Public Health 150 October 29, 2012 MIDTERM EXAMINATION

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1 Public Health 150 October 29, 2012 MIDTERM EXAMINATION Select the best answer from the multiple choice questions. There are 94 questions and 14 pages (printed on both sides of 7 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 bubbles in the columns for the letters of your name and numbers of your identification number correctly. Use a #2 pencil and fill all circles completely. 1. Which of the following is the best definition of public health? a. Ensuring the health of the individual by maintaining and improving the health of the community b. The science and art of preventing disease, prolonging life, and promoting health through the organized efforts of medical science c. The process of mobilizing local, state/provincial, national and international resources to assure the conditions in which all people can be healthy d. All of these are great definitions, but c. is the best since Detels et al. wrote it e. None of these 2. Public health does which of the following: a. Mobilizes communities b. Provides conditions conducive to health c. Promotes healthy lifestyles e. a. and c. above 3. Which of the following is NOT a modern challenge of public health? a. Emergence of new pathogens. b. Persistence of old diseases due to drug resistance/mutation c. Growing burden of noncommunicable (chronic) diseases d. Globalization, social dislocation, and war e. All of these are modern challenges of public health 4. The major cause of poor health globally is: a. Tobacco b. Lack of exercise c. Poverty d. Environmental problems e. Poor diet 5. The population of the world in 2012 is approximately: a. 2 billion b. 5 billion c. 7 billion d. 15 billion e. 25 billion 1

2 6. Globally, at birth, there are: a. More females than males b. More males than females c. An equal number of males and females 7. Globally, among those over 65 years older, there are: a. More females than males b. More males than females c. An equal number of males and females 8. Globally, the major reason for increased longevity is: a. Improved sanitation b. Immunization programs c. Improved treatment of diseases d. Medicare e. Health education 9. Globally, the average number of children per woman is two to three: 10. Globally, the most common religion is: a. Christianity b. Muslim (Islam) c. Judaism d. Atheists e. Buddhism 11. The most common first language globally is: a. English b. Spanish c. Chinese d. French e. American 12. The productive age population (15-65 years) represents the highest proportion of the total population in: a. Developed countries b. Developing countries c. Is approximately the same proportion in all countries d. Is decreasing globally e. a. and d. 13. Males are the more fragile gender: 2

3 14. The ratio of the populations of developing countries to developed countries is decreasing as the developing countries become more affluent: 15. According to estimates based on disability-adjusted life years, which of the following will be the greatest cause of disability adjusted life years globally after cardiovascular diseases? a. Cancer b. Diabetes c. Depression d. Accidents e. Injuries 16. Which of the following is a holy trinity of epidemiology? a. Time, place, agent b. Person, place environment c. Agent, host, environment d. Agent, environment, time e. Person, host, environment 17. Epidemiology is a body of knowledge gained from previous studies: 18. Epidemiologists describe disease factors in terms of: a. Characteristics of affected individuals b. Geographic area in which disease occurs c. Temporal characteristics of the disease 19. A study that compares the prevalence of suspected causal factors between those with and without disease is a/an: a. Ecologic study b. Cohort study c. Experimental study d. Meta-analysis e. Case-control study 20. Cohort study designs are: a. Not suitable for study of infectious diseases b. Follow only exposed individuals over time c. Expensive and time-consuming to conduct d. Based on non-enumerated source populations e. Not suitable for study of occupational hazards 3

4 21. Incidence includes: a. New cases b. New cases occurring in a defined time period c. Existing cases present at a single time point d. New cases, plus existing cases plus deaths e. New cases plus existing cases occurring in a defined time period 22. Prevalence includes: a. New cases b. New cases occurring in a defined time period c. Existing cases present at a single time point d. New cases, plus existing cases plus deaths e. New cases plus existing cases occurring in a defined time period 23. Which of the following pieces of evidence does NOT support the hypothesis of direct fecal-oral transmission of C. philippinensis? a. Clustering of cases within households b. Sequential occurrence of multiple cases within households c. Proximity of cases to the coast d. The impact of treatment e. The similarity of the age-gender distribution of sequential cases to the agegender distribution of Pudoc West 24. In constructing an epidemic curve the ordinate (vertical axis) displays a measure of: a. Time b. Magnitude of outcome c. Gender d. Sexual activities e. Teacher evaluation scores 25. The ultimate truth in epidemiology is: a. The instructor, Professor Detels b. The denominator c. Incidence d. Prevalence e. Morbidity 26. Implementation science is used for: a. Establishing incidence b. Establishing prevalence c. Evaluating strategies to translate science into public health action d. Assessing the relationship between incidence, prevalence and morbidity e. Determining morbidity 27. Epidemiology is the core science of public health: 4

