Legal Med Pearls Handout October 2023 PDF

TOPNOTCH MEDICAL BOARD PREP LEGAL MED, MED JURIS, AND ETHICS PEARLS HANDOUT BY DR. GEREMIAH LLANES For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the October 2023 PLE batch. This will be rendered obsolete for the...

TOPNOTCH MEDICAL BOARD PREP LEGAL MED, MED JURIS, AND ETHICS PEARLS HANDOUT BY DR. GEREMIAH LLANES For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the October 2023 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. IMPORTANT LEGAL INFORMATION The handouts, videos and other review materials, provided by Topnotch Medical Board Preparation Incorporated are duly protected by RA 8293 otherwise known as the Intellectual Property Code of the Philippines, and shall only be for the sole use of the person: a) whose name appear on the handout or review material, b) person subscribed to Topnotch Medical Board Preparation Incorporated Program or c) is the recipient of this electronic communication. 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Topnotch review materials are updated every six (6) months based on the current trends and feedback. Please buy all recommended review books and other materials listed below. THIS HANDOUT IS NOT FOR SALE! This handout is only valid for the October 2023 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. LEGAL MEDICINE, MEDICAL JURISPRUDENCE, AND ETHICS – PEARLS By Geremiah Edison Daniel C. Llanes, MD Which instance is the physician-patient relationship breached? A. Abandonment 1. B. Treatment harm C. Breach of privacy during an autopsy D. Non-payment of professional fees TERMINATION OF THE CONTRACT • Recovery of patient • Death of patient • Withdrawal of MD provided that oPatient has consented to the withdrawal oPatient is given ample time to look for another MD • • • • Discharge of the MD by the patient Death or incapacity of MD Fulfilment of obligations stipulated in the contract In cases of emergency, when the attending MD/ MD of choice of patient is available; or when there is cessation of the condition of emergency • Expiration of the period, if the contract of the medical service is for a specific period • Mutual agreement between the MD and patient that the MDpatient relationship is terminate While driving by a busy street, you witnessed the confrontation between the police and a gang. During this conflict, you noticed an adult civilian was shot and was limping towards safety. Which action upholds your inherent right as a physician? 2. A. Not responding due to possible harm to yourself B. Counterflowing to reach the victim C. Deciding on behalf of the conscious, stable, and mentally sound victim D. Asking the patient for compensation for the service you will render RIGHTS OF A PHYSICIAN INHERENT INCIDENTAL • To choose patients • Right of way while oExcept in emergencies responding to call of oIf with threat to MD – may emergency not respond • Exemption from execution oIf during an epidemic – of instruments and library need to respond • To hold certain offices • To limit practice • To compensation • To determine appropriate • To membership in medical management procedures societies • To avail of hospital services • To perform certain services 3. An intern was found guilty of gross negligence resulting in homicide. Which is not applicable? A. Civil liability B. Administrative liability C. Criminal liability D. All liabilities are applicable LIABILITIES OF PHYSICIANS Tips to remember: Bases: Needed for conviction Penalty Venue of trial Term used in court 4. CRIMINAL “gusto ka MAKULONG!” • Revised Penal Code (Article 365) • Guilt beyond reasonable doubt CIVIL “gusto ka MAG-MULTA!” • Civil code 19, 20, 21, 2176 and the Family Code • Preponderance of evidence • Prison/ Fine • Damages • Court • “People of the Philippines vs. Cruz” • Court • Plaintiff (nagsampa ng kaso) vs Defendant (kinasuhan) Instead of using the pediatric dose of a drug, the doctor ordered the nurse to give the adult dose to a pediatric patient. The patient subsequently died from the adverse drug reaction. Who is liable? A. Doctor B. Nurse C. Hospital D. Doctor and nurse DOCTRINE OF OSTENSIBLE AGENT • Pathologists, radiologists, and anesthesiologists are usually employees and at the same time independent contractors. • Most courts consider them as ostensible agents therefore, the hospital must be held liable for their negligent act ADMINISTRATIVE “gusto ka ALISAN NG LISENSYA!” • Medical Act 1959, Code of Ethics (Standard of care and Medical Etiquette) • Substantial evidence • Warning, Reprimand, Suspension, Revocation o Reinstatement: after 2 years • Board of Medicine (PRC) • Complainant vs. Respondent Which doctrine does not imply the responsibility of a person who is not negligent for the wrongful conduct or negligence of another? 5. A. Doctrine of Imputed Negligence B. Captain of the Ship Doctrine C. Borrowed Servant Doctrine D. Doctrine of Contributory Negligence DOCTRINE OF VICARIOUS LIABILITY • Responsibility of a person who is not negligent, for the wrongful conduct or negligence of another • aka doctrine of imputed negligence, doctrine of respondeat superior • If employer-employee relationship is established, negligence of employee is conclusively the liability of the employer BORROWED SERVANT DOCTRINE • Employees of the hospital are sometimes temporarily under the supervision and control of another. • Consultant borrows the service of the residents and interns. The consultant will be liable for any mistakes made by the trainees CAPTAIN OF THE SHIP DOCTRINE • Surgeon likened to a captain of the ship • The head surgeon is responsible for anything that will go wrong in the OR • Can still be held responsible for the actions of another specialist who helped (imposes more responsibility) TOPNOTCH MEDICAL BOARD PREP LEGAL MED, MED JURIS, AND ETHICS PEARLS HANDOUT BY DR. GEREMIAH LLANES For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] This handout is only valid for the October 2023 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Page 1 of 12 TOPNOTCH MEDICAL BOARD PREP LEGAL MED, MED JURIS, AND ETHICS PEARLS HANDOUT BY DR. GEREMIAH LLANES For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the October 2023 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. 