Medical Ethics Final Exam
A 23 year old is in a serious motor vehicle accident and is pronounced brain dead. It is unclear whether he was registered As an organ donor and his driver's license is not available and you must make a time sensitive decision on whether or not he is a viable donor. His wife is unclear what he would have wanted, but she is herself an organ donor and gives consent for her husbands organs to be harvested for donation. Before anything can be done, the deceased patients parents arrive and inform the doctors that they have never heard him discuss the issue of organ donation before and express the preference that their sons organ NOT be donated. The wife has stepped out and is unavailable so you cannot get gets parties together to discuss. You make every effort to get both parties together but cannot. What is the most appropriate course? A. Accept the wife's consent and notify the organ donation network B. Accept the parents declination and do not notify the organ donation network C. Make contact with the patients siblings to help make a decision D. No answer text provided.
A. Accept the wife's consent and notify the organ donation network
Which type of surveillance is most appropriate for controlling the spread of Coronavirus (2019-nCoV) ? A. Active surveillance B. Passive surveillance C. Sentinel surveillance D. Rumour surveillance
A. Active surveillance
The most important ethical principle is: A. Autonomy B. Beneficence C. Nonmaleficence D. Justice
A. Autonomy
A 30-year-old pregnant woman presents to your clinic for prenatal care. She has a history of having had syphilis in the past and chlamydia earlier in this pregnancy. She has never had an HIV test done. She is 36 weeks gestation and is offered an HIV test as part of her prenatal care but she declines to have it done. Despite your best attempts at discussing the importance of early detection and the risk to her unborn child, she continues to refuse. What is your response? A. Do not perform the test as she has the right to refuse B. Perform the test as it is necessary to protect the health of the baby. C. Obtain consent from the father of the child. D. Obtain a court order to test the patient.
A. Do not perform the test as she has the right to refuse
A 35-year-old male presents to your clinic for the first time. He has a diagnosis of HIV, and despite not taking any medications, he has a high CD4 count and low viral load (very well controlled). He is married and confesses to you that he does not always use protection when having intercourse with his wife. She is unaware of his HIV status. Since his CD4 count is so good even without medication, he sometimes feels like he does not have the virus. What is the next step? A. Encourage discussion between the husband and wife and strongly suggest he inform his wife of his HIV status B. Inform his wife yourself of your patient's HIV status C. Have the Department of Health notify his wife D. If you can convince him to practice safe, protected sex, then there is no need for notification
A. Encourage discussion between the husband and wife and strongly suggest he inform his wife of his HIV status
A 45- year-old woman is brought to the hospital by her husband. The patient complains of right lower quadrant pain and an ultrasound is performed with results concerning for appendicitis. She is taken to the operating room where her appendix is removed, however, you notice a tumor is attached to her right ovary. What is the next best course of action? A. Leave the tumor in place and end the surgery B. Excise as much of the tumor as possible but leave the ovary in place. C. Exercising "standard of care", remove the patients ovary. D. Talk to the patient's husband who is waiting nearby and ask him how his wife would want them to proceed (using substituted judgement).
A. Leave the tumor in place and end the surgery
Your ethics professor enjoys a 3-week vacation in Dubai then visits her family in New England for 2 weeks before returning to California. Shortly after her return to California, she falls ill. After a series of tests she is diagnosed with Middle East Respiratory Syndrome (MERS), Babesiosis, and Lyme disease. All three diseases are reportable to the State of California. List these diseases in order of urgency of reportability beginning with the most urgent disease. A. Middle East Respiratory Syndrome (MERS), Babesiosis, and Lyme disease. B. Middle East Respiratory Syndrome (MERS), Lyme disease, and Babesiosis C. Babesiosis, Middle East Respiratory Syndrome (MERS), and Lyme disease. D. Babesiosis, Lyme disease., and Middle East Respiratory Syndrome (MERS)
A. Middle East Respiratory Syndrome (MERS), Babesiosis, and Lyme disease.
A 5 year old child arrives with their babysitter to the Emergency Department after falling off their bike and rupturing their spleen. The divorced parents of this child are not present for consent. Emergency surgery is needed as soon as possible to save the child's life. Which of the following is the best choice? A. No consent is needed as this is a life threatening injury B. You must have consent from both parents. C. You must have consent from at least one parent D. You may get consent from the babysitter
A. No consent is needed as this is a life threatening injury
A 5 year old child arrives with their babysitter to the Emergency Department with a broken arm. Non-surgical reduction and a cast is needed. The divorced parents of this child are not present for consent. Which of the following is the best choice. A. No parental consent is needed as the treatment is minor. Reduce the fracture and place the cast. B. Parental consent from both parents is needed. C. Parental consent is needed from at least one parent. D. You may get consent from the babysitter.
