Ethics of emerging technologies — MCQs

10 questions

A 28-year-old woman comes to the physician for genetic counseling prior to conception. For the past year, she has had intermittent episodes of headache, nausea, abdominal pain, and tingling of her fingers. She also complains of dark urine during the episodes. Her mother and maternal uncle have similar symptoms and her father is healthy. Her husband is healthy and there is no history of serious illness in his family. Serum studies show elevated concentrations of porphobilinogen and δ-aminolevulinic acid. What is the probability of this patient having a child with the same disease as her?

A 45-year-old man is brought to the emergency department by his friends because of a 1-hour history of shortness of breath and squeezing chest pain. They were at a party where cocaine was consumed. A diagnosis of acute myocardial infarction is made. The physician stabilizes the patient and transfers him to the inpatient unit. Six hours later, his wife arrives at the emergency department and requests information about her husband's condition. Which of the following is the most appropriate action by the physician?

A 15-year-old female presents to her family physician for an annual school physical exam and check-up. She is accompanied by her mother to the visit and is present in the exam room. The patient has no complaints, and she does not have any past medical problems. She takes no medications. The patient reports that she remains active, exercising 5 times a week, and eats a healthy and varied diet. Which of the following would be the best way for the physician to obtain a more in-depth social history, including sexual history and use of alcohol, tobacco, or recreational drugs?

A 28-year-old woman dies shortly after receiving a blood transfusion. Autopsy reveals widespread intravascular hemolysis and acute renal failure. Investigation reveals that she received type A blood, but her medical record indicates she was type O. In a malpractice lawsuit, which of the following elements must be proven?

A 3-year-old is brought to the pediatrician by his mother because she is concerned about recent changes to his behavior. She states that he has seemed to regress in his motor development and has been having occasional brief episodes of uncontrollable shaking. During the subsequent work up, a muscle biopsy is obtained which demonstrates red ragged fibers and a presumptive diagnosis of a genetic disease made. The mother asks if her other son will be affected. What should be the physician's response?

An 87-year-old man with glioblastoma multiforme is informed that the size and location of the tumor make operative resection impossible, and he has a prognosis of between 3-6 months. The patient then asks whether it would be possible to get a prescription for lethal medications so that he would be able to end his life if his situation deteriorated further. The physician says that he is unable to prescribe such drugs because assisted suicide is not legal in their state. Refusing to help a patient commit suicide is most consistent with which of the following ethical principles?

A 26-year-old man comes to the emergency department because of a 1-week history of fever, throat pain, and difficulty swallowing. Head and neck examination shows an erythematous pharynx with purulent exudates overlying the palatine tonsils. Microscopic examination of a throat culture shows pink, spherical bacteria arranged in chains. Treatment with amoxicillin is initiated. A day later, a physician colleague from another department approaches the physician in the lobby of the hospital and asks about this patient, saying, "Did you see him? What does he have? He's someone I play football with and he hasn't come to play for the past 5 days. I'm worried about him." Which of the following is the most appropriate action by the physician?

A 34-year-old man presents to the local clinic with a 2 month history of midsternal chest pain following meals. He has a past medical history of hypertension. The patient takes lisinopril daily. He drinks 4–5 cans of 12 ounce beer daily, and chews 2 tins of smokeless tobacco every day. The vital signs are currently stable. Physical examination shows a patient who is alert and oriented to person, place, and time. Palpation of the epigastric region elicits mild tenderness. Percussion is normoresonant in all 4 quadrants. Murphy’s sign is negative. Electrocardiogram shows sinus rhythm with no acute ST segment or T wave changes. The physician decides to initiate a trial of omeprazole to treat the patient’s gastroesophageal reflux disease. How can the physician most effectively assure that this patient will adhere to the medication regimen?

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?

Q10

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?

Ethics of emerging technologies US Medical PG Practice Questions and MCQs

Question 1: A 28-year-old woman comes to the physician for genetic counseling prior to conception. For the past year, she has had intermittent episodes of headache, nausea, abdominal pain, and tingling of her fingers. She also complains of dark urine during the episodes. Her mother and maternal uncle have similar symptoms and her father is healthy. Her husband is healthy and there is no history of serious illness in his family. Serum studies show elevated concentrations of porphobilinogen and δ-aminolevulinic acid. What is the probability of this patient having a child with the same disease as her?

