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INTERNATIONAL MEDICAL AND TECHNOLOGICAL UNIVERSITY

FACULTY OF MEDICINE
UNIVERSITY EXAMINATION IN MEDICAL ETHICS (MET 300)
V/EX V/VI CRASH
PAPER I
DATE 04.10.2012 TIME: 9.00-12.00 NOON

INSTRUCTIONS:
This paper consists of Multiple Choice questions. Each of the following questions is followed by
5 responses a to e. Choose the one correct response by circling around the letter. There is no
penalty for wrong answer.

1. When we talk of patient’s autonomy, it implies that;

a. patient has to follow the advice given by the doctor
b. has the liberty to decide by himself what he wants to do
c. he has no right to refuse medicines prescribed by the doctor
d. d. should not question about the medicines given by the doctor
e. e. patient is not allowed to communicate his views to the doctor

2. When we say not inflicting harm to the patient, we mean;

a. patients should not be given injections because they are painful
b. patients should not undrgo any surgical procedure withoud anaesthesia
c. giving an anaesthetic we are inflicting pain to patient
d. it excludes some psychological trauma induced by the doctor
e. it is synonymus with non- malficence

3. The introduction of patient’s bill of right will result into;

a. raised awareness amongst doctors while attending patients
b. a reduction in the quality of health carte provided
c. weakening of the relationship between the health care providers and clients
d. patients getting the worst form of treatment from doctors
e. patients participating less effectively in health matters

4. In paternalism ;
a. The patient has the right to decide what he wants
b. The doctor listens and abides to patient’s decisions
c. The doctor gives guidance and advice to patient
d. Is synonymus with the principle of autonomy
e. The patient can advise the doctor about the medicine he/she wants

5. Which of the following may fall under advertising and canvassing contrary to medical
ethics ?
a. Announcement by the Medical Association of Tanganyika of change of address
b. Doctor making a card showing his name, professional qualification, home address and
telephone number
c. Making a signboard for the purpose of assisting patients to locate a Practitioner
d. Making signboard at he door indicating the title “Senior Consultant Surgeon
e. Emblem on the door “ the only chest surgeon south of the Sahara”

6. In therapeutic misadventure;
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a. Injury or death of patient occurs during treatment or diagnosis.

b. Refers to those deaths occurring during experimentation only.
c. the doctor gives the wrong dose of a drug to patient.
d. Sensitivity tests are of no help to those previously having shown drug reaction.
e. The doctor need not inform the patient of untoward side effects of a drug.

7. About the Jewish Chronic Disease Hospital study all true except ;
a. Debilitated patients were starved to death
b. The aim of the study was to see the body’s ability to reject cancer cells
c. Study involved injection of live cancer cells to the patients
d. Consent given was only verbally and not written
e. Patients did not know they were given cancer cells

8. When a research subject gets side effects from a certain procedure done on him;
a. He should be excluded from the study
b. He should be given reassurance to continue with the study
c. The nature of the side effects should be looked into and appropriate measures taken
d. Should immediately be taken to hospital without delay
e. The researcher must provide some token to the subject as compensation.

9. When planning to carry research on human subjects;

a. Giving incentives to the participants in order to make them consent is something to be
encouraged to bring a success.
b. When the procedure involves some minor risk it is not proper to inform them lest they
withdraw from study
c. Participants should be informed of untoward effects of the study and let them decide
whether or not to participate
d. Involve them in the study first and thereafter inform them of untoward effects
e. Choose the group that does not appear to offer resistance

10. The Belmont Report in 1979 was important for;

a. prevention of human torture.
b. Laying down of principles governing the donation of organs
c. Formation of principles governing the conduct of research on human subjects.
d. Putting emphasis on issues pertaining to the ethical code of conduct among medical
practitioners.
e. Giving guidelines on the relationship between the doctor and patient.

