Prometric

Safety & Ethics

 Ethics
1. Autonomy → the right of self-government / patient right to take decisions
about life and bodies.
2. Patient with meningitis, need admission and he want to leave hospital
without sign against medical advice → report to health authority.
3. Rich patient like your manner and your character and want to be your
friend what should you do:
• this can be a start for new friendship
• your relation with the patient should be confined to your work
and ethically relation??
• you could use this to gain some privilege
• no relationship is allowed.
4. Your collage attends to publish research with fake results → ask him not
to do?
5. Patient ask you to add drug in his prescription for his relative → refuse
with odd
6. mother of a patient, she refuses that her child will be checked by trainees
and she asked for the consultant, what should you tell her→ these trainees are
under direct supervision of the consultant
7. an aggressive consultant that writes wrong doses → tell the head of
department
8. a good consultant that writes wrong doses,→ inform about the guidelines,
after that, he became aggressive→ tell head of department

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 9. you notice change in consultant behavior → tell head of department
10. a doctor that works in governmental hospital, and works in a private
hospital that Effects on his work in governmental hospital, what should you
tell him → he must abide the rules and laws of ministry of health
11. Your relative asked to do some lab investigation for him → seek
permission from administration
12. a patient was in RTA and was admitted to a private hospital on a
ventilator and his relatives have no money → transfer to another hospital
13. barber return from vacation with virus c what to do → inform authority
14. A doctor is going to present in conference. Company that produced new
drug suggested to sponsor his trip. What to do→ Reject the offer.
15. Patient gave you a gift and you refused. Next day she attempted suicide
as she felt rejected. What you should do in this situation: → Explain for patient
that it's unethical to accept gift then refuse
16. pt. diagnosed recently with osteosarcoma; u want to start chemo but she
insists to speak to other doctor for other opinion→ transfer her to another
specialist.
17. Pt with hx of hernia, he came now complaining of pain and he want to
make a complaint against u because u don't want to do the surgery, what
should u do?
• do the surg
• call the security
• referral to another surgeon

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 18. Patient got spine TB and treated accordingly, got liver failure from the
treatment and admitted to ICU. Son is angry and want to suit the doctor. What
is your response?
A. Tell him that can happen to anybody.
B. Help him to suit the doctor.
C. Calm him and tell him the case will be investigated.
19. Pt threatened u for complaining if you don’t do the surgery
A. consult physician
B. call social worker
C. do it
D. ethical committee
The answer is: Refer the patient or B
20. consented patient on research should know → all details, aim of the study
and complication
21. Female refuse to consent for surgery the pt refuse to do, what will you
do?
A. referral
B. take permission from husband
C. call hospital admin
D. force pt. to do it
Answer: respect her wish or C by exclusion
22. 90 yrs. male with severe symptoms of respiratory symptoms anesthesia
doctor suggest delay for stabilization, surgeon decide to a surgery is
mandatory to save his life→ explain to the patient and signed high risk
consent

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 23. Scenario of an elderly with an advanced cancer. Anesthetist thinks
operation not advised but surgeon wants to operate. What should you do?
A. Take a high-risk consent,
B. The surgeon should operate with another anesthetist,
C. Inform hospital ethics committee,
D. Refer patient to another facility.
24. 85 years old has terminal lung cancer, he can’t breathe, he can’t make
decisions very well, the doctor wants to do debulking of cancer to help him
breathing well, and the success of this operation will improve his live, but the
dr also knows that can develop the complication of the operation and the
anesthesia. What the dr should do?
A. go ahead surgery
B. informed consent patient
C. search alternative decision maker consent
25. 15 years old for surgery from where you get consent→ parents
26. what is central ethical issue in research: → consent..
27. doctor want to measure bp of female pt. The pt extended her arm and the
physician took her bp→ Extending her arm considered to be agreement and
consent.
28. A study conducted to evaluate medication among depressed pts. they
were not taking their medications regularly: →
A. unacceptable study because it affects drug efficacy.
B. acceptable because the pt signed the consent voluntary.
C. unacceptable because we cannot take consent from
depressed pts.

