功能障碍的病变基础是（　　）。", "answer": "细支气管炎及细支气管周围炎", "meta_info": "第1篇　呼吸系统", "answer_idx": "C", "A": "支气管平滑肌萎缩", "B": "支气管软骨萎缩、纤维化", "C": "细支气管炎及细支气管周围炎", "D": "支气管腺体增生、肥大", "language": "zh"}
{"question": "1．含巯基的氨基酸是（　　）。", "answer": "半胱氨酸", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "蛋氨酸", "B": "丝氨酸", "C": "半胱氨酸", "D": "脯氨酸", "language": "zh"}
{"question": "2．肠结核最常见的病变部位是（　　）。", "answer": "回盲部", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "横结肠", "B": "降结肠", "C": "回盲部", "D": "直肠及乙状结肠", "language": "zh"}
{"question": "成人心肺复苏抢救时胸外按压与人工呼吸通气的比例（　　）。", "answer": "30:2", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "15:2", "B": "30:2", "C": "10:2", "D": "5:2", "language": "zh"}
{"question": "2．乙型脑炎可见（　　）。", "answer": "嗜神经细胞现象", "meta_info": "病理学", "answer_idx": "D", "A": "陷窝细胞", "B": "类上皮细胞", "C": "泡沫细胞", "D": "嗜神经细胞现象", "language": "zh"}
{"question": "下列对葡萄球菌生物学性状的描述中，错误的是（　　）。", "answer": "有透明质酸荚膜", "meta_info": "医学微生物学", "answer_idx": "B", "A": "革兰染色阳性球菌", "B": "有透明质酸荚膜", "C": "无鞭毛", "D": "致病菌产生血浆凝固酶", "language": "zh"}
{"question": "患者，女，46岁。胸闷不适半年，近来出现进行性四肢无力。胸部X线片发现右前上纵隔阴影。1．该患者首先考虑的诊断是（　　）。", "answer": "胸腺瘤", "meta_info": "第1篇　呼吸系统", "answer_idx": "B", "A": "神经源性肿瘤", "B": "胸腺瘤", "C": "食管囊肿", "D": "支气管囊肿", "language": "zh"}
{"question": "男，26岁，饱餐后剧烈运动时腹痛2小时，阵发性加剧，脐周伴腰背痛，呕吐频繁，吐后症状无缓解，腹肌紧张，脐周有压痛及反跳痛，肠鸣音亢进，有气过水声。4．根本治疗是（　　）。", "answer": "钻孔冲洗引流术", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "冬眠物理降温", "B": "预防感染", "C": "钻孔冲洗引流术", "D": "血肿清除术", "language": "zh"}
{"question": "女，50岁。未孕，绝经2年。近半年阴道流水样白带，近2周出现阴道间断少量血性排液。妇科检查宫颈光滑，子宫如妊娠6周大，双侧附件未扪及异常。3．确诊后最适合的治疗方案是（　　）。", "answer": "全子宫切除及双附件切除术", "meta_info": "第5篇　女性生殖系统", "answer_idx": "C", "A": "放射治疗", "B": "宫颈锥形切除", "C": "全子宫切除及双附件切除术", "D": "诊断性刮宫", "language": "zh"}
{"question": "传染病的基本特征为（　　）。", "answer": "有病原体，有传染性，有流行病学特征，有感染后免疫", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "C", "A": "有传染源、传染性、易感人群", "B": "有传染源、传播途径、免疫性", "C": "有病原体，有传染性，有流行病学特征，有感染后免疫", "D": "有传染性、流行性、免疫性", "language": "zh"}
{"question": "2．用冰袋给高热病人降温是增加（　　）。", "answer": "传导散热", "meta_info": "生理学", "answer_idx": "B", "A": "辐射散热", "B": "传导散热", "C": "对流散热", "D": "蒸发散热", "language": "zh"}
{"question": "钩端螺旋体病实验室血清学试验，哪一种有较高的特异性和敏感性？（　　）", "answer": "凝集溶解试验", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "A", "A": "凝集溶解试验", "B": "乳胶凝集试验", "C": "红细胞凝集试验", "D": "红细胞溶解试验", "language": "zh"}
{"question": "3．患者，7个月，发热4天，体温最高为39℃，当地医院诊断为“上呼吸道感染”，静脉滴注3天头孢唑啉及利巴韦林，今晨热退，但见面、颈及躯干皮肤有红色斑丘疹（　　）。", "answer": "幼儿急疹", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "麻疹", "B": "幼儿急疹", "C": "猩红热", "D": "荨麻疹", "language": "zh"}
{"question": "施行结肠瘘口关闭手术，手术区消毒应为（　　）。", "answer": "由手术区外周向瘘口周围进行", "meta_info": "第八部分　其他疾病", "answer_idx": "B", "A": "由手术区上方向下方进行", "B": "由手术区外周向瘘口周围进行", "C": "由手术区中心向四周进行", "D": "由手术区一侧向另一侧进行", "language": "zh"}
{"question": "1．可结合Hb，防止其从肾脏丢失的是（　　）。", "answer": "结合珠蛋白", "meta_info": "生物化学", "answer_idx": "C", "A": "铜蓝蛋白", "B": "铁转运蛋白", "C": "结合珠蛋白", "D": "α球蛋白", "language": "zh"}
{"question": "膜型IgM为（　　）。", "answer": "单体", "meta_info": "医学免疫学", "answer_idx": "C", "A": "六聚体", "B": "五聚体", "C": "单体", "D": "双体", "language": "zh"}
{"question": "9岁男孩，午餐时突发神志丧失，手中持碗掉落，打碎后即醒，脑电图示：3周/秒棘慢波规律和对称性发放。最可能的诊断是（　　）。", "answer": "失神发作", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "复杂部分发作", "B": "部分性发作", "C": "失神发作", "D": "不能分裂的癫痫发作", "language": "zh"}
{"question": "医学心理学的定义是（　　）。", "answer": "研究心理与健康和疾病之间关系的学科", "meta_info": "医学心理学", "answer_idx": "A", "A": "研究心理与健康和疾病之间关系的学科", "B": "是护理心理学的分支学科", "C": "由心理学家弗洛伊德首次提出", "D": "以上都正确", "language": "zh"}
{"question": "患者，女，28岁。停经3个月，早孕反应消失，阴道少许流血2天。妇科检查：宫口闭，子宫如妊娠8周大，质软，双侧附件区未触及异常。1．为明确诊断，首选的检查是（　　）。", "answer": "B超检查", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "腹部CT检查", "B": "B超检查", "C": "诊断性刮宫", "D": "血黄体酮测定", "language": "zh"}
{"question": "智商同为85，其一是山区农民，结合他受教育程度和所处环境，考虑其智力基本正常；其二是某大学教授，结合其他表现，考虑有大脑退行性改变的可能。这遵了循心理测验的（　　）。", "answer": "客观性原则", "meta_info": "医学心理学", "answer_idx": "B", "A": "保密性原则", "B": "客观性原则", "C": "统一性原则", "D": "以上都不是", "language": "zh"}
{"question": "绝大多数血浆蛋白质来自于（　　）。", "answer": "肝合成", "meta_info": "生物化学", "answer_idx": "A", "A": "肝合成", "B": "肾合成", "C": "浆细胞合成", "D": "消化道吸收", "language": "zh"}
{"question": "患者，男，40岁。咳嗽、脓痰半年，尤以运动后明显加重，每次咳痰均带血，明显乏力，近3个月来体重下降约4kg，无明显发热。吸烟10余年，1～2包/d，高血压病史4年。查体：浅表淋巴结未及，肝脾肋下未及，杵状指（＋）。3．下列治疗措施中，不正确的是（　　）。", "answer": "外科手术治疗", "meta_info": "第1篇　呼吸系统", "answer_idx": "B", "A": "足量应用抗生素", "B": "外科手术治疗", "C": "静脉给予垂体后叶素", "D": "清除气道分泌物", "language": "zh"}
{"question": "急性淋巴细胞白血病首选治疗药物是（　　）。", "answer": "VP", "meta_info": "第一部分　血液系统疾病", "answer_idx": "A", "A": "VP", "B": "小剂量阿糖胞苷", "C": "HOAP", "D": "DA或HA", "language": "zh"}
{"question": "女，28岁。间断下腹痛4年余，大便2～3次/日，稀便，无脓血，便后下腹痛可缓解。粪常规检查：未见细胞，潜血试验阴性，查体无异常发现。1．该患者最可能的诊断是（　　）。", "answer": "肠易激综合征", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "溃疡性结肠炎", "B": "克罗恩病", "C": "肠易激综合征", "D": "慢性细菌性痢疾", "language": "zh"}
{"question": "1．分泌大量降钙素的甲状腺癌是（　　）。", "answer": "髓样癌", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "C", "A": "滤泡状腺癌", "B": "未分化癌", "C": "髓样癌", "D": "转移癌", "language": "zh"}
{"question": "小儿原发型肺结核，以下哪项不常见？（　　）", "answer": "肺部中小水泡音", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "发热", "B": "肺部中小水泡音", "C": "X线示肺门淋巴结肿大", "D": "食欲减退，乏力，盗汗", "language": "zh"}
{"question": "Friedman等人研究后认为，具有A型行为特征的人易患（　　）。", "answer": "冠心病", "meta_info": "医学心理学", "answer_idx": "A", "A": "冠心病", "B": "高血压", "C": "肿瘤", "D": "哮喘病", "language": "zh"}
{"question": "3岁以上儿童哮喘诊断依据中，错误的是（　　）。", "answer": "抗生素治疗有明显疗效", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "喘息呈反复发作", "B": "肾上腺皮下注射有明显疗效", "C": "舒喘灵气雾剂有明显疗效", "D": "抗生素治疗有明显疗效", "language": "zh"}
{"question": "活性甲基的供体是（　　）。", "answer": "S-腺苷甲硫氨酸", "meta_info": "生物化学", "answer_idx": "C", "A": "S-腺苷同型半胱氨酸", "B": "氨基甲酸", "C": "S-腺苷甲硫氨酸", "D": "氨基甲酰磷酸", "language": "zh"}
{"question": "对肾综合征出血热来说，下述哪一项是错误的？（　　）", "answer": "每年7～9月份为流行高峰", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "D", "A": "野生鼠类是主要传染源", "B": "病原体是RNA病毒", "C": "可经呼吸道传播", "D": "每年7～9月份为流行高峰", "language": "zh"}
{"question": "2．急性重型肝炎（　　）。", "answer": "溶解坏死", "meta_info": "病理学", "answer_idx": "C", "A": "点状坏死", "B": "桥接坏死", "C": "溶解坏死", "D": "凝固坏死", "language": "zh"}
{"question": "2．宫颈黏膜上皮为（　　）。", "answer": "单层高柱状上皮", "meta_info": "第5篇　女性生殖系统", "answer_idx": "A", "A": "单层高柱状上皮", "B": "鳞状上皮化生", "C": "有纤毛的高柱状上皮", "D": "生发上皮", "language": "zh"}
{"question": "2．饮清水1000ml主要引起（　　）。", "answer": "ADH分泌减少", "meta_info": "生理学", "answer_idx": "D", "A": "血浆晶体渗透压升高", "B": "血浆腔体渗透压降低", "C": "肾素分泌减少", "D": "ADH分泌减少", "language": "zh"}
{"question": "1．检查羊水以下指标，反应胎儿肺成熟度的是（　　）。", "answer": "卵磷脂/鞘磷脂比值", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "卵磷脂/鞘磷脂比值", "B": "淀粉酶值", "C": "胆红素类物质", "D": "肌酐值", "language": "zh"}
{"question": "在伤寒病的潜伏期，伤寒杆菌一般在机体的何种组织细胞中寄生、繁殖（　　）。", "answer": "巨噬细胞", "meta_info": "病理学", "answer_idx": "A", "A": "巨噬细胞", "B": "T细胞", "C": "胆囊", "D": "心脏", "language": "zh"}
{"question": "1．肠伤寒（　　）。", "answer": "肉芽肿性炎", "meta_info": "病理学", "answer_idx": "B", "A": "假膜性炎", "B": "肉芽肿性炎", "C": "变质性炎", "D": "出血性炎", "language": "zh"}
{"question": "颅内压主要是通过下列哪项进行生理凋节？（　　）", "answer": "脑脊液量", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "颅内静脉血", "B": "脑脊液量", "C": "脑组织中含水量", "D": "血液中PaCO2", "language": "zh"}
{"question": "1．感知学训练（　　）。", "answer": "乳儿期", "meta_info": "医学心理学", "answer_idx": "A", "A": "乳儿期", "B": "幼儿期", "C": "童年期", "D": "青年期", "language": "zh"}
{"question": "降血糖作用最弱、作用持续时间最短的药物是（　　）。", "answer": "甲苯磺丁脲", "meta_info": "药理学", "answer_idx": "A", "A": "甲苯磺丁脲", "B": "格列吡嗪", "C": "格列本脲", "D": "珠蛋白锌胰岛素", "language": "zh"}
{"question": "下列哪项是初次接种麻疹减毒活疫苗的时间？（　　）", "answer": "8个月以上易感儿", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "4个月以上易感儿", "B": "5个月以上易感儿", "C": "7个月以上易感儿", "D": "8个月以上易感儿", "language": "zh"}
{"question": "休克在微循环衰竭期最突出的情况是（　　）。", "answer": "血管内高凝状态", "meta_info": "第2篇　心血管系统", "answer_idx": "A", "A": "血管内高凝状态", "B": "后括约肌收缩状态", "C": "代谢性碱中毒", "D": "前括约肌收缩状态", "language": "zh"}
{"question": "2．右肾下段2.5cm×2.0cm癌，左肾无功能。应选择的治疗方法是（　　）。", "answer": "肾部分切除术", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "免疫治疗", "B": "根治性肾切除术", "C": "肾部分切除术", "D": "放射治疗", "language": "zh"}
{"question": "男，60岁。突发性心前区疼痛2小时，既往有高脂血症和吸烟史，无高血压和出血性疾病史。查体：BP 150／90mmHg，双肺呼吸音清。心率89次/分，律齐。心电图示Ⅱ、Ⅲ和aVF导联ST段下斜型压低0.2mV，V1～V6导联ST段弓背向上抬高0.3～0.5mV。该患者最关键的治疗是（　　）。", "answer": "再灌注治疗", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "口服硝苯地平控释片", "B": "再灌注治疗", "C": "口服速效救心丸", "D": "口服血管紧张素转换酶抑制剂", "language": "zh"}
{"question": "经胃管肠内营养时，判断胃潴留发生的标准是在每次输营养液30分钟后，回抽量应至少大于（　　）。", "answer": "150ml", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "100ml", "B": "150ml", "C": "50ml", "D": "250ml", "language": "zh"}
{"question": "初孕妇，25岁，妊娠31周。从妊娠29周起反复3次阴道流血，量少，无腹痛，再次阴道流血同月经量。查体：P 88次/分，BP 110/70/mmHg，子宫软，无宫缩，枕左前位，胎头高浮，胎心率130次/分。1．首先考虑的诊断是（　　）。", "answer": "中央性前置胎盘", "meta_info": "第5篇　女性生殖系统", "answer_idx": "B", "A": "低置性前置胎盘", "B": "中央性前置胎盘", "C": "边缘性前置胎盘", "D": "部分性前置胎盘", "language": "zh"}
{"question": "3．6～14岁小儿贫血的标准（　　）。", "answer": "Hb<120g/L", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "Hb<150g/L", "B": "Hb<145g/L", "C": "Hb<120g/L", "D": "Hb<90g/L", "language": "zh"}
{"question": "电镜下，肝细胞脂肪变的脂滴形成于（　　）。", "answer": "内质网内", "meta_info": "病理学", "answer_idx": "B", "A": "胞浆基质内", "B": "内质网内", "C": "高尔基体内", "D": "溶酶体内", "language": "zh"}
{"question": "关于乳酸脱氢酶同工酶的叙述，正确的是（　　）。", "answer": "LDH1在心肌含量最高", "meta_info": "生物化学", "answer_idx": "A", "A": "LDH1在心肌含量最高", "B": "LDH1在肝脏含量最高", "C": "LDH5由4个H亚基组成", "D": "LDH5在骨骼肌含量最高", "language": "zh"}
{"question": "促红细胞生成素（EPO）的产生部位主要是（　　）。", "answer": "肾", "meta_info": "第二部分　模拟试题", "answer_idx": "B", "A": "肝", "B": "肾", "C": "脾", "D": "骨髓", "language": "zh"}
{"question": "3．属于超抗原的是（　　）。", "answer": "金黄色葡萄球菌肠毒素", "meta_info": "医学免疫学", "answer_idx": "A", "A": "金黄色葡萄球菌肠毒素", "B": "ABO血型物质", "C": "二硝基苯酚", "D": "BSA", "language": "zh"}
{"question": "脓性指头炎的治疗措施中，错误的是（　　）。", "answer": "必须在局部出现波动时方可切开引流", "meta_info": "第八部分　其他疾病", "answer_idx": "D", "A": "局部热敷，理疗", "B": "抬高患肢，给止痛剂", "C": "应用磺胺药或抗生素", "D": "必须在局部出现波动时方可切开引流", "language": "zh"}
{"question": "防治静脉血栓的口服药物是（　　）。", "answer": "华法林", "meta_info": "药理学", "answer_idx": "C", "A": "尿激酶", "B": "链激酶", "C": "华法林", "D": "草酸钾", "language": "zh"}
{"question": "一足月顺产儿，25天，出生体重3.2kg，母乳喂养，生后第3天出现黄疸，至今黄疸不退，小儿吃奶好，体温正常。体检：体重3.85kg，除皮肤黄染外，无其他异常，血、尿常规均正常，血清胆红素180μmol/L。处理方法是（　　）。", "answer": "暂停母乳", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "交换输血", "B": "口服泼尼松", "C": "服用苯巴比妥", "D": "暂停母乳", "language": "zh"}
{"question": "对于丙型肝炎下列哪项是不正确的？（　　）", "answer": "肝细胞癌和丙肝病毒感染无关", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "D", "A": "急性丙型肝炎症状较轻", "B": "易转为慢性肝炎", "C": "HCV感染主要通过输血获得", "D": "肝细胞癌和丙肝病毒感染无关", "language": "zh"}
{"question": "精神分析常用的方法是（　　）。", "answer": "自由联想", "meta_info": "医学心理学", "answer_idx": "D", "A": "潜能的发挥", "B": "宣泄", "C": "认知领悟", "D": "自由联想", "language": "zh"}
{"question": "机体受外源抗原刺激后，发生免疫应答的部位是（　　）。", "answer": "淋巴结", "meta_info": "第二部分　模拟试题", "answer_idx": "B", "A": "骨髓", "B": "淋巴结", "C": "腔上囊", "D": "外周血", "language": "zh"}
{"question": "胃食管反流病治疗措施不包括（　　）。", "answer": "高脂肪饮食", "meta_info": "第3篇　消化系统", "answer_idx": "C", "A": "应用促胃肠动力药", "B": "抗酸治疗", "C": "高脂肪饮食", "D": "减肥", "language": "zh"}
{"question": "新生儿金黄色葡萄球菌败血症治疗首选（　　）。", "answer": "万古霉素", "meta_info": "第5篇　女性生殖系统", "answer_idx": "A", "A": "万古霉素", "B": "阿米卡星", "C": "青霉素", "D": "氨苄西林", "language": "zh"}
{"question": "轻型腹泻与重型腹泻的区别点是（　　）。", "answer": "较重的胃肠道症状，伴较明显的脱水及电解质紊乱", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "大便每日10次以上", "B": "呕吐频繁", "C": "黄色水样便或蛋花汤样便", "D": "较重的胃肠道症状，伴较明显的脱水及电解质紊乱", "language": "zh"}
{"question": "女，55岁。因甲状腺功能亢进症行甲状腺次全切除术后1小时，突感呼吸困难。查体：面色青紫，颈部肿胀。引起呼吸困难最可能的原因是（　　）。", "answer": "气管塌陷", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "气管塌陷", "B": "双侧喉返神经损伤", "C": "切口内出血", "D": "甲状腺危象", "language": "zh"}
{"question": "患者，男，29岁，左前胸刀刺伤半小时。查体：烦躁不安，皮肤苍白湿冷，呼吸困难，脉细弱，140次/分，颈静脉怒张，血压70/50mmHg，左前胸第5肋间处见约4cm刀伤口。2．哪项是最可能的诊断？（　　）", "answer": "心脏压塞", "meta_info": "第八部分　其他疾病", "answer_idx": "A", "A": "心脏压塞", "B": "心脏大血管破裂", "C": "左侧进行性血胸", "D": "失血性休克", "language": "zh"}
{"question": "tRNA的二级结构是（　　）。", "answer": "三叶草形", "meta_info": "生物化学", "answer_idx": "D", "A": "线型", "B": "双螺旋", "C": "超螺旋", "D": "三叶草形", "language": "zh"}
{"question": "下列哪项是风湿性心脏病最常受累的瓣膜？（　　）", "answer": "二尖瓣", "meta_info": "病理学", "answer_idx": "A", "A": "二尖瓣", "B": "肺动脉瓣", "C": "主动脉瓣", "D": "三尖瓣", "language": "zh"}
{"question": "细胞膜受体的化学本质为（　　）。", "answer": "糖蛋白", "meta_info": "生物化学", "answer_idx": "A", "A": "糖蛋白", "B": "肽类", "C": "糖类", "D": "脂类", "language": "zh"}
{"question": "肝性脑病患者可采取下列何种溶液灌肠？（　　）", "answer": "稀醋酸液", "meta_info": "第3篇　消化系统", "answer_idx": "B", "A": "肥皂水", "B": "稀醋酸液", "C": "地塞米松", "D": "脂肪乳", "language": "zh"}
{"question": "有一名53岁男患者，入院前3小时突然剧烈头痛伴呕吐，CT检查后入院，入院检查意识清，痛苦病容，四肢肌张力肌力改变不明显，项强直（+），头CT脑沟脑池有高密度影像，眼底检查玻璃体膜下片状出血。2．最多的出血来源是（　　）。", "answer": "颅内动脉瘤", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "脑动脉硬化", "B": "颅内动脉瘤", "C": "烟雾病", "D": "脑肿瘤卒中", "language": "zh"}
{"question": "患者，男，30岁，餐后突发右上腹及剑突下痛，放射到右肩及后背部，2h后疼痛剧烈，伴恶心，并吐出所进食物。仍不缓解，急诊就医。数年“胃病”史及胆石症历史，间有胆绞痛发作，查体：痛苦病容，体温37.2℃，呼吸28/min，浅快，律齐；全腹胀，上腹肌紧张，压痛反跳痛（+）；移动性浊音（±）。白细胞12×109/L，血红蛋白125g/L，尿淀粉酶400U（温氏法正常值32U）。3．为了确立诊断可选择的检查中，不包括（　　）。", "answer": "急诊上消化道钡剂检查", "meta_info": "第二部分　模拟试题", "answer_idx": "D", "A": "急诊B超检查", "B": "血淀粉酶检查", "C": "诊断性腹腔穿刺检查", "D": "急诊上消化道钡剂检查", "language": "zh"}
{"question": "3．过敏毒素作用是（　　）。", "answer": "C3a", "meta_info": "医学免疫学", "answer_idx": "D", "A": "C1-C4", "B": "C3b", "C": "C", "D": "C3a", "language": "zh"}
{"question": "2．对细胞免疫和体液免疫均起辅助作用的是（　　）。", "answer": "Th", "meta_info": "医学免疫学", "answer_idx": "C", "A": "Tc", "B": "Ts", "C": "Th", "D": "B-2", "language": "zh"}
{"question": "8个月男孩，12天来持续高热、咳嗽、喘憋，加重3天，嗜睡，抽风2次，昏迷抢救无效死亡，胸片左肺下呈大片状阴影。尸检：病理所见为支气管和肺泡间质炎，病灶互相融合，气管、支气管上皮广泛坏死，支气管管腔闭塞，肺实质严重炎症实变。考虑符合（　　）。", "answer": "腺病毒肺炎", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "呼吸道合胞病毒肺炎", "B": "金黄色葡萄球菌肺炎", "C": "腺病毒肺炎", "D": "支原体肺炎", "language": "zh"}
{"question": "青年女性，每日乘车上班，某日再次乘车时，突然感到车子有了变化，四周气氛变得诡异，似有不祥预兆，但说不清具体内容，这属于（　　）。", "answer": "原发性妄想之妄想心境", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "原发性妄想之妄想心境", "B": "被洞悉感", "C": "罪恶妄想", "D": "被害妄想", "language": "zh"}
{"question": "抑制Th2功能的细胞因子是（　　）。", "answer": "IFN-γ", "meta_info": "医学免疫学", "answer_idx": "B", "A": "IL-2", "B": "IFN-γ", "C": "IL-4", "D": "IL-5", "language": "zh"}
{"question": "患者严重腹水，抽吸大量腹水后突然发生晕厥、出冷汗、四肢发冷等症状，其最可能的原因是（　　）。", "answer": "腹腔血管减压后充血", "meta_info": "病理学", "answer_idx": "C", "A": "病体虚弱", "B": "病情严重", "C": "腹腔血管减压后充血", "D": "脑栓塞", "language": "zh"}
{"question": "初始T细胞是（　　）。", "answer": "未接触抗原的成熟T细胞", "meta_info": "医学免疫学", "answer_idx": "C", "A": "经抗原活化过的T细胞", "B": "具有记忆功能T细胞", "C": "未接触抗原的成熟T细胞", "D": "未接触抗原的未成熟T细胞", "language": "zh"}
{"question": "一因车祸受重伤的男子被送去医院急救，因没带押金，医生拒绝为病人办理住院手续，当病人家属拿来钱时，已错过了抢救最佳时机，病人死亡。本案例违背了病人权利的哪一点?（　　）", "answer": "享有基本的医疗权", "meta_info": "医学伦理学", "answer_idx": "C", "A": "享有知情同意权", "B": "享有保密和隐私权", "C": "享有基本的医疗权", "D": "享有参与治疗权", "language": "zh"}
{"question": "2岁半男孩，PPD试验硬结直径12mm，未种过卡介苗，考虑可能是（　　）。", "answer": "活动性结核", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "活动性结核", "B": "非典型分枝杆菌感染", "C": "未感染过结核", "D": "支原体感染", "language": "zh"}
{"question": "男性，34岁。被汽车撞伤下腹部及会阴部。测血压70/50mmHg（9.33/6.67kPa）。体检及辅助检查发现骨盆骨折、腹膜后血肿、后尿道损伤。3．如伤后2～3天疼痛无缓解，反而加剧,应首先考虑（　　）。", "answer": "并发感染加重", "meta_info": "第八部分　其他疾病", "answer_idx": "A", "A": "并发感染加重", "B": "组织缺血", "C": "神经系统受损", "D": "感觉过敏", "language": "zh"}
{"question": "下列哪项不是风湿性心包炎的表现？（　　）", "answer": "心音增强", "meta_info": "第2篇　心血管系统", "answer_idx": "C", "A": "有心包摩擦音", "B": "呼吸困难", "C": "心音增强", "D": "颈静脉怒张", "language": "zh"}
{"question": "患者，男，65岁，肥胖，暴食后胸痛，疑心肌梗死，测血乳酸脱氢酶同工酶。已知乳酸脱氢酶是由两种亚基组成的四聚体，它有多少种类的同工酶？（　　）", "answer": "5种", "meta_info": "生物化学", "answer_idx": "C", "A": "2种", "B": "3种", "C": "5种", "D": "6种", "language": "zh"}
{"question": "女，70岁。因尿路感染于10天前开始服用氨苄西林，现出现腹泻。取标本，培养出大量革兰阳性葡萄球菌。病人腹泻的机制是（　　）。", "answer": "菌群失调", "meta_info": "第3篇　消化系统", "answer_idx": "D", "A": "细菌侵袭肠黏膜所致", "B": "内毒素作用于肠黏膜", "C": "肠毒素使腺苷环化酶活性增加", "D": "菌群失调", "language": "zh"}
{"question": "伤寒病人发病第1周内，分离病原菌应采取的标本是（　　）。", "answer": "血液", "meta_info": "医学微生物学", "answer_idx": "A", "A": "血液", "B": "尿液", "C": "呕吐物", "D": "脑脊液", "language": "zh"}
{"question": "患者，男，30岁，惠甲状腺功能亢进症，突然出现双下肢不能动。检查：双下肢膝腱反射战退，无肌萎缩。血钾测定23mmol/L，你认为最可能是下列哪种情况？（　　）", "answer": "周期性瘫痪", "meta_info": "第二部分　模拟试题", "answer_idx": "B", "A": "慢性甲亢性肌病", "B": "周期性瘫痪", "C": "周围神经炎", "D": "癔症", "language": "zh"}
{"question": "抗药性细菌广泛存在的最大因素是（　　）。", "answer": "抗生素滥用的结果", "meta_info": "医学微生物学", "answer_idx": "C", "A": "院内感染盛行", "B": "正常菌群消失", "C": "抗生素滥用的结果", "D": "人群抵抗力下降", "language": "zh"}
{"question": "1．速效胰岛素是（　　）。", "answer": "半慢胰岛素锌混悬液", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "A", "A": "半慢胰岛素锌混悬液", "B": "慢胰岛素锌混悬液", "C": "低精蛋白锌胰岛素", "D": "精蛋白锌胰岛素", "language": "zh"}
{"question": "青年男性，2天来胸背部疼痛，今晨出现双下肢无力，伴二便障碍，查体：脐以下各种感觉障碍，双下肢肌力0级，无病理反射。2．首先应做的有诊断意义的检查是（　　）。", "answer": "胸椎MRI", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "腰穿脑脊液检查", "B": "头部MRI", "C": "颈椎MRI", "D": "胸椎MRI", "language": "zh"}
{"question": "医疗机构对其医疗废物暂时储存的时间不得超过（　　）。", "answer": "2d", "meta_info": "卫生法规", "answer_idx": "B", "A": "1d", "B": "2d", "C": "3d", "D": "5d", "language": "zh"}
{"question": "2．百白破疫苗初种年龄是（　　）。", "answer": "3个月", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "2个月", "B": "3个月", "C": "8个月", "D": "生后2～3天", "language": "zh"}
{"question": "2．肺鳞癌（　　）。", "answer": "中央型多见", "meta_info": "病理学", "answer_idx": "A", "A": "中央型多见", "B": "周围型多见", "C": "常具有内分泌功能", "D": "肿瘤呈胶冻状", "language": "zh"}
{"question": "女性，16岁。高热、寒战、腰痛2天，尿呈酱油色，红细胞2.0×1012/L，网织红细胞50%，血Ham试验（+），血红蛋白尿（+）。下列处理方法适宜的是（　　）。", "answer": "输洗涤红细胞", "meta_info": "第一部分　血液系统疾病", "answer_idx": "B", "A": "输新鲜全血", "B": "输洗涤红细胞", "C": "输血浆", "D": "脾切除", "language": "zh"}
{"question": "女，43岁。左乳头溢液10余天。无不适症状。查体：乳房视诊无异常发现，未扪及肿块，无压痛，按压左乳晕外上方可见黄褐色溢液。门诊首选的检查是（　　）。", "answer": "溢液涂片细胞学检查", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "热图像检查", "B": "钼靶X线摄片", "C": "B型超声检查", "D": "溢液涂片细胞学检查", "language": "zh"}
{"question": "3．可引起反射性心动过速的降压药（　　）。", "answer": "硝苯地平", "meta_info": "第2篇　心血管系统", "answer_idx": "A", "A": "硝苯地平", "B": "倍他乐克（美托洛尔）", "C": "氢氯噻嗪", "D": "哌唑嗪", "language": "zh"}
{"question": "心动周期中室内压最高时相当于下列哪期？（　　）", "answer": "快速射血期末", "meta_info": "生理学", "answer_idx": "B", "A": "等容收缩期末", "B": "快速射血期末", "C": "等容舒张期末", "D": "缓慢射血期末", "language": "zh"}
{"question": "长期应用氯丙嗪的病人停药后容易出现（　　）。", "answer": "迟发性运动障碍", "meta_info": "药理学", "answer_idx": "C", "A": "静坐不能", "B": "帕金森综合征", "C": "迟发性运动障碍", "D": "急性肌张力障碍", "language": "zh"}
{"question": "男性，26岁，一天前搬家时腰扭伤。腰剧痛并向右下肢放射，不能平卧，咳嗽加剧，痛窜至足背，伴麻木，大小便正常。检查：腰背肌痉挛，L4～5椎旁压痛，腰向前弯曲受限，右下肢直腿抬高受限，膝腱与跟腱反射正常，肌力正常，足背与小腿外侧感觉过敏。1．最可能的诊断是（　　）。", "answer": "腰椎间盘突出症", "meta_info": "第四部分　运动系统疾病", "answer_idx": "B", "A": "急性腰扭伤", "B": "腰椎间盘突出症", "C": "腰椎小关节滑膜嵌顿", "D": "腰椎横突骨折", "language": "zh"}
{"question": "哪种营养素不能为机体提供能量？（　　）", "answer": "维生素类", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "蛋白质类", "B": "淀粉类", "C": "糖类", "D": "维生素类", "language": "zh"}
{"question": "临床诊断脊柱结核，下列指标最有价值的是（　　）。", "answer": "x线摄片", "meta_info": "第四部分　运动系统疾病", "answer_idx": "B", "A": "局部疼痛肿胀", "B": "x线摄片", "C": "消瘦、贫血、盗汗及食欲不振", "D": "结核菌素试验阳性", "language": "zh"}
{"question": "男性，28岁，查血压160/95mmHg（21.3/12.6kPa），Hb 80g/L，尿蛋白（+），颗粒管型2或3个/HP，BUN 10mmol/L，Cr 220μmol/L。对该患者不宜采取（　　）。", "answer": "高蛋白饮食", "meta_info": "第二部分　模拟试题", "answer_idx": "B", "A": "低蛋白饮食", "B": "高蛋白饮食", "C": "低钠饮食", "D": "根据尿量多少适当限水", "language": "zh"}
{"question": "小儿，身体健康，体重7.5kg、身长62cm，会翻身，能独坐很久，不会爬，能发出“爸爸”、“妈妈”等复音，但无意识，能听懂自己的名字，其月龄最可能为（　　）。", "answer": "7个月", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "3～4个月", "B": "5个月", "C": "6个月", "D": "7个月", "language": "zh"}
{"question": "男，8岁。右足底被铁锈钉刺伤12天，出现张口困难，继之出现苦笑面容，角弓反张，声响及触碰病人可诱发上述症状，神志清楚，无发热。1．该病致病菌属于（　　）。", "answer": "革兰阳性厌氧芽胞杆菌", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "革兰阴性大肠杆菌", "B": "革兰阴性变形杆菌", "C": "革兰阳性厌氧芽胞杆菌", "D": "革兰阳性梭形芽孢杆菌", "language": "zh"}
{"question": "可抑制细胞氧化磷酸化速率的物质是（　　）。", "answer": "一氧化碳", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "磷酸戊糖", "B": "细胞色素C", "C": "一氧化碳", "D": "磷酸激酶", "language": "zh"}
{"question": "引起血清钙离子浓度降低的因素是（　　）。", "answer": "血pH值升高", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "血浆蛋白浓度降低", "B": "血pH值升高", "C": "血磷降低", "D": "血1,25-(QH)2D3增高", "language": "zh"}
{"question": "3．医疗机构对本单位内被传染病病原体污染的场所、物品以及医疗废物（　　）。", "answer": "在指定场所进行医学观察和采取其他必要的预防措施", "meta_info": "卫生法规", "answer_idx": "C", "A": "予以隔离治疗，隔离期限根据医学检查结果确定", "B": "确诊前在指定场所单独隔离治疗", "C": "在指定场所进行医学观察和采取其他必要的预防措施", "D": "必须依照法律法规的规定实施消毒和无害化处置", "language": "zh"}
{"question": "7个月小儿，咳嗽流涕2天，发热半天，体温39.0℃，惊厥1次，5min后自行缓解。体检：神志清，前囟平坦。肺呼吸音清，无脑膜刺激征。WBC 6.5×109/L，血钙2.24mmol/L。3．治疗宜采用（　　）。", "answer": "降温、止惊、抗病毒治疗", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "立即止惊", "B": "大剂量抗生素静滴", "C": "大剂量抗病毒药静滴", "D": "降温、止惊、抗病毒治疗", "language": "zh"}
{"question": "肺泡回缩力主要来自于（　　）。", "answer": "肺泡膜的液体分子层表面张力", "meta_info": "生理学", "answer_idx": "A", "A": "肺泡膜的液体分子层表面张力", "B": "肺泡的弹性纤维", "C": "胸廓弹性回缩", "D": "肺泡表面活性物质", "language": "zh"}
{"question": "急性肢体动脉栓塞的临床表现“5p”，不包括（　　）。", "answer": "脉快", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "感觉异常", "B": "麻痹", "C": "脉快", "D": "苍白", "language": "zh"}
{"question": "男婴，8个月，自幼人工喂养，未补充维生素D制剂，近年来出现多汗、烦躁、夜惊，查体：方颅，出牙延迟，串珠，诊断为佝偻病活动期，发病机制下列哪项是错误的？（　　）", "answer": "甲状腺代偿功能不足", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "尿磷排出增加", "B": "维生素D缺乏", "C": "钙、磷肠道吸收减少", "D": "甲状腺代偿功能不足", "language": "zh"}
{"question": "1．糖酵解和糖异生共同的代谢场所是（　　）。", "answer": "细胞液", "meta_info": "生物化学", "answer_idx": "C", "A": "溶酶体", "B": "微粒体", "C": "细胞液", "D": "核蛋白体", "language": "zh"}
{"question": "1．糖原分解首先生成的物质是（　　）。", "answer": "1-磷酸果糖", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "葡萄糖", "B": "1-磷酸果糖", "C": "6-磷酸果糖", "D": "6-磷酸葡萄糖", "language": "zh"}
{"question": "患者外伤致腓骨小头处骨折，伤后患足不能背屈，其原因是（　　）。", "answer": "腓总神经损伤", "meta_info": "第四部分　运动系统疾病", "answer_idx": "C", "A": "坐骨神经损伤", "B": "胫后肌损伤", "C": "腓总神经损伤", "D": "胫后神经损伤", "language": "zh"}
{"question": "某女性患者，26岁，公司文员。半年前离婚后，常自觉身体不舒服，睡眠不好。一次下班回家后突然感到恐惧、紧张，有要死亡的感觉，又感觉似乎失去自我控制感。同时伴有全身大汗、心悸气憋，想喊叫又喊不出。大约五六分钟后逐渐平静下来。她的病可能是（　　）。", "answer": "急性焦虑症（惊恐发作）", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "恐怖症", "B": "急性焦虑症（惊恐发作）", "C": "慢性焦虑症", "D": "精神分裂症", "language": "zh"}
{"question": "男，50岁。因高血压，高脂血症服用阿司匹林3个月，1个月来反复出现上腹疼痛，查体：腹软，中上腹压痛，下列治疗药物中首选的是（　　）。", "answer": "奥美拉唑", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "阿莫西林", "B": "克拉霉素", "C": "奥美拉唑", "D": "多潘立酮", "language": "zh"}
{"question": "男，60岁。活动时胸骨后疼痛，胸骨右缘第2肋间可闻及4/6级收缩期喷射样杂音。最可能的诊断是（　　）。", "answer": "主动脉瓣狭窄", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "主动脉瓣关闭不全", "B": "二尖瓣狭窄", "C": "主动脉瓣狭窄", "D": "肺动脉瓣狭窄", "language": "zh"}
{"question": "关于腹股沟疝的描述正确的是（　　）。", "answer": "斜疝疝囊颈在腹壁下动脉外侧", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "斜疝疝块外形多呈半球形", "B": "斜疝疝囊颈在腹壁下动脉外侧", "C": "直疝精索在疝囊后方", "D": "直疝多见于儿童", "language": "zh"}
{"question": "2．上述哪项起抑制作用？（　　）", "answer": "Ts", "meta_info": "医学免疫学", "answer_idx": "B", "A": "Tc", "B": "Ts", "C": "Th", "D": "Th2", "language": "zh"}
{"question": "目前治疗哮喘最有效的药物是（　　）。", "answer": "肾上腺皮质激素类", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "拟肾上腺素类", "B": "茶碱类", "C": "抗胆碱药物", "D": "肾上腺皮质激素类", "language": "zh"}
{"question": "在幼儿园里，一男孩2岁，发热伴咳嗽2～3天，初拟诊为上呼吸道感染，次日体温更高，皮肤可见红色斑丘疹，考虑麻疹，即送回家。3．在上述幼儿园中，为制止麻疹流行，对其他易感儿应采取的最佳措施为（　　）。", "answer": "应急接种麻疹疫苗", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "全部口服利巴韦林", "B": "应急接种麻疹疫苗", "C": "分别留在家里，不要上幼儿园", "D": "应用广谱抗生素", "language": "zh"}
{"question": "女，5岁。因低热、盗汗及干咳2个月入院，体检：T 38℃，消瘦，面色苍白，两肺呼吸音清，OT试验（＋＋＋），中性粒细胞稍高，血培养（－），胸片示肺门淋巴结肿大，可能的诊断是（　　）。", "answer": "原发型肺结核", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "急性风湿热", "B": "原发型肺结核", "C": "大叶性肺炎", "D": "肺不张", "language": "zh"}
{"question": "吗啡和哌替啶的共同作用不包括（　　）。", "answer": "止泻", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "体位性低血压", "B": "止泻", "C": "抑制呼吸", "D": "镇痛", "language": "zh"}
{"question": "医疗过程中，医生充当家长式角色的医患关系模式属于（　　）。", "answer": "权威模式", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "权威模式", "B": "共同参与模式", "C": "军队管理模式", "D": "听取建议模式", "language": "zh"}
{"question": "病毒的最基本结构为（　　）。", "answer": "核衣壳", "meta_info": "医学微生物学", "answer_idx": "C", "A": "衣壳", "B": "包膜", "C": "核衣壳", "D": "刺突", "language": "zh"}
{"question": "洛夏墨迹试验相当于（　　）。", "answer": "人格测验", "meta_info": "医学心理学", "answer_idx": "B", "A": "诊断测验", "B": "人格测验", "C": "智力测验", "D": "评定量表", "language": "zh"}
{"question": "哪种心律失常是小儿预激综合征患者最常见的并发症？（　　）", "answer": "阵发性室上性心动过速", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "I度房室传导阻滞", "B": "室性心动过速", "C": "完全性房室传导阻滞", "D": "阵发性室上性心动过速", "language": "zh"}
{"question": "20岁，男性，四肢无力4天，无尿便障碍，无发热。查四肢肌力Ⅲ级，四肢远端痛觉减退，腱反射弱，无病理反射，腰穿正常。首先考虑的疾病是（　　）。", "answer": "格林—巴利综合征", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "格林—巴利综合征", "B": "脊髓灰质炎", "C": "周期性麻痹", "D": "重症肌无力", "language": "zh"}
{"question": "患者，8岁，水肿、少尿，尿量浓茶色，伴头痛、眼花、呕吐，血压170/120mmHg，尿蛋白（+），红细胞30个/HP，颗粒管型0或1个/HP。诊断可能为（　　）。", "answer": "急性肾炎高血压脑病", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "慢性肾炎", "B": "急性肾炎高血压脑病", "C": "肾炎性肾病", "D": "急进性肾炎", "language": "zh"}
{"question": "肝硬化患者易发生消化性溃疡的主要原因为（　　）。", "answer": "黏膜缺氧", "meta_info": "第3篇　消化系统", "answer_idx": "A", "A": "黏膜缺氧", "B": "刺激胃酸分泌的物质不能被灭活", "C": "高胃泌素血症", "D": "内毒素增多", "language": "zh"}
{"question": "下列5种肝炎病毒中哪一种为DNA病毒？（　　）", "answer": "HBV", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "B", "A": "HAV", "B": "HBV", "C": "HCV", "D": "HDV", "language": "zh"}
{"question": "观察铁剂治疗缺铁性贫血是否有效的早期指标是（　　）。", "answer": "网织红细胞上升", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "红细胞数上升", "B": "网织红细胞上升", "C": "血清转铁蛋白饱和度增加", "D": "血清铁蛋白增加", "language": "zh"}
{"question": "3．大肠杆菌和其他致病菌引起的混合感染脓液特点是（　　）。", "answer": "脓液稠厚有粪臭", "meta_info": "第八部分　其他疾病", "answer_idx": "D", "A": "脓液稀薄，淡黄，量较多", "B": "脓液稠厚，黄色，不臭", "C": "脓液有特殊恶臭", "D": "脓液稠厚有粪臭", "language": "zh"}
{"question": "2．眩晕是由于（　　）。", "answer": "椎基底动脉系统TIA", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "椎基底动脉系统TIA", "B": "颈内动脉血栓形成", "C": "大脑前动脉血栓形成", "D": "大脑后动脉血栓形成", "language": "zh"}
{"question": "下列关于IgA肾病错误的说法是（　　）。", "answer": "预后良好，很少有肾功能恶化", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "病理类型主要为系膜增生性肾小球肾炎", "B": "确诊有赖于肾活检病理检查", "C": "预后良好，很少有肾功能恶化", "D": "常在感染后72小时以内发作肉眼血尿", "language": "zh"}
{"question": "高压蒸汽灭菌的标准方法是在1.05kg/cm2蒸气压力下(121.3℃)，灭菌时间为（　　）。", "answer": "15～20分钟", "meta_info": "医学微生物学", "answer_idx": "C", "A": "1～5分钟", "B": "6～10分钟", "C": "15～20分钟", "D": "21～25分钟", "language": "zh"}
{"question": "下列哪项为脊髓前角细胞病损的瘫痪特点？（　　）", "answer": "节段性分布的弛缓性瘫，不伴感觉障碍", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "单瘫", "B": "节段性分布的弛缓性瘫，不伴感觉障碍", "C": "四肢远端肌肉瘫痪", "D": "截瘫", "language": "zh"}
{"question": "免疫增强疗法不应用于（　　）。", "answer": "自身免疫病", "meta_info": "医学免疫学", "answer_idx": "A", "A": "自身免疫病", "B": "肿瘤", "C": "病毒或真菌感染", "D": "免疫缺陷病", "language": "zh"}
{"question": "重度有机磷农药中毒的表现，下述组合哪一项是恰当的？（　　）", "answer": "瞳孔明显缩小、大汗、流涎、神志模糊、血压升高", "meta_info": "第八部分　其他疾病", "answer_idx": "D", "A": "瞳孔明显缩小、大汗、流涎、神志模糊、心动过速", "B": "瞳孔明显缩小、大汗、流涎、视力模糊、肌无力", "C": "瞳孔明显缩小、大汗、流涎、神志不清、发绀", "D": "瞳孔明显缩小、大汗、流涎、神志模糊、血压升高", "language": "zh"}
{"question": "肌糖原分解不能直接补充血糖的原因是肌肉缺少（　　）。", "answer": "葡萄糖-6-磷酸酶", "meta_info": "生物化学", "answer_idx": "D", "A": "脱支酶", "B": "糖原磷酸化酶a", "C": "糖原磷酸化酶b", "D": "葡萄糖-6-磷酸酶", "language": "zh"}
{"question": "25岁初产妇，孕足月，胎儿顺利娩出4分钟后，阴道间歇流出暗红色血液约100mL。检查子宫底升高，阴道口外露的脐带自行向外延长。首先应考虑出血的原因是（　　）。", "answer": "胎盘滞留", "meta_info": "第5篇　女性生殖系统", "answer_idx": "C", "A": "宫颈裂伤", "B": "凝血功能障碍", "C": "胎盘滞留", "D": "胎盘早期剥离", "language": "zh"}
{"question": "注射青霉素过敏引起的过敏性休克是（　　）。", "answer": "变态反应", "meta_info": "药理学", "answer_idx": "D", "A": "副作用", "B": "后遗效应", "C": "毒性反应", "D": "变态反应", "language": "zh"}
{"question": "新生儿胆红素脑病早期的主要临床特征是（　　）。", "answer": "拒乳、嗜睡、肌张力低", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "体温升高、体重减轻", "B": "肢体痉挛、角弓反张", "C": "前囟隆起、骨缝分离", "D": "拒乳、嗜睡、肌张力低", "language": "zh"}
{"question": "依据病因及发病机制，贫血可分为（　　）。", "answer": "红细胞生成减少、红细胞破坏过多及失血三类", "meta_info": "第一部分　血液系统疾病", "answer_idx": "C", "A": "红细胞生成减少、造血功能不良及红细胞破坏过多三类", "B": "红细胞生成减少、造血功能不良两类", "C": "红细胞生成减少、红细胞破坏过多及失血三类", "D": "红细胞生成减少、溶血、失血、再生障碍性贫血（简称再障）及缺铁等五类", "language": "zh"}
{"question": "关于肠结核的临床表现，下列哪项错误？（　　）", "answer": "多不伴有肺结核", "meta_info": "第3篇　消化系统", "answer_idx": "D", "A": "多见于青少年与壮年", "B": "腹部肿块主要见于增生型肠结核", "C": "腹泻是溃疡型肠结核的主要临床表现之一", "D": "多不伴有肺结核", "language": "zh"}
{"question": "新生儿缺氧缺血性脑病时发生惊厥，首选的药物是（　　）。", "answer": "苯巴比妥钠", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "甘露醇", "B": "地塞米松", "C": "苯巴比妥钠", "D": "苯妥英钠", "language": "zh"}
{"question": "某人患有脚气病，可能是由于缺乏（　　）。", "answer": "硫胺素（维生素B1）", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "维生素A", "B": "叶酸", "C": "维生素D", "D": "硫胺素（维生素B1）", "language": "zh"}
{"question": "关于急性白血病错误的说法是（　　）。", "answer": "常见巨脾", "meta_info": "第一部分　血液系统疾病", "answer_idx": "D", "A": "白细胞减少", "B": "白细胞异常增多", "C": "血片中可见原始细胞", "D": "常见巨脾", "language": "zh"}
{"question": "营养不良可引起的致死并发症是（　　）。", "answer": "自发性低血糖", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "营养性贫血", "B": "维生素缺乏", "C": "腹泻病", "D": "自发性低血糖", "language": "zh"}
{"question": "休克病人治疗过程中中心静脉压为20cmH2O，血压120／80mmHg，处理原则为（　　）。", "answer": "舒张血管", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "适当补液", "B": "收缩血管", "C": "舒张血管", "D": "补液试验", "language": "zh"}
{"question": "一女性病人，28岁，妊娠后期出现进行性背痛，下肢乏力，食欲减退。查体见第7胸椎轻度后突，有叩痛。X线片示第6、7胸椎间隙变窄，椎旁软组织阴影膨隆；血沉60mm/小时。最可能的诊断是（　　）。", "answer": "胸椎结核", "meta_info": "第四部分　运动系统疾病", "answer_idx": "B", "A": "胸椎血管瘤", "B": "胸椎结核", "C": "胸椎转移癌", "D": "化脓性脊椎炎", "language": "zh"}
{"question": "在治疗菌痢时，不宜应用（　　）。", "answer": "次碳酸铋", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "C", "A": "复方磺胺甲基异唑", "B": "氯霉素", "C": "次碳酸铋", "D": "庆大霉素", "language": "zh"}
{"question": "下列哪项能识别转录起始点?（　　）", "answer": "σ因子", "meta_info": "生物化学", "answer_idx": "C", "A": "核心酶", "B": "ρ因子", "C": "σ因子", "D": "DNAβ蛋白", "language": "zh"}
{"question": "男，51岁，腹痛伴腹胀1天。暴饮暴食后突然剧烈上腹痛，之后出现腹胀，停止排气、排便。查体：T 38.2℃，P 120次/分，R 25次/分，BP 135/73mmHg。腹部明显膨隆，双侧腰肋部皮下瘀斑，全腹肌紧张，压痛和反跳痛（＋），肠鸣音消失。实验室检查：血清淀粉酶180U/L，WBC 17×109/L。1．关于该患者的肠外营养支持，正确的是（　　）。", "answer": "加入谷氨酰胺以保护肠黏膜屏障", "meta_info": "第3篇　消化系统", "answer_idx": "C", "A": "各种营养成分应单瓶输注", "B": "以外周静脉输注为主", "C": "加入谷氨酰胺以保护肠黏膜屏障", "D": "加人白蛋白作为肠外营养的氮源", "language": "zh"}
{"question": "初孕妇，26岁。妊娠38周，自觉胎动减少10小时入院。2．入院后B超检查提示羊水平段5cm，无应激试验反应型，此时正确的处理措施是（　　）。", "answer": "人工破膜", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "人工破膜", "B": "间歇吸氧并严密观察", "C": "静脉滴注缩宫素", "D": "米索前列醇引产", "language": "zh"}
{"question": "对于颅底骨折，下述哪一项是错误的？（　　）", "answer": "可表现为中枢性面瘫", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "根据部位可分为三型", "B": "形态多为线形骨折", "C": "若伤及颈动脉，形成海绵窦瘘", "D": "可表现为中枢性面瘫", "language": "zh"}
{"question": "患儿，8岁，反复水肿8个月，血压150/100mmHg。尿常规：蛋白质（++），红细胞满视野。血浆白蛋白15g/L，球蛋白20g/L，胆固醇12.5mmol/L。诊断最可能是（　　）。", "answer": "肾炎性肾病", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "单纯性肾病", "B": "急性肾炎", "C": "肾炎性肾病", "D": "急进性肾炎", "language": "zh"}
{"question": "1．电泳分离蛋白质的依据是（　　）。", "answer": "蛋白质是两性电解质", "meta_info": "生物化学", "answer_idx": "A", "A": "蛋白质是两性电解质", "B": "蛋白质分子大小不同", "C": "蛋白质多肽链中氨基酸是借肽键相连", "D": "蛋白质溶液为亲水胶体", "language": "zh"}
{"question": "定期考核不合格的医师暂停执业活动期满，再次考核仍不合格的处置为（　　）。", "answer": "注销注册，收回医师执业证书", "meta_info": "卫生法规", "answer_idx": "D", "A": "可再试用一年", "B": "再次接受培训", "C": "暂停执业活动三年", "D": "注销注册，收回医师执业证书", "language": "zh"}
{"question": "新生儿期特点是（　　）。", "answer": "死亡率高", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "对外界环境适应能力强", "B": "发病率低", "C": "死亡率高", "D": "体温维持较稳定", "language": "zh"}
{"question": "血脑屏障是指（　　）。", "answer": "上述三种屏障合称", "meta_info": "药理学", "answer_idx": "C", "A": "血—脑屏障", "B": "脑脊液—脑细胞屏障", "C": "上述三种屏障合称", "D": "第一和第三种屏障合称", "language": "zh"}
{"question": "患者，女，45岁。1年前出现左下肢行走10余分钟后胀痛。休息片刻缓解，再行走后疼痛又出现。无吸烟史，发病前半年左足部外伤已治愈，体格检查：左下肢皮色较苍白，左足背动脉未触及。最可能的诊断是（　　）。", "answer": "血栓闭塞性脉管炎", "meta_info": "第2篇　心血管系统", "answer_idx": "A", "A": "血栓闭塞性脉管炎", "B": "动脉粥样硬化性闭塞症", "C": "多发性大动脉炎", "D": "静脉炎", "language": "zh"}
{"question": "患者，男，18岁。因转移性右下腹痛12小时入院，诊断为“急性阑尾炎”，当晚行阑尾切除术，病理为坏疽性阑尾炎。自术后次晨起，患者表现为腹痛，烦躁不安，未解小便。查体：面色较苍白，皮肤湿冷，心率110次/min，较弱，血压80/60mmHg，腹稍胀，全腹压痛，轻度肌紧张，肠鸣音减弱。2．为明确诊断，最好选择采取何种措施（　　）。", "answer": "诊断性腹腔穿刺", "meta_info": "第3篇　消化系统", "answer_idx": "C", "A": "腹部X线透视", "B": "腹部B超", "C": "诊断性腹腔穿刺", "D": "导尿", "language": "zh"}
{"question": "女性，52岁，发现右乳外上象限肿块1周，查肿块约2.0cm×1.5cm，质硬，活动度小。2．最可能的诊断是（　　）。", "answer": "乳腺癌", "meta_info": "第八部分　其他疾病", "answer_idx": "B", "A": "乳腺囊性增生病", "B": "乳腺癌", "C": "乳腺纤维腺瘤", "D": "乳腺囊肿", "language": "zh"}
{"question": "胃癌有胸骨后疼痛和进行性吞咽困难，提示胃癌发病部位为（　　）。", "answer": "贲门、胃底", "meta_info": "第3篇　消化系统", "answer_idx": "D", "A": "胃窦、胃体", "B": "胃体，贲门", "C": "胃小弯、胃窦", "D": "贲门、胃底", "language": "zh"}
{"question": "转氨酶的辅酶中含有的维生素是（　　）。", "answer": "维生素B6", "meta_info": "生物化学", "answer_idx": "C", "A": "维生素B1", "B": "维生素B2", "C": "维生素B6", "D": "维生素B12", "language": "zh"}
{"question": "在对枪乌贼巨大轴突进行实验时，改变标本浸浴液中的哪项因素不会对静息电位的大小产生影响?（　　）", "answer": "Na+浓度", "meta_info": "生理学", "answer_idx": "A", "A": "Na+浓度", "B": "pH", "C": "温度", "D": "缺氧", "language": "zh"}
{"question": "肾病综合征患者出现高脂血症的原因是（　　）。", "answer": "肝合成脂蛋白增加", "meta_info": "第4篇　泌尿系统", "answer_idx": "A", "A": "肝合成脂蛋白增加", "B": "脂蛋白分解增加", "C": "低蛋白血症", "D": "高脂饮食", "language": "zh"}
{"question": "1．转铁蛋白的主要功用是（　　）。", "answer": "运输铁", "meta_info": "生物化学", "answer_idx": "A", "A": "运输铁", "B": "运输铜", "C": "能与细胞外血红蛋白结合", "D": "运输胆红素", "language": "zh"}
{"question": "女性，69岁。发现右乳房肿块1个月。既往有乳腺增生史，曾服用活血化瘀中药治疗。体检：双侧乳房、乳头对称，乳头无凹陷，皮肤无橘皮样改变，右乳外上象限可触及一1cm×1.3cm大肿块，质中等，表面尚光滑，活动。右腋窝可触及肿大的淋巴结，活动度良好。细针穿刺肿块细胞学检查发现癌细胞。2．如该患者锁骨上淋巴结有癌细胞转移，其TNM分期为（　　）。", "answer": "Ⅳ期", "meta_info": "第八部分　其他疾病", "answer_idx": "D", "A": "0期", "B": "Ⅰ期", "C": "Ⅱ期", "D": "Ⅳ期", "language": "zh"}
{"question": "糖尿病是一组病因不明的内分泌代谢病，其共同主要标志是（　　）。", "answer": "高血糖", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "C", "A": "乏力", "B": "消瘦", "C": "高血糖", "D": "尿糖阳性", "language": "zh"}
{"question": "女，54岁。双腕、双手近端指间关节、掌指关节肿痛3年，晨僵1小时。查体：双腕、双手2～4掌指关节及3～4近端指间关节肿胀，压痛（＋），ANA（－）。2．该患者关节病变的基本病理特征是（　　）。", "answer": "滑膜炎", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "附着点炎", "B": "韧带炎", "C": "滑膜炎", "D": "血管炎", "language": "zh"}
{"question": "女，32岁。左下腹痛2个月。黄稀便，每日3次。结肠镜示：直肠、乙状结肠糜烂及浅溃疡，大范围充血、水肿。最可能的诊断是（　　）。", "answer": "溃疡性结肠炎", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "结肠癌", "B": "慢性肠炎", "C": "溃疡性结肠炎", "D": "克罗恩病", "language": "zh"}
{"question": "关节内骨折最常见的并发症是（　　）。", "answer": "创伤性关节炎", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "骨折不愈合", "B": "创伤性关节炎", "C": "骨化性肌炎", "D": "骨折畸形愈合", "language": "zh"}
{"question": "男性患者，45岁，摔伤后右髋疼痛半天，拍片示右股骨颈骨折，基底型，GardenⅡ型，首选的治疗方案为（　　）。", "answer": "空心钉固定术", "meta_info": "第四部分　运动系统疾病", "answer_idx": "D", "A": "右人工股骨头置换术", "B": "右全髋关节置换术", "C": "右髋关节融合术", "D": "空心钉固定术", "language": "zh"}
{"question": "锁骨骨折常用的治疗方法是（　　）。", "answer": "手法复位，横“8”字绷带固定", "meta_info": "第四部分　运动系统疾病", "answer_idx": "A", "A": "手法复位，横“8”字绷带固定", "B": "切开复位，内固定", "C": "手法复位，夹板固定", "D": "手法复位，石膏外固定", "language": "zh"}
{"question": "有关代谢性酸中毒的描述，以下错误的是（　　）。", "answer": "高渗脱水酸中毒，纠正酸中毒应先给予NaHCO3", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "C", "A": "代谢性酸中毒指血液中HCO3_浓度原发性减少", "B": "代谢性酸中毒常伴有高血钾", "C": "高渗脱水酸中毒，纠正酸中毒应先给予NaHCO3", "D": "代谢性酸中毒多发生在脱水、休克等情况下", "language": "zh"}
{"question": "有关全身性感染致病菌的描述正确的是（　　）。", "answer": "革兰阳性球菌感染倾向于血液播散，形成转移性脓肿", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "革兰阳性球菌感染多出现低温，低白细胞，低血压", "B": "厌氧菌感染多为一般细菌感染后的二重感染", "C": "革兰阳性球菌感染多为克雷伯杆菌", "D": "革兰阳性球菌感染倾向于血液播散，形成转移性脓肿", "language": "zh"}
{"question": "病毒复制周期中，与隐蔽期有关的是（　　）。", "answer": "生物合成", "meta_info": "医学微生物学", "answer_idx": "C", "A": "吸附", "B": "脱壳", "C": "生物合成", "D": "装配与释放", "language": "zh"}
{"question": "初次应答最主要的特点是（　　）。", "answer": "IgM产生的快", "meta_info": "医学免疫学", "answer_idx": "C", "A": "IgG大量产生", "B": "IgG产生的快", "C": "IgM产生的快", "D": "IgG的亲和力强", "language": "zh"}
{"question": "男，26岁。感冒2周后出现双下肢近端无力。查体：双上肢肌力3级，双下肢肌力3级，四肢腱反射消失，手套袜子样痛觉减退，双腓肠肌压痛阳性。其原因最可能是（　　）。", "answer": "急性炎症性脱髓鞘性多发性神经病", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "脊髓压迫症", "B": "周期性麻痹", "C": "急性心肌炎", "D": "急性炎症性脱髓鞘性多发性神经病", "language": "zh"}
{"question": "别嘌呤醇是通过抑制什么来治疗痛风?（　　）", "answer": "黄嘌呤氧化酶", "meta_info": "生物化学", "answer_idx": "A", "A": "黄嘌呤氧化酶", "B": "尿酸氧化酶", "C": "腺苷脱氨酸", "D": "鸟嘌呤脱氢酶", "language": "zh"}
{"question": "下列哪项是紫外线对DNA的损伤的主要机制？（　　）", "answer": "嘧啶二聚体形成", "meta_info": "生物化学", "answer_idx": "B", "A": "磷酸二酯键断裂", "B": "嘧啶二聚体形成", "C": "碱基插入", "D": "碱基缺失", "language": "zh"}
{"question": "糖原分子中一个葡萄糖单位经糖酵解途径分解成乳酸时能产生多少分子ATP？（　　）", "answer": "3", "meta_info": "生物化学", "answer_idx": "B", "A": "2", "B": "3", "C": "4", "D": "5", "language": "zh"}
{"question": "患者，男，28岁。上呼吸道感染后2周，出现肉眼血尿、颜面水肿入院。体检：血压20/13.5kPa（150/100mmHg），尿蛋白（＋），红细胞满视野，血Cr 180μmol/L。4．[假设信息]此时应考虑的最可能诊断是（　　）。", "answer": "新月体肾炎", "meta_info": "第4篇　泌尿系统", "answer_idx": "A", "A": "新月体肾炎", "B": "弥漫性内皮系膜细胞增生性肾炎", "C": "系膜毛细血管性肾炎", "D": "IgA肾病", "language": "zh"}
{"question": "肺炎链球菌脑膜炎选择青霉素治疗时，其剂量范围在（　　）。", "answer": "每日40万～80万IU/kg", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "每日10万～20万IU/kg", "B": "每日20万～40万IU/kg", "C": "每日40万～80万IU/kg", "D": "每日80万～100万IU/kg", "language": "zh"}
{"question": "最容易引起细菌污染反应的血液制品是（　　）。", "answer": "浓缩血小板", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "浓缩红细胞", "B": "新鲜冰冻血浆", "C": "冷沉淀", "D": "浓缩血小板", "language": "zh"}
{"question": "阿司匹林下述反应哪一项是错误的？（　　）", "answer": "减少出血倾向", "meta_info": "药理学", "answer_idx": "C", "A": "解热作用", "B": "减少炎症组织PG生成", "C": "减少出血倾向", "D": "可出现耳鸣、眩晕", "language": "zh"}
{"question": "不属于脑器质性精神障碍的是（　　）。", "answer": "躯体疾病所致精神障碍", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "老年痴呆", "B": "脑炎伴发精神障碍", "C": "脑血管病所致精神障碍", "D": "躯体疾病所致精神障碍", "language": "zh"}
{"question": "1．血栓头部的主要成分是（　　）。", "answer": "纤维蛋白及血小板", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "纤维蛋白及血小板", "B": "血小板及粒细胞", "C": "纤维蛋白及粒细胞", "D": "纤维蛋白及红细胞", "language": "zh"}
{"question": "1．5cm×4cm的肾癌，靠近肾门，对侧肾功能正常。应选择的治疗方法是（　　）。", "answer": "根治性肾切除术", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "免疫治疗", "B": "根治性肾切除术", "C": "肾部分切除术", "D": "放射治疗", "language": "zh"}
{"question": "治疗新鲜髋关节后脱位的措施，不应选择（　　）。", "answer": "即刻手术切开复位", "meta_info": "第四部分　运动系统疾病", "answer_idx": "D", "A": "复位后持续皮牵引固定于伸直位，外展位3～4周", "B": "早期进行股四头肌收缩活动及踝部功能锻炼", "C": "伤后3个月患肢不能负重，以免股骨头缺血坏死", "D": "即刻手术切开复位", "language": "zh"}
{"question": "下列关于下肢动脉粥样硬化狭窄保守治疗错误的是（　　）。", "answer": "间歇性跛行患者，应尽量少走动，减轻肢痛发作", "meta_info": "第2篇　心血管系统", "answer_idx": "A", "A": "间歇性跛行患者，应尽量少走动，减轻肢痛发作", "B": "选择不影响下肢局部血流的袜或鞋", "C": "患肢经常保持清洁，避免外伤", "D": "静息痛患者，可采用头高脚低位，增加下肢血流灌注", "language": "zh"}
{"question": "1．癌组织中实质与间质大致相等是（　　）。", "answer": "乳腺单纯癌", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "乳腺导管内癌", "B": "乳腺单纯癌", "C": "乳腺硬癌", "D": "乳腺髓样癌", "language": "zh"}
{"question": "2．青年男性蛋白尿患者，诊断首先考虑（　　）。", "answer": "原发性肾小球肾炎", "meta_info": "第4篇　泌尿系统", "answer_idx": "D", "A": "狼疮性肾炎", "B": "尿酸肾病", "C": "肾淀粉样变性", "D": "原发性肾小球肾炎", "language": "zh"}
{"question": "男性，47岁，腹胀、纳差半年。6小时前突然呕血约1000mL来急诊，既往HBsAg（＋）。查体：P 125次/min，BP 70/50mmHg，巩膜轻度黄染，肝脾肋下未触及，移动性浊音（＋），下肢有可凹性水肿。1．引起呕血的最可能病因是（　　）。", "answer": "肝硬化", "meta_info": "第3篇　消化系统", "answer_idx": "B", "A": "胃癌", "B": "肝硬化", "C": "胃溃疡", "D": "十二指肠溃疡", "language": "zh"}
{"question": "下列哪项是治疗失眠症比较有效，并且使用最多的药物？（　　）", "answer": "镇静催眠药", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "抗抑郁药", "B": "抗精神病药", "C": "镇静催眠药", "D": "抗躁狂药", "language": "zh"}
{"question": "患者，男，64岁，咳嗽气喘40年，5年来间断加重。一周来咳喘、痰多伴嗜睡。血气结果显示：呼吸性酸中毒伴代谢性酸中毒。以下治疗不当的是（　　）。", "answer": "静点5%碳酸氢钠，纠正酸中毒", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "A", "A": "静点5%碳酸氢钠，纠正酸中毒", "B": "纠正电解质紊乱", "C": "提高通气量，给予氧疗", "D": "应用抗生素药物控制感染", "language": "zh"}
{"question": "SLE病人最典型的面部表现是（　　）。", "answer": "蝶形红斑", "meta_info": "第五部分　风湿免疫性疾病", "answer_idx": "B", "A": "痤疮", "B": "蝶形红斑", "C": "色素沉着", "D": "紫癜", "language": "zh"}
{"question": "2．颈1-4神经根刺激可能出现的体征是（　　）。", "answer": "屈颈试验阳性", "meta_info": "第二部分　模拟试题", "answer_idx": "D", "A": "Kernig征阳性", "B": "分离性感觉障碍", "C": "Babinski征阳性", "D": "屈颈试验阳性", "language": "zh"}
{"question": "近年来输血后肝炎主要由哪一种病毒引起?（　　）", "answer": "丙型肝炎病毒", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "C", "A": "乙型肝炎病毒", "B": "甲型肝炎病毒", "C": "丙型肝炎病毒", "D": "丁型肝炎病毒", "language": "zh"}
{"question": "卵巢动脉来自（　　）。", "answer": "腹主动脉", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "腹主动脉", "B": "髂内动脉", "C": "髂外动脉", "D": "肾动脉", "language": "zh"}
{"question": "女，72岁。腹痛6小时。进食油腻食物后突发腹痛，以中上腹部为剧。查体：P 110次/分，BP 110/60mmHg。右上腹部可触及表面光滑包块，有压痛。首选的检查是（　　）。", "answer": "腹部B超", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "腹部B超", "B": "上消化道X线钡剂造影", "C": "腹部X线平片", "D": "胃镜", "language": "zh"}
{"question": "女，65岁。阵发性腹痛、腹胀、停止排气排便2天。既往有类似发作，程度较轻，未诊治。查体：P 100次/分，BP 110/70mmHg，双肺呼吸音清，未闻及干湿性啰音，心率100次/分，心律齐，腹肌紧张，压痛明显，反跳痛阳性，移动性浊音阳性。最可能的诊断是（　　）。", "answer": "绞窄性肠梗阻", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "不全性粘连性肠梗阻", "B": "绞窄性肠梗阻", "C": "麻痹性肠梗阻", "D": "完全性高位肠梗阻", "language": "zh"}
{"question": "3．能够杀灭各型阿米巴原虫，适用于肠内、外急慢性阿米巴病的是（　　）。", "answer": "甲硝唑", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "氯喹", "B": "磷酸伯氨喹", "C": "甲硝唑", "D": "吐根碱", "language": "zh"}
{"question": "4．完全断裂时可闭合断端，另行胃空肠吻合束（　　）。", "answer": "十二指肠断裂", "meta_info": "第3篇　消化系统", "answer_idx": "C", "A": "肝破裂", "B": "脾破裂", "C": "十二指肠断裂", "D": "广泛结肠破裂", "language": "zh"}
{"question": "长期应用可以引起成瘾的药物是（　　）。", "answer": "哌替啶", "meta_info": "药理学", "answer_idx": "D", "A": "阿司匹林", "B": "布洛芬", "C": "芬太尼", "D": "哌替啶", "language": "zh"}
{"question": "1．增高可持续2周的心肌梗死的心肌坏死标志物是（　　）。", "answer": "cTnT", "meta_info": "第2篇　心血管系统", "answer_idx": "A", "A": "cTnT", "B": "CK-MB", "C": "MYO（肌红蛋白）", "D": "cTnI", "language": "zh"}
{"question": "急性胆囊炎的临床表现不包括（　　）。", "answer": "大多伴有黄疸", "meta_info": "第3篇　消化系统", "answer_idx": "B", "A": "右上腹持续性痛并阵发性加重", "B": "大多伴有黄疸", "C": "右上腹局限性肌紧张", "D": "可伴有右肩部不适症状", "language": "zh"}
{"question": "1岁小儿，腹泻7天，经第一阶段输液后已排尿，呼吸见平稳，脉搏有力，血钠136mmol/L，CO2CP13.6mmol/L，血钾3.0mmol/L。第二阶段应用哪一种液体继续输给？（　　）", "answer": "含0.15%氯化钾1：4含钠液", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "含0.15%氯化钾的生理盐水", "B": "含0.15%氯化钾1：4含钠液", "C": "含0.15%氯化钾2：l等张含钠液", "D": "含0.15%氯化钾2：3：1含钠液", "language": "zh"}
{"question": "药物依赖指（　　）。", "answer": "对药物强烈的渴求", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "对药物强烈的渴求", "B": "精神依赖", "C": "躯体依赖", "D": "对药物的需要", "language": "zh"}
{"question": "女婴5个月，突然高热烦躁，吃奶后频繁呕吐，两眼凝视，前囟紧张，脑脊液细胞数850×109/L，中性0.7，淋巴0.3，糖2.0mmol/L，蛋白1.2g/L，氯100mmol/L。3．为快速降低颅内压首选（　　）。", "answer": "20%甘露醇", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "20%甘露醇", "B": "高渗糖", "C": "醋唑酰胺", "D": "腰穿减压", "language": "zh"}
{"question": "女，22岁，在读大学生。于半年前觉得其身材不够苗条，开始极端地限制饮食，每餐只吃青菜、水果及极少量米饭。喝水较少，称水喝多了会浮肿。体型日渐消瘦，但其仍认为偏胖。近1个月暴饮暴食，进食后为避免体重反弹而自行催吐，每周4～5次，并出现失眠，整夜难以入睡，情绪低落，不能坚持上课。2．对患者的治疗措施不包括（　　）。", "answer": "电抽搐治疗", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "电抽搐治疗", "B": "认知行为治疗", "C": "驱体支持治疗", "D": "小剂量抗精神病药物治疗", "language": "zh"}
{"question": "能促进维生素B12吸收的物质是（　　）。", "answer": "内因子", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "胃蛋白酶", "B": "碳酸氢盐", "C": "内因子", "D": "粘液", "language": "zh"}
{"question": "在骨折复位中，以下哪项正确？（　　）", "answer": "若无骨骺损伤，可允许儿童下肢骨折短缩2厘米以内", "meta_info": "第四部分　运动系统疾病", "answer_idx": "C", "A": "骨折部分的旋转移位、分离移位不必完全矫正", "B": "允许成人下肢骨折存在与关节活动方向垂直的侧方成角", "C": "若无骨骺损伤，可允许儿童下肢骨折短缩2厘米以内", "D": "肱骨干骨折必须达到解剖复位", "language": "zh"}
{"question": "女，33岁，慢性肝炎病史5年，妇科检查宫颈糜烂Ⅲ度，子宫正常大小，要求避孕，应选择（　　）。", "answer": "避孕套", "meta_info": "第5篇　女性生殖系统", "answer_idx": "C", "A": "短效避孕药", "B": "宫内节育器", "C": "避孕套", "D": "安全期避孕", "language": "zh"}
{"question": "女，45岁，近1年来盗汗，心悸，易怒，食量增加。检查：突眼，心率110次/分，血压126/84mmHg，甲状腺弥漫性肿大Ⅲ°，心律齐、无杂音，举手颤动明显。查血T3、T4高于正常值。诊为原发性甲亢，经抗甲状腺药物治疗后复发，拟行甲状腺双侧次全切除术。1．若用丙基硫氧嘧啶+碘剂作术前准备，未达手术要求的表现是（　　）。", "answer": "心率在90～100次/分", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "A", "A": "心率在90～100次/分", "B": "血T3、T4值均正常", "C": "甲状腺缩小变硬", "D": "基础代谢率低于+20%", "language": "zh"}
{"question": "病人义务不包括（　　）。", "answer": "完全听从医师安排", "meta_info": "医学伦理学", "answer_idx": "A", "A": "完全听从医师安排", "B": "不将疾病传播他人", "C": "认真执行医嘱", "D": "如实提供病情信息", "language": "zh"}
{"question": "男性，25岁，鼻衄、牙龈出血、皮肤瘀斑3天。查体：T 37.8℃，胸骨压痛，血常规：WBC 2.8×109/L，Hb 80g/L，PLT1.8×109/L，血分类中未见异常细胞，尿常规可见多个红细胞。3．最可能的诊断为（　　）。", "answer": "急性非淋M3+弥散性血管内凝血", "meta_info": "第一部分　血液系统疾病", "answer_idx": "A", "A": "急性非淋M3+弥散性血管内凝血", "B": "急性非淋M5", "C": "急性非淋M3", "D": "以上均不对", "language": "zh"}
{"question": "2．动脉粥样硬化（　　）。", "answer": "弹力型动脉内膜脂质沉积", "meta_info": "病理学", "answer_idx": "A", "A": "弹力型动脉内膜脂质沉积", "B": "细动脉玻璃样变", "C": "大中动脉纤维素样坏死及风湿小体形成", "D": "细小动脉纤维素样坏死", "language": "zh"}
{"question": "4．铜蓝蛋白的主要功用是（　　）。", "answer": "运输铜", "meta_info": "生物化学", "answer_idx": "B", "A": "运输铁", "B": "运输铜", "C": "是丝氨酸蛋白酶的抑制剂", "D": "运输胆红素", "language": "zh"}
{"question": "弥漫性毛细血管内增生性肾炎的肉眼病变是（　　）。", "answer": "大红肾", "meta_info": "病理学", "answer_idx": "A", "A": "大红肾", "B": "固缩肾", "C": "多囊肾", "D": "大白肾", "language": "zh"}
{"question": "患者，男，17岁。感冒伴发热8天后出现全身性水肿，血压155/90mmHg，尿蛋白（＋），红细胞（＋＋＋），白细胞3个/HP，ASO 600U。此患者水肿的主要机制是（　　）。", "answer": "球管失衡", "meta_info": "第4篇　泌尿系统", "answer_idx": "D", "A": "抗利尿激素分泌过多", "B": "醛固酮增高", "C": "血浆胶体渗透压降低", "D": "球管失衡", "language": "zh"}
{"question": "男性患者，32岁，近10年反复咳嗽、咳脓痰，间断痰中带血，晨起为重，抗感染治疗后病情可暂时短期缓解，但从未系统体检。2．患者出现大咯血，一次咯血远大于200mL，每日咯血＞500mL，监测血压为：80/40mmHg，四肢厥冷，心率130次/min，神志恍惚。血常规：血红蛋白65g/L。需要的紧急处理不包括（　　）。", "answer": "体位引流", "meta_info": "第1篇　呼吸系统", "answer_idx": "C", "A": "积极补液及输血", "B": "应用静脉止血药物", "C": "体位引流", "D": "保持呼吸道通畅", "language": "zh"}
{"question": "女，30岁，体检时发现，HbsAg、抗-HBc、抗-HBe阳性，判断是否有传染性还应作的检查是（　　）。", "answer": "HBV DNA", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "肝功能", "B": "HBV DNA", "C": "肝脏B超", "D": "肝脏MRI", "language": "zh"}
{"question": "男，44岁，切伤右手中指，即刻来诊。检查神经肌腱功能正常。处理出血最简便、有效的方法是（　　）。", "answer": "局部包扎或缝合止血", "meta_info": "第四部分　运动系统疾病", "answer_idx": "D", "A": "以止血钳夹住血管5min", "B": "冷冻止血", "C": "以气压止血带止血", "D": "局部包扎或缝合止血", "language": "zh"}
{"question": "原发性免疫缺陷病的治疗不正确的为（　　）。", "answer": "丙种球蛋白制剂仅适用于治疗IgG缺乏病", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "选择性IgA缺乏病禁忌输血或血制品", "B": "合并感染时，应选用杀菌强的抗菌药物治疗", "C": "丙种球蛋白制剂仅适用于治疗IgG缺乏病", "D": "胸腺发育不全出现低钙抽搐除给钙剂外，还应给维生素D3", "language": "zh"}
{"question": "女性，38岁，洗衣时突发右侧肢体活动不灵。查体：意识清，失语，二尖瓣区可闻双期杂音，心房纤颤，右侧偏瘫，上肢重于下肢，右偏身痛觉减退。诊断最可能是（　　）。", "answer": "脑栓塞", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "脑血栓形成", "B": "脑栓塞", "C": "脑出血", "D": "蛛网膜下腔出血", "language": "zh"}
{"question": "先天性甲状腺功能减退症的新生儿筛查，下列哪项是错误的？（　　）", "answer": "TSH＞20mU/L即可确诊", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "生后2～3天的新生儿", "B": "应用干血滴纸片", "C": "测TSH的浓度", "D": "TSH＞20mU/L即可确诊", "language": "zh"}
{"question": "7个月患儿，呕吐腹泻4天，大便8～10次/天。量多，呈蛋花汤样，尿量极少，皮肤弹性差，呈花纹状，眼窝、前囟明显凹陷，心音低钝，四肢厥冷，大便镜检偶见白细胞，血清钠为128mmol/L。1．该患儿的诊断为（　　）。", "answer": "重度低渗性脱水", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "中度等渗性脱水", "B": "重度等渗性脱水", "C": "中度低渗性脱水", "D": "重度低渗性脱水", "language": "zh"}
{"question": "对已确诊患有乳腺癌的1000名妇女和未患乳腺癌的1000名妇女，用以乳腺癌筛选的试验检查，结果发现前者有900名为阳性结果，后者有100名为阳性结果。2．该试验的假阳性率是（　　）。", "answer": "10%", "meta_info": "第二部分　模拟试题", "answer_idx": "D", "A": "90%", "B": "30%", "C": "2%", "D": "10%", "language": "zh"}
{"question": "急性白血病出血的主要原因是（　　）。", "answer": "血小板减少", "meta_info": "第一部分　血液系统疾病", "answer_idx": "B", "A": "纤维蛋白溶解", "B": "血小板减少", "C": "DIC", "D": "AT-Ⅲ减少", "language": "zh"}
{"question": "患者，男，50岁，突起呼吸困难，咳粉红色泡沫痰。BP 190/100mmHg。该患者的最佳治疗药物是（　　）。", "answer": "硝普钠", "meta_info": "第2篇　心血管系统", "answer_idx": "B", "A": "氨荼碱", "B": "硝普钠", "C": "多巴酚丁胺", "D": "硝酸甘油", "language": "zh"}
{"question": "男性，27岁。右足底被铁钉刺伤1O天后突然出现张口困难，继之出现苦笑面容，角弓反张，每次发作数秒钟。声响及触碰病人时均可诱发上述症状，发作间歇期肌肉仍不能完全松弛，神志一直清楚，无发热。2．预防该病发生的关键是（　　）。", "answer": "早期彻底清创，改善局部循环", "meta_info": "第八部分　其他疾病", "answer_idx": "A", "A": "早期彻底清创，改善局部循环", "B": "中和游离毒素", "C": "控制和解除痉挛", "D": "防治并发症", "language": "zh"}
{"question": "男，60岁，右髋部疼痛2年余，加重伴跛行1个月，既往有“慢性肾炎史”，长期口服“激素”治疗。体检：右髋关节“4”字试验阳性。1．该患者首先应做的检查是（　　）。", "answer": "摄双侧髋关节正位片", "meta_info": "第四部分　运动系统疾病", "answer_idx": "B", "A": "血常规+血沉", "B": "摄双侧髋关节正位片", "C": "髋关节穿刺+细菌培养", "D": "髋关节片+活检", "language": "zh"}
{"question": "2．生后2个月时应接种的疫苗是（　　）。", "answer": "脊髓灰质炎疫苗", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "麻疹疫苗", "B": "乙肝疫苗", "C": "流感疫苗", "D": "脊髓灰质炎疫苗", "language": "zh"}
{"question": "男54岁。胸痛3天，深吸气时明显，屏气时消失。胸痛最可能的原因是病变累及（　　）。", "answer": "胸膜", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "食管", "B": "肺尖", "C": "胸膜", "D": "主动脉", "language": "zh"}
{"question": "Apgar评分内容不包括哪一项？（　　）", "answer": "原始反射", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "心率", "B": "呼吸", "C": "原始反射", "D": "皮肤颜色", "language": "zh"}
{"question": "2．慢性阻塞性肺疾病（COPD）急性加重期、Ⅱ型呼吸衰竭、肺性脑病、昏迷患者最常采用的氧疗措施是（　　）。", "answer": "机械通气", "meta_info": "第1篇　呼吸系统", "answer_idx": "C", "A": "高浓度吸氧", "B": "无创正压通气", "C": "机械通气", "D": "高压氧舱", "language": "zh"}
{"question": "抗原抗体反应的特异性主要依赖于（　　）。", "answer": "抗原和抗体的构象", "meta_info": "医学免疫学", "answer_idx": "C", "A": "抗原的分子量", "B": "抗体的电荷", "C": "抗原和抗体的构象", "D": "抗原和抗体的浓度", "language": "zh"}
{"question": "男，36岁，心悸、怕热、手颤乏力一年，大便不成形，日3～4次，体重下降11公斤，查体：脉搏90次/分，血压128／90mmHg，皮肤潮湿，双手细颤，双眼突出，甲状腺弥漫Ⅱ度肿大，可闻及血管杂音，心率104次/分，律不齐，心音强弱不等，腹平软，肝脾肋下未及，双下肢无水肿。1．为明确诊断，首选检查是（　　）。", "answer": "血TSH，T3，T4", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "甲状腺摄131I率", "B": "血TSH，T3，T4", "C": "TRH兴奋实验", "D": "抗甲状腺抗体", "language": "zh"}
{"question": "男，38岁。反复发作肉眼血尿8年，均在上呼吸道感染后1～2天出现。发作间期多次查尿常规示蛋白（＋～＋＋），沉渣镜检RBC 8～10/HP，双下肢无水肿。尿蛋白定量0.8g/d，肾功能正常。该患者临床诊断为（　　）。", "answer": "无症状性血尿和蛋白尿", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "高血压肾损害", "B": "无症状性血尿和蛋白尿", "C": "慢性肾小球肾炎", "D": "肾病综合征", "language": "zh"}
{"question": "患者意识清醒，右眼睑下垂，瞳孔散大，光反射消失，眼球外斜视，额纹不对称，露齿时口角右偏，伸舌左偏，左侧中枢性偏瘫，病变部位在（　　）。", "answer": "右侧中脑", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "右侧中脑", "B": "右侧脑桥", "C": "右侧处延髓，脑桥及中脑", "D": "右侧内囊病变发展形成天幕疝", "language": "zh"}
{"question": "1．阿尔茨海默病性痴呆（　　）。", "answer": "潜隐发病，以记忆力下降为主要表现的痴呆", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "以人格改变为早期症状的痴呆", "B": "潜隐发病，以记忆力下降为主要表现的痴呆", "C": "有痴呆症状伴明显的视幻觉及类帕金森氏病症状", "D": "遗忘综合征伴有脑震荡后综合征", "language": "zh"}
{"question": "上消化道大出血休克时，首先的治疗措施（　　）。", "answer": "积极补充血容量", "meta_info": "第3篇　消化系统", "answer_idx": "D", "A": "放置胃管注入止血药物", "B": "平卧位，下肢抬高并予吸氧", "C": "紧急胃镜止血", "D": "积极补充血容量", "language": "zh"}
{"question": "一位来访者单位的同事，要求了解当事人心理治疗情况，心理治疗师婉言拒绝，这是因为（　　）。", "answer": "心理治疗的保密原则", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "出于对来访者的尊重", "B": "保持客观中立的立场", "C": "心理治疗的关系限定原则", "D": "心理治疗的保密原则", "language": "zh"}
{"question": "骨、关节结核最多见于（　　）。", "answer": "脊柱", "meta_info": "第四部分　运动系统疾病", "answer_idx": "A", "A": "脊柱", "B": "膝关节", "C": "髋关节", "D": "腕关节", "language": "zh"}
{"question": "男性，加岁，被他人发现颈部肿块2天而来就诊。体格检查发现气管右侧可扪及一结节，质硬，可随吞咽上下移动，同侧胸锁乳突肌前缘可扪及2个肿大淋巴结。首先考虑的诊断是（　　）。", "answer": "甲状腺癌", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "D", "A": "颈淋巴结炎", "B": "恶性淋巴瘤", "C": "甲状腺腺瘤", "D": "甲状腺癌", "language": "zh"}
{"question": "2．抑癌基因致癌（　　）。", "answer": "等位基因缺失或失活引起细胞癌变", "meta_info": "生物化学", "answer_idx": "D", "A": "启动子插入", "B": "聚合酶链反应", "C": "反转录一聚合酶链反应", "D": "等位基因缺失或失活引起细胞癌变", "language": "zh"}
{"question": "诊断支气管扩张首选的检查是（　　）。", "answer": "胸部高分辨CT", "meta_info": "第1篇　呼吸系统", "answer_idx": "B", "A": "胸部超声", "B": "胸部高分辨CT", "C": "支气管造影", "D": "胸部磁共振", "language": "zh"}
{"question": "铁剂治疗缺铁性贫血时，下列哪项最早显示疗效？（　　）", "answer": "网织红细胞增多", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "血清铁增多", "B": "网织红细胞增多", "C": "血红蛋白及红细胞增多", "D": "口唇色泽开始变红", "language": "zh"}
{"question": "1．具有氧化酶活性的为（　　）。", "answer": "铜蓝蛋白", "meta_info": "生物化学", "answer_idx": "D", "A": "免疫球蛋白", "B": "肌红蛋白", "C": "脂蛋白", "D": "铜蓝蛋白", "language": "zh"}
{"question": "患者左侧面部痛觉减退，左侧直接角膜反射消失，间接角膜反射存在，张口时，下颌左偏，病损部位在（　　）。", "answer": "左侧三叉神经", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "左侧三叉神经", "B": "左侧面神经", "C": "右侧三叉神经", "D": "左侧三叉神经及左侧面神经", "language": "zh"}
{"question": "乙胺丁醇最常见的不良反应是（　　）。", "answer": "球后视神经炎", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "皮疹", "B": "药物热", "C": "肾功能损害", "D": "球后视神经炎", "language": "zh"}
{"question": "男，60岁。肺癌根治术后1天，胸腔闭式引流1.5小时引出血性液体500ml。查体：P120次/分，BP100／75mmHg。此时最重要的处理方法是（　　）。", "answer": "开胸止血", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "输注全血", "B": "继续观察", "C": "开胸止血", "D": "快速补液", "language": "zh"}
{"question": "初产妇总产程不超过（　　）。", "answer": "24小时", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "16小时", "B": "18小时", "C": "22小时", "D": "24小时", "language": "zh"}
{"question": "某患者乘车时，急刹车，右膝前方受到撞击，出现右髋剧痛，髋关节运动障碍，处于屈曲内收、内旋畸形状态。4．该病人治疗4周后，自行下地负重行走，正常活动，预计可能发生下述哪种情况?（　　）", "answer": "股骨头缺血性坏死", "meta_info": "第四部分　运动系统疾病", "answer_idx": "C", "A": "关节周围组织损伤", "B": "习惯性关节脱位", "C": "股骨头缺血性坏死", "D": "髋关节周围创伤性骨化", "language": "zh"}
{"question": "HLA-Ⅱ类抗原不在下述哪种细胞表面表达?（　　）", "answer": "粒细胞", "meta_info": "医学免疫学", "answer_idx": "D", "A": "B细胞", "B": "活化T细胞", "C": "血管内皮细胞", "D": "粒细胞", "language": "zh"}
{"question": "男婴，8个月，已发热、惊厥3天，诊断为“化脓性脑膜炎”，下列哪项处理不当？（　　）", "answer": "必要时抽放脑脊液以降压", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "及早选用有效抗生素进行治疗", "B": "及时退热，控制惊厥发作", "C": "保证足够的热量及液体", "D": "必要时抽放脑脊液以降压", "language": "zh"}
{"question": "有关结肠癌的描述，正确的是（　　）。", "answer": "浸润型癌多发生在左半结肠，易引起肠腔狭窄", "meta_info": "第3篇　消化系统", "answer_idx": "C", "A": "溃疡型癌多见于右半结肠，一般预后良好", "B": "肿块型癌多发生在升结肠，易引发肠梗阻", "C": "浸润型癌多发生在左半结肠，易引起肠腔狭窄", "D": "患者血清CEA均增高", "language": "zh"}
{"question": "Calot三角组成包括肝脏下缘、胆囊管和（　　）。", "answer": "肝总管", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "右肝管", "B": "肝总管", "C": "左肝管", "D": "胆总管", "language": "zh"}
{"question": "处理头部创伤时，必须遵循的外科原则是（　　）。", "answer": "清创术应争取在8h内进行，一般不得超过24h", "meta_info": "第八部分　其他疾病", "answer_idx": "D", "A": "伤口一律全层缝合", "B": "头皮下出血点必须结扎", "C": "大块的头皮缺损只能留作二期处理", "D": "清创术应争取在8h内进行，一般不得超过24h", "language": "zh"}
{"question": "下列哪种药物会引起可逆性前庭反应？（　　）", "answer": "米诺环素", "meta_info": "药理学", "answer_idx": "B", "A": "四环素", "B": "米诺环素", "C": "多西环素", "D": "土霉素", "language": "zh"}
{"question": "下列哪种不属于抗血小板聚集和黏附的药物？（　　）", "answer": "双香豆素", "meta_info": "第2篇　心血管系统", "answer_idx": "C", "A": "阿司匹林", "B": "氯吡格雷", "C": "双香豆素", "D": "芬氟咪唑", "language": "zh"}
{"question": "2．哪项能体现人体实验科学原则？（　　）", "answer": "弱势人群若参加实验，需要监护人的签字", "meta_info": "医学伦理学", "answer_idx": "B", "A": "不选择弱势人群作为受试者", "B": "弱势人群若参加实验，需要监护人的签字", "C": "以健康人或病人作为受试对象", "D": "实验中受试者得到专家的允许后可自由决定是否退出", "language": "zh"}
{"question": "人绒毛膜促性腺激素的作用不包括（　　）。", "answer": "促进胰岛素生成作用", "meta_info": "第5篇　女性生殖系统", "answer_idx": "C", "A": "抑制植物凝集素对淋巴细胞的刺激作用", "B": "维持月经黄体寿命，使其成为妊娠黄体，增加甾体激素分泌，维持妊娠", "C": "促进胰岛素生成作用", "D": "促进雄激素芳香化转化为雌激素能刺激孕酮的形成", "language": "zh"}
{"question": "维生素D缺乏性佝偻病后遗症期的临床特征是（　　）。", "answer": "骨骼畸形", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "骨骼畸形", "B": "血磷、钙降低", "C": "血碱性磷酸酶升高", "D": "易激惹、烦闹、多汗", "language": "zh"}
{"question": "有关直肠癌的描述，错误的是（　　）。", "answer": "常以完全性肠梗阻就诊", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "多有里急后重、肛门下坠感", "B": "常以完全性肠梗阻就诊", "C": "多有带黏液的血便", "D": "早期可表现为大便习惯改变", "language": "zh"}
{"question": "走路滑倒，枕部着地，意识进行性恶化，右瞳散大，左侧偏瘫，颈强直，考虑（　　）。", "answer": "右小脑幕切迹疝", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "外伤性蛛网膜下腔出血", "B": "右额对冲伤", "C": "右小脑幕切迹疝", "D": "脑干伤", "language": "zh"}
{"question": "1．急进性肾小球肾炎的病理类型是（　　）。", "answer": "新月体性肾小球肾炎", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "微小病变型肾病", "B": "新月体性肾小球肾炎", "C": "硬化性肾小球肾炎", "D": "系膜增生性肾小球肾炎", "language": "zh"}
{"question": "复方碘溶液治疗用于（　　）。", "answer": "甲亢术前准备", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "A", "A": "甲亢术前准备", "B": "甲亢术后复发", "C": "甲减", "D": "亚急性甲状腺炎", "language": "zh"}
{"question": "下列关于胰腺炎的叙述不正确的是（　　）。", "answer": "血清淀粉酶＞300U/L即可诊断", "meta_info": "第3篇　消化系统", "answer_idx": "D", "A": "腹痛多向腰背部放射，以左侧为著", "B": "治疗期间禁食、胃肠减压", "C": "禁食期靠静脉应用高浓度脂肪乳作为营养支持", "D": "血清淀粉酶＞300U/L即可诊断", "language": "zh"}
{"question": "1．轮状病毒致婴幼儿秋季腹泻经（　　）。", "answer": "消化道传播", "meta_info": "医学微生物学", "answer_idx": "A", "A": "消化道传播", "B": "血液传播", "C": "性接触传播", "D": "垂直传播", "language": "zh"}
{"question": "女性，45岁，肢体软弱无力，夜尿多2年余，今晨起双下肢不能活动。查体：血压170／100mmHg，均匀性轻度肥胖。双下肢松弛性瘫痪，血钾2.4mmol/L，最可能的诊断是（　　）。", "answer": "原发性醛固酮增多症", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "原发性高血压", "B": "嗜铬细胞瘤", "C": "肾性高血压", "D": "原发性醛固酮增多症", "language": "zh"}
{"question": "女孩，12岁，经常患感冒和肺炎。查体：心前区隆起，无震颤，胸骨左缘第2肋间可闻及2级喷射性杂音，P2＞A2伴有固定分裂，心电显示电轴右偏，V1呈rsR'波形，14mm，2mm，P-R间期0.16秒。1．该患儿考虑何种先天性心脏病？（　　）", "answer": "房间隔缺损", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "房间隔缺损", "B": "肺动脉狭窄", "C": "动脉导管未闭", "D": "室间隔缺损", "language": "zh"}
{"question": "1．上皮组织分化的肿瘤是（　　）。", "answer": "乳腺髓样癌", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "颈部淋巴管瘤", "B": "皮肤恶性黑色素瘤", "C": "乳腺髓样癌", "D": "睾丸精原细胞瘤", "language": "zh"}
{"question": "脑出血的预后与（　　）。", "answer": "以上都是", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "部位有关", "B": "出血量有关", "C": "出血量、部位有关", "D": "以上都是", "language": "zh"}
{"question": "使蛋白质分子在280nm具有光吸收的最主要成分是（　　）。", "answer": "色氨酸的吲哚环", "meta_info": "生物化学", "answer_idx": "C", "A": "丝氨酸的羟基", "B": "苯丙氨酸的苯环", "C": "色氨酸的吲哚环", "D": "组氨酸的咪唑环", "language": "zh"}
{"question": "患儿，8个月，腹泻4天，水样便，1日10余次。12小时无尿，呼吸深大，前囟眼窝明显凹陷，四肢凉。血钠127mmol/L，血钾4mmol/L，血钙2.25mmol/L，二氧化碳合力11.2mmol/L。3．补充累积损失液为主阶段的输液速度、张力及补液量为（　　）。", "answer": "每小时8～10ml/kg，2/3张450ml", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "每小时8～10ml/kg，1/3张600ml", "B": "每小时8～10ml/kg，2/3张450ml", "C": "每小时4～5ml/kg，1/2张450ml", "D": "每小时4～5ml/kg，1/3张450ml", "language": "zh"}
{"question": "患者，男，60岁，咳嗽、痰中带血、体重减轻2个月，曾予青霉素800万单位肌注5天，口服止咳、祛痰药无效。体格检查；左外侧胸第4、5肋间语颤减低，叩诊浊音，WBC 8.7×109/L，N 0.69。1．病史中应特别注意询问（　　）。", "answer": "吸烟史", "meta_info": "第1篇　呼吸系统", "answer_idx": "B", "A": "有无胸痛及其部位，性质", "B": "吸烟史", "C": "盗汗史", "D": "慢性支气管炎病史", "language": "zh"}
{"question": "男，23岁。头晕、乏力1个月，加重伴鼻出血3天。查体：贫血貌，全身皮肤散在出血点，浅表淋巴结未触及肿大，心肺及腹部未见异常。实验室检查：Hb 75g/L，WBC 1.2×109/L，PLT 15×109/L，网织红细胞0.002。该患者可能的免疫异常是（　　）。", "answer": "CD8＋T细胞比例增高", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "CD4＋T细胞比例降低", "B": "CD8＋T细胞比例增高", "C": "TNF水平降低", "D": "补体降低", "language": "zh"}
{"question": "女，18岁，突然剧烈头痛、呕吐，查体：颈项强直，克氏征阳性，布氏征阳性，CT示侧裂池、环池内高密度影，诊断首先考虑（　　）。", "answer": "蛛网膜下腔出血", "meta_info": "第二部分　模拟试题", "answer_idx": "B", "A": "脑膜炎", "B": "蛛网膜下腔出血", "C": "脑肿瘤", "D": "脑脓肿", "language": "zh"}
{"question": "关于产前检查，正确的是（　　）。", "answer": "一般孕妇妊娠20～36周，每4周检查一次", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "一般孕妇妊娠20～36周，每4周检查一次", "B": "首次产前检查是从妊娠12周开始", "C": "高危孕妇从妊娠开始每2周一次", "D": "一般孕妇共进行产前检查10～12次", "language": "zh"}
{"question": "关于动脉粥样硬化的叙述，错误的是（　　）。", "answer": "胸主动脉病变最重", "meta_info": "病理学", "answer_idx": "B", "A": "病变多位于主动脉各分支开口处", "B": "胸主动脉病变最重", "C": "病变可继发钙化、出血", "D": "可继发血栓形成", "language": "zh"}
{"question": "用钼靶X线摄片检查方法做乳腺癌的筛检试验，分别检查了100名经活检确诊为乳腺癌的妇女和100名未患乳腺癌的妇女，结果如下表：2．此项筛检中特异度为（　　）。", "answer": "84％", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "16％", "B": "84％", "C": "64％", "D": "74％", "language": "zh"}
{"question": "甲状腺功能低下的主要临床表现是（　　）。", "answer": "智力落后、生长发育迟缓、生理功能低下", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "智力落后、生长发育迟缓、生理功能低下", "B": "智力落后、运动落后、语言落后", "C": "智力落后、肌张力增高，运动障碍", "D": "智力正常、腓肠肌肥大，肌无力", "language": "zh"}
{"question": "饮食中碳水化合物提供的能量占总能量的百分比是（　　）。", "answer": "50%～60%左右", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "20%～30%左右", "B": "50%～60%左右", "C": "30%～40%左右", "D": "8%～15%左右", "language": "zh"}
{"question": "既可通过水平传播，也可通过垂直传播的疾病是（　　）。", "answer": "乙型肝炎", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "流行性感冒", "B": "流行性脑脊髓膜炎", "C": "甲型肝炎", "D": "乙型肝炎", "language": "zh"}
{"question": "体内脂肪大量动员时，肝内生成的乙酰辅酶A可生成（　　）。", "answer": "酮体", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "葡萄糖", "B": "二氧化碳和水", "C": "胆固醇", "D": "酮体", "language": "zh"}
{"question": "反应直接作用在感觉器官的客观事物个别属性的心理现象是（　　）。", "answer": "感觉", "meta_info": "医学心理学", "answer_idx": "A", "A": "感觉", "B": "情绪", "C": "记忆", "D": "思维", "language": "zh"}
{"question": "慢性粒细胞白血病最典型的染色体变化是出现了（　　）。", "answer": "t（9；22）（q34；q11）", "meta_info": "第一部分　血液系统疾病", "answer_idx": "B", "A": "t（15；17）", "B": "t（9；22）（q34；q11）", "C": "t（9；21）", "D": "t（11；8）（q34；q11）", "language": "zh"}
{"question": "贫血时病人皮肤及黠膜苍白，较为可靠的检查部位是（　　）。", "answer": "睑结合膜、指甲及口唇", "meta_info": "第一部分　血液系统疾病", "answer_idx": "D", "A": "手背皮肤及口腔黏膜", "B": "耳轮皮肤", "C": "颈部皮肤及舌面", "D": "睑结合膜、指甲及口唇", "language": "zh"}
{"question": "治疗成人股骨头缺血性坏死，下述哪一项措施应特殊强调？（　　）", "answer": "减少负重", "meta_info": "第四部分　运动系统疾病", "answer_idx": "C", "A": "非甾体类抗炎剂", "B": "理疗", "C": "减少负重", "D": "扩血管药物", "language": "zh"}
{"question": "下列哪组有关乙型肝炎血清学检查结果提示有较大传染性？（　　）", "answer": "HBsAg阳性，HBeAg阳性，抗-HBc阳性", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "D", "A": "抗-HBc阳性", "B": "抗-HBs阳性，抗-HBe阳性，抗-HBc阳性", "C": "单纯HBsAg阳性", "D": "HBsAg阳性，HBeAg阳性，抗-HBc阳性", "language": "zh"}
{"question": "符合甲状旁腺功能亢进症的实验室检查结果的是（　　）。", "answer": "高血钙、低血磷和高尿钙", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "高血钙、高血磷和低尿钙", "B": "高血钙、低血磷和低尿钙", "C": "高血钙、低血磷和高尿钙", "D": "低血钙、高血磷和高尿钙", "language": "zh"}
{"question": "病人看到房屋倾斜，汽车变得扭曲，电线杆像筷子一样细，这种现象是（　　）。", "answer": "视物变形", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "错觉", "B": "视物变形", "C": "非真实感", "D": "人格解体", "language": "zh"}
{"question": "1．确诊前列腺癌的检查是（　　）。", "answer": "前列腺穿刺活检", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "前列腺穿刺活检", "B": "直肠指检", "C": "前列腺MRI", "D": "前列腺B超", "language": "zh"}
{"question": "某患者乘车时，因急刹车，右膝前方受到撞击，出现右髋剧痛，髋关节运动障碍，处于屈曲内收，内旋，畸形状态。2．可能出现的合并损伤是（　　）。", "answer": "坐骨神经", "meta_info": "第四部分　运动系统疾病", "answer_idx": "A", "A": "坐骨神经", "B": "股神经", "C": "胫神经", "D": "腓总神经", "language": "zh"}
{"question": "女，34岁。胸闷、气短1个月余，伴干咳。查体：R 22次/min，BP 90/80mmHg，端坐位，颈静脉怒张，双肺未闻及干湿性啰音，心率90次/min，律齐，心音低而遥远，P2无亢进，肝肋下3cm，肝颈静脉回流征阳性，双下肢水肿。其心浊音界可能为（　　）。", "answer": "烧瓶样", "meta_info": "第2篇　心血管系统", "answer_idx": "B", "A": "靴型", "B": "烧瓶样", "C": "向左扩大", "D": "普大心", "language": "zh"}
{"question": "男，42岁。阵发性上腹痛3年，夜间加重，疼痛有季节性，冬季明显，有反酸，为进一步确诊，首选的检查方法是（　　）。", "answer": "胃镜检查", "meta_info": "第3篇　消化系统", "answer_idx": "A", "A": "胃镜检查", "B": "CT检查", "C": "MRI", "D": "B超", "language": "zh"}
{"question": "6个月婴儿，半天来突然抽搐3次，抽时双眼上翻。四肢抖动，持续2分钟自然缓解，抽后意识清，吃奶。询问病史，生后人工喂养，近日夜惊多汗。查体：营养中等，枕秃明显，囟门2.5cm×2.5cm，颈软。患儿再度抽搐。最恰当的处理原则是（　　）。", "answer": "先止惊及缓慢静脉注射钙剂，后改为口服钙，再用维生素D", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "先补充钙，同时止惊、吸氧", "B": "先用维生素D，同时补充钙，再吸氧", "C": "先补充钙剂及维生素D，然后吸氧、止惊", "D": "先止惊及缓慢静脉注射钙剂，后改为口服钙，再用维生素D", "language": "zh"}
{"question": "红细胞渗透脆性增大时（　　）。", "answer": "对低渗盐溶液抵抗力减少", "meta_info": "生理学", "answer_idx": "C", "A": "红细胞不易破裂", "B": "对高渗盐溶液抵抗力减少", "C": "对低渗盐溶液抵抗力减少", "D": "对低渗盐溶液抵抗力增加", "language": "zh"}
{"question": "下列符合营养性缺铁性贫血的是（　　）。", "answer": "RBC数减少＜Hb量减少，TIBC升高", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "RBC数减少＞Hb量减少，TIBC降低", "B": "RBC数减少=Hb量减少，TIBC升高", "C": "RBC数减少＜Hb量减少，TIBC升高", "D": "RBC数减少＜Hb量减少，TIBC降低", "language": "zh"}
{"question": "男性，18岁学生，不出门怕见人，不去上课，纠缠父母出钱给自己做美容手术半年。原因是半年来反复照镜子发现自己的鼻子比以前变大了，难看了。说班上的同学都讥笑他，出门就感觉别人在说他，别人的眼光看他时很特别，能使他头痛。父母不愿意出钱就说父母不关心他，父母不是亲生的，曾说要去做亲子鉴定。3．判断一种抗精神病药是否有效至少要足量使用（　　）。", "answer": "6周", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "4周", "B": "5周", "C": "6周", "D": "8周", "language": "zh"}
{"question": "一般头皮裂伤清创的时限不应超过（　　）。", "answer": "24小时", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "24小时", "B": "72小时", "C": "8小时", "D": "48小时", "language": "zh"}
{"question": "女性，29岁。阑尾切除术后5天，体温一直在38.5～39.2℃，并出现腹泻10次/日，有里急后重感。应考虑可能并发（　　）。", "answer": "盆腔脓肿", "meta_info": "第八部分　其他疾病", "answer_idx": "C", "A": "切口感染", "B": "切口裂开", "C": "盆腔脓肿", "D": "手术后出血", "language": "zh"}
{"question": "女性，21岁，舞蹈演员。8个月前，因同事偶尔说了句“最近胖了”遂采取各种措施节食，家人劝阻时，以食欲不佳等理由拒绝进餐，体重由以往54kg降至32kg（身高1.65m），近3个月来出现闭经，体检见皮肤干燥、苍白，形体消瘦，严重营养不良。3．此类病人死亡原因多见于（　　）。", "answer": "营养代谢障碍及感染", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "自杀", "B": "营养代谢障碍及感染", "C": "消化道出血", "D": "以上都不是", "language": "zh"}
{"question": "35岁已婚妇女，停经50天阴道少量出血，3天后止，未就诊。现停经5个月，未觉胎动，伴阴道少量出血7天。2．最可能的诊断是（　　）。", "answer": "稽留流产", "meta_info": "第5篇　女性生殖系统", "answer_idx": "B", "A": "先兆流产", "B": "稽留流产", "C": "不全流产", "D": "葡萄胎", "language": "zh"}
{"question": "患者，46岁，脐右侧阵发性疼痛6个月，左下肢麻木，右下肢无力4个月。检查发现左腹股沟以下痛觉减退，触觉存在，右下肢音叉振动觉消失，右下肢肌力4级，右膝踝反射亢进，右侧巴氏征（+）。病变位于（　　）。", "answer": "右侧T10节段", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "右侧T10节段", "B": "左侧T12节段", "C": "右侧T12节段", "D": "左侧T10节段", "language": "zh"}
{"question": "3．导致溶血性尿毒综合征(HUS)概率增大的致病物质是（　　）。", "answer": "SLT(志贺样毒素)", "meta_info": "医学微生物学", "answer_idx": "C", "A": "LT(不耐热肠毒素)", "B": "ST(耐热肠毒素)", "C": "SLT(志贺样毒素)", "D": "CFA(定居因子)", "language": "zh"}
{"question": "患者，男，31岁。近半年来反复心悸、胸痛、劳力性呼吸困难，时有头晕或短暂神志丧失。体检发现：心脏轻度增大，心尖部有2级收缩期杂音和第四心音，胸骨左缘第3～4肋间闻及较粗糙的喷射性收缩期杂音。3．应选用的药物是（　　）。", "answer": "心得安（普萘洛尔）", "meta_info": "第2篇　心血管系统", "answer_idx": "B", "A": "硝酸甘油", "B": "心得安（普萘洛尔）", "C": "卡托普利", "D": "速尿", "language": "zh"}
{"question": "肺循环血流量增多，而左心室、主动脉及体循环血流量减少的先心病为（　　）。", "answer": "房间隔缺损", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "动脉导管未闭", "B": "房间隔缺损", "C": "法洛四联症", "D": "肺动脉狭窄", "language": "zh"}
{"question": "不符合冠心病心绞痛特点的是（　　）。", "answer": "常放射至右肩、右臂内侧", "meta_info": "第2篇　心血管系统", "answer_idx": "D", "A": "部位在胸骨体中上段的后面", "B": "在体力活动或情绪激动当时发作", "C": "有压迫感或紧缩感", "D": "常放射至右肩、右臂内侧", "language": "zh"}
{"question": "男，24岁，腹泻2天，大便每日10余次，为稀水样，呕吐4次，无发热、腹痛及里急后重。发病前3天曾去过有腹泻流行的江南海滨农村，并曾多次饮生水。体检：体温36.5℃，血压85/60mmHg，中度脱水貌。粪便镜检见少量白细胞及红细胞，粪便悬滴镜检见运动力很强的细菌。2．有关治疗措施，下列说法错误的是（　　）。", "answer": "抗菌药物的应用是治疗的关键", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "C", "A": "应尽快补充足够的液体及电解质", "B": "必要时可加用血管活性药物", "C": "抗菌药物的应用是治疗的关键", "D": "及时补钾", "language": "zh"}
{"question": "3．上述哪项为以精神分析理论为基础的疗法？（　　）", "answer": "自由联想疗法", "meta_info": "医学心理学", "answer_idx": "A", "A": "自由联想疗法", "B": "森田疗法", "C": "询者中心疗法", "D": "支持疗法", "language": "zh"}
{"question": "胆总管结石梗阻后最典型的临床表现是（　　）。", "answer": "Charcot三联征", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "Whipple三联征", "B": "Charcot三联征", "C": "Grey-Turner征", "D": "Cullen征", "language": "zh"}
{"question": "下列哪项是晚期慢性肾小球肾炎最主要的改变？（　　）", "answer": "肾小球纤维化、玻璃样变", "meta_info": "病理学", "answer_idx": "A", "A": "肾小球纤维化、玻璃样变", "B": "肾小球肥大", "C": "肾小球萎缩", "D": "脏层上皮细胞增生", "language": "zh"}
{"question": "在某地区的死因顺位中，成年人的首位死凶是心脏病，并且有连年上升趋势。下列各项措施中不属于该地区优先策略的是（　　）。", "answer": "大力发展心脏专科医院，为患者提供优质的治疗服务", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "以高胆固醇血症和家族史为指标，确定高危人群，然后做适当干预", "B": "大力发展心脏专科医院，为患者提供优质的治疗服务", "C": "在社区人群中开展减少心脏病危险因素的咨询", "D": "加强公共场所与工作场所的控烟", "language": "zh"}
{"question": "引起急性毛细支气管炎的病原体是（　　）。", "answer": "呼吸道合胞病毒", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "呼吸道合胞病毒", "B": "腺病毒", "C": "柯萨奇A组病毒", "D": "轮状病毒", "language": "zh"}
{"question": "1．220V电压接触伤时可发生（　　）。", "answer": "心脏损害", "meta_info": "第八部分　其他疾病", "answer_idx": "D", "A": "皮肤损害", "B": "肝肾损害", "C": "肺部损害", "D": "心脏损害", "language": "zh"}
{"question": "男，65岁。腹部手术后出现疼痛，使用吗啡镇痛治疗，复查血气示pH 7.32，PaCO2 50mmHg，PaO2 54mmHg，该患者低氧血症最可能的发生机制是（　　）。", "answer": "肺泡通气量下降", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "氧耗量增加", "B": "肺泡通气量下降", "C": "弥散功能障碍", "D": "通气/血流比例失衡", "language": "zh"}
{"question": "苯丙酮尿症患儿主要的神经系统异常表现是（　　）。", "answer": "智能发育落后", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "肌张力增高", "B": "智能发育落后", "C": "惊厥", "D": "腱反射亢进", "language": "zh"}
{"question": "最常见的危及生命的上消化道大出血的病因（　　）。", "answer": "门静脉高压症的食管胃底静脉曲张、破裂出血", "meta_info": "第3篇　消化系统", "answer_idx": "A", "A": "门静脉高压症的食管胃底静脉曲张、破裂出血", "B": "胃癌合并出血", "C": "出血性胃炎", "D": "胆道出血", "language": "zh"}
{"question": "1．切口出血、喉头水肿或气管塌陷可出现（　　）。", "answer": "呼吸困难、烦躁、发绀，甚至窒息", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "D", "A": "面肌、手足抽搐", "B": "声嘶，严重者失音、呼吸困难", "C": "音调降低或饮水时呛咳", "D": "呼吸困难、烦躁、发绀，甚至窒息", "language": "zh"}
{"question": "某患者自觉左侧肢体似有蚂蚁爬行，此种感觉障碍为（　　）。", "answer": "感觉异常", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "感觉倒错", "B": "感觉过敏", "C": "感觉异常", "D": "感觉减退", "language": "zh"}
{"question": "2岁男孩因感冒2天伴发热来诊。查体：体温39%，脉搏130次/分，神清，咽及右鼓膜中度充血，其余检查正常，在体检中，突然发呆，双眼上翻，出现四肢强直性阵挛性运动，对该患儿首先应该进行（　　）。", "answer": "保持呼吸道通畅，解痉", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "腰穿刺术", "B": "保持呼吸道通畅，解痉", "C": "全面体检", "D": "静脉注射地西泮", "language": "zh"}
{"question": "男性，10岁。一周前患上呼吸道感染，经治疗好转。近来出现大量蛋白尿、高度水肿、低蛋白血症和高胆固醇血症。本例的主要病变部位是（　　）。", "answer": "肾小球", "meta_info": "病理学", "answer_idx": "C", "A": "心脏", "B": "肾间质", "C": "肾小球", "D": "肾小管", "language": "zh"}
{"question": "无眩晕、无听力障碍和肌力完好的患者，出现右上肢指鼻试验不正确和轮替动作差、右下肢跟膝胫试验差。病损部位位于（　　）。", "answer": "右侧小脑半球", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "小脑蚓部", "B": "右侧小脑半球", "C": "左侧脑桥前庭神经核", "D": "右侧脑桥前庭神经核", "language": "zh"}
{"question": "2．1岁小儿应会的动作（　　）。", "answer": "独走", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "伸手取物", "B": "独坐", "C": "独走", "D": "双足跳", "language": "zh"}
{"question": "1．多西环素的药理作用是（　　）。", "answer": "对立克次体感染有效", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "对病毒感染有效", "B": "对念珠菌属的细菌感染有效", "C": "杀灭结核分枝杆菌", "D": "对立克次体感染有效", "language": "zh"}
{"question": "药物的副作用是指（　　）。", "answer": "治疗量时出现的与用药目的无关的作用", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "治疗量时出现的与用药目的无关的作用", "B": "用量过大或用药时间过长出现的对机体有害的作用", "C": "继发于治疗作用后出现的一种不良后果", "D": "与剂量无关的一种病理性免疫反应", "language": "zh"}
{"question": "女性，23岁，因恋爱受挫，近1个月来失眠，情绪低落，整日闷闷不乐，称“活着是件痛苦的事”，不思饮食，不注意仪容，不愿外出活动，时常流泪，认为自己能力低，脑子不灵活，又感前途渺茫，没有任何希望，曾服大量地西泮片自杀。体检、神经系统无异常，该病人的诊断为（　　）。", "answer": "抑郁发作", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "精神分裂症", "B": "恶劣心境", "C": "心理生理障碍", "D": "抑郁发作", "language": "zh"}
{"question": "2．化脓性胆管炎的主要症状是（　　）。", "answer": "腹痛伴发热、寒战、黄疸", "meta_info": "第3篇　消化系统", "answer_idx": "A", "A": "腹痛伴发热、寒战、黄疸", "B": "腹痛伴反酸、嗳气", "C": "腹痛伴呕吐、腹胀", "D": "腹痛伴腹泻", "language": "zh"}
{"question": "多次接受输血的病人所发生的非溶血性输血反应与下列哪种抗体有关（　　）。", "answer": "抗白细胞和抗血小板HLA抗体", "meta_info": "医学免疫学", "answer_idx": "D", "A": "ABO血型抗体", "B": "抗Ig抗体", "C": "抗DNA抗体", "D": "抗白细胞和抗血小板HLA抗体", "language": "zh"}
{"question": "5．引起“恐水症”的是（　　）。", "answer": "狂犬病病毒", "meta_info": "医学微生物学", "answer_idx": "A", "A": "狂犬病病毒", "B": "人乳头瘤病毒", "C": "人类免疫缺陷病毒", "D": "疱疹病毒", "language": "zh"}
{"question": "3．靠IL—2活化诱导才能具有更强的杀伤作用的细胞（　　）。", "answer": "LAK", "meta_info": "医学免疫学", "answer_idx": "D", "A": "Thl", "B": "Tc", "C": "Mφ", "D": "LAK", "language": "zh"}
{"question": "西方早有明确规定而在中国古代没有引起注意的医德规范是（　　）。", "answer": "保守医密准则", "meta_info": "医学伦理学", "answer_idx": "C", "A": "平等待患准则", "B": "医学人道准则", "C": "保守医密准则", "D": "尊重女患准则", "language": "zh"}
{"question": "男，8岁。足部刺伤1小时，已接受计划性混合疫苗注射，为预防破伤风，最重要的正确的处置是（　　）。", "answer": "注射破伤风类毒素0.5ml", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "注射TAT 750U", "B": "注射TAT 1500U", "C": "注射TAT 3000U", "D": "注射破伤风类毒素0.5ml", "language": "zh"}
{"question": "鉴别再障和白细胞不增多性白血病最重要的检查是（　　）。", "answer": "骨髓细胞学检查", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "周围血找幼稚白细胞", "B": "周围血找红细胞", "C": "骨髓细胞学检查", "D": "网织红细胞计数", "language": "zh"}
{"question": "化脓性脑膜炎患儿治疗5天明显好转后，体温又复回升，嗜睡、惊厥，前囟门隆起，头围增大，查脑脊液正常，可考虑为（　　）。", "answer": "并发硬脑膜下积液", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "继发病毒性脑膜炎", "B": "并发硬脑膜下积液", "C": "并发中毒性脑病", "D": "以上都不是", "language": "zh"}
{"question": "患儿，女，6个月。腹泻4天，每日10余次，稀水样，少许粘液，尿少，精神萎靡。查体：呼吸深长，皮肤花纹，弹性差。前囟、眼窝明显凹陷，肢冷，脉弱，心率160次/分，口唇樱桃红色。其可能诊断为婴儿腹泻病合并（　　）。", "answer": "重度脱水+酸中毒", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "重度脱水+酸中毒", "B": "中度脱水+酸中毒+心力衰竭", "C": "中度脱水+低钾血症", "D": "重度脱水+高钾血症+心力衰竭", "language": "zh"}
{"question": "正常小儿，身高85cm，前囟已闭，头围48cm，乳牙20枚，已会跳并能用简单的语言表达自己的需要，对人、事有喜乐之分。2．小儿的体重按公式计算约为（　　）。", "answer": "12kg", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "11kg", "B": "12kg", "C": "13kg", "D": "15kg", "language": "zh"}
{"question": "在传染病的预防工作中，有关单位应当按照国家规定，对下列人员采取有效的防护措施和医疗保健措施，除了（　　）。", "answer": "在工作中可能接触传染病病原体的", "meta_info": "卫生法规", "answer_idx": "B", "A": "从事传染病医疗的", "B": "在工作中可能接触传染病病原体的", "C": "在工作中接触传染病病原体的", "D": "从事传染病教学的", "language": "zh"}
{"question": "3．用碱性溶液冲洗阴道可提高疗效的是（　　）。", "answer": "外阴阴道假丝酵母菌病", "meta_info": "第5篇　女性生殖系统", "answer_idx": "B", "A": "滴虫性阴道炎", "B": "外阴阴道假丝酵母菌病", "C": "老年性阴道炎", "D": "幼女性阴道炎", "language": "zh"}
{"question": "正常成人的血液总量约相当于体重的（　　）。", "answer": "8%", "meta_info": "生理学", "answer_idx": "A", "A": "8%", "B": "60%", "C": "20%", "D": "40%", "language": "zh"}
{"question": "急性尿潴留病因中，属于非机械性梗阻的是（　　）。", "answer": "外伤性高位截瘫", "meta_info": "第4篇　泌尿系统", "answer_idx": "B", "A": "尿道结石", "B": "外伤性高位截瘫", "C": "尿道肿瘤", "D": "尿道狭窄", "language": "zh"}
{"question": "原核生物多肽合成的延长阶段需要将氨基酰，tRNA带人核糖体A位，与mRNA密码识别，参与这一作用的延长因子成分应为（　　）。", "answer": "EFTu-GTP", "meta_info": "生物化学", "answer_idx": "A", "A": "EFTu-GTP", "B": "EFTG", "C": "EFTu-GDP", "D": "EFT", "language": "zh"}
{"question": "1．小儿运动系统发育的规律是（　　）。", "answer": "先近端后远端", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "先快后慢", "B": "先慢后快", "C": "先达高峰后下降", "D": "先近端后远端", "language": "zh"}
{"question": "当动脉血压突然升高时，能引起（　　）。", "answer": "心迷走中枢兴奋", "meta_info": "生理学", "answer_idx": "B", "A": "心交感中枢兴奋", "B": "心迷走中枢兴奋", "C": "交感缩血管中枢兴奋", "D": "心迷走中枢抑制", "language": "zh"}
{"question": "女性，69岁。发现右乳房肿块1个月。既往有乳腺增生史，曾服用活血化瘀中药治疗。体检：双侧乳房、乳头对称，乳头无凹陷，皮肤无橘皮样改变，右乳外上象限可触及一1cm×1.3cm大肿块，质中等，表面尚光滑，活动。右腋窝可触及肿大的淋巴结，活动度良好。细针穿刺肿块细胞学检查发现癌细胞。4．如肿块切除加快速病理检查显示为乳腺增生性肿块，首选的治疗方法是（　　）。", "answer": "保乳手术", "meta_info": "第八部分　其他疾病", "answer_idx": "D", "A": "乳腺癌改良根治术", "B": "乳腺癌扩大根治术", "C": "全乳房切除术", "D": "保乳手术", "language": "zh"}
{"question": "腹部闭合性损伤合并出血性休克的处理原则是（　　）。", "answer": "积极抗休克同时剖腹探查", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "急诊剖腹探查", "B": "输血并给止血药", "C": "积极抗休克同时剖腹探查", "D": "积极抗休克，休克纠正后手术探查", "language": "zh"}
{"question": "新生儿高胆红素血症，可导致下列哪项？（　　）", "answer": "核黄疸", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "败血症", "B": "核黄疸", "C": "颅内出血", "D": "支气管肺炎", "language": "zh"}
{"question": "患儿，男，2岁。活动后气急、口唇青紫1年余。查体：胸骨左缘第3肋间闻及3/6级喷射性收缩期杂音。胸部X线片示心影稍增大，心尖圆钝上翘，肺动脉段凹陷，肺门血管影缩小，肺透亮度增加。最可能的诊断是（　　）。", "answer": "法洛四联症", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "完全性大动脉转位", "B": "房间隔缺损合并肺动脉高压", "C": "动脉导管未闭", "D": "法洛四联症", "language": "zh"}
{"question": "关于霍乱孤菌的生物学性状的描述，错误的是（　　）。", "answer": "ElTor生物型可形成芽胞", "meta_info": "医学微生物学", "answer_idx": "D", "A": "增菌培养基通常为碱性蛋白胨水", "B": "有菌毛和单鞭毛", "C": "悬滴观察呈穿梭样运动", "D": "ElTor生物型可形成芽胞", "language": "zh"}
{"question": "干扰素抗病毒作用特点中不包括（　　）。", "answer": "只能针对某种病毒，作用有特异性", "meta_info": "医学微生物学", "answer_idx": "D", "A": "间接灭活病毒", "B": "选择性作用于病毒感染细胞", "C": "高活性", "D": "只能针对某种病毒，作用有特异性", "language": "zh"}
{"question": "巴氏消毒法常用于消毒牛奶,其使用之温度和持续时间为（　　）。", "answer": "71.7℃　15～30s", "meta_info": "医学微生物学", "answer_idx": "D", "A": "71.7℃　30min", "B": "62.8℃　15min", "C": "71.7℃　30～60s", "D": "71.7℃　15～30s", "language": "zh"}
{"question": "胎儿娩出后4min，产妇出现多量阴道出血，最可能的诊断应是（　　）。", "answer": "宫缩乏力", "meta_info": "第二部分　模拟试题", "answer_idx": "A", "A": "宫缩乏力", "B": "宫颈裂伤", "C": "胎盘部分剥离", "D": "凝血功能障碍", "language": "zh"}
{"question": "不是脊髓灰质炎病毒致病特点的是（　　）。", "answer": "易侵入中枢神经系统引起肢体痉挛", "meta_info": "医学微生物学", "answer_idx": "C", "A": "5岁以下幼儿易感", "B": "多为隐性感染", "C": "易侵入中枢神经系统引起肢体痉挛", "D": "病后获得牢固免疫", "language": "zh"}
{"question": "患者，女，30岁。因下肢水肿2周就诊。体检：血压27/13kPa（200/100mmHg），尿蛋白（＋＋＋）、红细胞10～15个/HP，血Cr 150μmol/L，血白蛋白32g/L。5．下列何种治疗暂不考虑？（　　）", "answer": "青霉素治疗", "meta_info": "第4篇　泌尿系统", "answer_idx": "C", "A": "糖皮质激素", "B": "中医中药", "C": "青霉素治疗", "D": "以上都不是", "language": "zh"}
{"question": "下列哪项不是先天愚型的临床表现？（　　）", "answer": "皮肤粗糙、发干", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "身材矮小", "B": "智力低下", "C": "皮肤粗糙、发干", "D": "通贯手", "language": "zh"}
{"question": "女，28岁，妊娠38周，B超示胎儿脐带绕2周，拟行剖宫产术。4年前曾因外伤住院，接受输血后出现严重过敏反应。孕妇一般状况良好，心、肝、肾功能正常，血Hb 100g/L。术前拟申请备血400m1。应选择的血液成分是（　　）。", "answer": "洗涤红细胞", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "洗涤红细胞", "B": "悬浮红细胞", "C": "新鲜冰冻血浆", "D": "冷沉淀", "language": "zh"}
