Medical error disclosure US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Medical error disclosure. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Medical error disclosure US Medical PG Question 1: A 68-year-old man comes to the physician for a follow-up examination, accompanied by his daughter. Two years ago, he was diagnosed with localized prostate cancer, for which he underwent radiation therapy. He moved to the area 1 month ago to be closer to his daughter but continues to live independently. He was recently diagnosed with osteoblastic metastases to the spine and is scheduled to initiate therapy next week. In private, the patient’s daughter says that he has been losing weight and wetting the bed, and she tearfully asks the physician if his prostate cancer has returned. She says that her father has not spoken with her about his health recently. The patient has previously expressed to the physician that he does not want his family members to know about his condition because they “would worry too much.” Which of the following initial statements by the physician is most appropriate?
- A. “As your father's physician, I think that it's important that you know that his prostate cancer has returned. However, we are confident that he will respond well to treatment.”
- B. “I'm sorry, I can't discuss any information with you without his permission. I recommend that you have an open discussion with your father.” (Correct Answer)
- C. “It concerns me that he's not speaking openly with you. I recommend that you seek medical power of attorney for your father. Then, we can legally discuss his diagnosis and treatment options together.”
- D. “It’s difficult to deal with parents aging, but I have experience helping families cope. We should sit down with your father and discuss this situation together.”
- E. “Your father is very ill and may not want you to know the details. I can imagine it's frustrating for you, but you have to respect his discretion.”
Medical error disclosure Explanation: ***“I'm sorry, I can't discuss any information with you without his permission. I recommend that you have an open discussion with your father.”***
- This statement upholds **patient confidentiality** and **autonomy**, as the patient explicitly stated he did not want his family to know about his condition.
- It encourages communication between the patient and his daughter, which is the most appropriate way for her to learn about his health status.
*“As your father's physician, I think that it's important that you know that his prostate cancer has returned. However, we are confident that he will respond well to treatment.”*
- This violates the patient's **confidentiality** and explicit wish to keep his medical information private from his family.
- Sharing medical information without explicit consent, even with family, is a breach of ethical and legal guidelines (e.g., **HIPAA** in the United States).
*“It concerns me that he's not speaking openly with you. I recommend that you seek medical power of attorney for your father. Then, we can legally discuss his diagnosis and treatment options together.”*
- While seeking medical power of attorney is an option for future decision-making, it is **premature and inappropriate** to suggest it solely to bypass the patient's current desire for confidentiality, especially when he is still competent to make his own decisions.
- This suggestion could undermine the patient's autonomy and trust in his physician.
*“It’s difficult to deal with parents aging, but I have experience helping families cope. We should sit down with your father and discuss this situation together.”*
- This statement, while empathetic, still risks undermining the patient's **autonomy** by pushing for a joint discussion against his explicit wishes to keep his family unaware.
- The physician's primary obligation is to the patient's stated preferences regarding his medical information.
*“Your father is very ill and may not want you to know the details. I can imagine it's frustrating for you, but you have to respect his discretion.”*
- While this statement acknowledges the daughter's feelings and respects the patient's discretion, it uses a somewhat **judgmental tone** ("very ill") and the phrasing "you have to respect his discretion" can come across as abrupt or dismissive rather than purely informative or guiding.
- The most appropriate initial response should focus on the **physician's inability to share information** due to confidentiality rather than attributing motives to the patient's decision or explicitly telling the daughter how to feel.
Medical error disclosure US Medical PG Question 2: A 22-year-old man is brought to the emergency department by his friends 30 minutes after falling down a flight of stairs. His friends report that they were at a college party, where he drank large amounts of alcohol. He is aggressive and restless. Examination shows tenderness to palpation and swelling of his right lower leg. An x-ray of the right leg shows a lower tibial shaft fracture. The physician recommends overnight observation and surgery the following morning. The patient refuses the suggested treatment and requests immediate discharge. Otherwise, he says, he will call his lawyer and sue the entire medical staff involved in his care. Which of the following is the most appropriate response by the physician?
- A. You can leave the hospital after signing a self-discharge against medical advice form.
- B. If you don't consent to treatment, I'll be forced to obtain consent from your parents.
- C. I understand that you want to go home, but I'll have to keep you here as long as you are intoxicated. (Correct Answer)
- D. Have you ever felt you should cut down on your drinking?
- E. I can't force you to stay here, but I'll have to inform your dean of this incident.
Medical error disclosure Explanation: ***I understand that you want to go home, but I'll have to keep you here as long as you are intoxicated.***
- An **intoxicated patient may lack decision-making capacity** to refuse medically necessary treatment for a serious injury.
