MCQs EPIDEMIOLOGY BLOCK 1 REVISION (Incidence, prevalence, rates,

biases

1. In which one of the following circumstances will the prevalence of a

disease in the population increase, all else being constant?

A. If the incidence rate of the disease falls.

B. If the population in which the disease is measured increases
C. If survival time with the disease increases
D. If recovery of the disease is faster
E. If people dying with disease increases

Ans. C

2. What is the incidence rate in the following figure?

A. 6/6
B. 7/8
C. 9/9
D. 9/10
E. 8/8
 3. If chronicity of a disease is decreased than

A. Incidence and prevalence will increase

B. Incidence will be decreased
C. Prevalence will be decreased
D. Incidence will be increased
E. Both incidence and prevalence will be decreased

Ans. C
4. A newly developed, effective vaccine for the prevention of dengue
comes in the market. This will lead to

A. Decreased incidence
B. Decreased prevalence
C. Decreased incidence and prevalence
D. No change
E. Increased prevalence

Ans. C

5. A newly independent nation is trying to improve its Maternal mortality

ratio. Maternal mortality ratio is

A. Number of mothers dying in a month from any cause per 100

B. Number of Pregnancy related deaths during a given year per
100,000 live births in a population
C. Number of Pregnancy related deaths during a given year per 100
live + dead births in a population
D. Number pregnancy related deaths per 100,000 of population
E. Number of childbirth related deaths per year per 100,000
 Ans. B
6. In an epidemiological context, what is the population at risk?

A. The proportion of a population that engage in risky behaviors.

B. The group of people that may experience the outcome we want to
study.
C. A group of people participating in a study with unknown risk factor.
D. The population group with the highest relative risk of disease.
E. Young daring people wanting to take part in risk study

Ans. B

7. Which of the following statements about exposures is true?

A. Exposure' refers to contact with some factor that may be harmful or

beneficial to health.
B. An exposed individual has a greater risk of disease.
C. Dietary intake is not an 'exposure' because individuals make a choice
about what they eat.
D. High body mass index is a risk factor for a range of health conditions;
therefore, it cannot be treated as a single exposure.
E. Exposure means only harmful risk factor
Ans. A

8. A residency program organized a barbecue at the beginning of the

academic year to welcome the new class of first-year residents. The total
number of students was 100, including faculty, administration staff and
residents. Hamburgers, hotdogs and potato salad were served. The
following day, 28 of the attendees had diarrhea and vomiting. All of the
attendees were questioned about what they had eaten, and the following
table was obtained.
Food item or Number of Number of
combination of attendees who ate attendees who
items food item or developed
combination of diarrhea and
items vomiting
Hamburger 15 2
only
Hotdogs only 12 1
Potato salad 10 3
only
Hamburgers 25 5
and potato salad
Hotdogs and 8 3
potato salad Which
Hamburgers, 30 14 of the
hotdogs and
potato salad
following best describes the attack rate among all of the attendees who
had potato salad?
A. 8%
B. 11%
C. 13%
D. 20%
E. 34%

Ansswer G. 34%
Combination of food items with potato salad
 9. What is the crude mortality rate for Regionville? Regionville is a community
of 100,000 persons. During 2019 there were 1,000 deaths from all
causes. All cases of tuberculosis have been found and they total 300 – 200
males and 100 females. During 2019, there were 60 deaths from
tuberculosis, 50 of the males.
A. 300/100,000
B. 60/1000
 C. 1000/100,000
D. 100/100
E. 200/1000

Answer C. 1000/100,000
The crude mortality rate is the number of death occurring among
the population with a given geographical region during a given year per 1000 total
population.
To calculate the crude mortality rate, we need to know the total number of
death that year and the total population.
Crude death rate = total death/ total population
= 1000/100,000
= 10 per 1000.
Therefore, every other option listed above is wrong.

10. A newly independent nation is trying to improve its “Maternal mortality

rate”. Maternal mortality rate is

A. Number of mothers dying in a month from any cause per 100

B. Number of Pregnancy related deaths during a given year per 100,000
women of reproductive age in a population
C. Number of Pregnancy related deaths during a given year per 100 live +
dead births in a population
D. Number pregnancy related deaths/women of reproductive age in that
population in a specified period of time
E. Number of childbirth related deaths per year per 100,000
11. What is the prevalence rate in the following figure?

