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Chamberlain NR503 Epidemiology Final Exam ( Version 1) / Chamberlain NR 503 Final Exam: Population Health, Epidemiology & Statistical Principles (New 2020) | 100 % VERIFIED ANSWERS, GRADE A

NR 503 Epidemiology Final Exam / NR503 Epidemiology Final Exam: Population Health, Epidemiology & Statistical Principles: Chamberlain College Of Nursing Chamberlain NR 503 Epidemiology Final Exam / Chamberlain NR503 Final Exam: Population Health, Epidemiology & Statistical Principles Question 1 A randomized, double-blind clinical trial of a varicella vaccine observed an estimated incidence of 25% chickenpox episodes in persons receiving the vaccine, compared to 80% among persons receiving a placebo. The estimated efficacy of the vaccine is: • 55.0% • 65.0% • 68.8% • 71.4% • 80.0% Question 2 A study is conducted for a pharmaceutical agent that has shown promise for reducing heart disease among women. In order to more fully test the agent, an additional study is done restricting the participants to be randomized to those who have a history of hypertension. Which of the following advantages cannot be claimed by the researchers? • Power of the study is increased • Potential benefits in high-risk populations are increased • Validity of the study is increased by focus on a homogenous population • The generalizability of the study is increased • The overall cost of the study is decreased Question 3 A new drug treatment for cardiac thrombus claims to have a higher success rate than the current drug. A strong sign of the potential success is the lack of internal hemorrhaging starting 2 days after treatment. 168 patients who require treatment for cardiac thrombi are randomized after agreeing to participate in a trial of the new drug. The researchers were interested in whether the new drug reduced the need for blood transfusions due to internal hemorrhage compared to the current treatment. The following table summarizes the results of her study: What is the incidence of needing a blood transfusion in the group of persons who were randomized to the new drug treatment? • 31.0% • 41.1% • 51.2% • 62.3% • Incidence cannot be calculated with the information in this table Question 4 A new drug treatment for cardiac thrombus claims to have a higher success rate than the current drug. A strong sign of the potential success is the lack of internal hemorrhaging starting 2 days after treatment. 168 patients who require treatment for cardiac thrombi are randomized after agreeing to participate in a trial of the new drug. The researchers were interested in whether the new drug reduced the need for blood transfusions due to internal hemorrhage compared to the current treatment. The following table summarizes the results of her study: What is the number of persons who died in hospital in the study? • 7 • 17 • 28 • 35 • The number of deaths cannot be calculated as the death rate has not been age-adjusted Question 5 A new drug treatment for cardiac thrombus claims to have a higher success rate than the current drug. A strong sign of the potential success is the lack of internal hemorrhaging starting 2 days after treatment. 168 patients who require treatment for cardiac thrombi are randomized after agreeing to participate in a trial of the new drug. The researchers were interested in whether the new drug reduced the need for blood transfusions due to internal hemorrhage compared to the current treatment. The following table summarizes the results of her study: What is the main advantage of the randomization of the 168 study participants to one of the two drug treatment groups? • Ensures that the researchers are masked to the treatment group assignment for each participant • Facilitates the age-adjustment of the death rate in each group • Reduces the potential for selection bias in allocation of treatment group • Ensures that the study groups are comparable for characteristics such as age and severity of condition prior to treatment assignment • Ensures that non-compliance will not affect the results Question 6 A new drug treatment for cardiac thrombus claims to have a higher success rate than the current drug. A strong sign of the potential success is the lack of internal hemorrhaging starting 2 days after treatment. 168 patients who require treatment for cardiac thrombi are randomized after agreeing to participate in a trial of the new drug. The researchers were interested in whether the new drug reduced the need for blood transfusions due to internal hemorrhage compared to the current treatment. The following table summarizes the results of her study: The researchers interpret the findings to conclude that the new drug treatment is more likely to result in a blood transfusion and subsequent death. This statement is: • Incorrect as the data do not indicate the death rate among only those receiving a blood transfusion • Incorrect as the number of expected deaths is not known • Incorrect as the cause-specific death rate for internal hemorrhaging is not reported • Incorrect as the duration of time from blood transfusion to death is not reported • Correct Question 7 Which of the following statements best describe efficacy? • It is an estimate of the benefit of treatment under ideal conditions • It is an estimate of the benefit of treatment under routine conditions • It is an estimate of the reduction of disease in treated groups • It is an estimate of the reduction of disease in the population • It depends on the prevalence of disease Question 8 A multicenter double-blind randomized study was carried out to compare the effect of drug X with that of a placebo in patients surviving acute myocardial infarction (AMI). Treatment with the drug started 7 days after infarction in 1,884 patients, 52% of all persons who were evaluated for entry into the study. 945 participants were randomized to treatment with drug X while 939 were assigned to the placebo group. Patients were then followed for 12 months for reinfarction. There were 152 deaths in the placebo group and 98 in the group receiving drug X. After entry into the study, patients were first classified into three groups, those who had a previous AMI, those with a first AMI who were at high risk for other cardiovascular diseases such as congestive heart failure, and those with a first AMI who were at low risk for other cardiovascular diseases. Which term best describes the study design? • Cohort study • Randomized clinical trial with crossover design • Randomized clinical trial with factorial design • Randomized clinical trial with stratified randomization • Case study design Question 9 A multicenter double-blind randomized study was carried out to compare the effect of drug X with that of a placebo in patients surviving acute myocardial infarction (AMI). Treatment with the drug started 7 days after infarction in 1,884 patients, 52% of all persons who were evaluated for entry into the study. 945 participants were randomized to treatment with drug X while 939 were assigned to the placebo group. Patients were then followed for 12 months for reinfarction. There were 152 deaths in the placebo group and 98 in the group receiving drug X. After assignment to treatment group, 77% of those in the placebo group were men, while 80% of those in the drug X group were men. Which statement is most likely to be true? • Randomization failed because the percentage of men is different in each group • Randomization failed because the researchers should have made sure that each group had an equal percentage of men • Randomization failed since men are more likely to have a recurrent AMI in the drug X group • Randomization was successful because there are more men in the treatment group • Randomization was successful since the investigators did not alter the selection of participants in either group in order to ensure equal percentages of men Question 10 A multicenter double-blind randomized study was carried out to compare the effect of drug X with that of a placebo in patients surviving acute myocardial infarction (AMI). Treatment with the drug started 7 days after infarction in 1,884 patients, 52% of all persons who were evaluated for entry into the study. 