Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/114

Click to flip

114 Cards in this Set

  • Front
  • Back
Behavior

Women with anxiety about a gyne exam is told to relax and to imagine going through the steps of the exam.

What process does this exemplify?
Systematic desensitization
Behavior

65yo man is diagnosed with incurable metastatic pancreatic adenoCA. His family asks you, the doctor, not to tell the patient.

What do you do?
Assess whether telling the patient will negatively affect his health. If not, tell him.
Behavior

Man admitted for chest pain is medicated for ventricular tachycardia. The next day he jumps out of bed and does 50 pushups to show the nurses he has not had a heart attack. What defense mechanism is he using?
Denial
Behavior

You find yourself attracted to your 26yo patient.
What do you say?
Nothing!! the tone of the interview must be very professional; it is not acceptable to have any sort of romantic relationship with patients.

If you feel your actions may be misinterpreted, invite a chaperone into the room.
Behavior

Large group of people is followed over 10 yrs. Every 2 years, it is determined who develops heart disease and who does not.

What type of study is this?
Cohort study
Behavior

Girl can groom herself, can hop on one foot, and has an imaginary friend. How old is she?
Four years old
Behavior

Man has flashbacks about his girlfriends death 2 mths ago following a hit-and-run accident. He often cries and wishes for the death of the culprit.

What is the dx?
Normal bereavement
Behavior

36yo women with a strong FHx of breast CA refuses a mammogram because she heard it hurts.

What do you do?
Discuss the risks and benefits of not having a mammogram.
Each patient must give her own informed consent to each procedure; if the patient refuses, you must abide by her wishes.
Behavior

4yo girl complains of a burning feeling in her genitalia; otherwise she behaves and sleeps normally. Smear of discharge shows N.gonorrhoeae.

How was she infected?
Sexual abuse
Behavior

72 yo man insists on stopping treatment for his heart condition becuase it makes him feel funny.

What do you do?
Although you want to encourage the patient to take his medication, the patient has the final say in his own treatment regimen. You should investigate the "funny" feeling and determine if there are drugs available that don't elicit this particular side effect.
Behavior

During a particular stage of sleep, man has variable blood pressure, penile tumescence, and variable EEG;

What stage of sleep is he in?
REM sleep
Behavior

What type of study is a "case-control study" and what does it serve to measure?
Case control study:
Compare a group of people with disease to a group without

Measures: Odds ration (ex pts with COPD had higher odds of a hx of smoking that those without)

Observational and retrospective (cohort sutdy is prospective)
Behavior

What type of study is a "cohort study" and what does it serve to measure?
Cohort:
comare a group with a given risk factor to a group without, to assess whether the risk facotor increases the likelihood of disease.

Measures: relative risk (smokers had a higher risk of developing COPD than did nonsmokers)

Observational and prospective
Behavior

What type of study is a "cross-sectional study" and what does it serve to measure?
Cross-sectional

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

Measures: disease prevalence. Can show risk factor association with disease not not causality.
Behavior

Compare and contrast twin concordance study and adoption study:
Twin concordance study: compare freq with which both monozygotic twins or both dizygotic twins develop a disease. (measures heritability)

Adoption study: compare siblings raised by biologic vs adoptive parents. Measures heritability and influence of environmental factors.
Behavior

What are clinical trials? What is the highest quality of studies as a clinical trial?
Clinical trials: these are experimental studies that compare therapeutic benefits of two or more treatments, or treatment and placebo

The highest quality is when they are randomized and double-blinded.
Behavior

Describe the differences in the three phases of clinical trials?
Clinical trials
phase I: small number of pts usually nL volunteers (purpose: assess safety, tox, and pharmacokinetics)

phase II: Small number of pts with disease of interest (purpose: assess treatment efficacy, optimal dosing, and adverse effects)

phase III: large number of patients randomly assigned to either the treatment under investigation or to the best available treatment (or placebo). (Purpose: compare the new rx to the current care)

Is more convincing if double-blind
Behavior

What is meta-analysis?
A meta analysis is a pooling of data from several studies. Achieves greater statistical power and integrates results of similar studies.

