Practice MCQ Questions from FINAL REVIEW + LECTURES

An 80-year-old man is admitted to the hospital with a massive intracranial bleed. He has been placed on the ventilator because of the respiratory failure associated with intracranial herniation. When you try to remove the ventilator, there are no respirations. The patient makes no purposeful movements. There is no pupillary reaction when you shine a light in his eyes. Corneal reflexes are absent. The medical team has conducted all appropriate tests and concluded that the patient suffered irreversible cessation of entire brain function. Which of the following is the most appropriate action regarding this patient? 1. Make the patient DNAR 2. Get a court order authorizing vent removal 3. Remove the ventilator 4. Invoke a futility policy 5. Consult and ethics committee for evaluation

3. Remove the ventilator

Ms. Johnson presents with multiple medical problems has been admitted to your care in the intensive-care unit. The patient is in a persistent vegetative state secondary to anoxic encephalopathy and has now developed sepsis, hypotension, gastrointestinal bleeding, and 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 you feel the dialysis would be completely futile. She has a healthcare proxy. What should you do? 1. Offer hemodialysis 2. Suggest peritoneal dialysis 3. Renal transplant workup 4. Recommend dialysis not be performed 5. Give albumin

4. Recommend dialysis not be performed

Mr. Davenport is 72 years old and lives in Austin. He has some degree of dementia that manifests in the evenings, but otherwise he has no known cognitive impairments. One morning, Mr. Davenport slips and falls and is taken to the Emergency Department. His spouse, Mrs. Davenport, is 68 years old and in good mental and physical health. Mr. Davenport has three adult daughters and a friend (Mr. Clements) who is Mr. Davenport's designated agent under a Medical Power of Attorney. In the Emergency Department, Mr. Davenport is stabilized and diagnosed with a broken hip and fractured elbow. It is now noon and there are routine medical decisions to be made about possible surgeries and other interventions. Who makes the decisions? A) Mr. Davenport B) Mrs. Davenport C) Mr. Clements D) Mr. Davenport's oldest daughter E) The majority of Mr. Davenport's daughters

A) Mr. Davenport

Professional medical ethics is based on the concept of the health care provider as a fiduciary of the patient. This means that health care providers must: A) Protect and promote the health-related interests of their patients B) Ensure that their patients receive the best medical care available C) Make decisions on behalf of incapacitated patients when necessary D) Ensure equal access to healthcare for all of their patients E) Ensure that all patients receive medical care commensurate with their medical needs

A) Protect and promote the health-related interests of their patients

Mr. X comes to your clinic for a visit on Jan 1. The bill for services is $3000. He has employer-sponsored insurance and has not received any other health care services this year. His deductible is $1500 and he has a 20% co-insurance. How much should he expect to pay out of pocket? A) $1500 plus $600 B) $1500 plus $300 C) $600 plus $300 D) $1500 plus $0 E) $600 plus $0

B) $1500 plus $300

Imagine you usually spend $100/month on groceries. Your mom offers to cover 80% of your grocery bill while you're a broke med student. The 20% remaining of the bill that you will pay yourself is equivalent to what health insurance cost-sharing term? A) Co-pay B) Co-insurance C) Deductible D) Premium E) Risk-pooling

B) Co-insurance

You are caring for a 14 year old girl at a Planned Parenthood clinic in Texas whose mother requests to come into the examining room with her daughter. Your patient says she does not want her mother in the room. What is the most ethically appropriate response to the mother? A) Allow the mother in the room because the daughter is legally unable to make decisions for herself B) Do not allow the mother in the room because it would violate the daughter's right of confidentiality C) Assess the risks and the benefits of the mother's presence and make a decision based on this assessment D) Allow the mother in the room because it would be in the daughter's best interests E) Do not allow the mother in the room because the daughter is developmentally mature

B) Do not allow the mother in the room because it would violate the daughter's right of confidentiality

The ACA permitted insurance plans in health exchanges to impose surcharges of up to 50% for tobacco users as compared with non-users. What conception of fairness in insurance does this reflect? A. Actuarial fairness, because smoking is more common among lower SES individuals B. Actuarial fairness, because smoking is associated with higher expected annual costs C. Community rating, because smoking is more common among lower SES individuals D. Community rating, because smoking is associated with higher expected annual costs E. Community rating, because smoking is more common among older individuals