945 participants were randomized to treatment with drug X while 939 were assigned to the placebo group. Patients were then followed for 12 months for reinfarction. There were 152 deaths in the placebo group and 98 in the group receiving drug X. A preliminary analysis was conducted after 6 months and found that 87% of participants in the placebo group and 85% of those in the drug X group had taken more than 90% of their prescribed dosages. Which statement best describes this finding? • Randomization failed to ensure an equal likelihood of compliance with treatment • The characteristics of patients who failed to comply with the treatment dosages should be assessed as they may differ from those who complied • The study will find a decreased effect of AMI prevention in the drug X group since fewer participants complied with the prescribed treatment • The study will find an increased effect of AMI prevention in the placebo group since more participants complied with the prescribed treatment • The researchers should consider a crossover design in order to calibrate the compliance rates between each group Question 11 A multicenter double-blind randomized study was carried out to compare the effect of drug X with that of a placebo in patients surviving acute myocardial infarction (AMI). Treatment with the drug started 7 days after infarction in 1,884 patients, 52% of all persons who were evaluated for entry into the study. 945 participants were randomized to treatment with drug X while 939 were assigned to the placebo group. Patients were then followed for 12 months for reinfarction. There were 152 deaths in the placebo group and 98 in the group receiving drug X. Which of the following statements best describes the reason for conducting the study as a double-blind trial? • The placebo group will not have any reported side effects • The researchers might assign participants with more serious AMIs to the treatment group • Since the outcome studied is death, blinding the participants is unnecessary for this trial • Double blinding ensures that potential biases regarding selection, follow-up, and analysis can be reduced • Double blinding is no longer necessary after randomization is complete since the researchers cannot change the treatment group assignments Question 12 A multicenter double-blind randomized study was carried out to compare the effect of drug X with that of a placebo in patients surviving acute myocardial infarction (AMI). Treatment with the drug started 7 days after infarction in 1,884 patients, 52% of all persons who were evaluated for entry into the study. 945 participants were randomized to treatment with drug X while 939 were assigned to the placebo group. Patients were then followed for 12 months for reinfarction. There were 152 deaths in the placebo group and 98 in the group receiving drug X. The researchers conclude that treatment with drug X reduces mortality in patients who have had an AMI. The researchers are: • Correct because there are a fewer number of deaths in the drug X group • Correct because the rate of death is decreased in the drug X group • Incorrect because non-compliance may have reduced the number of observed deaths in the drug X group compared to the placebo group • Incorrect because randomization was not successful • Incorrect as the results are not generalizable to all patients with AMI since the researchers excluded 48% of the persons evaluated for the study Question 13 The following data come from a study of approaches to smoking cessation. Smokers who want to quit were randomized to one of four groups: control group C who received no intervention assistance, quitting guide group Q who received brochures about how to quit smoking, quitting guide and support group QS who received quitting brochures as well as social support brochures listing benefits of smoking cessation, and telephone support group T who received the brochures and a monthly phone call from a counselor. Participants received mailed surveys at 8, 16, and 24 months after randomization. The results after 2 years are in the table below. What is the overall quit rate after 2 years of follow-up? Question 14 The following data come from a study of approaches to smoking cessation. Smokers who want to quit were randomized to one of four groups: control group C who received no intervention assistance, quitting guide group Q who received brochures about how to quit smoking, quitting guide and support group QS who received quitting brochures as well as social support brochures listing benefits of smoking cessation, and telephone support group T who received the brochures and a monthly phone call from a counselor. Participants received mailed surveys at 8, 16, and 24 months after randomization. The results after 2 years are in the table below. Which group had the least success in terms of quitting smoking? • Group C • Group Q • Group QS • Group T • It cannot be determined since each group had participants with missing outcomes Question 15 The following data come from a study of approaches to smoking cessation. Smokers who want to quit were randomized to one of four groups: control group C who received no intervention assistance, quitting guide group Q who received brochures about how to quit smoking, quitting guide and support group QS who received quitting brochures as well as social support brochures listing benefits of smoking cessation, and telephone support group T who received the brochures and a monthly phone call from a counselor. Participants received mailed surveys at 8, 16, and 24 months after randomization. The results after 2 years are in the table below. What is the main purpose of randomization in this study? • To avoid assigning more persons who have tried and failed to quit in the past to the control group • To blind the researchers to the treatment group assignments • To ensure that rates of smoking cessation will be the same among the groups • To minimize differences in the dropout rate between the groups • To prevent subjects in the control group from reading materials that would help them to quit smoking Question 1 A study is planned to investigate the relationship of factors associated with maternal hypertension and the risk of congenital birth defects in children born to these women. Which of the following would be a reason for using a cohort study design? • The need to obtain data on the incidence of early fetal losses due to congenital birth defects • The low rate of congenital birth defects • The development of pregnancy-related hypertension in asymptomatic women • The consistency of recall of risk factors among women having children with and without congenital birth defects and those having children • Testing hypotheses about several different risk factors for congenital birth defects such as maternal age, diabetes, and previous miscarriage history Question 2 A researcher is interested in the etiology of myocardial infarction (MI) among men between 18 and 40 years of age. Her hypothesis concerns the influence of diets high in fat and subsequent development of MI. What is the best study approach to address this hypothesis? • Case-control study with cases of MI identified post-event and controls sampled from healthy men in the population, then have both groups complete dietary surveys • Case-report study describing the dietary habits in 100 men having an MI • Ecologic study with the rates of MI compared between cities with higher than average dietary fat intakes and cities with lower than average dietary fat intakes • Retrospective cohort study with medical records used to collect information on diet among men with and without an MI • Prospective cohort study identifying a population of men in this age group, administering a dietary survey and classifying men by high and low fat diet, then following both groups for the development of an MI Question 3 Which of the following is an advantage