Qualitative study designs — MCQs

10 questions

A 79-year-old male presents to your office for his annual flu shot. On physical exam you note several linear bruises on his back. Upon further questioning he denies abuse from his daughter and son-in-law, who live in the same house. The patient states he does not want this information shared with anyone. What is the most appropriate next step, paired with its justification?

A 52-year-old man with stage IV melanoma comes to the physician with his wife for a routine follow-up examination. He was recently diagnosed with new bone and brain metastases despite receiving aggressive chemotherapy but has not disclosed this to his wife. He has given verbal consent to discuss his prognosis with his wife and asks the doctor to inform her of his condition because he does not wish to do so himself. She is tearful and has many questions about his condition. Which of the following would be the most appropriate statement by the physician to begin the interview with the patient's wife?

Which of the following study designs would be most appropriate to investigate the association between electronic cigarette use and the subsequent development of lung cancer?

The APPLE study investigators are currently preparing for a 30-year follow-up evaluation. They are curious about the number of participants who will partake in follow-up interviews. The investigators noted that of the 83 participants who participated in the APPLE study's 20-year follow-up, 62 were in the treatment group and 21 were in the control group. Given the unequal distribution of participants between groups at follow-up, this finding raises concerns for which of the following?

A psychiatrist receives a call from a patient who expresses thoughts of harming his ex-girlfriend. The patient describes a detailed plan to attack her at her workplace. Which of the following represents the psychiatrist's most appropriate legal obligation?

A study is conducted in a hospital to estimate the prevalence of handwashing among healthcare workers. All of the hospital staff members are informed that the study is being conducted for 1 month, and the study method will be a passive observation of their daily routine at the hospital. A total of 89 medical staff members give their consent for the study, and they are followed for a month. This study could most likely suffer from which of the following biases?

You are currently employed as a clinical researcher working on clinical trials of a new drug to be used for the treatment of Parkinson's disease. Currently, you have already determined the safe clinical dose of the drug in a healthy patient. You are in the phase of drug development where the drug is studied in patients with the target disease to determine its efficacy. Which of the following phases is this new drug currently in?

A 28-year-old male presents to his primary care physician with complaints of intermittent abdominal pain and alternating bouts of constipation and diarrhea. His medical chart is not significant for any past medical problems or prior surgeries. He is not prescribed any current medications. Which of the following questions would be the most useful next question in eliciting further history from this patient?

A patient is in the ICU for diabetic ketoacidosis and is currently on an insulin drip. His electrolytes are being checked every hour and his potassium is notable for the following measures: 1. 5.1 mEq/L 2. 5.8 mEq/L 3. 6.1 mEq/L 4. 6.2 mEq/L 5. 5.9 mEq/L 6. 5.1 mEq/L 7. 4.0 mEq/L 8. 3.1 mEq/L Which of the following is the median potassium value of this data set?

Q10

The mean, median, and mode weight of 37 newborns in a hospital nursery is 7 lbs 2 oz. In fact, there are 7 infants in the nursery that weigh exactly 7 lbs 2 oz. The standard deviation of the weights is 2 oz. The weights follow a normal distribution. A newborn delivered at 10 lbs 2 oz is added to the data set. What is most likely to happen to the mean, median, and mode with the addition of this new data point?

Qualitative study designs US Medical PG Practice Questions and MCQs

Question 1: A 79-year-old male presents to your office for his annual flu shot. On physical exam you note several linear bruises on his back. Upon further questioning he denies abuse from his daughter and son-in-law, who live in the same house. The patient states he does not want this information shared with anyone. What is the most appropriate next step, paired with its justification?