A. 6/6
B. 7/8
C. 9/9
D. 9/10
E. 8/8

Ans. D
12. A new genetic test for cystic fibrosis was developed and tested on
100 neonates known to have the disease. It returns a positive result
in 98 of the neonates and a negative result in the other 2 neonates.
Which of the following can be concluded from this data about the new
test?

A. It has a negative predictive value of 98%

B. It has a positive predictive value of 98%
C. It has a prevalence of 98%
D. It has a sensitivity of 98%
E. It has a specificity of 98%
 Ans. D

13. 2. A town with 1000 citizens has a 10% prevalence of disease X. A

screening test for disease X just came out: with sensitivity of 80% and
a specificity of 70%. How many people (%) with disease will be
missed by this screening test'?

A. 100
B. 20
C. 270
D. 630
E. 80

Ans. 20

a. A new serum test was recently developed to detect antibodies

to a certain virus in order to diagnose the infection. One
thousand patients received the test and while 100 people had
the infection, only 80 of them tested positive. Of the 900 people
who did not have the infection, 800 tested negative and 100
tested positive. Which of the following percentages indicates
the specificity of this new test?

A. 10%
B. 44%
C. 80%
D. 88%
E. 98%

Ans. D
14. Your patient with chest pain wants to know if he is having a heart
attack. You tell him that his result of test A, a new test for diagnosing
myocardial ischemia (MI), is positive. The study results for test A
versus people who have true myocardial ischemia are given in table
below. Based upon test A, what is the probability that your patient is
experiencing myocardial ischemia?

A. 90%
B. 80%
C. 60%
D. 50%
E. 40%

Ans. B

15. A new test to diagnose urinary tract infections in women is being

evaluated. The comparison gold standard is positive urine dipstick
plus urine culture. Results of the study are given below
What is the new test’s specificity?
A. 10%
B. 30%
C. 56%
D. 70%
E. 90%

Ans. E
16. A rare metabolic disease has severe consequences if left untreated.
If detected early after birth the disease can be treated effectively and
all the severe sequelae can be prevented. It is most important for a
diagnostic test to be used in all newborns to have high:

A. Sensitivity
B. Specificity
C. Positive predictive value
D. Cutoff value
E. Negative predictive value

Ans. A

17. A new test to diagnose urinary tract infections (UTIs) is being

evaluated. The sensitivity of the test is 70% and the specificity is
90%. In the study there are 100 patients who truly have UTIs and 200
who truly do not. How many falls positives are in this study?

A. 20
B. 30
C. 70
D.100
E. 45

Ans. A
18. A patient in the emergency department has chest pain and shortness
of breath. You use test X to rule out the possibility of a pulmonary
embolus (PE). Her result is negative. Test X has a specificity of 80%
and a sensitivity of 90% when tested in 100 subjects with PE and 100
subjects without PE in the emergency department. What is the
probability that this patient truly does not have a pulmonary embolus?

A. 18%
B. 53%
C. 66%
D. 82%
E. 88%

Ans. E

19. The results of study investigating a new diagnostic test in diagnosing

acute myocardial infarction are given in the table below
What is the sensitivity of the new diagnostic test?

A. 25%
B. 37%
C. 55%
D. 70%
E. 75%

Ans. E
20. A new biomarker has been shown to allow for the early detection of
invasive gastric cancer. It has a sensitivity of 89% and a specificity of
85% when compared to endoscopy with multiple biopsies. The test is
used in two groups, a population in the United Stated, where 5 out of
100,000 people have gastric cancer, and a population in China,
where 100 out of 100,000 people suffer from the disease. Which of
the following is the most accurate statement concerning this new
test?

