chat transcript - behavioral science (biostats, epi, learnin

[Anonymous]

21:16:34 [ayouh] it was tooo red

21:17:05 [merjo13] 1-Sensitivity=False negative rate

21:17:12 [sanya] 1-specificity=?

21:17:48 [ayouh] listen : sensitity= true positives / all dieseased ppl. specificity = true -ve / all non diseased

21:18:10 [merjo13] False positive

21:18:21 [ayouh] false positive ratio

21:18:25 [sanya] yep

21:18:37 [merjo13] Accuracy?

21:19:24 [sanya] tp+tn/tp+tn+fp+fn

21:19:33 [merjo13] Yep

21:20:16 [ayouh] accuracy = trues / everything

21:20:19 [perch30] Accuracy 45% Meaning?

21:20:44 [merjo13] Which study pattern determines incidence?

21:21:10 [ayouh] in 45 % of cases the test is accurate

21:21:43 [ayouh] cohort ?

21:21:45 [sanya] cohort study

21:21:48 [perch30] cohort study determines incidence

21:22:14 [merjo13] That's right!

21:22:29 Step_1 enters this room

21:22:30 >[Step_1] Welcome to our chat. Please obey the net etiquette while chatting: try to be pleasant and polite.

21:22:56 [sanya] what else can you calculate with cohort study

21:23:02 [ayouh] when does prevelance = incidence ?

21:23:24 [ayouh] relative risk

21:23:35 [ayouh] odds ratio for case control ones

21:23:35 [sanya] cross sectional study

21:23:38 [merjo13] Causal relation determined with cohort

21:23:49 [Step_1] i hope that worked, but please forgive me if i disappear suddenly or do not make any comments for a while

21:24:08 [sanya] ok

21:24:13 [merjo13] Cross section determines prevalence

21:24:34 [merjo13] Its a great support that you are with us step 1

21:24:47 [ayouh] in acute diseases like flu, incidence = prevelance

21:25:03 [sweta_med] odds ratiois exposure for cases /exposure for control

21:25:22 [sanya] what else can you calculate with cohort study=relative risk+ attributable risk

21:26:07 [Step_1] what i was trying to say earlier was that "SENSITIVe people get sick" and "SPECial people dont get sick" so sensitivity determines diseased and specificity determines non-diseased.

21:26:20 [sweta_med] relative risk=incidence of exposed /incidence of non exposed

21:26:55 [perch30] thanks step 1

21:27:27 [merjo13] Attributable risk= Incidence in exposed- incednce in unexposed

21:27:41 [Step_1] you're welcome perch

21:28:10 kokushubila enters this room

21:28:29 [merjo13] Hi Koku

21:28:50 [kokushubila] Hi all

21:28:55 [Step_1] what happens to incidence and prevalence in the following situations? New effective treatment? New effective vaccine gains widespread use?

21:29:04 [Step_1] hi koku

21:29:29 [kokushubila] Hi Step _1,Merjo

21:29:36 [ayouh] treatment lower prevalance new vaccine lower incidence

21:29:51 [merjo13] New effective Treat= Inci-Same ,Prev Reduced

21:30:13 [merjo13] Vaccine= both reduces

21:30:29 [Step_1] With new treatment, the incidence (new cases) stays the same and the prevalence (overall cases) will decrease. whereas with the new vaccine, both will decrease. the reason is that treatment will not effect new cases where vaccines will.

21:30:42 [Step_1] very good

21:31:13 narang_nandini enters this room

21:31:24 dia_huq enters this room

21:31:29 [Step_1] what medical situation can increase prevalence?

21:31:34 [narang_nandini] hi all

21:31:40 [narang_nandini] hi

21:31:49 [merjo13] Hi nandhini

21:32:02 [Step_1] hi narang

21:32:05 [sweta_med] epidemics

21:32:10 [perch30] What if treatment increases prevalence... Is it good or bad?

21:32:19 [kokushubila] Hi narang

21:32:24 [merjo13] Chronic situations like Hypertension,diab

21:32:42 [merjo13] Good b'cos it increases the life span

21:32:54 [Step_1] let me ask this more specifically. if long term survival rates for diease are increasing, what would happen to incidence and prevalence?

21:33:27 [sanya] prevlence increases

21:33:31 [narang_nandini] prev.. increases

21:33:40 [merjo13] Incidence is the same preval increases

21:33:42 [sweta_med] incidence would be the same ,prevalence would increase

21:33:58 [ayouh] agree sweta

21:34:12 [Step_1] yes, prevalence increases and incidence is the same....thats what i was trying to get at....very good

21:34:18 [sweta_med] hi ayuuh

21:34:43 [narang_nandini] hey can we discuss biases.

21:34:58 [ayouh] hi sweta

21:35:12 [narang_nandini] if i m not biased

21:35:24 [Step_1] .

21:35:59 [narang_nandini] selectionbias..?

21:36:12 crusher enters this room

21:36:24 [merjo13] Hi crusher

21:36:25 [crusher] hi everyone

21:36:44 [kokushubila] Hi Crusher

21:36:45 [Step_1] real question presented a sample study of 20 people and presented results. asked why is the test not valid?

21:36:52 [sanya] sampleselected does not represent the population

21:37:05 [merjo13] Sample not representive of pop

21:37:29 [narang_nandini] expectancy bias

21:37:30 [merjo13] Ooh

21:37:31 [kokushubila] Sampling bias

21:37:33 [Step_1] agree with sanya and merjo

21:38:21 [Step_1] the ans i picked is that there was not enough power....but not sure if that was correct??

