- 1.
Which of the following are appropriate regarding the definition “quality-adjusted life year” (QALY)?
- a)
It represents a disability-adjusted life year
- b)
It is used in low-income countries to evaluate interventions of disability/mortality
- c)
It equates to one year in perfect health
- d)
It can be used over a woman’s lifetime as incremental cost effectiveness ratio (ICER)
- e)
It is the standard for return-on-investment calculations based on facts and not on models.
- a)
- 2.
The following statement(s) is/are true about breastfeeding?
- a)
The American College for Obstetrics and Gynecology recommends breastfeeding for 3 months and then to switch to breast-milk substitutes to allow working mothers more flexibility.
- b)
Long periods of breastfeeding in the US cause > $500 billion costs/year to compensate for lost working hours.
- c)
Breastfeeding for 6 months or longer is only advised for low-income countries where other substitutes are not available.
- d)
In mothers, breastfeeding rates >3 months result in decreasing rates of breast cancer, hypertension, myocardial infarction, diabetes and early death.
- e)
In children, breastfeeding of >3 months can reduce respiratory problems and asthma, necrotizing enterocolitis, infections, sudden infant death, and leukemia.
- a)
- 3.
Key sources of avoidable research waste were identified as a cumulative effect and contributed to how much of biomedical research investment?
- a)
10%
- b)
25%
- c)
50%
- d)
75%
- e)
85%
- a)
- 4.
Which of the following is/are true regarding life sciences research?
- a)
In 2010, worldwide expenditure on life sciences research was around $500 billion
- b)
In the US about $70 billion was spent in commercial research
- c)
In the US about $40 billion was spent in public and non-profit funding research
- d)
In the US >5% of US health-care expenditure was in life sciences research
- e)
Worldwide avoidable research waste equates to around $200 billion
- a)
- 5.
Which of the following features related to institutional health care is/are true?
- a)
The implementation of the WHO’s strategy for hand hygiene was most effective in high-income compared to low-income countries.
- b)
Increasing efforts for trained personnel, surveillance cultures, hand disinfection alcohol, and adherence to dress codes to fight against the increasing colonization rates with multi-drug resistant organisms produce increasing costs for perinatal centres which impair cost-effectiveness or risk-benefit ratios.
- c)
The problem of institutions employing physicians in their human resource management is that institutions (and their managers) cannot be audited.
- d)
Five choosing wisely criteria (e.g. by the SMFM) define per year what obstetricians should preferably do as standard procedures.
- e)
The management system is responsible for approximately 85% of unintended consequences of mistakes.
- a)
- 6.
The women’s-rights-based reductionist approach to obstetric ethics is based on which of the following?
- a)
The ethical principle of beneficence
- b)
The ethical principle of respect for patient autonomy
- c)
The moral status of the fetus
- d)
Applicable law
- e)
Professional integrity
- a)
- 7.
The professional responsibility model of obstetric ethics is based on a number of ethical considerations, including which of the following?
- a)
Respect for the autonomy of the pregnant woman
- b)
Respect for the autonomy of the fetus
- c)
Beneficence-based obligations to the fetal patient
- d)
Beneficence-based obligations to the pregnant patient
- e)
Fetal rights
- a)
- 8.
In which of the following ways should an obstetrician respond to a request for non-indicated caesarean delivery?
- a)
With shared decision making in all cases
- b)
By recommending against caesarean delivery
- c)
By routinely implementing such requests
- d)
By implementing such requests only after a very deliberative decision-making process
- e)
By requesting an ethics consultation
- a)
- 9.
Shared decision making is appropriate when there is a previous caesarean delivery in which of the following situations?
- a)
One previous low transverse incision
- b)
Two previous low transverse incisions
- c)
Three previous low transverse incisions
- d)
One previous classical incision
- e)
Two previous classical incisions
- a)
- 10.
The ethical concept of the fetus as a patient is based on which of the following?
- a)
The rights of the fetus
- b)
Autonomy-based obligations to the pregnant woman
- c)
Autonomy-based obligations to the fetus
- d)
Beneficence-based obligations to the pregnant woman
- e)
Beneficence-based obligations to the fetus.
- a)
- 11.
Which of the following is/are true regarding directive counselling for fetal benefit?
- a)
It is never justified because directive counselling is a form of paternalism
- b)
It is always justified out of respect for the fetus’ right to life
- c)
It is justified when the fetus is a patient
- d)
It is justified when the fetus is viable
- e)
It is justified when the fetus is pre-viable
- a)
- 12.
The following is/are ethical principles in the professional responsibility model of obstetric ethics:
- a)
Respect for the pregnant woman’s autonomy
- b)
Respect for fetal autonomy
- c)
Beneficence
- d)
Non-maleficence
- e)
Non-malfeasance
- a)
- 13.
Who has decision-making authority over medical treatment intended to benefit a fetus?
- a)
The clinician makes the decision, serving as the fetal surrogate
- b)
The pregnant woman makes the decision
- c)
The pregnant woman’s intimate partner, serving as the fetal surrogate, makes the decision
- d)
The pregnant woman and her intimate partner share decision-making authority equally
- e)
The clinician and the pregnant woman share decision-making authority equally
- a)
- 14.
