Behavioral Science: How To Use The Workbook With The Videos

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First Aid Express 2013 workbook: BEHAVIORAL SCIENCE page 1
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Behavioral Science
How to Use the Workbook with the Videos
Using this table as a guide, read the Facts in First Aid for the USMLE Step 1 2013,
watch the corresponding First Aid Express 2013 videos, and then answer the workbook
questions.
Facts in First Aid

Corresponding First Aid Express Workbook
for the USMLE
2013 video questions
Step 1 2013
50.1–51.1 Behavioral Science Epi/Biostats part 1 1–14
56.2–58.1 Behavioral Science Ethics 45–74
59.1–60.2 Behavioral Science Development 75–81
60.3–62.4 Behavioral Science Physiology 82–93
____________________________________________________________________________________________________________________
Copyright © 2013 by MedIQ Learning, LLC All rights reserved v1.2
page 2 First Aid Express 2013 workbook: BEHAVIORAL SCIENCE
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Questions
EPIDEMIOLOGY/BIOSTATISTICS
1. A case control study is described as _______________ (experimental/observational) and
_______________ (prospective/retrospective). (p. 50)
2. A cohort study is described as _______________ (experimental/observational) and

_______________ (prospective/retrospective). (p. 50)
3. True or False: In a cohort study, subjects are chosen on the basis of the presence or absence of
risk factors. (p. 50) _______________________________________________________________
4. True or False: A cohort study involves following subjects over a period of time to study the
development of disease. (p. 50) _____________________________________________________
5. True or False: A cross-sectional research study can show the correlation of a risk with a disease.
(p. 50) _________________________________________________________________________
6. Describe single-, double-, and triple-blinded studies. (p. 50) _______________________________

______________________________________________________________________________
7. What is the purpose of Phase III clinical trials? (p. 50) ___________________________________
8. What two major factors may limit the reliability of a meta-analysis? (p. 50) ____________________
9. How does a low prevalence of disease affect the positive predictive value of a test? (p. 51) ______
______________________________________________________________________________
10. In HIV testing, ELISA screening is _______________ (sensitive/specific) and has a high false-
_______________ (negative/positive) rate, with a _______________ (high/low) threshold. (p. 51)
11. In HIV testing, the Western blot test is _______________ (sensitive/specific) and has a high false-
_______________ (negative/positive) rate, with a _______________ (high/low) threshold. (p. 51)
12. How does a low prevalence of disease affect the negative predictive value of a test? (p. 51) _____
______________________________________________________________________________
13. If a diagnostic test has 100% sensitivity, what should the value of the false-negative rate equal?
(p. 51) _________________________________________________________________________
14. If a diagnostic test has 100% specificity, what should the value of the false-positive rate equal?
(p. 51) _________________________________________________________________________
15. What measure of disease frequency is calculated by dividing the total number of cases in the
population at a given time by the total population at a given time? (p. 52) ____________________
16. What measure of disease frequency is calculated by dividing the number of new cases in the
population during a period by the total population at risk during that time? (p. 52) ______________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
17. In chronic disease states such as diabetes is the prevalence of disease greater than, less than, or
equal to the incidence? (p. 52) ______________________________________________________
18. In acute disease states such as a common cold is the prevalence of disease greater than, less
than, or equal to the incidence? (p. 52) _______________________________________________
19. The statement "Patients with COPD had higher odds of a history of smoking than those without
COPD" pertains to _______________ (odds ratio / relative risk). (p. 52)
20. The statement "Smokers had a higher risk of developing COPD than did nonsmokers" pertains to
_______________ (odds ratio / relative risk). (p. 52)
21. True or False: When calculating the incidence of a disease, the total population at risk during a
certain time should include people who have the disease. (p. 52) ___________________________
22. True or False: The odds ratio for a disease based on exposure to a risk factor approximates the
relative risk if the prevalence of the disease is low. (p. 52) ________________________________
23. What epidemiologic measurement is equal to the difference in disease incidence between an
exposed group and an unexposed group? (p. 52) _______________________________________
24. _______________ (Precision/accuracy) refers to the trueness of test measurements (validity), and
_______________ (precision/accuracy) refers to the consistency and reproducibility of a test or the
absence of random variation in a test. (p. 53)
25. _______________ (Random/systematic) error reduces precision in a test, and _______________