{"question": "医疗保健机构提供的孕产期保健服务的内容包括（　　）。", "answer": "孕产妇保健、胎儿保健、新生儿保健、母婴保健指导", "meta_info": "卫生法规", "answer_idx": "D", "A": "孕产妇保健、新生儿保健", "B": "孕产妇保健、胎儿保健", "C": "胎儿保健、新生儿保健", "D": "孕产妇保健、胎儿保健、新生儿保健、母婴保健指导", "language": "zh"}
{"question": "铁的运输形式是（　　）。", "answer": "Fe3+-转铁蛋白", "meta_info": "生物化学", "answer_idx": "C", "A": "Fe2+", "B": "Fe2+-转铁蛋白", "C": "Fe3+-转铁蛋白", "D": "Fe3+-清蛋白", "language": "zh"}
{"question": "引起颅内压增高的主要原因是（　　）。", "answer": "颅内生理功能调节失效", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "脑血流量增加", "B": "脑组织体积增加", "C": "颅内生理功能调节失效", "D": "颅内占位性病变", "language": "zh"}
{"question": "提示非ST段抬高型急性冠脉综合征患者预后不良最有价值的线索是（　　）。", "answer": "血肌钙蛋白水平增高", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "最近48小时症状反复发作", "B": "血肌钙蛋白水平增高", "C": "发作时间超过30分钟", "D": "有静息胸痛发作", "language": "zh"}
{"question": "胚胎期是指受孕后的（　　）。", "answer": "8周以内", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "8周以内", "B": "9周以内", "C": "11周以内", "D": "12周以内", "language": "zh"}
{"question": "以下哪项是链球菌感染后急性肾小球肾炎必有的临床表现？（　　）", "answer": "水肿", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "镜下血尿", "B": "水肿", "C": "肉眼血尿", "D": "肾功能异常", "language": "zh"}
{"question": "左心感染性心内膜炎不可能栓塞的部位是（　　）。", "answer": "肺动脉", "meta_info": "第2篇　心血管系统", "answer_idx": "C", "A": "肾动脉", "B": "下肢动脉", "C": "肺动脉", "D": "大脑中动脉", "language": "zh"}
{"question": "2．体积小、张力高、周边隆起较硬的是（　　）。", "answer": "头皮下血肿", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "头皮下血肿", "B": "硬膜下血肿", "C": "硬膜外血肿", "D": "帽状腱膜下血肿", "language": "zh"}
{"question": "1．霍奇金病可出现（　　）。", "answer": "Reed-Sternberg细胞", "meta_info": "病理学", "answer_idx": "B", "A": "印戒细胞", "B": "Reed-Sternberg细胞", "C": "组织细胞", "D": "嗜银细胞", "language": "zh"}
{"question": "男，56岁。患帕金森病用L-dopa治疗，最终每日用到4g，两个月后症状明显好转，为加强营养自行服用多种维生素，其中有Vit6每天50mg，两天后病情明显加重，最可能的原因是（　　）。", "answer": "vit6加速L-dopa的外周代谢", "meta_info": "药理学", "answer_idx": "A", "A": "vit6加速L-dopa的外周代谢", "B": "Vit6化学上与L-dopa拮抗", "C": "VitB6生理上与L-dopa拮抗", "D": "VitB6减少L-dopa中枢脱羧", "language": "zh"}
{"question": "腹部手术后能进食的主要依据是（　　）。", "answer": "肛门排气后", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "胃管抽出澄清胃液", "B": "病人已下床活动", "C": "病人有明显饥饿感", "D": "肛门排气后", "language": "zh"}
{"question": "男性，25岁。因高位小肠瘘1天入院，入院后经颈内静脉插管滴入肠外营养液，两周后突然出现寒战、高热，无咳嗽、咳痰，腹部无压痛和反跳痛。2．观察8小时如果仍然有高热，应采取的措施是（　　）。", "answer": "拔除中心静脉导管", "meta_info": "第八部分　其他疾病", "answer_idx": "C", "A": "雾化吸人", "B": "胸腔穿刺抽气", "C": "拔除中心静脉导管", "D": "咽拭子细菌培养", "language": "zh"}
{"question": "2．学龄儿每日所需水分（　　）。", "answer": "75ml/kg", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "150ml/kg", "B": "125ml/kg", "C": "100ml/kg", "D": "75ml/kg", "language": "zh"}
{"question": "患儿10个月，因间断腹泻2个月，面色苍白1个月就诊。大便2～3次/日，呈糊状，母乳喂养，4个月添加辅食。患儿3个月时因患坏死性小肠结肠炎，而行小肠大部切除术，术后一般情况渐好转。体检：皮肤黏膜苍白，舌细微震颤，心脏（-），肝肋下2.5cm，脾肋下1cm。1．为做出初步诊断，最简便的辅助检查方法为（　　）。", "answer": "血常规+血涂片检查", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "血常规+血涂片检查", "B": "血清维生素B12含量测定", "C": "血清铁测定", "D": "红细胞寿命测定", "language": "zh"}
{"question": "除下列哪一种情形外孕妇必须进行产前诊断?（　　）", "answer": "年龄超过30周岁", "meta_info": "卫生法规", "answer_idx": "B", "A": "羊水过多或过少", "B": "年龄超过30周岁", "C": "胎儿发育异常或胎儿可能有畸形", "D": "孕早期接触过可能导致胎儿先天缺陷的物质", "language": "zh"}
{"question": "下列不属于宫颈癌相关危险因素的是（　　）。", "answer": "未生育", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "多个性伴侣", "B": "未生育", "C": "不洁性行为", "D": "过早性生活", "language": "zh"}
{"question": "钩端螺旋体可自储存宿主的（　　）。", "answer": "尿液排出", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "C", "A": "飞沫排出", "B": "粪便排出", "C": "尿液排出", "D": "鼻咽部分泌物排出", "language": "zh"}
{"question": "2．新生儿败血症并发休克的表现是（　　）。", "answer": "面色苍灰、皮肤发花、血压下降、少尿或无尿等", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "黄疸、肝脾增大、出血倾向、休克等", "B": "面色苍灰、皮肤发花、血压下降、少尿或无尿等", "C": "皮肤黏膜淤点淤斑、针眼渗血不止、消化道出血、肺出血等", "D": "腹胀、呕吐、肠鸣音减弱等", "language": "zh"}
{"question": "女，72岁，胃癌根治术后第6天，出现上腹疼痛，逐渐加重，伴恶心，呕吐，腹胀，腹腔引流管引出咖啡色浑浊液体。查体：腹膜刺激征（＋）。腹部B超提示腹腔积液。3．针对该病人，非手术中最重要的措施是（　　）。", "answer": "胃肠减压", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "低压灌肠", "B": "止痛", "C": "胃肠减压", "D": "抗生素治疗", "language": "zh"}
{"question": "关于白喉棒状杆菌，不正确的是（　　）。", "answer": "白喉的特异性治疗应早期足量使用类毒素", "meta_info": "医学微生物学", "answer_idx": "D", "A": "菌体一端或两端可见异染颗粒", "B": "在亚碲酸钾血琼脂平板上生成黑色菌落", "C": "调查人群对白喉有无免疫力可进行锡克试验", "D": "白喉的特异性治疗应早期足量使用类毒素", "language": "zh"}
{"question": "2岁患者，结核菌素1：2000硬结直径9mm，无临床症状，既往未接种卡介苗，下述哪一项处理正确？（　　）", "answer": "应用异烟肼治疗6～12个月", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "定期拍胸部X线片", "B": "定期复查结核菌素试验", "C": "应用异烟肼治疗3～5个月", "D": "应用异烟肼治疗6～12个月", "language": "zh"}
{"question": "男，48岁。突发呼吸困难，胸痛，晕厥，查体：颈静脉充盈，肺动脉瓣区第二心音亢进，最可能的原因为（　　）。", "answer": "肺动脉栓塞", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "呼吸衰竭", "B": "左心衰竭", "C": "肺动脉栓塞", "D": "冠心病", "language": "zh"}
{"question": "下列关于良好医患关系的重要性不包括（　　）。", "answer": "提高病人的社交能力", "meta_info": "医学心理学", "answer_idx": "A", "A": "提高病人的社交能力", "B": "提高病人对医务人员的信任度", "C": "造就医患之间良好的心理气氛", "D": "本身就是一种治疗手段", "language": "zh"}
{"question": "慢性粒细胞白血病最突出的特征是（　　）。", "answer": "粒细胞显著增多，脾明显肿大", "meta_info": "第一部分　血液系统疾病", "answer_idx": "A", "A": "粒细胞显著增多，脾明显肿大", "B": "肝肿大", "C": "腹胀、食后饱胀", "D": "乏力、低热、多汗", "language": "zh"}
{"question": "患者左侧软腭不能上提，左侧咽反射消失，伸舌偏左，左舌肌有萎缩，右侧偏瘫，右侧可引出Babinski征。应考虑病变在（　　）。", "answer": "左侧延髓", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "右侧延髓", "B": "左侧延髓", "C": "左侧脑桥", "D": "右侧内囊", "language": "zh"}
{"question": "在功能性垂体瘤中，最常见的为（　　）。", "answer": "泌乳素瘤", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "C", "A": "生长激素泌乳素混合瘤", "B": "生长激素瘤", "C": "泌乳素瘤", "D": "促甲状腺素瘤", "language": "zh"}
{"question": "关于涉及人体的临床医学研究，正确的是（　　）。", "answer": "必须在开始之前提交伦理委员会审查", "meta_info": "医学伦理学", "answer_idx": "A", "A": "必须在开始之前提交伦理委员会审查", "B": "在进行中必须提交伦理委员会审查", "C": "必须在完成之后提交伦理委员会进行监督", "D": "只要遵守国际国内准则就无须提交伦理委员会审查", "language": "zh"}
{"question": "新生儿胎便排完时间（　　）。", "answer": "3～4天", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "3～4小时", "B": "1～2天", "C": "3～4天", "D": "3～4周", "language": "zh"}
{"question": "下不是妄想特点的是（　　）。", "answer": "是一种虚幻的知觉体验", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "无事实依据但坚定不移的相信", "B": "具有个人特征，不同于集体共有的信念", "C": "内容受个人经历和时代背景影响", "D": "是一种虚幻的知觉体验", "language": "zh"}
{"question": "2．属于责任事故的为（　　）。", "answer": "贻误诊治和抢救时机造成危害后果", "meta_info": "卫生法规", "answer_idx": "A", "A": "贻误诊治和抢救时机造成危害后果", "B": "因不熟练，手术中误伤大血管造成大出血死亡", "C": "虽未造成死亡、残废、功能障碍，但造成一定损害，延长治疗时间", "D": "发生无法避免的医疗后果", "language": "zh"}
{"question": "下述检验中对重型肝炎诊断价值最小的为（　　）。", "answer": "血清ALT", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "A", "A": "血清ALT", "B": "血清胆固醇明显降低", "C": "血清胆碱酯酶活性明显降低", "D": "血清胆红素明显升高", "language": "zh"}
{"question": "患者男性，72岁。受凉后发热、咳嗽，咳黄色脓痰，X线显示双肺散在的小片状絮状阴影。其肺部病理改变应为（　　）。", "answer": "小叶性肺炎", "meta_info": "病理学", "answer_idx": "A", "A": "小叶性肺炎", "B": "粟粒性结核", "C": "弥漫性肺癌", "D": "肺梗死", "language": "zh"}
{"question": "女，58岁。呕血6小时入院。查体：脉搏120次/分，血压80/55mmHg。神志不清，营养状况差。巩膜明显黄染，腹壁可见静脉曲张，肝肋下可触及，质地较硬，边缘较钝，脾肋下6cm，移动性浊音阳性，肠鸣音弱。2．首选的检查是（　　）。", "answer": "腹部B超", "meta_info": "第3篇　消化系统", "answer_idx": "B", "A": "腹部X线片", "B": "腹部B超", "C": "上消化道钡餐造影", "D": "腹腔动脉造影", "language": "zh"}
{"question": "1．骨肉瘤（　　）。", "answer": "11～20岁", "meta_info": "第四部分　运动系统疾病", "answer_idx": "B", "A": "20～40岁", "B": "11～20岁", "C": "5～15岁", "D": "30岁以上的成年人", "language": "zh"}
{"question": "肝性脑病患者给予肠道抗生素的目的是（　　）。", "answer": "抑制肠道细菌", "meta_info": "第3篇　消化系统", "answer_idx": "B", "A": "消除细菌毒素", "B": "抑制肠道细菌", "C": "减少真菌感染", "D": "预防感染中毒性休克", "language": "zh"}
{"question": "某糖尿病患者为了控制血糖，在医生的建议下准备和营养师一起制定一份饮食计划。患者家属表示积极配合，本人也了解饮食控制的好处，但总认为无法管住自己，计划难以实施。对于这样患者的干预重点是（　　）。", "answer": "提高自我效能", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "提高自我效能", "B": "培养行为能力", "C": "建立支持性环境", "D": "提供社会支持", "language": "zh"}
{"question": "关于临产后宫颈变化的叙述，正确的是（　　）。", "answer": "宫颈管消失过程为先形成漏斗状，逐渐短缩直至消失", "meta_info": "第5篇　女性生殖系统", "answer_idx": "A", "A": "宫颈管消失过程为先形成漏斗状，逐渐短缩直至消失", "B": "前羊水囊形成使宫口不易扩张", "C": "初产妇宫颈管消失与宫口扩张同步进行居多", "D": "破膜后胎先露部直接压迫宫颈，影响宫口扩张", "language": "zh"}
{"question": "关于肺淤血的描述，错误的是（　　）。", "answer": "肺泡壁内可见纤维素渗出", "meta_info": "病理学", "answer_idx": "D", "A": "肺泡腔内可见水肿液", "B": "肺泡腔内可见红细胞", "C": "肺泡腔内可见心力衰竭细胞", "D": "肺泡壁内可见纤维素渗出", "language": "zh"}
{"question": "1．可阻滞钠、钾、钙离子通道（　　）。", "answer": "胺碘酮", "meta_info": "药理学", "answer_idx": "D", "A": "利多卡因", "B": "奎尼丁", "C": "普萘洛尔", "D": "胺碘酮", "language": "zh"}
{"question": "3．子宫内膜癌侵犯宫颈间质，属于（　　）。", "answer": "Ⅱ期", "meta_info": "第5篇　女性生殖系统", "answer_idx": "C", "A": "ⅠA期", "B": "ⅠB期", "C": "Ⅱ期", "D": "ⅢB期", "language": "zh"}
{"question": "下列关于肺癌的扩散转移，哪项是不对的？（　　）", "answer": "无肺内淋巴管转移", "meta_info": "病理学", "answer_idx": "D", "A": "肺鳞状细胞癌常侵及纵隔及心包", "B": "血道转移以脑、骨及肾上腺多见", "C": "周围型肺腺癌可直接侵犯胸膜", "D": "无肺内淋巴管转移", "language": "zh"}
{"question": "男性，30岁。头痛，时有呕吐，逐渐加重1个月，近期嗜睡，反应迟钝，时有头晕、猝倒，无头部外伤及急性炎症病史，血压正常。检查见视神经乳头水肿，血常规、血沉正常。1．初步的临床诊断应考虑为（　　）。", "answer": "颅内肿瘤", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "颅脑损伤", "B": "颅内肿瘤", "C": "颅内感染", "D": "椎动脉型颈椎病", "language": "zh"}
{"question": "诊断感染性心内膜炎的最重要方法是（　　）。", "answer": "血培养", "meta_info": "第二部分　模拟试题", "answer_idx": "C", "A": "免疫学检查", "B": "X线检查", "C": "血培养", "D": "常规生化检查", "language": "zh"}
{"question": "男，46岁，因直肠癌入院。癌肿距离肛缘5cm，大小为2cm×1cm，拟行手术治疗，患者强烈要求保留肛门。该患者保肛的病理依据是（　　）。", "answer": "向下的纵向浸润范围", "meta_info": "第3篇　消化系统", "answer_idx": "C", "A": "周围淋巴结状况", "B": "是否侵及泌尿系统", "C": "向下的纵向浸润范围", "D": "组织学分类", "language": "zh"}
{"question": "医德义务是（　　）。", "answer": "医德原则和规范转化为医务人员内心信念的结果", "meta_info": "医学伦理学", "answer_idx": "D", "A": "为了搞好医患关系", "B": "以谋求一种权利为前提的", "C": "医务人员对服务对象的一种承诺", "D": "医德原则和规范转化为医务人员内心信念的结果", "language": "zh"}
{"question": "2．新生儿缺氧缺血性脑病脑水肿时选用甘露醇，剂量是（　　）。", "answer": "每次0.25～0.5/kg，每4～6小时1次，连用3～5天", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "以抑制症状为主，伴有肌张力降低，原始反射减弱", "B": "瞳孔对光反射消失，昏迷，肌张力时高时低", "C": "负荷量20ml/kg，维持量每天3～5ml/kg", "D": "每次0.25～0.5/kg，每4～6小时1次，连用3～5天", "language": "zh"}
{"question": "结核性脑膜炎引起颅神经损害最常见的是（　　）。", "answer": "面神经", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "外展神经", "B": "面神经", "C": "动眼神经", "D": "滑车神经", "language": "zh"}
{"question": "下列哪项是IgG的生物学作用之一？（　　）", "answer": "与Ag结合后有激活补体", "meta_info": "医学免疫学", "answer_idx": "A", "A": "与Ag结合后有激活补体", "B": "是分泌液中主要的保护性抗体", "C": "不能透过胎盘", "D": "其Fc段可以与肥大细胞结合", "language": "zh"}
{"question": "33岁，已婚妇女，阴道分泌物增多伴外阴瘙痒1周。妇科检查见阴道后穹窿处多量稀薄泡沫状分泌物。宫颈充血，呈“草莓样”宫颈。诊断可能为（　　）。", "answer": "滴虫性阴道炎", "meta_info": "第5篇　女性生殖系统", "answer_idx": "C", "A": "外阴阴道假丝酵母菌病", "B": "细菌性阴道病", "C": "滴虫性阴道炎", "D": "宫颈炎", "language": "zh"}
{"question": "7．输血反应（　　）。", "answer": "属Ⅱ型超敏反应性疾病", "meta_info": "医学免疫学", "answer_idx": "B", "A": "属Ⅰ型超敏反应性疾病", "B": "属Ⅱ型超敏反应性疾病", "C": "属Ⅳ型超敏反应性疾病", "D": "不属于超敏反应性疾病", "language": "zh"}
{"question": "多器官疾病术前准备不正确的是（　　）。", "answer": "肾功能不全的病人，在有效的透析疗法支持下，可耐受手术", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "心力衰竭需控制3～4周", "B": "经常发作哮喘的病人，术前可口服地塞米松", "C": "肝功能严重损害的病人，一般不宜施行任何手术", "D": "肾功能不全的病人，在有效的透析疗法支持下，可耐受手术", "language": "zh"}
{"question": "2．乳腺癌CAF化疗方案是（　　）。", "answer": "环磷酰胺、阿霉素、氟尿嘧啶", "meta_info": "第八部分　其他疾病", "answer_idx": "A", "A": "环磷酰胺、阿霉素、氟尿嘧啶", "B": "环磷酰胺、甲氧蝶呤、氟尿嘧啶", "C": "环磷酰胺、紫杉醇、氟尿嘧啶", "D": "激素非依赖性肿瘤", "language": "zh"}
{"question": "脾切除对下列哪一种溶血性贫血疗效最好？（　　）", "answer": "遗传性球形红细胞增多症", "meta_info": "第一部分　血液系统疾病", "answer_idx": "D", "A": "阵发性睡眠性血红蛋白尿", "B": "自身免疫性溶血性贫血", "C": "海洋性贫血", "D": "遗传性球形红细胞增多症", "language": "zh"}
{"question": "女孩，1岁。腹泻4天。每日大便10余次，为蛋花汤水样便，伴呕吐、尿少。查体：T 38.5℃，前囟、眼窝凹陷，皮肤弹性差，四肢稍凉。实验室检查：血WBC 6.0×109/L，血Na＋ 127mmol/L， K＋ 3.7mmol/L，BE －15mmol/L。1．最可能的诊断是腹泻病伴（　　）。", "answer": "中度低渗性脱水，代谢性酸中毒", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "中度等渗性脱水，代谢性碱中毒", "B": "重度等渗性脱水，代谢性碱中毒", "C": "轻度等渗性脱水，代谢性酸中毒", "D": "中度低渗性脱水，代谢性酸中毒", "language": "zh"}
{"question": "2．风湿病（　　）。", "answer": "肉芽肿形成", "meta_info": "病理学", "answer_idx": "D", "A": "心肌糖原沉积", "B": "血浆LDL及VLDL含量增高", "C": "胶原纤维纤维素样坏死", "D": "肉芽肿形成", "language": "zh"}
{"question": "下列哪项属于必须由病人及其家属或者关系人签字同意的诊疗行为？（　　）", "answer": "手术、特殊检查、特殊治疗", "meta_info": "卫生法规", "answer_idx": "A", "A": "手术、特殊检查、特殊治疗", "B": "手术、非常规性的检查、特殊治疗", "C": "手术、创伤性检查、实验性治疗", "D": "除表皮手术以外的手术、特殊检查、特殊治疗", "language": "zh"}
{"question": "原发性慢性肾上腺皮质功能减退症典型体征是（　　）。", "answer": "皮肤黏膜色素沉着", "meta_info": "第二部分　模拟试题", "answer_idx": "C", "A": "皮肤紫纹", "B": "轻度肥胖", "C": "皮肤黏膜色素沉着", "D": "脉率增快", "language": "zh"}
{"question": "属于干性坏疽的是（　　）。", "answer": "糖尿病患者的下肢坏疽", "meta_info": "病理学", "answer_idx": "D", "A": "肠扭转引起的肠坏疽", "B": "化脓性感染引起的肺坏疽", "C": "坏疽性阑尾炎", "D": "糖尿病患者的下肢坏疽", "language": "zh"}
{"question": "男，25岁。有一天饮一两白酒后出现意识不清，怀疑同饮者欲加害于他，言语行为狂暴，将同饮者打伤，数十分钟后进入酣睡，醒后完全不能回忆，幼年受过脑外伤。该患者最可能的诊断是（　　）。", "answer": "病理性醉酒", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "病理性醉酒", "B": "遗忘综合征", "C": "脑外伤所致精神障碍", "D": "单纯性醉酒", "language": "zh"}
{"question": "肾细胞癌最常见的组织病理类型是（　　）。", "answer": "透明细胞癌", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "未分类肾细胞癌", "B": "集合管癌", "C": "嫌色细胞癌", "D": "透明细胞癌", "language": "zh"}
{"question": "患者，男，30岁，左前胸刀刺伤半小时。查体：烦躁不安，皮肤苍白湿冷，呼吸困难，脉细弱，140次/min，颈静脉怒张。血压70/50mmHg。左前胸第5肋间处见约4cm刀伤口。4．诊断明确后，正确的治疗措施是（　　）。", "answer": "心包穿刺减压后紧急手术", "meta_info": "第1篇　呼吸系统", "answer_idx": "C", "A": "胸膜腔闭式引流负压吸引", "B": "快速输血、补液、抗体克", "C": "心包穿刺减压后紧急手术", "D": "气管切开，呼吸机辅助呼吸", "language": "zh"}
{"question": "患者，女，65岁。冠心病心绞痛史8年，无高血压史，夜间突发心前区疼痛8小时入院，入院时血压为150/90mmHg。肺部未闻及湿啰音。心电图检查：V1～V3出现异常Q波伴ST段弓背向上抬高。3．上述患者出现频发室性早搏，有时呈阵发性室速，最恰当的处理是（　　）。", "answer": "静脉使用利多卡因", "meta_info": "第2篇　心血管系统", "answer_idx": "C", "A": "静滴维拉帕米", "B": "口服美西律", "C": "静脉使用利多卡因", "D": "口服普鲁卡因胺", "language": "zh"}
{"question": "对于急性ITP，下述哪一项是恰当的？（　　）", "answer": "骨髓巨核细胞以幼稚型为主", "meta_info": "第一部分　血液系统疾病", "answer_idx": "C", "A": "多见于女性", "B": "多见于成人", "C": "骨髓巨核细胞以幼稚型为主", "D": "大多数病人可迁延不愈转为慢性型", "language": "zh"}
{"question": "关于来访者中心疗法，不正确的是（　　）。", "answer": "医生在治疗中具有权威性作用", "meta_info": "医学心理学", "answer_idx": "A", "A": "医生在治疗中具有权威性作用", "B": "适用于感受到有压力的病人", "C": "医生是患者的朋友，必要时加以引导", "D": "病人要受到充分理解", "language": "zh"}
{"question": "辅助生育技术运用的医德要求不包括（　　）。", "answer": "坚持为大众服务的原则，任何人都可以使用", "meta_info": "医学伦理学", "answer_idx": "D", "A": "严格保密，实行三盲法", "B": "严格履行知情同意程序，尊重供受双方的意愿", "C": "坚持为计划生育和优生优育服务的目的，严格掌握适应症", "D": "坚持为大众服务的原则，任何人都可以使用", "language": "zh"}
{"question": "突触前抑制的特点是（　　）。", "answer": "潜伏期长，持续时间长", "meta_info": "生理学", "answer_idx": "A", "A": "潜伏期长，持续时间长", "B": "突触前轴突末梢释放抑制性递质", "C": "突触后膜的兴奋性降低", "D": "通过轴突-树突突触结构的活动来实现", "language": "zh"}
{"question": "呼吸中枢的正常兴奋依赖于血液中何种因素?（　　）", "answer": "正常浓度的CO2", "meta_info": "生理学", "answer_idx": "B", "A": "高浓度的O2", "B": "正常浓度的CO2", "C": "高浓度的CO2", "D": "正常浓度的O2", "language": "zh"}
{"question": "上运动神经元瘫痪，肌张力改变的特点通常是（　　）。", "answer": "上肢屈肌张力高，下肢伸肌张力高", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "上肢屈肌张力高，下肢伸肌张力高", "B": "上下肢均为屈肌张力高", "C": "上肢伸肌张力高，下肢屈肌张力高", "D": "上下肢屈伸肌张力均高", "language": "zh"}
{"question": "患儿5岁，近来活动减少，乏力、食欲减退、盗汗。胸透见右肺上叶下部片状阴影，右肺门淋巴结肿，诊断考虑为（　　）。", "answer": "原发性肺结核病", "meta_info": "病理学", "answer_idx": "B", "A": "支原体肺炎", "B": "原发性肺结核病", "C": "小叶性肺炎", "D": "病毒性肺炎", "language": "zh"}
{"question": "3．中毒性菌痢（　　）。", "answer": "卡他性炎", "meta_info": "病理学", "answer_idx": "C", "A": "假膜性炎", "B": "肉芽肿性炎", "C": "卡他性炎", "D": "出血性炎", "language": "zh"}
{"question": "患儿，6个月，腹泻20余天，每日10余次，稀水样便，体重5.3kg，精神萎靡，皮肤弹性极差，前囟及眼窝明显凹陷，四肢凉，血压偏低，口渴轻度，尿量极少，血钠125mmol/L，考虑诊断为（　　）。", "answer": "重度低渗脱水", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "重度等渗脱水", "B": "中度等渗脱水", "C": "重度低渗脱水", "D": "重度高渗脱水", "language": "zh"}
{"question": "气性坏疽最关键的治疗措施是（　　）。", "answer": "紧急手术处理", "meta_info": "第八部分　其他疾病", "answer_idx": "D", "A": "大剂量青霉素", "B": "高压氧疗法", "C": "输血、输液", "D": "紧急手术处理", "language": "zh"}
{"question": "2．淋巴结发育起始的胎龄是（　　）。", "answer": "10周", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "10周", "B": "20周", "C": "30周", "D": "40周", "language": "zh"}
{"question": "2．肺结核病（　　）。", "answer": "肉芽肿性炎", "meta_info": "病理学", "answer_idx": "C", "A": "纤维素性炎", "B": "化脓性炎", "C": "肉芽肿性炎", "D": "浆液性炎", "language": "zh"}
{"question": "患儿，男，10个月，母乳喂养，近3个月来面色渐苍白，间断腹泻，原可站立，现坐不稳，手足常颤抖。体检面色苍黄，略水肿，表情呆滞。血红蛋白80g/L，红细胞2.0×1012/L，白细胞6.0×109/L。1．该患儿可能是（　　）。", "answer": "营养性巨幼红细胞性贫血", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "维生素D缺乏性佝偻病", "B": "营养性缺铁性贫血", "C": "大脑发育不全", "D": "营养性巨幼红细胞性贫血", "language": "zh"}
{"question": "医德修养要坚持（　　）。", "answer": "实践性", "meta_info": "第二部分　模拟试题", "answer_idx": "C", "A": "集体性", "B": "组织性", "C": "实践性", "D": "机动性", "language": "zh"}
{"question": "3岁小儿，腕部骨化中心的数目约为（　　）。", "answer": "4个", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "2个", "B": "3个", "C": "4个", "D": "6个", "language": "zh"}
{"question": "治疗重度一氧化碳中毒首选的氧疗为（　　）。", "answer": "高压氧舱", "meta_info": "第八部分　其他疾病", "answer_idx": "D", "A": "呼吸新鲜空气", "B": "人工呼吸", "C": "面罩吸氧", "D": "高压氧舱", "language": "zh"}
{"question": "5．脑梗死（　　）。", "answer": "液化性坏死", "meta_info": "病理学", "answer_idx": "B", "A": "凝固性坏死", "B": "液化性坏死", "C": "气性坏疽", "D": "干性坏疽", "language": "zh"}
{"question": "免疫荧光呈线形的肾炎是何种病变？（　　）", "answer": "肺出血肾炎综合征", "meta_info": "病理学", "answer_idx": "C", "A": "膜性肾炎", "B": "IgA肾病", "C": "肺出血肾炎综合征", "D": "膜性增生性肾炎", "language": "zh"}
{"question": "切断动物颈部迷走神经后动物的呼吸将（　　）。", "answer": "变深变慢", "meta_info": "生理学", "answer_idx": "A", "A": "变深变慢", "B": "变浅变快", "C": "不变", "D": "变浅变慢", "language": "zh"}
{"question": "一男青年发热、休克。3日前因开始头痛入院，当13意识不清、昏迷，体温41℃，血压70/30mmHg，躯干皮肤出现红色斑点。用药后血压仍继续下降，第3天死亡。血培养发现G-茅尖状双球菌生长。请问导致感染的病原菌可能是（　　）。", "answer": "脑膜炎球菌", "meta_info": "医学微生物学", "answer_idx": "B", "A": "肠侵袭性大肠杆菌", "B": "脑膜炎球菌", "C": "肺炎球菌", "D": "金黄色葡萄球菌", "language": "zh"}
{"question": "哪项不是颅内压增高所致头颅X线平片特点？（　　）", "answer": "枕大孔扩大", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "脑回压迹加深", "B": "枕大孔扩大", "C": "蝶鞍扩大，前后床突骨质吸收", "D": "蛛网膜颗粒加深", "language": "zh"}
{"question": "2．X线检查肺动脉段凹陷见于（　　）。", "answer": "法洛四联症", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "室间隔缺损", "B": "动脉导管未闭合并肺动脉高压", "C": "法洛四联症", "D": "动脉导管未闭", "language": "zh"}
{"question": "男，45岁，间断腹泻5年，加重3月。大便每日4～5次，脓血便，纳差，体重减轻6kg，口服左氧氟沙星治疗2周后复查粪便常规：白细胞、红细胞满视野，隐血（＋）。血常规：HB 100g/L，WBC 4.5×109/L，PLT 215×109/L。2．最有可能的诊断（　　）。", "answer": "溃疡性结肠炎", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "肠道菌群失调", "B": "溃疡性结肠炎", "C": "细菌性痢疾", "D": "结肠癌", "language": "zh"}
{"question": "1．丹毒的致病菌是（　　）。", "answer": "β-溶血性链球菌", "meta_info": "第八部分　其他疾病", "answer_idx": "A", "A": "β-溶血性链球菌", "B": "梭状芽孢杆菌", "C": "大肠杆菌", "D": "金黄色葡萄球菌", "language": "zh"}
{"question": "成熟B细胞的膜表面免疫球蛋白主要有（　　）。", "answer": "mIgM和mIgD", "meta_info": "医学免疫学", "answer_idx": "C", "A": "mIgD和mIgG", "B": "mIgD和mIgE", "C": "mIgM和mIgD", "D": "mIgM和mIgG", "language": "zh"}
{"question": "女，45岁，厨师，头痛半年，加重伴呕吐1个月。无高血压，心脏病病史。查体：BP 130/86mmHg，颈无抵抗，眼底检查发现视乳头水肿，头颅CT检查提示脑实质多个低密度病灶，最可能的诊断是（　　）。", "answer": "脑肿瘤", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "脑肿瘤", "B": "腔隙性脑梗死", "C": "脑出血", "D": "脑脓肿", "language": "zh"}
{"question": "缺铁性贫血不可见到的是（　　）。", "answer": "游离原卟啉减少", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "血清铁降低", "B": "血清铁蛋白降低", "C": "转铁蛋白饱和度降低", "D": "游离原卟啉减少", "language": "zh"}
{"question": "男，32岁，右上臂刀割伤16小时，查体：T 36.5℃，P 80次/分，R 18次/分，BP 120/80mmHg，神志清楚，双肺呼吸音清，未闻及干湿啰音，心律齐，腹软，无压痛，右上臂外侧纵行伤口，长约4cm，边缘尚整齐。清创后，伤口不缝合，此时伤口内应放置的引流物是（　　）。", "answer": "乳胶片", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "烟卷纱布", "B": "生理盐水纱条", "C": "乳胶管", "D": "乳胶片", "language": "zh"}
{"question": "老年患者，前臂外伤25小时余来诊。查：体温37.9℃，前臂畸形，反常活动，创口流血，手腕活动自如，应考虑（　　）。", "answer": "开放性骨折", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "尺神经损伤", "B": "开放性骨折", "C": "正中神经损伤", "D": "前臂肌腱损伤", "language": "zh"}
{"question": "下列不支持肠易激综合征诊断的临床表现是（　　）。", "answer": "粪便排出顺利，无不尽感", "meta_info": "第3篇　消化系统", "answer_idx": "D", "A": "每天排便多于3次", "B": "每周排便少于3次", "C": "块状、硬粪便", "D": "粪便排出顺利，无不尽感", "language": "zh"}
{"question": "男，52岁.急性重症胰腺炎保守治疗中，尿量逐渐减少，无尿3日，出现气促、全身水肿，血压180/92mmHg，心率120次/分，听诊闻及两下肺布满细湿啰音.实验室检查：血钾6.9mmol/L，BUN 25.2mmol/L，肌酐577μmol/L，目前应采取的最有效治疗手段是（　　）。", "answer": "及时紧急透析", "meta_info": "第4篇　泌尿系统", "answer_idx": "D", "A": "袢利尿颈静脉注射", "B": "口服甘露醇或硫酸镁导泻", "C": "停止补液", "D": "及时紧急透析", "language": "zh"}
{"question": "关于大肠杆菌的特性，不正确的是（　　）。", "answer": "为肠道正常菌群，无致病作用", "meta_info": "医学微生物学", "answer_idx": "C", "A": "多数有普通菌毛和性菌毛", "B": "多数菌株有周身鞭毛", "C": "为肠道正常菌群，无致病作用", "D": "没有M抗原", "language": "zh"}
{"question": "急性化脓性脑膜炎用药原则错误的是（　　）。", "answer": "发现并发症立刻停药", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "静脉用药", "B": "剂量足够", "C": "疗程足够", "D": "发现并发症立刻停药", "language": "zh"}
{"question": "呼吸性酸中毒所致的电解质紊乱为（　　）。", "answer": "低氯血症", "meta_info": "第1篇　呼吸系统", "answer_idx": "D", "A": "高氯血症", "B": "低钾血症", "C": "高钠血症", "D": "低氯血症", "language": "zh"}
{"question": "以下有关丁型肝炎病毒（HDV）特性描述中错误的是（　　）。", "answer": "HDV为DNA病毒", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "D", "A": "HDV只有一个抗原抗体系统", "B": "在肝细胞核内可用免疫组化方法检出HDVAg", "C": "在血清中测不出游离的HDVAg", "D": "HDV为DNA病毒", "language": "zh"}
{"question": "1．小儿中度贫血的诊断指标是（　　）。", "answer": "Hb 90～60g/L", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "Hb＞120g/L", "B": "Hb 120～90g/L", "C": "Hb 90～60g/L", "D": "Hb＜30g/L", "language": "zh"}
{"question": "对于普萘洛尔，哪一项是不正确的？（　　）", "answer": "长期用药一旦病情好转应立即停药", "meta_info": "药理学", "answer_idx": "C", "A": "减少肾素的释放", "B": "阻断突触前膜β2受体减少去甲肾上腺素释放", "C": "长期用药一旦病情好转应立即停药", "D": "生物利用度个体差异大", "language": "zh"}
{"question": "患儿，1岁，未接种过麻疹疫苗，于半个月前曾接触过麻疹病儿，近4天发热、流涕、打喷嚏、畏光、咳嗽，昨日体温稍降，今日又发热，耳后发际部出现红色斑丘疹，疹间有健康皮肤，周围血白细胞4.5×109/L，最可能的诊断是（　　）。", "answer": "麻疹", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "幼儿急疹", "B": "麻疹", "C": "猩红热", "D": "荨麻疹", "language": "zh"}
{"question": "消化性溃疡深浅不一，通常深达下述哪层？（　　）", "answer": "肌层", "meta_info": "病理学", "answer_idx": "B", "A": "黏膜下层", "B": "肌层", "C": "浆膜层", "D": "超过浆膜层", "language": "zh"}
{"question": "1．营养性缺铁贫血的主要原因是（　　）。", "answer": "铁摄入量不足", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "红细胞生成素减少", "B": "铁摄入量不足", "C": "RNA合成减少", "D": "DNA合成不足", "language": "zh"}
{"question": "男性，30岁，右髋部疼痛1年，伴低热、盗汗、纳差及体重减轻。查体：右髋关节呈屈曲畸形，活动受限，Thomas征（+），ESR 30mm/h。X线片示右髋关节间隙变窄，关节面有骨质破坏，右髋臼有2cm大小空洞，内有坏死骨片。1．最可能的诊断是（　　）。", "answer": "全髋关节结核", "meta_info": "第四部分　运动系统疾病", "answer_idx": "C", "A": "髋关节滑膜结核", "B": "髋关节骨型结核", "C": "全髋关节结核", "D": "类风湿性髋关节炎", "language": "zh"}
{"question": "下列关于酮体的叙述中，错误的是（　　）。", "answer": "饥饿时酮体生成减少", "meta_info": "生物化学", "answer_idx": "D", "A": "糖尿病时可引起血酮体增高", "B": "酮体可以从尿中排出", "C": "酮体包括丙酮、乙酰乙酸和β-羟丁酸", "D": "饥饿时酮体生成减少", "language": "zh"}
{"question": "下列哪项不符合鞭毛的特性？（　　）", "answer": "大多数球菌具有鞭毛", "meta_info": "医学微生物学", "answer_idx": "C", "A": "可使细菌游动加速", "B": "可作为鉴定细菌分类的依据", "C": "大多数球菌具有鞭毛", "D": "鞭毛可发生变异", "language": "zh"}
{"question": "关于白三烯的叙述，错误的是（　　）。", "answer": "作用迅速而短暂", "meta_info": "生物化学", "answer_idx": "D", "A": "使支气管平滑肌收缩", "B": "调节白细胞的功能", "C": "促进炎症及过敏反应的发展", "D": "作用迅速而短暂", "language": "zh"}
{"question": "对于切除阑尾的术后病人，宜采取的医患模式为（　　）。", "answer": "指导－合作型", "meta_info": "医学心理学", "answer_idx": "B", "A": "被动－主动型", "B": "指导－合作型", "C": "共同参与型", "D": "合作－指导型", "language": "zh"}
{"question": "5个月男孩，发热、咳嗽、呼吸困难l周。查体：体温37.4℃，呼吸56次/分，心率210次/分，精神不振，唇周发绀，三凹征阳性，双肺满布喘鸣音，叩诊清音，肝肋下4cm，中度硬。胸部X线显示双肺散在小片状阴影及肺气肿。根据病情诊断为（　　）。", "answer": "呼吸道合胞病毒肺炎合并心力衰竭", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "呼吸道合胞病毒肺炎合并心力衰竭", "B": "革兰阴性杆菌肺炎合并心力衰竭", "C": "腺病毒肺炎合并心力衰竭", "D": "肺炎支原体肺炎合并心力衰竭", "language": "zh"}
{"question": "5．辅助诊断支原体肺炎的是（　　）。", "answer": "冷凝集试验", "meta_info": "医学微生物学", "answer_idx": "C", "A": "外斐试验", "B": "肥达试验", "C": "冷凝集试验", "D": "Ascolis试验", "language": "zh"}
{"question": "佝偻病性手足搐搦在痉挛发作时，哪项处理最正确？（　　）", "answer": "先用镇静剂再用钙剂", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "立即注射维生素D", "B": "迅速静脉注射甘露醇", "C": "先用镇静剂再用钙剂", "D": "先立即静脉注射钙剂", "language": "zh"}
{"question": "患者，女，33岁。健康查体时ECG发现偶发房性期前收缩。既往体健。查体：心界不大，心率80次/分，心脏各瓣膜区未闻及杂音。该患者最恰当的处理措施是（　　）。", "answer": "寻找病因，定期随诊", "meta_info": "第2篇　心血管系统", "answer_idx": "D", "A": "口服美西律", "B": "口服胺碘酮", "C": "口服普罗帕酮", "D": "寻找病因，定期随诊", "language": "zh"}
{"question": "小儿总能量的50%～60%来自（　　）。", "answer": "碳水化合物", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "蛋白质", "B": "脂肪", "C": "碳水化合物", "D": "矿物质", "language": "zh"}
{"question": "男孩，10岁。因高度水肿及大量蛋白尿，予泼尼松60mg/d治疗10周，病情未缓解来诊。查体：T 36.5℃，P 80次/分，R 18次/分，颜面明显水肿，面色苍白，肺部未闻及啰音，心（－），腹部较膨隆，肝脾触及不清，四肢明显水肿。实验室检查蛋白尿（＋＋＋），尿沉渣镜检RBC 50/HP，补体C3正常，肾功能正常。3．该患儿皮肤感染后出现发热，腹痛，四肢冰凉，尿少。查体：BP 60/40mmHg，实验室检查：血钠121mmol/L，血钾5.8mmol/L，此时患儿出现的并发症是（　　）。", "answer": "急性肾衰竭", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "低血容量性休克", "B": "肾小管功能障碍", "C": "肾静脉血栓形成", "D": "急性肾衰竭", "language": "zh"}
{"question": "男，50岁。因局部脓肿发生休克，经补充血容量，纠正酸中毒，血压、脉搏仍未好转，但无心衰现象，测中心静脉压为15cmH2O。其下一步治疗首选（　　）。", "answer": "应用血管扩张剂", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "应用血管扩张剂", "B": "应用血管收缩剂", "C": "补充高渗盐溶液", "D": "给予小剂量糖皮质激素", "language": "zh"}
{"question": "顽固性高血压是指（　　）。", "answer": "联用三种以上降压药正规治疗1个月，血压无明显下降", "meta_info": "第2篇　心血管系统", "answer_idx": "B", "A": "联用两种以上降压药正规治疗2个月，血压无明显下降", "B": "联用三种以上降压药正规治疗1个月，血压无明显下降", "C": "联用三种以上降压药正规治疗2个月，血压无明显下降", "D": "联用三种以上降压药正规治疗3个月，血压无明显下降", "language": "zh"}
{"question": "2．基因中被转录的非编码序列是（　　）。", "answer": "内含子", "meta_info": "生物化学", "answer_idx": "A", "A": "内含子", "B": "多顺反子", "C": "RNA聚合酶Ⅱ", "D": "原核RNA聚合酶σ", "language": "zh"}
{"question": "下列哪项为假（伪）膜性炎的主要渗出物？（　　）", "answer": "纤维素、中性粒细胞和坏死组织", "meta_info": "病理学", "answer_idx": "A", "A": "纤维素、中性粒细胞和坏死组织", "B": "纤维素、浆细胞和中性粒细胞", "C": "淋巴细胞、浆细胞和中性粒细胞", "D": "粘液、中性粒细胞和浆细胞", "language": "zh"}
{"question": "世界上最早的对于人体实验的国际性医德文献是（　　）。", "answer": "1946年的《纽伦堡法典》", "meta_info": "医学伦理学", "answer_idx": "B", "A": "1948年的《日内瓦宣言》", "B": "1946年的《纽伦堡法典》", "C": "1964年的《赫尔辛基宣言》", "D": "1981年的《人体生物医学研究的国际标准》", "language": "zh"}
{"question": "哪项药物控制癫痫发作最有效？（　　）", "answer": "卡马西平", "meta_info": "药理学", "answer_idx": "B", "A": "硝西泮", "B": "卡马西平", "C": "苯巴比妥", "D": "丙戊酸钠", "language": "zh"}
{"question": "患者，女，33岁，8年来，反酸、嗳气、上腹部饱胀，伴有规律性上腹痛，进食后加重。胃镜检查，胃窦小弯侧可见溃疡。胃镜下，不支持消化性溃疡诊断的是（　　）。", "answer": "溃疡周围粘膜皱襞中断、结节状肥厚", "meta_info": "病理学", "answer_idx": "D", "A": "溃疡底部平坦", "B": "溃疡边缘整齐", "C": "溃疡直径小于2cm", "D": "溃疡周围粘膜皱襞中断、结节状肥厚", "language": "zh"}
{"question": "2．相当于H-2I区的是（　　）。", "answer": "HLA-D", "meta_info": "医学免疫学", "answer_idx": "C", "A": "HLA-A", "B": "HLA-B", "C": "HLA-D", "D": "HLA-C＇", "language": "zh"}
{"question": "初产妇第二产程不应超过（　　）。", "answer": "2小时", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "30分钟", "B": "90分钟", "C": "2小时", "D": "150分钟", "language": "zh"}
{"question": "一女性，55岁，丧偶8年，现独居，嗜烟酒，不爱运动。平时性情抑郁，过分容忍，办事无主见，常顺从于别人。1月前行胃癌切除，术中及术后情绪低落，兴趣下降，独自流泪，有轻生之念。3．病人患胃癌的主要原因为（　　）。", "answer": "以上都是", "meta_info": "医学心理学", "answer_idx": "D", "A": "生活事件", "B": "情绪因素", "C": "不良生活习惯", "D": "以上都是", "language": "zh"}
{"question": "男性，63岁，吸烟。反复咳嗽、咳白色泡沫痰20余年，气促10年，近2d因受凉后出现发热伴咳黄脓痰，气喘不能平卧。查体双肺语颤减弱，可闻及散在干、湿啰音，心界缩小，心率110/min。该患者最可能的诊断是（　　）。", "answer": "慢性支气管炎急性发作", "meta_info": "第二部分　模拟试题", "answer_idx": "A", "A": "慢性支气管炎急性发作", "B": "支气管扩张", "C": "肺结核", "D": "肺癌", "language": "zh"}
{"question": "关于预防性应用抗生素，错误的是（　　）。", "answer": "清洁伤口预防术后伤口感染", "meta_info": "第八部分　其他疾病", "answer_idx": "C", "A": "涉及感染病灶或切口接近感染区域的手术", "B": "血管手术", "C": "清洁伤口预防术后伤口感染", "D": "操作时间长的大手术", "language": "zh"}
{"question": "关于急性风湿热的实验室检查的特点的描述错误的是（　　）。", "answer": "心电图P-R间期缩短", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "血沉增快", "B": "C反应蛋白增高", "C": "心电图P-R间期缩短", "D": "抗链球菌抗体滴度升高", "language": "zh"}
{"question": "2岁小儿股骨干骨折，最好选用哪一种治疗？（　　）", "answer": "垂直悬吊皮牵引", "meta_info": "第四部分　运动系统疾病", "answer_idx": "B", "A": "石膏绷带固定", "B": "垂直悬吊皮牵引", "C": "胫骨结节牵引", "D": "切开复位内固定", "language": "zh"}
{"question": "上腹部周期性钝痛、胃酸多一年余，胃小弯近幽门处有深达肌层的溃疡。诊断为（　　）。", "answer": "慢性消化性溃疡", "meta_info": "病理学", "answer_idx": "D", "A": "进展期胃癌、溃疡型", "B": "早期胃癌、凹陷型", "C": "急性消化性溃疡", "D": "慢性消化性溃疡", "language": "zh"}
{"question": "3．其基因组最小的病毒是（　　）。", "answer": "HDV", "meta_info": "医学微生物学", "answer_idx": "D", "A": "HAV", "B": "HBV", "C": "HCV", "D": "HDV", "language": "zh"}
{"question": "甲状腺功能亢进患者中，下列哪一项物质的浓度降低？（　　）。", "answer": "胆固醇", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "氨基酸", "B": "葡萄糖", "C": "胆固醇", "D": "尿酸", "language": "zh"}
{"question": "80岁男性，突然出现头痛、呕吐、意识不清，血压200/120mmHg，右侧瞳孔大，左侧偏瘫。此时，最重要的治疗措施是（　　）。", "answer": "应用脱水剂", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "外科手术", "B": "应用激素", "C": "应用脱水剂", "D": "应用止血剂", "language": "zh"}
{"question": "男性，19岁，2日来出现皮肤紫癜，以下肢为主，两侧对称，颜色鲜红，高出皮肤表面，伴有关节及腹痛，应诊断为（　　）。", "answer": "过敏性紫癜", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "血小板减少性紫癜", "B": "过敏性紫癜", "C": "急性白血病", "D": "急腹症", "language": "zh"}
{"question": "脉压增大常见的疾病是（　　）。", "answer": "甲状腺功能亢进", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "甲状腺功能亢进", "B": "心包积液", "C": "严重心力衰竭", "D": "无特征性疾病", "language": "zh"}
{"question": "根据移植物来源，哪种肾存活率最高（　　）。", "answer": "同卵双生同胞体供体肾", "meta_info": "医学免疫学", "answer_idx": "D", "A": "同种肾", "B": "父母的肾", "C": "非直系亲属供体肾", "D": "同卵双生同胞体供体肾", "language": "zh"}
{"question": "2．患者在直接经验、平等协作、促进成长的治疗方式中实现态度和行为的转变，属于（　　）。", "answer": "患者中心治疗", "meta_info": "医学心理学", "answer_idx": "C", "A": "折衷心理治疗", "B": "精神分析治疗", "C": "患者中心治疗", "D": "行为治疗", "language": "zh"}
{"question": "男性，51岁，5年前患左侧大脑中动脉血栓形成，遗留右侧半身轻瘫，一年来认为自己患了癌症，到处求医检查均被否定，但患者仍坚信不移，多次自杀未遂。查体：意识清，有命令性幻听、幻嗅、疑病妄想、被害妄想、情感脆弱、记忆力减退、理解力和判断力差，血压180／100mmHg。其最可能的诊断是（　　）。", "answer": "脑血管所致精神障碍", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "精神分裂症", "B": "早老性痴呆", "C": "人格障碍", "D": "脑血管所致精神障碍", "language": "zh"}
{"question": "患者女性，60岁，车祸后右股部肿痛4小时来院。查体：神志淡漠，面色苍白，T37.4℃，P130次/分，血压70/40mmHg，右股部明显肿胀，淤血，按压有异常活动。3．假设患者行手术治疗，术后第2天出现右侧小腿疼痛，肿胀压痛，右足末稍血运好，Homans征阳性，右股部切口对和正常，无红肿，无分泌物，该患者可能并发（　　）。", "answer": "右小腿深静脉血栓", "meta_info": "第四部分　运动系统疾病", "answer_idx": "B", "A": "右小腿软组织损伤", "B": "右小腿深静脉血栓", "C": "右小腿骨筋膜室综合征", "D": "切口感染骨髓炎", "language": "zh"}
{"question": "1．合并心功能不全的轻度高血压患者首选（　　）。", "answer": "氢氯噻嗪", "meta_info": "药理学", "answer_idx": "D", "A": "可乐定", "B": "普萘洛尔", "C": "硝普钠", "D": "氢氯噻嗪", "language": "zh"}
{"question": "小儿语言发育的三个阶段是（　　）。", "answer": "发音、理解、表达", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "单词、词组、句子", "B": "名词、动词、代名词", "C": "词组、简单句、复杂句", "D": "发音、理解、表达", "language": "zh"}
{"question": "下列疾病与结肠癌关系最密切的是（　　）。", "answer": "家族性结肠息肉病", "meta_info": "第3篇　消化系统", "answer_idx": "B", "A": "回盲部结核", "B": "家族性结肠息肉病", "C": "溃疡性结肠炎", "D": "克罗恩病", "language": "zh"}
{"question": "下列哪项可用内基小体辅助诊断？（　　）", "answer": "狂犬病", "meta_info": "医学微生物学", "answer_idx": "A", "A": "狂犬病", "B": "麻疹", "C": "水痘", "D": "出血热", "language": "zh"}
{"question": "患者，男，68岁，急性前壁心肌梗死。为预防再梗和猝死，如无禁忌证，宜尽早使用的药物是（　　）。", "answer": "美托洛尔", "meta_info": "第2篇　心血管系统", "answer_idx": "B", "A": "阿托品", "B": "美托洛尔", "C": "地高辛", "D": "美两律", "language": "zh"}
{"question": "新生儿溶血症有可能发生于（　　）。", "answer": "Rh-母亲再次妊娠，血型为Rh+的新生儿", "meta_info": "医学免疫学", "answer_idx": "B", "A": "Rh+母亲首次妊娠，血型为Rh+的新生儿", "B": "Rh-母亲再次妊娠，血型为Rh+的新生儿", "C": "Rh-母亲再次妊娠，血型为Rh-的新生儿", "D": "Rh-母亲首次妊娠，血型为Rh-的新生儿", "language": "zh"}
{"question": "1．激动时使骨骼肌收缩的为（　　）。", "answer": "N2受体", "meta_info": "药理学", "answer_idx": "D", "A": "α受体", "B": "β1受体", "C": "β2受体", "D": "N2受体", "language": "zh"}
{"question": "下列关于自身免疫性疾病的基本特征哪一个是错误的（　　）。", "answer": "部分自身免疫性疾病易发于男性", "meta_info": "医学免疫学", "answer_idx": "D", "A": "病情的转归与自身免疫应答强度密切相关", "B": "血液中可测到高效价的自身抗体", "C": "病情容易反复发作和慢性迁延", "D": "部分自身免疫性疾病易发于男性", "language": "zh"}
{"question": "下列有关电烧伤临床表现，错误的是（　　）。", "answer": "机体有出口和入口，出口较入口处重", "meta_info": "第八部分　其他疾病", "answer_idx": "A", "A": "机体有出口和入口，出口较入口处重", "B": "深部组织有夹心坏死", "C": "局部渗出较热烧伤严重", "D": "可出现“跳跃式”烧伤", "language": "zh"}
{"question": "男婴，肛温29℃，颜面、四肢、大腿皮肤硬肿，心率慢，应如何复温最合理？（　　）", "answer": "放置高于体温1～2℃的暖箱中", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "周围放热水瓶", "B": "放置高于体温1～2℃的暖箱中", "C": "放置37～38℃的暖箱中", "D": "在27～28℃的室温中自然复温", "language": "zh"}
{"question": "小儿腹泻第一天补液方法，下述哪一项是错误的？（　　）", "answer": "高渗性脱水用3:2:1溶液", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "等渗性脱水用2:3:1溶液", "B": "高渗性脱水用3:2:1溶液", "C": "低渗性脱水用4:3:2溶液", "D": "同时见尿补钾4～6天", "language": "zh"}
{"question": "在治疗菌痢时，不宜使用（　　）。", "answer": "次碳酸铋", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "D", "A": "呋喃唑酮", "B": "复方磺胺甲基异唑", "C": "氯霉素", "D": "次碳酸铋", "language": "zh"}
{"question": "决定免疫球蛋白类别的结区是（　　）。", "answer": "重链恒定区", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "轻链恒定区", "B": "重链恒定区", "C": "铰链区", "D": "重链可变区", "language": "zh"}
{"question": "关于急性炎症性脱髓鞘性多发性神经病的表述，下列错误的是（　　）。", "answer": "瘫痪由下肢开始向上肢蔓延，但不波及躯干肌", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "可伴脑神经麻痹", "B": "瘫痪由下肢开始向上肢蔓延，但不波及躯干肌", "C": "尿便障碍少见", "D": "多数病例可见脑脊液蛋白细胞分离", "language": "zh"}
{"question": "新生儿从母体获得的抗体IgG，逐渐消失的时间是（　　）。", "answer": "3～5个月", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "2～3个月", "B": "3～5个月", "C": "5～8个月", "D": "8～12个月", "language": "zh"}
{"question": "患儿3岁，因发热呕吐15天住院。查体：嗜睡状，营养差，颈抵抗（+），右侧鼻唇沟变浅，右眼闭合不全，心肺腹部未见异常，巴氏征（+）。脑脊液：外观毛玻璃样，蛋白0.8g/L，糖1.24mmol/L，氯化物100mmol/L，白细胞160×106/L，多核45%，单核55%。3．降低颅内压，首选（　　）。", "answer": "甘露醇", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "呋塞米", "B": "甘露醇", "C": "醋氮酰胺", "D": "50%葡萄糖", "language": "zh"}
{"question": "男孩，4岁，跑跳后左膝痛1周，未经诊治，1天前疼痛加重，伴发热，呕吐。查体：T 39.6℃，P 160次/分。左膝强迫微屈位，局部压痛（＋），肿胀不明显。实验室检查：血WBC 25×109/L，N 0.92。患膝及小腿X线片均未见异常。最可能的诊断是（　　）。", "answer": "急性血源性骨髓炎", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "半月板损伤", "B": "急性血源性骨髓炎", "C": "恶性肿瘤", "D": "急性风湿性关节炎", "language": "zh"}
{"question": "关于肺表面活性物质功能的说法正确的是（　　）。", "answer": "有助于维持肺泡的稳定性", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "增加肺泡表面张力", "B": "维持肺的回缩力", "C": "减小肺泡的压力", "D": "有助于维持肺泡的稳定性", "language": "zh"}
{"question": "急性下壁心肌梗死时血清CK-MB浓度的典型变化为发病后多少时间达到高峰（　　）。", "answer": "16～24小时达高峰", "meta_info": "第2篇　心血管系统", "answer_idx": "C", "A": "6～12小时达高峰", "B": "13～15小时达高峰", "C": "16～24小时达高峰", "D": "25～35小时达高峰", "language": "zh"}
{"question": "男，2岁，面色苍白半年，易疲乏，精神不集中，时而烦躁，纳差，异食癖，查体：皮肤及唇、口腔黏膜苍白，肝、脾肋下2指。实验室检查：Hb 86g/L，RBC 3.0×1012/L，MCV 65fl，MCHC 0.25。2．为明确诊断，需做的实验室检查是（　　）。", "answer": "血清铁、总铁结合力、转铁蛋白饱和度", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "血清铁、总铁结合力、转铁蛋白饱和度", "B": "血镁", "C": "血常规", "D": "DNA检测", "language": "zh"}
{"question": "正常人血浆中含量最多的蛋白质是（　　）。", "answer": "清蛋白", "meta_info": "生物化学", "answer_idx": "A", "A": "清蛋白", "B": "脂蛋白", "C": "免疫球蛋白", "D": "纤维蛋白原", "language": "zh"}
{"question": "男，50岁。呕血3小时。晚餐进食粗糙食物后突发呕鲜血，量约600ml。乙肝病史30年，曾有黑便史。查体：T 36.5℃，P 110次/分，R 20次/分，BP 110/70mmHg。皮肤未见出血点，可见肝掌。双肺呼吸音清，未闻及干湿性啰音，心律齐。腹软，无压痛，肝肋下未触及，脾肋下2cm。1．该患者发生呕血最可能的原因是（　　）。", "answer": "食管胃底曲张静脉破裂", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "十二指肠溃疡大出血", "B": "急性胆道大出血", "C": "食管胃底曲张静脉破裂", "D": "急性糜烂性胃炎", "language": "zh"}
{"question": "男，4个月，体重5kg，腹泻3天，每日7或8次，蛋花汤样、无腥臭，奶后呕吐2次。面色稍苍白，上腭裂，精神较差，皮肤稍干燥，眼窝、前囟凹陷，皮下脂肪0.3cm，皮肤弹性较差，哭有泪，四肢末梢较冷，血清钠128mmol/L。1．估计该患儿的脱水程度及性质是（　　）。", "answer": "中度低渗性脱水", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "中度等渗性脱水", "B": "轻度低渗性脱水", "C": "中度低渗性脱水", "D": "重度低渗性脱水", "language": "zh"}
{"question": "男性，30岁，患病4周，以高热为主，曾确诊伤寒，日前体温开始下降，食欲好转，体力渐增，脾肿大开始回缩，现在要特别注意（　　）。", "answer": "限制饮食", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "B", "A": "增加活动", "B": "限制饮食", "C": "继用足量抗生素", "D": "充足睡眠", "language": "zh"}
{"question": "急性重型肝炎防治肝性脑病措施中，哪一项是不正确的？（　　）", "answer": "高蛋白饮食", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "A", "A": "高蛋白饮食", "B": "给以六合氨基酸", "C": "口服乳果糖", "D": "给予左旋多巴治疗", "language": "zh"}
{"question": "2．天然蛋白质中不含有的氨基酸是（　　）。", "answer": "丝氨酸", "meta_info": "生物化学", "answer_idx": "B", "A": "半胱氨酸", "B": "丝氨酸", "C": "蛋氨酸", "D": "脯氨酸", "language": "zh"}
{"question": "易并发脑血栓的先天性心脏病是（　　）。", "answer": "法洛四联症", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "室间隔缺损", "B": "房间隔缺损", "C": "法洛四联症", "D": "卵圆孔未闭", "language": "zh"}
{"question": "病理性激情是一种突然发作的非常强烈而短暂的情感障碍，多伴有意识障碍，常见于（　　）。", "answer": "脑器质性精神障碍", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "神经症", "B": "抑郁症", "C": "多动症", "D": "脑器质性精神障碍", "language": "zh"}
{"question": "巨大甲状腺肿患者，气管插管全麻下手术，历时7小时，术后16小时发现患者烦躁不安、唇发绀、不能说话、呼吸极度困难，脉搏130次/分，血压160/100mmHg。检查切口无肿胀，引流管内仅少许陈旧性血液。此患者的手术并发症是（　　）。", "answer": "双侧喉返神经损伤", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "D", "A": "双侧喉上神经损伤", "B": "甲状腺危象", "C": "喉头水肿", "D": "双侧喉返神经损伤", "language": "zh"}
{"question": "亚急性细菌性心内膜炎发生在先天性心脏病患儿是由于（　　）。", "answer": "血液分流的冲击，心血管内膜增厚或纤维化，表面粗糙不平，易为细菌侵犯", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "抵抗力降低，易为细菌侵犯", "B": "血液分流的冲击，心血管内膜增厚或纤维化，表面粗糙不平，易为细菌侵犯", "C": "血流淤滞，黏稠度增加", "D": "缺氧、红细胞代偿增加", "language": "zh"}
{"question": "4．女，28岁，诊断为“妊娠糖尿病”，其治疗方案应选择（　　）。", "answer": "胰岛素", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "D", "A": "饮食控制+运动锻炼", "B": "双胍类", "C": "磺脲类", "D": "胰岛素", "language": "zh"}
{"question": "患者，男，体重50kg，躯干部、双臀及双大腿Ⅱ度烧伤，双小腿及双足Ⅲ度烧伤，以下哪项为第一个24h应补充的胶体液量？（　　）", "answer": "2700mL", "meta_info": "第八部分　其他疾病", "answer_idx": "C", "A": "1500mL", "B": "1800mL", "C": "2700mL", "D": "3600mL", "language": "zh"}
{"question": "有一病人尸检时发现脑膜充血、水肿，在脑及蛛网膜下腔内见到黄白色脓样渗出物，此脑病变属于（　　）。", "answer": "化脓性脑膜炎", "meta_info": "病理学", "answer_idx": "B", "A": "结核性脑膜炎", "B": "化脓性脑膜炎", "C": "浆液性脑膜炎", "D": "乙型脑炎", "language": "zh"}
{"question": "最有助于确诊肾动脉狭窄的检查是（　　）。", "answer": "肾动脉造影", "meta_info": "第2篇　心血管系统", "answer_idx": "B", "A": "静脉肾盂造影", "B": "肾动脉造影", "C": "磁共振成像", "D": "肾动脉核素图", "language": "zh"}
{"question": "根据《母婴保健法》的规定，经产前检查，医师发现或者怀疑胎儿异常的，对孕妇进行的措施是（　　）。", "answer": "产前诊断", "meta_info": "卫生法规", "answer_idx": "B", "A": "结扎手术", "B": "产前诊断", "C": "终止妊娠手术", "D": "医学技术鉴定", "language": "zh"}
{"question": "男，45岁。反复上腹痛2年，黑便2天，呕血伴头晕4小时。最适宜的止血治疗方式是（　　）。", "answer": "经胃镜止血", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "急症手术", "B": "经胃镜止血", "C": "静脉应用血管加压素", "D": "口服凝血酶", "language": "zh"}
{"question": "男性，58岁，心悸、手抖3年，加重1个月。体检：P110次/分，BP 22/9kPa；消瘦，皮肤潮湿，甲状腺可触及，未闻血管杂音；颈静脉无怒张，心界不大，心率134次/分，律绝对不整，心音强弱不等，肺、腹（-），下肢不肿。3．如选用手术治疗，其可能的并发症是（　　）。", "answer": "以上都可能", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "D", "A": "出血、感染、喉上及喉返神经损伤", "B": "甲亢危象", "C": "暂时或永久性甲旁低、甲低", "D": "以上都可能", "language": "zh"}
{"question": "2．恙虫病的传播媒介是（　　）。", "answer": "螨", "meta_info": "医学微生物学", "answer_idx": "D", "A": "鼠蚤", "B": "人虱", "C": "蜱", "D": "螨", "language": "zh"}
{"question": "Na+、K+在细胞内外不均衡分布是由于（　　）。", "answer": "膜上Na+−K+依赖式ATP酶的活动", "meta_info": "生理学", "answer_idx": "D", "A": "安静时K+比Na+更易穿透过细胞膜", "B": "K+的不断外流和Na+的不断内流", "C": "膜上载体和通道蛋白的共同作用", "D": "膜上Na+−K+依赖式ATP酶的活动", "language": "zh"}
{"question": "诊断肺栓塞的金标准是（　　）。", "answer": "肺血管造影", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "CT", "B": "超声心动图", "C": "肺通气/灌注（V/Q）显像", "D": "肺血管造影", "language": "zh"}
{"question": "关于TI-Ag哪一项是不正确的?（　　）", "answer": "大多数为蛋白质分子", "meta_info": "医学免疫学", "answer_idx": "A", "A": "大多数为蛋白质分子", "B": "可诱导体液免疫和细胞免疫", "C": "有免疫原性，无免疫反应性", "D": "需要单核巨噬细胞处理后，才能引起免疫应答", "language": "zh"}
{"question": "关于腹膜解剖生理的叙述，正确的是（　　）。", "answer": "腹膜具有很强的吸收能力，能够吸收腹腔内的积液、血液和细菌毒素", "meta_info": "第3篇　消化系统", "answer_idx": "D", "A": "正常情况下，腹腔内有75～100mL澄清液体和少量气体以润滑、间隔腹腔内的脏器", "B": "腹膜上具有丰富的腺体，在急性炎症时能够分泌大量的液体以稀释有害物质", "C": "腹膜分为壁腹膜、脏腹膜、肠系膜和网膜四个部分", "D": "腹膜具有很强的吸收能力，能够吸收腹腔内的积液、血液和细菌毒素", "language": "zh"}
{"question": "肝硬化食管静脉曲张破裂大出血后，可能出现的表现不包括（　　）。", "answer": "腹水减少", "meta_info": "第3篇　消化系统", "answer_idx": "C", "A": "血尿素氮增高", "B": "脾脏缩小", "C": "腹水减少", "D": "少尿", "language": "zh"}
{"question": "治疗小腿丹毒是，应首选（　　）。", "answer": "青霉素", "meta_info": "第八部分　其他疾病", "answer_idx": "D", "A": "红霉素", "B": "土霉素", "C": "庆大霉素", "D": "青霉素", "language": "zh"}
{"question": "血浆半衰期最长的钙拮抗剂是（　　）。", "answer": "氨氯地平", "meta_info": "药理学", "answer_idx": "C", "A": "尼卡地平", "B": "硝苯地平", "C": "氨氯地平", "D": "尼索地平", "language": "zh"}
{"question": "下述哪一项不是暴发型流脑（休克型）的典型表现？（　　）", "answer": "脑脊液“米汤样”，糖、氯减少", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "B", "A": "迅速扩大的全身瘀点、瘀斑", "B": "脑脊液“米汤样”，糖、氯减少", "C": "脑膜刺激征", "D": "血培养脑膜类双球菌阳性", "language": "zh"}
{"question": "下列叙述不符合恶性肿瘤发生发展的是（　　）。", "answer": "单个基因改变即可引起细胞恶性转变", "meta_info": "病理学", "answer_idx": "C", "A": "常为多阶段演进过程", "B": "癌症是一种基因病", "C": "单个基因改变即可引起细胞恶性转变", "D": "既有癌基因改变，又有肿瘤抑制基因改变", "language": "zh"}
{"question": "糖尿病酮症酸中毒的主要治疗是（　　）。", "answer": "补充体液和电解质，应用胰岛素", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "D", "A": "纠正酸中毒，补充体液和电解质", "B": "中枢兴奋剂，纠正酸中毒", "C": "纠正酸中毒，应用胰岛素", "D": "补充体液和电解质，应用胰岛素", "language": "zh"}
{"question": "3个月小儿，母乳喂养，腹泻2个月余，大便3～4次/日，糊状，无粘液脓血，精神食欲好，多种药物治疗无效，现体重5.8kg。诊断为（　　）。", "answer": "生理性腹泻", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "霉菌性肠炎", "B": "大肠杆菌肠炎", "C": "生理性腹泻", "D": "迁延性腹泻", "language": "zh"}
{"question": "3．慢性活动性肝炎（　　）。", "answer": "桥接坏死", "meta_info": "病理学", "answer_idx": "B", "A": "点状坏死", "B": "桥接坏死", "C": "大片状坏死", "D": "羽状坏死", "language": "zh"}
{"question": "某干部生活习惯良好，性格急躁，易冲动，工作认真，争强好胜，雄心勃勃，一年前因小事上火入院，诊断为冠心病，此病人的人格类型是（　　）。", "answer": "A型", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "A型", "B": "B型", "C": "C型", "D": "BC混合型", "language": "zh"}
{"question": "兴奋性突触后电位（EPSP）是由于突触后膜对下述哪些离子的通透性增加而引起的?（　　）", "answer": "K+、Na+，尤其是Na+", "meta_info": "生理学", "answer_idx": "B", "A": "K+、Na+，尤其是K+", "B": "K+、Na+，尤其是Na+", "C": "K+、Na+、Cl-，尤其是Cl-", "D": "Ca2+、K+、Cl-，尤其是Cl-", "language": "zh"}
{"question": "假（伪）膜性炎的渗出物主要为（　　）。", "answer": "纤维素、中性粒细胞和坏死组织", "meta_info": "病理学", "answer_idx": "B", "A": "单核细胞、淋巴细胞和坏死组织", "B": "纤维素、中性粒细胞和坏死组织", "C": "纤维素、浆细胞和中性粒细胞", "D": "黏液、中性粒细胞和浆细胞", "language": "zh"}
{"question": "关于胰高血糖素的叙述，错误的是（　　）。", "answer": "抑制脂肪动员", "meta_info": "生物化学", "answer_idx": "D", "A": "是主要升高血糖的激素", "B": "促进肝糖原分解升高血糖", "C": "促进糖异生升高血糖", "D": "抑制脂肪动员", "language": "zh"}
{"question": "心肌的等长调节通过改变下述哪项来调节心脏的泵血功能？（　　）", "answer": "心肌收缩能力", "meta_info": "生理学", "answer_idx": "C", "A": "肌小节初长", "B": "肌浆游离Ca2+", "C": "心肌收缩能力", "D": "横桥ATP酶活性", "language": "zh"}
{"question": "患者，男，55岁，反复不规则胃胀痛3年，胃镜诊断为萎缩性胃窦炎。3．以下哪项病理改变不但见于萎缩性胃炎，亦见于正常老年人？（　　）", "answer": "假性幽门腺增生", "meta_info": "第3篇　消化系统", "answer_idx": "B", "A": "轻度不典型增生", "B": "假性幽门腺增生", "C": "炎症细胞浸润", "D": "肠腺化生", "language": "zh"}
{"question": "关于经济因素对健康的影响，不正确的说法是（　　）。", "answer": "人群收入的绝对水平决定着经济对健康的影响程度", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "经济因素对健康的影响是多方面的", "B": "经济的发展应与社会发展及促进人群健康水平同步", "C": "人群收入的绝对水平决定着经济对健康的影响程度", "D": "单纯注重经济增长将危害人类的健康", "language": "zh"}
{"question": "患者左侧中枢性面、舌瘫，左上肢单瘫，伴左上肢局限性阵发性抽搐发作，病变部位在（　　）。", "answer": "右侧中央前回下部", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "右侧额中回后部", "B": "右侧额下回后部", "C": "右侧中央前回上部", "D": "右侧中央前回下部", "language": "zh"}
{"question": "1．原癌基因的活化方式之一（　　）。", "answer": "启动子插入", "meta_info": "生物化学", "answer_idx": "A", "A": "启动子插入", "B": "反转录一聚合酶链反应", "C": "Northern印迹", "D": "等位基因缺失或失活引起细胞癌变", "language": "zh"}
{"question": "在DNA和RNA分子中，下列叙述哪项正确？（　　）", "answer": "核糖不同而部分碱基不同", "meta_info": "生物化学", "answer_idx": "D", "A": "核糖和碱基都不同", "B": "核糖和碱基都相同", "C": "核糖相同而碱基不相同", "D": "核糖不同而部分碱基不同", "language": "zh"}
{"question": "患者，男，重体力劳动工人，腰腿痛，并向左下肢放散，咳嗽、喷嚏时加重。检查腰部活动明显受限，并向左倾斜，直腿抬高试验阳性。病程中无低热、盗汗、消瘦症状。8．以下哪项为该患者最易发生的并发症？（　　）", "answer": "股骨头缺血性坏死", "meta_info": "第四部分　运动系统疾病", "answer_idx": "C", "A": "髋内翻畸形", "B": "脂肪栓塞", "C": "股骨头缺血性坏死", "D": "髋关节周围创伤性骨化", "language": "zh"}
{"question": "液体培养基的主要用途是（　　）。", "answer": "增菌", "meta_info": "医学微生物学", "answer_idx": "C", "A": "分离单个菌落", "B": "观察细菌运动能力", "C": "增菌", "D": "检测细菌毒素", "language": "zh"}
{"question": "初次诊断活动期十二指肠溃疡，下列治疗中最适合的是（　　）。", "answer": "质子泵抑制药＋两种抗生素", "meta_info": "第3篇　消化系统", "answer_idx": "D", "A": "质子泵抑制药＋黏膜保护剂", "B": "促动力剂＋H2受体拮抗剂", "C": "联合应用两种黏膜保护剂", "D": "质子泵抑制药＋两种抗生素", "language": "zh"}
{"question": "男，45岁。发热、血ALT升高（ALT 42～78U/L）1个月。身高170cm，体重90kg。各项病毒学指标及自身免疫抗体均阴性。腹部B超示：肝脏回声增强，后部衰减，最佳的治疗措施是（　　）。", "answer": "调整生活方式并减轻体重", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "应用降脂药", "B": "休息并减少体力活动", "C": "应用保肝药物", "D": "调整生活方式并减轻体重", "language": "zh"}
{"question": "患儿，11个月。高热6d，精神差，频繁咳嗽，阵发性喘憋。体检：鼻翼扇动，吸气性凹陷，两肺叩诊稍浊，呼吸音减低，双肺闻及少量中湿啰音。白细胞数9.0×109/L，胸部X线摄片示双肺片状密度较淡阴影。最可能的诊断为（　　）。", "answer": "腺病毒肺炎", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "呼吸道合胞病毒肺炎", "B": "腺病毒肺炎", "C": "肺炎支原体肺炎", "D": "金黄色葡萄球菌性肺炎", "language": "zh"}
{"question": "女，42岁。发热2个月，体温38℃左右，发现左腹股沟可触及5cm×5cm质软肿物，按压痛。B超显示其为低回声。腰椎正位片示腰大肌阴影增宽，L1、L2椎体边缘骨质破坏，椎间隙狭窄。首先应考虑的诊断是（　　）。", "answer": "腰椎结核", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "腰椎结核", "B": "骨巨细胞瘤", "C": "转移性骨肿瘤", "D": "类风湿关节炎", "language": "zh"}
{"question": "2．乙型肝炎病毒常见的临床感染类型是（　　）。", "answer": "慢性感染", "meta_info": "医学微生物学", "answer_idx": "C", "A": "隐性感染", "B": "潜伏感染", "C": "慢性感染", "D": "慢发感染", "language": "zh"}
{"question": "不符合营养性巨幼红细胞性贫血临床表现的是（　　）。", "answer": "头围增大", "meta_info": "第二部分　模拟试题", "answer_idx": "B", "A": "毛发稀疏、发黄", "B": "头围增大", "C": "肝、脾大", "D": "舌炎", "language": "zh"}
{"question": "5．低钠血症（　　）。", "answer": "低渗性脑水肿", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "血管源性脑水肿", "B": "低渗性脑水肿", "C": "间质性脑水肿", "D": "脑肿胀", "language": "zh"}
{"question": "关于冠脉循环的血液特点，正确的是（　　）。", "answer": "冠脉血流量的多少主要取决于心肌的活动", "meta_info": "生理学", "answer_idx": "A", "A": "冠脉血流量的多少主要取决于心肌的活动", "B": "箍脉血流量的多少主要取决于冠脉的口径", "C": "冠脉血流量的多少主要取决于收缩压的高低", "D": "心率加快，冠脉血流量增加", "language": "zh"}
{"question": "1．多继发于长期使用广谱抗生素（　　）。", "answer": "金黄色葡萄球菌肠炎", "meta_info": "第二部分　模拟试题", "answer_idx": "D", "A": "致病性大肠埃希菌肠炎", "B": "轮状病毒性肠炎", "C": "细菌性痢疾", "D": "金黄色葡萄球菌肠炎", "language": "zh"}
{"question": "男性，3l岁。因失眠长期服药治疗，突然停药12h后，出现头痛、虚弱无力及肢体颤抖，所服药物最可能是（　　）。", "answer": "巴比妥类", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "巴比妥类", "B": "苯二氮类", "C": "吩噻嗪类", "D": "三环类抗抑郁药", "language": "zh"}
{"question": "血浆胶体渗透压的大小决定于（　　）。", "answer": "清蛋白浓度", "meta_info": "生物化学", "answer_idx": "A", "A": "清蛋白浓度", "B": "脂类的含量", "C": "葡萄糖浓度", "D": "Na+、Cl-等无机离子含量", "language": "zh"}
{"question": "清创的原则中，下列各项中错误的是（　　）。", "answer": "必须放置引流", "meta_info": "第八部分　其他疾病", "answer_idx": "D", "A": "清除伤口内异物", "B": "彻底止血", "C": "根据情况缝合伤口", "D": "必须放置引流", "language": "zh"}
{"question": "男性，8岁，枕部着地，昏迷5min后清醒，并自己回到家中，其后出现头痛并呈逐渐加重伴呕吐，1h后不省人事，急送医院。查体：17.3/12.0kPa（130/90mmHg），脉搏65/min，呼吸15/min，浅昏迷，右枕部头皮挫伤，左侧瞳孔4mm，对光反应消失；右侧瞳孔2.5mm，对光反应存在。2．最好的诊断措施是（　　）。", "answer": "头颅CT", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "脑电图", "B": "头颅MRI", "C": "头颅CT", "D": "头颅X线片", "language": "zh"}
{"question": "下列哪项为糖尿病酮症酸中毒的主要治疗？（　　）", "answer": "补充体液和电解质，应用胰岛素", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "D", "A": "纠正酸中毒，补充体液和电解质", "B": "中枢兴奋剂，纠正酸中毒", "C": "纠正酸中毒，应用胰岛素", "D": "补充体液和电解质，应用胰岛素", "language": "zh"}
{"question": "患者，男性，3岁，生后半年发现智能发育落后，反复惊厥，且尿有鼠尿臭味。查检：目光呆滞，毛发棕黄，心肺正常，四肢肌张力高，膝腱反射亢进，尿三氯化铁试验阳性。该患儿可能诊断为（　　）。", "answer": "苯丙酮尿症", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "苯丙酮尿症", "B": "组氨酸血症", "C": "半乳糖血下", "D": "肝糖原累积症", "language": "zh"}
{"question": "患者，女，25岁。发热、咽痛2天后出现肉眼血尿，血压130/70mmHg（17.3/9.4kPa），扁桃体Ⅱ度大、充血，余查体未见异常，血肌酐正常。1．对诊断及鉴别诊断帮助最小的是（　　）。", "answer": "尿蛋白定量", "meta_info": "第4篇　泌尿系统", "answer_idx": "C", "A": "肾活检", "B": "尿红细胞形态", "C": "尿蛋白定量", "D": "抗核抗体（ANA）", "language": "zh"}
{"question": "不能列为甲状腺大部切除术适应症的是（　　）。", "answer": "青少年甲亢患者", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "继发性甲亢或高功能腺瘤", "B": "中度以上的原发性甲亢", "C": "青少年甲亢患者", "D": "有压迫症状或胸骨后甲状腺肿并发甲亢", "language": "zh"}
{"question": "对于DNA连接酶的叙述下述哪一项正确？（　　）", "answer": "使相邻的两个片段连接起来", "meta_info": "生物化学", "answer_idx": "C", "A": "促进DNA形成超螺旋结构", "B": "合成RNA引物", "C": "使相邻的两个片段连接起来", "D": "以上都不是", "language": "zh"}
{"question": "男，67岁。头痛、呕吐3天，4个月前有头部摔伤史。头颅CT示右额颞顶新月形中等密度影。1．最有助于进一步明确诊断的检查是（　　）。", "answer": "脑脊液检查", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "MRI检查", "B": "脑脊液检查", "C": "脑血管造影", "D": "脑电图", "language": "zh"}
{"question": "等渗性缺水多发生在（　　）。", "answer": "胃肠液急性丧失", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "A", "A": "胃肠液急性丧失", "B": "大量出汗", "C": "吞咽困难", "D": "低位小肠瘘", "language": "zh"}
{"question": "男，72岁。4小时前因情绪激动突发极度气急，咳嗽，咳粉红色泡沫痰。出冷汗，焦虑不安。既往COPD史20年，高血压病25年。查体：T 36.2℃，P 120次/分，R 34次/分，BP 220／30mmHg，神志模糊，端坐位，口唇发绀。无颈静脉怒张。双肺可闻及细湿啰音及哮鸣音。心率120次/分，律齐，心尖区可闻及舒张早期奔马律及2/6级收缩期杂音，腹软，双下肢无水肿。血气分析：pH 7.28，PaO2 60mmHg，PaCO2 60mmHg。1．该患者突发气急的最可能原因是（　　）。", "answer": "高血压合并急性左心衰竭", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "肺动脉栓塞", "B": "COPD合并右心衰竭", "C": "COPD急性加重", "D": "高血压合并急性左心衰竭", "language": "zh"}
{"question": "1．多继发于长期使用广谱抗生素（　　）。", "answer": "金黄色葡萄球菌肠炎", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "轮状病毒性肠炎", "B": "生理性腹泻", "C": "细菌性痢疾", "D": "金黄色葡萄球菌肠炎", "language": "zh"}
{"question": "慢性肉芽肿病属于（　　）。", "answer": "吞噬细胞缺陷病", "meta_info": "医学免疫学", "answer_idx": "C", "A": "B细胞缺陷病", "B": "联合免疫缺陷病", "C": "吞噬细胞缺陷病", "D": "补体缺陷病", "language": "zh"}
{"question": "患者，男，60岁，反复上腹痛3年，疼痛节律不明显，食欲不振。突然呕血3次，每次300mL，经积极治疗24小时，出血仍不止。血压为12.0/6.7kPa（90/50mmHg）。用下列哪种治疗措施最适宜？（　　）", "answer": "尽快手术治疗", "meta_info": "第3篇　消化系统", "answer_idx": "C", "A": "注射巴曲酶", "B": "胃内去甲肾上腺素灌注", "C": "尽快手术治疗", "D": "输液输血", "language": "zh"}
{"question": "不是生长激素直接作用的是（　　）。", "answer": "促进软骨生长", "meta_info": "生理学", "answer_idx": "C", "A": "促进脂肪分解", "B": "诱导肝产生生长介素", "C": "促进软骨生长", "D": "增强脂肪酸氧化", "language": "zh"}
{"question": "患者，女，23岁。寒战、高热、咳脓痰2天。查体：体温39.2℃，左肺闻及湿啰音。X线胸片示：左肺下叶大片状致密影。给予抗生素治疗，2天后症状加重，胸痛并呼吸困难，左胸呼吸音降低，胸片示左胸腔积液。3．在治疗中错误的方法是（　　）。", "answer": "胸膜腔开放引流", "meta_info": "第1篇　呼吸系统", "answer_idx": "D", "A": "胸膜腔穿刺", "B": "全身支持治疗", "C": "应用广谱抗生素", "D": "胸膜腔开放引流", "language": "zh"}
{"question": "不符合无菌操作规则的是（　　）。", "answer": "同侧手术人员换位，一人应先退后一步，然后平移换位", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "同侧手术人员换位，一人应先退后一步，然后平移换位", "B": "手术进行时，不可开窗通风或用电扇", "C": "做皮肤切口之前，需用70％酒精再消毒皮肤一次", "D": "切开空腔脏器前，要用纱布垫保护周围组织", "language": "zh"}
{"question": "按一定的练习程序，学习有意识地控制或调节自身的心理、生理活动，以降低机体唤醒水平，调整因紧张刺激而紊乱的功能，这种疗法称（　　）。", "answer": "放松训练法", "meta_info": "医学心理学", "answer_idx": "D", "A": "厌恶疗法", "B": "条件操作法", "C": "模仿疗法", "D": "放松训练法", "language": "zh"}
{"question": "关于哺乳期避孕，正确的是（　　）。", "answer": "最好使用工具避孕", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "不需要避孕", "B": "应采用避孕药物", "C": "最好使用工具避孕", "D": "使用埋植避孕剂", "language": "zh"}
{"question": "田某，女，40岁，强迫性神经症患者，因持续出现焦虑不安就医。医生根据病情考虑给她开最新型的抗焦虑药；但患者由于经济状况不允许，要求改换普通的、价格较便宜的抗焦虑药物。对此案例的伦理分析，正确的是（　　）。", "answer": "医生需要与病人充分协商，若无法达成一致应充分考虑病人的要求", "meta_info": "医学伦理学", "answer_idx": "C", "A": "医生的决定是正确的，病人的要求是无理的", "B": "医生是权威，病人必须无条件地遵从医生所开的处方", "C": "医生需要与病人充分协商，若无法达成一致应充分考虑病人的要求", "D": "医生和病人都正确，任何一种方案都符合医学伦理的原则", "language": "zh"}
{"question": "男性，62岁。近3个月来逐渐出现上腹不适，进食后饱胀、嗳气，纤维胃镜发现大弯侧胃壁上1cm大小块状肿物，与周围组织界限不清，病理提示恶性。1．该肿瘤Borrmann分型（　　）。", "answer": "Ⅰ型", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "Ⅰ型", "B": "Ⅱ型", "C": "Ⅲ型", "D": "Ⅳ型", "language": "zh"}
{"question": "骨、关节结核最可靠的诊断依据是（　　）。", "answer": "细菌学、病理学诊断", "meta_info": "第四部分　运动系统疾病", "answer_idx": "D", "A": "结核中毒症状", "B": "寒性脓肿", "C": "既往结核病史", "D": "细菌学、病理学诊断", "language": "zh"}
{"question": "与细菌耐药性有关的遗传物质是（　　）。", "answer": "质粒", "meta_info": "医学微生物学", "answer_idx": "B", "A": "普通菌毛", "B": "质粒", "C": "细菌染色体", "D": "毒性噬菌体", "language": "zh"}
{"question": "急性病毒性心肌炎最有效的治疗措施是（　　）。", "answer": "完全休息，休息至临床症状消失，心脏大小恢复正常", "meta_info": "第2篇　心血管系统", "answer_idx": "B", "A": "用抗病毒药物治疗", "B": "完全休息，休息至临床症状消失，心脏大小恢复正常", "C": "静脉点滴心肌营养液如ATP、极化液、辅酶Q1等", "D": "应用激素强的松", "language": "zh"}
{"question": "新生儿出生时，身体红，四肢青紫，心率90次/分，呼吸20次/分，呼吸不规则，四肢能活动，弹足底有皱眉。2．诊断可能为（　　）。", "answer": "新生儿轻度窒息", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "新生儿重度窒息", "B": "新生儿轻度窒息", "C": "新生儿颅内出血", "D": "新生儿缺氧缺血性脑病", "language": "zh"}
{"question": "小儿出生后主要造血场所是（　　）。", "answer": "骨髓", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "肝脏", "B": "骨髓", "C": "脾脏", "D": "胸腺", "language": "zh"}
{"question": "痈常见于（　　）。", "answer": "糖尿病病人", "meta_info": "第八部分　其他疾病", "answer_idx": "D", "A": "高血压病人", "B": "心脏病人", "C": "肺结核病人", "D": "糖尿病病人", "language": "zh"}
{"question": "正常血钾值的范围是（　　）。", "answer": "3.5～5.5mmol/L", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "B", "A": "2.9～3.4mmol/L", "B": "3.5～5.5mmol/L", "C": "5.5～6.5mmol/L", "D": "6.5～7.5mmol/L", "language": "zh"}
{"question": "女性，25岁，无意中发现甲状腺肿块7天，近日迅速增长，伴有胀痛，甲状腺SPECT检查示甲状腺右叶冷结节，应初步判断为（　　）。", "answer": "甲状腺囊腺瘤并发囊内出血", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "单纯性甲状腺肿", "B": "结节性甲状腺肿", "C": "甲状腺癌", "D": "甲状腺囊腺瘤并发囊内出血", "language": "zh"}
{"question": "女，50岁。患慢性阻塞性肺疾病10年，近来出现胸闷咳嗽，体检发现心尖搏动范围加大，双下肢水肿。患者水肿最主要的原因是（　　）。", "answer": "血管静脉压增高", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "下肢深静脉血栓形成", "B": "心脏每搏输出量降低", "C": "下肢肌肉收缩功能障碍", "D": "血管静脉压增高", "language": "zh"}
{"question": "再次应答最主要的特点是（　　）。", "answer": "IgG大量产生", "meta_info": "医学免疫学", "answer_idx": "B", "A": "IgM产生量大", "B": "IgG大量产生", "C": "产生Ab潜伏期长", "D": "IgG的亲和力没变化", "language": "zh"}
{"question": "蛋白质合成的直接模板是（　　）。", "answer": "mRNA", "meta_info": "生物化学", "answer_idx": "D", "A": "DNA", "B": "tRNA", "C": "rRNA", "D": "mRNA", "language": "zh"}
{"question": "女，28岁。结婚5年未孕。自月经初潮起即35～60天行经一次。毛发浓密，面部痤疮明显，身高158cm，体重76kg。最可能的诊断是（　　）。", "answer": "多囊卵巢综合征", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "Asherman综合征", "B": "闭经泌乳综合征", "C": "多囊卵巢综合征", "D": "特纳综合征", "language": "zh"}
{"question": "凝血酶时间（PT）延长见于（　　）。", "answer": "纤维蛋白原含量降低", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "纤维蛋白原含量降低", "B": "凝血酶原含量降低", "C": "凝血因子Ⅲ含量降低", "D": "凝血因子Ⅸ含量降低", "language": "zh"}
{"question": "下述哪一项组合不正确？（　　）", "answer": "急淋白血病——过氧化物酶阳性", "meta_info": "第一部分　血液系统疾病", "answer_idx": "B", "A": "M3白血病——t（15：17）", "B": "急淋白血病——过氧化物酶阳性", "C": "慢粒白血病——NAP下降", "D": "慢淋白血病——以成熟小淋巴细胞为主", "language": "zh"}
{"question": "细胞内水肿的发生基础是（　　）。", "answer": "细胞内钠离子增多", "meta_info": "病理学", "answer_idx": "A", "A": "细胞内钠离子增多", "B": "细胞内钾离子增多", "C": "细胞内氯离子减少", "D": "细胞内钠离子减少", "language": "zh"}
{"question": "关于脂肪酸β-氧化的叙述不正确的是（　　）。", "answer": "每进行1次β-氧化产生2分子乙酰CoA", "meta_info": "生物化学", "answer_idx": "D", "A": "酶系存在于线粒体中", "B": "不发生脱水反应", "C": "脂肪酸的活化是必要的步骤", "D": "每进行1次β-氧化产生2分子乙酰CoA", "language": "zh"}
{"question": "女，5岁，自幼易感冒。生长发育尚可，心前区隆起，肺动脉瓣区有收缩期震颤，肺动脉第二音亢进。胸骨左缘第2、3肋间闻及Ⅲ～Ⅳ级收缩期、Ⅱ级舒张期杂音，血压90/30mmHg。胸片示左右心室肥大（左室为主），肺充血明显，肺动脉段突出，主动脉弓增宽。考虑最可能的诊断为（　　）。", "answer": "动脉导管未闭", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "室间隔缺损", "B": "动脉导管未闭", "C": "肺动脉狭窄", "D": "主动脉瓣狭窄伴关闭不全", "language": "zh"}
{"question": "肺炎球菌肺炎的抗生素治疗停药指标是（　　）。", "answer": "热退3天", "meta_info": "第1篇　呼吸系统", "answer_idx": "B", "A": "热退停药", "B": "热退3天", "C": "热退5～7天", "D": "胸片病变消退", "language": "zh"}
{"question": "既往月经规律，妊娠42＋5周，下列情况最不可能出现的是（　　）。", "answer": "羊水增多", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "羊水增多", "B": "羊水粪染", "C": "胎儿生长受限", "D": "胎儿过熟综合征", "language": "zh"}
{"question": "预防和控制伤寒的主要措施是（　　）。", "answer": "切断传播途径", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "D", "A": "检出带菌者，接触者进行医学观察", "B": "早期隔离和治疗病人", "C": "疫区消毒", "D": "切断传播途径", "language": "zh"}
{"question": "脂性肾病的临床特点是（　　）。", "answer": "高度选择性蛋白尿", "meta_info": "病理学", "answer_idx": "B", "A": "中度血尿", "B": "高度选择性蛋白尿", "C": "高度水肿", "D": "轻度蛋白尿", "language": "zh"}
{"question": "女婴，10个月。面色苍白3个月，嗜睡1周。平时食欲差。生后羊乳喂养，6个月加米糊。查体：头发稀黄，面色苍白，巩膜轻度黄染，心尖部可闻及2/6级收缩期杂音，肝肋下2cm，脾肋下未触及，最可能的诊断是（　　）。", "answer": "营养性巨幼细胞性贫血症", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "地中海贫血", "B": "营养性巨幼细胞性贫血症", "C": "遗传性球形红细胞增多症", "D": "缺铁性贫血", "language": "zh"}
{"question": "关于大肠癌的描述，正确的是（　　）。", "answer": "DukesD期有远隔器官转移", "meta_info": "病理学", "answer_idx": "D", "A": "盲肠癌最多见", "B": "类癌由腺瘤癌变而来", "C": "少数癌瘤产生CEA", "D": "DukesD期有远隔器官转移", "language": "zh"}
{"question": "患者，女，28岁。足月产后第3天，突然寒战，继之高热，同时尿急、尿痛，腰痛，下腹部痛。查体：肾区叩痛，下腹部压痛。尿白细胞20～30个/HP，白细胞管型1～2个/HP，尿蛋白（＋），末梢血白细胞高。3．治疗的主要措施是（　　）。", "answer": "静脉点滴抗菌药物", "meta_info": "第4篇　泌尿系统", "answer_idx": "B", "A": "体温过高时适量口服退热药物", "B": "静脉点滴抗菌药物", "C": "保持外阴清洁", "D": "提供足够热量", "language": "zh"}
{"question": "女性，40岁。幽门梗阻致反复呕吐15天入院，呼吸浅慢，血压90/70mmHg（12.0/9.3kPa）。实验室检查：血清钾3.0mmol/L、钠130mmol/L，pH 7.5，血浆HCO35mmol/L。3．该病人典型EKG早期改变是（　　）。", "answer": "T波降低、变平或倒置", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "D", "A": "QRS波增宽", "B": "P-R间期延长", "C": "U波", "D": "T波降低、变平或倒置", "language": "zh"}
{"question": "9个月男婴，腹泻3天，大便10次/日，量多，呈蛋花汤样，精神萎靡，眼泪少、尿少，血清钠135mmol/L。皮肤弹性差，唇红，呼吸深快，应诊断为（　　）。", "answer": "中度等渗性脱水，酸中毒", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "轻度等渗性脱水，酸中毒", "B": "重度低渗性脱水，酸中毒", "C": "中度等渗性脱水，酸中毒", "D": "重度等渗性脱水，酸中毒", "language": "zh"}
{"question": "潜意识又称无意识，在人的心理活动中一般处于（　　）。", "answer": "压抑状态", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "警觉状态", "B": "知觉状态", "C": "清晰状态", "D": "压抑状态", "language": "zh"}
{"question": "关于第二代抗精神病药物的描述，正确的是（　　）。", "answer": "能够有效地控制精神分裂症的阴、阳性症状", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "能够有效地控制精神分裂症的阴、阳性症状", "B": "在治疗精神病的阳性症状方面不如传统的抗精神病药物", "C": "多数药物锥体外系不良反应相对较多，但其他不良反应较少", "D": "主要包括氯普噻吨（泰尔登）、氯氮平、利培酮", "language": "zh"}
{"question": "脓性指头炎切开引流的指征是（　　）。", "answer": "搏动性跳痛", "meta_info": "第八部分　其他疾病", "answer_idx": "B", "A": "有波动感", "B": "搏动性跳痛", "C": "明显红肿", "D": "手指功能障碍", "language": "zh"}
{"question": "下列疾病中，不需应用抗菌药物的是（　　）。", "answer": "毛囊炎", "meta_info": "第八部分　其他疾病", "answer_idx": "B", "A": "丹毒", "B": "毛囊炎", "C": "开放性骨折", "D": "结肠手术前", "language": "zh"}
{"question": "2．Ⅲ型梅毒发生的坏死（　　）。", "answer": "干酪样坏死", "meta_info": "病理学", "answer_idx": "A", "A": "干酪样坏死", "B": "脂肪坏死", "C": "坏疽", "D": "液化性坏死", "language": "zh"}
{"question": "5天女孩，家中出生，母乳喂养，2天来皮肤黄染，拒奶，嗜睡，体温不升。查体：面色灰暗，四肢稍凉，脐轮红，可见脓性分泌物，肝脏肋下3cm，脾肋下2cm。3．治疗选择不恰当的是（　　）。", "answer": "20%甘露醇静脉推注", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "有效抗生素应用", "B": "应用静脉丙种球蛋白", "C": "20%甘露醇静脉推注", "D": "维持体温稳定", "language": "zh"}
{"question": "颅盖骨凹陷骨折的手术指征和术式，下列选项不对的是（　　）。", "answer": "手术术式为切除全部凹陷的骨片", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "深度＞1cm", "B": "位于重要功能区（中央区）", "C": "合并颅内血肿", "D": "手术术式为切除全部凹陷的骨片", "language": "zh"}
{"question": "性联无丙种球蛋白血症患者出现临床症状的时间一般是（　　）。", "answer": "生后6～9个月内", "meta_info": "医学免疫学", "answer_idx": "C", "A": "生后1个月内", "B": "生后3～5个月内", "C": "生后6～9个月内", "D": "学龄前", "language": "zh"}
{"question": "女性，23岁，因恋爱受挫，近1个月来失眠，情绪低落，整日闷闷不乐，称“活着是件痛苦的事”，不思饮食，不注意仪容，不愿外出活动，时常流泪，认为自己能力低，脑子不灵活，又感前途渺茫，没有任何希望，曾服大量地西泮片自杀。体检、神经系统无异常，该病人的诊断为（　　）。", "answer": "抑郁发作", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "恶劣心境", "B": "心理生理障碍", "C": "神经症", "D": "抑郁发作", "language": "zh"}
{"question": "新生儿重度窒息1分钟Apgar评分是（　　）。", "answer": "0～3分", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "0～3分", "B": "3～4分", "C": "4～5分", "D": "7～10分", "language": "zh"}
{"question": "2个月患儿，腹泻2天，大便1日10余次，蛋花汤样，呕吐、尿少，精神委靡，拒奶、面色苍白、前囟明显凹陷，粪便镜检每高倍视野2～3个白细胞，应考虑小儿腹泻伴有（　　）。", "answer": "酸中毒", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "低钾血症", "B": "酸中毒", "C": "休克", "D": "食物中毒", "language": "zh"}
{"question": "属于非细胞型微生物的是（　　）。", "answer": "禽流感病毒", "meta_info": "医学微生物学", "answer_idx": "B", "A": "大肠埃希菌", "B": "禽流感病毒", "C": "梅毒螺旋体", "D": "白色念珠菌", "language": "zh"}
{"question": "下列关于心电图的叙述，错误的是（　　）。", "answer": "P-R间期是由P波结束至QRS波开始之间的时程", "meta_info": "生理学", "answer_idx": "D", "A": "P波代表两心房去极化过程", "B": "QRS波群代表两心室去极化过程", "C": "T波代表两心室复极化过程", "D": "P-R间期是由P波结束至QRS波开始之间的时程", "language": "zh"}
{"question": "男，46岁。阵发性胸痛4个月，近7天于夜间睡眠时发作，持续约20分钟自行缓解。发作时心电图示V1～V4导联ST段抬高。查体：心界不大，未闻及心包摩擦音。该患者最可能的诊断是（　　）。", "answer": "变异型心绞痛", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "变异型心绞痛", "B": "急性心包炎", "C": "初发型劳力性心绞痛", "D": "恶化型劳力性心绞痛", "language": "zh"}
{"question": "蛋白质的消化酶主要来自（　　）。", "answer": "胰腺", "meta_info": "生物化学", "answer_idx": "D", "A": "小肠", "B": "胃", "C": "胆囊", "D": "胰腺", "language": "zh"}
{"question": "43岁女性，G3P2，20年前带环避孕10年。近5年来经量渐增多，痛经逐渐加重，并经期发低热。查体：子宫均匀增大，如孕8周大小，质硬，活动尚好，压痛（＋），双侧附件未及具体包块。2．应做以下哪种检查助诊？（　　）", "answer": "B超", "meta_info": "第5篇　女性生殖系统", "answer_idx": "C", "A": "分段诊刮送病理", "B": "血清雌激素", "C": "B超", "D": "宫颈活检", "language": "zh"}
{"question": "有一名确诊为小脑扁桃体疝的病人，下述哪些症状不是常见症状？（　　）", "answer": "早期出现一侧瞳孔散大", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "颈强", "B": "剧烈头痛，频繁呕吐", "C": "早期出现一侧瞳孔散大", "D": "呼吸骤停发生早", "language": "zh"}
{"question": "2．川崎病的皮肤特征是（　　）。", "answer": "手足硬性水肿", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "丘疹样荨麻疹", "B": "手足硬性水肿", "C": "皮下小结", "D": "蝶形红斑", "language": "zh"}
{"question": "抗甲状腺药物因WBC减少的停药指征是（　　）。", "answer": "WBC<3×109/L，中性粒细胞<1.5×109/L", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "A", "A": "WBC<3×109/L，中性粒细胞<1.5×109/L", "B": "WBC<2×109/L，中性粒细胞<1×109/L", "C": "WBC<3.5×109/L，中性粒细胞<1×109/L", "D": "WBC<2.5×109/L，中性粒细胞<1.5×109/L", "language": "zh"}
{"question": "下列属于凝集反应的是（　　）。", "answer": "肥达反应", "meta_info": "医学免疫学", "answer_idx": "A", "A": "肥达反应", "B": "对流免疫电泳", "C": "单向免疫扩散", "D": "抗链球菌溶血素“O”试验", "language": "zh"}
{"question": "10月男婴，经常出现夜惊不宁，近1周加重，多汗、烦闹。2．该患儿最可能的诊断是（　　）。", "answer": "佝偻病", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "佝偻病", "B": "上呼吸道感染", "C": "正常儿", "D": "营养不良", "language": "zh"}
{"question": "女性，37岁，1年前诊断为再生障碍性贫血，经治疗好转。2个月来乏力、头晕加重，间有酱油色尿。查：血红蛋白60g/L，白细胞4×109/L，血小板60×109/L，网织红细脚84%，骨髓增生活跃，细胞外铁阴性。1．对该患者下述检查最有意义的是（　　）。", "answer": "酸溶血实验", "meta_info": "第一部分　血液系统疾病", "answer_idx": "B", "A": "Coombs实验", "B": "酸溶血实验", "C": "冷热溶血实验", "D": "高铁血红蛋白还原实验", "language": "zh"}
{"question": "下列哪项是体内脂肪酸合成的主要原料?（　　）", "answer": "NADPH和乙酰CoA", "meta_info": "生物化学", "answer_idx": "A", "A": "NADPH和乙酰CoA", "B": "NADPH和乙酰乙酸", "C": "NADPH和丙二酰CoA", "D": "NADH和丙二酰CoA", "language": "zh"}
{"question": "女性，28岁，发热半月，弛张热，伴恶寒，关节痛，体检：皮肤瘀点，Osler结节，心脏有杂音，考虑为感染性心内膜炎，确诊的直接证据来自（　　）。", "answer": "组织学和细菌学检查", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "血液学检查", "B": "超声心动图检查", "C": "免疫学检查", "D": "组织学和细菌学检查", "language": "zh"}
{"question": "2．大肠杆菌和其他致病菌造成的混合感染的特点（　　）。", "answer": "脓液稠厚有粪臭", "meta_info": "第八部分　其他疾病", "answer_idx": "D", "A": "脓液稀薄、淡黄，量较多", "B": "脓液淡绿，有甜腥味", "C": "脓液有特殊恶臭", "D": "脓液稠厚有粪臭", "language": "zh"}
{"question": "女性，49岁，近半年来情绪低落，对任何事失去兴趣，自感体力不支，头昏，头痛，时常对家人表示愧疚，认为自己拖累了家庭，不如一死了之，曾打开煤气企图自杀，被制止后，又采取割腕自杀行为，认为只有这样才能洗清罪过，体检、神经系统无明显异常，该病人的诊断可能为（　　）。", "answer": "抑郁发作", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "恶劣心境", "B": "心因性精神障碍", "C": "抑郁发作", "D": "焦虑症", "language": "zh"}
{"question": "下述疾病中最可能引起金黄色葡萄球菌肺脓肿的是（　　）。", "answer": "皮肤疖肿", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "鼻窦炎", "B": "皮肤疖肿", "C": "牙周脓肿", "D": "食管穿孔", "language": "zh"}
{"question": "大脑皮质运动区病变的瘫痪多表现为（　　）。", "answer": "单瘫或不均等偏瘫", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "单瘫或不均等偏瘫", "B": "四肢瘫", "C": "完全性均等性偏瘫", "D": "截瘫", "language": "zh"}
{"question": "关于原癌基因的叙述，下述哪一项是不正确的?（　　）", "answer": "正常细胞无此基因", "meta_info": "生物化学", "answer_idx": "A", "A": "正常细胞无此基因", "B": "病毒感染可使该基因活化表达", "C": "基因突变可激活原癌基因表达", "D": "多种理化因素可活化此基因表达", "language": "zh"}
{"question": "以下哪项不属于预防心身疾病的措施？（　　）", "answer": "多参加社会活动", "meta_info": "医学心理学", "answer_idx": "A", "A": "多参加社会活动", "B": "健全自己的人格", "C": "养成健康行为习惯和生活方式", "D": "学会情绪调节", "language": "zh"}
{"question": "3．小儿极重度贫血（　　）。", "answer": "Hb<30g/L", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "Hb140～120g/L", "B": "Hb120～90g/L", "C": "Hb60～30g/L", "D": "Hb<30g/L", "language": "zh"}
{"question": "干性支气管扩张症的主要症状是（　　）。", "answer": "反复咯血", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "反复咳嗽", "B": "反复咯血", "C": "营养不良", "D": "肌肉酸痛", "language": "zh"}
{"question": "2．面神经受损（　　）。", "answer": "结核性脑膜炎", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "1岁之内患儿患化脓性脑膜炎易合并", "B": "结核性脑膜炎", "C": "脑膜炎双球菌脑炎", "D": "脑炎链球菌性脑膜炎", "language": "zh"}
{"question": "2．肺心病肺动脉高压形成的功能因素是（　　）。", "answer": "缺氧性肺血管收缩", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "慢性缺氧所致肺血管重建", "B": "缺氧性肺血管收缩", "C": "血液粘稠度增加", "D": "气道炎症", "language": "zh"}
{"question": "患者，男，55岁。患慢性肾小球肾炎10年。近1周来尿少、嗜睡，血压170/110mmHg，血肌酐680μmol/L，CO2CP 12mmol/L，血K＋ 7.8mmol/L。ECG显示T波高尖。今日突然抽搐，意识丧失，心搏骤停死亡。死亡最可能的原因是（　　）。", "answer": "高钾血症", "meta_info": "第4篇　泌尿系统", "answer_idx": "C", "A": "脑出血", "B": "心功能不全", "C": "高钾血症", "D": "代谢性酸中毒", "language": "zh"}
{"question": "含铜IUD的主要作用机制不包括（　　）。", "answer": "使宫颈黏液稠厚，不利于精子穿透", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "影响子宫内膜细胞糖原代谢和雌激素摄入", "B": "使宫颈黏液稠厚，不利于精子穿透", "C": "铜离子使精子头尾分离，不得获能", "D": "使受精卵运行速度与子宫内膜发育不同步", "language": "zh"}
{"question": "女，68岁。高血压病史5年，药物治疗后血压波动于140～170／50～80mmHg。既往糖尿病史。该患者的收缩压控制指标应低于（　　）。", "answer": "130mmHg", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "130mmHg", "B": "125mmHg", "C": "120mmHg", "D": "110mmHg", "language": "zh"}
{"question": "男孩9个月，混合喂养，未添加辅食，1个月来皮肤粘膜逐渐苍白，不爱活动，肝在肋下3cm，脾肋下1cm，血红蛋白81g/L，红细胞3.4×1012/L，血小板150×109/L。3．正确的治疗方法是（　　）。", "answer": "口服硫酸亚铁加维生素C", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "口服叶酸", "B": "口服硫酸亚铁加维生素C", "C": "每周输血一次5ml/kg，至贫血纠正", "D": "肌注维生素B12", "language": "zh"}
{"question": "1．急性风湿热伴有心脏炎无心力衰竭者，应卧床休息（　　）。", "answer": "4周", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "2周", "B": "4周", "C": "2个月", "D": "3个月左右", "language": "zh"}
{"question": "患者，女，30岁，转移性右下腹痛10小时入院，拟诊急性阑尾炎行手术治疗，术中探查发现阑尾充血水肿，表面有脓性分泌物，大网膜轻度包裹，局部有少量浑浊悬液，相邻右侧输卵管伞部充血水肿，表面有纤维素渗出，对该女性患者最合适的手术方式是（　　）。", "answer": "切除阑尾，吸尽阑尾周围渗液", "meta_info": "第3篇　消化系统", "answer_idx": "D", "A": "切除阑尾和右侧输卵管", "B": "切除阑尾，吸尽渗液后置腹腔胶管引流", "C": "切除阑尾，行广泛腹腔冲洗", "D": "切除阑尾，吸尽阑尾周围渗液", "language": "zh"}
{"question": "酶促反应中决定酶特异性的部分是（　　）。", "answer": "酶蛋白", "meta_info": "生物化学", "answer_idx": "A", "A": "酶蛋白", "B": "金属离子", "C": "底物", "D": "B族维生素", "language": "zh"}
{"question": "WHO推荐使用的口服补液盐的氯化钾的浓度为（　　）。", "answer": "0.15%", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "0.1%", "B": "0.15%", "C": "0.2%", "D": "0.3%", "language": "zh"}
{"question": "苯丙酮尿症临床症状，通常开始于（　　）。", "answer": "3～6个月", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "新生儿期", "B": "3～6个月", "C": "1岁时", "D": "2岁以后", "language": "zh"}
{"question": "在SLE应用激素冲击疗法中，下列选项一般不是适应证的是（　　）。", "answer": "严重血小板减少性紫癜", "meta_info": "第八部分　其他疾病", "answer_idx": "D", "A": "急性肾衰竭", "B": "NP狼疮的癫痫发作", "C": "NP狼疮的明显精神症状", "D": "严重血小板减少性紫癜", "language": "zh"}
{"question": "女性，54岁，优秀话务员。近几年怀疑丈夫有外遇，看电视时激动，控制不住，外出走失一周找不到自己的家，住在露天，公安人员收留送回家。吃饭用手抓着吃，记忆力下降，行为幼稚。既往高血压7年，脑梗塞后10个月。神经系统检查：BP225／110mmHg，说话口齿不清，右侧下肢轻偏瘫症状，肌张力增高。巴氏征（＋）。精神检查：意识清晰，智力减退，个人生活不能自理，二便失禁。2．最有可能的诊断为（　　）。", "answer": "脑血管性痴呆", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "老年性痴呆", "B": "脑血管性痴呆", "C": "脑肿瘤所致精神障碍", "D": "脑炎所致精神障碍", "language": "zh"}
{"question": "三岁患儿上楼梯时，其父向上牵拉右上肢，患儿哭叫，诉肘部疼痛，不肯用左手取物，最可能的诊断是（　　）。", "answer": "桡骨头半脱位", "meta_info": "第四部分　运动系统疾病", "answer_idx": "B", "A": "桡骨头骨折", "B": "桡骨头半脱位", "C": "肌肉牵拉伤", "D": "尺骨鹰嘴撕脱伤", "language": "zh"}
{"question": "最容易诱导免疫耐受的细胞是（　　）。", "answer": "T细胞", "meta_info": "医学免疫学", "answer_idx": "C", "A": "Mφ", "B": "B细胞", "C": "T细胞", "D": "NK细胞", "language": "zh"}
{"question": "5．内分泌治疗有效（　　）。", "answer": "激素依赖性肿瘤", "meta_info": "第八部分　其他疾病", "answer_idx": "D", "A": "环磷酰胺、阿霉素、氟尿嘧啶", "B": "环磷酰胺、甲氧蝶呤、氟尿嘧啶", "C": "环磷酰胺、紫杉醇、氟尿嘧啶", "D": "激素依赖性肿瘤", "language": "zh"}
{"question": "腰椎穿刺压颈试验旨在检查（　　）。", "answer": "脊髓疾病", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "小脑疾病", "B": "脑干疾病", "C": "脊髓疾病", "D": "周围神经疾病", "language": "zh"}
{"question": "胎儿宫内感染时，脐带血中含量增高的免疫球蛋白是（　　）。", "answer": "IgM", "meta_info": "医学免疫学", "answer_idx": "C", "A": "IgA", "B": "IgG", "C": "IgM", "D": "IgE", "language": "zh"}
{"question": "不以抗原决定簇与抗原受体结合的是（　　）。", "answer": "超抗原", "meta_info": "医学免疫学", "answer_idx": "B", "A": "完全抗原", "B": "超抗原", "C": "半抗原", "D": "TI抗原", "language": "zh"}
{"question": "女性，28岁，因服用某种物质而昏迷不醒。体检：血压110/80mmHg（14.7/10.7kPa），心率90次/min，肌肉震颤，皮肤湿冷，瞳孔针尖大小，口唇发绀，双肺可闻及湿哆音。应考虑哪种物质中毒? （　　）", "answer": "有机磷农药", "meta_info": "第八部分　其他疾病", "answer_idx": "D", "A": "巴比妥类", "B": "砷", "C": "氰化物", "D": "有机磷农药", "language": "zh"}
{"question": "早产儿，胎龄33周出生，生后4小时出现呼吸增快，进行性加重伴呼气性呻吟，青紫，肺呼吸音降低，心率增快，腹部（－）。1．首先考虑以下哪项诊断？（　　）", "answer": "新生儿肺透明膜病", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "新生儿感染性肺炎", "B": "新生儿肺出血", "C": "新生儿肺透明膜病", "D": "新生儿破伤风", "language": "zh"}
{"question": "4．治疗脑膜白血病（　　）。", "answer": "鞘内注射甲氨蝶呤", "meta_info": "第一部分　血液系统疾病", "answer_idx": "D", "A": "VP方案", "B": "输浓缩红细胞", "C": "口服别嘌呤醇", "D": "鞘内注射甲氨蝶呤", "language": "zh"}
{"question": "男，31岁。反酸伴上腹胀2个月，胸骨后烧灼样痛3天。最适当的处理措施是（　　）。", "answer": "口服奥美拉唑", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "口服阿司匹林，胸痛时舌下含硝酸甘油", "B": "冠状动脉造影", "C": "食管24小时pH监测", "D": "口服奥美拉唑", "language": "zh"}
{"question": "有一自发性蛛网膜下腔出血病人，其最常见的病因是（　　）。", "answer": "颅内动脉瘤", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "颅内动脉瘤", "B": "烟雾病", "C": "脑血管畸形", "D": "肿瘤卒中", "language": "zh"}
{"question": "引起肾脏体积明显缩小的疾病是（　　）。", "answer": "硬化性肾小球肾炎", "meta_info": "病理学", "answer_idx": "A", "A": "硬化性肾小球肾炎", "B": "肾硬化", "C": "肾脓肿", "D": "肾盂积水", "language": "zh"}
{"question": "腰椎结核伴有右髂窝脓肿，检查时托马斯征（Thomas）阳性，说明（　　）。", "answer": "右侧髂腰肌受刺激", "meta_info": "第四部分　运动系统疾病", "answer_idx": "C", "A": "右下肢有放射性疼痛", "B": "髋关节活动受限", "C": "右侧髂腰肌受刺激", "D": "右股四头肌受刺激", "language": "zh"}
{"question": "1．最容易发生骨筋膜室综合征的部位是（　　）。", "answer": "前臂", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "膝关节", "B": "肘关节", "C": "前臂", "D": "上臂", "language": "zh"}
{"question": "患者王某，男，39岁，主诉“舌感异常”到医院就诊，确诊为舌癌，入院治疗。其病情为病灶尚未转移。按当时的医疗水平及治疗手段，只有早期切病灶才能挽救病人。医生把治疗意见向患者的家属作了说明，希望她们向患者做工作，着重说明：“病灶只是溃疡，因为是恶性的，所以必须切除舌的1/3。”患者本人坚决反对手术。医生为了挽救病人生命，又向病人解释说，不是切掉舌，而烧灼舌的溃疡部分。患者在这种情况下答应了手术，切掉了舌的1/3，术后出现语言障碍，咀嚼、味觉功能减退。患者认为医生欺骗并坑害了自己，因而忧郁愤懑，在精神和肉体上蒙受了极大的痛苦，遂上告法院，要求赔偿，后经调解，并说明医生手术的目的与动机，患者撤回了上诉。1．请从本案评价医生的医学动机与手段哪一点是不相一致的（　　）。", "answer": "当病人反对手术，医生用烧灼舌部溃疡，来隐瞒手术的过程", "meta_info": "医学伦理学", "answer_idx": "A", "A": "当病人反对手术，医生用烧灼舌部溃疡，来隐瞒手术的过程", "B": "切除1/3舌部的目的是为了防止舌癌手术后复发，其手术动机也是好的", "C": "医生以“恶性溃疡”告之患者目的是消除患者对癌症的恐怖心理，动机是正确的", "D": "以上都是", "language": "zh"}
{"question": "男，56岁。间断发热1个月，进行性少尿、咯血10天，查体：BP 165/100mmHg，双肺听诊可闻及湿啰音，双下肢水肿。尿常规：蛋白（＋＋）。尿沉渣镜检：RBC 40～50/HP。血肌酐455μmmol/L，血尿素18.5mmol/L，ANA（－），抗中性粒细胞胞浆抗体（＋）。B超示双肾增大。该患者肾脏最可能的病理特征是（　　）。", "answer": "新月体形成", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "肾小球纤维化、玻璃样变", "B": "新月体形成", "C": "系膜局灶性节段性增宽或弥漫性增宽", "D": "系膜局灶性节段性硬化、玻璃样变", "language": "zh"}
{"question": "女，30岁。进行性痛经8年，婚后5年未孕。妇科检查：子宫大小正常，后位，固定，盆底可触及多个痛性结节，右侧附件区触及直径约6cm的囊性包块，不活动，左侧附件区组织略增厚。1．首先考虑的诊断是（　　）。", "answer": "子宫内膜异位症", "meta_info": "第5篇　女性生殖系统", "answer_idx": "D", "A": "盆腔结核", "B": "原发性痛经", "C": "慢性盆腔炎", "D": "子宫内膜异位症", "language": "zh"}
{"question": "良性肿瘤对机体影响最大的因素是（　　）。", "answer": "生长部位", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "生长部位", "B": "组织来源", "C": "生长时间", "D": "体积大小", "language": "zh"}
{"question": "生后1天新生儿白细胞20×109/L，N65%，L35%，幼稚细胞偶见。无异常临床表现，提示该新生儿为（　　）。", "answer": "正常", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "正常", "B": "体内有感染灶", "C": "有白血病", "D": "骨髓外造血", "language": "zh"}
{"question": "男，18岁。因终末肾脏病行肾脏移植手术，其母亲为其供肾者，这种移植类型是（　　）。", "answer": "同种异体移植", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "同种异体移植", "B": "异种移植", "C": "同系移植", "D": "自体移植", "language": "zh"}
{"question": "患者，女，39岁。因持续上腹痛伴恶心、呕吐3天入院。5年来有胆囊结石病，常有短暂上腹不适症状。B超显示胆囊有多发小结石，胆总管宽9mm，其内未见结石，胰腺肿大增厚，周围有积液。查体：体温37.7℃.脉率106次/min，呼吸28次/min，血压132/86mmHg，巩膜不黄，肺无啰音，上腹压痛，轻度肌紧张和反跳痛，肠鸣音较弱。化验WBC 13.5×109/L，血尿淀粉酶高出正常1倍以上。1．对该患者最可能的诊断是（　　）。", "answer": "胆源性胰腺炎", "meta_info": "第3篇　消化系统", "answer_idx": "B", "A": "急性胃炎", "B": "胆源性胰腺炎", "C": "急性胆囊炎", "D": "急性梗阻性化脓性胆管炎", "language": "zh"}
{"question": "正常脐带内含有（　　）。", "answer": "两条脐动脉，一条脐静脉", "meta_info": "第5篇　女性生殖系统", "answer_idx": "A", "A": "两条脐动脉，一条脐静脉", "B": "一条脐动脉，一条脐静脉", "C": "一条脐动脉，两条脐静脉", "D": "两条脐动脉", "language": "zh"}
{"question": "男性，20岁，2月初发病，主诉寒战、高热、剧烈头痛一天，曾呕吐3次。体检：神志清，体温39.8℃，颈强（±），皮肤有瘀点，咽部略充血，心肺腹无异常，克氏征（+）。血白细胞20×109/L，中性粒细胞85%。腰穿脑脊液，米汤样，Pandy（+++），细胞数3000×106/L，中性80%，糖1.12mmol/L（20mg%）。2．可能出现的并发症有（　　）。", "answer": "以上均是", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "D", "A": "化脓性关节炎", "B": "心内膜炎", "C": "肺炎", "D": "以上均是", "language": "zh"}
{"question": "1．患者尿频、尿急、尿痛、血尿、脓尿，下腹部压痛，考虑诊断为（　　）。", "answer": "膀胱炎", "meta_info": "第4篇　泌尿系统", "answer_idx": "B", "A": "急性附睾炎", "B": "膀胱炎", "C": "淋病性尿道炎", "D": "肾积脓", "language": "zh"}
{"question": "以下哪项是合成脂肪酸的乙酰CoA的主要来源？（　　）", "answer": "糖的分解代谢", "meta_info": "生物化学", "answer_idx": "A", "A": "糖的分解代谢", "B": "生酮氨基酸的分解代谢", "C": "胆固醇的分解代谢", "D": "生糖氨基酸的分解代谢", "language": "zh"}
{"question": "女，38岁。患慢性肝炎7年，要求给予避孕指导。应选择的避孕措施是（　　）。", "answer": "阴茎套避孕", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "安全期避孕", "B": "阴茎套避孕", "C": "口服短效避孕药", "D": "皮下埋植避孕", "language": "zh"}
{"question": "下述关于梅毒的叙述，正确的是（　　）", "answer": "树胶肿和血管炎是主要病变", "meta_info": "病理学", "answer_idx": "B", "A": "树胶肿内可见大量类上皮细胞", "B": "树胶肿和血管炎是主要病变", "C": "可导致主动脉狭窄", "D": "骨骼不受累", "language": "zh"}
{"question": "1．急性非淋巴细胞白血病化疗（　　）。", "answer": "HAP方案", "meta_info": "第一部分　血液系统疾病", "answer_idx": "B", "A": "VP方案", "B": "HAP方案", "C": "口服别嘌呤醇", "D": "鞘内注射甲氨蝶呤", "language": "zh"}
{"question": "下列哪项是炎症的基本病理变化？（　　）", "answer": "病变组织变质、渗出、增生", "meta_info": "病理学", "answer_idx": "C", "A": "组织的炎性充血和水肿", "B": "红、肿、热、痛、功能障碍", "C": "病变组织变质、渗出、增生", "D": "周围血液中白细胞增多和炎区白细胞浸润", "language": "zh"}
{"question": "不属于人格的投射类测验的是（　　）。", "answer": "范畴试验", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "主题统觉试验", "B": "霍兹曼墨迹试验", "C": "词语联想测验", "D": "范畴试验", "language": "zh"}
{"question": "按照执业医师法规定，应当进行重新注册的情形是中止医师执业活动一定期限以及本法第十五条规定的情形消失。申请重新执业的“一定期限”是指（　　）。", "answer": "2年以上", "meta_info": "卫生法规", "answer_idx": "A", "A": "2年以上", "B": "3年以上", "C": "4年以上", "D": "5年以上", "language": "zh"}
{"question": "患儿血清铁蛋白降低，红细胞游离原卟啉正常，未出现贫血表现。应诊断为（　　）。", "answer": "铁减少期（ID）", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "铁减少期（ID）", "B": "红细胞生成缺铁期（IDE）", "C": "缺铁性贫血期（IDA）", "D": "缺铁性贫血恢复期", "language": "zh"}
{"question": "肝硬化合并自发性细菌性腹膜炎时，选择抗生素的原则是（　　）。", "answer": "针对G－杆菌，兼顾G＋球菌", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "针对G－杆菌，兼顾G＋球菌", "B": "针对G＋杆菌，联合抗真菌药物", "C": "针对G－球菌，兼顾厌氧菌", "D": "针对G－杆菌，联合抗真菌药物", "language": "zh"}
{"question": "DNA以半保留复制方式进行复制，一完全被放射性核素标记的DNA分子置于无放射性标记的溶液中复制两代后，下述正确的是（　　）。", "answer": "仅2个分子的DNA有放射性", "meta_info": "生物化学", "answer_idx": "B", "A": "4个分子的DNA均无放射性", "B": "仅2个分子的DNA有放射性", "C": "4个分子的DNA双链中仅其一条链有放射性", "D": "以上都不是", "language": "zh"}
{"question": "男，24岁，精神分裂症，一直服用氯丙嗪50mg，tid，原来的激动不安、幻觉妄想已消失，近来有明显手指颤动，请选择一组药物代替氯丙嗪（　　）。", "answer": "氯氮平+苯海索", "meta_info": "药理学", "answer_idx": "B", "A": "氯丙嗪+左旋多巴", "B": "氯氮平+苯海索", "C": "米帕明+阿托品", "D": "氯丙嗪+阿托品", "language": "zh"}
{"question": "吗啡不用于慢性钝痛的原因是（　　）。", "answer": "连续多次应用易成瘾", "meta_info": "药理学", "answer_idx": "B", "A": "对钝痛的效果欠佳", "B": "连续多次应用易成瘾", "C": "引起体位性低血压", "D": "引起便秘和尿潴留", "language": "zh"}
{"question": "女，26岁。孕31周，双下肢水肿20天，既往无特殊病史。血压150/90mmHg，尿蛋白定量2g/24h。该患者最有可能的诊断是（　　）。", "answer": "轻度子痫前期", "meta_info": "第5篇　女性生殖系统", "answer_idx": "A", "A": "轻度子痫前期", "B": "中度子痫前期", "C": "先兆子痫", "D": "妊娠合并肾炎", "language": "zh"}
{"question": "高血压合并窦性心动过速的年轻患者宜首选何种抗高血压药？（　　）", "answer": "普萘洛尔", "meta_info": "药理学", "answer_idx": "C", "A": "硝普钠", "B": "甲基多巴", "C": "普萘洛尔", "D": "可乐定", "language": "zh"}
{"question": "属于孕激素的生理作用是（　　）。", "answer": "使阴道上皮细胞脱落加快", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "使阴道上皮细胞脱落加快", "B": "使宫颈黏液变稀薄", "C": "使子宫肌层增厚", "D": "使血循环中胆固醇水平降低", "language": "zh"}
{"question": "1．以上具有血管紧张素Ⅰ转换酶抑制作用，能防止和逆转心室肥厚的是（　　）。", "answer": "卡托普利", "meta_info": "药理学", "answer_idx": "C", "A": "肼屈嗪", "B": "米力农", "C": "卡托普利", "D": "地高辛", "language": "zh"}
{"question": "多囊卵巢综合征患者行诊断性刮宫，时机应选择在（　　）。", "answer": "月经前数日或月经来潮6小时内", "meta_info": "第5篇　女性生殖系统", "answer_idx": "B", "A": "月经第4日", "B": "月经前数日或月经来潮6小时内", "C": "月经第2日", "D": "无特殊要求", "language": "zh"}
{"question": "患者，女，50岁。缓起发热，咳嗽，痰呈脓性，伴腥臭味，每日约150mL。病程已10天，多种抗生素治疗不见改善。X线示右下肺叶后基底段团块状影，伴空洞和液平。两周前曾有拔牙史。1．本例诊断以下列哪种疾病最为可能？（　　）", "answer": "吸入性肺脓肿", "meta_info": "第1篇　呼吸系统", "answer_idx": "D", "A": "空洞性肺结核", "B": "阻塞性肺脓肿", "C": "支气管肺囊肿继发感染", "D": "吸入性肺脓肿", "language": "zh"}
{"question": "硬脑膜外血肿最常发生于（　　）。", "answer": "颞区", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "额区", "B": "顶区", "C": "颞区", "D": "枕区", "language": "zh"}
{"question": "42岁，女，患慢性肾炎3年，半年前因早孕行药物流产，现要求避孕指导，最正确的措施是（　　）。", "answer": "行输卵管结扎术", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "安全期避孕", "B": "口服短效避孕药", "C": "皮下埋植避孕", "D": "行输卵管结扎术", "language": "zh"}
{"question": "在补体经典途径激活过程中，不被裂解的补体组分是（　　）。", "answer": "C1", "meta_info": "医学免疫学", "answer_idx": "A", "A": "C1", "B": "C2", "C": "C3", "D": "C4", "language": "zh"}
{"question": "28岁妇女，主诉白带增多，检查宫颈阴道部宫口周围外观呈细颗粒状红色区，占整个宫颈面积的2/3，宫颈刮片巴氏染色H级。本例恰当处置应是（　　）。", "answer": "物理治疗", "meta_info": "第二部分　模拟试题", "answer_idx": "B", "A": "涂硝酸银腐蚀", "B": "物理治疗", "C": "宫颈锥形切除", "D": "宫颈切除", "language": "zh"}
