Normal distribution and z-scores

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Normal distribution and z-scores

Step2 Review

Step2 Review

Introduction to biostatistics
Types of data
Probability
Mean, median, and mode
Range, variance, and standard deviation
Standard error of the mean (Central limit theorem)
Normal distribution and z-scores
Paired t-test
Two-sample t-test
Hypothesis testing: One-tailed and two-tailed tests
One-way ANOVA
Two-way ANOVA
Repeated measures ANOVA
Correlation
Methods of regression analysis
Linear regression
Logistic regression
Spearman's rank correlation coefficient
Mann-Whitney U test
Kappa coefficient
Chi-squared test
Fisher's exact test
Kaplan-Meier survival analysis
Type I and type II errors
Sensitivity and specificity
Positive and negative predictive value
Test precision and accuracy
Incidence and prevalence
Relative and absolute risk
Odds ratio
Attributable risk (AR)
Mortality rates and case-fatality
DALY and QALY
Direct standardization
Indirect standardization
Study designs
Clinical trials
Disease causality
Selection bias
Confounding
Interaction
Prevention
Eczematous rashes: Clinical
Papulosquamous skin disorders: Clinical
Alopecia: Clinical
Hypersensitivity skin reactions: Clinical
Autoimmune bullous skin disorders: Clinical
Blistering skin disorders: Clinical
Hypopigmentation skin disorders: Clinical
Benign hyperpigmented skin lesions: Clinical
Skin cancer: Clinical
Immunodeficiencies: Clinical
Antihistamines for allergies
Glucocorticoids
Advanced cardiac life support (ACLS): Clinical
Supraventricular arrhythmias: Pathology review
Ventricular arrhythmias: Pathology review
Heart blocks: Pathology review
Coronary artery disease: Clinical
Heart failure: Clinical
Syncope: Clinical
Pericardial disease: Clinical
Cardiomyopathies: Clinical
Hypertension: Clinical
Hypercholesterolemia: Clinical
Sympatholytics: Alpha-2 agonists
Adrenergic antagonists: Presynaptic
Adrenergic antagonists: Alpha blockers
Adrenergic antagonists: Beta blockers
ACE inhibitors, ARBs and direct renin inhibitors
Thiazide and thiazide-like diuretics
Calcium channel blockers
cGMP mediated smooth muscle vasodilators
Class I antiarrhythmics: Sodium channel blockers
Class II antiarrhythmics: Beta blockers
Class III antiarrhythmics: Potassium channel blockers
Class IV antiarrhythmics: Calcium channel blockers and others
Lipid-lowering medications: Statins
Lipid-lowering medications: Fibrates
Miscellaneous lipid-lowering medications
Positive inotropic medications
Diabetes mellitus: Clinical
Hyperthyroidism: Clinical
Hypothyroidism and thyroiditis: Clinical
Parathyroid conditions and calcium imbalance: Clinical
Pituitary adenomas and pituitary hyperfunction: Clinical
Hypopituitarism: Clinical
Cushing syndrome: Clinical
Adrenal masses and tumors: Clinical
Adrenal insufficiency: Clinical
MEN syndromes: Clinical
Hyperthyroidism medications
Hypothyroidism medications
Insulins
Hypoglycemics: Insulin secretagogues
Miscellaneous hypoglycemics
Adrenal hormone synthesis inhibitors
Mineralocorticoids and mineralocorticoid antagonists
Esophageal disorders: Clinical
Esophagitis: Clinical
Gastroesophageal reflux disease (GERD): Clinical
Gastroparesis: Clinical
Malabsorption: Clinical
Inflammatory bowel disease: Clinical
Jaundice: Clinical
Cirrhosis: Clinical
Laxatives and cathartics
Antidiarrheals
Acid reducing medications
Fever of unknown origin: Clinical
Fat-soluble vitamin deficiency and toxicity: Pathology review
Anemia: Clinical
Microcytic anemia: Pathology review
Non-hemolytic normocytic anemia: Pathology review
Intrinsic hemolytic normocytic anemia: Pathology review
Extrinsic hemolytic normocytic anemia: Pathology review
Macrocytic anemia: Pathology review
Heme synthesis disorders: Pathology review