A. No parental consent is needed as the treatment is minor. Reduce the fracture and place the cast.
You are seeing a 60 year old male in your clinic following an inpatient admission. The patient has been hospitalized multiple times in the past few months with complicated UTIs and finally seems to be doing much better. At the outpatient clinic appointment, his wife hands you two tickets to a football game and states, "my husband and I want to thank you for everything you have done". She informs you that her husband works at the stadium and receives two free tickets to each home game and usually sells the tickets but wanted you to enjoy them. What is the most appropriate response? A. Thanks, but it is against my policy to accept expensive gifts B. Thanks, I cannot go but my Dad loves football and I'm sure he'll enjoy these C. Thanks, I'll have fun at the football game; but you should know that I give you the same level of care I give all of my patients D. Thanks, I do no normally accept gifts, but since they were free to you I can accept them
A. Thanks, but it is against my policy to accept expensive gifts
An unconscious 40 year old male is brought in with a gunshot wound to the abdomen. He requires a blood transfusion to save his life. He is wearing a t-shirt which reads "Don't Taze me Bro-I'm a Jehovah's Witness". Since the patient is unconscious and cannot consent, and the situtation is emergent, you order blood to be delivered STAT for your patient. Just as the blood products arrives, the patient's wife arrives and states it is against their religion to give blood transfusions and that he would decline if he were able to. Should you give the transfusion? A. Yes, you should give the blood products as ordered. B. No, the patient's wife does not consent to the treatment C. Yes, the patient's wife has no proof verifying her husbands religious beliefs and her word alone is not proof of her husbands beliefs. D. Consult an ethics committee.
A. Yes, you should give the blood products as ordered.
Kantian ethics requires the person to refrain from doing an immoral act, despite the consequences. In contrast, Utilitarianism requires the act: A. to produce the greatest good for the greatest number of people. B. to produce the greatest pleasure for the person committing the act C. to be independent of the consequences D. to be independent of the agent
A. to produce the greatest good for the greatest number of people.
Thomas Beauchamp and James Childress promote the principle approach for solving ethical dilemmas faced in the biomedical context. A. Autonomy, religion, law, and morals B. Autonomy, nonmaleficence, beneficence, justice C. Autonomy, maleficence, nonbeneficence, justice D. Autonomy, morals, ethics, and virtues
B. Autonomy, nonmaleficence, beneficence, justice
A minor may be emancipated by all of the following conditions except? A. Join the Armed Forces B. Have a child of your own C. Get Married D. Get a judge order
B. Have a child of your own
Identify the most influential event that led to the HHS Policy for Protection of Human Research Subjects. A. Nuremberg trials B. Syphilis Study at Tuskegee C. Willow brook Study
B. Syphilis Study at Tuskegee
A 70-year-old diabetic woman presents to the emergency room with an infection on her foot. X-rays and blood work confirm suspicion for osteomyelitis and the orthopedic surgeon is consulted. He recommends IV antibiotics and amputation of the foot. Informed of this, the patient refuses and says, "I know I'm going to eventually die and I do not want to be footless when I do." Despite the IV antibiotics, her respiratory status starts to decline and she is intubated for airway support. Her family arrives and asks that the surgeon amputate her foot in order to help stop the spread of infection and potentially save her life. What is the most appropriate course of action? A. Amputate her foot as she can no longer make decisions and her family is acting in her best interests. B. Treat her with antibiotics and supportive care, but do not amputate her foot. C. Consult the ethics committee. D. Find out if she has an advance directive or living will and if that does not forbid amputation, only then should you proceed with surgery.