- Before accepting a refusal of treatment or allowing AMA discharge, physicians must **assess the patient's capacity** to make informed decisions.
- Signs of impaired capacity include **acute intoxication, aggressive behavior, and restlessness**, all present in this patient.
- Temporarily holding a patient who lacks capacity and has a serious medical condition requiring urgent care is **legally and ethically justified** to prevent harm—this is NOT false imprisonment.
- Once the patient regains capacity (i.e., sobers up), his decision-making ability can be reassessed, and if he still refuses, AMA discharge can be offered.
*You can leave the hospital after signing a self-discharge against medical advice form.*
- While competent adults have the right to refuse treatment and leave AMA, this option is **premature** because it fails to address the patient's **impaired decision-making capacity** due to acute intoxication.
- A valid refusal requires **capacity to understand the risks and consequences** of leaving—offering AMA discharge without capacity assessment is inappropriate and potentially negligent.
*I can't force you to stay here, but I'll have to inform your dean of this incident.*
- Threatening to inform the patient's dean is a **breach of confidentiality** and an unprofessional response.
- Healthcare providers are bound by **patient confidentiality (HIPAA)**, and sharing this information without consent is unethical and illegal.
*If you don't consent to treatment, I'll be forced to obtain consent from your parents.*
- Since the patient is a **competent adult (age 22)**, his parents cannot give or withhold consent for his medical treatment.
- Parental consent is only required for **minors** or adults who have been legally declared **incompetent** through a court process.
*Have you ever felt you should cut down on your drinking?*
- While addressing alcohol use disorder is important, asking a **CAGE screening question** in this acute, high-stress situation is **inappropriate timing** and poor prioritization.
- The immediate priority is addressing the patient's **acute medical needs and impaired capacity**, not initiating a substance abuse screening.
Medical error disclosure US Medical PG Question 3: After the administration of an erroneous dose of intravenous phenytoin for recurrent seizures, a 9-year-old girl develops bradycardia and asystole. Cardiopulmonary resuscitation was initiated immediately. After 15 minutes, the blood pressure is 120/75 mm Hg, the pulse is 105/min, and the respirations are 14/min and spontaneous. She is taken to the critical care unit for monitoring and mechanical ventilation. She follows commands but requires sedation due to severe anxiety. Which of the following terms most accurately describes the unexpected occurrence in this patient?
- A. Active error
- B. Sentinel event (Correct Answer)
- C. Near miss
- D. Latent error
- E. Adverse event
Medical error disclosure Explanation: ***Sentinel event***
- A **sentinel event** is defined by the Joint Commission as an unexpected occurrence involving **death or serious physical or psychological injury**, or the risk thereof. In this case, the patient experienced **asystole** and required CPR, which constitutes a serious physical injury.
- While an adverse event occurred, the **severity** and the **need for extreme medical intervention** make it a sentinel event, triggering the need for a thorough investigation.
*Active error*
- An **active error** is a mistake made by a frontline worker (e.g., administering an erroneous dose). While present in this scenario, it is a type of error, not the overarching term for the **outcome** and **severity** of the event.
- Active errors are typically the **direct cause** of an adverse event, but the question asks for the term that most accurately describes the **unexpected occurrence** and its impact.
*Near miss*
- A **near miss** is an error that could have caused harm but did not, either by chance or through timely intervention. In this case, the patient **did experience harm** (bradycardia, asystole, CPR), so it is not a near miss.
*Latent error*
- A **latent error** is a hidden flaw in a system or process that does not immediately lead to an accident but creates the conditions for one. Examples include poor system design, inadequate training, or insufficient resources.
- While latent errors might have contributed to the erroneous dose being given, this term describes the **underlying systemic problems**, not the acute, serious patient outcome.
*Adverse event*
- An **adverse event** is any injury caused by medical management rather than the underlying disease. The patient indeed suffered an adverse event.
- However, **sentinel event** is a more specific and accurate term given the **extreme severity** (asystole, CPR) of the outcome, distinguishing it from less severe adverse events.
Medical error disclosure US Medical PG Question 4: A 28-year-old woman dies shortly after receiving a blood transfusion. Autopsy reveals widespread intravascular hemolysis and acute renal failure. Investigation reveals that she received type A blood, but her medical record indicates she was type O. In a malpractice lawsuit, which of the following elements must be proven?
- A. Duty, breach, causation, and damages (Correct Answer)
- B. Only duty and breach
- C. Only breach and causation
- D. Duty, breach, and damages
Medical error disclosure Explanation: ***Duty, breach, causation, and damages***
- In a medical malpractice lawsuit, all four elements—**duty, breach, causation, and damages**—must be proven for a successful claim.
