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점차 변화해가는 의사국가고시 유형에 맞게 문제를 편집하여 해설하였고 올해 새롭게 출제된 문제와 관련된 이론 부분을 강화하여, 앞으로 어떤 부분에서 어떤 유형의 문제가 나오더라도 여러분들이 쉽게 풀어낼 수 있도록 노력하였다. 또한 각 단원의 서두에 최근 국가고시 출제 경향 및 중요하게 다루어야 할 개념들에 대해 짤막한 언급을 실어 공부를 본격적으로 시작하기에 앞서 개략적인 내용을 파악할 수 있도록 하였다.

？ 2025년대비 Pacific KMLE 09-산과 ？
산과 총론
해부학 _13
골반 ··············································································································· 1 3
자궁 ··············································································································· 1 6
난관 ··············································································································· 2 2
외음부 ··········································································································· 2 4
질 ··················································································································· 2 5

발생학 _27
난자형성 ········································································································ 2 7
수정의 과정 ·································································································· 3 0
영양막 ··········································································································· 3 2
태아막 ··········································································································· 3 4
생식기의 발생 ······························································································· 3 6
양수 ··············································································································· 3 6

생식주기 _38
생식주기 ········································································································ 3 8
인간 융모생식샘자극호르몬 ········································································· 4 4
S t e r o i d h o r m o n e ············································ 4 7

산과 각론
산과학 개관 _51
통계 ··············································································································· 5 1

임신의 개관 _53
산과력 ··········································································································· 5 3
임신의 진단 ·································································································· 5 5
태반 통과 ······································································································ 5 5

태아의 발생과 성장 _58
태아의 발육 ·································································································· 5 8
태아 순환 ······································································································ 5 9
태아의 조혈기관 ··························································································· 6 2
태아의 폐성숙 ······························································································· 6 2

임신에 대한 모체의 적응 _66
임신 시 모체의 변화 ··················································································· 6 6
임신 중 철분 요구량 ··················································································· 7 0
임신 중 여성호르몬 합성 ············································································ 7 2

산전 관리 _73
임산부 진찰 ·································································································· 7 3
신경관결손의 예방 ······················································································· 7 8

산전 진단 _80
알파태아단백 ································································································· 8 0
산전 진단 ······································································································ 8 7
유전질환의 종류와 출생 결함 ····································································· 9 1

임신 중 태아감시 _93
임신 중 태아감시 ························································································· 9 3
태아 심장박동 ······························································································· 9 8
태아 곤란증 ································································································ 1 0 9
배꼽 동맥 도플러 속도계 ·········································································· 1 1 1

초음파 _113
초음파 ········································································································· 1 1 3

골반계측 _121
골반 협착, 산과결합선 ··············································································· 1 2 1

태축 ㆍ 태위 ㆍ 태세 ㆍ 태향 _125
태아의 태축 ㆍ 태위 ㆍ 태세 ㆍ 태향 ·································································· 1 2 5
복부 촉진 ···································································································· 1 2 9

정상분만 _131
분만 과정 ···································································································· 1 3 1
후두위 분만 시 기본 운동 ········································································ 1 3 5
부동고정위 ·································································································· 1 4 0
아두 형태의 변화 ······················································································· 1 4 2
자연분만에 관한 수기 ················································································ 1 4 3
태반 분만과 회음 열상 ·············································································· 1 4 5
회음절개술 ·································································································· 1 4 7

난 산 _149
난산 ············································································································· 1 4 9
난산(1)？Power의 문제 ············································································· 1 5 0
난산(2)？Passage의 문제 ··········································································· 1 5 3
난산(3)？Passenger의 문제 ······································································· 1 6 1
급속 분만 ···································································································· 1 6 9

조 산 _171
조산 ············································································································· 1 7 1
양막 파수 ···································································································· 1 7 7
조기 산통 ···································································································· 1 8 9

지연 임신 _195
지연 임신, 만기 후 출산 ··········································································· 1 9 5

태아 성장 지연 _199
태아 성장 지연 ··························································································· 1 9 9

거대아 _210
거대아(큰몸증) ···························································································· 2 1 0

다태 임신 _212
다태 임신 ···································································································· 2 1 2

양수 및 태반 이상 _220
양수과다증과 양수과소증 ··········································································· 2 2 0
태반이상 ······································································································ 2 2 7
탯줄이상 ······································································································ 2 2 8

자궁외 임신 _230
자궁외 임신 ································································································ 2 3 0

