Prep for USMLEPrep for USMLE
         Forum      |     Resources New Posts   |   Register   |   Login





 ethics 11 to 20  
Get Adobe Flash player



Post Reply  
  • 0/5
  • 1
  • 2
  • 3
  • 4
  • 5


Author24 Posts
  #1

11.You are a 4 yr medical student with a pt who has been in a severe motor vehicle accident. the pt has a subdural hematoma that led to cerebral herniation before it coudl be drained. over the last few days ,the pt has lost all brain stem reflexes nas is now brain dead. i have the closest relationship with the family than anyone on the team. the ventilator is to be removed soon and organ donation is considered.

who should ask for consent for organ donation???

a.you, because you haev the best relationship with the family

b the resident since u are only a student

c.attending on record

d.hospital administration

e.organ donor network.

12.A man arrives at the ER on a ventilator after an accident. He is brain dead by all criteria. He has an organ donor card in his wallet indicating his desire to donate. The organ donor team contacts the family. The family refuses to sign consent for donation.
What should be done??

a.remove organs anyway

b.wait for the pts heart to stop to remove organs.

c.Stop the ventilator & remove organs

d.Seek a court order to overrule the family

e.Honor the wishes of the family , no donation

13/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.

14.you have been invited toe participate in a “medical 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 foll 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

15.A 16 yr old female comes to your clinic .her pregnancy test is +. She wants to start prenatal care with you . she is adamant that you keep the pregnancy confidential from her parents.what should u tell her?

a.i will give u the care & keep the info confidential

b. I will not mention it to your parents unless they ask , I cant lie

c.iam sorry bu t I must tell them

d.i will not tell your parents but I must inform the father of the baby.

16. 17 year old boy with cystic fibrosis with near complete collapse of pulmonary functioning which the doctors think will never be better . he is on ventillator . a few days later when the doctor visits him the boy says that wants mechanical ventillation to be terminated . i thought about it a lot and that is my wish . when the boys wishes are related to the parents they r upset and ambivalent as how to proceed . the most likely outcome of this case is , the mecahanical ventillation will be

a maintained indefinitely

b maintained until such time that the parents give a clear decision

c maintained until the boy reaches the majority age

d terminated as the boy requests

e terminated or maintained at the attending physicians discretion.

17.A 37 yr old man comes to your office for his regular visit. He has seemed severyly depressed fro some time but refuses to discuss either his feelings or treatment options. He does not want antidepressants .

his only medication is Vitamins, your relationship with him is excellent but he just wont confide his feelings although he firmly denies suicidal ideation.

You prescribe a SSRI for him & tell him that it is a vitamin.Over a period of several months, his mood markedly improves & he feels much better

Which of the foll most appropriately characterizes your action????

a.Is appropriate because it benefited the patient.

b.Is appropriate because there were no side effects

c.Is not appropriate because you are not a psychiatrist

d.Is not appropriate because u treated the pt without his consent


e.Is acceptable as long as u inform the pt now that he is feeling better.

18.A 52 yr olds man with cerebral palsy is being evaluated for screening colonoscopy. He has a mental age of an 8 yr old & a second grade reading level in terms of comprehension.

He lives alone & survives on combination of Public assistance & part time jobs sweeping floors. U have thoroughly explained the procedure to him in terms of risks & benefits. He repeatedly refuses the procedure entirely on the basis of “ I just don’t want it “

What should u do?

a.perfoem the procedure

b.seek consent from the family

c.honor his decision & do not perform the colonoscopy

d.seek a court order mandating the procedure

19.45 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

20.An unconscious man is brought to the ER from a car crash. He is hemorrhaging profusely ,hypotensive & stuporous.

U have never met the pt before & the hospital has no records of him . He is wearing a Tshirt “ kiss me I am a Jehovah;s witness( the people who refuse blood & blood products )”.

What should u do ?

a.give the blood

b.wait for him to awaken to sign the consent

c.wait for family

d.seek a court order

e.only use IV fluids.



  #2

A
C
C
B
A
C
D
C
B
E


  #3

1A
2A
3B
4E
5A
6B
7D
8C
9B
10A



  #4

11 - A - you should initiate the conversation because you have the best relationship to the family
12 - E - honor family wishes
13 - ??? C
14 - E - none
15 - A
16 - B
17 - D
18 - C
19 - ??
20 - A


  #5

Hi Tanvir, Please post the correct answers ...



  #6

11) you should nt start the conversation because family knows you that might jeoparadize their decision
12) e 13) A 14) e 15) a 16) b 17) d 18) b 19)b 20)a


  #7

Here are my responses:
1-a
2-a
3-c
4-e
5-a
6-c
7-d
8-c
9-b
10-a

Waiting for the right answers ....


