Patient Safety & Quality Improvement USMLE Step 1 Practice Question
A 67-year-old man with atrial fibrillation has been taking warfarin for 18 months. He presents to the emergency department with severe epistaxis, hemoptysis, and a 2-day history of hematuria. Vital signs show BP 92/58, HR 118, RR 22. Laboratory studies reveal INR 8.5 (therapeutic range 2.0-3.0) and hemoglobin 7.2 g/dL (baseline 12.1 g/dL). The patient states he has not missed any doses and denies taking any new medications. Chart review shows no documentation that the patient was counseled about monitoring requirements or potential bleeding complications. Which of the following elements of informed consent was most clearly omitted in this case?
Answer choices
- ADisclosure of the patient's genetic CYP2C9 and VKORC1 polymorphisms that affect warfarin metabolism
- BExplanation of the specific target INR range and the importance of regular INR monitoringCorrect answer
- CDiscussion of the financial cost of warfarin therapy and availability of generic alternatives
- DReview of the patient's complete family history for inherited thrombophilia
- EDetailed discussion of the pathophysiology of atrial fibrillation and thromboembolic risk
- FComparison of warfarin efficacy rates at this specific hospital versus other institutions
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