1.

Which of these is the term commonly used for the breakout of a pathogen from its normal animal hosts to become an epidemic in humans? a. Reassortment b. Devolution c. Type II error d. Persistence e. scape from Restriction !!! ". Prion is the causative agent of #heep #crapie$ %ad &o' Disease ()ovine #pongiform ncephalitis*$ and human &ruet+feldt,-acob disease is very resistant to heat$ ultraviolet light$ many solvents$ nucleases$ lipases$ carbohydrate, digesting en+ymes$ and proteases unless partly denatured first in guanidinium chloride. It is a molecule$ believed to be 'hich one of the follo'ing? a. D./ b. R./ c. / protein !!! d. / carbohydrate e. / lipid 0. vidence )ased %edicine is highly recommended in clinical practice. Which one of these is the principal motivation that gave rise to this recommendation? a. To replace classical statistics 'ith better statistical tests and measures b. To reduce the accident rate in clinical practice (medical errors* !!! c. To encourage physicians to study more mathematics d. To avoid having to make use of genomic biomarkers e. To avoid having to make medical decisions

1. Which one of these does vidence )ased %edicine most seek to replace (get rid of*? a. /necdotal evidence$ personal physician e2perience$ and out,of,date medical training !!! b. Digital patient records (electronic medical records* c. &omputers d. Routine 3ab tests e. %anaged 4ealthcare (as practiced in the 5#/* 6. Which one of these is most likely to be generally considered incorrect? a. Diagnostic biosensors can be made by synthesi+ing peptides representing target epitopes$ attaching them to a carrier protein$ and raising antibodies in animals. b. 5se of the D./ polymerase chain reaction (P&R* can be used as a diagnostic in some circumstances c. /rtificial vaccines can be made by synthesi+ing peptides$ attaching them to a carrier protein$ and in7ecting them into humans

d. 3arge vehicles on the nanotechnology scale made from synthetic peptides 7oined together could in future be used in principle for gene therapy$ though the practice of gene therapy generally is really still in its infancy. e. .anotechnology using sub,microscopic molecular robots is likely to be feasible for curing /ID# by "818. !!! 9. Which one of these animals has been most significantly indicated as indicated as the source of a potential pandemic of #/R#? a. duck b. chicken c. pig d. horse e. civet !!! :. In this diagram of the influen+a virus$ 'hat part of the annotation is incorrect?

HA - hemagglutinin Neuraminic acid helical nucleocapsid (DNA plus NP protein) lipid bilayer membrane polymerase complex

%" Protein
M1Protein Pprotein
a. b. c. d. e. ;. 4/ hemaglutinin 4elical neucleocapsid .euraminic /cid !!! 3ipid bilayer comple2 Polymerase comple2

/ pathogen enclosed in posted envelopes 'as associated 'ith a biothreat attack on the 5nited #tates shortly after the attack on the World Trade &enter. Which pathogen is it? a. 3isteria monocytogenes b. 4ighly purified )otulin ()otulinus to2in* c. Infective 4aemophilus influen+ae particles d. #mallpo2

