1)
Which of the following is not included in descriptive epidemiology?
a)
Tabulating the number and causes of death among residents and workers after Hurricane Charley.
b)
Graphing the rate of sudden infant death syndrome (SIDS) per 100,000 births by year, noting on the graph the year in which the “Back to Sleep” campaign was launched.
c)
Creating a spot map with two different kinds of spots — one for human cases of West Nile virus infection and a different one for animal cases.
d)
Dividing the attack rate among persons at a company picnic who ate each food by the attack rate among persons who did not eat that food.
e)
Calculating the frequency distribution of clinical signs, symptoms, and laboratory findings among case-patients in a case-control study of amyotrophic lateral sclerosis (ALS, or Lou Gehrig disease).
2)
A case definition used during an outbreak investigation in which investigators are trying to identify a cause can include all of the following components except…
a)
clinical features, possibly including laboratory results, of the disease.
b)
date and time of onset of illness.
c)
person characteristics such as limits on age.
d)
place characteristics, such as restrictions by residence or membership in a group.
e)
the hypothesized exposure.
3)
Define: Endemic
a)
Average number of cases during the same period during the previous 3 years.
b)
Number of cases clearly greater than expected in a local area during a given period.
c)
Number of cases clearly greater than expected in multiple countries during a given period.
d)
Occasional cases at irregular intervals.
e)
Persistent level of disease.
4)
Define: Pandemic
a)
Average number of cases during the same period during the previous 3 years.
b)
Number of cases clearly greater than expected in a local area during a given period.
c)
Number of cases clearly greater than expected in multiple countries during a given period.
d)
Occasional cases at irregular intervals.
e)
Persistent level of disease.
5)
Define: Expected
a)
Average number of cases during the same period during the previous 3 years.
b)
Number of cases clearly greater than expected in a local area during a given period.
c)
Number of cases clearly greater than expected in multiple countries during a given period.
d)
Occasional cases at irregular intervals.
e)
Persistent level of disease.
6)
An epidemic curve should have all of the following features except…
a)
data are graphed as a vertical bar chart.
b)
Y-axis reflects number of cases.
c)
X-axis reflects date or time of onset of illness.
d)
X-axis includes a pre-epidemic (background) period.
7)
A case-control study differs from a cohort study in that…
a)
in a case-control study subjects are enrolled on the basis of their disease status in a cohort study they are not.
b)
in a case-control study information is collected on the subjects’ exposure status in a cohort study it is not.
c)
a case-control study has a comparison group (“controls”) a cohort study does not.
d)
a case-control study is typically used to identify causes a cohort study is typically used to learn about features of descriptive epidemiology.
8)
After a hurricane devastated multiple counties in a state, public health officials conducted a rapid needs assessment. They interviewed a representative sample of residents and asked about acute and chronic medical conditions, access to clean water, access to medications, and other immediate needs. This study design is a…
a)
case-control study
b)
cohort study
c)
community trial
d)
cross-sectional study
9)
The recommendation to drain standing water, thereby eliminating mosquito breeding sites and reducing the risk of vectorborne West Nile virus infection, is intended to interrupt which link in the chain of transmission?
a)
Portal of exit.
b)
Mode of transmission.
c)
Portal of entry.
d)
Host.
Use the following information for questions 10-15.
Eleven students experienced gastroenteritis after a school trip. The number of episodes of diarrhea reported by each student was 2, 11, 3, 2, 3, 5, 4, 3, 3, 5, and 3.
10)
What is the mean number of episodes of diarrhea among the students with gastroenteritis? (If necessary, round to nearest whole number.)
a)
2.0
b)
3.0
c)
4.0
d)
5.0
11)
What is the median number of episodes of diarrhea among the students with gastroenteritis?
a)
2.0
b)
3.0
c)
4.0
d)
5.0
12)
What is the mode of number of episodes of diarrhea among the students with gastroenteritis?
a)
2.0
b)
3.0
c)
4.0
d)
5.0
13)
What is the shape of the distribution of episodes of diarrhea?
a)
Skewed to the right
b)
Skewed to the left
c)
Normal
d)
Bimodal
14)
For this distribution of data, the median is the preferred measure of central location.
a)
True
b)
False
15)
For this distribution of data, the preferred measure of spread is which of the following?
a)
Midrange
b)
Range
c)
Standard deviation
d)
Variance
16)
Which is the most appropriate measure of central location for such laboratory assay dilution data as 1:8, 1:16, 1:32, 1:64, 1:128, etc.?
a)
Mean
b)
Median
c)
Mode
d)
Midrange
e)
Geometric mean
17)
Which measure of spread is most commonly reported with the mean?
