FA - Behavioral science - everything else

Question 1

patient autonomy

Answer 1

• respect patient as individuals (truth-telling, confidentiality)
• allow for autonomous choice (informed consent)
• honor their preference in accepting/not accepting medical caer

Question 2

beneficence definition

Answer 2

ethical (fiduciary) duty to act in the patient’s best interest.
-May conflict with autonomy (an informed patient has the right to decide) or what is best for society (traditionally, patient interest supersedes societal interest)

Question 3

Nonmaleficence definition

Answer 3

“Do no harm”

Balance against beneficence; if benefits > risks, patient may make an informed decision to proceed (most surgeries and meds fall into this category).

Question 4

what is this an example of?

stopping a treatment that has shown to be harmful to the patient

Answer 4

Nonmaleficence - “Do no harm”

Question 5

what is this an example of?

encouraging a patient to lose weight and stop smoking

Answer 5

beneficence - ethical (fiduciary) duty to act in the patient’s best interest

Question 6

what is this an example of? refusing to provide treatment that has not been shown to be effective

Answer 6

Nonmaleficence - “Do no harm”

Question 7

what is this an example of? educating the community about STDs

Answer 7

beneficence - ethical (fiduciary) duty to act in the patient’s best interest

Question 8

what is this an example of?

resuscitating a drowning patient

Answer 8

beneficence - ethical (fiduciary) duty to act in the patient’s best interest

Question 9

what is this an example of?

providing vaccination to the community

Answer 9

beneficence - ethical (fiduciary) duty to act in the patient’s best interest

Question 10

informed consent involves

Answer 10

disclosure
understanding
mental capacity
voluntariness (freedom from coercion and manipulation)

Question 11

exceptions to informed consent

Answer 11

patient is incompetent
emergency (ie ectopic pregnancy)
therapeutic privledge
waiver

Question 12

what is therapeutic priviledge

Answer 12

withholding information when disclosure would severely harm the patient or undermine informed decision-making capacity

Question 13

what is a waiver?

Answer 13

patient explicitly waives the right of informed consent

Question 14

When is consent required for minors?

Answer 14

DEPENDENTS less than 18yo

Question 15

When is consent NOT required for minors?

Answer 15

1) minor is legally emancipated (married, self-supported, or is in the military)
2) getting treatment for
- Sex (contraception, STDs, pregnancy)
- Drugs (addiction)
- Rock and roll (emergency/trauma)

Question 16

What must a physician do when involved in decision-making capacity

Answer 16

determine whether the patient is psychologically and legally capable of making a particular health care decision.

Question 17

What is an advance directive?

What are the 3 types?

Answer 17

Instructions given by a patient in anticipation of the need for a medical decision

• Oral advance directive
• Living Will (written advance directive)
• Medical Power of Attorney

Question 18

What is an oral advance directive? Problems with this?

Answer 18

Incapacitated patient’s prior oral statements commonly used as guide.

Problem: differences in interpretation

Question 19

What is a written advanced directive?

Answer 19

aka Living Will.

Describes treatments the patient wishes to receive or not receive if he/she loses decision-making capacity

Question 20

What is a medical power of attorney?

Answer 20

Agent/person designated to make medical decisions in the event that one loses decision-making capacity.

Can be revoked anytime patient wishes (REGARDLESS OF COMPETENCE); more flexible than a living will

Question 21

Surrogate decision maker

priority of surrogates?

Answer 21

individuals (surrogates) who know the patient determines what the patient would have done if he/she were competent; usually done in the case where there is no advance directive prepared

spouse
adult children
parents
adult siblings
other relatives

Question 22

exceptions to confidentiality? 4

Answer 22

1) physical harm to SELF or OTHERS others is serious and imminent - Tarasoff decision
2) reportable diseases
3) child/elder abuse
4) impaired drivers (ie one with epilepsy)

Question 23

Patient is not adherent.

Answer 23

dentify the reason for nonadherence and determine his/her willingness to change

do NOT

• coerce the patient into adhering
• refer him/her to another physician

Question 24

Patient desires an unnecessary procedure (or does not want a necessary treatment)

Answer 24

understand why the patient wants or does not want the procedure and address underlying concerns.

do NOT

• refuse to see the patient
• refer him/her to another physician
• avoid performing unnecessary procedures

Question 25

Patient has difficulty taking medications.

Answer 25

KISS - keep it simple, stupid - provide written instructions - simplify treatment regimens - use teach-back method to ensure patient comprehension.

Question 26

Family members ask for information about patient’s prognosis.

Answer 26

Avoid discussing issues with relatives w/p patient permission

Question 27

patient’s family member asks you not to disclose the results of a test if the prognosis is poor because the patient will be “unable to handle it.”

