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228 Cards in this Set
- Front
- Back
woman w/ anxiety about gyn exam is told to relax and imagine going through the steps of the exam. What process does this exemplify
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systematic desensitization
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65 y/o man is dx w/ incurable pancreatic adenocarcinoma. His family asks you, the doctor, not to tell the pt. What do you do?
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assess whether telling the pt will negatively affect his health. If not, tell him
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Man admitted for chest pain is medicated for ventricular tachycardia. The nexxt day he jumps out of bed and does 50 push ups to show the nurses he did not hav a heart attack. What defense mechanism is he using
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denial
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you find yourself attracted to your 26 y/o pt. What do you say.
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nothing! be professional. It is not acceptable to have a relationship with your pts.
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large group of people is followed over 10 years. Every 2 years. It is determined who develops heart dz and who does not. What type of study?
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cohort study
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girl can groom herself, hop on one foot and has an amaginary friend. How old is she?
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4 y/o
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man has flashbacks about his girlfriends death 2 mo. ago follwooingt a hit-and-run accident. He often cries and wishes for the death of the culprit. What is the dx?
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normal bereavemnt
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36 y/o woman with strong family hx of breast CA refuses mammogram because she heard it hurts. What do you do?
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discuss the risks and benefits of not havign a mammogram. Each pt must give her own informed consent to each procedure; if the pt refuses, you must abide by her wishes.
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4 y/o girl complains of burning feeling in her genetalia; otherwise she behaves and sleeps normally. Smear of the discharge shows N. gonorrhea. How was she infected
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sexual abuse
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72 y/o man insists on stopping tx for his heart conditon because it makes him feel "funny" What do you do?
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encourage pt to take his meds but pt has final say in his tx regimen. Investigate the "funny" feeling and determine if there are drugs available that don't elicit this particular side effect.
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This is an observational study. The sample is chosen based on presence (cases) or absence (controls) of dz. Info is collected about risk factors. It is often retrospective
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case control study
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this is an observational study. Sample is chosen based on presence or absense of risk factors. Subjects are followed over time for development of dz. Often prospective
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cohort study
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Framingham heart study is an exampel of this type of study
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cohort study
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This involves pooling data from several studies (often via a literature search) to achieve greater statistical power.
Limitations of individual studies prevail |
meta-analysis
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this is an experimental study. It compares the terapeutic benefits of 2 or more tx or tx & placebos
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clinical trial
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highest quality clinical trials are double ______
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blind
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this negative study finding occurs when 1 outcome is systematically favored over another.
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bias
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this type of bias is a nonrandom assignment to a study group
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selection bias
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this type of bias occurs when knowledge of the presence of a disorder alters recall by the subjects
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recall bias
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this type of bias occurs when subjects are not representitive; tehrefore results are not generalizable
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sampling bias
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this type of bias occurs when information is gathered at an inappropriate time
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late-look bias
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Give 4 ways to reduce bias:
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1) blind studies (single/double)
2) placebo responses 3) crossover studies (each subject acts as own control 4) randomixation |
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this describes total cases in population at a given time over total population
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prevalence
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this describes new cases in population over a given time over total population at risk during that time
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incidence
mneu: incidence is new incidents. note: when calculating incidence, don't forget that people previously positive for dz are no longer considered at risk |
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this is approximately equal to the incidence multiplied by the dz duration
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prevalence
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what is greater for chronic dzs like diabetes. prevalence or incidence
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prevalence.
|
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which is greater for acute dzs like the common cold. prevalence or incidence
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they are equal
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this describes the number of true positives divided by the number of all the people with the dz. It is the probability a positive test, given a person has the desease
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sensitivity
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sensitivity rules ______
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out
mneu: SNOUT |
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this is equal to 1-sensitivity
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false negative
|
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high sensitivity is desirable for this type of test
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screening
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This is the number of true negatives divided by number of all people without the desease. It is the probability of a negative test given taht a person is free of the dz.
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specificity.
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specificity rules _____
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IN
mneu: SPIN |
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this is equal to 1-specificity
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false positive rate
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high specificity is desirable for this type of test
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confirmatory test
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This is the number of true positives divided by number of people who tested positive for the dz.
It is the probability of having a condition given a positive test |
positive predictive value (PPV)
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This is the number of true negatives divided by number of people who tested negative for the dz.
