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122 Cards in this Set
- Front
- Back
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"Patients with Pancreatic cancer had a higher odds of a history of smoking than those without Pancreatic cancer." What kind of study can make this statement?
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Case-control (observation and retrospective). Uses Odds ratio (OR). key word "odds"
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Smokers have a higher risk of developing COPD than did nonsmokers
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Cohort. Prospective study asks, "what will happen"
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What study measures disease prevalence? What is this study limitation?
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Cross-sectional study. can show risk factor associations but does not establish causality.
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What study measure heritability?
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twin concordance study
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Which study measures heritability and influence of environmental factors
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Adoption study
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When is a clinical trial considered highest quality?
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When it uses randomized, controlled and double-blinded protections
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Which phase of clinical trial measures pharmacokinetics?
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Phase I. Small number of healthy volunteers looking at safety and toxicity too.
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Which phase of a clinical trial assess optimal dosing?
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Phase II. small number of patients with disease of interest. assesses efficacy and adverse effects also.
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What is the purpose of phase III clinical trial? What should be implemented to make the results more convincing?
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Compares new treatment to current standard of care (or placebo, if none exists). Double blinded is best
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What study is considered the highest echelon of clinical evidence? Limitations?
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meta-analysis. may be limited by quality of individual studies or bias in study section
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If all negatives are true negatives, what does that say about a test?
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100% sensitivity. TP/(TP+FN) =1
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when sensitivity is high, is it more of a utility in a area of low or high disease prevalence?
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Low. remember, a highly sensitive tests in real life should be one where you get all the diseased people at the expense of FP results
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What is the term which describes the ability of a test to indicate non-disease when disease is not present?
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specificity. TN/ TN+FP. how likely is the test going to be negative in non diseased person
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What factor determines a low positive predictive value?
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low disease prevalence
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What factor determines a low negative predictive value?
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high disease prevalence
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What term describes the probability that a person is actually disease free given a negative test result?
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TN / (TN + FN). negative predictive value
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What kind of study looks at point prevalence?
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cross-sectional study
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incidence x disease duration roughly equals...
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prevalence
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What groups do you exclude when calculating incidence
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people currently with the disease and those previously positive for it, are not considered at risk.
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When dose prevalence = incidence
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acute disease
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AD/BC
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Odds ratio. case-control, retrospective study
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A/(A+B) / C(C+B)
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relative risk. percent total given as disease in exposed group divided by disease in unexposed group. prospective cohort study.
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Attributable risk
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difference. a/a+b - c/c+d. difference in risk between exposed and unexposed groups.
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Absolute risk reduction
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same calculation as attributable risk. but you looking reduction of risk with use of treatment v. placebo.
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Number needed to treat
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1/ARR. examines the treatment
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If you are consistently getting the same results but those results do not measure what you intended them.
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High precision. low accuracy
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absence of random variation.
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good precision
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what measures the trueness of test
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validity or accuracy.
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4 ways to reduce bias in a study
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double blind, placebo, crossover (acts as own control), randomization
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nonrandom assignment to study group
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selection bias
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knowledge of presence of disorder alters recall by subjects
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recall bias
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subjects are not representative to general populations
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sampling bias
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use a survey to study fatal disease with only those patients still alive
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late-look bias (info gathered at inappropriate time
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teacher give more attention to certain students who end up getting higher scores than neglected students. (teachers didn't know they were in a study)
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procedure bias
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the effect of 1 factor distorts or confuses the effect of the other
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confounding
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A disease normally diagnosed at 35 years of age has a 0% survival rate for 5 years most patients dead by 40. A new testing actually catches the disease at 25, but most patients dead by 40. is this increased survival?
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no. lead time bias.
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What is one effect that is reduced with use of double blinded?
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pygmalion effect - when a researcher's belief in efficacy of treatment changes the outcome of study
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hawthorne effect
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when the gorup being studied changes its behavior owing to the knowledge of being studied
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positive skew
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mean > median > mode. asymmetry with tail on positive end of mean
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which statistical distribution is least affected by outliers in the sample?
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mode
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in study measuring A, v control: There is no difference in A vs. control
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null hypothesis
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In study measuring A v control: there is some difference
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Alternative hypothesis
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mistakenly accepting alternative hypothesis and rejecting null is measured by what value.
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p - value. probability of making a type I error or alpha error. "alpha males always think they are right"
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p < 0.05
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probability that results are purely by chance is less than 5%. less than 5% chance that you are making an alpha error
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stated there is no difference when one actually exists
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beta error or type II
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power is most influenced by what?
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sample size
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standard deviation / square root of sample size
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Standard error
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as sample size increases what happens to standard error?
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decreases
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what percent of population is withing 1 standard deviation of means? 2? 3?
