A 15 year old boy presented with wheezing when playing football and nocturnal cough.

Which is the best test to confirm the underlying condition? Available marks are shown in brackets 1) 2) 3) 4) 5) A trial of oral corticosteroids A trial of inhaled corticosteroids A trial of inhaled salbutamol Serial peak expiratory flow rate measurements Spirometry alone [0] [0] [0] [100] [0]

Comments: Demonstration of variable obstruction of the airways provides good evidence for asthma, with its characteristic morning dips. Failure to respond to bronchodilator therapy does not exclude asthma as response may be small in children, and in adults with persistent or more severe asthma. Those who fail to respond to inhaled bronchodilator require a steroid trial (either 4 weeks of high dose inhaled steroids or 2 weeks of oral Prednisolone).

In a study of a new drug for asthma, a researcher wishes to compare average serum drug concentrations in volunteers, four hours after taking the drug;

in the fasting state then after a meal

Which of the following would be the most appropriate statistical test to use? Available marks are shown in brackets 1) 2) 3) 4) 5) chi-squared test Pearson's correlation coefficient Student's paired t-test Student's unpaired t-test Wilcoxon test [0] [0] [100] [0] [0]

Comments: In this scenario we are dealing with use of the drug in the same volunteers with the intervention being the effect of feeding on drug concentrations. Thus you'll be comparing means in the same subjects and the paired t-test would be the most appropriate test. Go here for more statistical info. Which of the following statements is true of the pulmonary function test's vital capacity (VC)? Available marks are shown in brackets 1) 2) 3) 4) 5) Vital capacity cannot be measured from spirometry alone Vital capacity is increased in emphysema and reduced in interstitial fibrosis Vital capacity is the maximal amount of air which can be exhaled after maximal inspiration Vital capacity is the sum of tidal volume (VT) and inspiratory capacity (IC) Vital capacity, when reduced, is a specific indication of restrictive lung disease [0] [0] [100] [0]

A 7 month old boy is presented to a doctor by his parents with symptoms of reccurent upper respiratory tract infections. No other members of the family suffer from any smiliar infections.Physical examination

showed mild facial hypoplasia. Biochemistry investigations revealed hypocalcaemia. Microbiological investigations were normal and immunoglobulins were within normal limits. The infants immune function would show the following deficiency: Available marks are shown in brackets 1) 2) 3) 4) 5) Complement Deficieny B cell number and function T cell number and function Plasma Cell Macrophage number and function [0] [0] [100] [0] [0]

Comments: This child suffers from DiGeorges syndrome. Patients with DiGeorges Syndrome often have near normal levels of immunoglobulins but with significant decreases in T cell numbers and relative increase in the percentage of B cells. An 18 year-old female is admitted with a depression of her conscious level. Arterial blood gas analysis revealed: pH 7.26 pO2 12.1 kPa pC02 3.9 kPa standard bicarbonate 14.7 mmol/L Which one of the following would account for these results? Available marks are shown in brackets 1) 2) 3) 4) 5) Analytical error Metabolic acidosis Persistent vomiting Respiratory acidosis Respiratory alkalosis [0] [100] [0] [0] [0]

Comments: This patient has a metabolic acidosis with an effort at respiratoty compensation as reflected by elevated pO2 and reduced pCO2. This could be due to poisoning or a condition such as Diabetic ketoacidosis. Vomiting would cause a metabolic alkalosis.

An 18-year-old boy is suspected of having cystic fibrosis. Which of the following results would be most suggestive of this condition? Available marks are shown in brackets 1) 2) 3) 4) 5) Abnormal pancreatic function tests Abnormalities in lung function tests Bronchiectasis on a chest x-ray Elevated sweat chloride concentration Low immunoreactive plasma trypsinogen [0] [0] [0] [100] [0]

Comments:

The sweat test is the most important test for CF. Up to 99% of children with CF have sweat chloride and sodium levels above 70 and 60 mM respectively. In normal children, sweat sodium is higher than chloride. The reversed ratio is another pointer to CF. Two sweat tests should be performed spontaneously on both arms with pilocarpine iontophoresis. Older children with CF and pancreatic insufficiency have low immunoreactive trypsin. This and the other tests mentioned may be suggestive of CF but are not diagnostic. A new publication describes a new test for cystic fibrosis. You want to know what proportion of patients with cystic fibrosis who would be correctly identified by this new test. Which one of the following values would identify this? Available marks are shown in brackets 1) 2) 3) 4) 5) accuracy negative predictive value positive predictive value sensitivity specificity [0] [0] [0] [100] [0]

Comments: The proportion of patients with the disease who would be identified by the new test is the specificity. This refers to the proportion with the disease who truly have cystic fibrosis and are identified as such by the test. Positive predictive value refers to the percent of people having a positive test who actually have the disease interpreted in conjunction to the prevalence of the disease (True positives/True positives+False negatives). A new publication describes a new test for cystic fibrosis. You want to know what proportion of patients with cystic fibrosis would be correctly identified by this new test. Which one of the following values would identify this? Available marks are shown in brackets 1) 2) 3) 4) 5) accuracy negative predictive value positive predictive value sensitivity specificity [0] [0] [0] [100] [0]

Comments: The proportion of patients with the disease who would be correctly identified by the new test is the sensitivity. This refers to the proportion with the disease who truly have cystic fibrosis and are identified as such by the test. Positive predictive value refers to the percent of people having a positive test who actually have the disease interpreted in conjunction to the prevalence of the disease (True positives/True positives+False negatives).

Sensitivity, Specificity and Predictive Values

Association of symptoms or test results and disease

Clinical research often investigates the statistical relationship between symptoms (or test results) and the presence of disease. Chi-square analysis can be applied to the data in the form of a 2 by 2 table in order to assess the statistical significance of the association between the presence or absence of a symptom and the presence or absence of the disease under study. When significant associations are found, it is useful to express the data in ways which are clinically relevant. In order to communicate the results in a consistent manner, the following definitions have been developed.
Test Result Negative a absent disease present 8660 c 40 Positive b 960 d 340

Sensitivity the probability that a symptom is present (or screening test is positive) given that the person has the disease d/(c+d) 340 / (40+340) = .895. This is also know as the true positive rate. Specificity the probability that a symptom is not present (or screening test is negative) given that the person does not have the disease a/(a + b) 8660 / (8660 + 960) = .90. This is also known as true negative rate. Predictive value positive the probability that a person has the disease given a positive test result d / (b + d) 340 / (960+340) = .26 Predictive value negative the probability that a person does not have the disease given a negative test a / (a + c) 8660 / (8660+40) = .995 False negative a person who tests as negative but who is actually positive False positive a person who tests as positive but who is actually negative
In a study of a new drug for asthma, a researcher wishes to compare average serum drug concentrations

in volunteers, four hours after taking the drug; a. in the fasting state then b. after a meal. Which of the following would be the most appropriate statistical test to use? Available marks are shown in brackets 1) 2) 3) 4) 5) chi-squared test Pearsons correlation coefficient Students paired t-test Students unpaired t-test Wilcoxon test [0] [0] [100] [0] [0]

Comments: In this scenario we are dealing with use of the drug in the same volunteers with the intervention being the effect of feeding on drug concentrations. Thus youll be comparing means in the same subjects and the paired t-test would be the most appropriate test. Go here for more statistical info