EBM & Statistics Quiz

2022-3

Mark Kerr
Clinical Librarian
Data
To which of the following data types do the variables
describing gender, ethnicity or employment status
belong?

A. Ordinal data
Or categorical data
B. Nominal data
C. Continuous data
D. Discrete data
E. Binary data
F. None of the above
Bias
In which type of study does recall bias pose a
substantial problem?

A. Retrospective case-control study

B. Randomised controlled double-blind trial
C. Prospective cohort study
D. Systematic review and meta-analysis
E. Cross-over study
Random History Question
This is the first what? Electrocardiograph 1911
History of Medicine
Which pandemic killed the highest proportion of the
UK population?

A. Great Plague of London (1665) 20% (London – 100k of 460k)

B. Spanish Flu (1918-9) 0.7% (250,000 of 34m)
C. Covid 19 (2020-2022) 0.2% (160k of 70m)
D. The Black Death (1346 – 1353) 30-45% (2m of 4.8m)
E. Heart Disease (annually) 0.2% per annum

All historic figures are quite broad estimates

Bias: Which description matches which bias?
Hawthorne Effect D
Lead Time Bias A

Pygmalion Effect C
B
Late-Look Bias

A. Early detection confused with increased survival:

improved screening (natural history of disease same, but early detection suggests survival has increased)

B. Information gathered at an inappropriate time

e.g., using a survey to study a fatal disease (only those patients still alive will be able to answer survey)

C. Occurs when a researcher's belief in the efficacy of

a treatment changes the outcome of that treatment
D. Occurs when the group being studied changes its
behaviour owing to the knowledge of being studied
Random History Question
1898
“Dr. August Bier (1861-1949)
conducted the first spinal anesthetic
using what? 10 years later, he
popularized the intravenous regional
("Bier") block.”

Erythroxyline, also known as . . .

Cocaine
Forest Plots

F I G U R E 1 Forest plot of randomised controlled trials of Lactobacillus rhamnosus

GG (high dose and low dose) vs control in acute gastroenteritis. Effect on duration
of diarrhoea.

1. Is this results statistically significant?

2. Does this result show heterogeneity?
HISTORY: Iron lung
Invented in 1928 to support polio patients, when was
the last iron lung used in the UK?
The UK’s last user died in 2017 at the
age of 75.
Two are still in use in the USA.
Standard Deviation
True or False for each description:
A. Is the square root of the variance TRUE
B. 50% of the data set lies within one standard deviation
from the mean FALSE

C. 95% of the data set lies within two standard deviations

from the mean TRUE

D. Cannot be used for a data set with a skewed distribution

FALSE
E. One standard deviation is equal tro the mode.
FALSE
Standard Deviation
In a sample of 10,000 women, the age at the delivery of
their first child showed a normal distribution. Mean age
was 29 years old, with a standard deviation of 2 years.
A. Two standard deviations from the mean is 33yo TRUE
B. The variance is 3 years FALSE
C. No primiparous woman would be older than 40yo FALSE
D. The median age for a primiparous woman would be 29yo
E. The standard error of the mean is 0.2 TRUE TRUE

Variance is SD2 ; SE = SD ÷ √sample size

Clinical Audit
Which of these is an aim of clinical audit?

A. To reject or accept a null hypothesis FALSE

B. To assess the extent to which current practice
meets a defined set of standards TRUE

C. To assess differences between two different

populations FALSE

D. To establish what is best practice FALSE

E. To extrapolate theory in to practice FALSE

HISTORY: when did WHH open?
1979
Hypothesis testing
Which of the following statements regarding
hypothesis testing is true?

A. A type I error (α error) occurs when a null hypothesis that FALSE

is correct is accepted
B. A type II error (β error) occurs when a hypothesis that is FALSE
incorrect is rejected
C. A type III error is a study design that produces the wrong FALSE

answer to the right question

FALSE
D. The P (probability) value is the probability that defines how
likely it is that the null hypothesis is false
TRUE
E. The P value is the probability of an observed difference
Diagnostic
The figure depicts normal and disease populations
with frequency on the y-axis and the diagnostic test
value of the x-axis. The cutpoint is indicated by the
vertical black line, above which we consider the test
to be abnormal and below which we consider the test
to be normal. TN is true negatives and TP is true
positives. The arrow is pointing at the area that is
which of the following?

A. False negatives TRUE

B. True negatives FALSE
C. Positive predictive value (PPV) FALSE
D. Negative predictive value (NPV) FALSE
E. Sensitivity/ specificity FALSE
Statistical Methods
Of the following, which is a type of inferential
statistical method?

