05-17-2008, 08:46 PM
A 32-year-old man is comatose in the
intensive care unit. The patient
sustained a massive head injury in a
head-on motor vehicle accident 3
months ago and has been in a
vegetative state since that date. He
is ventilator-dependent and receives
nutritional support via a gastrotomy
tube. The patient makes no purposeful
movements and does not withdraw from
painful stimuli. There is discord
present within his family about
whether to withdraw care. His father
desires care to be withdrawn, whereas
his mother wants to continue maximal
supportive care. Which of the
following is the most important
determining factor in helping to
direct future care?
A. The decision of a
court-appointed legal guardian
B. The decision of the medical
and nursing team taking care of the
patient
C. The father's wishes, given
that he is the health care proxy
D. The opinion of the hospital
ethics committee
E. The patient's previously
expressed wishes regarding life
support, if known
A 24 yr old male is brought to the emergency room by a group of friends because he attempted to hang himself. On initial examination, it was evident that he has sustained a cervical vertebral fracture... he was quadriplegic, but made it evident that he didn't want any treatment. The possibility of respiratory paralysis was almost certain, unless an emergency spinal surgery was performed which has a success rate of 80% . It was known that he has been living with 2 of his best friends for past 7yrs. Upon contacting them, they revealed that he has been very depressed for over 1yr after the death of his girl friend. They said that he never talked about suicide. The friends didn't want forced treatment even if the condition is life threatening. What is the best action the Physician should take next?
1- Don't treat because the patient didnt want any treatment
2- Don't treat because the friends didn't want forced treatment
3- Go ahead with the surgery
4- Take it to the hospital ethics commitee
5- Go to the court.
29. An 84 yr old woman with sever Alzheimer™s disease is admittied , she has lost the ability to communicate , is bed bound & is unable to eat. She did not appoint a proxy & there is no written will or clear verbal advance directive. Multiple family members routinely visit her & u are unable to achieve as clear consensus amongnst family members of what the pt ˜s wishes were.
What should u do in terms of her care?
a.follow the wishes of the eldest child
b.follow what u think is best
c.ask another attending of his opinion
d.ask the hospital administrator for consent
e.pursue an ethics committee evaluation.
a female patient comes to see for routine care her husband is a friend of yours and on routine examinations she is found to have a sexually transmitted disease and you inform her of this. She tells you that she got this sexually transmitted disease while vacationing with her girlfriends she pleads with you not to tell her husband do you
a. comply with her wishes
b. tell her husband anyway
c get an ethics committee
37. U are an attending physician at the University hospital (hurray!!!!!!!!!!!!). one of the attendins from another division seems to be having memory difficult . U found him twice in the hallway having forgotten where he was going .
The residents tell u on the side that they don™t rely on him at all because œ he forgets everything we say anyway. The chief of service knows but doesn™t have enough attendings to fill a yearly schedule so he remains in place supervising both the resident performance as welll as patient care.
What should u do?
a.Nothing, the chief of service already knows
b. talk to him directly
c.tell your division head
d.report him to the state licensing board.
28.An elderly pt with progressive Parkinson disease come s to see u because of fever, cough ,shortness of breath, sputum production with pneumonia. The pt™s Parkinson disease has been worsening & he has become quite depressed. He has insomnia ,early morning waking, & wt loss as well as anhedonia. He is refusing antibiotics & is asking for palliative care only to help him die.
What should u do?
a.psychiatric evaluation
b sedate the pt
c.comply with pt™s wishes
d seek opinion of family
e.ethics committee referral.
32 yr old male physician who is an internist has a female patient for the past 2 yrs. They start spending time together outside the office. The female pt wants to begin a romantic relationship with the physician.
What should he tell her?
a.I can never do that with you ever.
b.We can be social but not sexual
c.We need the ethics board;s approval first
d.I cannot date u & be your doctor. May be in the future we can date, after u get another doctor.
e.Because this is your initiative ,we can begin dating
you have been invited toe participate in a œmedical jeopardy game sponsored by a pharmaceutical manufacuterer. the winners receive a 100$ gift certificate to the medical school bookstore. All the participants receive a stethoscope. The audience are participants receive a free meal.