to the conduct of a cohort study? • The study population is the same with regard to the risk factors for disease • The disease under study occurs rarely in the population • The incidence of the disease is high in the nonexposed group • The incidence of the disease is high in the exposed group • The study population includes a high number of undiagnosed, asymptomatic individuals with the disease Question 4 A cohort study is planned to investigate the potential adverse health effects of daily alcohol consumption. In assessing the risk of liver cancer related to alcoholism, which of the following is not an important methodologic consideration? • The need to study a large number of persons for a rare disease outcome • The difficulty of finding enough persons with liver cancer at the beginning of the study in whom alcohol consumption could be determined • The possible bias associated with persons describing alcohol usage • The likelihood that doctors would monitor alcoholics more closely for liver cancers • The possibility that persons would change their alcohol consumption practices during the study period Question 5 Which of the following is not an advantage of a retrospective cohort study? • Allows for the study of many disease outcomes resulting from an exposure • Incidence rates can be calculated • Possible bias due to selection of the cohort is eliminated • Potential recall bias can be minimized • Requires less follow-up time than a prospective cohort study Question 6 In a study of the adverse effects of x-rays among children, a retrospective cohort study was done using records from several large children’s hospitals for the period of 1980 to 1985. 10,000 children were selected as a representative population of ill children seen at the hospitals during that time. Subjects were classified according to whether or not they received an x-ray during their stay in the hospital and were followed from their hospital stay through 2005 for the development of cancer. During the follow-up period, 49 incident cancers occurred in 3,263 children who had received an x-ray, and 47 incident cancers occurred in the 6,737 children who had not received an x-ray during their hospitalization. In this retrospective study, which of the following groups are eligible for selection into the study? • Children receiving x-rays in 1990 • Children receiving x-rays in 1975 • Children receiving x-rays for broken bones in 1983 • Children in the hospital for cancer treatment in 1985 • Children who were treated in private clinics and hospitals in 1981 Question 7 In a study of the adverse effects of x-rays among children, a retrospective cohort study was done using records from several large children’s hospitals for the period of 1980 to 1985. 10,000 children were selected as a representative population of ill children seen at the hospitals during that time. Subjects were classified according to whether or not they received an x-ray during their stay in the hospital and were followed from their hospital stay through 2005 for the development of cancer. During the follow-up period, 49 incident cancers occurred in 3,263 children who had received an x-ray, and 47 incident cancers occurred in the 6,737 children who had not received an x-ray during their hospitalization. What are the rates of cancer incidence in each exposure group? Question 8 In a study of the adverse effects of x-rays among children, a retrospective cohort study was done using records from several large children’s hospitals for the period of 1980 to 1985. 10,000 children were selected as a representative population of ill children seen at the hospitals during that time. Subjects were classified according to whether or not they received an x-ray during their stay in the hospital and were followed from their hospital stay through 2005 for the development of cancer. During the follow-up period, 49 incident cancers occurred in 3,263 children who had received an x-ray, and 47 incident cancers occurred in the 6,737 children who had not received an x-ray during their hospitalization. What is the attributable risk of cancer due to x-ray in this study population? What is the interpretation of this estimate?   Question 9 In a study of the adverse effects of x-rays among children, a retrospective cohort study was done using records from several large children’s hospitals for the period of 1980 to 1985. 10,000 children were selected as a representative population of ill children seen at the hospitals during that time. Subjects were classified according to whether or not they received an x-ray during their stay in the hospital and were followed from their hospital stay through 2005 for the development of cancer. During the follow-up period, 49 incident cancers occurred in 3,263 children who had received an x-ray, and 47 incident cancers occurred in the 6,737 children who had not received an x-ray during their hospitalization. What is the risk ratio for the effect of exposure on the development of cancer in this study? What is the interpretation of this estimated ratio? Question 10 In a study of the adverse effects of x-rays among children, a retrospective cohort study was done using records from several large children’s hospitals for the period of 1980 to 1985. 10,000 children were selected as a representative population of ill children seen at the hospitals during that time. Subjects were classified according to whether or not they received an x-ray during their stay in the hospital and were followed from their hospital stay through 2005 for the development of cancer. During the follow-up period, 49 incident cancers occurred in 3,263 children who had received an x-ray, and 47 incident cancers occurred in the 6,737 children who had not received an x-ray during their hospitalization. Which of the following issues should the investigators consider when interpreting whether a causal association exists between cancer incidence and childhood x-ray? • Some study subjects were treated for cancer starting in 1980 • Some study subjects had parents who were diagnosed with cancer • Some children received x-rays at other hospitals not included in this study • The children were different ages when they were admitted to the hospital • All of the above Question 11 Which of the following may be a factor that would result from the inability to use randomization in a cohort study? • The possibility that a factor which leads to exposure may be causally associated with the disease • The possibility that a higher proportion of exposed persons may be included in the study • The possibility that a higher proportion of nonexposed persons may be included in the study • The study will take longer to conduct if randomization is not used • The possibility that several different types of diseases will develop in the study population Question 12 6,750 people who were free of disease X were enrolled in a cohort study in 1985 and followed with annual exams and interviews through 1995. Exposure to factor A was determined at study enrollment and the participants were followed until 1995 to observe new cases of disease X. Data from the study at the end of follow-up are shown in the following table. What is the incidence rate of disease X among persons exposed to factor A? • 0.04 • 0.19 • 0.25 • 4.00 • 5.17 Question 13 6,750 people who were free of disease X were enrolled in a cohort study in 1985 and followed with annual exams and interviews through 1995. Exposure to factor A was determined at study enrollment and the participants were followed until 1995 to observe new cases of disease X. Data from the study at the end of follow-up are shown in the following table. What is the relative risk for the effect of exposure to factor A on disease X? • 0.20 • 1.29 • 4.00 • 5.00 • 5.17 Question 14 In 2002, investigators started a study of the association of cholesterol levels and stroke in a group of 2,000 healthy persons who had participated in a cholesterol screening program in 1992. The investigators determined exposure categories using cholesterol levels in all