13-07-20

ĐẠI HỌC Y KHOA PHẠM NGỌC THẠCH

ÔN THI PHYSIKUM 2020 KHÁI NIỆM

CÁC PHÉP ĐO CƠ BẢN &
DỊCH TỄ HỌC SO SÁNH TỈ SUẤT

TRONG DỊCH TỄ HỌC

ThS. BS. NGUYỄN THẾ DŨNG 2
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A healthy student goes to the family doctor to complete his tetanus vaccination protection with
147. To which part of the prevention belongs most likely the tetanus vaccination?
the missing third injection. Smoking is prohibited in all practice rooms. During the vaccination,
the doctor advises him to avoid long sunbathing on the upcoming vacation and recommends
(A) primary prevention
that he take part in the early detection of skin cancer afterwards.
(B) secondary prevention
(C) tertiary prevention Which form of prevention was NOT addressed in the previous paragraph?
(D) behavior prevention
(E) relation prevention
(A) Primary prevention
(B) Secondary prevention
(C) Tertiary prevention
(D) Behavior prevention
(E) Relationship prevention

Behavior prevention: “avoid sunbathing” + “early detection of skin cancer”

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Relationship prevention: “Smoking is prohibited” (benefits for communities)

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Which of the following measures is most likely to be attributed to the area of primary Spring 2015
relationship prevention?
137. A representative population study reveals that 10% of women
(A) Education about the risks of smoking in school
in Germany suffer from depression at the time of study.
(B) Ophthalmic examinations in diabetic patients
Which characteristic value is most likely described here?
(C) Stress management courses for hospital doctors
(D) Screening for early detection of breast cancer
A. Incidence
(E) Ban on cigarette machines in and near schools
B. Positive predictive value
C. Prevalence
+ Not “A” or C: Behavioral prevention D. Sensitivity
+ Not “B” or “D”: Secondary prevention (Early detection) E. Specificity

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Spring 2011 Spring 2014

144. In an epidemiological study, the number of newly occurring 101. In a scientific journal you read that the incidence of myocardial infarction has
cases of a disease within a population during a certain period of decreased in the past 10 years.
What does this statement most likely mean?
time is determined.
Which characteristic is investigated? A. The number of new cases of myocardial infarctions has decreased.
B. The rate of re-infarctions has decreased.
(A) Attributable risk C. The proportion of affected people, who die of myocardial
(B) Incidence infarctions, has decreased.
(C) Prevalence D. The proportion of people dying from myocardial infarction
(D) Relative risk has decreased.
E. The accuracy rate of screenings for the early detection of
(E) Sensitivity myocardial infarctions has decreased.
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Fall 2011
Fall 2015
105. The relative risk of a disease is typically defined in epidemiology as
116. In one study, during the study all new-onset heart attacks1 are
A. Frequency of occurrence of the risk factors in a population
counted and placed in relation to the number of study participants2.
B. Percentage of patients who are also affected by a risk factor
How do you call the determined characteristic value most accurately?
C. Quotient of disease probability of the exposed and the unexposed disease
probability
(A)Relative Risk
D. Probability of risk factors compared to protective factors
(B) Incidence
E. Likely to develop in exposure to protective factors
(C) Prevalence
(D) Positive Predictive value Quotient ≈ Ratio
(E) Population Attributable Risk
1 Tử số 2 Mẫu số

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Spring 2014 Trường hợp Cross-sectional studies và

Case-Control studies
142. Which of the following statements concerning odds ratio (OR) is most
applicable? Cross-sectional studies: Case-Control studies:
tính được Prevalences tính được Proportions
A. The OR calculates the ratio of two proportions and is an estimation
measure for the relative risk.
B. An OR < 1 means that the risk of exposed people is bigger than the risk of Không tính được RR
non-exposed.
C. An OR = 1 means that the risk of exposed people is 100% higher than the
risk of non-exposed.
D. An OR > 1 means that the risk of exposed people is smaller than the risk of Prevalence Ratio Odds Ratio
non-exposed. (Tỉ số TLHM) (Tỉ số số chênh)
E. An OR can only be calculated if the relative risk has been previously
calculated. 11
Diễn đạt kết quả như RR

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A scientific study found that about 35% of the population-related risk of stroke can be attributed
to high blood pressure (arterial hypertension).
Which of the following statements best describes what this finding means?