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 29. pt. was in RTA, he had fractured leg, needs foot amputation, after u
explained the risks & benefits of the procedure. He agreed as he hears voices
telling him to do it. what to do:
A. find another decision maker as pt is not competent.
B. proceed to the life-saving surgery (emergency intervention)
C. involve another surgeon to confirm the importance of the
surgery
30. 65 years with vertebral lesion, biopsy report is MM. He is known to be
noncompliance. How would you make him now a compliance?
A. Tell him about the serious sign and symptoms
B. Show him how brilliant of a doctor you are.
C. Talk to him slowly step by step to make him understand
you
31. Pt. with severe heart disease with very poor prognosis he asked u not to
tell his wife because she will not tolerate, then his wife came to u asking about
his condition→ You should accept his wishes and not to tell his wife
32. elderly patient metastatic cancer his son asks you to not tell his father
about the diagnosis→ Tell he patient
33. HIV newly diagnosed ask not to tell his wife. What will you do:
A. Tell his wife mother and ask her to tell her daughter
B. Tell his wife
C. Protect the patient confidentiality
D. Reassure him and offer your assistance to till his wife
34. Patient came for surgery, after finishing it was discovered that the
surgeon assistant forgot infected sponge (or something like that) inside the
patient. The patient was taken urgently back to OR to be reported and to take

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 out the infected sponge. Your action should be→ Inform the patient and
apologies
35. patient doesn’t want to know the details, you are the surgeon
appreciated that, but the anesthesia doctor insists → Tell him the decision of
the anesthesia doctor
36. patient underwent surgery, during which surgeon faced with difficulty in
control bleeding...... it ends without complications. Next day the patient asks
why it takes this long time. What surgery should replay?
A. don’t tell him what happens
B. Tell him and reassure him that is no complication
C. tell Hospital ethics
37. Scenario, during surgery you injured CBD and the pt is ok what to do →
informs the Ptn
38. while you came to the clinic late the Ptn is angry → explain the reason of
being late.
39.
40. Resident was in operation room with the consultant and during the
operation the consultant did unnecessary intervention but the patient was
fine. What should the residents do?
A. Tell the patient
B. Tell the administration
C. Write what happened in surgery report
D. Consider nothing happened as the patient was fine
41. Mother brought her child to hospital. Surgeon discovered hernia and
decided to do surgery immediately. Mother refused. What to do?

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 A. Do surgery whatever mother decision (if emergency
case)
B. Inform hospital police!!!
C. Don't do surgery!!!
D. explain to the mother
42. you plan for emergency surgery but patient family refused and they want
to wait till spiritual person will come tomorrow →proceed with the surgery
and contact hospital and health authority
43. Medical representative asked from the doctor to prescribe a specific drug
for having a fully funded trip to attend a medical committee → Conflict of
interest
44. Pt in your clinic, forget everything you told him and asked you again the
same questions, what to do →Answer all questions again in a simple and
easy way
45. when not to tell patient about his condition
➔ if there is compelling evidence that disclosure will cause real harm
for example make a depressed patient attempt to suicide
➔ patient himself declares an informed preference for not being told
the truth.
46. conscious patient refusing operation but relatives accepting, what to do
→ patient must sign by himself
47. Patient with lung cancer and you want to start the chemotherapy but
relatives asked you not to tell him about his condition, what to do → Take
them to the patient and ask him to what extent he want to know about his
condition

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 48. drug company will give a consultant a big amount of money to write a
specific drug, what to do →Refuse it
49. 75 yrs old Pt with incurable cancer, his sons didn’t want you to tell him
not to broke his heart, what to do → Tell him according to the spike rules
50. Pt referred from another hospital with a specific diagnosis and in your
hospital, you found a completely different diagnosis, what to do→
A. tell the patient
B. don’t tell
C. investigate and after that call the doctor
51. 18 y male in the ER post RTA, need urgent exploration, his father is coming
to the hospital, and some relatives are present, how to take consent→ Doctor
sign for emergency
52. Recent invention of 4 points regulation for patient autonomy
A. Taking patient consent
B. Do not harm patient
53. girl cutting her wrist due to suicidal
A. Treat her & refer to psychiatrist
B. Refer her to another doctor
54. the best in practice → Follow protocol and guidelines

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 Patient Safety
1. someone who is corporation with Saudi authority for quality is??
• surgery supervisor
• radiation supervisor
• quality supervisor

2. which department deal with risky places ??