persons that were measured at the time of the screening program. A cutoff value of 200 mg/dL was used to define “high” cholesterol while those with levels below 200 were identified as having “low” cholesterol. Using this definition, 1,000 persons had “high” cholesterol levels while the remaining 1,000 persons had “low” cholesterol. The investigators determined that 150 cases of stroke occurred by the end of 2004, with 113 cases occurring in the high cholesterol group. What is the study design that the investigators used? • Case-control study • Retrospective cohort study • Prospective cohort study • Cross-sectional study • Randomized clinical trial Question 15 In 2002, investigators started a study of the association of cholesterol levels and stroke in a group of 2,000 healthy persons who had participated in a cholesterol screening program in 1992. The investigators determined exposure categories using cholesterol levels in all persons that were measured at the time of the screening program. A cutoff value of 200 mg/dL was used to define “high” cholesterol while those with levels below 200 were identified as having “low” cholesterol. Using this definition, 1,000 persons had “high” cholesterol levels while the remaining 1,000 persons had “low” cholesterol. The investigators determined that 150 cases of stroke occurred by the end of 2004, with 113 cases occurring in the high cholesterol group. What type of risk measure should the investigators calculate? • Odds ratio • Prevalence rate • Multiplicative interaction • Positive predictive value • Relative risk Question 16 In 2002, investigators started a study of the association of cholesterol levels and stroke in a group of 2,000 healthy persons who had participated in a cholesterol screening program in 1992. The investigators determined exposure categories using cholesterol levels in all persons that were measured at the time of the screening program. A cutoff value of 200 mg/dL was used to define “high” cholesterol while those with levels below 200 were identified as having “low” cholesterol. Using this definition, 1,000 persons had “high” cholesterol levels while the remaining 1,000 persons had “low” cholesterol. The investigators determined that 150 cases of stroke occurred by the end of 2004, with 113 cases occurring in the high cholesterol group. Using the reported study data, what is the estimate of the risk measure that was chosen? • 3.1 • 3.3 • 67% • 1.0 • 0.3 Question 17 In 2002, investigators started a study of the association of cholesterol levels and stroke in a group of 2,000 healthy persons who had participated in a cholesterol screening program in 1992. The investigators determined exposure categories using cholesterol levels in all persons that were measured at the time of the screening program. A cutoff value of 200 mg/dL was used to define “high” cholesterol while those with levels below 200 were identified as having “low” cholesterol. Using this definition, 1,000 persons had “high” cholesterol levels while the remaining 1,000 persons had “low” cholesterol. The investigators determined that 150 cases of stroke occurred by the end of 2004, with 113 cases occurring in the high cholesterol group. What is a necessary assumption for the study’s findings to be true? • There is no recall bias among the study participants • The cholesterol level measured in 1992 is a valid determinant of exposure status during the entire study period • The high and low cholesterol groups are randomly assigned • The age distribution of the cases and controls is equivalent • The cholesterol measure is modified by cigarette smoking practice Question 18 The following data are from a prospective study that examined the relationship between smoking and incidence of both myocardial infarction (heart attack) and breast cancer among women. What is the proportion attributable risk of breast cancer among smokers? • 20% • 40% • 50% • 60% • 80% Question 19 The following data are from a prospective study that examined the relationship between smoking and incidence of both myocardial infarction (heart attack) and breast cancer among women. What is the proportion attributable risk of breast cancer among smokers? What is the relative risk of myocardial infarction for smokers? • 0.5 • 1.0 • 1.3 • 2.0 • Cannot be calculated because the nondiseased numbers are not given Question 20 The following data are from a prospective study that examined the relationship between smoking and incidence of both myocardial infarction (heart attack) and breast cancer among women. If the proportion of smokers in this population is 30%, what is the population proportion attributable risk of breast cancer due to smoking? • 28% • 31% • 43% • 56% • 80% Question 21 A researcher is interested in the etiology of cervical cancer among women between 18 and 35 years of age. Her hypothesis concerns the influence of sexually transmitted diseases such as human papilloma virus (HPV) and subsequent development of cancer. What is the best study approach to address this hypothesis? • Case-control study of women 18 to 35 years of age identified with cervical cancer in the hospital (cases) compared to women admitted for other diseases (controls) • Descriptive study of 100 cases of cervical cancer • Prospective cohort study of women enrolled at 18 years of age and followed to 35 years of age • Retrospective cohort study of women identified with cervical cancer • Clinical trial randomizing women to HPV vaccine or placebo   Question 22 Suppose that 350 cervical cancer cases were identified and a random sample of women of the same age range who were admitted to the hospital included 500 eligible controls. After independent blood tests of all cases and controls, 90% of cases were positive for HPV antibodies while 63% of controls were positive for antibodies to the virus. What is the appropriate ratio measure of association and its value? • The ratio of HPV-exposed percentages equal to 1.4 • The ratio of nonexposed percentages equal to 4.1 • The number of exposed cases divided by the number of exposed controls equal to 1.0 • The number of nonexposed cases divided by the number of nonexposed controls equal to 0.2 • The ratio of the odds of exposure among cases and controls equal to 4.1 Question 23 Suppose that one third of all cervical cancer cases were smokers as were one third of all controls and smoking status is independent of HPV infection. Is smoking a potential confounder in this study? • Yes, the overall odds ratio is still equal to 4.1 after stratification • No, the chance of being a smoker among women with cervical cancer is the same as that of being a smoker among women without cervical cancer • No, the stratum-specific odds ratios must be equal to indicate confounding • Yes, but there is not adequate information on the proportion of smokers in each exposure group to judge the effect on the odds ratio • Yes, smoking is highly correlated with HPV infection Question 24 A case-control study was conducted to determine if an association exists between workers in uranium mines and loss of fertility due to reduced sperm count. A group of 200 men with low sperm count were identified from clinics located in areas with uranium mines. Each selected case was matched with a randomly selected male control on the following factors: race, age, area of residence, and smoking status. What is the purpose of matching? • Previous studies have shown that there are racial differences in low sperm count • Men of the same age should have the same sperm count level • Future analyses using this data can investigate if low sperm count is associated with public drinking water supplies • Smoking has no effect on sperm count so it should be the same among cases and controls • Matching makes it easier to identify an eligible control for the study Question 25 The following numbers of matched pairs were reported: 4 matched pairs in which both men worked in a uranium mine, 9 pairs in which the case had mine exposure but the control did not, 2 pairs in which the case had no mine exposure but