ABPS Patient Care & Treatment Decision Making 3 — Questions and Answers
Question 1: A physician learns that a patient has not disclosed a new HIV diagnosis to their sexual partner. What is the most ethically appropriate initial action?
- Immediately notify the partner without patient consent
- Counsel the patient on disclosure obligations and risks to the partner (Correct answer)
- Report to law enforcement
- Ignore the situation to protect patient confidentiality absolutely
Correct answer: Counsel the patient on disclosure obligations and risks to the partner
The physician should first counsel the patient about their duty to disclose; most jurisdictions allow but do not mandate immediate third-party notification.
Question 2: When applying evidence-based medicine to an individual patient, which factor is LEAST relevant?
- The patient's values and preferences
- The quality and applicability of clinical evidence
- The physician's clinical expertise
- The treatment cost compared to a different hospital system's pricing (Correct answer)
Correct answer: The treatment cost compared to a different hospital system's pricing
EBM integrates evidence quality, clinical expertise, and patient values—comparative pricing across institutions is not a core EBM component.
Question 3: A 72-year-old with heart failure and CKD stage 3 needs loop diuretic therapy. Which monitoring parameter is most critical?
- Weekly chest X-ray
- Serum electrolytes and renal function within 1-2 weeks of initiation (Correct answer)
- Daily echocardiography
- Monthly CBC only
Correct answer: Serum electrolytes and renal function within 1-2 weeks of initiation
Loop diuretics can cause electrolyte imbalances and worsen renal function, requiring early laboratory monitoring in CKD patients.
Question 4: Which scenario best represents shared decision-making?
- The physician selects treatment and informs the patient afterward
- The patient selects treatment independently without physician guidance
- The physician presents options with evidence, and patient preferences guide the final choice (Correct answer)
- Treatment is determined by the patient's insurance formulary
Correct answer: The physician presents options with evidence, and patient preferences guide the final choice
Shared decision-making involves the physician providing evidence-based options while integrating the patient's values into the final treatment plan.
Question 5: A 58-year-old with hypertension is started on lisinopril and develops a dry cough. What is the most appropriate next step?
- Add a cough suppressant and continue lisinopril
- Switch to an angiotensin receptor blocker (ARB) (Correct answer)
- Discontinue all antihypertensive therapy
- Add a beta-blocker and continue lisinopril
Correct answer: Switch to an angiotensin receptor blocker (ARB)
ACE inhibitor–induced cough is a class effect; switching to an ARB provides equivalent blood pressure control without this side effect.
Question 6: Which element is essential to demonstrate that a patient has decision-making capacity?
- Being at least 21 years of age
- Understanding information, appreciating consequences, reasoning through choices, and communicating a decision (Correct answer)
- Having a designated healthcare proxy on file
- Absence of any psychiatric diagnosis
Correct answer: Understanding information, appreciating consequences, reasoning through choices, and communicating a decision
Capacity requires four abilities: understanding, appreciation, reasoning, and communication of a consistent choice.
Question 7: A patient with type 2 diabetes and established cardiovascular disease requires glucose-lowering therapy beyond metformin. Which class of medication has the strongest evidence for cardiovascular risk reduction?
- Sulfonylureas
- GLP-1 receptor agonists or SGLT-2 inhibitors (Correct answer)
- DPP-4 inhibitors
- Alpha-glucosidase inhibitors
Correct answer: GLP-1 receptor agonists or SGLT-2 inhibitors
GLP-1 receptor agonists and SGLT-2 inhibitors have demonstrated cardiovascular outcome benefits in multiple large trials for patients with established CVD.
ABPS Patient Care & Treatment Decision Making 3
A physician learns that a patient has not disclosed a new HIV diagnosis to their sexual partner.
What is the most ethically appropriate initial action?