Epidemiology Final Exam Questions, Exams of Nursing

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1.True or False? Socrates popularized the notion that the environment is

associated with human disease: False

2.True or False? The epidemiologic and clinical descriptions of a disease are different:

True

3.True or False? In current thinking, the term epidemic is used only to describe

outbreaks of infectious disease.: False

4.True or False? Most of the time, epidemiologic researchers confront a problem

that has a clear etiologic basis.: False

5.Which of the following activities characterizes a clinical approach (as op- posed to

an epidermiologic approach): Description of specific signs and symp- toms in a

patient

6.Which of the following is usually an aim of epidemiology?: All of the above

7.True or False? The study of diseases linked to harmful physical energy, such as

ionizing radiation, would be outside the scope of epidemiology.: False

8.True or False? Environmental and occupational health problems are a spe-

cialization of epidemiology.: True

9.Which of the following activities characterizes an epidemiologic approach (as

opposed to a clinical approach)?: Surveillance of a population

10.True or False? The 1918 Influenza Pandemic is also known as "the Mother of All

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Pandemics.: True

11.True or False? The Framingham Heart Study, begun in 1948, pioneered

research into coronary heart disease risk factors.: True

12.The phases of the policy cycle include:: all of the above

13.The difference between primary and secondary prevention of disease

is: primary prevention means control of causal factors, while secondary

prevention means early detection and treatment of disease.

14.True or False? An example of operations research is using epidemiology to plan

the placement of health services in a community.: True

15.The uses of epidemiology include:: all of the above

16.According to the natural history of disease model, the time before the pre- cursors

of disease and the host interact is called the period of: prepathogenesis

17.Increases in lung cancer mortality, especially among women, illustrate which of the

following trends in disease occurrence?: a new epidemic disorder

18.True or False? John Cassel argued that the agent, host, and environment triad

provided an adequate explanation for chronic diseases of non-infectious origin.: False

19.There has been an increase in the number of epidemiologic studies re- ported in

medical journals because:: they interest the public and physicians concerned

with preventive medicine.

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20.True or False? The National Ambulatory Medical Care Survey is a contin- uing

probability survey of physicians who practice in public settings such as

V.A. centers.: false

21.What factors should be considered in measuring long-term changes in disease

frequency over time?: all of the above

22.Which form of prevention takes place after the precursors of disease interact

with the host?: both a and B

23.True or False? The existence of a dose-response relationship, that is, an increase

in disease risk with an increase in the amount of exposure, does not support the view

that an association is a causal one: False

24.True or False? High firearm death rates and homicide rates are indicators of

adverse conditions within the community.: True

25.The risk of acquiring a given disease during a time period is best deter- mined

by:: the incidence rate (cumulative incidence) for that disease in a given

period of time.

26.True or False? Calculation of the standardized mortality ratio is an example of the

direct method of age adjustment.: False

27.Successful treatment programs that would shorten the duration of a dis- ease

primarily affect:: the prevalence of the disease

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28.An epidemiologic survey of roller-skating injuries in Metroville, a city with a

population of 100,000 (during the midpoint of the year), produced the following data for a particular year:

The crude death rate for all causes was:: 900/100,000 × 100,

29.An epidemiologic survey of roller-skating injuries in Metroville, a city with a

population of 100,000 (during the midpoint of the year), produced the following data for a particular year:

The proportional mortality ratio (%) due to roller-skating was:: 90/900 x 100

30.True or False? The crude death rate is defined as the number of deaths in a given

year divided by a reference population (during mid-point of the year) multiplied by

100,000.: True

31.True or False? A prerequisite for using direct age adjustment is that the age-

specific death rates in the study population must be stable.: True

32.True or False? Certain diseases can occur more than once in the same individual

during a stated period of time. Repeated cases of the disease have no effect upon

incidence rates.: False

33.True or False? The point prevalence of a disease is defined as the number of

persons ill divided by the total number in the group at a point in time.: True

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34.The major disadvantage of crude rates is that:: they do not permit compari-

son of populations that vary in composition.