the control did, and 185 pairs in which neither man had worked in a uranium mine. What is the odds ratio for reduced sperm count among the uranium miners? • 4.5 • 14.4 • 28.8 • 41.1 • 46.3 Question 26 A case-control study of the relationship between high-fat diet and diabetes was performed. The results of the study are shown below, stratified by gender. What is the crude odds ratio for the association between high-fat diet and diabetes in this study? • 0.5 • 0.7 • 1.0 • 1.2 • 1.4 Question 27 A case-control study of the relationship between high-fat diet and diabetes was performed. The results of the study are shown below, stratified by gender. What is the odds ratio among men only? • 0.5 • 0.7 • 1.0 • 1.2 • 1.4 Question 28 A case-control study of the relationship between high-fat diet and diabetes was performed. The results of the study are shown below, stratified by gender. What is the odds ratio among women only? • 0.5 • 0.7 • 1.0 • 1.2 • 1.4 Question 29 A case-control study of the relationship between high-fat diet and diabetes was performed. The results of the study are shown below, stratified by gender. Based on the responses above, what is the most appropriate measure of association to present when reporting the results of this study? • The crude odds ratio • The weighted average of the stratum-specific odds ratios • The separate stratum-specific odds ratios • The odds ratio after adjustment for gender • None of the above; an incidence study should be done that better describes the relationship Question 30 A case-control study of the relationship between high-fat diet and diabetes was performed. The results of the study are shown below, stratified by gender. Which of the following is demonstrated by the stratified odds ratio shown above? • Confounding by gender • Effect modification by gender • Selection bias by gender • Recall bias by gender • Residual confounding by other factors that differ by gender such as exercise activity   Question 31 When incidence density sampling is used in a case-control study, which of the following is an important consideration? • A subject identified as a case may later be selected as a control • A subject selected as a control may later be selected as a case • Control subjects must remain disease free throughout the entire follow-up period • Each case is matched to a single control • Recall bias is not an issue since exposure is measured prospectively Question 32 A recent prospective study on baldness and coronary heart disease (CHD) concluded that there was no association between the two, despite earlier cross-sectional studies which showed that baldness was associated with CHD when the two were determined at the same time in men. Which Bradford-Hill criterion is being tested by the newer study? • Validity • Temporality • Biologic plausibility • Analogy • Dose-response Question 33 A study examined the relation between use of estrogen replacement therapy (ERT) and ovarian cancer mortality using a prospective design. Of 24,231 eligible women, none had a prior history of cancer, hysterectomy, or ovarian surgery at enrollment in 1982. During 12 years of follow-up, 44 deaths from ovarian cancer occurred. In the published results, the authors note that 12,543 were excluded from the original cohort due to missing information for prior history variables. Which of the following is of greatest concern when interpreting the study results? • Selection bias • Information bias • Confounding • Effect modification • Precision Question 34 A study examined the relation between use of estrogen replacement therapy (ERT) and ovarian cancer mortality using a prospective design. Of 24,231 eligible women, none had a prior history of cancer, hysterectomy, or ovarian surgery at enrollment in 1982. During 12 years of follow-up, 44 deaths from ovarian cancer occurred. In the published results, the authors note that 12,543 were excluded from the original cohort due to missing information for prior history variables. Age at menopause is a potential factor associated with use of ERT. The study investigators created three categories for age at menopause: less than 45 years, 46 through 54 years, and 55 years or more. After stratifying on age at menopause, the researchers reported relative risks of 0.97, 1.00 (referent), and 0.93 for each age group, respectively. Which of the following is true? • Age at menopause may modify the effect of ERT on ovarian cancer mortality • The odds ratios are biased toward the null due to information bias • The referent group of women who had menopause between age 46 and 54 years is incorrectly chosen • Age at menopause is unlikely to be a strong confounder of the relationship between ERT use and ovarian cancer mortality • The investigators need to analyze age as a continuous measure of years since creating categories may introduce misclassification Question 35 A case-control study was conducted to assess whether occupational radiation exposure among men was associated with Down syndrome in their children. The investigators matched cases and controls on age of the mother at childbirth by 5-year categories. Why was this done? • To minimize selection bias due to cases having older mothers • To minimize information bias about maternal age • To adjust for potential confounding by maternal age • To measure effect modification by increasing maternal age categories • To exclude children born to younger parents Question 36 A case-control study was conducted to assess whether occupational radiation exposure among men was associated with Down syndrome in their children. The investigators matched cases and controls on age of the mother at childbirth by 5-year categories. When possible, information on paternal radiation exposure was taken from employment records rather than from subject interviews. Why was this done? • To minimize detection bias for cases • To minimize differential misclassification of exposure • To remove selection bias of non–radiation exposed fathers • To provide dose-response information • To minimize recall bias of exposure Question 37 An epidemiologist was interested in determining whether aspirin was associated with an increased risk of gastrointestinal (GI) bleeding. She relied on primary physicians to identify 600 patients at a hospital who were taking a daily dose of aspirin and 600 other patients who were not taking aspirin. Subjects were followed for 1 year to detect any occurrences of GI bleeding. Due to publicity about the risk of bleeding associated with aspirin, primary physicians treating patients at the hospital followed their patients who were taking aspirin more closely than they were unexposed subjects. Which of the following describes the impact that this may have on the epidemiologist’s study? • Would result in nondifferential classification of exposure • Would result in differential classification of exposure • Would result in nondifferential classification of outcome • Would result in differential classification of outcome • Would introduce recall bias Question 38 An epidemiologist was interested in determining whether aspirin was associated with an increased risk of gastrointestinal (GI) bleeding. She relied on primary physicians to identify 600 patients at a hospital who were taking a daily dose of aspirin and 600 other patients who were not taking aspirin. Subjects were followed for 1 year to detect any occurrences of GI bleeding. Due to publicity about the risk of bleeding associated with aspirin, primary physicians treating patients at the hospital followed their patients who were taking aspirin more closely than they were unexposed subjects. Suppose that the study was repeated with a second physician who was responsible for verifying a diagnosis of GI bleeding in the patients. This physician was informed that all patients were using aspirin. If the likelihood of diagnosing the outcome among unexposed subjects was increased while all other diagnostic probabilities remained the same, what impact would this have on the bias? • The bias would be eliminated • The bias would