Prometric Questions - Yellow File - MOH | SPLE | HAAD | DHA - 30

 

Which of the following studies represent a cost-effectiveness study?  
A) Comparing costs for 2 therapeutically equivalent products   
B) Comparing costs and savings of a pharmacokinetic service diabetes clinic  
C) Comparing patients achieving control as the outcome for 2 antihyperglycemic  drugs 
D)Comparison of costs of 2 chemotherapy regimens with the using best supportive care

The correct answer is C) Comparing patients achieving control as the outcome for 2 antihyperglycemic drugs.

In pharmacoeconomics, the "type" of study is defined by how we measure the outcomes (the results) in relation to the costs.

Why Option C is Cost-Effectiveness Analysis (CEA)

A Cost-Effectiveness Analysis compares the costs of two or more alternatives against a natural clinical unit or outcome.

The Cost: Measured in monetary terms (dollars/riyals).

The Outcome: Measured in "natural units," such as "number of patients reaching target HbA1c," "years of life gained," or "mm Hg reduction in blood pressure."

The Result: Usually expressed as an Incremental Cost-Effectiveness Ratio (ICER).

Breaking Down the Other Study Types

It is common to confuse these four distinct types of economic evaluations:

Study Type	Cost Measurement	Outcome Measurement	Example from options
Cost-Minimization (CMA)	Dollars	Equivalent (Proven same)	A: Comparing 2 therapeutically equivalent products.
Cost-Benefit (CBA)	Dollars	Dollars (Savings/ROI)	B: Comparing costs and savings of a service.
Cost-Effectiveness (CEA)	Dollars	Natural Units (e.g., % control)	C: Comparing control as the outcome.
Cost-Utility (CUA)	Dollars	Quality of Life (QALYs)	(Not listed, but often used for Chemotherapy).

A Note on Option D

Option D is a bit of a "distractor." Comparing costs of chemotherapy vs. supportive care without defining a specific clinical outcome (like "months of survival") makes it an incomplete description. If it measured survival, it would be a CEA; if it measured quality-adjusted life years, it would be a CUA.

Option C is the most "textbook" definition because it explicitly links a clinical goal (achieving control) to the comparison of two drugs.

The treatment of tuberculosis (Anti TB) involves multiple medications that have to be taken for a long period of time.  Which of the following is the best way to ensure patient adherence  AntiTB?  
A) Apply Direct Observed Therapy, Short course strategy (DOT) 
B) Add multivitamins to increase absorption of AntiTB  
C) Interview the patient to assess their knowledge about AntiTB  
D) Review current medications profile to avoid drug-drug inten with AntiTB 

The correct answer is A) Apply Direct Observed Therapy, Short course strategy (DOTS).

Tuberculosis (TB) treatment is notoriously difficult for patients because it often lasts 6 to 9 months and involves a "cocktail" of several different antibiotics. When patients feel better after a few weeks, they often stop taking their pills, which leads to multidrug-resistant TB (MDR-TB).

Why DOTS is the Gold Standard:

The Direct Observed Therapy (DOT) strategy is the most effective way to ensure adherence because it removes the burden of "remembering" from the patient alone.

The Process: A trained health worker or designated community member watches the patient swallow their medication every single day.

The Result: It shifts the responsibility of cure from the patient to the healthcare provider, ensuring that doses aren't missed and resistance doesn't develop.

Monitoring: It also allows providers to immediately catch side effects that might otherwise cause a patient to quit the regimen.

Why the other options are less effective:

Option	Why it's not the "Best" for Adherence
B) Multivitamins	While certain vitamins (like B6/Pyridoxine) are given to prevent side effects from Isoniazid, they do nothing to ensure the patient actually swallows the TB medication.
C) Interviewing	Knowledge does not always equal behavior. A patient can understand exactly how the drug works and still forget to take it or stop because of side effects.
D) Reviewing Profile	This is vital for safety, but it doesn't guarantee the patient will stick to the long-term daily schedule required for a cure.

The 5 Pillars of the DOTS Strategy

To truly "ensure" adherence, the WHO outlines five specific components:

1. Political commitment with increased and sustained financing.
2. Case detection through quality-assured bacteriology.
3. Standardized treatment, with supervision and patient support.
4. An effective drug supply and management system.
5. Monitoring and evaluation system and impact measurement.

What kind of association between the variables if you want to an association  between age and depression pre/post drug (A) use? 
A) 2 continuous variables  
B) A continuous variables and a binary variable  
C) A continuous variables and an ordinal variable  
D) A continuous variables and a categorical variable  

The correct answer is B) A continuous variable and a binary variable.

In clinical research, "pre/post" scenarios involve comparing two distinct states or groups, which fundamentally changes how we categorize the data for an association test.

Breaking Down the Variables

To determine the "kind of association," we look at the nature of the data being measured:

Age: This is a Continuous Variable. It is measured on a scale (years) where the intervals between numbers are equal and meaningful.

Depression (Pre/Post Drug A): While depression itself can be measured on a scale, the "Pre/Post" aspect refers to a Binary Variable (also known as a dichotomous variable).

In this specific context, you are looking at the association of age with the change or the grouping (Before vs. After).

