Fa Behavioral Science

Front 1

A woman with anxiety about a gynecological exam is told to relax and to imagine going through the steps of the exam. What process does this exemplify?

Back 1

systematic desensitization

Front 2

63 year-old man is diagnosed with incurable metastatic pancreatic adenocarcinoma. His family asks you, the doctor, not to tell the pt. What do you do?

Back 2

Assess whether telling the pt will negatively affect his health. If not, tell him.

Front 3

A man admitted for chest pain is medicated for ventricular tachy. The next day he jumps out of bed and does 50 push ups to show nurses he has not had a heart attack. What defense mechanism is he using?

Back 3

Denial

Front 4

You find yourself attracted to your 26-year-old patient. What do you say?

Back 4

Nothing and invite a chaperone into the room if you feel your actions may be misinterpreted

Front 5

A large group of people is followed over 10 years. Every two years, it is determined who develops heart disease and who does not. What type of study is this?

Back 5

Cohort study

Front 6

A girl can groom herself, hop on one foot, and has an imaginary friend. How old is she?

Back 6

4

Front 7

A man has flashbacks about his girlfriend's death 2 months ago following a hit-and-run accident. He often cries and wishes for the death of the culprit. What is his diagnosis?

Back 7

Normal bereavement

Front 8

A 36-year-old woman with a strong family hx of breast cancer refuses a mamogram because she heard it hurts. What do you do?

Back 8

discuss risks and benefits; each pt must give consent so if the pt refuses, you must abide by her wishes

Front 9

A 4-year-old girl complains of a burning feeling in her genitalia; otherwise, she behaves and sleeps normally. Smear of the discharge shows N. gonorrhoeae. How was she infected?

Back 9

Sexual abuse

Front 10

A 72-year-old man insists on stopping treatment for his heart condition because it makes him feel "funny." What do you do?

Back 10

The pt has the final say in his tx, but you should investigate the "funn"y feeling and see if there are other drugs that do not illicit this response

Front 11

During a particular stage of sleep, a pt has variable blood pressure, penile tumescence and variable EEG. What stage of sleep is he in?

Back 11

REM sleep

Front 12

Comparing a group of people with a disease to a group of people without the disease is an example of what type of study?

Back 12

Case-control study: observational retrospective

Front 13

What types of measures are more common in retrospective case-control studies?

Back 13

Odds ratio (OR): Pts with COPD had higher odds of a hx of smoking than pts without COPD

Front 14

Comparing a group with a given risk factor to a group without in order to assess whether the risk factor increased the likelihood of disease is an example of what type of study?

Back 14

Cohort study: observational prospective

Front 15

What types of measures are more common in propsective cohort studies studies?

Back 15

Relative Risk (RR): "smokers had a higher risk for COPD than did nonsmokers"

Front 16

Collecting data from a group of people to assess frequency of disease (and related risk factors) at a particular point in timeis an example of what type of study?

Back 16

Cross-sectional study: observational

Front 17

Can cross-sectional studies prove causality of a risk to a disease?

Back 17

No. it can only show a risk factor association with a disease

Front 18

Comparing the frequency with which both monozygotic twins or both dizygotic twins develop a disease is an example of what type of study?

Back 18

twin concordance study

Front 19

Twin concordance studies measure what aspect of disease?

Back 19

heritability

Front 20

Comparing siblings raised by biologic vs. adoptive parents is an example of what type of study?

Back 20

Adoption study

Front 21

Adoption studies measure what aspects of disease?

Back 21

heritability plus environmental influences

Front 22

What type of study is of the highest quality?

Back 22

Randomized, double-blind, clinical trial

Front 23

What is the study sample and purpose of a Phase I clinical trial?

Back 23

small # of pts, usually nml volunteers; assess safety, toxicity, and pharmacokinetics

Front 24

What is the study sample and purpose of a Phase II clinical trial?

Back 24

small # of pts with dz of interest; assess tx efficacy, optimal dosing, and adverse effects

Front 25

What is the study sample and purpose of a Phase III clinical trial?