Leukemia: Clinical
Lymphoma: Clinical
Thrombocytopenia: Clinical
Bleeding disorders: Clinical
Thrombophilia: Clinical
Myeloproliferative neoplasms: Clinical
Plasma cell disorders: Clinical
Blood products and transfusion: Clinical
Anticoagulants: Heparin
Anticoagulants: Warfarin
Anticoagulants: Direct factor inhibitors
Antiplatelet medications
Thrombolytics
Hematopoietic medications
Ribonucleotide reductase inhibitors
Topoisomerase inhibitors
Platinum containing medications
Anti-tumor antibiotics
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DNA alkylating medications
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Antimetabolites for cancer treatment
Infective endocarditis: Clinical
Pneumonia: Clinical
Tuberculosis: Pathology review
Diarrhea: Clinical
Viral hepatitis: Clinical
Urinary tract infections: Clinical
Meningitis, encephalitis and brain abscesses: Clinical
Bites and stings: Clinical
Protein synthesis inhibitors: Aminoglycosides
Antimetabolites: Sulfonamides and trimethoprim
Antituberculosis medications
Miscellaneous cell wall synthesis inhibitors
Protein synthesis inhibitors: Tetracyclines
Cell wall synthesis inhibitors: Penicillins
Miscellaneous protein synthesis inhibitors
Cell wall synthesis inhibitors: Cephalosporins
DNA synthesis inhibitors: Metronidazole
DNA synthesis inhibitors: Fluoroquinolones
Integrase and entry inhibitors
Nucleoside reverse transcriptase inhibitors (NRTIs)
Protease inhibitors
Hepatitis medications
Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
Neuraminidase inhibitors
Herpesvirus medications
Azoles
Echinocandins
Miscellaneous antifungal medications
Anthelmintic medications
Antimalarials
Anti-mite and louse medications
Hypernatremia: Clinical
Hyponatremia: Clinical
Hyperkalemia: Clinical
Hypokalemia: Clinical
Metabolic and respiratory acidosis: Clinical
Metabolic and respiratory alkalosis: Clinical
Toxidromes: Clinical
Medication overdoses and toxicities: Pathology review
Acute kidney injury: Clinical
Chronic kidney disease: Clinical
Nephritic and nephrotic syndromes: Clinical
Renal tubular defects: Pathology review
Renal tubular acidosis: Pathology review
Osmotic diuretics
Carbonic anhydrase inhibitors
Loop diuretics
Potassium sparing diuretics
Stroke: Clinical
Seizures: Clinical
Headaches: Clinical
Hyperkinetic movement disorders: Clinical
Hypokinetic movement disorders: Clinical
Muscle weakness: Clinical
Disorders of consciousness: Clinical
Spinal cord disorders: Pathology review
Sympathomimetics: Direct agonists
Muscarinic antagonists
Cholinomimetics: Direct agonists
Cholinomimetics: Indirect agonists (anticholinesterases)
Anticonvulsants and anxiolytics: Barbiturates
Anticonvulsants and anxiolytics: Benzodiazepines
Nonbenzodiazepine anticonvulsants
Migraine medications
Anti-parkinson medications
Medications for neurodegenerative diseases
Asthma: Clinical
Chronic obstructive pulmonary disease (COPD): Clinical
Diffuse parenchymal lung disease: Clinical
Venous thromboembolism: Clinical
Acute respiratory distress syndrome: Clinical
Pleural effusion: Clinical
Pneumothorax: Clinical
Lung cancer: Clinical
Bronchodilators: Beta 2-agonists and muscarinic antagonists
Bronchodilators: Leukotriene antagonists and methylxanthines
Joint pain: Clinical
Rheumatoid arthritis: Clinical
Seronegative arthritis: Clinical
Systemic lupus erythematosus (SLE): Clinical
Sjogren syndrome: Clinical
Inflammatory myopathies: Clinical
Vasculitis: Clinical
Acetaminophen (Paracetamol)
Non-steroidal anti-inflammatory drugs
Opioid agonists, mixed agonist-antagonists and partial agonists
Antigout medications
Osteoporosis medications
Pregnancy
Routine prenatal care: Clinical
Hypertensive disorders of pregnancy: Clinical
Antepartum hemorrhage: Clinical
Premature rupture of membranes: Clinical