11. In The Wilbrook study

a. a study on the natural history of untreated syphilis in black men in USA was carried out.
b. A study on the natural history of infectious hepatitis was carried out on mentally defective
children.
c. Live cancer cells were injected into chronically ill and debilitated patients.
d. War prisoners were injected with poisonous substances.
e. People were experimentary exposed to radiation

12. A patient tells his family that he would never want to be "kept alive like a vegetable". The term
"vegetable" should be understood by the doctor to mean: 3
a. The patient does not want any heroics or extraordinary treatments.
b. Pull the plug if the patient is ever in terminal state on a respirator.
c. If the patient is in a comatose state, let him die.
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d. The doctor should interpret the term as vague and not helpful in advance care planning
discussions unless it is clarified.
e. None of the above

13. An elderly man with end-stage emphysema presents to the emergency room awake and alert and
complaining of shortness of breath. An evaluation reveals that he has pneumonia. His condition
deteriorates in the emergency room and he has impending respiratory failure, though he remains
awake and alert. A copy of a signed and witnessed living will is in his chart stipulates that he
wants no "invasive" medical procedures that would "serve only to prolong my death." No
surrogate decision maker is available.
Should mechanical ventilation be instituted?
a. The presence of a living will or other advance directive obviates the responsibility to
involve a competent patient in medical decision making.
b. If the patient has remained awake and alert, his living will is irrelevant to medical
decision making.
c. The potential risks and benefits of mechanical ventilation need not be presented to the
patient because of the presence of a valid living will.
d. Even if the patient refuses mechanical ventilation therapy, his wishes need not be
honored because he is in the emergency room.
e. None of the above

14. Jose is a 62-year-old man who just had a needle biopsy of the pancreas showing
adenocarcinoma. You run into his brother in the hall, and he begs you not to tell Jose because
the knowledge would kill him even faster. A family conference to discuss the prognosis is
already scheduled for later that afternoon. What is the best way for the doctor to handle the
situation?6
a. The doctor should honor the request of the family member who is protecting his
beloved brother from the bad news.
b. The doctor should tell Jose's brother that withholding information is not permitted
under any circumstance.
c. Jose should withhold informing the patient about the pancreatic cancer because of the
grave diagnosis.
d. The doctor should ask Jose how he wants to handle the information in front of the rest
of the family, and allow for some family discussion time for this matter.
e. All the above
15. A 25-year-old female medical student was doing a rotation in an HIV clinic. Sara is a 30-
year-old woman who dropped out of college after she found that she contracted HIV from her
husband, who has hemophilia. In talking to Sara, it turns out that the medical student and the
patient shared a number of things--both are from the same part of Montana originally, also have
young children, and like to cook. Sara now has advanced HIV. How should the medical student
tell Sara about the advanced HIV and that she will need some blood tests without making her
angry or upset?
a. The medical student should follow the protocol for breaking bad news because it covers
everything.
b. The medical student should tell Sara about the advanced HIV and the need for blood tests
and not be concerned about provoking a reaction.
c. The medical student should get another perspective perhaps from someone in clinic
who has known Sara before breaking the bad news.
d. A and B
e. None of the above
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16. A young mother has just been informed that her 2-year-old son has leukemia. The mother
refuses permission to begin chemotherapy and informs the oncology team that their family
physician (a naturopath) will follow the child's illness. What should you do as the team
physician?
a. I should wait to hear from the family physician.
b. I should honor the mother’s request in this situation.
c. I should arrange promptly a care conference with both the mother and the family's
naturopathic physician to discuss the chemotherapy.
d. If chemotherapy offers a clear and compelling survival benefit as the only hope this
child has, and the mother refuses treatment, I am professionally obligated to seek a
court order to appoint a guardian for the child.
e. None of the above
17. Your 36-year-old patient has just tested positive for HIV. He asks that you not to inform his wife
of the results and claims he is not ready to tell her yet.
What would you say to your patient?
a. Encourage the patient to share the information with his wife on his own, giving him a
bit more time if necessary.
b. Tell the patient that his wife is at serious risk for being infected with HIV, and that
you have a duty to ensure that she knows of the risk.
c. Tell the patient that public health law requires reporting both the patient and any
known sexual partners to local health officers.
d. None of the above
e. All the above.
18. A 60-year-old man has a heart attack and is admitted to the medical floor with a very poor
prognosis. He asks that you do not share any of his medical information with his wife as he does
not think she will be able to take it. His wife catches you in the hall and asks about her husband's
prognosis.
What are you required to do legally?
a. The doctor should inform the wife about her husband’s poor prognosis.
b. The doctor should not divulge the prognosis to the wife, but he should ask the nurse
to let the wife know about her husband’s condition.
c. The wife is certainly affected by her husband's health and prognosis and every effort
should be made to encourage an open dialogue between them.
d. The doctor should not encourage the patient to talk to his wife about his condition.
e. None of the above
19. A mother brings her 18-month-old daughter to your office for a routine physical examination.
The child has had no immunizations. Her mother says that they believe in naturopathic
medicine and prefer not to immunize their children.
You would tell the mother in this situation that: 13
a. You respect her (the mother’s) wishes and say no more.
b. The risk faced by unimmunized individuals is relatively high.
c. The mother's refusal to immunize poses a significant likelihood of harm to her child.
d. The physician should make sure that the child's mother understands the risks of
remaining unimmunized and attempt to correct any misconceptions about the degree
of risk associated with getting immunized.
e. None of the above
20. A 3-year-old child is brought to your clinic with a fever and stiff neck. You are quite certain
the child has meningitis. When you discuss the need for a spinal tap and antibiotic treatment,
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the parents refuse permission, saying, " We'd prefer to take him home and have our minister
pray over him."
How should the physician handle this?
a. The physician should do what the parents request to take the child home.
b. The physician should call the parent’s religious leader and have him come to the
hospital before providing standard medical therapy.
c. The physician has no duty to provide treatment to the child when the parents refuse
treatment.
d. When efforts to obtain parental permission to treat the patient fail, the physician is
justified in seeking legal help or may be legally authorized to proceed with the
procedure and treatment of the child.
e. None of the above

