School of Medicine

TYPE 1

Course: 2nd year MEDICINE

Subject: Epidemiology

Final exam

INDICATIONS TO BE TAKEN INTO ACCOUNT

 Please do not forget to write your name and identification number in the boxes on
the answer sheet before starting the exam. Remember that if this information is
unclear, it will not be possible to grade the test.

 This exam consists 75 questions. Each question has 4 possible answer

options; you must choose the most appropriate, only one. Before turning in the
test, check that it is not missing any pages.

 The exam will last for 2h 20 min. It is very important that you control the time
well, to avoid leaving questions unanswered.

 There are different types of exams. Check that the letter of your exam
corresponds with your answer sheet.

 On the test, wrong answers count negatively. For each incorrect answer, -1/3
points will be subtracted.

 If you believe that any question is open to challenge, you must inform your class
representative within 48 hours after the end of the exam. Only questions that are
communicated through this route and are duly justified will be considered for
challenge.
The following questions refer to the paper “Use of hormonal contraceptives
and risk of HIV-1 transmission: a prospective cohort study” (Lancet Infect Dis
2012;12:19-26)

1. We read in the introduction: “Hormonal contraceptive methods, including

daily oral pills and long-acting injectables, are used by more than 140
million women worldwide.” (data from 2009). Therefore:
1) The prevalence of the use of hormonal contraceptive methods worldwide in
2009 was very high.
2) Hormonal contraceptive methods were the most widely used family planning
methods in the world in 2009
3) The rate of use of hormonal contraceptive methods in 2009 was 140x10 6
woman-years.
4) We do not know the global prevalence of use of hormonal contraceptive
methods in 2009.

2. We read in Methods: “Rapid HIV-1 antibody tests were used for HIV-1
serological testing and positive results were confirmed by ELISA”. We can
state that:
1) The rapid tests probably had a higher sensitivity than the ELISA test.
2) The ELISA test probably had few false negatives, so it was used to confirm
the diagnosis.
3) The positive predictive value of the ELISA was very high.
4) Using only the rapid tests would have resulted in differential information
bias.

3. “Women were classified as exposed to hormonal contraception if they

reported hormonal use at the quarterly visit. Contraceptive use was
analysed as a time-dependent exposure, with women assumed to have
used the same method during the 3 months that elapsed between study
visits.” To what type of bias might this assumption have led to?
1) Selection bias of women exposed to hormonal contraceptive methods
2) Differential misclassification bias of the exposure
3) Non-differential misclassification bias of the exposure
4) Confounding

4. “We did separate analyses of the association of hormonal contraception

with HIV-1 acquisition by women (male-to-female transmission) and HIV-1
transmission from women to men (female-to-men transmission).” What was
the rationale for doing so?
1. To assess if sex may be an effect modifier
2. To assess if there was an important misclassification of the exposure
3. To limit a potential selection bias
4. To obtain more precise estimates of the measure of association
5. “Analyses were done for exposure to any hormonal contraception [...]; the
comparison group was women not using hormonal contraception, which
included women who had had a hysterectomy or tubal ligation, used
condoms only, or used no contraception”. Given that condom use
decreases the risk of HIV transmission, how will inclusion of condom users
in the comparison group affect the results?
1) It will lead to a non-differential misclassification of the exposure and thus to an
underestimation of the true measure of association.
2) It will lead to a non-differential misclassification of the exposure and thus to an
overestimation of the true measure of association.
3) If exclusive condom users had been excluded from the study, the measure of
association would have been closer to the null value.
4) If exclusive condom users had been excluded from the study, the measure of
association would have been even stronger.

6. For female-to-male transmission, only genetically linked seroconversions

within the partnership were included. This was an attempt to reduce or
avoid:
1) Non-differential information bias
2) Differential information bias
3) Unacceptability bias
4) Diagnosis suspicion bias

7. Previous results have shown that the hormonal contraception–HIV-1-risk

association was stronger for women who were aged less than 25 years.
These results suggest:
1) Analyses should be adjusted for women's age
2) There is a linear and constant gradient for every one year of increase of age
(dose-response relationship) between age and HIV-1 risk: the younger the
age, the higher the risk of HIV.
3) There seems to be an interaction between age and hormonal contraceptives
4) Women younger than 25 years from the general population should not take
hormonal contraceptives because their risk of HIV-1 infection is elevated

8. In the results section we read: “Among women that were HIV-

seronegatives, the 12 month retention was 93% and the 24 month retention
was 87%”. If the retention would have been much lower, with which kind of
bias could we have ended up?
1) Selection bias
2) Non differential information bias of the outcome
3) Differential information bias of the outcome
4) Migration bias
Please, consider the information in table 3.

