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PCM > Spring Semester Exam 1 > Flashcards

Spring Semester Exam 1 Flashcards

1
Q

What were the top 5 causes of death in the US in 2016?

A
  1. Heart disease
  2. Cancer
  3. Chronic lower respiratory diseases
  4. Accidents
  5. Stroke
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2
Q

Screening involves looking for a disease or risk factor in a patient who is otherwise ___.

A

Asymptomatic

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3
Q

What are the 5 qualities of a good screening test?

A
  1. High sensitivity and specificity
  2. High positive predictive value
  3. Simplicity and low cost
  4. Safety
  5. Acceptable to patients and clinicians
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4
Q

The number of people that must be screened to measure the magnitude of benefit is typically ___ to prevent 1 death.

A

Several hundred to more than 1,000

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5
Q

What are some of the adverse effects of screening?

A
  1. False positives
  2. Over-diagnoses
  3. Ability to treat
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6
Q

The ___ systematically reviews the evidence of effectiveness and develops recommendations for clinical preventive services.

A

USPSTF

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7
Q

True or false - the cost of preventive services has a primary role in determining USPSTF recommendations.

A

False - the cost of preventive services has no role or influence.

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8
Q

What are the three USPSTF ratings for strength of overall evidence?

A
  1. Good
  2. Fair
  3. Poor
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9
Q

A “good” USPSTF strength rating involves evidence that includes ___ results from ___ studies in ___ populations that ___ assesses effects on health outcomes.

A

Consistent; Well-designed; Representative; Directly

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10
Q

A “fair” USPSTF strength rating involves evidence that is ___ to determine effects on health outcomes, but the strength of the evidence is limited by the number, quality, or consistency of the individual studies, ___ to routine practice, or ___ nature of the evidence on health outcomes.

A

Sufficient; generalizability; indirect

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11
Q

A “poor” USPSTF strength rating involves evidence that is ___ to assess the effects on health outcomes because of limited number of power of studies, important ___ in their design or conduct, ___ in the chain or evidence, or lack of information on important health ___.

A

Insufficient; flaws; gaps; outcomes

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12
Q

What are the 5 types of USPSTF recommendations? Describe them.

A

A: strongly recommends/good evidence improves outcomes and benefits outweigh risks
B: recommends/fair evidence improves outcomes and benefits outweigh risks
C: no recommendation for or against/fair evidence to improve outcomes but harms = benefits
D: Recommend against/fair evidence for ineffective or harms > benefits
I: insufficient to recommend for or against/evidence is lacking or evidence of poor quality or conflicting evidence or benefit vs. harm cannot be determined

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13
Q

What is an example of an A Recommendation?

A

Screening for colorectal cancer, age 50-75

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14
Q

What are 2 examples of B Recommendations?

A

Screening adults for depression; breast cancer screening age 50-74

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15
Q

What are 2 examples of C Recommendations?

A

Routine screening for colorectal cancer age 76-85, breast cancer screening age 40-49

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16
Q

What are 3 examples of D Recommendations?

A

Screening for asymptomatic bacteruria in men and non-pregnant women, prostate cancer screening, colorectal cancer screening > age 85

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17
Q

What is an example of an I Recommendation?

A

Screening for oral cancer in asymptomatic adults

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18
Q

What are 2 ways for clinicians to get USPSTF recommendations?

A
  1. USPSTF website

2. ePSS app

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19
Q

What are Berwick’s 4 safety concerns?

A
  1. Don’t kill me.
  2. Don’t hurt me.
  3. Don’t make me feel helpless, take away clothes, insert things into me
  4. Don’t make me wait
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20
Q

What are the three major aspects of the universal protocol for surgery?

A
  1. Conduct a pre-procedure verification process.
  2. Mark the procedure site before the procedure is performed.
  3. Perform a time-out.
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21
Q

What are variables measured on a numerical scale?

A

Quantitative variables

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22
Q

What are variables not measured on a numerical scale?

A

Categorical (qualitative) variables

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23
Q

What are nominal variables?

A

Data that has no intrinsic order (hair colors, types of cars)

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24
Q

What are ordinal variables?

A

Data that has an intrinsic order (satisfaction scale)

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25
Q

What are interval variables?

A

Like ordinal data in that it follows a clear order but there is also a clear quantitative difference between value; does not have a meaningful zero (temperature)

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26
Q

What are ratio variables?

