Behavioral Science & Ethics USMLE Practice Questions
Medical ethics, patient communication, and healthcare systems.
4 free behavioral science & ethics practice questions
Pick an answer and check it. After each question you get the same explanation StepGenie students see: the stem decoded clue by clue, the reasoning chain with its infographic, why every wrong option is wrong, and the trap the question was built around. Step 1 questions test mechanism; Step 2 CK questions ask for the next step.
A 28-year-old man comes to his physician due to concerns about his long-term compatibility with his wife after recently relocating to a new city. He reports that he has been flirting with several female coworkers at his new job. Later, during a dinner outing with his wife, he accuses her of giving the waiter flirtatious looks and questions whether she has been cheating on him or trying to spend time with other men. The man's behavior is most consistent with which of the following psychological defense mechanisms?
Correct answer · C
Projection
Decoding the stem
Step-by-step reasoning
Step 1 of 5
Patient is engaging in flirting with coworkers, which may conflict with his commitment to his wife and cause internal discomfort.
Step 2 of 5
Instead of acknowledging his own problematic impulses, his psyche defends itself by externalizing the conflict.
Step 3 of 5
He then accuses his wife of flirting and cheating, despite no clear evidence in the vignette.
Step 4 of 5
This pattern—attributing one’s own unacceptable thoughts or impulses to another person—is the definition of projection.
Step 5 of 5
Thus, his behavior is most consistent with the defense mechanism projection rather than a change in behavior or memory suppression.
Why not the others?
A. Displacement
This option implies redirecting emotions from a threatening target to a safer one (e.g., yelling at a child instead of the boss), BUT this man is not redirecting anger; he is attributing his own flirting/infidelity impulses to his wife, which is projection, not displacement.
B. Dissociation
This option implies a disruption in memory, identity, or perception (e.g., depersonalization, amnesia) often after trauma, BUT the patient is fully aware, with no memory gaps or detachment; he is misattributing his own impulses to his wife instead.
D. Reaction formation
This option implies transforming unacceptable impulses into their opposite (e.g., being overly nice to someone you dislike), BUT he is not overcompensating by being excessively faithful or affectionate; he is accusing his wife of the very behavior he is engaging in, which is projection.
E. Repression
This option implies unconscious blocking of distressing thoughts or memories, BUT his flirting is not forgotten or kept from awareness—he openly reports it. The issue is where he assigns these impulses (onto his wife), which is characteristic of projection.
Exam trap
The stem highlights the wife’s alleged flirting, tempting you to focus on her behavior. The key is to notice the mirror: he is the one flirting and then attributes those very impulses to her—classic projection.
The bottom line
Projection: Attributing one’s own unacceptable thoughts or impulses (his flirting) to someone else (accusing wife of infidelity).
A 62-year-old woman comes to the clinic for a routine health maintenance visit and reports feeling well. She was vaccinated against influenza 6 months ago. Screening history is notable for a normal mammogram 1 year ago and normal Pap smear and colonoscopy 2 years ago. Medical history includes hypertension. Her father died of a myocardial infarction at age 50. She emigrated from Japan 30 years ago. She has an 18–pack-year smoking history (currently smokes half a pack of cigarettes daily) and drinks 4–5 glasses of wine per day. She exercises regularly by ballroom dancing twice weekly. Current medications are enalapril and low-dose aspirin. She is 165 cm (5 ft 5 in) tall and weighs 50 kg (110 lb), with a BMI of 18 kg/m². Vital signs are within normal limits. Cardiopulmonary examination reveals a soft S4 gallop; the remainder of the physical examination is unremarkable. Which of the following is the most appropriate next step in management?
Correct answer · C
Dual-energy x-ray bone absorptiometry
Decoding the stem
Step-by-step reasoning
- 1
She is a 62-year-old postmenopausal woman presenting for routine preventive care with no acute complaints.
- 2
Her age and risk factors (low BMI, smoking, heavy alcohol use) significantly increase her risk of osteoporosis and fragility fractures.
- 3
Guidelines recommend DXA bone density screening for all women ≥65, and for younger postmenopausal women with high fracture risk (eg, low BMI, smoking, alcohol).
- 4
Although she is slightly younger than 65, her multiple strong risk factors place her in the group warranting earlier DXA screening.
- 5
Other preventive measures (Pap, colonoscopy, influenza) are already up to date or not currently indicated, so Dual-energy x-ray bone absorptiometry is the most appropriate next step.
Why not the others?
