Env 1 What is the most common source of mercury poisoning in Canada
Fish
Thermometer industry
Dentists
inhalation
Fish
Env 2 who are the most exposed group to mercury poisoning in Canada
native Indians
Native Indians
Env 3 Which is NOT true regarding O3 (Ozone)?
-Increased around photocopy machine
-Can be harmful at ground level
-It’s mainly due to incomplete combustion of fossil fuels
Increased around photocopy machine
Env
Ra
4 Which is true regarding the side effects of radiation?
-Microwaves cause superficial burns
-Laser radiation can cause retinal burns
-UV can cause Alopecia Areata
-Beta ray can cause Leukemia
-Delta ray are dangerous for the central grey nucleus
Beta rays (or any other ionizing
radiation) can cause Leukemia
Env
Ra
5 Which of the following is true regarding non-ionizing radiation?
-Can cause Chronic bronchitis
-Can cause Loss of vision
-Can cause cataract
Near-UV (UV-A; 315-400 nm) causes
Cataract
Env
Ra
6 The commonest source of radiation exposure is
-Background exposure
Natural background radiation ~ 90 %
of all radiation sources
Env
Ra
7 Surveillance in medical worker for radiation hazard include all EXCEPT:
-Hematological examination
-Annual PE.
-Labeled panding (?!)
-Total body radiation count
Labeled panding (?)
epi 8 A new vaccine against measles is being evaluated. The following results of one full
year of study:
Diseased Healthy %
Unvaccinated 137 378 36.3
Vaccinated 51 266 19.2
What is the vaccine efficacy (VE)
-17.9 %
-47.0 %
-21.8 %
-36.3 %
47%. The Vaccine efficacy formula=
Incidence(vacc)-Incidence(unvacc) ÷
Incidence(unvacc)
=(36.3-19.2) ÷ 36.3=47%
If Incidence(vacc)=Incidence(unvacc) then
VE=0 ÷ Incidence(unvacc) =0%
If Incidence(vacc)=0 then
VE= Incidence(unvacc)-0 ÷
Incidence(unvacc) =100%
Epi 9 Which of the following is the least indicative of causality
temporal relation
Consistency
Biological plausibility
Analogy to similar conditions
Analogy; See the Bradford Hill
“criteria” for causality
Epi 10 Causality can be assessed by
Cohort study
Case-control study
Cross-sectional study
Both cohort and case-control studies.
Both cohort and case-control studies
Epi 11 Characteristic of the placebo effect. All true EXCEPT:
-50% effective
-Patients believe in treatment efficacy
-It is greater in IM than in PO.
-It decreases if used frequently because of dependence
-Naloxone effect shows that placebo effect occurs by inhibition by morphinic
receptors
(?) It decreases if used frequently
because of dependence
Epi 12 In placebo treatment. All are true EXCEPT:
-Response to placebo indicates that the cause is psychogenic
-Repeated use decreases its efficacy
-1/3 of those with organic causes respond to the placebo
Response to placebo indicates that the
cause is psychogenic
Epi 13 Study has been done between a risk factor and a disease, the odds ratio was 2.3 (p
value=0.4). What is true?
-There is significant association between risk factor and disease.
The association could have been due to
chance
2
-The disease is 2.3 times more in those having risk factor
The association could have been due to chance
Epi 14 What is the relative risk in the following cohort study: death in smokers= 1/1000,
death in non-smokers 0.05/1000.
1/1000 ÷ 0.05/1000
1/1000 ÷ 0.05/1000 x 5
1/1000 ÷ 0.05/1000 = 20
Epi 15 A study reveals that 10 yrs experienced drivers contributed to 60% of accident. 5 yrs
experienced drivers contributed 30% and those with 2 yrs contributed 10%. The
conclusion was that the more experienced drivers are more careless in driving. This
conclusion is not right because:
- Study did not measure the incidence of accidents
- Study not age-standardized
-Because there is no control group
Study did not measure the incidence of
accidents—Unlike prevalence,
incidence rates take the duration of
driving in consideration.
Epi 16 Study about the benefit of exercise in decreasing the risk of heart disease applied to a
group of volunteers in a factory with the rest of the factory employees representing
controls. Follow up was regular. The study shows lower rate of IHD (Ischemic Heart
Disease) in the exercising group. The conclusion: exercise protect against IHD may
be rejected because of:
-Selection bias
-Only men were included
-Only one company was involved
-Some IHD may be silent
Selection bias. The exercise group are
self-selected (volunteers) and are likely
to be different in other ways (other
than exercising)
Epi 17 Case-control study useful in:
Study of rare disease.
Study of common disease.
Does not provide odds ratios
It includes the whole population
Study of rare disease
Epi 18 A cohort study, which is true:
The study should start with all persons at the same time regardless of the appearance
of signs and symptoms
They should start when the signs and symptoms appear
should start when complications appear
The study should start with all persons
at the same time regardless of the
appearance of signs and symptoms
Epi 19 A cohort study, all are true except:
Relative risk can be calculated.
Incidence rate can be calculated.
Attributable risk can be calculated.
Prevalence rate can be calculated.
Prevalence rate can be calculated
Epi 20 Best sample for a study is taken from:
the general population
hospitals
the general population
Epi 21 In a cross-sectional study of 15-49 years old, peptic ulcer was more common among
females compared to males. The study findings can’t be generalized because:
there was no control group
limited to certain age group.
limited to certain age group
Epi 22 A researcher has planned to include 100 individuals in her study but she could only
recruit 75. She found a p value > 0.05 and concluded that the results are clinically
insignificant. What was worrying about this study:
a) She mixed between clinical and statistical significance.
She mixed between clinical and
statistical significance. Also the study
lacked power to detect meaningful
differences
Epi 23 You gave a new drug for hypertension to your patients. Those suffering from multiinfarct
dementia improved while those with Alzheimer’s did not. You want to give
this drug to your patients in the clinic. What type of trial is this?
a) Phase 1trial
b) Phase 2 trial
c) Phase 3 trial
Not totally clear but most likely answer
is Phase 3 trial
Epi 24 Randomization can limit all the following except
a) Known confounders
b) Unknown confounders
c) Selection bias
(?) Randomization can limit all three
Epi 25 Relation between asbestosis and smoking is called:
-Additive
-Synergistic
-antagonist
Synergistic
epi 26 Patient with history of HT and DM had an acute MI and died due to cardiac arrest. MI
3
Cd In writing the death certificate, what is the immediate cause of death?
