SPEX Exam Medical Ethics and Legal Medicine

Question 1

A 45-year-old alert, oriented man with newly diagnosed cancer refuses a recommended curative surgery after being fully informed of the risks, benefits, and alternatives.
He understands his prognosis without treatment.
The physician should:

Accepted Answer

Respect his decision and document the informed refusal

Answer

Consult psychiatry to assess competency because the decision is irrational

Answer

Contact his family to obtain surrogate consent for the procedure

Answer

Petition the court for an emergency guardian to authorize surgery

Question 2

A 16-year-old presents alone requesting treatment for a sexually transmitted infection. She asks that her parents not be told. In most U.S. jurisdictions, the physician should:

Accepted Answer

Treat her and maintain confidentiality, as minors may consent to STI care

Answer

Refuse to treat without parental consent because she is a minor

Answer

Treat her but is legally required to notify her parents

Answer

Report the case to child protective services as suspected sexual abuse

Question 3

A physician is treating a patient with schizophrenia who discloses during a session that he has detailed plans to stab his neighbor next week. He names the specific neighbor. The physician's legal and ethical obligation under the Tarasoff duty is to:

Accepted Answer

Warn the identifiable potential victim and/or notify law enforcement

Answer

Maintain confidentiality because the patient-physician relationship is privileged

Answer

Notify only the police and document the disclosure

Answer

Involuntarily hospitalize the patient without any obligation to warn the third party

Question 4

An 80-year-old patient with end-stage COPD has a valid living will stating she does not want mechanical ventilation. She is now obtunded and in acute respiratory failure. Her son (healthcare proxy) insists the team 'do everything.' The appropriate action is:

Accepted Answer

Honor the living will and forgo intubation; explain this to the son

Answer

Intubate the patient because the proxy has superseded the living will

Answer

Convene an ethics committee before making any clinical decision

Answer

Provide non-invasive ventilation as a compromise measure

Question 5

A physician discovers that a colleague is regularly performing procedures while impaired by alcohol. The most ethically and legally appropriate first step is:

Accepted Answer

Report the behavior to the hospital's physician health program or appropriate authority

Answer

Confront the colleague privately and advise him to seek treatment before reporting

Answer

Do nothing unless a patient is actually harmed

Answer

Inform patients seen by the impaired physician so they can file complaints

Question 6

For a procedure to meet the standard of informed consent, the physician MUST disclose all of the following EXCEPT:

Accepted Answer

The physician's personal success rate compared to national benchmarks

Answer

Nature of the proposed procedure

Answer

Material risks, including low-probability but severe outcomes

Answer

Reasonable alternatives including no treatment