21:38:51 [sweta_med] when the experimenters expectancy is known to the subjects

21:39:23 [sanya] pygmalion effect

21:39:32 [merjo13] Avoid by double blind study

21:39:44 [narang_nandini] can u plz explain with eg

21:41:11 [narang_nandini] we do one thing ...let's list all of them and differentiate with eg....do u agree?

21:41:23 [Step_1] if a taste test between pepsi and coke was done and the experimenter was seen drinking pepsi during a break....the subjects might inadvertently pick pepsi to please the experimenter

21:42:02 [merjo13] If one gp treated with a drug and another by placebo and if this is know and communicated to patients result twisted as to obtain the right value

21:42:17 [narang_nandini] this is good thanks

21:42:22 jwls29 enters this room

21:42:34 [perch30] i have to go, thanks and good night

21:42:40 [merjo13] It is from K ap

21:42:50 [Step_1] good chatting with you perch

21:42:59 [jwls29] hi all.

21:43:06 [Step_1] hi jwls

21:43:07 [jwls29] I can only stay a few mintues

21:43:09 [jwls29] minutes

21:43:17 [narang_nandini] ..the one we discussed earlier ...selection and sampling bias the difference?

21:43:17 [jwls29] just wanted to see how the chat was going

21:43:30 [narang_nandini] hi jwls

21:43:47 [sanya] hi jwls

21:43:52 [Step_1]>[merjo13] the bias definitions are from kap, but mine dont include examples

21:44:36 [Step_1] what is lead time bias? example?

21:45:01 [merjo13] But that is the best Step 1 and thanks as always

21:46:06 [sweta_med] when the the patientssurvival rate is more than expected

21:46:23 [jwls29] isn't lead time bias when we give a study credit for increased survival but it really is only early detection?

21:46:48 [narang_nandini] agreed with jwls

21:46:50 [merjo13] A screening test helps detect a disease early but mistook to have long survival

21:46:54 [Step_1] lead time bias gives a false estimate of survival rates. for example, patientsseem to live longer with the disease after it is uncovered by screening test, but actually do not. the result is not increaed survival, but simply that the disease is discovered sooner.

21:46:58 [sweta_med] yes i aree too

21:47:17 [narang_nandini] confounding bias?

21:47:21 SMS enters this room

21:47:26 [jwls29] the way i understand it is for example with mammographies

21:47:46 [jwls29] we aren't increasing survival we are just catching breast cancer earlier

21:48:01 [Step_1] more than one explanation can be found for presented results in confounding bias

21:48:02 sucess_doc enters this room

21:48:17 [Step_1] good example jwls

21:48:26 [jwls29] thanx

21:48:29 [sucess_doc] hi

21:48:33 [ayouh] or new treatment increasing survival

21:49:17 [kokushubila] Hello I will join you later, gotta do something first

21:49:39 [jwls29] confounding is when we don't know if results are because of one thing or is it something else that's causing it

21:49:53 [Step_1]>[ayouh] but with new treatment, the survival would actually be increasing, whereas with lead time bias, the survival only seems increased, but really not since the pt just knows about it longer

21:49:59 imrana enters this room

21:50:12 SMS exits from this room

21:50:25 [Step_1] ok kokush, will chat with you soon i hope

21:50:34 [Step_1] hi imrana and sms

21:50:42 [narang_nandini] hey jwls plz an eg

21:50:54 [jwls29] example given was 2 groups with htn put on an antihtn. the first group takes the antihypertensive but starts exercising and the second group just takes antihtn. They both have a decrease in bp. Did the first group have a decrease in bp b/c of the antihtn, the exercise or both?

21:50:55 [imrana] hi, step_

21:51:35 [narang_nandini] ok...that was nice

21:51:36 [jwls29] it's counfounding b/c the exercise was done so we don't know why the results are what they are

21:51:58 [narang_nandini] late look bias??

21:52:05 [Step_1] it looks like a good case of confounding because there is no control for the group with exercise alone

21:52:31 [kokushubila] Pray for me my exam is next week

21:52:42 [jwls29] late look is when we discover pts with disease too late

21:52:42 [kokushubila]

21:52:52 [imrana] u will do great

21:52:57 [crusher] wish u goodluck koku

21:53:02 [narang_nandini] all the best kokushubila

21:53:22 [ayouh] all teh best of luck koku

21:53:29 [narang_nandini] just do ur best and have faith in God

21:53:33 [imrana] can plz explain confounding

21:53:37 [sweta_med] all the best to koku.

21:53:38 [sanya] good luck koks

21:53:41 [kokushubila] Thanks all , I will join u later

21:53:46 [Step_1] kokush...you are all always in my prayers....but some extra ones for you this week and next

21:54:09 [ayouh] imrana plz change color

21:54:21 [Step_1]>[imrana] you might want to choose a brighter color from the rainbow on the right so that we can see your text better

21:54:28 [jwls29] good luck koku

21:54:31 [jwls29] u will do great

21:54:43 [imrana] i shall try

21:54:57 [ayouh] thanks great now...

21:55:47 [imrana] iam every new to this forum

21:55:56 [Step_1]>[imrana] confounding is when more than one thing can explain results. in the example given, the drop in bp could have been from either anti HTN meds or excercise...or both. so confounding meaning more than one possibility or combo of things

21:56:11 [kokushubila] THANKS ALL hope I will

21:56:25 [kokushubila] I will fight it

21:56:36 [imrana] thanks step_1

21:56:57 [Step_1] you will do great kokush, you know your stuff better than you think.

