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244 Cards in this Set

  • Front
  • Back
this type of study compares a group of people with a disease to a group of people who dont have the disease
case control
this type of study compares a group of people with a given risk factor to a group of people without the risk factor
cohort study
this type of study collects data from a group of people to assess the frequency of a disease at a particular point in time
cross sectional
proportion of all people WITH a disease who test positive
proportion of all people WITHOUT a disease who test negative
does specificity rule in or rule out a disease
sensitivity rules out a disease
specificity rules in a disease
Does increasing the threshold increase or decrease sensitivity? what about specificity?
increasing threshold decreases sensitivity
increasing threshold increases specificity
equation for sensitivity
TP/ (TP + FN)
equation for specificity
TN / (TN + FP)
equation for positive predictive value
TP / (TP + FP)
equation for negative predictive value
TN / (TN + FN)
difference between incidence vs. prevalence
incidence is the rate of a new disease
prevalence is the total number of people with the disease
difference between precision vs. accuracy
precision is the reliability of a test
accuracy is the validity of a test
this type of bias occurs when a researcher's belief in the efficacy of a treatment changes the outcome
pygmalion effect
this type of bias occurs when the group being studied changes its behavior owing to the knowledge that they are being studied
hawthorne effect
this type of bias occurs when information is gathered at inappropiate times such as using surveys to study fatal diseases (only those still alive are able to answer)
late-look bias
in this type of bias, early detection is confused with increased chance of survival
lead-time bias
this type of bias occurs when there are 2 closely related factors, and the effect that one factor has distorts/confuses the effect of the other factor
confounding bias
how do the mean, median, and mode relate to one another in positively and negatively skewed distributions
positive skew: mean > median > mode

negative skew: mean < median < mode
what is a t-test
checks the difference between the means of 2 groups
what is an ANOVA test
checks the difference between the means of 3 or more groups
what is a chi-square test
checks the difference between 2 or more percentages of outcomes (NOT means)
leading cause of death in the US in infants
congenital anomalies
leading cause of death in the US in children and teenagers
random injury
leading causing of death in the US in adults
leading cause of death in the US in the elderly
heart disease
which diseases are reportable
difference between Medicare and Medicaid
Medicare is for the elderly
Medicaid is for the poor
what are the 4 parts of Medicare
Part A: inpatient care, hospice, hospital care
Part B: outpatient care, PT, OMM
Part C: combined A/B
Part D: prescription drugs
4 exceptions to informed consent
1. patient is legally incompetent
2. emergency situitations
3. therapeutic privilege (withholding info because full disclosure would harm or undermine the patient)
4. patient has waived their rights
when is parental consent NOT required for a minor
if the minor is emancipated
if its an emergency
when prescribing contraceptives
treatment of STDs
medical care during pregnancy
management of drug addictions
at what times are Apgar scores taken
1 and 5 minutes
what 5 things are assessed in an Apgar score
appearance (blue; pink trunk; pink)
pulse (no pulse; <100; >100)
grimace (no grimace; grimace; grimace+cough)
activity (limp, some flexion, active flexion)
respiration (none, irregular, regular)
what a normal Apgar score
greater than or equal to 8
what are the normal motor and cognitive milestones of a 3 year old
stacks 8/9 blocks, rides a tricycle, copies lines/circles drawings, toilet training, speaks in complete sentences, and has a 900 word vocabulary
what are the normal motor and cognitive milestones of a 3 month old
holds head up, Moro reflex disappears, social smile
when does a baby develop stranger anxiety
8 months
at what Tanner Stage do the breasts start enlarging
stage 2
at what Tanner Stage do the glans develop and scrotal skin darken
stage 4
at what Tanner Stage do the areolae become raised
stage 4
at what Tanner Stage does the pubic hair darken
stage 3
what EEG waves are present when someone is awake, alert, and active
beta waves
what EEG waves are present when someone is awake but resting with their eyes closed
alpha waves
what EEG waves are present when someone is in stage 1 sleep
theta waves
what EEG waves are present when someone is in stage 2
sleep spindles and K complexes
what EEG waves are present when someone is in deep sleep
delta waves
what EEG waves are present when someone is in REM sleep
beta waves (some as when awake)
which EEG waves are the highest frequency and lowest amplitude
beta waves
which EEG waves are the lowest frequency and highest amplitude
delta waves
sleepwalking, night terrors, and bedwetting are all seen in what sleep stage
deep sleep (stages 3,4)
dreaming, erections, and memory formation occur during which sleep stage
REM sleep
bruxism occurs during which sleep stage
stage 2
physiologic responses by the body during REM sleep
loss of muscle tone, increased oxygen use, increased metabolism
during which sleep stage is GH secreted in large quantities in childhood
deep sleep (stages 3,4)
strenuous exercise during the day has largest effect on which sleep stage
deep sleep (stages 3,4)
neurotransmitter that mediates REM sleep
MOST important neurotransmitter initiating sleep
which brain stem controls eye movements during REM sleep
DOC for bedwetting (enuresis)
treatment for night terrors and sleep walking
substances that decrease REM
alcohol, benzodiazepine, barbiturates
which stage of sleep represents the largest proportion of total sleep time
stage 2
effects of depression on sleep
decreases deep sleep
decreases REM latency
increases total REM sleep
repeated nighttime awakenings
early morning awakening
treatment of narcolepsy
amphetamines, modafinil, sodium oxybate
symptoms of narcolepsy
excessive daytime sleepiness, hypnagogic/hypnopompic hallucinations, cataplexy, and disordered regulation of the sleep-wake cycle
nucleus that regulates circadian rhythms
suprachiasmatic nucleus
what secretes melatonin
pineal gland
difference between classical and operant conditioning
classical conditioning: a natural response is elicited by a learned stimulus

