1A: Dt 3 - 1

Front 1

Opacities on x-ray on both sides of carina

Back 1

B/l hilar adenopathy-->Sarcoidosis

Front 2

Dermatitis
Diarrhea
Dementia

Back 2

B3 (niacin) deficiency-->Pellagra

Front 3

Hyperphagia
Hypersexuality
Hyperorality
Hyperdocility

Back 3

Kluver-Bucy Syndrome (b/l amygdala lesion)

Front 4

Nystagmus
Intention tremor
Scanning speech

Back 4

Multiple Sclerosis

Front 5

Lower extremity purpura
Arthralgias
Renal Disease

Back 5

Henoch-Schönlein Purpura (vasculitis)

Front 6

AMA Abs

Back 6

Primary Biliary Cirrhosis

Front 7

Anti-Platelet Abs

Back 7

Idiopathic Thrombocytopenic Purpura

Front 8

New born
Chronic diarrhea
Failure to thrive
Chronic candida

Back 8

SCID: Severe combined immunodeficiency

Front 9

Child
Eczema
Coarse facial features
Cold abscesses

Back 9

Job Syndrome--Hyper-IgE

Front 10

Child
Partial albinism
Peripheral neuropathy
Recurrent infections

Back 10

Chediak-Higashi Syndrome

Front 11

Alpha-adrenergic antagonists used in treatment of pheochromocytoma

Back 11

Phenoxybenzamine
Phentolamine

Front 12

Ipratropium:
Use

Back 12

COPD
Asthma

Front 13

Atropine:
Use

Back 13

Induce mydriasis; cause cycloplegia (paralysis of ciliary mm)

Front 14

Tropicamide:
Use

Back 14

Induce mydriasis; cause cycloplegia (paralysis of ciliary mm)

Front 15

Which bacteria are obligate intracellular?
Why?

Back 15

Rickettsia
Chlamydia

Both lack ability to make ATP

(Stay inside when it's Really Cold)

Front 16

Which bacteria form spores?

Back 16

Bacillus
Clostridium
Coxiella burnetti

Front 17

Case-control study

Back 17

Compres group of people with dz to group without

Looks for prior exposure or risk factor

Asks "What happened?"--retrospective

Front 18

Cohort study

Back 18

Compres group with given exposure or risk factor to a group without

Looks to see if exposure increases likelihood of disease

Asks "What will happen?"
(Confirm risk factors, risk factor reduction)--prospective

Front 19

Cross-sectional study

Back 19

Collects data from group of people to assess frequency of disease (and risk factors) at a particular point in time

"What is happening?"

Front 20

Twin concordance study

Back 20

Compares frequency with which both monozygotic and dizygotic twins develop dz (measures heritability)

Front 21

Adoption study

Back 21

Compares siblings raised by biologic vs adoptive parents; measures heritability and influence of environmental factors

Front 22

Meta-analysis

Back 22

Pools data from several studies to come to an overall conclusion

Achieves greater statistical power and integrates results of similar studies.

May be limited by quality of individual studies or bias in study selection

Front 23

Draw disease x test table.
Label each box with relevant values.

Back 23

Front 24

What is sensitivity?
General and equation

Back 24

TP/(Everyone w/Dz)

Probability that person with a dz will test positive for that disease

Rules OUT dz

100% sensitivity means no false poz

Front 25

What is specificity?
General and equation

Back 25

TN/(People w/o dz)

Proportion of people without disease who test negative

Front 26

What is positive predictive value?
General and equation

Back 26

TP/(TP+FP)

Probability that person with positive test result actually actually has dz

Front 27

What is negative predictive value?
General and equation

Back 27

TN/(FN+TN)

Probability that person actually is disease free given a negative test result.

Front 28

Increased prevalence will increase _____.

Back 28

PPV

Front 29

Effect of prevalence on false negatives.

Back 29

High prevalence-->inc'd false negatives

Front 30

A test is positive for 800 of the 900 people who have disease X.

A test is negative for 1400 of 1600 people that do not have disease X.