21:57:10 [crusher] step1...>expectancy bias is that if the sample doesnot represent the population???

21:57:40 [narang_nandini] that is sampling bias

21:58:04 [crusher] then what is expectancy Bias???

21:58:06 [narang_nandini] b'cos sample is not the representative

21:58:07 [Step_1] i agree...that is sampling bias

21:58:33 [ayouh] what is selection bias then / sample bias ??

21:59:18 [Step_1] experimenter expectancy (pugmalion effect): experimenters expectations inadvertently communicated to subject, producing effects on their own. solution is double blind study

21:59:53 [Step_1] the example i had given was the experimenter drinking the pepsi

21:59:55 [narang_nandini] right as given the eg of pepsi and coke

22:00:30 [crusher] ok i got it now :- star

22:00:57 [narang_nandini] what is selection bias/

22:01:13 [jwls29] i have to go guys

22:01:25 [jwls29] if i'm finished with what i'm doing before midnight, i'll be back

22:01:29 [jwls29] bye

22:01:37 [Step_1] sampling bias example is predicting rates of heart disease by gathering subjects from local health club, or using only hospital records to estimate population prevalence

22:01:45 [narang_nandini] bye jwls..and thanks

22:01:53 [Step_1] see you in next chat jwls

22:01:56 [sweta_med] when the sample selected is not a representative of the population

22:02:19 [Step_1] slection bias is the same as sampling bias

22:02:24 [narang_nandini] that is sampling.....not selection

22:02:30 [narang_nandini] am i right?

22:02:49 [Step_1] or i should say that selection bias is an example of sampling bias

22:02:52 [narang_nandini] they are different.

22:02:52 [sweta_med] they are the same

22:02:54 [ayouh] no no...

22:03:04 [ayouh] i just checked f a 2004

22:03:31 [narang_nandini] <a href=http://www.amazon.com/exec/obidos/ASIN/0071429484/qid%3D1085033910/sr%3D2-1/valuetheplace-20>First Aid</a> quotes..selection-subjects chooses groups

22:03:37 [ayouh] selection bias is when subjects choose which group they want to be in

22:04:05 [narang_nandini] lets clear it with an eg

22:04:27 [sanya] K a p lan page 7 says both are same

22:04:33 [ayouh] i want to choose wether i want to drink pepsi or coke

22:04:48 [ayouh] i am a subject

22:05:00 [Step_1] even if the subjects themselves chose the groups making it selection bias....the sample selected would still not be respresentative of the population.....so its an also an example of sampling bias

22:05:06 [ayouh] the researcher does not assign subjects, subjects choose

22:05:29 [ayouh] wow...! you are something step -1

22:05:42 [ayouh] what if we get something like this in test

22:05:44 [narang_nandini] no ...i think ..that's not the same

22:05:55 [ayouh] what shouls we say having both choices ?

22:06:29 [narang_nandini] bcos selection ..in sampling bias is done by ...researchers

22:06:50 [Step_1] i didnt mean to say they were the same. i meant to say that selection bias is an example of sampling bias. but sampling bias is not always a selection bias...does that make sense?

22:07:10 [narang_nandini] that's seem right

22:07:34 [sweta_med] yes got that now

22:08:28 [Step_1] ok, maybe we should discuss standard deviation...i know this is very high yield

22:09:05 [narang_nandini] let's review measurement bias and hawthorne effect...the last one

22:09:21 [Step_1] ok

22:10:37 [Step_1] an example of measurement bias is measuring a pt's satisfaction with their respective physician leading uestions: "You don't like your doctor, do you?"

22:10:58 [narang_nandini] when people in study know they are being observed...the results.may change...that is hawthorne...am i right

22:10:59 [Step_1] the info is gathered in a manner which distorts the info

22:11:39 [Step_1]>[narang_nandini] yes, this is why it is important to have a control group

22:12:36 [Step_1] also the placebo effect can probably be explained by the hawthorne effect

22:13:51 [Step_1] another example might be the nervous pt who always has high blood pressure on office visits (because anxious about exam), but in reality doesn't have high bp

22:13:55 neurodoctor_75 enters this room

22:14:04 [neurodoctor_75] hi room

22:14:12 [Step_1] hi neuro

22:14:29 [neurodoctor_75] hi,step1

22:14:37 [Step_1] does that make sense for bias?

22:14:40 [crusher] isit not classic conditioning?

22:14:44 [narang_nandini] hi neuro..

22:16:18 [narang_nandini] can anyone differtiate expectancy bias from measuement bias

22:16:27 [Step_1]>[crusher] yes, can be classic conditioning to preform the test during later visits so that the patient is not as anxious. but also could be a stretch for hawthorne bias because pt is anious about being tested which can alter the results

22:16:35 [ayouh] the q. why was the measurement taken at the doc. office wrong ? not what caused the pt. to have high BP..is it clear crusher...plz correct me if i am wrong

22:17:26 [crusher] yes ayouh i ,m getting it

22:18:18 [Step_1] is everyone ok with bias? we should probalby move on soon

22:18:42 [merjo13] Yes

22:19:07 [ayouh] what decreases SEM ?