A. Sensitivity of the test is higher in the American population

B. Specificity of the test is higher in the Chinese population
C. Positive predictive value of the test is higher in the Chinese
population
D. Negative predictive value of the test is lower in the American
population
E. The test is not reliable in the American population

Ans. C
21. A geneticist is interested in the potential causes of a congenital
abnormality. She interviews the mothers of children with the
abnormality and discovers that several of them used acetaminophen
during pregnancy. Mother of children who do not have the
abnormality did not remember taking acetaminophen as frequently.
This type of investigation is subject to what type of bias?

A. Referral bias
B. Detection bias
C. Lead-time bias
D. Allocation bias
E. Recall bias

Ans. E

22. A researcher is interested in how often primary care physicians take

the sexual histories of their patients. Patients are asked to fill out a
questionnaire immediately upon exiting a doctor’s office. Once the
physicians are aware of the study, which of the following is a potential
problem?

A. Berkson’s bias
B. Pygmalion effect
C. Hawthorne effect
D. Lead-time bias
E. Recall bias

Ans. C
23. A new biomarker has been shown to allow for the early detection of
non-small cell lung carcinoma. A study of this new test demonstrates
that its use prolongs survival of lung cancer patients by three months
when compared to the survival of those subjects diagnosed by
conventional methods. The researchers conclude that the use of this
new biomarker improves prognosis in patients with non-small cell
cancer. Which of the following is a potential problem with this
conclusion?

A. Observer bias
B. Measurement bias
C. Rare disease assumption
D. Confounding
E. Lead-time bias

Ans. E
24. Doctors around the world are in dilemma whether to validate a costly
screening test for a particular cancer. A surgeon in a international
conference argued that there is no use of the test since knowing early
about the diagnosis doesn’t improve survival since the treatment are
not yet invented. Which bias is the surgeon tackling here?

A. Overdiagnosis
B. Omitted variable bias
C. Survivorship bias
D. Lead time bias
E. Late look bias

Ans. D
25. A new antihypertensive drug is being studied on 200 persons. They
are divided into a drug group and a placebo group of 100 patients
each, with free choice to join any group at their will. Which type of
bias is supposed to happen in this situation?

A. Recall bias
B. Selection bias
C. Pygmalion effect
D. Lead time bias
E. Late look bias

Ans. B
26. A group of researches were assigned to find out the prevalence of
peptic ulcer disease in Wichita Falls, Texas. They found out the
prevalence of 5/100 according to the hospital records. Which bias can
occur in the above situation?

A. Recall bias
B. Surveillance bias
C. Pygmalion effect
D. Berkson bias
E. Late look bias

Ans. D
27. A researcher who developed an antihypertensive drug is doing
interventional study on 1000 patients. He is enthusiastic and
therefore giving medication to both drug group and placebo group
himself. Which error or bias might occur?

A. Recall bias
B. Surveillance bias
C. Pygmalion effect
D. Berkson bias
E. Late look bias

Ans. C

28. A group of researchers were examining the risk of Alzheimer's

disease with Vaccine X. 300 subjects were given vaccine and 300
were given placebo. They were followed for 10 years. They got the
following data:
Alzheimer No Alzheimer

Vaccine 100 200

Placebo 50 250

A review of literature revealed that Hormone Replacement

Therapy is also associated with Alzheimer disease. The researchers
rearranged the data according to hormone replacement therapy as
follows:
 Subjects taking Hormone replacement therapy:

Alzheimer No
Alzheimer
Vaccine 50 150
Placeb 50 150
o

Subjects who were not taking Hormone replacement

therapy:
Alzheim No
er Alzheime
r
Vaccin 25 75
e
Placeb 25 75
o

The stratified result is explained by which of the following?

The stratified result is explained by which of the following?

A. Selection bias
B. Recall bias
C. Measurement bias
D. Pygmalion effect
E. Confounding bias

Ans. E
29. A group of researchers were examining the risk of Alzheimer's
disease with Vaccine X. 300 subjects were given vaccine and 300
were given placebo. They were followed for 10 years. They got the
following data:

Alzh N
eimer o
Alzhe
imer
Va 100 2
ccine 00
Pla 50 2
cebo 50

Subjects who were currently smoking:

Alzheimer No
Alzheimer
Vaccine 75 150
Placebo 25 150
 Subjects who were not currently smoking:

Alzheimer No
Alzheimer
Vaccine 25 75
Placebo 25 75

The stratified result is explained by which of the following?

