Glossary of USMLE 1 Behavioral Science

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Woman with anxiety about a gynecological exam is told to relax and imagine going through the steps of the exam. What process does this exemplify?
Systematic desensitization.
65-year old man is diagnosed with incurable metastatic pancreatic adenocarcinoma. His family asks you, the doctor, not to tell the patient. What do you do?
Assess whether telling the patient will negatively affect his health. If not, tell him.
Man admitted for chest pain is medicated for ventricular tachycardia. The next day he jumps out of bed and does 50 pushups to show the nurses he has not had a heart attack. What defense mechanism is he using?
You find yourself attracted to your 26-year-old patient. What do you say?
Nothing! The tone of the interview must be professional ... if you feel your actions may be misinterpreted, have a chaperone in the room.
Large group of people is followed over 10 years. Every 2 years, it is determined who develops heart disease and who does not. What type of study is this?
Cohort study.
Girl can groom herself, can hop on 1 foot, and has an imaginary friend. How old is she?
4 years old.

Cannot get an erection only with certain people
Erectile Dysfunction that is
36-year old woman with a strong family history of breast cancer refuses mammogram because she heard it hurts. What do you do?
Discuss the risks and benefits of not having a mammogram. Each patient must give her own informed consent to each procedure. If the patient refuses, you must abide by her wishes.
During a particular stage of sleep, man has variable blood pressure, penile tumescence, and variable EEG What stage of sleep is he in?
REM sleep.
A 15 year old girl of normal height and weight for her age has enlarged parotid glands but no other complaints; The mother confides that she found laxitives in the daughter's closet. What is the diagnosis?
11-year old girl exhibits Tanner stage 4 sexual development (almost full breats and pubic hair). What is the diagnosis?
Advanced stage, early development.
4 year old girl complains of a burning feeling in her genitalia; otherwise she behaves and sleeps normally. Smear of discharge shows N. gonorrhoeae. How was she infected?
Sexual abuse.
72 year old man insists on stopping treatment for his heart condition because it makes him feel "funny" What do you do?
Although you want to encourage the pt to take his meds, the pt has the final say in his own rx regimen. you should investigate the "funny" feeling and determine if there are drugs available that won't elicit this particular side effect.
Person demands only the best and most famous doctor in town. What is the personality disorder?
Nurse has episodes of hypoglycemia; blood analysis reveals no elevation in C-protein. What is the diagnosis?
Factitious disorder, self scripted insulin.
55 year old businessman complains of lack of successful sexual contacts with women and an inability to reach a full erection. Two years ago he had a heart attack. What might be the cause of his problem?
Fear of sudden death during intercourse.
What type of Observational Study: Sample chosen on presence of absence of disease. Information collected about exposure from past.
Case-control Study.
What type of Observational study: sample chosen based on presence of absence of risk factors. Subjects followed over time for development of disease.
Cohort Study.
Test type:
Pooling data from several studies (often via a literature search) to acheive greater statistical power
Experimental study:

compares therapeutic benefit of 2 or more treatments, or treatment and placebo
Clinical Trial
When the subjects choose the groups it may lead to what type of bias?
Selection bias.
When knowledge of the presence of the disease alters recall by the subjects what type of bias is likely?
Recall bias.
When subjects are not representative of the population and results are not generalizable, what type of bias is this?
Sampling bias.
When information gathered on subjects is done so at an inappropriate time, what bias is likely?
Late-look bias.
The total proportion of cases in a population at a given time.
The rate of new cases in a population in a given time.
Incidence x Disease Duration
For chronic diseases, which is larger - prevalence or incidence?
Prevalence > Incidence for Chronic Disease
When does prevalence = incidence?
For acute disease (ie the common cold)
What is sensitivity?
TP/(TP+FN) x 100 = Sensitivity
When is high sensitivity desirable?
In a screening test

Sensitivity = the number of people who HAVE the Dz
What is 1-sensitivity?
False negative ratio.
What is specificity equation?
TN/(TN+FP) x 100 = specificity
What is 1-specificity?
False positive ratio.
When is high specificity desirable?
In a confirmatory test

Specificity = # of people who DON'T have the Dz
Define: PPV
The probability of having a condition given a positive test

What is NPV?
The probability of not having the condition given a negative test.

