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1.you are a resident at the ER. An irate parent comes to you furious because the social worker has been asking him about striking his child. The child is a 5 yr old who has been in the ER 4 itmes this year with several episodes of trauma that did not seem related. Today,the child is brought with a complaint of â€œslipping into a hot bathtubâ€ with a burn wound on his legs., the parent threatens to sue you & saysâ€ how dare you think that about me , I love my son !â€.
What should you do?
a.give assurance to the parents & treat the patient;s injury appropriately
b.ask risk management to evaluate the case
c.admit the child to remove him from possibly dangerous environment
dcall the police
e.ask the father yourself if there has been any abuse
f.speak to the wife privately about possible episodes of abuse
g.explain to the parents that next time this happens you will have to call child protective services
h.report the family to child protective services
2.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 patientâ€™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.
3.You are seeing a pt who has TB.he is undocumented (illegal ) immigrant .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
4.A couple comes to see you after having tried INvitro fertilization & artificial insemination. Thery are very happy because now they have a child. They have a significant amount of left over sperm ,eggs, and some fertilized embryos & are thinking about selling them.
What should u tell them?
a.it is legal to sell only eggs
b.it is legal to sell only sperm
c.it is legal to sell both the sperm and eggs not the embryos
d,it is illegal to sell any of them
e.it is legal to sell all of them
5.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.
6.A 35 yr old female comes to your office with a large form to be filled certifying that she is in good health. This is part of her pre employment evaluation. The form also asks for the results of the patient;s adenomatous polyposis coli gene. This is in order for the company to deternmisne which of its long term employees will need care.
What should be your response?
a.perform the test
bperform the test but do not share the results with the employer.
c., do not perform the test
d.ask the pt if she wants the test done and the results reported.
e. perform the colonoscopy ,the employer is entitiled to know about current health problems not future ones,
f.include the test only if pt has family members with the disease.
7. you have a pt who is a HIV + physician. He has recently found out his status & you are the only one who know about it. Who are u legally obligated to inform??
a.his insurance company
d.his patients only if he performs surgery where transmission is possible
e.no one without his written consent
g.the hospital HR dept.
8.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 â€œ I have been in practice for 40 yrs , donâ€™t u think I know what am doing ?????.beta blockers are dangerous in CCFâ€â€. The pt looks proudly at the attending & says â€œ I have the smartest doctor in the worldâ€.
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.
9.A 47 yr old man with end stage renal failure has asked u to stop his dialysis. The pt fully understands he will die if dialysis is stopped for more than a few days or weeks . he is not depressed and not encephalopathic
What should u tell him?
a.I need a court order first
b.iam sorry ,I donâ€™t feel comfortable doing that.
c.I cant do that. Physician assisted suicide is not ethical.
d.I will stop when u get a kidney transplant
e.Although I disagree with your decision I will stop dialysis.
10. 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.
1 - c
2 - e
3 - a
4 - c
5 - c (DNR does not mean "do not treat"!)
6 - d
7 - e
8 - e
9 - e
10 - a (but not sure about it...)
7 tell his pt if he performs surgery...
Kindly post the correct answers. Thanks.
I think the question source is kaplan ethics book by cornard fischer. i have seen these questions before for my step 1. kindly post the right answers and the quest source!
completely agree with arlete
"HIPAA in which doctors are mandated to report gunshot wounds and are also required as medical professionals to report suspected child and elder abuse, and rape.
"But hospitals are cautioned that those reports must be made to public health officials and not necessarily made to police"
Emergency and non-emergency health care.
Health care providers and hospitals are not required to ask about a noncitizen's immigration status.
duty to warn of genetic disease to family members
Although such a privilege may have ethical precedent, no legal case, state or federal statute, nor common law dogma is cited that has permitted a legal privilege for genetic issues. Thus, until appropriate legislative or judiciary action occurs, practitioners should be cautious about disclosure to third parties (at least in jurisdictions where the Pate and Safer decisions are inapplicable). (1999 : .http://pediatrics.aappublications.org/cgi/content...
more bullcrap (2002:
In a Florida case, a medical malpractice action was taken by a patient's adult child on the basis of the physician's failure to warn the patient that her medullary thyroid carcinoma was genetically transferable. In this case, the court found that the duty to warn in any particular case depends upon the standard of care and that the duty to warn the adult patient is enough.
In a New Jersey case, a patient's adult child was diagnosed with colon cancer. The child sued the doctor who treated her father for the same disease 40 years before on the basis of failure to warn the family members of the potential risk. In this case, the court found that warning the adult patient was not enough.
...how about we also get a law degree just in case ...
Edited by peter90036 on Mar 21, 2008 - 4:40 PM
Thanks for the wonderful q's and explanations
here is some more info about DNR
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Kaplan Medical USMLE Medical Ethics
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