CPH Exam - All Sample Questions

A community has high rates of HIV infection among injection drug users (IDUs). The community council decides to legalize needle exchange programs in an effort to provide clean syringes to prevent the sharing of contaminated needles in drug-using networks. This type of program is an example of: (A) Harm reductions (B) Policy advocacy (C) Community organization (D) Behavior change

A

A short narrative or statement that describes the general focus and purpose of a program is called: (A) A mission statement (B) A long-term program goal (C) A long-range program plan (D) A program objective

A

According to John Wennberg and colleagues, small area variations in Medicare expenditures across geographic areas are primarily attributable to differences in: (A) Physician practice styles (B) Consumer preferences for high-cost services (C) Age of the population served (D) Health status of the population served

A

According to a Stock and Flow diagram, expanded intervention focused on "Tertiary prevention" is likely to have the following unintended consequence: (A) "Afflicted with Complications" will increase (B) Mortality will be delayed or reduced (C) "Safer Healthier People" will decrease (D) "Afflicted without Complications" will increase

A

An example of backward vertical integration by an academic medical center is: (A) Offering a managed care health plan (B) Establishing a skilled nursing unit within the hospital (C) Acquiring an established home health agency (D) Taking over a smaller, faith-based health care system

A

An illustration of the result of a negative (or balancing or stabilizing) feedback loop in public health can be found in: (A) A legislative mandate for infant and child inoculations (B) Rising health care costs (C) Increasing prevalence of antibiotic-resistant pathogens (D) The growth of available medical technology

A

Comparison of mortality rates due to cancer of the uterus in users and non-users of supplemental estrogen revealed the following mortality rates per 100,000: Age Users of Estrogen Non-Users of Estrogen 45-54 3.0 1.0 55-70 17.0 6.0 A valid conclusion derived from the above data concerning mortality among estrogen users is: (A) The mortality rates for cancer of the uterus are higher in estrogen users than non-users in both age groups studied (B) A causal relationship is demonstrated between the use of estrogen and incidence of uterine cancer (C) Mortality from cancer of the uterus rises with age regardless of whether estrogen is used (D) The mortality rate is lower in non-users than users because the symptoms of uterine cancer are detected earlier in the former group of women

A

Determining whether or not a program met the stated goals and objectives is an example of which of the following? (A) Outcome evaluation (B) Formative evaluation (C) Process evaluation (D) Evaluation report

A

Epidemiologic studies have shown a positive association between the concentration of particulate matter (PM) in ambient air and: (A) An increased incidence of respiratory-related morbidity and mortality (B) The destruction of the stratospheric ozone layer (C) Effects on global climate change, specifically increased Global Warming (D) Declines in bird populations due to thinning of their egg shells

A

Executive Order 12898, entitled "Federal Actions to Address Environmental Justice in Minority Populations and Low-Income Populations," is an example of which policy-making model? (A) Policy Action Change and Monitoring (PACM) model (B) Exposure-response relationship model (C) Integrated assessment model (D) NIMBY model

A

Exposure assessment attempts to answer all of the following questions except: (A) Toxicity of the exposure (B) Frequency and duration of exposure (C) Population exposed (D) Route of exposure

A

Franklin's Grove is the county seat of Franklin County, a small rural county in the Southeast. On the basis of its demographic and economic profile, it was selected as a health improvement zone to receive Federal funds to implement programs to improve progress toward reaching the national health objectives. Communities receiving such funds are charged with identifying the most significant gaps between the current health status and national health objectives and with putting programs in place to narrow such gaps. What is the first step to take to address the goals of the funding? (A) Consult Healthy People 2010 to identify relevant objectives (B) Convene a group of community leaders to decide how to spend the funds (C) Convene a group of community citizens to decide how to spend the funds (D) Consult an expert in community health to draw up a program plan

A

How many bases make up a codon? (A) 3 (B) 4 (C) 20 (D) 64

A

How many pairs of autosomes do humans have? (A) 22 (B) 23 (C) 44 (D) 46

A

If a threshold dose exists for an environmental agent: (A) There is a dose level below which the agent does not produce health effects (B) Any dose of the agent, no matter how small, carries some risk of adverse health effects (C) It is impossible to establish a no-observed-adverse-effect level (NOAEL) for that agent (D) The average level of exposure to the agent by the general population is assumed to be safe

A

If two copies of a mutant allele are necessary to cause symptoms of a disease to appear in the phenotype, what type of genetic disease is this? (A) Recessive (B) Sex-linked (C) Autosomal (D) Dominant

A

Leadership trait and skill theories: (A) Point to the right stuff for a leader to possess to be effective (B) Have not changed over time (C) Are not relevant to public health leaders (D) Prove leadership cannot be learned or developed

A

Mortality rates by sex in the United States generally show the following sex differences: (A) Males greater than females (B) Females greater than males (C) Males equal to females (D) Males equal to females in the first years of life

A

Municipal sewage is typically processed to remove organic material before disposing of the treated water. In large cities this treatment will generally consist of: (A) Biological treatment in an aerated activated sludge system, followed by settling to remove sludge solids, then chlorination prior to discharge. (B) Chemical treatment by coagulation and flocculation, followed by settling to remove solids, then chlorination prior to discharge. (C) Filtering through sand beds to remove organic solids, followed by chlorination prior to discharge. (D) Super-chlorination to destroy organic materials, followed by discharge.

A

Mutations in the _______________ gene lead to an increased risk for developing breast or ovarian cancer. (A) BRCA2 (B) PPARG (C) APC (D) hMSH1

A

New vaccines for influenza must be developed every year because: (A) Mutations result in new strains of the virus that are not affected by existing vaccines. (B) The virus produces enzymes that break down existing vaccines (C) The human body produces enzymes that break down existing vaccines (D) The human body produces antibodies that inactivate the vaccine

A

Nitrates in ground water are of particular concern in rural communities that rely on well water because: (A) Nitrates can cause Blue-Baby Syndrome in infants (B) Nitrates are potent carcinogens in adults (C) The well water will be undrinkable due to taste, odor, and color problems (D) The well water will form nitric acid and become corrosive to metal pipes in the water system

A

River water pollution due to storm water runoff from chemically fertilized farm fields is an example of: (A) Area source pollution (B) Point source pollution (C) Accidental and unforeseeable pollution (D) Unpreventable and inconsequential pollution

A

Systems thinking, while conceptually challenging, is one of the most valuable skills a manager can bring to resolving organizational problems because: (A) It provides a framework for viewing the organization as a series of interrelationships and lays the foundation for problem solving (B) Gives a good sense of the communication patterns between and among the various departments that comprise an organization (C) Leads to the best strategy for organizational change. (D) He can obtain an accurate accounting of the product or products produced by the organization.

A

The Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA): (A) Established the "Superfund" for financing cleanup of hazardous waste disposal sites, and the National Priorities List identifying such sites (B) Created the United States Environmental Protection Agency (EPA) and authorized the agency to regulate environmental pollutants (C) Established requirements and procedures for the proper disposal of municipal solid waste, e.g. via properly designed and operated municipal landfills (D) Imposed the requirement for federal agencies to prepare Environmental Assessments and Environmental Impact Statements of the environmental effects of proposed federal agency actions

A

The Stratospheric Ozone Layer is a concern because: (A) Degradation of the Ozone Layer increases the amount of ultraviolet radiation reaching the Earth's surface (B) An increase in the density of the Ozone Layer causes increases in Smog air pollution (C) The Ozone Layer is a primary contributor to Global Warming (D) An increase in the density of the Ozone Layer causes Acid Rain that can damage forests and lakes

A

The backbone of the DNA double helix is made up of linked sugar and phosphate molecules. What type of molecules extend from the backbone into the helix? (A) Bases (B) Amino acids (C) Lipids (D) Carbohydrates

A

The following statement is a tenet of which of these motivational models: "Individuals are motivated to satisfy lower-order physiological needs before they can respond to higher needs such as self-fulfillment."? (A) Hierarchy of needs (Maslow) (B) Expectancy theory (Vroom) (C) Two-factor theory (Herzberg) (D) Theory X/Theory Y (McGregor)

A

The incidence of bacteria such as Staphylococcus aureus that are resistant to antibiotics is (A) Increasing (B) Decreasing (C) Staying the same (D) Difficult to measure

A

The objective of the National Environmental Policy Act of 1969 and its equivalent at the State level is: (A) To subject a proposed major project or action to an environmental review study with a view to understanding the potential environmental effects of such a project or action and considering alternative projects and mitigating measures as appropriate (B) To ensure that an important industrial project or action is constructed (C) To ensure that the environment is protected at all cost (D) To achieve sustainable development while relieving the concerns of communities in which a major project or action will be located

A

The typical 'bell curve' of the incidence of new influenza cases during each year is illustrative of: (A) The combined operation of two feedback loops in which the positive (or reinforcing) feedback loop dominates early in the outbreak and the negative (or balancing or stabilizing) feedback loop dominates later in the outbreak (B) The isolated operation of a positive, or reinforcing, feedback loop (C) The combined operation of two constant and equally influential feedback loops; one that is positive (or reinforcing) and the second that is negative (or balancing or stabilizing) (D) The isolated operation of a negative (or balancing or stabilizing) feedback loop

