Partial exam Epidemiology, academic year 2017-18 Dpt.

Preventive Medicine and Public Health

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1. It is known that tobacco components may lead in some people to several cellular
mutations that could then lead to the appearance of cancer cells in the lung. But also
radon gas or environmental pollution may lead to these mutations. So, regarding lung
cancer, we can state that tobacco is a:
(1) Sufficient and necessary cause.
(2) Necessary but not sufficient cause.
(3) Sufficient but not necessary cause.
(4) Neither sufficient nor necessary.

2. In a review about the causal relationship between cannabis use and psychosis, we can
read the following sentence: “cannabis exposure has a stronger association with
psychosis outcomes than depression or anxiety outcomes”. Which causality criteria
does this sentence refer to?
(1) Dose-response relationship
(2) Specificity of the exposure
(3) Specificity of the outcome
(4) Consistency

3. In a review about the harmful effects of cannabis, we can read: “Since marijuana
contains many of the same compounds as tobacco, it has the same adverse effects on
the respiratory system when smoked as tobacco. In fact, smoking marijuana is more
harmful than tobacco smoking for two reasons: first, because it contains more tar and
carcinogens than tobacco, and secondly, because marijuana smokers tend to inhale
more deeply and for a longer period of time as compared to tobacco smokers.” What
causality criteria does this paragraph refer to?
(1) Biological plausibility
(2) Experimental evidence
(3) Consistency
(4) Temporal sequence

4. Which of the following measures is a secondary prevention mean of HIV infection?

(1) Routine diagnostic testing of HIV infection in all pregnant women
(2) Performing a caesarean delivery in HIV+ women
(3) Avoiding breastfeeding in HIV+ mothers
(4) Antiretroviral therapy during pregnancy in HIV+ women

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Partial exam Epidemiology, academic year 2017-18 Dpt. Preventive Medicine and Public Health

5. The Scopio Project aims to provide information on Spanish young population. A

representative sample of the Spanish population aged between 15 and 29 years was
selected. A total of 1247 participants (51.4% females, 48.6% males) answered a
questionnaire in April 2017. According to this study, 27% of the young people consider
that violence in the couple is a “normal behaviour”. Please, select the CORRECT
answer:
(1) This is a descriptive, cross-sectional and ecological study.
(2) Since the sample is representative, we can affirm that among Spanish young people
aged 15 to 29 years, the risk of considering that violence in the couple “is normal” is
27%.
(3) If the belief about normality of violence in the couple is significantly lower among females
than among males, we could affirm that there is an association between sex and this
belief.
(4) In the sample there are more females than males. Accordingly, the figure of 27% is not
representative for males.

6. Recently, the WHO has alerted on the rise of measles cases in Europe. During 2017,
21,315 cases were registered and there were 35 deaths due to measles. The historic
minimum was registered in 2016 during which 5,273 persons were affected. The three
most affected countries were Romania (5,562 cases), Italy (5,006 cases) and Ukraine
(4,767 cases). In Spain, 152 cases were registered. These data suggest that:
(1) The incidence of measles in Europe increased 404% in 2017 compared to 2016.
(2) The incidence of measles in Italy was 33 times higher than in Spain.
(3) in 2017, the highest risk for measles infection was observed in Romania.
(4) In 2017, infections by measles in Spain represented 0.7% of all registered cases in
Europe.

7. According to the WHO report, “Every new measles affected person in Europe reminds
us that non-vaccinated children and adults are at risk of developing measles and
spreading it to other persons who may not be candidates for vaccination”. Increasing
the vaccination coverage in those countries would represent a:
(1) Tertiary prevention strategy
(2) Primary prevention strategy
(3) Secondary prevention strategy
(4) Primary and secondary prevention strategy

8. We read a review on risk factors (sex, age, experience, physical fitness and equipment)
for ski injuries. Equipment related injuries are very frequent. In fact, 56% of knee
sprains in skiers could be avoided if skiers wore an equipment in perfect shape. What
epidemiological measure does this figure refer to?
(1) Preventive fraction
(2) Relative risk reduction
(3) Attributable risk among exposed
(4) Population attributable fraction

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Partial exam Epidemiology, academic year 2017-18 Dpt. Preventive Medicine and Public Health

Let us assume that we are in charge of a prevention program and that our goal is to
reduce automobile-related deaths. However, we have a limited budget and we want to have
the maximum impact on reducing deaths. We decide to conduct a cohort study of 10,000
drivers to examine risk factors for automobile-related deaths (please, assume that the
sample is representative of the general population). We are particularly interested in
factors like drunk driving and speeding since we believe interventions on these risk
factors are feasible. We obtain the following results:

Speeding Total drivers No. of deaths

Yes 2,000 100
No 8,000 80
Drunk driving Total drivers No. of deaths
Yes 300 45
No 9,700 135

9. Taking into account the available information, we can state that:

(1) Speeding increases the risk of death by 500%, whereas drunk driving increases the risk
by 1070%
(2) Speeding is more risky than drunk driving (100 deaths vs. 45 deaths).
(3) The risk of dying among drunk drivers is 15%.
(4) The risk of death due to drunk driving and speeding is 6.3% (145/2300).
10. If speeding drivers did not exceed speed limits:
(1) We could avoid 20 deaths for every 100 drivers
(2) We could avoid that 4% of these drivers died
(3) We could avoid 4% of the deaths among these drivers
(4) The risk of death would be 4 times lower

11. How many drunk drivers would need to avoid drunk driving in order to avoid 1 death
among them?
(1) 7
(2) 8
(3) 13
(4) 14

12. Assuming that the study sample is representative of the population, what proportion of
the deaths in the general population could be attributed to speeding?
(1) 18%
(2) 8%
(3) 44%
(4) 4%

13. After making sure that the ARE and the AFE for drunk driving are higher than for
speeding and estimating the population impact measures, we can conclude that
avoiding speeding has a greater impact at the population level (to avoid deaths due to
traffic accidents). Why?
(1) Because the risk of death among speeding drivers is substantially higher than the risk of
death among drunk drivers.
(2) Because speeding is more frequent than drunk driving.
(3) Because the strength of the association is higher for speeding than for drunk driving.
(4) In fact, the conclusion is wrong: drunk driving is responsible for more deaths at the
population level than speeding.

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Partial exam Epidemiology, academic year 2017-18 Dpt. Preventive Medicine and Public Health

Please, read the following data about the effectiveness of a vaccination program in a
population to prevent certain disease.

Population No. of cases

Vaccinated 306,045 150

Unvaccinated 298,655 515

14. Which % of the cases was the vaccine able to prevent among vaccinated people?
(1) 28
(2) 49
(3) 72
(4) 23

15. Which is the expected number of cases among the vaccinated population, if they were
unvaccinated? (please, make the calculations with decimals and round the last figure)
(1) It is not possible to know it
(2) 515
(3) 528
(4) 665

In the US, many people choose drinking raw milk because they believe that it is more
healthy. Nevertheless, raw milk can cause several diseases due to bacteria present in
milk. Therefore, the Department of Health has launched an informative campaign on the
risks of raw milk consumption on health and recommending pasteurized milk
consumption.

16. This campaign:

(1) Is a primary prevention strategy against infections transmitted through raw milk.
(2) It is a primordial prevention strategy since the campaign has been publicized to the
entire population.
(3) It is not a prevention strategy but a health recommendation that can or cannot be
followed by the population.
(4) it is a primary prevention strategy for those who decide not to consume raw milk and a
secondary prevention strategy for those who keep on consuming raw milk in spite of the
warning.

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Partial exam Epidemiology, academic year 2017-18 Dpt. Preventive Medicine and Public Health

Please, take a look at the informative poster of this campaign:

17. The figure 150 corresponds to:

(1) The RR for the association between raw milk consumption and the outbreak.
(2) The risk of the disease among raw milk consumers.
(3) The risk of the disease among consumers of raw milk that can be attributed to raw milk
consumption.
(4) The relative risk increase of the disease among raw milk consumers compared with
pasteurized milk consumers.

18. The figure 4 comes from:

(1) Comparing absolute measures
(2) Calculating a relative risk
(3) Calculating the incidence of outbreaks due to raw milk
(4) Calculating a prevalence ratio.

Due to the increase in the incidence of newborns with microcephaly in Brasil the following
studies were design to assess if Zika virus could be a causal agent of this disease:

A) In maternity hospitals across the country and between January and December 2015,
when a newborn with microcephaly was born, the mother was interviewed for her
exposure to Zika virus during pregnancy and blood samples were obtained from both, the
mother and the newborn, the newborn’s cephalic circumference was registered and the
newborn underwent scanning. The same procedure was done for a sample of similar
babies born without microcephaly.