{"question": "患儿，9个月，1个月前肺炎，治愈后始终不愿进食，仅吃母乳。近半个月，面色渐白，活动减少。血象：RBC 3.05×1012/L，Hb 70ｇ/L，WBC 8×109/L，PLT 156×109/L，MCV 72pg。MCH 25fl，MCHC30%。该患儿应考虑诊断为（　　）。", "answer": "缺铁性贫血", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "营养性混合性贫血", "B": "缺铁性贫血", "C": "巨幼细胞性贫血", "D": "再生障碍性贫血", "language": "zh"}
{"question": "男，50岁。情绪激动后突感头痛，伴恶心、呕吐和视物模糊2小时来诊。高血压病病史10年，查体：BP 230／140mmHg，双肺未闻及干湿性啰音，心率100次/分，律不齐，早搏2～4次/分，颈无抵抗，无肢体活动障碍及言语不利，最适宜的治疗措施是（　　）。", "answer": "静脉滴注硝普钠", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "静脉推注利多卡因", "B": "静脉推注普罗帕酮", "C": "静脉滴注硝普钠", "D": "静脉滴注呋塞米", "language": "zh"}
{"question": "头皮裂伤的最长清创时间，是（　　）。", "answer": "在应用抗生素情况下可延至72小时", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "4小时", "B": "12小时", "C": "24小时", "D": "在应用抗生素情况下可延至72小时", "language": "zh"}
{"question": "女孩，1岁，未接种过卡介苗，其父患活动性肺结核，时有咳血，目前小儿与父母生活在一起，但无任何症状，小儿胸部X线片未见异常，PPD试验（＋），除隔离父亲外，宜对小儿采取的措施是（　　）。", "answer": "口服异烟肼，疗程6～9个月", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "继续观察，暂不做任何处理", "B": "立即接种卡介苗", "C": "口服异烟肼，疗程6～9个月", "D": "口服利福平＋异烟肼，疗程1年", "language": "zh"}
{"question": "男，19岁。咽痛、发热伴咳嗽2周，眼睑水肿伴肉眼血尿3天。查体：BP 150/100mmHg，全身皮肤无皮疹。实验室检查：尿蛋白（＋＋），尿红细胞30～40/HP，管型3～5/LP，血C3降低，Scr 126μmol/L。2．该患者最可能出现的管型是（　　）。", "answer": "红细胞管型", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "透明管型", "B": "红细胞管型", "C": "白细胞管型", "D": "蜡样管型", "language": "zh"}
{"question": "2．治疗非霍奇金淋巴瘤首选（　　）。", "answer": "CHOP方案", "meta_info": "第一部分　血液系统疾病", "answer_idx": "B", "A": "MP方案", "B": "CHOP方案", "C": "MOPP方案", "D": "VP方案", "language": "zh"}
{"question": "小胃癌的定义是指癌灶直径小于（　　）。", "answer": "1.0cm", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "2.0cm", "B": "0.1cm", "C": "0.5cm", "D": "1.0cm", "language": "zh"}
{"question": "下列哪项不是病理性肾结核的特点？（　　）", "answer": "在尿中查不到结核杆菌", "meta_info": "第4篇　泌尿系统", "answer_idx": "D", "A": "主要在肾小球周围毛细血管丛内形成多发性微小结核病灶", "B": "这种早期结核病变可以全部自行愈合", "C": "不引起影像学改变", "D": "在尿中查不到结核杆菌", "language": "zh"}
{"question": "1．上述哪项是与细菌抵抗吞噬有关的结构？（　　）", "answer": "荚膜", "meta_info": "医学微生物学", "answer_idx": "A", "A": "荚膜", "B": "鞭毛", "C": "普通菌毛", "D": "芽胞", "language": "zh"}
{"question": "2岁小儿，2个月前患麻疹，1个月来咳嗽、发热，1周来嗜睡，间断呕吐。查体：T 38.9℃，嗜睡，营养差，颈抵抗（+），心肺腹部无异常。脑脊液WBC 150×106/L，单核65%，糖2.24mmol/L，氯化物102mmol/L，PPD试验（-）。3．此患儿PPD（-）的原因是（　　）。", "answer": "细胞免疫功能低下", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "体液免疫功能低下", "B": "细胞免疫功能低下", "C": "补体功能低下", "D": "吞噬细胞功能低下", "language": "zh"}
{"question": "4岁幼儿，摔倒后肩部疼痛。检查发现患肩下沉，患肢活动障碍，头向患侧偏斜，杜加（Dugas）征阴性。最可能的诊断是（　　）。", "answer": "锁骨骨折", "meta_info": "第四部分　运动系统疾病", "answer_idx": "C", "A": "臂丛神经损伤", "B": "肩关节脱位", "C": "锁骨骨折", "D": "桡骨小头半脱位", "language": "zh"}
{"question": "IgG用木瓜蛋白酶水解后可以形成（　　）。", "answer": "两个Fab段和一个Fc段", "meta_info": "医学免疫学", "answer_idx": "B", "A": "一个Fab段和一个Fc段", "B": "两个Fab段和一个Fc段", "C": "两个Fab段", "D": "一个F(ab’)2和pFc’", "language": "zh"}
{"question": "风疹应隔离至出疹后的（　　）。", "answer": "5天", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "3天", "B": "5天", "C": "7天", "D": "10天", "language": "zh"}
{"question": "属于营养必需脂肪酸的是（　　）。", "answer": "亚麻酸", "meta_info": "生物化学", "answer_idx": "A", "A": "亚麻酸", "B": "硬脂酸", "C": "油酸", "D": "月桂酸", "language": "zh"}
{"question": "骨折切开复位内固定的指征不包括（　　）。", "answer": "手法复位未能达到解剖复位的标准", "meta_info": "第四部分　运动系统疾病", "answer_idx": "C", "A": "关节内骨折手法复位后对位不好者", "B": "保守治疗未达到功能复位的标准", "C": "手法复位未能达到解剖复位的标准", "D": "骨折断端间有肌肉等软组织嵌入，手法复位失败者", "language": "zh"}
{"question": "在吮指癖小儿的手指上涂苦味油膏的疗法是（　　）。", "answer": "厌恶疗法", "meta_info": "医学心理学", "answer_idx": "A", "A": "厌恶疗法", "B": "消退法", "C": "系统脱敏法", "D": "生物反馈", "language": "zh"}
{"question": "3．腺病毒肺炎（　　）。", "answer": "肺部体征出现晚", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "常并发肺脓肿、肺大泡", "B": "肺部体征出现晚", "C": "肺部体征常不明显", "D": "常有梗阻性肺气肿、支气管周围炎", "language": "zh"}
{"question": "女性，44岁，反复发作上腹部疼痛3年，近3d上腹绞痛，伴发热寒战，皮肤巩膜黄染。3．若病人出现神志淡漠、嗜睡，最有效的治疗措施是（　　）。", "answer": "紧急手术解除胆道梗阻并减压引流", "meta_info": "第二部分　模拟试题", "answer_idx": "D", "A": "纠正水、电解质和酸碱平衡紊乱", "B": "给予有效足量抗生素", "C": "应用肾上腺皮质激素", "D": "紧急手术解除胆道梗阻并减压引流", "language": "zh"}
{"question": "金黄色葡萄球菌感染常导致（　　）。", "answer": "脓肿", "meta_info": "病理学", "answer_idx": "B", "A": "出血性炎", "B": "脓肿", "C": "蜂窝织炎", "D": "纤维素性炎", "language": "zh"}
{"question": "用绵羊红细胞能检出交叉抗体的是哪项（　　）。", "answer": "传染性单核细胞增多症", "meta_info": "医学免疫学", "answer_idx": "A", "A": "传染性单核细胞增多症", "B": "溃疡性结肠炎", "C": "风湿病", "D": "肾炎", "language": "zh"}
{"question": "1．复杂部分性发作的病损位于（　　）。", "answer": "颞叶", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "中央前回", "B": "颞叶", "C": "枕叶", "D": "小脑", "language": "zh"}
{"question": "子宫内膜异位症的临床特点是（　　）。", "answer": "继发性痛经，进行性加重", "meta_info": "第5篇　女性生殖系统", "answer_idx": "B", "A": "痛经程度与病变范围成正比", "B": "继发性痛经，进行性加重", "C": "均存在卵巢囊肿内陈旧性出血", "D": "15%～30%的患者月经正常", "language": "zh"}
{"question": "男，44岁。建筑工人，6小时前不慎从高处坠落摔伤，腰部疼痛，活动受限，不能独立行走。1．为明确有无合并神经损伤，最有意义的体格检查是（　　）。", "answer": "上下肢感觉运动", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "椎旁肌按压", "B": "直腿抬高实验", "C": "腰部过伸过屈", "D": "上下肢感觉运动", "language": "zh"}
{"question": "黄病毒的共同特点不包括（　　）。", "answer": "属于小RNA病毒科", "meta_info": "医学微生物学", "answer_idx": "A", "A": "属于小RNA病毒科", "B": "所致疾病多较重", "C": "有包膜和血凝素", "D": "衣壳呈二十面体立体对称", "language": "zh"}
{"question": "5岁女孩，自幼身体瘦弱，易患感冒。查体：心前区稍隆起，未触及震颤，胸骨左缘第2肋间可闻及Ⅱ级收缩期杂音，P2亢进，固定分裂。1．诊断考虑为（　　）。", "answer": "房间隔缺损", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "房间隔缺损", "B": "室间隔缺损", "C": "动脉导管未闭", "D": "病毒性心肌炎", "language": "zh"}
{"question": "患者，女，50岁，因呼吸困难和水肿入院。查体发现颈静脉怒张，肝在右肋缘下5cm，表面光滑，轻度压痛，双下肢压陷性水肿。2．该患者心音可有以下变化，除了（　　）。", "answer": "心尖部第一心音减弱", "meta_info": "第2篇　心血管系统", "answer_idx": "A", "A": "心尖部第一心音减弱", "B": "心尖部第一心音增强", "C": "肺动脉瓣区第二心音增强", "D": "心尖部第一心音可呈拍击性", "language": "zh"}
{"question": "某患者，放疗数周后出现中枢神经刺激症状，伴发热38℃，项强，脑脊液轻度混浊、淋巴细胞增多、蛋白质含量增多。若对脑脊液中可能存在的病原体进行分离培养，最好使用哪一种培养基？（　　）", "answer": "沙保弱培养基", "meta_info": "医学微生物学", "answer_idx": "C", "A": "巧克力琼脂培养基", "B": "血液琼脂培养基", "C": "沙保弱培养基", "D": "亚碲酸钾培养基", "language": "zh"}
{"question": "4．判断伤寒病人是否能解除隔离应采用（　　）。", "answer": "粪便培养", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "C", "A": "骨髓培养", "B": "尿培养", "C": "粪便培养", "D": "胆汁培养", "language": "zh"}
{"question": "2．检查HBsAg的常用方法是（　　）。", "answer": "ELISA", "meta_info": "医学免疫学", "answer_idx": "C", "A": "直接凝集", "B": "单向琼脂扩散", "C": "ELISA", "D": "荧光标记", "language": "zh"}
{"question": "肝脏进行生物转化时乙酰基的供体是（　　）。", "answer": "乙酰辅酶Ａ", "meta_info": "生物化学", "answer_idx": "C", "A": "乙酸", "B": "乙酰腺苷酸", "C": "乙酰辅酶Ａ", "D": "乙酰乙酯", "language": "zh"}
{"question": "1．可兴奋细胞接受阈下刺激，可出现（　　）。", "answer": "局部电位", "meta_info": "生理学", "answer_idx": "C", "A": "阈电位", "B": "负后电位", "C": "局部电位", "D": "正后电位", "language": "zh"}
{"question": "女，41岁，近一年来，月经量增多，经期延长，伴进行性痛经，且逐渐加重。体检示子宫质硬而有压痛。MRI示子宫均匀性增大。最有可能的诊断是（　　）。", "answer": "子宫腺肌病", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "多囊卵巢综合征", "B": "痛经", "C": "功能失调性子宫出血", "D": "子宫腺肌病", "language": "zh"}
{"question": "急性肾小球肾炎首先出现水肿的部位常为（　　）。", "answer": "眼睑", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "胫前", "B": "面部", "C": "双足", "D": "眼睑", "language": "zh"}
{"question": "急性肾炎与慢性肾炎的根本区别是（　　）。", "answer": "肾组织病理改变", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "起病缓急", "B": "高血压程度", "C": "有无肾功能减退", "D": "肾组织病理改变", "language": "zh"}
{"question": "抑郁症病人的睡眠障碍特点是（　　）。", "answer": "早醒", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "入睡困难", "B": "多梦", "C": "早醒", "D": "睡眠过多", "language": "zh"}
{"question": "患儿，女，5岁，发作性意识丧失，动作中止，发作中脑电图可见3Hz棘-慢波。智力基本正常。2．治疗该患儿的首选药物是（　　）。", "answer": "丙戊酸钠", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "托吡酯", "B": "苯妥英钠", "C": "拉莫三嗪", "D": "丙戊酸钠", "language": "zh"}
{"question": "骨髓增生异常综合征病人的骨髓幼稚细胞中有Auer小体，见于（　　）。", "answer": "RAEB-T型", "meta_info": "第一部分　血液系统疾病", "answer_idx": "C", "A": "RA型", "B": "RAEB型", "C": "RAEB-T型", "D": "CMML型", "language": "zh"}
{"question": "2．急性肾小球性肾炎的非典型表现（　　）。", "answer": "无症状性急性肾炎", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "高血压脑病", "B": "无症状性急性肾炎", "C": "肾炎性肾病", "D": "慢性肾炎", "language": "zh"}
{"question": "3．肾病综合征患儿，口服泼尼松2mg/kg/d，治疗2周后尿蛋白完全转阴，8周后尿蛋白再次(＋＋＋＋)，疗效判断为（　　）。", "answer": "复发", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "激素依赖型", "B": "激素部分敏感型", "C": "激素敏感型", "D": "复发", "language": "zh"}
{"question": "下列哪项是能与类风湿因子特异性结合的物质？（　　）", "answer": "自身变性的IgG", "meta_info": "医学免疫学", "answer_idx": "A", "A": "自身变性的IgG", "B": "自身变性的IgM", "C": "自身变性的IgE", "D": "自身变性的IgD", "language": "zh"}
{"question": "女，34岁。月经量进行性减少，现闭经半年，泌乳3个月，首选检查项目应是（　　）。", "answer": "血PRL测定", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "血hCG测定", "B": "血PRL测定", "C": "性激素测定", "D": "诊断性刮宫", "language": "zh"}
{"question": "静息电位大小接近于（　　）。", "answer": "钾平衡电位", "meta_info": "生理学", "answer_idx": "B", "A": "钠平衡电位", "B": "钾平衡电位", "C": "钙平衡电位", "D": "钠平衡电位与钾平衡电位之和", "language": "zh"}
{"question": "有竞争性抑制剂时酶反应动力学特点是（　　）。", "answer": "Km值增大，Vmax不变", "meta_info": "生物化学", "answer_idx": "A", "A": "Km值增大，Vmax不变", "B": "Km值降低，Vmax不变", "C": "Km值不变，Vmax增大", "D": "Km值和Vmax均降低", "language": "zh"}
{"question": "男，45岁。体检发现血糖升高，空腹血糖7.6mmol/L，餐后2小时血糖13.6mmol/L，  HbA1c 7.8％。查体：BP 150／100nmHg，BMI 28，心肺腹查体未见明显异常。3．该患者首选的降血压药物是（　　）。", "answer": "氯沙坦", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "氨氯地平", "B": "哌唑嗪", "C": "氢氯噻嗪", "D": "氯沙坦", "language": "zh"}
{"question": "丙氨酸-葡萄糖循环在肌肉和肝之间转运（　　）。", "answer": "氨", "meta_info": "生物化学", "answer_idx": "C", "A": "丙氨酸", "B": "丙酮酸", "C": "氨", "D": "乳酸", "language": "zh"}
{"question": "枕骨大孔疝常见病因是（　　）。", "answer": "小脑半球占位性病变", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "大脑半球占位性病变", "B": "小脑半球占位性病变", "C": "交通性脑积水", "D": "腹压增高", "language": "zh"}
{"question": "等渗性缺水短期内出现血容量明显不足时，提示体液丧失达体重的（　　）。", "answer": "5%", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "D", "A": "3.5%", "B": "3%", "C": "4%", "D": "5%", "language": "zh"}
{"question": "女，28岁。反复排黏液血便2年，加重3个月，抗生素治疗无效。肠镜示直肠至结肠脾曲黏膜弥漫性充血、水肿，较多糜烂及表浅小溃疡。最可能的诊断是（　　）。", "answer": "溃疡性结肠炎", "meta_info": "第3篇　消化系统", "answer_idx": "A", "A": "溃疡性结肠炎", "B": "克罗恩病", "C": "细菌性痢疾", "D": "结肠癌", "language": "zh"}
{"question": "右心衰竭时，产生水肿的主要始动因素是（　　）。", "answer": "毛细血管滤过压增高", "meta_info": "第2篇　心血管系统", "answer_idx": "A", "A": "毛细血管滤过压增高", "B": "毛细血管通透性增高", "C": "水与钠潴留", "D": "淋巴液回流受阻", "language": "zh"}
{"question": "患儿，8个月，腹泻4天，水样便，1日10余次。12小时无尿，呼吸深大，前囟、眼窝明显凹陷，四肢凉。血钠127mmol/L，血钾4mmol/L，血钙2.25mmol/L，CO2CP11.2mmol/L。首批应输入下列哪一种混合液？（　　）", "answer": "2：1等张含钠液", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "3：2：1液（1/2张）", "B": "2：1等张含钠液", "C": "1：2液（1/3张）", "D": "1：1液（1/2张）", "language": "zh"}
{"question": "患者，男，45岁，农民，5月中旬发病，起病急，发冷、发热、全身肌痛，5天后在某地医院诊断为败血症休克。经静脉补液及氨苄西林静脉滴注，次日血压正常，但病情加重，呃逆、呕吐、尿少入院。查体：体温37.3℃，血压150/100mmHg，皮肤黏膜有瘀点，球结膜充血、水肿，心肺未见异常，肝大肋下1.0cm，腰部有叩击痛。化验：白细胞50×109/L，中性粒细胞0.85，淋巴细胞0.15，血小板3×109/L，尿蛋白（＋＋＋＋）。最可能的诊断是（　　）。", "answer": "肾综合征出血热", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "D", "A": "败血症并感染性休克", "B": "急性粒细胞性白血病", "C": "钩端螺旋体病", "D": "肾综合征出血热", "language": "zh"}
{"question": "一般优势半球指的是（　　）占优势的一侧半球。", "answer": "语言活动功能", "meta_info": "生理学", "answer_idx": "C", "A": "重量", "B": "运动功能", "C": "语言活动功能", "D": "皮层沟回数", "language": "zh"}
{"question": "关于新生儿出生后1分钟的Apgar评分及其意义，错误的是（　　）。", "answer": "评分根据呼吸，心率及皮肤颜色", "meta_info": "第5篇　女性生殖系统", "answer_idx": "D", "A": "7分以上只需进行一般处理", "B": "4分以下应紧急抢救", "C": "应于出生5分钟内再次评分", "D": "评分根据呼吸，心率及皮肤颜色", "language": "zh"}
{"question": "药物一级动力学消除的特点为（　　）。", "answer": "为绝大多数药物的消除方式", "meta_info": "药理学", "answer_idx": "B", "A": "药物的半衰期与剂量有关", "B": "为绝大多数药物的消除方式", "C": "单位时间内实际消除的药量不变", "D": "单位时间内实际消除的药量递增", "language": "zh"}
{"question": "对于有严重自杀企图，使用抗抑郁药治疗无效的抑郁发作患者，可采用的有效治疗措施是（　　）。", "answer": "电休克治疗", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "心理治疗", "B": "生物反馈治疗", "C": "电休克治疗", "D": "加用抗精神病药物", "language": "zh"}
{"question": "小儿补充生理需要，所用液体的张力为（　　）。", "answer": "1/5张", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "1/5张", "B": "1/3张", "C": "1/2张", "D": "等张", "language": "zh"}
{"question": "1．诊断风湿热的次要表现是（　　）。", "answer": "血沉增快", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "皮肤环形红斑", "B": "血沉增快", "C": "抗链球菌抗体增高", "D": "骨关节面损伤", "language": "zh"}
{"question": "下列哪项是判断糖尿病控制程度较好的指标？（　　）", "answer": "糖化血红蛋白", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "C", "A": "饭后血糖", "B": "空腹血糖", "C": "糖化血红蛋白", "D": "OGTT", "language": "zh"}
{"question": "7月女婴，近1周易激怒，烦躁不安，呕吐2次，大便稀，2次/日，查体：嗜睡，前囟膨，有张力，颈强（＋/－），心肺正常，布氏征（＋），巴氏征（＋/－），为明确诊断，应做哪项检查？（　　）", "answer": "脑脊液检查", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "脑电图", "B": "脑CT", "C": "脑脊液检查", "D": "X线胸片", "language": "zh"}
{"question": "2．黏膜细胞保护剂（　　）。", "answer": "前列腺素E2的衍生物", "meta_info": "第3篇　消化系统", "answer_idx": "B", "A": "丙谷胺", "B": "前列腺素E2的衍生物", "C": "哌吡氮平", "D": "吗丁啉", "language": "zh"}
{"question": "男，28岁。枕部着地，昏迷5分钟后清醒，并自己回到家中，其后出现头痛并逐渐加重伴呕吐，1小时候不省人事，急送医院。查体：BP 160／90mmHg，脉率65次/分，呼吸15次/分。浅昏迷，右枕部头皮挫伤，左侧瞳孔4mm，对光反应消失；右侧瞳孔2.5mm，对光反应存在。2．最适当的检查方法是（　　）。", "answer": "头颅CT", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "脑电图", "B": "头颅MRI", "C": "头颅X线片", "D": "头颅CT", "language": "zh"}
{"question": "正常成年男性的血细胞在血液中所占的容积百分比是（　　）。", "answer": "40%～50%", "meta_info": "生理学", "answer_idx": "B", "A": "20%～30%", "B": "40%～50%", "C": "60%～65%", "D": "65%～70%", "language": "zh"}
{"question": "不属于机化的是（　　）。", "answer": "疖破溃后由周围组织修补", "meta_info": "病理学", "answer_idx": "D", "A": "大叶性肺炎合并肺肉质变", "B": "坏死组织由肉芽组织取代", "C": "脾梗死瘢痕灶", "D": "疖破溃后由周围组织修补", "language": "zh"}
{"question": "非幻觉性知觉障碍不包括（　　）。", "answer": "思维鸣响", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "思维鸣响", "B": "非真实感", "C": "人格解体", "D": "似曾相识感", "language": "zh"}
{"question": "肾病综合征患者高度水肿，尿量400～500ml/d，持续2周，尿蛋白（＋＋＋），血浆蛋白20g/L，肌酐清除率为100ml/min，本患者的治疗主要是（　　）。", "answer": "肾上腺皮质激素", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "速尿", "B": "消炎药", "C": "肾上腺皮质激素", "D": "血液透析", "language": "zh"}
{"question": "反映肺一次通气最大能力的是（　　）。", "answer": "肺活量", "meta_info": "生理学", "answer_idx": "C", "A": "潮气量", "B": "补吸气量", "C": "肺活量", "D": "时间肺活量", "language": "zh"}
{"question": "患者，女，入院3天，头部受伤后立即昏迷，10分钟后清醒，有呕吐，对受伤情况不能回忆，考虑是（　　）。", "answer": "脑震荡", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "脑震荡", "B": "脑干损伤", "C": "颅内血肿", "D": "脑挫裂伤", "language": "zh"}
{"question": "男，48岁，头痛，呕吐2周，颈项强直明显，用力后突然呼吸停止，双瞳孔等大。应考虑病变位于（　　）。", "answer": "颅后窝", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "右侧大脑半球", "B": "左侧大脑半球", "C": "颅后窝", "D": "颈髓", "language": "zh"}
{"question": "下列选项属于医师在执业活动中应负有的义务是（　　）。", "answer": "宣传卫生保健知识，对患者进行教育", "meta_info": "卫生法规", "answer_idx": "C", "A": "参加专业学术团体", "B": "人格尊严、人身安全不受侵犯", "C": "宣传卫生保健知识，对患者进行教育", "D": "享受国家规定的福利待遇", "language": "zh"}
{"question": "当医院出现医院感染散发病例时，经治医师应填表报告医院感染管理科的时间是（　　）。", "answer": "24小时内", "meta_info": "卫生法规", "answer_idx": "D", "A": "2小时内", "B": "4小时内", "C": "12小时内", "D": "24小时内", "language": "zh"}
{"question": "不是乳癌的临床表现的是（　　）。", "answer": "肿块表面光滑，活动度良好", "meta_info": "第八部分　其他疾病", "answer_idx": "C", "A": "癌块表面皮肤凹陷", "B": "肿块生长速度较快", "C": "肿块表面光滑，活动度良好", "D": "橘皮样外观", "language": "zh"}
{"question": "男性，24岁，贫血1年，皮肤散在出血点，肝脾未及，血红蛋白65g/L，红细胞2.0×1012/L，白细胞2×109/L，血小板27×109/L，骨髓增生活跃，粒系和红系多为晚期阶段，巨核细胞缺如，酸溶血试验阴性。最可能的诊断是（　　）。", "answer": "再生障碍性贫血", "meta_info": "第一部分　血液系统疾病", "answer_idx": "D", "A": "急性白血病", "B": "原发性血小板减少性紫癜", "C": "阵发性睡眠性血红蛋白尿", "D": "再生障碍性贫血", "language": "zh"}
{"question": "确诊系统性红斑狼疮最有价值的自身抗体是（　　）。", "answer": "抗dsDNA抗体", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "ANA", "B": "抗SSB抗体", "C": "抗SSA抗体", "D": "抗dsDNA抗体", "language": "zh"}
{"question": "患者发热、乏力、食欲不振、腹痛，以左下腹明显，腹泻早期稀便，排便次数增多后转为黏液脓血便，并有里急后重。应诊断为（　　）。", "answer": "急性细菌性痢疾", "meta_info": "病理学", "answer_idx": "A", "A": "急性细菌性痢疾", "B": "急性肠炎", "C": "食物中毒", "D": "肠道真菌病", "language": "zh"}
{"question": "细菌人工培养的实际应用不包括（　　）。", "answer": "传染病的治疗", "meta_info": "医学微生物学", "answer_idx": "D", "A": "细菌的鉴定", "B": "进行药物敏感试验", "C": "生物制品的制备", "D": "传染病的治疗", "language": "zh"}
{"question": "患者，男，50岁，因头晕2年就诊，门诊查心率70次/min，血压165/85mmHg，余未发现异常，以高血压收住院。1．该患者为排除继发性高血压，哪项检查无意义？（　　）", "answer": "心电图", "meta_info": "第2篇　心血管系统", "answer_idx": "A", "A": "心电图", "B": "肾功能", "C": "肾上腺B超", "D": "化验血电解质", "language": "zh"}
{"question": "男，50岁。头晕、乏力伴腰痛3个月。血常规：Hb 72g/L，WBC 6.4×109/L，Plt 125×109/L，ESR 106mm/h，血清蛋白电泳见M蛋白带。尿蛋白（＋）。骨髓细胞学检查：幼稚浆细胞占0.42。腰椎X线检查见第2、3椎体压缩性骨折。最可能的诊断是（　　）。", "answer": "多发性骨髓瘤", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "多发性骨髓瘤", "B": "骨转移癌", "C": "慢性肾小球肾炎", "D": "霍奇金淋巴瘤", "language": "zh"}
{"question": "老年人心理卫生保健主要包括（　　）。", "answer": "以上都包括", "meta_info": "医学心理学", "answer_idx": "D", "A": "加强人际交往", "B": "保持乐观情绪", "C": "修养个性", "D": "以上都包括", "language": "zh"}
{"question": "以下对糖尿病检验结果的解释正确的为（　　）。", "answer": "餐后2h血糖正常可以是糖尿病", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "D", "A": "尿糖阴性可以排除糖尿病", "B": "尿糖阳性可以诊断为糖尿病", "C": "尿酮阳性仅见于糖尿病", "D": "餐后2h血糖正常可以是糖尿病", "language": "zh"}
{"question": "3．尿激酶、链激酶（　　）。", "answer": "溶栓治疗", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "脑保护剂", "B": "抗凝治疗", "C": "溶栓治疗", "D": "血液稀释疗法", "language": "zh"}
{"question": "1．卵巢内胚窦瘤标记物是（　　）。", "answer": "血清AFP", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "血清雌激素", "B": "血清CA125", "C": "血清AFP", "D": "血清雄激素", "language": "zh"}
{"question": "容易见到角化珠的癌可以确定为（　　）。", "answer": "分化好的鳞癌", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "分化好的鳞癌", "B": "分化好的腺癌", "C": "分化差的鳞癌", "D": "分化差的腺癌", "language": "zh"}
{"question": "正常婴儿，体重7.5kg，身长68cm。前囟1.0cm，头围44cm。出牙4个。能独坐并能以拇、示指拿取小球。该儿最可能的月龄是（　　）。", "answer": "8个月", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "8个月", "B": "18个月", "C": "12个月", "D": "5个月", "language": "zh"}
{"question": "下列哪项是解热镇痛药解热作用的主要机制？（　　）", "answer": "抑制中枢PG合成", "meta_info": "药理学", "answer_idx": "A", "A": "抑制中枢PG合成", "B": "抑制外周PG合成", "C": "抑制中枢PG降解", "D": "增加中枢PG释放", "language": "zh"}
{"question": "寄生虫感染时，病灶内最常见的浸润细胞是（　　）。", "answer": "嗜酸性粒细胞", "meta_info": "病理学", "answer_idx": "C", "A": "中性粒细胞", "B": "淋巴细胞", "C": "嗜酸性粒细胞", "D": "嗜碱性粒细胞", "language": "zh"}
{"question": "被注销注册的医师如有异议时，可以自收到注销注册通知之日起多少日内，依法申请复议或者向人民法院提起诉讼（　　）。", "answer": "15日", "meta_info": "卫生法规", "answer_idx": "C", "A": "7日", "B": "5日", "C": "15日", "D": "30日", "language": "zh"}
{"question": "男，30岁，骑摩托撞车后受伤20分钟，被警察送入医院。入院后病人已清醒。神经系统检查无阳性发现。X线平片显示：有额颞线形骨折，右股骨干骨折。骨科医师收入院，采取牵引固定。2小时后因病人出现躁动请神经外科会诊。正确的建议应是（　　）。", "answer": "静脉注射适量的安定，立即行CT检查", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "躁动与疼痛有关，可肌肉注射度冷丁50mg", "B": "耐心为患者服务，满足病人的要求", "C": "为了治疗骨折，用镇静剂制动", "D": "静脉注射适量的安定，立即行CT检查", "language": "zh"}
{"question": "对功能减退性内分泌疾病首选的治疗为（　　）。", "answer": "替代治疗", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "B", "A": "对症治疗", "B": "替代治疗", "C": "支持治疗", "D": "放疗及化疗", "language": "zh"}
{"question": "分娩中有助于胎先露进行内旋转的肌肉是（　　）。", "answer": "盆底肛提肌", "meta_info": "第5篇　女性生殖系统", "answer_idx": "D", "A": "子宫平滑肌", "B": "会阴深横肌", "C": "肛门括约肌", "D": "盆底肛提肌", "language": "zh"}
{"question": "某人群随着环境有害物质暴露的增加，所引起的具有某种生物效应的人数随着变化的现象，为（　　）。", "answer": "剂量-反应关系", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "时间-效应关系", "B": "剂量-效应关系", "C": "剂量-反应关系", "D": "剂量-发病关系", "language": "zh"}
{"question": "关于产气荚膜梭菌，不正确的是（　　）。", "answer": "兼性厌氧菌", "meta_info": "医学微生物学", "answer_idx": "A", "A": "兼性厌氧菌", "B": "在牛乳培养基中可出现“汹涌发酵”现象", "C": "产生的α毒素为一种卵磷脂酶", "D": "可导致气性坏疽", "language": "zh"}
{"question": "下列关于肠破裂的叙述错误的是（　　）。", "answer": "十二指肠破裂的发生率最高", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "十二指肠破裂的发生率最高", "B": "十二指肠破裂多发生在第二、三段", "C": "十二指肠破裂发生在腹腔内部分可早期引起腹膜炎", "D": "小肠破裂可行一期修补或切除后一期吻合", "language": "zh"}
{"question": "乳头肌断裂致急性二尖瓣关闭不全时，下列描述正确的是（　　）。", "answer": "左心室大小无明显变化", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "左心室大小无明显变化", "B": "可无症状", "C": "左心房明显扩大", "D": "心电图示SV1＋RV5＞4.0mV", "language": "zh"}
{"question": "男，25岁，爱上了比他大30多岁的婶婶，明知不能继续发生这种性关系，但不能摆脱，而来寻求治疗，对于该患者首选的治疗方法为（　　）。", "answer": "精神分析", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "生物反馈", "B": "精神分析", "C": "放松训练", "D": "系统脱敏", "language": "zh"}
{"question": "气性坏疽的治疗不正确的是（　　）。", "answer": "首选氨基糖苷类抗生素", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "一经诊断，应急诊清创", "B": "伤口用3％的H2O2或1:1000高锰酸钾冲洗", "C": "首选氨基糖苷类抗生素", "D": "高压氧治疗", "language": "zh"}
{"question": "女，55岁，风湿性心脏瓣膜病二尖瓣狭窄15年，心房颤动1年。无活动后心悸和气短，无夜间阵发性呼吸困难。既往无高血压、糖尿病、脑血管病病史。超声心动图提示左房内径5.3cm。患者抗栓治疗的首选药物是（　　）。", "answer": "华法林", "meta_info": "第2篇　心血管系统", "answer_idx": "A", "A": "华法林", "B": "潘生丁（双嘧达莫）", "C": "氯吡格雷", "D": "阿司匹林", "language": "zh"}
{"question": "抗甲状腺药物主要的不良反应是（　　）。", "answer": "粒细胞减少", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "甲状腺肿大", "B": "肝功能损伤", "C": "肾功能损伤", "D": "粒细胞减少", "language": "zh"}
{"question": "男，23岁。3个月前劳务输出首次出国，出现紧张、心慌、易怒、失眠多梦，不愿上班，每天打电话向家人寻求安慰，回国1个月后症状自行缓解，恢复如常。该患者可能的诊断是（　　）。", "answer": "适应障碍", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "社交焦虑障碍", "B": "适应障碍", "C": "创伤后应激障碍", "D": "广泛性焦虑障碍", "language": "zh"}
{"question": "女性，35岁，3年前开始怀疑丈夫对其不忠，时常争吵，近1年来，跟踪丈夫，搜查丈夫的文件包，常听到脑子里有一女子声音说“你可怜”、“你真蠢”之类的话，因此不愿与家人同餐，不敢喝家中水，认为饭里、水里被放了毒药，认为丈夫与外人联合起来害她，病人常常哭泣。体检及神经系统检查无异常，此病人患有精神分裂症的哪种分型？（　　）", "answer": "偏执型", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "紧张型", "B": "单纯型", "C": "偏执型", "D": "青春型", "language": "zh"}
{"question": "中心静脉压的高低取决于下列哪项因素？（　　）", "answer": "心脏射血能力和静脉回心血量之间的相互关系", "meta_info": "生理学", "answer_idx": "C", "A": "血管容量和血量", "B": "动脉血压和静脉血压之差", "C": "心脏射血能力和静脉回心血量之间的相互关系", "D": "外周静脉压", "language": "zh"}
{"question": "胸骨左缘第3肋间舒张期叹气样杂音见于（　　）。", "answer": "主动脉瓣关闭不全", "meta_info": "第2篇　心血管系统", "answer_idx": "B", "A": "二尖瓣关闭不全", "B": "主动脉瓣关闭不全", "C": "肺动脉瓣狭窄", "D": "二尖瓣狭窄", "language": "zh"}
{"question": "以下可引起微小病变型肾病的药物是（　　）。", "answer": "非甾体抗炎药", "meta_info": "第4篇　泌尿系统", "answer_idx": "B", "A": "氨基糖苷类", "B": "非甾体抗炎药", "C": "环孢素A", "D": "磺胺类药物", "language": "zh"}
{"question": "有助于判断中骨盆狭窄的重要指标是（　　）。", "answer": "坐骨切迹宽度", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "髂嵴间径", "B": "髂棘间径", "C": "坐骨结节间径", "D": "坐骨切迹宽度", "language": "zh"}
{"question": "医学伦理学原则中的最高层次是（　　）。", "answer": "全心全意为人民健康服务", "meta_info": "医学伦理学", "answer_idx": "C", "A": "有利于病人", "B": "不伤害病人", "C": "全心全意为人民健康服务", "D": "尊重病人的自主性", "language": "zh"}
{"question": "小儿重症肺炎，最常见的酸碱平衡紊乱是（　　）。", "answer": "混合性酸中毒", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "呼吸性酸中毒", "B": "代谢性酸中毒", "C": "呼吸性碱中毒", "D": "混合性酸中毒", "language": "zh"}
{"question": "男孩，2岁，因呕吐频繁、水样便3天伴发热，于10月底入院，12小时无尿，查体：T 38℃，颜面苍白，皮肤弹性极差，眼窝凹陷，心肺听诊无异常，腹稍胀，肝脾无肿大，跟腱反射未引出，四肢末梢微冷，实验室检查：血钠138mmol/L。1．最可能的诊断是（　　）。", "answer": "轮状病毒肠炎", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "产毒性大肠埃希菌肠炎", "B": "轮状病毒肠炎", "C": "致病性大肠埃希菌肠炎", "D": "侵袭性大肠埃希菌肠炎", "language": "zh"}
{"question": "一小儿体重20kg，身长110cm，身长之中点位于脐与耻骨联合之间，腕部骨化中心出现7个，已出现第一磨牙，没开始换牙。2．小儿腕部骨化中心共有（　　）。", "answer": "10个", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "9个", "B": "10个", "C": "11个", "D": "12个", "language": "zh"}
{"question": "2．空腹血糖正常而餐后血糖明显升高者适合选用（　　）。", "answer": "阿卡波糖", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "C", "A": "二甲双胍", "B": "格列喹酮", "C": "阿卡波糖", "D": "胰岛素", "language": "zh"}
{"question": "医患关系的本质特征是（　　）。", "answer": "具有契约性质的信托关系", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "具有互利性质的经济关系", "B": "具有协作性质的买卖关系", "C": "具有依附性质的非平等关系", "D": "具有契约性质的信托关系", "language": "zh"}
{"question": "一正常小儿身高80cm，前囟已闭，头围47cm，乳牙16枚，能用简单的语言表达自己的需要，对人、事有喜乐之分。1．此小儿的年龄最可能是（　　）。", "answer": "1岁半", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "1岁", "B": "1岁半", "C": "2岁半", "D": "3岁", "language": "zh"}
{"question": "关于HLA—Ⅰ类抗原，下列哪项是正确的（　　）。", "answer": "存在于一切有核细胞上", "meta_info": "医学免疫学", "answer_idx": "C", "A": "只存在于B细胞上", "B": "只存在于白细胞上", "C": "存在于一切有核细胞上", "D": "以上都不正确", "language": "zh"}
{"question": "个性不包括（　　）。", "answer": "情感", "meta_info": "医学心理学", "answer_idx": "D", "A": "性格", "B": "气质", "C": "能力", "D": "情感", "language": "zh"}
{"question": "女，48岁。月经不规则2年余，阴道不规则流血20天。查体：中度贫血貌，子宫略大，稍软，无压痛，宫旁未触及异常。为确定诊断，首选的检查是（　　）。", "answer": "分段诊刮", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "盆腔CT检查", "B": "分段诊刮", "C": "盆腔B超", "D": "阴道镜检查", "language": "zh"}
{"question": "引起支气管哮喘反复发作的最重要的因素是（　　）。", "answer": "气道反应性炎症", "meta_info": "第1篇　呼吸系统", "answer_idx": "D", "A": "遗传因素", "B": "支气管黏膜下迷走神经感受器敏感", "C": "受体功能下降", "D": "气道反应性炎症", "language": "zh"}
{"question": "骶骨骨折时，最容易受损伤的神经是（　　）。", "answer": "S1和S2", "meta_info": "第四部分　运动系统疾病", "answer_idx": "A", "A": "S1和S2", "B": "L4和L5", "C": "L2和L3", "D": "股神经", "language": "zh"}
{"question": "男，60岁。慢性乙型病毒性肝炎病史35年，3次査血甲胎蛋白升高。肝脏触诊无异常。肝功能异常。腹部B超肝脏内见直径2cm占位性病变。对诊断及治疗最有意义的检查是（　　）。", "answer": "腹部增强CT", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "腹部增强CT", "B": "MRCP", "C": "放射性核素扫描", "D": "腹部X线平片", "language": "zh"}
{"question": "下列关于鸟氨酸循环的叙述，正确的是（　　）。", "answer": "鸟氨酸循环主要在肝内进行", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "鸟氨酸循环从氨基甲酰磷酸合成开始", "B": "每经历一次鸟氨酸循环消耗一分子氨", "C": "每经历一次鸟氨酸循环消耗2分子ATP", "D": "鸟氨酸循环主要在肝内进行", "language": "zh"}
{"question": "4．Ⅳ期淋巴瘤（　　）。", "answer": "病变累及左腋下淋巴结及肝脏", "meta_info": "第一部分　血液系统疾病", "answer_idx": "C", "A": "病变仅限于一个解剖部位", "B": "病变累及右侧颈、腋下和腹股沟淋巴结", "C": "病变累及左腋下淋巴结及肝脏", "D": "病变累及右锁骨上淋巴结和左腋下，并伴有高热", "language": "zh"}
{"question": "在临床医学研究中必须尊重受试者的知情同意权，下列做法中不正确的为（　　）。", "answer": "可以利诱受试者，让他同意", "meta_info": "医学伦理学", "answer_idx": "D", "A": "无行为能力者需获得代理同意", "B": "必需获得受试者的知情同意", "C": "禁止用欺骗的手法获得受试者同意", "D": "可以利诱受试者，让他同意", "language": "zh"}
{"question": "3．组胺的前体是（　　）。", "answer": "组氨酸", "meta_info": "生物化学", "answer_idx": "D", "A": "色氨酸", "B": "谷氨酸", "C": "苏氨酸", "D": "组氨酸", "language": "zh"}
{"question": "患者，女，32岁，月经量多已2年，近3个月来感乏力、头晕、心悸，查血红蛋白65g/L，白细胞6.0×109/L，血小板140×109/L，骨髓象：粒比红为1:1，红细胞增生活跃，中晚幼红细胞45%，体积小，胞质偏蓝，首选下列哪项治疗？（　　）", "answer": "口服铁剂", "meta_info": "第一部分　血液系统疾病", "answer_idx": "B", "A": "脾切除", "B": "口服铁剂", "C": "肌注维生素B12", "D": "口服叶酸", "language": "zh"}
{"question": "女，42岁。10年前分娩后闭经。1周前因不洁饮食出现腹泻，食欲减退，精神萎靡，卧床不起。今日上午被家人发现神志不清来急诊。查体：BP 80/50mmHg，皮肤苍白，毛发稀疏，消瘦，心率90次/分，血糖2.4mmol/L，胸部X线检查示“左上肺陈旧性结核”。1．应了解的最重要的既往史是（　　）。", "answer": "分娩出血史", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "胃肠道疾病史", "B": "糖尿病史", "C": "分娩出血史", "D": "结核病史", "language": "zh"}
{"question": "男性，14岁，自幼身体矮小，近3年增长＜5cm，学习成绩好。就诊查体：身高98cm，童音童貌，外生殖器未发育，睾丸小，骨年龄9～10岁。染色体正常，生长激素基础值1.11μg/L（正常0～5μg/L），胰岛素低血糖兴奋试验各时间点值均＜5μg/L。最可能的诊断是（　　）。", "answer": "垂体性侏儒", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "A", "A": "垂体性侏儒", "B": "Laron侏儒", "C": "体质性侏儒", "D": "青春期延迟", "language": "zh"}
{"question": "右心衰竭时水肿形成的主要机制是（　　）。", "answer": "毛细血管内静水压增加", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "血浆胶体渗透压降低", "B": "小动脉壁通透性增加", "C": "毛细血管内静水压增加", "D": "黏多糖在组织间隙内沉积", "language": "zh"}
{"question": "女，48岁。皮肤瘙痒，皮肤及巩膜黄染5年，血清总胆红素320μmol/L，经检查发现胃十二指肠粘连，行胃十二指肠切除术。下列哪种物质吸收不包括在内？（　　）", "answer": "维生素K", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "维生素C", "B": "钙", "C": "维生素D", "D": "维生素K", "language": "zh"}
{"question": "女，28岁。初孕妇，身高147cm。妊娠41周，规律宫缩12小时后孕妇紧张、乏力，BP 140/90mmHg，胎心率140次/分，枕左前位，先露S＝－1，宫口开大9cm，羊水清亮，坐骨棘间径8cm。该患者正确的处理是（　　）。", "answer": "剖宫产", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "徒手旋转胎头", "B": "产钳助娩", "C": "胎头吸引", "D": "剖宫产", "language": "zh"}
{"question": "女，26岁。平素月经规则，停经48天，阴道少量流血5天，偶有腹痛。检查宫颈口关闭，子宫大小与孕周相符。患者可能的诊断是（　　）。", "answer": "先兆流产", "meta_info": "第5篇　女性生殖系统", "answer_idx": "A", "A": "先兆流产", "B": "不全流产", "C": "完全流产", "D": "习惯性流产", "language": "zh"}
{"question": "急性化脓性阑尾炎属于（　　）。", "answer": "蜂窝织炎症", "meta_info": "病理学", "answer_idx": "D", "A": "变质性炎症", "B": "化脓性炎症", "C": "纤维素性炎症", "D": "蜂窝织炎症", "language": "zh"}
{"question": "下列选项与心身疾病的诊断无关的是（　　）。", "answer": "由某种躯体疾病引发心理障碍", "meta_info": "医学心理学", "answer_idx": "D", "A": "器质性病变的临床特点", "B": "排除神经症和精神病", "C": "单纯生物医学措施疗效甚微", "D": "由某种躯体疾病引发心理障碍", "language": "zh"}
{"question": "合成脂肪酸的乙酰CoA主要来自（　　）。", "answer": "糖的分解代谢", "meta_info": "生物化学", "answer_idx": "A", "A": "糖的分解代谢", "B": "胆固醇的分解代谢", "C": "脂肪酸的分解代谢", "D": "生酮氨基酸的分解代谢", "language": "zh"}
{"question": "女，48岁，近1个月感口渴，饮水量增至每天2000mL。身高156 cm，体重71kg，空腹血糖180 mg/dL（10.0 mmol/L），餐后血糖252 mg/dL（14.0 mmol/L），系初次发现血糖高，过去无糖尿病史。3．4年后该患者被发现有浸润型肺结核，降血糖治疗宜（　　）。", "answer": "胰岛素治疗", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "D", "A": "原降血糖药增加剂量", "B": "改用降血糖作用更强的口服降血糖药", "C": "双胍类、磺脲类、α-葡萄糖苷酶抑制剂联合使用", "D": "胰岛素治疗", "language": "zh"}
{"question": "下列有关衣原体正确的描述是（　　）。", "answer": "原体无繁殖能力，有毒性，而网状体有繁殖能力，无毒性", "meta_info": "医学微生物学", "answer_idx": "C", "A": "原体无代谢活性，网状体有代谢活性且胞外稳定性好", "B": "原体较大，网状体较小，所以原体有感染性", "C": "原体无繁殖能力，有毒性，而网状体有繁殖能力，无毒性", "D": "原体胞外稳定性好，个体大，而网状体胞外稳定性差，个体小", "language": "zh"}
{"question": "1．在一个心动周期中，动脉血压的平均值为（　　）。", "answer": "平均动脉压", "meta_info": "生理学", "answer_idx": "C", "A": "舒张压", "B": "脉压", "C": "平均动脉压", "D": "中心静脉压", "language": "zh"}
{"question": "纤维素性炎症的好发部位不包括（　　）。", "answer": "皮肤", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "心包", "B": "气管", "C": "结肠", "D": "皮肤", "language": "zh"}
{"question": "对内分泌功能亢进者，下列哪种治疗最为理想？（　　）", "answer": "手术切除增生或肿瘤", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "A", "A": "手术切除增生或肿瘤", "B": "化学治疗", "C": "药物抑制激素合成", "D": "放射治疗", "language": "zh"}
{"question": "2．烧伤患者发生的溃疡是（　　）。", "answer": "Curling溃疡", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "Cushing溃疡", "B": "Curling溃疡", "C": "食管腐蚀性溃疡", "D": "十二指肠溃疡", "language": "zh"}
{"question": "某医师在为患者施行右侧乳房肿瘤摘除术时，发现左侧乳房也有肿瘤，当即进行活检，确诊为乳腺病。医师判断将来可能癌变，未征求患者意见，同时切除了左侧乳房。医师的这种做法，违背了该病人的哪种权利？（　　）", "answer": "知情同意权", "meta_info": "医学伦理学", "answer_idx": "C", "A": "保密权", "B": "隐私权", "C": "知情同意权", "D": "获得信息权", "language": "zh"}
{"question": "引起继发性肺动脉高压最常见的原因是（　　）。", "answer": "慢性阻塞性肺疾病", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "慢性阻塞性肺疾病", "B": "肺结核", "C": "肺血栓栓塞", "D": "间质性肺炎", "language": "zh"}
{"question": "某患者双上肢痛温觉障碍，触觉和深感觉正常，病损部位在（　　）。", "answer": "颈5～胸2脊髓前联合", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "双侧颈5～胸8后根", "B": "双侧臂丛", "C": "颈5～胸2脊髓前联合", "D": "双侧颈膨大后索", "language": "zh"}
{"question": "患者，男，56岁，充血性心力衰竭，心率长期维持在100～110次/min。口服地高辛0.25mg每日1次，治疗2周后心室率无明显下降。为了控制心室率，应首选的措施是（　　）。", "answer": "β受体阻断药", "meta_info": "第2篇　心血管系统", "answer_idx": "D", "A": "加用普罗帕酮", "B": "加用胺碘酮", "C": "加用维拉帕米", "D": "β受体阻断药", "language": "zh"}
{"question": "急性苯中毒主要损害的是（　　）。", "answer": "神经系统", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "血液系统", "B": "神经系统", "C": "消化系统", "D": "呼吸系统", "language": "zh"}
{"question": "2．金黄色葡萄球菌蛋白A（　　）。", "answer": "超抗原", "meta_info": "医学免疫学", "answer_idx": "D", "A": "半抗原", "B": "自身抗原", "C": "同种异型抗原", "D": "超抗原", "language": "zh"}
{"question": "1．卵巢未成熟畸胎瘤（　　）。", "answer": "有恶性程度的逆转倾向", "meta_info": "第5篇　女性生殖系统", "answer_idx": "B", "A": "是最常见的卵巢良性肿瘤", "B": "有恶性程度的逆转倾向", "C": "具有男性化作用", "D": "CA125升高", "language": "zh"}
{"question": "患者，男，40岁，干部。近1个月出现情绪低落，对工作及娱乐全没有兴趣，卧床多，不思饮食，入睡困难，早醒，有轻生想法。2．目前治疗宜首选（　　）。", "answer": "SSRIs", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "传统抗精神病药物", "B": "非典型抗精神病药物", "C": "MAOIs", "D": "SSRIs", "language": "zh"}
{"question": "1．遗忘综合征的主要特征是（　　）。", "answer": "无意识障碍，近记忆力障碍明显，智能相对完好", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "无意识障碍，近记忆力障碍明显，智能相对完好", "B": "逐渐加重的记忆障碍及痴呆", "C": "突发昼轻夜重的神志不清", "D": "以近记忆力障碍为首发症状可伴人格改变", "language": "zh"}
{"question": "四环素族抗生素对细菌有选择性作用的原因是因为（　　）。", "answer": "可与30S亚基结合", "meta_info": "生物化学", "answer_idx": "A", "A": "可与30S亚基结合", "B": "可与50S亚基结合", "C": "可与40S亚基结合", "D": "可与60S亚基结合", "language": "zh"}
{"question": "女，45岁。尿频、尿急、尿痛2天，伴高热、寒战、腰痛半天。查体：T 39℃，BP110／70mmHg，左肾区有叩击痛。尿常规：蛋白（＋），RBC 2～5/HP，WBC 40～50/HP。最可能的诊断是（　　）。", "answer": "急性肾盂肾炎", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "肾肿瘤", "B": "肾结核", "C": "急性肾盂肾炎", "D": "慢性肾盂肾炎", "language": "zh"}
{"question": "女性，18岁，咳嗽4个月，伴低热，1个月前右膝部外伤。查体：跛行，右股四头肌萎缩，右膝肿胀，浮髌试验（+）。1．该患者应首先进行哪一项检查？（　　）", "answer": "胸部平片及右膝正侧位片", "meta_info": "第四部分　运动系统疾病", "answer_idx": "D", "A": "右膝CT", "B": "血沉", "C": "右膝穿刺抽液，生化检查及细菌培养", "D": "胸部平片及右膝正侧位片", "language": "zh"}
{"question": "对于溶血性贫血下述哪项是错误的？（　　）", "answer": "血清结合珠蛋白升高", "meta_info": "第一部分　血液系统疾病", "answer_idx": "B", "A": "血涂片中出现幼红细胞", "B": "血清结合珠蛋白升高", "C": "血清间接胆红素升高", "D": "红细胞寿命缩短", "language": "zh"}
{"question": "大肠癌最好发的部位是（　　）。", "answer": "直肠", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "升结肠", "B": "直肠", "C": "横结肠", "D": "降结肠", "language": "zh"}
{"question": "下列关于ATP合成酶的叙述，正确的是（　　）。", "answer": "结构中存在质子通道", "meta_info": "生物化学", "answer_idx": "C", "A": "位于线粒体外膜上", "B": "催化AMP磷酸化生成ATP", "C": "结构中存在质子通道", "D": "有一个亚基称为寡霉素", "language": "zh"}
{"question": "正常成人每天每公斤体重静息能量消耗（BEE）为（　　）。", "answer": "25kcal", "meta_info": "第八部分　其他疾病", "answer_idx": "B", "A": "15kcal", "B": "25kcal", "C": "30kcal", "D": "35kcal", "language": "zh"}
{"question": "急性坏死性胰腺炎常发生（　　）。", "answer": "血清脂肪酶升高", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "血钙升高", "B": "血清脂肪酶升高", "C": "血淀粉酶降低", "D": "血钾升高", "language": "zh"}
{"question": "12个月小儿，标准头围是（　　）。", "answer": "46cm", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "34cm", "B": "38cm", "C": "44cm", "D": "46cm", "language": "zh"}
{"question": "女性，28岁。发热、颈部疼痛1周，伴心慌、多汗，甲状腺Ⅱ度肿大，左侧可触及结节，质韧，有触痛，未闻及血管杂音；甲状腺吸131I率：3h 5%，24h 10%；FT4 32.2pmol/L（正常9.0～24.0pmol/L），FT3 6.8pmol/L（正常2.1～5.4pmol/L）。该患者最可能的诊断是（　　）。", "answer": "亚急性甲状腺炎", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "C", "A": "Graves病", "B": "结节性甲状腺肿伴甲亢", "C": "亚急性甲状腺炎", "D": "慢性淋巴细胞性甲状腺炎", "language": "zh"}
{"question": "患儿，女，6岁，近2周发热，伴肘膝大关节不规则肿痛；查体发现心音低钝，心率176次/分，肝于右肋下可触及3cm；实验室检查发现抗链“O”＞500U，血沉65mm/h。诊断为风湿热，并伴有心功能不全。治疗需给洋地黄制剂，剂量应如何掌握？（　　）", "answer": "给1/3～1/2", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "给足剂量", "B": "给1/3～1/2", "C": "给1/4～1/3", "D": "给1/2～1/4", "language": "zh"}
{"question": "70岁平素健康男性患者，股骨头下骨折，有移位，较恰当的治疗是（　　）。", "answer": "人工股骨头置换术", "meta_info": "第四部分　运动系统疾病", "answer_idx": "C", "A": "三刃行内固定", "B": "皮牵引", "C": "人工股骨头置换术", "D": "不需特殊治疗，卧床休息", "language": "zh"}
{"question": "上消化道出血最常见的病因是（　　）。", "answer": "消化性溃疡", "meta_info": "第二部分　模拟试题", "answer_idx": "B", "A": "食管贲门黏膜撕裂综合征", "B": "消化性溃疡", "C": "胆道出血", "D": "胃癌", "language": "zh"}
{"question": "关于干扰素，不正确的是（　　）。", "answer": "抗病毒感染具有特异性", "meta_info": "医学微生物学", "answer_idx": "C", "A": "诱导细胞产生抗病毒蛋白", "B": "具有种属特异性", "C": "抗病毒感染具有特异性", "D": "可增强NK细胞的杀伤活性", "language": "zh"}
{"question": "与血栓形成无关的是（　　）。", "answer": "纤维蛋白溶解酶增多", "meta_info": "病理学", "answer_idx": "D", "A": "心血管内膜损伤", "B": "血小板数量增多", "C": "癌细胞崩解产物", "D": "纤维蛋白溶解酶增多", "language": "zh"}
{"question": "关于核苷酸合成代谢的叙述，错误的是（　　）。", "answer": "嘌呤核苷酸从头合成主要场所在脑和骨髓", "meta_info": "生物化学", "answer_idx": "D", "A": "PRPP参与嘌呤、嘧啶的从头合成", "B": "PRPP参与嘌呤、嘧啶的补救合成", "C": "嘌呤核苷酸从头合成首先生成的是IMP", "D": "嘌呤核苷酸从头合成主要场所在脑和骨髓", "language": "zh"}
{"question": "青年男性患者，自高处坠落3h后送入医院，自诉胸背部疼痛，双下肢不能活动。3．CT显示胸11椎体爆裂性骨折，胸11椎体压缩l／2，椎管内有较大骨折块，同时伴有关节突交锁，合理的治疗方案是（　　）。", "answer": "手术减压，脊柱内固定术", "meta_info": "第四部分　运动系统疾病", "answer_idx": "A", "A": "手术减压，脊柱内固定术", "B": "手术切除相应椎板使脊髓减压", "C": "手法复位并行推拿治疗", "D": "颅骨牵引并使用激素及脱水药物", "language": "zh"}
{"question": "兴奋性突触后电位的产生，是由于突触后膜对下列哪种离子提高了通透性？（　　）", "answer": "Na+、K+，尤其是对Na+", "meta_info": "生理学", "answer_idx": "B", "A": "Na+、K+、Cl-，尤其是对K+", "B": "Na+、K+，尤其是对Na+", "C": "K+、Cl-，尤其是对Cl-", "D": "K+、Ca2+、Na+，尤其是对Ca2+", "language": "zh"}
{"question": "3．未经医师注册取得执业证书的（　　）。", "answer": "不得从事医师执业活动", "meta_info": "卫生法规", "answer_idx": "C", "A": "只准从事医疗业务", "B": "只准从事预防业务", "C": "不得从事医师执业活动", "D": "可以重新申请医师执业注册", "language": "zh"}
{"question": "男性，45岁，体胖，平素食欲佳。近1个月饮水量逐渐增多，每日约l500ml，尿量多，空腹血糖6.7mmol/L（120mg/dl），尿糖（+）。应做哪些检查来确诊糖尿病（　　）。", "answer": "葡萄糖耐量试验", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "C", "A": "24小时尿糖定量", "B": "皮质素葡萄糖耐量试验", "C": "葡萄糖耐量试验", "D": "24小时尿糖定量", "language": "zh"}
{"question": "下列哪种疾病的防治策略是打破免疫耐受（　　）。", "answer": "肿瘤", "meta_info": "医学免疫学", "answer_idx": "C", "A": "超敏反应性疾病", "B": "移植排斥反应", "C": "肿瘤", "D": "免疫缺陷病", "language": "zh"}
{"question": "Addison病应用。肾上腺皮质激素替代治疗，正确的为（　　）。", "answer": "应终生使用激素替代治疗", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "A", "A": "应终生使用激素替代治疗", "B": "给药途径以肌内注射为主", "C": "只有当感染、创伤等应激情况时才应用", "D": "合并结核时禁用", "language": "zh"}
{"question": "初产妇，25岁，确诊为急性乳腺炎，下列叙述错误的是（　　）。", "answer": "已形成脓肿，应切开排脓，切口应包绕乳头呈环状", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "全身应用抗生素", "B": "饮食宜清淡，易消化，忌辛辣", "C": "停止患侧哺乳，以吸乳器吸出乳汁", "D": "已形成脓肿，应切开排脓，切口应包绕乳头呈环状", "language": "zh"}
{"question": "患儿，4岁，近1个月来发热，面色渐苍白，多汗，易疲倦.近几日四肢大关节游走性疼痛。为确定是否为风湿性关节炎，医生做了一些检查，下述哪项对风湿性的可能有提示作用？（　　）", "answer": "抗链“O”", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "血沉", "B": "抗链“O”", "C": "心电图", "D": "血常规", "language": "zh"}
{"question": "心理测验应遵循的原则是（　　）。", "answer": "标准化、保密性、客观性", "meta_info": "医学心理学", "answer_idx": "D", "A": "真诚、中立、回避", "B": "自强、自立、自省", "C": "信度、效度、常模", "D": "标准化、保密性、客观性", "language": "zh"}
{"question": "CD8+Th细胞活化的第二信号是（　　）。", "answer": "CD4+Th与APC间黏附分子的作用", "meta_info": "医学免疫学", "answer_idx": "D", "A": "IL-2的作用", "B": "IL-1受体的表达", "C": "IL-5的作用", "D": "CD4+Th与APC间黏附分子的作用", "language": "zh"}
{"question": "男性，30岁，近一个月来反复照镜子，感到自己的耳朵特别大，脸变丑了，终日不敢出屋。此症状是（　　）。", "answer": "人格解体", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "幻觉", "B": "妄想", "C": "定向障碍", "D": "人格解体", "language": "zh"}
{"question": "男，36岁，反复乏力、恶心、纳差3年，明确诊断为慢性乙型病毒性肝炎，肝功时有波动。10天前因参加麦收而过于劳累，近1周来感高度乏力、食欲不振，伴恶心、呕吐、腹胀、尿黄，皮肤、巩膜黄疸进行性加深。化验：肝功TBIL 342μmol/L，DBIL170μmol/L，ALT 160U/L，HBsAg阳性。2．为进一步明确诊断，下列哪一项检查意义最小？（　　）", "answer": "血、尿常规检查", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "D", "A": "凝血酶原时问测定", "B": "胆碱酯酶活力测定", "C": "胆固醇含量测定", "D": "血、尿常规检查", "language": "zh"}
{"question": "对于实验动物切除胸腺后（新生期）机体淋巴结，叙述正确的是（　　）。", "answer": "深皮质缺乏T细胞", "meta_info": "医学免疫学", "answer_idx": "A", "A": "深皮质缺乏T细胞", "B": "浅皮质缺乏T细胞", "C": "生发中心缺乏T细胞", "D": "深皮质区无明显变化", "language": "zh"}
{"question": "女，28岁。在心理咨询中谈到所交的两个男朋友她都很喜欢，不知道该与哪个继续相处，难以做出抉择，希望得到帮助，而根据心理治疗的原则，心理咨询师没有替她做出决定。该咨询师遵循的原则是（　　）。", "answer": "中立原则", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "灵活原则", "B": "中立原则", "C": "耐心原则", "D": "回避原则", "language": "zh"}
{"question": "女，40岁。颈肩痛3个月，伴右手麻木，无视物模糊、步态不稳和眩晕。查体：颈部压缩，伴右上肢放射痛，压头试验阳性，右手“虎口区”麻木，右侧伸腕肌肌力减弱，Hoffrnann征阳性，考虑颈椎病。最可能的类型是（　　）。", "answer": "神经根型", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "神经根型", "B": "椎动脉型", "C": "脊髓型", "D": "复合型", "language": "zh"}
{"question": "关于慢性肺源性心脏病心力衰竭的病人使用利尿剂，下列哪项是正确的？（　　）", "answer": "血钾不高，利尿同时，只要患者有正常排尿即应常规补钾", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "出现水肿即可使用", "B": "血钾不高，利尿同时，只要患者有正常排尿即应常规补钾", "C": "为避免出现代谢性碱中毒，常用醋唑磺胺", "D": "足量，持续使用效果较好", "language": "zh"}
{"question": "1．哪项是NAD+中所含的维生素？（　　）", "answer": "维生素PP", "meta_info": "生物化学", "answer_idx": "D", "A": "泛酸", "B": "维生素B2", "C": "维生素B", "D": "维生素PP", "language": "zh"}
{"question": "A型性格的人易患下述何种疾病?（　　）", "answer": "冠心病", "meta_info": "医学心理学", "answer_idx": "B", "A": "支气管哮喘", "B": "冠心病", "C": "癌症", "D": "糖尿病", "language": "zh"}
{"question": "3．发出镫骨肌支以上处面神经炎引起（　　）。", "answer": "单侧周围性面瘫伴同侧舌前2/3味觉丧失及听觉过敏", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "单侧周围性面瘫", "B": "单侧周围性面瘫伴Hunt综合征", "C": "单侧周围性面瘫伴同侧舌前2/3味觉丧失", "D": "单侧周围性面瘫伴同侧舌前2/3味觉丧失及听觉过敏", "language": "zh"}
{"question": "霍奇金病最有诊断意义的细胞是（　　）。", "answer": "R-S细胞", "meta_info": "第一部分　血液系统疾病", "answer_idx": "A", "A": "R-S细胞", "B": "陷窝细胞", "C": "多形性瘤细胞", "D": "嗜酸性细胞", "language": "zh"}
{"question": "5个月女孩，因发热3天，呕吐2天伴惊厥2次就诊。平时体健，已接种卡介苗，否认结核接触史。2．最可能的诊断是（　　）。", "answer": "化脓性脑膜炎", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "高热惊厥", "B": "中毒型痢疾", "C": "化脓性脑膜炎", "D": "结核性脑膜炎", "language": "zh"}
{"question": "男，65岁。排便次数增加6个月，伴里急后重、排便不尽感。1个月来大便变细，偶有大便表面带血，自觉乏力，体重减轻4kg。1．首选的检查方法是（　　）。", "answer": "直肠指检", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "直肠指检", "B": "腹部超声", "C": "结肠镜", "D": "腹部CT", "language": "zh"}
{"question": "关于胃肠神经支配的叙述，正确的是（　　）。", "answer": "去除外来神经后，仍能完成局部反射", "meta_info": "生理学", "answer_idx": "C", "A": "所有副交感神经节后纤维均以乙酰胆碱为递质", "B": "外来神经对内在神经无调节作用", "C": "去除外来神经后，仍能完成局部反射", "D": "内在神经丛存在于黏膜下层和平滑肌之间", "language": "zh"}
{"question": "患者，女，40岁，洗衣时突发右侧肢体活动不灵。查体：意识清，失语，二尖瓣区可闻双期杂音，心律不齐，右侧偏瘫，上肢重于下肢，偏身痛觉减退。其诊断最可能是（　　）。", "answer": "脑栓塞", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "脑栓塞", "B": "脑血栓形成", "C": "脑出血", "D": "短暂脑缺血发作", "language": "zh"}
{"question": "测定蛋白质样品中某种相对分子质量的蛋白质最佳的方法是（　　）。", "answer": "免疫印迹试验(Western blotting)", "meta_info": "医学免疫学", "answer_idx": "B", "A": "免疫PCR", "B": "免疫印迹试验(Western blotting)", "C": "斑点杂交", "D": "Southern blotting", "language": "zh"}
{"question": "未成熟B细胞表面的标志是（　　）。", "answer": "mIgM", "meta_info": "医学免疫学", "answer_idx": "D", "A": "IgA", "B": "IgG", "C": "IgE", "D": "mIgM", "language": "zh"}
{"question": "男，38岁。因胃癌行胃大部分切除术，术前查Hb 110g/L，术中失血约1000ml，已输入平衡盐溶液2000ml，术后第1天感胸闷、气促。查体：T 37.0℃，BP 100/60mmHg。实验室检查：Hb 80g/L。最好应给患者输（　　）。", "answer": "悬浮红细胞", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "悬浮红细胞", "B": "浓缩血小板", "C": "全血", "D": "新鲜冰冻血浆", "language": "zh"}
{"question": "下列哪项不参与DNA复制?（　　）", "answer": "光修复酶", "meta_info": "生物化学", "answer_idx": "D", "A": "解链酶、拓扑酶", "B": "DNA聚合酶", "C": "模板、引物", "D": "光修复酶", "language": "zh"}
{"question": "管理本行政区域内医师工作的机构是（　　）。", "answer": "县级以上地方人民政府卫生行政部门", "meta_info": "卫生法规", "answer_idx": "C", "A": "县级以上人民政府工商行政部门", "B": "县级以上人民政府劳动人事部门", "C": "县级以上地方人民政府卫生行政部门", "D": "各级政府", "language": "zh"}
{"question": "男，40岁。右小腿不慎被手榴弹炸伤3小时，包扎后就诊。查体：右小腿后不规则伤口长4cm。肌肉破损、渗血，有弹药污染。宜采取的处理方法是（　　）。", "answer": "清创、引流后延期缝合", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "消毒、探查伤口后包扎", "B": "清创、引流缝合伤口", "C": "清创、引流后延期缝合", "D": "清创缝合伤口", "language": "zh"}
{"question": "2．胆总管远端单发1.0cm嵌顿结石目前常用术式是（　　）。", "answer": "奥狄（Oddis）括约肌切开成形术", "meta_info": "第3篇　消化系统", "answer_idx": "D", "A": "胆总管切开、T管引流术", "B": "肝内胆管空肠吻合术", "C": "胆总管切开、肝总管空肠Y型吻合术", "D": "奥狄（Oddis）括约肌切开成形术", "language": "zh"}
{"question": "某男性，28岁，经常在出家门以后担心门没有锁好，为此多次检查方可离去，以致有时上班迟到，为此来医院检查。3．数周以后，此病人说他所以要反复检查门锁是因为防止有人迫害他，因而要把房门锁好，此时病人的诊断应当考虑是（　　）。", "answer": "精神分裂症", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "神经症", "B": "精神分裂症", "C": "抑郁症", "D": "人格障碍", "language": "zh"}
{"question": "用于胃切除后引起的缺铁性贫血（　　）。", "answer": "右旋糖酐铁注射", "meta_info": "第一部分　血液系统疾病", "answer_idx": "C", "A": "糖皮质激素", "B": "切脾术", "C": "右旋糖酐铁注射", "D": "输血", "language": "zh"}
{"question": "肺炎支原体肺炎临床特点，正确的是（　　）。", "answer": "剧烈咳嗽突出", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "小婴儿多见", "B": "多无发热", "C": "剧烈咳嗽突出", "D": "头孢菌素治疗", "language": "zh"}
{"question": "测定乙型肝炎病毒表面抗原的亚型有助于（　　）。", "answer": "流行病学调查", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "B", "A": "评定传染性大小", "B": "流行病学调查", "C": "病原学诊断", "D": "判断预后", "language": "zh"}
{"question": "3．反复使用某种精神活性物质，对该物质的耐受性增高，减少或停用后出现戒断症状（　　）。", "answer": "依赖综合征", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "Wernick脑病", "B": "依赖综合征", "C": "脑震荡后综合征", "D": "Korsakoff综合征", "language": "zh"}
{"question": "6个月患儿，吐泻2天，呼吸46次/分，脉搏124次/分，皮肤弹性较差，哭时泪少，血钠136mmol/L，血钾4.0mmo/L，CO2CP14mmol/L，此患儿脱水程度及性质考虑（　　）。", "answer": "中度脱水，等渗性", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "轻度脱水，低渗性", "B": "轻度脱水，等渗性", "C": "中度脱水，低渗性", "D": "中度脱水，等渗性", "language": "zh"}
{"question": "下列预防和治疗术后肺不张的措施中，不恰当的是（　　）。", "answer": "术后胸、腹部切口应紧紧固定或绑扎", "meta_info": "第八部分　其他疾病", "answer_idx": "D", "A": "防止呕吐", "B": "鼓励咳痰", "C": "术前锻炼深呼吸", "D": "术后胸、腹部切口应紧紧固定或绑扎", "language": "zh"}
{"question": "下列哪项为支持安乐死的理由?（　　）", "answer": "人有死亡的权利", "meta_info": "医学伦理学", "answer_idx": "B", "A": "人无权主宰自己的生命", "B": "人有死亡的权利", "C": "活着是每个人不可剥夺的权利", "D": "安乐死的志愿难以确定", "language": "zh"}
{"question": "1．《医疗事故处理条例》规定，残疾生活补助费应根据伤残等级，自定残之月起最长赔偿 （　　） 。", "answer": "30年", "meta_info": "卫生法规", "answer_idx": "D", "A": "5年", "B": "10年", "C": "15年", "D": "30年", "language": "zh"}
{"question": "囊尾蚴在人体最常见的寄生部位是（　　）。", "answer": "皮下及肌肉", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "脊髓", "B": "心脏", "C": "眼", "D": "皮下及肌肉", "language": "zh"}
{"question": "2．远端易向后移位（　　）。", "answer": "股骨干下1/3骨折", "meta_info": "第四部分　运动系统疾病", "answer_idx": "C", "A": "股骨干上1/3骨折", "B": "股骨干中1/3骨折", "C": "股骨干下1/3骨折", "D": "胫骨骨折", "language": "zh"}
{"question": "下列哪项是弥漫性毛细血管内增生性肾小球肾炎电镜下的病变特点？（　　）", "answer": "肾小球毛细血管基底膜和脏层上皮细胞下见致密沉积物", "meta_info": "病理学", "answer_idx": "B", "A": "肾小球毛细血管基底膜内皮细胞下见致密沉积物", "B": "肾小球毛细血管基底膜和脏层上皮细胞下见致密沉积物", "C": "肾小球毛细血管基底膜内见致密沉积物", "D": "肾小球毛细血管基底膜有缺损", "language": "zh"}
{"question": "下列疾病中与朊病毒感染无关的是（　　）。", "answer": "亚急性硬化性全脑炎", "meta_info": "医学微生物学", "answer_idx": "C", "A": "羊瘙痒病", "B": "疯牛病", "C": "亚急性硬化性全脑炎", "D": "传染性痴呆", "language": "zh"}
{"question": "男，10岁，右大腿下端剧痛8天，寒战、高热，右膝不敢活动。体检：T39.5℃，P100次/分，右膝上方肿块，有深压痛，皮肤明显发红，血常规WBC 25000/mm，中性粒细胞90％，核左移。X线平片股骨未见异常。静滴青霉素400万U/d×3天，症状无明显好转。1．诊断应考虑为（　　）。", "answer": "急性化脓性骨髓炎", "meta_info": "第四部分　运动系统疾病", "answer_idx": "D", "A": "急性蜂窝质炎", "B": "急性化脓性关节炎", "C": "急性风湿性关节炎", "D": "急性化脓性骨髓炎", "language": "zh"}
{"question": "病儿，6个月，因便秘、食欲差、嗜睡、反应迟钝来诊。查体：体温：35.5℃，脉搏100次/分，呼吸30次/分，皮肤粗糙，干燥，头大，颈短，眼距宽，鼻梁宽平，腹胀，脐疝。2．为明确诊断应做哪一项检查？（　　）", "answer": "T3、T4、TSH", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "染色体检查", "B": "T3、T4、TSH", "C": "三氯化铁试验", "D": "代谢病筛查", "language": "zh"}
{"question": "慢性活动性胃炎最主要的病因是（　　）。", "answer": "幽门螺旋杆菌感染", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "饮食和环境因素", "B": "幽门螺旋杆菌感染", "C": "药物", "D": "应激", "language": "zh"}
{"question": "下列哪一种试验能明确区分脊髓灰质炎病毒的三个血清型（　　）。", "answer": "中和试验", "meta_info": "医学微生物学", "answer_idx": "B", "A": "补体结合试验", "B": "中和试验", "C": "蛋白质印迹法", "D": "血吸试验", "language": "zh"}
{"question": "结核病预防性化疗通常选用的药物是（　　）。", "answer": "异烟肼", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "异烟肼", "B": "链霉素", "C": "吡嗪酰胺", "D": "乙胺丁醇", "language": "zh"}
{"question": "根据CCMD-3，下列哪项不符合精神分裂症的诊断标准？（　　）", "answer": "一般继发于意识障碍", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "反复出现的言语性幻听", "B": "原发性妄想", "C": "社会功能严重受损", "D": "一般继发于意识障碍", "language": "zh"}
{"question": "智商同为85，其一是山区农民，结合他受教育程度和所处环境，考虑其智力基本正常；其二是某大学教授，结合其他表现，考虑有大脑退行性改变的可能，这是遵循心理测验的（　　）。", "answer": "客观性原则", "meta_info": "第二部分　模拟试题", "answer_idx": "C", "A": "标准化原则", "B": "保密性原则", "C": "客观性原则", "D": "以上都不是", "language": "zh"}
{"question": "肿瘤的恶性程度高低决定于（　　）。", "answer": "肿瘤细胞的分化程度", "meta_info": "病理学", "answer_idx": "C", "A": "肿瘤的发生部位", "B": "肿瘤的肉眼形态改变", "C": "肿瘤细胞的分化程度", "D": "肿瘤的生长速度", "language": "zh"}
{"question": "一腹泻婴儿，体重6kg，中度脱水，血清钠135mmol/L，第一天补液总量为（　　）。", "answer": "720～900ml", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "720～900ml", "B": "600～720ml", "C": "900～1080ml", "D": "1000～l200ml", "language": "zh"}
{"question": "女性，45岁，8个月来双侧掌指和指间关节肿痛伴晨僵，饮食正常，下肢不肿，X线片见关节间隙变窄，胸片见两侧少量胸水。此病人出现胸水的最大可能是（　　）。", "answer": "类风湿关节炎性胸膜炎", "meta_info": "第五部分　风湿免疫性疾病", "answer_idx": "A", "A": "类风湿关节炎性胸膜炎", "B": "系统性红斑狼疮性胸膜炎", "C": "结核性胸膜炎", "D": "右心衰竭", "language": "zh"}
{"question": "某患者脊髓腰段横断外伤后出现尿失禁，其机制为（　　）。", "answer": "初级排尿中枢与大脑皮质失去联系", "meta_info": "生理学", "answer_idx": "B", "A": "排尿反射传人神经受损", "B": "初级排尿中枢与大脑皮质失去联系", "C": "脊髓初级排尿中枢损伤", "D": "排尿反射传出神经受损", "language": "zh"}
{"question": "一位肿瘤病学专家在同事的协助下，为一肺癌病人做胸穿，抽出了1000毫升胸水。第二天早上交班时，这位专家问当班护士：此病人是什么时候做的胸穿？你注意观察了吗？病人的呼吸、心跳怎样？……护士有些紧张，答得不完全。这位专家说：这些内容医师要管，护士也要管，我们应共同努力。4．下述医师做法或叙述中，不符合“彼此平等、互相尊重”这一原则的为（　　）。", "answer": "护士发现医嘱中有点疑问，及时向医师提出，医师认为护士多事，才上了几天班，你懂什么", "meta_info": "医学伦理学", "answer_idx": "C", "A": "下级医师为上级医师掩饰失误，损害了病人利益", "B": "医师发现检验师检验报告不合格，只是当着病人的面说些“水平太低了”的话，然后又开出另一种检验项目单，嘱病人去做", "C": "护士发现医嘱中有点疑问，及时向医师提出，医师认为护士多事，才上了几天班，你懂什么", "D": "上级主管部门就病人反映的某医师开CT检查单而分得“开单费”的违规问题而来调查情况时，因怕伤害朋友情面和影响科室创收，知情医师不配合", "language": "zh"}
{"question": "通过抑制血管紧张素Ⅰ转换酶而发挥治疗慢性心功能不全作用的代表药有（　　）。", "answer": "卡托普利", "meta_info": "药理学", "answer_idx": "B", "A": "地高辛", "B": "卡托普利", "C": "氯沙坦", "D": "硝普钠", "language": "zh"}
{"question": "酶竞争性抑制剂的特点是（　　）。", "answer": "Km值增高，Vmax不变", "meta_info": "生物化学", "answer_idx": "D", "A": "Km值不变，Vmax降低", "B": "Km值不变，Vmax增高", "C": "Km值降低，Vmax降低", "D": "Km值增高，Vmax不变", "language": "zh"}
{"question": "患者，8个月，因面色苍白20天入院。查体：贫血外观，肝于右肋入触及2.5cm。血象：Hb80g/L，RBC3.08×1012/L。诊断为小细胞低色素性贫血，给予铁剂治疗，如有效，网织红细胞何时可达高峰？（　　）", "answer": "7～10天", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "2～4天", "B": "4～6天", "C": "6～8天", "D": "7～10天", "language": "zh"}
{"question": "下列哪项是构成移植物排斥反应的损伤机制中最主要的作用?（　　）", "answer": "Tc的细胞毒作用", "meta_info": "医学免疫学", "answer_idx": "C", "A": "Th产生α-TNF的作用", "B": "NK活化后杀伤的植物", "C": "Tc的细胞毒作用", "D": "活化的Mφ发挥的效应", "language": "zh"}
{"question": "脑干损伤的诊断依据下列哪项不适当？（　　）", "answer": "影像检查多有阳性发现，确诊需要CT检查", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "瞳孔不等大、缩小或多变，两侧眼球分离或其他眼姿异常", "B": "颅神经损害加交叉性麻痹或双侧锥体束征或伴有去大脑强直", "C": "生命体征变化：心血管功能紊乱多在呼吸改变或停止以后出现", "D": "影像检查多有阳性发现，确诊需要CT检查", "language": "zh"}
{"question": "1．治疗霍奇金病首选（　　）。", "answer": "MOPP方案", "meta_info": "第一部分　血液系统疾病", "answer_idx": "C", "A": "DA方案", "B": "MP方案", "C": "MOPP方案", "D": "VP方案", "language": "zh"}
{"question": "再障最主要的诊断依据是（　　）。", "answer": "骨髓增生不良", "meta_info": "第一部分　血液系统疾病", "answer_idx": "C", "A": "网织红细胞减少", "B": "全血细胞减少，有出血或感染表现", "C": "骨髓增生不良", "D": "肝脾淋巴结不肿大", "language": "zh"}
{"question": "氮杂丝氨酸能干扰或阻断核苷酸合成是因为其化学结构类似于？（　　）", "answer": "谷氨酰胺", "meta_info": "生物化学", "answer_idx": "D", "A": "谷氨酸", "B": "丝氨酸", "C": "天冬氨酸", "D": "谷氨酰胺", "language": "zh"}
{"question": "患者，男，16岁。骤起严重水肿入院，血压正常，腹水征（＋），尿蛋白（＋＋＋＋），红细胞0～2个/HP，24小时尿蛋白定量6g，血Cr 100μmol/L，血C3正常，血白蛋白24g/L。入院后予泼尼松每日40mg口服。2周后肾活检示：肾小球系膜轻度增生，肾小管上皮细胞空泡变性，免疫荧光检查（－），电镜下见上皮细胞足突融合。治疗6周后蛋白尿明显减少，8周后完全缓解。3．本例病理诊断应为（　　）。", "answer": "微小病变肾病", "meta_info": "第4篇　泌尿系统", "answer_idx": "B", "A": "系膜增生性肾炎", "B": "微小病变肾病", "C": "IgA肾病", "D": "膜性肾病", "language": "zh"}
{"question": "女性，31岁。产后3周，左乳房胀痛3天，伴寒战、发热。体检：左乳外上象限红肿，可触及一4cm×5cm大肿块，局部温度高，触痛明显，有波动感。血常规：WBC12.3×109/L，N92%。诊断为急性乳腺炎，首选的治疗是（　　）。", "answer": "局部切开引流加广谱抗菌素", "meta_info": "第八部分　其他疾病", "answer_idx": "D", "A": "局部热敷加广谱抗菌素", "B": "中药口服加广谱抗菌素", "C": "排空乳汁加广谱抗菌素", "D": "局部切开引流加广谱抗菌素", "language": "zh"}
{"question": "男，21岁，右利，突然癫痫发作并伴头痛、呕吐、颈项强直、低热、命名性失语。3．哪项检查对初步定位诊断最有帮助？（　　）", "answer": "语言检查", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "锥体束征检查", "B": "眼底检查", "C": "语言检查", "D": "音叉试验", "language": "zh"}
{"question": "下列有关DNA双螺旋结构的叙述，错误的是（　　）。", "answer": "两股单链从5′至3′端走向在空间排列相同", "meta_info": "生物化学", "answer_idx": "D", "A": "DNA双螺旋是核酸二级结构的重要形式", "B": "DNA双螺旋由两条以脱氧核糖—磷酸作骨架的双链组成", "C": "DNA双螺旋以右手螺旋的方式围绕同一轴有规律地盘旋", "D": "两股单链从5′至3′端走向在空间排列相同", "language": "zh"}
{"question": "男，22岁，因为怕脏和反复洗手等被诊断为强迫症。心理治疗师要求患者触摸地面、门把手等，之后不允许其洗手并要求其必须接着做事。经治疗，该患者的强迫症状逐渐减轻。这种治疗方法属于（　　）。", "answer": "冲击疗法", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "系统脱敏疗法", "B": "厌恶疗法", "C": "冲击疗法", "D": "逐级暴露疗法", "language": "zh"}
{"question": "关于真核生物mRNA的叙述哪项是正确的?（　　）", "answer": "有帽子结构与多聚A尾", "meta_info": "生物化学", "answer_idx": "D", "A": "帽子结构是多聚腺苷酸", "B": "mRNA的前体是snRNA", "C": "3＇端是7-甲基鸟苷三磷酸（m7-GPPP）", "D": "有帽子结构与多聚A尾", "language": "zh"}
{"question": "关于解偶联剂，错误的是（　　）。", "answer": "可抑制氧化反应", "meta_info": "生物化学", "answer_idx": "A", "A": "可抑制氧化反应", "B": "使ATP生成减少", "C": "使氧化反应和磷酸化反应脱节", "D": "常见的解偶联剂是二硝基酚", "language": "zh"}
{"question": "2．痉挛性截瘫将出现（　　）。", "answer": "剪刀样步态", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "醉汉步态", "B": "慌张步态", "C": "剪刀样步态", "D": "划圈样步态", "language": "zh"}
{"question": "提出“为救人学医则可，为谋利学医则不可”的是下列的哪一位（　　）。", "answer": "费伯雄", "meta_info": "医学伦理学", "answer_idx": "C", "A": "孔子", "B": "杨泉", "C": "费伯雄", "D": "孙思邈", "language": "zh"}
{"question": "男，30岁，患斑疹伤寒，应选用的药物是（　　）。", "answer": "四环素", "meta_info": "药理学", "answer_idx": "A", "A": "四环素", "B": "复方新诺明", "C": "氯霉素", "D": "氨苄西林", "language": "zh"}
{"question": "不属于病人权利的内容是（　　）。", "answer": "遵守医疗部门规章制度", "meta_info": "医学心理学", "answer_idx": "A", "A": "遵守医疗部门规章制度", "B": "受到社会尊重和理解", "C": "保守个人秘密", "D": "免除或部分免除健康时的社会责任", "language": "zh"}
{"question": "女，45岁。腹泻10年。精神紧张时加剧，排便前腹痛，排便后腹痛可缓解。大便为糊状，发病以来体重无明显变化。既往体健，平素进食好，睡眠差。查体：T 36.5℃，P 80次/分，R 18次/分，BP 120/80mmHg，未见皮疹，双肺呼吸音清，未闻及干湿性啰音，心律齐。腹软，无压痛。1．最有可能的诊断是（　　）。", "answer": "肠易激综合征", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "肠结核", "B": "肠易激综合征", "C": "结肠癌", "D": "克罗恩病", "language": "zh"}
{"question": "3．培养自制力的关键期（　　）。", "answer": "2～3岁", "meta_info": "医学心理学", "answer_idx": "C", "A": "0～1岁", "B": "1～3岁", "C": "2～3岁", "D": "3～7岁", "language": "zh"}
{"question": "男，14岁，因阵发性心悸3年，再发2小时入院，查体无异常发现，心电图示心率180次/分，节律规则，QRS波群时限0.11秒，可见逆行P波，该患者最可能的诊断为（　　）。", "answer": "阵发性室上性心动过速", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "阵发性室上性心动过速", "B": "阵发性室性心动过速", "C": "心房扑动", "D": "非阵发性房室交界区心动过速", "language": "zh"}
{"question": "对放射治疗最敏感的卵巢恶性肿瘤是（　　）。", "answer": "无性细胞瘤", "meta_info": "第二部分　模拟试题", "answer_idx": "D", "A": "未成熟型畸胎瘤", "B": "浆液性囊腺癌", "C": "颗粒细胞瘤", "D": "无性细胞瘤", "language": "zh"}
{"question": "一青年女性，脱发，四肢关节痛半年，肝脾均于肋下2cm扪及，查Hb 60g/L，RBC 1.8×1012/L，WBC 7.7×109/L，PLT 150×109/L，网织红细胞12%，骨髓示增生性贫血，血Ham试验（一），尿蛋白（++）。最可能的诊断是（　　）。", "answer": "自身免疫性溶血性贫血", "meta_info": "第一部分　血液系统疾病", "answer_idx": "B", "A": "急性白血病", "B": "自身免疫性溶血性贫血", "C": "脾功能亢进", "D": "阵发性睡眠性血红蛋白尿", "language": "zh"}
{"question": "临终关怀的意义，不正确的是（　　）。", "answer": "有利于安乐死立法", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "可以使晚期癌症患者免遭受折磨", "B": "体现了人类文明的进步", "C": "有利于安乐死立法", "D": "体现了生命的神圣、质量", "language": "zh"}
{"question": "各种周围血管疾病的描述中，不正确的是（　　）。", "answer": "血栓闭塞性脉管炎的特点是对称性和间歇性", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "雷诺病女性多见", "B": "血栓闭塞性脉管炎男性多见", "C": "血栓闭塞性脉管炎的特点是对称性和间歇性", "D": "“疼痛性股白肿”最常发生在产后", "language": "zh"}
{"question": "第三产程中，子宫不协调性收缩可造成（　　）。", "answer": "胎盘嵌顿", "meta_info": "第5篇　女性生殖系统", "answer_idx": "C", "A": "胎盘粘连", "B": "胎盘剥离不全", "C": "胎盘嵌顿", "D": "胎盘植入", "language": "zh"}
{"question": "心电图上Ⅰ和aVL导联出现急性心肌梗死的特异性改变，其梗死部位是心脏的（　　）。", "answer": "高侧壁", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "前壁", "B": "后壁", "C": "高侧壁", "D": "前间壁", "language": "zh"}
{"question": "下列哪项不是由于容量负荷过重所致心力衰竭的疾病（　　）。", "answer": "甲状腺功能亢进症", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "B", "A": "主动脉瓣关闭不全", "B": "甲状腺功能亢进症", "C": "室间隔缺损", "D": "动静脉瘘", "language": "zh"}
{"question": "下列关于甲状腺激素的作用，哪项错误？（　　）", "answer": "引起黏液性水肿", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "增加组织耗氧量，促进产热", "B": "促进婴幼儿脑和骨的发育", "C": "引起黏液性水肿", "D": "提高神经系统的兴奋性", "language": "zh"}
{"question": "1．引起继发性腹膜炎的细菌主要是（　　）。", "answer": "大肠埃希菌", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "大肠埃希菌", "B": "肺炎链球菌", "C": "铜绿假单胞菌", "D": "拟杆菌", "language": "zh"}
{"question": "哪种躯体疾病明显与心理因素相关？（　　）", "answer": "心身疾病", "meta_info": "医学心理学", "answer_idx": "D", "A": "癔病", "B": "疼痛", "C": "反应性精神病", "D": "心身疾病", "language": "zh"}
{"question": "2．低分子右旋糖酐（　　）。", "answer": "血液稀释疗法", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "脑代谢活化剂", "B": "抗凝治疗", "C": "血液稀释疗法", "D": "脑保护剂", "language": "zh"}
{"question": "卵磷脂经磷脂酶A2作用后的产物是（　　）。", "answer": "溶血磷脂酰胆碱和脂肪酸", "meta_info": "生物化学", "answer_idx": "C", "A": "甘油、脂肪酸和磷酸胆碱", "B": "磷脂酸和胆碱", "C": "溶血磷脂酰胆碱和脂肪酸", "D": "甘油二酯和磷酸胆碱", "language": "zh"}
{"question": "肾小管对HCO3-重吸收（　　）。", "answer": "以CO2的形式吸收", "meta_info": "生理学", "answer_idx": "B", "A": "主要在远曲小管讲行", "B": "以CO2的形式吸收", "C": "以HCO3-的形式吸收", "D": "滞后于Cl-吸收", "language": "zh"}
{"question": "男，60岁。晨醒后左侧肢体无力，刷牙时无法拿杯，有糖尿病和高血压病史，无心脏病史。半天后急诊。查体：左侧肢体肌力3级，腱反射高于右侧，左侧Babinski征阳性。左侧肢体痛温觉减退。可能的诊断是（　　）。", "answer": "脑血栓形成", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "脑转移癌", "B": "短暂性脑缺血发作", "C": "脑血栓形成", "D": "高血压性脑出血", "language": "zh"}
{"question": "过敏性炎中，哪种细胞是具有特征性的炎细胞（　　）。", "answer": "嗜酸粒细胞", "meta_info": "病理学", "answer_idx": "C", "A": "淋巴细胞", "B": "浆细胞", "C": "嗜酸粒细胞", "D": "单核巨噬细胞", "language": "zh"}
{"question": "预防日本血吸虫病的重点是（　　）。", "answer": "灭螺与查治病人、病畜", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "B", "A": "加强卫生宣教，增强防病知识", "B": "灭螺与查治病人、病畜", "C": "预防服药", "D": "个人防护", "language": "zh"}
{"question": "1．组织损伤后，由其邻近的健康细胞分裂增生完成修复的过程（　　）。", "answer": "再生", "meta_info": "病理学", "answer_idx": "C", "A": "化生", "B": "分化", "C": "再生", "D": "增生", "language": "zh"}
{"question": "男，3岁。腹泻4天，加重2天，稀水样便每日十余次，尿量减少。体检：眼窝凹陷，皮肤弹性差，脉搏可扪及。查血钠135mmol/L。其腹泻脱水的程度与性质应是（　　）。", "answer": "中度等渗性", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "轻度等渗性", "B": "中度高渗性", "C": "中度等渗性", "D": "重度低渗性", "language": "zh"}
{"question": "1．成人在安静清醒并闭眼时的脑电波是（　　）。", "answer": "α波", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "α波", "B": "β波", "C": "θ波", "D": "δ波", "language": "zh"}
{"question": "男，19岁。咽痛、发热伴咳嗽2周，眼睑水肿伴肉眼血尿3天。查体：BP 150/100mmHg，全身皮肤无皮疹。实验室检查：尿蛋白（＋＋），尿红细胞30～40/HP，管型3～5/LP，血C3降低，Scr 126μmol/L。1．该患者最可能的诊断为（　　）。", "answer": "急性肾小球肾炎", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "急进性肾小球肾炎", "B": "肾病综合征", "C": "急性肾小球肾炎", "D": "急性肾盂肾炎", "language": "zh"}
{"question": "关于结肠损伤的描述，不正确的是（　　）。", "answer": "结肠内细菌多，一旦损伤腹膜炎均很早表现出来", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "结肠损伤发生率低于小肠损伤", "B": "结肠内细菌多，一旦损伤继发腹腔感染较严重", "C": "部分结肠位居腹膜后，损伤常导致腹膜后感染", "D": "结肠内细菌多，一旦损伤腹膜炎均很早表现出来", "language": "zh"}
{"question": "受体激动剂的特点是（　　）。", "answer": "与受体有亲和力，有较强内在活性", "meta_info": "药理学", "answer_idx": "B", "A": "与受体有亲和力，无内在活性", "B": "与受体有亲和力，有较强内在活性", "C": "与受体无亲和力，有内在活性", "D": "与受体有亲和力，有弱的内在活性", "language": "zh"}
{"question": "下列属于稳定细胞的是（　　）。", "answer": "肾小管上皮细胞及肝细胞", "meta_info": "病理学", "answer_idx": "C", "A": "男性及女性生殖管道被覆上皮细胞", "B": "淋巴造血细胞", "C": "肾小管上皮细胞及肝细胞", "D": "表皮细胞和间皮细胞", "language": "zh"}
{"question": "男，58岁，患高血压性心脏病数年，有时因激动或过劳而发生心绞痛，最初经休息后尚可自行缓解，几天之后心绞痛加重并有心律失常，此时只好选用的药物是（　　）。", "answer": "硝酸甘油+普萘洛尔", "meta_info": "药理学", "answer_idx": "C", "A": "普萘洛尔+维拉帕米", "B": "地尔硫+普萘洛尔", "C": "硝酸甘油+普萘洛尔", "D": "地尔硫+维拉帕米", "language": "zh"}
{"question": "2．非浸润性突眼（　　）。", "answer": "交感神经兴奋致眼外肌及上睑肌张力增加所致，突眼度16～18mm", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "A", "A": "交感神经兴奋致眼外肌及上睑肌张力增加所致，突眼度16～18mm", "B": "交感神经兴奋致眼外肌及上睑肌张力增加所致，突眼度19mm以上，眶内成纤维细胞结合抗体增加", "C": "球后及眶内软组织水肿增生，粘多糖增多，淋巴细胞、浆细胞浸润，突眼度18mm", "D": "球后及眶内软组织水肿增生，单核细胞浸润，突眼度18mm", "language": "zh"}
{"question": "卡介苗接种后所致结核菌素阳性反应是指硬结直径（　　）。", "answer": "5～9mm，3～5d后反应消失", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "＜5mm", "B": "5～9mm，3～5d后反应消失", "C": "10～15mm，1周后留有色素", "D": "＞20mm", "language": "zh"}
{"question": "女，36岁。喘憋、咯血3小时。查体：BP 130／70mmHg，双肺布满湿啰音和哮鸣音，心率102次/分，心律齐，P2亢进，心尖部可闻及舒张期杂音。该患者最适宜的治疗是（　　）。", "answer": "静脉推注呋塞米", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "静脉滴注多巴胺", "B": "口服凝血酶", "C": "静脉滴注垂体后叶素", "D": "静脉推注呋塞米", "language": "zh"}
{"question": "吸入性肺脓肿最常见的病原体是（　　）。", "answer": "厌氧菌", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "铜绿假单胞菌", "B": "厌氧菌", "C": "表皮葡萄球菌", "D": "金黄色葡萄球菌", "language": "zh"}
{"question": "胃大弯上部癌淋巴结转移主要流向的淋巴结群（　　）。", "answer": "胰淋巴结、脾淋巴结", "meta_info": "第3篇　消化系统", "answer_idx": "B", "A": "幽门上淋巴结", "B": "胰淋巴结、脾淋巴结", "C": "胃上淋巴结", "D": "胃网膜右淋巴结", "language": "zh"}
{"question": "卵巢癌引起肾衰竭的原因是（　　）。", "answer": "肾后性急性肾衰竭", "meta_info": "第4篇　泌尿系统", "answer_idx": "A", "A": "肾后性急性肾衰竭", "B": "肾性肾衰竭", "C": "卵巢性肾衰竭", "D": "以上都不是", "language": "zh"}
{"question": "以下不能构成传染源的是（　　）。", "answer": "潜伏性感染者", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "C", "A": "患者", "B": "病原携带者", "C": "潜伏性感染者", "D": "受感染的动物", "language": "zh"}
{"question": "对于流感病毒的特点，哪项是错误的？（　　）", "answer": "不易发生抗原性变异", "meta_info": "医学微生物学", "answer_idx": "B", "A": "属于正黏病毒", "B": "不易发生抗原性变异", "C": "具有分节段的RNA", "D": "具有植物血凝素刺突", "language": "zh"}
{"question": "下列哪项是免疫耐受诱导的难易程度?（　　）", "answer": "成年期最难，新生期难，胚胎期容易", "meta_info": "医学免疫学", "answer_idx": "B", "A": "胚胎期最难，新生期难，成年期容易", "B": "成年期最难，新生期难，胚胎期容易", "C": "成年期最难，胚胎期难，新生期容易", "D": "新生期最难，成年期难，胚胎期容易", "language": "zh"}
{"question": "心动周期中，心室血液充盈主要是由于（　　）。", "answer": "心室舒张的抽收", "meta_info": "生理学", "answer_idx": "C", "A": "心房收缩的挤压作用", "B": "血液的重力作用", "C": "心室舒张的抽收", "D": "胸廓的扩张", "language": "zh"}
{"question": "病儿跌伤，X线摄片为左肱骨下端骨骺分离。3周后到市医院就诊，接诊医生填X线申请单时将左写成右，放射科发现错后，拍了左手，却将一个“右”字铅号贴在X线片上。入院后主治医师在主诉中写左，诊断上又写右，手术通知单上也写右。术前备皮时，病儿提到左臂受伤.护士仍在右臂备皮。手术医生术前曾去查看患者，检查了左臂，第二天手术时竟仍按病志在右臂上开了刀，暴露到关节囊未见异常时，经再次询问病儿，方发现开错了手术部位。3．该事件的程度属于（　　）。", "answer": "三级医疗事故", "meta_info": "卫生法规", "answer_idx": "B", "A": "一级医疗事故", "B": "三级医疗事故", "C": "严重差错", "D": "一般差错", "language": "zh"}
{"question": "医疗事故的违法性是指行为人在诊疗护理中违反（　　）。", "answer": "技术操作规程", "meta_info": "卫生法规", "answer_idx": "C", "A": "行政法规", "B": "法律", "C": "技术操作规程", "D": "和院方的约定", "language": "zh"}
{"question": "某县人口50万，约80%居民以河水为饮用水，该县设有一传染病科的综合医院，城市污水未经处理直接排入河水中。该县1986年1～11月份伤寒发病人数达1063例，超过该县历史(1958～1985年)同期平均发病人数的6.9倍。初步调查，发现患者集中于河水排污口的下游地带。4．这一地区应用以下哪种消毒法？（　　）", "answer": "过量氯消毒法", "meta_info": "预防医学", "answer_idx": "A", "A": "过量氯消毒法", "B": "二氧化氯消毒法", "C": "碘消毒法", "D": "持续氯消毒法", "language": "zh"}
{"question": "新生儿缺氧缺血性脑病多见于（　　）。", "answer": "足月儿", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "小于胎龄儿", "B": "足月儿", "C": "微小儿", "D": "足月小样儿", "language": "zh"}
{"question": "医疗机构药剂人员调配处方时的错误行为是（　　）。", "answer": "处方所列药品缺货时用同类药品代用", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "处方必须经过核对，对处方所列药品不得擅自更改", "B": "处方所列药品缺货时用同类药品代用", "C": "对有配伍禁忌的处方，应当拒绝调配", "D": "必要时，经处方医师更正或重新签字，方可调配", "language": "zh"}
{"question": "女，26岁。月经规律，现停经45d，阴道少量出血7d，时有阵阵腹痛或腰酸。妇科检查：宫颈软，摇摆痛（+），少量血染，宫体略大而软，附件（﹣），对此病例首先考虑何种疾病？（　　）", "answer": "宫外孕", "meta_info": "第二部分　模拟试题", "answer_idx": "B", "A": "子宫内膜癌", "B": "宫外孕", "C": "有排卵型功血", "D": "无排卵型功血", "language": "zh"}
{"question": "女，32岁。间歇出现颜面及下肢水肿已经5年，伴乏力、头痛。血压180/110mmHg，Hb 70g/L，尿蛋白（＋＋），尿红细胞6～10/HP。3．下列治疗药物中，不选用（　　）。", "answer": "糖皮质激素", "meta_info": "第4篇　泌尿系统", "answer_idx": "A", "A": "糖皮质激素", "B": "氢氯噻嗪", "C": "卡托普利", "D": "普萘洛尔", "language": "zh"}
{"question": "4．肝梗死（　　）。", "answer": "凝固性坏死", "meta_info": "病理学", "answer_idx": "C", "A": "点状坏死", "B": "桥接坏死", "C": "凝固性坏死", "D": "羽状坏死", "language": "zh"}
{"question": "男，重体力劳动工人，腰腿痛，并向左下肢放散，咳嗽，喷嚏时加重。检查腰部活动明显受限，并向左倾斜，直腿抬高试验阳性。病程中无低热、盗汗、消瘦症状。3．如病史2年，并逐年加重，已严重影响生活及工作，且出现尿便障碍。其治疗方法是（　　）。", "answer": "手术", "meta_info": "第四部分　运动系统疾病", "answer_idx": "D", "A": "理疗", "B": "牵引", "C": "用药", "D": "手术", "language": "zh"}
{"question": "原发性肝癌的发生主要与下列哪种因素有关？（　　）", "answer": "黄曲霉毒素污染", "meta_info": "第3篇　消化系统", "answer_idx": "B", "A": "肠道细菌感染", "B": "黄曲霉毒素污染", "C": "肠道戊型肝炎病毒感染", "D": "酒精中毒", "language": "zh"}
{"question": "动脉导管完全闭合绝大多数发生于（　　）。", "answer": "1岁以内", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "5个月内", "B": "3个月内", "C": "6个月内", "D": "1岁以内", "language": "zh"}
{"question": "异位妊娠最常见的发生部位是（　　）。", "answer": "输卵管壶腹部", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "输卵管间质部", "B": "输卵管系膜", "C": "输卵管壶腹部", "D": "输卵管峡部", "language": "zh"}
{"question": "颅内压增高的三主征包括（　　）。", "answer": "头痛、呕吐，视乳头水肿", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "头昏、头痛、呕吐", "B": "头痛、呕吐，视乳头水肿", "C": "意识不清、呕吐、行走不稳", "D": "血压升高、脉搏细弱、呼吸微弱", "language": "zh"}
{"question": "患者，女，49岁，左乳头刺痒，伴乳晕发红、糜烂3个月，查体双侧腋窝无肿大淋巴结，乳头分泌物涂片细胞学检查见癌细胞。该病人癌变的类型是（　　）。", "answer": "乳头湿疹样癌", "meta_info": "第八部分　其他疾病", "answer_idx": "A", "A": "乳头湿疹样癌", "B": "大汗腺样癌", "C": "黏液细胞癌", "D": "髓样癌", "language": "zh"}
{"question": "玻璃样变性不易发生于（　　）。", "answer": "肾远曲小管上皮细胞", "meta_info": "病理学", "answer_idx": "D", "A": "结缔组织", "B": "血管壁", "C": "浆细胞", "D": "肾远曲小管上皮细胞", "language": "zh"}
{"question": "1．BCG是一种（　　）。", "answer": "活疫苗", "meta_info": "医学微生物学", "answer_idx": "B", "A": "死疫苗", "B": "活疫苗", "C": "抗毒素", "D": "丙种球蛋白", "language": "zh"}
{"question": "急性硬脑膜外血肿典型的意识障碍过程是（　　）。", "answer": "昏迷—清醒—昏迷", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "昏迷—清醒", "B": "昏迷—清醒—昏迷", "C": "清醒—昏迷", "D": "昏迷—好转", "language": "zh"}
{"question": "男，72岁。脑血管病患者。住院期间突然半夜起床活动。无目的地摸床，摸墙，摸病友的头，自语，白天安静入睡。1．下列最有意义的检查是（　　）。", "answer": "MRI检查", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "CT检查", "B": "MRI检查", "C": "脑电图", "D": "超声检查", "language": "zh"}
{"question": "关于高血压病患者的降压治疗，下列提法正确的（　　）。", "answer": "有并发症患者，药物及治疗方案应个体化", "meta_info": "第2篇　心血管系统", "answer_idx": "A", "A": "有并发症患者，药物及治疗方案应个体化", "B": "血压控制越低越好。减少靶器官损害", "C": "尽量应用单种药物，降低药物副反应", "D": "血压控制达标后，应停止服用降压药物", "language": "zh"}
{"question": "女，59岁。乏力伴心悸、多汗、手颤、易饿3个月，脾气暴躁。每天大便4～5次，不成形。体重下降6.0kg。查体：甲状腺Ⅱ度肿大、质软，心率110次/分，律齐，心音有力。1．该患者最可能的诊断是（　　）。", "answer": "甲状腺功能亢进症", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "溃疡性结肠炎", "B": "2型糖尿病", "C": "甲状腺功能亢进症", "D": "更年期综合征", "language": "zh"}
{"question": "不属于预防医学的道德要求的是（　　）。", "answer": "防疫工作者有权在疫区切断传染病传播途径的各种措施", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "爱岗敬业，宣传大卫生法规，言传身教", "B": "改善工作和学习环境，严把防疫和食品卫生观", "C": "防疫工作者有权在疫区切断传染病传播途径的各种措施", "D": "提高社区服务水平，保障妇女儿童和老年人权益", "language": "zh"}
{"question": "43岁女性，G3P2，20年前带环避孕10年。近5年来经量渐增多，痛经逐渐加重，并经期发低热。查体：子宫均匀增大，如孕8周大小，质硬，活动尚好，压痛（＋），双侧附件未及具体包块。1．最可能的诊断是（　　）。", "answer": "子宫腺肌症", "meta_info": "第5篇　女性生殖系统", "answer_idx": "B", "A": "子宫内膜异位症", "B": "子宫腺肌症", "C": "妊娠子宫", "D": "子宫肉瘤", "language": "zh"}
{"question": "巨大帽状腱膜下血肿处理原则（　　）。", "answer": "抽吸后加压包扎", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "冷敷", "B": "预防感染", "C": "抽吸后加压包扎", "D": "切开引流", "language": "zh"}
{"question": "1．烦渴、高热、肌张力增高，甚至晾厥（　　）。", "answer": "高渗性脱水", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "低渗性脱水", "B": "高渗性脱水", "C": "高钾血症", "D": "高钙血症", "language": "zh"}
{"question": "1．阿司匹林过量可引起（　　）。", "answer": "水杨酸反应", "meta_info": "药理学", "answer_idx": "A", "A": "水杨酸反应", "B": "锥体外系反应", "C": "成瘾性", "D": "高血压症", "language": "zh"}
{"question": "患儿，5岁，半年来不规则发热，游走性大关节疼痛，伴局部红肿，查体见四肢屈侧有环形红斑。为了明确诊断医生做了一些实验室检查，请找出对诊断没有意义的指标（　　）。", "answer": "谷草转氨酶", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "抗链“O”", "B": "血常规", "C": "C反应蛋白", "D": "谷草转氨酶", "language": "zh"}
{"question": "男，35岁。近半年来出现尿频、尿不尽，肛周隐痛不适，拟诊断为慢性前列腺炎。下面检查结果哪一项有诊断意义？（　　）", "answer": "前列腺液常规示WBC 20～30个/HP，卵磷脂小体减少", "meta_info": "第4篇　泌尿系统", "answer_idx": "C", "A": "尿常规示WBC 2～4个/HP", "B": "B超示前列腺被膜增厚", "C": "前列腺液常规示WBC 20～30个/HP，卵磷脂小体减少", "D": "直肠指诊可触及前列腺增大", "language": "zh"}
{"question": "甲状腺切除术术后拆线的时间（　　）。", "answer": "4～5天", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "4～5天", "B": "6～7天", "C": "7～9天", "D": "14天", "language": "zh"}
{"question": "2．霍纳综合征的临床表现是（　　）。", "answer": "眼裂变小，瞳孔缩小，直接对光反射正常", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "眼裂扩大，瞳孔缩小，直接对光反射正常", "B": "眼裂变小，瞳孔缩小，直接对光反射正常", "C": "眼裂变小，瞳孔正常，直接对光反射正常", "D": "眼裂变小，瞳孔扩大，直接对光反射消失", "language": "zh"}
{"question": "卵巢内胚窦瘤的特异性肿瘤标志物是（　　）。", "answer": "AFP", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "AFP", "B": "hCG", "C": "PSA", "D": "CA199", "language": "zh"}
{"question": "下列关于梅毒螺旋体的叙述，正确的是（　　）。", "answer": "暗视野显微镜下可见", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "B", "A": "一般消毒剂如升汞、苯扎溴铵、酒精等均不能将其杀死", "B": "暗视野显微镜下可见", "C": "梅毒螺旋体是需氧微生物，在体外可存活较长时间", "D": "梅毒螺旋体耐热不耐寒", "language": "zh"}
{"question": "下叙哪项是体内氨的主要去路?（　　）", "answer": "合成尿素", "meta_info": "生物化学", "answer_idx": "B", "A": "生成铵盐", "B": "合成尿素", "C": "生成非必需氨基酸", "D": "参与嘌呤、嘧啶合成", "language": "zh"}
{"question": "2．慢性失血所致的贫血（　　）。", "answer": "小细胞低色素贫血", "meta_info": "第一部分　血液系统疾病", "answer_idx": "B", "A": "正细胞正色素贫血", "B": "小细胞低色素贫血", "C": "小细胞正色素贫血", "D": "大细胞低色素贫血", "language": "zh"}
{"question": "鉴别前列腺增生下尿路梗阻与神经源性膀胱病变的方法是（　　）。", "answer": "尿流动力学检查", "meta_info": "第4篇　泌尿系统", "answer_idx": "D", "A": "B超", "B": "膀胱镜检查", "C": "CT", "D": "尿流动力学检查", "language": "zh"}
{"question": "女，38岁，突然右侧偏瘫3小时，体检：失语，双眼向左凝视，右鼻唇沟浅，右侧肌张力低，肌力0级，角膜反射右（－），左（＋），腱反射右侧无反应，血压16／10kpa，心率100次/分，心尖区收缩期伴舒张期杂音Ⅲ级，房颤，最可能的诊断是（　　）。", "answer": "左半球脑栓塞", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "左半球脑出血", "B": "左半球脑栓塞", "C": "左半球脑血栓形成", "D": "右脑桥出血", "language": "zh"}
{"question": "正常儿，体重8.5kg、身长70cm，已会爬，试独站，会从抽屉中取玩具，能懂几个较复杂的词句，如“再见”等，不能模仿成人的动作，但看见熟人会伸手要人抱，其月龄最可能为（　　）。", "answer": "9个月", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "7个月", "B": "8个月", "C": "9个月", "D": "10～11个月", "language": "zh"}
{"question": "2．细菌性痢疾（　　）。", "answer": "急性渗出性炎", "meta_info": "病理学", "answer_idx": "C", "A": "急性增生性炎", "B": "急性化脓性炎", "C": "急性渗出性炎", "D": "慢性增生性炎", "language": "zh"}
{"question": "男，26岁。5天来鼻及牙龈出血，皮肤瘀斑。血红蛋白55g/L，白细胞10.0×109/L，血小板16×109/L。骨髓增生极度活跃，绝大多数细胞呈清一色，胞浆内有大小不等颗粒及成堆Auer小体，过氧化酶染色强阳性。3．应首选的治疗是（　　）。", "answer": "全反式维甲酸", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "DA方案", "B": "全反式维甲酸", "C": "VP方案", "D": "骨髓移植", "language": "zh"}
{"question": "女，18岁，上呼吸道感染、高热，青霉素皮试阳性，宜选用下列何药治疗？（　　）", "answer": "红霉素", "meta_info": "药理学", "answer_idx": "A", "A": "红霉素", "B": "羧苄西林", "C": "阿莫西林", "D": "头孢氨苄", "language": "zh"}
{"question": "女性足月新生儿，第1胎第1产，娩出经过顺利，无窒息，母乳喂养，生后18h出现黄疸并加重，胎粪已排空，生后第3天住院。体检：皮肤、巩膜中至重度黄染，心、肺听诊正常，肝肋下2.5cm，脾未及。血红蛋白12.5g/L，网织红细胞0.05，白细胞数11×1012/L，中性粒细胞0.7，血型A，血清总胆红素255μmol/L（15mg/dl），1分钟胆红素8μmol/L。2．为明确诊断，应选以下哪项检查项目？（　　）", "answer": "血型抗体检查", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "红细胞G-6-PD活性测定", "B": "肝功能、乙肝五项", "C": "血型抗体检查", "D": "肝及胆道超声检查", "language": "zh"}
{"question": "交通事故，右髋关节疼痛，不能活动，查体发现右髋关节屈曲内收、内旋畸形，诊断为（　　）。", "answer": "髋关节脱位", "meta_info": "第四部分　运动系统疾病", "answer_idx": "C", "A": "股骨颈骨折", "B": "股骨头骨折", "C": "髋关节脱位", "D": "股骨上端骨折", "language": "zh"}
{"question": "1．肾病综合征激素长程疗法时间为（　　）。", "answer": "9～12个月", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "8～12周", "B": "4～6个月", "C": "6～9个月", "D": "9～12个月", "language": "zh"}
{"question": "伤寒病程第3～4周，体温波动下降，食欲好转时，要特别注意（　　）。", "answer": "限制饮食", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "C", "A": "增加活动量", "B": "加强营养", "C": "限制饮食", "D": "口服多种维生素", "language": "zh"}
{"question": "下列哪一项不是婴儿期的保健重点？（　　）", "answer": "保温", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "保温", "B": "喂养", "C": "早教", "D": "预防接种", "language": "zh"}
{"question": "1．额叶肿瘤可出现（　　）。", "answer": "广泛智能受损、情感障碍和人格改变", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "大量丰富的视幻觉", "B": "Gerstmann综合征（手指失认、计算不能、书写不能和左右不分等）", "C": "大约1／2出现癫痫", "D": "广泛智能受损、情感障碍和人格改变", "language": "zh"}
{"question": "属于细胞因子的物质是（　　）。", "answer": "干扰素", "meta_info": "医学免疫学", "answer_idx": "B", "A": "调理素", "B": "干扰素", "C": "植物血凝素", "D": "胸腺素", "language": "zh"}
{"question": "属于Ⅰ型超敏反应的疾病是（　　）。", "answer": "过敏性休克", "meta_info": "医学免疫学", "answer_idx": "C", "A": "风湿病", "B": "肾小球肾炎", "C": "过敏性休克", "D": "接触性皮炎", "language": "zh"}
{"question": "给恋物癖者电击的方法属于（　　）。", "answer": "厌恶疗法", "meta_info": "医学心理学", "answer_idx": "C", "A": "家庭脱敏", "B": "冲击疗法", "C": "厌恶疗法", "D": "自由联想", "language": "zh"}
{"question": "室间隔缺损的血流动力学改变，首先引起（　　）。", "answer": "左心室增大", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "左心室增大", "B": "右心室增大", "C": "左心房扩大", "D": "肺动脉扩张", "language": "zh"}
{"question": "IgG不含的功能区是（　　）。", "answer": "CH2", "meta_info": "医学免疫学", "answer_idx": "C", "A": "V1", "B": "VH", "C": "CH2", "D": "CH4", "language": "zh"}
{"question": "患儿，男，1.5岁。其基础代谢所需热量占总热量的比例为（　　）。", "answer": "50%～60%", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "80%以上", "B": "70%～80%", "C": "50%～60%", "D": "30%～40%", "language": "zh"}
{"question": "急性糜烂出血性胃炎最常见的原因是（　　）。", "answer": "口服非甾体抗炎药", "meta_info": "第3篇　消化系统", "answer_idx": "D", "A": "不洁饮食", "B": "剧烈呕吐", "C": "刺激性食物", "D": "口服非甾体抗炎药", "language": "zh"}
{"question": "痴呆综合征的主要表现是（　　）。", "answer": "是全面的智能减退", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "有意识障碍", "B": "是全面的智能减退", "C": "注意力集中", "D": "多有妄想", "language": "zh"}
{"question": "2．属于医疗保健机构提供婚前卫生咨询的为（　　）。", "answer": "对生育保健提供医学意见", "meta_info": "卫生法规", "answer_idx": "D", "A": "性卫生知识教育", "B": "遗传病诊察", "C": "心理健康指导", "D": "对生育保健提供医学意见", "language": "zh"}
{"question": "新生儿贫血是指（　　）。", "answer": "Hb＜145g/L", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "Hb＜220g/L", "B": "Hb＜145g/L", "C": "Hb＜100g/L", "D": "Hb＜90g/L", "language": "zh"}
{"question": "诊断颅盖骨骨折通常依据（　　）。", "answer": "头颅X线摄片", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "头颅X线摄片", "B": "局部触诊闻及骨擦音", "C": "剧烈头痛伴呕吐", "D": "对侧肢体偏瘫", "language": "zh"}
{"question": "急性心肌梗死后，下列血中哪项指标最早出现异常？（　　）", "answer": "肌红蛋白", "meta_info": "第2篇　心血管系统", "answer_idx": "D", "A": "谷草转氨酶", "B": "肌酸磷酸激酶", "C": "谷丙转氨酶", "D": "肌红蛋白", "language": "zh"}
{"question": "2．急性链球菌感染后肾小球肾炎的特征性表现为（　　）。", "answer": "弥漫性毛细血管壁增厚", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "弥漫性毛细血管壁增厚", "B": "弥漫性系膜细胞增生及系膜基质增厚", "C": "肾小球毛细血管壁硬化", "D": "肾毛细血管基底膜不规则增生", "language": "zh"}
{"question": "下列不属于巨幼细胞性贫血实验室检查结果的是（　　）。", "answer": "骨髓有核红细胞呈“幼浆老核”现象", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "外周血中性粒细胞呈多分叶", "B": "骨髓可见巨中、晚幼粒细胞", "C": "外周血红细胞MCV增大", "D": "骨髓有核红细胞呈“幼浆老核”现象", "language": "zh"}
{"question": "下列关于大叶性肺炎的描述，哪项错误？（　　）", "answer": "炎症以嗜酸性粒细胞渗出为主", "meta_info": "病理学", "answer_idx": "B", "A": "由细菌感染引起", "B": "炎症以嗜酸性粒细胞渗出为主", "C": "不破坏肺泡壁结构", "D": "患者常有胸痛及咳铁锈色痰", "language": "zh"}
{"question": "急性脓胸最常继发于（　　）。", "answer": "肺部感染", "meta_info": "第1篇　呼吸系统", "answer_idx": "C", "A": "脓毒血症", "B": "胸部开放性损伤", "C": "肺部感染", "D": "气胸", "language": "zh"}
{"question": "左心室流入道和流出道的分界标志是（　　）。", "answer": "左房室瓣（二尖瓣）前瓣", "meta_info": "第2篇　心血管系统", "answer_idx": "B", "A": "左房室瓣（二尖瓣）后瓣", "B": "左房室瓣（二尖瓣）前瓣", "C": "室上嵴", "D": "室间隔", "language": "zh"}
{"question": "女孩，6岁，水肿伴尿少2天，病前10天有上感病史，查体：BP 130／90mmHg，眼睑及颜面水肿，双下肢轻度水肿，血Hb 100g/L，尿常规：沉渣镜检RBC 20～30/HP，WBC 3/HP，Pro(＋＋)。该患儿最可能的诊断是（　　）。", "answer": "急性链球菌感染后肾炎", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "泌尿系感染", "B": "急性链球菌感染后肾炎", "C": "肾炎性肾病综合征", "D": "急进性肾小球肾炎", "language": "zh"}
{"question": "乳房表浅脓肿切开引流，最佳切口是（　　）。", "answer": "轮辐状切口", "meta_info": "第八部分　其他疾病", "answer_idx": "A", "A": "轮辐状切口", "B": "“+”字切口", "C": "“++”切口", "D": "竖切口", "language": "zh"}
{"question": "非典型PKU所缺乏的酶不包括（　　）。", "answer": "苯丙氨酸羧化酶", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "苯丙氨酸羧化酶", "B": "6-丙酮酸四氢蝶呤合成酶", "C": "二氢生物蝶呤还原酶", "D": "四氢生物蝶呤还原酶", "language": "zh"}
{"question": "患儿，男，出生3天。黄疸迅速加重2天，足月儿，母乳喂养。母亲血型为O型、Rh阳性，父亲血型为AB型、Rh阳性，实验室检查：TBil 289μmol/L。1．为确诊最有效的检查是（　　）。", "answer": "改良直接抗人球蛋白实验", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "血培养", "B": "改良直接抗人球蛋白实验", "C": "血型", "D": "血涂片查红细胞形态", "language": "zh"}
{"question": "女性，30岁，以往有肺结核史，近1个月来腰背痛，伴低热、盗汗。查体：胸11和胸12棘突明显压痛。1．对该患者最简便有效的诊断方法为（　　）。", "answer": "摄胸腰段X线片", "meta_info": "第四部分　运动系统疾病", "answer_idx": "B", "A": "CT", "B": "摄胸腰段X线片", "C": "OT试验", "D": "核素骨扫描", "language": "zh"}
{"question": "下列关于医患关系的特性描述，不正确的是（　　）。", "answer": "医患关系是竞争与合作的关系", "meta_info": "医学伦理学", "answer_idx": "D", "A": "医患关系是契约关系", "B": "医患关系是信托关系", "C": "医患关系是服务与被服务的关系", "D": "医患关系是竞争与合作的关系", "language": "zh"}
{"question": "关于生物转化的特点，错误的是（　　）。", "answer": "营养物质比非营养物质转化速度快", "meta_info": "生物化学", "answer_idx": "A", "A": "营养物质比非营养物质转化速度快", "B": "生物转化反应都是由酶催化的", "C": "一种物质可经过几种连续反应", "D": "具有解毒与致毒的双重性", "language": "zh"}
{"question": "正态分布资料当μ恒定时，σ越大（　　）。", "answer": "曲线变胖", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "曲线变窄", "B": "曲线变胖", "C": "曲线变高", "D": "曲线变低", "language": "zh"}
{"question": "1．输血反应（　　）。", "answer": "属Ⅱ型超敏反应性疾病", "meta_info": "医学免疫学", "answer_idx": "B", "A": "属Ⅰ型超敏反应性疾病", "B": "属Ⅱ型超敏反应性疾病", "C": "属Ⅲ型超敏反应性疾病", "D": "不属于超敏反应性疾病", "language": "zh"}
{"question": "1．异卵双生子之间移植称为（　　）。", "answer": "同种异基因移植", "meta_info": "医学免疫学", "answer_idx": "B", "A": "同种同基因移植", "B": "同种异基因移植", "C": "异种移植", "D": "骨髓移植", "language": "zh"}
{"question": "早期中心型肺癌的常见症状是（　　）。", "answer": "咳嗽、血痰", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "高热、胸痛", "B": "上肢及颜面部肿胀", "C": "咳嗽、血痰", "D": "胸闷、呼吸困难", "language": "zh"}
{"question": "善于把已经开始了的事业进行到底，不达目的誓不罢休的意志品质是（　　）。", "answer": "意志的坚韧性", "meta_info": "医学心理学", "answer_idx": "C", "A": "意志的自觉性", "B": "意志的自制性", "C": "意志的坚韧性", "D": "意志的稳定性", "language": "zh"}
{"question": "HLA分子多态性部位是（　　）。", "answer": "肽结合区", "meta_info": "医学免疫学", "answer_idx": "A", "A": "肽结合区", "B": "跨膜区", "C": "胞质区", "D": "以上都不对", "language": "zh"}
{"question": "编码HLA-Ⅱ类抗原的基因位于（　　）。", "answer": "HLA-D", "meta_info": "医学免疫学", "answer_idx": "C", "A": "HIA-C", "B": "HLA-B", "C": "HLA-D", "D": "HLA-F", "language": "zh"}
{"question": "不适于心理治疗的是（　　）。", "answer": "重症精神障碍的急性期", "meta_info": "医学心理学", "answer_idx": "C", "A": "行为障碍", "B": "心身疾病", "C": "重症精神障碍的急性期", "D": "某些慢性病患者的恢复期", "language": "zh"}
{"question": "关节脱位的特有体征是（　　）。", "answer": "弹性固定", "meta_info": "第四部分　运动系统疾病", "answer_idx": "D", "A": "疼痛与压痛", "B": "反常活动", "C": "运动消失", "D": "弹性固定", "language": "zh"}
{"question": "男性，25岁，持续发热10d，开始为38℃左右，5d后持续高热39～40℃，伴腹胀和轻度腹泻。体检：体温40℃，呼吸26/min，脉搏86/min，神志淡漠。两肺无异常。心率86/min，律齐，第一心音偏低。腹胀、无压痛，肝右肋下2cm，软，脾左肋下1cm。血白细胞3.0×109/L，中性粒细胞75%，嗜酸性粒细胞0%，单核细胞5%，淋巴细胞20%。最可能的诊断是（　　）。", "answer": "伤寒、副伤寒", "meta_info": "第二部分　模拟试题", "answer_idx": "B", "A": "细菌性痢疾", "B": "伤寒、副伤寒", "C": "结缔组织病", "D": "结核病", "language": "zh"}
{"question": "男婴1岁，人工喂养，因出牙延迟，不会走路而来院就诊。平时多汗，烦躁，刚会独坐，前囟3cm×3cm，方颅，无乳牙萌出，肋骨串珠可疑。1．此时该患儿的血生化改变应是（　　）。\n血钙　　血磷　　血碱性磷酸酶", "answer": "↓　　　↓　　　　↑", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "↓　　　↓　　　　↓", "B": "↓　　　↑　　　　↑", "C": "↓　　　↓　　　　↑", "D": "正常　　↓　　　　↓", "language": "zh"}
