Social Sciences

Question 1

Which is the most important principle of medical ethics?

Answer 1

autonomy generally supersedes all else

Question 2

A patient has an advanced directive indicating he would like to be resuscitated in the event of cardiac death. However, during this hospitalization he has been found to have capacity and communicates the desire for DNR. He then goes unconscious and codes, what is the best next step?

Answer 2

fulfill the DNR request because it is the last known wish of the patient, which should be followed even if there is contradicting documentation filled out before

Question 3

What is the order of decision making in health care?

Answer 3

1. last known wishes of the patient, verbal or documented
2. advanced directive that includes an agent to carry out wishes
3. living will
4. persons clearly familiar with the patient’s wish (e.g. a friend who can prove she knew the patient’s wishes)
5. family (spouse first then adult children)
6. if the family is split, go to an ethics council or court order

Question 4

What role does the ethics committee play in medical decision making?

Answer 4

• resolving an unclear advance directive
• resolving issues of medical futility when an individual asks for tests and treatments that may have no benefit
• resolving disputes between family members with the same “rank” of decision making

Question 5

Rule #1 for health care decision making is what?

Answer 5

honor the last known wishes of the patient regardless, even if this is a wish expressed verbally in contradiction to an earlier written wish

Question 6

What role does a court order play in medical decision making?

Answer 6

this is useful in resolving issues on which the family is in disagreement and an ethics committee cannot reach a conclusion

Question 7

Minors have what medical decision-making capacity?

Answer 7

they are able to consent for contraception, prenatal care, substance abuse treatment, and STD treatment

Question 8

What happens if a patient is declared brain dead and the family would like to continue care?

Answer 8

brain death is legal death and as such, a physician does not need consent to stop therapy

Question 9

Who must obtain consent?
When is consent needed?
Who has decision making capacity for unborn babies?
What modes of interaction are acceptable for obtaining consent?

Answer 9

• the person performing the procedure must get consent
• consent is needed for each individual procedure
• mothers have the decision making capacity for their unborn children
• all modes are acceptable, including consent gained via telephone encounter

Question 10

What does a DNR include? How does this affect medical care?

Answer 10

• a DNR only means that if the patient dies, he or she should not undergo resuscitation
• these patients can still receive antibiotics, chemotherapy, and even surgery

Question 11

What is the law of double effect?

Answer 11

medications can be given that will hasten death as long as this is simply an adverse effect and the intent is to relieve pain

Question 12

What is futile care?

Answer 12

futile care is that which will offer no benefit and the physician is not obligated to provide it even if a patient or family member is request it; go to the ethics committee to resolve this issue

Question 13

Donation of which tissues can be financially compensated?

Answer 13

donation of renewable tissues like sperm, eggs, and blood products

Question 14

True or false, family members can refuse organ donation even if the patient has an organ donor card?

Answer 14

true

Question 15

When can confidentiality be broken?

Answer 15

when there is danger to others, including transmissible diseases, and when there is a court order

Question 16

From whom can physicians accept gifts?

Answer 16

small gifts can be accepted from patients as long as they are not tied to specific requests; however, gifts are never acceptable from industries such as drug companies

Question 17

Which types of abuse can be reported without consent? Which require consent?

Answer 17

• elderly and child abuse can be reported without or against the consent of the patient
• domestic violence requires consent of the patient

Question 18

How should you handle impaired drivers?

Answer 18

suggest the patient find another means of transportation but do not confiscate keys, refuse to let the individual leave, or hospitalize the patient

Question 19

What is the answer to any torture question and ethics?

Answer 19

the answer is “no” to any level of involvement, even if the role is to protect the patient against permanent harm

Question 20

What do sensitivity, specificity, PPV, and NPV indicate?

Answer 20

• sensitivity: if you have disease, will you have a positive test?
• specificity: if you don’t have disease, will you have a negative test?
• PPV: if you have a positive test, do you have disease?
• NPV: if you have a negative test, do you not have disease?

Question 21

What are the SNOUT/SPIN mnemonics?

Answer 21

• sensitive tests rule out disease with a negative result

- specific tests rule in disease with a positive result

Question 22

How are sensitivity and specificity calculated?