A. Selection bias
B. Measurement bias
C. Pygmalion effect
D. Confounding bias
E. Effect modification

Ans. E
30. A new estrogen receptor agonist is being evaluated for the treatment of
postmenopausal symptoms. A prospective study shows that the drug increased
risk of deep vein thrombosis (DVT) in treated woman who smoke compared to
untreated women who smoke, with a relative risk (RR) of 1.70 and a p-value of
0.01. In nonsmokers, no increased risk of DVT is evident with use of the drug
(RR= 0.96, p-value = 0.68). Which of the following describes this phenomenon?

A. Confounding
B. Effect modification
C. Latent period
D. Observer bias
E. Selection bias

Ans. B
31. Researchers are interested in the association between colorectal carcinoma and
nonsteroidal anti-inflammatory drug use. They first interview a group of patients
with biopsy-proven colorectal carcinoma and then interview a group consisting of
the patient’s neighbors who are of similar age and race. The analysis is based on
comparisons of the results of pairs of individuals with similar characteristics (one
from each of the 2 groups). This design technique best helps address which of
the following potential problems with this study?

A. Ascertainment bias
B. Confounding
C. Observer bias
D. Recall bias
E. Selection bias

Ans B
 32. Researchers conduct a prospective study that demonstrates an association
between alcohol consumption and transitional bladder carcinoma, with a relative
risk (RR) of 1.81 and p-value of 0.03. They then divide the study subjects into 2
groups, smokers and nonsmokers, and again examine the association between
alcohol consumption and bladder cancer:
Smokers: RR = 0.96; P = 0.87
Nonsmokers RR = 1.03, p = 0.96
The discrepancy between the overall results and the stratified results is best
explained by which of the following?
The discrepancy between the overall results and the stratified results is best
explained by which of the following?

A. Effect modification
B. Observer bias
C. Measurement bias
D. Recall bias
E. Confounding
Ans E
33. A study to assess spironolactone efficacy in patients with heart failure is
performed. 450 patients receive either spironolactone or placebo for two years.
Neither the patients nor physicians are aware of who takes the drug or placebo.
The study setup described above is most effective in preventing:

A. Beta error
B. Recall bias
C. Observer bias
D. Effect modification
E. Selection bias

Ans. C
34. A research company is trying to have a study pure of biases. They are
specifically concerned with Pygmalion effect. Which of the following should
eliminate concerned effect from the results?

A. Random independent sampling

B. Control group/placebo group
C. Multiple sources to confirm information
D. Stratify by severity
E. Double blind study

Ans. E

35. A group of researchers are doing research for “SARS”, severe acute respiratory
syndrome, a very severe with a total short time period. Which type of bias and
the solution is associated with the above situation.

A. Lead time bias/stratify by severity

B. Late look bias/multiple sources to confirm information
C. Confounding/multiple studies, good research design
D. Hawthorne effect/control group/placebo group
E. Berkson bias/random independent sampling
 Ans. B

36. Match the correct answer with “selection bias”

A. Internal validity
B. Small sample
C. Placebo group
D. Most common bias
E. External validity

Ans. A

37. The 1994 United States census reported the following population data for a
southern city: 500,000 fertile males; 450,000 fertile females; and 500,000 other
residents. In the same year, there were 4,000 live births, 3 fetal deaths, 4 deaths
among children younger than 1 year of age, and 40 maternal deaths as a result
of childbirth. What was the maternal mortality rate?

