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Behavioral
Question Case control study Odds ratio (ex: pts with COPD have higher odds of having a histroy of smoking) Cohort study Relative risk (smokers have higher risk of developing COPD than nonsmokers) Cross sectional study (doesn't establish a risk factor causality) Disease prevalence Heritability Heritability and environmental influence Phase I Phase II Phase III Meta-analysis (increases the power of the study) Quality of individual studies and bias Total cases in a given population at a given time / total at risk population (how many people at a single point in time have the disease) Answer A study that compares a group of people affected with a disease to a group without the disease (objective and retrospective) What measure can a case control study tell you? Study that compares a given risk factor to a group without the risk factor (assesses whether risk factor increases likelihood of disease, objective and prospective) What measure can a cohort study tell you? Study that assesses frequency of disease (and risk factors) at a particular point in time What measure can a cross sectional study tell you? What does twin concordance study measure? What does an adoption study measure? Small number of healthy volunteers. Assesses safty, toxicity, and pharmacokinetics. Small number of diseased patients. Assesses efficacy, dosing and adverse effects. Compares the new treatment to the current standard of care. Uses a large number of patients. Pooled data from several studies integrated. What is meta analysis limited by? Prevalence

New cases during a given time period / total at risk population during that same time Incidence period Prevalence a/(a+c) or 1-false negative rate Sensitivity (1 Specificity (1 d/(d+b) or 1 - false positive a/(a+b) Incidence X disease duration Sensitivity equation low false negative rate) low false positive rate) Specificity equation Positive predictive value equation
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YKS Positive predictive value (probablity that person with positive test actually has the disease)

Proportion of positive test results that are true positives

Negative predictive value (probability that a persond oesn't have the disease if they give Proportion of test results that are true negative a negative test) d/(c+d) (a/b)/(c/d) Odds ratio [a/(a+b)] / [c/(c+d)] Relative risk [a/(a+b)] - [c/(c+d)] Attributable risk Precision Random Systematic Accuracy Selection bias Recall bias Sampling bias Late-look bias Procedure bias 1. blind studies (double blind Crossover study Bimodal Gaussian Positive skew Negative skew Null hypothesis (H0) Alternative hypothesis (H1) Type I error (alpha) Type II error (beta) Negative predictive value equation Odds ratio equation Chances of having a disease in an exposed group compared to an unexposed group Relative risk equation Probability of getting a disease in an exposed group compared to an unexposed group Attributable risk equation The proportion of disease occurences that are a result of exposure to a risk factor Consistency and reproducability of a test. Type of error that reduces precision in a test Type of error tat reduces accuracy in a test Trueness of test measurements (validity) Caused by nonrandom assignment to a study group Caused by altered recall by subjects caused by knowing they have the disorder Caused by subjects being not representative of the population Caused by information being gathered at an innapropriate time Caused by subjects in different groups not being treated the same. best) 2. placebos 3. crossover studies 4. randomization Each subject acts as their own control (each pt gets placebo and treatment at some point) A statistical distribution with two humps Normal bell shaped curve (mean Asymetric distribution with tail on right (mean > median > mode) Asymetric distribution with tail on the left (mean < median < mode) Hypothesis that states there is no correlation Hypothesis that there is some correlation Stating that there is an effect when none exists (accepting an expirimental hypothesis when the null is true) Stating there is not an effect when one exists (failure to reject null hypothesis when it's false)
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Probability YKSmaking a type one error is of judged against alpha (a preset level of significance usually <.05) B (Beta) Power

Calculating probablity of making a type one error (p) The probabiliy of making a type one error 1 - Beta

1. total number of end points 2. difference in compliance (difference in mean values Three things that effect power between groups) 3. size of expected effect Increase sample size n Sigma SEM Sampling distribution of the mean (SEM or Z) SEM < sigma; as n increases, SEM decreases 68% 95% 99.7% Confidence interval t-test (Mr. T is mean) ANOVA (ANalysis Of VAriance) x2 test Correlation coefficient (r) Coefficient of determination (r2) PDR (1. prevent, 2. detect, 3. reduce disability) How do you increase power? Variable used for sample size in biostatistics Variable used for standard deviation in biostatistics (standard error of the mean, [sigma / sqrt(n)]) the standard deviation of the sampling distribution of the mean The range of means you might get if you averaged a subpopulation of values from a bigger population (will be slightly different than the whole populations mean due to chance) Relationships of SEM to standard deviation and sample size Population range that falls within 1 SD of the mean Population range that falls within 2 SD of the mean Population range that falls within 3 SD of the mean A range of numbers that encompasses the value that would be obtained if an experiment was performed many times (necessary because the valuemight change slightly each time) (a range from mean - Z to mean + Z; where Z is SEM; 95% (CI) Checks the difference between the means of two groups Checks the difference between the means of 3 or more groups A test that compares different percentages or proportions A range from -1 to 1 that describes how well two variables correlate (correlation coefficient)2 Mnemonic for stages of disease prevention

