First Aid for the USMLE Step 1 2011 EXPRESS workbook

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Behavioral Science
Questions EPIDEMIOLOGY/BIOSTATISTICS
1. A case control study is described as _______________ (experimental/observational) and _______________ (prospective/retrospective). (p. 50) A cohort study is described as _______________ _______________ (prospective/retrospective). (p. 50) (experimental/observational) and

2.

3.

True or False: In a cohort study, subjects are chosen on the basis of the presence or absence of risk factors. (p. 50) _______________________________________________________________ True or False: A cohort study involves following subjects over a period of time to study the development of disease. (p. 50) _____________________________________________________ True or False: A cross-sectional research study can show the correlation of a risk with a disease. (p. 50) _________________________________________________________________________ Describe the two general types of blinded studies. (p. 50) _________________________________ ______________________________________________________________________________

4.

5.

6.

7. 8.

What two major factors may limit the reliability of a meta-analysis? (p. 50) ____________________ How does a low prevalence of disease affect the positive predictive value of a test? (p. 51) ____ ______________________________________________________________________________

9.

In HIV testing, ELISA screening is _______________ (sensitive/specific) and has a high false_______________ (negative/positive) rate, with a _______________ (high/low) threshold. (p. 51) In HIV testing, the Western blot test is _______________ (sensitive/specific) and has a high false_______________ (negative/positive) rate, with a _______________ (high/low) threshold. (p. 51) How does a low prevalence of disease affect the negative predictive value of a test? (p. 51) ___ ______________________________________________________________________________

10.

11.

12.

If a diagnostic test has 100% sensitivity, what should the value of the false-negative rate equal? (p. 51) ___________________________________________________________________________ If a diagnostic test has 100% specificity, what should the value of the false-negative rate equal? (p. 51) ___________________________________________________________________________ What measure of disease frequency is calculated by dividing the total number of cases in the population at a given time by the total population at a given time? (p. 52) ____________________

13.

14.

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First Aid for the USMLE Step 1 2011 EXPRESS workbook

15.

What measure of disease frequency is calculated by dividing the number of new cases in the population during a period by the total population at risk during that time? (p. 52) ______________ In chronic disease states such as diabetes, is the prevalence of disease greater than, less than, or equal to the incidence? (p. 52) ______________________________________________________ In acute disease states such as a common cold, is the prevalence of disease greater than, less than, or equal to the incidence? (p. 52) _______________________________________________ The statement "Patients with COPD had higher odds of a history of smoking than those without COPD" pertains to _______________ (odds ratio / relative risk). (p. 52) The statement "Smokers had a higher risk of developing COPD than did nonsmokers" pertains to _______________ (odds ratio / relative risk). (p. 52) True or False: When calculating the incidence of a disease, the total population at risk during a certain time should include people who have the disease. (p. 52) ___________________________ True or False: The odds ratio for a disease based on exposure to a risk factor approximates the relative risk if the prevalence of the disease is low. (p. 52) ________________________________ What epidemiologic measurement is equal to the difference in disease incidence between an exposed group and an unexposed group? (p. 52) _______________________________________ _______________ (Precision/accuracy) refers to the trueness of test measurements (validity), while _______________ (precision/accuracy) refers to the consistency and reproducibility of a test and the absence of random variation in a test. (p. 52) _______________ (Random/systematic) error reduces precision in a test, while _______________ (random/systemic) error reduces accuracy in a test. (p. 52) Name four ways to reduce bias in epidemiologic studies. (p. 53) ___________________________ ______________________________________________________________________________

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23.

24.

25.

26.

What type of bias occurs when there are two closely associated factors and therefore the effect of one factor could change or confuse the effect of the other? (p. 53) __________________________ What is the name of the phenomenon whereby a researcher's belief in the efficacy of a treatment changes the outcome of that treatment? (p. 53) ________________________________________ In a data set that has a distribution with a negative skew, what is the relationship between the mean, the median, and the mode? (p. 53) _____________________________________________ In a data set that has a distribution with a positive skew, what is the relationship between the mean, the median, and the mode? (p. 53) __________________________________________________ Which characteristic is least affected by outliers: mean, median, or mode? (p. 53) ______________ What is the term for the hypothesis that there is no association between the variables being studied? (p. 54) _________________________________________________________________ In statistical calculations, the P value is equal to the probability of making what type of error? (p. 54) ___________________________________________________________________________

27.

