Ethics Flashcards

1
Q

When should an ethics committee be used to resolve disputes about a patient’s end of life?

A

Only when the patient does not have an advanced directive

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2
Q

5 exceptions to need for legal guardian consent in care of minors?

A

Emergency, Contraception, STD treatment, Substance abuse, Prenatal care

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3
Q

Purpose of Medicare part A?

A

Covers inpatient visits

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4
Q

Purpose of Medicare part B?

A

Covers outpatient visits

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5
Q

Purpose of Medicare part C?

A

Covers enrollment in private insurance

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6
Q

Purpose of Medicare part D?

A

Covers prescription drugs

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7
Q

4 aspects of a decision-specific capacity assessment?

A

Understands medical condition and proposed treatment, Appreciates consequences of treatment options, Communicates choice, Provides rationale for decision

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8
Q

4 aspects of obtaining informed consent?

A

Explain patient’s diagnosis, Describe proposed treatment, Discuss risks + benefits of proposed treatment, Provide treatment alternatives

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9
Q

5 steps of a Root Cause Analysis?

A

Collect data, Create causal factor flow chart, Identify root causes, Generate recommendations + Implement change, Measure success of changes

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10
Q

Quality improvement tool used to identify what-how-why an undesirable outcome occurred?

A

Root Cause Analysis

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11
Q

Physician obligation in setting of physician impairment due to drug use?

A

Mandatory reporting to physician health program, or state licensing board

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12
Q

What is the only criteria for a patient to receive hospice care?

A

Estimated life expectancy < 6 months

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13
Q

If patient cannot consent to hospice care due to AMS, but estimated life expectancy is < 6 months – should patient still receive hospice care?

A

Family may act as patient’s surrogate decision maker … if they agree to hospice care, patient will be eligible

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14
Q

Approach to informed consent in non-emergency situations?

A

Informed consent should be obtained from a parent/guardian before medical intervention in a minor

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15
Q

How can mistakes in healthcare be avoided in the Swiss Cheese Model?

A

Increase redundancy + Double checks

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16
Q

At what point should a hospital ethics committee become involved in a patient’s care plan?

A

When conflict arises between multiple family members regarding the appropriate course of care … despite adequate initial mediation by the physician

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17
Q

First step when members of patient’s family disagree about appropriate course of care?

A

Organize family meeting

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18
Q

Best initial management of elder abuse?

A

Separate patient from abuser ASAP

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19
Q

In which situation are patients able to refuse care?

A

If patient is competent

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20
Q

Normal Mini Mental Status Exam (MMSE) score?

A

MMSE > 26

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21
Q

Primary goal of management in a brain-dead organ donor?

A

Maintain a euvolemic, normotensive, normothermic state

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22
Q

Best approach to situation in which breach of privacy occurs with patient PHI?

A

Patient must be notified in writing; Notification should include description of breach, what information was disclosed, what actions are being take to mitigate breach, prevent future disclosure

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23
Q

____ is a law that prohibits discrimination by health insurers and employers on the basis of genetic information

A

Genetic Information Nondiscrimination Act (GINA)

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24
Q

4 questions included in CAGE screening for ETOH abuse?

A

C – cut down use, A – annoyed by people criticizing your drinking, G – guilty about drinking, E – eye-opener

