Ch 14-17

Question 1

Measures of health status traditionally have been based on mortality data. The principal reason this is no longer satisfactory is that:

a. Changes in diagnostic technology permit earlier detection of disease.
b. The infant mortality rate has declined so much that tit no longer serves as a useful index.
c. The population is older and more subjective to chronic illness than in the past.
d. There is less risk of fatal infection than in the past.
e. Traditional sources of mortality data have failed to include relevant subpopulations.

Answer 1

C. The population is older and more subjective to chronic illness than in the past.

Question 2

After the onset of blindness resulting from diabetic retinopathy, a 54-year-old man seems depressed. When you question him regarding the quality of life, he dejectedly tells you that 10 years “like this” is not worth 1 year of good health. Before going blind, the patient’s physician estimated that his life expectancy was 74 years. Which of the following statements is true for the patient?

a. His adjusted life expectancy is 76 years.
b. His healthy life expectancy is 76 years.
c. His healthy life expectancy cannot be calculated if he actually is depressed.
d. Each year of his life contributes less than 0.1 QALY.
e. Each year of his life contributes 10 QALY.

Answer 2

d. Each year of his life contributes less than 0.1 QALY.

Question 3

In which of the following ways is health promotion distinguished from disease prevention?

a. Only health promotion can begin before a disease becomes symptomatic.
b. Only health promotion involves materials and methods that are generally nonmedical.
c. Only health promotion is applied when a disease has developed.
d. Only health promotion is targeted at populations rather than individuals.
e. Only health promotion is targeted a specific diseases.

Answer 3

b. Only health promotion involves materials and methods that are generally nonmedical.

Question 4

Which of the following is an example of secondary prevention?

a. Cholesterol reduction in a patient with asymptomatic coronary artery disease
b. Prescription drug therapy for symptoms of menopause
c. Physical therapy after lumbar disk
d. Pneumococcal vaccine in a patient who has undergone splenectomy
e. Thrombolysis for acute myocardial infarction

Answer 4

a. Cholesterol reduction in a patient with asymptomatic coronary artery disease

Question 5

In chemistry, Le Chatlier’s principle states that – when a system at equilibrium is stressed, the system reacts to counterbalance the stress and reestablishes equilibrium. Applied to individual health, this principal might be adapted to state that when a healthy individual experiences distress. Successful adaptation to harmful stressors results in restoration of wellness. Unsuccessful adaptation would result in compromised function and would be an indication of:

a. Eustress
b. Overwhelming allostatic load
c. Latent disease
d. An advanced Leavell’s level
e. A low Leavell’s level

Answer 5

b. Overwhelming allostatic load

Question 6

Years of potential life lost (YPLL) is a measure of health status that:

a. Gives more weight to deaths occurring in those older and more experienced.
b. Directly assesses health-related quality of life.
c. Is a health status index.
d. Is equivalent to quality-adjusted life years (QALY).
e. Can always be calculated using life expectancy and age of death only.

Answer 6

e. Can always be calculated using life expectancy and age of death only.

Question 7

You are interested in helping a 45-year-old perimenopausal woman avoid osteoporosis. The patient is motivate but has a fixed income, is personally liable for her medical expenses because of lack of health insurance, and is concerned about the expense. Assume that (1) the cost of preventive medical therapy is fixed at $660 per year, (2) this therapy will prevent the development of a hip fracture in the a patient at age 68 years, (3)The current cost of surgical fixation of the hip fracture is $ 12,000, and (4) the yearly rate of inflation is 4%.

Disregarding any effects of inflation, how much money would the patient spend to prevent a hip fracture at age 68 years if she started medical therapy now?

a. $3,180
b. $12,000
c. $15,180
d. $29,700
e. $44,880

Answer 7

c. $15,180
68-45= 23
$660 x 23 = $15,180

Question 8

You are interested in helping a 45-year-old perimenopausal woman avoid osteoporosis. The patient is motivate but has a fixed income, is personally liable for her medical expenses because of lack of health insurance, and is concerned about the expense. Assume that (1) the cost of preventive medical therapy is fixed at $660 per year, (2) this therapy will prevent the development of a hip fracture in the a patient at age 68 years, (3)The current cost of surgical fixation of the hip fracture is $ 12,000, and (4) the yearly rate of inflation is 4%.

