Epidemiology

Question 1

A quality assurance program should include all the following features EXCEPT:

a - identify who is your customer (patient)
b - identify what services are required by the customer (patient)
c - identify how services are provided to the customer (patient)
d - identify the cost of the services to the customer (patient) compared to other institutions
e - identify processes by which services to the customer (patient) may be improved

Answer 1

d - identify the cost of the services to the customer (patient) compared to other institutions

the audit cycle

Question 2

What does random allocation achieve?

a - equal numbers in each arm of the trial
b - equal distribution of confounding factors
c - increased readership of your article
d - equal distribution of possible unknown factors

Answer 2

d - equal distribution of possible unknown factors

But b is also right
b - equal distribution of confounding factors

Question 3

You perform a biophysical profile on 100 patients. The test is positive in 10 cases. There are 2 stillbirths, both of which occurred in patients with a positive test result. The sensitivity of the test is:

a - 0%
b - 20%
c - 50%
d- 80%
e - 100%

Answer 3

e - 100%

Sensitivity = Chance that the test result will be positive in a patient who actually has the disease

Question 4

If test for Chlamydia has sensitivity 95% and specificity 95% and prevalence is 30% then positive predictive value is approx 90%. If prevalence is now 5% then PPV is:

a - 10%
b - 30%
c- 50%
d - 70%
e - 90%

Answer 4

c - 50%

PPV = (sensitivity x prevalence) / [ (sensitivity x prevalence) + ((1 – specificity) x (1 – prevalence)) ]

Question 5

If the sensitivity and specificity of a test stay the same with increasing prevalence the positive predictive value will:

a - increase
b - decrease
c - stay the same

Answer 5

a - increase

Question 6

To increase the power of a study you should:

a- employ a statistician
b - test for a high frequency outcome
c - test for a low frequency outcome
d - increase your sample size

Answer 6

d - increase your sample size

Question 7

Which of the following is an example of an indirect maternal death

a - woman dies after massive postpartum haemorrhage
b - woman dies of intracerebral haemorrhage associated with an eclamptic fit
c - woman dies of cardiac failure in labour secondary to mitral stenosis
d - woman dies of acute renal failure resulting after a placental abruption
e - woman dies of intraabdominal haemorrhage caused by and ectopic pregnancy

Answer 7

c - woman dies of cardiac failure in labour secondary to mitral stenosis

Question 8

Bias is

a - reduced by increasing sample size
b - systematic error
c - not affected by blinding

Answer 8

b - systematic error

consistently pushes results one way

Question 9

Most likely to cause maternal mortality

a- mitral stenosis
b - diabetes
c - PIH
d - Pulmonary stenosis

Answer 9

a- mitral stenosis

Question 10

In RCT the proven benefits of screening for GDM are
a - decreased PNM
b - decreased shoulder dystocia
c - decreased neonatal jaundice
d - all of the above
e - none of the above

Answer 10

d - all of the above

HAPO

Question 11

The difference between a case-control and a cohort study is:

a - in a case-control study the subjects are allocated by disease status and in a cohort study by exposure status
b - in a case-control study the subjects are allocated by exposure status and in a cohort study by disease status
c - a case-control study is retrospective whereas a cohort study is prospective
d - a case-control study is prospective whereas a cohort study is retrospective

Answer 11

a - in a case-control study the subjects are allocated by disease status and in a cohort study by exposure status

Question 12

A 32 yo with 2 children sees you requesting sterilisation. You decide not to. This decision is an example of a:

a - clinical decision
b - ethical decision
c - moral decision
d - collaborative decision

Answer 12

b - ethical decision

or a

not enough info

Question 13

The purpose of ethics is to:

a - resolve moral dilemmas
b - provide ultimate judgement
c - guide us in uncertainty
d - replace clinical decisions

Answer 13

c - guide us in uncertainty

Question 14

The decision to allocate funds towards the purchase of new laparoscopic equipment for the department of O&G is an example of the ethical principle of:

a - beneficence
b - non-maleficence
c - paternalism
d - distributive justice

Answer 14

d - distributive justice

Question 15

The application of ethics in O&G is:

a- free of moral and religious beliefs
b - influenced by personal opinion
c - different to ethics of everyday life

Answer 15

b - influenced by personal opinion

Question 16

Re positive predictive value. Which is correct?

a - For a given sensitivity and specificity positive predictive value increases with increasing prevalence
b - PPV may increase or decrease with increasing prevalence depending on other factors

Answer 16

a - For a given sensitivity and specificity positive predictive value increases with increasing prevalence

Question 17

Which of the following IS CORRECT

a. The sensitivity of a test is proportional to the specificity
b. Sensitivity and specificity are properties of a test not affected by the prevalence of the disease in question
c. Sensitivity and PPV are interchangeable terms
d. Specificity is the reciprocal of the NPV
e. When testing for a rare disease, a test with a high sensitivity and specificity will also have a high predictive value

Answer 17

b. Sensitivity and specificity are properties of a test not affected by the prevalence of the disease in question

