Biostats
Which study is best for determining prevalence?
A. Cohort
B. Cross Sectional
C. Case-Control
D. Crossover
Answer:
B – Cross sectional study is the best study suited to determine prevalence. They are used for population-based surveys and to assess the prevalence of diseases in clinic-based samples. The defining characteristic of these studies is that exposure and outcome are measured simultaneously. This creates the so-called "snapshot." In a case-control study, cases (individuals with disease) and controls (individuals without disease) are separately identified and exposures are measured for both groups. Odds ratio (OR) is measure of disease association in Case-Control studies. Case-control studies are useful for studying rare diseases/outcomes. In a cohort study, a group of individuals is followed over time (either prospectively or retrospectively) for the development of the outcome of interest. Relative risk (RR) is measure of disease association in Cohort studies. Cohort studies are frequently used to study incidence, risk factors, and prognosis. Crossover studies are defined by having "within subject" design, where subjects function as their own controls, meaning subjects serve both as controls and cases over time. These trials are often employed in the setting of chronic problems and short interventions.
35 year old female with a history of Schizophrenia and 10+ psychiatric hospitalizations, became noncompliant, decompensated, is now homeless and is floridly psychotic on the streets with poor social and family support. Which intervention would be best at this time to reduce the number of future hospitalizations for this patient?
A. Refer the patient to a Group Home.
B. Begin the patient on a trial of Clozapine.
C. Set the patient up for electroconvulsive therapy (ECT).
D. Set the patient up voluntarily with Assertive Community Treatment (ACT).
Answer:
D - Assertive Community Treatment (ACT) team is most effective in reducing inpatient hospital use, increasing housing stability, controlling psychiatric symptoms, and improving quality of life, for the severely mentally ill 24/7. The mission of ACT is to help people become independent and integrate into the community as they experience recovery. More resources are still needed unfortunately. The major issues with maintaining severely mentally ill in the community are in fact insufficient resources to maintain continuity of care outside in the community. ACT usually has a ratio of about 10:1, meaning that for every 10 clients there will be one team member assigned. An ACT team generally includes a psychiatrist, social workers, nurses, occupational therapists, peer support specialists, and more.
Culture correlates most with which of the following factors?
A. Race
B. Nationality
C. Gender
D. Ethnicity
Ans: D
Culture correlates most with ethnicity. People can be of the same race, gender, nationality and have different cultures
Groups of patients with Adjustment Disorder, Major Depressive Disorder and Persistent Depressive Disorder (dysthymia) were provided mood scales to fill out on their own. Mood scales were then collected in order to compare the means of the scores of the 3 groups. Which statistical method is used to do so?
A. Chi Square Test
B. Two Sample T Test
C. Meta-Analysis
D. Analysis Of Variance (ANOVA)
Answer:
D - Analysis Of Variance (ANOVA) compares 3 or more means. Comparing 2 means or 2 groups on a continuous variable would be best using a Two Sample T Test. Chi Square test is good for comparing proportions or relative frequencies in 2 populations that fall into well defines categories. They are usually used with used with 2x2 tables to test whether 2 nominal variables are associated. Within a Meta-Analysis study, information and results are pulled from many studies of similar design to create a strong statistical significance and the overall estimate of the effect of a variable through statistical review and interpretation.
Which one of the following most likely to be associated with more chaos by patients on the unit?
A. Change of shift.
B. Delayed Dinner.
C. Delayed breakfast.
D. Reduced temperature on the unit
Answer:
A – Change of shift due to ineffective handoffs and poor transfer of information to next shift. Nursing handover is a crucial part of effective and safe provision of health care.
Which patient population have more somatic complaints when they are depressed ?
A. Southeast Asians
B. Native Americans
C. African Americans
D. Caucasian
Answer: A. Southeast Asians. Of note, the most common complaints in southeast Asians who are diagnosed with a mental disorder are multiple somatic complaints. There have been a significant number of clinical studies in both psychiatry and primary care reporting that Asians with psychological distress or depression exhibit more somatic distress complaints than Caucasians.