a)
Interquartile range
b)
Midrange
c)
Range
d)
Standard deviation
e)
Variance
18)
One day, a researcher calculated measures of central location and spread on preliminary serum cholesterol results from 40 consecutive patients. The researcher obtained the following results:
arithmetic mean = 221.6 mg/dl
standard deviation = 30.1 mg/dl
median = 215 mg/dl
minimum = 110 mg/dl
mode = 210 mg/dl
maximum = 360 mg/dl
geometric mean = 218.9 mg/dl
The following day, the laboratory technician called to correct one value patient 37s serum cholesterol level was 380 mg/dL, not 280 mg/dL as initially reported. Which one of the following measures would not change as a result of this correction?
a)
Arithmetic mean
b)
Geometric mean
c)
Median
d)
Standard deviation
Use the following information for Questions 19–23.
Within minutes after the main course was served at a June wedding celebration that included a sit-down dinner, a number of guests began to experience tingling and burning around the mouth and facial flushing. Some had headaches and abdominal symptoms, and several elderly guests were transported to a local hospital. A quick-acting epidemiologist who was a guest at the wedding was able to determine that 25 of the 80 guests complained of the acute illness. The following two-by-two table indicates consumption of the main course by illness status.
Ill
Well
Total
Tuna
20
20
40
Lasagna
5
35
40
Total
25
55
80
19)
Which of the following is a food-specific attack rate?
a)
5/40
b)
20/20
c)
20/25
d)
25/80
20)
The fraction 20/25 is a/an…
a)
attack rate.
b)
food-specific attack rate.
c)
incidence proportion.
d)
proportion.
21)
The best measure of association to use for these data is a/an…
a)
food-specific attack rate.
b)
odds ratio.
c)
rate ratio.
d)
risk ratio.
22)
The best estimate of the magnitude of the association between tuna and illness is…
a)
4.0
b)
7.0
c)
31.3
d)
50.0
e)
80.0
23)
Which of the following describes the design of the study that was conducted?
a)
Case-control study
b)
Cross-sectional study
c)
Retrospective cohort study
d)
Community trial
24)
What type of measure are you calculating with the following fraction?
Number of persons living with HIV infection in State A during 2005
Estimated population of State A on July 1, 2005
a)
Attack rate
b)
Incidence rate
c)
Prevalence
d)
Mortality rate
25)
According to an analysis of vital statistics death certificate data from 1999, a total of 14,802 deaths were attributed to acquired immunodeficiency syndrome (AIDS) in the United States. The same year, 45,104 new cases of AIDS were reported. Assuming that these numbers are complete, the fraction 14,802/45,104 is which of the following types of measure?
a)
Case-fatality rate
b)
Cause-specific mortality rate
c)
Crude morality rate
d)
Death-to-case ratio
e)
Proportionate mortality
26)
Vaccine efficacy indicates which of the following?
a)
The proportion of vaccinated persons who develop immunity.
b)
The ratio of the number of vaccinated persons to unvaccinated persons.
c)
The proportion of persons who develop disease who are unvaccinated.
d)
The proportional reduction in disease among vaccinated persons compared with unvaccinated persons.
27)
The most appropriate time to create table shells is…
a)
before designing your questionnaire.
b)
before collecting your data.
c)
before transferring your data from questionnaire to computer.
d)
before editing (“cleaning”) your data.
e)
after cleaning your data, but before data analysis.
28)
What is the most important problem with the frequency distribution shown in the following table?
