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FirstAID > Behavioral Science > Flashcards

Behavioral Science Flashcards

1
Q

sensitivity =

A

=TP/(TP + FN)
=1-FN
*sensitivity rules OUT

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2
Q

specificity =

A

=TN/(TN + FP)
=1-FP
*specificity rules IN

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3
Q

Positive Predictive Value = PPV =

A

= TP/(TP + FP)

  • PPV = proportion of test results that are true positive
  • if increased prevalence, then increased PPV
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4
Q

Negative Predictive Value = NPV =

A

= TN/(TN+FN)

  • proportion of negative test results that are truly negative
  • increased prevalence, decreased NPV
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5
Q

Point prevalence =

A

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

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6
Q

Prevalence =

A

=incidence X disease duration

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7
Q

Incidence =

A

=new cases in popl over a given period of time/total popl at risk during that time period

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8
Q

Odds Ratio = OR =

A

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

*use OR for case-control studies

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9
Q

Relative Risk = RR=

A

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

*use RR for cohort studies

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10
Q

Attributable Risk =

A

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

*AR is the proportion of disease occurences attributable to exposure to a risk factor

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11
Q

Absolute Risk Reduction

A

the reduction in risk associated with a treatment as compared to a placebo

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12
Q

Number needed to treat = NNT =

A

= 1/absolute risk reduction

= 1/[a/(a+b)]

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13
Q

Number needed to harm = NNH =

A

= 1/attributable risk

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14
Q

Precision, Accuracy, Reliability, Validity, Random error, Systemic error

A 
Precision = Reliability
Accuracy = Validity

Random error - reduces precision in a test
Systemic error - reduces accuracy in a test

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15
Q

Standard error of the mean = SEM =

A

=σ/sqrt of n

used in Normal/Guassian/Bell-Shaped curves (where mean = mode = median)

where:
σ = standard deviation
sqrt of n = square root of sample size

*note: SEM decreases as n (sample size) increases

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16
Q

In a normal/gaussian/bell-curve (where mean=median=mode), what percent of the population is 1 σ (standard deviation) to either side of mean? 2σ to either side of mean? 3σ on either side of mean?

What percent of the population correlates wtih a σ = 1.645 on either side of the mean?

A

1σ on either side of mean = 68% of popl
2σ = 95%
3σ = 100% (99.7%)
1.645σ = 90% of popl

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17
Q

relationship of mean, median,mode in a positively-skewed statistical distribution?

A

positive skew: asymmetry with tail on the right

mean > median > mode

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18
Q

relationship of mean, median,mode in a negatively skewed statistical distribution

A

negative skew - asymmetry with tail on left

mean < median < mode

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19
Q

Null hypothesis = H0 =

A

hypothesis of no difference; there’s no association between disease and the risk factor in the population

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20
Q

Alternative hypothesis = H1

A

hypothesis that there is some difference; there is some association between the disease and the risk factor in the population

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21
Q

type 1/alpha error = false positive error

A

stating there is an effect or difference when none exists; accepting H1 (rejecting H0) when H0 is really true

*ie convicting an innocent man

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22
Q

p value

A

p = probablity of making a type 1 (alpha) error

ps not actually there)

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23
Q

Type 2/Beta error = False negative error

A

stating there is not an effect or difference when one exists; not rejecting H0 when it actually is false (so choosing H0 when H1 is true)

*ie setting a guilty man free

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24
Q

Beta

A

probability of making a type 2 (beta) error

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25
Q

Power =

A

= 1 - Beta

probability of rejecting H0 when it is in fact false or likelihood of finding a difference when one in fact exists

if increase sample size, then increase power (power in #s!)

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26
Q

Meta analysis

A

pools data/results from several similar studies to reach an overall conclusion; increases power

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27
Q

Confidence Interval = CI =

A

Range from [mean - Z(SEM)] to [mean + Z(SEM)]

*example, for a 95% CI:
= mean +/- 1.96 X SEM
= mean +/- 1.96 X (σ/sqrt n)

  • if 95% CI for a mean difference between 2 variable includes 0, then there’s no significan different and H0 is not rejected
  • if 95% CI for odds ratio or relative risk includes 1, H0 is not rejected
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28
Q

CI 90%, Z = ?
CI 95%, Z = ?
CI 99%, Z = ?

