First Aid Express 2016 workbook: BEHAVIORAL SCIENCE page 1

Behavioral Science
How to Use the Workbook with the Videos
Using this table as a guide, read the Facts in First Aid for the USMLE Step 1 2016,
watch the corresponding First Aid Express 2016 videos, and then answer the workbook
questions.

Facts in First Aid for

Corresponding First Aid Express Workbook
the USMLE Step 1
2016 videos questions
2016
32.139.1 Epidemiology/Biostatistics (5 videos) 142
39.242.1 Ethics (1 video) 4370
43.144.1 Development and Aging (1 video) 7173
44.246.4 Public Health 7481

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page 2 First Aid Express 2016 workbook: BEHAVIORAL SCIENCE

Questions

EPIDEMIOLOGY/BIOSTATISTICS
1. A case-control study is described as _______________ (experimental/observational) and
_______________ (prospective/retrospective). (p 32)

2. A cohort study is described as _______________ (experimental/observational) and

_______________ (prospective/retrospective). (p 32)

3. True or False: In a cohort study, subjects are chosen on the basis of the presence or absence of
risk factors. (p 32) -
___________________________________________________________________

4. True or False: A cohort study involves following subjects over a period of time to study the
development of disease. (p 32) _________________________________-
_____________________

5. True or False: A cross-sectional research study can show the correlation of a risk with a disease. (p
32) ___________________________________________________________________________

6. Describe single-, double-, and triple-blinded studies. (p 32) _______________________________

______________________________________________________________________________
7. What is the purpose of Phase III clinical trials? (p 32) ___________________________________

8. How does a low prevalence of disease affect the positive predictive value of a test? (p 33) ______
______________________________________________________________________________

9. Screening tests (eg, the ELISA in HIV testing) are _______________ (sensitive/specific) and have
a high false-_______________ (negative/positive) rate, with a _______________ (high/low)
threshold. (p 33)

10. Confirmatory testing (eg, a Western blot in HIV testing) is _______________ (sensitive/specific)
and has a high false-_______________ (negative/positive) rate, with a _______________
(high/low) threshold. (p 33)

11. How does a low prevalence of disease affect the negative predictive value of a test? (p 33) ______
______________________________________________________________________________

12. If a diagnostic test has 100% sensitivity, what should the value of the false-negative rate equal?
(p 33) __________________________________________________________________________

13. If a diagnostic test has 100% specificity, what should the value of the false-positive rate equal?
(p 33) __________________________________________________________________________

14. What measure of disease frequency is calculated by dividing the total number of cases in the
population at a given time by the total population at a given time? (p 33)
______________________

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 First Aid Express 2016 workbook: BEHAVIORAL SCIENCE page 3

15. What measure of disease frequency is calculated by dividing the number of new cases in the
population during a period by the total population at risk during that time? (p 33)
_________________

16. In chronic disease states such as diabetes is the prevalence of disease greater than, less than, or
equal to the incidence? (p 33) ______________________________________________________

17. In acute disease states such as a common cold is the prevalence of disease greater than, less
than, or equal to the incidence? (p33)
_____________________________________________________

18. True or False: When calculating the incidence of a disease, the total population at risk during a
certain time should include people who have the disease. (p 33)
_____________________________

19. The statement "Patients with COPD were more likely to have a history of smoking than those
without COPD" pertains to _______________ (odds ratio/ relative risk). (p 34 )

20. The statement "Smokers were more likely to develop COPD than nonsmokers" pertains to
_______________ (odds ratio/relative risk). (p 34)

21. True or False: The odds ratio for a disease based on exposure to a risk factor approximates the
relative risk if the prevalence of the disease is low. (p 34) ________________________________

22. How is the relative risk reduction calculated? (p 34)_____________________________________

______________________________________________________________________________

23. What epidemiologic measurement is equal to the difference in disease incidence between an
exposed group and an unexposed group? (p 34) _______________________________________

24. _______________ (Precision/accuracy) refers to the trueness of test measurements (validity), and
_______________ (precision/accuracy) refers to the consistency and reproducibility of a test or the
absence of random variation in a test. (p 35)

25. _______________ (Random/systematic) error reduces precision in a test, and _______________

(random/systemic) error reduces accuracy in a test. (p 35)

26. Name four ways to reduce bias in epidemiologic studies. (p 36) ___________________________
______________________________________________________________________________

27. What type of bias occurs when there are two closely associated factors and therefore the effect of
one factor could change or confuse the effect of the other? (p 36) __________________________

