HLSC 4613

Study Guide for Final Exam

1. Descriptive epidemiology
2. Study designs: (identify, compare and contrast, strengths and weaknesses of each
design)
a. Case Control
b. Cross Sectional
c. Ecologic
d. Cohort Study Designs
i. Retrospective
ii. Prospective

3. Data Interpretation
a. Be able to look at data and draw valid conclusions based on the evidence/data
provided. (validity of study design)
b. Bias (methods to control)
c. Confounding (methods to prevent and control)

4. Screening and screening analysis

a. Sensitivity/Specificity and relationship
b. Predictive value of a positive test (PVP/PPV)
c. Lead/Length time bias

Example Questions:

The state of Arkansas wants to enact a law to test for syphilis in all applicants for marriage
licenses. Your test for syphilis has a sensitivity of 80% and a specificity of 95%. Public health
statistics indicate that the prevalence of syphilis in this population is 1%.

A. What is the predictive value of a positive test in this situation?

A. 0.80
B. 0.14
C. 0.19
D. 0.61

2. Which of the following statements about sensitivity is true?

A. Sensitivity is the likelihood of having disease if you have a positive test.
B. A highly sensitive test will reduce the likelihood of false positives.
C. Lowering the cutoff blood sugar level for declaring someone to be diabetic will
increase the sensitivity of the test.
D. A highly sensitive test is necessary when one wishes to avoid false positives.
 3. Which of the following statements about specificity is true?
A. Specificity is the likelihood of having a negative test if you have the disease.
B. A highly specific test will reduce the likelihood of false positives.
C. The specificity of a test will be reduced for conditions of low prevalence.
D. Lowering the blood-sugar-level cutoff for diagnosing diabetes increases the
specificity of this test.

4. Which of the following statements about predictive value of a positive is true?

A. Predictive value of a positive test is the likelihood that persons with the disease
will have a positive test.
B. It is likely to be low when testing populations with low disease prevalence.
C. Having a high predictive value is especially important when treatment for the
condition being tested for is relatively benign and inexpensive.
D. Increasing the blood-sugar-level cutoff for diagnosing diabetes is likely to
reduce the predictive value of the test.

Data suggest that advanced age is a risk factor for fall. You decide to assess this by identifying
the next 100 fall victims in the emergency room and comparing them for age with 100
emergency room patients who did not fall.

5. What is the study design?

A. Cross-sectional
B. Cohort
C. Case-control
D. Randomized, double-blinded clinical trial

6. Which of the statements below is a feature of the study design cited above?
A. Studies of this design are unlikely to be affected seriously by bias.
B. The outcome measure for this design is the odds ratio.
C. The study yields age-specific incidence rates for history of fall in the past
year.
D. The study design is well suited to address temporal sequence of risk factors
and outcomes.

You would like to see if persons who have grab bars placed in their shower are less likely to
suffer falls there. You plan to enroll 100 persons to receive the grab bars and compare their
fall experience over the next year with 100 persons who did not receive grab bars.

7. What is the basic study design?

A. Cross-sectional
B. Cohort
C. Case-control
D. Randomized, double-blinded clinical trial
 8. Which of the statements below is a feature of the study design cited above?
A. Studies of this design are unlikely to be affected seriously by bias whether or not
they are randomized.
B. The preferred outcome measure for this design is the odds ratio.
C. The study as described yields age-specific incidence rates for history of fall in the
past year.
D. The study design is well suited to address temporal sequence of risk factors and
outcomes.

9. The study is completed and shows a 30% reduction in shower-related falls for the
group receiving grab bars. While presenting these results at a scientific meeting, a
colleague suggests the results might be due to younger age-and presumably better
balance-in the group receiving the bars. If true, this would be an example of
A. Selection bias
B. Information bias
C. Confounding
D. Interaction

10. You recently moved in to a new neighborhood and are delighted to learn that there is a
traditional “moving fast” during the holiday season. Participants prepare a course for
the neighborhood, and all the neighbors’ troop from house-to-house through the evening
to socialize and eat the course offered. You have prepared your specialty eggnog after
some initial concern about the expiration date for the eggs. After all, you muse, the
amount of alcohol in the eggnog should effectively sterilize it for most known pathogens
and a few yet to be described. One hundred people join the festivities, basking in the
holiday glow.

You are awakened the next morning by an overpowering nausea, which shortly
progresses to repeated bouts of vomiting. Fortunately your illness resolves over the next
two days. You hear that many other neighbors had similar experiences. You suspect that
this may represent an epidemic food-borne illness, and you interview your neighbors in
an attempt to identify the source of the outbreak. Memories have faded. As a result, you
interview about usual food preferences rather than trying to obtain an exact listing of
consumption.

The results are shown below.

Food Item Usually eat Rarely/never eat
Cases Unaffected Cases Unaffected
n n n n
Cheese fondue 45 42 5 8
Turkey stuffing 15 3 35 47
Turkey meat 25 20 25 30
Egg nog 20 40 30 10
Caesar salad 35 25 15 25

10. The most likely vehicle is

A. Cheese fondue
B. Turkey stuffing
C. Turkey meat
D. Egg nog
E. Caesar salad

11. The odds ratio showing the association between usually eating the food and the
implicated transmission for the disease is
A. 1.5
B. 6.7
C. 1.8
D. 2.3
Answers:
1. B, 2. C, 3. B, 4. B, 5. C, 6. B, 7. B, 8. B, 9. A, 10. B, 11. B