Social sciences

Question 1

25 yo intellectual disability.
emergency surgery needed but patient says she doesnt want it
next step in management?

Answer 1

involve the patients mother and explain the need for surgery in simple language!

family members, simple language, visual aids important

Question 2

sponge left in patient after surgery, count discrepancy was already brought to attention as possibility but was dismissed by surgeon.

what intervention is most likely to prevent root cause of this error?

Answer 2

simulation training in team based safety communication!!

having a brief time out before counting can increase situational awarenesss!!

Question 3

patient thinking that stomach would have to be taken out during cholecystectomy. doctor explains actual procedure. and then patient asks to take forms home to review with family

Answer 3

absence at scheduled follow up visits!!!

these are signs of low health literacy
other signs = not remembering to take meds

asking few or no questions prior to medical procedure

Question 4

missreading drug vials and administering wrong concentration

interventions focusing on what can help prevent this?

Answer 4

environmental design!!!
look-alike drugs stocked in separate places

Question 5

what information should be reviewed during time out before a surgery?

Answer 5

procedure to be performed!!!
location
patient details

Question 6

independent review by multiple team members helps prevent errors during medication reconciliation

Question 7

informed consent is never obtained retroactively

Question 8

doctor examines patient and notices leg pain but forgot to mention it during sign out. patient dies of PE. what intervention is appropriate to prevent this error?

Answer 8

implementing documentation protocols!!

not closed loop communication as it cant solve a problem due to omission

Question 9

complications discussed before a procedure but then something else occured during surgery as a complication, what do you tell patient after?

Answer 9

description of event and subsequent treatment, expected prognosis and consequences, and preventative strategies if was preventable

Question 10

palliative care. still in pain despite opiate use and resp depression as resp rate is <12

management?

Answer 10

increase morphine until adequate pain control is reached

Question 11

cardiologist becoming increasingly difficult to reach, unusually late rounding times etc increased irritability

mentions family emergency once

managment?

Answer 11

report to hospital physician health program!

Question 12

how do you verbally de-escalate a patient eg psychotic before administering medication or physically restraining them?

Answer 12

offer food drink blanket!

Question 13

patient with borderline personality disorder tells doctor
youre not good at your job, you just order tests for no reason

what should you say to handle?

Answer 13

let me come back with my team and we can review your treatment plan together!!

BPD and splitting - can view someone as all good or all bad. whole team care important

Question 14

i dont hear voices but i can understand they must be distressing -> dont mention medication is needed too early

Question 15

exceptions to maintaining confidentiality of minors include suicide ideation and self harming behaviour. adolescents should be encouraged to create a plan to inform their parents

Question 16

physicians can accept some gifts depending on cost type and timing
but gifts should never be accepted from someone experiencing a mood episode

Question 17

how do you handle request for physician assisted suicide?

ask the reason for request -> lets talk about how you came to this decision. so you can address concerns and help them

Question 19

If a patient doesn’t have capacity, try to contact patients sister/family (close at next of kin). If unavailable, a court appointed legal guardián can help

Question 20

Intially consents to operation, then develops an adverse reaction to the pre-medicación and be comes confused and agitated and asks for procedure to be canceled. What do You do?

Answer 20

Cancel it

Question 21

patient started a new medication from a different physician but benefits or safety seems unclear. advised to stop but patient doesnt want to. next step in management?

Answer 21

scehdule frequent follow ups and continue to see how patient feels on therapy

Question 22

considering average time to therapeutic benefit is important when prescribing drugs in the elderly

Question 23

patient wants to leave ama -> correct response is i want whats best for you, so i may be able to help if i understand your reasons, are you having drug cravings or fear of withdrawal?

Question 24

a run chart performance analysis is useful in assessing effect of a quality improvement intervention!!!

vs failure mode and effect analysis used as a prospective quality improvement tool

Question 25

communication failures = leading cause of adverse events in patients a uniform template eg checklist is important to prevent adverse events from communication failure during sign out

Question 26

advanced dementia, has stopped eating and drinking on own did not specify nutritional supprt needs in advacne directive next step in management?