35.True or False? The proportional mortality ratio (%) is defined as the mor- tality due

to a specific cause during a time period divided by the mortality due to all causes

during the same time period times 100.: True

36.True or False? One of three main purposes of descriptive epidemiology is to aid in

the creation of hypotheses.: True

37.True or False? The three categories of descriptive epidemiologic variables are

person, place, and time.: True

38.True or False? Developmental problems such as congenital birth defects occur

primarily late in life.: False

39.Which of the following reasons might account for place variation in dis- ease?:

all of the above

40.True or False? The human biological clock phenomenon is linked to place variation

in diseases.: False

41.Cyclic variations in the occurrence of disease may reflect:: all of the above

42.True or False? WHO is a major source of information about worldwide

international variations in rates of disease.: True

43.True or False? Nativity refers to place of origin of an individual.: true

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44.A null hypothesis is most similar to which of the following?: negative

declaration

45.A null hypothesis is most similar to which of the following?: True

46.Descriptive epidemiology has the following characteristics (Choose the incorrect

option):: allows causal inference from descriptive data

47.Which of Mill's four canons suggests that there is an association between

frequency of disease and the potency of a causative factor?: concomitant variation

48.Descriptive epidemiology characterizes the amount and distribution of disease

within a population and enables the researcher to:: b and c only

49.True or False? The National Health Survey consists of several distinct

programs conducted by the National Center for Health Statistics.: true

50.Choose the correct answer. Data on morbidity in the U.S. armed forces include::

all statements are correct

51.True or False? Health insurance statistics provide a generally representa- tive

picture of the health status of the United States population.: false

52.The best routinely available sources of data regarding the incidence of respiratory

disease outbreaks and other rapidly spreading conditions are:: - reports of

absenteeism from work and school

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53.True or False? The Freedom of Information Act exempts (does not allow) the

release of personal medical data: true

54.Morbidity surveys of the general population:: all of the above

55.Cautious use of information from death certificates is warranted because:-

: cause of death information may not be correct

56.The Vital Statistics Registration System in the U.S. collects data on all vital events

including:: a b and c

57.An abrupt drop in mortality due to a specific disease from one year to the next is

most likely due to: a change in the International Classification of Disease (ICD)

system

58.What is one of the widely used sources of statistical data on cancer?: dis- ease

registries

59.True or False? A registry is a centralized database of information about a disease.:

true

60.Which of the following data sources is most likely to provide a representa- tive

sample of the general health status of a population: a morbidity survey of the

general population

61.What data source has the advantage of being almost nearly complete in the

U.S.?: b and c

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62.Before utilizing data for an epidemiologic study, the researcher must first consider

the:: all of the above

63.True or False? A case-control study is purely a descriptive (as opposed to analytic)

study design: false

64.True or False? An ecologic comparison study is sometimes called a cross-

sectional ecologic study.: true

65.True or False? An ecologic study is one that examines a group as a unit of

analysis.: true

66.Case-control studies are among the best observational designs to study diseases

of:: low prevalence

67.A large medical center's oncology program reported an increased number of cases

of pancreatic cancer during a certain month. The hospital's epi- demiologist decided to research the problem. Tumor registry records were searched to identify all cases of pancreatic cancer during a five-year period; cancer patients were matched with patients treated for other diseases during the same five-year period. All subjects in the study were questioned about lifestyle factors including alcohol, tea, and coffee consumption. The resulting data are as follows: Note: Total number of male cancer patients = 200.

9 / 21 Total number of female cancer patients = 150. Total number of male patients (other diseases) = 300. Total number of female patients (other diseases) = 300.

Which number best approximates risk associated with alcohol Drinking in Men?: 1.

