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Behavioral Science Flashcards

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1
Q

Sensitivity (give formula and description)

A

If person has disease, what is probability test will be positive?

a/a+c

SN-N-OUT - highly SeNsitive test, when Negative, rules OUT disease (low false negative rate)

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2
Q

Specificity (give formula and description)

A

If person does not have disease, what is probability test will be negative?

d/b+d

SP-P-IN - highly SPecific test, when Positive, rules IN disease (low false positive rate)

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3
Q

Positive predictive value (give formula and description)

A

If test is positive, what is probability person actually has disease?

a/a+b

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4
Q

Negative predictive value (give formula and description)

A

If test is negative, what is probability person does not have disease?

d/c+d

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5
Q

Odds ratio (give formula and description)

A

Odds that group with disease was exposed to risk factor (a/c) divided by odds that group without disease was exposed to risk factor (b/d)

(a/c)/(b/d)

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6
Q

Relative risk (give formula and description)

A

Risk of developing disease in exposed group divided by risk of developing disease in unexposed group

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

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7
Q

Attributable risk (give formula and description)

A

Difference in risk between exposed and unexposed
Proportion of disease occurrences attributable to exposure

(a/a+b) - (c/c+d)

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8
Q

Relative risk reduction (give formula and description)

A

Proportion of risk reduction attributable to intervention compared to control

1 - RR

or 1 - (a/[a+b])/(c/[c+d])

In this case, assume RR is ratio of risk of disease in treated group:risk of disease in control group.

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9
Q

Absolute risk reduction (give formula and description)

A

Difference in risk (not proportion!) attributable to intervention as compared to control

(c/c+d) - (a/a+b)

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10
Q

Number needed to treat (give formula and description)

A

Number of patients who need to be treated for 1 patient to benefit

1/ARR

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11
Q

Number needed to harm (give formula and description)

A

Number of patients who need to be exposed for 1 patient to be harmed

1/AR

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12
Q

Precision v. accuracy

A

Precision - consistency and reproducibility of a test (reliability)
Accuracy - trueness of test measurements (validity)

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13
Q

Type I error (alpha) in hypothesis testing

A

Stating that there is an effect or difference when none exists (null hypothesis incorrectly rejected in favor of alternative hypothesis) - a false positive error

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14
Q

Type II error (beta) in hypothesis testing

A

Stating that there is not an effect or difference when one exists (null hypothesis not rejected when it is actually false) - false negative error

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15
Q

Define Presbycusis

A

Sensorineural hearing loss (often higher frequencies) due to destruction of hair cells at cochlear base (preserved low-frequency hearing at apex)

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16
Q

Define cataplexy

A

Loss of all muscle tone following strong emotional stimulus, like laughter

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17
Q

How long can the survival prognosis be in a patient to recommend hospice care?

A

Less than 6 months

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18
Q

What are situations in which parental consent is not required?

A

Sex - contraception, STIs, pregnancy (no parental consent required for prenatal care, but is required for termination)
Drugs - addiction
Rock and roll - emergency/trauma

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19
Q

If a physician does not personally believe in a procedure but they have the ability to perform it (i.e. abortion), are they required to perform it?

A

No, physician is not required to perform a procedure that go against their personal beliefs, but they must refer the patient to another provider

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20
Q

If you suspect domestic abuse, what strategies can be used in the interview?

A 
Ask others to leave room
Ask open ended questions
Do not pressure patient for more information
Ask patient if they feel safe
Ask if they have emergency plan
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21
Q

When can physicians challenge the medical decision made by parents about their child?

A

When the decision puts the child’s life in danger (i.e. stopping treatment for bacterial meningitis) - physician can get court injunction

22
Q

What is the order of surrogates if the patient did not prepare an advance directive?

A

Spouse > adult children > parents > adult siblings > other relatives

23
Q

Can physicians date former patients?

A

Yes as long as the physician is non-psychiatric and the physician-patient relationship has been terminated

24
Q

What are instances in which a physician is able to share patient information (with family members, other non-physicians) without explicit permission?

A
  • When patient is present and does not object to the sharing (i.e. ask if it’s okay to talk about with family members in room, patient says yes)
  • When patient is not present and provider determines with best judgment that it is in patient’s best interest (i.e. patient in emergency surgery, share condition with wife)
25
Q

Define lead-time bias

A

Lead time bias is an artificial increase in survival time among tested patients who actually have unchanged prognosis

26
Q

Define case fatality rate

A

Number of fatal cases of disease/total number of people who had disease

27
Q

What is the single most important way to decrease mortality, especially in diabetics?

A

Smoking cessation

28
Q

How does PPV and NPV vary with prevalence of a disease in the population?

A

PPV - varies directly i.e. the higher the prevalence, the higher the PPV
NPV - varies inversely i.e. the lower the prevalence, the higher the NPV

29
Q

What type of bias is ‘matching’ (patients with similar characteristics in treatment and control groups) used to prevent?

