Usmle Step 1: Behavioral

Front 1

Case-control study

Back 1

- observational/retrospective
- case (w/ disease) vs control (w/o disease)
- look for different factors
- determine odds ratios

Front 2

Cohort study

Back 2

- observational/prospective
- w/ factor vs w/o factor
- determine relative risk of developing disease

Front 3

Cross-sectional study

Back 3

- observational
- determine disease prevalence in a population

Front 4

Twin-concordance study

Back 4

- monozygotic vs dizygotic
- compare frequency that BOTH twins get disease
- determines heritability

Front 5

Adoption study

Back 5

- raised by biological parents vs. raised by adoptive parents
- measures heritability and environmental influences

Front 6

Phase I clinical trial

Back 6

- Small number of patients, usually healthy volunteers
- Assesses safety, toxicity, and
pharmacokinetics.

Front 7

Phase II clinical trial

Back 7

- Small number of patients with disease of interest
- Assesses treatment efficacy,
optimal dosing, and adverse
effects.

Front 8

Phase III clinical trial

Back 8

- large number of diseased patients randomly assigned to either the new treatment or best available treatment (or placebo)

Front 9

Meta analysis

Back 9

- pools together many studies to increase statistical power
- may be limited by quality of individual studies or bias in study selection

Front 10

Prevalence

Back 10

- percent of population w/ disease

Front 11

Incidence

Back 11

- percent of at-risk population who get disease in a given period of time

Front 12

Sensitivity

Back 12

- proportion of diseased who test positive
- a/(a+c)
- 1 - false positive rate
- SNOUT

Front 13

Specificity

Back 13

- proportion of healthy who test negative
- d/(d+b)
- 1 - false negative rate
- SPIN

Front 14

Positive predictive value (PPV)

Back 14

- proportion of positive test results that are true positives
- a/(a+b)

Front 15

Negative predictive value (NPV)

Back 15

- proportion of negative test results that are true negatives
- d/(c+d)

Front 16

Odds ratio

Back 16

odds of having disease in exposed group divided by odds of having disease in unexposed group

Front 17

Relative risk

Back 17

probability of having disease in exposed group divided by probability of having disease in unexposed group

Front 18

Attributable risk

Back 18

Risk of exposed group minus risk of unexposed group

Front 19

Precision

Back 19

absence of random variability

Front 20

Accuracy

Back 20

trueness of test measurement

Front 21

selection bias

Back 21

nonrandom group assignment

Front 22

recall bias

Back 22

knowledge of present alters recall by subjects

Front 23

sampling bias

Back 23

subjects are not representative of general population

Front 24

late look bias

Back 24

information gathered at inappropriate time

Front 25

procedure bias

Back 25

groups are not treated the same

Front 26

bimodal

Back 26

two humps

Front 27

positive skew

Back 27

asymmetric w/ tail on right

Front 28

negative skew

Back 28

asymmetric w/ tail on left

Front 29

null hypothesis

Back 29

there is no difference between groups

Front 30

alternate hypothesis

Back 30

there is a difference between groups

Front 31

type I error (alpha)

Back 31

stating that a difference exists when it does not

Front 32

type II error (beta)

Back 32

stating that a difference doesn't exist when it does

Front 33

power (1 - beta)

Back 33

likelihood of finding a difference if it does exist

Front 34

standard error (of the mean)

Back 34

SEM = standard deviation/(sample size)^.5

Front 35

confidence interval

Back 35

range of values in which there is a specific probability that the true value will fall

Front 36

t-test

Back 36

- checks difference between means of two groups
- Mr. T is MEAN

Front 37

ANOVA

Back 37

- checks difference between means of 3 or more groups
- ANalysis Of Variance of 3+

Front 38

chi squared

Back 38

- compares 2+ percentages or proportions

Front 39

primary

Back 39

- prevent disease from occurring (vaccination)

Front 40

secondary prevention

Back 40

- early detection (screening)

Front 41

tertiary

Back 41

reduce disability from disease (insulin)

Front 42

PDR

Back 42

prevent, detect, reduce

Front 43

prevention measures for diabetes

Back 43

Eye, foot exams; urine tests

Front 44

prevention measures for drug use

Back 44

Hepatitis immunizations; HIV, TB tests

Front 45

prevention measures for alcoholism

Back 45

Influenza, pneumococcal immunizations; TB test

Front 46

prevention measures for overweight

Back 46

Blood sugar tests for diabetes

Front 47

prevention measures for homeless, recent immigrant, inmate

Back 47

TB test

Front 48

prevention measures for high risk sexual behavior

Back 48

HIV, hepatitis B, syphilis, gonorrhea, chlamydia tests

Front 49

reportable diseases

Back 49

Hep, Hep, Hep, Hooray, the, SSSMMART Chick is Gone!
-Hep B, Hep A, Hep C, HIV, Salmonella, Shigella, Syphilis, Measles, Mumps, AIDS, Rubella, Tuberculosis, Chickenpox, Gonorrhea

Front 50

Leading causes of death for infants

Back 50

Congenital anomalies, short gestation/low birth weight, sudden infant death syndrome,
maternal complications of pregnancy, respiratory distress syndrome.