There are two types of applied

A. Arithmetic mean FALSE
statistics. Descriptive statistics
(means, medians, modes, SD,
B. Mode FALSE quartiles, and histograms)
describe the data in a sample.
C. Student’s t-test TRUE
Inferential statistics are statistical
D. Median FALSE methods that estimate whether
results suggest a real difference
E. Histogram FALSE between populations (such as the
Student’s t-test, ANOVA, and the
chi-squared test).
Power
Which of the following would increase the power of a
study?
A. Smaller significance level FALSE

B. Larger effects TRUE

C. Increased variability of the observations FALSE

D. Smaller sample size FALSE

E. None of the above FALSE

The power of a study is the probability that it would detect a statistically significant difference.
As the β value is the probability of accepting a hypothesis that is false, the power of the study (1
– β) is therefore the probability of rejecting the null hypothesis when it is false. The power of a
study should be at least 80% and is increased by several factors including larger significance
level, larger effects, decreased variability of the observations, and larger sample size.
Meta-Analysis
A meta-analysis gathers a number of studies similar in nature
to give one overall estimate of the effect. Which of the
following is a disadvantage of this technique?

A. Refinement/reduction of large amount of information FALSE

B. Efficiency relative to a new study FALSE
C. Publication bias for statistically significant studies TRUE
D. Power to detect effects of interest FALSE
E. Precision greater than a single study FALSE

The advantages include refinement and reduction, efficiency, generalizability and consistency,
reliability, and power and precision. The disadvantage include publication bias, clinical
heterogeneity, quality differences, and lack of independence of study subjects
HISTORY: How old is Intensive Care?
The Blegdam Hospital in Copenhagen was overwhelmed by over 300 seriously ill polio patients.
Without assistance to help them breathe, most would die. The only treatment available was a
mechanical respirator system, an iron lung. But there was only one iron lung in Copenhagen, just
6 of the chest ventilators and 316 patients that needed treatment.

Anaesthetist Bjorn Ibsen suggested that instead of forcing the chest to expand using negative
pressure provided by an iron lung, they forced air directly into the lungs with a tube, a
technique developed for use during surgery. This tube was attached to a simple rubber bag,
which could be pumped by hand. Hundreds of doctors, medical and dental students were
drafted-in to pump the bags and monitor the patients – up to 70 in the hospital at any one time.

The world’s first intensive care unit

(ICU), with a dedicated ward and
nursing staff was established the
following year – which year?

1953
Bias
Bias occurs when there is a systematic difference between the
results of a study and the true results. A bias that occurs
when a spurious association is noted due to a failure to adjust
fully for factors leading to an erroneous conclusion is called as
which of the following?

A. Observer bias FALSE

TRUE
B. Confounding bias
FALSE
C. Selection bias
FALSE
D. Information bias FALSE
E. Allocation bias
Terminology
Which of the following is a statistical term to describe the
consistency of a set of measurements or a measurement tool
or its repeatability and reproducibility?

A. Precision FALSE

B. Accuracy FALSE

C. Reliability TRUE

D. Validity FALSE

E. Power FALSE
Statistical Tests
Which of the following is a statistical test used for two large
(>5) groups of unpaired categorical data?

A. One-way ANOVA FALSE

B. χ2 test TRUE

C. McNemar’s test FALSE

D. Fisher’s exact test FALSE

E. Wilcoxon ranks sum test FALSE

Statistical Tests
 Incidence = the frequency of occurrence

Prevalence of new cases during a time period

Prevalence = proportion of the population
with the disease at a specific point in time

Which of the following is the correct definition for prevalence

of congenital heart disease?

A. No. of new cases during a period of time ÷ sum for each individual in the
FALSE
population of the length of time at risk of getting the disease
B. Number of individuals who get the disease during a certain period ÷ FALSE
number of individuals in the population at the beginning of the period X
C. Existing number of individuals having the disease at a specific time ÷
number of individuals in the population at that point in time
D. Number of new cases of the disease that occur in a population during a
period of time ÷ number of individuals in the population at the beginning of
FALSE
the period X
E. Number of individuals who get the disease during a certain period ÷ sum
FALSE
for each individual in the population of the length of time at risk of getting
Random History Question
Rescued from Greece in 1850 and brought to England, what
type of creature was Florence nightingale’s pet, called
Athena?
Hypothesis Testing
Which of the following statements regarding hypothesis testing is true?

A. A type I error (α error) occurs when a null hypothesis that is correct is

accepted FALSE
B. A type II error (β error) occurs when a hypothesis that is incorrect is
rejected FALSE
C. A type III error is a study design that produces the wrong answer to
the right question FALSE
D. The P (probability) value is the probability that defines how likely it is
that the null hypothesis is false FALSE
E. The P value is the probability of an observed difference occurring
solely by chance TRUE
Power
Which of the following would increase the power of a
study?