21. Mr. H is a 24-year-old man who resides in a skilled nursing facility, where he is undergoing
rehabilitation from a cervical spine injury. The injury left him quadriplegic. He has normal
cognitive function and no problems with respiration. He is admitted to your service for
treatment of pneumonia. The resident suggests antibiotics, chest physiotherapy, and
hydration. One day while signing out Mr. H to the cross covering intern, the intern says "he
should be a DNR ( do no resuscitation), based on medical futility."
How would you respond to the intern?
a. The patient should be a DNR because in this case CPR (cardiopulmonary
resuscitation) offers no chance of meaningful benefit to the patient and the probability
of success is <1%.
b. The patient should NOT be a DNR based on medical futility.
c. The patient should be a DNR because even if the CPR is successful, his quality of life
is below the minimum acceptable based on his quadriplegia and his pneumonia.
d. The patient should be a DNR because his quality of life is without value.
e. None of the above

22. Angela is a 72-year-old woman with end stage congestive heart failure from coronary artery
disease--she has had two myocardial infarctions. When her medical management is optimal,
she is just able to take care of herself in her own apartment, but with any small
decompensation, she ends up in the hospital. She comes in for a clinic visit, and her weight is
up 2 kilograms and she is complaining of paroxysmal nocturnal dyspnea, even though she has
been taking her meds as prescribed. Exasperated and discouraged, she asks, "Am I dying”?
The cardiologist replies: "Well, no--this is all reversible."
What would you, as the medical-legal consultant/ethicist, say to Angela? 22
a. Agree with the cardiologist that “--this is all reversible.”
b. Tell the patient that her condition has deteriorated and that she is dying.
c. Inform the patient that the clinical course of congestive heart failure is unpredictable
and includes periods of fairly good function alternating with decompensation right up
until death, and that the terminal event is often sudden.
d. Tell the patient that she needs a hospice referral because her severe end-stage
congestive heart failure is terminal.
e. None of the above
23. Which of the following is NOT an underlying goal of ethics committees?
a. To promote the rights of patients;
b. To promote shared decision making between patients (or their surrogates if decisionally
incapacitated) and their clinicians;
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c. To promote fair policies and procedures that maximize the likelihood of achieving good,
patient-centered outcomes;
d. To improve the public perception of health care professionals and health care institutions.
e. None of the above
24. A young accident victim has been in a persistent vegetative state for several months and
family members have insisted that "everything possible" be done to keep the patient alive.
Should you honor the family's request?
a. The request must be honored because the family members insisted to do “everything
possible”.
b. The request should be honored because of absence of a court order to withhold
treatment.
c. The request should NOT be honored because it is unreasonable.
d. The request need NOT be honored if the doctor and the members of the health care
team agree that the interventions in question requested by the family would be futile.
e. None of the above