-DM.
-HT.
-MI.
-Cardiac arrest
Cardiac arrest is the mode of death.
epi
Cd
27 Patient with breast CA underwent operative surgery and chemoradiotherapy, she
developed pneumonia followed by death. What is the underlying cause of death?
-complications of chemotherapy
-Breast CA
-Pneumonia
Breast ca.
epi
Cd
28 Patient died after suffering from TB, what will you write in death certificate as a
cause of death?
-Cardiac arrest
-TB
-Fever
-Loss of weight
TB
epic
d
29 An alcoholic and diabetic had active TB. Developed pneumonia and died. What will
you write in death certificate as underlying cause of death?
- Pneumonia
-TB
-Diabetes
-Old age
TB
Epi
d
30 A new test for CA Cervix allows better detection. All can be modified EXCEPT:
-Prevalence
-Incidence
-PPV
-NPV
-Survival rate
(?) All can be modified assuming that
better detection means better test
sensitivity and specificity. I would go
with survival rate assuming that better
detection does not mean that screening
works
Epi
d
31 Screening is useful in
rare untreatable disease
long time asymptomatic but treatable
long time asymptomatic but treatable
Epi
d
32 Which one of the following descriptors of a diagnostic test is influenced by the
prevalence of the disease being tested for:
-Specificity
-Sensitivity
-Accuracy
-Positive predictive value
-Reliability
Positive predictive value and so is
negative predictive value
Epi
d
33 Threshold of a screening test is increased. This will affect the test in terms of:
-Increased sensitivity and specificity
-Increased No. of FP.
-Increased No. of FN.
-decreased sensitivity and increased specificity.
decreased sensitivity and increased
specificity
Epi
d
34 Threshold of a screening test is increased. How it will affect sensitivity and
specificity?
a) Sensitivity increase and specificity decrease
b) Sensitivity decrease and specificity increase
Sensitivity decrease and specificity
increase
Epi
d
35 What will be the effect of increasing the prevalence of a disease for a screen test?
-Increase in the sensitivity of the test
-Increase in the specificity of the test
-Increase in the PPV.
-Increase in the NPV.
-Increase in the sensitivity and PPV. of the test
Increase in the PPV
Epi
d
36 What will increase false positive results?
-Increase in prevalence and decrease in the specificity of the test
-Increase in prevalence and decrease in the sensitivity of the test
-Decrease in prevalence and increase in the sensitivity of the test
-Increase in prevalence and increase in the sensitivity of the test
Increase in prevalence and decrease in
the specificity of the test
Epi
d
37 Liver on autopsy was found to be shrunken. During his life, the patient was told by
different physicians that he had a normal liver. How would you describe this test?
Good reliability, poor validity
Poor reliability, poor validity
Good reliability, poor validity
Epi 38 If sensitivity is 80% and specificity is 90%. What is the PPV: can’t be calculated
4
d 50%
70%
82%
can’t be calculated
Epi
d
39 Regarding screening for breast ca, all decrease except
Prevalence
Incidence
mortality
Incidence, but prevalence may not
necessary go down.
Epir 40 Population pyramid, what is true:
Age and sex distribution trend
Age and sex distribution over time
Age and sex distribution at one time
Age and sex distribution at one time
Epir 41 Definition of potential years of life lost (PYLL)
Epir 42 Definition of age-specific mortality/morbidity rate
Epir 43 Definition of average hospital stay
Epir 44 Definition of life expectancy
Epir 45 Definition of Prevalence: total number of cases in a population at a given time.
Epir 46 Definition of Crude birth rate
Epir 47 The prevalence of disease decreases while incidences increases when:
the chronic disease is treated by more facilities
the disease is being early detected and treated
the disease is being early detected and
treated
Epir 48 All are true regarding incidence EXCEPT:
-Take only the new case in consideration
-Estimates the risk of acquiring the disease in community
-Useful measure of disease burden in community
-Useful for both acute and chronic disease
Useful measure of disease burden in
community—that is the prevalence
Epir 49 The natural growth rate =
-Birth rate - immigration rate
-Birth rate - death rate + net migration rate
-Birth rate + immigration rate
-Birth rate - death rate + net migration
rate
net migration rate=Immigration rate -
Emigration rate
Epir 50 Study shows that specific mortality rate for stomach CA tends to decrease. What is
the most likely explanation?
-Decreased Prevalence
-Decreased Incidence
-Better screening
-Better treatment
Decreased Incidence also better
treatment
Epir 51 If a child develops diphtheria now the mortality is almost the same as it was 50 years
ago. But now the mortality rate is very low because
a) Incidence decreased
b) Prevalence decreased
c) Effective antibiotics developed
Incidence decreased
Epir 52 prevalence is affected by all except:
Incubation period of disease
Case fatality rate
duration of illness
incidence
Epir 53 In a study, the perinatal mortality rate among those who had home delivery was
lower than those who had hospital delivery. You will consider these results:
Correct
Incorrect because is no confidence interval
Incorrect because the 2 groups are not comparable
Incorrect because the 2 groups are not
comparable
Epir 54 What is the best way to appreciate health care quality during pregnancy and delivery
in Canada?
-Neonatal mortality rate
-Perinatal mortality rate
-Infant mortality rate
-Maternal mortality rate
Perinatal mortality rate
Hp 55 Most important Dietary modification of middle-aged group is:
-Total calorie content
-Fiber diet
-Carbohydrates content
-protein
(?) Fiber-rich diet.
5
Hp 56 Life expectancy is increased in Canada due to:
-Decreased infant mortality rate
-Availability of Diagnosis and treatment
-Improved socioeconomic status
-Antibiotics era
Improved socioeconomic status
Hp 57 Form 1971 to 1992 life expectancy for men has increased from 68 to 73 years,
women from 73 to 81 years. What is the most likely cause of these changes?
