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A 38-year-old female with a grade IIIB open tibia fracture is scheduled to undergo definitive fixation and subsequent flap coverage with the orthopaedic and plastic surgery teams. She is met in the pre-operative area by the surgical intern and paperwork is completed per institutional protocol. She is then brought back to the operating room. Which of the following is true regarding the pre-surgical timeout?
The surgical intern must be present because he brought the patient to the operating room
The timeout cannot begin without the implant representative
If both the orthopaedic and plastic surgical teams are present, a single timeout is sufficient for the entire procedure
The timeout may be completed as long as the attending is in an adjacent operating room
The pre-surgical timeout has not been shown to decrease complication rates
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A 25-year-old Spanish speaking male presents to the emergency department 6 hours after sustaining the injury seen in Figure A. He is grossly intoxicated and screaming in pain. Physical examination reveals a closed injury with overlying muscular compartments that are extremely firm to palpation. After sedating the patient, measurements of the intracompartmental pressures were all found to be >75mmHg. His wife is Spanish speaking and expected to arrive to the hospital in 2-3 hours with a relative to help with translation. No medical translator is available. You attempt to outline the risk and benefits of surgery to the patient, but the he repeatedly interrupts you and yells out ,"No surgery!". An English-Spanish speaking friend is with the patient and says that he has known the patient for over 2 years and will help with any decision making. What would be the next most appropriate step in the management of this patient?
Delay surgery to monitor the patient for impending compartment syndrome
Proceed with surgery with urgent fasciotomy after documenting the necessity of treatment without consent
Delay the surgery until the wife arrives and able to give informed consent with the aid of a translator
Proceed with surgery for urgent fasciotomy after obtaining informed consent from the patients friend
Respect the patients autonomy and reassess the patient in the morning when he demonstrates capacity to accurately comprehend the proposed treatment
The origin of bovine derived grafts is particularly important to which of the following religious groups?
Which of the following statements is inaccurate in describing the origin and purpose of the Institutional Review Boards (IRB)?
Began with the Nuremberg Code of Medical Ethics, which was developed by the Nuremberg Military Tribunal after the investigation of Nazi physicians
Fetuses, pregnant women, and children are considered vulnerable populations but prisoners are not
Emphasizes dignity and autonomy, and encompasses informed consent (quid vide)
The process for obtaining informed consent for patients included in clinical trials is mandated by the Institutional Review Board (IRB).
Requires fair selection of subjects and equal distribution of the benefits and burdens of research
As part of the "time-out" protocol recommended by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), all of the following are required EXCEPT?
Identify correct patient identity
Identify correct side of procedure
Identify correct site of procedure
Identify correct preoperative antibiotic
Agreement on the correct procedure to be done
Which of the following determines when a patient involved in a Worker's Compensation claim is allowed to choose their treating physician?
Health insurance carrier policy
Employer human resources policy
Which of the following complaints is most often reported by patients receiving care from an orthopaedic surgeon?
Long waits for patient visits
Refusal to refill narcotic prescriptions
Lack of technical skills by provider
Lack of medical knowledge of provider
Lack of empathy by provider
Effective communication between physicians and patients has been shown to affect all of the following EXCEPT?
Patient adherence to treatment
Incidence of malpractice suits
Incidence of Stark II litigation
An orthopaedic surgeon wishes to initiate advertising in a local newspaper to increase awareness of the medical services he provides. Which of the following can be used without being at risk of being deemed unfair, false, misleading or deceptive and subject to heavy penalties by the Federal Trade Commission?
"Bloodless arthroscopic surgery"
"Board Certified in Joint Replacement Surgery"
"New carpal tunnel release with relatively little pain"
"Injections to Cure Your Arthritis"
"Patients can return to all sports activity following joint replacement surgery"
A 13-year-old girl with a displaced proximal tibia fracture is brought into the emergency department by her adult cousin. The fracture needs surgical management. The child is living with her cousin's family while her parents are in Germany. While the child speaks fluent English, her cousin and her parents are German-only speaking. How should you consent this patient?
