Contents
- 1 ブロック過去問（ロイスから）
- 1.1 Question 1
- 1.2 Question 2
- 1.3 Question 3
- 1.4 Question 4
- 1.5 Question 5
- 1.6 Question 6
- 1.7 Question 7
- 1.8 Question 8
- 1.9 Question 9
- 1.10 Question 10
- 1.11 Question 11
- 1.12 Question 12
- 1.13 Question 13（Abo）
- 1.14 Question 14（Abo）
- 1.15 Question 15
- 1.16 Question 16
- 1.17 Question 17
- 1.18 Question 18（Abo）
- 1.19 Question 19（Abo）
- 1.20 Question 20（Abo）
- 1.21 Question 21（Abo）
- 1.22 Question 22（Pregnancy）
- 1.23 Question 23（Pregnancy）
- 1.24 Question 24（Abo）
- 1.25 Question 25（Abo）
- 1.26 Question 26（Abo）
- 1.27 Question 27（Abo）
- 1.28 Question 28（Pregnancy）
- 1.29 Question 29（Pregnancy）
- 1.30 Question 30（Abo）
- 2 Med Ethics Compilation
- 2.1 Question 1
- 2.2 Question 2
- 2.3 Question 3
- 2.4 Question 4
- 2.5 Question 5
- 2.6 Question 6
- 2.7 Question 7
- 2.8 Question 8
- 2.9 Question 9
- 2.10 Question 10
- 2.11 Question 11
- 2.12 Question 12
- 2.13 Question 13
- 2.14 Question 14
- 2.15 Question 15
- 2.16 Question 16
- 2.17 Question 17
- 2.18 Question 18
- 2.19 Question 19
- 2.20 Question 20
- 2.21 Question 21
- 2.22 Question 22（D）
- 2.23 Question 23
- 2.24 Question 24
- 2.25 Question 25（D）
- 2.26 Question 26
- 2.27 Question 27（D）
- 2.28 Question 28
- 2.29 Question 29
- 2.30 Question 30
- 2.31 Question 31（D）
- 2.32 Question 32（D）
- 2.33 Question 33（D）
- 2.34 Question 34
- 2.35 Question 35（D）
- 2.36 Question 36
- 2.37 Question 37（Pregnancy）
- 2.38 Question 38
- 2.39 Question 39（D）
- 2.40 Question 40（D）
- 2.41 Question 41（D）
- 2.42 Question 42（D）
- 2.43 Question 43（D）
- 2.44 Question 44（D）
- 2.45 Question 45
- 2.46 Question 46（D）
- 2.47 Question 47（D）
- 2.48 Question 48（Pregnancy）
- 2.49 Question 49
- 2.50 Question 50
- 2.51 Question 51
- 2.52 Question 52
- 2.53 Question 53
- 2.54 Question 54
- 2.55 Question 55
- 2.56 Question 56
- 2.57 Question 57（Pregnancy）
- 2.58 Question 58
- 2.59 Question 59
- 2.60 Question 60
- 2.61 Question 61
- 2.62 Question 62
- 2.63 Question 63
- 2.64 Question 64
- 2.65 Question 65
- 2.66 Question 66
- 2.67 Question 67
- 2.68 Question 68
- 2.69 Question 69
- 2.70 Question 70
- 2.71 Question 71
- 2.72 Question 72
- 2.73 Question 73
- 2.74 Question 74
- 2.75 Question 75
- 2.76 Question 76
- 2.77 Question 77
- 3 データプライバシー（自作）
ブロック過去問（ロイスから）
Question 1
The following are situations where withholding information from a patient can be justified EXCEPT:
a. The patient is a minor and lacks full decision-making capacity.
b. The patient has expressed a desire not to know the details of their diagnosis.
c. The patient is a child of a politician.
d. The information may cause psychological harm to the patient.
Answer: c. The patient is a child of a politician.
解説:
患者の社会的地位や家族の背景によって情報を隠すことは、倫理的に正当化できません。情報を隠すべきかどうかの判断は、患者の福祉や精神的な容量に基づいて行われるべきであり、外部的な要因は考慮されません。その他の選択肢は、患者が未成年である場合や、心理的負担を避けるために情報開示を控えることが適切な場合に限り、正当化されることがあります。
Question 2
Mr. W, a retired general, suffered a leg injury after a parasailing accident. During surgery, Dr. X recovered oversized tribal earrings at the surgical site. What is Dr. X’s responsibility?
a. Report it immediately to the authorities.
b. Invoke therapeutic privilege.
c. Inform the patient immediately after surgery.
d. Withhold the information for patient’s emotional well-being.
Answer: b. Invoke therapeutic privilege.
解説:
医師は患者に対してすべての情報を開示する義務がありますが、「治療上の特権（therapeutic privilege）」が適用される場合、医師は患者に害を及ぼす可能性がある情報を一時的に保留することができます。他の選択肢は、通常の診療行為としての範囲外であり、特に当局への報告や情報を意図的に隠すことは倫理的に問題があります。
Question 3
Which of the following is true about the process of truth-telling?
a. It involves using simple language for patient understanding.
b. It allows the patient to ask questions freely.
c. It requires setting aside sufficient time for communication.
d. It requires following the rules of the court.
Answer: d. Secure the report with the rules of court.
解説:
真実を伝えるプロセスは、患者とのコミュニケーションに焦点を当て、患者が診断や治療を理解しやすいように言葉を選び、時間をかけて話すことが必要です。しかし、法的手続きに基づいて報告書を作成することは、日常の診療においては真実を伝えるプロセスの一部とはみなされません。
Question 4
A 60-year-old patient with complaints of persistent but not extreme abdominal pain was diagnosed with hepatoma. He just retired and is about to leave for a world cruise with his wife. What should you do?
a. Withhold the diagnosis to let him enjoy his trip.
b. Inform his wife, but not the patient.
c. Delay telling him until after the trip.
d. Inform him about the diagnosis and discuss treatment options before the trip.
Answer: d. Inform him about the diagnosis and discuss treatment options before the trip.
解説:
患者には自分の健康状態について知る権利があり、治療の選択肢を理解し、旅行中に起こり得る健康リスクに備える必要があります。他の選択肢は患者の権利を無視しているか、倫理的に不適切です。特に妻にだけ情報を提供することは、患者の自己決定権を侵害する行為です。
Question 5
You are a male doctor who performed surgery on a 46-year-old patient for removal of a large intracerebral hemorrhage (ICH). The patient died three days later, and the patient’s wife is now asking about his condition in the hospital corridor. What should you do?
a. Inform her about the death immediately in the corridor.
b. Ask her to wait until she is calmer.
c. Tell her you will inform her after you finish your rounds.
d. Calm her and take her to a private room with a nurse or female doctor to inform her about her husband’s death.
Answer: d. Calm her and take her to a private room with a nurse or female doctor to inform her about her husband’s death.
解説:
家族に対して死亡を伝える際には、プライバシーと感情的なサポートが重要です。患者の妻がショックを受けないよう、落ち着いた環境で知らせるべきです。他の選択肢では、感情的な影響を十分に考慮しておらず、医療者としての配慮が欠けています。
Question 6
A 22-year-old college student was admitted for an acute exacerbation of asthma. After discharge, her professor asks you about her condition, claiming to be concerned about her well-being. What should you do?
a. Provide him with the details of her condition.
b. Ask the student for permission to share the details.
c. Tell him the student is fine without giving specifics.
d. Apologize and tell him that you cannot reveal the details due to patient confidentiality.
Answer: d. Apologize and tell him that you cannot reveal the details due to patient confidentiality.
解説:
患者のプライバシーは医療において最優先されるべきであり、たとえ教授や他者からの問い合わせであっても、情報を開示することはできません。他の選択肢は、患者のプライバシーを侵害する恐れがあり、医療倫理に反する行為です。
Question 7
A 35-year-old patient infected with HIV refuses to tell his wife about his condition despite your encouragement. He insists that he uses condoms most of the time, so it shouldn’t be an issue. What should you do?
a. Respect his confidentiality and not tell his wife.
b. Inform his wife against his wishes.
c. Contact legal authorities to intervene.
d. Convince him once again, and if he still refuses, inform his wife.
Answer: a. Respect his confidentiality and not tell his wife.
解説:
医師は患者の守秘義務を守らなければなりません。配偶者の健康が直接危険にさらされる場合を除き、患者が同意しない限り情報を開示することはできません。他の選択肢は、患者の権利を侵害するものであり、倫理的に問題があります。
Question 8
A five-year-old child is admitted with severe encephalitis and is likely to experience irreversible cognitive decline. How should you discuss the prognosis with the parents?
a. Withhold the full prognosis to avoid distress.
b. Give them vague details to soften the news.
c. Inform them that the child will likely recover with proper care.
d. Provide a clear and honest explanation about the poor prognosis.
Answer: d. Provide a clear and honest explanation about the poor prognosis.