Back 25

lg # of pts randomly assigned to either tx, best available tx, or placebo; compare new tx to current standard of care

Front 26

What is the purpose of a metaanalysis?

Back 26

Pools data from several studies; acheives greater statistical power and integrates results of similar studies

Front 27

How do you calculate prevalence?

Back 27

Prevalence =total cases in a population at a given time/total population at risk

Front 28

How do you calculate incidence?

Back 28

Incidence = new cases in a population ove a given time period/total population at risk during that time

Hint 28

Incidence is new incidents

Front 29

What is the general relationship between prevalence and incidence for chronic diseases (e.g., diabetes)?

Back 29

Prevalence > incidence

Front 30

What is the general relationship between prevalence and incidence for acute diseases (e.g., ommon cold)?

Back 30

prevalence = incidence

Front 31

The sensitivity of a test is a measure of what?

Back 31

the percent of people with the dz who test positive

Front 32

A high sensitivity value is desirable for what diagnsotic decisions?

Back 32

Desirable for ruling-out dz

Hint 32

SNOUT=SeNsitivity rules OUT

Front 33

Using the 2x2 table comparing test results ro actual presence of disease, how do you measure sensitivity?

Back 33

a/(a+c)

Front 34

The specificity of a test is a measure of what?

Back 34

Percent of people without the disease who test negative

Front 35

A high specificity value is desirable for what diagnsotic decisions?

Back 35

desirable for ruling-in a disease

Hint 35

SPIN=Specificity rules IN

Front 36

Using the 2x2 table comparing test results ro actual presence of disease, how do you measure specificity?

Back 36

d/d+b

Front 37

A positive predictive value (PPV) measures what?

Back 37

Percent of positive test results that are true-positives

Front 38

Using the 2x2 table comparing test results ro actual presence of disease, how do you measure positive predictive value?

Back 38

a/(a+b)

Front 39

A negative predictive value measures what?

Back 39

Percent of negative results that are true-negative

Front 40

Using the 2x2 table comparing test results ro actual presence of disease, how do you measurenegative predictive value?

Back 40

d/d+c

Front 41

How do you measure the Odds Ratio and for which studies are Odds Ratios used?

Back 41

Odds of having a dz in exposed group/odds of having dz in unexposed group; case control studies

Front 42

How do you measure the relative risk and for which studies are relative risks used?

Back 42

Relative probablility of getting the dz in exposed group versus the unexposed group; cohort studies

Front 43

What is the attributable risk?

Back 43

The differenc in risk between exposed and unexposed groups; the % of dz occurences that are the result of exposure

Front 44

Using the 2x2 table comparing risk factor to disease, how do you calculate odds ratio?

Back 44

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

Front 45

Using the 2x2 table comparing risk factor to disease, how do you calculate relative risk?

Back 45

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

Front 46

Using the 2x2 table comparing risk factor to disease, how do you calculate attributable risk?

Back 46

AR=(a/a+b)-(c/c+d)

Front 47

What is the difference between precision and accuracy?

Back 47

precision is the consistence and reproducibility of a test and the absence of random variation; accuracy is the trueness of the test measurements

Front 48

In general, what is bias?

Back 48

When one outcome is systematically favored over another outcome

Front 49

What are the four categories of bias?

Back 49

1. Selection bias (nonrandom) 2. Recall bias 3. Sampling bias (nonrepresentative subjects) 4. Late-look bias (inappropriate time)

Front 50

What are four ways to reduce bias?

Back 50

1. blind studies 2. placebo responses 3. crossover studies 4. Randomization

Front 51

What does a null hypothesis state?

Back 51

That there is no association between the dz and the risk factor in the population

Front 52

What is a Type 1 error (a)?

Back 52

Stating that there is an effect or difference when none exists (to reject the null hypothesisby mistake)

Front 53

What does a p value measure?

Back 53

the percent chance that the data will show something that is not really there

Front 54

What should a p value be in order to be statistically significant?

Back 54

p<.05

Front 55

If you are making a Type II (β) error, what are you doing?