change the risk estimate so that the association between GI bleeding and aspirin use would be reversed • The bias would decrease toward the null • The bias would increase the risk estimate • None of the above Question 39 Matching is employed in a case-control study in order to ensure that: • Variables associated with the outcome under study are controlled for in both the case and control groups • The eligible sample size is increased for case and control selection • Recall bias is minimized between cases and controls • The study investigators can estimate measures of association between matching variables and the outcome • The follow-up time for the study is decreased Question 40 The effect of exposure to high-density automobile traffic either as a bicyclist or pedestrian was compared to minimal or no exposure to automobile traffic. It is hypothesized that direct exposure to automobile traffic has an effect on acute myocardial infarction (MI). This association was studied with 500 incident cases of MI diagnosed in the emergency rooms of several hospitals and compared to 1,000 other subjects who visited the same emergency rooms for reasons other than cardiovascular and respiratory diseases. All subjects were asked to report the amount of time that they spent exposed to high-density traffic over the past month prior to their hospital visit. What type of study design is this? • Cross-sectional • Case-control • Retrospective cohort • Prospective cohort • Randomized clinical trial Question 41 The effect of exposure to high-density automobile traffic either as a bicyclist or pedestrian was compared to minimal or no exposure to automobile traffic. It is hypothesized that direct exposure to automobile traffic has an effect on acute myocardial infarction (MI). This association was studied with 500 incident cases of MI diagnosed in the emergency rooms of several hospitals and compared to 1,000 other subjects who visited the same emergency rooms for reasons other than cardiovascular and respiratory diseases. All subjects were asked to report the amount of time that they spent exposed to high-density traffic over the past month prior to their hospital visit. After completing the recruitment, the investigators compiled their data in the following table: Using the appropriate measure of association, as compared to the group with no traffic exposure, which of the following is a true statement concerning MI? • The estimated risk of MI is identical for those exposed to automobile traffic either daily or rarely • The estimated risk of MI was higher for those exposed rarely than for those exposed daily to automobile traffic • The estimated risk was higher for those exposed daily rather than for those exposed rarely to automobile traffic • Neither daily nor rare exposure to automobile traffic was associated with an increased risk for MI • None of the above Question 42 The effect of exposure to high-density automobile traffic either as a bicyclist or pedestrian was compared to minimal or no exposure to automobile traffic. It is hypothesized that direct exposure to automobile traffic has an effect on acute myocardial infarction (MI). This association was studied with 500 incident cases of MI diagnosed in the emergency rooms of several hospitals and compared to 1,000 other subjects who visited the same emergency rooms for reasons other than cardiovascular and respiratory diseases. All subjects were asked to report the amount of time that they spent exposed to high-density traffic over the past month prior to their hospital visit. Which of the following may explain the reason for the observed association? • Effect modification by time spent exposed to automobile traffic • Confounding by time spent exposed to automobile traffic • Recall bias among those with daily exposure to automobile traffic • Selection bias to avoid automobile traffic among those predisposed to MI • Confounding by exercise level for those with daily exposure to automobile traffic Question 43 Which of the following is an advantage of the case-control study design? • Recall bias is avoided • Little to no bias when assessing the outcome of interest • It is possible to study more than one exposure • It is possible to study more than one disease outcome • The study design is useful for studying rare exposures Question 44 A large case-control study using multiple recruitment centers was conducted comparing 2,987 lung smoker cases to 3,013 other hospitalized persons selected as controls. One objective was to study the association between occupational exposure to chemicals and lung cancer. After compiling the data, the investigators noted that 90% of persons with lung cancer were smokers while 67% of the controls were smokers. The most practical and efficient way to eliminate differences between the cases and controls with regard to smoking would be to: • Repeat the selection of the controls matching on smoking status • Calculate incidence rates for lung cancer by smoking status • Exclude smokers from the study • Classify subjects according to smoking status and compare occupational chemical exposures by each stratum of smoking • Ignore smoking classification and report unadjusted risk estimates Question 45 An investigator is interested in studying the adverse effects of exposure to toxic metals on neurologic diseases such as Alzheimer’s disease. In assessing this risk, all of the following are important considerations for a prospective study design except: • The need to recruit a large sample size • The possible bias introduced by lifetime exposure assessments • The difficultly in finding sufficient numbers of persons with neurologic disease in whom past metal exposures could be measured at the beginning of the study • The likelihood that persons with exposure to toxic metals may be more likely to receive a diagnosis of neurologic disease • The possibility that exposure to toxic metals may change during the follow-up period Question 46 A history of dietary supplement with calcium was recorded among 10,000 women over the age of 50. The women were followed for 2 years to determine if they experienced hip fracture. Calcium supplementation was reported by 31% of women who experienced hip fracture and by 46% of all other women. In a case-control study with equal numbers of cases and controls, what is the number of women with a hip fracture who are not taking calcium supplements? • 1,550 • 2,300 • 2,700 • 3,450 • 5,000   Question 47 A history of dietary supplement with calcium was recorded among 10,000 women over the age of 50. The women were followed for 2 years to determine if they experienced hip fracture. Calcium supplementation was reported by 31% of women who experienced hip fracture and by 46% of all other women. What are the odds of a hip fracture among women who are taking calcium supplements? • 0.25 • 0.45 • 0.67 • 0.85 • 1.28 Question 48 A history of dietary supplement with calcium was recorded among 10,000 women over the age of 50. The women were followed for 2 years to determine if they experienced hip fracture. Calcium supplementation was reported by 31% of women who experienced hip fracture and by 46% of all other women. What is the measure of association between calcium supplementation and hip fracture? • Relative risk = 0.72 • Relative risk = 1.39 • Odds ratio = 0.53 • Odds ratio = 1.89 • None of the above   Question 49 In a study of 100 cases of colon cancer in women, there were 200 age- and race-matched controls. The suspected etiologic factor was higher-than-average consumption of red meat. The absolute risk of colon cancer in persons with this level of consumption is: • 25% • 50% • 67% • 100% • Cannot be calculated Question 50 Why are controls needed in a case-control study? • The may be followed for development of the outcome of interest • They are less likely to have recall bias issues • They increase the size of the study so that risk estimates are significant • They do not have the exposure of interest and allow for the estimation of disease frequency among the unexposed • They do not