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120 Cards in this Set
- Front
- Back
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What does a case-control study compare?
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Group w/ a disease to a group w/out. Measures ODDS RATIO retrospectively.
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What does a cohort study compare?
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Group w/ risk factor for a disease vs. group w/out. Measures RELATIVE RISK of risk factor for the disease
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What does a cross-sectional study collect?
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Data from a group to assess DISEASE FREQUENCY @ a point in time
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What is a meta-analysis?
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Pools multiple studies for an overall conclusion. Highest echelon of clinical evidence
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What is disease prevalence?
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TOTAL cases / total population
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What is disease incidence?
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NEW cases / population @ risk. (Incidence = new Incidents)
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What kind of diagnostic test is used a screen for disease?
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Sensitive tests rule OUT. SNOUT = SeNsitive rules OUT. People w/ disease who test (+)
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What kind of diagnostic test is used to confirm disease?
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Specific tests rule IN. SPIN = SPecific rules IN. People w/out disease who test (-)
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What is positive predictive value?
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Proportion of (+) tests that are true (+). Whether person really has disease if test (+).
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What is negative predictive value?
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Proportion of (-) tests that are true (-). Whether person really is disease free if test (-)
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What is an odds ratio?
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Odds of disease in exposed group over odds of disease in unexposed group
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What is relative risk?
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Probability of getting disease in exposed group over unexposed group
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What is atrributable risk?
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Measures proportion of disease occurrences that are a result of the exposure
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What is selection bias?
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Nonrandom assignment to study groups
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What is recall bias?
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Subjects' recall is affected when they are aware of the presence of the disorder
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What is sampling bias?
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When subjects selected are not representative of general population
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What are some ways to ↓ bias in studies?
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Double blind, use placebo, randomization
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What does a null (Ho) hypothesis suggest?
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NO ASSOCIATION between disease & risk factor
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What does an alternative (H1) hypothesis suggest?
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SOME ASSOCIATION between disease & risk factor
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What is type I error (α)?
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Stating there is an effect when there isn't. Reject null hypothesis. Convict the innocent.
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What is type II error (β)?
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Stating there is Ø effect when there IS. Fail to reject null hypothesis when it is false. Setting guilty free
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What is study/test power?
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Liklihood of finding a difference if one exists. ↑ sample size = ↑ power
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What is 1⁰ disease prevention?
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PREVENT disease occurrence (vaccination)
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What is 2⁰ disease prevention?
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DETECT disease early (Pap smear)
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What is 3⁰ disease prevention?
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REDUCE disability from disease (insulin for diabetics)
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What preventive services do you give to diabetics?
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eye and foot exams; urine tests
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What preventive services do you give to drug users?
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hepatitis immunizations; HIV and TB tests
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What preventive services do you give to alcoholics?
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influenza and pneumococcal immunizations; TB test
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What preventive services do you give to overweight people?
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blood sugar test for diabetes
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What preventive services do you give to homeless people, recent immigrants, and inmates?
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TB test
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What preventive services do you give to people engaging in high-risk sexual behavior?
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tests for HIV, hepatitis B, syphilis, gonorrhea, and chlamydia
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What infectious diseases are reportable?
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HepA/B/C, HIV/AIDS, Salmonella, Shigella, Syphilis, Measles, Mumps, Rubella, TB, Chickenpox, Gonorrhea
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What are the leading causes of death in infants?
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congenital anomalies, low birth weight, SIDS, maternal complications, respiratory distress syndrome
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What are the leading causes of death from age 1-14?
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injuries, cancer, congenital anomalies, homicide, heart disease
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What are the leading causes of death from age 15-24?
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injuries, homicide, suicide, cancer, heart disease
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What are the leading causes of death from age 25-64?
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Cancer, heart disease, injuries, suicide, stroke
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What are the leading causes of death from age 65+?
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heart disease, cancer, stroke, COPD, pneumonia, influenza
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Who is Medicaid for?
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Very poor people
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Who is Medicare for?
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The elderly
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What are Medicare part A and part B for?
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Part A = hospital; partB = doctor bills
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What are the 4 core ethical principles?
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Autonomy, beneficence, nonmaleficence, justice
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Explain autonomy
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obligation to respect patients as individuals and to honor their preferences in medical care
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Explain beneficence
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acting in the patient's best interest; may conflict with autonomy
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Explain nonmaleficence
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Do no harm
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Explain justice
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treat all persons fairly
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What is informed consent?
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discussion of pertinent information (risks, benefits, alternatives); patient agreement to the plan; freedom from coercion
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What are some exceptions to informed consent?