Answer 26

handfeeding small portions of food and water!!! = use for patient comfort or pleasure rather than nutritional goals this is because loss of ability to independently feel is a sign of end stage dementia

Question 27

in ICU, doctor oders antibiotic for wrong patient and they have a nephrotoxic reaction. best step to prevent this?

Answer 27

daily team based interprofessional rounds in the ICU

Question 28

if a patient doesnt want to used painkillers or what you recommend for Osteoarthritis but would like to use alternative medicine supplements -> say using brands that have been verified by independent organizations is important, let me share some resources that may help you

Question 29

in hospitals, suboptimal hand hygeine protocols despite interventions eg more sinks -> improve individual accountability and organisational culture!!!

Question 30

mother is in critical decision. daughter has to make decision about withdrawing treatment. what you say is -> help me understand what your mother was like before she got sick, we can decide together what course is most appropriate -> learn about patients values not saying youll make the right decision etc you have her best interests

Question 31

for referral to hospice care, a patient must have a prognosis of

Question 32

if you are carrying out an RCT for an intervention for IBS, the control team should have treatment reflecting current IBS guidlines. NOT no treatment at all !!!

Question 33

distinguish framing bias!!! confirmation bias anchoring bias availability bias?

Answer 33

framing = allowing diagnosis to be influenced by context and previous diagnosis in same patient confirmation - emphasissing information that supports a presumed diagnosis over actual diagnosis anchoring - fixating on initial impressions to make a diagnosis. swayed by initial impression. availability = allowing recently seen cases to sway diagnosis!! eg other cases of influenza in community so this is incluenza

Question 34

on a phone order for medication to give to a patient, closed loop technique of communication is important!!

Question 35

in a patient with sciatica for instance which is potentially short term, and wants to be certified for disability benefits -> decline patients request but offer to certify for limited time off work

Question 36

team briefings and debriefings can improve team collaboration and achievement of shared team goals

Question 37

tools that stratify risk as high or low in populations with high probability for falls for instance, and not really useful as their positive predictive value is low

Question 38

RCTs pose risk to participants as they may recieve inferior treatment -> thus research team must regularly submit secured data to an independent committee for oversight

Question 39

RCT with interim results at 3 years showing intervention team doing better in all cause mortality than the control team -> stop the trial when an intervention indicates strong benefit or harm, stop trial early in this case because of harm to control group stop so control group can recieve the intervention

Question 40

regardless of patients behaviour, eg being racist, patient has ethical and legal duty to treat all patients with life threatening medical conditions

Question 41

when a treating physician belives that an essential medication is denied coverage by insurance company -> contact insurance company to request medical director review

Question 42

patient centered care includes discussing out of pocket costs for treatments

Question 43

over half of smokers quit succesfully, but it may take several attempts Dont say -> i know failure may hurt, let me know when you ar eready because you are being passive and lettign time pass

Question 44

it is important to explain the importance of primary care follow up when discharging to prevent things from being missed

Question 45

adenocarcinoma is found but the patient does not wish to know the results. next step in management?

Answer 45

ask the patient if there is a family member they can disclose the results to

Question 46

patients that are delirius or agitated should be placed in a room in direct line of view of supervising staff to prevent falls

Question 47

lack of impact on prognosis is not enough to justify not treating a patient. the only grounds on which you can do this is if the treatment is unlikley to provide benefit to the patient

Question 48

financial incentives from a manufacturing company or using their industry sponsored personel eg their statistician = COI and study should not proceed due to risk of bias!!

Question 49

placing additional sinks for hand hygeine but compliance is still low. what additional chnages should you make? -> installing alcohol gelling stations systems engineering is effective

Question 50

if paitient enters a medicinal trial and doctor happenes to be the investigator, you dont need to change doctors -> but you need to explain how clinical trials are conducted and that the patient may not recieve direct therapeutic benefit

Question 51

in order to register for hospice, you must discontinue any curative therapies only palliative therapy allowed

Question 52

when a family is reluctant to withdraw care from a terminally ill patient, what can be used?