A

What is the "reservoir host" for West Nile Virus? (A) Birds (B) Mosquitoes (C) Humans (D) Cattle

A

What is the next step when a baby has a positive result in the newborn screening? (A) Follow-up testing to confirm the diagnosis (B) Evaluation of the specimen handling (C) Referral to a specialist (D) Offer of genetic counseling to the family

A

When a mutation alters the structure of DNA, the effect on the body results from a corresponding change in the structure of a(n): (A) Protein (B) Steroid hormone (C) Amino acid (D) Vitamin

A

When a person is healthy, without signs and symptoms of disease, illness, or injury, the level of prevention most appropriate would be: (A) Primary prevention (B) Secondary prevention (C) Tertiary prevention (D) No prevention level is needed

A

Which leadership theory advances the notion that one's task-relationship orientation can only be modified within certain limits and that structural and power factors will dictate whether you have a good leadership "fit?" (A) Contingency (B) Path-Goal (C) Situational (D) Transformational

A

Which of the following assays would best reveal whether genetic damage was present in a group of people who were exposed to ionizing radiation when an accidental release occurred at a nuclear power plant? (A) Comet (or single-cell gel electrophoresis) assay (B) Ames test for reversion mutations (C) Increased mutation frequency at the HGPRT locus of hamster cells (D) None of these assays

A

Which of the following do social cognitive theory and the social ecological model have in common? (A) Both take into consideration factors that are within the individual and factors that operate outside the individual. (B) Both focus primarily on environmental determinants of behavior that must be addressed at the policy level. (C) Both come out of the value expectancy paradigm that associates behaviors with valued outcomes. (D) Both originally were developed exclusively to explain unhealthy versus healthy behaviors.

A

Which of the following is an expected benefit of consolidating independent hospitals and provider groups into an integrated health care system? (A) Economies of scale in production (B) Lower costs of integration (C) Ease of accommodating diverse organizational cultures (D) Immediate gains in administrative efficiency

A

Which of the following is not an example of a methodology used during a social assessment? (A) Process evaluation (B) Focus groups research (C) Delphi method (D) Survey administration

A

Which of the following is the most commonly occurring mosquito-borne disease in the United States? (A) West Nile Virus Neuroinvasive Disease (B) Malaria (C) Dengue Fever (D) Yellow Fever

A

Which of the following statements best characterizes a progressive employee discipline process? (A) The discipline process is structured as a staged series of increasingly severe responses to chronic violations of accepted rules of behavior. (B) The punishment must fit the crime. (C) Discipline is not considered relevant in the modern health care organization. (D) Progressive discipline allows the employee to exercise immunity for the first violation of the code of conduct.

A

Which of the following statements is not associated with the current paradigm of quality management in health care? (A) Sanctioning individuals for mistakes is the most appropriate method for ensuring effective quality of care (B) The appropriate locus for ensuring quality is at the system level (C) Process improvement is essential to ensuring quality of care (D) Employee satisfaction and patient satisfaction are closely linked

A

Which term refers to a collective body of individuals identified by geography, common interests, concerns, characteristics, or values? (A) Community (B) Population (C) Sample (D) Group

A

Why does the body need to maintain blood glucose levels in a narrow range? (A) Glucose is used for energy by brain cells at all times (B) Glucose is used by muscles for energy during exercise (C) Glucose is the central substance of carbohydrate metabolism (D) Glucose is converted into glycogen

A

Why have health disparities become a national public policy issue? (A) Because racial and ethnic minorities have become larger percentages of our total population (B) Because healthcare is presently conceptualized as a human right (C) Because minorities and community advocates are pushing for equal opportunities

A

A pediatric patient complaining of an inner ear infection was diagnosed by an overworked emergency room resident who then prescribed an asthma medication. This is an example of: (A) Poor interpersonal quality (B) Poor technical quality (C) Inequitable access (D) Inefficient access

B

A prevalence study of depression drew a sample of the residents of Houston by visiting all residents in randomly selected census tracts. A screening test with a sensitivity of 99% and a specificity of 50% was used to identify individuals as "likely depressed." The study reported a prevalence of 28%. This prevalence is: (A) A true representation of depression in this population (B) Higher than expected because of the specificity of the screening test (C) Lower than expected because of the specificity of the screening test (D) Higher than expected because of the sensitivity of the test (E) Lower than expected because of the sensitivity of the test

B

A primary technique for preventing food-borne disease in cafeteria-type food service establishments is: (A) Encouraging customers to wash their hands before eating (B) Maintaining warm foods at a sufficiently high holding temperature (C) Weekly application of pesticides to control cockroaches (D) Annual physical examinations of food service workers

B

A remote population of Pacific Islanders has lived without influence from the outside world for several centuries. The islanders were introduced to cigarettes as the influence of Western culture impacted their island about 25 years ago. The incidence of lung cancer is now high in the islanders who started to smoke 20 or more years ago. The observation of high levels of lung cancer after years of smoking is: (A) Unusual for Pacific Islanders who smoke (B) Typical for any population of smokers (C) Inconsistent with the standard model of tumor initiation, promotion, and progression (D) Insufficiently explained by the information above

B

A researcher is interested in identifying potential risk factors for a rare form of bone cancer in children. Which of the following study designs would be best suited to investigate the risk factors for this type of cancer? (A) Prevalence-survey (B) Case-control (C) Cohort (D) Descriptive (E) Experimental

B

All of the following are valid uses of systems models for constructing and analyzing explicit models of public health problems except: (A) Models provide an explicit framework on which disparate stakeholders can compare their knowledge, assumptions, and beliefs about the system (B) Use of a model assures us that we will devise and pursue the best possible interventions for achieving our public health goals (C) We can test the likely results of an intervention under a wide range of conditions and for a long period of time without actually risking harm to anyone for misguided or inefficient interventions (D) Models can reveal areas of ignorance of which we were not previously aware

B

An adult learner will likely respond more to which of the following? (A) Traditional lectures (B) Problem-solving experiences (C) Learning based on future developmental roles (D) Reading assignments only

B

An individual's capacity to obtain, interpret, and understand basic health information and services and the individual's competence to use such information and services in ways that advance health are called: (A) Medical informatics (B) Health literacy (C) Health education (D) Patient education

B

As a public health specialist, you have developed the ability to work effectively within the cultural context of a community that shares a diverse cultural background. This is termed: (A) Cultural awareness (B) Cultural competence (C) Cultural feasibility (D) Cultural measures

B

As a research analyst at a large HMO, you are asked to benchmark the percentage of enrollees treated for depression who received 6-month follow-up care. Applying Donabedian's framework, the percentage of enrollees receiving follow-up care is what type of indicator? (A) Structure (B) Process (C) Outcome (D) System

B

Cohort study is to risk ratio as: (A) Ecologic fallacy is to cross-sectional study (B) Case-control study is to odds ratio (C) Genetics is to environment (D) Rate ratio is to ecologic study

B

Compared with the situation in 1900, the number of deaths due to infectious diseases in the USA is: (A) About the same (B) Much less (C) Much more (D) About the same, but caused by different pathogens such as HIV

B

Criteria pollutants of the National Ambient Air Quality Standards (NAAQS) include: (A) Volatile organic compounds (VOCs) (B) Particulate matter (C) Mercury (D) Two major greenhouse gases, carbon dioxide and methane

B

Cryptosporidium can become a problem in municipal water supplies because it: (A) Bioaccumulates in fish (B) Can survive the chlorine treatment process (C) Can infect the lungs when water is vaporized, such as in a shower (D) Can bore directly through the skin

B

Cultural competence alone cannot address health disparity because: (A) Cultural competence is not well-implemented in the different health settings (B) There are other issues, such as low socioeconomic status and educational level, that contribute to health disparities and cannot be addressed by cultural competence (C) Discrimination against the racial groups is a structural problem in United States that cannot be solved with cultural competence techniques

B

Double-blinded (masked) studies are an important way to: (A) Achieve comparability of cases and controls (B) Avoid observer and interviewee bias (C) Avoid observer bias and sampling variation (D) Reduce the effects of sampling variation (E) Avoid interviewee bias and sampling variation

B

Dr. Sharon Smart is a senior genetics researcher for Genomatic, Inc., an emerging pharmaceutical company. Dr. Smart was the lead researcher in a recent large-scale clinical study designed to test the efficacy of Alive, a new pharmaceutical designed to successfully treat a terminal form of ovarian cancer. Dr. Smart received a call today from a colleague at Genomatic, Dr. Duit, the chief information officer, who worked in the company's headquarters in Seattle. Dr. Duit had recently received a request from the dean of the medical school at a major university that sought access to some of the company's clinical trials databases. Researchers at the medical school thought that some of Genomatic's information might further research on a joint pharmaceutical project between the university and Genomatic. Dr. Smart inquired as to whether she could share the data without specified informed consent of the subjects. Dr. Duit assured her that he spoke with the company's legal counsel and was informed that there is no state law against sharing this data (at least in Washington state). He also informed Dr. Smart that Genomatic's CEO recently pledged monetary support to the university and this was a mutually beneficial practice for both Genomatic and the university, and the public would benefit as well through improvements in medical science. He then stated that no one debates the value of using this data and instructed Dr. Smart to send him the data tomorrow. Assuming that the original consent forms do not authorize release of data to the university, what should Dr. Smart do to ensure that her response to the data request is responsible as well as legally and ethically sound? (A) Defer to Genomatic company policy and/or input from company officials (B) Involve as many knowledgeable people as possible in the decision making process (C) Limit disclosure to that which is clearly authorized by state privacy and reporting laws (D) Release all health information requested by the university to the chief information officer

