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NBME CBSE Public Health Sciences Part 1 Complete Exam Questions & Detailed Answers A+ Rated Study

Name: NBME CBSE Public Health Sciences Part 1 Complete Exam Questions & Detailed Answers A+ Rated Study
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NBME CBSE Public Health Sciences Part 1 Complete Exam Questions & Detailed Answers A+ Rated Study Guide Updated Version. What is a case series? Descr ... [Show More] iption of clinical findings/symptoms for several patients with the same diagnosis, treatment, or outcome. What is a cross-sectional study? Assesses the frequency of disease and risk-related factors in the present. What is a case-control study? Retrospectively compares a group of people with a disease to a group without the disease to determine if odds of prior exposure/risk factor differ. What is a cohort study? Compares a group of people with a given exposure/risk factor to a group without exposure to determine if the exposure/risk factor is associated with later development of disease. What is a twin concordance study? Compares the frequency with which both monozygotic twins vs both dizygotic twins develop the same disease to measure heritability and influence of environmental factors. What is an adoption study? Compares behavioral traits/genetics in siblings raised by biological vs adoptive parents to measure heritability and influence of environmental factors. What is an ecological study? Compares the frequency of disease and risk-related factors across populations to measure population data (not applicable to individuals). What is a clinic therapeutic trial? An experimental study involving humans that compares the benefits of two or more interventions. What are the criteria for a high-quality clinical trial? Randomized, controlled, and double-blinded What is a crossover clinical trial? Compares the effect of multiple treatments on a subject What is the purpose of randomizing the order of treatments in a crossover trial? To avoid bias What is a washout period in a crossover trial? A period between treatments to eliminate any lingering effects What is the advantage of using a crossover trial? Subjects serve as their own controls What is the intention-to-treat analysis? Analyzing all subjects according to their original assigned treatment What is the purpose of intention-to-treat analysis? To avoid bias from attrition, crossover, and noncompliance What is the disadvantage of intention-to-treat analysis? May dilute the true effects of the intervention What is the as-treated analysis? Analyzing subjects according to the treatment they actually received What is the disadvantage of as-treated analysis? Increases the risk of bias What is the per-protocol analysis? Excluding subjects who did not complete the originally assigned treatment What is the disadvantage of per-protocol analysis? Increases the risk of bias What are the five phases of clinical trials? Preclinical, Phase 0, Phase 1, Phase 2, Phase 3, Phase 4 What happens in the preclinical phase of clinical trials? Testing the drug in lab animals and in vitro What happens in Phase 0 of clinical trials? Initial assessment of pharmacokinetics and pharmacodynamics via microdosing What is the purpose of Phase 1 of clinical trials? Safety assessment and determining the maximum tolerable dose What is the purpose of Phase 2 of clinical trials? Assessing efficacy and short-term adverse effects What is the purpose of Phase 3 of clinical trials? Assessing effectiveness compared to standard of care or placebo What is the purpose of Phase 4 of clinical trials? Assessing long-term and rare adverse effects What is off-label drug use? Using a drug in a form, population group, or dosage not approved by the FDA What are possible reasons for off-label drug use? Lack of approved treatment or exploring alternative options What are the Bradford Hill Criteria? Principles supporting evidence of a causal relationship Strength Stronger association, more evidence for causation Consistency Repeated observations in multiple samples Specificity Stronger evidence with specific cause-effect relationship Temporality Cause precedes effect by expected time Biological gradient Greater effect with greater exposure to cause Plausibility Conceivable mechanism for cause leading to effect Coherence No conflict with existing scientific consensus Experiment Empirical evidence supporting cause and effect Analogy Comparable to established cause and effect Odds ratio Odds of exposure among cases vs controls Relative risk Risk of disease in exposed vs unexposed group Relative risk reduction Proportion of risk reduction attributable to intervention Attributable risk Difference in risk between exposed and unexposed groups Absolute risk reduction Difference in risk attributable to intervention Number needed to treat Number of patients needed to treat for 1 patient to benefit What is 1/ARR? Number needed to harm: number of patients who need to be exposed to a risk factor for 1 patient to be harmed. What does a higher number in 1/ARR indicate? Safer exposure. What is 1/AR? Case fatality rate: % of deaths occurring among those with disease. How is case fatality rate calculated? Deaths/cases * 100. What is mortality rate? # of deaths within a population within a defined period. How is mortality rate calculated? Deaths/total people. What is attack