Preclinical Behavioral Science and Social Sciences Review 2023: For USMLE Step 1 and COMLEX-USA Level 1 (2023)

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PRECLINICALBEHAVIORALSCIENCEANDSOCIALSCIENCESREVIEW2023FORUSMLESTEP1ANDCOMLEXUSALEVEL1®®USMLE®andUnitedStatesMedicalLicensingExamination®(FSMB),whicharenotaffiliatedwithKaplanandwerenotinvolvedintheproductionof,anddonotendorse,thisproduct.COMLEXUSA®isajointprogramoftheNationalBoardofMedicalExaminers(NBME)andtheFederationofStateMedicalBoardsisaregisteredtrademarkoftheNationalBoardofOsteopathicMedicalExaminers,Inc.(NBOME),whichisnotaffiliatedwithKaplanandwasnotinvolvedintheproductionof,anddoesnotendorse,thisproduct

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PRECLINICALBEHAVIORALSCIENCEANDSOCIALSCIENCESREVIEW2023FORUSMLE®COMLEXUSA®USMLE®STEP1ANDLEVEL1andUnitedStatesMedicalLicensingExamination®isajointprogramoftheNationalBoardofMedicalExaminers(NBME)andtheFederationofStateMedicalBoards(FSMB),whicharenotaffiliatedwithKaplanandwerenotinvolvedintheproductionof,anddonotendorse,thisproduct.COMLEXUSA®wasnotinvolvedintheproductionof,anddoesnotendorse,thisproduct.isaregisteredtrademarkoftheNationalBoardofOsteopathicMedicalExaminers,Inc.(NBOME),whichisnotaffiliatedwithKaplanan

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USMLE®andUnitedStatesMedicalLicensingExamination®isajointprogramoftheNationalBoardofMedicalExaminers(NBME)andtheFederationofStateMedicalBoards(FSMB),whicharenotaffiliatedwithKaplanandwerenotinvolvedintheproductionof,anddonotendorse,thisproduct.COMLEXUSA®isaregisteredtrademarkoftheNationalBoardofOsteopathicMedicalExaminers,Inc.(NBOME),whichisnotaffiliatedwithKaplanandwasnotinvolvedintheproductionof,anddoesnotendorse,thisproduct.Thispublicationisdesignedtoprovideaccurateinformationinregardtothesubjectmattercoveredasofitspublicationdate,withtheunderstandingthatknowledgeandbestpracticeconstantlyevolve.Thepublisherisnotengagedinrenderingmedical,legal,accounting,orotherprofessionalservice.Ifmedicalorlegaladviceorotherexpertassistanceisrequired,theservicesofacompetentprofessionalshouldbesought.Thispublicationisnotintendedforuseinclinicalpracticeorthedeliveryofmedicalcare.Tothefullestextentofthelaw,neitherthePublishernortheEditorsassumeanyliabilityforanyinjuryand/ordamagetopersonsorpropertyarisingoutof orrelatedtoanyuseofthematerialcontainedinthisbook.©2023byKaplanNorthAmerica,LLCPublishedbyKaplanMedical,adivisionofKaplanNorthAmerica,LLC.1515WestCypressCreekRoadFortLauderdale,Florida33309Allrightsreserved.Thetextofthispublication,oranypartthereof,maynotbereproducedinanymannerwhatsoeverwithoutwrittenpermissionfromthepublisher.Thisbookmaynotbeduplicatedorresold,pursuanttothetermsofyourKaplanEnrollmentAgreement.109876 543 21CourseISBN:9781506284415CourseKitISBN:9781506284651RetailISBN:9781506284392RetailKitISBN:97815062 84637KititemscomeasasetandshouldnotbebrokenoutandsoldseparatelyKaplanPublishingprintbooksareavailableatspecialquantitydiscountstouseforsalespromotions,employeepremiums,oreducationalpurposes.Formoreinformationortopurchasebooks,pleasecalltheSimon&Schusterspecialsalesdepartmentat8665061949

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EditorAlinaGonzalezMayo,MDPsychiatristDepartmentofVeteransAdministrationBayPines,FLContributorAliceAkunyili,MDAssistantDeanofAcademicAffairsNoordaCollegeofOsteopathicMedicineProvoUTTheeditorswouldliketoacknowledgeKevinSchuller,MDandKevinYang,MDfortheircontributions

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Wewanttohearwhatyouthink.WhatdoyoulikeornotlikeabouttheNotes?Pleaseemailusatmedfeedback@kaplan.com