A

Like interval data but can be reported as ratios; does have a meaningful zero (exam scores)

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27
Q

What are the two types of quantitative variables?

A

Interval and ratio

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28
Q

Quantitative variables can be discrete or continuous. What is the difference?

A

Discrete variables: whole numbers, no in-between

Continuous variables: intermediary variables (weight)

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29
Q

What are the three measurements of central tendency?

A
  1. Mean
  2. Median
  3. Mode
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30
Q

What is the mean?

A

Sum of all values/divided by # of values

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31
Q

What is the median?

A

Center number in the ordered sequence of data

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32
Q

What is the mode?

A

Most common number in the series

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33
Q

Which types of variables can be measured with mean, median, mode?

A

Nominal: mode
Ordinal: median and mode
Interval and Ratio: all 3

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34
Q

What are the three types of variability?

A

Biologic
Measurement
Statistical

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35
Q

What is biologic variability?

A

Difference in values of variables due to physiologic differences

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36
Q

What are the two types of biologic variability?

A
  1. Inter-individual variability

2. Intra-individual variability

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37
Q

What is measurement variability?

A

Variability based on differences due to the person performing the test (observer) and due to instrument being used (measurement)

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38
Q

What is statistical variability?

A

Dispersion, scatter, spread; describes how spread out a group of data is

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39
Q

What are the 4 measures of statistical variability?

A
  1. Range
  2. Interquartile range
  3. Variance
  4. Standard Deviation
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40
Q

What is range?

A

Difference between the highest and lowest values; significant limitations

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41
Q

What is interquartile range?

A

Less affected by extreme values; range of the middle 50% of scores

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42
Q

What is variance?

A

Variability among data points (how far each number in the set is from the mean)

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43
Q

What is standard deviation?

A

Average difference between the data points and the mean

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44
Q

What is a pattern of occurrence of variables?

A

Distribution

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45
Q

What are the two main types of distributions?

A

Discrete and Continuous (normal and non-normal)

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46
Q

What is the rule that describes a normal/Gaussian distribution?

A

68 (1 SD)
95 (2 SD)
99 (3 SD)

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47
Q

Describe non-normal distributions (skews).

A

Positive skew - skews to the right

Negative skew - skews to the left

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48
Q

What is the gold standard of diagnostic testing?

A
  1. Most accurate with no restrictions

2. Best test with reasonable conditions

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49
Q

An ideal diagnostic test would have no ___ and ___.

A

False negatives; false positives

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50
Q

Describe the 4 outcomes of diagnostic testing.

A
  1. True positive: positive test result, has disease
  2. False positive: positive test result, does not have disease
  3. False negative: negative test result, has disease
  4. True negative: negative test result, does not have disease
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51
Q

What is the probability that a test is positive when the disease is present or positive?

A

Sensitivity (true positive rate)

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52
Q

What is the probability that a test is negative when the disease is absent or negative?

A

Specificity (true negative rate)

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53
Q

Sensitivity = ?

A

True positive/Total disease positive

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54
Q

Specificity = ?

A

True negative/Total disease negative

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55
Q

When is sensitivity most helpful?

A

When the test is negative because there will be no false negatives; sensitivity helps rule OUT the disease (SNOUT)

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56
Q

When is specificity most helpful?

A

When the test is positive because there will be no false positives; helps rule IN the disease (SPIN)

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57
Q

What is prevalence?

A

Number of patients who have a disease among a population of people who both have and do not have the disease; = total disease positive/total population

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58
Q

What is a positive predictive value?

A

Probability that a person with a positive test will have the disease

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59
Q

What is a negative predictive value?

A

Probability of not having the disease with a negative test result

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60
Q

Positive predictive value = ?

A

True positive/Total test positive

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61
Q

Negative predictive value = ?

A

True negative/total test negative

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62
Q

Pre-test probability is ___. Post-test probability is ___.

A

Prevalence; predictive value

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63
Q

When prevalence is high, the PPV will be ___ and the NPV will be ___.

A

Higher; lower

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64
Q

When prevalence is low, the PPV will be ___ and the NPV will be ___.

A

Lower; higher

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65
Q

What is freedom from accidental injury caused by medical care or medical error, preventing harm to the patient?

A

Patient safety

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66
Q

What is a medical error?

A

An unintended act (omission or commission) or an act that does not achieve its intended outcome

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67
Q

What is excluded from the definition of medical error?

