Medical Ethics Practice Questions

Q: A patient was referred by a doctor to a radiologist for a CT scan and the doctor was given money for the referral. What is this unethical act called?

Fee splitting. ***Fee splitting*** - **Fee splitting** occurs when a healthcare provider (e.g., a doctor) receives payment for referring a patient to another healthcare provider or service (e.g., a radiologist). - This practice is considered unethical and often illegal because it creates a financial incentive for referrals, potentially leading to unnecessary services or choices not based on the patient's best interest. *Criminal negligence* - **Criminal negligence** involves a reckless disregard for the safety of others, leading to harm, often in situations where a duty of care was owed. - It is characterized by actions or inactions that demonstrate a gross deviation from the standard of care, resulting in injury or death, which is not the case in this scenario. *Commission* - In a medical context, **commission** generally refers to an action taken by a healthcare provider. While the act of referring a patient is a commission, it does not specifically define the unethical monetary exchange. - The term "commission" alone does not convey the unethical nature of receiving money for a referral. *Dichotomy* - **Dichotomy** in medical ethics refers to the division of fees between two healthcare providers for services actually rendered (e.g., a surgeon and assistant surgeon splitting a surgical fee). - While also ethically questionable in many contexts, dichotomy involves splitting fees for work performed, whereas fee splitting involves payment specifically for making a referral without providing additional services. *Medical maloccurrence* - **Medical maloccurrence** is a broad term that refers to an untoward event or bad outcome that occurs during medical care but does not necessarily imply negligence or wrongdoing. - It describes an adverse event that may happen despite appropriate care, which is distinct from an unethical financial arrangement.

Q: An 11-year-old girl is experiencing symptoms of fever and sore throat, and a throat swab was taken for culture. After the culture, which bag should be used to discard the swab?

Red bag. ***Red bag*** - This bag is designated for disposal of **infectious medical waste**, including items contaminated with blood, body fluids, or cultures. - The throat swab, potentially containing pathogenic microorganisms, falls under this category of **biohazardous waste**. *Blue bag* - This bag is typically used for **reusable linen** or certain types of **non-infectious waste** in healthcare settings. - It is not appropriate for discarding items that have been in contact with patient samples, like a throat swab. *White bag* - White bags are generally used for **general waste** or **non-hazardous office waste**, which is not infectious. - A throat swab from a patient with a suspected infection is considered hazardous and infectious, making a white bag unsuitable. *Yellow bag* - Yellow bags are used for the disposal of **clinical waste** such as anatomical/pathological waste, pharmaceutical waste, or items requiring incineration. - While some infectious waste may go in yellow bags, the red bag is more specifically designated for contaminated infectious waste like used swabs. *Black bag* - Black bags are used for **general non-hazardous waste** that does not pose any infectious or chemical risk. - A used throat swab from a patient with suspected infection is biohazardous and must not be disposed of in a black bag.

Q: Which of the following is most appropriate for managing a blood spill?

Sodium Hypochlorite. ***Sodium Hypochlorite*** - **Sodium hypochlorite** (bleach) is a widely recommended disinfectant for cleaning up blood spills due to its broad-spectrum antimicrobial activity. - It effectively **inactivates viruses**, bacteria, and fungi, including bloodborne pathogens like HIV, HBV, and HCV. - **CDC recommends** a 1:10 dilution of household bleach for blood spill decontamination with appropriate contact time. *Chlorhexidine* - **Chlorhexidine** is primarily an antiseptic used for skin disinfection before medical procedures. - While it has antimicrobial properties, it is not the preferred agent for decontaminating surfaces from large blood spills due to its less potent virucidal action compared to bleach. *Formaldehyde* - **Formaldehyde** is a potent disinfectant and sterilant, often used in histology and for sterilizing medical equipment. - However, it is highly toxic, a known carcinogen, and has a strong irritating odor, making it unsuitable for routine blood spill cleanup in clinical settings. *Ethyl Alcohol* - **Ethyl alcohol** (ethanol) is an effective antiseptic for skin and small surface disinfection, particularly against bacteria and some viruses. - Its efficacy against non-enveloped viruses and spores is limited, and it evaporates quickly, which makes it less reliable for disinfecting large blood spills that require sustained contact time. *Hydrogen Peroxide* - **Hydrogen peroxide** has antimicrobial properties and is used for surface disinfection in some healthcare settings. - However, it is less effective than sodium hypochlorite against certain bloodborne pathogens, requires higher concentrations for virucidal activity, and can be corrosive to some surfaces. - It may be unstable in storage and loses potency over time, making it less reliable for blood spill management protocols.