6. A doctor was caught spreading rumors about a patient being treated for an STD. The patient filed a civil case, claiming that the incident caused humiliation and anxiety. If found guilty, the doctor will be asked to pay which type of damages? A. Exemplary Damages B. Nominal Damages C. Compensatory Damages D. Moral Damages DAMAGES HIGHEST EXEMPLARY OR CORRECTIVE ACTUAL OR COMPENSATORY TEMPERATE OR MODERATE NOMINAL LOWEST MORAL LIQUIDATED 8. A 30/F was brought to the ER for loss of consciousness. The assessment of the physician was that intubation was necessary. Whose consent is prioritized? A. The patient B. The doctor C. The father D. The live-in partner RIGHT TO GIVE CONSENT PERSONS WHO CAN GIVE CONSENT: (IN ORDER) Patient is of Legal Age Patient is a Minor (<18 y/o) • Patient (must be of • Parents sound mind) oIf legitimate – father takes precedence • Spouse (legitimate) oIf illegitimate or <7 y/o – • Descendants mother takes precedence (legitimate) • Ascendants (parents, • Paternal grandparents • Maternal grandparents grandparents) • Eldest sibling (legal age) • Collaterals (siblings) • Guardians • Nearest of kin • Legally appointed guardian • Teachers and professors • State or government • Heads of children’s homes, orphanages, or similar institution (Doctrine of Parens Patriae) • Directors of trade establishments 9. Privileged communication obtained during the course of a physician-patient relationship may be breached in which instance? A. In the interest of public safety B. In response to media controversy C. In civil cases D. In compliance to a medical survey PRIVILEGED COMMUNICATION • Witness cannot be examined regarding information that was originally communicated to Definition them during a professional or confidential relationship, unless with consent • Spouse and partner • Lawyer, their secretary, clerk, stenographer, and the client Examples • Medical practitioner and the patient • Minister or priest (i.e., confession) • Public officer • Interest of public health, justice, and public safety Exceptions • Criminal proceedings 7. A 40/F who underwent exploratory laparotomy for small bowel obstruction developed sepsis after a week and died. Autopsy revealed forceps left inside the abdomen. If the surgeon is found guilty in a civil case, what damages will the surgeon pay? A. Exemplary Damages B. Nominal Damages C. Compensatory Damages D. Moral Damages • Monetary compensation over and above actual or compensatory damages • Awarded in medical negligence suits to deter other MD from doing the same • Adequate compensation only for pecuniary loss suffered by a person as they have duly proved • More than nominal but less than compensatory damages • When some pecuniary loss has been suffered but its amount cannot be proved with certainty • Small amount awarded to the plaintiff when there is no substantial loss or injury but the law recognizes a technical invasion of the plaintiff’s right or a breach of the defendant’s duty • Includes physical suffering, mental anguish, fright, serious anxiety, besmirched reputation, wounded feelings, moral shock, social humiliation, and similar injury • Agreed by the parties to a contract, to be paid in case of breach thereof A doctor was unable to comply to a subpoena to testify in a civil case. Despite the doctor living 10km away from the court, the doctor said that they had a family emergency in their province and that the travel costs were not covered. Which decision should the court make? A. Cite the doctor for contempt since the doctor has 10. no infirmity that renders them unable to attend B. Do not cite the doctor for contempt since the doctor should have been compensated for travel expenses C. Do not cite the doctor for contempt since the doctor had a family emergency to attend to D. Cite the doctor for contempt since the doctor's place of residence is <50km from the court SUBPOENA • Process to cause a witness to appear before a court and give testimony or production of evidence • Failure to comply without justifiable reason is grounds for reprimand, suspension, or revocation of certificate of registration TYPE Subpoena ad testificandum Subpoena duces tecum Subpoena duces tecum et ad testificandum REQUIREMENT TESTIMONY DOCUMENTS TESTIMONY + DOCUMENTS WHEN AN MD NEED NOT COMPLY WITH A SUBPOENA • When the issuing court has no jurisdiction over the subject matter and person of the case • When the place of residence is >50 km from the court (increased to 100km in 1997) • In civil cases, when transportation and other expenses are not given by the party requesting of their presence • When a MD is attending to an emergency and no one is available and competent enough to be their substitute • When a physician is suffering from an infirmity which may be aggravated if they comply 11. Who is not a member of the Board of Medical Education? A. Chair of the Board of Medical Examiners B. Secretary of Health C. Secretary of Education D. Representative of the UP College of Medicine TOPNOTCH MEDICAL BOARD PREP LEGAL MED, MED JURIS, AND ETHICS PEARLS HANDOUT BY DR. GEREMIAH LLANES For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] This handout is only valid for the October 2023 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Page 2 of 12 TOPNOTCH MEDICAL BOARD PREP LEGAL MED, MED JURIS, AND ETHICS PEARLS HANDOUT BY DR. GEREMIAH LLANES For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the October 2023 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. REGULATORY BODIES BOARD OF MEDICAL EDUCATION Role Functions Members • Concerned with standardization and regulation of medical education To determine and prescribe: • Requirement for admission to a recognized College of Medicine • Requirements for minimum Physical facilities • Minimum number and qualifications of teaching personnel • Minimum required curriculum • Secretary of Education or authorized rep (Chairman) • Secretary of Health or authorized rep • Director, Bureau of private schools or authorized rep • Chairman, Board of Medicine or authorized rep • Representative of PMA • Dean, UP College of Medicine • Representative of council of deans of Philippine Medical Schools • Representative of Philippine Medical Colleges PROFESSIONAL REGULATION COMMISSION • General supervision and regulation of all professions constituting the highly skilled manpower of the country. • Administering and conducting the licensure examinations of the various regulatory boards in accordance with its rules and regulations • One full time commissioner appointed by president • 2 full time associate commissioners appointed by president Requirements: • At least 40 years old • Familiar with principles of professional regulation and licensing • 5 years of executive or managerial experience Which is a prerequisite to practice medicine in the Philippines? A. Of sound body 12. B. At least 20 years old C. No score lower than 50% in any PLE subject D. Completed at least 6 months of internship PREREQUISITES TO PRACTICE MEDICINE • Age ≥ 21 years old • Passed the board examinations oAverage score of ≥75 in all 12 subjects oNo subject with a score of < 50 • Holder of a valid certificate of registration CANDIDATES FOR THE BOARD EXAMINATIONS • Citizen of the Philippines or a citizen of any foreign country with reciprocity • Good moral character • Sound of mind • Not convicted by a court of competent jurisdiction of any offense involving moral turpitude • Holder of the degree of Doctor of Medicine • Completed a calendar year of internship 13. Which individual is legally practicing medicine in the Philippines? A. A foreign surgeon vacationing in a remote island who