ABPS Patient Care & Treatment Decision Making 2 — Questions and Answers
Question 1: A 68-year-old patient with stage IV COPD refuses intubation during an acute exacerbation. What is the most appropriate next step?
- Intubate immediately to save the patient's life
- Respect the patient's refusal and pursue non-invasive ventilation and comfort measures (Correct answer)
- Contact the patient's family to override the refusal
- Discharge the patient and document refusal of care
Correct answer: Respect the patient's refusal and pursue non-invasive ventilation and comfort measures
A competent adult's refusal of treatment must be respected; non-invasive ventilation and comfort-focused care align with the patient's wishes.
Question 2: Which principle of bioethics is best exemplified when a physician discloses all risks of a surgical procedure before obtaining the patient's signature?
- Beneficence
- Non-maleficence
- Autonomy (Correct answer)
- Justice
Correct answer: Autonomy
Informed consent respects autonomy by ensuring the patient can make a voluntary, informed decision about their own care.
Question 3: A 45-year-old diabetic patient presents with a new HbA1c of 9.8%. Current regimen is metformin 1000 mg BID. What is the most guideline-concordant next step?
- Switch to insulin glargine monotherapy
- Add a second oral agent or GLP-1 agonist per ADA guidelines (Correct answer)
- Increase metformin to 2500 mg daily
- Refer immediately to endocrinology without treatment change
Correct answer: Add a second oral agent or GLP-1 agonist per ADA guidelines
ADA guidelines recommend combination therapy when HbA1c remains above goal on metformin monotherapy.
Question 4: During a care conference, the team disagrees on whether to pursue aggressive treatment for a terminally ill patient. What resource is most appropriate to resolve this conflict?
- The patient's insurance carrier
- Hospital ethics committee (Correct answer)
- State medical board
- Risk management department only
Correct answer: Hospital ethics committee
Ethics committees are specifically designed to mediate complex clinical-ethical disputes among patients, families, and care teams.
Question 5: A patient's surrogate decision-maker demands aggressive life-sustaining treatment the care team believes is medically futile. What is the best approach?
- Provide all requested treatment without question
- Explain the concept of medical futility and facilitate an ethics consultation (Correct answer)
- Transfer care to another facility immediately
- Discontinue all treatment without discussion
Correct answer: Explain the concept of medical futility and facilitate an ethics consultation
Open communication about futility combined with ethics consultation helps align surrogate expectations with medical reality.
Question 6: A 55-year-old man with chronic low back pain asks to continue opioid therapy indefinitely. What is the most appropriate response according to current pain management guidelines?
- Prescribe indefinitely to maintain the therapeutic relationship
- Reassess functional status, risks, and benefits; taper if risks outweigh benefits (Correct answer)
- Abruptly discontinue opioids to prevent dependence
- Refer to psychiatry before any pain management decisions
Correct answer: Reassess functional status, risks, and benefits; taper if risks outweigh benefits
CDC guidelines recommend periodic reassessment of opioid therapy with tapering when harms outweigh functional benefits.
Question 7: A 30-year-old pregnant patient in her third trimester is diagnosed with acute appendicitis. What is the correct treatment approach?
- Delay surgery until after delivery to avoid fetal risk
- Perform appendectomy promptly regardless of gestational age (Correct answer)
- Treat with antibiotics alone to avoid surgical risk
- Induce labor first, then address the appendicitis
Correct answer: Perform appendectomy promptly regardless of gestational age
Acute appendicitis in pregnancy requires prompt surgical intervention regardless of trimester, as delay increases perforation risk and fetal mortality.
ABPS Patient Care & Treatment Decision Making 2
A 68-year-old patient with stage IV COPD refuses intubation during an acute exacerbation.
What is the most appropriate next step?