e. /nthra2 !!! <. In 1<<:$ at least a fe' hundred people became infected 'ith the avian /=46.1 flu virus in 4ong >ong and 1; people 'ere hospitali+ed. #i2 of the hospitali+ed persons died. This virus 'as different and of great concern because a. It moved directly from pigs to people$ rather than having been altered by infecting chickens as an intermediate host b. It moved directly from chickens to people$ rather than having been altered by infecting pigs as an intermediate host !!! c. It moved directly from civets to people d. It moved directly from co's to people$ 'ithout consuming infected beef e. It could replicate outside an animal host 18. / typical point source epidemic differs from a common source epidemic by 'hich one of the follo'ing features? a. It is always food poising by definition b. %ore than 68? fatalities in the first "1 hours c. %ore than 18? fatalities and a very slo' onset follo'ed by clear series of ripples in the number of affected people d. / very slo' onslaught and typically a very long duration e. / very rapid onset and commonly a short duration !!! 11. Persistence or recycling of infection in the population can be identified by 'hich of the follo'ing? a. /n #,shaped development of the course of the epidemic 'ith time !!! b. / single peak or @spikeA 'ith rapid onset for the course of the epidemic 'ith time c. / single peak or @spikeA 'ith slo' onset for the course of the epidemic 'ith time d. / single peak or @spikeA 'ith rapid decay for the course of the epidemic 'ith time e. /l'ays t'o peaks or @spikesA for the course of the epidemic 'ith time 1". The .umber .eeded to Treat (..T* is calculated 'ith respect to t'o treatments / and )$ 'ith / typically a placebo$ and ) involving a drug (it is sometimes presented the other 'ay round$ since it is customary to Buote the result as positive 'hether positive or negative*. If the probabilities P(/* and P()* of this endpoint under treatments A and B$ respectively$ are kno'n$ then the ..T is calculated as 'hich one of these? a. logP(/*,logP()* b. 1=C(P(/*,P()*D !!! c. P(/* x P()* d. P(/* E P()* e. P(/* E P()*"

10. Which of these is the likelihood ratio 3RF for a diagnostic obtaining a negative result given the disease? a. P (Fve result G disease* P (Fve result G no disease* HHH by definition b. P (Eve result G disease* P (Fve result G no disease* c. P (disease G Fve result * P (disease G Fve result* d. P (disease G Eve result * P (disease G Fve result* e. P (Eve result G disease* P (Fve result G disease* 11. Which one of these best describes the philosophical position that patients participating in medical research$ or allo'ing their clinical records to be submitted anonymously to a data base$ are participating for the common good? a. &linical bioinformatics b. )ioinformatics c. &hemoinformatics d. /utonomy e. #olidarity HHH by definition 16. If the /bsolute Risk Reduction (/RR* is 8.1$ 'hat is the number of people needed to treat (..T*? a. 8.1 b. 8." c. 1 d. " e. 18 HHH ..T I 1=/RR I 1=8.1 I 18 19. The follo'ing 'as a pioneering study on one of the first large collections of patient medical records in digital and directly analy+able formJ @Data mining and clinical data repositoriesJ Insights from a !!!!! patient data setA Irene %. %ullins et al. &omputers in )iology and %edicine$ "889 DecK09(1"*J1061,::. 4o'
many patent records 'ere collected and data mined$ i.e. 'hich number has been replaced by !!!!!? a. 9: b. 99: c. 9$9:8 d. 99:$888 HHH /s in lecture$ but 9$9:8 'ould be too small a number for that study$ 'hile 9,: million 'ould be too large a number of data,minable digital medical records of that detail to have available in that period of recent history. e. 9$9:8$888

1:. Which of these is the sensitivity of a diagnostic test? a. P(no diseaseGFve result* b. P(diseaseGEve result*

c. P(Eve result G disease* HHH by definition$ but intuitively$ a test is the ability to pick up a positive result for the disease present. d. P(Fve result G disease* e. P(diseaseGEve result* P(diseaseGFve result* 1;. Which of these is Relative Risk (RR*?
a. P(disease G control group* FP(disease G test group* b. 1= CP(disease G control group* F P(disease G test group*D c. P(test group G disease* P(control group G disease* d. 1=CP(control group G disease* F P(test group G disease*D e. P(disease G test group* P(disease G control group* HHH by definition

1<. Which of these is not an e2ample of an odds ratio?

a. P(disease G test group* x P (no disease G control group* P(no disease G test group* x P(disease G control group* b. P(,heli2 G alanine at residue "9 x P (not ,heli2 G not alanine at residue "9* P(not ,heli2 G alanine at residue "9 * x P(G not ,heli2 G alanine at residue "9* c. P(Eve result G pregnant* x P(Fve result G not pregnant* P(Fve result G pregnant* x P(Eve result G not pregnant* d. P()ank openG #aturday* x P()ank closedG not #aturday* P()ank closedG #aturday* x P()ank openG not #aturday* e. P(diabetesG obesity* x P(obesity G no diabetes* P(no diabetesG no obesity* x P(no obesity G diabetes* HHH /ll the others are of reBuired form P(/ G )* P(.LT / G .LT )*