A. Influenza vaccination
This option implies she is due for her annual flu shot, BUT she was vaccinated 6 months ago, which is within the current season; repeating now is unnecessary.
B. Pap smear
This option implies cervical cancer screening is due, BUT her Pap smear was normal 2 years ago; at her age with normal history, interval is typically every 3–5 years, so she is not yet due.
D. Abdominal ultrasonography
This option implies screening for abdominal aortic aneurysm, which is recommended for men 65–75 with smoking history, BUT this patient is a woman and has no specific indication for abdominal US screening.
E. Colonoscopy
This option implies colorectal cancer screening is due, BUT she had a normal colonoscopy 2 years ago; with normal findings and average risk, the interval is every 10 years, so she is not due yet.
F. Low-dose chest CT
This option implies lung cancer screening, recommended for adults 50–80 with ≥20 pack-year history who currently smoke or quit within 15 years. She has only an 18–pack-year history, so she does not meet criteria.
G. Transesophageal echocardiography
This option implies concern for a specific cardiac structural/pathologic issue (eg, endocarditis, thrombus), BUT she is asymptomatic with only a soft S4 on exam, and there is no clinical suspicion requiring invasive imaging.
Exam trap
Multiple screening tests are mentioned (Pap, colonoscopy, influenza) to tempt you into repeating something already done. The key is to systematically ask, “Which age-appropriate screenings are not yet addressed, especially given her risk factors?” This points to osteoporosis screening (DXA) rather than reflexively choosing another cancer or vaccine option.
The bottom line
Postmenopausal osteoporosis screening with DXA scan is indicated in all women age ≥65 or younger women with significant risk factors (low BMI, smoking, alcohol).
A 55-year-old man presents to urgent care with several months of progressive weakness and unintentional 25-lb weight loss. He also reports intermittent abdominal pain. He has not seen a physician in 30 years. Several years ago, he was evaluated in the emergency department for abdominal pain and was told he had elevated liver enzymes from heavy alcohol use and incidental gallstones. He has a 50-pack-year smoking history. Temperature is 99.5°F (37.5°C), blood pressure is 161/108 mm Hg, pulse is 90/min, respirations are 17/min, and oxygen saturation is 95% on room air. Physical examination reveals an emaciated man. The abdomen is non-tender with a negative Murphy sign, and cardiopulmonary examination is unremarkable. Which of the following is the next best step in management?
Correct answer · A
CT scan of the abdomen
Decoding the stem
Step-by-step reasoning
- 1
An older man with significant unintentional weight loss and progressive weakness suggests a systemic, likely malignant etiology.
- 2
Intermittent abdominal pain in this age group with systemic symptoms raises concern for intra-abdominal malignancy, particularly pancreatic cancer.
- 3
A heavy smoking history (50 pack-years) is a strong risk factor for pancreatic adenocarcinoma.
- 4
Physical exam is largely benign (non-tender abdomen, negative Murphy), making acute cholecystitis or biliary colic less likely.
- 5
The appropriate next diagnostic test for suspected pancreatic or other intra-abdominal malignancy is a contrast-enhanced CT scan of the abdomen to evaluate the pancreas and surrounding structures.
Why not the others?
B. CT scan of the liver
This option implies a focus on primary or metastatic liver disease, which can cause weight loss, BUT his symptoms and risk profile more strongly suggest pancreatic or other intra-abdominal malignancy; a liver-only CT would miss other crucial pathology.
C. HIDA scan
This option implies suspected acute cholecystitis or gallbladder dysfunction, which presents with right upper quadrant pain, fever, and positive Murphy sign, BUT this patient has a non-tender abdomen and systemic signs of malignancy instead.
D. Right upper quadrant ultrasound
This option targets hepatobiliary pathology (gallstones, cholecystitis). While he has a history of gallstones, his current presentation is dominated by constitutional symptoms and no RUQ tenderness or biliary colic, making malignancy workup with CT abdomen more urgent.
E. Smoking cessation advice and primary care follow up
This implies a benign or preventive visit, which minimizes his red-flag symptoms. While cessation counseling is important, it is inappropriate as the next best step given severe weight loss and suspected malignancy requiring urgent imaging.
Exam trap
The prior history of gallstones and alcohol-related liver enzyme elevation tempts you to chase biliary disease, but the key is the constitutional symptoms + heavy smoking, which demand a malignancy workup with CT abdomen, not gallbladder-focused tests.
The bottom line
Pancreatic cancer suspected in an older heavy smoker with weight loss and abdominal pain → evaluate with contrast-enhanced CT abdomen.