B

Franklin's Grove is the county seat of Franklin County, a small rural county in the Southeast. On the basis of its demographic and economic profile, it was selected as a health improvement zone to receive Federal funds to implement programs to improve progress toward reaching the national health objectives. Communities receiving such funds are charged with identifying the most significant gaps between the current health status and national health objectives and with putting programs in place to narrow such gaps. Given the factors presumed to be responsible for the major health problems in this scenario, what would be the best source for community planners to use to find data on how widespread each behavioral factor is at the state or local level? (A) Healthy People 2010 midcourse review (B) Behavioral Risk Factor Surveillance System (BRFSS) (C) Community Guide to Preventive Services (D) Morbidity and Mortality Weekly Report

B

Franklin's Grove is the county seat of Franklin County, a small rural county in the Southeast. On the basis of its demographic and economic profile, it was selected as a health improvement zone to receive Federal funds to implement programs to improve progress toward reaching the national health objectives. Communities receiving such funds are charged with identifying the most significant gaps between the current health status and national health objectives and with putting programs in place to narrow such gaps. Using the PRECEDE framework, the county health department has conducted a social and health diagnosis. Some of the most severe quality-of-life problems were related to limb amputation and kidney failure. Prevalent health problems included diabetes, hypertension, and cardiovascular disease. Which of the following behavioral factors are most likely responsible for the above health and quality-of-life issues in Franklin 's Grove? (A) Unprotected sex, early sexual initiation, use of drugs (B) Sedentary lifestyle, high caloric consumption, low fiber intake (C) Advanced age, low levels of education, history of racism (D) Frequent tobacco, drug, and alcohol us

B

HAACP is a food safety system employed to: (A) Detect bacterial contamination in food after it happens (B) Before they happen, identify and control problems that may cause foodborne illness (C) Isolate and identify bacterial pathogens from a foodborne illness outbreak (D) Set temperature limits for food containing eggs

B

Hazard identification accomplishes the following: (A) Describes the relationship between exposure and disease (B) Identifies and selects the environmental agents for assessment (C) Measures the magnitude, duration, and timing of human exposure (D) Identifies the completed exposure pathway

B

Hemolytic Uremic Syndrome is caused by which organism? (A) West Nile Virus (B) E. coli strain 0157:H7 (C) Cryptosporidium (D) Streptococcus pneumoniae

B

If a chemical that is directly cytotoxic is detoxified by metabolism via the microsomal enzyme system and if the activity of this system correlates with basal metabolic rate, which of the following species is expected to be the most sensitive to the chemical (assuming that all of the animals are given an equivalent dose based on weight)? (A) Human (B) Mouse (C) Rat (D) Dog

B

In a cross-sectional study of peptic ulcer among men and women aged 35 to 59, 70 per 100,000 men and 95 per 100,000 women met the criteria for symptomatic peptic ulcer disease. The inference that in this age group, women are at greater risk of developing peptic ulcer is: (A) Correct (B) Incorrect because of failure to distinguish between incidence and prevalence (C) Incorrect because rates were used to compare males and females (D) Incorrect because of failure to recognize a possible cohort effect (E) Incorrect because there is no comparison or control group

B

In communicating the "channel" is: (A) The appropriate television listing for reaching the most people in a demographic (B) The medium in which the message travels (C) The pathway of least resistance among

B

Informed consent does not include: (A) risks and benefits (B) technical terms (C) understandable terms (D) research topic

B

Latency refers to: (A) The range of concentrations of a chemical that is below threshold (B) The period of time between exposure to a chemical and occurrence of a health outcome (C) The period of time required to remove half of the dose of a chemical from the body (D) The period of time between contact with a chemical and an increase in blood concentration

B

Lead contamination of outdoor air in large cities has been greatly reduced over the past 25 years through: (A) Restrictions on the sale of lead-based paints (B) A ban on the sale of gasoline containing lead anti-knock compounds (C) Widespread use of clean-burning coal in electric power plants (D) Strict regulations on the proper disposal of batteries containing lead

B

Morbidity rates by sex in the United States show the following sex differences: (A) Males greater than females (B) Females greater than males (C) Males equal to females (D) Males equal to females in the first years of life

B

One implication of the claim that "the complex organization tends to map its environment" is that the public health agency: (A) Uses geographic information system (GIS) technology to map the spread of a contagious disease (B) Hires a professional to provide environmental law expertise (C) Only serves the population within its political boundaries (D) Identifies its various constituencies geographically

B

One of the key criteria for an effective team is: (A) There is no conflict between team members (B) Team members have a clear goal on which the leader helps them focus (C) Team members all have an MPH (D) Team members receive the same compensation

B

Public health actions frequently involve a balancing of individual rights vs. the good of the community. Where that balance is struck is based on: (A) Explicit direction found in the US Constitution (B) Societal values (C) Science (D) What is right and what is wrong

B

Public health is concerned with the health of populations. Accordingly one of the core functions of public health as described by the Institute of Medicine (1988) is: (A) Refining the definition of populations (B) To create and advocate for solutions to address, at all levels, the health concerns of populations (C) Making certain that health policy legislation always contains the phrase "population health" (D) Developing a new model for solving all public health problems

B

Public health leaders when making decisions face the challenge of: (A) Protecting the rights and liberties of those individuals affected by disease (B) Creating maximum benefit for all (C) Minimizing resource expenditure (D) Gaining trust from health care providers they serve

B

Routine monitoring of water in a reservoir has found a high count of E. coli. Of the following, you would be most concerned that the contaminated water might also contain: (A) Clostridium botulinum (B) Salmonella (C) Legionella (D) Staphylococcus aureus

B

SCHIP is a federal program that is important for public health because: (A) It remedies the state differences in health insurance that characterize Medicaid (B) It covers preventive services for children who otherwise might not have access to them (C) It provides a comprehensive immunization program (D) It increases funding for school health initiatives

B

Several years ago, a cottage industry existed at an elevation of 1,000 meters above sea level in a mountainous region of Japan. In the wintertime, inhabitants earned their living by manufacturing tatami mats. The indoor work was carried out in so-called kakoi (closed rooms), with tightly sealed windows and wall crevices. The crowded rooms, heated by an open charcoal fire, provided approximately 5 cubic meters of air volume per person, about as much as a Boy Scout tent. In the beginning stage of disease, affected workers complained of stiffness in the shoulders, backache, fatigue, and dizziness. As the disease progressed, workers became short of breath on exertion and experienced tightness and pain below the breast bone, numbness in the arms and hands, and swelling of the face. The attacks of shortness of breath occurred mostly at night, whereas the episodes of pain and tightness around the heart, a condition known as angina pectoris, followed light work during the day. The carboxyhemoglobin levels in the exposed workers: (A) Was found in the kidneys (B) Was elevated (C) Stayed the same (D) Dropped below 10% of normal levels

B

Several years ago, a cottage industry existed at an elevation of 1,000 meters above sea level in a mountainous region of Japan. In the wintertime, inhabitants earned their living by manufacturing tatami mats. The indoor work was carried out in so-called kakoi (closed rooms), with tightly sealed windows and wall crevices. The crowded rooms, heated by an open charcoal fire, provided approximately 5 cubic meters of air volume per person, about as much as a Boy Scout tent. In the beginning stage of disease, affected workers complained of stiffness in the shoulders, backache, fatigue, and dizziness. As the disease progressed, workers became short of breath on exertion and experienced tightness and pain below the breast bone, numbness in the arms and hands, and swelling of the face. The attacks of shortness of breath occurred mostly at night, whereas the episodes of pain and tightness around the heart, a condition known as angina pectoris, followed light work during the day. Which term is used to characterize the social condition of unequal distribution of environmental hazards experienced by minority populations or groups with low income? (A) Environmental equity (B) Environmental justice (C) Environmental pollution (D) Environmental democracy

B

The "police powers" that public officials rely on to enforce compliance with public health standards and interventions are based on: (A) Explicit language in the U.S. Constitution (B) Inferences about the government's obligation to protect the health, safety, and welfare of its citizens (C) Inferences from the Racketeer Influenced and Corrupt Organization (RICO) Act legislation (D) Presidential executive orders

B

The construct of normative beliefs is from which model/theory? (A) Transtheoretical model (B) Theory of reasoned action/planned behavior (C) Social cognitive theory (D) Social ecological model

B

The exposure standard for lead in children has been lowered over the years because even small amounts can result in: (A) Childhood cancers, such as leukemia (B) Impaired cognitive development and learning ability (C) Impaired formation of bone mineral (D) Reduced rate of growth

B

The main risk factor of a hemorrhagic stroke is: (A) Atherosclerosis (B) High blood pressure (C) High blood sugar (D) Blood clot in the heart