(A) If arterial hypertension is present, the risk of stroke is about 35%.

(B) Up to 35% of all strokes could be avoided if the hypertension could be treated well
enough. CÁC THIẾT KẾ NGHIÊN CỨU
(C) The risk of suffering a stroke is 35% greater in patients with arterial hypertension
than in people with normal blood pressure values. TRONG DỊCH TỄ HỌC
(D) About 35% of the general population suffer from high blood pressure.
(E) Out of 100 people with arterial hypertension, 35 will die from a stroke.
Phát biểu kết quả tương tự như kết quả của Nguy cơ qui thuộc % (AR%) chỉ khác ở chỗ
kết quả này tính trên cả dân số (Population Attributable Fraction/PAF - % Nguy cơ qui
trách trong dân số)

Phát biểu:
Nếu THA gây đột quỵ thì 35% trường hợp đột quỵ trong dân số người THA có thể loại
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bỏ 14
được nếu (họ) được điều trị đủ tốt (để HA không cao).

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Spring 2011 Spring 2010

141. Which statement about the study of point prevalence applies the most? 125. Which of the following statements best characterizes cross-sectional studies?
In studies of point prevalence
(A)A group of persons studied at multiple points in time.
(A)there is a high capacity for analyzing the influence of risk factors on health (B) It is possible to examine the impact of risk factors retrospectively.
and disease (C) It is possible to determine the frequency of occurrences of new cases of
(B) pre-post comparisons take place illness.
(C) experiments are performed (D) It is possible to determine the prevalence of diseases.
(D) the re-emergence of diseases is examined (E) The procedure of pairing (matching) is used.
(E) a cross-sectional study design is used

Công dụng của Cross-sectional study (Prevalence study): tìm Prevalence

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Fall 2011

112. In a representative population study with a point in time (test date)

measurement, it is found that women are more likely to suffer from
depression than men.
Which type of study is most likely used here?

A. Case-control study
B. Prospective cohort study
C. Quasi-experimental study
D. Cross-sectional study
E. Randomized controlled trial
Single point in time B + ~ Depression TX+ ~ Women
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women are more likely to suffer from depression than men

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Spring 2009 Spring 2010

131. In a study, heart attack patients1 and a matching group of healthy people2
are retrospectively interviewed about psychosocial stress3. 126. Which of the following statements best characterizes randomized controlled
trials?
This type of study can best be characterized as
(A) In this type of study, the subjects are studied retrospectively.
(A) Case-control study (B) The subjects are required to participate in such studies as far as a clinical
(B) Cohort study benefit can be expected.
(C) Quasi-experimental study (C) The subjects are assigned to an intervention or a control group according to
(D) Cross-sectional study their preference.
(D) The subjects are examined at a singular point in time.
(E) Randomized controlled trial
(E) Using this type of study, the effect of a therapy can be examined.
1 Cases (nhóm Bệnh)
2 Controls (nhóm Chứng) Answer A không đúng vì “retrospectively”, nghe như Case-Control study.
3 TX với Yếu tố nguy cơ Answer B không đúng vì “as far as … benefit .. expected”, nghe như Cohort study.
Answer C không đúng vì “assigned …. their preferences”, ngược với randomization.
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Answer D không đúng vì “singular point in time”, nghe như Cross-sectional study.

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Fall 2015 Spring 2014

108. Which of the statements about randomization in the context of randomized
112.Which type of study has to verify the effectiveness1 of a new treatment controlled studies (trials) is NOT true?
method2, which is to shorten the duration of treatment for acute back pain,
with the highest methodological quality3? (A) Its goal is the structural equivalence of intervention group and control group.
(B) It enables the control of individual influences on the result of the study.
(A) Cohort study 1
(C) It fosters the representativity of the participants.
(B) Naturalistic study
(D) It aims at minimizing systematic errors.
(C) Pre-post study with control group
(E) It secures that each participants has the same chance of being attributed to
(D) Quasi experimental study
(E) Randomized controlled trial 2 intervention group or control group.