28. What is the name of the phenomenon whereby a researcher's belief in the efficacy of a treatment
changes the outcome of that treatment? (p 36) ________________________________________

29. In a data set that has a distribution with a negative skew, what is the relationship between the
mean, the median, and the mode? (p 37)
__________________________________________________
______________________________________________________________________________

30. In a data set that has a distribution with a positive skew, what is the relationship between the mean,
the median, and the mode? (p 37) __________________________________________________

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page 4 First Aid Express 2016 workbook: BEHAVIORAL SCIENCE

______________________________________________________________________________

31. Which characteristic is least affected by outliers: mean, median, or mode? (p 37) ______________

32. What is the term for the hypothesis that there is no association between the variables being
studied? (p 37)
__________________________________________________________________________

33. In a data set that has a normal (Gaussian) distribution, what percentage of the data falls within two
standard deviations of the mean? What percentage falls within 3 SDs of the mean? (p 37)
______________________________________________________________________________

34. In statistical calculations, the P value is equal to the probability of making what type of error? (p 38)
______________________________________________________________________________

35. In a statistical analysis, if P = 0.03, what is the probability that the data will show a difference by
chance alone when none truly exists? (p 38) __________________________________________

36. In statistical analysis, if = 0.2, what is the probability that the null hypothesis has been falsely
accepted? (p 38) ________________________________________________________________

37. The power of a statistical test depends on which three factors? (p 38) ______________________
______________________________________________________________________________

38. What study parameter is calculated when the probability of making a type II error is subtracted from
1? (p 37) ______________________________________________________________________

39. If the 95% confidence interval for a mean difference between two variables includes 0, the null
hypothesis _______________ (is/is not) rejected. (p 38)

40. What type of statistical test is used to check for a difference between the means of three or more
groups? (p 39) __________________________________________________________________

41. What type of statistical test is used to check for a difference between the means of two groups?
(p 39) ________________________________________________________________________

42. What statistical term's absolute value indicates the strength of the correlation between two
variables? (p 39)
_________________________________________________________________________

ETHICS
43. What are the four core ethical principles of medicine? (p 39) ______________________________
______________________________________________________________________________

44. True or False: Patient autonomy may conflict with beneficence. (p 39) ______________________

45. Which right is being exercised when a patient makes an informed decision to proceed with a
medical treatment when the benefits of the intervention outweigh its risks? (p 39) _____________

46. What must be explained by a doctor to obtain informed consent? (p 40) ____________________

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 First Aid Express 2016 workbook: BEHAVIORAL SCIENCE page 5

______________________________________________________________________________

47. What are the four exceptions to informed consent? (p 40) ________________________________
______________________________________________________________________________

48. Name four conditions in which a minor may be considered emancipated. (p 40) _______________
______________________________________________________________________________

49. What five requirements must be met in order to determine that a patient has full decision-making
capacity? (p 40) _________________________________________________________________
______________________________________________________________________________

50. What term refers to an incapacitated patient's previous oral statements, which are commonly used
to guide medical decisions? (p 41) __________________________________________________

51. What four factors give greater validity to a patient's oral advance directive? (p 41) _____________
______________________________________________________________________________

52. What is the term for the legal document that describes treatments the patient wishes to receive or
not receive if he/she becomes incapacitated and cannot communicate about treatment decisions?
(p 41) _________________________________________________________________________

53. What legal term refers to a patient's authorization of a surrogate to may make medical decisions in
the event that the patient loses decision-making capacity? (p 41) __________________________

54. True or False: When authorizing a medical power of attorney, the patient may specify decisions
that are to be made in certain clinical situations. (p 41)
______________________________________

55. True or False: A patient's agent authorized with medical power of attorney retains that power
unless it is revoked by the patient. (p 41)
___________________________________________________

56. Which type of advance directive provides greater flexibility, a living will or a medical power of
attorney? (p 41) _________________________________________________________________

57. What standard should be used to determine the amount of medical information to disclose to a
patient's family or friends? (p 41) ___________________________________________________

58. In the case of serious infectious diseases, a physician may have a duty to break patient
confidentiality to warn certain groups of people. Name the two groups. (p 41)
____________________________
______________________________________________________________________________

59. What legal precedent requires physicians to directly inform and protect a potential victim from
harm, even if it involves a breach of confidentiality? (p 41) ________________________________

60. A child presents to the emergency department with multiple fractures and bruises of different ages.
The patient's mother requests that authorities not be involved. Must the physician respect her
request for confidentiality? Why or why not? (p 41) _____________________________________
______________________________________________________________________________

