Exam 3
local or state, depending on the town
A physician working in an emergency room in Town A, USA, has just examined a tourist from Southeast Asia with watery diarrhea. The physician suspects the man might have cholera. The physician should notify the . . . A. Local (town or county) health agency. B. State health department. C. Centers for Disease Control and Prevention (CDC). D. U.S. Department of State. E. Washington, D.C., embassy of country of origin (ask for health attaché).
geographic location of exposure of each case-patient, residence of each case-patient
A spot map is particularly useful for displaying: A. Geographic location of exposure of each case-patient B. Residence of each case-patient C. Incidence rate of disease by area D. Prevalence rate of disease by area
Data collection, analysis, interpretation, dissemination
As described in this lesson, public health surveillance includes which activities? A. Data collection. B. Data analysis. C. Data interpretation. D. Data dissemination. E. Disease control.
A
At the Eclipse Restaurant, sodium nitrite was mistaken for table salt in the preparation of breakfast one morning only
nature of disease, number of cases, resources available, health departments traditional attitude toward conducting field investigations
Factors that influence a health department's decision whether or not to conduct a field investigation in response to one or more cases of disease include: A. The nature of the disease B. The number of cases C. Resources available D. Health department's traditional attitude toward conducting field investigations
false
Health-care providers might be important sources of surveillance data used by public health officials, and they should receive feedback to close the surveillance loop as a courtesy; however, the results almost never have any relevance to patient care provided by those health-care providers. A. True. B. False.
true
Ideally, a case definition is 100% accurate in identifying who does and does not have the disease in question, but in reality few case definitions achieve this ideal. A. True B. False
false
If a particular outbreak presents an unusual opportunity to learn more about the disease and its epidemiology by conducting a study, but early disease control measures would interfere with the study, one should conduct the study quickly, then implement control measures immediately afterwards. A. True B. False
If the problem is new and systematically collected data are needed to characterize the disease and its impact on the public, To guide, monitor, and evaluate programs to prevent or control the problem.
Initiating surveillance for a public health problem or adding a disease to the notifiable disease list is justified for which of the following reasons? A. If it is a communicable disease with a high case-fatality rate. B. If the problem is new and systematically collected data are needed to characterize the disease and its impact on the public. C. If a program at CDC has recommended its addition to better understand national trends and patterns. D. To guide, monitor, and evaluate programs to prevent or control the problem.
Environmental monitoring data, hospital discharge data, lab results, notifiable disease reports
Key sources of morbidity data include which of the following? A. Environmental monitoring data. B. Hospital discharge data. C. Laboratory results. D. Notifiable disease reports. E. Vital records.
hospital discharge data, laboratory results, notifiable disease reports
Key sources of morbidity data include which of the following? A. Environmental monitoring data. B. Hospital discharge data. C. Laboratory results. D. Notifiable disease reports. E. Vital records.
true
Negative Predictive Value is the probability that a test reflects a person who does not have the disease you are testing for. T or F
false
Notifiable disease surveillance usually focuses on morbidity from the diseases on the list and does not cover mortality from those diseases. A. True. B. False.
false
Once a case definition for an outbreak investigation has been established, it should not be changed. A. True B. False
all
One week, a state health department received substantially more case reports of a disease in one county than had been reported during the previous 2 weeks. No increase was reported in neighboring counties. Possible explanations for this increase include which of the following? A. An outbreak in the county. B. Batch reports. C. Duplicate reports. D. Increase in the county's population. E. Laboratory error.
Investigation efforts take priority over disease control and prevention efforts
Outbreak with known causative agent, but unknown source and mode of transmission A. Disease control and prevention efforts take priority over investigation efforts B. Investigation efforts take priority over disease control and prevention efforts
disease control and prevention efforts take priority over investigation efforts
Outbreak with known causative agent, source, and mode of transmission A. Disease control and prevention efforts take priority over investigation efforts B. Investigation efforts take priority over disease control and prevention efforts
Investigation efforts take priority over disease control and prevention efforts
Outbreak with unknown causative agent, source, and mode of transmission A. Disease control and prevention efforts take priority over investigation efforts B. Investigation efforts take priority over disease control and prevention efforts
false
Positive Predictive Value is a constant measurement of a test, regardless of the population it is used on. T or F
similar but unrelated case, secondary case
Possible explanations for a case that occurs substantially later than the other cases in an outbreak include: A. Similar but unrelated disease B. Secondary case C. Case with unusually long incubation period D. Time of exposure later than others E. Error in recording date
A method to monitor occurrences of public health problems.
Public health surveillance can be described primarily as which of the following? A. A method to monitor occurrences of public health problems. B. A program to control disease outbreaks. C. A system for collecting health-related information. D. A system for monitoring persons who have been exposed to a communicable disease.
