Terms Test 1

Question 1

Positive Renforcement

Answer 1

he process by which presentation of a stimulus (drug) increases the probability of a response (non dependent drug taking paradigms)

Question 2

Negative Reenforcement

Answer 2

A process by which removal of an aversive stimulus (negative emotional state of drug withdrawal) increases the probability of a response (dependence-induced drug taking)

Question 3

Cannabinoids

Answer 3

Most commonly used illicit drug

Medicinal uses: antiemetic, appetite stimulant, anticonsulsant, and analgesic.

Abuse potential: More people sought treatment for marijuana than any other illicit drug.

Acute effects: slowed cognitive processing, impaired short-term memory, inhibition, concentration, visual-spatial processing. May precipitate psychotic disorder. Associated w/ relapse of other addicitons.

Long term effects: 9% become addicted. After one month of abstinence “minimal effects on cognition”, endocrine effects

Question 4

Stimulants (cocaine, methamphetamines)

Answer 4

Increase monomaines (DA, NE, and 5HT)

DA- acutely enhance, but chronically depletes

Acute effects on CNS: energy, alertness, decreased appetite, anxiety, paranoia, irritability, siezures, increased HR, BP, and TMP.

Question 5

Sedatives/Hypnotics

Answer 5

Most people become dependent when treating an anxiety disorder of insomnia.

Severe withdrawal (up to 50% of people on benzos)

Symptom rebound (anxiety, insomnia, muscle tension) lasts up to 3 weeks after discontinuation is mostly a withdrawal syndrome

Symptom reemergence is not a withdrawal syndrome. Reoccurence of original sx. Can last months.

Question 6

Alcohol

Answer 6

Wide variety of target proteins unlke drugs that are more specific.

Adults metabolize avg. of 1 oz per 3 hours.

Withdrawal sx:
0-36 hrs: seuzures (BAC doesn’t have to equal 0 to start), increased HR, BP, Temp,

Alcohol + Tobacco = synergistic effects on risks for cancer

Abuse is common, but often undetected by medical staff.

Question 7

Opiods

Answer 7

Risk w/ nonmedical or perscription abuse

OD can cause death (respiratory suppression)

Anhedonia makes dependence hard to break.

Question 8

Abuse

Answer 8

An intense desire to obtain increasing amounts of a particular drug to the exclusion of all other activities

Question 9

Dependence

Answer 9

The body’s physical need (addiction) to a specific drug. Dependence may result in physical harm, behavior problems, and association with people who also abuse drugs. Stopping can result in withdrawal.

Question 10

Tolerance

Answer 10

A state of progressively decreased responsiveness to a substance.

Takes more to get high.

Question 11

Compulsive Use

Answer 11

• Drug is taken in larger amounts or for longer periods.
• Persistent desire to or unsuccessful attempts at controlling use of substance
• Development of a substance centered lifestyle
• Neglect of signficant personal or social interests or obligations.

Question 12

Leading COD’s Age 1-24

Answer 12

1. ) Unintentional Injuries (38%)
2. ) Homicide (13%)
3. ) Suicide (12%)
4. ) Cancer (7%)
5. ) Heart disease (3%)

Question 13

Leading COD’s Ages 25-44

Answer 13

1. )Unintentional injuries (25%)
2. ) Cancer (14%)
3. ) Heart Disease (12%)
4. ) Suicide (11%)
5. ) Homicide (6%)

Question 14

Leading COD’s Agest 45-64

Answer 14

1. ) Cancer (32%)
2. ) Heart disease (21%)
3. ) Unintentional injuries (7%)
4. ) Chronic lower respiratory disease (4%)
5. ) Chronic liver disease and cirrhosis (4%)

Question 15

Leading COD’s Ages 65+

Answer 15

1. ) Heart Disease (27%)
2. ) Cancer (22%)
3. ) Chronic lower respirator disease (7%)
4. ) Stroke (6%)
5. ) Alzheimer’s disease (5%)

Question 16

WHO ranking of national health care systems

Answer 16

Five factors:

1. ) Health level (life expectancy; 25% weight)
2. ) Responsiveness (Speed, privacy protections, choice of care; 12.5% weight)
3. ) Financial Fairness (25% weight)
4. ) Health Distribution (how equally resources are shared; 25% weight)
5. ) Responsiveness distribution (how equally responsiveness if distributed; 12.5% weight)

U.S. ranked 37th.

Question 17

ACA key points

Answer 17

1. ) Expanded medicaid and increased number of plans subsidized
2. ) Created/Encouraged ACOs to coordinate care delivery for specified populations (pay based on outcomes)
3. ) ACOs will contract with PCMHs to deliever and coordinate care acoss the spectrum of patient needs.

Question 18

IHI Triple Aim

Answer 18

1. ) Experience of Care
2. ) Population health
3. ) Per capita cost

Question 19

Normative

Answer 19

Counting or measuring a behavior, event, etc. then defining the most common as normal

Question 20

Reliability

Answer 20

Consistency of prediction over time, over predictors, over individuals and/or over assesment techniques.

AKA repeatability

Question 21

Validity

Answer 21

AKA Accuracy

Degree of accuracy of predictive statements. Any statement can be valid or invalid (p=0 or p=1)

Diagnostic predictions are never wholly valid

Question 22

Extinction

Answer 22

Whatever can be learned can be unlearned. Once reward/punishments change behaviors should fade.

Question 23

Positive punishment

Answer 23

The presentation of an unfavorable event or outcome in order to weaken the response that follows.