did several appendectomies B. An MD graduate who failed the boards doing consultations during the pandemic under the directive of the DOH Secretary C. A civilian using an AED on a coworker who suddenly collapsed in the office D. A psychologist issuing a prescription to their client without orders from a doctor BOARD OF MEDICINE • Possess legal authority to pass upon qualifications and fitness of applicants to practice medicine and to discipline licensed physicians • To determine and prepare contents of the licensure examination • Promulgate rules and regulations for the proper conduct of the examinations. Corrections and registrations. • Administer oath • Investigate violations, issues subpoena • Issue Certificate of Registration • Suspend, revoke or reissue Certificate of Registration • Study circumstances affecting the practice of medicine and promulgate necessary rules and regulations • Conduct investigations of complaints against physicians and promulgate decisions • Composed of 6 members to be appointed by the PH President from a list of ≤12 names approved and submitted by the Executive council of PMA • Recommendation does not preclude the president to appoint anyone who is not recommended Qualifications: • Natural born Filipino citizen • Duly-registered physician • Be at least 40 years old • Has been in practice for at least 10 years • Good moral character w/ recognized standing in medical profession as certified by PMA • Not a member of the faculty of any medical school and has no pecuniary interest in any institution at the time of their appointment ACTS CONSIDERED PRACTICE OF MEDICINE • Who shall for compensation, fee, salary or reward, physically examine a person, diagnose, treat, operate or prescribe any remedy for human disease, injury, or deformity • Who shall by means of signs, cards, advertisement either offer or undertake by any means or method to diagnose, treat, operate, or prescribe any remedy • Who shall use the title of MD after their name ACTS NOT CONSIDERED PRACTICE OF MEDICINE • Any medical student enrolled in medical school or graduate under training provided they render service under direct supervision and control of registered Physician • Any person rendering service gratuitously in cases of emergency • Any person who administers household remedy as per classification of existing Pharmacy laws • Other duly registered healthcare professionals practicing within the scope of their field oDentist oMasseur or physiotherapist oOptometrist oClinical psychologist or mental hygienist oProsthetists LIMITED PRACTICE OF MEDICINE • Physicians from other countries with authorization from the Board of Medicine oFor specific and definite cases oAttached to international bodies or organizations assigned to perform certain definite work in the Philippines • Commissioned medical officers of the United States armed forces stationed in the Philippines oServing only the members of the said armed forces and within the limit of their territorial jurisdiction • Foreign physicians employed as exchange professors in special branches of medicine or surgery whose service may be necessary in the discretion of the Board of Medical Education • Medical students who have completed the first four years of medical course, graduates of medicine and registered nurses who may be given limited and special authorization by the Secretary of Health to render medical services during epidemics or national emergencies TOPNOTCH MEDICAL BOARD PREP LEGAL MED, MED JURIS, AND ETHICS PEARLS HANDOUT BY DR. GEREMIAH LLANES For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] This handout is only valid for the October 2023 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Page 3 of 12 TOPNOTCH MEDICAL BOARD PREP LEGAL MED, MED JURIS, AND ETHICS PEARLS HANDOUT BY DR. GEREMIAH LLANES For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the October 2023 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Which is not included in referrals between doctors? A. Permission from the primary physician 14. B. Clinical abstract C. Payment for referral D. Purpose of referral PMA REFERRAL SYSTEM • The primary and consultant physicians should always observe the proper protocol of the referral system • The consultant may make another referral but should seek permission from the primary physician • In making a referral, a physician should forward a clinical abstract and specify the purpose as to whether the case is for opinion/evaluation, for co-management, or for transfer of service • A physician shall not receive any commission for referring patients to a colleague, third person or institution. However, nominal gifts during occasions may be received by a physician 15. Which is true of corpus delicti as a type of medical evidence? A. Witness recounts an event orally B. Links the suspect to the crime C. Proves the crime existed D. Preservation and presentation of evidence AUTOPTIC/REAL TESTIMONIAL DOCUMENTARY PHYSICAL Corpus Delicti Associative Tracing CRIMINALISTIC 16. TYPES OF EVIDENCE TYPE EXPERIMENTAL DEFINITION • Evidence perceived by the senses – sight, hearing, taste, smell, and touch • Given orally and expressed under oath • Whether as an ordinary or expert witness • Performing experiments in view of the court to confirm or corroborate allegations • Document – instrument on which is recorded by means of letters, figures, or marks intended to be used for the purpose of recording • Articles and materials found in connection with the investigation that aid in establishing the perpetrator’s identity or the circumstances of the crime • Objects or substances which may be a part of the body of the crime that prove that the crime existed • Link the suspect to the crime • Assist the investigator in locating the suspect • Identification, collection, preservation, and mode of presentation of physical evidence • Application of sciences in crime, detection and investigation Which evidence presented in a homicide case is considered a corroborative evidence? A. Blood of the suspect on the victim's body B. A gun found on the ground near the victim's body C. CCTV footage of a witness seeing the suspect fleeing the crime scene D. Suspect's clothes testing positive on paraffin test EVIDENCES FOR CONVICTION TYPE DIRECT CIRCUMSTANTIAL CORROBORATIVE DEFINITION • Proves the fact in dispute without the aid of any inference or presumption • Corresponds to the precise or actual point at issue • Evidence that can stand on its own • Proof of fact/s from which, taken either singly or collectively, the existence of a particular fact in dispute may be inferred as a necessary or probable consequence • Evidence that cannot stand alone • Collection of facts and information that backs up someone's story or support a proposition that is already supported by some initial evidence • Upholds the testimony of the witness A body was found missing its lower extremities. Which measurement can be used to