False
Public health surveillance is only conducted by public health agencies. A. True. B. False.
Confirm that the number of cases exceeds the expected number, Verify the diagnosis, Talk with laboratorians about specimen collection, Conduct active surveillance for additional cases, Analyze data by time, place, and person, Generate hypotheses, Conduct a case-control study
What are the steps of an outbreak investigation: CttNoCEtEN, VtD, TwLASC, CASfAC, ADbTPaP, GH, CaCCS 1. Analyze data by time, place, and person 2. Conduct a case-control study 3. Generate hypotheses 4. Conduct active surveillance for additional cases 5. Verify the diagnosis 6. Confirm that the number of cases exceeds the expected number 7. Talk with laboratorians about specimen collection
total have/grand total
What is the formula for prevalence?
Receiving calls from affected residents and healthcare providors
Which are the most common ways that a local health department uncovers outbreaks? A. Performing descriptive analysis of surveillance data each week B. Performing time series analysis to detect deviations from expected values based on the previous few weeks and comparable periods during the previous few years C. Receiving calls from affected residents D. Receiving calls from healthcare providers E. Reviewing all case reports received each week to detect common featuresI
the wedding cake
Which food is the most likely culprit? A. Punch B. Wedding cake C. Sushi D. Can't determine from the data presented. E. Must be more than one food.
actions to control the disease problem
Which of the following is NOT part of a public health surveillance program? Identify, define, and measure the health problem, Analyze and interpret data, Actions to control the disease problem, Monitor and periodically evaluate the usefulness and quality of surveillance
all
Which of the following may be useful in generating hypotheses in an outbreak setting? A. Review the literature B. Look at the descriptive epidemiology C. Look at the outliers D. Talk with the local health authorities E. Talk with a few of the case-patients F. Talk with subject matter experts
It tells you the probability that a test reflects a person who has the disease.
Which of the following statements is NOT true when describing Sensitivity? It is the ability of a test to correctly identify people who have the disease you are testing for. It tells you the probability that a test reflects a person who has the disease. It increases or decreases in relation to the specificity of your test. It measures a marker of a given disease, and may not detect all cases of disease.
It is the probability that a test reflects a person who does not have the disease you are testing for
Which of the following statements is true when describing Negative Predictive Value? It tells you the probability that a test reflects a person who has the disease. It measures the effectiveness of a test in returning a negative test result to people who do not have the disease. It is a constant measurement of a test, regardless of the population it is used on. It is the probability that a test reflects a person who does not have the disease you are testing for.
It tells you the probability that a test reflects a person who has the disease.
Which of the following statements is true when describing Positive Predictive Value? It tells you the probability that a test reflects a person who has the disease. It is the ability of a test to correctly identify people who have the disease you are testing for. It is a constant measurement of a test, regardless of the population it is used on. It increases when prevalence of the disease within your population decreases.
false
Underreporting is not a problem for detecting outbreaks of notifiable diseases because the proportion of cases reported tends to remain relatively stable over time. A. True. B. False.
Mortality
Vital statistics are important sources of data on which of the following? A. Morbidity. B. Mortality. C. Health-related behaviors. D. Injury and disability. E. Outpatient health-care usage.
true
Vital statistics provide an archive of certain health data. These data do not become surveillance data until they are analyzed, interpreted, and disseminated with the intent of influencing public health decision-making or action. A. True. B. False.
It is the ability of a test to correctly identify people who have the disease you are testing for.
Which of the following statements is true when describing Sensitivity? It is the ability of a test to correctly identify people who have the disease you are testing for. It relates to how a practitioner interprets a test result. It tells you the probability that a test reflects a person who has the disease. It measures the effectiveness of a test in returning a negative test result to people who do not have the disease.
It measures the effectiveness of a test in returning a negative test result to people who do not have the disease.
Which of the following statements is true when describing Specificity? It is the ability of a test to correctly identify people who have the disease you are testing for. It is affected by the prevalence of disease within the population you are testing. It measures the effectiveness of a test in returning a negative test result to people who do not have the disease. It tells you the probability that a negative test result reflects a person who does not have the disease.