解説:
子供の重篤な状態については、親に対して正直で透明性のある説明を行うことが必要です。情報を隠すことや誤った希望を与えることは、後に信頼関係を損なう可能性があります。他の選択肢は、真実を伝える責任を果たしていません。
Question 9
A 38-year-old man with gastric cancer is reluctant to undergo surgery despite a poor prognosis. What should you do?
a. Avoid discussing the prognosis to prevent distress.
b. Tell his family instead of him.
c. Try to convince him without disclosing the full prognosis.
d. Inform him about the condition and help him make an informed decision.
Answer: d. Inform him about the condition and help him make an informed decision.
解説:
患者には自分の病気についての情報を知り、治療の選択肢を理解する権利があります。医師は真実を隠さず、患者が十分な知識をもとに意思決定できるようサポートする必要があります。他の選択肢は、患者の自己決定権を尊重していません。
Question 10
A 28-year-old man with severe alcohol dependence has normal liver function tests, but his wife asks you to scare him by saying the tests show some abnormalities to convince him to get treatment. What should you do?
a. Tell him the reports are normal but could worsen if he continues drinking.
b. Comply with the wife’s request to scare him.
c. Say nothing and let the wife handle the situation.
d. Reassure him that his liver is perfectly fine.
Answer: a. Tell him the reports are normal but could worsen if he continues drinking.
解説:
医師は事実に基づいた情報を提供する義務があり、患者に誤った情報を与えて怖がらせることは倫理に反します。正確な情報を伝え、患者に将来のリスクを理解させることが重要です。他の選択肢は、真実をねじ曲げたり、患者に不必要な混乱を与えたりするもので、不適切です。
Question 11
Which of the following is NOT helpful when delivering bad news to a patient?
a. Choose a quiet and private environment.
b. Use medical jargon to maintain professionalism.
c. Allow the patient time to ask questions.
d. Provide emotional support throughout the conversation.
Answer: b. Use medical jargon to maintain professionalism.
解説:
医療用語を多用することは、患者にとって理解が困難で、コミュニケーションを阻害する可能性があります。医師は、わかりやすい言葉で説明し、患者が理解しやすいようにする必要があります。その他の選択肢は、適切な配慮を示しており、患者との信頼関係を築くために重要です。
Question 12
A seriously ill newborn is facing an uncertain future. When deciding on treatment, what should be considered?
a. Only the parents’ wishes.
b. The newborn’s potential future wishes as an adult.
c. The doctors’ opinions only.
d. Immediate financial costs.
Answer: b. The newborn’s potential future wishes as an adult.
解説:
倫理的な意思決定には、新生児が将来的に自己決定できるときに望むであろう選択肢も考慮する必要があります。他の選択肢は、親や医師の希望のみを優先しており、将来の本人の選択を無視しています。
Question 13（Abo）
Which of the following statements about abortion in the Philippines is NOT true?
a. Abortion is legal under certain circumstances.
b. It is strictly prohibited by law.
c. The Revised Penal Code Act 3815 criminalizes abortion.
d. There are no provisions for legal abortion under the current law.
Answer: a. Abortion is legal under certain circumstances.
解説:
フィリピンでは中絶は法律で厳しく禁止されており、いかなる状況においても合法化されていません。Revised Penal Code Act 3815 に基づき、中絶は犯罪とみなされます。他の選択肢は、フィリピンにおける中絶に関する法律を正確に反映しています。
Question 14（Abo）
Which of the following is NOT true about the Reproductive Health Law (RA 10354) in the Philippines?
a. It provides access to contraceptives.
b. It promotes family planning education.
c. It mandates government funding for abortion services.
d. It guarantees maternal healthcare services.
Answer: c. It mandates government funding for abortion services.
解説:
フィリピンのReproductive Health Law (RA 10354)は、避妊具へのアクセスや家族計画の教育を推進し、母子保健サービスを保証していますが、中絶に対する資金提供は行っていません。他の選択肢は、法律が提供する実際のサービスや支援を反映しています。
Question 15
Which of the following is NOT considered an ethical justification for overriding truth-telling to a patient?
a. The patient does not want to know the truth.
b. The truth would cause unnecessary psychological harm to the patient.
c. The patient’s family asks to withhold the information.
d. The patient’s condition may worsen if they know the truth.
Answer: c. The patient’s family asks to withhold the information.
解説:
患者の家族の意向で情報を隠すことは倫理的に正当化できません。情報開示は基本的に患者の権利であり、家族の意向は優先されません。他の選択肢は、患者自身の福祉や心理的な影響を考慮した上で、真実を伝えるかどうかの判断が適切な場合があります。
Question 16
Which of the following is NOT a valid consideration when assessing a minor’s decision-making capacity?
a. Maturity level.
b. Understanding of the information provided.
c. Socioeconomic status.
d. Ability to appreciate the consequences of their decision.
Answer: c. Socioeconomic status.
解説:
未成年者の意思決定能力を評価する際には、成熟度や情報の理解、決定がもたらす結果を理解できる能力が重要です。しかし、社会経済的な地位はその評価基準には含まれません。他の選択肢は未成年者の意思決定能力を評価するための適切な要素です。
Question 17
Which of the following is a correct description of Gillick competence?
a. Children under the age of 16 can never consent to medical treatment.
b. Only parents can consent to treatment for children under 16.
c. Children over the age of 16 have full autonomy in medical decisions.
d. Children under 16 can consent to treatment if they have sufficient maturity and understanding.
Answer: d. Children under 16 can consent to treatment if they have sufficient maturity and understanding.
解説:
Gillick competenceの原則では、16歳未満の子供でも、十分な成熟度と理解力があれば、自らの医療に関する同意を与えることができます。他の選択肢は、Gillick competenceの概念を正確に反映していないため、不正確です。
Question 18（Abo）
According to WHO, which of the following factors most significantly impacts the safety of abortions?
a. The age of the woman.
b. The financial resources available.
c. The legality of the procedure.
d. The marital status of the woman.
Answer: c. The legality of the procedure.
解説:
WHOによれば、中絶の安全性は、その手続きが合法であるかどうかに大きく依存しています。違法な中絶は、医療環境が不適切であることが多く、重大な健康リスクを伴う可能性があります。他の選択肢は、中絶の安全性に対する影響は比較的小さいです。
Question 19（Abo）
Which country was the first to legalize abortion for any reason and had the highest rate of abortions per capita?
a. Sweden
b. USA
c. USSR
d. France
Answer: b. USA.
解説:
アメリカはRoe v. Wade裁判により、中絶が合法化された国の一つであり、その後、他の国々よりも中絶の割合が高くなったことがあります。他の選択肢は、アメリカほど中絶の件数が多くはありませんでした。
Question 20（Abo）
Which of the following is NOT one of the key pillars of the Philippine Reproductive Health Law?
a. Access to family planning services.
b. Maternal healthcare.
c. Respect for life.
d. Sex education.
Answer: c. Respect for life.
解説:
Reproductive Health Law (RA 10354)の主要な柱は、家族計画サービスへのアクセス、母子保健、そして性教育です。「Respect for life」は法律の理念に含まれているものの、法の主要な支柱として明確には定義されていません。他の選択肢は、この法律が明確に取り上げている要素です。
Question 21（Abo）
Which of the following is NOT true about abortion in Japan?
a. Abortion is permitted for socioeconomic reasons.
b. Parental consent is required for minors seeking abortion.
c. Abortions can only be performed before the 24th week of pregnancy.
d. Abortion is entirely prohibited under all circumstances.
Answer: d. Abortion is entirely prohibited under all circumstances.
解説:
日本では、経済的理由や身体的な健康のために中絶が認められていますが、全ての状況において中絶が完全に禁止されているわけではありません。他の選択肢は、日本の中絶に関する法律や規制を正確に反映しています。
Question 22（Pregnancy）
Which of the following statements is NOT true about artificial insemination?
a. The sperm donor remains anonymous in many cases.
b. It involves direct insertion of sperm into the woman’s reproductive tract.
c. The process is only used in cases of male infertility.
d. Artificial insemination can use either donor sperm or the partner’s sperm.
Answer: c. The process is only used in cases of male infertility.
解説:
人工授精は、男性の不妊治療だけでなく、女性側の問題や同性カップルの妊娠支援のためにも使用されることがあります。他の選択肢は人工授精の一般的な特徴を正確に反映しています。
Question 23（Pregnancy）
Which of the following best describes in vitro fertilization (IVF)?
a. Sperm is injected directly into the uterus to fertilize an egg.
b. Fertilization occurs in a laboratory, and the embryo is later transferred to the uterus.
c. Sperm is inserted into the fallopian tube where fertilization occurs naturally.
d. An egg and sperm are mixed inside the woman’s body to promote natural fertilization.
Answer: b. Fertilization occurs in a laboratory, and the embryo is later transferred to the uterus.
解説:
体外受精（IVF）とは、卵子と精子を体外で受精させ、その後胚を子宮に移植する方法です。他の選択肢は異なる生殖技術を説明しており、IVFとは異なります。
Question 24（Abo）
What was the impact of the death of Savita Halappanavar in Ireland?
a. It led to a complete ban on abortion in Ireland.
b. It triggered significant legal changes, eventually leading to the legalization of abortion in Ireland.
c. It resulted in stricter regulations for reproductive health services.
d. It had no significant impact on Irish abortion laws.
