Ethics and research questions 2019

Qs were collected from multi-specialty

30 June- 4 July 2019

1- Two doctors talking out loud and mentioning patients name, what did they violate?
- patient’s confidentiality

2- Scenario of a patient came to your clinic, chose a procedure but you weren’t convinced with the
procedure and chose another one instead, what did this act violate?
- patient’s autonomy ?

Beauchamp and Jim Childress four principles

Respect for Acknowledge a person’s right to make choices, to hold views, and to take actions based on
Persons/Autonomy personal values and beliefs
Justice Treat others equitably, distribute benefits/burdens fairly.
Nonmaleficence (do no Obligation not to inflict harm intentionally;
harm) In medical ethics, the physician’s guiding maxim is “First, do no harm.”
Provide benefits to persons and contribute to their welfare. Refers to an action done for the benefit
Beneficence (do good)
of others.

3- Which of the following indicates preservation of pt safety?

- To do no harm for the pt ?
- To do welfare for the pt
Explanation above

4- Meaning of beneficence ?
- to do welfare for the patient.
Explanation above

5- They showed a forest plot and asked what is this graph called
Forest plot (Blobbogram), is a graphical display of estimated results from a number of scientific studies
addressing the same question, along with the overall results.

6- Nurse got needle stick injury from a patient, she refused to do incident report saying that her patient is
decent and clean, as observing physician, what will you do?
- report incidence
- Respect nurse opinion
- Order serology for the patient
- Go through patients past medical records

7- The patient developed anaphylaxis reaction after exposed to penicillin but delayed the transport to be
evaluated by the physician, when the physician saw the patient he completely normal with no delayed
symptoms :
- Initiate investigation to see whose responsible
- Debriefing with the team
- Label medication as allergen in patients EHR
- Report incidence, ??

8- Some question about research and the sponsor has something to do with the research result , the answer
was :
- conflict of interest

9- Patient with gunshot no bleeding suture done and he want to go home what you well do ?
- agree with pt
- report to police
- report to ethical

10- Physician wanted to work in a research with a drug company, how can he do this while maintaining
ethics? (same as Q 8)
- declare conflict of interest
- Feeling able to do this without affecting study results
- Participate since the very beginning
- ??

11- Fight between EM and ENT regarding accepting a case, what frame should you use for proper
referral?
- assessment, recommendation, (2 more words)
- Pay attention to non verbal clues

12- Elderly got a medication daily when it should have been taking weakly, in order to reduce drug
related errors, which of the following have been applied?
- two step prescription for medication by two health care people (something similar to this)
- Two weeks prescription

13- HIV patient tells he will use condom and ask you not inform his wife, what to do:
- Inform wife immmediatly
- Encourage the pt to tell his wife
- Let him sign a consent that he will use a condom

14- Which of the following is sentinel error?

- Nurse took the wrong med but didn't give it to the patient
- They surgically removed the wrong kidney by mistake

15- Young man with contagious disease, needs treatment which should prevent the spreading of
the disease, but the patient refused.
what is the action of the doctor?
- to tell him that the medication is compulsory
- to respect his wish
- let him sign consent and leave him
- let him sign consent and treat him

16- A doctor taking care of a patient for long time and the patient is deteriorating. He refused to
transfer him to any other doctor, according to patient's rights, he is violating:
- Beneficenc
- Non maleficence ? Do no harm?
- Autonomy

17- Indian guy who needed a procedure and there was language barrier difficulty, the team tried
to explain to him. Then they decided to let the patient sign and proceed with the procedure,
Which ethical principle was unsatisfied :
- Autonomy ?
- Providing interpreter ?? could be?
- Valid consent

18- What is the most important thing to check before giving patient a medication ?
- Vital signs
- Alergic reaction

19- Which type of research can expedite IRB approval?

- Minimum risk to human
- There is an intervention with risk
- Risk is unpredictable
- No intervention or risk
20- Patient was involved in RTA, he had fractured leg. needs foot amputation, he was refusing
the surgery even after you explained the risks & benefits of the procedure. Then he agreed
because he hears voices telling him to do it. What to do?
- Find another decision maker because pt is not competent
- Proceed to the life-saving surgery even though patient is not competent
- Involve another surgeon to confirm the importance of the surgery

21- Patient chooses not to donate his organs (?he wrote a letter). Later, he had a traumatic
accident with poor outcome his family suggested that his organs should be donated accordingly:
What is the best ethical practice :
- Take a consent from his son and take his organs
- No organ donation for this patient
- If there is a patient in need, take his organs

22- 75 y/o pt has incurable disease, his sons told you not to tell their father because he is a soft
hearted person, you explained to them that the patient has the right to know about his illness but
they Refused.. What is the next appropriate step the doctor Should do?
- Try to persuade the sons again, and if they refused not to tell him
- Respect their wish
- Call all the family and tell them to diclose the information to the pt
- To disclose the info to the pt himself useing SPIKES protocol ? ?