To develop hypotheses about the cause of the outbreak, To learn more about the clinical manifestations of the disease
Why should an investigator who has no clinical background nonetheless talk to a patient or two as an early step in the outbreak investigation? A. To advise the patient about common risk factors and the usual course of the illness, after reviewing such information in appropriate reference material B. To develop hypotheses about the cause of the outbreak C. To learn more about the clinical manifestations of the disease D. To verify the clinical findings as part of verifying the diagnosis E. To verify the laboratory findings as part of verifying the diagnosis
surveillance for consumer
____ Based on statistically valid sample. A. Notifiable disease surveillance B. Surveillance for consumer product-related injuries C. Both. D. Neither
both
____ Can monitor trends over time. A. Notifiable disease surveillance B. Surveillance for consumer product-related injuries C. Both. D. Neither
neither
____ Can watch for disease before a patient seeks care from a health-care provider A. Surveillance based on a specific case definition for a disease (e.g., listeriosis). B. Syndromic surveillance based on symptoms, signs, or other characteristics of a disease, rather than specific clinical or laboratory diagnostic criteria. C. Both. D. Neither
neither
____ Complete, unbiased reporting A. Notifiable disease surveillance B. Surveillance for consumer product-related injuries C. Both. D. Neither
notifiable disease surveillance
____ Focused on identifying individual cases. A. Notifiable disease surveillance B. Surveillance for consumer product-related injuries C. Both. D. Neither
predictive value positive
____ Of 16 statistically significant aberrations (deviations from baseline) detected by syndromic surveillance, only one represented an actual outbreak of disease. A. Predictive value positive. B. Sensitivity. C. Specificity. D. Validity.
notifiable disease surveillance
____ State-based, with subsequent reporting to CDC. A. Notifiable disease surveillance B. Surveillance for consumer product-related injuries C. Both. D. Neither
sensitivity
____ Surveillance detected 23 of 30 actual cases of a disease. A. Predictive value positive. B. Sensitivity. C. Specificity. D. Validity.
both
____ Watches for diseases that might be caused by acts of biologic or chemical terrorism A. Surveillance based on a specific case definition for a disease (e.g., listeriosis). B. Syndromic surveillance based on symptoms, signs, or other characteristics of a disease, rather than specific clinical or laboratory diagnostic criteria. C. Both. D. Neither
both
____ Watches for individual cases of disease of public health importance A. Surveillance based on a specific case definition for a disease (e.g., listeriosis). B. Syndromic surveillance based on symptoms, signs, or other characteristics of a disease, rather than specific clinical or laboratory diagnostic criteria. C. Both. D. Neither.
cluster
10 cases of cancer diagnosed over 2 years among residents of a single neighborhood (previous data not available) A. Cluster B. Epidemic C. Outbrea
epidemic
200 cases of Marburg virus infection in several districts in Angola over several months (usually none) A. Cluster B. Epidemic C. Outbreak
outbreak
40 cases of Salmonella Enteritidis in 1 week traced to a single meal served at a cafeteria (usually none) A. Cluster B. Epidemic C. Outbreak
clinical features, time, place, person
A case definition during an outbreak investigation should specify: A. Clinical features B. Time C. Place D. Person E. Hypothesized exposure
all
A case report form devised for an outbreak investigation usually includes which of the following types of information? A. Identifying information B. Demographic information C. Clinical information D. Risk factor information E. Reporter, interviewer, or data abstractor information
all
A group of tourists on a weeklong bus tour of a European country experienced an outbreak of norovirus. The group had followed a consistent meal time pattern: each morning they had breakfast together in whichever hotel they had stayed from 6:00 a.m. to 7:00 a.m., stopped for lunch from 1:00 p.m. to 2:00 p.m., then had dinner together either at the next hotel or at a restaurant at about 7:00 p.m. The incubation period for norovirus is about 24-48 hours, with a median of about 33 hours. On which day and at which meal was exposure most likely? A. April 19 Dinner B. April 20 Breakfast C. April 20 Lunch D. April 20 Dinner E. April 21 Breakfast
C
A malfunctioning space heater was used each time the outside temperature dropped below freezing
C (ensure that all persons with a responsibility to report understand the requirements and reasons for reporting and how reports will be used.)
A state health department decides to strengthen its notifiable disease reporting. The one best action to take is to . . . A. allow reporting through use of the Internet. B. require more disease-specific forms from local health departments. C. ensure that all persons with a responsibility to report understand the requirements and reasons for reporting and how reports will be used. D. reduce the number of diseases on the list
true
This study is an example of a retrospective cohort study. A. True B. False
false
To avoid skipping a critical step, investigators should conduct the steps of an outbreak investigation in the precise order you answered in Question 5. A. True B. False
D
Common cold passed from classmate to classmate
all
Common methods of identifying additional cases (expanding surveillance) as part of an outbreak investigation include: A. Advising the public through newspapers, TV, radio, and the health department's website to contact the local health department B. Asking case-patients who they were with at the time of exposure (if known) C. Sending a fax to healthcare providers D. Telephoning the infection control practitioners at local hospitals
a, b, c, d
Common uses and applications of public health surveillance include which of the following? A. Detecting individual persons with malaria so that they can receive prompt and appropriate treatment. B. Helping public health officials decide how to allocate their disease control resources. C. Identifying changes over time in the proportion of children with elevated blood lead levels in a community. D. Documenting changes in the incidence of varicella (chickenpox), if any, after a law requiring varicella vaccination took effect.
