95. A 25-year old female medical student or resident noticed a mistake made by a junior attending
physician during rounds. She is afraid of that attending physician. What is the appropriate way
to handle the situation? (Important)
Answer: She should discuss the situation with a more senior attending physician for appropriate
interpretation, advice, and assistance.
96. A 26-year old male medical student or resident made a mistake during patient care. He is
afraid of what might result. What is the appropriate way to handle the situation?
Answer: He should disclose the mistake to the attending physician and try to learn from that
mistake. The patient should be notified as well.
97. A 63-year old female health care worker is concerned about taking care of patients with HIV
infection or multidrug-resistant tuberculosis. What is the appropriate way to handle the
Answer: The physician should provide appropriate care to patients despite personal risk.
Institutions should reduce the risk of infection by appropriate equipment, supervision, and
training. Her concern should be taken seriously.
98. A 30-year old male physician has an opportunity for financial incentive if he sees more
patients and refers them unnecessarily. What is you opinion about this?
Answer: The physician should provide only care that is in the patient’s best interest.
99. Two physicians are discussing a case inside the elevator of a hospital. What is your opinion
Answer: They should not do that because they have to maintain the patient’s confidentiality.
100. The patient’s confidentiality should be maintained except in the following situations:
Physicians should override third parties in case of domestic violence, child abuse, elderly
abuse, gunshot wounds, syphilis, and tuberculosis. They should report these cases to appropriate
101. A physician is experiencing a very difficult ethical issue regarding a complicated case. He
is confused. What should be the next step?
Answer: he should discuss the matter with other faculty members in his health care team,
colleagues, or hospital ethics committee.
102. What is the final plan of action in an ethical issue?
Answer: Both patient and physician should agree regarding final management. The patient should be
well-informed about the medical condition. The physician should be sympathetic and knowledgeable
regarding the relevant medical condition.
103. DNR (do not resuscitate) order. This is appropriate if the patient or surrogate signed that
order or if CPR (cardiopulmonary resuscitation) would be futile. Physicians should write DNR
orders and the reason for them in the chart. Please remember, “slow” or “show” codes are not
acceptable. Foods and fluids are considered therapies that should be stopped. (Important)
104. (A)Brain death (adult): (Important)
(i) Definition by the President’s Committee:
Death is an irreversible cessation of circulation and respiratory functions or irreversible
cessation of all functions of the entire brain and brain stem.
(ii) The criteria of brain death by the staff of Massachusetts General Hospital and the Harvard
Death occurs when there is absence of all signs of receptivity, responsivity, and all brainstem
reflexes, and the EEG is isoelectric. Sometimes metabolic disorders and intoxications may mimic
the above findings.
(iii) The guidelines of brain death:
(a) The diagnosis should be made also by another physician and confirmed by clinical findings and
(b) The family should be notified. They should not make the decision about discontinuing medical
treatment except in a situation where the patient has directed the family to make the decision.
(c) The physician should discuss with another physician before removing supportive measures
(d) Family members may request organ donation, and in many states physicians may request the
family to make an organ donation.
(B) Brain death (children):
(i) Definition: same as in adults.
(ii) Criteria: similar in children and adults, but the period of observation is longer in
Children 1wk-2mo of age: two separate examinations 48 hours apart
Children 2mo-1yr of age: two separate examinations 24 hours apart
Children more than 1 yr of age: two separate examinations 12 hours apart
Spontaneous movements must be absent, with the exception of spinal cord reflex withdrawal and
Generalized flaccidity should be present. The presence of clinical criteria for 2 days in term
and 3 days in preterm infants indicates brain death in majority of asphyxiated newborns. The
absence of cerebral blood flow on radionuclide scan and silence of electrical activity on EEG are
not always observed in brain-dead newborns. There is no universal consensus about the definition
of neonatal brain death. The decision is made after discussion with the family and health care
team. If there is difference of opinion, the ethics committee should be consulted. The decision
is made on the basis of what is in the best interest of the infants and children.
105. Practice guidelines for physicians:
(i) The best way to practice medicine is to select useful diagnostic techniques and therapeutic
measures which are most appropriate to a particular patient and clinical condition.
