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Semester 4: Nutrition and Metabolism > PBL Topic 4 Case 8 > Flashcards

PBL Topic 4 Case 8 Flashcards

1
Q

Identify the two main steps of micturition

A
  • Bladder fills until tension in its wall rises above a threshold
  • Which elicits a nervous reflex that empties the bladder
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2
Q

Identify the two parts of the bladder

A
  • Body (major part)

- Neck (funnel shaped inferior part)

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3
Q

What name is given to the smooth muscle of the bladder?

A
  • Detrusor muscle
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4
Q

What is the main function of the detrusor muscle?

A
  • Emptying the bladder
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5
Q

What is the trigone?

A
  • Triangular shaped area
  • With a smooth mucosa
  • Upper two apices receive the ureters
  • Lower apex opens into urethra
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6
Q

What is the internal urethral sphincter composed of and what is its function?

A
  • Involuntary smooth muscle
  • Prevents emptying of bladder until pressure in the body of the bladder rises above a threshold
  • Controlled by micturition centre in periaqueductal gray
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7
Q

What is the external urethral sphincter composed of and what is its function?

A
  • Voluntary skeletal muscle

- Used to consciously prevent urination

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8
Q

What is the main innervation to the bladder?

A
  • Pelvic nerves
  • Which carry sensory and motor signals
  • Which connect through spinal cord through sacral plexus
  • Connecting to cord segments S2-S3
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9
Q

What are the sensory and motor functions of nerves supplying the bladder?

A
  • Sensory: Detects degree of stretching

- Motor: Contraction of detrusor muscle, emptying of bladder

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10
Q

What is the function of the pudendal nerve in the innervation of the bladder??

A
  • Innervates the external urethral sphincter
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11
Q

What is the function of the sympathetic chains in the innervation of the bladder?

A
  • Stimulate blood vessels
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12
Q

Which nerves do the fibres of the sympathetic chain pass through to innervate the bladder?

A
  • Hypogastric nerves

- Connecting mainly with L2 of spinal cord

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13
Q

Outline the process of renal emptying of urine

A
  • Stretching of renal calyces as they are filled with urine
  • Which increases inherent pacemaker activity
  • Which initiates peristaltic contractions
  • Which spread to renal pelvis along ureters
  • Forcing urine from the renal pelvis into the bladder
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14
Q

What is the role of sympathetic and parasympathetic signals to the ureters?

A
  • Parasympathetics enhance peristaltic contractions

- Sympathetics inhibit peristaltic contractions

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15
Q

What is vesicoureteral reflux?

A
  • Shorter course of ureter in the bladder
  • Contraction of bladder does not fully occlude ureter
  • Causing reflux and enlargement of ureters
  • Increasing pressure and damaging renal calyces and medulla
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16
Q

What is the ureterorenal reflex?

A
  • Blockage of ureter stimulates pain fibres
  • Which causes constriction of renal arterioles
  • Decreasing urine output from kidney
  • To prevent excess flow into the renal pelvis with a blocked ureter
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17
Q

What causes a micturition reflex?

A
  • Stretch reflex initiated in posterior urethra as bladder fills
  • Which is conducted to sacral segment of cord
  • And reflexively back again to bladder through parasympathetic nerve fibres
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18
Q

Why is the micturition reflex considered to be self-regenerative?

A
  • Initial bladder contraction activates stretch receptors
  • To cause a greater increase in sensory impulses
  • Which causes a further increase in bladder contraction
  • This process begins to fatigue, permitting bladder relaxation
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19
Q

Identify a secondary reflex caused by the micturition reflex?

A
  • A reflex passes through pudendal nerve
  • To inhibit the external urethral sphincter
  • If this inhibition is more potent in the brain than the sphincter muscles urination will occur
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20
Q

Where are the strong facilitative and inhibitor centres for micturition located in the brain?

A
  • Pons
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21
Q

How does voluntary urination occur?

