EPIDEMIOLOGY 227 FINAL EXAMINATION. June

Transcription

1 EPIDEMIOLOGY 227 FINAL EXAMINATION June Select the best answer for the multiple choice questions. There are 9 questions and 14 pages on the examination. Notify the instructor if your examination does not have 14 pages. Clearly indicate on the scan form the one best answer to each question among the answers provided. Be sure that you have selected your choice correctly on the scan form. Be sure that you have entered your name and identification number on the scan form and filled out the columns for the letters of your name and numbers of your identification number correctly (see front and back). Use a #2 pencil and fill all circles completely. 1. The countries with the highest number of injecting drug users are: a. China, USA, Russia b. South Africa, Thailand, Myanmar c. Indonesia, China, USA d. Russia, Finland and France e. England, Japan and Taiwan 2. The proportion of former drug users released from rehabilitation centers in Asia who return to drug use is: a. 10% b. 25% c. 50% d. 75% e. 90% 3. A recent study in Bangladesh suggests that risk of HIV infection among drug injectors sharing equipment is three-fold higher than for those who do not share injecting equipment: 4. Drug users in Asia tend to remain within their families in Asia: 5. The most important factor in reducing the incidence of new drug users in the intervention study in southern Yunnan Province reported by Professor Detels was: a. Leadership from Beijing b. Opening of needle exchange and methadone clinics c. Persuading the local communities to take the leadership for developing the intervention d. Mobilization of the staff of the local anti-epidemic stations e. Declaration of a war on drugs by Jin Tao 1

2 6. The largest risk group for new HIV infections in the United States is among: a. Men who have sex with men b. Injecting drug users c. Commercial sex workers d. Women e. Heterosexual men 7. In Los Angeles, the group with the highest prevalence of HIV infection is: a. Men who have sex with men but don t use metamphetamine b. Injecting drug users c. Men who have sex with men and use metamphetamine d. Hispanic-American women e. European-American women 8. Needle exchange programs are unlikely to succeed if they are not combined with other services: 9. Drug users successfully treated with methadone increase their numbers of sexual partners: 10. Contingency management of metamphetamine users is: a. Anticipating metamphetamine usuage by addicts b. Planning for future use of metamphetamine c. Preventing purchase of metamphetamine d. Paying for drug-free urine samples e. All of the above 11. Structural interventions to prevent HIV involve: a. Improved access to condoms b. Policy to establish needle exchange programs c. Policy to increase access to HIV testing e. b. and c. above 12. Task shifting in behavioral intervention programs is: a. Utilization of non-health professionals to implement the intervention b. Changing the tasks to be performed by the participants in the behavioral intervention c. Achieving a consensus on who is to perform which intervention tasks d. Shifting the tasks to be performed by staff weekly 2

3 13. Behavioral theory attempts to explain the elements necessary for achieving behavior change, but does not specify the content of the intervention nor the techniques necessary for behavior change: 14. Cost-effectiveness of targeted behavioral interventions is greatest for: a. Persons living with HIV/AIDS b. High-risk persons c. At-risk persons d. The general population 15. Newly developed self-directed behavioral strategies involve: a. Community health workers b. Provider networks c. Cell-phone/i-pod technology d. Mass media strategies e. a. and d. above 16. Which of the following attributes of surveillance is least important? a. Ongoing (periodic) collection of data b. A high level of accuracy c. Timely analysis d. Dissemination of results e. Periodic evaluation 17. Surveillance is useful to detect: a. Human disease outbreaks b. Zoonotic disease outbreaks c. Lapses in food/water safety e. a. and b.above 18. Surveillance requires: a. A functional diagnostic algorithm b. A competent laboratory for confirmation of diagnosis c. A strategy for accessing target populations 19. Surveillance usually uses which of the following design strategies? a. A cross-sectional survey b. Formation of a cohort c. Case-control documentation d. Nested case-control strategy e. Serial cross-sectional surveys 3

