MCQ bank · 9 questions · free
Ethics, consent & patient safety MCQs with answers
9 single-best-answer questions on capacity, consent, candour, M&M meetings and patient safety. Try each one, then open the answer to see the explanation, why the other options are wrong, and the guideline or trial behind it.
A 70-year-old with capacity refuses surgery for a perforated bowel after a clear explanation that he will probably die without it. What should the surgeon do?
- Sedate him and operate
- Ask the family to consent instead
- Respect his decision, document the discussion, explore his reasons and concerns, offer alternatives and comfort care, and make sure he knows he can change his mind
- Discharge him without further care
- Operate anyway because it is life-saving
Show the answer and explanation
Answer: C. Respect his decision, document the discussion, explore his reasons and concerns, offer alternatives and comfort care, and make sure he knows he can change his mind. An adult with capacity has the right to refuse treatment, even if the decision seems unwise or will lead to death. The doctor’s role is to ensure the decision is informed and voluntary, explore any misunderstandings or fears, and continue to offer care.
Why not the others? Relatives cannot override the decision of an adult with capacity.
References
How is mental capacity to make a specific decision assessed?
- By a cognitive score alone
- By their age
- Whether the person can understand the relevant information, retain it long enough, use or weigh it, and communicate a decision
- By whether they agree with the doctor
- By the diagnosis alone, such as dementia
Show the answer and explanation
Answer: C. Whether the person can understand the relevant information, retain it long enough, use or weigh it, and communicate a decision. Capacity is decision-specific and time-specific, and it is presumed unless shown otherwise. A diagnosis such as dementia does not automatically remove capacity. Doctors should support the patient to decide, for example by choosing a good time and using simple language or interpreters.
Why not the others? An unwise decision is not proof of incapacity.
References
An unconscious trauma patient needs an emergency laparotomy. No relatives can be reached and there is no advance decision. What is the legal and ethical basis for operating?
- Treatment necessary to save life or prevent serious harm can be given in the patient’s best interests in an emergency
- Wait until the patient wakes up
- Wait for a court order
- Ask a hospital administrator to sign
- Surgery is not allowed without written consent
Show the answer and explanation
Answer: A. Treatment necessary to save life or prevent serious harm can be given in the patient’s best interests in an emergency. In an emergency where a patient lacks capacity and treatment cannot wait, doctors may provide treatment that is immediately necessary in the patient’s best interests. Known wishes (for example an advance refusal of blood) must still be respected.
Why not the others? Document the reasons clearly.
References
During a cholecystectomy, a swab was retained and found on a later scan. The patient recovers after its removal. What should happen?
- Blame the scrub nurse
- Alter the operation note
- Do not tell the patient to avoid complaints
- Tell the patient it was an unavoidable complication
- Open and honest disclosure: tell the patient what happened, apologise, explain the consequences and the steps being taken, and report it through the incident system for learning
Show the answer and explanation
Answer: E. Open and honest disclosure: tell the patient what happened, apologise, explain the consequences and the steps being taken, and report it through the incident system for learning. Doctors have a professional duty of candour. Apologising is not an admission of legal liability. Reporting allows systems learning, for example improving swab counts. Altering records is a serious professional offence.
Why not the others? Patients are more likely to complain when they feel information is hidden.
References
When obtaining consent for a laparoscopic cholecystectomy, which risks must be discussed?
- Material risks: those a reasonable person in the patient’s position would consider significant, or that this patient would consider significant, plus reasonable alternatives (including no treatment)
- Only the risk of death
- No risks, to avoid worrying the patient
- Whatever the surgeon thinks is relevant, regardless of the patient
- Only risks that occur in more than 10% of patients
Show the answer and explanation
Answer: A. Material risks: those a reasonable person in the patient’s position would consider significant, or that this patient would consider significant, plus reasonable alternatives (including no treatment). Since the Montgomery judgement in the UK, consent is based on what matters to the patient, not only on what a body of doctors would disclose. For cholecystectomy, this includes bile duct injury, bile leak, bleeding, conversion, retained stones and post-cholecystectomy symptoms, and alternatives such as non-operative management.
Why not the others? Consent is a process, not a signature.
References
What is the main purpose of a surgical morbidity and mortality (M&M) meeting?
- To criticise juniors publicly
- To decide legal liability
- Learning from adverse outcomes to improve care and systems, in a confidential, non-punitive environment
- To discipline individual surgeons
- To replace incident reporting
Show the answer and explanation
Answer: C. Learning from adverse outcomes to improve care and systems, in a confidential, non-punitive environment. Effective M&M meetings review cases honestly, identify individual and system factors, and lead to changes in practice. A culture of blame discourages honest presentation and reduces learning.
Why not the others? Actions agreed at M&M should be followed up.
References
A patient’s deterioration after surgery (rising respiratory rate, falling blood pressure) went unrecognised on the ward for 12 hours before he died of sepsis. Which system measure most directly reduces this “failure to rescue”?
- More paperwork
- Blaming the nurse
- Fewer observations at night
- A track-and-trigger early warning score (such as NEWS2) with a clear escalation pathway to a senior or critical care outreach team
- Restricting visitors
Show the answer and explanation
Answer: D. A track-and-trigger early warning score (such as NEWS2) with a clear escalation pathway to a senior or critical care outreach team. Failure to rescue (death after a treatable complication) varies widely between hospitals. Regular observations, early warning scores that trigger escalation, rapid response teams and a culture where staff can escalate concerns reduce it.
Why not the others? Hospitals with similar complication rates can have very different failure-to-rescue rates.
References
An author wants to list an AI chatbot as a co-author because it helped write the paper. What do journal standards say?
- AI tools cannot be authors because they cannot take responsibility for the work; their use should be disclosed, and the human authors remain accountable for accuracy, including invented references
- AI-generated text is always accurate
- AI use never needs disclosure
- AI can be listed as first author
- Only the AI is responsible for errors
Show the answer and explanation
Answer: A. AI tools cannot be authors because they cannot take responsibility for the work; their use should be disclosed, and the human authors remain accountable for accuracy, including invented references. Authorship requires accountability for the work. AI tools can produce plausible but false statements and invented references (“hallucination”), so human authors must check all content and disclose how AI was used.
Why not the others? Using AI to write without checking can lead to research misconduct.
References
A Jehovah’s Witness with capacity needs major surgery with a risk of bleeding and has an advance decision refusing blood. What is correct?
- Refuse to operate on principle
- Transfuse secretly under anaesthesia
- Respect the refusal; discuss in advance which products and techniques are acceptable (such as cell salvage, tranexamic acid, iron and erythropoietin), and optimise haemoglobin before surgery
- Ask relatives to override the decision
- Transfuse in an emergency regardless
Show the answer and explanation
Answer: C. Respect the refusal; discuss in advance which products and techniques are acceptable (such as cell salvage, tranexamic acid, iron and erythropoietin), and optimise haemoglobin before surgery. A valid refusal by an adult with capacity must be respected, even if it risks death. Planning reduces risk: preoperative anaemia management, meticulous haemostasis, cell salvage if acceptable, and senior surgical and anaesthetic involvement. Children are treated differently, and court involvement may be needed.
Why not the others? Transfusing against a valid refusal is assault.
References