3 Việc Ngẫu nhiên hoá: tránh SAI SỐ DO CHỌN MẪU

21 (A) (B) (D) (E) 22

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Spring 2009
128. Which of the following statements concerning the “number needed to treat (NNT)”
is correct?
134. In a randomized controlled study, a training program for heart attack patients,
which was supposed to lower the risk of another heart attack, was evaluated. (A) the NNT depends from the risk perception of the patient
(B) the NNT is the degree for the benefit of an intervention
In the intervention group the risk of recurrence during a certain period of time (C) the NNT is the degree for the evaluation of cross-section studies
was 4%, while it was 8% in the control group. (D) the NNT is the degree to denominate the relative risk
What is the number needed to treat (NNT)? (E) the NNT is the higher, the more effective a treatment is
A. 4
B. 12 ARR = IINT ─ ICT = 4% - 8% = - 4%
C. 20
NTT = 1 / ARR = 1 / 0,04 = 25
D. 25
E. 200
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Spring 2011
142. In a study of primary prevention of hypercholesterolemia the mortality risk
was reduced from 2% in the control group to 1.5% in the treatment group by
a lipid-lowering medication.
What is the number needed to treat?

(A) 2
(B) 25
(C) 50
ARR = IINT ─ ICT = 2% - 1.5% = -0.5%
(D) 200
(E) 500
NTT = 1 / ARR = 1 / 0,005 = 200

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A new drug is to be launched on the market. Clinical studies show that out of 100 patients
111. A 50-year-old patient is interested in participating in a screening program for
taking the drug, 50 show a significant symptom reduction. In contrast, out of 100 people in the
the early detection of breast cancer and a succeeding early therapy if placebo group, only 45 people show a significant reduction in symptoms.
necessary. According to the values of this study, how large is the number needed to treat (NNT) to
Which characteristic value is most adequate to demonstrate the risk reduction to achieve a significant symptom reduction through the drug?
die of breast cancer to the patient in a population of women of her age?
(A) 2
A. Sensitivity (B) 5
B. Specificity (C) 20
C. Number needed to screen/treat (D) 95
(E) 105
D. Cohen’s d
E. Negative predictive value
ARR = (50/100) ─ (45/100) = 5/100
Anwers A, B, D, E hoàn toàn không liên quan gì đến risk reduction.
NNT = 1/ARR = 1/0.05 = 20
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Spring 2011 The only thing you know about a drug is that it halves the risk of serious complications
from an illness during the treatment period.
Which statement on the benefit of the drug can be derived directly from this information?
145. By the use of a cholesterol-lowering drug, a study could show that a heart
attack could be prevented (reduced) in 2 of 100 participants. (A) The absolute risk of a serious complication is 50%.
Which measure best describes these two participants? (B) The incidence of serious complications is twice as high without taking the drug as
with taking it.
(A) Absolute risk reduction (C) The number needed to treat to avoid serious complications is 2.
(D) When taking the drug, the complication rate is reduced to 50%.
(B) Attributable risk
(E) Out of 100 patients who receive the drug, 50 benefit from taking it.
(C) Number needed to treat (NNT)
(D) Odds ratio
(E) Relative risk + Not “A”: Absolute risk chỉ tính cho từng nhóm
+ Not “C”: không biết ARR nên không thể tính NNT
+ Not “D”: làm sao biết complication rate ban đầu là bao nhiêu mà cho rằng giảm còn 50%
Anwers B, D, E không liên quan gì đến risk reduction (of a heart attack). + Not “E”: cần phải có AR mới tính được benefit này
Anwer C cũng không phải, vì không phải điều trị 100 participants để có 2
được prevented.
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(A) ARR = -2% (ICT – IĐC = 98/100 – 100/100)

