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Ethics ( #74-97)

Terms in this set (96)

Incidence
Prevalence
chronic conditions like diabetes- incidence much lower than prevalence.
as disease duration decreases- incidence and prevalence may be close to equal
Case fatality rate
Relative risk*****
Odds ratio*****
Calculation of disease risk
Attributable risk
Relative risk equation and interpretation
In a population of sexually active people, 20% have HPV infection. In a population of people who are not sexually active, only 5% have HPV infection. What is the attributable risk of sexual activity to HPV?
Absolute risk reduction
Number needed to treat
How do you calculate confidence intervals?
What is the equation for odds ratio? What is the equation for relative risk?
When is the odds ratio a good approximation of relative risk?
When the prevalence is low
What does it mean when the relative risk is equal to one?
No association between the risk factor and the disease
What is most important in a screening test? In a confirmatory test?
What equations represent sensitivity, specificity, positive and negative predictive values when using antibodies to x to detect disease x?
Antibodies to x vs. autoimmune disease x:
Present/present 800
Absent/present 100
Present/absent 200
Absent/absent 1400
Assuming a normal bell-shaped distribution, what percentage of the study population falls within 1 standard deviation, 2 standard deviations and 3 standard deviations of the mean?
Odds ratio vs. relative risk
odds ratio is close to relative risk when the prevalence of a disease is low. (A and C become negligible)
Attributable risk
Diagnostic tests- Sensitivity, specificity, PPV, NPV
Sensitivity
Specificity
High and low prevalence vs. positive and negative predictive values
if prevalence is low (say ovarian cancer), the positive predictive value of CA-125 is low. Most women who have a positive CA-125 do not have ovarian cancer.
PPV and NPV
Positive likelihood ratio
Odds of having a positive test result in individuals with a disease, compared to the odds of a positive result in those without the disease.

HIV test: infected person should test positive, non-infected should test negative.
Negative likelihood ratio
Negative likelihood ratio: odds of having a negative test result in individuals with a disease, compared to the odds of a negative result in those without the disease
Analysis of diagnostic tests
Likelihood ratios
Accuracy
Types of error
Statistical significance
Power
Type I error
Type II error
Which antihypertensive class is first-line in patients with the following conditions?
No comorbidities
Diabetes
Heart failure (multiple)
What are 4 signs and symptoms of strep pharyngitis?
What are the usual imaging studies in a trauma series?
Which antihypertensive class is first-line in patients with the following conditions?
BPH
Left ventricular hypertrophy
Hyperthyroid
Osteoporosis
Which antihypertensive class is first-line in patients with the following conditions?
Benign essential tremor
Post-menopausal female
Migraines
Study requirements
Randomized clinical trial
Cohort study
Case control study
Cross-sectional survey
Case series
meta-analysis
Types of bias:
Enrollment/selection
Types of bias:
Investigator
Types of bias:
Lead Time
Types of bias:
Length
Types of bias:
Observational
Types of bias:
Publication
Types of bias:
Recall
Types of bias:
Self-selection
Identify the study design:
Identifies 2 groups: Diseased group and healthy group. Retrospectively compares them. Weakened by recall and selection biases.
Case control study
Identify the study design:
Seeks to estimate disease prevalence and exposure across a population
Cross-sectional survey
Identify the study design:
Examines a collection of studies on a given subject
Meta-analysis
Identify the study design:
Prospective blinded study involving placebos, existing therapies and experimental interventions
Randomized clinical trial
Identify the study design:
Focuses on ONE group with a shared exposure or disease and either prospectively or retrospectively compares them
Cohort study
Identify the study design:
Examines a collection of cases to seek insight into the diseases of interest. Useful in rare diseases.
Case series
Identify each type of bias:
Memory erros produce incorrect data
Recall bias
Identify each type of bias:
subject awareness of being studied alters their answers and behavior from normal
Observational bias
Identify each type of bias:
certain medical studies attract subjects with particular medical histories rather than general population
Self-selection bias
Identify each type of bias:
studies that show a difference are preferably published and then later included in meta-analysis rather than studies that support the null hypothesis
Publication bias
Identify each type of bias:
Screening tests designed to detect asymptomatic disease may miss rapidly-progressive disease because the interval between successive screenings only detects slowly-progressive ones.
Length bias
Identify each type of bias:
Screening test may allow earlier diagnosis of disease but does not translate into actual length of survival.
Lead-time bias
What is the treatment for Guillain-Barre syndrome?
Plasmapheresis or IVIG
Give one or the other
Earlier is better.
Then supportive care. 30% may need mechanical ventilation.
What is the cause of chest pain in a young patient that has angina at rest with ST segment elevation but normal cardiac enzymes?
Prinzmetal's angina
What infection can cause diarrhea and pseudoappendicitis?
Yersinia enterocolitica
A smoker has rapid onset JVD, facial swelling and altered mental status. What is the treatment?
Superior vena cava
A 24-year old woman comes to the clinic for a checkup and is found to have markedly elevated BP. She is at a recommended body weight, follows a good diet, exercises and does not smoke or use birth control. What might be the cause of her HTN? What might be seen on radiological imaging?
Renal artery stenosis caused by fibromuscular dysplasia
Angiogram would show "Beads on a string" appearance on renal artery angiogram.
Which oral hypoglycemic medicine should not be given when a patient is to have a radiologic procedure in which he will need IV contrast?
Metformin
The mother of an adolescent boy wants you to ask her son (your patient) if he is gay. How do you proceed?
You can ask about their sexuality as it pertains to the patient's health, but can't convey that information back to family members.
What are the 4 elements of a malpractice claim?
What are the 2 ways that the standard of care can be established in a malpractice case?
Expert testimony
Doctrine of "Res ipsa loquitur" = "it speaks for itself" ex: surgical sponge left behind.
A surgical sponge is left behind in a patient's abdomen following a laparotomy. The hospital, the surgeon, scrub nurse and circulating nurses are all named in the subsequent malpractice suit. T he surgeon claims that the scrub nurse, (not the surgeon) is responsible for making sure that the sponge count was correct. Why does this argument not free the surgeon from legal liability?
Legal principle of "vicarious liability"
Supervisor liable.
What should you do in the case of a child's parents refusing a clearly life-saving tx for their child in an emergency situation?
Under what circumstances are you allowed to break confidentiality with a patient?
A cancer patient is emergently intubated in the ER after a motor vehicle accident. The patient's family brings you a DNR signed by the patient stating that she doesn't wish to be intubated. What do you do next?
Extubate the patient
Withdrawal of care is the same as withholding the care in the first place.
Where in the US is euthanasia legal?
A patient has a living will that states he doesn't want to be placed on a ventilator. His wife tells you to place him on the ventilator for one week and then remove it if he's not improving. What should you do in this scenario?
Should not intubate this patient
Why can a heavily intoxicated patient refusing medical intervention be treated temporarily against his will?
Confidentiality
Public reporting
When is confidentiality not mandated?
Informed consent and full disclosure
Capacity
Physicians determine capacity, judges determine competence
Durable power of attorney and living will
DNR
Life Support
Physician aided death
Death
Organ donation
Required things for public reporting
can break confidentiality
can also report impaired ability to drive
child abuse
elder abuse
Physician assisted suicide
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