A. 40/4007
B. 40/4000
C. 40/950,000
D. 40/450,000
E. 47/450,000

Ans. D

38. A cross-sectional study of the relationship between smoking and anxiety found
the following among 1000 people:
High anxiety Low anxiety
level level
What is the prevalence of high anxiety in Smokers 200 300
these 1000 people?
Nonsmoker 100 400
s
a. 20%
b. 30%
c. 40%
d. 50%
e. Cannot be computed from the data given
 Ans. B

39. Text X for rheumatoid arthritis is positive in 150 out of 200 patients with
rheumatoid arthritis and is negative in 180 out of 200 people without rheumatoid
arthritis. In the population of people under study, what is the chance that a
positive test result, in a randomly selected individual indicates that the person
has rheumatoid arthritis?

a. 70%
b. 75%
c. 88%
d. 90%
e. 95%

Ans. C

40. Which of the following examples best illustrates prevalence rate?

A. Number of new cases of multiple sclerosis per 100,000 population per year
B. Number of new cases of cancer of the prostate per 100,000 men per year
C. Number of 10-year-old children who die of leukemia per 100,000
population per year
D. Number of multiple sclerosis patients per 100,000 population per year
E. Number of tuberculosis related death total persons with tuberculosis

Ans. D
41. A drug is discovered that is very effective in curing a form of cancer that was
previously rapidly fatal. Which of the following factors would be LEAST affected
by this drug discovery for this form of cancer?

a. Crude mortality rate

b. Cause-specific mortality rate
c. Prevalence rate
d. Incidence rate
e. Both d and e are correct

Ans D

42. In 2019, 1200 deaths occurred within a population of 1,000,000. At the

beginning of the year, this population was known to include 900 individuals with
lung cancer. During the year, 300 new cases of lung cancer were diagnosed,
and by the end of 1990, 60 people had died of the disease. The crude mortality
rate per 100,000 population in 1990 was

a. 0.2
b. 6
c. 30
d. 90
e. 120

Ans E

43. Suppose that 80 consecutive women entering a Gynecological unit for various
problems, have a Pap for cervical cancer (screening test) done on them, and
also have a biopsy for pathological analysis (gold standard test). The following
results are obtained and put in a 2 by 2 table. Sensitivity and specificity of the
Pap smear for cervical cancer is

a) 85% and 90%

b) 90% and 85% BIOPSY AND PATOHLOGY
c) 100% and 90% Cervical Ca No Cervical Ca TOTAL
Paps +v 18 9 27
Paps -v 2 51 53
TOTAL 20 60 80
 d 79% and 80%
e 80% and 90%

Ans B

44. A new test for the detection of baldness is devised. It is applied to the
population of 200 men who live in the US and insist that they have hair. Based
on a gold standard-namely, asking the subjects to remove their hats ---- 20 of the
200 men are actually bald. The test detects 12 cases of baldness, of which 8 are
positive by the gold standard and 4 are negative. Based on these data, the
sensitivity of the new test is:

a. 176/188
b. 8/12
c. 8/20
d. 4/180
e. 176/180

Ans B

45. In 1st January 1990, 400 women in a given county where there was no
emigration or immigration, had breast cancer. Twenty new cases of breast
cancer occurred by June 30th 1990 and by June 30th, 15 of the total number of
women with breast cancer had died. Between 1st January 1990 and 31st
December, a total of 35 new cases of breast cancer occurred. The population of
women in this county was 50,000 by June 30th 1990. What was the point
prevalence rate of breast cancer in women in this county by June 30th 1990?

a) 0.0081 per 50,000

b) 10.8 per 1000
c) 12.0 per 50,000
d) 6.5 per 1000
e) 9.5 per 10,000
 Ans. A

46. The number of deaths to infants under 28 days of age in a defined place and
time period per thousand live births is called

a) Perinatal mortality rate

b) Infant mortality rate
c) Neonatal mortality rate
d) Post neonatal mortality rate
e) None of the above

Ans. C

47. Crude death rates in populations are determined by

a. the causes of death
b. the size of the population and the total number of deaths
c. seasonal variation in mortality rates and diagnostic consistency
d. disease surveillance and reporting
e. the age distribution
Ans B

48. In a classroom of 25 students (15 males and 10 females), 5 males develop

hepatitis A over a 2-week period. During the next 6 weeks, an additional 3 males
and 2 females develop the infection. The Attack rate of hepatitis A in this
classroom is

A. 25%
B. 30%
C. 35%
D. 40%
E. 45%
 Ans D

49. 1-Specificity is

A. Falls negative
B. Falls positive
C. Tue positive
D. True negative
E. None of the above

Ans. B