Chronic Disease Epidemiology
Test Questions
Course Introduction
Chronic Disease Epidemiology explores the distribution, determinants, and prevention strategies for non-communicable diseases such as cardiovascular disease, diabetes, cancer, and respiratory illnesses within populations. The course covers epidemiological methods for studying chronic conditions, risk factor assessment, measurement of disease burden, and approaches to surveillance. Students will examine the impact of behavioral, environmental, genetic, and social factors on chronic disease patterns and review case studies to strengthen their abilities to interpret and critique epidemiologic research. Emphasis is placed on the application of epidemiologic principles to public health practice and policy development aimed at reducing chronic disease incidence and improving population health outcomes.
Recommended Textbook
Gordis Epidemiology 6th Edition by Celentano ScD MHS
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Chapter 1: Introduction
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Q1) Over the past century,a marked decline in the mortality rates of many infectious diseases has been observed.Which of the following is the most likely reason for the observed decline in mortality rates from common infectious diseases?
A) Development of penicillin
B) Development of insulin
C) Development of vaccines
D) Improvement in social conditions
E) Worse sanitation and unsafe water
Answer: D
Q2) This historic character observed that childbed fever mortality was more common among women treated by physicians and medical students compared with women treated by midwives.Based on his observations,he implemented a hand wash policy that resulted in a decrease in mortality.Name the character that we are talking about.
A) John Snow
B) Edward Jenner
C) D.A. Henderson
D) Leon Gordis
E) Ignaz Semmelweis
Answer: E
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Chapter 2: The Dynamics of Disease Transmission
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Q1) An outbreak of measles occurred in City A.There were 1,000 confirmed cases among children younger than 10 years old.Unfortunately,50 children died of measles.Fifty represent 5% of the total number of cases.What concept is being illustrated in this example?
A) Attack rate
B) Secondary attack rate
C) Case-fatality rate
D) Incubation period
E) Subclinical disease
Answer: C
Q2) What is the most accurate definition of the incubation period (of an infectious disease)?
A) The time of onset of clinical illness or the onset of recognizable symptoms
B) The interval from receipt of infection to the time of onset of clinical illness (the onset of recognizable symptoms)
C) The time of invasion by an infectious agent
D) The time between initiation of infection and first shedding or excretion of the agent
E) The period between exposure and the onset of infectiousness
Answer: B
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4
Chapter 3: The Occurrence of Disease: Idisease
Surveillance and Measures of Morbidity
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Q1) An epidemiologist decides to investigate the incidence of diabetes in a population of 300 older adults who live in a nursing home.She visits the nursing home in January 1,2017 and later in December 31 of the same year.She looks into the records of these patients and learns that in her first visit,25 patients had diabetes and 35 in her second visit.What number should be in the numerator for her calculation of incidence?
A) 10
B) 25
C) 35
D) 300
E) 275
Answer: A
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Chapter 4: The Occurrence of Disease: II Mortality and Other Measures of Disease Impact
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Q1) In 2016 there were 7,467 million people in the world.According to the World Health Organization,in the same year there were 56.9 million deaths worldwide; of those,15.2 million were due to ischemic heart disease or stroke.What was the proportionate mortality of those two causes combined for that year?
A) 0.8%
B) 0.2%
C) 3.7%
D) 13.5%
E) 26.7 %
Q2) According to the Centers of Disease Control and Prevention (CDC),during the Ebola outbreak of 2014 in West Africa,there were a total of 14,124 Ebola cases in Sierra Leone and 3,956 deaths due to Ebola.What was the case fatality rate in that country?
A) 3.5%
B) 22%
C) 28%
D) 3,956
E) 14,124
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Chapter 5: Assessing the Validity and Reliability of Diagnostic and Screening Tests
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Q1) Two infectious disease epidemiologists want to investigate a new laboratory test that identifies TB infections.Dr.Merritt uses the standard test,which has a sensitivity of 80% and a specificity of 90%.Dr.Foundry uses the new laboratory test,which is 90% sensitive and 99% specific.Now,epidemiologists decide to run those two test as sequential tests (two-stage testing).What is the effect on net sensitivity of sequential tests?
