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1. You work in an insurance company, you have a patient 65 years old. He has depression with H/O hospitalization twice after the death of his son. On routine X-Ray chest you diagnose inoperable lung cancer. His wife tells you he is about to retire in 2 months, and they are planning a trip to USA. What are you going to do?
A. Withhold the diagnosis because of his psychiatric condition
B. Tell only the wife to provide support and care
C. Withhold the diagnosis because it is fatal and has no cure.
2. A man came to ER after MVA in shock requires blood transfusions. You find in his wallet a card indicating that he is a member of Jehovah's witnesses (refuse blood transfusion under any circumstances). The card was unexpired, his wife insists on giving him blood transfusion to save his life.
A. Do not give blood and let him die
B. Follow the directions of his wife
C. Ask the hospital legal committee
D. Call the group to find out if he is really a member
4. A 9 year old was bitten by a flying bat in an area known to be rabid, during the interview with the parents. You are Orthodox Jehovah's. They accepted to give their son the vaccine but not the Immunoglobulins, as it is prepared from human sources. You talked to the child that accepted to follow his parent's decision. Your action will be:
A. You will give the vaccine as it's effectiveness is 100%
B. You will inform the child aid society of the parent's refusal to give the complete course of treatment.
C. You will give the vaccine because there is a great probability that these bats are not rabid
D. You will give both the vaccine and IG to the child.
5. A 35- year old male, one of your patients's for four years, has contacted you and asked you to sign a form for him that he was sick last week. He has to present the form to his employer and mention that during this time he had flu and it was not severe enough to make him come to you and he did not want to abuse the health system. You believe your patient. what will be your action?
A. Tell him that this is illegal and you can not sign the form
B. Sign the form but indicate that you did not see the patient and explain why?
C. Sign the form because you know your patient very well
D. Call his employer and explain what was the situation
6. A patient with Alzheimer disease for the past many years is brought to you. You diagnose him to be case of cancer prostate. His wife is her primary caregiver. She does not want him to know. You will not tell him because:
A. These old people mostly don't want to know about such illnesses
B. His wife is his caregiver and he will be depressed if he comes to know and it will be very hard for her to manage him
C. It will not make any difference in the treatment because it is a serious condition and has no cure and his wife should keep on caring for him
D. He has dementia; he won't understand the situation anyway.
Edited by achilles on Apr 20, 2006 - 12:03 PM
1-B, cant explain.
2-A, pt has a card that expresses his wishes
4-D, parents cannot withhold Rx for rabies which is always fatal without Rx.
5-D, cant explain.
2 D card is unexpired
4 D Life threatening
5 A can`t explain
6 C can`t explain
1-A HE HAS HISTORY OF DEPRESSION WHICH CAN WORSEN
2-A YOU CAN,T TRANSFUSE AGAINST HIS WILL .
3-D CHILDS LIFE IS AT STAKE
4 -C DON,T COMPLICATE IT FOR YOURSELF IF YOU R SIGNING THE FORM NOONE HAS ASKED YOU ABOUT HIS VISIT
5-B ONLY MY WILD GUESS
1-puzzled. I would choose the option whenre he should know. Are you sure these were the only options provided?
5-a-You didn't see him being sick, why would You sign a paper confirming his sickness?
agree with Rasul except
Alzheimer disease Pt has dementia esecially for recent memory . he will not remember even if you told him.
I also doubt that something is missing in 1
Dear Srf, You have a point about Alzheimer patients. They really have poor memory.
Though from my experience of handling this kind of patients-if confronted with some stressful news or event, they seem not to show any immediate reaction that whould indicate they understood what went on. But later it somehow twists in their bizaare brains, and they become agitated, aggressive, angry, more psychotic than before-they become harder to handle.
Eversince I started working with Alzheimer patients, if they score more than zero on mini-mental status exam, I try to treat them as alert person as much as possible(except the decision-making, of course).
agree with you rasul on the 5th question. the answer should be A. thanks.
and thanks for sharing your experience on alzheimer's pts with us rasul.
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