9. What measures of frequency are displayed in table 3?

1) Cumulative incidences
2) Incidence densities
3) Prevalences
4) Hazard ratios

10.“In adjusted Cox analysis, use of hormonal contraceptives was associated

with a two times increased risk of HIV-1 acquisition”. What figure in table 3
is this statement referring to?
1) 1,98 (1,06-3,68)
2) 2,05 (1,04-4,04)
3) 2,19 (1,01-4,74)
4) 1,80 (0,92-3,52)

11.Hazard ratio (HR) for women < 25 years was 1.96 and 2.21 for women >25
years. No significant differences were found among both HR. Therefore:
1) There is confounding between age and hormonal contraceptives use
2) There is interaction between age and risk of HIV
3) There is confounding by age
4) There is no interaction by age and hormonal contraceptives use

12.In table 3, what does it mean that the HR is adjusted for the variables listed
in the foot of the table?
1) The results can be generalized because confounding by these variables has
been eliminated.
2) The value of these variables has been taken into account in estimating the
effect of contraceptives on the risk of HIV infection
3) The modifying effect of these variables has been eliminated.
4) The association between contraceptives and HIV infection is clearly causal
because confounding has been completely eliminated
13. 3.07% of the women who used injectable contraceptives became HIV
infected because they used this type of contraceptive method. What
measure of impact does this figure correspond to?
1) Absolute risk increase
2) Risk fraction
3) Relative risk increase
4) Relative risk

14.In the results section, we read: “To account for the potential persistent
biological effects of hormonal contraception on HIV-1 risk when women
switched contraceptive methods, we assessed the effect of extending the
exposure window for 3 months after last hormonal contraceptive use”.
What is the underlying concept for running this analysis?
1) Induction period
2) Latency period
3) Effect modification
4) Confounding

15.We read in the Discussion section: “Several studies show—with similar

magnitude of their effect estimates—the potential for hormonal
contraception to increase women’s risk for being infected by HIV-1, even
after controlling for sexual behaviour”. What causality criterio does this
statement refer to?
1) Coherence
2) Consistency
3) Experimental evidence
4) Strength of the association

16. We also read: “Clinical and laboratory studies have suggested possible
mechanisms by which hormonal contraception could influence HIV
susceptibility and infectiousness including changes to vaginal structure,
cytokine regulation, CCR5 expression, and cervicovaginal HIV shedding”.
In this paragraph, the authors are discussing:
1) The biological plausibility of the association between hormonal contraception
and HIV infection.
2) Temporal sequence of the association between hormonal contraception and
HIV infection.
3) Experimental evidence on the effect of hormonal contraception.
4) Consistency on the association between hormonal contraception and HIV
infection.
17. In the discussion section, we read “Our analyses controlled for age,
pregnancy, condom use, and HIV-1 concentrations in the infected partner
[...]. Only a clinical trial with random assignment of women to effective
hormonal contraception versus non-hormonal contraception could
definitively assess HIV-1 risk from different contraceptive methods.”
According to this statement, what would the main advantage of such a
trial be?
1) Better control for confounding factors.
2) Better addressing of the effect modifiers.
3) Limiting of losses to follow-up.
4) Better classification of the exposure.

