•You are called to obtain surgical consent from an 84-year-old man who is hospitalized after suffering a right femoral neck fracture, for repair of that fracture. The patient has a long history of multi-infarct dementia and major depression. He lives with his daughter and her husband. They report to you that he lost his footing while walking and suffered a fall. There was no loss of consciousness and no evidence by history that the fall was syncopal in nature. You read the psychiatric evaluation in his chart that notes that the patient, despite some dementia, confusion, and odd mannerisms, is competent to make his own medical decisions and fully understands the nature of his condition. When you enter the room to obtain consent from the patient for surgery, he responds with situation-inappropriate responses, fails to make eye contact with you, and is not oriented to place or time. The patient has no power of attorney or health care proxy listed in his medical record. The most appropriate course of action is to •
A. call a family member to consent for the patient •
B. consent the patient for surgery, he has been cleared by psychiatry •
C. consent the patient for surgery with a note explaining his condition in the chart •
D. do not consent the patient for surgery •
E. perform your own competency test on this patient
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Archer USMLE Step 3 and Internal medicine blogs are the products of highly successful Archer USMLE reviews. These blogs are run by board-certified teaching physicians. From time to time, several evidence based guidelines on disease management strategies and patient care will be posted and discussed here to help USMLE Step 3 examinees and those appearing for Internal Medicine Boards. These include the areas of medicine that are highly tested on USMLE 3 as well as Internal medicine board exams.