(trues over falses)
OR - approximates RR if prevalence of disease is not too high.
Best data analysis for:

1. Case-control

2. Cross-sectional

3. Cohort

Which deals w/ Prevalence? Incidence?
Case-control: Odds Ratio

Cross-Sectional: Chai squared

Cohort: Relative Risk
Attributable risk formula?
The consistency and reproducibility of a test is the ....
The trueness of the test measurements is the ...
Gaussian distribution is ...
a normal distribution (bell curve) (mean=median=mode)
Where is the "tail" on a positive skew distribution?

relation b/t mean, median and mode?
is asymmetry with the tail to the right, hump on the left

(Mean > Median > Mode)
Where is the "tail" on a Negative skew distribution?

relation b/t mean, median and mode?
is asymmetry with the tail to the left, hump on the right

(Mean < Median < Mode)
A null hypothesis is ...
Opposite of what you want to show.

There is no association (ie between the risk factor and the disease in the popuation.)
The alternative hypothesis is ...
There is some difference (ie between the disease and the risk factor in the population)
Error type:
Stating there IS an effect or difference where none really exists.
Type 1 error

(alpha probability)
Error type:
Stating there IS NOT an effect or difference when one really exists.
Type II error (beta)
the probability of rejecting the null hypothesis when it is in fact false.
Equation for Relative Risk


How do you increase study power in a test?
increase the sample size.
Confidence interval equation

What is Z for 95%?

When is Null Accepted w/ respect to CI?
CI = mean +/- Z (SD/sqroot of N)

95% = 2

99% = 2.5

If the CI includes zero, Null is accepted.
Normal (Gaussian) distribution has what percentage of the population in each standard deviation?
- 68% within 1 SD

- 95% within 2 SDs

- 99.7% within 3 SDs.
what does a t-test measure?

How many nominals vs intervals?
the difference between the means of two groups only

1 nominal and 1 interval
What does ANOVA measure?

How many nominal vs interval?
the difference between means of 3 or more groups

2+ nominal and 1 interval
What does a Chi square measure?
Difference b/t 2+ nominal data types
(NO mean values)
What does a Correlation coefficient indicate?
the strength of the correlation between two consecutive variables. The sign indicates a positive or negative.
(no nominals...intervals only)
What is Primary Disease Prevention?
Prevent the disease from occuring.
What is Secondary Disease Prevention?
Early detection of the disease

What is Tertiary Disease prevention?
Reduce mobidity from the disease.
List the (12)* Reportable Diseases
Hep B; Hep A;
Salmonella / Shigella / Syphilis; Measles / Mumps; AIDS; Rubella; TB;
Chickenpox; Gonorrhea
Is HIV reportable?
While AIDS is reportable in all states, HIV reporting laws are state dependent.
What are the (3) leading causes of death for infants in the US?
1. Congenital anomalies

2. Short gestation/LBW

What are the leading (4) causes of death for children age 1-14 in the US?
1. Injuries

2. Cancer

3. Congenital anomalies

4. Homicide
What are the top (3) leading causes of death for people 15-24 years of age in the US?
1. Injuries

2. Homicide

3. Suicide
What are the leading (5)causes of death for adults 25-64 yo in the US?
1. Cancer
2. Heart disease
3. Injuries
4. Suicide
5. Stroke
What are the leading (5)causes of death for adults over the age of 65 in the US?
1. Heart disease
2. Cancer
3. Stroke
5. Pneumonia
Difference b/t Transsexual and Transvestite
Cross-dresses and uncomfortable w/ gender

Cross-dresses but comfortable w/ gender
What is Therapeuic Privledge
Withholding information when disclosure would severely harm the patient or undermine informed decision making capacity.
True or False: A patients family cannot require that a doctor withhold information from the patient.
What does the CI mean if it excludes "1"?
It is significant