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Spring 2015
Thiết kế nghiên cứu Phân tích Tổng hợp
(Meta - Analysis) 110. An analysis is published in a journal, which summarizes the effects observed
in several randomized controlled trials, by calculating a total effect.
Which analysis procedure is most likely in this approach?
Là một thiết kế nghiên cứu đặc biệt qua đó nhà nghiên cứu tổng
hợp các kết quả nghiên cứu từ các nghiên cứu độc lập đã được A. Content analysis
tiến hành bởi các nhóm nghiên cứu trước đây B. Factor analysis
("conducting research about previous research“) C. Meta – analysis
D. Variance analysis
E. Regression analysis
Meta – analysis chỉ có thể được tiến hành nếu chúng ta có khả
năng xác định 1 số đo mô tả gọi là effect size (hệ số ảnh hưởng).

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Fall 2011 Effect size là chỉ số để đo độ lớn của 1 hiệu quả điều trị (can thiệp).
113. During the preparation of a guideline for the treatment of chronic heart
failure, scientists perform a systematic literature search to find all studies on
Effect size cũng là số đo mô tả được chuẩn hoá (standardized) để
the efficacy of a particular drug. They take information about the effect dễ so sánh kết quả của các nghiên cứu khác nhau được tính toán
strength of the drug from the single study reports and join them to make trên những thang đo lường khác nhau (số đo effect size không có
a total value. đơn vị).
How is this procedure called?
Số đo Effect size thường dùng nhất trong Meta-analysis là
A. External validation Cohen’s d.
B. Cross-validation
C. Meta-analysis
D. Ecological study
E. Replication
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Spring 2015
Cohen’s d: là hiệu của 2 số trung bình (tính được từ 2 mẫu hoặc 2 112. In a randomized controlled study on the treatment of depression, a mean
dân số khác nhau) chia cho độ lệch chuẩn. depression strength of 25 on a depression scale is shown in the experimental
group after therapy; in the placebo group the value is 30. The standard
deviation was 10 in both groups, before as well as after the intervention.
̅ − ̅ Which statement is correct for the group difference after the intervention?
=
The effect size (Cohen’s d) is

Trường hợp SD bằng nhau, mẫu số là s (giống A. 0.5 ̅ = 30 ̅ = 25

nhau); trường hợp SD hoặc phương sai không B. 1 SD = 10 (trường hợp ĐLC bằng nhau)
bằng nhau, mẫu số là pooled SD. C. 5
D. 10
Luôn luôn lấy số Mean lớn trừ cho số Mean nhỏ E. 15
̅ − ̅
= = (30 – 25)/10 = 0.5
để tránh trường hợp d là số âm. 35 36

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Spring 2010 What is the most likely statement of effect size as a measure of a treatment effect?
127. A clinical study with measurements before and after the intervention (pretest; posttest)
investigated whether a disease management program (experimental group, EG) is superior to A. As the effect size increases, the NNT (increases?).
the standard treatment (control group, CG) of blood pressure in hypertensive patients. B. As the effect size increases, the test power drops.
In this study, how can the size of the intervention effect (measure for the strength of effect C. As the level of significance increases, the effect size decreases.
Cohen's d) be calculated correctly? D. As the sample size increases, the effect size increases.
E. The effect size decreases with increasing scattering.
(A) based on the difference of blood pressure values of EG and CG in the post-test,
divided by the pooled standard deviation
(B) based on the difference between the pretest and posttest blood pressure values in the
intervention group ̅ − ̅
(C) on the basis of the confidence interval, within which the "true" value lies
=
(D) based on the p-value in the test of significance
(E) based on the comparison of the pretest-posttest blood pressure differences between EG and
s (standard deviation) is a measure of scattering
CG
Blood pressure là biến số liên lục, phân phối bình thường. EG có posttest Mean riêng và CG
có posttest Mean riêng. 37 38
Lấy hiệu của 2 Means này chia cho pooled SD để có Cohen’s d

