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 ethics 41 to 50  



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41.An elderly pt with multiple medical problems has been admitted to your care in the ICU. The pt is in a persistent vegetative state secondary to anoxic encephalopathy & has now developed sepsis ,hypotension, GI bleeding & respiratory failure, requiring intubation. There is no improvement expected in the underlying severe brain damage . renal failure develops to the point of needing dialysis but u feel the dialysis would be completely futile.

Which of the foll is the most appropriate step in management ?

a.hemodialysis

b.Peritoneal dialysis

c.Renal transplantation

d.Give albumin

e.Recommend that dialysis not be performed.

42.You have a 65 yr old Mr.Johnson with progressive glaucoma in your office. His vision is severly impaired & getting worse . u strongly doubt that he can read traffic signs on the highway. U have repeatedly encouraged him to curtail his driving but he has not.

What is your responsibility towards this pt.?

a.keep the information confidential

b.Seek the pts family & inform them

c.Inform the pt of your duty to report to the DMV

d.Take away his driver;s license

e.Suspend his DL

43.A 7-year-old girl is brought to the emergency department by her mother because of "fever and a rash." When asked to give a more detailed history, the mother has difficulty providing any additional information. The mother appears tearful and the child cannot take her eyes off the floor. U are unable to engage the child in any conversation. Her temperature is 36.7 C (98.0 F). Physical examination is unremarkable.

The most appropriate next step is to

A. admit the child to the hospital for evaluation and protection

B. ask if there is anyone else in the house that is sick

C. ask the mother and child separately what is concerning them

D. obtain a psychiatry consult immediately

E. send the child home and arrange for a family assessment on a home visit Explanation:

44,A 30-year-old woman comes to your office "for a prescription of propranolol for stage fright." She tells U that she is a professional singer and lately she has been experiencing "butterflies" and palpitations before performances. She has been so worried about having one of these symptoms that she is having trouble sleeping at night.

She tells U that a friend of hers has a similar problem and propranolol has "cured her." She has been a patient of yours for the past 10 years and you remember that she has severe asthma, requiring many hospitalizations, the most recent being 2 weeks ago. Her asthma attacks have been increasingly more severe and have been occurring at an increased frequency. She tells U that she is in a rush and all she needs is the prescription.

The most appropriate next step is to

A. administer a pulmonary function test

B. explain that propranolol is not a good drug for her

C. give her a referral to a psychiatrist

D. order a chest x-ray

F.prescribe propranolol for her to take before her performances

45.A 23-year-old woman is admitted to the hospital for altered mental status. On evaluation in the emergency department, the patient was found to have severe hypernatremia, a serum sodium of 161 mEq/L. There is no other past medical history or allergy history available.

The patient appeared pale and profoundly dehydrated. She had evidence of prior scars, possibly surgical, on her abdomen, chest, and arms. The patient was admitted and over the next few days the patient's hypernatremia was corrected and her metabolic parameters normalized. She was able to give a more detailed history about her social situation.

She describes feeling very depressed lately and having had an argument with her new boyfriend several days prior to her admission. U suspect that she may be a victim of domestic abuse.

The most appropriate initial step in addressing your concern is to

A.ask her for the number of her boyfriend to address your concerns with him directly

B. ask her to offer more details about the nature of her relationship with her new boyfriend

C. explain to her that her relationship is obviously not having a positive impact on her life

D. refer her case to the department of social services in obligation of your reporting duty as a physician

E. refer her to a psychiatrist who specializes in domestic abuse

46.A 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"

47.A 16-year-old girl comes to the office after her boyfriend of 2 years abruptly ended their relationship. She has been a patient of yours for the past 7 years and seems to feel very comfortable talking about relationships and sexual issues with you.

She says that she just decided to have sexual intercourse with him a month ago and that this was a "huge deal" because it was her first "abandoned" her. She suddenly becomes silent and begins to cry. She takes a tissue out her pocketbook and remains silent.

At this point you should

A. advise her to "pull herself together"

B. maintain eye contact, and after a few minutes say, "I understand that this is hard for you"

C. remain silent for however long she needs to compose herself

D. tell her not to cry and say, "he is not worth getting so upset over"

E. use this time to review the notes in her chart

F.recommend that she go talk to a psychiatrist

48. A 70-year-old man is admitted to the hospital for weight loss, anemia, and worsening of his stomach pain that he thinks is due to an ulcer. However, the results of tests that are performed confirm the diagnosis of an inoperable cancer. U are told that when one of your residents tried to break the news to him, he became mad, frustrated, and began to yell. He accused him of being ignorant and threatened to sue him.

U go to see the patient and he says, "U think I am crazy and don't see what you are doing? They called you so that I don't sue your young doctor for not knowing what he is doing. U just want to help your buddies here, but you really can't help me".

The most appropriate management is to

A. clarify that the other physician is not a "buddy" and offer to help him explore his decision about a lawsuit

B. empathize with his feelings of anger, grief, and fear indicating that anger is a defense against intolerable emotions

C. explain that suing physicians is not always successful, and instead suggest that the patient should take care of his affairs given his prognosis

D. offer to refer the patient to another team and physician in order to help him find someone he can trust

E. sympathize with how badly he is treated and support the lawsuit

49.U are notified that one of your patients, a 30-year-old woman, delivered a healthy baby girl 6 hours earlier. U happen to be in the hospital discharging another patient, so U go to the labor and delivery floor to see her. She has had depressive disorder over the years. She developed postpartum "blues" after her last child was born that resolved spontaneously after 5 days.

U hear a woman screaming as U get off the elevator and head towards her room. As U get closer, U recognize the voice and realize that it is your patient. She is running around her room, tearing off the hospital gown, and yelling that, "they are coming to get her." When she sees that U are standing in the room, she begins to throw flower vases, the telephone, and the bedding at U.

The nurses appear and tell you that she has been very disorganized and has had bizarre, grandiose delusions. She then goes back to the nurse's station. U notice the newborn in the corner of the room.

The most appropriate next step is to

A. ask the nurse to get haloperidol from the medication closet

B. call for an immediate psychiatry consultation

C. encourage her to breastfeed and bond with her newborn

D. remove the newborn from the room

E. try to talk to her and calm her down

50.A 35-year-old obese man comes your office because he has been "feeling really bad lately." He says that for the past three months he has been having trouble sleeping and has not been "in the mood" to go out.

He has even stopped going to basketball games with friends, which was his favorite hobby. He has missed many days of work and finds it very difficult to concentrate. He states that he feels "pretty helpless." All of his friends from college are married with kids, and he says that he "can't even get a date," so he basically gave up on having a family. He just feels "worthless".

The most vital question to ask at this time is

A. "Are you currently questioning your sexual orientation?"

B. "Do you ever feel like 'life really is not worth it and that you should end it all'?"

C. "Do you think that your life would be much better if you were dating?"

D. "Have any of your friends ever tried to set you up on a blind date?"

E. "Why haven't you tried to lose weight?"

51,A 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."





  #2

41 e

42 c

43 c

44 b

45 b

46c

47b

48b

49d

50b

51 c



  #3

think the same except first q: 41a


  #4

I have the same answers as drbin, except for 50 which I thought was C. However, after reviewing it again, I agree that it should be B. This is a patient with depression and it is always imperative to ask about suicidal thoughts.

What do you guys think??


  #5

agree with all the answers of drbin.nod



  #6

good job drbinnod



  #7

49 E



  #8

all same except 41,which is a



  #9

drtanvir , can u please put the answers smiling face






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