BBH 440: Final Exam
A study looking at breast cancer in women found that 70/100 of women with breast cancer did not use calcium supplements compared with 30/100 of women without breast cancer. What would the equation to calculate the odds ratio be? HINT: you should set up a 2 x 2 table to answer this.
(30/70/(70/30)
Which of the following is Florence Nightingale NOT remembered for:
-*vaccinations* -nursing -hygiene -statistics
Which of the following would NOT be a reason for seeing a decrease in the prevalence of a disease?
-Decrease in incidence of the disease -Rapid increase in death due to the disease -Rapid increase in recovery from the disease -*Improvement in treatment of the disease (but not cured)*
Why is it that individuals switch to using heroin after becoming addicted to opioid pain relievers (OPRs)?
-Heroin is less expensive than prescription opioids -Heroin is more easily accessible than prescription opioids
All of the following are true about incidence EXCEPT:
-Incorporates an aspect of time -Can be used to measure how quickly a disease is spreading -Can be used to assess causal factors -*The denominator includes all individuals in a population during that period of time*
Which types of tests are done to screen for CVD?
-Weight (to calculate BMI) -Systolic and diastolic blood pressure
When would you use the indirect method for age adjustment?
-When you don't know the age-specific rates -When the age-specific rates are unstable or unreliable
Which of the following would NOT be considered host factors that influence susceptibility, exposure, and/or response to agents?
-age -health of immune system -a person's disease history -*all of the above could be considered host factors*
ecological fallacy
-an error of reasoning -occurs when conclusions are drawn about individuals from data that are associated with groups (CANT DRAW CONCLUSIONS)
These are components of a good clinical trial, EXCEPT for:
-blinding -placebo -randomization -use of concurrent controls -*all are components of a good clinical trial*
Why is time trend useful in epidemic curves?
-date of illness onset for the first case -date of illness onset for last case -date when the outbreak peaked
Characteristics of an outbreak
-pattern of spread -magnitude -time trend -exposure and disease incubation period
Bradford Hill Criteria for Causality
-temporality -strength -dose response -consistency -biological plausibility -experiment -specificity -coherence
Nosocomial infections are often the result of:
-unsterile environmental surfaces -drug resistance of infectious agents -lack of hand washing
Why is exposure useful in epidemic curves?
-we are able to determine a probably date of common exposure for a common point source epidemic
Two hundred and fifty people attended a picnic (80 men and 170 women). One hundred and twelve became ill after attending the picnic (36 men and 76 women), of which, 34 men and 76 women got sick after eating salad greens and 2 men got sick after eating raw meat. What is the attack rate for attendees at this picnic?
112/250
Health officials are monitoring a screening program for STD testing at a facility. 250 individuals have been tested for a particular STD. 60 people tested positive and 190 people tested negative. Of the 60 people who tested positive, 8 truly did not have the disease (false positive). Of the 190 who tested negative, 180 truly did not have the disease. What would the negative predictive value be for this test?
180 / 180 + 10 = 95%
how would this odds ratio be expressed as a percent change OR=0.67 (95% CI:0.53-0.81)
33% decrease (below 1 is decrease)
The following statements are true about 5-year survival rates for cancer EXCEPT for:
5-year survival rates are highly influenced by prevalence of cancer type.
In a sample of 1000 people who are screened, 100 actually have disease A. The screening test identifies 95/100 of the diseased individuals as potential disease cases. The sensitivity of the screening test is:
95%
Prior to George Soper's work to identify Mary Mallon's role in the typhoid epidemic, it was thought that typhoid was:
A common source disease from food/water
The DPCP is the period of time between __________________ and __________________
A screening test being able to identify disease; onset of symptoms
What is the typical relationship between the length of the DPCP and the progression of disease?
A shorter DPCP indicates a faster progression of disease
Alzheimer's disease is characterized by a loss of neurons in the brain due to __________.
Abnormally-folded proteins
What is generally the best predictor of how rapidly Parkinson's disease will progress once it is diagnosed?
Age of the patient at diagnosis
Which of the following statements is NOT true about epidemic curves?
An epidemic curve is a statistical calculation of how an outbreak of disease affects a population
Which of the following is NOT an example of a physiological characteristic that confers innate immunity?
Antibodies passed from mother to baby
A pandemic is more likely to occur as a result of:
Antigenic shift
Which of the following is NOT a part of the Health and Human Service 5-point strategy to combat opioid abuse?
Better genetic testing for predisposition of addiction
Which of the following types of cancers could be labeled as "good" based on high 5-year survival rates?
