Advanced Epidemiology and Bio-statistics for Nursing

“Practice Questions I”

Question 1 is based on the following information:

A physical examination and an audiometric test were given to 600 persons with suspected hearing problems, of whom 300 were actually found to have them. The results of the examinations were as follows:

PHYSICAL EXAMINATION
HEARING PROBLEMS
Result Present Absent
Positive 250 35
Negative 50 265

AUDIOMETRIC TEST
HEARING PROBLEMS
Result Present Absent
Positive 285 50
Negative 15 250

1. Compared with the physical examination, the audiometric test is: [ONE POINT]

a. Equally sensitive and specific
b. Less sensitive and less specific
c. Less sensitive and more specific
d. More sensitive and less specific
e. More sensitive and more specific

Questions 2 is based on the information given below:

In an Asian country with a population of 20 million people, 80,000 deaths occurred during the year ending December 31, 2015. These deaths included 65,000 deaths from cholera in 90,000 people who were sick with cholera.

1. What was the case-fatality rate from cholera in 2015? Write comments about the calculated case fatality. [ONE POINT]
2. What would be the effect on age-specific incidence rates if women with hysterectomies were excluded from the denominator of calculations, assuming that there are some women in each age group who have had hysterectomies? [ONE POINT]
   a. the rates would remain the same
   b. the rates would tend to decrease
   c. the rates would tend to increase
   d. the rates would increase in older groups and decrease in younger groups
   e. it cannot be determined whether the rates would increase or decrease
3. At an initial examination in Oxford, Mass., migraine headache was found in 10 of 1,000 men aged 30 to 35 years and in 20 of 1,000 women aged 30 to 35 years. The inference that women have a two times greater risk of developing migraine headache than do men in this age group is: [ONE POINT]
   a. correct
   b. incorrect, because a ratio has been used to compare male and female rates
   c. incorrect, because of failure to recognize the effect of age in the two groups
   d. incorrect, because no data for a comparison or control group are given
   e. incorrect, because of failure to distinguish between incidence and prevalence
4. Age-adjusted death rates are used to: [ONE POINT]
   a. Correct death rates for errors in the statement of age
   b. Determine the actual number of deaths that occurred in specific age groups in a population
   c. Correct death rates for missing age information
   d. Compare deaths in persons of the same age group
   e. Eliminate the effects of differences in the age distributions of populations in comparing death rates
5. For a disease such as pancreatic cancer, which is highly fatal and of short duration: [ONE POINT]

a. Incidence rates and mortality rates will be similar
b. Mortality rates will be much higher than incidence rates
c. Incidence rates will be much higher than mortality rates
d. Incidence rates will be unrelated to mortality rates
e. None of the above

Question 7 and 8 are based on the following information:
In 1990, there were 2,365 deaths due to lung diseases in miners aged 20 to 64 years. The expected number of deaths in this occupational group, based on age-specific death rates from lung diseases in all males aged 20 to 64 years, was 1,050 during 1990

1. What was the standardized mortality ratio (SMR) for lung diseases in miners? [ONE POINT]
2. Interpret the value of the SMR and discuss the implication on nursing practice: [ONE POINT]

Questions 9-12 are based on the information given below: show the calculation and comment on the validity of the audiometric test.

AUDIOMETRIC TEST
HEARING PROBLEMS
Result Present Absent
Positive 285 10
Negative 15 190

1. The sensitivity of the audiometric test was: [ONE POINT]
2. The specificity of the audiometric test was: [ONE POINT]
3. The positive predictive value of the audiometric test was: [ONE POINT]
4. The negative predictive value of the audiometric test was: [ONE POINT]
5. Which of the following is a good index of the severity of a short-term, acute disease? [ONE POINT]
   a. Cause-specific death rate
   b. 5-year survival
   c. Case-fatality rate
   d. Standardized mortality ratio
   e. None of the above
6. The occurrence in a community or region of cases of an illness, specific health-related behavior, or other health-related events clearly in excess of normal expectancy is a/an: [ONE POINT]

A: Pandemic
B: Endemic
C: Epidemic

1. The level of prevention that takes place during the early phases of pathogenesis and includes activities that limit the progression of disease is: [ONE POINT]

