Medical Ethics Practice Questions

Question 1

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 2

An 83-year-old man presents to the gastroenterologist to follow-up on results from a biopsy of a pancreatic head mass, which the clinician was concerned could be pancreatic cancer. After welcoming the patient and his wife to the clinic, the physician begins to discuss the testing and leads into delivering the results, which showed metastatic pancreatic adenocarcinoma. Before she is able to disclose these findings, the patient stops her and exclaims, "Whatever it is, I don't want to know. Please just make me comfortable in my last months alive. I have made up my mind about this." Which of the following is the most appropriate response on the part of the physician?

Accepted Answer

"If that is your definite wish, then I must honor it"

Answer

"The cancer has spread to your liver"

Answer

"As a physician, I am obligated to disclose these results to you"

Answer

"If you don't know what condition you have, I will be unable to be your physician going forward"

Answer

"Please, sir, I strongly urge you to reconsider your decision"

Question 3

A research group wants to assess the safety and toxicity profile of a new drug. A clinical trial is conducted with 20 volunteers to estimate the maximum tolerated dose and monitor the apparent toxicity of the drug. The study design is best described as which of the following phases of a clinical trial?

Accepted Answer

Phase I

Answer

Phase 0

Answer

Phase III

Answer

Phase V

Answer

Phase II

Question 4

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 5

A 73-year-old man is brought to the emergency department by ambulance after being found to be non-communicative by his family during dinner. On presentation he appears to be alert, though he is confused and cannot follow instructions. When he tries to speak, he vocalizes a string of fluent but unintelligible syllables. Given this presentation, his physician decides to administer tissue plasminogen activator to this patient. This intervention best represents which of the following principles?

Accepted Answer

This does not represent prevention

Answer

Tertiary prevention

Answer

Primary prevention

Answer

Quaternary prevention

Answer

Secondary prevention

Question 6

A 14-year-old girl presents to the emergency room complaining of abdominal pain. She was watching a movie 3 hours prior to presentation when she developed severe non-radiating right lower quadrant pain. The pain has worsened since it started. She also had non-bloody non-bilious emesis 1 hour ago and continues to feel nauseated. Her temperature is 101°F (38.3°C), blood pressure is 130/90 mmHg, pulse is 110/min, and respirations are 22/min. On exam, she has rebound tenderness at McBurney point and a positive Rovsing sign. She is stabilized with intravenous fluids and pain medication and is taken to the operating room to undergo a laparoscopic appendectomy. While in the operating room, the circulating nurse leads the surgical team in a time out to ensure that introductions are made, the patient’s name and date of birth are correct, antibiotics have been given, and the surgical site is marked appropriately. This process is an example of which of the following human factor engineering elements?

Accepted Answer

Standardization

Answer

Forcing function

Answer

Safety culture

Answer

Simplification

Answer

Resilience engineering

Question 7

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?"

Question 8

A 28-year-old woman is brought to the emergency department after being resuscitated in the field. Her husband is with her and recalls seeing pills beside her when he was in the bathroom. He reveals she has a past medical history of depression and was recently given a prescription for smoking cessation. On physical exam, you notice a right-sided scalp hematoma and a deep laceration to her tongue. She has a poor EEG waveform indicating limited to no cerebral blood flow and failed both her apnea test and reflexes. She is found to be in a persistent vegetative state, and the health care team starts to initiate the end of life discussion. The husband states that the patient had no advance directives other than to have told her husband she did not want to be kept alive with machines. The parents want all heroic measures to be taken. Which of the following is the most accurate statement with regards to this situation?

Accepted Answer

The patient’s husband may be appointed as her health care surrogate and may make end-of-life decisions on her behalf.

Answer

The physician may be appointed as the patient’s health care surrogate and may make end-of-life decisions on her behalf.

Answer

The patient’s parents may be appointed as her health care surrogate and may make end-of-life decisions on her behalf.

Answer

An ethics committee must be appointed as the patient’s health care surrogate and may make end-of-life decisions on her behalf.

Answer

A court-appointed guardian may be appointed as the patient's health care surrogate and may make end-of-life decisions on her behalf.

Question 9

A 26-year-old man comes to the emergency department because of a 1-week history of fever, throat pain, and difficulty swallowing. Head and neck examination shows an erythematous pharynx with purulent exudates overlying the palatine tonsils. Microscopic examination of a throat culture shows pink, spherical bacteria arranged in chains. Treatment with amoxicillin is initiated. A day later, a physician colleague from another department approaches the physician in the lobby of the hospital and asks about this patient, saying, "Did you see him? What does he have? He's someone I play football with and he hasn't come to play for the past 5 days. I'm worried about him." Which of the following is the most appropriate action by the physician?

Accepted Answer

Inform the colleague that they cannot divulge any information about the patient

Answer

Inform the colleague that they should ask the patient's attending physician

Answer

Tell the colleague the patient's case file number so they can look it up themselves

Answer

Tell the colleague that they cannot tell them the diagnosis but that their friend was treated with antibiotics

Answer

Ask the colleague to meet in the office so they can discuss the patient in private

Question 10

A 40-year-old woman presents to her physician's home with a headache. She describes it as severe and states that her symptoms have not been improving despite her appointment yesterday at the office. Thus, she came to her physician's house on the weekend for help. The patient has been diagnosed with migraine headaches that have persisted for the past 6 months and states that her current symptoms feel like her previous headaches with a severity of 3/10. She has been prescribed multiple medications but is generally non-compliant with therapy. She is requesting an exam and urgent treatment for her symptoms. Which of the following is the best response from the physician?

Accepted Answer

Unfortunately, I cannot examine and treat you at this time. Please set up an appointment to see me in my office.

Answer

It sounds to me like you are in a lot of pain. Let me see how I can help you.

Answer

Do not come to my house when you have medical problems. You should make an appointment.

Answer

Your symptoms seem severe. Let me perform a quick exam to see if everything is alright.

Answer

You should go to the emergency department for your symptoms rather than coming here.

Medical Ethics

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Ethical principles (autonomy, beneficence, non-maleficence, justice)

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Conflicts of interest

Truth-telling and disclosure

Confidentiality boundaries

Resource allocation ethics

Research ethics and IRBs

Reproductive ethics

Genetic testing ethics

Professional boundaries

Medical error disclosure

Ethics of emerging technologies

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