estimate the height? A. 6x the length of the head 17. B. Twice the distance of the vertex to the pubic symphysis C. 1.5x the length of the torso D. The distance between the wrists with the arms outstretched HEIGHT APPROXIMATION • Eight times the length of the head • Distance between the tips of both middle fingers with the arms extended laterally • Twice the length of one arm plus 12 inches from the clavicle and 1.5 inches from the sternum • Twice the length from the vertex of the skull to the pubic symphysis • Distance between the suprasternal notch and the pubic symphysis ~1/3 of the height • Distance from the base of the skull to the coccyx is ~ 44% of the height • Tip of olecranon process to the tip of the middle finger is ~5/19 of the height EXAMPLE A case of physical assault • Fingerprints of the suspect on the victim • Physical injuries on the victim • A bat with the suspect’s name • Blood of the victim at the crime scene • Witness said the suspect’s shirt was torn during the scuffle – the suspect’s torn shirt was presented as evidence 1 2 1 3 4 5 2 6 7 8 18. 19. Which dental feature need not be recorded? A. Number B. Location C. Treatment D. Prosthesis During a breast examination, the doctor suddenly carressed the patient's breasts. The patient complained, but the doctor scolded the patient and continued to fondle the breasts. The doctor can be charged with? A. Rape B. Acts of lasciviousness C. Simple seduction D. Ordinary qualified seduction TOPNOTCH MEDICAL BOARD PREP LEGAL MED, MED JURIS, AND ETHICS PEARLS HANDOUT BY DR. GEREMIAH LLANES For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] This handout is only valid for the October 2023 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Page 4 of 12 TOPNOTCH MEDICAL BOARD PREP LEGAL MED, MED JURIS, AND ETHICS PEARLS HANDOUT BY DR. GEREMIAH LLANES For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the October 2023 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. SEX CRIMES CRITERIA FOR BRAIN DEATH CRIME ACTS RAPE Carnal knowledge SIMPLE SEDUCTION Sexual intercourse ORDINARY QUALIFIED SEDUCTION Sexual intercourse • • • • • • • INCESTUOUS QUALIFIED SEDUCTION Sexual intercourse • • • ACTS OF LASCIVIOUSNESS Any act which tends to excite lust • REQUISITES Offended party is a woman Any of the following: oUse of force or intimidation oWoman is deprived of reason/ unconscious oWoman < 12 y/o Offended party is a woman 16-18 years old Use of deceit Offended party is a virgin 1218 years old Committed by a person who shall be entrusted with the woman seduced Abuse of authority and confidence There is blood relationship Woman need not be a virgin and may be >18 years old Offended party can be of either sex Any of the following: oUse of force or intimidation oOffended party is deprived of reason/ unconscious oOffended party < 12 y/o Which is true of both adultery and concubinage? A. The offender can be of any sex B. They fall under crimes of chastity 20. C. The third party must know that the offender is married D. The affair occurs under scandalous circumstances CRIMES OF CHASTITY Offender Elements ADULTERY Wife ALL of the ff: • Woman is married • Sex with another man • Man knows her to be married CONCUBINAGE Husband ANY of the ff: • Keep a mistress in the conjugal dwelling • Sex under scandalous circumstances with another woman • Cohabit with another woman Which term refers to a perversion wherein sexual pleasure is attained by watching couples undress or have intercourse? 21. A. Voyeurism B. Partialism C. Scoptophilia D. Ospresiophilia Which term refers to a form of sexual perversion in which three persons are participating in the sexual orgies? A. Troilism 22. B. Tribadism C. Pygmalionism D. Incendiarism Which refers to a person's personal sense of identity as characterized, among others, by manner of clothing, inclinations, and behavior in relation to masculine or feminine conventions? 23. A. Gender B. Gender identity C. Sex D. Sexual orientation GENDER IDENTITY • Personal sense of identity as characterized, among others, by manner of clothing, inclinations, and behavior in relation to masculine or feminine conventions • A person may have a male or female identity with physiological characteristics of the opposite sex in which case this person is considered transgender 24. Which is not part of the Harvard Report of 1968's criteria for brain death? A. Unreceptivity and unresponsibility B. No movements or breathing C. Flat EEG D. Falling arterial pressure without any support HARVARD REPORT • Unreceptivity and unresponsibility • No movements or breathing • No reflexes • Flat EEG PHILADELPHIA PROTOCOL • Lack of responsiveness to internal and external environment • Absence of spontaneous breathing movements for 3 minutes • No muscular movements with generalized flaccidity and no evidence of postural activity or shivering • Absence of reflexes and response • Isoelectric EEG • Falling arterial pressure without support by drugs or other means Which refers to the progressive fall of body temperature after death? A. Livor mortis 25. B. Post-mortem caloricitry C. Suggillation D. Algor mortis SIGNS OF DEATH • Magnus test • Icards test CESSATION OF • Diaphanous test HEART AND • Application of heat on skin CIRCULATION • Palpation of radial pulse • Dropping of melted wax • Examination with a mirror • Examination with Feather or cotton CESSATION OF fibers RESPIRATION • Examination with a glass of water • Winslow test • The progressive fall of the body COOLING OF THE BODY (ALGOR temperature is one of the most MORTIS) prominent signs of death INSENSIBILITY OF THE BODY & LOSS OF POWER TO MOVE CHANGES IN THE SKIN CHANGES ABOUT THE EYE 26. • No stimulus can produce voluntary movement • Post mortem Contact Flatteningbody becomes flattened over the areas which are in contact with the surface it rests due to loss of elasticity • Loss of corneal reflexes • Clouding of the cornea • Flaccidity of the eyeball • The pupil is in position of rest • Tache noir de la sclerotique Which best describes marbolization? A. Accumulation of blood in the dependent portions of the body B. Formation of gases during decomposition C. Prominence of superficial veins with reddish discoloration D. Instantaneous rigidity of the muscles at death due to extreme tension, exhaustion, or nerve injury PUTREFACTIVE CHANGES • Tissue color changes oMarbolization – prominence of superficial veins with reddish discoloration • Evolution of gases in tissue • Soft tissue liquefaction 27. An obese body with loose-fitting clothes was found at the bottom of a river. Autopsy revealed the cause of death to be blunt force trauma to the head. What factor will delay the putrefaction of the body? A. Submersion in water B. The movement of the river C. Obesity D. Loose-fitting clothes TOPNOTCH MEDICAL BOARD PREP LEGAL MED, MED JURIS, AND ETHICS PEARLS HANDOUT BY DR. GEREMIAH LLANES For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] This