Twenty patients are provided Venlafaxine until their mood improves. 16 patients respond to 37.5 mg PO daily, 2 patients respond to 75 mg PO daily, and 2 patients respond to 150 mg PO daily. What best reflects the skewed distribution of effective dose of Venlafaxine in this group of patients?
A. Mean
B. Median
C. Mode
D. All of above
Answer:
B – Median (the middle of all observations) is the measure of central tendency that analyzes an outcome measure with significantly skewed distribution of its values. Mean (the average of all observations) is the measure of central tendency in a skewed distribution that moves farthest away from the mode in the direction of skewness. Mode is the most commonly occurring value
Who and what is part of the psychiatric assertive community treatment case management model?
A. Interdisciplinary team, services in situ, high staff to patient ratio, and intensive inpatient research
B. Interdisciplinary team, services in situ, high patient to staff ratio, and intensive outpatient research
C. Interdisciplinary team, services in situ, high staff to patient ratio, and intensive outpatient research
D. Interdisciplinary team, services in situ, equal staff to patient ratio, and intensive outpatient research
Answer:
C - Interdisciplinary team, services in situ, high staff to patient ratio, and intensive outpatient research. ACT usually has a ratio of about 10:1, meaning that for every 10 clients there will be one t
includes a psychiatrist, social workers, nurses, occupational therapists, peer support specialists, and more.
Puerto Rican and other Latin American patients are more likely than those from western culture to report their depression as what?
A. Nervousness
B. Shame
C. Which-craft or a curse
D. Anger
Answer:
A. Nervousness. Due to lack of cultural competence, cultural differences may lead doctors to misdiagnose those from the Hispanic community. For instance, they may describe their symptoms of depression as “nervios” (nervousness), tiredness or as a physical ailment. These symptoms are consistent with depression, but doctors who are not trained in of how culture influences a person’s interpretation of their symptoms may assume it is a different issue.
What measure should be maximized in a screening test to miss the fewest individuals with an illness?
A. Sensitivity
B. Specificity
C. Positive Predictive Value
D. Negative Predictive Value
Answer:
A – Sensitivity is a statistical term that refers to the proportion of patients with the condition in question that a test accurately detects. It is the ability of the test to correctly identify those who have the disease. Specificity on the other hand is the ability of the test to correctly identify those who do not have the disease. For instance, if a new screening test correctly classifies early cognitive impairment in 60% and normal cognition in 70%, the 60% would refer to sensitivity, whereas 70% would refer to specificity.
Patient with Major Depressive Disorder goes to receive both interpersonal therapy with beginning an SSRI. Patient receives Zoloft 25 mg PO daily by the psychiatrist and the interpersonal therapy from a psychologist. Who is responsible and accountable for what?
A. Psychiatrist – medication only, Psychologist – medication and psychotherapy
B. Psychiatrist – medication and psychotherapy , Psychologist – medication and psychotherapy
C. Psychiatrist – medication only, Psychologist – psychotherapy only
D. Psychiatrist – medication and psychotherapy , Psychologist – psychotherapy only
Answer:
D. Psychiatrist – medication and psychotherapy , Psychologist – psychotherapy only.
Within which ethnicity do females report highest rate of intimate partner violence?
A. Southeast Asians
B. Native Americans
C. African Americans
D. Hispanic Americans
Answer: B. Native Americans. The lifetime victimization rate is 1.2 times as high for American Indian and Alaska Native women as for White women; For men, it is 1.3 times as high. More than four in five American Indian and Alaska Native adults (83 percent) have experienced some form of violence (psychological aggression or physical violence by intimate partners, stalking, or sexual violence) in their lifetime.
What is it called when a test measures what it is supposed to measure?
A. Precision
B. Reliability
C. Validity
D. Power
Answer:
C – Validity (also known as accuracy) will produce the correct results and what the test is supposed to measure. Reliability (also known as precision) is how well a study can be replicated / reproducible based on its quality. If a study has high reliability, it consistently produces the same result for any given patient. Power (1 – beta) is the probability of correctly rejecting the null hypothesis. Power depends on sample size and effect size.
