Epidemiology is the study of the distribution and determinants of health-related states and events in specified populations, and the application of this study to control health problems. This course provides foundational knowledge of epidemiological methods, including study design, measures of disease frequency and association, sources of error, and strategies for bias control. Students will learn to interpret epidemiological data, critically assess public health research, and apply epidemiological reasoning to solve health challenges at both the population and community levels.
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Q1) 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
Q2) 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
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Chapter 2: The Dynamics of Disease Transmission
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Q1) 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
Q2) 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
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Chapter 3: The Occurrence of Disease: Idisease
Surveillance and Measures of Morbidity
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Q1) In the student's health clinic of a certain university,140 cases of foot-hand-mouth disease were identified among the undergraduate students.This viral infection is usually mild,and none of the students got any complication.Because it is rare to observe this condition in people older than 10 years,the university reported their findings to the city's health department.Three officers were sent to the university to interview and examine all the infected students and their contacts.By sending the three officers,what type of surveillance was implemented by the city health department in response to the university's report?
A) Sentinel
B) Periodic
C) Systematic
D) Passive
E) Active Answer: E
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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) A 60-year-old patient,who is an epidemiologist,was tested for Raven disease; his test came back positive.However,he is curious about the sensitivity of the test.
\[\begin{array} { | l | c | c | c | }
\hline \text { Test } & \text { Disease } ( + ) & \text { No disease } ( - ) & \text { Total } \\
Using this table,calculate the sensitivity of the test.
A) 4%
B) 33%
C) 66%
D) 70%
E) 96%
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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) 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
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 the nested case-control study?
A) A control who is selected early in the study could later develop the disease but cannot be a case in the same study.
B) In nested case-control studies, controls are a sample of individuals who are at risk for the disease at the time each case of disease develops.
C) Controls are randomly chosen from the defined cohort with which the study began.
D) The problems of possible recall bias from conventional case-control studies still remains.
E) Nested case-control studies are often less economical to conduct.
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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Chapter 10: Assessing Preventive and Therapeutic
Measures: Randomized Trials
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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) 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
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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 information summarizes the exercise status and obesity status in a case-control study.What is the odds ratio of regular exercise in this study? Use the following table to answer the question. Exercise Status by Obesity Status \[\begin{array}{r}
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Chapter 13: More on Risk: Estimating the Potential for Prevention
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Q1) The following is a measure of the strength of association,typically used in case-control studies to measure the association between exposure and disease:
A) Incidence rate
B) Population attributable fraction
C) Attributable fraction
D) Prevalence
E) Odds 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 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
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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) 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) Smoking participants of a cohort study are more likely to drop out.It is known that the effect of asbestos on getting cancer is much stronger among smokers.When analyzing data for this study,researchers find no association between asbestos and cancer.A potential explanation for the results of the study is
A) confounding.
B) effect modification.
C) selection bias.
D) information bias.
E) specificity of association.
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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 discordance rate,in dizygotic twins,of the disease in twin pairs with at least one affected member?
A) 0.1
B) 0.2
C) 0.6
D) 0.8
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 efficiency?
A) A measure of a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions.
B) The process of testing a vaccine in a community where some of individuals do not want to be vaccinated.
C) The process of testing a new drug in a community where individuals have various compliances of drug intake.
D) The process of estimating the best effort of intervention or procedure.
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) In the model of the Natural History of Disease,the period of time between the onset of signs and symptoms of disease and its ultimate outcome (cure,control,or death) is known as
A) preclinical phase.
B) clinical phase.
C) clinical horizon.
D) incubation period.
E) latent period.
Q2) A recent study found that screening for disease X led to increased survival.In the study,those who were screened were generally younger,healthier,and more aware of their health than those who were not screened.This makes it hard to evaluate whether the improvement in survivorship was due to the screening program or due to the characteristics of those who are screened.What is the name of this issue when evaluating the effect of a screening program?
A) Lead time bias
B) Overdiagnosis bias
C) Selection bias
D) Misclassification bias
E) Length-biased sampling
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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) 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.
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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