No consent is needed given the urgent nature of the injury, proceed with surgery
Talk with the cousin, using the child as a translator
Talk with the cousin, using a German-translator
Call the parents in Germany, using the child as a translator over the phone
Call the parents in Germany, using a German-translator over the phone
The Emergency Medical Treatment and Active Labor Act (EMTALA) requires which of the following?
Insurance level must be discussed with the accepting facility
All appropriate laboratory workup must be completed
The patient must be medically stable for transfer
Exiting facility must not have resources to properly treat
Cost(s) of transportation must be within reason
An orthopedic surgeon meets with an attorney because a malpractice claim has been filed against him. Which of the following diagnoses is most likely to result in a malpractice claim?
Fracture of the radius
Herniated intervertebral disc
A 65-year-old man sustains the reverse obliquity intertrochanteric fracture as shown in Figure A. He undergoes fixation with a sliding hip screw construct and his 3 month postoperative radiograph is shown in Figure B. His treating surgeon states that the "standard of care was performed for his fracture pattern" and the patient asks you as a consulting surgeon for a second opinion. Each of the following statements regarding your legal and ethical obligations as the consulting surgeon providing a second opinion are true EXCEPT?
Second-opinion physicians have an ethical obligation to discuss the standard of care for reverse obliquity hip fractures
Second-opinion physicians have a legal obligation to become an expert witness for the patient/plaintiff in a negligence lawsuit against the treating physician
Many states have mandatory or voluntary medical-error reporting systems that the consulting surgeon is ethically mandated to utilize
Second-opinion physicians do not have a legal obligation to disclose errors made by other physicians
It is a fundamental ethical requirement that a physician should at all times deal honestly and openly with patients
All of the following are Standards of Professionalism relating to interactions with industry for practicing orthopaedic surgeons EXCEPT:
Decline gifts from industry with a market value over $100 (unless they are medical textbooks or patient educational materials)
Disclose to the patient any financial arrangements with industry that relates to the patient's treatment
Accept no direct financial inducements from industry for utilizing a particular implant
Disclose any relationship with industry to colleagues who may be influenced by your work
Decline to participate in industry sponsored non-CME courses or conferences
All of the following are true regarding a physician responding to a formal written complaint by a patient EXCEPT:
Complaint should be taken seriously
Written response by the physician is required
Physician mandated to retain an attorney to address the formal complaint
Patient should be supplied with contact information for the institution's patient representative department
Law mandates that the physician respond to the formal complaint
According to patients and colleagues surveyed, orthopaedic surgeons are given the highest ratings for their skills in which of the following areas?
It is considered optimal to obtain written informed consent for an elective surgical procedure in which of the following clinical settings?
By the hospital risk manager upon admission
By the nurse in pre-op holding
By the surgeon in pre-op holding
By the surgeon's scheduler greater than 7 days prior
By the surgeon in the office within 7 days prior
You have helped develop a new total knee prosthesis and receive royalties as a result. You have a patient who you believe would benefit from this new design. What is the most appropriate action?
implant the device but do not tell the patient your financial relationship
use a device that you feel is inferior to avoid a conflict of interest
disclose your financial relationship to the patient before performing surgery
do not bill the patient's insurance company for the surgery
refer the patient to another surgeon
A patient is consented for a right wrist open reduction and internal fixation. After the patient is prepped and draped, a skin incision is made. It is recognized intra-operatively, however, that a skin incision was made on the incorrect side (left). Subsequent right wrist open reduction and internal fixation goes uneventfully. What is the next best course of action?
do not tell the patient or family
contact the Risk Management department
immediately discuss the situation with the patient and family
alter the medical record
only discuss the situation with the patient if he or she brings it up.
A 25-year-old man sustains a Grade III-A open tibial shaft fracture secondary to a motorcycle accident. The patient is unconscious and has no family members who can be reached for consent. What is the most appropriate course of action?