It is the probability of not having the condition given a negative test |
negative predictive value (NPV)
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unlike sensitivity and specificity, predictive values are dependent on this
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prevalence of the dz
the higher the prevalence off the diz the higher the positive predictive value of the test. |
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p. 63 predictive value graphic
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--
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this descrives the odds of having a dz in the exposed gorup divided by the odds of having dz in unexposed group.
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odds ratio (OR)
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how are odds are calculated within a group
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as number with dz divided by number without the dz
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if the prevenance of the dz is not too high the OR approximates this
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relative risk
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OR is used in this type of study
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case-control
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this describes the disease risk in exposed group divided by dz risk in uneposed gorup
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relative risk (RR)
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how is relative risk calculated within a group
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number with dz divided by total number of people in the gourp.
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relative risk is used for what type of studies
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cohort studies
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graphic odds ratio v. relative risk p. 63
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--
|
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the consistency and reproducibility of a test (reliability)
the absense of random variation in a test |
precision
|
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the trueness of test measurements (validity)
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accuracy
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random error leads to reduced this in a test
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precision
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systematic error leads to reduced this in a test
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accuracy
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image p. 64. Accuracy and Precision
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--
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In a normal /Gaussian/Bell shaped statistical distribution curve, How are the mean, median, and mode related
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equal to each other
|
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bimodal distribution means
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2 humps
|
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This type of skew describes tail on the right. The mean>median>mode
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positive skew
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This type of skew describes tail on the left. The mean<median<mode
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negative skew
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this describes a hypothesis of no difference. E.g., there is no association between the dz and risk factor in the population
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null hypothesis (Ho)
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this describes a hypothesis that there is some difference (e.g., there is some association between the dz and the risk factor in the population
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Alternative hypothesis (H1)
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image - statistical hypothesis p. 64
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--
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This type of error is stating that there IS an effect or difference when none exists (to mistakenly accept the experimental hypothesis and reject the null hypothesis).
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Type I error (α)
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ρ is judged against α, a preset level of significance (usually <0.5). ρ=
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probability of making a type I error
|
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if ρ < .05 then
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there is less than a 5% chance that the data will show something that is not really there
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α=
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you saw a difference that idd not exist--for example, convicting an innocent man
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This type of error states that there IS NOT an effect or difference when one exists (to fail to reject the null hypothesis when in fact Ho is false.
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type II error (β)
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β=
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the probably of making a type II error
you did not "see" a difference that does exist--for example, setting a guilty man free |
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This is the probability of rejecting a null hypothesis when it is in fact false.
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power (1-β)
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Power depends on:
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1) total number of end points experienced by population
2) difference in compliance b/n tx groups (differences in the mean values between groups) 3) size of expected effect |
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what is the most common way you can increase the power of the study
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increase sample size
mneu: there is power in number |
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n=
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sample size
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σ=
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standard deviation
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SEM=
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=standard error of the mean
=σ√n |
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SEM is __ than σ
SEM ______ as n increases |
less than
decreases |
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this describes the range of values in which a specified probability of the means of repeated samples would be expected to fall
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confidence interval (CI)
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CI=
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range from [mean-Z(SEM)] to [mean + Z(SEM)].
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what CI is often used
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95% (corresponding to p=.05)
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what is the Z for 95% CI
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Z=1.96
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If the 95% CI for a mean difference between 2 variables includes 0, then
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there is no significant difference and Ho is not rejected
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If the 95% CI for odds ratio or relative ris includes 2, Ho is _____
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not rejected
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this type of test checks the difference between the means of 2 groups
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t- test
mneu: Mr. T is MEAN |
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this checks the difference between the means of 3 or more groups
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ANOVA
mneu: ANalysis Of VAriance of 3 or more variables |
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this checks the difference between 2 or more percentages or proportions of categorical outcomes (not mean values)
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χ^2
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always between -1 and 1. Absolute value indicates strenghth of correlation b/n 2 variables
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coorelation coefficient
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r^2
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coefficient of determination
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Describe primary, secondary, and tertiary dz prevention
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primary-prevent dz occurance (e.g., vaccination)
secondary-early detection of dz (e.g., Pap smear) tertiary- reduce disability from dz (e.g., exogenous insulin for dbts mneu: PDR (prevent, detect, reduce disability) |
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Given the risk factor give the important prevention services:
dbts |
eye, foot exams, urine test
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Given the risk factor give the important prevention services:
drug use |
hepatitis immunizations, HIV, TB tests
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Given the risk factor give the important prevention services:
alcoholism |
influenza, pneumococcal immunizations, TB test
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Given the risk factor give the important prevention services:
overweight |
blood sugar tests for dbts
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Given the risk factor give the important prevention services:
homeless, recent immigrant inmate |
TB test
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Given the risk factor give the important prevention services:
High risk sexual behavior |
HIV, hepatitis B, syphilis, gonorrhea, clamydia tests.
