Ethical Issues and RisksAssociated with Catheterizationand Interventional Procedures

Question 1

What must physicians prioritize when caring for patients?

Answer 1

The patient’s welfare must be paramount.

Question 2

On what basis should physicians prescribe drugs and treatments?

Answer 2

Based solely on medical considerations and patients’ preferences.

Question 3

What should physicians disclose to patients regarding conflicts of interest?

Answer 3

Any conflicts of interest related to their relationships with or investments in companies.

Question 4

What steps should a physician take if they face an unresolved conflict of interest?

Answer 4

Consult with disinterested colleagues or an institutional ethics committee.

Question 5

Are physicians allowed to accept financial inducements from industry?

Answer 5

No, they must not accept direct or indirect financial inducements.

Question 6

What constitutes unacceptable inducements for physicians?

Answer 6

Payments over and above the actual cost of completing postmarketing surveys.

Question 7

What should clinicians disclose when presenting clinical research or experience?

Answer 7

Their own or their institution’s financial relationship with the manufacturer.

Question 8

What is the role of peer review in medical practice according to ethical standards?

Answer 8

It is a critical component of continuous quality improvement and appropriateness review.

Question 9

What is the ethical stance on performing inappropriate procedures on patients?

Answer 9

It is profoundly unethical and may result in permanent loss of membership in the society.

Question 10

What should be explained to patients prior to performing a procedure?

Answer 10

Details of the procedure, potential risks and benefits, and all reasonable alternatives.

Question 11

What is the ethical choice for managing a patient with unstable coronary lesions?

Answer 11

Ameliorate the unstable coronary lesion and address other relevant interventions.

Question 12

What is the ethical dilemma faced by interventional cardiologists regarding sedation?

Answer 12

Lack of authority to administer propofol despite it being the most medically optimal approach.

Question 13

What is the Federal Physician Self-Referral Law also known as?

Answer 13

The Stark Law.

Question 14

What does the Stark Law prohibit?

Answer 14

Referrals for designated health services to entities with which the physician has a financial relationship.

Question 15

What is the purpose of the Medicare–Medicaid Anti-Kickback Statute?

Answer 15

To prohibit remuneration to induce referrals of items or services covered by Medicare or Medicaid.

Question 16

What are the Belmont principles that guide ethical practices?

Answer 16

Beneficence, respect for persons, and justice.

Question 17

What should a laboratory director do in response to sexual harassment complaints?

Answer 17

Review policies and ensure a professional, non-hostile working environment.

Question 18

What defines sexual harassment according to the EEOC?

Answer 18

Unwelcome sexual advances and other verbal or physical conduct of a sexual nature.

Question 19

What is the ethical guideline regarding CPR for patients in cardiac arrest?

Answer 19

All patients should receive resuscitation unless there is a valid DNR order or signs of irreversible death.

Question 20

What criteria may justify withholding attempts to resuscitate newborns?

Answer 20

Gestation <23 weeks, birth weight <400 g, or confirmed anencephaly.

Question 21

What does a valid DNR order indicate about a patient?

Answer 21

The patient has expressed a desire not to receive resuscitative measures.

Question 22

What are signs of irreversible death?

Answer 22

• Rigor mortis
• Decapitation
• Dependent lividity

Question 23

In which scenarios is withholding resuscitation appropriate for newborns?

Answer 23

• Confirmed gestation <23 weeks
• Birth weight <400 g
• Anencephaly—confirmed trisomy 13 or 18

Question 24

What do current guidelines say about medical therapies for patients with DNR/DNI orders?

Answer 24

There is no contraindication to medical therapies unless prompted by decisions for comfort care.

Question 25

What is the classification rating for primary PCI at hospitals without on-site cardiac surgery?

Answer 25

Class IIa recommendation (Level of Evidence B)

Question 26

What does the Class IIb recommendation for elective PCI indicate?

Answer 26

It might be considered with proper planning and rigorous patient selection.

Question 27

What are the primary ethical principles in resource allocation?

Answer 27

• Equity
• Justice
• Utility

Question 28

Define distributive justice.

Answer 28

The fair distribution of resources to a given population.

Question 29

What is compensatory justice?

Answer 29

The belief that an injured person should receive a benefit proportional to their loss.

Question 30

What should be prioritized in managing acute hypotension post-catheterization?

Answer 30

Normalization and stabilization of blood pressure.

Question 31

What may bradycardia and vagal symptoms indicate in a hypotensive patient?

Answer 31

Possibility of vasovagal hypotension or anaphylactoid reaction.

Question 32

What is a key management step for hypotension after intervention?

Answer 32

Consider IV pressors for blood pressure support.

Question 33

What should be discussed with a terminally ill patient regarding an ICD?

Answer 33

• Potential benefits and burdens of the device
• Pain from defibrillation shocks
• Turning off the ICD will not cause death or increased pain

Question 34

What is the role of a substitute decision-maker?

Answer 34

To approximate the patient’s wishes when they cannot make competent decisions.

Question 35

What principles guide therapy regarding advance directives?

Answer 35

• Patient autonomy
• Respect for the patient’s wishes
• Ethical decision-making

Question 36

What must interventional cardiologists do if they find a procedure is not indicated?

Answer 36

They must cancel the procedure or reassess the hemodynamic significance.

Question 37

What are essential elements of informed consent?

Answer 37

• Full disclosure of risks and benefits
• Patient understanding of the procedure
• Patient competence to make decisions
• Autonomy free from undue influence
• Documentation of consent

Question 38

What is an anaphylactoid reaction?

Answer 38

A non-immune mediated reaction resembling anaphylaxis, often triggered by contrast material.

Question 39

What should be done for a patient experiencing an anaphylactoid reaction?

Answer 39

Administer volume expansion, IV diphenhydramine, and IV glucocorticoids.

Question 40

What is the best practice for patients with a history of contrast reaction?

Answer 40

Pretreatment with preventive agents starting 24 hours before the procedure.

Question 41

What is the recommended approach for disclosing medical errors?

Answer 41

Full and honest disclosure to maintain trust and responsibility.