Step 1 Express 2018-Public Health Sciences

First Aid Express 2018 workbook: PUBLIC HEALTH SCIENCES page 1
Public Health Sciences
Questions
EPIDEMIOLOGY AND BIOSTATISTICS

1. A case-control study is described as _______________ (experimental/observational) and
_______________ (prospective/retrospective). (p 252)
2. A cohort study is described as _______________ (experimental/observational) and

_______________ (prospective/retrospective). (p 252)
3. True or False: In a cohort study, subjects are chosen on the basis of the presence or absence of risk
factors. (p 252) __________________________________________________________________
4. True or False: A cohort study involves following subjects over a period of time to study the
development of disease. (p 252) ____________________________________________________
5. True or False: A cross-sectional research study can show the correlation of a risk with a disease.
(p 252) ________________________________________________________________________
6. Describe single-, double-, and triple-blinded studies. (p 252) ______________________________
______________________________________________________________________________
______________________________________________________________________________
7. What is the purpose of Phase III clinical trials? (p 252) ___________________________________
______________________________________________________________________________
8. How does a low prevalence of disease affect the positive predictive value of a test? (p 253)
______________________________________________________________________________
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page 2 First Aid Express 2018 workbook: PUBLIC HEALTH SCIENCES
9. Screening tests (eg, the ELISA in HIV testing) are _______________ (sensitive/specific) and have
a high false-_______________ (negative/positive) rate, with a _______________ (high/low)
threshold. (p 253)
10. Confirmatory testing (eg, a Western blot in HIV testing) is _______________ (sensitive/specific) and
has a high false-_______________ (negative/positive) rate, with a _______________ (high/low)
threshold. (p 253)
11. How does a low prevalence of disease affect the negative predictive value of a test? (p 253) _____
______________________________________________________________________________
12. If a diagnostic test has 100% sensitivity, what should the value of the false-negative rate equal?
(p 253) _________________________________________________________________________
13. If a diagnostic test has 100% specificity, what should the value of the false-positive rate equal?
(p 253) _________________________________________________________________________
14. The statement "Patients with COPD were more likely to have a history of smoking than those without
COPD" pertains to _______________ (odds ratio / relative risk). (p 254)
15. The statement "Smokers were more likely to develop COPD than nonsmokers" pertains to
_______________ (odds ratio / relative risk). (p 254)
16. True or False: The odds ratio for a disease based on exposure to a risk factor approximates the
relative risk if the prevalence of the disease is low. (p 254) _______________________________
17. How is the relative risk reduction calculated? (p 254) ____________________________________
18. What epidemiologic measurement is equal to the difference in disease incidence between an
exposed group and an unexposed group? (p 254) ______________________________________
19. What measure of disease frequency is calculated by dividing the total number of cases in the
population at a given time by the total population at a given time? (p 255) ___________________
20. What measure of disease frequency is calculated by dividing the number of new cases in the
population during a period by the total population at risk during that time? (p 255) _____________
21. In chronic disease states, such as diabetes, is the prevalence of disease greater than, less than, or
equal to the incidence? (p 255) _____________________________________________________

22. In acute disease states, such as a common cold, is the prevalence of disease greater than, less than,
or equal to the incidence? (p 255) ____________________________________________________
23. True or False: When calculating the incidence of a disease, the total population at risk during a
certain time should include people who have the disease. (p 255) __________________________
24. _______________ (Precision/accuracy) refers to the trueness of test measurements (validity), and
_______________ (precision/accuracy) refers to the consistency and reproducibility of a test or the
absence of random variation in a test. (p 255)
25. _______________ (Random/systematic) error reduces precision in a test, and _______________