A. 25%
B. 67%
C. 50% (Correct Answer)
D. 100%

Explanation: ***50%*** - This patient's symptoms (headache, nausea, abdominal pain, tingling, dark urine) and elevated **porphobilinogen** and **δ-aminolevulinic acid** are highly suggestive of **Acute Intermittent Porphyria** (AIP). - AIP is an **autosomal dominant** disorder. Therefore, there is a **50% chance** that any child of an affected parent will inherit the disease-causing allele. - Since her husband is healthy with no family history, he does not carry the mutation, making this a straightforward autosomal dominant inheritance calculation. *25%* - This probability would be expected in an **autosomal recessive** inheritance pattern when two carrier parents have a child, which is not the case here. - It would also be the probability for an X-linked recessive disorder if the mother is a carrier and the father is unaffected, and they are discussing a son's inheritance. - The clinical presentation and family history (mother and maternal uncle affected, consistent with autosomal dominant pattern) rule out this probability. *67%* - This probability is seen in specific genetic scenarios, such as the chance of a phenotypically normal sibling of an individual with an autosomal recessive disease being a carrier. - It's not a standard probability for direct offspring of an affected individual with an autosomal dominant condition. - This does not apply to the straightforward inheritance question being asked here. *100%* - This probability would occur if the disease were inherited in an **autosomal dominant** manner and the affected parent was **homozygous dominant** for the mutation. - However, this is extremely rare in AIP, as most affected individuals are **heterozygous**. - The family history pattern (affected mother with unaffected father having an affected child) is consistent with heterozygosity, not homozygosity.

Question 2: A 45-year-old man is brought to the emergency department by his friends because of a 1-hour history of shortness of breath and squeezing chest pain. They were at a party where cocaine was consumed. A diagnosis of acute myocardial infarction is made. The physician stabilizes the patient and transfers him to the inpatient unit. Six hours later, his wife arrives at the emergency department and requests information about her husband's condition. Which of the following is the most appropriate action by the physician?

A. Ask the wife for a marriage certificate
B. Inform the wife about her husband's condition
C. Consult the hospital ethics committee
D. Obtain authorization from the patient to release information (Correct Answer)
E. Request the patient's durable power of attorney document

Explanation: ***Obtain authorization from the patient to release information*** - Under **HIPAA (Health Insurance Portability and Accountability Act)**, patient information is confidential and cannot be shared without their express consent, even with close family members like a spouse, once the patient is **conscious and able to make decisions**. - The patient, being stabilized, is likely **competent** to authorize the release of his medical information to his wife, ensuring his **autonomy** and privacy are respected. *Ask the wife for a marriage certificate* - A marriage certificate does not automatically grant access to a spouse's medical information if the patient is **competent** and has not provided consent. - Requesting such documentation is generally **not standard practice** and does not supersede the need for patient authorization under HIPAA. *Inform the wife about her husband's condition* - Releasing medical information without the patient's explicit consent would be a direct **violation of patient confidentiality** and **HIPAA regulations**, even if the individual is a spouse. - Although well-intentioned, this action could have legal and ethical repercussions for the physician and the hospital. *Consult the hospital ethics committee* - While ethics committees handle complex ethical dilemmas, this situation is a straightforward matter of **patient confidentiality** and **HIPAA compliance**. - The direct course of action is to seek patient authorization, rather than escalating to an ethics committee for a clearly defined privacy issue. *Request the patient's durable power of attorney document* - A **durable power of attorney (DPOA)** for healthcare is only activated when a patient is **incapacitated** and unable to make decisions for themselves. - Since the patient is stabilized and presumably competent to make decisions about his care, a DPOA is not relevant at this time.

Question 3: A 15-year-old female presents to her family physician for an annual school physical exam and check-up. She is accompanied by her mother to the visit and is present in the exam room. The patient has no complaints, and she does not have any past medical problems. She takes no medications. The patient reports that she remains active, exercising 5 times a week, and eats a healthy and varied diet. Which of the following would be the best way for the physician to obtain a more in-depth social history, including sexual history and use of alcohol, tobacco, or recreational drugs?

