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M2T1 PCBM COMBANK Questions 2017

Terms in this set (39)

A 34-year-old male presents to his physician's office for a pre-employment physical exam. His review of systems is negative and his physical exam is unremarkable. At the end of the visit he presents the doctor with a form that must be completed. The form requests the results of a number of genetic tests that the company requires for all potential employees. The most appropriate course of action is for the physician to:

A. advise the patient that this could be a violation of the Americans with Disabilities Act (ADA)
B. advise the patient that this could be a violation of Genetic Information Nondiscrimination Act (GINA)
C. advise the patient that this could be a violation of HIPAA
D. order the tests per the employer's request
B. advise the patient that this could be a violation of Genetic Information Nondiscrimination Act (GINA)
A 34-year-old male who was recently terminated from a job seeks counseling from a psychiatrist for depression. While explaining his symptoms to the physician, the patient discloses that he has a gun in the trunk of his car and that he plans to drive to his former boss's home and shoot him after the session. Given this information, the best course of action for this physician is to:

A. attempt to contain the patient and inform both law enforcement and the patient's former boss of the patient's intentions
B. inform both law enforcement and the patient's former boss of the patient's intentions
C. inform law enforcement of the patient's intentions
D. inform the patient's former boss of the patient's intentions
E. keep the patient's intentions confidential
A. attempt to contain the patient and inform both law enforcement and the patient's former boss of the patient's intentions
A 37-year-old female is notified that her primary care physician will be leaving the multi-provider practice to open his own private practice. The patient requests her medical records so she can transfer them to her physician's new office. Which of the following is most accurate regarding such medical records?

A. The practice has the right to refuse the patient's request because the records belongs to the practice
B. All medical records are regulated by the state; therefore, patients must file a formal request with government officials for their release
C. medical records are considered personal property of the patient; therefore, patients have the right to see and obtain a copy of their medical records
D. medical records are owned by the practice; however, patients have a right to see and get a copy of their records
D. medical records are owned by the practice; however, patients have a right to see and get a copy of their records
A 36-year-old married female has just been told she is HIV-positive. After explaining what the results mean, she is advised that it is important for her to discuss the results with her husband. The patient states she does not think she is brave enough to tell him, and prefers her HIV status stay between her and the physician. The most appropriate course of action is to:

A. gain consent from the patient to notify the state health department and any contacts at significant risk for exposure to HIV
B. notify the Center for Disease Control and Prevention (CDC), then continue to persuade her to tell her husband
C. notify the state health department and ask that they inform the husband
D. notify the state health department and provide the patient with resources that will help her discuss the results with her husband
E. tell the patient that all information regarding her medical condition is confidential and will not be divulged to anyone without her consent
D. notify the state health department and provide the patient with resources that will help her discuss the results with her husband
A 44-year-old male with schizophrenia has been non-compliant with his medications. He has been suffering from delusions and is convinced his wife is having an affair. He informs his psychiatrist that he has been thinking of hurting his wife and wants to buy a gun to kill her. Which of the following mandates that the physician take measures to protect the patient's wife?

A. Cruzan v. Director
B. Public Health Service Act
C. Schloendorff v. Society of New York Hospital
D. Tarasoff v. Regents of the University of California
E. The Patient Self Determination Act
D. Tarasoff v. Regents of the University of California
A 62-year-old female presents alone to the ED with SOB. Her medications include metoprolol, simvastatin and warfarin. Labs reveal an INR of 4.3 and a hemoglobin of 4.8 g/dl. Her code status is DNR/DNI. The patient is frightened and requests her family not be informed about her condition or prognosis. When her husband arrives he anxiously asks about her condition. The most appropriate course of action is to:

A. consult the hospital ethics committee
B. explain that the patient is currently in stable condition but has requested privacy until further notice
C. explain that the patient requested privacy until further notice and ask him to wait patiently in the lobby
D. inform him that the patient is present at this facility and ask him to wait patiently in the lobby
E. provide brief answers to his questions and ask him to wait in the lobby
C. explain that the patient requested privacy until further notice and ask him to wait patiently in the lobby
A 34-year-old female has been diagnosed with anxiety and depression and consults her PCP weekly via telephone about her struggles and refuses any suggested pharmacologic or psychological therapy. One afternoon the patient calls the PCP's office threatening that she plans to commit suicide. What is the most appropriate course of action for the PCP?