25. An elderly patient with irreversible respiratory disease is in the intensive care unit where
repeated efforts to wean him from ventilatory support have been unsuccessful. There is
general agreement among the health care team that he could not survive outside of an
intensive care setting. The patient had requested antibiotics should he develop an infection
and CPR if he has a cardiac arrest.
Should a distinction be made between the interventions requested by the patient?
a. The request by the patient for both the antibiotics and CPR must be honored.
b. The request by the patient for both the antibiotics and CPR should NOT be honored.
c. The doctor should obtain a court order before withholding CPR.
d. If there is a professional consensus about the futility of the CPR in this patient, then
there is a basis for overriding the patient’s request for CPR but not the antibiotics.
e. None of the above

26. An elderly man who lives in a nursing home is admitted to the medical ward with pneumonia.
He is awake but severely demented. He can only mumble, but interacts and acknowledges
family members. The admitting resident says that treating his pneumonia with antibiotics
would be "futile" and suggests approaching the family with this stance.
27. Do you agree?
a. No I disagree because for this patient, treating pneumonia with antibiotics stands a
reasonable chance of success.
b. Yes I agree that because the patient is severely demented, treating his pneumonia with
antibiotics would be "futile".
c. Yes I agree that the treatment of pneumonia in this severely demented patient is futile
because antibiotics may be ineffective, especially if the etiology is non-bacterial.
d. A, b and c
e. None of the above.
28. A 22-year-old woman is admitted to the hospital with a headache, stiff neck and photophobia
but an intact mental status. Lab test reveals cryptococcal meningitis, an infection commonly
associated with HIV infection. When given the diagnosis, she adamantly refuses to be tested
for HIV.
How should the medical staff handle the situation?
a. Test for HIV despite the patient’s refusal.
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b. Do not test for HIV, because as for any other medical procedure, testing should be
done only with the informed consent of the patient.
c. Test the patient for HIV anonymously, without any identifying remarks.
d. Report the patient’s cryptococcal meningitis to the Public Health Department and ask
the Department to test the patient for HIV.
e. Discharge the patient immediately
29. One of your clinic patients is a 35-year-old man with AIDS on Medicare who is an active
intravenous drug user. He uses heroin and cocaine, but he never shares needles and is reliably
present at all his clinic visits. He admits that he is often unable to take his medicines regularly
when he is using drugs. He is asking about antiretroviral therapy with protease inhibitors. You
have just read that HIV viral resistance to protease inhibitors occurs rapidly when patients are
unable to take their medicines reliably.
Should you prescribe protease inhibitors to this patient?
a. No, because the problem of resistance is a real concern in a patient who cannot take
his medicines reliably.
b. No, because the patient is continuing to use heroin and cocaine.
c. Yes because the patient wants the protease inhibitors.
d. Yes, because the doctor is under a duty not to abandon the patient and to continue an
ongoing therapeutic relationship and encourage him with information and guidance
about his HIV disease and issues of addiction.
e. None of the above
30. A 64-year-old woman with Multiple Sclerosis is hospitalized. The team feels she may need
to be placed on a feeding tube soon to assure adequate nourishment. They ask the patient
about this in the morning and she agrees. However, in the evening (before the tube has been
placed), the patient becomes disoriented and seems confused about her decision to have the
feeding tube placed. She tells the team she doesn't want it in. They revisit the question in the
morning, when the patient is again lucid. Unable to recall her state of mind from the previous
evening, the patient again agrees to the procedure.
Is this patient competent to decide?
a. This patient is competent to decide because her underlying disease is NOT impairing
her decision making capacity.
b. This patient is competent to decide during her lucid periods.
c. The patient’s decision making capacity is questionable, and getting a surrogate
decision maker involved can help determine what her real wishes are.
d. In this situation where the patient is changing her decision, the doctor should decide
whether or not to place a feeding tube.
e. None of the above
31. A 55-year-old man has a 3-month history of chest pain and fainting spells. You feel his
symptoms merit cardiac catheterization. You explain the risks and potential benefits to him,
and include your assessment of his likely prognosis without the intervention. He is able to
demonstrate that he understands all of this, but refuses the intervention.
Can the refuse of the intervention be legally?
No, because the patient does not comprehend the severity of his cardiovascular condition.
a. No, because the patient has a documented life threatening cardiac condition.
b. Yes, because he is competent to make this decision, and the doctor has a duty to
respect his choice.
c. The doctor can perform the cardiac catheterization after obtaining a court order.
d. A & B
e. None of the above
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32. A 28-year-old man presents to the emergency room with testicular torsion, in extreme pain.
Emergency surgery is scheduled, but the urologist will be unable to see the patient for at least
one hour. He asks that the patient not be given any pain medication, so that "consent can be
obtained" when he sees the patient.
Are the surgeon's concerns about informed consent valid?
a. Yes, because the surgeon has to obtain informed consent from the patient before
surgery and the pain medication will invalidate the consent.
b. Yes, because the hospital policy requires the presence of informed consent from a
lucid person before surgery.
c. The informed consent is not required in this case because it is an emergency.
d. The surgeon concerns are not valid because severe pain, by impairing a patient's
ability to listen and understand, is an encumbrance to the informed consent process.
e. All the above