A

Acts that did not achieve their desired outcomes because of underlying illness or additional patient comorbidities and outcomes known to be risks of specific procedures

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68
Q

Describe the swiss cheese model of error.

A

Individual actions may result in errors; multiple safety barriers are in place; weaknesses exist in the barriers and the cheese may align to lead to a harmful event

69
Q

What is an intensive effort to find what is the underlying or root cause of a bad outcome?

A

Root cause analysis

70
Q

What are the three types of error?

A
  1. Skill based - acted on auto-pilot, not intended
  2. Rule based - action intended but wrong rule
  3. Knowledge based - probelm solving in new situation
71
Q

What are the two types of skill-based errors and how can they be avoided?

A
  1. Slips: an action
  2. Lapse: mental inaction
    Rx: Stop Think Act Review
72
Q

What are the two types of rule-based errors and how can they be avoided?

A
  1. Mistake: inadvertently chose the wrong rule or misapplied the rule
  2. Violation: intentionally choose not to follow a rule
    Rx: algorithms, ready access to rules
73
Q

What is concluding a diagnosis early and failing to be inclusive of other differentials?

A

Premature closure

74
Q

What is not considering unusual diagnoses?

A

Zebra retreat

75
Q

What is being unduly persuaded by early features such as triage notes or PCP’s perception?

A

Anchoring

76
Q

What is the most common type of cognition error?

A

Premature closure

77
Q

What is involved in the “bad apple” theory of error?

A

Error is due to a character flaw in the individual; getting rid of bad apples will get rid of errors

78
Q

What is involved in a culture of safety?

A

Errors are a system property, safety is a management function, there are multiple causes and levels of analysis, avoids guilt and blame, fixes systems, not people

79
Q

___ commit to seek knowledge, reward safe practice, and communicate effectively.

A

High Reliability Organizations

80
Q

What are some HRT behaviors?

A
  1. Sensitivity to operations
  2. Commitment to resilience
  3. Deference to expertise
  4. Reluctance to simplify
  5. Preoccupation with failure
81
Q

What are some healthcare factors that increase the likelihood of human errors?

A

Personal physiology of each patient, distracting environment, autonomy and lack of standardized processes, cumbersome technology, cultural features

82
Q

What are some instances in which errors are likely to occur?

A
  1. Reliance on memory
  2. Multiple hand-offs
  3. Many individuals involved in care
  4. High acuity of illness or injury
  5. Need for rapid decisions
  6. High volume, unpredictable patient flow (SATO - Speed Accuracy Trade Off)
83
Q

What is involved in human factors engineering?

A
  1. Standardize (limit unwanted variability)
  2. Simplify processes and reduce unnecessary steps
  3. Error-proof the process
  4. Provide added benefit
84
Q

Cognition errors are caused by natural human ___.

A

Bias

85
Q

What is the integrated pattern of thoughts, communications, actions, customs, beliefs, values, and institutions associated with racial, ethnic, or linguistic groups, as well as with religious, spiritual, biological, geographical, or sociological characteristics?

A

Culture

86
Q

What are some aspects of culture in a medical encounter?

A

Perceptions/beliefs of health and well-being and related practices, linguistics and communication, literacy level, sense of self and space, dress, modesty, privacy

87
Q

What are some aspects of culture in health routines?

A

Perceptions/beliefs and rituals, family composition, roles and household culture and priorities, food and eating habits, time perception

88
Q

True or false - competence is constructed.

A

True

89
Q

What are preventable differences in burden of disease or opportunity to achieve optimal health that are experienced by socially disadvantaged populations?

A

Health disparities

90
Q

True or false - race is a social construct.

A

True

91
Q

Define intimate partner violence.

A

Physical, sexual, or psychological harm by a current or former partner for the purpose of gaining or maintaining power and control

92
Q

What are the 5 subtypes of intimate partner violence?

A
  1. Physical violence
  2. Sexual violence
  3. Stalking
  4. Psychological aggression/emotional abuse
  5. Control of reproductive or sexual health
93
Q

___% of American women suffer physical violence, sexual violence, or stalking by an intimate partner. 28% of American men suffer the same.

A

36; 28

94
Q

___% of both women and men experience psychological aggression or emotional abuse by an intimate partner.

A

50

95
Q

What are some individual risk factors for IPV?

A
  1. Low income
  2. Young age
  3. Low level of education
  4. Delinquency in adolescence
  5. Alcohol abuse
  6. Mental illness (depression)
  7. Witnessing or experiencing violence in childhood
96
Q

What are some community risk factors for IPV?