handout is only valid for the October 2023 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Page 5 of 12 TOPNOTCH MEDICAL BOARD PREP LEGAL MED, MED JURIS, AND ETHICS PEARLS HANDOUT BY DR. GEREMIAH LLANES For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the October 2023 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. FACTORS AFFECTING RATE OF PUTREFACTION INTERNAL EXTERNAL FACTORS FACTORS • Older age • Exposure to free air • Obesity • Moderate amount of moisture • Death from Faster infection or • Clothing (initially, by putrefaction anasarca maintaining body temperature) • Running water • Younger age • Excessive moisuture • Still-birth • Clothing (subsequently, (sterile) by protecting body from Slower insects) putrefaction • Tight clothing • Still water • Dry absorbent soil Which modification of putrefaction forms a greasy, brown-white substance that has a rancid odor? A. Maceration 28. B. Saponification C. Mummification D. Liquefaction SPECIAL MODIFICATION OF PUTREFACTION • Mummification oDehydration of the whole body oNatural vs Artificial • Saponification or Adipocere Formation oFatty tissues are transformed to soft brownish-white substance oAdipocere – waxy, greasy; rancid, moldy odor • Maceration oSoftening of tissues in a fluid medium devoid of putrefactive microorganisms 29. 30. A body was found in a basement. On examination there were no signs of muscle stiffening or skin discoloration. There are also no maggots found on the body. What is the most likely time since death? A. Less than 3 hours B. 3-6 hours C. 6-12 hours D. More than 12 hours A body was found in a basement. On examination, there were no signs of muscle stiffening and there is green discoloration over the whole abdomen which is spreading to the chest. What is the most likely time since death? A. 12 hours B. 18 hours C. 20 hours D. 24 hours DURATION OF DEATH Presence of Rigor Mortis Presence of postmortem lividity Onset of decomposition • • • • • • • • Stage of Decomposition Entomology of the Cadaver Stage of Digestion of food in the stomach • • • • Average onset 3-6 hours after death Fully developed after 12 hours Absent all over after 24 hours Its disappearance is concomitant with the onset of putrefaction Develops 3-6 hours after death Fully developed after 12 hours In tropical countries decomposition is early and the average time is 2448 hrs. The approximate time of death may be inferred from the degree of decomposition Several factors which modify putrefaction of the body Usual time for egg to be hatched into larva is 24 hours If there are maggots- death is more than 24 hours It takes normally 3-4 hours for the stomach to evacuate the contents after a meal Presence of live fleas in clothing in Drowning Cases Amount of Urine in the bladder State of the Clothing Chemical Changes in Cerebrospinal Fluid • A flea can survive for approximately 24 hours submerged in water • Fleas can no longer be revived more than that period • The amount of urine in the urinary bladder may indicate the time of death if the patient was last seen voiding • Circumstantial proof of the time of death is the apparel of the deceased • Lactic acid increases • Non-protein nitrogen increases • Amino- acid concentration rises A 29/M died after touching an exposed electric wire. Examination of the body revealed electrical arborization and third degree burns. What is the main cause of death from electricity? 31. A. Ventricular fibrillation B. Respiratory failure C. Mechanical asphyxia D. Shock Which is the best definition of burking? A. Use of hands to constrict the neck and cause asphyxia B. Covering the nostrils and mouth with hands 32. while kneeling or sitting on the chest C. Closure of the external respiratory orifices by use of hands or other means D. Use of ligature and the weight of the body to compress the neck DEATH BY ASPHYXIA • Suspension of the body by ligature Hanging encircling the neck and the constricting force is the weight of the body • Strangulation by ligature – compression of the neck via ligature and the constricting force is not the weight of the body Strangulation • Manual strangulation or throttling – constricting force applied to the neck is the hand • Exclusion of air from the lungs by closure of external respiratory orifices Suffocation (smothering) or foreign body impaction in airways (choking) • Nostrils and mouth are submerged and Submersion prevent free entrance of air into the air or Drowning passage and lungs • Free exchange of air in the lung is prevented by immobility of the chest and abdomen due to external pressure or crush injury Compression • Burking – Kneeling/sitting on the chest with hands closing the nostrils and mouth • Crucifixion Irrespirable • CO, CO2, HS, HCN, SO2 gases 33. Characteristic of a medico-legal autopsy and not a pathologic autopsy: A. Done to confirm clinical findings B. Consent is given by the law C. Performed by a health officer D. Removal of tissues for further examination PATHOLOGIC AUTOPSY Purpose Requirement Emphasis • Confirmation of clinical findings • Consent of next of kin • Notation of all abnormal findings TOPNOTCH MEDICAL BOARD PREP LEGAL MED, MED JURIS, AND ETHICS PEARLS HANDOUT BY DR. GEREMIAH LLANES For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] This handout is only valid for the October 2023 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. MEDICO-LEGAL AUTOPSY • Correlation of tissue changes to criminal act • Law gives consent • Effect of wrongful act on the body Page 6 of 12 TOPNOTCH MEDICAL BOARD PREP LEGAL MED, MED JURIS, AND ETHICS PEARLS HANDOUT BY DR. GEREMIAH LLANES For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the October 2023 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. PATHOLOGIC AUTOPSY Conclusion Minor or nonpathological findings • Summation of all abnormal findings • Need not be mentioned in the report MEDICO-LEGAL AUTOPSY • Must be specific for the purpose of determining the relationship of the death to the criminal act • Must be included if the investigator thinks it will be useful Which is not a condition wherein an autopsy is performed? A. Upon written request of police authorities 34. B. Upon order of a competent court, mayor and or fiscal C. When required by special laws D. When the nearest of kin shall request verbally INDICATIONS FOR AUTOPSIES • Whenever required by special laws • Upon order of the court, mayor and a provincial or city fiscal • Upon written request of police authorities • Whenever the solicitor general, provincial or city fiscal shall deem it necessary • Whenever nearest kin shall request in writing the authorities concerned Which person, when killed, is not classified as parricide? A. Natural child born out of wedlock 35. B. Legal wife C. Legitimate grandfather D. Sibling PARRICIDE • Killing of one’s relative • Requisites oA person was killed by the offender oThe person killed was the father, mother, or child (whether legitimate