(ii) Practice guidelines can reduce the health care costs, which improves health care to patients
who even do not have adequate health care benefits.
(iii) Please remember, guidelines do not and should not be the only way of managing an individual
106. Some important points about patients:
(i) For a patient with an incurable disease, the major goal of therapy should be the enhancement
of the quality of life.
(ii) The patient care begins with a personal relationship between the patient and the physician.
If a patient has confidence on the physician, reassurance may be the best therapy. The patient
must understand that the physician is giving the best possible care available.
107. Patients who do not have decision-making capacity about their medical care:
The patients who do not have decision-making capacity usually arrange for surrogates who make
decisions for them. Their choices depend on their values. Psychiatrists are helpful in mentally
impaired patients. Family members are usually the surrogates, because they know the patients very
Advanced directives: statements made in advance in case patients lose their decision-making
capacity in the future. These directives indicate the names of surrogates and which interventions
are acceptable or not acceptable to them. These are achieved by oral conversation (most common
form), living will, health care power of attorney, or physicians can ask the patient in advance.
Absence of advance directives and surrogates: physicians can make the decision using all
information and should respect the patient’s values. Physicians must know the laws of the state
in which they practice.
Patient preferences are known:
The decision is made with the patient’s best interest in mind.
Disagreements between potential surrogates or between the physician and surrogate: Physicians can
consult with the hospital ethics committee or with other physicians. The courts should be only
the last resort.
108. Down syndrome with different medical conditions: (Very Important)
(a) Duodenal atresia at birth: surgical repair is recommended as it is done regularly.
(b) VSD (ventricular septal defect) in newborn period: initial conservative medicals management
is followed by surgical repair as it is done regularly.
(c) Cyanotic heart disease at birth: immediate medical management, which is followed by surgical
repair as it is required routinely.
(d) Cosmetic surgical condition (e.g., rhinophyma or big nose): there is no urgency to repair the
underlying condition, but it can be done as it is performed regularly.
(e) Neural tube defects (e.g., meningomyelocele): surgical repair is recommended as it is done
Please remember, a patient’s management should be discussed with his/her parents and the decision
made with the best interest of the patient in mind.
109. A healthy male patient with Down Syndrome lives independently. He went to a doctor for
facial cosmetic surgery. Can he make his own decision? (Important)
Answer: yes. The patient can make his decision if he understands the procedure and the
consequences. He lives independently which indicates that he is capable of making his own
110. A patient went to the doctor due to throat pain. The doctor asked the patient what her
problem was. The patient said that she woke up at six o’clock in the morning, went to the
bathroom, ate breakfast, and went to drop her children at school. She then came back home, stared
cooking and continues to talk about irrelevant things. What should the doctor do to stop the
patient from rambling? (Important)
Answer: the doctor should ask the patient to tell him what problems she has related only to her
111. A patient went to a doctor for abdominal pain but remained quiet throughout the visit. He
did not tell the doctor enough about his symptoms. What should the doctor do? (Important)
Answer: the doctor must ask the patient detailed questions about his abdominal pain. It is the
doctor’s obligation to find out as much as he can about the patient. Without enough information,
the doctor will not be able to make an accurate diagnosis.
112. A patient walked into his doctor’s office with acute abdominal pain. He has been suffering
from ulcerative colitis. The patient is noncompliant and did not visit for the past six months.
What should the doctor do in this situation? (Very Important)
Answer: The doctor should find out more about the patient’s abdominal pain before making any
other decision. The doctor should always be responsible with the patients.
113. A terminally ill pancreatic cancer patient with multiple metastasis is admitted to the
He is in critical condition. The patient wants to know his prognosis. What should the doctor say?
Answer: the doctor should tell the patient politely that he will discuss his condition with him
The doctor should never specify the longevity of the patient. The doctor should tell the truth
even when the patient is a child. The doctor should not hide any medical information from the
114. A patient is recently diagnosed with cancer. He is nervous but is eager to know about his
medical diagnosis. What should the doctor’s reply be? (Important)
Answer: the doctor should gently tell the patient his condition.