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Give the reportable dzs
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Hep B
Hep A Salmonella Shigella Syphilis Measles Mumps AIDS Rubella TB Chickenpox Gonorrhea mneu: B.A. SSSMMART CHICKEN or you're Gone |
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leading causes of death in US of infants
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congenital anomalies, short gestation/low birth weight, SIDS, maternal complications of pregnancy, rspiratory distress syndrome
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leading causes of death in US of children 1-14
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injuries, Cancer, congenital anomalies, homocide, heart dz
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leading causes of death in US of people 15-24
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injuries, homocide, suicide, cancer, heart dz
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leading causes of death in US of people 25-64
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Cancer, heart dz, injuries, suicide, stroke
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leading causes of death in US of people 65+
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heart dz, cancer, stroke, COPD, pneumonia, influenza
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Medicare and medicaid are federal programs that originated from amendments to the social security act.
MedicarE is for ________ MedicaiD is for ________ |
Elderly
Destitute |
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medicare part A pays for _____
medicare part B pays for ____ |
A=hospital
B=doctor bills |
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this describes the obligation to respect pts as individuals and to honor their preferences in medical care
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autonomy
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informed consent legally requires these 3 things
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1) discussion of pertinant information
2) pts agreement to the plan of cre 3) freedom from coertion |
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in informed consent pts must understand these 3 things
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risks, benefits, and alternatives (including no interventions)
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Give the 3 exceptions to informed consent
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1) pt lacks decision-making capacity (not legally competent)
2) implied consent in an emergency 3) therapeutic privilage (withholding info when disclosure would severely harm the pt or undermine informed decision-making capacity 4) waiver (pt waves rights) |
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pts decision making capacity depends on these 5 things
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1) pt makes and communicates a choice
2) pt is informed 3) decision remains stable over time 4) decision is consistant w/ pts values and goals 5) decision is not a result of delusions or hallucinations |
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T or F. Pts family cannot require that a doctor withhold info from the pt
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T
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Describe what an oral advance directive is
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when an incapacitated pts prior oral statements are used as a guide. Problems arise form variance in interpretation. If pt was informed, directive is specific, pt made a choice, and decision was repeated over time, the oral directive is more valid.
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this is when a pt directs physician to withold or withdraw life-sustaining tx if the pt develops a terminal dz or enters a persistant vegitative state
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living will
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this is when a pt designates a surrogate to make medical decisions in the event that the pt loses decision-making capacity. Pt may also specify decisions in clinical situations. Surrogate retains power unless revoked by pt. More flexible than a living will, supersedes living wil if both exist
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durable power of atterney
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"do no harm". However, if benefits of intervention outweigh the risks, a pt may make an informed decision to procede
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nonmaleficence
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Physicians have special ethical responsibility to act in the pts best interest (physician is a fiduciary"). Pt autonomy may conflict.
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beneficence
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respect for the pts privacy and autonomy. Disclosing info to family & friends should be guided by pts wishes. Pts may wave rights
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confidentiality
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Give the 2 exceptions to confidentiality
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1) harm to others
2) harm self |
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duty to break confidentiality because of potential to harm others can take several forms. Give 3 examples
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1) infectious dzs- duty to warm public officials and identifiable people at risk
2) Child/Elder abuse 3) Impared auto drivers |
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what landmark decision involved a psychiatrist who did not break confidentiality to warn apotential homocide victem
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Tarasoff decision
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Civil suit under negligence requires these 3 things
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1) Dereliction- Physician breach of duty to patient
2)Damage--pt suffers harm 3) Direct- breach of duty causes harm mneu: 3 Ds |
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what is the most common factor leading to litigation
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poor communication between physician and patient
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In a criminal suit the burdenof proof is "beyond a reasonable doubt", the burden of proof in a malpractice suit is ___________
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"more likely than not"
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Given the situation, give the appropriate response:
pt is noncompliant |
work to improve the physician-pt relationship
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Given the situation, give the appropriate response:
pt has difficulty taking medications |
provide written instructions. Attempt to simplify tx regimens
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Given the situation, give the appropriate response:
family members ask for info about a pts prognosis |
avoid discussing issues w/ relatives w/out the permission of the pt
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Given the situation, give the appropriate response:
17 y/o girl is pregnant and requests an abortion |
many states require parental notification or consent for minors for an abortion. Parental consent is NOT required for emergency situations, tx of STDs, medical care during pregnancy, prescriptions for contraceptives, and management of drug addicition
|
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Given the situation, give the appropriate response:
A terminally ill pt requests physician assistance in ending his life |
in the overwhelming majority of states, refuse involvement in any form of physician assisted suicide. Physician may, however, prescribe medically appropriate analgesics that coincidentally shorten the pts life.