Answer 27

Explain that as long as the patient has decision-making capacity and does not indicate otherwise, communication of information concerning his/her care will NOT be withheld

Question 28

A child wishes to know more about his/her illness.

Answer 28

Ask what the parents have told the child. Parents of a child decide what information can be relayed about the illness.

Question 29

A 17-year-old girl is pregnant and requests an abortion.

Answer 29

get parental notification or consent for minors Unless she is at medical risk, do NOT - advise a patient to have an abortion regardless of her age or the condition of the fetus

Question 30

15-year-old girl is pregnant and wants to keep the child. Her parents want you to tell her to give the child up for adoption.

Answer 30

patient retains the right to make decisions regarding her child, even if her parents disagree DO - provide info about the practical issues of caring for a baby - discuss the options, if requested - encourage discussion between the teenager and her parents to reach the best decision.

Question 31

A terminally ill patient requests physician assistance in ending own life.

Answer 31

refuse involvement in any form of physician- assisted suicide. May prescribe medically appropriate analgesics that coincidentally shorten lifespan

Question 32

Patient is suicidal.

Answer 32

Assess the seriousness and if it is serious, hospitalize patient voluntarily or involuntarily

Question 33

Patient states that he/she finds you attractive.

Answer 33

Ask direct, closed-ended questions and use a chaperone if necessary. Never say: “There can be no relationship while you are a patient," - implies that a relationship may be possible if the individual is no longer a patient

Question 34

A woman who had a mastectomy says she now feels “ugly.”

Answer 34

Find out why the patient feels this way. do NOT offer falsely reassuring statements (e.g., “You still look good.”).

Question 35

Patient is angry about the amount of time he/she spent in the waiting room.

Answer 35

Acknowledge the patient’s anger and Apologize for any inconvenience Avoid explaining the delay.

Question 36

Patient is upset with the way he/she was treated by another doctor, or staff.

Answer 36

Doctor: suggest that the patient speak directly to that physician regarding his/her concerns. Staff: tell the patient you will speak to that person.

Question 37

A drug company offers a “referral fee” for every patient a physician enrolls in a study.

Answer 37

Eligible patients who may benefit from the study may be enrolled - however, it is never acceptable for a physician to receive compensation from a drug company. Patients must be told about the existence of a referral fee.

Question 38

A physician orders an invasive test for the wrong patient.

Answer 38

regardless of how serious or trivial the error, ethically obligated to inform a patient that a mistake has been made.

Question 39

A patient requires a treatment not covered by his/her insurance.

Answer 39

Never limit or deny care because of the expense in time or money. Discuss all treatment options with patients, even if some are not covered by their insurance companies.

Question 40

Apgar score of >7

Answer 40

good

Question 41

Apgar score of >4-6

Answer 41

assist and stimulate

Question 42

Apgar score of <4-6

Answer 42

resuscitate If it remains < 4 at later time points, there is increased risk of long-term neurological damage.

Question 43

low birth weight is defined as: causes? associations

Answer 43

<2500 g prematurity or intrauterine growth retardation (IUGR) SIDs + increased overall mortality

Question 44

Of the three types of Advance Directives, which is the most specific? Which is the most flexible? Which is the most sketchy?

Answer 44

(Jen's interpretation to help her remember) - Most specific seems to be the Living Will (written advance directive). written by patient and says what to do in various situations if she loses decision-making ability. - Most flexible seems to be the Medical Power of Attorney. Can be revoked at any time regardless of patient competence. - "Oral advance directive" kinda sounds like everyone's best guess.

Question 45

APGAR stands for what?

Answer 45

``` Appearance Pulse Grimace Activity Respiration ```

Question 46

moro reflex disappears at

Answer 46

3 mo

Question 47

rooting reflex disappears at

Answer 47

4 mo

Question 48

palmar reflex disappears at

Answer 48

6 mo

Question 49

babinski reflex disappears at

Answer 49

12 mo

Question 50

social smile? stranger anxiety? separation anxiety?

Answer 50

social smile = 2 mo stranger anxiety = 6 mo separation anxiety = 9 mo

Question 51

separation anxiety from mom rapprochement (moves away from and returns to mom) comfortably spends part of day away from mom

Answer 51

separation anxiety from mom = 9 mo rapprochement (moves away from/returns to mom) = up to 2.9 mo comfortably spends part of day away from mom = 3yo and on

Question 52

when does children do parallel play (play side by side)? cooperative play (play together)?

Answer 52

``` parallel play (play side by side) = 1.0 - 2.9 yo cooperative play (play together) = 3.0 - 5 yo ```

Question 53

how do developing countries differ in terms of overall disease morbidity compared to developed countries?

Answer 53

developing countries = younger population developed countries = older population

Question 54

how does REM and slow wave sleep change in the elderly?

Answer 54

decrease