115. A patient is recently diagnosed with cancer. Previously, he had an episode of a nervous
breakdown after hearing a family death and had to be admitted to a hospital. He loves his family
members and tends to be very open with them on all issues. How should the doctor tell the patient
about his current state? (Important)
Answer: the doctor should call his family members and discuss the patient’s medical condition
openly and politely.(WRONG IF DISCLOSING BAD NEWS CLEARLY PUTS PT IN NERVOUS BREAKDOWN CONDITION
WAIT AND GRADUALLY TELL THE PT.NEVER BREAK CONFIDENTIALETY)
116. A male patient was admitted with severe myocardial infarction. He was admitted to the ICU
and his condition is very critical. He does not know the reason for his admission. The patient is
unstable. What should the doctor tell the patient? (Important)
Answer: the doctor should wait until the patient is stabilized and then gently tell him his
medical condition.(HIDING SOMETHING FROM THE PT MAKES HIM MORE SUSPICIOUS AND MAY LEAD TO ALL
KIND OF MISCONCEPTION IN PTS MIND SO NEVER WAIT TO TELL PT UNLESS TELLING IS CLEARLY DETREMENTAL)
117. A mother gave birth to a premature baby who was admitted to the NICU (neonatal intensive
care unit). The baby is on a mechanical ventilator. The mother wants to hold the baby IN HER
ARMS. What should the doctor do in this situation? (Important)
Answer: the mother should be allowed to hold the baby.
118. A male patient is recently diagnosed with HIV. Should the doctor ask about his sexual
orientation (i.e., male, female, or both)? (Important)
Answer: yes, the doctor should ask the patient directly but politely about his sexual
119. A homosexual male patient went to a doctor. The patient’s partner was recently diagnosed
with HIV. Should the doctor ask the patient whether he is being penetrated by his partner or he
penetrates his partner?
Answer: yes, because the person who is being penetrated has a higher incidence of HIV due to
trauma in perianal area.
120. A 6-year old boy comes to the ER after drowning. He expired in the ER despite appropriate
resuscitations. The family members became angry which is a reflection of a sense if guilt and
helplessness. What is the appropriate way of giving information to the family members?
Answer: the physician should give the information clearly and compassionately when there is no
hope for survival. Parents need to know that everything was done to save the child.
121. A pregnant woman who is Rh(-)ve became sensitized. She had H/O induced abortions. Her
husband is not aware of his wife’s previous abortions. He wants to know from the physician how
she became sensitized. (Very Important)
Answer: the physician should tell the man to ask his wife. The physician should not mention
anything about the patient’s H/O abortions.
122. A mother brought her infant to the ER. The radiologist test reveals old fractures of the
ribs. She did not know anything about that. (Very Important)
Answer: this is a case of child abuse. This case should be reported to child welfare agency.
123. A physician is examining a child with respiratory distress. The child’s mother became
anxious during the physical examination. Please remember, a patient’s management should be
discussed with his/her parents and the decision made with the best interest of the patient in
Answer: child abuse.( ICUDNT UNDERSTANMD THE QUESTION)
124. A mentally retarded patient became pregnant. The patient does not want an abortion. Her
mother and husband want an abortion. What should a physician do in this situation? (Important)
Answer: abortion should not be performed.BCUZ SHE IS COMPETENT UNLESS PROVED OTHERWISE
125. A male physician is examining an adolescent or adult female patient. What should a physician
do in this situation? (Important)
Answer: a chaperone should be present during the physical examination. The same rules apply when
a physician is examining a patient who appears to be seductive. (Important)
126. A female physician is examining an adolescent or adult male patient. What should a physician
do in this situation? (Important)
Answer: a chaperone should not be present during the physical exam.
127. A suspected HIV patient expired in a car accident. He signed for organ donations. What
should a physician do in this situation?
Answer: his HIV status is not certain. The organs can be preserved until the HIV status is
confirmed. If the test for HIV is positive, organs should be discarded.