Breast, testicular, prostate
The Women's Health Initiative Clinical Trial ended early due to:
Early findings that HRT may have led to higher risk for breast cancer
Based on evidence from the National Transportation Safety Board Study shown in class, fatigue-related accidents occur most often in the:
Early morning (1-7am)
A researcher obtains data from hospital records on the number of asthma cases in 1972 in County X, as well as data regarding pesticide use on crops for that same year in the same county. The researcher finds a correlation between the two variables. This is what type of study?
Ecological
Who contributed to the development of the smallpox vaccine?
Edward Jenner, and Benjamin Jesty
T/F: There is a link between thimerosal and ASD
FALSE: no link
T/F: boys are 3 times more likely than girls to develop ASD?
FALSE; 4 times
T/F: Most strain or E. coli are harmful to humans
FALSE; harmless
consent can only be given verbally and requires that a person be competent in order to agree to engage in sexual activity
False
Which of the following is NOT considered a modifiable (controllable) risk factor for CVD?
Family history
An agent is highly contagious; upon introduction to a population, it spreads rapidly throughout the population. It often causes illness, but not serious illness such as death. Which best describes the agent?
High infectivity, low virulence
If an infectious agent can survive many adverse environmental conditions but rarely causes severe or fatal illness, it is said to have:
High resistance, low virulence
In general, which of the following cancer stages has the worst prognosis?
IV
Lily a 54 year old woman who has had Type 2 diabetes for 3 years. She regularly is monitored to manage her condition, but recently has been experiencing some concerning symptoms. At her most recent visit, there was discussion of the possibility of dialysis. What is the most likely complication from diabetes that Lily is experiencing?
Impairment of kidney function
Which of the following would be considered a confounding variable?
In a study of the effects of frequent exercise on risk of heart disease: the history of diabetes
Which of the following was NOT a finding from the Sexual Misconduct Survey?
In most cases, the perpetrator was a stranger
Which of the following is TRUE regarding the interpretation of relative risk values?
In order for a relative risk to be meaningfully interpreted, a p-value must be present to evaluate statistical significance
Which would NOT be considered a distal outcome of sleep loss?
Increased risk of falls and injury
The difference between incubation time and generation time is:
Incubation time is the time between infection and the first appearance of symptoms, while generation time is the time between infection and when a host is most contagious
Acetylcholinesterase inhibitors work to treat Alzheimer's disease by:
Inhibiting the activity of an enzyme involved in the breakdown of the neurotransmitter acetylcholine
Which of the following is NOT a limitation of the "high-risk" prevention strategy?
It creates more benefits than risks
Jackson recently was the victim of sexual assault. Which of the following is Jackson LEAST likely to experience afterwards?
Jackson could be experiencing all of the above
A disease outbreak occurs where the first case is January 17th, the last case is February 5th, and the peak number of cases is on January 27th. The average incubation period for the pathogen that caused the outbreak is 12 days with a range of 10-15 days. What is the probable date of common exposure?
January 15th
Which of the following characterizes Type II diabetes?
Late age of onset of symptoms
What role did Purdue Pharma play in opioid consumption in mid 1990s?
Manufactured extended release OxyContin
All of the following are true about mortality trends in the past century EXCEPT:
Mortality rates from infectious diseases have steadily increased since the 1918 Spanish flu
Researchers are conducting a study to examine the potential relationship between physical activity and obesity in adolescents. They conduct a survey asking college students to report the number of minutes of moderate to vigorous physical activity in a typical week and self-reported height and weight to compute BMI. What type of bias is most likely to affect their results?
Non-response bias; OR recall bias
Which of the following is NOT an example of a ratio?
Number of homicides of which were male
A researcher conducts a survey in which it is asked, "Are you now suffering from depression or have you ever experienced an episode of depression in your life?" The rate that would be obtained if the researcher then calculated the total number of individuals who have experienced depression (now and in the past) out of the total group surveyed would be:
Period prevalence rate
-unblinded, uncontrolled study with less than 30 people -*purpose is to determine the safety of a test in humans* -usually uses healthy subjects -often undergo intense monitoring
Phase #1 trial
-*test ability of a drug or combo; produce measurable effects on the disease* -well-controlled, involve diseased patients -Phase 1 & 2 may be combined for some drugs
Phase #2 trial
-post-marketing studies to further assess risk; benefits efficacy against alternative therapies, optimal dosing -post-marketing studies sometimes show the drug is very risky; sometimes lead to withdrawal of drug by FDA
Phase #4 trial
Researchers are designing a study to see if their new drug Superb is better at improving one's cognitive function than regular exercise or taking supplements. What kind of trial is this?
Phase 3
Which of the following most accurately describes the "prevention paradox"?
