Ethics

Ab 1 Sexually abused child. Which is the most suggestive sign:


-Vulvar bruise

-Laceration on the labia

-Ruptured hymen

-Labial agglutination

(?)Ruptured hymen

Ab 2 Sexually abused child. Which is the least diagnostic sign:

-Vulvar hematoma

-Vaginal laceration

-Gonoccoal infection

-Condyloma accuminata

-Culture positive for Chlamydia

(?)Vulvar hematoma

Ab 3 Sexually abused female Child. What is the best diagnostic sign:

Bruises on body

Stains on clothes

Torn clothes

Ruptured hymen

(?)Ruptured hymen

Ab 4 Sexual abuse is associated with all of the following EXCEPT:

-Development of secondary sexual characteristics

-Most of assailants are known to the victim

-More common in F. Than in M.

-Specific or generalized fears, depression & night mares

Development of secondary sexual

characteristics

Ab 5 Child sexual abuse. All are true except

a) Advanced sexual knowledge

b) Well developed secondary sexual character

Well developed secondary sexual

character

Ab 6 Sexual abuse associated with all following except

a) 3 generations living under one roof

b) Mother giving responsibilities to her children

(?)

Ab 7 Sexual abuse all true except

The abuser has an identifiable mental illness

The perpetrator is known to the child

Child take early responsibility

The perpetrator insist the child not to tell about abuse

(?)The abuser has an identifiable

mental illness

Ab 8 Child presented with S&S of STD, what is your next step

Treat the patient

Inform CAS (Children’s Aid Society)

Inform CAS

Ab 9 Battered Child.

a) The batterers usually were victims during childhood

The batterers usually were victims

during childhood

Ab 10 Child with bilateral burns on his lower limb, his mother said that they

were due to crawling near the heater. What is the diagnosis?

-Shaken baby syndrome

-Child abuse

(?) Perhaps child abuse but not enough

details

Abo 11 Old patient abused by his wife complained to u, you will do all the

following EXCEPT:

-Send the patient to day care

-Frequent visit to house

-Reassurance

(?)Send the patient to day care

Abo 12 Old lady with dementia and bruises on arms. She complained that her

grand-daughter has beaten her, what the grand-daughter will most

likely say when confronted:

She will become upset and point out that the old lady is demented

Bruises are due to attempts at dressing her

Bruises are because of fall down.

(?)

Abo 13 Elderly abused by his brother in-law. He requested that nobody is told.

What action:

Inform police

Inform health officer

Inform health officer

Arrange frequent visits

Abs 14 Spousal abuse which true

Commonly diagnosed by doctors

< 5% of cases present to medical care

< 5% of cases present to medical care

Abs 15 Women abused by her husband, do all except

Discuss with her the reasons for the problem

Give her info on women shelters etc

Tell her that it is not her fault

Discuss with her the reasons for the

problem

Abs 16 The definition of sexual assault

-The victim does not give consent

The victim does not give consent

Abx 17 Child custody, most concern is about:

Financial situation of each parent

Respect for child wishes

The reliability of the mother as a care taker

History of child abuse

Respect for child wishes

Abx 18 Adopted children

Tend to search for their biological parents when they are older

Tend to search for their biological

parents when they are older

Bd 19 Which is true regarding the diagnosis of brain death for organ

transplantation?

-Absence of all spinal reflex

-EEG completely flat for 48 h.

-Could be diagnosed clinically

Could be diagnosed clinically (see

below)

Co 20 Confidentiality can be breached except

If there is risk for the patient

If there is risk for others

If there is benefit for the patient

For hospital record keeping

If there is benefit for the patient

Co 21 Confidentiality can be breached except

Presence of court order

Child abuse

Patient dangerous to others

Presence of communicable disease

High probability of benefit for patient

High probability of benefit for patient

Co 22 Which of the following you should not notify the police about?

