Biostats (2).

docx

21. In a recent study, 1000 perimenopausal women who are regular clients at the Mt. Sinai
clinic women aged 40-50 coming for routine check-up are asked about their smoking
status. 25% of the women are smokers. Over the following 10 years, the number of
clients who develop breast cancer is documented. Which of the following best describes
the study design?
A. Prospective cohort study
B. Retrospective cohort study
C. Case control study
D. Cross-sectional study
E. Randomized clinical trial

22. A cohort study evaluates the relationship between smoking and lung cancer. The smoking
status of 5,000 men aged 50 -55 years old is determined by a simple questionnaire.
Consequently, the ten year follow-up shows that smoking increases the risk of lung
cancer. On review of the study results, 1700 participants were lost to follow up. which of
the following biases is most likely to be present in this scenario?
A. Observer bias
B. Selection bias
C. Ascertainment bias
D. Recall bias

23. A researcher is determining the association between Autism and the ingestion of
paracetamol during pregnancy. Mothers of the children attending the out-patient pediatric
clinic are recruited to participate in the survey. The questionnaire included the history of
paracetamol consumption during pregnancy with specific reference to quantity and
number of times. Mothers of children with and without autism were enrolled in the
survey. This type of investigation is most susceptible to which of the following types of
bias?
A. Referral bias
B. Detection bias
C. Lead time bias
D. Allocation bias
E. Recall bias
F. Selection bias
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24. A researcher wants to determine the association between level of exercise intensity and
average weight lost in three groups. The groups are divided into Group 1 light exercise
(15 mins activity), Group 2 moderate exercise (30 mins activity) and Group 3 (45 mins
activity) measured over a period of 30 days. The average weight loss of each group was
analysed. Which of the following is the most appropriate statistical method to compare
the average weight lost results among all 3 groups?
A. ANOVA
B. Chi squared
C. Meta Analysis
D. Multiple linear regression
E. Pearson correlation coefficient
F. Two sample T-Test

25. A researcher was interested in assessing the degree of diabetic retinopathy in 1000
diabetic patients recruited from the endocrinology clinic. For purposes of the study, five
ophthalmologists were contracted. Of the five ophthalmologists, two had previous
knowledge of patient diagnosis, who as a result were more likely to report abnormal
findings. Which of the following bias is most likely present in this study?
A. Confounding
B. Lead time bias
C. Recall bias
D. Selection bias
E. Observer bias

26. Factory workers are followed for a period of 25 years in order to determine how many
develop mesothelioma. During this period, their exposure to asbestos is documented. The
Results are given below.

Asbestos Exposure Yes No

Diseased 40 80 120
Non-Diseased 40 240 280
80 320 400

What is the 20-year risk of developing mesothelioma in patients with asbestos exposure?

A. 0.5
B. 0.3
C. 0.25
D. 0.2
E. 0.14
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27. A scientist was reaching the effect of giving a newly developed flu jab to prevent people
developing the novel virus which is causing flu-like symptoms. A new inflammatory
marker is being studied. As the Flu jab (vaccine) is administered to the population at risk,
the following plot is obtained:

Based on the plot, the correlation coefficient between the two variables is closest to:
A. +0.8
B. +0.2
C. 0
D. -0.2
E. -0.8

28. An actuarist was tasked with developing a payment plan for physicians in numerous
states across the Caribbean region. The actuarist wanted to ensure that a fixed amount of
money per patient per unit of time paid is in advance to the physician for the delivery of
health care services. The health care services included in the payment plan are
preventive, diagnostic, and treatment services, injections, immunizations, and
medications administered in the office, health education and counseling services
performed in the office and routine vision and hearing screening. Which of the following
payment methods is best described in this plan?
A. Capitation
B. Discounted fee for service
C. Fee for service
D. Salary
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29. A study is designed to determine the average cholesterol levels in a group of vegans in a
population. A random sample of 200 vegans is recruited and the relevant data is collected
The researcher performs the appropriate analysis He also states that he is 95% confident
that the population mean of the cholesterol level lies between 5.4 and 6.3 mmol/L The
last statement is based on which of the following calculations?
A. Mean ±1.96*SD/√ n
B. Mean ±1.96*SD
C. Mean ±2.58*SD/√n
D. Mean ±2.58*SD
E. Mean ±SD/n