(if CI is greater then 1 = higher risk; less then 1 = lower risk)
Define Transference.
When the patient projects feelings stemming from their personal life onto their physician.
Define Countertransference.
When the doctor projects feelings stemming from their personal life onto the pt.
Stimulus changes but produces same response
Classical conditioning
Same stimulus leads to different response
Operant conditioning
Adding a stimulus increases behavior
Positive Reinforcement

Removing a stimulus increases behavior
Negative Reinforcement
True or False: reinforcement schedules determine how quickly a behavior is learned or extinguished.
Reinforcement type:

reward received after every response;
rapidly extinguished
Continuous reinforcement schedule
Reinforcement type:
reward received after random number of responses;
slowly extinguished.
Variable Ratio reinforcement schedule
What are ages for the following IQ tests: Stanfornd-Binet; WISC-III; WPPSI; Denver Developmental; WAIS-R?
Denver Developmental: < 2yo

Stanford-Binet: 2-4 yo

WPPSI: 4-6 yo
(age where still may PP in pants)

WISC-III: 6-16 yo

WAIS-R: >17 (like R-rated movies)
How does the Stanford Binet test calculate intelligence?
IQ as (mental age/chronological age) x 100
How does Wechsler (WAIS) measure intelligence?
11 subtests (6 verbal, 5 performance)

Mean is 100, SD = 15.
What is the IQ cuttoff for diagnosis of mental retardation?
IQ < 70 or 2 SD below mean.
True or False: IQ tests are objective test.
True ... but they are NOT projective tests.
What type of reinforcement is the best way to learn?
Start w/ Continuous then move to Variable Ratio
What is an oral advanced directive?
In an incapacitated state, a pts prior oral statement is commonly used as a guide.
What is a written advanced directive?
a living will.
pt desingnates a surrogate to make a medical decision in the event that the patient loses decision making capacity. pt can specify decisions in certain clinical situations, and can revoke power.
Durable power of attorney
"do no harm"
The physicians ethical responsibility to act in the patients best interest. Can conflict with autonomy.

[Best interest = Beneficence]
What should guide the physicans decision to disclose information to family and friends?
What the patient wants, or would want.
In what circumstances can a physician break confidentiality?
1. potential harm to others is serious.

2. liklihood of harm to self is great.

3. no alternative means exist to warn and protect those at risk
What steps may a physician take to prevent harm caused by a patients infectious disease?
Physician may have a duty to warn public health officials (reportable diseases) and identify people at risk.
What is the Tarasoff decision?
A law requiring physician to directly inform and protect a potential victim from harm; may involve a breach of confidentiality.
May a physician break confidentiality if they suspect child or elder abuse?
When may a physician break confidentiality if in cases of an automobile accident?
Only if they suspect that the driver was imparied
How may a physician handle a suicidal or homicidal patient?
The physician may hold the patient involuntarily for a period of time ... or until psychiatric evaluation is completed.
A civil suit under negligence requires what 3 things?
1. Physician breach of duty to patient (Dereliction)

2. patient suffers harm (damage)

3. Breach of duty causes harm (Direct)
What is the most common factor leading to litigation between the physician and pt?
poor communication.
In a criminal suit the burden of proof is "beyond a reasonable doubt" ... in a malpractice suit the burden of proof is ...
"more likely than not"
Unaware that one is ill
unable to locate ones own body parts
Define depersonalization
body seems unreal or dissociated
What is involved in orienting the patient?
person, place, and time
What is the order of orientation loss in a disoriented patient?
time goes first, then place, and last person
Sleep disorder:

patient kicks and hits spouse without knowledge
REM sleep disorder

(normal paralysis of muscles not present)
Define retrograde amnesia
inability to remember things that occured before a CNS insult
What is Korsakoff's anmesia?
classic anterograde anmesia caused by a thymine deficiency.
A alcoholic patient presents with anterograde amnesia, and confabulations. What is the likely diagnosis?
Korsakoffs amnesia
chance of having DM is 10%, chance of obesity is 30%. What is the chance of meeting someone obese, wth DM or both?
.1 + .3 - (.1 x .3) =

.4 - .03 = .37 = 37%
What is SES based on?
Education and Occupation

(not income)
When is suicide most likely?

