Questions 1 and 2 use the information below:

Population of the city of Atlantis on March 30, 2003 = 193,000
No. of new active cases of TB occurring between January 1 and June 30, 2003 = 62
No. of active TB cases according to the city register on June 30, 2003 = 338
1. The incidence rate of active cases of TB for the 6-month period was: [ONE POINT]
a. 7 per 100,000 population
b. 14 per 100,000 population
c. 26 per 100,000 population
d. 32 per 100,000 population
e. 130 per 100,000 population
2. The prevalence of active TB as of June 30, 2003, was: [ONE POINT]
a. 14 per 100,000 population
b. 130 per 100,000 population
c. 144 per 100,000 population
d. 175 per 100,000 population
e. none of the above

3. Which of the following is an advantage of active surveillance? [ONE POINT]
a. requires less project staff
b. is relatively inexpensive to employ
c. more accurate due to reduced reporting burden for health care providers
d. relies on different disease definitions to account for all cases
e. reporting systems can be developed quickly

Questions 4 is based on the information given below:

In an Asian country with a population of 20 million people, 100,000 deaths occurred during the year ending December 31, 2005. These deaths included 87,000 deaths from cholera in 100,000 people who were sick with cholera.

4. What was the case-fatality rate from cholera in 2005? [ONE POINT]

5. What would be the effect on age-specific incidence rates if women with hysterectomies were excluded from the denominator of calculations, assuming that there are some women in each age group who have had hysterectomies? [ONE POINT]
a. the rates would remain the same
b. the rates would tend to decrease
c. the rates would tend to increase
d. the rates would increase in older groups and decrease in younger groups
e. it cannot be determined whether the rates would increase or decrease

Question 6 is based on the following information:

A colon cancer screening study is being conducted in Nottingham, England. Individuals 50 to 75 years old will be screened with the Hemoccult test. In this test, a stool sample is tested for the presence of blood.
6. If the Hemoccult test result is negative, no further testing is done. If the Hemoccult test result is positive, the individual will have a second stool sample tested with the Hemoccult II test. If this second sample also tests positive for blood, the individual will be referred for more extensive evaluation. What is the effect on net sensitivity and net specificity of this method of screening? [ONE POINT]

a. Net sensitivity and net specificity are both increased
b. Net sensitivity is decreased and net specificity is increased
c. Net sensitivity remains the same and net specificity is increased
d. Net sensitivity is increased and net specificity is decreased
e. The effect on net sensitivity and net specificity cannot be determined from the data

7. At an initial examination in Oxford, Mass., migraine headache was found in 5 of 1,000 men aged 30 to 35 years and in 10 of 1,000 women aged 30 to 35 years. The inference that women have a two times greater risk of developing migraine headache than do men in this age group is: [ONE POINT]
a. correct
b. incorrect, because a ratio has been used to compare male and female rates
c. incorrect, because of failure to recognize the effect of age in the two groups
d. incorrect, because no data for a comparison or control group are given
e. incorrect, because of failure to distinguish between incidence and prevalence

8. Age-adjusted death rates are used to: [ONE POINT]
a. Correct death rates for errors in the statement of age
b. Determine the actual number of deaths that occurred in specific age groups in a population
c. Correct death rates for missing age information
d. Compare deaths in persons of the same age group
e. Eliminate the effects of differences in the age distributions of populations in comparing death rates

9. For a disease such as pancreatic cancer, which is highly fatal and of short duration: [ONE POINT]

a. Incidence rates and mortality rates will be similar
b. Mortality rates will be much higher than incidence rates
c. Incidence rates will be much higher than mortality rates
d. Incidence rates will be unrelated to mortality rates
e. None of the above

10. In 1990, there were 6,000 deaths due to lung diseases in miners aged 20 to 64 years. The expected number of deaths in this occupational group, based on age-specific death rates from lung diseases in all males aged 20 to 64 years, was 2,600 during 1990.
a. What was the standardized mortality ratio (SMR) for lung diseases in miners? [ONE POINT]

b. Interpret the value of the SMR: [ONE POINT]

Questions 11-14 are based on the information given below:

A physical examination was used to screen for breast cancer in 2,800 women with biopsy-proven adenocarcinoma of the breast and in 5,300 age- and race-matched control women. The results of the physical examination were positive (i.e., a mass was palpated) in 2,200 cases and in 600 control women, all of whom showed no evidence of cancer at biopsy.
11. The sensitivity of the physical examination was: [ONE POINT]