A
  • Person contracts abdominal muscle
  • Which increases pressure in bladder
  • Allowing extra urine to enter bladder
  • Which stimulates stretch receptors
  • Excites micturition reflex /reflex inhibition of external sphincter
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22
Q

Outline the pathophysiology of atonic bladder

A
  • Sensory nerve fibres from bladder are destroyed
  • Preventing stretch signals from bladder
  • Bladder fills to capacity and overflows a few drops at a time (incontinence)
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23
Q

Identify two causes of atonic bladder

A
  • Crush injury to sacral region of spinal cord

- Damage to dorsal root fibres in neurosyphilis (tabes syphilis)

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24
Q

Outline the pathophysiology of automatic bladder

A
  • Loss of facilitative impulses from brain stem and cerebrum
  • Micturition reflex can still occur they are just no longer controlled by brain
  • Micturition reflex can be stimulated by catheterisation or stimulating the skin in the genital region
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25
Q

Outline the pathophysiology of uninhibited neurogenic bladder

A
  • Damage to spinal cord and brainstem
  • Which interrupts the inhibitory signals
  • Which results in frequent and uncontrolled micturition
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26
Q

Outline the physiologic anatomy of the male sexual organs

A
  • Sperm formed in seminiferous tubules of testes
  • Sperm empties into epididymis then into ductus deferens
  • Which receives seminal vesicles and empties into prostate
  • Prostate empties into ejaculatory duct then into urethra
  • Which receives mucus from bulbourethral glands
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27
Q

Identify contents of the prostatic secretions

A
  • Calcium
  • Citrate ion
  • Phosphate ion
  • Clotting enzyme
  • Profibrinolysin
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28
Q

How are prostatic secretions added to the semen

A
  • Simultaneous contraction of prostate gland and ductus deferens
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29
Q

What is the pH of prostatic secretions? What is the importance of this?

A
  • Slightly alkaline
  • Neutralises acid of vas deferens and vaginal secretions
  • Optimum motility and fertility of sperm at pH of 6-6.5
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30
Q

Which hormone is responsible for growth of the prostate? Describe the growth pattern of the prostate

A
  • Testosterone
  • Remains small during childhood and begins to grow at puberty
  • Reaches a stationary size by 20
  • May involute after 50 with decreases testosterone production
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31
Q

Which cells of the testes secrete testosterone?

A
  • Interstitial cells of Leydig
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32
Q

Which hormone stimulates testosterone production?

A
  • LH
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33
Q

Outline the formation of testosterone from acetyl-CoA

A
  • Cholesterol is synthesised from acetyl-CoA
  • Followed by production of intermediate hormones (17-a hydroxypregnenolone and DHEA)
  • And finally androstenedione
  • Which is converted to testosterone
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34
Q

When does LH secretion begin?

A
  • Puberty
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35
Q

Identify the effects of testosterone on the male sexual organs

A
  • Maturation of reproductive organs
  • Development of secondary sexual characteristics
  • Thereafter, maintenance of spermatogenesis (Sertoli cells)
  • Maturation of spermatozoa
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36
Q

Identify the anabolic effects of testosterone

A
  • Development of musculature
  • Increased bone growth
  • Closure of epiphyses following puberty
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37
Q

Outline how testosterone exerts its effects on cells

A
  • Testosterone converted to dihydrotestosterone
  • By 5a-reductase
  • Binds to testosterone receptors
  • Modifies gene transcription by interacting with nuclear receptors
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38
Q

What is benign prostatic hyperplasia?