A

CI 90%, Z = 1.645
CI 95%, Z = 1.96
CI 99%, Z = 2.58

*95% CI, corresponds to p=0.05

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29
Q

t-test vs ANOVA vs chi^2

A

t-test –> checks difference between means of 2 groups

ANOVA –> checks difference between means of 3 or more groups

chi-square test –> checks the difference between 2 or more percentages or proportions of categorical outcomes (not of mean values)

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30
Q

correlation coefficient = r:

A

r is always between -1 and 1; the closer the absolute value of r is to 1, the stronger the correlation between the 2 variables

*usually report r^2 = coefficient of determination

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31
Q

Medicare vs Medicaid:

A

Medicare: pts > 65 years old ( e for elderly), <65 with certain disabilities, and pts with ESRD

Medicaid: federal and state healt assistance for people with very low income (d for destitute)

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32
Q

core ethical principles: autonomy, beneficence, nonmaleficence, justice

A

autonomy - must respect patients as individuals and honor their preferences in medical care

beneficence - physicians must act in patients’ best interest; may conflict with autonomy. if pt can make an informed decision, then pt ultimatley has right to decide

nonmaleficence - “do no harm”; but, if benefits of an intervention outweigh risks, pt may make informed decision to proceed (ie with surgeries, meds…)

justice - treat persons fairly

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33
Q

Exceptions to informed consent:

A

1) Pt lacks decision-making capacity or is legally incompetent (ie minors)
2) Implied consent in an emergency
3) Therapeutic privilege - withholding information when disclosure would severely harm pt or undermind informed decision-making capacity
4) Waiver - pt waives right of informed consent

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34
Q

Minors: Exceptions for when parental consent is NOT required:

A
  • pt is married, self-supporting, has kids, is in military
  • emergency situations
  • contraceptives
  • treatment involving STDs, medical care during pregnancy, managing drug addiction
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35
Q

Advance directives:

  • Oral
  • Living will
  • Durable power of attorney
A
  • oral advance directive - use incapacitated pt’s prior oral statements as a guide; more valide if pt was informed, directive was specific, pt made a choice; decision was repeated over time to multiple people
  • living will = written advance directive - written by pt ahead of time, in case he/she become incapacitated and cannot communicate
  • durable power of attorney - pt designates a surrogate to make medical decisions in case he/she loses decision-making capacity; surrogate retains power unless revoked by a patient; more flexible than a living will
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36
Q

Can a pt’s family require a doctor to withhold information from the pt?

A

No.

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37
Q

Priority of surrogates, if a patient becomes incompetent, but did not prepare an advance directive:

A

spouse > adult children > parents > siblings > other relatives

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38
Q

Exceptions to confidentiality:

A
  • potential harm to others is serious
  • likelihood of harm to self is great
  • no alternative means exist to warn or to protect those at risk
  • physicians can take steps to prevent harm:

1) reportable disease - physicians my have to warn public officials and identifiable people at risk
2) Tarasoff decision - law requiring physician to directly inform and protect potential victrim from harm; may involve breach of confidentiality
3) child and/or elder abuse (obligated to report SUSPICION)
4) impaired automobile drivers
5) suicidal/homicidal pts

39
Q

What are considered “reportable diseases” (which may be exceptions to confidentiality)

A

1) STDs: AIDS, gonorrhea, syphilis (sometimes chlamydia, depends on state)
2) Hepatitis
3) Child immunization infections: MMR and chickenpox
4) Food poisoning: shigella, salmonella
5) TB

40
Q

What do you do if a 17 year old girl is pregnant and requests an abortion?

A

many states require parental notification or consent for minors for an abortion; UNLESS SHE IS AT MEDICAL RISK, do not advise a patient to have an abortion regardless of her age or the condition of the fetus

41
Q

what to do if a patient is suicidal?

A

assess the seriousness of the threat; if serious, suggest that the patient voluntarily remain in the hospital; a patient can be hospitalized involuntarily if he/she refuses.

42
Q

Apgar score

A

= assessment of newborn health via a 10-point scale; evaluated at 1 minute and 5 minutes post-birth
*based on:

  • Appearance
  • Pulse
  • Grimace
  • Activity
  • Respiration
  • > or = to 7 - good
  • 4-6 - assist and stimulate
  • <4 at later time points, then risk that child will develop long-term neuro damage
43
Q

Definition of low birth weight?