68.Examples of exposure data in ecologic studies include:: all of the above

69.True or False? A cross-sectional study allows the demonstration of a time

sequence between exposure and disease.: false

70.In case-control studies, the odds ratio is used as an estimate of the relative risk. In

order for this approximation to be reasonable, some conditions must be met. Which of the following conditions is not necessary in order to use the odds ratio to estimate the

relative risk?: the exposure in the question is rare in the population

71.Examples of descriptive epidemiologic studies do not usually include:: co- hort

studies

72.Ecologic studies:: are a good approach for generating hypotheses

73.True or False? Controls are needed in a case-control study to evaluate whether

the frequency of a factor or past exposure among the cases is different from that

among comparable persons who do not have the disease under investigation.: true

74.A major advantage of cohort studies over case-control studies with re- spect to the

role of a suspected factor in the etiology of a disease is that:: they permit direct

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estimation of risk of disease in those exposed to the suspected factor.

75.As an epidemiologist you are going to investigate the effect of a drug suspected of

causing malformations in newborn infants when the drug in question is taken by pregnant women during the course of their pregnancies. As your sample you will use the next 200 single births occurring in a given hospital. For each birth a medication history will be taken from the new mother and from her doctor; in addition, you will review medical records to verify use of the drug. [N.B.: These mothers are considered to have been followed prospectively during the entire course of their pregnancies, because a com- plete and accurate record of drug use was maintained during pregnancy.] The resultant data are: Forty mothers have taken the suspected drug during their pregnancies. Of these mothers, 35 have delivered malformed infants. In addition, 10 other infants are born with malfunctions.

What type of study design is this?: A. Retrospective cohort study

76.Forty mothers have taken the suspected drug during their pregnancies. Of these

mothers, 35 have delivered malformed infants. In addition, 10 other

11 / 21 infants are born with malfunctions.

Suppose that a relative risk of 0.5 has been found. Which interpretation might follow?: a

and d

77.Practical considerations in the design of cohort studies do not usually include::

age of the investigator

78.A five-year prospective cohort study has just been completed. The study was

designed to assess the association between supplemental vitamin A exposure and mortality and morbidity for measles. The RR for incidence of measles was 0.75 and the RR for measles mortality was 0.5.

Which statement is correct?: One of the problems that this study may have

faced is individuals lost to follow-up during the five-year period

79.Nested case-control studies:: all of the above

80.True or False? Relative risk is the ratio of the risk of disease among the exposed

to the risk among the unexposed.: true

81.Which of the following individuals helped draw people's attention to the method

of cohort analysis?: frost

82.Cohort study is to risk ratio as:: case-control study is to odds ratio

83.An ambispective cohort study is also known as a:: historical prospective

study

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84.Phase III clinical trials for a cancer drug involve:: comparing survival rates for

the new drug versus extant therapies

85.Which types of health issues are likely to be addressed in community trials?:

all of the above topics

86.To assess clinical end points, investigators:: all of the above

87.Identify which of the following six types of study designs most appropri- ately

characterizes the situation described below. The physical examination records of the incoming freshmen class of 1935 at the University of Minnesota are examined in 1980 to see whether their recorded height and weight at the time of admission to the university are re-

lated to their chance of developing coronary heart disease by 1981.: Historical

prospective cohort study

88.Controlled clinical trials enable researchers to:: all of the above

89.A prophylactic trial is designed to:: A. evaluate the effectiveness of a sub-

stance used to prevent disease

90.Which type of evaluation requires the collection of baseline information before

the program starts?: Impact evaluation

91.Identify which of the following six types of study designs most appropri- ately

characterizes the situation described below. To test the efficacy of a health education program in reducing the risk of

13 / 21 foodborne and waterborne diseases, the residents of two Peruvian villages were given an intensive health education program. At the end of two years, the incidence rates of important water-borne and food-borne diseases in these villages were compared with

those in two similar control villages without any education program.: community trial

