Bioethics

1. A young man is brought to the ER after a MVA. It was a head on collision between a small car and his truck. The old lady driving the car died on the spot. This young man has a few bruises on his chest and abdomen. He is otherwise stable and seems to have no serious injuries. In the mean time police arrives and ask you to with draw some blood for the blood alcohol levels. What you will do? A. Ignore the police B. Order the nurse to withdraw blood and label it and send it to the laboratory C. Make a telephone call to the laboratory staff and request them as if they could do the blood alcohol from the same amount of blood sent for other investigations. D. Tell the police that you need to take consent from the patient Ans: d 2. Now you have ordered the laboratory for the blood alcohol level. What will you tell the police? A. Ignore the police B. Tell the police that this is confidential information and you cannot hand it over to them. C. Just write your orders on the paper and leave rest to the Hospital staff nurse to deal with the police D. As soon as you receive the results of the investigations, hand them over to the police E. Tell the police that they have to bring the subpoena F. Tell the police that they have to bring the court order Ans: F 3. A 45 years old man comes to you with a H/O dysuria. You suspect him for Gonococcal urethritis. He requests you to code his specimen without his name as his wife works in that laboratory and reads all the reports. What you will do? A. Send a coded sample to the lab. B. Convince him to disclose this to his wife.

C. Send the specimen to another lab. D. Tell the patient that you cannot send the coded sample. Ans: B 4. A 55- year old man comes to the ER and the attending physician has decided to perform immediate surgery. The patient thinks that the physician is very young and he is not experienced enough to perform surgery. In fact the physician just finished his residency 7 months ago. What this physician should do? A. Ask for the help of another surgeon B. Explain the seriousness and emergency for the surgery effectively C. Tell the hospital authorities about the situation. Ans: B 5. A 65- year old man is in the CCU and is in coma. He has already given an advanced directive for a SDM. This person is his nephew and is on his way to the hospital. What as a physician you will discuss with him in this situation where a decision to remove the life support measures needs to be taken? A. What a sensible person will want in this situation. B. SDM will decide about the type of treatment given to the patient C. SDM and physician will take the decision together D. As a physician you will ask about the wishes of the patient when he was competent. SDM: substitute decision maker Ans:D 6. As a physician you have two patients for lung transplantation. You only have one pair of lungs available. One of the patients is 55 years old and is a Non smoker. The other patient is 45 years old and in spite of all efforts is unable to quit smoking. How will you take a decision about the transplantation between the two patients? A. According to the age of the patient B. Productivity C. The probability for quitting smoking

Ans: B 7. 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 Ans:B 8. A man comes to you for a repeat prescription of a narcotic drug. After a detailed history and physical you discover that this patient is not in need of these drugs. A colleague of yours is regularly giving him this repeat prescription. In the mean time your colleague arrives and you tell him about the situation and he says that this is none of your business. What you will do in this situation? D. Prescribe the medication E. Suggest your colleague to send this patient to the Drug control and rehabilitation centre. F. Report your colleague to the college of physicians and surgeons G. Report this all to the hospital authorities Ans: F 9. A man is a very heavy drinker of alcohol. The decision to report him is because he is A. Flying an aeroplane B. Driving a car C. Works in a laboratory D. Sexually abuses his 8 years-old step daughter Ans: D 10. A patient has undergone Laparotomy for appendicitis and you have left a piece of gauze into her abdomen that is discovered on USG. You removed it after reopening the wound. What will you tell the patient?