Answer: b. It triggered significant legal changes, eventually leading to the legalization of abortion in Ireland.
解説:
サビータ・ハラッパナヴァールの死亡は、アイルランドで中絶を合法化するための重要な転機となり、最終的には中絶法の改正が行われました。他の選択肢は、彼女の死がもたらした重要な法的影響を反映していません。
Question 25（Abo）
Which of the following contraceptive methods was affected by the Temporary Restraining Order (TRO) issued under the Reproductive Health Law in the Philippines?
a. Oral contraceptives
b. Condoms
c. Implants
d. IUDs
Answer: c. Implants
解説:
フィリピンでは、Reproductive Health Lawの一部施行に対して一時的な差し止め命令（TRO）が出され、特にインプラント型の避妊具が影響を受けました。他の選択肢は、この特定のTROによって直接影響を受けたものではありません。
Question 26（Abo）
Which of the following is NOT considered a key component of the Philippine Reproductive Health Act of 2012?
a. Access to comprehensive family planning services.
b. Provision of maternal and child healthcare.
c. The promotion of abortion services.
d. Implementation of sex education programs.
Answer: c. The promotion of abortion services.
解説:
フィリピンのReproductive Health Lawでは、避妊や家族計画、母子保健、性教育の推進が重要な要素となっていますが、中絶サービスの推進は含まれていません。その他の選択肢は、この法律の実際の目的と一致しています。
Question 27（Abo）
Which of the following countries does NOT allow abortion on socioeconomic grounds?
a. Japan
b. India
c. South Africa
d. United Kingdom
Answer: a. Japan
解説:
日本では中絶は健康や経済的理由に基づいて許可されていますが、他の国々に比べて、より厳しい制限が設けられています。他の選択肢は、中絶が経済的理由で認められている国々です。
Question 28（Pregnancy）
Which of the following statements is NOT true about artificial insemination?
a. It requires the identity of the donor to remain anonymous.
b. It can involve either donor sperm or the partner’s sperm.
c. It is a common treatment for infertility.
d. It involves placing sperm directly into the reproductive tract.
Answer: a. It requires the identity of the donor to remain anonymous.
解説:
多くの人工授精プログラムでは、精子提供者の匿名性が守られますが、提供者が身元を明かす場合もあります。他の選択肢は人工授精の一般的な特徴を正確に説明しています。
Question 29（Pregnancy）
Which of the following describes in vitro fertilization (IVF)?
a. Sperm and egg are mixed in a laboratory dish for fertilization, and the embryo is later implanted in the uterus.
b. Sperm is inserted into the uterus, and fertilization occurs naturally.
c. Fertilization occurs within the fallopian tubes after sperm is injected.
d. Sperm is injected directly into an egg inside the woman’s body.
Answer: a. Sperm and egg are mixed in a laboratory dish for fertilization, and the embryo is later implanted in the uterus.
解説:
体外受精（IVF）では、卵子と精子を体外で受精させ、その後に胚を子宮に移植するプロセスが行われます。他の選択肢は異なる生殖技術を説明しており、IVFのプロセスとは異なります。
Question 30（Abo）
In Ireland, the death of Savita Halappanavar led to which significant legal change?
a. The complete prohibition of abortion.
b. The legalization of abortion.
c. Stricter laws regarding contraception.
d. A ban on prenatal genetic testing.
Answer: b. The legalization of abortion.
解説:
サビータ・ハラッパナヴァールの悲劇的な死は、アイルランドでの中絶合法化に向けた重要な転換点となり、最終的には中絶法の改正が行われました。他の選択肢は、この事件の影響を正確に反映していません。
Med Ethics Compilation
Question 1
An 18-year-old married ATV driver was admitted due to dysuria and urinary hesitancy. His mother is repeatedly calling to inquire about the test results, but the results are not all in, and his wife is not available. The nurse refers the situation to you. What is the most appropriate response?
a. Call the laboratory to facilitate the result.
b. Tell the nurse to relay everything.
c. Do not entertain the mother.
d. Inform the patient first prior to any disclosure.
Answer: d. Inform the patient first prior to any disclosure.
解説:
患者のプライバシーと守秘義務を尊重する必要があります。患者本人に対して情報を開示し、彼が同意しない限り、他の人に情報を伝えることはできません。母親であっても、プライバシー保護は優先されます。他の選択肢は倫理的および法的に問題がある対応です。
Question 2
An 18-year-old married ATV driver was admitted due to dysuria and urinary hesitancy. His mother is calling for test results, and his wife is out. You plan to insert a Foley catheter, but the patient is asleep. What should you do?
a. Inform the patient.
b. Let the mother sign the consent form.
c. Insert immediately as it is urgent.
d. Wait until the patient’s wife comes back.
Answer: a. Inform the patient.
解説:
患者が意識がある場合、医師は患者本人に情報を提供し、同意を得なければなりません。母親や妻に代わりに署名を求めることは、患者が成人であれば不適切です。他の選択肢は、患者の同意を得ない医療行為を行うもので、倫理的に問題があります。
Question 3
For the same patient, who should sign the consent form for Foley catheter insertion?
a. Mother
b. Patient
c. His wife
d. No need to sign
Answer: b. Patient
解説:
18歳の成人であるため、法的には患者自身が医療行為に対する同意を与える責任があります。母親や妻が代わりに同意することは、特別な理由がない限り認められません。他の選択肢は不正確です。
Question 4
Sheki, a female acrobat, refuses to be seen by medical students in her room. She is practicing her right to:
a. Confidentiality
b. Privacy
c. Refuse treatment
d. Informed consent
Answer: b. Privacy
解説:
患者は医療行為を受ける中で、個人情報やプライバシーが守られる権利を持っています。Shekiが医学生に診察されることを拒否するのは、プライバシー保護の一環です。他の選択肢は、このシナリオには当てはまりません。
Question 5
The following are true about patient’s rights, EXCEPT:
a. Every person has a right to health and medical care corresponding to his state of health.
b. If the patient has to wait for care, he shall be informed of the reason for the delay.
c. If any person cannot immediately be given treatment that is medically necessary, he shall be allowed to go home.
d. The patient has the right to appropriate health and medical care of good quality.
Answer: c. If any person cannot immediately be given treatment that is medically necessary, he shall be allowed to go home.
解説:
患者が緊急に治療を必要とする場合、適切な医療を提供する必要があり、家に帰すべきではありません。他の選択肢は、患者の権利に関する正しい記述です。
Question 6
The patient may be subjected to a procedure without written informed consent in the following cases, EXCEPT:
a. When the patient is either a minor or legally incompetent.
b. When the patient waives his right in writing.
c. When the law makes it compulsory for everyone to submit to a procedure.
d. When the patient is at the emergency room.
Answer: a. When the patient is either a minor or legally incompetent.
解説:
未成年者や法的無能力者に対しては、法的代理人の同意が必要です。他の選択肢は、緊急時や法的に義務付けられた場合において、書面の同意なしに行える状況です。
Question 7
Which of the following is NOT an example of professionalism?
a. Adhering to legal standards.
b. Arriving for work on time.
c. Maintaining appropriate dress.
d. Admitting patients in a private room.
Answer: d. Admitting patients in a private room.
解説:
プロフェッショナリズムとは、法的基準を守り、時間厳守し、適切な服装を保つことなどを指します。患者を個室に入れることはプロフェッショナリズムに関連するものではありません。
Question 8
A 40-year-old female patient returns for an appointment and expresses concerns about her husband. She asks for more time to discuss the details, but there are still patients waiting. How should you handle the situation?
a. Tell her to leave as there are other patients waiting.
b. Call the guard to facilitate her exit.
c. Grant her request to maintain the doctor-patient relationship.
d. Tell her you need to discuss only the most urgent issue due to time constraints.
Answer: d. Tell her you need to discuss only the most urgent issue due to time constraints.
解説:
医師は他の患者の時間も考慮し、限られた時間の中で最も緊急な問題に焦点を当てるべきです。必要な場合には別途時間を設けることも考えられます。他の選択肢は適切な対応ではありません。
Question 9
Three trauma patients are brought to the ER, and one of them accuses another of being involved in an affair. What is your most appropriate response?
a. Go to the wife and show her compassion.
b. Scold the husband for causing the trouble.
c. Take note of the injuries and give immediate intervention.
d. Defer treatment until a police officer arrives.
Answer: c. Take note of the injuries and give immediate intervention.
解説:
医師の第一の責任は患者の治療にあり、感情的な状況に巻き込まれるべきではありません。警察の到着を待つことなく、緊急治療を行うことが優先されます。
Question 10
An elderly man with end-stage emphysema has a living will stating he wants no invasive procedures, but he is awake and alert in the ER. Should mechanical ventilation be instituted?
a. The living will obviates the need for involving the patient in decision making.
b. If the patient is awake and alert, the living will is irrelevant.
c. The potential risks and benefits of mechanical ventilation need not be presented to the patient.
d. Even if the patient refuses mechanical ventilation, his wishes need not be honored in the ER.