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patient lacks decision-making capacity or is legally incompetent; implied consent in an emergency; therapeutic privilege; waiver
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What are exceptions to parental consent for minors?
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if the minor is married or otherwise emancipated
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What are the components of decision-making capacity?
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patient makes and communicates choice; patient is informed; decision remains stable; decision is consistent with the patient's values; no delusions or hallucinations
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Can the patient's family require the doctor to withhold info from the patient?
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No
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What are oral advance directives?
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The patient's prior oral statements are used as a guide. Valid if prior to incapacity the conditions for decision-making were met.
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What are the 2 forms of written advance directives?
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living will and durable power of attorney
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What is a living will?
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describes treatments the patient wishes to receive or not receive when incapacitated
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What is a durable power of attorney?
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Patient designates a surrogate to make decisions should they lose the capacity. More flexible than a living will.
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What is confidentiality?
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Respects patient privacy and autonomy. Disclosing info should be guided by what the patient would want. The patient may wave the right to confidentiality.
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What are some exceptions to confidentiality?
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Potential harm to self or others is serious and there is no alternative means to warn or protect those at risk.
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What are some examples of exceptions to confidentiality in order to prevent harm?
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Notifying public health about infectious disease; Tarasoff decision; child/elder abuse; impaired drivers; suicidal/homocidal patients
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What are the 4 D's of malpractice
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Duty to the patient; Dereliction of duty; Damage to patient; Direct link between dereliction and damage
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What is the burden of proof in a malpractice suit?
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That 'more likely than not' it occurred. Note it is NOT 'beyond a reasonable doubt.
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What does the Good Samaritan Law do?
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Relieves health care workers and laypersons from liability in certain emergency situations.
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What is the appropriate response to a noncompliant patient?
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Work to improve the physician-patient relationship
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What is the appropriate response to a patient who has difficulty taking his or her meds?
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Provide written instructions; attempt to simplify regimen
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What is the appropriate response to family members asking about a relative's prognosis?
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Avoid discussing issues with relatives without permission.
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What is the appropriate response to a pregnant 17 year-old who requests an abortion?
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Many states require parental consent for abortion. Parental consent is not required in an emergency, for STD treatment, for medical care during an emergency, or management of addiction.
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What is the appropriate response to a patient who requests assistance in ending his or her life?
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In most states physician should refuse involvement. However, physician can prescribe appropriate analgesics that coincidentally shorten the patient's life.
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What is the appropriate response when a patient says he or she finds you attractive?
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Ask direct, closed-ended questions and use a chaperone.
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What is the appropriate response when a patient refuses a necessary procedure or wants an unnecessary one?
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Attempt to understand the decision and address the underlying concern. Avoid unnecessary procedures.
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What is the appropriate response to a patient upset about the amount of time he spent in the waiting room?
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Apologize for the inconvenience, but don't try to explain.
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What is the appropriate response when a is upset by the way they were treated by another doctor?
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Suggest the patient speak directly to the other physician. If the problem is with a member of the office staff, tell the patient you will speak to the individual.
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What is the appropriate response when a child wants to know more about her illness?
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Ask what the parents have told the child. It is up to the parents how much info can be relayed.
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What is the appropriate response when a patient continues to smoke, believing cigarettes are good for him?
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Ask how the patient feels about his or her smoking. Offer advice on cessation if they seem willing to try.
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What is the appropriate response when a minor requests condoms?
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Physicians can provide counsel and contraception to minors without parental knowledge or consent.
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What does APGAR stand for?
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Appearance, Pulse, Grimace, Activity, Respiration
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How is the APGAR scored?
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It is a 10 point scale, with each category getting from 0 to 2 points. The higher the score, the better.
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When is the APGAR score measured?
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At 1 minute and 5 minutes after birth
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What is the definition of low birth weight?
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Less than 2500g
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What are complications of low birth weight?
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Greater incidence of physical and emotional problems, infections, respiratory distress syndrome, necrotizing enterocolitis, intraventricular hemorrhage, and persistent fetal circulation.
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What are some causes of low birth weight?
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Prematurity or intrauterine growth retardation.
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What is the motor milestone for an infant birth-3months?
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rooting reflex
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What are the motor and cognitive milestones for an infant at 3 months?
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Motor: holds head up, Moro reflex disappears; Cognitive: social smile
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What are the motor and cognitive milestones for an infant at 4-5 months?
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Motor: rolls front to back, sits when propped; Cognitive: recognizes people
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What are the motor and cognitive milestones for an infant at 7-9 months?
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Motor: sits alone, crawls; Cognitive: stranger anxiety, orients to voice
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What is the motor milestones for infants at 12-14 months?