-Vaccination
-Better management of ischemic diseases
-Use of antibiotics
-Improvement of life style
-Generalization of health care
Improvement of life style
Hp 58 The most important cause of increased complications of measles in developed
countries is:
-Inadequate immunization
-Inadequate nutrition
Inadequate nutrition
Hp 59 Tertiary prevention is
-Rehabilitation.
Rehabilitation.
Hp 60 all the following are primary prevention except:
-Immunization
-Health related education
-Pap smear
Pap smear
Hp 61 What’s the best criterion for estimating population health?
-Amount of money spent on health
-GDP
-Ratio of physicians per habitant
-Number of hospitals
(?) not clear
Hp 62 WHO conference in 1978 in Alma Mata, Russia- declaration on
a) Primary health care
b) Polio eradication by 2005
c) Small pox eradication
Primary health care
Hp 63 Health promotion is defined as
Enabling people to increase control and to improve health
Hp 64 Which of the following is the most effective way to prevent dental caries in children?
a) Fluoridation of water
b) Dental flossing
Fluoridation of water
Hp 65 Periodic health examination not true
a) Detection of chronic diseases
b) Behavior change and hygiene
c) More focused annual physical examination
(?)More focused annual physical
examination
Hp 66 All of the following are done at the community level except:
Oral polio vaccine
Prophylaxis for malaria
Prophylaxis for malaria
Hp 67 A man drinks, smokes and puts his seatbelt 75% of time, what will increase his life
expectancy:
Stop drinking
Stop smoking
Put his seatbelt 100% of the time
Stop smoking
Risk of death from smoking 1:200;
recommendation A
Risk of death from RTA 1:17000
recommendation B
Hp 68 Culture shock can be reduced by:
Intact family
Rapid integration within community
Psychiatric help
Financial support
(?)Rapid integration within community
Hs 69 Which one of the following affects the outcome and future planning of Canadian
health program?
-Accident
-Age
Age
Hs 70 What population group is expected to increase in Canada next years?
-Neonates
-10-15 years.
-20-40 years.
-40-65 years.
-Above 65 years.
Above 65 years
6
Hs 71 Which will increase day care load in the next decade?
-Heart disease
-CA.
-Dementia
-Accident
Dementia
Hs 72 The following disease are more frequent in poor than in rich Canadians EXCEPT:
-Suicide
-Coronary heart disease
-Lung CA
-Stroke
-Breast CA
Breast CA
Hs 73 Why high socio-economic status is associated with less morbidity and mortality
More education
Economic status
Better child care
(?) More education
Hs 74 Which of the following does not cause mortality difference in Canada?
Unemployment
living in a village
smoking
(?) living in a village
Hs 75 The most important cause of difference between male and female mortality rates is
due to:
-Accident
-Puerperal
-suicide
Accident
Hs 76 All the following causes of death are different between men and women except:
-Accident
-Ca breast
-CVA
-IHD
-Liver cirrhosis
Liver cirrhosis
Hs 77 Information about mortality in Canada can be obtained from
-Canada statistics
-Public health center
-Out Patient clinic
Canada statistics
Hs 78 Information about morbidity in Canada can be obtained from
-Canada statistics
-Public health center
-Out Patient clinic
Canada statistics
Hs 79 Which is the commonest cause of mortality in children aged 5 to 9 years in Canada?
-Leukemia
-Cancer
-Accidents
-Congenital malformation
Accidents
Hs 80 The leading cause of PYLL loss is
-IHD
-Cancer
-Accident
Depends on age but generally cancer is
the leading cause
Hs 81 The most common cancer in Canada?
a) Lung
b) breast
c) prostate
d) Brain
e) Skin
Skin
Hs 82 The most common cancer incidence in Canadian men (excluding skin)?
a) Lung
b) prostate
c) colorectal
d) thyroid
e) stomach
prostate
Hs 83 The second common cancer mortality in Canadian women
a) Lung
b) breast
c) colorectal
breast
7
d) ovary
e) Uterus
Hs 84 The most common cause of death among children 1-4 yrs of age
burns
MVA
Drowning
Homicide
suicide
MVA
Hs 85 The most common cause of death among men under 30
Accidents
cancer
Homicide
suicide
Accidents
Hs 86 The most common cause of death among children under 1 year of age
congenital anomalies
(?) perinatal conditions
Hs 87 The most common cause of death among aboriginal men
trauma and poisoning
trauma and poisoning
Hs 88 Aboriginal Canadians have higher risk
Infant mortality
Hs 89 which of the following is the most common condition in Canada
a) cervical malignancy
b) endometrial malignancy
c) endometrial polyp
d) septulum uterus
(?) endometrial polyp
Inf 90 Young girl presents with fever, conjunctivitis, developed rash in her neck, cheeks
and malar area. Whitish spots in buccal mucosa. What is your first step:
notify public health
check immunization status of all peers
check immunization status of your pregnant secretary
start vaccination in school
Measles; notify public health
Inf 91 All the following are causes of variable incubation period except:
Herd immunity
Immunization
Host resistance
Mode of transmission
Herd immunity
Inf 92 Epidemic curves All kinds of curves
Inf 93 After eliminating measles, what could be reduced:
Immunization
Reporting of new cases
Surveillance of new cases
Hospital cost spent on measles treatment
Hospital cost spent on measles
treatment
Inf 94 Food poisoning after food by 3 hrs. Cause?
a) Staph.
Inf 95 In case of food poisoning; what action?
verify with other GPs
verify with lab staff
Notify public health
Notify public health
Inf 96 Isolation of disease depends on?
Infectivity of the disease
Length of incubation period
(?)Infectivity of the disease
Inf 97 Most important factor in food poisoning
Food handlers hygiene
Oc 98 The most common cause of sick leave
back pain
Headache
Accidents
back pain
oc 99 Of the following CA. Which one is caused by vinyl chloride:
-Lungs
-Esophagus
-Rhinopharynx
-Liver
-Bladder
Liver
Oc 100 The following are carcinogenic EXCEPT: Fat
8
-Fat
-Monosodium glutamate
-Benzene
-Nickel
-Arsenic
Oc 101 All are carcinogenic EXCEPT:
-Uranium
-Arsenic
-Radon
-Chromium
-Lead
Lead
Oc 102 The following are matched EXCEPT:
-Nut chewing and mouth cancer
-Alcohol and esophageal cancer
-Nickel and liver cancer
-Radiation and leukemia
Nickel and liver cancer
Oc 103 In which case occupational deafness is mostly suspected
-Unable to hear the bell sound at 3 m.
