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BR-Epidemiology&BM
5/31/06
| Question | Answer |
|---|---|
| woman w/anxiety about gyn exam is told to relax and imagine going thru steps of exam is an example of: | systematic desensitization |
| a 65yo man diagnosed w/incurable metastatic pancreatic adenocarcinoma; his family asks you not to tell the patient, what do you do? | assess whether telling pt will negatively affect his health. if not, tell him |
| man admitted for chest pain is medicated for V-tach; the next day he jumps out of bed and does push ups to show nurses he didn't have a heart attack; what is this defense mechanism? | Denial |
| You find yourself attracted to a 26yo patient; what do you say? | NOTHING! the tone of interview must be professional; if you feel your actions could be misinterpreted, invite a chaperone into the room |
| large group of people is followed for 10yrs, every 2 yrs heart disease is assessed; what kind of study is it? | Cohort |
| Girl can groom herself, can hop on one foot and has an imaginary friend, how old is she? | 4 |
| man has flashbacks about girlfriend's death 2 months ago following an accident. he often cries and wishes he had died; what is the diagnosis? | normal bereavement |
| 36yo woman w/strong family h/o breast cancer refuses a mammogram b/c she heard it hurts; what do you do? | discuss risks/benefits. she must make her own decision after being informed |
| during what stage of sleep is there variable BP, penile erection and variable EEG? | REM |
| 15yo girl of normal height and wt has enlarged parotid glands, but no other complaints. the mother confides that she found laxatives in her daughter's closet; what is dx? | bulimia nervosa |
| 11yo girl exhibits Tanner stage 4 sexual development (almost full breasts and pubic hair), what is diagnosis? | advanced stage, early development |
| 4yo girl complains of burning in her genitalia; otherwise she behaves and sleeps normally; smear of discharge has N. gonorrhea, how was she infected? | sexual abuse |
| 72yo man insists on stopping treatment for heart condition b/c it makes him feel funny; what do you do? | investigate the "funny" feeling and determine if you can switch drugs w/o this side effect |
| Person demands the best doctor in town, why? | he is Narcissistic |
| Nurse has episodes of hypoglycemia, blood has no elevated C-ptn; why? | she's self administering insulin; this is a factitious disorder |
| 55yo businessman cannot get erection; 2 years ago he had a heart attack, what might be causing his problem | fear of sudden death during intercourse |
| Case-control study | observational; often retrospective; sample chosen based on presence or absence of dz; information is collected about risk factors |
| Cohort study | observational study; sample chosen based on presence or absence of risk factors; subjects followed over time for development of disease; ex: Framingham heart study |
| Meta-analysis | pooling of data from several studies (usu via literature search) to achieve greater statistical power; cannot overcome limitations of individual studies or bias in study selection |
| Clinical Trial | Experimental study; Compares therapeutic benefit of 2 or more treatments or treatment and placebo; Highest-quality study when Randomized and Double-blinded |
| Selection bias | subjects choose group |
| Recall bias | knowledge of presence of disroder alters recall by subjects |
| Sampling bias | subjects are not representative; the results are not generalizable |
| Late-look bias | information gathered at an inappropriate time |
| What are 4 ways to reduce bias of one outcome being more likely than another? | blind studies, placebo responses, crossover studies (each subject acts as own control), randomization |
| Prevalence | the total number of cases in a population at a given time |
| Incidence | the number of new cases in a population per unit time |
| How do you calculate disease prevalence? | Multiply the Incidence by the Disease Duration |
| What is the relationship btw prevalence and incidence for chronic diseases (ex: diabetes)? | the prevalence is greater |
| What is the relationship btw prevalence and incidence for acute diseases (ex: common cold)? | the prevalence is equal to the incidence |
| Sensitivity calculation | number of true positives divided by the number of all the people with the disease |
| What does the sensitivity rule? | it rules out those without the disease |
| When do you want a high sensitivity? | for screening tests; the false negative ratio is 1 minus the value |
| Specificity calculation | number of true negatives divided by the number of all people without the disease |
| What does specificity rule? | it rules people with the disease in |
| When do you want a high specificity? | in a confirmatory test |
| Positive Predictive Value (PPV) calculation | number of true positives divided by the number of people who tested positive for the disease |
| What does the positive predictive value tell you? | the probability of having a condition, given a positive test |
| Negative predictive value (NPV) calculation | number of true negatives divided by the number of people who tested negative for a disease |
| What does the negative predictive value tell you? | the probability of NOT having the condition, given a negative test result |