- The healthcare provider had a **duty** to provide competent care, they **breached** that duty by administering the wrong blood type, this breach **caused** the patient's death and renal failure, and these injuries constitute **damages**.
*Only duty and breach*
- While **duty** and **breach** are necessary components, proving only these two is insufficient for a malpractice claim.
- It must also be demonstrated that the breach directly led to the patient's harm and resulted in legally recognized damages.
*Only breach and causation*
- This option omits the crucial elements of professional **duty** owed to the patient and the resulting **damages**.
- A claim cannot succeed without establishing that a duty existed and that quantifiable harm occurred.
*Duty, breach, and damages*
- This option misses the critical element of **causation**, which links the provider's breach of duty to the patient's injuries.
- Without proving that the breach *caused* the damages, even if a duty was owed and breached, and damages occurred, the claim would fail.
Medical error disclosure US Medical PG Question 5: A 13-year-old boy is brought to the emergency department after being involved in a motor vehicle accident in which he was a restrained passenger. He is confused and appears anxious. His pulse is 131/min, respirations are 29/min, and blood pressure is 95/49 mm Hg. Physical examination shows ecchymosis over the upper abdomen, with tenderness to palpation over the left upper quadrant. There is no guarding or rigidity. Abdominal ultrasound shows free intraperitoneal fluid and a splenic rupture. Intravenous fluids and vasopressors are administered. A blood transfusion and exploratory laparotomy are scheduled. The patient's mother arrives and insists that her son should not receive a blood transfusion because he is a Jehovah's Witness. The physician proceeds with the blood transfusion regardless of the mother's wishes. The physician's behavior is an example of which of the following principles of medical ethics?
- A. Autonomy
- B. Nonmaleficence
- C. Informed consent
- D. Justice
- E. Beneficence (Correct Answer)
Medical error disclosure Explanation: ***Beneficence***
- The physician prioritized the patient's immediate survival and well-being, which is the core principle of **beneficence** (acting in the best interest of the patient).
- In cases of life-threatening emergencies, especially with minors, the duty to preserve life often outweighs other considerations like parental wishes, particularly when the patient lacks the capacity for **informed refusal**.
*Autonomy*
- The physician’s action directly overrides the mother's wishes, which would be an infringement of surrogate autonomy for a minor.
- While patient autonomy is a fundamental principle, it was superseded by the immediate need to save the patient's life.
*Nonmaleficence*
- **Nonmaleficence** means "do no harm." While transfusions have risks, refusing one in this critical situation would cause more harm (death) than performing it.
- The physician acted to prevent immediate harm (death from hemorrhage), even if it meant overriding a family's wishes regarding the specific treatment method.
*Informed consent*
- **Informed consent** requires obtaining permission from a capacitated patient (or legal guardian for a minor) after explaining the risks and benefits of a treatment.
- In this emergency scenario, the patient is a minor and incapacitated, and the urgent need for a life-saving intervention (blood transfusion for a splenic rupture) did not allow for full informed consent or negotiation with the mother, who was refusing a life-saving measure.
*Justice*
- **Justice** refers to the fair and equitable distribution of healthcare resources and equal treatment, which is not the primary ethical concern in this personal patient-physician interaction.
- The scenario focuses on the individual patient's treatment decision, not broader societal resource allocation or fairness in access to care.
Medical error disclosure US Medical PG Question 6: A psychiatrist receives a call from a patient who expresses thoughts of harming his ex-girlfriend. The patient describes a detailed plan to attack her at her workplace. Which of the following represents the psychiatrist's most appropriate legal obligation?
- A. Warn the ex-girlfriend and notify law enforcement (Correct Answer)
- B. Only notify the patient's family
- C. Warn only law enforcement
- D. Maintain patient confidentiality
Medical error disclosure Explanation: ***Warn the ex-girlfriend and notify law enforcement***
- This scenario directly triggers the **"duty to warn"** and **"duty to protect"** principles, primarily stemming from the **Tarasoff v. Regents of the University of California** case.
- The psychiatrist has a legal obligation to take reasonable steps to protect the identifiable victim, which includes directly warning the intended victim and informing law enforcement.
*Only notify the patient's family*
- Notifying the patient's family alone does not fulfill the **legal obligation to protect** an identifiable third party from a serious threat of harm.
- While family involvement might be part of a comprehensive safety plan, it is insufficient as the sole action in this critical situation.
*Warn only law enforcement*
- While notifying law enforcement is a crucial step, the **Tarasoff duty** specifically mandates warning the **intended victim** directly (or those who can reasonably be expected to notify the victim).