B. Actuarial fairness, because smoking is associated with higher expected annual costs

You are working at the desk in your hospital when another employee of the hospital asks for information about a patient who was admitted last night with a pulmonary embolus secondary to cancer. You know the details of the case. The person requesting the information states that he is a close friend of the patient. He also shows you proper identification proving he does work at the hospital. Which of the following is the most appropriate response to this request? A) Give him information about the patient because he is a close friend B) Give him information about the patient because he is an employee of the hospital C) Do not give him information about the patient because the patient has not consented D) Do not give him information about the patient because he is not a relative E) Give him information about the patient because the patient is indigent

C) Do not give him information about the patient because the patient has not consented

Ms. K is 55-year-old woman who has been admitted to the hospital for worsening mental status, poor nutrition, and respiratory functioning. The patient has Creutzfeldt-Jakob disease and will not likely improve. At this time, she lacks decision making capacity and is unlikely to recover her ability to make medical decisions. Over the last several months Ms. K has told you repeatedly that she does not want to be "kept alive as a vegetable." Her condition is irreversible. Her Directive to Physicians states that she does not want "any placement of a nasogastric or gastric tube for enteral feeding." Ms. K has executed a Medical Power of Attorney and designated as her agent a friend who is a nurse. The friend insists that you place a nasogastric tube. What should you do? A) Inform the friend that legally she cannot be Ms. K's agent because she is a healthcare provider B) Consult the ethics committee because a life-sustaining intervention is involved C) Do not insert the nasogastric tube because to do so would be inconsistent with theDirective E) Act as directed by the friend because she is Ms. K's agent F) Insert the nasogastric tube because to do so would be in Ms. K's best interests

C) Do not insert the nasogastric tube because to do so would be inconsistent with the Directive

Which of the following most accurately describes the primary role of an institutional review board (IRB)? A) Protect research institutions from liability B) Protect researchers from liability C) Ensure the ethical treatment of human research subjects D) Ensure studies are scientifically accurate E) Ensure studies are financially feasible for research institutions

C) Ensure the ethical treatment of human research subjects

Mr. G is a 52-year-old man admitted to the hospital with an ischemic stroke. He is unresponsive, unable to communicate, and tests show that he has sever anoxic brain injury with edema. His physician recommends either doing a tracheotomy or shifting the goals of care to comfort care only. Mr. G has no legal guardian and no Medical Power of Attorney. According to Texas law, who is his legal surrogate to make this decision? A) His adult son B) His ex-wife with whom he is still close C) His wife although he had recently stated his intention to divorce her D) His mother E) His best friend since childhood

C) His wife although he had recently stated his intention to divorce her

Sarah is 9 years old and is brought to the Emergency Department after sustaining injuries in a motor vehicle accident. Initial examination shows that Sarah has internal bleeding and needs surgery. She has lost a lot of blood and there is a good chance that she will need a blood transfusion to save her life during surgery. Her mother, who was driving the car and also was injured, explains that they are devout Jehovah's Witnesses and that under no circumstances should Sarah receive a blood transfusion. What is the most appropriate course of action? A) Evaluate Sarah to determine if she has decision making capacity B) Inform Sarah's mother that because the situation is life threatening, both she and her daughter will be transfused C) Inform Sarah's mother that Sarah will be transfused but that the mother herself may refuse the transfusion D) Withhold the transfusion from both Sarah and her mother E) Transfuse Sarah only if she provides her consent

C) Inform Sarah's mother that Sarah will be transfused but that the mother herself may refuse the transfusion

Ms. G is a retired airplane, automobile, and motorcycle enthusiast who lives in Dallas. She has executed a Directive to Physicians and keeps a copy in her glovebox and a digital copy has been placed in her electronic medical record. The Directive states that she does not want to be intubated if she has a terminal or irreversible condition. One evening, Ms. G has an auto accident and is brought to the Emergency Department. She has a possible closed head injury and her respiratory status is deteriorating. She lacks decision making capacity. The care team has located Ms. G's Directive but is not sure of her diagnosis or prognosis at this time. If she is not intubated, she will most likely die. What should the care team do? A) Intubate only if the hospital ethics committee agrees with that decision B) Intubate only if Ms. G has executed a Medical Power of Attorney (MPOA) and her MPOA agent agrees with that decision C) Intubate immediately in accordance with the standard of care D) Do not intubate in accordance with Ms. G's Directive E) Do not intubate if Ms. G's spouse says she would not want to be intubated

