2 Questions from behavioral section of qbank

[cubbyphan]

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I have 2 questions regarding questions I missed on qbank. After reading the explanation I still don't agree with Kaplan's answers.

One question asks about a conflict where the daughter has power of attorney from 2 years ago and wants to go against a living will from 1 month ago. The Kaplan explanation says that power of attorney overrides a living will. Anyone know where this answer comes from? Cause some law website I looked it up on said that someone with power of attorney cannot go against wishes expressly written out in a living will.

Secondly there is a question about a man who comes into the ED for suicidal, homicidal, and paranoid tendencies. I'm not sure how the whole question is worded, but the gist of it is that the man doesn't want to talk, gets angry when the physician asks him more questions. He has used drugs in the past but denies recent use. The question asks which can be ruled out. Kaplan says you can rule out malingering and the explanation is that usually patients become angry with malingering when the physician digs deeper with the questioning. Since this is exactly how the patient responded, why would you rule that out? 60% of the people got this question right, so I must be missing something. Anyone else have this question?

 

[SkylineMD]

im using Qbank to prepare for a shelf exam and I ran across both of those questions. For the first question, I also thought that a living will that was created 1month prior to admission for the illness would supercede the power of attorney given 2 years prior. I would think that because even though the person gave someone else a power of attorney, the wish of the patient was apparent in the living will... kaplan disagrees

the second question is malingering because that would be the most likely diagnosis in this case. It would thus be the first thing you would want to rule out.

 

[cubbyphan]

Ok I found the question and it is phrased "should be ruled out first". So this means that you want to try to rule it out then? That makes sense. When I read it I took it to mean that that you would exclude it from the differential diagosis, but now I see what they mean. Thanks.

From what I understand about the first question, the timing doesn't matter so much. It's just that when a patient clearly makes their wishes known, someone with power of attorney shouldn't be able to go against them.

 

[SkylineMD]

From what I understand about the first question, the timing doesn't matter so much. It's just that when a patient clearly makes their wishes known, someone with power of attorney shouldn't be able to go against them.

i agree... in some of the qbank questions they state clearly that if the patients wishes supercede any other document or decision (well a few exceptions allowed...i.e. some AIDS cases) but in this case, the patient obviously stated in the living will that she would want care terminated and thus is HER decision when she was in a competent state of mind.

 

[Idiopathic]

Ok I found the question and it is phrased "should be ruled out first". So this means that you want to try to rule it out then? That makes sense. When I read it I took it to mean that that you would exclude it from the differential diagosis, but now I see what they mean. Thanks.

Exactly true. The first diff, which should be ruled out, is malingering.

 

[Idiopathic]

One question asks about a conflict where the daughter has power of attorney from 2 years ago and wants to go against a living will from 1 month ago. The Kaplan explanation says that power of attorney overrides a living will. Anyone know where this answer comes from? Cause some law website I looked it up on said that someone with power of attorney cannot go against wishes expressly written out in a living will.

Maybe the worst question in history. A power of attorney can supercede a living will if the wishes arent clearly spelled out. If the living will just says "I dont want to be on a respirator" and the docs want to put in a feeding tube, the POA takes effect. It depends on the nature of the argument and what the living will states. The point to remember is that whatever is in the living will is rock solid, and as long as the debate is over what is in the patients own words, it obviously takes over. IF interpretation needs to be done, then POA will supercede. Probably doesnt help in this question.

 

[ssm82]

I have 2 questions regarding questions I missed on qbank. After reading the explanation I still don't agree with Kaplan's answers.

One question asks about a conflict where the daughter has power of attorney from 2 years ago and wants to go against a living will from 1 month ago. The Kaplan explanation says that power of attorney overrides a living will. Anyone know where this answer comes from? Cause some law website I looked it up on said that someone with power of attorney cannot go against wishes expressly written out in a living will.

Secondly there is a question about a man who comes into the ED for suicidal, homicidal, and paranoid tendencies. I'm not sure how the whole question is worded, but the gist of it is that the man doesn't want to talk, gets angry when the physician asks him more questions. He has used drugs in the past but denies recent use. The question asks which can be ruled out. Kaplan says you can rule out malingering and the explanation is that usually patients become angry with malingering when the physician digs deeper with the questioning. Since this is exactly how the patient responded, why would you rule that out? 60% of the people got this question right, so I must be missing something. Anyone else have this question?

So we learned in our ethics class in huge letters on our power point slides that the Power of Attorney overrides all. Whos knows, it may be a state thing.

 

[SkylineMD]

While reading the behavioral science section of First Aid 2006, I read the following on page 67 under written advance directive:

(last sentence in regards to power of attorney) - "supersedes living will if both exist"

 

[velo]

oh qBanks BS section is, well, BS anyway.

Did you get to the one where they tell you to biopsy the ovarian tumor? Whoops, actually you should have asked your attending about that one

 

[AlternateSome1]

Did anyone else get a kick out of the question about the man who is choking after signing a DNR? Only 63 percent got it right, which means about 37% would either sit there and hold his hand as he choked to death, pat him on the back, or run to find someone else to help him. Now that is scary.

 

[cfcrml]

Wait..I got that question, answered it correctly, but don't remember what I put! Will someone remind me what the correct answer is??

Did anyone else get a kick out of the question about the man who is choking after signing a DNR? Only 63 percent got it right, which means about 37% would either sit there and hold his hand as he choked to death, pat him on the back, or run to find someone else to help him. Now that is scary.

 

[JulianCrane]

I just got a question asking me to calculate the 95% confidence interval!! I'm sorry, but I don't think that's a realistic boards question. Or is it?? Oh well, I'm taking it tomorrow and at this point, I just don't give a damn.

 

[velo]

I just got a question asking me to calculate the 95% confidence interval!! I'm sorry, but I don't think that's a realistic boards question. Or is it?? Oh well, I'm taking it tomorrow and at this point, I just don't give a damn.

yeah that's a legit question
its easy points if you just remember a few equations.

SEM= SD/ sq rt N

95%CI= mean +/- (1.96 x SEM)

 

[AlternateSome1]

Wait..I got that question, answered it correctly, but don't remember what I put! Will someone remind me what the correct answer is??

The main idea is that DNR means "do not resuscitate", it does NOT mean "do not treat". If someone starts choking, do what you would normally do, the heimlich maneuver.

 

[Idiopathic]

I just got a question asking me to calculate the 95% confidence interval!! I'm sorry, but I don't think that's a realistic boards question. Or is it?? Oh well, I'm taking it tomorrow and at this point, I just don't give a damn.

plus or minus two SD from the mean, right?

 

[Idiopathic]

While reading the behavioral science section of First Aid 2006, I read the following on page 67 under written advance directive:

(last sentence in regards to power of attorney) - "supersedes living will if both exist"

Not if the living will clearly spells out "i dont want to be on a ventilator". that is ultimately what should be done. if interpretation must be done, then POA supercedes.

 

[AlternateSome1]

plus or minus two SD from the mean, right?

No, that is the range in which 95% of subjects fall. The formulas for CI were typed out by Velo (a few posts up).