Which of the following is most appropriate to accept?
A,all the gifts
b.only the meal
c. only the stethoscope
d.the meal ,stethoscope, not the gift certificate
e.none of it
You are the staff physician in a state penitentiary in a state where capital punishment is legal. An execution is in progress & the warden calls u because the technician is unable to start the IV line. The warden wants u to start the line & supervise the pharmacist.
What should u tell him ?
A no problem, I will start the line
b.i can start the line but I will no push the medications
c.i am sorry I cannot participate
d.i can take care of all of it.
A physician in a busy inner city environment has developed his practice over the years to the point that he no longer needs to solicit new pts. He does not want to expand his hours of work, so he decides to limit his practice. He instructs his office staff to begin refusing to accept new pts.
Which of the foll most appropriately describes the action?
a.it is both legal & ethical
b.it is ethically acceptable but not illegal
c.he is within his legal rights to refuse pts but is ethically unacceptable
d.it is both illegal & unethical
e.it is ethical as long as he arranges transfer of care to another physician
45 yr old Mr.Smith consents to a procedure on his left ear. After the pt is anaesthetized Dr.Wright discovers that the right ear is in greater need for surgery. What should the surgeon do??
a.perform the procedure on the right ear as it is more necessary
b wake up the pt & seek consent for the procedure on the right ear
c. seek a second opinion from another surgeon & proceed with the more necessary procedure
d.seek consent from family.
e.perform the procedure on both ears
The neighbor of a l4-year-old boy brings him to the emergency department after sustaining a laceration to the scalp from head trauma. You evaluate him and determine
that suturing of the scalp will be necessary. no parents are identified.
Which of the following is the most accurate?
a. He is an emancipated minori thc paticnt can give consent.
b. The neighbor can give consent.
c. Wait for the consent of at least one parent.
d. Wait for the consent of both parents.
e. Seek a court-appointed legal guardian.
f, Conscnt is not necessary in this case.
A patient comes to the ER with a gun shot wound in his thigh. He says he was shot accidentally while hunting with his cousin . You treat the wound & give him antibiotics.
What should u do now?
a.report to the police
b.do not report to the police
c.it was accidental ,so It does not warrant to report
d.encourage the patient to report to the police
e report only if patient consents to it.
You are seeing a pt who has TB.he is undocumented (illegal ) immigrant from Mexico..His family will need to be screened for TB with PPD testing. He is frightened of being deported if the dept of health learns of his illegal status.
What should u tell him ?
a.dont worry the dept of health does not ask or report immigration status
b.only people who are noncompliant with medications are reported to the govt.
c.dont worry I will fully treat u before we deport u.
d.iam sorry but there is nothing I can do about this. There is mandatory reporting to the govt.
You are a resident managing a pt with cellulitis . the pt has a history of CCF and a normal EKG. The pt is on digoxin, ACE inhibitor & diuretic but not a beta blocker. You cannot find a CI to the use of a beta blocker in the chart or in discussion with pt. u ask the attending why there is no beta blocker & he looks at u as if u had an anoxic encephalopathy., he says œ I have been in practice for 40 yrs , don™t u think I know what am doing ?????.beta blockers are dangerous in CCF. The pt looks proudly at the attending & says œ I have the smartest doctor in the world.
What should u do??
a.wait for the attending to leave & give pt a prescription for carvedilol
b.suggest the pt tofind another doctor.
c.report the physician to the state licensing board
d.do nothing he is the attending on record
e.bring the disagreement to the chief of staff
f.help the pt find a good lawyer & volunteer to testify.
Your patient has just recently been diagnosed with familial adenomatous polyposis (FAP). The patient has become divorced and refuses to give you consent to inform his ex-wife who now has custody of their children. He threatens to sue u if u reveal elements of his medical care to his ex-wife.
What should u do?
a.respect the patients right to confidentiality.
b.transfer the patient™s care to another physician
c.ask the health dept to inform the ex-wife
d.seek a court order to inform the ex-wife
e.inform the ex-wife of the risk to the children.
f.inform the ex-wife;s doctor.
you have a pt with severe MS that is advanced & progressive who now develops renal failure secondary to DM, the pt is alert & has ERECTED to put DNR order in place at her own discretion. The pts K levels are now elevated at 8 meq/l.