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TableofContentsPARTI:EPIDEMIOLOGYANDBIOSTATISTICSCHAPTER1:Epidemiology..... ... ............. ... .....3CHAPTER2:Biostatistics..... ... ............... . .....25PARTII:BEHAVIORALSCIENCECHAPTER3:DevelopmentalLifeCycle.. ............. ... .....53CHAPTER4:TheoriesofLearningandBehavioralModification..... ... ...65CHAPTER5:DefenseMechanisms. ... ............. ... .....71CHAPTER6:PsychologicalHealthandTesting............. . .....77CHAPTER7:SubstanceUseDisorders. . ............... . .....83CHAPTER8:SleepandSleepDisorders. ............... . .....93CHAPTER9:Psychiatric(DSM5)Disorders.............. . .....99CHAPTER10:Psychopharmacology.. . ............... . ....117CHAPTER11:BrainFunctionandNeurocognitiveDisorders...... ... ..125CHAPTER12:Ethics,Law,andPhysicianBehavior........... . ....135CHAPTER13:HealthCareDeliverySystems.............. . ....157PARTIII:SOCIALSCIENCESCHAPTER14:BasicScienceofPatientSafety............. . ....161INDEX.... ..... ..... ..... ..... ..... ..... ..193

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PARTIEPIDEMIOLOGYANDBIOSTATISTIC

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EpidemiologyLEARNINGOBJECTIVES❏Answerquestionsaboutepidemiologicmeasures❏Useknowledgeofscreeningtests❏ExplaininformationrelatedtostudydesignsEPIDEMIOLOGICMEASURESEpidemiologyisthestudyofthedistributionanddeterminantsofhealthrelatedstateswithinapopulation.Itreferstothepatternsofdiseaseandthefactorsthatinfluencethosepatterns.•Endemic:theusual,expectedrateofdiseaseovertime;thediseaseismaintainedwithoutmuchvariationwithinaregion•Epidemic:occurrenceofdiseaseinexcessoftheexpectedrate;usuallypresentsinalargergeographicspanthanendemics(epidemiologyisthestudyofepidemics)•Pandemic:worldwideepidemic•Epidemiccurve:visualdescription(commonlyhistogram)ofanepidemiccurveisdiseasecasesplottedagainsttime;classicsignatureofanepidemicisa“spike”intimeThetoolsofepidemiologyarenumbers;thenumbersinepidemiologyareratiosconvertedintorates.Thedenominatoriskey:whois“atrisk”foraparticulareventordiseasestate.Todeterminetherate,comparethenumberofactualcaseswiththenumberofpotentialcases:____________ActualcasesPotentialcases=Numerator____________Denominator=RATERatesaregenerally,thoughnotalways,per100,000personsbytheCentersforDiseaseControl(CDC),butcanbeperanymultiplier.(Vitalstatisticsareusuallyper1,000persons.)Adiseasemayoccurinacountryataregularannualrate,whichmakesitendemic.Ifthereisasuddenriseinthenumberofcasesinaspecificmonth,wesaythatthereisanepidemic.Asthediseasecontinuestoriseandspreadtoothercountries,itbecomesapandemic.Thustheterminologyisrelatedtoboththenumberofcasesanditsgeographicaldistribution.1https://radiologyebook.vn/

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PARTI|EPIDEMIOLOGYANDBIOSTATISTICSBehavioralScience/SocialSciencesThegraphbelowrepresentstheincidenceof2diseases(casesin100,000).Disease1isendemicastherateofdiseaseisconsistentmonthtomonthwithminorvariationinthenumberofcases.Disease2experiencesanepidemicinMarchandAprilinwhichthenumberofcasesisinexcessofwhatisexpected.January35February45March38April48May45June45July35August35Althoughthedataisin100,000cases,thevariationindisease1isstillconsistentwhencomparedtodisease2.FigureI11.Epidemicvs.EndemicCasesConsiderthefollowingscenario.Aruralfarmerbeginstosellmeatthatisinfectedwithsalmonella.Within2days,hundredsofnearbyvillagersbegintoexperiencecrampyabdominalpain.Thisisanexampleofanepidemic.Thesuddenriseofsalmonellagastroenteritisinthisvillageismuchhigherthantheaverageincidenceforthegiventimeperiod.Nowwhatifthefarmerships1,000poundsofinfectedbeeftootherregionsinthecountrybeforeherealizeswhathappened?Whatcanoneanticipatewouldhappen?Theansweristherewouldbenochangetotheendemicrateofgastroenteritis.Thefarmerisonlyshippingout1,000poundsofbeeftoafewcitiesnationwide.Unliketheearlierscenariowhichaddressedthepopulationofavillage,thiswouldbetheentirenation.Assumingthateverypersonwhoconsumesthebeefgetsgastroenteritis,thatnumberwouldnotsignificantlyincreasethenationalaverageofcasesandwouldthereforenotsignificantlychangetheincidenceofthediseasenationwide.IncidenceandPrevalenceIncidencerate(IR)istherateatwhichneweventsoccurinapopulation.•Thenumeratoristhenumberofneweventsthatoccurinadefinedperiod.•Thedenominatoristhepopulationatriskofexperiencingthisneweventduringthesameperiod.https://radiologyebook.vn/

