Evidence-based medicine and other

Question 1

What are the types of observational studies?

Answer 1

• case-control study
• cohort study
• cross-sectional study

Question 2

What is the positive of observational studies?

Answer 2

they don’t involve interventions so are safer than RCTs

Question 3

What are the features of case-control studies?

Answer 3

• backwards direction of research enquiry so look at past risk factor and calculate odds of getting disease
• people selected first then their risk factor is measured

Question 4

What is the bias in case-control studies?

Answer 4

• selection
• observer (knowledge of whether they are case or control)
• recall (cases will be better)
• survivor (high fatality diseases = big bias)

Question 5

What is confounding?

Answer 5

when another variable is driving the outcome more than the one being studied

Question 6

What are the positives and negatives of case-control studies?

Answer 6

+rapid and cheap
+good for rare diseases
-bias
-incidence rates can’t be done as you are choosing patients with the disease

Question 7

What are the features of cohort studies?

Answer 7

• good for infrequent exposure
• disease incidence can be measures as people don’t start with disease
• risk can be monitored over time

Question 8

What can be calculated from cohort studies?

Answer 8

the relative risk ratio can be used to work out hot many times higher the risk of developing the disease is when a patient has a risk factor

Question 9

What are the two types of cohort study?

Answer 9

• prospective: follow-up into future but is time-consuming and expensive
• retrospective: looks back to a point, cohort is established because they have a disease which is cheaper and faster

Question 10

What are cohort studies not good for?

Answer 10

rare diseases

Question 11

What are the biases present in cohort studies?

Answer 11

• selection
• information
• confounding

Question 12

What are the features of a cross-sectional study?

Answer 12

• specific point in time
• survey
• quick and cheap

Question 13

What P value causes the null hypothesis to be rejected?

Answer 13

P<0.05 means there is less than a 5% chance that the result is due to change so the null hypothesis is rejected

Question 14

What do adipocytes secrete?

Answer 14

cytokines which then attract macrophages which infiltrate adipose tissue

Question 15

What does obesity predispose to?

Answer 15

inflammation at the ER can’t cope with the metabolic demands

Question 16

What does Orlistat do?

Answer 16

inhibits the action of lipase so fat is not absorbed in the gut

Question 17

What are the types of bariatric surgery?

Answer 17

• gastric band= restrictive, simplest surgically, not the best outcomes
• Roux-en-Y gastric bypass= both restrictive and malabsorptive, bypasses stomach and a lot of the duodenum
• vertical sleeve gastrectomy= restrictive, stomach is smaller

Question 18

What is the RMR?

Answer 18

the resting metabolic rate is the baseline calories burnt by being alive (contributed to by fat mass and fat-free mass)

Question 19

What changes the RMR?

Answer 19

it will lower more in response to weight loss which is also known as adaptive thermogenesis

Question 20

When can a patient not consent for themselves?

Answer 20

• lost capacity
• severe mental health issues
• limited capacity due to age

Question 21

What can the thyroid be imaged with?

Answer 21

CT and US or nuclear medicine

Question 22

What can the pituitary gland by imaged with?

Answer 22

MRI

Question 23

What are the features of a thyroid US?

Answer 23

• safe
• no radiation
• well tolerated

Question 24

When is a thyroid US used?

Answer 24

euthyroid with palpable nodules and hyperthyroid with focal masses

Question 25

What does a homogenous reduced tracer on a thyroid scan suggest?

Answer 25

thyroiditis

Question 26

What does focal uptake on a thyroid scan suggest?

Answer 26

multi nodular goitre with dominant nodule

Question 27

What imaging types can adrenal glands be seen on?

Answer 27

CT and MRI

Question 28

What condition is diffuse brittle bones?

Answer 28

osteoporosis

Question 29

What condition is diffuse soft bones?

Answer 29

rickets, osteomalacia and Paget’s

Question 30

Where are the most common places for osteoporotic fractures?

Answer 30

• proximal femur
• sacrum and pubic rami
• thoracolumbar vertebral bodies
• distal radius

Question 31

What are the different types of neoplastic involvement?

Answer 31

• lytic: bone destruction

- sclerotic: bone formation

Question 32

What is seen in lytic bone destruction?

Answer 32

• medullary lucency

- loss of inner cortex

Question 33

What is seen in sclerotic bone lesions?

Answer 33

• featureless white bone

- cortical destruction

Question 34

What is an insulin receptor?

Answer 34

tyrosine kinase

Question 35

What is a calcium receptor?

Answer 35

GPCR

Question 36

What is a GH receptor?

Answer 36

cytokine

Question 37

What goes through the rich cavernous sinus?

Answer 37

CN3,4,5(branch 1 and 2)and 6

Question 38

What is given in hospital for hypoglycaemia?

Answer 38

20% dextrose

Question 39

What is given to renal failure patients with vit D deficiency?

Answer 39

activated D3 as the activation occurs in the kidneys so normal D3 won’t work

Question 40

What is seen in Graves’ disease in the thyroid?

Answer 40

uniform increased uptake

Question 41

What are the values for the levels of prolactin?

Answer 41

• microprolactinoma is prolactin over 5000

- macroprolactinoma is prolactin over 60000

Question 42

What is hypopituitarism except PRL?

Answer 42

disconnection hyperprolactinaemia