ABPS Patient Care & Treatment Decision Making 5 — Questions and Answers
Question 1: A patient with metastatic cancer requests experimental treatment not yet approved by the FDA. What is the most appropriate physician response?
- Prescribe the treatment immediately to honor the patient's autonomy
- Explain the evidence status, discuss risks and alternatives, and explore compassionate use or clinical trial enrollment (Correct answer)
- Refuse any discussion of unapproved treatments
- Report the patient to the hospital administration
Correct answer: Explain the evidence status, discuss risks and alternatives, and explore compassionate use or clinical trial enrollment
Physicians should explain the evidence limitations and explore legitimate pathways such as clinical trials or FDA compassionate use programs.
Question 2: What is the most important principle when transitioning a patient from curative to palliative care?
- Stopping all medications immediately
- Ensuring the patient's goals, values, and comfort guide the transition (Correct answer)
- Transferring care to hospice without patient discussion
- Maintaining all prior treatments to avoid apparent abandonment
Correct answer: Ensuring the patient's goals, values, and comfort guide the transition
Goals-of-care conversations that center the patient's values and comfort needs are essential when transitioning from curative to palliative intent.
Question 3: A physician suspects a colleague is impaired by substance use while on duty. What is the most appropriate initial action?
- Ignore the suspicion to protect the colleague's career
- Report the concern to the chief of staff, department head, or hospital patient safety officer (Correct answer)
- Confront the colleague publicly in front of patients
- Wait for a patient complaint before taking action
Correct answer: Report the concern to the chief of staff, department head, or hospital patient safety officer
Physician impairment is a patient safety issue and must be reported through appropriate institutional channels promptly.
Question 4: A 50-year-old woman with newly diagnosed breast cancer is overwhelmed and asks the physician to 'just decide' on treatment. What is the best response?
- Make all decisions unilaterally without further discussion
- Acknowledge her distress, provide clear information, and offer to schedule a follow-up to revisit the decision together (Correct answer)
- Refer immediately to psychiatry before any treatment planning
- Require her to decide independently before providing information
Correct answer: Acknowledge her distress, provide clear information, and offer to schedule a follow-up to revisit the decision together
Acknowledging emotional distress while ensuring ongoing access to information respects autonomy without abandoning the patient in a vulnerable moment.
Question 5: Which factor most strongly predicts poor medication adherence in outpatient chronic disease management?
- Patient age over 65
- Complex multi-drug regimens with frequent dosing schedules (Correct answer)
- Presence of a primary care physician
- Diagnosis of hypertension rather than diabetes
Correct answer: Complex multi-drug regimens with frequent dosing schedules
Regimen complexity and dosing frequency are among the strongest predictors of non-adherence in chronic disease management.
Question 6: A hospitalized patient suddenly develops altered mental status. Which initial step is most important in evaluating acute delirium?
- Order a psychiatric consultation immediately
- Perform a focused history, medication review, and targeted physical examination to identify reversible causes (Correct answer)
- Administer haloperidol empirically without workup
- Transfer to the ICU without further assessment
Correct answer: Perform a focused history, medication review, and targeted physical examination to identify reversible causes
Delirium is a medical emergency requiring systematic search for reversible precipitants such as infections, medications, metabolic derangements, and pain.
Question 7: A 78-year-old with multiple comorbidities is being evaluated for elective total knee replacement. Which preoperative assessment is most important for surgical risk stratification?
- Routine dental X-rays
- Comprehensive functional status evaluation and cardiac risk assessment using validated tools such as the Revised Cardiac Risk Index (Correct answer)
- Lung function testing regardless of respiratory symptoms
- Ophthalmology clearance
Correct answer: Comprehensive functional status evaluation and cardiac risk assessment using validated tools such as the Revised Cardiac Risk Index
Functional status and cardiac risk stratification using tools like the RCRI are essential preoperative assessments to guide perioperative management in elderly patients.
ABPS Patient Care & Treatment Decision Making 5
A patient with metastatic cancer requests experimental treatment not yet approved by the FDA.
What is the most appropriate physician response?