A. Tell the patient she should go to the closest emergency department
B. Schedule the patient to come in for an appointment the next day
C. Immediately discharge the patient from the practice
D. Transfer care to a psychiatrist
E. Call 911 immediately
E. Call 911 immediately
A 35-year-old female is admitted to the hospital for acute appendicitis. The medical team recommends the patient have an appendectomy. Before the procedure, the surgeon explains the procedure, its risks and benefits, as well as the alternatives to the patient in order to obtain the patient's informed consent. Which of the following established the legal precedence for obtaining informed consent?

A. Tarasoff v. Regents of the University of California
B. Bouvia v. Superior Court
C. Schloendorff v. Society of New York Hospital
D. Cruzan v. Director
E. Roe v. Wade
C. Schloendorff v. Society of New York Hospital
A 26-year-old pregnant patient presents to her obstetrician for a prenatal visit with a history of gonorrhea, HPV, multiple sexual partners and intravenous drug use. Due to her history the obstetrician recommends a HIV test, but despite an explanation of why the test is so important and the effect HIV can have on the patient and her baby, the patient refuses because she does not want to know whether she has HIV. How should the obstetrician proceed?

A. Document the patient's decision and do not perform the HIV test without her consent
B. Report the patient to the police for child abuse
C. Perform the HIV test under the guise of another blood test
D. Deny the patient care unless she consents to the HIV test
E. Report the patient to the state's public health department so they can require the HIV test
A. Document the patient's decision and do not perform the HIV test without her consent
A 86-year-old female with three children is admitted to the hospital with a compression fracture, prompting concern that she has an underlying malignancy. Her eldest son requests that the possibility of cancer not be discussed with his mother. He relays that, culturally, as the eldest son he will make medical decisions on her behalf. Furthermore, he believes this information would be distressing to her and she would prefer not to know. The best course of action is to:

A. ask for an ethics consultation
B. ask psychiatry to assess the patient's capacity
C. ask the patient if she would like to be informed or defer to a surrogate
D. disregard the family and inform the patient of the potential diagnosis
E. respect the family's wishes and speak only with them
C. ask the patient if she would like to be informed or defer to a surrogate
A 66-year-old married male with diabetes, hypertension, end-stage renal disease on hemodialysis and peripheral vascular disease is admitted with gangrene of his right lower extremity. The vascular surgeon performs an angiogram and determines that the patient needs an amputation. The patient refuses surgery, stating, "My leg feels fine." The best course of action is for the surgeon to:

A. assess the patient's capacity
B. obtain a court order to perform the surgery
C. obtain consent from the patient's wife
D. respect the patient's wishes and not operate
E. take him to the operating room and perform the surgery
A. assess the patient's capacity
A 10-year-old male is brought to the ED by a neighbor with a small laceration to the forehead. Both parents are on their way to the hospital. Physical examination reveals a 2-cm laceration that require sutures. The most appropriate next step is to:

A. allow the patient to consent to the procedure himself.
B. delay sutures until consent is obtained from one parent.
C. permit the neighbor to give consent as a temporary legal guardian.
D. suture the laceration and obtain consent after the parents arrive.
E. suture the laceration without consent.
B. delay sutures until consent is obtained from one parent.
A 16-year-old female brings her three-month-old daughter to the pediatrician's office for evaluation. The office staff is concerned because the mother arrived to the office alone with the child. Which of the following is the most appropriate course of action?

A. call child protective services.
B. call the state medical board for permission to see the patient.
C. examine the child per the mother's request.
D. tell the mother she must be accompanied by an adult for her daughter to be seen in the office.
C. examine the child per the mother's request.
A sexually active 15-year-old girl comes to the clinic for dyspareunia and vaginal discharge and does not want her parents to find out. On speculum examination you find she has cervicitis. The pregnancy test is negative. There is no emergency, but the infection is modest and requires medication. Which of the following is the most appropriate action to take?