A
  • Non-neoplastic enlargement of prostate gland
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39
Q

Outline the epidemiology of BPH

A
  • Occurs commonly and progressively after 50

- Affects 75% of men aged 70-80 years

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40
Q

Outline the aetiology of BPH

A
  • Dihydrotestosterone activates gene transcription to promote cell growth and survival
  • Causing proliferation of glands and stroma of the transition zone
  • Contraction of hyperplastic smooth muscle mediated by alpha-adrenergic receptor
  • Role of persistent inflammation resulting in secretion of growth-promoting cytokines
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41
Q

Outline the morphology of BPH

A
  • Hyperplasia in both lateral lobes
  • Hyperplasia of periurethral glands projecting into bladder giving a median lobe
  • Circumscribed nodules and cysts
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42
Q

Outline the four main pathological mechanisms in the development of symptoms in BPH

A
  • Hyperplastic nodules compress prostatic urethra, distorting its course
  • Involvement of periurethral zone interferes with sphincter mechanism
  • Contraction of hyperplastic smooth muscle
  • Inflammatory cell infiltration
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43
Q

Identify the three groups lower urinary tract symptoms (LUTS)

A
  • Bladder sensation symptoms (increased or decreased)
  • Storage symptoms (frequency, nocturia, urgency, incontinence)
  • Voiding symptoms (hesitancy, poor stream, straining, dribbling)
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44
Q

Outline the findings of a DRE in BPH

A
  • Asymmetrical enlargement of both lateral lobes

- Gland has a firm, rubbery consistency

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45
Q

Outline the pathology of hydroureter identify a complication of it

A
  • Continued bladder obstruction causes hypertrophy and trabeculation
  • Which fails and allows reflux of urine
  • Which causes dilation of ureters
  • Results in dilation of renal pelvises (bilateral hydronephrosis)
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46
Q

Why does cystitis occur in BPH? What are the symptoms

A
  • Residual urine causes cystitis due to coliform organisms

- With dysuria, haematuria and increased frequency

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47
Q

Outline a complication of cystitis

A
  • Ascending infection causes pyelonephritis with impaired renal function
  • Which can result in the formation of calculi and septicaemia
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48
Q

Identify the investigations in the diagnosis of BPH

A
  • Scoring of symptoms using IPPS
  • Microbiological exam for evidence of infection
  • U+E for kidney function
  • Ultrasonography indicated enlarged prostate and obstruction
  • Elevated prostate specific antigen to rule out cancer
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49
Q

Outline the management of BPH

A
  • Pharmacological treatments e.g. finasteride and tamsulosin, anti-inflammatory drugs and antibiotics
  • Urethral catheter drainage in acute retention
  • Surgery (transurethral resection of hyperplastic prostate tissue) where catheterisation is impossible
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50
Q

Outline the mechanism of action of finasteride

A
  • Inhibits 5a reductase

- Reduced dihydrotestosterone formation

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51
Q

Outline the mechanism of action of tamsulosin

A
  • a1A receptor antagonist
  • Relaxation of smooth muscle of bladder neck
  • Inhibition of hypertrophy
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52
Q

Why is tamsulosin preferred over other alpha receptor antagonists

A
  • Selective for bladder

- Causes less hypertension

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53
Q

Identify an adverse effect of tamsulosin

A
  • Failure of ejaculation
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54
Q

Identify a difference in the indication of finasteride and tamsulosin

A
  • Finasteride indicated when prostate > 40 cm3

- Tamsulosin indicated when prostate < 40 cm3

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55
Q

Outline the epidemiology of prostate cancer

A
  • Second leading cause of male death from malignancy in Europe/USA
  • Incidence is 40,000, with 10,000 deaths annually
  • Peak incidence between 65-75
  • Rare below 50
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56
Q

Which zone do most prostate tumours arise?

A
  • Peripheral zone
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57
Q

Why can prostate carcinoma arise after transurethral resection?

A
  • This operation does not remove the peripheral zone
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58
Q

What type of tumour are most prostate cancers?

