MCCQE Part I flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Sensitivity definition

Proportion of people with disease who test positive: TP/(TP+FN). A highly sensitive test is useful to rule out disease when the result is negative.

Specificity definition

Proportion of people without disease who test negative: TN/(TN+FP). A highly specific test is useful to rule in disease when the result is positive.

Positive predictive value

Probability that a positive test means disease is present: TP/(TP+FP). It rises as disease prevalence in the tested population rises.

Likelihood ratio positive

Sensitivity divided by (1 minus specificity). Values above 10 substantially raise post-test probability of disease; values near 1 change little.

Number needed to treat

Reciprocal of the absolute risk reduction: 1 divided by the difference in event rates between control and treatment groups.

Anion gap formula

Sodium minus (chloride plus bicarbonate). Normal is roughly 8 to 12 mmol/L; an elevated gap with acidosis suggests ketones, lactate, uremia, or toxins.

Corrected sodium in hyperglycemia

Add 1.6 mmol/L to measured sodium for every 5.5 mmol/L that glucose exceeds 5.5 mmol/L, because hyperglycemia dilutes measured sodium.

Winters formula

Expected PaCO2 in metabolic acidosis equals 1.5 times bicarbonate plus 8, with a range of plus or minus 2.

Elements of informed consent

Capacity, disclosure of material risks and benefits and alternatives, and voluntariness. A capable patient may refuse treatment, including life-saving treatment.

Pretest probability drives testing

Very low probability may require no test, intermediate probability warrants a discriminatory test, and very high probability may justify empiric treatment without testing.

SPIKES framework

Six steps for breaking bad news: Setting, Perception, Invitation, Knowledge, Emotions with empathy, and Strategy with summary.

Teach-back method

The clinician asks the patient to restate the plan in their own words. A correct restatement confirms comprehension; an incorrect one prompts re-explanation.

Ask-tell-ask sequence

Elicit the patient's current understanding, provide information in small chunks, then check understanding before continuing.

Shared decision-making

Presenting options with risks and benefits, exploring the patient's values, and agreeing on a plan together. The clinician alone deciding is not shared decision-making.

Qualified medical interpreter

A trained interpreter, not a family member, is indicated when language barriers could affect clinical accuracy, consent, or safety.

Acknowledge emotion first

Naming the patient's emotion before giving information reduces anxiety and improves retention of the message that follows.

Open-ended to closed questions

Begin with open-ended questions and active listening, then use focused closed questions to obtain precise details.

Health literacy red flags

Missed appointments, medication errors, and asking few questions suggest low health literacy; plain-language materials at about grade 6 reading level help.

Closed-loop communication

Sender gives an order, receiver repeats it back, sender confirms. This reduces handover and medication errors in teams.

SBAR handover

A structured handover: Situation, Background, Assessment, Recommendation. It standardizes transfer of clinical information between team members.

Graded conflict resolution

Address conflict directly and privately first, then involve the team lead, then use formal channels if unresolved.

Role clarity on teams

Each team member's scope of practice, such as pharmacist medication review or nurse monitoring, should be explicitly stated to reduce duplication.

Psychological safety

Team members can raise concerns without fear. It is associated with fewer adverse events and better error reporting.

Impaired colleague obligation

Protect patients first: intervene, escalate to the appropriate authority, and document. Patient safety precedes collegial loyalty.

Interprofessional rounds

Structured rounds where each discipline contributes an assessment improve outcomes; the physician remains accountable for the overall medical plan.

PDSA cycle

Plan-Do-Study-Act: small tests of change are preferred over large untested redesigns in quality improvement.

Run chart interpretation

A run chart or control chart distinguishes true improvement, called special-cause variation, from random variation in a measured process.

Choosing Wisely principle

Avoid tests and treatments whose harm or cost exceeds benefit; deprescribing is an active stewardship step, not a withdrawal of care.

Root cause analysis

A review after a critical incident that examines system factors rather than individual blame, aiming to redesign processes to prevent recurrence.

Adverse event disclosure

Adverse events should be disclosed to patients; disclosure improves trust and is an ethical and often legal obligation.

Just culture categories

Human error is consoled, at-risk behaviour is coached, and reckless behaviour is sanctioned. This separates system learning from accountability.

Urgency-based triage

Access and wait times are managed by triage based on medical urgency; first-come-first-served is inappropriate for urgent cases.