33. A 36-year-old man presents for bone marrow donation for transplantation. His primary care
physician contacts the anesthesiologist to report that the patient is extremely anxious about
the procedure. The primary doctor requests that the anesthesiologist not discuss risks with the
patient, since it might "scare" the patient into not providing bone marrow for a sick cousin.
Should you curtail risk discussion?34
a. Yes because the primary care physician personally contacted the anesthesiologist.
b. Yes for the purpose of improving the likelihood that the patient will cooperate with
bone marrow harvest.
c. No because curtailing the risk discussion to avoid scaring the patient is a distinctly
unethical practice.
d. A &B
e. None of the above.
34. An otherwise healthy 54-year-old man presents for radical retropubic prostatectomy, and
expresses interest to his anesthesiologist in having postoperative epidural narcotic pain
management. The anesthesiologist believes it provides superior pain control, but is informed
by the surgeon that the patient "is not to have an epidural."
Is the anesthesiologist obliged to "take an order" from the surgeon?
a. Yes, because the surgeon is the captain of the team.
b. No, because the patient requested the epidural narcotic.
c. No, because anesthesiologists have special knowledge and training which are not
shared by the surgeon with regard to the safe administration of anesthesia, which is as
far as possible in keeping with the patient's wishes.
d. B & C
e. None of the above
35. A 28-year-old woman presents for diagnostic laparoscopy for pelvic pain. During
laparoscopy, the surgeon announces that she intends to proceed to hysterectomy for multiple
uterine myomata. The anesthesiologist then declares that he will "wake the patient up" rather
than allow the surgeon to proceed, due to lack of consent for the procedure, and questionable
medical necessity.
Can the anesthesiologist "tell" the surgeon what to do?
a. No, the anesthesiologist can not “tell” the surgeon what to do.
b. No because the hysterectomy will obviate the need for a second surgery.
c. No because the hysterectomy is medically necessary at the moment.
d. Yes he can legally and ethically.
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e. None of the above

