ABPS Patient Care & Treatment Decision Making 4 — Questions and Answers
Question 1: A patient refuses blood transfusion on religious grounds despite life-threatening anemia (Hgb 4 g/dL). They are alert and oriented. What should the physician do?
- Transfuse immediately to prevent death
- Respect the refusal and maximize alternative interventions such as IV iron and erythropoiesis-stimulating agents (Correct answer)
- Obtain a court order to override the refusal
- Transfer to another facility that will transfuse without consent
Correct answer: Respect the refusal and maximize alternative interventions such as IV iron and erythropoiesis-stimulating agents
A competent adult's religiously-motivated refusal must be respected; the physician should optimize alternatives to transfusion.
Question 2: What is the primary purpose of a do-not-resuscitate (DNR) order?
- To withhold all medical treatment from the patient
- To document that CPR should not be initiated in the event of cardiac or respiratory arrest (Correct answer)
- To allow the family to override the patient's wishes
- To limit hospitalization to 24 hours
Correct answer: To document that CPR should not be initiated in the event of cardiac or respiratory arrest
A DNR order specifically addresses CPR and does not limit other treatments; it reflects patient preferences regarding resuscitation.
Question 3: A 40-year-old patient with no cardiac history presents with atypical chest pain. ECG and troponins are normal. What is the most appropriate next step?
- Discharge home without further workup
- Perform immediate coronary angiography
- Conduct stress testing or advanced imaging based on pretest probability (Correct answer)
- Start empiric anticoagulation
Correct answer: Conduct stress testing or advanced imaging based on pretest probability
Risk stratification using pretest probability guides appropriate further testing such as stress testing or CT coronary angiography in low-to-intermediate risk patients.
Question 4: A pediatric patient requires surgery but parents refuse consent due to cultural beliefs. The surgery is not immediately life-threatening but delays may cause significant harm. What is the appropriate action?
- Proceed with surgery over the parents' objection
- Respect the refusal and provide no treatment
- Engage the ethics committee and consider legal intervention if harm is imminent (Correct answer)
- Discharge the child immediately
Correct answer: Engage the ethics committee and consider legal intervention if harm is imminent
When parental refusal places a child at significant risk, ethics consultation and potential legal intervention to protect the child's best interests are appropriate.
Question 5: Which of the following best defines the standard of care in medical practice?
- The most advanced treatment available regardless of cost
- The level of care a reasonably competent physician would provide under similar circumstances (Correct answer)
- Treatment mandated by hospital administration
- The cheapest effective treatment option
Correct answer: The level of care a reasonably competent physician would provide under similar circumstances
Standard of care is defined as what a reasonably competent physician with similar training would do under similar clinical circumstances.
Question 6: A 65-year-old with atrial fibrillation and a CHA₂DS₂-VASc score of 4 is not on anticoagulation due to a prior GI bleed 18 months ago. What is the most appropriate management?
- Permanently withhold anticoagulation due to prior GI bleed history
- Reassess bleeding risk, address reversible causes, and initiate anticoagulation if benefit outweighs risk (Correct answer)
- Start aspirin monotherapy as a safer alternative to anticoagulation
- Refer to cardiology only without any treatment change
Correct answer: Reassess bleeding risk, address reversible causes, and initiate anticoagulation if benefit outweighs risk
A remote GI bleed is not a permanent contraindication; reassessing bleeding risk and treating reversible causes often allows safe anticoagulation initiation.
Question 7: Which approach is most consistent with culturally competent care?
- Applying identical treatment protocols to all patients regardless of background
- Using professional medical interpreters and adapting communication to the patient's cultural context (Correct answer)
- Deferring all decisions to the patient's family rather than the patient
- Avoiding discussion of cultural beliefs to prevent bias
Correct answer: Using professional medical interpreters and adapting communication to the patient's cultural context
Culturally competent care involves using interpreters, understanding cultural context, and tailoring communication to improve patient engagement and outcomes.
ABPS Patient Care & Treatment Decision Making 4
A patient refuses blood transfusion on religious grounds despite life-threatening anemia (Hgb 4 g/dL).
They are alert and oriented.
What should the physician do?