operant conditioning: specific action is elicited because it produces a reward
difference between positive and negative reinforcement and what type of conditioning is it seen in
positive reinforcement: desired reward produces action

negative reinforcement: behavior is elicited to avoid or by removal of an adverse stimulus

*these methods of reinforcements are seen in operant conditioning
According to Freud, which portion of the mind is absent in criminals
they lack the superego
according to Freud, which portion of the mind utilizes defense mechanisms
the ego
according to Freud, which portion of the mind is entirely subconscious and is responsible for primal urges such as sex and aggression
the Id
what are the 4 "mature" defense mechanisms
altruism, humor, sublimation, suppression
defense mechanism characterized by temporary, drastic changes in personality, memory, consciousness, or behavior to avoid emotional stress
someone with severe dissociation can result in what disorder
multiple personality disorder
defense mechanism characterized by avoided ideas and feelings are transferred to some neutral person or object
defense mechanism characterized by an unacceptable internal impulse attributed to an external source
defense mechanism characterized by unacceptable feelings/ideas are unconsciously replaced by an emphasis on the exact opposite
reaction formation
defense mechanism characterized by emotionally reverting back to childhood
difference between repression and suppression
repression is involuntary and suppression is voluntary
defense mechanism characterized by the belief that all people are either good or bad at different times
splitting is associated with what personality disorder
borderline personality disorder
defense mechanism characterized by replacing an unacceptable wish or action with one that is similar but doesn't conflict with one's values or morals
sex addict gives up sex and instead writes couples self-help books about sex is an example of what type of defense mechanism
choosing not to think about an exam until the night before is what defense mechanism
a mafia boss makes a large donation to a funeral home is an example of what type of defense mechanism
patient says all doctors and nice and all nurses are mean
teenager can't remember being raped is what defense mechanism
child starts bedwetting again when his little brother is born is an example of what type of defense mechanism
a pervert becomes a monk is an example of what type of defense mechanism
reaction formation
childhood disorder characterized by limited attention span, poor impulse control, hyperactivity, motor impairment, and emotional lability; commonly has difficulty in school despite normal intelligence
MOA of methylphenidate
increase dopamine
childhood disorder characterized by repititive pervasive behaviors including physical aggression, destruction of property, and theft
conduct disorder
conduct disorder that does NOT spontaneously remit after childhood can become what personality disorder
antisocial personality disorder
childhood disorder characterized by patterns of hostile and defiant behavior towards authority figures
oppositional defiant disorder
patient presents with random, brief jerky movements in his extremities and head; these symptoms have been ongoing randomly for the past year; coprolalia is noted during the PE
Tourettes commonly occurs along with what personality disorder
treatment for Tourettes
haloperidol (DOC), pimozide, clonidine
characterized by severe language impairment and poor social interactions; tendency to focus on innanimate objects rather than people; behaviors are reptitive; patient has trouble making eye contact
mild developmental disorder characterized by reptitive behaviors and problems socializing; intelligence is normal; there is no language impairment
special type of autism characterized by having a unique/unusual ability often confused with genius intelligence
X-linked disorder seen only in girls characterized by loss of development, mental retardation, loss of verbal abilities, ataxia, and stereotyped handwriting
Rett's disorder
neurotransmitter imbalance seen in anxiety
increased NE
decreased GABA
decreased serotonin
neurotransmitter imbalance seen in depression
decreased NE
decreased serotonin
decreased dopamine
neurotransmitter imbalance seen in Alzheimers
decreased ACh
neurotransmitter imbalance seen in Huntingtons
decreased GABA
decreased ACh
neurotransmitter imbalance seen in Schizophrenia
increased dopamine
neurotransmitter imbalance seen in Parkinsons
decreased dopamine
increased serotonin
increased ACh
DOC for the tremors in Tourettes and other movement disorders
does delirium have a normal EEG? what about dementia?
delirium has an abnormal EEG
dementia has a normal EEG
perceptions in the absence of external stimuli
a dehydrated person stranded in the desert sees a lake when its not really there is an example of what
misinterpretations of actual present external stimuli
When a doctor enters the room, the patient looks at the doctor and screems saying she sees an evil clown-- this is an example of what
false beliefs that are not shared by members of a culture that a person maintains despite obvious proof disproving it
a patient cowers in fear seeing nurses walking through the halls and thinks they are all aliens planning her abduction-- this is an example of what
visual hallucinations are associated with what condition
delirium and drug toxicity
auditory hallucinations are associated with what condition
olfactory hallucinations are associated with what 2 conditions
epilepsy and brain tumors
tactile hallucinations are MOST commonly seen in what 2 conditions
alcohol withdrawal and cocaine addicts (they often feel bugs crawling on their limbs)
difference between a hypnagogic and hypnopompic hallucination
hypnagogic: occurs prior to falling asleep