-Decreased in hearing high intensity voices
-Decreased peak at 4000 hertz on the audiogram
-Deafness at speaking voice
Decreased peak at 4000 hertz on the
audiogram is characteristic
Oc 104 Occupational deafness, usually caused by
-high frequency loss
low frequency loss
High frequency loss
Oc 105 Which is the most practical measure to reduce occupational deafness?
-The usage of daily prophylactic ear plugs during duty
-Measuring the noise frequency
-Usage of ear protection
The usage of daily prophylactic ear
plugs during duty
Oc 106 Most common source of silicosis exposure in Canada is:
-Sandblasting
-Coal dust
-Brake lining
-High concentration of Gases
Sandblasting
oc 107 Which is the most likely to be associated with Leukemia?
-Aromatic hydrcarbones
-Ionized radiation
-Benzoalphaperines
Ionized radiation
Oc 108 The most common occupational disease in Canada.
a) silicosis
b) dermatitis
c) asthma
d) Asbestosis
e) Carpal tunnel syndrome
dermatitis
Oc 109 TB can occur as a complication of:
Silicosis
Asbestosis
Lead
Coal
Silicosis
Oc 110 which is not a cause for occupational asthma.
a) Vinyl chloride
(?)
Oc 111 Which causes nasal sinus ca.
a) Nickel
b)
Oc 112 A man working in tree cutting presented with numbness and pain in both hands.
Which is true:
a) The symptoms are most likely due to his work
The symptoms are most likely due to
his work
Oc 113 How to prevent lead poisoning among workers in a battery factory
Hand wash before eating
Shower after finishing
Protective gear (gloves etc)
Good ventilation
(?) hand wish or ventilation
Oc 114 The most common cause of dermatitis is
Occupational
Atopic
9
Allergic contact
atopic
diaper
Oc 115 Workers with video display terminal are susceptible to
cancer
cataract
dermatitis
deep thermal injury
(?) none of those. Mostly eye fatigue
and muscular sprains. Cataract is not
confirmed.
Oc 116 The best way to prevent muscular sprains and strains at work
ergonomic engineering
gloves
sprints
treatment and rehabilitation
ergonomic engineering
Oc 117 A worker in a chemical factory presented with clear picture of hepatitis and contact
dermatitis. He denies that other workers have the same illness. What action
Notify public health
Visit place of work
Notify public health
Oc 118 Byssinosis is an occupational disease seen in
Workers in cotton factory
In sugar canes
Workers in cotton factory
Oc 119 In Byssinosis
Bronchoconstriction occurring in cotton workers
May lead to emphysema and irreversible bronchoconstriction
Unlike asthma, symptoms decrease with repeated exposure
Byssinosis is a chronic, asthma-like narrowing of the airways. Results from inhaling particles
of cotton or jute. Symptoms are usually more pronounced when returning to work after a
weekend and subside as the worker becomes reaccustomed to the environment. Prolonged
exposure can cause chronic bronchitis. It does not lead to permanently disabling lung disease.
May lead to emphysema and
irreversible Bronchoconstriction
Org 120 Who is ultimately responsible for the (standard) health care quality?
-Board of directors
-Staff
-Chief physician
-Chief of staff
(?)Board of directors
Org 121 The biggest budget percentage goes to:
Hospitals
Doctors
Labs
Hospitals
org 122 What is the allowed amount of GNP (gross national product) to health in Canada?
-4% - 8%
-8 % - 12 %
-12 % - 15 %
-16 % - 24 %
-25 % - 36 %
8 % - 12 %
Org 123 What is the rule of Royal collage of Canada?
-Credentialing body (certification of specialist)
Org 124 About the licensing authority. Which of the following is true?
a) Interest of public is most
Org 125 What is the policy of Canada to decrease the health expenditure?
-Advise the health professional to use the health resources
org 126 All the following are function of public health except:
Health promotion
Immunization
Control of the conditions at workplace
(?)Control of the conditions at
workplace
Org 127 Who pays for health care of aboriginals?
a) Federal government
Org 128 Concerning the function of provincial/territorial health care all is true except
Immunization
Long term and home care
Public health policy
Surveillance
(?)Public health policy
Org 129 A hospital with long waiting list reduced length of stay what will be the effect
Decrease in nursing staff
Decrease in occupancy rate
(?)Decrease in occupancy rate
10
Decrease in use of diagnostic services
Increased access for emergency cases
Org 130 Concerning Canada health act,
Expenses of health care are portable between provinces
Every one has access to medical insurance
All true: comprehensiveness, coverage,
universality, portability
Ra 131 Which of the following radiation has the deepest penetration in human tissue:
-Alpha
-Gamma
-X-ray
-Delta
-UV
Gamma also x-rays
sm 132 Nicotinic skin patchy is contraindicated in:
-Pregnancy
-CVA
-Ischemic Heart disease
-Alcoholic
NB. (not sure)
Pregnancy
Sm 133 A smoker tries to quit many times last year, what age group he is most likely in
-40s
-30s
(?)
Sm 134 What is true regarding smoking restriction in public places?
-Decreases the incidence of chronic respiratory disease
-Decreases the incidence of allergic respiratory disease
-Decreases the incidence of cardio vascular disease
-Shortens hospital stay
(?) All except shortening hospital stay
sm 135 Smoking withdrawal which of the following is the most common symptom:
-Insomnia
-Tachycardia
-Anorexia
Insomnia (but irritability is the
commonest)
Sm 136 Regarding smoking cessation. All are true EXCEPT:
-Decreased lung CA occurrence as other nonsmoking population by 2-3 years of
cessation
-Improvement of claudication
3 years after quitting: risk of heart
attack is the same as for a non-smoker
10 years after quitting: lung cancer
risk is halved
15 years after quitting: health is
effectively the same as a non-smoker
Sm 137 All the following tumors associated with TOBACCO use except
-Bladder
-Esophagus
-Liver
-Cervix
-Lung
Liver
Sm 138 The least effective smoking prevention measure in schools:
use of resistance skills
reduced sales to minors
Frequent sessions
(?)reduced sales to minors
St 139 Experimental study done with 2 drugs, shows that the result is significant, the
epidemiologist wrote in his report that “p” is less than 0.5. What does that mean?
