Munity Health Center - 23q - Q PDF

2 Item: 1 of 23 ljl f> Mark <::J t::>
Q. ld: 5004 [ Previous Next

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Researchers w ant to further investigate the association between a new hypolipidemic drug and the
. L2J occurrence of severe acute m yositis. They noted that although several other studies reported this side
8 effect, none of these studies statistically obtained a significant difference in the occurrence of severe acute
9 m yositis between the treatment and placebo groups. W hich of the follow ing is the best method to further
10 investigate the abovementioned association?
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12
r A. Conduct a new large-scale clinical trial.
:I ~~ I r B. Review the medical charts to re-ascertain the events.
15
16 r C. Do stratified analysis on multiple risk factors.
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r D. Pool the data from several trials.
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19 r E. Ignore the possible association between the drug and acute m yositis.
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Item: 2 of 23
Q. ld: 6109 [
ljl f> Mark <::J
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A new screening test is being evaluated for the early detection of stomach cancer. It is based on the
. L2J measurement of a new serologic marker of gastric adenocarcinoma. The test is compared to traditional
8 strategy of endoscopic evaluation of high-risk patients; this show ed an increase in the survival of patients by
9 several w eeks. This increase in survival is statistically significant, although no difference is detected in the
10 rate of radical gastrectom y between the two groups. W hich of the follow ing is the best explanation for the
11 study results presented above?
12
:I ~~ I r A. Low sensitivity
15 r B. Selection bias
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17
r C. l ength-time bias
18 r D. l ead-time bias
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r E. Recall bias
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-:m2 Item: 3 of 23 ljl f> Mark <::J t::>

Case reports indicate that the exposure to manganese in miners may lead to central nervous system
. L2J damage, particularly Parkinson-like syndrome. A group of investigators w anted to investigate this problem
8 further to define the potential association between the exposure and increased mortality in miners. They
9 calculated standardized mortality ratio (SMR), w hich is equal to 1.75. W hich of the follow ing is the best
10 statement concerning the result of the study?
11
12
r A. SMR is an unadjusted measure of the overall mortality.
:I ~~ I r B. SMR is not generally applicable to occupational studies.
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16
r C. The observed number of death is higher than expected.
17 r D. The crude rate of death is high.
18
19
E. The effect of exposure seems to vary by age.
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21 r
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A study w as conducted to assess the relationship between the use of an over-the-counter pain reliever during
pregnancy and the development of a neural tube defect in the offspring. Mothers w hose children have neural
8 tube defects, as w ell as age-matched controls (mothers w hose children do not have such abnormalities),
9 w ere interview ed using a standard questionnaire. The study show ed that the use of the pain reliever during
10 pregnancy increases the risk of a neural tube defect, even after adjusting for race, other medication use,
11 family history of congenital abnormalities, and serum folate levels. The odds ratio (OR) is 1.5; p is 0.03.
12 W hich should be the major concern w hile interpreting the results of this study?
:I ~~ I r A. Selection bias
15
16 r B. Interview er bias
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18
r C. Recall bias
19 r D. Observer bias
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21
r E. Confounding
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ifhe following vignette a!J!J'!!'
Iie~s~t~o:..!t!.!C
hes.!.!
ne~x~t_,3!...'i~
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m£s:o----------------------'
It is estimated that the prevalence of smoking in a population is 50%. A cohort study conducted using a
8 random sample from this population showed that the five-year risk of ischemic stroke is 1:1,000 in smokers
9 and 0.5:1,000 in non-smokers.
10
11 Item 1 of 3
12
:I ~~ I
What is the relative risk (RR) of ischemic stroke for smokers compared to non-smokers?
15 r A. RR =1.0
16
17 r B. RR =1.5
18 r C. RR =2.0
19
20 r D. RR =2.5
21 r E. RR =3.0
22
23
1
3
4
&- 8
9
Item 2 of 3
W hat percentage of the strokes observed in smokers is attributed to their smoking status?
10
r A. 10%
11
12 r B. 25%
:I ~~ I r c. 33%
15 r D. 50%
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17 r E. 75%
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19
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a••8
9
Item 3 of 3
W hat percentage of the strokes observed in the population is attributed to sm oking?
10
r A. 10%
11
12 r B. 25%
:I ~~ I r c. 33%
15 r D. 50%
16
17 r E. 75%
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A cohort study of 4,000 patients examines the role of vitamin D supplements on the incidence of colon
J 7! cancer. Relative risk (RR) calculations w ith their corresponding 95% confidence intervals {CI) are reported for
su bJ]ect s t ak1ng VIt am1n D versus cont roIs aftera 5-year f oII ow -ui) i)enod:
9
10 RR (95% Cl)
11
Colon cancer adjusted for age and
12 0.71 (0.61-0.81)
gender
:I ~~ I Colon cancer mortality adjusted for

