Medical Ethics Bimonthly Exam

1.

Medical Ethics is a field of study & practice which primarily focuses on

A. what a doctor can do to his/her patient
B. what a doctor should do for his/her patient
C. what a doctor can do for himself/herself
D. what a doctor should do outside the scope of medical practice

2.

In essence, the definition of ethics in #1 means that

A. morals & values observed by non-doctors do not apply to the medical setting
B. the patients wishes are the doctors priority, so the doctor must always follow the patient
C. what you are capable of as a doctor justifies whatever it is that you do to your patient
D. just because you can do something doesnt mean you ought to be doing it

3.

As a doctor, your wish to do good for people/patients means

A. you can do as you please, since your wishes are beneficient to the patient anyway
B. your intention justifies your actions good intentions necessarily mean you will end up doing what is
good for the patient
C. your patient has no say in the matter youre the expert, so whatever you dictate is to be done
D. you need to take into consideration what your patient would like to happen or to be done

4.

Respecting the autonomy of the patient means that

A. you should always do what the patient wants you to do, regardless of your expertise
B. you acknowledge that the patient most likely doesnt know anything about medical treatment, so this
allows you to do whatever you feel is best for the patient
C. you acknowledge that the patient holds the final decision as to what medical intervention or
management he/she will eventually undergo
D. your job as a doctor is to provide only the kind of medical information which the patient can most
likely understand no need to talk to the patient about confusing medical terms

5.

A critical component of #4 is
A. deference to the patients wishes
B. superiority over the patient in terms of technical knowledge
C. competence of the patient in decision-making
D. condescension to the patient & his/her family

6.

In cases where #5 is compromised, the doctor must follow

A. whomever the patient assigned/appointed as his/her surrogate
B. prior wishes of the patient, as told to the doctor or to next of kin
C. previously recorded instructions from the patient, especially those which are legally recognized
D. all of the above

7.

Before you can do good for your patient, you must first make sure that what you are about to do
A. is cleared by your lawyer
C. will not harm the patient
B. has been fully documented
D. cannot be traced back to you

8.

Since some necessary treatments may also expose the patient to possible risk of harm, the best way to
proceed with treatment is
A. to not tell the patient about the possible harmful side-effects of the treatment, so the patient will
consent to being treated
B. to emphasize the details of only the benefits of the treatment, while barely going into the details of the
possible harm of the treatment
C. to scare the patient into backing out of treatment by telling the patient the details of the harmful sideeffects
D. to present to the patient the potential benefit as well as the potential harm of the treatment as
objectively as possible

9.

As a doctor, if you present a treatment option to your patient, you must also tell the patient about
A. alternatives to the said treatment option
B. risks & benefits of each treatment option
C. indications for each treatment option (i.e., why treatment is needed in the first place)
D. all of the above

10.

If you managed to do #9, assuming the patient is capable of understanding what you told him/her, then
you have achieved
A. partial emancipation of the patient
B. full emancipation of the patient
C. the conditions that are compatible with full informed consent
D. the conditions consistent with the idea of primum non nocere

11.

Just because you have achieved #10 does not necessarily mean you can proceed with the treatment.
Your proposed treatment may still be undoable if
A. the said treatment violates existing laws or accepted rules
B. the patient is deemed legally unfit to choose to be treated as such
C. the said treatment puts somebody else at significant risk
D. all of the above

12.

You need not achieve [the correct answer in] #10 if

A. you are in an emergency situation and do not have the benefit of time
B. you are exercising therapeutic privilege in order to protect the patient
C. you believe that the situation is futile, and that no amount of treatment can change the situation
D. all of the above

13.

Withholding life-saving treatment from a patient who is incapable of deciding to be treated is considered
as something
A. definitely unethical & most likely illegal
B. you should do until the patients next of kin / spouse / legal guardian gives you the go-signal to treat
C. acceptable, as long as your original intentions were beneficent
D. all of the above

14.

An 18-year old patient with Downs syndrome

A. need not be given life-saving medical treatment if his/her parents refuse on the basis of the childs
mental status
B. needs to be treated based on his/her medical needs, not based on his/her incapacity to make
decisions
C. needs to be referred first to a psychologist or psychiatrist before life-saving treatment can begin
D. all of the above

15.