When inflation is taken into account, what is the cost of surgery to repair a hip fracture in the patient at age 68 years?

a. ($15,180)(0.04)^23
b. ($15,180)(1 + 0.04)^23
c. ($12,000)(0.04)^23
d. ($12,000)(1 + 0.04)^23
e. ($12,000)(1 - 0.04)^23

Answer 8

d. ($12,000)(1 + 0.04)^23

Question 9

When true inflation-adjusted costs are considered, you determine that the total cost of medical therapy would be close to $42,000 over 23 years, whereas surgical fixation would cost about $48,000 in 23 years. Given this information, you decide that medical therapy to prevent hip fracture:

a. Has a favorable cost-benefit ratio.
b. Has a higher time value of money.
c. Is appropriate for the patient.
d. Is not worth the money for the patient.
e. Is cost-effective.

Answer 9

a. Has a favorable cost-benefit ratio.

Question 10

Vaccinating a health care worker against hepatitis B virus.

a. Health promotion
b. Secondary prevention
c. Specific protection
d. Tertiary prevention

Answer 10

C. Specific Protection

Question 11

Giving isoniazid for 1 year to a 28-year old medical student whose result in the tuberculin skin test using purified protein derivative recently converted from negative to positive.

a. Health promotion
b. Secondary prevention
c. Specific protection
d. Tertiary prevention

Answer 11

B. Secondary Prevention

Question 12

Performing carotid endartectomy in a patient with transient ischemic attacks.

a. Health promotion
b. Secondary prevention
c. Specific protection
d. Tertiary prevention

Answer 12

d. Tertiary prevention

Question 13

Recommending regular physical activity to a patient with no known medical problems.

a. Health promotion
b. Secondary prevention
c. Specific protection
d. Tertiary prevention

Answer 13

a. Health Promotion

Question 14

Incorporates life expectancy and the perceived impact of disability on the quality of life.

a. General well-being adjustment scale
b. Healthy life expectancy
c. Life expectancy free of disability
d. Quality-adjusted life years (QALY)

Answer 14

d. Quality-adjusted life years (QALY)

Question 15

The number of years of life remaining expected to be free of serious disease.

a. General well-being adjustment scale
b. Healthy life expectancy
c. Life expectancy free of disability
d. Quality-adjusted life years (QALY)

Answer 15

b. Healthy life expectancy

Question 16

A measure of mental health, general well-being, self-control and vitality.

a. General well-being adjustment scale
b. Healthy life expectancy
c. Life expectancy free of disability
d. Quality-adjusted life years (QALY)

Answer 16

a. General well-being adjustment scale

Question 17

The average number of years of disability –free life remaining at a given age.

a. General well-being adjustment scale
b. Healthy life expectancy
c. Life expectancy free of disability
d. Quality-adjusted life years (QALY)

Answer 17

c. Life expectancy free of disability

Question 18

In the 1950s, Hollingshead and Redlich showed an association between social class and mental illness, with more cases of mental illness found in the lower social classes. This finding:

a. Indicates that mental illness and social class are correlated; causality is uncertain.
b. Indicates that mental illness and social class are correlated; the relationship is indirect.
c. Indicates that mental illness and social class are correlated; poverty produces more mental illness.
d. Indicates that the treatment of mental illness should include social welfare.
e. Is spurious because it is not biologically plausible.

Answer 18

a. Indicates that mental illness and social class are correlated; causality is uncertain.