Highest echelon of clinical evidence.

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

What is the formula for prevalence?
Prevalence = total cases in population at a given time / total population at risk for disease
Behavior

What is the formula for incidence?
Incidence = new cases in population over a given time period / total population at risk during that time

"Incidence is new Incidents"

Note: when calculating don't forget that people previously positive for a disease are no longer considered at risk
Behavior

What is the formula for prevalence?
Prevalence = incidence x disease duration
Behavior

For chronic disease, is prevalence greater or less than incidence?
Prevalence is greater since it is a chronic disease there will be more total cases (current sufferers) than new cases.
Behavior

For acute disease, is prevalence greater or less than incidence?
Prevalence = incidence (eg common cold)
Behavior

Sensitivity?
Percent of people with disease who test positive.
High value is desirable for ruling out disease (low false-negative)

a/(a+c) = 1-percent false negatives

SNOUT=sensitivity rules OUT
Behavior

Specificity?
Percent of people without disease who test negative

d/(d+b) = 1-percent false positives
SPIN = SPecficity rules IN
Behavior

Positive predictive value
Percent of positive test results that are true-positive.
Probability that person actually has the disease given a positive test result.

a/(a+b)
Behavior

Negative predicitve value
Percent of negative test results that are true-negative.
Probability that person actually is disease free given a negative result

=d/(c+d)
Behavior

What is an "odds ratio" for case control studies?
Odds of having disease in exposed group divided by odds of having disease in unexposed group.

Approximates relative risk if prevalence of disease is not too high.

(a/b)/(c/d) = ad/bc

"Patients with COPD had higher odds of a history of smoking than those without COPD"
Behavior

What is "relative risk" for cohort studies?
Relative probability of getting a disease in the exposed group compared to the unexposed group.
Calculated as percent with disease in exposed group divided by percent with disease in unexposed group.

= [a/(a+b)]/[c/(c+d)]
Behavior

What is the attributable risk?
The difference in risk between exposed and unexposed groups (ie also the percent of disease occurrences that are a result of the exposure)

Ex. smoking causes 1/3 of causes of pneumonia

a/(a+b) - c/(c+d)
Behavior

What is precision?
Precision: the consistancy and reproducibility of a test (reliability)

The absence of random variation (all hit in the same spot though it may not be in the bullseye)
Behavior

What is random error do?
What does systematic error do?
Random error: reduces precision in a test

Systematic error: reduces accuracy
Behavior

What is accuracy?
Accuracy is the trueness of test measurements (validity)
Behavior

What is the formula for prevalence?
Prevalence = total cases in population at a given time / total population at risk for disease
Behavior

What is the formula for incidence?
Incidence = new cases in population over a given time period / total population at risk during that time

"Incidence is new Incidents"

Note: when calculating don't forget that people previously positive for a disease are no longer considered at risk
Behavior

What is the formula for prevalence?
Prevalence = incidence x disease duration
Behavior

For chronic disease, is prevalence greater or less than incidence?
Prevalence is greater since it is a chronic disease there will be more total cases (current sufferers) than new cases.
Behavior

For acute disease, is prevalence greater or less than incidence?
Prevalence = incidence (eg common cold)
Behavior

Sensitivity?
Percent of people with disease who test positive.
High value is desirable for ruling out disease (low false-negative)

a/(a+c) = 1-percent false negatives

SNOUT=sensitivity rules OUT
Behavior

Specificity?
Percent of people without disease who test negative

d/(d+b) = 1-percent false positives
SPIN = SPecficity rules IN
Behavior

Positive predictive value
Percent of positive test results that are true-positive.
Probability that person actually has the disease given a positive test result.

a/(a+b)
Behavior

Negative predicitve value
Percent of negative test results that are true-negative.
Probability that person actually is disease free given a negative result

=d/(c+d)
Behavior

What is an "odds ratio" for case control studies?
Odds of having disease in exposed group divided by odds of having disease in unexposed group.

Approximates relative risk if prevalence of disease is not too high.