22:19:08 [sweta_med] thats ok will we go on to biosats

22:20:10 sucess_doc enters this room

22:20:10 [narang_nandini] the incresed number of population...decreases SEM

22:20:48 wisdom enters this room

22:20:49 [ayouh] excellent..increase n

22:21:17 [ayouh] n is sample size

22:21:21 [Step_1] hi sucess and wisdom

22:21:30 [Step_1] if 100 members take test, how many will have score of more than 2 SD above the mean?

22:21:41 [sucess_doc] hi

22:21:57 [narang_nandini] 2.5%

22:22:02 [crusher] 95%

22:22:05 [ayouh] 34

22:22:22 [narang_nandini] above the mean..?

22:22:23 [ayouh] 68

22:22:28 [ayouh] sorry 68

22:22:52 [merjo13] 95%

22:23:00 [Step_1] ok, within 1 SD above AND below its 68%, 2SD is 95% and 3 is 99.7%....

22:23:08 [wisdom] expectancy bias u have what u had expected from

22:23:09 [sucess_doc] 95%

22:23:27 [Step_1] so above alone is only have of any of those numbers because doesnt include below

22:23:53 [wisdom] expectancy bias /u have what u expected from

22:24:01 [ayouh] yeah..only above

22:24:04 [imrana] can explain 1sd above and below 68%

22:24:17 [wisdom] hi

22:24:29 [Step_1] above 2SD is about 2.5%. now the real trick is that the number was asked rather than the percentage....in this example its the same, but do not confuse on real test

22:24:30 sohel enters this room

22:24:37 [ayouh] 1 sd above is 34 %, 2 above 68

22:25:13 [ayouh] sorry...u r right step 1

22:25:28 [wisdom] hi

22:25:38 [wisdom] hi

22:25:47 [sohel] hi

22:25:54 [ayouh] hi wisdom....join us and change color so we can see you...

22:25:57 [wisdom] hi

22:26:41 [narang_nandini] won't we take beyond 2SD...??

22:26:42 [crusher] selection/sampling/expectancy/confubaltion/hawthorne effect/lead time bias so far we study

22:27:25 [Step_1] so in a better example, it would have said 200 people tested and want to know how many above 2 SD? the percent would be 2.5% of 200, so the number would be 5

22:27:33 [ayouh] more contrast please wisdom....go with bright colors plz

22:28:16 [narang_nandini] that's right.

22:28:24 [Step_1] hi sohel

22:28:42 [sweta_med] how many caesa would be there or 2sd below the mean

22:28:52 [narang_nandini] actually the ques was ...little confusing...is every one clear?

22:29:01 [ayouh] 2.5 %

22:29:14 [ayouh] 2sd below the mean

22:29:14 [Step_1] its much easier to visualize with a diagram. there is a good example in the step 1 forum that i will bump for you all tomorrow. definitely take a look at it because most likely will see on exam

22:29:41 [merjo13] Thanks in advance

22:29:57 [Step_1]>[sweta_med] the same percentage of 2.5% (approx)

22:29:59 [sweta_med] thanks a lot

22:30:08 [sohel] hi,is it ok if i am a silent observer

22:30:10 [crusher] i would come later got to go now

22:30:27 [narang_nandini] plz any one ....chi -square,pearson corelation,t-test

22:30:42 [Step_1] ok crush. will talk to you soon

22:31:07 [wisdom] it's okay

22:31:20 [Step_1] yes sohel, jump in whenever you feel comfortable....whatever helps you learn better

22:31:34 [wisdom] i did

22:32:04 [Step_1] which test, ANOVA vs t test vs chi squared, checks differences between 2 means?

22:32:13 [ayouh] wisdom plz plz change color...i have been starring at this screen almost all day long...bright bright plz...

22:32:38 [sohel] thanks a bunch, iam just reading for the 1st time so

22:32:47 [narang_nandini] yes...they are not clear ...

22:32:49 [ayouh] chi square

22:33:04 [wisdom] i did

22:33:29 [sweta_med] they are not clear to me too

22:33:35 [Step_1] "Mr T is mean", so the T test is to compare 2 means. chi squared wil compare percentages or proportions

22:33:42 [ayouh] the backround is dark...plz pick something light...

22:34:36 [narang_nandini] what abt paired t-test and pooled t-test and unpaired t- test

22:34:54 [imrana] plz can u explain with e.g

22:36:06 [Step_1] let me try to find an example....if anyone else has one, please feel free

22:38:08 [Step_1] cant find one, so i'll try to make one up. for simplicity, i'll just stick to the general tests. comparing the average usmle pass rates of u.s. vs fmgs would involve what test?

22:38:28 [Step_1] never mind....i just found examples....one minute to type

22:38:49 [narang_nandini] chi sq

22:39:03 [narang_nandini] am i right/?

22:40:10 [Step_1] i gave a bad example because can be more than one test. if dealing with percentages, would be chi sq, but if straight means, would be T test.

22:40:56 [Step_1] t test used for 2 groups only. ex....does psycho therapy with pts suffering from acute MI reduce length of convalescence compared therapy goup?.....this is example in kap lan

22:41:01 [narang_nandini] i think ...this will also include discussion of what type of data we are using

22:41:20 [imrana] nd chi sq is %

22:41:56 [imrana] sorry

22:42:06 usmlez enters this room

22:42:26 [imrana] t test is mean and chi sq is %

22:42:56 [Step_1] pooled t test is refular t test, assuming the variances of 2 groups are the same. matched pairs t test is if each person in one group is matched with a person in the second. applies to before and after measures. this is also according to kap lan.