Answer: b. If the patient is awake and alert, the living will is irrelevant.
解説:
患者が意識があり、判断能力がある場合、その時点での意思が最優先されます。リビングウィルは意識がない場合に適用されるため、現在の意思決定が重要です。他の選択肢は誤解を招くものです。
Question 11
A 64-year-old woman with Multiple Sclerosis is hospitalized and agrees to a feeding tube in the morning, but later becomes disoriented and refuses it. The next day, she is lucid again and agrees to the procedure but cannot recall her previous state. Is she competent to decide?
a. This patient is competent to decide because her underlying disease is NOT impairing her decision-making capacity.
b. This patient is competent to decide during her lucid periods.
c. The patient’s decision-making capacity is questionable, and getting a surrogate decision maker involved can help determine her true wishes.
d. In this situation where the patient is changing her decision, the doctor should decide whether or not to place a feeding tube.
Answer: c. The patient’s decision-making capacity is questionable, and getting a surrogate decision maker involved can help determine her true wishes.
解説:
この患者は一貫して判断を下せるわけではないため、判断能力に疑問が生じます。患者の混乱と記憶の欠如がある場合、代理意思決定者を介して患者の真の意志を確認することが必要です。他の選択肢は、判断能力を過剰に信頼するものです。
Question 12
A 75-year-old woman shows signs of abuse, possibly inflicted by her husband, who is her primary caregiver. She pleads with you not to say anything. How should you handle this situation?
a. This is a case of elder abuse, and the doctor is required to report incidents of abuse to the authorities.
b. The doctor is not permitted under HIPAA (Health Insurance Portability and Accountability Act) to report the abuse.
c. The patient should not be reported.
d. The laws supporting reporting elder abuse allow the doctor to break confidentiality and report suspected abuse.
Answer: d. The laws supporting reporting elder abuse allow the doctor to break confidentiality and report suspected abuse.
解説:
高齢者虐待の疑いがある場合、医師は守秘義務を超えて報告する法的義務があります。HIPAAは報告を制限するものではなく、高齢者の安全を確保するための法的枠組みが存在します。他の選択肢は事実に反します。
Question 13
A 60-year-old man with a poor prognosis asks you not to share any medical information with his wife, fearing she won’t handle it well. His wife asks you about his condition in the hallway. What are you required to do legally?
a. The doctor should inform the wife about her husband’s poor prognosis.
b. The doctor should not divulge the prognosis to the wife but should ask the nurse to let her know.
c. The wife is affected by her husband’s condition, and efforts should be made to encourage an open dialogue.
d. The doctor should not encourage the patient to talk to his wife about his condition.
Answer: c. The wife is affected by her husband’s condition, and efforts should be made to encourage an open dialogue.
解説:
配偶者の健康に大きな影響を与えるため、夫婦間でのオープンな対話を促すことが重要です。患者がプライバシーを望んだ場合でも、家族の福祉を考慮するべきです。他の選択肢は倫理的に不適切です。
Question 14
A mother brings her 18-month-old daughter for a routine exam and says they prefer not to immunize their child. How should you handle this?
a. Respect the mother’s wishes and say no more.
b. The risk faced by unimmunized individuals is relatively high.
c. The mother’s refusal to immunize poses a significant likelihood of harm to her child.
d. Make sure the mother understands the risks of not immunizing and attempt to correct any misconceptions.
Answer: d. Make sure the mother understands the risks of not immunizing and attempt to correct any misconceptions.
解説:
予防接種を拒否することは、子供に重大な健康リスクをもたらす可能性があるため、医師はリスクを説明し、誤解を正す努力をしなければなりません。母親の意向をただ尊重するだけでは、子供の健康が危険にさらされる可能性があります。
Question 15
When is a patient’s consent necessary?
a. In an emergency, when the patient needs a tracheostomy.
b. In a woman diagnosed with ectopic pregnancy that turns out to be acute appendicitis.
c. During an appendectomy, when the surgeon discovers an abnormal-looking ovary and decides to remove it.
d. During a laparotomy, when an artery is bleeding and the surgeon decides to ligate it.
Answer: c. During an appendectomy, when the surgeon discovers an abnormal-looking ovary and decides to remove it.
解説:
予期しない追加手術に対しては、患者の事前の同意が必要です。緊急でない限り、追加手術は同意なしで行うべきではありません。他の選択肢は、緊急時や手術の範囲内の対応であり、追加の同意が不要な場合です。
Question 16
James, an 18-year-old married male diagnosed with ruptured acute appendicitis, is still living with and dependent on his parents. Who should give consent for his surgery?
a. Parents
b. James
c. His wife
d. His doctor
Answer: b. James
解説:
18歳は法的に成人とみなされ、彼自身が手術の同意を与える権利を持っています。親や妻が代わりに同意を与える必要はありません。他の選択肢は法的に適切ではありません。
Question 17
The most important consideration regarding the information in informed consent is:
a. It be understood by the patient.
b. It must be communicated free of emotion.
c. It must be technically accurate.
d. It must be delivered in writing.
Answer: a. It be understood by the patient.
解説:
インフォームドコンセントでは、患者が情報を理解できることが最も重要です。技術的に正確であることや書面で提供されることも重要ですが、理解が伴わない場合、それらは無意味です。
Question 18
The following persons, in the order of priority, may give consent:
a. Spouse > either parent > son or daughter of legal age > guardian > brother or sister of legal age
b. Either parent > spouse > brother or sister of legal age > guardian > son or daughter of legal age
c. Guardian > brother or sister of legal age > either parent > son or daughter of legal age > spouse
d. Spouse > son or daughter of legal age > either parent > brother or sister of legal age > guardian
Answer: a. Spouse > either parent > son or daughter of legal age > guardian > brother or sister of legal age.
解説:
法的には、最優先される同意権者は配偶者であり、次に両親、次いで成年の子供、保護者、兄弟姉妹の順に同意権があります。他の選択肢は誤った順序を示しています。
Question 19
Which of the following is NOT true about the right to privacy?
a. The privacy of the patient must be assured at all stages of treatment.
b. The patient has the right to be free from unwarranted public exposure.
c. Informing the spouse or family up to the fourth degree of the patient’s condition is allowed.
d. Provided that the patient of legal age shall have the right to choose whom to inform.
Answer: c. Informing the spouse or family up to the fourth degree of the patient’s condition is allowed.
解説:
患者の状態について、許可なく広範な親族に情報を提供することは、プライバシーの侵害です。患者は、誰に情報を伝えるかを選択する権利を持っています。他の選択肢は患者のプライバシーに関する正しい記述です。
Question 20
On the right to information, the following are true EXCEPT:
a. The patient or their legal guardian has the right to be informed of the evaluation of the nature and extent of the disease.
b. He is not entitled to a thorough explanation of his bill.
c. At the end of confinement, the patient is entitled to a brief, written summary of the course of illness.
d. The patient is entitled to reproduction, at his/her expense, of pertinent medical records even if financially incapable.
Answer: b. He is not entitled to a thorough explanation of his bill.
解説:
患者は、自分の医療費や治療内容について十分な説明を受ける権利を持っています。他の選択肢は、患者の情報に関する権利を正確に述べています。
Question 21
The right to choose a health care provider and facility covers the following, EXCEPT:
a. The patient is free to choose the health care provider to serve him.
b. The patient has the right to discuss his condition with a consultant specialist, at the patient’s request for free.
c. He also has the right to seek a second opinion and subsequent opinions if appropriate, from another health care provider/practitioner.
d. The patient is free to choose the facility except when he is under the care of a service facility or when public health and safety demands or when the patient expressly waives this right in writing.
Answer: b. The patient has the right to discuss his condition with a consultant specialist, at the patient’s request for free.
解説:
患者には医療提供者や医療施設を選ぶ権利がありますが、無料で専門医の相談を受ける権利は通常ありません。他の選択肢は患者の選択権を正しく説明しています。
Question 22（D）
Which of the following is NOT true regarding the right to self-determination?
a. The patient has the right to avail himself/herself of any recommended diagnostic and treatment procedures.
b. Any person of legal age and sound mind may make an advance written directive.
c. Such an advance directive is written by the physician to administer terminal care when the patient suffers from the terminal phase of a terminal illness.
d. He is informed of the medical consequences of his choice.
Answer: c. Such an advance directive is written by the physician to administer terminal care when the patient suffers from the terminal phase of a terminal illness.
解説:
事前指示は患者自身によって書かれるものであり、医師が書くものではありません。他の選択肢は、自己決定権に関する正しい記述です。
Question 23
Regarding the right to leave, the following are true EXCEPT:
a. No patient shall be detained against his/her will in any health care institution solely on the basis of failure to settle financial obligations.
b. The patient has the right to leave the hospital or any other health care institution regardless of physical condition.
c. Unpaid bills shall be considered as a loss of income by the hospital and health care provider and deducted from gross income as income loss for that year.
d. The patient shall be allowed to leave the hospital even if no arrangements have been made to settle unpaid bills.