A. Disallow the mother to be present in the examination room throughout the entirety of the visit
B. Give the patient a social history questionnaire to fill out in the exam room
C. Ask the mother to step outside into the hall for a portion of the visit (Correct Answer)
D. Ask the patient the questions directly, with her mother still in the exam room
E. Speak softly to the patient so that the mother does not hear and the patient is not embarrassed

Explanation: ***Ask the mother to step outside into the hall for a portion of the visit*** - This approach allows the physician to speak with the adolescent **privately and confidentially**, which is crucial for obtaining sensitive information such as sexual history, drug use, and mental health concerns. - Adolescents are more likely to disclose personal information when their parents are not present, fostering trust and ensuring **comprehensive history-taking** vital for their well-being. *Disallow the mother to be present in the examination room throughout the entirety of the visit* - This is an **overly restrictive** approach that might create tension or distrust between the physician, patient, and parent, especially at the start of the visit. - While privacy is essential for sensitive topics, parental presence can be valuable for discussing general health, family history, and **treatment plans**, especially for younger adolescents. *Give the patient a social history questionnaire to fill out in the exam room* - While questionnaires can be useful for gathering basic information, they often **lack the nuance** of a direct conversation and may not prompt the patient to elaborate on sensitive issues. - Furthermore, having the mother present while the patient fills out a questionnaire on sensitive topics still **compromises confidentiality** and may lead to incomplete or dishonest answers. *Ask the patient the questions directly, with her mother still in the exam room* - Asking sensitive questions with a parent present is **unlikely to yield truthful and complete answers**, as adolescents may feel embarrassed, judged, or fear parental disapproval. - This approach compromises the **confidentiality** that is fundamental to building trust with adolescent patients. *Speak softly to the patient so that the mother does not hear and the patient is not embarrassed* - Speaking softly is **unprofessional** and still does not guarantee privacy, as the mother might still overhear parts of the conversation. - This method also **fails to establish true confidentiality**, which is central to building rapport and encouraging open communication with adolescent patients about sensitive topics.

Question 4: A 28-year-old woman dies shortly after receiving a blood transfusion. Autopsy reveals widespread intravascular hemolysis and acute renal failure. Investigation reveals that she received type A blood, but her medical record indicates she was type O. In a malpractice lawsuit, which of the following elements must be proven?

A. Duty, breach, causation, and damages (Correct Answer)
B. Only duty and breach
C. Only breach and causation
D. Duty, breach, and damages

Explanation: ***Duty, breach, causation, and damages*** - In a medical malpractice lawsuit, all four elements—**duty, breach, causation, and damages**—must be proven for a successful claim. - The healthcare provider had a **duty** to provide competent care, they **breached** that duty by administering the wrong blood type, this breach **caused** the patient's death and renal failure, and these injuries constitute **damages**. *Only duty and breach* - While **duty** and **breach** are necessary components, proving only these two is insufficient for a malpractice claim. - It must also be demonstrated that the breach directly led to the patient's harm and resulted in legally recognized damages. *Only breach and causation* - This option omits the crucial elements of professional **duty** owed to the patient and the resulting **damages**. - A claim cannot succeed without establishing that a duty existed and that quantifiable harm occurred. *Duty, breach, and damages* - This option misses the critical element of **causation**, which links the provider's breach of duty to the patient's injuries. - Without proving that the breach *caused* the damages, even if a duty was owed and breached, and damages occurred, the claim would fail.

Question 5: A 3-year-old is brought to the pediatrician by his mother because she is concerned about recent changes to his behavior. She states that he has seemed to regress in his motor development and has been having occasional brief episodes of uncontrollable shaking. During the subsequent work up, a muscle biopsy is obtained which demonstrates red ragged fibers and a presumptive diagnosis of a genetic disease made. The mother asks if her other son will be affected. What should be the physician's response?

A. There is a 50% chance he will be affected
B. There is a 100% chance he will be affected, and the severity will be the same
C. There is a 25% chance he will be affected
D. There is a 100% chance he will be affected, but the severity may be different (Correct Answer)
E. He will be unaffected