92.True or False? Treatment crossover refers to any change of treatment for a patient

in a clinical trial that involves a switch of study treatments.: true

93.True or False? Randomized controlled trials at the community level are typically

used in special situations where there is a simple intervention.: true

94.Surrogate endpoints in clinical trials may include:: all of the above

95.True or False? In community intervention studies, it is important for the

investigator to evaluate whether a program has achieved its intended results before

assuming the benefits of the intervention.: true

96.Refer to the 2 by 2 table below

Assuming that the sample table is for a cohort study, define the risk difference or

attributable risk:: (A/A+B) - (C/C+D)

97.The death rate per 100,000 for lung cancer is 7 among non-smokers and 71 among

smokers. The death rate per 100,000 for coronary thrombosis is 422 among non- smokers and 599 among smokers. The prevalence of smoking in the population is 55%.

The relative risk of dying for a smoker compared to a non-smoker is:: D. 10.1 for lung

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cancer and 1.4 for coronary thrombosis.

98.The death rate per 100,000 for lung cancer is 7 among non-smokers and 71 among

smokers. The death rate per 100,000 for coronary thrombosis is 422 among non- smokers and 599 among smokers. The prevalence of smoking in the population is 55%. On the basis of the relative risk and etiologic fractions associated with smoking for lung cancer and coronary thrombosis, which of the following statements is most likely

to be correct?: Smoking seems much more likely to be causally related to

lung cancer than to coronary thrombosis.

99.The population etiologic fraction is a measure of the proportion of the disease

rate in a population attributable to the exposure of interest. This measure of effect

is influenced by:: a and c

100. True or False? The term attributable risk is defined as the ratio of the

incidence of a disease among exposed individuals to the incidence among non-

exposed individuals.: false

101. The death rate per 100,000 for lung cancer is 7 among non-smokers and 71

among smokers. The death rate per 100,000 for coronary thrombosis is 422

15 / 21 among non-smokers and 599 among smokers. The prevalence of smoking in the population is 55%.

The population etiologic fraction of disease due to smoking is:: C. 0.83 for lung

cancer and 0.18 for coronary thrombosis.

102. When assessing a positive relationship between alcohol consumption and

oral cancer using a case-control study, increasing the sample size of the study will result in which of the following? i. A lower p value ii. A greater odds ratio iii. A smaller 95% confidence interval iv. A higher disease prevalence

Circle the best response.: none of the above

103. True or False? The term attributable risk is also known as the rate differ-

ence or risk difference.: true

104. The population etiologic fraction for a particular disease from Factor X

alone is five times greater than that from Factor Y alone. If the relative risk associated with Factor X is 2, and with Factor Y is 20, which of the following statements is true?:

Fewer persons are exposed to Factor Y than to Factor X.

105. If it is accepted that an observed association is a causal one, an estimate of

the impact that a successful preventive program might have can be derived from::

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attributable risk

106. A causal association between factor and outcome can refer to: c and d

107. A causal association between factor and outcome can refer to: Selection

bias: survival bias

108. The purpose of a double-blind study is to:: avoid observer and

interviewee bias.

109. A double-blind study of a vaccine is one in which:: neither observers nor

subjects know which subject receives the vaccine and which receives a

placebo.

110. True or False? The purpose of matching in a case-control study is to se- lect

the controls in such a way that the control group has the same distribution as the cases

with respect to certain confounding variables.: true

111. The strategy which is not aimed at reducing selection bias is:: standard-

ized protocol for structured interviews.

112. An epidemiologic experiment is performed in which one group is exposed to a

suspected factor and the other is not. All individuals with an odd hospital admission number are assigned to the second group. The main purpose of this procedure is to::

improve the likelihood that the two groups will be comparable with regard to

known and unknown confounding factors.