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You are reading a scientific study that tested a newly developed drug for treating high blood 123. Which of the following methodological statements concerning variables is correct?
pressure against an older substance.
The intervention group received the new drug, the control group the old drug. It is reported (A) In the investigation of the influence of alcohol consumption for the risk to have lung
that there was a more pronounced drop in blood pressure in the intervention group. The cancer, smoking should be considered as a potential disturb (confounding) variable
difference between the two groups was statistically significant (p <0.001). (B) The moderator-variable is a dependent variable which will not be considered in the trial
Which of the following parameters would be best suited to assess whether the difference found design
is relevant for the future treatment of patients? (C) In a cross-section trial the specificity of the dependent variables will be actively changed
by the researcher
(A) Alpha error level (D) If the effect of a drug is for women better than for men, sex is a dependent variable
(B) Beta error level (E) If the life style change leads initially to a decrease of blood pressure and therefore the
(C) Effect size (e.g. Cohens d) frequency of an infarct incidence decreases, then blood pressure is a
(D) Standard deviation mediator-variable
(E) Test strength (power) (C) In cross-sectional studies, investigators can only OBSERVE (observational), not INTERVENE
(interventional/experimental)

The new drug is more effective for treating high BP than the old drug.
(D) Effect of a drug is a dependent variable, sex is independent variable.
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Confounders (A) In the investigation of the influence of alcohol consumption for the risk to have lung cancer, smoking
Confounders are variables that is both an ancestor of the exposure and an ancestor of the should be considered as a potential disturb (confounding) variable.
outcome. For instance, Z is a confounder Ancestor: independent/predictive variable

X Y X Y

Y: risk of lung cancer

Z X: alcohol consumption Z

Z: smoking Not a confounder

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(B) The moderator-variable is a dependent variable which will not be considered in the
trial design

A moderator is a qualitative (e.g., sex, race class) or

quantitative (e.g., level of reward) variable that affects
the direction and/or strength of the relation between
an independent/predictor variable and a dependent/
criterion variable.” (Baron & Kenny, 1986, p 1174). (E) If the life style change leads initially to a decrease of blood pressure and therefore the
frequency of an infarct incidence decreases, then blood pressure is a mediator-variable

Life style Infarct

change BP control
X: Socio-economic status Y: Treatment attendance rate Incidence
(X) (M )
Independent variable Dependent variable (Y)

Moderators: Miles from agency;

Not a dependent variable
Family support; Multiple jobs
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In one study, the likelihood of suffering a new heart attack1 in the course of the study was A prospective cohort study shows a relationship between the extent of alcohol consumption
significantly increased in people with pronounced occupational stress levels compared to and the risk of lung cancer. However, if one also takes into account the extent of cigarette
people with less pronounced stress levels2. Study participants who, in addition to pronounced smoking through statistical control / adjustment, the connection between alcohol
stress loads, are characterized by the experience of lack of social support from colleagues3, consumption and the risk of lung cancer can no longer be demonstrated.
which was also recorded in the study, are more than twice as likely to have a new heart attack How is the variable “alcohol consumption” best described in the research question examined?
compared to those who were solely stressed.
Which term best describes the function of poor social support in this example?
(A) Confounder
(B) Causal risk factor
(A) Dependent variable
(B) Causal risk factor (C) Mediator
(C) Mediator (D) Moderator
(D) Moderator (E) Risk indicator
(E) Confounding variable
1
Neither “A” nor “B”: không phải là 1 nguyên nhân của K. Phổi
Dependent variable
1 Independent variable
3 Moderator (Moderating variable)

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Neither “C” nor “D”: không phải là biến số điều hoà hoặc trung gian trong mối liên
quan nhân-quả giữa hút thuốc lá và K. Phổi