A clinically depressed patient who manages to jump off the roof deck of a building in I.T. Park
A. can refuse any further elective medical treatment from any doctor, assuming he/she survives the fall
B. needs to first be declared by a court of law as legally incapable of sound decisions before a doctor
can proceed with treatment
C. should be admitted into the Psych ward on an emergency basis
D. all of the above

A patient gets admitted in a hospital for chronic bouts of abdominal pain & jaundice. She gets diagnosed with
common bile duct obstruction due to gallstones, and consents for an elective gall bladder / gallstone removal
surgery. Her surgeon gives her a choice of either traditional open surgery (i.e., wide incision into the abdomen
under the right rib cage) or laparoscopic surgery (i.e., four small incisions in the abdomen where a rigid endoscope
& some laparoscopic instruments will inserted for doing the gall bladder removal).
The surgeon tells the patient that an open surgery has higher risk for infection, entails more post-operative pain
(and thus more pain relievers needed), more blood loss, and a longer hospital stay & recovery time. However, he
also tells her that a laparoscopic surgery may end up being converted to an open surgery if intra-operative findings
or intra-operative/post-operative developments dictate that an open surgery approach would be best for doing the
gall bladder removal. Eventually, the patient consents to the laparoscopic surgery.
16.

During the laparoscopy, the surgeon notices an obvious mass, freely suspended on the anterior wall of the
right/proximal transverse colon and out of the way of his surgical field. Nobody had known about this
mass prior to the laparoscopic surgery none of the imaging studies had picked up this mass, and the
patient had no clinical symptoms that wouldve suggested the presence of such a mass.
Upon contemplating about this mass, the surgeon gets worried that it might be a previously unnoticed
malignant tumor, and entertains the idea of maybe getting a sample of it for histopathology analysis. If he
decides to do a biopsy of that mass before finishing the laparoscopy, he would then be violating the
principle of
A. beneficence
C. non-maleficence
B. informed consent
D. [none of the above]

17.

If the said mass happened to be adherent to the fundus of the gall bladder (instead of being freely
suspended & out of the way of the gall bladder surgery), then doing a surgical procedure on this newly
discovered mass would violate the principle of
A. beneficence
C. non-maleficence
B. informed consent
D. [none of the above]

18.

While trying to sample the mass in #16, the said mass began bleeding profusely, forcing the surgeon to
convert the laparoscopy into a fully open laparotomy in order to stop the bleeding. In this case, the
surgeon wouldve violated the principle of
A. justice
C. non-maleficence
B. beneficence
D. [none of the above]

19.

While trying to separate the adherent mass in #17, the said mass began bleeding profusely, forcing the
surgeon to convert the laparoscopy into a fully open laparotomy in order to stop the bleeding. In this case,
the surgeon wouldve violated the principle of
A. justice
C. non-maleficence
B. beneficence
D. [none of the above]

20.

Given a different scenario: there were no intra-operative surprises (no masses of any kind, just an inflamed
gall bladder); the laparoscopy went according to plan; the patient came out of the recovery room. On the
1st post-operative day, the patient was doing fine and was recovering quite well. On the 2 nd post-operative
day, she began experiencing abdominal bloating & fullness, with some generalized pain. On the 3 rd postop day, she exhibited with abdominal rigidity & pallor, with more abdominal pain. The surgeon ordered for
full lab & imaging work-ups and discovered a significantly low RBC count and accumulated fluid in the
peritoneal cavity on ultrasound scan. The surgeon then recommended that the patient be returned to the
OR for a full open laparotomy procedure in order to find out what was going on.
The surgeon was justified in his recommending another surgical procedure based on the principle of
A. autonomy
C. non-maleficence
B. beneficence
D. [none of the above]

21.

Upon doing the second operation, the surgeon discovered that there was bleeding coming from the
underside of the liver from where the gall bladder was removed. He thus proceeded to cauterize the
bleeding liver surface in order to stop the bleeding.
Later, upon reviewing the video recording of the original laparoscopic gall bladder removal, the surgeon
noticed that he forgot to inspect the liver bed from which the gall bladder was removed. He most likely did
not see the small bleeding capillaries that later produced the hemoperitoneum of the patient. This was
why neither he nor the patient could explain the post-operative clinical symptoms which eventually led to
the second surgery.
In this case, he had unintentionally violated the principle of
A. autonomy
C. non-maleficence
B. beneficence
D. [none of the above]

22.

Assume again the scenario in #16 but this time, the surgeon decides to leave the colonic mass alone.
He does not sample the mass, and goes on to remove the gall bladder in laparoscopic fashion, just as he
had told the patient he would. He completes the GB laparoscopic removal without any further incident.
The patient comes out of the OR, makes a full recovery, and gets discharged after 3 days.
The surgeon forgets to mention the incidental finding of the colonic mass to the patient after the gall
bladder surgery. In other word, he violated the principle of
A. beneficence
C. non-maleficence
B. informed consent
D. [none of the above]

23.