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113. Which of the following is not a method for controlling the effects of

confounding in epidemiologic studies?: blinding

114. In a survey which uses lay interviewers to interview one person about his or

her health and the health of household members, the sources of error include:: all of

the above

115. You are investigating the role of physical activity in heart disease and

suggest that physical activity protects against having a heart attack. While presenting these data to your colleagues, someone asks if you have thought about confounders such as factor X. This factor X could have confounded your interpretation of the data if

it:: is a factor associated with physical activity and heart disease.

116. A test that determines whether disease is actually present is a:: diagnostic

test

117. A new antibody test detects serum antibodies against virus X (sensitiv- ity

99%, specificity 90%). When applied in a group of hospitalized patients diagnosed as having virus X infections, the test is found to have a positive predictive value of 85%. When used to screen a group of healthy blood donors for virus X infections, the test is found to have a positive predictive value of 30%. Which of the following best explains

this difference between the positive predictive values?: The prevalence of virus X

infection is higher among the hospital patients than among blood donors

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118. A screening examination was performed on 250 persons for Factor X,

which is found in disease Y. A definitive diagnosis for disease Y among the 250 persons had been obtained previously. The results are charted below:

The sensitivity of this test is expressed as:: 80%

119. True or False? Validity is the ability of a measuring instrument to give a true

measure.: true

120. Sensitivity and specificity of a screening test refer to its:: validity

121. True or False? Reliability refers to the ability of a measuring instrument to

give consistent results on repeated trials, regardless of its accuracy.: true

122. A new blood test has been developed to screen for disease Z. Re- searchers

establish 50 units as a cut point above which a test is considered positive and thereby indicative of disease. The test manufacturers determine that the test's sensitivity is unacceptably low. However, the manufacturers are not concerned with the specificity and do not want the cost of the test to rise. How can they improve the sensitivity of the

test?: Lower the cut point below 50 units.

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123. True or False? Specificity refers to the ability of a screening test to identify

only nondiseased individuals who actually do not have the disease.: true

124. True or False? It is possible for a measure to be valid but unreliable.: false

125. A new screening test for Lyme disease is developed for use in the general

population. The sensitivity and specificity of the new test are 60% and 70%, respectively. Three hundred people are screened at a clinic during the first year the new test is implemented. Assume the true prevalence of Lyme disease among clinic attendees is 10%. Calculate the following value

The predictive value of a positive test is:: 18.2%

126. The degree of agreement among several trained experts refers to:: D.

inter-judge reliability

127. A screening examination was performed on 250 persons for Factor X,

which is found in disease Y. A definitive diagnosis for disease Y among the 250 persons had been obtained previously. The results are charted below:

The specificity of this test is expressed as:: 70%

128. True or False? The presence of an infectious agent is a sufficient cause for

outbreaks of infectious disease to occur.: false

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129. True or False? Incubation period refers to the time between the start of an

infection and the beginning of the period of communicability.: false

130. True or False? Lyme disease is an example of a disease transmitted by

arthropod vectors.: true

131. The site where a disease agent enters the body is the:: portal of entry

132. True or False? Diseases that have only human reservoirs and are trans-

mitted from person to person are the zoonoses.: false

133. Schistosomiasis is an example of:: biological agents-helminth

134. True or False? If a disease is fatal, virulence can be measured by the case

fatality rate.: true

135. True or False? An enzootic disease among animals is similar to an

endemic disease among humans.: true

136. True or False? Physical environmental factors in the natural history of

disease include weather, temperature, and biologic components.: false

137. True or False? Administration of immune globulin confers passive immu-

nity.: true

138. An outbreak of salmonellosis occurred after an epidemiology department

luncheon, which was attended by 485 faculty and staff. Assume everyone ate the same food items. Sixty-five people had fever and diarrhea, five of these

21 / 21 people were severely affected. Subsequent laboratory tests on everyone who attended the luncheon revealed an additional 72 cases.

The attack rate of salmonellosis was:: 28.2%

139. Someone suggests immunization as a means of reducing disease, specif-

ically the feared UJ (uderlinger jacamoodi). What part of the disease cycle is he or she

trying to affect?: host