Question 19

Which of the following is a relatively minor contributor to individual health?

a. Household income
b. Personal education
c. Clean water
d. Adequate food
e. Health care

Answer 19

e. Health care

Question 20

A 63-year-old man has high blood pressure, high cholesterol, and poorly controlled diabetes. His physician is concerned that he is a t high risk for a heart attack and counsels him to quit smoking. According to the Health Belief Model, in order for the patient to change his behavior and quit smoking, he must believe:

a. Smoking is a disease
b. He can easily survive a heart attack.
c. Quitting will be difficult.
d. Quitting can prevent a heart attack.
e. The physician has the patient’s best interest in mind.

Answer 20

d. Quitting can prevent a heart attack.

Question 21

A 63-year-old man has high blood pressure, high cholesterol, and poorly controlled diabetes. His physician is concerned that he is a t high risk for a heart attack and counsels him to quit smoking.
The patient considered his physician’s advice and purchased nicotine gum. By the transtheoretical model, the purchase of the gum represents what stage of change.
a. Precontemplation
b. Contemplation
c. Preparation
d. Action
e. Maintenance

Answer 21

c. Preparation

Question 22

Mother cows (vacca in Latin) pass protection from disease to their calves through breast mild. Similarly, human mothers can pass protection from disease to their infants through breast milk. Both such transfers of immunity are examples of :

a. Vaccination
b. Passive immunity
c. Active immunity
d. Herd immunity
e. Cell-mediated immunity

Answer 22

B & E

Passive and cell-mediated immunity

Question 23

A population’s risk of disease unvaccinated is 90%. With vaccine that risk falls to 10%. The vaccine’s effectiveness is thus (0.9 – 0.1)/0.9 = 88.9%. This quantity is equivalent to the:

a. Attack rate (AR)
b. Number needed to treat (NNT)
c. Relative risk (RR)
d. Relative risk reduction (RRR)
e. Absolute risk reduction (ARR)

Answer 23

d. Relative risk reduction (RRR)

Question 24

Which of the following is a valid medical reason not to immunize a child (or an adult)?

a. Redness and swelling at the injection site following a previous vaccination
b. Fever from a previous vaccination
c. Fever at presentation for vaccine
d. Current therapy with antibiotic
e. Encephalopathy of unknown cause within 7 days of previous vaccination

Answer 24

e. Encephalopathy of unknown cause within 7 days of previous vaccination

Question 25

After a lecture on diabetes management, a medical student tells a patient, “Your hyperglycemia is well above the normal range. The indicated treatment at this time is insulin.” The patient stares blankly. When the attending physician enters the room, she asks the patient, “What do you call your problem? What do you think causes it, and how do you think we should treat it?” The patient replies, “I have ‘the sugar.’ I think it’s because I eat too many sweets. I think I need to cut back on sweets.”
The physician nods and says, “You’re right in that you have sugar; you have too much sugar in the wrong places, and your body is not handling it well. Certainly the foods you choose to eat, including sweets, are an important part of getting your sugar under control. Let’s talk about how we can improve your sugar by changing the kinds of foods you eat, then about other ways we may need to consider to get the problem under control.” In the scenario above, the attending physician’s approach is sensitive to:
a. Cultural competency and health literacy
b. Cultural competency but not health literacy
c. Health literacy but not cultural competency
d. Neither health literacy nor cultural competency
e. Only to the medication agenda of the medical student

Answer 25

a. Cultural competency and health literacy

Question 26

Which of the following could be an example of secondary prevention?

a. Detection and treatment of hypertension
b. Early treatment of diabetic nephropathy
c. Folic acid supplementation of foods
d. Percutaneous transluminal coronary angioplasty
e. Vaccination against hepatitis B

Answer 26

a. Detection and treatment of hypertension

Question 27

A screening program is designed for the early detection of lung cancer after a clinical study shows promising results. The survival time from diagnosis in individuals whose lung cancer was detected by screening is 3 months longer than that in individuals who did not undergo screening, but rather were diagnosed after presenting with symptoms of lung cancer. This difference is most likely caused by:

a. Better clinical care of the patients found through screening
b. Effect modification
c. Lead-time bias
d. Length bias
e. Observer bias

Answer 27

c. Lead-time bias

Question 28

A screening program designed to find candidates for liver transplantation would be ill-advised because:

a. False-negative results might occur.
b. The condition is too common.
c. The necessary resources for treatment are in short supply.
d. The population at risk is unknown.
e. The treatment is invasive.