What is the best Tx?
coming out of a depression

(giving meds leads to malpractice)
Most common work-related disability anywhere
What are Freud's three structures of the mind?
Id, Ego, Superego
Define the Id.
Primal urges, sex and aggression.
Define the Superego.
Moral values and conscience
Define the Ego.
Mediator between unconcious mind and external world.

pleasure from watching others

1. Pleasure from giving others pain

2. Pleasure from receiving pain from others


(S and M)
Define: Pre-concious
What you are able to make consious with effort

Gender Identity
Who you think you are sexually
What is the Gender identity and Partner preference for:

1. Heterosexual male

2. Homosexual male

3. Transexual male

4. Transvestite male
1. G = male; P = female

2. G = male; P = male

3. G = female; P = male (usually)

4. G = male; P = female
auditory hallucinations, delusions, strange behavior, and loose associations
What are some negative symptoms of schizophrenia?
flat affect;
social withdrawal;
lack of motivation
How long must a patient experience symptoms of schizophrenia for a diagnosis?
Periods of psychosis or disturbed behavior lasting > 6 months.
What are the 5 types of schizophrenia?
1. Disorganized (strangest)

2. Catatonic

3. Paranoid

4. Undifferentiated (many)

5. Residual (had it before)
schizophrenia for a brief period of 30 days to six months
What is schizoaffective disorder?
combination of Schizophrenia and Depression
In one word, describe Clusters A, B, and C personality disorders.
A = weird

B = wild

C = worried
What are 3 types of Cluster A personality disorders?

1. Paranoid (Afraid)

2. Schizoid (Alone)

3. Schizotypal (Amazing powers)
Personality Disorder:

distrust and suspiciousness, projection is main defense mechanism
Paranoid personality
Personality disorder:

voluntary social withdrawal, limited emotional expression
Schizoid personality
Personality disorder:

interpersonal awkwardness, odd thought patterns and appearance; eccentric behaviors (thinks they are magical)
Schizotypal personality
Personality disorders that lead pts to be erratic, emotional, or dramatic and have a genetic association with mood disorders are classified as what Cluster type?
Cluster B
What are the 4 types of Cluster B personality disorders
B disorders:
1. Antisocial (Bad)
2. Borderline
3. Histrionic (Boobs in face)
4. Narcissistic (Better then you)
Personality disorder:

disregard for and violation of rights of others, criminality, males more often affected than females
Anti-social personality
Personality disorder:

unstable mood and behavior, impulsiveness, sense of emptiness. women more often affected than men
Borderline personality
Personality disorder:

excessive emotionality, somatization, attention seeking, sexually provacative
Histrionic personality
Personality disorder:

gradiosity, sense of entitlement, may demand "top" physician, or best health care
Narcissistic personality
Pts with personality disorders that leave them anxious or fearful and have a genetic association with anxiety disorders are classified as what Cluster type?
Cluster C personality disorders
List 3 types of Cluster C personality disorders

1. Avoidant (Coward)

2. Obsessive-Compulsive

3. Dependent (Clingy)
Personality disorder:

sensitive to rejection, socially inhibited, timid, feelings of inadequacy
Avoidant personality
Personality disorder:

preoccupation with order, perfectionism, and control
Obsessive-Compulsive personality
Personatliy disorder:

submissive and clinging, excessive need to be taken care of, low self confidence
Dependent personality
Who does MedicarE provide for?
The Elderly
Who does MedicaiD provide for?
The Destitute.
Medicaid is federal and state assistance for very poor people.
Ethically, what do you do if your patient is non-compliant?
Work to improve the physician patient relationship.
Ethically, what do you do if your patient has difficulty taking medication?
Provide written instructions, attempt to simplify the treatment regimen.
MCC of significant downward shift in SES
Disabling Physical problems
What do you do if a 17 year old girl is pregnant and asks for an abortion.
inform the patient that most states require parental conset for minors for an abortion.
What do you do if a terminally ill patient requests assistance in ending his life?
refuse involvement in any form of euthanasia.
physician may however prescribe appropriate analgesics that may coicidentally shorten a patient's life.
What do you do if a patient states that he finds you attractive?
ask direct, closed ended questions and use a chaperone if necessary.
What do you do if a patient refuses a necessary procedure or desires and unnecessary one?
attempt to understand why the patient wants/does not want the procedure. address underlying concerns. avoid performing unnecessary procedures.
What do you do if a patient is angry about the amount of time he spent in the waiting room?
apologize for any inconvenience. stay away from efforts to try to explain the delay.
what do you do if the patient is upset with the way he was treated by another doctor?
suggest that the patient speak directly to the physician regarding the concerns. if the problem is with a member of the office staff ... tell the patient you will speak to that individual.
What do you do if a child wishes to know more about his illness?
Ask what the parents have told the child about his illness. Parents of a child decide what information can be relayed about the illness.
How is Tardive Dyskinesia managed?