36. A 22-year-old woman in her first pregnancy with an unremarkable prenatal course presents
with preterm labor at 28 weeks gestation. Her contractions were successfully stopped with
terbutaline. Discharge planning was reviewed with her, and she was instructed to follow a
regimen of bedrest and oral terbutaline. She reported that she did not intend to comply with
these instructions. She believed that God would not allow her to labor unless it was time for
the baby to deliver, and she indicated that He had communicated this to her.
How would you handle this situation?
a. Refer the patient to a psychiatrist.
b. Conduct extensive, non-coercive discussions to ensure that this patient understands
the implications of refusing therapy.
c. Suggest that she invite her spiritual advisor to meet and talk together about her beliefs
and the impact on her fetus.
d. Both (b) and (c).
e. None of the above
37. An 18-month-old child presents to the clinic with a runny nose. Since she is otherwise well,
the immunizations due at 18 months are administered. After she and her mother leave the
clinic, you realize that the patient was in the clinic the week before and had also received
immunizations then.
Should you tell the parents about your mistake?
a. No because the error is a trivial one.
b. No because no harm is done.
c. No because the mother will never find out.
d. Yes because an open and honest approach to errors is most appropriate
e. None of the above
38. A 3-month-old has been admitted to the hospital with a newly diagnosed ventricular septal
defect. She is in early congestive heart failure and digoxin is indicated. After discussing the
proper dose with the attending physician, you write an order for the drug. Thirty minutes later
the baby vomits and then has a cardiac arrest and dies. You discover that in writing the
digoxin order you misplaced the decimal point and the child got 10 times too much digoxin.
What is your duty here?
a. Inform the parents about the mistake and say you are sorry.
b. Do not inform the parents.
c. Do not say sorry.
d. Let the liability insurance company handle everything, because a malpractice lawsuit
may follow.
e. None of the above
39. A 3-year-old presents to the emergency department. She was diagnosed with pyelonephritis
by her physician yesterday, treated with an intramuscular injection of antibiotic and sent
home on an oral antibiotic. She is vomiting today and unable to keep the antibiotic down. As
you prepare to admit her, you feel she should have been admitted yesterday.
Should you tell the parents that their physician made a mistake?
a. Yes the parents should be told.
b. The parents should not be told.
c. Discuss the case first with the other treating physician, then tell the parents.
d. Report the incident to the risk manager and not the parents.
e. None of the above
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68. Melinda is a married 35-year-old pregnant childless woman who has lost four previous
pregnancies between 16 and 23 weeks gestation. She currently has reached 23 weeks and 3
days of gestation, her fetus is seemingly healthy, and has an estimated weight of 550 grams .
She has ruptured her bag of waters and is now having labor that seems unstoppable with
tocolytics. Delivery seems inevitable.
What is the physician’s duty to inform the parents?
a. Inform the parents that the fetus is not viable.
b. Inform the parents that the 23-week-old baby will either die or live with
significant handicap.
c. Provide sufficient medical information to the parents about the care and possible
outcome of the baby so they can make their own informed choice.
d. Inform the parents to choose passive comfort care mode treatment for the baby
rather than aggressive measures.
e. None of the above
69. A 4-year-old with an obviously broken forearm is brought to the emergency department
by her baby-sitter. Both the baby-sitter and emergency room staff have attempted to reach
her parents without success.
Can you treat this child without parental permission?
a. No. The parents must consent first.
b. The Baby-sitter’s permission would be sufficient without the parent’s consent.
c. Because the parents can not be reached, the doctor should first obtain a court
order before treating the infant.
d. The doctor should proceed with x-rays and treatment of the child’s fractured
forearm without the consent.
e. None of the above
70. An ill-appearing 2-year-old with a fever and stiff neck appears to have meningitis. His
parents refuse a lumbar puncture on the grounds that they have heard spinal taps are
extremely dangerous and painful.
What are the physician’s legal-ethical obligations in this case?
a. Obtain an ethics consultation.
b. Fully inform the parents, and should they refuse to give permission, the physician
is justified in proceeding with the procedure and treatment of the child.
c. Obtain a court order to perform the lumbar puncture and treat the child.
d. Be sure the parents’ refusal is fully informed, document the refusal in the chart,
and do not perform the lumbar puncture.
71. A 5-year-old child has just had his second generalized tonic-clonic seizure in a 4 month
period. You have recommended starting an anticonvulsant. The parents have concerns
about the recommended medication and would prefer to wait and see if their son has more
seizures.
How should you respond to the parents’ request?
a. Obtain an ethics consultation.
b. Obtain a court order to treat the child.
c. Report the case as child abuse.
d. Fully inform the parents, and should they refuse to give anticonvulsants to the
child, the physician should abide by the parents’ decision.
e. None of the above
72. Mrs. Franklin, an 81-year-old Alzheimer's patient hospitalized under your care has been
asked to participate in a clinical trial testing a new drug designed to help improve
memory. You were present when the clinical investigator obtained a signed informed
consent from Mrs. Franklin a few days ago. However, when you visit Mrs. Franklin today
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and ask her if she is ready to begin the study tomorrow, she looks at you blankly and
seems to have no idea what you are talking about.
What should you do?
a. The signed informed consent for the clinical drug testing is in doubt, and should
not be done.
b. The primary investigator should be contacted to discuss Mrs. Franklin's
participation in the trial.
c. A surrogate who can give consent for her participation may be contacted if the
clinical trial is deemed to be in her best interests.
d. (a), (b) and (c) are all correct
e. None of the above
73. During the conduct of a large clinical trial of an investigational drug, preliminary analysis
of results show that there were three times as many participants in the experimental group
who experienced severe nausea and vomiting compared to the control group. Two of the
cases were severe enough to require that the participants be hospitalized. This is despite
the fact that the preliminary analysis shows that there may be a moderate benefit with the
drug.
What should be done?
a. The large clinical trial should be stopped immediately.
b. The adverse events should be reported to the Data Safety Monitoring Board, and
the serious adverse events must be reported to the IRB.
c. Complete the trial then report in details all the adverse events.
d. The adverse events are not serious enough to report.
e. None of the above
74. After having completed a study that involved the collection of tissue from the subjects, an
investigator wishes to perform additional analysis of the archived tissue samples. This
nature of this analysis was not explicitly stated in the original consent form.
Should the investigator be required to obtain explicit consent for the new research?
a. The investigator is required to obtain explicit consent for the new research from
the IRB.
b. The investigator is NOT required to obtain explicit consent for the new research.
c. The investigator is required to obtain a general consent.
d. The investigator is required to obtain explicit consent for the new research from
the patient.
e. None of the above
75. A 28-year-old male is admitted with bacterial endocarditis and needs a replacement of his
prosthetic heart valve. After his first replacement, he continued to abuse intravenous
drugs. The medical team feels it would be "futile" and a waste of medical resources to
replace this heart valve yet again.
Is the team's judgment appropriate in this case?
a. The team's judgment is appropriate in this case.
b. If the patient consents to the heart valve replacement, it should be done because it
is not “futile”.
c. If the patient can pay for the heart valve replacement, it should be done.
d. Replacing the heart valve is “futile”.
e. None of the above