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ChAPTER1|EPIDEMIOLOGYIncidencerate=___________________________________NumberofneweventsinaspecifiedperiodNumberofpersons“exposedtorisk”ofbecomingnewcasesduringthisperiodTheIRincludesonlynewcasesofthediseasethatoccurredduringthespecifiedperiod,notcasesthatwerediagnosedearlier.ThisisespeciallyimportantwhenworkingwithinfectiousdiseasessuchasTBandmalaria.If,overthecourseofayear,5menarediagnosedwithprostatecancer,outofatotalmalestudypopulationof200(withnoprostatecanceratthebeginningofthestudyperiod),theIRofprostatecancerinthispopulationwouldbe0.025(or2,500per100,000menyearsofstudy).Attackrateisthecumulativeincidenceofinfectioninagroupofpeopleobservedoveraperiodoftimeduringanepidemic,usuallyinrelationtofoodborneillness.Itismeasuredfromthebeginningofanoutbreaktotheendoftheoutbreak.Attackrate=__________________________________________NumberofexposedpeopleinfectedwiththediseaseTotalnumberofexposedpeopleAttackrateisalsocalledattackratio;consideranoutbreakofNorwalkvirusinwhich18peopleinseparatehouseholdsbecomeill.Ifthepopulationofthecommunityis1,000,theoverallattackrateis_____1,000́100%=1.8%.18́10nFigureI12.ReportedCasesofHepatitisCintheUnitedStatesFigureI13.CumulativeIncidence2005–2015https://radiologyebook.vn/

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PARTI|EPIDEMIOLOGYANDBIOSTATISTICSBehavioralScience/SocialSciencesPrevalenceisallpersonswhoexperienceaneventinapopulation.Thenumeratorisallindividualswhohaveanattributeordiseaseataparticularpointintime(orperiodoftime).Thedenominatoristhepopulationatriskofhavingtheattributeordiseaseatthatpointintimeormidwaythroughtheperiod.Prevalence=___________________________________Allcasesofadiseaseatagivenpoint/periodTotalpopulation“atrisk”forbeingcasesatagivenpoint/period́10nPrevalence,inotherwords,istheproportionofpeopleinapopulationwhohaveaparticulardiseaseataspecifiedpointintime(oroveraspecifiedperiodoftime).Thenumeratorincludesbothnewcasesandoldcases(peoplewhoremainedillduringthespecifiedpointorperiodintime).Acaseiscountedinprevalenceuntildeathorrecoveryoccurs.Thismakesprevalencedifferentfromincidence,whichincludesonlynewcasesinthenumerator.Prevalenceismostusefulformeasuringtheburdenofchronicdiseaseinapopulation,suchasTB,malariaandHIV.Forexample,theCDCestimatedtheprevalenceofobesityamongAmericanadultsin2001atapproximately20%.Sincethenumber(20%)includesallcasesofobesityintheUnitedStates,wearetalkingaboutprevalence.NOTEPrevalenceisameasurementofallindividuals(newandold)affectedbythediseaseataparticulartime,whereasincidenceisameasurementofthenumberofnewindividualswhocontractadiseaseduringaparticularperiodoftime.Pointprevalenceisusefulforcomparingdiseaseatdifferentpointsintimeinordertodeterminewhetheranoutbreakisoccurring.Weknowthattheamountofdiseasepresentinapopulationchangesovertime,butwemayneedtoknowhowmuchofaparticulardiseaseispresentinapopulationatasinglepointintime(“snapshotview”).PerhapswewanttoknowtheprevalenceofTBinCommunityAtoday.Todothat,weneedtocalculatethepointprevalenceonagivendate.ThenumeratorwouldincludeallknownTBpatientswholiveinCommunityAthatday.ThedenominatorwouldbethepopulationofCommunityAthatday.Periodprevalence,ontheotherhand,isprevalenceduringaspecifiedperiodorspanoftime.Thefocusisonchronicconditions.Inthe“prevalencepot,”incident(ornew)casesaremonitoredovertime.Newcasesjoinpreexistingcasestomakeuptotalprevalence.IncidentCasesGeneralPopulationatRiskRecoveryPrevalentCasesRecoverywithImmunityFigureI14.PrevalencePotPrevalentcasesleavetheprevalencepotinoneof2ways:recoveryordeath.6Mortalithttps://radiologyebook.vn/