-The association is less than 1\20 (5%) likely to be due to chance alone
st 140 The test used to compare 2 means:
T-test
Q-square test
T-test
st 141 A new anti-hypertensive drug was given to a group of volunteers. What of the
following is used to study the effect of the drug before and after treatment
T-test
Q-square test
Pearson correlation
Paired T-test
Paired T-test
St 142 70% of women in North America use tampons. In a sample of 36 Canadian women
who had toxic shock syndrome, 35 were using tampons. A chi-Square test was
significant (since 70% of 36 =25). The conclusion that TSS is associated with use of
tampons is:
not justified because there was no
control group
11
justified
not justified because chi-square test was misinterpreted
not justified because observer bias was committed
St 143 In a small town. The incidence of disease A is (iA) 8\1000. The disease B not
related to disease A has an incidence of (iB) 12\1000. What is the probability that
the Patientwill have both of the disease In the same time?
-iA + iB
-iA X iB
-(iA + iB) \ 1 - (iA + iB)
-(iA + iB) \ 2
-(iA + iB) \ (iA - iB)
iA X iB
Tr 144 Best prophylaxis for a Canadian traveling to a Malaria area with no resistant strains
is:
Chloroquine
Meflaquine
Meflaquine
Tr 145 Best advice for a Canadian traveling to an area endemic of cholera:
Cholera vaccine
Avoid drinking unboiled water and uncooked food
Prophylactic antibiotics
Avoid drinking unboiled water and
uncooked food
Va 146 Which of the following is the least effective vaccine:
-BCG.
-MMR
-HBV
-Pertussis
Pertussis or BCG; Vaccine efficacy of
Pertussis: 35%-96%
BCG: 0%-80%
Others > 90%
Depends on population etc
Va 147 All are live attenuated vaccine except:
-BCG.
-Yellow fever
-Polio
-Measles
-Diphtheria
Diphtheria is toxoid
Va 148 How often do u give a booster in people previously adequately immunized against
tetanus:
-Every 10 years
Td given every 10 years to adutls
va 149 All are included in the routine immunization EXCEPT:
-Measles
-Pneomococus vaccination
-Mumps
-Rubella
Pneomococus vaccination
Va 150 which of the following diseases can be prevented by a live attenuated vaccine except
a) typhoid
b) measles
c) polio
d) rubella
e) diphtheria
diphtheria
Va 151 which of the following diseases can be prevented by a vaccination except
a) Mumps
b) measles
c) Roseola
d) rubella
e) diphtheria
Roseola
Va 152 Which of the following vaccine causes more side effect:
-Pertussis
-Measles
-Diphtheria
-Yellow fever
Pertussis
Va 153 The vaccine which is given to adults (or recommended every 10 years) is:
-DT Pertussis
-Td
-T
-DT and Polio
Td
va 154 Pertussis vaccine is contraindicated in
-Egg allergy
-Encephalitis after the previous dose
Encephalitis after the previous dose
12
-Upper respiratory tract infection with slight fever
va 155 influenza vaccine is contraindicated in
One year old
congenital immunodeficiency
acquired immunodeficiency
Under 6 months
Under 6 months
Va 156 About live attenuated vaccine, all true except
a) they are save in patients with AIDS
b) In pregnancy they may cause problems
In pregnancy they may cause problems
Va 157 Haemophilus influenza vaccine is:
a conjugate vaccine
killed vaccine
live attenuated vaccine
a conjugate vaccine
Va 158 Which of the following is passive immunization:
diphtheria
Rabies
Rabies
Va 159 MMR is used in all following except
Nephritic syndrome on perdinsone treatment.
Va 160 Live attenuated vaccine. All true except
Can give life-long immunity
Can not be given in immunodeficiency
Produce infection as naturally acquired diseases
xGe
n
161 An autosomal recessive disease is present in a community at the rate
1:40000.What is the probability of any two marrying to get a child with the
disease?
-1:200
-1:400
-1:4000
-1:40000
Or what is the prevalence of the defective allele.
Answer in this case is 1:200
I think the answer is d, 1:40000.
This is a question about Hardy-
Weinberg equilibrium
(population genetics; See
Davidson’s Principles and
Practice of Medicine for
details). Briefly, for an
autosomal recessive disease (eg
cystic fibrosis), two mutant
alleles are needed for the disease
to develop (one good allele is
enough to maintain function).
Suppose that the frequency
(prevalence) of the mutant allele
is p and that of the normal allele
is q, a population is in Hardy-
Weinberg equilibrium if it
satisfies the following equation:
p2 + 2pq + q2 =1
Now p2 is the proportion of
people who would have 2
mutant alleles and therefore
have the disease. It was given
that p2= 1:40000 or 0.000025.
So p or the prevalence of the
mutant allele is equal to the
square root of 0.000025 = 0.005.
If 2 random people marry, each
has a probability of 0.005 to
carry the mutant allele. From the
multiplicative law of
probability, the probability that
their child will receive both
13
mutant alleles is 0.005 X
0.005= 0.000025 or 1:40000.
PS: Multiplicative law of
probability: The probability of
the joint occurrence of two
independent events = product of
their separate probabilities OR
p(X,Y) = p(X) * p(Y)
xGe
n
162 A lady carrier of an X linked recessive disease marries a normal man. They have 2
daughters. What is the probability of each of them of becoming a carrier?
a) 1 in 4
b) 1 in 8
c) 1 in 16
d) 1 in 64
The probability that a girl will become
a carrier is 50%. The probability of
both of them becoming carrier is ½ x
½ =1/4 (25% or 1 in 4)
xGe
n
163 The tree of autosomal dominant transmission
Xge
n
164 A woman consults you because of a possibility of her offspring having Huntington’s
Chorea. Her father is affected. Her husband family doesn’t have this disease What is
the possibility that her children will develop the disease?