Table. Number of deaths from diabetes mellitus (ICD-10* code E10) by age group — United States, 2002
Age group (years)
Number of deaths
<1 1 1-5 3 5–15 34 15–25 171 25–35 642 35–45 2,164 45–55 5,496 55–65 10,022 65–75 16,709 75–85 23,282 <85 14,724 Unknown 1 Total 73,249 * International Classification of Diseases, 10th revision, 1992 a) Age group intervals of different sizes. b) Inclusion of death in person with unknown age. c) No column for percent distribution. d) Overlapping class intervals. e) Cannot calculate rates without providing population figures. 29) In the United States, the annual number of reported cases of measles has ranged from over 250,000 in 1965 to less than 100 in 2000. Which type of graph can best display these numbers by year? a) Arithmetic-scale line graph b) Bar chart c) Histogram d) Semilogarithmic-scale line graph 30) Researchers asked 100 women with colon cancer and 200 women without colon cancer if they had ever smoked more than 100 cigarettes in their lifetime (yes / no). What is the best way to display the data from this study? a) Bar chart b) Frequency distribution c) Line listing d) Pie chart e) Two-by-two table 31) The best measure of association to use for the study described in Question 30 is a/an… a) incidence proportion. b) odds ratio. c) rate ratio. d) risk ratio. 32) A hospital infection control practitioner wants to display the number of cases of surgical wound infections by week for the months of July and August. The number of cases per week ranges from 0 to 10. Which type of graph should be used? a) Arithmetic-scale line graph b) Polygon c) Histogram d) Semilogarithmic-scale line graph 33) Which of the following factors cannot be gleaned from an epidemic curve alone, that is, without additional information? a) Pattern of spread in the population b) Probable short-term direction of the epidemic, e.g., more or fewer cases c) Risk of disease among the population d) Time course of the epidemic to date 34) Which of the following graphs is not appropriate for displaying data from a one-variable table such as a frequency distribution? a) Box plot b) Dot plot c) Pie chart d) Simple bar chart e) Scatter diagram 35) What is the primary disadvantage of a spot map? a) The dots for two cases in the same location overlie each other therefore, a spot map cannot accurately portray the number of cases at the same location. b) The map does not reflect risk of disease. c) The map cannot indicate geographic location with enough precision to guide disease control and prevention efforts. d) The map does not take into account differences in the age distributions of different areas. 36) A comprehensive definition of public health surveillance is that it is the ongoing, systematic collection, analysis, and interpretation of health-related data essential to the planning, implementation, and evaluation of public health practice, closely integrated with the timely dissemination of these data to those responsible for prevention and control. a) True b) False 37) Which one of the following activities is not considered part of the activities of public health surveillance? a) Collecting case reports on occupationally related illness. b) Tabulating causes and circumstances of death from medical examiners’ records. c) Deciding that an influenza epidemic is in progress on the basis of an increase in laboratory reports of influenza isolates. d) Distributing meningococcal vaccine to prevent additional cases on a college campus. e) Posting last month’s counts of reportable diseases on the health department’s Internet site for health-care providers. 38) The ultimate goal of public health surveillance is… a) to guide public health action and policy. b) to monitor long-term trends in disease occurrence. c) to detect short-term trends in disease occurrence. d) to generate hypotheses and stimulate research. 39) The ability of a surveillance system to detect the cases it is intended to detect is referred to as: a) Predictive value positive b) Representativeness c) Sensitivity d) Specificity 40) What is the primary limitation of state notifiable disease surveillance systems? a) Absence of requirement for out-of-state laboratories to report. b) Lack of timeliness of notification of serious cases. c) Lack of representativeness of reported cases. d) Underreporting by those expected to report. e) Inconsistent use of standard case definitions. 41) Vital statistics are important sources of data on: a) Morbidity b) Mortality c) Risk factor prevalence d) Injury and disability e) Outpatient health-care utilization 42) A passive surveillance system is usually less expensive, more easily sustainable, and less sensitive than an active surveillance system. a) True b) False 43) Which of the following is not an example of syndromic surveillance? a) Surveillance of emergency room visits coded by chief complaint. b) Surveillance of acute flaccid paralysis in the effort to eradicate poliomyelitis. c) Surveillance of antibiotic resistance patterns transmitted electronically from hospital laboratories. d) Surveillance of calls to nurse hot lines. 44) The primary purpose for evaluating a surveillance system is to ensure that the system is… a) addressing the most important public health problems. b) cost-effective. c) operating as efficiently as possible. d) serving a useful public health function. 45) Which of the following defines the predictive value positive of a surveillance system? a) The proportion of reported cases that are laboratory-confirmed. b) The proportion of cases of disease in a community that are reported to the health department. c) How well the reported cases represent all of the cases (reported and unreported) in the community. d) The proportion of reported case-patients that truly have the disease. 46) Usually, the first two steps of an outbreak investigation, other than preparing for field work, are… a) confirm the diagnosis and develop a case definition. b) confirm the existence of an outbreak and confirm the diagnosis. c) develop a case definition and develop a plan to seek additional cases through widened surveillance. d) create a line listing and characterize the cases by time, place, and person. 47) After a case definition has been established early in an investigation, to maintain consistency, it should not be changed. a) True b) False 48) Which one of the following categories is usually not included on a data collection form used during an outbreak investigation? a) Patient identifying information b) Clinical information c) Health insurance information d) Risk factor information e) Reporter information (source of report) 49) Which one of the following is the least appropriate way to generate hypotheses in an outbreak investigation? a) Go to the CDC or state health department Internet site to learn more about the disease and its transmission. b) Talk with 2–4 of the case-patients. c) Conduct a case-control study. d) Characterize the reported cases by time, place, and person. e) Interview the case-patients that do not fit the usual pattern. 50) When should control and prevention measures be implemented? a) After establishing the existence of an outbreak. b) After identifying additional cases through widened surveillance. c) After characterizing the reported cases by time, place, and person. d) After executing analytic and additional studies to confirm the agent, source, and mode of transmission. e) As early as possible.
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