A
  • Adenocarcinoma

- Often described as microacinar

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59
Q

Identify two rare subtypes of prostate cancer

A
  • Small cell carcinoma

- Large duct carcinoma

60
Q

Identify a grading system used for prostate cancer

A
  • Gleason grading system
61
Q

Identify five Gleason patterns

A
  • GP1: Not carcinoma
  • GP2: Small, circumscribed masses of regular glands
  • GP3: Separate gland profiles that infiltrate into normal glands
  • GP4: Fused glands / cribiform structures
  • GP5: Undifferentiated, central necrosis
62
Q

How is the Gleason Grading system used?

A
  • Gives a combined score using most dominant pattern and next most frequent pattern
  • E.g. GP5 +GP4 = GP9
  • Doubled when only one pattern is seen
  • E.g. GP3 + GP3 = GP6
63
Q

What is a prostatic intraepithelial neoplasia

A
  • Common precursor of carcinoma
  • Which composes of malignant cells
  • That are confined within ductal system
  • With no invasion of stroma
64
Q

Identify 3 modes of spread of prostate cancer

A
  • Direct invasion into seminal vesicles, bladder
  • VIa lymphatics to sacral, iliac or para-aortic nodes
  • Via blood to bone (osteosclerotic), lungs and liver
65
Q

Identify the four main clinical features of prostate cancer

A
  • Urinary symptoms e.g. changes in frequency
  • Rectal exam revealing hard craggy prostate
  • Bone metastases e.g localised back pain
  • Lymphadenopathy due to metastasis
66
Q

What is prostate specific antigen?

A
  • Glycoprotein produced by prostate epithelium
  • Which has a role in liquefaction of semen
  • Increases with age
  • Elevated serum levels in prostatic cancer
67
Q

Identify three common ways used to diagnose prostate cancer

A
  • DRE
  • PSA
  • Transrectal ultrasound-guided needle biopsy
68
Q

Outline the management of prostate cancer

A
  • Early confined tumour removed by radical prostatectomy
  • Endocrine treatment e.g. orchidectomy, androgen suppressing drugs
  • Chemotherapy where endocrine therapy fails
  • Analgesia or radiotherapy for relief of back pain
69
Q

Identify two androgen receptor antagonists and briefly how they work

A
  • Flutamide
  • Abiraterone
  • Which inhibit CYP17 which is necessary for androgen production
70
Q

Identify two GnRH agonists and briefly how they work

A
  • Goserelin
  • Leuprorelin
  • Which occupy pituitary receptors, preventing them from responding to GnRH pulses which normally stimulate LH and FSH
71
Q

Identify one adverse effect of GnRH agonists

A
  • Cause initial rise in LH and testosterone

- Which require an anti-androgen e.g. flutamide

72
Q

Outline the prognosis of prostate cancer

A
  • Life expectancy of an incidental finding of focal carcinoma is normal
  • 10 year survival rate is 70% in more substantial tumours
  • 10 year survival rate is 10% if metastases are present
73
Q

Outline the uses of ultrasound in renal imaging

A
  • Renal size
  • Dilatation
  • Tumours and cysts
  • Bladder emptying
74
Q

What is the resistivity index?

A
  • Ratio of peak systolic and diastolic velocities
  • Influenced by the resistance to flow through these vessels.
  • Using doppler techniques
75
Q

Identify conditions that result in an elevated resistivity index

A
  • Acute glomerulonephritis

- Rejection of renal transplant

76
Q

Identify 4 limitations of ultrasound scanning

A
  • Poor visualisation of renal pelvis, calyces and ureters
  • May miss renal and ureteric calculi
  • It is operator dependent
  • It is often less clear in obese patients
77
Q

What does pyelography involve? Describe the two types

A
  • Injection of contrast medium into the collecting system
  • Allows for drainage and stent insertion in obstruction
  • Anterograde: insertion of fine needle into pelvicalyceal system under ultrasound
  • Retrograde: insertion of catheters into ureteric orifices at cystoscopy.
78
Q

What is the first line investigation in ureteric colic?