B

The most important reason for reduced mortality during the initial stage of a demographic transition is: (A) Increased use of antibiotics (B) Improved sanitation (C) Increased immunization (D) Screening for common infectious diseases

B

The principal difference between those who believe in universal health care and those who believe in a free market system for allocating care is: (A) A willingness to sustain continuing tax increases to support a predetermined level of care for those who cannot afford to pay for their own care (B) The belief that health care is an entitlement versus the belief that health care is a reward (C) A moral judgment regarding the origin of disease and the corresponding belief that we all are ultimately responsible for our own health and well being (D) A desire to not have the government involved in the health care of its citizens

B

The staff at the state health department Birth Defects Registry systematically visit the labor and delivery units of all hospitals in the state on an on-going basis and review their records to identify major congenital malformations. This is an example of: (A) Sentinel surveillance (B) Active surveillance (C) Passive surveillance (D) Syndromic surveillance (E) Reportable conditions

B

The step in program planning where planners use data to identify and rank health problems is called: (A) Behavioral assessment (B) Epidemiological assessment (C) Ecological assessment (D) Environmental assessment

B

The two largest categories of expenditures for the Medicare program (not necessarily in order of magnitude) are: (A) Hospitals and nursing homes (B) Physicians and hospitals (C) Public health and physicians (D) Hospitals and pharmaceuticals

B

Waste management is a key environmental public health issue. Hazardous waste is managed from cradle to grave under the Federal Resource Conservation and Recovery Act. The Comprehensive Environ mental Response, Compensation, and Liability Act requires the clean-up of hazardous waste dump sites that threaten public health. States have parallel hazardous waste laws and exclusively regulate non-hazardous waste. Incorporated in these regulatory efforts are some waste management programs, of which the following is preferred: (A) Treatment of biohazards before they are disposed (B) Waste minimization through reuse, recycling, and investment in renewable energy (C) Waste disposal in sanitary landfills (D) Storage of waste in containers buried within impervious geological formations

B

What are public health ethics? (A) Motivation based on ideas of right and wrong (B) Values that guide actions to promote health and prevent injury and disease among the population (C) Principles of conduct governing an individual or profession (D) Branch of philosophy dealing with values relating to human conduct, with respect to the goodness and badness of the motives and ends of such actions

B

What is true about an incremental approach to program planning in public health? (A) Uses multiple sources and methods to collect similar information (B) Results in plans that may be redundant or leave gaps (C) Provides an intensive, detailed description and analysis of a single project (D) Produces a plan where the specification of every step depends upon the results of previous steps

B

What would be the best source of information on adult and infant mortality? (A) Disease registers (B) Vital statistics (C) Special survey study (D) Hospital clinic statistics

B

Which ethnic group has a higher proportion of HIV infections and AIDS cases than would be expected from their census population size? (A) Whites (B) Blacks (C) Hispanics (D) Asian/Pacific Islanders

B

Which of the following best characterizes the "iron triangle" logic of U.S. health care policy goals? (A) Making necessary tradeoffs to achieve acceptable levels of quality of and access to health services while insuring profitability for health care providers (B) Making necessary tradeoffs to achieve acceptable quality of and access to health services while controlling cost (C) Maintaining highest quality of and full access to services regardless of cost (D) Providing highest quality of services to all who can afford to pay and rationing services for those who cannot.

B

Which of the following best characterizes the contingency theory of leadership? (A) The leader's authority is contingent upon subordinates (B) The leader's effectiveness depends upon factors in the leadership context (C) The leader's effectiveness is contingent primarily on the technical competency of her/his followers (D) The leader's authority is contingent upon formal rules and sanctions

B

Which of the following had the greatest impact on average life expectancy? (A) Vaccinations for infectious diseases (B) Improvements in sanitation and hygiene (C) Advances in medical care technology (D) Health education

B

Which of the following is most likely to enhance the staff performance appraisal? (A) Deferring performance feedback until the scheduled annual appraisal (B) Setting performance goals in collaboration with the employee (C) Refusing to award outstanding ratings that might lead the employee to expect a merit-based salary increase (D) Ensuring that no negative information is included in the written appraisal to decrease legal liability

B

Which of the following is not a principle/key concept in community organization and community building practice? (A) Critical consciousness and empowerment (B) Critical allocation of resources and sharing among partners (C) Principle of relevance or "start where the people are" (D) Principle of participation

B

Which of the following methods allows for the conduct of the most accurate exposure assessment in workers? (A) Determination of the chemical in the air (B) Biomonitoring determination of metabolites of the chemicals in blood and urine (C) Determination of the chemical on the skin (D) Estimation of the exposure by taking an occupational history

B

Which of the following practices assures equity and accountability when making health policy decisions in a community? (A) Giving privileges to the minority groups in the community (B) Collecting accurate demographic, health, and health-related data about the individuals in the community (C) Including minorities in the decision-making groups

B

Which of the following principles of medical and public health ethics requires doing no harm while promoting the welfare of others? (A) Autonomy (B) Beneficence (C) Privacy (D) Justice

B

Which of the following statements best characterizes the contingency theory of leadership? (A) The leader's authority is unchallenged by subordinates. (B) The leader's effectiveness depends on various factors in the leadership context. (C) The leader's effectiveness is contingent primarily on the technical competence of followers. (D) The leader's authority depends on formal legislation and sanctions.

B

Which of the following terms from the social cognitive theory refers to the dynamic interaction among the person, environment, and behavior? (A) Behavioral norms (B) Reciprocal determinism (C) Decisional balance (D) Bidirectional dependence

B

Which of the following water-borne disease organisms is very difficult to kill by chemical disinfection of drinking water supply systems and has caused a major US disease outbreak in recent years? (A) Vibrio cholerae (causes cholera) (B) Cryptosporidium (causes Cryptosporidiosis) (C) Giardia lamblia (causes Giardiasis) (D) E. coli (causes acute gastroenteritis)

B

A case-control study comparing ovarian cancer cases with community controls found an odds ratio of 2.0 in relation to exposure to radiation. Which is the correct interpretation of the measure of association? (A) Women exposed to radiation had 2.0 times the risk of ovarian cancer when compared to women not exposed to radiation (B) Women exposed to radiation had 2.0 times the risk of ovarian cancer when compared to women without ovarian cancer (C) Ovarian cancer cases had 2.0 times the odds of exposure to radiation when compared to controls (D) Ovarian cancer cases had 2.0 times the odds of exposure to radiation when compared to women with other cancers

C

A health policy that is implemented within a representative democracy with separation of powers at all governmental levels and that is characterized by the presence of well-funded interest groups: (A) Will reflect the preferences of the majority of citizens (B) Must be based on the best scientific evidence available (C) Will represent a compromise among multiple and competing interests (D) Is doomed to failure

C

A population of rural women experiences a high rate of mortality related to breast cancer. Researchers at a local university implement a breast cancer screening intervention. This intervention is an example of: (A) Tertiary prevention (B) Advocacy (C) Secondary prevention (D) Primary prevention

C

A positive (or reinforcing) feedback loop is: (A) A relationship in which the change in one factor leads to the increase (positive change) in another factor (B) A closed circular sequence of cause and effect relationships in which the original element is made to grow ever faster (C) A closed circular sequence relationships in which, once some original element is made to change (increase or decrease), subsequent cause and effect relationships cause the original element to move ever-faster in the direction of its original change (D) A closed circular sequence of relationships in which the change of any element is restricted to reinforce the system's stability

C

A screening test is used in the same way in two similar populations, but the proportion of false-positive results among those who test positive in population B is higher than that among those who test positive in population A. What is the most likely explanation for this finding? (A) The specificity of the test is higher in population A (B) The specificity of the test is lower in population A (C) The prevalence of disease is higher in population A (D) The prevalence of disease is lower in population A

C

All intervention messages (printed, computer-delivered, or Internet-based) must: (A) Start with the most important information first (B) Include graphics, pictures, and the like to attract people's attention (C) Be written at a reading level suitable to the target population (D) Be no longer than four sentences so that the reader does not become bored

C

All of the following statements are true about both prospective and retrospective cohort studies except: (A) They measure the incidence of disease (B) They allow assessment of possible associations between exposure and many outcomes (C) They require the manipulation of the exposure of interest by the investigator (D) They avoid bias that might occur if measurement of exposure is made after the outcome of interest is known

C

An outbreak of pneumonia has occurred at a resort, and you determine that Legionella is the organism that is responsible. To find the source of the bacteria, one of the highest priorities would be to check: (A) Food handlers for infected cuts and sores (B) For dead animals on the property (C) Hot tubs, showers, and fountains and the water sources that supply them (D) Employees who have come to work with influenza

C

Analyzing historical leaders to determine the distinguishing qualities of their leadership is the focus of the: (A) behavioral approach (B) style approach (C) trait approach (D) transformational approach

C

By what programmatic mechanism does the U.S. Environmental Protection Agency (EPA) work with States to implement Environmental Standards such as NAAQS? (A) By creating a memorandum of understanding focusing on cost sharing of environmental burdens (B) By establishing air quality monitoring stations (C) By using a State Implementation Plan (SIP) approved by the EPA (D) By funding risk assessment studies that provide a basis for the NAAQS for any criterion pollutant