If, in the scenario depicted in #16, the surgeon decides to call for the patients husband in order to ask
permission to biopsy the newly discovered colonic mass (because the patient herself is asleep due to
anesthesia), then he wouldve been following the principle of
A. informed consent
C. informed consent by living will
B. informed consent by proxy/surrogate
D. [none of the above]

24.

If, in the scenario depicted in #16, the surgeon decides to record a video image of the colonic mass and
save it for a later discussion with the patient, then he wouldve been following the principle of
A. informed consent
C. informed consent by living will
B. informed consent by proxy/surrogate
D. [none of the above]

25.

Going through all the trouble of offering laparoscopic surgery & investigating on that colonic mass - even if
the patient is under charity ward care (i.e., not a fully paying private patient) - is an example of the principle
of
A. beneficence
C. non-maleficence
B. informed consent
D. justice

26.

The right to privacy is defined as...

A. the right to be left alone
B. the right to be free from undesired public scrutiny
C. the right to live without unwarranted interference by the public
D. all of the above

27.

As a fundamental human right, privacy is not nullified by...

A. membership to any social/political organization C. marriage or familial relations
B. membership to any religion
D. all of the above

28.

Medical information about a patient can be indiscriminately released to...

A. the mass media
C. other doctors who are not with the medical team
B. the patient's next of kin
D. none of the above

29.

A Tarasoff warning is a breach in patient-doctor confidentiality which is justified by the concept that...
A. the coverage of protection of the private patient ends where public peril begins
B. the coverage of protection of the public ends where private patient peril begins
C. the coverage of protection of the private patient can never be compromised
D. protection of the confidentiality of the private patient is no better than the public common knowledge

30.

Issuing a Tarasoff warning to a third party is NOT justified in this instance:

A. your sexually active patient comes out HIV-positive on blood testing which the patient requested
B. your patient confesses that he plans on kidnapping & torturing somebody whom you both know
C. your sexually active patient comes out HIV-positive on blood testing which you ordered on your own
D. all of the above are justified

An orthopedic spine surgeon schedules an urgent lumbar fusion procedure for a patient exhibiting with rapid lower
extemity neurologic deterioration due to lumbar nerve root compression. In the hospital where he practices, the
surgeon has access to 3 companies which provide for lumbar pedicle screws & rods that are used in this procedure.
Company A has a screw-&-rod system which is known to be the most expensive -- but also proven
to have the most reliable performance (no problems with intra-operative installation, no
problems on post-operative healing).
Company C provides the cheapest priced screw-&-rod system -- but its implants have been shown
to fracture at the screw neck or cut through vertebral body bone on occasion (thus,
necessitating a few re-operations in the past).
Company B distributes a mid-priced implant system with good post-operative performance -- but
comes with operating instruments that are somewhat more difficult to use than either A or C.
Plus, the implant sales representative/agent for Company B is a bit unreliable & obnoxious.
31.

The patient needs to have this surgery done, but her family has limited funds to finance the surgical
expense. She & her family request the surgeon to help cut costs in the needed procedure so that she can
finally have the surgery at the soonest possible time.
The surgeon sets a date for the surgery, and decides to offer implant systems of companies A & B to the
patient -- but does not mention company C due to the fact that the implants from that company have a bit
of a complication history with breaking and/or cutting through bone.
The surgeon would justify this action by invoking the principle of...
A. autonomy
C. non-maleficence
B. beneficence
D. confidentiality

32.

By intentionally not telling the patient & family of the option of Company C's implants, the surgeon is also
violating the principle of...
A. autonomy
C. non-maleficence
B. beneficence
D. confidentiality

33.

By recommending the implants of company A, the surgeon is exercising the principle of...
A. informed consent
C. non-maleficence
B. beneficence
D. confidentiality

34.

During the planning process for the surgery, the surgeon never mentioned to the patient & her family that
there would be risks involved -- e.g., the possibility of post-operative infection, the chance of implant cutthrough (which is negligible in company A's system, but apparently significantly present with company C's
implants), the chance of nerve root injury (regardless of which implant system is used -- a very very small,
but ever present risk), the chance of possible anesthetic complications (again, very very small, but ever
present). The surgeon only bothered to explain the benefits of undergoing this surgery -- i.e., the highly
probably recovery of neurologic function.
The surgery pushes through without incident using company A's implants, and the patient recovers her
neurologic function as probabilities had predicted. Two years after surgery, the patient is practically back

to full normal function, and is happy with her recovery.