Front 51

Leading causes of death for 1-14

Back 51

Injuries, cancer, congenital anomalies, homicide, heart disease.

Front 52

Leading causes of death 15-24

Back 52

Injuries, homicide, suicide, cancer, heart disease.

Front 53

Leading causes of death 25-64

Back 53

Cancer, heart disease, injuries, suicide, stroke.

Front 54

Leading causes of death 65+

Back 54

Heart disease, cancer, stroke, COPD, pneumonia, influenza.

Front 55

medicare

Back 55

for the elderly

Front 56

medicaid

Back 56

for the destitute

Front 57

core ethical principles

Back 57

autonomy, beneficence, non-maleficence, justice

Front 58

exceptions to informed concent

Back 58

- patient lacks capacity
- implied in emergency
- therapeutic privilege
- waiver

Front 59

consent for minors

Back 59

parental consent required unless married or otherwise emancipated

Front 60

living will

Back 60

states treatments patient wishes to receive or not receive if the patient becomes incapacitated

Front 61

durable power of attourney

Back 61

patient designates surrogate to make decisions if the patient becomes incapacitated

Front 62

exceptions to confidentiality

Back 62

1. Potential harm to others is serious
2. Likelihood of harm to self is great
3. No alternative means exist to warn or to protect those at risk
4. Physicians can take steps to prevent harm

Front 63

malpractice

Back 63

duty, dereliction, damage, direct

Front 64

good samaritan law

Back 64

Relieves health care workers, as well as laypersons in some instances, from liability in
certain emergency situations with the objective of encouraging health care workers to offer assistance.

Front 65

APGAR score

Back 65

Appearance, Pulse, Grimace, Activity, Respiration

Front 66

changes in elderly

Back 66

1. Sexual changes: elderly Men––slower erection/ejaculation, longer refractory period Women––vaginal shortening, thinning, and dryness
2. Sleep patterns–– ↓ REM sleep, ↓ slow-wave sleep, ↑ sleep latency, ↑ awakenings during the night
3. Common medical conditions––arthritis, hypertension, heart disease, osteoporosis
4. Psychiatric disorders (excluding comorbidities)
are found at a lower prevalence among the
healthy elderly than at other life stages
5. ↑ suicide rate (males 65–74 years of age have
the highest suicide rate in the United States)
6. ↓ vision, hearing, immune response, bladder
control
7. ↓ renal, pulmonary, GI function
8. ↓ muscle mass, ↑ fat

Front 67

Kübler-Ross grief stages

Back 67

- Denial, Anger, Bargaining, Grieving, Acceptance.
- Death Arrives Bringing Grave Adjustments

Front 68

Stress effects

Back 68

Stress induces production of free fatty acids, 17-OH corticosteroids, lipids, cholesterol,
catecholamines; affects water absorption, muscular tonicity, gastrocolic reflex, and mucosal circulation.

Front 69

Sexual dysfunction

Back 69

Differential diagnosis includes:
1. Drugs (e.g., antihypertensives, neuroleptics, SSRIs, ethanol)
2. Diseases (e.g., depression, diabetes)
3. Psychological (e.g., performance anxiety)

Front 70

Body-mass index

Back 70

weight in kg/(heigh in meters)^2

Front 71

Sleep stage Awake

Back 71

Beta waveforms

Front 72

Sleep stage 1

Back 72

Theta waveforms

Front 73

Sleep stage 2

Back 73

sleep spindles and K complexes

Front 74

Sleep stage 3-4

Back 74

Delta waveforms

Front 75

Sleep stage REM

Back 75

Beta waveforms

Front 76

sleep stages helpful phrase

Back 76

at night, BATS Drink Blood

Front 77

REM sleep

Back 77

REM sleep is like sex:
↑ pulse, penile/
↑ clitoral tumescence,
↓ with age.

Front 78

Narcolepsy

Back 78

Disordered regulation of sleep-wake cycles. May include hypnagogic (just before sleep) or hypnopompic (just before awakening) hallucinations. The patient’s nocturnal and narcoleptic sleep episodes start off with REM sleep. Cataplexy (loss of all muscle tone following a strong emotional stimulus) in some patients. Strong genetic component. Treat with stimulants (e.g., amphetamines).