10 USMLE Ethics and Preventive Medicine Questions with Answers and Explanations (Set 1)

These 10 USMLE ethics and preventive medicine practice questions cover patient autonomy, refusal of treatment, consent for minors, decision-making with family, screening tests, cervical cancer screening, HPV vaccination, tetanus prophylaxis and global causes of death. Each question includes the correct answer and an explanation.

Written by Dr. Ray Makar, MD, author of the Repeated USMLE Questions eBook series.

Prefer video? Watch daily USMLE case questions on MedFocus by Dr. Ray on YouTube.

How to use this page: read the question, pick your answer, then tap Show Answer and Explanation.

Questions

Question 1. You receive a phone call from a nurse at a nursing home telling you that your patient has refused to take her medications for the third day. She is 75 years old, competent and has a disability of both lower limbs. What is your best response to the nurse’s concern?

A- Ask the patient the reason for her refusal and don’t force her to take her medications
B- Ask the nursing home staff to force the patient to take her medications
C- Call her family to find a way to make her take the medications
D- Tell the patient that if she doesn’t take her medications, there is no need for future appointments

Competent patients have the right to refuse to take their medications. Health care provider can only interfere in this situation by asking for the reason of refusal. Other choices are all false. We can’t force patients to take their medications as it is considered violation of their right to refuse medication. Calling family is considered HIPAA violation. Health care providers have obligation to see their patients.
The correct answer is A

 

Question 2. A 17 year old girl is brought to the emergency room by her boyfriend complaining of severe and progressive abdominal pain. Physical examination and laboratory tests confirm a diagnosis of appendicitis. An emergent appendectomy is recommended. Who should sign the consent of surgery?

A- Her father
B- Her boyfriend
C- The ER physician
D- Her regular physician
E- She does not need a consent

A patient under 18 years old who needs surgery needs consent from a parent or legal guardian. The consent should be signed by a parent or a guardian. Her boyfriend or physicians are not authorized to sign the consent in this case unless there is a life-threatening situation arises and they can not reach her parents or guardians.
Note: in a true emergency when a parent cannot be reached, surgery should not be delayed (the emergency exception).
The correct answer is A

 

Question 3. A 25-year-old man presents to his physician for his first annual physical examination. He moved to the city for a new job and he got health insurance so, he decided to do regular annual checks. His past medical, surgical and family histories are unremarkable. He does not smoke or drink alcohol. He does not take any recreational drugs. His physical examination and laboratory tests are normal. What is the recommended screening test for all patients at his age?

A- ECG stress test
B- Prostate specific antigen (PSA)
C- Depression screening test
D- Colonoscopy
E- Erythrocyte sedimentation rate

The only screening test would be recommended at this time is depression-screening test. All new patients with or without a history of psychological disorders should be encouraged to do a depression-screening test. ECG stress test and erythrocyte sedimentation rate are not screening tests while PSA and colonoscopy are recommended at older age.
The correct answer is C

 

Question 4. A 37-year-old woman presents to the office for a consultation about family planning. She is married for 11 years and she has never had any extra-marital relationships. They have been tested negative for HIV infection. She hopes to become pregnant and to stop using condoms. She had normal Pap smears for the past 18 years. The last Pap smear was 1 year ago. When does she need to have her next Pap smear?

A- During this visit
B- in 6 months
C- in 1 year
D- in 2 years
E- in 3 years

This patient is at low risk of cervical cancer. She is in a monogamous relationship for 11 years and she had many negative Pap smears along the past 18 years. For these reasons, it is appropriate to lengthen the interval for Pap smear tests to every 3 years. So, her next Pap smear should be in 2 years as her last one was 1 year ago.
The correct answer is D

 

Question 5. A 29-year-old man is brought to the ER by a policeman. He was driving his car under the influence of alcohol. The policeman asks the ER physician to get a sample of this patient’s gastric contents for analysis. The physician explains the procedure to him but the patient refuses to go through it. What is the best next action?

A- Force the patient to do the procedure
B- Respect the patient’s wishes and don’t do this procedure
C- Convince the patient falsely that this procedure is part of treatment and do it
D- Inject the patient with anesthesia and do the procedure

The physician’s mission is to take care of patients under all circumstance. The physician should respect the right of any patient to refuse treatments or any other procedures. The policeman doesn’t have the authority on medical decisions and medical ethics. However, blood alcohol level can be performed without the patient’s permission.
The correct answer is B

 

Question 6. An 88-year-old woman complains of fatigue and loss of weight over the past 6 months. She lives alone and she has no children. She has a long history of controlled hypertension with atenolol. Vital signs are within normal limits. Her weight is 5 lb less than it was in her last medical visit. Physical examination is unremarkable. Laboratory tests including CBC, thyroid panel and creatinine are normal. Her health screening tests are up-to-date and are unremarkable. What is the appropriate next step?