(random/systemic) error reducesThis
accuracy in atotest.
copy belong (p. 53)
the User: 61838
26. Name four ways to reduce bias in epidemiologic studies. (p. 53) ___________________________
______________________________________________________________________________
27. What type of bias occurs when there are two closely associated factors and therefore the effect of
one factor could change or confuse the effect of the other? (p. 53) __________________________
28. What is the name of the phenomenon whereby a researcher's belief in the efficacy of a treatment
changes the outcome of that treatment? (p. 53) ________________________________________
29. In a data set that has a distribution with a negative skew, what is the relationship between the
mean, the median, and the mode? (p. 54) _____________________________________________
30. In a data set that has a distribution with a positive skew, what is the relationship between the mean,
the median, and the mode? (p. 54) __________________________________________________
31. Which characteristic is least affected by outliers: mean, median, or mode? (p. 54) ______________
32. What is the term for the hypothesis that there is no association between the variables being
studied? (p. 54) _________________________________________________________________
33. In statistical calculations, the P value is equal to the probability of making what type of error?
(p. 54) _________________________________________________________________________
34. In a statistical analysis, if P = 0.03, what is the probability that the data will show a difference by
chance alone when none truly exists? (p. 54) __________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
35. In statistical analysis, if β = 0.2, what is the probability that the null hypothesis has been falsely
accepted? (p. 54) ________________________________________________________________
36. In a data set that has a normal (Gaussian) distribution, what percentage of the data falls within two
standard deviations of the mean? What percentage falls within 3 SDs of the mean? (p. 54)
______________________________________________________________________________
37. The power of a statistical test depends on which three factors? (p. 55) ______________________
______________________________________________________________________________
38. What study parameter is calculated when the probability of making a type II error is subtracted from
1? (p. 55) ______________________________________________________________________
39. If the 95% confidence interval for a mean difference between two variables includes 0, the null
hypothesis _______________ (is/is not) rejected. (p. 55)
40. What type of statistical test is used to check for a difference between the means of three or more
groups? (p. 55) __________________________________________________________________
41. What type of statistical test is used to check for a difference between the means of two groups?
(p. 55) ________________________________________________________________________
42. What statistical term's absolute value indicates the strength of the correlation between two
variables? (p. 55) ________________________________________________________________
43. Give an example of primary, secondary, and tertiary

This copy belong disease
to the User: 61838prevention strategies. (p. 55) ______
______________________________________________________________________________
44. What two federally funded healthcare programs originated from amendments to the Social Security
Act? Who is eligible for these programs? (p. 56) ________________________________________
______________________________________________________________________________
ETHICS
45. What are the four core ethical principles of medicine? (p. 56) ______________________________
______________________________________________________________________________
46. True or False: Patient autonomy may conflict with beneficence. (p. 56) ______________________
47. True or False: If the benefits of an intervention outweigh the risks, a patient may make an informed
decision to proceed, thus overriding the ethical principle of nonmaleficence. (p. 56) ____________
48. Which right is being exercised when a patient makes an informed decision to proceed with a
medical treatment when the benefits of the intervention outweigh its risks? (p. 56) _____________
49. What must be explained by a doctor to obtain informed consent? (p. 56) ____________________
______________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
50. What are the four exceptions to informed consent? (p. 56) ________________________________
______________________________________________________________________________
51. What are four conditions in which a minor may be considered emancipated? (p. 56) ___________
______________________________________________________________________________
52. What are the five requirements that must be met in order to determine that a patient has full
decision-making capacity? (p. 57) ___________________________________________________
______________________________________________________________________________
53. True or False: A patient's family can require that a doctor withhold information from the patient.
(p. 57) ________________________________________________________________________
54. What term refers to an incapacitated patient's previous oral statements, which are commonly used
to guide medical decisions? (p. 57) __________________________________________________
55. What four factors give greater validity to a patient's oral advance directive? (p. 57) _____________
______________________________________________________________________________
56. What is the term for the legal document that describes treatments the patient wishes to receive or
not receive if he/she becomes incapacitated and cannot communicate about treatment decisions?
(p. 57) _________________________________________________________________________
57. What legal term refers to a patient's designated surrogate who may make medical decisions in the
event that the patient loses This
decision-making capacity?
copy is downloaded (p. 57)
on: 5/25/2013 8:10_____________________________
PM
58. True or False: When authorizing a power of attorney, the patient may specify decisions that are to
be made in certain clinical situations. (p. 57) ___________________________________________
59. True or False: A patient's agent authorized with power of attorney retains that power unless it is
revoked by the patient. (p. 57) ______________________________________________________
60. Which type of advance directive provides greater flexibility, a living will or a durable power of
attorney? (p. 57) _________________________________________________________________
61. What standard should be used to determine the amount of medical information to disclose to a
patient's family or friends? (p. 57) ___________________________________________________
62. In the case of serious infectious diseases, a physician may have a duty to break patient
confidentiality to warn certain groups of people. Name the two groups. (p. 57) ________________
______________________________________________________________________________
63. What legal precedent requires physicians to directly inform and protect a potential victim from
harm, even if it involves a breach of confidentiality? (p. 57) ________________________________
64. A child presents to the emergency department with multiple fractures and bruises of different ages.
The patient's mother requests that authorities not be involved. Must the physician respect her
request for confidentiality? Why or why not? (p. 57) _____________________________________
______________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
65. A young woman confides to her physician that she has considered ending her life by ingesting a
bottle’s worth of her prescription pills, and that she does not want anyone else to know of her plan.
Must the physician respect her request for nondisclosure? Why or why not? (p. 57) ___________
______________________________________________________________________________
66. A patient discloses that he frequently drives after consuming four or five drinks at the bar. In the
office, the patient clearly has been drinking alcohol and has arrived on his own. Is the physician
obligated to uphold confidentiality? Why or why not? (p. 57) _______________________________
______________________________________________________________________________
67. What is an appropriate response to a patient who is upset about how he or she was treated by
another doctor? (p. 58) ____________________________________________________________
68. What is an appropriate response to a child who wishes to know more about his or her illness?
(p. 58) _________________________________________________________________________
69. What is an appropriate response to a patient who is noncompliant? (p. 58) ___________________
______________________________________________________________________________
70. What is an appropriate response to a 17-year-old girl who is pregnant and requests an abortion?
(p. 58) _________________________________________________________________________
71. What is an appropriate response to a terminally ill patient who requests physician assistance with
ending his or her life? (p. 58) _______________________________________________________
72. What is an appropriate response Thistocopy

