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Communication Skills Ethics — Step 1 practice questions
66 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
Ethics questions in this section combine two things the exam tests separately elsewhere. Capacity, consent, confidentiality, and end-of-life decisions. These questions ask what you would say next, and the answer is usually the option that acknowledges the patient before acting.
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
An investigator proposes enrolling prisoners in a trial of a new analgesic, offering substantial payment and reduced work duties for participation. Which of the following is the principal ethical concern?
Explanations
A. Payment for research participation is always unethical
Reasonable compensation for time and inconvenience is ethical; the problem is disproportionate inducement in a coercive setting.
B. The incentives may be coercive in a setting of constrained liberty, compromising voluntary consent in a population requiring additional protections · correct
Prisoners are a specially protected population precisely because incarceration constrains freedom and makes incentives disproportionately influential — undue inducement threatens the VOLUNTARINESS required for valid consent. Federal regulations impose additional safeguards, including restrictions on permissible research categories and requirements that benefits not be so large as to distort judgment. Other vulnerable groups include children, pregnant women, and those with impaired capacity.
C. Prisoners can never participate in any research under any circumstances
Prisoner research is permitted under specific protective conditions, not categorically banned.
D. The main concern is the scientific validity of pain measurement
Methodologic concerns are secondary to the consent problem.
E. Institutional review board approval is not required for prisoner research
IRB review is required, with additional prisoner representation on the board.
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