Prevention strategies that benefit the population as a whole often do very little to help the individual
1906 Pure Food and Drug Act
Prohibits the sale and transport of adulterated or mislabeled food, drinks and drugs. Prohibits the mislabeling and misbranding of products.
Which of the following would NOT be considered a responsibility of an epidemiologist?
Provide a diagnosis for an emerging infectious disease
With a _______ , the values of X are not contained within the value of Y, whereas with a _______, the values of X are contained in the value of Y.
Ratio: Proportion
Which of the following correctly orders the procedural steps for procedural steps for conducting a clinical trial?
Select Sample→ randomization of participants→ apply intervention→ assess outcome
E. coli's powerful toxin
Shiga toxin
Marisa loves to work out but can't stand working out first thing in the morning because she feels extremely tired. This would best be described by the term:
Sleep inertia
This risk factor for diabetes has to do with increasing levels of cortisol as well as making one feel more hungry and less satisfied after having eaten. Which example below best fits this concept?
Sleeping fewer hours due to over commitments of school work, job, and/or social responsibilities
Virulence is characterized by:
The capacity of an infectious agent to cause a very serious illness or death
In an experiment it is found that the odds ratio for a particular exposure and a disease is 1.89 and it is statistically significant. This suggests that:
The exposure is associated with increased probability of having the disease
An epidemic curve shows progression of illnesses in an outbreak over time. What is usually put on the vertical axis (Y axis) of the curve?
The number of persons infected with the illness
A 5-year survival rate refers to:
The proportion of patients who are still alive 5 years after cancer diagnosis
herd immunity
The resistance of a group to an attack by a disease to which a large proportion of the members of the group are immune -halts transmission
There were 1,986,000 deaths in the United States in 1982. What additional information is required to compute the crude mortality rate?
The total US population in 1982
Patient #1 has 80mg/dL HDL and 160mg/dL LDL. Patient #2 has 60 mg/dL HDL and 120 mg/dL LDL. Which patient would appear to have the higher risk for heart disease based on these numbers?
Their risk is equal
Incubation period
Time period between initial contact with the infectious agent and the appearance of the first signs or symptoms of the disease
Which of the following trends associated with diabetes prevalence and risk factors is NOT true?
Type 1 diabetes is associated with a higher genetic basis than type 2 diabetes
The most recent 2009 H1N1 outbreak was a result of antigenic shift and reassortment between human, avian, and swine viruses. What subtype of influenza virus did this include?
Type A
Having had the chicken pox previously confers what kind of immunity?
acquired natural active
In 1948, the Framingham Heart Study recruited 5,209 men and women between the ages of 30 and 62 from the town of Framingham, Massachusetts, and conducted extensive physical examinations and lifestyle interviews every 2 years to determine what risk factors are associated with cardiovascular disease. Is this an example of descriptive or analytic epidemiology?
analytic
To examine the relationship between long-term e-cigarette use (5+ years) and cardiac arrhythmia; group of long-term non e-cigarette users without cardiac arrhythmia were recruited into the study. Monthly resting HR were taken to assess arrhythmia.
analytic and observational
In the direct method of age adjustment, after selecting a reference population, the next step is to:
apply age-specific rates from study population A to the reference population
After being bitten by a rabid bat, a woman is given an injection of human antibodies (e.g., rabies immunoglobulin). This creates what type of immunity?
artificial-passive
Individuals are classified as pre-diabetic based on their:
blood glucose levels
This treatment for coronary artery disease involves creating a new route for blood to travel around an arterial blockage:
bypass surgery
A research group is interested in studying the relationship between episodes of anger and heart attacks. They find a group of people who have had heart attacks and ask them whether they experienced an episode of anger in the 2 hours before their heart attack. They also ask them if they experienced an episode of anger in another 2-hour period the week before having a heart attack. This is what type of study?
case-crossover study
Marilyn is diagnosed with Stage 4 lung cancer and starts treatment that involves regularly taking a medicine that kills rapidly dividing cells.The terms for this type of treatment is:
chemotherapy
This cancer treatment involves the use of chemical agents, often those that target cell division in the hopes of inhibiting the spread of cancerous cells.
chemotherapy
Strength training on cardiovascular risk among women; 30,548 women without CVD aged 15-64 participated from 1978-1995
cohort study
John Snow helped end the cholera epidemic by showing that it was predominantly a:
common source epidemic
harbors and can spread the agent after the clinical symptoms have disappeared
convalescent carrier
James is recovering from an illness. He is feeling better, but still not 100%. James is most likely in what stage of the illness?