18. One of the limitations of the study was that contraceptive use was
determined by self-report. What type of bias might this have led to and
how could this affect the measure of association?
1) Non-differential misclassification bias, underestimation
2) Non-differential misclassification bias, overestimation
3) Differential misclassification bias, underestimation
4) Differential misclassification bias, overestimation

19. In the discussion, we read “Our data do not provide estimates of HIV-1
risk related to other hormonal contraceptives, such as implants, patches,
or combination injectables.” Based on which epidemiological criterion
would you expect the results for the assessed contraceptive methods to
be applicable to these other contraceptive methods?
1) Consistency
2) Coherence
3) Analogy
4) Biological plausibility

In 2015 and 2016, two meta-analyses were published supporting the increased
risk of HIV in women using injectable contraceptives. However, some authors
argued that the studies had limitations and also that HIV risk with other
contraceptives had not been evaluated. Therefore, they conducted a
multicenter clinical trial in Africa that aimed to compare the HIV incidence in
users of injectable contraceptives (DMPA-im), copper intrauterine device (IUD)
and subcutaneous hormonal implant (LNG). It was published in 2019 in Lancet.

20. Please, select the CORRECT statement regarding the last trial:
1) It was likely to be an open trial
2) Given that it was a multicenter trial, the sample was representative of the
general population
3) Since the exposure was a contraceptive method, participating women could
select which method of contraception they wanted to use
4) It is a factorial trial with 3 groups
21. In the trial, 397 incident HIV infections were observed: 143 (36%) in the
DMPA-im group, 138 (35%) in the IUD group and 116 (29%) in the LNG
group. Therefore:
1) The group with the highest risk of infection was the DMPA-im group, although
the differences between the groups are probably not statistically significant.
2) It is confirmed that injectable contraceptives (DMPA-im) increase the risk of
HIV compared to the other methods.
3) There is approximately 24% higher risk of infection in the DMPA-im group
than in the LNG group.
4) From these data it is not possible to conclude which group has a higher risk of
infection.

Please, consider the results from the trial

22. Please, select the CORRECT answer about the figure:

1) Infection rates for the 3 contraceptive groups are presented.
2) The increased risk of infection in the 3 types of contraceptives is not
statistically significant
3) All women who started the trial were followed for 18 months in all 3 groups
4) The risk of HIV infection for each of the methods is about 4-7% after 18
months of follow-up.
23. In this trial it was not considered ethical to assign women to a placebo
group because they all wanted to avoid pregnancy. Therefore:
1) A selection bias has been committed.
2) The results will clearly be overestimated because all women were using a
contraceptive method.
3) No measures of association can be estimated because there is no
comparison group.
4) We cannot adequately assess whether HIV cases in DMPA-im users are
attributable to DMPA-im.

24. In the Discussion section of the clinical trial, authors stated: “HIV
incidence was high for all three groups”. With all the data you already
have on this trial, what can we say about these 3 contraceptive methods?
1) All 3 methods could increase the risk of HIV
2) Injectable contraceptives are ruled out as being responsible for the increase in
HIV cases in women who use them.
3) Cases of HIV in users of any of these 3 methods are due to the use of these
methods.
4) The women who used these methods were already infected at the beginning
of the trial and that is why the incidence was so high.

25. After publication of the last trial, WHO claimed that “new study finds no
link between HIV infection and contraceptive methods”. Based on the
results in figure 3, the most appropriate interpretation would be that….
1) ...there are no differences between the three methods in terms of HIV
infection risk, but the three seem to increase the risk of HIV
2) ... the risk of HIV attributable to 3 contraceptive methods is not significant
3) ... injectable contraceptives do not increase the risk of HIV infection
4) ... 3 contraceptive methods increase the risk of HIV infection

--------------------------------------

26. What type of preventive measure is a population-based campaign

recommending HIV testing?
1) Primary prevention
2) Secondary prevention
3) Tertiary prevention
4) Primordial prevention

27. Women with a family history of or other breast cancer risk factors are
being targeted to take drugs such as raloxifene to prevent the occurrence
of breast cancer. What type of preventive measure is being done?
1) Primary prevention
2) Secondary prevention
3) Tertiary prevention
4) Quaternary prevention
28. Drug therapy to reduce virus levels in semen of HIV patients is a ______
prevention measure for their sexual partner:
1) Primary
2) Secondary
3) Tertiary
4) Quaternary

29. Careful control of insulin levels and patient education among patients with
diabetes is a:
1) Primary prevention strategy
2) Secondary prevention strategy
3) Tertiary prevention strategy
4) Quaternary prevention strategy

30. Unhealthy diets may lead to an increased risk of hypercholesterolemia.

Nevertheless, not all people with unhealthy dietary habits develop
hypercholesterolemia. On the other hand, there are people who develop
hypercholesterolemia although they adhered to a healthy diet. According
to this information we can conclude that an unhealthy diet is:
1) A necessary but not sufficient cause for hypercholesterolemia.
2) A sufficient but not necessary cause for hypercholesterolemia.
3) Neither a necessary nor a sufficient cause for hypercholesterolemia.
4) A sufficient and necessary cause for hypercholesterolemia.