C

Children and adolescents below the age of consent are incapable of making determinations on their own behalf when exposed to cigarette advertising and promotion. They need protection from those who seek to stimulate their desires for harmful goods. Cigarette smoking once commenced is driven by the addictive power of nicotine. By restricting advertising and promotion to children, limits would also be imposed on adults. The moral argument to support the ban is: (A) children and adolescents below the age of consent need protection (B) the public needs protection (C) nicotine has addictive power (D) advertising is manipulative

C

Community rating basis for health insurance: (A) Automatically assigns lower rates to subscribers from disadvantaged communities (B) Allows community representatives to negotiate favorable rates (C) Spreads the risk across the pool of insured (D) Benefits financially the healthiest insured people who use the fewest services

C

Environmental risk assessment is: (A) A method of generating new empirical data on health effects (B) A method of performing basic research (C) A synthesis of existing scientific information, often aimed at addressing specific regulatory or policy issues (D) A method of determining the cause of a disease

C

Excellent managers motivate people to get a job done as specified. Leaders: (A) Find new ways to do the job (B) Supervise managers (C) Motivate people to approach the job in ways they could never have imagined (D) Evaluate the performance of the completed job

C

Executive managers in a not-for-profit health care organization have an obligation to: (A) Maximize return for their stockholders (B) Increase revenues annually (C) Be prudent stewards of the community's assets (D) Avoid earning any net income, i.e., profits

C

For the overarching guidance of an organization, which of the following should be measurable? (A) Vision and values (B) Mission and vision (C) Goals and objectives (D) Mission and goals

C

In a large case-control study of pancreatic cancer, 20% of the cases were found to be diabetic at the time of diagnosis, compared to 5% of a control group (matched by age, sex, ethnic group, and several other characteristics) that was examined for diabetes at the same time that the cases were diagnosed. The authors concluded that diabetes played a causal role in the development of pancreatic cancer. This conclusion: (A) Is correct (B) May be incorrect because there is no control or comparison group (C) May be incorrect because of failure to establish the time sequence between the onset of diabetes and pancreatic cancer (D) May be incorrect because of less complete ascertainment of diabetes in pancreatic cancer cases (E) May be incorrect because of more complete ascertainment of pancreatic cancer in non-diabetic people

C

In a population of 5,000 people, 100 ate spinach contaminated with E. coli (O157:H7) and became ill. Of the ill, 15 died. What was the case fatality rate? (A) 20 per 1,000 (B) 3 per 1,000 (C) 150 per 1,000 (D) 15 deaths

C

In order to effectively evaluate organizational performance, an administrator must also have: (A) Measurable performance indicators (B) Previously agreed upon performance standards (C) Measurable performance indicators benchmarked to previously agreed upon performance standards (D) Measurable performance indicators that can be used to identify acceptable and superior performance

C

In part due to the public attention focused on environmental pollution by Rachel Carson's book "Silent Spring", as well as studies such as those showing a drastic decline in the American Bald Eagle population, a ban was issued on the use of: (A) Chlorofluorocarbon (CFC) refrigerant gases (B) Leaded gasoline (C) DDT pesticide (D) Asbestos insulation materials

C

In the absence of HIV infection, the CD4+ T lymphocyte count of a healthy individual is approximately 2,000 cells/µl. How much does this count have to fall to as part of the diagnosis of AIDS? (A) 1,000 (B) 500 (C) 200 (D) 10

C

It is essential in cohort studies of the role of a suspected factor in the etiology of a disease that: (A) There are equal numbers of people in both study groups. (B) At the beginning of the study, those with the disease and those without the disease have equal risks of having the factor. (C) The exposed and non-exposed groups under study should be as similar as possible with regard to possible confounders. (D) The incidence of the disease is low.

C

Many people do not attempt to decrease unhealthy behaviors such as overeating or smoking because they lack the confidence that they can successfully change. This is an example of: (A) Perceived susceptibility (B) Perceived severity (C) Perceived self-efficacy (D) Perceived response efficacy

C

Several years ago, a cottage industry existed at an elevation of 1,000 meters above sea level in a mountainous region of Japan. In the wintertime, inhabitants earned their living by manufacturing tatami mats. The indoor work was carried out in so-called kakoi (closed rooms), with tightly sealed windows and wall crevices. The crowded rooms, heated by an open charcoal fire, provided approximately 5 cubic meters of air volume per person, about as much as a Boy Scout tent. In the beginning stage of disease, affected workers complained of stiffness in the shoulders, backache, fatigue, and dizziness. As the disease progressed, workers became short of breath on exertion and experienced tightness and pain below the breast bone, numbness in the arms and hands, and swelling of the face. The attacks of shortness of breath occurred mostly at night, whereas the episodes of pain and tightness around the heart, a condition known as angina pectoris, followed light work during the day. The major human portal of entry for the contaminant/pollutant was: (A) Dermal (B) Oral (C) Respiratory (D) Transplacental

C

Several years ago, a cottage industry existed at an elevation of 1,000 meters above sea level in a mountainous region of Japan. In the wintertime, inhabitants earned their living by manufacturing tatami mats. The indoor work was carried out in so-called kakoi (closed rooms), with tightly sealed windows and wall crevices. The crowded rooms, heated by an open charcoal fire, provided approximately 5 cubic meters of air volume per person, about as much as a Boy Scout tent. In the beginning stage of disease, affected workers complained of stiffness in the shoulders, backache, fatigue, and dizziness. As the disease progressed, workers became short of breath on exertion and experienced tightness and pain below the breast bone, numbness in the arms and hands, and swelling of the face. The attacks of shortness of breath occurred mostly at night, whereas the episodes of pain and tightness around the heart, a condition known as angina pectoris, followed light work during the day. The most likely contaminant/pollutant causing the described symptoms was: (A) Sulfur dioxide (B) Particulates (C) Carbon monoxide (D) Carbon dioxide

C

Some infectious micro-organisms almost always cause symptoms of disease, whereas others do not. Which of the following infections only show symptoms in around 10% of infections? (A) Measles (B) Chickenpox (C) Poliomyelitis (D) Rabies

C

The "danger zone," in which bacteria multiply fast enough to become a hazard, is: (A) 32° - 100° F (B) 32° - 212° F (C) 40° - 140° F (D) 40° - 212° F

C

The Gram-staining technique is used to classify what type of micro-organism? (A) Viruses (B) Protozoa (C) Bacteria (D) Prions

C

The burden of environmental contamination and pollution is not equally distributed. Some areas and populations, particularly people of color and low-income communities, have been disproportionately affected by environmental insults or lack equal access to social, economic, and environmental amenities. Understanding why this happens is crucial, and new methods of collaboration must be developed to redress the harm, restore human and environmental health, allow sustainable development to proceed, and develop policies to prevent these inequities from recurring. Along the Texas-Mexico border, there are many examples of environmental insults that disproportionately affect the Hispanic segment of the population. Many of these people live in colonias (neighborhoods). Some of these colonias are very primitive, with unpaved roads, no running water (water is brought in via tanker trucks), and no public sewage. The lack of a potable water supply is an example of environmental insult. All of the following are potential sources of contamination of a water supply that is delivered by a tanker truck to a storage tank located at the home, except for: (A) Storage tank at the home (B) Plumbing from tank into the home (C) Source of potable water (D) Source of river water

C

The burden of environmental contamination and pollution is not equally distributed. Some areas and populations, particularly people of color and low-income communities, have been disproportionately affected by environmental insults or lack equal access to social, economic, and environmental amenities. Understanding why this happens is crucial, and new methods of collaboration must be developed to redress the harm, restore human and environmental health, allow sustainable development to proceed, and develop policies to prevent these inequities from recurring. Along the Texas-Mexico border, there are many examples of environmental insults that disproportionately affect the Hispanic segment of the population. Many of these people live in colonias (neighborhoods). Some of these colonias are very primitive, with unpaved roads, no running water (water is brought in via tanker trucks), and no public sewage. The lack of a potable water supply is an example of environmental insult. Safe, high-quality drinking water is an essential aspect of public health. Potable water should not contain: (A) Disinfection residual (B) Chlorine (C) Biocides (D) Fluorides

C

The definition of healthcare marketing is: (A) The process of publicizing services and programs (B) Management activities that create markets for goods and services (C) A management process that assesses customer wants and needs and performs the activities associated with the development, pricing, provision, and promotion of product solutions that satisfy those wants and needs (D) Multi-media outreach to a single or multiple target audiences

C

The difference between primary and secondary prevention of disease is: (A) Primary prevention focuses on control of causal factors, while secondary prevention focuses on control of symptoms (B) Primary prevention focuses on control of acute disease, while secondary prevention focuses on control of chronic disease (C) Primary prevention focuses on control of causal factors, while secondary prevention focuses on early detection and treatment of disease (D) Primary prevention focuses on increasing resistance to disease, while secondary prevention focuses on decreasing exposure to disease

C

The double arrows between groups of people in a Stock and Flow diagram illustrate: (A) "Flows," the accumulation of individuals in certain conditions at any point in time (B) "Stocks," the accumulation of individuals in certain conditions at any point in time (C) "Flows," the movement of individuals during a specific interval of time (D) "Stocks," the movement of individuals during a specific interval of time