P(.LT / G )* P(/ G .LT )* that you should have noticed in learning the formula. This one is 7ust plane 'rong. "8. If patients diagnosed 'ith acute hepatitis / are believed to be arriving at your office at random$ and acute hepatitis / represents "? of the population$ 'hat should you believe are the chances of three 'ith acute hepatitis / arriving in succession? a. 8.888" b. 8.8881 c. 8.88888" d. 8.888881 e. 8.88888; HHH P(/* x P(/* x P(/* I 8.8" x 8.8" x 8.8" I 8.88888; "1. In the case of Muestion "8 regarding acute hepatitis / patients$ 'hich one of these should a 5# physician do? a. &heck 'hether this is truly random$ e.g. perhaps they came as a group. b. &heck 'hether it the "? relates to the population represented by your patients c. /sk for further diagnostic tests as a check

d. No to the library and check 'hether this is a reasonable probability e. .otify the 5# authorities *** Requirement in US, and similar to practice question with change of disease) "". )% currently holds that the strongest evidence for therapeutic interventions is provided by 'hich of these? a. Information obtained by a good day spent in the library. b. Randomi+ed$ double,blind$ placebo,driven trials involving a homogeneous patient population and medical condition.HHH by definition c. / notebook of your carefully prepared &ritically /ssessed Topics d. Patient opinion e. 2pert opinion "0. The large amount of digital medical information no' appearing in the 'orld is mainly comprised of 'hich of these? a. %edical images HHH b. D./ c. Digital patient records d. Proteomic data e. 4ealth insurance claims "1. Which of these concerning %igraine is most likely to be correct? a. %igraine is a purely vascular disorder b. %igraine is neurological$ often associated 'ith a 'ave of depolari+ation in the visual corte2 'hich appears to the sufferer as an aura HHH c. %igraine is al'ays associated 'ith headache. d. %igraine is not genetic$ but an effect of environment only e. %igraine is a rare disease compared 'ith cardiovascular and cancers. "6. /myloid plaBue is composed of aggregates of protein fragments proteolytically derived from a precursor protein called /PP. It is a characteristic feature of 'hich disease? a. %igraine b. Diabetes c. 4ypoglycemia caused by poisoning by the unripe /ckee fruit d. &ystic fibrosis e. /l+heimerOs HHH "9. The e2plicit methodologies used to determine Pbest evidenceP 'ere largely established by the %c%aster 5niversity research group in &anada. That group 'as led mainly by 'hich of these? a. David #ackett and Nordon Nuyatt HHH /s taught in clinical bioinformatics set$ and repeat in overvie'=revie' set. b. %uir Nray c. /rchie &ochrane

d. 3ouis Pasteur e. -ames T. Watson ":. The main interest for the use of )% at this time is 'hich of these? a. To make physicians make better and more efficient use of their time b. To reduce medical errors HHH Taught e2tensively in lecture as main theme. c. To improve physicianOs understanding of probabilistic reasoning d. To facilitate research e. To help promote use of computers ";. Lne of the earliest medical 2pert #ystems from #tanford 5niversity$ actually for microbiological diagnosis and prescription$ 'as 'hich of these? a. I.T R.I#T b. %Q&I. HHH #lide in &linical )ioinformatic set$ @The DebateJ Pioneers Thought #o. %a7or Pioneering Tools Were ProbabilisticA c. 4/3 <888 d. DL>TLR e. @Doctor -oeA "<. Differential Diagnosis is best considered as 'hich of these? a. considering the possible causes of a patientOs clinical problem$ and ho' to rank the options by likelihood$ seriousness$ and treatability b. ho' to select and interpret diagnostic tests$ in order to confirm or e2clude a diagnosis$ based on considering their precision$ accuracy$ acceptability$ e2pense$ safety$ etc. HHH c. ho' to select treatments to offer patients that do more good than harm and are 'orth the efforts and costs of using them d. the clinical practice of )% e. the use of genomic biomarkers 08. #econdary (integrative* studies of observational type are those in 'hich there isR a. no intervention and no variable manipulated HHH you cannot be intervening and controlling variables if you are 7ust observing$ any'ay. b. intervention and no variable manipulated c. no intervention and variables manipulated d. intervention and variables manipulated e. a randomi+ed controlled trial 01. Etiology isR a. The estimate of the patientOs likely clinical course over time and anticipating likely complications of the disease b. The cause of a disease$ or ho' to identify causes for disease HHH The study and practice of the prevention of disease c. The application of )% to cost analysis d. The practice of clinical e2amination.

