Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
74 Cards in this Set
- Front
- Back
|
What types of studies are possible, how are they conducted and what is the end measurement?
|
1. Case-controlled: compares group w/ dz to group w/o (Odds Ratio)
2. Cohort: compares group w/ given risk factor to group w/o (RR) 3. Cross-sectional: collects data from group to assess frequency of dz (prevalence) 4. Twin concordance study: compares frequency that twins both develop dz (measures heritability) 5. Adoption study: compares siblings raised by biologic vs adoptive parents (measure heritability and environmental influence) |
|
|
What provides the highest-quality study for clinical trials?
|
randomized
controlled double-blinded |
|
|
What are the 3 phases of clinical trials and what occurs in each?
|
I: small #, healthy volunteers - assess safety, toxicity and pharmacokinetics
II: small #, dz of interest - assess tx efficacy, optimal dosing and adverse effects III: Large #, randomly assigned to other tx or placebo - compares new tx to current standard of care |
|
|
What is a meta-analysis and what may it be limited by?
|
pools data from several studies to come to an overall conclusion
- may be limited by quality of individual studies or bias in study selection |
|
|
How are prevalence and incidence calculated?
|
Prevalence = total cases in pop at given time/total pop at risk
Incidence = new cases in pop over given time/total pop at risk during that time |
|
|
How should a 2X2 table be set up?
|
x = dz
y = test a = dz + test + b = dz - test + c = dz + test - d = dz- test - |
|
|
What is sensitivity and specificity and how are they calculated?
|
Sens: proportion of all people w/ dz who test pos = a/(a+c)
Spec: proportion of all people w/o dz who test neg = d/(d+b) |
|
|
What is positive and negative predictive values and how are they calculated?
|
PPV: proportion of pos test that are true pos = a/(a+b)
NPV: proportion of neg test that are true neg = d/(c+d) |
|
|
How does inc prevalence affect PPV and NPV?
|
inc PPV
dec NPV |
|
|
What is an odds ratio and how is it calculated?
|
odds of having dz in exposed group/odds of having dz in unexposed group
= (a/b)/(c/d) = ad/bc |
|
|
What is relative risk and how is it calculated?
|
relative probability of getting dz in exposed group compared to unexposed group
RR = a/(a+b) / c/(c+d) |
|
|
What is attributable risk and how is it calculated?
|
difference in risk b/w exposed and unexposed groups
a/(a+b) - c/(c+d) |
|
|
What is difference b/w precision and accuracy and what types of errors reduce them?
|
Precision: consistency and reproducibility of test (dec w/ random error)
Accuracy: trueness of test measurement (dec w/ systematic error) |
|
|
What are the different types of bias and how can they be reduced?
|
1. Selection: nonrandom assignment to group
2. Recall: knowledge of presence of disorder alters recall 3. Sampling: subjects not representative relative to gen pop 4. Late-look: information gathered at inappropriate time 5. Procedure: groups not treated the same Improvement: blinding, placebo, crossover studies, randomization |
|
|
What is the difference b/w a positive and negative skew?
|
Skews bell curve:
pos = asymmetry w/ tail on R (mean>median>mode) neg = asymmetry w/ tail of L (mean< median < mode) |
|
|
What is the difference b/w a type I and type II error?
|
I: stating that there is an effect when none exists
II: stating that there is no effect when one exists |
|
|
What does p do?
|
p = probability of making type I error
Judged against a (which is usually <0.5) |
|
|
How is power calculated and what does it depend on?
|
1 - B (B = probability of making type II error)
1. total number of end points 2. difference in compliance 3. size of expected effect |
|
|
How is SEM calculated and what info does it hold?
|
SEM = standard error of the mean
= SD/square root of n estimate of quality of sample |
|
|
How is confidence interval calculated?
|
range from [mean-Z(SEM) to mean +Z(SEM)]
|
|
|
What does a t-test check?
|
difference b/w means of 2 group
|
|
|
What does an ANOVA test check?
|
difference b/w means of 3 or more groups
|
|
|
What does an x2 test check?
|
difference b/w 2 or more percentages or proportions of categorical outcomes
|
|
|
What is the correlation coefficient (r)?
|
numeric representation of correlation
b/w -1 and 1 and closer absolute value of r is to 1, stronger the correlation b/w the 2 variables |
|
|
What does 1o, 2o and 3o dz prevention mean?
|
1o - prevent dz occurence
2o - early detection of dz 3o - reduce disability from dz |
|
|
What are the reportable dzs?
|
Hep Hep Hep Hooray, the SSSMMART Chick is Gone!