22:43:27 [narang_nandini] oh.. good

22:43:30 [Step_1] to be honest, i think this is not very high yield and too in depth. wouldnt worry too much about the details

22:44:17 [imrana] thanks for yr effort

22:44:19 [narang_nandini] but to answer the q's....we have to clear the concept

22:45:25 [narang_nandini] i have seen at least one - two qs ..of such types in every practice test.

22:45:29 [Step_1] this is true. not saying to ignore it. just dont feel to bad if the concepts seem difficult because i dont think they are heavily test....but they do test on it to some point i'm sure


22:49:55 sweta_med enters this room

22:50:56 wisdom enters this room

22:51:11 sohel enters this room

22:51:15 Step_1 enters this room

22:51:16 >[Step_1] Welcome to our chat. Please obey the net etiquette while chatting: try to be pleasant and polite.

22:51:19 [sweta_med] hi i had some login problem

22:51:46 imrana enters this room

22:51:54 [Step_1] i think we all got booted i hope everyone makes it back

22:52:00 [wisdom] hi

22:52:19 [wisdom] had login problem

22:52:19 merjo13 enters this room

22:52:40 [merjo13] Yes

22:53:20 [Step_1] good to see most of us back....lets continue

22:53:25 [Step_1] mainly know the types of tests used for different situations.....main take home point is that T test is means and chi square is percentages. ANOVA compares 3 or more variables

22:53:55 [imrana] nice

22:54:06 [merjo13] thankyou guys for all the info nice chatting... bye

22:54:20 [wisdom] agree with step 1

22:54:22 sohel exits from this room

22:54:34 sohel enters this room

22:54:47 [Step_1] thats for chat merjo, hope to see you next chat

22:55:55 [merjo13] yes sure..bye I'll read the transcript and catch with you guys

22:56:33 [Step_1] lets cover some social statistics (from epi). what else to cover tonight?

22:56:42 [sweta_med] could we move on to learning and behavior

22:56:54 [wisdom] lleaving

22:56:57 [sweta_med] ok step_1

22:57:53 [Step_1] which one first? learning and behavior or social stats? up to you all.

22:58:15 [narang_nandini] thanks step1

22:58:30 [sweta_med] we could do social stats first

22:59:13 [Step_1] ok, we'll just hit some high points since we're a bit behind and have lots to go....sound good

22:59:54 [Step_1] what is the single best predictor for suicide? (kinda tricky) what are some other predictors?

23:00:11 ayouh enters this room

23:00:33 [ayouh] previous attempts ?

23:00:54 [Step_1] single best predictor is a previous suicide attempt. very good ayouh

23:01:25 [narang_nandini] SAD PERSONS

23:01:52 [Step_1] others ans one or other? males or females?

23:02:02 [imrana] male

23:02:18 [ayouh] females attempt more, men coommit more

23:02:28 [ayouh] men succeedd

23:02:44 [Step_1] males more often probably because sucessful more often whereas females have more attempts....very good!

23:03:01 [Step_1] what race?

23:03:10 [imrana] white

23:03:15 [ayouh] white

23:03:18 [narang_nandini] sex(male),age,depression,previous attept,ethanol,rational thought,sickness....from <a href=http://www.amazon.com/exec/obidos/ASIN/0071429484/qid%3D1085033910/sr%3D2-1/valuetheplace-20>FA</a>

23:03:59 [Step_1]>[narang_nandini] excellent. and white race is correct...very good

23:04:48 [Step_1] be able to distinguish between child abuse and other causes of trauma

23:04:50 [narang_nandini] most severe grief reaction.....death of child or death of spouse??

23:04:52 [sweta_med] lower serotonin levels,

23:05:30 [wisdom] depression

23:05:47 [imrana] burn marks

23:05:55 [Step_1] if you see something like multiple bruises at different stages of healing....is this abuse likely?

23:05:58 [narang_nandini] multiple bruises,fractures,cigrattes burns..

23:06:00 [imrana] in child abuse

23:06:16 [wisdom] death of the child

23:06:34 Roxanita enters this room

23:06:35 [Step_1] yes, multiple bruises at different stages is abuse unless proven otherwise

23:07:07 [sweta_med] if the burn injuries are on the arms then its achild abuse rather than a trauma

23:07:15 [wisdom] death of child , more severe grief

23:07:32 [wisdom] agree

23:07:58 [Step_1] which is reportable vs non reportable? spousal, child, elder abuse?

23:08:18 [imrana] child and elder abuse

23:08:21 [narang_nandini] why not spouse...actually ...i saw same ans...but i m not able to understand why?

23:08:26 [wisdom] spousal non reportable

23:08:47 [Roxanita] Hi Step 1, good to see you. even late

23:09:04 [narang_nandini] agreed abt reportable

23:09:12 [Step_1] which is mandatory vs non mandatory reportable offense.....spousal, child, elder abuse?

23:09:13 [narang_nandini] hi roxanita

23:09:13 [imrana] reportable, and spousal is a domestic issue

23:09:31 [Step_1] sorry for repeating...system running wierd

23:09:43 [Step_1] hi rox....great to see you

23:10:22 [Step_1] elder and child is reportable, but spousal is not.

23:10:31 [Step_1] good job

23:10:54 [Roxanita] Step 1 I am sure you will beat the 90's, good luck

23:11:38 [Step_1] child and elderly assumed cannot report it themselves because caretaker might be abusing. but spouse is considered independent and able to report themselves.