Patient calls the psychiatrist in the ED complaining of command-type auditory hallucinations telling him to kill others. What is the first thing the psychiatrist should do?
A. Tell patient to come to the Emergency Room immediately.
B. Contact collateral.
C. Obtain phone number and address of patient.
D. Ask the patient if the voices are coming within his head or outside of his head.
Answer:
C. Obtain phone number and address of patient.
What is ethnicity?
A. Group of individuals who share religious beliefs and ancestry.
B. Group of individuals who share the same eating habits.
C. Group of individuals who share physical characteristics and risk factors.
D. Group of individuals who share a sense of identity, ancestry, beliefs and history.
Answer:
D. Ethnicity is a group of individuals who share a sense of identity, common ancestry, beliefs and history. Race is based on physical characteristics whereas ethnicity incorporates multiple factors. The concept of race is the sociopolitical designation assigning individuals to a particular group that has meaning derived from prevailing societal attitudes.
What terms best defines the degree of spread of scores about the mean?
A-Mean
B-Median
C-Standard Deviations
D-None of the above
Ans:
C- Standard Deviation
In statistics, the standard deviation is a measure of the amount of variation or dispersion of a set of values. A low standard deviation indicates that the values tend to be close to the mean (also called the expected value) of the set, while a high standard deviation indicates that the values are spread out over a wider range.
31 y/o postpartum F distressed by fantasies of smothering baby, tearfully describes feeling overwhelmed by the burden of the child care. She denies SI/HI, but describes feeling some evil external force taking her baby away. Requests outpt psych f/u & refuses voluntary admission and her husband says everything is fine. Next step:
A- Voluntary admission
B-Follow the patient wishes
C-Involuntary Admission
D-Place the patient under observation
Ans:
INVOLUNTARY ADMISSION
Involuntary civil commitment is the admission of individuals against their will into
a mental health unit.
30 y/o MD who has emigrated from China to the US continues to take pride in family recipes, but has recently embraced American ballroom dancing. This represents which of the following:
A-Nervousness
B- Acculturation
C-Cultural Form
D-Belief System
Ans:
ACCULTURATION
Acculturation is a process of social, psychological, and cultural change that stems from the balancing of two cultures while adapting to the prevailing culture of the society. Acculturation is a process in which an individual adopts, acquires and adjusts to a new cultural environment
What statistical measure should be used to determine how 2 independent variables affect the frequency of the occurrence rate of an event?
A-Meta Analysis
B-Chi square
C- Regression Analysis
D-Case Control Study
ns:
C -REGRESSION ANALYSIS
Regression analysis is a powerful statistical method that allows you to examine the relationship between two or more variables of interest. While there are many types of regression analysis, at their core they all examine the influence of one or more independent variables on a dependent variable.
30 y/o angry, agitated patient is admitted to the ER. He is evaluated during initial interview as psychotic and high risk for imminent violence. He refuses medication. What would be the most appropriate intervention at this time?
A- Verbal de-escalation
B-External/4 point Leather restraint
C-Verbal De-escalation, keep him in seclusion room
D-Counsel, and offer PO medication again
Ans:
B- External/4 point Leather restraint
24y/o Colombian-American is concerned about how to maintain his parent’s cultural heritage after he marries a Caucasian. Which type of acculturative stress is he dealing with?
A-Assimilation
B-Separation
C-Marginalization
D-Integration
Ans:
INTEGRATION
During the acculturation process, individuals could experience one or all of the four dimensional of acculturation such as integration, assimilation, separation, and marginalization. Integration is when individuals maintain their cultures and are able to accept and adapt to the host's cultures.
What is used to report the deviation of a value from its group mean, expressed in standard deviation units?
A-Confidence Interval
B-Cohort study
C-Type 1 error
D-Z scor
Ans:
D - Z SCORE
A z-score describes the position of a raw score in terms of its distance from the mean, when measured in standard deviation units. The z-score is positive if the value lies above the mean and negative if it lies below the mean.