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68%, 95%, 99%
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you are confident that the mean falls within a certain range of normals defines what?
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confidence interval.
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mean - Z*(standard error) to mean + Z*(standard error) =
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confidence interval
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what p value corresponds to 95% CI. What Z value should you use?
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0.05. Z = 1.96.
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If 95% Confidence interval between two variables contains 0.
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null hypothesis not rejected aka your hypothesis is wrong. there is no difference
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If 95% confidence interval studying relative risk (cohort) or odds ratio (control, retrospective) dose not include 1
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null is rejected. Meaning that there is a difference between risk and no risk. if the CI for RR or OR DOES CONTAIN 1 then null is NOT rejected and you can say there is no difference.
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what test checks difference b/w means of 2 groups
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t test. mr T is mean.
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chi sqaured
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checks difference between 2 or more percentages or proportions of categorical outcomes (not mean values)
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the closer the absolute value or r is to 1...
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the stronger the correlation between the 2 variables
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3 steps of disease prevention (in order)
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prevent (vaccinate), detect (i.e. pap smear), reduce disability (chemotherapy in cancer). PDR
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a prevention measureof examining eye, feet and urine is useful for what?
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diabetes
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a prevention measure of examining hepatitis immunizations, HIV and TB tests are useful in a person with what risk factor
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drug use
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prevention measures of influenza, pneumoccoccal immunization and TB testing is useful in people with what risk factor?
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alcholism
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testing blood sugar tests for diabetes is a good prevention service in what kind of patient
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a fat one
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HIV and other STD tests are useful prevention services in people high risk sexual behavior
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true
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Hep, Hep, Hep Hooray, the SSSMMART Chick is Gone!
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diseases that are reportable. Hepatitis A-C, HIV, Salmonella, Shigella, syphilis, measles, mumps, AIDS rubella, Tuberculosis, Chicken pox and Gonorrhea
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leading causes of death is US in infants:
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congenital anomalies, sort gestation/low birth weight, SIDS, RDS
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leading causes of death is US in 1-14
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injuries, cancer
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Is stroke a leading cause of death in 15-25?
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no. thats 25-64. leading causes: injuries, cancer, congenital anomalies, homicide, and heart disease
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leading causes of death is US 65+ include pneumonia and influenza?
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yup. others: heart disease, cancer, stroke, COPD,
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Who is medicare for?
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Elderly. medicarE. part A hospital. part B doctor bills
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Which federal and state assistance program is for the low income?
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medicaiD. Destitute
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what is the core ethical principle which states the obligation to respect patients as individuals and honor their preferences
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autonomy
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what is the core ethical principle that states that we have a special ethical (fiduciary) duty to act in the best interest of the patient? What core principle does this conflict with?
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Beneficence. conflicts with autonomy. if patient can make informed decision, ultimately the patient has right to decide.
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what is the core ethical principle states do no harm?
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nonmaleficence. but benefits of intervention outweight the risks. surgeries fall into the category
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discussion of pertinent info, patient aggreement to the plan and freedom of coercion ar legally required by...
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informed consent
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if a patient is drunk, can they make informed consent.
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no
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should you with hold procedures in an life or death situation if you have yet to get consent for the minor?
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no
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can oral statements be used as a guide if patient becomes incapacitied?
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yup
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potential harm to self or others (violence, suicide, infections, child/elder abuse, imparied drivers) are exception to what?
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confidentiality
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what is the most common factor leading to litigation b/w patients and physician?
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poor communication
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1) don't pass the buck 2) what would a boyscout do 3) don't judge 4) be direct
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tips for ethical situations
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APGAR score. stands for what? evaluated at what time?
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Appearence, Pulse, Grimice, Activity, Respiration. at 1 minute at 5 minutes. 10 point scalre.
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in apgar scores, a P stands for what. at what is considered 1 point? 2 points?
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pulse less than 100/min is 1 pt. more than 100 = 2pts
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G, in apgar score stands for what? what is 2 points? 1 point?
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G grimace. 1 pt = grimace. 2 pt = grimcae + cough
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T/F: low birthweight is associated w/ greater incidence of physical and emotion problems?
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true. also caused by prematurity. complications include infections, RDS, necrotizing entercolitis, intraventricular hemmorrhage and persistant fetal circulation.
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birth-3 months. Motor and cognitive/social milestones?