- Relying solely on law enforcement might not ensure the immediate safety of the ex-girlfriend, especially if there's a delay in their response or ability to locate her.
*Maintain patient confidentiality*
- Patient confidentiality is a cornerstone of psychiatric practice, but it is **not absolute** when there is a serious and imminent threat of harm to an identifiable individual.
- The **duty to protect** a potential victim *outweighs* the duty to maintain confidentiality in such extreme circumstances.
Medical error disclosure US Medical PG Question 7: A 56-year-old man presents to the family medicine office since he has been having difficulty keeping his blood pressure under control for the past month. He has a significant medical history of hypertension, coronary artery disease, and diabetes mellitus. He has a prescription for losartan, atenolol, and metformin. The blood pressure is 178/100 mm Hg, the heart rate is 92/min, and the respiratory rate is 16/min. The physical examination is positive for a grade II holosystolic murmur at the left sternal border. He also has diminished sensation in his toes. Which of the following statements is the most effective means of communication between the doctor and the patient?
- A. “What is causing your blood pressure to be elevated?” (Correct Answer)
- B. “Have you been taking your medications as prescribed?”
- C. “Would you like us to consider trying a different medication for your blood pressure?”
- D. “You are taking your medications as prescribed, aren’t you?”
- E. “Why are you not taking your medication?”
Medical error disclosure Explanation: ***“What is causing your blood pressure to be elevated?”***
- This is an **open-ended question** that encourages the patient to share their perspective, concerns, and potential reasons for the elevated blood pressure, fostering a **patient-centered approach**.
- It allows the physician to understand the patient's individual circumstances, medication adherence, lifestyle factors, or other contributing issues without being judgmental or leading.
*“Have you been taking your medications as prescribed?”*
- This is a **closed-ended question** that primarily elicits a "yes" or "no" answer, providing limited insight into the patient's actual adherence and the underlying reasons for non-adherence.
- While important, phrasing it this way might make the patient feel interrogated or judged, potentially hindering honest communication.
*“Would you like us to consider trying a different medication for your blood pressure?”*
- This question prematurely jumps to a solution without fully understanding the cause of the elevated blood pressure and the patient's perspective.
- It bypasses the crucial step of investigating potential reasons for poor blood pressure control, which could include non-adherence, lifestyle factors, or secondary hypertension, rather than necessarily a medication efficacy issue.
*“You are taking your medications as prescribed, aren’t you?”*
- This is a **leading question** that implies an expectation and can make the patient feel pressured to answer affirmatively, even if they are not consistently taking their medication.
- Such phrasing can create a defensive environment and discourage the patient from openly discussing adherence challenges.
*“Why are you not taking your medication?”*
- This is a **direct and accusatory question** that implies blame and can immediately put the patient on the defensive, making them less likely to be honest or forthcoming about their medication habits.
- It fails to create a supportive or collaborative atmosphere, which is essential for effective patient-physician communication.
Medical error disclosure US Medical PG Question 8: A regional academic medical center has 10 cases of adenovirus in the span of a week among its ICU patients. A committee is formed to investigate this outbreak. They are tasked with identifying the patients and interviewing the care providers to understand how adenovirus could have been spread from patient to patient. This committee will review charts, talk to the care provider teams, and investigate current patient safety and sanitation measures in the ICU. The goal of the committee is to identify weaknesses in the current system and to put in place a plan to help prevent this sort of outbreak from reoccurring in the future. The committee is most likely using what type of analysis?
- A. Simulation
- B. Root cause analysis (Correct Answer)
- C. Algorithmic analysis
- D. Heuristic analysis
- E. Failure mode and effects analysis
Medical error disclosure Explanation: ***Root cause analysis***
- The committee's goal is to **identify weaknesses** in the current system and **prevent recurrence**, which aligns perfectly with the principles of **root cause analysis (RCA)**.
- RCA is a structured method for **identifying the underlying causes** of problems or incidents, rather than just addressing symptoms.
*Simulation*
- **Simulation** involves creating a model of a process or system to test different scenarios and predict outcomes.
- While useful for planning, it's not the primary method for investigating an actual past event or identifying causative factors after an outbreak has occurred.
*Algorithmic analysis*
- **Algorithmic analysis** is primarily used in computer science to evaluate the efficiency and complexity of algorithms.
- It does not apply to investigating the spread of infectious diseases or healthcare system failures.
*Heuristic analysis*
- **Heuristic analysis** involves using a rule of thumb or an educated guess to solve a problem quickly and efficiently, especially when perfect solutions are not feasible.
- This approach is less systematic and comprehensive than what is required to thoroughly investigate an outbreak and identify root causes.