-50 %
-0 %
-25 %
-100 %
(?) The probability that this woman
carries the gene is 50%. Given that the
husband is not a carrier, 50% of their
children will receive the gene. Given
only this information, 25% of children
will receive the gene (and develop the
disease since Huntington’s is
dominant)
XG
er
165 Elderly Patient : Prefer to sit home and to be visited by relatives.
XG
er
166 The most common dental disease in elderly
Peridontitis
All are true except:
a_one indirect measure of the population's health status is the percentage of low birth weight
neonate
b_accidents are the largest cause of potential year of life lost in canada
c_the canadian population is steadily undergoing rectangularization of mortality
d_morbidity is defined as all health outcomes excluding death
e_ the neonatal mortalilty rate is the number of infant deaths divided by the number of live
births multiplied by 1000
D
In Canada the admissions for the following cases are going to increase in future as a major
health problem .
1. Accidents.
2. Malignant diseases.
3. Senile dementia.
4. Disabled old patients.
Five physicians are deliberating over whether the patient they have
> examined is exhibiting the auscultatory signs of mitral valve prolapse or
> not. Assuming that there would be agreement by chance of 50%, but, in
> fact, four of the five physicians actually agree on the findings, what is
> the choice-corrected agreement (kappa) for the clinical findings?
> 1) 0.8
> 2) 0.75
> 3) 0.6
> 4) 0.7
> 5) 0.5
Kappa is measure of agreement
(between 2 or more observer) that is
more than expected by chance.
Kappa = (Observed - Expected
agreement) / (1 - Expected agreement)
Kappa= ( 0.8 – 0.5) / (1-0.5) = 0.3 /.5
= 0.6
93-1.0 Excellent Agreement
0.81-0.92 Very good agreement
0.61-0.80 Good agreement
0.41-0.60 Fair Agreement
0.21-0.40 Slight Agreement
0.01-0.20 Poor Agreement
= 0 No Agreement
The incidence of an autosomal recessive disorder is 1 per 2500 live births. Assuming This is not strictly public health. It is
14
that the population in a given community is relatively isolated and homogeneous,
what is the recessive gene frequency for unaffected individuals in this community?
1) 1 in 1250
2) 1 in 500
3) 1 in 250
4) 1 in 50
5) 1 in 25
more of a genetics question. But I
agree with you that ph questions could
be hard. But if you know the answer
that will guarantee you a high score
because hard questions carry more
weight. I’ll try at least to explain what
I understand about this MCQ.
Hardy-Weinberg equilibrium could be
explained as follows: for an autosomal
recessive disease (eg cystic fibrosis),
two mutant/defective alleles are
needed for the disease to develop (one
good allele is enough to maintain
function). Suppose that the frequency
(prevalence) of the mutant allele is p
and that of the normal allele is q, a
population is in Hardy-Weinberg
equilibrium if it satisfies the following
equation:
p2 + 2pq + q2 =1 ;
This equation comes simply from
multiplying (p+q) for the mother with
(p+q) for the father (random mating of
2 people) which will give p2 + 2pq +
q2. The equation says that:
1) The percentage of people
homozygote for the mutant allele (and
therefore will develop the disease
because both alleles are defective) = p2
(square of the prevalence of the mutant
allele or p).
2) The percentage of people
homozygote for the normal allele= q2
(square of the prevalence of the normal
allele or q).
3) The rest will be heterozygoes. But
they will not develop the disease b/s as
we said this autosomal recessive
disease.
Now p2 is the proportion of people
who would have 2 mutant alleles and
therefore have the disease (in this case,
this is 1 per 2500 live births). But p is
the prevalence of the mutant allele. So
to find out the prevalence of the mutant
allele we will just have to take the
square root of 1 per 2500 and that will
give the answer.
Live attenuated vaccines
Live attenuated vaccines usually are created from the naturally occurring germ itself. The germs used in these vaccines still can
infect people, but they rarely cause serious disease. Viruses are weakened (or attenuated) by growing them over and over again in a
laboratory under nourishing conditions called cell culture. The process of growing a virus repeatedly-also known as passing--serves
to lessen the disease-causing ability of the virus. Vaccines are made from viruses whose disease-causing ability has deteriorated
from multiple passages. Examples of live attenuated vaccines include:
1. Measles vaccine (as found in the MMR vaccine) 2. Oral polio vaccine (OPV)
3. Mumps vaccine (MMR vaccine) 4. Varicella (chickenpox) vaccine
15
5. Rubella (German measles) vaccine ( MMR vaccine)
Inactivated (killed) vaccines
Inactivated (killed) vaccines cannot cause an infection, but they still can stimulate a protective immune response. Viruses are
inactivated with chemicals such as formaldehyde. Examples of inactivated (killed) vaccines:
Inactivated polio vaccine (IPV), which is the shot form of the polio vaccine
Inactivated influenza vaccine
Toxoid vaccines
Toxoid vaccines are made by treating toxins (or poisons) produced by germs with heat or chemicals, such as formalin, to destroy
their ability to cause illness. Even though toxoids do not cause disease, they stimulate the body to produce protective immunity just
like the germs' natural toxins. Examples of toxoid vaccines:
Diphtheria toxoid vaccine (may be given alone or as one of the components in the DTP, DTaP, or dT vaccines)
Tetanus toxoid vaccine (may be given alone or as part of DTP, DTaP, or dT)
Component vaccines
Some vaccines are made by using only parts of the viruses or bacteria. These vaccines cannot cause disease, but they can stimulate
the body to produce an immune response that protects against infection with the whole germ. Four of the newest vaccines are made
this way. Examples of component vaccines:
1. Haemophilus influenzae type b (Hib) vaccine 2. Hepatitis A (Hep A) vaccine
3. Hepatitis B (Hep B) vaccine 4. Pneumoccocal conjugate vaccine
16
In Canada low income is associated with increased risk of all except;
a)low birth wt
b)infant mortality rate
c)varicella
d)fire death
e)social behavior problem.