23:12:07 [sweta_med] is repression n example for child abuse

23:12:46 [Step_1] thanks for the confidence rox...which i had that kind of confidence for myself. i'd be happy with anything above 75 and will leave it in God's hands to determine

23:14:16 [Step_1] i suppose that repression can be a defense mech used to cope with previous child abuse, but i wouldn't say its an example of it. but i think i know what you mean.

23:14:46 [sweta_med] ok i got it

23:15:57 [Step_1] fastest growing age cohort (tricky)

23:17:09 [Roxanita] ok guys, today you have done Epidemio? and now is behavioral, have you finished all, because you are in legal issues now

23:17:22 [sweta_med] 25yr age group, not sure

23:17:51 [Step_1] we had this in a previous chat and i think we determined that the fastest growing cohort is above 85. that doesnt mean it will be the largest percentage of pop....it means that people over 85 are growing larger than the other groups.

23:18:51 [sweta_med] ok

23:19:37 [Step_1] by larger....i dont mean in size....dont expect giant elderly pts :LOL:

23:21:08 [Step_1] sorry...bad joke...lets move on...

23:21:37 [Roxanita] it was not a bad joke

23:21:38 [Step_1] 3 most common causes of death in u.s.?

23:22:49 [imrana] heart diseaes, accident , cancers

23:23:32 [Step_1] heart dz, neoplams, stroke are top 3 causes of death in u.s. for all age groups....accidents is #5. but 2 of 3 is not bad imrana

23:25:07 [Step_1] how about some learning and behavior? should we move on?

23:25:23 [sweta_med] sure

23:25:27 [imrana] sure

23:25:35 [narang_nandini] sure

23:25:42 [Roxanita] ok, heart disease, Neoplasia and Cerebrovascular (stroke), 4) chronic respiratory and 5) accidents (50% vehicles)

23:25:43 [Step_1] everyone still there?

23:25:50 gurryaj enters this room

23:26:15 [Step_1] good rox

23:26:33 [Roxanita] my notes are from 2002, is still the same right?

23:26:33 [Step_1] hi gurray

23:27:01 [Step_1] i have the same rox....should be the same

23:27:32 [Step_1] what is difference between conditioned and unconditioned response?

23:28:20 [Roxanita] what are the symptoms that patients with factitious disorder mostly fake?

23:30:45 [Step_1] unconditioned response (UCR) happens naturally such as salivation after the site of food. whereas conditioned is learned such as ringing the bell to cause salivation. the salivation would not normally occur with ringing the bell unless conditioned to do so.

23:31:18 [sweta_med] unconditioned response is not not dependent on learning

23:32:24 [Step_1] factitious has intentional symtom production with unconscious motivation

23:33:28 [Step_1] both primary and secondary gain in factitious disorder

23:33:31 [Roxanita] ok Unconditioned Response UCR is natural while Conditioning Response CR is learned

23:33:52 [Step_1]>[sweta_med] thats right sweeta...good

23:34:06 [Step_1]>[Roxanita] yes

23:34:46 [Step_1] what is difference between pos and neg reinforcement?

23:35:05 sanya enters this room

23:35:27 [Roxanita] I though patients with Factitious Disorder intentionally produce or fake their symptoms?

23:36:06 [imrana] pos reinforcement with a reward

23:36:14 [ayouh] thats maligering

23:37:27 [Step_1] the symptom production is intentional....but they dont know why they are doing it....because unconcious motivation. malingering has both intentional symptoms and motivation....like a kid who fakes stomach ache to miss school.

23:37:32 [ayouh] in malingering pt. fakes symptoms or claims them..you can tell they are not true...factitous pt. creates symptoms UNCONSCIOUSLY

23:39:30 Robertd enters this room

23:39:59 [Step_1] i respectfully disagree....well, partly. somatoform has unconscious symptom prod and unconscious motivation, malingering has both intentional. factitious is in the middle where they know they are producing fake symptoms (somatoform does not know they are fake) but does not know why they are doing

23:40:53 [Roxanita] could anybody give me the page in &lt;a target=new href=http://click.linksynergy.com/fs-bin/click?id=c97WUMRO5hY&offerid=47491.10002441&type=3 &subid=0 >Kaplan&lt;/a><IMG border=0 width=1 height=1 src=http://ad.linksynergy.com/fs-bin/show?id=c97WUMRO5hY&bids=47491.10002441&type=3&sub id=0 > of factitious D. ?

23:41:06 [Roxanita] page of k-aplan please ?

23:42:11 [Roxanita] what about factitious disorder by proxy or Munchausen's syndrome by proxy?

23:42:22 [Step_1] my notes are older, but its page 70 in my notes if that helps....at the end of defense mech section

23:43:12 [ayouh] malingering is a pt. who comes in and lists all classical signs and symotoms of X disease...and all PE , labs, tests, x-rays shows that he does not...pt. wants to be admitted to hospital bcz he is homeless for example...

23:43:57 [Step_1] munchausen syndrom by proxy involves inducing symptoms in others, such as a mother producing symptoms in her child. this is part of factitious disorder because the mom knows she is producing the symptoms....but does not know why

23:44:50 [Roxanita] baby in crib?

23:45:03 [Step_1]>[ayouh] i agree because the homeless has a reason for lying, so he makes up symptoms consciously and the motivation is also intentional....so malingering in that case

23:45:34 [Step_1] malingering is purely for secondary gain

23:46:25 [Step_1]>[Roxanita] not sure what you're asking?