have the outcome of interest and allow for estimation of exposure frequency among those without the disease Question 51 When is odds ratio obtained in a case-control study a reliable approximation of the relative risk for the general population? • The exposure distribution among cases is representative of all persons with disease • The exposure opportunity for controls is equivalent to the distribution of exposure opportunities for the population without the disease • When the disease under investigation is rare in the population • a and b only • All of the above Question 52 In a published epidemiologic study investigating infertility related to sexually transmitted diseases (STD), the authors state that 5% of identified cases refused enrollment, 10% of identified cases were lost to follow-up prior to data collection, and 10% of interviewed cases had missing data for one or more key variables describing exposure. Based on this information, which of the following statements is most likely to be true? • Some degree of bias is inevitable • There is a potential for selection bias which could be differential with respect to cases and controls • There is a potential for selection bias which could be nondifferential with respect to cases and controls • There is likely to be nondifferential misclassification of the outcome • There is no selection bias; however, confounding may be introduced by missing variables Question 53 In a published epidemiologic study investigating infertility related to sexually transmitted diseases (STD), the authors state that 5% of identified cases refused enrollment, 10% of identified cases were lost to follow-up prior to data collection, and 10% of interviewed cases had missing data for one or more key variables describing exposure. After data were gathered for the study, the investigators decided to restrict the analysis to women only, rather than including both men and women in the study. Assuming that sex is a confounder of the exposure–disease relationship under investigation, this decision would have which of the following effects? • Increase internal validity • Increase potential confounding • Enable the study of sex as an effect modifier • Increase the likelihood of a statistically significant result • Introduce selection bias based on sex Question 54 In a published epidemiologic study investigating infertility related to sexually transmitted diseases (STD), the authors state that 5% of identified cases refused enrollment, 10% of identified cases were lost to follow-up prior to data collection, and 10% of interviewed cases had missing data for one or more key variables describing exposure. In the primary analysis of the study, the investigators measured exposure as a dichotomous variable (any history of STD compared to no history of STD). In subsequent analyses, the investigators looked at the relationship between specific STDs and infertility. They noted the following measures of association: for past history of gonorrhea, the odds ratio was 2.4 with a 95% confidence interval of 1.3 to 4.4. For past history of chlamydia, the odds ratio was 1.8 with a 95% confidence interval from 1.2 to 2.1. These results indicate that: • There is effect modification by STD type since the odds ratios are different from each other • There is confounding by STD type since the odds ratios are different from each other • The odds ratio for chlamydia is more precise than the odds ratio for gonorrhea • The odds ratio for chlamydia is biased toward the null • Neither odds ratio is a reliable approximation of the relative risk Question 55 If an investigator is analyzing the results of a clinical trial, then applying the “intention to treat” rule means that which type of bias is most likely to result? • Misclassification bias • Confounding • Effect modification • Selection bias • No bias would result Question 56 Investigators wanted to know if some military personnel are more error prone than others and would be a poor risk for training as a pilot. A study was done in which individuals who had injuries during basic training were compared to individuals who had not had an injury during training. Both groups were asked to recall episodes during childhood when they had had accidents that resulted in an injury. The individuals with a training injury reported more incidents during childhood when they had an injury. Therefore, the military command concluded that some persons are more likely to be error prone and that individuals with a childhood injury should be excluded from pilot training. One commanding officer disagreed with this conclusion. He asked the investigators to design a second study in which all individuals were asked about childhood injuries prior to the start of basic training. The group who reported having a childhood injury was compared to the group who had not had a childhood injury to determine which group had a higher rate of injuries during basic training. At the end of follow-up, there was no difference in the rate of injuries experienced by each group. What type of design was used for the first study? • Cross-sectional • Case-control • Retrospective cohort • Prospective cohort • Randomized clinical trial Question 57 Investigators wanted to know if some military personnel are more error prone than others and would be a poor risk for training as a pilot. A study was done in which individuals who had injuries during basic training were compared to individuals who had not had an injury during training. Both groups were asked to recall episodes during childhood when they had had accidents that resulted in an injury. The individuals with a training injury reported more incidents during childhood when they had an injury. Therefore, the military command concluded that some persons are more likely to be error prone and that individuals with a childhood injury should be excluded from pilot training. One commanding officer disagreed with this conclusion. He asked the investigators to design a second study in which all individuals were asked about childhood injuries prior to the start of basic training. The group who reported having a childhood injury was compared to the group who had not had a childhood injury to determine which group had a higher rate of injuries during basic training. At the end of follow-up, there was no difference in the rate of injuries experienced by each group. What type of study design was used for the second study? • Cross-sectional • Case-control • Retrospective cohort • Prospective cohort • Randomized clinical trial Question 58 Investigators wanted to know if some military personnel are more error prone than others and would be a poor risk for training as a pilot. A study was done in which individuals who had injuries during basic training were compared to individuals who had not had an injury during training. Both groups were asked to recall episodes during childhood when they had had accidents that resulted in an injury. The individuals with a training injury reported more incidents during childhood when they had an injury. Therefore, the military command concluded that some persons are more likely to be error prone and that individuals with a childhood injury should be excluded from pilot training. One commanding officer disagreed with this conclusion. He asked the investigators to design a second study in which all individuals were asked about childhood injuries prior to the start of basic training. The group who reported having a childhood injury was compared to the group who had not had a childhood injury to determine which group had a higher rate of injuries during basic training. At the end of follow-up, there was no difference in the rate of injuries experienced by each group. Which study better tests the hypothesis that there is a relationship between childhood injury and subsequent injury during basic training? • Case-control study • Prospective cohort study • Both studies adequately test the hypothesis • Neither study adequately tests the hypothesis • A randomized trial should be performed to