0". Which of these is not currently considered an @# optionA on the )% @pyramidA? a. #I%53/TIL. S 5se of computer ,based systems biology to model the disease state of the patient HHH b. #Q#T %# , &omputeri+ed Decision #upport #ystems c. #Q.LP# # , )% Internet InBuires T )% -ournal /bstracts d. #Q.T4 # # , especially &hochrane Revie's e. #T5DI # , Lriginal /rticles Published in -ournals 00. Which of these is second in the @)asic thical principlesA of the )elmont Report? .ote that t'o of the follo'ing are not basic ethical principles in the report. (Research paper reading test* a. Respect for Persons. S Respect for person incorporates at least t'o ethical convictionsJ first$ that individuals should be treated as autonomous agents$ and second$ that persons 'ith diminished autonomy are entitled to protection. b. Beneficence. S Persons are treated in an ethical manner not only by respecting their decisions and protecting them from harm$ but also by making efforts to secure their 'ellbeing. HHH c. /s listed in )elmont ReportS ). )asic thical Principles 1. Respect for Persons ". )eneficence 0. -ustice d. Justice. Who ought to receive the benefits of research and bear its burdens? This is Buestion of 7ustice$ in the sense of @fairness in distributionA or @'hat is deserved.A /n in7ustice occurs 'hen some benefit to 'hich a person is entitled is denied 'ithout good reason or 'hen some burden is imposed unduly. e. Solidarit and the !ommon "ood. #ub7ects should be made to understand the benefits of participating in research and sharing their clinical data anonymously. f. Right to #reatment. .o one should be denied medical treatment irrespective of ability to pay for such treatment. 01. Which of these is least likely to 7ustify notification of the appropriate authorities by a physician a. 4IU in a 11 year old b. Plague c. /nthra2 d. 5ne2pected deterioration of health of an elderly person in a nursing home e. &ommon cold in an elderly person HHH not on list of @notifiablesA in last lecture. 06. Personalized medicine comes closest to meaning 'hich of these? a. &hoice of prescription based on the patientOs genomics$ clinical history$ and lifestyle.HHH #ee slide in clincal bioinformatics setJ,

Vour #teps to #afety

UID .& )/# D % DI&I. The mother of the follo'ing$ promoting the idea of using mainly latest proven facts from the largest number of patients I.VLR%/TIL. )/# D % DI&I. )% and other medical functions implemented on computers #TR/TIVI D % DI&I. refines 1," by adding the genomics for genomically distinguished groups of patients P R#L./3IW D % DI&I. goes further by holistically taking into account the genomics$ proteomics$ clinical history$ and lifestyle of the individual patient

