Informed consent Practice Questions

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?

Accepted Answer

“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.”

Answer

“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.”

Answer

“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.”

Answer

“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.”

Answer

“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.”

Question 2

A 42-year-old woman presents to the physician with symptoms of vague abdominal pain and bloating for several months. Test results indicate that she has ovarian cancer. Her physician attempts to reach her by phone multiple times but cannot reach her. Next of kin numbers are in her chart. According to HIPAA regulations, who should be the primary person the doctor discusses this information with?

Accepted Answer

The patient

Answer

The patient's brother

Answer

The patient's husband

Answer

The patient's daughter

Answer

All of the options

Question 3

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?

Accepted Answer

The spouse

Answer

An older sibling

Answer

Physician

Answer

Legal guardian

Answer

The parents

Question 4

A 54-year-old man suffered an anterior wall myocardial infarction that was managed in the cath lab with emergent coronary stenting and revascularization. The patient states that his wife, adult children, and cousins may be disclosed information regarding his care and health information. The patient has been progressing well without any further complications since his initial catheterization. On hospital day #3, a woman stops you in the hall outside of the patient's room whom you recognize as the patient's cousin. She asks you about the patient's prognosis and how the patient is progressing after his heart attack. Which of the following is the most appropriate next step?

Accepted Answer

Ask for identification confirming that the woman is truly the patient's cousin

Answer

Decline to comment per HIPAA patient confidentiality regulations

Answer

Direct the woman to discuss these issues with the patient himself

Answer

Ask the patient if it is acceptable to share information with this individual

Answer

Discuss the patient's hospital course and expected prognosis with the woman

Question 5

A 15-year-old teenager presents to the emergency department via emergency medical service (EMS) after a motor vehicle accident. The patient is in critical condition and is hemodynamically unstable. It becomes apparent that the patient may require a blood transfusion, and the parents are approached for consent. They are Jehovah’s Witnesses and deny the blood transfusion, saying it is against their beliefs. However, the patient insists that she wants the transfusion if it will save her life. Despite the patient’s wishes, the parents remain steadfast in their refusal to allow the transfusion. Which of the following is the most appropriate course of action?

Accepted Answer

Obtain a court order to give blood products.

Answer

Give the patient the blood transfusion.

Answer

Give intravenous fluids to attempt to stabilize the patient.

Answer

Do not give blood transfusion due to the parents’ refusal.

Answer

Consult the hospital ethics committee.

Question 6

A 79-year-old man with a history of prostate cancer is brought to the emergency department because of lower abdominal pain for 1 hour. He has not urinated for 24 hours. Abdominal examination shows a palpable bladder that is tender to palpation. A pelvic ultrasound performed by the emergency department resident confirms the diagnosis of acute urinary retention. An attempt to perform transurethral catheterization is unsuccessful. A urology consultation is ordered and the urologist plans to attempt suprapubic catheterization. As the urologist is called to see a different emergency patient, she asks the emergency department resident to obtain informed consent for the procedure. The resident recalls a lecture about the different modes of catheterization, but he has never seen or performed a suprapubic catheterization himself. Which of the following statements by the emergency department resident is the most appropriate?

Accepted Answer

“I would prefer that you obtain informed consent when you become available again.”

Answer

“Suprapubic catheterization is not the treatment of choice for this patient.”

Answer

“I would be happy to obtain informed consent on your behalf, but I'm not legally allowed to do so during my residency.”

Answer

“I will make sure the patient reads and signs the informed consent form.”

Answer

“I will ask the patient to waive informed consent because this is an urgent procedure.”

Question 7

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?

Accepted Answer

Duty, breach, causation, and damages

Answer

Only duty and breach

Answer

Only breach and causation

Answer

Duty, breach, and damages

Question 8

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?

Accepted Answer

Warn the ex-girlfriend and notify law enforcement

Answer

Only notify the patient's family

Answer

Warn only law enforcement

Answer

Maintain patient confidentiality

Question 9

An epidemiologist is evaluating the efficacy of Noxbinle in preventing HCC deaths at the population level. A clinical trial shows that over 5 years, the mortality rate from HCC was 25% in the control group and 15% in patients treated with Noxbinle 100 mg daily. Based on this data, how many patients need to be treated with Noxbinle 100 mg to prevent, on average, one death from HCC?

Accepted Answer

10

Answer

20

Answer

73

Answer

50

Answer

100

Question 10

A 28-year-old male presents to his primary care physician with complaints of intermittent abdominal pain and alternating bouts of constipation and diarrhea. His medical chart is not significant for any past medical problems or prior surgeries. He is not prescribed any current medications. Which of the following questions would be the most useful next question in eliciting further history from this patient?

Accepted Answer

"Can you tell me more about the symptoms you have been experiencing?"

Answer

"Does the diarrhea typically precede the constipation, or vice-versa?"

Answer

"Is the diarrhea foul-smelling?"

Answer

"Please rate your abdominal pain on a scale of 1-10, with 10 being the worst pain of your life"

Answer

"Are the symptoms worse in the morning or at night?"

Informed consent

Study Resources

Lessons

Questions

Flashcards

Lessons

Elements of informed consent

Capacity to consent

Exceptions to informed consent

Special populations (minors, mentally ill)

Documentation requirements

Surrogate decision-making

Advance directives

Withdrawal of consent

Cultural factors in consent

Ethical dilemmas in obtaining consent

Practice Questions

Flashcards

About Informed consent for USMLE

Lessons in Informed consent

Master Informed consent