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Behavioral Flashcards

0
Q

Triple blinded means:

A

Additional blinding of researchers analyzing the data.

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1
Q

What is the purpose of a phase I clinical trial?

A

Is it safe - toxicity, safety

Small number of healthy volunteers

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2
Q

Phase II clinical trial:

A

Does it work.

Small number of patients with disease.

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3
Q

Phase III

A

Large number of patients randomly assigned to treatment under investigation or best treatment available.

Is it as good or better?

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4
Q

Phase IV

A

Post marketing surveillance trial of patients AFTER approval.

Can it stay?
Detects rare or long-term adverse effects.

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5
Q

What is specificity?

What does specificity do in terms of ruling in and ruling out?

A

Specificity is
TN/(TN + FP)

Specificity - SP-P-IN - highly specific testosterone when positive rules in.

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6
Q

What value varies directly with disease prevalence?

A

PPV - Positive predictive value.

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7
Q

How can you calculate prevalence from incidence rate?

A

Prevalence = incidence rate x average disease duration

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8
Q

How do you calculate the odds ratio?

A

Odds group with disease exposed / odds group without disease exposed.

Typically used in case-control studies. “Control the odds”.

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9
Q

Relative Risk Reduction:

A

1-RR.

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10
Q

“Risky cohort”

A

Relative risk - cohort study

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11
Q

What is attributable risk?

A

It is the difference in risk between exposed and unexposed. It also is the proportion of disease occurrences attributable to that exposure.

A/a+b - C/c+d

Attributable risk percent = 100 x [(Risk in exposed - Risk in Unexposed)/(Risk in exposed)]

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12
Q

Number need to treat

A

1/ARR

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13
Q

Number needed to harm

A

1/AR

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14
Q

What is precision?

A

Precision is the consistency and reproducibility of a test. Reliability. Random error reduces precision.

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15
Q

What is the standard error of then mean?

A

It is an estimate of how much variability exists between the sample mean and the true population mean.

SEM = standard deviation/sqrt(n). N is the sample size.

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16
Q

In a positively skewed data set, what pattern is USUALLY observed:

A

Mean > median > mode

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17
Q

Increase power when:

A

Increase sample size, increase effect size, or increase precision of measurement.

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18
Q

If the confidence interval crosses or includes __ for 2 variables, then null hypothesis cannot be rejected. If the confidence interval crosses ____ for relative risk or odds ratio, then the null hypothesis cannot be rejected.

A

For 2 variables if it crosses 0. For relative risk or odds ratio if it crosses 1.

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19
Q

How is confidence interval calculated?

A

It is calculated: as the range from mean - Z (SEM) to mean + Z(SEM)

95%CI - 1.96
99%CI - 2.58

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20
Q

T-test is for ___.

For 3 or more groups, use _____

A

T-test is for 2.

ANOVA is for 3 or more groups.

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21
Q

The coefficient of determination is equal to

A

r^2 and is usually what is reported.

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22
Q 
Disease prevention:
Primary
Secondary
Tertiary
Quaternary
A

Prevent - vaccination
Screen - Pap smear
Treat

Quaternary - ID patients at risk of unnecessary treatment.

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23
Q

Apgar scores and management

A

Apgar - appearance, pulse, grimace, activity, respiration

Apgar - 7 or more - healthy
Apgar 4-6 - assist and stimulate
Apgar less than 4, resuscitate.

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24
Q

Low birth weight is less than _____g

A

2500g

25
Q

Age = cubes stacked/3.

A

Repeat

26
Q

Presbycusis

A

High frequency hearing gets lost with age.

27
Q

Changes in the elderly:

A

Women - vaginal shortening, thinning, dryness

Sleep patterns: reduced REM and slow wave sleep. Greater sleep onset latency and earlier awakenings. These sleep patterns are due to REDUCED or DECR in acetylcholine.

High suicide rate especially for white men over 85.

Reduced immune response, bladder control. Increased fat and less muscle mass.

28
Q

Most common cause of death in US by age :

A

Less than 1 yr: congenital malformations,
1-44yrs: unintentional injury
45-64: Cancer
65 and older: heart disease.

29
Q

What is normal pupil size?

A

2-4mm in light. 4-8mm in dark.

30
Q

If a patient expresses a decision to the physician that he would like only his adult children informed of his test results and not him, the appropriate next step is:

A

Ask WHY (open-ended manner).

31
Q

In order to diagnose antisocial personality disorder in a person over the age of 18, evidence of conduct disorder preceding age ___ must be present. What is the highest co-morbidity for this group?

A

15

Substance use disorder.

32
Q

Personality disorders and co-morbidities.

A

Cluster A - Paranoid, Schizoid, Schozotypal - Schizophrenia (Weird)

Cluster B - Histrionic, Borderline, Antisocial, Narcisisstic - Substance use and mood disorders (Wild)

Cluster C - Avoidant, Dependent, Obsessive-Compulsive - Anxiety (Worried

33
Q

What level of weight loss is worrisome for pathological grief?

A

8lbs or more

34
Q

What symptoms are concerning for an abnormal grief reaction?

A

Pathological grief includes: excessive, intense, or prolonged grief. In ADDITION, it includes, delayed, denied, or inhibited grief.