28.

29.

30. 31.

32.

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First Aid for the USMLE Step 1 2011 EXPRESS workbook

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33.

In a statistical analysis, if P = 0.03, what is the percentage of chance that the data will show a difference by chance alone when none truly exists? (p. 54) _______________________________ In statistical analyses, if = 0.2, what is the percentage of chance that the null hypothesis has been falsely accepted? (p. 54) ______________________________________________________ The power of a statistical test depends on which three factors? (p. 54) _______________________ ______________________________________________________________________________

34.

35.

36.

What study parameter is calculated when the probability of making a type II error is subtracted from 1? (p. 54) ______________________________________________________________________ In a data set that has a normal (Gaussian) distribution, what percentage of the data falls within two standard deviations of the mean? What percentage falls within 3 SDs of the mean? (p. 54) ______________________________________________________________________________ If the 95% confidence interval for a mean difference between two variables includes 0, the null hypothesis _______________ (is/is not) rejected. (p. 55) What type of statistical test is used to check for a difference between the means of three or more groups? (p. 55) __________________________________________________________________ What type of statistical test is used to check for a difference between the means of two groups? (p. 55) ___________________________________________________________________________ What statistical term's absolute value indicates the strength of the correlation between two variables? (p. 55) ________________________________________________________________ Given an example of primary, secondary, and tertiary disease prevention strategies. (p. 55) _____ ______________________________________________________________________________

37.

38.

39.

40.

41.

42.

43.

List the 12 diseases that are reportable in all states. (p. 56) _______________________________ ______________________________________________________________________________ ______________________________________________________________________________

44.

List in order, from most to least common, the three leading causes of death for people 15-24 years old in the United States. (p. 56) _____________________________________________________ List in order, from most to least common, the three leading causes of death for people >65 years old in the United States. (p. 56) _____________________________________________________ What two federally funded healthcare programs originated from amendments to the Social Security Act? Who is eligible for these programs? (p. 56) ________________________________________ ______________________________________________________________________________

45.

46.

ETHICS
47. What are the four core ethical principles of medicine? (p. 57) ______________________________ ______________________________________________________________________________

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First Aid for the USMLE Step 1 2011 EXPRESS workbook

48. 49.

True or False: Patient autonomy may conflict with beneficence. (p. 57) ______________________ True or False: If the benefits of an intervention outweigh the risks, a patient may make an informed decision to proceed, thus overriding the ethical principle of nonmaleficence. (p. 57) ____________ Which right is being exercised when a patient makes an informed decision to proceed with a medical treatment when the benefits of the intervention outweigh its risks? (p. 57) _____________ What must be explained by a doctor to obtain informed consent? (p. 57) ____________________ ______________________________________________________________________________

50.

51.

52.

What are the four exceptions to informed consent? (p. 57) ________________________________ ______________________________________________________________________________

53.

What are four conditions in which a minor may be considered emancipated? (p. 57) ___________ ______________________________________________________________________________

54.

What are the five requirements that must be met in order to determine that a patient has full decision-making capacity? (p. 57) ___________________________________________________ ______________________________________________________________________________

55.

True or False: A patient's family can require that a doctor withhold information from the patient. (p. 57) ___________________________________________________________________________ What term refers to an incapacitated patient's previous oral statements, which are commonly used to guide medical decisions? (p. 57) __________________________________________________ What four factors give greater validity to a patient's oral advance directive? (p. 57) ___________ ______________________________________________________________________________

56.

57.

58.

