BHP IV 2008

1. A 12-year-old boy has pituitary tumor resulting in GH and ACTH deficiency. The doctor recommends an operation to remove the pituitary tumor. The boy’s parents refuse because of financial problems. His grandfather is worried about treatment failure.
Regarding the patient’s refusal, you consider it as:
A. Patient’s preference
B. Autonomy on behalf of the patient
C. Cultural belief
D. Nonmalficence
E. Justice

2. Which of the following is the ethical issue regarding the financial problem and the grandfather’s concern?
A. Patient’s …
B. Patient’s surrogate
C. Patient’s responsibilities
D. Quality of life
E. Contextual factors

3. The doctor ignores the parents’ refusal. What principle is applied by the doctor?
A. Paternalism
B. Beneficence
C. Autonomy and self-determination
D. Patient’s incapability
E. Quality of life

4. A 45-year-old man is admitted to emergency room with impaired consciousness due to diabetic ketoacidosis. He didn’t agree with all treatment. Treatment initiated on authorization of his wife. What is the most reasonable objection?
A. Treatment will be painful such as frequent IV blood sampling
B. Decision is incapacitated by diabetic encephalopathy
C. …
D. Not informed about the treatment
E. He was dying

5. In the case of an emergency like this, even if the patient had intact decision-making capacity and no one around could give permission to do the treatment, which of the following is the most appropriate decision and most ethically permissible?
A. Do not give treatment
B. Consultation with the ethical committee
C. Respect the patient’s right
D. Ask the patient to sign the statement of refusal
E. Directly treat the patient properly without any permission

6. Type II diabetic gave birth to a newborn with congenital anomaly of anencephaly. Which of the following is your decision as a doctor?
A. Not resuscitating the baby because the baby won’t survive
B. Not telling the mother
C. Resuscitate and assist respiration
D. Ask the mother’s opinion
E. Give oxygen by mask
7. While examine a patient with gangrene foot, you cover your nose with handkerchief. What is the category of your behavior?
A. Beneficence
B. Against respect for the person
C. Justice
D. Malficence
E. Unclassified

8. –

9. A 15-year-old adolescent girld suffers from non-toxic goiter. She asks the doctor to do operation. Which is the appropriate response?
A. Agree to do the operation
B. Operation will be done without parent’s permission
C. Doctor refuses because there is medical indication
D. Doctor recommends radiotherapy
E. Doctor does the operation with special fee

10. –

11. A 45-year-old man is diagnosed having type 2 diabetes mellitus. As a doctor, what is the appropriate information that should be given to this patient?
A. Alternative treatment
B. Personal hygiene
C. Change of job
D. Diabetes health care play a role in making sure that the patient’s consent is an informed one
E. Recommendation of not doing any sport

12. –

13. A 24-year-old man comes to the doctor to ask about his fiancée. She has type I diabetes mellitus. What should you do as a doctor?
A. Verocity (truth-telling)
B. Don’t tell anything without his fiancée permission
C. Ask both of them to see you
D. Tell Mr. Beny that Mona has a life-long disease
E. Ask him to ask her parent

14. –

15. A 25-year-old woman is a diabetic, now is 18 weeks pregnant. Ultrasonography shows severe congenital anomalies in the baby. Doctor recommends her to do abortion but she refuses. What is the appropriate action of the doctor?
A. Ask the husband to consent on behalf of Nina
B. Respect her decision
C. Persuade her to do abortion by giving more information
D. Give abortive medicine without Nina’s consent
E. Refer to another doctor

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From past years

1. You’re a doctor in remote area. A patient with diabetes comes to you. The only live-saving treatment is insulin, and the only available insulin is porcine insulin. The patient is a Moslem, and you’re a Moslem too.
A. Give insulin without telling the family
B. Ask permission from Moslem leader in the community
C. Just give saline infusion
D. Ask the family to pray for a miracle
E. None of the above

2. During the last few months, Mr. Don’s HbA1c level is always above 10%. Doctor recommend treatment with injection of insulin, but he refuses. What should the doctor do?
A. Do not insist because he has the right to refuse
B. Ask his wife to persuade him for the treatment
C. Stop treating him
D. Ask for help from health community
E. Alternatively change his diet

3. Baby boy born from diabetic mother has anencephaly. What would you do?
A. No resuscitation
B. Ask hospital ethic committee
C. Ask religious person
D. Don’t tell the mother about the baby’s abnormality
E. Ask father of the baby for consent to not resuscitate

4. Mrs. Cicih would like to increase weight. Doctor gives green tablet without any information regarding side effects, for how long she should take the drug. The green tablet is prednisone. From ethical point of view, doctor provides…
A. Beneficence
B. Malficence
C. Justice
D. Patient’s demand
E. None

materi BHP IV : ETHICS IN PEDIATRIC CARE

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