In this case, did the surgeon violate any ethical principle?
A. Yes - no full informed consent was really present at the time of surgery.
B. Yes - beneficence was not observed since the surgery was not indicated for this patient.
C. Yes - non-maleficence was not observed since the surgeon used implants of company A.
D. All of the above were violated in this case.
35.

What if, instead of achieving full recovery, the patient in #34 underwent the surgery and came out
paraplegic (i.e., with significant post-operative paralysis of both lower extremities). What principle would've
been violated by that result?
A. autonomy
C. non-maleficence
B. informed consent
D. all of the above were violated in this case

36.

To continue the scenario in #35, the patient gets referred to Rehab Med, under the management of a
rehab doctor/physiatrist. The patient gets very depressed and angry over time due to the lack of progress
of her paraplegia. At one point, she tells her physical therapist that she plans to shoot her surgeon dead
once she gets the opportunity on a future consult. The physical therapist, being a bit alarmed by this
sentiment, decides to share it with the physiatrist.
In this case, the physiatrist...
A. shouldn't bother with relaying a warning to the surgeon, since the patient was obviously just
depressed and angry at her situation, and would unlikely ever carry out her threat.
B. shouldn't bother with relaying a warning to the surgeon, since the story came as mere "rumor".
C. should blog about this new development on her Twitter & Facebook pages, and hopefully manage to
warn the surgeon who might be in some real danger.
D. should talk to the patient and ascertain the patient's mindset, perhaps even refer the patient to a
mental health specialist; then, possibly warn the surgeon of this negative development in their
patient-doctor relationship before any possible adverse event might occur.

37.

If, in the scenario in #31, the surgeon had decided to tell the patient & family about company C's implants
as well -- and assuming that the patient opted for the implants of company C because they were the
cheapest among the choices, despite having options A & B available -- the surgeon would now have to
honor the patient's choice of implant. So the surgery gets scheduled with implant C as primary
consideration for doing the fusion.
However, during the middle of the surgery, as the procedure came to the point where the implants had to
be installed, the surgeon decides to push through with using the implants of company A, he would be
violating...
A. the patient's autonomy
C. the patient's right to an informed consent
B. the patient's right to distributive justice
D. the patient's right to an informed refusal

38.

What if, in #37, the surgeon changed his mind about the implants (pedicle screws) because, upon
preparing & creating the holes for the screws, he felt that the vertebrae of the patient was osteoporotic
(i.e., the bone matrix was softer than normal, and would most likely be cut by implants that had a potential
for bony cut-through), then by deciding to change to implant system A, the surgeon would be exercising...
A. autonomy
C. non-maleficence
B. beneficence
D. distributive justice

39.

If it turned out that, secretly, the surgeon is HepatitisB-positive, by not disclosing this to the patient &
family as well as to the hospital & OR staff, he would be liable of violating...
A. nothing -- as long as he practices universal precautionary measures in doing the surgery.
B. the patient's autonomy.
C. the patient's right for a full informed consent.
D. the patient's right to distributive justice.

40.

Assume that the patient in #35 went to the press with her story. Consider the statement: "if some of the
controversial details of this case were to ever reach the media, people would be entitled to know
everything about what went on with the surgeon and his post-operative patient."

Actually, that statement would be...

A. false -- because the hospital would have to cover up the details in order to legally protect itself.
B. true -- because the people have a right to know.
C. false -- the media would have to have court orders to give them authority to see the medical records.
D. true -- because everyone's right to privacy is rendered null & void when the press gets involved.
For #41 to #45, use the following choices:
A. autonomy
B. informed consent

C.
D.
E.

beneficence
non-maleficence
justice

41. Refers to the fair use of medical resources in dealing with medical needs & priorities of al sorts of patients.
42. Refers to the right of the patient to determine his/her own fate as far as medical management is concerned.
43. A condition achieved by laying out the advantages & disadvantages of all practical treatment options for the
patient to appreciate & choose from.
44. A condition under which the principal tenet/rule of the Hippocaratic Oath of physicains is satisfied.
45. This is mirrored by one's desire to do what should be done, not merely what can be done.
For #46 to #50, use the following choices:
A. confindentiality
B. Tarasoff precedent case

C.
D.
E.

doctor's duty to protect

primum non nocere
universal precaution

46. The legal source of the ruling which allows for a physician to perform a specific type of breach in the right to
privacy of the patient.
47. A practice by which the patient's privacy is protected while under the care of a physician.
48. Based on #46, this tenet was later established to allow for the safety of third parties who may be under harms
way.
49. The primary duty of & challenge to all doctors.
50. This protects the practicing physician from disclosing sensitive information regarding his/her health status.

A.
B.
A.
B.
C.
D.

C.
D.