31. A cohort study with a follow-up of 5 years was conducted to assess the
association between smoking and coronary heart disease (CHD). Results
are shown in the following table:
Outcome after 5 years
Study inception CHD No CHD

2000 Smokers 55 1945

4000 Non-smokers 20 3980

If smokers had not smoked, __% of CHD cases among smokers could have
been avoided. What is the value for these percentage?
1) 44.4
2) 81.8
3) 2.25
4) 10

32. A retrospective cohort study is conducted to assess the survival of

patients with type 2 diabetes according to their glycosylated hemoglobin
 (HbA1c) levels, a parameter that indicates glycemic control. What groups
would have to be compared in this study?
1) People with diabetes versus people without diabetes
2) People with high HbA1c versus people with low HbA1c
3) People with diabetes and high HbA1c vs. people without diabetes and low
HbA1c
4) People with diabetes and high HbA1c vs. people without diabetes and high
HbA1c

33. A trial about the prevention of breast cancer mortality through a screening
program with mammograms showed a population preventive fraction of
0.079. Please, check the CORRECT answer:
1) The mammogram program avoids 79 deaths per year per 1000 women in the
population, who undergo a mammogram.
2) If all the population underwent a mammogram, we could potentially prevent
7.9% of breast cancer deaths that actually occurring in that population.
3) If all the women from a population underwent a mammogram, we would avoid
79 deaths per year per 1000 women from that population.
4) For 1000 women from a population that underwent a mammogram during one
year, we could potentially avoid 79 breast cancer deaths.

34. In a study, people who have come to the emergency room due to injuries
after a road traffic accident and patients who come to the same
emergency room having sports injuries are selected. They are asked
about their alcohol consumption in the last 24 hours, to assess the
association between alcohol consumption and road traffic injuries. What
is the study design?
1) Cross-sectional study
2) Case series
3) Retrospective cohort study
4) Case-control study

35. A characteristic of an experimental study that a cohort study does NOT

show is that:
1) It is an analytical study
2) Odds ratios can be calculated
3) It is always longitudinal
4) The treatment assignment can be blinded

36. To determine whether the regular use of acetylsalicylic acid (ASA)

increases the risk of hypertension, a group of patients is selected from a
health care center. Their blood pressure was measured to classify them as
hypertensive and normotensive, and they were asked whether they
usually take ASA. What was the study design?
1) Retrospective cohort study
2) Prospective cohort study
3) Cross-sectional study
4) Case-control study
37. Which of the following is a limitation of the design from the previous
question?
1) The risk of hypertension associated with usual ASA consumption cannot be
estimated.
2) Odds ratios cannot be calculated
3) Loss to follow-up and missing values at the end of the study
4) Diagnostic suspicion bias.

38. You want to assess whether ibuprofen consumption is associated with the
incidence of severe hepatitis. You have information on the consumption of
ibuprofen (packages sold) in the different autonomous communities over
the last 5 years. You also have information on the incidence of severe
hepatitis by autonomous community. The study to be carried out is a/an:
1) Ecological study
2) Case-control study
3) Cohort study
4) Experimental study

39. In 2018, the European Medicines Agency made a statement about the
possible teratogenic effect of dolutegravir (DTV) and advised against
prescribing that drug to women planning a pregnancy. The information
was based on a study in Botswana of children born to 11,558 HIV+
mothers in which they found that 0.9% (4/426) of mothers who took DTV
during pregnancy had a child with a neural tube defect, compared to 0.1%
of mothers who took other antiretroviral drugs. The study conducted was
probably:
1) Analytic observational
2) Experimental analytical (clinical trial)
3) Observational case-control
4) Descriptive longitudinal