{"question": "初孕妇，25岁。妊娠31周，从妊娠29周起反复3次阴道流血，量少，无腹痛。再次阴道流血同月经量。查体：P 88次/分，BP 110／70mmHg，子宫软，无宫缩，枕左前位，胎头高浮，胎心率144次/分。3．错误的处理方法是（　　）。", "answer": "直接阴道检查确定前置胎盘类型", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "出血停止可期待治疗", "B": "卧床休息，应用宫缩抑制剂", "C": "直接阴道检查确定前置胎盘类型", "D": "输液备血", "language": "zh"}
{"question": "男，60岁。右腹股沟区肿块2年，平卧消失。查体：右耻骨结节外上方有一半球形肿块，未进入阴囊，可用手回纳，压住腹股沟韧带中点上方，咳嗽时仍可见肿块突出。最可能的诊断是（　　）。", "answer": "腹股沟直疝", "meta_info": "第3篇　消化系统", "answer_idx": "C", "A": "隐睾", "B": "腹股沟斜疝", "C": "腹股沟直疝", "D": "精索鞘膜积液", "language": "zh"}
{"question": "近球小管对小管液的重吸收为（　　）。", "answer": "等渗性重吸收", "meta_info": "生理学", "answer_idx": "A", "A": "等渗性重吸收", "B": "低渗性重吸收", "C": "受抗利尿激素的调节", "D": "受醛固酮的调节", "language": "zh"}
{"question": "酪氨酸的补充可节省体内的（　　）。", "answer": "苯丙氨酸", "meta_info": "生物化学", "answer_idx": "A", "A": "苯丙氨酸", "B": "组氨酸", "C": "亮氨酸", "D": "蛋氨酸", "language": "zh"}
{"question": "女，68岁。夜尿增多2年，乏力3个月，既往因头痛长期服用“去痛片”10余年，否认高血压、糖尿病病史，查体：BP 125/80mmHg，双下肢无水肿，尿比重1.005，RBC 0～1/HP，尿蛋白（＋），尿糖（＋＋），血Hb 85g/L，Cr 265μmol/L，Glu 5.5mmol/L。该患者肾功能不全最可能的原因是（　　）。", "answer": "慢性肾小管间质肾病", "meta_info": "第4篇　泌尿系统", "answer_idx": "C", "A": "糖尿病肾病", "B": "慢性肾小球肾炎", "C": "慢性肾小管间质肾病", "D": "慢性肾盂肾炎", "language": "zh"}
{"question": "5．肾梗死（　　）。", "answer": "梗死灶锥体形", "meta_info": "病理学", "answer_idx": "B", "A": "梗死灶地图形", "B": "梗死灶锥体形", "C": "梗死灶节段状", "D": "梗死灶发生液化", "language": "zh"}
{"question": "1．流行性乙型脑炎（　　）。", "answer": "蚊媒传染", "meta_info": "病理学", "answer_idx": "C", "A": "空气飞沫传染", "B": "接触传染", "C": "蚊媒传染", "D": "跳蚤媒介传染", "language": "zh"}
{"question": "对诊断肾结核最有意义的是（　　）。", "answer": "静脉尿路造影", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "尿路平片", "B": "肾图", "C": "静脉尿路造影", "D": "膀胱镜检", "language": "zh"}
{"question": "3．对发作频繁、每月发作2次者用（　　）。", "answer": "普萘洛尔、苯噻啶等药物", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "发作早期给麦角胺咖啡因", "B": "5-羟色胺受体激动剂", "C": "普萘洛尔、苯噻啶等药物", "D": "皮质类固醇", "language": "zh"}
{"question": "男性，60岁。曾在石英粉厂工作30年，因慢性肺源性心脏病致呼吸衰竭、心力衰竭死亡。尸检时双肺重量及体积均有增加，双肺中、下叶近肺门处多个散在灰白结节，结节圆形、直径2～5mm、质硬；镜检为矽肺结节。双肺结节病变未超过全肺1／3。死前X线片示结节分布不少于4个肺区，试判断其矽肺处于第几期（　　）。", "answer": "Ⅱ期", "meta_info": "病理学", "answer_idx": "C", "A": "0期", "B": "Ⅰ期", "C": "Ⅱ期", "D": "以上都不是", "language": "zh"}
{"question": "羊奶的营养价值与牛奶大致相同，但是羊奶喂养的小儿容易发生大细胞性贫血主要是因为（　　）。", "answer": "羊奶中叶酸含量很少", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "羊奶中维生素D含量很少", "B": "羊奶中维生素K含量很少", "C": "羊奶中叶酸含量很少", "D": "羊奶中维生素A含量很少", "language": "zh"}
{"question": "女，74岁。间断感觉环境晃动伴恶心2天，共发作5次，每次持续10～15分钟，有高血压史。发作时查体：水平眼震阳性，左侧指鼻试验和跟膝胫试验阳性，闭目直立试验阳性。发作间歇期查体正常。双侧前庭功能试验正常。头颅CT无异常。可能的诊断是（　　）。", "answer": "短暂性脑缺血发作", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "短暂性脑缺血发作", "B": "小脑梗死", "C": "脑桥梗死", "D": "中脑梗死", "language": "zh"}
{"question": "心排血指数为下列哪项?（　　）", "answer": "心率×每搏量/体表面积", "meta_info": "生理学", "answer_idx": "A", "A": "心率×每搏量/体表面积", "B": "心率×体表面积", "C": "心排血量×体表面积", "D": "心排血量×心率/体表面积", "language": "zh"}
{"question": "男，41岁，因发热2周于8月20日入院，伴腹痛、腹泻，稀便每日5～6次，有皮疹。体检：体温39℃，四肢及躯干皮肤可见荨麻疹，浅表淋巴结轻度肿大，肝肋下3cm，质软，轻触痛。发病前1个月曾去安徽出差。初步诊断为急性血吸虫病。3．该病主要病变部位在（　　）。", "answer": "肝、结肠", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "D", "A": "皮肤、淋巴结", "B": "肺、脑", "C": "肝、脾", "D": "肝、结肠", "language": "zh"}
{"question": "患儿，2岁，既往确诊为先天性心脏病室间隔缺损，近1周发热、咳嗽，近3天喘，听诊双肺可闻及中小水泡音，胸骨左缘第3、4肋间闻及3级收缩期杂音，肝肋弓下4cm。下列哪一项处置是错误的？（　　）", "answer": "以上均不是", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "快速洋地黄化", "B": "吸氧", "C": "静脉滴注抗生素", "D": "以上均不是", "language": "zh"}
{"question": "下列呼吸类型与疾病的关系，正确的是（　　）。", "answer": "脑出血——间停呼吸", "meta_info": "第1篇　呼吸系统", "answer_idx": "C", "A": "精神紧张——深大呼吸", "B": "糖尿病酮症——潮式呼吸", "C": "脑出血——间停呼吸", "D": "精神紧张——潮式呼吸", "language": "zh"}
{"question": "下列不属于急链后肾小球肾炎病理变化的是（　　）。", "answer": "上皮细胞增生", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "内皮细胞增生", "B": "系膜细胞增生", "C": "驼峰", "D": "上皮细胞增生", "language": "zh"}
{"question": "1．侵袭性大肠杆菌肠炎（　　）。", "answer": "多夏季起病，黏液脓血便，便常规大量白细胞、可见红细胞", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "大便呈暗绿色、海水样，黏液较多。便常规有大量脓细胞、革兰阳性细菌", "B": "大便呈稀黄色，泡沫较多，可呈豆腐渣样、便常规少量白细胞", "C": "多夏季起病，黏液脓血便，便常规大量白细胞、可见红细胞", "D": "秋季起病，大便呈蛋花汤样、量多、次数多、无腥臭味，便常规偶见白细胞", "language": "zh"}
{"question": "某人在意外事故中脊髓受损，丧失横断面以下一切躯体与内脏反射活动，但数周后屈肌反射、腱反射等反射开始逐渐恢复。这表明该患者的损伤为（　　）。", "answer": "脊休克", "meta_info": "生理学", "answer_idx": "B", "A": "脑水肿", "B": "脊休克", "C": "脊髓水肿", "D": "疼痛性休克", "language": "zh"}
{"question": "蛋白质二级结构是指（　　）。", "answer": "局部主链的空间构象", "meta_info": "生物化学", "answer_idx": "B", "A": "氨基酸的排列顺序", "B": "局部主链的空间构象", "C": "亚基间相对的空间位置", "D": "每一原子的相对空间位置", "language": "zh"}
{"question": "男婴，40天，过期产，出生后第3天出现黄疸，至今尚未完全消退。生后少哭，少动。吃奶尚可，大便2天1次，色黄。腹软较胀，有脐疝，肝肋下2cm.血清总胆红素170μmol/L，结合胆红素21μmol/L，血红蛋白110g/L，红细胞3.8×109/L。2．为确诊，应选择哪一项检查？（　　）", "answer": "血清T3、T4、TSH检查", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "血清病毒特异抗体检测", "B": "血清T3、T4、TSH检查", "C": "血培养", "D": "钡剂灌肠", "language": "zh"}
{"question": "医师在执业活动中违反卫生行政规章制度造成严重后果的，卫生行政部门可以责令其暂停一定期限的执业活动。该期限是（　　）。", "answer": "6个月以上1年以下", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "6个月以上1年以下", "B": "1年以上2年以下", "C": "1个月以上3个月以下", "D": "3个月以上6个月以下", "language": "zh"}
{"question": "2．治疗顽固性呃逆的药物是（　　）。", "answer": "氯丙嗪", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "地西泮", "B": "异丙嗪", "C": "乙琥胺", "D": "氯丙嗪", "language": "zh"}
{"question": "男性，35岁，右肾疼痛，尿常规红细胞充满/HP，白细胞2～3个/HP，尿路平片可见右下段输尿管走行区高密度阴影0.6cm，IVU可见右输尿管下段结石，其上输尿管轻度扩张，右肾轻度积水。1．输尿管结石绞痛发作时应给予的治疗是（　　）。", "answer": "用药物解除绞痛症状", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "大量饮水，促使结石排出", "B": "立即手术取石", "C": "输尿管导管套石", "D": "用药物解除绞痛症状", "language": "zh"}
{"question": "患者，女，62岁，车祸后右股部肿痛4小时来院。查体：神志淡漠，面色苍白，T 37.4℃，P 130次/分，血压70/40mmHg，右股部明显肿胀，淤血，按压有异常活动。3．假设患者行手术治疗，术后第2天出现右侧小腿疼痛，肿胀压痛，右足末稍血运好，Homans征阳性，右股部切口对和正常，无红肿，无分泌物，以下哪项为该患者可能的并发症？（　　）", "answer": "右小腿深静脉血栓", "meta_info": "第四部分　运动系统疾病", "answer_idx": "B", "A": "切口感染骨髓炎", "B": "右小腿深静脉血栓", "C": "右小腿骨筋膜室综合征", "D": "右小腿软组织感染", "language": "zh"}
{"question": "HIV侵入人体后的临床经过可分为（　　）。", "answer": "四期", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "B", "A": "二期", "B": "四期", "C": "五期", "D": "六期", "language": "zh"}
{"question": "2．给高热患者酒精擦浴是为了增加（　　）。", "answer": "蒸发散热", "meta_info": "生理学", "answer_idx": "C", "A": "发汗", "B": "传导散热", "C": "蒸发散热", "D": "辐射散热", "language": "zh"}
{"question": "男，54岁，建筑工人，不慎从高处坠落，不省人事送入医院抢救。医院虽进行了抢救，但l周后，病情未好转并出现了感染性中毒性休克，继而发生循环功能障碍。预后估计不好，当家属和单位得知病人预后消息后，表现为两种态度：家属要求放弃治疗和抢救，而单位则要求继续抢救和治疗。面对这两种态度，医生应该做何种选择最符合伦理原则（　　）。", "answer": "在取得家属和单位的共同支持下，停止抢救与治疗", "meta_info": "医学伦理学", "answer_idx": "C", "A": "尊重家属的意见，停止抢救和治疗", "B": "尊重单位的意见，继续抢救和治疗", "C": "在取得家属和单位的共同支持下，停止抢救与治疗", "D": "在意见不统一情况下，采取一般疗法", "language": "zh"}
{"question": "男，62岁。左胸痛4天，胸闷、气促2天。查体：左下肺呼吸音消失，心率100次/分，律齐。为明确诊断，首选的检查是（　　）。", "answer": "胸部X线片", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "血心肌坏死标志物", "B": "胸部X线片", "C": "血D-二聚体", "D": "胸部B超", "language": "zh"}
{"question": "某人的血浆中只含有抗A凝集素，该人的血型不可能是（　　）。", "answer": "A型", "meta_info": "生理学", "answer_idx": "A", "A": "A型", "B": "AB型", "C": "B型", "D": "Rh型", "language": "zh"}
{"question": "谷类和豆类食物的营养互补氨基酸是（　　）。", "answer": "赖氨酸和色氨酸", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "赖氨酸和谷氨酸", "B": "赖氨酸和甘氨酸", "C": "赖氨酸和酪氨酸", "D": "赖氨酸和色氨酸", "language": "zh"}
{"question": "关于抗疟药的叙述，恰当的是（　　）。", "answer": "青蒿素治疗疟疾的最大缺点是复发率高", "meta_info": "药理学", "answer_idx": "C", "A": "氯喹可根治间日疟", "B": "氯喹对阿米巴痢疾有效", "C": "青蒿素治疗疟疾的最大缺点是复发率高", "D": "伯氨喹可用作疟疾病因性预防", "language": "zh"}
{"question": "女，54岁，手指有弹响指，可能患有的疾病是（　　）。", "answer": "狭窄性腱鞘炎", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "痛风", "B": "指骨骨折", "C": "狭窄性腱鞘炎", "D": "骨关节炎", "language": "zh"}
{"question": "下列关于抗组胺药物正确的说法是（　　）。", "answer": "以上均正确", "meta_info": "医学免疫学", "answer_idx": "D", "A": "与组胺受体结合，阻碍组胺药理效应的发挥", "B": "不影响IgE与肥大细胞结合", "C": "过敏反应发生前给药比发生后给药更有效", "D": "以上均正确", "language": "zh"}
{"question": "一位肿瘤病学专家在同事的协助下，为一肺癌病人做胸穿，抽出了1000毫升胸水。第二天早上交班时，这位专家问当班护士：此病人是什么时候做的胸穿？你注意观察了吗？病人的呼吸、心跳怎样？……护士有些紧张，答得不完全。这位专家说：这些内容医师要管，护士也要管，我们应共同努力。5．下述医师做法或叙述中，不符合“彼此独立、互相支持和帮助”这一原则的为（　　）。", "answer": "“医生的嘴，护士的腿”", "meta_info": "医学伦理学", "answer_idx": "A", "A": "“医生的嘴，护士的腿”", "B": "医师发现检验师检验报告不合格，只是当着病人的面说些“水平太低了”的话，然后又开出另一种检验项目单，嘱病人去做", "C": "下级医师为上级医师掩饰失误，损害了病人利益", "D": "上级主管部门就病人反映的某医师开CT检查单而分得“开单费”的违规问题而来调查情况时，因怕伤害朋友情面和影响科室创收，知情医师不配合", "language": "zh"}
{"question": "女，55岁。拔牙后间断发热2个月。既往有室间隔缺损病史。实验室检查：血培养为草绿色链球菌。最有助于明确发热病因的检查是（　　）。", "answer": "经食道超声心动图", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "血类风湿因子", "B": "经食道超声心动图", "C": "血清补体", "D": "眼底检查", "language": "zh"}
{"question": "患者，男，钡剂胃透检查，见胃壁僵硬，胃腔变小，黏膜皱襞大部分消失。应诊断为（　　）。", "answer": "弥漫浸润型胃癌", "meta_info": "病理学", "answer_idx": "B", "A": "隆起型胃癌", "B": "弥漫浸润型胃癌", "C": "浅表扩散性胃癌", "D": "局限浸润型胃癌", "language": "zh"}
{"question": "1．运输外源性甘油三酯的脂蛋白（　　）。", "answer": "乳糜微粒", "meta_info": "生物化学", "answer_idx": "A", "A": "乳糜微粒", "B": "低密度脂蛋白", "C": "中间密度脂蛋白", "D": "高密度脂蛋白", "language": "zh"}
{"question": "女，27岁。产后第4天，出现寒战、高热、腰痛，尿白细胞30/HP，尿蛋白（＋），尿痛，下腹痛，肾区叩击痛，耻骨上压痛（＋），血象WBC 18×109/L。3．治疗症状不缓解考虑更换抗生素的时间是（　　）。", "answer": "72小时内无效可换药", "meta_info": "第4篇　泌尿系统", "answer_idx": "A", "A": "72小时内无效可换药", "B": "48小时内无效可换药", "C": "36小时内无效可换药", "D": "24小时内无效可换药", "language": "zh"}
{"question": "1l岁小孩，踢球时被人踢伤左腿，体检：左小腿下l／3腓侧有压痛。局部肿胀，明显畸形。可闻及骨摩擦音，该患者步行入院。诊断最大可能是（　　）。", "answer": "腓骨闭合性骨折", "meta_info": "第四部分　运动系统疾病", "answer_idx": "D", "A": "胫骨骨折", "B": "胫腓骨闭合性骨折", "C": "骨筋膜室综合征", "D": "腓骨闭合性骨折", "language": "zh"}
{"question": "男，5岁。尿少2天，晨起眼睑水肿，下肢凹陷性浮肿，查尿蛋白（＋＋＋），红细胞0～3个/HP，BP 100∕70mmHg，首先考虑的诊断是（　　）。", "answer": "单纯性肾病", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "肾炎性肾病", "B": "单纯性肾病", "C": "急性肾炎", "D": "慢性肾炎", "language": "zh"}
{"question": "增生型皮质醇增多症伴垂体微腺瘤，下述治疗方案中应首先（　　）。", "answer": "经蝶窦切除垂体微腺瘤", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "C", "A": "一侧肾上腺全切，一侧大部分切除", "B": "双肾上腺全切加垂体放疗", "C": "经蝶窦切除垂体微腺瘤", "D": "肾上腺次全切除加神经递质抑制剂", "language": "zh"}
{"question": "正常小儿后囟闭合的时间一般于出生后（　　）。", "answer": "6～8周", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "3～5周", "B": "6～8周", "C": "9～11周", "D": "12～14周", "language": "zh"}
{"question": "男孩，4岁，一向偏食，不吃鱼、肉、蛋，仅食蔬菜，近日发现面色渐苍白，不愿活动，时而腹泻。查体：心肺正常，肝脏于肋下触及3cm，脾未及。血象：Hb 60g/L，RBC 2.90×1012/L，血涂片：红细胞大小不等，以小为主，中心淡染区扩大。3．引起此病的主要病因是（　　）。", "answer": "摄入量不足", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "长期腹泻", "B": "先天贮备不足", "C": "摄入量不足", "D": "患有慢性失血性疾病", "language": "zh"}
{"question": "4．胆红素自肝脏排出的主要形式是（　　）。", "answer": "胆红素葡萄糖醛酸酯", "meta_info": "生物化学", "answer_idx": "C", "A": "硫酸胆红素", "B": "胆红素-清蛋白", "C": "胆红素葡萄糖醛酸酯", "D": "胆素原族", "language": "zh"}
{"question": "男性，25岁，因食不洁食物后出现剧烈呕吐和腹泻，同时伴有头晕、四肢湿冷，血压90/70mmHg，脉搏100次/分。最重要的处置是（　　）。", "answer": "补液", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "A", "A": "补液", "B": "利尿", "C": "强心", "D": "抗生素", "language": "zh"}
{"question": "长链脂肪酸的合成原料是（　　）。", "answer": "乙酰CoA", "meta_info": "生物化学", "answer_idx": "B", "A": "乙酰乙酸", "B": "乙酰CoA", "C": "乙酰乙酰CoA", "D": "琥珀酰CoA", "language": "zh"}
{"question": "脊柱结核发生率最高的部位是（　　）。", "answer": "腰椎", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "腰椎", "B": "颈椎", "C": "胸椎", "D": "骶椎", "language": "zh"}
{"question": "1．心身疾病的诊断原则之一是（　　）。", "answer": "病情变化与心理社会因素有关", "meta_info": "医学心理学", "answer_idx": "B", "A": "培养健全人格，锻炼应对能力，获取社会支持", "B": "病情变化与心理社会因素有关", "C": "心身相结合的原则", "D": "心理治疗", "language": "zh"}
{"question": "女，35岁，G6P1。月经量增多3年，经期及周期正常。妇科检査：子宫前位，饱满，活动差，无压痛。推荐该患者最佳的避孕方法是（　　）。", "answer": "避孕套", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "避孕套", "B": "体外排精", "C": "紧急避孕药", "D": "短效口服避孕药", "language": "zh"}
{"question": "女性，32岁，病人表现为紧张恐惧，坐立不安，有大祸临头之感，惶惶不可终日，说不出具体原因，属于（　　）。", "answer": "焦虑", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "焦虑", "B": "恐惧", "C": "易激惹", "D": "情感不稳", "language": "zh"}
{"question": "对慢性丙型肝炎的治疗，不是应用干扰素治疗目的的是（　　）。", "answer": "消除血清中抗HCV", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "D", "A": "抑制或清除血清和组织中：HCV", "B": "中止或减缓病程，防止肝硬化", "C": "改善肝脏组织学病变", "D": "消除血清中抗HCV", "language": "zh"}
{"question": "属于偏头痛持续状态的是（　　）。", "answer": "偏头痛发作持续72小时，期间有2小时的缓解", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "头痛发作后伴眼肌瘫痪持续3天", "B": "先偏瘫、麻木和失语30分钟后发生头痛", "C": "周期性发生某些症状而无头痛，或与头痛交替出现", "D": "偏头痛发作持续72小时，期间有2小时的缓解", "language": "zh"}
{"question": "休克患者动态监测中心静脉压值为25cmH2O，表示（　　）。", "answer": "充血性心力衰竭", "meta_info": "第2篇　心血管系统", "answer_idx": "D", "A": "静脉血管床过度收缩", "B": "肺循环阻力增加", "C": "心肌梗塞", "D": "充血性心力衰竭", "language": "zh"}
{"question": "关于二尖瓣关闭不全听诊特点，下列叙述正确的是（　　）。", "answer": "心尖区第一心音减弱或消失", "meta_info": "第2篇　心血管系统", "answer_idx": "A", "A": "心尖区第一心音减弱或消失", "B": "吸气时增强", "C": "响度在3/6级以下", "D": "不出现第三心音", "language": "zh"}
{"question": "患者，男，38岁。发热半个月，弛张热型，伴恶寒、关节痛。体检：皮肤瘀点、Osler结节，心脏有杂音，考虑为感染性心内膜炎。确诊的直接证据来自（　　）。", "answer": "血液细菌学检查", "meta_info": "第2篇　心血管系统", "answer_idx": "D", "A": "心电图检查", "B": "血液学检查", "C": "免疫学检查", "D": "血液细菌学检查", "language": "zh"}
{"question": "患者，女，58岁，绝经7年，子宫不规则出血2个月，阴道分泌物增多，乳房发胀数日。检查子宫正常大小，左附件可触及拳头大小、囊实性包块，活动无压痛。其诊断可能为（　　）。", "answer": "卵巢颗粒细胞瘤", "meta_info": "第5篇　女性生殖系统", "answer_idx": "D", "A": "子宫内膜息肉", "B": "子宫内膜异位症", "C": "输卵管、卵巢积水", "D": "卵巢颗粒细胞瘤", "language": "zh"}
{"question": "患者，女性，70岁，因尿路感染于5天前开始服用氨苄西林，现出现腹泻。取便标本，培养出大量革兰阳性葡萄球菌。试问腹泻发生机制是（　　）。", "answer": "菌群失调", "meta_info": "医学微生物学", "answer_idx": "A", "A": "菌群失调", "B": "内毒素作用于肠黏膜", "C": "细菌侵袭肠黏膜所致", "D": "肠蠕动加快", "language": "zh"}
{"question": "小谢在施工中突发意外造成大量失血，送医院后急需输血，但现在小谢已无自主意识且家属不在身边，下列哪项是此时治疗的医务人员应该做的？（　　）", "answer": "报医院职能部门或主管领导签字同意后输血", "meta_info": "卫生法规", "answer_idx": "D", "A": "等待家属赶到签署《输血治疗同意书》后再行输血", "B": "经科室主任同意签字后输血", "C": "请陪同人员和朋友签署《输血治疗同意书》后输血", "D": "报医院职能部门或主管领导签字同意后输血", "language": "zh"}
{"question": "培养钩端螺旋体的最佳体温（　　）。", "answer": "28℃", "meta_info": "医学微生物学", "answer_idx": "C", "A": "37℃", "B": "35℃", "C": "28℃", "D": "20℃", "language": "zh"}
{"question": "重度有机磷中毒时，全血胆碱酯酶活力应为（　　）。", "answer": "30%以下", "meta_info": "第八部分　其他疾病", "answer_idx": "D", "A": "60%以下", "B": "50%以下", "C": "40%以下", "D": "30%以下", "language": "zh"}
{"question": "女，68岁，1年前于坐位早餐时突感心悸。随之意识丧失跌倒，数分钟后意识恢复，无大汗、肢体抽搐、口吐白沫和大小便失禁。1年来反复发作上述症状3次，发作与体位和运动无关。查体：BP 130/70mmHg，心率48次/min。心电图示二度Ⅱ型房室传导阻滞。该患者意识丧失最可能的原因是（　　）。", "answer": "心律失常", "meta_info": "第2篇　心血管系统", "answer_idx": "B", "A": "低血糖", "B": "心律失常", "C": "癫痫发作", "D": "迷走神经张力增高", "language": "zh"}
{"question": "急进性肾小球肾炎的病理特点是（　　）。", "answer": "肾小球囊壁层上皮细胞显著增生", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "肾小球系膜细胞大量增生", "B": "肾小球内皮细胞显著增生", "C": "肾小球囊壁层上皮细胞显著增生", "D": "毛细血管基底膜大量钉状突起", "language": "zh"}
{"question": "10个月女婴，单纯母乳喂养，面色渐苍白2个月，烦躁，食欲不佳，不愿活动，肝肋下2cm，脾肋下可触及边缘。Hb70g/L，RBC3.6×1012/L，MCV70fl，MCH23pg，MCHC29%。最可能的诊断是（　　）。", "answer": "营养性缺铁性贫血", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "再生障碍性贫血", "B": "营养性缺铁性贫血", "C": "营养性巨幼红细胞性贫血", "D": "铁粒幼红细胞性贫血", "language": "zh"}
{"question": "下列烧伤急救原则中，正确的是（　　）。", "answer": "立即消除烧伤原因", "meta_info": "第八部分　其他疾病", "answer_idx": "D", "A": "凡有呼吸道烧伤，一律做气管切开", "B": "凡有烧伤者，一律用杜冷丁止痛", "C": "热液烫伤者，不能用较干净冷水浸泡", "D": "立即消除烧伤原因", "language": "zh"}
{"question": "男性，60岁，突然右口角流涎，言语不清，右上下肢无力，活动不灵，右偏身感觉减退，看不见右侧物体，病变位于（　　）。", "answer": "左侧内囊", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "左侧中央后回", "B": "左侧中央前回", "C": "左侧额下回后部", "D": "左侧内囊", "language": "zh"}
{"question": "已知碘锐特在流经肾循环后可被完全清除，给某人静脉滴注碘锐特后，肾每分钟可将660ml血浆中碘锐特完全清除，该数值为（　　）。", "answer": "肾血浆流量", "meta_info": "生理学", "answer_idx": "B", "A": "肾小球滤过率", "B": "肾血浆流量", "C": "肾小管分泌率", "D": "肾小管重吸收率", "language": "zh"}
{"question": "3．儿童期以最少出现并发症的是（　　）。", "answer": "房间隔缺损", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "室间隔缺损", "B": "房间隔缺损", "C": "法洛四联症", "D": "完全性大动脉错位", "language": "zh"}
{"question": "糖尿病酮症酸中毒抢救的主要措施为（　　）。", "answer": "补生理盐水+胰岛素", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "B", "A": "补液", "B": "补生理盐水+胰岛素", "C": "抗感染", "D": "纠正电解质紊乱", "language": "zh"}
{"question": "1．股骨颈骨折（　　）。", "answer": "易发生缺血性骨坏死", "meta_info": "第四部分　运动系统疾病", "answer_idx": "C", "A": "易发生肱动脉损伤", "B": "易发生腘动脉损伤", "C": "易发生缺血性骨坏死", "D": "易发生桡神经损伤", "language": "zh"}
{"question": "下列关于女性生殖器结核的临床特点，错误的是（　　）。", "answer": "腹泻、便秘交替", "meta_info": "第5篇　女性生殖系统", "answer_idx": "D", "A": "不孕", "B": "月经失调", "C": "下腹坠痛", "D": "腹泻、便秘交替", "language": "zh"}
{"question": "动机产生的两个条件是（　　）。", "answer": "需要和诱因", "meta_info": "医学心理学", "answer_idx": "C", "A": "需求和目标", "B": "需要和目的", "C": "需要和诱因", "D": "意志和目的", "language": "zh"}
{"question": "从东南亚入境一男子，3天前因突然剧烈呕吐，腹泻而入院，腹泻呈米泔水样，粪检发现穿梭状运动的细菌，请问致病菌可能是（　　）。", "answer": "霍乱弧菌", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "副溶血弧菌", "B": "肠炎杆菌", "C": "鼠伤寒沙门菌", "D": "霍乱弧菌", "language": "zh"}
{"question": "患儿，腹泻3天，伴发热39℃（R），每日大便7～10次，稀水样，粪质少。患儿今烦躁、哭吵，面色红，口唇及舌干燥，欲饮。可能的诊断为（　　）。", "answer": "高渗性脱水", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "高渗性脱水", "B": "接近休克状态", "C": "低渗性脱水", "D": "等渗性脱水", "language": "zh"}
{"question": "具有亲细胞作用的抗体是（　　）。", "answer": "IgE", "meta_info": "医学免疫学", "answer_idx": "B", "A": "IgD", "B": "IgE", "C": "IgG", "D": "IgA", "language": "zh"}
{"question": "心理社会因素参与的躯体疾病称为（　　）。", "answer": "心身疾病", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "情绪反应", "B": "心理障碍", "C": "精神疾病", "D": "心身疾病", "language": "zh"}
{"question": "炎性充血主要是指（　　）。", "answer": "动脉扩张，局部组织含血量增多", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "动脉扩张，局部组织含血量增多", "B": "静脉回流障碍，组织含血量增多", "C": "炎症区域小血管破裂", "D": "炎症区域组织间隙中血量增多", "language": "zh"}
{"question": "患者男，29岁，右胫、腓骨闭合骨折后行手法复位石膏外固定24小时后，出现患肢持续性剧烈疼痛，进行性加重。2．若患肢由疼痛转为无痛，出现皮肤苍白、大理石花纹，感觉异常、肌力减弱，最有可能的诊断是（　　）。", "answer": "骨筋膜室综合征", "meta_info": "第四部分　运动系统疾病", "answer_idx": "A", "A": "骨筋膜室综合征", "B": "DIC", "C": "下肢静脉栓塞", "D": "血栓闭塞性脉管炎", "language": "zh"}
{"question": "患维生素D缺乏性佝偻病的9～10个月婴儿多见的骨骼改变是（　　）。", "answer": "方颅", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "颅骨软化", "B": "肋骨串珠", "C": "方颅", "D": "肋膈沟", "language": "zh"}
{"question": "2．高渗性非酮症性糖尿病昏迷（　　）。", "answer": "尿糖（++++），酮体（-）", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "A", "A": "尿糖（++++），酮体（-）", "B": "尿糖（++++），酮体强阳性", "C": "尿糖（-），酮体（-）", "D": "尿糖（-），酮体（+）", "language": "zh"}
{"question": "胆汁质气质的人，其高级神经活动类型属于（　　）。", "answer": "强、不均衡而灵活的兴奋型", "meta_info": "医学心理学", "answer_idx": "C", "A": "强、均衡而灵活的活泼型", "B": "强、均衡而不灵活的安静型", "C": "强、不均衡而灵活的兴奋型", "D": "弱、均衡、灵活的灵活型", "language": "zh"}
{"question": "库存枸橼酸钠血，一般超过（　　）周不宜再用。", "answer": "3周", "meta_info": "第一部分　血液系统疾病", "answer_idx": "A", "A": "3周", "B": "4周", "C": "6周", "D": "8周", "language": "zh"}
{"question": "生物医学模式向生物—心理—社会医学模式的转变，引起医德的下述变化，但除外（　　）。", "answer": "医德根本宗旨的变化", "meta_info": "医学伦理学", "answer_idx": "A", "A": "医德根本宗旨的变化", "B": "促进了生命伦理学的诞生", "C": "医德理论的变化", "D": "医德意识的变化", "language": "zh"}
{"question": "秋季流行腹泻中，6个月小儿，2天吐泻20余次，精神委靡，皮肤干燥，弹性较差，眼窝明显凹陷，尿量明显减少，唇干肢冷，血压70/40mmHg，体温36.5℃，恰当补液应为（　　）。", "answer": "120～150ml/（kg·d）", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "90～120ml/（kg·d）", "B": "120～150ml/（kg·d）", "C": "150～180ml/（kg·d）", "D": "＞180ml/（kg·d）", "language": "zh"}
{"question": "下列哪一种激素是由下丘脑产生的？（　　）", "answer": "精氨酸加压素", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "C", "A": "黄体生成素", "B": "泌乳素", "C": "精氨酸加压素", "D": "促甲状腺素", "language": "zh"}
{"question": "肺腺癌的描述不正确的是（　　）。", "answer": "常有吸烟史", "meta_info": "病理学", "answer_idx": "A", "A": "常有吸烟史", "B": "可伴有粘液分泌", "C": "常有肺门淋巴结转移", "D": "常有乳头形成", "language": "zh"}
{"question": "下列慢性粟粒性肺结核病的描述，哪项不对？（　　）", "answer": "由肺门淋巴结干酪样坏死破入颈内静脉发生血行播散引起", "meta_info": "病理学", "answer_idx": "C", "A": "多见于成年人", "B": "肺内原发综合征多已钙化痊愈", "C": "由肺门淋巴结干酪样坏死破入颈内静脉发生血行播散引起", "D": "肺内形成新旧不等的病变", "language": "zh"}
{"question": "良性卵巢肿瘤伴右侧胸水形成可见于（　　）。", "answer": "纤维瘤", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "浆液性囊腺瘤", "B": "粘液性囊腺瘤", "C": "卵泡膜细胞瘤", "D": "纤维瘤", "language": "zh"}
{"question": "女性，22岁，皮肤反复出现紫癜增多2年，确诊为ITP。本病首选治疗药物是（　　）。", "answer": "肾上腺皮质激素", "meta_info": "第一部分　血液系统疾病", "answer_idx": "A", "A": "肾上腺皮质激素", "B": "输新鲜血", "C": "脾切除", "D": "免疫抑制剂", "language": "zh"}
{"question": "1岁小儿患麻疹后5周，低热，食欲不振，消瘦，盗汗。查体：两肺无湿啰音。OT试验1：2000浓度结果为阴性。下列哪一项检查最重要？（　　）", "answer": "胸部X线摄片", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "血培养", "B": "白细胞计数及分类", "C": "血沉", "D": "胸部X线摄片", "language": "zh"}
{"question": "1．上述哪项是HLA-D相关位点？（　　）", "answer": "H-2I", "meta_info": "医学免疫学", "answer_idx": "C", "A": "H-2K", "B": "H-2D", "C": "H-2I", "D": "H-2S", "language": "zh"}
{"question": "3．可直接激活蛋白激酶C的为（　　）。", "answer": "IP3", "meta_info": "生物化学", "answer_idx": "C", "A": "cGMP", "B": "磷脂酰丝氨酸", "C": "IP3", "D": "GSH", "language": "zh"}
{"question": "1．四肢强直，躯背过伸、呈角弓反张状，称为（　　）。", "answer": "去大脑强直", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "小脑幕切迹疝", "B": "去皮层强直", "C": "去大脑强直", "D": "大脑镰下疝", "language": "zh"}
{"question": "24岁女性，停经58d，13d前行人工流产吸宫术。术后持续阴道出血。1．初步考虑的诊断是（　　）。", "answer": "吸宫不全", "meta_info": "第二部分　模拟试题", "answer_idx": "B", "A": "子宫穿孔", "B": "吸宫不全", "C": "子宫内膜炎", "D": "漏吸", "language": "zh"}
{"question": "慢性菌痢的病程应该超过的时间是（　　）。", "answer": "2个月", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "B", "A": "3个月", "B": "2个月", "C": "半年", "D": "1年", "language": "zh"}
{"question": "2．肉芽组织取代坏死组织、血栓及渗出物的过程（　　）。", "answer": "机化", "meta_info": "病理学", "answer_idx": "A", "A": "机化", "B": "分化", "C": "再生", "D": "增生", "language": "zh"}
{"question": "女，50岁。未孕，绝经2年。近半年阴道流水样白带，近2周出现阴道间断少量血性排液。妇科检查宫颈光滑，子宫如妊娠6周大，双侧附件未扪及异常。1．此患者最可能的诊断为（　　）。", "answer": "子宫内膜癌", "meta_info": "第5篇　女性生殖系统", "answer_idx": "C", "A": "子宫黏膜下肌瘤", "B": "子宫内膜息肉", "C": "子宫内膜癌", "D": "子宫颈癌", "language": "zh"}
{"question": "成人糖尿病酮症酸中毒胰岛素治疗方案是（　　）。", "answer": "每小时静脉滴注4～6U普通胰岛素", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "C", "A": "每4小时静脉滴注5～10U普通胰岛素", "B": "每2小时静脉滴注5～10U鱼精蛋白锌胰岛素", "C": "每小时静脉滴注4～6U普通胰岛素", "D": "每小时静脉滴注5～10U鱼精蛋白锌胰岛素", "language": "zh"}
{"question": "营养性缺铁性贫血患儿最适合的治疗应是（　　）。", "answer": "餐间服用硫酸亚铁及维生素C", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "餐前服用富马酸铁", "B": "餐后服用硫酸亚铁及B族维生素", "C": "反复多次少量输血及硫酸亚铁", "D": "餐间服用硫酸亚铁及维生素C", "language": "zh"}
{"question": "女性，48岁，身高160cm，体重68kg，近半年口渴多饮，多尿，伴乏力，空腹血糖6.9mmol/L。3．若上述措施不能有效控制血糖，该患者应采取的治疗是（　　）。", "answer": "双胍类药物", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "B", "A": "磺脲类药物", "B": "双胍类药物", "C": "胰岛素治疗", "D": "磺脲类药物+胰岛素治疗", "language": "zh"}
{"question": "小儿先天性心脏病中属于青紫型的是（　　）。", "answer": "法洛四联症", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "室间隔缺损", "B": "动脉导管未闭", "C": "肺动脉狭窄", "D": "法洛四联症", "language": "zh"}
{"question": "胆管癌的主要表现是（　　）。", "answer": "无痛性黄疸", "meta_info": "第3篇　消化系统", "answer_idx": "D", "A": "厌食、恶心呕吐", "B": "腹痛、黄疸", "C": "腹痛、黄疸和寒战、高热", "D": "无痛性黄疸", "language": "zh"}
{"question": "4．NK（　　）。", "answer": "ADCC", "meta_info": "医学免疫学", "answer_idx": "D", "A": "Ab阻断、中和作用", "B": "调理作用", "C": "裂解细胞作用", "D": "ADCC", "language": "zh"}
{"question": "免疫缺陷病的发生可能是由于（　　）。", "answer": "以上任一均可", "meta_info": "医学免疫学", "answer_idx": "D", "A": "T细胞发育缺陷", "B": "吞噬细胞功能缺陷", "C": "补体功能缺陷", "D": "以上任一均可", "language": "zh"}
{"question": "30岁男患，病程4个月，头痛发病，入院前出现左侧肢体无力和呕吐。入院检查，意识清，眼底视乳头水肿，左上下肢肌力Ⅳ级，腱反射活跃，病理征（+）。3．根本治疗原则是（　　）。", "answer": "去病因治疗", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "给予镇痛剂", "B": "冬眠物理降温", "C": "去病因治疗", "D": "去骨歼颅减压", "language": "zh"}
{"question": "与中骨盆狭窄无关的是（　　）。", "answer": "骶尾关节活动度", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "坐骨切迹宽度", "B": "骶尾关节活动度", "C": "坐骨棘间径", "D": "骶骨弯曲度", "language": "zh"}
{"question": "先天愚型最常见的染色体异常为（　　）。", "answer": "21-三体畸变", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "21-三体畸变", "B": "G/G易位", "C": "嵌合体", "D": "18-三体畸变", "language": "zh"}
{"question": "下述不是肿瘤的疾病是（　　）。", "answer": "室壁瘤", "meta_info": "病理学", "answer_idx": "B", "A": "霍奇金病", "B": "室壁瘤", "C": "葡萄胎", "D": "自血病", "language": "zh"}
{"question": "男孩，2岁。因颜面及四肢凹陷性水肿1周来诊。查体：BP 85／55mmHg，尿蛋白（＋＋＋），RBC 1～2/HP，血浆总蛋白40g/L，清蛋白20g/L，胆固醇6.2mmol/L，尿素氮5.5mmol/L。最可能的诊断是（　　）。", "answer": "单纯性肾病综合征", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "单纯性肾病综合征", "B": "IgA肾病", "C": "肾炎性肾病综合征", "D": "急性肾小球肾炎", "language": "zh"}
{"question": "1．下运动神经元是（　　）。", "answer": "脊髓前角细胞", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "脊髓前角细胞", "B": "中央前回Betz细胞", "C": "基底神经节", "D": "小脑", "language": "zh"}
{"question": "诊断反流性食管炎最可靠的方法是（　　）。", "answer": "胃镜", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "胃镜", "B": "食管滴酸试验", "C": "食管钡剂X线检查", "D": "食管测压", "language": "zh"}
{"question": "关于生长因子的叙述，错误的是（　　）。", "answer": "均不属于癌基因表达产物", "meta_info": "生物化学", "answer_idx": "B", "A": "由不同的细胞合成后分泌的", "B": "均不属于癌基因表达产物", "C": "最终启动相关基因转录", "D": "调节细胞生长、分化", "language": "zh"}
{"question": "2．房室瓣关闭见于（　　）。", "answer": "等容收缩期初", "meta_info": "生理学", "answer_idx": "A", "A": "等容收缩期初", "B": "等容收缩期末", "C": "等容舒张期初", "D": "等容舒张期末", "language": "zh"}
{"question": "急性苯中毒主要损害（　　）。", "answer": "中枢神经系统", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "中枢神经系统", "B": "循环系统", "C": "血液系统", "D": "呼吸系统", "language": "zh"}
{"question": "患儿，女，2个月。拒食、吐奶、嗜睡3天，查体：面色青灰，前囟紧张，脐部少许脓性分泌物。为明确诊断，最关键的检查是（　　）。", "answer": "脑脊液检查", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "头颅CT", "B": "血培养", "C": "血气分析", "D": "脑脊液检查", "language": "zh"}
{"question": "子宫内膜癌绝大多数患者的首发症状是（　　）。", "answer": "异常阴道出血", "meta_info": "第5篇　女性生殖系统", "answer_idx": "A", "A": "异常阴道出血", "B": "阴道排出大量脓血性分泌物", "C": "宫腔积脓", "D": "下腹疼痛", "language": "zh"}
{"question": "3．是氢氯噻嗪的利尿机制（　　）。", "answer": "抑制髓袢升支粗段皮质部Na+、Cl-的重吸收", "meta_info": "药理学", "answer_idx": "B", "A": "明显抑制集合管碳酸酐酶活性", "B": "抑制髓袢升支粗段皮质部Na+、Cl-的重吸收", "C": "竞争性拮抗醛固酮受体", "D": "直接抑制远端小管对K+的分泌", "language": "zh"}
{"question": "两样本均数比较的t检验，其目的是检验（　　）。", "answer": "两样本所属的总体均数是否相等", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "两样本均数是否相等", "B": "两样本所属的总体均数是否相等", "C": "两样本所属总体的均数相差有多大", "D": "两样本均数相差有多大", "language": "zh"}
{"question": "治疗变异型心绞痛的药物是（　　）。", "answer": "维拉帕米", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "多巴胺", "B": "维拉帕米", "C": "麻黄碱", "D": "普萘洛尔", "language": "zh"}
{"question": "男性，66岁，无痛性肉眼血尿伴条状血块2个月，B超可见左肾轻度积水，2次细胞学检查未见癌细胞。2．若检查发现左肾盂内似有充盈缺损，尿细胞学检查为可疑细胞，进一步选择什么方法检查？（　　）", "answer": "左肾逆行造影", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "CT", "B": "MRI", "C": "左肾逆行造影", "D": "左肾穿刺造影", "language": "zh"}
{"question": "下列有关基础代谢中的叙述哪一项是错误的？（　　）", "answer": "反映人体最低的能量代谢水平", "meta_info": "第二部分　模拟试题", "answer_idx": "C", "A": "在基础状态下测定", "B": "儿童高于成年人", "C": "反映人体最低的能量代谢水平", "D": "临床常用相对值表示", "language": "zh"}
{"question": "癌的肉眼形态，下述哪种可能性最大？（　　）", "answer": "火山口状溃疡", "meta_info": "病理学", "answer_idx": "C", "A": "绒毛状", "B": "乳头状", "C": "火山口状溃疡", "D": "肿块状", "language": "zh"}
{"question": "关于思维障碍的诊断意义，以下哪项错误？（　　）", "answer": "思维贫乏主要见于抑郁症病人", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "在意识清晰状态下出现联想松散。思维破裂，思维中断等常指向精神分裂症", "B": "在意识不清晰的状况下常出现思维结构方面的障碍", "C": "慢性的脑器质性精神病常出现病理性赘述", "D": "思维贫乏主要见于抑郁症病人", "language": "zh"}
{"question": "1．急性非淋巴细胞白血病化疗（　　）。", "answer": "HAP方案", "meta_info": "第一部分　血液系统疾病", "answer_idx": "B", "A": "VP方案", "B": "HAP方案", "C": "输浓缩红细胞", "D": "鞘内注射甲氨蝶呤", "language": "zh"}
{"question": "肺毛细血管楔压（PCWP）的正常值范围是（　　）。", "answer": "0.8～2.0kPa", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "0.5～0.7kPa", "B": "0.8～2.0kPa", "C": "2.1～2.5kPa", "D": "2.6～2.9kPa", "language": "zh"}
{"question": "典型化脓性脑膜炎脑脊液变化是（　　）。", "answer": "细胞数增高，蛋白升高，糖降低", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "细胞数增高，蛋白升高。糖正常", "B": "细胞数增高，蛋白升高，糖升高", "C": "细胞数增高，蛋白升高，糖降低", "D": "细胞数增高，蛋白降低，糖降低", "language": "zh"}
{"question": "左室内压下降速度最快是在（　　）。", "answer": "等容舒张期", "meta_info": "生理学", "answer_idx": "B", "A": "快速充盈期", "B": "等容舒张期", "C": "等容收缩期", "D": "减慢射血期", "language": "zh"}
{"question": "关于正常足月儿的生理特点，下述错误的是（　　）。", "answer": "腹壁反射，提睾反射均可引出", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "安静时呼吸40次/min", "B": "睡眠时平均心率140次/min", "C": "腹壁反射，提睾反射均可引出", "D": "生后10日内不需补钾", "language": "zh"}
{"question": "女，16岁。被侧塌的房屋压伤后腹痛伴呕吐1小时。查体：P 140次/分，R 26次/分，BP 80／54mmHg，神志清，痛苦面容，腹肌紧张，有压痛和反跳痛，移动性浊音（＋），肠鸣音消失。3．非手术治疗，最主要的措施是（　　）。", "answer": "快速补充血容量", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "使用止痛药物", "B": "使用止血药物", "C": "给予一次大剂量糖皮质激素", "D": "快速补充血容量", "language": "zh"}
{"question": "镇痛作用最强的药物是（　　）。", "answer": "芬太尼", "meta_info": "药理学", "answer_idx": "A", "A": "芬太尼", "B": "吗啡", "C": "喷他佐辛", "D": "美沙酮", "language": "zh"}
{"question": "患者，男，35岁。突发剧烈头痛伴恶心、呕吐、烦躁不安1天。查体：双眼视力重度减退、双颞侧偏盲。急诊CT示鞍区椭圆形占位性病变3cm×2cm×2cm大小，内呈高密度影，可见液平面，幕上脑室扩大。应采取的有效治疗措施是（　　）。", "answer": "急症手术视神经减压", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "立即给予糖皮质激素治疗", "B": "立即给予神经营养药", "C": "迅速给予镇静处理", "D": "急症手术视神经减压", "language": "zh"}
{"question": "上消化道出血时，为寻找出血的病因，首选的检查方法是（　　）。", "answer": "胃镜检查", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "胃镜检查", "B": "上消化道钡餐", "C": "大便隐血试验", "D": "选择性动脉造影", "language": "zh"}
{"question": "2．突出体现医德情感作用的为（　　）。", "answer": "一位急诊病人被送到医院，因其满身血污，其他病人及其家属见了忙掩鼻躲开，而应诊医护人员则顾不得脏不脏，出于责任心赶紧给病人做检查和处置", "meta_info": "医学伦理学", "answer_idx": "B", "A": "某地一些临床名家自发组织了X俱乐部，其活动宗旨是：定期聚会，坦诚交待自己误诊误治的情况并互相交流体会", "B": "一位急诊病人被送到医院，因其满身血污，其他病人及其家属见了忙掩鼻躲开，而应诊医护人员则顾不得脏不脏，出于责任心赶紧给病人做检查和处置", "C": "在病人及其家属的一再恳求下，某手术组决心为一高龄病人做心脏手术，但手术前这个手术组提出必须先去做公证", "D": "医师保证不泄露病人隐私，终于使病人放心地述说了全部病情信息", "language": "zh"}
{"question": "女，60岁。宫颈癌行子宫切除术后3天，晨起时突发左小腿疼痛，左足不能着地踏平，行走时疼痛加重。查体：左小腿肿胀，深压痛，足背动脉搏动存在。首先的检查为（　　）。", "answer": "下肢超声多普勒", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "同位素骨扫描", "B": "下肢X线平片", "C": "下肢MRI", "D": "下肢超声多普勒", "language": "zh"}
{"question": "低血钾引起代谢性碱中毒是因为肾小管（　　）。", "answer": "H+－Na+交换增强", "meta_info": "生理学", "answer_idx": "A", "A": "H+－Na+交换增强", "B": "HCO3-重吸收增强", "C": "K+－Na+交换增强", "D": "NH4+－K+交换减弱", "language": "zh"}
{"question": "急性机械性肠梗阻引起的首要病理生理改变是（　　）。", "answer": "体液丧失", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "呼吸衰竭", "B": "体液丧失", "C": "感染", "D": "毒素中毒", "language": "zh"}
{"question": "某老人跌倒后，右髋疼痛，步行到医院，X线片示外展型嵌插型股骨颈骨折，正确的治疗方法是（　　）。", "answer": "持续皮牵引固定6～8周", "meta_info": "第四部分　运动系统疾病", "answer_idx": "A", "A": "持续皮牵引固定6～8周", "B": "立即手术行三刃钉内固定", "C": "皮牵引6～8周后，三刃钉内固定", "D": "夹板固定", "language": "zh"}
{"question": "糖尿病合并高血压的患者，血压控制目标值应小于（　　）。", "answer": "130／80mmHg", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "130／80mmHg", "B": "150／90mmHg", "C": "140／80mmHg", "D": "130／90mmHg", "language": "zh"}
{"question": "1．有眩晕、眼震、构音障碍、交叉性瘫痪，见于（　　）。", "answer": "椎-基底动脉血栓形成", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "椎-基底动脉血栓形成", "B": "大脑前动脉血栓形成", "C": "大脑中动脉血栓形成", "D": "蛛网膜下腔出血", "language": "zh"}
{"question": "导致继发性腹膜炎的细菌一般是（　　）。", "answer": "大肠杆菌", "meta_info": "第3篇　消化系统", "answer_idx": "B", "A": "变形杆菌", "B": "大肠杆菌", "C": "混合性细菌", "D": "结核菌", "language": "zh"}
{"question": "股骨颈骨折时，股骨头缺血性坏死率最高的是（　　）。", "answer": "完全性经颈骨折", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "不完全性基底骨折", "B": "完全性基底骨折", "C": "不完全性经颈骨折", "D": "完全性经颈骨折", "language": "zh"}
{"question": "结核性腹膜炎患者，在抗结核治疗中出现失眠、神经错乱，引起此种作用的药物可能是（　　）。", "answer": "异烟肼", "meta_info": "药理学", "answer_idx": "D", "A": "PAs", "B": "利福平", "C": "吡嗪酰胺", "D": "异烟肼", "language": "zh"}
{"question": "患者，女性，40岁，发现左乳肿物，并伴肿物区皮肤红肿1周，无明显疼痛及全身症状，查体：左乳肿物约1cm×1cm大小，表面约2cm×2cm区域皮肤红肿，行乳腺钼钯检查发现左乳约2cm。区域内大量密集钙化。1．此病人应首先考虑诊断（　　）。", "answer": "炎性乳癌", "meta_info": "第八部分　其他疾病", "answer_idx": "B", "A": "乳腺炎", "B": "炎性乳癌", "C": "乳腺结核", "D": "乳腺淤乳囊肿", "language": "zh"}
{"question": "男，28岁。心悸、无力、手颤抖3个月，大便每日2～3次，不成形。体重下降5kg，1周前诊断为甲状腺功能亢进症，尚未治疗，昨晚饮白酒半斤，呕吐一次，晨起醒来发现双下肢不能活动。1．为明确下肢不能活动的原因，首先应测定（　　）。", "answer": "血钾", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "血钠", "B": "血镁", "C": "血糖", "D": "血钾", "language": "zh"}
{"question": "机体内环境的稳态是指（　　）。", "answer": "细胞外液的物理、化学因素保持着动态平衡", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "细胞外液的物理、化学因素保持着动态平衡", "B": "细胞内液理化性质保持不变", "C": "细胞外液理化性质保持不变", "D": "细胞内液的化学成分相对恒定", "language": "zh"}
{"question": "对危重急性中毒患者，应立即采取的措施是（　　）。", "answer": "维持生命体征并终止毒物接触", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "维持生命体征并终止毒物接触", "B": "洗胃，迅速排出消化道毒物", "C": "导泻，迅速排出体内毒物", "D": "使用特效解毒药", "language": "zh"}
{"question": "2．氨在血液中的主要运输形式是（　　）。", "answer": "丙氨酸和谷氨酰胺", "meta_info": "生物化学", "answer_idx": "A", "A": "丙氨酸和谷氨酰胺", "B": "谷氨酸和丙氨酸", "C": "瓜氨酸和精氨酸", "D": "组氨酸和赖氨酸", "language": "zh"}
{"question": "糖尿病性血管病变，最具有特征性的为（　　）。", "answer": "微血管病变", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "B", "A": "合并高血压", "B": "微血管病变", "C": "周围动脉硬化一下肢坏疽", "D": "脑血管病变", "language": "zh"}
{"question": "某男，5岁，突发高热、呕吐、惊厥，数小时后出现面色苍白、四肢厥冷、脉搏细速、血压下降至休克水平。经实验室检查诊断为暴发型流行性脑膜炎所致感染中毒性休克，应采取的抗休克药物为（　　）。", "answer": "糖皮质激素", "meta_info": "药理学", "answer_idx": "D", "A": "肾上腺素", "B": "阿托品", "C": "酚妥拉明", "D": "糖皮质激素", "language": "zh"}
{"question": "男孩，1.5岁，已发热、咳嗽1周，近3天气促、喘息加重。查体：面色苍白，烦躁，双肺听诊闻及中小水泡音。病史中曾有过皮肤脓疱疹。血象：白细胞19×109/L，分叶粒细胞占0.9，淋巴细胞占0.1。2．此时最重要的治疗是（　　）。", "answer": "左胸腔穿刺排脓", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "大流量吸氧", "B": "再加一种抗生素", "C": "给予镇静药", "D": "左胸腔穿刺排脓", "language": "zh"}
{"question": "癫痫持续状态是指（　　）。", "answer": "全面强直-阵挛发作频繁发生，伴意识持续不清", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "连续的失神发作", "B": "全面强直-阵挛发作频繁发生，持续24小时", "C": "发作自一处开始，按大脑皮质运动区逐渐扩展", "D": "全面强直-阵挛发作频繁发生，伴意识持续不清", "language": "zh"}
{"question": "在任何原因引起的急性继发性化脓性腹膜炎的病例中，其最关键的治疗是（　　）。", "answer": "消除病因，充分引流，用抗生素", "meta_info": "第3篇　消化系统", "answer_idx": "D", "A": "输血", "B": "应用大量广谱抗生素", "C": "禁食和胃肠减压", "D": "消除病因，充分引流，用抗生素", "language": "zh"}
{"question": "男，72岁。脑血管病患者。住院期间突然半夜起床活动。无目的地摸床，摸墙，摸病友的头，自语，白天安静入睡。3．该患者治疗不宜选用的药物是（　　）。", "answer": "丙戊酸钠", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "胆碱酯酶抑制剂", "B": "氟哌啶醇", "C": "苯二氮类镇静催眠药", "D": "丙戊酸钠", "language": "zh"}
{"question": "患者，男，65岁。持续性上腹部疼痛半年。消瘦、贫血、乏力，偶有恶心、呕吐。查体：呈贫血貌，上腹部剑突下轻压痛。应采用哪种辅助检查确定诊断？（　　）", "answer": "纤维胃镜检查", "meta_info": "第3篇　消化系统", "answer_idx": "C", "A": "胃液分析", "B": "B超检查", "C": "纤维胃镜检查", "D": "血清胃泌素测定", "language": "zh"}
{"question": "提示上运动神经元损害最有意义的体征是（　　）。", "answer": "病理征阳性", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "瘫痪肌肉不萎缩", "B": "病理征阳性", "C": "腱反射减弱", "D": "肌张力正常", "language": "zh"}
{"question": "3．强心苷治疗房扑的药理基础是（　　）。", "answer": "缩短心房的ERP", "meta_info": "药理学", "answer_idx": "C", "A": "增加房室结的隐匿性传导", "B": "加强心肌收缩力", "C": "缩短心房的ERP", "D": "以上都不是", "language": "zh"}
{"question": "38岁已婚妇女，闭经半年。查子宫稍小。肌内注射黄体酮20mg，连用3日，未见撒药性流血，再给予己烯雌酚1mg，连服20日，后3天加用安宫黄体酮10mg，出现撤药性流血。此病例诊断为（　　）。", "answer": "Ⅱ度闭经", "meta_info": "第5篇　女性生殖系统", "answer_idx": "C", "A": "子宫性闭经", "B": "Ⅰ度闭经", "C": "Ⅱ度闭经", "D": "下丘脑性闭经", "language": "zh"}
{"question": "合成血红素的关键酶是（　　）。", "answer": "ALA合酶", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "ALA合酶", "B": "葡萄糖激酶", "C": "丙酮酸激酶", "D": "异柠檬酸脱氢酶", "language": "zh"}
{"question": "在蛋白质消化中起外肽酶作用的是（　　）。", "answer": "氨基肽酶", "meta_info": "生物化学", "answer_idx": "D", "A": "胰蛋白酶", "B": "糜蛋白酶", "C": "胃蛋白酶", "D": "氨基肽酶", "language": "zh"}
{"question": "健康成人，若失血量达1000ml，应输注（　　）。", "answer": "浓缩红细胞", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "浓缩白细胞", "B": "血小板制剂", "C": "浓缩红细胞", "D": "冰冻红细胞", "language": "zh"}
{"question": "男，45岁。上腹部疼痛9小时，向背部放射，伴恶心、呕吐。发病前大量饮酒。查体： T 38.3℃，P 100次/分，上腹部肌紧张，压痛、反跳痛阳性。1．最可能的诊断是（　　）。", "answer": "急性胰腺炎", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "急性胰腺炎", "B": "十二指肠溃疡穿孔", "C": "急性胆囊炎", "D": "急性胆管炎", "language": "zh"}
{"question": "女，48岁。接触性出血3个月。妇科检查：宫颈呈糜烂状，宫体大小正常，活动好，双侧附件区无异常，三合诊（－）。阴道镜下活检病理示鳞状细胞癌，间质浸润深度6mm。2．最适宜的手术方式为（　　）。", "answer": "广泛性子宫切除术＋盆腔淋巴结切除术", "meta_info": "第5篇　女性生殖系统", "answer_idx": "C", "A": "改良广泛子宫切除术＋盆腔淋巴结切除术", "B": "宫颈锥切术＋盆腔淋巴结切除术", "C": "广泛性子宫切除术＋盆腔淋巴结切除术", "D": "筋膜外子宫全切术＋盆腔淋巴结切除术", "language": "zh"}
{"question": "给家兔静脉注射去甲肾上腺素后血压升高，肾小球滤过率和尿量迅速减少，下述哪项是该动物肾小球滤过率降低的主要原因？（　　）", "answer": "肾血流量减少", "meta_info": "生理学", "answer_idx": "D", "A": "肾小球毛细血管血压升高", "B": "肾小囊内液胶体渗透压降低", "C": "血浆胶体渗透压降低", "D": "肾血流量减少", "language": "zh"}
{"question": "男，60岁。因胃溃疡合并多次大出血，行胃大部切除术。1．该病人术后5天出现胃出血，最可能的原因是（　　）。", "answer": "吻合口部分粘膜坏死脱落", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "吻合口缝线感染", "B": "吻合口部分粘膜坏死脱落", "C": "应激性溃疡", "D": "术后胃内残余血", "language": "zh"}
{"question": "正常情况下肺通气阻力主要来自（　　）。", "answer": "肺泡表面张力", "meta_info": "生理学", "answer_idx": "C", "A": "惯性阻力", "B": "肺回缩力", "C": "肺泡表面张力", "D": "组织的黏滞力", "language": "zh"}
{"question": "男性，41岁，腰痛伴右下肢放射痛3个月，反复发作，与劳累有关，咳嗽或用力排便时可加重疼痛。查体：右直腿抬高试验40°阳性，加强试验阳性。X线片示L4椎间隙变窄。1．最可能的诊断为（　　）。", "answer": "腰椎间盘突出症", "meta_info": "第四部分　运动系统疾病", "answer_idx": "D", "A": "急性腰扭伤", "B": "腰椎横突综合征", "C": "腰椎管狭窄症", "D": "腰椎间盘突出症", "language": "zh"}
{"question": "对于TFⅡD的叙述，下述哪项是正确的?（　　）", "answer": "是惟一能与TATA盒结合的转录因子", "meta_info": "生物化学", "answer_idx": "A", "A": "是惟一能与TATA盒结合的转录因子", "B": "具有ATP酶活性", "C": "能促进RNApolⅡ与启动子结合", "D": "抑制DNA基因转录", "language": "zh"}
{"question": "男，40岁。渐起走路不稳2年，有共济失调障碍，步幅加宽，左右摇摆。最可能受损的部位是（　　）。", "answer": "小脑蚓部", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "小脑半球", "B": "小脑蚓部", "C": "丘脑", "D": "大脑半球", "language": "zh"}
{"question": "可出现血液中抗壁细胞抗体阳性的疾病是（　　）。", "answer": "慢性萎缩性胃炎", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "慢性非萎缩性胃炎", "B": "急性胃炎", "C": "慢性萎缩性胃炎", "D": "反流性食管炎", "language": "zh"}
{"question": "哪项是急性炎症性脱髓鞘性多发性神经病最严重的危险症状？（　　）", "answer": "呼吸肌麻痹", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "心力衰竭", "B": "呼吸肌麻痹", "C": "肺部感染", "D": "吞咽困难", "language": "zh"}
{"question": "阿司匹林的不良反应不包括（　　）。", "answer": "溶血性贫血", "meta_info": "药理学", "answer_idx": "B", "A": "胃黏膜糜烂及出血", "B": "溶血性贫血", "C": "诱发哮喘", "D": "血管神经性水肿", "language": "zh"}
{"question": "坏死组织经腐败菌作用后常发生（　　）。", "answer": "坏疽", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "空洞", "B": "梗死", "C": "坏疽", "D": "栓塞", "language": "zh"}
{"question": "下列胰岛素药理作用的描述哪一项是不正确的（　　）。", "answer": "促进糖原分解", "meta_info": "药理学", "answer_idx": "B", "A": "促进蛋白质合成", "B": "促进糖原分解", "C": "抑制蛋白质分解", "D": "促进葡萄糖的氧化和酵解", "language": "zh"}
{"question": "肾母细胞瘤最早出现的临床表现是（　　）。", "answer": "腹部肿块", "meta_info": "第4篇　泌尿系统", "answer_idx": "B", "A": "腹痛", "B": "腹部肿块", "C": "发热", "D": "贫血", "language": "zh"}
{"question": "体内氨的主要来源是（　　）。", "answer": "氨基酸脱氨基", "meta_info": "生物化学", "answer_idx": "C", "A": "肾脏产氨", "B": "肠道吸收", "C": "氨基酸脱氨基", "D": "碱基分解", "language": "zh"}
{"question": "1岁内小儿体重前半年每月平均增长（　　）。", "answer": "600～800g", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "300～400g", "B": "400～500g", "C": "500～600g", "D": "600～800g", "language": "zh"}
{"question": "按照需要起源，可把需要分为哪两大类?（　　）", "answer": "生理性需要和社会性需要", "meta_info": "医学心理学", "answer_idx": "A", "A": "生理性需要和社会性需要", "B": "物质需要和精神需要", "C": "生理性需要和心理性需要", "D": "物质需要和心理需要", "language": "zh"}
{"question": "4．患者阴囊疼痛，畏寒。发热。考虑诊断为（　　）。", "answer": "急性附睾炎", "meta_info": "第4篇　泌尿系统", "answer_idx": "B", "A": "慢性前列腺炎", "B": "急性附睾炎", "C": "淋病性尿道炎", "D": "肾积脓", "language": "zh"}
{"question": "2．研究者和研究对象均不知分组情况的为（　　）。", "answer": "双盲", "meta_info": "预防医学", "answer_idx": "A", "A": "双盲", "B": "单盲", "C": "样本含量", "D": "随机分组", "language": "zh"}
{"question": "在急性腹膜炎的情况下，下列哪一种原因最常引起早期发热？（　　）", "answer": "急性阑尾炎，胆囊炎穿孔", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "胃十二指肠溃疡穿孔", "B": "急性阑尾炎，胆囊炎穿孔", "C": "实质性脏器破裂", "D": "代谢性酸中毒", "language": "zh"}
{"question": "在治疗佝偻病的有效措施中，应除外以下哪项？（　　）", "answer": "多吃豆类食品和蔬菜", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "补充有效剂量的维生素D和钙剂", "B": "提倡母乳喂养", "C": "多吃豆类食品和蔬菜", "D": "加强体格锻炼", "language": "zh"}
{"question": "输血可传播下列哪一种疾病？（　　）。", "answer": "疟疾", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "结核", "B": "疟疾", "C": "钩虫病", "D": "甲型肝炎", "language": "zh"}
{"question": "Addison病由于醛固酮缺乏可产生了（　　）。", "answer": "低钠高钾血症", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "D", "A": "高钠低钾血症", "B": "低钠低钾血症", "C": "低钾低钙血症", "D": "低钠高钾血症", "language": "zh"}
{"question": "女性，38岁，2个月来智力下降，记忆力减退，体重增加10kg，毛发脱落，血清胆固醇320mg%。最可能的诊断是（　　）。", "answer": "甲状腺功能减退症", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "A", "A": "甲状腺功能减退症", "B": "甲状腺功能亢进症", "C": "高脂血症", "D": "神经衰弱", "language": "zh"}
{"question": "患者女性，30岁，背部肿块，红、肿、疼痛3天，寒战，发热39℃。查体：背部肿起约3cm×5cm。触之有波动感，给以局部引流和全身应用抗生素后，仍有寒战、高热，最恰当的治疗措施是（　　）。", "answer": "寻找有无其他感染病灶", "meta_info": "第八部分　其他疾病", "answer_idx": "C", "A": "局部理疗", "B": "局部再次清创扩大引流", "C": "寻找有无其他感染病灶", "D": "使用抗霉菌药物治疗", "language": "zh"}
{"question": "5．新生儿常见的特殊生理状态之一是（　　）。", "answer": "足月新生儿生后3～5天出现乳腺肿大", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "皮肤发亮，水肿毳毛多", "B": "皮肤色红润，皮下脂肪丰满，毳毛少", "C": "呼吸常不规则，甚至呼吸暂停", "D": "足月新生儿生后3～5天出现乳腺肿大", "language": "zh"}
{"question": "现代医学模式是（　　）。", "answer": "生物、心理、社会医学模式", "meta_info": "医学心理学", "answer_idx": "D", "A": "宗教医学模式", "B": "生物医学模式", "C": "心理医学模式", "D": "生物、心理、社会医学模式", "language": "zh"}
{"question": "在精索前方将腹内斜肌下缘和联合肌腱缝至腹股沟韧带上的疝修补术是（　　）。", "answer": "Ferguson修补术", "meta_info": "第3篇　消化系统", "answer_idx": "B", "A": "Bassini修补术", "B": "Ferguson修补术", "C": "Halsted修补术", "D": "疝成形术", "language": "zh"}
{"question": "男，45岁。低热、干咳2周，经胸部X片诊断为浸润性肺结核。既往有高血压史5年，痛风史3年，口服药物治疗。在患者进行抗结核治疗时，应避免使用的药物治疗是（　　）。", "answer": "吡嗪酰胺", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "利福平", "B": "乙胺酰胺", "C": "吡嗪酰胺", "D": "链霉素", "language": "zh"}
{"question": "2．最可能为结核性腹膜炎腹水的是（　　）。", "answer": "腹水比重＞1.018，李凡他（Rivaha）试验阳性", "meta_info": "第3篇　消化系统", "answer_idx": "B", "A": "腹水比重＜1.016，蛋白20g/L", "B": "腹水比重＞1.018，李凡他（Rivaha）试验阳性", "C": "乳糜样腹水", "D": "腹水细胞总数＞1000×106/L，分类以中性粒细胞为主", "language": "zh"}
{"question": "女，38岁。突发心悸伴烦躁和胸闷30分钟，四肢发凉，曾出现黑朦，收入急诊监护病房。查体：BP 70/50mmHg，心率180次/min，心律绝对不齐，心音强弱不等，心脏各瓣膜区未闻及杂音。心电图提示“预激综合征伴心房颤动”。2．在诊疗过程中，该患者突然意识丧失。全身青紫，肢体抽搐，血压测不到，心音消失。心电图QRS波及T波完全消失，代之以大小不等、极不均匀的低小波。该患者需立即采取的治疗措施是（　　）。", "answer": "非同步直流电除颤", "meta_info": "第2篇　心血管系统", "answer_idx": "B", "A": "心室超速起搏治疗", "B": "非同步直流电除颤", "C": "植入永久起搏器", "D": "植入临时起搏器", "language": "zh"}
{"question": "患者，老年男性，因咳嗽，咳黄痰3d就诊。查体发现主动脉瓣区粗糙的收缩期杂音。超声心动图示主动脉瓣狭窄，左心室射血分数55%，心电图检查正常。请问对该患者哪一项处置方法不恰当（　　）。", "answer": "血管紧张素转化酶抑制药", "meta_info": "第二部分　模拟试题", "answer_idx": "C", "A": "抗生素", "B": "化痰药物", "C": "血管紧张素转化酶抑制药", "D": "胸部X线检查", "language": "zh"}
{"question": "目前治疗系统性红斑狼疮的主药为（　　）。", "answer": "泼尼松", "meta_info": "第二部分　模拟试题", "answer_idx": "D", "A": "非甾体抗炎药", "B": "磷酸氯喹", "C": "雷公藤总甙", "D": "泼尼松", "language": "zh"}
{"question": "下列各种引流管，错误的处理是（　　）。", "answer": "留置胆管内的T形管可在术后l周拔除", "meta_info": "第3篇　消化系统", "answer_idx": "C", "A": "要注意观察各种引流管是否通畅", "B": "仔细记录引流液的色泽和容积", "C": "留置胆管内的T形管可在术后l周拔除", "D": "腹腔烟卷引流一般在术后24～72小时拔除", "language": "zh"}
{"question": "在临床医学研究中，可以获得意外损伤赔偿指（　　）。", "answer": "意外损伤者或死亡者家属有权获得因实验意外损伤而应得的公平赔偿", "meta_info": "医学伦理学", "answer_idx": "B", "A": "因参加试验而意外受损伤者有权力要求获得高额赔偿", "B": "意外损伤者或死亡者家属有权获得因实验意外损伤而应得的公平赔偿", "C": "可预见的不良反应可以接受赔偿", "D": "死亡者家属是无权力要求获得赔偿的", "language": "zh"}
{"question": "查体时鉴别腹股沟斜疝与直疝最有意义的是（　　）。", "answer": "回纳后压迫腹股沟深环，疝块是否能够复出", "meta_info": "第3篇　消化系统", "answer_idx": "D", "A": "疝的外形", "B": "疝内容物是否进入阴囊", "C": "疝囊是否位于腹壁下动脉外侧", "D": "回纳后压迫腹股沟深环，疝块是否能够复出", "language": "zh"}
{"question": "女，9个月，8kg，发热呕吐腹泻3d，大便蛋花汤样，无腥臭味，尿量明显少。精神委靡，皮肤弹性差，眼凹陷，唇樱红，四肢凉，诊断为婴儿腹泻，血钠132mmol/L。1．水电解质紊乱的类型是（　　）。", "answer": "中度脱水伴酸中毒", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "轻度脱水", "B": "重度脱水", "C": "中度脱水伴酸中毒", "D": "重度脱水伴酸中毒", "language": "zh"}
{"question": "2．类风湿因子测定（　　）。", "answer": "抗球蛋白试验(Coomb’s试验)", "meta_info": "医学免疫学", "answer_idx": "B", "A": "玻片凝集法", "B": "抗球蛋白试验(Coomb’s试验)", "C": "间接乳胶凝集试验", "D": "免疫比浊法", "language": "zh"}
{"question": "男，32岁，发现血压增高3年。近1年血压持续为170～200／130～140mmHg，近1周头痛、视力模糊。眼底检查发现乳头水肿，最可能的诊断为（　　）。", "answer": "恶性高血压", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "急性视乳头病变", "B": "恶性高血压", "C": "脑梗死", "D": "高血压脑病", "language": "zh"}
{"question": "有一名颅底骨折病人，哪一项是恰当的？（　　）", "answer": "着重观察有无脑损伤，并处理脑脊液漏，神经损伤等", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "血性脑脊液病人，腰穿放脑脊液", "B": "伤后视力减退，超过一个月可手术减压", "C": "颅底骨折需手术治疗，以便神经减压", "D": "着重观察有无脑损伤，并处理脑脊液漏，神经损伤等", "language": "zh"}
{"question": "有机磷杀虫药中毒的原理是（　　）。", "answer": "胆碱酯酶失活", "meta_info": "第八部分　其他疾病", "answer_idx": "A", "A": "胆碱酯酶失活", "B": "交感神经兴奋", "C": "胆碱酯酶活性增强", "D": "磷酰化胆碱酯酶减少", "language": "zh"}
{"question": "与体内尿酸累积相关的酶是（　　）。", "answer": "黄嘌呤氧化酶", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "酰胺转移酶", "B": "转甲酰基酶", "C": "黄嘌呤氧化酶", "D": "磷酸核糖焦磷酸合成酶", "language": "zh"}
{"question": "男性，20岁，3天前患感冒后发热38℃，左侧胸部刺痛，查体：左腋下，左下胸可听到胸膜摩擦音，最合适的诊断是（　　）。", "answer": "干性胸膜炎", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "肺炎球菌肺炎", "B": "葡萄球菌肺炎", "C": "癌性胸膜炎", "D": "干性胸膜炎", "language": "zh"}
{"question": "关于补体的叙述哪项是错误的？（　　）", "answer": "受抗原刺激后产生的", "meta_info": "医学免疫学", "answer_idx": "D", "A": "存在于正常人和动物新鲜血清中一组不耐热糖蛋白", "B": "具有酶活性", "C": "其性质不稳", "D": "受抗原刺激后产生的", "language": "zh"}
{"question": "下列哪项是医师在执业活动中享有的权利?（　　）", "answer": "人格尊严、人身安全不受侵犯", "meta_info": "医学伦理学", "answer_idx": "B", "A": "尊重患者隐私权", "B": "人格尊严、人身安全不受侵犯", "C": "努力钻研业务，及时更新知识", "D": "宣传普及卫生保健知识", "language": "zh"}
{"question": "对于新型隐球菌的特点，哪项是错误的？（　　）", "answer": "不易侵犯中枢神经系统", "meta_info": "医学微生物学", "answer_idx": "D", "A": "主要经呼吸道传播", "B": "菌体外有肥厚的荚膜", "C": "鸽子可能是其自然宿主", "D": "不易侵犯中枢神经系统", "language": "zh"}
{"question": "关于智商，以下说法正确的是（　　）。", "answer": "离差智商表示被试者的成绩偏离同年龄组平均成绩的距离", "meta_info": "医学心理学", "answer_idx": "D", "A": "智力和智商是同一个概念", "B": "离差智商的计算公式：IQ＝MA/CA×1OO", "C": "韦克斯勒提出了比率智商", "D": "离差智商表示被试者的成绩偏离同年龄组平均成绩的距离", "language": "zh"}
{"question": "女孩，5岁。精神欠佳半个月，发热、头痛、呕吐10天。半个月前开始出现精神不佳，10天来每天发热，最高体温38.1℃，进食减少，伴头痛，呕吐。2个月前曾患“麻疹”。查体：精神差，消瘦，右眼外展受限，颈抵抗（＋），Kerning征（＋），Brudzinski征（＋）。PPD试验（－）。3．提示该疾病进入晚期的表现是（　　）。", "answer": "昏迷", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "肢体偏瘫", "B": "惊厥", "C": "昏迷", "D": "腹壁反射消失", "language": "zh"}
{"question": "女，25岁。上腹痛6天，餐后突然加剧4小时，并很快波及全腹，既往有胃病史。当时查体：全腹压痛、反跳痛，肌紧张，肝浊音界消失，肠鸣音减弱。2．最有助于诊断的检查是（　　）。", "answer": "立位腹部平片", "meta_info": "第3篇　消化系统", "answer_idx": "D", "A": "腹腔穿刺", "B": "腹部B超", "C": "腹部CT", "D": "立位腹部平片", "language": "zh"}
{"question": "在医疗实践活动中分配医疗收益与平衡时，类似的个案适用相同的准则，不同的个案适合不同的准则，这所体现的医学伦理基本原则（　　）。", "answer": "公正原则", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "尊重原则", "B": "不伤害原则", "C": "公正原则", "D": "有利原则", "language": "zh"}
{"question": "2．绞窄性斜疝局部有感染者，应选的合理手术方式（　　）。", "answer": "疝囊高位结扎术", "meta_info": "第3篇　消化系统", "answer_idx": "A", "A": "疝囊高位结扎术", "B": "Bassini法修补术", "C": "Halsted法修补术", "D": "McVay法修补术", "language": "zh"}
{"question": "引起左心室后负荷增高的主要因素是（　　）。", "answer": "体循环高压", "meta_info": "第2篇　心血管系统", "answer_idx": "B", "A": "肺循环高压", "B": "体循环高压", "C": "回心血量增加", "D": "血细胞比容增大", "language": "zh"}
{"question": "高分化鳞癌的病理形态特点是（　　）。", "answer": "癌巢细胞间可见间桥并见角化珠形成", "meta_info": "病理学", "answer_idx": "D", "A": "癌细胞突破基底膜", "B": "鳞状上皮呈乳头状生长", "C": "形成大小不一的鳞状细胞巢", "D": "癌巢细胞间可见间桥并见角化珠形成", "language": "zh"}
{"question": "女，15岁，因突发寒战、高热、呕吐入院。经检查：血压75/45mmHg，脑膜刺激征阳性，WBC25×109/L，中性粒细胞占90%，脑脊液涂片发现革兰阴性双球菌。病人四肢厥冷，口唇发绀，面色苍白，确诊后，除立即给青霉素抗感染外，还应给哪种药治疗？（　　）", "answer": "阿托品", "meta_info": "药理学", "answer_idx": "C", "A": "多巴胺", "B": "肾上腺素", "C": "阿托品", "D": "东莨菪碱", "language": "zh"}
{"question": "结核性腹膜炎最有价值的检查是（　　）。", "answer": "腹腔镜检查＋腹膜活检", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "PPD试验", "B": "结肠镜检查", "C": "腹膜腔积液检查", "D": "腹腔镜检查＋腹膜活检", "language": "zh"}
{"question": "老年女性患者，20年前曾发热、腰痛、尿频。现多尿，血压明显升高，并有氮质血症。此种疾病的肾脏肉眼所见可能为（　　）。", "answer": "以上都不是", "meta_info": "病理学", "answer_idx": "D", "A": "蚤咬肾", "B": "大白肾", "C": "颗粒性固缩肾", "D": "以上都不是", "language": "zh"}
{"question": "正常新生儿，足月顺产，无窒息史，第四天突然出现拒乳，体温不升，双眼凝视，前囟膨隆，抽搐1次，颈强不明显，心肺正常，血常规：白细胞20×109/L，下列哪项最可能是其致病菌？（　　）", "answer": "大肠杆菌", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "流感嗜血杆菌", "B": "肺炎链球菌", "C": "大肠杆菌", "D": "脑膜炎双球菌", "language": "zh"}
{"question": "急、慢性白血病鉴别主要依靠（　　）。", "answer": "骨髓原始细胞的多少", "meta_info": "第一部分　血液系统疾病", "answer_idx": "D", "A": "发病急缓，病程长短", "B": "肝脾淋巴结肿大", "C": "外周血原始细胞的多少", "D": "骨髓原始细胞的多少", "language": "zh"}
{"question": "女，28岁，已婚，因消瘦、乏力、多食，心悸3个月就诊，近2年来服用口服避孕药。1．下列哪项体征最有诊断意义？（　　）", "answer": "甲状腺Ⅱ°肿大，双上级可闻及血管杂音", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "心动过速", "B": "双手震颤", "C": "皮肤潮湿", "D": "甲状腺Ⅱ°肿大，双上级可闻及血管杂音", "language": "zh"}
{"question": "1．上叙哪项是竞争性抑制作用的特点（　　）。", "answer": "Km增大，Vmax不变", "meta_info": "生物化学", "answer_idx": "C", "A": "Km增大，Vmax增大", "B": "Km减小，Vmax增大", "C": "Km增大，Vmax不变", "D": "Km不变，Vmax减小", "language": "zh"}
{"question": "急性再障感染最多见于（　　）。", "answer": "呼吸道", "meta_info": "第一部分　血液系统疾病", "answer_idx": "B", "A": "颅内", "B": "呼吸道", "C": "皮肤黏膜", "D": "肛周感染", "language": "zh"}
{"question": "伤寒最具特征性的病变部位在（　　）。", "answer": "回肠下段集合淋巴结与孤立淋巴滤泡", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "C", "A": "肠系膜淋巴结", "B": "结肠", "C": "回肠下段集合淋巴结与孤立淋巴滤泡", "D": "乙状结肠", "language": "zh"}
{"question": "1．组织破损时，创面上血液发生的变化是（　　）。", "answer": "凝固", "meta_info": "生理学", "answer_idx": "D", "A": "聚集", "B": "叠连", "C": "凝集", "D": "凝固", "language": "zh"}
{"question": "S—R变异的菌落改变为（　　）。", "answer": "光滑型变为粗糙型", "meta_info": "医学微生物学", "answer_idx": "B", "A": "粗糙型变为光滑型", "B": "光滑型变为粗糙型", "C": "无薄膜型变为有薄膜型", "D": "无改变", "language": "zh"}
{"question": "脊髓灰质炎的初种年龄是（　　）。", "answer": "2个月", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "3个月", "B": "2个月", "C": "1个月", "D": "4个月", "language": "zh"}
{"question": "4．仅糖异生需要的是（　　）。", "answer": "果糖双磷酸酶-1", "meta_info": "生物化学", "answer_idx": "D", "A": "磷酸果糖激酶-2", "B": "3-磷酸甘油醛脱氢酶", "C": "丙酮酸激酶", "D": "果糖双磷酸酶-1", "language": "zh"}
{"question": "患者，女，45岁。车祸后双侧股骨干骨折。血压90/60mmHg，中心静脉压8cmH2O，首选的处理措施是（　　）。", "answer": "补液试验", "meta_info": "第2篇　心血管系统", "answer_idx": "D", "A": "强心药治疗", "B": "糖皮质激素治疗", "C": "应用肾上腺素", "D": "补液试验", "language": "zh"}
{"question": "男，40岁，农民，发热、头痛、腰痛、恶心3天。体检：体温39.2℃，血压95/65mmHg，面颈及前胸部皮肤潮红，球结膜充血、水肿，可见出血点，腋下及背部见条索状出血点。拟诊断为流行性出血热。2．下列治疗对流行性出血热发热期患者不适宜的是（　　）。", "answer": "应用大剂量解热镇痛药物", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "A", "A": "应用大剂量解热镇痛药物", "B": "短期应用肾上腺皮质激素", "C": "短期应用环磷酰胺", "D": "补充液体，维持水电解质平衡", "language": "zh"}
{"question": "一侧颈平面以下痛觉消失，对侧深感觉消失，病变部位在（　　）。", "answer": "脊髓半侧", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "脊髓横贯", "B": "脊髓半侧", "C": "脊髓前联合", "D": "脊髓后角", "language": "zh"}
{"question": "心身疾病不包括（　　）。", "answer": "重症肌无力", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "糖尿病", "B": "冠心病", "C": "支气管哮喘", "D": "重症肌无力", "language": "zh"}
{"question": "与接合有关的细菌结构是（　　）。", "answer": "Ⅱ型菌毛", "meta_info": "医学微生物学", "answer_idx": "D", "A": "鞭毛", "B": "纤毛", "C": "绒毛", "D": "Ⅱ型菌毛", "language": "zh"}
{"question": "2．绒癌（　　）。", "answer": "滋养细胞增生并侵入子宫肌层和血管，不见绒毛结构，伴大片坏死出血", "meta_info": "第5篇　女性生殖系统", "answer_idx": "C", "A": "滋养细胞增生，绒毛间质水肿，间质内胎源性血管消失", "B": "滋养细胞不典型增生，侵入子宫肌层，可见绒毛结构", "C": "滋养细胞增生并侵入子宫肌层和血管，不见绒毛结构，伴大片坏死出血", "D": "由细胞滋养细胞分化出合体滋养细胞，二者分裂增生与胚外中胚层一起组成绒毛膜", "language": "zh"}
{"question": "确证HIV抗体初筛阳性者，常采用（　　）。", "answer": "Western blot测定HIV抗体", "meta_info": "医学微生物学", "answer_idx": "C", "A": "ELISA测定P24抗原", "B": "CD4细胞培养分离HIV", "C": "Western blot测定HIV抗体", "D": "OT试验检测免疫功能", "language": "zh"}
{"question": "5．激肽样物质是（　　）。", "answer": "C4a2a", "meta_info": "医学免疫学", "answer_idx": "D", "A": "C", "B": "C3bBbp", "C": "C5a", "D": "C4a2a", "language": "zh"}
{"question": "医学心理学的研究任务不包括（　　）。", "answer": "研究治疗方法在治疗中的影响", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "研究心理在疾病过程中的变化", "B": "研究心理在疾病过程中的作用", "C": "研究心理治疗在疼痛发展中的意义", "D": "研究治疗方法在治疗中的影响", "language": "zh"}
{"question": "有关淋巴瘤的描述中，哪一项是错误的？（　　）", "answer": "分为良性淋巴瘤和恶性淋巴瘤", "meta_info": "病理学", "answer_idx": "A", "A": "分为良性淋巴瘤和恶性淋巴瘤", "B": "组织学上形态多样", "C": "可多中心发生", "D": "小儿也可发生", "language": "zh"}
{"question": "女性，32岁，病人表现紧张恐惧，坐立不安，有大祸临头之感，惶惶不可终日，说不清具体原因。此症状是（　　）。", "answer": "焦虑状态", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "焦虑状态", "B": "情感暴发", "C": "恐怖症", "D": "心境恶劣", "language": "zh"}
{"question": "Ⅰ型糖尿病死亡的主要原因是（　　）。", "answer": "肾小球硬化症", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "C", "A": "脑血管病", "B": "冠心病", "C": "肾小球硬化症", "D": "感染性休克", "language": "zh"}
{"question": "患儿女，5岁，因发热10天不退，皮肤出现环形红斑，并伴有肘膝关节游走性疼痛而入院，抗“O”＞500U，考虑为风湿热，治疗中给予青霉素静脉滴注，目的是（　　）。", "answer": "清除链球菌感染病灶", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "防止心脏病变", "B": "制止风湿的活动", "C": "清除链球菌感染病灶", "D": "防止感染加重", "language": "zh"}
{"question": "不符合溶血性黄疸临床特点的是（　　）。", "answer": "尿胆红素阳性", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "血清总胆红素增高", "B": "尿胆红素阳性", "C": "血清间接胆红素升高", "D": "网织红细胞升高", "language": "zh"}
{"question": "关于对伤口愈合不利的原因，应除外（　　）。", "answer": "碱中毒组织水肿", "meta_info": "第八部分　其他疾病", "answer_idx": "B", "A": "低蛋白血症", "B": "碱中毒组织水肿", "C": "维生素C缺乏", "D": "剧烈咳嗽", "language": "zh"}
{"question": "下列属于初级胆汁酸的是（　　）。", "answer": "甘氨胆酸", "meta_info": "生物化学", "answer_idx": "B", "A": "牛磺脱氧胆酸", "B": "甘氨胆酸", "C": "甘氨石胆酸", "D": "甘氨脱氧胆酸", "language": "zh"}
{"question": "肺的静态顺应性越大时，下列哪项叙述正确？（　　）", "answer": "肺的弹性阻力小，肺扩张程度大", "meta_info": "生理学", "answer_idx": "C", "A": "肺的弹性阻力小，肺扩张程度小", "B": "肺的非弹性阻力大，肺扩张程度大", "C": "肺的弹性阻力小，肺扩张程度大", "D": "肺的非弹性阻力与肺的扩张度无变化", "language": "zh"}
{"question": "重症肌无力属于（　　）。", "answer": "神经-肌肉接头传递障碍性疾病", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "遗传性疾病", "B": "神经本身病变的疾病", "C": "神经-肌肉接头传递障碍性疾病", "D": "肌肉本身病变的疾病", "language": "zh"}
{"question": "3．P波消失。代之以均齐的“F”波（　　）。", "answer": "心房扑动", "meta_info": "第2篇　心血管系统", "answer_idx": "B", "A": "心室颤动", "B": "心房扑动", "C": "心房颤动", "D": "尖端扭转型室速", "language": "zh"}
{"question": "3．含量最多的Ig是（　　）。", "answer": "IgG", "meta_info": "医学免疫学", "answer_idx": "A", "A": "IgG", "B": "IgM", "C": "IgD", "D": "IgE", "language": "zh"}
{"question": "2个月小儿，男，生后双眼分泌物多，20多天起流涕、鼻塞，近10多天咳嗽、气促，一直无发热，体检两肺可闻及少量中细湿啰音，末梢血WBC8.8×109/L，查血冷凝集试验（-），病毒分离（-），胸片示两肺纹理重，有过度充气，可见小点片状阴影。考虑诊断为（　　）。", "answer": "衣原体肺炎", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "衣原体肺炎", "B": "肺炎链球菌肺炎", "C": "金黄色葡萄球菌肺炎", "D": "合胞病毒肺炎", "language": "zh"}
{"question": "对于糖皮质激素的应用，下述哪一项是错误的？（　　）", "answer": "水痘和带状疱疹", "meta_info": "药理学", "answer_idx": "A", "A": "水痘和带状疱疹", "B": "过敏性休克和心源性休克", "C": "风湿和类风湿关节炎", "D": "中毒性肺炎、重症伤寒和急性粟粒性肺结核", "language": "zh"}
{"question": "女性，28岁，孕2个月，近1个月心悸、多汗、易饥、体重下降。轻度突眼，甲状腺Ⅱ度肿大，质软，无震颤，未闻血管杂音。心、肺、腹（-）。1．帮助确诊最有价值的辅助检查是（　　）。", "answer": "FT3、FT4", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "C", "A": "甲状腺131I摄取率", "B": "TRH兴奋试验", "C": "FT3、FT4", "D": "T3、T4", "language": "zh"}
{"question": "对于腹部手术后切口化脓性感染，错误的处理是（　　）。", "answer": "切开引流冲洗后立即缝合", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "应用抗菌药物", "B": "拆除缝线，散开切口", "C": "局部处理", "D": "切开引流冲洗后立即缝合", "language": "zh"}
{"question": "关于小儿体液免疫的特点，下列哪一项是错误的？（　　）", "answer": "免疫球蛋白是巨噬细胞产物", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "IgG有四个亚类", "B": "免疫球蛋白包括IgA、lgG、IgM、IgD及IgE五类", "C": "免疫球蛋白是巨噬细胞产物", "D": "小儿体液免疫的发育随年龄增长逐步完善", "language": "zh"}
{"question": "用青霉素治疗可引起赫氏反应的疾病是（　　）。", "answer": "梅毒", "meta_info": "药理学", "answer_idx": "D", "A": "气性坏疽", "B": "大叶性肺炎", "C": "草绿色链球菌性心内膜炎", "D": "梅毒", "language": "zh"}
{"question": "急性痢疾临床分型不包括（　　）。", "answer": "爆发性", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "中毒型", "B": "爆发性", "C": "普通型", "D": "重型", "language": "zh"}
{"question": "2．医疗事故的客观方面（　　）。", "answer": "实施了违反卫生管理法律、行政法规、部门规章和诊疗护理规范、常规的行为", "meta_info": "卫生法规", "answer_idx": "D", "A": "造成患者人身损害", "B": "过失", "C": "违法行为和损害结果之间有因果关系", "D": "实施了违反卫生管理法律、行政法规、部门规章和诊疗护理规范、常规的行为", "language": "zh"}
{"question": "青年男性患者，自高处坠落3h后送入医院，自诉胸背部疼痛，双下肢不能活动。4．若经恰当处理1周后，双下肢功能恢复不理想，此时要注意的并发症是（　　）。", "answer": "褥疮", "meta_info": "第四部分　运动系统疾病", "answer_idx": "D", "A": "硬膜外粘连", "B": "内固定器材断裂", "C": "椎管内活动性出血", "D": "褥疮", "language": "zh"}
{"question": "手部创伤止血时止血带应缚于（　　）。", "answer": "上臂上1/3处", "meta_info": "第四部分　运动系统疾病", "answer_idx": "A", "A": "上臂上1/3处", "B": "上臂中1/3处", "C": "上臂下1/3处", "D": "前臂中端", "language": "zh"}
{"question": "男性，22岁，大学二年级学生，近一年来听课发愣，不做笔记，时有自语、自笑，动作迟缓，吃一顿饭要一个多小时，病人5天前开始终日卧床，不吃饭，不知上厕所。精神检查：意识清晰，卧床不动不语，针刺其身体无反应，肌张力增高，令病人张嘴，反把嘴闭得更紧，把病人肢体摆成不舒服的姿势，可以保持很久不变，躯体及神经系统检查无异常。2．该患者的正确诊断是（　　）。", "answer": "精神分裂症", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "脑炎", "B": "精神发育迟滞", "C": "癔症", "D": "精神分裂症", "language": "zh"}
{"question": "心理健康的标准不包括（　　）。", "answer": "信仰坚定", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "人格完整", "B": "信仰坚定", "C": "情绪良好", "D": "人际和谐", "language": "zh"}
{"question": "女，56岁。2小时前不慎摔倒，左髋部疼痛，无法行走。X线检查示左股骨颈中段骨折并有短缩完全移位，Pauwels角为60°。骨颈骨折的类型是（　　）。", "answer": "内收型骨折", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "外展型骨折", "B": "GardenⅠ型骨折", "C": "内收型骨折", "D": "GardenⅡ型骨折", "language": "zh"}
{"question": "医学伦理学的原则，不包括（　　）。", "answer": "知情", "meta_info": "医学伦理学", "answer_idx": "B", "A": "有利", "B": "知情", "C": "尊重", "D": "公正", "language": "zh"}
{"question": "2．矽肺可出现的病变是（　　）。", "answer": "早期肺门淋巴结病变", "meta_info": "病理学", "answer_idx": "C", "A": "肺肉质变", "B": "肺脓肿", "C": "早期肺门淋巴结病变", "D": "蜂窝肺", "language": "zh"}
{"question": "甾体激素避孕药的避孕机制不包括（　　）。", "answer": "阻止精子与卵子的结合", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "影响输卵管功能", "B": "改变宫颈黏液的性质", "C": "阻止精子与卵子的结合", "D": "改变子宫内膜形态与功能", "language": "zh"}
{"question": "女性，36岁，房屋倒塌，胸部以上被压伤30分钟，呼吸困难，无腹痛、呕吐。检查：血压140/110mmHg，脉率110次/分，呼吸34次/分。神志清，两眼结合膜有出血，颈静脉怒张，前胸及肩部有散在的出血点，尿常规阴性。最可能的诊断是（　　）。", "answer": "创伤性窒息", "meta_info": "第八部分　其他疾病", "answer_idx": "C", "A": "挤压伤综合征", "B": "创伤性休克", "C": "创伤性窒息", "D": "广泛软组织挫伤", "language": "zh"}
{"question": "对细菌性痢疾来说哪一项是对的？（　　）", "answer": "潜伏期1～2天", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "A", "A": "潜伏期1～2天", "B": "通常结肠与小肠均有炎症", "C": "近年来在临床上很少见", "D": "治疗菌痢，首选氯霉素", "language": "zh"}
{"question": "胎头矢状缝与骨盆入口右斜径一致的胎位是（　　）。", "answer": "枕左前", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "枕左后", "B": "枕左前", "C": "枕右前", "D": "枕右横", "language": "zh"}
{"question": "患者，6岁，发热2天，伴咽痛、皮疹1日。查体：体温38.7℃，咽部充血，草莓舌，面部潮红，躯干部见细小鲜红色充血性皮疹。诊断为猩红热。治疗首选（　　）。", "answer": "青霉素", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "头孢唑啉", "B": "红霉素", "C": "氯霉素", "D": "青霉素", "language": "zh"}
{"question": "禽类B细胞分化成熟的部位在（　　）。", "answer": "法氏囊(腔上囊)", "meta_info": "医学免疫学", "answer_idx": "B", "A": "骨髓", "B": "法氏囊(腔上囊)", "C": "淋巴结", "D": "脾脏", "language": "zh"}
{"question": "预防风湿热复发的最有效药物是（　　）。", "answer": "青霉素", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "阿司匹林", "B": "ACTH", "C": "青霉素", "D": "泼尼松", "language": "zh"}
{"question": "患者，女，18岁。入学体检时发现心尖部舒张期隆隆样杂音，能提示病变瓣膜弹性良好的体征是（　　）。", "answer": "开瓣音", "meta_info": "第2篇　心血管系统", "answer_idx": "C", "A": "P2分裂", "B": "舒张期奔马律", "C": "开瓣音", "D": "P2亢进", "language": "zh"}
{"question": "一位3岁病儿患急性菌痢住进医院，经治疗本已好转，行将出院。其父母觉得小儿虚弱，要求输血。碍于情面，医生同意了。可护士为了快点交班，提议给予静脉推注输血。当时病儿哭闹，医护齐动手给他输血过程中，病儿突发心跳骤停死亡。此案例中医护人员发生的伦理过错是（　　）。", "answer": "曲解家属自主权，违反操作规程，违背了不伤害病人的原则", "meta_info": "医学伦理学", "answer_idx": "D", "A": "无知无原则，违背了人道主义原则", "B": "无知无原则，违背了有利病人的原则", "C": "曲解家属自主权，违反操作规程，违背了有利病人的原则", "D": "曲解家属自主权，违反操作规程，违背了不伤害病人的原则", "language": "zh"}
{"question": "下列哪项是降血糖作用最弱、作用持续时间最短的药物？（　　）", "answer": "甲苯磺丁脲", "meta_info": "药理学", "answer_idx": "A", "A": "甲苯磺丁脲", "B": "格列吡嗪", "C": "格列本脲", "D": "珠蛋白锌胰岛素", "language": "zh"}
{"question": "男，59岁。进食哽噎1月余，症状逐渐加重，近半年来左胸痛，服用“救心丸”无改善。为明确诊断，首选的检查是（　　）。", "answer": "胃镜", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "胸部MRI", "B": "胃镜", "C": "心电图", "D": "胸部CT", "language": "zh"}
{"question": "NST无反应型提示（　　）。", "answer": "胎儿储备能力降低", "meta_info": "第5篇　女性生殖系统", "answer_idx": "D", "A": "胎儿脐带绕颈", "B": "胎儿头部受压", "C": "胎儿心脏异常", "D": "胎儿储备能力降低", "language": "zh"}
{"question": "胆固醇在体内代谢的主要去路是（　　）。", "answer": "胆汁酸", "meta_info": "生物化学", "answer_idx": "B", "A": "胆红素", "B": "胆汁酸", "C": "维生素D", "D": "雌激素", "language": "zh"}
{"question": "下列哪项符合1～2岁幼儿1年中增长的身高数？（　　）", "answer": "12cm", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "3cm", "B": "5cm", "C": "12cm", "D": "13cm", "language": "zh"}
{"question": "癫痫患者服用抗癫痫药最切忌（　　）。", "answer": "突然停药", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "同时合用两种药", "B": "只在夜间服", "C": "药物价格太高", "D": "突然停药", "language": "zh"}
{"question": "患者，女，30岁，2周前出现双下肢无力，次日双上肢亦感沉重，并双眼睑闭合不全，l周后不能行走，双上肢不能抬举，今日上午出现声音嘶哑，胸闷，气促，无排尿障碍。2．在治疗上，以下哪项最重要？（　　）", "answer": "维持呼吸功能", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "补钾", "B": "抗生素使用", "C": "大剂量激素的使用", "D": "维持呼吸功能", "language": "zh"}
{"question": "38岁初产妇，在家中经阴道自然分娩，胎儿、胎盘娩出。因时多时少的阴道持续流血1小时，急诊就诊。2．产科检查可见产妇流出的血液有凝血块，此时首选的治疗应是（　　）。", "answer": "输液输血，补充血容量", "meta_info": "第5篇　女性生殖系统", "answer_idx": "A", "A": "输液输血，补充血容量", "B": "静脉滴注缩宫素", "C": "迅速补给纤维蛋白原", "D": "消毒纱条填塞宫腔", "language": "zh"}
{"question": "属于卵巢性索一间质细胞肿瘤的是（　　）。", "answer": "颗粒细胞癌", "meta_info": "第二部分　模拟试题", "answer_idx": "B", "A": "胚胎癌", "B": "颗粒细胞癌", "C": "卵巢甲状腺肿", "D": "畸胎瘤", "language": "zh"}
{"question": "1．麻疹和传染性肝炎的紧急预防（　　）。", "answer": "丙种球蛋白", "meta_info": "医学免疫学", "answer_idx": "A", "A": "丙种球蛋白", "B": "免疫毒素", "C": "抗淋巴细胞丙种球蛋白", "D": "抗HIV血清", "language": "zh"}
{"question": "分泌胰岛素的细胞是（　　）。", "answer": "β细胞", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "α细胞", "B": "PP细胞", "C": "δ细胞", "D": "β细胞", "language": "zh"}
{"question": "处理外伤性直肠损伤选择（　　）。", "answer": "乙状结肠造瘘，2～3个月后处理", "meta_info": "第3篇　消化系统", "answer_idx": "A", "A": "乙状结肠造瘘，2～3个月后处理", "B": "完全切除", "C": "直肠切除后吻合", "D": "生理盐水冲洗，待其自行吻合", "language": "zh"}
{"question": "有一名30岁男性患者，病程4个月，头痛发作入院。入院前出现左侧肢体无力和呕吐。入院查体：意识清，眼底视乳头水肿，左上下肢肌力Ⅳ级，腱反射活跃，病理征（+）。2．应采用的检查是（　　）。", "answer": "CT", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "X线颅片", "B": "脑血管造影", "C": "CT", "D": "ECT", "language": "zh"}
{"question": "在某医院急诊室，医生正在抢救一位车祸伤者。由于失血过多，该伤者急需输血，但医院血库恰巧没有了血浆。向血站求救，血站碰巧也没有了经过检测的血浆。为了不延误抢救伤者，医院只好从血站拿了11200ml刚刚采集未经检测的血液，将其全部输给伤者。伤者得救了，但却因此感染了丙肝。1．伤者感染丙肝，应对伤者承担法律责任的人是（　　）。", "answer": "医院", "meta_info": "卫生法规", "answer_idx": "A", "A": "医院", "B": "医务人员", "C": "伤者", "D": "血站", "language": "zh"}
{"question": "3．颅后窝骨折（　　）。", "answer": "乳突下瘀血斑出现Battle征", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "鼻流血", "B": "双眼睑皮下青紫，逐渐加重，出现熊猫眼征", "C": "乳突下瘀血斑出现Battle征", "D": "脑脊液耳漏", "language": "zh"}
{"question": "正常足月妊娠，子宫腔容量平均比未孕时增加的倍数是（　　）。", "answer": "1000", "meta_info": "第5篇　女性生殖系统", "answer_idx": "D", "A": "100", "B": "300", "C": "800", "D": "1000", "language": "zh"}
{"question": "男性，35岁，3年来多尿，口渴，多饮、多食，疲倦无力，注意力不集中，失眠，情绪低落，少言、少动，主动性差，反应迟钝，心烦，紧张。l周来兴奋不安、躁动、语无伦次而住院。2．该患者最可能的诊断是（　　）。", "answer": "糖尿病所致精神障碍", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "糖尿病所致精神障碍", "B": "甲状腺功能减退所致精神障碍", "C": "甲状腺功能亢进所致精神障碍", "D": "肾上腺皮质功能减退所致精神障碍", "language": "zh"}
{"question": "《母婴保健法》规定孕产期保健服务内容不包括（　　）。", "answer": "终止妊娠", "meta_info": "卫生法规", "answer_idx": "A", "A": "终止妊娠", "B": "母婴保健指导", "C": "新生儿保健", "D": "胎儿保健", "language": "zh"}
{"question": "1．属于精神分裂症是（　　）。", "answer": "情感倒错", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "童样痴呆", "B": "睡眠障碍", "C": "强制性哭笑", "D": "情感倒错", "language": "zh"}
{"question": "女，58岁。低热伴右侧腹部隐痛不适半年。查体：贫血貌，右侧中腹部扪及5cm×3cm质硬肿块，可推动，压痛不明显。首选的治疗方法是（　　）。", "answer": "结肠镜", "meta_info": "第3篇　消化系统", "answer_idx": "B", "A": "全消化道钡餐造髟", "B": "结肠镜", "C": "静脉肾盂造影", "D": "腹部CT", "language": "zh"}
{"question": "女，18岁。突然剧烈头痛、呕吐，查体：颈项强直，克氏征阳性，布氏征阳性，CT示侧裂池、环池内高密度影，诊断首先考虑（　　）。", "answer": "蛛网膜下腔出血", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "脑膜炎", "B": "蛛网膜下腔出血", "C": "脑肿瘤", "D": "脑脓肿", "language": "zh"}
{"question": "以下不符合血栓的论述的是（　　）。", "answer": "毛细血管内血栓多为白色血栓", "meta_info": "病理学", "answer_idx": "D", "A": "静脉内血栓尾部多为红色血栓", "B": "下肢血栓多于上肢", "C": "静脉血栓多于动脉血栓", "D": "毛细血管内血栓多为白色血栓", "language": "zh"}
{"question": "1．仅磷酸戊糖途径需要的是（　　）。", "answer": "6-磷酸葡萄糖脱氢酶", "meta_info": "生物化学", "answer_idx": "C", "A": "磷酸果糖激酶-2", "B": "3-磷酸甘油醛脱氢酶", "C": "6-磷酸葡萄糖脱氢酶", "D": "果糖双磷酸酶-1", "language": "zh"}
{"question": "服用避孕药后有少量阴道流血，正确的处理方法是（　　）。", "answer": "加服少量雌激素", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "加服少量雌激素", "B": "需立即停药", "C": "加服少量雄性激素", "D": "加倍服药", "language": "zh"}
{"question": "患者，男性，35岁。双下肢水肿2周。查体：血压130/80mmHg，双下肢轻度凹陷性水肿。尿常规：蛋白（++++），红细胞（++）。Scr 122μmol/L。血浆清蛋白28g/L。2．若骨活检示肾小球系膜轻度增生，系膜区可见免疫复合物沉积，最可能的诊断为（　　）。", "answer": "系膜毛细血管性肾小球肾炎", "meta_info": "第二部分　模拟试题", "answer_idx": "B", "A": "系膜增生性肾小球肾炎", "B": "系膜毛细血管性肾小球肾炎", "C": "微小病变性肾病", "D": "膜性肾病", "language": "zh"}
{"question": "男性，27岁，心悸气短，胸闷、胸痛、晕厥。查体：胸骨左缘第3肋间3/6级收缩期杂音，超声：室间隔:左室后壁为1.5:1。SAM（＋）。2．超声心动图SAM征指的是（　　）。", "answer": "二尖瓣前叶收缩期向前运动", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "二尖瓣前叶收缩期向前运动", "B": "二尖瓣后叶与前叶同向运动", "C": "三尖瓣后叶舒张期向后运动", "D": "主动脉瓣收缩期向前运动", "language": "zh"}
{"question": "女，40岁。近4年来逐渐出现活动后心悸、气短。查体：心尖部可闻及舒张期隆隆样杂音。3．最有助于确诊的检查是（　　）。", "answer": "超声心动图", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "心电图", "B": "超声心动图", "C": "胸部X线摄片", "D": "冠状动脉造影", "language": "zh"}
{"question": "1．脂肪酸合成的关键酶是（　　）。", "answer": "乙酰CoA羧化酶", "meta_info": "生物化学", "answer_idx": "A", "A": "乙酰CoA羧化酶", "B": "HMGCoA裂解酶", "C": "HMGCoA合酶", "D": "HMGCoA还原酶", "language": "zh"}
{"question": "患儿1岁，男性，因长期腹泻引起营养性缺铁性贫血，近1个月来患支气管肺炎。Hb40g/L，RBC2.5×1012/L。应首先采用哪一项措施？（　　）", "answer": "输血", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "肌内注射右旋糖酐铁", "B": "增加富含铁质的饮食", "C": "抗感染治疗", "D": "输血", "language": "zh"}
{"question": "女，55岁。反复咳嗽、咳痰、气促30年，加重伴低热1月。既往高血压病史10年，血压控制满意。查体：T 38℃，P 110次/分，R 24次/分，BP 160／90mmHg。口唇发绀，颈静脉怒张，双肺可闻及哮鸣音和湿啰音，律齐，P2＞A2，剑突下可闻及3/6级收缩期杂音。腹膨隆，肝肋下4cm，压痛（＋）。肝颈静脉回流征阳性，双下肢水肿。1．该患者最可能的诊断是（　　）。", "answer": "肺心病", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "冠心病", "B": "肺血栓栓塞", "C": "肺心病", "D": "风湿性心脏瓣膜病", "language": "zh"}
{"question": "下述哪一项不是下运动神经元？（　　）", "answer": "皮质脑干束", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "前根", "B": "脊髓前角细胞", "C": "神经丛", "D": "皮质脑干束", "language": "zh"}
{"question": "HIV感染导致大量减少的细胞是（　　）。", "answer": "CD4＋T细胞", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "单核细胞", "B": "CD8＋T细胞", "C": "粒细胞", "D": "CD4＋T细胞", "language": "zh"}
{"question": "哮喘患儿出现持续状态，治疗应选用（　　）。", "answer": "静脉应用糖皮质激素", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "口服氨茶碱类药物", "B": "口服免疫抑制剂", "C": "静脉应用糖皮质激素", "D": "去除诱导因素", "language": "zh"}
{"question": "有关心身疾病中的冠心病，下述说法哪项不正确？（　　）", "answer": "紧张情绪不是冠心病发病的重要原因之一", "meta_info": "医学心理学", "answer_idx": "B", "A": "高脂血症是生理原始病因", "B": "紧张情绪不是冠心病发病的重要原因之一", "C": "改变精神状态和行为方式可改善预后但不能预防其发作", "D": "它是近代社会严重威胁人类健康的一种心身疾病", "language": "zh"}
{"question": "女性，28岁，1年前与丈夫离婚后，经常失眠伴头痛，近3个月来无原因的认为邻居指桑骂槐的议论她；走在街上，感到路人用别样眼光看她，行人的咳嗽、吐痰举动都是针对她的，认为家中被安装了监视器，自己的一举一动都被监视了，为此不思饮食，有自杀念头。体检及神经系统无异常。1．该病情的诊断最可能是（　　）。", "answer": "精神分裂症", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "焦虑症", "B": "抑郁症", "C": "心理生理障碍", "D": "精神分裂症", "language": "zh"}
{"question": "血栓闭塞性脉管炎早期的主要临床症状是（　　）。", "answer": "间歇性跛行", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "下肢麻木感", "B": "间歇性跛行", "C": "足背动脉搏动消失", "D": "血管杂音", "language": "zh"}
{"question": "下列哪项不是特重型颅脑损伤的诊断标准？（　　）", "answer": "昏迷时间长达12小时", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "脑原发伤重，伤后深昏迷，有去大脑强直", "B": "已有晚期脑疝发生，生命体征严重紊乱或呼吸已停止", "C": "脑原发伤重，伤后深昏迷伴有其他脏器损伤、休克", "D": "昏迷时间长达12小时", "language": "zh"}
{"question": "男，35岁。右下肢疼痛1年。让其抬高右下肢80度，1分钟后下肢皮肤苍白，再让其下肢垂于床沿，大约1分钟后下肢皮肤颜色方恢复正常。该检查结果提示（　　）。", "answer": "Buerger试验阳性", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "Buerger试验阳性", "B": "大隐静脉瓣膜和小腿交通支静脉瓣膜功能（Perthes）试验阳性", "C": "Pratt试验阳性", "D": "Lasegue试验阳性", "language": "zh"}
{"question": "卵巢肿瘤的治疗，以下哪项错误？（　　）", "answer": "凡恶性肿瘤，无论是否年轻及是否有生育要求，均应行双侧附件切除", "meta_info": "第5篇　女性生殖系统", "answer_idx": "B", "A": "凡良性病变的年轻患者，手术时应保留一侧卵巢", "B": "凡恶性肿瘤，无论是否年轻及是否有生育要求，均应行双侧附件切除", "C": "良性肿瘤年轻患者，可行卵巢肿瘤剥除术", "D": "恶性肿瘤以手术为主，辅助化疗", "language": "zh"}
{"question": "患者，男性，35岁。双下肢水肿2周。查体：血压130/80mmHg，双下肢轻度凹陷性水肿。尿常规：蛋白（++++），红细胞（++）。Scr 122μmol/L。血浆清蛋白28g/L。3．若为上述病理类型，首选治疗药物为（　　）。", "answer": "糖皮质激素", "meta_info": "第二部分　模拟试题", "answer_idx": "C", "A": "环孢素A", "B": "霉酚酸酯", "C": "糖皮质激素", "D": "硫唑嘌呤", "language": "zh"}
{"question": "1．医疗事故的主观方面（　　）。", "answer": "过失", "meta_info": "卫生法规", "answer_idx": "A", "A": "过失", "B": "违法行为和损害结果之间有因果关系", "C": "实施了违反卫生管理法律、行政法规、部门规章和诊疗护理规范、常规的行为", "D": "医疗机构和医务人员", "language": "zh"}
{"question": "属于完全性再生的是（　　）。", "answer": "肝细胞点、灶状坏死愈合", "meta_info": "病理学", "answer_idx": "C", "A": "皮肤溃疡愈合", "B": "肺空洞愈合", "C": "肝细胞点、灶状坏死愈合", "D": "心肌梗死灶的修复", "language": "zh"}
{"question": "一患者因不遵医嘱将2次的药1次服用，自认为是“首次剂量加倍”，结果造成强心苷用量过大，引起室性心动过速。此时应如何治疗？（　　）", "answer": "应用利多卡因", "meta_info": "药理学", "answer_idx": "B", "A": "减量", "B": "应用利多卡因", "C": "吸氧治疗", "D": "合用奎尼丁", "language": "zh"}
{"question": "某癌症患者，心理状态较差且预后不良，治疗过程中需要家属的积极配合。对此，医生关于患者的最佳告知方式是（　　）。", "answer": "告知家属实情并对患者适度告知", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "告知家属实情并对患者适度告知", "B": "告知患者部分病情并向家属保密", "C": "直接告知患者实情", "D": "告知患者及家属实情", "language": "zh"}
{"question": "手术区皮肤消毒的范围最少距手术切口（　　）。", "answer": "15cm", "meta_info": "第八部分　其他疾病", "answer_idx": "C", "A": "10cm", "B": "5cm", "C": "15cm", "D": "30cm", "language": "zh"}
{"question": "4．最容易发生6个月～3岁小儿，发热初起突然惊厥，多见于（　　）。", "answer": "高热惊厥", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "低血镁", "B": "婴儿痉挛症", "C": "维生素D缺乏性手足搐搦症", "D": "高热惊厥", "language": "zh"}
{"question": "1．以上是复杂部分性发作的病损的是（　　）。", "answer": "颞叶", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "黑质-纹状体", "B": "颞叶", "C": "枕叶", "D": "中央前回", "language": "zh"}
{"question": "患者，男，23岁，生吃水果后出现腹痛、腹泻，伴里急后重，体温38.5℃。血常规：白细胞10×109/L，中性粒细胞0.9，淋巴细胞0.1。便常规：脓液（＋＋），红细胞6个/HP，白细胞10个/HP。最可能的诊断为（　　）。", "answer": "细菌性痢疾", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "C", "A": "病毒性肠炎", "B": "肠伤寒", "C": "细菌性痢疾", "D": "霍乱", "language": "zh"}
{"question": "原发性肾小球疾病的病理特点，错误的是（　　）。", "answer": "急进性肾炎主要是光镜下30%以上肾小球的肾小囊中有大新月体形成", "meta_info": "第4篇　泌尿系统", "answer_idx": "C", "A": "膜性肾病是光镜下主要为不伴细胞增生的弥漫性肾小球毛细血管基底膜增厚", "B": "微小病变是光镜下无明显异常，电镜下可见上皮细胞肿胀、足突广泛融合", "C": "急进性肾炎主要是光镜下30%以上肾小球的肾小囊中有大新月体形成", "D": "急性链球菌感染后肾小球肾炎主要是弥漫增生性肾小球炎症（内皮与系膜细胞增生）", "language": "zh"}
{"question": "下述哪项能与DNA结合并阻止转录进行?（　　）", "answer": "阻遏物", "meta_info": "生物化学", "answer_idx": "D", "A": "反式作用因子", "B": "正调控蛋白", "C": "诱导物", "D": "阻遏物", "language": "zh"}
{"question": "某小学，6月，一次中午进食火腿汉堡包、粥、煮鸡蛋、炒空心菜、萝卜干，4小时后部分同学出现头痛、恶心、呕吐、食欲不振、腹泻、腹痛，个别有发热，体温38～40℃。2．引起食物中毒的食品可能是（　　）。", "answer": "火腿汉堡包", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "火腿汉堡包", "B": "煮鸡蛋", "C": "炒空心菜", "D": "萝卜干", "language": "zh"}
{"question": "属于复方短效口服避孕药副反应的是（　　）。", "answer": "能使水钠潴留", "meta_info": "第5篇　女性生殖系统", "answer_idx": "D", "A": "能引起经血量增多，不适用于经量偏多的妇女", "B": "孕激素引起宫颈黏液量增多致白带增多", "C": "体重减轻系因食欲不佳、进食少", "D": "能使水钠潴留", "language": "zh"}
{"question": "初产妇，26岁，妊娠39周，临产后9小时。胎儿娩出5分钟，胎盘未娩出，不恰当的处理是（　　）。", "answer": "压耻骨联合上方", "meta_info": "第5篇　女性生殖系统", "answer_idx": "A", "A": "压耻骨联合上方", "B": "检查宫体是否变硬", "C": "阴道有无流血", "D": "轻压耻骨联合上方", "language": "zh"}
{"question": "3．桡骨茎突狭窄性腱鞘炎（　　）。", "answer": "Finkelstein试验阳性", "meta_info": "第四部分　运动系统疾病", "answer_idx": "D", "A": "肩关节外展受限", "B": "肩部疼痛、无活动受限", "C": "肘关节外侧疼痛", "D": "Finkelstein试验阳性", "language": "zh"}
{"question": "正常足月新生儿（　　）。", "answer": "出生体重2500～39999", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "出生体重2500～30009", "B": "出生体重2500～39999", "C": "出生体重2000～24999", "D": "出生体重＞40009", "language": "zh"}
{"question": "女，40岁。低热伴腹痛、腹胀1个月。查体：体形消瘦，腹部略膨隆，触诊呈揉面感，移动性浊音阳性，双下肢无水肿。2．最有意义的检查是（　　）。", "answer": "腹腔穿刺及腹水化验", "meta_info": "第3篇　消化系统", "answer_idx": "A", "A": "腹腔穿刺及腹水化验", "B": "腹部X线平片", "C": "腹部B超", "D": "腹部CT", "language": "zh"}
{"question": "肝细胞碎片状坏死多见于（　　）。", "answer": "慢性活动性肝炎", "meta_info": "病理学", "answer_idx": "C", "A": "急性普通型肝炎", "B": "急性重型肝炎", "C": "慢性活动性肝炎", "D": "乙型肝炎病毒携带者", "language": "zh"}
{"question": "女，1.5岁，由于皮肤脓胞疹破溃感染后出现咳嗽，弛张热4天，喘息1日。查体：精神状态极差，呼吸快，右上肺闻及细哕音。右肺叩诊浊音。血常规：白细胞28×109/L，中性粒细胞占0.88。胸片检查：多发性脓肿。诊断为（　　）。", "answer": "金黄色葡萄球菌肺炎合并脓胸", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "腺病毒肺炎合并胸腔积液", "B": "支原体肺炎合并胸腔积液", "C": "金黄色葡萄球菌肺炎合并脓气胸", "D": "金黄色葡萄球菌肺炎合并脓胸", "language": "zh"}
{"question": "女，23岁。1个月前分娩后出现失眠、心情烦躁。近2周加重，认为自己很笨，没有能力带好小孩，怕小孩夭折，觉得丈夫不再喜欢自己了，猜疑丈夫有外遇，整日以泪洗面，称不想活了，基至要带着孩子一起去死，遂入院治疗。1．患者最可能的诊断是（　　）。", "answer": "抑郁发作", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "抑郁发作", "B": "适应障碍", "C": "焦虑状态", "D": "妄想性障碍", "language": "zh"}
{"question": "下列临床表现中，最不常见于慢性粒细胞白血病的是（　　）。", "answer": "淋巴结肿大", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "乏力，低热", "B": "胸骨中下段压痛", "C": "淋巴结肿大", "D": "巨脾", "language": "zh"}
{"question": "2．不能体现知情同意的为（　　）。", "answer": "以健康人或患者作为受试对象", "meta_info": "医学伦理学", "answer_idx": "A", "A": "以健康人或患者作为受试对象", "B": "不选择弱势人群作为受试者", "C": "实验中受试者得到专家的允许后可自由决定是否退出", "D": "弱势人群若参加实验，需要监护人的签字", "language": "zh"}
{"question": "女性，27岁，右颈部肿物伴低热2周，抗生素治疗无效，经查体临床诊断为亚急性甲状腺炎，下述哪一项检查结果不支持诊断？（　　）", "answer": "TSAb阳性", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "D", "A": "FT3，高，TSH降低", "B": "血沉快", "C": "FT3，正常，TSH正常", "D": "TSAb阳性", "language": "zh"}
{"question": "在骨折的急救中，哪项处理不正确？（　　）", "answer": "开放外露的骨折断端均应立即复位", "meta_info": "第四部分　运动系统疾病", "answer_idx": "B", "A": "首先抢救生命", "B": "开放外露的骨折断端均应立即复位", "C": "妥善的外固定十分重要", "D": "病人经妥善固定后，应迅速转运往医院", "language": "zh"}
{"question": "女，60岁。接触性出血半年。妇科检查：外阴阴道未见异常，宫颈肥大糜烂、质脆，子宫及双附件未见异常。3．适宜的治疗措施是（　　）。", "answer": "全子宫切除治疗", "meta_info": "第5篇　女性生殖系统", "answer_idx": "D", "A": "微波治疗", "B": "激光治疗", "C": "随诊观察", "D": "全子宫切除治疗", "language": "zh"}
{"question": "下列哪一种不是致癌物质？（　　）", "answer": "金", "meta_info": "病理学", "answer_idx": "B", "A": "砷", "B": "金", "C": "铬", "D": "镍", "language": "zh"}
{"question": "患者，9岁，眼睑浮肿4天，近2日加重，浮肿渐及全身，尿少，今晨感觉上腹部不适，频咳、气急。查体：体温37.5℃，眼睑及下肢浮肿，血压150/100mmHg，心率116次/分，心音钝，两肺闻及水泡音，肝肋下2.0cm。尿常规：蛋白质（++），红细胞20～30个/HP，血尿素氮6mmol/L。1．诊断考虑为（　　）。", "answer": "急性肾炎伴循环充血", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "急性肾炎伴肾功不全", "B": "急性肾炎伴肺炎", "C": "急性肾炎伴循环充血", "D": "急性肾炎伴心肌炎", "language": "zh"}
{"question": "男，64岁。右侧腹股沟区可复性肿块6年。查体：患者直立时，在腹股沟内侧、耻骨结节上外方有一4cm×4cm半球形肿物，未进入阴囊，平卧后自行消失。2．该患者最有效的治疗方法是（　　）。", "answer": "疝修补术", "meta_info": "第3篇　消化系统", "answer_idx": "C", "A": "用棉线束带或绷带压迫内环口", "B": "注射硬化剂", "C": "疝修补术", "D": "疝囊高位结扎术", "language": "zh"}
{"question": "我国普遍采用的围生期定义是（　　）。", "answer": "胎龄满28周至出生后7足天", "meta_info": "第5篇　女性生殖系统", "answer_idx": "B", "A": "胎龄满27周至出生后7足天", "B": "胎龄满28周至出生后7足天", "C": "胎龄满27周至出生后15足天", "D": "胎龄满28周至出牛后15足天", "language": "zh"}
{"question": "肝硬化失代偿期患者发生大呕血后出现的体征变化，正确的是（　　）。", "answer": "脾脏缩小", "meta_info": "第3篇　消化系统", "answer_idx": "B", "A": "肝脏缩小", "B": "脾脏缩小", "C": "腹水量明显减少", "D": "蜘蛛痣消失", "language": "zh"}
{"question": "男，45岁。脾切除、小肠切除吻合术后第4天，已排气，头痛、恶心、腹胀，随后出现寒战、四肢发绀。体温39.6℃，脉搏108次/分，血压135/85mmHg，近24小时尿量650mL。轻度腹胀，腹软，全腹轻压痛，无反跳痛、肌紧张。肠鸣音3次/分。2．最有可能出现异常的是（　　）。", "answer": "白细胞计数", "meta_info": "第3篇　消化系统", "answer_idx": "A", "A": "白细胞计数", "B": "立位腹部透视", "C": "腹部超声检查", "D": "血清钾离子", "language": "zh"}
{"question": "急性水肿型胰腺炎最主要的临床表现（　　）。", "answer": "腹痛", "meta_info": "第3篇　消化系统", "answer_idx": "A", "A": "腹痛", "B": "呕吐", "C": "发热", "D": "便血", "language": "zh"}
{"question": "心动周期中，哪一时相室内压升高速率最快？（　　）", "answer": "等容收缩期", "meta_info": "生理学", "answer_idx": "B", "A": "减慢射血期", "B": "等容收缩期", "C": "快速射血期", "D": "快速充盈期", "language": "zh"}
{"question": "女性，33岁，1年来乏力，发热、关节痛，面颊部有蝶形红斑，口腔鼻腔黏膜溃疡，为无痛性。2个月来，病人兴奋、躁动，幻听、幻视，被害妄想，关系妄想。2．主要治疗措施是（　　）。", "answer": "肾上腺皮质激素", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "肾上腺皮质激素", "B": "硫唑嘌呤", "C": "环磷酰胺", "D": "阿司匹林", "language": "zh"}
{"question": "3．瘘管（　　）。", "answer": "具有两端开口的病理性通道", "meta_info": "病理学", "answer_idx": "A", "A": "具有两端开口的病理性通道", "B": "表面或黏膜上皮坏死脱落形成较深缺损", "C": "单个毛囊发生的化脓性炎", "D": "多个毛囊发生的化脓性炎", "language": "zh"}
{"question": "以下情况不属于心理社会因素的是（　　）。", "answer": "抽烟喝酒", "meta_info": "医学心理学", "answer_idx": "B", "A": "心理冲突", "B": "抽烟喝酒", "C": "强迫性人格", "D": "离婚", "language": "zh"}
{"question": "女，30岁，哮喘持续2天，动脉血气分析pH 7.35，PaCO29.3kPa（70mmHg），PaO26.6kPa（50mmHg），BE+2mmol/L，HCO3－26mmol/L，其酸碱代谢紊乱的类型为（　　）。", "answer": "代偿性呼吸性酸中毒", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "C", "A": "呼吸性碱中毒", "B": "代谢性酸中毒", "C": "代偿性呼吸性酸中毒", "D": "代谢性碱中毒", "language": "zh"}
{"question": "1．唯一能通过胎盘（　　）。", "answer": "IgG", "meta_info": "医学免疫学", "answer_idx": "A", "A": "IgG", "B": "IgM", "C": "sIgA", "D": "IgE", "language": "zh"}
{"question": "1．破伤风属于（　　）。", "answer": "特异性感染", "meta_info": "第八部分　其他疾病", "answer_idx": "D", "A": "菌血症", "B": "急性感染", "C": "非特异性感染", "D": "特异性感染", "language": "zh"}
{"question": "4．枕骨大孔疝（　　）。", "answer": "呼吸骤停", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "呼吸骤停", "B": "昏迷，患侧瞳孔散大，对侧肢体偏瘫", "C": "血压升高，脉搏变慢，出现潮式呼吸", "D": "烦躁，高热，去脑强直发作", "language": "zh"}
{"question": "胫骨平台骨折，最容易引起的并发症是（　　）。", "answer": "创伤性关节炎", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "骨筋膜室综合征", "B": "骨化性肌炎", "C": "骨折不愈合", "D": "创伤性关节炎", "language": "zh"}
{"question": "患者，男，52岁，上腹部疼痛反复发作5年，近7天出现腹胀、呕吐。经X线钡餐检查诊断十二指肠溃疡伴幽门梗阻。最适宜的手术方式是（　　）。", "answer": "毕Ⅱ式胃大部切除术", "meta_info": "第3篇　消化系统", "answer_idx": "B", "A": "毕Ⅰ式胃大部切除术", "B": "毕Ⅱ式胃大部切除术", "C": "胃空肠吻合术", "D": "迷走神经干切断术", "language": "zh"}