What is the term for the legal document that describes treatments the patient wishes to receive or not receive if he/she becomes incapacitated and cannot communicate about treatment decisions? (p. 57) _________________________________________________________________________ What legal term refers to a patient's designated surrogate who may make medical decisions in the event that the patient loses decision-making capacity? (p. 57) _____________________________ True or False: When authorizing a power of attorney, the patient may specify decisions that are to be made in certain clinical situations. (p. 57) ___________________________________________ True or False: A patient's agent authorized with power of attorney retains that power unless it is revoked by the patient. (p. 57) ______________________________________________________ Which type of advanced directive provides greater flexibility, a living will or a durable power of attorney? (p. 57) _________________________________________________________________ What standard should be used to determine the amount of medical information to disclose to a patient's family or friends? (p. 58) ___________________________________________________ In the case of serious infectious diseases, a physician may have a duty to break patient confidentiality to warn certain groups of people. Name the two groups. (p. 58) ________________ ______________________________________________________________________________ Copyright 2011 by MedIQ Learning, LLC All rights reserved

59.

60.

61.

62.

63.

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65.

What legal precedent requires physicians to directly inform and protect a potential victim from harm, even if it involves a breach of confidentiality? (p. 58) ________________________________ A child presents to the emergency department with multiple fractures and bruises of different ages. The patient's mother requests that authorities not be involved. Must the physician respect her request for confidentiality? Why or why not? (p. 58) _____________________________________ ______________________________________________________________________________

66.

67.

A young woman confides to her physician that she has considered ending her life by ingesting a bottles worth of her prescription pills, and that she does not want anyone else to know of her plan. Must the physician respect her request for nondisclosure? Why or why not? (p. 58) ___________ ______________________________________________________________________________

68.

A patient discloses that he frequently drives after consuming four or five drinks at the bar. In the office, the patient clearly has been drinking alcohol and has arrived on his own. Is the physician obligated to uphold confidentiality? Why or why not? (p. 58) _______________________________ ______________________________________________________________________________

69.

True or False: In a medical malpractice suit, the burden of proof is "beyond a reasonable doubt." (p. 58) _________________________________________________________________________ What is the most common factor that leads to litigation in medical malpractice? (p. 58) ________ ______________________________________________________________________________

70.

71.

What is an appropriate response to a patient who is upset about how he or she was treated by another doctor? (p. 59) ____________________________________________________________ What is an appropriate response to a child who wishes to know more about his or her illness? (p. 59) ___________________________________________________________________________ What is an appropriate response to a patient who is noncompliant? (p. 59) __________________ ______________________________________________________________________________

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What is an appropriate response to a 17-year-old girl who is pregnant and requests an abortion? (p. 59) _________________________________________________________________________ What is an appropriate response to a terminally ill patient who requests physician assistance with ending his or her life? (p. 59) _______________________________________________________ What is an appropriate response to a patient who states that he or she finds you attractive? (p. 59) ______________________________________________________________________________ What is an appropriate response to a patient who refuses a necessary procedure or desires an unnecessary one? (p. 59) __________________________________________________________ What is an appropriate response to a patient who continues to smoke? (p. 59) ________________ ______________________________________________________________________________

75.

76.

77.

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First Aid for the USMLE Step 1 2011 EXPRESS workbook

DEVELOPMENT
79. Fill in the chart with the appropriate criteria for calculating the Apgar score. (p. 60) Criteria Appearance Pulse Grimace Activity Respiration 0 Points 1 Point 2 Points

80.

What are five major complications of low birth weight? (p. 60) _____________________________ ______________________________________________________________________________

81.

What is the approximate age of a child who is anxious when separated from his or her mother? (p. 60) ___________________________________________________________________________ What is the approximate age range of a child who plays alongside, but not with, another child? (p. 60) ___________________________________________________________________________ What Tanner stage involves pubic hair development in both sexes and breast tissue elevation in females? (p. 60) _________________________________________________________________ What Tanner stage involves the areola elevating in females, and the penis width increasing, the scrotal skin darkening, and the glans developing in males? (p. 60) __________________________ What sexual changes normally occur in elderly men? (p. 61) ______________________________ ______________________________________________________________________________

82.

83.

84.

85.

86. 87.

True or False: One may experience illusions during normal bereavement. (p. 61) ______________ Name three types of symptoms that a patient with pathologic grief may experience. (p. 61) _____ ______________________________________________________________________________

88.