• risk manger
• quality
• patient safety
3. Your hospital has many issues about safety, infection …. and the task has
been assigned to you to manage these problems, your 1st priority will be → ??
• High risk problems?
• Safety problems
• Treatment problem
• System analysis
4. Patient safety protocol adopts instructions of →??
• WHO
• MOH

Patient Safety Center (SPSC) follow WHO

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 5. A patient was taken to the room after the operation, she underwent
epidural anesthesia to relieve pain, she was suffering from severe headache
and the nurse gave her opium, the patient went into a coma and is now on a
ventilator → miss recovery from nursing
6. In the ER a nurse gave a wrong medication to a patient after verbal order
from the doctor, how to avoid → Double check the drug
7. patient take methotrexate once daily instead of once weakly how to
prevent this double check with the pharmacist
8. how to avoid error during blood sampling → double identifiers
9. old patient had THA and you kept her in hospital for one week for follow
up, on 6th day you found soft tissue loss in her back and thigh area(sores),
what could be done to prevent this → daily check for the whole body
10. patient on wheelchair at his home, (long scenario) he falls down during
moving, what's the cause → patient locked the brakes while he was moving
11. a nurse had needle prick from a patient, she refuses doing lab tests and
said that the patient has no infectious diseases, what should you do→ lab. tests
for the patient
12. a patient was admitted to hospital for ?? cardiac problem and became
stable and well, then suddenly collapsed, it was found that she was given
insulin instead of clexane, what should you do → incident report of fatal
mistake
13. one of the relatives was visiting a patient and fall down as the floor was
wet, what action will you do→ make an incident report
14. During the night shift and in the handover, the dose of Abs wasn't
appropriately documented and missed, what to do?
• Incidence report
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 • Punish them
• Inform health authority
15. good consultant that doesn`t follow infection control principles, an
infection outbreak has occurred in his department, what should be done →
increase health educational program (send him to infection control course)
16. patient going to do cardiac cath. And the consultant isn`t available, one
of his trainees is going to do the operation, what should be told to the patient→
about competence of doing operation
17. a doctor was trying to write cipro for a patient and the system refused, the
pharmacist came to the doctor and told him that the system informed that the
patient has allergy to that medication. This's an example of what→ human
factors engineering (it is the interface between different components, e.g.,
human-machine interface, human-environment interface, human-human
interface, and human software interface.)
18. you ask the nurse to give a medication to a patient (ranitidine i think) she
gave him insulin. The patient lost his consciousness but you were able to save
his. What should you do→ tell all the hospitals that you have look alike sound
alike (LA/SA) medication
19. taking wrong medication by patient due to → similarity in shape
20. how to avoid drug intake problems→ document name, dose and rout of
administration
21. Doctor told the nurse to give the patient a medicine that is intravenously
but the nurse by mistake gave the patient lidocaine because it was beside the
wanted drug and the patient died. What is this case?

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 A.the same medicine
B. mistake in prescription and administer
C. disconnection between doctor and nurse
D. unlike medicine

22. Doctor who is leader for a team is doing CPR for a patient. The doctor's
role in providing protection for the patient is:
A.Put another nurse instead of him
B. Put a resident instead of him
C. Providing more practice for the team
D. Make communication more between the team
23. A nurse gave a Pt 10 times fluid prescribed for him (error), when you
should inform the Pt → Immediately
24. Someone from Pharmacy Company came to your clinic and explain to you
about their new drug and it is already used in another countries→ the
eligibility of any new drug should be licensed from the institution
25. Surgeon forget after appendectomy a gauze and foreign body showed in
image, how to avoid → check number before incision and before wound
closure, what should a surgeon do after → tell the patient
26. Surgeon is doing OP for patients with Hepatitis C and suddenly he was
injured by an injection. What is the percentage of getting infection?
• 30%
• 3%
• 0.3%
• 0.03%

HBV 30%, HCV 3%, HIV 0.3%

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 27. A physician picked up a car accident victim from the street and brought
him to the ER by his car. He did not want to wait for an ambulance because
the patient’s condition was critical. Physical examination in the ER reveals
quadriplegia. Is the physician liable for this consequence→ yes, because the
physician did not protect the neck of the patient resulting in quadriplegia?
28. Seizure pt. taking drug decreases attention, and he is a bus driver… your
action → tell not to drive, if he did not → tell his supervisor
29. Muslim patient came seeking medical advice, according to scholars
(Ulama) according to Islamic jurisprudence ‫الفقه‬, which statement is true→
Shariah law
‫ل ضرارا‬
‫ل ضرر و ا‬
‫معنى اإلجابة ا‬
30. Major accident with many injured persons, patient transmitted to
operation room, surgeons worry about HIV outbreak from patient wound →

non handed technique in instrument handling in OR

31. patient moves in a wheelchair without a companion inside the hospital,
how to prevent this → policy inside hospital
32. one of the following is a medical error:
• mistaken diagnosis or prescription
• negligence
• Management plan not completed as intended
33. Indian patient with difficulty to communicate and surgeons did an effort
to explain the plan of treatment then a written consent taken, what right not
satisfied?
• Valid consent?
• Availability of interpreter