A. Tell the patient that she had developed some complication and now she is all right and can go home B. Tell her the truth about the gauze in a nice way. C. Dont tell her anything. Ans: B 11. A 21- year old woman comes to your office for the treatment of some infection. You have prescribed antibiotics. Patient does not have money to buy antibiotics. You provide her the antibiotics from some samples in your office. What this action is considered as? A. 12. One of your patients comes to you after she had a MVA. You treated her and sent home. 2 weeks later her lawyer calls you and asks for the release of all information about her. What you will tell him about this? A. Release all the information to him. B. Tell the lawyer that this information cannot be released because it is confidential. C. Release the information if the patient consents. Ans: C 13. What is the ethical view about electronic mailing? A. B. C. D . 14. A 60- year old man was given a liver transplant 2 years back, which was rejected. Now he is again demanding a transplant. What is true regarding this request? A. The fear of rejection again B. Long waiting list C. He is not productive D. It is not worth giving transplant again. Ans: C

15. An 82- year old lady living with her grand daughter who is divorced was brought to you in the ER stating that her grand mother has a H/O repeated falls. On examination you find out that she has dementia and you found multiple bruises on her arms. The grand daughter tells you that the patient is very uncooperative and stubborn. What do expect what the actual situation is? A. The grand daughter is abusing her B. She is very stubborn and does not listen to her grand daughter C. The grand daughter is very proud that she does not accept help from the other family members. Ans: A 16. An unconscious old man is brought to the ER from a nursing home by his son and a daughter. On examination you find that he needs a feeding tube. His son says, that go ahead and put the feeding tube in. The daughter is against that. What will you do? A. Go ahead and incubate. B. Consult the ethics board of the hospital C. Ask the court to appoint a legal guardian D. Do not intubate Ans: c 17. You work in an insurance company, you have a patient 65 years old. He has depression with H/O hospitalization twice after the death of his son. On routine X-Ray chest you diagnose inoperable lung cancer. His wife tells you he is about to retire in 2 months, and they are planning a trip to USA. What are you going to do? A. Withhold the diagnosis because of his psychiatric condition B. Tell only the wife to provide support and care C. Withhold the diagnosis because it is fatal and has no cure. Ans: Tell the husband becos psych condition does not make him incompetent-maybe b? 18. A patient is undergoing surgery, In an informed consent, the patient must know all except A. Details of surgical procedure

B. Alternative methods of treatment other than surgery C. All risks related to surgery Ans: Tell basics of surgery- A 19. 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 Jehovahs 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 Ans: Do not give him blood, but give him other lifesaving treatment. Maybe of these c? 20. A 9 year old was bitten by a flying bat in an area known to be rabid, during the interview with the parents. You are Orthodox Jehovahs. They accepted to give their son the vaccine but not the Immunoglobulins, as it is prepared from human sources. You talked to the child that accepted to follow his parents decision. Your action will be: A. You will give the vaccine as its effectiveness is 100% B. You will inform the child aid society of the parents refusal to give the complete course of treatment. C. You will give the vaccine because there is a great probability that these bats are not rabid D. You will give both the vaccine and IG to the child. Ans: B 21. A 35- year old male, one of your patientss for four years, has contacted you and asked you to sign a form for him that he was sick last week. He has to present the form to his employer and mention that during this time he had flu and it was not severe enough to make him come to you and he did not want to abuse the health system. You believe your patient. what will be your action? A. Tell him that this is illegal and you can not sign the form

B. Sign the form but indicate that you did not see the patient and explain why? C. Sign the form because you know your patient very well D. Call his employer and explain what was the situation Ans: A 22. A 58-year old patient was admitted to the hospital for appendicectomy. During the surgery his condition deteriorated and he passed into coma. You started tube feeding. The patient has no family member or friends around and no advanced directive. When can you stop the tube feeding? A. You can not atop it except by the court order B. You stop it according to the need of his bed for another patient C. You can not stop it because his condition was not serious D. You can stop it according to the opinion of another physician E. You consult CEO of the hospital to take a legal action. Ans: A 23. A patient with Alzheimer disease for the past many years is brought to you. You diagnose him to be case of cancer prostate. His wife is her primary caregiver. She does not want him to know. You will not tell him because: A. These old people mostly dont want to know about such illnesses B. His wife is his caregiver and he will be depressed if he comes to know and it will be very hard for her to manage him C. It will not make any difference in the treatment because it is a serious condition and has no cure and his wife should keep on caring for him D. He has dementia; he wont understand the situation anyway. Ans: D 24. A patient presented to your office with active T.B. You prescribed the medication and you gave him another appointment for follow up but he didnt show up. Your secretary called him to set another appointment and he didnt show up again. You sent him a letter threatening him to inform public health. He sent you a letter through his lawyer accusing you of breeching the confidentiality. What will be your action? A. Get a court order as an obligation for treatment B. Inform the public health