  #8

right anwers11 E,12 E,13 C 14 A 15 A ,17 D 18 C 19 B 20 A

I am not sure of the 17 anwers but the rest of the anwers I have confirmed that


  #9

16 b 17 d ?


  #10

ladyluck if these are correct answers I have 6 correct and 4 incorrect which is 60%...just ok.... taking into consideration fact that I haven't studied ethics at all...
Not that bad.

second questions-Why no donation if his wish was to donate organs and he has donor card? Why do we need to follow wishes of his family?

Thanks!


  #11

Its not we first of all, it the organ donor team/ network who does that.
Its whats done in US, because nobody want a news in the front page, like " organ donor team snatched the organ of a person against family's wish". Its negative publicity against organ donation. And its one of the reason why now you see advertisement in TV like those who have a organ donor card, please inform their family members of his wish so that its accomplished in case of an accident. Lawfully they can take the organ, but they don't do it.



  #12

11 E

12 E

13 C

14 A

15 A

16 B

17 D (no need to confirm the answer , never lie that's it )

18 C

19 B

20 A (implied consent - no solid proof like a card or so) tattoo's and shirt logos are not used as IDs






  #13

hi
very goosd questions ,but can some one post the CORRECT answers,plz.
thanks...


"EVERY WORD THAT U STUDY CAN HELP HUMANITY...'''


  #14

explanation for 14:

ans: a all the gifts

gifts under 100$ value are acceptable. At the same time, personal items like scarf, paper
weight, etc, if pt gives to physician are also acceptable. gifts from patients are accepted
so as to maintain the doc/pt relationship.
Gifts over 100 $ are unacceptable & also if they are given in requirement of something in
return.





explanation for 15:

Ans: a.i will give u the care & keep the info confidential

Prenatal care is the general exception to the parental notification rule and consent for
treatment of minors. You do not have to inform the parents or the father of the baby. This
confidentiality also extends to protecting the pt if the parents were to ask.
The question arised when we were discussing this Q as to whether or not this patient is
emancipated, The Q stem gives no indication of that.
We do not assume she is emancipated or not. If the USMLE want u to make your
decision based on the “emancipated minor”,the Q stem will clearly state that the patient is
living on their own, paying bills ,etc…….
Emancipated or not, we are not obligated for parental notification in cases of
1.Pregnancy
2.Contraception
3.Substance abuse
4.STDs
In an emergency dealing with minors there is no need for parental consent.
that came up, but this Q is not about consent ,it is about notification, they are 2 separate
entities.
If there is an option of “ encourage discussion with parents” that is the BEST choice.
Although there is no obligation to notify parents, the USMLE wants to “encourage the pt
to discuss with the parents”
The Q of notification of abortion or rather consent of parent to abortion came up

To make the abortion issue clear:
The rules on parental consent in cases of abortion vary from state to state. Since the
USMLE is a national exam, there cannot be a single answer that either says “no parental
consent” or “yes parental consent”. Therefore the answer will be to “encourage the
patient to discuss the issue with parents”



  #15

This is how I answered the questions

11 a (since you have the best relation with the family, I think why not ask them for consent. the point is, that even if you are a medical student, you should establish rapport, and use that rapport

12 c If brain death is met by all criteria, it is the duty and decision of doctors to stop the ventilator. and since he is brain dead, the ventilator should be stopped. Now, he has a donor card, so why ask the family ?? i think the answer is C


13 ?b No clue whatsoever, maybe u can start the line, but not qualified to push the medication ... no clue again !!!!!

14 a its a medical jeopardy, so i dont think its wrong to accept all gifts. u are getting the gifts because your knowledge exceeds the knowledge of other participants ... so whats ethically wrong ?

15 c Pregnancy never redeems the girl of still being a minor, unless she was emanicipated by other criteria. I think the parents should be notified.

16 b he is still a minor, so the decision is the parents decision

17 d

18 c he is an adult, over the legal age. so you respect his wish

19 b

20 a ... A t-shirt is not indicative to his ID. he might be poor, and have got this tshirt as a donation for example !!!


  #16

After reading Avir's explanation for question 15, I think he is right.

But what about my other questions, what do you think guys?


  #17

those are Conrad Fisher expl, not mine


  #18

awesome, then can you provide us with the rest of the correct answers ?


  #19

u better google for his book, sure u will find it and download

don't take it personal man, but is better that way


  #20

Sure ... Nothing Personal my friend





Bookmark and Share





Login or Register to post messages








show Similar forum topics

OSCE Ethics Stations and Ethics
Ethics Q&A
ethics Qs
show Related resources

Kaplan Medical USMLE Medical Ethics
USMLE Step 3 Board Certification Review: Pediatrics and Medical Ethics








Advertise | Support | Privacy | TOS | Premium | Contact