A) 72%
B) 80%
C) 89%
D) 90%
E) 98%
Q2) The following are problems generated when a patient is given a false-positive diagnosis,except:
A) Generate unnecessary expenses, as those labeled positive often go through other diagnostic procedures.
B) Generates anxiety and worry.
C) Increased burden to the healthcare system
D) The opportunity for an effective intervention is missed.
E) Unnecessary treatments are administered.
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Chapter 6: The Natural History of Disease: Ways of Expressing Prognosis
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Q1) The following table describes the survival of patients treated from disease X from 2015 to 2017 followed for 3 years (assuming no loss to follow-up).What was the probability of surviving the third year? \(\begin{array}{r} \text { Number alive at the end of year }\quad \\ \begin{array}{|l|l|l|l|l|}
\hline \text { Year of treatment } & \text { Number of patients treated } & \quad 1 \text { year } & \quad 2 \text { year } &\quad 3 \text { year } \\
\hline 2015 & 100 & 67 & 42 & 30 \\
\hline 2016 & 50 & 31 & 18 & \\
\hline 2017 & 75 & 52 & & \\
\hline \text { Totals } & 225 & 150 & 60 & 30 \\
\hline \end{array}\end{array}\)
A) 0.29
B) 0.33
C) 0.61
D) 0.67
E) 0.71
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Chapter 7: Observational Studies
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Q1) Which of the following biases is the most accurate explanation of the following situation? Epidemiologists are studying the possible relationship of cholera infections to drinking water.They conduct a case-control study and interview patients with cholera infection (cases) and persons without cholera infection (controls).A patient who was diagnosed with cholera often tries to identify all kinds of information related to drinking water.However,controls who were not diagnosed with cholera may not remember water they drink which is not from an unhygienic source.
A) Recall bias
B) Selection bias
C) Misclassification bias
D) Publication bias
E) Exclusion bias
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Chapter 8: Cohort Studies
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Q1) Some researchers want to investigate the association of work stress and risk of cardiovascular mortality.Investigators selected a systematic sample of 902 participants in strata by sex,age,and occupational group from the Valmet factories in Jyväskylä,in central Finland.Baseline examination in 1973 determined cases of cardiovascular disease,behavioral and biologic risks,and stressful characteristics of work.Follow-up examinations included measurement of blood pressure,cholesterol concentration,and body mass index in 1978 and in 1983.Work stress and risk of cardiovascular mortality: a study of industrial employees What kind of study design is this?
A) Cross-sectional study
B) Prospective cohort study
C) Case-control study
D) Randomized trial
E) Case report
Q2) In which of the following study designs is possible to calculate incidence rate?
A) Cross-sectional
B) Case-control
C) Cohort
D) Case-series
E) Report of a case
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Page 10
Chapter 10: Assessing Preventive and Therapeutic
Measures: Randomized Trials
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Q1) Two similar drugs (drug A and drug B) to alleviate back pain were released simultaneously.An investigator decides to test which of the drugs works better.He decides to conduct a trial in which randomly,half of the participants receive drug A for a month while the other half received drug B.After 2 weeks without any medication,participants switch the drug they were receiving (those who received A start taking B,and those who received B start taking A).What type of study design was illustrated in this example?