convalescent period
To examine the association between sexting behaviors and sexually transmitted infections (STI's); sexting behaviors, sexual behaviors, recent STI's, and demographic information
cross-sectional study
The number of new cases per year of a disease has not changed, but a drug-resistant strain of the bacteria that causes the disease has led to significant increases in the number of deaths due to the disease. These changes will likely cause the prevalence rate to:
decrease
an infectious agent is killed off or in remission during his stage
defection period
A researcher conducts a survey of college students in Pennsylvania to find out how many of the use marijuana on a regular basis. Is this an example of descriptive or analytic epidemiology?
descriptive
A researcher conducts a survey that is used to find the prevalence of HPV in the United States. Based on this information alone, this is what type of research:
descriptive
The form of diabetes that is characterized by hyperglycemia is known as:
diabetes mellitus
Samantha recently found out she has herpes simplex and suspects it came from a stranger she kissed at a party a few weeks ago. Assuming her suspicion is correct, what type of transmission is this?
direct - host-to-susceptible host contact
Which key term in the definition of epidemiology is best described as "the study of frequency and pattern of health events in a population"?
distribution
Parkinson's disease is characterized primarily by the loss of _________ neurons in the _____________.
dopamine; substantia nigra
One important finding from the Doll and Hill Physician's Study was that as the number of cigarettes smoked increased, there was greater risk for lung cancer mortality. This is an example of which of Bradford Hill's criteria of causality?
dose response
To evaluate an intervention to reduce hypertension among adults; local schools, community events, mass media, 4 cities in southeast U.S.
ecological study
62 cases of hepatitis A were reported in Pennsylvania in 2018, slightly less than the annual average
endemic disease
47 cases of acute flaccid myelitis
epidemic disease
Diabetes insipidus is characterized by hyperglycemia.
false
During the development of atherosclerosis, blood clotting and obstruction lead to an inflammatory response.
false
L-DOPA is capable of stopping the neurodegeneration that occurs in Parkinson's disease.
false
Sexual assault is predominately a US public health issue as opposed to a global health issue.
false
The term "cancer" describes any tumor, whether the tumor is classified as "benign" or "malignant."
false
During a study testing a new screening tool for a chronic disease, an individual is screened for the disease and the test comes back negative; however, in reality, the person does have the disease. The initial screening test is an example of a:
false negative
Charlotte goes to the doctor complaining of a sore throat and is diagnosed with strep throat. The next day, her symptoms get much worse and for a few days she has a severe fever, sore throat, and difficulty swallowing. These few days where her symptoms are at their worst is known as:
fastigium period
An outbreak occurs where the first case is detected on February 15th, the last case is detected on February 27th, and the peak is on February 22nd. The average incubation period for the disease is 7 days with a range from 1-15 days. What is the probable period of exposure?
february 12-14
Ignaz Semmelweis is known for his work to emphasize the importance of _________ in preventing disease.
hand-washing
harbors and can spread pathogen but is not ill and never shows symptoms of disease
healthy carrier
A pathogen is extremely contagious but when people are infected by it they generally don't ever become sick and they display no clinically apparent symptoms. Based on this information the pathogen has:
high infectivity
Which is NOT true about hypercholesterolemia?
high levels of HDL are a risk factor in progression of atherosclerosis
The most common form of cardiovascular disease is:
hypertension
After a chemical spill, a number of workers spend various amounts of time working at the spill site to clean it up. A researcher keeps track of the number of hours they spend working there, then 6 months later calculates the number of new cases of respiratory illness that have occurred in the workers out of the total number of hours spent working at the site (for all workers). This rate would be known as a/an:
incidence-density rate
In the small rural community, numerous young and healthy adults have moved away in search of better job opportunities. What is the likely effect on the prevalence of diabetes in this community?
increased prevalence
Joe wakes up one morning with a sore throat and runny nose. He thinks back to when he might have gotten infected. Joe is trying to calculate his:
incubation time
Tom has been exposed to a virus but hasn't developed and symptoms yet. He is however contagious. What type of carrier would he be?
incubatory carrier
Jason walks into class without realizing that a student had sneezed as she walked out 15 minutes earlier and expelled viral particles that remained in the air, floating on dust particles. Jason walks through this "cloud" of viral particles and becomes sick 3 days later. What type of transmission is this?
indirect-airborne
loss to follow-up (selection)
individuals are lost to follow-up over the study; *more problematic if non-random*, should NOT exceed 20% (cohort)
healthy worker bias (selection)
individuals who participate in studies tend to be healthier than those who do not (cohort)
The "secondary attack rate" helps identify agents with high ____?