C. Contact your lawyer to handle the case D. Consult the special lawyer for a legal advice Ans: C.??B 25. A female just delivered a baby and she and her husband refused the Erythromycin drops to be put into the babys eyes. What will be your action? A. Call the child aid society for advice B. Do as the parents want C. Put the eye drops even if the parents refuse Ans: B 26. You prescribed antipsychotic to the patient with Parkinsonism. In the follow up you stopped the drug. On the second day the patient falls and his hip is fractured. His daughter tells you that this is your fault. What will you do? A. Call your insurance company B. Call his lawyer to discuss for compensation C. Tell her that this is a side effect and it can happen in some patients D. You dont do any thing because the incidence occurred after you stopped the medicine Ans: C 27. A14-year old girl comes to you and asks you to prescribe OCPs to her. What will you do? A. Prescribe the pills to her B. Call her mother for permission Ans: A 28. A diabetic patient comes to the ER with impending gangrene. You informed her about amputation to save her life. She tells you that I came to this world with my both limbs and I will leave the same way. In the meantime she loses consciousness. Her family is asking you to amputate her leg to save her life. What will you do? A. Amputate because now she is incompetent and her family is now responsible for making decisions.

B. Treat the sepsis irrespective of the outcome C. Ask your lawyer D. Ask the legal committee of the hospital Ans: B 29. A mother comes to your office with her 14- year old son. She wants an unsightly sebaceous cyst to be removed from his face while the son does not want it. Your action will be: A. Do as the boy wishes and dont remove the cyst B. Do as the mother wishes and remove it because she is the legal guardian C. Take a needle biopsy only D. Send to a surgeon Ans:A 30. If you have an AIDS patient what you will do? A. Notify the public health B. Notify his close contacts C. The public health office was already notified when he was HIV positive Ans: A 31. You are making a research and you tested all the patients in a group. You are working on HIV to exclude HIV positives from your study. The public health received coded results and the results were anonymous. What will be your action towards the patients who are HIV positive? A. Inform the patients with their illness (positive results) B. Inform their family doctor although he did not ask for it. Ans: A 32. According to the regulations inside the operating room. What is true? A. Screen all the doctors and nurses for hepatitis B and AIDS B. Screen all patients before operation C. Use strict precautions treating all patients as infected. Ans:C

33. A mother brought her 12- year old girl complaining of vulval rash. She said that my daughter is ruining our marriage. She wants to sleep with her every night and she doesnt like her stepfather. You suspect that the stepfather is abusing her sexually. What to do? A. Notify child aid society B. Call step father and interview him alone Ans: A 34. Which one is considered an invalid consent? A. Patient on his way for laparoscopic cholecystectomy, premedicated and the nurse made him sign the form in a hurry. B. His alcoholic brother gives a consent on telephone Ans: A 35. A patient has lung cancer. He should write all of the following in his Will except: A. Types of treatments he has refused while he is conscious B. Family members will be taking his decisions when he will be unconscious C. Options about end of life care Ans: A 36. You are called to visit a house where someone in that family died suddenly. You have never seen them before. What will be your action? A. Call the coroner and medical examiner B. You take the history from the relatives and sign the death certificate C. You take history, sign the death certificate and inform the coroner. Ans: A 37. You were called in a jail where an inmate died in the morning with blood all over his face. What will you do? A. Call the coroner B. Examine the dead body and sign the death certificate Ans: A