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ChAPTER1|EPIDEMIOLOGYTableI11.IncidenceandPrevalenceWhathappensif:NeweffectivetreatmentisinitiatedNumberofpersonsdyingfromtheconditionincreasesIncidencenochangeNeweffectivevaccinegainswidespreadusedecreasenochangeAdditionalFederalresearchdollarsaretargetedtoaspecificconditionBehavioralriskfactorsarereducedinthepopulationatlargeContactsbetweeninfectedpersonsandnoninfectedpersonsarereducedForairborneinfectiousdisease?Fornoninfectiousdisease?RecoveryfromthediseaseismorerapidthanitwasoneyearagoLongtermsurvivalratesforthediseaseareincreasingnochangedecreasePrevalencedecreasedecreasedecreasenochangedecreaseNOTEMorbidityrateistherateofdiseaseinapopulationatrisk(forbothincidentandprevalentcases),whilemortalityrateistherateofdeathinapopulationatrisk(incidentcasesonly).decreasenochangenochangenochangedecreasenochangedecreaseincreaseLungCancerCasesinaCohortofHeavySmokersDiseasecourse,ifany,for10patients123456789101/1/2006Key:Onset1/1/2007DurationTerminalEventFigure12.CalculatingIncidenceandPrevalenceFigureI15.CalculatingIncidenceandPrevalencehttps://radiologyebook.vn/

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PARTI|EPIDEMIOLOGYANDBIOSTATISTICSBehavioralScience/SocialSciencesBasedonthegraphabove,calculatethefollowing:•Prevalenceoflungcancerfrom1/1/2006–1/1/2007oNumberofpatientswho“had”lungcancerinthistimeperiodfromthegraph:(7)oNumberofpatientsatriskinthistimeperiod:(9)[excludepatient#2whodiedbeforethetimeperiod]oPrevalence:(7/9)oTypeofprevalence:(periodprevalence)•Incidenceoflungcancerfrom1/1/2006–1/1/2007oNumberofpatientswhodevelopedlungcancerinthistimeperiod:(4)oNumberofpatientsatriskinthistimeperiod:(6)[excludepatientswhowerealreadysickatthestartofthetimeperiodandthosewhodiedbeforethetimeperiod]oIncidence:(4/6)RecallQuestionPrevalencecanbedefinedaswhichofthefollowing?A.NumberofneweventsinaspecifiedperiodoverthenumberofpersonsatriskofbecomingnewcasesduringthesameperiodB.Numberofexposedpeopleinfectedwithadiseaseover thetotalnumberofexposedpeopleC.AllcasesofadiseaseatagivenpointoverthetotalpopulationatriskforbeingcasesatthesamepointD.NumberofactualcasesoverpotentialcasesE.RateofdeathinapopulationatriskAnswer:CNOTEUsecautionusingthecruderate.Imaginethatinagivencity,therearealotofolder,retiredpeople—thecruderateofmyocardialinfarctionwillappearhigher,eventhoughtherateforeachagegrouphasnotactuallychanged.Crude,Specific,andStandardizedRatesCruderateistheactualmeasuredrateforawholepopulation,e.g.,rateofmyocardialinfarctionforawholepopulation.Specificrateistheactualmeasuredrateforasubgroupofpopulation,e.g.,“agespecific”or“sexspecific”rate.Forinstance,therateofmyocardialinfarctionamongpeopleage>65inthepopulationortherateofbreastcanceramongthefemalepopulation.Ifyouareprovidedspecificrates,youcancalculatethecruderate.Thecruderateofanentirepopulationisaweightedsumofeachofthespecificrates.Theweightedspecificratesthatareaddedtogetheriscalculatedinthetablebelow.https://radiologyebook.vn/

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