Incidence of the problem, Public concern about the problem, Social and economic impact of the problem
Criteria for prioritizing health problems for surveillance include which of the following? A. Incidence of the problem. B. Public concern about the problem. C. Number of previous studies of the problem. D. Social and economic impact of the problem
chronic diseases, communicable diseases, health related behaviors, occupational hazards presence of viruses in mosquitoes
Current public health surveillance targets which of the following? A. Chronic diseases. B. Communicable diseases. C. Health-related behaviors. D. Occupational hazards. E. Presence of viruses in mosquitoes.
Purpose and objectives of surveillance, Resources needed to conduct surveillance, Presence of characteristics of well-conducted surveillance
Evaluating and improving surveillance should address which of the following? A. Purpose and objectives of surveillance. B. Resources needed to conduct surveillance. C. Effectiveness of measures for controlling the disease under surveillance. D. Presence of characteristics of well-conducted surveillance.
employer records
Data collected for health related purposes usually comes from all of these sources EXCEPT: Health care providers and facilities, Individual persons, The environment, Employer records
vital registration, randomized clinical trials, population surveys
Data collected through which of the following methods is commonly used for surveillance? A. Vital registration. B. Randomized clinical trials. C. Disease notifications. D. Population surveys.
false
Descriptive epidemiology is essential for "characterizing the outbreak" by time, place, and person, but has little bearing on the analytic epidemiology. A. True B. False
all
Disease control measures can be directed at the: A. Agent B. Source C. Mode of transmission D. Portal of entry E. Host susceptibility
the caterer, local officials wedding party family and attendees
Results of this outbreak investigation should be communicated to: A. The caterer B. Local officials C. Wedding party family and attendees D. World Health Organization
and during the previous 2-4 weeks, comparable weeks of the previous 2-5 years, by county, by county, divided by each county's population
Routine analysis of notifiable disease surveillance data at the state health department might include looking at the number of cases of a disease reported this week . A. and during the previous 2-4 weeks. B. and the number reported during the comparable weeks of the previous 2-5 years. C. simultaneously by age, race, and sex of the patient. D. by county. E. by county, divided by each county's population (i.e., county rates).
true
Specificity is the probability that a negative test result reflects a person who does NOT have the disease. T or F
table 2 box a / total tests (column) table 1 =
Steps for Net Sensitivity
A / (A+C)
Steps for calculating sensitivity
false
Syndromic surveillance is the most accurate of all surveillance methods. T or F
false
The case definition used for surveillance of a health problem should be the same as the case definition used for clinical (treatment) purposes. A. True. B. False.
presence of a comparison group
The key feature of an analytic (epidemiologic) study is: (Select only one answer) A. Analysis by time, place, and person B. Calculation of a risk ratio or odds ratio C. Use of Epi Info to analyze the data D. Presence of a comparison group
state health department
The list of diseases that a physician must report to the local health department is typically compiled by the . . . A. Local health department. B. State health department. C. Centers for Disease Control and Prevention (CDC). D. Council of State and Territorial Epidemiologists (CSTE). E. Medical licensing board.
risk ratio
The most appropriate measure of association for these data is the: A. Attributable risk percent B. Chi-square C. Odds ratio D. Risk ratio
Provide timely information on disease patterns and trends to those who need to know it.
The primary reason for preparing and distributing periodic surveillance summaries is which of the following? A. Document recent epidemiologic investigations. B. Provide timely information on disease patterns and trends to those who need to know it. C. Provide reprints of MMWR articles, reports, and recommendations. D. Acknowledge the contributions of those who submitted case reports.
positive test, negative test
left side of 2X2 table
specificity
measures the effectiveness of a test in returning a negative test result to people who do not have the disease
predictive value
relates to how a practitioner interprets a single test result
D / (B+D)
steps for calculating specificity
D / (C+D)
steps for negative predictive value
table 1 box d + table 2 box d / do not have total total table 1
steps for net specificity
A / (A+B
steps for positive predictive value
negative predictive value
takes all of the negative test results in a population and then determines the probability that any single test reflects a parson who has the disease.
positive predictive value
takes all of the positive test results in a population and then determines the probability that any single test reflects a parson who has the disease.
sensitivity
the ability of a test to correctly identify people who have the disease you are testing for.
have disease, do not have disease
top of 2X2 table
Increase specificity or prevalence
what would you need to do to increase PPV?