Answer: b. The patient has the right to leave the hospital or any other health care institution regardless of physical condition.
解説:
患者の健康状態が重大な場合、医師は患者の安全を考慮して、退院を遅らせることを推奨する場合があります。他の選択肢は、患者の退院権に関する正しい説明です。
Question 24
Which of the following is an example of an ethical conflict doctors face when treating dying patients?
a. Defining the exact criteria for death.
b. Convincing the family to remove a person from life support.
c. Deciding what to do when treatment that extends life also prolongs suffering.
d. Ongoing court battles over the legal status of euthanasia and doctor culpability.
Answer: c. Deciding what to do when treatment that extends life also prolongs suffering.
解説:
治療が患者の苦痛を長引かせるか、延命させるかの判断は医師にとって大きな倫理的問題です。他の選択肢は倫理的な葛藤を具体的に扱っていません。
Question 25（D）
A living will sets out which of the following?
a. The attorney’s right to make financial decisions on a person’s behalf.
b. The doctor’s right to terminate treatment.
c. The ill person’s right to express their wishes at the end of life.
d. The nurse’s right to choose intensive and aggressive treatments.
Answer: c. The ill person’s right to express their wishes at the end of life.
解説:
リビングウィルは患者自身が終末期医療においてどのような治療を受けたいかを表明するものであり、他者の権利を規定するものではありません。
Question 26
The following factors are considered in deciding a minor’s decision-making capacity, EXCEPT:
a. Chronological age.
b. Personal experience.
c. Emotional maturity.
d. Medical experience.
Answer: d. Medical experience.
解説:
未成年者の意思決定能力は年齢、経験、そして感情的成熟度によって評価されますが、医療経験自体は直接的な判断基準にはなりません。
Question 27（D）
The effects of advance care planning on end-of-life care include the following, EXCEPT:
a. Strengthened patient autonomy.
b. Decreased hope.
c. Decreased net costs of care.
d. Improved quality of care.
Answer: b. Decreased hope.
解説:
アドバンスケアプランニングは患者の自律性を強化し、ケアの質を向上させるとされていますが、希望を減少させるものではありません。
Question 28
False reassurance can result in more anxiety. Which of the following explains this best?
a. The trust between the patient and the physician will be broken.
b. The trust between the patient and the family members will be broken.
c. The trust between the family members and the physician will be broken.
d. Reassurance is never a good thing.
Answer: a. The trust between the patient and the physician will be broken.
解説:
誤った安心感を与えることは、患者と医師の信頼関係を壊し、さらなる不安を引き起こす可能性があります。他の選択肢は、問題の核心に触れていません。
Question 29
How is Gillick competency defined?
a. Children under 16 can consent to contraception if necessary.
b. Children under 16 can consent to an abortion if necessary.
c. Children between the ages of 16-18 can consent to medical treatment.
d. Children under 16 can consent if they have sufficient maturity and understanding.
Answer: d. Children under 16 can consent if they have sufficient maturity and understanding.
解説:
Gillickコンピテンシーでは、16歳未満の子供でも、十分な成熟度と理解力があれば、医療行為に対する同意ができるとされています。
Question 30
The following situations allow patients to make meaningful decisions for future healthcare crises, EXCEPT:
a. Understanding of life-limiting medical conditions.
b. Support of loved ones.
c. Patient’s choice not to make decisions.
d. Previous experiences of medical interventions.
Answer: c. Patient’s choice not to make decisions.
解説:
患者が意思決定をしない選択をした場合、将来の医療危機に備えた意味のある意思決定が行われません。他の選択肢は正しい判断基準です。
Question 31（D）
What is the common problem with advance directives?
a. They are not enforceable by law, and therefore doctors and family frequently disregard them.
b. Many people cannot or will not write a living will because their religion condemns it as a form of suicide.
c. In some cases, people will change their minds as they near death, but they will not get a chance to change their advance directive.
d. It does not fulfill its main function of relieving doctors of responsibility for stopping treatment.
Answer: c. In some cases, people will change their minds as they near death, but they will not get a chance to change their advance directive.
解説:
事前指示書を書いた後、死が近づくにつれて考えを変える人がいるかもしれませんが、その変更の機会が与えられない場合があります。他の選択肢は誤解を招きます。
Question 32（D）
What is the function of funeral practices and rituals?
a. To help resolve family conflicts.
b. To help the bereaved family cope with grief and re-establish community bonds after the loss.
c. To take the bereaved family’s attention away from the death and reaffirm life’s deeper meaning.
d. To give family and friends the opportunity to cut ties with the deceased and continue on with their lives.
Answer: b. To help the bereaved family cope with grief and re-establish community bonds after the loss.
解説:
葬儀や儀式は、遺族が悲しみに対処し、社会的なつながりを再確立するための助けとなります。他の選択肢は儀式の役割を正確に反映していません。
Question 33（D）
From published studies, the pattern of grieving depends on all of the following, EXCEPT:
a. The gender of the bereaved person.
b. How the patient dies.
c. How suddenly the death occurred.
d. The age of the bereaved person.
Answer: b. How the patient dies.
解説:
喪失の悲しみのパターンは、年齢や性別、死がどれほど突然であったかに影響されますが、患者の死因自体が直接的な要因ではありません。
Question 34
Which of the following is true when deciding for seriously ill newborns?
a. When an intervention no longer helps to achieve the goals of care or promote quality of life, it is unethically appropriate to withdraw it.
b. Decision makers must assess whether the choice for the newborn will negate a choice the future individual would want to make.
c. Decisions to discontinue care can be allowed in any circumstance.
d. Providing information to support parents in decision-making about their child’s care is a key responsibility for parents.
Answer: b. Decision makers must assess whether the choice for the newborn will negate a choice the future individual would want to make.
解説:
新生児のケアにおいて、将来の本人の意思決定を考慮して決定することが求められます。他の選択肢は正しくありません。
Question 35（D）
Studies that compare older and younger people find that older people express more concern about which of the following aspects of death?
a. The pain of dying.
b. The fear of dying.
c. The process of dying.
d. The emotional trauma of dying.
Answer: c. The process of dying.
解説:
高齢者は死そのものよりも、死に至る過程に対する懸念を抱く傾向があります。他の選択肢は、主に若い人々が抱く懸念です。
Question 36
Which of the following is NOT true about prenatal genetic testing?
a. It is used to determine whether a fetus is affected by genetic abnormalities.
b. It is used to determine the sex of the fetus.
c. Depending on the findings, a decision can be made to proceed with or terminate the pregnancy.
d. Physicians do not need to determine when to offer such tests as it is the patient’s decision.
Answer: d. Physicians do not need to determine when to offer such tests as it is the patient’s decision.
解説:
医師は検査のタイミングや必要性についての判断を行い、患者に選択肢を提供する責任があります。他の選択肢は正しい情報です。
Question 37（Pregnancy）
The following are reasons why a surrogate may be needed, EXCEPT:
a. The genetic mother is unable to carry the child to term because of disease or injury.
b. The genetic mother may possess deleterious genetic traits that could be passed on to the child.
c. The couple is unable to adopt a child.
d. The genetic father is too old to safely carry a child to term, or the child may be born with abnormalities.
Answer: d. The genetic father is too old to safely carry a child to term, or the child may be born with abnormalities.
解説:
遺伝的父親が子供を出産できない理由で代理母を必要とすることはありません。他の選択肢は代理母が必要とされる正当な理由を示しています。
Question 38
Which of the following is NOT true when dealing with end-of-life issues?
a. Physicians should be knowledgeable about ethical issues relevant to end-of-life care.
b. The physician needs to have a good understanding of ethical principles and issues.
c. On issues such as medical futility and withdrawing/withholding medical interventions, the sole decision maker is the physician.
d. Patient autonomy should always be preserved even when the patient lacks decision-making capacity.
Answer: c. On issues such as medical futility and withdrawing/withholding medical interventions, the sole decision maker is the physician.
解説:
医師は患者や家族と相談して決定を下すべきであり、一方的に判断するべきではありません。他の選択肢は正しい情報です。
Question 39（D）
At the end of life, the Rule of Double Effect can be applied in which of the following settings?
a. Giving a higher dose of narcotics can relieve the patient from suffering.
b. In any circumstance, it is not permissible.
c. The prime intention is to control the pain.
d. The purpose is to hasten death.
Answer: c. The prime intention is to control the pain.
解説:
二重効果の原則は、痛みを和らげるために行われた行為が、結果として生命を短縮する可能性がある場合に適用されますが、目的は痛みの管理にあります。
Question 40（D）
This country allows physician-assisted suicide without a minimum age requirement, diagnosis, or symptom state:
a. Colombia
b. Spain
c. Switzerland
d. Netherlands
Answer: c. Switzerland
解説:
スイスでは、年齢や診断、症状に関係なく、医師による自殺幇助が合法とされています。他の国は、制限がより厳しい場合があります。
Question 41（D）
Which of the following is true about spiritual care at the end of life?
a. The physician should not explore the patient’s past and current spiritual life.
b. Spirituality may span affirmation of specific religious beliefs central to the life of the dying.
c. Religion is not part of the patient’s management.
d. Spiritual issues should be left as the responsibility of family members.
