Quantitative Decision Tools

a / (a + c)

What is the formula for calculating Sensitivity using a standard 2x2 table?

d / (b + d)

What is the formula for calculating Specificity using a standard 2x2 table?

a / (a + b)

What is the formula for calculating Positive Predictive Value (PPV)?

d / (c + d)

What is the formula for calculating Negative Predictive Value (NPV)?

Sensitivity / (1 - Specificity)

What is the mathematical formula for the Positive Likelihood Ratio (LR+)?

(1 - Sensitivity) / Specificity

What is the mathematical formula for the Negative Likelihood Ratio (LR-)?

1 - Sensitivity

How do you calculate the False Negative Rate?

1 - Specificity

How do you calculate the False Positive Rate?

Probability / (1 - Probability)

What is the formula to convert Pretest Probability into Pretest Odds?

Pretest Odds x Likelihood Ratio

How is Posttest Odds calculated?

Posttest Odds / (1 + Posttest Odds)

What is the formula to convert Posttest Odds back into Posttest Probability?

SnNOut

Which mnemonic states that a highly sensitive test, when negative, is useful for ruling out a disease?

SpPIn

Which mnemonic states that a highly specific test, when positive, is useful for ruling in a disease?

Likelihood Ratio

Which diagnostic metric acts as a multiplier to show how much the probability of disease changes given a test result?

Likelihood-Ratio Nomogram

Which clinical tool allows a clinician to graphically determine posttest probability by drawing a line between pretest probability and the LR?

Diagnostic Threshold

In the threshold model, what is the level below which a physician rules out a condition and stops testing?

Treatment Threshold

In the threshold model, what is the level above which a physician initiates treatment without further testing?

Rt / Rc

What is the formula for calculating Relative Risk (RR)?

Rc - Rt

What is the formula for Absolute Risk Reduction (ARR)?

ARR / Rc or 1 - RR

What are the two formulas used to calculate Relative Risk Reduction (RRR)?

1 / ARR

What is the formula for calculating the Number Needed to Treat (NNT)?

Risk in the Treatment group

In therapeutic benefit calculations, what does the symbol Rt represent?

Risk in the Control group

In therapeutic benefit calculations, what does the symbol Rc represent?

No difference

In Relative Risk, what does a result of 1 indicate?

Treatment reduces risk

In Relative Risk, what does a result of less than 1 indicate?

Treatment increases risk

In Relative Risk, what does a result of greater than 1 indicate?

Bayes Rule

Which statistical rule is used to calculate the likelihood of disease following a positive test by incorporating pretest probability and test characteristics?

Gold Standard

What term refers to the accepted reference test that defines the presumably true state of a patient's disease?

6.5 percent

At what specific HbA1c percentage cut-off is the test considered specific enough to be diagnostic for diabetes?

LR+ greater than 10

What Likelihood Ratio value is generally considered to represent a significant or conclusive change to posttest probability for a positive result?

LR- less than 0.1

What Likelihood Ratio value is generally considered to represent a significant or conclusive change to posttest probability for a negative result?

LR = 1

What Likelihood Ratio value indicates that a test has no diagnostic value?

Revised Cardiac Risk Index

What does the acronym RCRI stand for in preoperative assessment?

Ischemic heart disease, Heart failure, Cerebrovascular disease, Insulin-dependent diabetes, Renal insufficiency, and High-risk surgery

What are the six predictors used in the Revised Cardiac Risk Index?

Creatinine greater than or equal to 2.0 mg/dL

What specific creatinine cut-off is an independent risk factor for perioperative cardiac complications in the RCRI?

0.4 percent

In the RCRI, what is the estimated risk of cardiac death or arrest for a patient with 0 predictors?

0.9 percent

In the RCRI, what is the estimated risk for a patient with 1 predictor?

6.6 percent

In the RCRI, what is the estimated risk for a patient with 2 predictors?

Greater than 11 percent

In the RCRI, what is the estimated risk for a patient with 3 or more predictors?

Goldman-Cecil Medicine classification

Which classification system defines low surgical cardiac risk as less than 1 percent?

Intermediate risk

A surgical procedure with a cardiac risk of 1 to 5 percent is classified as what?

High risk

A surgical procedure with a cardiac risk greater than 5 percent is classified as what?

Duke Activity Status Index

What does the acronym DASI stand for?

Metabolic Equivalents

What does the metric METs stand for in functional capacity assessment?

4 METs

Climbing two flights of stairs without difficulty represents a functional capacity of at least how many METs?

0.8 METs

According to the DASI, what is the MET value for being able to take care of yourself (eating, dressing, bathing)?

2.1 METs

According to the DASI, what is the MET value for participating in strenuous sports like swimming or football?

ARISCAT Risk Index

Which tool is used to predict the risk of postoperative pulmonary complications?

45 points

A patient is classified as High Risk for pulmonary complications if their ARISCAT score is greater than or equal to what?