a patient
belong towho refuses
the User: 61838 a necessary procedure or desires an
unnecessary one? (p. 58) __________________________________________________________
73. What is an appropriate response to a patient who continues to smoke? (p. 58) ________________
______________________________________________________________________________
74. What is an appropriate response to a patient who states that he or she finds you attractive? (p. 58)
______________________________________________________________________________
DEVELOPMENT
75. What are the five criteria for calculating an Apgar score? (p. 59) ____________________________
______________________________________________________________________________
76. What are five major complications of low birth weight? (p. 59) ____________________________
______________________________________________________________________________
77. What is the approximate age of a child who is anxious when separated from his or her mother?
(p. 59) _________________________________________________________________________
78. What is the approximate age range of a child who plays alongside, but not with, another child?
(p. 59) _________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
79. What sexual changes normally occur in elderly men? (p. 60) ______________________________
______________________________________________________________________________
80. True or False: One may experience hallucinations during normal bereavement. (p. 60) __________
81. Name three types of symptoms that a patient with pathologic grief may experience. (p. 60) ______
______________________________________________________________________________
PHYSIOLOGY
82. Which four classes of drugs or substances can cause sexual dysfunction? (p. 60) ___________
______________________________________________________________________________
83. What is the BMI of a person who weighs 90 kg and is 180 cm tall? (p. 60) ____________________
84. Awake and alert states are characterized by what electroencephalogram waveform? (p. 61)____
______________________________________________________________________________
85. REM sleep is characterized by what electroencephalogram waveform? (p. 61) ________________
______________________________________________________________________________
86. Which area of the brain is responsible for rapid eye movements during sleep? (p. 61) ___________
87. Which drug is used to treat enuresis? What is its mechanism of action? (p. 61) ________________
______________________________________________________________________________
88. Which drug class is used to treat night terrors and sleepwalking? What is its mechanism of action?
(p. 61) _________________________________________________________________________
89. Name four physiologic changes that occur during REM sleep. (p. 61) _______________________
______________________________________________________________________________
90. What is the principle neurotransmitter involved in REM sleep? (p. 61) ______________________
______________________________________________________________________________
91. What sleep disorder is characterized by cataplexy and hypnagogic hallucinations? (p. 62) ______
______________________________________________________________________________
92. What is the most common medical treatment for narcolepsy? (p. 62) _______________________
______________________________________________________________________________
93. Circadian rhythms dictate the release of which hormones and neurotransmitters? (p. 62) _______
______________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
Answers
EPIDEMIOLOGY/BIOSTATISTICS
1. Observational; retrospective.
2. Observational; prospective (more common) or retrospective.
3 True.
4. True for prospective cohort studies.
5. True. (However, it cannot show causality.)
6. In single-blind studies, subjects are not aware of their study-group assignment. In double-blind
studies, neither doctors nor subjects are aware of study-group assignment. In triple-blind studies,
the researchers analyzing the data are also unaware of study-group assignment.
7. To compare the efficacy of the new treatment with the current standard of care.
8. The quality of the individual studies, and bias in the selection of studies for analysis.
9. The positive predictive value of the test is lower for a disease that has a lower prevalence.
10. Sensitive; positive; low. This copy is downloaded on: 5/25/2013 8:10 PM
11. Specific; negative; high.
12. The negative predictive value of the test is higher for a disease that has a lower prevalence.
13. It should equal 0. (All cases of the disease are detected by the test.)
14. It should equal 0. (All patients without the disease are identified correctly.)
15. Point prevalence.
16. Incidence. (Incidence refers to new incidents).
17. Much greater than the annual incidence (because of the long duration of the disease).
18. Approximately equal (for diseases of short duration).
19. Odds ratio.
20. Relative risk.
21. False. (The total population at risk during a certain period should not include people who have the
disease because incidence is a measure of new cases of a disease; those who have the disease
are not at risk of getting the disease.)
22. True.
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
23. Attributable risk; it is the percentage of cases of a disease caused by a risk factor.
24. Accuracy; precision.
25. Random; systematic.
26. Use blinded studies (preferably double blind), assess placebo responses, perform a crossover
study, and use randomization.
27. Confounding bias, in which the causal relationship is better explained by a variable other that the
one being studied.
28. Observer-expectancy effect.
29. Mean < median < mode.
30. Mean > median > mode.
31. Mode.
32. Null hypothesis.
33. Type I error (α). (This type of error occurs when it is incorrectly concluded that an association is
present.)
34. 3%.
35. This copy an
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36. 95% fall within 2SDs of the mean, and 99.7% fall within 3SDs of the mean.
37. The sample size, precision of measurement, and the size of the expected effect.
38. Power.
39. If the 95% CI includes 0, the null hypothesis is not rejected because there is no significant
difference between the two variables.
40. Analysis of variance (ANOVA).
41. t-test.
42. Correlation coefficient (r).
43. Vaccination is a primary disease prevention strategy, because the vaccinated person is not
considered susceptible to the disease. A Pap smear is secondary disease prevention, since it can
detect cervical cancer at an early, treatable stage. Chemotherapy is tertiary disease prevention, as
it is intended to reduce disability from disease once it has occurred.
44. Medicare and Medicaid. MedicarE is for the Elderly, and MedicaiD is for the Destitute.
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
ETHICS
45. Autonomy, beneficence, nonmaleficence, and justice.
46. True.
47. True.
48. Autonomy.
49. The risks and benefits of the proposed intervention, and the risks and benefits of the alternatives
(including doing nothing).
50. If the patient lacks decision-making capacity; if the situation is emergent; if disclosure of information
would harm the patient; and if the patient waives the right of informed consent.
51. If the minor is married, self-supporting, has children, or is in the military.
52. The patient must make and communicate a choice; the patient must be informed; the decision must
remain stable over time; the decision must be consistent with the patient's values and goals; and
the decision cannot be a result of delusions or hallucinations.
53. False. (A patient's family cannot require the physician to withhold information from the patient.)
54. Oral advance directive.