유 산 _240
자연 유산 ···································································································· 2 4 0
인공 유산 ···································································································· 2 4 4
임신 고혈압 _250
임신 중 고혈압 ··························································································· 2 5 0

산과적 출혈 _264
분만 전 출혈의 원인 ················································································· 2 6 4
태반조기박리 ······························································································· 2 6 4
전치태반 ······································································································ 2 7 3
분만 후 출혈 ······························································································ 2 8 0
자궁 파열 ···································································································· 2 8 8
자궁내번증 ·································································································· 2 9 2
양수색전증 ·································································································· 2 9 5

태아의 질환 및 손상 _298
태아의 용혈성 질환 ··················································································· 2 9 8
자궁 내 태아사망 ······················································································· 3 0 2

산욕기 _304
산욕기 ········································································································· 3 0 4

산욕기 질환 _308
산욕열 ········································································································· 3 0 8

임신의 내과적 ㆍ 외과적 합병증 _316
임신 중 심혈관계 질환 ·············································································· 3 1 6
임신 중 Thromboembolic disease？DVT와 P E ······································ 3 1 9
임신 중 호흡기계 질환？결핵 ··································································· 3 2 1
임신 중 회음부 질환 ················································································· 3 2 3
임신 중 비뇨기계 질환 ·············································································· 3 2 4
임신 중 소화기계 질환 ·············································································· 3 2 8
임신 중 내분비계 질환？당뇨병 ······························································· 332
임신 중 내분비계 질환？갑상샘 기능항진증 ··········································· 3 4 2
임신 중 결체조직 질환 ·············································································· 3 4 5
임신 중 감염 질환(1)？만성 자궁내감염, Parvovirus, 수두 ··················· 3 4 7
임신 중 감염 질환(2)？선천성 풍진 증후군 ··········································· 3 5 1
임신 중 감염 질환(3)？매독 ····································································· 3 5 6
임신 중 감염 질환(4)？I n f l u e n z a ············································· 3 5 9

임신과 약물 _361
임신과 약물 ································································································ 3 6 1
임신과 방사선 노출 ··················································································· 3 7 2

산과 수기 및 수술 _375
제왕절개술 ·································································································· 3 7 5
자궁절제술의 적응증 ·················································································· 3 8 0

참고문헌 _381
찾아보기 _384

머리말
의사 국가고시를 준비하는 여러분 그리고 의과대학에서 의학을 공부하고 있는 여러분 모두에게 2024년 대비 Pacific KMLE가 의지하고 볼 수 있는 책이 되기를 소망하며 글을 시작합니다.

여러분이 앞으로 치르게 될 의사 국가고시는 크게 실기시험과 필기시험으로 구성되어 있습니다.

우선, 실기시험은 매년 9월 초에 시작하여 약 2개월 동안 진행되며 수험생은 각자 지정된 시험일에 국시원을 방문하여 하루 동안에 모든 시험을 치르게 됩니다. 특히, 진료문항과 수기문항이 종합문항으로 합쳐진 다양한 시험 방식과 둘 이상의 주소로 접근해야 하는 새로운 유형들도 출제되기 때문에 실기시험 준비도 열심히 하시길 바랍니다. Pacific KMLE에는 필기시험뿐만 아니라 실기시험에도 도움이 되는 내용들이 포함되어 있으니 실기시험을 공부하다가 필요한 지식이 있을 때 참고하여 보시면 좋겠습니다.

본 책의 주 목적인 필기시험은 보건의약관계법규, 의학총론, 의학각론 3개 과목으로 구성되어 있으며 이틀에 걸쳐 시험을 치르게 됩니다. 특히, 2024학년도 의사 국가고시 필기시험은 작년과 비슷한 문제 형식으로 멀티미디어 문항을 포함한 컴퓨터시험으로 출제되었습니다. 2022학년도부터 기존의 OMR 마킹을 이용한 지필시험이 아닌, 컴퓨터를 이용한 컴퓨터시험(CBT)으로 진행되는 점은 학생들의 적응이 필요한 부분입니다. 국시원 홈페이지에서 바뀐 CBT 시스템을 체험해 볼 수 있으니 확인하시면 좋겠습니다.