SÀNG LỌC

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Fall 2011
104. A screening test can give a positive or negative test value for a particular disease, related
to "healthy" or "sick" conditions only in this disease.
Then, what refers to the sensitivity of the screening test?
A. Probability of a negative test value in actually healthy people
B. Probability of a positive test value when people are actually sick
C. Probability of being sick for a negative test value in reality
D. Probability of being actually healthy for a negative test value
E. Probability of being actually sick with a positive test value
104. In a screening test which can give negative or positive test values a certain disease was
investigated. In the following “healthy” and “sick” should refer only to this disease.
What is then the sensitivity of this screening test?
(A) The likelihood of a negative test result at in reality healthy persons
(B) The likelihood of a positive test result at in reality sick persons
(C) The likelihood to be in reality sick at a negative test result
(D) The likelihood to be in reality healthy at a negative test result
(E) The likelihood to be in reality sick at a positive test result

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Spring 2011 Fall 2009

137. A screening test for depression diagnosis has a high sensitivity, if:
143. A screening test classifies 80 out of 100 people who actually have the disease
of interest to be positive. (A) There is a very high probability of depression in the positive test results
Which criterion corresponds to the value of 80%? (B) The prevalence of depression in the population studied is high.
(C) The rate of false positive results is low.
(A) Negative predictive value (D) It excludes the largest possible proportion of patients who actually have no depression.
(E) It covers the largest possible proportion of patients who actually suffer
(B) Positive predictive value
from depression.
(C) Prevalence
(D) Sensitivity Answer A: liên quan với positive predictive value
(E) Specificity
Answer B: cũng liên quan đến positive predictive value

Answer C: không đúng, false positive results sẽ cao

Answer D: liên quan đến specificity

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Fall 2010

141. A screening test that has been used in high-risk populations, will now be
applied in the general population, where the prevalence of the disease of
interest is significantly lower.
Which characteristic value of the screening test is thereby probably
reduced significantly?
High-risk population: population with
(A) Negative predictive value high prevalence of the diasease of
(A) There is a very high probability of depression in the
positive test results (B) Positive predictive value interest

(C) Reliability
(D) Sensitivity
(E) Specificity
(B) The prevalence of depression in the population studied is (C) The rate of false positive results is low.
high. (E) It covers the largest possible proportion of patients
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who actually suffer from depression

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Spring 2009 Screening methods are used for the early detection of diseases and are effective if the survival
time and/or quality of life of the patient is improved by the early diagnosis and early treatment.
124 What can be referred to as a "positive predictive value”? If, in men who do not belong to any of the known risk groups (homosexuals, iv drug addicts), in
a screening test of two men who tested positive, only one is actually infected with HIV, then
(A) Proportion of persons without the disease who were classified by the test result correctly what is the characteristic value?
(negatively)
(B) Proportion of persons whose negative test result was correct in all persons with a negative (A) Negative predictive value
test result (B) Positive predictive value
(C) Proportion of individuals whose positive test result was correct in all persons with (C) Point prevalence
a positive test result (D) Sensitivity
(D) Proportion of people who are classified as ill by the test result, although there is no disease (E) Specificity
(E) Proportion of people who are classified as healthy by the test result, although there is a
disease

“Positive test result was correct” = Test (+) and Disease (+)

Answers A, B, D, E bị loại vì có gì đó “negative” (healthy, no disease, without disease, negative

test result,..), trong khi trong công thức tính PV+ chỉ toàn là positive (positive test result,
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If the positive correctness (also: positive predictive value) of a screening procedure is 0.75, this
The proportion of men who have been diagnosed with a suspected viral infection by means means that
of a rapid HIV test, even though they do not have HIV infection, is equal to
(A) 75% of all healthy people are correctly classified as "healthy" by the test
(A) The proportion of false negatives (B) the test produces the right result in 75 out of 100 cases
(B) The proportion of false positives (C) 75 of 100 patients are correctly classified as "sick" by the test
(C) of reliability (D) of 100 people classified as "healthy" by the test, 75 are actually healthy
(D) Sensitivity (E) of 100 people classified as "sick" by the test, 75 have the disease
(E) Specificity Classified as “sick” by the test = Test (+)

Have been diagnosed by means of a rapid HIV test = Test (+)

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