76. Mr. Steven is a 70-year-old man with end-stage COPD, admitted last month with
pneumonia. His course was complicated by respiratory failure needing mechanical
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ventilation, and multiple efforts to wean him have been unsuccessful. Awake and alert, he
now communicates through written notes that he wants the ventilator taken off.
Will you honor his request?
a. If the patient’s decision making capacity is intact, his request should be honored.
b. His request should not be honored.
c. The surrogate decision maker should make the final decision.
d. A court order is necessary because the outcome of taking him off the respirator is
death certain
e. None of the above
77. Mrs. Hanes is a 62-year-old woman with metastatic breast cancer. She was admitted with
dehydration and weakness. Her cancer treatments have failed, as she now has a
recurrence. The oncologists are contemplating some new palliative chemotherapy. The
nutrition team is concerned about her cachexia and recommends total parenteral nutrition
(TPN).
Should the patient be started on TPN?
a. The patient should NOT be started on TPN.
b. The patient should be started on TPN.
c. The patient decides whether or not to be started on TPN after being fully informed
about all the treatment choices and probable outcomes.
d. The treatment with TPN is “futile” in this patient and will serve no purpose.
e. All the above
78. A 65-year-old man comes to his physicians with complaints of abdominal pain that is
persistent but not extreme. Workup reveals that he has metastatic cancer of the pancreas.
The man has just retired from a busy professional career, and he and his wife of 40 years
are about to leave on a round-the-world cruise that they've been planning for over a year.
Should you tell him his diagnosis?60
a. Withhold telling the man his diagnosis for fear of psychological harm.
b. The man should be told his diagnosis, prognosis, and treatment options before his
planned trip.
c. It is best to wait until he returns from his trip before telling him the diagnosis.
d. Tell the wife the diagnosis, and let her decide when to inform the patient and her
husband of 40 years.
e. None of the above
79. An 80-year-old Asian woman is hospitalized with weight loss, generalized weakness, and
a pulmonary mass. Work-up reveals that she has pulmonary tuberculosis. Her family
approaches the physician and asks that the patient not be told, stating that in her
upbringing in mainland China tuberculosis was considered fatal and to tell her would be
like giving her "a death sentence."
Should you respect the family's concerns?
a. The doctor should explore the patient's belief system then decide accordingly
whether or not to inform the patient.
b. The doctor should respect and follow the family’s request.
c. The physician has a duty to inform the patient and the Department of Public
Health about the diagnosis.
d. It would be justifiable in this case to withhold the diagnosis of tuberculosis based
on cultural beliefs.
e. None of the above
80. Adolescence is a time marked by many changes including:
a. Biological, psychological and economical
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b. Psychological, biological and political