Which of the foll is most appropriate.
a.dialysis cannot be done because of the DNRorder
b.you can do the dialysis if the DNR is reversed for the procedure
c.go ahead with the dialysis, ignore the DNR order
d.Give kayexalate until DNR status is discussed with the family.
An emancipated minor is free to make health care decisions in all areas, not only, just STDs but also for prenatacl care, contraception,or substance abuse.
~2~ The state has an interest in the welfare of the child that exceeds the parental right to deny therapy for the child if the child's life is in danger.
~3~ Medical info cannot be released to anyone without the pt's consent, however it can be released to close family members like wife or parents, without the pt's consent.
~4~ A pt who has DNR orders written, cannot undergo surgery.
~5~ Spousal consent is required to carry out sterilization.
~6~ Spousal consent is needed to perform an abortion.
pharmaceutical company approaches you about a clinical research project involving your office patients. Your patients with high blood pressure will be eligible to be treated with a new medication that has just been released by the FDA. The object of the study is to evaluate risks and benefits of this medication in an unselected office population. The pharmaceutical company will pay $250 per patient for the expenses generated by the study, and one year™s salary for a data manager and will supply the drug free of charge. Meetings to discuss the initiation of the study and follow-up results will be held in New Orleans and Honolulu. Your spouse will be invited as a company™s guest to attend these meetings since they will take away from home.
Participating in the study would be considered appropriate professional behavior if:
a. Your patients signed an informed consent.
b. Your patients sign an informed consent and your partners approve the study.
c. An oversight committee of the hospital where you have privileges or your regional medical society approves the study.
d. None of the above.
A 34 yr old man is brought to the ER with fever, headache & a change in mental status leading to significant disorientation. His head CT is normal but he is in need for an urgent LP & IV antibiotics.
He is agitated & is waving at anyone who tries to get near him . Co-workers accompany him . the resident informs u that the pt is pushing away the LP needle.
What should u do ?
A sedate the pt with lorazepan & perform LP
B wait for family to obtain consent
C use blood cultures as an alternative
D MRI of brain
E ask co-workers to sign consent.
58-year-old man comes to the office 7 weeks after his wife died from complications during breast cancer surgery. He says that he "misses her like crazy" and it is so hard for him because he did not expect to "ever lose her." He often finds himself crying in the bathroom at work.
However, it is the weekends that are especially difficult. He goes out for dinner and to the movies with their 2 children and his friends, but he typically feels a little detached. It is "really hard to handle" seeing other men with their wives. He is very "sad" and wants to know if he is going to be "okay".
The most appropriate response to this patient is
A. "It seems like you are experiencing a major depressive episode that we can treat with fluoxetine"
B. "Let's see how you feel in a few weeks and we will discuss the most appropriate treatment then"
C. "You are experiencing grief, which is a completely normal and expected reaction to the loss of your wife"
D. "You have an adjustment disorder that should be treated with psychotherapy"
E. "You should have your friends set you up with a widowed woman who will understand you"
35-year-old woman comes to the office asking you to drug test her 12-year-old son. She states that her son is normally a very kind and interactive child, however, for the last 3 months, he has become increasingly withdrawn. He is in his room most of the time except for when he is at school.
His grades have dropped from an A- average to C- this past semester. He refuses to see any of his friends and does not even eat much during dinner anymore. She has confronted her son multiple times about his situation, but he continually denies everything, including drug or alcohol use.
The mother is visibly upset at this situation and is tearful about it. She tells you that you are her son's "only help." The most appropriate response to the mother's request is:
A. "Just bring your son in and we can then get a urine test for alcohol and substance use."
B. "I am sorry but I can't legally test your son for any drugs without him consenting to it first."
C. "It is possible that your son may be suffering from depression and I think that you should bring him in for me to talk to him."
D. "These are classic symptoms for schizophrenia. The best thing to do would be to start him on some anti-psychotic medications."
E. "Your son is most probably abusing drugs and alcohol, so you should send him to a rehabilitation facility immediately."
