PH150 December 9, 2009

FINAL EXAMINATION

NOTE: #85 was previously posted as “false” being correct - this is wrong - now
modified to indicate that “true” is correct

Select the best answer for each multiple choice questions. There are 93 questions and
14 pages on the examination. Notify the instructor if your examination does not have 14
pages. Clearly indicate on the scan form the one best answer to each question among
the answers provided. Be sure that you have selected your choice correctly on the scan
form. Be sure that you have entered your name and identification number on the scan
form and filled out the columns for the letters of your name and numbers of your
identification number correctly (see front and back). Use a #2 pencil and fill all circles
completely.

1. Which of the following is the usual progression from exposure to disease?

a. Exposure - effective dose - disease
b. Exposure - absorbed dose - early response - disease
c. Exposure - absorbed dose - effective dose - disease
d. Exposure - absorbed dose - effective dose – early response - disease
e. Exposure - absorbed dose - metabolic dose - effective dose - early
response - disease

2. Improvement of the environment requires primarily behavioral and social change:

a. True
b. False

3. The four major elements of risk assessment are:

a. Hazard identification, exposure assessment, hazard modification, risk
characterization
b. Hazard identification, exposure assessment, dose response
assessment, risk characterization
c. Hazard identification, exposure assessment, dose response assessment,
legislation
d. Hazard identification, dose response assessment, hazard modification,
legislation

4. Development of environmental policy requires decisions in the face of

uncertainty:
a. True
b. False

5. The International Agency on Research on Cancer identified how many proven

carcinogens?
a. 11
b. 74
c. 503
d. 1008
 e. >5,000

6. The highest concentration of diesel particles in Southern California is found along

which freeway?
a. 405
b. 110
c. 105
d. 710
e. 5

7. Precautionary measures are those taken to reduce exposures for which cause
and effect has been fully established:
a. True
b. False

8. Lead is most difficult to remove from which of the following tissues in children?
a. Blood
b. Intestine
c. Bone
d. Hair
e. Liver

9. Which of the following had the most profound effect in reducing lead in blood in
humans from 1975-1990?
a. Removal of lead from batteries
b. Removal of lead from gasoline
c. Removal of lead from paint
d. Removal of lead from metal used in automobile production
e. Removal of lead from detergents

10. Which of the following compounds is most carcinogenic for humans?

a. Cr VI
b. Cr III
c. Diesel exhaust
d. Methylene chloride

11. Which of the following is a common contaminant of water causing dry gangrene
and other skin problems in many areas of the world?
a. Lead
b. Arsenic
c. Cr VI
d. Cr III
e. Mercury

12. The highest risk of air pollution-related cancer in the Los Angeles basin is from:
a. Diesel particles
b. 1,3 butadiene
c. Carbonyls
 d. Benzene

13. Which of the following particles penetrate the blood-brain barrier?

a. Large particles, fine particles and ultra-fine particles
b. Fine particles and ultra-fine particles
c. Ultra-fine particles only

14. The recent epidemic of syphilis in Los Angeles County is occurring primarily
among:
a. Commercial sex workers
b. Men who have sex with men
c. Heterosexual males
d. Heterosexual females
e. Drug users

15. Which of the following is NOT a reportable sexually transmitted disease in Los
Angeles?
a. Syphilis
b. Human papilloma virus infection
c. Chlamydia
d. Gonorrhea
e. HIV/AIDS

16. Which of the following is the most common sexually transmitted infection in Los
Angeles County?
a. Chlamydia
b. Gonorrhea
c. Syphilis
d. HIV/AIDS
e. Pelvic inflammatory disease

17. The majority of chlamydia and gonorrhea infections do not cause symptoms in
women:
a. True
b. False

18. Focusing interventions on “core transmitters” is an effective strategy to reduce

STDs:
a. True
b. False

19. InSpotLA is an effective tool to:

a. Interrupt STD transmission
b. Promote STD and HIV testing and treatment
c. Promote notification of partners of infected individuals

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 d. All of the above
e. a. and b. above

20. Which of the following is the highest risk human papilloma virus type for cervical
cancer?
a. 16
b. 11
c. 43
d. 44
e. 42