A
  • CT scan (Ultrasound if Woman)
79
Q

Identify an advantage and a disadvantage of CT scanning

A
  • It gives clear definition regardless of obesity

- Radiation and contrast nephrotoxicity

80
Q

Identify two other uses of CT scanning

A
  • Characterising cysts and masses

- Useful in trauma, haemorrhage and stenosis

81
Q

Identify 3 uses of MRI scanning

A
  • Characterise renal masses
  • Staging of renal, prostate and bladder cancers
  • Angiography with gadolinium
82
Q

Why is it advised not to use gadolinium in patients with renal insufficiency

A
  • Development of nephrogenic systemic fibrosis
83
Q

How is renal biopsy performed?

A
  • Transcutaneously under ultrasound

- Which is then examined by histological staining, microscopy or immunofluorescence

84
Q

Outline the uses of renal biopsy

A
  • Nephrotic and nephritic syndromes
  • Acute and chronic kidney disease
  • Haematuria
85
Q

Identify 3 contraindications to renal biopsy

A
  • Disordered coagulation or thrombocytopenia
  • Uncontrolled hypertension
  • Kidneys that are less than 60% the predicted size
86
Q

Identify four complications of renal biopsy

A
  • Mild pain
  • Bleeding into urine
  • Bleeding around the kidney
  • Arteriovenous fistula
87
Q

Identify 7 causes of urinary tract obstruction

A
  • Urinary calculi
  • Tumours e.g. prostatic carcinoma
  • Inflammation e.g. urethritis
  • Benign prostatic hypertrophy
  • Uterine prolapse
  • Congenital defects e.g. meatal stenosis
88
Q

Outline how urinary tract obstruction causes atrophy

A
  • Increase in pressure proximal to obstruction
  • Which is transmitted to collecting ducts, with loss of tubular function
  • Increase interstitial pressure reduces medullary blood flow
89
Q

Why is there an increased risk of UTIs and urolithiasis in urinary tract obstruction?

A
  • Stagnant urine predisposes to bacterial infections

- And development of magnesium ammonium phosphate stones

90
Q

Identify symptoms of an upper tract obstruction

A
  • Loin pain
  • Anuria suggests complete bilateral obstruction
  • Polyuria due to impairment of renal tubular concentrating capacity
  • Malaise, fever, septicaemia due to infection
91
Q

Identify the symptoms of bladder outflow obstruction

A
  • Hesitancy, narrowing and diminished force of urinary stream
  • Terminal dribbling
  • Sense of incomplete bladder emptying.
  • Infection suggested by increased frequency and urgency, urge incontinence, dysuria and the passage of cloudy smelly urine.
92
Q

Outline the findings on examination in urinary tract obstruction?

A
  • Palpable hydronephrotic kidney (owing to dilatation of renal pelvis, calyces and papillae)
  • Enlarged bladder can be felt or percussed
93
Q

Why is it important to examine the genitalia in suspected urinary tract obstruction?

A
  • Malignancy is a cause of obstruction
94
Q

What do

routine blood and biochemical investigations show in urinary tract obstruction?

A
  • Raised serum urea or creatinine
  • Hyperkalaemia
  • Anaemia of chronic disease
  • Blood in urine
95
Q

What do plain x-rays show in urinary tract obstruction?

A
  • Stones

- Calcification

96
Q

Why is ultrasonography used in urinary tract obstruction?

A
  • Upper tract dilatation
97
Q

What are the three aims of treatment in urinary tract obstruction?

A
  • Relieve obstruction e.g. external drainage of urine by nephrostomy,
  • Treating the underlying cause
  • Preventing and treating infection
98
Q

Outline factors that affect prognosis in urinary tract obstruction?

A
  • The site of obstruction
  • Whether obstruction is partial or complete
  • Duration of obstruction
  • Whether or not infection occurs
99
Q

What is urolithiasis?

