Blueprint MCAT Full-Length 1: Psych/Soc 1 – Pain Medication

Session 228

We’re 75% through with reviewing Blueprint’s full-length exam 1! Now, we move on to the psychology and sociology section. Join us as we tackle the first passage.

We’re joined by Paul from Blueprint MCAT. If you would like to follow along on YouTube, go to premed.tv.

Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points.

[03:29] What’s Your Game Plan?

Whatever your game plan is that you’ve established during your practice, stick with it. In general, when you’re transitioning from section to section, Paul advises students to get up and take a quick break. Get a drink of water or do some nice stretches just to calm yourself down. Mentally dump everything you just did from the previous section.

Paul says going about different sections using different strategies worked for him. And so, he didn’t want to carry over his thinking from one section to the next. Now, if you come across a big passage, go though it paragraph by paragraph, pausing as you go.

[06:58] Passage 1 (Questions 1 – 5)

Treatment of pain in emergency departments at hospitals is somewhat subjective, with physicians making determinations of whether or not to administer analgesics based on a number of criteria. One set of criteria pertains to physician interpersonal factors, including warmth with patient, interaction style, and questioning behavior and how these factors influence patient response, including patient communication and self-advocacy.

Notes:

This paragraph is introducing us to this idea about administering pain meds. Why do physicians choose or choose not to administer that to their patients? And it seems like it’s going to be focusing on that relationship between individuals and the interpersonal interaction between the physician and their patients.

So some words we could definitely highlight here include:

administer analgesics based on a number of criteria
physician interpersonal factors

[08:48] Paragraph 2

A characteristic found to influence the administration of pain medication has been race, with previous research findings indicating that Caucasian patients were twice as likely as Hispanic patients to receive pain medications for bone fractures, when controlling for multiple patient variables. However, other research findings have been equivocal about the relationship between patient race and pain medication administration, with differences in regional location and institutional setting likely affecting that relationship.

Notes:

This paragraph has red flags for possible MCAT questions. We see research findings or anything research design-related so we want to try to capture that in our highlighting.

[10:36] Paragraph 3

To investigate how patient race may affect pain medication disbursal, researchers examined the records of patients seen for bone fractures at several hospitals, recording the type of medication prescribed and the race of the patient. Researchers first conducted a chi-square analysis. This was done to examine the frequency of analgesic administration to African-Americans and Caucasians, with results presented in the following table (with the α level set to 0.05 for all experiments, χ2=1.2, p= 0.12).

Table 1 Percent of patients receiving analgesics by race

Notes:

We could highlight “To investigate” because this is going to give us a clue that if we need more info on a method or what they actually did in this research, this is the paragraph where we’re going to find it.

Hopefully, the MCAT is not going to ask us a random question on how to do statistical analysis. But just note that we’re given a p value at the end of this paragraph. And so, we could highlight p equals 0.12.

'In general, for the MCAT, a p value of 0.05 or under that is statistically significant.'Click To Tweet

In general, for the MCAT, a p value of 0.05 or under that is statistically significant. And so, we have a p value of 0.12. So the difference between these groups – African American and Caucasian – is not going to be significant.

Don’t deep dive because you don’t need to be an expert on this table. They may not even ask a question about it.

When analyzing a table, read the caption first. Then try to determine axes or those bolded columns and what’s being presented. And for this, they’re giving us the percentage. These percentages are pretty close. And this p value is 0.12. So statistically, there’s not a difference in the percent receiving analgesics between African-Americans and Caucasians.

[13:54] Paragraph 4

Researchers also examined the type of analgesic prescribed. They conducted a logistic regression analysis on opioid prescription by patient race and similarity of patient and provider race, with the odds ratios presented in the following table (and with the reference group presented in parentheses).

Table 2 Odds ratio of opioid prescription by patient race and patient and provider race

Notes:

First, if you’re not sure why African-American is in parentheses, we can just go back to the previous paragraph or any information on the figure to refresh yourself. Then you see in that last sentence of the final paragraph with the reference group presented in the parentheses. So we’re looking at Caucasians and referencing that to African American.

Then we see the odds ratio and the 95% confidence interval that does not include 1. Essentially, what this means is that the odds of being prescribed an opioid are 1.7 times greater for Caucasians than African Americans.

And looking at the Same Patient/Provider Race (Different), it’s comparing the groups that have the same race to a patient and provider of a different race. And it looks like an odds ratio of 2.55 and that 95% confidence interval still doesn’t include 1. It’s still going to be a real statistical set of data that we can interpret. And so the odds of being prescribed an opioid are 2.55 times higher if the patient and provider race is the same versus if it was different.

