SPEX SPEX Analysis Exam 4 — Questions and Answers
Question 1: A competent adult patient refuses a blood transfusion on religious grounds, even though the physician believes it is life-saving. What is the ethically correct action?
- Administer the transfusion to save the patient's life
- Obtain a court order to override the refusal
- Respect the patient's refusal and document it (Correct answer)
- Transfer care to another physician who will transfuse
Correct answer: Respect the patient's refusal and document it
Competent adults have the right to refuse medical treatment, including life-saving measures, based on the principle of autonomy.
Question 2: According to USPSTF guidelines, at what age should colorectal cancer screening begin for average-risk adults?
- 40 years
- 45 years (Correct answer)
- 50 years
- 55 years
Correct answer: 45 years
The USPSTF updated its recommendation in 2021 to begin colorectal cancer screening at age 45 for average-risk adults.
Question 3: A physician is treating a patient who is a mandatory reporter situation — the patient discloses child abuse occurring at home. What must the physician do?
- Keep the disclosure confidential per HIPAA
- Report to child protective services immediately (Correct answer)
- Discuss with the patient before deciding to report
- Seek ethics committee approval first
Correct answer: Report to child protective services immediately
Physicians are mandatory reporters and are legally required to report suspected child abuse to child protective services, overriding patient confidentiality.
Question 4: Which of the following vaccines is recommended annually for all adults regardless of age?
- Pneumococcal vaccine
- Shingrix (zoster vaccine)
- Influenza vaccine (Correct answer)
- Tdap booster
Correct answer: Influenza vaccine
Annual influenza vaccination is recommended by the ACIP for all individuals 6 months of age and older.
Question 5: A patient asks their physician to provide a fraudulent sick note to avoid work. What is the appropriate physician response?
- Provide the note to maintain the therapeutic relationship
- Write the note if the patient appears stressed
- Refuse, as providing false documentation violates medical ethics (Correct answer)
- Consult with a colleague before deciding
Correct answer: Refuse, as providing false documentation violates medical ethics
Providing fraudulent documentation is a breach of medical ethics and professional integrity, and constitutes fraud.
Question 6: Which of the following is the most effective primary prevention strategy for cardiovascular disease in the general population?
- Daily low-dose aspirin for all adults over 40
- Smoking cessation, diet modification, and exercise (Correct answer)
- Routine coronary artery calcium scoring
- Prescribing statins to all adults
Correct answer: Smoking cessation, diet modification, and exercise
Lifestyle modifications including smoking cessation, healthy diet, and regular physical activity are the cornerstone of primary cardiovascular disease prevention.
Question 7: An elderly patient with dementia cannot make medical decisions. There is no advance directive, but the patient previously expressed treatment preferences to family. What guides decision-making?
- Physician's best clinical judgment alone
- Substituted judgment using the patient's prior expressed wishes (Correct answer)
- Majority vote among family members
- Default to full resuscitation in all cases
Correct answer: Substituted judgment using the patient's prior expressed wishes
Substituted judgment requires surrogates to make decisions based on what the patient would have wanted, not what the surrogate prefers.
SPEX SPEX Analysis Exam 4
A competent adult patient refuses a blood transfusion on religious grounds, even though the physician believes it is life-saving.
What is the ethically correct action?