10Competencies/Health Care/Biostatistics An HIV test result is positive. The patient asks how likely he is to have HIV, given this positive result. The patient is asking about what aspect of the test? A. Sensitivity B. Specificity C. Positive predictive value D. Negative predictive value In clinical trials, what biases do randomization and single blinding minimize? A. Selection and placebo effect biases B. Selection and observer biases C. Design and placebo effect biases D. Definition and observer biases E. Selection and observer biases Which of the following factors is most predictive of subsequent disciplinary actions during a career as a physician? A. Undergraduate science class grades B. MCAT score C. Medical school grades D. USMLE Step 1 score E. Unprofessional behavior during medical school In the setting of a mass casualties, the Centers for Disease Control and Prevention recommends following the SALT algorithm for triage. For what does the acronym SALT stand? A. Sort, Assess, Lifesaving interventions, and Treatment/Transport B. Separate, Assess, Lifesaving interventions, and Transport C. Save, Alert, Lifesaving interventions, and Transport D. Save, Alert, Limit damage, and Treatment/Transport E. Save, Assess/Alert, Lifesaving intervention, and Treatment In the setting of mass causalities, to what do the conventional triage colors red, yellow, green, and black refer? A. Immediate, delayed, minimal, expectant B. Delayed, immediate, minimal, expectant C. Minimal, delayed, immediate, expectant D. Expectant, immediate, delayed, minimal E. Expectant, minimal, immediate, delayed The focus on positive deviance is an essential component for process improvement as defined by the international health-care institution. What is the major focus of this component? A. Identifying the characteristics of bad performance B. Identifying the characteristics of successful performance C. Identifying opportunities for improvement D. Expressing appreciation for hard work E. Rejecting lazy behaviors Closing films following a posterior spinal decompression and fusion show that you have performed surgery at the wrong level. What is the best next course of action? A. Inform the family of the mistake, complete the procedure at the correct level, and inform the risk management team. B. Complete the procedure at the correct level, and do not inform the family. C. Finish closing, and do not disclose the wrong-level surgery. D. Finish closing, and inform the risk management team. E. Finish closing, and inform the patient that he might need revision surgery at a later date. In the 2010 guidelines for the management of intracranial hemorrhage, there is a class 2b, level B recommendation in favor of minimally invasive clot evacuation with or without thrombolytic usage. What is the interpretation of this level of recommendation? A. The benefits largely outweigh the risks of procedure, but there are very limited data to endorse it. B. It is reasonable to perform the procedure, but there are very limited data to endorse it. C. It is not unreasonable to perform the procedure, and there are multiple population-based studies to endorse it. D. It is not unreasonable to perform the procedure, but there are limited data to endorse it. E. The procedure is contraindicated because of a lack of data to endorse it. The wife of a spine surgeon owns a rehabilitation facility. Her husband frequently refers patients to her institute for postoperative rehabilitation. Which of the following laws is the spine surgeon violating? A. Stark law B. Federal anti-kickback statute C. Antitrust law D. False claim act A 30-year-old man sustained a massive neurologic injury following a motor vehicle collision. Despite all medical efforts, he is declared brain dead, and the regional organ procurement organization is contacted. The patient is confirmed to have listed himself as an organ donor; however, his wife refuses to proceed with donation. What is the best course of action? A. Proceed with the donation. B. Stop the donation, as the wife is the patient’s medical decision maker. C. Proceed with the donation after obtaining consent from the patient’s brother. D. Proceed with the donation after obtaining consent from the patient’s mother. E. Obtain a court order to proceed with the donation. One hundred new cases of craniopharyngiomas are diagnosed every year in the United States (population 320 million), and there are currently 6,400 people known to be living with craniopharyngiomas. What is the incidence and prevalence of craniopharyngiomas? A. Incidence: 1/3,200,000; prevalence: 1/50,000 B. Incidence: 1/1,600,000; prevalence: 1/100,000 C. Incidence: 1/3,200,000; prevalence: 1/100,000 D. Incidence: 1/1,600,000; prevalence: 1/50,000 E. Incidence: 1/1,000,000; prevalence: 1/25,000 The investigators of the HEAT (Hydrogel Endovascular Aneurysms Treatment) trial wanted to compare the effectiveness of hydrogel coils to the effectiveness of bare platinum coils. They