adequately test the hypothesis   Question 59 Investigators wanted to know if some military personnel are more error prone than others and would be a poor risk for training as a pilot. A study was done in which individuals who had injuries during basic training were compared to individuals who had not had an injury during training. Both groups were asked to recall episodes during childhood when they had had accidents that resulted in an injury. The individuals with a training injury reported more incidents during childhood when they had an injury. Therefore, the military command concluded that some persons are more likely to be error prone and that individuals with a childhood injury should be excluded from pilot training. One commanding officer disagreed with this conclusion. He asked the investigators to design a second study in which all individuals were asked about childhood injuries prior to the start of basic training. The group who reported having a childhood injury was compared to the group who had not had a childhood injury to determine which group had a higher rate of injuries during basic training. At the end of follow-up, there was no difference in the rate of injuries experienced by each group. Which of the following may explain why the two studies observed different results concerning the association between childhood injury and training injury? • Confounding by age • Effect modification by type of training • Misclassification bias toward the null in the prospective cohort study • Potential selection bias in the case-control study • Potential recall bias in the case-control study Question 60 In a study of oral contraceptive (OC) use and hypertension, male interviewers for the study found a lower prevalence of OC use among participants than did female interviewers using the same questionnaire. Which term best describes this finding? • Selection bias • Differential misclassification • Nondifferential misclassification • Confounding • Effect modification Question 61 A matched case-control study of sunscreen use during childhood and melanoma results in an odds ratio of 1.0. Cases of melanoma were matched by sex and race to controls who were identified by random digit dialing. What is the most likely explanation for the study’s null finding? • Selection bias for controls • Confounding by age • Information bias concerning past sunscreen use • Lack of a true association between childhood sunscreen use and melanoma • Inadequate sample size Question 62 Among patients with liver cancer, current alcohol drinkers have a worse prognosis for survival than nondrinkers. What would be the impact on the odds ratio for a case-control study of current alcohol use and liver cancer mortality if prevalent cases were included with incident cases of the cancer? • Increase the odds ratio when prevalent cases are included • Decrease the odds ratio when prevalent cases are included • There would be no difference in the odds ratio estimated by either study • The odds ratio would be affected by differential selection bias • The odds ratio would be a better approximation of the relative risk Question 63 In a cohort study, the reported relative risk was 2.0; however, the investigators concluded that the study likely had a bias away from the null hypothesis, but they concluded that an association did exist between the exposure and the outcome. The true relative risk is most likely: • 0.5 • 1.0 • 1.5 • 2.0 • 4.0 Question 64 In a case-control study of maternal cigarette smoking as a risk factor for low birth weight, the investigators concluded that mothers of children with low birth weight were more likely to report smoking during pregnancy relative to mothers of children with normal birth weight. The reporting error most likely caused the odds ratio to: • Increase above the true value • Decrease below the true value but remain positive • There was no change in the odds ratio from the true value • Change direction such that smoking prevented low birth weight • Equal the relative risk Question 65 In a case-control study of obesity and adult-onset asthma, controls are matched to cases on the basis of race and gender. This approach to selection is intended to decrease the influence of which type of bias? • Selection bias • Ecologic fallacy • Information bias • Misclassification • Confounding Question 66 In a case-control study of computer display exposure and glaucoma, cases and controls were also asked about television watching habits. Errors in recall of exposure to video screens occurred with equal frequency among cases and controls. Which one of the following biases likely occurred? • Selection bias • Ecologic fallacy • Nondifferential misclassification • Differential misclassification • Confounding Question 67 In a case-control study of computer display exposure and glaucoma, cases and controls were also asked about television watching habits. Errors in recall of exposure to video screens occurred with equal frequency among cases and controls. What is the most likely effect of this bias on the measure of association reported by the study? • Underestimated the true relationship • Overestimated the true relationship • No effect on the estimate • Cannot be determined because the bias is differential • The estimate is valid if adjusted for confounders Question 68 In a case-control study of computer display exposure and glaucoma, cases and controls were also asked about television watching habits. Errors in recall of exposure to video screens occurred with equal frequency among cases and controls. Which of the following methods for adjusting for confounding by age is most likely to affect the generalizability of the study findings? • Randomization • Restriction of study subjects to those less than 50 years old • Stratification to several age groups • Matching by age plus or minus 5 years • Adjustment for age in a regression analysis Question 69 In a cohort study of occupational exposure to a chemical and subsequent incidence of bladder cancer, all workers who smoked were more likely to die of other causes before bladder cancer was diagnosed. What was the effect of this premature mortality on the measure of association reported by the study? • Underestimated the true relationship • Overestimated the true relationship • No effect on the estimate • Cannot be determined because the bias is differential • The estimate is valid if adjusted for smoking Question 70 Which of the following statements about person-years is not true? • It allows for different lengths of follow-up time among study subjects • It is a valid denominator for estimates of risk for individuals • 20 persons followed for 5 years each contribute the same amount of person-years as 200 subjects followed for 6 months each • It is the amount of time that a subject was without the outcome • Person-years are not calculated for time during a study when outcome status is not known for subjects lost to follow-up Question 1 A large company institutes a new wellness program aimed at improving the health of its 50,000 employees. As a part of the program, all employees are given physical examinations and screening tests. One of the tests given to male employees is the prostate specific antigen (PSA) test with all employees testing positive being referred to their private physician for a thorough examination involving the standard test, a digital rectal examination (DRE). What will happen to the apparent incidence rate of prostate cancer in the company during the first year of this program? • Incidence rate will stay the same • Incidence rate will increase • Incidence rate will decrease • Incidence rate will equal the general population rate • Not enough information is available   Question 2 A large company institutes a new wellness program aimed at improving the health of its 50,000 employees. As a part of the program, all employees are given physical examinations and screening tests. One of the tests given to male employees is the prostate specific antigen (PSA) test

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