Competencies/Health Care/Biostatistics Flashcards by Neurosurgery Udayana

An HIV test result is positive. The patient asks how likely he is to have HIV, given this positive result. The patient is asking about what aspect of the test
A. Sensitivity
B. Specificity
C. Positive predictive value
D. Negative predictive value

C. Positive predictive value

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In clinical trials, what biases do randomization and
single blinding minimize?
A. Selection and placebo effect biases
B. Selection and observer biases
C. Design and placebo effect biases
D. Definition and observer biases
E. Selection and observer biases

A. Selection and placebo effect biases

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Which of the following factors is most predictive of subsequent disciplinary actions during a career as a physician?
A. Undergraduate science class grades
B. MCAT score
C. Medical school grades
D. USMLE Step 1 score
E. Unprofessional behavior during medical school

E. Unprofessional behavior during medical school

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In the setting of a mass casualties, the Centers for Disease Control and Prevention recommends following the SALT algorithm for triage. For what does the acronym SALT stand?
A. Sort, Assess, Lifesaving interventions, and Treatment/Transport
B. Separate, Assess, Lifesaving interventions, and Transport
C. Save, Alert, Lifesaving interventions, and Transport
D. Save, Alert, Limit damage, and Treatment/ Transport
E. Save, Assess/Alert, Lifesaving intervention, and Treatment

A. Sort, Assess, Lifesaving interventions, and Treatment/Transport

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In the setting of mass causalities, to what do the conventional triage colors red, yellow, green, and black refer?
A. Immediate, delayed, minimal, expectant
B. Delayed, immediate, minimal, expectant
C. Minimal, delayed, immediate, expectant
D. Expectant, immediate, delayed, minimal
E. Expectant, minimal, immediate, delayed

A. Immediate, delayed, minimal, expectant

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The focus on positive deviance is an essential com-
ponent for process improvement as defined by the
international health-care institution. What is the
major focus of this component?
A. Identifying the characteristics of bad
performance
B. Identifying the characteristics of successful
performance
C. Identifying opportunities for improvement
D. Expressing appreciation for hard work
E. Rejecting lazy behaviors

B. Identifying the characteristics of successful
performance

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Closing films following a posterior spinal decom-
pression and fusion show that you have performed
surgery at the wrong level. What is the best next
course of action?
A. Inform the family of the mistake, complete the
procedure at the correct level, and inform the risk management team.
B. Complete the procedure at the correct level,
and do not inform the family.
C. Finish closing, and do not disclose the wrong-
level surgery.
D. Finish closing, and inform the risk manage-
ment team.
E. Finish closing, and inform the patient that he
might need revision surgery at a later date.

A. Inform the family of the mistake, complete the
procedure at the correct level, and inform the risk management team.

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In the 2010 guidelines for the management of intracranial hemorrhage, there is a class 2b, level B recommendation in favor of minimally invasive clot evacuation with or without thrombolytic usage. What is the interpretation of this level of recommendation?
A. The benefits largely outweigh the risks of procedure, but there are very limited data to endorse it.
B. It is reasonable to perform the procedure, but there are very limited data to endorse it.
C. It is not unreasonable to perform the procedure, and there are multiple population-based studies to endorse it.
D. It is not unreasonable to perform the procedure, but there are limited data to endorse it.
E. The procedure is contraindicated because of a lack of data to endorse it.

D. It is not unreasonable to perform the procedure, but there are limited data to endorse it.

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The wife of a spine surgeon owns a rehabilitation
facility. Her husband frequently refers patients
to her institute for postoperative rehabilitation.
Which of the following laws is the spine surgeon
violating?
A. Stark law
B. Federal anti-kickback statute
C. Antitrust law
D. False claim act

A. Stark law

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A 30-year-old man sustained a massive neurologic
injury following a motor vehicle collision. Despite
all medical efforts, he is declared brain dead, and
the regional organ procurement organization is
contacted. The patient is confirmed to have listed
himself as an organ donor; however, his wife refuses
to proceed with donation. What is the best course
of action?
A. Proceed with the donation.
B. Stop the donation, as the wife is the patient’s
medical decision maker.
C. Proceed with the donation after obtaining
consent from the patient’s brother.
D. Proceed with the donation after obtaining
consent from the patient’s mother.
E. Obtain a court order to proceed with the
donation

A. Proceed with the donation.

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One hundred new cases of craniopharyngiomas are diagnosed every year in the United States (population 320 million), and there are currently 6,400 people known to be living with craniopharyngiomas. What is the incidence and prevalence of craniopharyngiomas?
A. Incidence: 1/3,200,000; prevalence: 1/50,000
B. Incidence: 1/1,600,000; prevalence: 1/100,000
C. Incidence: 1/3,200,000; prevalence: 1/100,000
D. Incidence: 1/1,600,000; prevalence: 1/50,000
E. Incidence: 1/1,000,000; prevalence: 1/25,000