23- Patient k/c schizophrenia brought to ER, he was agitated and having hallucinations. You felt
it's needed to call his primary consultant who works in another hospital.
What is appropriate for the primary consultant to do?
- accept consent from patient through the phone.
- accept consent from his family through the phone.
- ask for official request to give the information.
- just give the information without consent ??
24- According to " your 5 moments for hand hygiene " when you should wash your hand:
- either before or after you touch the patient
- if you touch the patient's surroundings
- after aseptic procedure
- after body fluid exposure

25- A study of depression among population consent was explained and taken what type of
review need to be taken by Research Investigator:
- Full
- Expatiated
- Exempt?

Source:
https://www.research.uci.edu/compliance/human-research-protections/researchers/levels-of-review.html

26- You are a researcher of a project with company and the data of the patient in a file in your
office with easy access to the author , co author and the sponsor of the project.
Which of the following lead to break the patient confidentiality :
- Pt. Autonomy.
- Sponsors accessibility to the data.??

27- Which of the following in consider never miss? (Maybe they mean Near miss ?)
- Massive Transfusion
- ASA1 Class ll
- Patient. death

28- You are performing procedure , nurse tells you there is missed needle what you will do ?
- X RAY ??
- Close the patient x
- Palpate to find it x
- Open the suture line and look for it ??. If not found go for xray.

29- Nurse gave lidocaine IV instead of Abx by mistake, What type of error?
- same shape ???
- same sound
- same prescription
30- According to previous case, patient died and the action was > nurse got fired, what do you
think of this action?
- wrong action???

31- Patient diagnosed to some type of cancers and she doesn't want to know the results, what you
will do?
- Respect her choice.
- Give her other appointment.
- Treat her as she wants.
- Talk with one of family members to take decision.
Different q, Female with breast cancer the son asks you not to tell her what would you do?
- Assess patient competence???
- Tell her
- Don’t tell her
- Ask her if she wants to know ?
32- Pregnant lady with placenta accreta she delivered and developed PPH, now she needs
hysterectomy to save her life. She and her husband refused to sign the consent, what is your
action?

- Respect their choice

- The physician should sign the consent and proceed with the surgery . (Life threatening)
- Ask them to sign refuse of treatment paper
- Call a senior family member to sign instead of them

33- Patient with missed abortion , they decided to do dilation and curettage .. instead they did
hysterectomy by mistake.

- don’t till the patient

- inform the patient by the physician
- refers the case to health authority

34- During laparotomy before closure the nurse told you that there’s a towel missing .. she
looked everywhere and you are sure that it’s not in the wound , what would you do?
- Obtain radio ??
- Wound exploration x u r sure?
- Close x
- Report as error in counting. x

35- Post laparotomy on x ray there’s a towel?

- Disclosing error??
- Disclosing apparent complication
- Disclose

36- Husband and wife came to the clinic for IVF, they took the sperms from the husband, later
on they got divorced, the wife came to your clinic again asking to continue the IVF, what should
you do?
- cancel ???
- consent from the wife enough
- consent from X husband

37- Consultant tried to enter a drug in the system but he couldn’t and he received a call from the
pharmacist telling him that this drug could interact with another drugs of the patient,, what do
you call this?
• Human interference???

38- Randomized Clinical Trials, what stage ?

I
IIa
III
IV

Type 1a
Level 3

39- Calculate median ??

The # in the middle of the sequence ( eg 1-2-3-4-5-6-7) Median is 4
Keep in mind need to re-arrange highest till the lowest. If 2 numbers in the middle then add the and divide on 2

40- RR for non exposure?

RR= A/(A+B) / C/(C+D)

41 - Type of Bias for a case of scabies??

Common types of BIAS:
1. Confirmation bias
Occurs when the person performing the data analysis wants to prove a predetermined assumption.
2. Selection bias
This occurs when data is selected subjectively. As a result, the sample used is not a good reflection of the population.
3. Outliers
An outlier is an extreme data value. E.g. a patient with an age of 110 years.
4. Confounding variabelen
If the research results show that when more ice creams are sold more people drown, ask whether they have checked for what are known as
confounding variables. In this case, the confounding variable will be the temperature. If the weather is hotter, people will eat more ice cream and
more people will go swimming.

42- Freshly graduate doctor was treating a difficult case in the clinic and didn’t refer him to an
experienced specialized doctor because he was afraid of criticism what ethical principle did he
violate?
- non maleficence (Do no harm)
43- Patient is for big toe amputation, You explain everything and asks if he understood.
This is ?
- Consent ??
- Assess pt capacity ??
44- Definition of autonomy ??
- The right of patients to make decisions about their medical care without their healthcare
provider trying to influence the decision.