4 20. Which of the following surveillance strategies is subject to the least bias? a. Unlinked anonymous b. Voluntary anonymous c. Voluntary confidential d. Routine confidential e. Opportunistic sampling 21. The ultimate objective of sentinel surveillance for HIV is to stimulate appropriate political and social action: 22. Sentinel surveillance for AIDS cases provides an early warning of an impending HIV/AIDS epidemic: 23. The results of sentinel surveillance need to be disseminated to: a. Decision makers b. Data collectors c. The general public e. a. and c. above 24. The risk of receiving a unit of blood contaminated with HIV is now one (1) per: a. 500,000 units b. 1 million units c. 2 million units d. 50 million units 25. To assure that the blood supply in the United States is safe, all blood is tested for HIV using: a. Nucleic acid testing (TMA) b. p24 antigen testing c. gp120 antibody testing d. p24 antibody testing e. p17 testing 26. The risk of infection from a unit of blood is greatest for which of the following organisms? a. HIV b. Hepatitis B c. Hepatitis C d. HTLV-1 4

5 27. Because there is an urgent need for blood in the U.S., blood banks use a cash incentive to increase the supply of blood: 28. Telephone call-back by blood donors is designed to: a. Correct information about blood type b. Facilitate stigma-free self-exclusion of blood use c. Assure that blood is correctly identified d. To exclude blood donations by persons with diabetes 29. Factor VIII is now considered to be safe because: a. It is tested for pathogens b. It is made synthetically and is not derived from blood c. Donors are carefully screened before donating d. Donors are not offered incentives 30. The goal of blood banks in the United States is to: a. Provide cost-effective testing of all blood donations b. Guarantee that blood is free of HIV, HCV, HBV and syphilis c. Provide blood that has zero risk of pathogens d. Eliminate costly testing of pathogens with low prevalence 31. In an effort to protect the blood supply, prospective male blood donors are required to admit whether they engage in sex with other men: 32. Over half of Hispanic-Americans in the U.S. originally came from which of the following countries? a. Cuba b. Haiti c. Mexico d. Puerto Rico e. Central America 33. Which of the following is true about Mexicans living in the U.S.? a. 10% of all Mexicans live in the U.S. b. They are the largest group of Latinos in the U.S. c. Most are undocumented aliens d. a. and b. above e. All of the above 5

6 34. All of the following characteristics of Latinos except one below delay their HIV testing and receipt of care. Which of these is NOT a reason for the delays? a. A greater tolerance for homosexual behavior b. Gender inequality c. Machismo d. Drub and alcohol abuse e. Fear of stigma of HIV 35. Which of the following increase(s) the risk of HIV for Latina women? a. Male infidelity b. Domestic violence c. Most (about 2/3) of Latina women with AIDS report having multiple sex partners in their lifetime d. a. and b. above e. All of the above 36. Men on the down low refers to: a. Latinos who are addicted to methamphetamine b. Men who identify as heterosexual but have undisclosed sex with other men c. Illegal immigrants who receive money for wages that are not reported d. Men who, because of no income, are forced to sleep on the streets e. None of the above 37. The treatment of Latinos with HIV must take into account cultural factors that may differ from white culture, including: a. Punctuality not considered essential b. Being rushed may be seen as rude behavior c. Communication may be less direct d. Preference for mutual respect in relations with authority figures e. All of the above 38. The region of the U.S. that borders Mexico, compared to the U.S. average, has: a. A higher incidence of infectious diseases b. Higher unemployment c. Lower education d. Lower income e. All of the above 39. Which men are at the highest risk for HIV/AIDS in Mexico? a. Injecting drug users b. Men who have sex with men c. Heterosexuals d. Hemophiliacs 6