-Child abuse

-Spouse abuse

-Child neglect

-None of the above

-Spouse abuse

Co 23 You should report all to the law (?) except

Medical lab technician abused his daughter when drunk

If he has Chlamydia infection

If you believe that his drinking is affecting his work

If you think he drives while drunk

If you think he flies a plane while drunk

(?) If you think he drives while drunk

Co 24 When should your report your colleague

She has sexual relation with her patient

Drinks heavily at weekends

She takes medications without prescription

If she reports that she hears voices

She has sexual relation with her

patient

Co 25 A depressed man told you he plans to kill his ex-wife and her

boyfriend. What action:

Write to the wife

Inform police

Tell nobody, do not breach confidentiality.

Inform police

Co 26 A man suspected of having gonorrhea. His wife works in the lab.

He doesn’t want her to know his specimen. What to do.

a) Ask him to tell his wife

Report the case to public health

authorities

b) Put a code no. on the sample, not his name.

c) Don’t listen to him

d) Send him to the public sexually transmitted disease clinic

Co 27 Husband wants to end what his wife thinks is a happy marriage. She is

crying. What action?

a) Spend one and a half hours with each of them doing psychotherapy

b) Talk with both parties and try to find out what caused the crisis

c) Send to a lawyer

d) Send to a marriage counselor

e) Send to a psychiatrist

Send to a marriage counselor

Co 28 You diagnose a patient with active TB. Her refuses treatment and

threatens to sue you if you notify his case to public health. What

action:

Call your lawyer

Notify public health

Do nothing

Notify public health

Co 29 Elderly with dementia diagnosed with lung cancer. His wife requests

that he is not to be told. What action

Do not tell him because he will become difficult to handle

Do not tell him because he is incompetent and can’t understand the

nature of the disease

Do not tell him because he is

incompetent and can’t understand the

nature of the disease

nt 30 An old diabetic lady presented with gangrenous foot and sepsis. She

refused amputation. She came back few days later but is now deemed

not competent. Her family requested amputation. What action:

Treat by other means

Amputate

Treat by other means, do not

amputate. This is one exception of the

“emergency rule”

nt 31 Old demented lady being fed by NGT. Her son wants the tube

removed. His sister disagrees. What action?

Remove tube.

Call lawyer

Consult the hospital’s ethics committee

Consult the hospital’s ethics

committee

nt 32 A patient with DM and HTN. He told you in private that if he got a

heart attack he does not to be resuscitated. Because this is your lucky

day, he becomes arrested when you start examining him, what action:

Resuscitate

Contact family and ask for consent.

Make sure he is comfortable (?) but do not resuscitate

Make sure he is comfortable (?) but do

not resuscitate

nt 33 Before carrying out a medical procedure, what action?

Tell all possible side effects

Tell only the common side effects

Tell all common or serious risks.

nt 34 Before elective surgery, you will do all except:

Alternative choices for treatment

Risks of surgery

Details of surgical procedure

Details of surgical procedure

nt 35 A woman is worried that her 14 yrs old daughter is seeking oral

contraceptives. What action:

Reassure the women and schedule a second visit

Explain that most 14 yrs old girls are sexually active

Give her a OC supply for her daughter.

Contact the daughter and offer her the pill.

? This is about “Mature minor rule”.

Basically 14 yrs old does not need

parental consent to receive

treatment/interventions including OCP

and abortion

nt 36 15 years old girl is seeking oral contraceptives. What action:

She must bring consent from parents

Give her OC supply and schedule follow-up

Advice that her partner uses condoms for contraception

Give her OC supply and schedule

follow-up. “Mature minor rule”

nt 37 A young female known case of anorexia nervosa. She refuses hospital

admission. You can do all except:

Admit her to hospital

Admit her to hospital

Start follow-up and treatment

Give her appetite stimulants.

nt 38 Which of the following should be decided by both husband and wife:

Elective surgery for their child

Sterilization

Organ donation

Sterilization

nt 39 A mother refuses treatment for her child who was diagnosed with

asthma (first visit). What action:

Give usual treatment

Avoid all allergen

Do patch skin test

Avoid all allergen

Nt 40 A lady for laparoscopic tubal ligation on the way to theater she asks

you for removal of a mole on her forearm while she is under GA. She

is already on premedication. What you will tell her?

a) You cannot do the procedure, as consent should be taken before

coming to theatre and before giving premedications.

b) Agree to do the procedure

You cannot do the procedure, as

consent should be taken before coming

to theatre and before giving

premedications.