{"question": "男性，65岁，既往有高血压病史约5年，血压控制不稳定，饮酒史30年，3～4两/日。某日中午饮2两白酒后，突然出现口齿不清，瘫软在地，送往医院途中，情绪烦躁，神情恐惧，要拔除输液管，不能辨认亲人。2．首选辅助检查为（　　）。", "answer": "颅脑CT", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "颅脑CT", "B": "血液酒精浓度测定", "C": "脑脊液常规、生化", "D": "脑电图", "language": "zh"}
{"question": "脑复苏治疗的重点是（　　）。", "answer": "防治脑水肿", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "降低大脑耗氧量", "B": "防治脑水肿", "C": "促进脑细胞功能恢复", "D": "降低脑细胞能量消耗", "language": "zh"}
{"question": "下述有关蛋白质的叙述哪项是不正确的?（　　）", "answer": "蛋白质分子都具有四级结构", "meta_info": "生物化学", "answer_idx": "C", "A": "蛋白质分子都具有一级结构", "B": "蛋白质的三级结构是整条肽链的空间结构", "C": "蛋白质分子都具有四级结构", "D": "蛋白质四级结构中亚基的种类和数量均不固定", "language": "zh"}
{"question": "肾病综合征患儿突然出现肉眼血尿伴腰痛，最可能的是（　　）。", "answer": "并发肾静脉血栓", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "并发泌尿系感染", "B": "肾功能衰竭", "C": "肾炎性肾病", "D": "并发肾静脉血栓", "language": "zh"}
{"question": "女性，30岁，3个月来工作较累，近3周出现兴趣缺乏，易疲劳，言语少，动作迟缓，自觉脑子笨，没有以前聪明，早醒，食欲减退，腹胀，便秘，全身酸痛，有时感心慌气紧。总觉自己患了不治之症，给家庭带来许多麻烦。该病人的诊断最可能是（　　）。", "answer": "抑郁症", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "焦虑症", "B": "神经衰弱", "C": "抑郁症", "D": "心身疾病", "language": "zh"}
{"question": "3．决定Ig类和亚类的部位（　　）。", "answer": "CH", "meta_info": "医学免疫学", "answer_idx": "C", "A": "VL+CL", "B": "铰链区", "C": "CH", "D": "CL", "language": "zh"}
{"question": "钩端螺旋体病的肺出血型，其出血症状一般常在病程的第几天（　　）。", "answer": "第3～4天", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "C", "A": "第2～3天", "B": "第1～2天", "C": "第3～4天", "D": "第5～7天", "language": "zh"}
{"question": "患者，女，25岁。发热、咽痛2天后出现肉眼血尿，血压130/70mmHg（17.3/9.4kPa），扁桃体Ⅱ度大、充血，余查体未见异常，血肌酐正常。4．是否使用糖皮质激素取决于（　　）。", "answer": "尿蛋白定量", "meta_info": "第4篇　泌尿系统", "answer_idx": "C", "A": "感染是否已经控制", "B": "肾组织中是否有新月体", "C": "尿蛋白定量", "D": "使用止血药", "language": "zh"}
{"question": "女孩，3岁。身高75cm，智力低下，鼻梁低平，舌体宽厚，常伸出口外，腹轻胀，便秘，有脐疝。1．最可能的诊断是（　　）。", "answer": "先天性甲状腺功能减低症", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "黏多糖病", "B": "先天性甲状腺功能减低症", "C": "骨软骨发育不良", "D": "先天性巨结肠", "language": "zh"}
{"question": "3．上述哪项是对肿瘤细胞通过细胞因子发挥作用的细胞？（　　）", "answer": "Th1", "meta_info": "医学免疫学", "answer_idx": "A", "A": "Th1", "B": "Tc", "C": "Mφ", "D": "LAK", "language": "zh"}
{"question": "亚急性细菌性心内膜炎好发于原先受损伤的瓣膜，最常发生于下述哪种情况？（　　）", "answer": "风湿性二尖瓣或主动脉瓣受损的瓣膜", "meta_info": "病理学", "answer_idx": "A", "A": "风湿性二尖瓣或主动脉瓣受损的瓣膜", "B": "动脉粥样硬化受累的主动脉瓣膜", "C": "先心病受损的瓣膜", "D": "无损伤的瓣膜", "language": "zh"}
{"question": "组成卵磷脂分子的成分有（　　）。", "answer": "胆碱", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "乙醇胺", "B": "胆碱", "C": "肌醇", "D": "丝氨酸", "language": "zh"}
{"question": "下列项不符合脑缺血卒中的表现？（　　）。", "answer": "多动态起病", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "多发生在60岁以上", "B": "多动态起病", "C": "意识障碍轻或无", "D": "脑脊液无色透明", "language": "zh"}
{"question": "股骨颈骨折引起股骨头坏死的主要原因是（　　）。", "answer": "股骨头血供受损", "meta_info": "第四部分　运动系统疾病", "answer_idx": "C", "A": "骨折畸形愈合", "B": "病人年龄大", "C": "股骨头血供受损", "D": "长期卧床", "language": "zh"}
{"question": "心理治疗的性质（　　）。", "answer": "帮助病人自己改变自己的过程", "meta_info": "医学心理学", "answer_idx": "A", "A": "帮助病人自己改变自己的过程", "B": "是朋友间的聊天", "C": "病人被动地接受治疗", "D": "是心理卫生课", "language": "zh"}
{"question": "早发型新生儿败血症的感染途径最常见的是（　　）。", "answer": "母亲垂直传播感染胎儿", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "母亲垂直传播感染胎儿", "B": "胎膜早破", "C": "产时胎儿通过产道吸入污染的分泌物", "D": "脐带感染", "language": "zh"}
{"question": "3．木瓜酶水解的片段是（　　）。", "answer": "2Fab段+Fc段", "meta_info": "医学免疫学", "answer_idx": "A", "A": "2Fab段+Fc段", "B": "铰链区", "C": "可变区", "D": "稳定区", "language": "zh"}
{"question": "28岁初产妇，产科检查提示臀先露，选用外转胎位术的最佳时间是（　　）。", "answer": "妊娠32～34周", "meta_info": "第5篇　女性生殖系统", "answer_idx": "C", "A": "妊娠26～28周", "B": "妊娠30～32周", "C": "妊娠32～34周", "D": "妊娠34～36周", "language": "zh"}
{"question": "患者，女，39岁，反复四肢无力3月，咳嗽3天。肢体无力在活动后加重，休息后减轻。检查：双肺少量啰音，右侧上睑下垂，双瞳孔等大，四肢肌力4级，感觉正常，疲劳试验阳性，强的松治疗有效。2．易与本病混淆的是（　　）。", "answer": "Lambert-Eaton综合征", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "TIA", "B": "Lambert-Eaton综合征", "C": "格林-巴利综合征", "D": "进行性肌营养不良", "language": "zh"}
{"question": "下列哪项是诊断肉瘤的主要形态依据？（　　）", "answer": "瘤细胞弥漫分布与间质分界不清", "meta_info": "病理学", "answer_idx": "D", "A": "浸润性生长", "B": "包膜消失", "C": "瘤细胞异型性明显", "D": "瘤细胞弥漫分布与间质分界不清", "language": "zh"}
{"question": "5．预后最好的甲状腺癌为（　　）。", "answer": "甲状腺乳头状腺癌", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "A", "A": "甲状腺乳头状腺癌", "B": "未分化癌", "C": "髓样癌", "D": "转移癌", "language": "zh"}
{"question": "患者，男，23岁，1h前被刀刺伤来诊，血压8.00/6.67kPa（60/50mmHg），面色苍白，呼吸困难，颈静脉怒张，呼吸音尚好，心音遥远，伤口在左锁骨中线第4肋间，诊断最可能是（　　）。", "answer": "心包积血", "meta_info": "第八部分　其他疾病", "answer_idx": "B", "A": "开放气胸", "B": "心包积血", "C": "肺损伤", "D": "张力气胸", "language": "zh"}
{"question": "下列哪一项不是血浆蛋白的生理功能？（　　）", "answer": "排泄功能", "meta_info": "生理学", "answer_idx": "D", "A": "营养功能", "B": "缓冲功能", "C": "免疫功能", "D": "排泄功能", "language": "zh"}
{"question": "女，60岁。一周前家人发现晨起不能唤醒，急诊查血糖2.1mmol/L，既往无糖尿病病史。查体：BP 120／85mmHg，心率105次/分，BMI 32。此时，该患者最有可能异常的激素是（　　）。", "answer": "胰岛素", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "胰岛素", "B": "生长激素", "C": "糖皮质激素", "D": "甲状腺激素", "language": "zh"}
{"question": "有关奥美拉唑的叙述，错误的是（　　）。", "answer": "代谢成次磺酸和亚磺酰胺后失活", "meta_info": "药理学", "answer_idx": "B", "A": "口服后，浓集于壁细胞分泌小管周围", "B": "代谢成次磺酸和亚磺酰胺后失活", "C": "能够不可逆的抑制H+-K+-ATP酶的作用", "D": "不影响内因子的分泌", "language": "zh"}
{"question": "患者，6个月，高热10余日，咳嗽、气促，其母患肺结核。查体：精神萎靡，面色苍白，双肺呼吸音粗，肝肋下2.5cm，脾触及边缘，前囟膨隆，颈强（±）。OT试验阴性，胸片提示双肺中外带均有粟粒状阴影。2．患儿OT试验出现阴性反应，最可能的原因为（　　）。", "answer": "机体免疫反应受到抑制", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "没有受过结核菌感染", "B": "机体免疫反应受到抑制", "C": "技术误差", "D": "试剂失效", "language": "zh"}
{"question": "1．在线粒体和胞液进行（　　）。", "answer": "糖有氧氧化", "meta_info": "生物化学", "answer_idx": "B", "A": "糖酵解", "B": "糖有氧氧化", "C": "磷酸戊糖途径", "D": "糖原分解", "language": "zh"}
{"question": "患者有损害，但医疗机构不承担赔偿责任（　　）。", "answer": "患者或者其近亲属不配合医疗机构进行符合诊疗规范的诊疗", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "患者或者其近亲属不配合医疗机构进行符合诊疗规范的诊疗", "B": "未经患者同意公开其病历资料", "C": "未尽到与当时医疗水平相应的诊疗义务", "D": "在诊疗活动中，医务人员未尽到向患者或其家属说明病情和医疗措施等义务，造成患者损害的", "language": "zh"}
{"question": "2．新生儿硬肿症多见于（　　）。", "answer": "早产儿", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "足月儿", "B": "低出生体重儿", "C": "过期产儿", "D": "早产儿", "language": "zh"}
{"question": "男，59岁。2型糖尿病病史7年，口服格列本脲15mg/d和二甲双胍2.0g/d治疗。8个月前眼底检查可见微血管瘤、出血和硬性渗出。近1个月来视力明显减退，眼底检查可见视网膜新生血管形成和玻璃体积血。BP 160／100mmHg，BMI 28.4㎏/㎡，空腹血糖7.1mmol/L，餐后2小时血糖14.6mmol/L，糖化血红蛋白7.6％。3．对该患者糖尿病视网膜病变最合适的治疗为（　　）。", "answer": "激光治疗", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "降血压治疗", "B": "抗纤溶治疗", "C": "激光治疗", "D": "抗凝治疗", "language": "zh"}
{"question": "下列哪项为机体内环境？（　　）", "answer": "细胞外液", "meta_info": "生理学", "answer_idx": "B", "A": "体液", "B": "细胞外液", "C": "血液", "D": "组织液", "language": "zh"}
{"question": "4．感受行高，耐受性低，速度慢且不灵活具有刻板性（　　）。", "answer": "抑郁质", "meta_info": "医学心理学", "answer_idx": "B", "A": "胆汁质", "B": "抑郁质", "C": "多血质", "D": "抑制质", "language": "zh"}
{"question": "易发生小流行肺炎类型是（　　）。", "answer": "支原体肺炎", "meta_info": "第1篇　呼吸系统", "answer_idx": "D", "A": "厌氧菌肺炎", "B": "肺炎链球菌肺炎", "C": "克雷伯杆菌肺炎", "D": "支原体肺炎", "language": "zh"}
{"question": "慢性粒细胞白血病病人有哪条染色体改变？（　　）", "answer": "t（9:22）（q34:q11）", "meta_info": "第一部分　血液系统疾病", "answer_idx": "A", "A": "t（9:22）（q34:q11）", "B": "t（15:1）", "C": "t（11:8）（q34:q11）", "D": "16号染色体结构异常", "language": "zh"}
{"question": "1．交感缩血管纤维末梢释放的递质是（　　）。", "answer": "去甲肾上腺素", "meta_info": "生理学", "answer_idx": "A", "A": "去甲肾上腺素", "B": "乙酰胆碱", "C": "多巴胺", "D": "5-羟色胺", "language": "zh"}
{"question": "8岁男孩，水肿，尿色红2d入院，查体：颜面眼睑水肿，心肺听诊无异常，尿常规有红细胞（+++），蛋白（+），患儿半个月前患过扁桃体炎。3．发生上述情况，首先应采取的措施是（　　）。", "answer": "使用呋塞米（速尿）", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "加强抗生素的运用", "B": "使用呋塞米（速尿）", "C": "补充氯化钠", "D": "血液透析", "language": "zh"}
{"question": "椎体横突骨折多发生在（　　）。", "answer": "L2、3、4", "meta_info": "第四部分　运动系统疾病", "answer_idx": "D", "A": "C5、6、7", "B": "T5、6、7", "C": "T10、11、12", "D": "L2、3、4", "language": "zh"}
{"question": "有机磷中毒，烟碱样症状是（　　）。", "answer": "肌纤维颤动", "meta_info": "第八部分　其他疾病", "answer_idx": "D", "A": "多汗", "B": "流涎", "C": "恶心、呕吐", "D": "肌纤维颤动", "language": "zh"}
{"question": "与宫颈癌发生密切相关的是（　　）。", "answer": "人乳头瘤病毒", "meta_info": "第5篇　女性生殖系统", "answer_idx": "A", "A": "人乳头瘤病毒", "B": "麻疹病毒", "C": "禽流感病毒", "D": "乙肝病毒", "language": "zh"}
{"question": "10个月患儿，早产，初生体重2kg，牛奶喂养，未添加辅食，发现面色苍白5个月。查体：体重7kg，面色苍白，肝肋下3cm，脾肋下1.5cm，血象：红细胞3.5×1012/L，血红蛋白75g/L，白细胞6.0×109/L，中性粒细胞30%，淋巴细胞68%，单核细胞2%，网织红细胞0.4%。1．下列治疗欠妥的是（　　）。", "answer": "反复输血，以刺激骨髓造血", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "添加含铁辅食", "B": "两餐之间服用铁剂", "C": "加服维生素C", "D": "反复输血，以刺激骨髓造血", "language": "zh"}
{"question": "女性，21岁，舞蹈演员。8个月前，因同事偶尔说了句“最近胖了”遂采取各种措施节食，家人劝阻时，以食欲不佳等理由拒绝进餐，体重由以往54kg降至32kg（身高1.65m），近3个月来出现闭经，体检见皮肤干燥、苍白，形体消瘦，严重营养不良。3．此类病人死亡原因多见于（　　）。", "answer": "营养代谢障碍及感染", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "意外", "B": "营养代谢障碍及感染", "C": "消化道出血", "D": "以上都不是", "language": "zh"}
{"question": "取得执业助理医师执业证书后，具有中等专业学校医学专业学历，在医疗、预防、保健机构中需工作满几年方可参加执业医师资格考试（　　）。", "answer": "满5年", "meta_info": "卫生法规", "answer_idx": "D", "A": "满1年", "B": "满2年", "C": "满4年", "D": "满5年", "language": "zh"}
{"question": "对于普萘洛尔，哪一项是错误的？（　　）", "answer": "长期用药一旦病情好转应立即停药", "meta_info": "药理学", "answer_idx": "C", "A": "减少肾素的释放", "B": "阻断突触前膜β2受体减少去甲肾上腺素释放", "C": "长期用药一旦病情好转应立即停药", "D": "生物利用度个体差异大", "language": "zh"}
{"question": "2岁的男婴，近4日来发热38～39℃，烦躁不安，精神不振，喷射性呕吐，2或3次/日。查体：精神萎靡，目光凝视，心音纯正、有力，呼吸粗糙，双扁桃体Ⅱ°充血，肝、脾不大，颈轻度抵抗，克氏征（++），巴氏征（+）。为确诊首先应做何种检查？（　　）", "answer": "腰穿检查脑脊液", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "血细胞计数和分类", "B": "腰穿检查脑脊液", "C": "结核菌素试验", "D": "头颅CT", "language": "zh"}
{"question": "对严重浸润性突眼的甲亢病人治疗应选用（　　）。", "answer": "抗甲状腺药物+糖皮质激素+甲状腺片", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "C", "A": "131I治疗", "B": "复方碘溶液", "C": "抗甲状腺药物+糖皮质激素+甲状腺片", "D": "抗甲状腺药物治疗", "language": "zh"}
{"question": "低钾血症一般不表现为（　　）。", "answer": "碱性尿", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "碱中毒", "B": "碱性尿", "C": "心电图出现U波", "D": "腱反射减弱", "language": "zh"}
{"question": "下述氨基酸中属于人体必需氨基酸的是（　　）。", "answer": "苏氨酸", "meta_info": "第二部分　模拟试题", "answer_idx": "B", "A": "组氨酸", "B": "苏氨酸", "C": "脯氨酸", "D": "丝氨酸", "language": "zh"}
{"question": "1．根据ISFC∕WHO对缺血性心脏病的分类，初发劳累性心绞痛是（　　）。", "answer": "劳累性心绞痛病程在1个月以内", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "劳累性心绞痛病程在1个月以内", "B": "劳累性心绞痛临床特点1个月以上无变化", "C": "劳累性心绞痛病程在3个月以内", "D": "劳累性心绞痛临床特点3个月以上无变化", "language": "zh"}
{"question": "断肢再植成功率最高的上臂外伤种类是（　　）。", "answer": "被劫匪利刀砍断的上臂", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "被机床压断的上臂", "B": "被火车碾压断的上臂", "C": "被滚动皮带绞断的上臂", "D": "被劫匪利刀砍断的上臂", "language": "zh"}
{"question": "2．属于精神分裂症是（　　）。", "answer": "蜡样屈曲", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "蜡样屈曲", "B": "思维奔逸", "C": "焦虑", "D": "恐怖", "language": "zh"}
{"question": "男性，56岁，进行性贫血1年，剧烈腰痛3个月。血红蛋白89g/L，白细胞3.4×109/L，血小板68×109/L，血沉18cm/h，尿蛋白（++），骨髓异常浆细胞54%，血清蛋白电泳出现M蛋白。4．与诊断不符的血液学改变是（　　）。", "answer": "无幼粒、幼红细胞", "meta_info": "第一部分　血液系统疾病", "answer_idx": "A", "A": "无幼粒、幼红细胞", "B": "血沉显著增快", "C": "血片中见红细胞排成线串状", "D": "全血细胞减少", "language": "zh"}
{"question": "一男性患者，慢性咳嗽、咳痰20余年，痰多呈白色黏液样，有时为黄脓痰，近半年来咳痰偶带血丝，气急不能平卧，桶状胸，近日腹部膨隆，腹水（+）。完整的诊断应为（　　）。", "answer": "慢性支气管炎、肺气肿、肺心病", "meta_info": "病理学", "answer_idx": "A", "A": "慢性支气管炎、肺气肿、肺心病", "B": "慢性支气管炎", "C": "慢性支气管炎、肺癌、肺气肿、肺心病", "D": "慢性支气管炎、肺炎、肺气肿、肺心病", "language": "zh"}
{"question": "急性糜烂出血性胃炎最常见的原因是（　　）。", "answer": "口服非类固醇消炎药", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "不洁饮食", "B": "剧烈呕吐", "C": "刺激性食物", "D": "口服非类固醇消炎药", "language": "zh"}
{"question": "诊断颅内占位病变无痛、安全、准确的方法是（　　）。", "answer": "头颅CT", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "头颅CT", "B": "头颅X线平片", "C": "脑电图", "D": "气脑造影", "language": "zh"}
{"question": "初孕妇，28岁，妊娠36周，血压升高3周。今晨突然腹痛，呈持续性，阵发性加重。BP 150/98mmHg，心率112次/min，尿蛋白（＋＋），阴道少量流血。3．此时对诊断最有价值的辅助检查是（　　）。", "answer": "B型超声检查", "meta_info": "第5篇　女性生殖系统", "answer_idx": "A", "A": "B型超声检查", "B": "肝功能检查", "C": "白细胞计数", "D": "血细胞比容", "language": "zh"}
{"question": "男性，40岁，因发热，便秘，食欲不振12天入院，查体：肝大，肋下1cm，软，脾肋下及边，血常规WBC 2.7×109/L，中性粒细胞52%，淋巴细胞44%，血清ALT 120U/L，肥达反应：“O”1:160，“H”1:160。4．在治疗过程中哪项是不正确的？（　　）", "answer": "高压灌肠", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "低压灌肠", "B": "高压灌肠", "C": "缓泻药应用", "D": "抗生素", "language": "zh"}
{"question": "男婴，8个月。腹泻伴呕吐3天，无尿6小时。大便10～15次/天，呈蛋花汤样伴黏液，有腥臭味。查体：T 37.8℃，表情淡漠，前囟、眼窝明显凹陷，皮肤弹性差，可见花纹，四肢厥冷，双肺呼吸音清，心率120次/分，腹软，无明显压痛。实验室检查：粪镜检偶见白细胞，血钠134mmol/L。3．首批快速扩容静脉输液应给予（　　）。", "answer": "2:1等张含钠液", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "1/3张含钠液", "B": "2:1等张含钠液", "C": "1/2张含钠液", "D": "4/5张含钠液", "language": "zh"}
{"question": "某患者有丛林接触史，突然高热，用变形杆菌OXk株做抗原与患者血清进行定量凝集试验，抗体效价为1:320，该病人可能患何种疾病？（　　）", "answer": "恙虫病", "meta_info": "医学微生物学", "answer_idx": "C", "A": "伤寒病", "B": "风湿病", "C": "恙虫病", "D": "地方性斑疹伤寒", "language": "zh"}
{"question": "右侧额纹消失、眼睑不能闭合、鼻唇沟变浅，露齿时口角偏向左侧，考虑哪种病变？（　　）", "answer": "右侧周围性面神经麻痹", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "左侧中枢性面神经麻痹", "B": "右侧周围性面神经麻痹", "C": "右侧中枢性面神经麻痹", "D": "双侧周围性面神经麻痹", "language": "zh"}
{"question": "男，40岁。车祸外伤后10小时，当时无昏迷。入院时查体：神志清楚，答话切题，右侧肢体肌力4级，霍夫曼征阳性，头颅X线平片及CT均提示左顶骨凹陷性骨折，直径3cm，深度2cm。正确的治疗是（　　）。", "answer": "手术摘除凹陷的骨折碎片，解除对脑组织压迫", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "抗感染治疗", "B": "手术摘除凹陷的骨折碎片，解除对脑组织压迫", "C": "脱水治疗", "D": "保守治疗，应用神经营养剂", "language": "zh"}
{"question": "女，56岁。右下肢静脉迂曲扩张20年，伴下肢酸胀、水肿，活动或抬高患肢减轻，近2年右足靴区皮肤发红，时有瘙痒，逐渐加重。查体：右下肢大腿内侧、小腿后有迂曲扩张之静脉团，足靴区色素沉着，皮肤变厚。2．为进一步明确病因，应进行的检查是（　　）。", "answer": "深静脉瓣功能试验", "meta_info": "第2篇　心血管系统", "answer_idx": "D", "A": "下肢静脉压测定", "B": "静脉多普勒血流检查", "C": "静脉造影", "D": "深静脉瓣功能试验", "language": "zh"}
{"question": "剧烈呕吐后出现呕血的情况强烈提示（　　）。", "answer": "食管贲门黏膜撕裂综合征", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "食管胃底静脉曲张破裂", "B": "慢性胃炎", "C": "食管贲门黏膜撕裂综合征", "D": "食管癌", "language": "zh"}
{"question": "病人自觉大脑突然涌现出大量不自主的、杂乱无章的陌生思维内容是（　　）。", "answer": "强制性思维", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "强制性思维", "B": "思维奔逸", "C": "强迫性思维", "D": "思维散漫", "language": "zh"}
{"question": "口服药治疗甲亢的适应证是（　　）。", "answer": "病情轻，甲状腺较小者", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "A", "A": "病情轻，甲状腺较小者", "B": "胸骨后甲状腺肿", "C": "结节性高功能腺瘤", "D": "中、重度甲亢", "language": "zh"}
{"question": "激活B细胞产生抗体过程中有T细胞和Mφ中参与的抗原物质（　　）。", "answer": "TD-Ag", "meta_info": "医学免疫学", "answer_idx": "C", "A": "半抗原", "B": "TI-Ag", "C": "TD-Ag", "D": "共同抗原", "language": "zh"}
{"question": "休克代偿期表现不包括（　　）。", "answer": "血压下降", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "血压下降", "B": "兴奋", "C": "过度通气", "D": "舒张压升高", "language": "zh"}
{"question": "胎儿血液循环出生后的改变，下列哪项是不正确的（　　）。", "answer": "肺循环压力增高", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "肺小动脉肌层退化", "B": "肺循环压力增高", "C": "卵圆孔关闭", "D": "动脉导管关闭", "language": "zh"}
{"question": "血管壁玻璃样变多见于（　　）。", "answer": "细动脉", "meta_info": "病理学", "answer_idx": "C", "A": "大动脉", "B": "中型动脉", "C": "细动脉", "D": "小静脉", "language": "zh"}
{"question": "患者，男，35岁。发现高血压7个月，未服药，改善生活行为后血压为140～150/90～95mmHg，心率56次/min。该患者治疗首选的药物是（　　）。", "answer": "培哚普利", "meta_info": "第2篇　心血管系统", "answer_idx": "C", "A": "哌唑嗪", "B": "利血平", "C": "培哚普利", "D": "比索洛尔", "language": "zh"}
{"question": "可以减弱心理应激的负面影响的方法除外（　　）。", "answer": "坚持面对严酷的现实", "meta_info": "医学心理学", "answer_idx": "C", "A": "学会放松技术", "B": "保持乐观的心情", "C": "坚持面对严酷的现实", "D": "取得社会支持", "language": "zh"}
{"question": "2．同时有交界痣和皮内痣的改变（　　）。", "answer": "混合痣", "meta_info": "病理学", "answer_idx": "A", "A": "混合痣", "B": "皮内痣", "C": "交界痣", "D": "恶性黑色素瘤", "language": "zh"}
{"question": "机体对青霉素最易产生以下何种不良反应？（　　）", "answer": "变态反应", "meta_info": "药理学", "answer_idx": "D", "A": "停药反应", "B": "特异质反应", "C": "副反应", "D": "变态反应", "language": "zh"}
{"question": "1．辅助诊断风湿热的是（　　）。", "answer": "抗链“O”试验", "meta_info": "医学微生物学", "answer_idx": "C", "A": "肥达试验", "B": "外斐试验", "C": "抗链“O”试验", "D": "胆汁溶菌试验", "language": "zh"}
{"question": "2．高血压性心脏病（　　）。", "answer": "心脏肥大", "meta_info": "病理学", "answer_idx": "D", "A": "疣状心内膜炎", "B": "心瓣膜穿孔", "C": "心内膜心肌纤维化", "D": "心脏肥大", "language": "zh"}
{"question": "关于DNA聚合酶的叙述错误的是（　　）。", "answer": "以NTP为原料", "meta_info": "第二部分　模拟试题", "answer_idx": "C", "A": "需模板DNA", "B": "延伸方向为5′一3′", "C": "以NTP为原料", "D": "具有3′一5′外切酶活性", "language": "zh"}
{"question": "1．出血时间延长，血块退缩不良（　　）。", "answer": "血小板质或量的异常", "meta_info": "第一部分　血液系统疾病", "answer_idx": "C", "A": "凝血酶形成障碍", "B": "纤维蛋白形成障碍", "C": "血小板质或量的异常", "D": "血管壁的异常", "language": "zh"}
{"question": "不适用于培养病毒的方法是（　　）。", "answer": "人工合成培基", "meta_info": "医学微生物学", "answer_idx": "D", "A": "传代细胞培养", "B": "适龄鸡胚接种", "C": "易感动物接种", "D": "人工合成培基", "language": "zh"}
{"question": "5．以失眠、头痛、情绪不稳、疲乏、注意力不集中为主要表现，实验室检查多无异常发现（　　）。", "answer": "脑震荡后综合征", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "依赖综合征", "B": "戒断综合征", "C": "脑震荡后综合征", "D": "Korsakoff综合征", "language": "zh"}
{"question": "患儿，男，2岁半，自幼人工喂养，食欲极差，有时腹泻。身高85cm，体重7500g，皮肤干燥、苍白，腹部皮下脂肪厚度约0.3cm，脉搏缓慢，心音较低钝。2．如果此患儿出现哭而少泪，眼球结膜有毕脱斑，那么下列哪项正确？（　　）", "answer": "维生素A缺乏", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "维生素A缺乏", "B": "维生素E缺乏", "C": "维生素C缺乏", "D": "维生素D缺乏", "language": "zh"}
{"question": "男性,35岁，体重60kg。烧伤总面积为60%，伤后第一个8h所需晶、胶体量是（　　）。", "answer": "2700ml", "meta_info": "第八部分　其他疾病", "answer_idx": "B", "A": "1700ml", "B": "2700ml", "C": "3400ml", "D": "3600ml", "language": "zh"}
{"question": "脑局灶性病变时，病人听到事实不存在的鸣笛声，此种幻觉称为（　　）。", "answer": "原始性幻听", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "原始性幻听", "B": "反射性幻听", "C": "机能性幻听", "D": "心因性幻听", "language": "zh"}
{"question": "4个月婴儿，发热，咳嗽2天，嗜睡，反复惊厥半天。查体：精神差，前囟膨隆，两肺可闻及中小水泡音，颈无抵抗，双巴氏征阳性。2．为明确诊断，应做的检查是（　　）。", "answer": "脑脊液检查", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "脑脊液检查", "B": "脑电图", "C": "血培养", "D": "PPD检查", "language": "zh"}
{"question": "女，50岁，高热，寒战5天，意识模糊1天。既往体健。查体：T 39℃，P 120次/分，R 22次/分，BP 80／50mmHg，皮肤散在出血点和瘀斑，双肺未见异常，心率120次/分，律齐，腹软，肝肋下0.5cm，脾肋下及边。检查：Hb 100g/L，WBC 25.3×109/L，血培养示大肠埃希菌生长，PT 18秒（正常对照13秒），INR 2.1，血纤维蛋白原定量108g/L，诊断为大肠埃希菌败血症，可能合并DIC。1．下述检查对确诊DIC意义不大的是（　　）。", "answer": "血小板功能", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "复查血纤维蛋白原定量", "B": "复查血小板数量", "C": "血小板功能", "D": "FDP测定", "language": "zh"}
{"question": "禁用放射性碘治疗的甲亢病人包括（　　）。", "answer": "以上都是", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "D", "A": "20岁以下，妊娠、哺乳期", "B": "严重心、肝、肾功能衰竭", "C": "重症浸润性突眼、甲亢危象", "D": "以上都是", "language": "zh"}
{"question": "关于错觉的定义正确的是（　　）。", "answer": "对客观事物歪曲的知觉", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "无客观刺激时的知觉体验", "B": "对客观事物歪曲的知觉", "C": "对客观事物作出相反印象的知觉障碍", "D": "以上都不对", "language": "zh"}
{"question": "在诊疗同意制度中，如果病人方面的意见不统一，医师应当以谁的意见为准？（　　）", "answer": "病人家属或者关系人", "meta_info": "卫生法规", "answer_idx": "A", "A": "病人家属或者关系人", "B": "病人本人", "C": "必须等病人和家属或者关系人意见统一后才能决定诊疗方案", "D": "对病人的诊疗有利者", "language": "zh"}
{"question": "将患者米泔水样粪便作悬滴在光学显微镜下观察，有穿梭运动的微生物最有可能是（　　）。", "answer": "霍乱弧菌", "meta_info": "医学微生物学", "answer_idx": "C", "A": "致病性大肠杆菌", "B": "伤寒沙门菌", "C": "霍乱弧菌", "D": "痢疾志贺菌", "language": "zh"}
{"question": "在人体实验中，医务人员应遵循的道德原则不包括（　　）。", "answer": "实验中未给受试者带来危害的情况下，受试者不能退出实验", "meta_info": "医学伦理学", "answer_idx": "D", "A": "以维护和增进人类的健康为目的", "B": "以大量、充分、可靠的动物实验为基础", "C": "以受试者知情同意为前提", "D": "实验中未给受试者带来危害的情况下，受试者不能退出实验", "language": "zh"}
{"question": "当某一感官处于功能状态时，另一感官出现幻觉，此现象为（　　）。", "answer": "反射性幻觉", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "内脏性幻觉", "B": "假性幻觉", "C": "反射性幻觉", "D": "原始性幻觉", "language": "zh"}
{"question": "男性，29岁，低热，酱油色尿2个月。查体：巩膜黄染，贫血面容，肝脾不肿大。血红蛋白73g/L，血小板100×109/L，白细胞4.4×109/L，网织红细胞计数0.15，尿隐血阴性。3．如需治疗，哪一项治疗不宜？（　　）", "answer": "全血或补铁", "meta_info": "第一部分　血液系统疾病", "answer_idx": "B", "A": "皮质激素短期应用", "B": "全血或补铁", "C": "洗涤红细胞悬液", "D": "雄激素", "language": "zh"}
{"question": "急性脊髓炎的可能诱因是（　　）。", "answer": "疫苗接种", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "疫苗接种", "B": "肠道感染", "C": "败血症", "D": "肺炎", "language": "zh"}
{"question": "初孕妇，25岁，妊娠31周。从妊娠29周起反复3次阴道流血，量少，无腹痛，再次阴道流血同月经量。查体：P 88次/分，BP 110/70/mmHg，子宫软，无宫缩，枕左前位，胎头高浮，胎心率130次/分。3．错误的处理方法是（　　）。", "answer": "直接阴道检查确定前置胎盘类型", "meta_info": "第5篇　女性生殖系统", "answer_idx": "B", "A": "卧床休息，应用宫缩抑制剂", "B": "直接阴道检查确定前置胎盘类型", "C": "输液备血", "D": "继续流血，应行剖宫产术", "language": "zh"}
{"question": "某肺部肿瘤患者，手术切除标本镜下见癌细胞呈巢状，角化珠明显，有清楚的细胞间桥，应诊为（　　）。", "answer": "肺高分化鳞癌", "meta_info": "病理学", "answer_idx": "B", "A": "肺鳞癌", "B": "肺高分化鳞癌", "C": "肺低分化鳞癌", "D": "肺瘢痕癌", "language": "zh"}
{"question": "肝脓肿的特点正确的是（　　）。", "answer": "阿米巴肝脓肿脓液为褐色，无臭味", "meta_info": "第3篇　消化系统", "answer_idx": "C", "A": "细菌性肝脓肿常为单发、较大", "B": "阿米巴肝脓肿起病急，伴寒战、高热", "C": "阿米巴肝脓肿脓液为褐色，无臭味", "D": "阿米巴肝脓肿病人粪便中可找到阿米巴原虫", "language": "zh"}
{"question": "女，48岁，近1个月感口渴、饮水量增至每天2000ml。身高156cm、体重71kg。空腹血糖180mg/dl（10.0mmol/L）、餐后血糖252mg/dl（14.0mmol/L）。系初次发现血糖高，无糖尿病病史。2．按以上建议治疗3个月后空腹血糖153mg/dl（8.5mmol/L）、餐后血糖225mg/d1（12.5mmol/L）。进一步治疗为（　　）。", "answer": "二甲双胍", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "C", "A": "氯磺丙脲", "B": "格列齐特", "C": "二甲双胍", "D": "人胰岛素", "language": "zh"}
{"question": "1．围生期保健重点（　　）。", "answer": "降低异常产发生", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "孕母保健", "B": "降低异常产发生", "C": "加强品德教育", "D": "完成基础计划免疫", "language": "zh"}
{"question": "女性，26岁，牙龈出血伴月经过多1年，双下肢可见散在出血点及紫癜，肝脾不大，血红蛋白90g/L，白细胞5.5×109/L，分类正常，血小板25 ×109/L，尿常规正常。1．最可能的诊断为（　　）。", "answer": "特发性血小板减少性紫癜", "meta_info": "第一部分　血液系统疾病", "answer_idx": "C", "A": "过敏性紫癜", "B": "急性白血病", "C": "特发性血小板减少性紫癜", "D": "缺铁性贫血", "language": "zh"}
{"question": "慢性肾衰竭进展过程中最早出现的临床表现常为（　　）。", "answer": "消化道症状", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "消化道症状", "B": "出血", "C": "反复感染", "D": "骨痛", "language": "zh"}
{"question": "女，32岁，头痛一年半，近2个月头痛加重，伴有喷射样呕吐。烦躁后出现意识障碍，右侧瞳孔缩小，后又散大，光反应迟钝，左侧肢体运动障碍，呼吸加快，CT示左顶叶肿瘤。紧急抢救措施应是（　　）。", "answer": "20%甘露醇静脉注射", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "立即开颅切除肿瘤", "B": "20%甘露醇静脉注射", "C": "脑脊液体外引流", "D": "气管插管，保持呼吸道通畅", "language": "zh"}
{"question": "下列哪项是抗铜绿假单胞菌作用最强的头孢菌素？（　　）", "answer": "头孢他定", "meta_info": "药理学", "answer_idx": "B", "A": "头孢孟多", "B": "头孢他定", "C": "头孢噻吩", "D": "头孢哌酮", "language": "zh"}
{"question": "风湿性心内膜炎的描述哪项正确？（　　）", "answer": "瓣膜赘生物粘连牢固", "meta_info": "病理学", "answer_idx": "A", "A": "瓣膜赘生物粘连牢固", "B": "瓣膜赘生物中早期有细菌", "C": "受累瓣膜以三尖瓣多见", "D": "受累瓣膜以三尖瓣及肺动脉瓣多见", "language": "zh"}
{"question": "正常人先用力深吸气，然后以最快的速度呼出气体。第1秒末的呼出气量占肺活量的百分数应为（　　）。", "answer": "83%", "meta_info": "生理学", "answer_idx": "A", "A": "83%", "B": "60%", "C": "99%", "D": "100%", "language": "zh"}
{"question": "RNA是指下列哪项？（　　）", "answer": "核糖核酸", "meta_info": "生物化学", "answer_idx": "B", "A": "脱氧核糖核酸", "B": "核糖核酸", "C": "脱氧核糖核苷酸", "D": "核糖核苷酸", "language": "zh"}
{"question": "4．老年人多发（　　）。", "answer": "股骨颈骨折", "meta_info": "第四部分　运动系统疾病", "answer_idx": "C", "A": "股骨干上1/3骨折", "B": "股骨干中1/3骨折", "C": "股骨颈骨折", "D": "胫骨骨折", "language": "zh"}
{"question": "男，55岁，胃溃疡病史5年。近一月来症状加重，2小时前餐后突发上腹部剧痛，并扩散至全腹，诊断为胃溃疡穿孔。最佳的治疗方法是（　　）。", "answer": "胃大部切除术", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "穿孔修补术", "B": "全胃切除术", "C": "胃大部切除术", "D": "穿孔修补加选择性迷走神经切断术", "language": "zh"}
{"question": "高血压病时，血管壁的玻璃样变性主要发生在（　　）。", "answer": "细小动脉", "meta_info": "病理学", "answer_idx": "D", "A": "小动脉", "B": "大动脉", "C": "静脉", "D": "细小动脉", "language": "zh"}
{"question": "小儿体重在1岁至12岁时每年增长约（　　）。", "answer": "2kg", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "2kg", "B": "4kg", "C": "6kg", "D": "8kg", "language": "zh"}
{"question": "卡介苗是（　　）。", "answer": "保持免疫原性，减毒的活的牛型结核分枝杆菌", "meta_info": "医学微生物学", "answer_idx": "C", "A": "加热处理后的人型结核分枝杆菌", "B": "发生了抗原变异的牛型结核分枝杆菌", "C": "保持免疫原性，减毒的活的牛型结核分枝杆菌", "D": "保持免疫原性，减毒的活的人型结核分枝杆菌", "language": "zh"}
{"question": "医师行使道德权利的特点之一是（　　）。", "answer": "自主性", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "自主性", "B": "冲动性", "C": "组织性", "D": "集体性", "language": "zh"}
{"question": "下列哪项不是急性化脓性腹膜炎腹痛的特点？（　　）", "answer": "阵发性全腹痛", "meta_info": "第3篇　消化系统", "answer_idx": "B", "A": "剧烈、持续性", "B": "阵发性全腹痛", "C": "改变体位时疼痛加剧", "D": "病人多不愿改变体位", "language": "zh"}
{"question": "2．高血压伴脑缺血者宜选用（　　）。", "answer": "尼莫地平", "meta_info": "药理学", "answer_idx": "B", "A": "美托洛尔", "B": "尼莫地平", "C": "硝苯地平", "D": "氢氯噻嗪和普萘洛尔", "language": "zh"}
{"question": "王某，女，19岁。最近因高考失利而出现情绪低落和失眠的情况。王某的母亲知道王某有位表哥是心理治疗师，比较熟悉和了解王某的情况，要求其给王某做心理治疗，但被这位表哥拒绝了。其表哥拒绝提供治疗服务所依据的原则为（　　）。", "answer": "回避原则", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "保密原则", "B": "回避原则", "C": "发展原则", "D": "灵活原则", "language": "zh"}
{"question": "3．能感受血浆晶体渗透压改变的渗透压感受器位于（　　）。", "answer": "下丘脑", "meta_info": "生理学", "answer_idx": "D", "A": "入球小动脉", "B": "颈动脉体和主动脉体", "C": "左心房和腔静脉", "D": "下丘脑", "language": "zh"}
{"question": "患者女性，31岁。发现颈部无症状的肿块3周。体检：健康女性，体温36.6℃，血压135/70mmHg，脉搏82次/分，呼吸20次/分。未发现突眼征，甲状腺左叶下极可触及3cm×4cm大肿块，表面光滑，质地柔软，随吞咽上下移动。1．对诊断最有帮助的检查是（　　）。", "answer": "细针穿刺细胞学检查", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "C", "A": "颈部B超", "B": "甲状腺摄131碘率的测定", "C": "细针穿刺细胞学检查", "D": "血清学检查", "language": "zh"}
{"question": "3．阿米巴痢疾的病理特点（　　）。", "answer": "正常肠黏膜上较多孤立的小脓肿，进而形成口小底大的烧瓶样溃疡", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "D", "A": "肠黏膜弥漫性纤维蛋白渗出性炎症", "B": "全身单核一巨噬细胞系统的增生性反应", "C": "肠黏膜弥漫水肿及肠壁增厚", "D": "正常肠黏膜上较多孤立的小脓肿，进而形成口小底大的烧瓶样溃疡", "language": "zh"}
{"question": "女，5岁，营养发育正常，其标准体重、身长最可能为（　　）。", "answer": "18kg，105cm", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "16kg，105cm", "B": "16kg，100cm", "C": "18kg，105cm", "D": "18kg，110cm", "language": "zh"}
{"question": "关于女性外生殖器解剖，正确的是（　　）。", "answer": "女性外生殖器即外阴", "meta_info": "第5篇　女性生殖系统", "answer_idx": "A", "A": "女性外生殖器即外阴", "B": "前庭大腺开口于阴道内", "C": "女性阴毛分布呈菱形", "D": "阴道前庭为双侧大阴唇之同的菱形区", "language": "zh"}
{"question": "有关心身疾病的诊断标准，以下不正确的是（　　）。", "answer": "出现幻觉", "meta_info": "医学心理学", "answer_idx": "D", "A": "性格上可能存在某种缺陷", "B": "有器质性的病变", "C": "疾病的发生、发展有明确的心理社会因素", "D": "出现幻觉", "language": "zh"}
{"question": "下列哪项是测定蛋白质样品中某种相对分子质量的蛋白质最佳的方法？（　　）", "answer": "免疫印迹试验（Westernblotting）", "meta_info": "医学免疫学", "answer_idx": "C", "A": "免疫沉淀法", "B": "免疫PCR", "C": "免疫印迹试验（Westernblotting）", "D": "斑点杂交", "language": "zh"}
{"question": "女，6岁，持续发热2周，伴双下肢关节酸痛、乏力来院。2周前患扁桃体炎，曾用青霉素治疗3天。T 38.0℃，P 92次/min，面色苍白，心尖区1/6级收缩期杂音，左踝关节稍红肿，轻压痛，活动障碍，胸腹部散在红色斑丘疹，压之褪色，1cm×2cm大小，中央色淡，高热时明显。4．患儿即将出院，有关出院医嘱，下列不正确的是（　　）。", "answer": "可发展成慢性心瓣膜病", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "继续休息，定期门诊随访", "B": "阿司匹林疗程需4～6周", "C": "长效青霉素预防，持续5年", "D": "可发展成慢性心瓣膜病", "language": "zh"}
{"question": "女，35岁。支气管哮喘史20年，近2周来出现活动耐力下降。该患者最重要的治疗措施是规律使用（　　）。", "answer": "联合吸入糖皮质激素和长效β2受体激动剂", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "糖皮质激素气雾剂", "B": "长效β2受体激动剂", "C": "短效β2受体激动剂", "D": "联合吸入糖皮质激素和长效β2受体激动剂", "language": "zh"}
{"question": "烧伤达表皮层，按分度法属于（　　）。", "answer": "Ⅰ°", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "Ⅰ°", "B": "浅Ⅱ°", "C": "Ⅲ°", "D": "不在分度内", "language": "zh"}
{"question": "患者女性，31岁。发现颈部无症状的肿块3周。体检：健康女性，体温36.6℃，血压135/70mmHg，脉搏82次/分，呼吸20次/分。未发现突眼征，甲状腺左叶下极可触及3cm×4cm大肿块，表面光滑，质地柔软，随吞咽上下移动。3．检查结果符合结节性甲状腺肿，需手术治疗的原因是（　　）。", "answer": "可能发生癌变", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "D", "A": "可能发生单纯性甲状腺肿", "B": "可能发生甲状腺腺瘤", "C": "可能发生亚急性甲状腺炎", "D": "可能发生癌变", "language": "zh"}
{"question": "不属于思维内容障碍的是（　　）。", "answer": "思维散漫", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "思维散漫", "B": "被洞悉感", "C": "被控制感", "D": "罪恶妄想", "language": "zh"}
{"question": "2．原位癌（　　）。", "answer": "子宫颈癌0期", "meta_info": "病理学", "answer_idx": "A", "A": "子宫颈癌0期", "B": "子宫颈癌Ⅰ期", "C": "子宫颈癌Ⅲ期", "D": "子宫颈癌Ⅳ期", "language": "zh"}
{"question": "2．急性低位小肠梗阻，心率120次/分，血压90/60mmHg，尿少，无口渴，考虑存在（　　）。", "answer": "等渗性缺水", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "B", "A": "低钾血症", "B": "等渗性缺水", "C": "高渗性缺水", "D": "低钙血症", "language": "zh"}
{"question": "下列哪项不属于Ⅰ型超敏反应的特点？（　　）", "answer": "造成组织损伤", "meta_info": "医学免疫学", "answer_idx": "D", "A": "发生速度快", "B": "IgE介导", "C": "有明显的个体差异", "D": "造成组织损伤", "language": "zh"}
{"question": "腹股沟疝查体时，压迫腹股沟管深环的部位是（　　）。", "answer": "腹股沟韧带中点上方2cm", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "耻骨结节外侧2cm", "B": "肿块隆起最明显处", "C": "精索内前方2cm", "D": "腹股沟韧带中点上方2cm", "language": "zh"}
{"question": "1．感觉增强（　　）。", "answer": "是神经衰弱的常见症状", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "是急性精神分裂症的常见症状", "B": "是慢性精神分裂症的常见症状", "C": "是抑郁症的常见症状", "D": "是神经衰弱的常见症状", "language": "zh"}
{"question": "患者从高处跌下已3小时，左腰部受伤疼痛剧烈，血尿。查体BP 80／60mmHg，左腰部触痛明显，腹部压痛，无反跳痛，其治疗方法是（　　）。", "answer": "输血", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "输液抗感染", "B": "卧床休息", "C": "手术治疗", "D": "输血", "language": "zh"}
{"question": "一患儿，腹部剧烈疼痛，伴恶心、呕吐，以急腹症入院。术中见肠套叠，肠管暗红，表面无光泽，该处可见纤维素样物附着，该肠管可能发生的病变是（　　）。", "answer": "肠管梗死", "meta_info": "第3篇　消化系统", "answer_idx": "C", "A": "静脉淤血", "B": "动脉充血", "C": "肠管梗死", "D": "急性肠炎", "language": "zh"}
{"question": "患者，10个月，母乳喂养近1个月，面色渐苍白，不愿活动，食欲差。查体发现肝脏增大，于右肋下可触及3cm，心率124次/分，节律不整，心音尚有力。其肝大的原因最可能是（　　）。", "answer": "骨髓外造血", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "急性肝炎", "B": "心功能不全", "C": "正常现象", "D": "骨髓外造血", "language": "zh"}
{"question": "下列哪项不是风湿性心包炎的表现？（　　）", "answer": "心音增强", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "心前区疼痛", "B": "呼吸困难", "C": "有心包摩擦音", "D": "心音增强", "language": "zh"}
{"question": "2．佝偻病激期（　　）。", "answer": "血清钙、磷降低，长骨干骺端临时钙化带模糊", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "血清钙正常，血磷偏低，碱性磷酸酶增高", "B": "血清钙、磷、碱性磷酸酶均正常，有“O”形腿", "C": "血清钙、磷趋向正常，长骨钙化带重新出现", "D": "血清钙、磷降低，长骨干骺端临时钙化带模糊", "language": "zh"}
{"question": "下列哪项不是影响创伤修复的因素？（　　）", "answer": "贫血", "meta_info": "第八部分　其他疾病", "answer_idx": "D", "A": "低蛋白血症", "B": "铁铜锌等微量元素缺乏", "C": "使用皮质激素", "D": "贫血", "language": "zh"}
{"question": "地高辛治疗心房纤颤的主要作用是（　　）。", "answer": "减慢房室传导", "meta_info": "药理学", "answer_idx": "B", "A": "抑制窦房结", "B": "减慢房室传导", "C": "降低浦肯野纤维的自律性", "D": "直接降低心房的兴奋性", "language": "zh"}
{"question": "32岁男性，体检发现如下结果：HBsAg（+）HBeAg（+）抗-HBc（+），可排除（　　）。", "answer": "接种过疫苗，对乙肝病毒有免疫力", "meta_info": "医学微生物学", "answer_idx": "D", "A": "急性乙型肝炎", "B": "慢性乙型肝炎", "C": "无症状携带者", "D": "接种过疫苗，对乙肝病毒有免疫力", "language": "zh"}
{"question": "婴儿每日水的需要量是（　　）。", "answer": "150ml/kg", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "170ml/kg", "B": "150ml/kg", "C": "100ml/kg", "D": "80ml/kg", "language": "zh"}
{"question": "哪项是脑血栓形成的最常见病因？（　　）", "answer": "脑动脉粥样硬化", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "血压偏低", "B": "脑动脉粥样硬化", "C": "各种脑动脉炎", "D": "高血压", "language": "zh"}
{"question": "判断流感病毒接种鸡胚尿囊腔是否生长，应选择（　　）。", "answer": "血凝试验", "meta_info": "医学微生物学", "answer_idx": "B", "A": "红细胞吸附试验", "B": "血凝试验", "C": "血凝抑制试验", "D": "间接血凝试验", "language": "zh"}
{"question": "1．囊虫病的发生过程中，人是（　　）。", "answer": "猪肉绦虫的中间宿主", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "A", "A": "猪肉绦虫的中间宿主", "B": "牛肉绦虫的中间宿主", "C": "牛肉绦虫的终末宿主", "D": "短膜壳绦虫的终末宿主", "language": "zh"}
{"question": "女，43岁。诊断风湿性心脏瓣膜病20余年。查体：心前区未触及震颤，胸骨左缘第3肋间可闻及舒张期叹气样杂音，心尖部可闻及舒张早中期杂音，S1减弱。最可能的诊断是（　　）。", "answer": "主动脉瓣关闭不全伴二尖瓣相对性狭窄", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "主动脉瓣关闭不全伴二尖瓣器质性狭窄", "B": "主动脉瓣关闭不全伴二尖瓣相对性狭窄", "C": "主动脉瓣器质性狭窄伴二尖瓣器质性狭窄", "D": "主动脉瓣相对性狭窄伴二尖瓣器质性狭窄", "language": "zh"}
{"question": "乳腺钼钯检查以下哪一项不是乳癌征象？（　　）", "answer": "乳腺局部区域3个圆形钙化", "meta_info": "第八部分　其他疾病", "answer_idx": "A", "A": "乳腺局部区域3个圆形钙化", "B": "乳腺高密度毛刺影", "C": "乳腺内泥沙样钙化", "D": "临近高密度影的皮肤增厚凹陷", "language": "zh"}
{"question": "不能用紫外线制备病毒灭活疫苗的原因是（　　）。", "answer": "此种灭活疫苗经可见光照射可复活病毒", "meta_info": "医学微生物学", "answer_idx": "C", "A": "此种灭活的疫苗抗原性弱", "B": "此种灭活疫苗易诱发被接种者癌瘤", "C": "此种灭活疫苗经可见光照射可复活病毒", "D": "此种灭活疫苗接种引起机体副反应大", "language": "zh"}
{"question": "肌肉组织中氨基酸脱氨基作用的主要方式是（　　）。", "answer": "嘌呤核苷酸循环", "meta_info": "生物化学", "answer_idx": "A", "A": "嘌呤核苷酸循环", "B": "转氨基", "C": "L-谷氨酸氧化脱氨基", "D": "转氨基与L-谷氨酸氧化脱氨基", "language": "zh"}
{"question": "引起原发性甲状腺功能减退症的原因是（　　）。", "answer": "以上均是", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "D", "A": "自身免疫性甲状腺炎", "B": "放疗", "C": "遗传因素", "D": "以上均是", "language": "zh"}
{"question": "糖酵解途径的关键酶是（　　）。", "answer": "磷酸果糖激酶-1", "meta_info": "第二部分　模拟试题", "answer_idx": "B", "A": "乳酸脱氢酶", "B": "磷酸果糖激酶-1", "C": "磷酸果糖激酶-2", "D": "3-磷酸甘油醛脱氢酶", "language": "zh"}
{"question": "男，35岁。右上臂外伤6小时。查体：压痛、畸形，伴异常活动，垂腕、最可能的诊断是（　　）。", "answer": "肱骨干骨折合并桡神经损伤", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "肱骨外科颈骨折合并腋神经损伤", "B": "肱骨外科颈骨折合并肌皮神经损伤", "C": "肱骨干骨折合并桡神经损伤", "D": "肱骨干骨折合正中神经损伤", "language": "zh"}
{"question": "米非司酮用于紧急避孕的机制是（　　）。", "answer": "以上都有可能", "meta_info": "第5篇　女性生殖系统", "answer_idx": "D", "A": "抑制排卵", "B": "干扰着床", "C": "影响输卵管正常蠕动", "D": "以上都有可能", "language": "zh"}
{"question": "人既有情绪又有情感，是因为（　　）。", "answer": "人既有生理需要又有社会需要", "meta_info": "医学心理学", "answer_idx": "A", "A": "人既有生理需要又有社会需要", "B": "情绪是情感的外在表现", "C": "情绪冲动性大，情感少冲动", "D": "情绪与情感互不影响", "language": "zh"}
{"question": "大量出汗时尿量减少，主要是由于（　　）。", "answer": "血浆晶体渗透压升高，引起抗利尿激素分泌", "meta_info": "生理学", "answer_idx": "A", "A": "血浆晶体渗透压升高，引起抗利尿激素分泌", "B": "血浆晶体渗透压降低，引起抗利尿激素分泌", "C": "血容量减少，导致肾小球滤过率减少", "D": "血浆胶体渗透压升高，导致肾小球滤过率减少", "language": "zh"}
{"question": "患儿，10岁，右大腿下端疼痛伴高热达39.5℃ 1天，怀疑为急性化脓性骨髓炎。1．体格检查有力的证据是（　　）。", "answer": "右股骨下端（干骺端）深压痛", "meta_info": "第四部分　运动系统疾病", "answer_idx": "B", "A": "右股骨下端肿胀", "B": "右股骨下端（干骺端）深压痛", "C": "右股骨下端皮温升高", "D": "局部血管充盈怒张", "language": "zh"}
{"question": "女，6岁，3岁时发现有室间隔缺损，当时未曾手术治疗，最近来门诊检查时发现有显著的肺动脉高压，在这种情况下主要引起哪一方面的改变？（　　）", "answer": "右心室增大", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "右心房增大", "B": "肺充血显著", "C": "左心房增大", "D": "右心室增大", "language": "zh"}
{"question": "2．免疫应答发生的基地是（　　）。", "answer": "外周免疫器官", "meta_info": "医学免疫学", "answer_idx": "C", "A": "淋巴结", "B": "胸腺", "C": "外周免疫器官", "D": "脾", "language": "zh"}
{"question": "肝硬化病人的腹水形成，主要的原因是（　　）。", "answer": "门静脉压升高", "meta_info": "病理学", "answer_idx": "B", "A": "肝功能障碍", "B": "门静脉压升高", "C": "低蛋白血症", "D": "醛固酮、抗利尿激素增多", "language": "zh"}
{"question": "3．GPT（或GOT）的辅酶是（　　）。", "answer": "磷酸吡哆醛", "meta_info": "生物化学", "answer_idx": "C", "A": "NAD", "B": "FAD", "C": "磷酸吡哆醛", "D": "HS-CoA", "language": "zh"}
{"question": "1．低渗性缺水引起体液容量的变化为（　　）。", "answer": "血浆、组织间液、细胞内液都减少，以组织间液减少为主", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "D", "A": "以血液浓缩为主", "B": "血浆、组织间液、细胞内液都减少，以血浆减少为主", "C": "血浆、组织间液、细胞内液都减少，以细胞内液减少为主", "D": "血浆、组织间液、细胞内液都减少，以组织间液减少为主", "language": "zh"}
{"question": "不属于病人权利内容的是（　　）。", "answer": "遵守医疗部门规章制度", "meta_info": "医学心理学", "answer_idx": "B", "A": "享受医疗服务", "B": "遵守医疗部门规章制度", "C": "保守个人秘密", "D": "免除或部分免除健康时的社会责任", "language": "zh"}
{"question": "外科病人在创伤、手术后蛋白质的日需量是（　　）g/kg。", "answer": "2.0～3.0", "meta_info": "第八部分　其他疾病", "answer_idx": "D", "A": "0.5～0.6", "B": "1.2～1.5", "C": "1.6～2.0", "D": "2.0～3.0", "language": "zh"}
{"question": "心尖搏动点向左下移位常见于（　　）。", "answer": "左心室增大", "meta_info": "第2篇　心血管系统", "answer_idx": "C", "A": "右心房增大", "B": "心包积液", "C": "左心室增大", "D": "左心房增大", "language": "zh"}
{"question": "激活的PKC能磷酸化的氨基酸残基为（　　）。", "answer": "丝氨酸/苏氨酸", "meta_info": "生物化学", "answer_idx": "B", "A": "酪氨酸/丝氨酸", "B": "丝氨酸/苏氨酸", "C": "丝氨酸/组氨酸", "D": "苏氨酸/组氨酸", "language": "zh"}
{"question": "男，72岁。胃大部切除毕Ⅰ式吻合术后6天。有肛门排气后开始进流质物质饮食，进食后腹胀并呕吐，呕吐物中含胆汁。查体：心肺未见明显异常，腹部可见胃型，无蠕动波。腹部X线片示残胃内大量液体潴留。最可能的原因是（　　）。", "answer": "残胃蠕动功能障碍", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "残胃蠕动功能障碍", "B": "吻合口水肿", "C": "近端空肠逆流", "D": "远端空肠梗阻", "language": "zh"}
{"question": "1．医疗机构发现乙类或丙类传染病病人（　　）。", "answer": "应当根据病情采取必要的治疗和控制传播措施", "meta_info": "卫生法规", "answer_idx": "D", "A": "予以隔离治疗，隔离期限根据医学检查结果确定", "B": "确诊前在指定场所单独隔离治疗", "C": "在指定场所进行医学观察和采取其他必要的预防措施", "D": "应当根据病情采取必要的治疗和控制传播措施", "language": "zh"}
{"question": "急性有机磷中毒患者应用阿托品过量引起中毒时，解毒剂是（　　）。", "answer": "毛果芸香碱", "meta_info": "第八部分　其他疾病", "answer_idx": "B", "A": "青霉胺", "B": "毛果芸香碱", "C": "依地酸钠钙", "D": "二巯丙醇", "language": "zh"}
{"question": "前囟的正确测量方法是（　　）。", "answer": "对边中点连线", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "临边中点连线", "B": "邻角顶点连线", "C": "对边中点连线", "D": "对角定点连线", "language": "zh"}
{"question": "肠结核最常见的发病部位是（　　）。", "answer": "回盲部", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "直肠", "B": "乙状结肠", "C": "回盲部", "D": "升结肠", "language": "zh"}
{"question": "HLA分子参与下列哪种细胞的分化过程（　　）。", "answer": "前T细胞分化为成熟T细胞", "meta_info": "医学免疫学", "answer_idx": "D", "A": "造血干细胞分化为淋巴样干细胞", "B": "淋巴样干细胞分化为祖B细胞", "C": "祖T细胞分化为前T细胞", "D": "前T细胞分化为成熟T细胞", "language": "zh"}
{"question": "股骨下1/3骨折后，远折端向后倾斜移位，主要是由于（　　）。", "answer": "腓肠肌的牵拉", "meta_info": "第四部分　运动系统疾病", "answer_idx": "B", "A": "股二头肌的牵拉", "B": "腓肠肌的牵拉", "C": "半腱肌的牵拉", "D": "半膜肌的牵拉", "language": "zh"}
{"question": "血液中生物活性最强的甲状腺激素是（　　）。", "answer": "三碘甲腺原氨酸", "meta_info": "生理学", "answer_idx": "D", "A": "一碘酪氨酸", "B": "碘化酪氨酸", "C": "二碘酪氨酸", "D": "三碘甲腺原氨酸", "language": "zh"}
{"question": "下列各项中不属于佝偻病初期临床表现的是（　　）。", "answer": "惊厥", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "易激惹", "B": "多汗", "C": "枕秃", "D": "惊厥", "language": "zh"}
{"question": "2．卡介苗的初种年龄是（　　）。", "answer": "出生时", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "2个月", "B": "3个月", "C": "出生时", "D": "1岁", "language": "zh"}
{"question": "情绪与情感的区别是（　　）。", "answer": "情感的产生多与社会需要的满足有关", "meta_info": "医学心理学", "answer_idx": "D", "A": "情感冲动性较大", "B": "情感的产生有较大的情境性", "C": "情感表现外露", "D": "情感的产生多与社会需要的满足有关", "language": "zh"}
{"question": "下列哪项不是骨肉瘤的临床特点？（　　）", "answer": "局部压迫症状出现较晚", "meta_info": "第四部分　运动系统疾病", "answer_idx": "B", "A": "常见于股骨下端，胫骨或腓骨上端", "B": "局部压迫症状出现较晚", "C": "X线表现为骨破坏与成骨并存", "D": "多见于年轻人", "language": "zh"}
{"question": "TD-Ag诱发机体免疫反应必须有下列哪组细胞参与?（　　）", "answer": "T淋巴细胞、B淋巴细胞、单核巨噬细胞", "meta_info": "医学免疫学", "answer_idx": "B", "A": "B淋巴细胞和单核巨噬细胞", "B": "T淋巴细胞、B淋巴细胞、单核巨噬细胞", "C": "B淋巴细胞、NK细胞", "D": "T淋巴细胞和单核巨噬细胞", "language": "zh"}
{"question": "成熟B细胞表面不表达的是（　　）。", "answer": "CD2", "meta_info": "医学免疫学", "answer_idx": "D", "A": "MHC-Ⅰ类分子", "B": "MHC-Ⅱ类分子", "C": "CD35", "D": "CD2", "language": "zh"}
{"question": "医疗保健机构必须经县级以上地方人民政府卫生行政许可，才能开始下述哪项母婴保健技术服务？（　　）", "answer": "婚前医学检查、遗传病诊断、产前诊断及施行结扎手术和终止妊娠手术", "meta_info": "卫生法规", "answer_idx": "C", "A": "施行结扎手术和终止妊娠手术", "B": "婚前医学检查、母婴保健指导和计划生育手术", "C": "婚前医学检查、遗传病诊断、产前诊断及施行结扎手术和终止妊娠手术", "D": "婚前医学检查、遗传病诊断、婚前保健、孕产期保健、新生儿保健", "language": "zh"}
{"question": "溶血性链球菌感染后引起风湿热是一种（　　）。", "answer": "结缔组织免疫性炎性病变", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "结缔组织免疫性炎性病变", "B": "结缔组织溶解性病变", "C": "结缔组织弥漫性增生性病变", "D": "结缔组织无菌性坏死性病变", "language": "zh"}
{"question": "高某，男性，63岁，4年前开始，近1年日益加重，不认识女儿，摔废旧物品，出门找不到家，不会穿衣，常呆坐，呆立呆望，不言不语，对人冷淡，不关心家人。既往史：有冶游史。躯体神经系统检查：无异常精神检查，意清，定向障碍，记忆障碍，个位数计算正确，两位数加法常错，夜间不眠，到处摸索，说身边有人唱歌内容听不清，流露出悲观情绪，未见自杀行为，生活不能自理。化验：康华试验阴性，CSF正常，CT示脑萎缩、额颞叶明显。2．关于治疗效果及预后，正确的是（　　）。", "answer": "无有效治疗，预后不良", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "无有效治疗，预后不良", "B": "抗梅毒治疗，预后较好", "C": "手术治疗预后较好", "D": "脑脊液分流手术，预后尚可", "language": "zh"}
{"question": "女，25岁，妊娠10周，5日前出现双眼异物感，逐渐加重，并出现畏光、流泪，及多量粘液性分泌物。诊断为沙眼。下列用药正确的是（　　）。", "answer": "红霉素", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "四环素", "B": "氯霉素", "C": "红霉素", "D": "链霉素", "language": "zh"}
{"question": "血清中常规检测不到的HBV标志物是（　　）。", "answer": "HBeAg", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "HBsAg", "B": "HBeAg", "C": "抗-HBe", "D": "抗-HBc", "language": "zh"}
{"question": "男，3岁，偏食，不吃鱼肉类制品，近1个月来，家长发现其脸色渐苍白，自诉全身无力。查体：心尖部可闻及Ⅳ级收缩期杂音，肝于右肋下可触及3.0cm，脾于肋下可触及边缘。Hb50g/L，RBC2.95×1012/L，MCV74fl，MCH26pg，MCHC30%，考虑为缺铁性贫血。2．铁剂治疗后，Hb恢复正常，还需继续用药多长时间（　　）。", "answer": "2个月左右", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "1个月左右", "B": "1.5个月左右", "C": "2个月左右", "D": "半年左右", "language": "zh"}
{"question": "女，15岁，烦躁、怕热、多汗，体重减轻2个月，查体：BP 120／60mmHg，体型偏瘦，皮肤潮湿，手指震颤，轻微突眼，甲状腺弥漫Ⅰ度肿大，质地软，无触痛，可闻及轻度血管杂音，心率108次/分，经甲状腺功能检查确诊Graves病，首选的治疗是（　　）。", "answer": "丙硫氧嘧啶", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "普萘洛尔", "B": "丙硫氧嘧啶", "C": "核素131I", "D": "甲状腺大部切除", "language": "zh"}
{"question": "胆囊动脉最多来源于（　　）。", "answer": "肝右动脉", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "肝总动脉", "B": "肝固有动脉", "C": "腹腔干", "D": "肝右动脉", "language": "zh"}
{"question": "阵发性睡眠性血红蛋白尿特异性的诊断依据为（　　）。", "answer": "Ham试验（+）", "meta_info": "第二部分　模拟试题", "answer_idx": "C", "A": "Coombs试验（+）", "B": "尿含铁血黄素试验（+）", "C": "Ham试验（+）", "D": "网织红细胞增高", "language": "zh"}
{"question": "下列关于脂肪变性的描述，正确的为（　　）。", "answer": "严重贫血时，心肌乳头肌可呈虎斑状", "meta_info": "病理学", "answer_idx": "C", "A": "磷中毒时，脂肪变性首先累及肝小叶中央的细胞", "B": "肝淤血时，脂肪变性首先累及肝小叶周边的细胞", "C": "严重贫血时，心肌乳头肌可呈虎斑状", "D": "心肌脂肪变性常严重影响心脏功能", "language": "zh"}
{"question": "评价新生儿窒息程度的Apgar评分指标不包括（　　）。", "answer": "体温", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "体温", "B": "心率", "C": "肌张力", "D": "皮肤颜色", "language": "zh"}
{"question": "女性，18岁，1型糖尿病病史3年，因“肺部感染”诱发糖尿病酮症酸中毒。2．抢救该患者时，胰岛素最佳使用方法是（　　）。", "answer": "小剂量胰岛素静脉滴注", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "C", "A": "大剂量胰岛素静脉推注", "B": "大剂量胰岛素皮下注射", "C": "小剂量胰岛素静脉滴注", "D": "小剂量胰岛素静脉推注", "language": "zh"}
{"question": "慢性细菌性痢疾迁延型是指病情迁延不愈，病程至少超过（　　）。", "answer": "60天", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "150天", "B": "60天", "C": "28天", "D": "7天", "language": "zh"}
{"question": "无症状原发型肺结核，治疗选择方案为（　　）。", "answer": "异烟肼+利福平，9～12个月", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "异烟肼+利福平，9～12个月", "B": "异烟肼+乙胺丁醇，6～9个月", "C": "异烟肼+利福平+乙胺丁醇，6～9个月", "D": "异烟肼+利福平+乙胺丁醇，9～12个月", "language": "zh"}
{"question": "2．小剂量阿司匹林预防血栓形成的机制是（　　）。", "answer": "抑制TXA2生成", "meta_info": "药理学", "answer_idx": "A", "A": "抑制TXA2生成", "B": "抑制胆碱酯酶", "C": "激动多巴胺受体", "D": "阻断多巴胺受体", "language": "zh"}
{"question": "女性，54岁，诊断为急性坏疽性阑尾炎伴弥漫性腹膜炙入院，行阑尾切除术，术后第5天腹胀、腹痛，发热，体温39℃，大便4～6/d，呈水样。肛门有下坠感，腹部有轻压痛，未触及肿块。首先应考虑的并发症是（　　）。", "answer": "盆腔脓肿", "meta_info": "第二部分　模拟试题", "answer_idx": "D", "A": "急性肠炎", "B": "阑尾残株炎", "C": "门静脉炎", "D": "盆腔脓肿", "language": "zh"}
{"question": "1．根据抗原受体的类型可将T细胞分为（　　）。", "answer": "αβT细胞和γδT细胞", "meta_info": "医学免疫学", "answer_idx": "A", "A": "αβT细胞和γδT细胞", "B": "CD4+T细胞和CD8+T细胞", "C": "Th0、Thl、Th2和Th3细胞", "D": "初始T细胞和记忆性T细胞", "language": "zh"}
{"question": "下述对戊型肝炎病毒(HEV)的描述，错误的一项是（　　）。", "answer": "基因组是单股负链RNA(-ssRNA)", "meta_info": "医学微生物学", "answer_idx": "B", "A": "为直径27～34nmRNA病毒", "B": "基因组是单股负链RNA(-ssRNA)", "C": "基因组含3个开放性读框(ORF)，其中ORF2和部分ORF3编码的蛋白质具有抗原特异性", "D": "中国HEV株与缅甸株属同一基因型，而与墨西哥株分属不同基因型", "language": "zh"}
{"question": "较少出现精神病性症状的疾病状态是（　　）。", "answer": "兴奋状态", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "强迫状态", "B": "谵妄状态", "C": "妄想状态", "D": "兴奋状态", "language": "zh"}
{"question": "1．真核mRNA3’端特征是（　　）。", "answer": "PolyA尾", "meta_info": "生物化学", "answer_idx": "A", "A": "PolyA尾", "B": "m7GpppNm", "C": "倒L形", "D": "cAMP", "language": "zh"}
{"question": "患者，30岁，11月中旬发病，发热、全身痛、尿少，入院时发病5天。查体可见面部充血，结膜出血，皮下可见瘀点、瘀斑。经化验检查，最后确诊为肾综合征出血热。1．其出血原因中哪一项不正确？（　　）", "answer": "以上都不是", "meta_info": "第八部分　其他疾病", "answer_idx": "D", "A": "血管损伤", "B": "肝素物质增多", "C": "DIC早期", "D": "以上都不是", "language": "zh"}
{"question": "周围性舌下神经麻痹的症状不包括（　　）。", "answer": "一侧麻痹伸舌时舌尖偏向麻痹对侧", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "一侧麻痹伸舌时舌尖偏向麻痹对侧", "B": "一侧麻痹，伸舌时舌尖偏向麻痹侧", "C": "舌肌萎缩及伴有肌束震颤", "D": "电检查有变性的反应", "language": "zh"}
{"question": "手术当日早晨体温＞38.5℃的择期手术患者，首先处理的原则是（　　）。", "answer": "暂停手术", "meta_info": "第八部分　其他疾病", "answer_idx": "B", "A": "予退热药物", "B": "暂停手术", "C": "应用抗生素", "D": "不用特殊处理", "language": "zh"}
{"question": "男性，34岁，建筑工人，一次事故严重外伤，大量出血，血压下降少尿，经抢救低血压和血容量已纠正后，尿量仍很少，为避免肾功衰竭的进展，应给予哪一种药物？（　　）", "answer": "呋塞米", "meta_info": "药理学", "answer_idx": "B", "A": "螺内酯", "B": "呋塞米", "C": "氢氯噻嗪", "D": "卡托普利", "language": "zh"}
{"question": "男，50岁，四肢麻胀、乏力逐渐加重近2年，1个月前不慎滑倒，当即出现四肢活动障碍。查体：神志清楚，头部活动无明显受限，第2肋以下皮肤痛觉减退，四肢不能主动活动，肌张力增高，病理征（+）。X线片示颈4胸1椎体后缘骨质增生，椎间隙变窄。诊断为（　　）。", "answer": "脊髓型颈椎病", "meta_info": "第四部分　运动系统疾病", "answer_idx": "B", "A": "颈椎脱位", "B": "脊髓型颈椎病", "C": "颈椎肿瘤", "D": "颈椎管内肿瘤", "language": "zh"}
{"question": "对医患之间信托关系正确的理解是（　　）。", "answer": "不同于一般陌生人关系", "meta_info": "医学伦理学", "answer_idx": "B", "A": "类似于陌生人关系", "B": "不同于一般陌生人关系", "C": "“父子关系”", "D": "主动-被动关系", "language": "zh"}
{"question": "关于风湿小体的组成成分的描述，错误的是（　　）。", "answer": "泡沫样细胞", "meta_info": "病理学", "answer_idx": "C", "A": "黏液样变性", "B": "枭眼细胞和毛虫样细胞", "C": "泡沫样细胞", "D": "单核细胞和淋巴细胞", "language": "zh"}
{"question": "某一细胞群体杀伤肿瘤细胞的机制为释放溶酶体直接杀伤、ADCC效应、分泌TNF等细胞因子。该细胞是（　　）。", "answer": "Mφ", "meta_info": "医学免疫学", "answer_idx": "A", "A": "Mφ", "B": "LAK", "C": "Tc", "D": "TIL", "language": "zh"}
{"question": "下列血管闭塞最易导致偏瘫的是（　　）。", "answer": "大脑中动脉", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "大脑中动脉", "B": "脊髓前动脉", "C": "小脑下前动脉", "D": "大脑前动脉", "language": "zh"}
{"question": "1．骨关节炎可表现为（　　）。", "answer": "休息痛", "meta_info": "第四部分　运动系统疾病", "answer_idx": "A", "A": "休息痛", "B": "侏儒", "C": "驼背", "D": "高热", "language": "zh"}
{"question": "患儿，女，3岁。自幼活动后气促，平素易患上呼吸道感染及支气管肺炎。体检：体格瘦小，无发绀，双肺呼吸音粗，P2增强，胸骨左缘第2肋间闻及粗糙响亮的连续性机器样杂音，可闻及股动脉枪击音。1．此患儿为以下哪种先心病？（　　）", "answer": "动脉导管未闭", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "房间隔缺损", "B": "肺动脉狭窄", "C": "动脉导管未闭", "D": "法洛四联症", "language": "zh"}
{"question": "男，35岁。骨盆骨折伴后尿道损伤，急性尿潴留，试插尿管失败。最佳的急诊处理办法是（　　）。", "answer": "耻骨上膀胱造瘘", "meta_info": "第4篇　泌尿系统", "answer_idx": "C", "A": "热敷", "B": "针灸", "C": "耻骨上膀胱造瘘", "D": "急诊行尿道断端吻合术", "language": "zh"}
{"question": "男性，27岁，发热、头晕、视物模糊l周。血常规示血红蛋白69g/L，白细胞15×109/L，分类中可见原始细胞。1．对诊断最有价值的检查是（　　）。", "answer": "骨髓细胞化学染色检查", "meta_info": "第一部分　血液系统疾病", "answer_idx": "D", "A": "血涂片碱性磷酸酶染色", "B": "骨髓细胞形态学检查", "C": "骨髓细胞染色体检查", "D": "骨髓细胞化学染色检查", "language": "zh"}
{"question": "一位住在妇产科病房的病人，手术后腹胀，哭闹着要找科主任来给她看一看。科主任来后，经仔细查看，发现患者只是心理上有些问题，于是说了一些安慰她的话，病人便安静下来了，还有说有笑。有同事见了不以为然地说，这也值得主任来管?科主任莞尔一笑，说：“难道当主任的就非得看什么大病吗?”“有些劳动是平凡的，好像毋须一顾，但是，它的精神是神圣的，一个人没有这种神圣的感觉，他就不会每件事都那么仔细、耐心地去做。”这充分体现了（　　）。", "answer": "现代医学观、公正原则、正直美德", "meta_info": "医学伦理学", "answer_idx": "B", "A": "现代医学观、不伤害原则、同情美德", "B": "现代医学观、公正原则、正直美德", "C": "传统医学观、公正原则、正直美德", "D": "以上都不是", "language": "zh"}
{"question": "1．减少左旋多巴不良反应并增加其疗效的药物是（　　）。", "answer": "卡比多巴", "meta_info": "药理学", "answer_idx": "C", "A": "苯巴比妥", "B": "乙琥胺", "C": "卡比多巴", "D": "维生素B6", "language": "zh"}
{"question": "下述哪项能增加左旋多巴疗效，减少不良反应？（　　）", "answer": "卡比多巴", "meta_info": "药理学", "answer_idx": "A", "A": "卡比多巴", "B": "利血平", "C": "维生素B6", "D": "苯乙肼", "language": "zh"}
{"question": "确定患者重型颅脑损伤深昏迷最有价值的体征是（　　）。", "answer": "深浅反射消失", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "肠鸣音消失", "B": "三凹征阳性", "C": "深浅反射消失", "D": "呼之不应", "language": "zh"}
{"question": "小肠是吸收的主要部位，主要与其结构的哪项特点有关?（　　）", "answer": "面积大", "meta_info": "生理学", "answer_idx": "C", "A": "壁厚", "B": "长度长", "C": "面积大", "D": "通透性大", "language": "zh"}
{"question": "男，62岁。间隔咳嗽、咳痰10余年，喘息5年，加重3天入院。吸烟41年，30支/日，已戒5年。查体：烦躁，球结膜充血、水肿，口唇发绀。桶状胸，双肺呼吸音低，右下肺可闻及少许湿性啰音，肝肋下5cm，肝颈静脉回流征（＋），双下肢水肿。血K＋ 4.5mmol/L。Na＋ 129mmol/L，Cl－ 90mmol/L。2．该患者目前最重要的治疗措施为（　　）。", "answer": "无创通气", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "静脉滴注支链氨基酸", "B": "无创通气", "C": "利尿", "D": "纠正电解质紊乱", "language": "zh"}
{"question": "男，53岁。上腹胀痛10余年，多于饭后约30分钟加重。半年来上腹痛加重，伴反酸，间断呕吐胃内容物。吸烟15年饮白酒10年，每日约半斤。患者的病变最可能位于（　　）。", "answer": "胃窦", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "胃窦", "B": "胃体", "C": "贲门", "D": "胃底", "language": "zh"}
{"question": "女性，35岁，诊甲亢后即行甲状腺次全切手术，术后病人出现高热，心率160次/分，烦躁不安，大汗淋漓，腹泻，应首先考虑的诊断是（　　）。", "answer": "甲亢危象", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "B", "A": "甲亢术后感染", "B": "甲亢危象", "C": "甲亢危象前期", "D": "甲亢术后感染性腹泻", "language": "zh"}
{"question": "传染病的诊断与普通疾病的不同点是（　　）。", "answer": "仔细了解流行病学资料", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "B", "A": "细做体检", "B": "仔细了解流行病学资料", "C": "做血常规检查", "D": "必要时做影像医学检查", "language": "zh"}
{"question": "关于慢性肾盂肾炎的描述，正确的是（　　）。", "answer": "间质化脓性炎", "meta_info": "病理学", "answer_idx": "A", "A": "间质化脓性炎", "B": "肾周围组织不受累", "C": "不引起肾功能不全", "D": "血源性感染占多数", "language": "zh"}
{"question": "不属于病毒复制周期的为（　　）。", "answer": "扩散", "meta_info": "医学微生物学", "answer_idx": "C", "A": "脱壳", "B": "吸附与穿入", "C": "扩散", "D": "装配与释放", "language": "zh"}
{"question": "营养不良患儿应用苯丙酸诺龙的主要作用是（　　）。", "answer": "促进蛋白质合成", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "促进消化功能", "B": "促进食欲", "C": "促进蛋白质合成", "D": "增强机体免疫功能", "language": "zh"}
{"question": "单核吞噬细胞系统不含（　　）。", "answer": "中性粒细胞", "meta_info": "医学微生物学", "answer_idx": "B", "A": "单核细胞", "B": "中性粒细胞", "C": "尘细胞", "D": "脑内小胶质细胞", "language": "zh"}
{"question": "双香豆素的抗凝血机制是（　　）。", "answer": "影响凝血因子Ⅱ、Ⅶ、Ⅸ、X的合成", "meta_info": "药理学", "answer_idx": "B", "A": "加速AT Ⅲ对凝血因子的灭活作用", "B": "影响凝血因子Ⅱ、Ⅶ、Ⅸ、X的合成", "C": "能对抗凝血因子II a、Ⅶa、IXa、Xa的作用", "D": "激活纤溶酶", "language": "zh"}
{"question": "下列均为引起缺氧性肺血管收缩的体液因素，除了（　　）。", "answer": "一氧化氮生成增加", "meta_info": "第1篇　呼吸系统", "answer_idx": "D", "A": "前列腺素增加", "B": "血栓素增加", "C": "内皮素释放增加", "D": "一氧化氮生成增加", "language": "zh"}
{"question": "女，24岁。足月妊娠临产10小时，宫口扩张2cm，自觉下腹部持续疼痛，孕妇烦躁不安，疼痛喊叫，宫缩频率高，子宫下段收缩最强。3．此时应首选的措施是（　　）。", "answer": "肌注哌替啶", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "静滴缩宫素", "B": "行剖宫产", "C": "肌注哌替啶", "D": "无需任何处理", "language": "zh"}
{"question": "患儿，4岁，消瘦，活动后有气急、心悸，查体：时于胸骨左缘第2肋间听到粗糙而响亮的连续性机器杂音，初步诊断为动脉导管未闭。该畸形首先可以引起下列哪一方面的改变？（　　）", "answer": "肺动脉扩张", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "右心室增大", "B": "肺动脉扩张", "C": "左心室增大", "D": "右心房增大", "language": "zh"}
{"question": "小儿出生后各系统、器官的生长发育不平衡，呈现先快后慢的是（　　）。", "answer": "神经系统", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "免疫系统", "B": "消化系统", "C": "生殖系统", "D": "神经系统", "language": "zh"}
{"question": "最易发生抗原变异的病毒是（　　）。", "answer": "流行性感冒病毒", "meta_info": "医学微生物学", "answer_idx": "B", "A": "狂犬病毒", "B": "流行性感冒病毒", "C": "冠状病毒", "D": "乙型肝炎病毒", "language": "zh"}
{"question": "1．加入局麻药液中延长其作用时间的是（　　）。", "answer": "肾上腺素", "meta_info": "药理学", "answer_idx": "A", "A": "肾上腺素", "B": "去甲肾上腺素", "C": "多巴胺", "D": "麻黄碱", "language": "zh"}
{"question": "人的心理实质是（　　）。", "answer": "脑的机能", "meta_info": "医学心理学", "answer_idx": "B", "A": "心脏的功能", "B": "脑的机能", "C": "个性的反映", "D": "对事物整体属性的反映", "language": "zh"}
{"question": "各级卫生行政部门应当（　　）。", "answer": "对妇幼保健机构进行执业登记、注册、校验和监督工作", "meta_info": "卫生法规", "answer_idx": "C", "A": "设立母婴保健执法监督机构", "B": "做好妇幼保健机构的规划设置", "C": "对妇幼保健机构进行执业登记、注册、校验和监督工作", "D": "允许婚前保健服务机构设在乡级以上医疗、保健机构中", "language": "zh"}
{"question": "男性，42岁，因心慌、胸闷5天入院，心电图显示频发性室性早搏，宜选用哪一种抗心律失常药？（　　）", "answer": "胺碘酮", "meta_info": "药理学", "answer_idx": "A", "A": "胺碘酮", "B": "奎尼丁", "C": "美西律", "D": "普罗帕酮", "language": "zh"}
{"question": "患儿5岁，半年来全身逐渐浮肿，食欲减退，有时恶心、呕吐。化验：尿蛋白+++，尿少，血浆蛋白减少为15g/L，血胆固醇升高为13mmol/L。此患者临床表现为（　　）。", "answer": "肾病综合征", "meta_info": "病理学", "answer_idx": "B", "A": "急性肾炎综合征", "B": "肾病综合征", "C": "慢性肾炎综合征", "D": "肺出血肾炎综合征", "language": "zh"}
{"question": "治疗三叉神经痛首选（　　）。", "answer": "卡马西平", "meta_info": "药理学", "answer_idx": "C", "A": "扑米酮", "B": "苯妥英钠", "C": "卡马西平", "D": "阿司匹林", "language": "zh"}
{"question": "关于糖异生生理意义的叙述，错误的是（　　）。", "answer": "促进肌糖原的生成", "meta_info": "生物化学", "answer_idx": "C", "A": "促进甘油的代谢", "B": "补充血液葡萄糖", "C": "促进肌糖原的生成", "D": "防止乳酸中毒", "language": "zh"}
{"question": "男，36岁，5d前发热、咽疼，应用抗生素治疗无效。颈部浅表淋巴结肿大，咽部充血，扁桃体Ⅱ度肿大，下肢少许瘀斑。白细胞16.6×109/L，原始细胞0.60，血红蛋白80g/L，血小板34×109/L。2．下列哪项为体检中应特别注意的体征？（　　）", "answer": "浅表淋巴结肿大", "meta_info": "第一部分　血液系统疾病", "answer_idx": "B", "A": "睑结膜苍白", "B": "浅表淋巴结肿大", "C": "皮肤出血点", "D": "心脏杂音", "language": "zh"}
{"question": "下列原有疾病基础上遭受急性损害后不易发生MODS的是（　　）。", "answer": "风湿性关节炎", "meta_info": "第1篇　呼吸系统", "answer_idx": "A", "A": "风湿性关节炎", "B": "心肌梗死", "C": "肝硬化", "D": "慢性肾小球肾炎", "language": "zh"}
{"question": "女性，35岁，经产妇，乳头溢液污染内衣1年余，暗棕色，乳腺未触及肿块，诊断可能为（　　）。", "answer": "乳管内乳头状瘤", "meta_info": "第八部分　其他疾病", "answer_idx": "B", "A": "急性乳房炎", "B": "乳管内乳头状瘤", "C": "乳房纤维腺瘤", "D": "乳房肉瘤", "language": "zh"}
{"question": "2．渗出性结核性胸膜炎属于（　　）。", "answer": "浆液性炎症", "meta_info": "病理学", "answer_idx": "B", "A": "变质性炎症", "B": "浆液性炎症", "C": "纤维素性炎症", "D": "化脓性炎症", "language": "zh"}
{"question": "丹毒的致病菌是（　　）。", "answer": "厌氧性链球菌", "meta_info": "第八部分　其他疾病", "answer_idx": "A", "A": "厌氧性链球菌", "B": "变形杆菌", "C": "大肠杆菌", "D": "梭状芽孢杆菌", "language": "zh"}
{"question": "患者，男，31岁。近半年来反复心悸、胸痛、劳力性呼吸困难，时有头晕或短暂神志丧失。体检发现：心脏轻度增大，心尖部有2级收缩期杂音和第四心音，胸骨左缘第3～4肋间闻及较粗糙的喷射性收缩期杂音。2．最有价值的诊断方法是（　　）。", "answer": "超声心动图", "meta_info": "第2篇　心血管系统", "answer_idx": "C", "A": "胸部X线摄片", "B": "心电图", "C": "超声心动图", "D": "PET", "language": "zh"}
{"question": "1．体征以喘鸣音为主的肺炎是（　　）。", "answer": "呼吸道合胞病毒肺炎", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "呼吸道合胞病毒肺炎", "B": "葡萄球菌肺炎", "C": "革兰阴性杆菌肺炎", "D": "腺病毒肺炎", "language": "zh"}
{"question": "下列哪项为确诊CO中毒最主要的依据?（　　）", "answer": "血液中碳氧血红蛋白的有无", "meta_info": "第八部分　其他疾病", "answer_idx": "C", "A": "与CO接触的时间", "B": "空气中CO的浓度", "C": "血液中碳氧血红蛋白的有无", "D": "昏迷的深度", "language": "zh"}
{"question": "嘌呤环中的N7来源于（　　）。", "answer": "Gly", "meta_info": "生物化学", "answer_idx": "D", "A": "Asp", "B": "Ala", "C": "Gln", "D": "Gly", "language": "zh"}
{"question": "急性血源性骨髓炎最常见的致病菌是（　　）。", "answer": "金黄色葡萄球菌", "meta_info": "第四部分　运动系统疾病", "answer_idx": "B", "A": "白色葡萄球菌", "B": "金黄色葡萄球菌", "C": "大肠杆菌", "D": "肺炎链球菌", "language": "zh"}
{"question": "一女性，55岁，丧偶8年，现独居，嗜烟酒，不爱运动。平时性情抑郁，过分容忍，办事无主见，常顺从于别人。1月前行胃癌切除，术中及术后情绪低落，兴趣下降，独自流泪，有轻生之念。4．对这种病人临床上应采取的措施为（　　）。", "answer": "以上都是", "meta_info": "医学心理学", "answer_idx": "D", "A": "认知疗法", "B": "精神分析疗法", "C": "药物治疗", "D": "以上都是", "language": "zh"}
{"question": "对于大叶性肺炎，下述哪一项是错误的？（　　）", "answer": "造成整个大叶破坏", "meta_info": "病理学", "answer_idx": "B", "A": "纤维素性炎", "B": "造成整个大叶破坏", "C": "主要是由肺炎链球菌引起", "D": "多见于青壮年", "language": "zh"}
{"question": "乳癌最早的临床表现为（　　）。", "answer": "乳房单发小肿块", "meta_info": "第八部分　其他疾病", "answer_idx": "C", "A": "乳房疼痛", "B": "乳房多发肿块", "C": "乳房单发小肿块", "D": "乳头内陷", "language": "zh"}
{"question": "地高辛治疗心房颤动的主要作用是（　　）。", "answer": "减慢房室传导", "meta_info": "药理学", "answer_idx": "C", "A": "直接降低心房的兴奋性", "B": "降低浦肯野纤维的自律性", "C": "减慢房室传导", "D": "缩短心房有效不应期", "language": "zh"}
{"question": "下列不属于突发公共事件的是（　　）。", "answer": "重大交通事故", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "自然灾害", "B": "恐怖袭击事件", "C": "森林火灾", "D": "重大交通事故", "language": "zh"}
{"question": "2．胎心率减速与宫缩无固定关系，下降迅速且下降幅度大。恢复也迅速，临床提示的情况是（　　）。", "answer": "宫缩时脐带受压，兴奋迷走神经", "meta_info": "第5篇　女性生殖系统", "answer_idx": "C", "A": "宫缩时胎头受压", "B": "胎儿受镇静药物的影响", "C": "宫缩时脐带受压，兴奋迷走神经", "D": "胎儿状况良好", "language": "zh"}
{"question": "原发性肝癌最多见的淋巴转移的部位是（　　）。", "answer": "肝门", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "肝门", "B": "腹膜后", "C": "腹主动脉旁", "D": "锁骨上", "language": "zh"}
{"question": "肠上皮化生的概念是（　　）。", "answer": "胃黏膜上皮转变为肠黏膜上皮", "meta_info": "病理学", "answer_idx": "A", "A": "胃黏膜上皮转变为肠黏膜上皮", "B": "原来无上皮的部位出现肠黏膜上皮", "C": "肠黏膜上皮细胞转变为胃黏膜上皮", "D": "呼吸道黏膜上皮转变为肠黏膜上皮", "language": "zh"}
{"question": "结核属于（　　）。", "answer": "Ⅳ型超敏反应", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "Ⅰ型超敏反应", "B": "Ⅲ型超敏反应", "C": "Ⅳ型超敏反应", "D": "Ⅴ型超敏反应", "language": "zh"}
{"question": "男性，26岁，突然出现从一侧手指开始的抽动，向腕部、臂、肩部及半身扩展。诊断最可能是（　　）。", "answer": "Jackson癫痫", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "全面性强直-阵挛发作", "B": "精神运动性发作", "C": "Jackson癫痫", "D": "部分性感觉性发作", "language": "zh"}
{"question": "肝性脑病最有意义的体征是（　　）。", "answer": "扑翼样震颤", "meta_info": "第3篇　消化系统", "answer_idx": "D", "A": "头晕", "B": "踝阵挛阳性", "C": "巴宾斯基征阳性", "D": "扑翼样震颤", "language": "zh"}
{"question": "当C5～T2脊髓前联合受损时，可有以下哪种表现？（　　）", "answer": "双上肢痛温觉减退或缺失。触觉及深感觉保留", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "双上肢痛温觉及触觉障碍，深感觉保留", "B": "双上肢痛温觉减退或缺失。触觉及深感觉保留", "C": "双上肢及上胸部痛温觉减退或缺失，触觉及深感觉保留", "D": "双上肢深、浅感觉均减退或缺失", "language": "zh"}
{"question": "预防急性肾功能衰竭应选用的是（　　）。", "answer": "甘露醇", "meta_info": "药理学", "answer_idx": "D", "A": "呋噻米", "B": "氢氯噻嗪", "C": "氨苯蝶啶", "D": "甘露醇", "language": "zh"}
{"question": "胎心变化中，不能诊断胎儿窘迫的是（　　）。", "answer": "胎心早期减速", "meta_info": "第5篇　女性生殖系统", "answer_idx": "B", "A": "胎心率＜120次/分", "B": "胎心早期减速", "C": "胎心晚期减速", "D": "胎心变异减速", "language": "zh"}
{"question": "1．给高热患者用冰帽降温是通过增加（　　）。", "answer": "传导散热", "meta_info": "生理学", "answer_idx": "B", "A": "发汗", "B": "传导散热", "C": "对流散热", "D": "辐射散热", "language": "zh"}
{"question": "男，45岁。发热3天，少尿1天，于12月15日入院。查体：BP 60／30mmHg，神志清，球结膜充血、水肿，双下肢有出血点。实验室检查：血WBC 25×109/L。PLT 50×109/L，尿蛋白（＋＋＋）。1．最可能的诊断是（　　）。", "answer": "肾综合征出血热", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "立克次体病", "B": "流行性感冒", "C": "钩端螺旋体病", "D": "肾综合征出血热", "language": "zh"}
{"question": "下列哪两个既有区别又密切联系的方面属于人的心理现象？（　　）", "answer": "心理过程和人格", "meta_info": "医学心理学", "answer_idx": "C", "A": "认识过程和人格", "B": "认识过程和意志过程", "C": "心理过程和人格", "D": "情感过程和意志过程", "language": "zh"}
{"question": "硫脲类药物的作用机制是（　　）。", "answer": "抑制甲状腺激素的生物合成", "meta_info": "药理学", "answer_idx": "A", "A": "抑制甲状腺激素的生物合成", "B": "抑制甲状腺组织摄取碘", "C": "抑制甲状腺激素的释放", "D": "降解已合成的甲状腺激素", "language": "zh"}
{"question": "一次多量空气进入静脉可引起猝死，最低进入空气量约为（　　）。", "answer": "100ml", "meta_info": "病理学", "answer_idx": "D", "A": "1ml", "B": "10ml", "C": "50ml", "D": "100ml", "language": "zh"}
{"question": "1．考核发证必须由省、自治区、直辖市卫生行政部门负责（　　）。", "answer": "婚前医学检查", "meta_info": "卫生法规", "answer_idx": "A", "A": "婚前医学检查", "B": "遗传病诊断", "C": "终止妊娠", "D": "孕产期保健服务", "language": "zh"}
{"question": "女，52岁，1小时前呕血1000mL。既往史：HBsAg（＋）20年，冠心病史10年，近期有心绞痛发作。不宜应用的药物是（　　）。", "answer": "血管加压素", "meta_info": "第3篇　消化系统", "answer_idx": "A", "A": "血管加压素", "B": "支链氨基酸", "C": "奥美拉唑", "D": "法莫替丁", "language": "zh"}
{"question": "在线粒体中进行的代谢过程是（　　）。", "answer": "氧化磷酸化", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "脂肪酸合成", "B": "糖酵解", "C": "糖原合成", "D": "氧化磷酸化", "language": "zh"}
{"question": "1．瞳孔对光反射中枢位于（　　）。", "answer": "中脑", "meta_info": "生理学", "answer_idx": "C", "A": "脊髓", "B": "延髓", "C": "中脑", "D": "下丘脑", "language": "zh"}
{"question": "患者15岁，于3年前开始有发作性意识丧失，全身抽搐，持续5～6分钟恢复，发作当时面色青紫，有时伴尿失禁、舌咬伤，有时夜间睡眠中发作。体检及各项检查均正常。患者叔父有与患者相同的病史，该病人应诊断为（　　）。", "answer": "特发性全面强直-阵挛发作", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "特发性失神发作", "B": "癔病", "C": "特发性全面强直-阵挛发作", "D": "症状性全面强直-阵挛发作", "language": "zh"}
{"question": "16岁女性，骑自行车时与三轮车相撞，自觉外阴疼痛难忍并肿胀。根据女性外阴解剖学特点，可能发生的是（　　）。", "answer": "大阴唇血肿", "meta_info": "第5篇　女性生殖系统", "answer_idx": "C", "A": "处女膜破裂", "B": "小阴唇裂伤", "C": "大阴唇血肿", "D": "前庭大腺肿大伴出血", "language": "zh"}
{"question": "1岁患儿，生后1个月时因患肺炎于外院诊断为先天性心脏病，共患肺炎3次。查体：生长发育差，心尖搏动弥散，胸骨左缘第三、四肋间可闻及Ⅲ～Ⅳ级粗糙的全收缩期杂音，传导广泛，有震颤，P2亢进。3．此患儿P2亢进表示（　　）。", "answer": "肺动脉压增高", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "左向右分流量大", "B": "右心室肥厚", "C": "心力衰竭", "D": "肺动脉压增高", "language": "zh"}
{"question": "下列切口不宜放置纱条引流的是（　　）。", "answer": "乳腺癌改良根治术", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "腹壁切口感染", "B": "脓性指头炎切开", "C": "掌中间隙脓肿切开", "D": "乳腺癌改良根治术", "language": "zh"}
{"question": "下列关于冠脉血流量的叙述，错误的是（　　）。", "answer": "在心肌收缩加强时增多", "meta_info": "生理学", "answer_idx": "A", "A": "在心肌收缩加强时增多", "B": "占心输出量的4%～5%", "C": "动脉舒张压升高时增多", "D": "与心肌代谢水平成正比", "language": "zh"}
{"question": "3．注销注册、收回医师执业证书（　　）。", "answer": "受刑事处罚的", "meta_info": "卫生法规", "answer_idx": "C", "A": "造成医疗责任事故、情节严重的", "B": "隐匿、伪造或者擅自销毁医学文书，构成犯罪的", "C": "受刑事处罚的", "D": "考核不合格的医师", "language": "zh"}
{"question": "1．胆总管泥沙样结石伴远端狭窄宜选择的术式是（　　）。", "answer": "胆总管切开，胆总管空肠Y型吻合术", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "胆总管切开，T管引流术", "B": "肝内胆管空肠吻合术", "C": "胆总管切开，胆总管空肠Y型吻合术", "D": "胆囊造瘘术", "language": "zh"}
{"question": "26岁已婚女性，停经6周，少量阴道流血2天，突感下腹坠痛及肛门坠胀感，伴头晕呕吐半天。查体：面色苍白，血压90/60mmHg，右下腹压痛、反跳痛、腹肌紧张。妇科检查：阴道少量血性物，宫颈举痛（＋），后穹隆饱满，子宫稍大，附件区触诊不满意。3．确诊后，正确处理措施为（　　）。", "answer": "输血同时手术探查", "meta_info": "第5篇　女性生殖系统", "answer_idx": "B", "A": "静脉输液", "B": "输血同时手术探查", "C": "雌激素治疗", "D": "应用抗生素", "language": "zh"}
{"question": "致病性大肠杆菌致病特点是（　　）。", "answer": "内外毒素同时致病", "meta_info": "医学微生物学", "answer_idx": "C", "A": "只引起肠道感染", "B": "不引起泌尿生殖器感染", "C": "内外毒素同时致病", "D": "不引起败血症", "language": "zh"}
{"question": "男，40岁，推销员，自述半小时前又突然感到气紧，胸闷，心悸，头晕，出汗，认为生命垂危，被送来急诊。近2月来，这种情况发生过3次，每次持续约0.5～1小时，发病间隙期一切正常，发病与饮食无关。2．最有助于鉴别诊断的项目是（　　）。", "answer": "心电图检查", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "追问起病诱因", "B": "血钾测定", "C": "心电图检查", "D": "脑电图检查", "language": "zh"}
{"question": "女性，40岁，患糖尿病1年，身高156cm，体重为70kg，无酮症，空腹血糖7.8mmol/L，最佳治疗方案是（　　）。", "answer": "适当运动+饮食运动", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "B", "A": "饮食疗法+胰岛素", "B": "适当运动+饮食运动", "C": "卧床休息+饮食治疗", "D": "格列本脲+饮食治疗", "language": "zh"}
{"question": "下列激素与水盐代谢无关的是（　　）。", "answer": "胰岛素", "meta_info": "生理学", "answer_idx": "A", "A": "胰岛素", "B": "抗利尿激素", "C": "醛固酮", "D": "雌激素", "language": "zh"}
{"question": "女，65岁，因抑郁症入院，米帕明100mgbid治疗，近来头痛，视物模糊、复视、眼压高，诊断为药源性青光眼，原因可能是合并应用了下述哪种药物所致？（　　）", "answer": "苯海索", "meta_info": "药理学", "answer_idx": "B", "A": "地西泮", "B": "苯海索", "C": "可待因", "D": "阿司匹林", "language": "zh"}
{"question": "下列哪项为我国医德发展史上最早系统论述医德规范的名篇?（　　）", "answer": "《黄帝内经》", "meta_info": "医学伦理学", "answer_idx": "A", "A": "《黄帝内经》", "B": "《伤寒论》", "C": "《医家五戒十要》", "D": "《大医精诚论》", "language": "zh"}
{"question": "面部“危险三角区”疖的危险性在于（　　）。", "answer": "引起海绵状静脉窦炎", "meta_info": "第八部分　其他疾病", "answer_idx": "C", "A": "容易引起眼球后感染", "B": "抗生素治疗无效", "C": "引起海绵状静脉窦炎", "D": "容易形成痈", "language": "zh"}
{"question": "女，25岁，初产妇。孕50天，行人工流产术，术中出现心率50次/分，BP 80／50mmHg，面色苍白，呕吐，应考虑为（　　）。", "answer": "人工流产综合反应", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "子宫穿孔", "B": "吸宫不全", "C": "羊水栓塞", "D": "人工流产综合反应", "language": "zh"}
{"question": "男，65岁。间断腹胀、上腹隐痛25年。胃镜检查提示：胃体黏膜变薄，血管透见，皱襞稀疏。患者可能缺乏的维生素是（　　）。", "answer": "维生紊B12", "meta_info": "第3篇　消化系统", "answer_idx": "B", "A": "维生素B4", "B": "维生紊B12", "C": "维生素B2", "D": "维生素D", "language": "zh"}
{"question": "女性，29岁，已婚，近3周来无明显诱因出现情绪低落，晨重夕轻，兴趣缺乏，精力减弱，青语减少，动作迟缓，自觉前途暗淡，悲观失望，早醒，食欲，性欲减退，自罪自责，多次自杀未遂。该患者应诊断为（　　）。", "answer": "抑郁症", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "神经衰弱", "B": "反应性精神障碍", "C": "抑郁症", "D": "恶劣心境", "language": "zh"}
{"question": "关于手外伤清创术的处理原则，下列选项不正确的是（　　）。", "answer": "软组织缺损较大有骨外露时，最好用游离植皮术", "meta_info": "第四部分　运动系统疾病", "answer_idx": "D", "A": "最好在气囊止血带下进行", "B": "不能在有张力的情况下，勉强缝合伤口", "C": "创口方向纵行越过关节或与指蹼边缘平行时，应采用“Z”字成形术", "D": "软组织缺损较大有骨外露时，最好用游离植皮术", "language": "zh"}
{"question": "pH对酶促反应的影响是（　　）。", "answer": "能改变酶分子中一些必需基团的解离状态", "meta_info": "生物化学", "answer_idx": "B", "A": "能使酶促反应的平衡常数增大", "B": "能改变酶分子中一些必需基团的解离状态", "C": "大多数酶具有相同的最适pH", "D": "大多数酶的最适pH远离中性", "language": "zh"}
{"question": "关于记忆的理解，不正确的是（　　）。", "answer": "对识记的事物不能再认或回忆，只有通过重新学习才能再认或回忆的现象是暂时性遗忘", "meta_info": "医学心理学", "answer_idx": "C", "A": "是一种很重要的心理过程，贯穿在人的各种心理活动之中", "B": "包括识记、保持、再认和回忆三个基本环节", "C": "对识记的事物不能再认或回忆，只有通过重新学习才能再认或回忆的现象是暂时性遗忘", "D": "直观的、形象的、有意义的材料比抽象的、枯燥的材料识记效果好", "language": "zh"}
{"question": "链球菌感染后急性肾小球肾炎最常见的临床表现是（　　）。", "answer": "镜下血尿", "meta_info": "第4篇　泌尿系统", "answer_idx": "B", "A": "肉眼血尿", "B": "镜下血尿", "C": "高血压", "D": "结石", "language": "zh"}
{"question": "1．上述哪项引起闭眼困难？（　　）", "answer": "面神经损害", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "动眼神经损害", "B": "三叉神经损害", "C": "面神经损害", "D": "舌下神经损害", "language": "zh"}
{"question": "男性，58岁，渐发性双上肢震颤、活动不利半年。既往体健，无慢性疾病史。头颅MRl无异常发现。查体：面部表情呆滞，四肢肌张力增高，齿轮样，双上肢向前平伸时可见4或5次/分钟震颤，双手指鼻试验正常。1．体检时不可能发现的体征是（　　）。", "answer": "“开—关”现象", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "路林手现象", "B": "写字过小征", "C": "齿轮样强直", "D": "“开—关”现象", "language": "zh"}
{"question": "2．治疗慢性肾小球肾炎，可引起高血钾的药物是（　　）。", "answer": "ACEI类", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "β受体阻滞剂", "B": "呋塞米", "C": "ACEI类", "D": "α受体阻滞剂", "language": "zh"}
{"question": "3．肾综合征出血热少尿期，肺感染治疗首选药物（　　）。", "answer": "头孢类", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "A", "A": "头孢类", "B": "大环内酯类", "C": "氨基糖苷类", "D": "喹诺酮类", "language": "zh"}
{"question": "《医疗事故处理办法》中所称的医疗事故是指在诊疗护理工作中（　　）。", "answer": "因医务人员诊疗护理过失，直接造成病员死亡、残废、组织器官损伤导致功能障碍", "meta_info": "卫生法规", "answer_idx": "C", "A": "因医务人员直接造成病员死亡、残废、组织器官损伤导致功能障碍", "B": "因医务人员诊疗护理过失，直接造成病员死亡、残废、功能障碍", "C": "因医务人员诊疗护理过失，直接造成病员死亡、残废、组织器官损伤导致功能障碍", "D": "因医务人员诊疗护理过失，直接造成病员的危害后果", "language": "zh"}
{"question": "男，25岁，平素健康。淋雨后，突发寒战、高热、头痛。第3天出现右侧胸痛、咳嗽、咳痰，胸片示右上肺大片实变影。1．体检不会出现的体征是（　　）。", "answer": "气管向左侧偏移", "meta_info": "第1篇　呼吸系统", "answer_idx": "C", "A": "右上肺语颤增强", "B": "右上肺叩诊浊音", "C": "气管向左侧偏移", "D": "急性病容", "language": "zh"}
{"question": "1周岁时体重增长平均值大约是（　　）。", "answer": "9kg", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "8kg", "B": "9kg", "C": "10kg", "D": "15kg", "language": "zh"}
{"question": "白色血栓形成的主要成分是（　　）。", "answer": "血小板", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "纤维素", "B": "中性粒细胞", "C": "血小板", "D": "单核细胞", "language": "zh"}
{"question": "社区获得性肺炎最常见的致病菌是（　　）。", "answer": "肺炎链球菌", "meta_info": "第1篇　呼吸系统", "answer_idx": "D", "A": "流感嗜血杆菌", "B": "肺炎支原体", "C": "嗜肺军团菌", "D": "肺炎链球菌", "language": "zh"}
{"question": "某一细胞因子在淋巴细胞识别Ag时作为第二信使，使T细胞活化成为有效应的细胞参与免疫应答。该细胞因子是（　　）。", "answer": "IL-1", "meta_info": "医学免疫学", "answer_idx": "A", "A": "IL-1", "B": "IL-4", "C": "IL-10", "D": "IL-12", "language": "zh"}
{"question": "1．能体现人体实验知情同意的为（　　）。", "answer": "弱势人群若参加实验，需要监护人的签字", "meta_info": "医学伦理学", "answer_idx": "D", "A": "以健康人或患者作为受试对象", "B": "实验时使用对照和双盲法", "C": "实验中受试者得到专家的允许后可自由决定是否退出", "D": "弱势人群若参加实验，需要监护人的签字", "language": "zh"}
{"question": "患儿，4个月，冬季出生。生后牛乳喂养，突发四肢抽搐，面肌颤动，两眼上翻，持续数秒至数分钟后自然缓解，1天来发作4～5次，每次缓解后一切活动正常。1．最可能的诊断是（　　）。", "answer": "维生素D缺乏性手足搐搦症", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "癫痫", "B": "低血糖", "C": "化脓性脑膜炎", "D": "维生素D缺乏性手足搐搦症", "language": "zh"}
{"question": "关于性联无丙种球蛋白血症（　　）。", "answer": "是原发性T细胞缺陷病", "meta_info": "医学免疫学", "answer_idx": "B", "A": "是最常见的先天性B细胞免疫缺陷病", "B": "是原发性T细胞缺陷病", "C": "临床上主要表现为反复化脓性细菌感染", "D": "前B细胞数目正常，T细胞数量及功能亦正常", "language": "zh"}
{"question": "1．Ⅰ（轻）度营养不良（　　）。", "answer": "体重低于正常均值15%～25%", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "体重低于正常均值5%～10%", "B": "体重低于正常均值15%～25%", "C": "体重低于正常均值25%～40%", "D": "体重低于正常均值40%～60%", "language": "zh"}
{"question": "50岁妇女，白带带血1月，复查，宫颈中度糜烂，易出血，子宫大小质地正常，附件正常，阴道镜下多点活检报告为：CIN Ⅲ，其处理下述哪项恰当？（　　）", "answer": "子宫全切术", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "子宫全切术", "B": "诊断性刮宫", "C": "定期随访", "D": "激光治疗", "language": "zh"}
{"question": "某医师为不得罪同事，将病人严格区分为“你的”和“我的”，对其他医师所负责的病人一概不闻不问，即使同事出现严重失误，也是如此。这种做法违反了哪一条正确处理医务人员之间关系的道德原则（　　）。", "answer": "彼此信任、互相协作和监督", "meta_info": "医学伦理学", "answer_idx": "B", "A": "彼此独立、互相支持和帮助", "B": "彼此信任、互相协作和监督", "C": "彼此独立、互相协作和监督", "D": "彼此平等、互相协作和监督", "language": "zh"}
{"question": "幼儿期年龄的划分应是（　　）。", "answer": "1岁到3岁", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "出生到2岁", "B": "1岁到3岁", "C": "1岁到4岁", "D": "2岁到4岁", "language": "zh"}
{"question": "不是下运动神经元的是（　　）。", "answer": "皮质脑干束", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "脊髓前角细胞", "B": "神经丛", "C": "周围神经系统", "D": "皮质脑干束", "language": "zh"}
{"question": "下列各项中，哪一项不是《传染性非典型肺炎防治管理办法》规定的医疗机构的职责?（　　）", "answer": "对传染性非典型肺炎疫情进行监测与预警", "meta_info": "卫生法规", "answer_idx": "C", "A": "及时、如实报告疫情", "B": "宣传疾病防治科学知识", "C": "对传染性非典型肺炎疫情进行监测与预警", "D": "对医疗机构内病人或者疑似病人污染的场所、物品、排泄物进行严格的卫生处理", "language": "zh"}
{"question": "患者，女，36岁。发热盗汗，腹泻便秘交替2个月就诊。体检：腹部平软，右下腹轻度压痛，未扪及包块，粪检无特殊。2．若胃肠钡餐检查示回盲部有钡影跳跃征，应考虑何诊断？（　　）", "answer": "肠结核", "meta_info": "第3篇　消化系统", "answer_idx": "A", "A": "肠结核", "B": "溃疡性结肠炎", "C": "慢性阑尾炎", "D": "回盲部肿瘤", "language": "zh"}
{"question": "35岁，女性，步行中后仰跌倒，右手掌撑地伤后1小时，右肩痛，不敢活动。检查：右肩方肩畸形，Dugas征（+）。2．需要对右肩关节做的辅助检查是（　　）。", "answer": "正位及穿胸位平片", "meta_info": "第四部分　运动系统疾病", "answer_idx": "C", "A": "正位平片", "B": "正侧位平片", "C": "正位及穿胸位平片", "D": "CT", "language": "zh"}
{"question": "震颤麻痹的症状不包括（　　）。", "answer": "动作时震颤加剧", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "小写症", "B": "面具脸", "C": "慌张步态", "D": "动作时震颤加剧", "language": "zh"}
{"question": "8个月婴儿，发热、呕吐、腹泻3天，大便稀水样，7～8次/日，于11月25日入院。体检：T38.5℃，轻度脱水貌，咽充血，心肺未见异常，肠鸣音稍亢进，大便镜检脂肪球（++）。最可能的诊断为（　　）。", "answer": "病毒性肠炎", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "上呼吸道感染", "B": "生理性腹泻", "C": "病毒性肠炎", "D": "侵袭性大肠杆菌肠炎", "language": "zh"}
{"question": "1．属于磷酸戊糖通路的酶是（　　）。", "answer": "6-磷酸葡萄糖脱氢酶", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "6-磷酸葡萄糖脱氢酶", "B": "苹果酸脱氢酶", "C": "丙酮酸脱氢酶", "D": "葡萄糖-6-磷酸酶", "language": "zh"}
{"question": "与肝癌相关的肿瘤抗原是（　　）。", "answer": "AFP", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "AFP", "B": "TSA", "C": "CTA", "D": "PSA", "language": "zh"}
{"question": "具备下述条件的可以参加执业助理医师资格考试：具有高等学校医学专科学历，在医疗、预防、保健机构中试用期满（　　）。", "answer": "1年", "meta_info": "卫生法规", "answer_idx": "C", "A": "18个月", "B": "6个月", "C": "1年", "D": "3年", "language": "zh"}
{"question": "男，30岁。30分钟前被刀刺右前胸部，咳血痰，呼吸困难。体检：血压107/78mmHg，脉搏96次/分，右前胸有轻度皮下气肿，右锁骨中线4肋间可见3cm长创口，随呼吸有气体进出伤口的响声。1．该患者纵隔的位置是（　　）。", "answer": "在左侧与正中间摆动", "meta_info": "第1篇　呼吸系统", "answer_idx": "D", "A": "右偏", "B": "左偏", "C": "在右侧与正中间摆动", "D": "在左侧与正中间摆动", "language": "zh"}
{"question": "2．使用氢氯噻嗪治疗尿崩症时为达良好效果应注意（　　）。", "answer": "限制钠盐", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "B", "A": "适当限制饮水", "B": "限制钠盐", "C": "低钾血症", "D": "密切监测血压、体重", "language": "zh"}
{"question": "下述哪项不是心理应激对健康的消极影响？（　　）", "answer": "适应性调整，恢复内稳态", "meta_info": "医学心理学", "answer_idx": "A", "A": "适应性调整，恢复内稳态", "B": "使已有的疾病加重", "C": "损害适应能力，引发心身症状", "D": "与其他因素共同影响引发新的疾病", "language": "zh"}
{"question": "头期胃液分泌的调节是（　　）。", "answer": "神经—体液调节", "meta_info": "生理学", "answer_idx": "D", "A": "纯非条件反射", "B": "纯神经调节", "C": "纯体液调节", "D": "神经—体液调节", "language": "zh"}
{"question": "关于错觉的定义正确的是（　　）。", "answer": "对客观事物歪曲的知觉", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "无客观刺激时的知觉体验", "B": "对客观事物歪曲的知觉", "C": "可以纠正的一种知觉障碍", "D": "对客观事物作出相反印象的知觉障碍", "language": "zh"}
{"question": "28岁女性，产后8个月，哺乳。厌食1周。妇科检查子宫软，如妊娠40天大小，人工流产术中，探针探宫腔深度14cm，患者无明显腹痛，无阴道流血。1．应该考虑（　　）。", "answer": "子宫穿孔", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "子宫肌瘤", "B": "子宫肥大", "C": "子宫后位", "D": "子宫穿孔", "language": "zh"}
{"question": "3．重度低渗性脱水（　　）。", "answer": "血清钠为119mmol/L失水量为体重的11%", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "血清钠为125mmol/L，失水量为体重的8%", "B": "血清钠为131mmol/L，失水量为体重的5%", "C": "血清钠为119mmol/L失水量为体重的11%", "D": "血清钠为155mmol/L，失水量为体重的6%", "language": "zh"}
{"question": "肝素抗凝的主要作用机制是（　　）。", "answer": "增强抗凝血酶Ⅲ活性", "meta_info": "生理学", "answer_idx": "D", "A": "抑制凝血酶原的激活", "B": "抑制因子X的激活", "C": "促进纤维蛋白吸附凝血酶", "D": "增强抗凝血酶Ⅲ活性", "language": "zh"}
{"question": "女，30岁。化脓性阑尾炎术后一周，切口红肿硬结，但拆线后未见脓性分泌物，切口愈合类型应记为（　　）。", "answer": "Ⅲ/乙", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "Ⅱ/乙", "B": "Ⅲ/甲", "C": "Ⅲ/乙", "D": "Ⅲ/丙", "language": "zh"}
{"question": "女婴，3个月。高热，频繁呕吐3天，嗜睡。查体：双眼凝视，反应差，脐部见少量脓性分泌物，前囟膨隆，心肺正常，脑膜刺激征（＋）。2．错误的处理措施是（　　）。", "answer": "腰穿降颅压", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "抗生素治疗10～14天", "B": "严密观察生命体征", "C": "必要时可以应用肾上腺皮质激素", "D": "腰穿降颅压", "language": "zh"}
{"question": "为保证材料真实，也为了维护心理治疗本身的声誉及权威性，因此心理治疗要坚持（　　）。", "answer": "保密原则", "meta_info": "医学心理学", "answer_idx": "B", "A": "真诚原则", "B": "保密原则", "C": "中立原则", "D": "回避原则", "language": "zh"}
{"question": "关于磷酸戊糖途径的叙述，错误的是（　　）。", "answer": "不产生CO2", "meta_info": "生物化学", "answer_idx": "B", "A": "6-磷酸葡萄糖脱氢酶是此途径的关键酶", "B": "不产生CO2", "C": "产生5-磷酸核糖", "D": "产生NADPH", "language": "zh"}
{"question": "3．第二信使（　　）。", "answer": "DG", "meta_info": "生物化学", "answer_idx": "A", "A": "DG", "B": "Na+-K+-ATP酶", "C": "F-F0复合体", "D": "GLUT4", "language": "zh"}
{"question": "男，50岁。突发心悸1小时，20年前曾诊断为“预激综合征”。查体：BP 70／50mmHg，心率190次/分，心律绝对不齐。心电图示QRS波宽大畸形。该患者最佳治疗措施是（　　）。", "answer": "同步直流电复律", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "静脉推注维拉帕米", "B": "同步直流电复律", "C": "静脉推注毛花苷丙", "D": "Valsalva动作", "language": "zh"}
{"question": "男，10岁，畏寒、高热、头痛、呕吐l天。全身皮肤见散在瘀斑，颈软。血压70/40mmHg，脑脊液检查细胞数0.15×109/L，蛋白微量，糖2.8mmol/L。下列检查有利于快速诊断的是（　　）。", "answer": "皮肤瘀斑涂片检查", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "C", "A": "脑脊液培养", "B": "脑脊液涂片检查", "C": "皮肤瘀斑涂片检查", "D": "咽拭子培养", "language": "zh"}
{"question": "某男，60岁，高血压，蛋白尿多年，近日有多尿、夜尿，呕吐症状，无脓尿、菌尿，死后，肾脏肉眼观可能为（　　）。", "answer": "颗粒性固缩肾", "meta_info": "病理学", "answer_idx": "C", "A": "大红肾", "B": "蚤咬肾", "C": "颗粒性固缩肾", "D": "多发性肾硬化", "language": "zh"}
{"question": "男，41岁。胃部不适、食欲减退3个月。胃镜检查发现胃窦前壁直径0.5cm的浅溃疡，幽门螺杆菌阳性。超声胃镜示病变侵及浅肌层，病理可见印戒细胞。最适当的治疗是（　　）。", "answer": "手术治疗", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "应用质子泵抑制剂", "B": "经胃镜病变黏膜切除术", "C": "手术治疗", "D": "应用胃黏膜保护剂", "language": "zh"}
{"question": "Tc细胞(CTL)表面具有鉴定意义的标志是（　　）。", "answer": "CD8分子", "meta_info": "医学免疫学", "answer_idx": "A", "A": "CD8分子", "B": "CD4分子", "C": "CD3分子", "D": "CD80分子", "language": "zh"}
{"question": "房间隔缺损最常见的类型为（　　）。", "answer": "继发孔缺损", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "原发孑孔缺损", "B": "卵圆孔未闭", "C": "继发孔缺损", "D": "原发孔缺损伴二尖瓣裂", "language": "zh"}
{"question": "具有四级结构的蛋白质分子，在一级结构分析时发现（　　）。", "answer": "具有一个以上N端和C端", "meta_info": "生物化学", "answer_idx": "A", "A": "具有一个以上N端和C端", "B": "具有一个N端和几个C端", "C": "只有一个N端和C端", "D": "一定有二硫键存在", "language": "zh"}
{"question": "骨折后最易发生骨缺血性坏死的部位是（　　）。", "answer": "股骨头", "meta_info": "第四部分　运动系统疾病", "answer_idx": "A", "A": "股骨头", "B": "桡骨远端", "C": "肱骨头", "D": "胫骨内髁", "language": "zh"}
{"question": "药物的治疗指数是指（　　）。", "answer": "LD50与ED50的比值", "meta_info": "药理学", "answer_idx": "C", "A": "ED50与LD50之间的距离", "B": "ED50与LD50的比值", "C": "LD50与ED50的比值", "D": "ED90与LD10的比值", "language": "zh"}
{"question": "出血坏死性胰腺炎最常见的并发症（　　）。", "answer": "休克", "meta_info": "第3篇　消化系统", "answer_idx": "D", "A": "败血症", "B": "消化道出血", "C": "胰周围脓肿", "D": "休克", "language": "zh"}
{"question": "可导致马尾神经损伤的是（　　）。", "answer": "第2腰椎骨折脱位", "meta_info": "第四部分　运动系统疾病", "answer_idx": "D", "A": "第10胸椎骨折脱位", "B": "第11胸椎骨折脱位", "C": "第1腰椎骨折脱位", "D": "第2腰椎骨折脱位", "language": "zh"}
{"question": "女，40岁。右上腹胀痛伴畏寒，发热2天，巩膜黄染1天。查体：T 39℃，P 100次/分，右上腹部压痛，反跳痛及肌紧张明显，肝区叩击痛阳性。血WBC 18.2×109/L，N 0.85。B超示胆囊及胆总管结石。该患者最可能感染的致病菌是（　　）。", "answer": "大肠埃希菌", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "草绿色链球菌", "B": "大肠埃希菌", "C": "铜绿假单胞菌", "D": "肺炎链球菌", "language": "zh"}
{"question": "I型变态反应（　　）。", "answer": "能拮抗腺苷引起的支气管痉挛", "meta_info": "第八部分　其他疾病", "answer_idx": "B", "A": "减少cGMP浓度", "B": "能拮抗腺苷引起的支气管痉挛", "C": "抑制肥大细胞和嗜碱粒细胞释放生物介质", "D": "激素合成剂", "language": "zh"}
{"question": "下述有关双链DNA中碱基含量关系哪项是错误的？（　　）", "answer": "A+T=G+C", "meta_info": "生物化学", "answer_idx": "B", "A": "A+C=G+T", "B": "A+T=G+C", "C": "A+G=C+T", "D": "G=C", "language": "zh"}
{"question": "5岁女孩，自幼身体瘦弱，易患感冒。体检：心前区稍隆起，未触及震颤，胸骨左缘第2肋间闻及2/6级收缩期杂音，P2亢进，固定分裂。1．最可能的诊断是（　　）。", "answer": "房间隔缺损", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "房间隔缺损", "B": "室间隔缺损", "C": "动脉导管未闭", "D": "病毒性心肌炎", "language": "zh"}
{"question": "2．促进造血干细胞增生分化的细胞因子是（　　）。", "answer": "G-CSF", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "IL-2", "B": "IFN-γ", "C": "IL-4", "D": "G-CSF", "language": "zh"}
{"question": "血浆晶体渗透压降低时会引起（　　）。", "answer": "红细胞膨胀和破裂", "meta_info": "生理学", "answer_idx": "D", "A": "组织液增加", "B": "尿少", "C": "红细胞萎缩", "D": "红细胞膨胀和破裂", "language": "zh"}
{"question": "关于幻觉的定义正确的是（　　）。", "answer": "一种虚幻的知觉", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "现实刺激时知觉体验", "B": "一种虚幻的知觉", "C": "一种异样的感觉", "D": "虚假的感觉", "language": "zh"}
{"question": "男婴，6个月，因呕吐、腹泻3天，加剧1天，尿少来院急诊。体温38℃，眼窝前囟显凹，皮肤弹性较差，血Na+140mmol/L。动脉血气：pH7.2，BE12mmol/L。最适宜的处理是（　　）。", "answer": "1.4%碳酸氢钠静脉滴注", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "静脉注射25%葡萄糖溶液", "B": "禁食6小时，以后牛奶喂养", "C": "2：3：1溶液静脉滴注", "D": "1.4%碳酸氢钠静脉滴注", "language": "zh"}
{"question": "1．用于甲型肝炎诊断的标志物是（　　）。", "answer": "血清抗-HAV IgM", "meta_info": "医学微生物学", "answer_idx": "B", "A": "血清抗-HAV IgG", "B": "血清抗-HAV IgM", "C": "甲型肝炎灭活疫苗", "D": "甲型肝炎减毒活疫苗", "language": "zh"}
{"question": "女，10岁，3周前患“感冒”。突然发热3天，38度左右。眼睑及颜面部水肿。尿检红细胞6个/HP，尿蛋白定性（＋＋＋）。血压120／90mmHg。该患儿最有可能的诊断是（　　）。", "answer": "急性肾小球肾炎", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "慢性肾小球肾炎", "B": "急性肾小球肾炎", "C": "慢性肾炎急性发作", "D": "IgA肾病", "language": "zh"}
{"question": "患者，男，38岁，车祸致胸部损伤。出现严重呼吸困难。查体：BP 80/60mmHg，脉细速，皮肤完整，气管左移，颈静脉充盈。颈部及胸部皮下气肿，右胸廓饱满，肋间隙增宽，叩鼓音，右肺呼吸音消失。最可能的诊断是（　　）。", "answer": "张力性气胸", "meta_info": "第1篇　呼吸系统", "answer_idx": "A", "A": "张力性气胸", "B": "闭合性气胸", "C": "开放性气胸", "D": "肺爆震伤", "language": "zh"}
{"question": "男，5岁，持续发热15d，体温39～39.5℃，伴腹泻每日3～5次。查体：神萎，心率72/min，肝右肋下2cm，脾肋下1.5cm，血常规检查：WBC3.0×109/L，中性粒细胞60%，淋巴细胞40%，嗜酸粒细胞0，ALT200U/L，血清抗-HBs阳性，该病例的诊断最可能是（　　）。", "answer": "急性乙型肝炎", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "A", "A": "急性乙型肝炎", "B": "钩端螺旋体病", "C": "急性血吸虫病", "D": "急性细菌性痢疾", "language": "zh"}
{"question": "3．可能有心功能不全存在的是（　　）。", "answer": "中心静脉压很低，尿量少", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "中心静脉压很低，尿量多", "B": "中心静脉压偏低，尿量少", "C": "中心静脉压很高，尿量多", "D": "中心静脉压很低，尿量少", "language": "zh"}
{"question": "当一个人认为自己对所处环境没有控制力并无力改变它的时候，就会产生（　　）。", "answer": "失助感", "meta_info": "医学心理学", "answer_idx": "C", "A": "愤怒", "B": "猜疑", "C": "失助感", "D": "主观感觉异常", "language": "zh"}
{"question": "下列关于结核性腹膜炎全身症状的叙述。错误的是（　　）。", "answer": "毒血症状明显者见于粘连型", "meta_info": "第3篇　消化系统", "answer_idx": "D", "A": "主要症状是发热和盗汗", "B": "热型以低热和中等热最多", "C": "约1/3患者呈弛张热", "D": "毒血症状明显者见于粘连型", "language": "zh"}
{"question": "4．药物过敏性血小板减少性紫癜（　　）。", "answer": "属Ⅱ型超敏反应性疾病", "meta_info": "医学免疫学", "answer_idx": "B", "A": "属I型超敏反应性疾病", "B": "属Ⅱ型超敏反应性疾病", "C": "属Ⅳ型超敏反应性疾病", "D": "不属于超敏反应性疾病", "language": "zh"}