A

<2500 g

  • associated with increased physical and emotional problems
  • caused by prematurity or intrauterine growth retardation
  • complications: infections, RDS, necrotizing enterocolitis (if feed neonate with formula too soon), intraventricular hemorrhage, and persistent fetal circulation (PDA, PFO…)
44
Q

Berkson’s bias

A

a type of selection bias; studies on hospitalized patients

45
Q

selection bias

A

nonrandom assignment to study group (ie berkson’s bias; loss to follow-up)

46
Q

recall bias

A

knowledge of presence of disorder alters recall by subjects

47
Q

sampling bias

A

subjects are not representative relative to general population; so, results are not generalizable

48
Q

late-look bias

A

information gathered at an inappropriate time; a type of recall bias
-ie using a suvery to study a fatal disease (b/c only pts still alive can answer the survey…)

49
Q

procedure bias

A

subjects in different groups are not treated the same - ie pay more attention to treatment group, stimulating greater compliance

50
Q

confoundibg bias

A

occurs with 2 closely associated factors; the effect of 1 factor distorts or confuses the effect of the other

51
Q

lead-time bias

A

early detection confused with increased survival; seen with imporved screening (the natural history of the disease is not changed; but, early detection makes it seem as though survival has increased)

52
Q

Pygmalion effect

A

when a researcher’s belief in the efficacy of a treatment changes the outcome of that treatment

53
Q

Hawthorne effect

A

when a group being studied changes its behavior owing to the knowledge being studied

54
Q

How to reduce bias:

A

1) Blind studies
2) Placebos
3) Crossover studies (ie each subject is at some point on placebo and some point on drug; so each subject acts as own control to limit confounding bias)
4) Randomizaton to limit selection bias and confounding bias

55
Q

At what age does the moro reflex disappear?

A

between birth and 3 mos

56
Q

when does a child begin to have stranger anxiety?

separation anxiety?

A

stranger anxiety: 7-9 mos

separation anxiety: 12-15 mos

57
Q

when does a child begin to climb stairs?

A

12-24 months

58
Q

block stacking milestones in child development?

A
  • stacks 3 blocks at 1 year

- stacks 6 blocks at 2 years

59
Q

when can a child begin feeding self with a fork and spoon?

A

24-26 months

60
Q

when may a child kick a ball?

A

24-36 months

61
Q

toilet training age?

A

24-36 months (pee at three!)

62
Q

tricycle riding age?

A

3 years (3-cycle at 3!)

63
Q

gender identity development age?

A

24-36 months

64
Q

buttons and zippers, brushes teeth, hops on 1 foot, makes stick figure drawings?

A

4 years old

65
Q

imaginary friends age?

A

4 years old

66
Q

copies line or circle drawings - development age?

A

3 years old

67
Q

Changes in the elderly: (sex, sleep, suicide, vision, hearing, immune, bladder, renal, pulmonary, GI, muscle mass, fat)

A

1) Sex: (note: sex interest does not change)
- Men–> slower erection/ejaculation, longer refractory period
- Women –> vaginal shortening,thinning, dryness
2) Sleep:
- decreased REM, slow-wave sleep (stages 3 and 4)
- increased latency and awakenings (takes longer to reach REM sleep)
3) increased suicide rate (males 65-74 yo have highest suicide rate in US)
4) decreased vision, hearing, immune response, bladder control
5) decreased renal, pulmonary, GI function
6) decreased muscle mass, increased fat

*Note: 5 and 6 affect drug dosage and metabolism; for this reason, start SLOW and LOW when giving drugs to elderly!

68
Q

Normal bereavement vs Pathologic grief

A

Normal bereavement: shock, denial, guilt, somatic symptoms; can last up to 2 months; may experience illusions

Pathologic grief: excessively intense grief, grief that lasts >2 months; or grief that is delayed, inhibited or denied. May have depressive symptoms, delusions, hallucinations.

69
Q

Physiologic effects of stress:

A

stress induces production of:

  • free fatty acids
  • 17-OH corticosteroids (increased corticosteroids –> immunosuppression)
  • lipids
  • cholesterol
  • catecholamines
  • also, affects: water absorption (have decreased water absorption), muscular tonicity, gastrocolic reflex, and mucosal circulation
70
Q

How to calculate BMI?

What BMI range = overweight?

A

BMI = weight in kg/(height in meters)^2

Overweight: 25.0-29.9
Obese: >30
morbidly obese: >40

71
Q

Drugs, Diseases, and Psychological issues that may lead to sexual dysfunction:

A

Drugs: antihypertensives, esp Beta-blockers; neuroleptics; SSRIs; ethanol
Dieases: depression, diabetes, atherosclerosis (because decreased blood flow to area), hyperprolactinemia, low testosterone
Psychological: Performance anxiety

72
Q

only serotonin-releasing neurons in CNS?