5 28. The art of epidemiology includes knowing when epidemiologic methods are the best way to study a problem and when epidemiologic methods are NOT the best way to study a problem: 29. What disease is currently causing more cases now (October 2012) than it ever has in recorded history of the United States? a. Syphilis b. Tubercilosis c. West Nile disease d. Polio e. HIV/AIDS 30. July 2012 was the warmest month on record in the United States in history: 31. Infectious disease results from an imbalance between,, and : a. Immune competence, host, exercise b. Virus, bacteria, and parasite c. Sleep, transmission, incubation time d. Transmission, infectivity and DNA structure e. Agent, host, and environment 32. Which of the following factors influences the host s response to influenza? a. Age b. Pre-exiting immunity c. Concurrent health problems d. All of these e. None of these 33. Which diseases were the leading causes of death in the United States in both 1900 and 2001? a. Heart disease and cancer b. HIV/AIDS and cancer c. Pneumonia, influenza, and HIV/AIDS d. Pneumonia, influenza, and heart disease e. Pneumonia, influenza, and meningitis 34. What virus caused Curry Village in Yosemite National Park to close in September 2012? a. West Nile virus b. HIV c. Small pox d. Hantavirus e. Influenza H5N1 5

6 35. Which of the following infectious diseases has NOT changed the face of human history? a. The Black Plague /the Black Death b. Cholera c. Tuberculosis/consumption d. Bacterial dysentery e. None of these 36. What drug-resistant microbe(s) is/are currently causing many cases in the United States? a. Syphilis b. Gonorrhea c. Tuberculosis e. b. and c. above 37. Which infectious disease caused the highest mortality globally in 2002? a. HIV b. Lower respiratory infections c. Diarrhea d. Dengue e. Polio 38. The majority of infectious diseases occurring globally today are in: a. East Asia b. Southeast Asia c. Sub-Saharan Africa d. Japan e. Los Angeles 39. The major factor responsible for periodic outbreaks of severe influenza is: a. Increasing susceptibility of human to influenza b. Increasing size of the vulnerable population c. Antigenic drift d. Host immune incompetence e. Political in-fighting 40. Urbanization promotes the rapid spread of infectious diseases through: a. Increasing population density (crowding) b. Creating inadequate resources for safe waste disposal c. Creating inadequate provision of safe drinking water e. b. and c. above 41. Climate change promotes transmission of infectious agents by changing the distribution of vectors globally: 6

7 42. Which of the following factors play(s) a role in appearance and transmission of infectious diseases? a. Human host genetic profiles b. Social factors c. Political factors e. b. and c. above 43. Which of the following is an example of a newly emerging disease? a. Sudden acute respiratory syndrome (SARS) b. Malaria c. Tuberculosis d. Dengue e. Staphlococcal disease 44. What is the single most effective strategy to reducing the threat of infectious diseases? a. Immunizations b. Drug development c. Hygiene education d. Generating political willpower e. None of these 45. Identifying problems related to the public s health is an example of: a. Assessment b. Assurance c. Policy determination d. Luck e. All of the above 46. Laws banning smoking in public places are an example of: a. Behavioral interventions b. Biomedical interventions c. Structural interventions e. a. and c. above 47. Resolving uncertainty is a major role of biostatistics: 48. The role of biostatistics is to: a. Measure problems b. Quantify associations of risk factors and outcomes c. Set policy 7

