Principles of Epidemiology
Mock Exam
Course Introduction
Principles of Epidemiology introduces students to the fundamental concepts and methods used in the study of the distribution and determinants of health and disease in populations. The course covers the history of epidemiology, measures of disease frequency and association, study design, outbreak investigation, and the critical evaluation of epidemiologic evidence. Through real-world examples and case studies, students will learn how to apply epidemiological reasoning to public health problems, interpret basic statistical outcomes, and consider ethical issues related to disease surveillance and prevention. This foundational course equips learners with the analytical tools necessary for advanced public health study and practice.
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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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) Thanks to the contributions of Edward Jenner,the following disease was eradicated later by efforts organized by D.A.Henderson:
A) Cholera
B) Smallpox
C) Chickenpox
D) Polio
E) Zika
Answer: B
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Page 3
Chapter 2: The Dynamics of Disease Transmission
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Q1) During the conquest of Mexico,outbreaks played an important role that favored the Spaniards.There were several outbreaks of smallpox that killed thousands of natives.Smallpox was introduced into America by the Europeans.Why were the natives particularly afflicted by smallpox outbreaks?
A) Among natives, the proportion of susceptibles was higher.
B) Among Spaniards, the proportion of immunes was extremely low.
C) Spaniards had the cure for smallpox.
D) Natives had a gene that made them more prone to die from smallpox.
E) Spaniards were protected from smallpox because they had armors.
Answer: A
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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4
Chapter 3: The Occurrence of Disease: Idisease
Surveillance and Measures of Morbidity
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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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Chapter 4: The Occurrence of Disease: II Mortality and
Other Measures of Disease Impact
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Q1) City A suffered some political changes and was divided into two cities named Alpha and Beta.Five years after the division,mortality rates in both cities are compared.The all-cause mortality rate in City Alpha is much higher than the rate in Beta.When looking at the demographic characteristics in the cities,you notice that the age distribution is almost exactly the same in both cities.What do you expect to find when the age-adjusted mortality rates are calculated and compared?
A) City Alpha will have a much higher age-adjusted mortality rate than Beta.
B) City Beta will have a much higher age-adjusted mortality rate than Alpha.
C) The age-adjusted mortality rate will be much lower than the unadjusted rate in Alpha.
D) The age-adjusted mortality rate will be much lower than the unadjusted rate in Beta.
E) The answer cannot be determined without the actual numbers.
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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.What is the sensitivity of the physical examination?
A) 32%
B) 47%
C) 56%
D) 57%
E) Cannot calculate it based on given information
Q2) Which of the following statement about positive predictive value is the most accurate?
A) Positive predictive value is a fixed characteristic of the test. It will not change over the person, place, and time.
B) Positive predictive value is affected by the sensitivity of the test only.
C) Specificity will not affect the positive predictive value.
D) Positive predictive value is the probability that a diseased person (case) in the population tested will be identified as diseased by the test.
E) None of above.
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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) Epidemiologists tried to examine the distribution of multimorbidity,and of comorbidity of physical and mental health disorders,in relation to age and socioeconomic deprivation.They extracted data on 40 morbidities from a database of 1,751,841 people registered with 314 medical practices in Scotland as of March 2007.They analyzed the data according to the number of morbidities,disorder type (physical or mental),sex,age,and socioeconomic status.They defined multimorbidity as the presence of two or more disorders.[From Barnett K,Mercer SW,Norbury M,et al.Epidemiology of multimorbidity and implications for health care,research,and medical education.Lancet.2012;380(9836):37-43.] What is the proper classification for this study?
A) Cross-sectional study
B) Prospective cohort study
C) Case-control study
D) Randomized trial
E) Case report
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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) 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) 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 \[\begin{array}{r}
\text { Obesity status }\\
\text { Exercise status } \begin{array} {|l|l|l|}
\hline& \text { Yes } & \text { No } \\
\hline \text { Yes (regular exercise) } & 7 & 27 \\
\hline \text { No (no exercise) } & 43 & 73\\
\hline \end{array}\end{array}\]
A) 0.16
B) 0.26
C) 0.37
D) 0.44
E) 0.59
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Chapter 13: More on Risk: Estimating the Potential for Prevention
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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) 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) 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 would you conclude about income as a potential confounder in this association?
A) Income is a confounder.
B) Income is not a confounder.
C) Income is an effect modifier.
D) Income is not associated with cardiovascular disease.
E) Income is not associated with ethnicity.
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) 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 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.
Q2) 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
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18
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 most reasonable conclusion to be drawn from these data?
A) Positive predictive value of new diagnostic tool for breast cancer in City A is higher than expected positive predictive value in City B.
B) Positive predictive values will be higher than sensitivity.
C) Positive predictive value is affected by the specificity of the test only.
D) Prevalence will not affect the positive predictive value.
E) Positive predictive value is a fixed characteristic of the test. Therefore the positive predictive value in City A will be same as positive predictive value in City B.
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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) 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.
Q2) 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.
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