Stages of labor
Abnormal labor: Clinical
Vaginal versus cesarean delivery: Clinical
Postpartum hemorrhage: Clinical
Gestational trophoblastic disease: Clinical
Breastfeeding
Abdominal pain: Clinical
Puberty and Tanner staging
Amenorrhea: Clinical
Contraception: Clinical
Virilization: Clinical
Infertility: Clinical
Vulvovaginitis: Clinical
Sexually transmitted infections: Clinical
Menopause
Abnormal uterine bleeding: Clinical
Ovarian cysts, cancer, and other adnexal masses: Clinical
Endometrial hyperplasia and cancer: Clinical
Cervical cancer: Clinical
Vaginal cancer: Clinical
Vulvar cancer: Clinical
Estrogens and antiestrogens
Progestins and antiprogestins
Androgens and antiandrogens
Aromatase inhibitors
Uterine stimulants and relaxants
Newborn management: Clinical
Neonatal ICU conditions: Clinical
Congenital TORCH infections: Pathology review
Neonatal jaundice: Clinical
Perinatal infections: Clinical
Congenital disorders: Clinical
Congenital heart defects: Clinical
Autosomal trisomies: Pathology review
Miscellaneous genetic disorders: Pathology review
Disorders of carbohydrate metabolism: Pathology review
Disorders of fatty acid metabolism: Pathology review
Glycogen storage disorders: Pathology review
Lysosomal storage disorders: Pathology review
Mood disorders: Clinical
Anxiety disorders: Clinical
Schizophrenia spectrum disorders: Clinical
Dissociative disorders: Clinical
Eating disorders: Clinical
Obsessive compulsive disorders: Clinical
Trauma- and stressor-related disorders: Clinical
Disruptive, impulse-control and conduct disorders: Clinical
Personality disorders: Clinical
Sleep disorders: Clinical
Somatic symptom disorders: Clinical
Sexual dysfunctions: Clinical
Paraphilic disorders: Clinical
Substance misuse and addiction: Clinical
Drug misuse, intoxication and withdrawal: Hallucinogens: Pathology review
Psychiatric emergencies: Pathology review
Preoperative evaluation: Clinical
Postoperative evaluation: Clinical
General anesthetics
Local anesthetics
Neuromuscular blockers
Esophageal surgical conditions: Clinical
Gastrointestinal bleeding: Clinical
Peptic ulcers and stomach cancer: Clinical
Appendicitis: Clinical
Diverticular disease: Clinical
Hernias: Clinical
Bowel obstruction: Clinical
Colorectal cancer: Clinical
Abdominal trauma: Clinical
Anal conditions: Clinical
Gallbladder disorders: Clinical
Pancreatitis: Clinical
Breast cancer: Clinical
Benign breast conditions: Pathology review
Anatomy clinical correlates: Anterior and posterior abdominal wall
Anatomy clinical correlates: Breast
Valvular heart disease: Clinical
Chest trauma: Clinical
Anatomy clinical correlates: Thoracic wall
Anatomy clinical correlates: Heart
Anatomy clinical correlates: Pleura and lungs
Anatomy clinical correlates: Mediastinum
Dizziness and vertigo: Clinical
Thyroid nodules and thyroid cancer: Clinical
Neck trauma: Clinical
Nasal, oral and pharyngeal diseases: Pathology review
Traumatic brain injury: Clinical
Brain tumors: Clinical
Lower back pain: Clinical
Eye conditions: Refractive errors, lens disorders and glaucoma: Pathology review
Eye conditions: Retinal disorders: Pathology review
Eye conditions: Inflammation, infections and trauma: Pathology review
Anatomy clinical correlates: Clavicle and shoulder
Anatomy clinical correlates: Axilla
Anatomy clinical correlates: Arm, elbow and forearm
Anatomy clinical correlates: Wrist and hand
Anatomy clinical correlates: Median, ulnar and radial nerves
Burns: Clinical
Prostate disorders and cancer: Pathology review
Testicular tumors: Pathology review
Kidney stones: Clinical
Renal cysts and cancer: Clinical
Urinary incontinence: Pathology review
PDE5 inhibitors
Peripheral vascular disease: Clinical
Leg ulcers: Clinical
Aortic aneurysms and dissections: Clinical