A
  1. Poverty
  2. Lank of sanctions against abusers
  3. Paternalistic cultural constructs of gender roles
  4. Divorce is uncommon
  5. Women do not work outside the home
  6. Violence is common
97
Q

In the LGBTQ community, which populations have the highest rates of IPV?

A

Bisexual and trans women

98
Q

___% of adult IPV victims report being abused in the teen years.

A

25

99
Q

Women who are abused have ___x more hospital admissions than women who are not abused.

A

3.5

100
Q

What is the USPSTF grade for screening women of childbearing age for IPV?

A

B

101
Q

What is the HITS tool?

A 
How often does your partner:
1. physically Harm you?
2. Insult or talk down to you?
3. Threaten you with harm?
4. Scream or curse at you?
(score of 10+ is positive)
102
Q

What is the most dangerous time for a woman in an IPV situation?

A

When she tries to leave

103
Q

What are 4 types of reporting standards by various states?

A
  1. Require reporting of injuries caused by weapons
  2. Require reporting for injuries caused in violation of criminal laws, as a result of violence, or through non-accidental means
  3. Specifically address reporting in IPV cases
  4. No general reporting laws
104
Q

What are exceptions to reporting rules?

A

You must report abuse of children, teens, elders, and disabled adults

105
Q

What does RADAR stand for?

A
  1. Routinely screen every patient
  2. Ask non-judgmental questions
  3. Document your findings
  4. Assess the patient’s safety
  5. Respond, review options and provide referrals
    (Follow up)
106
Q

What are some predictors of difficulty in medical school in the first two years?

A

Lack of exercise, increased alcohol use, sleep deprivation, not asking for hlep

107
Q

What are some predictors of difficulty in medical school in the last two years?

A

Daily hassles, interpersonal conflicts, not asking for help

108
Q

What are some predictors of success in medical school?

A

Personality traits and emotional intelligence

109
Q

___% of female and ___% of male medical students and residents experienced pronounced symptoms of anxiety and depression.

A

40; 27

110
Q

___% of physicians report anxiety, sleeplessness, or depression.

A

30-50

111
Q

Suicide rates in medicine are ___x that of the general population.

A

2

112
Q

___% of physicians have alcohol use disorder.

A

10

113
Q

Overall, physicians have a ___ divorce rate than the average population.

A

Lower

114
Q

Physicians married to physicians have a very ___ divorce rate.

A

Low

115
Q

What are the two main categories of study design?

A
  1. Observational studies

2. Experimental studies

116
Q

What type of study design involves a detailed description of a case or a few similar cases?

A

Case reports and case series

117
Q

What type of study design involves the lowest level of evidence?

A

Case reports and case series

118
Q

What types of study involves looking at what is happening to a group of people at a particular point in time?

A

Cross-sectional studies

119
Q

What type of study serves as the basis for diagnostic testing and predictive values that guide clinical practice?

A

Cross-sectional studies

120
Q

What type of study is retrospective and best used for rare conditions?

A

Case-control studies

121
Q

What type of study is longitudinal?

A

Cohort studies (can be prospective or retrospective)

122
Q

What is the difference between retrospective cohort and case-control studies?

A

Case-control studies are studying the DISEASE to identify risk factors. Cohort studies study the RISK FACTOR and the extent of exposure to the risk factor to determine its association with disease.

123
Q

What is the allocation of individuals randomly to an experimental or control group?

A

Randomization (random allocation)

124
Q

What is the process of separating subjects into strata based on prognostic factors known to be strongly related, then randomizing each strata?

A

Stratified randomization

125
Q

What is the process of blinding in which those assigning the patients do not know which treatment will be assigned?

A

Allocation blinding

126
Q

What is the process of blinding in which the patients do not know what group they are in?

A

Single-blinding

127
Q

What is the process of blinding in which patients and physicians do not know what group the patients are in?

A

Double-blinding

128
Q

In this phase of clinical trials, the drug or treatment is given to a large group (300-3000+) to confirm effectiveness, monitor side effects, and compare it to the current standards of care.

A

Phase 3

129
Q

In this phase of clinical trials, the new drug or treatment is tested in a small group (20-50) for the first time to determine safe dose and side effects.

A

Phase 1

130
Q

In this phase of clinical trials, the drug or treatment is given to a larger group (50-300) to further evaluate its efficacy and safety.

