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Quantitative Clinical Reasoning Flashcards

6 cards from real HSRT practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

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  1. A drug reduces systolic BP by 8 mmHg on average (95% CI: 2–14 mmHg, p=0.01). A colleague says: 'The effect is statistically proven and clinically definitive.' Which quantitative critique is MOST appropriate?

    Answer: The CI shows uncertainty from 2 to 14 mmHg; clinical significance of an 8 mmHg reduction is modest and depends on baseline BP and cardiovascular risk

    Statistical significance (p=0.01) does not equal clinical significance. An 8 mmHg average with CI 2–14 mmHg may or may not be meaningful depending on clinical context.

  2. A clinical trial reports the Number Needed to Treat (NNT) for a new anticoagulant to prevent one stroke is 50 over 5 years. A colleague argues this means the drug is not very effective. How should you respond quantitatively?

    Answer: NNT of 50 must be weighed against the NNH (Number Needed to Harm) for bleeding risk and the baseline risk of stroke — context determines clinical value

    NNT must be interpreted alongside NNH, baseline risk, and the severity of the outcome — an NNT of 50 for stroke prevention may be excellent given stroke's severity.

  3. A clinical study reports a relative risk reduction (RRR) of 50% for a new cancer screening program. The control group event rate (cancer death) is 2%. What is the absolute risk reduction (ARR)?

    Answer: 1% (50% of 2%)

    ARR = RRR × baseline rate = 50% × 2% = 1%. Relative risk reduction always needs to be converted to absolute terms to assess clinical impact.

  4. A patient asks: 'My PSA test came back positive. Does that mean I have prostate cancer?' The test has 80% sensitivity and 70% specificity. The prevalence of prostate cancer in men his age is 5%. What should the clinician communicate about the positive predictive value?

    Answer: The PPV is approximately 12–15%, meaning most men with a positive PSA at this prevalence do NOT have prostate cancer

    At 5% prevalence with 80% sensitivity and 70% specificity, the PPV is approximately 12–15% — the majority of positives are false positives.

  5. A hospital compares its 30-day mortality rate (8%) for cardiac surgery against a national benchmark (6%). Before concluding performance is substandard, which quantitative adjustment is MOST essential?

    Answer: Risk-adjust for patient case mix — hospitals treating higher-acuity, comorbid patients are expected to have higher crude mortality rates

    Crude mortality comparisons across institutions are only valid after risk adjustment for patient acuity, comorbidities, and case complexity.

  6. A dietitian calculates that a patient needs 1800 kcal/day. The patient reports eating an average of 1200 kcal/day. Which quantitative statement BEST characterizes the deficit?

    Answer: The patient has a 600 kcal/day deficit (33% below requirements), which if sustained over one week creates a cumulative deficit of 4200 kcal

    600 kcal/day deficit is 33% below calculated needs; cumulating this over 7 days (4200 kcal) contextualizes the clinical significance of the shortfall.