designed a study in which patients were allocated to the hydrogel group or the bare platinum group on a random basis just prior to undergoing the procedure. Patients were not told which type of coils was being used. What was the design of this study? A. Randomized, double-blinded, prospective clinical study B. Randomized, single-blinded, prospective clinical study C. Nonrandomized, single-blinded, prospective clinical study D. Nonrandomized, single-blinded, retrospective clinical study E. Randomized, double-blinded, retrospective clinical study What ACGME Core Competency is demonstrated when residents present and discuss their research with colleagues at national meetings? A. Patient care B. Medical knowledge C. Interpersonal skills and communication D. Practice-based learning and improvement E. System-based practice A medical device manufacturer is rewarding spine surgeons who use its devices with free vacations. What law is violated by this arrangement? A. Stark law B. Federal anti-kickback statute C. Antitrust law D. False claim act A group of undergraduate students develops image processing software that automatically assesses the degree of midline shift in a head CT scan as soon as the images are acquired and before the images are sent to the radiologist. The test is repeated four times on the first volunteer, and the obtained values are 0, 3, 5, and 2 mm of midline shift. This study can be considered NOT: A. Reliable B. Valid C. Accurate D. Sensitive E. Specific Two studies were conducted on the same population to assess the association between smoking and the development of carotid artery atherosclerosis. The first study showed a relative risk of 5.0 and a 95% confidence interval of 3.8 to 5.2. The second study showed a relative risk of 4.9 and a 95% confidence interval of 0.9 to 5. What is the most likely explanation of the observed results? A. The first study is not statistically significant. B. The first study is biased. C. The second study is inaccurate. D. The sample size in the second study is small. E. The sample size in the first study is small. What statistical test would be the most appropriate to compare a quantitative variable in four groups? A. ANOVA B. Student t-test C. Paired t-test D. Chi-square test E. Fisher exact test A group of medical students was asked to design a study to assess the efficacy of intracranial hemorrhage evacuation versus nonsurgical management. The students decided to enroll patients with large posterior fossa hemorrhages in their study and randomly assign them to one of the two study arms. What major ethical principle of clinical trials did the students most violate? A. Equipoise B. Autonomy C. Nonmaleficence D. Justice E. Disclosure What ACGME core competency is demonstrated when residents present errors at a morbidity and mortality conference? A. Patient care B. Medical knowledge C. Practice-based learning and improvement D. Systems-based practice E. Professionalism A pharmaceutical company has developed a test to predict the eventual development of Alzheimer disease in currently asymptomatic patients. This test has an 85% sensitivity and 80% specificity. For asymptomatic patients between the ages of 40 and 55, the test’s positive predictive value is 25%, and its negative predictive value is 96%. A 50-year-old asymptomatic patient has a negative test. What is the probability that the patient develops Alzheimer disease? A. 30% B. 20% C. 15% D. 4% E. 0% A pharmaceutical company develops a test to screen for glioblastomas. A study run by the company showed that this new test prolongs the survival of patients with glioblastomas by several months. The researchers conclude that use of the test improves the outcome of glioblastoma patients. What is the most likely bias of this study? A. Observer bias B. Measurement bias C. Lead-time bias D. Confounding bias E. Sampling bias What is the size of treatment effect classification if a procedure is reasonable to perform in the setting of a certain pathology? A. Class 1 B. Class 2A C. Class 2B D. Class 3 E. Class 4 Following a motor vehicle collision, a 3-year-old child is diagnosed with an intracranial hemorrhage and is taken emergently to the operating room. While there, a blood transfusion becomes indicated. The patient’s parents are informed and refuse transfusion on religious grounds. They threaten to sue the surgeon if blood is transfused. What is the next best course of action? A. Do not transfuse the patient. B. Try to reason with the family and obtain permission to transfuse. C. Contact the hospital legal counsel and proceed with transfusion. D. Proceed with transfusion after documenting the indication in the chart. E. Obtain a court order to proceed with transfusion. Use the following information to answer questions 24 and 25: The box plot in this image reports the time in minutes required by a surgeon to perform an aneurysm clipping procedure.
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