A

Raphe nucleus

73
Q

Which stage of sleep do we spend most of the time in?

A

Stage 2

74
Q

EEG waveform patterns during each sleep stage:

A

“at night, BATS Drink Blood”

  • awake (eyes open) –> Beta waves (highest frequency, lowest amplitude)
  • awake (eyes closed) –> Alpha waves
  • stage 1 –> Theta waves
  • stage 2 –> Sleep spindles and K complexes
  • stage 3 –> Delta waves (lowest frequency, highest amplitude)
  • REM –> Beta waves
75
Q

During which sleep stage does one have sleep spindles and K complexes on EEG?

A

Stage 2 sleep

76
Q

What is the key to initiating sleep?

A

Serotonergic predominance of the raphe nucleus

77
Q

What drug can be used to treat enuresis (bed-wetting) and why?

A

Imipramine, because it decreases stage 3 sleep (when bed-wetting occurs)

78
Q

During what sleep stage does teeth grinding (bruxism) occur?

A

Stage 2 (deeper sleep, when have sleep spindles and K complexes on EEG)

79
Q

During what sleep stages may one experience sleepwalking, night terrors, or bed-wetting?

A

Stage 3 sleep (deepest, non-REM sleep; slow-wave sleep; have delta waves on EEG)

80
Q

During what sleep stage does one experience: dreaming, loss of motor tone, memory processing, erections, increased brain oxygen use?

A

REM sleep; Beta waves on EEG

81
Q

Alcohol, Benzos, and Barbiturates do what to sleep stages?

A

Reduced REM and delta (stage 3) sleep

82
Q

What drug may be useful to treat night terrors and sleepwalking and why?

A

Benzos; because decrease stage 3 sleep, during which sleepwalking and night-terrors occur

83
Q

What is the principal neurotransmitter in REM sleep?

A

Acetylcholine

84
Q

How does NE affect REM sleep?

A

NE reduces REM sleep

85
Q

How often does REM sleep occur?

A

Every 90 minutes; increased duration as go through the night

86
Q

Pulse, BP, eye activity, and penile/clitoral tumescence (swollen-ness) during REM sleep:

A
  • increased and variable pulse and BP
  • extraocular movements during REM sleep d/t PPRF activity (REM = Rapid eye movements; mediated by PPRF)
  • Penile/Clitoral tumescence

“REM sleep is like sex: increased pulse, penile/clitoral tumescence, decreases with age)

87
Q

Why is REM sleep also called “paradoxical sleep” or “desynchronized sleep”?

A

Because it has the same EEG pattern as wakefulness (Beta waves)

88
Q

What mediates the rapid eye movements of REM sleep?

A

PPRF (paramedian pontine reticular formation/conjugate gaze center)

89
Q

How do sleep patterns change in depressed patients?

A
  • decreased slow-wave sleep (stage 3)
  • decreased REM latency (so, get to REM quicker!)
  • increased REM early in sleep cycle
  • increased total REM sleep
  • repeated nighttime awakenings
  • early-morning awakenings
90
Q

Hypnagogic vs Hypnopompic hallucinations?

A 
Hypnagogoic = just before sleep
Hypnopompic = just before awakening

*pts wtih narcolepsy may have these hallucinations

91
Q

Naroclepsy:

  • what is it?
  • main presentation?
  • treatment?
A
  • disordered regulation of sleep-wake cycles
  • pts are very tired during day
  • may have hypnogogic or hynopompic hallucinations
  • nocturnal and narcoleptic sleep episodes start off with REM sleep
  • Cataplexy in some pts
  • Genetic component
  • Treat with stimulants (amphetamines, modafinil) and sodium oxygbate
92
Q

Cataplexy

A
  • loss of all muscle tone following a strong emotional stimulus, ie laughter
  • seen in some pts with narcolepsy
93
Q

What controls the circadian rhythm?

A

SCN (suprachiasmatic nucleus) of the hypothalamus drives the circadian rhythm; controls ACTH, prolactin, melatonin, nocturnal NE release

  • Retina stimulates SCN –> NE release –> Pineal gland –> Melatonin
  • So, SCN is regulated by the environment (light); so retina stimulates SCN
94
Q

Kubler-Ross Grief Stages

A

(may not occur in this order)

1) Denial
2) Anger
3) Bargaining
4) Grieving
5) Acceptance

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