Of the following which is most effective in reducing inpatient hospital use, increasing housing stability, controlling psychiatric sx, and improving quality of life, for the severely mentally ill.
A-APH
B- Weekly Out Patient clinics
C-Assertive Community Care
D- Visiting Nurse
Ans:
ASSERTIVE COMMUNITY CARE
C- Assertive community treatment (ACT) is a form of community-based mental health care for individuals experiencing serious mental illness that interferes with their ability to live in the community, attend appointments with professionals in clinics and hospitals, and manage mental health symptoms
A Japanese family who recently moved from Japan brings their 6 yo child for an evaluation. They express concerns that the child appears depressed, is reluctant to go to school, and is fearful that harm will befall the parents. During the evaluation it is noted that the child sleeps in the same room as the parents. Which of the following is the most likely explanation of this sleeping arrangement?
A-Cultural Norm
B-Dysfunction
leep disorder treatment
D-Integration
Ans::
Cultural Norm
Cultural norms are the standards we live by. They are the shared expectations and rules that guide behavior of people within social groups. Cultural norms are learned and reinforced from parents, friends, teachers and others while growing up in a society
How can we determine the difference between incidence rates in exposed and non-exposed groups?
A-Relative risk
B-Genetic risk
C-Naturalistic study
D-Attributable risk
Ans:
D- Attributable risk
Attributable risk the amount or proportion of incidence of disease or death (or risk of disease or death) in individuals exposed to a specific risk factor that can be attributed to exposure to factorto the difference in the risk for unexposed gps
Public mental health clinicians who follow patients through all phases of mental health?
A-Supervisor
B-Case manager
C-Senior Nurse Practitioner
D-Psychotherapist
Ans:
CASE MANAGERS
Case Manager, a person who is coordinating and providing care that is safe, timely, effective, efficient, equitable, and client-centered.
Immigrants to US experience stress & demoralization most during which period?
A-Initial few months
B-In USA, immigrants never experience stresses
C- During first year in the country
D-During first 1-3 years in the country
Ans:
D- DURING FIRST 1-3 YEARS IN THE COUNTRY
Ulysses syndrome (Immigrant Syndrome of Chronic and Multiple Stress) is an atypical set of depressive, anxious, dissociative, and somatoform symptoms that results from being exposed to extreme levels of stress and demoralization unique to the process of modern migration. Rather than a mental disorder, this syndrome is a natural reaction to toxic levels of stress seen in migrants who are otherwise in normal mental health
RCT where patient receives one medication for 8 weeks, then breaks 4 weeks, then another med for 8 weeks. What kind of study?
A-Cohort
B-Cross Sectional
C-Naturalistic study
D-Cross over
Ans:
D-CROSSOVER
In medicine, a crossover study or crossover trial is a longitudinal study in which subjects receive a sequence of different treatments. While crossover studies can be observational studies, many important crossover studies are controlled experiments
C&L psych sees 58 y/o widowed patient medicine wants to discharge d/t negative workup for abdominal pain and nausea. Patient refuses to return home to adult kids because the food they prepare are making her sick and causing her symptoms. MSE unremarkable and no past psych hx. Next step?
A-Counsel the Patient and the family
B-Schedule meeting with the medical team, patient and the family
C-Start PPI
D-Schedule meeting with the family, talk about changing the menu
Ans: D
Schedule meeting with the medical team, patient and the family
The culturally and Linguistically Appropriate Services (CLAS) federal standards for healthcare Organizations require the organizations to:
A-Provide information verbally to all patients
B-Have the patient related materials available in the patient’s native languages
C-Do not provide the information material in the patient’s native languages
D-Have the patient related material available in English language
ANS:
B- Have the patient related materials available in the patient’s native languages.
Culturally and linguistically appropriate services ( CLAS ) is a way to improve the quality of services provided to all individuals, which will ultimately help reduce health disparities and achieve health equity. CLAS is one of the strategy to help eliminate health inequities.