or illegitimate), or any of their ascendants or descendants, or spouse (must be legitimate) of the offender A victim was shot in their anterior chest while inside a church. The suspect was captured and during interrogation admitted that they were paid to kill the victim and that they were not remorseful for their actions. Which aggravating circumstance is 36. present? A. Treachery B. Committed in sacred grounds C. In consideration of a price, reward, or promise D. With cruelty, or outraging or scoffing at the victim or corpse HOMICIDE VS MURDER • BOTH HAVE INTENT TO KILL • Homicide oReckless imprudence resulting in homicide oPlain and simple homicide • Murder = homicide + aggravating circumstances AGGRAVATING CIRCUMSTANCES • Treachery • Use of superior force with the aid of armed men, or employing means to weaken the defense or of means or persons to ensure or afford impunity and nighttime to increase chance of success • Done during a shipwreck, conflagration, earthquake, eruption of a volcano, destructive cyclone, epidemic or other public calamity • Committed in the presence of the chief executive (President) or in the palace grounds (Malacañang) • With cruelty, by deliberately and inhumanly augmenting the suffering of the victim, or outraging or scoffing at their person or corpse • In consideration of a price, reward, or promise • Evident premeditation Prior to the 1987 constitution, what method of judicial death was recognized by our civil law? A. Hanging 37. B. Musketry C. Drowning D. Electrocution JUDICIAL DEATH (“DEATH PENALTY”) Death by electrocution Death by hanging Death by musketry Other methods • Only method recognized by the civil law prior to the 1987 constitution • Death may be due to shock, respiratory failure, prolonged and violent convulsion • Death may be due to asphyxia or injury to the cervical part of the spinal cord • Applied to military personnel and decided by court marshals • Considered less heinous than hanging • Not recognized by the law prior to 1987 constitution • Lethal injection • Impaling • Beheading • Stoning • Crucifixion • Strangling • Beating • Drowning What is the minimum required distance of a burial ground from a water source? A. 20m 38. B. 25m C. 40m D. 50m BURIAL REQUIREMENTS • The body must be buried within 48 hours after death except: oWhen it is still a subject matter of legal investigation oWhen it is specifically authorized by local health authorities oImpliedly when the body is embalmed • The body must be buried within 12 hours if death is from communicable disease unless the local health officer permits otherwise • Death Certificate is necessary before burial oCode of Sanitation Requirement oShould be forwarded to the municipal secretary within 48 hours after death • Permission from the provincial Fiscal or from Municipal Mayor is necessary if death is due to violence or crime • Burial grounds requirements o≥25 meters from any dwelling house o≥50 meters from either side of a river/any source of water A victim suffered multiple wounds to the torso and loss of vision in one eye after being physically assaulted. They were hospitalized for 5 days. The offender is liable for? 39. A. Serious physical injury B. Less serious physical injury C. Slight physical injury D. Mutilation LEGAL CLASSIFICATION MUTILATION SERIOUS PHYSICAL INJURIES • Looping or cutting off any parts of the living body • Duration of incapacity for labor or >30 days • Any injury resulting in insanity, imbecility, impotence, blindness, loss of speech, loss of senses, deformity LESS SERIOUS PHYSICAL INJURIES • Duration of incapacity for labor >10 days SLIGHT PHYSICAL INJURY • Duration of incapacity for labor <10 days • No duration of incapacity • No need for medical assistance 40. Which is not a provision of Presidential Decree 169? A. The constabulary shall report any incident to the ministry of health B. A physician is required to report any serious physical injury to the nearest constabulary C. Any violation of the decree shall lead to imprisonment of 1-3 years D. Any violation of the decree shall lead to cancellation of the physician's license TOPNOTCH MEDICAL BOARD PREP LEGAL MED, MED JURIS, AND ETHICS PEARLS HANDOUT BY DR. GEREMIAH LLANES For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] This handout is only valid for the October 2023 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Page 7 of 12 TOPNOTCH MEDICAL BOARD PREP LEGAL MED, MED JURIS, AND ETHICS PEARLS HANDOUT BY DR. GEREMIAH LLANES For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the October 2023 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. PRESIDENTIAL DECREE NO. 169 A 32/M was found dead at his apartment with wound to the neck. Suspecting a different REQUIRING DOCTORS, HOSPITALS, CLINICS, ETC. TO REPORT cause of death, which characteristic points to TREATMENT FOR PHYSICAL INJURIES the wound being inflicted after death? “The attending physician of any hospital, medical clinic, 41. A. Presence of hemorrhage sanitarium or other medical establishments, or any medical B. Absence of clotting practitioner, who has treated any person for serious or less C. Gaping of the wound edges serious physical injuries shall report the fact of such treatment D. Wound stains are not removed by personally or by fastest means of communication to the nearest washing Philippine Constabulary unit without delay” • Penalties oImprisonment of 1-3 years oFine of P1000-3000 oCancellation of license ANTEMORTEM VS POSTMORTEM WOUNDS ANTEMORTEM POSTMORTEM • More or less copious • Slight or none at all Hemorrhage • Generally arterial • Always venous Spouting of blood (+) (-) Clotting (+) (-) • Deeply stained • Not deeply stained Edges • Not removed by washing • Removed by washing • Edges gape owing to the reaction of the skin • Do not gape, but are closely Gaping and muscle fibers approximated to each other Inflammation and reparative process (+) (-) (Vital Tissure Reaction) Which part of the firearm refers to the diameter of the barrel between two lands or the internal diameter? A. Breech 42. B. Caliber C. Cartridge D. Muzzle GUNSHOT WOUNDS Entrance wound Abrasion collar • Caliber – internal diameter (diameter of the barrel between two lands) 43. Examination of a gunshot wound during an autopsy revealed a muzzle imprint around the wound. What was the most likely distance of the firearm? A. <1cm B. 1-15cm C. 15-60cm D. >60cm GUNSHOT ENTRANCE WOUNDS SHORT RANGE NEAR FIRE (1-15cm) Large, circular or oval Inverted Distinct (+) Smudging Prominent w/ singeing of hair (+) Others (+) muzzle imprint (+)blackening of the bullet (+) carboxyhemoglobin (+) Tattooing (+) contact ring A 24/F was found dead in the woods with several gunshot wounds. What characteristic will differentiate an entry wound from an exit wound? 