또한, 2022학년도 국시부터 출제문항 수의 축소와 함께 시행된 멀티미디어문항의 출제, 작년부터 없어진 R형 문제와 같이 문제 유형에도 많은 변화가 있었습니다. 출제문항 수 변화와 관련한 변화를 자세히 살펴보면, 의학각론 문제 수가 기존 280문항에서 240문항으로 축소되어 총 출제문항 수가 기존 360문항에서 320문항으로 축소되었고, 32문항씩 출제되던 R형 문제가 없어졌습니다. 시험 시간이 기존 5교시에서 4교시로 축소되었으나, 이에 따라 교시별 문항 수는 각 교시 당 80문항으로 증가(기존에는 각 교시 당 70문항, 1교시만 80문항 출제)하였습니다. 이를 고려하여 교시 별 시험시간은 각 교시 당 105분으로 확대(기존에는 각 교시 당 90분, 1교시만 100분)되었습니다.

또 다른 하나의 큰 변화인 멀티미디어문항은 ‘문항줄기(또는 답가지)에 텍스트와 함께 동영상, 소리 등 멀티미디어 자료를 포함한 문항’을 의미합니다. 컴퓨터시험(CBT)으로의 변화에 따라 이러한 멀티미디어 자료를 이용한 문항 출제가 가능해져 임상 증상과 신체 진찰 소견의 종합적인 이해가 필요합니다.
2022년도 3문제, 2023년도 6문제, 2024년도에 9문제가 출제되었으며 점차 확대되는 추세이기 때문에 잘 대비하셔야 합니다. 별도 공지가 없다면 올해와 마찬가지로 ‘2025학년도 제89회 의사 국가고시’ 필기시험에도 9문제 출제될 예정입니다.

교시 별로 살펴보면, 1교시에는 보건의약관계법규 20문제와 예방의학을 포함한 의학총론 60문제가 출제되며 나머지 교시들에는 의학각론 문제가 80문제씩 출제됩니다. 하지만 실제로 의학총론과 의학각론은 내용이 명확하게 구분되어 있지 않습니다. 멀티미디어문항은 다른 의학총론, 각론 문제들과 섞여서 나오며, 모든 교시에서 출제되었습니다. 필기시험의 경우에는 전 과목 총점 60% 이상(192문항), 각 과목 점수 40%(보건의약관계법규 8문항, 의학총론 24문항, 의학각론 96문항) 이상일 경우 합격입니다.
보건의약관계법규는 문제수가 적으니 각별히 주의해야 합니다.

2024년도 필기시험은 합격 요건을 충족하는 데에는 무리가 가지 않도록 이전 국시와 같은 평이한 난이도의 문제가 다수 출제되었으나, 높은 난이도의 문제와 함께 생소한 개념들이 다수 출제되어 고득점을 얻기에는 어려운 구조로 출제되었습니다. 또한, 얕게 공부할 경우 헷갈리기 쉬운 개념 문제나 매력적인 오답이 많은 까다로운 문제들이 출제되었습니다. 국가고시 문제와 답안이 공개되면서 조금씩 난이도가 높아지고 있는 추세이며, 환자가 호소하는 증상 및 징후, 제시된 검사 결과들을 종합적으로 판단해야 하는 증례 위주의 문제들이 다수 출제되었습니다. 더 나아가, 증례에서 제시된 질환에 대한 전형적인 검사나 치료법보다는 차선책으로 선택할 수 있는 처치와 2차 약제 등을 묻는 문제 역시 다수 출제되어, 꼼꼼히 공부하고 정리해 놓아야 풀 수 있는 문제들이 출제되고 있습니다. 다만, 그동안 생소한 개념이 출제되는 경우 임상의학종합평가에서 미리 신호를 주는 경우가 많았으며, 따라서 2025년도 필기시험 대비 시에는 반드시 2024년 임상의학종합평가를 꼭 충분히 학습하시기 바랍니다.

2025년 대비 Pacific KMLE에서는 점차 변화해가는 의사국가고시 유형에 맞게 문제를 편집하여 해설하였고 올해 새롭게 출제된 문제와 관련된 이론 부분을 강화하여, 앞으로 어떤 부분에서 어떤 유형의 문제가 나오더라도 여러분들이 쉽게 풀어낼 수 있도록 노력하였습니다. 또한 각 단원의 서두에 최근 국가고시 출제 경향 및 중요하게 다루어야 할 개념들에 대해 짤막한 언급을 실어 공부를 본격적으로 시작하기에 앞서 개략적인 내용을 파악할 수 있도록 하였습니다.

2025년 대비 Pacific KMLE는 최근 시험 경향의 분석을 통해 합격과 더불어 고득점을 원하시는 분들을 위해 다음과 같은 부분에 중점을 두고 개정하였습니다.

