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Woman with anxiety about a gynecological exam is told to relax and imagine going through the steps of the exam.
What process does this exemplify?
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Systematic desensitization.
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65-year old man is diagnosed with incurable metastatic pancreatic adenocarcinoma. His family asks you, the doctor, not to tell the patient.
What do you do?
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Assess whether telling the patient will negatively affect his health. If not, tell him.
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Man admitted for chest pain is medicated for ventricular tachycardia. The next day he jumps out of bed and does 50 pushups to show the nurses he has not had a heart attack.
What defense mechanism is he using?
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Denial.
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You find yourself attracted to your 26-year-old patient.
What do you say?
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Nothing! The tone of the interview must be professional ... if you feel your actions may be misinterpreted, have a chaperone in the room.
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Large group of people is followed over 10 years. Every 2 years, it is determined who develops heart disease and who does not.
What type of study is this?
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Cohort study.
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Girl can groom herself, can hop on 1 foot, and has an imaginary friend.
How old is she?
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4 years old.
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Man has flashbacks about his girlfriend's death 2 months ago following a hit-and-run accident. He often cries and wishes for the death of the culprit.
What is the diagnosis?
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Normal bereavement.
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36-year old woman with a strong family history of breast cancer refuses mammogram because she heard it hurts.
What do you do?
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Discuss the risks and benefits of not having a mammogram. Each patient must give her own informed consent to each procedure. If the patient refuses, you must abide by her wishes.
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During a particular stage of sleep, man has variable blood pressure, penile tumescence, and variable EEG
What stage of sleep is he in?
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REM sleep.
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15 year old girl of normal height and weight for her age has enlarged parotid glands but not other complaints. The mother confides that she found laxitives in the daughter's closet.
What is the diagnosis?
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Bulimia.
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11-year old girl exhibits Tanner stage 4 sexual development (almost full breats and pubic hair).
What is the diagnosis?
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Advanced stage, early development.
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4 year old girl complains of a burning feeling in her genitalia; otherwise she behaves and sleeps normally. Smear of discharge shows N. gonorrhoeae.
How was she infected?
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Sexual abuse.
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72 year old man insists on stopping treatment for his heart condition because it makes him feel "funny"
What do you do?
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Although you want to encourage the pt to take his meds, the pt has the final say in his own rx regimen. you should investigate the "funny" feeling and determine if there are drugs available that won't elicit this particular side effect.
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Person demands only the best and most famous doctor in town.
What is the personality disorder?
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Narcissism.
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Nurse has episodes of hypoglycemia; blood analysis reveals no elevation in C-protein.
What is the diagnosis?
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Factitious disorder, self scripted insulin.
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55 year old businessman complains of lack of successful sexual contacts with women and an inability to reach a full erection. Two years ago he had a heart attack.
What might be the cause of his problem?
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Fear of sudden death during intercourse.
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Observational Study. Sample chosen on presence of absence of disease. Information collected about exposure.
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Case-control Study.
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Often retrospective |
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Observational study. sample chosen based on presence of absence of risk factors. Subjects followed over time for development of disease.
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Cohort Study.
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The Framingham heart study. |
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Pooling data from several studies (often via a literature searach) to acheive greater statistical power.
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Meta-analysis.
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Cannot overcome limitations of individual studies or bias in study selection. |
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Experimental study. compares therapeutic benefit of 2 or more treatments, or treatment and placebo.
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clinical trial.
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Highest-quality study when randomized and double blinded.
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List 4 ways to reduce bias in a study.
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1. Blind studies.
2. Placebo responses.
3. Case-crossover design.
4. Randomization
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When the subjects choose the groups it may lead to what type of bias?
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Selection bias.
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When knowledge of the presence of the disease alters recall by the subjects what type of bias is likely?
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Recall bias.
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When subjects are not representative of the population and results are not generalizable, what type of bias is this?
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Sampling bias.
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When information gathered on subjects is done so at an inappropriate time, what bias is likely?
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Late-look bias.
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The total proportion of cases in a population at a given time.
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Prevalence.
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The rate of new cases in a population in a given time.
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Incidence.
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Incidence x Disease Duration
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Prevalence
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For chronic diseases, which is larger - prevalence or incidence?
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Prevalence > Incidence for Chronic Disease
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When does prevalence = incidence?
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For acute disease (ie the common cold)
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What is sensitivity?
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TP/(TP+FN) x 100 = Sensitivity
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When is high sensitivity desirable?
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In a screening test.
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SNOUT = Sensitivity Rules Out |
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What is 1-sensitivity?
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False negative ratio.
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What is specificity?
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TN/(TN+FP) x 100 = specificity
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What is 1-specificity?
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False positive ratio.
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When is high specificity desirable?
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In a confirmatory test.
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SPIN = specificity rules in. |
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What is the PPV?
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The probability of having a condition given a positive test.
TP/(TP+FP) = PPV
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What is NPV?
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The probability of not having the condition given a negative test.
TN/(TN+FN) = NPV
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Unlike sensitivity and specificity, the predictive values are ....
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dependent on the prevalence of disease. The higher the prevalence of disease, the higher the predictive value of the test.
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a/(a+c)
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sensitivity
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d/(b+d)
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specificity
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a/(a+b)
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PPV
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d/(c+d)
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NPV
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(a/b)/(c/d)
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OR - approximates RR if prevalence of disease is not too high.
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Used in case control studies |
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[a/(a+b)]/[c/(c+d)]
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RR - relative risk
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Used in cohort studies |
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Attributable risk formula?
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[a/(a+b)]-[c/(c+d)]
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The consistency and reproducibility of a test is the ....
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Precision.
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Absence of random variation in a test ....
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Precision.
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The trueness of the test measurements is the ...
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Accuracy
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Reduced precision means
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increase in random error
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