40. According to the study in the previous question, treatment with DTV had a
relative increase of risk of malformation of____% compared to other
antiretrovirals.
1) 9
2) 8
3) 800
4) 900

41. If the women who took DTV during pregnancy had not taken it, ___% of
them would have been prevented from having a child with a neural tube
defect:
1) 0.8
2) 0.9
3) 88.8
4) 80
42. How many pregnant women who took DTV would have had to stop taking
it to prevent 1 child being born with a neural tube defect?
1) 2
2) 125
3) 8
4) 112

43. In a report on the possible side effects of the COVID-19 vaccines, we read:
“Many countries have systems in which health-care workers can submit
reports about side effects that occur after an injection. This kind of
surveillance can detect signs of rare adverse events, but most systems
are not designed to definitely determine their exact cause because…”:
1) There is no registry of adverse effects in unvaccinated people to compare
them to.
2) This is not a clinical trial.
3) The data are aggregated and the ecological fallacy may happen.
4) People analyzing the data know who has been vaccinated and who has not
been vaccinated

44. What type of analysis would you perform to maintain the baseline
comparability of the groups you intend to compare and to provide
information on the effectiveness of a treatment under real-life conditions
in a trial?
1) An intention-to-treat analysis
2) A per-protocol analysis
3) Block randomization
4) Triple blind trial

45. What name would best fit a trial in which all participants received all the
treatments and only the order of the treatments differed?
1) Crossover trial
2) Factorial trial
3) Parallel group trial
4) Trial with stratified randomization

46. What measure of association would you calculate in a cross-sectional

study?
1) Relative Risk
2) Rate Ratio
3) Prevalence ratio
4) Ratio of incidence densities

47. Which of the following measures of association shows the strongest

association?
1) OR=0.8
2) OR=0.4
3) OR=0.2
4) OR=0.6
48. In a case-control study to assess the association between sleeping when
using contact lenses and the occurrence of ocular keratitis, how would
you interpret an OR=1.85?
1) Those who sleep using contact lenses have a 1.85% increased risk of ocular
keratitis
2) Sleeping with contact lenses increases the risk of ocular keratitis by 85%.
3) Ocular keratitis is 85 times more common among Those who sleep using
contact lenses than among those who do not
4) Sleeping with contact lenses is 85% more likely among those who have ocular
keratitis than among those who do not.

49. In a cohort study to evaluate the effect of high prebiotic intake on the
development of overweight compared to low prebiotic intake we found
this result: OR=0.86, (95% CI 0.77-0.97). The data indicate that:
1) High consumption of prebiotics prevents 14% of the cases of obesity.
2) The higher the intake of prebiotics, the greater the weight loss.
3) If overweight people took high doses of prebiotics, 14% of them would be
prevented from developing overweight.
4) High intake of prebiotics reduces the risk of overweight by 14% in relative
terms compared to low intake.

50. In a cohort study on risk factors for ICU admission for SARS-CoV-2, we
found that people with obesity had, in relative terms, a 10% higher risk of
ICU admission than patients without obesity (fictitious data). What
epidemiological measure is this figure referring to?
1) Relative risk increase
2) Risk among exposed patients
3) Absolute risk increase
4) Risk fraction among exposed

51. Given the data in the table below, what is the frequency measure we can
calculate among those with moderate alcohol consumption?

Moderate alcohol intake

Acute myocardial infarction Yes No

Cases 187 42

Person-years 39.600 20.400

1) CI=187/(42+187)= 81.6%.
2) ID=187/(39,600)= 0.0047 years-1
3) Prevalence=187/(39,600+20,400)=0.31%
4) Odds=187/42=4.45%.

52. If in a case-control study assessing the association between vitamin C

intake and respiratory infections, the Microbiology resident collects self-
 reported vitamin C intake rather than measuring blood levels, what bias
might be present?
1) Selection bias
2) Exposure information bias
3) Outcome reporting bias
4) Berkson bias

53. What effect will the bias in the previous question have on the measure of
association?
1) Underestimation
2) Overestimation
3) Depends on where the cutoff point for vitamin C is placed.
4) Will not change because it picks up the intake equally across participants

54. In a cohort study on migraine risk factors, 30% of those who consume
alcohol every day report that they only consume it 1-2 times/week. What
bias is happening and how will it affect the measure of association?
1) Differential information bias, underestimation of the RR.
2) Non-differential information bias, underestimation of the RR.
3) Differential unacceptability bias, overestimation of the RR
4) Unacceptability bias, RR unchanged because the percentage misclassified is
less than 50%.