(a/b)/(c/d) = ad/bc

"Patients with COPD had higher odds of a history of smoking than those without COPD"
Behavior

What is "relative risk" for cohort studies?
Relative probability of getting a disease in the exposed group compared to the unexposed group.
Calculated as percent with disease in exposed group divided by percent with disease in unexposed group.

= [a/(a+b)]/[c/(c+d)]
Behavior

What is the attributable risk?
The difference in risk between exposed and unexposed groups (ie also the percent of disease occurrences that are a result of the exposure)

Ex. smoking causes 1/3 of causes of pneumonia

a/(a+b) - c/(c+d)
Behavior

What is precision?
Precision: the consistancy and reproducibility of a test (reliability)

The absence of random variation (all hit in the same spot though it may not be in the bullseye)
Behavior

What is random error do?
What does systematic error do?
Random error: reduces precision in a test

Systematic error: reduces accuracy
Behavior

What is accuracy?
Accuracy is the trueness of test measurements (validity)
Behavior Medicine

Selection bias?
Selection: nonrandom assignments to study group

Bias occurs when one outcome is systematically favored over another
Behavior Medicine

Recall bias?
Recall bias: knowledge of presence of disorder alters recall by subjects

Bias occurs when one outcome is systematically favored over another
Behavior medicine

Sampling bias?
Sampling bias: subjects are not representative; therefore results are no generalizable

Bias occurs when one outcome is systematically favored over another
Behavior medicine

Late-look bias?
Late-look: information gathered at an inappropriate time

Bias occurs when one outcome is systematically favored over another
Behavior medicine

Four ways to reduce bias?
1. blind studies (double blind is best)
2. placebo responses
3. cross over studies (each subject acts as own control)
4. randomization
Behavior medicine

Compare normal, positive skew, and negative skew in bell-shaped curves?
Normal: mean = median = mode

Positive skew: mean>median>mode

Negative skew:
Mean<median<mode
Behavior medicine

What is a null hypothesis?
Hypothesis of no difference (eg there is no association between the dz and the risk factor in the population)
Behavior medicine

What is an alternative hypothesis?
Hypothesis that there is some difference (association) beetween the disease and the risk factor in the population.
Behavior

Type I error (alpha)
Stating that there is an effort of difference when none exists (to mistakenly accept the experimental hypothesis and reject the null hypothesis).

p (probability of making a type I error) judged against alpha, a preset level of significance (usually < 0.5).

alpha: you "saw" a difference that did not exist (covicting an innocent man)
Behavior

What does it mean if p < 0.05?
There is less than a 5% chance that the data will show something that is not really there.
Behavior

What is a type II error (beta)
Stating that there is NOT an effect or difference when one exists (to fail to reject the null hypothesis when in fact H0 is false).

Beta is the probability of making a type II error. Beta = you did not "see" a difference that does exist (setting a guilty man free)
Behavior

What is power? (1-beta)
Probability of rejecting the null hypothesis when it is in fact false, or the likelihood of finding a difference if one in fact exists.
Behavior

What three things does the "power" depend on?
It depends on:
1. total number of end points experienced by population
2. difference in compliance between treatment groups (differences in the mean values between groups)
3. size of expected effect
Behavior

What happens to "power" if you increase sample size?
You increase the power

"there is power in numbers"

Power: 1-beta (beta: you did not "see" a difference that exists)
Behavior

What is a confidence interval?
Range of values in which a specified probability of the means of repeated samples would be expected to fall
Behavior

What does a t-test check? What does ANOVA check?
Checks the difference between the means of 2 groups. (Mr. T is MEAN)

ANOVA checks the difference between the means of 3 or more groups. (ANOVA=ANalysis Of VAriance of 3 or more variables)
Behavior

What does x squared (x2) check?
X2 checks the difference between 2 or more percentages or proportions of categorical outcomes (not mean values).
Behavior

What is a correlation coefficient (r)?
R is always between -1 and +1.