|
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Given the situation, give the appropriate response:
pt states that he finds you attractive |
ask direct, closed-ended questions and use a chaperone if necessary. Romantic relationships with pts are NEVER appropriate.
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Given the situation, give the appropriate response: Pt refuses a necessary procedure or desires an unnecessary one.
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attempt to understand why the pt wants/does not want the procedure. Address the underlying concerns. Avoid performing unnecessary procedures
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Given the situation, give the appropriate response: Pt is angry about the amount of time he spent in the waiting room
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apologize to the pt for any inconvenience. Stay away from efforts to explain the delay
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Given the situation, give the appropriate response: Pt is upset with the way he was treated by another doctor
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suggest that the pt speak directly to that physician regarding his concerns. If the problem is with a member of the office staff, tell the pt you will speak to that indiviedual.
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Given the situation, give the appropriate response: A child wishes to know more about his illness
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Ask waht the parents have told the child about his illness. Parents of a child decide what info can be relayed about the illness
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Given the situation, give the appropriate response: Pt continues to smoke, believing that cigarettes are good for him
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Ask how the pt feels about his smoking. Offer advice on cessation if the pt seems willing to make an effort to quit.
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How is APGAR scored and what does the APGAR SCORE stand for
|
scored 0-2. 10 is a perfect score.
Appearance (color) [blue, trunk pink, all pink] Pulse [0,<100,100+] Grimace [0,grimace, grimace+cough] Activity [no tone, some, active] Respiration [0,irregular, regular] |
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<2500g. Associated with greater incidence of physical and emotional problems. Caused by prematurity or intrauterine growth retardation. Complications include infections, respiratiory distress syndrome, necrotizing enterocolitis, intraventricular hemorrhage, and persistent fetal circulation.
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low birth weight
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long-term deprivation of affection results in these 7 things
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1) decreased mm tone
2)poor language skills 3)poor socialization skills 4)lack of basic trust 5) anaclitic depression 6) weight loss 7) physical illness severe deprevation can result in infant dealth mneu: The 4 Ws: Weak, Wordless, Wanting (socially), Wary |
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deprevation for greater than how long can lead to irreversible changes
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6 mo
|
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this describes depression in an infant owing to continued separation from caregiver--can result in failure to thrive. Infant becomes withdrawn and unresponsive.
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anaclitic depression
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children often due this when they are under stress-physical illness, punishment, birth of a new sibling, tiredness. An example is bed-wetting in a previously toilet-trained child.
