AMA Journal of Ethics®

Illuminating the art of medicine

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AMA Journal of Ethics®

Illuminating the art of medicine

Virtual Mentor. February 2005, Volume 7, Number 2.

Test Questions

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Test Questions: Quality of Life and Clinical Decision Making

Quality of Life

1. According to commentary on clinical case 1, some ethical concerns that arise when considering prenatal genetic screening for a disease like HD are:
A. For a late onset disease like HD, knowing that one carries the gene can turn an otherwise normal early life into one filled with anxiety.
B. It is difficult to predict quality-of-life.
C. Abortion because of a genetic defect is unethical.
D. All of the above.
E. A and B.
2. A patient with breast cancer has had surgery, chemotherapy, and radiation—all apparently successful. In advising her about optional adjuvant therapy, the physician should:
A. Take into account her weariness and frustration with past treatment regimens and her reluctance to continue being a "patient."
B. Insist on the adjuvant therapy despite the patient's weariness and frustration over past treatment.
C. Help the patient work through a risk-benefit analysis of the adjuvant treatment.
D. Suggest that the patient join a support group.
E. A, C, and D.
F. B and D.
3. According to Case 3 commentary, the main ethical reason for not placing a PEG in Ms McGoldrick is:
A. For a competent patient, autonomy supersedes all other considerations, and Ms MCGoldrick has stated that she does not want a PEG.
B. A PEG would achieve neither clinical goals nor Mrs. McGoldrick's goals.
C. The patient's sister and daughter have decided that her quality of life is not significantly impaired by not having a PEG.
D. No data has conclusively proven the benefits of PEG for the elderly, thus making it an ineffective use of scarce resources.
4. The 5 domains that quality-of-life instruments typically measure are:
A. Function, satisfaction, work disability, pain, general health status.
B. Function, work, disability, sexual function, pain, medical history.
C. Life expectancy, function, pain, medical history and activities of daily living (ADL).
D. Life expectancy, function, pain, clinical test results, ability to perform ADL.
5. According to Braizer, a possible way to address the current disparities between quality-of-life scores assessed by those in full health and by those in less-healthy states for the purpose of resource allocation is to:
A. Accept only the general public's quality-of-life ranking when allocating community resources.
B. Accept only the ranking of those in a given health state.
C. Discontinue use of the quality-of-life scale because there is no way to perfect it.
D. Ask patients to better describe their health states, and then ultimately let the general public make the ranking decision.
6. Koch criticizes the quality-of-life research of Menzel and Ubel for:
A. Assumptions inherent in the researchers' questions and the methodology employed.
B. The use of the term "disability" and the researcher's apparent lack of familiarity with the literature written from the perspective of difference.
C. Assumptions that any departure from full health produces a correlative decrease in subjective quality-of-life assessments.
D. All of the above.
E. B and C.
7. According to the appeals court, Elizabeth Bouvia had the right to have her nasogastic tube removed because:
A. She had a fundamental right to refuse medical treatment.
B. Her rights superseded the state's interest.
C. Quality of life was a valid and essential consideration.
D. Fulfilling the patient's wish was not viewed as equivalent to assisting her in suicide.
E. All of the above.
F. A, B, and C.
8. What was the overall policy goal of the Oregon Plan?
A. To exclude treatments for Medicaid recipients that the state deemed to be ineffective.
B. To provide Medicaid benefits for more people by restricting non-essential services.
C. To reduce taxes while still funding a growing Medicaid demand.
D. To encourage people on Medicaid to opt out of the system and use a private payor instead.
9. What are the major criticisms of QALYs as expressed by Wyatt?
A. QALYs are inherently incoherent, misleading, and not nearly as objective as they claim to be.
B. Quality-of-life scores are too objective and do not allow for the patient's perceptions.
C. Using quality-of-life measures improperly places the burden of accommodating for physical impairments on political leaders instead of physicians.
D. Quality-of-life measures compromise the clinical decision-making role of the physician.
10. According to the medicine and society article, the following trends have contributed to consumer demand for enhancement interventions:
A. Managed care corporations and an increase in illness among the general population.
B. Consumer-capitalist driven American health care system.
C. Physician willingness to prescribe anti-depressants for shyness.
D. An ill-defined desire for improved quality of life.
E. All of the above.
F. B and D.
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