(random/systemic) error reduces accuracy in a test. (p 255)
26. What is a good strategy to reduce lead-time bias in epidemiology studies? (p 256) _____________
______________________________________________________________________________
27. What type of bias occurs when there are two closely associated factors and therefore the effect of
one factor could change or confuse the effect of the other? (p 256) _________________________
28. What is the name of the phenomenon whereby a researcher's belief in the efficacy of a treatment
changes the outcome of that treatment? (p 256) ________________________________________
29. In a data set that has a distribution with a negative skew, what is the relationship between the mean,
the median, and the mode? (p 257) ___________________________________________________
30. In a data set that has a distribution with a positive skew, what is the relationship between the mean,
the median, and the mode? (p 257) __________________________________________________
31. Which characteristic is least affected by outliers: mean, median, or mode? (p 257) _____________
32. What is the term for the hypothesis that there is no association between the variables being studied?
(p 257) _________________________________________________________________________
33. In a data set that has a normal (Gaussian) distribution, what percentage of the data falls within two
standard deviations of the mean? What percentage falls within 3 SDs of the mean? (p 257)
______________________________________________________________________________
34. In statistical calculations, the P value is equal to the probability of making what type of error?
(p 258) ________________________________________________________________________

35. In a statistical analysis, if P = 0.03, what is the probability that the data will show a difference by
chance alone when none truly exists? (p 258) _________________________________________
36. In statistical analysis, if β = 0.2, what is the probability that the null hypothesis has been falsely
accepted? (p 258) _______________________________________________________________
37. The power of a statistical test depends on which three factors? (p 258) ______________________
______________________________________________________________________________
38. What study parameter is calculated when the probability of making a type II error is subtracted from
1? (p 258) ______________________________________________________________________
39. If the 95% confidence interval for a mean difference between two variables includes 0, the null
hypothesis _______________ (is/is not) rejected. (p 258)
40. What type of statistical analysis pools summary data from multiple studies for a more precise
estimate of the size of an effect? (p 259) _______________________________________________
41. What type of statistical test is used to check for a difference between the means of three or more
groups? (p 259) __________________________________________________________________
42. What type of statistical test is used to check for a difference between the means of two groups?
(p 259) _________________________________________________________________________
43. What statistical term's absolute value indicates the strength of the correlation between two variables?
(p 259) _________________________________________________________________________
ETHICS
44. What are the four core ethical principles of medicine? (p 260) _____________________________
______________________________________________________________________________
45. True or False: Patient autonomy may conflict with beneficence. (p 260) _____________________
46. Which right is being exercised when a patient makes an informed decision to proceed with a medical
treatment when the benefits of the intervention outweigh its risks? (p 260) _____________________

47. What four steps are required for informed consent? (p 260) ____________________
______________________________________________________________________________
48. What are the four exceptions to informed consent? (p 260) _______________________________
______________________________________________________________________________
______________________________________________________________________________
49. Name three conditions in which a minor may be considered emancipated. (p 260) _______________
______________________________________________________________________________
______________________________________________________________________________
50. What six requirements must be met in order to determine that a patient has full decision-making
capacity? (p 261) ________________________________________________________________
______________________________________________________________________________
51. What term refers to an incapacitated patient's previous oral statements, which are commonly used
to guide medical decisions? (p 261) _________________________________________________
52. What four factors give greater validity to a patient's oral advance directive? (p 261) _____________
______________________________________________________________________________
______________________________________________________________________________
53. What is the term for the legal document that describes treatments the patient wishes to receive or
not receive if he/she becomes incapacitated and cannot communicate about treatment decisions?
(p 261) ________________________________________________________________________
54. What legal term refers to a patient's authorization of a surrogate to may make medical decisions in
the event that the patient loses decision-making capacity? (p 261) ___________________________
55. True or False: When authorizing a medical power of attorney, the patient may specify decisions that
are to be made in certain clinical situations. (p 261) _______________________________________
56. True or False: A patient's agent authorized with medical power of attorney retains that power unless
it is revoked by the patient. (p 261) ___________________________________________________

57. Which type of advance directive provides greater flexibility, a living will or a medical power of
attorney? (p 261) ________________________________________________________________
58. True or False: A patient's family can require that a doctor withhold information from the patient.
(p 262) _______________________________________________________________________
59. What is an appropriate response to a patient who is upset about how he or she was treated by
another doctor? (p 262) ___________________________________________________________
60. What is an appropriate response to a patient who is noncompliant? (p 262) _________________