Answer: b. Spirituality may span affirmation of specific religious beliefs central to the life of the dying.
解説:
スピリチュアルケアは、患者の宗教的・精神的な信念を尊重することが含まれます。医師がスピリチュアルな側面を探ることは、患者の全体的なケアの一環です。その他の選択肢は、スピリチュアルケアの重要性を軽視しています。
Question 42（D）
Which of the following is NOT true about a Do Not Resuscitate (DNR) order?
a. The patient or family members decide.
b. The doctor orders it in the chart.
c. Once a DNR is ordered, the status applies until the patient dies.
d. Directives on the use of resuscitative measures such as CPR and medications should be specified.
Answer: c. Once a DNR is ordered, the status applies until the patient dies.
解説:
DNRは患者の状態が変化した場合に再評価されるべきであり、一度発令された後も、変更が可能です。他の選択肢は、DNRに関する正しい説明です。
Question 43（D）
At the end of life care, which of the following principles applies?
a. Beneficence – avoidance of infliction of intentional harm.
b. Nonmaleficence – doing what is good for the patient.
c. Autonomy – the patient’s right to self-determination.
d. Justice – truthfulness in delivering healthcare.
Answer: c. Autonomy – the patient’s right to self-determination.
解説:
終末期医療では、患者が自己決定権を持つことが重要です。他の選択肢は倫理原則の定義に誤りがあります。Beneficence は「患者の利益を最優先にすること」、Nonmaleficence は「害を与えないこと」を指します。
Question 44（D）
Which of the following is NOT true about dealing with end-of-life issues?
a. Physicians should be knowledgeable of ethical issues pertinent to end-of-life care.
b. The physician needs to have a good understanding of ethical principles and issues.
c. On issues such as medical futility and withdrawing or withholding medical interventions, the sole decision-maker is the physician.
d. Patient autonomy should always be preserved, even when the patient lacks decision-making capacity.
Answer: c. On issues such as medical futility and withdrawing or withholding medical interventions, the sole decision-maker is the physician.
解説:
医療の無益性や治療の中止に関する決定は、医師が単独で行うものではなく、患者や家族と相談して決めるべきです。他の選択肢は倫理的に正しい説明です。
Question 45
Which of the following is NOT true about handling contraception?
a. The primary concern should always be the welfare of the patient.
b. The doctor must respect the patient’s right to make their own decisions.
c. If the doctor has strong religious opposition to birth control, he should advise patients following his paternalistic view.
d. Doctors should explain the methods available and help patients weigh the advantages and disadvantages of the methods.
Answer: c. If the doctor has strong religious opposition to birth control, he should advise patients following his paternalistic view.
解説:
医師は自分の宗教的な見解を患者に押し付けるべきではなく、患者の選択を尊重し、医療の選択肢を公平に説明すべきです。他の選択肢は患者中心のケアの正しい原則です。
Question 46（D）
Ameenah has asked Gamora and her sibling Nebula to sign a document stating that they will make decisions on her behalf should she lose her mental capacity. What is this document called?
a. A living will.
b. An incapacitated wish.
c. A proxy directive.
d. An advanced instruction.
Answer: c. A proxy directive.
解説:
代理指示書（proxy directive）は、患者が意思決定能力を失った場合に、他者が代わりに意思決定を行うことを指示する書類です。Living will（リビングウィル）は終末期の治療に関する指示を記述する文書です。
Question 47（D）
Tom was in a car accident and is now in a coma. His medical chart indicates that he is not to be revived if his heart stops. What is this medical order called?
a. Fail-to-revive order.
b. Do-not-resuscitate order.
c. Advance-directive order.
d. Living-will order.
Answer: b. Do-not-resuscitate order.
解説:
「DNR（Do-not-resuscitate）オーダー」は、心停止が発生しても蘇生を行わないという指示を示します。その他の選択肢は、DNRを正しく表現していません。
Question 48（Pregnancy）
What is the Reproductive Health Law in the Philippines known as?
a. RA 9262
b. RA 10173
c. RA 10354
d. RA 3815
Answer: c. RA 10354
解説:
RA 10354は、フィリピンのReproductive Health Lawとして知られており、性と生殖に関する健康サービスの提供を規定しています。他の選択肢は別の法律を指します。
Question 49
A retired general was rushed to the hospital for urinary hesitancy. His family demanded attention from a specific doctor, but the hospital protocol did not allow this. What should the attending physician do?
a. Don’t mind them, just continue with your management.
b. Refuse to admit the patient.
c. Advise them to go to the hospital where their preferred specialists are affiliated.
d. Let them sign a waiver.
Answer: c. Advise them to go to the hospital where their preferred specialists are affiliated.
解説:
家族が特定の医師を求める場合、提携病院に行くよう勧めることが最も適切です。その他の選択肢は患者のケアや倫理的対応において問題があります。
Question 50
A popular doctor has returned to the Philippines and wants to open a clinic but has no patients after three months. Which of the following would you NOT advise?
a. Offer promos/discounts to the first 100 patients.
b. Post on Facebook about the clinic’s opening.
c. Give tokens to the first patients.
d. Give incentives to paramedical/hospital staff for referring cases to the clinic.
Answer: d. Give incentives to paramedical/hospital staff for referring cases to the clinic.
解説:
医療従事者に対して紹介料を支払うことは、倫理的に問題があり、規制違反になる可能性があります。その他の選択肢は合法的なマーケティング手法です。
Question 51
A 68-year-old widow was shot and transported to a hospital without available surgeons. If you were the doctor who initially denied the case, how would you address this?
a. Be firm in your decision not to accept the patient.
b. File a complaint against the PNP for illegally transporting the patient.
c. Offer the hospital ambulance to transport the patient to the tertiary hospital.
d. Start an IV line, pack the wounds, and send the patient to the tertiary hospital.
Answer: d. Start an IV line, pack the wounds, and send the patient to the tertiary hospital.
解説:
緊急時には可能な限りの応急処置を行い、適切な治療が提供できる病院へ転送することが最善です。患者を拒否することは不適切です。
Question 52
In a COVID-19 scenario where one patient tests positive, how should you handle the situation according to Utilitarian Theory of Justice?
a. Do not announce the result.
b. Ask the nurse to explain the protocol.
c. Isolate the patient who tested positive.
d. Call the guard to maintain order.
Answer: c. Isolate the patient who tested positive.
解説:
Utilitarian Theory of Justiceでは、最も多くの人々の利益を考慮して行動することが重要です。感染が広がらないように、陽性患者を隔離するのが最善の対応です。
Question 53
The secrecy of information in a physician-patient relationship when demanded by law is called:
a. Private communication.
b. Ethical information.
c. Confidential information.
d. Privileged communication.
Answer: d. Privileged communication.
解説:
医師と患者の間の「privileged communication」は、法律によって守られ、特定の条件下でのみ開示されることが許される情報です。他の選択肢は適切な法律用語ではありません。
Question 54
Why is Medical Ethics important?
a. It is part of the curriculum.
b. Health care decisions are analyzed clinically.
c. Decisions are not based on ethical grounds.
d. It defends against increasing litigation.
Answer: d. It defends against increasing litigation.
解説:
医療倫理は、医療者が法的問題を回避し、適切な意思決定を行うために重要です。その他の選択肢は、医療倫理の重要性を正しく反映していません。
Question 55
A 32-year-old patient refuses stitches for a profusely bleeding wound, claiming it is small. What should be the best response?
a. Sedate and suture the patient.
b. Make sure the patient is competent.
c. Respect his decision.
d. Ask his wife.
Answer: b. Make sure the patient is competent.
解説:
患者が治療を拒否する場合、まず患者の判断能力があることを確認する必要があります。判断能力がある場合には、患者の意思を尊重することが求められます。
Question 56
A six-month-old infant presents with severe respiratory distress and cyanosis. What should be your priority?
a. Admit and intubate the patient.
b. Continue taking the history for clarification.
c. Let the mother and aunt agree first.
d. Refer to the tertiary hospital immediately.
Answer: a. Admit and intubate the patient.
解説:
緊急時には、適切な治療（この場合、気管挿管）を迅速に行うことが最優先されます。家族間の合意やさらなる履歴調査は後回しにすべきです。
Question 57（Pregnancy）
An IUD was inserted into a patient after delivery without her explicit consent. This is an example of:
a. Coercion.
b. Autonomy.
c. Paternalism.
d. Rule of Double Effect.
Answer: a. Coercion.
解説:
患者の同意なしに避妊手段を挿入することは強制であり、倫理的に問題があります。患者の自己決定権を尊重しない行為は、患者の意思に反する医療介入です。
Question 58
Which document summarizes ethical principles and guidelines for research involving human subjects?
a. Nuremberg Code.
b. Declaration of Helsinki.
c. The Belmont Report.
d. The Willowbrook Experiment.
Answer: b. Declaration of Helsinki.