30. A researcher conducted a cohort study to assess the risk of sedenterism with the
development of obesity. The researcher concluded that the relative risk associated
between the risk factor under investigation and obesity is 2.4 (2.0-3.2) at the 95%
confidence interval. Which of the following 'p' values is most consistent with the results
described above?
A. 0.04
B. 0.06
C. 0.09
D. 0.11
E. 0.20

31. In a population of 6,000,000 contains 20,000 people who have Disease X. There are
5000 new cases of the disease a year and 10,000 deaths attributable to disease X. There
are 60,000 deaths per year from all causes. What is the incidence of the disease?
A. 10000/6000000
B. 60,000/6000000
C. 5000/5980000
D. 20,000/6000000
E. 5000/60,000

32. Disease X has a high fatality rate if left untreated. However, early detection by the
national screening programe improves prognosis of disease and offers complete cure
once treated effectively. As such it is important for the screening test to have high:
A. Sensitivity
B. Specificity
C. Positive Predictive value
D. Cut-off value
E. True negatives
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33. Cervical cancer has a higher prevalence Population A when compared to Population B.
The identical screening programme is being implemented in both populations. Which
epidemiological parameter will change based on the differences in prevalence between
the two populations.
A. Sensitivity
B. Specificity
C. Positive predictive value
D. Likelihood ratio positive
E. Meta analysis

34. A clinical trial is being designed to determine the efficacy of a new drug for leukemia
while comparing it to the standard treatment available. The new drug will be compared
with the standard care in order to assess if the new drug will possibly reduce the
incidence of recurrent leukemia by 20%. The recurrence rate on standard therapy is found
to be 4%. In order for the new drug to be approved, what is the acceptable maximal
incidence of recurrent disease acceptable for persons being treated with the new drug?
A. 5.2%
B. 3.2%
C. 3.6%
D. 4.8%
E. 2.8%

35. A screening test for cancer of the cervix. The test has a sensitivity of 80% and a
specificity of 90%. Test is tested on 200 female participants of which when tested 100
females have cancer of the cervix and 100 females do not. What is the probability that
this patient truly does not have a pulmonary embolus?
A. 10%
B. 80%
C. 85%
D. 89%
E. 90%

36. A cohort study of 1500 women was conducted to determine the association between
consumption of oral contraceptives and uterine cancer. The study determined that the risk
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of uterine cancer for those that consumed oral contraceptives was (2.0, 95% CI – 1.5-3.5)
compared to those that did not consume oral contraceptives. According to the study
results, what percent of uterine cancer in women can be attributed to consumption of oral
contraceptives ?
A. 25%
B. 80%
C. 70%
D. 50%
E. 90%

37. The graph below shows the leading causes of cancer mortality of all females in the USA.

B A
C
D
E
S

Which of the following curves best corresponds to lung cancer?

A. D
B. B
C. C
D. A
E. E

38. A cohort study of 1000 women aged 40-55 years of age assesses the association between
consumption of calcium supplementsand the development of osteoporosis. The statistical
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analysis included adjustment for all confounding factors associated to the development of
osteoporosis in women. The results showed that women aged 40-55 years old who
consumed calcium supplemts for at least 5 years have a relative risk of developing
osteoporosis of 0.50 (p < 0.001), while the women who consumed calcium supplements
for less than 5 years have a relative risk of developing osteoporises of 0.80 (p = 0.30).
Which of the following factors best explains why the relative risk of osteoporosis
decreases with longer calcium supplemnts use?
A. Selection bias
B. Lead time bias
C. Latent period
D. Rare disease assumption
E. Observer bias

39. A screening test is being used to determine patients with and without cancer. However, a
researcher wants to improve the potential of the test by reducing the number of false
negatives and false positives.

