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Bioethics in

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
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
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.
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.
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.
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
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?
7. Send the patient to the drug control centre.
8. Inform the transportation authority
9. Inform the police

10. Inform his employer

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?
A. Prescribe the medication
B. Suggest your colleague to send this patient to the Drug control
and rehabilitation centre.
C. Report your colleague to the college of physicians and
surgeons
D. Report this all to the hospital authorities
9. A man is a very heavy drinker of alcohol. The decision to report him is
because he is
11. Flying an aeroplane
12. Driving a car
13. Works in a laboratory
14. Sexually abuses his 8 years-old step daughter
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?
15. Tell the patient that she had developed some complication and now
she is all right and can go home
16. Tell her the truth about the gauze in a nice way.
17. Dont tell her anything.
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?
18. Release all the information to him.

19. Tell the lawyer that this information cannot be released because it

is confidential.
20. Release the information if the patient consents.
13. What is the ethical view about electronic mailing?
A. Do not send patients file and information through E-mail.
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?
21. The fear of rejection again
22. Long waiting list
23. He is not productive
24. It is not worth giving transplant again.
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?
25. The grand daughter is abusing her
26. She is very stubborn and does not listen to her grand daughter
27. The grand daughter is very proud that she does not accept help from
the other family members.
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?
28. Go ahead and intubate.
29. Consult the ethics board of the hospital
30. Ask the court to appoint a legal guardian
31. Do not intubate
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?

32. Withhold the diagnosis because of his psychiatric condition


33. Tell only the wife to provide support and care
34. Withhold the diagnosis because it is fatal and has no cure.

18. A patient is undergoing surgery, in an informed consent, the patient must


know all except
35. Details of surgical procedure
36. Alternative methods of treatment other than surgery
37. All risks related to surgery
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
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:
38. You will give the vaccine as its effectiveness is 100%
39. You will inform the child aid society of the parents refusal to
give the complete course of treatment
40. You will give the vaccine because there is a great probability
that these bats are not rabid
41. You will give both the vaccine and IG to the child.
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?
42. Tell him that this is illegal and you can not sign the form
43. Sign the form but indicate that you did not see the patient and
explain why?
44. Sign the form because you know your patient very well

45. Call his employer and explain what was the situation

22. A 58-year old patient was admitted to the hospital for appendectomy.
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?
46. You can not stop it except by the court order
47. You stop it according to the need of his bed for another patient
48. You can not stop it because his condition was not serious
49. You can stop it according to the opinion of another physician
50. You consult CEO of the hospital to take a legal action.
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:
51. These old people mostly dont want to know about such illnesses
52. 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
53. 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
54. He has dementia; he wont understand the situation anyway.
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?
55. Get a court order as an obligation for treatment
56. Inform the public health
57. Contact your lawyer to handle the case
58. Consult the special lawyer for a legal advice
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?
59. Call the child aid society for advice
60. Do as the parents want
61. Put the eye drops even if the parents refuse

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?
62. Call your insurance company
63. Call his lawyer to discuss for compensation
64. Tell her that this is a side effect and it can happen in some patients
65. You dont do any thing because the incidence occurred after you
stopped the medicine
27. A 14-year old girl comes to you and asks you to prescribe OCPs to her.
What will you do?
66. Prescribe the pills to her
67. Call her mother for permission
68. Consult her for STD and safe sex and then prescribe the pills
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?
69. Amputate because now she is incompetent and her family is now
responsible for making decisions.
70. Treat the sepsis irrespective of the outcome
71. Ask your lawyer
72. Ask the legal committee of the hospital
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:
73. Do as the boy wishes and dont remove the cyst
74. Do as the mother wishes and remove it because she is the legal
guardian
75. Take a needle biopsy only
76. Send to a surgeon
30. If you have an AIDS patient what you will do?
77. Notify the public health
78. Notify his close contacts

79. The public health office was already notified when he was HIV

positive
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?
80. Inform the patients with their illness ( positive results)
81. Inform their family doctor although he did not ask for it.
32. According to the regulations inside the operating room. What is true?
82. Screen all the doctors and nurses for hepatitis B and AIDS
83. Screen all patients before operation
84. Use strict precautions treating all patients as infected.
33. A mother brought her 12- year old girl complaining of vulvar 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?
85. Notify Child Aid Society
86. Call step father and interview him alone
34. Which one is considered an invalid consent?
87. Patient on his way for laparoscopic cholecystectomy, premedicated and the nurse made him sign the form in a hurry.
88. His alcoholic brother gives consent on telephone.
89. Both of them
35. A patient has lung cancer. He should write all of the following in his
Will except:
90. Types of treatments he has refused while he is conscious
91. Family members will be taking his decisions when he will be
unconscious
92. Options about end of life care
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?
93. Call the coroner and medical examiner
94. You take the history from the relatives and sign the death certificate
95. You take history, sign the death certificate and inform the coroner.

37. You were called in a jail where an inmate died in the morning with blood
all over his face. What will you do?
96. Call the coroner
97. Examine the dead body and sign the death certificate
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?
98. You just let them resuscitate him to save his life
99. Inform your colleague about the patients will
100.
Consult the hospital ethics board
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
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?
101.
Call the chief of staff
102.
Call head of hospital board
103.
Call security
104.
Send him home
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?
105.
Take a consent for surgery from his intoxicated friend
106.
Wait for his parents to come to ER and then take the consent
and do surgery
107.
Do the surgery and later explain to his parents

42. A surgeon has hepatitis B and is positive for HBs and no anti-HBs. What
Should be done?
108.
He should abstain from coming to the theatre
109.
He should wear two gloves
110.
Inform the licensing authority
43. Physicians are normally required to
111.Follow the ethics of CMA
112.
Should not socialize with the patients
44. A patient is positive for HIV and requests you not to tell his wife as she
Will dump him. What will you do?
113. Inform his wife
114. Convince him to explain his wife about every thing
115. Inform the public health
116. Dont breech the confidentiality of patient
45. Who gives the privilege for working in a hospital?
117.
Board of trustees
118.
College of physicians and surgeons of Ontario
119.
Chief executive of the hospital
120.
Chief of staff
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 ask you
to release the information. What will you do?
121.
Take consent from the patient and give information
122.
Ask the patient to release the information
123.
If there is a subpoena go to the court and give information
yourself
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?
124.
You will give blood because its an emergency
125.
You will give blood because the card is neither witnessed nor
signed
126.
Do not give blood

127.

Treat with solutions other than blood

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?
128.
You will write the test in the chart
129.
You will tell him that he can not refuse this test
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?
130.
Legal guardian
131.
Do surgery if it's a life saving one
50. A patient is involved in MVA and you treat the patient. Now her
insurance company asks for some information. What will you do?
132.
Take consent from the patient, fax the papers to the insurance
company and charge a fee??!
133.
Ask the patient to sign the release of information from and fax
the papers to the insurance company.
134.
You will mail the papers to the insurance company because
your phone line is not confidential.
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
135. US Govt. can sue you because everything is paid by them
136. They will sue you because everything was settled when he left
the house
137. He came to your clinic because your clinic was famous
138. There is a rule to sue for the complaint of that patient
52. A patient comes to you and you diagnose him with CS pancrease 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?
139. Tell her the truth
140. Go according to the wishes of the patients relatives
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 him. After further questioning he also reveals that he has all the
intentions to kill his wife and her boy friend. What will you do?
141.
Inform the police

142.
143.
144.

Inform the wife


You dont have to breech the confidentiality of your patient
Inform the police and the wife