Shared Flashcard Set

Details

ICDM
exam 1 flash cards
67
Medical
Graduate
08/25/2009

Additional Medical Flashcards

 


 

Cards

Term
Multiple Determinants of Health
Definition
Health Care, Behavior, Biology, Environmental, Social/Economic

"Have Big breakfasts - egg sandwiches"
Term
A public health approach
Definition
Prevention, clear consistent messages, benefits environment and community, sustained, measurable improvements, evidence (science) based
Term
3 public health challenges (IOM)
Definition
Globalization
Scientific and Medical Technology
Demographic changes
Term
"abnormal labs"
Definition
in top or bottom 2.5% In a panel of 20 tests one would by chance be abnormal
Term
representative error
Definition
ignoring the exception to the rule
"common things are common" mentality

Avoid by: differential diagnosis every time
Term
Attribution error
Definition
Letting our proconceptions influence our diagnosis

Avoid by: dont make assumptions
consciously alter persons connotation
"we attribute diseases based on looks"
Term
affective error
Definition
not wanting to believe bad things or do uncomfortable things to the people we love- to objects of "affection"

avoid by: play it by the book, put feelings aside
Term
Availability Error
Definition
overly influenced by the last or most memorable case-- our brain makes that answer "available"

Avoid by: ask "why" you think that?
Don't be afraid to DO nothing for a little while
Term
Gestalt reasoning
Definition
subconcious
pattern recognition
Strength- can dicern something is wrong
Weakness- not comprehensive
Term
confirmation bias
Definition
cherry-picking facts to "confirm" our diagnosis, ignore what doesnt fit--
Term
commission bias
Definition
the need to DO something
Term
Structured reasoning
Definition
structured analysis, conscious effort

strenths: comprehensive, standardized
weaknesses: impersonal, time/effort intensive
Term
Four Quadrant Approach to Clinical Ethics
Definition

Medical Indications            Patient Preferences

 

 

 

 

 

Quality of Life                 Contextual Features

Term
Ethical Hierarchy
Definition

1. Ethical Theory

2. Principles

3. Rules

4. Particular judgements and actions

Term
4 Principles of Clinical Ethics
Definition

1. Autonomy

2. Beneficence

3. Non-maleficence

4. justice

Term
Deontology
Definition

Emphasizes: the action

 

Actions are right or wrong in and of themselves, emphasizes duty

 

Problems: competing duties? cold?

Term
Virtue
Definition

Emphasizes: Agent

What would virtuous person do?

The "good"

what is motivation of doer?

 

Problems: competing virtues, good people make mistakes

Term
consequentialism
Definition

emphasizes: outcome

 

ends justify the means

 

Problems: aren't some things just wrong?

How do you define "good" outcome?

Term
moral sentiment
Definition

intuitive sense of right and wrong

"gut reaction"

Hard to explain/ argue

 

Problems:How can you resolve conflict? What if your moral compass is totally off?

Term
3 element types of informed consent
Definition

Threshold elements

Information elements

Decision Elements

Term
2 Threshold elements in informed consent
Definition

competence

voluntariness

Term
3 information elements of informed consent
Definition

Disclosure

recommendation

understanding

Term
2 Consent elements of informed consent
Definition

decision

authorization

Term
Price v. Neland
Definition

supreme court case- 1963

Says attending physician is ultimately responsible

Term
Harris vs. Robert C. groth
Definition

Supreme court case 1983

 

follow up to price v. Neland

 

Says attending physician is ultimately responsible (for informed consent etc)

Term
4 Exceptions to informed consent
Definition

Emergency

Medical Neglect

Waiver to informed consent

Incompetence (lack of DMC)

 

Term
Guardian
Definition
Person named by court to make decisions of pts. behalf
Term
Agent
Definition
Person named in DPA-HC to make decisons for pt
Term
surrogate
Definition
person best able to offer sustituted judgement in absence of DPA-HC
Term
Best Interests
Definition