hypnapompic: occurs after waking from sleep
schizophrenia lasting <1 month and linked to stress
brief psychotic disorder
schizophrenia lasting 1-6 months
schizophreniform disorder
characterized by a 2 week period of psychotic, schizophrenia-like symptoms combined with either major depression, a manic episode, or combination of the 2
schizoaffective disorder
time frame needed to diagnose schizophrenia
symptoms MUST last >6 months
illicit drug linked to schizophrenia in teens
this type of schizophrenia is often confused by the religious community for demonic possession
catatonic schizophrenia
what are the positive symptoms of schizophrenia
hallucinations (auditory)
disorganized speech
catatonic behavior
what are the negative symptoms of schizophrenia
flatt affect
social withdrawal
lack of motivation
lack of speech or thought
type of schizophrenia characterized by poor grooming habits, disheveled appearance, silliness, facial grimacing, mirror gazing, and an early age of onset
disorganized schizophrenia
type of schizophrenia characterized by stupor, agitation, lack of coherent speech, bizarre postures, abnormal flexibility/contorsions, and lack movement or emotional repsonses for hours at a time
catatonic schizophrenia
type of schizophrenia characterized by grandiose delusions of persecution; age of onset is older than other types
paranoid schizophrenia
subtype of schizophrenia that is a combination of at least 2 different types of schizophrenia
undifferentiated schizophrenia
type of schizophrenia characterized by previous episodes of psychosis causing residual symptoms-- but no current symptoms of psychosis
residual schizophrenia
patient presents with psychotic symptoms and is noted for the recent development of delusions; he had no past history of any psychological disorders nor does he have any family history of them; social history revealed that he started dating a new woman 6 months ago who suffers from delusional disorder; what is the man diagnosed with
shared psychotic disorder (folie a deux)
characterized by a single persistent, nonbizarre belief lasting more than 1 month
delusional disorder
MOST common group of people to suffer from dissociative identity disorder (aka multiple personality disorder)
women with a history of sexual abuse
abrupt change in geographic location leading to dissociation of one's identity; usually linked to traumatic circumstances
dissociative fugue
characterized by a 1 week period of easy distractibility, irresponsibility, grandiosity, flight of ideas, agitation, decreased need for sleep, and talkativeness
manic episode
difference between manic and hypomanic episode
hypomanic episodes are like manic episodes but not severe enough to cause marked impairment in social and occupational functioning; there is no need to hospitalize and no psychotic features
difference between bipolar I and bipolar II disorder
bipolar I has manic episodes
bipolar II has hypomanic episodes
DOC for bipolar disorder
what is cyclothymic disorder
combination of dysthymia (mild depression lasting >2 years) and hypomanic episodes
mild depression lasting >2 years
differences between normal grief and depression
normal grief:
-minor weight loss (<5 lbs)
-minor sleep disturbance
-mild guilt
-attempts to return to work and socializing
-cries and expresses their sadness
-severity decreases after 2 months
-all symptoms resolve within 1 year
-treatment is supportive with sleep agents