A. Breach patient confidentiality, as this patient's care should be discussed with the daughter as she is his primary caregiver
B. See the patient back in 2 weeks and assess whether the patient's condition has improved, as his condition is not severe
C. Do not break patient confidentiality, as elder abuse reporting is not mandatory
D. Do not break patient confidentiality, as this would potentially worsen the situation
E. Breach patient confidentiality, as this patient is a potential victim of elder abuse and reporting is mandated in most states (Correct Answer)

Explanation: ***Breach patient confidentiality, as this patient is a potential victim of elder abuse and reporting is mandated in most states*** - As a physician, there is a **legal and ethical obligation** to report suspected elder abuse in most US states, even when the patient denies it and requests confidentiality. - Physicians are typically **mandatory reporters** under state law, and must report to Adult Protective Services or law enforcement when elder abuse is suspected. - The patient's safety and legal requirements outweigh the right to confidentiality in jurisdictions with mandatory reporting laws. *Breach patient confidentiality, as this patient's care should be discussed with the daughter as she is his primary caregiver* - Breaching confidentiality to discuss this with the daughter would be inappropriate, especially since the daughter and son-in-law are the **suspected abusers**. - Discussing with the primary caregiver is only appropriate if the patient has given **explicit consent** and there are no suspicions of abuse from that caregiver. *See the patient back in 2 weeks and assess whether the patient's condition has improved, as his condition is not severe* - This option is inappropriate because it delays intervention in a potentially **dangerous situation**. - Suspected abuse warrants **immediate action** to ensure the patient's safety, regardless of the perceived severity of current injuries. *Do not break patient confidentiality, as elder abuse reporting is not mandatory* - In **most states**, physicians have **mandatory reporting laws** for elder abuse, making this statement generally incorrect. - Physicians are typically considered "mandated reporters" and are legally required to report suspected abuse to the appropriate authorities in their jurisdiction. *Do not break patient confidentiality, as this would potentially worsen the situation* - While this is a valid concern in some situations, the **primary responsibility** of a physician is to protect vulnerable patients from harm. - Reporting suspected abuse initiates protective measures and is legally required in most states, as the potential benefit of intervention outweighs the risk of worsening the situation.

Question 2: A 52-year-old man with stage IV melanoma comes to the physician with his wife for a routine follow-up examination. He was recently diagnosed with new bone and brain metastases despite receiving aggressive chemotherapy but has not disclosed this to his wife. He has given verbal consent to discuss his prognosis with his wife and asks the doctor to inform her of his condition because he does not wish to do so himself. She is tearful and has many questions about his condition. Which of the following would be the most appropriate statement by the physician to begin the interview with the patient's wife?

A. Have you discussed a living will or goals of care together?
B. We should talk about how we can manage his symptoms with additional chemotherapy.
C. Why do you think your husband has not discussed his medical condition with you?
D. What is your understanding of your husband's current condition? (Correct Answer)
E. Your husband has end-stage cancer, and his prognosis is poor.

Explanation: ***What is your understanding of your husband's current condition?*** - This statement initiates the conversation by **assessing the wife's current knowledge** and emotional state, which is crucial for delivering sensitive and appropriate information. - It allows the physician to tailor the discussion to her specific understanding and concerns, ensuring that information is delivered compassionately and effectively. *Have you discussed a living will or goals of care together?* - This question is too abrupt and **premature** as an opening, as the wife is clearly distressed and unaware of the full severity of her husband's condition. - Discussions about end-of-life planning should only occur after the patient's wife has a clear understanding of the diagnosis and prognosis, and has processed this information. *Your husband has end-stage cancer, and his prognosis is poor.* - While factual, this statement is **too blunt and lacks empathy** for an opening, especially given the wife's emotional state and lack of prior knowledge. - Delivering such devastating news directly without first assessing her understanding or providing context can be traumatic and impede effective communication. *We should talk about how we can manage his symptoms with additional chemotherapy.* - This statement implies a focus on further aggressive treatment which may not be appropriate given the **new bone and brain metastases** and aggressive prior chemotherapy, suggesting a limited benefit of more chemotherapy. - It also **diverts from the primary need to discuss the overall prognosis** and the patient's rapidly declining condition, which the doctor has been asked to convey. *Why do you think your husband has not discussed his medical condition with you?* - This question is **accusatory** and places blame on either the patient or the wife, which is inappropriate and unhelpful in a sensitive medical discussion. - It shifts the focus away from providing medical information and empathy towards a speculative and potentially confrontational topic.

Question 3: Which of the following study designs would be most appropriate to investigate the association between electronic cigarette use and the subsequent development of lung cancer?

