HSS UW

Question 1

What are the three progressive end-of-life philosophies in patient treatment/management?

Answer 1

No escalation of treatment (NEOT) –> +/-Time-limited trial (intensive care for 2-3 days) –> Withdrawal of life support.

Question 2

What are some types of cognitive biases that may cause errors in medicine?

Answer 2

Question 3

Physician liability can be minimized, and the practice of defensive medicine can be reduced by _______.

Answer 3

Implementing evidence-based clinical pathways or practice guidelines.

Question 4

The typical age of onset of adolescent non-suicidal self-injury (NSSI) such as cutting, burning, and scratching is ____.

Answer 4

12-14 yrs

Question 5

What are some exceptions to maintaining confidentiality in minors exhibiting non-suicidal self-injury (NSSI)?

Answer 5

-suicidal/homicidal ideation or potentially dangerous self-harming behavior (use of razors, sutures)
-Abuse
-Neglect
-Impairment/distress
-multiple episodes (cuts/marks in different stages of healing)
-Escalating frequency

Question 6

Airborne precautions must be used for which infectious disease agents?

Answer 6

-M. TB
-Rubeola virus (Measles)
-VZV (Chicken Pox)
-Herpes Zoster virus (Shingles)

Question 7

What are examples of advanced directive?

Answer 7

1. Living Will.
2. Power of Attorney (medical/healthcare).
3. Health Care Instructions.

Question 8

Of the substitute decision-makers, who has the highest authority in decision-making for an incapacitated patient?

Answer 8

Pt. directed proxy (eg. durable power of attorney).

Question 9

If there is no prior patient-directed proxy such as a medical/healthcare power of attorney, who can act as a substitute decision-maker?

Answer 9

-Court-appointed guardian, or
-Non-designated next-of-kin (spouse > parents > adult children > Adult siblings > other adult relatives > friends).

Question 10

What are some patient selection criteria for home hospice care?

Answer 10

-Life expectancy </= 6 months
-agreement to forgo curative & life-sustaining t/t.
-Family/private caregiver available for daily needs.
-current symptoms can be m/m with home care.

Question 11

Home hospice care can be provided at which locations other than home?

Answer 11

-assisted living facility
-nursing home

Question 12

Explain the ethical principle of “proportionality” in the practice of medicine.

Answer 12

The ethical principle of proportionality ensures that the methods used to achieve a sufficiently worthwhile medical goal are necessary, appropriate, and not excessive.

Question 13

Which specific scenarios grant emancipation to adolescents (minors)?

Answer 13

Emancipation to minors (adolescents) is granted when they are (any of the following)

-a parent
-married
-financially independent.
-in military service
-high-school graduate
-homeless.

Question 14

When a patient refuses t/t for a serious illness, the next important step is to assess their _____.

Answer 14

decision-making capacity (DMC).

Question 15

What are the 4 primary components of decision-making capacity (DMC)?

Answer 15

1. Ability to clearly COMMUNICATE a choice.
2. UNDERSTAND the information provided.
3. Appreciate the CONSEQUENCES of the choice.
4. Provide a RATIONALE for the decision: pt. is able to weigh the risks and benefits and provide reasons for refusing the t/t.

Question 16

Health care value is defined as _____.

Answer 16

the ratio of health care quality to costs, whereby
health care quality measures include
-patient outcomes (morbidity, mortality)
-pt. safety (adverse events)
-pt. care metrics (satisfaction, wait times).

and

Costs include total costs of care per patient over the course of the entire treatment.

Question 17

According to the Joint Commission’s root cause analysis, failures in ____ and _____, are the most common causes of sentinel events (serious errors causing pt. death or serious harm) in hospital settings.

Answer 17

failures in communication and teamwork.

examples include:
-miscommunication during transfers of care
-excessive team hierarchy
-poor interprofessional collaboration.

Question 18

In hospice care for end-stage terminal illness, the focus of pt. management shifts from _____ to _____.

Answer 18

m/m focus in hospice care shifts from extending life to providing maximum comfort even if it compromises the length of life.

An example includes: increasing the dose of morphine to relieve refractory/intractable pain even if it entails the development/worsening of respiratory depression and hypoxemia.

Question 19

According to current guidelines, _______ test is not indicated for uncomplicated, acute back pain (< 4-6 weeks) without any red flags such as constitutional symptoms, or h/oprior malignancy.

Answer 19

imaging

Question 20

What are the characteristic features of USDA areas classified as “Food Deserts”?

Answer 20

Areas with a poverty rate of at least 20% or a median family income of less than 80% of the surrounding area median income,
and
with at least 500 people (33%) living > 1 mile away from a grocery store (> 10 miles in rural areas).

Question 21

Prednisone goes to the ____ to convert into the active form of prednisolone.

Answer 21

liver;

hence, prednisolone is preferred in pts. with liver disease.

Question 22

What is medication reconciliation?

Answer 22

the process of reviewing and updating a patient’s medication regimen.

Question 23

True/False? The right to refuse treatment by a patient with intact decision-making capacity includes emergency treatment.

Answer 23

True