Explanation: ***There is a 100% chance he will be affected, but the severity may be different*** - The patient's symptoms (motor regression, seizures, red ragged fibers on muscle biopsy) are classic for a **mitochondrial disorder**, which are inherited via **maternal inheritance**. - All children of an affected mother will inherit the affected mitochondria; however, the **heteroplasmy** (proportion of mutated mitochondria inherited) can vary, leading to different disease severities. *There is a 50% chance he will be affected* - This inheritance pattern is typical for **autosomal dominant** disorders, or occasionally X-linked disorders in males. - Mitochondrial disorders do not follow autosomal dominant inheritance, as they are exclusively inherited from the mother. *There is a 100% chance he will be affected, and the severity will be the same* - While there is a 100% chance of inheriting the mutated mitochondria from an affected mother, the **phenotypic expression and severity can vary widely** due to heteroplasmy. - The proportion of mutated mitochondria can differ in various tissues and between offspring, leading to variable clinical manifestations. *There is a 25% chance he will be affected* - This represents the risk of inheritance for an **autosomal recessive** disorder when both parents are carriers. - Mitochondrial inheritance does not follow an autosomal recessive pattern. *He will be unaffected* - This would only be true if the mother's mitochondrial DNA were not affected or if the inheritance pattern allowed for some children to be completely spared, which is not the case for mitochondrial disorders. - Since the mother is the carrier of the mitochondrial mutation, all her children will inherit the mutated mitochondria.

Question 6: An 87-year-old man with glioblastoma multiforme is informed that the size and location of the tumor make operative resection impossible, and he has a prognosis of between 3-6 months. The patient then asks whether it would be possible to get a prescription for lethal medications so that he would be able to end his life if his situation deteriorated further. The physician says that he is unable to prescribe such drugs because assisted suicide is not legal in their state. Refusing to help a patient commit suicide is most consistent with which of the following ethical principles?

A. Beneficence
B. Distributive justice
C. Non-maleficence (Correct Answer)
D. Autonomy
E. Formal justice

Explanation: ***Non-maleficence*** - Non-maleficence is the ethical principle to **"do no harm"** to the patient, one of the four core pillars of medical ethics. - In the context of physician-assisted suicide, refusing to prescribe lethal medications is **most directly grounded** in the principle of not causing harm or death to the patient, even when requested. - While legal constraints exist, the **underlying ethical rationale** for opposition to physician-assisted suicide in traditional medical ethics is that actively ending a patient's life violates the fundamental duty not to harm. - This principle holds that the physician's role is to **preserve life and relieve suffering** through palliative care, not to cause death. *Formal justice* - Formal justice refers to the principle of treating **similar cases in a similar manner** and applying rules consistently. - While the physician is following the law equally for all patients, formal justice is more about **procedural fairness** than the substantive ethical principle underlying the refusal to end life. - This principle is relevant but is **not the primary ethical foundation** for opposing physician-assisted suicide. *Beneficence* - Beneficence is the ethical principle of acting in the **best interest of the patient** and promoting their well-being. - While some might argue that respecting the patient's wish could be beneficent, traditional medical ethics views **preserving life** and providing comfort care as beneficent, rather than facilitating death. - This principle could be invoked on either side of the debate but is **less specific** than non-maleficence in this context. *Autonomy* - Autonomy is the principle of respecting a patient's right to make **decisions about their own medical care**. - While the patient is expressing an autonomous wish, the physician's refusal demonstrates that autonomy has **limits when it conflicts** with other ethical principles (non-maleficence) and legal constraints. - This scenario represents a tension between autonomy and other ethical duties. *Distributive justice* - Distributive justice concerns the **fair allocation of resources** and burdens within society. - This principle is generally applied to situations involving healthcare access, resource scarcity, or equitable treatment for groups of people, and is **not directly relevant** to an individual physician's decision regarding assisted suicide.

Question 7: A 26-year-old man comes to the emergency department because of a 1-week history of fever, throat pain, and difficulty swallowing. Head and neck examination shows an erythematous pharynx with purulent exudates overlying the palatine tonsils. Microscopic examination of a throat culture shows pink, spherical bacteria arranged in chains. Treatment with amoxicillin is initiated. A day later, a physician colleague from another department approaches the physician in the lobby of the hospital and asks about this patient, saying, "Did you see him? What does he have? He's someone I play football with and he hasn't come to play for the past 5 days. I'm worried about him." Which of the following is the most appropriate action by the physician?