Determine:
Sensitivity
Specificity
PPV
NPV

Back 30

Sensitivity = TP/(Total w/Dz) = 800/900 = 0.89

Specificity = 1400/1600 = 0.88

PPV = TP/(TP+FP) = 800/(800+200) = 0.8

NPV = TN/(TN+FN) = 1400/(100+1400) = 0.93

Front 31

What is prevalence?

Back 31

(Total cases in population at a given time)/(Total population at a given time)

Front 32

What is incidence?

Back 32

(New cases in a population over a given time period)/(total population at risk during that time period)

Do not include people who had disease before given period!

Front 33

Prevalence = incidence for _______.

Back 33

Acute diseases (common cold)

Front 34

Relative risk:
Study type used for
What is it?
Equation

Back 34

Cohort study

Relative probability of getting disease in exposed group compared to unexposed group

%Disease in exposed group/%Disease in unexposed group

Don't forget percent!!! In decimal form, duh.

Front 35

Attributable risk:
What is it?
Equation

Back 35

Difference in risk between exposed and unexposed group, or proportion of dz occurrences attributable to the exposure

%dz in exposure group - %dz in non-exposure group

Front 36

Odds ratio:
Study type used for
What is it?
Equation

Back 36

Used for case-control studies

Odds of having dz in exposed group divided by odds of having disease in unexposed group

Approximates relative risk if prevalence is low

ad/bc = (exposed with disease * unexposed without dz)/(exposed no dz * unexposed with dz)

Front 37

What is absolute risk reduction?

Back 37

Reduction in risk assocd w/treatment as compared to placebo

Formula is same as attributable risk (except your exposure is something that should reduce risk of dz, e.g., abx):

%dz in exposure group - %dz in non-exposure group

Front 38

What is number needed to treat?

Back 38

1/absolute risk reduction=

1/(%dz in exposure group - %dz in non-exposure group)

How many ppl you need to treat to save 1 life

Front 39

What is number needed to harm?

Back 39

1/attributable risk=
1/(%dz in exposure group - %dz in non-exposure group)

Front 40

100 patients receive medication Z to prevent DM
200 patients did not receive medication Z

10 patients in experimental group developed DM
40 patients in control group developed DM

Calculate absolute risk reduction and number needed to treat.

Back 40

Absolute risk reduction:
10/100 - 40/200 = -0.1-->reduce risk by 10%

NNT = 1/-.1 = 10-->need to treat 10 pts to save 1 life

Front 41

A physician is looking for risk factors for a disease. He interviews 100 hospitalized patients with the disease and 100 hospitalized patients without the disease.

What type of study is this?

Back 41

Case-control study (retrospective)

Front 42

A new glucose test arrives.

There is a standard substance provided that has 90 mg/dL of glucose.

Your repeated measurements of substance reveals the following values: 54, 56, 55, 54, 53, 56, 55, and 54.

What can you say about the precision and accuracy of your new glucose test?

Back 42

Precise (staying within a narrow range)
Not accurate (not close to 90)

Front 43

A group of people that smoke and a group that does not smoke are followed over 20 years. Every 2 years, it is determined who develops cancer and who does not.

What type of study is this?

Back 43

Prospective study, determining risk factors-->Cohort study

Front 44

A certain screening test has a 1% false-negative rate.

What is the sensitivity of the test?

Back 44

Sensitivity = TP/(total w/dz)

False-negative rate = 1%
False-negative = Poz Dz, Neg Test

Take 100 people:
99 test positive
1 tests negative

Sensitivity = 99/100 = .99

Note: sensitivity = 1-FN rate

Front 45

The prevalence of varicella in a population A is 2 times the prevalence of varicella in population B.

The incidence is the same in populations A and B.

What can be assumed about disease duration in population A versus population B?

Back 45

Duration is 2x longer in populn A than it is in populn B.

Front 46

What does it mean if the relative risk is <1?

Back 46

Disease is less likely to occur in exposed group

Front 47

What does it mean if the relative risk is >1?

Back 47

Dz more likely to occur in exposed group

Front 48

What does it mean if the relative risk is =1?

Back 48

No different in risk of dz between exposure groups

Front 49

Precision vs Accuracy

Back 49

Precision = reproducibility of test result

Accuracy = validity (trueness of test measurements)

Front 50

What is a crossover study and how does it reduce bias?