C

The four P's of marketing health services include: (A) Product, promotion, prestige, and planning (B) Product, place, promotion, and pragmatism (C) Product, price, place, and promotion (D) Product, price, precision, and promotion (E) Personnel, promotion, price, and place

C

The largest single component in most public health and health care budgets, and therefore the one with which managers must be most familiar is: (A) Computer software and hardware (B) Pharmaceuticals (C) Personnel (D) Shortfalls

C

The practice of linguistic competency refers to all but the following: (A) The capacity of an organization and its personnel to communicate effectively (B) Conveying information in a manner that is easily understood by diverse audiences (C) Use of family members as medical interpreters (D) Assisting persons of limited English proficiency, low or no literacy skills

C

The recent pattern of U.S. per capita health care spending over the past 40 years (provided by the U.S. Congressional Budget Office), increasing at an annual average of 5% over the rate of inflation, generates: (A) A linear graph of annual spending with a slope of .05 (B) Spending that is approximately constant in real terms (C) An ever-increasing rate of growth of expenditures with a constant doubling time of about 14 years (D) An ever-increasing rate of growth of expenditures with ever-decreasing doubling times

C

The skills required for public health leaders today: (A) Are the same as they have always been (B) Pertain more to management and fiscal oversight (C) Require more collaborative approaches with cross-sector and community partners (D) Should place an emphasis on emergency preparedness

C

The social marketing conceptual framework if known for its 4 P's and competition. Which of the following is not one of the 4 P's? (A) Price (B) Product (C) Population (D) Place

C

The term "nosocomial" refers to infections acquired in what place? (A) The patient's home (B) The patient's workplace (C) A hospital (D) Public transportation

C

Theory is defined as: (A) A branch of philosophy that deals with morality (B) A tested set of hypotheses listed in order of importance (C) A systematic relationship of constructs devised to analyze, predict, and otherwise explain the nature of behavior of a specified set of phenomena (D) A verified fact that the majority does not believe to be true

C

What are the basic component units that are linked together to make proteins? (A) Sugars (B) Nucleotides (C) Amino acids (D) Lipids

C

What is the best explanation for the importance of liquidity to the not-for-profit health care organization (HCO) and its stakeholders? (A) Liquidity is necessary to ensure that the HCO achieves its revenue projections. (B) In the event that the HCO decides to invest heavily in plant expansion, it will have cash on hand. (C) Liquidity will allow the HCO to cover its short-term obligations and unexpected cash demands. (D) All HCO competitors have liquidity.

C

What is the best screening recommendation for lung cancer? (A) X-ray examination annually (B) Blood test annually (C) No screening recommended (D) Sputum cytology every 3 years

C

What is the function of law in public health? (A) To govern and "police" individual interests of all citizens (B) Coercive interventions aimed at changing individual behaviors of the population (C) To create a mission for public health authorities, assign their functions, and specify the manner in which they may exercise authority (D) To empower governments to act and set limits on power

C

What is the relevance of HEDIS for ensuring quality in health care delivery? (A) HEDIS (Health Enforcement, Disciplinary & Investigation Staff) is the agency the Centers for Medicare and Medicaid Services that investigates and prosecutes fraud and abuse violations in Medicare-funded hospitals (B) Health Education Deserves Industry Support (HEDIS) is a consumer advocacy group that lobbies corporations to invest in employee health and fitness (C) The Health Plan Employer Data and Information Set (HEDIS) provides an assessment tool for measuring the quality of care provided by HMOs (D) HEDIS (Healthcare Education Development & Improvement System) provides programmed instruction and self-assessment tools for professional development of clinical managers in health care

C

What is the term for recommendations about how to treat a patient with a particular disease that are based on findings from experimental and/or observational studies? (A) Cost analysis (B) Physician consensus statements (C) Clinical practice guidelines (D) Patient preference guidelines

C

What is true about a comprehensive rational approach to program planning in public health? (A) Facts are presented in narrative, not numerical, format. (B) The approach represents a consistent alignment with only one point of view (C) Results in an encompassing, intertwined set of actions. (D) Must include procedures to help groups recognize that different values may be a source of conflict in planning

C

What measures have been shown to be highly effective in controlling the spread of MRSA in hospitals? (A) Increased doses of antibiotics (B) Changing the layout of beds in Intensive Care Units (C) Increased adherence to basic sanitation procedures, such as use of hand sanitizer (D) Transfer of infected patients to isolation wards

C

When planning print materials for a public health education program, you should always: (A) Use at least 4 color printing (B) Work with an experienced graphic designer (C) Test them with members of the intended audience (D) Use the largest print possible

C

Which is not one of the values and beliefs underlying the public health code of ethics? (A) Humans are inherently social and interdependent (B) Humans have a right to the resources necessary for health (C) Full knowledge is required for public health actions (D) People and their physical environment are interdependent

C

Which method of acquiring HIV infection is the only one that is increasing in the USA? (A) Blood transfusion (B) Homosexual male-male sex (C) Heterosexual sex (D) Injection Drug Use

C

Which of the following disinfection methods is most commonly used in US drinking water supply systems? (A) Ozonation (B) Bromination (C) Chlorination (D) Ultraviolet irradiation

C

Which of the following have not been demonstrated as gender-linked health disparities? (A) Domestic and sexual violence (B) Sexually transmitted infections, including HIV/AIDS (C) Unintentional and intentional injuries (D) Health care decision-making (E) Clients being less informed about and taking less responsibility for their own health

C

Which of the following is a problem with live, attenuated vaccines? (A) They are very expensive to produce (B) They produce a weak response and require booster shots (C) They can revert to a virulent form (D) People can develop allergic reactions to them

C

Which of the following is not a construct from the Health Belief Model? (A) Susceptibility (B) Cues to action (C) Decisional balance (D) Barriers

C

Which of the following is not a disease that can be contracted by the food-borne route? (A) Salmonellosis (B) Giardiasis (C) West Nile Virus Neuroinvasive Disease (D) Hepatitis A

C

Which of the following is not a true statement about the policy-making process? (A) A policy is a blueprint for action relevant to some area of public concern (B) Policy-making often occurs in the absence of complete information about all relevant variables (C) Only experts trained in public policy have a meaningful role to play in policy development (D) Policies as enacted often reflect compromises among key players with conflicting interests

C

Which of the following is the best example of intrapersonal factors that affect an individual's behavior as outlined by the Social Ecological Model? (A) National laws and policies (B) Informal social networks (C) Personal knowledge or skills (D) Community partnerships

C

Which of the following most directly deals with the issue of internal validity in program evaluation design? (A) Having a reliable and valid measurement instrument (B) Having well-written process objective (s) (C) Having a comparison group (D) Ensuring generalizability of program effects

C

Which of the following pairs of values are most likely to conflict during a response to a public health emergency? (A) Truth-telling versus justice (B) Beneficence versus justice (C) Individual autonomy versus community welfare (D) Community welfare versus justice

C

Which of the following statements best characterizes the research findings on trait-based approaches to leadership theory? (A) Intelligence, high energy and initiative are proven to be the necessary and sufficient set of characteristics for effective leadership (B) Leadership traits are based on nature, not nurture; so leaders are born, not made (C) No one set of traits has been established as being necessary and sufficient for effective leadership behavior (D) Personality traits of leaders are irrelevant to their effectiveness in their leadership roles

C

Which of the following terms is defined as "the systematic determination of certain risks to a population incident to a disaster"? (A) Baseline data evaluation (B) Risk communication (C) Vulnerability assessment (D) Biohazard analysis

C

Which of the following terms is expressed as a ratio (as distinguished from a proportion)? (A) Male Births / Male + Female Births (B) Female Births / Male + Female Births (C) Male Births / Female Births (D) Stillbirths / Male + Female Birth

C

Which type of radiation has the greatest ability to penetrate body tissue? (A) a-radiation (B) ß-radiation (C) Gamma-radiation (D) Ultraviolet radiation

C

While the 10th amendment to the constitution gives the states primary responsibility for public health, inequities between and among the states persist because: (A) The amendment did not specify standards of care that each state had to meet (B) Standards of care are implied but implementation is left to the states (C) Each state has the right to define and delegate authority and responsibility for public health services (D) Public health services are funded through property taxes that vary from state to state

C

A person's blood pressure is 140/90 mm Hg. Would he or she be classified as: (A) Optimal (B) Normal (C) Having high normal blood pressure (D) Having hypertension

D

According to Mintzberg, "the central purpose of structure [in an organization] is to": (A) Produce a high-quality product (B) Allow for the development of strategy based on the organization's mission, vision, and values (C) Provide the content for organization charts (D) Coordinate the work of the organization, which has been divided in a variety of ways

D

All of the following are responsibilities prescribed for Federal agencies under Executive Order 12898, except: (A) Creation of an interagency working group (B) Development of agency strategies (C) Federal agency responsibilities for Federal programs (D) Mandate for the polluters-pay principle

D

Anonymous data is data for which identifying information was (A) collected (B) linked (C) retrieved (D) not maintained