A. Provide appropriate medications and do not inform her parents.
B. Make at least a "good faith" effort to notify her parents and treat her.
C. Wait to inform at least one parent.
D. Treat only if she agrees to inform her parents.
E. Treat her now and inform the parents later.
A. Provide appropriate medications and do not inform her parents.
A 16-year-old female comes to the clinic after missing a period. Her pregnancy test is positive and she wants to start prenatal care with you. She is adamant that you do not tell her parents. What should you tell her?

A. "I will give you the care you need and keep it confidential."
B. "I will not mention it to your parents unless they ask. I can't lie."
C. "I am sorry, but I must tell them."
D. "I will not tell your parents, but I must inform the father of the baby."
A. "I will give you the care you need and keep it confidential."
Minors' Right of Consent in PA

What conditions at ANY AGE does a minor have a right to consent to?
Substance abuse, STDs (including HIV/AIDS), reproductive health (eg. contraceptive, emergency contraception, pregnancy testing, pregnancy-related conditions, except abortion)

Minor parents may consent to all healthcare services for their child.
Minors' Right of Consent in PA

What conditions at AGES 14 AND OLDER does a minor have a right to consent to?
Mental health (including inpatient admission)
When it comes to mental health, what are the parents allowed to do?

If a minor aged 14 or older admitted themselves at a mental health facility, what does the facility need to do?
Parents may consent to mental health services without minor's consent.

Parental notice is required for in-patient services.
What healthcare rights do minor parents have?
Minor parents may consent to all healthcare services for their child.
A 32-year-old GlP0 female at 29 weeks' gestation with intrauterine growth restriction is advised by her obstetrician to have an urgent cesarean section. After a thorough explanation of the risks, benefits and alternatives of the procedure, the patient continues to refuse the intervention and requests a second opinion.

The obstetrician defers to the patient based on the ethical principle of:
A. Autonomy
B. Beneficence
C. Justice
D. Non-maleficence
E. Paternalism
A. Autonomy
During a fight a 33-year-old female boxer sustains a C1-C2 cervical spine fracture resulting in paralysis from the neck down and is ventilator dependent. She is fully alert, able to make medical decisions and understands her condition. Two weeks post injury the patient tells you she wants the ventilator withdrawn and that she understands she will not survive without it.

What should you do?

A. Consult the Ethics Committee.
B. Attempt to involve the patient's family.
C. Remove the ventilator.
D. Order a Psychiatry consult to assess the patient's decision-making ability.
E. Have the patient meet someone with the same condition to hear how the other patient has coped.
C. Remove the ventilator.
A 56-year-old married male with metastatic cancer has failed multiple rounds of chemotherapy, each course complicated by nausea, vomiting and admission for neutropenic fever. He is now encephalopathic, delirious and lacks decision-making capacity. Given his current clinical condition and prior non-response to treatment, further chemotherapy is contraindicated. Instead, his oncologist recommends hospice care and aggressive pain management, which he discusses with the patient's wife.

Which ethical principle supports this recommendation to withhold further chemotherapy?
A. autonomy
B. paternalism
C. justice
D. non-maleficence
D. non-maleficence
A 34-year-old man is brought to the ED with a fever, headache, stiff neck and significant disorientation. He needs an urgent head CT and lumbar puncture. He is agitated and pushes away anyone who tries to get near him. Co-workers brought him in and contact information for his family is unavailable.

What are your options?

What option is the most appropriate?
In medical emergencies (i.e., potential for loss of life or limb, or for serious permanent injuries) informed consent is not required based on the presumption that a "reasonable person" would want to be saved.

This exception does not apply to patients who have previously stated their wishes to have life-sustaining/life-saving treatment withheld, whether verbally or by way of an advance directive, DNR Order or Declaration of Faith (e.g., Jehovah's Witness or Christian Scientist).