8 49. What statistical test is used to measure the relationship of two dichotomous variables (2X2 table)? a. Chi square b. Correlation coefficient c. Multiple regression analysis d. Multiple logistic regression analysis e. Any of the above 50. In a study population, we identify a relationship between lung cancer and smoking. This means: a. Everyone who smokes will get lung cancer b. The group of people who smoke are more likely than those who do not smoke to develop lung cancer c. Everyone who refrains from smoking will get lung cancer d. Everyone who smokes will not get lung cancer 51. In an observational study, we observe a relationship between consuming fast food (the predictor variable) and weight gain (the outcome variable). This means: a. Fast food causes weight gain b. Fast food is associated with weight gain c. Fast food is correlated with weight gain d. a. b. and c. above are correct e. b. and c. above 52. In contingency table analysis, we compute a Chi square test statistic to determine whether our outcome is statistically significant. What do we typically use as our cut off value to determine statistical significance? a. P<0.1 b. P<0.01 c. P<0.5 d. P< To look at the relationship between multiple variables and a binary outcome (yes/no), which of the following biostatistical strategies is appropriate? a. Chi square b. Correlation coefficient c. Multiple regression analysis d. Multiple logistic regression analysis e. Any of the above 54. When do we use logistic regression? a. When our outcome (y) variable is continuous b. When our outcome (y) variable is binary c. When our predictor (x) variable is continuous d. When our predictor (x) variable is binary 55. Survival analysis measures the risk of dying from a disease: 8

9 56. Which disease is related with protein deficiency, severe edema, hair discoloration, but can be reversed rapidly with a high protein diet? a. Kwashiorkor b. Marasmus c. Stunting d. Underweight 57. Which disease is related with total energy depletion, where individuals are alert, ravenous and irritable, potentially causing cognitive impairment? a. Kwashiorkor b. Marasmus c. Stunting d. Underweight 58. Which of the following deficiencies results in goiters and cretinism? a. Folic Acid b. Vitamin A c. Iodine d. Zinc 59. Breast milk provides: a. Protection against many infectious agents b. An appropriate mix of nutrients c. Growth-stimulating factors for the digestive tract e. a. and c. above 60. Vitamin A deficiency causes: a. Irreversible blindness b. Stunting c. Impaired wound healing d. Impaired immune function e. a. and d. above 61. A deficiency of iodine in children is associated with: a. Thyroid deficiency b. Impaired intellectual capacity c. Living in mountainous areas 62. Deficient folic acid levels in very early pregnancy increase the likelihood of neural tube (spinal) defects: 9

10 63. Which of the following is not true of breast milk? a. Those not exclusively breastfeeding for the first 4-6 months (EBF) have double the infant mortality rate as EBF in developing countries b. Enhances child spacing as it suppresses ovulation c. Anti-infective agents to help protect the infant from disease are true 64. The quality of a mother s breast milk depends on her health status: 65. In developing countries, it is recommended that HIV-uninfected mothers continue breast feeding their babies for: a. 3 months b. 6 months c. 12 months d. 24 months e. Five years 66. Exclusive breast feeding of babies should continue for: a. 3 months b. 6 months c. 12 months d. 24 months e. Five years 67. Obesity in children in developed countries is associated with early occurrence of type 2 diabetes: 68. The prevalence of obesity is highest in which of the following subgroups in the United States? a. European-Americans b. Asian-Americans c. African-Americans d. Hispanic-Americans 69. Obese individuals are often subjected to: a. Stigma b. Victim blaming c. Mandatory self-help programs 10

11 70. The Women, Infant and Children Program in the US is: a. Funded by the USDA b. Provides nutrition assistance c. Targets pregnant women and children < 5 years d. Reaches 50+% of all infants in the United States e. All of the above 71. According to the reading, the interaction of nutrition and infection is: a. The leading cause of morbidity and mortality in developing countries b. A synergistic relationship that exists between nutritional status and infection c. Measles, AIDS, and weaning are examples of interactions between nutrition and infection are true 72. Which of the following is FALSE regarding the developmental origins of adult disease hypothesis? a. Is based upon the idea of fetal programming, where the fetus makes physiological adaptations in response to changes in its environment to prepare itself for postnatal life b. Is based upon the idea of developmental plasticity, a phenomenon by which one genotype can give rise to a range of different physiological states in response to different environmental conditions during development c. Periconception events are not as important: offspring of women exposed to famine in early gestation, although of normal birth weight, did not have an increased risk of adult disease are true 73. Health insurance differs from other forms of insurance in that: a. The insured event is not out of the ordinary. b. Insured events are not independent. c. The financial outcome of some insured events are manageable. d. a. and b. above e. a., b., and c. above 74. The major source of medical care financing for Americans is: a. Medicare b. Private insurance c. Medicaid d. The Veteran s Administration e. Charitable organizations 75. In 1990, Blue Cross/Blue Shield Insurance plans covered twice as many Americans with private insurance as any other health insurance plan: 11