C) Intubate immediately in accordance with the standard of care

Which of the following are key components of decision making capacity? A) Understanding, Affect, Judgment, Conclusion B) Reasoning, Understanding, Clarity, Insight C) Understanding, Appreciation, Reasoning, Communication D) Reasoning, Understanding, Insight, Communication E) Understanding, Clarity, Reasoning, Judgment

C) Understanding, Appreciation, Reasoning, Communication

In allocating scarce resources, there is consensus that the appeal to justice at least requires us to: A) Allocate resources to patients who need them to thrive B) Allocate resources to patients who can pay for them C) Allocate resources to patients who would medically and socially benefit the most from them D) Allocate resources to patients in a socially non-discriminatory manner E) Allocate resources to patients in a manner that promotes the virtue of self-sacrifice

D) Allocate resources to patients in a socially non-discriminatory manner

What is the effect of a copayment on moral hazard? A) It increases the quantity of care demanded and increases the deadweight loss B) It increases the quantity of care demanded and decreases the deadweight loss C) It decreases the quantity of care demanded and does not change the deadweight loss D) It decreases the quantity of care demanded and decreases the deadweight loss E) It decreases the quantity of care demanded and increases the deadweight loss

D) It decreases the quantity of care demanded and decreases the deadweight loss

A 15 year old girl arrives at your Texas clinic with her mother. She tells you she fell down a short flight of stairs and complains that she cannot walk without pain. After a physical examination, you conclude that she likely has a sprained ankle but recommend an X-ray to rule out a fracture. Her mother consents to the X-ray, but the girl refuses based on her concerns about the safety of radiation exposure from X-rays, which she has researched in school. Assuming there is no emergency, what is the most ethically appropriate course of action? A) Require your patient to obtain an X-ray because mom assents to it. B) Do not require your patient to obtain an X-ray because she is a mature minor C) Do not require your patient to obtain an X-ray because she has not assented to it D) Try to convince your patient of the safety of X-rays and obtain her assent to it. E) Try to convince mom to reconsider in light of your patient's concerns

D) Try to convince your patient of the safety of X-rays and obtain her assent to it.

Informed consent generally requires: A) That the health care provider disclose more risks than benefits of alternative treatments B) That the health care provider disclose all possible alternative treatments C) That the health care provider disclose only alternative treatments covered by the patient's insurance D) that the health care provider disclose only reasonable alternative treatments E) That the health care provider disclose all possible risks and benefits of alternative treatments

D) that the health care provider disclose only reasonable alternative treatments

Which of the following is NOT true of the third-party payer system in the United States? A) Medicare is provided to individuals based on their age and not their income B) Medicaid is available to low-income children and pregnant women C) Employer-sponsored health insurance generally includes some form of cost-sharing D) Health care provided by the VA is an example of "socialized medicine" in the UnitedStates E) Cost-sharing is a mechanism to ensure that all insureds have access to the care they demand

E) Cost-sharing is a mechanism to ensure that all insureds have access to the care they demand

You are a psychiatrist working in Houston. One of your patients is a 32-year old man who tells you that his wife just left him and he is miserable. He says that he can't bear the idea of her with another man. He tells you that he went to her new apartment the other night and waited for her with a butcher's knife. She never came home and he fears that she was with another man. Can you warn your patient's wife that she may be in danger? A) No because he has not said that he wants to kill her B) Yes because she is in imminent physical danger C) Yes because Texas follows the Tarasoff rule D) No because you must maintain your patient's confidentiality in all circumstances E) No because in Texas the person in danger cannot be warned

E) No because in Texas the person in danger cannot be warned

In which of the following situations is it appropriate to conclude that a patient does not have decision making capacity? A) The patient is clinically depressed and the prospect of making decisions for herself is increasing her anxiety B) The patient has waived her right to make treatment decisions for herself C) The patient's spouse insists that the patient is not making decisions in her best interests D) The patient has decided to withdraw life-sustaining treatment E) The patient's Directive to Physicians is in effect