21. The leading cause of death in Los Angeles County in 2005 was:
a. Coronary heart disease
b. Lung cancer
c. Emphysema
d. Alzheimer’s disease
e. Homicide

22. The decline in deaths from infectious diseases was more rapid before the
development of vaccines than after:
a. True
b. False

23. The leading behavioral cause of death in the United States in 2000 was:
a. Poor diet/activity patterns
b. Tobacco smoking
c. Alcohol ingestion
d. Sexual behavior
e. Use of illicit drugs

24. Life expectancy at birth in 2000 was highest for which of the following groups in
the U.S.?
a. European-Americans
b. Hispanic-Americans
c. African-Americans
d. Asian-Americans
e. Native Americans

25. The most rapidly increasing cause of disability-adjusted life years (DALYS) in Los
Angeles County is:
a. Coronary heart disease
b. Cancer
c. Alzheimer’s disease
d. Stroke
e. Stomach cancer

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26. The number of AIDS cases in Los Angeles County continues to rise:
a. True
b. False

27. The highest proportion of TB cases in Los Angeles County is occurring among:
a. Native-Americans
b. European migrants
c. Hispanic- and Asian-American migrants
d. African migrants
e. African-Americans

28. Use of marijuana:

a. Decreases motivation
b. Diminishes cognitive functions (reasoning)
c. Both of the above
d. Neither of the above

29. Persons living in extended cities (e.g. Los Angeles) are more likely than persons
living in concentrated cities (e.g. New York) to:
a. Walk less in their leisure time
b. Have high blood pressure
c. Have higher body mass indices (weight for height)
d. All of the above
e. a. and c. above

30. The characteristics and qualities of the community in which we live are a major
determinants of our health:
a. True
b. False

31. The percentage of the population living in poverty worldwide declined between
1970 and 2000:
a. True
b. False

32. Diesel particulate pollution of the air contributes to:

a. Premature deaths
b. Lost workdays
c. Global warming
d. All of the above
e. a. and b. above

33. The factor that has caused the greatest improvement in health in the last 50
years in the United States has been:

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 a. Implementation of new health-related policies
b. Promotion of behavioral changes
c. Health education programs
d. Environmental interventions
e. STD programs
34. Childhood obesity is more prevalent in the more affluent (richer) communities in
Los Angeles County:
a. True
b. False

35. Which of the following items from McDonald’s contains the highest number of
calories?
a. Big Mac
b. Four hamburgers
c. One large McDonald’s milkshake
d. Two egg McMuffins

36. Regular physical activity is associated with:

a. Increased life span and function
b. Improved mental health
c. Improved immune function
d. All of the above
e. a. and b. above

37. Which of the following represent the majority group in Los Angeles County?
a. European-Americans
b. African-Americans
c. Hispanic-Americans
d. Asian-American
e. None of the above

38. Developing countries have which of the following dietary problems?

a. Under-nutrition
b. Over-nutrition
c. Vitamin deficiencies
d. All of the above
e. a. and c. above

39. Children with Kwashiorkor:

a. Are thin and emaciated
b. Are swollen and edematous
c. Have diets low in protein
d. Recover within 2-3 weeks with proper diet
e. b., c. and d. above

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40. Over-use of sunscreen may result in:
a. Vitamin C deficiency
b. Vitamin D deficiency
c. Skin disorders
d. Hyperthyroidism
e. Iodine deficiency

41. Cardiovascular diseases are the number-one killer of women in all of the
following groups EXCEPT:
a. African-Americans
b. Hispanic-Americans
c. Asian-Americans
d. European-Americans

42. Which of the following states has the largest native American population?
a. Colorado
b. New Mexico
c. California
d. Arizona
e. Utah

43. The Office of Management and Budget designated racial/ethnic categories on the
basis of:
a. Socio-political characteristics
b. Biologic characteristics
c. Skin color
d. Observer decision

44. Smoking levels are highest in which of the following groups?

a. African-Americans
b. Hispanic-Americans
c. Asian-Americans
d. European-Americans
e. Native-Americans