{"question": "男性，42岁，近一个月来在刷牙时常出现右上牙部及右面部疼痛，每次持续5～6秒钟，神经系统检查无阳性体征。1．首先考虑的诊断是（　　）。", "answer": "三叉神经痛", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "牙痛", "B": "三叉神经痛", "C": "鼻窦炎", "D": "单纯感觉性发作（癫痫）", "language": "zh"}
{"question": "2．左心窒内压上升速度最快是在（　　）。", "answer": "等容收缩期", "meta_info": "生理学", "answer_idx": "A", "A": "等容收缩期", "B": "等容舒张期", "C": "快速射血期", "D": "快速充盈期", "language": "zh"}
{"question": "老年男性发生膀胱结石最常见的诱因是（　　）。", "answer": "前列腺增生", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "膀胱炎", "B": "前列腺炎", "C": "前列腺增生", "D": "膀胱异物", "language": "zh"}
{"question": "正常小儿乳牙萌出的年龄应为（　　）。", "answer": "4～10个月", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "4个月", "B": "5个月", "C": "10个月", "D": "4～10个月", "language": "zh"}
{"question": "扩血管作用最强的钙拮抗剂是（　　）。", "answer": "尼索地平", "meta_info": "药理学", "answer_idx": "C", "A": "尼卡地平", "B": "硝苯地平", "C": "尼索地平", "D": "拉西地平", "language": "zh"}
{"question": "男，45岁。胃镜检查提示十二指肠球部溃疡，经药物治疗3个月仍反复发作。行胃大部切除毕Ⅱ式吻合术，术后并发症属于远期并发症的是（　　）。", "answer": "早期倾倒综合征", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "输入袢梗阻", "B": "早期倾倒综合征", "C": "输出袢梗阻", "D": "十二指肠残端破裂", "language": "zh"}
{"question": "不是分枝杆菌特性的是（　　）。", "answer": "专性厌氧", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "抗酸染色阳性", "B": "专性厌氧", "C": "营养要求高", "D": "毒力和耐药性均可发生变异", "language": "zh"}
{"question": "属于N1型胆碱能受体阻断剂的是（　　）。", "answer": "六烃季铵", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "十烃季铵", "B": "六烃季铵", "C": "酚妥拉明", "D": "普萘洛尔", "language": "zh"}
{"question": "γ运动神经元的功能是（　　）。", "answer": "使肌梭感受器处于敏感状态", "meta_info": "生理学", "answer_idx": "D", "A": "发动牵张反射", "B": "直接支配梭外肌纤维使其收缩", "C": "使肌梭在肌肉收缩时放电停止", "D": "使肌梭感受器处于敏感状态", "language": "zh"}
{"question": "1．分泌促胃液素的细胞是（　　）。", "answer": "G细胞", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "壁细胞", "B": "主细胞", "C": "肥大细胞", "D": "G细胞", "language": "zh"}
{"question": "暴发型流脑休克型治疗哪一项是错误的？（　　）", "answer": "禁用肾上腺皮质激素", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "D", "A": "控制感染", "B": "纠正休克", "C": "冬眠疗法", "D": "禁用肾上腺皮质激素", "language": "zh"}
{"question": "可降低香豆素类抗凝作用的药物是（　　）。", "answer": "苯妥英钠", "meta_info": "药理学", "answer_idx": "D", "A": "阿司匹林", "B": "保泰松", "C": "甲磺丁脲", "D": "苯妥英钠", "language": "zh"}
{"question": "提示铁缺乏的较敏感指标是（　　）。", "answer": "血清铁蛋白＜12μg/L", "meta_info": "第一部分　血液系统疾病", "answer_idx": "D", "A": "红细胞游离原卟啉＞0.9μmol/L", "B": "血清铁＜9.0～10.7μmol/L", "C": "总铁结合力＞62.7μmol/L", "D": "血清铁蛋白＜12μg/L", "language": "zh"}
{"question": "2．上述哪项属于吞噬细胞缺陷病（　　）。", "answer": "慢性肉芽肿", "meta_info": "医学免疫学", "answer_idx": "A", "A": "慢性肉芽肿", "B": "DiGeorge综合征", "C": "Bruton病", "D": "补体缺陷病", "language": "zh"}
{"question": "1．可以引起人类呼吸道、肠胃道、泌尿道及眼部感染的病毒是（　　）。", "answer": "腺病毒", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "呼吸道合胞病毒", "B": "腮腺炎病毒", "C": "腺病毒", "D": "麻疹病毒", "language": "zh"}
{"question": "哪级政府负责储备防治传染病的药品医疗器械和其他物资，以备调用?（　　）", "answer": "县级以上人民政府", "meta_info": "卫生法规", "answer_idx": "B", "A": "市级以上人民政府", "B": "县级以上人民政府", "C": "省级以下人民政府", "D": "中央人民政府", "language": "zh"}
{"question": "患者女性，45岁，左乳房外上象限4cm×3cm肿块，距乳头5cm，可推动。但是病人双手叉腰时肿块活动度明显受限，左腋窝未扪及肿大淋巴结。1．该患者最佳的定性诊断方法是（　　）。", "answer": "细针穿刺细胞学检查", "meta_info": "第八部分　其他疾病", "answer_idx": "D", "A": "钼靶X线摄片", "B": "切取活检", "C": "B超", "D": "细针穿刺细胞学检查", "language": "zh"}
{"question": "3．流行性斑疹伤寒的传播媒介是（　　）。", "answer": "人虱", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "人虱", "B": "鼠蚤", "C": "恙螨", "D": "蜱", "language": "zh"}
{"question": "下列疾病中，最容易并发骨筋膜室综合征的是（　　）。", "answer": "肱骨髁上骨折", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "肩关节后脱位", "B": "桡骨远端骨折", "C": "肱骨髁上骨折", "D": "髋关节后脱位", "language": "zh"}
{"question": "男，25岁，发现血尿、蛋白尿2年。查体：BP 150／90mmHg，双下肢无水肿。实验室检查：尿蛋白定量0.5～0.8g/d，尿RBC 5～10/HP，血Cr 125μmol/L，血胆固醇6.0mmol/L。B超表示双肾大小正常。2．首选的进一步检查项目是（　　）。", "answer": "肾穿刺病理检查", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "肾穿刺病理检查", "B": "双肾CT", "C": "肾小管功能检查", "D": "24小时尿钠测定", "language": "zh"}
{"question": "无芽孢厌氧菌引起的感染不包括（　　）。", "answer": "食物中毒", "meta_info": "医学微生物学", "answer_idx": "D", "A": "败血症", "B": "组织坏死", "C": "局部炎症", "D": "食物中毒", "language": "zh"}
{"question": "1．与上级领导的关系紧张（　　）。", "answer": "与工作有关的应激源", "meta_info": "医学心理学", "answer_idx": "C", "A": "化学因素", "B": "物理因素", "C": "与工作有关的应激源", "D": "心理应激源", "language": "zh"}
{"question": "为了切实做到尊重病人自主性或决定，医生向病人提供信息时不能（　　）。", "answer": "诱导", "meta_info": "医学伦理学", "answer_idx": "B", "A": "适量", "B": "诱导", "C": "理解", "D": "开导", "language": "zh"}
{"question": "不支持新生儿化脓性脑膜炎临床表现的是（　　）。", "answer": "苦笑面容", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "苦笑面容", "B": "吐奶", "C": "拒食、少动", "D": "黄疸", "language": "zh"}
{"question": "男性，22岁，骨关节痛半个月，全血细胞减少，骨髓原始细胞占70%，POX阴性，红系、巨核系受抑。2．此类患者完全缓解后作何种治疗，长期存活的可能性最大（　　）。", "answer": "异基因骨髓移植", "meta_info": "第一部分　血液系统疾病", "answer_idx": "C", "A": "同基因骨髓移植", "B": "自体外周血干细胞移植", "C": "异基因骨髓移植", "D": "长期化疗", "language": "zh"}
{"question": "下述溶血性贫血的检查哪组是错误的？（　　）", "answer": "血红蛋白电泳——蚕豆病", "meta_info": "第一部分　血液系统疾病", "answer_idx": "D", "A": "酸化血清溶血试验——阵发性睡眠性血红蛋白尿", "B": "抗人球蛋白试验——自身免疫性溶血性贫血", "C": "外周血中出现大量靶形红细胞——海洋性贫血", "D": "血红蛋白电泳——蚕豆病", "language": "zh"}
{"question": "下列哪项是慢性粒细胞白血病的临床特点？（　　）", "answer": "脾脏显著肿大，并有腹胀、低热、乏力", "meta_info": "第一部分　血液系统疾病", "answer_idx": "A", "A": "脾脏显著肿大，并有腹胀、低热、乏力", "B": "容易并发感染", "C": "纵隔淋巴结肿大", "D": "低热、无汗", "language": "zh"}
{"question": "哮喘持续状态有效的药物治疗是（　　）。", "answer": "地塞米松", "meta_info": "第二部分　模拟试题", "answer_idx": "C", "A": "头孢他啶", "B": "阿托品", "C": "地塞米松", "D": "右旋糖酐-40", "language": "zh"}
{"question": "下列哪项为重型肝炎应用乳果糖的目的？（　　）", "answer": "减少氨从肠道吸收", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "B", "A": "增加肝脏营养", "B": "减少氨从肠道吸收", "C": "促进肝细胞再生", "D": "恢复正常神经递质", "language": "zh"}
{"question": "女，45岁。茶色尿伴腰背痛1个月。查体：贫血貌，巩膜黄染，肝肋下未触及，脾肋下2cm，腹部移动性浊音（－）。血常规：Hb 72g/L，WBC 6.0×109/L，PLT 126×109/L，网织红细胞0.12。Coombs实验（＋），Ham实验（－）。该患者最可能的诊断是（　　）。", "answer": "自身免疫性溶血性贫血", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "自身免疫性溶血性贫血", "B": "脾功能亢进", "C": "骨髓增生异常综合征", "D": "阵发性睡眠性血红蛋白尿", "language": "zh"}
{"question": "1．上述各项可影响甲状腺功能的药物是（　　）。", "answer": "胺碘酮", "meta_info": "药理学", "answer_idx": "C", "A": "奎尼丁", "B": "普鲁卡因胺", "C": "胺碘酮", "D": "维拉帕米", "language": "zh"}
{"question": "10天男婴，足月顺产，母乳喂养，家长为预防小儿佝偻病的发生，来医院咨询。1．医生的下列指导不恰当的是（　　）。", "answer": "1个月开始添加蛋黄，鱼泥等", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "1个月开始添加蛋黄，鱼泥等", "B": "坚持日光浴", "C": "1个月开始添加鱼肝油", "D": "按时补充钙剂", "language": "zh"}
{"question": "下述哪项是消化性溃疡的最常见合并症？（　　）", "answer": "出血", "meta_info": "病理学", "answer_idx": "C", "A": "穿孔", "B": "幽门狭窄", "C": "出血", "D": "粘膜萎缩", "language": "zh"}
{"question": "男性，25岁，车祸伤及右髋部，右髋疼，不敢活动右下肢，右下肢呈屈曲、内收、内旋和短缩畸形，最可能的诊断是（　　）。", "answer": "髋关节后脱位", "meta_info": "第四部分　运动系统疾病", "answer_idx": "C", "A": "股骨颈骨折", "B": "股骨转子骨折", "C": "髋关节后脱位", "D": "股内收肌扭伤", "language": "zh"}
{"question": "糖尿病患者尿量增多的原因是（　　）。", "answer": "小管液溶质浓度过高", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "饮水过多", "B": "肾小球滤过率增高", "C": "肾小管重吸收氯化钠量减少", "D": "小管液溶质浓度过高", "language": "zh"}
{"question": "Killip分级，心功能Ⅲ级指下列哪一项？（　　）", "answer": "肺部有啰音，且啰音的范围大于1/2肺野（肺水肿）", "meta_info": "第2篇　心血管系统", "answer_idx": "A", "A": "肺部有啰音，且啰音的范围大于1/2肺野（肺水肿）", "B": "未闻及肺部啰音和第三心音", "C": "肺部有啰音，但啰音的范围小于1/2肺野", "D": "血压＜70/40mmHg", "language": "zh"}
{"question": "揭示风湿活动的诊断依据下列哪一项是错误的？（　　）", "answer": "抗链“O”增高", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "血沉增快", "B": "具有发热乏力、苍白、脉搏增快等表现", "C": "CRP黏蛋白增高", "D": "抗链“O”增高", "language": "zh"}
{"question": "6个月以内婴儿无热性支气管肺炎应考虑（　　）。", "answer": "衣原体肺炎", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "合胞病毒肺炎", "B": "金黄色葡萄球菌肺炎", "C": "肺炎支原体肺炎", "D": "衣原体肺炎", "language": "zh"}
{"question": "男，58岁。外出途中突然头痛、眩晕，伴呕吐、走路不稳前来急诊。查体：BP 180／105mmHg，心率62次/分，双眼向右水平眼震，右手指鼻不准，右侧跟膝胫试验阳性。3．首先应采取的处理措施是（　　）。", "answer": "降低颅内压", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "快速静脉滴注地塞米松10mg", "B": "降低颅内压", "C": "肌注苯巴比妥钠预防癫痫", "D": "若CT示出血量达到5ml时，手术治疗", "language": "zh"}
{"question": "诊断抑郁症的首要症状是（　　）。", "answer": "情绪低落、兴趣下降", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "精力明显减退、疲乏", "B": "思维困难、联想缓慢", "C": "情绪低落、兴趣下降", "D": "失眠、早醒、体重减轻", "language": "zh"}
{"question": "下列哪项为最常见的急性脑病综合征的意识障碍（　　）。", "answer": "谵妄状态", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "昏睡", "B": "嗜睡", "C": "昏迷", "D": "谵妄状态", "language": "zh"}
{"question": "男，45岁。突发心脏骤停，经心肺复苏后血压70／40mmHg，心率34次/分。该患者应选用的药物是（　　）。", "answer": "阿托品", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "阿托品", "B": "普罗帕酮", "C": "利多卡因", "D": "胺碘酮", "language": "zh"}
{"question": "30岁，男性，突然不规则发热20余日，于5月8日急诊入院。查体：巩膜黄染，肝脾在肋下1.0cm。血白细胞总数4.0×109/L，总胆红素定量98μmol/L（正常＜17.1μmol/L），ALT 85单位，尿蛋白（+），肥达反应“O”1：80，“H”1：160，抗HBs（+），下列哪项检查最有利于确定诊断？（　　）", "answer": "骨髓细菌培养", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "B", "A": "血涂片检疟原虫", "B": "骨髓细菌培养", "C": "粪便细菌培养", "D": "凝溶试验", "language": "zh"}
{"question": "女，27岁，发热、鼻出血7天，牙龈增生似海绵状，胸骨压痛明显。血红蛋白60g/L，白细胞42×109/L，血小板20×109/L。骨髓原始细胞90%，POX（－），PAS阳性呈粗颗粒状，非特异性酯酶阴性，血清溶菌酶正常。应诊断为（　　）。", "answer": "急性淋巴细胞白血病", "meta_info": "第一部分　血液系统疾病", "answer_idx": "C", "A": "急性早幼粒细胞白血病", "B": "急性单核细胞白血病", "C": "急性淋巴细胞白血病", "D": "急性红白血病", "language": "zh"}
{"question": "NK细胞（　　）。", "answer": "具有ADCC效应", "meta_info": "医学免疫学", "answer_idx": "B", "A": "具有MHC限制性", "B": "具有ADCC效应", "C": "分泌与Th2相同的细胞因子", "D": "具有抗体产生作用", "language": "zh"}
{"question": "结核结节主要由什么细胞构成（　　）。", "answer": "类上皮细胞", "meta_info": "病理学", "answer_idx": "C", "A": "浆细胞", "B": "巨噬细胞", "C": "类上皮细胞", "D": "成纤维细胞", "language": "zh"}
{"question": "青霉素作用的细菌靶位是（　　）。", "answer": "细胞壁的五肽交联桥", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "细胞质的质粒", "B": "细胞质的核糖体", "C": "细胞壁的磷壁酸", "D": "细胞壁的五肽交联桥", "language": "zh"}
{"question": "男，74岁，反复咳嗽、咳痰30年。近5年家庭氧疗。1周前因受凉后出现喘息。不能入睡，家属给予“舒乐安定”口服，并增加吸氧浓度。延长吸氧时间。昨日出现昏睡，原因为（　　）。", "answer": "CO2潴留", "meta_info": "第1篇　呼吸系统", "answer_idx": "D", "A": "舒乐安定中毒", "B": "脑梗死", "C": "低钠血症", "D": "CO2潴留", "language": "zh"}
{"question": "2．葡萄球菌肺炎（　　）。", "answer": "肺浸润，多发性肺脓肿", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "小片阴影，肺纹理增多，肺气肿多见", "B": "肺浸润，多发性肺脓肿", "C": "多种多样，基本改变为支气管肺炎征象", "D": "以肺门阴影增浓为突出", "language": "zh"}
{"question": "有明显神经精神症状的营养性巨幼细胞性贫血，应首选的治疗药物是（　　）。", "answer": "维生素B12", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "维生素C", "B": "硫酸亚铁", "C": "维生素B12", "D": "叶酸", "language": "zh"}
{"question": "目前世界上流行性出血热疫情最重的国家是（　　）。", "answer": "中国", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "C", "A": "俄罗斯", "B": "芬兰", "C": "中国", "D": "印度", "language": "zh"}
{"question": "细菌与所致疾病搭配不当的是（　　）。", "answer": "流感杆菌——流感", "meta_info": "医学微生物学", "answer_idx": "D", "A": "百日咳杆菌——百日咳", "B": "铜绿假单胞菌——烧伤感染", "C": "军团菌——军团菌病", "D": "流感杆菌——流感", "language": "zh"}
{"question": "患者，男，35岁。6天前因溃疡病出血行毕Ⅱ式胃大部切除术，2天来上腹胀满.进食后半小时尤甚，常恶心、呕吐，吐出胆汁样液体。量较多，不含食物。呕吐后症状缓解。查体：轻度脱水，上腹略饱满，轻度压痛。最可能的诊断是（　　）。", "answer": "输入袢梗阻", "meta_info": "第3篇　消化系统", "answer_idx": "B", "A": "吻合口梗阻", "B": "输入袢梗阻", "C": "输出袢梗阻", "D": "倾倒综合征", "language": "zh"}
{"question": "婴儿秋季腹泻的病原为（　　）。", "answer": "轮状病毒", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "金黄色葡萄球菌", "B": "大肠杆菌", "C": "轮状病毒", "D": "埃可病毒", "language": "zh"}
{"question": "女，4岁。发热，呕吐1周，双眼呆滞1天。查体：消瘦明显，颈项强直。经治疗无效死亡。尸体解剖见脑膜血管扩张淤血，脑底蛛网膜下隙见灰白色胶样渗出物聚集，以脑桥、脚间池、视神经交叉处最明显，并见灰白色粟粒大小结节弥漫分布。镜下见渗出物中有淋巴细胞、单核细胞、纤维素及肉芽肿。最可能的诊断是（　　）。", "answer": "结核性脑膜炎", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "流行性乙型脑炎", "B": "化脓性脑脊髓膜炎", "C": "结核性脑膜炎", "D": "多发性脑脓肿", "language": "zh"}
{"question": "下列关于抗生素的使用原则中错误的是（　　）。", "answer": "能联合用药，不单用", "meta_info": "第八部分　其他疾病", "answer_idx": "D", "A": "选用药源充足的", "B": "选用价格较便宜的", "C": "选用副作用小的", "D": "能联合用药，不单用", "language": "zh"}
{"question": "2．对ALA合酶具有强烈抑制作用的是（　　）。", "answer": "高铁血红素", "meta_info": "生物化学", "answer_idx": "A", "A": "高铁血红素", "B": "琥珀酰辅酶A", "C": "胆红素", "D": "乙酰辅酶A", "language": "zh"}
{"question": "全面强直-阵挛性发作治疗间突然停药，可导致（　　）。", "answer": "癫痫持续状态", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "失眠", "B": "精神萎靡", "C": "失神发作", "D": "癫痫持续状态", "language": "zh"}
{"question": "肝脏产生酮体过多意味的是（　　）。", "answer": "糖供应不足", "meta_info": "生物化学", "answer_idx": "C", "A": "肝中脂代谢紊乱", "B": "肝功能增强", "C": "糖供应不足", "D": "脂肪摄取过多", "language": "zh"}
{"question": "男，54岁。发作性胸痛3天，于劳累时发作，休息5分钟可缓解，每天发作3～4次，最近2小时内上述症状发作2次，每次持续20分钟。该患者最恰当的处理措施是（　　）。", "answer": "立即收住院监测心电图和血肌钙蛋白", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "门诊预约超声心动图检查", "B": "立即收住院行心电图运动负荷试验", "C": "立即收住院监测心电图和血肌钙蛋白", "D": "立即收住院行胸部x线片检查", "language": "zh"}
{"question": "腰间盘突出症与椎管内肿瘤最有鉴别意义的辅助检查是（　　）。", "answer": "MRI", "meta_info": "第四部分　运动系统疾病", "answer_idx": "C", "A": "CT", "B": "X线片", "C": "MRI", "D": "肌电图", "language": "zh"}
{"question": "患者，1岁，弛张热，发热5天，咳嗽、气喘4天，用青霉素静脉滴注4天症状好转不明显，今日突然烦躁，呼吸困难，阵发性咳嗽。查体：体温39℃，呼吸60次/分，心率增快，170次/分，节律整。胸片示气管右移，左肺液气胸。1．该患儿最可能的诊断是（　　）。", "answer": "金黄色葡萄球菌肺炎", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "支原体肺炎", "B": "金黄色葡萄球菌肺炎", "C": "毛细支气管肺炎", "D": "肺炎链球菌肺炎", "language": "zh"}
{"question": "下列肛门部疾患中，不会便鲜血的是（　　）。", "answer": "肛瘘", "meta_info": "第3篇　消化系统", "answer_idx": "A", "A": "肛瘘", "B": "肛裂", "C": "内痔", "D": "混合痔", "language": "zh"}
{"question": "3．一般来说，医患之间信托—契约关系所倡导的医患交往模式是（　　）。", "answer": "指导—合作型", "meta_info": "医学伦理学", "answer_idx": "C", "A": "患者主导型", "B": "主动—被动型", "C": "指导—合作型", "D": "共同参与型", "language": "zh"}
{"question": "女性，25岁，因心慌、多汗、消瘦1年就诊。体检：甲状腺Ⅲ度肿大，质软，无压痛，两侧上极可闻及血管杂音，心率100次/min，心音亢进。3．该患者最可能的诊断是（　　）。", "answer": "毒性弥漫性甲状腺肿", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "C", "A": "单纯性甲状腺肿", "B": "地方性甲状腺肿", "C": "毒性弥漫性甲状腺肿", "D": "慢性淋巴细胞性甲状腺炎", "language": "zh"}
{"question": "不属于肺结核一线治疗药物的是（　　）。", "answer": "左氧氟沙星", "meta_info": "第1篇　呼吸系统", "answer_idx": "D", "A": "吡嗪酰胺", "B": "利福平", "C": "异烟肼", "D": "左氧氟沙星", "language": "zh"}
{"question": "伤寒的基本病理特点是（　　）。", "answer": "全身单核—吞噬细胞系统的增生性反应", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "A", "A": "全身单核—吞噬细胞系统的增生性反应", "B": "枯否细胞增生", "C": "淋巴细胞增生", "D": "网状细胞增生", "language": "zh"}
{"question": "心指数指的是（　　）。", "answer": "心排血量／体表面积", "meta_info": "生理学", "answer_idx": "B", "A": "心排血量／体重", "B": "心排血量／体表面积", "C": "心排血量／心室舒张末期容积", "D": "每搏输出量／体表面积", "language": "zh"}
{"question": "先天性甲状腺功能减低症服用甲状腺制剂治疗时间是（　　）。", "answer": "终生", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "1～2年", "B": "4～6年", "C": "6～8年", "D": "终生", "language": "zh"}
{"question": "诊断有机磷中毒最重要的指标是（　　）。", "answer": "血胆碱酯酶活性降低", "meta_info": "第八部分　其他疾病", "answer_idx": "C", "A": "出现毒蕈碱和烟碱样症状", "B": "确切的接触史", "C": "血胆碱酯酶活性降低", "D": "呕吐物和衣服有大蒜味", "language": "zh"}
{"question": "临床用血的包装、储存、运输，不符合国家规定的卫生标准和要求的，给予警告，（　　）。", "answer": "可以并处10000元以下的罚款", "meta_info": "卫生法规", "answer_idx": "B", "A": "可以并处3000元以上的罚款", "B": "可以并处10000元以下的罚款", "C": "可以并处8000元以下的罚款", "D": "可以并处5000元以上的罚款", "language": "zh"}
{"question": "溶血反应的早期特征是（　　）。", "answer": "腰背部疼痛，心前区压迫感", "meta_info": "第一部分　血液系统疾病", "answer_idx": "A", "A": "腰背部疼痛，心前区压迫感", "B": "恶心、呕吐", "C": "出现荨麻疹", "D": "皮肤有淤斑及出血点", "language": "zh"}
{"question": "女，28岁。脸部变圆伴血压升高6个月，闭经2个月，无高血压家族史。查体：BP 160／100mmHg，向心性肥胖，满月脸，水牛背，腹部见宽大紫纹，双下肢水肿，实验室检查：血钠149mmol/L，血钾3.2mmol/L。1．该患者最可能的诊断是（　　）。", "answer": "库欣综合征", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "单纯性肥胖", "B": "库欣综合征", "C": "妊娠", "D": "嗜铬细胞瘤", "language": "zh"}
{"question": "下述哪项为免疫系统的三大功能？（　　）", "answer": "免疫防御、免疫自稳、免疫监视", "meta_info": "医学免疫学", "answer_idx": "D", "A": "免疫防御、免疫应答、免疫记忆", "B": "免疫应答、免疫记忆、免疫监视", "C": "免疫防御、免疫记忆、免疫监视", "D": "免疫防御、免疫自稳、免疫监视", "language": "zh"}
{"question": "产妇郑某住院分娩，分娩过程中由于医护人员操作错误，造成郑某大出血死亡。此后其家属进行的下列哪项行为是不恰当的？（　　）", "answer": "要求死者生前的主治医生先行赔付", "meta_info": "卫生法规", "answer_idx": "C", "A": "要求医院方就患者死亡给出合理解释", "B": "要求将死者尸体冻存在医院停尸房，待5天后进行尸检", "C": "要求死者生前的主治医生先行赔付", "D": "要求进行医疗事故鉴定", "language": "zh"}
{"question": "合并急性左心衰竭的阵发性室上性心动过速，最佳治疗是（　　）。", "answer": "直流电复律", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "静脉注射维拉帕米", "B": "直流电复律", "C": "置入起搏器", "D": "射频消融", "language": "zh"}
{"question": "女，40岁，10天前骑车时被汽车撞伤，当即昏迷。查体，患者呈深昏迷，双瞳孔不等大，忽大忽小，双眼向左侧凝视，四肢肌张力高，Babinski（+），腰穿压力不高，CT未见颅内血肿。根据上述资料，应诊断为（　　）。", "answer": "原发性脑干损伤", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "广泛脑挫裂伤", "B": "弥漫性轴索损伤", "C": "脑震荡", "D": "原发性脑干损伤", "language": "zh"}
{"question": "对于胰岛素的作用下述哪一项是错误的？（　　）", "answer": "抑制蛋白质合成，抑制氨基酸进入细胞", "meta_info": "药理学", "answer_idx": "B", "A": "促进葡萄糖利用，抑制糖原分解和产生", "B": "抑制蛋白质合成，抑制氨基酸进入细胞", "C": "促进脂肪合成，抑制脂肪分解", "D": "促进钾进入细胞，降低血钾", "language": "zh"}
{"question": "下列哪项是新月体性肾炎的主要病变？（　　）", "answer": "球囊壁层上皮细胞增生", "meta_info": "病理学", "answer_idx": "D", "A": "单核细胞的渗出", "B": "血管内皮细胞坏死", "C": "中性粒细胞的渗出", "D": "球囊壁层上皮细胞增生", "language": "zh"}
{"question": "1．ABO血型系统中，四种血型的红细胞上都含有（　　）。", "answer": "H抗原", "meta_info": "生理学", "answer_idx": "B", "A": "D抗原", "B": "H抗原", "C": "尿激酶", "D": "TFPI", "language": "zh"}
{"question": "2．干扰dUMP转变生成dTMP的是（　　）。", "answer": "甲氨蝶呤", "meta_info": "生物化学", "answer_idx": "A", "A": "甲氨蝶呤", "B": "阿糖胞苷", "C": "6-巯基嘌呤", "D": "8-氮杂鸟嘌呤", "language": "zh"}
{"question": "3．治疗急性淋巴细胞白血病首选（　　）。", "answer": "VP方案", "meta_info": "第一部分　血液系统疾病", "answer_idx": "D", "A": "DA方案", "B": "MP方案", "C": "MOPP方案", "D": "VP方案", "language": "zh"}
{"question": "女，28岁，双眼睑下垂，复视2年。溴吡斯的明治疗症状一度缓解。近期出现屈颈、抬头无力、四肢疲软。此病人的重症肌无力属于（　　）。", "answer": "全身型", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "全身型", "B": "眼肌型", "C": "脊髓肌型", "D": "肌萎缩症", "language": "zh"}
{"question": "患者，左眼瞳孔散大，视力下降，光照左眼时瞳孔无改变，照右眼时双瞳孔均缩小，病变为（　　）。", "answer": "左视神经损害", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "左视神经损害", "B": "左动眼神经麻痹", "C": "右视神经损害", "D": "右动眼神经麻痹", "language": "zh"}
{"question": "体内可以直接还原生成脱氧核苷酸的是（　　）。", "answer": "二磷酸核苷", "meta_info": "生物化学", "answer_idx": "C", "A": "核糖", "B": "核糖核苷", "C": "二磷酸核苷", "D": "三磷酸核苷", "language": "zh"}
{"question": "3．作为N10-CHO-FH4来源的是（　　）。", "answer": "色氨酸", "meta_info": "生物化学", "answer_idx": "A", "A": "色氨酸", "B": "组氨酸", "C": "谷氨酸", "D": "苯丙氨酸", "language": "zh"}
{"question": "关于癌基因的叙述，不正确的是（　　）。", "answer": "可诱导细胞凋亡", "meta_info": "生物化学", "answer_idx": "D", "A": "包括病毒癌基因和细胞癌基因", "B": "能在体外引起细胞转化", "C": "是细胞增殖的正调节基因", "D": "可诱导细胞凋亡", "language": "zh"}
{"question": "高血压病死亡原因最常见的为（　　）。", "answer": "脑血管意外", "meta_info": "第2篇　心血管系统", "answer_idx": "B", "A": "心肌梗死", "B": "脑血管意外", "C": "肾衰竭", "D": "心功能不全", "language": "zh"}
{"question": "男性，65岁。下楼时不慎摔伤右髋部，查体右下肢短缩，外旋50°畸形，右髋肿胀不明显，但有叩痛。2．为证实诊断首先需要的检查是（　　）。", "answer": "X线平片", "meta_info": "第四部分　运动系统疾病", "answer_idx": "A", "A": "X线平片", "B": "CT检查", "C": "MRI检查", "D": "关节造影", "language": "zh"}
{"question": "用左旋多巴或M-受体阻断药治疗震颤麻痹（帕金森病），症状不能缓解的是（　　）。", "answer": "静止性震颤", "meta_info": "药理学", "answer_idx": "D", "A": "随意运动减少", "B": "动作缓慢", "C": "面部表情呆板", "D": "静止性震颤", "language": "zh"}
{"question": "患儿，女，9个月。腹泻4天，约10次/日，呈稀水样，伴呕吐，每天2～3次，尿量减少。查体：皮肤干，弹性差，眼窝、前囟凹陷，心音低钝。最重要的处理措施是（　　）。", "answer": "纠正水电解质紊乱", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "控制感染", "B": "给予助消化药", "C": "纠正水电解质紊乱", "D": "给予止吐药", "language": "zh"}
{"question": "男性，20岁，胆囊切除、胆总管引流术后，引流处拔管后胆汁外流。此病变应诊断为（　　）。", "answer": "瘘管", "meta_info": "病理学", "answer_idx": "C", "A": "糜烂", "B": "机化", "C": "瘘管", "D": "窦道", "language": "zh"}
{"question": "某35岁女性，10年前曾有难产史，产后无乳、闭经，食欲不振，疲乏无力，血压偏低，因腹泻、脱水入院。1．对其行下列检查，最可能出现异常的是（　　）。", "answer": "ACTH", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "A", "A": "ACTH", "B": "PRL", "C": "血糖", "D": "电解质", "language": "zh"}
{"question": "足月儿，第l胎。生后2天黄疸明显，肝脾略肿大。血总胆红素255μmol/L（15mg/dl），1分钟胆红素2μmol/L，血型A，Rh，CcDee，直接抗人球蛋白试验弱阳性，母血型O，Rh，CcDEe。1．此患儿黄疸的原因最可能是（　　）。", "answer": "新生儿ABO溶血", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "生理性黄疸", "B": "新生儿败血症", "C": "新生儿ABO溶血", "D": "G-6-PD缺乏症", "language": "zh"}
{"question": "3．病情未得到控制，出现全身黄染的感染是（　　）。", "answer": "气性坏疽", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "痈", "B": "丹毒", "C": "急性化脓性腹膜炎", "D": "气性坏疽", "language": "zh"}
{"question": "初孕妇，28岁，妊娠36周。血压升高3周，今晨突然腹痛，呈持续性，阵发性加重。BP 150／98mmHg，心率112次/分，尿蛋白（＋＋），阴道少量流血。1．体格检查最可能发现的子宫体征是（　　）。", "answer": "不规则收缩，较硬，有压痛，宫缩间歇子宫不完全松弛", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "不规则收缩，较硬，有压痛，宫缩间歇子宫不完全松弛", "B": "有规则阵发性收缩，宫缩间歇期子宫完全松弛", "C": "局部隆起有包块，有压痛", "D": "上端硬，下端膨隆压痛，交界处有环形凹陷", "language": "zh"}
{"question": "男孩，9岁。眼睑水肿伴少尿3天。茶色尿1天。病前3周曾患皮肤脓肿、疱疮。查体：P 110次/分。BP 130/90mmHg。肝右肋下1cm，压痛（＋），双下肢明显非凹陷性水肿。目前最主要的治疗措施是（　　）。", "answer": "呋塞米", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "卡托普利", "B": "青霉素", "C": "限盐饮食", "D": "呋塞米", "language": "zh"}
{"question": "1．患者，男，19岁，爬树时自3米高坠落，诉腰背痛，双下肢活动力量差。急救搬运时采取的方法是（　　）。", "answer": "两至三人托扶伤员躯干，使成一整体搬动，避免躯干扭转，移至木板", "meta_info": "第四部分　运动系统疾病", "answer_idx": "B", "A": "专门托扶伤员头部，沿纵轴向上略牵引，头颈随躯干一同缓慢搬移，放置木板上后，用折好的衣物放在颈部两例固定", "B": "两至三人托扶伤员躯干，使成一整体搬动，避免躯干扭转，移至木板", "C": "让伤者平卧，使受伤下肢处于伸直外旋位", "D": "一人抬躯干，一人抬下肢，尽快送至医院做X线检查", "language": "zh"}
{"question": "女婴，8个月。水样便3天，10余次/日，呕吐3～4次/日，尿量减少。查体：体重8kg，眼窝凹陷，皮肤弹性差，四肢尚暖，血钠125mmol/L。2．第一天补液总量是（　　）。", "answer": "120～150ml/kg", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "80～100ml/kg", "B": "150～180ml/kg", "C": "120～150ml/kg", "D": "60～80ml/kg", "language": "zh"}
{"question": "男婴，生后24天，近4天哭闹剧烈，拒乳，呕吐1天，抽搐3次人院，患儿生后无窒息史。查体：体温不升，反应差，消瘦，脐部见少量脓性分泌物，前囟膨满，双眼凝视，心肺正常，脑膜刺激征（-）。2．该患儿最易出现的并发症是（　　）。", "answer": "硬膜下积液", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "智力落后", "B": "脑积水", "C": "硬膜下积液", "D": "低钙抽搐", "language": "zh"}
{"question": "一位高烧病人，把给他静脉输液的皮管看成一条蛇，非常恐惧。这种症状是（　　）。", "answer": "错视", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "错视", "B": "非真实感", "C": "视物变形症", "D": "空间知觉障碍", "language": "zh"}
{"question": "2．治疗铜绿假单胞菌感染首选的药物是（　　）。", "answer": "环丙沙星", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "磺胺嘧啶", "B": "异烟肼", "C": "甲氧苄啶", "D": "环丙沙星", "language": "zh"}
{"question": "2．丹毒的特点是（　　）。", "answer": "病灶呈浅状红晕，边界清楚，有压痛", "meta_info": "第八部分　其他疾病", "answer_idx": "B", "A": "红肿病灶与正常组织无明显界限", "B": "病灶呈浅状红晕，边界清楚，有压痛", "C": "感染灶质地坚硬，表面有多个黄色脓点", "D": "全身不同部位有多个毛囊和皮脂腺的炎症", "language": "zh"}
{"question": "提示二尖瓣狭窄合并左心房增大的主要心电图改变是（　　）。", "answer": "双峰P波", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "高尖P波", "B": "双峰P波", "C": "QRS波群宽", "D": "T波明显倒置", "language": "zh"}
{"question": "进入空气中毒物浓度很高的生产场所时应使用（　　）。", "answer": "隔离式防毒面具", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "防毒口罩", "B": "隔离式防毒面具", "C": "过滤式防毒面具", "D": "涂防护油膏", "language": "zh"}
{"question": "女，29岁，半小时前从高处跌落，右下肢疼痛，活动受限。查体：神志清楚，右侧大腿、小腿压痛（＋），畸形，异常活动。1．为明确诊断，首先应进行的检查是（　　）。", "answer": "X线片", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "B超", "B": "MRI", "C": "X线片", "D": "CT", "language": "zh"}
{"question": "男，56岁。反复咳嗽30年伴间断咯血。发作时使用“头孢菌素”及止血治疗可缓解。查体：左下肺可闻及湿性啰音。胸部X线片示左下肺纹理增粗、紊乱。为明确咯血的病因，宜首先采取的检查是（　　）。", "answer": "胸部高分辨CT", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "支气管镜", "B": "胸部高分辨CT", "C": "肺通气/灌注扫描", "D": "支气管动脉造影", "language": "zh"}
{"question": "下列有关右旋糖酐的叙述，错误的是（　　）。", "answer": "可降低毛细血管通透性", "meta_info": "药理学", "answer_idx": "C", "A": "具有渗透性利尿作用", "B": "可改善微循环", "C": "可降低毛细血管通透性", "D": "抑制血小板聚集", "language": "zh"}
{"question": "维持胸内负压的必要条件是（　　）。", "answer": "胸膜腔密闭", "meta_info": "生理学", "answer_idx": "D", "A": "胸廓扩张", "B": "呼气肌收缩", "C": "呼吸道存在一定阻力", "D": "胸膜腔密闭", "language": "zh"}
{"question": "急性骨髓炎，在骨膜下或骨髓内抽得脓液后，最关键的治疗措施是（　　）。", "answer": "局部引流", "meta_info": "第四部分　运动系统疾病", "answer_idx": "A", "A": "局部引流", "B": "联合使用大量抗生素", "C": "多次抽脓并注入抗生素", "D": "进行脓液细菌培养及药敏试验，据结果调整用药", "language": "zh"}
{"question": "肺通气的原动力是（　　）。", "answer": "呼吸肌收缩和舒张引起的呼吸运动", "meta_info": "生理学", "answer_idx": "D", "A": "胸内压与大气压之差", "B": "胸内压与肺内压之差", "C": "气体分压差", "D": "呼吸肌收缩和舒张引起的呼吸运动", "language": "zh"}
{"question": "某患者乘车时，因急刹车，右膝前方受到撞击，出现右髋剧痛，髋关节运动障碍，处于屈曲内收，内旋，畸形状态。1．应诊断为（　　）。", "answer": "髋关节后脱位", "meta_info": "第四部分　运动系统疾病", "answer_idx": "C", "A": "股骨颈骨折", "B": "股骨粗隆间骨折", "C": "髋关节后脱位", "D": "髋关节前脱位", "language": "zh"}
{"question": "1．流行性感冒病毒的感染属于（　　）。", "answer": "急性感染", "meta_info": "医学微生物学", "answer_idx": "A", "A": "急性感染", "B": "慢性感染", "C": "潜伏感染", "D": "慢发病毒感染", "language": "zh"}
{"question": "急性链球菌感染后肾小球肾炎电镜下的典型表现是（　　）。", "answer": "电子致密物呈“驼峰”样在上皮下沉积", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "广泛足突消失", "B": "电子致密物呈“飘带”样在肾小球基底膜沉积", "C": "电子致密物呈“驼峰”样在上皮下沉积", "D": "电子致密物在系膜区沉积", "language": "zh"}
{"question": "5．血-胎盘屏障（　　）。", "answer": "免疫屏障(内部)", "meta_info": "医学微生物学", "answer_idx": "A", "A": "免疫屏障(内部)", "B": "病毒抑制物", "C": "细胞作用", "D": "中和抗体", "language": "zh"}
{"question": "女性，35岁，黄疸、贫血伴关节酸痛3个月。查体：巩膜黄染，脾肋下2cm。血红蛋白589/L，白细胞5×109/L，血小板110×109/L，网织红细胞计数0.25，外周血涂片成熟红细胞形态正常，尿隐血试验阴性。无家族史。3．首选哪一项治疗措施？（　　）", "answer": "肾上腺皮质激素", "meta_info": "第一部分　血液系统疾病", "answer_idx": "B", "A": "脾切除", "B": "肾上腺皮质激素", "C": "环磷酰胺", "D": "大剂量丙种球蛋白", "language": "zh"}
{"question": "3．50岁女性，突发剧烈头痛、呕吐，发作性左侧肢体麻木，抽搐一次，血压195/130mmHg，头CT未见异常，降血压后恢复正常，应诊断为（　　）。", "answer": "高血压脑病", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "短暂性脑缺血发作", "B": "高血压脑病", "C": "壳核出血", "D": "脑栓塞", "language": "zh"}
{"question": "关于人类胚胎干细胞研究和应用的伦理原则，不正确的是（　　）。", "answer": "配子和胚胎等属于个人财产，允许买卖，符合公平的原则", "meta_info": "医学伦理学", "answer_idx": "D", "A": "无论胚胎是不是人，都应该得到尊重", "B": "需先经动物实验等措施，以符合安全和有效的原则", "C": "禁止故意生产、销售、买卖配子和胚胎等，以防止商品化", "D": "配子和胚胎等属于个人财产，允许买卖，符合公平的原则", "language": "zh"}
{"question": "常用于检查血液和组织中的梅毒螺旋体的染色方法是（　　）。", "answer": "镀银染色法", "meta_info": "医学微生物学", "answer_idx": "C", "A": "革兰染色法", "B": "墨汁染色法", "C": "镀银染色法", "D": "鞭毛染色法", "language": "zh"}
{"question": "男婴，生后24天，近4天哭闹剧烈，拒乳，呕吐1天，抽搐3次入院，患儿生后无窒息史。查体：体温不升，反应差，消瘦，脐部见少量脓性分泌物，前囟膨满，双眼凝视，心肺正常，脑膜刺激征（－）。1．该患儿最可能的诊断是（　　）。", "answer": "化脓性脑膜炎", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "新生儿缺氧缺血性脑病", "B": "颅内出血", "C": "化脓性脑膜炎", "D": "脑发育不全", "language": "zh"}
{"question": "风湿热最常见的皮肤表现是（　　）。", "answer": "皮下小结", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "荨麻疹", "B": "结节性红斑", "C": "多形红斑", "D": "皮下小结", "language": "zh"}
{"question": "在风湿病中最具诊断意义的病变是（　　）。", "answer": "风湿小结", "meta_info": "病理学", "answer_idx": "B", "A": "胶原纤维的纤维素样变性", "B": "风湿小结", "C": "心外膜纤维素渗出", "D": "心内膜纤维组织增生", "language": "zh"}
{"question": "男性患者，一个月前因外伤手术输血800ml，近一周出现乏力、食欲缺乏，尿色加深。化验：ALT500U/L，抗：HCV（+），HCVPCR（+），抗HBc（+）。应考虑诊断为（　　）。", "answer": "急性丙型肝炎，既往有乙肝病毒感染史", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "A", "A": "急性丙型肝炎，既往有乙肝病毒感染史", "B": "急性乙、丙型肝炎", "C": "乙、丙型肝炎病毒合并感染", "D": "急性乙型肝炎", "language": "zh"}
{"question": "1．用药期间可引起眼泪、尿等呈橘红色的药物（　　）。", "answer": "利福平", "meta_info": "药理学", "answer_idx": "C", "A": "异烟肼", "B": "链霉素", "C": "利福平", "D": "乙胺丁醇", "language": "zh"}
{"question": "下列哪项不是风湿活动的指标？（　　）", "answer": "血ASO大于500单位", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "不规则发热、乏力", "B": "面色苍白，心率增快", "C": "血ASO大于500单位", "D": "血沉增快，黏蛋白增加", "language": "zh"}
{"question": "关于生长激素作用的叙述，错误的是（　　）。", "answer": "促进脂肪的合成", "meta_info": "生理学", "answer_idx": "B", "A": "加速蛋白质的合成", "B": "促进脂肪的合成", "C": "过量时可抑制葡萄糖的利用", "D": "促进骨、软骨、肌肉的分裂增殖", "language": "zh"}
{"question": "男性，36岁，突起昏迷，四肢瘫痪，双侧瞳孔“针尖样”缩小。其最可能的诊断是（　　）。", "answer": "脑桥出血", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "小脑出血", "B": "脑桥出血", "C": "额叶出血", "D": "基底节出血", "language": "zh"}
{"question": "2．《医疗事故处理条例》规定，对70周岁以上的患者因医疗事故致残的，赔偿其残疾生活补助费的时间不超过（　　）。", "answer": "15年", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "5年", "B": "10年", "C": "15年", "D": "30年", "language": "zh"}
{"question": "巨大卵巢囊肿与腹水最有鉴别意义的体征是（　　）。", "answer": "尺压试验时，直尺随腹主动脉搏动", "meta_info": "第5篇　女性生殖系统", "answer_idx": "D", "A": "脐上移", "B": "腹部叩及浊音", "C": "腹部两侧叩诊呈鼓音", "D": "尺压试验时，直尺随腹主动脉搏动", "language": "zh"}
{"question": "患者，女，29岁。发现右乳房肿块1年。体检：双侧乳房、乳头不对称，右乳头凹陷，皮肤可见橘皮样改变，右乳外上近乳晕区可触及一2.2cm×2.5cm×3cm大肿块，质硬，表面不光滑，固定。右腋窝末触及肿大的淋巴结。细针穿刺细胞学检查发现癌细胞。首选哪项治疗（　　）。", "answer": "乳腺癌改良根治术", "meta_info": "第八部分　其他疾病", "answer_idx": "B", "A": "全乳房切除术", "B": "乳腺癌改良根治术", "C": "乳腺癌扩大根治术", "D": "保留乳房的乳腺癌切除术", "language": "zh"}
{"question": "45岁男性，车祸3小时。入院诊断：骨盆骨折、左股骨干骨折及左胫骨开放性骨折。首先应密切观察的并发症是（　　）。", "answer": "休克", "meta_info": "第四部分　运动系统疾病", "answer_idx": "A", "A": "休克", "B": "泌尿系统感染", "C": "疼痛", "D": "坠积性肺炎", "language": "zh"}
{"question": "1．病人对从未见到过的人感到很熟悉，该症状属于（　　）。", "answer": "似曾相识", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "言语运动性幻觉", "B": "错觉", "C": "听幻觉", "D": "似曾相识", "language": "zh"}
{"question": "下列关于器官移植中受体选择的标准的描述，首先应考虑的标准是（　　）。", "answer": "医学标准", "meta_info": "医学伦理学", "answer_idx": "A", "A": "医学标准", "B": "综合社会标准", "C": "政治标准", "D": "年龄标准", "language": "zh"}
{"question": "下列氨基酸含巯基的是（　　）。", "answer": "半胱氨酸", "meta_info": "生物化学", "answer_idx": "A", "A": "半胱氨酸", "B": "丝氨酸", "C": "脯氨酸", "D": "鸟氨酸", "language": "zh"}
{"question": "女性，44岁。右颈部包块伴发热1个月入院，活检诊断为弥漫性大细胞型，B细胞来源，脾肋下5cm，肝不大，骨髓穿刺涂片内有12%淋巴肉瘤细胞。2．临床分期属（　　）。", "answer": "ⅣB", "meta_info": "第一部分　血液系统疾病", "answer_idx": "C", "A": "ⅢA", "B": "ⅢB", "C": "ⅣB", "D": "ⅡB", "language": "zh"}
{"question": "弗洛伊德认为人格包含的是（　　）。", "answer": "本我、自我、超我", "meta_info": "医学心理学", "answer_idx": "B", "A": "意识、前意识、潜意识", "B": "本我、自我、超我", "C": "知、情、意", "D": "性格、脾气、能力", "language": "zh"}
{"question": "女，36岁。间断腹痛、腹泻5年，大便3～5次/日，带黏液，无脓血，便后胀痛缓解，受凉及紧张后症状加重，无发热，抗生素治疗无效。体重无减轻。粪隐血试验阴性。1．为确定诊断，首选的检查是（　　）。", "answer": "结肠镜", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "结肠镜", "B": "粪细菌培养", "C": "小肠X线钡剂造影", "D": "腹部B型超声", "language": "zh"}
{"question": "对于以节肢动物为媒介的组合，哪一项是错误的？（　　）", "answer": "乙型脑炎病毒、麻疹病毒", "meta_info": "医学微生物学", "answer_idx": "A", "A": "乙型脑炎病毒、麻疹病毒", "B": "乙型脑炎病毒、登革病毒", "C": "登革病毒、恙虫病立克次体", "D": "乙型脑炎病毒、Q热柯克斯体", "language": "zh"}
{"question": "3．胃溃疡表面毛细血管壁坏死、破裂可出现（　　）。", "answer": "大便隐血试验阳性", "meta_info": "病理学", "answer_idx": "B", "A": "幽门梗阻", "B": "大便隐血试验阳性", "C": "慢性穿孔", "D": "癌变", "language": "zh"}
{"question": "能反映均数抽样误差大小的指标是（　　）。", "answer": "标准误", "meta_info": "预防医学", "answer_idx": "A", "A": "标准误", "B": "变异系数", "C": "均数", "D": "标准差", "language": "zh"}
{"question": "女，35岁。发现左颈部前一无痛性肿块一年，约1cm大小，近一个月来出现声音嘶哑。查体：甲状腺左下极质硬结节，直径1.5cm，随吞咽活动，颈部未触及肿大淋巴结。最可能的诊断是（　　）。", "answer": "甲状腺癌", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "甲状腺囊肿", "B": "甲状腺舌骨囊肿", "C": "甲状腺癌", "D": "甲状腺腺瘤", "language": "zh"}
{"question": "患者，女，29岁。上肢血压180～200/100～110mmHg，下肢血压140/80mmHg。体检：肩胛间区可闻及血管杂音，伴震颤，尿17-酮、17-羟类固醇正常，尿苦杏仁酸正常。其高血压原因应考虑为继发于（　　）。", "answer": "主动脉缩窄", "meta_info": "第2篇　心血管系统", "answer_idx": "B", "A": "嗜铬细胞瘤", "B": "主动脉缩窄", "C": "皮质醇增多症", "D": "原发性醛固酮增多症", "language": "zh"}
{"question": "锁骨上淋巴结转移癌的原发部位最常见的是（　　）。", "answer": "胃", "meta_info": "病理学", "answer_idx": "C", "A": "食管", "B": "乳腺", "C": "胃", "D": "肝脏", "language": "zh"}
{"question": "某中年男性因突发急症在大街上摔倒并昏迷，由路人送至附近医院，被确诊为脑出血，急需手术，但医务人员无法联系到其亲属。在此情况下，可以决定为其急诊手术的人员是（　　）。", "answer": "院长或其授权人", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "医院所在地民政部门负责人", "B": "医院所在地派出所负责人", "C": "院长或其授权人", "D": "路人", "language": "zh"}
{"question": "1．肥达试验O、H凝集效价均高于正常（　　）。", "answer": "肠热症可能性大", "meta_info": "医学微生物学", "answer_idx": "A", "A": "肠热症可能性大", "B": "肠热症可能性小", "C": "预防注射或回忆反应", "D": "细胞免疫功能低下", "language": "zh"}
{"question": "最常引起代谢性碱中毒的外科疾病是（　　）。", "answer": "幽门梗阻", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "C", "A": "结肠癌", "B": "食道癌", "C": "幽门梗阻", "D": "以上都不是", "language": "zh"}
{"question": "患者女，60岁，摔伤后左髋部疼痛6小时入院。查体：左下肢外旋畸形，左下肢短缩。X线片示：左股骨颈骨折头下型，移位明显。3．若伤后及时行切开复位空心钉三枚固定，患者术后半年下地活动渐感左髋部疼痛，影响行走，术后1年拍片示：左股骨头区塌陷变形，密度不均，髋臼形态尚可，该患者诊断为（　　）。", "answer": "左股骨头无菌性坏死", "meta_info": "第四部分　运动系统疾病", "answer_idx": "D", "A": "左股骨颈病理骨折", "B": "左股骨头压缩折", "C": "左股骨头转移瘤", "D": "左股骨头无菌性坏死", "language": "zh"}
{"question": "下面哪项不是股骨颈骨折的典型畸形表现？（　　）", "answer": "伤侧足呈90°外旋畸形", "meta_info": "第四部分　运动系统疾病", "answer_idx": "C", "A": "大转子上移征", "B": "伤侧足呈45°～60°外旋畸形", "C": "伤侧足呈90°外旋畸形", "D": "股骨大转子顶端在Nelaton线之上", "language": "zh"}
{"question": "毛果芸香碱选择性激动的受体是（　　）。", "answer": "M受体", "meta_info": "药理学", "answer_idx": "A", "A": "M受体", "B": "N1受体", "C": "α受体", "D": "β受体", "language": "zh"}
{"question": "女，34岁，进入刚装修好的房屋，突然心慌、胸闷、大汗、呼吸困难。既往曾有类似情况发生。根据病人情况初步诊断为（　　）。", "answer": "支气管哮喘", "meta_info": "第1篇　呼吸系统", "answer_idx": "C", "A": "慢性支气管炎", "B": "急性肺炎", "C": "支气管哮喘", "D": "支气管炎", "language": "zh"}
{"question": "甲状腺大部切除术后，患者在饮水时发生误咽和呛咳，其原因是（　　）。", "answer": "手术损伤了喉上神经内支", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "A", "A": "手术损伤了喉上神经内支", "B": "手术损伤了喉上神经外支", "C": "手术损伤了甲状旁腺", "D": "甲状腺危象前期表现", "language": "zh"}
{"question": "男性，75岁，进行性排尿困难6个月，直肠指诊发现前列腺右侧有2cm×2cm硬结，1周后行PSA检查为120ng/ml，核素全身骨扫描示骨盆及腰椎系统放射性浓聚区，诊断为前列腺癌骨转移，对此患者现最适宜的治疗是（　　）。", "answer": "双睾丸切除＋抗雄激素药物＋放射治疗", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "根治性前列腺切除＋放射治疗", "B": "根治性前列腺切除＋化疗", "C": "前列腺切除＋综合治疗", "D": "双睾丸切除＋抗雄激素药物＋放射治疗", "language": "zh"}
{"question": "1．因胆汁酸过少而易于形成胆结石的是（　　）。", "answer": "胆固醇", "meta_info": "生物化学", "answer_idx": "A", "A": "胆固醇", "B": "直接胆红素", "C": "间接胆红素", "D": "次级胆汁酸", "language": "zh"}
{"question": "患者，1岁，发热3天，流涕、咳嗽，咽部及眼结膜充血，在下眼睑边缘见Stimson线，口腔黏膜充血，既往未接种麻疹疫苗，该患儿诊断为麻疹，属麻疹病程哪一期（　　）。", "answer": "前驱期", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "卡他期", "B": "前驱期", "C": "潜伏期", "D": "恢复期", "language": "zh"}
{"question": "男，71岁，反复活动时心前区疼痛3个月，5小时前情绪激动时再次发作，持续不缓解，高血压病史10年，查体：BP 110/65mmHg，双肺呼吸音清，心率96次/分，律齐，未闻及杂音，血肌钙蛋白升高，心电图：V4导联ST段压低0.1mV，T波低平，不适宜的治疗措施是（　　）。", "answer": "溶栓治疗", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "抗血小板及抗凝治疗", "B": "溶栓治疗", "C": "β受体拮抗剂", "D": "他汀类药物", "language": "zh"}
{"question": "最能准确反映肾小球滤过率的指标是（　　）。", "answer": "内生肌酐清除率", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "内生肌酐清除率", "B": "血肌酐", "C": "血尿素氮", "D": "血尿素清除率", "language": "zh"}
{"question": "关于胃肠激素的叙述，错误的是（　　）。", "answer": "胃肠道发现的肽不存在于其他系统的器官中", "meta_info": "生理学", "answer_idx": "D", "A": "由胃肠黏膜的内分泌细胞合成释放", "B": "调节其他激素的释放", "C": "具有促进消化道组织的代谢和生长的作用", "D": "胃肠道发现的肽不存在于其他系统的器官中", "language": "zh"}
{"question": "肿瘤治疗方法不包括（　　）。", "answer": "血浆置换", "meta_info": "医学免疫学", "answer_idx": "C", "A": "非特异性免疫治疗", "B": "抗肿瘤导向治疗", "C": "血浆置换", "D": "过继免疫治疗", "language": "zh"}
{"question": "患者女性，38岁，乘车时右腿放在左腿上，突然刹车时右膝受到撞击致右髋疼痛不能活动，4小时后来医院就诊，查体见患肢短缩，右髋屈曲、内收、内旋畸形。2．应首先作下列哪项检查?（　　）", "answer": "双侧髋关节正侧位片", "meta_info": "第四部分　运动系统疾病", "answer_idx": "C", "A": "右髋关节X线侧位片", "B": "右髋关节X线正位片", "C": "双侧髋关节正侧位片", "D": "MRI检查", "language": "zh"}
{"question": "在上运动神经元和感觉完好的情况下，右上腹壁反射消失提示（　　）。", "answer": "右侧胸髓7～8节段病损", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "右侧胸髓3～4节段病损", "B": "右侧胸髓5～6节段病损", "C": "右侧胸髓7～8节段病损", "D": "右侧胸髓9～10节段病损", "language": "zh"}
{"question": "血红素合成的限速酶是（　　）。", "answer": "ALA合酶", "meta_info": "生物化学", "answer_idx": "B", "A": "尿卟啉原Ⅰ合成酶", "B": "ALA合酶", "C": "血红素合成酶", "D": "尿卟啉原Ⅲ合成酶", "language": "zh"}
{"question": "女，24岁，腋窝淋巴结肿大约半年，手术切除。手术标本为直径约2cm的卵圆形淋巴结，切面大部为淡黄色、质软、易碎的坏死灶；镜下检查，坏死灶为红染的、颗粒状、无结构的物质，坏死灶周围可见类上皮细胞和多核巨细胞。以上所描述的坏死是（　　）。", "answer": "干酪样坏死", "meta_info": "病理学", "answer_idx": "D", "A": "梗死", "B": "干性坏死", "C": "气性坏死", "D": "干酪样坏死", "language": "zh"}
{"question": "男性，44岁，发现HBsAg阳性9年，时有增高，近3周来食欲下降，尿黄，明显乏力，齿龈出血，近2周尿少。查体：神清，扑翼样震颤（+），化验：ALT176U/L，TBIL432μmol/L，PT38s（对照13s），该患者诊断应为（　　）。", "answer": "病毒性肝炎乙型慢性重度", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "B", "A": "病毒性肝炎乙型亚急性重型", "B": "病毒性肝炎乙型慢性重度", "C": "乙肝后肝硬化", "D": "病毒性肝炎乙型慢性中度", "language": "zh"}
{"question": "纠正休克所致组织低灌注和缺氧的关键措施是（　　）。", "answer": "补充血容量", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "应用血管活性药物", "B": "补充血容量", "C": "积极处理原发病", "D": "纠正酸中毒", "language": "zh"}
{"question": "男，32岁。炸石作业时不慎炸伤右大腿5小时。伤后出血约400ml。查体：T 36.5摄氏度，P 80次/分，R 18次/分，BP 110/80mmHg，神志清楚，双肺呼吸音清，未闻及干湿性啰音，心律齐，腹软，无压痛。右大腿可见一长约10cm不规则皮肤伤口，肌肉部分破损。对该患者处理错误的是（　　）。", "answer": "清创后一期缝合伤口", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "清创后一期缝合伤口", "B": "清创、引流后延期缝合", "C": "同时应用抗生素和TAT", "D": "伤口近心端扎止血带，送医院", "language": "zh"}
{"question": "女，45岁。肥胖。餐后发作右上腹部阵发性绞痛，每次发作持续约2～3小时，疼痛向右肩背部放射，伴有饱胀感。首选的检查方法是（　　）。", "answer": "B超", "meta_info": "第3篇　消化系统", "answer_idx": "A", "A": "B超", "B": "CT", "C": "MRI", "D": "PET", "language": "zh"}
{"question": "1，25-二羟维生素D3作用的靶器官不包括（　　）。", "answer": "肾小球", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "小肠黏膜", "B": "肾小管", "C": "肾小球", "D": "成骨细胞", "language": "zh"}
{"question": "52岁脑梗死患者，病后第3天意识不清，血压140/105mmHg，左侧偏瘫，脑压280mmH2O，宜首先选用（　　）。", "answer": "20%甘露醇静脉点滴", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "扩血管治疗", "B": "降血压治疗", "C": "尿激酶静脉点滴", "D": "20%甘露醇静脉点滴", "language": "zh"}
{"question": "急性肾衰竭患者少尿期或无尿期出现水中毒的主要原因是（　　）。", "answer": "未严格限制入水量", "meta_info": "第4篇　泌尿系统", "answer_idx": "B", "A": "钠中毒", "B": "未严格限制入水量", "C": "体内内生水过多", "D": "抗利尿激素增加", "language": "zh"}
{"question": "2．流行性脑脊髓膜炎（　　）。", "answer": "空气飞沫传染", "meta_info": "病理学", "answer_idx": "B", "A": "消化道传染", "B": "空气飞沫传染", "C": "接触传染", "D": "跳蚤媒介传染", "language": "zh"}
{"question": "心理治疗医生是否成熟、称职的重要条件及心理治疗成败的关键是（　　）。", "answer": "建立良好的医患关系", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "医生的技术水平", "B": "心理治疗实施的计划性", "C": "是否坚持保密原则", "D": "建立良好的医患关系", "language": "zh"}
{"question": "关于母乳营养素的特点，下列选项错误的是（　　）。", "answer": "含矿物质锌、铁、钙较低", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "不饱和脂肪酸较多", "B": "乳糖含量高，且以乙型乳糖为主", "C": "牛磺酸含量较多", "D": "含矿物质锌、铁、钙较低", "language": "zh"}
{"question": "促胃液素的生理作用不包括（　　）。", "answer": "促进唾液分泌", "meta_info": "生理学", "answer_idx": "C", "A": "促进胃运动", "B": "刺激胃酸分泌", "C": "促进唾液分泌", "D": "促进胆汁分泌", "language": "zh"}
{"question": "不属于急性胰腺炎手术适应证的是（　　）。", "answer": "急性水肿性胰腺炎", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "多次反复发作胰腺炎", "B": "胰腺假性脓肿", "C": "急性水肿性胰腺炎", "D": "胆源性胰腺炎", "language": "zh"}
{"question": "肾癌的主要治疗方法是（　　）。", "answer": "根治性肾切除", "meta_info": "第4篇　泌尿系统", "answer_idx": "B", "A": "单纯肾切除", "B": "根治性肾切除", "C": "肾部分切除", "D": "肾移植", "language": "zh"}
{"question": "患儿，8个月，诊断为佝偻病活动期，正在治疗时，患儿出现发热、咳嗽，且肺部听诊闻及中小水泡音，此时选择哪一种方法治疗佝偻病更好？（　　）", "answer": "维生素D330万IU，2次肌内注射，相隔2～4周", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "暂不治疗佝偻病，先治疗肺炎", "B": "维生素D360万IU，肌内注射1次，同时补钙", "C": "维生素D330万IU，2次肌内注射，相隔2～4周", "D": "维生素D380万IU，2次肌内注射", "language": "zh"}
{"question": "新生儿败血症血象的典型表现是（　　）。", "answer": "白细胞小于5×109/L或大于20×109/L", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "白细胞小于5×109/L或大于20×109/L", "B": "中性粒细胞大于或等于20%", "C": "淋巴细胞大于或等于50%", "D": "中性粒细胞大于或等于50%", "language": "zh"}
{"question": "不符合大叶性肺炎表现的是（　　）。", "answer": "可继发肺脓肿", "meta_info": "第1篇　呼吸系统", "answer_idx": "C", "A": "属浆液性炎", "B": "多由肺炎双球菌引起", "C": "可继发肺脓肿", "D": "可继发肺肉质变", "language": "zh"}
{"question": "乳癌最早表现为（　　）。", "answer": "乳房单发小肿块", "meta_info": "第八部分　其他疾病", "answer_idx": "B", "A": "乳房疼痛", "B": "乳房单发小肿块", "C": "皮肤呈“橘皮样”改变", "D": "乳头内陷", "language": "zh"}
{"question": "根据传染病法的规定，不属于乙类传染病的是（　　）。", "answer": "霍乱", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "脊髓灰质炎", "B": "麻疹", "C": "梅毒", "D": "霍乱", "language": "zh"}
{"question": "35岁，女性，双胎妊娠，胎膜早破，规律宫缩15小时，子宫颈口开大2cm，行剖宫产术，术后静脉点滴抗生素预防感染。第4天出现发冷、发热和腹痛，乳房胀，体温39.5℃，持续4小时。检查子宫底平脐，压痛阳性，恶露污浊有臭味。2．最可能造成感染的原因是（　　）。", "answer": "胎膜早破", "meta_info": "第5篇　女性生殖系统", "answer_idx": "B", "A": "年龄过大", "B": "胎膜早破", "C": "乳头皲裂", "D": "胎盘残留", "language": "zh"}
{"question": "3．指黏膜上皮层或皮肤表皮层内的重度非典型增生，尚未突破基底膜（　　）。", "answer": "原位癌", "meta_info": "病理学", "answer_idx": "B", "A": "单纯癌", "B": "原位癌", "C": "癌珠", "D": "非典型性增生", "language": "zh"}
{"question": "患儿，10个月，生后反复患肺炎，2天前开始发热咳嗽、气促、烦躁不安。查体：口唇发绀，呼吸48次/分，心率198次/分，心音低钝，胸骨左级第3、4肋间可闻及Ⅲ级收缩期杂音，双肺中、小水泡音，肝肋下3.0cm，双足背轻度水肿。1．其诊断可能是（　　）。", "answer": "室间隔缺损合并肺炎和心力衰竭", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "室间隔缺损合并心力衰竭", "B": "室间隔缺损", "C": "室间隔缺损合并肺炎和心力衰竭", "D": "室间隔缺损合并亚急性细菌性内膜炎", "language": "zh"}
{"question": "女，34岁，干咳一个月，无发热、盗汗，反复静滴头孢菌素半个月未见效，查体：T 36.8℃，双侧颈部均可触及黄豆大淋巴结，质软活动，双肺未闻及干湿啰音，为明确诊断，首选的检查是（　　）。", "answer": "胸部X线片", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "血沉", "B": "胸部X线片", "C": "痰找结核杆菌", "D": "肺功能", "language": "zh"}
{"question": "新生儿ABO血型不合指（　　）。", "answer": "母亲为O型，婴儿是A或B型", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "母亲为A型，婴儿是O型", "B": "母亲为AB型，婴儿是O型", "C": "母亲为O型，婴儿是A或B型", "D": "母亲为O型，婴儿是AB型", "language": "zh"}
{"question": "下列提示胎盘功能正常的情况是（　　）。", "answer": "尿雌激素/肌酐比值＞15", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "血清胎盘生乳素突然降低50%", "B": "胎动＜10次/12小时", "C": "尿雌激素/肌酐比值＞15", "D": "NST试验无反应型", "language": "zh"}
{"question": "有长期咳嗽史的病人，其心电图QRS额面平均电轴≥90°，重度顺时钟转位，RV1＋SV3≥1.05mV，PII＞0.22mV，最可能的诊断是（　　）。", "answer": "慢性肺源性心脏病", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "阻塞性肺气肿", "B": "慢性肺源性心脏病", "C": "风湿性心脏病二尖瓣狭窄", "D": "房间隔缺损", "language": "zh"}
{"question": "枕先露行阴道助产时，确定胎位除注意囟门外，可作为依据的颅缝是（　　）。", "answer": "矢状缝", "meta_info": "第5篇　女性生殖系统", "answer_idx": "B", "A": "额缝", "B": "矢状缝", "C": "冠状缝", "D": "人字缝", "language": "zh"}
{"question": "2．手术间的消毒宜应用（　　）。", "answer": "紫外线", "meta_info": "医学微生物学", "answer_idx": "D", "A": "高压蒸汽灭菌", "B": "干烤", "C": "滤过除菌", "D": "紫外线", "language": "zh"}
{"question": "缩窄性心包炎中最常见的病因是（　　）。", "answer": "结核性", "meta_info": "第2篇　心血管系统", "answer_idx": "B", "A": "肿瘤性", "B": "结核性", "C": "真菌性", "D": "细菌性", "language": "zh"}
{"question": "脊髓型颈椎病最重要的诊断依据为（　　）。", "answer": "四肢麻、无力，病理反射（+）", "meta_info": "第四部分　运动系统疾病", "answer_idx": "C", "A": "双上肢麻木", "B": "眼痛、面部出汗失常", "C": "四肢麻、无力，病理反射（+）", "D": "肢体发凉，无或少汗", "language": "zh"}
{"question": "关于急性心肌梗死心肌损伤标记物的描述不正确的是（　　）。", "answer": "肌钙蛋白起病后6小时内升高，5～6天恢复正常", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "肌红蛋白起病后2小时内升高，12小时内达到高峰，24～48小时恢复正常", "B": "肌钙蛋白起病后6小时内升高，5～6天恢复正常", "C": "CK-MB起病后4小时内增高，16～24小时达到高峰，3～4天恢复正常", "D": "LDH在起病后8～10小时后升高，1～2周内恢复正常", "language": "zh"}
{"question": "慢性酒中毒治疗多采用（　　）。", "answer": "综合性疗法", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "对症治疗", "B": "综合性疗法", "C": "戒酒", "D": "支持治疗", "language": "zh"}
{"question": "男，56岁。尿中泡沫增多2年，间断双下肢水肿，晨轻暮重半年。既往患2型糖尿病15年，目前使用二甲双胍（1.5g/日）联合预混胰岛素30R（早、晚餐前皮下注射）治疗。冠心病病史10年，2年前行PTCA治疗。查体：BP 155/85mmHg，腹型肥胖，心肺无显著异常，双下肢轻度凹陷性水肿。尿蛋白（＋＋）。1．入院后监测血压波动于140～150/75～85mmHg，首选的降压药物是（　　）。", "answer": "ACEI或ARB类", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "α受体拮抗剂", "B": "ACEI或ARB类", "C": "β受体拮抗剂", "D": "钙通道阻滞剂", "language": "zh"}
{"question": "女性，20岁，约2周前起有感冒样症状，3天前出现双下肢无力，次日双上肢及双面肌均无力，检查见四肢弛缓性瘫痪，腱反射消失，感觉正常，病后第10天腰椎穿刺脑脊液无色透明，淋巴细胞5个/mm３，蛋白120mg/dl，糖70mg/dl。本病例诊断最大可能是（　　）。", "answer": "急性炎症性脱髓鞘性多发性神经病", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "进行性肌营养不良", "B": "周期性瘫痪", "C": "急性炎症性脱髓鞘性多发性神经病", "D": "脑干脑炎", "language": "zh"}
{"question": "男，50岁。自幼起常咳嗽、咳痰，近2年来症状加重，1周前咯鲜血1次，量约100ml。查体：左下肺可闻及湿啰音，胸部X线片示左下肺纹理粗乱。为明确诊断首选的检查是（　　）。", "answer": "胸部高分辨CT", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "支气管镜", "B": "胸部高分辨CT", "C": "支气管动脉造影", "D": "支气管碘油造影", "language": "zh"}
{"question": "1．病人无根据的认为自己犯下了滔天大罪,对不起国家和人民（　　）。", "answer": "自罪妄想", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "被害妄想", "B": "夸大妄想", "C": "自罪妄想", "D": "疑病妄想", "language": "zh"}
{"question": "2．属于急性风湿热的主要表现可有（　　）。", "answer": "皮下结节", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "瓣膜病", "B": "皮下结节", "C": "血沉增快、CRP阳性", "D": "心电图可见ST段下移及T波平坦或倒置", "language": "zh"}
{"question": "患者，男性，52岁，因咳嗽、胸闷、气短1周收入住院。查体：T 37.5℃，R 24/min，口唇发绀，左锁骨上可触及一花生米大之淋巴结，质硬、固定、无压痛，气管向左侧移位，右肺叩诊呈浊音、语颤明显减弱、呼吸音消失。胸腔积液常规示蛋白含量35g/L，WBC 850×106/L。，中性粒细胞占20%，淋巴细胞占80%。LDH 800U/L，PPD（+）。最可能的诊断是（　　）。", "answer": "右侧结核性胸膜炎", "meta_info": "第二部分　模拟试题", "answer_idx": "A", "A": "右侧结核性胸膜炎", "B": "右侧恶性胸腔积液", "C": "右侧化脓性胸腔积液", "D": "右侧漏出性胸腔积液", "language": "zh"}
{"question": "病原体进入人体后，是否引起疾病，主要取决于（　　）。", "answer": "病原体的致病能力和机体的免疫功能", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "B", "A": "病原体的数量", "B": "病原体的致病能力和机体的免疫功能", "C": "病原体的侵袭力", "D": "机体的抵抗能力", "language": "zh"}
{"question": "诊断慢性阻塞性肺疾病（COPD）的必要条件是（　　）。", "answer": "肺功能检查示阻塞性通气功能障碍", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "胸部X线片示肺纹理增粗紊乱", "B": "肺功能检查示阻塞性通气功能障碍", "C": "高分辨率CT示肺气肿改变", "D": "慢性咳嗽、咳痰病史", "language": "zh"}
{"question": "女孩，2岁半，心前区听到2～3级收缩期杂音，胸部X线片显示两肺野肺纹理减少。下列哪种先天性心脏病的可能性最大？（　　）", "answer": "法洛四联症", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "房间隔缺损", "B": "动脉导管未闭", "C": "法洛四联症", "D": "肺动脉狭窄", "language": "zh"}
{"question": "2．外展神经麻痹引起（　　）。", "answer": "眼球处于内斜位", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "双眼共同偏视", "B": "瞳孔散大，对光反射消失", "C": "瞳孔呈现针尖样", "D": "眼球处于内斜位", "language": "zh"}
{"question": "“过客白细胞”是指（　　）。", "answer": "移植物中的APC", "meta_info": "医学免疫学", "answer_idx": "B", "A": "受者体内的APC", "B": "移植物中的APC", "C": "移植物中的中性粒细胞", "D": "受者体内的CD4T细胞", "language": "zh"}
{"question": "下列对阿片类药物叙述错误的是（　　）。", "answer": "镇痛的同时可产生意识丧失", "meta_info": "药理学", "answer_idx": "D", "A": "镇痛作用强大", "B": "作用机制与激动阿片受体有关", "C": "反复多次应用易产生耐受性及成瘾性", "D": "镇痛的同时可产生意识丧失", "language": "zh"}
{"question": "某年夏季，某县中心小学47名学生相继出现剧烈呕吐、上腹部剧烈疼痛、腹泻等症状，少数患者有低热。调查得知发病学生在当天上午均吃过学校供应的课间餐（外购的奶油蛋糕），未吃者不发病。患者发病的潜伏期最短为1小时，最长为6小时。1．引起此次食物中毒最可能的细菌（或毒素）是（　　）。", "answer": "金黄色葡萄球菌肠毒素", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "副溶血性弧菌", "B": "沙门菌属", "C": "蜡样芽胞杆菌", "D": "金黄色葡萄球菌肠毒素", "language": "zh"}
{"question": "男性，15岁。自幼轻微外伤后出血不止，因右膝关节肿胀5天入院。体检：皮肤黏膜无出血，出血时间lmin，凝血时间30min，凝血酶原时间正常。疾病分类属于（　　）。", "answer": "凝血活酶生成障碍", "meta_info": "第一部分　血液系统疾病", "answer_idx": "B", "A": "血管壁功能异常", "B": "凝血活酶生成障碍", "C": "凝血酶生成障碍", "D": "纤维蛋白生成障碍", "language": "zh"}
{"question": "非法采集血液，应承担的法律不包括（　　）。", "answer": "警告", "meta_info": "卫生法规", "answer_idx": "A", "A": "警告", "B": "罚款", "C": "没收违法所得", "D": "取缔", "language": "zh"}
{"question": "评估呼吸气流是否受限最常用的指标是（　　）。", "answer": "FEV1/FVC", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "残气量/肺总量（RV/TLC）", "B": "FEV1％预计值", "C": "峰流速（PEF）", "D": "FEV1/FVC", "language": "zh"}
{"question": "女，38岁。右肩部外伤后疼痛、活动受限2小时。查体：右侧肩胛盂处有空虚感，Dugas征阳性。X线检查未见骨折。首选的治疗方法是（　　）。", "answer": "麻醉下Hippocrates法复位", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "外展支具固定", "B": "三角巾悬吊固定", "C": "切开复位", "D": "麻醉下Hippocrates法复位", "language": "zh"}
{"question": "女性，发热起病，乏力、腹胀、食欲缺乏，发病第9天出现躁动不安，神志不清，巩膜及皮肤深度黄染，肝界缩小，注射部位可见瘀斑，血胆红素定量300μmol/L，ALTl50U/L，血清蛋白29g/L。1．此患者临床诊断应考虑（　　）。", "answer": "急性重型肝炎", "meta_info": "第八部分　其他疾病", "answer_idx": "A", "A": "急性重型肝炎", "B": "急性黄疸型肝炎", "C": "淤胆型肝炎", "D": "中毒性肝炎", "language": "zh"}
{"question": "决定细胞单位时间能产生兴奋最多次数的是（　　）。", "answer": "绝对不应期", "meta_info": "生理学", "answer_idx": "A", "A": "绝对不应期", "B": "恢复期", "C": "超常期", "D": "正常期", "language": "zh"}
{"question": "2．脑内突然涌现大量杂乱无章的联想，无法控制是（　　）。", "answer": "强制性思维", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "强制性思维", "B": "痴呆", "C": "关系妄想", "D": "木僵", "language": "zh"}
{"question": "女，22岁。左额部被刀划伤12小时就诊。查体：左额部有3cm长伤口，深及骨膜，有血痂，伤口周边无红肿。宜采取的处理方法是（　　）。", "answer": "清创后一期缝合", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "清创后二期缝合", "B": "清创后一期缝合", "C": "清创后放置橡胶片引流", "D": "局部应用抗生素", "language": "zh"}
{"question": "1．颈4～5骨折脱位合并脊髓损伤（　　）。", "answer": "四肢全瘫", "meta_info": "第四部分　运动系统疾病", "answer_idx": "B", "A": "立即窒息死亡", "B": "四肢全瘫", "C": "上肢屈肘动作存在，伸肘及手的功能丧失，下肢瘫", "D": "下肢痉挛性瘫", "language": "zh"}
{"question": "2．能感受肾小管液中NaCl含量变化的感受器位于（　　）。", "answer": "近球小体", "meta_info": "生理学", "answer_idx": "B", "A": "入球小动脉", "B": "近球小体", "C": "颈动脉体和主动脉体", "D": "左心房和腔静脉", "language": "zh"}
{"question": "男性，38岁，1个月来乏力、食欲差，左上腹胀痛。查体：肝肋下3cm，脾肋下10cm，血红蛋白70g/L，白细胞260×109/L，血小板210×109/L，白细胞分类：中性粗细胞及晚幼粒细胞为主，中性粒细胞碱性磷酸酶活性减低，首选治疗（　　）。", "answer": "羟基脲", "meta_info": "第二部分　模拟试题", "answer_idx": "A", "A": "羟基脲", "B": "三代头孢菌素", "C": "脾切除", "D": "DA方案", "language": "zh"}
{"question": "有关类风湿关节炎和类风湿因子的描述正确的是（　　）。", "answer": "类风湿关节炎可出现类风湿因子阴性", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "类风湿因子阳性可诊断类风湿关节炎", "B": "类风湿关节炎可出现类风湿因子阴性", "C": "类风湿因子属于抗核抗体谱", "D": "平时最常测定的类风湿因子为IgG型", "language": "zh"}
{"question": "诊断肉瘤的主要形态依据（　　）。", "answer": "瘤细胞弥漫分布与间质分界不清", "meta_info": "病理学", "answer_idx": "C", "A": "包膜消失", "B": "瘤细胞异型性明显", "C": "瘤细胞弥漫分布与间质分界不清", "D": "血行转移", "language": "zh"}
{"question": "女性，13岁，昨日进食海鲜，今晨开始畏寒、发热、腹痛，以左下腹痛为重，腹泻伴明显里急后重，每日大便8次，初为稀便，继之为黏液脓血便.此病例的诊断为（　　）。", "answer": "急性普通型细菌性痢疾", "meta_info": "第二部分　模拟试题", "answer_idx": "A", "A": "急性普通型细菌性痢疾", "B": "中毒型细菌性痢疾", "C": "霍乱", "D": "急性肠炎", "language": "zh"}
{"question": "下列对于tRNA的叙述哪项是正确的?（　　）", "answer": "tRNA富有稀有碱基和核苷", "meta_info": "生物化学", "answer_idx": "C", "A": "tRNA是由103个核苷酸组成", "B": "tRNA的二级结构是二叶草型", "C": "tRNA富有稀有碱基和核苷", "D": "在其DHU环中有反密码子", "language": "zh"}
{"question": "头皮裂伤的最长清创时间是（　　）。", "answer": "在应用抗生素情况下可延至72小时", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "4小时", "B": "12小时", "C": "24小时", "D": "在应用抗生素情况下可延至72小时", "language": "zh"}
{"question": "为了戒除烟瘾，在每次吸烟后，应用某种引起恶心、呕吐的药物，反复几次，就再不想吸烟了。这种戒烟方法是（　　）。", "answer": "厌恶疗法", "meta_info": "医学心理学", "answer_idx": "C", "A": "条件操作法", "B": "系统脱敏法", "C": "厌恶疗法", "D": "暴露疗法", "language": "zh"}
{"question": "1．肺炎链球菌的主要致病物质是（　　）。", "answer": "荚膜", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "外毒素", "B": "菌毛", "C": "鞭毛", "D": "荚膜", "language": "zh"}
{"question": "研究者对某铜矿厂全体男职工共150人开展一项前列腺癌筛查研究，筛查出阳性为100人，其中有73人确诊为前列腺癌；阴性为50人，确诊没有前列腺癌的为43人。1．该检测方法的灵敏度为（　　）。", "answer": "73％", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "73％", "B": "69％", "C": "50％", "D": "33％", "language": "zh"}
{"question": "患者感染病原微生物后，血清中最早出现的特异性免疫球蛋白是（　　）。", "answer": "IgM", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "IgM", "B": "IgD", "C": "IgA", "D": "IgE", "language": "zh"}
{"question": "正常人血中HCO3_与H2C03之比为（　　）。", "answer": "20：1", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "C", "A": "10：1", "B": "15：1", "C": "20：1", "D": "30：1", "language": "zh"}
{"question": "女，32岁。有心脏病病史4年。最近感到心悸，听诊发现心率100次/分，心律绝对不齐，第一心音强弱不等，心尖部有舒张期隆隆样杂音。2．为进一步确诊心律失常的类型应首选（　　）。", "answer": "心电图检查", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "嘱病人左侧卧位听诊", "B": "嘱病人屏气后听诊", "C": "心电图检查", "D": "X线胸片", "language": "zh"}
{"question": "急性肾炎病人的尿沉渣中的成分不包括（　　）。", "answer": "脓细胞", "meta_info": "病理学", "answer_idx": "A", "A": "脓细胞", "B": "上皮细胞", "C": "管型", "D": "蛋白质", "language": "zh"}
{"question": "某校住校学生郑某感到不适。几天后确诊患病毒性肝炎。校保健室初步诊治，便安排其去市医院住院治疗，并未引起注意。过几天后，又有郑某的同学、班主任教师、军训的军官相继发病。保健室负责人及管理学生的干部为此受到学校的严厉批评。2．应当报告疫情者可能承担的法律责任是（　　）。", "answer": "行政处分", "meta_info": "卫生法规", "answer_idx": "A", "A": "行政处分", "B": "注销注册", "C": "吊销执照", "D": "行政罚款", "language": "zh"}
{"question": "患哪些疾病的小儿易发生佝偻病？（　　）", "answer": "肾脏疾病", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "重度营养不良", "B": "肾脏疾病", "C": "先天性心脏病", "D": "上呼吸道感染", "language": "zh"}
{"question": "周期性瘫痪的补钾盐方式首选的是（　　）。", "answer": "口服氯化钾", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "口服氯化钾", "B": "静滴氯化钠加氯化钾", "C": "静滴氯化钾", "D": "静滴林格液", "language": "zh"}
{"question": "根据《献血法》的规定，血站对献血者每次采集的血液量为（　　）。", "answer": "200毫升；400毫升", "meta_info": "卫生法规", "answer_idx": "C", "A": "100毫升；150毫升", "B": "200毫升；300毫升", "C": "200毫升；400毫升", "D": "300毫升；400毫升", "language": "zh"}
{"question": "男，20岁。右胸刀刺伤2小时就诊，既往体健。查体：T 36.5℃，P 120次/分，R 24次/分，BP 80／60mmHg。面色苍白，皮肤潮湿，右胸腋前线第5肋间2cm伤口，有血液流出，右胸叩诊实音，呼吸音减弱。急行胸腔闭式引流，引流出血性液体约600ml，1小时内又引流出血性液体300ml。1．此时首先考虑的诊断是（　　）。", "answer": "进行性血胸", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "凝固性血胸", "B": "创伤性血胸", "C": "迟发性血胸", "D": "进行性血胸", "language": "zh"}
{"question": "某孕妇到妇幼保健站体检，医生发现胎儿有异常，经过进一步检查发现胎儿是无脑儿，该医生向孕妇说明了情况并提出医学意见是（　　）。", "answer": "终止妊娠", "meta_info": "卫生法规", "answer_idx": "A", "A": "终止妊娠", "B": "经一个月观察后再处理", "C": "给予药物治疗", "D": "手术治疗", "language": "zh"}
{"question": "不属于宫颈癌临床表现的是（　　）。", "answer": "不孕", "meta_info": "第5篇　女性生殖系统", "answer_idx": "D", "A": "绝经后阴道出血", "B": "接触性阴道出血", "C": "血性白带", "D": "不孕", "language": "zh"}
{"question": "男，36岁，发热2周，伴乏力、食欲不振、轻度腹胀。体检：体温39.3℃，心率80次/min，脾左肋下2cm可及，外周血白细胞4.5×109/L，中性粒细胞0.60，淋巴细胞0.40；肥达反应：“O”抗体效价1：160，“H”抗体效价1：160。4．病原治疗首选（　　）。", "answer": "氧氟沙星", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "C", "A": "复方新诺明", "B": "氨苄西林", "C": "氧氟沙星", "D": "庆大霉素", "language": "zh"}
{"question": "下列疾病应用高效孕激素和假孕疗法治疗效果较差的是（　　）。", "answer": "子宫腺肌病", "meta_info": "第5篇　女性生殖系统", "answer_idx": "D", "A": "卵巢巧克力囊肿", "B": "膀胱的子宫内膜异位", "C": "子宫直肠陷凹病灶", "D": "子宫腺肌病", "language": "zh"}
{"question": "脑器质性精神障碍的病理改变大多是因为（　　）。", "answer": "脑萎缩和变性", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "脑代谢障碍", "B": "脑萎缩和变性", "C": "脑肿瘤", "D": "脑外伤", "language": "zh"}
{"question": "患儿，男，7月，因发热、腹泻2天于10月16日入院。2天前开始发热，呕吐2次，继之出现腹泻，稀水样便6～8次/天，量多，次日热退吐止，腹泻加重，尿量减少，精神萎靡，前囟眼窝凹陷，皮肤弹性差，心肺听诊阴性。1．最可能的腹泻原因是（　　）。", "answer": "病毒性腹泻", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "细菌性痢疾", "B": "病毒性腹泻", "C": "坏死性小肠结肠炎", "D": "急性胃肠炎", "language": "zh"}
{"question": "子宫颈癌的始发部位通常是（　　）。", "answer": "子宫颈移行带区", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "子宫颈组织学内口区", "B": "子宫颈管柱状上皮区", "C": "子宫颈移行带区", "D": "宫颈鳞状上皮区", "language": "zh"}
{"question": "下列何种情况属于炎症性渗出？（　　）", "answer": "烧伤后皮肤水泡形成", "meta_info": "病理学", "answer_idx": "A", "A": "烧伤后皮肤水泡形成", "B": "碰伤后皮下血肿形成", "C": "胸膜间皮瘤患者胸腔积液", "D": "以上都不是", "language": "zh"}
{"question": "5岁女孩，外院诊断为先天性心脏病Roger病。此患儿首先出现的血流动力学变化是（　　）。", "answer": "左心室扩大", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "左心房、右心房扩大", "B": "左心室、右心室扩大", "C": "左心室扩大", "D": "右心室扩大", "language": "zh"}
{"question": "血小板输注禁忌症（　　）。", "answer": "血栓性血小板减少性紫癜", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "化疗导致的血小板减少", "B": "血小板功能障碍", "C": "血栓性血小板减少性紫癜", "D": "放疗导致的血小板减少", "language": "zh"}
{"question": "女性，40岁。四肢关节肿痛l0年，X线示双手指关节及腕关节有多处骨质破坏，关节检查有多个关节肿痛，脾脏肋下2cm，质较硬。化验：WBC 2.3×109/L，血小板66×109/L，ESR 50mm/h，长期服用非甾体类消炎药。最可能的诊断是（　　）。", "answer": "Felty综合征", "meta_info": "第五部分　风湿免疫性疾病", "answer_idx": "B", "A": "系统性红斑狼疮", "B": "Felty综合征", "C": "肝硬化脾亢", "D": "药物性再障", "language": "zh"}
{"question": "对于中毒性痢疾下列哪一项是错误的？（　　）", "answer": "由痢疾杆菌裂解后释放出大量外毒素进入血循环所致", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "本病的发生与患儿特异性体质有关", "B": "多见于2～7岁体质较好小儿", "C": "由痢疾杆菌裂解后释放出大量外毒素进入血循环所致", "D": "未腹泻前即出现严重的感染中毒症状", "language": "zh"}
{"question": "2．分离培养脑膜炎奈瑟菌选用（　　）。", "answer": "巧克力色培养基", "meta_info": "医学微生物学", "answer_idx": "C", "A": "血平板", "B": "沙保培养基", "C": "巧克力色培养基", "D": "罗氏培养基", "language": "zh"}
{"question": "判断乳腺包块周围血供情况首选的检查方法是（　　）。", "answer": "乳腺B超", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "乳腺MRI", "B": "乳腺B超", "C": "钼钯摄片", "D": "PET-CT", "language": "zh"}
{"question": "增生型皮质醇增多症伴垂体微腺瘤，首选的治疗方案是（　　）。", "answer": "经蝶窦切除垂体微腺瘤", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "C", "A": "双肾上腺全切加垂体放疗", "B": "肾上腺次全切除加垂体放疗", "C": "经蝶窦切除垂体微腺瘤", "D": "一侧肾上腺全切，一侧大部分切除", "language": "zh"}
{"question": "2．贲门失弛症吞钡X线片示（　　）。", "answer": "食管下段呈鸟嘴状改变", "meta_info": "第3篇　消化系统", "answer_idx": "A", "A": "食管下段呈鸟嘴状改变", "B": "食管中段局限性充盈缺损", "C": "食管大部分呈线性狭窄", "D": "食管下段黏膜呈串珠样改变", "language": "zh"}
{"question": "男性，30岁，工程师，大学文化，一年前独自到树林中迷路时，听到两个割草人在谈话：“在树林中看到一头黑熊。”找这两个人时旁边一个人都没有，四处寂静无声。后来在车间丁作时看到了自己家墙上的钟和图画，或者“就是现在眼前”或者“在头脑里面”。有时耳边听到一群不工作的人放肆地大量喝酒。对妻子到医院探视抱有憎恨，认为医生要毒死他。躯体检查无异常。1．该患者诊断考虑（　　）。", "answer": "精神分裂症", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "精神分裂症", "B": "脑器质性精神病", "C": "癔病", "D": "抗抑郁治疗", "language": "zh"}
{"question": "男性，26岁。外伤致肱骨中下1/3长斜形骨折，来院检查时发现有垂腕、垂指畸形。2．该患者宜选择痛苦小，稳妥的治疗方法为（　　）。", "answer": "手法复位，悬垂石膏固定，观察2～3个月，如垂腕垂指无恢复再行手术治疗", "meta_info": "第四部分　运动系统疾病", "answer_idx": "D", "A": "立即切开复位，内固定，同时探查并修复受损的神经", "B": "手法复位，小夹板固定，观察", "C": "手法复位，U形石膏固定，观察", "D": "手法复位，悬垂石膏固定，观察2～3个月，如垂腕垂指无恢复再行手术治疗", "language": "zh"}
{"question": "24岁女性，停经58d，13d前行人工流产吸宫术。术后持续阴道出血。2．为明确诊断，首先应选用的辅助检查方法是（　　）。", "answer": "B超检查", "meta_info": "第二部分　模拟试题", "answer_idx": "C", "A": "腹腔镜检查", "B": "子宫镜检查", "C": "B超检查", "D": "血常规检查", "language": "zh"}
{"question": "男性，30岁，车祸2小时后来院。一般情况尚好，右小腿中上段皮裂伤14cm，软组织挫伤较重，胫骨折端有外露，出血不多。在进行X线片检查前2．此时最佳的处理方法是（　　）。", "answer": "清创术，骨折复位，外固定支架固定", "meta_info": "第四部分　运动系统疾病", "answer_idx": "A", "A": "清创术，骨折复位，外固定支架固定", "B": "清创术，夹板固定", "C": "清创术，骨折复位，髓针内固定", "D": "清创术，骨折复位，钢板内固定", "language": "zh"}
{"question": "医师在执业活动中享有的权利为（　　）。", "answer": "人格尊严、人身安全不受侵犯", "meta_info": "卫生法规", "answer_idx": "B", "A": "努力钻研业务，及时更新知识", "B": "人格尊严、人身安全不受侵犯", "C": "尊重患者隐私权", "D": "爱岗敬业，努力工作", "language": "zh"}
{"question": "某患者被疑为新型隐球菌性脑膜炎，最有意义的快速诊断方法是，采集脑脊液，离心沉渣后，进行哪项检查？（　　）", "answer": "涂片后墨汁染色", "meta_info": "医学微生物学", "answer_idx": "D", "A": "新型隐球菌培养", "B": "钩端螺旋体培养", "C": "涂片后革兰染色", "D": "涂片后墨汁染色", "language": "zh"}
{"question": "女，24岁，足月妊娠临产10小时，孕妇烦躁不安，疼痛喊叫，肠胀气。检查发现宫缩间歇期不放松，子宫长度34cm，腹围100cm，枕左前位，胎心156次/min，宫口扩张1cm，胎头S－2。2．最可能的原因是（　　）。", "answer": "头盆不称", "meta_info": "第5篇　女性生殖系统", "answer_idx": "C", "A": "羊水过多", "B": "脐带脱垂", "C": "头盆不称", "D": "胎儿窘迫", "language": "zh"}
{"question": "1．穿棉衣御寒主要是降低（　　）。", "answer": "对流散热", "meta_info": "生理学", "answer_idx": "C", "A": "辐射散热", "B": "传导散热", "C": "对流散热", "D": "蒸发散热", "language": "zh"}
{"question": "患者，5岁，水肿、少尿10余日，既往健康。查体：神志清，血压100/70mmHg，颜面及四肢凹陷性水肿。尿检：蛋白质（+++），红细胞8～10个/HP。血浆清蛋白25g/L，胆固醇9mmol/L。治疗应选（　　）。", "answer": "泼尼松口服8～12周", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "泼尼松口服8～12周", "B": "静脉注射呋塞米+青霉素", "C": "泼尼松+环磷酰胺口服8～12周", "D": "泼尼松口服9～12月", "language": "zh"}
{"question": "癌痛治疗三阶梯方法中哪一项是错误的？（　　）", "answer": "不宜用强阿片药物，以免成瘾", "meta_info": "药理学", "answer_idx": "D", "A": "用药剂量要个体化", "B": "要按时，而不按需（只在痛时）给药", "C": "对轻度疼痛选用镇痛解热药", "D": "不宜用强阿片药物，以免成瘾", "language": "zh"}
{"question": "患者，男，70岁。右腹股沟区肿块3年，平卧消失。查体：右耻骨结节外上方有一半球形肿块，未进入阴囊，可用手回纳，压住腹腔沟韧带中点上方咳嗽时仍可见肿块突出。最可能的诊断是（　　）。", "answer": "腹股沟直疝", "meta_info": "第二部分　模拟试题", "answer_idx": "B", "A": "腹股沟斜疝", "B": "腹股沟直疝", "C": "精索鞘膜积液", "D": "交通性鞘膜积液", "language": "zh"}
{"question": "男，21岁。头痛、嗜睡伴发热，意识不清加重，大小便失禁，全身强直性抽搐半分钟，脑脊液检查蛋白质、糖、氯化物均在正常值范围内。最可能的诊断是（　　）。", "answer": "单纯疱疹性脑炎", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "流行性乙型脑炎", "B": "单纯疱疹性脑炎", "C": "病毒性肝炎", "D": "肾综合征出血热", "language": "zh"}
{"question": "引起单纯性下肢静脉曲张的原因是（　　）。", "answer": "静脉壁薄弱和静脉内压持续升高", "meta_info": "第2篇　心血管系统", "answer_idx": "C", "A": "妊娠子宫压迫", "B": "长时间站立", "C": "静脉壁薄弱和静脉内压持续升高", "D": "髂静脉血栓形成", "language": "zh"}
{"question": "刘某等人未经有关部门批准，私设地下血站，非法采集血液，获取可观利益，经群众举报被查获。根据《献血法》规定，对刘某等人可以作出行政处罚的部门是（　　）。", "answer": "县级以上地方人民政府卫生行政部门", "meta_info": "卫生法规", "answer_idx": "B", "A": "省级卫生行政部门", "B": "县级以上地方人民政府卫生行政部门", "C": "县级人民政府药品监督管理部门", "D": "县级人民政府公安部门", "language": "zh"}
{"question": "下列对于增强子的叙述不正确是（　　）。", "answer": "增强子只在个别真核生物中存在，无普遍性", "meta_info": "生物化学", "answer_idx": "D", "A": "增强子是远离启动子的顺式作用元件", "B": "增强子决定基因表达的组织特异性", "C": "增强子作用无方向性", "D": "增强子只在个别真核生物中存在，无普遍性", "language": "zh"}
{"question": "动脉粥样硬化最好发生的部位是（　　）。", "answer": "主动脉", "meta_info": "病理学", "answer_idx": "A", "A": "主动脉", "B": "脑动脉", "C": "肾动脉", "D": "冠状动脉", "language": "zh"}
{"question": "病人自觉大脑突然出现大量不自主的、杂乱无章的陌生思维内容是（　　）。", "answer": "强制性思维", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "强制性思维", "B": "思维散漫", "C": "思维奔逸", "D": "被洞悉感", "language": "zh"}
{"question": "3．轮状病毒肠炎（　　）。", "answer": "秋季起病，大便呈蛋花汤样、量多、次数多、无腥臭味，便常规偶见白细胞", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "大便呈水样便、腥臭味，便常规有白细胞，少量红细胞", "B": "大便呈稀黄色，泡沫较多，可呈豆腐渣样、便常规少量白细胞", "C": "多夏季起病，粘液脓血便，便常规大量白细胞、可见红细胞", "D": "秋季起病，大便呈蛋花汤样、量多、次数多、无腥臭味，便常规偶见白细胞", "language": "zh"}
{"question": "诊断低位肠梗阻最可靠的证据是（　　）。", "answer": "腹部平片示小肠多个阶梯状气液平", "meta_info": "第3篇　消化系统", "answer_idx": "A", "A": "腹部平片示小肠多个阶梯状气液平", "B": "脐周可闻气过水音", "C": "置胃管行胃肠减压后梗阻症状明显减轻", "D": "频繁呕吐、呕吐量大", "language": "zh"}
{"question": "胃溃疡底部常见动脉内血栓机化，下述哪项是该处血栓形成的最主要机制？（　　）", "answer": "溃疡组织释出多量组织凝血酶原", "meta_info": "病理学", "answer_idx": "A", "A": "溃疡组织释出多量组织凝血酶原", "B": "溃疡处动脉内膜炎致内膜粗糙", "C": "溃疡处纤维化使动脉内血流不规则", "D": "胃液促进凝血过程", "language": "zh"}
{"question": "女，40岁。半月前头痛，恶心，呕吐2次，伴低热，问话不答。独自发呆，卧床不起，抽搐2次。查体：血压140／90mmHg，下肢肌张力增高，右侧巴氏征（＋）。脑电图：弥漫性σ波，以额颞叶为主，有阵发性尖波发放。3．首选的治疗手段是（　　）。", "answer": "抗病毒治疗与对症治疗", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "心理治疗", "B": "中药治疗", "C": "抗病毒治疗与对症治疗", "D": "抗抑郁药物", "language": "zh"}
{"question": "关于妊娠期母体乳房的变化，正确的是（　　）。", "answer": "乳头增大变黑，乳晕颜色加深", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "妊娠晚期开始乳汁分泌", "B": "大量雌激素刺激乳腺腺泡发育", "C": "初乳为白色浓稠液体", "D": "乳头增大变黑，乳晕颜色加深", "language": "zh"}
{"question": "13岁女性，2年前起病，于生气后突然大叫一声，随之倒地呼之不应，牙关紧闭，双眼上视，头颈后仰，四肢抽搐，无二便失禁，无舌咬伤。发作停止后对整个过程不能回忆，未给予特殊处置，照常上学。2个月后于夜间入睡后又出现抽搐，有小便失禁。抽搐停止后，突然起床冲出门外，无目的漫游，呼之不应，冲动毁物，持续2小时后恢复清醒，对经过全无记忆。此后反复有类似发作，平均每月3次。3．最有效的治疗措施为（　　）。", "answer": "卡马西平治病", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "氯丙嗪治疗", "B": "心理治疗", "C": "卡马西平治病", "D": "电休克", "language": "zh"}
{"question": "下列叙述，不属于病人道德权利的是（　　）。", "answer": "要求保守个人任何隐私的权利", "meta_info": "医学伦理学", "answer_idx": "D", "A": "拒绝治疗和人体实验的权利", "B": "享受医疗服务的权利", "C": "获得所患病情实况的权利", "D": "要求保守个人任何隐私的权利", "language": "zh"}
{"question": "我国肺动脉栓塞最常见病因是（　　）。", "answer": "心脏病", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "血栓", "B": "心脏病", "C": "肿瘤", "D": "遗传因素", "language": "zh"}
{"question": "治疗癫痫持续状态的首选药物是（　　）。", "answer": "安定，缓慢静脉注射", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "50%苯妥英钠，缓慢静脉注射", "B": "副醛缓慢静脉注射", "C": "10%水合氯醛，保留灌肠", "D": "安定，缓慢静脉注射", "language": "zh"}
{"question": "4．恢复经验的过程（　　）。", "answer": "再现", "meta_info": "医学心理学", "answer_idx": "B", "A": "保存", "B": "再现", "C": "再认", "D": "复述", "language": "zh"}
{"question": "对于普萘洛尔抗心绞痛方面，哪一项是不正确的？（　　）", "answer": "对变异性心绞痛效果好", "meta_info": "药理学", "answer_idx": "A", "A": "对变异性心绞痛效果好", "B": "久用后不宜突然停药", "C": "对兼有高血压的效果好", "D": "对稳定型和不稳定型心绞痛都有效", "language": "zh"}
{"question": "下述哪一项不属于锥体外系？（　　）", "answer": "内囊", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "红核", "B": "纹状体", "C": "黑质", "D": "内囊", "language": "zh"}
{"question": "哪项为外科感染发生的最重要的原因？（　　）", "answer": "致病菌侵入人体", "meta_info": "第八部分　其他疾病", "answer_idx": "A", "A": "致病菌侵入人体", "B": "伤口/创面的存在", "C": "未及时使用抗生素", "D": "局部组织血供循环不佳", "language": "zh"}
{"question": "2．诊断早期原发性肝癌最有意义的检查是（　　）。", "answer": "血清甲胎蛋白检测", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "血清甲胎蛋白检测", "B": "腹部CT检查", "C": "血CEA", "D": "血CRP", "language": "zh"}
{"question": "15天新生儿，男性，以反应差不吃奶2天，加重1天收入院。查体：反应差，面色发灰，皮肤轻度黄染，有少量出血点，心音稍低，肺呼吸音清析，腹软，肝肋下2cm，脾肋下1cm，四肢活动少，腋下、背部可见数个脓疱疹，绿豆到黄豆大小，有黄色脓性渗出液，脐部干燥，神经系统未见异常。白细胞21×109/L，中性70%，淋巴30%，血小板90×109/L。2．根据病史、查体和白细胞变化考虑哪种细菌感染可能性大？（　　）", "answer": "葡萄球菌", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "大肠杆菌", "B": "破伤风杆菌", "C": "葡萄球菌", "D": "脑膜炎双球菌", "language": "zh"}
{"question": "女性，18岁，发热、鼻出血、皮肤紫癜2周。舌尖可见血疱，双下肢可见瘀斑，浅表淋巴结及肝脾未及，胸骨压痛阴性。血红蛋白52g/L，白细胞2.0×109/L，中性粒细胞0.24，淋巴细胞0.75，嗜碱粒细胞0.1，血小板22×109/L，网织红细胞0.1。胸部X线片示右下肺炎。2．明确诊断应先做哪项检查？（　　）", "answer": "骨髓检查", "meta_info": "第一部分　血液系统疾病", "answer_idx": "B", "A": "B超", "B": "骨髓检查", "C": "MRI", "D": "放射性核素骨扫描", "language": "zh"}
{"question": "1．浸润性突眼（　　）。", "answer": "球后及眶内软组织水肿增生，粘多糖增多，淋巴细胞、浆细胞浸润，突眼度19mm以上，眶内成纤维细胞结合抗体增加", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "D", "A": "交感神经兴奋致眼外肌及上睑肌张力增加所致，突眼度16～18mm", "B": "交感神经兴奋致眼外肌及上睑肌张力增加所致，突眼度19mm以上，眶内成纤维细胞结合抗体增加", "C": "球后及眶内软组织水肿增生，粘多糖增多，淋巴细胞、浆细胞浸润，突眼度18mm", "D": "球后及眶内软组织水肿增生，粘多糖增多，淋巴细胞、浆细胞浸润，突眼度19mm以上，眶内成纤维细胞结合抗体增加", "language": "zh"}
{"question": "关于尊重原则，正确的是（　　）。", "answer": "尊重原则也包括尊重那些没到法定年龄的人，有时甚至还包括他们的有些决定", "meta_info": "医学伦理学", "answer_idx": "C", "A": "尊重原则是指尊重那些值得尊重的人和他们的决定", "B": "尊重原则不包括尊重那些没到法定年龄的人和他们的决定", "C": "尊重原则也包括尊重那些没到法定年龄的人，有时甚至还包括他们的有些决定", "D": "尊重原则与有利原则冲突时，绝对要以尊重原则为主", "language": "zh"}
{"question": "硝酸甘油通过下列哪种作用产生抗心绞痛效应（　　）。", "answer": "扩张小动脉、小静脉和较大的冠状血管", "meta_info": "药理学", "answer_idx": "C", "A": "心肌收缩力减弱", "B": "心率减慢，心脏舒张期相对延长", "C": "扩张小动脉、小静脉和较大的冠状血管", "D": "扩张小动脉，回心血量减少，心室容积减少，心肌耗氧量降低", "language": "zh"}
{"question": "能同时启动内源和外源性凝血途径引起DIC的是（　　）。", "answer": "严重感染", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "羊水栓塞", "B": "急性早幼粒细胞性白血病", "C": "广泛创伤", "D": "严重感染", "language": "zh"}
{"question": "7月初，6岁小儿突发高热，抽搐，昏迷，脑膜刺激征（±），初步诊为乙脑，首先要鉴别的疾病是（　　）。", "answer": "中毒性菌痢", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "A", "A": "中毒性菌痢", "B": "感染中毒性脑病", "C": "散发性脑炎", "D": "结核性脑膜炎", "language": "zh"}
{"question": "关于IFN-α和IFN-β哪种叙述是错误的（　　）。", "answer": "发挥作用不需与相应受体结合", "meta_info": "医学免疫学", "answer_idx": "D", "A": "由白细胞、成纤维细胞和病毒感染的组织细胞产生", "B": "可由病毒、多聚肌苷酸和多聚胞苷酸诱导产生", "C": "具有抗病毒作用", "D": "发挥作用不需与相应受体结合", "language": "zh"}
{"question": "1．治疗有神经系统症状的巨幼细胞性贫血首选药（　　）。", "answer": "维生素B12", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "维生素B12", "B": "叶酸", "C": "维生素C", "D": "维生素B6", "language": "zh"}
{"question": "女，38岁。粘液脓血便伴里急后重3年。近1周腹痛加重。体检：体温37.5℃，贫血貌，左下腹部轻压痛。2．为明确诊断首选的检查是（　　）。", "answer": "结肠镜检查", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "尿常规", "B": "血清CA19-9", "C": "腹部CT", "D": "结肠镜检查", "language": "zh"}
{"question": "男性，50岁，甲亢患者，甲状腺Ⅱ°肿大，有房颤。经丙硫氧嘧啶治疗3个月后，甲状腺未缩小，房颤未消失。此病治疗应（　　）。", "answer": "改用放射性131I治疗", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "C", "A": "继续原治疗+普萘洛尔", "B": "继续原有治疗", "C": "改用放射性131I治疗", "D": "改用手术治疗", "language": "zh"}
{"question": "活动性风湿性心脏病时，阿绍夫小体常见部位是（　　）。", "answer": "心肌间质", "meta_info": "病理学", "answer_idx": "C", "A": "心外膜内", "B": "心瓣膜内", "C": "心肌间质", "D": "心肌传导系统", "language": "zh"}
{"question": "根据骨折是否与外界相通，可把骨折分为（　　）。", "answer": "开放性骨折和闭合性骨折", "meta_info": "第四部分　运动系统疾病", "answer_idx": "D", "A": "压缩性骨折和横行骨折", "B": "稳定性骨折和不稳定性骨折", "C": "完全性骨折和不完全性骨折", "D": "开放性骨折和闭合性骨折", "language": "zh"}
{"question": "下列不属于酶联免疫吸附试验(ELISA)的方法是（　　）。", "answer": "Western印迹法", "meta_info": "医学免疫学", "answer_idx": "A", "A": "Western印迹法", "B": "间接法", "C": "BAS-ELISA", "D": "ELISPOT测定法", "language": "zh"}
{"question": "男性，43岁，近20年来每年发作一次鬼神附体，以大仙口气说话，要求父亲烧香拜佛，持续数小时后痊愈，一个半月前开始疲乏无力，不认家人，好忘事，小便尿在裤内，右侧轻偏瘫，右手拿不住东西，好跟别人说话。既往史：23岁时有冶游史。神经系统检查：两侧瞳孔不等大，右瞳孔边缘不整齐，左侧椭圆形，右侧瞳孔光反射消失。2．最可能是哪个诊断?（　　）", "answer": "大脑梅毒所致精神障碍", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "大脑梅毒所致精神障碍", "B": "癔症", "C": "早老性痴呆", "D": "脑肿瘤", "language": "zh"}
{"question": "男，75岁。排尿困难3年，加重2周。直肠指检发现前列腺结节，质地硬。血清PAS 30ng/ml。1．为明确诊断，最重要的检查是是（　　）。", "answer": "前列腺穿刺活检", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "前列腺穿刺活检", "B": "前列腺MRI", "C": "膀胱尿道镜检查", "D": "经直肠前列腺超声", "language": "zh"}
{"question": "关于食管的描述正确的是（　　）。", "answer": "食管可分为颈部、胸部和腹部三部分", "meta_info": "第3篇　消化系统", "answer_idx": "B", "A": "食管的两端经常处于开放状态", "B": "食管可分为颈部、胸部和腹部三部分", "C": "食管的腹部段最长", "D": "食管由平滑肌组成", "language": "zh"}
{"question": "女性，53岁，10年前出现情绪低落与情感高涨交替出现，情绪低落时表现为早醒、闷闷不乐、不思饮食，对事物失去兴趣，足不出户，轻生念头明显，持续2～3个月后，突然转为话多、兴奋、整日忙忙碌碌、四处购物、爱交际、自感精力充沛，才智过人，持续1月后，再次转为情绪低落，如此反复。体检及神经系统无异常。4．碳酸锂早期副作用表现为（　　）。", "answer": "恶心呕吐，腹泻", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "恶心呕吐，腹泻", "B": "甲状腺肿大", "C": "体重增加", "D": "心电图低钾样改变", "language": "zh"}
{"question": "患者，女，42岁。发热、咳嗽、右胸痛3天。查体：T 38.5℃.右下肺语音震颤增强，呼吸音略减弱。该患者最可能的诊断是（　　）。", "answer": "肺炎", "meta_info": "第1篇　呼吸系统", "answer_idx": "B", "A": "气胸", "B": "肺炎", "C": "胸腔积液", "D": "肺气肿", "language": "zh"}
{"question": "下列哪项是双胍类降糖药最常见的副作用？（　　）", "answer": "胃肠道反应", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "B", "A": "低血糖", "B": "胃肠道反应", "C": "过敏性皮疹", "D": "肝功能异常", "language": "zh"}
{"question": "以躯干、四肢等大腿肌肉群参与为主的、有节律、时间较长，能够维持在一个稳定状态的身体活动称为（　　）。", "answer": "有氧运动", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "阻力活动", "B": "体适能", "C": "协调性活动", "D": "有氧运动", "language": "zh"}
{"question": "影响外周阻力最主要的因素是（　　）。", "answer": "小动脉口径", "meta_info": "生理学", "answer_idx": "D", "A": "红细胞数目", "B": "血液黏滞性", "C": "血管长度", "D": "小动脉口径", "language": "zh"}
{"question": "慢性支气管炎患者咳痰的病变基础是（　　）。", "answer": "黏液腺肥大、增生，分泌亢进，浆液腺黏液化", "meta_info": "第1篇　呼吸系统", "answer_idx": "D", "A": "黏膜上皮纤毛倒伏、脱失", "B": "细支气管周围炎", "C": "黏膜上皮细胞变性、坏死、脱落", "D": "黏液腺肥大、增生，分泌亢进，浆液腺黏液化", "language": "zh"}
{"question": "FAB分类，哪一项POX反应、非特异酯酶均阴性？（　　）", "answer": "ALL-L3", "meta_info": "第一部分　血液系统疾病", "answer_idx": "A", "A": "ALL-L3", "B": "M3b", "C": "M5", "D": "M4", "language": "zh"}
{"question": "衣氏放线菌感染最常见部位是（　　）。", "answer": "面、颈部软组织", "meta_info": "医学微生物学", "answer_idx": "C", "A": "中枢神经系统", "B": "骨和关节", "C": "面、颈部软组织", "D": "肺部", "language": "zh"}
{"question": "乳腺癌的癌前病变是（　　）。", "answer": "纤维囊性乳腺病伴不典型增生", "meta_info": "病理学", "answer_idx": "B", "A": "硬化性乳腺病", "B": "纤维囊性乳腺病伴不典型增生", "C": "纤维腺癌", "D": "乳腺结构不良", "language": "zh"}
{"question": "流行性乙型脑炎，下列哪项是病变最轻的部位？（　　）", "answer": "脊髓", "meta_info": "病理学", "answer_idx": "A", "A": "脊髓", "B": "基底节", "C": "脑桥", "D": "延髓", "language": "zh"}
{"question": "女，60岁。上腹胀痛伴恶心。呕吐2天，右下腹痛阵发加剧、腹胀半天。查体：T 38.3℃，P 120次/分，BP 150／90mmHg，全腹压痛（＋），右下腹明显，有肌紧张，肝浊音界存在，未闻及肠鸣音。实验室检查：WBC 13.0×109/L，N 0.88。右下腹穿刺抽出黄色混浊液体2ml，镜检脓细胞（＋＋）。最可能的诊断是（　　）。", "answer": "阑尾炎穿孔并弥漫性腹膜炎", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "绞窄性肠梗阻", "B": "阑尾炎穿孔并弥漫性腹膜炎", "C": "消化性溃疡穿孔并弥漫性腹膜炎", "D": "伤寒肠穿孔并弥漫性腹膜炎", "language": "zh"}
{"question": "男性，67岁。上腹痛半年，黑便两个月。手术标本胃窦部粘膜弥漫增厚、质硬、磁白色，并可见磁白色条索侵入肌层，深达浆膜，胃小弯及大弯淋巴结肿大。该病变最可能是（　　）。", "answer": "胃腺癌", "meta_info": "病理学", "answer_idx": "B", "A": "胃溃疡病", "B": "胃腺癌", "C": "胃鳞癌", "D": "以上都不是", "language": "zh"}
{"question": "某患者因外伤引起脊髓半离断，其感觉障碍表现为（　　）。", "answer": "离断侧深感觉障碍，对侧浅感觉障碍", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "离断侧深感觉障碍，对侧浅感觉障碍", "B": "离断侧深感觉、浅感觉均障碍", "C": "离断侧深感觉障碍，对侧浅感觉正常", "D": "离断侧浅感觉障碍，对侧深感觉正常", "language": "zh"}
{"question": "治疗风湿性心肌炎的首选药是（　　）。", "answer": "肾上腺皮质激素", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "阿司匹林", "B": "吲哚美辛", "C": "布洛芬", "D": "肾上腺皮质激素", "language": "zh"}
{"question": "肺炎患儿进食不足或不能进食时，输注液体宜选用（　　）。", "answer": "生理维持液", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "生理维持液", "B": "5%葡萄糖", "C": "2∶2∶1液", "D": "5%碳酸氢钠", "language": "zh"}
{"question": "患儿，2岁，近20天低热、咳嗽、盗汗、乏力。双肺呼吸音粗，胸部X线见左肺哑铃“双极影”。下述哪一项不是判断活动性肺结核的主要指征？（　　）", "answer": "痰液中找到革兰阴性杆菌", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "结核中毒病状", "B": "未接种卡介苗“OT”试验≥20mm", "C": "痰液中找到革兰阴性杆菌", "D": "纤维支气管镜检查有明显支气管结核病变", "language": "zh"}
{"question": "男，20岁。乏力、皮肤色素沉着1年余，经常感冒，食欲差，偶尔恶心、呕吐。查体：P 84次/分，BP 90/60mmHg，体形偏瘦，皮肤较黑，掌纹、乳晕、齿龈、颊黏膜等色素沉着明显。余未见异常。最可能的诊断是（　　）。", "answer": "原发性肾上腺皮质功能减退症", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "结核", "B": "淋巴瘤", "C": "原发性肾上腺皮质功能减退症", "D": "先心病", "language": "zh"}
{"question": "下列药物中，治疗急性心源性肺水肿的首选药物是（　　）。", "answer": "呋塞米", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "呋塞米", "B": "螺内酯", "C": "氨苯蝶啶", "D": "乙酰唑胺", "language": "zh"}
{"question": "关于卵巢形态特征，说法正确的是（　　）。", "answer": "卵巢实质由皮质和髓质组成", "meta_info": "第5篇　女性生殖系统", "answer_idx": "D", "A": "卵巢白膜是平滑肌组织", "B": "卵巢以骨盆漏斗韧带与子宫相连", "C": "卵巢表面有腹膜覆盖", "D": "卵巢实质由皮质和髓质组成", "language": "zh"}
{"question": "2．子宫颈癌（　　）。", "answer": "与病毒感染有关", "meta_info": "病理学", "answer_idx": "A", "A": "与病毒感染有关", "B": "雌激素增高", "C": "遗传因素", "D": "C+B", "language": "zh"}
{"question": "1．刺激小肠黏膜释放促胰液素的最强的物质是（　　）。", "answer": "盐酸", "meta_info": "生理学", "answer_idx": "A", "A": "盐酸", "B": "蛋白质分解产物", "C": "脂酸钠", "D": "脂肪", "language": "zh"}
{"question": "一急性白血病患者住院3周后，高热、头痛、呕吐、颈项强直，此时最佳治疗方案为（　　）。", "answer": "化疗＋鞘内注射", "meta_info": "第一部分　血液系统疾病", "answer_idx": "B", "A": "抗生紊", "B": "化疗＋鞘内注射", "C": "免疫抑制剂", "D": "输血", "language": "zh"}
{"question": "男，45岁，外伤失血性休克，输入大量血液一周后，全身皮下散在紫癜，血小板低于10×109/L。治疗用药应是（　　）。", "answer": "地塞米松", "meta_info": "药理学", "answer_idx": "C", "A": "氨甲苯酸", "B": "阿司匹林", "C": "地塞米松", "D": "麻黄素", "language": "zh"}
{"question": "治疗肝癌的首选方法是（　　）。", "answer": "肝切除", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "肝切除", "B": "介入治疗", "C": "化疗", "D": "放疗", "language": "zh"}
{"question": "男，4个月，体重5kg，腹泻3天，每日7或8次，蛋花汤样、无腥臭，奶后呕吐2次。面色稍苍白，上腭裂，精神较差，皮肤稍干燥，眼窝、前囟凹陷，皮下脂肪0.3cm，皮肤弹性较差，哭有泪，四肢末梢较冷，血清钠128mmol/L。2．其第一天补液总量每公斤为（　　）。", "answer": "120～150ml", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "60～80ml", "B": "90～120ml", "C": "120～150ml", "D": "150～180ml", "language": "zh"}
{"question": "7岁女童，性格腼腆，近1个月来频繁出现夜间睡眠时哭喊，多在前半夜，并拍打被褥，神情恐惧，难以唤醒，约5min后安静重新入睡，次日不能回忆夜间发生之事。1．根据以上病史，诊断考虑（　　）。", "answer": "夜惊", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "夜惊", "B": "分离性漫游", "C": "梦魇", "D": "恐惧症", "language": "zh"}
{"question": "27岁，男性，病程5年，性格孤僻，不上班，将自己的东西都卖掉，流浪街头，睡门洞，在饭店讨饭吃，时有自言自语，经常呼唤着因病过世的母亲的名字。精神检查：意识清晰，衣着不整，表情淡漠，对人冷淡，常对人冷笑，孤僻离群，时有奇怪想法，如“不能利用出现的一种倾向掩盖另一种倾向”。躯体及神经系统检查无异常。诊断为（　　）。", "answer": "精神分裂症", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "抑郁症", "B": "精神分裂症", "C": "精神发育迟滞", "D": "脑器质性精神障碍", "language": "zh"}
{"question": "对利多卡因抗心律失常作用叙述正确的是（　　）。", "answer": "缩短动作电位时程和有效不应期，相对延长有效不应期", "meta_info": "药理学", "answer_idx": "D", "A": "β受体阻断作用", "B": "促进Na+内流", "C": "抑制K+外流", "D": "缩短动作电位时程和有效不应期，相对延长有效不应期", "language": "zh"}
{"question": "2．按测验形式可分为（　　）。", "answer": "个别测验和团体测验", "meta_info": "医学心理学", "answer_idx": "C", "A": "能力测验、人格测验、神经心理测验、评定量表、职业咨询测验", "B": "智力测验、特殊能力测验、成就测验和人格测验", "C": "个别测验和团体测验", "D": "常规测验和投射测验", "language": "zh"}
{"question": "有关DNA分子碱基组成的Chargaff规则揭示中，错误的是（　　）。", "answer": "同一个体的肝脏和肾脏的DNA具有不同的碱基组成", "meta_info": "生物化学", "answer_idx": "C", "A": "腺嘌呤与胸腺嘧啶的含量相等", "B": "不同生物种属的DNA碱基组成不同", "C": "同一个体的肝脏和肾脏的DNA具有不同的碱基组成", "D": "同一个体的肌细胞和神经细胞的DNA具有相同的碱基组成", "language": "zh"}
{"question": "初产妇，28岁。在家中自然分娩后15天，阴道多量流血1天。无寒战、高热。查体： T 37℃，P 80次分，R 18次分，BP 90/60mmHg，子宫如妊娠3个月大，质软，压痛不明显，宫口松，能容2指。其阴道流血最可能的原因是（　　）。", "answer": "胎盘、胎膜残留", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "胎盘、胎膜残留", "B": "子宫颈裂伤", "C": "子宫内膜炎", "D": "子宫脱垂", "language": "zh"}
{"question": "保存断肢最好的方法是（　　）。", "answer": "包装于口袋内干燥冷藏", "meta_info": "第四部分　运动系统疾病", "answer_idx": "C", "A": "浸泡于抗生素溶液中", "B": "浸泡于新洁尔灭溶液中", "C": "包装于口袋内干燥冷藏", "D": "置于冰块内", "language": "zh"}
{"question": "女性，25岁，近年来难以控制地持续服用某种药物，且每次用药量不断增加，不服药或少服药时感到痛苦难忍，因此无法停服此药。2．该患者目前处于下列哪一种状态?（　　）", "answer": "心理依赖状态", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "焦虑状态", "B": "谵妄状态", "C": "妄想状态", "D": "心理依赖状态", "language": "zh"}
{"question": "女性，27岁，患糖尿病5年，消瘦，血糖常在167mmol/L（300mg/dl）以上，易出现酮症，胰岛素释放试验低平型，较好的治疗方案是（　　）。", "answer": "饮食疗法+胰岛素", "meta_info": "第二部分　模拟试题", "answer_idx": "B", "A": "运动疗法+饮食疗法+胰岛素", "B": "饮食疗法+胰岛素", "C": "单纯胰岛素治疗", "D": "甲福明+饮食疗法，必要时加胰岛素", "language": "zh"}
{"question": "以下不属于心身疾病的诊断标准的为（　　）。", "answer": "存在心理疾病", "meta_info": "医学心理学", "answer_idx": "C", "A": "有器质性的病变", "B": "疾病发生、发展与心理应激相平行", "C": "存在心理疾病", "D": "用单纯的生物医学治疗收效甚微", "language": "zh"}
{"question": "在DTH对造成小静脉内皮细胞损伤的主要细胞因子是（　　）。", "answer": "a-TNF", "meta_info": "医学免疫学", "answer_idx": "A", "A": "a-TNF", "B": "γ-IFN", "C": "IL-2", "D": "ICAM-1", "language": "zh"}
{"question": "患者，男，55岁，胃溃疡病史5年。近1个月来症状加重，2h前餐后突发上腹部剧痛，并扩散至全腹，诊断为胃溃疡穿孔。最佳的治疗方法是（　　）。", "answer": "胃大部切除术", "meta_info": "第二部分　模拟试题", "answer_idx": "C", "A": "非手术治疗", "B": "全胃切除术", "C": "胃大部切除术", "D": "穿孔修补加选择性迷走神经切断术", "language": "zh"}
{"question": "男，21岁。患急性白血病半个月，化疗期间出现皮肤瘀斑。血常规：Hb 70g/L，RBC 2.4×1012/L，WBC 2.6×109/L，PLT 10×109/L，给予输注机采血小板1个治疗量。输注完毕后，患者出现严重吸气性呼吸困难伴喘鸣。查体：T 36.8℃，P 115次/分，R 25次/分，BP 85/50mmHg。该患者最可能发生的输血不良反应是（　　）。", "answer": "严重过敏反应", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "严重过敏反应", "B": "急性溶血性输血反应", "C": "输血相关低血压", "D": "输血相关循环超负荷", "language": "zh"}
{"question": "下列哪项不是医疗机构应当在12小时内向当地卫生行政部门报告的重大医疗过失行为?（　　）", "answer": "同时二人人身损害后果的", "meta_info": "卫生法规", "answer_idx": "D", "A": "发生死亡的", "B": "有重度残疾的", "C": "有中度残疾的", "D": "同时二人人身损害后果的", "language": "zh"}
{"question": "急性肝衰竭最多见的病因是（　　）。", "answer": "病毒性肝炎", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "化学性中毒", "B": "病毒性肝炎", "C": "烧伤", "D": "妊娠高血压综合症", "language": "zh"}
{"question": "雌激素的生理作用，不正确的是（　　）。", "answer": "促进水与钠排泄", "meta_info": "第二部分　模拟试题", "answer_idx": "B", "A": "使子宫发育", "B": "促进水与钠排泄", "C": "促进输卵管发育", "D": "促进骨中钙的沉积", "language": "zh"}
{"question": "在吮指癖小儿的手指上涂苦味油膏的治疗属（　　）。", "answer": "厌恶疗法", "meta_info": "医学心理学", "answer_idx": "A", "A": "厌恶疗法", "B": "厌恶想象治疗", "C": "系统脱敏治疗", "D": "满灌法治疗", "language": "zh"}
{"question": "男，30岁。30分钟前被刀刺右前胸部，咳血痰，呼吸困难。体检：血压107/78mmHg，脉搏96次/分，右前胸有轻度皮下气肿，右锁骨中线4肋间可见3cm长创口，随呼吸有气体进出伤口的响声。2．此时应采取的急救措施是（　　）。", "answer": "立即闭合胸部创口", "meta_info": "第1篇　呼吸系统", "answer_idx": "C", "A": "吸氧", "B": "静脉穿刺输液", "C": "立即闭合胸部创口", "D": "立即剖胸探查", "language": "zh"}
{"question": "滤过分数是指（　　）。", "answer": "肾小球滤过率／肾血浆流量", "meta_info": "生理学", "answer_idx": "A", "A": "肾小球滤过率／肾血浆流量", "B": "肾小球滤过率／肾血流量", "C": "肾血浆流量／肾血流量", "D": "肾血流量／肾血浆流量", "language": "zh"}
{"question": "男性，22岁，8年前患右胫骨上段急性骨髓炎，经综合治疗症状体征消失，但1年后开始反复出现右膝关节下方流脓。检查：右膝下方有一窦道，少许脓性分泌物。X线平片右胫骨上段有大块死骨，胫骨干包壳形成。1．临床诊断为（　　）。", "answer": "慢性骨髓炎", "meta_info": "第四部分　运动系统疾病", "answer_idx": "B", "A": "软组织感染", "B": "慢性骨髓炎", "C": "急性骨髓炎再发", "D": "骨肿瘤溃破", "language": "zh"}
{"question": "1．急性腹泻（　　）。", "answer": "病程<2周", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "病程<2周", "B": "病程>2个月", "C": "病程>6个月", "D": "病程2周～6个月", "language": "zh"}
{"question": "3．恶性肿瘤时腹腔积液（　　）。", "answer": "腹腔积液，液体内多量红细胞", "meta_info": "病理学", "answer_idx": "D", "A": "腹腔积液，液体细胞含量高，蛋白含量低", "B": "腹腔积液，液体细胞含量高，蛋白含量高", "C": "腹腔积液，液体比重低，蛋白含量低", "D": "腹腔积液，液体内多量红细胞", "language": "zh"}
{"question": "交感和副交感神经节前纤维释放的递质是（　　）。", "answer": "乙酰胆碱", "meta_info": "生理学", "answer_idx": "C", "A": "肾上腺素", "B": "去甲肾上腺素", "C": "乙酰胆碱", "D": "肾上腺素和去甲肾上腺素", "language": "zh"}