55. The patient was informed, the
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on: 5/25/2013 8:10made
PM a choice, and the decision was
repeated over time.
56. Living will (i.e., written advance directive).
57. Durable power of attorney.
58. True.
59. True.
60. A durable power of attorney.
61. The disclosure of information to family or friends should be guided by what the patient would want.
62. Public officials and identifiable people who may be at risk.
63. The Tarasoff Decision.
64. No; a physician may break confidentiality to report the abuse (or suspected abuse) of a child or an
elderly person.
65. No; a physician may break confidentiality to report a suicidal or homicidal patient.
66. No; a physician can break confidentiality to report an impaired driver.
67. Suggest that the patient speak directly to that physician about the concerns. If the problem is with a
member of the office staff, inform the patient that you will speak to that person.
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
68. Ask the parents what they have told the child about his or her illness. (The parents decide what
information should be relayed to the child about the illness.)
69. Attempt to identify the patient’s reason for noncompliance and whether he or she is willing to
change the behavior. Do not force the patient to comply or refer the patient to another physician.
70. Many states require parental notification or consent for minors to have an abortion. However,
parental consent is not required for emergency situations, the treatment of sexually transmitted
diseases, medical care during pregnancy, prescriptions for contraceptives, or the management of
drug addiction.
71. In most states, physicians should refuse to be involved in any form of assisted suicide; however,
the physician may prescribe medically appropriate analgesics that coincidentally shorten the
patient's life.
72. Attempt to understand why the patient wants or does not want the procedure; address the
underlying concerns, and avoid performing unnecessary procedures.
73. Ask how the patient feels about smoking; offer advice about cessation if the patient seems willing
to make an effort to quit.
74. Ask direct closed-ended questions, and use a chaperone if necessary. (Romantic relationships with
patients are never appropriate.)
DEVELOPMENT This copy belong to the User: 61838