45. Among youths aged 12-17 years, smoking rates are higher in:
a. Males
b. Females

46. In the U.S., cardiovascular death rates (heart disease) are higher in:
a. Males
b. Females

47. The leading underlying cause of poor health globally, in the opinion of Dr. Detels,
is:

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 a. Tobacco
b. Poverty
c. Malnutrition
d. Air and water pollution
e. Obesity

48. The “epidemiologic transition” in developing countries refers to:

a. Simultaneous occurrence of infectious diseases and diseases of
affluence
b. The increasing prevalence of chronic diseases
c. The decline of infectious diseases
d. The increasing wealth and attention to public health

49. Globally ,over one-third of new HIV infections are occurring in which age group?
a. <15 years
b. 15-24 years
c. 25-34 years
d. 35-44years
e. 44+ years

50. The disparity between HIV/AIDS is highest for:

a. African-American vs. European-American men
b. African-American vs. European-American women
c. Hispanic-Americans vs. European-Americans
d. Asian-Americans vs. European-Americans

51. The risk of HIV infection is greatest for:

a. Women in vaginal intercourse
b. Men in vaginal intercourse
c. The inserting partner in anal intercourse
d. The receptive partner in anal intercourse
e. The receptive partner in oral-genital intercourse

52. The major source of continuing transmission of HIV globally is:

a. Commercial sex workers
b. Men who have sex with other men
c. Individuals who do not know they are infected
d. Injection drug users
e. Plasma donors

53. The most important factor for successful HIV/AIDS intervention in a country is:
a. Political will
b. Condom availability
c. Microbicide availability
d. Legalization of commercial sex

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 e. Establishment of methadone maintenance programs

54. One of the success stories in HIV/AIDS intervention globally is that over 60% of
HIV-infected mothers to be are now receiving anti-retroviral treatment before or
during delivery:
a. True
b. False

55. Which of the following types of intervention are most likely to have the greatest
impact?
a. Behavioral
b. Structural
c. Political
d. Social

56. Which of the following intervention strategies was used most frequently globally
for control of both the SARS and H1N1 epidemics before the H1N1 vaccine
became available?.
a. Quarantine and isolation
b. Serologic testing
c. Treatment of affected individuals
d. Testing sick people for the presence of the virus

57. Which of the following is the most important requirement for a successful
vaccine?
a. Eliciting protective humoral immunity
b. Eliciting protective cellular immunity
c. Safety
d. a. and b. above

58. The factor that played the greatest role in reduction of tuberculosis in the 20th
century was:
a. Development of effective treatment
b. Vaccination
c. Improved sanitation
d. Improved housing and reduced crowding
e. Reduction of indoor air pollution

59. The primary goal of a vaccine is:

a. Prevention of infection
b. Prevention of clinical disease
c. Prevention of morbidity and mortality

60. Surveillance is an essential first step in confronting an infectious disease

outbreak:

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 a. True
b. False

61. In infectious diseases, the major objective of public health is to:

a. Protect the infected
b. Protect the uninfected

62. Public health ethics differ from medical and research ethics because it is focused
on:
a. The patient
b. The community
c. The participant/subject
d. The legislature
e. The government

63. Ethics is built on a well-established set of rules that can be invoked to ensure
justice and equity:
a. True
b. False

64. It is ethical to exclude children, mentally impaired persons, the elderly, and
pregnant women from research because of the difficulty in conducting research
among them:
a. True
b. False

65. Fertility in the United States has leveled off at approximately 2 per woman since
1990:
a. True
b. False

66. Health promotion combines educational and environmental support for actions
and conditions conducive to good health:
a. True
b. False

67. The main adverse health outcome of long-term smoking is:

a. Cardiovascular and cerebro-vascular diseases
b. Lung cancer
c. Kidney disease
d. Liver disease
e. Gastric(stomach) cancer

68. The change of attitudes towards smoking was a key factor in developing
structural interventions against smoking:

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 a. True
b. False

69. The aging of the population in the United States over the last 50 years is due to:
a. Declining birth rates
b. Declining mortality rates
c. Both of the above
d. Neither of the above

70. The leading factor contributing to the declining death rate in those aged 75-84
years in the U.S. is a decline in deaths due to:
a. Heart disease
b. Cerebrovascular diseases
c. Cancer
d. Chronic respiratory diseases
e. Diabetes