A: Primary Prevention
B. Secondary Prevention
C. Tertiary Prevention

1. The probability that an event will occur, e.g., that an individual will become ill or die within a stated period of time or by a certain age is: [ONE POINT]

A: Epidemiologic Transition
B. Risk
C. Hypothesis

1. Which of the following is an observational study: [ONE POINT]

A: Randomized control trials
B: Hybrid study
C: Cohort study

1. Wearing a safety belt is an example of which level of prevention? [ONE POINT]

a) Primary prevention
b) Secondary prevention
c) Tertiary prevention
d) Community prevention

1. Providing education to a diabetic on how to use his/her insulin is an example of which level of prevention? [ONE POINT]

a) Primary prevention
b) Secondary prevention
c) Tertiary prevention
d) Community prevention

1. Providing training or instructing patients on how to modify their diets and take their medications to prevent a second heart attack is an example of __ prevention. [ONE POINT]

a) primary
b) secondary
c) tertiary
d) community

e) 15. 21. Sensitivity and specificity are important criteria for screening and diagnostic instruments. What is sensitivity? [ONE POINT]

A) Different method of measuring the same attributes yielding similar results
B) Ability to differentiate the construct being measured from other similar concepts
C) Instrument's ability to identify a case correctly
D) Instrument's ability to identify non-cases correctly.

22. The nurse researcher knows that there are two primary criteria for assessment of an instrument. What is reliability? [ONE POINT]

A) Degree of consistency or accuracy with which an instrument measures an attribute
B) Magnitude and direction of a relationship between two variables
C) Extent to which an instrument yields the same results on repeated administrations
D) Extent to which an instrument's items are measuring the same attribute

Questions 23 and 24 use the information below:

Population of the city of Atlantis on March 30, 2003 = 300,000
No. of new active cases of TB occurring between January 1 and June 30, 2003 = 90
No. of active TB cases according to the city register on June 30, 2003 = 345

1. The incidence rate of active cases of TB for the 6-month period was: [ONE POINT]
   a. 7 per 100,000 population
   b. 14 per 100,000 population
   c. 26 per 100,000 population
   d. 30 per 100,000 population
   e. none of the above
2. The prevalence of active TB as of June 30, 2003, was: [ONE POINT]
   a. 14 per 100,000 population
   b. 115 per 100,000 population
   c. 147 per 100,000 population
   d. 175 per 100,000 population
   e. none of the above
3. Which of the following is an advantage of active surveillance? [ONE POINT]
   a. requires less project staff
   b. is relatively inexpensive to employ
   c. more accurate due to reduced reporting burden for health care providers
   d. reporting systems can be developed quickly
   e. relies on different disease definitions to account for all cases
4. Which of the following is a measure of disease prognosis? [ONE POINT]
   a) Prevalence
   b) Median survival time
   c) Age-adjusted mortality rates
5. Which of the following is a case-control study? [ONE POINT]
   a. Study of past mortality or morbidity trends to permit estimates of the occurrence of disease in the future
   b. Study of the incidence of cancer in men who have quit smoking
   c. Analysis of previous research in different places and under different circumstances to permit the establishment of hypotheses based on cumulative knowledge of all known factors
   d. Obtaining histories and other information from a group of known cases and from a comparison group to determine the relative frequency of a characteristic or exposure under study
   e. Both a and c
   f. None of the above
6. Explain the relationship between sensitivity and false negative results?
   Give example (ONE POINT)
7. What type of study design is considered to be the ‘gold standard’ in assessing cause and effect relationship? [ONE POINT]
   a. Cohort
   b. Case-control
   c. Ecological
   d. Experimental
8. Residents of three villages with three different types of water supply were asked to participate in a survey to identify cholera carriers. Because several cholera deaths had occurred recently, virtually everyone present at the time underwent examination. The proportion of residents in each village who were carriers was computed and compared. What is the proper classification for this study? [ONE POINT]
   a. Case-control study
   b. Cohort study
   c. Cross-sectional study
   d. Experimental study

Sample Solution