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regression to younger behavior
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give some signs of physical abuse
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healed fractures on x-ray, cigarette burns, subdural hematomas, multiple bruises, retinal hemorrhage on detachment
|
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what is the abuser profile of a physical abuser
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usally female and the primary caregiver
|
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how many deaths occur each year in the US from physical abuse
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~3000
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give some signs of sexual abuse
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genital/anal trauma, STDs, UTIs
|
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Give the profile of a sexual abuser
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usaually male and known to the victem
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what is the peak age incidence of sexual abuse
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9-12
|
|
3 mo motor milestones
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holds head up, Moro reflex disapears
|
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3 mo cognitive/social milestone
|
social smile
|
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4-5 mo motor milestones
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rolls front to back, sits when propped
|
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4-5 mo cognitive/social milestone
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recognizes people
|
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7-9 mo motor milestones
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sits alone, crawls
|
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7-9 mo cognitive/social milestones
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stranger anxiety, orients to voice
|
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12-14 mo motor milestones
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upgoing babinski disappears
|
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15 mo motor milestones
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walks
|
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15 mo cognitive/social milestones
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few words, separation anxiety
|
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12-24 mo motor milestones
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climbs stairs, stacks 3 blocks
|
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12-24 mo cognitive/social milestone
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object permanance
|
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18-24 motor milestones
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stacks 6 blocks
|
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18-24 cognitive/social milestone
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rapproachement
|
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24-48 mo cognitive/social milestone
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parallel play
|
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24-36 cognitive/social milestone
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core gender identity
|
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30-36 mo motor milestones
|
stacks 9 blocks
|
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30-36 mo cognitive/social milestones
|
toilet training
|
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3 yrs motor milestones
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rides tricycle, copies line or circle drawing
|
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3 yrs cognitive/social milestone
|
group play
|
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4 yrs motor milestones
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simple drawing (stick figure), hops on 1 foot
|
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4 yrs cognitive/social milestone
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cooperative play, imaginary friends
|
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6-11 yrs motor milestones
|
reads; understands death
|
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6-11 yrs cognitive/social milestone
|
development of conscience (superego), same-sex friends, identification with same- sex parent
|
|
11 y/o girls
13 y/o boys |
abstract reasoning (formal operations), formation of personality
|
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does sexual interest decrease with age
|
no
|
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describe sexual changes that occur in men in elderly
|
slower erection/ejaculation, longer refractory period
|
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describe sexual changes that occur in women in elderly
|
vaginal shortening, thinning, and dryness
|
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describe changes in sleep patterns in the elderly
|
decrease REM
decrease slow wave sleep increase sleep latency, increase awakinings during the night |
|
common medical conditions occuring in the elderly
|
arthritis, hypertension, heart dz, osteoporosis
|
|
In the elderly psychiatric problems (e.g., depression become more prevalent. T or F
|
T
|
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suicide rate increases in elderly. T or F
|
T
|
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does intellegence decrease w/ age
|
no
|
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in the elderly mm mass ___, and fat ___
|
decreases
increases |
|
normal bereavement is is characterized by
|
shock, denial, guit, and somatic symptoms, sometimes may experience illusions.
|
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how long does normal bereavmant usually last
|
6 mo to 1 yr
|
|
Describe pathological grief
|
includes excessively intense or prolonged grief or grief that is delayed, inhibited, or denied. May experience depressive symptoms, delusions, and hallucinations
|
|
Give the Kubler-Ross grief stages
|
Denial, Anger, Bargaining, Grieving, Acceptance
mneu: Death Arrives Bringing Grave Adjustments note: stages do not necessarily occur in this order and >1 stage can be present at once. |
|
Give 5 effects of stress
|
induces production of free fatty acids, 17-OH corticosteroids, lipids, cholesterol, catecholamines; affects water absorption, muscular tonicity, gastrocolic reflex, and mucosal circulation. May exacerbate certain physical disorders (including CHF, dbts, RA, IBS, gastric ulcer).
|
|
give the DDX of sexual disfunction
|
1) Drugs (e.g., antihypertensives, neuroleptics, SSRIs, etoh)
2) Diseases (e.g., depression, dbts) 3) psychological (e.g., performance anxiety) |
|
this is the measure of weight adjusted for height
|
BMI
|
|
BMI=
|
=weight in kg/height in m^2
|
|
BMI underweight
|
<18.5
|
|
BMI normal
|
18.5-25
|
|
BMI overweight
|
25-30
|
|
BMI obese
|
>30
|
|
give 2 famous IQ tests
|
Stanford-Binet & Wechsler
|
|
this IQ test calculates IQ as mental age/chronological age x 100
|
stanford-Binet
|
|
this IQ test uses 11 subtestes (6 verbal, 5 performance)
|
Wechler Adult Intelligence Schale
|
|
what is the mean IQ test and standard deviation
|
mean=100
SD=15 |
|
mental retardation
|
IQ<70
|
|
severe MR
|
IQ<40
|
|
profound MR
|
IQ<20
|
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IQ scores are correlated w/ genetic factors and are hightly correlated w/ school achievement. T or F
|
T
|
|
IQ tests are objective (not projective) tests. T or F
|
T
|
|
this describes learning in which a natural response (e.g. salvation) is elicited by a conditioned, or learned, stimulus (bell) that previously was presented in conjunction with an unconditioned stimulus (food)
|
classical conditioning
note: Pavlov's classical experiments w/ dogs--ringing the bell provoked salivation |
|
This describes learning in which a particular action is elicited because it produces a reward
|
operant conditioning
|
|
in operant conditioning, this describes when a desired reward produces action (e.g., mouse presses button to get food)
|
positive reinforcement
|
|
in operant conditioning, this describes when removal of aversive stimulus increases behavior (mouse presses button to avoid shock)
|
negative reinforcement
note: do not confused w/ punishment |
|
this determines how quickly a behavior is learned or extinguished
|
Pattern of reinforcement
|
|
this type of reinforcement schedule describes when a reward is received after every response. It is rapidly extinguished.