-significant weight loss (>5% of body)
-significant sleep disturbance
-intense guilt
-hallucinations and delusions
-doesnt resume work or socializing
-severe symptoms last >2 months
-symptoms progress >1 year
-treatment is benzodiazepines, antidepressants, antipsychotics, ECT
time difference between grief and depression
grief resolves within 1 year
depression lasts >1 year
symptoms of atypical depression that differ from regular depression
atypical depression has hypersomnia, overeating, and mood reactivity
treatment of atypical depression
difference in the time periods between postpartum blues, postpartum depression, and postpatum psychosis
postpartum blues (50-85% of women): resolves within 10 days
postpartum depression (10-15% of women): lasts 2 weeks - 2 months
postpartum psychosis: (0.1% of women): lasts 4-6 weeks
a patient is in risky surgery for a hemorrhage in his femoral artery after a work-related incident; the patient dies and the doctor tells the spouse the bad news; upon hearing of her husband's death, she experiences heart palpitations, nausea, light-headedness, chest pains, chills, sweating, shaking, and shortness of breath; what is happening
panic attack
2 MOST common examples of social phobias
public speaking and using public restrooms
condition characterized by having panic-like symptoms in wide open spaces, crowds, or uncontrollable public situations
patient presents for a routine annual physical; when you walk in she is on the phone, but then quickly ends the call-- after hanging up, you notice she opens and closes her phone 3 times before putting in away in her purse; during the history you note that she is very persistent on needing to be in a clean environment--she admits to using hand sanitizier dozens of times per day and vacuums in the morning and night; after the PE, when she is putting her shoes back on you also notice she unties and ties her shoes 3 times before standing up; what underlying condition does she likely have
time difference between acute stress disorder and PTSD
<1 month is acute stress disorder
>1 month is PTSD
a veteran presents for a complete history/physical after returning from war several months ago; his history is remarkable for recurrent nightmares of his killings during the war--some nights he says he can only manage 2 hours of sleep because of it
time frame required to diagnose general anxiety disorder
>6 months

(<6 months is considered adjustment disorder)
patient presents to his psychiatrist with complaints of ongoing anxiety for the past year; the anxiety does not appear to be related to a specific person, event, or situation; as a result, the patient has had trouble sleeping and has had frequent heartburn
general anxiety disorder
patient presents complaining of severe back pain; all tests are negative; PMH is remarkable for oxycodon abuse
difference between malingering and factitious disorder
malingering ceases after secondary gain (i.e. drugs, work compensation)

facititious disorder does NOT cease after primary gains (i.e. receiving medical care is their sole motive)
patient presents complaining of lower back pain; PMH is remarkable for several outpatient visits in the last year; after the PE findings come back negative, the patient is not satisfied and asks for blood work, and MRI, and colonoscopy
Munchausen's syndrome (aka chronic factitious disorder)
condition characterized by a caregiver knowingly and willingly causing illness to a child to assume the sick role
Munchausens by proxy
which complaints are alway present in somatization disorder
patient has at least 4 complaints with at least 2 GI, 1 sexual, and 1 neuro complaint
characterized by sudden loss of both sensory and motor function (eg. limb paralysis and blindness) following an acute stressor
conversion disorder
anxiety over having a serious medical condition despite medical evaluation and reassurance
DOC for hypocondriasis
characterized by preoccupation with imagined and usual false defects in appearance; PMH will be remarkable for several cosmetic surgeries or intent for them
body dysmorphic disorder
personality disorders appear under what axis of the DSM assessment
clinical disorder, mental disorders, and learning disorders appear under what axis of the DSM assessment
acute medical conditions and physical disorders appear under what axis in the DSM assessment
psychosocial and environmental factors affecting one's condition appear under what axis of the DSM assessment
what are the cluster A personality disorders
paranoid, schizoid, schizotypal