Transcript

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Let’s say you ask 1000 men for their weight, and then you plot their answers on a histogram, which is a plot that shows the distribution of any measurement or data.

Let’s say that the average weight is 170 pounds or about 77 kilograms, and that it turns out that the majority of men weighed that amount, whereas fewer men weighed a little bit higher or a little bit lower than the average, and even fewer men weighed much higher or much lower than the average.

If we draw a curve over the top of our histogram, we get the normal distribution curve, which is also called the bell curve, because it’s shaped like a bell.

The bell curve is symmetrical, with half the data on the left of the average and half the data on the right side of the average.

The area under the bell curve is equal to 1, or 100%, with the highest percentage of data in the middle section and the lowest percentage of data in the outer tails of the curve.

Typically, for population data, the average point in a bell curve is labeled with the greek letter mu, and mu refers to the mean, median, and mode, because when data are normally distributed, the mean, median, and mode are all equal to each other.

The standard deviation is a measure of how spread out the data are from the average, and for population data it’s represented by the greek letter sigma.

For example, let’s say the standard deviation of weight for our sample of men is 29 pounds, or 13 kilograms.

In a normal distribution, 68 percent of the data are within one standard deviation.

That means that 68 percent of men will weigh somewhere between 170 minus 29, or 141 pounds, and 170 plus 29, or 199 pounds.

Also, 95 percent of the data are found within two standard deviations - so, since 29 times 2 is 58, then 95 percent of men will weigh somewhere between 170 minus 58, or 112 pounds, and 170 plus 58, or 228 pounds.

Finally, 99.7 percent the data are found within three standard deviations, and since 29 times 3 is 87, 99.7% of men will weigh between 170 minus 87, or 83 pounds, and 170 plus 87, or 257 pounds.

This is called the empirical rule, or the 68-95-99.7 rule.

Now, the shape of the bell curve depends on the size of the standard deviation.

A small standard deviation, like if it was only 5 pounds, tells you that most of the data are clustered around the average - and this makes the bell curve very tall and skinny.

On the other hand, a large standard deviation, like if it was 50 pounds, tells you that most of the data are way above and way below the average - and this makes the bell curve look very wide and flat.

Now, let’s say a man named Micah weighs 220 pounds, and he wants to know how close his weight is to the average weight.

We can calculate how much more he weighs than the average by subtracting the average weight, 170 from his weight, 220, which equals 50.

But telling Micah that he weighs 50 pounds over the average doesn’t really have much meaning, because he probably doesn’t know if 50 pounds is a lot higher or only a little higher than the average.

Instead, we might tell Micah his z-score, or standard score, which is a measure of how many standard deviations his weight is from the average weight.

Z-scores range from negative 3 standard deviations, which would be on the very far end of the left tail, to positive 3 standard deviations, which would be on the very far end of the right tail.

In the normal distribution, the average value is the reference point, so the average value equals 0 standard deviations.

To figure out a z-score for an individual measurement - like Micah’s weight - we use the equation z equals the measurement minus the average measurement in the population, divided by the standard deviation for the population.

Usually, the individual measurement is represented by the letter x, so the equation can also be written z equals x minus mu, divided by sigma.

So, to figure out Micah’s z-score, we do 220 minus 170, divided by 29, which equals 1.72.

This means that Micah weight is 1.72 standard deviations above the population average.

Key Takeaways

The normal distribution is a continuous probability distribution that is symmetric about the mean, with a bell-shaped curve. 68%, 95%, and 99% of the data lies within one, two, and three standard deviations from the mean, respectively. The normal distribution represents the occurrence of many natural phenomena.

On the other hand, a Z-score indicates the number of standard deviations between a certain value and the mean. A Z-score of 0 indicates that the data point is exactly at the mean. A Z-score of 1 indicates that the data point is one standard deviation above the mean, and a Z-score of -1 indicates that the data point is one standard deviation below the mean. Z-scores can be used to determine how unusual a data point is within a dataset that follows a normal distribution.