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NBME 24 Answers

nbme24/Block 1/Question#1 (reveal difficulty score)
A researcher hypothesizes that exposure to ...
Case-control study ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: clinical_trials medicine biostats

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 +16  upvote downvote
submitted by โˆ—lsmarshall(465)
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An experimental design or experimental study must have an intervention, by definition. Case-control studies are observational studies, not experimental. This question is technically incorrect. They wanted to amke a point that case-control studies are time and cost efficient since they don't require following patients over time or any resources besides reviewing/gathering information. Case series could not test this hypothesis.

Also, the wording "associated wit an increased risk" somewhat alludes to case-control studies only having the ability to find odds of an associations between exposure and outcome, but not establish causal relationship.

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bigjimbo  classic nbme +3
poisonivy  totally agree, I dont understand why the right answer is Case control since that is not experimental +2
howdywhat  am I subject to this kind of poor wording for the day of the exam? +1
ajss  I bieleve so +2
aaftabsethi1  Why not a retrospective cohort study ? +1
joeschmo  Case-control studies are largely retrospective by nature. You can retrospectively look back at samples and ask "what happened?" +



 +6  upvote downvote
submitted by โˆ—catch-22(98)
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I woud do a retrospective cohort here. I don't think this question is correct and provides too little information to get the correct answer. "Time efficient" is the operant word here but they simply didn't consider that retrospective cohort would be a better design here as long as the variables are coded.

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sherry  I agree. I was hesitating between the two choices. I still think cohort study is better regarding the "risk". I hope this kind of questions wont pop out on the real thing. +3
soph  I think key here was they were measuring risk though +1
yex  I also chose cohort, since it is comparing a given exposure. +2
raspberryslushy  I was also thinking retrospective cohort study - just as time efficient, can look at risk, and the Q stem said the cancer was common, and I think of case-control for rare conditions. It's like they forgot a cohort study could be retrospective. +2
boostcap23  The classic example they always give for why not to do retrospective cohort is because patients who have whatever disease your testing for are more likely to remember all their risk factor exposures than a normal person that doesn't have any disease. Of course in this case I'm sure the people running the study would be the ones who figure out how much arsenic was in the water but this also would be very time consuming to figure out for each individual person in the study. Thus a case-control study where you look at a group of people with >50 arsenic exposure and a group <5 arsenic exposure and simply see who has cancer and who doesn't would be easier and take less time. +2
hunter_dr  According to the B&B and UWORLD, if question stem measures the exposure first, then it have to be a cohort study and you will do relative risk calculation, which is why i picked that as an answer. However, I do see 'Cases' and 'Control' both in the questions so maybe it is case-control study.. Bottom line is----WASTED MY $60 +



 +3  upvote downvote
submitted by โˆ—misterdoctor69(70)
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I think something not mentioned yet is the fact that odds ratio can be used to estimate relative risk in RARE diseases as per the Rare Disease Assumption (where disease prevalence is <10%). Although the cancer in this question is described as "common," (common relative to other cancers), the cancer is still probably rare overall.

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 +2  upvote downvote
submitted by โˆ—cmun777(37)
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I think the key on this question is recognizing how much "most time-efficient" jumps out in the question stem - a pretty unique thing to be specifically asking. Going off that and the fact they want to look at exposure -> outcome, by far the fastest approach would be to find people who currently have the dz in question and then just ask them if they have a previous exposure aka case-control.

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an_improved_me  I feel like you just described a prospective cohort? Find ppl with the disease (same populatin and outcome), and then see if they had a similar risk factor; then follow them to see if they had a risk factor. Case-control would be: Have two groups of people, some with the Dx, others without. See if there is a difference in proportion that have/don't have a risk factor Someone please correct me if i'm wrong? +2



 +1  upvote downvote
submitted by al1234(1)
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If it had stated a 'Rare Cancer' I would have thought case control. But it said common cancer.... Any thoughts on this?

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kbizzitt  I believe what they are getting at with the "common cancer" is that it is easily definable as a case. This way you can easily determine who is a case and who would be a control. Then you go back and see if that case had exposure or not. +1



 +0  upvote downvote
submitted by โˆ—soph(84)
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I think key here is they are investigating the hypothesis of ammount of arsenicin water increases RISK of cancer.... best way to measure risk is case control.

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nbmehelp  If they were measuring risk shouldn't it be a cohort study though? By looking at first aid.. +6
270onstep1  They both can determine risk. Key here is the time efficiency of case-control studies when compared to cohort. +1
suckitnbme  Case-control only determines odds ratio which is not calculating risk. In rare diseases the odds ratio can be used as an estimate of the risk ratio however. +2



 +0  upvote downvote
submitted by โˆ—dentist(94)
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pretty good summary

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drdoom  welcome, O great physician of the skull and oral cavity. we revere your intricate understandings of the face, jaw, maxilla and all their tiny and hidden foramina. teach us your ways. +8



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