A. Incidence: 1/3,200,000; prevalence: 1/50,000

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The investigators of the HEAT (Hydrogel Endovascular Aneurysms Treatment) trial wanted to compare the effectiveness of hydrogel coils to the effectiveness of bare platinum coils. They designed a study in which patients were allocated to the hydrogel group or the bare platinum group on a random basis just prior to undergoing the procedure. Patients were not told which type of coils was being used. What was the design of this study?
A. Randomized, double-blinded, prospective clinical study
B. Randomized, single-blinded, prospective clinical study
C. Nonrandomized, single-blinded, prospective clinical study
D. Nonrandomized, single-blinded, retrospective clinical study
E. Randomized, double-blinded, retrospective clinical study

B. Randomized, single-blinded, prospective clinical study

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What ACGME Core Competency is demonstrated
when residents present and discuss their research
with colleagues at national meetings?
A. Patient care
B. Medical knowledge
C. Interpersonal skills and communication
D. Practice-based learning and improvement
E. System-based practice

C. Interpersonal skills and communication

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A medical device manufacturer is rewarding spine
surgeons who use its devices with free vacations.
What law is violated by this arrangement?
A. Stark law
B. Federal anti-kickback statute
C. Antitrust law
D. False claim act

B. Federal anti-kickback statute

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A group of undergraduate students develops image
processing software that automatically assesses the
degree of midline shift in a head CT scan as soon as
the images are acquired and before the images are
sent to the radiologist. The test is repeated four
times on the first volunteer, and the obtained val-
ues are 0, 3, 5, and 2 mm of midline shift. This
study can be considered NOT:
A. Reliable
B. Valid
C. Accurate
D. Sensitive
E. Specific

A. Reliable

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Two studies were conducted on the same popu-
lation to assess the association between smoking
and the development of carotid artery atheroscle-
rosis. The first study showed a relative risk of 5.0
and a 95% confidence interval of 3.8 to 5.2. The sec-
ond study showed a relative risk of 4.9 and a 95%
confidence interval of 0.9 to 5. What is the most
likely explanation of the observed results?
A. The first study is not statistically significant.
B. The first study is biased.
C. The second study is inaccurate.
D. The sample size in the second study is small.
E. The sample size in the first study is small.

D. The sample size in the second study is small.

What statistical test would be the most appropriate
to compare a quantitative variable in four groups?
A. ANOVA
B. Student t-test
C. Paired t-test
D. Chi-square test
E. Fisher exact test

A. ANOVA

A group of medical students was asked to design a study to assess the efficacy of intracranial hemorrhage evacuation versus nonsurgical management. The students decided to enroll patients with large posterior fossa hemorrhages in their study and randomly assign them to one of the two study arms. What major ethical principle of clinical trials did the students most violate?
A. Equipoise
B. Autonomy
C. Nonmaleficence
D. Justice
E. Disclosure

A. Equipoise

What ACGME core competency is demonstrated when residents present errors at a morbidity and mortality conference?
A. Patient care
B. Medical knowledge
C. Practice-based learning and improvement
D. Systems-based practice
E. Professionalism

C. Practice-based learning and improvement

A pharmaceutical company has developed a test to predict the eventual development of Alzheimer disease in currently asymptomatic patients. This test has an 85% sensitivity and 80% specificity. For
asymptomatic patients between the ages of 40 and 55, the test’s positive predictive value is 25%, and its negative predictive value is 96%. A 50-year-old asymptomatic patient has a negative test. What is the probability that the patient develops Alzheimer disease?
A. 30%
B. 20%
C. 15%
D. 4%
E. 0%

D. 4%

A pharmaceutical company develops a test to screen
for glioblastomas. A study run by the company
showed that this new test prolongs the survival of
patients with glioblastomas by several months.
The researchers conclude that use of the test
improves the outcome of glioblastoma patients.
What is the most likely bias of this study?
A. Observer bias
B. Measurement bias
C. Lead-time bias
D. Confounding bias
E. Sampling bias

C. Lead-time bias

What is the size of treatment effect classification if a procedure is reasonable to perform in the setting of a certain pathology?
A. Class 1
B. Class 2A
C. Class 2B
D. Class 3
E. Class 4

B. Class 2A

Following a motor vehicle collision, a 3-year-old child is diagnosed with an intracranial hemorrhage and is taken emergently to the operating room. While there, a blood transfusion becomes indicated. The patient’s parents are informed and refuse transfusion on religious grounds. They threaten to sue the surgeon if blood is transfused. What is
the next best course of action?
A. Do not transfuse the patient.
B. Try to reason with the family and obtain permission to transfuse.
C. Contact the hospital legal counsel and proceed with transfusion.
D. Proceed with transfusion after documenting the indication in the chart.
E. Obtain a court order to proceed with
transfusion.