B. Treat her with antibiotics and supportive care, but do not amputate her foot.
You are working in a busy urban emergency department when the paramedics bring in a patient who has just finished seizing. You read through the patients medical records and discover the patient has a history of pseudo-seizures and possible malingering. Just then, the nurse comes outside of the room to inform you the patient has started seizing again. You have the nurse give the patient a placebo and as she administers normal saline through the IV you shout to the patient "I'm giving you a powerful anti-seizure medication!". The patient stops seizing shortly after. After you leave the room the nurse stops you outside ans says, "You can't tell the patient that!". How should you respond? A. Placebos are perfectly legal and I did nothing wrong B. You are right. I will go back in the patient room and tell them the truth C. If it had not worked, we were ready to treat the patient with real medication so the patient was never in danger D. Since you pushed the saline, you should explain it to the patient
B. You are right. I will go back in the patient room and tell them the truth
A 12 Year Old Child is brought to the Emergency Department after being hit by a car when riding his bike. Significant blood loss requires blood products to save his life. His parents reveal they are Jehovah's Witnesses' and do not consent to the blood. The child is sure to die. Which of the following allows for life saving medical care to be given? A. Mature Minor Law B. Emancipation of Minor Law C. Best Interest Standard D. None of these. You must honor the parents decision in their child's care.
C. Best Interest Standard
A patient is admitted to the hospital overnight with unstable angina. Despite it being an academic hospital, the patient states that he does not want any students taking care of him. A physician assistant student completing morning rounds with their resident preceptor. Due to a busy morning schedule and time constraints, the resident assigns you to this patient. How should you introduce yourself? (Your name is Jane Doe and you are in your final clinical rotation in PA school) A. Hello, I am Physician Assistant Jane Doe B. Hello, I'm Jane C. Hello, I'm Jane Doe, Physician Assistant student D. Hello, I am Jane Doe, soon-to-be Physician Assistant
C. Hello, I'm Jane Doe, Physician Assistant student
You are in clinic seeing a patient for routine follow up. The patient has a history of schizophrenia and informs you that he does not like his boss. The patient asks if everything he tells you is confidential. You confirm that it is and he admits, "sometimes I think I might kill him if I get a chance." What is the most appropriate action? A. Maintain confidentiality while attempting to discourage the patient from his plan B. Inform law enforcement agencies of the threat to the patient's boss C. Inform both the patient's boss and law enforcement of the threat D. Admit the patient for homicidal ideations but maintain confidentiality
C. Inform both the patient's boss and law enforcement of the threat
You are seeing a 70 year old male patient with progressive glaucoma. His vision is severely impaired and is worse compared to his last visit six months ago. On multiple visits in the past you have informed him to stop driving but he has not. You suspect that he now has difficulty reading the traffic signs. What is your responsibility toward this patient? A. Maintain confidentiality but continue to encourage him to seek alternative modes of transportation B. Notify the patient's family of the risk he is putting himself at by continuing to drive C. Inform the patient that legally you report him to the DMV D. Rescind his driver's license
C. Inform the patient that legally you report him to the DMV
You are working in the emergency department when a patient arrives with a complicated hand laceration. You consult an Ortho-Hand surgeon who examines the patient and makes the diagnosis of a tendon laceration. When the surgeon discovers the patient is HIV positive they request that you refer the patient to a different surgeon as they do not want to risk infection by caring for this patient. Is the surgeon within their legal rights to refuse this patient? A. Yes, as long as the condition is not life threatening, physicians may refuse any patient B. Yes, while it is unethical to refuse a patient, the specialist is within their legal right to refuse C. No, the surgeon has formed a patient-physician relationship and cannot abandon the patient unless the patient condition is outside of their scope of practice D. No, the physician is violating the principle of non-maleficence
C. No, the surgeon has formed a patient-physician relationship and cannot abandon the patient unless the patient condition is outside of their scope of practice
A patient was involved in a serious motor vehicle accident. After two weeks in the ICU, the patient is declared brain dead. You are the ICU PA who has cared for the patient throughout his stay and have formed the closest relationship with his family. Who should obtain consent for organ donation? A. You B. Your supervising physician C. Organ procurement coordinator/Organ donor network D. Social Worker
C. Organ procurement coordinator/Organ donor network
When making medical decisions for a patient who lacks capacity to do so, what is the legal hierarchy for medical decision making? A. Patients spouse, patient, patients parents, patients children B. Patient, patients parents, patients spouse, patients children C. Patients spouse, patients adult children, patients parents, patients siblings
C. Patients spouse, patients adult children, patients parents, patients siblings
The Delegation of Services agreement should be completed by the: A. Hiring manager and the supervising physician B. Hiring manager and the Physician Assistant C. Supervising Physician and the Physician Assistant D. Physician Assistant and the Medical Assistant
C. Supervising Physician and the Physician Assistant
You are the inpatient physician assistant taking care of an elderly woman who will likely be diagnosed with metastatic cancer pending the results of a biopsy. Although the patient is alert and oriented, she is very sick and the family has concerns regarding lack of a cure. The family asks that you and your supervising physician inform them of the results of the biopsy. They do not want to upset the patient further. What should you tell them? A. You and your supervising physician will communicate the results to them first B. You ask for the ethics committee to get involved C. Tell them that you are obligated to inform the patient of the findings D. Explain to them that the decision can only be made by a healthcare proxy