Answer 22

• sensitivity = TP/(TP + FN)

- specificity = TN/(TN + FP)

Question 23

What question does sensitivity answer and how is it calculated?

Answer 23

sensitivity answers “if you have disease, will you have a positive test” and it is calculated as TP/(TP + FN)

Question 24

What questions does specificity answer and how is it calculated?

Answer 24

specificity answers “if you don’t have disease, will you have a negative test” and it is calculated as TN/(TN + FP)

Question 25

How does prevalence of a disease affect NPV and PPV?

Answer 25

as prevalence increases, the PPV increases while the NPV declines

Question 26

What is the absolute risk reduction and the relative risk reduction?

Answer 26

- ARR is the absolute difference in mortality between groups (3% - 2% = 1% ARR) - RRR is the difference divided by the mortality in the control group (1% / 3% = 33% RRR)

Question 27

With normal distribution, how many data points are included by 1, 2, and 3 standard deviations?

Answer 27

68, 95, and 99.7 percent of data points

Question 28

What is the central limit theorem?

Answer 28

the idea that as you collect more data, it tends to collect around the center of the graph; this is represented by the SEM = ó/sqrt(n)

Question 29

What does the confidence interval tell you? How can it be tightened?

Answer 29

- it tells you how scattered or precise the data is and is essentially 2 times the SEM - because it is related to the SEM, increasing the sample size (n) will decrease the CI - CI = 2SEM = 2ó/sqrt(n) and for every quadrupling of the sample size, the CI is cut in half

Question 30

What is the relationship between, mean, median, and mode on a right-skewed distribution?

Answer 30

- mode is farthest left - median is in the middle - mean is the right

Question 31

What makes a data set skewed?

Answer 31

- when the mean is different from the median | - the direction of the mean tells you the direction of the skew

Question 32

How are incidence and prevalence defined?

Answer 32

- incidence is the number of new cases per unit time | - prevalence is the number of existing cases at any particular time

Question 33

What is the difference between reliability, validity, accuracy, and precision?

Answer 33

- reliability: reproducibility - validity: same as accuracy - accuracy: combination of sensitive and specific - precision: degree of clustering, lack of randomness

Question 34

What is meant by an accurate test?

Answer 34

this is a test that is both sensitive and specific

Question 35

What is a cohort study? How do we analyze it?

Answer 35

- it is a prospective observational study that starts with individuals of known exposure and looks for disease - analyzed using relative risk

Question 36

What is a case-control study? How do we analyze it?

Answer 36

- it is a retrospective observational study that starts with individuals of known disease status and looks for prior exposures - analyzed using odds ratio

Question 37

What is the difference between relative risk and odds ratio?

Answer 37

relative risk is used to analyze a cohort study while odds ratios are used to analyze case-control studies

Question 38

What is the Hawthorne effect? How is it eliminated?

Answer 38

- the form of bias in which individuals alter their behavior because they know they are being watched - eliminated by using a control group and blinding both investigators and participants

Question 39

What are the following types of bias: - lead time - ascertainment/sampling - nonresponse - berkson - neyman/prevalence - attrition - observer - reporting - surveillance

Answer 39

- lead time: early detection is confused with improved survival - ascertainment: study population differs from target population - nonresponse: error if nonresponders differ in some way from responders - berkson: hospital-based patients lead to different results than for target population - neyman: exposures long before assessment misses diseased patinets that died or recovered earlier - attrition: loss of participants to follow up - observer: observers misclassify data due to personal differences - reporting: subjects change rporting due to social stigmatization attached - surveillance: risk factor itself causes increased monitoring, which increases probability of identifying a disease

Question 40

What are type I and type II errors?

Answer 40

- type I error is also known as alpha and is the risk of rejecting the null hypothesis when it is really true; it is the risk of a false positive - type II error is also known as beta and is the risk of rejecting the alternative hypothesis when it is really true; it is the risk of a false negative

Question 41

Which medical errors require reporting to the patient?

Answer 41

all medical errors, regardless of whether there were any adverse outcomes, should be reported to the patient

Question 42

Describe a study that uses a factorial design. Describe a study that uses cross-over design.

Answer 42

- factorial involves randomizing patients to different interventions with study of two or more variables - cross-over involves patients being randomized to one of two different interventions for a period of time and then switching to the other group after the period is up