Criteria for involuntary hospitalization of a suicidal patient include all of the following, except:
Correct Answer B:
At times, involuntary hospitalization becomes necessary. If at all possible, voluntary hospitalization is always better. However, often the reasoning ability of a mentally ill person in crisis is impaired, and it is not always possible to convince him of the need for inpatient treatment.
Consequently, a person may be seriously ill, but if he refuses treatment, he cannot be committed to a hospital against his will unless he meets all of the following criteria:
He/she must have a mental illness, his/her behavior and actions must be driven by or be a consequence of this mental illness, because of his/her behavior, there must be a reasonable expectation that serious physical harm to self or others will occur in the near future.
Also one of the following three conditions must be present:
There is an imminent threat that the person will harm himself or herself, there is an imminent threat that the person will cause serious physical harm to someone else, or the person is not able to provide for his or her basic physical needs so as to guard against serious harm.
A 34-year-old white male is brought to the emergency department following an automobile accident in which he was the only occupant of the vehicle. He lost control of the vehicle and hit a utility pole. He was knocked unconscious initially, but he is now awake and combative. You note a strong smell of alcohol. He has a frontal hematoma approximately 3 cm in diameter and an actively bleeding 4-cm laceration of the occiput. He will not permit you to examine him further and he prepares to leave the emergency department.
You should:
Correct Answer A:
Two of the most important ethical principles in medicine are respect for autonomy and beneficence. Respect for autonomy means regarding patients as rightfully self-governing in matters of choice and action. To make an autonomous decision, the patient must be mentally sound, have knowledge and understanding of the facts, and be free of coercion. Beneficence means that physicians are motivated solely by what is good for the patient. There are often ethical conflicts between these two principles. This particular patient is clearly in need of further emergency treatment, but he refuses. He has had a significant head injury, is combative and possibly intoxicated, and therefore cannot be considered mentally sound. The physician should detain him for his own good and provide the appropriate care. Threatening the patient, having him sign out against medical advice, or encouraging him to return later is not appropriate because his mentation is impaired.
Which one of the following statements about genital human papillomavirus (HPV) infection is true?
Correct Answer D:
In the late 1980s human papillomavirus (HPV) was linked to cervical cancer and clinicians were advised to aggressively treat all patients with suspected HPV disease, including those with genital warts. More recent data indicate clearly that cervical cancer and genital warts result from different HPV types and do not appear to be linked. Specifically, external genital warts usually contain HPV types 6 or 11, and cervical cancer is associated with HPV types 16, 18, 31, 33, and others. In the 1970s, it was demonstrated that a single sexual contact with a person infected with external genital warts carries about a 60% chance of transmission. A history of multiple partners is the most important risk factor for acquiring HPV infection. Because it is not possible to culture papillomavirus in cells, alternative methods are used to detect genital HPV expression: inspection with the unaided eye or with hand-held lens magnification, colposcopy, cytologic smears or biopsies, and viral DNA detection methods.
You approach the administrator of your small-town hospital about the possibility of starting a cardiac rehabilitation program.
Which one of the following is true concerning such programs?
Cardiac rehabilitation programs are safe and effective. Rates of coronary events in rehabilitation setting are very low. Cardiac rehabilitation consistently improves exercise capacity and has favorable effects on coronary risk factors, even without nutritional counseling. A baseline exercise stress test prior to starting cardiac rehabilitation is necessary to screen for exertional ischemia or arrhythmias, and serves as a basis for prescribing an exercise regimen. The exercise prescription is individualized based on results of the exercise stress test, the age of the patient, and the patient’s clinical status.
What is the prevalence of microscopic carcinoma of the prostate among 80-year-old males examined in autopsy studies?
Correct Answer E:
An astonishingly high prevalence of microscopic foci of well-differentiated adenocarcinoma has been found at autopsy in serial sections of prostate glands considered to be normal from men over the age of 50. The incidence of such tumors nearly doubles with each decade of age, starting at 10% for men in their 50s and rising to 70% for men in their 80s.
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