*Failure mode and effects analysis*
- **Failure mode and effects analysis (FMEA)** is a proactive method used to identify **potential failure modes** in a system and their effects *before* an event occurs.
- The committee is investigating an **already existing problem**, making RCA more appropriate than FMEA, which is used for risk assessment of future processes.
Medical error disclosure US Medical PG Question 9: An 86-year-old male is admitted to the hospital under your care for management of pneumonia. His hospital course has been relatively uneventful, and he is progressing well. While making morning rounds on your patients, the patient's cousin approaches you in the hallway and asks about the patient's prognosis and potential future discharge date. The patient does not have an advanced directive on file and does not have a medical power of attorney. Which of the following is the best course of action?
- A. Direct the cousin to the patient's room, telling him that you will be by within the hour to discuss the plan.
- B. Explain that you cannot discuss the patient's care without explicit permission from the patient themselves. (Correct Answer)
- C. Provide the cousin with the patient's most recent progress notes and a draft of his discharge summary.
- D. Explain that the patient is progressing well and should be discharged within the next few days.
- E. Refer the cousin to ask the patient's wife about these topics.
Medical error disclosure Explanation: ***Explain that you cannot discuss the patient's care without explicit permission from the patient themselves.***
- This is the **correct ethical and legal action** in healthcare to maintain patient confidentiality, as the patient has not designated a medical power of attorney or filed an advance directive.
- The **Health Insurance Portability and Accountability Act (HIPAA)** protects patient health information, requiring explicit patient consent before disclosure to anyone, including family members, unless specific exceptions apply (e.g., immediate threat to safety, treatment purposes directly).
*Direct the cousin to the patient's room, telling him that you will be by within the hour to discuss the plan.*
- While ultimately the patient needs to be involved, directly discussing **private health information** with the cousin without the patient's consent first is a breach of **confidentiality**.
- This approach prematurely assumes the patient will grant permission or wishes for this specific family member to be involved, which might not be true.
*Provide the cousin with the patient's most recent progress notes and a draft of his discharge summary.*
- This action represents a clear and significant **breach of patient confidentiality** and **HIPAA regulations**.
- Without explicit patient consent, sharing detailed medical records with anyone, including family, is strictly prohibited.
*Explain that the patient is progressing well and should be discharged within the next few days.*
- Even a general statement about the patient's condition and discharge plans can be considered a **breach of confidentiality** under HIPAA.
- Such information, while seemingly innocuous, reveals that the individual is indeed a patient and implies details about their health status, which requires patient consent to disclose.
*Refer the cousin to ask the patient's wife about these topics.*
- There is no information provided that the **patient's wife** has legal authority (e.g., **medical power of attorney**) or explicit permission from the patient to discuss his medical information.
- Referring the cousin to the wife without verifying her authority could lead to further breaches of **confidentiality** if the wife is not authorized to share such details.
Medical error disclosure US Medical PG Question 10: A 29-year-old man is admitted to the emergency department following a motorcycle accident. The patient is severely injured and requires life support after splenectomy and evacuation of a subdural hematoma. Past medical history is unremarkable. The patient’s family members, including wife, parents, siblings, and grandparents, are informed about the patient’s condition. The patient has no living will and there is no durable power of attorney. The patient must be put in an induced coma for an undetermined period of time. Which of the following is responsible for making medical decisions for the incapacitated patient?
- A. The spouse (Correct Answer)
- B. An older sibling
- C. Physician
- D. Legal guardian
- E. The parents
Medical error disclosure Explanation: ***The spouse***
- In the absence of a **living will** or **durable power of attorney**, the law typically designates the **spouse** as the primary decision-maker for an incapacitated patient.
- This hierarchy is established to ensure decisions are made by the individual most intimately connected and presumed to understand the patient's wishes.
*An older sibling*
- Siblings are generally further down the **hierarchy of surrogate decision-makers** than a spouse or parents.
- They would typically only be considered if higher-priority family members are unavailable or unwilling to make decisions.
*Physician*
- The physician's role is to provide medical care and guidance, not to make medical decisions for an incapacitated patient when family surrogates are available.
- Physicians only make decisions in **emergency situations** when no surrogate is immediately available and treatment is immediately necessary to save the patient's life or prevent serious harm.
*Legal guardian*
- A legal guardian is usually appointed by a **court** when there is no appropriate family member available or when there is a dispute among family members.
- In this scenario, with a spouse and other close family members present, a legal guardian would not be the first choice.
*The parents*
- While parents are close family members, they are typically considered **secondary to the spouse** in the hierarchy of surrogate decision-makers for an adult patient.
- They would usually only be the decision-makers if the patient were unmarried or the spouse were unavailable.
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