Document the necessity for treatment and proceed immediately with definitive fracture care
Proceed with a preliminary irrigation and debridement in the emergency department, apply a splint, and wait for him to regain consciousness before proceeding with definitive treatment
Contact a hospital administrator for approval of care
Confirm and document the necessity of care with a colleague with similar expertise and knowledge prior to proceeding with surgery
Proceed immediately to the operating room for definitive treatment without further documentation
When a Workers' Compensation patient recovers after an injury to a point that further restoration of function is no longer anticipated, he or she is said to have reached which of the following?
Maximum medical improvement
A player on a professional football team sustains a knee injury and is diagnosed with an anterior cruciate ligament rupture. When employed as the team physician, your ethical obligation is to inform
the player but not the team.
the team but not the player.
neither the team nor the player.
both the team and the player.
the team, the player, and the media
A 21-year-old collegiate scholarship football player has an episode of transient quadriplegia. An MRI scan of the cervical spine reveals cord edema and severe congenital spinal stenosis. The athlete has aspirations of playing on a professional level and demands that he be allowed to play. The team physician should give what recommendation to the college?
Do not allow the athlete to return to football.
Allow the athlete to participate.
Allow the athlete to play only if he signs a waiver.
Suggest that the college and atahlete enter binding arbitration.
Allow the athlete to play with special equipment.
There is increasing concern about the ethical relationship of orthopaedists to the orthopaedic equipment industry. Which of the following describes the most appropriate relationship?
Industry-paid travel, hotel (for the surgeon and spouse), and registration at a university-sponsored CME course
Industry-paid travel and hotel for a faculty member at an industry-sponsored meeting that is not CME approved
Consultation agreement ($50,000/annum) between the surgeon and the company for evaluation of the implant system with required oral reporting of impressions
A restricted grant from a company to an orthopaedic residency program with the stipulation that the third year residents be sent to an industry-sponsored course
Industry-paid dinner at a premium restaurant ($200/person) for surgeon and office staff at which a new set of surgical instrumentation is presented
In which of the following scenarios should a physician be relieved of their duties?
After 24 hours of continuous work
A significant error in care is noted
The physician appears fatigued
Physician is recovering from an ankle fracture
Chemical impairment is suspected
An orthopaedic surgeon is a team physician for a college football team. In which of the following scenarios is it appropriate to discuss a 19-year-old collegiate football player's lumbar spondylosis without additional consent from the player?
Discussing with the player's mother
Discussing with the player's treating chiropractor
Discussing with the player's long-time highschool football coach
Discussing with a reporter from a local newspaper
Discussing with the player's fiancee
A busy orthopaedic surgeon enters the operating suite to a prepped and draped patient who is scheduled for a right knee ACL reconstruction. During the diagnostic arthroscopy, the surgeon sees an intact ACL. The MRI is reviewed and found to be of the left knee. Wrong site surgery could have been likely avoided if which of following was done?
Confirmation of the operative procedure with the circulating nurse
Confirmation of the correct site with the resident taking care of the patient
Examining the patient the day before in the office
Confirming and placing initials on the operative extremity with the patient in the pre-operative holding area
Giving the patient instructions to mark their own extremity the night before surgery at home
Which of the following terms is defined as a loss of function resulting from an anatomic or physiologic derangement?
The operative report of a recent patient incorrectly documents the timing of peri-operative antibiotic administration. How should the medical record be legally altered?
Obtain written approval from the hospital medical director
Obtain written approval from the risk management team
Obtain written approval from your lawyer and the senior partners of his law firm
No approval is needed, as you were the treating surgeon and have identified the error
It is illegal to alter the medical record, but an addendum can be made
Which of the following terms best describes failure to exercise the degree of diligence and care that a reasonable and prudent person would exercise under similar conditions?
Standard of care
Breach of duty
A pediatric orthopaedic surgeon refers a child to a neurologist. The neurologist’s office requests the office records of the pediatric orthopaedic surgeon. To maintain Health Insurance Portability and Accountability Act (HIPAA) compliance, what must the surgeon obtain from the parent(s) prior to sending records?
No additional consent needed
Written approval with notarization
Telephone consent witnessed by a nurse
What function does computerized physician order entry have on medication monitoring?