23:46:44 [ayouh] and like that kid who does not want to go to school

23:47:08 [ayouh] example of factitious ?

23:47:28 [Roxanita] Symptoms often faked include: Seizures, fever, abdominal pain

23:48:12 [sweta_med] how can somatoform have both primary nad secondary gains?

23:48:50 [Roxanita] Patients with factitious disorder intentionally produce or fake symptoms of a mental or physical illness to gain medical attention.

23:49:22 [Step_1] an example of factitious is the munchausen syndrome and by proxy.

23:50:07 [Step_1] the best way to remember this is that somatoform is aware of nothing, malingering is aware of everything, and factitious is aware of some things....

23:51:34 [Step_1] the gain can be gained consciously or subconsciously. they can gain without knowing it.

23:51:53 [sweta_med] ok

23:52:06 [Roxanita] thanks step 1

23:52:28 [Step_1] hope that makes sense

23:52:46 [sweta_med] yes thanks

23:52:48 [imrana] yes

23:53:26 [Step_1] is there anything in particular you want to cover because getting close to the end?

23:53:46 [Roxanita] what do you guys have for saturday chat?

23:54:30 [imrana] step_1 u have recently given yr exam can u plz tell us the the topic which we should really emphasis

23:54:36 [Step_1] the remainder of behavioral for sat. anything not covered tonight like personality, defense mechs, child develop, sleep, etc

23:54:39 [ayouh] eating disorders ?

23:55:13 [ayouh] substanse abuse

23:55:14 [sweta_med] sleep disorders, dsm,child development

23:55:18 [ayouh] substance

23:55:18 [Step_1] what topics from tonight, from behavioral, or in general?

23:55:42 [ayouh] bulemia, anorexia

23:56:44 [Step_1] you know what i just realized....ethics is heavily tested and we didn't cover it. maybe we will include it for next chat too?

23:56:46 [Roxanita] DSM IV criteria for anorexia nervosa?

23:58:21 [ayouh] pt. was diagnosed in your clinic with aids..do you tell spouse ?

23:59:03 [imrana] depends

23:59:20 [Roxanita] I think you first let the patient do it on his own and if he doesn't do it then you should do it

23:59:34 [imrana] if the pt wants to conf

23:59:40 [Step_1] tough one. the spouse is in danger, but confidentiality...hmmm. i think that the danger to spouse is more important than the confidentiality.....but not sure?

23:59:57 [ayouh] aids is reportable disease guys...

--------- The messages that have been sent today start below ---------

00:00:07 [Roxanita] Daugherty gave the ame example and he said that

00:00:18 [Roxanita] reportable disease yup

00:00:33 [imrana] u are right

00:00:48 [Step_1] reportable to cdc, but this is issue of ethics...right?

00:01:05 [ayouh] you breach confidentiality when danger to others

00:01:29 [sweta_med] i ve to go. seeyou on sat.

00:01:42 [ayouh] if you don't the spouse might sue you for contracting hiv from your pt.

00:01:49 [ayouh] see you sweta

00:01:55 [imrana] so, it means the docter can tell the spouse

00:02:04 [Step_1] i agree, i think you need to tell wife, but probably go for option where you ask pt to discuss with wife

00:02:39 [Roxanita] yup, you first let the patient do it and if he doesn't want, there you go

00:02:55 [Step_1] bye sweta. see you sat

00:02:59 [ayouh] you should i think make an appoitment at your office...but guys definetely pick the choice where you tell the spouse...forget confidentiality

00:03:24 [Step_1] i agree...good question

00:03:40 [Roxanita] ok, page 202 k-aplan

00:04:11 [Roxanita] "If patient is a threat to self or other, the physician MUST break Confidentiality"

00:04:20 [Step_1] that reminds me of a real question. family asks doctor to choose best treatment for incompetent mom. what is this called?

00:05:10 [Step_1] things like autonomy, transference, beneficience, etc?

00:05:22 [ayouh] best lentem someting...

00:05:50 [imrana] i think autonomy

00:06:51 [Step_1] i think that autonomy is the opposite where the patient has the right to decide. whereas beneficience means that the doc acts in best interest of pt. but not sure??

00:07:15 [Roxanita]

00:07:45 [Step_1] i wish those questions came with answers

00:07:51 [imrana] that make sense

00:07:58 [ayouh] locum parentis

00:08:08 [ayouh] got it...Locum Parentis

00:08:51 [ayouh] well...i guess this is when there is no guardian

00:09:03 [Step_1] that could be it. maybe that was a choice.. i dont remember now

00:09:41 [Step_1] well the guardian basically put it in your hands as the doc, so not sure

00:09:56 [ayouh] assuming resposibility...

00:10:16 [ayouh] doc. acting on locum parentis is assuming responsibility

00:10:18 [Roxanita] 7. An 82-year-old man comes to the physician for evaluation of chest pain. He lives with his daughter's family. He has numerous welts and abrasions and appears to be malnourished. He says his diet is fine. Which of the following is the most appropriate next step in patient care?

00:10:24 [Roxanita] A)Confront his family about the abuseB)Enroll the family in family counseling C) Notify social services of the potential abuse D)Place him in a nursing home E)Refer him to a residential community

00:11:05 [Roxanita] what would you choose step 1?

00:11:07 [ayouh] C

00:11:29 [ayouh] Report...