______________________________________________________________________________
61. What is an appropriate response to a 17-year-old girl who is pregnant and requests an abortion?
(p 262) _________________________________________________________________________
______________________________________________________________________________
62. What is an appropriate response to a terminally ill patient who requests physician assistance with
ending his or her life? (p 262) ______________________________________________________
______________________________________________________________________________
63. What is an appropriate response to a patient who refuses a necessary procedure or desires an
unnecessary one? (p 262) _________________________________________________________
64. What is an appropriate response to a patient who states that he or she finds you attractive?
(p 262)_________________________________________________________________________
65. What standard should be used to determine the amount of medical information to disclose to a
patient's family or friends? (p 264) __________________________________________________
66. What are the four general exceptions to maintaining patient confidentiality? (p 264) ___________
_____________________________________________________________________________
_____________________________________________________________________________
67. In the case of serious infectious diseases, a physician may have a duty to break patient confidentiality
and warn which group of people? (p 264) _____________________________________________

68. A child presents to the emergency department with multiple fractures and bruises of different ages.
The patient's mother requests that authorities not be involved. Must the physician respect her
request for confidentiality? Why or why not? (p 264) _____________________________________
______________________________________________________________________________
69. A young woman confides to her physician that she has considered ending her life by ingesting a
bottle’s worth of her prescription pills, and that she does not want anyone else to know of her plan.
Must the physician respect her request for nondisclosure? Why or why not? (p 264) ___________
______________________________________________________________________________
70. A patient discloses that he frequently drives after consuming four or five drinks at the bar. In the
office, the patient clearly has been drinking alcohol and has arrived on his own. Is the physician
obligated to uphold confidentiality? Why or why not? (p 264) ______________________________
_____________________________________________________________________________
THE WELL PATIENT

71. What sexual changes normally occur in elderly men? (p 264) _____________________________
______________________________________________________________________________
HEALTHCARE DELIVERY
72. Give an example of primary, secondary, and tertiary disease prevention strategies. (p 265) ______
______________________________________________________________________________
73. Match the following. (p 265)

_____ A. Capitation 1. Patient pays for an incident of care
_____ B. Discounted fee-for-service 2. Physician receives set payment for each patient
_____ C. Global payment 3. Patient pays for each test or procedure at a
discounted rate
_____ D. Bundled payment 4. Patient pays for each individual service
_____ E. Fee-for-service 5. Healthcare organization receives a set amount
per service

74. What two federally funded healthcare programs originated from amendments to the Social Security
Act? Who is eligible for these programs? (p 266) _______________________________________
______________________________________________________________________________
75. What is the most common cause of death in young adults? (p 266) _________________________
76. What is the most frequent cause of readmissions for those with Medicaid? (p 266) _____________
______________________________________________________________________________
QUALITY AND SAFETY

77. Match the following. (p 267)
_____ A. Outcome 1. Ratio of patients whose HbA1c was measured in the past 6 months
_____ B. Process 2. Incidence of hypoglycemia among patients with measured HbA1c
_____ C. Balancing 3. Average HbA1c of patients with diabetes
_____ D. Structural 4. Number of diabetes educators
78. Complete the following Process improvement model (p 267)
P_____________________________________________________________________________
D_____________________________________________________________________________
S_____________________________________________________________________________
A_____________________________________________________________________________
79. Patient misidentification is an example of ________________(active/latent) error. (p 268)
80. Root cause analysis is a______________ (prospective/retrospective) approach to analyzing medical

error. (p 268)

Answers
EPIDEMIOLOGY AND BIOSTATISTICS

1. Observational; retrospective (Asks, “what happened?” Past tense. i.e. retrospective.)
2. Observational; prospective (more common) or retrospective.
3 True.
4. True for prospective cohort studies.
5. True. (However, it cannot show causality.)
6. In single-blind studies, subjects are not aware of their study-group assignment. In double-blind
studies, neither doctors nor subjects are aware of study-group assignment. In triple-blind studies,
doctors, subjects, and researchers analyzing the data are unaware of study-group assignment.
7. To compare the efficacy of the new treatment with the current standard of care.
8. The positive predictive value of the test is lower for a disease that has a lower prevalence.
9. Sensitive; positive; low.
10. Specific; negative; high.
11. The negative predictive value of the test is higher for a disease that has a lower prevalence.
12. It should equal 0. (All cases of the disease are detected by the test.)
13. It should equal 0. (All patients without the disease are identified correctly.)
14. Odds ratio.
15. Relative risk.
16. True.
17. 1 – Relative risk = 1 – [a/(a+b)]/[c/(c+d)]
18. Attributable risk; it is the percentage of cases of a disease caused by a risk factor.