Binary variables have only two categories (e.g., 0 for "Pre" and 1 for "Post").

Why the others don't fit:

A (2 Continuous): This would apply if you were comparing Age vs. a Depression Score (like a PHQ-9 score).

C (Ordinal): This would apply if "Depression" was categorized only as "Mild, Moderate, Severe" without the Pre/Post timing.

D (Categorical): While Binary is a type of categorical variable, "Categorical" usually implies three or more groups (e.g., Drug A vs. Drug B vs. Placebo). In a simple Pre/Post study, Binary is the more precise statistical description.

Statistical Application

If you were running this analysis, you would likely use a Point-Biserial Correlation. This specific test measures the strength of the relationship between one continuous variable (Age) and one binary variable (Pre/Post status).

Note: If you were measuring the change in depression scores (a continuous number) across different age groups, the variables would be viewed differently, but based on "Pre/Post" phrasing, it targets the binary timing.

Which one of the following questioning techniques uses hints and aid patients in answering questions?  
A) Changing questions  
B)Empathic responding  
C) Prompting while asking 

D) Redirection the questions

The correct answer is C) Prompting while asking.

In a clinical or therapeutic setting, prompting is a supportive technique used to help a patient who might be struggling to find a word, remember a detail, or articulate a specific feeling. It involves providing "scaffolding"—hints or gentle cues—to guide them toward a complete response without putting words in their mouth.

Why "Prompting" is the Right Choice

Prompting is essentially a bridge between a patient's silence and their answer. It is particularly useful for patients with cognitive impairment, high anxiety, or those who are simply overwhelmed by a complex medical history.

How it works: You might provide the first letter of a word, a category (e.g., "Was the pain more like a physical sensation or an emotion?"), or a partial sentence for them to complete.

The Goal: To reduce the patient's frustration and maintain the flow of the diagnostic interview.

Comparing the Other Techniques  

Technique	Definition	Purpose
Changing questions	Rephrasing or switching the topic entirely.	Used if a patient clearly doesn't understand the original question.
Empathic responding	Acknowledging the patient's feelings (e.g., "I can see that talking about this is difficult").	Used to build rapport and trust, not necessarily to extract a specific answer.
Redirection	Gently steering the conversation back to the relevant topic.	Used when a patient becomes tangential or starts talking about unrelated matters.

Example of Prompting in Practice:

Doctor: "Can you describe the type of pain you're feeling in your chest?"

Patient: "It's... I don't know... it's hard to say."

Doctor (Prompting): "Is it more of a sharp feeling, or does it feel more like a heavy pressure?"

Why the others are incorrect:

A) Changing questions → Rephrasing or moving to another question, not necessarily giving hints.

B) Empathic responding → Showing understanding and emotional support, not aiding with hints.

D) Redirection of questions → Steering the conversation back to the topic, not providing cues.

Which of the following describe glucose uptake and usage by brain as compared to other tissues of the body?  
A) Brain cell can uptake and use glucose only in the presence  
B) Brain cells can uptake and use glucose without being stimulated by insulin  
C) Brain cells can uptake and use glucose when glucose is above 100 mg/dL in the blood  
D) Brain cells can uptake and use glucose when the insulin is at high level in the body

The correct answer is B) Brain cells can uptake and use glucose without being stimulated by insulin.

To understand why this is the case, it helps to look at how different tissues in your body "unlock" their doors to let energy in.

The Brain's Special Status

While muscle and fat cells are like high-security vaults that require an insulin "key" to open their glucose channels, the brain is more like an "open door" policy. This is a vital evolutionary survival mechanism: because the brain is your most metabolically demanding organ, it cannot afford to wait for hormonal signals to get the fuel it needs to keep you alive.

Key Differences in Glucose Uptake

Feature	Muscle & Fat Tissues	Brain Tissue
Primary Transporter	GLUT4 (Insulin-dependent)	GLUT1 & GLUT3 (Insulin-independent)
Insulin Requirement	Requires insulin to move transporters to the cell surface.	Transporters are always present on the cell membrane.
Low Blood Sugar	Uptake slows down significantly to save fuel for the brain.	Continues to pull glucose as long as it's available in the blood.
Response to Meal	Uptake spikes after eating (when insulin is high).	Uptake remains relatively constant regardless of insulin levels.

Why the other options are incorrect:

A & D: These suggest the brain is dependent on insulin. In reality, if the brain required insulin to function, people with untreated diabetes (who have no insulin or severe resistance) would lose brain function almost immediately.

C: The brain doesn't have a "cutoff" at 100 mg/dL. It will continue to harvest glucose even at lower concentrations, though very low levels (hypoglycemia) will eventually lead to cognitive impairment because there simply isn't enough physical sugar to go around.

Prometric Questions - Yellow File - MOH | SPLE | HAAD | DHA - 27
Prometric Questions - Yellow File - MOH | SPLE | HAAD | DHA - 26
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Prometric Questions - Yellow File - MOH | SPLE | HAAD | DHA - 24
Prometric Questions - Yellow File - MOH | SPLE | HAAD | DHA - 23
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Prometric Questions - Yellow File - MOH | SPLE | HAAD | DHA - 21

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