I.e. parking ticket

Question 24

Negative punishment

Answer 24

AKA punishment by removal

I.e. failing grade

Question 25

Generalized reinforcer

Answer 25

Any reinforcer that acts across many different behaviors and people and culture. Attention, affection, and approval.

Question 26

Couvade syndrome

Answer 26

Male experiences similar pregnancy sx as wife

Question 27

APGAR

Answer 27

Test performed twice at one minute and at five minutes. Five clinical signs scored 0,1, or 2 One minute scores less than 4 = severe nervous system depression, immediate resuscitation Five minute scores less than 7 place infant at risk for subsequent CNS dysfunction ``` Appearance Pulse Grimace Appearance Respiration ```

Question 28

Edinburgh Post-natal Depression Scale

Answer 28

Test to assess mothers for post-natal depression. Consists of ten statements relating of post-natal depression.

Question 29

The social smile

Answer 29

Smiling may begin as early as two weeks. At four months, peak smiling to unfamiliar face 5-6 months selective smiling to key persons (parents, sibs) 7-8 = stranger anxiety

Question 30

Denver II

Answer 30

Scoring: Pass, fail, refusal, no opportunity to try. Scored ITEMS as: Advanced (completely right of normal) Normal - Age line falls between 25th and 75th percentile Caution - Child fails or refuses item when age line falls between the 75th and 90th percentile Delayed - Completely left of age line Interpreations: Cautious/Conservative Normal: max of one caution Suspect: two or more cautions/ or one or more delay Untestable: Refusal scores on one or more or falls delayed on more than two. Rescreen in 1-2 weeks if suspect or unstestable Goals of test: Make parents more aware of norms, systematically docuement progress, facilitate early id or delays.

Question 31

Ages and Stages Questionnaire

Answer 31

Series of dev and social-emotional screening instrument for children from one month to 5 and 1/2 years.

Question 32

Risk Factors for Divorce

Answer 32

``` Age - 20s and 30s Often have young children Married average of seven years Lower SES Married as teenagers Short courtship Conceive child before married. ```

Question 33

Classification schema for prevention and control of chronic disease

Answer 33

Health promotion (entire populaton; prevent risk factors) --> primary prevention (one or more risk factors; prevent development of disease) --> secondary prevention (limited disease; prevent disease progression/recurrence) --> tertiary prevention (symptomatic or advanced disease; reduce complications or disability)

Question 34

BMI

Answer 34

weight in kg / height in m squared Four disclaimers: -It may over estimate body fat in athletes -It may underestimate body fat in older persons - Should not be used in pregnancy, except in pre to pose comparisons -Endurance athletes should not be assesses using BMI. >20 = underweight 20-24.9 = normal 25-29.9=preobese 30-34.9 = Obese class I 35-39.9 = Obese Class II

Question 35

Four subgroups whom clearly benefit from statins

Answer 35

1. ) clinically evident ASCVD 2. ) Primary LDL that is > 190 3. ) Type I or II DM and LDL > 70 4. ) 10 year risk of ascvd of >7.5% and an LDL of >70

Question 36

Z distribution

Answer 36

Special case of normal distribution w/ idealized mean of 0 and S of 1. Need normal sample sizes > 100 Z score of 1.96 = 95% C.I.

Question 37

Critical region

Answer 37

Alpha Area under curve that include unlikely sampling outcomes if null is true. i.e. if alpha = 0.05 anything >1.96 will be in the critical region. 1 tailed - don't divide alpha by two and focus on one side (positive or negative). 5% in one tail. z = 1.65 2 tailed - Normal distribution. 2.5% in each tail. a =1.96

Question 38

Student's T Distribution

Answer 38

Used w/ smaller samples (N30

Question 39

Type 1 Error

Answer 39

False positive

Question 40

Type 2 Error

Answer 40

False negative

Question 41

Observational Study

Answer 41

Patients observed and outcomes are measured. No attempt is made to affect the outcome. Positives: probability sampling, great intro tool, answer some questions that controlled can't due to morals/ethics Negatives: low validity across cultures, correlations no causations, rely on self-reporting.

Question 42

Trend

Answer 42

Longitudinal study that measures changes in a population over time. I.e. Survey of college freshman each year.

Question 43

Cohort

Answer 43

Longitudinal study that measures Changes and follow a particular population over time. I.e. 25 MS1's in 2014 and 25 MS2's in 2015. Can be a different individuals, but same population. *Boards often state cohort, but don't differentiate from panel.

Question 44

Panel

Answer 44

Longitudinal study that measures changes in the SAME PEOPLE over time. I.e. 200 Diabetics in 2013 and same 200 diabetics in 2014 *Boards often state cohort, but don't differentiate from panel.

Question 45

Qualitative

Answer 45

High valididty. In depth/ nuanced

Question 46

Quantitative

Answer 46

High reliability. Generalized sampling.

Question 47

Nomothetic Causation

Answer 47

1. )Correlation/Association 2. )Temporal Order 3. )Non-spuriousness

Question 48

Clinical Trial Phases

Answer 48

Phase I - Safety and side effects Phase II - Ideal dosing Phase III - Experimental vs. control Phase IV - continued evaluation of FDA-approved therapy.

Question 49

Hawthorne effect

Answer 49

Researcher attention affects behavior

Question 50

External invalidity

Answer 50

Lack of applicability to real world

Question 51

Internal Invalidity

Answer 51

Anything other than the stimulus that influences results.