Back 55

You stated that there is not a differencewhen one exists (fail to reject the null hypothesis when the null is false)

Front 56

When would you use a t-Test vs. ANOVA vs. x2

Back 56

t-Test = checks the difference between the means of 2 groups; ANOVA = checks the difference between the means of 3 or more groups;x = difference between 2 or more percentages or proportions of categorical outcomes

Front 57

Which diseases are reportable?

Back 57

Hep B, HepA, Salmonella, Shigells, Syphilis, Measels, Mmps, AIDS, Rubella, TB, Chicken Pox, Gonorrhea

Hint 57

eveything you can get from sex and your childhood immunizations

Front 58

What is the difference between Medicare and Medicaid?

Back 58

Medicare is for the elderly, medicaid is for the low income people

Front 59

What are the three levels of disease prevention?

Back 59

1'=prevent dz occurrence (vaccines); 2'=early detection of dz 3'=reduce disability from dz

Hint 59

PDR = prevent, detect, reduce disability

Front 60

What are the leading causes of death in infants?

Back 60

congential abnormalities, premies/low birth weight, SIDS, maternal complications of pregnancy, respiratory distress syndrome

Front 61

What are the leading causes of death in 1-14 year olds?

Back 61

Injuries, cancer, congenital, homicide, heart dz

Front 62

What are the leading causes of death in 15-24 year olds?

Back 62

injuries, homicide, suicide, cancer, heart dz

Front 63

What are the leading causes of death in 25-64 year olds?

Back 63

cancer, heart dz, injuries, suicide, stroke

Front 64

What are the leading causes of death in 65+ year olds?

Back 64

heart dz, cancer, stroke, COPD, pneumonia, flu

Front 65

What are the core ethical principles of medicine?

Back 65

Autonomy, beneficence (act in the pts best interest); nonmaleficence (do no harm); Justice (treat all fairly)

Front 66

In order to obtain informed consent, what three things are legally required?

Back 66

1. discussion of pertinent information, 2. Pt's agreement to plan of care, 3. Freedom from coercion

Front 67

What are the four exceptions to informed consent?

Back 67

1. pt lacks decision making capacity 2. implied consent in an emergency 3. therapeutic privilege 4. Waiver

Front 68

What are the 5 criteria for decision-making capacity?

Back 68

1. pt makes and communicates choice, 2. pt is informed, 3. Decision remains stable over time, 4. decision is consistent with pt's values and goals, 5. decision is not a result of delusions or hallucinations

Front 69

What is an oral advanced directive?

Back 69

incapacitated pt's prior oral statements commonly used as a guide. Problems arise in interpretation.

Front 70

What are the two most common types of written advanced directives?

Back 70

Living will and Durable Power of Attorney

Front 71

What are the four exceptions to confidentiality?

Back 71

1. potential harm to others, 2. likelihood of harm to self, 3. no alternative means exist to protect those at risk, 4. physicians can take steps to prevent harm

Front 72

What are the four criteria to file a civil suit of malpractice?

Back 72

1. physician had a Duty ot the pt, 2. Physician breached the duty, 3. patient suffers harm, 4. the breach of the duty is what caused the harm

Hint 72

Four D's: duty, dereliction, damage, direct

Front 73

What is the most common factor leading to litigation?

Back 73

poor communication between physician and pt

Front 74

What is the appropriate response to the follwing wthical situation: pt is noncompliant?

Back 74

work to improve the physician-pt relationship

Front 75

What is the appropriate response to the follwing wthical situation: pt has difficulty taking medications?

Back 75

provide written instructions; attempt to simplify tx regimens

Front 76

What is the appropriate response to the follwing wthical situation: family members ask for info about pt's prognosis?

Back 76

avoid discussion issues with relatives without the permission of the pt

Front 77

What is the appropriate response to the follwing wthical situation: 17-year old girl is pregnant and requests an abortion?

Back 77

many states require parental consent; NOT required for an emergency/tx of STDs/medical care during pregnancy/management of drug addiction

Front 78

What is the appropriate response to the follwing wthical situation: terminally ill pt requests physician assistance in ending his life?