0.75 (0.60-0.90)
15 age and gender
16
17 A separate double-blind randomized clinical trial assigns 3,900 subjects to vitamin D supplementation or
18 placebo. The follow ing results are reported for subjects taking vitamin D versus placebo after a 5-year
19 follow -UiJ i)eriod·
20
21 Hazard ratio (95% Cl}
22 Colon cancer 0.98 (0.92-1.07)
23
Colon cancer mortality 1.01 (0.94-1.10)
W hich of the follow ing best describes the results of both studies?
r A. Cancer prevention using vitamin D lacks biological plausibility

r B. Lead-time bias best explains the discrepancy in study results
r C. Residual confounding best explains the discrepancy in study results
r D. Results of both studies support using vitamin D for colon cancer prevention
r E. The clinical trial w as underpow ered to detect any difference in outcomes
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A large-scale clinical trial is being planned to evaluate the effect of a non-selective beta-blocker, propranolol,
. L2J on the clinical course of portal hypertension . The primary outcomes of the study are all-cause mortality and
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major gastrointestinal hemorrhage. Secondary outcomes are minor gastrointestinal hemorrhage and the
number of hospitalizations. The investigators are concerned about the possibility that major gastrointestinal
hemorrhage events could be over-reported in the placebo group. W hich of the follow ing is the most useful
technique to reduce this possibility?
:I ~~ I r A. Randomization
15 r B. Blinding
16
17 r C. Matching
18 r D. Restriction
19
20 r E. Stratified analysis
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Q, ld: 5172 [ Previous Next
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A group of researchers w ants to investigate an outbreak of acute diarrhea that occurred in a small coastal
. L2J tow n. Approximately 50 people had a severe hemorrhagic diarrhea, and one fatal case w as reported. The
8 researchers believe that the outbreak is related to the seafood prepared at one of the coastal restaurants.
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11
12
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W hich of the follow ing study designs is most appropriate to test the hypothesis?
r A. Cohort study
r B. Cross-sectional study
15 r C. Case-control study
16 r D. Correlational study
17
18 r E. Clinical trial
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A randomized, double-blinded clinical trial w as conducted to evaluate the effect of a new hypolipidemic drug
. L2J on the survival of patients after percutaneous coronary intervention (PCI). 1000 patients undergoing PCI w ere
8 randomly assigned to the drug or placebo group. 500 patients w ere in each group. The two groups w ere then
9 follow ed for three years for the development of acute coronary syndromes. Severe acute m yositis w as
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12
:I ~~ I
15
reported as a rare side effect of the drug therapy, but the difference between the two groups in the occurrence
=
of this side effect w as not statistically significant (p 0.09). The same side effect w as reported in several
small clinical trials of this drug. W hich of the follow ing is the most likely cause for the failure to detect a
significant statistical difference in the occurrence of acute m yositis between the treatment and placebo
groups?
16
17
r A. Ascertainment bias
18 r B. Short follow -up period
19
20
r C. Inappropriate selection of the patients
21 r D. Small sample size
22
23
r E. Observer's bias
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A follow -up study w as conducted to assess the effect of circumcision on the incidence of penile carcinoma. A
. L2J large cohort w as investigated. The rate in uncircumcised males w as 8/ 1000, and the rate in circumcised
8 males w as 6/ 1000. The investigators concluded that circumcision may be markedly effective in reducing the
9 incidence of the disease in the population. According to the study results, how many patients should be
10 circumcised to prevent one case of penile carcinoma?
11
tr15
16
r A. 100
r 8 . 250
r C. 500
17 r D. 1000
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19
r E. 5000
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The following vignette applies to the next 2 items