Please put answer in one place so every one can see.
thanks
intensive care unit. The patient
sustained a massive head injury in a
head-on motor vehicle accident 3
months ago and has been in a
vegetative state since that date. He
is ventilator-dependent and receives
nutritional support via a gastrotomy
tube. The patient makes no purposeful
movements and does not withdraw from
painful stimuli. There is discord
present within his family about
whether to withdraw care. His father
desires care to be withdrawn, whereas
his mother wants to continue maximal
supportive care. Which of the
following is the most important
determining factor in helping to
direct future care?
A. The decision of a
court-appointed legal guardian
B. The decision of the medical
and nursing team taking care of the
patient
C. The father's wishes, given
that he is the health care proxy
D. The opinion of the hospital
ethics committee
E. The patient's previously
expressed wishes regarding life
support, if known
A 24 yr old male is brought to the emergency room by a group of friends because he attempted to hang himself. On initial examination, it was evident that he has sustained a cervical vertebral fracture... he was quadriplegic, but made it evident that he didn't want any treatment. The possibility of respiratory paralysis was almost certain, unless an emergency spinal surgery was performed which has a success rate of 80% . It was known that he has been living with 2 of his best friends for past 7yrs. Upon contacting them, they revealed that he has been very depressed for over 1yr after the death of his girl friend. They said that he never talked about suicide. The friends didn't want forced treatment even if the condition is life threatening. What is the best action the Physician should take next?
1- Don't treat because the patient didnt want any treatment
2- Don't treat because the friends didn't want forced treatment
3- Go ahead with the surgery
4- Take it to the hospital ethics commitee
5- Go to the court.
29. An 84 yr old woman with sever Alzheimer™s disease is admittied , she has lost the ability to communicate , is bed bound & is unable to eat. She did not appoint a proxy & there is no written will or clear verbal advance directive. Multiple family members routinely visit her & u are unable to achieve as clear consensus amongnst family members of what the pt ˜s wishes were.
What should u do in terms of her care?
a.follow the wishes of the eldest child
b.follow what u think is best
c.ask another attending of his opinion
d.ask the hospital administrator for consent
e.pursue an ethics committee evaluation.
a female patient comes to see for routine care her husband is a friend of yours and on routine examinations she is found to have a sexually transmitted disease and you inform her of this. She tells you that she got this sexually transmitted disease while vacationing with her girlfriends she pleads with you not to tell her husband do you
a. comply with her wishes
b. tell her husband anyway
c get an ethics committee
37. U are an attending physician at the University hospital (hurray!!!!!!!!!!!!). one of the attendins from another division seems to be having memory difficult . U found him twice in the hallway having forgotten where he was going .
The residents tell u on the side that they don™t rely on him at all because œ he forgets everything we say anyway. The chief of service knows but doesn™t have enough attendings to fill a yearly schedule so he remains in place supervising both the resident performance as welll as patient care.
What should u do?
a.Nothing, the chief of service already knows
b. talk to him directly
c.tell your division head
d.report him to the state licensing board.
28.An elderly pt with progressive Parkinson disease come s to see u because of fever, cough ,shortness of breath, sputum production with pneumonia. The pt™s Parkinson disease has been worsening & he has become quite depressed. He has insomnia ,early morning waking, & wt loss as well as anhedonia. He is refusing antibiotics & is asking for palliative care only to help him die.
What should u do?
a.psychiatric evaluation
b sedate the pt
c.comply with pt™s wishes
d seek opinion of family
e.ethics committee referral.
32 yr old male physician who is an internist has a female patient for the past 2 yrs. They start spending time together outside the office. The female pt wants to begin a romantic relationship with the physician.
What should he tell her?
a.I can never do that with you ever.
b.We can be social but not sexual
c.We need the ethics board;s approval first
d.I cannot date u & be your doctor. May be in the future we can date, after u get another doctor.
e.Because this is your initiative ,we can begin dating
you have been invited toe participate in a œmedical jeopardy game sponsored by a pharmaceutical manufacuterer. the winners receive a 100$ gift certificate to the medical school bookstore. All the participants receive a stethoscope. The audience are participants receive a free meal.