Answer 52

no escalation of treatment orders

Question 53

telephone based follow up appointments post discharge reduces readmission rates as patients are not lost to follow up

Question 54

old woman with mild cognitive impairment admitted for a fall. ankle in brace.. fall 5 months ago as well lives independently at home what can be done to prevent future occurrence of fall?

Answer 54

home health care! not SNF as this is for patients that cant live at home eg post stroke rehabilitation, severe cognitive impairment

Question 55

Training patients on how to identify and align care delivery with patient preferences is most likely to improve health care communication for patients of minority backgrounds

Question 56

Doctors can not determine if someone has the competency to agree to a treatment competency decisión is made by a judge. Doctors can only determine capacity. So answer here was ask wife about how to proceed with treatment of husband

Question 57

Error reporting Systems enable hospital systems to report observed patient safety incidents -> to improve it’s effectiveness develop Methods for further investigating snd responding to each submitted report

Question 58

When systemic problems in health care quality is observed in a hospital, its important to approach stakeholders -> meet with the director of the hospitalist group and offer to participate on a committe promoting patient health outcomes. Rather than submitting an anonymous report!!

Question 59

Patient with meningitis, Wants to leave the hospital. What fo you do?

Answer 59

Hospitalise the patient against their wishes -> public health threat

Question 60

Trauma and needs blood transfusión not oriented. But wife says he is a jehovah witness and would not want one. No advance directive. What do You do?

Answer 60

Discontinue and provide alternative therapies A default surrogate decisión Maker eg wife children can consent to or refuse treatment when there’s no advance directive

Question 61

In a non emergency situation when office is already closed, do not evalúate patient and schedule appoibtment in normal office hours. NOT contact after hours on call physician as this is for emergencies only

Question 62

A fishbone diagram is used to?

Answer 62

Organize categories and causes of errors that undermine system performance.

Question 63

Patient requestong antibiotics but there’s no indicaction You should respond by saying -> treating a chest cold with antibiotics is typically not very useful because it’s caused by a virus let’s talk about some of the risks of antibiotics Important to mention risks and then say chest cold so more at ease about well being

Question 64

Wish and worry framework should be used for BBN I wish you could stay alive until xyz, but i worry you may not

Question 65

If a patients pysychotic illness does not interfere with their ability to understand a certain procedure and they refuse the procedure, you have to respect that

Question 66

In an elderly patient, the number of physicians prescribing drugs to the patient should be reduced. Have primary care physician prescribe most drugs to prevent adverse drug events. More effevtive than pill box

Question 67

The quality improvement process called lean = identifying and reducing waste within a process is what is used when doctors decide to schedule mothers apoointment at the same time as Babys well being check

Question 68

If participantd in a research study are only working 2 hours each day for 6 weeks But you want to pay them 6 weeks worth of salary mínimum wage, this is overcompensation So recruitment plan is innappropriate because it is likely to constitute inducement

Question 69

Signing a form patients must do this before starting opioids meds. Patient is frustrated and feels they are being treated like an addict -> say to them it’s part of out safety standard procedure for everyone who is on opioids

Question 70

A failure mode and effect analysis can be performed even before a problem arises, for example before a hospital starts running

Question 71

Most effective method to combat physician burnout?

Answer 71

Hire scribes for medical documentation! (Amboss question)

Question 72

16 year old girl. Mole on face wanting excision. Physician says it is usually benign with very low risk of malignancy. Patient is aware but still wants excision. What is the appropriate response?

Answer 72

I cannot perform the procedure unless your parents consent to it. *when under 18, you require consent and the only exceptions = 1. emergencies lifesaving treatments = trauma suicide 2. sexual care = contraception, STI, pregnancy 3. Addiction care eg drugs (Amboss ppq)

Question 73

Daughter asks doctor not to tell the mother the results of the mother’s test. What should the doctor do next?

Answer 73

Clarify with the daughter the reason for the request!! NOT ask the patient if she wants to know the results or not. Can withhold results if there is a good reason (Amboss ppq)

Question 74

Patient with Alzheimer’s died under unexplained circumstances, next of kin is refusing autopsy. NeXT step in management?