A. Subjects with lung cancer who smoke and subjects with lung cancer who did not smoke
B. Subjects who smoke electronic cigarettes and subjects who smoke normal cigarettes
C. Subjects with lung cancer who smoke and subjects without lung cancer who smoke
D. Subjects with lung cancer and subjects without lung cancer
E. Subjects who smoke electronic cigarettes and subjects who do not smoke (Correct Answer)

Explanation: ***Subjects who smoke electronic cigarettes and subjects who do not smoke*** - This design represents a **cohort study**, which is ideal for investigating the **incidence** of a disease (lung cancer) in groups exposed and unexposed to a risk factor (electronic cigarette use). - By following these two groups over time, researchers can directly compare the **risk of developing lung cancer** in e-cigarette users versus non-smokers. *Subjects with lung cancer who smoke and subjects with lung cancer who did not smoke* - This option incorrectly compares two groups both with lung cancer, where the exposure to smoking can either be **electronic or traditional cigarettes,** but does not provide a control group without lung cancer to assess the association. - This design would not allow for the calculation of an **incidence rate** or a **relative risk** of lung cancer development specific to electronic cigarette use. *Subjects who smoke electronic cigarettes and subjects who smoke normal cigarettes* - This design compares two different types of smoking, which might be useful for comparing their relative risks but doesn't include a **non-smoking control group** to establish the absolute association with electronic cigarettes. - While it could show if e-cigarettes are "safer" than traditional cigarettes, it wouldn't directly answer whether e-cigarettes themselves **cause lung cancer**. *Subjects with lung cancer who smoke and subjects without lung cancer who smoke* - This describes a **case-control study** but focuses on smoking in general rather than specifically electronic cigarettes, which is the independent variable of interest. - While valuable for identifying risk factors, it would need to specifically differentiate between **electronic cigarette smokers** and other smokers to answer the question adequately. *Subjects with lung cancer and subjects without lung cancer* - This general description of a **case-control study** is too broad; it does not specify the exposure of interest, which is electronic cigarette use. - To be relevant, the study would need to gather data on **electronic cigarette use** in both the lung cancer group and the non-lung cancer control group.

Question 4: The APPLE study investigators are currently preparing for a 30-year follow-up evaluation. They are curious about the number of participants who will partake in follow-up interviews. The investigators noted that of the 83 participants who participated in the APPLE study's 20-year follow-up, 62 were in the treatment group and 21 were in the control group. Given the unequal distribution of participants between groups at follow-up, this finding raises concerns for which of the following?

A. Volunteer bias
B. Reporting bias
C. Inadequate sample size
D. Attrition bias (Correct Answer)
E. Lead-time bias

Explanation: ***Attrition bias*** - **Attrition bias** occurs when participants drop out of a study, especially if the dropout rate differs between the intervention and control groups, which can lead to a **skewed comparison** of outcomes. - The unequal distribution of participants (62 vs. 21) between the treatment and control groups at the 20-year follow-up suggests that a disproportionate number of participants may have dropped out of one group, thus leading to attrition bias. *Volunteer bias* - **Volunteer bias** occurs when individuals who volunteer for a study differ significantly from the general population or those who decline to participate, potentially affecting the study's **generalizability**. - This scenario describes differences in retention *after* initial participation, not differences in initial willingness to join. *Reporting bias* - **Reporting bias** refers to the selective reporting of study findings, where positive or statistically significant results are more likely to be published or emphasized than negative or non-significant ones, which can distort the overall evidence base. - This bias relates to how results are disseminated, not to differential dropout rates or participant retention in a study. *Inadequate sample size* - **Inadequate sample size** means that the number of participants in a study is too small to detect a statistically significant effect if one truly exists, leading to a lack of **statistical power**. - While the overall number of participants at follow-up might be small, the primary concern here is the *unequal distribution* between groups, indicating a problem with participant retention rather than just a low total count. *Lead-time bias* - **Lead-time bias** occurs when early detection of a disease (e.g., through screening) makes survival appear longer than it actually is, without necessarily prolonging the patient's life, by advancing the **point of diagnosis**. - This bias is relevant to screening programs and disease detection, not to the differential dropout rates observed in a longitudinal study.

Question 5: A psychiatrist receives a call from a patient who expresses thoughts of harming his ex-girlfriend. The patient describes a detailed plan to attack her at her workplace. Which of the following represents the psychiatrist's most appropriate legal obligation?