Which of the following is most appropriate to accept?
A,all the gifts
b.only the meal
c. only the stethoscope
d.the meal ,stethoscope, not the gift certificate
e.none of it
You are the staff physician in a state penitentiary in a state where capital punishment is legal. An execution is in progress & the warden calls u because the technician is unable to start the IV line. The warden wants u to start the line & supervise the pharmacist.
What should u tell him ?
A no problem, I will start the line
b.i can start the line but I will no push the medications
c.i am sorry I cannot participate
d.i can take care of all of it.
A physician in a busy inner city environment has developed his practice over the years to the point that he no longer needs to solicit new pts. He does not want to expand his hours of work, so he decides to limit his practice. He instructs his office staff to begin refusing to accept new pts.
Which of the foll most appropriately describes the action?
a.it is both legal & ethical
b.it is ethically acceptable but not illegal
c.he is within his legal rights to refuse pts but is ethically unacceptable
d.it is both illegal & unethical
e.it is ethical as long as he arranges transfer of care to another physician
45 yr old Mr.Smith consents to a procedure on his left ear. After the pt is anaesthetized Dr.Wright discovers that the right ear is in greater need for surgery. What should the surgeon do??
a.perform the procedure on the right ear as it is more necessary
b wake up the pt & seek consent for the procedure on the right ear
c. seek a second opinion from another surgeon & proceed with the more necessary procedure
d.seek consent from family.
e.perform the procedure on both ears
The neighbor of a l4-year-old boy brings him to the emergency department after sustaining a laceration to the scalp from head trauma. You evaluate him and determine
that suturing of the scalp will be necessary. no parents are identified.
Which of the following is the most accurate?
a. He is an emancipated minori thc paticnt can give consent.
b. The neighbor can give consent.
c. Wait for the consent of at least one parent.
d. Wait for the consent of both parents.
e. Seek a court-appointed legal guardian.
f, Conscnt is not necessary in this case.
A patient comes to the ER with a gun shot wound in his thigh. He says he was shot accidentally while hunting with his cousin . You treat the wound & give him antibiotics.
What should u do now?
a.report to the police
b.do not report to the police
c.it was accidental ,so It does not warrant to report
d.encourage the patient to report to the police
e report only if patient consents to it.
You are seeing a pt who has TB.he is undocumented (illegal ) immigrant from Mexico..His family will need to be screened for TB with PPD testing. He is frightened of being deported if the dept of health learns of his illegal status.
What should u tell him ?
a.dont worry the dept of health does not ask or report immigration status
b.only people who are noncompliant with medications are reported to the govt.
c.dont worry I will fully treat u before we deport u.
d.iam sorry but there is nothing I can do about this. There is mandatory reporting to the govt.
You are a resident managing a pt with cellulitis . the pt has a history of CCF and a normal EKG. The pt is on digoxin, ACE inhibitor & diuretic but not a beta blocker. You cannot find a CI to the use of a beta blocker in the chart or in discussion with pt. u ask the attending why there is no beta blocker & he looks at u as if u had an anoxic encephalopathy., he says œ I have been in practice for 40 yrs , don™t u think I know what am doing ?????.beta blockers are dangerous in CCF. The pt looks proudly at the attending & says œ I have the smartest doctor in the world.
What should u do??
a.wait for the attending to leave & give pt a prescription for carvedilol
b.suggest the pt tofind another doctor.
c.report the physician to the state licensing board
d.do nothing he is the attending on record
e.bring the disagreement to the chief of staff
f.help the pt find a good lawyer & volunteer to testify.
Your patient has just recently been diagnosed with familial adenomatous polyposis (FAP). The patient has become divorced and refuses to give you consent to inform his ex-wife who now has custody of their children. He threatens to sue u if u reveal elements of his medical care to his ex-wife.
What should u do?
a.respect the patients right to confidentiality.
b.transfer the patient™s care to another physician
c.ask the health dept to inform the ex-wife
d.seek a court order to inform the ex-wife
e.inform the ex-wife of the risk to the children.
f.inform the ex-wife;s doctor.
you have a pt with severe MS that is advanced & progressive who now develops renal failure secondary to DM, the pt is alert & has ERECTED to put DNR order in place at her own discretion. The pts K levels are now elevated at 8 meq/l.