Answer 74

Report the death to the local death investigation office!! Autopsies don’t require next of kin consent so you don’t need a court order. Court orders are more used for parents who decide against life-saving treatments for their non terminally ill child eg seeking court order for neo-adjuvant chemotherapy for neuroblastoma

Question 75

Patient has gone in for cholecystectomy, whilst in there, they find a portion of small intestine is necrotic due to a large embolism. Treatment is additional surgery with small bowel resection and thromboendarterectomy. NeXT step in management?

Answer 75

Immediate surgery on the table. Emergency, you don’t need consent

Question 76

Patient reports sexual violence. First step in management?

Answer 76

Take patient to a vacant/private room! Have to ensure they feel safe first before you perform any examinations.

Question 77

Advanced Dementia signs eg speech problems, incontinence, food regurgitation. Next step in management?

Answer 77

Home hospice care!!!. Hospice care as life expectancy <6 months Not inpatient palliative care as only for those whose symptoms aren’t controlled at home

Question 78

Masturbation in young boy that doesn’t cause distress or interfere with daily functioning. Management?

Answer 78

Reassurance

Question 79

Patient that cancer has progressed and is in unbearable pain. First step in management?

Answer 79

Increase pain medication!!! Not hospice care

Question 80

17 year old that lives alone and supports himself financially and has not had any contact with family for a year with a lipoma on forehead. Next step in management?

Answer 80

Offer surgical removal He is emancipated! - can achieve this by marriage and military service too

Question 81

Patient with schizophrenic episode that has bought a gun. Next step in management?

Answer 81

Notify law enforcement

Question 82

Sexual of romantic relationships with current patients are unethical!!! When no longer a patient they are ok. Unless psych patient

Question 83

Patient has MI and is hospitalized but now stable. Wife wants information. Next step?

Answer 83

Obtain consent from patient first!! Only in emergency or patient incapacitated that you can disclose about general health status

Question 84

Homeless. Pain in left leg. Does not have health insurance of money to pay. Next step?

Answer 84

Perform a medical screening examination and provide stabilizing treatment if needed.

Question 85

Cannot prescribe medication to a friend unless an emergency. Treatment in general of family and friends is not illegal!!! But advised against. So if patient has an unstable pelvic fracture and requires urgent surgery, is in hospital where daughter works and insists that daughter does procedure? Next step in management?

Answer 85

Daughter seek permission from the primary attending surgeon to the an assistant surgeons in the procedure!!! NOT the primary attending surgeon Exception would be emergency like this where no other qualified surgeon

Question 86

Patient is brain dead but family want to continue carrying on life support measures, next step in management?

Answer 86

Bring case to ethics committee!! Not explain that brain dead

Question 87

Medical students should not disclose results of diagnostic work up or treatment decisions to patients -> say I have results but need to discuss with team first

Question 88

Patient dies no organ wishes. Sibling says they would have wanted to donate. Parents say no. Court approached and advice was to follow the law. What to do?

Answer 88

No organ donation! Spouse -> parents -> siblings -> close friends

Question 89

Physician referring patient to a rehab facility that he is the owner of. Also no indications for rehab needed. Next step in management?

Answer 89

Contact state medical licensing board. NOT reporting incident to local physician health program -> That’s for physician impairment due to mental health, substance use, or conditions that limit motor skills or cognitive capacity

Question 90

Organ donor card on patient overrides family Wishes

Question 91

Capacity is a clinical determinación and so as doctors you don’t assess competence = legal determination made by court

Question 92

In rape case, do not call police unless patient requests

Question 93

Patient can refuse blood transfusion for self but not for child, even if jehovahs witnes

Question 94

Cutting in kids does Not automatically mean suicidality, if no suicidal ideation and just coping/minicry can keep confidencial

Question 95

Motivation al interviewing is most effective for adherence in adults/kids

Question 96

Patient has right to refuse med student Participation. Surgeon can refuse if non Emergency and university hospital

Question 97

Aggressive patient -> offer food/drink renorient. If fails -> physical restraint /haloperidol

Question 98

Patient comes after Clinic hours with non Emergency -> advise to return tomorrow

Question 99

Genetic testing, encourage to inform relatives but can not disclose without consent. Employers can not request tests