{"question": "男，2岁。因间断性四肢抽搐就医。1日无热惊厥发作十数次，脑电图无异常。发作后神志清醒无神经系统症状。查体可见“鸡胸样”畸形和“O”型腿。实验室检查示血Ca 45mmol/L。血镁、尿镁正常。最有可能的诊断是（　　）。", "answer": "维生素D缺乏性手足抽搐症", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "维生素D缺乏性手足抽搐症", "B": "低镁血症", "C": "婴儿痉挛症", "D": "原发性甲状腺旁腺功能减退", "language": "zh"}
{"question": "有关女性生殖器结核病理的正确描述是（　　）。", "answer": "输卵管结核多为双侧性", "meta_info": "第二部分　模拟试题", "answer_idx": "A", "A": "输卵管结核多为双侧性", "B": "输卵管结核常由子宫内膜结核蔓延而来", "C": "宫颈结核较多见，呈菜花状", "D": "盆腔腹膜结核多合并子宫内膜结核", "language": "zh"}
{"question": "男，40岁。因腹胀、乏力、纳差3天来诊。10年前体检发现HBsAg阳性，HBeAg阳性，ALT正常，口服中药断续治疗，有长期大量饮酒史。家中母亲及2个兄弟均为乙肝患者。查体：神志清楚，面色晦暗.无明显黄染，肝肋下未触及，脾肋下3cm。腹水征（＋）。实验室检查：ALT 50U/L，HBV-DNA 2×105拷贝/ml。2．最重要的治疗药物是（　　）。", "answer": "核苷（酸）类似物", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "核苷（酸）类似物", "B": "丹参", "C": "甘草酸制剂", "D": "干扰素", "language": "zh"}
{"question": "细胞静息电位为－90mV，当其受到刺激后变为－100mV时的膜电位变化称为（　　）。", "answer": "超极化", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "极化", "B": "复极化", "C": "超极化", "D": "去极化", "language": "zh"}
{"question": "血气胸开胸手术处理的指征不包括（　　）。", "answer": "胸腔闭式引流后呼吸系统症状缓解，血压稳定者", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "胸腔活动性出血，血压降低", "B": "大咳血不止", "C": "大的开放性胸壁伤的闭合修补", "D": "胸腔闭式引流后呼吸系统症状缓解，血压稳定者", "language": "zh"}
{"question": "下述哪一项符合动脉导管未闭的检查所见？（　　）", "answer": "心导管检查，肺动脉血氧含量高于右心室", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "心电图检查，电轴右偏，右室肥厚", "B": "X线检查，主动脉结小", "C": "心导管检查，肺动脉血氧含量高于右心室", "D": "舒张压正常", "language": "zh"}
{"question": "2．前列腺手术后出血宜选用（　　）。", "answer": "氨甲环酸", "meta_info": "药理学", "answer_idx": "B", "A": "维生素K", "B": "氨甲环酸", "C": "硫酸亚铁", "D": "尿激酶", "language": "zh"}
{"question": "男，40岁，5年前曾患“大脑炎”，近两个月来经常发作性出现虚幻感，看到有蛇或鼠等讨厌动物出现，扑打过程中有时砸坏东西，几分钟后才知什么也没有，可选用下述哪种药物治疗？（　　）", "answer": "卡马西平", "meta_info": "药理学", "answer_idx": "B", "A": "氯丙嗪", "B": "卡马西平", "C": "米帕明", "D": "碳酸锂", "language": "zh"}
{"question": "女，23岁。停经两个月，同时伴大量阴道流血，心慌，不能平卧一天。心率100次/分。妇科检查见宫口有组织物排出，子宫如两个月妊娠大小。该患者的处理措施不包括（　　）。", "answer": "肌注黄体酮", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "肌注黄体酮", "B": "给予输液及止血药物", "C": "查血β-hCG", "D": "立即行清宫术", "language": "zh"}
{"question": "3．用于预防麻疹、腮腺炎和风疹的联合疫苗是（　　）。", "answer": "MMR", "meta_info": "医学微生物学", "answer_idx": "B", "A": "BCG", "B": "MMR", "C": "OPV", "D": "TAT", "language": "zh"}
{"question": "乳腺癌侵犯乳房悬韧带（Cooper韧带），引起的相应体征是（　　）。", "answer": "肿瘤表面皮肤凹陷（酒窝征）", "meta_info": "第八部分　其他疾病", "answer_idx": "C", "A": "橘皮样变", "B": "乳头内陷", "C": "肿瘤表面皮肤凹陷（酒窝征）", "D": "局部水肿", "language": "zh"}
{"question": "对于雷尼替丁，哪项是错误的？（　　）", "answer": "也能中和胃酸，减轻对溃疡面的刺激", "meta_info": "药理学", "answer_idx": "C", "A": "抑制胃酸分泌作用比西米替丁强", "B": "是H2受体阻断药", "C": "也能中和胃酸，减轻对溃疡面的刺激", "D": "对基础胃酸和夜间胃酸分泌都抑制", "language": "zh"}
{"question": "女性，18岁。低热，腹痛、腹泻伴腹胀2个月。体查：腹壁揉面感，腹部移动性浊音阳性。腹水为渗出液。为明确诊断，下列检查最有价值的是（　　）。", "answer": "腹膜活检", "meta_info": "第二部分　模拟试题", "answer_idx": "B", "A": "结核菌素试验", "B": "腹膜活检", "C": "腹水细菌培养", "D": "血沉", "language": "zh"}
{"question": "胃溃疡最少见的并发症是（　　）。", "answer": "癌变", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "癌变", "B": "呕血", "C": "穿孔", "D": "黑便", "language": "zh"}
{"question": "一女性，55岁，丧偶8年，现独居，嗜烟酒，不爱运动。平时性情抑郁，过分容忍，办事无主见，常顺从于别人。1月前行胃癌切除，术中及术后情绪低落，兴趣下降，独自流泪，有轻生之念。4．对这种病人临床上应采取哪一种措施?（　　）", "answer": "以上都是", "meta_info": "医学心理学", "answer_idx": "D", "A": "认知疗法", "B": "支持性心理治疗", "C": "精神分析疗法", "D": "以上都是", "language": "zh"}
{"question": "患者，男，64岁，身高160cm，体重70kg，尿糖（－），糖耐量试验结果为空腹5.0mol/L，1小时7.6mmol/L，2小时7.0mmol/L，3小时5.4mmol/L。应考虑为（　　）。", "answer": "可排除糖尿病", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "B", "A": "无临床意义", "B": "可排除糖尿病", "C": "可诊为糖尿病", "D": "以上都不是", "language": "zh"}
{"question": "1．糖酵解中催化不可逆反应的酶包括（　　）。", "answer": "己糖激酶", "meta_info": "生物化学", "answer_idx": "D", "A": "异柠檬酸脱氢酶", "B": "葡萄糖-6-磷酸酶", "C": "苹果酸脱氢酶", "D": "己糖激酶", "language": "zh"}
{"question": "5．一个测验工具能够测量出其所要测东西的真实程度，反映工具的正确性称为（　　）。", "answer": "效度", "meta_info": "医学心理学", "answer_idx": "B", "A": "信度", "B": "效度", "C": "常模", "D": "客观性原则", "language": "zh"}
{"question": "男，54岁。活动时喘憋渐加重，出现夜间憋醒。高血压病史10余年。超声心动图：左心房、左心室扩大，LVEF 35％。患者喘憋的机制为（　　）。", "answer": "心室搏出量占心室舒张末容积的百分比明显降低", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "左心室充盈压明显降低", "B": "左心室每搏功明显高于右心室每搏功", "C": "左心室心搏出量明显少于右心室心搏出量", "D": "心室搏出量占心室舒张末容积的百分比明显降低", "language": "zh"}
{"question": "男，25岁。反复腹痛、腹泻、便血10个月。近日加重伴发热，体温39℃，1天前因腹痛肌注阿托品治疗6小时后腹胀明显。查体：血压70／50mmHg，心率120次/分。最可能出现的情况是（　　）。", "answer": "中毒性巨结肠", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "肠穿孔", "B": "肠梗阻", "C": "肠出血", "D": "中毒性巨结肠", "language": "zh"}
{"question": "用于胃食管反流病诊断性治疗的药物是（　　）。", "answer": "奥美拉唑", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "多潘立酮", "B": "枸橼酸铋钾", "C": "奥美拉唑", "D": "雷尼替丁", "language": "zh"}
{"question": "李医生在为一胃癌病人手术时，发现腹腔内已有转移，肿瘤与周围组织粘连很严重，切除肿瘤已无意义，便关腹结束手术。事后发现，一把止血钳被落在病人腹内。此行为被认定为：三级医疗责任事故。李医生可能承担的法律责任是（　　）。", "answer": "责令暂停执业6个月", "meta_info": "卫生法规", "answer_idx": "A", "A": "责令暂停执业6个月", "B": "罚款", "C": "赔偿患者损失", "D": "追究刑事责任", "language": "zh"}
{"question": "1．治疗贫血（　　）。", "answer": "EPO", "meta_info": "第五部分　风湿免疫性疾病", "answer_idx": "D", "A": "抗CD3单克隆抗体", "B": "抗肿瘤坏死因子抗体", "C": "α干扰素", "D": "EPO", "language": "zh"}
{"question": "3．世界上第1个安乐死合法化的国家是（　　）。", "answer": "荷兰", "meta_info": "第二部分　模拟试题", "answer_idx": "D", "A": "美国", "B": "英国", "C": "法国", "D": "荷兰", "language": "zh"}
{"question": "男，62岁。左侧胸痛伴呼吸困难1天。疼痛呈持续性锐痛，咳嗽时加剧，无放射痛、发热。查体：BP 110／80mmHg，呼吸急促，口唇发绀，双肺未闻及干湿啰音，P2亢进，各瓣膜区未闻及杂音，左下肢水肿。胸痛最可能的原因是（　　）。", "answer": "肺梗死", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "气胸", "B": "肺梗死", "C": "胸膜炎", "D": "心绞痛", "language": "zh"}
{"question": "皮质醇增多症最常见的病因为（　　）。", "answer": "双肾上腺皮质增生", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "B", "A": "肾上腺皮质腺癌", "B": "双肾上腺皮质增生", "C": "肾上腺皮质腺瘤", "D": "异位ACTH综合征", "language": "zh"}
{"question": "男性，58岁，20余日来，发热，肝区痛，纳差，消瘦。查：肝肋下2cm，有触痛，WBC 9.8×109/L，中性28%，B超示肝内有液性占位。下列药物应首选（　　）。", "answer": "甲硝唑", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "B", "A": "吐根碱", "B": "甲硝唑", "C": "氯喹", "D": "大剂量青霉素", "language": "zh"}
{"question": "“过客白细胞”是（　　）。", "answer": "移植物中的APC", "meta_info": "医学免疫学", "answer_idx": "B", "A": "受者体内的APC", "B": "移植物中的APC", "C": "移植物中的中性粒细胞", "D": "受者体内的单核细胞", "language": "zh"}
{"question": "下列哪一项对鉴别类风湿关节炎和风湿性关节炎无帮助？（　　）", "answer": "关节肿痛", "meta_info": "第五部分　风湿免疫性疾病", "answer_idx": "A", "A": "关节肿痛", "B": "关节畸形", "C": "RF", "D": "血清抗链球菌溶血素“O”", "language": "zh"}
{"question": "女性，45岁，四肢无力，站立不稳，进行性加重半年，无外伤史。查体：双下肢肌张力高、腱反射亢进，Hoffmann征（+），Babinski征（+）。2．应首先选择的治疗方法是（　　）。", "answer": "手术治疗", "meta_info": "第四部分　运动系统疾病", "answer_idx": "B", "A": "理疗", "B": "手术治疗", "C": "颏枕带牵引", "D": "带围领和颈托", "language": "zh"}
{"question": "下列药物中，抑制胃酸分泌作用最强的是（　　）。", "answer": "奥美拉唑", "meta_info": "药理学", "answer_idx": "B", "A": "西咪替丁", "B": "奥美拉唑", "C": "碳酸氢钠", "D": "丙谷胺", "language": "zh"}
{"question": "属于药物流产禁忌证的是（　　）。", "answer": "妊娠剧吐", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "妊娠剧吐", "B": "瘢痕子宫", "C": "严重骨盆畸形", "D": "哺乳期妊娠", "language": "zh"}
{"question": "3．正常情况下，羊水的pH为（　　）。", "answer": "7.0～7.5", "meta_info": "第5篇　女性生殖系统", "answer_idx": "D", "A": "＜4.5", "B": "4.5～5.5", "C": "6.5～7.0", "D": "7.0～7.5", "language": "zh"}
{"question": "局麻药的作用机制是（　　）。", "answer": "在神经膜内侧阻断Na+内流", "meta_info": "药理学", "answer_idx": "B", "A": "在神经膜内侧阻断K+内流", "B": "在神经膜内侧阻断Na+内流", "C": "在神经膜内侧阻断Cl-内流", "D": "降低静息膜电位", "language": "zh"}
{"question": "下列哪种幻觉形式为临床最常见？（　　）", "answer": "幻听", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "幻听", "B": "幻视", "C": "幻味", "D": "内脏幻觉", "language": "zh"}
{"question": "3．造成膜对Na+通透性突然增大的临界电位称（　　）。", "answer": "阈电位", "meta_info": "生理学", "answer_idx": "B", "A": "动作电位", "B": "阈电位", "C": "局部电位", "D": "静息电位", "language": "zh"}
{"question": "患者，男，60岁，右下肢无力3个月，左下半身麻木，检查：左乳头水平以下痛温觉减退，右膝腱反射亢进，右Babinski征（+），右髂前上棘以下音叉振动觉减退，右足趾位置觉减退，常因为以下哪种病变？（　　）", "answer": "右侧T4水平半侧损害", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "右侧T4水平半侧损害", "B": "左侧T4水平半侧损害", "C": "T4水平横贯性损害", "D": "左侧T4水平后索损害", "language": "zh"}
{"question": "28岁，孕34周，10天前开始感觉乏力，食欲差，近5天病情加重，伴呕吐，巩膜发黄，神志欠清而入院，血压135／90mmHg，ALT 35U/L，胆红素176μmol/L，尿蛋白（＋）。1．首先选择的检查是（　　）。", "answer": "肝炎病毒抗炎抗体七项", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "碱性磷酸酶", "B": "胆酸", "C": "肝炎病毒抗炎抗体七项", "D": "血糖", "language": "zh"}
{"question": "1．急性心肌梗死患者，肺部有湿啰音，但啰音范围小于1/2肺野，判断为（　　）。", "answer": "KillipⅡ级", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "KillipⅡ级", "B": "KillipⅢ级", "C": "NYHAⅡ级", "D": "NYHAⅣ级", "language": "zh"}
{"question": "2．HbO2促进不带O2的亚基结合O2的现象，称为（　　）。", "answer": "协同效应", "meta_info": "生物化学", "answer_idx": "C", "A": "变构蛋白", "B": "变构效应", "C": "协同效应", "D": "以上都不是", "language": "zh"}
{"question": "1．心动周期中主动脉血压最低值称为（　　）。", "answer": "舒张压", "meta_info": "生理学", "answer_idx": "B", "A": "收缩压", "B": "舒张压", "C": "脉搏压", "D": "平均动脉压", "language": "zh"}
{"question": "下列哪些是关于人体实验的错误说法？（　　）", "answer": "必须在自体身上进行", "meta_info": "医学伦理学", "answer_idx": "B", "A": "是医学的起点和基础", "B": "必须在自体身上进行", "C": "人体实验是医学科研的重要内容", "D": "必须以动物实验为前提", "language": "zh"}
{"question": "炎症的基本病理变化是（　　）。", "answer": "病变组织变质、渗出、增生", "meta_info": "病理学", "answer_idx": "C", "A": "组织、细胞的变性坏死", "B": "红、肿、热、痛、功能障碍", "C": "病变组织变质、渗出、增生", "D": "周围血液中自细胞增多和炎区白细胞浸润", "language": "zh"}
{"question": "患者，女，22岁。十二指肠溃疡病史2年，口服药物治疗，因12小时前呕吐鲜血来诊，血压为80/50mmHg，输血1000mL后，血压仍有波动。查体：贫血貌，剑突下压痛，腹软。此患者最适宜的治疗方法是（　　）。", "answer": "抗休克治疗的同时行急诊剖腹手术", "meta_info": "第2篇　心血管系统", "answer_idx": "D", "A": "胃镜电凝止血", "B": "静脉注射止血药", "C": "快速补液、输血", "D": "抗休克治疗的同时行急诊剖腹手术", "language": "zh"}
{"question": "3．HLA-DR是（　　）。", "answer": "同种异型抗原", "meta_info": "医学免疫学", "answer_idx": "B", "A": "异种抗原", "B": "同种异型抗原", "C": "异嗜性抗原", "D": "自身抗原", "language": "zh"}
{"question": "缺铁性贫血，铁剂治疗5～10天首先出现的治疗反应是（　　）。", "answer": "网织红细胞数升高", "meta_info": "第一部分　血液系统疾病", "answer_idx": "C", "A": "血清铁增加", "B": "骨髓外铁增加", "C": "网织红细胞数升高", "D": "红细胞平均直径恢复正常", "language": "zh"}
{"question": "患者女性，35岁，颈部增粗，伴失眠，易激动，食欲亢进半年。查体：甲状腺弥漫性肿大，眼球突出，P100次/分，BP130/80mmHg，CT示胸骨后甲状腺肿。为明确诊断，抽血测T3、T4和TSH。1．预计与该患者病情最为相符的检查结果是（　　）。", "answer": "T3显著增高，T4略为增高，TSH降低", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "D", "A": "T3略增高，T4显著增高，TSH降低", "B": "T3略增高，T4显著增高，TSH增高", "C": "T3显著增高，T4略为增高，TSH增高", "D": "T3显著增高，T4略为增高，TSH降低", "language": "zh"}
{"question": "患者女性，45岁，因巨大结节性甲状腺肿于颈丛麻醉下行一侧甲状腺全切、另一侧甲状腺大部切除术，术后第2天突然发生窒息，面肌和手足持续性痉挛。2．下一步需要做的检查是（　　）。", "answer": "抽血查血清钙、磷浓度", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "A", "A": "抽血查血清钙、磷浓度", "B": "抽血查T3、T4", "C": "抽血查血糖", "D": "抽血查肝功能", "language": "zh"}
{"question": "女，55岁。右下腹隐痛5个月，近3个月来乏力、消瘦，常有低热。查体：结膜苍白，右侧腹部5cm×3cm肿块。化验：血红蛋白95g/L。3．右侧结肠癌最多见的大体形态是（　　）。", "answer": "肿块型", "meta_info": "第3篇　消化系统", "answer_idx": "B", "A": "浸润型", "B": "肿块型", "C": "浸润溃疡型", "D": "髓质型", "language": "zh"}
{"question": "最有助于确诊肾动脉狭窄的检查是（　　）。", "answer": "肾动脉造影", "meta_info": "第4篇　泌尿系统", "answer_idx": "A", "A": "肾动脉造影", "B": "静脉肾盂造影", "C": "放射性核素肾图", "D": "肾动脉核素图", "language": "zh"}
{"question": "脑的重量与年龄的关系，错误的是（　　）。", "answer": "4岁时脑重达到成人水平", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "出生时脑重370g，占体重10%～12%", "B": "6个月时脑重600～700g", "C": "2岁时脑重1000g", "D": "4岁时脑重达到成人水平", "language": "zh"}
{"question": "1岁男孩，持续发热5天，体温达39℃，伴咳嗽，喘憋，精神差，嗜睡，发病4天后肺部出现中小水泡音，血象WBC7×109/L，中性粒细胞40%，淋巴细胞60%。肺部X线片示：左肺散在斑片影，右肺下野见大片状密度增高影。可能的诊断为（　　）。", "answer": "腺病毒肺炎", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "衣原体肺炎", "B": "金黄色葡萄球菌肺炎", "C": "腺病毒肺炎", "D": "支原体肺炎", "language": "zh"}
{"question": "正常小儿血象白细胞分类，中性粒细胞为主的年龄为（　　）。", "answer": "生后4～6天前及4～6岁后", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "生后7～10天前及7～10岁后", "B": "生后4～6天前及4～6岁后", "C": "生后2～4天前及2～4岁后", "D": "生后15天前及15岁后", "language": "zh"}
{"question": "关于中心静脉压的叙述，错误的是（　　）。", "answer": "心脏射血能力较强，中心静脉压就会较高", "meta_info": "生理学", "answer_idx": "D", "A": "指右心房和胸腔内大静脉的血压", "B": "正常变动范围为4～12cmH2O", "C": "是反映心血管功能的又一指标", "D": "心脏射血能力较强，中心静脉压就会较高", "language": "zh"}
{"question": "女，17岁。疲乏无力，心烦易怒，怕热多汗半年，易饿。体重下降11kg，月经量减少，经期仅1～2天。查体：BP 140／70mmHg，皮肤微潮，手有细颤，轻微突眼，甲状腺Ⅰ度弥漫性肿大，质软，无触痛。1．该患者最可能的诊断是（　　）。", "answer": "Graves病", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "糖尿病", "B": "自主神经功能紊乱", "C": "单纯性甲状腺肿", "D": "Graves病", "language": "zh"}
{"question": "5．甲状腺功能减退所致精神障碍，最常见的症状为（　　）。", "answer": "抑郁", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "抑郁", "B": "焦虑", "C": "精神运动性抑制", "D": "精神运动性兴奋", "language": "zh"}
{"question": "血红蛋白(Hb)具有运输O2的功能，当O2与Hb结合后可引起Hb构象变化，这种现象称为（　　）。", "answer": "变构效应", "meta_info": "生物化学", "answer_idx": "D", "A": "变构激活", "B": "变构抑制", "C": "协同效应", "D": "变构效应", "language": "zh"}
{"question": "宫口开全后，开始保护会阴的时机应是（　　）。", "answer": "胎头拨露阴唇后联合紧张时", "meta_info": "第二部分　模拟试题", "answer_idx": "C", "A": "胎头开始拨露时", "B": "胎头拨露10min时", "C": "胎头拨露阴唇后联合紧张时", "D": "胎头开始着冠时", "language": "zh"}
{"question": "哌替啶与阿托品合用治疗胆绞痛，是因为哌替啶（　　）。", "answer": "可使胆道括约肌痉挛，提高胆内压", "meta_info": "药理学", "answer_idx": "D", "A": "可引起恶心、呕吐等胃肠反应", "B": "抑制呼吸", "C": "易成瘾", "D": "可使胆道括约肌痉挛，提高胆内压", "language": "zh"}
{"question": "男孩，14岁，因腹痛来院就诊。查体：双下肢出现对称性成片状小出血点，尿常规发现血尿（+++），该患者诊断最可能是（　　）。", "answer": "过敏性紫癜肾炎", "meta_info": "第一部分　血液系统疾病", "answer_idx": "B", "A": "肾血管畸形", "B": "过敏性紫癜肾炎", "C": "肾绞痛", "D": "肾下垂", "language": "zh"}
{"question": "男性，27岁，发热、头晕、视物模糊l周。血常规示血红蛋白69g/L，白细胞15×109/L，分类中可见原始细胞。2．本患者骨髓涂片中早幼粒细胞占60%，应诊断为哪型急性非淋巴细胞白血病？（　　）", "answer": "M3型", "meta_info": "第一部分　血液系统疾病", "answer_idx": "C", "A": "M1型", "B": "M2型", "C": "M3型", "D": "M4型", "language": "zh"}
{"question": "1．Ⅰ型呼吸衰竭最常见的病因是（　　）。", "answer": "ARDS", "meta_info": "第1篇　呼吸系统", "answer_idx": "C", "A": "特发性肺间质纤维化", "B": "COPD", "C": "ARDS", "D": "肺脓肿", "language": "zh"}
{"question": "继发性闭经最常见的是（　　）。", "answer": "下丘脑性闭经", "meta_info": "第5篇　女性生殖系统", "answer_idx": "C", "A": "原发性闭经", "B": "子宫性闭经", "C": "下丘脑性闭经", "D": "垂体性闭经", "language": "zh"}
{"question": "患儿，男，4个月，体重5kg，腹泻3天，每日7或8次，蛋花汤样、无腥臭，奶后呕吐2次。面色稍苍白，上腭裂，精神较差，皮肤稍干燥，眼窝、前囟凹陷，皮下脂肪0.3cm，皮肤弹性较差，哭有泪，四肢末梢较冷，血清钠128mmol/L。2．其第一天补液总量每千克为（　　）。", "answer": "120～150ml", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "60～80ml", "B": "90～120ml", "C": "120～150ml", "D": "150～180ml", "language": "zh"}
{"question": "1．葡萄球菌肺炎（　　）。", "answer": "弛张高热", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "稽留高热", "B": "弛张高热", "C": "低热", "D": "不发热", "language": "zh"}
{"question": "关于腹膜的解剖生理，错误的是（　　）。", "answer": "脏腹膜比壁腹膜痛觉敏感", "meta_info": "第3篇　消化系统", "answer_idx": "D", "A": "成人腹膜总面积可达2m2", "B": "腹膜有强大吸收力", "C": "腹膜可分泌大量渗出液", "D": "脏腹膜比壁腹膜痛觉敏感", "language": "zh"}
{"question": "湿性坏疽的叙述，下述哪一项是错误的？（　　）", "answer": "由于动脉阻塞、静脉回流正常引起", "meta_info": "病理学", "answer_idx": "B", "A": "常见于肺、肠和子宫等内脏器官", "B": "由于动脉阻塞、静脉回流正常引起", "C": "坏死组织内有大量腐败菌繁殖", "D": "全身中毒症状重", "language": "zh"}
{"question": "关于人体实验中的知情同意，正确的是（　　）。", "answer": "已同意参加实验的受试者签署知情同意书后，可以随意退出实验", "meta_info": "医学伦理学", "answer_idx": "D", "A": "“知情”是指受试者参加实验前，知道即将开始的实验的目的、方法、预期的好处，不包括潜在的严重的风险，以免增加受试者的心理负担", "B": "“同意”是指受试者口头上明确表示同意参加实验", "C": "缺乏或丧失自主能力的人不能作为受试者参加实验", "D": "已同意参加实验的受试者签署知情同意书后，可以随意退出实验", "language": "zh"}
{"question": "血小板增多的常见原因不包括（　　）。", "answer": "急性淋巴细胞白血病", "meta_info": "第一部分　血液系统疾病", "answer_idx": "D", "A": "急慢性炎症", "B": "缺铁性贫血", "C": "癌症患者", "D": "急性淋巴细胞白血病", "language": "zh"}
{"question": "锥体束损害的反射改变为（　　）。", "answer": "深反射亢进，浅反射减弱或消失", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "深浅反射均亢进", "B": "深反射亢进，浅反射减弱或消失", "C": "深反射亢进，浅反射正常", "D": "深反射减弱或消失，浅反射正常", "language": "zh"}
{"question": "1．肝细胞脂肪变性为（　　）。", "answer": "脂质沉积", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "细胞水肿", "B": "脂质沉积", "C": "结缔组织玻璃样变", "D": "细胞内玻璃样变", "language": "zh"}
{"question": "男性，19岁，9个月前开始右上臂肿胀，疼痛，诊断为右肱骨上端骨肉瘤，首选的治疗方案是（　　）。", "answer": "术前化疗加根治性手术后放疗", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "化疗", "B": "左肩关节离断术", "C": "肿瘤刮除术", "D": "术前化疗加根治性手术后放疗", "language": "zh"}
{"question": "慢性肾功能不全周围神经病变中较明显的表现是（　　）。", "answer": "不宁腿综合征", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "弛缓性瘫痪", "B": "震颤", "C": "不宁腿综合征", "D": "偏身瘫痪", "language": "zh"}
{"question": "男，50岁。活动后心悸，气短5年，加重伴少尿1周。查体：双肺底可闻及细湿啰音，心尖搏动位于第5肋间锁骨中线外2cm，范围较弥散，心率106次/分，律不齐，双下肢凹陷性水肿。最有助于确诊的检查是（　　）。", "answer": "超声心动图", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "胸部X线片", "B": "超声心动图", "C": "尿常规", "D": "心电图", "language": "zh"}
{"question": "原发性肝细胞性肝癌最理想的肿瘤标记物是（　　）。", "answer": "AFP", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "AFP", "B": "GGT2", "C": "CA19-9", "D": "CA125", "language": "zh"}
{"question": "3．链球菌感染后肾小球肾炎（　　）。", "answer": "交叉反应性抗体", "meta_info": "医学免疫学", "answer_idx": "D", "A": "修饰抗原", "B": "抗独特型抗体", "C": "抗同种异型抗体", "D": "交叉反应性抗体", "language": "zh"}
{"question": "符合Ⅲ度胎盘早剥临床表现的是（　　）。", "answer": "休克程度与阴道流血量不成正比", "meta_info": "第5篇　女性生殖系统", "answer_idx": "D", "A": "腹部柔软", "B": "听诊胎心正常", "C": "妊娠晚期无痛性阴道出血", "D": "休克程度与阴道流血量不成正比", "language": "zh"}
{"question": "女，25岁。活动后突然左下腹剧痛，伴有恶心、呕吐，月经规律，末次月经为8天前，妇科检查：左侧附件区可触及手拳大小囊实性包块，触痛，推移后疼痛加剧。首先考虑为（　　）。", "answer": "卵巢囊肿蒂扭转", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "卵巢黄体破裂", "B": "输卵管妊娠破裂", "C": "急性阑尾炎", "D": "卵巢囊肿蒂扭转", "language": "zh"}
{"question": "某县血站在采血前没有做健康检查，将患有乙型肝炎病原携带者的血液采集混入血库，使用于临床后，造成2人由于输血患了乙型肝炎，对2名由于输入该血站血液感染了乙型肝炎的患者处理是（　　）。", "answer": "血站依法赔偿医疗费", "meta_info": "卫生法规", "answer_idx": "C", "A": "血站负责人赔偿医疗费", "B": "医院赔偿医疗费", "C": "血站依法赔偿医疗费", "D": "医生赔偿医疗费", "language": "zh"}
{"question": "病毒感染机体后，在体内由局部向远处扩散的方式不包括（　　）。", "answer": "经免疫系统播散", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "沿神经播散", "B": "经淋巴播散", "C": "经组织间隙播散", "D": "经免疫系统播散", "language": "zh"}
{"question": "男，25岁。发热3周于8月20日来诊，体温大于39℃，病初皮肤出现少数皮疹，头痛，腰痛，眼眶痛。患者可能的病症是（　　）。", "answer": "肾综合征出血热", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "肾综合征出血热", "B": "流行性乙型脑炎", "C": "麻疹", "D": "肾病综合征", "language": "zh"}
{"question": "关于汉坦病毒，不正确的是（　　）。", "answer": "病后免疫力短暂", "meta_info": "医学微生物学", "answer_idx": "C", "A": "主要传染源为黑线姬鼠", "B": "主要症状为高热、出血和肾脏损伤", "C": "病后免疫力短暂", "D": "可使用灭活疫苗进行预防", "language": "zh"}
{"question": "下述哪项不是营养性巨幼细胞性贫血的病因？（　　）", "answer": "长期服用维生素C", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "长期羊奶喂养", "B": "慢性腹泻", "C": "长期服用维生素C", "D": "肝脏疾病", "language": "zh"}
{"question": "损伤性骨化最常见于（　　）。", "answer": "肘关节", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "腕关节", "B": "肘关节", "C": "髋关节", "D": "膝关节", "language": "zh"}
{"question": "基因表达中的诱导现象指（　　）。", "answer": "由底物的存在引起代谢底物的酶的合成", "meta_info": "生物化学", "answer_idx": "D", "A": "细菌利用葡萄糖作碳源", "B": "阻遏物的生成", "C": "细菌不用乳糖做碳源", "D": "由底物的存在引起代谢底物的酶的合成", "language": "zh"}
{"question": "新生儿化脓性脑膜炎主要致病菌是（　　）。", "answer": "大肠杆菌、金黄色葡萄球菌", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "淋球菌", "B": "葡萄球菌", "C": "大肠杆菌、金黄色葡萄球菌", "D": "脑膜炎双球菌", "language": "zh"}
{"question": "1．上述疾病中，易侵犯颅神经，尤其是面神经的是（　　）。", "answer": "结核性脑膜炎", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "病毒性脑炎", "B": "中毒性脑病", "C": "隐球菌性脑膜炎", "D": "结核性脑膜炎", "language": "zh"}
{"question": "患者，男，35岁。3天前遇雨淋透衣衫。昨起畏寒高热，咳嗽，以干咳为主，偶见带铁锈色黄痰，伴右侧胸痛就诊。体检：急性病容，体温38.9℃。右上肺叩实，闻及支气管呼吸音。心率102次/min，律齐，心音强。2．该病例最可能的典型X线征象是（　　）。", "answer": "大叶实变", "meta_info": "第1篇　呼吸系统", "answer_idx": "A", "A": "大叶实变", "B": "跨叶段的肺浸润", "C": "散在多发性浸润", "D": "肺叶浸润伴空洞形成", "language": "zh"}
{"question": "新生儿开始排便的时间常为生后（　　）。", "answer": "24小时", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "24小时", "B": "36小时", "C": "60小时", "D": "72小时", "language": "zh"}
{"question": "下列哪项是呆小症与侏儒症的最大区别?（　　）", "answer": "智力低下", "meta_info": "生理学", "answer_idx": "C", "A": "内脏增大", "B": "身体更矮", "C": "智力低下", "D": "肌肉发育不良", "language": "zh"}
{"question": "最常见于幼女和少女的卵巢肿瘤是（　　）。", "answer": "内胚窦瘤", "meta_info": "第5篇　女性生殖系统", "answer_idx": "B", "A": "纤维瘤", "B": "内胚窦瘤", "C": "颗粒细胞瘤", "D": "黏液性囊腺瘤", "language": "zh"}
{"question": "下列关于开展生殖技术的伦理原则的表述，哪项错误？（　　）", "answer": "促进商品化的原则", "meta_info": "医学伦理学", "answer_idx": "C", "A": "夫妻双方自愿的原则", "B": "供精者知情同意的原则", "C": "促进商品化的原则", "D": "互育和保密的原则", "language": "zh"}
{"question": "新生儿缺氧缺血性脑病易出现低血糖，此时应选择的葡萄糖输注速度是每分钟（　　）。", "answer": "6～8mg/kg", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "3～5mg/kg", "B": "6～8mg/kg", "C": "16～20mg/kg", "D": "12～15mg/kg", "language": "zh"}
{"question": "3．6岁小儿中点位于（　　）。", "answer": "身长的中点在脐与耻骨联合上缘之间", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "身长的中点在脐下", "B": "身长的中点在脐与耻骨联合上缘之间", "C": "身长的中点在耻骨联合上缘", "D": "身长的中点在耻骨联合下缘", "language": "zh"}
{"question": "2．提示乙肝病毒复制并具有强传染性的指标是（　　）。", "answer": "HBeAg", "meta_info": "医学微生物学", "answer_idx": "B", "A": "HBsAg", "B": "HBeAg", "C": "抗-HBs", "D": "抗-HBc", "language": "zh"}
{"question": "女，35岁。颈部肿块4年余，随吞咽上下移动。近3个月肿块增大明显。手术切除后病理诊断为甲状腺滤泡状腺癌。其最主要的病理诊断依据是（　　）。", "answer": "甲状腺滤泡上皮细胞明显异型性", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "甲状腺滤泡上皮细胞明显异型性", "B": "甲状腺滤泡上皮细胞侵犯包膜", "C": "甲状腺滤泡上皮细胞核呈毛玻璃样改变", "D": "甲状腺组织内出现乳头结构", "language": "zh"}
{"question": "卵巢肿瘤最常见的并发症是（　　）。", "answer": "蒂扭转", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "破裂", "B": "恶变", "C": "感染", "D": "蒂扭转", "language": "zh"}
{"question": "2．重症肌无力（　　）。", "answer": "四肢无力，休息后减轻，活动后加重", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "四肢无力，脑脊液蛋白细胞分离", "B": "四肢无力，手套、袜套样感觉障碍", "C": "四肢无力，休息后减轻，活动后加重", "D": "四肢无力，肩胛带骨盆带萎缩", "language": "zh"}
{"question": "下列关于乳腺癌的描述，正确的是（　　）。", "answer": "多数为浸润性导管癌", "meta_info": "病理学", "answer_idx": "C", "A": "多来源于肌上皮细胞", "B": "多发生于内上象限", "C": "多数为浸润性导管癌", "D": "以血道转移多见", "language": "zh"}
{"question": "1．5岁小儿轻度贫血的诊断指标是（　　）。", "answer": "血红蛋白正常下限～90g/L", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "血红蛋白144～120g/L", "B": "血红蛋白～60g/L", "C": "血红蛋白正常下限～90g/L", "D": "血红蛋白<30g/L", "language": "zh"}
{"question": "1．Somogyi效应的原因是（　　）。", "answer": "夜间曾发生过低血糖", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "晚餐碳水化合物摄入过多", "B": "夜间曾发生过低血糖", "C": "清晨胰岛素作用不足", "D": "清晨胰岛素拮抗激素增多", "language": "zh"}
{"question": "下列哪一项不符合良性肿瘤？（　　）", "answer": "常呈浸润性生长", "meta_info": "病理学", "answer_idx": "A", "A": "常呈浸润性生长", "B": "异型性小", "C": "术后一般很少复发", "D": "不发生转移", "language": "zh"}
{"question": "一位母亲带着未进行任何预防接种的3个月女孩到医院就诊，哪一项措施是不正确的？（　　）", "answer": "立即接种卡介苗", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "立即接种卡介苗", "B": "适时补种脊髓灰质炎三价混合疫苗", "C": "指导合理添加辅食", "D": "做健康检查和体格测量", "language": "zh"}
{"question": "鲁某，男性，28岁，自述脑子空洞洞的，整天什么事也不想，常沉默不语，交谈时词汇量特别少，如问“谁送你来的？”答“父亲”，问“以前做什么工作？”答“不知道”。该症状属于（　　）。", "answer": "思维贫乏", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "思维中断", "B": "思维贫乏", "C": "思维迟缓", "D": "思维松弛", "language": "zh"}
{"question": "查体时鉴别腹股沟斜疝与直疝最有意义的是（　　）。", "answer": "疝囊是否位于腹壁下动脉外侧", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "疝的外形", "B": "疝内容物是否进入阴囊", "C": "疝囊是否位于腹壁下动脉外侧", "D": "回纳后压迫腹股沟浅环，疝块是否能够复出", "language": "zh"}
{"question": "不属于用问卷法进行测验的为（　　）。", "answer": "主题统觉测验", "meta_info": "医学心理学", "answer_idx": "B", "A": "明尼苏达多项人格调查表", "B": "主题统觉测验", "C": "艾森克人格问卷", "D": "精神症状自评量表", "language": "zh"}
{"question": "某医师在为患者施行右侧乳房肿瘤摘除术时，发现左侧乳房也有肿瘤，当即进行活检，确诊为乳腺病。医师判断将来可能癌变，未征求患者意见，同时切除了左侧乳房。医师的这种做法，违背了病人权利的哪一点?（　　）", "answer": "知情同意权", "meta_info": "医学伦理学", "answer_idx": "C", "A": "平等的医疗权", "B": "隐私权", "C": "知情同意权", "D": "获得信息权", "language": "zh"}
{"question": "多根多处肋骨骨折患者，最典型的症状和体征是（　　）。", "answer": "反常呼吸运动", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "呼吸困难", "B": "伤处肿胀青紫", "C": "反常呼吸运动", "D": "胸廓挤压痛", "language": "zh"}
{"question": "初产妇第一产程活跃期延长是指活跃期超过（　　）。", "answer": "8小时", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "8小时", "B": "12小时", "C": "10小时", "D": "6小时", "language": "zh"}
{"question": "女，32岁。胃溃疡史3年，今突发上腹剧痛，面色苍白，大汗。查体：全腹压痛，腹肌紧张，疑似穿孔。急性穿孔诊断后手术治疗效果最好的时间是（　　）。", "answer": "8小时", "meta_info": "第3篇　消化系统", "answer_idx": "D", "A": "48小时", "B": "12小时", "C": "24小时", "D": "8小时", "language": "zh"}
{"question": "男性，45岁。近三年反复间断咳嗽、咳白色泡沫粘痰，时而伴喘息，其发作多在秋冬季，持续三个月左右。查体可闻及双肺干、湿啰音及哮鸣音。该患者可能患有（　　）。", "answer": "慢性支气管炎", "meta_info": "病理学", "answer_idx": "C", "A": "支气管哮喘", "B": "急性气管支气管炎", "C": "慢性支气管炎", "D": "矽肺", "language": "zh"}
{"question": "弥漫性毛细血管内增生性肾小球肾炎病变的特征是（　　）。", "answer": "毛细血管内皮细胞及系膜细胞增生", "meta_info": "病理学", "answer_idx": "D", "A": "毛细血管内血栓形成及基膜增厚", "B": "嗜中性粒细胞浸润及肾球囊上皮细胞增生", "C": "毛细血管壁纤维素样坏死", "D": "毛细血管内皮细胞及系膜细胞增生", "language": "zh"}
{"question": "4．黏膜大量浆液渗出属（　　）。", "answer": "卡他性炎", "meta_info": "病理学", "answer_idx": "B", "A": "脓肿", "B": "卡他性炎", "C": "纤维索性炎", "D": "积脓", "language": "zh"}
{"question": "对曾应用环丙沙星短期治疗疑诊伤寒的患者，用哪一种培养为优？（　　）", "answer": "骨髓培养", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "B", "A": "粪便培养", "B": "骨髓培养", "C": "血培养", "D": "尿培养", "language": "zh"}
{"question": "女，30岁。乏力、头晕伴月经过多半年，化验：Hb 60g/L，RBC 3.1×1012/L，WBC 7.3×109/L，红细胞中心淡染区扩大。该患者最可能的化验结果是（　　）。", "answer": "血清铁降低，总铁结合力增高，红细胞游离原卟啉增高", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "血清铁降低，总铁结合力降低，红细胞游离原卟啉增高", "B": "血清铁降低，总铁结合力增高，红细胞游离原卟啉增高", "C": "血清铁增高，总铁结合力增高，红细胞游离原卟啉降低", "D": "血清铁降低，总铁结合力增高，红细胞游离原卟啉降低", "language": "zh"}
{"question": "法洛四联症，对病理生理影响最大的畸形是（　　）。", "answer": "肺动脉狭窄", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "右位主动脉弓", "B": "肺动脉狭窄", "C": "室间隔缺损", "D": "右心室肥厚", "language": "zh"}
{"question": "维系蛋白质一级结构的化学键是（　　）。", "answer": "肽键", "meta_info": "生物化学", "answer_idx": "C", "A": "氢键", "B": "疏水键", "C": "肽键", "D": "范德华力", "language": "zh"}
{"question": "男孩，1岁。因身材矮小、智能发育迟缓就诊。查体：身长63cm，表情呆滞，四肢肌张力低下，眼距宽，鼻梁低平，眼外眦上斜，四肢短，手指短，小指内弯。对明确诊断最有意义的检查是（　　）。", "answer": "染色体核型分析", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "染色体核型分析", "B": "尿三氯化铁试验", "C": "血钙、磷、碱性磷酸酶检测", "D": "血氨基酸分析", "language": "zh"}
{"question": "抑郁发作时，一日之内的规律多为（　　）。", "answer": "昼重夜轻", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "中午起逐渐加重", "B": "昼重夜轻", "C": "昼轻夜重", "D": "中午最严重以后减轻", "language": "zh"}
{"question": "轻度或中度高血压病人，术前要求血压（　　）。", "answer": "维持原水平", "meta_info": "第八部分　其他疾病", "answer_idx": "B", "A": "降至正常", "B": "维持原水平", "C": "降至原水平低点", "D": "以上都不是", "language": "zh"}
{"question": "男性，29岁，低热，酱油色尿2个月。查体：巩膜黄染，贫血面容，肝脾不肿大。血红蛋白73g/L，血小板100×109/L，白细胞4.4×109/L，网织红细胞计数0.15，尿隐血阴性。2．为明确诊断应做哪一项检查？（　　）", "answer": "Ham试验", "meta_info": "第一部分　血液系统疾病", "answer_idx": "D", "A": "血红蛋白电泳", "B": "Coombs试验", "C": "外周血涂片观察红细胞形态", "D": "Ham试验", "language": "zh"}
{"question": "4个月小儿，面部经常出湿疹，腹泻3月，每日3～4次，呈黄色糊状便，精神食纳好，营养中等。可能的诊断是（　　）。", "answer": "生理性腹泻", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "慢性腹泻", "B": "迁延性腹泻", "C": "生理性腹泻", "D": "感染性腹泻", "language": "zh"}
{"question": "下列关于清创的原则中，错误的是（　　）。", "answer": "必须放置引流", "meta_info": "第八部分　其他疾病", "answer_idx": "D", "A": "切除失去活力的组织", "B": "彻底止血", "C": "根据情况缝合伤口", "D": "必须放置引流", "language": "zh"}
{"question": "慢性乙型肝炎最重要的治疗是（　　）。", "answer": "抗病毒治疗", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "抗纤维化治疗", "B": "免疫调节治疗", "C": "保肝治疗", "D": "抗病毒治疗", "language": "zh"}
{"question": "患者，女，65岁，心尖部可闻及3/6级收缩期杂音，最有助于明确诊断的检查是（　　）。", "answer": "超声心动图", "meta_info": "第2篇　心血管系统", "answer_idx": "D", "A": "胸部X线片", "B": "心肌MRI显影", "C": "心电图", "D": "超声心动图", "language": "zh"}
{"question": "2．急淋白血病（　　）。", "answer": "PAS阳性", "meta_info": "第一部分　血液系统疾病", "answer_idx": "C", "A": "NAP强阳性", "B": "t（9：22）（q34：q11）", "C": "PAS阳性", "D": "非特异性酯酶阳性，能被NaF抑制", "language": "zh"}
{"question": "GH兴奋试验有助于明确病因诊断的情况是（　　）。", "answer": "身材矮小", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "身材矮小", "B": "身材高大", "C": "肥胖", "D": "肢端肥大", "language": "zh"}
{"question": "听幻觉最常发生于（　　）。", "answer": "精神分裂症", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "躁狂症", "B": "抑郁症", "C": "精神分裂症", "D": "强迫症", "language": "zh"}
{"question": "患者，女，55岁。2周前心前区剧烈疼痛，随后心悸、气促，怀疑急性心肌梗死。最有用的酶学检查是（　　）。", "answer": "肌钙蛋白T", "meta_info": "第2篇　心血管系统", "answer_idx": "C", "A": "LDH", "B": "CPK", "C": "肌钙蛋白T", "D": "乳酸脱氢酶", "language": "zh"}
{"question": "正常成年人安静时的肺通气与血流比值为（　　）。", "answer": "0.84", "meta_info": "生理学", "answer_idx": "C", "A": "0.024", "B": "0.48", "C": "0.84", "D": "0.24", "language": "zh"}
{"question": "4．强迫观念（　　）。", "answer": "大脑中反复出现的观念，明知不必要，却摆脱不了，感到非常痛苦", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "联想过程缺乏一定方向，概念间缺乏内在联系", "B": "大脑中反复出现的观念，明知不必要，却摆脱不了，感到非常痛苦", "C": "持续地重复某一单调的语句", "D": "缺乏事实依据，患者却坚信不疑的病理信念", "language": "zh"}
{"question": "患者，5岁，于8月中旬发病，高热2小时，抽搐1次，有进不洁食物史，无呕吐、腹泻。查体：面色苍白，意识朦胧，四肢凉，血压70/40mmHg。1．诊断首先考虑（　　）。", "answer": "中毒性菌痢", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "乙型脑炎", "B": "中毒性菌痢", "C": "阿米巴痢疾", "D": "病毒性脑炎", "language": "zh"}
{"question": "2．肺炎支原体肺炎（　　）。", "answer": "热型不定", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "稽留高热", "B": "弛张高热", "C": "低热", "D": "热型不定", "language": "zh"}
{"question": "初产妇，28岁。妊娠34周，恶心，呕吐，腹胀，黄疸，轻度乏力，诊断为妊娠合并急性乙型病毒性肝炎。该患者的治疗是（　　）。", "answer": "立即隔离、保肝治疗", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "立即隔离、保肝治疗", "B": "无需特殊处理，等至顺产", "C": "人工引产", "D": "严密监护下继续妊娠", "language": "zh"}
{"question": "动脉粥样硬化中脂纹病变中主要成分是（　　）。", "answer": "泡沫细胞", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "平滑肌细胞", "B": "中性粒细胞", "C": "单核细胞", "D": "泡沫细胞", "language": "zh"}
{"question": "子宫内膜异位症的好发部位是（　　）。", "answer": "卵巢", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "子宫内膜", "B": "子宫阔韧带", "C": "子宫圆韧带", "D": "卵巢", "language": "zh"}
{"question": "30岁，月经4～5/24～25天，习惯性流产3次，基础体温呈双相，高温相持续8～10天，应诊断为（　　）。", "answer": "黄体功能不全", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "黄体功能不全", "B": "子宫内膜不规则脱落", "C": "无排卵性功血", "D": "有排卵性功血，月经过少", "language": "zh"}
{"question": "关于Ag因素对免疫耐受影响的描述哪一项是恰当的?（　　）", "answer": "抗原的持续存在是维持免疫耐受的重要条件", "meta_info": "医学免疫学", "answer_idx": "A", "A": "抗原的持续存在是维持免疫耐受的重要条件", "B": "Ag经皮下或肌肉注射易形成耐受", "C": "Ag有多种不同的决定簇易形成耐受", "D": "耐受原多为大分子颗粒性物质", "language": "zh"}
{"question": "女性，26岁。因甲状腺癌行甲状腺全切除术，术后当晚出现呼吸困难，伤口肿胀有血液渗出，最佳急救处理为（　　）。", "answer": "拆除缝线，敞开手术创腔", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "气管切开", "B": "气管插管", "C": "静注地塞米松", "D": "拆除缝线，敞开手术创腔", "language": "zh"}
{"question": "2岁男孩，未接种麻疹疫苗，今在托儿所中接触麻疹患儿，当即给予丙种球蛋白注射，对该小儿应检疫观察多少天（　　）。", "answer": "21天", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "7天", "B": "21天", "C": "28天", "D": "无需检疫", "language": "zh"}
{"question": "患者，女，34岁。吸烟，近1年来右下肢行走后疼痛，休息后好转，出现间歇性跛行。近1个月来，右脚趾变黑、皱缩、失去知觉。此种病变是（　　）。", "answer": "干性坏疽", "meta_info": "第2篇　心血管系统", "answer_idx": "C", "A": "干酪样坏死", "B": "固缩坏死", "C": "干性坏疽", "D": "变性", "language": "zh"}
{"question": "HSV-1(单纯疱疹病毒)主要潜伏部位是（　　）。", "answer": "三叉神经节", "meta_info": "医学微生物学", "answer_idx": "D", "A": "口唇皮肤", "B": "脊髓后根神经节", "C": "骶神经节", "D": "三叉神经节", "language": "zh"}
{"question": "1．患者认真讲了一番话，但周围的医生们都不理解他要说什么问题，该症状为（　　）。", "answer": "思维散漫", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "思维被夺取", "B": "思维被洞悉", "C": "思维贫乏", "D": "思维散漫", "language": "zh"}
{"question": "4．青霉素过敏性休克（　　）。", "answer": "属Ⅰ型超敏反应性疾病", "meta_info": "医学免疫学", "answer_idx": "A", "A": "属Ⅰ型超敏反应性疾病", "B": "属Ⅱ型超敏反应性疾病", "C": "属Ⅲ型超敏反应性疾病", "D": "属Ⅳ型超敏反应性疾病", "language": "zh"}
{"question": "在对医德评价内涵的理解中，不正确的是（　　）。", "answer": "评价内容的主观性", "meta_info": "医学伦理学", "answer_idx": "B", "A": "评价主体的社会性", "B": "评价内容的主观性", "C": "评价标准的客观性", "D": "评价结果的原则性", "language": "zh"}
{"question": "对苯海索的叙述，不正确的是（　　）。", "answer": "对氯丙嗪引起的震颤麻痹无效", "meta_info": "药理学", "answer_idx": "B", "A": "阻断中枢胆碱受体", "B": "对氯丙嗪引起的震颤麻痹无效", "C": "对僵直和运动困难疗效差", "D": "外周抗胆碱作用比阿托品弱", "language": "zh"}
{"question": "胃-食管反流病的主要发病机制不包括（　　）。", "answer": "夜间胃酸分泌过多", "meta_info": "第二部分　模拟试题", "answer_idx": "A", "A": "夜间胃酸分泌过多", "B": "异常的下食管括约肌一过性松弛", "C": "胃排空异常", "D": "食管酸廓清能力下降", "language": "zh"}
{"question": "关于肠道杆菌的论述，不正确的是（　　）。", "answer": "肠道杆菌中致病菌可分解乳糖", "meta_info": "医学微生物学", "answer_idx": "C", "A": "所有肠道杆菌都不形成芽孢", "B": "肠道杆菌均为G-杆菌", "C": "肠道杆菌中致病菌可分解乳糖", "D": "肠道杆菌中非致病菌可分解乳糖", "language": "zh"}
{"question": "1．学龄前儿每日所需水分（　　）。", "answer": "100ml/kg", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "125ml/kg", "B": "100ml/kg", "C": "75ml/kg", "D": "40ml/kg", "language": "zh"}
{"question": "含有七个疏水性跨膜区的细胞因子受体为下述哪项（　　）。", "answer": "G蛋白耦联受体家族", "meta_info": "医学免疫学", "answer_idx": "D", "A": "免疫球蛋白基因家族", "B": "造血因子受体家族", "C": "神经生长因子及肿瘤坏死因子受体家族", "D": "G蛋白耦联受体家族", "language": "zh"}
{"question": "一重症肌无力病人因肺部感染应用卡那霉素治疗，3天后发生危象，这时首先应（　　）。", "answer": "保证呼吸道通畅和正常换气", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "鉴别危象类型，给予针对性治疗", "B": "停用卡那霉素", "C": "保证呼吸道通畅和正常换气", "D": "积极治疗肺部感染", "language": "zh"}
{"question": "5．医疗机构（　　）。", "answer": "承担与医疗救治有关的传染病防治工作和责任区域内的传染源隔离预防工作", "meta_info": "卫生法规", "answer_idx": "B", "A": "承担传染病监测、预测、流行病学调查、疫情报告以及其他预防控制工作", "B": "承担与医疗救治有关的传染病防治工作和责任区域内的传染源隔离预防工作", "C": "在各自的职责范围内负责传染病防治工作", "D": "主管全国传染病防治及其监督管理工作", "language": "zh"}
{"question": "下列有关病毒疫苗的描述，错误的是（　　）。", "answer": "灭活疫苗通常可引起粘膜分泌IgA抗体", "meta_info": "医学微生物学", "answer_idx": "D", "A": "减毒活疫苗是病毒已失去致病力，但仍有使机体产生中和抗体的能力", "B": "减毒活疫苗有病毒恢复毒力的可能", "C": "灭活疫苗可诱导机体产生IgG抗体而起到保护性免疫作用", "D": "灭活疫苗通常可引起粘膜分泌IgA抗体", "language": "zh"}
{"question": "处方一般不得超过几日用量？（　　）", "answer": "7日", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "3日", "B": "5日", "C": "7日", "D": "10日", "language": "zh"}
{"question": "初产妇，26岁，妊娠38周。规律宫缩8小时，宫口开大6cm，S＋1，胎膜已破。胎儿体重估计3000g，血压130/80rnmHg，胎心144次/min。2小时后肛查：宫口仍6cm、边薄，先露S＋1，宫缩力弱，20秒/5～6分，胎心好。应诊断为（　　）。", "answer": "活跃期停滞", "meta_info": "第5篇　女性生殖系统", "answer_idx": "B", "A": "活跃期延长", "B": "活跃期停滞", "C": "第二产程延长", "D": "滞产", "language": "zh"}
{"question": "临床上常用于诊断乙型脑炎的方法是（　　）。", "answer": "测定体内特异性IgM抗体", "meta_info": "医学微生物学", "answer_idx": "D", "A": "脑脊液中分离病毒", "B": "测定补体结合抗体", "C": "测定中和抗体", "D": "测定体内特异性IgM抗体", "language": "zh"}
{"question": "人体内能进入肠肝循环的胆色素是（　　）。", "answer": "胆素原", "meta_info": "生物化学", "answer_idx": "B", "A": "胆红素", "B": "胆素原", "C": "粪胆素", "D": "尿胆素", "language": "zh"}
{"question": "初孕妇，28岁，妊娠36周。血压升高3周，今晨突然腹痛，呈持续性，阵发性加重。BP 150／98mmHg，心率112次/分，尿蛋白（＋＋），阴道少量流血。3．最可能出现的情况是（　　）。", "answer": "胎盘早剥", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "前置胎盘", "B": "子宫肌瘤红色样变", "C": "胎盘早剥", "D": "先兆子宫破裂", "language": "zh"}
{"question": "女孩，2岁。自幼体弱，多次患肺炎。胸部X线片：左心房、左心室增大，肺野充血，主动脉影增宽。最可能的诊断是（　　）。", "answer": "动脉导管未闭", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "艾森门格综合征", "B": "动脉导管未闭", "C": "房间隔缺损", "D": "室间隔缺损", "language": "zh"}
{"question": "轻度或中度高血压患者，术前要求血压控制情况为（　　）。", "answer": "维持原水平", "meta_info": "第八部分　其他疾病", "answer_idx": "A", "A": "维持原水平", "B": "降至正常", "C": "降至正常水平点", "D": "以上都不是", "language": "zh"}
{"question": "中间综合征常发生在一氧化碳中毒后（　　）。", "answer": "30～60天", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "24～96小时", "B": "7～9天", "C": "12～24天", "D": "30～60天", "language": "zh"}
{"question": "维拉帕米对哪一种心律失常疗效最好？（　　）", "answer": "阵发性室上性心动过速", "meta_info": "药理学", "answer_idx": "C", "A": "室性心动过速", "B": "室性期前收缩", "C": "阵发性室上性心动过速", "D": "强心苷过量的心律失常", "language": "zh"}
{"question": "鉴别醛固酮瘤及特发性醛固酮增多症，下述哪个试验最有意义？（　　）", "answer": "18-羟皮质酮测定", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "B", "A": "去氧皮质醇测定", "B": "18-羟皮质酮测定", "C": "血浆ACTH测定", "D": "血浆肾素一血管紧张素测定", "language": "zh"}
{"question": "某县妇幼保健院组织医疗队下乡为孕妇、产妇进行产前定期检查。1．该检查属于医疗保健机构为孕产妇提供孕产期保健服务内容中的（　　）。", "answer": "孕妇、产妇保健", "meta_info": "卫生法规", "answer_idx": "B", "A": "母婴保健指导", "B": "孕妇、产妇保健", "C": "胎儿保健", "D": "新生儿保健", "language": "zh"}
{"question": "2．单位时间内两侧肾生成的超滤液量称为（　　）。", "answer": "肾小球滤过率", "meta_info": "生理学", "answer_idx": "A", "A": "肾小球滤过率", "B": "滤过分数", "C": "血浆清除率", "D": "球—管平衡", "language": "zh"}
{"question": "为使血浆pH保持在正常的范围，[HCO3-]/[H2CO3]保持在（　　）。", "answer": "20∶1", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "B", "A": "15:1", "B": "20∶1", "C": "25∶1", "D": "30∶1", "language": "zh"}
{"question": "女，68岁，反复咳嗽咳痰20年，气喘10年，加重伴下肢水肿一周入院，高血压病史10余年，最高血压145／90mmHg，查体：T 37.8℃，口唇发绀，血压135／80mmHg，双下肺散在湿啰音和哮鸣音，肝肋下3cm，肝颈静脉回流征阳性，双下肢水肿，WBC 9.3×109/L。3．符合该患者ECG表现的是（　　）。", "answer": "胸前导联顺钟向转位", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "普遍导联ST段弓背向上抬高", "B": "电轴左偏", "C": "P波增宽有切迹", "D": "胸前导联顺钟向转位", "language": "zh"}
{"question": "关于感染性休克病人应用糖皮质激素的依据与方法，错误的是（　　）。", "answer": "糖皮质激素应从大剂量开始", "meta_info": "药理学", "answer_idx": "D", "A": "糖皮质激素可以稳定细胞及溶酶体膜，免受内毒素破坏", "B": "大剂量糖皮质激素对心脏发挥正性肌力作用", "C": "适当应用糖皮质激素可以减少合并症", "D": "糖皮质激素应从大剂量开始", "language": "zh"}
{"question": "肝细胞呈碎片状及桥接坏死主要见于（　　）。", "answer": "重度慢性肝炎", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "亚急性重型肝炎", "B": "轻度慢性肝炎", "C": "重度慢性肝炎", "D": "急性普通型肝炎", "language": "zh"}
{"question": "按照测验的目的来分类，以下哪个选项不正确？（　　）", "answer": "投射测验", "meta_info": "医学心理学", "answer_idx": "D", "A": "智力测验", "B": "特殊能力测验", "C": "人格测验", "D": "投射测验", "language": "zh"}
{"question": "女，28岁，停经55天，伴恶心呕吐。妇科检查：子宫增大约妊娠50天大小，双侧附件（－）。该病例首选的辅助检查是（　　）。", "answer": "B超", "meta_info": "第5篇　女性生殖系统", "answer_idx": "A", "A": "B超", "B": "宫颈黏液检查", "C": "血HCG检查", "D": "黄体酮试验", "language": "zh"}
{"question": "要从混合的T、B细胞中分离T细胞，最佳的方法是（　　）。", "answer": "流式细胞技术", "meta_info": "医学免疫学", "answer_idx": "A", "A": "流式细胞技术", "B": "放射免疫分析法", "C": "ELISA", "D": "双向琼脂扩散试验", "language": "zh"}
{"question": "3．一定社会群体或集团的人们，依据一定的道德观念，对社会生活中的事件或人的行为形成的带有倾向性的共同看法，并以此对人的行为或组织施加影响是指（　　）。", "answer": "社会舆论", "meta_info": "医学伦理学", "answer_idx": "A", "A": "社会舆论", "B": "传统习俗", "C": "医德评价", "D": "医德修养", "language": "zh"}
{"question": "男，38岁。醉酒后出现发热，咳嗽、咳脓臭痰5天，伴右侧胸痛。查体：T 39.2℃，P 112次/分，R 26次/分，BP 130/80mmHg。神志清楚，右中肺少许湿性啰音。胸部X线片示右中肺团块状影。可见空洞和气液平。血WBC 16.3×109/L，中性粒0.88，淋巴0.10。该患者最可能的诊断是（　　）。", "answer": "肺脓肿", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "大叶性肺炎", "B": "肺脓肿", "C": "肺癌", "D": "真菌性肺炎", "language": "zh"}
{"question": "26岁，男性，入院前2小时被他人用斧砍伤致股骨下段骨折。查体：足背动脉触不到，足苍白、发凉，血压测不到。正确的诊断是（　　）。", "answer": "股骨下段开放性骨折，股动脉损伤伴休克", "meta_info": "第四部分　运动系统疾病", "answer_idx": "B", "A": "股骨下段骨折伴休克", "B": "股骨下段开放性骨折，股动脉损伤伴休克", "C": "股骨下段开放性损伤伴股动脉损伤", "D": "股骨下段开放性骨折伴休克", "language": "zh"}
{"question": "阑尾最常发生的肿瘤是（　　）。", "answer": "类癌", "meta_info": "第3篇　消化系统", "answer_idx": "C", "A": "淋巴瘤", "B": "平滑肌瘤", "C": "类癌", "D": "小细胞癌", "language": "zh"}
{"question": "3．大叶性肺炎是（　　）。", "answer": "纤维素性炎", "meta_info": "病理学", "answer_idx": "A", "A": "纤维素性炎", "B": "化脓性炎", "C": "出血性炎", "D": "浆液性炎", "language": "zh"}
{"question": "女，65岁。间断咳嗽、咳痰10年，加重伴呼吸困难2天。血气分析：pH 7.35，PaO2 56mmHg，PaCO2 46mmHg。给予该患者鼻导管吸氧治疗。如需使用的吸氧浓度为27％，则其氧流量应调整为（　　）。", "answer": "1.5L/min", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "1.0L/min", "B": "1.5L/min", "C": "2.0L/min", "D": "2.5L/min", "language": "zh"}
{"question": "人道主义最初是由下列哪类人提出来的革命口号？（　　）", "answer": "资产阶级", "meta_info": "医学伦理学", "answer_idx": "B", "A": "无产阶级", "B": "资产阶级", "C": "地主阶级", "D": "小资产阶级", "language": "zh"}
{"question": "某一细胞因子在淋巴细胞识别Ag时作为第二信使，使T细胞活化成为有效应的细胞参与免疫应答。该细胞因子是（　　）。", "answer": "IL-1", "meta_info": "医学免疫学", "answer_idx": "A", "A": "IL-1", "B": "IL-4", "C": "IL-2", "D": "IL-12", "language": "zh"}
{"question": "男，35岁。持续高热、恶心、呕吐、食欲不振伴腹泻5天入院。查体：皮肤、巩膜轻度黄染，胸部可见数枚淡红色斑丘疹，脾脏肋下可触及。实验室检查：血WBC 3.2×109/L，PLT 100×109/L。ALT 140U/L，TBiL 45μmol/L。肥达反应O 1:32。该疾病的特征性病理变化是（　　）。", "answer": "全身单核巨噬细胞系统增生", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "全身单核巨噬细胞系统增生", "B": "肠黏膜淤血水肿", "C": "中性粒细胞浸润", "D": "干酪样坏死性肉芽肿形成", "language": "zh"}
{"question": "1一个患有巨大结节性甲状腺肿的病人在管内插管麻醉下行双侧甲状腺大部切除术，术后当晚出现呼吸困难、烦躁、发绀，脉率130次/分，血压170/100mmHg，伤口引流渗血不多，颈部不肿。可能是（　　）。", "answer": "喉头水肿", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "B", "A": "气管塌陷", "B": "喉头水肿", "C": "切口出血压迫", "D": "双侧喉返神经损伤", "language": "zh"}
{"question": "3．内外源凝血系统共同激活因子（　　）。", "answer": "X因子", "meta_info": "第一部分　血液系统疾病", "answer_idx": "B", "A": "Ⅻ因子", "B": "X因子", "C": "Ⅷ因子", "D": "Ⅲ因子", "language": "zh"}
{"question": "在骨骼肌兴奋-收缩偶联中起关键作用的离子是（　　）。", "answer": "Ca2＋", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "Na＋", "B": "K＋", "C": "Ca2＋", "D": "Mg2＋", "language": "zh"}
{"question": "男性，55岁，双下肢无力半年，右侧明显，近2个月行走不稳，右手不能扣纽扣，无外伤史，无发热。查体：颈背部无明显压痛，两上肢前臂、手及上臂尺侧皮肤感觉减退，右侧尤其明显，四肢肌张力增高，肱二头肌反射亢进，双侧膝踝反射亢进，右髌阵挛阳性，右巴宾斯基征阳性。4．应考虑的治疗是（　　）。", "answer": "手术", "meta_info": "第四部分　运动系统疾病", "answer_idx": "C", "A": "颈枕吊带牵引", "B": "推拿按摩治疗", "C": "手术", "D": "颈托围领", "language": "zh"}
{"question": "Colles骨折，最有诊断意义的体征（　　）。", "answer": "典型畸形", "meta_info": "第四部分　运动系统疾病", "answer_idx": "A", "A": "典型畸形", "B": "局部肿胀", "C": "反常活动", "D": "手功能受限", "language": "zh"}
{"question": "在下列疾病中，哪一种不适宜使用洋地黄类药物？（　　）", "answer": "下壁心肌梗死伴完全性房室传导阻滞", "meta_info": "第2篇　心血管系统", "answer_idx": "D", "A": "高血压性心脏病伴慢性心衰", "B": "无器质性心脏病患者发生阵发性室上性心动过速", "C": "风湿性心脏病二尖瓣狭窄伴快速心室率的心房颤动", "D": "下壁心肌梗死伴完全性房室传导阻滞", "language": "zh"}
{"question": "免疫系统包括（　　）。", "answer": "A、B和C", "meta_info": "医学免疫学", "answer_idx": "D", "A": "中枢淋巴器官", "B": "外周淋巴器官", "C": "免疫活性细胞", "D": "A、B和C", "language": "zh"}
{"question": "以下关于急腹症手术适应证的描述，最恰当的是（　　）。", "answer": "消化道穿孔不是剖腹手术术的绝对适应证", "meta_info": "第3篇　消化系统", "answer_idx": "A", "A": "消化道穿孔不是剖腹手术术的绝对适应证", "B": "肠梗阻只有明确诊断绞窄时才可手术", "C": "黏连性肠梗阻不需手术治疗", "D": "先有发热的急性腹痛，一般是外科急腹症，均应考虑手术", "language": "zh"}
{"question": "从事母婴保健工作的人员违反母婴保健法规定，有下述情形的，给予行政处分，情节严重的，依法取消执业资格（　　）。", "answer": "做胎儿性别鉴定", "meta_info": "卫生法规", "answer_idx": "D", "A": "做医学技术鉴定", "B": "做产前诊断", "C": "做终止妊娠", "D": "做胎儿性别鉴定", "language": "zh"}
{"question": "引起慢性肾功能不全的最常见的继发性肾脏病是（　　）。", "answer": "糖尿病肾病", "meta_info": "第4篇　泌尿系统", "answer_idx": "B", "A": "乙肝相关性肾炎", "B": "糖尿病肾病", "C": "良性肾小动脉硬化", "D": "系统性红斑狼疮", "language": "zh"}
{"question": "不符合轮状病毒肠炎的特点是（　　）。", "answer": "夏季多见", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "夏季多见", "B": "多见于6～24个月", "C": "常出现脱水", "D": "常伴有发热", "language": "zh"}
{"question": "28岁男性患者，有不洁性史和注射吸毒史。近半年体重下降，因发热、咳嗽、反复出现疱疹以及口腔真菌感染入院。应选择下列哪种标本和检测项目进行检查？（　　）", "answer": "血清，人类免疫缺陷病毒抗体", "meta_info": "医学微生物学", "answer_idx": "D", "A": "尿道分泌物，淋球菌", "B": "皮疹渗出物，梅毒螺旋体", "C": "口腔标本，酵母菌假菌丝", "D": "血清，人类免疫缺陷病毒抗体", "language": "zh"}
{"question": "关于应对的说法不正更的是（　　）。", "answer": "应对都能消除自己的紧张", "meta_info": "医学心理学", "answer_idx": "C", "A": "应对是一种心理现象", "B": "应对是人面对应激源时的一种反应", "C": "应对都能消除自己的紧张", "D": "应对过程是通过努力克服困难的过程", "language": "zh"}
{"question": "慢性锥体束病变，深层反射应是（　　）。", "answer": "增高", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "减低", "B": "增高", "C": "无变化", "D": "增高或减低", "language": "zh"}
{"question": "急性脑梗死溶栓治疗的禁忌证是（　　）。", "answer": "发病6小时，头CT显示肿瘤，有占位效应", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "发病6小时，头CT显示肿瘤，有占位效应", "B": "急性卒中3小时意识蒙胧者", "C": "2个月前曾有动脉穿刺史", "D": "病前抗血小板治疗，化验示血小板数为150×109/L", "language": "zh"}
{"question": "下述消毒灭菌法错误的是（　　）。", "answer": "金属器械——漂白粉", "meta_info": "医学微生物学", "answer_idx": "A", "A": "金属器械——漂白粉", "B": "含糖培养基——间歇灭菌法", "C": "饮水——氯气", "D": "排泄物——漂白粉", "language": "zh"}
{"question": "Murphy征阳性提示是（　　）。", "answer": "急性胆囊炎", "meta_info": "第3篇　消化系统", "answer_idx": "D", "A": "细菌性肝脓肿", "B": "肝总管结石", "C": "左肝管结石", "D": "急性胆囊炎", "language": "zh"}
{"question": "男，48岁。左上腹部外伤3小时，急诊留观时出现口渴、烦躁、左上腹疼痛加剧。体温39.1℃，复查血常规提示白细胞计数明显升高，下一步治疗应选择（　　）。", "answer": "急诊剖腹探查", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "急诊剖腹探查", "B": "皮下注射吗啡", "C": "腹部CT检查", "D": "抗感染治疗后择期手术", "language": "zh"}
{"question": "对于有严重自杀企图，使用抗抑郁药治疗无效的抑郁发作患者，可采用的有效治疗措施是（　　）。", "answer": "电休克治疗", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "心理治疗", "B": "生物反馈治疗", "C": "电休克治疗", "D": "胰岛素昏迷治疗", "language": "zh"}
{"question": "骨巨细胞瘤的性质属于（　　）。", "answer": "潜在恶性", "meta_info": "第四部分　运动系统疾病", "answer_idx": "B", "A": "良性", "B": "潜在恶性", "C": "高度恶性", "D": "性质不明", "language": "zh"}
{"question": "妊娠、糖尿病患者及接受大量雌激素治疗的患者易发生（　　）。", "answer": "外阴阴道假丝酵母菌病", "meta_info": "第5篇　女性生殖系统", "answer_idx": "B", "A": "滴虫性阴道炎", "B": "外阴阴道假丝酵母菌病", "C": "婴幼儿外阴阴道炎", "D": "淋球菌阴道炎", "language": "zh"}
{"question": "女性，70岁。以突发性意识丧失入院。检查：患者神志不清，口角向右侧上方歪斜，右侧上下肢软、无力，血压180／100mmHg。叩诊心界稍大。尿常规：蛋白（+），红细胞（+）。眼底：视乳头水肿，视网膜动脉银白色，周围可见少许出血。该患者最可能的诊断是（　　）。", "answer": "高血压病伴左侧内囊出血", "meta_info": "病理学", "answer_idx": "B", "A": "冠心病伴心肌梗死", "B": "高血压病伴左侧内囊出血", "C": "尿毒症", "D": "颅内肿瘤", "language": "zh"}
{"question": "2．《医疗事故处理条例》规定，对60周岁以上的患者因医疗事故致残的，赔偿其残疾生活补助费的时间不超过（　　） 。", "answer": "15年", "meta_info": "卫生法规", "answer_idx": "C", "A": "5年", "B": "10年", "C": "15年", "D": "20年", "language": "zh"}
{"question": "风湿热的发病常与下列哪种病原体感染有关？（　　）", "answer": "A组B型溶血性链球菌", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "A组A型溶血性链球菌", "B": "A组B型溶血性链球菌", "C": "皮肤溶血性链球菌", "D": "肺炎链球菌", "language": "zh"}
{"question": "新生儿溶血病如需要换血疗法，经审核和患儿家属或监护人同意后，换血工作应由（　　）。", "answer": "上级医师和输血科人员共同实施", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "经治医师实施", "B": "输血科人员实施", "C": "经治医师和输血科人员共同实施", "D": "上级医师和输血科人员共同实施", "language": "zh"}
{"question": "凡血袋有下述情形之一的，一律不得发出，除了（　　）。", "answer": "没有说明书", "meta_info": "卫生法规", "answer_idx": "A", "A": "没有说明书", "B": "过期", "C": "血袋有破损、漏血", "D": "标签破损、字迹不清", "language": "zh"}
{"question": "类风湿关节炎的关节特点不包括（　　）。", "answer": "以大关节受累为主", "meta_info": "第四部分　运动系统疾病", "answer_idx": "B", "A": "关节痛是最早的关节症状", "B": "以大关节受累为主", "C": "关节强直", "D": "关节活动障碍", "language": "zh"}
{"question": "下列哪项是血液中生物活性最强的甲状腺激素?（　　）", "answer": "三碘甲腺原氨酸", "meta_info": "生理学", "answer_idx": "C", "A": "碘化酪氨酸", "B": "二碘酪氨酸", "C": "三碘甲腺原氨酸", "D": "四碘甲腺原氨酸", "language": "zh"}
{"question": "早期缺铁性贫血形态学改变为（　　）。", "answer": "正细胞正色素性贫血", "meta_info": "第一部分　血液系统疾病", "answer_idx": "B", "A": "小细胞正色素性贫血", "B": "正细胞正色素性贫血", "C": "大细胞性贫血", "D": "以上全不是", "language": "zh"}
{"question": "下列哪项不属于患者的权利？（　　）", "answer": "获取工资报酬和津贴，享受国家规定的福利待遇权", "meta_info": "医学伦理学", "answer_idx": "B", "A": "疾病认知权", "B": "获取工资报酬和津贴，享受国家规定的福利待遇权", "C": "知情同意权", "D": "保守个人秘密权", "language": "zh"}
{"question": "早期诊断佝偻病的可靠指标是（　　）。", "answer": "血清25（OH）D3水平降低", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "钙磷乘积下降", "B": "血浆中cAMP水平降低", "C": "血清25（OH）D3水平降低", "D": "骨骼X线改变", "language": "zh"}
{"question": "60岁男性，活动中突感眩晕，枕部疼痛、呕吐，步态不稳，20min后昏迷，呼吸节律不整，诊断脑出血，其部位是（　　）。", "answer": "小脑", "meta_info": "第二部分　模拟试题", "answer_idx": "D", "A": "脑颞叶", "B": "基底节", "C": "脑桥", "D": "小脑", "language": "zh"}
{"question": "初产妇，26岁。妊娠39周。分娩过程中自觉下腹部持续疼痛，拒按，烦躁不安。产科检查：下腹部压痛，胎位不清，胎心不规律，宫口停止扩张，胎先露部下降停止。诊断为“高张性宫缩乏力”。下列处理错误的是（　　）。", "answer": "立即静脉注射缩宫素", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "处理原则是调节子宫收缩，恢复正常节律及其极性", "B": "立即静脉注射缩宫素", "C": "给予强镇静剂", "D": "经上述处理未能得到纠正者，均应行剖产术", "language": "zh"}
{"question": "男，40岁。双下肢水肿1个月。查体：BP 150／100mmHg，尿红细胞3～5/HP，尿蛋白5g/d，血清蛋白20g/L，血肌酐70μmol/L。近3天腰痛，尿量减少。复查尿常规：尿红细胞30～50/HP。B超示右肾增大。1．血尿加重最可能的原因是（　　）。", "answer": "肾静脉血栓形成", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "急性过敏性间质肾炎", "B": "肾静脉血栓形成", "C": "合并泌尿系统肿瘤", "D": "尿路感染", "language": "zh"}
{"question": "1．代谢性酸中毒（　　）。", "answer": "HCO3-↓，pH↓，PCO2正常", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "A", "A": "HCO3-↓，pH↓，PCO2正常", "B": "HCO3-正常，pH↓，PCO2↑", "C": "HCO3-正常，pH↓，PCO2↓", "D": "HCO3-↓，pH↑，PCO2↓", "language": "zh"}
{"question": "一婴儿出现发热，咳嗽、咳痰、气喘，胸透见双肺下叶散在分布着边界不清的阴影。最可能的诊断是（　　）。", "answer": "小叶性肺炎", "meta_info": "病理学", "answer_idx": "C", "A": "大叶性肺炎", "B": "间质性肺炎", "C": "小叶性肺炎", "D": "肺脓肿", "language": "zh"}
{"question": "3．属于躁狂症是（　　）。", "answer": "思维奔逸", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "蜡样屈曲", "B": "情绪低落", "C": "思维奔逸", "D": "恐怖", "language": "zh"}
{"question": "女，31岁。发热伴刺激性干咳3天，一周前陪伴5岁女儿住院，女儿4天前好转已出院，查体：T 38.5℃，心肺正常，血常规正常，胸部X线片示右下肺少许薄片状阴影，该患者经验性治疗首选的药物是（　　）。", "answer": "阿奇霉素", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "阿莫西林", "B": "阿奇霉素", "C": "奥司他韦", "D": "阿米卡星", "language": "zh"}
{"question": "女性,54岁，有甲亢的病史，近日因过劳和精神受刺激而出现失眠、心慌、胸闷。体检见心率160次/分，心电有明显的心肌缺血改变、窦性心律不齐。此时最好选用（　　）。", "answer": "普萘洛尔", "meta_info": "药理学", "answer_idx": "C", "A": "奎尼丁", "B": "胺碘酮", "C": "普萘洛尔", "D": "利多卡因", "language": "zh"}
{"question": "大型室间隔缺损后期出现青紫时，肺血管的主要改变是（　　）。", "answer": "梗阻型肺动脉高压", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "梗阻型肺动脉高压", "B": "动力型肺动脉高压", "C": "肺血增多", "D": "肺血减少", "language": "zh"}
{"question": "患儿4个月，发热咳嗽1天，惊厥5～6次，抽后吃奶好。体检：T 38.2℃，发育营养中等，精神好，咽部充血，有颅骨软化，前囟平，其他未见异常，周围血WBC8×109/L，中性粒细胞56%，其惊厥原因最可能是（　　）。", "answer": "维生素D缺乏性手足搐搦症", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "低血糖", "B": "维生素D缺乏性手足搐搦症", "C": "中毒性脑病", "D": "化脓性脑膜炎", "language": "zh"}
{"question": "一大面积烧伤患者，近日来常寒战、高热，呈间歇热，四肢厥冷，紫绀，尿量明显减少，很快血压下降，发生休克。其最可能的原因是（　　）。", "answer": "革兰阴性细菌败血症", "meta_info": "第八部分　其他疾病", "answer_idx": "B", "A": "革兰阳性细菌败血症", "B": "革兰阴性细菌败血症", "C": "厌氧菌性败血症", "D": "二重感染", "language": "zh"}
{"question": "4．手术治疗的副作用为（　　）。", "answer": "听力减退或丧失、面部感觉减退或丧失、其他脑神经麻痹", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "头晕、口干、行走不稳", "B": "手颤、记忆力减退、睡眠中肢体抖动", "C": "听力减退或丧失、面部感觉减退或丧失、其他脑神经麻痹", "D": "偶有一过性头晕、全身瘙痒和复视", "language": "zh"}
{"question": "下列哪项是HIV的受体？（　　）", "answer": "CD4分子", "meta_info": "医学免疫学", "answer_idx": "B", "A": "CD2分子", "B": "CD4分子", "C": "CD5分子", "D": "CD8分子", "language": "zh"}
{"question": "关于醋酸泼尼松龙局部封闭，下列说法错误的是（　　）。", "answer": "必须配合口服止痛药治疗", "meta_info": "第四部分　运动系统疾病", "answer_idx": "D", "A": "适用于诊断明确的慢性损伤性炎症", "B": "严格无菌操作", "C": "注意部位准确", "D": "必须配合口服止痛药治疗", "language": "zh"}
{"question": "下列关于骨骼肌-神经接头处兴奋传递特点的描述，错误的是（　　）。", "answer": "神经兴奋后肌肉不一定收缩", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "单向传递", "B": "神经兴奋后肌肉不一定收缩", "C": "时间延搁", "D": "化学传递", "language": "zh"}
{"question": "治疗新鲜髋关节后脱位的措施，不应选择（　　）。", "answer": "即刻手术切开复位", "meta_info": "第四部分　运动系统疾病", "answer_idx": "D", "A": "Aillis法手法复位", "B": "复位后持续皮牵引固定于伸直，外展位3～4周", "C": "伤后3个月患肢不能负重，以免股骨头缺血坏死", "D": "即刻手术切开复位", "language": "zh"}
{"question": "牛奶中以甲型乳糖为主有利于肠道内（　　）。", "answer": "大肠杆菌生长", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "双歧杆菌生长", "B": "乳酸杆菌生长", "C": "大肠杆菌生长", "D": "溶血性链球菌生长", "language": "zh"}
{"question": "女，19岁。近2周来发热38℃左右，伴恶心、呕吐、腹泻。继而出现心悸、胸痛、呼吸困难、晕厥发作。体检发现：面色苍白，精神萎靡，心率40次/分，律齐，心尖部第一心音低钝，且可闻及“大炮音”。临床诊断病毒性心肌炎。1．心电图表现最可能是（　　）。", "answer": "三度房室传导阻滞", "meta_info": "第2篇　心血管系统", "answer_idx": "C", "A": "窦性心动过缓", "B": "二度房室传导阻滞", "C": "三度房室传导阻滞", "D": "心肌梗死", "language": "zh"}
{"question": "男性，54岁。既往有冠心病史，因急性阑尾炎拟行急诊手术。测血压160/90mmHg（17/12kPa），脉搏45次/min，术前准备可选择（　　）。", "answer": "阿托品0.5mg术前皮下注射", "meta_info": "第八部分　其他疾病", "answer_idx": "B", "A": "硝酸甘油5mg加入5%葡萄糖溶液500ml，静脉点滴", "B": "阿托品0.5mg术前皮下注射", "C": "地高辛0.25mg，每日1～2次口服", "D": "硝普钠静脉点滴，快速降压", "language": "zh"}
{"question": "男性，3l岁。因诊断抑郁发作，给予三环类抗抑郁药连续治疗3个月，最常见的药物副作用是（　　）。", "answer": "口干、视物模糊、心律失常", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "肝损害", "B": "粒细胞缺乏", "C": "口干、视物模糊、心律失常", "D": "高热、肠麻痹", "language": "zh"}
{"question": "患儿，3岁，发热半月余，咳嗽、乏力、消瘦、盗汗。查体发现双肺呼吸音粗，X线检查提示为原发综合征，“OT”试验“+++”。2．该患儿强化阶段治疗选择（　　）。", "answer": "异烟肼+利福平+链霉素", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "异烟肼+链霉素", "B": "异烟肼+利福平", "C": "异烟肼+利福平+链霉素", "D": "异烟肼+链霉素+乙胺丁醇", "language": "zh"}
{"question": "65岁女性，跌倒时右手掌着地，腕部疼痛，肿胀，压痛，无反常活动，但餐叉状畸形明显，该患者最可能的诊断是（　　）。", "answer": "右腕Colles（科雷）骨折", "meta_info": "第四部分　运动系统疾病", "answer_idx": "B", "A": "右舟状骨骨折", "B": "右腕Colles（科雷）骨折", "C": "尺骨茎突骨折", "D": "右腕关节挫伤", "language": "zh"}
{"question": "男性，30岁，既往有贫血，2d采突然高热头痛呼吸困难，尿量100ml/d，血压12/6kPa，血红蛋白40g/L，网织红细胞12%，TC0 217mmol/L，BUN 14mmol/L，其诊断为（　　）。", "answer": "急性溶血性贫血伴肾功能不全", "meta_info": "第二部分　模拟试题", "answer_idx": "C", "A": "慢性肾炎急性发作", "B": "感染中毒性肾功能不全", "C": "急性溶血性贫血伴肾功能不全", "D": "以上均不可能", "language": "zh"}
{"question": "乳腺癌来源于（　　）。", "answer": "乳腺导管上皮及腺泡上皮", "meta_info": "第二部分　模拟试题", "answer_idx": "C", "A": "小叶间质", "B": "导管内乳头状瘤", "C": "乳腺导管上皮及腺泡上皮", "D": "乳腺纤维腺瘤", "language": "zh"}
{"question": "男，23岁，农民，11月份因发热、头痛、呕吐3d为主诉入院。查体：面颈部潮红，双腋下少许出血点，化验：尿常规蛋白（++）红细胞3～10个/HP，末梢血象：WBC23.0×109/L，异型淋巴细胞0.10，PLT48×109/L2．住院2d后，热退但症状加重，出血点增加，四肢厥冷，脉搏细弱，BP：80/60mmHg，此时对该患者的治疗原则为（　　）。", "answer": "以应用血管活性药物为主", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "B", "A": "以扩容为主", "B": "以应用血管活性药物为主", "C": "以应用激素为主", "D": "以输入胶体液为主", "language": "zh"}
{"question": "男性，26岁，生活懒散，面无表情，父母来看他，从不称呼父母更无问候言语，只顾埋头吃零食，视父母兄妹如陌生人，该症状属于（　　）。", "answer": "情感淡漠", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "情感淡漠", "B": "情感平淡", "C": "情感低落", "D": "情感倒错", "language": "zh"}
{"question": "免疫球蛋白中识别抗原的部位是（　　）。", "answer": "VL和VH", "meta_info": "医学免疫学", "answer_idx": "C", "A": "Fc段", "B": "可变区", "C": "VL和VH", "D": "CH1区", "language": "zh"}
{"question": "骨折的专有体征是（　　）。", "answer": "反常活动", "meta_info": "第四部分　运动系统疾病", "answer_idx": "C", "A": "局部疼痛", "B": "局部肿胀", "C": "反常活动", "D": "功能障碍", "language": "zh"}
{"question": "神经末梢释放神经递质的方式是（　　）。", "answer": "出胞", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "单纯扩散", "B": "经载体易化扩散", "C": "主动转运", "D": "出胞", "language": "zh"}
{"question": "肝脏所特有的生成酮体的酶是（　　）。", "answer": "HMGCoA裂解酶", "meta_info": "生物化学", "answer_idx": "B", "A": "HMGCoA还原酶", "B": "HMGCoA裂解酶", "C": "HMGCoA合成酶", "D": "β-羟丁酸脱羧酶", "language": "zh"}
{"question": "不会导致组织水肿的因素是（　　）。", "answer": "血浆胶体渗透压升高", "meta_info": "生理学", "answer_idx": "B", "A": "毛细血管血压升高", "B": "血浆胶体渗透压升高", "C": "静脉回流受阻", "D": "组织液胶体渗透压升高", "language": "zh"}
{"question": "骨髓增生异常综合征患者的骨髓原始细胞中有Auer小体，见于（　　）。", "answer": "RAEB-t型", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "RA型", "B": "RAS型", "C": "CMML型", "D": "RAEB-t型", "language": "zh"}
{"question": "男，48岁。进行性贫血，消瘦、乏力半年，有时右腹隐痛，无腹泻。查体：右中腹部扪及肿块，肠鸣音活跃。2．如果需要手术治疗，针对该手术，术前准备最重要的是（　　）。", "answer": "肠道准备", "meta_info": "第3篇　消化系统", "answer_idx": "B", "A": "纠正营养不良", "B": "肠道准备", "C": "心肺功能检查", "D": "备皮", "language": "zh"}
{"question": "男，40岁。便秘l年，近半月来大便时肛门疼痛，粪便表面及便纸上附有鲜血。其诊断最可能是（　　）。", "answer": "肛裂", "meta_info": "第3篇　消化系统", "answer_idx": "D", "A": "内痔", "B": "直肠癌", "C": "肛瘘", "D": "肛裂", "language": "zh"}
{"question": "急性心肌梗死溶栓治疗中最常用的溶栓剂是（　　）。", "answer": "尿激酶", "meta_info": "第2篇　心血管系统", "answer_idx": "B", "A": "肝素", "B": "尿激酶", "C": "抗栓酶", "D": "呋塞米", "language": "zh"}
{"question": "1．慢性感染性贫血（　　）。", "answer": "血清铁降低，总铁结合力降低，血清铁蛋白正常或增高", "meta_info": "第一部分　血液系统疾病", "answer_idx": "B", "A": "血清铁增高，总铁结合力正常，血清铁蛋白正常或增高", "B": "血清铁降低，总铁结合力降低，血清铁蛋白正常或增高", "C": "血清铁降低，总铁结合力增高，血清铁蛋白降低", "D": "血清铁增高，总铁结合力降低，血清铁蛋白降低", "language": "zh"}
{"question": "高位肠梗阻的呕吐特点是（　　）。", "answer": "出现早、次数多", "meta_info": "第3篇　消化系统", "answer_idx": "A", "A": "出现早、次数多", "B": "出现早、次数少", "C": "出现早、次数多、量多", "D": "出现迟、次数少、量多", "language": "zh"}
{"question": "男性，60岁，肠梗阻3天入院。查体：血压70/40mmHg，血钠125mmol/L，血钾3.2mmol/L，血气分析pH 7.31。2．该患者[HCO3-]最少高于多少时，不需补充碱剂（　　）。", "answer": "16～18mmol/L", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "D", "A": "10～12mmol/L", "B": "12～14mmol/L", "C": "14～16mmol/L", "D": "16～18mmol/L", "language": "zh"}
{"question": "男，48岁。上腹部不适，食欲减退2年。胃镜检查提示慢性萎缩性胃炎，黏膜病理检查提示慢性萎缩性胃炎，重度肠上皮化生。为防止癌变，最合适的随访检查方法是（　　）。", "answer": "胃镜", "meta_info": "第3篇　消化系统", "answer_idx": "C", "A": "腹部CT", "B": "上消化道造影", "C": "胃镜", "D": "血清肿瘤标志物", "language": "zh"}
{"question": "男，70岁。乏力、腰痛半个月。既往体健。查体：轻度贫血，腹部压痛，实验室检查：Hb 80g/L，WBC 5.6×109/L，PLT 156×109/L，血清总蛋白108g/L，清蛋白30g/L，血肌酐177μmol/L。骨髓细胞学检查示骨髓中异常浆细胞占0.45，腰椎X线片示第2腰椎压缩性骨折。2．根据目前的临床资料及Durie和Salmon临床分期标准，该患者最可能的临床分期是（　　）。", "answer": "Ⅲ期B组", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "Ⅲ期A组", "B": "Ⅰ期B组", "C": "Ⅲ期B组", "D": "Ⅱ期B组", "language": "zh"}
{"question": "男，30岁。因腹泻1天，于7月15日来诊，腹泻次数多不可数。为稀便和大量水样便，继之呕吐4次。尿少，无发热，无明显腹痛及里急后重。1周前往外地旅游，昨日归来。查体：T 35.5℃，P 120次/分，BP 70／40mmHg，精神萎靡，烦躁，皮肤弹性差，口干，腹部凹陷，无肌紧张、压痛及反跳痛，肠鸣音活跃。实验室检查：血WBC 18×109/L，Hb 170g/L。粪常规检查：水样便，镜检WBC 0～2/HP。为明确诊断，应首先进行的检查是（　　）。", "answer": "粪便动力及制动试验", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "红细胞沉降率", "B": "粪隐血试验", "C": "粪便动力及制动试验", "D": "血生化", "language": "zh"}
{"question": "判断烧伤创面深度的主要依据是（　　）。", "answer": "创面残存上皮的有无和多少", "meta_info": "第八部分　其他疾病", "answer_idx": "D", "A": "创面有无水疱", "B": "创面的肿胀程度", "C": "创面疼痛情况", "D": "创面残存上皮的有无和多少", "language": "zh"}
{"question": "绝大多数急性心肌梗死的病因是（　　）。", "answer": "冠状动脉内动脉粥样斑块破裂，血栓形成", "meta_info": "第2篇　心血管系统", "answer_idx": "A", "A": "冠状动脉内动脉粥样斑块破裂，血栓形成", "B": "冠状动脉痉挛，血栓形成", "C": "动脉粥样斑块逐渐进展直至完全阻塞冠状动脉管腔", "D": "心力衰竭", "language": "zh"}
{"question": "胎心减速一般不会发生在（　　）。", "answer": "胎儿缺氧早期", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "胎儿缺氧早期", "B": "严重胎儿缺氧", "C": "羊水过少", "D": "第二产程延长", "language": "zh"}
{"question": "乙类传染病中下列疾病必要时采取强制性措施控制，除了（　　）。", "answer": "伤寒", "meta_info": "卫生法规", "answer_idx": "A", "A": "伤寒", "B": "淋病", "C": "梅毒", "D": "炭疽", "language": "zh"}
{"question": "2．迁延性腹泻（　　）。", "answer": "病程2周～2个月", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "病程<2周", "B": "病程2周～2个月", "C": "病程2周～6个月", "D": "病程>6个月", "language": "zh"}
{"question": "某儿童，发热5天，伴咳嗽，胸部透视右肺下叶有散在小病灶阴影，最可能是（　　）。", "answer": "小叶性肺炎", "meta_info": "病理学", "answer_idx": "C", "A": "支气管扩张", "B": "干酪样肺炎", "C": "小叶性肺炎", "D": "粟粒性肺结核", "language": "zh"}
{"question": "医务人员的共同义务和天职是（　　）。", "answer": "共同维护病人的利益和社会公益", "meta_info": "第二部分　模拟试题", "answer_idx": "D", "A": "彼此平等，相互尊重", "B": "彼此独立，相互支持和帮助", "C": "彼此信任，相互协作和监督", "D": "共同维护病人的利益和社会公益", "language": "zh"}
{"question": "下列哪一项不是SCL-90的症状维度？（　　）", "answer": "智力", "meta_info": "医学心理学", "answer_idx": "D", "A": "躯体化", "B": "强迫", "C": "精神质", "D": "智力", "language": "zh"}
{"question": "患者，女，53岁，患风湿性心脏病，心功能不全Ⅱ度。经地高辛治疗4周后病情缓解，但出现恶心、呕吐、黄视等。心电图：P-P和P-R间期延长。测血中地高辛浓度为3.2ng/ml。诊断为地高辛中毒。除立即停药外，还应用哪种药物治疗？（　　）", "answer": "阿托品", "meta_info": "药理学", "answer_idx": "B", "A": "利多卡因", "B": "阿托品", "C": "普萘洛尔", "D": "普鲁卡因胺", "language": "zh"}
{"question": "3．出血时间延长.毛细血管脆性试验阳性，血块退缩良好（　　）。", "answer": "血管壁的异常", "meta_info": "第一部分　血液系统疾病", "answer_idx": "D", "A": "凝血酶形成障碍", "B": "纤维蛋白形成障碍", "C": "血小板质或量的异常", "D": "血管壁的异常", "language": "zh"}
{"question": "患者男性，20岁，右大腿刀刺伤18h，刀口处红肿，有渗出液。目前最适当的治疗措施是（　　）。", "answer": "清理伤口后换药", "meta_info": "第八部分　其他疾病", "answer_idx": "C", "A": "抗生素治疗", "B": "理疗", "C": "清理伤口后换药", "D": "局部固定", "language": "zh"}
{"question": "原发性肾小球疾病的病理分型不包括（　　）。", "answer": "肾病综合征", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "局灶性节段性病变", "B": "肾病综合征", "C": "膜性肾病", "D": "增生性肾炎", "language": "zh"}
{"question": "女性，l6岁，别人讲什么话，病人就学什么话，如医生问她：“你叫什么名字？”答：“你叫什么名字”；问：“你今年多大岁数？”答：“你今年多大岁数”。此症状属（　　）。", "answer": "模仿言语", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "持续言语", "B": "模仿言语", "C": "重复言语", "D": "病理性赘述", "language": "zh"}
{"question": "对某小学学生进行视力检查，五年级总人数80人，视力低下的人数为30人，调查所有学生视力低下的人数为100人，则五年级视力低下占全体视力低下的构成比（　　）。", "answer": "30％", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "20％", "B": "25％", "C": "30％", "D": "80％", "language": "zh"}
{"question": "患者饮水呛咳，声音嘶哑，右软腭抬举无力，病损部位在（　　）。", "answer": "右舌咽迷走神经", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "右侧皮质脑干束", "B": "左侧皮质脑干束", "C": "双侧皮质脑于束", "D": "右舌咽迷走神经", "language": "zh"}
{"question": "2．急性淋巴细胞白血病选用（　　）。", "answer": "VP方案", "meta_info": "第一部分　血液系统疾病", "answer_idx": "D", "A": "VAD方案", "B": "CHOP方案", "C": "MOPP方案", "D": "VP方案", "language": "zh"}
{"question": "能翻转肾上腺素升压作用的药物是（　　）。", "answer": "α受体阻断药", "meta_info": "药理学", "answer_idx": "C", "A": "N受体阻断药", "B": "β受体阻断药", "C": "α受体阻断药", "D": "H1受体阻断药", "language": "zh"}
{"question": "女，20岁，因皮肤紫癜1个月，高热、口腔黏膜血疱、牙龈出血不止2天住院。肝、脾、淋巴结不大、胸骨无压痛。化验：Hb 40g/L，WBC 2.0×109/L，RBC 15×109/L。骨髓增生极度减低，全片未见巨核细胞。诊断首先考虑（　　）。", "answer": "急性再生障碍性贫血", "meta_info": "第一部分　血液系统疾病", "answer_idx": "A", "A": "急性再生障碍性贫血", "B": "慢性再生障碍性贫血", "C": "急性白血病", "D": "过敏性紫癜", "language": "zh"}
{"question": "胫骨易发生骨折的部位是（　　）。", "answer": "横切面三棱形与四边形移行部位", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "上端干骺端部位", "B": "横切面四边形部位", "C": "横切面三棱形与四边形移行部位", "D": "胫骨下端之踝上部位", "language": "zh"}
{"question": "正常小儿头围的增长规律，以下错误的是（　　）。", "answer": "1岁时头围近48cm", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "生后前3个月增长6cm", "B": "生后第二年增长2cm", "C": "2～5岁增长2cm", "D": "1岁时头围近48cm", "language": "zh"}
{"question": "通常不存在于RNA中，也不存在DNA中的碱基是（　　）。", "answer": "黄嘌呤", "meta_info": "生物化学", "answer_idx": "B", "A": "鸟嘌呤", "B": "黄嘌呤", "C": "腺嘌呤", "D": "尿嘧啶", "language": "zh"}
{"question": "下列哪项是治疗心脏骤停的首选？（　　）", "answer": "心内注射肾上腺素", "meta_info": "药理学", "answer_idx": "D", "A": "静脉滴注去甲肾上腺素", "B": "静脉滴注地高辛", "C": "肌内注射可拉明（尼可刹米）", "D": "心内注射肾上腺素", "language": "zh"}
{"question": "某男，45岁，接触粉尘工龄为12年，近2年有胸闷、气短症状，X线胸片检查有密集度1级的不规则形小阴影，分布范围两个肺区，可考虑诊断为（　　）。", "answer": "一期尘肺(Ⅰ)", "meta_info": "预防医学", "answer_idx": "A", "A": "一期尘肺(Ⅰ)", "B": "一期尘肺(Ⅰ+)", "C": "二期尘肺(Ⅱ)", "D": "二期尘肺(Ⅱ+)", "language": "zh"}
{"question": "4．脾破裂的主要症状是（　　）。", "answer": "腹痛伴休克、贫血", "meta_info": "第3篇　消化系统", "answer_idx": "D", "A": "腹痛伴发热、寒战、黄疸", "B": "腹痛伴反酸、嗳气", "C": "腹痛伴呕吐、腹胀", "D": "腹痛伴休克、贫血", "language": "zh"}
{"question": "a-葡萄糖苷酶抑制药常见不良反应是（　　）。", "answer": "腹胀和腹泻", "meta_info": "第二部分　模拟试题", "answer_idx": "A", "A": "腹胀和腹泻", "B": "下肢水肿", "C": "乳酸性酸中毒", "D": "充血性心力衰竭", "language": "zh"}
{"question": "下列哪项为锥体束病损时肌张力改变？（　　）", "answer": "痉挛性折刀样肌张力增高", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "痉挛性折刀样肌张力增高", "B": "肌张力减低", "C": "强直性铅管样肌张力增高", "D": "去脑强直或去皮质强直", "language": "zh"}
{"question": "A型标准血清与B型血液混合时会发生（　　）。", "answer": "红细胞凝集", "meta_info": "生理学", "answer_idx": "B", "A": "红细胞叠连", "B": "红细胞凝集", "C": "血液凝固", "D": "无反应", "language": "zh"}
{"question": "李医生在为一胃癌病人手术时，发现腹腔内已有转移，肿瘤与周围组织粘连很严重，切除肿瘤已无意义，便关腹结束手术。事后发现，一把止血钳被落在病人腹内。此行为被认定为：三级医疗责任事故。李医生可能承担的法律责任是（　　）。", "answer": "责令暂停执业6个月", "meta_info": "卫生法规", "answer_idx": "A", "A": "责令暂停执业6个月", "B": "罚款", "C": "赔偿患者损失", "D": "追究刑事责任", "language": "zh"}
{"question": "急性阑尾炎闭孔内肌试验阳性提示阑尾的位置是（　　）。", "answer": "盆部", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "盆部", "B": "回肠前位", "C": "回肠下位", "D": "盲肠后位", "language": "zh"}
{"question": "患儿，1岁，不会走，不会叫爸爸、妈妈。查体：眼距宽，鼻梁宽平，唇厚，舌大，反应差，皮肤粗糙，脐疝。为确诊，应做哪一项检查？（　　）", "answer": "T3、T4、TSH", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "X线腕骨片", "B": "三氯化铁试验", "C": "GH测定", "D": "T3、T4、TSH", "language": "zh"}
{"question": "1．多继发于长期使用广谱抗生素（　　）。", "answer": "金黄色葡萄球菌肠炎", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "致病性大肠杆菌肠炎", "B": "轮状病毒性肠炎", "C": "细菌性痢疾", "D": "金黄色葡萄球菌肠炎", "language": "zh"}
{"question": "2．大叶性肺炎病变部位是（　　）。", "answer": "肺泡", "meta_info": "病理学", "answer_idx": "B", "A": "主支气管", "B": "肺泡", "C": "呼吸性细支气管以远的末梢肺组织", "D": "肺间质", "language": "zh"}
{"question": "脂肪动员的关键酶是（　　）。", "answer": "激素敏感性三酰甘油酶", "meta_info": "生物化学", "answer_idx": "D", "A": "脂蛋白脂肪酶", "B": "二酰甘油二酯酶", "C": "三酰甘油三酯酶", "D": "激素敏感性三酰甘油酶", "language": "zh"}
{"question": "卫生领域中的公平性是指生存机会（　　）。", "answer": "以需要为导向", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "以社会阶层为导向", "B": "以支付能力为导向", "C": "以需要为导向", "D": "以市场经济规律为导向", "language": "zh"}
{"question": "4个月男孩，反复发作吸气困难伴有喉鸣，口唇发绀数次，间歇期活泼如常，无缺氧，体温不高，心肺正常，今天突然发作不易缓解，急诊入院。3．治疗原则（　　）。", "answer": "保持呼吸道通畅，补钙，维生素D治疗", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "保持呼吸道通畅，补钙，维生素D治疗", "B": "立即补钙，维生素D治疗", "C": "立即给大剂量维生素D肌肉注射", "D": "维生素D治疗，补钙，多晒太阳", "language": "zh"}
{"question": "心室肌细胞动作电位的0期去极是因为哪种通道开放?（　　）", "answer": "Na+", "meta_info": "生理学", "answer_idx": "A", "A": "Na+", "B": "Ca2+", "C": "Cl-", "D": "Mg2+", "language": "zh"}
{"question": "男，32岁。2天前饮酒后出现右上腹疼痛，向右肩部放射。查体：右上腹肌紧张，压痛（＋）。Murphy征（＋）。最可能的诊断是（　　）。", "answer": "急性胆囊炎", "meta_info": "第3篇　消化系统", "answer_idx": "B", "A": "十二指肠球部溃疡", "B": "急性胆囊炎", "C": "急性胰腺炎", "D": "右肾结石", "language": "zh"}
{"question": "患者，女，40岁，一个月前患急性扁桃体炎，治愈。近来颜面浮肿，尿量减少，尿检查见蛋白、少量红细胞及管型，血压轻度增高，治疗2个月后痊愈。可能是哪型肾炎，少尿的机制是（　　）。", "answer": "弥漫性毛细血管内增生性肾炎，肾小球内皮细胞及系膜细胞增生挤压毛细血管引起少尿", "meta_info": "病理学", "answer_idx": "B", "A": "IgA肾病，由于肾小球系膜增生引起少尿", "B": "弥漫性毛细血管内增生性肾炎，肾小球内皮细胞及系膜细胞增生挤压毛细血管引起少尿", "C": "快速进行性肾炎，大量新月体阻塞肾球囊引起少尿", "D": "弥漫性毛细血管内增生性肾炎，肾小管重吸收功能亢进引起少尿", "language": "zh"}
{"question": "常见的可引起新生儿先天畸形的病毒是（　　）。", "answer": "风疹病毒", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "风疹病毒", "B": "麻疹病毒", "C": "狂犬病毒", "D": "脊髓灰质炎病毒", "language": "zh"}
{"question": "引起出血性疾病较常见的因素是（　　）。", "answer": "血小板因素", "meta_info": "第一部分　血液系统疾病", "answer_idx": "D", "A": "血管外因素", "B": "肝素或香豆类药物", "C": "抗凝血物质活性增加", "D": "血小板因素", "language": "zh"}
{"question": "关于母乳营养素的特点，下列哪项是错误的？（　　）", "answer": "含矿物质锌、铁、钙较低", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "蛋白质生物价值高", "B": "不饱和脂肪酸较多", "C": "牛磺酸含量较多", "D": "含矿物质锌、铁、钙较低", "language": "zh"}
{"question": "2．男，1岁。智能落后，表情呆滞，鼻梁低，舌宽大并常伸出口外，皮肤苍黄、粗糙，四肢粗短，腱反射减弱（　　）。", "answer": "先天性甲状腺功能减低症", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "软骨发育不良", "B": "先天性甲状腺功能减低症", "C": "佝偻病", "D": "苯丙酮尿症", "language": "zh"}
{"question": "刚出生的新生儿，尚未哺乳，无黄疸，血象白细胞20×109/L，中性粒细胞0.65，淋巴细胞0.35，最大可能是（　　）。", "answer": "正常现象", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "宫内感染", "B": "正常现象", "C": "先天性白血病", "D": "新生儿溶血", "language": "zh"}
{"question": "54岁女性，脑动脉硬化症病史3年，突感眩晕、呕吐、言语不清。查体：声音嘶哑、吞咽困难、言语含混，左眼裂小、瞳孔小、水平眼震、左面部右半身痛觉减退，左侧指鼻试验不准。应诊断为（　　）。", "answer": "左侧小脑后下动脉血栓形成", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "右侧颈内动脉血栓形成", "B": "左侧大脑前动脉血栓形成", "C": "左侧颈内动脉血栓形成", "D": "左侧小脑后下动脉血栓形成", "language": "zh"}
{"question": "风湿性疾病指（　　）。", "answer": "累及关节及周围软组织的一大类疾病", "meta_info": "第五部分　风湿免疫性疾病", "answer_idx": "A", "A": "累及关节及周围软组织的一大类疾病", "B": "病毒感染的一类疾病", "C": "嗜酸粒细胞增多的一类疾病", "D": "血尿酸增高的一组疾病", "language": "zh"}
{"question": "与细菌耐药性有关的结构是（　　）。", "answer": "异染颗粒", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "性菌毛", "B": "细菌染色体", "C": "质粒", "D": "异染颗粒", "language": "zh"}
{"question": "可以诊断胎儿窘迫的是（　　）。", "answer": "胎儿头皮血pH为7.18", "meta_info": "第5篇　女性生殖系统", "answer_idx": "D", "A": "破膜后羊水Ⅰ度污染", "B": "胎心监护见到早期减速", "C": "宫缩高峰时胎心110次/分", "D": "胎儿头皮血pH为7.18", "language": "zh"}
{"question": "病人在意识清晰时出现幻视多见于（　　）。", "answer": "精神分裂症", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "神经症", "B": "精神分裂症", "C": "抑郁症", "D": "心理因素相关生理障碍", "language": "zh"}
{"question": "体内ATP生成的主要方式是（　　）。", "answer": "氧化磷酸化", "meta_info": "生物化学", "answer_idx": "D", "A": "有机磷脱羧", "B": "底物磷酸化", "C": "肌酸磷酸化", "D": "氧化磷酸化", "language": "zh"}
{"question": "3．肾脏移植后发生在1年后的慢性肾衰的主要原因是（　　）。", "answer": "慢性排斥反应", "meta_info": "医学免疫学", "answer_idx": "C", "A": "超急排斥反应", "B": "急性体液排斥反应", "C": "慢性排斥反应", "D": "迟发型排斥反应", "language": "zh"}
{"question": "初产妇，27岁，妊娠39周，规律宫缩8小时。血压110/70mmHg，骨盆不小，预测胎儿体重2600g，枕左前位，胎心率正常。肛查宫口开大3cm，S＝0，正确处置应为（　　）。", "answer": "不需干涉产程进程", "meta_info": "第5篇　女性生殖系统", "answer_idx": "A", "A": "不需干涉产程进程", "B": "静脉滴注缩宫素", "C": "静脉推注地西泮", "D": "静脉推注地塞米松", "language": "zh"}
{"question": "关于临终关怀符合伦理学的原因，说法错误的是（　　）。", "answer": "可以减轻家庭的经济负担", "meta_info": "医学伦理学", "answer_idx": "A", "A": "可以减轻家庭的经济负担", "B": "提高病人的生命质量", "C": "客观上可以节约卫生资源", "D": "为了人类文明的进步", "language": "zh"}
{"question": "女性，53岁，3个月前在火车上急性起病，突然不认识女儿，恐惧地说：“头痛，眼前有甲虫飞舞，兴奋，应当杀死她。”耳边听至儿子、女儿说话声，经当地治疗症状消失。1周前当听到儿子死亡的消息复发，症状同前。既往高血压史5年。血压200／90mmHg；神经系统检查正常；精神检查：意识模糊，恐惧，有幻觉，思维不连贯，智力减退，记忆力差，有时意识清晰，叙述自己儿子已死亡，性格急躁，易激动，血压升高时精神症状加重。3．本病例治疗应采取（　　）。", "answer": "脑血管病+抗精神病", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "治疗血管病", "B": "脑血管制剂", "C": "脑血管病+抗精神病", "D": "心理治疗", "language": "zh"}
{"question": "6个月婴儿，半天来突然抽搐3次，抽时双眼上翻，四肢抖动，持续2分钟自然缓解，抽后意识清，吃奶。询问病史，生后人工喂养，近日夜惊多汗。查体：营养中等，枕秃明显，囟门2.5cm×2.5cm，颈软。患儿再度抽搐。最恰当的处理原则是（　　）。", "answer": "先止惊及缓慢静脉注射钙剂，后改为口服钙，再用维生素D", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "先用维生素D，同时补充钙，再吸氧", "B": "先补充钙剂及维生素D，然后吸氧、止惊", "C": "先补钙，同时吸氧、止惊，然后用维生素D", "D": "先止惊及缓慢静脉注射钙剂，后改为口服钙，再用维生素D", "language": "zh"}
{"question": "女，42岁，阵发性心悸3年.无心跳间歇感，发作时按摩颈动脉心悸可突然终止。发作时心电图显示：心室率190次/min，逆行P波，QRS波群形态与时限正常。该患者最可能的诊断是（　　）。", "answer": "阵发性室上性心动过速", "meta_info": "第2篇　心血管系统", "answer_idx": "C", "A": "窦性心动过速", "B": "心房扑动", "C": "阵发性室上性心动过速", "D": "心房颤动", "language": "zh"}
{"question": "各种类似神经症的症状在临床各科均可见到，而属于神经症的症状应该是（　　）。", "answer": "非源于躯体疾病和精神疾病，而是由于心理社会因素和个性弱点共同作用引起的神经症症状", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "非源于躯体疾病和精神疾病，而是由于心理社会因素和个性弱点共同作用引起的神经症症状", "B": "重性精神病早期表现的神经症症状", "C": "脑器质性损害伴有的神经症症状", "D": "物质依赖戒断反应的神经症症状", "language": "zh"}
{"question": "下述哪种胆汁酸是初级胆汁酸？（　　）", "answer": "甘氨胆酸", "meta_info": "生物化学", "answer_idx": "B", "A": "牛磺脱氧胆酸", "B": "甘氨胆酸", "C": "牛磺石胆酸", "D": "甘氨脱氧胆酸", "language": "zh"}
{"question": "中年妇女，剧咳后右大腿卵圆窝部肿块突然增大、变硬，疼痛难忍。1天后用手法还纳，之后出现剧烈的持续性下腹痛。并有明显的腹肌紧张、压痛与反跳痛。最可能的诊断为（　　）。", "answer": "绞窄性疝合并急性腹膜炎", "meta_info": "第3篇　消化系统", "answer_idx": "D", "A": "易复性疝", "B": "嵌顿疝", "C": "难复性疝", "D": "绞窄性疝合并急性腹膜炎", "language": "zh"}
{"question": "患者，女性，28岁。停经55d，伴恶心、呕吐，妇科检查：子宫增大约妊娠50d，双倒附件（-）。2．若确定为妊娠，应选择最佳的终止妊娠方法是（　　）。", "answer": "人工流产吸宫术", "meta_info": "第二部分　模拟试题", "answer_idx": "B", "A": "药物流产", "B": "人工流产吸宫术", "C": "人工流产钳刮术", "D": "乳酸依沙吖啶引产", "language": "zh"}
{"question": "1．上述哪项参与操纵子正调控（　　）。", "answer": "CAP", "meta_info": "生物化学", "answer_idx": "B", "A": "TFⅡB", "B": "CAP", "C": "乳糖", "D": "抑制基因", "language": "zh"}
{"question": "关于体内酶促反应特点的叙述，错误的是（　　）。", "answer": "温度对酶促反应速度没有影响", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "具有高催化效率", "B": "温度对酶促反应速度没有影响", "C": "可大幅度降低反应活化能", "D": "具有可调节性", "language": "zh"}
{"question": "关于朦胧状态的说法，下列哪项错误？（　　）", "answer": "注意力一般不受影响", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "意识范围狭窄", "B": "意识清晰度的下降", "C": "可有欣快、焦虑等情绪症状", "D": "注意力一般不受影响", "language": "zh"}
{"question": "3．属于链球菌感染的证据为（　　）。", "answer": "抗“O”＞500U", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "瓣膜病", "B": "抗“O”＞500U", "C": "血沉增快、CRP阳性", "D": "心电图可见ST段下移及T波平坦或倒置", "language": "zh"}
{"question": "心室肌有效不应期的长短主要取决于（　　）。", "answer": "动作电位2期时程", "meta_info": "生理学", "answer_idx": "B", "A": "阈电位水平高低", "B": "动作电位2期时程", "C": "钠泵功能", "D": "动作电位传导速度", "language": "zh"}
{"question": "造成先天性甲状腺功能减低症最主要的原因是（　　）。", "answer": "甲状腺不发育或发育不全", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "促甲状腺激素缺陷", "B": "碘缺乏", "C": "甲状腺不发育或发育不全", "D": "甲状腺或靶器官反应低下", "language": "zh"}
{"question": "痢疾杆菌的致病性主要决定于（　　）。", "answer": "对肠黏膜上皮细胞具有侵袭力", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "D", "A": "外毒素", "B": "内毒素", "C": "能对抗肠黏膜局部免疫力，分泌性IgA", "D": "对肠黏膜上皮细胞具有侵袭力", "language": "zh"}
{"question": "囊虫寄生于人体的部位中最严重的是（　　）。", "answer": "脑", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "B", "A": "肌肉", "B": "脑", "C": "皮下", "D": "脊髓", "language": "zh"}
{"question": "男性，34岁。肾病综合征十多年。近年来出现高血压、多尿、夜尿。近来出现贫血、视力减退、心律不齐，全身出现尿味、身体虚弱等症状。数月后，呕吐、抽搐、昏迷而死亡。肾脏的病理表现可能为（　　）。", "answer": "颗粒性固缩肾", "meta_info": "病理学", "answer_idx": "C", "A": "双肾弥漫性增大", "B": "单侧肾脏病变", "C": "颗粒性固缩肾", "D": "肾梗死", "language": "zh"}
{"question": "蛋白质-热能营养不良的少见并发症是（　　）。", "answer": "佝偻病", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "营养性贫血", "B": "呼吸道感染", "C": "腹泻", "D": "佝偻病", "language": "zh"}
{"question": "HIV的感染途径不包括（　　）。", "answer": "呼吸道传播", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "输血制品", "B": "呼吸道传播", "C": "母婴传播", "D": "性接触传播", "language": "zh"}
{"question": "1．不含活菌的状态（　　）。", "answer": "无菌", "meta_info": "医学微生物学", "answer_idx": "B", "A": "灭菌", "B": "无菌", "C": "抑菌", "D": "防腐", "language": "zh"}
{"question": "肾上腺皮质激素治疗结核性脑膜炎的疗程是（　　）。", "answer": "8～12周", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "3～6周", "B": "2～3周", "C": "6～8周", "D": "8～12周", "language": "zh"}
{"question": "女，78岁。腹部疼痛5天，以右下腹为重，伴呕吐。检查：急性病容，右下腹饱满压痛，肌紧张。血白细胞4.5×109/L，腹部透视可见少量气液平面。最可能的诊断为（　　）。", "answer": "阑尾周围脓肿", "meta_info": "第3篇　消化系统", "answer_idx": "A", "A": "阑尾周围脓肿", "B": "结肠癌", "C": "急性胰腺炎", "D": "急性胆囊炎", "language": "zh"}
{"question": "引起波浪热的主要原因是（　　）。", "answer": "反复形成菌血症，细菌内毒素刺激体温调节中枢", "meta_info": "医学微生物学", "answer_idx": "D", "A": "反复形成败血症", "B": "细菌有较特殊的内毒素", "C": "细菌在胞内繁殖，抗体和药物难起直接作用", "D": "反复形成菌血症，细菌内毒素刺激体温调节中枢", "language": "zh"}
{"question": "以下关于病人的权利不包括（　　）。", "answer": "继续保持原有的生活习惯", "meta_info": "医学心理学", "answer_idx": "C", "A": "受社会尊重、理解", "B": "享受医疗服务", "C": "继续保持原有的生活习惯", "D": "保守个人秘密", "language": "zh"}
{"question": "子宫肌瘤的症状与下列何项关系密切？（　　）", "answer": "肌瘤与肌层的关系（粘膜下，浆膜下，壁间）", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "肌瘤的大小", "B": "肌瘤生长部位（宫体，宫颈）", "C": "发生年龄", "D": "肌瘤与肌层的关系（粘膜下，浆膜下，壁间）", "language": "zh"}
{"question": "链激酶属于（　　）。", "answer": "纤维蛋白溶解药", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "促凝血药", "B": "纤维蛋白溶解药", "C": "抗贫血药", "D": "抗血小板药", "language": "zh"}
{"question": "下列各项中不属于预防性应用抗生素的适应证是（　　）。", "answer": "胃迷走神经切断术", "meta_info": "第八部分　其他疾病", "answer_idx": "C", "A": "开放性骨折", "B": "上消化道溃疡穿孔", "C": "胃迷走神经切断术", "D": "结肠手术前肠道准备", "language": "zh"}
{"question": "下列哪项不是嘌呤核苷酸从头合成的原料?（　　）", "answer": "S-腺苷蛋氨酸", "meta_info": "生物化学", "answer_idx": "D", "A": "一碳单位", "B": "R-5-P", "C": "天冬氨酸、甘氨酸", "D": "S-腺苷蛋氨酸", "language": "zh"}
{"question": "中毒型细菌性痢疾的发病年龄多见于（　　）。", "answer": "2～7岁", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "1～2岁", "B": "2～7岁", "C": "7～10岁", "D": "大于10岁", "language": "zh"}
{"question": "能引起骨骼肌神经-肌接头处产生终板电位的神经递质是（　　）。", "answer": "乙酰胆碱", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "去甲肾上腺素", "B": "乙酰胆碱", "C": "谷氨酸", "D": "多巴胺", "language": "zh"}
{"question": "患者男性，36岁。不慎从建筑工地3m高处坠落，自主呼吸困难、腹痛、腰痛。急诊查体时发现右胸有一伤口，有气泡和血液滴出。神志清，左上腹擦痕及少量淤斑。心率110次/分。血压90/60mmHg，呼吸36次/分，B超示脾破裂，X线片示腰5压缩性骨折。该患者创伤类型为（　　）。", "answer": "多发伤", "meta_info": "第八部分　其他疾病", "answer_idx": "B", "A": "混合伤", "B": "多发伤", "C": "胸腹伤", "D": "联合伤", "language": "zh"}
{"question": "医师对同一个患者申请一天备血达到或超过一定数量时，必须报医院医务部门批准，该血量是（　　）。", "answer": "1600ml", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "1600ml", "B": "1400ml", "C": "1000ml", "D": "1200ml", "language": "zh"}
{"question": "下列哪项是慢性淋巴性甲状腺炎引起原发性甲状腺功能减退症替代治疗的原则？（　　）", "answer": "从小剂量开始，逐渐递增到合适剂量", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "B", "A": "由大剂量开始，逐渐递减到合适剂量", "B": "从小剂量开始，逐渐递增到合适剂量", "C": "甲减越严重，起始剂量应越大", "D": "间断用药有利于预防心绞痛", "language": "zh"}
{"question": "下列关于神经症的诊断不正确的是（　　）。", "answer": "符合症状标准至少1个月", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "有社会功能受损或无法摆脱的精神痛苦", "B": "排除精神分裂症、偏执性精神病、心境障碍等", "C": "符合症状标准至少1个月", "D": "主动求医", "language": "zh"}
{"question": "2．对重症颅内压增高病人禁用的药物是（　　）。", "answer": "度冷丁", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "20％甘露醇", "B": "双氢氯噻嗪", "C": "度冷丁", "D": "地塞米松", "language": "zh"}
{"question": "某3岁小儿，因误服敌敌畏迅速送医院抢救，洗胃后给予阿托品、碘解磷定治疗。目前患者出现皮肤潮红，瞳孔扩大，心率加快，应采取以下哪种措施？（　　）", "answer": "阿托品逐渐减量至停药", "meta_info": "药理学", "answer_idx": "D", "A": "加大碘解磷定用量", "B": "立即停用阿托品", "C": "肌注毛果芸香碱", "D": "阿托品逐渐减量至停药", "language": "zh"}
{"question": "目前确定乳腺肿块性质最可靠的方法是（　　）。", "answer": "活组织病理检查", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "B超", "B": "近红外线扫描", "C": "液晶热图像", "D": "活组织病理检查", "language": "zh"}
{"question": "易造成蛛网膜下腔出血的疾病是（　　）。", "answer": "颅内动脉瘤", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "颅内动脉瘤", "B": "后颅窝肿瘤", "C": "巨大硬脑膜外血肿", "D": "脑挫裂伤", "language": "zh"}
{"question": "关于转氨酶的叙述，正确的是（　　）。", "answer": "以L-谷氨酸与α-酮酸的转氨酶最为重要", "meta_info": "生物化学", "answer_idx": "D", "A": "体内只有少数氨基酸参与转氨基作用", "B": "转氨酶只存在肝和心肌组织", "C": "磷酸吡哆醛将氨基转给α-酮酸", "D": "以L-谷氨酸与α-酮酸的转氨酶最为重要", "language": "zh"}
{"question": "诊断为流行性出血热患者，病程第6天尿量80mL/d，血压186/110mmHg，脉洪大，面浮肿，体表静脉充盈，双肺底有散在湿啰音，此时在治疗上应采取下述何组措施为好（　　）。", "answer": "严格控制输液量，高效利尿剂，早期导泻", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "A", "A": "严格控制输液量，高效利尿剂，早期导泻", "B": "采用利尿合剂，纠正酸中毒，扩血管药", "C": "采用高渗葡萄糖液，降压，利尿", "D": "纠正酸中毒，降压，激素，利尿", "language": "zh"}
{"question": "1．合并厌氧菌感染时需选（　　）。", "answer": "甲硝唑类", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "D", "A": "大环内酯类", "B": "氨基糖苷类", "C": "喹诺酮类", "D": "甲硝唑类", "language": "zh"}
{"question": "患儿，男，1.5岁，咳嗽、发热3天，双肺闻及散在的细湿啰音及广泛呼吸时哮鸣音，血常规：白细胞15×109/L，中性粒细胞60%，胸片正位片：两下肺散在斑片状影，诊断最可能是（　　）。", "answer": "支气管肺炎", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "支气管肺炎", "B": "支原体肺炎", "C": "腺病毒肺炎", "D": "金黄色葡萄球菌肺炎", "language": "zh"}
{"question": "妄想是（　　）。", "answer": "不能被说服的病态信念", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "大量涌现的不自主的观念", "B": "不能被说服的病态信念", "C": "无法摆脱的重复出现的观念", "D": "抽象的概念荒谬地具体化", "language": "zh"}
{"question": "患者，男，60岁，突发心前区疼痛2小时。既往有高脂血症和吸烟史，无高血压和出血性疾病史。查体：BP 150/90mmHg，双肺呼吸音清.心率89次/min，律齐。心电图示Ⅱ、Ⅲ和aVF导联ST段下斜型压低0.2mV，V1～V6导联ST段弓背向上抬高0.3～0.5mV。该患者最关键的治疗是（　　）。", "answer": "再灌注治疗", "meta_info": "第2篇　心血管系统", "answer_idx": "B", "A": "口服硝苯地平控释片", "B": "再灌注治疗", "C": "口服速效救心丸", "D": "口服血管紧张素转换酶抑制剂", "language": "zh"}
{"question": "tRNA转录后稀有碱基的生成不包括（　　）。", "answer": "脱羧反应", "meta_info": "生物化学", "answer_idx": "D", "A": "甲基化反应", "B": "还原反应", "C": "转位反应", "D": "脱羧反应", "language": "zh"}
{"question": "女，54岁。发热、胸痛伴心包摩擦音，曾用非激素类抗炎药。3周后呼吸困难加重，心率110次/分，律齐，心音遥远，血压90/70mmHg，肝大，下肢水肿。2．患者还存在具有诊断价值的体征是（　　）。", "answer": "奇脉", "meta_info": "第2篇　心血管系统", "answer_idx": "B", "A": "水冲脉", "B": "奇脉", "C": "重搏脉", "D": "正常脉", "language": "zh"}
{"question": "下述哪项反应不是检测细胞免疫的技术（　　）。", "answer": "溶血空斑试验", "meta_info": "医学免疫学", "answer_idx": "B", "A": "E玫瑰花结形成试验", "B": "溶血空斑试验", "C": "抗CD3抗体荧光计数", "D": "混合淋巴细胞培养", "language": "zh"}
{"question": "有一名颅内压增高病人，持续颅内压增高导致病理生理紊乱，但应除外（　　）。", "answer": "早期血压下降、脉搏变快、呼吸增快", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "胃肠道出血、溃疡", "B": "脑血管自动调节功能失调", "C": "脑疝形成", "D": "早期血压下降、脉搏变快、呼吸增快", "language": "zh"}
{"question": "女，50岁。反复癫痫发作1周。查体：BP 130／86mmHg，一般情况好，上肢皮下可触及数个黄豆大小结节，无压痛，心肺查体无异常，腹软无压痛。为明确病因诊断，首先应做的检查是（　　）。", "answer": "皮下结节活检", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "抗核抗体检查", "B": "头颅CT", "C": "包虫皮试", "D": "皮下结节活检", "language": "zh"}