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 • Explanation of a plan
• Autonomy
34. patient very low socioeconomic want to sell his organ as donation, what
to do → Refuse it
35. CBAHI’s Mission→ Establishing health quality standards
36. CBAHI adopted to instructions of → ISQUA > WHO > ministry of health
37.You are implemented in CBAHI in your hospital but your friends have
some reservation on you, what to do → Try to talk to your colleagues about
the importance of CBAHI
38. Before undergoing in renal transplant procedure, the surgeon knew that
the patient paid to the donor, what to do → cancel the procedure
39. A pharmacist in a hospital with most cases of (DM, asthma) and he made
a contract for a chemotherapy , what rule did he broke → Utility
40. Hand washing → Before and after contacting with the patient
41. Physicians who don’t follow hand washing and caused spread of infection
in the ICU, what to do → Send him to training program about hand washing
42. what is the distance from x-ray source required to decrease the radiation
exposure by 100%?
a) 6 feet
b) 4 feet
c) 2 feet
d) 8 feet
43. Your colleague took lidocaine syringe instead of another drug as they are
very similar and injected a patient and he developed arrhythmias and
died. How to be avoided ?
• Ask him to reconfirm the drug before use
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 • Put label on the syringe
• Change the shape of the syringe
44. Sequence of wearing (donning) PPE → Gown , mask , Google , gloves
45. Sequence of removal (doffing) of PPE → Gloves, goggle, gown , mask
46. Time for hand washing?
• 20 – 30 Alcohol
• 40 – 60 Soap
47. Following industrial injury, the best indicator for patient early return to
work is → Job satisfaction
48. You were informed by the infection control team that there is a klebsiella
outbreak in the hospital and there is an ICU patient with klebsiella
infection, how to know that they are the same source → Phenotyping

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 Statistics
1. Expedite review means → Research with minimal harm to the Pt
2. study conducted in Saudi Arabia about the association between gender,
age, Bp, smoking and risk for CVS disease. Parameters: Age (in years), gender
(male or female), Bp (numbers), smoking status (nonsmoker, Occasionally
smoker, Heavy smoker). What are 2 parameters to compare by chi square →
heart disease+ smoking (Chi-Square test is used when you are analysis
Qualitative categorical variable)
3. Case scenario about study to be conducted on population DM, HTN,
parameters are (Age, Heart disease, Smoking, Systolic BP) which of the
following can be used for t-test→ systolic blood pressure to smoking and
non-smoking group ( T-test is used in Numeric or Qualitative parameters
and it is looking for the mean)
4. a study compares smoker and non-smoker Blood pressure. what test
should be used to know significance → T – test.
5. A study was conducted to determine if there was a difference in the
prevalence of diabetes mellitus among health care workers in Riyadh. The
results showed that 30 out of 100 doctors were diabetic as compared to 50 out
of 200 nurses. Remember: (doctors Nurses) (Diabetic- non diabetic)
Which is the most appropriate statistical test?
• t-test
• ANOVA
• Chi-square.

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 • Correlation
6. what is the type of study, 2groups were followed after exposure to risk
factor→ Cohort
7. resident noticed consults doing knee aspiration with incomplete aseptic
conditions need to do study for safety of such patients what type of study??
• Retrospective
• prospective
• follow up study
• cohort is the preferred answer if present?
8. 30-500 babies who were exposed to diethylstilbestrol in utero were
followed up for 20 years and the occurrence of cancer in this group was
compared with that of 1500 babies not exposed to DES, over the same period
of time. What is the study design?
• Cohort
• Case control
• Cross sectional
• Correlation study
9. When you testing population with risk factor for cancer.
• Prospective cohort
• Case-control study
• RCT
• cross sectional.
10. what is the study for rare disease that can be prospective or
retrospective?
• Prevalence study

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 • Cohort
• Case-control
11. prospective study for Tendon Achilles rupture. 16 patients in every group.
Randomized disruption of patient between tow treatment & blinded
observers. First group received primary repair of rupture with suture & the
other group just end to end repair without suturing. Both group received the
same protocol postoperatively. The investigator was looking for re-rupture
rate, which was not significant. What is the type of this study & what is the
level of evidence?
• Prognostic study, level 1.
• Therapeutic study, level 1.
• Therapeutic study, level 2.
• Therapeutic study, level 3.
12. when u increase the population size the width of confidence interval will→
Decrease.
13. Study conducted on obese patient for the risk of angina P< 0.04→ This
means that angina will be more in obese patients
14. question about investigator want to see the association between the pt
gender and mortality. The null hypothesis:
• female mortality # male mortality (no relation)
• female mortality =male mortality .
• an association between mortality
15. question about age of participants: 12,29,29,31,47,64,64,74 , Which of the
following is central tendency to have more than one value.:
• a-mode

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 • b-range
• c-median.
• d-variance.
16. One question about categories and another one about histogram.