Q: Swab is discarded in which color bin

Yellow bag. ***Yellow bag*** - Items in the **yellow bag** include **infectious/clinical waste** that may or may not be contaminated with human waste and may contain chemicals or pharmaceutical waste. - As **swabs** are used for collecting biological samples that may contain infectious agents, they are classified as **infectious waste** and must be disposed of in a yellow bag for appropriate incineration. *White bag* - **White bags** are typically used for the disposal of **amalgam waste**, which includes teeth with amalgam fillings (unless the tooth is a biopsy sample), removed amalgam fillings, and encapsulated dental amalgam. - This category is distinct from general clinical waste, which swabs fall under. *Red bag* - **Red bags** are used for **anatomical waste**, which includes body parts, organs, and visible blood. - **Swabs** do not fall into this category, as they are not anatomical waste, even if they contain blood. *Blue bag* - **Blue bags** are designated for the disposal of **pharmaceutical waste** that is not cytotoxic or cytostatic. - This typically includes expired or unused medications, not general clinical waste like swabs. *Green bag* - **Green bags** are used for **general/non-infectious waste** such as disposable items not contaminated with body fluids. - **Swabs** used for biological sample collection are considered infectious waste, not general waste, so they do not belong in green bags.

Q: A 62-year-old woman is brought to the physician by her daughter for the evaluation of weight loss and a bloody cough that began 3 weeks ago. Twenty years ago, she had a major depressive episode and a suicide attempt. Since then, her mental status has been stable. She lives alone and takes care of all her activities of daily living. The patient has smoked 1 pack of cigarettes daily for the past 40 years. She does not take any medications. An x-ray of the chest shows a central solitary nodule in the right lung; bronchoscopy with transbronchial biopsy shows a small cell lung cancer. A CT scan of the abdomen shows multiple metastatic lesions within the liver. The patient previously designated her daughter as her healthcare decision-maker. As the physician goes to reveal the diagnosis to the patient, the patient's daughter is waiting outside her room. The daughter asks the physician not to tell her mother the diagnosis. Which of the following is the most appropriate action by the physician?

Clarify the daughter's reasons for the request. ***Clarify the daughter's reasons for the request*** - The patient's **autonomy** and right to know her diagnosis are paramount unless she clearly indicates otherwise or lacks decision-making capacity. - Before proceeding, understanding the daughter's concerns allows the physician to address them while upholding the patient's rights and ensuring empathetic communication. *Ask the patient if she wants to know the truth* - While patient preference is crucial, directly asking this question without first addressing the daughter's request can create an immediate conflict and potentially undermine trust. - It might put the patient in an awkward position if she feels pressured by her daughter's presence or wishes. *Encourage the daughter to disclose the diagnosis to her mother* - Disclosing complex medical diagnoses, especially those with serious prognoses, is the physician's responsibility, given their expertise and ethical obligations. - Shifting this burden to the daughter can cause her undue stress and may not guarantee that the information is conveyed accurately or empathetically. *Withhold the diagnosis from the patient* - Withholding a diagnosis from a **competent patient** violates their **autonomy** and ethical principles of informed consent. - The patient has no apparent cognitive impairment, lives independently, and has the right to make decisions about her own care. *Disclose the diagnosis to the patient* - While ultimately the correct action if the patient wishes to know, it's not the *most appropriate initial* action in light of the daughter's explicit request. - Proceeding without understanding the daughter's concerns first could lead to immediate family conflict and complicate future care discussions.

Question 1

A patient was referred by a doctor to a radiologist for a CT scan and the doctor was given money for the referral. What is this unethical act called?

Accepted Answer

Fee splitting

Answer

Criminal negligence

Answer

Commission

Answer

Medical maloccurrence

Answer

Dichotomy

Question 2

An 11-year-old girl is experiencing symptoms of fever and sore throat, and a throat swab was taken for culture. After the culture, which bag should be used to discard the swab?

Accepted Answer

Red bag

Answer

Blue bag

Answer

White bag

Answer

Yellow bag

Answer

Black bag

Question 3

Which of the following is most appropriate for managing a blood spill?

Accepted Answer

Sodium Hypochlorite

Answer

Chlorhexidine

Answer

Formaldehyde

Answer

Ethyl Alcohol

Answer

Hydrogen Peroxide

Question 4

Swab is discarded in which color bin

Accepted Answer

Yellow bag

Answer

White bag

Answer

Red bag

Answer

Blue bag

Answer

Green bag

Question 5

A 62-year-old woman is brought to the physician by her daughter for the evaluation of weight loss and a bloody cough that began 3 weeks ago. Twenty years ago, she had a major depressive episode and a suicide attempt. Since then, her mental status has been stable. She lives alone and takes care of all her activities of daily living. The patient has smoked 1 pack of cigarettes daily for the past 40 years. She does not take any medications. An x-ray of the chest shows a central solitary nodule in the right lung; bronchoscopy with transbronchial biopsy shows a small cell lung cancer. A CT scan of the abdomen shows multiple metastatic lesions within the liver. The patient previously designated her daughter as her healthcare decision-maker. As the physician goes to reveal the diagnosis to the patient, the patient's daughter is waiting outside her room. The daughter asks the physician not to tell her mother the diagnosis. Which of the following is the most appropriate action by the physician?

Accepted Answer

Clarify the daughter's reasons for the request

Answer

Ask the patient if she wants to know the truth

Answer

Encourage the daughter to disclose the diagnosis to her mother

Answer

Withhold the diagnosis from the patient

Answer

Disclose the diagnosis to the patient

Medical Ethics — MCQs

Medical Ethics — MCQs

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