Repeated USMLE Questions Step 1- 270

A 78- year-old-man who is recently diagnosed with a malignant brain tumor visits his physician with his wife to discuss his treatment options with radiotherapy and chemotherapy. When the physician explains the benefits and risks of each option, he notices that the patient does not understand everything he is saying. Meanwhile, his wife understands and asks questions. The physician knows them very well as they both share their own values and make their medical decisions together for a long time. They both agree to proceed with radiation and chemotherapy.

What is the most appropriate next step in management?

A-Start treatment immediately

B-Start treatment after obtaining a written consent from his wife

C-Refer the patient for psychiatric evaluation

D-Seek guardianship through the court

E-Schedule another appointment for the patient only to be sure of his own decision


One of the main rules before you start any treatment is being sure that the patient understands all the benefits and risks of all treatment options. In this case, the patient cannot fully understand everything while his wife sounds comprehensive. Because you know them a long time ago and you know that her decision would be the best interest for her husband, then, you should seek a written consent from her before you start the treatment. It is important for legal reasons to have a written consent rather than oral one. There is no need for psychiatric evaluation as the patient’s ability of thought could be affected by the brain tumor. There is also no need for another appointment or guardianship as his wife is considered undisputed surrogate decision-maker.

The correct answer is B

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6 thoughts on “Repeated USMLE Questions Step 1- 270”

  1. Great question. In this case, a guardianship will be appointed through court.

  2. What would’ve been the answer of the wife wasn’t supportive?

  3. Thank you so much Dr Bezabeh

  4. I disagree with you Dr Ejiofor. History and examination are enough in this case to decide that this person in incompetent. Thank you for your comment.

  5. C
    From the case scenario the patient seems not to be competent in making an adequate decision. To be sure he needs psychiatric evaluation.

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