| Unlike sensitivity and specificity, the predictive values are.... | dependent on the prevalence of the disease in the population |
| The higher prevalence of a disease... | the higher the positive predictive value of the test |
| Odds Ratio Calculation | the odds of having a disease in exposed group divided by the odds of having a disease in a non-exposed group; (this is calculated within a group as number with disease divided by number without disease) |
| What does the Odds Ratio approximate? | The relative risk (if the prevalence of the disease is not too high) |
| When is the Odds Ratio used? | for case-controlled (restrospective) studies |
| Relative Risk | The disease risk in an exposed group divided by the disease risk in an unexposed group; (calculated within a group as the number with the disease divided by the total number of people in the group) |
| What is Relative Risk used for? | Cohort studies |
| Define Precision | the consistency and reproducibility of a test (reliability); The absense of random variation in a test |
| Define Accuracy | The trueness of test measurements |
| Rreduced precision in a test causes: | Random Error |
| Reduced accuracy in a test causes: | Systematic Error |
| When is a test reliable? | when repeat measurements are the same; the test is reproducible and dependable |
| When is a test valid? | if it measures what is supposed to be measured; it truly measures what it is supposed to; it is appropriate |
| Normal Statistical Distribution is... | Gaussian; Bell-shaped...the median = the mode = the mean |
| What is a bimodal distribution? | 2 humps |
| Positively Skewed Distribution | there is asymmetry with the tail on the right; the mean > median > mode |
| Negatively Skewed Distribution | the tail is on the left; mean < median < mode |
| Null Hypothesis (H0) | is the hypothesis of no difference; there is no association between the disease and the risk factor in the population |
| Alternative Hypothesis (H1) | hypothesis that there is some difference; ex: there is some association between the disease and the risk factor in the population |
| Type I error (alpha) | states there is an effect or difference when none exists (to mistakenly accept the experimental hypothesis and reject the null hypothesis); alpha is a preset level of significance (usu p < .05) |
| p value | the probability of making a type I error |
| What does a p value < .05 mean? | there is less than a 5% chance that the data will show something that is not really there |
| What does alpha stand for? | is means you "saw" a difference that did not exist (for example, convicting an innocent man) |
| Type II error (beta) | States that there is NOT an effect of difference when one exists; (to fail to reject the null hypothesis when in fact H0 is false) |
| What does beta stand for? | the probability of making a type II error; you did not "see" a difference that does exist (ex: setting a guilty man free) |
| Power in statistics means... | the probability of rejecting the null hypothesis when it is in fact false; it depends on the total number of end points experienced by the population AND the difference in compliance btw treatment groups (differnces in the mean values btw grps) |
| What do you do to the power if you increase the sample size? | you increase it; there are no numbers; it equals 1 minus beta |
| When do you accept the null hypothesis? | When the confidence interval includes zero |
| What is the confidence interval? | the mean +/- 1.96 |
| What is the purpose of a t-test? | to check the difference between the means of 2 groups |
| What does ANOVA (analysis of variance) do? | it checks the difference btw the means of 3 or more groups |
| What does X^2 (chi square) do? | it checks the difference btw 2 or more percentages or proportions of categorical outcomes (not mean values) |
| Correlation coefficient (r) | it is always between -1 and +1; an Absolute value indicates strength of correlation btw 2 variables |
| What are the 3 tiers of disease prevention? PDR | Prevent (ex: vaccine), Detect (ex: Pap smear), Reduce disability (ex: exogenous insulin for diabetes) |
| Prevention measures for Diabetes | eye, foot exams; urine tests |
| Prevention measures for Drug Abuse | HIV, TB tests; hepatitis immunizations |
| Prevention measures for Alcoholism | Influenza, Pneumococcal immunizations; TB test |
| Prevention measures for Overweight | blood sugar tests for diabetes |
| Prevention measures for Homeless, recent immigrant | TB test |
| Prevention measures for High-risk sexual behavior | HIV, hepatitis B, syphilis, gonorrhea, chlamydia tests |
| What are the reportable diseases? B. A. SSSMMART Chicken or you're Gone | HBV, HAV, Salmonella, Shigella, Syphilis, Measles, Mumps, AIDS, Rubella, TB, Chickenpox, Gonorrhea |
| Leading cause of death in infants | congenital anomalies, short gestation/low birth wt, SIDS, maternal complications of pregnancy, respiratory distress syndrome |
| Leading cause of death in 1-14yo | injuries, cancer, congenital anomalies, homicide, heart disease |
| Leading cause of death in 15-24yo | injuries, homicide, suicide, cancer, heart disease |
| Leading cause of death in 25-64yo | cancer, heart disease, injuries, suicide, stroke |
| Leading cause of death in 65+ | heart disease, cancer, stroke, COPD, pneumonia, influenza |
Created by:
bscaryp