Em Administration, Ethics, And Legal Aspects Via Pretest

Front 1

1. All of the following are elements of a hospital’s disaster
plan EXCEPT
(A) activation mechanism
(B) capacity assessment
(C) communication
(D) discharge of predisaster patients
(E) training and drills

Back 1

1. The answer is D. (Chapter 5) A good hospital disaster plan includes a mechanism of
activation, assessment of the hospital’s capacity, establishment of disaster command,
communication, supplies, administrative and treatment areas, and training and drills.
Although immediate discharge of predisaster patients may augment capacity, it is not
contemplated in the regulations of the Joint Commission of the Accreditation of Healthcare
Organizations. Good disaster planning also includes assessment of likely hazards
and cooperation between the hospital and the community.

Front 2

2. All of the following are helpful strategies to cope with
shift work EXCEPT
(A) counterclockwise shift rotation
(B) isolated night shifts
(C) bright light (
10,000 lux) for 2 h after rising
(D) regular exercise
(E) anchor sleep and naps

Back 2

2. The answer is A. (Chapter 288) When shifts must be rotated, they should be rotated
in a clockwise manner (each change to a later, not earlier, shift), ideally with 1 month or
more per rotation. Sporadic night shifts are less disruptive than longer stretches of nights
to circadian rhythms. Anchor sleep involves sleeping for the same 4-h period each night,
regardless of the shift worked.

Front 3

3. All of the following statements are true of sexual
assault EXCEPT
(A) The physician’s first responsibility is to the
patient, not to the legal system
(B) All patients should be offered follow-up
(C) Lack of genital injuries makes involuntary
intercourse unlikely
(D) Facial or extremity injuries are common
(E) Every female patient should have a
pregnancy test

Back 3

3. The answer is C. (Chapter 290) Lack of genital injuries does not imply consensual
intercourse, although their presence may suggest force. Toluene dye staining with colposcopy
may identify lesions in the posterior fourchette suggestive of rape that are not
visible on routine examination. Because rape is a violent crime, nongenital injuries are
common, particularly of the face and extremities. Preexisting pregnancy must be ruled
out before offering pregnancy prophylaxis. Follow-up is necessary to assess the effectiveness
of pregnancy and sexually transmitted disease prophylaxis, and patients frequently
require additional counseling.

Front 4

4. Each of the following is an ethical justification to
terminate or withhold cardiopulmonary resuscitation
EXCEPT
(A) preexisting poor quality of life
(B) a valid do-not-resuscitate order
(C) known irreversible and untreatable terminal
illness
(D) nonsurviveable trauma, such as decapitation
(E) failure to respond to standard protocols according
to advanced cardiac life support

Back 4

4. The answer is A. (Chapter 13) Judgments about quality of life are highly subjective
and individual, and physicians should refrain from making such judgments about their
patients. When a patient is known to have an untreatable terminal illness, it is appropriate
to withhold resuscitation, but this level of knowledge is rarely available in the emergency
setting. Often, only the failure to respond to resuscitation efforts will determine
that the patient has “irreversible cessation of circulatory and respiratory functions.”

Front 5

5. Each of the following is an expected physician
response to a malpractice suit EXCEPT
(A) disbelief
(B) anger
(C) depression
(D) threats against the suing patient
(E) self-doubt and difficulty making decisions

Back 5

5. The answer is D. (Chapter 288) Malpractice stress syndrome is a pattern of response
characterized by disbelief, anger, and depression, followed by isolation, embarrassment,
and self-doubt. The greatest predictor of dysfunction is isolation. Peer support groups
composed of other physicians who have experienced litigation are very helpful in preventing
or relieving the sense of isolation.