what is the adverse affect of the drug?
1. Do not stop taking the meds abruptly, instead switch to an atypical...
2. Clozapine

A child puts everything in their mouth. How old are they?
1st year of life.
An infant sits with support, how old is she?
4 months
An infant stands with help, how old is he?
8 months
A baby is crawling, how old is she?
9 months
A little girl just learned to walk on her own, how old is she?
13 months
A child has just learned to climb (crawl up) the stairs alone, how old is he?
18 months
At what age does an emergence of hand preference first appear?
18 months
A child has lots of energy, can walk backwards, turn doorknobs, unscrew jars, and scribble with crayons. How old is she?
2 years
A child can ride a tricycle, go up the stairs normally, draw recognizable figures and has just started toilet training. How old is he?
3 years.
A child can descend the stairs normally and hop on one foot. How old is she?
4 years
At what age will a child develop complete sphincter control (toilet trained)?
5 years
At 5 years of age, what percentage of the adult brain mass does the child have?
A child has most of her permanent teeth, how old is he?
11 years
True or False: Boys and girls have roughly the same height to weight ratio between ages 6-12 years?
False: boys are heavier than girls.
At what age does the adolescent growth spurt usually kick in?
Around 12 years, earlier for girls than for boys.
A baby plays patty cake and peek a boo, how old is she?
10 months
A baby is experiencing stranger anxiety, how old is he?
6 months
A baby has started showing signs of normal separation anxiety, how old is she?
1 year.
The parent is the central figure and issues of trust are key, how old is the child?
1st year of life.
A toddler will engage in parallel play, but "no" is still her favorite word, how old is she?
1 year
A toddler is selfish and self centered, aggresive, and tends to immitate mannerisms and activities, how old is he?
2 years
A baby can follow objects to midline, how old is she?
4 months
A baby is putting his feet in his mouth, how old is he?
5 months
A baby will approach a toy with one hand, and then change hands with the toy, how old is she?
1st year of life
A baby first laughs outloud, how old is she?
4 months
A baby has started saying "ma-ma-ma" and "da-da-da", how old is he?
10 months
Sensation and movement are most important, schemas are being developed, and assimilation and accomidation are priorities at what age in Piaget's development?
1st year of life.
In Piaget's Cognitive Development, at what age does a baby acheive object permanence?
1 year
A baby kicks and throws a ball, how old is he?
1 year
A baby can stack three cubes, how old is she?
18 months.
A todler is using two word sentences and has a vocabulary of about 250 words, how old is he?
1 year
A todler has started using pronouns and shows great variations in timing of language. Her parents seem to understand her better. How old is she?
2 years
A toddler is using complete sentences and has a vocabulary of 900 words, although he appears to understand 4x that many words. Strangers can understand him. How old is he?
3 years
A child tells stories, uses prepositions, plurals, and has discovered compound sentences, how old is she?
4 years
A child can stand on her tiptoes, how old is she?
2.5 years
A child is able to aim and throw a ball and stack 6 cubes, how old is he?
2 years
In Piaget's view, a child who can use symbols and has concrete use of objects and use of symbols along with a strong egocentrism is how old?
2 years
At what age is gender identity fixed?
3 years
A child knows her full name and what sex she is, how old is she?
3 years
Two children are observed to be taking turns with a toy, how old are they?
3 years
At what age is a child likely to start grooming themselves and brushing their own teeth?
4 years
A toddler can catch a ball, stack 9 cubes, cut paper with scissors and keeps unbottoning his shirt buttons, how old is he?
3 years
A child can point to and count three objects, repeat four digits, and name colors correctly, how old is she?
4 years
A child has an imaginary friend and this is entirely normal for this age group, how old is she?
4 years
Two children are caught "playing doctor", at what age does this curiosity manifest?
4 years
A child is having terrible nightmares and needs the light left on at night for fear of monsters, how old is he?
4 years
At what age does a child adopt personal speech patterns?
adolescence (12+)
At what age does communication become the focus of friendships?
adolescence (12+)
A child repeatedly asks for the meaning of words, how old is she?
5 years
A child can count 10 objects correctly, how old is she?
5 years
What figures can children copy at ages:
1. 3
2. 4
3. 4.5
4. 5
5. 6
6. 7
(in alphabetical order except diamond is last)