Back 50

Crossover study is when you start with two groups:
1 with placebo
1 with drug

Then 6 months later placebo group gets drug, and drug group gets placebo

Reduces bias bc each subject acts as own control

Front 51

Identify bias:
In a drug trial, only patients with end-stage disease are selected to receive drug.

Back 51

Selection bias

Front 52

Identify bias:
Studies performed on patients that have been hospitalized.

Back 52

Berkson's bias--bias of syx, severity of dz, access to care, popularity of institution, etc.

Front 53

Identify bias:
Ask parents of autism patients what happened 3 days before child developed autism.

Back 53

Recall bias

Front 54

Identify bias:
A questionnaire of risk factors for MI is sent out to survivors of MI.

Back 54

Selection bias (what about those who did no survive MI?)

Front 55

Identify bias:
Study performed in China may not be generalizable to US population.

Back 55

Sampling bias--subjects not generalizable to population

Front 56

Identify bias:
Benefit of new drug during study may have been due to study requiring participants to attend clinic monthly and therefore receive better healthcare.

Back 56

Procedure bias--subjects in different groups not treated to same

Front 57

Identify bias:
Asbestos miners may be more likely to have cancer because they mine asbestos because they're more likely to smoke.

Back 57

Confounding bias--related variables

Front 58

Identify bias:
A test detects disease before it's detected by traditional diagnostics, but early detection does not increase survival.

Back 58

Lead-time bias

Front 59

Identify bias:
An orthopedic surgeon performs a study on arthroscopic knee surgery.

Back 59

Pygmalion effect: researcher's belief in efficacy of tx changes outcome of tx

Front 60

Identify bias:
In studying effects of MVI on longevitiy, study group not only takes daily MVI, but also consumers multiple other vitamins on daily basis.

Back 60

Hawthorn effect: group being studied changes its behavior owing to knowledge of being studied

Front 61

What is positive skew?

Back 61

Mean > median > mode (Asymmetry with tail on right)

Tail, not hump!!

Front 62

What is negative skew?

Back 62

Mean<median<mode (asymmetry with tail on left)

Tail, not hump!!

Front 63

What is a null hypothesis?

Back 63

Hypothesis of no difference (no association between dz and risk factor in populn)

H0

Front 64

What is an alternative hypothesis?

Back 64

Hypothesis that there is some difference (there is association between disease and risk factor in populn)

H1

Front 65

Type I error (alpha)

Back 65

Stating there is an effect/difference when none exists (mistakenly accept experimental hypothesis and reject null)

Remember p value = probability of making type I error

Front 66

Type II error (beta)

Back 66

Stating there is NOT an effect or difference when one exists (fail to reject null hypothesis when in fact H0 is false).

Note: beta = probability of making a type II error

Front 67

What is a p value?

Back 67

Probability of making a type I (alpha) error

If p<0.05, less than 5% chance that have rejected H0 when H0 is true.

Front 68

What is power?
How is it calculated?
How can it be increased?

Back 68

Power = 1-beta

Power is probability of rejecting null hypothesis when it is in fact false, or likelihood of finding a difference if one exists.

Depends on total number of end points experienced by populn
Difference in compliance between groups
Size of expected effect

Inc sample size-->inc power

Front 69

How much of a population do the following SDs contain:
±1SD
±2SD
±3SD

Back 69

±1SD: 68%
±2SD: 95%
±3SD: 99.7%

Front 70

±____SD contains 90% of population.

Back 70

±1.645 SD

Front 71

What is a confidence interval?
How is it determined for:
90% CI
95% CI

Back 71

Range of values in which you'd expect if repeated the study

CI = range from [mean-Z(SEM)] to [mean +Z(SEM)]

Note: for 95% CI (correlates to p=0.05), Z = 1.96 (can use 2)
for 90% CI, Z = 1.645

SEM = SD/(sqrt of N)

Front 72

If mean heart rate for a sample is 74 bmp and SEM is 2, you can be 95% certain that the true mean lies within ________.