b. Vreedom to choose your hospital 'hen sick. c. Vreedom to choose your physician. d. Vreedom to choose pharmaceutical administration by tablet$ in7ection$ or enema. e. Inclusion of patientOs name and address on clinical records submitted to shared collections for data mining. 09. If ;? of the population has malaria$ 'hat is the probability of finding one person 'ith malaria in that population by random selection? a. ; b. 8.; c. 8.8; HHH ;?=188 I 8.8; probability. Probability is a scale 8 to 1$ Percentage 8 to 188. asyJ kno'ing this is a reBuirement for everyday life$ not 7ust being a physician. d. 8.88; e. 8.888; 0:. Which one of these must lie bet'een 8 and 1 (inclusive*? a. Probability HHH The rest are ratios or logs of them$ and can range in principle from minus infinity to plus infinity. b. 3ikelihood c. Ldds ratio d. 3og Ldds ratio e. >$ the ratio of the probability of 'hat is observed and 'hat is e2pected on a chance basis. 0;. When a'aiting for your turn 'ith the 5# physician and the paramedic or nurse asks @do you have any allergiesA$ this is 7ust a nice 'ay of saying 'hich of these? a. Do you suffer from @hay feverA? b. Do you have any notifiable diseases? c. Do you have any adverse drug reactions that you are a'are of? HHH )asically this is the general kno'ledge common sense Buestion.. Lne of the fe' drugs that is close to being an allergic type of response are some penicillins$ 'hich 'ere discussed. )ut to not kno' this one you must have never been to a doctor before. /lso$ the only other ans'er that makes

sense in terms of any reaction to something is (a*$ and 'hy 'ould they consistently ask about hay fever? d. Do you have any psychiatric disorders dangerous to the health of patient and community? e. /re you a victim of domestic or child abuse? 0<. Which of the follo'ing is mostly likely true? a. /ID# as the term is usually understood can be due to primary causative viruses other than 4IU b. In the 5#$ the incidence of /ID# in persons aged "6,11$ has never been as high as deaths due to accidental causes c. / fe' people e2posed to 4IU are resistant due to differences in one of their cell surface receptors !!! d. Washing household and other surfaces 'ith disinfectant 'ill significantly reduce the risk of acBuiring 4IU e. 5se of condoms as contraceptive does not significantly reduce the risk of 4IU infection 18. Vree distribution of condoms in the fights against /ID# is an e2ample of 'hich of these? a. Primary prevention !!! b. #econdary prevention c. Tertiary prevention d. Muaternary prevention e. .one of the above 11. Which one of these pathogens is most likely to cause food poisoning because cooked shrimp is not kept refrigerated? a. Rhinovirus b. Uibrio parahaemolyticus !!! c. Influen+a d. The causative agent of )ovine #pongiform ncephalopathy e. &andida 1". Lne of the follo'ing genetic disorders correlates strongly 'ith areas of the 'orld 'here a ma7or disease propagated by an insect vector is endemic. Which one of these is the best candidate for that gene? a. Nene for sickle cell anemia !!! b. Nene for ata2ia c. Nene for &reu+feldt -acob Disease d. /n oncogene e. The gene for a variant of lyso+yme 10. Which county is believed the most likely point of origin of 46.1 /vian Influen+a a. /frica

b. urope c. India d. &hina !!! e. Russia 11. The follo'ing are appro2imately in order of their devastating affect. )ut 'hich 'as the first one to occur as a ma7or pandemic? a. @#panish VluA /(41.1* !!! b. @/sian VluA / (4"."* c. @4ong >ong VluA /(40."* d. @/vian VluA /(46.1* e. @/vian VluA /(4<."* 16. /ll of the follo'ing are kno'n to be typically transmitted by an insect vector e2cept one$ for 'hich an insect vector is not yet kno'n or proven. Which is it? a. bola !!! b. West .ile virus c. 3yme disease d. %alaria e. Qello' Vever 19. The 43/ (4uman 3eukocyte /ntigen* genes help the immune system distinguish the bodyXs o'n proteins from proteins made by foreign invaders such as viruses and bacteria. These genes sho' considerable polymorphic variation from individual to individual. Vor e2ample$ hundreds of versions (alleles* of 43/,) are kno'n$ each of 'hich is given a particular number (such as 43/,)":*. What is the most likely e2planation for this gene variation? a. %olecular diversity allo's a huge variety of ne' foreign proteins to be identified$ and also increases the chances that some members of a population are more likely to survive a ne' epidemic !!! b. The function is not very important$ and hence there is no evolutionary pressure to keep the gene seBuence constant c. The genes are continually being modified somatically by invading viruses d. The protein products of the genes are modified by bacterial en+ymes e. The protein products of the genes are modified by peptide breakdo'n products of invading organisms 1:. 4IU is 'hich one of these? a. /n R./ virus 'ithout a lipid membrane b. / D./ virus 'ithout a lipid membrane c. / retrovirus !!! d. / prokaryote e. .one of the above