A. Smaller significance level FALSE

B. Larger effects TRUE

C. Increased variability of the observations FALSE

D. Smaller sample size FALSE

E. None of the above

FALSE
Meta-Analysis
A meta-analysis is a technique in which results from a number of studies
that are similar in nature are gathered to give one overall estimate of
the effect. Which of the following is a disadvantage of this technique?

FALSE
A. Refinement and reduction of large amount of information
B. Efficiency relative to a new study FALSE

C. Publication bias for statistically significant studies TRUE

D. Power to detect effects of interest FALSE
E. Precision greater than a single study FALSE
Risk Ratio
In a prospective study of new antiarrhythmic agent, the investigators
found that 16 of 465 children (3.4%) in the treatment group had
arrhythmias while in the placebo group, 23 of 465 children (4.9%) had
arrhythmias. What is the risk ratio?

FALSE
A. 1.44
FALSE
B. 0.44
C. 0.69 3.4 / 4.9 = 0.69 TRUE

D. 0.31 FALSE
E. None of the above FALSE
Data Types
What is an example of discrete data?

Number of previous pregnancies in a pregnant woman TRUE

A person’s weight FALSE

The temperature of a freezer FALSE

The change in mortality following an intervention FALSE

None of the above FALSE

Relative Risk Reduction
Which of the following is the relative risk reduction (RRR) in this study?
[16 of 465 children (3.4%) in the treatment group
had arrhythmias while in the placebo group, 23 of
465 children (4.9%) had arrhythmias]

A. 44% FALSE

B. 31% 4.9 - (3.4/4.9) = 31% TRUE

C. 69% FALSE
D. 144% FALSE
E. None of the above FALSE
Number Needed to Treat
What is the number of patients who need to be treated (NNT) for one to
get benefit of the drug?

A. 67 NNT=100/ARR = 1 / 4.9-3.4 = 1 / 1.5 = 67 TRUE

B. 15 FALSE
C. 20 FALSE
D. 29
FALSE
E. None of the above
FALSE

[16 of 465 children (3.4%) in the treatment group

had arrhythmias while in the placebo group, 23 of
465 children (4.9%) had arrhythmias]
Publication Bias
Which of these is not a cause of publication bias?

A. Statistically significant results in the included studies FALSE

B. Fashion and popularity of the research topic FALSE

C. Source of sponsorship and funding FALSE

D. Language of original article FALSE
E. Registration of study protocols
TRUE

The factors in A-D can all affect the likelihood of being accepted for publication in journals, and
being found in searches used to inform a systematic review
Accuracy & Precision
This image shows the relationship between accuracy and precision to be
which of the following?

A. Accurate and precise FALSE

B. Not accurate but precise TRUE

C. Accurate but not precise FALSE
D. Not accurate nor precise
FALSE
E. None of the above
FALSE
Which Test?
Which of the following is a statistical test used for two large (>5) groups
of unpaired categorical data?

A. One-way ANOVA FALSE

B. χ2 test TRUE
C. McNemar’s test FALSE
D. Fisher’s exact test FALSE
E. Wilcoxon ranks sum test FALSE
Phases of Research
A pediatric cardiologist is interested in studying intravenous milrinone in
pediatric septic shock and is organizing a randomized controlled
multicenter trial involving over 300 children with septic shock in the
pediatric intensive care unit setting. He is primarily interested in
assessing the benefit of milrinone compared to traditional inotropic
agents. This phase of the clinical trial would be considered as which of
the following?

FALSE
A. Phase 0
FALSE
B. Phase I
C. Phase II FALSE

D. Phase III TRUE

E. Phase IV FALSE
HISTORY: How old is Intensive Care?
The Blegdam Hospital in Copenhagen was overwhelmed by over 300 seriously ill polio patients.
Without assistance to help them breathe, most would die. The only treatment available was a
mechanical respirator system, an iron lung. But there was only one iron lung in Copenhagen, just
6 of the chest ventilators and 316 patients that needed treatment.

Anaesthetist Bjorn Ibsen suggested that instead of forcing the chest to expand using negative
pressure provided by an iron lung, they forced air directly into the lungs with a tube, a
technique developed for use during surgery. This tube was attached to a simple rubber bag,
which could be pumped by hand. Hundreds of doctors, medical and dental students were
drafted-in to pump the bags and monitor the patients – up to 70 in the hospital at any one time.

The world’s first intensive care unit

(ICU), with a dedicated ward and
nursing staff was established the
following year – which year?

1953