Back 72

CI = range from [mean-Z(SEM)] to [mean +Z(SEM)]

=74 +/- (1.96 x 2)

Front 73

Using confidence intervals, when can H0 be accepted?

Back 73

If CI range of means contains 0.

Front 74

Using relative risk or _______, when can H0 be accepted?

Back 74

If RR or Odds Ratio = 1, H0 cannot be rejected.

Front 75

In a study of USMLE scores at a particular school, the mean is 230 and the SD is 20.

N=100

What is the 95% CI?

Back 75

CI = range from [mean-Z(SEM)] to [mean +Z(SEM)]

CI = 230 ± (230 - 2*20/√100) to (230 + 2*20/√100)

226-234

Front 76

In a study of USMLE scores at a particular school, the mean is 230 and the SD is 20.

N=16

What is the 95% CI?

Back 76

CI = range from [mean-Z(SEM)] to [mean +Z(SEM)]

CI = 230 ± (230 - 2*20/√16) to (230 + 2*20/√16)

220-240

Front 77

What does a t-test examine?

Back 77

compares means of two groups

Front 78

What does an ANOVA examine?

Back 78

compares means of multiple groups

Front 79

What does a chi-square examine?

Back 79

looks at differences in percentages/proportions of groups, NOT MEANS

Front 80

Correlation coefficient

Back 80

between -1 and plus 1, closer to 1-->stronger correlation between variables

Closer to -1-->inverse relation

Front 81

Disease prevention:
Primary vs Secondary vs Tertiary

Back 81

Primary: prevent dz occurrence (HPV vaccine)

Secondary: early detection of dz (Pap smear)

Tertiary: reduce disability from dz (chemotx)

Front 82

What diseases are reportable?

Back 82

STDs: AIDS, gonorrhea, syphilis

Hep A, B, C

Kid immunizations: Measles/Mumps/Rubella, Chickenpox

Diarrhea: Salmonella, Shigella

Tb

Front 83

Leading causes of death in:
Infants

Back 83

Congenital anomalies
Short Gestation
Sudden infant death syndrome
Respiratory distress syndrome

Front 84

Leading causes of death in:
Age 1-14

Back 84

Injuries
Cancer
Congenital anomalies

Front 85

Leading causes of death in:
Age 15-24

Back 85

Injuries
Homicide
Suicide

Front 86

Leading causes of death in:
Age 25-64

Back 86

Cancer
Heart Dz
Injuries

Front 87

Leading causes of death in:
Age 65+

Back 87

Heart dz
Cancer
Stroke
COPD

Front 88

Premium vs Co-Pay

Back 88

Premium = amt insured person pay insurance company (usually monthly)

Co-pay: amt insured person pays at time of service (e.g., $30 for clinic visit/drug, etc)

Front 89

HMO v PPO

Back 89

HMO: health maintenance organization
PCP is gatekeeper to specialist
In order for medical expenses to be covered, provider has to be in network

PPO: preferred provider organization
No gatekeeper to specialist
Patient can see whomever they want; cost is higher for out of network care

Front 90

What is utilization management?

Back 90

Someone that evaluates appropriateness, necessity, and efficiency of health care services

Front 91

What is the resource-based relative value scale?

Back 91

Scale that determines what a physician should be paid for a very specific procedure (CPT code) or service in a specific region of the country based on physician work, regional expense, and regional malpractice expenses

Front 92

Medicare vs Medicaid

Back 92

MedicarE for Elderly; >65 or <65 with certain disabilities and those with end stage renal dz

MedicaiD is for Destitute--federal and state health assistance for people with very low income

Front 93

Medicare:
Parts A vs B vs C vs D

Back 93

A: inpatient care in hospitals, hospice, home health care

B: outpt care, dosctors' services, PT/OT

C: combination of A and B ("Medicare Advantage")

D: stand-alone prescription drug coverage

Front 94

What is capitation?

Back 94

Fixed payment for a period of time or number of patients.

Ex:
ER shift
Concierge practice (give me $3K and i'll take care of you and your children for a year)
HMO

Front 95

When is pay for performance utilized?

Back 95

Inc'd pay by health care organization for meeting preventive medicine targets (vaccines, colonoscopy, HgA1C)