rate? Proportion of exposed people who become ill. How is attack rate calculated? People who become ill/total people exposed. What is demographic transition? As a country proceeds to higher levels of development, birth and mortality rates decline to varying degrees, changing the age composition of the population. What are the characteristics of a growing population? Short life expectancy, increasing mortality rate, increasing birth rate. What are the characteristics of a stable population? Long life expectancy, low mortality rate, low birth rate. What are the characteristics of a declining population? Long life expectancy, low mortality rate, really low birth rate. What is likelihood ratio? Probability of + result in patient with disorder/Probability of + result in patient without disorder = sensitivity/1-specificity = TP rate/FP rate. How is the likelihood ratio for a negative result calculated? Probability of - result in patient with disorder/Probability of - result in patient without disorder = 1-sensitivity/specificity = FN rate/TN rate. What is a Kaplan-Meier curve used for? To display time-to-event data, often used to examine mortality. What is survival probability? 1 - event probability. What factors affect PPV and NPV in the evaluation of diagnostic tests? Disease prevalence in the population being tested. What is test efficiency? (TP+TN)/(TP+FN+FP+TN). What is sensitivity? Proportion of all people with disease who test + or the ability of a test to correctly identify those with disease. What does a value approaching 100% in sensitivity indicate? Desirable for ruling out disease, indicates a low false-negative rate. What is a high sensitivity test used for? Screening. What is sensitivity? Proportion of people with disease correctly identified by a test What is the value of sensitivity approaching 100% desirable for? Ruling in disease What does sensitivity indicate? Low false positive rate How is sensitivity calculated? TP/(TN+FP) What is the 1-FP rate? Complement of false positive rate When is a high specificity test used? Confirmation after a positive screening What is positive predictive value? Probability that a person with a positive test result actually has the disease How is positive predictive value calculated? TP/(TP+FP) How does positive predictive value vary? Directly with pretest probability What is negative predictive value? Probability that a person with a negative test result actually does not have the disease How is negative predictive value calculated? TN/(TN+FN) How does negative predictive value vary? Inversely with prevalence or pretest probability What does the receiver operating characteristic (ROC) curve demonstrate? How well a diagnostic test can distinguish between two groups What does the ROC curve plot? True positive rate (sensitivity) against false positive rate (1-specificity) What does a better performing test have in terms of the ROC curve? Higher area under the curve (AUC) and closer to the upper left corner What is precision? Consistency and reproducibility of a test What decreases precision? Random variation or random error What happens when precision increases? Lower standard deviation (SD) and higher statistical power (beta) What is accuracy? Closeness of test results to true values What decreases accuracy? Systematic error or bias in a test What is incidence? Number of new cases divided by the number of people at risk What is prevalence? Number of existing cases divided by the number of people in the population What is the formula for calculating prevalence? Prevalence = incidence rate * average duration of disease / (1 - prevalence) What happens to prevalence with an increase in prevalence? Increase in positive predictive value (PPV) and decrease in negative predictive value (NPV) What happens to incidence and prevalence with increased survival time? No incidence and high prevalence What happens to incidence and prevalence with high mortality? No incidence and low prevalence What happens to incidence and prevalence with faster recovery time? No incidence and low prevalence What is extensive vaccine administration? Low incidence and prevalence What are low risk factors? Low incidence and prevalence What is high diagnostic sensitivity? High incidence and prevalence What happens when a new effective treatment is started? No incidence and low prevalence What is low contact between infected and non-infected patients with airborne infectious disease? Low incidence and prevalence What is selection bias? Nonrandom sampling or treatment allocation that makes the study population not representative of the target population What is convenience sampling? Enrolling patients based on ease of contact What is Berkson bias? Cases and/or controls selected from hospitals that are less healthy and have different exposures What is attrition bias? Participants lost to follow-up have a different prognosis than those who complete the study How can bias be reduced? Randomization and ensuring the choice of the right comparison/reference group What is recall bias? Awareness of disorder alters recall by subjects What can reduce recall bias? Decreasing time from exposure to follow-up and using medical records as resources What is measurement bias? Information is gathered in a systematically distorted manner What is the Hawthorne effect? Participants change behavior upon awareness of being