Answer 28

c. The necessary resources for treatment are in short supply.

Question 29

Data obtained through screening at health fairs are of little epidemiologic value because:

a. Comorbid conditions may go undetected.
b. False-positive results are common.
c. Follow-up is inadequate.
d. Most conditions are rare in random samples.
e. Self-selection produces a biased sample.

Answer 29

e. Self-selection produces a biased sample.

Question 30

There are now recommendations against the routine use of prostate-specific antigen to screen for prostate cancer partly because:

a. Prostate cancer cannot be detected until it is symptomatic.
b. Prostate cancer is a rare disease.
c. Although uncommon, false-positive results are associated with poor patient outcomes.
d. The appropriate management of asymptomatic prostate cancer is uncertain.
e. There is no effective treatment for prostate cancer.

Answer 30

d. The appropriate management of asymptomatic prostate cancer is uncertain.

Question 31

Twenty-five tests are being performed together in a multiphasic screening program. If the tests measure different values (i.e., the tests are independent), and if each test has a 5% false-positive error rate, the approximate percentage of healthy participants in whom at least one false-positive result would be found is:

a. 26%
b. 33%
c. 54%
d. 72%
e. 82%

Answer 31

d. 72%

Question 32

1. The concept of “lifetime health monitoring” refers to:
   a. Routine performance of a comprehensive physical examination
   b. The aggregate use of diagnostic technology during an individual’s lifetime
   c. The compilation of a comprehensive list of risk factors for chronic disease accumulated over a lifetime
   d. The completion of periodic health surveys compiled in a national database
   e. Modification of periodic physical examinations to focus on likely conditions in a given individual

Answer 32

e. Modification of periodic physical examinations to focus on likely conditions in a given individual

Question 33

The U.S. Preventive Services Task Force (USPSTF) was created by the Department of Health and Human Services to:

a. Make evidence-based lifestyle recommendations toward the prevention of chronic diseases.
b. Devise strategies for preventing the spread of infectious diseases domestically.
c. Devise strategies for preventing the development of antimicrobial resistance.
d. Devise strategies for prevention of teen pregnancy and preterm birth.
e. Recommend appropriate roles for screening and case finding in the periodic physical examination.

Answer 33

e. Recommend appropriate roles for screening and case finding in the periodic physical examination.

Question 34

Health risk assessments (HRAs) are used to determine an individual’s “risk age.” Which of the following is correct regarding risk age?

a. If the chronologic age exceeds the risk age, the risk of death is below average.
b. If the risk age exceeds the chronologic age, the risk of death is below average.
c. If the risk age is low, the risk of death is high.
d. The risk age is defined by the age of onset of risk factors for chronic disease.
e. The risk of death is greatest when the risk age equals the chronologic age.

Answer 34

a. If the chronologic age exceeds the risk age, the risk of death is below average.

Question 35

A professional organization makes a recommendation for universal screening for autism spectrum disorder (ASD) in young children. The recommendation is not based on a systematic review of the literature but rather expert consensus. Critics of the recommendation point out potential financial and emotional conflicts of interest and are concerned about the very low specificity that prior literature reports of the screening test. The critics concerns about specificity would be most justified if:

a. The prevalence of ASD is low.
b. The sensitive of the screening test is low.
c. The harms associated with false-positive screens are unknown.
d. Early detection of ASD by screening results in no meaningful long-lasting improvement compared to detection of ASD through routing care.
e. Screening does not detect ASD significantly earlier than detection through routine care.

Answer 35

c. The harms associated with false-positive screens are unknown.