71. Strategies to reduce falls among the elderly include:

a. Promotion of physical activity
b. Reducing the number of drugs taken by individuals
c. Improved design of housing for the elderly
d. All of the above
e. a. and b. above

72. The primary goal of Healthy People 2010 is to increase the number of years
healthy life as opposed to increasing the number of years of life:
a. True
b. False

73. Exclusive breastfeeding of children for the first six months of life decreases the
infant mortality rate by:
a. 10%
b. 50%
c. 75%
d. 100%

74. Pregnant women in developing nations face the following public health problems
concerning nutrition:
a. Poor nutrition prior to getting pregnant
b. Poor nutrition during pregnancy
c. Consuming less in order to have easier deliveries
d. All of the above
e. a. and b. above

75. Successful efforts to reduce smoking include:

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 a. Taxation of cigarettes
b. Physician counseling
c. Social pressure
d. All of the above

76. Public health has the responsibility to guarantee good health for all:
a. True
b. False

77. Tobacco companies target kids and adolescents with messages regarding smoking
because people who start smoking earlier in life are more likely to continue
smoking throughout their lifetime:
a. True
b. False

78. Now that countries such as the United States have greatly increased regulation and
litigation against those that manufacture and produce cigarettes, smoking
consumption has decreased worldwide:
a. True
b. False

79. If passed without substantial changes, House Bill 3200 will do all of the following,
EXCEPT:
a. Mandate health insurance for all
b. Require all employers to provide health care coverage or pay into a trust
fund
c. Expand Medicare eligibility
d. Regulate the health care exchange and small group insurance markets

80. Currently, the economic burden of illness in the United States is highest for which
of the following?
a. HIVAIDS
b. Alzheimer’s disease
c. Cardiovascular disease
d. Cancer
e. Occupational diseases and injuries

81. The highest frequency of unintentional injuries among workers in the U.S. occurs
among:
a. Elderly workers
b. Women
c. Workers in the first year of a new job
d. Young workers

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82. The media is a major resource for promoting public health:
a. True
b. False

83. Which of the following health care groups experiences the highest rate of non-
fatal violence?
a. Nurses
b. Physicians
c. Mental health professionals
d. Occupational health professionals
e. Technicians

84. The primary functions of public health include:

a. Assessment
b. Policy-setting/advising
c. Provision of medical services
d. a., b. and c. above
e. a. and b. above

85. Epidemiology uses time, place, and person to describe the relationship of agent,
host and environment: - NOTE THAT THIS WAS PREVIOUSLY INCORRECTLY
POSTED AS “FALSE” BEING THE CORRECT ANSWER
a. True
b. False

86. The largest proportion of financing for health in the U.S. in 2004 was provided by:
a. Employer health plans
b. Out-of-pocket payments
c. The U.S. government
d. Private health insurance

87. Today, nearly 50% of healthcare is financed by this source and continues to grow
in proportion to other sources:
a. Out-of-pocket payments
b. Private health insurance
c. Government
d. Other private

88. In Canada and the U.K., healthcare is financed publicly. If the United States
moved towards 100% public finance, which system would we be more similar to
and why?
a. Canada, because our National Health Service would deliver care to all
b. The U.K., because private providers make up the largest proportion

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 c. Canada, because healthcare is provided by both private and public
providers
d. The U.K., because care delivery is shared by a balanced public/private
partnership

89. Unions in the United States have been gaining strength in the last three decades:
a. True
b. False

90. Covering your mouth and nose when sneezing is an example of self-protection
against H1N1 influenza:
a. True
b. False

91. Which of the following agents has become resistant to multiple drugs?
a. Schistosomiasis
b. N. gonorrhoeae (gonorrhea)
c. Syphilis
d. H1N1
e. All of the above

92. Which of the different public health approaches is used to modify intake for
prevention and control of micronutrient deficiencies?
a. Dietary diversification
b. Fortification
c. Supplementation
d. All of the above

93. Disability at age 65 years is

a. Decreasing
b. Increasing rapidly
c. Increasing slightly
d. Steady

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