observed How can bias be reduced in data collection? Standardized, objective, and previously tested methods of data collection and a placebo group What is procedure bias? Subjects in different groups are not treated the same How can procedure bias be reduced? Masking and use of a placebo to reduce influence of participants and researchers on interpretation of outcomes What is observer-expectancy bias/Pygmalion effect? Researcher's belief in the efficacy of a treatment changes the outcome of that treatment How can observer-expectancy bias be reduced? Masking and use of a placebo to reduce influence of participants and researchers on interpretation of outcomes What is lead-time bias? Early detection interpreted as an increase in survival, but the disease course has not changed What is meant by 'reduced by measuring 'back-end' survival'? Adjusting survival based on disease severity at diagnosis. What is length-time bias? Screening test detects diseases with long latency periods. How can length-time bias be reduced? Randomized controlled trials assigning subjects to screening or no screening. What is confounding? Factor related to both exposure and outcome that distorts the effect on outcome. How can confounding be reduced? Crossover studies, matching participants, analytic techniques, and stratified analysis. What is effect modification? Exposure leads to different outcomes in subgroups stratified by a factor. How can effect modification be reduced? Crossover studies, matching participants, analytic techniques, and stratified analysis. What are the measures of central tendency? Mean, median, and mode. Which measure of central tendency is most affected by outliers? Mean. Which measure of central tendency is least affected by outliers? Mode. What are the measures of dispersion? Standard deviation, standard error, and variance. What does standard deviation measure? Variability in a set of values. What does standard error estimate? Variability in sample means around the true population mean. How is variance calculated? Standard deviation squared. How is standard error calculated? Standard deviation divided by the square root of sample size. How does standard error change with sample size? It decreases as sample size increases. What is a normal distribution? A bell-shaped distribution with mean=median=mode. Which measure of central tendency is best for a normal distribution? Mean. What is a bimodal distribution? A distribution suggesting two different populations. What is positive skew? Mean > median > mode, with a longer tail to the right. What is the alternative hypothesis? Hypothesis of some difference or relationship. What is the definition of P value? Probability of obtaining results as extreme as observed assuming null hypothesis is correct. What is the commonly accepted value for P value? 0.05 What is a correct result in statistical hypothesis testing? There is an effect or difference when one exists or there is no effect or difference when none exists. What is a Type I error? There is an effect or difference when none exists. What is the relationship between statistical significance and clinical significance? They are not equal. What is another name for a Type I error? False positive error. When would the null hypothesis be rejected as false? If the probability of making a Type I error is higher than the P value. What is a Type II error? There is no effect or difference when none exists. What is another name for a Type II error? False negative error. How can you increase power and decrease Type II error? By increasing sample size, expected effect size, precision of measurement, and statistical significance level. What happens to Type II error when Type I error increases? It decreases. What is the definition of statistical significance? The likelihood of study results being due to chance. What does high statistical significance indicate? Low probability that results are due to chance. What is the definition of clinical significance? Measure of the effect of outcomes of treatment. What is a confidence interval? Range of values within which the true mean of the population is expected to fall with a specified probability. What is the formula for a confidence interval? CI = 1 - alpha What is the commonly used value for alpha? 0.05 When is the null hypothesis rejected and results are significant? When the 95% CI for mean difference excludes 0 or the 95% CI for odds ratio or relative risk excludes 1. When is the null hypothesis not rejected and results are not significant? When the 95% CI for mean difference includes 0 or the 95% CI for odds ratio or relative risk includes 1. What does it mean if the confidence intervals between two groups overlap? There is no significant difference between the two groups. What is the purpose of a meta-analysis? To pool summary data from multiple studies for a more precise estimate of the size of an effect. What does a meta-analysis estimate? Heterogeneity of effect sizes between studies. What is the purpose of a systematic review? To improve power, strength of evidence, and generalizability of study findings. What are the limitations of a systematic review? Limited by quantity of individual studies and bias in study selection. [Show Less]

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NBME CBSE Public Health Sciences Part 1 Complete Exam Questions & Detailed Answers A+ Rated Study