A PGY-2 resident has worked 75 hours in the current week. The resident began his call shift yesterday at 06:00. The resident had 2 days completely off work in the previous two weeks. During the call day, the resident admits a pediatric patient with a rare brain tumor.
The next day, the resident hands off call responsibilities to another resident. However, he then stays to assist with a rare pediatric brain tumor resection until noon. Which ACGME duty hour rule applies?
A. Adequate rest between duty periods
B. Minimum days off
C. Maximum duty period length
D. In house call limitation
E. 80 hour work week
C. Maximum duty period length
The ACGME limits continuous duty hours not to exceed 24 hours, with an allowable extension for continuity of patient care. Justifications for extensions include continuity of care for a severely Ill or unstable patient, Academic Importance of the events transpiring, or humanistic attention to the needs of a patient or family.
- A Type 2 error (false negative) in interpreting clinical trials occurs when:
A. Inadequate informed consent was obtained in over half the cases.
B. A treatment is found to be ineffective but the sample size is too small.
C. A positive result relies on an incorrect statistical test
D. The test is not randomized or controlled.
E. Gender makeup of the experimental and control populations are not equal.
B. A treatment is found to be ineffective but the sample size is too small.
- A medical device company is sponsoring a presentation regarding a new implant they have developed for treatment of spinal instability. The presentation is followed by a modest meal at a local restaurant. At the conclusion of the meal, the company representative passes out gifts to the attending physicians, as a “thank you” for taking time out of their personal lives to attend a work meeting. Which of the following gifts would be acceptable under the AMA code of ethics and Advamed guidelines?
A. Tickets to professional basketball game the following week
B. Textbook of spinal anatomy with company logo Imprinted on cover
C. $100 gift certificate to restaurant
D. Golf shirt with company logo displayed on sleeve
B. Textbook of spinal anatomy with company logo Imprinted on cover
Any gifts accepted by physicians should primarily be directed towards allowing the physician to provide better care to patients. Accordingly, textbooks, modest meals, and other gifts are allowed if they primarily are geared towards the provision of education Cash payments and gifts unrelated to the physicians work are not allowed
- A physician chooses to utilize a questionnaire-based outcome measure in his/her practice The questionnaire is administered to a core group of patients and then readministered to the same patients within a few days. The purpose of this exercise is to confirm that the replies to the same questions by the same patients do not change after a few days. A statistical analysts is completed to assess the degree of similarity between the first and second replies In this setting. This type of analysis for an outcome measure is a reflection of its:
A. Responsiveness
B. Integrity
C. Reliability
D. Sensitivity
E. Validity
C. Reliability
- An appropriate way for a neurosurgeon working in a complex team environment to mitigate stress and fatigue would be to:
A. Not acknowledge stress and fatigue, therefore reducing its effect on performance.
B Recognize stress and fatigue, thereby increasing the use of threat and error management strategies.
C. Rely on previous experience of chronic stress and fatigue during residency training to overcome these factors
D. Deny the existence of stress and fatigue in order to avoid distraction from the task at hand.
B Recognize stress and fatigue, thereby increasing the use of threat and error management strategies.
- Certain medical conditions are subject to mandatory physician reporting. You evaluate a recent immigrant from Mexico complaining of occasional back pain. He has not been previously evaluated by a physician in the United states. Which of the following diagnoses are required by law to report, if the patient reveals it to you as
part of their medical history?
A.inactive TB
B. Assault
C. Polio
D. Cysticercosis
E. AIDS
E. AIDS
- Company X offers surgeons $100 for each time they implant their patented deviced. Which federal statue has been violated?
A. EMTALA
B. Anti-Kickback
C. Stark
D. HIPAA
E. This is not a violation
B. Anti-Kickback
- Dr. Carter is investing with a group of surgeons who want to open an ambulatory surgery center (ASC). In order for this investment to pass Anti-Kickback statutes, what should Dr. Carter’s admitting status be at the proposed ASC?
A. Nonadmitting
B. Consult only
C. Active status
D. Emeritus
C. Active status
In order for Dr. Carter to fall within a safe-harbor of the federal anti-kickback law, he must be an active member of the staff and operate at the proposed ASC. Non-surgeon Investors are not allowed to participate in ASC because of the potential for such physicians to refer to surgeons who use facilities that those non-surgeons own.
- Dr. Jones designed a new instrument, obtained a patent, and sold the device to Company X. Dr. Jones then became an employee of Company X and draws a fair market value annual salary for marketing the instrument. Under what conditions can Dr. Jones give a presentation about this Instrument at a CNS or MNS sanctioned meeting?
A. In a break-out session
B. Only if he is rot the first author
C. in poster form only
D. with disclosures on the first slide
E. Dr.Jones cannot give the presentation
D. with disclosures on the first slide
- Dr. Jones is presenting a paper she co-authored at a CNS/AANS CME sanctioned meeting. She has disclosed a conflict of interest (COl) w1th Company Z prior to the meeting. Her presentation will include information about products made by Company Z. In order for the paper to be presented, Dr. Jones must:
A. Limit her comments to research data and results.
B. Disclose COI without limiting comments.
C. Eliminate her COI with Company Z within one month prior to the meeting.
D. Have the paper presented by a co-author without COL
A. Limit her comments to research data and results.
Dr. Jones may still speak at this meeting provided her comments are limited to the data and results of her research. Even if another co-author were to present the same data, because Dr. Jones was a co-author. The disclosures and limitations would transfer to the co-author. COI is retrospective 12 months, thus eliminating COl one month prior to the meeting would be insufficient.