Hep B, Hep A, Hep C HIV Salmonella, Shigella, Syphilis Measles, Mumps AIDS Rubella Tb Chickenpox Gonorrhea |
|
|
What is the leading cause of death in the US for infants?
|
congenital anomalies, short gestation/low birth weight
SIDS Maternal complications of pregnancy Respiratory distress syndrome |
|
|
What is the leading cause of death in the US for age 1-14?
|
Injuries
Ca Congenital anomalies Homicide Heart dz |
|
|
What is the leading cause of death in the US for age 15-24?
|
Injuries
Homicide Suicide Ca Heart dz |
|
|
What is the leading cause of death in the US for age 25-64?
|
Ca
Heart dz Injuries Suicide Stroke |
|
|
What is the leading cause of death in the US for >65?
|
Heart dz
Ca Stroke COPD pneumonia influenza |
|
|
What is the difference b/w Medicare Part A and Part B?
|
A = hospital
B = doctor bills |
|
|
What are the core ethical principles?
|
Autonomy: honor preferences of individuals
Beneficence: ethical duty to act in pt's best interest Nonmaleficence: do no harm Justice: tx persons fairly |
|
|
What is legally required for informed consent?
|
1. discussion of pertinent info
2. pt's agreement to plan of care 3. freedom from coercion |
|
|
What are the exceptions to informed consent?
|
1. Pt lacks decision-making capacity or is legally incompetent
2. implied in an emergency 3. therapeutic priviledge (withholding info b/c disclosure would severly harm pt) 4. Waiver |
|
|
What is necessary to show decision-making capacity?
|
1. pt makes and communicates a choice
2. pt is informed 3. decision remains stable over time 4. decision is consistent w/ pt's values and goals 5. decision is not result of delusions or hallucinations |
|
|
What does a living will do?
|
Describes tx pt wishes to receive if they cannot communicaate
|
|
|
What does a durable power of attorney do?
|
Pt designates surrogate to make medical decisions in event that they lose decision-making capacity
|
|
|
What are the exception to confidentiality?
|
1. Potential harm to others is serious
2. Likelihood of harm to self is great 3. No alternative means exist to warn or protect those at risk 4. Physicians can take steps to prevent harm |
|
|
What evidence does a civil negligence suit require?
|
1. Duty (physician had duty to pt)
2. Dereliction (physician breached duty) 3. Damage (pt suffered harm) 4. Direct (breach of duty was what caused harm) *"More likely than not" rather than "beyond a reasonable doubt" |
|
|
How is the APGAR test scored?
|
0-2 points
Appearance: blue - trunk pink - all pink Pulse: none, <100/min, >100/min Grimace: none, grimace, grimace + cough Activity: limp, some, active Respiration: none, irregular, regular |
|
|
What is low birth weight defined as and what are some common complications?
|
<2500 g
- infections, respiratory distress syndrome, necrotizing enterocolitis, intraventricular hemorrhage, persistent fetal circulation |
|
|
What are the motor and cognitive/social milestones for birth-3 mo?
|
rooting reflex
|
|
|
What are the motor and cognitive/social milestones for 3 mo?
|
holds head up, Moro reflex disappears
social smile |
|
|
What are the motor and cognitive/social milestones for 4-5 mo?
|
Rolls front to back, sits when propped
recognizes people |
|
|
What are the motor and cognitive/social milestones for 7-9 mo?
|
sits alone, crawls
stranger anxiety, orients to voice |
|
|
What are the motor and cognitive/social milestones for 12-14 mo?
|
upgoing Babinski disapears
|
|
|
What are the motor and cognitive/social milestones for 18-24 mo?
|
Stacks 6 blocks
rapprochment |
|
|
What are the motor and cognitive/social milestones for 24-48 mo?