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25
Best management of needle stick, in which patient refuses to be tested for HIV?
Initiate HIV post-exposure prophylaxis for healthcare provider who experienced needle-stick
26
Description of an active error?
Involves actions of frontline personnel
27
Description of a latent error?
Involves organizational vulnerabilities; Occurs at level of system
28
3 examples of latent errors?
Inadequate staffing, Organizational policies, Patient complexitiy
29
Description of a sentinel event?
Unexpected outcome, usually involving serious injury or death
30
What is the initial phase of a root cause analysis?
Collecting relevant data, creating a causal factor flow chart
31
Role of morphine in palliative care?
Pain control, control dyspnea
32
2 AEs of morphine use in palliative care?
Miosis, respiratory depression
33
Description of pre-contemplative stage?
Patient is not ready for change
34
Motivational strategy during pre-contemplative stage?
Have patient evaluate the consequences of current behavior
35
Description of contemplative stage?
Patient is thinking of change
36
Motivational strategy during contemplative stage?
Have patient discuss pros + cons of behavior
37
Description of preparation stage?
Patient is ready for change
38
Motivational strategy during preparation stage?
Encourage initiation of small steps
39
Description of action stage?
Patient is making the change
40
Motivational strategy during action stage?
Enlist support
41
Description of maintenance stage?
Changes have been integrated
42
Motivational strategy during maintenance stage?
Provide follow-up support
43
Description of identification stage?
Behavior is automatic
44
Motivational strategy during identification stage?
Praise changes
45
46 yo male presents to hospital for multiple episodes of pancreatitis; On DC prep, patient’s PCP tells hospitalist that he would like to discontinue relationship with patient due to drug-seeking behavior, verbally-abusive behavior - what is best step in management?
ASk PCP to continue care for patient until another provider is ID’d
46
When is it appropriate for PCPs to terminate relationship with patient?
Only after giving reasonable notice … OR … providing referral to another PCP who is willing to accept paitent
47
Purpose of pre-clinical trials?
Explore given how new treatment may work
48
Study population of pre-clinical trials?
Laboratory in animal bottles
49
Purpose of phase 1 clinical trials?
Evaluate safety
50
Study population of phase 1 clinical trials?
Healthy subjects, small number
51
Purpose of phase 2 clinical trials?
Explore efficacy (does it work?)
52
Study population of phase 2 clinical trials?
Small number of affected subjects
53
Purpose of these three clinical trials?
Compare new treatment to current Standard of care
54
Study population of phase 3 clinical trials?
Large number of effective subjects randomly assign to treatment or control
55
Purpose of these for clinical trials?
Identify rare and long-term adverse X
56
44 yo male presents for annual wellness exam; Drinks socially, but father + brother are both recovering ETOH; What is best question to ask to screen patient for unhealthy ETOH use?
How many times in past year have you consumed 5+ drinks (4+ for women) in a day
57
What is a “save” in ethics?
Mistake that is caught before it ever reaches the patient
58
Indication for home health services?
Patients must have serious illness that Requires skilled care, and must be homebound
59
What are 3 criteria for a patient being homebound?
Use of supportive device for mobility, ability to leave home only with assistance, medical contraindication to being home
60
Which risks of treatment should be included and informed consent?
Risks that are reasonable patient in a similar situation would want to know
61
Three aspects of obtaining informed consent?
State proposed treatment, good alternative treatment options, consist of delay in proposed treatment
62
Four elements of decisional capacity?
Patient communicates choice, patient understands medical condition, patient appreciates consequences of treatment options, patient provides rationale for decision
63
___ are standardize decision tools that are often integrated into the electronic medical record
Clinical pathways
64
Description of FMLA?
Provides employees with after 12 weeks of unpaid leave
65
What are two conditions appropriate for FMLA?
Employee with serious illness, employee caring for immediate family member
66
Can a psychiatrist engage in a sexual relationship with a former patient, who has not been seen by physician in 1+ years?
No … according to board of psychiatry’s ethics code, sexual relationship between patient are provider are ALWAYS unethical (either current or former patients)
67
If a physician is presenting on a new drug, what is appropriate compensation to accept from the pharmaceutical company?
Allow pharmaceutical company to pay for travel expenses and reasonable honoraria … But physician must retain full control over presentation content, and must include financial disclosures
68
Should patients be informed of resident involvement in surgery during process of obtaining informed consent?
Yes
69
Which ethical principle applies to assuming patient is full code in an emergency setting?
Beneficence
70
Ethical principle of Beneficence refers to …
Physician duty to be of benefit to patients
71
68 yo male presents for 4 weeks SOB and LE edema; Suffered 2 prior MI, A-Fib; PE shows rate 122, bibasilar crackles, S3 heart sound, 2+ edema – which event is patient most likely to develop during admission – drug AE, pressure ulcer, fall, hospital-acquired infection, wrong-site procedure?
Adverse drug event
72
What are the 4 major categories of adverse events that occur during admission?
Operative, adverse drug, general care (wound, fall), infection
73
The most common AEs in hospitalized patient are related to …
Surgery
74
In patients not undergoing surgery, the largest group of hospital AEs is …
Adverse drug events
75
___ refers to a team-based model in which a surgeon and hospitalist share responsibility for a surgical patient’s care
Comanagement
76
Comanagement is characterized by …
Automatic involvement of hospitalist for surgical patients who meet specific criteria
77
3 strategies that can optimize effectiveness of comanagement model?
Define clear roles, refine clinical processes through continuous cycles of testing + assessment, track important clinical outcomes
78
When can exceptions be made to informed consent by parents in medical care of minors?
Emergency care
79
6 characteristics of emancipated minors?
Parent, married, military, financially independent, high school graduate, homeless
80
4 specific medical conditions that do not require informed consent for minors?
Sexually transmitted infections, substances, pregnancy, contraception
81
Approach to involvement of incarcerated populations in research studies?
Certain forms of research with incarcerated populations are permissible, but additional IRB approval is necessary
82
What is the first step in approaching vaccine-hesitant parents?
Engage in open dialogue
83
If a parent cannot be convinced to vaccinate their child, what is the next approach?
Maintain patient relationship, plan to reopen vaccine discussion at next visit
84
What are 4 steps in assessing decision-making capacity in a patient?
Communicates a choice, understands information provided, appreciates consequences, rationale provided for decision
85
Indication for home health services?
Patients must have serious illness that requires skilled care, and must be homebound
86
What are 3 criteria for a patient being homebound?
Use of supportive device for mobility, ability to leave home only with assistance, medical contraindication to being home
87
Which risks of treatment should be included and informed consent?
Risks that are reasonable patient in a similar situation would want to know
88
3 aspects of obtaining informed consent?
State proposed treatment, good alternative treatment options, consist of delay in proposed treatment
89
4 elements of decisional capacity?
Patient communicates choice, patient understands medical condition, patient appreciates consequences of treatment options, patient provides rationale for decision
90
___ are standardize decision tools that are often integrated into the electronic medical record
clinical pathways
91
Description of FMLA?
Provides employees with after 12 weeks of unpaid leave
92
What are two conditions appropriate for FMLA?
Employee with serious illness, employee caring for immediate family member
93
Next step for physician who has high suspicion for abusive relationship of exploitation?
Obligated to notify state Child Protective Services or Law Enforcement
94
Double-blinded RCT investigates relationship between hypolipidemic drug and survival of patients after PCI; Severe acute myositis is reported as a rare side effect of drug therapy, but difference between placebo and drug group is not significant – what accounts for failure to detect a significant statistical difference?
Small sample size
95
“what accounts for failure to detect a significant statistical difference” refers to …
Power
96
33 yo female is pregnant; She has multiple sexual partners, and is unsure who is father of her child; Patient refuses HIV testing – what is best response?
Although I highly recommend testing, you have the right to refuse
97
How often should smoking cessation be discussed with patient who still enjoys smoking?
Every time patient visits the office