Question 36

Which is an example of tertiary prevention?

a. Hospice care (end-of-life palliative care)
b. Occupational therapy after a stroke
c. Post-exposure prophylaxis for rabies
d. Treatment of essential hypertension
e. Using nasal steroids with topical decongestants to prevent rebound congestion

Answer 36

b. Occupational therapy after a stroke

Question 37

Under what circumstances can primary and tertiary prevention of medical disease most obviously be achieved concurrently in different individuals through the treatment of one patient?

a. Never, because primary and tertiary prevent are mutually exclusive.
b. When a patient is treated for a hip fracture
c. When a patient is treated for active tuberculosis
d. When a patient is treated for cystitis (an uncomplicated urinary tract infection)
e. When a patient is treated for a heart attack

Answer 37

c. When a patient is treated for active tuberculosis

Question 38

How much higher is the age-specific risk of myocardial infarction (heart attack) in smokers than in nonsmokers?

a. The risk is not higher.
b. 1.33 times as high
c. Twice as high
d. 10 times as high
e. 100 times as high

Answer 38

c. Twice as high

Question 39

According to ATP III (Adult Treatment Panel III, or the Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults), the desirable level of LDL cholesterol varies according to:

a. Race
b. Presence of diabetes
c. Body Mass Index
d. Level of triglycerides in the blood
e. Presence or absence of symptomatic coronary artery disease

Answer 39

e. Presence or absence of symptomatic coronary artery disease

Question 40

A disadvantage of using only the total cholesterol (TC) level to predict the risk of cardiovascular disease is that:

a. HDL is included in the measure
b. The ratio of LDL to VLDL is unknown.
c. TC levels are estimated rather than measured.
d. TC levels fluctuate wildly.
e. In contrast to triglyceride levels, TC levels vary with meals.

Answer 40

a. HDL is included in the measure

Question 41

According to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and treatment of High blood Pressure (JNC 7), which of the following medication classes has a compelling indication to be given for all of these conditions associated with hypertension: high cardiovascular disease risk, treatment after heart attack, treatment after stroke, treatment for heart failure, chronic kidney disease, and diabetes.

a. Alpha blockers
b. Angiotensin-converting enzyme (ACE) inhibitors
c. Calcium channel blockers
d. Thiazide diuretics
e. Beta blockers

Answer 41

b. Angiotensin-converting enzyme (ACE) inhibitors

Question 42

The Diabetes Control and Complications Trial (DCCT) showed that:

a. Microvascular complications of diabetes are independent of glycemic control.
b. Monitoring the urine glucose level is more cost-effective than monitoring the blood glucose level.
c. Only macrovascular complications of diabetes are preventable.
d. The risk of hypoglycemia outweighs the benefit of tight glycemic control.
e. Tight glycemic control delays the onset of microvascular complications.

Answer 42

e. Tight glycemic control delays the onset of microvascular complications.

Question 43

Kidney damage in diabetes, as revealed by microalbuminuria (inappropriate appearance of protein in urine), is best treated with:

a. A sulfonylurea
b. An ACE inhibitor
c. Dialysis
d. Insulin
e. Lifestyle modifications

Answer 43

b. An ACE inhibitor

Question 44

An elderly man has his first stroke (cerebrovascular accident). In the United States, tertiary prevention of first stroke:

a. Includes the restoration of functional ability through physical therapy.
b. Is generally ineffective because the incidence of first stroke is rising.
c. Is generally ineffective because risk factors for a first stroke are largely unknown.
d. Relies predominantly on pharmacotherapy for hyperlipidemia.
e. Relies predominantly on screening for a carotid stenosis.

Answer 44

a. Includes the restoration of functional ability through physical therapy.

Question 45

Two soldiers are severely burned in an explosion during combat. They have minimal loss of physical function but comparably disfiguring facial and body burns. After the war, one soldier becomes a confident motivational speaker whereas the other becomes chronically depressed and avoids leaving the house. The two soldiers have:

a. Different disease, different disability
b. The same disease, different disability
c. Different disease, different illness
d. The same disease, different illness
e. The same illness, different disability

Answer 45

d. The same disease, different illness