19. What type of study was conducted?:

(1) Prospective cohort study
(2) Retrospective cohort study
(3) Nested case-control study
(4) Case-control study

20. In the previous study, what measure could be estimated to assess if Zika virus was
associated with microcephaly?
(1) Relative risk
(2) Odds Ratio
(3) Cumulative incidence among exposed
(4) Attributable risk among exposed

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Partial exam Epidemiology, academic year 2017-18 Dpt. Preventive Medicine and Public Health

21. The measure of association for that study was statistically significant (73.1; 95% CI 13-
∞). Accordingly, we can state that:
(1) Zika virus is a causal agent of microcephaly.
(2) Taking into account the design and the results, criteria for strength of association and
temporal sequence are fulfilled.
(3) The measure of association is very strong and statistically significant, so that we can
consider that the association between Zika virus and microcephaly is causal.
(4) We need more data before we can conclude that Zika virus is a causal agent of
microcephaly.

B) Another study recruited pregnant women with skin lesions associated to Zika. They
were analysed for Zika, dengue and chikungunya (all of them viruses transmitted by
Aedes). Later on, these women were followed-up to assess the proportion of women who
delivered a newborn with microcephaly or other malformations associated to the different
infections and the pregnancy trimester in which the infection may lead to the appearance
of microcephaly.

22. What type of study has been conducted?:

(1) Prospective cohort study
(2) Cross-sectional study
(3) Case-control study
(4) Case series

23. In the previous study, the proportion of women who delivered a newborn with
microcephaly or other malformations was:
(1) An incidence
(2) A prevalence
(3) A ratio
(4) A period prevalence

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24. Investigators gathered data on the number of motor vehicles over time in a city. They
found that the increase of motor vehicles correlated strongly with the increase in lung
cancer in that city. Does this indicate that motor vehicle use is a cause of lung cancer?
(1) Yes, since the correlation is strong, there is a strong association.
(2) No, because the number of cars was likely to be inaccurate.
(3) No, because the sample size is unkown.
(4) No, because these data were obtained in an ecological study.

25. A researcher selected a sample of 40 healthy subjects who received a new

antihypertensive drugs over 12 months to assess safety and tolerance to the drug.
This is a:
(1) Phase I experimental study
(2) Phase II experimental study
(3) Pragmatic experimental study
(4) It is not an experimental study because there is no control group

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Partial exam Epidemiology, academic year 2017-18 Dpt. Preventive Medicine and Public Health

26. We plan to run a study aiming to estimate the prevalence of myopia in the population
and evaluate if it is associated to an excessive exposure to screens (cellphone,
computer…). We select a random sample of the population and evaluate their visual
capacity. We ask our participants about their exposure to screens and other potential
risk factors. What type of study would we be running?
(1) Case series
(2) Cross-sectional study
(3) Case-control study
(4) Cohort study

27. Which is the main limitation of the previous study?

(1) We cannot tell the temporal sequence between exposure to screens and myopia.
(2) It is impossible to calculate the impact of exposure to screens and the development of
myopia.
(3) There can be participants who do not want to participate in our study or may be lost
during follow-up.
(4) We can neither evaluate associations nor generalize the results to the entire population.

28. The aim of a study was to assess factors associated to meniscus tear among patients
aged younger than 50 years. Forty-five patients from a traumatology office who had
been diagnosed of meniscus tear were selected and asked about the type of physical
activity that they had engaged in before suffering the meniscus tear and about their
lifestyles. What type of study is being described?
(1) Case series
(2) Cross-sectional study
(3) Case-control study
(4) Retrospective cohort study

29. In 2017, researchers from a hospital looked for cancer patients who had suffered a
thrombosis between 2010 and 2016 and who were later treated with some type of
anticoagulants to avoid new episodes of thrombosis. The aim was to evaluate if oral
anticoagulants were as safe and effective as subcutaneous heparin to prevent a new
episode of thrombosis for a period of 6 months after the first thrombosis. What type of
study is being described?
(1) Pragmatic experimental study
(2) Prospective cohort study
(3) Retrospective cohort study
(4) Non-inferiority experimental study

30. Researchers identified 290 patients treated with heparin. Out of the 290 under heparin
treatment, 21 had a new thrombosis during the 6 months after the first thrombosis. Out
of 190 treated with oral anticoagulants, 12 had a thrombosis. The 95% CI for the
measure of association was (0.56-2.32). Please, select the WRONG statement:
(1) The use of heparin increases the risk of thrombosis by 15% compared to the use of oral
anticoagulants.
(2) The risk of a new episode of thrombosis under heparin treatment was 7.2%.
(3) Treatment with oral anticoagulants is more effective than heparin for the prevention of
new episodes of thrombosis among cancer patients.
(4) The incidence of thrombosis among patients under oral anticoagulant treatment was
13% lower than among patients under heparin treatment.