Hep, hep, hep, hooray, the SSSMMART Chick is Gone (hep a, b, c, HIV, Salmonella, Mnemonic for reportable diseases shigella, syphilis, measles, mumps, aids, rubella, tuberculosis, chickenpox, gonorrhea) MedicarE Medicare part A Autonomy, beneficence, nonmaleficence, justice Physicians have a fiduciary (special ethical)
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Elderly, medicaiD hospital; Medicare part B Core ethical principles of healthcare

duty to act YKSthe patient's best interest, and in Beneficence allow them the right to make an informed decision if possible "Do no harm" Nonmaleficence 1. discussion of pertinent information, 2. patient agrees with plan of care, 3. patient is Legal requirements of informed consent (3) free from coercion 1. Legally incompetent 2. Implied consent (emergency) 3. Therapeutic priveledge 4. Waiver Therapeutic priviledge Minor is married or emancipated Only if the patient revokes the power. What are the 4 exceptions to informed consent Withholding information when disclosure would harm the patient or undermine the outcome When do you not need parental consent for a minor? In a written advance directive, when is the surrogate's power revoked?

1. Potential harm to others 2. Likely to harm self 3. No alternative means to wanr/protect What are the 4 exceptions to confidentiality those at risk 4. Physician can prevent harm Tasaroff decision Law requiring physician to directly inform and protect a potential victim from harm (even if it breaches confidentiality)

1. the Dr had a duty to that patient 2. The doctor breached that duty 3. The patient Duty, Dereliction, Damage, Direct) suffered harm 4. The breach of duty caused the harm (4 D's Depends on the state Can a teenager request an abortion? 1. emergency situations 2. STD treatment 3. during pregnancy 4. drug addiction 5 times when parental consent is not required management 5. contraception Parents decidewhat a child will be told about Does a child have a right to know about their illness? their illness APGAR score Low birth weight Development from birth - 3 months Development at 3 months Development from 4-5 months Development from 7-9 months (baby crawls away from a stranger) Development from 12-14 months Development at 15 months Babinski disappears Walks, few words, separation anxiety (child can walk and is experiencing rapprochement (goes from mom then returns))
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Appearance, pulse, grimace, activity, respiration (2 is perfect, 0 is nothing) < 2500 g at birth, increased incidence of infections, persistent fetal circulation, respiratory distress syndrome Rooting reflex Hold head up, social smile, moro (startle) reflex disappears (baby holds his head up and smiles) Rolls front to back, sits up when propped, recognizes people (baby recognizes mom as she props him up) Sits alone, crawls, stranger anxiety

Development at year 1 Development at year 2

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Climbs stairs, object permanence, stacks 3 cubes, rapprochement Two-word sentences (telegraphic), stacks 6 blocks, 200 word vocab, says "no," names objects, transition objects (security blanket) Complete sentences, stacks 9 blocks, 900 word vocab, rides tricycle, toilet training (pee at three) alternates feet upstairs, strangers can understand, can take turns, draws a circle (child goes to preschool) Uses compound sentences and can tell stories, counts 3 objects, imagination and imaginary fears, alternates feet down stairs, draws a cross (then a rectangle at 4 1/2) Asks the meaning of words, counts 10 objects, complete sphincter control, dresses and undresses, oedipal phase, conformity to peers important, brain 75% of adult size, draws a square (child goes to kindergarden) Refined motor skills, rides bicycle, rules of the game, demonstrates competence, law of conservation, develops conscience, shifts from egocentric speech Growth spurts, onset of sexual maturation, personal identity and conformity is important, personal speech patterns, systematic problem solving, handles hypotheticals Slower erection, vaginal dryness, (dec) REM sleep, (inc) REM latency, (dec) incidence psychiatric illnesses, (inc) suicide, (dec) renal / GI function, (dec) muscle; (intelligence and sexual interest do not decrease) 1. Childhood, 2. adrenarche (pubic hair), (inc) testes / breast size, 3. (inc) darkness of pubic hair, penis length, 4. development of glans, (inc penis length), raised areolae 5. Adult, areolae no longer raised (lasts 6 months to 1 year) (can last 1 year or be excessively intense) Depressive symptoms, delusions, hallucinations, can be caused if grief is denied or inhibited Denial, anger,bargaining, grief, acceptance (inc) free fatty acids, corticosteroids, lipids, catecholamines, cholesterol; affects water absorption, muscle tone, gastrocolic reflex Drugs (neuroleptics, SSRIs, etc.), diseases (depression), psychological (performance anxiety) (body mass index) Weight in kg / height in m squared "at night" BATS Drink Blood

Development at year 3

Development at year 4

Development at year 5

Development from ages 6-12

Development at > 12 years

Changes in elderly

Tanner stages of sexual development Normal grief symptoms Shock, denial, guilt, illusions Pathologic grief Kubler-Ross grief stages Effects of stress Causes of sexual dysfunction BMI Sleep stages Beta (awake), alpha (drowsy), Theta (light sleep), sleep spindles and K complexes

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YKS (deeper sleep), delta (deepest sleep), beta (REM)

Features of delta sleep Features of REM sleep Narcolepsy symptoms Cataplexy

Night terrors, sleep walking, bed wetting, imipramine and benzodiazapines reduce stage 4 sleep Erection, increased O2 use, memory functions; 5-HT from raphe nucleus initiates sleep, ACh mediates REM sleep, NE reduces REM sleep, PPRF activity (eye movements) Hypnagogic / hypnapompic hallucinations, narcoleptic episodes and normal sleep start with REM sleep Loss of all motor tone after a strong emotional stimulus

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