Physicians are obligated to make a good faith attempt to determine whether the patient has already made decisions regarding the use of life-sustaining/life-saving measures.
A 43-year-old female Jehovah's Witness is currently in the ICU being treated for hepatic encephalopathy and lacks decision-making capacity. The patient had previously made clear to the ICU Attending that she is a devout Jehovah's Witness and does not want any blood products. After the patient's condition further deteriorates the ICU Attending asks the resident to order a blood transfusion. What is the most appropriate course of action for the resident?

A. Refuse to order the transfusion for the patient
B. Give the patient blood substitutes and only order the transfusion if still needed
C. Refer the case to the hospital ethics committee
D. Contact the hospital's legal department
E. Transfuse the patient per the attending physician's orders
A. Refuse to order the transfusion for the patient
A 12-year-old male is brought into the emergency department by ambulance after being struck by a car. He suffered multiple internal injuries and will die without an immediate blood transfusion. His parents, who arrive at the hospital just behind the ambulance, state that a transfusion is against their religious beliefs and refuse to consent. What should you do?

A. Follow the parent's wishes
B. Give the patient a blood transfusion
C. Consult the hospital ethics committee
D. Transfer the patient to another hospital
E. Call child protective services immediately
B. Give the patient a blood transfusion
A 34-year-old married female is undergoing a laparoscopic appendectomy for acute appendicitis. Immediately after inserting the laparoscope the surgeon notes an ovarian mass and consults gynecology. Both agree that a biopsy of the mass is also indicated. The patient has not consented to this second procedure.

The most appropriate course of action is to
A. finish the appendectomy and, once the patient is awake, obtain her consent for the biopsy
B. obtain consent from the patient's husband and perform the biopsy
C. perform the biopsy and obtain the patient's consent post-operatively
D. perform the biopsy but only inform the patient if the pathology is concerning
E. terminate the surgery, wake the patient up, and obtain a new consent for both procedures
B. obtain consent from the patient's husband and perform the biopsy
Which of the following is the best predictor of one's health?

A. Whether or not you smoke
B. What type of diet you eat
C. Whether or not you are wealthy
D. Whether or not you have health insurance
E. Whether or not you exercise regularly
C. Whether or not you are wealthy
Citizens of industrialized countries have longer life expectancies and better health because:

A. The spend more on medical care
B. They are more egalitarian
C. They smoke less
D. They eat better
E. They have universal health coverage
B. They are more egalitarian
From the age of 5, African-American men in Harlem have a shorter life expectancy than which group?

A. Japanese
B. Bangladeshis
C. Cubans
D. Algerians living in Paris
E. All of the above
E. All of the above
A primary care physician refers a stable patient to a cardiologist who accepts all insurance providers. After a short wait while on the phone trying to make an appointment, the patient is informed that the cardiologist has declined to see her. Which of the following best describes the ethical implications of this scenario?

A. abandonment on the part of the primary care physician
B. breach of duty on the part of the cardiologist
C. loss of consortium on the part of the primary care physician
D. negligence on the part of the cardiologist
E. no ethical fault for either the cardiologist or primary care physician
E. no ethical fault for either the cardiologist or primary care physician
A 55-year-old male patient has failed to pay numerous medical bills because his insurance company no longer covers his physician's services. He becomes upset when his physician refuses to provide medical care during a routine office visit, and he subsequently files a lawsuit citing abandonment. The physician could have protected himself by

A. calling the patient to discuss that he can no longer provide services
B. having the patient sign a contract stating he will make the payments
C. offering the patient a discounted rate for repayment
D. referring him to another physician who takes his insurance
E. sending the patient a letter stating he can no longer provide services
E. sending the patient a letter stating he can no longer provide services
A 72-year-old female lives in a rural town with only one family practice physician. The next-closest physician's office is 20 miles away. She has not seen a physician in over ten years and is concerned about her general health. Upon calling the doctor's office, she is told that he is not taking new patients at this time and is unwilling to see her. The patient becomes infuriated and threatens to sue the doctor. It is most accurate to state that the