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Partial exam Epidemiology, academic year 2017-18 Dpt. Preventive Medicine and Public Health

At the Department of Preventive Medicine, the project SENDO has started recently. In the
website, we can read: “SENDO Project will allow to assess the effect of diet and lifestyle
factors on child and adolescent health, which will enable us to better understand some
diseases and design prevention strategies. Follow-up will be done yearly with an online
questionnaire addressed to the parents and to the child about diet, lifestyle factors,
relevant medical information, etc.”

31. SENDO is a:
(1) Prospective cohort study
(2) Retrospective cohort study
(3) Nested case-control study
(4) Experimental study

32. Due to its design, SENDO is NOT the most appropriate design to:
(1) Evaluate different exposures at the same time.
(2) Examine several outcomes of the same exposure.
(3) Evaluate diseases with a low frequency of occurrence with a high attributable fraction.
(4) Evaluate diseases with a long induction and/or latency period that appear during
adulthood.

33. We want to evaluate the association between sleep and wakefulness duration and
childhood unintentional injury. The parents of 292 injured children who presented at
the Children's Emergency Center were interviewed. Sleep or wakefulness status of the
child was assessed retrospectively for each of the 48 hours before injury. For each
child, we compared the 24 hours immediately before the injury with hours 25 to 48.
Which is the design of the study?
(1) Retrospective cohort
(2) Matched case control
(3) Case crossover
(4) Case series

As you may recall, in one of the workshops you learned about the history of retrolental
fibroplasia (RLF).

34. One of the first things that the doctors asked themselves was whether the condition
was present or not at the moment of birth, due to its association with prematurity.
Which causality criteria were they thinking about?
(1) Temporal sequence
(2) Biological plausibility
(3) Specificity of the exposure
(4) Specificity of the outcome

35. In the case-control study conducted by Kinsey and Zacharias, they observed that
sick babies stayed on average 10 days longer at the intensive care unit and
received oxygen for an average of 9 days longer than healthy children. These
results suggested that:
(1) Oxygen administered at the intensive care units was causing RLF.
(2) RLF was more frequent among children hospitalized for more than 10 days at the
intensive care unit than among children who stayed for a shorter time.
(3) The longer stay at the intensive care unit and the higher exposure to oxygen therapy, the
higher the incidence of RLF.
(4) Admission at the intensive care unit and oxygen therapy were risk factors for RLF.

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Partial exam Epidemiology, academic year 2017-18 Dpt. Preventive Medicine and Public Health

36. In the study by Dr. Patz, babies born weighing less than 1500 gr. were randomly
allocated to one of these treatments: (A) oxygen concentration ranging from 65% to
70% for 4-7 weeks or (B) oxygen concentration at 40% or less only in response to a
specific clinical need and for 1-14 days. What type of clinical trial was conducted?
(1) Phase I
(2) Non-inferiority
(3) Parallel group
(4) Explicative

37. During the study, some nurses did not want to comply with high oxygen doses and
switched off the oxygen during nighttime for some of the babies. Eleven of the 76
babies were not considered for the analyses because of missing information during
follow-up or lack of compliance with the study protocol (babies from both groups were
not taken into consideration for the analyses). The results were remarkable: the
incidence of RLF was higher in group A than in group B. Accordingly:
(1) If the 76 children had been included, between-group differences would have been
smaller.
(2) The results with the 76 children would have been similar, because babies from both
groups were excluded from the analyses (the RR would not change).
(3) We do not know the characteristics of the babies excluded from the analyses. Thus, we
cannot assume if the association would become stronger or weaker.
(4) Since a per-protocol analysis has been conducted, the incidences in both groups are
going to be lower than if an intention-to-treat analysis had been conducted.

38. Concretely, 61% of the babies in group A developed RLF, and 16% of the babies in
group B developed RLF. Accordingly, if children in group A had received the dose that
children in group B received, we could have avoided that XXX of them developed RLF.
What is the value of XXX?
(1) 45%
(2) 73.7%
(3) 16%
(4) 3.8%

39. How many babies in group A should have been treated with the oxygen dose of group
B in order to avoid 1 case of RLF in group A?
(1) 2
(2) 3
(3) 45
(4) 16

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40. We read in a paper on sexually transmitted infections that “seroprevalence of herpes

virus type 2 (HSV-2) is 2.3% in girls aged 14-19 years and 15.6% in girls aged 20-29
years”. This means:
(1) Girls aged 20-29 years have a higher risk of having antibodies against HSV-2 than girls
aged 14-19 years.
(2) The relative risk of having antibodies against VHS-2 among girls aged 14-19 years
compared to girls aged 20-29 years is 0.15.
(3) The presence of antibodies against HSV-2 is 6.8 times more prevalent among girls aged
20-29 years than among girls aged 14-19 years.
(4) Girls aged 14-19 years have an approximately 7-fold lower risk of infection than girls
aged 20-29 years. Thus, being young (aged 14-19 years) is a protective factor against
HSV-2 infection.

