An asymptomatic 52-year-old computer programmer is diagnosed with stage T1 localized breast cancer.

Mr. S, a 74-year-old retired gas station owner with Alzheimer disease and coronary artery disease, is admitted with a stroke. An ECG also shows an acute myocardial infarction with many premature ventricular contractions.

Assume the same medical facts as in Case 10, but Mr. S has made no statements about his preferences for care. His wife and daughter believe that he would not want to receive continued intensive care after failing to improve from his stroke.

Assume the same medical facts as in Case 10, but Mr. S has made no statements about his preferences for care and has no family members. He has lived in a nursing home for several years and has no friends who visit him regularly.

Assume that Mrs. O, the 64-year-old retired grocery store owner with end-stage interstitial lung disease from Case 9, was intubated in the ED.

Assume that Mrs. O, the 64-year-old retired grocery store owner with end-stage interstitial lung disease from Case 9, is transferred out of the ICU with DNAR and DNI orders, based on the family reports of her previous statements.

A 58-year-old woman with dysphagia is found to have inoperable carcinoma of the esophagus. She realizes her poor prognosis and opts for palliation.

A 74-year-old man with severe Alzheimer disease is transferred from a nursing home for treatment for pneumonia.

Mr. D is a 72-year-old homebound man with multisystem failure admitted to a community hospital for pneumonia, a myeloproliferative disorder, and failure to thrive.

Mrs. M is 57-year-old machinist who has recurrent head and neck cancer that has progressed despite radiation and chemotherapy. She cannot swallow foods and secretions and has to sit upright at night to spit out her secretions

Mrs. M, the patient with head and neck cancer in Case 18, is found at home by her husband after a suicide attempt. She has ingested a combination of tricyclic antidepressants, barbiturates, and alcohol and has left a long explanatory note.

A 64-year-old man has inoperable pancreatic cancer and obstructive jaundice.

Mrs. O, the 64-year-old retired grocery store owner with end-stage interstitial lung disease from Case 9, has mechanical ventilation withdrawn based on evidence that she would not want such treatment.

A 34-year-old unemployed homeless man with acquired immunodeficiency syndrome (AIDS) (CD4 level 47) is admitted to your service with Pneumocystis carinii pneumonia. His IV has infiltrated, and you are asked to restart it.

Suppose your favorite uncle has been recommended to have coronary artery bypass and graft (CABAG) by his primary care physician and cardiologist in New York.

Recall the first time you did a lumbar puncture (LP) (or central line, major suturing, or other major procedure).

On a clerkship you observe what you consider unethical behavior by one of your attending physicians. On several occasions, his speech is slurred and you smell alcohol on his breath.

A 42-year-old man is admitted to you with diabetic ketoacidosis. After treatment with intravenous fluids and an insulin drip, the patient’s glucose declines from 745 to 289 mg per dl after 4 hours.

A 15-year-old high-school student comes to the physician because of dysuria and a discharge from his penis after intercourse without a condom.

A 10-year-old boy is taken to the ED with vomiting and right lower quadrant abdominal pain and is found to have appendicitis.

A 34-year-old grade school teacher is hospitalized after an automobile accident that ruptures his spleen. A devout Jehovah’s Witness, he refuses transfusion.

A 45-year-old sales clerk has a 1/2-cm breast mass that is found to be malignant on needle aspiration. With either mastectomy or lumpectomy plus radiation, she has an excellent chance of being cured of her cancer.

A 76-year-old retired teacher with a history of coronary artery disease is hospitalized after a syncopal episode. He is found to have ventricular tachycardia.

A colleague asks your advice on a difficult case. A 19-year-old college swimmer reveals that she has started to take anabolic steroids, which she obtains through friends at the gym where she lifts weights.

A 40-year-old auto mechanic is found to have a localized breast cancer, which is treated with lumpectomy and radiation.

A 72-year-old retired lawyer comes into the hospital with lower abdominal pain. He is found to have guaiac positive stools and anemia. You plan to do a colonoscopy, but the patient refuses.

Mrs. O, a 64-year-old retired grocery store owner with end-stage interstitial lung disease, presents to the emergency department for shortness of breath that began several days ago.