解説:
ヘルシンキ宣言は、人間を対象とした研究に関する倫理的原則を定めた国際的な指針です。その他の選択肢は、異なる文脈での倫理に関する文書や事件です。
Question 59
Which theory holds that justice requires equals to be treated equally and unequals unequally, but in proportion to relevant inequalities?
a. Utilitarian Theory of Justice.
b. Egalitarian Theory of Justice.
c. Principle of Formal Justice.
d. Libertarian Theory of Justice.
Answer: c. Principle of Formal Justice.
解説:
形式的正義の原則は、等しい者を平等に扱い、不平等な者をその不平等に応じて不平等に扱うことを要求します。その他の理論は異なる正義の概念に基づいています。
Question 60
A physician may apply a procedure to the patient even if it is against the patient’s wishes if:
a. The procedure is necessary for the good of the patient.
b. The procedure is required by law.
c. There is implied consent by the patient’s spouse.
d. The procedure is free.
Answer: b. The procedure is required by law.
解説:
法的に義務付けられている場合、患者の同意がない場合でも、医師は処置を行うことができます。他の選択肢は正当化されません。
Question 61
Which of the following is NOT true of the Hippocratic Oath?
a. It is an important event in the development of medical ethics.
b. It first appeared in 400 BCE.
c. It is an oath historically taken by doctors swearing to practice medicine ethically.
d. The one used during the oath-taking ceremony was based on the revision of Louis Mozzarella.
Answer: d. The one used during the oath-taking ceremony was based on the revision of Louis Mozzarella.
解説:
現代のヒポクラテスの誓いはさまざまな改訂がされてきましたが、Louis Mozzarellaという人物の改訂に基づいたものではありません。他の選択肢は、ヒポクラテスの誓いに関する正確な情報です。
Question 62
It is the core motivator for behavior:
a. Ethics
b. Values
c. Principle
d. Morals
Answer: b. Values
解説:
「価値観（Values）」は、人の行動における主要な動機付け要因です。他の選択肢は、行動や意思決定に影響を与えるが、核心的な動機とは異なります。
Question 63
After their last subject, Julito ordered a buy-one-take-one cappuccino for himself. Dionisio wanted a macchiato but chose to have ice cream instead. Julito’s act is an example of:
a. Beneficence
b. Nonmaleficence
c. Persuasion
d. Autonomy
Answer: d. Autonomy
解説:
「Autonomy（自律）」は、自分の行動を自分で選択する能力を意味します。ジュリトは自分で飲み物を選択したため、これは自律の例です。
Question 64
It refers to one’s ability to make a particular decision:
a. Autonomy
b. Voluntariness
c. Competency
d. Rationalization
Answer: c. Competency
解説:
「Competency（判断能力）」は、特定の意思決定をする能力を指します。他の選択肢は意思決定に関連する概念ですが、判断能力とは異なります。
Question 65
According to the Rule of Double Effect, the permissible effect may be pursued even though the harmful effect may follow, in the following conditions EXCEPT:
a. The agent intends only the good effect.
b. The bad effect must be a means to the good effect.
c. The good effect must outweigh the bad effect.
d. The act must be good.
Answer: b. The bad effect must be a means to the good effect.
解説:
二重効果の原則では、悪い効果は善い効果を達成するための手段であってはならず、善い効果のみを意図して行動する必要があります。他の条件は二重効果の原則に合致します。
Question 66
Which of the following does NOT describe confidentiality?
a. It is basically a legal obligation.
b. It points to the duty that rests on those to whom private information is entrusted.
c. It is the individual’s right to be free from unwanted external scrutiny.
d. Privileged communication should not be unnecessarily disclosed.
Answer: c. It is the individual’s right to be free from unwanted external scrutiny.
解説:
「個人のプライバシーからの保護」は、守秘義務とは異なる概念です。守秘義務は、特に医療者が個人情報を第三者に開示しない義務に関連しています。
Question 67
Which of the following is NOT true of Electronic Medical Records (EMRs)?
a. They transcend the physical limitation of paper files.
b. They improve the quality and accuracy of data.
c. They facilitate access and sharing of health information.
d. They tend to redefine the scope of informed consent.
Answer: d. They tend to redefine the scope of informed consent.
解説:
電子カルテ（EMR）はインフォームドコンセントの範囲を再定義するものではありません。EMRの主な目的は、情報の保存とアクセスを改善し、医療の質と効率を向上させることです。
Question 68
It is verbal or written communication by a patient wishing to receive treatment:
a. Informed consent
b. Implied consent
c. Expressed consent
d. Proxy consent
Answer: c. Expressed consent
解説:
「Expressed consent（明示的同意）」は、患者が口頭または書面で明示的に治療を希望する場合に与える同意を指します。
Question 69
This law provides that individuals availing of insurance coverage sign waivers allowing health maintenance organizations to access their medical records in exchange for benefits or claims:
a. RA 3185
b. RA 7875
c. RA 8505
d. RA 386
Answer: b. RA 7875
解説:
RA 7875は、フィリピンの国民健康保険制度（PhilHealth）に関する法律であり、医療記録へのアクセスに関する規定も含まれています。
Question 70
Which of the following can be done when a person lacks decision-making capacity?
a. Wait for the nearest kin to decide.
b. Give the patient time to organize his thoughts.
c. The doctor decides.
d. Identify an appropriate surrogate.
Answer: d. Identify an appropriate surrogate.
解説:
患者が意思決定能力を欠いている場合、適切な代理人を特定して意思決定を委ねることが一般的な手順です。他の選択肢は、代理意思決定のプロセスにそぐわないものです。
Question 71
Which of the following statements is true?
a. Health care providers are the holders of privacy.
b. Patients are the bearers of the duty of confidentiality.
c. Revelation of secrets is now criminalized.
d. Any injury that the patient may incur will make the physician liable.
Answer: c. Revelation of secrets is now criminalized.
解説:
患者の秘密を暴露することは多くの国で刑事罰の対象となっています。プライバシーと守秘義務の保持者は医療提供者であり、患者は守秘義務を課せられていません。
Question 72
This requires that subjects be informed that they may decline to take part in a clinical investigation or may stop participation at any time without penalty or loss of benefits:
a. Informed consent
b. Voluntary participation
c. Internal arrangement
d. Confidentiality
Answer: b. Voluntary participation
解説:
「Voluntary participation（自主参加）」は、臨床試験に参加する被験者が自発的に参加を決定できることを意味し、参加を拒否したり中断したりすることができます。
Question 73
Which of the following is NOT true about withholding information from a patient?
a. Withholding information without the patient’s knowledge is ethically unacceptable.
b. The obligation to communicate means that the physician must give information immediately.
c. Once the emergency situation has been resolved, the physician should convey the information.
d. Withholding information is allowed in an emergency situation.
Answer: b. The obligation to communicate means that the physician must give information immediately.
解説:
医師は患者に情報を提供する義務がありますが、緊急事態や適切なタイミングで情報を伝えることができない場合があります。他の選択肢は正しい記述です。
Question 74
This is an act protecting individual personal information in information and communications systems in the government and private sectors:
a. RA 9262
b. RA 10173
c. RA 3185
d. RA 7875
Answer: b. RA 10173
解説:
RA 10173は、フィリピンの「データプライバシー法」であり、個人情報の保護に関する規定を定めています。
Question 75
In order to be an autonomous choice, the following must be complied EXCEPT:
a. The choice must be adequately informed.
b. The patient should have decision-making capacity.
c. The patient is competent.
d. It should be involuntary.
Answer: d. It should be involuntary.
解説:
自律的な選択は、患者が十分に情報を与えられ、判断能力を持ち、意思をもって行われる必要があります。「自律的」であるためには、自発的でなければなりません。
Question 76
Informed consent involves all of the following EXCEPT:
a. Facilitating the potential subject’s comprehension of the information.
b. Providing a potential subject with inadequate information about participation.
c. Obtaining the potential subject’s voluntary agreement to participate.
d. Providing adequate opportunity for the potential subject to ask questions.
Answer: b. Providing a potential subject with inadequate information about participation.
