Environmental Health
Exam Answer Key
Course Introduction
Environmental Health explores the relationship between human health and the environment, examining how environmental factors such as air, water, soil, and chemical agents impact public health and well-being. The course covers principles of toxicology, risk assessment, and exposure pathways, alongside the study of environmental policy, regulation, and sustainable practices. Students will learn to identify and evaluate hazards, understand the health effects of environmental contaminants, and discuss intervention strategies for mitigating risks. Through case studies and real-world examples, the course emphasizes the importance of interdisciplinary approaches and community engagement in addressing environmental health challenges.
Recommended Textbook
Gordis Epidemiology 6th Edition by Celentano ScD
MHS
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150 Verified Questions
150 Flashcards
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Chapter 1: Introduction
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Sample Questions
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) Which of the following is an example of tertiary prevention?
A) Vaccination for rotavirus for children younger than the age of 1 year
B) Surgical amputation of an extremity with osteosarcoma (bone cancer)
C) Screening for gestational diabetes after 24 weeks of pregnancy
D) Sexual education program in elementary schools
E) Increasing taxes for buying cigarettes
Answer: B
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3
Chapter 2: The Dynamics of Disease Transmission
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Q1) The population of Oriol City in June 2018 was 612,437.According to the Oriol City's health department,there were 329 new cases of Raven's disease during 2018.Counting those new cases,by December 31 it was estimated that there were 6580 persons with Raven's disease in Oriol City.What was the prevalence of Raven's disease in 2018?
A) 26 per 100,000 population
B) 33 per 100,000 population
C) 54 per 100,000 population
D) 1074 per 100,000 population
E) 5000 per 100,000 population
Answer: D
Q2) Malaria is a parasitic disease transmitted by the Anopheles mosquito bite.This mode of transmission is called A) direct.
B) single exposure.
C) multiple exposure.
D) mosquitosis.
E) vector.
Answer: E
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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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5
Chapter 4: The Occurrence of Disease: II Mortality and Other Measures of Disease Impact
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Q1) For a disease such as seasonal influenza,which is less fatal and of short duration?
A) Incidence rates and mortality rates will be similar.
B) Mortality rates will be much higher than incidence rates.
C) Incidence rates will be much higher than mortality rates.
D) Incidence rates will be unrelated to mortality rates.
E) None of the above.
Q2) The mayor of Baby City is interested in comparing the infant mortality rate (infants are defined as babies younger than the age of 12 months) of Baby City with the infant mortality rate of Adult City.He argues that the age distributions of these cities are very different and therefore asks you to calculate the age-adjusted infant mortality rate.What is the best approach?
A) Use direct adjustment.
B) Use indirect adjustment.
C) Calculate the standardized mortality ratio.
D) Explain that no age adjustment is needed when comparing with age-specific mortality rates.
E) Use the World Health Organization standard population to calculate an adjusted rate.
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Page 6
Chapter 5: Assessing the Validity and Reliability of Diagnostic and Screening Tests
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Q1) A physical examination,digital rectal exam,was used to screen for prostate cancer in 290 men with biopsy-proven prostate cancer and in 516 age- and race-matched control men,all of whom showed no evidence of cancer at biopsy.The results of the physical examination were positive in 136 cases and in 165 control men.Now,the health commissioner in City A decides to use a physical exam,digital rectal exam,as a primary screening test for prostate cancer.What will be the positive predictive value of the physical examination?
A) 45%
B) 47%
C) 68%
D) 82%
E) Cannot calculate it based on given information
Q2) A diagnostic test with a very high sensitivity but very low specificity has the following problem:
A) It will miss a big proportion of true cases (label them as negatives).
B) It will correctly identify all negative cases.
C) It will label a big proportion of healthy people as sick (false-positives).
D) It will be very expensive to administer.
E) Specificity is the single most important characteristic of a test.
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Chapter 6: The Natural History of Disease: Ways of Expressing Prognosis
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Q1) Which of the following illustrates a violation to one of the assumptions made when using the Kaplan-Meier method?
A) Some patients who dropped out of the study have a similar probability of survival as those who remained in it.
B) Patients present the outcome at different time intervals.
C) An event of interest different from death is studied.
D) There is a significant improvement in the treatment of the condition being studied in the middle of the duration of the study.
E) The median survival time is longer than the duration of the study.
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Chapter 7: Observational Studies
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Q1) Which term most accurately describes the following definition? "A study that examines the relationship between diseases (or other health outcomes) and other variables of interest as they exist in a defined population <u>at one particular time</u>." [Porta M,ed.A Dictionary of Epidemiology.New York: Oxford University Press; 2014.]
A) Ecologic study
B) Cross-sectional study
C) Case-control study
D) Cohort study
E) Randomized trial
Q2) Which term most accurately describes the following definition? "The observational epidemiological study of persons with the disease (or another outcome variable) of interest and a suitable control group of persons without the disease (comparison group,reference group)." [Porta M,ed.A Dictionary of Epidemiology.New York: Oxford University Press; 2014.]
A) Ecologic study
B) Cross-sectional study
C) Case-control study
D) Cohort study
E) Randomized trial
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Chapter 8: Cohort Studies
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Q1) Which of the following statements is the most accurate characteristic of cohort studies?
A) It is an efficient study designs for studying rare disease.
B) The temporality of the exposure preceding the outcome is hard to determine.
C) The incidence rate of disease in the exposure group is compared directly to the incidence rate of disease in the unexposed group.
D) The exposure and outcomes are captured at the same time.
E) The participants are randomly allocated to exposure and nonexposure categories.