12 76. Poverty is associated with: a. Malnutrition b. Lower life expectancy c. Higher infant mortality e. b. and c. above 77. The survival of the developed countries with a rapidly aging population will require: a. Delaying the age of retirement b. Increasing productivity of the working age population c. Euthanasia for those over 75 years 78. By 2050, the country with the highest proportion of elderly will be: a. China b. Japan c. Indonesia d. United States e. Mexico 79. Lifespan is shortest in which of the following regions? a. United States b. South America c. East Asia d. Sub-Saharan Africa e. Northern Europe 80. Rapidly increasing urbanization of the world s population will require: a. Better strategies to rapidly increase vital services, including provision of safe water and waste disposal b. More effective control of air and water pollutants c. Enforcing strict limitations on rural-urban migration 81. In the United States which of the following causes the most deaths annually? a. Guns b. Motor vehicle accidents c. Drugs d. Penicillin 82. The leading cause of death of African-American males years old is: a. Diabetes b. Cardiovascular diseases c. Accidents d. Suicide e. Homicide 12

13 83. Which of the following strategies is a structural intervention? a. Anti-smoking campaigns b. Health education in schools c. Laws requiring helmets for motorcycle riders d. Taxing cigarettes at a high rate e. c. and d. above 84. Provision of condoms to individuals is what kind of intervention a. Biomedical intervention b. Behavioral intervention c. Structural intervention 85. Knowledge is sufficient for behavior change: 86. One aspect of the CONSORT intervention reporting is Fidelity. What does fidelity refer to? a. Content and how the intervention is delivered b. The target population c. Whether the intervention was delivered as intended d. The period of time and spacing of contacts 87. The built environment can be either a barrier or facilitator to behavior change. 88. What is the difference between effectiveness and efficacy? a. Effective treatment provides results in a usual or routine setting that may or may not be controlled for research purposes (real world situation) whereas efficacious treatment provides positive results in a controlled experimental research trial b. Effective treatment provides positive results in a controlled experimental research trial whereas efficacious treatment provides results in a usual or routine setting that may or may not be controlled for research purposes (real world situation) c. Neither are correct d. Both are correct, the terms effective and efficacious are interchangeable 89. Which of the following behavior change theories includes relapse as a normal part of the learning process? a. Health Belief Model b. Social Learning Theory c. Stages of Change d. Diffusion of Innovations 13

14 90. Focusing interventions on popular opinion leaders and trend setters is an example of: a. The health belief model b. Social learning theory c. Stages of change theory d. Diffusion of innovations theory 91. Task shifting is a strategy to: a. Reduce the responsibility of physicians b. Training lower level health worker to deliver health services c. Create a range of strategies which can be used by health professionals 92. Mobile phones can be used to: a. Provide information b. Train health workers c. Monitor behaviors and performance 93. Which of the following is an example of Dual Use Research of Concern (DURC)? a. Altering the genes of H5N1 Avian Influenza so it has better transmission in ferrets b. Creating a novel virus that s transmitted easily from person to person. c. Discovering a fungus that can improve brain function but causes mild diarrhea. d. All of these 94. What is the primary reason that treated/reclaimed wastewater in Orange County, CA is not directly routed towards potable drinking water sources? a. Engineering difficulties in removing fecal contaminants or small viruses. b. Preventing seawater from seeping into local aquifers. c. Fear of new outbreaks of waterborne illness like cholera or Cryptosporidiosis d. Psychological aversion to excrement that is deeply rooted in society e. None of these 14