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motor: rooting reflex, turning head when check is stroked (breastfeeding) C/S: social smile
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milestones for 7-9 months
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motor: sits alone, crawls. C/S: stranger anxiety
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milestones for 15 months, still an infant
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M: walks, babinski dissppears (full myelination) c/s: few words, separation anxiety
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milestones 12-24 months (1-2 years old) todler
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M: climb stairs, number of blocks stacked = age in years/3 (i.e. 6 by age two). C/s: object permanence; 200 words and 2-word sentences at age 2
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24-36 mo mile stones, todler
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no specific motor. c/s: core gender identity, parallel play
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30-36 mo milestones (preschool)
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stacks 9 blocks. c/s: toilet trained (pee at 3)
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3 years of age mile stones
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m: rides a trike (3 wheels, age 3); copies line or circle drawing. c/s: 900 words and complete sentences
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motor milestone: simple drawings (stick figure), hopes one foot. c/s: cooperative play, imaginary friends, grooms self, brushes teeth, buttons and zips
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age 4 milestones
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which piaget stage is defined by egocentric exploration, novel use of objects to obtail goal and understanding of object permanence?
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sensorimotor stage
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which piaget stage is defined by magical thinking and lack of logical thinking?
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preopertational stage ages 2-7
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concrete operational stage is defined by what features?
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logical thinking, no longer egocentric
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at what tanner stage does adrenarche occur?
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2nd stage. public hair appears (adrenarche); breast enlarge.
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what stage does public hair become curly?
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3rd stage of tanner. hair darkens, curls and penis size increases
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which tanner stage involves development of the glans and raising of the areolae?
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4th tanner stage. also includes increase in penis width, darking scrotal skin.
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what tanner involves non raised areolae
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tanner stage 5 is where areolae (no longer raised) and i guess 1-3.
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describe increase/decrease in elderly: REM, slow wave sleep, latency and awakenings
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decrease, decrease, increase
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does the incidence of psychiatric disorders increase or decrease in elderly?
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decrease
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suicide rate in the elderly
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highest rate in the US in age group 65-74
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A patient, whose wife died 4 months ago, who has been feeling guilty about why he is alive has reports that he sees illusion of her. Is this pathological?
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No. normal bereavement characterized by shock, denial, gulty and somatic symptoms typically lasts 6 months to one year. illusions are reported
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A patient, whose wife died 2 years ago, tells you he hears her speaking to him. is this pathological?
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yes. patholgoica grief includes excessive or prolonged grief, or grief that is delayed, inhibited or denied. may experience depressive symptoms, delusions and halluncinations.
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name stages of grief
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denial, anger, bargaining, grieving (depression), acceptance. do not occur in this order all the time. and more than one stage can be present.
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t/f: stress induces production of free fatty acids.
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true. stress response included corticosteroids, FFA, lipids, cholesterol catecholamines; affects water absorption, muscle tone, GC reflex, and mucosal circuation
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what is included in the differential diagnosis of sexual dysfunction?
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drugs, disease, psychological.
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Whats the mnemonic for EEG wave forms in sleep?
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At night, BATS Drink B. B - awake eyes open, A - awake eyes closed, T - light sleep, S - stands for sleep spindles and K comples, D - deep sleep B- again but for REM
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What EEG waveform should you see in a person who meditates frequently?
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alpha. awake, eyes closed.
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What sleep stage do you see teeth grinding?
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stage 2. sleep spindles and K complexs, this is deeper sleep than theta wave sleep. you get bruxism (teeth grinding) as well? MOST SLEEP IS HERE IN YOUNG ADULTS 45%
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What stage do you see sleepwalking; night terrors; and bed wetting?
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delta sleep (low freq, high amplitude, slow wave). both delta and beta REM each account for 25% of sleep. delta and beta REM decrease in the elderly.
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which stage of sleep do you see increase of oxygen consumption in the brain?
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beta wave REM. highest frequency, lowest amplitude (like awake). you get dreams here, loss of motor tone, memory processing function, erections and increase oxygen use by brain. At night BATS Drink Blood.
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which nuclei is most important to initiating sleep?
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raphe nuclues releases serotonin to initiate sleep.
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which neurotransmitter reduces REM sleep?
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NE
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what is the paramedian pontine reticular formation/conjugate gaze center doing in REM sleep?
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causes EOM
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what drug shortens stage 4 sleep?
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benzodiazepines. stage 4 is delta (lowest frequency, highest amplitude).
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why is imipramine used to treat enuresis?
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it shortens stage 4 sleep, where bedwetting occurs. imipramine is a TCA. remember the three C's (toxicity)
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When does REM occur in a narcopleptic?
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start of sleep. may include hypnogogic (before sleep) or hypnopompic (before wake) hallucinations.
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what is ther term called when you lose all muscle tone following a strong emotional stimulus?
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cataplexy
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what drugs are used to treat narcolepsy
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stimulants (amphetamines, modafinil).
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which nucleus drives circadian rhythm?
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suprachiasmatic nucleus. SCN --> NE release --> pineal gland --> melatonin.
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T/F: environment regulates circadian rhythm.
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True. SCN regulated by sunlight.
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