infectivity
If an individual is known to be sick, they would be _________________ from the healthy population; if they have been exposed to a pathogen but it is not yet known if they will get sick, they would be _______________.
isolated; quarantined
An advantage of an ecological study is:
it can examine broad trends across diseases and exposures
When a screening test picks up more cases of slowly progressing, less severe disease because the quickly progressing and more serious cases of disease have a shorter asymptomatic phase, it can inflate survival statistics. This is known as:
length bias
When a screening test picks up more cases of slowly progressing and less severe disease because the quickly progressing and more serious
length time
Pathogen B is very contagious but the vast majority of people who become infected with it never display any clinical signs of disease. Based on this information, pathogen B had:
low pathogenicity
which is the deadliest cancer type in women?
lung/bronchus
Jocelyn has previously been infected with measles. When she is exposed to the measles virus again, her immune system recognizes it and prevents her from getting sick. What type of immunity is this?
natural-active
A study compares performance data from 2 groups of participants. Group A includes people who sleep between 10pm and 8am, and Group B includes people who sleep between midnight and 6am every day for 2 weeks. Everything else is equal between the groups. They find that group A performs better than group B. Which determinant of sleepiness is most likely contributing to this result?
nightly sleep duration
A researcher publishes a case series that describes 18 cases of a previously unknown disease. Based on the information in the case series, the author concludes that the disease is caused by excessive sun exposure. Disregarding any of the potential details of the case series, is the researcher able to make this conclusion?
no
Over 20 million people worldwide died from influenza (Spanish Flu) in 1918-1919
pandemic disease
Which of the following is NOT a Bradford Hill criteria for causality?
particularity
Patient #1 has a total cholesterol of 200 and HDL of 50. Patient #2 has a total cholesterol of 210 and HDL of 70. Based on these numbers alone, which patient seems to have a higher risk of cardiovascular disease?
patient #1
Alejandra is a 12 year old girl living in the town of Guatapé, Colombia and became ill after spending time playing around animals. The infection was unfamiliar to the members of the community and many others became ill. James is an English backpacker who spent a few days in Guatapé visiting the nearby lake during the same week that the townspeople became ill. Upon returning to the city of Medellín, he fell ill and soon thereafter, infection was widespread in the neighborhood where he was staying. Local and international public health officials caught wind of the news and soon James' story made international headlines. In this scenario, Alejandra is the __________ and James is the __________.
primary case; index case
During the stage of clinical disease, it is likely to find all types of prevention EXCEPT for:
primary prevention
Ethan recently attended a family reunion and noticed some of his family members were not feeling well. A few days later, he woke up with a fever and sore throat. What part of the natural history of disease does the first appearance of the fever and sore throat represent?
prodromal point
Which of the following would be the best study to use if you wanted to be able to confidently say one variable causes another variable to change?
prospective cohort study
The population of State College is 41,757 and the number of automobiles registered to members of the population is 30,016. There are thus 30,016 cars to 41,757 people or .72 cars per person. This comparison is a:
ratio
1924 Grade A Pasteurized Milk Ordinance
requires pasteurization of milk because it will kill harmful bacteria
Study participants sometimes have a difficult time answering questions accurately (difficulty with recall, lying, etc). This represents what type of bias?
response bias
A program has been created to work with local hair stylists to show them how to detect unusual moles and lesions on a client's head. If the stylist sees an unusual spot, they are encouraged to refer their clients to a local dermatologist for subsequent testing for skin cancer. This program is best described as what type of prevention?
secondary, population level
Bradykinesia is a term that refers specifically to the _____________ seen in Parkinson's disease.
slow movement
The first vaccine was developed to prevent:
smallpox
Which stage would taking a medication such as buprenophrine for opioid use disorder be in?
stage of recover, disability, or death
Javier has 3 roommates. Two of Javier's roommates have been sick for nearly a week with a contagious respiratory illness. They both went to Health Services for testing, diagnosis, and treatment but still have all the symptoms. The third roommate has been feeling fine, with no signs of being sick. Javier was also fine until yesterday, when he began showing many of the same symptoms of the illness as the first two roommates. Which would best describe Javier?
suspect case
Based on the sleep homeostatic model, the more hours you spend awake after the time you would generally sleep...
the higher your sleep drive is
On an epidemic curve for a common point source the time period between exposure and the peak number of reported cases represents:
the mean incubation period
All of the following are true about inactivated vaccines EXCEPT:
the pathogen may revert to a virulent form
Which of the following is NOT true regarding ASD?
thimerosal in vaccines is an environmental cause
If a mortality rate increases after age adjustment, it suggests the study population is __________ than the reference population.
younger