Absolute value indicates strength of correlation between two variables.
Behavior

What is the coefficient of determination?
r squared (r=strength of correlation between two variables)
Behavior

What are the primary, secondary, and tertiary goals of disease prevention?
PDR
1: Prevent disease occurance (vaccination)
2: Early detection of disease (Pap smear)
3: Reduce disability from disease (eg exogenous insulin for diabetes)
Behavior

What are three important preventative measures for pts who use drugs?
Hepatitis immunizations, HIV and TB tests
Behavior

What are three important preventative measures for pts who are alcoholics?
TB tests, influenza vaccine, pneumococcal immunizations
Behavior

What is one important preventative measure in pt who is obese?
Blood sugar tests
Behavior

What is one important preventable measure for pts who are immigrants, homeless, or inmates?
TB test
Behavior

What are five preventable measures for pt who engage in high-risk sexual behaviors?
HIV, hepatitis B, syphilis, gonorrhea, chlamydia test
Behavior

What are the reportable diseases?
B.A. SSSMART Chicken or your Gone:
hep B
hep A
Salmonella
Shigella
Syphilis
Measles
Mumps
Aids
Rubella
Tuberculosis
Chicken pox
Gon-orrhea
Behavior

What is the leading causes of death in infants?
Congential anomalies, short gestation/low birth weight, sudden infant death syndrome, maternal complications of pregnancy, respiratory distress syndrome.
Behavior

What is the leading causes of death in children Age 1-14?

Age 15-24?
1-14: injuries, cancer, congenital anomalies, homicide, heart disease

15-24: injuries, homicide, suicide, cancer, heart disease
Behavior

What is the leading causes of death in adults aged 25-64

Age 65+?
Age 25-64:
Cancer, heart disease, injuries, suicide, stroke

Age 65+:
Heart disease, cancer, stroke, COPD, pneumo, influenza
Behavior

Autonomy?
Autonomy: obligation to respect patients as individuals and to honor their preferences in medical care.
Behavior

Benificence?
Physicians have a special ethical (fiduciary) duty to act in the patient's best interest.
This may conflict with autonomy. If the patient can make an informed decision, ultimately, the patient has the right to decide.
Behavior

Nonmaleficence?
"Do no harm".

However, if benefits of an intervation outweigh the risks, a patient may make an informed decision to proceed (most surgeries fall into this category)
Behavior

Justice
Justice: to treat persons fairly
Behavior

What three things does informed consent legally require?
1. discussion of pertinent information
2. patients agreement to the plan of care
3. freedom from coercion

(basically: the patient must understand the risks, benefits, and alternatives, which include no intervation)
Behavior

What are the four exceptions to informed consent?
1. patient lacks decision-making capacity
2. implied consent in an emergency
3. therapeutic privilege: withholding information when disclosure would severely harm the patient or undermine informed decision-making capacity
4. Waiver: patient waives the right of informed consent
Behavior

Decision-making capacity is based on five things:
1. patient makes and communicates a choice
2. patient is informed
3. decision remains stable over tiem
4. decision is consistant with patients values and goals
5. decision is not a result of delusions or hallucinations
Behavior

Can the patients family demand the dr withhold information from a patient?
No- illegal if doctor agrees
Behavior

What is an oral advanced directive?
Incapacitated patient's prior oral statements commonly used as a guide.

Problems arise from varience in interpretation. If patient was informed, directive is specific, patient made a choice, and decision was repeated over time, the oral directive is more valid.
Behavior

What is a living will?
Advanced directive in which the patient directs the physician to withhold or withdraw life-sustaining treatment if the patient develops a terminal diseae or enters a persistant vegetative state.
Behavior

What is the durable power of attorney?

Compare this to a living will
A person the pt designates a surrogate to make medical decisions in the event that the patient loses decision-making capacity. Patient may also specify decisions in specific clinical situations.

The power of attorney retains the power unless revoke by patient.