38. Patient wrote his advanced directive (living will). He wrote in front of you that he should not be resuscitated in the event of his cardiac arrest. 2 years later he comes to the ER with cardiac arrest. A colleague of yours has intubated him and is resuscitating. You reach there. What will you do? A. You just let them resuscitate him to save his life B. Inform your colleague about the patients will C. Consult the hospital ethics board Ans: B 39. A patient wrote his advanced directive and mentioned about no resuscitation in the event of his cardiac arrest. 2 years later he comes to you and while you are examining him he goes into a cardiac arrest. What will be your immediate action? A. Do CPR B. Do not resuscitate and let him die in peace C. Contact your lawyer D. Inform the coroner Ans: B 40. Your colleague is ready to perform a surgery and you find out that he is drunk. You requested him to transfer the care to another surgeon. He becomes angry and refuses to do so. What will you do? A. Call the chief of staff B. Call head of hospital board C. Call security D. Send him home Ans: B. 41. A teenage boy coming to the ER with fractured arm. He is also on LSD and was intoxicated. His fracture needs open reduction immediately because you are worried about the neurovascular compromise of the arm. His intoxicated friend tells you that his parents will kill him if they come to know of him being under the effect of LSD. What will be your action? A. Take a consent for surgery from his intoxicated friend B. Wait for his parents to come to ER and then take the consent and do surgery C. Do the surgery and later explain to his parents

Ans: C 42. A surgeon has hepatitis B and is positive for HBs and no anti HBS. What Should be done? A. He should abstain from coming to the theatre x B. He should wear two gloves ???? C. Inform the licensing authority x Ans????? B..C 43. Physicians are normally required to A. Follow the ethics of CMA B. Should not socialize with the patients CMA-canadian medical association Ans: A 44. A patient is positive for HIV and requests you not to tell his wife as she Will dump him. What will you do? A. Inform his wife B. Convince him to explain his wife about every thing C. Inform the public health D. Dont breech the confidentiality of patient Ans: B 45. Who gives the privilege for working in a hospital? A. Board of trustees B. College of physicians and surgeons of Ontario C. Chief executive of the hospital D. Chief of staff Ans: D 46. A patient comes to you with injuries after MVA. You treat him and send him home. A few days later you are called by an insurance agent and asks you to release the information. What will you do? A. Take consent from the patient and give information B. Ask the patient to release the information C. If there is a subpoena go to the court and give information yourself

Ans:A 47. 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 Jehovahs Witness card in her pocket. The card is not signed. What will you do? A. You will give blood because its 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 Ans: B 48. You suspect that your patient has HIV and you ask him for the HIV test but he refuses. What is coercion in this case? A. You will write the test in the chart B. You will tell him that he can not refuse this test Ans: A 49. In a MVA a patient is brought comatosed in the ER. He needs immediate surgery. He has no SDM. What will you do in this situation? A. Legal guardian B. Clinical ethics board Ans: go for immediate surgery 50. A patient is involved in MVA and you treat the patient. Now her insurance company asks for some information. What will you do? A. Take consent from the patient, fax the papers to the insurance company and charge a fee. B. Ask the patient to sign the release of information from and fax the papers to the insurance company. C. You will mail the papers to the insurance company because your phone line is not confidential. Ans: B

51. A patient comes from USA and you treat him. Everything goes all right but when he went to USA he charged you for some maltreatment. He can sue you because A. US Govt. can sue you because everything is paid by them B. They will sue you because everything was settled when he left the house C. He came to your clinic because your clinic was famous D. There is a rule to sue for the complaint of that patient Ans: D 52. A patient comes to you and you diagnose him with Ca pancreas and relative told you that according to her condition dont tell her. Next morning when patient asked you about the diagnosis. What will you tell her? A. Tell her the truth B. Go according to the wishes of the patients relatives Ans: A 53. A 40-year old patient of yours comes to you and tells you that he is suffering from great anxiety just because he has a suspicion that his wife is cheating on her. After further questioning he also reveals that he has all the intentions to kill his wife and her boy friend. What will you do? A. Inform the police B. Inform the wife C. You dont have to breech the confidentiality of your patient D. Inform the police and the wife Ans:D