7 40. What proportion of women infected with HIV in the United States report only one sexual partner in their lifetime? a. 10% b. 27% c. 39% d. 65% e. 92% 41. By 28 days post-partum, what proportion of HIV-infected infants will have a positive test for HIV-DNA? a. 12% b. 26% c. 37% d. 54% e. 98% 42. HIV-infected mothers who breastfeed their infants should supplement breast feeding with high-nutrition foods: 43. A C-section delivery will significantly reduce the likelihood of in-utero infection of the infant with HIV: 44. The risk of HIV infection through breast feeding decreases with duration of breast feeding: 45. Protease inhibitors are not the drug of choice for antenatal treatment of the mother to prevent HIV transmission to the infant because they: a. Are expensive b. Do not cross the placenta c. Have many side effects d. Do not prevent infection of the CD4 cell e. All of the above 46. AIDS was first described in homosexual men in which city? a. San Francisco b. Los Angeles c. Rio de Janeiro d. Paris e. Bangkok 7

8 47. Stonewall refers to: a. How gays dealt with the police b. The gay bar where the gay liberation movement began c. The barriers that gays face from the heterosexual population d. The wall surrounding prisons for gays e. The frustration gays feel about not being allowed to marry 48. What disease was diagnosed in the first cases of AIDS? a. Pneumocystis pneumonia b. Kaposi s sarcoma c. Thrush d. Hepatitis e. Pemphigus 49. The terms gay and MSM are interchangeable: 50. Serosorting is the practice of: a. Having sex with only men of the same HIV status as oneself b. Segregating HIV-positive prisoners from HIV-negative prisoners c. Testing persons to determine if they are infected d. Classifying the results of HIV testing 51. The epidemic of metamphetamine is affecting which subgroup most severally? a. Female sex workers b. Male sex workers c. Gay men d. Hispanics e. Asian-Americans 52. Females of which of the following groups are at the highest risk of HIV? a. European-Americans b. Asian-Americans c. Hispanic-Americans d. Native-Americans (Indians) e. African-Americans 53. In the following transmission dynamics model, what does c represent? R0= ßx c x D a. Case reproduction rate b. Efficiency of transmission c. Duration of infection d. Mean rate of partner change 8

9 54. Disassortative mixing is random selection of sexual partners by sexually active persons: 55. Factors encouraging disassortive mixing include: a. Gender, gender norms, age, sex ratio imbalances b. Gender norms, sex ratio imbalances, availability of public sex venues c. Gender, sex ratio imbalances, availability of public sex venues d. Race, sex ratio imbalances, gender norms 56. Sexual concurrency is a major factor in fueling an epidemic of sexually transmitted diseases: 57. African-American women are: a. Less likely to marry b. More likely to marry at an older age c. More likely to get divorced e. b. and c. above 58. The pool of eligible men for African-American women to marry is lower than for European-American women because: a. Many African-American men are in prison b. The rate of homicide among African-American men is higher than for European-American men c. The ratio of males to females at birth is lower among African-Americans 59. Public health ethics focuses on: a. The patient b. The community c. The research subject d. Minorities e. Women 60. The primary goal of public health is to protect: a. The uninfected b. The infected c. Persons with chronic diseases d. Persons with cholera 9

10 61. Informed consent was first mandated by: a. The Nuremberg Code b. The Declaration of Helsinki c. The Council for International Organizations of Medical Science d. The Belmont Report 62. The three core principles of ethical research as enumerated by the Belmont Report are: a. Fairness, equity and compensation b. Respect for persons, beneficence, justice c. Equity, respect for persons, remuneration d. Justice, equity and fairness e. Remuneration, respect for person and beneficence 63. The CIOMS Guidelines provide precise rules covering the entire range of ethical research: 64. Informed consent means that the potential participant has: a. Received the necessary information b. Understood the information c. Has not been subject to coercion or undue influence 65. Informed consent can only list known and anticipated risks associated with participation in a study: 66. Which of the following complications of HIV infection is not associated with a high risk of death? a. AIDS dementia complex b. Peripheral neuropathy c. Meningitis d. Progressive multifocal leukoencephalopathy e. All of the above are associated with a high risk of death 67. The group with the highest proportion of late-stage HIV/AIDS at the time of initial diagnosis is highest for which ethnic subgroup in the U.S.? a. European-Americans b. Hispanic-Americans c. African-Americans d. Asian-Americans 10