|
continuous
note: Think vending machine-- you stop using it if it does not deliver. |
|
this type of reinforcement schedule describes when a reward is received after random number of responses. It is slowly extinguish
|
variable ratio
note: think slot machine--continue to play even if it rarely rewards |
|
this occurs when pt projects feelings about formative or other important persons onto physician (e.g., psychiatrist=parent)
|
transference
|
|
this describes when doctor projects feelings about formative or other important persons onto patient
|
countertransference
|
|
describe Id
|
primal urges, sex, and aggression (I want it.)
|
|
describe Superego
|
Moral values, conscience. (YOu know you can't have it)
|
|
describe Ego
|
Mediator between the unconscious mind and the external world (Deals with the conflict)
|
|
In the topographic theory of the mind this describes what you are aware of
|
conscious
|
|
In the topographic theory of the mind this describes what you are able to make conscious with effort (e.g., your phone number)
|
preconscious
|
|
In the topographic theory of the mind this describes what you are not aware of; the central goal of Freudian psychoanylysis is to make the pt aware of what is hidden in his/her unconscious.
|
unconscious
|
|
this describes repressed sexual feelings of a child for the opposite-sex parent, accompanied by rivalry with same-sex parent. First described by Freud.
|
Oedipus complex
|
|
these are automatic and unconscious reactions to psychological stress
|
ego defences
|
|
give the mature ego defenses
|
sublimation, altruism, suppression, humor
mneu: MATURE women ware a SASH |
|
altruism
|
guilty feelings alleviated by unsolicited generosity towards others
e.g., mafia boss makes large donation to charity |
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humor
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appreciating the amusing nature of an anziety-provoking or adverse situation
e.g., nervous medical student jokes about the boards |
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sublimation
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process whereby one replaces an unacceptable wish with a course of action that is similar to the wish but does not conflict with one's value system.
e.g., aggressive impulses used to succeed in business ventures |
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suppression
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voluntary (unlike other defenses) witholding of an idea or feeling from conscious awareness
e.g., choosing not to think about the USMLE until the week of teh exam |
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acting out
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unacceptable feelings and thoughts are expressed through actions
e.g., tantrums |
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dissociation
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temporary, drastic change in personality, memory, consciousness, or motor behavior to avoid emotional stress
e.g.,exteme forms can result in multiple personalities (dissociative identity disorder) |
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denial
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avoidance of awareness of some painful reality
e.g., a common reaction in newly diagnosed AIDS & CA pts |
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displacement
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process whereby avided ideas and feeligns are transferred to some neutral person or object
e.g., mother yells at child because she is angry at her husband |
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fixation
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partially remaining at a more childish level of development
e.g., men fixating on sports games |
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identifications
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modeling behavior after another person who is more powerful (although not necessarily admired).
e.g., abused child becomes an abuser |
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isolation
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separation of feelings from ideas and events
e.g., describing murder in graphic detail with no emotional response |
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projection
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an unacceptable internal impulse is atttributed to an external source
e.g., a man who wants another woman thinks his wife is cheating on him |
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rationalization
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proclaiming logical reasons for actions actually performed for other reasons, usually to avoid self blame
e.g., saying the job was not important anyway, after getting fired. |
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reaction formation
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process whereby a warded-off idea or feeling is replaced by an (unconsciously derived) emphasis on its opposite
e.g., a pt w/ libidinous thoughts enters a monastery |
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regression
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turning back the maturational clock and going back to earlier modes of dealing with the world
e.g., seen in children under stress (e.g., bed-wetting) and in pts on dialysis (e.g., crying) |
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repression
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involuntary witholding of an idea or feeling from conscious awareness. The basic mechanism underlying all others.
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Splitting
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belief that peoplea re either good or bad
e.g., a pt says that all the nurses are cold and insensitive but that the doctors are warm and friendly. |