Answer is C
It has been reported that the mortality rate for uranium miners is higher than that of the general
population. Before giving serious attention to this report, which one of the following questions would
you want answered first?
Was the comparison made with mortality rates for the entire general population?
Are uranium miners exposed to factors other than radiation which might increase their mortality
rate?
Is the numerator large enough?
What are the causes of death among uranium miners?
Have the two rates in question been standardized for age?
This is a difficult question because the “questions you would want answered first” is kind of subjective.
Generally when comparing mortality rates you would like to exclude the following alternative
explanations for any observed differences:
1. Confounding by age which could happen if the average miner is older than the average person in
the general population and would result in higher mortality rates among the miners simply
because they are older. Age standardization is then necessary before one could make valid
comparisons.
2. Statistical precision. If the mortality rate among the miners is based on 2 or 3 deaths (the
numerator in the mortality rate) then the difference may be due to chance. Suppose that there
are 100 miners and one died (due to any reason) then the mortality rate will be 1% which is
higher than general population mortality rate of let us say 1 per 1000. But because the first is
based on one death only, it is far from reliable. So you need reasonably large number of deaths
before you could make valid comparison.
I personally would choose [e] but can’t rule out [c].
A researcher tested a drug on people with vascular dementia. It reduced problems in behaviour. Then he used same drug for people with Alzheimer
and also produced a similar effect. Now he…?tests it or …This is called?
• Clinical trial 1
• Clinical trial 2
• Clinical trial 3
• Clinical trial 4
• Inventory therapy
There is not enough information to make a correct choice. The difference between phase 2 and phase 3 trials is that in phase 2 trial the drug is
given to a small group of patients to test its efficacy and safety. In phase 3 trials the new drug is compared with standard treatment to see if it
would do better. Phase 3 trials usually involve large number of patients and are often randomized and double-blind (neither the patient nor the
doctor knows what the patient is getting).
Phase 1 trials are small studies to test the safery of the drug usually on volunteers or patients with advanced disease. Phase 4 trials are studies done
to after the drug is marketed to detect any long term side effects.
17
. In designing a community prevention program, which one should be undertaken first?
a) Obtain guarantee of funding
b) Estimate the cost-benefit of intervention
c) Quantify objectives
d) Carry out a community needs assessment
e) Formulate possible strategies of screening
Example 26-1
A consumer group would like to evaluate the success of three different commercial weight loss programs. To do this, subjects are assigned to one of
three programs (Group A, Group B and Group C). The average weight of the subjects is not significantly different at the start of the study (Time 1).
Each group follows a different diet regimen. At time 1 and at the end of the 6 week study (Time 2); the subjects are weighed and their blood
pressure measurements are obtained. Examples of how statistical tests can be used to analyze the results of this study are given below.
1. t-test : Difference between the means of two samples.
a. Independent (Nonpaired) test: Tests the main difference in body weights of subjects in Group A and subjects in Group B at Time 1 (i.e. two
groups of subjects are sampled in one occasion)
b. Dependent (Paired test) : tests the mean difference in body weights of people in Group A at time 1 and time 2 (ie the same people are
sampled at 2 occasions)
2. Analysis of Variance: DIfference between the means of more than 2 samples
a. One Way analysis : Tests the mean difference in body weights of subjects in Group A, Group B and Group C at time 2 (ie one variable : group)
b. Two way analysis : tests the mean differences in body weights of men and women and in body weights if group A , Group b and Group C at
time 2 (i.e 2 variables: sex and group)
3. Correlation : The mutual relation between 2 continuous variables
tests the relation between blood pressure and body weight in all subjects at time 2.
4. Chi Square test: Differences between frequencies in a sample..
tests the difference among the percentage of subjects with body weight of 140lb or less in group A,B, and C at Time 2
Life expectancy is a comprehensive measure of
the health status of a population. This measure is
the age beyond which less than about 0.1% of
the original cohort of people live.
the usual amount of time a person in a
population can expect to live free of disease.
the maximum age that human beings as a species
could reach under optimum conditions.
the age where 50% or more of a population
cohort have died.
on the average, the expected number of years to
be lived by a cohort.
To estimate survival from a follow-up study,"time zero" must be defined precisely for each patient . this is best ensured
by
Let us work our way through this tough MCQ.
2. enrolling all patients on the same calendar date .
is obviously wrong as it is almost impossible to do that.
4. measuring from the time the disease is detected by a screening program .
This is also wrong. Using screen-determined zero time will tend to introduce lead time bias, i.e., cases detected by
screening will appear to live longer simply because they were detected earlier in their natural history.
5. selecting all patients of clinically comparable points in the course of the disease .
I excluded this option because it says “selecting”. We are not interested in selecting patients. Our aim is to define the
point in time from which to start “measuring” survival time. All the other options emphasize this “measuring”. So this is
an option designed to throw us off
We are left with 2 options:
1. "back dating" the entrance to the date of onset of the first symptoms , as obtained from the history
18
3. measuring from the first instance when each patient's symptoms met certain criteria for severity .
Both generally sound good. I thought that 3 is perhaps more objective. For instance, in a study of survival from lung
cancer it would be better to develop objective criteria for cough as initial symptom than to simply ask patients when
they started coughing. I am therefore inclined to go with option 3.
That is right. The immediate cause of death is by definition the one that immediately preceded death. (Which one would be obvious
form the context of the question.) Because this question was most likely about the underlying cause of death, it may not be possible
to determine the immediate cause of death from the information given.
. All of the following are responsibilities of
local public health units in Canada EXCEPT
health education.
immunization.
communicable disease control.
health promotion.
investigation of sudden death.
.1) From information recorded at school A it was
found that, out of a total of 400 missed 'person days'
during November, 100 were due to measles; 200 to
"flu"; and the rest to various other causes. At school
B in the same neighborhood, during the same period of
time, a total of 75 children were absent for 1 or more
days. Of these, 25 had suffered from measles, 25 from
"flu" and the rest from various other causes. It can
be concluded that
a)the overall morbidity rate was higher in school
A than in school B.
b)the incidence of "other causes" was greater in
school A than in school B.
c)none of the conclusions listed can be reached
with the data provided.
d)the incidence of measles was greater in school
B than in school A.
e)the incidence of "flu" was greater in school A
than in school B.