A. patient is likely to win the threatened suit
B. physician is not legally obligated to evaluate nor refer the patient
C. physician is not obligated to see the patient but must provide an appropriate referral
D. physician is obligated to see her because she is elderly
E. physician must offer the patient at least one yearly exam due to proximity of the patient to another physician
B. physician is not legally obligated to evaluate nor refer the patient
A physician running a busy practice in an underserved area decides that he is too overwhelmed by his patient load. He instructs his office staff to refuse new patients into the practice but continues to see all members of his current patient population. It is most accurate that the decision is:

A. both ethically acceptable and legal
B. ethically acceptable but illegal
C. illegal in underserved areas
D. legal but only ethical if he arranges for referral of new patients to another practice
E. legal but unethical
A. both ethically acceptable and legal
A 58-year-old male with well-controlled diabetes and hypertension repeatedly comes late to appointments with his internist. He was over two hours late to his last two appointments and became verbally abusive to staff and other patients when he was not seen immediately. He is told multiple times by his internist that if he continues to engage in these behaviors he will be discharged form the practice and referred to another physician. Unfortunately, he continues to be verbally abusive to the physician and staff. The most appropriate course of action is to:

A. make the patient an appointment with another doctor
B. notify the patient in writing that he is discharged from the practice
C. refuse to provide the patient with a copy of his medical records
D. stop refilling current prescriptions for his diabetes and hypertension
E. tell the receptionist to stop taking the patient's calls
B. notify the patient in writing that he is discharged from the practice
A resident on the cardiology service is called to evaluate a patient who is experiencing acute chest pain. The resident assesses the chest pain to be non-cardiac in nature and decides not to order an ECG. Later on that night, the patient experiences a massive myocardial infarction and dies. Which of the following statements is most applicable concerning the legality of this case?

A. the attending physician can be found to be at fault for negligence
B. patients without insurance cannot sue for events which occurred during an unpaid hospital stay
C. residents can be cited in lawsuits but are not liable for financial detriments
D. residents cannot be cited in a lawsuit
E. there are no grounds for a lawsuit, given that the resident had the best interests for the patient
A. the attending physician can be found to be at fault for negligence
A 23-year-old female undergoes emergent surgery for acute appendicitis. After the procedure is completed, an abdominal radiograph is obtained and identifies a scalpel inside the abdominal cavity. The physician is subsequently sued and found guilty of medical malpractice based on:

A. failure to diagnose
B. gross negligence
C. res ipsa loquitur
D. vicarious liability
E. volenti non fit injuria
C. res ipsa loquitur
A 55-year-old male is consented for an elective surgery for an abdominal hernia repair. During the surgery, the surgeon also removes the patient's appendix due to a suspicious cyst-like lesion. After the surgery, the man contacts a lawyer wishing to know if that were the right thing for the surgeon to do. The lawyer correctly tells the man that he believes the surgeon is guilty of:

A. battery
B. futility
C. negligence
D. Nonmaleficence
E. the physician cannot be held liable in this situation
A. battery
A 24-year-old female at 35-weeks gestation consents to receiving a blood transfusion and subsequently develops an infection with hepatitis B virus. Although the patient was told about the chance of several complications associated with blood transfusion, she was not informed about the possibility of infectious disease transmission, as this is now a rare complication. The patient files a suit against the doctor. The most likely outcome of the suit is that the

A. patient wins the case because the disease was contracted from the transfused blood
B. patient wins the case because this risk was not discussed
C. physician wins the case because he did not prepare the blood products
D. physician wins the case because the complication is rare
E. physician wins the case because the patient cannot prove the disease came from the transfused blood
B. patient wins the case because this risk was not discussed
A 33-year-old construction worker is brought in by emergency medical services after falling 10 feet at a worksite. He has no health insurance and has not had any medical care since he was a child. Which law serves to ensure that he now receives the care he needs ?

A. Emergency Medical Treatment and Active Labor Act
B. Good Samaritan Law
C. Public Health Service Act
D. The Stafford Act
E. Volunteer Protection Act
A. Emergency Medical Treatment and Active Labor Act
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