17. 13- research of 80 people (sample) result came 35% prevalence of

something 95% CI between 25-45. If increase sample size what will be the CI:
• a-decreased
• b-increased
• c-same
• d-reach up to 50%.
18. different numbers (47,85,84,73,63,46,63)
Most frequent value represents→ mode. Mean = (78+87+97+96+79) / 5 =
Median = 78, 79, 87, 96, 97
19. which is the mode of 78,87,97,96,79 → NON Mode = most frequent number =
non
Range = 97 -78 =

20. what is the mode of distribution of 21, 12,

13,13,13,14,14,14, 24
• bimodal distribution

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 • multimodal distribution
• unimodal distribution
21. a new drug for disease prevents death but not cause recovery from disease
→ This will increase prevalence.
22. what dose p value mean → The probability of getting the results you did
(or more extreme results) given that the null hypothesis is true.
23. groups, one on placebo and other on analgesia, p value = 0.002. What
dose it mean?
• Effective drug
• Has evidence
The ideal answer is: there is STRONG evidence that the medication is
effective. Remember this study result tells that the medication can be
statistically significant but still not clinically significant.
24. randomized prospective study of the efficacy of a new diagnostic test to
detect deep venous thrombosis has just been completed. Each patient had
venography as the definitive test to detect the thrombosis. Of 100 patients
tested, 10 were true positive, 30 were false negative, 40 were true negative and
20 were false positive. What is the sensitivity of the test?
• 25%
• 50%
• 59%

25. table 2x2 want you to calculate (epidemiological measures of

association). Measure relative risk

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 26. Calculate epidemiological measure of
association → 0.67
27.which part of article involve the
design of study & analytic measure:
a) result
b) discussion
c) abstract
28. What determines the prevalence of a disease→ predictive value

‫حاجةااذااحصلتاتعملامشكلةا كبيرةابسااتلحقتاواالمرةاالجايةااذااحصلتاتعملامشكلةااكب ار‬

risk •
prevelance •
ignorance •

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 Notes
Translation done by

• certified employee
• commertial telephone service
• volunteer translator
• Family member or friend should not involved in translation

Operative consent:

• elective surgery 7 days before in doctor office ( payment issues)

• no conscent needed in limb threating injury even the patient is refuse , but
documentation is needed because of irrepairable harm
• friend request only if his presnce in trama field , no family member and not
concious patient

Checklist assessment:

• before induction of anaesthesia

• before skin incision
• before leaving operation room

Religion and implant:

• bovine graft not used with hindostan

• procaine implant not used with muslims and jewish

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 it is illegal to altered medical record, but addendum could be
made in case of error in documentation

Type of study

• Cohort: patients with similar characteristics or exposure studied over time;

either prospective or retrospective
• Cross-sectional study design: population is studied at a specific tim and all
measurements are made with no follow -up. These studies help describe
prevalence of a disease at one specific instance in time.
• Cross over study: use of 2 or more therapies one after another randomly to
wash out period bias

Data:

✓ variance: variability of individual data from the mean

✓ Mode: most frequent occurring data
✓ confidence interval: if experiment repeated C interval give set of values
in which true value located
✓ relative risk = incidence in study /controlled group
✓ pre-protocol: exclude patients not stike to guidelines
✓ intent to treat: include patient not stike to guidlines

Tests:

✓ Student t-test: parametric date (age - wt)

✓ Fisher man test for small sample size
✓ Man -whitent test : non parametric data and categorical comparison
✓ Chi-square test: 2or more categorical data

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 ✓ Bonferroni: correction to P value when multiple tests over single
data
✓ ANOVA analysis mean

power of study:

✓ It is the probability of study to detect true effect of tested

intervention
✓ alpha error: rejected true null hyopsis when it should be accepted
✓ beta error accepts null hyposis when it should be rejected
✓ when null hyposis is correct power = 1 - beta error
✓ P- value significant if < 0.05 A statistical test is associated with a P
value of 0.04. What is the interpretation of this value → There is
4% chance of being wrong when the test is described as
“statistically significant?”

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Level of evidence

❖ Level 1: randomized controlled studies; systematic review of level 1

❖ Level 2: prospective cohort study; poorly randomized controlled (have less
than 80% follow -up)
❖ Level 3: case-control; retrospective cohort study; systematic review L3
❖ Level 4: case series; case-control studies with poor reference standard
❖ Level 5: expert opinion

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