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Print date: September 13, 2016

EPI-820: Homework II - Evidence-Based Medicine
This homework consists of a combination of multiple choice and short answer questions. Each correct answer for
the multiple choice questions are worth 2 marks. Marks available for each short-answer question are indicated in
brackets e.g., (5). Some of the multiple choice questions ask you to identify more than one correct answer (indicated
by the statement “Which of the following statements are true”). Where space is given for the short-answer questions
please show your workings, as well as your final answer. Extra marks will be awarded for neat, easy to read
work! (N.B. Distant students may find it easier to fax their answers (517-432-1130).

If a patient sees a clinician and complains of being sick:


Which of the following statements are true:


The patients will always have a disease
The patients may or may not have an illness
The patient will always have an obvious sickness
Treating the underlying disease will always satisfy the patient.

Validity refers to the repeatability of a measurement.
Precision refers to the accuracy of a measurement.
Hard data should be repeatable.
A remedy for poor validity is to repeat the measurement.
A remedy for poor precision is to repeat the measurement.

You are trying to counsel Mrs. Jones, a thin, 55 year old, post-menopausal women to stop smoking. She has
been a pack-a-day smoker for 32 years, but feels fit and healthy and walks 3 miles every day. Her family
history and physical exam is unremarkable. She refuses to discuss taking menopausal estrogens, since her
sister had a “bad reaction” to them, and she defends her smoking habit by quoting a magazine article that
says smoking reduces the risk of endometrial cancer by one half. In order to make a convincing case for
her to quit, you do the following calculations:
You estimate the 10-year risk of lung cancer, coronary heart disease (CHD) and endometrial
cancer in a similar non-smoking women to be 0.1%, 8% and 1%, respectively. You find out the
relative risks (RR) for a pack-a-day smoker for lung cancer, CHD, and endometrial cancer to be
10, 2.5 and 0.5, respectively.
a. Complete the following table (4):
Lung CA


10-yr risk non-smoker
RR of smoking
10-yr risk smoker
Attributable risk (risk
difference) of smoking


Endometrial CA.

What was the Relative Risk Reduction of Pravastatin in this study? (2) b. (2) 4. explain what the data in the table mean to her and why they make a convincing argument that she should quit smoking. and 284 “events” in the 3. over a 5 year period. only a U of M graduate). Jones? Which measure tells you that? (2) d. a. There were 172 “events” in the 3. but no previous history of coronary heart disease. What do you think would happen to the NNT if this trial were repeated in Scottish men who had both hypercholesterolemia and a history of coronary heart disease? (1) 2 . Which of the three diseases is more important in terms of clinical impact to Mrs.b. Which of the three diseases is more causally related to smoking? Which measure indicates that? (2) c. What is the Number-Needed-to-Treat (NNT) based on these results? (2) c. Jones can understand (she is after all.302 men in the intervention arm. The West of Scotland Coronary Prevention Trial (WOSCOP) study was a randomized clinical trial that tested the efficacy of Pravastatin (a cholesterol lowering “statin” drug) in several thousand men with hypercholesterolemia. What do you think would happen to the NNT if this trial were repeated in Scottish men who had neither hypercholesterolemia nor a history of coronary heart disease? (1) d. In words that Mrs.293 men in the placebo arm.

3 . Possibly and Dr. while Dr. a. Construct the two-by-two agreement table (4). Maybe called normal. What is the expected degree of agreement due to chance? (4) c. Calculate the Kappa statistic and interpret (4). Two radiologists (Dr. b.5. Maybe) independently reviewed 65 cervical radiographs for the presence of vertebral canal stenosis. Maybe identified 11 cases as having stenosis that Dr. Possibly identified 3 cases as abnormal that Dr. The two radiologists both agreed that stenosis was present in 7 cases and absent in 44. Dr. Possibly called normal.

a 100% sensitive test is negative. The presence of a disease may be absolutely confirmed if: a. The clue is 100% sensitive. A disease may be excluded from consideration because: a. Which of the following are true? a. c. a 100% specific test is positive. When used to screen 5000 people. e. how many positive tests will be found? Of these how many will actually have cancer? What is this measure called? (4) 4 . The clue is 100% specific. A test for the presence of cancer has an 80% true positive rate and a 2% false positive rate. the case resembles the classic disease pattern. 7. b. 8. d. a 100% specific test is negative. all of the above. a. e. c. Of 25 patients with cancer. it is rare. b. Of 50 patients known not to have cancer. The absence of the clue excludes the disease. a 100% sensitive test is positive. Tachycardia is always present in hyperthyroidism. a test for a competing disease is positive. e. 9. a test for a competing disease is negative.6. only 1% of which have cancer. None of the above. d. d. b. how many can be expected to have a negative result? (2) b. c. how many will have a negative result? (2) c. The presence of the clue diagnoses the disease. it is very common.