128. A patient who expired in a car accident signed in his license foe organ donations. His
license has expired. He always wanted to donate his organs. What should a physician do in this
Answer: physican cannot accept organs because the signed consent has expired.ASK FAMILY MEMBERS
ABOUT WISHES OF THE PT IF HE WANTED TO DONATE ORGANS.JUST AHVING AN ORGAN DONOR CARD DOESNT TELL
PT INTENT.MAY BE HE SHUD HAVE DONE TO SHOW OFF OR GET A BONUS OR FORCRD BY SOMEONE.EVEN IF DONOR
CARD HAD NOT EXPIRED AND FAMILY UNANAMOUSLY SAID THAT PT DIDNT WANTED TO DONATE ORGANS DONOT
ACCEPT ORGANS FOR TRANSPLANT
129. A male physician sexually harassed a female patient during the physical examination. The
patient complained to a nurse. What should the nurse do in this situation?
Answer: the nurse should tell the patient to make an official report to the hospital authority or
to an appropriate agency.
130. A chronic male smoker comes to the physician for his heart problems. The physician wanted
his patient to quit smoking. What should the physician advise in this situation?
Answer: the physician should ask the patient to quit smoking immediately because patients are
usually more responsive when they are ill. The physician should assist the smoker to move one
step closer to quitting.
131. A terminally ill patient did not sign a DNR (do not resuscitate) order, however, he signed a
DNI (do not intubate) order. What should the physician do in this situation?
Answer: the physician should follow his orders i.e., the patient should be resuscitated but
should not be intubated, despite severe hypoxic condition of the patient.
132. A terminally ill patient signed a DNR order, however, he did not sign a DNI (do not
intubate) order. He wants to be intubated but not resuscitated. What should a physician do in
Answer: the physician should follow his orders i.e., the patient should be intubated but should
not be resuscitated.
133. An adolescent car accident victim was brought to the ER in an unconscious state. The patient
needs immediate surgical interventions. The surgeon was unable to contact any family member to
obtain consent. What should a surgeon do in this situation? (Important)
Answer: the surgeon should do the procedure without waiting to obtain a consent for the benefit
of the patient.
134. An obgyn doctor is recently diagnosed with HIV infection. He is receiving medication for
HIV. His physical and mental conditions are normal. Should he tell his patients or fellow
physicians about his HIV status?
Answer: no, however, the doctor should take appropriate precautions for infection control. He
does not have to tell his fellow physicians about his HIV status including the physicians who are
referring patients to him. The doctor is allowed to see patients if he takes appropriate
precautions. However, he should notify the hospital authority.
135. A physician is scared of seeing an HIV patient with an open wound. Can a physician refuse to
see a patient?
Answer: yes, however, a physician’s refusal to see a patient is unethical but is legal.
136. An elderly semicomatose patient may require surgical intervention. His family members are
confused about the surgery. They asked the surgeon for his opinion. What should the surgeon’s
Answer: the surgeon can give his opinion and act as a moral surrogate for the benefit of the
patient. (Very Important)
137. A 12-year old boy is diagnosed with a terminal illness (e.g., malignancy). He asked the
doctor about his prognosis. His parents requested the doctor not to tell him the bad news. What
should the doctor do in this situation? (Very Important)
Answer: the doctor should tell the truth politely and compassionately to the patient.YES TOTALYY
CORRECT CHILD NEEDS TO BE BE TOLD OF HIS TERMINAL ILLNESS IF HE CAN UNDERSTAND THE SITUATION AND
IRREVERSIBILTY OF DEATH.TRY TO CONVINCE PARENTS FIRST.
138. A 55-year old woman is recently diagnosed with right breast cancer. The doctor told the
patient that she will require surgery for removal of the right breast. She started to cry. What
should a doctor do in this situation?
Answer: first, the doctor should give her some tissue paper for wiping her tears. Then, the
doctor should be sympathetic to her and console her. He might tell her that similar reactions are
usually expected from other patients with breast cancer. Please do not mention that she will be
fine with a breast implant or without a right breast because she is already 55-years old.
139. A mother is carrying a 500 gram premature fetus which develops acute fetal distress. The
physician wanted to perform a cesarean section. Mother refused cesarean section. What should the
doctor do in this situation?
Answer: the physician should arrange a bedside conference with the mother along with other
physicians, social worker, and administrator to discuss the ma