A) Cross-sectional study
B) Factorial randomized clinical trial
C) Crossover randomized clinical trial
D) Crossover cohort study
E) Phase II clinical trial
Q2) Participants in a clinical trial might report different symptoms when they know they are part of the intervention group instead of the control group.To avoid that,researchers use the following:
A) Confounding
B) Randomization
C) Concealment of random allocation
D) Masking
E) Effect modifiers
Page 11
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Chapter 11: Randomized Trials: Some Further Issues
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Q1) Epidemiologists decided to investigate the effect of sunscreens on sunburns.They ran an epidemiologic study to see the association of sunscreens and sunburns.Overall,460 people have enrolled in the study.Investigators randomly allocated 230 people to the treatment group (sunscreens) and 230 to the control group (placebo).They exposed those 460 people to the high mountain trail on a sunny day.At the end of the study,30 people developed sunburns in the sunscreen group and 130 people developed sunburns in the placebo group.What type of study design is this?
A) Cross-sectional study
B) Prospective cohort study
C) Case-control study
D) Randomized trial
E) Case-control study.
Q2) What is the primary purpose of randomization?
A) To prevent bias in the assignment of treatment
B) To provide a probability basis for statistical testing
C) To ensure the same number of people are randomized to each group
D) To ensure that the subjects not to know which group they are assigned to
E) To guarantee the comparability of the different treatment groups
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Chapter 12: Estimating Risk: Is There an Association
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Q1) The following table summarizes the findings of a cohort study.Participants were enrolled in January 1,2015,and followed up until December 31,2015.Researchers were interested in the effect of physical activity on cardiovascular disease. \[\begin{array} { |
l | c | c | c | }
\hline & \text { Cardiovascular events } & \text { No events } & \text { Total } \\
\hline \text { Physically active } & 28 & 1,972 & 2,000 \\
\hline \text { Inactive } & 75 & 2,925 & 3,000 \\
\hline
\end{array}\] Based on the previous information,calculate the relative risk of cardiovascular events for those who were physically active.
A) 0.38
B) 0.56
C) 1.50
D) 1.79
E) 2.68
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Chapter 13: More on Risk: Estimating the Potential for Prevention
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Q1) What is the best measure of association to explain what percentage of the new diagnoses of disease X are explained by exposure to Y among those exposed to Y?
A) Relative risk
B) Risk ratio
C) Odds ratio
D) Attributable risk
E) Incidence rate ratio
Q2) The incidence of disease X is 56/1,000 per year among smokers and 33/1,000 per year among nonsmokers.What proportion of cases of disease X are due to smoking among those who smoke?
A) 23%
B) 33%
C) 41%
D) 56%
E) 59%
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Chapter 14: From Association to Causation: Deriving
Inferences From Epidemiologic Studies
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Q1) In a hypothetical cross-sectional study,marriage was found to be strongly associated with increased levels of happiness.Authors concluded that marriage was a cause of happiness.However,a reviewer of this study argued that because it is a cross-sectional study,it could not be determined whether marriage caused happiness or happiness caused marriage.What criterion of causal relationships was not met in the study according to the reviewer?
A) Strength of association
B) Biologic plausibility
C) Dose response
D) Temporal relationship
E) Replication of findings
Q2) Temporal relationship is a necessary criterion to establish causality.Which of the following epidemiologic study design allows to evaluate temporal relationship?
A) Cross-sectional
B) Case-control
C) Transversal
D) Cohort
E) Literature review
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Q1) This table shows incidence rates (per 100,000) of groups exposed to neither risk factors or to one or two risk factors for lung cancer.What is the expected value of incidence rate X on asbestos exposure group among smokers in multiplicative scale? Incidence Rates of Lung Cancer by Asbestos and Smoking Exposure Status \[\begin{array}{r}
\text { Smoking status }\quad\\ \text { Asbestos exposure } \begin{array} {|l|l|l|}
\hline& \text { Yes } \quad \quad& \text { No }\quad\quad \\
\hline \text { Yes (regular exercise) } & 2.0 & 2.6 \\
\hline \text { No (no exercise) } & 4.0 & x\\
\hline \end{array}\end{array}\]
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Chapter 16: Identifying the Roles of Genetic and Environmental Factors
in Disease
Causation
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Q1) The following suggests environmental factors causing a disease:
A) Monozygotic twins getting the same disease
B) Family history of disease
C) Early development
D) A rapid change in the trends of disease over time
E) Biologic brothers adopted by different families getting the same disease
Q2) A total of 1,500 pairs of adult twins,600 monozygotic and 900 dizygotic,were studied to estimate the concordance for a childhood cancer.In the 600 monozygotic twins,40 of the pairs were concordant for the disease,60 of the pairs were discordant for the disease,and neither twin had the disease in the remaining 500 pairs.In the 900 dizygotic twins,30 of the pairs were concordant for the disease,120 of the pairs were discordant for the disease,and neither twin had the disease in the remaining 750 pairs.What is the concordant rate,in monozygotic twins,of the disease in twin pairs with at least one affected member?