00:11:40 [ayouh] then do anything else

00:11:42 [Step_1] let me first narrow it down to either a or c

00:11:59 [Step_1] i would go with c i think

00:12:19 [Step_1] reportable offense as we said before

00:12:23 [Roxanita] this is from NBME. I would pick C) also

00:12:24 [ayouh] I agree C... A does not accomplish much...

00:12:51 [ayouh] the rest are escape goats from reality...

00:13:03 [imrana]

00:13:59 [Step_1] if you get a chance, try to listen to the test taking skills audio from daugherty....i just realized that i used his method of narrowing and selecting choices....he has great adivice

00:14:50 [Step_1] let me throw in a disclaimer and say that the real questions i mention are from the mock exam i took

00:15:45 [Step_1] but that is one of the reaons why i'm joining these sessions. so that i can point out some high yield info as i see the material again

00:16:45 [Roxanita] Mock Exam for step 1?

00:16:47 [Step_1] i'll continue to do this throughout the sessions if i get the chance to attend them



00:19:46 [Roxanita] I got loooooots of questions of behavioral science

00:20:18 [Roxanita] but mostly related to doctor-patient relation

00:20:28 [Step_1] i saw looots of ethics questions

00:20:40 [Step_1] yes...doctor pt questions...exactly

00:20:45 [Roxanita] ok

00:21:32 [Roxanita] I still don't know when I am going to attempt again

00:21:35 [Step_1] oh, another one. you have a med school friend who recently opened a practice and asks for referrals. what do you do?

00:22:07 [Roxanita] But I appreciate a looooooooot your contribution here Step 1, God bless you my friend

00:22:11 [ayouh] if he is good why not ?

00:22:22 [Step_1] report him to med boards, say "ok, no prob"., ask to tour new facilities, etc?

00:22:24 [ayouh] what are some choices plz ?

00:22:40 [ayouh] ask to tour facilities ?

00:23:08 [ayouh] thats what I think >,,,

00:23:11 [Roxanita] choices please?

00:23:19 [Step_1] you've provided as much or more help to us all rox....so thank you too

00:23:54 [Step_1] report him to med boards, say "ok, no prob"., ask to tour new facilities, etc? were some choices, cant remember exactly

00:25:09 [ayouh] you need the best for your pt. ...judge for yourself if his facilites are good...

00:25:29 [ayouh] if they are you garentee your pt. will get good help..

00:25:44 uhm enters this room

00:25:50 [Step_1] here is another. cardiologist friend gets sent pt from primary care friend. Nothing wrong found in pt. What to do next? .....

00:26:11 [Roxanita] and what did you answered for that step1?

00:26:33 [Step_1] sched follow up with cardo, give verbal report to nurse of primary care, send written report to primary care

00:27:08 [ayouh] send writen report

00:27:10 ggg enters this room

00:27:29 [Roxanita] agree, send writen report

00:28:43 [Step_1] i didnt see anything wrong with the friend asking for referrals that it would need to be reported, so i eliminated that and got stuck on the other two. i cant remember which i chose because i was torn between reality (no prob) and what they wanted to hear (probably tour facilities).

00:29:08 [Step_1] i chose send written report for that one.

00:30:21 [Roxanita] steve_daugherty@k aplan.com

00:30:35 [Step_1] 2 similar behavior questions here.....

00:31:01 [Roxanita] he will answer your questions, just say you are his student at &lt;a target=new href=http://click.linksynergy.com/fs-bin/click?id=c97WUMRO5hY&offerid=47491.10002441&type=3 &subid=0 >Kaplan&lt;/a><IMG border=0 width=1 height=1 src=http://ad.linksynergy.com/fs-bin/show?id=c97WUMRO5hY&bids=47491.10002441&type=3&sub id=0 > lectures

00:31:59 [Roxanita] I think I am going to send him my doubts

00:32:23 [ayouh] can we discuss genetics somtime

00:32:41 [Step_1] stressed new mom complains of lack of sleep. what to do? another had 80 yo female complains of poor sleep 3 weeks after death of husband and cries saying its difficult. both had similar choices of prescribe benzos, normal and will go away, ask if sucidal or homcidal tendencies?

00:32:47 [Roxanita] he is the professor for Behavioral at K-aplan: steve_daugherty@k aplan.com

00:33:27 [Step_1] he is a great prof and i learned alot from him....good idea

00:36:03 [Step_1] a biostats question had two bell shaped curves side by side with little overlap (in kap lan) and had line moved from left to right and asked what happens? inc or dec in sens, spec, PPV, NPV, etc?

00:37:15 [Roxanita] ok, that always come right, it's worth to have it at the tips of your fingers

00:37:24 [ayouh] iam tired guys...when is next session...

00:37:44 [ayouh] i will have to say nite for tonight..

00:38:02 [Step_1] wow, we went way over. sorry. next chat on sat. good night all

00:38:17 [Roxanita] what did you put on the suicidal or homicide tendencies step 1?

00:38:19 [ayouh] nite...

00:39:33 [Step_1] in both these cases, they are probably normal reactions. but you probably should play it safe and ask about suicidal tendencies is my guess. what do you think?

00:39:52 [Roxanita] please don't forget to put the transcript?

00:40:15 [Roxanita] so one of the choices was that? I think is good

00:40:17 SMS enters this room

00:40:23 [Step_1] we all got disconnected at some point, but i will put whatever i have

00:41:25 [Roxanita] Thanks Step 1, bye everybody, see you on saturday

00:41:43 usmle_exam enters this room

00:41:49 [Step_1] good night