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what's a case-control study? : compares a group of people with disease to a group


without. looks for prior exposure or risk factors. asks what happened
measure of risk in case-control study? : Odds Ratio (OR)
Patients with COPD had higher odds of a history of smoking than those without CO
PD had is an example of? : Case-control study
what's the odds ratio, in context of case-control? : odds of exposure in cases / o
dds of exposure in controls. (P/(1-P1)) / (P2 / (1-P2))
what's the odds of an event? : probability of an event occuring / probability of a
n event not occuring
what's a cohort study? : compares a group with given exposure to a group without e
xposure. it can be prospective(who will develop disease), retrospective (who had ex
posure). it accesses whether or not the risk factors increase likelihood of disea
se
what's the cohort in a cohort study? : the group with the given risk factor, in a
prospective study we follow the cohort into the future
measure for cohort study? : relative risk
what's relative risk? : ratio of probability of event occuring in the exposed grou
p versus a non-exposed group
example of cohort study? : looking at uncontrolled hypercholesterolemia and futu
re risk of MIs
what's a cross-sectional study? : purely observational and asks what is happening be
cause it takes place in the present time. collects frequencies of disease and re
lated risk factors
characteristic measure for cross-sectional study? : disease prevalence
disease prevalence? : % of patients who have disease
A study was conducted to determine the cardiotoxicity of azithromycin (macrolide
). One group of patients taking azithromycin is compared with a group who do not
take any azithromycin. it was shown that that azithromycin group had increased
risk of cardiovascular death, what type of study is this? : perspective cohort s
tudy
highest quality clinical trials are? : randomized, controlled double-blinded tri
als
phase I of clinical trial is done on what patients? : small number of healthy vo
lunteers
goal of phase I of clinical trial? : safety and toxicity
phase II of clinical trial is done on what patients? : small number of patients
with disease
goal of phase II of clinical trial? : dosing and efficacy
phase III of clinical trial is done on what patients? : thousands of patients
goal of phase III of clinical trial? : compare treatment to current standard of
care
phase IV of clinical trial is done on what patients? : surveilence of patients o
n the drugs
goal of phase IV of clinical trial? : detect rare side effects
efficacy of a drug is defined in terms of? : Vmax
optimal dosing of a drug is defined in terms of? : potency, drug clearance, Vd a
nd BA
adverse effects of a drug is defiend by? : the theraputic index (LD50/ED50)
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*** very high yield? : ok
how to draw the 2 by 2? : top = disease +/-; left = test +/-
what's sensitivity? : likelihood of a test to be positive if the patient has the d
isease. it's for ruling out
how to calculate sensitivity? : everyone who tests positive = TP / (TP / FN) = 1
- false negative
what's specificity? : likelihood a patient will have not the disease if the test i
s negative
how to calculate sensitivity? : TN / (TN + FP) = 1 - false positive rate
ELISA is what type of test? : high sensitivity test, so good for rulling out HIV

western blot is what type of test? : high specificity test. good for ruling in H
IV and diagnosing HIV
PPV? : proportion of the positive results that are true positives
how to calculate PPV? : true positives / (true positives + false positives)
if a patient asks, what are the likelihood that I have the disease after getting a
positive test result, what are they asking for? : the PPV
NPV? : proportion of the negative results that are true negatives. probability t
hat a person is actually disease free given a negative test result
how to calculate NPV? : true negatives / (TN + FN)
both PPV and NPV vary with? : disease prevalence. the higher the prevalence the
higher the PPV and the lower the NPV
what happens to the PPV if the diease prevalence is low? : even diseases with hi
gh specificity will have low PPV
what happens to the NPV if the disease prevalence is high? : NPV goes down even
if the sensitivity is high
A new assay for detecting prostate cancer is being tested in 120 patients withou
t the disease. 108 recieved negative test results. what's the speicificity? : spei
cificity = TN / (TN + FP). 2 by 2 (Z) = ?, 12, ?, 108. 108 / (12 + 108)
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prevelance vs incidence for acute versus chronic diseases? : for acute diseases
incidence are very similar (such as common cold) ; for chronic diseases prevalen
ce = incidence * duration
how to calculate the odds ratio? : ad / bc = ((a/c) / (b/d))