解説:
インフォームドコンセントは、患者に適切な情報を提供し、自発的な同意を得ることを目的としています。情報が不十分であれば、インフォームドコンセントは成立しません。
Question 77
This principle underlies the medical maxim “Primum Non Nocere”:
a. Beneficence
b. Nonmaleficence
c. Scylla & Charybdis
d. Maleficence
Answer: b. Nonmaleficence
解説:
「Primum Non Nocere（まず害を与えるな）」は、「Nonmaleficence（無害）」の原則に基づいており、医師が患者に害を与えないように行動することを求めています。
データプライバシー（自作）
Question 1:
Which law in the Philippines protects the privacy of personal information and ensures the free flow of information within government and private sector information systems?
a. Republic Act No. 8505
b. Republic Act No. 10173
c. Republic Act No. 4200
d. Republic Act No. 9165
Answer: b. Republic Act No. 10173
解説:
Republic Act No. 10173, also known as the Data Privacy Act of 2012, は、個人情報のプライバシーを保護し、政府および民間セクターの情報通信システムで情報が自由に流れるようにするための法律です。他の選択肢は異なる法律を指しています。たとえば、
aはレイプ被害者の保護に関する法律（8505）
cはワイヤータッピングに関する法律（4200）
dは薬物リハビリテーション記録の機密性（9165）
を保護する法律です。
Question 2:
Under which law is unauthorized access to electronic data and documents punishable by fines and mandatory imprisonment?
a. Republic Act No. 8504
b. Republic Act No. 9165
c. Electronic Commerce Act of 2000
d. Republic Act No. 4200
Answer: c. Electronic Commerce Act of 2000
解説:
Electronic Commerce Act of 2000は、無許可のコンピュータシステムへのアクセスを禁じており、これに違反した者には罰金と懲役が科されます。
aはHIV感染者のプライバシー保護に関する法律（8504）
bは薬物リハビリテーション記録の機密性保護に関する法律
dは対ワイヤータッピング法です。
Question 3:
Which of the following laws ensures the confidentiality of HIV patients’ personal information?
a. Republic Act No. 8504
b. Republic Act No. 10173
c. Republic Act No. 9344
d. Republic Act No. 4200
Answer: a. Republic Act No. 8504
解説:
Republic Act No. 8504は、HIV患者の個人情報を守るために作られた法律です。他の選択肢は異なる分野の法律であり、bはデータプライバシー法、cは未成年者の保護に関する法律、dは対ワイヤータッピング法です。
Question 4:
Which of the following situations is an exception to confidentiality due to public order and safety?
a. Consent of the patient
b. Reporting of certain communicable diseases
c. Lawful order of the court
d. Research purposes
Answer: b. Reporting of certain communicable diseases
解説:
伝染病の報告義務は、公秩序と安全のために情報の機密性が例外となるケースです。aは患者の同意に基づく例外、cは裁判所命令に基づく例外、dは研究目的のための匿名化されたデータ使用に関する例外です。
Question 5:
Which law prohibits unauthorized recording and disclosure of private communications, including doctor-patient conversations?
a. Republic Act No. 8504
b. Republic Act No. 9165
c. Republic Act No. 4200
d. Republic Act No. 10173
Answer: c. Republic Act No. 4200
解説:
Republic Act No. 4200, 対ワイヤータッピング法は、無許可の録音や個人の会話の内容を記録・公開することを禁じています。他の選択肢は、aはHIV患者の情報保護、bは薬物リハビリテーション記録の機密性、dはデータプライバシー法を指しています。
Question 6:
Which law mandates the confidentiality of records related to drug rehabilitation?
a. Republic Act No. 8504
b. Republic Act No. 9165
c. Republic Act No. 4200
d. Republic Act No. 9344
Answer: b. Republic Act No. 9165
解説:
Republic Act No. 9165は薬物リハビリテーションを受けた人々の記録の機密性に関する法律です。他の選択肢は、aはHIV患者の情報保護、cはワイヤータッピング法、dは未成年者の保護に関する法律です。
Question 7:
Which law provides protection for rape victims’ confidentiality?
a. Republic Act No. 8505
b. Republic Act No. 10173
c. Republic Act No. 9165
d. Republic Act No. 9344
Answer: a. Republic Act No. 8505
解説:
Republic Act No. 8505は、レイプ被害者の保護に関する法律です。他の選択肢は異なる法律を指しています。bはデータプライバシー法、cは薬物リハビリテーション記録の機密性保護、dは未成年者の保護に関する法律です。
Question 8:
Which law emphasizes the confidentiality of records related to violence against women and their children?
a. Republic Act No. 8504
b. Republic Act No. 9262
c. Republic Act No. 4200
d. Republic Act No. 9344
Answer: b. Republic Act No. 9262
解説:
Republic Act No. 9262は、女性と子どもに対する暴力に関連する記録の機密性を保護する法律です。他の選択肢は、aはHIV患者の情報保護、cは対ワイヤータッピング法、dは未成年者の保護に関する法律です。
Question 9:
Which law governs the confidentiality of juvenile records?
a. Republic Act No. 8504
b. Republic Act No. 9344
c. Republic Act No. 9165
d. Republic Act No. 10173
Answer: b. Republic Act No. 9344
解説:
Republic Act No. 9344は、未成年者に関する法的問題に対する保護を定めた法律です。他の選択肢は異なる分野に関連する法律で、aはHIV患者の情報保護、cは薬物リハビリテーション記録の機密性、dはデータプライバシー法です。
Question 10:
Under what circumstances can medical information be disclosed for research purposes without patient consent?
a. When the data is anonymized
b. For insurance claim purposes
c. Under lawful court order
d. When reporting communicable diseases
Answer: a. When the data is anonymized
解説:
患者の同意なしで医療情報を研究目的で使用できるのは、データが匿名化され、敏感でない場合に限ります。bは保険請求のための開示、cは裁判所命令による開示、dは伝染病報告のための開示です。
ここで言う「敏感でない (non-sensitive)」とは、医療データが個人のプライバシーや安全に重大な影響を与えない性質を持っていることを指します。具体的には、以下のような情報が含まれていない場合を指します。
敏感な情報とは
- 個人を特定できる情報 (Personally Identifiable Information, PII): 名前、住所、電話番号、個人識別番号など、個人を直接特定できる情報。
- 健康に関する詳細な情報 (Health Information): 診断名、病歴、処方薬、治療内容、HIVや精神疾患のようなセンシティブな疾患の情報。
- 遺伝情報 (Genetic Information): 遺伝的な素因や検査結果など、遺伝に関するデータ。
例として敏感でない情報
- 集計データ (Aggregate Data): 特定の個人を識別できない、年齢や性別、診療の傾向など、統計的なデータ。
- 匿名化されたデータ (Anonymized Data): 個人を特定できないようにすべての識別情報が削除されたデータ。
したがって、「敏感でない」とは、個人の特定やその人のプライバシーに対してリスクを生じさせる可能性が極めて低い情報であることを意味します。このようなデータであれば、研究目的で患者の同意なしに使用できる場合があります。
| 法律の名称 (Law/Act Name) | 内容 (Content) |
|---|---|
| フィリピン共和国法第10173号 (Republic Act No. 10173) | データプライバシー法 (Data Privacy Act of 2012)。個人情報の保護と情報の自由な流れを確保する法律。 |
| フィリピン憲法第3条 (Article 3 of the Philippine Constitution) | 通信および書簡のプライバシーは不可侵。裁判所命令または公共の安全・秩序のために必要な場合を除く。 |
| フィリピン民法 (Republic Act No. 386, Civil Code) | すべての人は、他者の尊厳、人格、プライバシー、心の平和を尊重する義務がある。 |
| 改正刑法 (Revised Penal Code, Act No. 3185) | 秘密の漏洩を犯罪とし、特に政府職員や医師が取得した機密情報の不正な開示に対して処罰する。 |
| フィリピン共和国法第8505号 (Republic Act No. 8505) | レイプ被害者の保護に関する法律 (Rape Victim Assistance and Protection Act of 1998)。 |
| フィリピン共和国法第9344号 (Republic Act No. 9344) | 未成年者の保護に関する法律 (Juvenile Justice and Welfare Act of 2006)。 |
| フィリピン共和国法第8504号 (Republic Act No. 8504) | HIV患者の個人情報の取り扱いに関する法令。 |
| フィリピン共和国法第9165号 (Republic Act No. 9165) | 薬物リハビリテーションの記録の機密性を保護する法令。 |
| フィリピン共和国法第9262号 (Republic Act No. 9262) | 女性とその子どもに対する暴力に関連する記録の機密性を保護する法令。 |
| 電子商取引法 (Electronic Commerce Act of 2000) | 電子データやメッセージの機密性を守る義務。無許可のコンピュータシステムへのアクセスは罰金および懲役が科される。 |
| フィリピン共和国法第4200号 (Republic Act No. 4200) | 対ワイヤータッピング法 (Anti-Wiretapping Law)。無許可での通信の録音や開示を禁じ、医師と患者の会話も含まれる。 |
| フィリピン共和国法第7875号 (Republic Act No. 7875) | 保険加入者が医療記録へのアクセスを許可する場合、保険請求の目的での開示が可能。 |
| フィリピン共和国法第3753号 (Republic Act No. 3753) | 出生や死亡の登録に関する法令。 |
| フィリピン共和国法第3573号 (Republic Act No. 3573) | 伝染病の報告義務に関する法令。 |
| 大統領令第212号 (Presidential Decree No. 212) | 重傷や軽傷の治療報告に関する法令。 |
| 大統領令第603号 (Presidential Decree No. 603) | 子どもへの虐待や虐待の報告義務に関する法令。 |
| 裁判所命令 (Lawful Order of the Court) | 有効な召喚状、令状、または裁判所の命令に基づき、健康情報の開示が許可される。 |
| National Ethical Guidelines for Health Research | 研究目的で医療記録を使用する場合、データが匿名化され敏感でない限り、患者の同意なしで使用が許可される。 |
| WMA国際医療倫理コード (WMA’s International Code of Medical Ethics) | 倫理的に、患者や他者に差し迫った危険がある場合には、機密性を破ることが許される。 |
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