A

Confounding bias

30
Q

What type of study evaluates whole population characteristics/risks instead of individuals?

A

Ecological study

31
Q

What is effect modification?

A

When effect of an exposure on an outcome is modified by another variable (i.e. smoking status can modify effect of some drugs)
Once stratified, this reveals a significant difference between the stratified groups that was not present previously

32
Q

Define standard error of mean (with formula)

A

SEM = SD/root(n)

Estimate of variability exists between sample mean and true population mean
Hence, as number of people in sample increases, SEM decreases

33
Q

How is the Confidence Interval calculated?

A

CI = mean +/- (Z-score * SEM)

Use SEM when research is done on samples rather than entire population - accounts for variability due to sampling

34
Q

Compare a T-test, ANOVA, and Chi-square test

A

T-test - compare means of 2 groups
ANOVA - compare means of 3 or more groups
Chi-square - check differences between 2 or more percentages/proportions of categorical oucomes

35
Q

What are the different payment methods used by health insurance companies to pay physicians?

A

Capitation - paid fixed amount per enrollee, gives incentive to contain costs since have a fixed budget to work with, focus on preventative care more

Fee for service - paid for amount of services ordered (leads to many costly and unnecessary tests)

Discounted fee for service - less payment for services (physician may think twice before ordering some tests)

Salary - receive same payment no matter what, no incentive to change practices

36
Q

In a screening test, is it more important to have high sensitivity or specificity?

A

Sensitivity

Want the test to have a high probability to detect the disease when the disease is present - low false negative rate

37
Q

Double blinding is used to primarily prevent what type of bias?

A

Observer bias

38
Q

Attributable risk percentage (formula an definition)

A

100 x ( [RR - 1] / RR)

Excess risk in exposed population that can be attributed to the risk factor (i.e. what percentage of small cell lung caricnoma in smokers can be attributed to smoking)

Also can be 
100 x (AR/RR)
39
Q

What is Berkson’s bias?

A

Study population selected from hospital is less healthy than general population

40
Q

What are the 3 most common cancers affecting women in the US, listed in order of incidence?

A

Breast
Lung
Colon

41
Q

Who should obtain informed consent?

A

Always the physician performing the procedure (i.e. don’t ask intern to do it)

42
Q

Describe facilitation as an interviewing technique

A

Encouraging the patient to talk more about experience (i.e. and then what happened?)

43
Q

Describe empathy as an interviewing technique

A

Express understanding of patient’s experience and difficulties (i.e. walk in patient’s shoes)

44
Q

Describe reflection as an interviewing technique

A

Repeat what patient said, as a summary

45
Q

Describe support as an interviewing technique

A

Express concern for patient and their experiences independent of understanding (vs. empathy where understanding is expressed)

46
Q

Describe confrontation as an interviewing technique

A

Point out discrepancies in patient’s responses

47
Q

What are developmental milestones for Infants (0-12 mo)?

A

Mnemonic: Parents Start Observing

Motor

  • Primitive reflexes disappear (Moro, rooting, palmar, Babinski)
  • Posture
  • Picks up toys, Pincer grasp
  • Points to objects

Social

  • Social smile
  • Stranger anxiety
  • Separation anxiety

Verbal/Cognitive

  • Orients - first to voice, then name and gestures
  • Object permanence
  • Oratory - says mama and dada
48
Q

What are developmental milestones for Toddlers (1-3 years)?

A

Mnemonic: Child Rearing Working

Motor

  • Cruises
  • Climbs stairs
  • Cubes stacked
  • Cultured

Social

  • Recreation - parallel play
  • Rapprochement - moves away from another and returns to mother
  • Realization - core gender identity formed

Verbal/Cognitive
- Words - 200 words by age 2 (two zeroes)

49
Q

What are developmental milestones for Preschool age (3-5 years)?

A

Mnemonic: Don’t Forget Learning

Motor

  • Drive
  • Drawings - copies line or circle, stick figure
  • Dexterity - hops on one foot, grooms self

Social

  • Freedom
  • Friends

Verbal/Cognitive

  • Language - 1000 words by age 3 (three zeroes)
  • Legends - tell detailed stories
50
Q

What measurement is often associated with a case-control study?

A

Odds ratio

Case control study compares group of people with disease to group without disease and looks for prior exposure or risk factor
OR - odds that cases were exposed to risk factor/odds that controls were exposed to risk factor

51
Q

What measurement is often associated with a cohort study?

A

Relative risk

Cohort study compared group with an exposure to group without and exposure and looks to see if exposure increases likelihood of disease
RR - risk of developing disease in exposed group/risk of developing disease in unexposed group

52
Q

What are the 3 most common cancers affecting women in the US, listed in order of mortality?

A

Lung
Breast
Colon

Behavioral Science (3 decks)

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