55. A case-control study on the risk of venous thromboembolism among oral

contraceptive users was conducted. Cases were women aged 20 to 44
years who were hospitalized for a venous thromboembolism. Controls
were similarly aged women who were hospitalized for an acute illness or
elective surgery at the same hospitals. The observed OR was 10.2. Several
reports of association between oral contraceptives and venous
thromboembolism had already been published before this study was
conducted. As a result of these previously published studies, healthcare
providers were more likely to hospitalize women with symptoms of
thromboembolism who were currently taking oral contraceptives than
symptomatic women who were not taking oral contraceptives. What type
of bias might have happened in the case-control study and what
consequences might it have had?
1) Selection bias, underestimation
2) Selection bias, overestimation
3) Differential misclassification bias, overestimation
4) Differential misclassification bias, underestimation

56. Why is it important to maximize retention in prospective studies?

 1) To avoid misclassifying people who develop the disease as not having
developed it
2) To avoid misclassifying people who have not developed the disease as
having developed it
3) To avoid selection bias
4) To avoid interaction when loses are informative

57. In a hypothetical case-control study of drug exposure and the risk of

breast cancer, there was a 1.9-fold increased odds of breast cancer among
women who were exposed. When data were stratified by age, there was no
association between drug exposure and breast cancer, neither in the
younger aged group, nor in the older age group. What would you conclude
based on these results?
1) Age was an effect modifier
2) Age was a confounder and there is no actual association between drug
exposure and breast cancer
3) Age was a confounder and there is an actual association between drug
exposure and breast cancer
4) Age was a mediator in the association between drug exposure and breast
cancer risk

58. An investigator is interested in comparing rates of hypertension in two

populations. Which of the following should be taken into account when
deciding whether it is necessary to standardize the rates by race?
1) The age-specific rate of hypertension in the two populations.
2) Whether the racial distribution differs in the two populations.
3) Whether the rate of hypertension differs in the two populations.
4) The rate of hypertension in the standard population.

59. How would you describe the relationship between the risk allele G and the
exposure E in their relationship with the risk of developing the disease D
in the following figure?

1) There is an antagonic interaction in the additive scale

2) There is a synergistic effect in the additive scale
3) There is a qualitative interaction in the additive scale
4) There is no substantial interaction in the additive scale
A study was carried out to evaluate whether the diagnostic code of Chlamydia
infection recorded in the medical records is valid when the result of the
laboratory diagnostic test is not available. Records from the last 15 years were
reviewed. Of the 176,241 positive laboratory tests for Chlamydia, only 11,515
had a corresponding diagnostic code in the medical records. Of the 4,450,150
negative tests, 23,366 had the disease code in the medical records. Therefore:

60. The Positive Predictive Value (PPV) of the diagnostic code is:
1) 6.5%
2) 33%
3) 49.3%
4) 3.9%

61. The probability that the diagnostic code misidentifies patients who have
not had Chlamydia infection is:
1) 0.5%
2) 6.5%
3) 96.4%
4) 99.5%

62. If the validity of the diagnostic code was analyzed in another sample with
a higher prevalence of Chlamydia infection:
1) The sensitivity and specificity of the diagnostic code would increase.
2) The probability of having had the infection when there is a diagnostic code in
the clinical history would increase.
3) The diagnostic code will have fewer false negatives but false negatives would
increase.
4) Predictive values will remain unchanged but false negatives would decrease.

63. The Mini-Mental State Examination (MMSE) is a paper-based test when

considering a diagnosis of dementia. It has a maximum score of 30, with
lower scores indicating more severe cognitive problems. In an ROC, we
find an AUC=0.80 for the MMSE. How would you interpret this AUC?
1) The probability for a patient with dementia to show a positive result is 80%.
2) The probability for a patient with dementia to show a positive result and for a
patient without dementia to show a negative result is 80%.
3) The probability of a randomly chosen patient with dementia to have a lower
score than a randomly chosen patient without dementia is 80%.
4) The probability of a randomly chosen patient with dementia to have a higher
score than a randomly chosen patient without dementia is 80%.