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page 6 First Aid Express 2016 workbook: BEHAVIORAL SCIENCE

61. A young woman confides to her physician that she has considered ending her life by ingesting a
bottles worth of her prescription pills, and that she does not want anyone else to know of her plan.
Must the physician respect her request for nondisclosure? Why or why not? (p 41) ___________
______________________________________________________________________________

62. A patient discloses that he frequently drives after consuming four or five drinks at the bar. In the
office, the patient clearly has been drinking alcohol and has arrived on his own. Is the physician
obligated to uphold confidentiality? Why or why not? (p 41) _______________________________
______________________________________________________________________________

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 First Aid Express 2016 workbook: BEHAVIORAL SCIENCE page 7

63. True or False: A patient's family can require that a doctor withhold information from the patient.
(p 41) ________________________________________________________________________

64. What is an appropriate response to a patient who is upset about how he or she was treated by
another doctor? (p 42) ____________________________________________________________

65. What is an appropriate response to a child who wishes to know more about his or her illness?
(p 42) _________________________________________________________________________

66. What is an appropriate response to a patient who is noncompliant? (p 42) ___________________

______________________________________________________________________________

67. What is an appropriate response to a 17-year-old girl who is pregnant and requests an abortion? (p
42) ___________________________________________________________________________

______________________________________________________________________________

68. What is an appropriate response to a terminally ill patient who requests physician assistance with
ending his or her life? (p 42) _______________________________________________________
______________________________________________________________________________

69. What is an appropriate response to a patient who refuses a necessary procedure or desires an
unnecessary one? (p 42) __________________________________________________________

70. What is an appropriate response to a patient who states that he or she finds you attractive? (p 42)
______________________________________________________________________________

DEVELOPMENT AND AGING

71. What is the approximate age of a child who is anxious when separated from his or her mother?
(p 43) _________________________________________________________________________
72. What is the approximate age range of a child who plays alongside, but not with, another child?
(p 43) _________________________________________________________________________

73. What sexual changes normally occur in elderly men? (p 44) ______________________________
______________________________________________________________________________

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page 8 First Aid Express 2016 workbook: BEHAVIORAL SCIENCE

PUBLIC HEALTH
74. Give an example of primary, secondary, and tertiary disease prevention strategies. (p 44)
Primary: ______________________________
Secondary: ____________________________
Tertiary: _______________________________
75. What two federally funded healthcare programs originated from amendments to the Social Security
Act? Who is eligible for each of these these programs? (p 44) ____________________________
______________________________________________________________________________

76. What is the most common cause of death in young adults? (p 45)__________________________

77. What is the most frequent cause of readmissions for patients with Medicaid? (p
45)______________

78. What are the four components of the process improvement model? (p 45)
P____________
D____________
S____________
A____________
79. Match the examples with the corresponding quality measurement. (p 46)
_____ A. Outcome 1. Average HbA1c of patients with diabetes
_____ B. Process 2. Incidence of hypoglycemia among patients with
_____ C. Balancing measured HbA1c
3. Ratio of patients whose HbA1c was measured in
the past 6 months

80. Patient misidentification is an example of ________________ (active/latent) error. ( p 46)

81. Root cause analysis is a______________ (prospective/retrospective) approach to analyzing
medical error. (p 46)

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 First Aid Express 2016 workbook: BEHAVIORAL SCIENCE page 9

Answers

EPIDEMIOLOGY/BIOSTATISTICS
1. Observational; retrospective.

2. Observational; prospective (more common) or retrospective.

3 True.

4. True for prospective cohort studies.

5. True. (However, it cannot show causality.)

6. In single-blind studies, subjects are not aware of their study-group assignment. In double-blind
studies, neither doctors nor subjects are aware of study-group assignment. In triple-blind studies,
the researchers analyzing the data are also unaware of study-group assignment.

7. To compare the efficacy of the new treatment with the current standard of care.

8. The positive predictive value of the test is lower for a disease that has a lower prevalence.

9. Sensitive; positive; low.

10. Specific; negative; high.

11. The negative predictive value of the test is higher for a disease that has a lower prevalence.

12. It should equal 0. (All cases of the disease are detected by the test.)

13. It should equal 0. (All patients without the disease are identified correctly.)

14. Point prevalence.

15. Incidence. (Incidence refers to new incidents).

16. Much greater than the annual incidence (because of the long duration of the disease).

17. Approximately equal (for diseases of short duration).

18. False. (The total population at risk during a certain period should not include people who have the
disease because incidence is a measure of new cases of a disease; those who have the disease
are not at risk of getting the disease.)