Nt 41 Active Jehovah witness man carrying a “No blood transfusion” card is

brought to the ER after MVA. He requires blood transfusion. What to

do?

a) Don’t give blood transfusion

Don’t give blood transfusion

Nt 42 A child presented with 2 degree burns of lower limbs and pain in the

neck area and back. The parents insist on treating the burn only. What

action:

Treat and schedule follow-up

Question the kid privately about abuse

Admit without parental consent

Arrange a pediatric consultation for child abuse

Treat and schedule follow-up

Nt 43 A 15 yrs child refuses surgery for sebaceous cyst. The mother insists

on the operation and gave consent, you will:

Do the operation

Refuse to do the operation because the child did not consent

Contact CSA

Do the operation

Ntr 44 In the ER, a trial for a new treatment for chest pain is planned. Which

is true:

Such studies should not be done on emergent cases as they need

immediate management

Such studies should not be done because patients do not have full

capacity to give consent

In principal such trials should be

approved by IRB.

Ntr 45 New drug for hypertension results in improvement in those with mutliinfacrt

dementia but not in those with Alzheimer’s. What should you

do before prescribing this drug to your patients:

Talk to patients and get verbal consent.

Get approval from ethics committee

Get approval from ethics committee

Xb 46 A surgeon smelled of alcohol and appeared drunk when he showed for

operation, what is your action:

Tell him he should not operate

Call the police

Enlist another colleague’s help to convince him not to operate

Enlist help from nurses

?

Xb 47 A surgeon sexually harasses nurses. He has history of similar problems

in other hospitals. What action

Fire him

Inform chief surgeon

Inform the provincial college of physicians and surgeons.

Inform the provincial college of

physicians and surgeons

Xb 48 Electronic mailing

Federal law banned prescription of narcotics by email

See http://www.amaassn.

org/ama/pub/category/2386.html

All messages received and sent should be kept in patient record

All e-mails and prescriptions are illegal

CMA does not cover liability of information dispersed on the Internet

Xb 49 Electronic mailing

Use of encryption is mandatory

CMA does not hold someone liable for medical advice given online

Prescriptions for narcotics can’t be given online

Patient consent should be sought before using email.

Xb 50 During your rounds, you noticed that a patient is dead with blood froth

on his face. Action

Collect blood for investigations

Collect vomit for investigations

Notify the coroner

Notify the coroner-- a public official

who holds an inquiry into violent or

suspicious deaths

Xb 51 Common reasons for suspending a doctor:

Sexual abuse

Drug abuse

? Drug abuse

Xb 52 A female known case of dependent personality visited your clinic.

Afterward you saw her outside looking for a means of transport. What

could make you liable for professional misconduct

If you offer her a ride home

If you show her the bus stop

If you stop a taxi for her

If you become angry because she is waiting outside your clinic

(?)If you offer her a ride home

xGe

r

53 elderly people

a) Prefer to live alone and like their children to visit them

b) Live alone because of geographical distribution children have to

live away

c) Like to live alone and don’t like visitors

Xx 54 All are true regarding the role of physician in trauma patient EXCEPT:

-Assess the patient Condition clinically

-Can determine the duration of treatment

-Estimate the compensation of the patient

Estimate the compensation of the

patient

Xx 55 An elderly man scheduled for OT notices that the surgeon is young

and questions his experience, what action:

Operate.

