Epidemiologic Methods
Test Preparation
Course Introduction
This course provides an in-depth introduction to the fundamental principles and methods used in epidemiologic research. Students will explore study designs such as cohort, case-control, and cross-sectional studies, and gain practical skills in measuring disease frequency, association, and causation. Emphasis is placed on the application of epidemiologic methods to public health practice, including the control of bias, confounding, and error. Through lectures, readings, and hands-on exercises, students will develop the ability to critically evaluate epidemiologic literature and conduct basic epidemiologic analyses, preparing them to apply these methods in real-world public health and clinical research settings.
Recommended Textbook
Gordis Epidemiology 6th Edition by Celentano ScD MHS
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19 Chapters
150 Verified Questions
150 Flashcards
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Chapter 1: Introduction
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Sample Questions
Q1) 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
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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Page 3
Chapter 2: The Dynamics of Disease Transmission
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Sample Questions
Q1) What is the name of the occurrence of a clearly higher than expected number of cases of a disease within a limited geographical region?
A) Pandemic
B) Epidemic
C) Endemic
D) Zoonosis
E) Attack rate
Answer: B
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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Sample Questions
Q1) At an initial examination in Baltimore,Maryland,disease X was found in 10 of 1,000 men aged 40 to 50 years and in 10 of 2,000 women aged 30 to 40 years.Which of the following statement is the most accurate inference for the risk of developing disease X?
A) Men have a 2 times greater risk of developing disease X than women.
B) Women have a 2 times greater risk of developing disease X than men.
C) People aged between 40 and 50 years have a 2 times greater burden of developing disease X than people aged between 30 and 40.
D) People aged between 30 and 40 years have a 2 times greater burden of developing disease X than people aged between 40 and 50.
E) We cannot make any inference of risk of developing disease X.
Answer: E
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5
Chapter 4: The Occurrence of Disease: II Mortality and
Other Measures of Disease Impact
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Sample Questions
Q1) 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.
Q2) 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.
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Chapter 5: Assessing the Validity and Reliability of Diagnostic and Screening Tests
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Sample Questions
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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Sample Questions
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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Sample Questions
Q1) Researchers wanted to provide additional support for a causal association between human papillomavirus (HPV) and oropharyngeal cancers.They performed an epidemiologic study of 100 patients with newly diagnosed oropharyngeal cancer and 200 control patients without cancer to evaluate associations between HPV infection and oropharyngeal cancer.[D'souza G,Kreimer AR,Viscidi R,et al.A study of human papillomavirus and oropharyngeal cancer.N Engl J Med.2007;356(19):1944-1956.] What kind of study design is this?
A) Retrospective cohort study
B) Prospective cohort study
C) Case-control study
D) Randomized trial
E) Case report
Q2) A researcher study of Baltimore's neighborhoods showed that those neighborhoods with lower median household income experienced a higher teen pregnancy rate.What type of study design was used?
A) Cohort
B) Case-control
C) Ecologic
D) Experimental
E) Randomized trial
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Chapter 8: Cohort Studies
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Sample Questions
Q1) 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
Q2) 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.
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Chapter 10: Assessing Preventive and Therapeutic
Measures: Randomized Trials
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Sample Questions
Q1) 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
Q2) 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
Page 11
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Chapter 11: Randomized Trials: Some Further Issues
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Sample Questions
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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Sample Questions
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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Sample Questions
Q1) A politician asks an epidemiologist how many cases of coronary heart disease can be prevented if they manage to eliminate the exposure to smoking in city A.The epidemiologists explain that,if they eliminate smoking,they could prevent 22% cases of coronary heart disease.What measure of association was used to answer this question?
A) Population attributable risk
B) Odds ratio
C) Relative risk
D) Incidence rate
E) Risk ratio
Q2) 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 relative risk of smoking in this cohort study?
A) 0.5
B) 1.7
C) 3.5
D) 4.8
E) 7.5
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Epidemiologic Studies
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Sample Questions
Q1) Cardiorespiratory fitness,measured as VO max in mL/kg/min (maximum oxygen consumption),is associated with increased longevity.Recent evidence suggests that higher fitness increases the life span.Those with a low VO max have a life expectancy after 60 years of 7 years,those with moderate VO max of 15 years,and those with a high VO max have a life expectancy after 60 of 23 years.Which of the causal criteria is illustrated with this example?
A) Temporal relationship
B) Strength of association
C) Replicability of findings
D) Specificity of association
E) Dose-response effect
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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Sample Questions
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 most reasonable conclusion to be drawn from these data?
A) Genetic factors are unimportant in the etiology of childhood cancer.
B) The data suggest a potentially important genetic component.
C) The incidence of childhood cancer within monozygotic twins is higher than dizygotic twins.
D) The prevalence of childhood cancer within dizygotic twins is higher than monozygotic twins.
E) Environmental factors are the major determinants of child food cancer.
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Chapter 17: Using Epidemiology to Evaluate Health Services
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Sample Questions
Q1) According to the healthy people 2020,the following is an indicator of access to health services:
A) Persons with a usual primary care provider
B) Persons with a diagnosed diabetes whose A1c is greater than 9%
C) Adolescents with a major depressive episode in the past 12 months
D) Knowledge of serostatus among human immunodeficiency virus (HIV)-positive persons
E) Adult cigarette smoking
Q2) The government of Country A decided to introduce a new treatment strategy for disease X.It was decided that,starting in January 1,2019,all patients diagnosed with disease X in public hospitals would receive the new treatment.Researchers were asked to evaluate the new treatment.Which of the following designs is the best approach to evaluate the new treatment?
A) Randomized clinical trial
B) Case-control study
C) Cross-sectional survey
D) Before-after study
E) Case-series
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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.Now,the epidemiologists want to use the new diagnostic tool for screening program in Cities A and B.Based on previous cross-sectional studies,the prevalence of breast cancer is 5% in City A and 1% in City B.What is the expected positive predictive value of new diagnosis tool for breast cancer in City A?
A) 30%
B) 43%
C) 81%
D) 89%
E) 91%
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Chapter 19: Epidemiology and Public Policy
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Q1) 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
Q2) 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.
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Page 20
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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