Which of the following parameters must be altered in order to achieve a reduction in false
negatives and false positives?
A. Higher sensitivity and higher specificity
B. Higher sensitivity and lower specificity
C. Higher sensitivity and same specificity
D. Lower sensitivity and higher specificity
E. Lower sensitivity and lower specificity

40. A newborn diagnosed with neonatal jaundice has a series of serum bilirubin tests
performed in order to effectively clinically manage the neonate. Over a five day period,
the following readings are recorded I mmol/L: 395, 350, 275, 250 and 200. On the 6 th day
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the serum bilirubin level was 150mm/L. Which of the following measures of central
tendency will remain unchanged?
A. Mean
B. Mode
C. Standard deviation
D. Variance
E. Range

41. A new drug is being developed in order to treat Stage 3 lymphoma. The protocols dictate
that a survival analysis has to be conducted 6 months subsequent to treatment The results
are given in the table below.

Treated with new drug Treated with placebo

Alive 40 76
Dead 120 76

Which of the following best represents the number needed to harm for drug X?
A. 2
B. 3
C. 4
D. 7
E. 9

42. A new screening test has been developed for the early detection of Disease X and is
compared to the gold standard available. 500 particpants are randomly selected from the
community for testing. Results of the study are given below.

Test Results
Screening test Positive Negative Total
results
Positive 130 60 190
Negative 20 290 310
Total 150 350 500
Which of the following is the positive predictive value of the test under study?

A. 130/150
B. 130/190
C. 20/310
D. 290/310
E. 60/190
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43. A screening test implemented in population A allows for early detection of Disease X and
as such allows for the start of earlier treatment. In population B the screening test is not
available and hence patients are detected by way of routine methods (no screening
program available). A review of the data of both programs in each population shows that
survival rates have increased by one year in Population A. The public health specialist
concludes that the use of the screening test improves prognosis in population A. 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

44. In a recent study, men with and without lung cancer were recruited and their history of
smoking status in the past twenty years was asked via a self-administered questionnaire.
Which of the following measures of risk will the researcher most likely report?
A. Relative risk
B. Median survival
C. Exposure odds ratio
D. Relative rate
E. Prevalence Odds ratio

45. A new drug X for treatment of recurrent arthritis is being compared to the standard
treatment. The absolute risk reduction for the new drug X versus the standard therapy is
2%. The incidence of arthritis with standard therapy is 5% and there are 30 current cases
of patients with active arthritic pains in the new drug X group, how many total
participants are there in the drug X group?
A. 3000
B. 1800
C. 1200
D. 1000
E. 900
F. 600

46. Which of the following combinations of cancers represent the most commonly diagnosed
and cause of mortality in women in the USA?
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A. Breast, lung, colon

B. Lung,skin, colon
C. Breast, ovary, lung
D. Lung, breast, cervix
E. Breast, pancreas, lung

47. The data for Northwestern District is shown in the table below:

Diseases Fatal cases Non-Fatal

cases
COVID-19 50 100
Salmonella 25 1000
E.Coli 40 70
Dengue 10 50
Trachoma 15 45

What is the case-fatality rate for E.Coli the Northwestern District?

A. 50/100
B. 40/110
C. 40/70
D. 10/50
E. 70/1265

48. A cohort study of 900 hypertensive patients was designed to determine the association
between Atenolol consumption and heart attack. The data retrieved from the study
showed that 150 hypertensive patients out of 500 who had taken atenolol had developed a
heart attack; 100 hypertensive patients out of 400 who had not taken atenolol had a heart
attack. What is the relative risk of developing a heart attack in hypertensive patients
taking atenolol compared to hypertensive patients who are not taking atenolol?
A. 150x250/100x400
B. 150x350/100x300
C. 150x900/100x900
D. (350/500)/(300/400)
E. (150/500)/(100/400)

49. A new biomarker test for detecting lung cancer is negative in 80% of patients who do not
have the disease. The test is used on 6 serum samples taken from patients without lung
cancer, what is the probability of getting at least 1 positive test result?
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A. 1- (0.05*6)
B. 0.05*6
C. 0.05⁶
D. 0.95⁶
E. 1-0.80⁶