1;. &alculate the case fatality rate for pulmonary embolism for a hospital of 1888 patients 'here 198 'ere diagnosed 'ith that disease and 18 of those died from it. Which one of these is the correct ans'er? a. "? b. 19? c. "6? !!! d. 08? e. 68? 1<. Infectious pathogens ne' to humans and threatening or causing epidemics in humans tend to be more serious than those 'hich have been infecting humans for thousands of years. /ll of the follo'ing might be argued to have some relevance$ but 'hich one is believed to be the best e2planation? a. It does not benefit a pathogen or any parasite to kill its host too Buickly$ since this reduces its propagation by infection$ so the less pathogenic infections tend to surviveK also the more susceptible humans died out long ago$ leaving ourselves as the members of the population 'hich are more resistant to those diseases !!! b. The correlation arises simply because the 'orld population is no' much larger c. Recent pathogens all carry drug resistance as a result of the recent use of antibiotics in medical history d. 4uman diet has deteriorated from that of early humans living in a more natural environment$ 'eakening the capacity of the immune system to respond e. 4umans have recently tended to live much longer lives especially in the industrial nations$ and old people tend to be more readily infected by unusual diseases 68. Whenever it is reasonably possible$ epidemiological statistics refer to the susceptible$ not total$ part of a population. Vor e2ample$ it 'ould be unreasonable to consider females as being at risk from prostate cancer in the calculation of prevalence. 4o'ever$ it is not al'ays easy to identify factors 'hich reduce or increase susceptibility. Which one of the follo'ing have been the easiest to identify in large populations up to "889$ and is thus e2cluded from the susceptible population during a viral epidemic? a. The number of people 'ith a gene variant 'hich prevents the virus from entering the cell b. The number of people 'ith an 43/ gene variant 'hich allo's complete immunological resistance c. The number of people 'ho have been treated by a vaccine 'hich is typically effective$ or 'ho have already caught the disease previously (assuming the particular disease cannot be caught t'ice* !!! d. The number of people 'ho are @carriersA$ i.e. 'ho are infected but asymptomatic

e. The number of people 'ho shelter themselves in a basement 'ith food and 'ater during the course of an epidemic 61. %ost and probably all of the serious epidemics and common infectious diseases of childhood are no' believed by the ma7ority of microbiologists to be zoonotic. This means 'hich one of these? a. They arrived on meteorites or dust from space (e.g. @4oyleOs 4ypothesisA Vrederick 4oyle 1<16,"881$ )ritish /stronomer Royal* b. They arose by spontaneous mutations in the so,called @7unk D./A regions of the human chromosomes c. They 'ere ancient organisms from the Precambrian period long trapped in rocks and occasionally released d. They 'ere originally pathogens of plants e. They 'ere originally pathogens of animals !!! 6". The term @4yperendemicA usually means 'hich of these? a. / geographical distribution 'hich is more 'idely spread around the 'orld than an endemic one b. / disease 'ith very high mortality c. / high epidemic rate d. / high endemic rate !!! e. /n epidemic 'hich is generally propagated by skin contact 60. The incidence rate for a disease is 'hich of the follo'ing$ multiplied by 188? 4intJ The definition of the incidence rate of a disease is often confused 'ith the definition of the attack rate and sometimes even 'ith the definition of prevalence rate. 4o'ever$ the distinction is perhaps clearer if you 'ant a useful measurement 'hich spans the period of a long epidemic$ despite the fact the number of affected people and the number of susceptible people can change a lot during that time. a. The number of contracting the disease in an outbreak of$ for e2ample$ food poisoning$ divided by the total number of people at risk b. The number of ne' cases of a disease in a given period of time$ divided by the total mid,period number of people at risk !!! c. The number of ne' cases of a disease$ divided by the total number of people at risk d. The number of people dying$ divided by the total number at risk e. The number of people involved in incidents involving police or military in an area under emergency regulations$ divided by the total people in that area 61. During the month of Lctober$ a measles outbreak in an elementary school caused the absence of 188 of its 188 pupils. During the month of .ovember$ an additional 188 pupils 'ere diagnosed 'ith measles. The attack rate for .ovember$ making the usual assumptions$ is closest to 'hich one of these? a. "6? b. 00? !!!