|
parallel play
|
|
|
What are the motor and cognitive/social milestones for 24-36 mo?
|
core gender ID
|
|
|
What are the motor and cognitive/social milestones for 30-36 mo?
|
stacks 9 blocks
toilet training |
|
|
What are the motor and cognitive/social milestones for 3 yrs?
|
rides tricycle, copies line or circle drawing
900 words and complete sentences |
|
|
What are the motor and cognitive/social milestones for 4 yrs?
|
simple drawings (stick figure), hops on 1 foot
cooperative play, imaginary friends, grooms self, brushes teeth |
|
|
What are the motor and cognitive/social milestones for 6-11 yr?
|
reads, understands death, develops conscience, same-sex friends, ID w/ same-sex parent
|
|
|
What are the motor and cognitive/social milestones for 11 yr (girl), 13 (boy)?
|
abstract reasoning, formation of personality
|
|
|
What are the motor and cognitive/social milestones for 15 mo?
|
walks
few words, separation anxiety |
|
|
What are the motor and cognitive/social milestones for 12-24 mo?
|
climbs stairs, stacks 3 blocks
object permanenct, 200 words and 2-word sentences |
|
|
What sexual changes occur in the elderly?
|
men - slower erection/ejaculation, longer refractory period
women - vaginal shortening, thinning and dryness |
|
|
What sleep changes occur in the elderly?
|
dec REM sleep, dec slow-wave sleep, inc sleep latency, inc awakenings during night
|
|
|
What are some common medical conditions in the elderly?
|
arthritis
htn heart dz osteoporosis |
|
|
What population has the highest suicide rate in the US?
|
males 65-74 y/o
|
|
|
What systemic physiologic changes occur in the elderly?
|
dec vision, hearing
dec immune response dec renal function/bladder control dec pulmonary fnx dec GI fnx dec muscle mass and inc fat |
|
|
What are the Tanner stages?
|
1. childhood
2. pubic hair begins to develop (adrenarche), inc size of testes, breast tissue elevation 3. inc pubic hair, darkens, becomes curly, inc penis size/length 4. inc penis width, darker scrotal skin, development of glans, raised areolae 5. adults; areolae no longer raised |
|
|
What is normal bereavement characterized by?
|
shock
denial somatic sxs typically lasts 6 mo to 1 yr *may experience illusions |
|
|
What does pathologic grief include?
|
excessively intense or prolonged grief or grief that is delayed, inhibited or denied
* may experience depressive sxs, delusions and hallucinations |
|
|
What are the Kubler-Ross grief stages?
|
Denial, anger, bargaining, grieving, acceptance
|
|
|
What is the ddx for sexual dysfunction?
|
1. Drugs (antihtn, neuroleptics, SSRIs, ethanol)
2. Dz (depression, DM) 3. Psychological (performance anxiety) |
|
|
How is BMI calculated and what are the different values?
|
BMI = wt (kg)/height (m2)
<18.5 = underweight 18.5-24.9 = normal 25.0-29.9 = overweight >30 = obese |
|
|
What occurs in each sleep stages and what is the EEG waveform?
|
Awake - Beta (high freq, low amp)
Awake (eyes closed) - alpha 1 - light sleep (theta) 2 - deeper sleep (sleep spindles and K complexes) 3-4 - deepest, non-REM sleep, sleepwalking, night terrors, bedwetting (delta - lowest frequ, highest amp) REM - dreaming, loss of motor tone, erections, inc brain O2 use (beta) |
|
|
What percentage of total sleep time is spent in each stage?
|
1 (5%)
2 (45%) 3-4 (25) REM (25%) |
|
|
How do neurotransmitters affect sleep patterns?
|
seratoning predominance of raphe nucleus key to initiating sleep
NE reduced REM sleep ACh principally involved in REM sleep |
|
|
What are teh extraocular movements during REM sleep due to?
|
activity of the paramedian pontine reticular fromation/conjugate gaze center)
|
|
|
How do benzodiazepines affect sleep?
|
shorten stage 4 - useful for night terrors and sleepwalking
|
|
|
How is nocturnal enuresis tx?
|
Imipramine - dec stage 4 sleep
|