A) 0.1
B) 0.4
C) 0.6
D) 0.7
E) 1.5
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Chapter 17: Using Epidemiology to Evaluate Health Services
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Q1) Which of the following statements is the most accurate definition of effectiveness?
A) Testing a vaccine in a group of consenting individuals.
B) A measure of a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions.
C) Testing a vaccine in a community where some of individuals do not want to be vaccinated.
D) The process of making the best use of scarce resources.
E) The effects or end results achieved in relation to the effort expended in terms of money, resources, and time.
Q2) In general terms,a health indicator is a
A) rare disease that reflects how the system deals with complex conditions.
B) sentinel condition that is assumed to reflect the general level of health care.
C) disease that reflects infant health.
D) disease that reflects maternal and child health.
E) statistical test used to compare the health situation of two countries.
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Chapter 18: Epidemiologic Approach to Evaluating Screening Programs
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Q1) Which of the following statements is the most accurate example of primary prevention?
A) Promoting antismoking campaign in the community
B) Taking low-dose computed tomography scan to detect the early stage of lung cancer
C) Quitting smoking after diagnosis of chronic obstructive pulmonary disease
D) Removal of malignant lung cancer to reduce the pain from tumor
E) Participating in cancer rehabilitation programs in primary health care center after surgery
Q2) Which of the following statements is the most accurate example of secondary prevention?
A) Providing human papillomavirus (HPV) vaccines to kids who are 11 or 12 years of age
B) Using condoms to prevent sexually transmitted disease
C) Taking a routine Pap smear test
D) Receiving a hysterectomy after diagnosis of cervical cancer
E) Participating in rehabilitation programs to reduce the pain after surgery
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Chapter 19: Epidemiology and Public Policy
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Q1) Which of the following statements is not an accurate description of epidemiology in health policy?
A) A major role of epidemiology is a basis for developing policies that may affect human health.
B) One of the roles of epidemiology in public health policy is for risk assessment.
C) Some researchers use systematic review or meta-analysis to synthesize the literature regarding a specific health topic.
D) Epidemiology is the only relevant scientific discipline in the process of risk assessment.
E) Journals that may not want to publish the studies report no association will increase the publication bias.
Q2) What is the name of the chart that is typically used to depict the results of a meta-analysis?
A) Forest plot
B) Pie chart
C) Box plot
D) Manhattan plot
E) Bar chart
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Chapter 20: Ethical and Professional Issues in Epidemiology
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Q1) A challenge in epidemiologic research that explores the effect of race on cardiovascular disease is that
A) measuring race is hard because is a poorly understood concept and its validity is questionable.
B) measuring race requires DNA testing.
C) there are too many human races.
D) race is usually not associated with health outcomes.
E) cardiovascular disease is not well defined.
Q2) One difference between epidemiology and other scientific disciplines,regarding the impact of their findings,is that
A) epidemiologic findings are not prone to falsification.
B) epidemiology is the only science that deals with humans.
C) epidemiologic findings have immediate policy implications for clinical practice and public health.
D) epidemiologic findings are not prone to misinterpretations.
E) epidemiologic findings are the easiest to understand.
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