c. 68? d. :6? e. 188? 66. The @prevalenceA of a disease$ as distinct from the @prevalence rateA$ is 'hich of the follo'ing? a. The number of people affected for 'hom the disease is endemic in a specified area divided by the number of people affected by the same disease in a pandemic outbreak b. The number of ne' cases during a specified period divided by the total mid,period population at risk c. The incidence multiplied by the duration of disease !!! d. The number of people having the disease divided by the total number of people at risk at a particular time e. The incidence of the disease in areas 'here it is endemic 69. The @epidemiologistsO bathtubA is a model used to e2press 'hich of the follo'ing? a. The relation bet'een incidence$ prevalence$ mortality$ and rate of cure or spontaneous recovery in an epidemic !!! b. 3evels of 'ater contamination in reservoirs c. Degrees of personal hygiene d. &ontagion in shared 'ashing facilities e. The resources available for investigating an epidemic 6:. #everal patients admitted themselves into hospital after a night suffering from food poisoning cased by #taphylococcus aureus to2in. They had very severe 'idespread muscular cramps. Which of these should have been administered immediately? a. / pencillinase,resistant antibiotic b. %edications such as &ompa+ine or Tigan for nausea and vomiting c. %edications such as 3omotil or Imodium for cramping and diarrhea d. #aline intravenously or aBueous sodium chloride solution orally !!! e. Water alone 6;. In 'hich of the follo'ing ma7or epidemics has medical science been slo' to respond 'ith a vaccine but has responded 'ith a ne' drug , a protease inhibitor? a. %alaria b. Influen+a c. /ID# !!! d. Tuberculosis e. #mallpo2 6<. 5ntil about the year "888 in the 5#$ male,to,male homose2ual contact and use of in7ected illegal drugs 'ere the ma7or cause of /ID# cases. 4o'ever after that

another cause overtook in7ection of illegal drugs and it is also a ma7or cause of /ID# in the so,called @Third WorldA. Which one is it? a. 4eterose2ual contact !!! b. Prior infection by tuberculosis c. 4IU,infected blood transfusions d. Vemale,to,female homose2ual contact e. Transmission of 4IU by mosBuito 98. There are many definitions of epidemiology$ such as @The )asic #cience of Public 4ealthA. /ll of the follo'ing are relevant$ but 'hich one is most likely to also be considered a reasonable definition of epidemiology? a. The application of biostatistics to epidemics b. The investigation of the freBuency$ distribution$ and dynamics of disease or other health,related issues 'ithin a defined human or animal population$ typically during a specified period$ and of the factors 'hich determine these !!! c. The study of +oonotic diseases d. %icrobiology applied to large human populations e. Uigilance and defense against natural and malicious biothreat 91. @Malaria is endemic in many countries. Which of these represents the counties mentioned most often mentioned? a. /frica$ the %iddle ast$ /sia$ #outh /merica$ and the #outh Pacific !!! b. urope and Russia c. &hina$ India$ and Tai'an d. -apan and >orea e. /ustralia and .e' Wealand 9". It has been of significance in epidemiology that many pathogens such as scherichia coli are no' kno'n to carry$ or can acBuire$ a gene for the en+yme penicillinase (,lactamase*. That en+yme confers drug resistance to several penicillins. Which one of the follo'ing diseases also dangerous because of its to2in is caused by a pathogen 'hich also often has a penicillinase gene? a. Influen+a b. #taphylococcus infection !!! c. bola d. /ID# e. %ad &o' Disease ()ovine #pongiform ncephalopathy* 90. There is a term used in viral epidemiology$ 'ell e2emplified by studies on ho' ne' strains of influen+a emerge. Which one is it? a. &loning b. Reassortment !!! c. Point mutation d. Vrame shift mutation e. .eutral mutation