C. Tell them that you are obligated to inform the patient of the findings
A runaway trolley is heading down a track where it will kill 5 people. You are standing next to a lever which could divert the trolley to another track and only kill one person. You decide to pull the lever to change the direction of the path to kill one person. Your reasoning for doing this is that you would save the lives of 5 people. This is an example of which of the following? A. Deontological ethics B. Virtue ethics C. Utilitarian ethics D. Moral reasoning
C. Utilitarian ethics
A 26-year old woman presents to your office with complaints of hand pain that she attributes to an injury that occurred at work while operating a machine. Radiographs are obtained and a care plan is developed. A representative from her place of employment contacts your office for copies of the medical records regarding the office visit and radiographic findings. What is your obligation to your patient in regards to patient confidentiality? A. You inform the representative from her place of employment that you are unable to give any copies of her medical records because doing so violates her confidentiality. B. You inform the representative that you are going to fax her entire medical record today. C. You inform the representative that you are going to fax only the portions of the medical record relevant to the hand injury. D. Consult an ethics committee.
C. You inform the representative that you are going to fax only the portions of the medical record relevant to the hand injury.
Once a physician assistant is nationally certified by the NCCPA, and licensed by their state, how many CME's (continuing medical education) units are needed to maintain certification? A. 100 Category 1 CME's every six years B. 100 Category 1 CME's every two years C. 100 CME's with a minimum of 50 Category I CMEs every six years D. 100 CME's with a minimum of 50 Category I CMEs every 2 years
D. 100 CME's with a minimum of 50 Category I CMEs every 2 years
Surveillance is the collection, analysis, interpretation, and dissemination of data regarding a health event for use in public health action to reduce morbidity and mortality to improve health. Which types of data are included? A. Infectious disease data B. Chronic disease data C. Vector distribution data D. All of the above
D. All of the above
You work with a medical assistant colleague who is suffering from sinusitis and asks if you can write a prescription for Augmentin for her. They have had sinusitis before and have used this medication with success. What should you do? (Choose the best answer) A. Respectfully decline and advise your colleague to see their own PCP for prescriptions B. After getting the OK from your supervising physician, write the prescription and document in the chart your exam and treatment plan. C. Get a brief history and complete a brief exam, give some patient education, then advise to follow up with their personal physician D. All of the above answers are correct.
D. All of the above answers are correct.
You have taken the PANCE. You passed, but barely. You were tripped up over this question about a Morton's Neuroma and do not remember learning this in PA school. You have since looked it up. You meet will some classmates for drinks one night and discover two of your classmates have not yet taken the test. After several margaritas you begin a lengthy discussion about Mortons' Neuromas and other tricky test question on the PANCE. What are some of the consequences of this action? (Choose the best answer) A. You could lose your PA certification for sharing standardized test questions B. You have negatively effected the integrity of a standardized test question C. Your friends are at a slightly unfair advantage compared to other test takers D. All the above are true statements
D. All the above are true statements
A 35-year-old male comes to your office for a pre-employment physical and hands you a form given to him by his potential employer. He needs the form to give him a clean bill of health so that he can qualify for health insurance. The form also asks for an FAP gene test to determine risk for colon cancer. What should your response be? A. Perform the test and indicate the results on the form B. Perform the test but do not share the results with the employer C. Do not perform the test D. Ask the patient if he wants the test done and the results reported
D. Ask the patient if he wants the test done and the results reported
The principles of medial ethics include autonomy, beneficence, nonmaleficence, and justice. (Veracity, or truthtelling, is commonly included in this list). Deontological ethics, or Kantian ethics, focuses on the "act" whereas Utilitarianism, or consequentialism, focuses on the end result. Which of the following statements is TRUE: A. Autonomy, beneficence, nonmaleificence and justice are deontological B. Autonomy, beneficence, nonmaleificence and justice are consequentialist C. Autonomy and Justice are consequentialist, beneficence and nonmaleficence are deontological D. Autonomy and Justice are deontological, beneficence and nonmaleficence are consequentialist
D. Autonomy and Justice are deontological, beneficence and nonmaleficence are consequentialist
The Physician Assistant National Re-certification Examination (PANRE) must be taken at what interval to maintain certification? A. Every 5 years B. Every 6 years C. Every 8 years D. Every 10 years
D. Every 10 years
A 65 year old male is hospitalized for weight loss and dysphagia. A new diagnosis of esophageal cancer is reached and after extensive workup it is determined his life expectancy is about 6 months. As you enter the room to tell him the news, his family is sitting around the bed. What is the most appropriate response? A. I have some bad news to tell you B. The results of your tests are back. Your cancer is very advanced and the results suggest you have about 6 months to live. C. I have the results of your test. Would you like your family to stay or would you prefer they step out? D. I have the results of your tests. I would like to discuss them with you privately.