Q2) The main difference between a cohort study and a randomized trial is that
A) cohort studies are longitudinal and randomized trials are cross-sectional.
B) only clinical trials can evaluate the effect of a drug.
C) randomized trials are experimental and cohort studies are observational.
D) clinical trials are observational and cohort studies are experimental.
E) at the beginning of a clinical trial, participants are free of disease, and cohort studies start with patients with a disease.
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10
Chapter 10: Assessing Preventive and Therapeutic
Measures: Randomized Trials
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Q1) In a clinical trial,sometimes patients agree to receive an intervention but later decide to stop taking the medication.Moreover,some patients who were assigned to placebo decide to stop taking the placebo pill and buy the drug on their own (even when they do not know that they are taking a placebo pill).When this happens,researchers typically do the analysis according to the original assignment of the treatment regardless of the actual treatment received.What is the name of this procedure to analyze the data?
A) Randomization
B) Intention-to-treat analysis
C) Concealment of random allocation
D) Analysis as treated
E) Mediation analysis
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
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Chapter 11: Randomized Trials: Some Further Issues
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Q1) 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
Q2) 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.
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Chapter 12: Estimating Risk: Is There an Association
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Q1) Consider the following 2 × 2 table from a hypothetical cohort study.Calculate the relative risk of CVD comparing those with high fasting glucose ( 126 mg/dL) with those with normal fasting glucose (<126 mg/dL) \[\begin{array} { | l | c | c | c | } \hline \text { Serum fasting glucose } & \text { Developed CVD } & \text { Did not develop CVD } & \text { Total } \\ \hline \geq 126 \mathrm { mg } / \mathrm { dL } \text { (exposed) } & 125 & 325 & 450 \\
\hline < 126 \mathrm { mg } / \mathrm { dL } \text { (not exposed) } & 50 & 500 & 550 \\
\hline \text { Total } & 175 & 825 & 1000 \\
\hline
\end{array}\]
A) 0.33
B) 0.75
C) 1.02
D) 3.08
E) 5.34
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Page 13
Chapter 13: More on Risk: Estimating the Potential for Prevention
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Q1) In a cohort study of smoking and myocardial infarction in City A,the number of myocardial infarctions were 250 cases among 7,000 smokers and the number of myocardial infarctions were 150 cases among 20,000 nonsmokers.What is the attributable risk (risk difference) of smoking?
A) 2.8 per 1,000
B) 3.6 per 1,000
C) 7.5 per 1,000
D) 28.2 per 1,000
E) 35.7 per 1,000
Q2) 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
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Epidemiologic Studies
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Q1) Lack of physical activity is a known factor associated with colon cancer.However,colon cancer develops even among active individuals.Moreover,several individuals who perform very little levels of physical activity never develop colon cancer.Hence,in the causal relationship between physical inactivity and colon cancer,the lack of physical activity is
A) necessary and sufficient.
B) sufficient but not necessary.
C) necessary but not sufficient.
D) neither necessary not sufficient.
E) confounded.
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) Investigators think that income might be a confounder in the relationship between Hispanic ethnicity and cardiovascular disease.They conduct a case-control study,and they match cases and controls based on income.They find that Hispanics are more likely to have cardiovascular disease as compared with non-Hispanics.What is the measure of association used in such study?
A) Risk ratio
B) Relative risk
C) Incidence rate ratio
D) Attack rate
E) Odds ratio
Q2) In a case-control study,a researcher found no association between exposure to A and disease B.Later she found out that there was a misclassification when measuring exposure to A,in both cases and controls.What is a potential explanation for the results (no association) of this case-control study?
A) Nondifferential misclassification
B) Differential misclassification
C) Selection bias
D) Confounding
E) Effect-modification
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Chapter 16: Identifying the Roles of Genetic and Environmental
Factors in Disease Causation
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Q1) 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
Q2) 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
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Chapter 17: Using Epidemiology to Evaluate Health Services
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Q1) 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.
Q2) 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.
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Chapter 18: Epidemiologic Approach to Evaluating Screening Programs
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Q1) Epidemiologists decided to investigate the validity of new diagnostic tool for breast cancer.They used this new diagnostic tool for breast cancer in 150 women with biopsy-proven breast cancer in 300 age- and race-matched control women.The results of the new tool were positive in 136 cases and in 35 control women,all of whom showed no evidence of cancer at biopsy.What is the sensitivity of new diagnosis tool for breast cancer?
A) 9%
B) 12%
C) 33%
D) 91%
E) 88%
Q2) 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
Page 19
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Chapter 19: Epidemiology and Public Policy
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Q1) When decision makers are in the process of assessing whether a new policy should be implemented to avoid a certain health risk,besides considering the scientific evidence available,they should also take into account the following societal consideration:
A) If that decision would make them look good with constituents
B) The proportion of the population would be protected by such policy
C) If that new policy was proposed by prestigious academics
D) The media's opinion about the policy
E) The incidence rate of the disease
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) What of the following is an obligation that researchers have with study participants?
A) Provide a financial incentive to participate in the study.
B) Provide free treatment for any condition the subjects have.
C) Communicate the study results clearly.
D) Enroll all family members of the participants if they want to be part of the study.
E) Provide free diagnostic procedures, even if those are not related with the study.
Q2) To abide with the ethical principle of autonomy,epidemiologic research requires
A) epidemiologists to provide financial incentives.
B) to obtain participant's consent before collecting any information.
C) to investigate only participants who are in excellent health.
D) share participant's information with any institution.
E) that only one researcher is able to access the data collected.
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