A 22-year-old man with schizophrenia is brought to the emergency department by police after being found at a mall parking lot screaming at bystanders, chasing them, and threatening to harm them. He insists that the people he was chasing are government agents sent to kill him. In the emergency department, he is markedly agitated, appears to be responding to internal stimuli, and threatens to harm hospital staff and other patients if he is not allowed to leave. He refuses any evaluation or treatment. Which of the following is the most appropriate next step in management?
Correct answer · D
Begin treatment due to patient's lack of decision making capacity.
Decoding the stem
Step-by-step reasoning
- 1
Decision-making capacity requires understanding, appreciation, reasoning, and ability to express a choice about treatment.
- 2
This patient has severe persecutory delusions and is responding to internal stimuli → he cannot accurately understand his condition or risks.
- 3
His agitation and violent threats show he is an imminent danger to others if not treated or contained.
- 4
In emergencies where a patient lacks decision-making capacity and there is risk of serious harm, physicians may treat under implied consent.
- 5
Therefore, immediate treatment (e.g., sedation, antipsychotics, safety measures) is appropriate without his consent.
Why not the others?
A. Determine patient competency.
This option implies a legal court determination (competency), which is not done in the ED. BUT the clinician only needs to assess capacity, which is already clearly lacking due to active psychosis and dangerousness; delaying for formal competency is inappropriate in an emergency.
B. Let the patient leave against medical advice.
This option implies the patient has intact capacity and is not dangerous. BUT he is acutely psychotic and threatening harm to others, so he cannot leave; you must protect staff, other patients, and the public.
C. Wait for a psychiatrist to determine patient capacity.
This option implies you must defer capacity assessment. BUT all physicians are responsible for assessing capacity, especially in emergencies; waiting delays necessary treatment despite imminent risk.
E. Ask the police to escort the patient to jail.
This option implies this is primarily a legal/criminal issue. BUT his behavior is driven by acute psychosis and lack of capacity, making this a medical/psychiatric emergency requiring stabilization, not incarceration.
Exam trap
Students often confuse capacity (clinical, any physician, situation-specific) with competency (legal, court-determined). In emergencies with clear lack of capacity and risk of harm, do not delay for formal evaluations—treat immediately under implied consent.
The bottom line
Acute psychosis with danger to others = lacks decision-making capacity; physicians may treat emergently without consent to ensure safety.
Source: StepGenie question bank. Questions are written by StepGenie, not taken from NBME or USMLE materials, and are chosen for this page by how students actually performed on them (first-attempt accuracy on StepGenie). Selection last refreshed September 5, 2026.
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About Behavioral Science & Ethics
Coverage of medical ethics, informed consent, patient autonomy, end-of-life care, and healthcare policy. Master physician-patient relationships and navigate complex ethical scenarios.
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Informed Consent: Memory Palace for Elements & Exceptions
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Behavioral Science & Ethics — Frequently Asked Questions
What makes informed consent valid?
The patient must have decision-making capacity, receive adequate disclosure of the diagnosis, the proposed intervention, its risks and benefits and the alternatives including doing nothing, understand that information, and give consent voluntarily without coercion. Consent is a process rather than a signature, and a signed form without genuine understanding is not valid consent.
How do you handle a minor requesting confidential care?
Most jurisdictions allow minors to consent without parental involvement for care relating to sexually transmitted infections, contraception, pregnancy and substance use, and emancipated minors may consent broadly. Emergency care proceeds without waiting for consent. Confidentiality is still broken when there is risk of serious harm to the patient or to others.
What are the four core principles of medical ethics?
Autonomy is respect for the patient’s right to make their own decisions. Beneficence is acting in the patient’s interest. Non-maleficence is avoiding harm. Justice is fair distribution of resources and equitable treatment. Exam questions usually present a conflict between two of these, and autonomy generally prevails when a patient has capacity.
When can confidentiality be broken?
When there is a credible threat of serious harm to an identifiable third party, in reportable communicable diseases, in suspected child or elder abuse, and in cases of impaired drivers or impaired colleagues where the law requires reporting. Outside these situations the default is to protect confidentiality, and the exam rewards discussing disclosure with the patient first.
Are the behavioral science & ethics practice questions on this page free?
Yes. The 4 questions above come from StepGenie's question bank and can be answered here without an account, with the full explanation shown after each one. From the link under the set you can try three more Behavioral Science & Ethics questions in the dashboard preview, also without an account; a free account is what lets you choose the system and keep going.