D

Biological, environmental, behavioral, organizational, political, and social factors that contribute to the health status of individuals, groups and communities are commonly referred to as: (A) Health behavior causal factors (B) Social ecology factors (C) Needs assessment factors (D) Determinants of health

D

Case-control studies are among the best observational designs to study diseases of: (A) High prevalence (B) High validity (C) Low case fatality (D) Low prevalence

D

Children and adolescents below the age of consent are incapable of making determinations on their own behalf when exposed to cigarette advertising and promotion. They need protection from those who seek to stimulate their desires for harmful goods. Cigarette smoking once commenced is driven by the addictive power of nicotine. By restricting advertising and promotion to children, limits would also be imposed on adults. The empirical argument to support the ban is: (A) when children receive a free cigarette, they begin smoking routinely (B) outdoor advertising effects child behavior (C) advertising leads to erratic adult smoking behavior (D) restricting advertising will decrease smoking by children

D

Dr. Sharon Smart is a senior genetics researcher for Genomatic, Inc., an emerging pharmaceutical company. Dr. Smart was the lead researcher in a recent large-scale clinical study designed to test the efficacy of Alive, a new pharmaceutical designed to successfully treat a terminal form of ovarian cancer. Dr. Smart received a call today from a colleague at Genomatic, Dr. Duit, the chief information officer, who worked in the company's headquarters in Seattle. Dr. Duit had recently received a request from the dean of the medical school at a major university that sought access to some of the company's clinical trials databases. Researchers at the medical school thought that some of Genomatic's information might further research on a joint pharmaceutical project between the university and Genomatic. Dr. Smart inquired as to whether she could share the data without specified informed consent of the subjects. Dr. Duit assured her that he spoke with the company's legal counsel and was informed that there is no state law against sharing this data (at least in Washington state). He also informed Dr. Smart that Genomatic's CEO recently pledged monetary support to the university and this was a mutually beneficial practice for both Genomatic and the university, and the public would benefit as well through improvements in medical science. He then stated that no one debates the value of using this data and instructed Dr. Smart to send him the data tomorrow. Thinking about the subject's informed consent as a primary issue, what should Dr. Smart do in regards to forwarding the requested data to the chief information officer at Genomatic? (A) Send the information as requested (B) Inform Genomatic officials of the request and request their support (C) Carefully review the state reporting requirements and privacy laws (D) Determine the scope of Genomatic's subjects' informed consent, and determine if the informed consent language authorizes the release of medical records to the university

D

Federal environmental laws usually allow States to make parallel environmental laws as long as standards in the latter are: (A) Higher than Federal standards (B) In conflict with Federal standards (C) Same as, or equal to Federal standards (D) No less stringent than Federal standards

D

Franklin's Grove is the county seat of Franklin County, a small rural county in the Southeast. On the basis of its demographic and economic profile, it was selected as a health improvement zone to receive Federal funds to implement programs to improve progress toward reaching the national health objectives. Communities receiving such funds are charged with identifying the most significant gaps between the current health status and national health objectives and with putting programs in place to narrow such gaps. The Franklin County health program planners intend to keep close track of the number of programs and activities offered, the number of adults and children who participate in each program or activity, and all feedback given by community members about the programs and activities. These actions would most appropriately fit into which of the following evaluation categories? (A) Cost-effectiveness (B) Impact (C) Outcome (D) Process

D

Identify which of the following terms characterizes the throughput of the health care system? (A) The geographical boundary that defines the system's market (B) Measures of patient's functionality post-surgery (C) Patient satisfaction scores (D) The core technologies involved in providing health care services

D

If a food contaminated with a virus, such as hepatitis A, is left out for 4 hours in a kitchen at a temperature of 85 degrees Fahrenheit, the virus count in the food: (A) Increases exponentially because viruses multiply rapidly under these conditions (B) Increases slowly because the food temperature is still not as high as body temperature (C) Can increase or remain the same depending on the acidity of the food (D) Does not change

D

In health care systems, such as those involving disease incidence related to smoking, that contain both reinforcing (positive) and balancing (negative or stabilizing) feedback loops: (A) The reinforcing loop always dominates (B) The balancing loop always dominates (C) The reinforcing loop dominates early, but dominance later switches to the balancing loop (D) The reinforcing and balancing loops may alternate in dominance, depending on the details of the overall system

D

In ordinary usage, the verb to communicate means which of the following: (A) to tell a person something specific (B) to provide clear and precise instructions (C) interact in written form as opposed to verbal in the legal sense (D) to exchange thoughts, feelings, and information

D

In the planning process, the group being served is referred to as the: (A) Pilot population (B) Key informants (C) General population (D) Priority population

D

In what part of sub-Saharan Africa is HIV prevalence the greatest? (A) West (Nigeria, Chad, Mali) (B) East (Kenya, Ethiopia, Somalia) (C) Central (Congo, Malawi, Uganda) (D) South (South Africa, Zimbabwe, Zambia)

D

Information management deserves greater attention nationally from public health administrators and managers. Which of the functions below would not be a priority reason for IMs increased funding for public health departments? (A) Pivotal, all encompassing role information plays in management's organizing function (B) Strategic implications of storing information for operational decision making (C) Potential information management holds for mitigating health disparities (D) Potential for developing public health electronic medical records

D

It is frequently said that the most difficult component of the policy process is not implementation but getting health legislation approved because of the (A) Politics of health care and services delivery are so value laden (B) Need to have funds to hire well connected lobbyists (C) Very different opinions held by the two major political parties (D) Ability to preserve and keep a piece of legislation on the agenda and in front of those in power

D

It is often said that the typical manager (and health care managers are no exception) devote up to 81% of his/her time to communication daily. This implies that: (A) Managers have to be equipped with the most technological advancements for speedy communication (B) Have a thorough understanding of the communication process including the role of "noise" in the communication process (C) Know how to encode and decode a message (D) Have a thorough understanding of the communication process including when to use the most appropriate communication venue and how to use it most effectively

D

Personal traits that are considered important for leadership success include: (A) age (B) gender (C) personality (D) self-confidence

D

Phase 2 metabolism usually involves: (A) Microsomal enzymes (B) Decrease in the polarity of a chemical (C) Increase in the toxicity of a chemical (D) Addition of an endogenous moiety

D

Re-negotiating your salary with your boss for good job performance is an example of: (A) Transformational leadership (B) Style leadership (C) Contingent reward (D) Transactional leadership

D

Rocky Mountain Spotted Fever and Lyme Disease are examples of diseases transmitted by: (A) Mosquitoes (B) Polluted water (C) Contaminated food (D) Ticks

D

Systems can be viewed as hierarchic in that visible events are the expression of patterns of behavior, which in turn, are the expression of or result of systemic structures. With that view, often illustrated with the image of an iceberg, which of the following statements is true? (A) A focus on events is sufficient to create a new and better system (B) A deep understanding of the systemic structures limits us to being reactive to recent events (C) Systems such as health care are so massive that the only feasible approach to change is to react with minor adjustments in response to the superficial and accessible events (D) Creative and transformative changes to the underlying systemic structure permit the creation of different futures

D

The "Greenhouse Gas" of primary concern in global warming is: (A) Chlorofluorocarbon refrigerant (B) Carbon monoxide (C) Sulfur dioxide (D) Carbon dioxide

D

The CDC argues that the current focus of the US health systems is on "tertiary preventions." According to a Stock and Flow diagram, that focus would be most likely to produce which of the following outcomes? (A) Minimize overall prevalence of the disease or condition in the population (B) Minimize overall financial expenditures for treatment of the disease or condition (C) Minimize the cost of lost wages from the disease or condition (D) Minimize or delay mortality from the disease or condition

D

The CEO of a managed care organization praised her administrators at a national conference for exceeding their enrollment targets. She noted that long waits for care and travel distances might increase but that the members would certainly understand given the popularity of their health plan. The CEO's statements reflect: (A) A sound knowledge of quality care (B) The ability to integrate quality and organizational solvency (C) A serious lack of understanding around members' perceptions of quality of care and the consequences of poor organizational performance (D) Her perception of quality care

D

The Emergency Planning and Community Right to Know Act establishes the State Emergency Response Commissions (SERCs) and the Local Emergency Planning Committees (LEPCs) to develop comprehensive emergency response plans to address releases of extremely hazardous substances (EHSs). Such plans must contain the following information: (A) Material safety data sheet, monitoring device, and emission gauge (B) Environmental review process and names of responsible people (C) Medical personnel, evacuation plan, and first aid kits (D) Identity of regulated facilities, evacuation plan, medical response, and procedure for notifying people named in the plan as well as the general public that a release has occurred

D

The best example of culturally appropriate community engagement and empowerment refers to which of the following? (A) Teaching community members how to best communicate with providers (B) Conducting health needs and assets assessment with communities and sharing the information with them (C) Teaching self-determination to community members (D) Implementing health projects that result in the reciprocal transfer of knowledge and skills among all collaborators and partners