Ask nurses for help to persuade patient

Inform about your experience and let the patient decide.

Inform about your experience and let

the patient decide

A 25-year-old Jehovah's Witness man is scheduled for emergency surgery

following a motor vehicle accident in which he sustained pelvic fractures.

The patient is competent and lucid before the surgery and refuses the

administration of blood products. Which course of action is most appropriate

in the event of significant intra-operative blood loss?

1) administration of packed red cells in the recovery

2) use of a cell saver

3) administration of hydroxyethyl starch

4) administration of packed cells after obtaining consent

5) intra-operative autologous blood donation

Criteria For Diagnosis of Brain Death

In 1981, the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral

Research (USA) developed standards for the determination of brain death which with some modifications are

accepted worldwide.

Some steps are important to be followed:

? Unresponsiveness

o The patient is completely unresponsive to external visual, auditory, and tactile stimuli and is incapable of

communication in any manner.

? Absence of cerebral and brain stem function

o Pupillary responses are absent, and eye movements cannot be elicited by the vestibulo-ocular reflex or by irrigating the

ears with cold water.

o The corneal and gag reflex are absent, and there is no facial or tongue movement.

o The limbs are flaccid, and there is no movement, although primitive withdrawal movements in response to local painful

stimuli, mediated at a spinal cord level, can occur.

o Apnea Test: An apnea test should be performed to ascertain that no respirations occur at a PCO2 level of at least 60

mmHg. The patient oxygenation should be maintained with giving 100% oxygen by a cannula inserted into endotracheal

tube as the PCO2 rises. The inability to develop respiration is consistent with medullary failure.

? Nature of coma must be know

o Known structural disease or irreversible systemic metabolic cause that can explain the clinical picture.

? Some causes must be ruled out

o Body temperature must be above 32 C to rule out hypothermia

o No chance of drug intoxication or neuromuscular blockade

o Patient is not in shock

? Persistence of brain dysfunction

o Six hours with a confirmatory isoelectric EEG or electrocerebral silence, performed according to the technical standards

of the American Electroencephalographic Society

o Twelve hours without a confirmatory EEG

o Twenty-four hours for anoxic brain injury without a confirmatory isoeletric EEG

? Confirmatory tests (are not necessary to diagnose brain death)

o EEG with no physiologic brain activity

o No cerebral circulation present on angiographic examination( is the principal legal sign in many European countries)

o Brain stem-evoked responses with absent function in vital brain stem structures

1. A truck driver comes to you for a regular physical examination. He tells you that he is regularly taking

Amphetamines to keep himself alert and high. What you will do at this moment?

A. Send the patient to the drug control centre.

B. Inform the transportation authority

C. Inform the police

D. Inform his employer

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

3. A couple is coming from British Columbia. They get involved in a MVA. They are brought to the hospital.

The husband died right away and the wife is in need of blood. The nurse finds out a Jehovah’s Witness card

in her pocket. The card is not signed. What will you do?

A.You will give blood because it’s an emergency

B. You will give blood because the card is neither witnessed nor signed

C. Do not give blood

D. Treat with solutions other than blood

a female just delivered a baby and she and her husband refused the erythromycin drops to be put into the baby's eyes. what will be your

action ?

1) call the child aid society for advice

2) do as the parents want

3) put the eye drops even if the parents refuse

f the parents refuse- u have to document that u explained to them the benefits and the risks of taking the drops and the risks of not taking

the drops and also document their reason for refusal- this is not a life saving procedure and only a prophylaxis...-

1. CAS only gets involved when there is danger to the child(eg if the child was having some eye disease and the parents were refusing

treatment.

2. if a child is incompetent the parents are the decision makers for the child u have to respect their wishes bu make sure that they

understand everything and u can document eveyrthing

so the answer here would be do as they want- or if there is another option which says to explin them everything or document ur

conversation that would be a better answer