Epidemiology Flashcards
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
d - identify the cost of the services to the customer (patient) compared to other institutions
the audit cycle
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
d - equal distribution of possible unknown factors
But b is also right
b - equal distribution of confounding factors
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%
e - 100%
Sensitivity = Chance that the test result will be positive in a patient who actually has the disease
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%
c - 50%
PPV = (sensitivity x prevalence) / [ (sensitivity x prevalence) + ((1 – specificity) x (1 – prevalence)) ]
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
a - increase
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
d - increase your sample size
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
c - woman dies of cardiac failure in labour secondary to mitral stenosis
Bias is
a - reduced by increasing sample size
b - systematic error
c - not affected by blinding
b - systematic error
consistently pushes results one way
Most likely to cause maternal mortality
a- mitral stenosis
b - diabetes
c - PIH
d - Pulmonary stenosis
a- mitral stenosis
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
d - all of the above
HAPO
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
a - in a case-control study the subjects are allocated by disease status and in a cohort study by exposure status
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
b - ethical decision
or a
not enough info
The purpose of ethics is to:
a - resolve moral dilemmas
b - provide ultimate judgement
c - guide us in uncertainty
d - replace clinical decisions
c - guide us in uncertainty
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
d - distributive justice
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
b - influenced by personal opinion
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
a - For a given sensitivity and specificity positive predictive value increases with increasing prevalence
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
b. Sensitivity and specificity are properties of a test not affected by the prevalence of the disease in question
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%
c. 50%
PPV = true positives / all positives
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
a. The improved outcome from an inert therapy
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
d. The sum of the number of stillbirths and the number of neonatal deaths divided by the total number of births
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
c. POP-Q score by a blinded assessor at 3 months
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
a. Increasing the sample size
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
d. 10 per thousand total births
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
e. 100 percent
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.
b. When an RCT that addresses a clinical problem has been performed, this will outweigh all other evidence
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
d. None of the above
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
b. The negative predictive value was 80% in this study
Testing a newborn for phenylketonuria is
a. Diagnostic testing
b. Predictive testing
c. Carrier testing
d. Exclusion testing
a. Diagnostic testing
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
b. Most patients do not wish to be told their diagnosis
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
c. Antepartum steroids given to mothers before the premature delivery of an infant