Hence, we could assume that Caucasians are more likely to have the opioids prescribed, but it’s a lot more likely to have opioids prescribed if you are the same race patient as the provider. No matter what that race is, both of those have increased likelihood, but 2.55 is pretty big.

[17:59] Question 1

The methodology employed in the study can best be described as:

a retrospective chart review.
a prospective chart review.
an embedded field study.
a longitudinal study.

Thought Process:

This is retrospective, going back in time, looking at the charts and seeing what happened. Longitudinal study is looking at data over time. We don’t really necessarily know what that would look like in practice, but we know it’s not embedded. It’s not over time. And so, A makes the most sense.

Correct Answer: A

[19:18] Question 2

In the research cited, if it was found that Hispanic patients were prescribed less pain medication than Caucasian patients due to Hispanic patients having disproportionally less insurance than Caucasian patients, then insurance coverage would be considered:

a moderating variable.
a mediating variable.

C.a confounding variable.

both an independent and dependent variable.

Thought Process:

This is an example of how the MCAT is mile-wide, inch-deep, and the psych/social section is where it definitely shines through. But just know these three variables.

A – Moderating affects the strength of the relationship. An example is how caffeine gives you energy. Or if you eat a grapefruit or a grapefruit juice with coffee, you get more energy because it makes it stronger.

B – Mediating is like a mechanism. So oftentimes, it explains the relationship between the two variables. This is actually the correct answer because it’s explaining that relationship. It’s not a mechanism in a way that we would think maybe for bio/biochem. But it is explaining the relationship of why those Hispanic patients were prescribed less pain medication than Caucasian patients. And the question stem has the keywords “due to” so it’s explaining it.

C – Confounding is just another independent variable that’s thrown into the mix. Ideally, we could control it. It’s like an extra independent variable is going to impact that dependence.

D – we could get rid of this right off the bat because you’re not going to have that in the same study.

“The MCAT is most definitely a reading comprehension test.”Click To Tweet

This question is an example of how content is just hinged on just this one word, and so, maybe you don’t need to be as much of an expert on the content. If you can just make sure you read a little closer and pick out those words, you can actually get by with knowing less.

You just have to figure out the testing method and how to work those questions. It can be frustrating. But it can also be an opportunity to get things right where you don’t necessarily know all the content to answer it without that little catch.

Correct Answer: B

[27:06] Question 3

What could be a possible explanation for the results found in the study?

There were more Caucasian than African-American doctors.
Opioids are not analgesics.
There were more Caucasian than African-American patients.

D.There is a disproportionately higher percentage of Caucasian doctors matched with Caucasian patients than African-American doctors matched with African-American patients.

Thought Process:

A & C – A and C would not be true because they’re too similar. So if A would be correct the C would almost have to be correct.

B – Opioids are not analgesics. So this is definitely not correct.

D – It makes sense for those odd ratios given to us in Table 2. And so, it looks like Caucasians are more likely to get opiates or opioids prescribed. Also, it looks like the Same Patient Provider Race is more likely to get opioids prescribed than if you were a Different Patient Provider Race.

And when that matchup occurs, you’re 2.55 times more likely to receive opioids then if you had a patient and provider with different races, and so that could possibly explain why Caucasians have 1.7 times the chance of being prescribed opioids compared to African American.

Notice, too, that D is the only one with the percentage brought in, instead of just looking at pure numbers as A and C do.

Correct Answer: D

[36:09] Question 4

The class of medications described in the passage are similar to endogenous hormones produced in what endocrine gland?

Anterior pituitary
Posterior pituitary
Adrenal cortex
Adrenal medulla

Thought Process:

We’re talking about these pain relievers, and we have opioids specifically. So hopefully, you can think that this is very similar to endorphins. And if you did your prep, you should know some very basic facts about different drug classes.

After long use of opioids, you’re going to stop making endorphins because they act very similarly. And so your body no longer produces endorphins, which is why the withdrawal from opioids is so terrible. And so we’re going to look for an answer that has endorphins.

Correct Answer: A

[40:04] Question 5

Subjects in the study who experience withdrawal from the opioids prescribed for injury are likely to exhibit all of the following upon physical examination EXCEPT:

increased perspiration.
tremors.
increased anxiety.
pupillary constriction.

Thought Process:

Just using that outside knowledge, and even for some based on personal experience where they’ve met patients who exhibited withdrawal symptoms, we know A, B and C are correct. And so that leaves us with D.

Correct Answer: D