12. The specificity of the physical examination was: [ONE POINT]

13. The positive predictive value of the physical examination was: [ONE POINT]

14. The negative predictive value of the physical examination was: [ONE POINT]

Question 15 is based on the following information:

A physical examination and an audiometric test were given to 500 persons with suspected hearing problems, of whom 300 were actually found to have them. The results of the examinations were as follows:

PHYSICAL EXAMINATION
HEARING PROBLEMS
Result Present Absent
Positive 265 35
Negative 35 165

AUDIOMETRIC TEST
HEARING PROBLEMS
Result Present Absent
Positive 285 15
Negative 15 185

15. Compared with the physical examination, the audiometric test is: [ONE POINT]

a. Equally sensitive and specific
b. Less sensitive and less specific
c. Less sensitive and more specific
d. More sensitive and less specific
e. More sensitive and more specific

16. Which of the following is a good index of the severity of a short-term, acute disease? [ONE POINT]
a. Cause-specific death rate
b. 5-year survival
c. Case-fatality rate
d. Standardized mortality ratio
e. None of the above

17. The occurrence in a community or region of cases of an illness, specific health-related behavior, or other health-related events clearly in excess of normal expectancy is a/an: [ONE POINT]
A: Pandemic
B: Endemic
C: Epidemic

18. The level of prevention that takes place during the early phases of pathogenesis and includes activities that limit the progression of disease is: [ONE POINT]

A: Primary Prevention
B. Secondary Prevention
C. Tertiary Prevention

19. The probability that an event will occur, e.g., that an individual will become ill or die within a stated period of time or by a certain age is: [ONE POINT]

A: Epidemiologic Transition
B. Risk
C. Hypothesis

20. A measure that refers to the mortality rate associated with a specific cause of death divided by the population size at the midpoint of a time period times a multiplier is the: [ONE POINT]

A: Crude Death Rate
B: Sex-specific Rate
C: Cause-Specific Mortality Rate

21. Wearing a safety belt is an example of which level of prevention? [ONE POINT]

a) Primary prevention
b) Secondary prevention
c) Tertiary prevention
d) Community prevention

22. Providing education to a diabetic on how to use his/her insulin is an example of which level of prevention? [ONE POINT]

a) Primary prevention
b) Secondary prevention
c) Tertiary prevention
d) Community prevention

23. Encouraging individuals to take a daily dose of aspirin to reduce the chance of a heart attack is an example of which level of prevention? [ONE POINT]

a) Primary prevention
b) Secondary prevention
c) Tertiary prevention
d) Community prevention

24. Epidemiology is: [ONE POINT]

a) a method of applying primary, secondary, and tertiary prevention in a community setting.
b) concerned primarily with the empowerment of individuals in the of care their own health.
c) the study of the distribution and determinants of diseases in a specific population.
d) concerned only with life expectancy of humans.

25. Providing training or instructing patients on how to modify their diets and take their medications to prevent a second heart attack is an example of ________ prevention. [ONE POINT]

a) primary
b) secondary
c) tertiary
d) community

e) 15. 26. Sensitivity and specificity are important criteria for screening and diagnostic instruments. What is specificity? [ONE POINT]

A) Different method of measuring the same attributes yielding similar results
B) Ability to differentiate the construct being measured from other similar concepts
C) Instrument’s ability to identify a case correctly
D) Instrument’s ability to identify non-cases correctly.

27. The nurse researcher knows that there are two primary criteria for assessment of an instrument. What is reliability? [ONE POINT]

A) Degree of consistency or accuracy with which an instrument measures an attribute
B) Magnitude and direction of a relationship between two variables
C) Extent to which an instrument yields the same results on repeated administrations
D) Extent to which an instrument’s items are measuring the same attribute

28. Which of the following improves the reliability of diabetes screening tests? [ONE POINT]
a) Having the same lab analyze all samples
b) Taking more than one sample for each subject and averaging the results
c) Insuring that the instrument is standardized before each sample is analyzed
d) a and c only
e) All of the above

29. Which of the following is a measure of disease prognosis? [ONE POINT]
a) Prevalence
b) Median survival time
c) Age-adjusted mortality rates
d) Standardized mortality ratio