A. Warn the ex-girlfriend and notify law enforcement (Correct Answer)
B. Only notify the patient's family
C. Warn only law enforcement
D. Maintain patient confidentiality

Explanation: ***Warn the ex-girlfriend and notify law enforcement*** - This scenario directly triggers the **"duty to warn"** and **"duty to protect"** principles, primarily stemming from the **Tarasoff v. Regents of the University of California** case. - The psychiatrist has a legal obligation to take reasonable steps to protect the identifiable victim, which includes directly warning the intended victim and informing law enforcement. *Only notify the patient's family* - Notifying the patient's family alone does not fulfill the **legal obligation to protect** an identifiable third party from a serious threat of harm. - While family involvement might be part of a comprehensive safety plan, it is insufficient as the sole action in this critical situation. *Warn only law enforcement* - While notifying law enforcement is a crucial step, the **Tarasoff duty** specifically mandates warning the **intended victim** directly (or those who can reasonably be expected to notify the victim). - Relying solely on law enforcement might not ensure the immediate safety of the ex-girlfriend, especially if there's a delay in their response or ability to locate her. *Maintain patient confidentiality* - Patient confidentiality is a cornerstone of psychiatric practice, but it is **not absolute** when there is a serious and imminent threat of harm to an identifiable individual. - The **duty to protect** a potential victim *outweighs* the duty to maintain confidentiality in such extreme circumstances.

Question 6: A study is conducted in a hospital to estimate the prevalence of handwashing among healthcare workers. All of the hospital staff members are informed that the study is being conducted for 1 month, and the study method will be a passive observation of their daily routine at the hospital. A total of 89 medical staff members give their consent for the study, and they are followed for a month. This study could most likely suffer from which of the following biases?

A. Attrition bias
B. Hawthorne effect (Correct Answer)
C. Confounding bias
D. Berksonian bias
E. Observer-expectancy bias

Explanation: ***Hawthorne effect*** - This bias occurs when individuals modify their behavior in response to being **observed** or knowing they are part of a study. In this scenario, healthcare workers, knowing they are being observed for handwashing, are likely to wash their hands more frequently than usual. - The intent of the study is to estimate the **prevalence** of handwashing; however, the observed rates will be artificially inflated due to the subjects' awareness of being studied, leading to an inaccurate estimate. *Attrition bias* - **Attrition bias** arises when there is **differential loss to follow-up** between study groups, which can lead to biased results. - This study design involves observing a defined group for a month, but there's no indication of loss of participants or differential dropout from specific intervention or control groups. *Confounding bias* - **Confounding bias** occurs when an unmeasured or uncontrolled factor (a **confounder**) is associated with both the exposure and the outcome, distorting the true association. - While confounding is a common bias in observational studies, the primary issue described here is the direct impact of observation on behavior, not an unmeasured external variable influencing both the behavior and its measurement. *Berksonian bias* - **Berksonian bias** (or admission rate bias) is a type of selection bias that occurs in case-control studies when hospital-based controls or cases are used, and the probability of being admitted to the hospital is influenced by both the exposure and the disease itself. - This study is a **prevalence study** involving direct observation of healthcare workers, not a case-control study, making Berksonian bias irrelevant. *Observer-expectancy bias* - **Observer-expectancy bias** occurs when the **researcher's expectations** or beliefs influence their observations or interpretation of data. - The scenario describes the participants (healthcare workers) changing their behavior due to being observed, not the observer's expectations influencing the recorded data, which would be the **Hawthorne effect**.

Question 7: You are currently employed as a clinical researcher working on clinical trials of a new drug to be used for the treatment of Parkinson's disease. Currently, you have already determined the safe clinical dose of the drug in a healthy patient. You are in the phase of drug development where the drug is studied in patients with the target disease to determine its efficacy. Which of the following phases is this new drug currently in?