A

Phase 2

131
Q

In this phase of clinical trials, the drug is monitored for rarer long-term side effects.

A

Phase 4

132
Q

What is a comprehensive review of many studies (and often study type) to summarize findings on a particular health topic?

A

Systematic review

133
Q

What is a statistical analysis of multiple studies to develop a single conclusion?

A

Meta-analysis

134
Q

What type of sampling involves an entire population that has equal probability of selection?

A

Simple random sampling (e.g., lottery)

135
Q

What type of sampling involves a population divided into strata based on some similar characteristic, then within each group a simple random sample is taken?

A

Stratified sampling

136
Q

What type of sampling involves knowing and numbering the entire population of interest randomly, then selecting every nth person?

A

Systematic random sampling

137
Q

What type of sampling involves dividing a population into groups that are heterogenous, meaning each group should be a representation of the whole population, then randomly sampling only some of the groups and obtaining data on all in that group?

A

Cluster sampling

138
Q

Stratified sampling has ___ variance within strata and ___ variance between strata.

A

Low; high

139
Q

Cluster sampling has ___ variance within the cluster and ___ variance between clusters.

A

High; low

140
Q

___ sampling is aimed at increasing precision. ___ sampling is aimed at reducing costs.

A

Stratified; cluster

141
Q

What type of sampling combines the previously describe methods?

A

Multi-stage

142
Q

What is the proportion of persons in a population who have a particular disease or condition at a specific point in time or over a specified period of time?

A

Prevalence

143
Q

Prevalence measures ___ cases.

A

Existing

144
Q

Point prevalence = ? (formula)

A

Total cases at a given time/Total population at a given time

145
Q

What is the proportion of new cases in a population initially free of the disease over a specified period of time?

A

Incidence

146
Q

Incidence = ? (formula)

A

New cases over a period of time/Total population at risk during the time period

147
Q

Describe the relationship between prevalence and incidence typically seen with acute illnesses like colds.

A

New cases and cures/deaths are equal, prevalence remains the same

148
Q

Describe the relationship between prevalence and incidence typically seen with chronic illnesses like diabetes.

A

New cases > cures/deaths, prevalence increases

149
Q

Describe the relationship between prevalence and incidence typically seen with illnesses that are preventable/curable like mumps with MMR vaccine.

A

New cases < cures/deaths, prevalence decreases

150
Q

This type of risk is equivalent to the incidence.

A

Absolute risk

151
Q

Absolute risk = ? (formula)

A

New cases in a period of time/Population at risk

152
Q

This type of risk is a risk ratio.

A

Relative risk (How many times more likely are those who are exposed to get the disease than those who are not exposed)

153
Q

Relative risk ? (formula)

A

Probability of getting disease in exposed/Probability of getting disease in non-exposed; RR = A/(A+B) / C/(C+D) - risk/disease chart

154
Q

This type of risk is the risk difference or the proportion of risk that is caused by the exposure

A

Attributable risk

155
Q

Attributable risk = ? (formula)

A

AR = (A/(A+B)) - (C/(C+D)) - risk/disease chart

156
Q

RR > 1 suggests…

A

…increased risk of outcome in the exposed group

157
Q

RR = 1 suggests…

A

…no difference in risk between the exposed and unexposed groups

158
Q

RR < 1 suggests…

A

…a reduced risk in the exposed group

159
Q

What indicates if and how risk decreases with treatment?

A

Absolute risk reduction

160
Q

Absolute risk reductoin = ?

A

ARR = (C/(C+D)) - (A/(A+B))

161
Q

What is the number of people you need to treat in order to prevent disease in one person?

A

Number Needed to Treat

162
Q

What is the number of people you would need to treat for one person to suffer a harmful event?

A

Number Needed to Harm

163
Q

Number Needed to Treat = ? (formula)

A

1/absolute risk reduction

164
Q

Number Needed to Harm = ? (formula)

A

1/attributable risk

165
Q

___ are used in case-control (retrospective) studies because you cannot calculate incidence rates and the disease outcome is already known.

A

Odds ratios

166
Q

This describes the ratio of outcome and has a value from 0 to infinity.

A

Odds

167
Q

This describes the fraction of an outcome when every outcome is considered and has a value from 0 (impossible) to 1 (inevitable)

A

Probability

168
Q

Odds Ratio = ? (formula)

A

Odds of having a disease in exposed group/Odds of having disease in the unexposed group = AD/BC

PCM (3 decks)

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