Back 78

in most states, refuse invovlement in any form of phys-assisted suicide; can give medically appropriate analgesics that coincidently shorten a person's life

Front 79

What is the appropriate response to the follwing wthical situation: pt states that he/she finds you attractive?

Back 79

Ask direct, closed-ended questions and use a chaperone, if necessary. Never appropriate to get romantically involved with a pt

Front 80

What are the motor and cognitive milestones for the following age group: 24-48 mos?

Back 80

parallel play

Front 81

What are the motor and cognitive milestones for the following age group: 24-36 mos?

Back 81

core gender identity

Front 82

What are the motor and cognitive milestones for the following age group: 30-36 mos?

Back 82

stacks 9 blocks; toilet training

Front 83

What are the motor and cognitive milestones for the following age group: 3 yrs?

Back 83

rides trike, copies line or circle drawing; group play

Front 84

What are the motor and cognitive milestones for the following age group: 4 yrs?

Back 84

simple drawings, hops on one foot; cooperative play, imaginary friends, grooms self, brushes teeth

Front 85

What are the motor and cognitive milestones for the following age group:6-11 yrs?

Back 85

reads, understands death; development of conscience, same sex friends, identification with same sex parent

Front 86

What are the motor and cognitive milestones for the following age group: 11 yrs, girls?

Back 86

Abstract reasoning, formation of personality

Front 87

What are the motor and cognitive milestones for the following age group: 13 yrs (boys)?

Back 87

Abstract reasoning, formation of personality

Front 88

What are the five Tanner stages of sexual development?

Back 88

1. childhood, 2. pubic hair beigns to develop, increased testes size, breast tissue elevation, 3. increased pubic hair, darkens, becomes curly, increase penis size/length, 4. increased penis width, glans, raise areola, 5. adult (areola no longer raised)

Front 89

What are the characteristics of normal grief? How long does it last?

Back 89

shock, denial, guilt and somatic symptoms; lasts 6 months to 1 year

Front 90

What are the Grief stages?

Back 90

Denial, anger, Bargaining, Greiving, Acceptance

Hint 90

Death Arrives Bringing Grave Adjustments

Front 91

What is the differential diagnosis for sexual dysfunction?

Back 91

Drugs (anti-HTN, neuroleptics, SSRI's, ethanol), Diseases, Psychological (performance anxiety)

Front 92

How does one calculate BMI?

Back 92

weight in kg/(ht in meters)^2

Front 93

What are the BMI ranges for underweight, nl, overweight and obese, respectively?

Back 93

< 18.5; 18.5-24.9; 25.0-29.9; >30.0

Front 94

What type of EEG wave form will you have if you are awake with your eyes closed?

Back 94

alpha

Front 95

How much of a young adult's time is spent in light sleep?

Back 95

5%

Front 96

How much of a young adult's time is spent in deeper sleep (one level deeper than light sleep)?

Back 96

45%

Front 97

How much of a young adult's time is spent in deepest, non-REM sleep?

Back 97

25%

Front 98

How much of a young adult's time is spent in REM sleep?

Back 98

25%

Front 99

At which stage of sleep does one experience sleepwalking, night terrors and bed wetting?

Back 99

Deepest, non-REM sleep

Front 100

At which stage of sleep does one experience dreaming, loss of motor tone, erections and increased O2 brain use?

Back 100

REM sleep

Front 101

What type of EEG wave form will you have if you are in REM sleep?

Back 101

Beta waves

Hint 101

Same as if you are awake

Front 102

What class of drugs reduce stage 4 (deep non-REM) sleep and are thus good for treating sleepwalking and night terrors?

Back 102

Benzos

Front 103

What drug is used to treat enuresis by decreasing stage 4 sleep?

Back 103

Imipramine

Front 104

The activity of the PPRF (paramedian pontine reticular formation/conjugate gaze center) is responsible for what patter during sleep?

Back 104

the extraocular movements during REM sleep

Front 105

T/F: NE induces REM sleep

Back 105

False: NE reduces REM sleep

Front 106

What are the signs of narcolepsy (aside from just being asleep at awkward times)?

Back 106

hypnogogic or hypnopompic hallucinations; sleep starts with REM sleep; cataplexy may occur

Front 107

What is the tx for narcolepsy?