(the "weird" ones)
what are the cluster B personality disorders
antisocial, borderline, histrionic, narcissistic

(the "wild" ones)
what are the cluster C personality disorders
avoidant, obsessive-compulsive, depedent

(the "worried" ones)
during a routine H/P, the patient appears to acting very suspiciously and doesn't seem to trust you; he admits to having an affair, yet he is also worried that his wife is cheating on him; what personality disorder does he MOST likely have?
which defense mechanism is linked to a paranoid personality disorder
a patient returns to his oncologist for reading of his lab results; upon telling the patient he doesn't have cancer, he has no emotional response--the doctor questions him to see if he understands the good news, to which the patient replies "that's good" but still showing no emotion; his PMH is remarkable for social withdrawal, yet he appears content with his life the way it is; what personality disorder does he MOST likely have
MAJOR difference between schizoid and avoidant personality disorders
schizoid patients are content with their social and emotional withdrawal
avoidant patients desire relationships and emotional bonds but are too fearful to pursue them
During rotations, you come across a patient who is very well groomed and sharply dressed, yet he is stammering on and on about his theory that he and his friends can fly; toxicology screens are negative; what personality disorder does he MOST likely have
personality disorder characterized by a disregard for an violation of the rights of others; prone to criminal acts; more common in males
after breaking up with her boyfriend of 2 years, she reports that he is now stalking her and threatening suicide if she doesnt get back together with him; she states that during their relationship, his mood was often unstable in social situations, he had very few friends, he was promiscuous at times and occassionally would cut himself; what personality disorder does he MOST likely have
upon entering the room for a routine H/P with a female patient, you note that she is dressed in very revealing clothing and flirts with you; after speaking with one of your colleagues, he mentions that the same thing happened to him, when he saw her several weeks ago for a physical; what personality disorder does the woman MOST likely have
during a routine H/P with a patient, he notes that he recently got promoted in his job and expresses his idea that he is more qualified than the CEO of the company; he also made a crude joke about his coworker and friend of whom he won the promotion over; upon questioning him aboout his job, he reacts with sudden rage and becomes defensive; what personality disorder does he MOST likely have
25 y/o male patient has a history of poor socialization and has had few friends in his life; he has never had a girlfriend for fear of rejection though he does want a relationship; what personality disorder does he MOST likely have
you are seeing an 18 y/o female patient for the first time; upon questioning her about her school (she is about to graduate a senior in high school), she goes on and on about wanting to have the highest GPA in her school; she tells you that she will be graduating 3rd in her class of 400, yet is very disappointed she is not number 1; further questioning reveals she is a very organized and clean person, and makes it a priority to help maintain the house with her parents; what personality disorder does he MOST likely have
a teenage girl meets with a psychiatrist for the first time; she explains difficulty she has had maintaining relationships; she has had 9 boyfriends in the past year, all of whom broke up with her saying she was extremely clingy and wanted to be taken care of; during the H/P, you suspect she has a low self-confidence; what personality disorder does he MOST likely have
female patient presents complaining of amenorrhea; her PMH is remarkable for multiple fracutres; labs reveal anemia and electrolyte imbalances; her BMI is 15.8; whats the MOST likely diagnosis
anorexia nervosa
female patient presents for an annual H/P; PE is remarkable for enamel erosion and calluses on the dorsal side of her hands; labs reveal electrolyte disturbances and alkalosis; PMH is remarkable for parotitis; it's noted that she became very tense when questioned about her diet; what's the MOST likely diagnosis
what is Russell's sign
calluses on the dorsal side of the hand seen in bulimia (formed from inducing vomiting)
during a smoking cessation counselling, the patients admits she would like to quit smoking, but doesnt intend to in the near future; what stage is she in
during a smoking cessation counselling, the patient denies that her smoking is a problem to her health; what stage is she in
during a smoking cessation counselling, the patient admits she is ready to quit smoking and discusses all possible treatment with you; what stage is she in
lab test specific for alcohol intoxication
how will AST compare to ALT in alcohol toxicity
AST will be twice ALT
DOC for alcohol toxicity
treatment for alcohol withdrawal (delirium tremens)
patient presents in ED with vomiting and seizures; PE is remarkable for pinpoint pupils and CNS depression; what overdose is MOST likely
DOC for opioid overdose
naloxone, naltrexone
DOC for benzodiazepine overdose
patient presents to the ED with severe chest pain; cardiac enzymes are within range; PE reveals pupillary dilation, tactile hallucinations, paranoid ideations; what overdose is MOST likely
treatment of cocaine overdose
patient presents to ED with delirium and psychosis; PE is remarkable for fever, vertical/horizontal nystagmus, tachycardia, and excessive salivation; what overdose is MOST likely
patient presents to the ED with marked anxiety and delusions; PE reveals visual hallucinations and pupillary dilations; the patient also appears to having a flashback from a random event in his past; what overdose is MOST likely
patient presents to the ED with paranoid delusions and anxiety; PE reveals impaired judgement, dry mouth, hallucinations, and increased hunger; the patient appears to be in a euphoric state; what overdose is MOST likely
long-term treatment for heroin addicts
methadone or suboxone
DOC for chronic alcoholism
DOC for depression with insomnia
MOA of antipsychotics
blocks D2 receptors
neuroleptic malignant syndrome is a SE with what class of drugs
serious, irreversible SE of antipsychotics
tardive dyskinesia
SE of chlorpromazine
corneal deposits
SE of thioridazine
retinal deposits
DOC for neuroleptic malignant syndrome
patient presents to the ED with rapid onset high fever and rigidity of the muscles; his vitals are unstable; his PMH is remarkable for Schizophrenia diagnosed more than 20 years ago; he has been on the same medications for the whole duration; what is he diagnosed with?
neuroleptic malignant syndrome (secondary to his anti-psychotic meds)
MOA of the newer atypical antipsychotics
blocks 5-HT2, dopamine, alpha, and H1 receptors
SE of clozapine
major benefit of using the newer atypical antipsychotics
less side effects and does NOT cause tardive dyskinesia
MOA of lithium
inhibits phosphoinositol cascade
cardiac defect linked to lithium
Ebstein's anomaly
SE of lithium
tremor, edema, heart blocks, hypothyroidism, nephrogenic diabetes insipidus, teratogen
DOC for general anxiety disorder