19. Odds ratio.

20. Relative risk.

21. True.

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22. 1 Relative risk = 1 [a/(a+b)]/[c/(c+d)]

23. Attributable risk; it is the percentage of cases of a disease caused by a risk factor.

24. Accuracy; precision.

25. Random; systematic.

26. Use blinded studies (preferably double blind), assess placebo responses, perform a crossover
study, and use randomization.

27. Confounding bias, in which the causal relationship is better explained by a variable other that the
one being studied.

28. Observer-expectancy effect.

29. Mean < median < mode.

30. Mean > median > mode.

31. Mode.

32. Null hypothesis.

33. 95% fall within 2SDs of the mean, and 99.7% fall within 3SDs of the mean.

34. Type I error (). (This type of error occurs when it is incorrectly concluded that an association is
present.)

35. 3%.

36. 20%. (This is generally considered an acceptable level for in a study design).

37. The sample size, precision of measurement, and the size of the expected effect.

38. Power.

39. If the 95% CI includes 0, the null hypothesis is not rejected because there is no significant
difference between the two variables.

40. Analysis of variance (ANOVA).

41. t-test.

42. Correlation coefficient (r).

ETHICS
43. Autonomy, beneficence, nonmaleficence, and justice.

44. True.

45. Autonomy.

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46. The risks and benefits of the proposed intervention, and the risks and benefits of the alternatives
(including doing nothing).

47. If the patient lacks decision-making capacity; if the situation is emergent; if disclosure of information
would harm the patient; and if the patient waives the right of informed consent.

48. If the minor is married, self-supporting, has children, or is in the military.

49. The patient must make and communicate a choice; the patient must be informed; the decision must
remain stable over time; the decision must be consistent with the patient's values and goals; and
the decision cannot be a result of delusions or hallucinations.

50. Oral advance directive.

51. The patient was informed, the directive is specific, the patient made a choice, and the decision was
repeated over time.

52. Living will (ie, written advance directive).

53. Durable power of attorney.

54. True.

55. True.

56. A durable power of attorney.

57. The disclosure of information to family or friends should be guided by what the patient would want.

58. Public officials and identifiable people who may be at risk.

59. The Tarasoff Decision.

60. No; a physician may break confidentiality to report the abuse (or suspected abuse) of a child or an
elderly person.

61. No; a physician may break confidentiality to report a suicidal or homicidal patient.

62. No; a physician can break confidentiality to report an impaired driver.

63. False. (A patient's family cannot require the physician to withhold information from the patient.)

64. Suggest that the patient speak directly to that physician about the concerns. If the problem is with a
member of the office staff, inform the patient that you will speak to that person.

65. Ask the parents what they have told the child about his or her illness. (The parents decide what
information should be relayed to the child about the illness.)

66. Attempt to identify the patients reason for nonadherence and whether he or she is willing to
change the behavior. Do not force the patient to comply or refer the patient to another physician.

67. Many states require parental notification or consent for minors to have an abortion. However,
parental consent is not required for emergency situations, the treatment of sexually transmitted
diseases, medical care during pregnancy, prescriptions for contraceptives, or the management of
drug addiction.

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page 12 First Aid Express 2016 workbook: BEHAVIORAL SCIENCE

68. In most states, physicians should refuse to be involved in any form of assisted suicide; however,
the physician may prescribe medically appropriate analgesics that coincidentally shorten the
patient's life.

69. Attempt to understand why the patient wants or does not want the procedure; address the
underlying concerns, and avoid performing unnecessary procedures.

70. Ask direct closed-ended questions and use a chaperone if necessary. (Romantic relationships with
patients are never appropriate.)

DEVELOPMENT AND AGING

71. 9 months.

72. 24 to 48 months (parallel play).

73. Slower erection/ejaculation and a longer refractory period.

PUBLIC HEALTH
74. Vaccination is a primary disease prevention strategy, because the vaccinated person is not
considered susceptible to the disease. A Pap smear is secondary disease prevention, since it can
detect cervical cancer at an early, treatable stage. Chemotherapy is tertiary disease prevention, as
it is intended to reduce disability from disease once it has occurred.

75. Medicare and Medicaid. MedicarE is for the Elderly, and MedicaiD is for the Destitute.

76. Unintentional injury.

77. Mood disorders.

78. Plan, Do, Study, and Act.

79. A-1, B-3, C-2.

80. Active.

81. Retrospective.

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