Which of the foll is most appropriate.
a.dialysis cannot be done because of the DNRorder
b.you can do the dialysis if the DNR is reversed for the procedure
c.go ahead with the dialysis, ignore the DNR order
d.Give kayexalate until DNR status is discussed with the family.
An emancipated minor is free to make health care decisions in all areas, not only, just STDs but also for prenatacl care, contraception,or substance abuse.
~2~ The state has an interest in the welfare of the child that exceeds the parental right to deny therapy for the child if the child's life is in danger.
~3~ Medical info cannot be released to anyone without the pt's consent, however it can be released to close family members like wife or parents, without the pt's consent.
~4~ A pt who has DNR orders written, cannot undergo surgery.
~5~ Spousal consent is required to carry out sterilization.
~6~ Spousal consent is needed to perform an abortion.
pharmaceutical company approaches you about a clinical research project involving your office patients. Your patients with high blood pressure will be eligible to be treated with a new medication that has just been released by the FDA. The object of the study is to evaluate risks and benefits of this medication in an unselected office population. The pharmaceutical company will pay $250 per patient for the expenses generated by the study, and one year™s salary for a data manager and will supply the drug free of charge. Meetings to discuss the initiation of the study and follow-up results will be held in New Orleans and Honolulu. Your spouse will be invited as a company™s guest to attend these meetings since they will take away from home.
Participating in the study would be considered appropriate professional behavior if:
a. Your patients signed an informed consent.
b. Your patients sign an informed consent and your partners approve the study.
c. An oversight committee of the hospital where you have privileges or your regional medical society approves the study.
d. None of the above.
A 34 yr old man is brought to the ER with fever, headache & a change in mental status leading to significant disorientation. His head CT is normal but he is in need for an urgent LP & IV antibiotics.
He is agitated & is waving at anyone who tries to get near him . Co-workers accompany him . the resident informs u that the pt is pushing away the LP needle.
What should u do ?
A sedate the pt with lorazepan & perform LP
B wait for family to obtain consent
C use blood cultures as an alternative
D MRI of brain
E ask co-workers to sign consent.
58-year-old man comes to the office 7 weeks after his wife died from complications during breast cancer surgery. He says that he "misses her like crazy" and it is so hard for him because he did not expect to "ever lose her." He often finds himself crying in the bathroom at work.
However, it is the weekends that are especially difficult. He goes out for dinner and to the movies with their 2 children and his friends, but he typically feels a little detached. It is "really hard to handle" seeing other men with their wives. He is very "sad" and wants to know if he is going to be "okay".
The most appropriate response to this patient is
A. "It seems like you are experiencing a major depressive episode that we can treat with fluoxetine"
B. "Let's see how you feel in a few weeks and we will discuss the most appropriate treatment then"
C. "You are experiencing grief, which is a completely normal and expected reaction to the loss of your wife"
D. "You have an adjustment disorder that should be treated with psychotherapy"
E. "You should have your friends set you up with a widowed woman who will understand you"
35-year-old woman comes to the office asking you to drug test her 12-year-old son. She states that her son is normally a very kind and interactive child, however, for the last 3 months, he has become increasingly withdrawn. He is in his room most of the time except for when he is at school.
His grades have dropped from an A- average to C- this past semester. He refuses to see any of his friends and does not even eat much during dinner anymore. She has confronted her son multiple times about his situation, but he continually denies everything, including drug or alcohol use.
The mother is visibly upset at this situation and is tearful about it. She tells you that you are her son's "only help." The most appropriate response to the mother's request is:
A. "Just bring your son in and we can then get a urine test for alcohol and substance use."
B. "I am sorry but I can't legally test your son for any drugs without him consenting to it first."
C. "It is possible that your son may be suffering from depression and I think that you should bring him in for me to talk to him."
D. "These are classic symptoms for schizophrenia. The best thing to do would be to start him on some anti-psychotic medications."
E. "Your son is most probably abusing drugs and alcohol, so you should send him to a rehabilitation facility immediately."
Please put answer in one place so every one can see.
thanks