19. Point prevalence.
20. Incidence. (Incidence refers to new incidents.)
21. Much greater than the annual incidence (because of the long duration of the disease).
22. Approximately equal (for diseases of short duration).
23. False. (The total population at risk during a certain period should not include people who have the
disease because incidence is a measure of new cases of a disease; those who have the disease are
not at risk of getting the disease.)
24. Accuracy; precision.
25. Random; systematic.
26. Adjust survival according to the severity of disease at diagnosis.
27. Confounding bias, in which the causal relationship is better explained by a variable other that the
one being studied.
28. Observer-expectancy bias or Pygmalion effect.
29. Mean < median < mode.
30. Mean > median > mode.
31. Mode.
32. Null hypothesis.
33. 95% fall within 2SDs of the mean, and 99.7% fall within 3SDs of the mean.
34. Type I error (α). (This type of error occurs when it is incorrectly concluded that an association is
present.)
35. 3%.
36. 20%. (This is generally considered an acceptable level for β in a study design.)
37. The sample size, precision of measurement, and the size of the expected effect.
38. Power.

39. If the 95% CI includes 0, the null hypothesis is not rejected because there is no significant difference
between the two variables.
40. Meta-analysis.
41. Analysis of variance (ANOVA).
42. t-test.
43. Correlation coefficient (r).
ETHICS
44. Autonomy, beneficence, nonmaleficence, and justice.
45. True.
46. Autonomy.
47. Disclosure, understanding, capacity, voluntariness.
48. Acronym WIPE: Waiver, legally Incompetent, therapeutic Privilege, Emergency situation.
49. If the minor is married, self-supporting, or is in the military.
50. The patient must be at least 18 years old or otherwise legally emancipated; the patient must make
and communicate a choice; the patient must be informed; the decision must remain stable over time;
the decision must be consistent with the patient's values and goals; and the decision cannot be a
result of altered mental status or mood disorder.
51. Oral advance directive.
52. The patient was informed, the directive is specific, the patient made a choice, and the decision was
repeated over time.
53. Written advance directive (ie living will).
54. Medical power of attorney.
55. True.
56. True.

57. A medical power of attorney.
58. False. (A patient's family cannot require the physician to withhold information from the patient.)
59. Suggest that the patient speak directly to that physician about the concerns. If the problem is with a
member of the office staff, inform the patient that you will speak to that person.
60. Attempt to identify the patient’s reason for nonadherence and whether he or she is willing to change
the behavior. Do not force the patient to comply or refer the patient to another physician.
61. Many states require parental notification or consent for minors to have an abortion. However,
parental consent is not required for emergency situations, the treatment of sexually transmitted
diseases, medical care during pregnancy, prescriptions for contraceptives, or the management of
drug addiction. A physician should not sway the patient’s decision for or against an elective abortion.
62. In most states, physicians should refuse to be involved in any form of assisted suicide; however, the
physician may prescribe medically appropriate analgesics that coincidentally shorten the patient's
life.
63. Attempt to understand why the patient wants or does not want the procedure; address the underlying
concerns, and avoid performing unnecessary procedures.
64. Ask direct closed-ended questions and use a chaperone if necessary. It may be necessary to
transition care to another physician. (Romantic relationships with patients are never appropriate.)
65. The disclosure of information to family or friends should be guided by professional judgment of the
patient’s best interest.
66. Serious and imminent potential physical harm to others; high likelihood of harming self; no other way
to warn or protect those at risk; and physician can take steps to prevent harm.
67. Public officials, who will then notify people at risk.
68. No; a physician may break confidentiality to report the abuse (or suspected abuse) of a child or an
elderly person.
69. No; a physician may break confidentiality to report a suicidal or homicidal patient.
70. No; a physician can break confidentiality to report an impaired driver.