Note, somatic symptoms such as headaches are a NORMAL part of bereavement.

35
Q

What is sublimation?

A

It is a MATURE defense mechanism where uncomfortable emotions (e.g. Anger) are channeled in a socially useful way. E.g. Social justic advocate.

36
Q

What is reaction formation?

A

It is an immature defense mechanism where you act the opposite way of how you really feel – burnt out doctor especially dedicates time to mentoring med students, woman with deep feelings for someone other than her spouse shows her spouse lots of love in response.

37
Q

What does a Good Samaritan law protect against:

What does it imply/require.

A

It DOES NOT protect against anything.

It implies/requires the use of standard of care. If care provided is negligent or individual (volunteer) providing it is not qualified to do so, he/she is liable.

38
Q

Developmental milestones:

A

Rolling over - 4 months - on to tummy. 6 months - both sides

39
Q

In an opioid OVERDOSE one might expect to see:

Why/how does Naloxone work?

A

Miosis (constricted pupils), bradycardia, respiratory depression, decreased bowel sounds.

Why does Naloxone work? it works by displacing the opioids from the opioid receptor.

40
Q

What drugs are benzodiazepines?
What does benzodiazepine toxicity look like?
What drug reverts benzodiazepine toxicity?

A

Drugs that end in –Pam. Lorazepam etc.

Benzodiazepine toxicity/overdose - CNS depression - somnolence, ataxia, impaired motor function.

What is the drug to revert benzodiazepines toxicity? Flumanezil

41
Q

What is fomepizole?

A

Fomepizole is an inhibitor of alcohol dehydrogenase. It prevents conversion of ethylene glycol to oxalic acid and methanol to formic acid. It is used primarily as an antidote to methanol poisoning.

42
Q

A patient with (performance) anxiety – anxiety specific to an event – who has asthma SHOULD NOT be given what common treatment for this condition?

What is the first line therapy for a general social phobia?

A

Propanolol - the non-selective beta blocker will result in bronchoconstriction.

First-line treatment for social phobia - SSRI.

43
Q

What does the p value describe?

A

The p value describes the pro laity of observing the given data or something more extreme assuming the null hypothesis is true.

P is the probability of making a type 1 error.

44
Q

Suicide risk:

A

Compared to other age groups, children under 15 and adults between ages 25-40 have a DECR risk of suicide. Highest age risk is 45-65

45
Q

What are the risk factors for completing suicide?

A

SAD PERSONS - sex, age, depression, previous attempt, ethanol, rational thinking impaired, sickness, organized plan, no significant other social support lacking.

Women attempt suicide more. But men complete more.

46
Q

Developmental milestones:

Shapes - copies

A

Circle - 3 yrs,
Cross - 4 yrs
square - 5 yrs
Triangle - 6 yrs

Alternating feet on stairs - 3 years
Hop on 1 foot - 4

47
Q

What is the first-line treatment for all PTSD?

A

SSRI! As far as psychotherapy, use CBT.

48
Q

What is Prozac’s generic name?

A

Fluoxetine

49
Q

What are the MAOI’s?
How do they work?
What can you not consume on them?

A

E.g. Phenelzine. Note there is no consistent pharmacologic suffix.
They work by increasing 5-HT
Tyramine crisis (potentially lethal) can occur if MAOI’s are taken with tyramine rich foods like certain cheeses and wine.

50
Q

Operant conditioning

A

Positive reinforcement - give a reward when desired behavior is observed.
Negative reinforcement - the absence of a normally present negative reality. E.g. Child cleans so parents will stop nagging her.

51
Q

Disulfiram is an example of what type of conditioning

A

Aversive, classical conditioning.

52
Q

Nortriptyline, a ____ (medication class) acts by:

A

Inhibiting the reuptake mechanism responsible for reuptake of serotonin and norepinephrine.

Serious adverse effects include: arrythmia, prolonged QT, seizures - Coma, convulsions, cardiotoxicity. Also anti-cholinergic effects, dry mouth and urinary retention.

53
Q

How long must a delusion be present to be part of criteria for delusional disorder?

A

1 month

54
Q

Odds ratio

A

(P/1-P)/ (q/1-q). Question 29 – first URx test.

55
Q

Wernicke’s encephalopathy presents clinically as:

Histopathologically as:

A

Clinical presentation: confusion, ophthalmaplegia (blurry vision), and ataxia. Can also have memory loss due to Korsakoff’s disease. This encephalopathy is due to THIAMINE deficiency. Note, Korsakoff’s amnesia can be associated with confabulation, making new memories and fabricating stories to make things fit.

Histopathologically: symmetric lesions in paraventricular regions of the thalamus and hypothalamus, mammillary bodies, and peri-aqueductal region of midbrain.

56
Q

Modafinil is an amphetamine derivative that promotes wakefulness.

A

Repeat

57
Q

At what point is the Babinski reflex extinguished?

A

12 months

58
Q

In the setting of a mentally impaired patient whose legal guardian says do not inform, therapeutic privilege wins.

A

Repeat.

59
Q

Recall the MMSE - mini-mental status exam is out of ____ points

A

30 points.

60
Q

Autism spectrum disorder is associated with:

A

Tuberous sclerosis.

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