A. Phase 4
B. Phase 1
C. Phase 2 (Correct Answer)
D. Phase 0
E. Phase 3

Explanation: ***Phase 2*** - **Phase 2 trials** involve studying the drug in patients with the target disease to assess its **efficacy** and further evaluate safety, typically involving a few hundred patients. - The question describes a stage after safe dosing in healthy patients (Phase 1) and before large-scale efficacy confirmation (Phase 3), focusing on efficacy in the target population. *Phase 4* - **Phase 4 trials** occur **after a drug has been approved** and marketed, monitoring long-term effects, optimal use, and rare side effects in a diverse patient population. - This phase is conducted post-market approval, whereas the question describes a drug still in development prior to approval. *Phase 1* - **Phase 1 trials** primarily focus on determining the **safety and dosage** of a new drug in a **small group of healthy volunteers** (or sometimes patients with advanced disease if the drug is highly toxic). - The question states that the safe clinical dose in a healthy patient has already been determined, indicating that Phase 1 has been completed. *Phase 0* - **Phase 0 trials** are exploratory, very early-stage studies designed to confirm that the drug reaches the target and acts as intended, typically involving a very small number of doses and participants. - These trials are conducted much earlier in the development process, preceding the determination of safe clinical doses and large-scale efficacy studies. *Phase 3* - **Phase 3 trials** are large-scale studies involving hundreds to thousands of patients to confirm **efficacy**, monitor side effects, compare it to commonly used treatments, and collect information that will allow the drug to be used safely. - While Phase 3 does assess efficacy, it follows Phase 2 and is typically conducted on a much larger scale before submitting for regulatory approval.

Question 8: A 28-year-old male presents to his primary care physician with complaints of intermittent abdominal pain and alternating bouts of constipation and diarrhea. His medical chart is not significant for any past medical problems or prior surgeries. He is not prescribed any current medications. Which of the following questions would be the most useful next question in eliciting further history from this patient?

A. "Does the diarrhea typically precede the constipation, or vice-versa?"
B. "Is the diarrhea foul-smelling?"
C. "Please rate your abdominal pain on a scale of 1-10, with 10 being the worst pain of your life"
D. "Are the symptoms worse in the morning or at night?"
E. "Can you tell me more about the symptoms you have been experiencing?" (Correct Answer)

Explanation: ***Can you tell me more about the symptoms you have been experiencing?*** - This **open-ended question** encourages the patient to provide a **comprehensive narrative** of their symptoms, including details about onset, frequency, duration, alleviating/aggravating factors, and associated symptoms, which is crucial for diagnosis. - In a patient presenting with vague, intermittent symptoms like alternating constipation and diarrhea, allowing them to elaborate freely can reveal important clues that might not be captured by more targeted questions. *Does the diarrhea typically precede the constipation, or vice-versa?* - While knowing the sequence of symptoms can be helpful in understanding the **pattern of bowel dysfunction**, it is a very specific question that might overlook other important aspects of the patient's experience. - It prematurely narrows the focus without first obtaining a broad understanding of the patient's overall symptomatic picture. *Is the diarrhea foul-smelling?* - Foul-smelling diarrhea can indicate **malabsorption** or **bacterial overgrowth**, which are important to consider in some gastrointestinal conditions. - However, this is a **specific symptom inquiry** that should follow a more general exploration of the patient's symptoms, as it may not be relevant if other crucial details are missed. *Please rate your abdominal pain on a scale of 1-10, with 10 being the worst pain of your life* - Quantifying pain intensity is useful for assessing the **severity of discomfort** and monitoring changes over time. - However, for a patient with intermittent rather than acute, severe pain, understanding the **character, location, and triggers** of the pain is often more diagnostically valuable than just a numerical rating initially. *Are the symptoms worse in the morning or at night?* - Diurnal variation can be relevant in certain conditions, such as inflammatory bowel diseases where nocturnal symptoms might be more concerning, or functional disorders whose symptoms might be stress-related. - This is another **specific question** that should come after gathering a more complete initial picture of the patient's symptoms to ensure no key information is overlooked.

Question 9: A patient is in the ICU for diabetic ketoacidosis and is currently on an insulin drip. His electrolytes are being checked every hour and his potassium is notable for the following measures: 1. 5.1 mEq/L 2. 5.8 mEq/L 3. 6.1 mEq/L 4. 6.2 mEq/L 5. 5.9 mEq/L 6. 5.1 mEq/L 7. 4.0 mEq/L 8. 3.1 mEq/L Which of the following is the median potassium value of this data set?