A pregnant woman is more likely to have a parental obligation to choose a particular treatment approach in which of the following circumstances?
- a)
The treatment and its possible benefits have not been thoroughly investigated by clinical research protocols
- b)
The treatment poses minimal risk to the pregnant woman
- c)
The pregnant woman’s intimate partner supports that treatment approach
- d)
The pregnant woman has made it clear to the clinician that she intends to continue her pregnancy
- e)
The treatment is anticipated to bring about substantial benefits
- a)
- 15.
In which of the following situations would a clinician be ethically justified in taking a directive counselling approach?
- a)
When the pregnant woman’s intimate partner has a strong preference for one treatment approach
- b)
When the pregnant woman comes from a different culture than the clinician
- c)
When the pregnant woman’s interests are in conflict with fetal interests
- d)
When the pregnant woman has a parental obligation to choose one treatment approach
- e)
Never, because of the duty to respect the pregnant woman’s autonomy
- a)
- 16.
Which of the following describes a clinician’s ethical obligations with respect to cultural differences?
- a)
The clinician should be sensitive to cultural differences and seek to understand the pregnant woman’s preferences and values
- b)
The clinician should accommodate the pregnant woman’s preferences when they are based on cultural beliefs
- c)
The clinician should be aware that being strongly directive against a patient’s cultural views may undermine the patient-clinician relationship
- d)
The clinician should respect the pregnant woman’s decisions if they are in line with the clinician’s own cultural beliefs
- e)
The clinician should avoid discussing cultural differences to avoid bias
- a)
- 17.
A 35-year-old woman, Mrs. R, is 18 weeks pregnant with her third pregnancy. Her first pregnancy was an uneventful elective caesarean delivery and her second pregnancy ended in a medical abortion. She takes risperidone. She is compliant with her prenatal visits. During her third prenatal visit her doctor informs her that her fetus suffers from multiple anomalies including bilateral renal agenesis and myelomeningocele. The doctor explained to her that the fetal condition is not compatible with life. She believes her baby’s illness is a punishment from God and she is determined to do every possible thing to save her baby’s life. Recently, she read an article on the Internet about miraculous fetal surgery that helps babies with meningomyelocele to walk and have normal bowel and bladder function. She insists on being referred to a fetal centre that can provide her baby with the best possible care, and threatens to sue her doctor for negligence. Her physician is concerned about her on several levels including her mental health status, the need to minimize unnecessary/unhelpful medical interventions, and her jeopardizing her own clinical integrity by demanding a referral for an unindicated surgery.
Which of the following is/are appropriate to this situation?
- a)
Immediately notify legal counsel for liability protection
- b)
Conduct extensive, non-coercive discussions to ensure that Mrs. R understands the condition
- c)
Refer the patient to a psychiatrist in order to assess her decision making capacity
- d)
Respect patient autonomy and refer her to a fetal care centre
- e)
Consult risk management regarding hospital policy regarding a surrogate for decision making
- 18.
A 40 year old woman, Mrs. M, is 14 weeks pregnant with her second pregnancy. Her past medical history and obstetrical history are unremarkable. She was referred to the fetal centre because of an abnormal first-trimester integrated test suggestive of Trisomy 18. The fetal ultrasound reveals a female fetus with hydrocephalus, growth restriction, increased nuchal translucency, and absence of the nasal bone. After genetic counselling an amniocentesis was performed which confirmed the initial diagnosis. Her Obstetrician-Gynecologist provided her with some information about Trisomy 18. She then stated to her doctor: “I know that Trisomy 18 is lethal and that she is going to die soon after birth. I will however not terminate the pregnancy unless I know that she will remain alive after birth and that she will suffer from being treated.” When her doctor asked her about her preferred mode of delivery she answered: “I am not willing to undergo a Caesarean delivery unless vaginal delivery is certain to increase risk to my baby”.
Which of the following is/are appropriate to this situation?
- a)
Discuss the current meaning of the term lethal fetal anomaly and clarify the uncertainty and difficulty that surrounds the prediction of life expectancy in Trisomy 18
- b)
Describe the increased risk of needing an emergency Caesarean delivery because of fetal hydrocephalus and cephalopelvic disproportion
- c)
Reassure the patient that the fetus will die soon after birth and that no intervention is required
- d)
Conduct non-coercive discussions regarding the fetus’ condition and the recommendation of non-aggressive fetal management
- e)
Suggest cephalocentesis as a method to permit vaginal delivery
- a)
- 19.
The following statements is/are true about genetic counselling:
- a)
The early pioneers were biologists and geneticists.
- b)
Classical genetic counselling included pedigree taking and medical examination.
- c)
The eugenics movement aimed at decreasing the prevalence of harmful traits.
- d)
Genetic counselling is guided by two major principles of decision-shaping process, non-directive and directive counselling.
- e)
The directive method of genetic counselling is most widely supported.
- a)
- 20.
The following statement(s) is/are true about prenatal genetic counselling:
- a)
It relies on ultrasound to examine the fetal phenotype.