D. Proceed with transfusion after documenting the indication in the chart.

The box plot in this image reports the time in min-
utes required by a surgeon to perform an aneurysm
clipping procedure.
What is the upper limit of the first quartile?
A. 175
B. 225
C. 250
D. 275
E. 350

B. 225

The box plot in this image reports the time in minutes required by a surgeon to perform an aneurysm clipping procedure. What is indicated by the upper whisker of the box plot?
A. The greatest outlier
B. The greatest non-outlier
C. The lower limit of the fourth quartile
D. The ninth decile
E. The 95% confidence interval

B. The greatest non-outlier

A study is being conducted to evaluate daily variations in intracranial pressure in head trauma patients. The following values (in mm Hg) are obtained every 5 minutes over a 1-hour period: 13, 14, 13, 15, 16, 14, 15, 13, 16, 14, 16, 14. What are the median, mode, and mean of this
distribution?
A. 14, 14, 14.4
B. 15, 14, 14.4
C. 14, 15, 16
D. 15, 14, 14.9
E. 14, 15, 14.4

A. 14, 14, 14.4

A. HR = OBS/INTER

In a recent trial comparing observation to interventional therapy for unruptured brain arteriovenous malformations, the risk of death or stroke from an arteriovenous malformation was significantly lower in the observation group compared with the interventional therapy group, with a hazard ratio (HR) of 0.27. The 95% confidence interval for the above HR of 0.27 was 0.14–0.54. What is the 95% confidence interval?
A. 95% of the calculated HRs for this study lie within the interval 0.14–0.54.
B. There is a 95% probability that the real HR for the above study lies within the interval 0.14–0.54.
C. If the study is repeated 100 times, the HR will be between 0.14 and 0.54 at least 95 times.
D. There is only a 5% chance that the obtained HR is incorrect.
E. The interval of 0.14–0.54 represents the values of the HRs for which the difference between the real population HR and the calculated HR is not statistically significant.

E. The interval of 0.14–0.54 represents the values of the HRs for which the difference between the real population HR and the calculated HR is not statistically significant.

An unconscious patient brought into the emer-
gency room following a car crash is found to have
a large epidural hematoma. The patient’s identity
is unknown, and he has no family available. The
neurosurgeon on call believes that a craniotomy
would save the patient’s life. What should be done
regarding an emergent procedure?
A. No procedure should be done as it is illegal to
operate on a patient without informed consent.
B. The neurosurgeon should document the need
for surgery in the chart and then proceed with
surgery.
C. At least two doctors should document the need
for surgery in the chart prior to the surgeon’s
proceeding with surgery.
D. A court order for surgery should be obtained
prior to surgery.
E. The ethics committee of the hospital should
be consulted prior to surgery.

B. The neurosurgeon should document the need
for surgery in the chart and then proceed with
surgery.

A new test is developed to screen for gliomas. The blood level of the biomarker has been demonstrated to correlate with the presence of a glioma in a positive population, and the blood level is minimal in a healthy population. A cutoff point was chosen at point A in the graph shown in this figure. If the cutoff is moved from point A to B, the positive predictive value of the test:
A. Will decrease
B. Will increase
C. Will remain the same
D. Will randomly change
E. Cannot be determined

A. Will decrease

In the STASCIS trial (early versus delayed decompression for traumatic cervical spinal cord injury), 30% of patients were lost to follow-up at 6 months. Although this is typical for a trauma study, what type of bias could this represent?
A. Selection bias
B. Recall bias
C. Confounding bias
D. Observer bias
E. Ascertainment bias

A. Selection bias

A study is conducted to assess how the initial blood
flow through a graft determines the duration for
which the graft will remain patent. The plot shown
in this figure was obtained. What type of relation-
ship is demonstrated?
A. Linear with a positive correlation coefficient
B. Linear with a null correlation coefficient
C. Linear with a negative correlation coefficient
D. Logarithmic with a positive correlation
coefficient
E. Logarithmic with a negative correlation
coefficien

A. Linear with a positive correlation coefficient

A group of vascular neurosurgeons wants to study the relationship between smoking and the development of carotid atherosclerosis. They enroll the first 1,500 patients aged between 40 and 60 years that present to clinic, checked their smoking statuses, and obtained carotid ultrasounds to assess for atherosclerosis. What is the design of this study?
A. Prospective cohort
B. Retrospective cohort
C. Case-control
D. Cross-sectional
E. Randomized clinical trial

D. Cross-sectional

In enhancing quality of care, what is a process
change?
A. Change in how a task is performed
B. Change in the way the team perceives a task
C. Change in the outcome
D. Change in the work culture/environment
E. Change in the amount of work

A. Change in how a task is performed

A neurosurgical resident does not remember how to renally dose levetiracetam. He performs a search in an electronic pharmacological database. This scenario best represents which ACGME Core Competency?
A. Medical knowledge
B. Professionalism
C. Systems-based practice
D. Patient care
E. Interpersonal skills and communication

A. Medical knowledge

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