. L2J A study is conducted to assess the role of different treatment regimens on cardiovascular outcomes. Tw o
8
9 treatment arms are evaluated: high-dose hydrochlorothiazide (100 mg) and low -dose hydrochlorothiazide (25
10 mg). After a defined follow -up period, the mean systolic blood pressure (BP) in the high-dose group is 139
11 mmHg and the mean diastolic BP is 88 mmHg. In the low -dose group, the mean values are 143 mmHg and
12 92 mmHg, respectively. A two-sample t-test gives p-values of 0.03 for the systolic and 0.04 for the diastolic
BP differences between the two groups. The relative risk (RR) of sudden cardiac death in the low -dose as
'fr
15
compared to the high-dose group is 0.4 (95% confidence interval 0.25 - 0.55).
Item 1 of 2
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17
W hich of the follow ing is the best statement concerning the results of the study?
18
19
20 r A. High-dose hydrochlorothiazide has no additional benefit in low ering BP as compared to low -dose
21 hydrochlorothiazide
22 r B. Low -dose hydrochlorothiazide reduced the risk of sudden death in the cohort by 40%
23
r C. High-dose hydrochlorothiazide doubled the risk of sudden death in the cohort
r D. The risk of sudden death in the low -dose group is 40% of the risk in the higher-dose group
E. The dose of hydrochlorothiazide is not significantly related to the risk of sudden death
r
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Item 2 of 2
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8 Another subset of patients in this cohort w as given placebo, and the risk of sudden death w as assessed. This
9 group's RR of sudden death is very close to 1.0 w hen compared to the low -dose hydrochlorothiazide group,
10 although the mean systolic and diastolic BP are higher w hen compared to the low -dose hydrochlorothiazide
11 group. W hich of the follow ing is the best statement concerning the risk of sudden death in this cohort of
12 patients?
~ 15
r A. The risk of sudden death in the cohort is high
16 r B. High-dose hydrochlorothiazide increases the risk of sudden death approximately 2.5 times
17
r C. High-dose hydrochlorothiazide increases the risk of sudden death by 60%
18
19 r D. Low -dose hydrochlorothiazide decreases the risk of sudden death almost 3 times
20 r E. Hydrochlorothiazide is a safe drug regardless of the dose
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23
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A 38-year-old Caucasian primigravida presents to the physician's office at 20 w eeks gestation for prenatal
. L2J counseling. She is concerned about the risk of Dow n syndrome, and asks about the measures to diagnose it
8 early. The physician explains that triple screening may detect up to 50% of the cases of chromosomal
9 abnormalities, and that amniocentesis may detect approximately 90% of the cases. She decides not to
10 undergo any test. Eighteen w eeks later, she gives birth to a child w ith Dow n syndrome. W hen the physician
11 compared amniocentesis to triple screening, w hich of the follow ing did he emphasize?
12
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r A. Increase in false negatives
r B. Increase in false positives
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17
r C. Increase in positive predictive value
18 r D. Increase in negative predictive value
19
20
r E. Increase in sensitivity
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A study examines participation in cardiac rehabilitation in patients follow ing their first-ever episode of
. L2J m yocardial infarction in Oakland County, Michigan, from 1991-2010. The follow ing graphs are reported:
8
9 90
10 P-value for interaction
11
12
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70
age•year <0.001
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22 0
23 1991-1995 1996-2000 2001-2005 2006-2010
Year of myocardial infarction
• Elderly (~70 years old) • Young (<70 years old)

IOUSMUWorld. U.C
P-value for interaction

80 sex•year = 0.002
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;a~ 60
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1991-1995 1996-2000 2001-2005 2006-2010
. L2J
8 Year of myocardial infarction
9
• Elderly (~70 years old) • Young (<70 years old)
10 eUSMI.£World, U.C
11
12
P-value for interaction
:I ~~ I .,
80 sex' year = 0.002
--
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• 15 70
:c_
60
17 ..,-
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c: c:
18 ·- 0 50
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23 a.
10
0
1991-1995 1996-2000 2001-2005 2006-2010
Year of myocardial infarction
• Women • Men
eUSMI.£World, U.C
W hich of the follow ing is the best statement based on the information presented?
r A. Cardiac rehabilitation participation declined sharply for all age categories

r B. Cardiac rehabilitation participation of w omen increased over time
r C. Elderly patients benefited m ost from cardiac rehabilitation participation
r D. There w ere gender differences in the trend of cardiac rehabilitation participation
r E. Young male patients show ed higher m otivation than young female patients
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A large-scale clinical trial w as conducted to assess the effect of carvedilol (a mixed alpha- and beta-blocker)
. L2J on the clinical course of New York Heart Association class III-IV chronic heart failure. The study reported that
8 serum noradrenaline levels (a marker of the degree of neurohumoral activation) w ere correlated w ith serum
9 = =
sodium levels w ith correlation coefficient r -0.39 (p 0.005). W hich of the follow ing statements best
10 describes the observed relationship between serum noradrenaline levels and serum sodium levels?
11
12
r A. Serum noradrenaline levels increase as serum sodium levels decrease
:I ~~ I r B. Serum noradrenaline levels increase as serum sodium levels increase
• 15
-
• 16 r C. The measure of association does not reach statistical significance
r D. There is a strong correlation between serum noradrenaline and serum sodium levels
18
19
E. Variations in serum noradrenaline levels change serum sodium levels
20
21
22 r
23
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A randomized, double-blinded clinical trial w as conducted to assess the role of multidrug chemotherapy in the
. L2J treatment of patients w ith stage Ill and IV stomach cancer. 150 patients in the treatment group and 100
8 patients in the placebo group w ere follow ed for 24 months. 120 patients in the treatment group (80%) and 80
9 patients in the placebo group (80%) died during the follow -up period. The investigators conclude that the
10 treatment is effective. W hich of the follow ing is the most likely explanation of such a conclusion?
11
12
r A. Observer's bias may be present
:I ~~ I r B. Selective survival may be an issue
15
• 16 r C. The results are confounded
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• 17
19
20
21
22
r D. Time-to-event data w ere analyzed
r E. Tw o-year risk w as calculated
23
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A group of investigators is exploring trends in the incidence of coronary heart disease (CHD) in a large
. L2J population . They studied several factors in relation to the incidence of the disease. The relationships between
8 the cigarette sales in the population (average number of cigarette packs sold per person per day) and the
9 incidence of CHD (per 1000 people) over time are given on the figure below .
10
11
Cigarettes Sales Time, years
12 packs per day per person
:I ~~ I 1.5 1970
15
16 1.0 1980
17
- 18
20
21
22
23
0.5
0.1 -
1990
2000
50 60 70 80 90
Incidence of CHD, per 1 000
W hich of the follow ing is the best statement concerning the results of the study?
r A. No stable trend is present in the incidence of CHD over time.