THE WELL PATIENT

71. Slower erection/ejaculation and a longer refractory period.
HEALTHCARE DELIVERY
72. Vaccination is a primary disease prevention strategy, because the vaccinated person is not
considered susceptible to the disease. A Pap smear is secondary disease prevention, since it can
detect cervical cancer at an early, treatable stage. Chemotherapy is tertiary disease prevention, as
it is intended to reduce disability from disease once it has occurred.
73. A-2, B-3, C-1, D-5, E-4
74. Medicare and Medicaid. MedicarE is for the Elderly, and MedicaiD is for the Destitute.
75. Unintentional injury
76. Mood disorders
QUALITY AND SAFETY

77. A-3, B-1, C-2, D-4
78. Plan: define problem and solution
Do: test new process
Study: measure and analyze
Act: integrate new process into regular workflow
79. Active
80. Retrospective

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First Aid Express 2018 workbook: PUBLIC HEALTH SCIENCES page 1

Public Health Sciences

EPIDEMIOLOGY AND BIOSTATISTICS

_______________ (prospective/retrospective). (p 252)

2. A cohort study is described as _______________ (experimental/observational) and

6. Describe single-, double-, and triple-blinded studies. (p 252) ______________________________

7. What is the purpose of Phase III clinical trials? (p 252) ___________________________________

Copyright © 2018 by ScholarRx All rights reserved v1.0

17. How is the relative risk reduction calculated? (p 254) ____________________________________

Copyright © 2018 by ScholarRx All rights reserved v1.0

25. _______________ (Random/systematic) error reduces precision in a test, and _______________

Copyright © 2018 by ScholarRx All rights reserved v1.0

Copyright © 2018 by ScholarRx All rights reserved v1.0

Copyright © 2018 by ScholarRx All rights reserved v1.0

60. What is an appropriate response to a patient who is noncompliant? (p 262) _________________

Copyright © 2018 by ScholarRx All rights reserved v1.0

THE WELL PATIENT

73. Match the following. (p 265)

Copyright © 2018 by ScholarRx All rights reserved v1.0

QUALITY AND SAFETY

78. Complete the following Process improvement model (p 267)

79. Patient misidentification is an example of ________________(active/latent) error. (p 268)

80. Root cause analysis is a______________ (prospective/retrospective) approach to analyzing medical

Copyright © 2018 by ScholarRx All rights reserved v1.0

EPIDEMIOLOGY AND BIOSTATISTICS

2. Observational; prospective (more common) or retrospective.

4. True for prospective cohort studies.

5. True. (However, it cannot show causality.)

9. Sensitive; positive; low.

10. Specific; negative; high.

14. Odds ratio.

15. Relative risk.

17. 1 – Relative risk = 1 – [a/(a+b)]/[c/(c+d)]

Copyright © 2018 by ScholarRx All rights reserved v1.0

19. Point prevalence.

20. Incidence. (Incidence refers to new incidents.)

22. Approximately equal (for diseases of short duration).

24. Accuracy; precision.

25. Random; systematic.

26. Adjust survival according to the severity of disease at diagnosis.

28. Observer-expectancy bias or Pygmalion effect.

29. Mean < median < mode.

30. Mean > median > mode.

32. Null hypothesis.

Copyright © 2018 by ScholarRx All rights reserved v1.0

41. Analysis of variance (ANOVA).

43. Correlation coefficient (r).

47. Disclosure, understanding, capacity, voluntariness.

49. If the minor is married, self-supporting, or is in the military.

51. Oral advance directive.

53. Written advance directive (ie living will).

54. Medical power of attorney.

Copyright © 2018 by ScholarRx All rights reserved v1.0

57. A medical power of attorney.

67. Public officials, who will then notify people at risk.

70. No; a physician can break confidentiality to report an impaired driver.

Copyright © 2018 by ScholarRx All rights reserved v1.0

THE WELL PATIENT

73. A-2, B-3, C-1, D-5, E-4

75. Unintentional injury

76. Mood disorders

QUALITY AND SAFETY

78. Plan: define problem and solution

Do: test new process

25. _ (Random/systematic) error reduces precision in a test, and _