This is more flexable that a living will and supersedes living will if both exist.
Behavior

Give an example where the patient may waive the right to confidentiality?
When disclosing info to insurance companies
Behavior

What are four exceptions to confidentiality?
1. potential harm to others is serious
2. likelihood of harm to self is great
3. no alternative means exists to warn or to protect those at risk
4. physicians can take steps to prevent harm

(ex. infectious dzs, Tarasoff decision, child/elder abuse, impaired auto drivers, suicidal/homicidal pt)
Behavior

What is the Tarasoff decision?
A law requiring physician to directly inform and protect potential victim from harm; this may involve breach of confidentiality
Behavior

What are the four D's in malpractice that are required to have existed in order to file a civil suit for negligence?
Duty: physician had a duty to the patient
Derelication: physician breached that duty
Damage: patient suffered harm
Direct: the breach of duty is what directly caused the harm
Behavior

Compare the burden of proof in a criminal case and in a malpractice suit?
Criminal: burden of proof is "beyond a reasonable doubt"

Malpractice: burden of proof is "more likely than not"
Behavior

Ethical sitiation
What is the appropriate response to:

Family members ask for information about the patients prognosis
Avoid discussing issues with relatives without the permission of the patient
Behavior

Ethical sitiation
What is the appropriate response to:

A 17yo girl is pregnant and requests an abortion
Many states require parental notification of consent for minor for an abortion. Parental consent is NOT required for emergency situations, treatment of STDs, medical care during pregnancy, and management of drug addiction
Behavior

Ethical sitiation
What is the appropriate response to:

A terminally ill patient requests physician assistance in ending his life?
In the overwhelming majority of states, the physician must refuse involvment in any form of physician-assisted suicide.

Physician may prescribe medically appropriate analgesics that coincidentally shorten the patients life.
Behavior

Ethical sitiation
What is the appropriate response to:

The pt states that he finds you attractive
Ask direct, closed-ended questions and use a chaperone.

Romantic relationships with patients are NEVER appropriate
Behavior

A child wishes to know more about his illness
Ask what the parents have told the child about his illness.
Parents of a child decide what information can be relayed about the illness
Behavior

Pediatric patient requests condoms:
Physicians can provide counsel and contraceptives to minor without a parent's knowledge or consent
Behavior

What are the five things looked at for the APGAR score?
Appearance (blue, trunk pink, all pink)
Pulse (none, <100, >100/min)
Grimace (none, grimace, grimace+cough)
Activity (limp, some, active)
Respiration (none, irregular, regular)
Behavior

What is the exact definition of low birth weight and what is it associated with?
<2500mg

Associated with greater incidence of physical and emotional problems.

Infantile assoc: infections, respiratory distress syndrome, necrotizing enterocolitis, intraventricular hemorrhage, and persistant fetal circulation
Behavior

At what age can baby hold head up?
What two other things are assoc with this age?
3months:
Holds head up
Moro reflex
Behavior

When does upgoing Babinski disappear?
At 12-14mths
Behavior

When should a child walk by? What two other things are assoc with this age?
15mths

Should speak a "few" words and have separation anxiety
Behavior

At what age should a child be sitting alone and crawling?

What else is associated with this age?
7-9

Stranger anxiety and orients to voice
Behavior

At what age should a child roll front to back and sit when propped?
4-5mths

Also should recognize people at this age.
Behavior

What are three things assoc wtih ages 12-24mths?
1. climbs stairs
2. stack 3 blocks
3. understand object permanence
Behavior

What two things are assoc with ages 18-24mths
Stacks 6 blocks
Rapprochment (child moves away from and then returns to mother for reassurance)
Behavior

At what age should the child be able to stack 9 blocks?

What else is assoc with this age?
30-36mths (preschool)

Toilet training
Behavior

At what age should a child be able to ride a tricycle? What other 3 things are assoc with this age?
3yrs

Rides a tricycle
copies line
draws circles
can engage in group play
Behavior

At what age can a child make simple drawings like stick figures or copying crosses?

What FIVE other things are assoc with this age?
4yrs

simple drawings
hops on 1 foot
cooperative play
imaginary friends
grooms self
brushes teeth
Behavior

At what age can a child skip and draw triangles?
5years
Behavior

At what age range can a child understand death?

What three other things are associated with this age?
6-11yrs

development of conscience (superego)
same-sex friends
ID with same-sex parent
Behavior

At what age to girls and boys develop abstract reasoning and form their personality?
11yrs for girls
13yrs for boys