# # Pediatric Critical Care Review Hasan Pappas

1. The process of informed consent involves that the patient or the patient’s surrogate: A. Is/Are competent B. Have comprehensible information about the medical situation and treatment C. Have information about alternative treatments and their consequences, and have an understanding of what they have learned D. All of the above E. Only A and B are true Click here for answer 2. Children who can make their own decisions and give consents for medical treatment separate from their parents include: A. Children who are pregnant or are already parents B. Children who graduated from high school C. Children who have joined the armed forces D. Children who live separately and independent from their parents E. All of the above Click here for answer 3. Appropriate statements pertaining to the mature minor doctrine include all of the following except: A. A minor (child) should have the opportunity to accept or decline life sustaining treatment such as mechanical ventilation or dialysis B. The child may refuse a blood transfusion that might otherwise be essential for appropriate medical care, if this is due to long-standing, well thought beliefs such as those held by adolescents who are Jehovah’s witnesses C. The law does recognize that some children have legitimate independent claims regarding their medical care that may differ from the expressed wishes of their parents D. This legal entitlement means that the proposed decision maker is actually competent E. Physicians must assess the decision making capacity of patients or their surrogates Click here for answer 4. In order to give an informed consent, the patient or legal guardian must possess a decision- making capacity. This capacity has several features and elements which include all of the following except: A. The patient or surrogate does not need to have the ability to manipulate the information provided to them B. Capacity includes the ability to deliberate about alternative options C. Capacity to make medical decisions involves specific determinations for each significant decision D. Capacity involves the ability to understand and communicate about the medical situation E. Capacity involves the ability to make a choice among alternatives Click here for answer 5. You are involved in the treatment of a critically ill child with sepsis and multiple organ dysfunction syndrome at a university children’s hospital. In this situation, all of the following actions and statements are true except: A. Parental religious beliefs should not prevent this child from receiving a clearly beneficial therapy B. The best interest of the child should remain the guiding principle in most cases where there is any dispute with the parents C. Treatment can go forward with permission from only one parent D. When parents refuse involvement of trainees in the care of their child, the best course of action is to remind them that this is a teaching institution and proceed with the care with your trainees E. Children may receive treatment by court approval over and against parental wishes, when the therapy constitutes the standard of care Click here for answer 6. In order for a patient to succeed in a claim for damages, he/she must prove: A. That the physician failed to meet the standard of care B. That the physician’s error led to legally recognized injuries C. That the physician’s error approximately caused the patient to suffer legally recognizable damage D. All of the above E. A only Click here for answer 7. Regarding the doctor/patient relationship involved in a malpractice suit, which of the following statements is true: A. It is illegal to alter patient’s medical records at a later time even when a reason for addition is indicated B. It can be hard to deny charges that inappropriate care was provided when the medical record have little or no information C. When a physician treats a patient with a chronic medical problem, he/she is liable for the entire problem even after one encounter D. Most jurisdictions state that the physician is responsible for the patient’s non-compliance E. All of the above Click here for answer 8. In the US, a 14-year-old who is healthy without any significant past medical history is most likely to die from: A. Suicide B. Homicide C. Leukemia D. Accident E. Brain tumor Click here for answer 9. “Baby Doe” regulations include that health care providers cannot withhold medically beneficial treatment from a child on the basis of a handicap. Exception(s) include: A. If the infant is imminently dying B. The treatment would be inhumane C. The infant is permanently comatose D. All of the above E. A and B only Click here for answer 10. You are called to the Pediatric ICU as soon as possible because the parents of a 6-month-old child with Down’s syndrome and atrioventricular canal defect in congestive heart failure are very angry at the staff, and are expressing dissatisfaction with the care provided to their child. Upon your arrival you notice the father is indeed very angry and is asking to transfer his child to another institution. All of the following would be appropriate responses except: A. Listening to their concerns is one of the most effective interventions in dealing with this family B. A team meeting with this family should be promptly convened C. You should remind the parents that you and the staff were up all night taking care of this child, and at this point, everybody on the team is somewhat tired and exhausted D. Accept the emotional outburst of the father calmly E. Assure the parents that their child is being appropriately cared for and comforted Click here for answer 11. Measures that can be taken to prevent hostility among parents such as the ones above include: A. Orientation to policies of the Pediatric ICU as soon as possible after the admission of the child B. Introduction of the staff soon after admission C. If there is evidence that the parents are showing signs of dissatisfaction with the care, a team meeting with the family should be promptly convened D. Family education to alleviate any knowledge deficit E. All of the above Click here for answer 12. A 12-month-old baby of a single mother, who was apparently being watched by the mother’s boyfriend, was admitted to your Pediatric ICU for persistent seizures. Physical examination was significant for the presence of multiple retinal hemorrhages and the CT scan revealed intracerebral hemorrhage and a subdural hematoma. Correct statements pertaining to this case include all of the following except: A. A complete copy of the medical record is extremely helpful during the initial investigation B. If you are asked to testify in court regarding this case, a monitory compensation is expected C. Accidental injury other than a car accident rarely causes intracranial injury in infants D. Remind your staff that the parents of this child should be treated in the same professional and supportive manner that is employed with the parents of any other critically injured child E. In discussing this case with one of your residents who will be testifying in court, it is crucial to remember that most physicians are unprepared by training and experience to go to court as expert witnesses Click here for answer Answers 1. D All of the above are involved in the process of “informed consent.” (Fuhrman BP, et al. Pediatric Critical Care, 2nd Edition; pp 10-11) 2. E These children are referred to as emancipated minors. (Fuhrman BP, et al. Pediatric Critical Care, 2nd Edition; pp 10-12) 3. D It does not assume that the patient or the surrogate is competent. This must be assessed by the physician as indicated in Answer E. (Fuhrman BP, et al. Pediatric Critical Care, 2nd Edition; pp 9-14) 4. A It does include the ability to manipulate the information and deliberate about alternatives. (Fuhrman BP, et al. Pediatric Critical Care, 2nd Edition; pp 9-14) 5. D The best course of action is direct inquiry into their fears and guilt which is likely to provide the best resolution for all parties. (Fuhrman BP, et al. Pediatric Critical Care, 2nd Edition; pp 18-22) 6. D In order to succeed in a claim for damage, it must meet all the above criteria. (Fuhrman BP, et al. Pediatric Critical Care, 2nd Edition; pp 18-22) 7. B As long as the reason and the date are stated, adding to medical records is not illegal. Jurisdictions vary on the essence of compliance. (Fuhrman BP, et al. Pediatric Critical Care, 2nd Edition; pp 20-22) 8. D Accidents and adverse effects are the most common causes of death in children 13-15 years of age. (Fuhrman BP, et al. Pediatric Critical Care, 2nd Edition; p 4) 9. D “Baby Doe” regulations (introduced in 1982 by the federal government) prohibit withholding or withdrawing of beneficial medical treatment from any infant on the basis of handicap or prognosis for quality of life. The three exceptions are: 1) infant is permanently comatose; 2) treatment is inhumane; and 3) infant is immediately dying. (Fuhrman BP, et al. Pediatric Critical Care, 2nd Edition; pp 34) 10-11. C, E It is more helpful in dealing with these families to have a caring attitude rather than a defensive attitude. (Fuhrman BP, et al. Pediatric Critical Care, 2nd Edition; pp 38-41) 12. A The complete record may be needed if the case goes to trial. It is rarely helpful in the initial investigation because so much of the record pertains to investigation. (Fuhrman BP, et al. Pediatric Critical Care, 2nd Edition; pp 18-23)