1. Circle
2. Cross
3. Rectangle
4. Square
5. Triangle
6. Diamond
At what age will a child first express romantic feelings towards others, perhaps as an Oedipal phase?
5 years
A child can draw a recognizable man, dress and undress herself, and catch a ball with two hands, how old is she?
5 years
Age range of Parrallel Play?
2 - 4 years
Age for Object permanence?
12 - 24 mo
A child shows a shift from egocentric to social speech and incomplete sentences decline, how old is he?
6-12 years
Identity is the critical issue in what age range?
adolescence (12+)
Conformity is most important for what age range?
11-12 years
When do cross gender relationships first take off?
adolescence (12+)
A teacher has noticed many of her kids are quitting organized sports, how old is her class likely to be?
adolescents (12+)
A teacher has noticed that for her kids, the "rules of the game" are paramount. How old is her class?
6-12 years
At what age range are organized sports first possible?
6-12 years
Demonstrating competence is key for what age group?
6-12 years
At this age range there is a separation of the sexes and sexual feelings are not apparent.
6-12 years
At this age range there is an adherence to logic, concrete operations, and no hypotheticals.
6-12 years
Children of this age group can use seriation, and have a personal sense of right and wrong.
6-12 years
At this age, children can handle hypotheticals, being systematic problem solving and deal with the past, present, and future.
adolescence (12+)
APGAR stands for what?
Appearance (color)
Ages of the operational stages:

1. Pre-operational

2. Concrete

3. Formal
Pre-operational: 2-7 yo

Concrete operational: 7-11 yo
(reason, logic, volume, etc)

Formal Operational: >11 yo
(abstract thought)
What the three levels of appearance (color) on the APGAR scale?
0 = blue/pale

1 = trunk pink

2 = all pink
What describes the three levels of pulse on the APGAR score?
0 = 0

1 = <100

2 = >100
Describe the 3 levels of muscle tone on the apgar scale.
0 = limp

1 = some

2 = active
Describe the three levels of respiratory effort on the APGAR scale.
0 = none

1 = irregular

2 = regular
What is the definition of low birth weight in grams?
< 2500 g
How long does deprivation of affection need to continue before changes may be irreversible?
> 6 months
Depression in an infant owing to continued separation from caregiver - it can result in failure to thrive
Anaclitic depression
An infant becomes withdrawn and unresponsive when left in a crowded daycare for a few weeks, what may be the problem?
Anaclitic depression
When a child is found to be physically abused, who is typically the abuser?
usually female and the primary caregiver.
When a child is found to be sexually abused, who is typically the abuser?
A male who is known to the victim.
At what age are most children sexually abused?
9-12 years.
a milder form of autism involving problems with social relationships and repetative behavior
Asperger syndrome
X-linked disorder seen only in girls. Characterized by loss of development and mental retardation appearing at about 4 years.
Rett disorder
What is the current treatment for autism?
increase communication and social skills
Why aren't boys seen with Rett syndrome?
With this X-linked disorder, boys die in utero.
What is the treatment for ADHD?
methylphenidate (Ritalin)
Describe conduct disorder
continued behavior violating social norms.

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