Patient Safety, Risk Management & Performance Improvements for Healthcare Professionals.

Risk Management Quiz

(All questions are mandatory)

1 )

A 34-year-old male is involved in a motor vehicle accident. His car rolled over. At the scene, he complained to the paramedics about numbness and weakness in both arms, but had no other complaints. On arrival in the emergency department, he had no complaints at all, and the C-spine films were negative. Neurologic exam was completely intact. What is the best approach to this patient?

It’s this patient’s lucky day. Discharge with follow-up PRN.

Treat immediately with low dose methylprednisolone.

Consider the possibility of a spinal cord injury without radiologic abnormality (SCIWORA).

Observe for one hour. If there is a significant problem, it will appear in that time frame.

2 )

Diagnosis of ectopic pregnancy is often missed or delayed because:

It is misdiagnosed as fibroid uterus.

It is misdiagnosed as pelvic inflammatory disease.

The patient insists she has a normal intrauterine pregnancy.

Ectopic pregnancy is extremely rare and not often considered.

3 )

The presence of a BhCG level below 500 rules out the possibility of a ruptured ectopic pregnancy.

True

False

4 )

All of the following are common reasons why the diagnosis of subarachnoid hemorrhage is delayed or missed except:

This is often a very difficult diagnosis to make.

SAH often presents like other headaches.

Headache is a common presentation and there is a very low incidence of SAH.

The classic presentation of SAH (i.e., acute onset of a severe, diffuse headache often associated with nausea, vomiting, neck pain or stiffness and altered mental status) is uncommon.

Patients with SAH improve dramatically after administration of an anti-emetic agent.

5 )

A 23-year-old female presents with a mild headache in the frontal area. She does not appear to be in significant distress. There is no prior history of headache. She is awake and alert, talking with family. On physical exam there is no neurologic deficit. Patient feels better after 30 of Toradol IV and states she is ready to go home. In the patient history, she tells you that her father and brother died from a subarachnoid hemorrhage. What step should you take at this point?

The headache is resolved. No further management is necessary.

The patient may be at increased risk based on family history, but the presentation is completely inconsistent with SAH. Discharge on analgesics.

Do an MRI.

This patient is at increased risk based on family history. Do a CT scan. If the scan is negative, follow up with lumbar puncture.

6 )

A review of missed myocardial infarction litigation indicates that the physician’s failure to obtain or rely upon critical historical factors plays a significant role in the failure to diagnose.

True

False

7 )

A 37-year-old man with a history of CAD was taken to the emergency department after experiencing chest pain, shortness of breath, and a feeling of numbness in his left arm. Assume that this patient had very mild aching-like pain, which was completely resolved with a GI cocktail. The patient felt great and demanded to go home. Which of the following is true?

The patient should be reassured that this is not a heart problem, and he should follow up with his private physician.

The patient should be instructed that his condition is life-threatening, and he should be discharged only after an informed refusal of care.

The patient should be tied down, and an ECG and cardiac markers should be performed against his will.

None of these are true.

8 )

Which of the following is not a risk factor for aortic dissection?

Marfan's Syndrome

Ehlers-Danlos Syndrome

Hypertension

Male gender

Pregnancy

Eisenmenger complex

9 )

Which of the following is not characteristic of the pain of thoracic aortic dissection?

Pain of sudden, acute onset

Migration of pain

Crescendo pain similar to the pain of myocardial ischemia

Pain both above and below the diaphragm

Pain may remit into a latent period

10 )

What percentage of standard chest x-rays are completely normal with thoracic aortic dissection?

Zero

10% to 20%

20% to 30%

Over half

11 )

Which of the following is the most common erroneous discharge diagnosis when the diagnosis of abdominal aortic aneurysm is missed?

Diverticulitis

Myocardial infarction

Gall bladder disease

GI bleed

12 )

The most common erroneous discharge diagnosis in failure to diagnose appendicitis cases is:

Pelvic inflammatory disease

Ectopic pregnancy

Gastroenteritis

Bowel obstruction

13 )

Which of the following is not a commonly recognized fact pattern in pediatric meningitis lawsuits?

Febrile illness - non-CNS focus of infection

Hyperpyrexia

Delay in administration of antibiotics

Fever greater than 104.2 in children under one year

Neonatal meningitis

14 )

Common reasons for litigation against physicians related to the failure to diagnose or the delay in diagnosis of torsion testicle include all of the following except:

Torsion sometimes presents with pain in the inguinal and lower abdominal areas with little or no discomfort in the testicles.

The clinician is sometimes thrown off track by a history of mild trauma.

The testicle sometimes torses and then detorses. When the patient presents to the office or emergency department, the pain is improved or gone.

The physician fails to consider risk factors, so he does not seriously consider the problem.

Torsion is often mistaken for epididymitis.

The failure to evaluate for Prehn’s sign.

15 )

Computerized ECG interpretations are reliable tools for detecting ischemic episodes.

True

False

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U.S. Patent No. 7,197,492