D. I have the results of your tests. I would like to discuss them with you privately.
Your patient has just been recently diagnosed with familial adenomatous polyposis. This disorder is chronic, progressive, and fatal. There is a genetic test that can tell whether children of parents with the disease will develop it. The test is very accurate. The patient is recently divorced and refuses to give his consent to inform his ex-wife who now has full custody of their three children. He threatens to sue you if you reveal any element of his medical care to his ex-wife. What should you do? A. Respect the patient's right to confidentiality. B. Ask the health department to inform the patient's ex-wife regarding disease risk to the children. C. Seek a court order to inform the patient's ex-wife D. Inform the patient's ex-wife of the risk to the children.
D. Inform the patient's ex-wife of the risk to the children.
According to Title 17, California Code of Regulations, while of the following reportable communicable diseases must be reported immediately by telephone? A. Meningitis (Viral, Bacterial, Fungal, Parasitic) B. Mumps C. Dengue Virus Infection D. Measles
D. Measles
A 55 year old male patient presents to the ED complaining of chest pain. An EKG shows an ST elevation myocardial infarction (STEMI) and the patient needs further intervention. You inform the patient of the risks of having the angiogram which include development of a hematoma or coronary rupture and describe the benefits of stopping the chest pain and providing definitive treatment of the infarction. He opts to forgo the angiogram because of a fear of adverse effects and you proceed with medical management. The patient goes into cardiac arrest and dies. What will be the most likely outcome? A. You are not liable because he refused the treatment that was offered. B. You are not liable because you followed the "informed consent" standard and documented your conversation with the patient. C. You are liable because patients cannot refuse life saving treatments and the patient had no real chance of survival without the angiogram. D. You are liable because you failed to inform the patient of the risks of refusing the angioplasty.
D. You are liable because you failed to inform the patient of the risks of refusing the angioplasty.
Giving lectures, completing journal readings, and teaching PA students are all activities which can be logged under Category 1 CME activities. True or False
False
The regulations strongly suggest but do not require that the informed consent process be delivered in a language that is understandable to the subject. True or False
False
You are uncomfortable prescribing narcotics for back pain to a patient who states he is a commercial bus driver. You initially decline to prescribe but the patient then complains to your practice manager. Your supervising physician approaches you and instructs you to write a prescription for this patient. You must prescribe narcotics to this patient because your supervising physician told you to do so. True or False
False
A Physician Assistant is required to have a delegation of services agreement completed prior to beginning a new job. True or False
True
A patient is in a coma, has absence of brain stem reflexes, and cannot breathe on their own. The patient has been determined to have irreversible loss of all functions of the brain, including the brain stem. The heart remains beating. This patient is clinically deceased (true or false).
True
Casuistry is a resolving of specific cases of conscience, duty, or conduct through interpretation of ethical principles or religious doctrine. True or False
True
If informed consent information is presented orally, it must be documented using a short form that states that all the required elements were presented orally. True or False
True
Step Parents may consent to treatment of a minor only if they have legally adopted the child, been designated legal guardian, or has completed and signed a "Caregiver's Authorized Affidavit". True or False
True
Your PA colleague has a history of migraines treated with multiple pain medications for which he has prescriptions for. He confides in you that his past work experience is in Emergency Medicine but was "blacklisted" from the local ED group for practicing under the influence of medications. He explains he cannot work without his pain medications. While he is talking to you his eyes look "glassy" and you wonder if he is currently under the influence of these medications. You should inform your practice manager immediately of your suspicions. True or False
True