Ascites, Encephalopathy, Bilirubin, Albumin, and Prothrombin Time/INR

What are the five parameters used in the Child-Turcotte-Pugh (CTP) score for cirrhosis?

Child Class A

Which CTP class is associated with a 10 percent mortality rate during abdominal operations?

Child Class C

Which CTP class is associated with a 76 percent mortality rate during abdominal operations?

Model for End-Stage Liver Disease

What does the acronym MELD stand for?

MELD score greater than 15

At what MELD score threshold is elective surgery usually contraindicated?

ACTH Stimulation Test

Which test is used to determine if the HPA axis is intact in patients taking exogenous corticosteroids?

Greater than or equal to 18 to 20 micrograms/dL

In an ACTH stimulation test, what peak cortisol level indicates a normal response?

250 micrograms

What is the standard dose of cosyntropin administered during an ACTH stimulation test?

Hgb greater than 10 g/dL

What is the hemoglobin cut-off above which transfusion is generally not indicated in a stable surgical patient?

50,000

What is the minimum platelet count required for most major surgeries?

INR less than 1.5

In preoperative coagulation studies, the Prothrombin Time (PT) should be within 3 seconds of control, corresponding to what INR?

150 to 300 minutes

How many minutes of moderate physical activity per week are required to be categorized as Sufficiently Active?

WHO-APP Cut-offs

Which BMI classification system is recommended for use in the medical write-up for adult Filipinos?

Obesity

A BMI of 25 kg/m2 or higher in an adult Filipino is classified as what?

Overweight

A BMI of 23 to 24.9 kg/m2 in an adult Filipino is classified as what?

Waist circumference greater than or equal to 90 cm

What is the obesity cut-off for waist circumference in Filipino males?

Waist-to-hip ratio greater than or equal to 0.85

What is the obesity cut-off for waist-to-hip ratio in Filipino females?

140/90 mmHg

What is the blood pressure cut-off for hypertension according to the Philippine Society of Hypertension?

12 hours

How many hours after quitting smoking does the carbon monoxide level in the blood drop to normal?

1 year

How long after quitting smoking is the risk of coronary heart disease half that of a smoker?

21 days

What is the half-life of Serum Albumin, making it a marker for chronic nutrition?

2 days

What is the half-life of Prealbumin, making it a marker for acute nutritional changes?

24 to 30 points

On the full Mini Nutritional Assessment (MNA), what score indicates a normal nutritional status?

Less than 17 points

On the full MNA, what score indicates the patient is malnourished?

12 to 14 points

On the MNA Short Form (MNA-SF), what score indicates a well-nourished status?

0 to 7 points

On the MNA-SF, what score range indicates the patient is malnourished?

0 to 4 points

In the Geriatric Depression Scale (GDS) short form, what score range is considered normal?

12 to 15 points

In the GDS short form, what score indicates severe depression?

Greater than 24 points

On the Folstein MMSE, what score indicates normal cognition?

Less than 10 points

On the Folstein MMSE, what score signifies severe cognitive impairment?

3 points per year

By how many points do MMSE scores typically decline per year in individuals with Alzheimer's disease?

Mini-Cog

Which 3-minute instrument consists of a 3-item word recall and a Clock Drawing Test?

Less than 3

What Mini-Cog score threshold is validated as a positive screen for dementia?

2 points

In Mini-Cog scoring, how many points does a normal clock drawing receive?

FRAIL Scale

Which 5-item scale assesses Fatigue, Resistance, Aerobic capacity, Illnesses, and Loss of weight?

Greater than or equal to 3

What score on the FRAIL scale indicates that an elderly patient is frail?

Greater than or equal to 4

What score on the SARC-F questionnaire indicates probable sarcopenia?

T-score of -2.5 or below

What DEXA scan T-score threshold is used to diagnose osteoporosis?

Timed Get Up and Go

Which test times a patient walking 3 meters to assess fall risk?

16 seconds

A Timed Get Up and Go test should ideally be completed in less than how many seconds?

20 seconds

Any score greater than how many seconds on the Get Up and Go test prompts an in-depth evaluation?

Dependence on 2 tasks

What number of KATZ BADL or Lawton IADL dependencies signals a need for 12-hour caregiver support?

Dependence on 4 tasks

What number of KATZ BADL or Lawton IADL dependencies signals a need for 24-hour caregiver support?

Hills Criteria

What set of nine criteria is used to determine the likelihood that an association between work and disease is causal?

Strength of Association

Which Hills Criterion asks how many times more likely the disease is in the exposed group?

Biological Gradient

Which Hills Criterion states that increased exposure is associated with an increased effect?

85 decibels

What is the Threshold Limit Value (TLV) for noise in the Philippines for an 8-hour workday?

115 decibels

According to OSHS, what is the maximum permissible level for any continuous intermittent noise exposure?

Class D

Which DOLE-OSHS rating designates a worker who is unfit or unsafe for any type of employment?

Hierarchy of Controls

What is the method of ranking safeguards from most to least effective to protect workers?

Elimination

What is the most effective level in the Hierarchy of Controls?