how to calculate the relative risk? : a / (a+b) / (c / (c+d)) = fraction of dise
ase in exposed group / fraction of disease in unexposed group
what's attributable risk? : difference in risk between exposed and unexposed group
s. a / (a+b) - c / (c+d) similar to relative risk but is minus
*** what's the number needed to treat? : 1 / aboslute risk reduction
*** what's the number needed to harm? : 1 / attributable risk
absolute risk fraction? : attributable risk / (a / (a+b)) = (RR - 1) / RR
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opposite of precision is? : random error
opposite of accuracy is? : systematc error
loss to followup is what type of bias? : selection bias
sampling bias? : when the sample is not representative of the population
when information is gathered at an inappropriate time, what type of bias is this
? : late-look bias, such as using a survey to study a fatal disease
when patients from different groups in a study are not treated the same, what ki
nd of bias is happening? : procedure bias
what's lead-time bias? : early detection is confused with a increase in survival (
commonly seen in improved screening)
observer expectancy effect? : when the researcher's belief in the efficacy of the
treamtment changes the outcome of treatment - form of observer bias and can be av
oided by having an interpreter of outcomes
*** what's the hawthrone effect? : when the group being studied changes behavior b
ecause they know they are under observation
review of an example of hawthrone effect? : ok
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what percent of population falls within 1, 2, and 3 SDs? : 94, 95, 99.7
what's SEM? : standard error of the mean = SD / sqrt(n); n = sample size. basicall
y illustrates how as sample size increases, the variation amongst different mean
s decreases
positive vs negative skewed distribution? : positive = tail on the right, with m
ean > median > mode; negative = tail on left with mean < median < mode
best measure of central tendency? : median
which type of measure is most resistant to outliers? : mode
2 by 2 table for statistical hypothesis? : top = reality (Ha, Ho); left = study
result (Ha, Ho). Z = power, a, b, correct
what's type I error? : incorrectly stating that there's a difference when there's no d
ifference in reality. a = p value
what's type II error? : stating that there's no difference when in fact there is a d
ifference in reality
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*** what's power? : likelihood of rejecting a null hypothesis when it's actually fal
se = 1 - beta
power of a study increases with? : increased sample size, increased expected eff
ect size, increase precision of measurement, increasing alpha
when should the H0 not be rejected, with respect to CI? : if CI for the mean dif
ference between two groups includes 0. if CI for odds ratio includes 1
when should the H0 be rejected, with respect to CI? : if the CI for two groups d
on't overlap
*** t-test compares what? : means of 2 groups
ANOVA test compares what? : means of 3 or more groups
chi-squared test compares what? : 2 or more percentages / proportions of categor
ical data rather than mean values [such as comparing proportion of smokers with
lung cancer compared to proportion of nonsmokers with lung cancer]
tiers of disease prevention? : PDR = prevent, detect and reduce; primary = preve
nt; secondary = screening; tertiary = reduce disability / treat
examples of primary disease prevention? : vaccines and hand washing
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medicare is available to? : patients over 65 or under 65 with certain disabiliti
es and those with ESRD
parts of medicare? : A = impatient care, skilled nursing, home care, hospice; B
= outpatient care; doctor's services; physical and occupational therapy; C = A + B
; D = stand-alone prescription drug coverage
medicaid? : federal and state health assistance for people with very low income
core principles in medical ethics? : patient autonomy; beneficiences; nonmalefic
ence; justice
what's patient autonomy? : respect patient and their preferences
beneficicence? : physicans have special ethical duty to act in patient's best inte
rest
nonmaleficence? : do no harm, unless benefits outweighs risks, patient can opt-in
when is informed consent not required? : lacks legal capacity, implied consent i
n emergency, theraputic privilage
what's theraputic privilage? : when information disclosure can severely harm the p
atient. example = suicidal patient with new diagnosis of cancer
consent for minors? : < 18 of age, consent from parent unless child is emancipat
ed (married, self-supporting, has children or is in military)
when is minor consent not required? : emergency situations such as contraceptive
s, STD treatments, medical care during pregnancy and drug addiction management.