Question 18

A rapid diagnostic test for Chamydia has sensitivity 95% and specificity 95%. In an STI clinic with a prevalence of Chlamydia of 30 percent, the positive predictive value is 90%. In a private practice with a prevalence of Chlamydia of 5 percent, the positive predictive value is about:

a. 5%
b. 30%
c. 50%
d. 90%
e. 95%

Answer 18

c. 50%

PPV = true positives / all positives

Question 19

What is a ‘placebo effect’

a. The improved outcome from an inert therapy
b. The effect of blinding patients to the nature of their therapy
c. The effect of blinding clinicians to their patients allocation
d. The effect of blinding those assessing outcomes to the allocations

Answer 19

a. The improved outcome from an inert therapy

Question 20

The perinatal mortality rate is

a. The number of babies born alive who die within 28 days of birth divided by the total number of live births
b. The sum of the stillbirth rate and the neonatal death rate
c. The number of stillbirths divided by the total number of babies born
d. The sum of the number of stillbirths and the number of neonatal deaths divided by the total number of births

Answer 20

d. The sum of the number of stillbirths and the number of neonatal deaths divided by the total number of births

Question 21

In an RCT of a new repair technique for rectocele, the MOST APPOPRIATE method for determining outcome of the repair is

a. Sim speculum examination by surgeon after 3 months
b. Validated Pelvic organ prolapse questionnaire assessed by the surgeon after 3 months
c. POP-Q score by a blinded assessor at 3 months
d. Bimanual examination by a blinded external observer at 3 months

Answer 21

c. POP-Q score by a blinded assessor at 3 months

Question 22

The statistical power of a study is MOST LIKELY to be increased by

a. Increasing the sample size
b. Employing a statistician
c. Selecting a beta value of 80 percent
d. Selecting an outcome end-point occurring at low frequency
e. Selecting an outcome end-point occurring at high frequency

Answer 22

a. Increasing the sample size

Question 23

The current perinatal mortality rate for Australia is CLOSEST TO

a. 5 per 1000 live births
b. 5 per 1000 total births
c. 10 per thousand live births
d. 10 per thousand total births
e. 15 per thousand live births
f. 15 per thousand total births

Answer 23

d. 10 per thousand total births

Question 24

100 high risk patients undergo fetal biophysical profile. 10 patients have a positive test. Two stillbirths result, both of which came from the pool of patients with a positive test. The sensitivity of the fetal biophysical profile test in this population is

a. 0 percent
b. 2 percent
c. 20 percent
d. 80 percent
e. 100 percent

Answer 24

e. 100 percent

Question 25

Which is LEAST CORRECT

a. A finding of no difference between the two arms of an RCT may reflect the fact that the study did not have a sufficient sample size to detect a clinically important difference
b. When an RCT that addresses a clinical problem has been performed, this will outweigh all other evidence
c. The incorporation of multiple trial centres facilitates the achievement of a large sample size often required for an RCT, but may necessitate flexible trial protocols to accommodate a broad spectrum of clinical opinion
d. Flexible entry criteria facilitate the achievement of a large sample size often required for an RCT but at the cost of a conclusion drawn from a heterogeneous population that may not apply to subgroups within the population.

Answer 25

b. When an RCT that addresses a clinical problem has been performed, this will outweigh all other evidence

Question 26

Which of the following actions and activities in the physician/patient relationship is NOT an example of sexual misconduct

a. The patient and physician mutually consent to the sexual relationship
b. A romantic relationship between a physician and current patient in which emotional counselling has taken place
c. A romantic relationship between a physician and a former patient in which emotional counselling has taken place
d. None of the above

Answer 26

d. None of the above

Question 27

Review the diagram and choose the CORRECT statement
Disease present Disease absent
Test positive 80 20
Test negative 20 80

a. The test correctly identified 40% (80/200) of the disease in the study participants
b. The negative predictive value was 80% in this study
c. The sensitivity and specificity were each 40%
d. If the test detected serious female disease and cost $10, it would be cost effective to screen all women

Answer 27

b. The negative predictive value was 80% in this study

Question 28

Testing a newborn for phenylketonuria is

a. Diagnostic testing
b. Predictive testing
c. Carrier testing
d. Exclusion testing

Answer 28

a. Diagnostic testing

Question 29

Which of the following is NOT a reason, identified by the literature, for patient’s expression of dissatisfaction while being told their diagnosis

a. Doctors perceive their breaking bad news skills to be inadequate
b. Most patients do not wish to be told their diagnosis
c. Doctors fear that breaking bad news will cause long term harmful consequences
d. Patients may not be asking questions for which they desire more information

Answer 29

b. Most patients do not wish to be told their diagnosis

Question 30

Which of the following programs LOWERS total medical costs

a. Maternal serum alpha-fetoprotein screening in pregnant women
b. Screening mammograms for women aged 40-50
c. Antepartum steroids given to mothers before the premature delivery of an infant
d. Complete blood counts as part of an annual routine examination

Answer 30

c. Antepartum steroids given to mothers before the premature delivery of an infant