{"question": "2．开展新生儿甲状腺功能减低症筛查工作属于（　　）。", "answer": "孕产期保健服务", "meta_info": "卫生法规", "answer_idx": "D", "A": "婚前医学检查", "B": "遗传病诊断", "C": "严重传染病诊断", "D": "孕产期保健服务", "language": "zh"}
{"question": "肾结核最具有特征性的临床表现是（　　）。", "answer": "慢性膀胱刺激症状", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "发热伴盗汗", "B": "肉眼血尿", "C": "慢性膀胱刺激症状", "D": "消瘦", "language": "zh"}
{"question": "医生甲因犯罪被判处有期徒刑2年，1997年9月20日被捕，1999年9月20日释放，医生甲不予执业医师注册的期限是（　　）。", "answer": "释放之日起2年内", "meta_info": "卫生法规", "answer_idx": "C", "A": "被捕之日起3年内", "B": "释放之日起1年内", "C": "释放之日起2年内", "D": "释放之日起3年内", "language": "zh"}
{"question": "患者，女，28岁。发热半个月，弛张热型，伴恶寒、关节痛。体检：皮肤瘀点、Osler结节，心脏有杂音，考虑为感染性心内膜炎，确诊的直接证据来自（　　）。", "answer": "组织学和细菌学检查", "meta_info": "第2篇　心血管系统", "answer_idx": "D", "A": "X线和心电图检查", "B": "超声心动图检查", "C": "免疫学检查", "D": "组织学和细菌学检查", "language": "zh"}
{"question": "4．白喉（　　）。", "answer": "以纤维蛋白渗出为主的炎症", "meta_info": "病理学", "answer_idx": "B", "A": "以血浆渗出为主的炎症", "B": "以纤维蛋白渗出为主的炎症", "C": "以局限性化脓为主的炎症", "D": "以中性粒细胞浸润为主的炎症", "language": "zh"}
{"question": "1．支气管黏膜上皮的鳞状上皮化生（　　）。", "answer": "慢性支气管炎", "meta_info": "病理学", "answer_idx": "B", "A": "大叶性肺炎", "B": "慢性支气管炎", "C": "小叶性肺炎", "D": "肺气肿", "language": "zh"}
{"question": "下列哪项是原核细胞型的微生物？（　　）", "answer": "放线菌、破伤风梭菌", "meta_info": "医学微生物学", "answer_idx": "B", "A": "链球菌、念珠菌", "B": "放线菌、破伤风梭菌", "C": "酵母菌、淋球菌", "D": "隐球菌、结核分枝杆菌", "language": "zh"}
{"question": "关于痈，下列哪项是错误的？（　　）", "answer": "唇痈可手术治疗", "meta_info": "第八部分　其他疾病", "answer_idx": "C", "A": "可由多个疖融合而成", "B": "常发生在颈项及背部", "C": "唇痈可手术治疗", "D": "手术治疗时切口要超过炎症范围少许", "language": "zh"}
{"question": "尸检发现患儿两肺密布灰白色粟粒大小结节，同时肝、脾、肾亦见同样病变，脑底部脑膜渗出物呈毛玻璃样外观。结核杆菌可能从哪里入血播散引起上述病变（　　）。", "answer": "肺原发灶", "meta_info": "病理学", "answer_idx": "B", "A": "上腔静脉", "B": "肺原发灶", "C": "无名静脉", "D": "下腔静脉", "language": "zh"}
{"question": "维护受试者利益，可通过以下方式予以保障，除外（　　）。", "answer": "实验中若出现严重的可能危害受试者利益的情况发生，在不影响实验继续的前提下，要立即采取措施以减轻对受试者的伤害", "meta_info": "医学伦理学", "answer_idx": "D", "A": "以动物实验为基础", "B": "实验中有专家参与或指导", "C": "对受试者做到知情同意", "D": "实验中若出现严重的可能危害受试者利益的情况发生，在不影响实验继续的前提下，要立即采取措施以减轻对受试者的伤害", "language": "zh"}
{"question": "女，68岁。高血压病史5年，药物治疗后血压波动于140～170/90～100mmHg，既往糖尿病史。该患者的收缩压控制目标应低于（　　）。", "answer": "130mmHg", "meta_info": "第2篇　心血管系统", "answer_idx": "B", "A": "140mmHg", "B": "130mmHg", "C": "120mmHg", "D": "110mmHg", "language": "zh"}
{"question": "男性，67岁，COPD患者，多次住院治疗。半年前出院时血气分析示：pH 7.37，PaCO2 48mmHg，PaO2 65mmHg。3天前受凉后再次出现咳嗽、咳痰，呼吸困难加重。复查血气分析示：pH 7.25，PaCO2 65mmHg，PaO2 52mmHg。该患者低氧血症加重的最重要机制是（　　）。", "answer": "肺泡通气量下降", "meta_info": "第1篇　呼吸系统", "answer_idx": "B", "A": "通气血流比例失衡", "B": "肺泡通气量下降", "C": "肺内分流", "D": "肺换气功能障碍", "language": "zh"}
{"question": "男，68岁。反复咳嗽\\咳痰20余年，气短5年。患者长期使用吸入糖皮质激素及支气管舒张剂治疗，近1周症状控制欠满意，联合使用某药物治疗。此后出现排尿困难。该患者近来增加的药物最可能的（　　）。", "answer": "M受体拮抗剂", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "茶碱类", "B": "M受体拮抗剂", "C": "口服糖皮质激素", "D": "祛痰治疗", "language": "zh"}
{"question": "描述产前诊断描述有误的是（　　）。", "answer": "产前诊断需终止妊娠，手术不一定经本人或家属同意", "meta_info": "卫生法规", "answer_idx": "D", "A": "孕早期有苯接触史，需做产前诊断", "B": "经产前检查，医师发现胎儿异常需做产前诊断", "C": "孕妇如果经常泡洗烫水澡(40℃以上)，需做产前诊断", "D": "产前诊断需终止妊娠，手术不一定经本人或家属同意", "language": "zh"}
{"question": "早期梅毒治疗首选（　　）。", "answer": "苄星青霉素G", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "A", "A": "苄星青霉素G", "B": "多西环素", "C": "红霉素", "D": "盐酸四环素", "language": "zh"}
{"question": "特发性血小板减少性紫癜患者，查血小板10×109/L。2．经足量的皮质激素治疗6个月后，查血小板20×109/L，进一步治疗应选择（　　）。", "answer": "脾切除", "meta_info": "第一部分　血液系统疾病", "answer_idx": "B", "A": "继续用糖皮质激素治疗", "B": "脾切除", "C": "输血小板", "D": "抗纤溶药物", "language": "zh"}
{"question": "某糖尿病患者伴有浸润性肺结核，应用甲苯磺丁脲、利福平、链霉素，用抗结核药二月后，尿糖加重并出现肝功能不良，其原因是（　　）。", "answer": "利福平诱导肝药酶", "meta_info": "药理学", "answer_idx": "C", "A": "患者又染上了肝炎", "B": "甲苯磺丁脲有肝毒性", "C": "利福平诱导肝药酶", "D": "以上都不是", "language": "zh"}
{"question": "加压素合成部位在（　　）。", "answer": "下丘脑视上核", "meta_info": "生理学", "answer_idx": "D", "A": "神经垂体", "B": "肾上腺", "C": "下丘脑室旁核", "D": "下丘脑视上核", "language": "zh"}
{"question": "女，28岁。间断性下腹痛4年余，大便2～3次/日，稀便，无脓血，便后下腹痛可缓解。粪常规检查：未见细胞，隐血试验阴性，查体无异常发现。2．最适合的治疗药物为（　　）。", "answer": "匹维溴铵", "meta_info": "第3篇　消化系统", "answer_idx": "B", "A": "糖皮质激素", "B": "匹维溴铵", "C": "柳氮磺砒啶", "D": "硫唑嘌呤", "language": "zh"}
{"question": "梗死是指（　　）。", "answer": "缺血引起的坏死", "meta_info": "病理学", "answer_idx": "A", "A": "缺血引起的坏死", "B": "生理性程序性死亡", "C": "厌氧细菌感染而引起的坏死", "D": "结核杆菌感染而引起的坏死", "language": "zh"}
{"question": "急性心肌梗死的超急性期心电图改变是（　　）。", "answer": "T波高耸", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "ST段明显抬高", "B": "T波高耸", "C": "T波倒置", "D": "R波降低", "language": "zh"}
{"question": "70岁震颤麻痹患者最有效的治疗药物是（　　）。", "answer": "复方左旋多巴", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "金刚烷胺", "B": "复方左旋多巴", "C": "丙炔苯丙胺", "D": "卡马西平", "language": "zh"}
{"question": "2．分泌组胺的细胞是（　　）。", "answer": "肥大细胞", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "壁细胞", "B": "主细胞", "C": "肥大细胞", "D": "G细胞", "language": "zh"}
{"question": "患者，男，40岁。发现风湿性心脏病10余年。查体：双侧颊部皮肤呈紫红色，心界向左扩大，心腰膨隆，心率96次/分，心尖部可闻及开瓣音及舒张期隆隆样杂音。该患者查体还可能发现的其他阳性体征是（　　）。", "answer": "肺动脉瓣区舒张早期杂音", "meta_info": "第2篇　心血管系统", "answer_idx": "A", "A": "肺动脉瓣区舒张早期杂音", "B": "胸骨左缘第3肋间收缩期杂音", "C": "第一心音减弱", "D": "第二心音逆分裂", "language": "zh"}
{"question": "患者40岁，是同性恋者，近日出现腹泻、消瘦、低热，经多方检查，最后诊断为艾滋病，对艾滋病病毒有抑制作用的是（　　）。", "answer": "叠氮脱氧胸苷", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "B", "A": "喷他脒", "B": "叠氮脱氧胸苷", "C": "胸腺肽", "D": "核糖核酸", "language": "zh"}
{"question": "金黄色葡萄球菌感染最常引起（　　）。", "answer": "脓肿", "meta_info": "病理学", "answer_idx": "B", "A": "蜂窝织炎", "B": "脓肿", "C": "出血性炎", "D": "浆液性炎", "language": "zh"}
{"question": "3岁女孩，因生长发育瘦小，肤色及口唇较黯，怀疑有先天性心脏病就诊。2．若该患儿体检发现口唇黏膜青紫，胸骨左缘2～3肋间闻及2/6～3/6级收缩期杂音，P2减弱、轻度杵状指（趾），为进一步明确先心病类型，最简便经济的检查是（　　）。", "answer": "心脏X线摄片", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "动脉血氧饱和度测定", "B": "心脏X线摄片", "C": "二维超声心动图", "D": "右心导管造影", "language": "zh"}
{"question": "小儿骨骼发育中，正确的是（　　）。", "answer": "出生时足踝部骨化中心已出现", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "后囟闭合最迟的年龄为出生后2周", "B": "颅缝一般闭合的年龄为2个月", "C": "出生时足踝部骨化中心已出现", "D": "脊柱增长1岁以后快于下肢", "language": "zh"}
{"question": "青年运动员，髌下痛，右膝无力3个月，屈伸膝痛，上下楼梯困难。体检：髌骨边缘压痛，髌骨研磨试验（+）。股四头肌轻度萎缩。右膝平片未见异常，核素扫描见髌骨局限性放射线浓聚。临床诊断为（　　）。", "answer": "髌骨软骨软化症", "meta_info": "第四部分　运动系统疾病", "answer_idx": "D", "A": "半月板损伤", "B": "交叉韧带损伤", "C": "副韧带损伤", "D": "髌骨软骨软化症", "language": "zh"}
{"question": "男，4岁，高热、腹痛、腹泻1天，为黏液脓血便，伴里急后重，反复惊厥，逐渐出现昏睡、神志不清，病前吃过未洗黄瓜。最有可能的诊断是（　　）。", "answer": "急性细菌性痢疾", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "伤寒", "B": "肠结核", "C": "急性细菌性痢疾", "D": "流行性乙型肝炎", "language": "zh"}
{"question": "用于肝细胞癌患者普查、诊断、判断疗效和预测复发的检验项目应首选（　　）。", "answer": "甲胎蛋白", "meta_info": "第3篇　消化系统", "answer_idx": "A", "A": "甲胎蛋白", "B": "γ-谷氨酰转肽酶", "C": "α-L-岩藻糖苷酶", "D": "PSA", "language": "zh"}
{"question": "女，28岁。平时月经规则。现停经2个月，阴道流血10天。妇科检查：子宫如妊娠3个月大，软，无压痛，双侧附件区均扪及5cm囊性包块，壁薄，活动好，无压痛。血HCG增高明显。3．适宜的治疗措施是（　　）。", "answer": "负压吸宫术", "meta_info": "第5篇　女性生殖系统", "answer_idx": "A", "A": "负压吸宫术", "B": "化学药物治疗", "C": "子宫切除术", "D": "免疫疗法", "language": "zh"}
{"question": "2．妊高症孕妇伴脑水肿时首选药物是（　　）。", "answer": "甘露醇", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "硫酸镁", "B": "哌替啶", "C": "阿托品", "D": "甘露醇", "language": "zh"}
{"question": "中毒型细菌性痢疾的特点是（　　）。", "answer": "可以出现滤泡性肠炎的变化", "meta_info": "病理学", "answer_idx": "C", "A": "常由毒力强的志贺菌引起", "B": "明显的腹泻及脓血便", "C": "可以出现滤泡性肠炎的变化", "D": "容易转为慢性细菌性痢疾", "language": "zh"}
{"question": "判断糖尿病控制程度较好的指标是（　　）。", "answer": "糖化血红蛋白", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "B", "A": "饭后血糖", "B": "糖化血红蛋白", "C": "空腹血浆胰岛素含量", "D": "OGTT", "language": "zh"}
{"question": "男性，28岁，心慌、怕热、多汗、消瘦、易饿4个月，甲状腺弥漫性Ⅰ度肿大，血TSH降低，T3和T4增高，诊为甲亢。他巴唑（甲巯咪唑）每天30mg，20天后血白细胞2.2×109/L，中性粒细胞1.0×109/L。下一步治疗应（　　）。", "answer": "他巴唑与升白细胞药合用", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "B", "A": "他巴唑剂量减半再用", "B": "他巴唑与升白细胞药合用", "C": "改用丙硫氧嘧啶", "D": "核素131I治疗", "language": "zh"}
{"question": "引起牙周脓肿最常见的病原菌是（　　）。", "answer": "无芽胞厌氧菌", "meta_info": "医学微生物学", "answer_idx": "C", "A": "甲型溶血性链球菌", "B": "类白喉杆菌", "C": "无芽胞厌氧菌", "D": "绿脓杆菌", "language": "zh"}
{"question": "前置胎盘首选的检查方法是（　　）。", "answer": "B型超声检查", "meta_info": "第5篇　女性生殖系统", "answer_idx": "C", "A": "阴道内诊检查", "B": "下腹部听诊胎盘杂音", "C": "B型超声检查", "D": "放射性同位素扫描", "language": "zh"}
{"question": "窦房结P细胞动作电位0期去极的离子基础是（　　）。", "answer": "Ca2+内流", "meta_info": "生理学", "answer_idx": "A", "A": "Ca2+内流", "B": "K+内流", "C": "Ca2+外流", "D": "K+外流", "language": "zh"}
{"question": "2．脱水加低钠血症（　　）。", "answer": "低渗性脱水", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "等渗性脱水", "B": "低渗性脱水", "C": "高渗性脱水", "D": "高钾血症", "language": "zh"}
{"question": "血尿病人，膀胱镜见膀胱右侧壁有一2.5cm×1.0cm新生物，有蒂，距右输尿管口3cm，活检诊断移行细胞癌T3期，首选的治疗方法是（　　）。", "answer": "膀胱全切除术", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "膀胱灌注化疗", "B": "经尿道膀胱肿瘤电切术", "C": "膀胱部分切除术", "D": "膀胱全切除术", "language": "zh"}
{"question": "对于骨骼肌兴奋-收缩耦联，下列哪项是错误的?（　　）", "answer": "终末池中Ca2+逆浓度差转运", "meta_info": "生理学", "answer_idx": "B", "A": "电兴奋通过横管系统传向肌细胞深部", "B": "终末池中Ca2+逆浓度差转运", "C": "Ca2+进入肌浆与肌钙蛋白结合", "D": "兴奋-收缩耦联的结构基础为三联管", "language": "zh"}
{"question": "逆转录是指（　　）。", "answer": "以RNA为模板合成DNA", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "以RNA为模板合成RNA", "B": "以DNA为模板合成DNA", "C": "以RNA为模板合成蛋白质", "D": "以RNA为模板合成DNA", "language": "zh"}
{"question": "梗死呈地图状的器官是（　　）。", "answer": "心", "meta_info": "病理学", "answer_idx": "C", "A": "脾", "B": "肾", "C": "心", "D": "小肠", "language": "zh"}
{"question": "补体系统在激活后可以（　　）。", "answer": "裂解细菌", "meta_info": "医学免疫学", "answer_idx": "D", "A": "诱导免疫耐受", "B": "抑制变态反应", "C": "启动抗体的类别转换", "D": "裂解细菌", "language": "zh"}
{"question": "预后最差的乳癌局部表现是（　　）。", "answer": "乳房皮肤急性炎症表现", "meta_info": "第八部分　其他疾病", "answer_idx": "B", "A": "乳房皮肤橘皮样表现", "B": "乳房皮肤急性炎症表现", "C": "乳头湿疹样表现", "D": "乳头牵缩", "language": "zh"}
{"question": "下列关节脱位的特有体征，哪一项是恰当的？（　　）", "answer": "畸形，弹性固定，关节空虚", "meta_info": "第四部分　运动系统疾病", "answer_idx": "D", "A": "肿胀，畸形，功能障碍", "B": "畸形，反常活动，关节空虚", "C": "畸形，反常活动，弹性固定", "D": "畸形，弹性固定，关节空虚", "language": "zh"}
{"question": "下列关于医德良心的描述，不正确的是（　　）。", "answer": "医德良心的内容是主观的", "meta_info": "医学伦理学", "answer_idx": "B", "A": "医德良心是一个最古老的医德范畴", "B": "医德良心的内容是主观的", "C": "医德良心是社会关系的反映", "D": "医德良心是医务人员在履行医德义务过程中形成的深切的道德责任感和自我评价能力", "language": "zh"}
{"question": "2．智能低下，特殊面容是（　　）。", "answer": "先天性甲状腺功能减低症", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "先天性甲状腺功能减低症", "B": "佝偻病", "C": "垂体性侏儒症", "D": "先天性巨结肠", "language": "zh"}
{"question": "对于细胞水肿下列叙述中哪一项是不正确的？（　　）", "answer": "继续发展，可形成玻璃样变", "meta_info": "病理学", "answer_idx": "D", "A": "细胞膜受损，钠泵功能障碍所致", "B": "胞核淡染或稍大，有时不清", "C": "属于可恢复性病变", "D": "继续发展，可形成玻璃样变", "language": "zh"}
{"question": "下列哪种措施有利于建立免疫耐受（　　）。", "answer": "应用抗IL-2受体的单克隆抗体", "meta_info": "医学免疫学", "answer_idx": "B", "A": "应用IL-2", "B": "应用抗IL-2受体的单克隆抗体", "C": "将负载肿瘤抗原的树突状细胞(DC)回输机体", "D": "应用基因修饰的“瘤苗”", "language": "zh"}
{"question": "女，28岁。左乳皮肤水肿、发红2个月，口服抗生素未见好转。查体：T 37.0℃，左乳皮肤发红、水肿，呈“橘皮样”，乳头内陷，乳房质地变硬，无触痛。未扪及肿块。左腋下扪及多个肿大淋巴结、质硬、融合，无触痛。血常规：WBC 8.0×109/L，N 0.67。2．最佳治疗方案是（　　）。", "answer": "穿刺活检后化疗", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "局部按摩", "B": "静脉应用广谱抗生素", "C": "局部热敷、理疗", "D": "穿刺活检后化疗", "language": "zh"}
{"question": "患者，30岁，11月中旬发病，发热、全身痛、尿少，入院时发病5天。查体可见面部充血，结膜出血，皮下可见瘀点、瘀斑。经化验检查，最后确诊为肾综合征出血热。2．此后的化验检查中有一项是多余的，应是（　　）。", "answer": "尿酮", "meta_info": "第八部分　其他疾病", "answer_idx": "D", "A": "离子", "B": "肾功能", "C": "血小板", "D": "尿酮", "language": "zh"}
{"question": "对功能减退性内分泌疾病应首选下列哪一种治疗？（　　）", "answer": "替代治疗", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "B", "A": "对症治疗", "B": "替代治疗", "C": "病因治疗", "D": "支持治疗", "language": "zh"}
{"question": "男性，35岁，右肾疼痛，尿常规红细胞充满/HP，白细胞2～3个/HP，尿路平片可见右下段输尿管走行区高密度阴影0.6cm，IVU可见右输尿管下段结石，其上输尿管轻度扩张，右肾轻度积水。2．患者中西药物治疗和大量饮水活动后绞痛解除，突然出现尿流中断及排尿终末痛，原因是（　　）。", "answer": "结石到膀胱", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "急性前列腺炎", "B": "结石到膀胱", "C": "结石到尿道", "D": "尿道炎", "language": "zh"}
{"question": "肱骨中下1/3骨折，最易并发（　　）。", "answer": "桡神经损伤", "meta_info": "第四部分　运动系统疾病", "answer_idx": "C", "A": "尺神经损伤", "B": "正中神经损伤", "C": "桡神经损伤", "D": "肱二头肌断裂伤", "language": "zh"}
{"question": "患者肱骨中段骨折已6个月，局部有异常活动，X线片对位对线良好，但仍有骨折线，骨痂极少，骨端有硬化现象，采用何种治疗为宜？（　　）", "answer": "钢板内固定加植骨加石膏外固定", "meta_info": "第四部分　运动系统疾病", "answer_idx": "D", "A": "继续小夹板固定", "B": "胸肩肱石膏外固定", "C": "钢板内固定+植骨", "D": "钢板内固定加植骨加石膏外固定", "language": "zh"}
{"question": "3．颅内压增高程度较轻的病例应选用（　　）。", "answer": "双氢氯噻嗪", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "20％甘露醇", "B": "双氢氯噻嗪", "C": "度冷丁", "D": "地塞米松", "language": "zh"}
{"question": "7岁小儿，在夏秋季节突然高热不退，反复惊厥，考虑中毒型细菌性痢疾，做下列哪项检查最有助于早期诊断（　　）。", "answer": "便常规检查", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "血常规检查", "B": "便常规检查", "C": "脑脊液检查", "D": "血液培养", "language": "zh"}
{"question": "女性，40岁。其丈夫吸烟多年。患者右侧胸痛3个月。X线片示右肺近胸膜处有一直径4cm球形阴影，与周围肺组织界清，同时右肺门淋巴结肿大。请判断该女士可能患（　　）。", "answer": "肺腺癌", "meta_info": "病理学", "answer_idx": "B", "A": "肺鳞状细胞癌", "B": "肺腺癌", "C": "细支气管肺泡细胞癌", "D": "小细胞癌", "language": "zh"}
{"question": "新生儿溶血病中，最常见的是（　　）。", "answer": "RhE溶血病", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "RhD溶血病", "B": "RhE溶血病", "C": "其他Rh溶血病", "D": "AISO溶血病", "language": "zh"}
{"question": "男婴，6个月。高热3天，惊厥2次，呕吐2次，不伴腹泻，查体：心、肺均无异常。血WBC 18×109/L，N 0.85。查体最应注意的体征是（　　）。", "answer": "前囟隆起", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "前囟隆起", "B": "颈强直", "C": "Babinski征（＋）", "D": "Kernig征（＋）", "language": "zh"}
{"question": "男，71岁。间断咳嗽、咳痰20余年，加重伴喘憋1周。近2天出现嗜睡。查体：意识模糊，口唇发绀，球结膜水肿，双肺满布哮鸣音。双下肢水肿。2．患者经吸氧治疗后呼吸困难进一步加重。血气分析示：pH 7.10，PaO2 65mmHg，PaCO2 102mmHg，查体：昏睡，口唇发绀，双肺散在干湿性啰音。此时，应首选的治疗措施是（　　）。", "answer": "机械通气", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "糖皮质激素静脉滴注", "B": "大剂量利尿剂静脉滴注", "C": "呼吸兴奋剂静脉滴注", "D": "机械通气", "language": "zh"}
{"question": "医师在执业活动中履行下列义务，除了（　　）。", "answer": "参与所在机构的民主管理", "meta_info": "卫生法规", "answer_idx": "A", "A": "参与所在机构的民主管理", "B": "遵守职业道德", "C": "尊重患者，保护患者的隐私", "D": "宣传卫生保健知识", "language": "zh"}
{"question": "女，70岁。突发胸闷、喘憋10小时入院。既往高血压病史12年，糖尿病病史5年。查体：BP 160／90mmHg，端坐呼吸。双肺可闻及广泛湿啰音及散在哮鸣音。心率128次/分，心律齐，心脏各瓣膜区未闻及杂音。ECG示：V1～V6导联ST段抬高。动脉血气分析：pH 7.35，PaO2 71mmHg，PaCO2 40mmHg。2．最恰当的药物治疗是（　　）。", "answer": "静脉滴注硝酸甘油", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "口服华法林", "B": "静脉滴注糖皮质激素", "C": "静脉滴注硝酸甘油", "D": "静脉滴注抗生素", "language": "zh"}
{"question": "女性，17岁。颈部肿大1年，无怕热、多食、易激动。查体：脉率、血压正常，甲状腺弥漫性肿大，质地柔软，未触及结节，表面光滑。采用的最佳治疗措施是（　　）。", "answer": "小剂量甲状腺素治疗", "meta_info": "第二部分　模拟试题", "answer_idx": "A", "A": "小剂量甲状腺素治疗", "B": "口服甲硫氧嘧啶治疗", "C": "注射131Ⅰ治疗", "D": "甲状腺大部切除术", "language": "zh"}
{"question": "关于断肢再植原则，下列哪项是错误的？（　　）", "answer": "肌腱常作二期缝接", "meta_info": "第四部分　运动系统疾病", "answer_idx": "C", "A": "首先进行彻底的清创", "B": "需要时可将骨骼短缩后重建", "C": "肌腱常作二期缝接", "D": "主要的动、静脉均应吻合", "language": "zh"}
{"question": "病员行胃大部切除、胃空肠吻合术。手术操作无误.术后状态良好。第5天感到张口、下咽困难。第6天出现角弓反张，抽搐，诊断为破伤风，经医院抢救无效，于10月11日死亡。患者找到区卫生行政部门申诉。经区医疗事故鉴定委员会鉴定，不属事故，10月31日区卫生行政部门结论为医院无责任，并将通知书交与家属。家属仍不服。家属可以向上一级卫生行政部门申请复议的有效期限是（　　）。", "answer": "11月15日前", "meta_info": "卫生法规", "answer_idx": "C", "A": "11月5日前", "B": "11月7日前", "C": "11月15日前", "D": "11月30日前", "language": "zh"}
{"question": "不是自律细胞的是（　　）。", "answer": "心房、心室肌细胞", "meta_info": "生理学", "answer_idx": "B", "A": "心室传导束的浦肯野细胞", "B": "心房、心室肌细胞", "C": "窦房结P细胞", "D": "房结区细胞", "language": "zh"}
{"question": "在传染病的预防工作中，有关单位应当按照国家规定，对下列人员采取有效的防护措施和医疗保健措施，除了（　　）。", "answer": "在工作中可能接触传染病病原体的", "meta_info": "卫生法规", "answer_idx": "B", "A": "从事传染病医疗的", "B": "在工作中可能接触传染病病原体的", "C": "在工作中接触传染病病原体的", "D": "现场处理疫情的", "language": "zh"}
{"question": "行为学派认为心身障碍的根源是（　　）。", "answer": "通过错误的学习而习得的", "meta_info": "医学心理学", "answer_idx": "C", "A": "潜意识中的心理冲突", "B": "对欲求的呐喊", "C": "通过错误的学习而习得的", "D": "错误的认知评价", "language": "zh"}
{"question": "下列何者是革兰阴性化脓性球菌（　　）。", "answer": "淋病奈瑟菌", "meta_info": "医学微生物学", "answer_idx": "C", "A": "溶血性链球菌", "B": "金黄色葡萄球菌", "C": "淋病奈瑟菌", "D": "以上都不是", "language": "zh"}
{"question": "右手食指指腹切削伤，有较大皮肤缺损，创底组织血液循环良好，此伤口正确的处理方法是（　　）。", "answer": "中厚皮片移植", "meta_info": "第四部分　运动系统疾病", "answer_idx": "B", "A": "切除末节指骨，缩短手指后直接缝合", "B": "中厚皮片移植", "C": "带蒂皮辦移植", "D": "凡士林纱布覆盖包扎，定期换药", "language": "zh"}
{"question": "3．泌乳素瘤最常出现（　　）。", "answer": "停经泌乳", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "A", "A": "停经泌乳", "B": "鼻宽舌大", "C": "腋毛阴毛脱落", "D": "体温食欲异常", "language": "zh"}
{"question": "患者18岁之前，由于各种原因造成大脑发育不良或受阻，智能发育停留在一定阶段，落后于同龄正常人群，社会适应不良，此症状属于（　　）。", "answer": "精神发育迟滞", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "遗忘", "B": "精神发育迟滞", "C": "痴呆", "D": "错构", "language": "zh"}
{"question": "男，56岁。咳嗽伴痰中带血2周，胸部X线片及CT检查发现右肺上叶周围型结节，痰细胞学检查示：鳞癌可能性大。该患者首选治疗是（　　）。", "answer": "手术治疗", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "免疫治疗", "B": "手术治疗", "C": "介入治疗", "D": "放射治疗", "language": "zh"}
{"question": "2．属人工主动免疫的是（　　）。", "answer": "经接种疫苗获得免疫", "meta_info": "医学微生物学", "answer_idx": "C", "A": "经胎盘、初乳获得免疫", "B": "经注射抗毒素获得免疫", "C": "经接种疫苗获得免疫", "D": "经隐性感染或患病后获得免疫", "language": "zh"}
{"question": "女性，28岁，已婚，因消瘦、乏力、多食、心悸3个月就诊。近2年应用口服避孕药。3．应选择哪一项治疗？（　　）", "answer": "丙硫氧嘧啶治疗+普萘洛尔治疗", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "C", "A": "他巴唑（甲巯咪唑）治疗", "B": "丙硫氧嘧啶治疗", "C": "丙硫氧嘧啶治疗+普萘洛尔治疗", "D": "过氯酸钾治疗", "language": "zh"}
{"question": "保密的重要性不包括（　　）。", "answer": "不危害他人及社会", "meta_info": "医学伦理学", "answer_idx": "B", "A": "不引起患者家庭纠纷", "B": "不危害他人及社会", "C": "不引起医患矛盾", "D": "不导致患者自残等后果", "language": "zh"}
{"question": "男，10岁，右大腿下端剧痛8天，寒战、高热，右膝不敢活动。体检：T39.5℃，P100次/分，右膝上方肿块，有深压痛，皮肤明显发红，血常规WBC 25000/mm，中性粒细胞90％，核左移。X线平片股骨未见异常。静滴青霉素400万U/d×3天，症状无明显好转。3．如果使用抗生素治疗后全身及局部症状均消失，进一步治疗需（　　）。", "answer": "继续应用抗生素3周", "meta_info": "第四部分　运动系统疾病", "answer_idx": "C", "A": "立即手术钻孔引流", "B": "停用抗生素", "C": "继续应用抗生素3周", "D": "手术开窗减压", "language": "zh"}
{"question": "腹部手术后多采用（　　）。", "answer": "低半坐位", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "平卧位", "B": "俯卧位", "C": "高坡卧位", "D": "低半坐位", "language": "zh"}
{"question": "2．环形双链DNA，具有两个复起始点，一个可在大肠杆菌中推动它的复制，另一个可在酵母细胞中推动复制（　　）。", "answer": "穿梭质粒", "meta_info": "生物化学", "answer_idx": "D", "A": "DNA", "B": "装配型质粒", "C": "M13-DNA", "D": "穿梭质粒", "language": "zh"}
{"question": "下列哪项是神经—骨骼肌接头处的兴奋传递物质？（　　）", "answer": "乙酰胆碱", "meta_info": "生理学", "answer_idx": "C", "A": "多巴胺", "B": "肾上腺素", "C": "乙酰胆碱", "D": "谷氨酸", "language": "zh"}
{"question": "男，67岁。咳嗽、咳痰20年，加重伴气短1周。查体：T 36.8℃，双肺呼吸音减弱，语音震颤减弱，叩诊呈过清音。该患者最可能的诊断是（　　）。", "answer": "慢性阻塞性肺疾病", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "气胸", "B": "心力衰竭", "C": "慢性阻塞性肺疾病", "D": "支气管哮喘", "language": "zh"}
{"question": "7岁女孩，低热半月，消瘦轻咳。查体：T38℃，营养差，右背下部听诊呼吸音减低，下肢有结节性红斑，接种过卡介苗，PPD试验强阳性。2．最可能的诊断是（　　）。", "answer": "原发性肺结核", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "原发性肺结核", "B": "结核性脑膜炎", "C": "继发性肺结核", "D": "结核性胸膜炎", "language": "zh"}
{"question": "3．正常人血液中血小板计数是（　　）。", "answer": "（100～300）×109个/L", "meta_info": "生理学", "answer_idx": "B", "A": "（4～10）×109个/L", "B": "（100～300）×109个/L", "C": "400万～500万个/ml", "D": "（3.5～5.0）×1012个/L", "language": "zh"}
{"question": "女性，42岁，1年前与丈夫感情突然变坏，常失眠，感到全身不适，认为丈夫在食物中放了毒药暗害她，故吃饭时总是让丈夫先吃，而后她再吃。某次吃饭时要和丈夫交换饭碗，并说：“试验试验你。”之后抱着孩子哭了起来，说：“妈妈舍不得你呀!”认为鸡蛋中有辣味，饭里放了药使她泻肚子。3．病人可能的诊断是（　　）。", "answer": "精神分裂症", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "神经衰弱", "B": "抑郁症", "C": "精神分裂症", "D": "焦虑性神经症", "language": "zh"}
{"question": "下述哪项是NK细胞所不具备的生物学功能？（　　）", "answer": "通过释放蛋白水解酶杀伤病毒感染的靶细胞", "meta_info": "医学免疫学", "answer_idx": "D", "A": "非特异杀伤肿瘤靶细胞", "B": "非特异杀伤某些病毒感染的靶细胞", "C": "通过ADCC作用杀伤肿瘤和病毒感染的靶细胞", "D": "通过释放蛋白水解酶杀伤病毒感染的靶细胞", "language": "zh"}
{"question": "治疗先天性甲状腺功能减低症用甲状腺片的维持量[mg/（kg·d）]为（　　）。", "answer": "4～8", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "2～4", "B": "1～2", "C": "4～8", "D": "8～12", "language": "zh"}
{"question": "病毒复制周期不包括（　　）。", "answer": "扩散", "meta_info": "医学微生物学", "answer_idx": "D", "A": "脱壳", "B": "吸附与穿入", "C": "生物合成", "D": "扩散", "language": "zh"}
{"question": "女，26岁，妊娠33周，妊娠期糖尿病，通过调整饮食血糖水平控制良好，胎儿大小发育正常，下一步的处理是（　　）。", "answer": "继续控制饮食", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "给予地塞米松", "B": "继续控制饮食", "C": "每日检测血糖", "D": "加用胰岛素治疗", "language": "zh"}
{"question": "对医疗废物的收集，运转，贮存，处置中的疾病防治工作，进行定期检测监督检查的部门是（　　）。", "answer": "卫生行政主管部门", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "市容监督机关", "B": "城市规划行政部门", "C": "卫生行政主管部门", "D": "环境保护行政部门", "language": "zh"}
{"question": "下列哪项为医学心理学的研究对象？（　　）", "answer": "影响健康的有关心理问题和行为", "meta_info": "医学心理学", "answer_idx": "C", "A": "心理活动的规律的学科", "B": "疾病的发生发展的规律", "C": "影响健康的有关心理问题和行为", "D": "疾病的预防和治疗的原则", "language": "zh"}
{"question": "既能治疗风湿性关节炎，又有抗血栓形成作用的药物是（　　）。", "answer": "阿司匹林", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "布洛芬", "B": "阿司匹林", "C": "喷他佐辛", "D": "哌替啶", "language": "zh"}
{"question": "男性，突发寒战，体温39℃左右，腹泻十余次，伴里急后重，初为稀便，很快转化为脓血便。粪便常规：红细胞5个/HP，白细胞10个/HP，脓液（++）。1．该患者最可能诊断为（　　）。", "answer": "细菌性痢疾", "meta_info": "第八部分　其他疾病", "answer_idx": "A", "A": "细菌性痢疾", "B": "阿米巴痢疾", "C": "伤寒", "D": "食物中毒", "language": "zh"}
{"question": "对于医疗机构的执业要求规定，医疗机构必须将以下哪项悬挂于明显处，除了？（　　）", "answer": "诊疗医生", "meta_info": "卫生法规", "answer_idx": "B", "A": "医疗机构执业许可证", "B": "诊疗医生", "C": "收费标准", "D": "诊疗时间", "language": "zh"}
{"question": "10岁女孩，因水肿、少尿7天入院。入院后病情逐渐加重，每日尿量30ml，水肿明显，精神差，呼吸深长，经治疗4周仍不缓解，临床考虑为急进性肾炎。现处理的重点是（　　）。", "answer": "甲泼尼龙冲击", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "用头孢三嗪", "B": "环磷酰胺冲击", "C": "保证液体入量", "D": "甲泼尼龙冲击", "language": "zh"}
{"question": "2．弥散性血管内凝血消耗性低凝血期（　　）。", "answer": "纤维蛋白原降低", "meta_info": "第一部分　血液系统疾病", "answer_idx": "B", "A": "血小板增加", "B": "纤维蛋白原降低", "C": "PT缩短", "D": "Hb降低", "language": "zh"}
{"question": "1．静息电位接近于（　　）。", "answer": "K+平衡电位", "meta_info": "生理学", "answer_idx": "B", "A": "K+外流", "B": "K+平衡电位", "C": "Na+内流", "D": "Na+平衡电位", "language": "zh"}
{"question": "7个月女婴，以发热、咳嗽、喘憋6天为主诉入院。入院后第二天患儿突然面色灰白，极度烦躁不安，呼吸明显增快，印次/分，听心音低钝，节律整，心率180次/分，呈奔马律，双肺闻及广泛的水泡音，肝肋下3cm，下肢有浮肿。血常规：白细胞55×109/L。胸片双肺见小片状影，肺纹理增强，肺气肿。3．该并发症的急救措施首选（　　）。", "answer": "静脉给予毒毛花苷K制剂", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "能量合剂，丹参等营养心肌", "B": "2:1等张含钠液扩容", "C": "静脉给予毒毛花苷K制剂", "D": "降低脑水肿，营养脑细胞", "language": "zh"}
{"question": "关于自知力的描述，正确的是（　　）。", "answer": "自知力可用于判断精神疾病的严重程度", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "自知力可用于判断精神疾病的严重程度", "B": "自知力是对自己行为的控制能力", "C": "分离（转换）性障碍患者都有自知力", "D": "精神病性症状完全缓解后自知力就会完全恢复", "language": "zh"}
{"question": "临床上说的肛裂三联征是指（　　）。", "answer": "肛裂、前哨痔、相应位置的肛乳头肥大", "meta_info": "第3篇　消化系统", "answer_idx": "A", "A": "肛裂、前哨痔、相应位置的肛乳头肥大", "B": "肛裂、内痔、前哨痔", "C": "内痔、外痔、肛裂", "D": "肛裂、外痔、前哨痔", "language": "zh"}
{"question": "女性，45岁，肥胖多年，口渴5个月，尿糖（+），空腹血糖7.9mmol/L，饭后2小时血糖12.1mmol/L。2．本病人应首选下述哪一种药物或治疗？（　　）", "answer": "单纯饮食治疗", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "D", "A": "磺脲类降糖药", "B": "双胍类降糖药", "C": "胰岛素", "D": "单纯饮食治疗", "language": "zh"}
{"question": "1．哪种药物口服难吸收，用于肠道感染？（　　）", "answer": "呋喃唑酮", "meta_info": "药理学", "answer_idx": "A", "A": "呋喃唑酮", "B": "甲氧苄啶", "C": "磺胺嘧啶", "D": "环丙沙星", "language": "zh"}
{"question": "男孩，12岁。诊断为左胫骨近端骨髓炎，经局部引流后症状好转，但目前局部仍有窦道流脓。X线检查显示有大块死骨及新生骨，有包壳形成。最主要的治疗措施是（　　）。", "answer": "清除病灶", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "清除病灶", "B": "间断应用抗生素", "C": "窦道刮除术", "D": "石膏固定", "language": "zh"}
{"question": "下列哪项为以滑膜炎为基本病理改变的风湿病？（　　）", "answer": "类风湿关节炎", "meta_info": "第五部分　风湿免疫性疾病", "answer_idx": "A", "A": "类风湿关节炎", "B": "风湿性关节炎", "C": "骨性关节炎", "D": "痛风性关节炎", "language": "zh"}
{"question": "月经周期中期能起正反馈作用于下丘脑-垂体的激素是（　　）。", "answer": "雌激素", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "孕激素", "B": "雄激素", "C": "雌激素", "D": "甲状腺激素", "language": "zh"}
{"question": "肾综合征出血热治疗原则“三早一就”是（　　）。", "answer": "早发现，早休息，早期就近治疗", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "C", "A": "早诊断，早休息，早期就近治疗", "B": "早休息，早治疗，就近治疗", "C": "早发现，早休息，早期就近治疗", "D": "早治疗，早控制，早期就近治疗", "language": "zh"}
{"question": "腹股沟斜疝特点是（　　）。", "answer": "疝囊颈在腹壁下动脉外侧", "meta_info": "第3篇　消化系统", "answer_idx": "D", "A": "多见于老年", "B": "疝囊颈在腹壁下动脉内侧", "C": "半球形，基底较宽", "D": "疝囊颈在腹壁下动脉外侧", "language": "zh"}
{"question": "男，62岁。进行性吞咽困难2月余。既往体健。查体：T 36.5℃，P 80次/分，R 18次/分，BP 120/80mmHg。浅表淋巴结未触及肿大，双肺呼吸音清，未闻及干湿性啰音，心律齐，未闻及杂音，腹软，无压痛。上消化道X线钡剂造影：食管下段黏膜紊乱，部分管壁僵硬。为明确诊断，首选的检查是（　　）。", "answer": "食管镜", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "食管B超", "B": "食管镜", "C": "PET CT", "D": "食管拉网细胞学检查", "language": "zh"}
{"question": "dTMP是由下列哪种核苷酸直接转变来的？（　　）", "answer": "dUMP", "meta_info": "生物化学", "answer_idx": "D", "A": "TMP", "B": "dCMP", "C": "dUDP", "D": "dUMP", "language": "zh"}
{"question": "艾滋病的病原特点下列哪一项不对？（　　）", "answer": "主要侵犯CD8+细胞", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "D", "A": "有HIV-1和HIV-2两个型", "B": "属逆转录病毒科", "C": "慢病毒亚科", "D": "主要侵犯CD8+细胞", "language": "zh"}
{"question": "女，35岁。近5年来间断头痛，每月发作1～2次，MRI示左顶枕脑内蜂窝样血管流空影，呈楔形。2．进一步最有价值的诊断方法应选择（　　）。", "answer": "DSA", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "CT", "B": "CTA", "C": "MRA", "D": "DSA", "language": "zh"}
{"question": "对于IgE下述哪一项是错误的?（　　）", "answer": "寄生虫感染使IgE水平降低", "meta_info": "医学免疫学", "answer_idx": "C", "A": "56℃30分钟可使IsE灭活", "B": "IgE的H链有4个CH区", "C": "寄生虫感染使IgE水平降低", "D": "在个体发育过程中发育较晚", "language": "zh"}
{"question": "传染病的基本特征为（　　）。", "answer": "有病原体，有传染性，有流行病学特征，有感染后免疫", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "C", "A": "有传染源、传染性、易感人群", "B": "有传染源、传播途径、免疫性", "C": "有病原体，有传染性，有流行病学特征，有感染后免疫", "D": "有病原体，流行性，易感性", "language": "zh"}
{"question": "2．急性硬膜外血肿（　　）。", "answer": "伤后无昏迷，3小时后意识障碍", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "伤后无昏迷，3小时后意识障碍", "B": "伤后立即昏迷，伴去脑强直发作", "C": "伤后昏迷，片刻后清醒", "D": "伤后浅昏迷，脑脊液血性", "language": "zh"}
{"question": "红细胞比容的定义是红细胞（　　）。", "answer": "在血液中所占容积百分比", "meta_info": "生理学", "answer_idx": "C", "A": "与血清容积之比", "B": "与血浆容积之比", "C": "在血液中所占容积百分比", "D": "在血液中所占重量百分比", "language": "zh"}
{"question": "小儿巴氏征阳性在何时为生理现象（　　）。", "answer": "2岁之前", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "2岁之前", "B": "3.5岁之前", "C": "3岁之前", "D": "2.5岁之前", "language": "zh"}
{"question": "新生儿出生体重3.2kg。生后48小时血清总胆红素257mmol/L（15mg/dL），结合胆红素34.2mmol/L（2mg/dL）。首选治疗方案是（　　）。", "answer": "光照治疗", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "光照治疗", "B": "肌注苯巴比妥钠", "C": "换血疗法", "D": "应用利尿剂", "language": "zh"}
{"question": "甲状腺患侧腺叶大部切除术适用于（　　）。", "answer": "甲状腺高功能腺瘤", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "甲状腺乳头状癌", "B": "青少年原发性甲亢", "C": "甲状腺高功能腺瘤", "D": "桥本病", "language": "zh"}
{"question": "男性，38岁，腹泻1天住院。大便10多次，为少量粘液便。BP 110/70mmHg，T38.4℃，脐周肠鸣音活跃，大便镜检WBC 20～30/HP，RBC 2～4/HP，血WBC 16.2×109/L，中性89%。本病人最可能的诊断是（　　）。", "answer": "急性细菌性痢疾", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "A", "A": "急性细菌性痢疾", "B": "肠伤寒", "C": "霍乱", "D": "急性胃肠炎", "language": "zh"}
{"question": "目前医护人员称呼病人时用姓名，而不用床号，是为了满足病人的（　　）。", "answer": "尊重的需要", "meta_info": "医学心理学", "answer_idx": "B", "A": "安全需要", "B": "尊重的需要", "C": "获取信息的需要", "D": "康复的需要", "language": "zh"}
{"question": "患者男性，25岁。因高位小肠瘘1天入院。入院后经颈内静脉插管滴入肠外营养液，2周后突然出现寒战、高热，无咳嗽、咳痰，腹部无压痛和反跳痛。2．观察8小时如果仍然有高热，应采取的措施是（　　）。", "answer": "拔除中心静脉导管", "meta_info": "第八部分　其他疾病", "answer_idx": "C", "A": "肠外营养液中增加胰岛素", "B": "雾化吸入", "C": "拔除中心静脉导管", "D": "咽拭子细菌培养", "language": "zh"}
{"question": "男孩，左肘摔伤急诊就医，小夹板外固定后，前臂肿胀，手部青白发凉，麻木无力，经拍X线片，诊断为左肱骨髁上骨折伸直型，若不及时处理，其最可能的后果是（　　）。", "answer": "缺血性肌挛缩", "meta_info": "第四部分　运动系统疾病", "answer_idx": "D", "A": "感染", "B": "缺血性骨坏死", "C": "骨化性肌炎", "D": "缺血性肌挛缩", "language": "zh"}
{"question": "女，69岁。突发胸骨后压榨样疼痛6小时，持续不缓解。查体：BP 160／70mmHg，心率97次/分。心电图示V1～V6导联ST段水平型压低0.3～0.5mV，实验室检查：血清肌钙蛋白I增高。该患者不宜采取的治疗是（　　）。", "answer": "静脉滴注尿激酶", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "静脉滴注硝酸甘油", "B": "嚼服阿司匹林", "C": "吸氧", "D": "静脉滴注尿激酶", "language": "zh"}
{"question": "男，73岁。头痛、精神异常，左侧肢体无力5天，加重偶伴呕吐1天，3个月前有头部外伤史，查体：BP 160／95mmHg，神志清楚，双侧视乳头水肿，左侧肢体肌力4级。1．该患者最可能的诊断是（　　）。", "answer": "慢性硬脑膜下血肿", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "急性硬脑膜下血肿", "B": "急性硬脑膜外血肿", "C": "亚急性硬脑膜下血肿", "D": "慢性硬脑膜下血肿", "language": "zh"}
{"question": "2．急性化脓性阑尾炎属（　　）。", "answer": "蜂窝织炎症", "meta_info": "病理学", "answer_idx": "C", "A": "变质性炎症", "B": "纤维素性炎症", "C": "蜂窝织炎症", "D": "化脓性炎症", "language": "zh"}
{"question": "1．女性，30岁，钼钯片示其左乳外上区域高密度影约1cm×1cm，毛刺征（+），细针穿刺细胞学检查为可见癌细胞。应采取的手术为（　　）。", "answer": "乳腺癌局部广泛切除+腋窝淋巴结清扫术", "meta_info": "第八部分　其他疾病", "answer_idx": "A", "A": "乳腺癌局部广泛切除+腋窝淋巴结清扫术", "B": "乳腺癌根治术", "C": "乳腺癌姑息切除术", "D": "乳腺单纯切除术", "language": "zh"}
{"question": "对于作为应激源的生活事件的说法正确的是（　　）。", "answer": "生活事件的数量可以决定其对健康和疾病的影响程度", "meta_info": "医学心理学", "answer_idx": "D", "A": "不包括工作问题", "B": "没有正性的生活事件", "C": "生活事件的致病性与其性质无关", "D": "生活事件的数量可以决定其对健康和疾病的影响程度", "language": "zh"}
{"question": "初种麻疹减毒活疫苗的时间是（　　）。", "answer": "生后8个月", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "生后4个月", "B": "生后2个月", "C": "生后8个月", "D": "4岁时加强一次", "language": "zh"}
{"question": "通常不存在于核酸的碱基是（　　）。", "answer": "黄嘌呤", "meta_info": "生物化学", "answer_idx": "A", "A": "黄嘌呤", "B": "鸟嘌呤", "C": "胞嘧啶", "D": "尿嘧啶", "language": "zh"}
{"question": "高血压病脑出血破裂的血管多发生在（　　）。", "answer": "豆纹动脉", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "大脑中动脉", "B": "内囊动脉", "C": "豆纹动脉", "D": "大脑前动脉", "language": "zh"}
{"question": "小儿重度脱水有明显周围循环障碍，扩容液输注时间为（　　）。", "answer": "30～60min", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "10～20min", "B": "30～60min", "C": "70～90min", "D": "130～150min", "language": "zh"}
{"question": "HPV的宿主范围是（　　）。", "answer": "人", "meta_info": "医学微生物学", "answer_idx": "D", "A": "人和哺乳动物", "B": "人和灵长类动物", "C": "人和猩猩", "D": "人", "language": "zh"}
{"question": "男，20岁。持续喘息发作24小时来急诊。既往哮喘病史12年。查体：端坐呼吸，大汗淋漓，发绀，双肺布满哮鸣音。动脉血气分析结果示：pH 7.21，PaCO2 70mmHg，PaO2 55mmHg。此时应紧急采取的治疗措施是（　　）。", "answer": "机械通气", "meta_info": "第1篇　呼吸系统", "answer_idx": "A", "A": "机械通气", "B": "静脉滴注糖皮质激素", "C": "静脉注射氨茶碱", "D": "补充液体", "language": "zh"}
{"question": "不需与周期性瘫痪进行鉴别的是（　　）。", "answer": "癫痫单纯运动性发作", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "格林-巴利综合征", "B": "原发性醛固酮增多症", "C": "肾小管性酸中毒", "D": "癫痫单纯运动性发作", "language": "zh"}
{"question": "1．治疗血吸虫病的药物是（　　）。", "answer": "吡喹酮", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "吡喹酮", "B": "氯喹", "C": "奎宁", "D": "伯氨喹", "language": "zh"}
{"question": "为了切实做到尊重病人自主性或决定，医生向病人提供信息时要避免（　　）。", "answer": "诱导", "meta_info": "医学伦理学", "answer_idx": "A", "A": "诱导", "B": "理解", "C": "适度", "D": "开导", "language": "zh"}
{"question": "不是限制性内切酶识别序列的特点的是（　　）。", "answer": "限制性内切酶的切口均是黏性末端", "meta_info": "生物化学", "answer_idx": "D", "A": "常由4～6个核苷酸组成", "B": "一般具有回文结构", "C": "少数内切酶识别序列中的碱基可以有规律地替换", "D": "限制性内切酶的切口均是黏性末端", "language": "zh"}
{"question": "下列凝血因子中，不属于维生素K依赖性的是（　　）。", "answer": "Ⅷ", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "Ⅶ", "B": "Ⅹ", "C": "Ⅷ", "D": "Ⅸ", "language": "zh"}
{"question": "4．利多卡因缩短动作电位时程的作用可表现为（　　）。", "answer": "心电图Q—T间期缩短", "meta_info": "药理学", "answer_idx": "B", "A": "心电图P—P（或R—R）间期延长", "B": "心电图Q—T间期缩短", "C": "心电图Q—T间期延长", "D": "心电图P—R间期缩短", "language": "zh"}
{"question": "区分血尿与血红蛋白尿的主要方法是（　　）。", "answer": "做尿沉渣镜检", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "观察血尿颜色", "B": "做尿胆原测验", "C": "做尿潜血测验", "D": "做尿沉渣镜检", "language": "zh"}
{"question": "20岁，男性，夜间骑自行车时，头朝下跌于壕沟，发生四肢不全瘫，X线片显示齿状突骨折伴半脱位，此时在治疗上最先采取的措施是（　　）。", "answer": "颅骨牵引固定", "meta_info": "第四部分　运动系统疾病", "answer_idx": "B", "A": "吊带牵引", "B": "颅骨牵引固定", "C": "石膏领固定", "D": "切开复位内固定", "language": "zh"}
{"question": "有一名45岁女患者，车祸头部受伤，伤后即昏迷，1小时后入院。入院时中度昏迷，右侧瞳孔散大，光反射消失，左上下肢病理征（+）。3．根本治疗措施为（　　）。", "answer": "血肿清除术", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "脱水治疗", "B": "冬眠物理降温", "C": "止血，预防感染治疗", "D": "血肿清除术", "language": "zh"}
{"question": "肝脏在脂肪代谢中产生过多酮体主要由于（　　）。", "answer": "糖的供应不足或利用障碍", "meta_info": "生物化学", "answer_idx": "D", "A": "肝脏中脂肪代谢障碍", "B": "肝功能不好", "C": "脂肪摄入过多", "D": "糖的供应不足或利用障碍", "language": "zh"}
{"question": "男性患者2岁，高热，呼吸困难，双肺散在小水泡音，诊断为支气管肺炎，青霉素过敏试验（+），宜选用（　　）。", "answer": "红霉素", "meta_info": "药理学", "answer_idx": "D", "A": "氯霉素", "B": "头孢唑啉", "C": "磺胺嘧啶", "D": "红霉素", "language": "zh"}
{"question": "对于医患双方权利与义务的下列口号和做法中，不可取的为（　　）。", "answer": "患者是上帝", "meta_info": "医学伦理学", "answer_idx": "B", "A": "把维护患者正当权利放在第一位", "B": "患者是上帝", "C": "医者不是上帝", "D": "医者的正当权益也必须得到保证", "language": "zh"}
{"question": "感染性休克的常见病原体为（　　）。", "answer": "革兰阴性细菌", "meta_info": "第2篇　心血管系统", "answer_idx": "A", "A": "革兰阴性细菌", "B": "革兰阳性细菌", "C": "支原体", "D": "肺炎链球菌", "language": "zh"}
{"question": "下面对于通气与血流比值的叙述哪项是错误的?（　　）", "answer": "通气与血流比值减少，意味着生理无效腔增大", "meta_info": "生理学", "answer_idx": "A", "A": "通气与血流比值减少，意味着生理无效腔增大", "B": "安静时正常值为0.84", "C": "肺尖部比值增大，可达3", "D": "肺下部部分血流得不到充分气体交换，比值变少", "language": "zh"}
{"question": "神经末梢释放递质是通过什么方式?（　　）", "answer": "出胞作用", "meta_info": "生理学", "answer_idx": "D", "A": "单纯扩散", "B": "易化扩散", "C": "入胞作用", "D": "出胞作用", "language": "zh"}
{"question": "小脑幕切迹疝常见原因（　　）。", "answer": "幕上一侧占位性病变", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "A", "A": "幕上一侧占位性病变", "B": "小脑幕下占位性病变", "C": "脑室内占位性病变", "D": "广泛脑水肿", "language": "zh"}
{"question": "关于成人特发性血小板减少性紫癫，正确的是（　　）。", "answer": "女性青春期易发病", "meta_info": "第一部分　血液系统疾病", "answer_idx": "B", "A": "主要见于男性", "B": "女性青春期易发病", "C": "多有淋巴细胞增多", "D": "常于发病后4周自行缓解", "language": "zh"}
{"question": "哮喘发作时，对缓解支气管痉挛作用最快的是（　　）。", "answer": "特布他林", "meta_info": "第1篇　呼吸系统", "answer_idx": "B", "A": "氨茶碱", "B": "特布他林", "C": "色甘酸钠", "D": "异丙托溴铵", "language": "zh"}
{"question": "女，25岁，低热，腹痛1个月，尿少，腹围增加1周，查体腹部弥漫压痛（＋），揉面感，移动性浊音阳性。3．应采用的主要治疗措施是（　　）。", "answer": "抗结核治疗", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "抗结核治疗", "B": "口服利尿剂", "C": "静脉点滴抗生素", "D": "静脉输注尿蛋白", "language": "zh"}
{"question": "1．肩关节脱位的主要体征是（　　）。", "answer": "杜加（Dugas）征阳性", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "“4”字试验阳性", "B": "杜加（Dugas）征阳性", "C": "直腿抬高试验（Lasegue）阳性", "D": "压头试验阳性", "language": "zh"}
{"question": "女，40岁。餐后突发右上腹及剑突下痛，放射到右肩及后背部，2小时后疼痛剧烈，伴恶心，并吐出所进食物，仍不缓解，急诊就医。数年胃病史及胆石病史，间有胆绞痛发作。查体：痛苦病容，体温37.2℃，呼吸28次、分，浅快，律齐。全腹胀，上腹肌紧张，压痛反跳痛（＋），移动性浊音（±），白细胞12×109/L，血红蛋白125g/L，尿淀粉酶400U（温氏法正常值32U）。1．下列初步诊断中，不可能的是（　　）。", "answer": "急性胃肠炎", "meta_info": "第3篇　消化系统", "answer_idx": "D", "A": "胃十二指肠溃疡穿孔", "B": "急性胆囊炎", "C": "急性肠梗阻", "D": "急性胃肠炎", "language": "zh"}
{"question": "40岁女性患者，突然剧烈头痛、呕吐、右眼睑下垂，见右眼球活动受限，呈外展位，对光反应消失，视力正常。查体：颈项强直，克氏征（+）。4．若腰穿获得血性脑脊液应与下列疾病鉴别，哪项除外？（　　）", "answer": "脑内肿瘤", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "颅内动静脉畸形", "B": "高血压脑出血", "C": "脑内肿瘤", "D": "外伤性蛛网膜下腔出血", "language": "zh"}
{"question": "肺气肿的严重后果不包括（　　）。", "answer": "导致支气管扩张", "meta_info": "病理学", "answer_idx": "D", "A": "肺源性心脏病", "B": "自发性气胸", "C": "发作性呼气性呼吸困难", "D": "导致支气管扩张", "language": "zh"}
{"question": "3．脑栓塞最常见的病因是（　　）。", "answer": "风湿性心脏病", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "高血压", "B": "先天性脑底动脉瘤", "C": "休克", "D": "风湿性心脏病", "language": "zh"}
{"question": "男性，70岁。1年前因壶腹癌行Whipple手术，手术恢复好。近2个月来反复发热，伴寒战，最高体温达39.5℃，WBC 15×109/L。，血清ALT 121U/L，TBil 589μmol/L，CT示肝内多发直径1～2cm低密度灶，边缘强化明显。2．发生上述情况的原因是（　　）。", "answer": "胆肠吻合口狭窄", "meta_info": "第3篇　消化系统", "answer_idx": "A", "A": "胆肠吻合口狭窄", "B": "手术时输血感染", "C": "免疫功能低下", "D": "以上都不对", "language": "zh"}
{"question": "早产儿易发生佝偻病，主要是由于（　　）。", "answer": "体内储钙不足，生长发育快", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "肝肾功能较差", "B": "胃肠道对维生素D吸收不良", "C": "易发生胃肠道功能紊乱", "D": "体内储钙不足，生长发育快", "language": "zh"}
{"question": "新生儿败血症早期最主要的特点是（　　）。", "answer": "缺乏特异症状", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "高热", "B": "白细胞总数升高", "C": "硬肿", "D": "缺乏特异症状", "language": "zh"}
{"question": "关于脂肪动员的叙述，错误的是（　　）。", "answer": "分解肝内脂肪", "meta_info": "生物化学", "answer_idx": "C", "A": "分解脂肪组织中的脂肪", "B": "肾上腺素促进脂肪动员", "C": "分解肝内脂肪", "D": "胰岛素抑制脂肪动员", "language": "zh"}
{"question": "能改善稳定型心绞痛患者临床预后的是（　　）。", "answer": "阿司匹林", "meta_info": "第2篇　心血管系统", "answer_idx": "B", "A": "尿激酶", "B": "阿司匹林", "C": "速效救心丸", "D": "硝酸甘油", "language": "zh"}
{"question": "男性，20岁，11h前被刀刺伤来诊，血压60/50mmHg，面色苍白，呼吸困难，颈静脉怒张，呼吸音尚好，心音遥远，伤口在左锁骨中线第4肋间，最可能的诊断是（　　）。", "answer": "心包积血", "meta_info": "第二部分　模拟试题", "answer_idx": "C", "A": "肺损伤", "B": "开放气胸", "C": "心包积血", "D": "张力气胸", "language": "zh"}
{"question": "维生素D缺乏性佝偻病不正确的预防措施（　　）。", "answer": "早产儿2个月开始补充维生素D", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "适当多晒太阳", "B": "提倡母乳喂养", "C": "孕母补充维生素D及钙剂", "D": "早产儿2个月开始补充维生素D", "language": "zh"}
{"question": "心房颤动最常见于下列哪种疾病？（　　）", "answer": "风心病二尖瓣狭窄", "meta_info": "第2篇　心血管系统", "answer_idx": "A", "A": "风心病二尖瓣狭窄", "B": "高心病", "C": "甲亢性心脏病", "D": "缩窄性心包炎", "language": "zh"}
{"question": "狼疮肾炎诱导期治疗中，以下免疫抑制剂中首选的是（　　）。", "answer": "环磷酰胺", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "硫唑嘌呤", "B": "甲氨蝶呤", "C": "环磷酰胺", "D": "雷公藤", "language": "zh"}
{"question": "治疗维生素B12缺乏所致的营养性巨幼红细胞性贫血，以下不正确的是（　　）。", "answer": "必须同时加用叶酸治疗", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "肌肉震颤可用镇静剂", "B": "肌注维生素B12至血象恢复正常为止", "C": "必须同时加用叶酸治疗", "D": "严重贫血伴心功能不全者应及时输血", "language": "zh"}
{"question": "1．壳核出血30ml（　　）。", "answer": "甘露醇脱水治疗", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "抑制血小板治疗", "B": "溶栓治疗", "C": "降压治疗", "D": "甘露醇脱水治疗", "language": "zh"}
{"question": "人体在禁食12h后，于清晨清醒，静卧半小时及室温20～25℃条件下，测量到的1h产热量称（　　）。", "answer": "基础代谢率", "meta_info": "生理学", "answer_idx": "B", "A": "新陈代谢", "B": "基础代谢率", "C": "基础代谢", "D": "能量代谢", "language": "zh"}
{"question": "下列哪项是急性失血时最先出现的调节反应?（　　）", "answer": "交感神经兴奋", "meta_info": "生理学", "answer_idx": "B", "A": "血管的自身调节", "B": "交感神经兴奋", "C": "血中血管升压素增多", "D": "血中血管紧张素Ⅱ增多", "language": "zh"}
{"question": "患儿，2岁，既往确诊为先天性心脏病室间隔缺损，近1周发热、咳嗽，近3天喘，听诊双肺可闻及中小水泡音，胸骨左缘第3、4肋间闻及Ⅲ级收缩期杂音，肝肋弓下4cm。下列处置不当的是（　　）。", "answer": "以上均不是", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "应用利尿剂", "B": "吸氧", "C": "快速洋地黄化", "D": "以上均不是", "language": "zh"}
{"question": "抑制胃液分泌的重要因素为（　　）。", "answer": "脂肪", "meta_info": "生理学", "answer_idx": "B", "A": "低张溶液", "B": "脂肪", "C": "蛋白质", "D": "促胰酶素", "language": "zh"}
{"question": "1．Mφ（　　）。", "answer": "ADCC", "meta_info": "医学免疫学", "answer_idx": "D", "A": "Ab阻断、中和作用", "B": "调理作用", "C": "裂解细胞作用", "D": "ADCC", "language": "zh"}
{"question": "2．新生儿血容量大约占体重的（　　）。", "answer": "10%", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "6%～8%", "B": "8%～10%", "C": "10%", "D": "10%～12%", "language": "zh"}
{"question": "女，70岁。反复咳嗽、咳痰伴气促15年。查体：双肺呼吸音减弱。辅助检查结果中对明确诊断最有价值的是（　　）。", "answer": "肺功能示FEV1/FVC明显降低", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "肺功能示FVC明显降低", "B": "肺功能示FEV1/FVC明显降低", "C": "肺功能示DLCO下降", "D": "肺泡动脉氧分压差增大", "language": "zh"}
{"question": "男，35岁。因胃癌入院手术，输注红细胞2单位，新鲜冰冻血浆，在输血开始后4小时，患者突然气急，迅速出现呼吸困难，T 37℃，P 98次/分，R 28/分，BP 120／70mmHg。该患者出现的最可能是（　　）。", "answer": "输血相关急性肺损伤", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "循环超负荷", "B": "急性溶血反应", "C": "过敏反应", "D": "输血相关急性肺损伤", "language": "zh"}
{"question": "肿瘤细胞被细胞毒性T细胞杀伤的关键条件是（　　）。", "answer": "表达MHCⅠ类分子", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "表达黏附分子", "B": "表达MHCⅠ类分子", "C": "分泌细胞因子", "D": "表达MHCⅡ类分子", "language": "zh"}
{"question": "男，50岁。某公司总经理。在公司某次业务培训会的开幕式上致辞后出现口误，宣布“会议闭幕”。此口误背后折射出该总经理的心理活动为（　　）。", "answer": "潜意识", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "潜意识", "B": "超我", "C": "意识", "D": "本我", "language": "zh"}
{"question": "下述哪项是抗体?（　　）", "answer": "溶血素", "meta_info": "医学免疫学", "answer_idx": "A", "A": "溶血素", "B": "细菌素", "C": "植物血凝素", "D": "抗生素", "language": "zh"}
{"question": "糖尿病伴高血压患者首选的降压药是（　　）。", "answer": "血管紧张素转化酶抑制剂", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "利尿剂", "B": "钙离子拮抗剂", "C": "β受体阻滞剂", "D": "血管紧张素转化酶抑制剂", "language": "zh"}
{"question": "处理外伤性直肠损伤选择（　　）。", "answer": "乙状结肠造瘘，2～3个月后处理", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "一期修补", "B": "直肠切除后吻合", "C": "乙状结肠造瘘，2～3个月后处理", "D": "生理盐水冲洗，待其自行吻合", "language": "zh"}
{"question": "男性，49岁，刺激性咳嗽5个月，视物不清10天，胸片示左肺上叶尖端边缘直径8cm不规则块状阴影，此病变造成的颈交感神经综合征不包括（　　）。", "answer": "声音嘶哑", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "面部无汗", "B": "瞳孔缩小", "C": "声音嘶哑", "D": "上眼睑下垂", "language": "zh"}
{"question": "下列疾病所致的肺动脉高压中最主要由低氧血症所致的是（　　）。", "answer": "COPD", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "肺血栓栓塞", "B": "COPD", "C": "特发性肺动脉高压", "D": "心源性肺水肿", "language": "zh"}
{"question": "男性，50岁，因发作性胸前区疼痛1个月入院，静息心电图V4，V5，V6的ST段压低＞2mm，T波倒置，行冠脉造影检查各冠脉血管光滑，无狭窄，血流通畅，最可能的诊断是（　　）。", "answer": "X综合征", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "不稳定型心绞痛", "B": "X综合征", "C": "变异型心绞痛", "D": "心脏神经症", "language": "zh"}
{"question": "尿毒症患者高血压最主要的原因是（　　）。", "answer": "水钠潴留", "meta_info": "第4篇　泌尿系统", "answer_idx": "B", "A": "肾素增多", "B": "水钠潴留", "C": "血管加压素增多", "D": "红细胞增多", "language": "zh"}
{"question": "男性，54岁，甲亢房颤史5年，药物治疗后3年，因消瘦、便频、心前区不适再次就诊。查体：心界扩大，双胫前水肿，心率120次/分，节律极不规整。疑为甲亢性心脏病。在诊断时，下列不能进行的检查为（　　）。", "answer": "T3抑制试验", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "C", "A": "FT3、FT4、TSH", "B": "甲状腺吸碘率", "C": "T3抑制试验", "D": "TRH兴奋试验", "language": "zh"}
{"question": "人体营养必需氨基酸的来源是（　　）。", "answer": "在体内不能合成，必须从食物中获取", "meta_info": "生物化学", "answer_idx": "D", "A": "在体内可由脂肪转变生成", "B": "在体内可由糖转变生成", "C": "在体内可由其他氨基酸生成", "D": "在体内不能合成，必须从食物中获取", "language": "zh"}
{"question": "膀胱肿瘤最常见的病理类型是（　　）。", "answer": "移行细胞癌", "meta_info": "第4篇　泌尿系统", "answer_idx": "C", "A": "小细胞癌", "B": "内翻性乳头状瘤", "C": "移行细胞癌", "D": "鳞癌", "language": "zh"}
{"question": "1．较大范围的坏死，伴有腐败细菌的生长（　　）。", "answer": "坏疽", "meta_info": "病理学", "answer_idx": "D", "A": "机化", "B": "包裹", "C": "钙化", "D": "坏疽", "language": "zh"}
{"question": "上述哪项是大叶性肺炎的主要病理学特征？（　　）", "answer": "纤维素性炎", "meta_info": "病理学", "answer_idx": "A", "A": "纤维素性炎", "B": "化脓性炎", "C": "出血性炎", "D": "间质性炎", "language": "zh"}
{"question": "女，65岁。进行性吞咽困难3个月，体重下降7kg，目前能进半流食。3．进一步确诊的首选检查方式是（　　）。", "answer": "食管镜检查活检", "meta_info": "第3篇　消化系统", "answer_idx": "D", "A": "胸部CT", "B": "食管超声检查", "C": "食管拉网", "D": "食管镜检查活检", "language": "zh"}
{"question": "下述哪一项检查不是内分泌疾病的病因学检查？（　　）", "answer": "视野测定", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "B", "A": "针吸活检", "B": "视野测定", "C": "受体功能研究", "D": "激素或受体基因的分析", "language": "zh"}
{"question": "2．饮水及泳池（　　）。", "answer": "0.2～0.5ppm氯", "meta_info": "医学微生物学", "answer_idx": "D", "A": "2%来苏水", "B": "75%乙醇", "C": "2%戊二醛溶液", "D": "0.2～0.5ppm氯", "language": "zh"}
{"question": "属抑菌作用的抗结核药物是（　　）。", "answer": "乙胺丁醇（EMB）", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "异烟肼（INH）", "B": "利福平（RFP）", "C": "乙胺丁醇（EMB）", "D": "吡嗪酰胺（PZA）", "language": "zh"}
{"question": "腹部钝性损伤，腹壁未破裂却导致腹内下列某一脏器破裂时，出现腹膜炎症状最晚的是（　　）。", "answer": "结肠", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "空肠", "B": "回肠", "C": "结肠", "D": "十二指肠", "language": "zh"}
{"question": "以下不适合用输尿管镜碎石的是（　　）。", "answer": "输尿管狭窄", "meta_info": "第4篇　泌尿系统", "answer_idx": "A", "A": "输尿管狭窄", "B": "阴性结石", "C": "结石停留时间较长", "D": "肥胖患者", "language": "zh"}
{"question": "足月妊娠40周时的羊水量约为（　　）。", "answer": "800mL", "meta_info": "第5篇　女性生殖系统", "answer_idx": "C", "A": "300mL", "B": "400mL", "C": "800mL", "D": "1000mL", "language": "zh"}
{"question": "幽门梗阻患者，下列术前准备最重要的是（　　）。", "answer": "高渗盐水洗胃", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "纠正碱中毒", "B": "低渗盐水洗胃", "C": "口服抗菌药物", "D": "高渗盐水洗胃", "language": "zh"}
{"question": "初级胆汁酸在肠道细菌作用下转变为次级胆汁酸的主要反应是（　　）。", "answer": "脱羟", "meta_info": "生物化学", "answer_idx": "B", "A": "氧化", "B": "脱羟", "C": "结合", "D": "还原", "language": "zh"}
{"question": "男性，35岁。两个月前由高处跌落，发生第一腰椎压缩性骨折，双下肢不全瘫，经Ommipaque脊髓造影发现有不全梗阻，脊髓被向后突出的第一腰椎后缘骨嵴压迫。此时应采用（　　）。", "answer": "手术治疗", "meta_info": "第四部分　运动系统疾病", "answer_idx": "D", "A": "自身功能复位", "B": "双踝悬吊复位", "C": "两桌法复位", "D": "手术治疗", "language": "zh"}
{"question": "急性非ST段抬高型心肌梗死治疗时不宜采用溶栓疗法的主要原因是（　　）。", "answer": "冠脉内主要是白血栓", "meta_info": "第2篇　心血管系统", "answer_idx": "A", "A": "冠脉内主要是白血栓", "B": "冠脉阻塞不完全", "C": "冠脉痉挛是发病的主要因素", "D": "病情危急程度较轻", "language": "zh"}
{"question": "尿培养的球菌菌落计数不低于多少才有诊断意义？（　　）", "answer": "1000/ml", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "100/ml", "B": "500/ml", "C": "1000/ml", "D": "10000/ml", "language": "zh"}
{"question": "有关滴虫性阴道炎，以下哪项错误？（　　）", "answer": "滴虫为条件致病菌，可经内源性传染", "meta_info": "第5篇　女性生殖系统", "answer_idx": "D", "A": "可经性交直接传播，也可经污染的衣物等间接传播", "B": "常伴有外阴瘙痒、性交痛、尿频、尿痛及不育", "C": "阴道分泌物悬滴法显微镜下检查找到滴虫即可诊断", "D": "滴虫为条件致病菌，可经内源性传染", "language": "zh"}
{"question": "1．T淋巴细胞在免疫应答过程中可产生的细胞因子是（　　）。", "answer": "干扰素", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "免疫球蛋白", "B": "免疫球蛋白G", "C": "干扰素", "D": "补体", "language": "zh"}
{"question": "能够引起排卵后体温升高的激素是（　　）。", "answer": "孕激素", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "黄体生成素", "B": "卵泡刺激素", "C": "雌激素", "D": "孕激素", "language": "zh"}
{"question": "女性，l8岁，发热咽痛鼻出血10天，胸骨压痛明显，右下肢皮肤可触及3cm×3cm大小肿块，质硬。红细胞2 ×109/L，血红蛋白60g/L，白细胞2×109/L，血小板20×109/L。骨髓增生极度活跃，原始细胞80%，部分胞浆中可见Auer小体，POX染色弱阳性，PAS染色胞浆淡红色，醋酸萘酚酯酶染色阳性，能被NaF抑制。诊断是（　　）。", "answer": "急性单核细胞白血病", "meta_info": "第一部分　血液系统疾病", "answer_idx": "C", "A": "急性早幼粒细胞自血病", "B": "急性粒细胞白血病", "C": "急性单核细胞白血病", "D": "急性红白血病", "language": "zh"}
{"question": "关于骨关节炎，下列选项不正确的是（　　）。", "answer": "可长期使用皮质激素类药物进行关节内注射", "meta_info": "第四部分　运动系统疾病", "answer_idx": "C", "A": "主要病变是关节软骨的退行性变和继发性骨质增生", "B": "女性多于男性", "C": "可长期使用皮质激素类药物进行关节内注射", "D": "原发性骨关节炎多见于50岁以上的肥胖者", "language": "zh"}
{"question": "对于慢性粒细胞白血病急性变下述哪一项不符？（　　）", "answer": "外周血出现有核红细胞", "meta_info": "第一部分　血液系统疾病", "answer_idx": "A", "A": "外周血出现有核红细胞", "B": "外周血嗜碱粒细胞＞20%", "C": "除Ph染色体外，出现其他染色体异常", "D": "原因不明的血小板进行性减少或增高", "language": "zh"}
{"question": "患儿，男，7个月，呕吐、腹泻3天，无尿12小时，体温：37.8℃，嗜睡与烦躁交替，双眼深陷，口唇干燥，皮肤弹性差，四肢冷，见花纹，脉细弱（160次/分），心音低，呼吸深长（60次/分），腹部肠鸣音亢进。血象：血红蛋白150g/L，白细胞13.0×109/L，中性粒细胞占0.4，淋巴细胞占0.6。初步诊断为小儿腹泻伴有（　　）。", "answer": "重度脱水，代谢性酸中毒", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "重度脱水，代谢性酸中毒", "B": "中度低渗性脱水，代谢性酸中毒", "C": "重度脱水，低钾血症，代谢性酸中毒", "D": "败血症休克，低钾血症，代谢性酸中毒", "language": "zh"}
{"question": "5岁男婴，第一胎第一产，足月，出生后母乳喂养，平时体质弱，常患病，如“肺炎”“气管炎”“腹泻”等，一直未添加辅食，近2日呕吐，1或2次/日，为胃内容物。查体：精神萎靡，营养状况差，体重5kg，前囟已闭，心肺无异常，皮肤弹性差，皮下脂肪消失，四肢肌张力低下。1．该男婴的诊断是（　　）。", "answer": "营养不良Ⅲ度", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "营养不良Ⅱ度", "B": "营养不良Ⅰ度", "C": "营养不良Ⅲ度", "D": "营养不良Ⅲ度，伴重度脱水", "language": "zh"}
{"question": "男，45岁。餐后突发右上腹阵发性绞痛伴恶心2天，尿色呈浓茶样。既往有类似发作。查体：急性病容，巩膜黄染，双肺呼吸音清，未闻及干湿性啰音，右上腹深压痛，无肌紧张，最可能的诊断是（　　）。", "answer": "胆总管结石", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "急性胰腺炎", "B": "胆道蛔虫病", "C": "胆总管结石", "D": "胆总管囊肿", "language": "zh"}
{"question": "1．呼吸困难.咳粉红色泡沫样痰，双肺满布干湿啰音，双下肢无水肿，诊断宜首先考虑（　　）。", "answer": "急性左心衰竭", "meta_info": "第2篇　心血管系统", "answer_idx": "B", "A": "全心衰竭", "B": "急性左心衰竭", "C": "慢性右心衰竭", "D": "慢性左心衰竭", "language": "zh"}
{"question": "1．遗传性球形红细胞增多症溶血主要为（　　）。", "answer": "血管外溶血", "meta_info": "第一部分　血液系统疾病", "answer_idx": "B", "A": "血管内溶血", "B": "血管外溶血", "C": "原位溶血", "D": "脾功能亢进", "language": "zh"}
{"question": "下列哪项不是医师在执业活动中享有的权利？（　　）", "answer": "对病人进行无条件临床实验治疗", "meta_info": "卫生法规", "answer_idx": "B", "A": "接受继续医学教育和技能培训", "B": "对病人进行无条件临床实验治疗", "C": "在执业范围内进行疾病诊查和治疗", "D": "获得与本人执业活动相当的医疗设备基本条件", "language": "zh"}
{"question": "强迫症治疗的药物宜选用（　　）。", "answer": "氯丙咪嗪", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "氯丙嗪", "B": "脑复康", "C": "维生素B族", "D": "氯丙咪嗪", "language": "zh"}
{"question": "食管癌的典型临床症状是（　　）。", "answer": "进行性吞咽困难", "meta_info": "第3篇　消化系统", "answer_idx": "D", "A": "食管内异物感", "B": "咽部干燥感", "C": "吐血", "D": "进行性吞咽困难", "language": "zh"}
{"question": "以下关于人格测验的说法正确的是（　　）。", "answer": "MMPI主要测量被试的精神症状", "meta_info": "医学心理学", "answer_idx": "B", "A": "EPQ共有3个分量表", "B": "MMPI主要测量被试的精神症状", "C": "EPQ中的P代表神经质，N代表精神质", "D": "MMPI是根据因素分析法编制的", "language": "zh"}
{"question": "大肠癌的好发部位以下列哪项为最多？（　　）", "answer": "直肠", "meta_info": "病理学", "answer_idx": "A", "A": "直肠", "B": "乙状结肠", "C": "升结肠", "D": "横结肠", "language": "zh"}
{"question": "按照假药论处的药品是（　　）。", "answer": "被污染的药品", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "未标明有效期的药品", "B": "擅自添加矫味剂的药品", "C": "更改生产批号的药品", "D": "被污染的药品", "language": "zh"}
{"question": "痛风症是因为血中哪种物质在关节、软组织处沉积?（　　）", "answer": "尿酸", "meta_info": "生物化学", "answer_idx": "A", "A": "尿酸", "B": "次黄嘌呤", "C": "尿素", "D": "胆固醇", "language": "zh"}
{"question": "女孩，2岁，自幼牛乳喂养，未按要求添加辅食，有时腹泻，逐渐消瘦。查体：身高80cm，体重7000g，皮下脂肪减少，腹壁皮下脂肪厚度＜0.4cm，皮肤干燥、苍白，肌张力明最减低，肌肉松弛，脉搏缓慢，心音较低钝。1．此患儿目前最可能的主要诊断应是（　　）。", "answer": "营养不良", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "营养性缺铁性贫血", "B": "先天性甲状腺功能减低症", "C": "营养不良", "D": "婴幼儿腹泻", "language": "zh"}
{"question": "女，70岁。风湿性心脏瓣膜病20年，因心悸5天就诊。查体：自动体位，BP 150／70mmHg，心率119次/分，心律绝对不齐，心音强弱不等。心电图示：心房颤动。2．宜首选的抗凝治疗是（　　）。", "answer": "华法令", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "华法令", "B": "肝素", "C": "尿激酶", "D": "复方丹参片", "language": "zh"}
{"question": "女性，25岁，停经2个月，腹痛伴多量阴道流血1天。检查：宫口有组织物堵塞。子宫如2个月妊娠大小。最恰当的处理是（　　）。", "answer": "立即行清宫术", "meta_info": "第5篇　女性生殖系统", "answer_idx": "D", "A": "肌注黄体酮", "B": "查血hCG", "C": "给予输液及止血治疗", "D": "立即行清宫术", "language": "zh"}
{"question": "男婴，6个月，足月顺产，人工喂养。查体：体重5.4kg，身长66cm，前囟未闭，未出牙，皮肤干燥，腹部皮下脂肪厚度0.6cm，心肺未见异常。最可能的诊断是（　　）。", "answer": "轻度营养不良", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "重度营养不良消瘦型", "B": "轻度营养不良", "C": "重度营养不良水肿型", "D": "正常婴儿", "language": "zh"}
{"question": "从理论上来讲，下列哪种动物的血清蛋白对猴子具有较强的免疫原性（　　）。", "answer": "鱼", "meta_info": "医学免疫学", "answer_idx": "D", "A": "马", "B": "鸡", "C": "小鼠", "D": "鱼", "language": "zh"}
{"question": "某1岁患儿，男因抽搐入院。上呼吸道感染2天，昨夜发热、嗜睡。体温400℃，WBC 17×109/L，腰穿脑脊液细胞数4×109/L，中性粒细胞占0.88，诊断为细菌性脑膜炎。细菌培养时发现在预加的金葡菌菌落周围生长旺盛，出现卫星现象。革兰染色为G-杆菌。试问所感染的细菌可能是（　　）。", "answer": "流感杆菌", "meta_info": "医学微生物学", "answer_idx": "C", "A": "B群链球菌", "B": "肺炎克雷伯菌", "C": "流感杆菌", "D": "铜绿假单胞菌", "language": "zh"}
{"question": "3．小脑病变（　　）。", "answer": "醉汉步态", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "跨阈步态", "B": "醉汉步态", "C": "慌张步态", "D": "划圈样步态下述病变引起", "language": "zh"}
{"question": "某患者因与人争吵后服用敌敌畏，引起有机磷中毒，被给予大量阿托品治疗。阿托品对有机磷中毒症状无效的是（　　）。", "answer": "肌束颤动", "meta_info": "生理学", "answer_idx": "C", "A": "肠痉挛", "B": "大汗", "C": "肌束颤动", "D": "瞳孔缩小", "language": "zh"}
{"question": "关于子宫内膜癌的转移途径错误的是（　　）。", "answer": "盆、腹腔播散种植为最常见途径", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "宫底部癌灶可经骨盆漏斗韧带淋巴管网向上至腹主动脉旁淋巴结", "B": "盆、腹腔播散种植为最常见途径", "C": "血行转移较少见，晚期可至肺、肝、骨骼", "D": "下段及宫颈管癌灶可至宫旁闭孔，髂内、髂外及髂总淋巴结", "language": "zh"}
{"question": "女，21岁。早晨被发现昏睡不醒，枕头旁边有呕吐物。同寝室人有头晕、乏力、恶心症状，房间用煤炉取暖。既往体健。查体：T 35.6℃，P 100/次，R 26次/分，BP 120/75mmHg。神志不清，双侧瞳孔等圆等大，对光反射存在，心、肺检查未见异常，无颈强直，病理反射未引出。为明确诊断，最有意义的检查是（　　）。", "answer": "血碳氧血红蛋白浓度测定", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "脑脊液常规检查", "B": "头颅CT", "C": "血碳氧血红蛋白浓度测定", "D": "血及呕吐物毒物检查", "language": "zh"}
{"question": "2．男性，14岁。发热，咽痛伴齿龈出血1周来急诊。查体：浅表淋巴结肿大，肝肋下1cm，脾肋下3cm，胸骨压痛（+），血红蛋白80g/L，白细胞18.2×109/L，PLT 84×109/L，骨髓增生活跃。原始细胞占60%，糖原染色阳性，粗颗粒状。血清和尿溶菌酶低。该病例临床诊断为（　　）。", "answer": "急性淋巴细胞白血病", "meta_info": "第一部分　血液系统疾病", "answer_idx": "C", "A": "急性红白血病", "B": "急性早幼粒细胞白血病", "C": "急性淋巴细胞白血病", "D": "急性粒细胞白血病", "language": "zh"}
{"question": "男，70岁，因观看足球比赛突然晕倒而入院治疗。查体发现左侧上、下肢瘫痪，腱反射亢进，左侧眼裂以下面瘫，伸舌时舌尖偏向左侧。左半身深、浅感觉消失。双眼左侧半视野缺失，瞳孔对光反射存在。考虑病变的部位在（　　）。", "answer": "右侧内囊", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "C", "A": "左侧中央前、后回", "B": "左侧内囊", "C": "右侧内囊", "D": "右侧中央后回", "language": "zh"}
{"question": "下列属于酒精戒断综合征的是（　　）。", "answer": "震颤谵妄", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "震颤谵妄", "B": "酒精性痴呆", "C": "酒精所致幻觉症", "D": "柯萨可夫综合征", "language": "zh"}
{"question": "血浆的pH主要决定于下述哪个缓冲对（　　）。", "answer": "NaHCO3／H2CO3", "meta_info": "生理学", "answer_idx": "B", "A": "K2HPO4／KH2PO4", "B": "NaHCO3／H2CO3", "C": "Na2HPO4／NaH2PO4", "D": "蛋白质-Na／蛋白质", "language": "zh"}
{"question": "下列哪项为确诊流行性脑脊髓膜炎最可靠的根据？（　　）", "answer": "以上都不是", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "D", "A": "高热、头痛、呕吐", "B": "脑膜刺激征（+）", "C": "脑脊液符合化脓性脑膜炎改变", "D": "以上都不是", "language": "zh"}
{"question": "治疗军团菌病的首选药物是（　　）。", "answer": "红霉素", "meta_info": "药理学", "answer_idx": "B", "A": "麦迪霉素", "B": "红霉素", "C": "土霉素", "D": "四环素", "language": "zh"}
{"question": "先天性甲状腺功能减低症最常见于（　　）。", "answer": "过期产儿", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "早产儿", "B": "足月儿", "C": "过期产儿", "D": "低出生体重儿", "language": "zh"}
{"question": "男，72岁，10小时前突发昏迷。CT诊断为脑出血，2小时前胃管引流出咖啡色液体约50毫升，其上消化道出血最可能的原因是（　　）。", "answer": "应激引起急性胃黏膜病变", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "胆汁反流性胃炎", "B": "感染引起急性胃黏膜病变", "C": "药物性胃炎", "D": "应激引起急性胃黏膜病变", "language": "zh"}
{"question": "关于基因表达的叙述，错误的是（　　）。", "answer": "所有基因表达都经历转录和翻译过程", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "所有基因表达都经历转录和翻译过程", "B": "某些基因表达经历转录和翻译过程", "C": "某些基因表达产物是蛋白质分子", "D": "某些基因表达产物不是蛋白质分子", "language": "zh"}
{"question": "某儿童8岁，在智力测验中得分为100，则其智商（IQ）为（　　）。", "answer": "平常", "meta_info": "医学心理学", "answer_idx": "C", "A": "超常", "B": "优秀", "C": "平常", "D": "以上都不对", "language": "zh"}
{"question": "女，36岁。腹泻伴纳差、乏力、消瘦、发热5月余，大便为黄色糊状，3～5次/日。1．下列辅助检查最有助于明确诊断的是（　　）。", "answer": "结肠镜及活检", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "结肠镜及活检", "B": "消化道造影", "C": "红细胞沉降率", "D": "粪便检查", "language": "zh"}
{"question": "男性，30岁，右髋部疼痛1年，伴低热、盗汗、纳差及体重减轻。查体：右髋关节呈屈曲畸形，活动受限，Thomas征（+），ESR 30mm/h。X线片示右髋关节间隙变窄，关节面有骨质破坏，右髋臼有2cm大小空洞，内有坏死骨片。2．最佳治疗方案是（　　）。", "answer": "抗结核治疗2～4周后行病灶清除术", "meta_info": "第四部分　运动系统疾病", "answer_idx": "C", "A": "立即进行病灶清除", "B": "患肢持续皮肤牵引", "C": "抗结核治疗2～4周后行病灶清除术", "D": "关节穿刺抽脓，注入抗结核药物", "language": "zh"}
{"question": "1．一类能促进基因转录活性的顺式作用元件是（　　）。", "answer": "增强子", "meta_info": "生物化学", "answer_idx": "A", "A": "增强子", "B": "启动子", "C": "操纵子", "D": "转座子", "language": "zh"}
{"question": "男，56岁。反复上腹痛10年余，加重3个月，伴乏力。查体：结膜苍白，上腹部轻压痛。下列检查中，对明确诊断及指导治疗最有价值的是（　　）。", "answer": "胃镜及活检", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "X线上消化道造影", "B": "胃镜及活检", "C": "腹部CT", "D": "血清肿瘤标志物", "language": "zh"}
{"question": "最易合并脓胸的肺炎是（　　）。", "answer": "金葡菌肺炎", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "合胞病毒肺炎", "B": "金葡菌肺炎", "C": "支原体肺炎", "D": "腺病毒肺炎", "language": "zh"}
{"question": "3．起病急骤，以片断妄想、幻觉或多种妄想、幻觉或言语、行为紊乱的精神病性症状为主，病程至少数小时至1个月的是（　　）。", "answer": "急性短暂性精神障碍", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "D", "A": "偏执型分裂症", "B": "单纯型分裂症", "C": "紧张型分裂症", "D": "急性短暂性精神障碍", "language": "zh"}
{"question": "婴儿肠套叠的三大典型临床表现是（　　）。", "answer": "腹痛、血便、腹部肿块", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "腹痛、血便、腹部肿块", "B": "腹痛、哭闹、腹部肿块", "C": "腹痛、呕吐、腹部肿块", "D": "腹痛、腹胀、呕吐", "language": "zh"}
{"question": "关于正常人胰液的叙述，错误的是（　　）。", "answer": "胰泌素可使胰液中酶含量大增", "meta_info": "生理学", "answer_idx": "D", "A": "胰液的HCO3-浓度高", "B": "每天分泌量超过1000ml", "C": "胰液中含有消化酶种类最多", "D": "胰泌素可使胰液中酶含量大增", "language": "zh"}
{"question": "肿瘤转移的确切依据是（　　）。", "answer": "在远隔器官形成与原发瘤同一组织学类型的肿瘤", "meta_info": "病理学", "answer_idx": "D", "A": "肿瘤细胞侵入静脉", "B": "肿瘤细胞侵入动脉", "C": "肿瘤细胞出现在血液中", "D": "在远隔器官形成与原发瘤同一组织学类型的肿瘤", "language": "zh"}
{"question": "急性肾炎与急进性肾炎临床表现相似之处是（　　）。", "answer": "浮肿、少尿、高血压", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "浮肿、少尿、高血压", "B": "中度贫血", "C": "肾功能迅速恶化", "D": "持续无尿", "language": "zh"}
{"question": "2．溃疡性结肠炎的好发部位是（　　）。", "answer": "直肠和乙状结肠", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "结肠脾曲", "B": "结肠肝曲", "C": "直肠和乙状结肠", "D": "回盲部", "language": "zh"}
{"question": "判断组织兴奋性高低常用的简便指标是（　　）。", "answer": "阈强度", "meta_info": "生理学", "answer_idx": "B", "A": "时值", "B": "阈强度", "C": "刺激强度对时间的变化率", "D": "刺激的频率", "language": "zh"}
{"question": "血清酶检测对病毒性肝炎的诊断哪一项最为敏感和有意义（　　）。", "answer": "ALT", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "B", "A": "AKP", "B": "ALT", "C": "AST", "D": "乳酸脱氢酶", "language": "zh"}
{"question": "关于用作基因载体的质粒的叙述，不正确是（　　）。", "answer": "是双链线性分子", "meta_info": "生物化学", "answer_idx": "B", "A": "能在宿主细胞独立自主地进行复制", "B": "是双链线性分子", "C": "易从一个细菌转移入另一个细菌", "D": "常带抗药基因", "language": "zh"}
{"question": "化脓性脑膜炎与结核性脑膜炎在脑脊液检查中根本区别是（　　）。", "answer": "脑脊液检菌", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "脑脊液细胞数及分类", "B": "糖及氯化物定量", "C": "脑脊液检菌", "D": "脑脊液外观", "language": "zh"}
{"question": "下述哪项是cAMP对转录起始的调控?（　　）", "answer": "以cAMP-CAP复合物与操纵基因结合，使该基因开放", "meta_info": "生物化学", "answer_idx": "B", "A": "与RNApolⅡ结合，促进酶的活性", "B": "以cAMP-CAP复合物与操纵基因结合，使该基因开放", "C": "单独与操纵基因结合，封闭其基因表达", "D": "与阻遏蛋白结合，去阻遏作用", "language": "zh"}
{"question": "男，50岁，右髋部疼痛3年，加重2个月，伴跛行，酗酒史10年。查体：直腿抬高试验阳性，有“4”字征阳性。2．初步诊断（　　）。", "answer": "右股骨头缺血性坏死", "meta_info": "第四部分　运动系统疾病", "answer_idx": "C", "A": "强直性脊柱炎", "B": "髋关节化脓性关节炎", "C": "右股骨头缺血性坏死", "D": "右髋关节创伤性滑膜炎", "language": "zh"}
{"question": "哪种抗结核药可续用于肺结核复治？（　　）", "answer": "异烟肼", "meta_info": "第1篇　呼吸系统", "answer_idx": "C", "A": "对氨基水杨酸钠", "B": "链霉素", "C": "异烟肼", "D": "乙胺丁醇", "language": "zh"}
{"question": "影响能量代谢最为显著的因素是（　　）。", "answer": "肌肉活动", "meta_info": "生理学", "answer_idx": "B", "A": "进食", "B": "肌肉活动", "C": "环境温度", "D": "性别与年龄", "language": "zh"}
{"question": "促使缩胆囊素释放作用最强的物质是（　　）。", "answer": "蛋白分解产物", "meta_info": "第二部分　模拟试题", "answer_idx": "A", "A": "蛋白分解产物", "B": "脂酸钠", "C": "糖类", "D": "HCl", "language": "zh"}
{"question": "体内大多数由内分泌腺释放的激素转送到靶组织的方式为（　　）。", "answer": "远距分泌", "meta_info": "生理学", "answer_idx": "A", "A": "远距分泌", "B": "自分泌", "C": "旁分泌", "D": "腔分泌", "language": "zh"}
{"question": "男，55岁。因持续胸痛10小时收入院。查体：BP 120/80mmHg，高枕卧位，双肺可闻及较多细湿啰音，啰音范围大于1/2肺野。心电图示：V1～V4导联ST段抬高0.2～0.4mV。该患者的心功能分级是（　　）。", "answer": "Killip Ⅲ级", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "Killip Ⅱ级", "B": "NYHA Ⅲ级", "C": "NYHA Ⅳ级", "D": "Killip Ⅲ级", "language": "zh"}
{"question": "男，5岁。畏寒、高热1周余。查体：T 39.5℃，P 132次/分，R 28次/分，BP 85/50mmHg，左臂皮肤可见瘀斑，胸骨无压痛，双肺呼吸音粗，右肺可闻及湿性啰音，肝脾肋下未触及。实验室检查：Hb 102g/L，WBC 16.8×109/L，PLT 45×109/L，PT 18秒（对照12秒），纤维蛋白原1.19g/L。该患者最可能的诊断是（　　）。", "answer": "肺部感染合并DIC", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "肺结核", "B": "肺部感染合并DIC", "C": "急性白血病", "D": "肺血栓栓塞症", "language": "zh"}
{"question": "4．慢性瓣膜病（　　）。", "answer": "瓣膜增厚、粘连、卷曲", "meta_info": "病理学", "answer_idx": "B", "A": "瓣膜穿孔", "B": "瓣膜增厚、粘连、卷曲", "C": "室问隔缺损", "D": "在已有病变的心瓣膜上形成菜花状、易脱落的赘生物", "language": "zh"}
{"question": "男，5岁，患结核性脑膜炎，控制炎症首选的治疗是（　　）。", "answer": "链霉素+异烟肼+利福平+吡嗪酰胺", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "链霉素+异烟肼+利福平+吡嗪酰胺", "B": "链霉素+异烟肼", "C": "链霉素+对氨水杨酸钠", "D": "链霉素+异烟肼+对氨水杨酸钠", "language": "zh"}
{"question": "Dane颗粒是指（　　）。", "answer": "乙型肝炎病毒", "meta_info": "医学微生物学", "answer_idx": "B", "A": "丁型肝炎病毒", "B": "乙型肝炎病毒", "C": "戊型肝炎病毒", "D": "丙型肝炎病毒", "language": "zh"}
{"question": "女，40岁。低热伴腹痛、腹胀1个月。查体：体形消瘦，腹部略膨隆，触诊呈揉面感，移动性浊音阳性，双下肢无水肿。1．最有可能的诊断是（　　）。", "answer": "结核性腹膜炎", "meta_info": "第3篇　消化系统", "answer_idx": "A", "A": "结核性腹膜炎", "B": "原发性腹膜炎", "C": "慢性胆囊炎", "D": "慢性肠梗阻", "language": "zh"}
{"question": "1．苯丙酮尿症（　　）。", "answer": "智力低下，表情呆滞，反复抽搐，尿发霉臭味", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "智力低下，特殊外貌，关节过伸，通贯手", "B": "智力低下，特殊外貌，四肢粗短，躯干较长", "C": "智力低下，表情呆滞，反复抽搐，尿发霉臭味", "D": "智力低下，表情呆滞，面色蜡黄，舌头震颤", "language": "zh"}
{"question": "被甲类传染病病原体污染的污水、污物、粪便，有关单位必须按照下列规定进行处理（　　）。", "answer": "在卫生防疫机构的指导监督下进行严密消毒后处理", "meta_info": "卫生法规", "answer_idx": "A", "A": "在卫生防疫机构的指导监督下进行严密消毒后处理", "B": "在卫生防疫机构的指导下进行消毒后处理", "C": "在卫生防疫机构的指导监督下进行消毒后处理", "D": "由卫生防疫机构进行严密消毒后处理", "language": "zh"}
{"question": "患儿，2岁，百日咳后持续发热半月余，体温在380℃左右，易倦、纳差、消瘦。近1周头痛，烦躁，时有呕吐。查体：心肺听诊无异常，肝肋下1.0cm，颈强（±）。脑脊液：外观清，蛋白（+），细胞数80×106/L，糖2.5mmol/L，氯化物115mmol/L。诊断为（　　）。", "answer": "结核性脑膜炎", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "百日咳合并脑炎", "B": "结核性脑膜炎", "C": "病毒性脑膜炎", "D": "化脓性脑膜炎", "language": "zh"}
{"question": "非选择性的钙拮抗剂是（　　）。", "answer": "氟桂利嗪", "meta_info": "药理学", "answer_idx": "A", "A": "氟桂利嗪", "B": "维拉帕米", "C": "硝苯地平", "D": "地尔硫卓", "language": "zh"}
{"question": "阿米巴痢疾的发病是由于经口感染（　　）。", "answer": "溶组织阿米巴包囊", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "D", "A": "结肠阿米巴滋养体", "B": "微小阿米巴滋养体", "C": "溶组织阿米巴滋养体", "D": "溶组织阿米巴包囊", "language": "zh"}
{"question": "1岁小儿，5天频咳、喘憋、持续高热。体检：T39.5℃，嗜睡与烦躁交替，口周发青，两肺呼吸音粗，闻少量干啰音，X线可见左下大片状阴影。最可能的诊断为（　　）。", "answer": "腺病毒肺炎", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "腺病毒肺炎", "B": "呼吸道合胞病毒肺炎", "C": "金黄色葡萄球菌肺炎", "D": "急性支气管炎", "language": "zh"}
{"question": "引起生物地球化学疾病的原因是（　　）。", "answer": "土壤或水中某些元素过高或过低", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "某些生物病原体的污染", "B": "工业企业排放物的污染", "C": "某些病原体与化学污染物的", "D": "土壤或水中某些元素过高或过低", "language": "zh"}
{"question": "1．急性血源性骨髓炎早期的病理特点是（　　）。", "answer": "骨质破坏、坏死", "meta_info": "第四部分　运动系统疾病", "answer_idx": "A", "A": "骨质破坏、坏死", "B": "骨髓内脓疡", "C": "反应性新骨形成", "D": "软组织蜂窝织炎", "language": "zh"}
{"question": "关于心动周期的叙述，哪项不正确？（　　）", "answer": "心动周期缩短时，收缩期与舒张期均等缩短", "meta_info": "生理学", "answer_idx": "D", "A": "是指心脏机械活动周期", "B": "房缩期为0.1s，室缩期为0.3s，全心舒张期为0.4s", "C": "心率增快，心动周期缩短", "D": "心动周期缩短时，收缩期与舒张期均等缩短", "language": "zh"}
{"question": "骨肉瘤的主要诊断依据是（　　）。", "answer": "出现肿瘤性骨组织", "meta_info": "病理学", "answer_idx": "C", "A": "好发于青少年", "B": "血道转移", "C": "出现肿瘤性骨组织", "D": "可发生病理性骨折", "language": "zh"}
{"question": "广谱抗心律失常药是（　　）。", "answer": "胺碘酮", "meta_info": "药理学", "answer_idx": "C", "A": "利多卡因", "B": "普萘洛尔", "C": "胺碘酮", "D": "普鲁帕酮", "language": "zh"}
{"question": "无偿献血的血液用途，必须符合下列规定（　　）。", "answer": "必须用于临床", "meta_info": "卫生法规", "answer_idx": "C", "A": "在保证临床用血的前提下，可以出售给血液制品生产单位", "B": "在保证临床用血的前提下，可以出售给单采血浆站", "C": "必须用于临床", "D": "由卫生行政部门根据情况确定", "language": "zh"}
{"question": "槟榔肝的典型病变是（　　）。", "answer": "肝血窦扩张淤血，肝细胞脂肪变性", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "肝小叶结构破坏", "B": "肝细胞坏死", "C": "门静脉分支扩张淤血", "D": "肝血窦扩张淤血，肝细胞脂肪变性", "language": "zh"}
{"question": "SLE病人最典型的面部表现是（　　）。", "answer": "蝶形红斑", "meta_info": "第五部分　风湿免疫性疾病", "answer_idx": "C", "A": "湿疹", "B": "痤疮", "C": "蝶形红斑", "D": "紫癜", "language": "zh"}
{"question": "葡萄胎刮宫5个月，妊娠试验又呈（＋），肺部已出现转移灶。最大的可能为（　　）。", "answer": "绒癌", "meta_info": "第5篇　女性生殖系统", "answer_idx": "B", "A": "再次葡萄胎", "B": "绒癌", "C": "宫外孕", "D": "宫内妊娠", "language": "zh"}
{"question": "男，40岁。饮酒后突发腹痛24小时，腹痛剧烈，呈持续性，腹痛从上腹部很快波及全腹，伴恶心、呕吐。查体：腹部膨隆，全腹肌紧张，有压痛、反跳痛，脐周Cullen征（＋），血清淀粉酶8500U/L。决定手术治疗，术中常规处理措施中最重要的是（　　）。", "answer": "坏死组织清除加引流", "meta_info": "第3篇　消化系统", "answer_idx": "C", "A": "坏死组织切除", "B": "探查并解除胆道梗阻", "C": "坏死组织清除加引流", "D": "胰腺部分切除", "language": "zh"}
{"question": "2．慢性粒细胞性白血病（　　）。", "answer": "Ph染色体阳性", "meta_info": "第一部分　血液系统疾病", "answer_idx": "A", "A": "Ph染色体阳性", "B": "中性粒细胞碱性磷酸酶积分增高", "C": "骨髓细胞内可见Auer小体", "D": "糖原染色阳性", "language": "zh"}
{"question": "牙17颗，会用勺子吃饭，会说2～3个字构成的句子，最可能的年龄是（　　）。", "answer": "5岁", "meta_info": "第六部分　儿科疾病", "answer_idx": "D", "A": "1岁", "B": "2岁", "C": "3岁", "D": "5岁", "language": "zh"}
{"question": "女性，25岁，左膝外上方逐渐隆起包块伴酸痛半年，X线平片提示左股骨下端外侧有一病灶，边缘膨胀，中央有肥皂泡样改变，无明显的骨膜反应。1．其诊断考虑为（　　）。", "answer": "骨巨细胞瘤", "meta_info": "第四部分　运动系统疾病", "answer_idx": "C", "A": "骨髓瘤", "B": "骨肉瘤", "C": "骨巨细胞瘤", "D": "骨囊肿", "language": "zh"}
{"question": "脂肪栓塞病人死亡原因常见于下述哪种情况？（　　）", "answer": "急性右心衰竭", "meta_info": "病理学", "answer_idx": "A", "A": "急性右心衰竭", "B": "脑出血", "C": "肾功能衰竭", "D": "急性左心衰竭", "language": "zh"}
{"question": "青年男性，2天来胸背部疼痛，今晨出现双下肢无力，伴二便障碍，脐以下各种感觉障碍，双下肢肌力0级，无病理反射。1．最可能的诊断是（　　）。", "answer": "急性脊髓炎", "meta_info": "第三部分　精神神经系统疾病", "answer_idx": "B", "A": "脊髓出血", "B": "急性脊髓炎", "C": "格林一巴利综合征", "D": "大脑旁脑膜瘤", "language": "zh"}
{"question": "下列哪项消化性溃疡最易发生出血？（　　）", "answer": "十二指肠球后部溃疡", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "十二指肠球后部溃疡", "B": "胃小弯溃疡", "C": "幽门管溃疡", "D": "复合型溃疡", "language": "zh"}
{"question": "对流动人口中的传染性非典型肺炎病人、疑似病人处理的原则是（　　）。", "answer": "就地隔离、就地观察、就地治疗", "meta_info": "卫生法规", "answer_idx": "C", "A": "就地控制、就地治疗、就地康复", "B": "就地隔离、就地治疗、就地康复", "C": "就地隔离、就地观察、就地治疗", "D": "就地观察、就地治疗、就地康复", "language": "zh"}
{"question": "男性，34岁。2个月来无痛性颈淋巴结肿大，间断发热3个月，查体：脾肋下4cm。4．此患者首选的治疗为（　　）。", "answer": "化疗", "meta_info": "第一部分　血液系统疾病", "answer_idx": "B", "A": "放射治疗", "B": "化疗", "C": "颈部淋巴结切除", "D": "免疫抑制剂治疗", "language": "zh"}
{"question": "男，38岁。因车祸致骨盆、股骨骨折急诊手术。术后1天逐渐出现憋气，烦躁不安，经皮血氧饱和度（SpO2）监测示：由98％逐渐下降至87％，经面罩给氧（5L/min）后SpO2增加至89％，但症状缓解不明显。查体：T 37.2℃，P 103次/分，R 32次/分，BP 90／60mmHg，意识清楚，口唇发绀，双肺呼吸音对称，双肺闻及少许湿啰音。该患者最可能的诊断是（　　）。", "answer": "肺血栓栓塞", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "肺血栓栓塞", "B": "腹腔内出血", "C": "急性左心衰竭", "D": "急性呼吸窘迫综合征", "language": "zh"}
{"question": "发生急性炎症的组织内浸润细胞主要为（　　）。", "answer": "中性粒细胞", "meta_info": "病理学", "answer_idx": "D", "A": "浆细胞", "B": "淋巴细胞", "C": "巨噬细胞", "D": "中性粒细胞", "language": "zh"}
{"question": "情绪的组成部分有（　　）。", "answer": "以上都是", "meta_info": "医学心理学", "answer_idx": "D", "A": "主观体验", "B": "生理唤醒", "C": "行为表现", "D": "以上都是", "language": "zh"}
{"question": "HIV的易感者不包括（　　）。", "answer": "吸食大麻者", "meta_info": "医学微生物学", "answer_idx": "D", "A": "血友病患者", "B": "男性同性恋者", "C": "卖淫嫖娼者", "D": "吸食大麻者", "language": "zh"}
{"question": "4．病原体寄生于机体某些部位，但不排出体外，待机体免疫功能下降时，可引起显性感染的是（　　）。", "answer": "潜伏性感染", "meta_info": "第七部分　传染病、性传播疾病", "answer_idx": "D", "A": "病原体被消灭或排出体外", "B": "隐性感染", "C": "病原携带状态", "D": "潜伏性感染", "language": "zh"}
{"question": "2．感染性结石的性质是（　　）。", "answer": "磷酸盐结石", "meta_info": "第一部分　历年真题", "answer_idx": "D", "A": "尿酸结石", "B": "混合型结石", "C": "碳酸盐结石", "D": "磷酸盐结石", "language": "zh"}
{"question": "女，56岁。近3个月来常感头晕目眩，记忆力明显减退，情绪低落，对事情不感兴趣。最需要进行检查（　　）。", "answer": "抑郁自评量表", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "头颅MRI", "B": "抑郁自评量表", "C": "焦虑自评量表", "D": "CT检查", "language": "zh"}
{"question": "男，28岁。呕吐，腹胀3天，胡言乱话1天。查体：巩膜明显黄染，肝浊音界缩小。血ALT 520U/L，TBil 215μmol/L，DBil 138μmol/L。其典型的病理改变主要是（　　）。", "answer": "多个小叶或大块肝细胞坏死", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "汇管区纤维化", "B": "多个小叶或大块肝细胞坏死", "C": "淤血性改变", "D": "汇管区中性粒细胞变性", "language": "zh"}
{"question": "男，65岁。发热，咳嗽4天，查体：T 39℃，口唇发绀，双下肺可闻及湿啰音，既往体健，否认肺部疾病病史，SpO2 85%，肺部X线片示双下肺感染，可作为经验性抗感染治疗首选的药物是（　　）。", "answer": "β-内酰胺类/β-内酰胺酶制剂＋喹诺酮类", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "碳青霉类", "B": "大环内酯类", "C": "β-内酰胺类/β-内酰胺酶制剂＋喹诺酮类", "D": "氯喹诺酮类＋氨基糖苷类", "language": "zh"}
{"question": "治疗流脑首选磺胺嘧啶（SD）是因为（　　）。", "answer": "血浆蛋白结合率低", "meta_info": "药理学", "answer_idx": "D", "A": "对脑膜炎双球菌敏感", "B": "血浆蛋白结合率高", "C": "细菌产生抗药性较慢", "D": "血浆蛋白结合率低", "language": "zh"}
{"question": "患者，男，35岁。3天前遇雨淋透衣衫。昨起畏寒高热，咳嗽，以干咳为主，偶见带铁锈色黄痰，伴右侧胸痛就诊。体检：急性病容，体温38.9℃。右上肺叩实，闻及支气管呼吸音。心率102次/min，律齐，心音强。1．该病例最可能的诊断是（　　）。", "answer": "肺炎链球菌肺炎", "meta_info": "第1篇　呼吸系统", "answer_idx": "B", "A": "肺炎支原体肺炎", "B": "肺炎链球菌肺炎", "C": "流感嗜血杆菌肺炎", "D": "肺炎克雷伯杆菌肺炎", "language": "zh"}
{"question": "1．对急性肾盂肾炎诊断有意义的尿常规检查是（　　）。", "answer": "白细胞管型", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "上皮细胞管型", "B": "白细胞管型", "C": "颗粒管型", "D": "红细胞管型", "language": "zh"}
{"question": "急性肺水肿最特异的临床表现为（　　）。", "answer": "咳大量粉红色泡沫痰", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "肺动脉瓣区第二心音亢进", "B": "咳大量粉红色泡沫痰", "C": "左肺底湿啰音", "D": "气促、发绀", "language": "zh"}
{"question": "女性，48岁。发作性剑突下及右上腹绞痛3天，伴有寒战，半年前有过类似发作史。查体：体温39℃，脉搏110次/分，血压140／85mmHg，血常规检查：WBC 12×109/L，N 80％，神志清楚，皮肤、巩膜轻度黄染，右肋缘下扪及肿大的胆囊、触痛。2．首选的检查方法是（　　）。", "answer": "腹部B超", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "腹部B超", "B": "MRCP", "C": "ERCP", "D": "PTC", "language": "zh"}
{"question": "1．患者女性，6岁，烧伤50%，Ⅲ度20%，体温37℃，心率136次/分，呼吸36次/分，创面可见坏死斑，血培养为阴沟杆菌，考虑为（　　）。", "answer": "败血症", "meta_info": "第八部分　其他疾病", "answer_idx": "A", "A": "败血症", "B": "菌血症", "C": "创面脓毒症", "D": "真菌败血症", "language": "zh"}
{"question": "镇痛、解热、抗炎药的作用机制是（　　）。", "answer": "抑制PG的生物合成", "meta_info": "药理学", "answer_idx": "C", "A": "直接抑制PG的生物效应", "B": "直接抑制中枢神经系统", "C": "抑制PG的生物合成", "D": "减少PG的分解代谢", "language": "zh"}
{"question": "1．有扑翼样震颤而脑电图多正常的肝性脑病属于（　　）。", "answer": "肝性脑病前驱期", "meta_info": "第3篇　消化系统", "answer_idx": "A", "A": "肝性脑病前驱期", "B": "肝性脑病昏迷前期", "C": "肝性脑病昏睡期", "D": "隐性肝性脑病", "language": "zh"}
{"question": "男性，65岁。下楼时不慎摔伤右髋部，查体右下肢短缩，外旋50°畸形，右髋肿胀不明显，但有叩痛。1．该患者最可能的诊断是（　　）。", "answer": "右股骨颈骨折", "meta_info": "第四部分　运动系统疾病", "answer_idx": "C", "A": "右髋关节后脱位", "B": "右髋关节前脱位", "C": "右股骨颈骨折", "D": "右股骨转子间骨折", "language": "zh"}
{"question": "男，42岁。进油腻饮食后腹胀、腹痛4小时。持续性上腹痛，伴有恶心、呕吐、发热、腰背部不适。查体：T 38.4℃，P 124次/min，BP 90/60mmHg，急性痛苦貌，巩膜无黄染，腹饱满，腹肌紧张，有压痛和反跳痛，上腹为主，肠鸣音消失。右下腹穿刺抽出淡红色血性液体。血WBC 16.2×109/L，N 0.9。血清淀粉酶6000U/L（Somogyi法）。1．引起这种疾病常见因素不包括（　　）。", "answer": "胃食管反流", "meta_info": "第3篇　消化系统", "answer_idx": "D", "A": "腹部外伤", "B": "暴饮暴食", "C": "酗酒", "D": "胃食管反流", "language": "zh"}
{"question": "2．一氧化碳中毒的机制是（　　）。", "answer": "影响血液中氧的释放和传递，导致低氧血症和组织缺氧", "meta_info": "第二部分　模拟试题", "answer_idx": "D", "A": "该气体与细胞色素氧化酶中三价铁和谷胱苷肽结合，抑制细胞呼吸酶", "B": "该气体与氧化型细胞色素氧化酶中的二价铁结合，引起细胞内窒息", "C": "引起氧分压增加，导致组织供氧不足，引起缺氧", "D": "影响血液中氧的释放和传递，导致低氧血症和组织缺氧", "language": "zh"}
{"question": "“献血大王”刘某，在过去的7年间，献血总量已达到5600ml。快满50周岁的刘某告诉记者，如果身体一直保持健康状态，他满55周岁以前，还可争取无偿献血（　　）。", "answer": "10次", "meta_info": "第一部分　历年真题", "answer_idx": "C", "A": "7次", "B": "9次", "C": "10次", "D": "11次", "language": "zh"}
{"question": "女性，18岁，1型糖尿病病史3年，因“肺部感染”诱发糖尿病酮症酸中毒。1．以下对诊断有特殊意义的临床表现是（　　）。", "answer": "呼气有烂苹果味", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "D", "A": "明显的口渴多饮多尿", "B": "低血压", "C": "昏迷", "D": "呼气有烂苹果味", "language": "zh"}
{"question": "4．纤维组织内颗粒状、团块状、强嗜酸红染的无结构物质，状似纤维素（　　）。", "answer": "纤维素样变性", "meta_info": "病理学", "answer_idx": "C", "A": "水变性", "B": "脂肪变性", "C": "纤维素样变性", "D": "钙化", "language": "zh"}
{"question": "男，45岁。脾切除、小肠切除吻合术后第4天，已排气，头痛、恶心、腹胀，随后出现寒战、四肢发绀。体温39.6℃，脉搏108次/分，血压135/85mmHg，近24小时尿量650mL。轻度腹胀，腹软，全腹轻压痛，无反跳痛、肌紧张。肠鸣音3次/分。1．最可能的原因为（　　）。", "answer": "革兰阴性杆菌感染", "meta_info": "第3篇　消化系统", "answer_idx": "D", "A": "小肠吻合口瘘", "B": "手术后创面出血", "C": "急性肾衰竭", "D": "革兰阴性杆菌感染", "language": "zh"}
{"question": "女，18岁。下腹疼痛2个月，盆腔B超检查子宫大小正常，左侧宫旁探及6cm×5cm×3cm大小肿物，边界清，血清AFP 900μg/L。最可能的诊断是（　　）。", "answer": "卵巢内胚窦瘤", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "卵巢畸胎瘤", "B": "卵巢内胚窦瘤", "C": "卵巢卵泡膜细胞瘤", "D": "卵巢无性细胞瘤", "language": "zh"}
{"question": "女，45岁。2周前上腹部被自行车把撞伤。近6天来上腹持续性胀痛，餐后加重，伴恶心、呕吐。查体：体温38.5℃，上腹偏左明显膨隆，可扪及边界不清的痛性肿块，不活动。首选的检查应当是（　　）。", "answer": "腹部B超检查", "meta_info": "第3篇　消化系统", "answer_idx": "C", "A": "X线胸腹部透视", "B": "纤维十二指肠镜检查", "C": "腹部B超检查", "D": "CT", "language": "zh"}
{"question": "女，55岁。上腹胀痛8个月，突发剧痛2小时。查体：T 36.5℃，P 80次/分，R 18次/分，BP 120/80mmHg，消瘦、贫血貌，左锁骨上淋巴结肿大1.8cm×1.5cm，质硬，无压痛。双肺呼吸音清，未闻及干湿性啰音，心律齐，全腹肌紧张，上腹明显压痛、反跳痛。立位腹部X线平片可见膈下游离气体。下一步治疗最合理的术式为（　　）。", "answer": "姑息性胃大部切除术", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "姑息性胃大部切除术", "B": "胃造瘘术", "C": "胃癌根治术", "D": "胃空肠吻合术", "language": "zh"}
{"question": "有关原癌基因，下列描述中哪一项是错误的？（　　）", "answer": "其编码产物对细胞的生长起抑制作用", "meta_info": "病理学", "answer_idx": "B", "A": "是正常细胞的固有基因", "B": "其编码产物对细胞的生长起抑制作用", "C": "结构发生改变后可转化为癌基因", "D": "以上都不是", "language": "zh"}
{"question": "高渗性缺水的早期主要症状是（　　）。", "answer": "口渴", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "D", "A": "谵妄", "B": "幻觉", "C": "恶心", "D": "口渴", "language": "zh"}
{"question": "对于心身关系，哪项是最正确的?（　　）", "answer": "心身统一论", "meta_info": "医学心理学", "answer_idx": "A", "A": "心身统一论", "B": "心身二元论", "C": "心身还原论", "D": "心身平行论", "language": "zh"}
{"question": "下列情况中，除哪项外均可见于动脉导管未闭？（　　）", "answer": "X线检查肺野清晰", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "心尖部短促的舒张期杂音", "B": "X线检查肺野清晰", "C": "股动脉枪击音", "D": "心电图正常或左心室肥厚", "language": "zh"}
{"question": "下述关节脱位的特有体征，正确的是（　　）。", "answer": "畸形，弹性固定，关节空虚", "meta_info": "第四部分　运动系统疾病", "answer_idx": "C", "A": "压痛，肿胀，淤斑", "B": "畸形，反常活动，关节空虚", "C": "畸形，弹性固定，关节空虚", "D": "畸形，反常活动，弹性固定", "language": "zh"}
{"question": "吸入性肺脓肿多发生于右肺最主要的原因是（　　）。", "answer": "右主支气管陡直，较粗大", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "右主支气管较短", "B": "右主支气管陡直，较粗大", "C": "右主支气管周围淋巴结多", "D": "右主支气管较长", "language": "zh"}
{"question": "人体的营养非必需氨基酸是（　　）。", "answer": "酪氨酸", "meta_info": "生物化学", "answer_idx": "B", "A": "赖氨酸", "B": "酪氨酸", "C": "亮氨酸", "D": "蛋(甲硫)氨酸", "language": "zh"}
{"question": "患儿，6个月，咳喘3天入院，下午突然喘憋加重，口唇发绀，鼻翼扇动。查体：呼吸80次/分，三凹征阳性，两肺闻及广泛哮鸣音，右肺底闻及少许小水泡音。血白细胞4.0×109/L，淋巴细胞占0.6。胸部正位片，见少量点片状影及肺气肿。1．最可能的诊断是（　　）。", "answer": "合胞病毒肺炎", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "肺炎链球菌肺炎", "B": "腺病毒肺炎", "C": "合胞病毒肺炎", "D": "哮喘性支气管炎", "language": "zh"}
{"question": "男，50岁。晨起刷牙时左口角流水，伴左耳后痛。查体：左额纹消失，左眼闭合无力，左鼻唇沟浅，口角右歪。最可能的诊断是（　　）。", "answer": "左面神经炎", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "左面神经炎", "B": "左三叉神经第1支受损", "C": "中枢性面瘫", "D": "左三叉神经第3支受损", "language": "zh"}
{"question": "1．假膜性炎（　　）。", "answer": "黏膜表面有坏死组织、纤维素、炎细胞为主的炎症", "meta_info": "病理学", "answer_idx": "D", "A": "黏膜的浆液渗出性炎", "B": "皮肤烫伤的水疱", "C": "伤口表面的脓苔", "D": "黏膜表面有坏死组织、纤维素、炎细胞为主的炎症", "language": "zh"}
{"question": "10个月男婴，血象：白细胞10×109/L中性粒细胞占0.6，淋巴细胞占0.35，单核细胞占0.02。下列哪一个结论是恰当的（　　）。", "answer": "总数正常，分类不正常", "meta_info": "第六部分　儿科疾病", "answer_idx": "B", "A": "总数分类均正常", "B": "总数正常，分类不正常", "C": "总数不正常，分类正常", "D": "总数偏高，淋巴细胞偏低", "language": "zh"}
{"question": "激素的第二信使不包括（　　）。", "answer": "PIP2", "meta_info": "生物化学", "answer_idx": "A", "A": "PIP2", "B": "Ca2+", "C": "DG", "D": "IP3", "language": "zh"}
{"question": "8岁患儿，水肿、少尿4d，近1d来诉头痛、头昏、呕吐并抽搐1次，查体：体温37.3℃，血压22.7/16.0kPa（170/120mmHg），血BUN7.8mmol/L，尿常规示：蛋白++，红细胞＞100个/HP，白细胞30个/HP，该惠儿准确的诊断为（　　）。", "answer": "肾炎性肾病，高血压脑病", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "急进性肾炎", "B": "慢性肾炎急性发作", "C": "肾炎性肾病，高血压脑病", "D": "急性肾炎，颅内出血", "language": "zh"}
{"question": "下列酶中，不需尼克酸衍生物为辅酶的是（　　）。", "answer": "琥珀酸脱氢酶", "meta_info": "生物化学", "answer_idx": "D", "A": "γ羟丁酸脱氢酶", "B": "异柠檬酸脱氢酶", "C": "苹果酸脱氢酶", "D": "琥珀酸脱氢酶", "language": "zh"}
{"question": "在无人监督、单独工作时，仍然坚持医德信念，自觉地履行医德原则和规范，主动自觉地为病人谋利益。这属于医德修养方法中的（　　）。", "answer": "慎独的方法", "meta_info": "医学伦理学", "answer_idx": "A", "A": "慎独的方法", "B": "积善的方法", "C": "舆论导向的方法", "D": "学习的方法", "language": "zh"}
{"question": "患者，女，30岁，农民。因扁桃体炎复发到某医院就诊，医生给他开了价格较昂贵的新抗生素.患者要求改用过去用过较为便宜而有效的青霉素。从医患是契约关系分析，医生最正确的选择是（　　）。", "answer": "医生和病人都具有独立的人格，医生应考虑病人提出的正当合理的要求", "meta_info": "医学伦理学", "answer_idx": "A", "A": "医生和病人都具有独立的人格，医生应考虑病人提出的正当合理的要求", "B": "患者就诊是自愿的，应服从医生的治疗方案", "C": "治疗活动中，当医生的权利和患者的权利发生冲突时，首先要考虑患者的利益", "D": "治疗活动中，患者具有治疗的拒绝权，拒绝使用新抗生素", "language": "zh"}
{"question": "患儿，女，10个月。新生儿期确诊先天性甲状腺功能减低症，即开始口服甲状腺干粉片治疗，目前维持剂量为每日50mg，近日发现患儿烦躁，多汗，消瘦，腹泻，此时应采取的措施是（　　）。", "answer": "减少甲状腺片剂量", "meta_info": "第六部分　儿科疾病", "answer_idx": "A", "A": "减少甲状腺片剂量", "B": "增加甲状腺片剂量", "C": "改用甲状腺素钠", "D": "不作特殊处理", "language": "zh"}
{"question": "3．产生IL-4的是（　　）。", "answer": "Th2", "meta_info": "医学免疫学", "answer_idx": "B", "A": "Thl", "B": "Th2", "C": "Tc", "D": "Mφ", "language": "zh"}
{"question": "男，68岁。反复咳嗽、咳痰15年，加重伴发热3天。吸烟史40年，1包/天。查体：T 38.8℃，口唇发绀。桶状胸，双肺可闻及哮鸣音和湿啰音。血WBC 10.3×109/L，N 0.85。该患者最可能的诊断是（　　）。", "answer": "慢性阻塞性肺疾病", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "肺血栓栓塞", "B": "慢性阻塞性肺疾病", "C": "支气管扩张", "D": "支气管哮喘", "language": "zh"}
{"question": "女性，35岁，6年前分娩时失血过多伴晕厥，产后无乳汁，闭经2～3年伴怕冷、乏力，体位性头晕，餐前经常手抖、心悸、饥饿感。查体：消瘦，嗓音低哑，毛发稀疏，双乳房萎缩，血压80/50mmHg。血糖4.0mmol/L（正常3.68～6.12mmol/L），血皮质醇、雌二醇均低，FSH、LH基础值不低，B超示子宫体积小。2．当进一步鉴别原发或继发性内分泌功能低减时，下列哪个试验对病人具有危险性？（　　）", "answer": "胰岛素负荷试验", "meta_info": "第二部分　代谢、内分泌系统疾病", "answer_idx": "D", "A": "TRH兴奋试验", "B": "TSH兴奋试验", "C": "CRH兴奋试验", "D": "胰岛素负荷试验", "language": "zh"}
{"question": "男，56岁。咳嗽、胸闷、憋气2天，持续不缓解。查体：左侧呼吸运动减低，叩诊呈鼓音，呼吸音明显减低。胸部X线片示左肺萎陷，压缩约90％。该患者最有效的治疗措施是（　　）。", "answer": "胸腔闭式引流", "meta_info": "第一部分　历年真题", "answer_idx": "B", "A": "低流量吸氧", "B": "胸腔闭式引流", "C": "胸腔穿刺排气", "D": "解痉平喘", "language": "zh"}
{"question": "刘某是某公司经理，因被怀疑贪污，突然被检察院传讯，并拘留24小时，导致他精神极度紧张，大哭大闹，但第二天突然表情呆滞，问话不答，两眼凝视，全身肌肉紧张，四肢抖动。两个月之后一直自觉乏力，头昏、头痛，心慌、胸闷，严重时甚至要昏倒，睡眠差，情绪不稳定，不愿出门，不愿与人交往。1．以下关于刘某出现的应激反应的说法，不正确的是（　　）。", "answer": "只出现急性应激反应", "meta_info": "医学心理学", "answer_idx": "B", "A": "出现激情爆发", "B": "只出现急性应激反应", "C": "存在情感障碍", "D": "出现生活习惯和行为模式的改变", "language": "zh"}
{"question": "2．脊髓灰质炎疫苗初种年龄（　　）。", "answer": "2个月", "meta_info": "医学免疫学", "answer_idx": "A", "A": "2个月", "B": "3个月以上", "C": "8个月", "D": "1岁以上", "language": "zh"}
{"question": "麻疹合并肺炎时，应隔离至出疹后的（　　）。", "answer": "10天", "meta_info": "第六部分　儿科疾病", "answer_idx": "C", "A": "3天", "B": "5天", "C": "10天", "D": "14天", "language": "zh"}
{"question": "2．患者男性，16岁，咽喉疼痛5天。昨天感寒战，发热39.5℃。血白细胞为18.5×109/L，中性粒细胞90%，血培养阴性。考虑的诊断是（　　）。", "answer": "毒血症", "meta_info": "第八部分　其他疾病", "answer_idx": "D", "A": "革兰阴性菌败血症", "B": "革兰阳性菌败血症", "C": "脓血症", "D": "毒血症", "language": "zh"}
{"question": "确切地说，按规定积极参加会诊，这一做法最能体现的正确处理医务人员之间关系的意义和道德原则为（　　）。", "answer": "有利于医院集体力量的发挥，彼此独立、互相支持和帮助", "meta_info": "医学伦理学", "answer_idx": "A", "A": "有利于医院集体力量的发挥，彼此独立、互相支持和帮助", "B": "有利于建立和谐的医患关系，共同维持社会公益", "C": "有利于分担风险，彼此独立、相互支持和帮助", "D": "有利于医院集体力量的发挥，彼此信任、礼尚往来", "language": "zh"}
{"question": "卫生资源配置中，不符合配置原则的是（　　）。", "answer": "效率最大化原则", "meta_info": "第一部分　历年真题", "answer_idx": "A", "A": "效率最大化原则", "B": "公正原则", "C": "合理化原则", "D": "效益最大化原则", "language": "zh"}
{"question": "男，25岁，背部刀伤，伤口流血2h，体查：神志尚清楚，诉口渴，皮肤苍白，稍冷，脉搏110/min，血压12/9.33kPA（90/70mmHg），脉压小，表浅静脉塌陷，尿少。1．此病人休克达何种程度？（　　）", "answer": "中度", "meta_info": "第二部分　模拟试题", "answer_idx": "A", "A": "中度", "B": "轻度", "C": "重度", "D": "代偿期", "language": "zh"}