A. 6.05
B. 5.10
C. 5.16
D. 5.45 (Correct Answer)
E. 3.10

Explanation: ***5.45*** - To find the **median**, first arrange the potassium values in ascending order: 3.1, 4.0, 5.1, 5.1, 5.8, 5.9, 6.1, 6.2. - Since there are **eight** (an even number) values, the median is the average of the two middle values (the 4th and 5th values): (5.1 + 5.8) / 2 = 10.9 / 2 = **5.45**. *6.05* - This value might be obtained by incorrectly averaging a different pair of numbers or miscalculating the average of the sorted data set. - It is not the correct median for this particular data set of potassium values. *5.10* - While 5.1 is present twice in the data set, and is one of the middle values, it is not the **median** because the **median** for an even number of values is the average of the two middle numbers, not just one of them. - This would be the median if the values were 3.1, 4.0, 5.1, 5.1, 5.1, 5.8, 5.9, 6.1. *5.16* - This value does not correspond to any of the numbers in the data set nor does it result from the correct calculation of the **median**. - It might represent an incorrect average or a miscalculation of a percentile. *3.10* - This value is the **minimum** potassium level recorded, not the median. - The median represents the middle value in a sorted data set, while the minimum is the lowest value.

Question 10: The mean, median, and mode weight of 37 newborns in a hospital nursery is 7 lbs 2 oz. In fact, there are 7 infants in the nursery that weigh exactly 7 lbs 2 oz. The standard deviation of the weights is 2 oz. The weights follow a normal distribution. A newborn delivered at 10 lbs 2 oz is added to the data set. What is most likely to happen to the mean, median, and mode with the addition of this new data point?

A. The mean will increase; the median will increase; the mode will stay the same
B. The mean will increase; the median will stay the same; the mode will stay the same (Correct Answer)
C. The mean will stay the same; the median will increase; the mode will stay the same
D. The mean will increase; the median will increase; the mode will increase
E. The mean will stay the same; the median will increase; the mode will increase

Explanation: ***The mean will increase; the median will stay the same; the mode will stay the same*** - The **mean** is highly sensitive to outliers. Adding a newborn weighing 10 lbs 2 oz (significantly heavier than the original mean of 7 lbs 2 oz) will increase the total sum of weights, thus **increasing the mean**. - The **median** is the middle value in an ordered dataset. With 37 newborns, the median is the 19th value. Adding one more (38 total) makes the median the average of the 19th and 20th values. Since the new value (10 lbs 2 oz) is added at the extreme high end of the distribution, the 19th and 20th positions contain the same values as before. Therefore, the median will **stay the same**. - The **mode** is the most frequent value. Since there are 7 infants already at 7 lbs 2 oz, adding a single infant at 10 lbs 2 oz will not change the most frequent weight in the dataset. The mode will **stay the same** at 7 lbs 2 oz. *The mean will increase; the median will increase; the mode will stay the same* - While the **mean will increase** due to the added outlier, the **median will not change**. With 38 observations, the median becomes the average of the 19th and 20th values, which remain unchanged since the outlier is added at position 38. - The **mode** correctly stays at 7 lbs 2 oz as the new data point does not become the most frequent value. *The mean will stay the same; the median will increase; the mode will stay the same* - The **mean will not stay the same** because an outlier significantly higher than the current mean will always pull the mean higher. - The **median will also not increase** as the middle values (19th and 20th positions) remain unchanged when adding an extreme outlier. *The mean will increase; the median will increase; the mode will increase* - While the **mean will increase**, the **median will not change** because the middle positions are unaffected by adding one extreme outlier. - The **mode will not change** as the new data point (10 lbs 2 oz) is unique and doesn't become the most frequent value; 7 lbs 2 oz remains most frequent with 7 occurrences. *The mean will stay the same; the median will increase; the mode will increase* - This option is incorrect because the **mean will definitely increase** with the addition of a much larger value. - The **median will not increase** as it depends on the middle positions, not extreme values. - The **mode will not increase** as adding one 10 lb 2 oz infant won't make that weight the most frequent.

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free