- During performance of a lumbar discectomy, there is a delay in radiology availability. The spinal surgeon elects to proceed with laminotomy and disc space exploration but finds no herniated disc material. A subsequent intra-operative radiograph demonstrates that the neurosurgeon is operating at the wrong level. The spinal surgeon adjusts the level of approach and successfully completes the procedure. In this circumstance, of the following. the neurosurgeon should:
A. Consult risk management committee and ask them to disclose the error
B. Disclose the error to a quality assurance committee, but not to the patient
C. Request that the patient advocate disclosure the error to the patient
D. Not disclosure the error because the patient was not harmed
E. Disclose the error to the patient in a timely fashion
E. Disclose the error to the patient in a timely fashion
- Federal health care insurance agencies including Medicaid and Medicare have established spesific standards for medical coding, biling , and reimbursement. Under these systems, primary responsibility for accurate coding and biling rests with :
A. The surgical practice manager
B. The surgical coding specialist
C. The hospital biling departement
D. The operative surgeon
E. The hospital compliance officer
D. The operative surgeon
- In order to provide useful, high quality medical evidence, a clinical study should employ an outcome measure that has the following characteristics :
A. published, peer review, and objective
B. Subjective, straightforward, and simple to employ
C. Reproducible, nonbiased, and comprehensive
D. Parametric, nonbiased, and comprehensive
E. Reliable, valid, and responsive
E. Reliable, valid, and responsive
- Steep gradients In authority can negatively impact patient safety when:
A. Fear or litigation results in physician migration out or a community.
B. Surgical instruments are incorrectly counted at the beginning of a case.
c. An incomplete medical record results in a missed drug allergy.
D. Overcrowded operating rooms create delays in scheduling.
E. A nurse who is unable to reach a resident and does not call an attending
E. A nurse who is unable to reach a resident and does not call an attending
- The agencies for Healthcare Research and Quality (AHRQ) is charged in part with promoting evidence-based medical practice. AHRO reports recommend standards, Guidelines and Options for practice that are based on a scale of evidence class (or quality) from the peer-reviewed, clinical literature. In the case of a retrospective. Case-controlled study of craniotomy plus whole brain radiation therapy versus stereotactic radiosurgery plus whole brain radiation therapy for solitary lung cancer brain metastasis. The evidence class is:
A. Not classifiable
B. Class III
C. Class I
D. Class II
D. Class II
- The Joint Commission on the Accreditation of Health Care Organizations (JCAHO) has issued a set of National Patient Safety Goals to be implemented by all hospitals and hospital-based practitioners by January 1st, 2005. One of JCAHO’s 2005 national patient safety goals is:
A. Include the use of the patient room number as a patient identifier whenever administering medications or performing procedures.
B.Standardize a list of abbreviations, acronyms and symbols that are not to be used throughout the organizatlon
C. Assure that the full range of manufactured drug concentrations and Intravenous solutions are readily available within the hospital.
D. Implement a process to mark the surgical site involving nursesiO.R. technicians.
E. For verbal telephone orders, verify the order by having the person receiving the order read-back the key portions.
B.Standardize a list of abbreviations, acronyms and symbols that are not to be used throughout the organizatlon
- The class of evidence associated with a controlled study of severe closed head injury demonstrating reduced brain parenchymal loss and enhanced residual motor function in rodents treated with hypertonic saline versus mannitol after injury is:
A. Class I
B. Class II
c. Class Ill
d. not classifiable
d. not classifiable
- What is the ACGME definition of systems-based practice?
A. Make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment.
B. Demonstrate an investigatory and anal~ic thinking approach to clinical situations.
C. Know and apply the basic and clinically supportive sciences which are appropriate to their discipline.
D. Partner with health care managers and providers to assess, coordinate. and improve health care.
E. Demonstrate sensitivity and responsiveness to patients’ culture, age, gender, and disabilities.
D. Partner with health care managers and providers to assess, coordinate. and improve health care.
- When looking at the total cost of medical malpractice in the U.S., what fraction of the total money involved (including legal expenditures, settlements, and judgemenets) ends up going to the plaintiff (patient)?
A. 1/5
B. 3/4
C. 112
D. 1/3
D. 1/3
One criticism of the medical malpractice system in the U.S. is that it is very inefficient. While only 2% of patients that are injured by a physician ever file a claim, only 17% of those who do file a claim appear to have suffered from real physician negligence. All of this makes for a system that has high transaction costs and has the majority (~62%) of the money going toward the payment of attorneys with only ~38% going to plaintiffs.
- Which of the following activities must be submitted to institutional review board (IRS) for supervision?
A. You investigate the relationship between socioeconomics and post-concussion syndrome by reviewing hospital records to correlate return visits with residential Zip Code.
B. In response co an elevated CSF shunt infection race. the hospital infection control service prospectively observes 20 shunt operations and discover that holes in gloves correlate with infection Double gloving is adopted
C. A school-age child suffers a gun shot wound to the brachial plexus and subsequently develops a neuropathic pain syndrome. You prescribe an off label use of gabapentin.
D. An 11 year old harbors an incidentally discovered internal carotid aneurysm. You treat this lesion with endovascular placement of coils approved by the FDA for use in patients 18 years old and older.
E. All neurosurgeon at your institution shave the scalp for cranial surgery. In response to an article about shaveless neurosurgery, you adopt this practice.
A. You investigate the relationship between socioeconomics and post-concussion syndrome by reviewing hospital records to correlate return visits with residential Zip Code.
