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Ethics — Step 1 practice questions
68 questions in this area, with an explanation for every answer choice.
Three samples below, free and without an account.
How this shows up on Step 1
Capacity, consent, confidentiality, and end-of-life decisions. Answers follow consistent principles, so once the framework is clear these questions become reliable marks. The best answer usually respects patient autonomy while addressing the immediate concern.
Sample questions
Sample question 1
Before a laparoscopic cholecystectomy, a surgeon describes the procedure and its risks. Which of the following elements is REQUIRED for the consent to be valid?
Explanations
A. Disclosure of the diagnosis, nature of the procedure, risks and benefits, alternatives including no treatment, and confirmation that the patient understands and is deciding voluntarily · correct
Valid informed consent requires the patient to have CAPACITY, receive adequate DISCLOSURE (diagnosis, proposed intervention, risks and benefits, alternatives including doing nothing), demonstrate UNDERSTANDING, and decide VOLUNTARILY without coercion. Exceptions are narrow: emergencies where consent cannot be obtained, waiver by the patient, and legally incompetent patients requiring a surrogate.
B. Approval from the patient's spouse
A competent adult does not need family approval.
C. Disclosure of every conceivable risk regardless of likelihood or severity
The standard is material risks — those a reasonable patient would want to know — not an exhaustive list.
D. Disclosure only of risks the physician considers important, without discussing alternatives
Omitting alternatives invalidates the consent.
E. A signed form, which by itself constitutes valid consent
A signature documents the process but does not substitute for it.
Sample question 2
A patient sends a message through the electronic portal describing new chest pain. Which of the following is the most appropriate response?
Explanations
A. Portal messages are appropriate for any clinical situation including emergencies
Emergencies require immediate in-person or emergency care.
B. Documentation of portal communication in the record is unnecessary
Portal communication forms part of the medical record.
C. Ignore the message, since portal communication is informal
Clinical messages require timely appropriate response.
D. Direct the patient to seek immediate in-person evaluation, since portal messaging is unsuitable for potentially emergent symptoms and response timing cannot be guaranteed · correct
Electronic portal messaging improves access and convenience but has clear limitations: it is ASYNCHRONOUS with no guaranteed response time, lacks examination and nonverbal information, and is therefore unsuitable for potentially EMERGENT symptoms — patients should be told this explicitly at enrollment and redirected to urgent evaluation when messages describe concerning symptoms. Clinical portal communication becomes part of the medical RECORD and must be documented, must respect privacy safeguards, and should not be used to manage conditions requiring examination.
E. Provide detailed management advice by message without evaluation
Chest pain requires evaluation rather than remote advice.
Sample question 3
A patient asks that nothing discussed in the visit be shared with anyone. Which of the following best describes the appropriate response?
Explanations
A. Information may be shared freely with any family member who asks
Family disclosure requires patient authorization.
B. Promise absolute confidentiality without qualification
Absolute promises cannot be honored and destroy trust when broken.
C. Confidentiality ends once the patient leaves the clinic
The obligation continues indefinitely, including after death.
D. Explain that confidentiality is protected but not absolute, with recognized exceptions including reportable diseases, suspected abuse, serious threats to identifiable others, and legal requirements · correct
Confidentiality underpins the therapeutic relationship by enabling honest disclosure, but it has RECOGNIZED LIMITS that should be explained honestly rather than promised away: mandatory reporting of communicable diseases, suspected child and elder abuse, certain injuries; duty to protect identifiable third parties from serious threats; impaired drivers in some jurisdictions; and court orders. Promising absolute confidentiality is both untrue and damaging when the promise must be broken. Information sharing with family requires the patient's permission, and disclosures should be limited to the minimum necessary.
E. Explain that confidentiality has no legal protection
Confidentiality has substantial legal protection.
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