True or False: The five stages of grief progress in a predictable order. (p. 61) _________________

PHYSIOLOGY
89. What four physiologic mechanisms can be affected by stress? (p. 61) _______________________ ______________________________________________________________________________ 90. Which four classes of drugs or substances can cause sexual dysfunction? (p. 61) ___________ ______________________________________________________________________________

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page 7

91.

Awake and alert states are characterized by what electroencephalogram waveform? (p. 62) ____ ______________________________________________________________________________

92.

REM sleep is characterized by what electroencephalogram waveform? (p. 62) _______________ ______________________________________________________________________________

93. 94.

Which area of the brain is responsible for rapid eye movements during sleep? (p. 62) ___________ Which drug is used to treat enuresis? What is its mechanism of action? (p. 62) _______________ ______________________________________________________________________________

95.

Which drug class is used to treat night terrors and sleepwalking? What is its mechanism of action? (p. 62) _________________________________________________________________________ Name four physiologic changes that occur during REM sleep. (p. 62) _______________________ ______________________________________________________________________________

96.

97.

What is the principle neurotransmitter involved in REM sleep? (p. 62) ______________________ ______________________________________________________________________________

98.

What sleep disorder is characterized by cataplexy and hypnagogic hallucinations? (p. 63) ______ ______________________________________________________________________________

99.

What is the most common medical treatment for narcolepsy? (p. 63) _______________________ ______________________________________________________________________________

100. Circadian rhythms dictate the release of which hormones and neurotransmitters? (p. 63) _______ ______________________________________________________________________________

Answers EPIDEMIOLOGY/BIOSTATISTICS
1. 2. 3 4. 5. 6. Observational; retrospective. Observational; prospective. True. True. True. (However, it cannot show causality.) In single-blind studies, subjects are not aware of their study-group assignment. In double-blind studies, neither researchers nor subjects are aware of study-group assignment. The quality of the individual studies, and bias in the selection of studies for analysis.

7.

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8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20.

The positive predictive value of the test is lower for a disease that has a lower prevalence. Sensitive; positive; low. Specific; negative; high. The negative predictive value of the test is higher for a disease that has a lower prevalence. It should equal 0. (All cases of the disease are detected by the test.) It should equal 0. (All patients without the disease are identified correctly.) Point prevalence. Incidence. (Incidence refers to new incidents). Much greater than the annual incidence (because of the long duration of the disease). Approximately equal (for diseases of short duration). Odds ratio. Relative risk. False. (The total population at risk during a certain period should not include people who have the disease because incidence is a measure of new cases of a disease; those who have the disease are not at risk of getting the disease.) True. Attributable risk; it is the percentage of cases of a disease caused by a risk factor. Accuracy; precision. Random; systematic. Use blinded studies (preferably double blind), assess placebo responses, perform a crossover study, and use randomization. Confounding bias, in which the causal relationship is better explained by a variable other that the one being studied. Pygmalion effect. Mean < median < mode. Mean > median > mode. Mode. Null hypothesis. Type I error (). (This type of error occurs when it is incorrectly concluded that an association is present.) Copyright 2011 by MedIQ Learning, LLC All rights reserved

21. 22. 23. 24. 25.

26.

27. 28. 29. 30. 31. 32.

First Aid for the USMLE Step 1 2011 EXPRESS workbook

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33. 34. 35.

3%. 20%. (This is generally considered an acceptable level for in a study design). The total number of end points experienced by the population, the difference in compliance between the treatment groups, and the size of the expected effect. Power. 95% fall within 2SDs of the mean and 99.7% fall within 3SDs of the mean. If the 95% CI includes 0, the null hypothesis is rejected as there is no significant difference between the two variables. Analysis of variance (ANOVA). t-test. Correlation coefficient (r). Vaccination is a primary disease prevention strategy, as the vaccinated person is not considered susceptible to the disease. A Pap smear is secondary disease prevention, since it can detect cervical cancer at an early, treatable stage. Chemotherapy is tertiary disease prevention, as it is intended to reduce disability from disease once it has occurred. AIDS, chickenpox, gonorrhea, hepatitis A and B, measles, mumps, rubella, salmonella, shigella, syphilis, and tuberculosis. Injuries, homicide, and suicide. Heart disease, cancer, and stroke. Medicare and Medicaid. MedicarE is for the Elderly, while MedicaiD is for the Destitute.