A. Inform the colleague that they should ask the patient's attending physician
B. Inform the colleague that they cannot divulge any information about the patient (Correct Answer)
C. Tell the colleague the patient's case file number so they can look it up themselves
D. Tell the colleague that they cannot tell them the diagnosis but that their friend was treated with antibiotics
E. Ask the colleague to meet in the office so they can discuss the patient in private

Explanation: ***Inform the colleague that they cannot divulge any information about the patient*** - The **Health Insurance Portability and Accountability Act (HIPAA)** strictly prohibits the disclosure of a patient's **Protected Health Information (PHI)** without their explicit consent. - Even if the inquirer knows the patient, a physician-patient relationship creates a **duty of confidentiality** that supersedes personal acquaintance. - Disclosing any information without patient consent, even to another physician, violates HIPAA regulations. *Tell the colleague the patient's case file number so they can look it up themselves* - Providing the case file number would enable unauthorized access to the patient's medical records, thereby violating **patient confidentiality** and **HIPAA regulations**. - This action does not rectify the breach of confidentiality and escalates the potential for further misuse of PHI. *Inform the colleague that they should ask the patient's attending physician* - Recommending that the colleague ask the attending physician shifts the burden but does not address the underlying ethical and legal obligation of the current physician to maintain **confidentiality**. - The attending physician would also be bound by **HIPAA** and ethical guidelines not to disclose information without consent. *Tell the colleague that they cannot tell them the diagnosis but that their friend was treated with antibiotics* - While seemingly less specific, stating that the friend was treated with **antibiotics** is still a disclosure of **Protected Health Information (PHI)**. - This action violates **patient confidentiality** as it reveals a detail of the patient's medical management without consent. *Ask the colleague to meet in the office so they can discuss the patient in private* - Moving to a private setting does not negate the fact that discussing the patient's information with an unauthorized individual is a **breach of confidentiality**. - The location of the conversation does not change the ethical and legal obligations to protect **PHI**.

Question 8: A 34-year-old man presents to the local clinic with a 2 month history of midsternal chest pain following meals. He has a past medical history of hypertension. The patient takes lisinopril daily. He drinks 4–5 cans of 12 ounce beer daily, and chews 2 tins of smokeless tobacco every day. The vital signs are currently stable. Physical examination shows a patient who is alert and oriented to person, place, and time. Palpation of the epigastric region elicits mild tenderness. Percussion is normoresonant in all 4 quadrants. Murphy’s sign is negative. Electrocardiogram shows sinus rhythm with no acute ST segment or T wave changes. The physician decides to initiate a trial of omeprazole to treat the patient’s gastroesophageal reflux disease. How can the physician most effectively assure that this patient will adhere to the medication regimen?

A. Instruct the patient to purchase a weekly pill organizer
B. Have the patient repeat back to the physician the name of the medication, dosage, and frequency (Correct Answer)
C. Provide the patient with details of the medication on a print-out
D. Contact the pharmacist because they can explain the details more thoroughly
E. Tell the patient to write the medication name, dosage, and frequency on their calendar at home

Explanation: ***Have the patient repeat back to the physician the name of the medication, dosage, and frequency*** - The **"teach-back" method** is an effective way to confirm patient understanding and improve adherence by having the patient restate information in their own words. - This method allows the physician to identify and clarify any misunderstandings immediately, ensuring the patient comprehends the **medication regimen**. *Instruct the patient to purchase a weekly pill organizer* - While a **pill organizer** can be helpful for medication organization, simply telling the patient to buy one does not guarantee they will understand or consistently use it. - It does not address the fundamental issue of ensuring the patient fully comprehends the **medication instructions** and its importance. *Provide the patient with details of the medication on a print-out* - A print-out provides information, but merely giving a patient a **document** does not confirm they have read, understood, or retained the information. - Many patients may not read or fully comprehend written materials, making it less effective than active engagement methods like **teach-back**. *Contact the pharmacist because they can explain the details more thoroughly* - Pharmacists play a crucial role in medication education, but delegating the primary explanation entirely removes the physician's opportunity to assess the patient's immediate understanding and address concerns directly. - The **physician-patient interaction** is a key moment for establishing a shared understanding of the treatment plan. *Tell the patient to write the medication name, dosage, and frequency on their calendar at home* - This method relies on the patient's ability and willingness to *independently* record and recall information, which may not be sufficient for comprehensive understanding or adherence. - It does not provide an immediate feedback loop for the physician to assess the patient's comprehension of the **treatment plan**.

Question 9: 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?

A. Criminal negligence
B. Commission
C. Medical maloccurrence
D. Fee splitting (Correct Answer)
E. Dichotomy

Explanation: ***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.

Question 10: 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?

A. Blue bag
B. Red bag (Correct Answer)
C. White bag
D. Yellow bag
E. Black bag

Explanation: ***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.

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