44. A. Size of wound smaller than bullet B. Presence of contusion collar C. Stellate wound shape D. Positive paraffin test GUNSHOT ENTRANCE VS EXIT WOUNDS ENTRANCE EXIT • May be absent if bullet is Presence of wound • Always present lodged inside the body • Smaller than Size of bullet in the bullet • Always bigger comparison to the (owing to the than the bullet hole in the skin elasticity of the tissue) MEDIUM RANGE (15-60cm) Inverted edges (+) (+) if <30cm (+/- ) Tattooing (+) contact ring Edges Shape Contusion/abrasion collar Tattooing; smudging Underlying tissues Paraffin test ENTRANCE • Inverted • Usually oval/round depending upon the angle of approach • Present due to bullet contact • (+) contact ring • May be present with near-fire • Do not protrude • May be positive TOPNOTCH MEDICAL BOARD PREP LEGAL MED, MED JURIS, AND ETHICS PEARLS HANDOUT BY DR. GEREMIAH LLANES For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] This handout is only valid for the October 2023 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. >60 cm Circular or oval (-) (-) (+) contact ring EXIT • Everted • Does not manifest any shape; can be stellate • Absent • Always absent • May be protruding • Always negative Page 8 of 12 TOPNOTCH MEDICAL BOARD PREP LEGAL MED, MED JURIS, AND ETHICS PEARLS HANDOUT BY DR. GEREMIAH LLANES For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the October 2023 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. 45. The shirt of a suspect was found at the crime scene. The suspect was denying use of any firearm. What can be used to test the presence of gunpowder residues on the shirt? A. Walker test B. Berberio test C. Precipitin test D. Guaiacum test GUNSHOT WOUNDS TESTS TESTS FOR PRESENCE OF POWDER RESIDUES On the skin • Dermal nitrate test (paraffin, diphenylamine, Lung’s test, Gonzales test) oPresence of small particles containing nitrate or nitrite à blue reaction oTest is not conclusive as to the presence of gunpowder On clothing • Walker test oIf unburned powder grains are present, it will result to the production of dark red or orange brown spots on the prepared paper MNEMONIC PRE-si-PATING Test Pre → Pare → Lalaki → Semen Pating → Nakakaamoy ng dugo → Blood Pre → Pare → Tao vs Hayop ← Pating Determines whether the blood or semen is of human or not A 24/F came to your clinic for a large bruise on her lower back. She does not recall when the discoloration appeared. On examination, the contusion is green in color. When did the incident 46. most likely occur? A. The past 48 hours B. 2-3 days ago C. 4-5 days ago D. A week ago CONTUSIONS COLOR Red-purple Green Yellow Disappearance AGE OF CONTUSION • Soon after its complete development • 4-5 days • 7-10 days • Gradually starts after 14-15 days • Ultimate disappearance varies from 1-4 weeks A 2/M was rushed to the emergency room after a cup of boiling water fell on their feet. On examination, the whole skin on the affected area is destroyed with formation of a yellowish-brown slough that is not very painful to touch. What is the degree of the burn 47. according to Dupuytren's classification? A. First degree B. Second degree C. Third degree D. Fourth degree CLASSIFICATION OF BURN INJURIES FIRST DEGREE SECOND DEGREE THIRD DEGREE FOURTH DEGREE FIFTH DEGREE SIXTH DEGREE • Erythema or simple redness of the skin associated with superficial inflammation and slight swelling • (+)vesicle formation with acute inflammation • The superficial layers of the epithelium are destroyed • (+)destruction of the cuticle and part of the true skin • Burned area is very painful • The whole skin is destroyed with formation of slough which is yellowish brown/parchment like • Not very painful • There is involvement of deep fascia and muscles • There is charring of the limb involving subjacent tissues, organs and bone 48. 49. A live-in couple had a child. After 3 years, they got married. Right after the marriage, the child is: A. Illegitimate since the child was born before marriage B. Legitimated since there was subsequent marriage C. Legitimate since the child is natural D. Illegitimate since the child is spurious Which of the following is a legitimate child? A. A child from an incestuous marriage B. A child conceived by a prostitute C. A child conceived in an act of adultery D. A child from a bigamous marriage LEGITIMATE CHILDREN • Born in lawful wedlock OR within 300 days after the dissolution of marriage • Requisites for Presumption oThere is a valid marriage oThe birth of the child took place after 180 Legitimate days following the celebration of marriage Children OR within 300 days following its (proper) dissolution oThere is no physical impossibility of the husband having accessto the wife during the first 120 days of the 300 days preceding the birth of the child • Legitimation – process by which a child born out of lawful wedlock are considered legitimate by law • Requisites Legitimated oChild must be natural Children oChild must be acknowledged by both parents before marriage oThere must be subsequent marriage of the parents • Adoption act by which relations of paternity Adopted and filiation are recognized as legally existing Children between persons not related by nature ILLEGITIMATE CHILDREN Natural • Born outside of lawful wedlock Children • Parents were not disqualified by any (proper) impediment to marry Natural • Children born of void marriages or Children by those born of voidable marriages Legal Fiction • Acknowledged by the father or mother Natural separately if the acknowledging parent Children by was legally competent to contract Presumption marriage at the time of conception • Adulterous children oChildren conceived in adultery or concubinage Spurious • Sacrilegious children Children oChildren born of ordained parents Not considered • Incestuous children natural oChildren born from blood-related parents • Manceres oChildren conceived by prostitutes A patient has been wearing a neck brace and on a wheelchair for a year despite normal findings since the alleged onset of symptoms. Mental status exam is essentially normal. What term describes this 50. phenomenon? A. Schizophrenia B. Feigned Malingering C. Factitious Malingering D. Imbecility MALINGERING • Feigning or simulation of a disease or injury characterized by ostentation, exaggeration and inconsistency. TOPNOTCH MEDICAL BOARD PREP LEGAL MED, MED JURIS, AND ETHICS PEARLS HANDOUT BY DR. GEREMIAH LLANES For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] This handout is only valid for the October 2023 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Page 9 of 12 TOPNOTCH MEDICAL BOARD PREP LEGAL MED, MED JURIS, AND ETHICS PEARLS HANDOUT BY DR. GEREMIAH LLANES For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the October 2023 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. FEIGNED or FICTITIOUS • Out of pure imagination and does not have factual basis. Alleged disease or injury does not exist at all When to suspect malingering FACTITIOUS • Disease or injury really exists but is converted to a more serious disability or injury or to an exaggeration of the real