- b)
It assesses the fetal genotype using cytogenetic and molecular methods.
- c)
It has implemented prenatal screening methods to enable decision making about termination of the pregnancy.
- d)
It should inform the pregnant woman when a detected fetal disorder is treatable.
- e)
Preconception genetic counselling should be considered upon history of infertility.
- a)
- 21.
The following statement(s) is/are true about prenatal testing:
- a)
Ultrasound soft markers always have to be disclosed.
- b)
All NIPT tests are screening tests with no diagnostic value.
- c)
Preimplantation genetic diagnosis can select against >100 genetic diseases.
- d)
Preimplantation genetic diagnosis can assist in the treatment of sick children.
- e)
Third trimester abortions can never be justified.
- a)
- 22.
Infertility is a global biopsychosical and cultural problem. Which of the following statements is/are true?
- a)
The clinical definition of infertility is uniformly 12 months of trying
- b)
Infertility does not involve gender suffering.
- c)
The incidence of infertility does not increase with advancing maternal age till the age of 38.
- d)
Infertility in women is most notable after age 38
- e)
Infertility affects more than 186 million ever-married women of reproductive age (15–49) in developing countries including China
- a)
- 23.
Globally the least global need for ART is 1500 cycles per million population per year (mppy). Which of the following statements is/are true?
- a)
Most developed countries perform more than 1500 cycles/mppy.
- b)
Few developed countries perform more than 2000 cycles/mppy.
- c)
Nearly 50% of infertile couples in developing countries have access to ART.
- d)
ART is the only line of treatment for unexplained and moderate male factor infertility.
- e)
IVF is the most likely end point for unexplained infertility
- a)
- 24.
The moral status of the embryo has created a lot of ethical debate all over the world and in all societies. Which of the following statements is/are true?
- a)
Most global human right courts have confirmed that it is not admissible to grant the status of person to the embryo.
- b)
The embryo is not co-insured as a person before 14 days after fertilization because it is still capable of division.
- c)
The embryo is not co-insured as a person before 28 days after fertilization because it is still capable of division.
- d)
The early stages of the embryo ethically require a special status as it is not a human being but has a human life.
- e)
Selective fetal reduction in multiple pregnancy is rejected by most religions because it destroys the life of one or more embryos.
- a)
- 25.
When resources are limited ART services may not be provided by public funds which should be utilized to provide basic health needs for the greatest sector of population. Which of the following statements is/are true?
- a)
In developing countries not providing ART service does not violate the ethical principle of justice.
- b)
When resources are limited the ethical principles of utility and justice do not conflict with each other.
- c)
When resources are limited the ethical principle of liberty does not conflict with utility and justice.
- d)
Positive rights are those that states are legally obligated to implement in all cases.
- e)
Negative rights enable states to prohibit or unduly obstruct services of which individuals may avail themselves based on their reproductive choice.
- a)
- 26.
Which of the following is/are a unique challenge to healthcare in low income countries?
- a)
Politicization of healthcare priorities
- b)
Inadequate financial resources
- c)
Brain drain
- d)
Inadequate infrastructure
- e)
Technological obsolescence
- a)
- 27.
Evidence-based clinical science has shown that in low income countries, the following intervention(s) is/are not beneficial and in fact leads to negative unintended consequences.
- a)
Access to caesarean section
- b)
Routine corticosteroids to mothers at risk for preterm delivery
- c)
Availability of obstetric forceps.
- d)
Training of specialist obstetrician/gynecologists
- e)
Expanded education for reproductive health professionals
- a)
- 28.
During the first week of her month-long rotation in a LMIC, an OB/GYN resident sees an older woman with known advanced cancer brought to the hospital by her family complaining of pain and extreme fatigue. After assessment the hemoglobin result indicates severe anemia and the resident explains the test results and offers admission for blood transfusion which the patient accepts. The resident returns to the labor ward where her attending physician is just coming out of a complicated surgery. The attending informs the resident that the young mother died after a postpartum hemorrhage because there was no blood available in the hospital for transfusion.
Which of the following ethical principles was/were impacted by the resident’s actions?
- a)
Beneficience
- b)
Nonmaleficence
- c)
Respect for autonomy
- d)
Justice
- e)
Liberty
- a)
- 29.
Upon return from a 6 week GHE in a resource limited setting, a third-year medical student told his roommate that he was sick and tired of patients showing up to the emergency department for care rather than seeing their primary care physicians. He just couldn’t believe how many resources were squandered by these patients who were clearly “just too lazy to go to the doctor.” Which professional virtue(s) was/were directly impacted by the medical student’s global health experience?
- a)
Self-effacement
- b)
Self-sacrifice
- c)
Compassion
- d)
Integrity
- e)
Patient-centredness
- a)
- 30.
Which of the following is/are recognized benefits of GHEs?
- a)
Improved clinical acumen and skills
- b)
Enhanced understanding of public health and social justice issues
- c)
Increased ability to function in resource limited settings
- d)
Trainees who participate in GHEs are more likely to enter general medical practice
- e)
Trainees who participate in GHEs are more likely to work in resource constrained environments
- a)
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