A- MRI of the brain
B- Further investigations including liver function test
C- Begin anti-depressive medication
D- Discontinue atenolol
E- Arrange nursing and supportive assistance

This patient lives alone and most probably, she is too old to take care of herself. Her examination and laboratory tests are normal. She does not need extra tests. The best approach to this patient is to help her to arrange nurse visits and support with a social worker for counseling as she might need help with shopping and cooking healthy meals and performing other daily activities.
The correct answer is E

 

Question 7. The World Health Organization develops health care services to help low-economic countries to improve the quality of primary health care for elderly people. What is the most common cause of death in low-economic countries?

A- Diarrheal diseases
B- Lower respiratory tract infections
C- HIV/AIDS
D- Ischemic heart disease
E- Stroke

The most common cause of death in low-economic countries is lower respiratory tract infections as pneumonia. Ischemic heart disease and stroke are the most common causes in high-economic countries. Diarrheal diseases are the most common cause of death in young age low-economic population. HIV/AIDS is not the most common cause of death in any age group.
The correct answer is B

 

Question 8. 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

 

Question 9. A 55-year-old woman presents to the emergency room for a cut wound on her hand. While she was cutting a piece of meat, she lost control of the knife resulting in a longitudinal wound in her hand. Bleeding stopped after a few minutes. Now she is concerned about tetanus vaccination. Records show that she received all the doses of tetanus-diphtheria (Td) and the last one was 4 years ago. What is the appropriate therapy for prophylaxis of tetanus in this patient?

A- No further therapy
B- Tetanus toxoid
C- Tetanus immunoglobulin
D- Tetanus toxoid and tetanus immunoglobulin
E- Tetanus toxoid followed by tetanus immunoglobulin after 5 days

No further therapy. This patient already had 3 doses of Td and the last one was less than 5 years ago. Tetanus toxoid is given if the patient has a clean wound and the last dose of tetanus was more than 10 years ago or dirty wound and the last dose was more than 5 years ago. Tetanus immunoglobulin is added to tetanus toxoid in cases of dirty wounds if the last dose was given more than 5 years ago.
The correct answer is A

 

Question 10. A 24-year-old woman visits her physician for consultation about human papillomavirus (HPV) vaccine. She has been sexually active since she was a senior in high school with multiple partners. She had her last Pap smear last year and it was normal. On examination, there are multiple vaginal non-tender wart-like projections. What is the best advice concerning HPV vaccine to this patient?

A- She already has HPV infection so, no need for the vaccine
B- She already has HPV infection but she should take the vaccine for other strains of HPV
C- HPV vaccine is essential to treat the current infection
D- She can only take the vaccine later after full recovery
E- No need for the vaccine as long as Pap smear is normal

This patient is a good candidate for HPV vaccine. HPV vaccine protects against several strains of virus which are mainly responsible for genital warts and cervical cancer. Infection with one strain makes this patient susceptible to infection with other strains especially concerning her sexual history with multiple partners. HPV vaccine is not used in treatment of any condition and is safe to be administered at any stage of infection to protect against other strains of HPV virus. A normal Pap smear does not rule out the need for vaccination.
The correct answer is B

 

High-yield points from this set

  • A competent patient may refuse any treatment; ask why, but do not force it.
  • Minors need a parent’s or guardian’s consent for surgery, except in an emergency when no parent can be reached.
  • All adults should be screened for depression.
  • Women 30–65 with normal results: Pap test every 3 years (or HPV co-testing every 5 years).
  • A competent patient may refuse a test requested by police; respect the refusal.
  • Weight loss in an isolated elderly person with normal work-up: arrange social support and services.
  • Lower respiratory infections are a leading cause of death in low-income countries.
  • When a patient cannot fully understand, involve the trusted family member he chooses in decisions.
  • Clean minor wound with 3 or more tetanus doses and the last one under 10 years ago: no prophylaxis needed.
  • HPV vaccine is recommended through age 26 and can be considered up to age 45.

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