complaint • Presence of a cause for the subject to malinger • Inconsistency between the injuries or disease suffered from and the symptoms or disability manifested • Symptoms not supported w/ organic lesion • Abrupt onset of symptoms. • Refusal to be subjected to painful or annoying treatment Which perceptual disturbance is a false interpretation of an external stimulus? A. Delusion 51. B. Hallucination C. Illusion D. Obsession DISORDERS OF PERCEPTION • False interpretation of an external stimulus Illusion • May be manifested with the sense of sight, hearing, taste, touch and smell. • An erroneous perception without external object of stimulus • Visual • Auditory • Olfactory (smell) • Gustatory (taste) Hallucination • Tactile (touch) • Kinesthetic (movement) • Hypnagogic (False sensory perception occurring midway between falling asleep and being awake) • Lilliputian (perception in decrease in size) A 43/F thinks that she is suffering from an incurable disease in which she is unable to work on account of the disease. Despite any effort to disprove her claim, she still believes she has the disease. What type of 52. delusion is present? A. Hypochondriacal delusion B. Self-accusatory delusion C. Nihilistic delusion D. Control delusion DELUSIONS • False belief that one is in possession of Delusion of great power, wealth, wisdom, Grandeur strength, etc Delusion of • False belief that one is being Persecution persecuted Delusion of • False belief that one is always the subject Reference of conversation, news, speech, or action Delusion of Self• False belief to have committed a crime accusation or hurt others Delusion of • False belief from pathological jealousy Infidelity that one’s lover is unfaithful Nihilistic • False belief that there is no world, that one Delusion does not exist, and that their body is dead Delusion of • False belief that one is financially Poverty ruined Delusion of • False belief that one is being controlled Control by others • False belief that one is suffering from an incurable disease, parts of their Hypochondriacal body are non-functioning, or that Delusion they are not physically capacitated to do a thing on account of the disease Delusion of • False belief that some parts of the body Negation are missing Which drug is allowed to be used in sports? A. Anabolic agents 53. B. Antibiotics C. Beta-2 agonists D. Diuretics PROHIBITED AND REGULATED DRUGS • Opium and its active components and derivatives (heroin, morphine) • Coca leaf and its derivatives (cocaine) PROHIBITED • Hallucinogenic drugs (LSD) • Indian hemp (marijuana) and its derivatives • Other narcotic drugs • Barbiturates REGULATED • Amphetamines (shabu) • Hypnotic drugs (methaqualone) • Prohibited at all times oNon-approved substances oAnabolic agents oEPO, Peptide hormones, GH oBeta-2 agonists oHormones and metabolic modulators oDiuretics and masking agents BANNED IN SPORTS • Prohibited in-competition oStimulants oNarcotics oCannabinoids oGlucocorticoids • Prohibited in particular sports oBeta-blockers Possessing how much shabu will be penalized with life imprisonment but not death? A. 5g 54. B. 10g C. 50g D. 100g What is the minimum amount of marijuana possession required to sentence a person to life imprisonment? 55. A. 10g B. 50g C. 500g D. 1000g DRUG POSSESSION AND PENALTIES Life Imprisonment to Death PROHIBITED DRUGS • Opium • Morphine • Heroin • Cocaine or cocaine hydrochloride • Marijuana resin or marijuana resin oil • Methylenedioxymethamphetamine (MDA) (ecstasy) ≥10g • Paramethoxyamphetamine (PMA) • Trimethoxyamphetamine (TMA) • Lysergic acid diethylamine (LSD) • Gamma hydroxyamphetamine (GHB) • Similarly designed or newly introduced drugs and their derivatives without having any therapeutic value or if the quantity possessed is far beyond therapeutic requirements REGULATED DRUGS ≥50g • Methamphetamine hydrochloride (shabu) ≥500g • Marijuana Life Imprisonment 10 – <50g • Methamphetamine hydrochloride (shabu) Imprisonment of 20 years and 1 day – life 5 – <10g • All drugs above except for marijuana 300 – <500g • Marijuana Imprisonment of 12 years and 1 day – 20 years <5g • All drugs above except for marijuana <300g • Marijuana TOPNOTCH MEDICAL BOARD PREP LEGAL MED, MED JURIS, AND ETHICS PEARLS HANDOUT BY DR. GEREMIAH LLANES For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] This handout is only valid for the October 2023 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Page 10 of 12 TOPNOTCH MEDICAL BOARD PREP LEGAL MED, MED JURIS, AND ETHICS PEARLS HANDOUT BY DR. GEREMIAH LLANES For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the October 2023 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. A doctor lost their copy of an S2 prescription for the first time. The court ruled that the lapse was intentional. Which penalty will the doctor receive? 56. A. Reprimand B. Fine of 20,000 C. Revocation of license D. Imprisonment for <6 months OTHER DRUG CRIMES AND PENALTIES • ≥6 months rehab (1st offense) • Imprisonment of 6 yrs and 1 day – 12 Use of yrs (2nd offense) Dangerous Drug • Fine of P50,000 – P200,000 • If with possession, penalty is for possession • Reprimand (unintentional lapses) • Fine of P20,000 (1st offense) Loss of S2 • Fine of P35,000 (2nd offense) Prescription • Imprisonment of 6 months and 1 day to Copy 4 years and fine of P10,000 – P50,000 + Suspension/revocation of license (3rd offense) • Imprisonment of 12 yrs. and 1 day to Unnecessary 20 years Prescription of • Fine of P100,000 – P500,000 Dangerous Drug • Revocation of License Unlawful • Life imprisonment to death Prescription of • Fine of P500,000 – P10,000,000 Dangerous Drug Disorientation, mental confusion, dizziness, sensory disturbances exaggerated emotional state suggests that the alcohol blood level is? 57. A. 0.4 g% B. 0.2 g% C. 0.1 g% D. 0.05 g% BLOOD ALCOHOL LEVELS BLOOD CLINICAL SIGNS AND SYMPTOMS ALCOHOL 10 mg % • Pleasant clearing of the head 20 mg % • Physical feeling of well-being • Increased self-confidence • decreased inhibitions 50 mg % • diminution of attention • judgment and control • Some mental confusion • Incompetency • decreased inhibitions 100 mg % • loss of critical judgment • impairment of memory and comprehension • Disorientation • Decreased sense of • Mental pain 150–300 mg confusion • Slurred speech % • Dizziness • Exaggerated • Sensory emotions disturbances • Apathy; general inertia; decreased response to stimuli; impaired 300 mg % consciousness; sleep or stupor; may lose sphincter control • Complete unconsciousness; coma; depressed or abolished reflexes; 400 mg % embarrassment of circulation and respiration; incontinence of urine and feces. BLOOD ALCOHOL ≤ 0.05 g % 0.1 – 0.15 g % DEGREE OF INTOXICATION • Not considered intoxicated • Unfit to drive motor cars 0.15 – 0.2 g % • Intoxicated to the extent of staggering 0.5 g % • In a coma Which is a reason why alcohol causes accidents? A. Decreases reaction time 58. B. Diminishes confidence C.