2)Over the last 40 years, expectation of life at
birth in Canada has improved steadily in both sexes.
The main reason for this overall increase in life
expectancy is
a)the trend toward lower fertility rates.
b)the average age of the population is increasing.
c)improvements in cause-specific mortality rates.
d)the decline in the infant mortality rate.
e)decreases in death rates at older ages.
3)Prevalance rate is 1/40000. then what is the prevalence of the disease
a. 1/40000
b.1/400
c.1/1000
4)It has been reported that the mortality rate
for uranium miners is higher than that of the general
population. Before giving serious attention to this
report, which one of the following questions would you
want answered first?
a)Was the comparison made with mortality rates for the entire general population?
b)Are uranium miners exposed to factors other than radiation which might increase their mortality rate?
19
c)Is the numerator large enough?
d)What are the causes of death among uranium miners?
e)Have the two rates in question been standardized for age?
5)decreased mortality rate of stroke is due to:
a) better control of blood pressure
b) regular use of aspirin
c) improvement of surgery process
6) Which of the following statements regarding perinatal mortality is
true?
A) the fetal mortality rate plus the number of fatalities among
live-born neonates within the first 6 days of life
B) the number of fatalities within the first 27 days of life
C) the number of abortions plus the fetal mortality rate (including
the number of fatalities within the first 6 months of life)
D) mortality occurs within the first year of life
7)The most frequently used indicator for the quality of life is:
A) the life expectancy rate at birth
B) the life expectancy rate without chronic disease and disability
C) the life expectancy rate at 60 years of age
D) the raw mortality rate
Reliable indicators of a quality-life include:
A) the amount of the gross domestic product
B) the unemployment rate
C) the raw mortality rate
D) crime statistics
E) leisure utilization statistics
9)According to 1990 data, which of the following causes resulted in
the highest mortality rate per 10,000 inhabitants in Hungary?
A) mortality due to hypertension
B) mortality due to ischemic heart disease (IHD)
C) mortality due to cerebrovascular diseases
D) mortality due to myocardial infarction
A 25-year-old Jehovah's Witness man is scheduled for emergency surgery following a motor vehicle accident in which he sustained
pelvic fractures. The patient is competent and lucid before the surgery and refuses the administration of blood products. Which
course of action is most appropriate in the event of significant intra-operative blood loss?
1) administration of packed red cells in the recovery
2) use of a cell saver
3) administration of hydroxyethyl starch (SM XX)
4) administration of packed cells after obtaining consent
5) intra-operative autologous blood donation
low effectivenss of pap smear is due to
a.high risk patient not screened
b. doctor cannot interpret the result effectively
c.low specificity of the test
20
cervical cancer is still high due to
high risk groups arent screened
increased incidence in past years
low specificity of pap smear
in studie of program on cohort of patient should be studied to provide accurate information on survival.cohort best assembled by
enrolling
a all patient e disease of interst and estimating the date of onset of 1.symptom
b all pat.on the same calender date
c pat.when try develop 1.complication of disease
d only pat compliance e treatment for their disease
e pat.at an early & uniform point in the course of their disease
a 58 year old patient was admitted to the hospital for appendicectomy. during the surgery his condition deteriorated and he passed
into coma. you started tube feeding. the patient has no family members or friends around and no advance directive. when can you
stop the tube feeding ?
1) you cannot stop it except by the order of court
2) you stop it according to the need of his bed for another patient
3) you cannot stop it because his condition was not serious
4) you can stop it according to the opinion of another physician
5) you consult CEO of the hospital to take a legal action
In a class of 25 students (15 male ,10 female)5 develop HA over 2 weeks period, during next 6 weeks add. 3 male and 2 f.
developed HA. Secondary attack rate of HA which one of the following?
20%
25 %
40%
50%
73%
The primary attack rate is just the incidence rate=No of all infections/population at risk =10/25. The incidence rate is called attack
rate when there is a dramatic and sudden increase in the occurrence of a disease (usually an infection). The secondary attack rate
(calculated as per doctorzeeek post) is a measure of the transmissibility/contagiousness of the infection ie the ability of the
infectious agent to spread from the index case to susceptible contacts. The formula for secondary attack rate (SAR) is
SAR (%)=(No of cases –No of initial cases) divided by (Total No in group- No of initial cases)
In this case SAR(%) = (10-5) / (25-5) = 5/20 = 25%
who is responsible for recalling faullty medical equipment
a_health canada
b_association of pharmaceuticals
c_health protection branch
d_medical equipment branch
e_royal college of physicians and surgeons
Health Canada
Hemochromatosis has a prevalence of 0.5% in the general population-----treatment of choice is regular phlebotomy. You decided
to initiate a new test for this disease. The literature : a sensitivity of 80.5% and a specificity of 89.5% for this test. You screen
1000 people ---institute treatment solely on the results of the test. Which one of the following is correct?
1) you will treat 40 people with phlebotomy
2) 995 people will not be treated
3) 100 people who do not have the disease will be treated with phlebotomy
4) 80% of the subjects will be correctly diagnosed
5) 200 people who have the disease will be denied treatment
21
0.5% have the disease so 0.5 X 1000 = 5 (true) cases and 995 are normal
If you then apply the reported sensitivity and specificity to these numbers, you will get the following table
Disease Total
Test Yes No
+ve 4 105 109
-ve 1 890 891
--------------------------------------------------------------------------------------------
Total 5 995 1000
From the table you could see that “(3) 100 people who do not have the disease will be treated with phlebotomy” is the closest to
the truth. All the other options do not fit the data.
All of the following are characteristics of provincial voluntary health organizations, EXCEPT
1) provincial governments contribute to their funding in proportion to the number of members. (XX)
2) they are governed by volunteers rather than by professionals.
3) they often carry out programs of education for the public, patients, their families, or health professionals.
4) they may provide direct services to patients.
5) they may conduct research or provide funds to others for research.
Thursday, January 14, 2010
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I really like it. Thanks for sharing. I learn something totally new and challenging. MCCEE
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