c. Biological, psychological and social
d. None of the above is true
e. All the above
81. The main benefits of Voluntary Counselling and Testing include:
a. Prevention of further spread of HIV transmission and an opportunity to start
early care, treatment and support services
b. Prevention of further spread of HIV transmission and an opportunity to expose
those who are already infected.
c. An opportunity to start early care, treatment and support services and report
the employees who are HIV positive to their respective employers for support.
d. a and b are correct
e. none of the above

82. Mature minors who are eligible to VCT in accordance to Tanzania national HIV and
AIDS policy are :
a. Adolescents who are married and have children or who are sexually active.
b. Adolescents from poor families
c. Adolescents from the minority groups
d. a and b are correct.
e. None of the above

83. Shared Confidentiality means:

a. a client using VCT or PITC service involves significant others in the
counselling process including receiving the HIV test result.
b. A person disclosing the test result to a boss in a work place.
c. A counselor shares test results with employers of the clients using VCT
d. A counselor shares the test results with the spouses of the clients using VCT.
e. None of the above

84. Issues to adhere to in a counselling relationship include:

a. Client welfare, non-discrimination, respecting differences and clients’ rights.
b. Client welfare, non-discrimination, meeting personal needs from clients and
respecting differences in clients.
c. Pressurizing clients who need counseling to get it, non-discrimination and
observing clients’ rights.
d. a and c are correct.
e. All the above

85. The Purpose of Counselling Ethics is:

a. To establish and maintain standards for counseling and to inform and protect
members of the public as well as counsellors.
b. To protect clients from the African cultural malpractices.
c. To help counselors gain enough money for their service.
d. a and b are correct.
e. None of the above

86. Fundamental Principles of VCT(Voluntary Counselling and Treatment) in Tanzania

include
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a. Privacy, No-test without counseling, Confidentiality, Non-discrimination,

and Referral system.
b. Privacy, couple counseling, post-test counseling, confidentiality,Non-
discrimination and Referral system.
c. Privacy, group counseling, confidentiality, Non-discrimination and Referral
system.
d. Privacy, Post-test counseling only, Confidentiality, Non-discrimination and
Referral system.
e. All the above