Reduces the rate of medication errors
Improves physician satisfaction
Decreases narcotic requirements by patients
Increases rates of allergy related medication errors
Improves physician knowledge about the drugs they are prescribing
You are caring for a 50-year-old male who is 2 years status-post a work related pilon fracture. Since this is a workers compensation case, your patient is interested in settling his claim. When can his claim be legally settled?
Once the fracture has united
2 years post-injury
Following release to light duty work
Following release to full duty work
Not until maximum medical improvement is declared by you as the treating physician
Which of the following best describes the benefits of implementing diversity and cultural competency in orthopaedic training programs?
Incorporating foreign languages in the residency curriculum to improve communication with members of diverse backgrounds.
Teaching the social stereotypes of diverse cultures to improve the delivery of healthcare.
Establishing racial and gender enrolment quotas in residency programs to better serve all members of the community.
Enhancing trainees knowledge of diverse cultures to improve patient-physician relationships, optimize patient access to orthopaedic care, and enhance the quality and delivery of care.
Promoting orthopaedic trainees to travel to other countries to obtain surgical experience in different cultures.
A 60 year-old male was brought into the operating room for total hip replacement. Before making the incision, what precautionary procedure must be performed by the entire staff to minimize surgical error?
Mark the word "No" on the nonoperative extremities
Use intraoperative fluoroscopic imaging
Have blood products ready in the operating room
Use the newest prosthesis
A 50-year-old male sustains a closed head injury and closed femur fracture after falling off of a ladder. His GCS is currently 15, and he only speaks Spanish; he has several family members in the waiting room of the hospital. Which of the following is true regarding informed consent for fixation of his femur fracture?
Patient must be able to read the consent form
Patient must be able to sign the consent form
Patient does not need to be able to communicate in any manner to give his or her own informed consent
Patient must not be on any antidepressant medication prior to verbal or written informed consent
Patient should give verbal informed consent prior to narcotic administration
Prior to undergoing a total knee arthroplasty at an academic medical center a patient is told during informed consent by the attending surgeon that resident involvement in the case will be limited to retracting. During the case the attending is present up to trialing of the selected components. The surgeon leaves prior to cementing to start trialing components in another case while the chief resident remains alone in the room for the completion of the case. Which of the following is true regarding the ethics of this practice?
This practice is ethically sound as the attending was present for the surgical timeout
This practice is ethically sound as long as another attending surgeon was immediately available to assist
This practice is ethically sound as the surgery was performed at an academic medical center
This practice is ethically unsound as this represents overlapping surgery
This practice is ethically unsound as the patient was misled
The Stark II regulations limit which of the following activities for physicians who accept Medicare and/or Medicaid insurance payments?
Direct use of implant manufacturer financial support for non-CME courses
Use of in-office durable medical equipment for patient care
Physician office space rental at fair market value prices
Direct physician employment by a hospital system
Referral of patients to entities in which the physician has a financial relationship
Which of the following statements is true regarding the ethical management of orthopaedic implants?
A surgeon who receives monetary gain from a device he/she has developed may not use this device on his/her own patients.
Only studies with positive results should be published. Studies with negative findings should be dismissed.
It is acceptable to rely on the word of the industry sales representative when choosing an orthopaedic implant during preoperative planning.
It is the responsibility of the surgeon to be aware of the implant's clinical track record.
Only implants with support from peer-reviewed clinical literature may be used in the operating room.
A hospital has recently moved from a paper to a computerized physician order entry (CPOE) system. Compared to the previous safety auditing reports, the hospital can now expect which of the following?
A decrease in nephrotoxic drug dosing
No improvement in prescribing behaviors
An increase in patient satisfaction following use of patient controlled analgesia (PCA)
An increase in sentinel events
No effect on physician prescribing errors
All of the following are desired goals of improved diversity and cultural competence in orthopaedics EXCEPT:
Understand cultural differences so that patient-physician relationships are enhanced
Reduce disparities in healthcare
Establishment of quotas for minority and female medical students
Access to orthopaedic care is optimized
Better serve the nation's diverse population