A
  • Development of calculi (stones)
  • Which may occur at any level of urinary tract
  • But most frequently within the kidney
100
Q

Identify the four most common types of stones and what each type is associated with

A
  • Calcium stones: hypercalciuria
  • Uric stones: hyperuricaemia
  • Magnesium ammonium phosphate: bacterial infections e..g Proteus
  • Cysteine stones: cystinuria
101
Q

Outline the clinical features of urolithiasis

A
  • Infections
  • Haematuria due to mucosal injury
  • Pain worsened by measures that increase urine volume
  • Pain worsened by physical exertion owing to movement of calculi
102
Q

What is ureteric colic and what are the symptoms?

A
  • Stone enters ureter causing obstruction or spasm during its passage
  • Abrupt pain that starts and stops
  • From flank to iliac fossa and testes or labium (loin to groin!)
  • Associated with vomiting, sweating, pallor, haematuria
103
Q

What are the investigations in urolithiasis?

A
  • Mid stream specimen for urine culture
  • Serum urea, electrolytes, creatinine, calcium levels
  • Plain x-ray
  • CT-KUB
104
Q

Outline the treatments of urolithiasis

A
  • Analgesia e.g. diclofenac intravenously
  • Small stones pass spontaneously though alpha blockers (tamsulosin) facilitate spontaneous expulsion
  • Large stones removed by extracorporeal shock wave lithotripsy (ESWL), YAG laser of percutaneous nephrolithotomy
105
Q

Identify the two routes of infection in acute pyelonephritis

A
  • Haematogenous spread secondary to septicaemia

- Ascending urinary tract infection

106
Q

Identify the mechanism by which lower urinary tract infections cause acute pyelonephritis

A
  • Vesicoureteric reflux
  • Due to congenital abnormality
  • Or bladder outflow obstruction
107
Q

Why are urinary tract infections more common in women?

A
  • Short urethra

- Urethral trauma associated with sexual intercourse

108
Q

Identify two other common causes of urinary tract infection

A
  • Pregnancy

- Diabetes mellitus

109
Q

Ascending infection is usually with which type of bacteria?

A
  • Enteric gram negative bacilli

- Such as E.coli and enterobacter

110
Q

Identify three causes of pyelonephritis due to haematogenous spread

A
  • Endocarditis
  • Osteomyelitis
  • Soft tissue abscesses
111
Q

Identify the clinical features of acute pyelonephritis

A
  • Fever and malaise
  • Loin pain and tenderness
  • LUTS such as frequency and dysuria
112
Q

Identify the histological findings in acute pyelonephritis

A
  • Large number of neutrophils (pyuria) and neutrophil casts
113
Q

What is the treatment for acute pyelonephritis?

A
  • Amoxicillin

- Co-amoxiclav or ciprofloxacin for resistant organisms

114
Q

What is chronic pyelonephritis

A
  • Renal scarring and chronic inflammation

- Secondary to untreated vesicoureteric reflux or urinary tract obstruction

115
Q

What are the clinical features of chronic pyelonephritis?

A
  • Asymptomatic
  • Followed by signs and symptoms of CKD
  • Such as malaise, loss of appetite, insomnia, nocturia and polyuria
116
Q

What are the morphological findings of chronic pyelonephritis?

A
  • Renal fibrosis with a segmental distribution
  • Dilated and distorted calyces
  • Casts of uromodulin (glycoprotein produced by tubular epithelium)
117
Q

What is xanthogranulomatous pyelonephritis?

A
  • Variant of chronic pyelonephritis
  • With large collections of foamy macrophages appearing as yellow nodules
  • Associated with proteus infections and obstruction
118
Q

What is tuberculous pyelonephritis?

A
  • Caused by haematogenous spread from lungs

- Characterised by granulomatous inflammation.

119
Q

Which type of pre-operative fear is related to a decrease in post-operative stress?