45- Study for patient who are using anti-perspirant develop breast cancer
- Cohort ??
46- Patients in a study chosen by computer ?
- Randomised prospective ?
47- you’re performing a surgery and you find swelling “not related to surgery “
And you take it out. What didn’t you take under consideration?
- Autonomy ?
- Scope of consent
-
48- female pt for OR , the husband didnt agree so the pt didn’t sign , what is affected ?
Autonomy ??

49- Negatively skewed distribution??

- Mean < median < mode

-ve skewed = Mean < Median < Mode

+ve skewed= Mean > Median > Mode

‫ سؤال يحتاج حساب بالريسرش‬2‫احد الشباب اي ار يقولون ماجاهم و‬

50 - An angry woman during the morning round refuse her daughter to be examined by any
intern trainee. She stated that she wants her to daughter to be examined only by the consultant.
Your action should be:
A. Discharge her daughter.
B. Inform her the trainee must train on patient.
C. Tell her the trainee are working under consultant supervision
D. Let her daughter to be exmined by trainee forcefully

51 - You notice that your consultant become forgetfulness. He is very kind and gentle during
teaching and honest. When you inform him about his condition he denies and become angry.
You should:
A. Keep following his medical action.
B. Inform the head of department.
C. Ignore your notice
52 - 50 years old gentleman was diagnosed to have hepatitis C. He works as barber and he asked
you not to till about his diagnosis:
A. You should respect his confidentiality
B. You should report to the principle authority
C. You encourage him to till about his condition

53 - 40 years old women complaining of epigastric abdominal pain. She was evaluated and her
physician decide to give her IV ranitidine. 15 minute later she was found to be hypotensive when
declare what happen it appears the nurse gave her clonidine a well known medication to decrease
blood pressure instead of ranitidine. What supposed to decrease such an event:
A. electronic prescription
B. Double check prescription

54 - A physician decide to decrease the risk of drug-drug interaction, what he supposed to do:
- Document a good history.
- Avoid abbreviation to know the medication ?

55 - You gave a patient an instruction about his medication, the best way to maximize his
understanding to the instruction:
- written instruction ?
- Repeat the instruction
- Reply instruction ?

56 – Scenario and ask when to use SPIKES protocol ?

- Gyne procedure and urgent hysterectomy is indicated
- To till mother about her child brain death

57 - The most frequent medical error from highest to lowest:

- wrong dose, wrong medication, medication not administered, wrong patient.

58-The most important thing in clinical practice of medicine:

- Knowing patient information
- Tracking patient diagnosis

59 – A patient is inside, what can break or violate the patient privacy?

- Presence of unrelated medical personnel.

60 - What can break confidentiality of the patient?

- Leaving manual records open outside while you are not using it.

61- Most common cause of drug error?

- Hand writing.

62 – Urgent procedure, Father on the way to the hospital, Who will sign the form?
 - Call father over the phone
- The oldest relative around
- You as a physician

63 – In regards to Organ donation, Who should speak with the patient about it?
- The primary physician of the patient.

64- Nurse gave insulin instead of heparin to a patient, then patient have experienced a sever
hypoglycemia. What to do ?
- Report to head nurse
- Talk directly to the nurse.

65 – Unclear Q in regards to CBAHI.

A resident will be in charge, his colleagues are not exited and till him that it is just an act. What
he state to them about CBAHI?
- To do recruitment
- To improve quality
- To supervise hospitals
66- A pediatric consultant in charge of CBAHI, How can he prepare the hospital to accredited
the CBAHI certificate ?
- To implement WHO standers.
- To check essentials safety measures.

67- A researcher is planning to test a drug but did not tell the participant about all SE of the drug,
what he failed in ?
- Provide full informed consent
- Tell all the negative SE.

68 – Patient want to be discharged and refuse to sign DAMA as well, What to do?
- Don’t discharge
- Force him with security to sign
- He is not obligated to sign.

69 – Q asking what to do before surgical incision:

- Check allergy
- Check labs
- Check consent

70- What is the most common cause of medication error ? Look alike sound like meds ?
- Pt restless won’t sit down ??
- Take collateral or observe

71 - When to break confidence ?

 - Criminal act ??
- STD
- CA
- Infection

72 - Patient with complete hearing loss / doctor want to examine him ? What to do ?
- Ask relative if he has physical sign to communicate
- do examination with out talking anything’s
- trying to talk with high perched sound
- chose to find a type of communications
73 - Child with meningitis, the family refuse the LP what to do ?
- proceed with LP
- start empirical AB
Sign on refusal (paper?) and discharge.
74 - female patient come to clinic with strange clothes and talk with low tone , close and ask
personal Q to the doctor >>
- Call a nurse
- Refer to another doctor

75- Patient is talkative and jump from subject to subject how to deal with priority
- Give other appointment

76- A physician well present a lecture about HTN, a drug company have talked to him
About new antihypertensive drug that they have. What should he do?
- Present the lecture with out taljing about the drug.

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