parents also cannot refuse treatment for their children in life or death situati
ons
if the patient has decision-making capacity, patient's family cannot do what? : as
k physician to withold information
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priority order of surrogates? : spouce, adult children, parents, adult siblings,
other relatives
general exceptions to confidentiality? : harm to others is serious, likelihood o
f harm to self is great
cases when confidentiality doesn't hold? : impaired automobile patients, suicidal
patients, child abusers, STD, food poisoning, TB
*** what's the Tarasoft decision? : requires physicians to directly inform and pro
tect potential victims from harm even if it breaches confidentiality
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what should the physicians never do? : refer to another physician because the bo
ards belief all physicians must handle ethical responsibility. and never go to e
thics board
if a child wishes to know more about a illness, what to tell? : ask what parents
have told them about his / her illness because the parents decide what informat
ion can be relayed
what to advise when a minor requests an abortion? : some states require notifica
tion of guardians. do not advise to get an abortion unless at medical risk
parents can never force a child to give up her child up for adoption? : children
always have the final say so physician should facilitate communication between
parents and child
what to never tell a patient if he finds you attractive? : a relationship is not
appropriate with a patient because this would indicate it might be possible if he
/ she is no longer a patient. so in these cases ask direct, close-ended questio
ns and use chaperone if necessary
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what's the apgar score? : screening for new borne health evaluated at 1 min and 5
min after birth. A = appearance, P = pulse; G = grimmace, A = activity, R = resp
iration
cutoff for low birth weight? : < 2500 g
what's low birth weight associated with? : greater incidence of emotional / physic
al problems later in life
most common etiologies of low birth weight? : prematurity or intrauterine growth
restriction
*** typical question will ask about a behavior and whether or not its appropriat
e for that age group? : ok
motor development at 3 months? : rooting, holds head up, Moro reflex dissapears
motor development at 9 months? : sits alone, crawls, transfer toy from hand to h
and
motor development for 15 months? : walks, babinski sign dissapears
social development at 3 months? : social smile
social development at 9 months? : stranger anxiety
social development at 15 months? : seperation anxiety
verbal / cognitive development at 3 months? : orienting / responding to sound
verbal / cognitive development at 9 months? : responds to name, use gestures, pl
ays peek-a-boo
verbal / cognitive development at 15 months? : few words
motor development at 12 - 24 months? : climb stairs, stacking blocks (age in yea
rs x 3)
motor development at 3 years? : feeds self, kick ball
social development at 12 - 24 months? : reproachment = leaves mother then return
s
social development at 3? : core gender identity, parallel play
verbal / cognitive development at 12 - 24 months? : 200 words and 2 word phrases
+ object permanence
verbal / cognitive development at 3 years? : toilet training [pee at age 3]
motor development in prschool by age 3? : copying lines and circles. riding tric
ycles
motor development in preschool by age 4? : uses bottoms and zippers, grooms self
, hop on 1 feet, makes simple drawings
social milestones at 3 years? : comfortably spending part of day away from mothe
r
social milestones by age 4? : cooperative play and imaginary friends
verbal / cognitive milestone at 3? : 900 words and complete sentences
verbal / cognitive milestone at 4? : can tell detailed stories / use preposition
s
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*** does sexual interest decline with age? : no
sleeping pattern with respect to aging? : REM decreases, slow wave decreases, an
d increase in delay before falling asleep and increase in number of awakenings p
er night
fat change with age? : brown (heat generating) fat decreases; white fat increase
s
*** does intelligence decrease with normal aging? : no
how to calculate BMI? : weight in Kg / height
overweight BMI? : over 25
morbid obesity BMI? : over 40
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stages of sleep? : awake, N1, N2, N3, REM
EEG wave for during awake? : beta (highest frequency and lowest amplitude)
EEG wave for awake but with eyes closed? : Alpha
EEG for stage N1 (light sleep)? : Theta
EEG for stage N2 (deeper sleep)? : K complexes and sleep spindles
when do grinding of teeth / clenching of jaw occur? : stage N2
which NT is critical for initiating sleep? : seratonin release from raphe nuclei
EEG for stage N3 (deepest non REM sleep)? : deta waves (lowest frequency but hig
hest amplitude)
what happens in N3? : sleep waking, night terror and bedwetting
treatment for sleep waking, night terror and bedwetting? : benzodiazepine for ni
ght terrors / sleep walking; imipramine for bedwetting for decreasing stage 3 sl
eep
EEG for REM? : beta (same as during awake stage) and has sawtooth appearance
why do eyes move during REM? : paramedian pontine formation aka gaze center neur
ons
major NT in REM? : Ach
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changes in sleep in depression? : decreased slow-wave sleep, REM early and prolo
nged and repeated nighttime awakenings and early morning awakening
*** most important sleep indicator for depression? : early morning awakening
sleep pattern for narcolepsy? : they start with REM sleep rather than stage 1 sl
eep
what kind of hallucinations do narcoleptics experience? : hypnagogic (just befor
e sleep); hypnopompic (just before awakening)
what's cataplexy? : loss of all muscle tone upon awakening. can occur in some narc
oleptics
treatment for narcolepsy? : stimulants such as amphetamine and modafnil and sodi
um oxylate
what's the circadian rythmn driven by? : superchiasmatic nucleus of hypothalamus >
NE > pineal gland > melatonin (induces drowsiness at night)
what population is at risk for sleep terror? : children
what stage of sleep does sleep terror occur in? : N3
presentation of night terror? : patients usually have no recollection of episode
s. occurs in N3. usually self resolves