What reasonable person would want

 

drawback: impersonal

Term
Hierarchy of Ethical Decision Making
Definition

Autonomy

Substituted Judgement

Best interests

Term
POLST
Definition

Type of DNR

valid only at Fletcher Allen

 

as opposed to COLST

valid in all clinical settings

Term
Exceptions to Confidentiality
Definition

Pt threat to harm self

pt threat to harm others

Required by Law

(ex. communicable diseases, bites of rabid animals, child abuse, cancer registry)

Term
religion
Definition

one's relationship to the divine

manifested in group observance of ritual

Term
spirituality
Definition

one's personal understanding of the relationship between oneself, others and the universe

 

may involve "religion"

 

include values, goals, priorities

Term
3 Characteristics of a "profession"
Definition

1) self-regulation

2) expert knowledge

3) Fiduciary Responsibility

Term
self-regulation
Definition

§  being professional vis-à-vis:

1)Yourself: don’t self-medicate or self-diagnose

2)Family & friends: don’t treat family and friends

3)Staff: be respectful, but accept your authority

4)Health care industry: There is no free lunch!

Term
Fiduciary Responsibility
Definition

 an unequal relationship based on trust, where the focus is on the best interests of the vulnerable party

 

based on communication and humanism

Term
Medical Error
Definition

commissions or omissions

would be judged wrong at time it occurred

doesn't necessarily lead to negative consequence

distinct from mal-outcome

 

Term
carrier frequency
Definition
prevalence of specific allele among individuals in a given population
Term
allele frequency
Definition
frequency of specific allele among all alleles in a given population
Term
Assumptions in H-W equilibrium
Definition

large population/ random mating

constant allele frequencies

Term
H-W equation
Definition

(p+q)^2= p^2+ 2pq+q^2

 

 

2pq= carrier frequency

 

q^2= frequency of condition

Term
Proband
Definition
The first family member clinically diagnosed with the condition
Term
Autosomal Dominant
Definition

 No skipped generations

Each child has 50% chance of getting it

transmitted equally to men and women

Term
Autosomal Recessive
Definition

Affect members of sibship

Parents are heterozygous carriers

carriers have 1 in 4 chance of affected child

Term
mosaicism
Definition
mitotic mutation in fetus
Term
somatic mution
Definition
mitotic mutation in tumor
Term
acrocentric chromosomes
Definition
chromosomes with small p arm that consits of a stalk and a sattelite that code for ribosomal RNA - form nucleolus of cell
Term
Heterochromatin
Definition

-dark bands

-relatively inactive

Term
Euchromatin
Definition

light bands

actively transcribed

Term
Euploid
Definition

Chromosome number is a multiple of 23

 

-"just like you (eu)"

Term
Aneuploidy
Definition
-Chromosome number not multiple of 23
Term
robertsonian translocation
Definition

structural abnormality

-two acrocentric chromosomes fuse together

-p arms lost

- result in two long arms (q arms)

Term
pleitropy
Definition

refers to the effect on one person

-genetic expression affects multiple organ systems

Term
variable expression
Definition

refers to the genetic expression in population

-condition is expressed differently in different people

Term
penetrance
Definition

the propability of an individual expressing a condition given inheritance of the pre-disposing genotype

 

- happens in cancer

Term
Locus heterogeneity
Definition
the production of identical phenotypes by a mutation at two or more different loci
Term
Allelic Heterogeneity
Definition

populations: different mutant alleles at same locus

 

individual: the same or similar phenotypes may be caused by different mutation alleles rather than identical alleles at the same loci

 

carriers by difinition exhibit allelic heterogeneity

Term
two ways of getting declared dead
Definition

1) heart-lung death

2) death by neurologic criteria

Term
Quinlan
Definition

1976

"even patients who lack DMC have right to refuse life-sustaining treatment"

Term
Cruzan
Definition

-states can set "reasonable standards"

-artificial hydration and nutrition is life-sustaining treatment

 

Term
Quill v. Vacco
Definition

1997

The court unanimously rules

Difference between letting die and making die

Term
Washington v Glucksberg
Definition

The right to suicide has no place in constitution

outweighed by "compelling state interest"

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