36. 37. 38.

39. 40. 41. 42.

43.

44. 45. 46.

ETHICS
47. 48. 49. 50. 51. Autonomy, beneficence, nonmaleficence, and justice. True. True. Autonomy. The risks and benefits of the proposed intervention, and the risks and benefits of the alternatives (including doing nothing). If the patient lacks decision-making capacity; if the situation is emergent; if disclosure of information would harm the patient; and if the patient waives the right of informed consent. If the minor is married, self-supporting, has children, or is in the military.

52.

53.

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54.

The patient must make and communicate a choice; the patient must be informed; the decision must remain stable over time; the decision must be consistent with the patient's values and goals; and the decision cannot be a result of delusions or hallucinations. False. (A patient's family cannot require the physician to withhold information from the patient.) Oral advance directive. The patient was informed, the directive is specific, the patient made a choice, and the decision was repeated over time. Living will (i.e., written advance directive). Durable power of attorney. True. True. A durable power of attorney. The disclosure of information to family or friends should be guided by what the patient would want. Public officials and identifiable people who may be at risk. The Tarasoff Decision. No; a physician may break confidentiality to report the abuse of a child or an elderly person. No; a physician may break confidentiality to report a suicidal or homicidal patient. No; a physician can break confidentiality to report an impaired driver. False. (In a medical malpractice suit, the burden of proof is "more likely than not.") Poor communication between the physician and the patient. Suggest that the patient speak directly to that physician about the concerns. If the problem is with a member of the office staff, inform the patient that you will speak to that person. Ask the parents what they have told the child about his or her illness. (The parents decide what information should be relayed to the child about the illness.) Working to improve the physician-patient relationship. Many states require parental notification or consent for minors to have an abortion. However, parental consent is not required for emergency situations, the treatment of sexually transmitted diseases, medical care during pregnancy, prescriptions for contraceptives, or the management of drug addiction. In most states, physicians should refuse to be involved in any form of assisted suicide; however, the physician may prescribe medically appropriate analgesics that coincidentally shorten the patient's life.

55. 56. 57.

58. 59. 60. 61. 62. 63. 64. 65. 66. 67. 68. 69. 70. 71.

72.

73. 74.

75.

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76.

Ask direct closed-ended questions, and use a chaperone if necessary. (Romantic relationships with patients are never appropriate.) Attempt to understand why the patient wants or does not want the procedure; address the underlying concerns, and avoid performing unnecessary procedures. Ask how the patient feels about smoking; offer advice about cessation if the patient seems willing to make an effort to quit.

77.

78.

DEVELOPMENT
79. Criteria Appearance Pulse Grimace Activity Respiration 0 Points Blue 0 None Limp None 1 Point Trunk pink 1 Grimace Some Irregular 2 Points All pink 2 Grimace + cough Active Regular

80.

Infection, neonatal respiratory distress syndrome, necrotizing enterocolitis, intraventricular hemorrhage, and persistent fetal circulation. 15 months. 24 to 48 months (parallel play). Tanner stage 2. Tanner stage 4. Slower erection/ejaculation and a longer refractory period. True. Depressive symptoms, delusions, and hallucinations. False. (They do not always occur in a predictable order.)

81. 82. 83. 84. 85. 86. 87. 88.

PHYSIOLOGY
89. 90. Water absorption, muscular tonicity, gastrocolic reflex, and mucosal circulation. Antihypertensives, neuroleptics, selective serotonin reuptake inhibitors, ethanol.

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91. 92. 93. 94. 95. 96.

Beta (highest frequency, lowest amplitude). Beta. The paramedian pontine reticular formation/conjugate gaze center. Imipramine; it shortens the duration of stage 4 sleep. Benzodiazepines; they shorten REM and delta sleep. Increased and variable pulse, rapid eye movement, increased and variable blood pressure, and penile/clitoral tumescence. Acetylcholine. Narcolepsy. Stimulants (such as amphetamines or modafinil).

97. 98. 99.

100. ACTH, prolactin, melatonin, and nocturnal norepinephrine.

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