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Motor: upgoing Babinski disappears
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What are the motor and cognitive milestones for infants at 15 months?
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Motor: walks; Cognitive: few words, separation anxiety
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What are the motor and cognitive milestones for a toddler at 12-24 months?
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Motor: climbs stairs, stacks 3 blocks; Cognitive: object permanence, 200 words and 2-word sentences at age 2
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What are the motor and cognitive milestones for a toddler at 18-24 months?
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Motor: stacks 6 blocks; Cognitive: rapprochement
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What are the cognitive milestones for a toddler at 24-28 months?
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Cognitive: parallel play
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What are the cognitive milestones for a toddler at 24-36 months?
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Cognitive: core gender identity
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What are the motor and cognitive milestones for a preschooler at 30-36 months?
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Motor: stacks 9 blocks; Cognitive: toilet training (pee at 3)
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What are the motor and cognitive milestones for a preschooler at 3 years?
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Motor: rides tricycle (3 wheeler at age 3), copies line or circle drawings ; Cognitive: 900 words and complete sentences
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What are the motor and cognitive milestones for a preschooler at 4 years?
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Motor: simple drawing (stick figure), hops on one foot; Cognitive: cooperative play, imaginary friends, grooms self, brushes teeth
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What are the cognitive developments for 6-11 year-olds?
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Reads, understands death, development of conscience (superego), same-sex friends, identification with same-sex parent
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What are the cognitive developments at puberty (11 for girls, 13 for boys)?
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Abstract reasoning (formal operations), formation of personality
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What sexual changes occur in elderly males?
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slower erection/ejaculation, longer refractory period
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What sexual changes occur in elderly females?
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vaginal shortening, thinning and dryness
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How do sleep patterns change in the elderly?
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Decreased: REM and slow-wave sleep. Increased: sleep latency, number of awakenings
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What medical conditions are common to the elderly?
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Arthritis, Hypertension, Heart Disease, Osteoporosis
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What is the prevalence of psych disorders in the elderly relative to other age groups?
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Lower prevalence among healthy elderly
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What age/gender group has the highest suicide rate?
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Males age 65-74
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What organ systems show decline in elderly people?
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Vision, Hearing, Immune, bladder control, renal, pulmonary, GI, muscle mass
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How do sexual interest and intelligence change as we age?
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They do NOT decline
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Decribe tanner stage 1
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Childhood
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Describe tanner stage 2
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Pubic hair develops (adrenarche), testes enlarge, breast tissue elevates
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Describe tanner stage 3
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Pubic hair increases, darkens, curls. Penis size/length increase.
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Describe tanner stage 4
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Penis widens, scrotum darkens, glans develop, areolae raise.
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Describe tanner stage 5
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Adult, areolae no longer raised.
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What occurs during normal grief?
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Normal bereavement with shock, denial, guilt, and somatic symptoms. Duration 6mo-1yr. May have illusions.
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Describe pathologic grief.
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Grief is intense, prolonged, delayed, inhibited, or denied. May have depression, delusions, hallucinations.
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List the Kubler-Ross grief stages
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Denial, Anger, Bargaining, Grieving, Acceptance.
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What are the effects of stress?
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Increases FFA's, 17-OH corticosteroids, lipids, cholesterol, catecholamines. Affects water absorption, muscular tonicity, gastrocolic reflex, and mucosal circulation
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What is the DDx of sexual dysfunction?
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Drugs (Ethanol, SSRI's, Neuroleptics, Antihypertensives), Diseases (depression/diabetes), Psych (performance anxiety)
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What is the equation for BMI?
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BMI = Weight(kg)/Height squared (m), >25 = overweight, >30 = obese
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What happens in stage 1 sleep?
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Light sleep, theta waves on EEG
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What happens in stage 2 sleep?
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Deeper sleep, sleep spindles and K-complexes on EEG
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What happens in stage 3-4 sleep?
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Deepest non-REM sleep, sleepwalking, night-terrors, betwetting (slow-wave), Delta waves on EEG
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What happens in REM sleep?
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Dreaming, loss of motor tone, memory processing, erections, inc. O2 utilization, Beta waves on EEG
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What do Benzos and imipramine do to sleep stages?
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Shorten stage 4 sleep, imipramine for enuresis, benzos for night terrors or sleepwalking
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What neurotransmitter is responsible for REM sleep?
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Acetylcholine
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How does REM sleep change with age?
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Decreases
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What are some characteristics narcolepsy?
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Hallucinations, Begins with REM sleep, cataplexy (loss of muscle tone), treat with amphetamines
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