(because its not affected by alcohol and doesnt have sexual SE associated with SSRIs)
blocks reuptake of NE and serotonin
major toxicities linked to TCAs
convulsions, coma, cardiotoxicity ("The 3 C's")
DOC for TCA overdose
sodium bicarbonate
TCA recommended for use in elderly
why are most TCAs contraindicated in the elderly
causes severe confusion and hallucinations
TCA that can be used in Parkinsons
(due to anticholinergic effects)
normal time period for antidepressants to show effects in the patient
2-4 weeks
generally the safest class of anti-depressants due to its limited and mild SE
major SE of SSRI that most people complain about
sexual dysfunction
DOC for serotonin syndrome
never combine an SSRI with what drugs?
MAOIs or meperidine
(causes serotonin syndrome)
SNRI that can be used to treat diabetic neuropathies
SNRI that can be used to treat general anxiety disorder
major SE of MAOI (when used alone)
hypertensive crisis secondary to tyramine ingestion
foods that contain tyramine and thus should be avoided in people taking MAOIs
red wine and aged cheese
antidepressant used in smoking cessation
MOA of mitrazapine
alpha-2 antagonist
SE of mitrazapine
sedation, weight gain
antidepressant used for insomnia
major SE of trazodone
priapism and postural hypotension
DOC for insomnia
zolpidem (ambian)
MOA of ramelteon
increases melatonin secretion