E) The patient's Directive to Physicians is in effect

Which of the following statements describes how to address the ethical appeals when they conflict in a particular case? A) We must give priority to the appeal to consequences in the ethical analysis B) We will not be able to provide an ethically justified recommendation C) We should wait for the clinical facts to change before making a recommendation. D) We must give priority to the appeal to rights in the ethical analysis E) We should attempt to mitigate the conflict through a case management plan

E) We should attempt to mitigate the conflict through a case management plan

A hospital develops a policy for controlled donation after circulatory death (DCD). The policy specifies important details of the DCD process including the following: a. Potential DCD donors are patients with non-recoverable and irreversible neurologic injuries resulting in ventilator dependence b. the patient or surrogate decision maker must have have the decision to withdraw the ventilator and other life-sustaining therapies independently and prior to the decision to donate organs c. donation occurs after irreversible cessation of circulatory and respiratory functions according to the standard of practice d. for DCD donors, the declaration of cardiopulmonary death will be determined by a physician on the transplant team. True or False: This policy is ethically appropriate.

False

The United States system allows for financial incentives to be provided to encourage donation True or False

False

From 1999-2004, how many times did TADA process result in WH/WD against MDM preferences? a. 0-50 b. 50-100 c. 150-200 d. 250-300 e. 300+

a. 0-50

An unconscious man is brought to the emergency department for a motor vehicle accident hemorrhaging profusely, hypotensive and stuporous. You have never met the patient before and no one at your institution knows him. He is wearing a T-shirt that says, "Kiss me, I'm a Jehovah's Witness." What should you do about the blood transfusion? a. Give the blood. b. Wait for him to awaken enough to sign consent. c. Wait for the family. d. Seek a court order. e. Give intravenous fluids alone.

a. Give the blood.

Ms. G is a retired airplane, automobile, and motorcycle enthusiast. She has family in the healthcare field, and has executed a Directive to Physicians. She keeps a copy in her glovebox and has a digital copy placed in her EHR. It states that she does not want to be intubated if she has a terminal or irreversible condition. One evening, Ms. G has an auto accident and is brought to the ED, where her Directive is found. She has a possible closed head injury, and her respiratory status is deteriorating. The ED team, however, is not sure of her diagnosis or prognosis at this time. If she is not intubated, she will most likely die. What should her ED team do? a. Intubate b. Do not intubate c. Consult an ethics committee for evaluations d. Wait for a healthcare proxy to arrive and ask him/her e. Consult the PCP who helped create the directive

a. Intubate

A 34 yo woman who is 33 5/7 weeks pregnant presents with with chest pain and has an abnormal EKG concerning for a myocardial infarction. She is accompanied by her husband. She has received prenatal care and there have been no complications to date with her pregnancy. What is the most appropriate course of action to take next? a. Treat the woman based on standard guidelines, and take to cardiac cath lab b. Delay treatment of woman until she receives steroids for lung maturity of her fetus c. Suggest emergency C-sxn to husband d. Perform OB ultrasound to assess age of fetus

a. Treat the woman based on standard guidelines, and take to cardiac cath lab

You are preparing a clinical trial of different doses of a certain medication. The medication has already been proven to be clinically effective and is already approved by the Food and Drug Administration (FDA). You are only studying to see whether a higher dose of the medication will lead to enhanced benefit. Which of the following is true concerning your study? a. Institutional Review Board (IRB) approval is not necessary. b. Informed consent is required to participate. c. Informed consent is not required because the medication has already been FDA-approved. d. Informed consent is not required because you are trying to demonstrate benefit, not harm.

b. Informed consent is required to participate.

You are on your OB/GYN rotation and have been having a difficult time learning how to do the internal pelvic exam. While scrubbing in for an elective tubal ligation under general anesthesia your intern suggests that this would be a good opportunity to get some extra practice doing a pelvic exam while the patient is under anesthesia because they will be very relaxed and it will be easier to identify the ovaries. Which of the following is the best course of action? a. Say "That's unethical, they told us in our ethics class that there was an ACOG policy against that" b. Say "That's a good idea, can you help me ask the next patient for permission while she's in pre-op" c. Ask your attending if it's okay for you to do the exam d. Politely decline and bring the issue to the attention of the course director

b. Say "That's a good idea, can you help me ask the next patient for permission while she's in pre-op"