Back 107

stimulants (amphetamines)

Front 108

What is the mean IQ?

Back 108

100 with a st deviation of 15

Front 109

What are the IQ criteria for a dx of mental retardation, severe MR, profound MR, respectively?

Back 109

<70, <40, <20

Front 110

What is an example of "classical conditioning"?

Back 110

Pavlov's doga natural response (salivation) is elicited by a learned stimulus (bell ring) that previously was presented in conjunction with an unconditioned stimulus (food)

Front 111

What is operant conditioning?

Back 111

learning in which a particular action is elicited because it produces a reward

Front 112

Define positive reinforcement.

Back 112

desired reward produces action (mouse presses button to get food)

Front 113

Define negative reinforcement.

Back 113

removal of adverse stimulus increases behavior (mouse presses button to avoid shock)

Front 114

Which form of reinforcement is associated with a rapidly extinguished behavioral response: continuous or variable ratio?

Back 114

Continuous

Hint 114

Think vending machine: you stop using if it does not deliver vs. Slot Machine: continue to play even if it rarely rewards

Front 115

What is transference?

Back 115

When a pt projects feelings about formative or other important persons onto a physician

Hint 115

psychiatrist = parent

Front 116

What is countertransference?

Back 116

when the dr projects feelings about a formative or other important persons onto the pt

Front 117

What are Freud's 3 structures of the mind?

Back 117

Id, Ego, Superego

Front 118

What characteristics are commonly associated with the Id?

Back 118

Primal urges, sex and aggression

Front 119

What characteristics are commonly associated with the Ego?

Back 119

mediator between unconscious mind and external world; deals with the conflict between Id and Superego

Front 120

What characteristics are commonly associated with the Superego?

Back 120

Moral values, conscience

Front 121

What is the Oedipus Complex?

Back 121

repressed feelings of a child for the opposite-sex parent, accompanied by rivalry with same sex parent

Front 122

What are ego defenses, in general?

Back 122

automatic and unconscious reactions to psychological stress

Front 123

What are the 4 mature ego defenses?

Back 123

Altruism, Humor, Sublimation, Suppression

Hint 123

SASH

Front 124

Extreme forms of this immature ego defense are seen in multiple personality disorders.

Back 124

Dissociation: temporary, drastic change in personality, memory, consciousness, or motor behavior to avoid emotional stress

Front 125

A mother yelling at her child because she is angry at her husband is an example of which immature ego defense?

Back 125

displacement

Front 126

An abused child becoming an abuser is an example of which immature ego defense?

Back 126

identification

Front 127

Describing a murder in graphic detail with no emotional response is an example of which immature ego defense?

Back 127

Isolation: separation of feelings from ideas/events

Front 128

What is the appropriate response to the follwing ethical situation: pt states that he/she finds you attractive?

Back 128

Ask direct, closed-ended questions and use a chaperone, if necessary. Never appropriate to get romantically involved with a pt

Front 129

What is the appropriate response to the follwing ethical situation: pt refuses a necessary procedure or requests an unnecessary one?

Back 129

attempt to understand why the pt wants/refuses the procedure. Address underlying concerns. Avoid performing unnecessary procedures

Front 130

What is the appropriate response to the follwing ethical situation: pt is angry about the amount of time spent in the waiting room?

Back 130

apologize; stay away from efforts to explain the delay

Front 131

What is the appropriate response to the follwing ethical situation: pt is upset with the way he was treated by another doctor?

Back 131

suggest that the pt speak directly to that dr regarding his concerns

Front 132

What is the appropriate response to the follwing ethical situation: a child wishes to know more about his illness?

Back 132

ask what the parents have told him; parents of a child decide what information can be relayed about the illness

Front 133

What is the appropriate response to the follwing ethical situation:pt continues to smoke, believing cigarettes are good for him?

Back 133

ask how the pt feels about his smoking; offer adivce on cessation is the pt seems willing to make an effort to quit

Front 134

What is the appropriate response to the follwing ethical situation: pediatric pt requests condoms?

