Which one of the following descriptors of a diagnostic test is influenced by the prevalence of the disease being tested for:
Correct Answer D:
Positive predictive value (PPV) is a proportion of people with a positive test who have the disease. It is related to prevalence. The higher the prevalence, the higher the PPV will be.
Note: Do not confuse PPV with sensitivity, which is a proportion of people with disease who are correctly identified by a positive test.
A 39-year-old physician is convicted of narcotic abuse. He successfully completes a 3 month drug rehabilitation program.
Following this treatment, his privilege to practice medicine will be determined by which of the following?
Correct Answer C:
Depending upon the specialty of medicine and the province in which the physician practices, provincial medical board determines whether a physician known to have abused narcotics can practice medicine again. In anesthesia, for example, a rehabilitated physician can no longer practice anesthesia, but may continue to practice in another specialty. These regulations vary widely from province to province and from profession to profession. The key factor is the successful completion of a board-mandated drug rehabilitation program. The provincial medical board determines his privilege to practice.
You are discussing treatment options with a 75-year-old woman with chronic renal failure. Her medical history also includes diabetes mellitus, hypertension, hypercholesterolemia, and a left above-the-knee amputation secondary to severe peripheral vascular disease. She lives with her dog in a one-bedroom apartment in the suburbs and is dependent upon a wheelchair for ambulation. Her support system includes a home health aide, several friends who live 5 to 6 miles from her apartment and Meals-on-Wheels.
Which of the following is the most appropriate advice to give this patient regarding long-term management?
Correct Answer B:
The most common cause of chronic renal failure is diabetes mellitus. This patient has dialysis dependent renal failure and very specific social constraints on her ability to receive therapy. For this reason, the initiation of dialysis at home would suit both her medical needs and her social needs.
Physicians do not make decisions about excluding patients from care based upon social, financial or any other factor. Physicians present to their patients all of the options for their care and assist the patient in making the best decision for them. The physician acts as the patient advocate. If the patient refuses dialysis after being presented with that option by her physician, that is her right.
Peritoneal dialysis is an option for this patient, but generally, hemodialysis is utilized first for a number of reasons. Once patients have exhausted access to their circulation, or they have a specific contra-indication to hemodialysis, a peritoneal dialysis (PD) catheter can be placed and PD can be utilized.
The occurrence of an illness, in a specific population or area, suddenly and in numbers clearly in excess of normal expectancy is called:
Hyperendemic disaese - a disease that is constantly present at a high incidence and/or prevalence rate and affects all age groups equally.
An epidemic disease is a disease that many people acquire over a short periodoccurring suddenly in numbers clearly in excess of normal expectancy.
An endemic disease is one that is always present in a population and is occurring at the usual expected rate. Enzootic disease - prevalent among or restricted to animals of a specific geographic area.
A pandemic disease is a world-wide epidemic disease.
The constant presence of a disease or infectious agent in a given area or population is termed:
Infectious disease statistical terminology:
PEARL: An infectious disease is endemic if it is constantly present in a given area or population.
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