You are a sub-I on an inpatient team and go to see your patient who was hospitalized with cellulitis and now has chest pain. When taking your initial history, the patient told you that they take 125mcg of levothyroxine for hypothyroidism. You notice that the patient has received 12.5mg for the past few days based on a resident order. Your and your resident get along but are not friends. What do you do? a. Do the standard chest pain protocol evaluation, including EKG and blood tests. If they are normal, do not say anything about the dosing error. b. Inform the patient that a medication error occurred and you will be monitoring them closely. Then, anonymously report the incident as a "medication error" through the hospitals electronic quality improvement system. c. Inform your resident that you think a medication error occurred, and is causing the symptoms. Ask them who they think should tell the patient. d. Inform your attending on rounds "I noticed that the resident ordered the wrong dose of levothyroxine. I think that has caused their chest pain."

c. Inform your resident that you think a medication error occurred, and is causing the symptoms. Ask them who they think should tell the patient.

You are discussing the care of an elderly woman with her family. Although she is awake and alert, the patient is very ill and physically fragile. You are awaiting the results of a biopsy for what will likely be cancer, which has already metastasized through the body. The family asks that you inform them first about the results of the biopsy. They are very loving and caring and are constantly surrounding the patient. They do not want to depress the patient further, and because there will be no hope for a cure they see no reason to ruin her remaining life with this information. What should you tell them? a. You will honor their wishes. b. You agree with their wishes and you ask them to give you the written request. c. You ask them to involve the hospital ethics committee. d. You tell them you are obligated to inform the patient of the findings. e. Explain to them that decision can only be made by the health care proxy.

d. You tell them you are obligated to inform the patient of the findings.

A 47-year-old man with end-stage renal failure has asked you to stop his dialysis. The patient fully understands that he will die if he stops dialysis for more than a few days or weeks. You believe he may be a kidney transplant candidate someday and he does not appear to have a poor quality of life. He is not depressed and not encephalopathic. What should you tell him? a. "I need a court order first" b. "I am sorry; I don't feel comfortable doing that" c. I can't do that. Physician-assisted suicide is not ethical" d. "I will stop when we get you a kidney transplant" e. "Although I disagree with your decision, I will stop the dialysis" f. "I cannot do that. We already started dialysis. Now we have to continue"

e. "Although I disagree with your decision, I will stop the dialysis"

You are the general internist in a large, multispecialty physician group. The office-based pregnancy test on your patient has just become positive and you estimate the gestational age of the fetus at 8 weeks. You are a deeply religious person in a conservative midwestern city and you are opposed to abortion because you believe that life begins at conception. After extensive discussion about the options your patient asks to be referred for an abortion. Which of the following is the most appropriate action? a. inform the patient that you are morally opposed to abortion and cannot make the referral. b. terminate your relationship with the patient as her physician c. propose social work/psychological evaluation of the patient d. tell her you will make the referral after a 30-day consideration period in which she may change her mind e. Refer the patient for the abortion

e. Refer the patient for the abortion

A 58 year old man is out of town on business in New York. He has a myocardial infarction and deteriorates despite thrombolytics and angioplasty. He is intubated and is disoriented and unable to understand his condition. He needs a coronary bypass. His wife is the health-care proxy but she is in another city. You would like her consent in order to perform the surgery because she is the designated surrogate. Which of the following is true in this case? a. She must come to the hospital to sign consent in person. b. The wife must designate a local guardian until her arrival. c. You must repeat the angioplasty instead. d. Telephone consent is only valid for minor procedures. e. Take consent for the bypass over the phone and have a second person witness the telephone consent.

e. Take consent for the bypass over the phone and have a second person witness the telephone consent.

A 18yo woman who is 19 weeks pregnant has a routine fetal ultrasound that shows coarctation of the aorta. She asks about genetic testing which she previously declined. What do you do? a. CoA can be associated with T13 and T18. b. Cell-Free Testing False negative rate for T13 and T18 are 5-8%. Turnaround time is 7 days. c. Amniocentesis (wks 17-20) can be associated with fetal loss. Turnaround time is 7-10 days. Chorionic villus sampling results (wks 10-14) within 48 hours. d. T13 and T18 are often embryological lethal. e. Ask her to return with the father of the fetus. f. Arrange for amniocentesis. g. Call the genetic counselor and plan for repeat fetal echocardiogram. h. Perform Cell-free testing.

g. Call the genetic counselor and plan for repeat fetal echocardiogram.