Economy

Question 1

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

Answer 1

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

Question 2

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?

Answer 2

Each year of his life contributes less than 0.1 QALY.

Question 3

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

Answer 3

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

Question 4

4. Which of the following is an example of secondary prevention?

Answer 4

Cholesterol reduction in a patient with asymptomatic coronary artery disease

Question 5

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:

Answer 5

Overwhelming allostatic load

Question 6

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

Answer 6

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

Question 7

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 apatient 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?

Answer 7

$15,180

Question 8

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

Answer 8

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

Question 9

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:

Answer 9

Has a favorable cost-benefit ratio.

Question 10

10. Vaccinating a health care worker against hepatitis B virus.

Answer 10

Specific protection

Question 11

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.

Answer 11

Secondary prevention

Question 12

12. Performing carotid endartectomy in a patient with transient ischemic attacks.

Answer 12

Tertiary prevention

Question 13

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

Answer 13

Health promotion

Question 14

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

Answer 14

Quality-adjusted life years (QALY)

Question 15

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

Answer 15

Healthy life expectancy

Question 16

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

Answer 16

General well-being adjustment scale

Question 17

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

Answer 17

Life expectancy free of disability

Question 18

1. 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:

Answer 18

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

Question 19

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

Answer 19

Health care

Question 20

3. A 63-year-old man has high blood pressure, high cholesterol, and poorly controlled diabetes. His physician is concerned that he is at 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,

Answer 20

Quitting can prevent a heart attack.

Question 21

4. The patient from question 3 considered his physician’s advice and purchased nicotine gum. By the transtheoretical model, the purchase of the gum represents what stage of change.

Answer 21

Preparation

Question 22

5. 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 :

Answer 22

Passive immunity

Question 23

6. 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:

Answer 23

Relative risk reduction (RRR)

Question 24

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

Answer 24

Encephalopathy of unknown cause within 7 days of previous vaccination

Question 25

8. 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:

Answer 25

Cultural competency and health literacy

Question 26

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

Answer 26

Detection and treatment of hypertension

Question 27

2. 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:

Answer 27

Lead-time bias

Question 28

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

Answer 28

The necessary resources for treatment are in short supply.

Question 29

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

Answer 29

Self-selection produces a biased sample.

Question 30

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

Answer 30

The appropriate management of asymptomatic prostate cancer is uncertain.

Question 31

6. 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:

Answer 31

72%

Question 32

7. The concept of “lifetime health monitoring” refers to:

Answer 32

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

Question 33

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

Answer 33

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

Question 34

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

Answer 34

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

Question 35

10. 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

Answer 35

The harms associated with false-positive screens are unknown.

Question 36

1. Which is an example of tertiary prevention?

Answer 36

Occupational therapy after a stroke

Question 37

2. 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?

Answer 37

When a patient is treated for active tuberculosis

Question 38

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

Answer 38

Twice as high

Question 39

4. 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:

Answer 39

Presence or absence of symptomatic coronary artery disease

Question 40

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

Answer 40

HDL is included in the measure

Question 41

6. 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.

Answer 41

Angiotensin-converting enzyme (ACE) inhibitors

Question 42

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

Answer 42

Tight glycemic control delays the onset of microvascular complications.

Question 43

8. Kidney damage in diabetes, as revealed by microalbuminuria (inappropriate appearance of protein in

Answer 43

An ACE inhibitor

Question 44

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

Answer 44

Includes the restoration of functional ability through physical therapy.

Question 45

10. 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:

Answer 45

The same disease, different illness