11 68. HIV infects which of the following cells in the central nervous system? a. Macrophages b. Astrocytes c. Neurons 69. Hairy leukoplakia: a. Occurs in early HIV disease b. Is difficult to treat effectively c. Occurs only in late HIV disease d. a. and b. above e. b. and c. above 70. The most common opportunistic infection diagnostic of AIDS is: a. Histoplasmosis b. Toxoplamosis c. Pneumocystis carinii d. Mycobacterium tuberculosis e. Leishmaniasis 71. Which of the following outcomes of HIV infection have increased since the discovery of HAART? a. AIDS malignancies b. Cardiovascular disease c. Metabolic disorders 72. According to a 2005 study in the United Kingdom, the leading cause of AIDSrelated deaths among individuals treated with HAART was: a. Poor adherence to medication (not taking pills) b. Diagnosis too late for effective treatment c. Untreatable complications of HIV infection d. Multiple drug resistance 73. The innate immune response requires: a. Natural killer (NK) cells b. Granulocytes c. Antigen-presenting cells 74. HIV incorporates the complete lipid layer of the CD4 cell into the progeny viruses as they bud: 11

12 75. An acquired immune response requires primarily: a. T cells b. B cells c. Macrophages 76. Neutralization of HIV by the immune system is hindered by: a. The time required to produce neutralizing antibodies b. The rapid rate of mutation of HIV c. Glycosylation of gp120 and gp41 e. b. and c. above 77. Which of the following cancers is currently diagnostic of AIDS? a. Kaposi s sarcoma b. Non-Hodgkin s lymphoma c. Cervical cancer 78. What proportion of infected persons are years of age? a. One third b. One quarter c. One half d. Three quarters 79. The single most important key to the success of the MACS has been: a. The brilliance of the principal investigator b. The commitment of the staff c. The commitment of the participants d. The funding from the National Institute of Health e. The support of the School of Public Health 80. Which of the following subgroups MACS is most likely to contribute to the discovery of a preventive vaccine? a. Long-term non-progressors b. Long-term survivors with low levels of CD4+ cells c. Uninfected men with many different anal insertive partners d. Uninfected men who have very few partners e. Treated men with resistant virus 81. According to the recent MACS study, use of non-injection drugs does NOT increase the risk of HIV infection: 12

13 82. Which of the following components of the MACS was most important in facilitating the use of the nested case-control design for biologic correlates of outcomes? a. Computerized data storage b. Repository of biologic specimens c. The compliance of the participants d. The competence of the staff e. The brilliance of the principal investigator 83. In 2010, the U.S. federal HIV/AIDS budget requested the highest priority for which of the following areas? a. Treatment b. Prevention c. Research d. None of the above 84. Medicaid is a federal/state health insurance program for: a. Low-income people only b. Low-income and disabled persons c. People over 65 years of age d. None of the above 85. Which of the following is not an appropriate study design for conducting surveillance? a. Cohort studies b. Cross-sectional studies c. Case control studies d. Serial cross-sectional studies 86. Risk of transmission of HIV per sexual act depends on: a. Viral RNA level b. Presence/absence of concurrent STDs and other infections c. Condom use 87. The comprehensive package for prevention, treatment and care of HIV among people who inject drugs include: a. Clean needle and syringe program b. HIV testing and counseling c. Antiretroviral treatment 13

14 88. The objectives of a vaccine for an infectious disease agent are to: a. Prevent infection b. Prevent clinical disease c. Prevent transmission 89. The biggest barrier to development of an HIV/AIDS vaccine is: a. Cost of production b. Issues of safety c. No naturally occurring long lasting protective immunity observed d. Difficulties with isolating the virus in culture 90. The concept of exceptionalism implies that: a. HIV-infected persons are exceptional b. HIV/AIDS should not be subject to the usual public health measures c. HIV is an exceptional virus e. a. and c. above 91. The objective of needle and syringe exchange programs is to: a. Reduce risk of HIV, HCV and HBV to individual drug users b. To reduce the prevalence of HIV-, HCV- and HBV-contaminated needles and syringes in the community c. To assure safe sex behaviors 14