64. We read that a given diagnostic test is 2.3 times more likely to provide a
positive result among sick patients than among healthy people. What does
this figure refer to?
1) AUC in an ROC
2) Positive likelihood ratio
3) Positive predictive value
4) Odds of the positive predictive value
The following 4 questions refer to the paper entitled: “Effect of high-intensity
interval training (HIIT) on metabolic parameters in women with polycystic
ovary syndrome: A systematic review and meta-analysis of randomized
controlled trials”.

65. The authors formulate their aim as “Therefore, this systematic review
aimed to synthesize available evidence on the effects of [high-intensity
interval training] on metabolic parameters and body composition in
women with [polycystic ovary syndrome].” What element of the PICO rule
does the high-intensity interval training correspond to?
1) P
2) I
3) C
4) O

66. In the methods section, we read “We registered the review on PROSPERO
(2020 CRD42020173105) and provided updates to the protocol, when
appropriate.” What is the rationale for doing so?
1) Publishing two papers on the same topic, one on the methodology and
another one on the results
2) To warrant that the protocol was established a priori
3) For the methods to be reproducible
4) For the methods to be explicit enough

Here you can find figure 3d from this paper, which has been partially deleted.

67. Which study accounted for more weight in this meta-analysis?

1) The study by Almmening et al
2) The study by Ribeiro et al
3) The study by Samadi et al
4) We cannot say about this because the corresponding column has been
deleted.

68. What would you conclude in terms of the heterogeneity in figure 3?

1) Evidence for heterogeneity was low
2) Evidence for heterogeneity was moderate and significant
3) Evidence for heterogeneity was moderate though non-significant
 4) Evidence for heterogeneity was high and significant
69. If results from a meta-analysis suggest high heterogeneity, what would
you do next?
1) Estimate the results from a fixed-effects method and use those as final
estimates
2) Estimate the results from a random-effects method and use those as final
estimates
3) Conduct stratified analyses
4) Exclude the study with the highest weight to see if the other studies are
consistent

70. As time goes by, in developed countries, an increase in the crude

mortality rate can be observed mainly due to:
1) A worsening of the level of health care
2) Aging of the population
3) Calculation with outdated data
4) Survival bias

71. Life expectancy:

1) It is a synthetic indicator of the state of health of populations.
2) It provides information on the average number of years that the inhabitants of
a country can live.
3) It is calculated taking into account the birth rates of a population.
4) It indicates the % of inhabitants aged >80 years of age

72. To compare the infant mortality rates of two populations:

1) It is necessary to adjust for the age structure of the populations.
2) They must have been calculated taking into account deaths of children under
1 year of age.
3) It is not possible to compare them because it depends on the causes of
mortality in each population.
4) It is essential to know the size of each population to be able to compare them.

73. For there to be generational replacement in a population, which

demographic indicator must be >2.1?
1) General fertility rate (Tasa global de fecundidad general)
2) Birth rate (Tasa de natalidad)
3) Total fertility rate (Índice sintético de fecundidad)
4) Sundbarg index

74. Which of the following statements about utilities in a decision tree is

FALSE:
1) They have a subjective component
2) An outcome with high utility may have little weight in the final decision tree if
the probability of its occurrence is very low.
3) The expected utility is obtained by multiplying the value we give to an event
by the probability of its occurrence.
 4) The value of the utility is necessarily always greater than the probability with
which we multiply it because a probability is always between 0 and 1
75. Which of the following statements about a decision tree is FALSE:
1) The clinical decision tree cannot be used if we are not able to assign a
specific probability value to a probabilistic node.
2) In a probabilistic node with "n" branches, we only need to search for "n-1"
probabilities in the literature.
3) A clinical decision tree should contain all the possible options that can occur
from the initial clinical decisions we want to consider. It should be as
comprehensive as possible.
4) This methodology aims to integrate the best available evidence so that our
decisions are as objective as possible.