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A woman with anxiety about a gynecological exam is told to relax and to imagine going through the steps of the exam. What process does this exemplify?
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systematic desensitization
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63 year-old man is diagnosed with incurable metastatic pancreatic adenocarcinoma. His family asks you, the doctor, not to tell the pt. What do you do?
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Assess whether telling the pt will negatively affect his health. If not, tell him.
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A man admitted for chest pain is medicated for ventricular tachy. The next day he jumps out of bed and does 50 push ups to show 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 and invite a chaperone into the room if you feel your actions may be misinterpreted
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A large group of people is followed over 10 years. Every two 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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A girl can groom herself, hop on one foot, and has an imaginary friend. How old is she?
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4
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A 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 his diagnosis?
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Normal bereavement
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A 36-year-old woman with a strong family hx of breast cancer refuses a mamogram because she heard it hurts. What do you do?
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discuss risks and benefits; each pt must give consent so if the pt refuses, you must abide by her wishes
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A 4-year-old girl complains of a burning feeling in her genitalia; otherwise, she behaves and sleeps normally. Smear of the discharge shows N. gonorrhoeae. How was she infected?
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Sexual abuse
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A 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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The pt has the final say in his tx, but you should investigate the "funn"y feeling and see if there are other drugs that do not illicit this response
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During a particular stage of sleep, a pt 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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Comparing a group of people with a disease to a group of people without the disease is an example of what type of study?
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Case-control study: observational retrospective
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What types of measures are more common in retrospective case-control studies?
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Odds ratio (OR): Pts with COPD had higher odds of a hx of smoking than pts without COPD
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Comparing a group with a given risk factor to a group without in order to assess whether the risk factor increased the likelihood of disease is an example of what type of study?
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Cohort study: observational prospective
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What types of measures are more common in propsective cohort studies studies?
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Relative Risk (RR): "smokers had a higher risk for COPD than did nonsmokers"
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Collecting data from a group of people to assess frequency of disease (and related risk factors) at a particular point in timeis an example of what type of study?
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Cross-sectional study: observational
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Can cross-sectional studies prove causality of a risk to a disease?
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No. it can only show a risk factor association with a disease
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Comparing the frequency with which both monozygotic twins or both dizygotic twins develop a disease is an example of what type of study?
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twin concordance study
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Twin concordance studies measure what aspect of disease?
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heritability
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Comparing siblings raised by biologic vs. adoptive parents is an example of what type of study?
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Adoption study
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Adoption studies measure what aspects of disease?
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heritability plus environmental influences
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What type of study is of the highest quality?
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Randomized, double-blind, clinical trial
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What is the study sample and purpose of a Phase I clinical trial?
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small # of pts, usually nml volunteers; assess safety, toxicity, and pharmacokinetics
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What is the study sample and purpose of a Phase II clinical trial?
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small # of pts with dz of interest; assess tx efficacy, optimal dosing, and adverse effects
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What is the study sample and purpose of a Phase III clinical trial?
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lg # of pts randomly assigned to either tx, best available tx, or placebo; compare new tx to current standard of care
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What is the purpose of a metaanalysis?
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Pools data from several studies; acheives greater statistical power and integrates results of similar studies
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How do you calculate prevalence?
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Prevalence =total cases in a population at a given time/total population at risk
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How do you calculate incidence?
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Incidence = new cases in a population ove a given time period/total population at risk during that time
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Incidence is new incidents |
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What is the general relationship between prevalence and incidence for chronic diseases (e.g., diabetes)?
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Prevalence > incidence
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What is the general relationship between prevalence and incidence for acute diseases (e.g., ommon cold)?
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prevalence = incidence
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The sensitivity of a test is a measure of what?
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the percent of people with the dz who test positive
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A high sensitivity value is desirable for what diagnsotic decisions?
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Desirable for ruling-out dz
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SNOUT=SeNsitivity rules OUT |
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Using the 2x2 table comparing test results ro actual presence of disease, how do you measure sensitivity?
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a/(a+c)
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The specificity of a test is a measure of what?
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Percent of people without the disease who test negative
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A high specificity value is desirable for what diagnsotic decisions?
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desirable for ruling-in a disease
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SPIN=Specificity rules IN |
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Using the 2x2 table comparing test results ro actual presence of disease, how do you measure specificity?
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d/d+b
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A positive predictive value (PPV) measures what?
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Percent of positive test results that are true-positives
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Using the 2x2 table comparing test results ro actual presence of disease, how do you measure positive predictive value?
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a/(a+b)
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A negative predictive value measures what?
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Percent of negative results that are true-negative
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Using the 2x2 table comparing test results ro actual presence of disease, how do you measurenegative predictive value?
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d/d+c
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How do you measure the Odds Ratio and for which studies are Odds Ratios used?
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Odds of having a dz in exposed group/odds of having dz in unexposed group; case control studies
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How do you measure the relative risk and for which studies are relative risks used?
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Relative probablility of getting the dz in exposed group versus the unexposed group; cohort studies
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What is the attributable risk?
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The differenc in risk between exposed and unexposed groups; the % of dz occurences that are the result of exposure
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Using the 2x2 table comparing risk factor to disease, how do you calculate odds ratio?
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OR=(a/b)/(c/d)=ad/bc
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Using the 2x2 table comparing risk factor to disease, how do you calculate relative risk?
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RR=[a/(a+b)]/[c/(c+d)]
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Using the 2x2 table comparing risk factor to disease, how do you calculate attributable risk?
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AR=(a/a+b)-(c/c+d)
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What is the difference between precision and accuracy?
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precision is the consistence and reproducibility of a test and the absence of random variation; accuracy is the trueness of the test measurements
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In general, what is bias?
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When one outcome is systematically favored over another outcome
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What are the four categories of bias?
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1. Selection bias (nonrandom) 2. Recall bias 3. Sampling bias (nonrepresentative subjects) 4. Late-look bias (inappropriate time)
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What are four ways to reduce bias?
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1. blind studies 2. placebo responses 3. crossover studies 4. Randomization
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