1. 국가고시 출제 유형이 변화함에 따라 점차 기존에 출제된 족보내용만 외우는 공부가 아닌, 전반적인 내용을 종합적으로 평가함으로써 적절한 검사 방법 및 치료를 떠올리고 선택하는 논리적 사고가 중요해지고 있습니다. 이에 따라 ‘이론학습 후 문제해결’ 순서를 유지하여 이론을 충분히 학습한 후 문제풀이를 통해 이를 적용해보고 복습하면서 문제해결 능력을 다질 수 있도록 하였습니다.
또한 이론학습 부분의 질적인 향상을 위해 작년 의료법규 개정사항 및 앞으로 2024년도에 개정되고 시행될 사항, 예방의학 분야에서 업데이트된 통계정보 등 최신 지견을 반영하였습니다. 그리고 검사와 치료를 단순히 나열하는 방식에서 벗어나 특정 상황에서 어떠한 처치를 해야 하는지에 대한 기준을 명확하게 제시하기 위해 노력하였습니다. 추가적으로 국가고시 문제에서 사용되는 한글용어를 사용하여 실제 시험장에서 문제를 풀 때 의학용어 때문에 정답선택에 차질이 생기지 않도록 하였습니다.

2. 출제빈도와 임상적 중요성을 고려하여 ‘중요항목’을 반영하였습니다. 2016년도 국가고시부터 기본 항목이 폐지되고 임상표현 중심의 평가목표가 제시되면서 기존에 출제되지 않았던 부분에서도 문제가 많이 출제 되고 있습니다. 이에 각 파트의 앞부분에 출제경향과 중요사항을 제시하여 공부할 때 어떤 부분에 집중해야 하는지 파악할 수 있도록 하였고, 그동안 출제빈도가 낮았던 항목도 최근 국가고시의 출제 경향을 고려하여 ‘중요항목’으로 표시했습니다. ‘중요항목’을 완벽하게 숙지하고 시험장에 들어간다면 안전하게 합격을 노려볼 수 있을 것입니다.

3. 국가고시 출제 경향을 이해하고 중요한 부분에 더욱 집중할 수 있도록 기출문제에 A, B, C 분류를 적용하였습니다. 최근에 국가고시에 출제된 최신 경향이 반영된 문제를 A로 분류하였고, B와 C는 편집자의 재량에 따라 중요도와 출제 가능성을 고려하여 분류하였습니다. 최대한 효율적으로 공부할 수 있도록 최근 출제 경향에서 벗어나는 문제, 같은 내용이 반복되어 쉽게 풀리는 문제들은 삭제하였습니다. 특히, 각 단원에서 2024년도 의사국가고시와 관련된 문제를 찾아 문제번호에 색을 표시하였고, 모의고사 대비에 있어서도 어려움이 없도록 하고자 하였습니다.

4. 문제에 충실하고 통합적이며, 이해하기 쉬운 해설을 달기 위해 노력하였습니다. 또한 필요치 않게 긴 해설을 줄여 가독성을 높이되, 매력적인 오답에 한하여 최선의 답이 아닌 이유를 기술하여 비슷하지만 다른 문제가 출제되더라도 잘 대비할 수 있도록 준비하였습니다.

마지막으로, 최신 문헌을 참고하여 문제에 대해 정확한 해설을 하기 위해 노력하였습니다(Harrison 제21판, Cecil 제27판, Sabiston 제21판, Schwartz 제11판, Nelson 제21판, Berek&Novak 제16판, Williams 제26판, Middleton’s Allergy 제9판, 산과학 제6판, 응급의학 제2판, 홍창의 소아과학 제12판, 부인과학 6판, 소화기계질환 4판, 최신정신의학 제6판, DSM-5, 신경정신의학 제3판, 신경과학 2판, 신경학 3판, 신경외과학 제4판, 이비인후과학 개정 2판(2018), 안과학 제13판, 피부과학 제7판, 의대생을 위한 피부 과학 제5판, 비뇨기과학 제5판, 2022 AHA guideline, 학생을 위한 정형의학 제4판, 예방의학과 공중보건학 제4판, 법제처 법률 원문 참고). 특히, 2022년에 Harrison, Williams 두 교과서가 개정되었으며, 이 두 교과서에서 확인된 변화를 모두 새롭게 정리하여 교재에 반영하였습니다.
위와 같은 기준에 의해 개정된 2025년 대비 Pacific KMLE가 의사국가고시를 준비하는 예비 의사선생님들에게 시험의 길잡이가 될 수 있기를 바랍니다. 이 책에 나오는 지식을 시작으로 좋은 의사가 되어 예비 의사선생님들의 앞날에 행복만이 가득하길 기원합니다.

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