Back 134

physicians CAN provide consultaiton and contraceptives to minors without a parent's knowledge or consent

Front 135

When are AGPAR scores evaluated?

Back 135

10 point scale at 1 minute and 5 minutes after birth

Front 136

What does AGPAR measure?

Back 136

Appearance, Pulse, Grimace, Activity, Respiration

Front 137

What is a low birth weight defined as?

Back 137

< 2500g

Front 138

What are the motor and cognitive milestones for the following age group: 3 mos?

Back 138

Holds head up, disappearance of moro reflex; social smile

Front 139

What are the motor and cognitive milestones for the following age group: 4-5 mos?

Back 139

rolls front to back, sits when propped; recognizes people

Front 140

What are the motor and cognitive milestones for the following age group: 7-9 mos?

Back 140

sits alone, crawls; stranger anxiety, orients to voice

Front 141

What are the motor and cognitive milestones for the following age group: 12-14 mos?

Back 141

Upgoing babinski sign disappears

Front 142

What are the motor and cognitive milestones for the following age group: 15 mos?

Back 142

walks; few words, separation anxiety

Front 143

What are the motor and cognitive milestones for the following age group: 12-24 mos?

Back 143

climbs stairs, stacks 3 blocks; object permanence

Front 144

A patient with libidinous thoughts entering a monastery is an example of which immature ego defense?

Back 144

reaction formation

Front 145

A pt stating that all nurses are cold and unfriendly while all drs are warm and sensitive is an example of which immature ego defense?

Back 145

splitting: belief that people are all good or all bad

Front 146

A man who wants another woman thinking his wife is cheating on him is an example of which immature ego defense?

Back 146

projection: an unacceptable internal impulse is attributed to an external source

Front 147

Which ego defense mechanis is characterized by alleviating guily feelings by unsolicited gerosity towards others?

Back 147

altruism

Front 148

Which ego defense mechanis is characterized by appreciating the amusing nature of an anxiety-provoking or adverse situation?

Back 148

humor

Front 149

Which ego defense mechanis is characterized by the replacement of an unacceptable wish with a course of action that is similar to the wish but does not conflict with one's value system?

Back 149

sublimation

Front 150

Which ego defense mechanis is characterized by voluntary witholding of an idea of feeling from conscious awareness?

Back 150

suppression

Front 151

Which ego defense mechanis is characterized by unacceptable feelings and thoughts expressed through actions?

Back 151

acting out

Front 152

Which ego defense mechanis is characterized by temporary, drastic changes in personality, memory, consciousness or motor behavior to avoid emotional stress.

Back 152

dissociation

Front 153

Which ego defense mechanis is characterized by avoidance of awareness of some painful reality?

Back 153

denial

Front 154

Which ego defense mechanis is characterized by a process whereby avoided ideas and feelings are transferred to some neutral person or object?

Back 154

displacement

Front 155

Which ego defense mechanis is characterized by partially remaining at a more childish level of development?

Back 155

fixation

Front 156

Which ego defense mechanis is characterized by modeling behavior after another person who is more powerful (though not necessarily admired)?

Back 156

identification

Front 157

Which ego defense mechanis is characterized by a separation of feelings from ideas and events

Back 157

isolation

Front 158

Which ego defense mechanis is characterized by an unacceptable internal impulse attributable to an external source?

Back 158

projection

Front 159

Which ego defense mechanis is characterized by proclaiming logical reasons for actions actually performed for other reasons, usually to avoid self-blame?

Back 159

rationalization

Front 160

Which ego defense mechanis is characterized by a process whereby a warded-off area or feeling is replaced by an (unconsciously derived) emphasis on its opposite?

Back 160

reaction formation

Front 161

Which ego defense mechanis is characterized by turning back the maturational clock and going back to earlier modes of dealing with the world?

Back 161

regression

Front 162

Which ego defense mechanism is characterized by an involuntary withholding of an idea or feeling from conscious awareness. The basic mechanism underlying all others?

Back 162

repression

Front 163

Which ego defense mechanism is characterized by the belief that people are either all good or all bad?

Back 163

splitting