D

The burden of environmental contamination and pollution is not equally distributed. Some areas and populations, particularly people of color and low-income communities, have been disproportionately affected by environmental insults or lack equal access to social, economic, and environmental amenities. Understanding why this happens is crucial, and new methods of collaboration must be developed to redress the harm, restore human and environmental health, allow sustainable development to proceed, and develop policies to prevent these inequities from recurring. Along the Texas-Mexico border, there are many examples of environmental insults that disproportionately affect the Hispanic segment of the population. Many of these people live in colonias (neighborhoods). Some of these colonias are very primitive, with unpaved roads, no running water (water is brought in via tanker trucks), and no public sewage. The lack of a potable water supply is an example of environmental insult. There are several methods for making drinking water available. Which of the following is not an acceptable method from a health standpoint? (A) Using a tank truck to deliver water from a potable source (B) Using a community tap connected to a potable source (C) Pumping water from an uncontaminated aquifer (D) Pumping water directly from a river

D

The following are characteristics of a cross-sectional study except: (A) Characteristics of "case" are clearly defined (B) The study is done on a defined population (C) All members of the population should be able to experience the outcome of interest (D) Patients are followed for a sufficient period of time for outcome events to occur (E) The study is done on a representative sample of the target population

D

The most promising resolution to the problem of health disparities includes: (A) Improved data collection and evaluation of health care systems (B) An increase of diverse providers involved in disparities-reduction programs (C) Minimum standards for culturally and linguistically competent health services (D) Expansion of coverage plans for all ethnic, racial low-income groups

D

The nutrient-rich solids produced as a byproduct of municipal sewage treatment and often proposed for use a soil amender in agriculture is termed: (A) Hazardous waste (B) Suspended Solids (C) Biochemical Oxygen Demand (BOD) (D) Sludge

D

The primary disadvantage of incremental program budgeting is: (A) It makes comparison from one year to the next difficult (B) It requires the justification of all dollars allocated (C) It requires far more time and effort than zero-based budgeting (ZBB) (D) It may not reflect the current programmatic priorities of the organization

D

The primary purpose of strategic planning is: (A) To beat the competition (B) To define the organization's vision (C) To maximize financial status (D) To determine the direction an organization will pursue within its chosen environment and guide the allocation of resources and efforts

D

The relative risk of drying for smokers compared to non-smokers is: "The death rate per 100,000 for lunch cancer is 7 among non-smokers and 71 among smokers. The death rate per 100,000 for coronary thrombosis is 422 among non-smokers and 599 among smokers. The prevalence of smoking in the populations is 55%. (A) 9.1 for lung cancer and 0.30 for coronary thrombosis (B) 9.1 for lung cancer and 1.4 for coronary thrombosis (C) 10.1 for lung cancer and 8.4 for coronary thrombosis (D) 10.1 for lung cancer and 1.4 for coronary thrombosis (E) 12.4 for lung cancer and 1.7 for coronary thrombosis

D

The single best predictor of poor health is: (A) Poor sanitary conditions (B) Lack of medical care (C) Genetics (D) Poverty

D

Understanding (and ultimately affecting) the local community dynamics (incidence and prevalence) of asthma requires insights into the feedback loops within and between which areas of public health specialization? (A) Behavioral health and environmental health (B) Environmental health and epidemiology (C) Epidemiology, behavioral health, and health management (D) Behavioral health, epidemiology, health management, and environmental health

D

What are the non-traditional partners that could be effective collaborators in community-wide preparedness planning? (A) Public safety agencies (e.g. Fire, Police) (B) Public health departments (C) Emergency management (D) Social service and faith-based agencies

D

What is an evaluation designed to present conclusions about whether a program should be sustained, changed, or eliminated? (A) Needs assessment (B) Implementation evaluation (C) Process evaluation (D) Summative evaluation

D

What kind of infectious agent is a prion? (A) A bacterium (B) A virus (C) A protozoan (D) A protein

D

What simple, low-tech sanitation measure can dramatically reduce the spread of enteric bacteria and viruses? (A) Disposing of stagnant water (B) Sleeping under an insecticide-soaked bednet (C) Vaccination of those individuals who work on the water supply (D) Chlorination of drinking water

D

Which measure of mortality would you calculate to determine the proportion of all deaths that is caused by heart disease? (A) Case fatality (B) Cause-specific mortality rate (C) Crude mortality rate (D) Proportionate mortality ratio (E) Potential years of life lost

D

Which of the following is an example of a utilization rate used to monitor health system performance? (A) Congenital syphilis rate (B) Late stage breast cancer incidence rate (C) Infant mortality rate (D) Readmission rate for depression

D

Which of the following is defined as a community's ability to define and solve its own problems? (A) Social capital (B) Community development (C) Community organization (D) Community capacity

D

Which of the following is likely to be a major obstacle to community readiness for a public health emergency such as an act of bioterrorism? (A) People no longer feel anxiety about the risks of bioterrorism (B) The average person has faith that public officials are competent to handle such threats (C) The consequences of the anthrax-letter threat following 9/11 were far less serious than anticipated (D) Individuals are unsure about the practical actions to take to protect themselves and their families

D

Which of the following is the best example of a process evaluation for a program designed to decrease mortality from drinking and driving among high school youth? (A) Document change in mortality associated with drinking and driving (B) Document change in numbers of youth riding with impaired drivers (C) Document about risks of riding with impaired drivers (D) Document number of students who attend the school's alcohol-free party

D

Which of the following leadership strategies is likely to be most effective for the head of a research team intending to implement an evaluation study of the effectiveness of an intervention to prevent high risk behavior among pre-teens in a low-SES community by partnering with community representatives and parents of at-risk children? (A) Convey an attitude of solicitous, paternal concern, insuring the community leaders that whatever the team does will benefit the community (B) Clearly demonstrate your own academic credentials and "track record" to convince the community representatives of your expertise, skills and knowledge of the problem (C) Tell the community leaders that your only agenda is to help improve their community (D) Invite the community leaders to work collaboratively to plan, develop and implement the research study/intervention

D

Which of the following processes from the Transtheoretical Model refers to substituting healthy behaviors for unhealthy ones? (A) Stimulus control (B) Consciousness raising (C) Reinforcement management (D) Counter-conditioning

D

Which of the following represents a boundary management function in public health? (A) Creating cubicles for the staff to maximize the efficiency of the work space (B) Developing maps showing the incidence of diabetes within target communities (C) Reprimanding an employee for behavior perceived to be sexual harassment (D) Scheduling the Director of the county health department to be interviewed by a journalist about a recent outbreak of food-borne illness

D

Which of the following statements accurately describes the financing of health care in the United States? (A) Public health services represent approximately half of the total expenditures for health care (B) Health care expenditures as a percentage of GDP have remained stable within the range of 5%-8% since the 1970s (C) Medicare funds most of the services received by the elderly living in institutional long term care facilities (D) Medicaid is a Federal-State partnership which covers some health care and related services for low-income families with children and individuals who are elderly, blind and disabled

D

Which of the following statements is true about surveillance data? (A) It cannot be used to detect geographical clusters (B) It includes information on health outcomes, but not exposures or risk factors (C) It provides early recognition of an infectious disease outbreak, but is much less useful for noninfectious disease events (D) It can be used to monitor temporal trends in disease (E) It only includes data pertaining to vaccine-related diseases

D

Which of the following statements is true with respect to power? (A) Power depends upon the use of force (B) The exercise of power is a last resort when politics fails to achieve organizational objectives (C) The abuse of power only adversely affects those in the subordinate position of power (D) Power is the capacity of a person to influence other persons to do things

D

Which of the following statements regarding disease measures is inaccurate? (A) Prevalence equals duration times incidence (B) Prevalence is a proportion (C) Cumulative incidence is a proportion (D) Incidence density is a proportion

D

Which of the following terms refers to a consumer-driven application of sales and promotional techniques to the analysis (including the review of background information and formative work), planning, implementation, and evaluation of programs designed to encourage positive health behaviors within intended audiences? (A) Health communication (B) Health promotion (C) Focus group testing (D) Social marketing

D

Why are polio outbreaks hard to control? (A) Because the virus is spread by the fecal-oral route (B) Because the virus crosses the blood-brain barrier (C) Because the virus causes several different kinds of paralysis (D) Because the virus does not cause recognizable symptoms for up to 35 days from infection

D

Within the body, lipophilic substances: (A) Are poorly absorbed in the digestive tract. (B) Are excreted rapidly in the urine. (C) Accumulate in bones and teeth (D) Accumulate in body fat

D

You are working within a public health setting and are planning a program to reduce cholesterol levels in men 40-60 years old. Which one of the following is the most important component of your program? (A) Organize local doctors to lecture on cholesterol reduction (B) Conduct a demonstration of cholesterol lowering foods (C) Give each participant a pamphlet with information (D) Measure their blood cholesterol levels before, during and after the program

D

When confronted with constrained community resources for emergency preparedness, a critical success factor for a community emergency response program is: (A) Community-wide practice drills (B) A community-wide alert system (C) A unified command and control center (D) A community-wide campaign promoting family preparedness (E) All of the above

E

Which of the following could be routinely considered as part of the "public" in planning for effective communication at the community level? (A) Citizens (B) Elected officials (C) The media (D) Employees (E) Regulators (F) All of the above

F

Leadership is a process involving influence toward goal attainment and: (A) is predicated on politics (B) relies on CQI (C) focuses on quantitative assessment (D) occurs within a group

d