75. Appearance, Pulse, Grimace, Activity, Respiration.
76. Infection, neonatal respiratory distress syndrome, necrotizing enterocolitis, intraventricular

hemorrhage, and persistent fetal circulation.
77. 15 months.
78. 24 to 48 months (parallel play).
79. Slower erection/ejaculation and a longer refractory period.
80. False.
81. Depressive symptoms, delusions, and hallucinations.
PHYSIOLOGY
82. Antihypertensives, neuroleptics, selective serotonin reuptake inhibitors, ethanol.
2 2
83. BMI = weight in kilograms / (height in meters) = 90 kg / (1.8 m) = 28.
84. Beta (highest frequency, lowest amplitude).
85. Beta.
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
86. The paramedian pontine reticular formation/conjugate gaze center.
87. Imipramine; it shortens the duration of stage 3 sleep.
88. Benzodiazepines; they shorten REM and delta sleep.
89. Increased and variable pulse, rapid eye movement, increased and variable blood pressure, and
penile/clitoral tumescence.
90. Acetylcholine.
91. Narcolepsy.
92. Stimulants (such as amphetamines or modafinil).
93. ACTH, prolactin, melatonin, and nocturnal norepinephrine.

____________________________________________________________________________________________________________________

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Facts in First Aid

2. A cohort study is described as _______________ (experimental/observational) and

6. Describe single-, double-, and triple-blinded studies. (p. 50) _______________________________

25. _______________ (Random/systematic) error reduces precision in a test, and _______________

43. Give an example of primary, secondary, and tertiary

72. What is an appropriate response Thistocopy

2. Observational; prospective (more common) or retrospective.

4. True for prospective cohort studies.

5. True. (However, it cannot show causality.)

11. Specific; negative; high.

15. Point prevalence.

16. Incidence. (Incidence refers to new incidents).

18. Approximately equal (for diseases of short duration).

19. Odds ratio.

20. Relative risk.

24. Accuracy; precision.

25. Random; systematic.

28. Observer-expectancy effect.

29. Mean < median < mode.

30. Mean > median > mode.

32. Null hypothesis.

40. Analysis of variance (ANOVA).

42. Correlation coefficient (r).

51. If the minor is married, self-supporting, has children, or is in the military.

54. Oral advance directive.

56. Living will (i.e., written advance directive).

57. Durable power of attorney.

60. A durable power of attorney.

62. Public officials and identifiable people who may be at risk.

63. The Tarasoff Decision.

66. No; a physician can break confidentiality to report an impaired driver.

DEVELOPMENT This copy belong to the User: 61838

76. Infection, neonatal respiratory distress syndrome, necrotizing enterocolitis, intraventricular

78. 24 to 48 months (parallel play).

79. Slower erection/ejaculation and a longer refractory period.

81. Depressive symptoms, delusions, and hallucinations.

84. Beta (highest frequency, lowest amplitude).

86. The paramedian pontine reticular formation/conjugate gaze center.

87. Imipramine; it shortens the duration of stage 3 sleep.

88. Benzodiazepines; they shorten REM and delta sleep.

92. Stimulants (such as amphetamines or modafinil).

93. ACTH, prolactin, melatonin, and nocturnal norepinephrine.

This copy belong to the User: 61838

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25. _ (Random/systematic) error reduces precision in a test, and _