ethics/professional responsibility

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Question 1 / 3

689e7488fb44f3cd6134f5fe

Ethicolegal

ethics

professional responsibility

Case History

A PGY-1 resident is working in a busy pediatric emergency department in downtown Montreal. A 6-year-old girl, presenting with status epilepticus, has been admitted, and her seizures have been controlled with IV lorazepam. The attending physician, Dr. Dubois, verbally orders a loading dose of phenytoin at 20 mg/kg, to be administered STAT. The resident quickly calculates the dose for the 20 kg child and realizes the ordered dose of 400 mg is significantly higher than the typical recommended dose range for phenytoin in pediatric patients, which is usually around 15-20 mg/kg given slowly to avoid adverse effects. The resident recalls that rapid administration or an excessively high dose can lead to severe cardiac complications and central nervous system depression. Despite the chaotic environment, the resident feels a professional obligation to address this potential medication error. What is the most appropriate initial course of action for the resident?

Lab Parameter	Value	Reference Range

A ) Administer the phenytoin as ordered, trusting the attending's judgment given their experience.

B ) Inform the attending physician that the ordered dose is incorrect and refuse to administer it, demanding a new order.

C ) Calmly approach the attending physician, state the calculated dose, express the concern regarding potential toxicity based on standard guidelines, and ask for clarification or re-evaluation.

D ) Administer a dose that the resident believes is safe and appropriate, then document the rationale in the patient's chart after the fact.

E ) Contact the hospital's pharmacy immediately to report a prescribing error before discussing it with the attending physician.

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Question 2 / 3

689e7488fb44f3cd6134f607

Ethicolegal

ethics

professional responsibility

Case History

A 68-year-old patient, Ms. Evelyn Tremblay, presents to a specialized cardiac arrhythmia clinic in Montreal, Quebec, following a referral from her family physician. The referral note vaguely mentions "recurrent palpitations" and "dizziness," but lacks critical details regarding prior cardiac investigations (e.g., ECGs, Holter monitor results, echocardiogram reports), a comprehensive list of current medications, or a clear timeline of symptom progression. During her initial consultation, the arrhythmia specialist finds Ms. Tremblay to be anxious and only able to provide fragmented historical details. Consequently, the specialist must dedicate considerable time to collating basic information, and further tests cannot be ordered until previous results are obtained, necessitating additional appointments and delays.Which of the following represents the most significant immediate professional ramification arising from the family physician's incomplete referral in the healthcare context?

Lab Parameter	Value	Reference Range

A ) Compromised patient safety due to delayed diagnosis and inefficient resource utilization.

B ) Potential for a formal complaint to the provincial College of Physicians and Surgeons regarding unprofessional conduct.

C ) An increased risk of medical malpractice litigation against the referring physician for negligence.

D ) Deterioration of the inter-professional relationship between the family physician and the specialist, affecting future referrals.

E ) Financial penalties imposed by provincial health authorities for inadequate documentation.

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Question 3 / 3

689e7488fb44f3cd6134f60a

Ethicolegal

ethics

professional responsibility

Case History

A 45-year-old female presents to a emergency department with acute right lower quadrant pain. A computed tomography (CT) scan of the abdomen and pelvis is performed to rule out appendicitis. The radiology report's conclusion confirms acute appendicitis. However, in the detailed body of the report, a small (6 mm) non-calcified nodule is incidentally noted in the right lung base, described as indeterminate but not specifically highlighted for follow-up in the conclusion. The emergency physician, focused on the acute surgical issue, reviews the conclusion, confirms the diagnosis, and admits the patient for appendectomy. No mention or plan for the lung nodule is made in the patient's discharge summary. Eight months later, the patient returns to her family physician with persistent cough and dyspnea. A repeat CT scan reveals significant growth of the previously noted lung nodule, now indicative of advanced bronchogenic carcinoma. Considering medical-legal principles and the standard of care, what aspect of this scenario represents the most likely breach of professional duty by the attending physician?

Lab Parameter	Value	Reference Range

A ) The radiologist's failure to explicitly recommend follow-up for the lung nodule in the report conclusion.

B ) The attending physician's lack of a comprehensive review of the entire radiology report prior to the patient's discharge.

C ) The absence of a clear institutional policy mandating automatic specialist referral for all incidental imaging findings.

D ) The patient's inability to recognize the significance of a vague finding mentioned in a complex medical report.

E ) The limited scope of the initial consultation, which focused exclusively on the acute abdominal pain.

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