r B. Quitting smoking decreases the risk of CHD for a person living in this population .
r C. Cigarette sales w ere stable over time in the population .
r D. No individual-level conclusions can be ascertained from the given plot .
r E. Discordant changes in cigarette sales and incidence of CHD are present.
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Several tests have been developed to measure the serologic markers of breast cancer. These tests have
. L2J different specificities and sensitivities for the early stage of breast cancer. If positive, w hich of the following
8 tests will have the highest positive predictive value for the disease with an assumed prevalence of 10%?
9
10
11 r A. Sensitivity - 65%, specificity - 97%
12
r B. Sensitivity - 70%, specificity - 94%
:I ~~ I r C. Sensitivity - 75%, specificity - 92%
15
r D. Sensitivity - 80%, specificity - 90%
16
17 r E. Sensitivity - 85%, specificity - 90%
18
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Several clinical trials studied the effect of a new antiviral agent on symptomatic relief of genital herpes simplex
. L2J virus infection. All trials w ere based on physician report of symptom improvement; valacyclovir w as used as a
8 comparator. The pooled analysis of studies that blinded only patients favored valacyclovir w ith an odds ratio
9 of 1.65 (95% confidence interval, 1.53-1.75). The pooled analysis of studies that blinded both patients and
10 treating physicians favored the new agent w ith an odds ratio of 0.64 (95% confidence interval, 0.38-0.79).
11 W hich of the follow ing best explains the difference in the reported odds ratios?
12
:I ~~ I r A. Effect m odification
15 r B. Lead-time bias
16
17
r C. Observer bias
18 r D. Publication bias
19
--20
r E. Randomization failure
22
• 23
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Tw o groups of investigators are interested in the problem of esophageal cancer in a population that has a high
. L2J prevalence of hot beverage consumption. One group conducted study A, w hich show ed that hot beverage
8 consumption is associated w ith esophageal cancer, w ith an odds ratio (OR) of 1.51 and 95% confidence
9 interval of 1.19 to 1.81. The other group conducted study B, w hich demonstrated an OR of 1.46 and 95%
10 confidence interval of 0.95 to 1.97. W hich of the follow ing is the best statement concerning the results of
11 these two studies?
12
:I ~~ I r A. The result of study A is not statistically significant

15 r B. The sample in study B is poorly selected
16
r C. The result in study A is not valid
17
18 r D. The sample size in study B is small
19
E. P value in study B is less than 0.05
20
- 21
• 23 r
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Several tests have been developed to measure the serologic markers of breast cancer. These tests have
. L2J different specificities and sensitivities for the early stage of breast cancer. Which of the following tests could
8 be the best screening test for the early detection of breast carcinoma if applied to a population with a stable
9 incidence of the disease?
10
11
12
r A. Sensitivity - 80%, specificity - 90%
:I ~~ I
r B. Sensitivity- 65%, specificity - 97%
15 r C. Sensitivity - 70%, specificity - 94%
16 r D. Sensitivity - 75%, specificity - 92%
17
18 r E. Sensitivity - 85%, specificity - 90%
19
20
21
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2 Item: 1 of 23 ljl f> Mark <::J t::>

Q. ld: 5004 [ Previous Next

-:m2 Item: 3 of 23 ljl f> Mark <::J t::>

W hat percentage of the strokes observed in the population is attributed to sm oking?

:I ~~ I Colon cancer mortality adjusted for

r A. Cancer prevention using vitamin D lacks biological plausibility

The following vignette applies to the next 2 items

• Elderly (~70 years old) • Young (<70 years old)

P-value for interaction

r A. Cardiac rehabilitation participation declined sharply for all age categories

r A. No stable trend is present in the incidence of CHD over time.

:I ~~ I r A. The result of study A is not statistically significant

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