A
  • Moderate pre-operative fear
  • It is associated with defence mechanisms, coping strategies, seeking out relevant information
  • Which all increase confidence in the outcome
120
Q

Identify the four types of information that could be used to affect the outcome of recovery from surgery

A
  • Sensory information: dealing with feelings and reflecting on them
  • Procedural information: learning about the actual intervention
  • Coping skills information: teaching possible coping strategies
  • Behavioural instruction: how to behave afterwards (e.g. relaxing)
121
Q

Outline the importance of pre-operative information

A
  • Reduces anxiety, pain rating, length of hospitalisation and analgesic intake
  • As it allows patient to mentally rehearse their anticipated worries
  • So worries become predictable
122
Q

What is consequentialism?

A
  • Morally right action is one that gives the best consequences
  • Action taken is justified as the consequences are for the greater good
123
Q

Identify three types of consequentialism

A
  • Utilitarianism: promotes happiness for the greatest number of people
  • Egoism: best course of action is what is best for the individual
  • Altruism: doing what is best for other’s wellbeing
124
Q

Identify two weaknesses of consequentialism

A
  • Hard to know what consequences will be

- Some actions are self-evidently wrong even if consequences are good

125
Q

What is deontology?

A
  • Fundamental rules to be followed
  • One must act from duty
  • Certain acts are wrong regardless of consequences
126
Q

Identify a weakness of deontology

A

-Ignores the consequences which may not all be good

127
Q

What is virtue ethics?

A
  • Virtues are characteristics that promote human flourishing

- They include comparison, patience, kindness and fidelity

128
Q

Identify two weaknesses of virtue ethics

A
  • Centres on the person and includes the whole of a person’s life
  • Does not provide clear guidance, there are no general agreement on what the virtues are, virtues are relative to culture
129
Q

What is principalism?

A
  • Focus on four ethical principles e.g. autonomy, beneficence, non-maleficences and justice
130
Q

What is dynamism?

A
  • Claims all situations are dynamic

- Emphasises that a decision taken at one time may not be appropriate at a later stage

131
Q

What is sensitivity?

A
  • Proportion of people with the disease correctly identified by the test.
  • Probability that the test result will be positive when the disease is present
  • True positive rate
132
Q

What is specificity?

A
  • Proportion of people without the disease correctly identified by the test;
  • Probability that a test result will be negative when the disease is not present
  • True negative rate.
133
Q

How is the sensitivity of a test calculated?

A
  • TP / TP + FN
134
Q

How is the false negative rate calculated?

A
  • FN / TP + FN

- 1 - Sensitivity

135
Q

How is the specificity of a test calculated?

A
  • TN / FP + TN
136
Q

How is the false positive rate calculated?

A
  • FP / FP + TN

- 1 - Specificity

137
Q

What is a positive predictive value?

A
  • Probability that the disease is present when the test is positive
138
Q

How is the positive predictive value calculated?

A
  • TP / TP + FP
139
Q

What is a negative predictive value?

A
  • Probability that the disease is not present when the test is negative
140
Q

How is the negative predictive value calculated?

A
  • TN / TN + FN
141
Q

What is meant be trade off between sensitivity and specificity?

A
  • Changing the cut off point for a positive outcome
  • Will either increase specificity and decrease sensitivity
  • Or vice versa
142
Q

What name is given to a graph that presents the sensitivity and specificity?

A
  • Receiver Operating Characteristics Curve
143
Q

How can the accuracy of a diagnostic test be measured using an ROC curve?

A
  • An area of 1 represents a perfect test, where sensitivity and specificity are both 1
  • An area of 0.5 represents a worthless test, where sensitivity and specificity are both 0.5
144
Q

How does the shape of the curve represent accuracy of a diagnostic test?

A
  • An area of 0.5 would be found with a diagonal line

- The closer the curve follows the left and top border, the more accurate the test

145
Q

What does the IPSS take into account?

A
  • Severity of LUTS symptoms

- And QALY measure

Semester 4: Nutrition and Metabolism (17 decks)

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