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Partial exam Epidemiology, academic year 2017-18 Dpt. Preventive Medicine and Public Health

In a paper published in JAMA (JAMA 2005;294:914-23), the association between regular

aspirin use and risk of colorectal cancer was evaluated. The following table shows the
main results:

Years of aspirin use

0 1-5 6-10 11-20 >20

No cases/pers-years 396/665,129 213/297,733 157/224,518 95/175,419 101/229,218

RR (95% CI) 1 1.04 0.89 0.67 0.68

(0.88-1.24) (0.74-1.08) (0.54-0.85) (0.54-0.85)

41. According to this information, we know that it was a:

(1) Case-control study
(2) Cohort study
(3) Nested case-control study
(4) Experimental study

42. According to the information provided in the table:

(1) Taking aspirin for more than 20 years decreases the risk of colorectal cancer by 68%.
(2) Taking aspirin for up to 10 years does not significantly change the risk of colorectal
cancer.
(3) Not taking aspirin does not increase the risk of colorectal cancer (RR=1).
(4) We can conclude that aspirin does not protect against colorectal cancer because there
are cancer cases among participants who take aspirin.

43. In a report from the Ministry of Health on alcohol consumption and driving, we can
read: “Alcohol increases the time our body needs to receive information, process it
and respond. Driving at 90 km/h, without having drunk, the distance traveled during the
reaction time is 25 meters. At the legal limit of 0.5 g/l of alcohol in blood, the reaction
time increases from 1 second to 1.5 seconds, and the distance traveled becomes 37
meters”. A blood alcohol concentration of 0.5 g/l:
(1) Increases by 12% the distance traveled during reaction time.
(2) Multiplies by 50 the time of reaction compared to not having drunk.
(3) Increases by 50% the reaction time compared to not having drunk.
(4) Significantly increases the reaction distance but not the reaction time.

44. Induction period of a disease is defined as:

(1) Birth until first exposure to the risk factor.
(2) Beginning until end of exposure to the risk factor.
(3) Exposure to the risk factor until disease onset.
(4) First until last case of the disease.

45. Which of the following periods is more variable/dependent upon the diagnostic
capacity of the used diagnostic procedures?
(1) Induction
(2) Susceptibility
(3) Latency
(4) Incubation

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Partial exam Epidemiology, academic year 2017-18 Dpt. Preventive Medicine and Public Health

46. The Ministry of Health and Consumer Affairs launched a campaign on the responsible
use of antibiotics to avoid the appearance of bacterial resistance. One of the mottos of
the campaign was: “Not all infections are caused by bacteria. Therefore, not all
infections need to be treated with antibiotics. Taking antibiotics when they are not
needed leads to bacterial resistance against antibiotics”. This motto is a:
(1) Primordial prevention strategy of the appropriate use of antibiotics
(2) Primary prevention strategy of bacterial resistance to antibiotics
(3) Primary prevention strategy of bacterial infections and resistance to antibiotics
(4) Tertiary prevention strategy of adverse effects of antibiotics

47. What does it mean that the association between a risk factor and a disease is
statistically significant?
(1) There is a causal relationship between the risk factor and the disease.
(2) There is a non-spurious association between the risk factor and the disease.
(3) There is an association between the risk factor and the disease that does not seem to be
due to chance.
(4) The alternative hypothesis is true.

48. Which of the following factors can increase the prevalence of a disease?
(1) High mortality among cases
(2) Improvement of the diagnostic procedures of the disease
(3) Improvement of treatments that cure the disease
(4) Immigration of people who are not susceptible of developing the disease

49. Systematic errors or biases:

(1) Affect the precision of the estimate. Thus, it is more difficult to find statistically significant
association measures.
(2) Do not always happen in the same direction.
(3) Affect validity rather than precision.
(4) Are not constant in all measures and are thus unpredictable.

50. In a case-control study on the nutritional risk factors for colorectal cancer, we can
read: “cases were incident cases of colorectal cancer that had been histologically
confirmed”. What type of bias did the authors try to avoid by selecting these cases?
(1) Berkson bias
(2) Neyman’s fallacy
(3) Healthy volunteer bias
(4) Diagnostic suspicion bias

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