91. Which of the follo'ing is normally considered an e2ample of #econdary Prevention? a. /dministration of antibiotics to infected people !!! b. Tetanus vaccination for teenagers c. Vluoridation of 'ater d. Palliative treatment and rehabilitation therapy e. #e2 education 96. Which of the follo'ing is most likely to be considered a point source type of epidemic? a. ating food contaminated by #taphylococcus from the nose of a cook in a restaurant !!! b. ating food in a restaurant that is one of many to 'hich infected eggs have been delivered c. &reu+feldt,-acob disease (from eating beef from co's infected 'ith the causative agent of %ad &o' Disease* d. /n influen+a epidemic e. / measles epidemic 99. In a population over a period of one year there 'ere :8$888 live births and ";8 deaths bet'een "8 to "; 'eeks gestation and 1 to 1 'eeks postpartum. 5sing the usual multiplication factor that gives convenient numbers$ the perinatal mortality rate is 'hich one of these? a. 8.88"6 b. 8.881 c. ".6 d. 1 !!! e. "68 9:. .e2t page sho'se the W4LOs Top 18 diseases of the developing 'orld. What is the most likely e2planation for 'hy is there no entry (e2cept a dash$ minus sign* in the top right hand corner$ for lo'er respiratory infections? a. They include a variety of diseases such as bronchitis and pneumonia and the incidence is not often nor adeBuately reported !!! b. These infections 7ust developed in "889 and have not yet been adeBuately studied c. verybody in any developing country is infected d. It is confused 'ith tuberculosis e. There is not yet a vaccine$ and the number is 'ithheld to avoid panic

Disease

Annual mortality rate

Annual infection rate

1.

Lower respiratory infections

4 million

2.

HIV/AIDS

3 million

39.4 million1

3.

Malaria

15 million

300515 million

4.

Diarrhea

2.2 million

4 billion

5.

Tuberculosis

2 million

8 million

6.

Measles

530,000

30 million

7.

Whooping cough

200,000300,000

2040 million

8.

Tetanus

214,000

500,000

9.

Meningitis

174,000

1 million +

10.

Syphilis

157,000

12.2 million1

9;. Which of the follo'ing is an annual crude mortality rate for$ for e2ample$ a specified #tate of the 5#? a. /ll deaths in a year due to any cause divided by the population at the end of the year b. The @normal death rateA$ i.e. all deaths in a year due to any cause divided by the total midyear population !!! c. /ll deaths due to an epidemic divided by the total midyear population d. /ll deaths due to any infection divided by the total midyear population e. /ll deaths due to an epidemic divided by the population at the beginning of the year 9<. There 'ere 9888 deaths (1"88 stroke$ 1"88 leukemia$ "68 pneumonia$ "68 4odgkinOs$ and "688 acute myocardial infarction* in a county in the 5# in 1<<1. The proportionate mortality rate for stroke 'as 'hich? a. 18? b. "8? !!! c. 06? d. 08? e. 68? :8. The case fatality rate is 'hich of these? a. The number of deaths due to a disease divided by the number of people at risk$ the result being typically multiplied by a hundred b. .umber of deaths due to a disease divided by the number of people 'ith the disease$ the result being typically multiplied by a hundred !!! c. The number of cases discarded from the study due to suspected lack of reliability$ sometimes e2pressed for a specific time interval d. The time period from the moment at 'hich a disease is diagnosed as terminal up to the moment of patient death e. The average gradient of the @caseA or @envelopeA dra'n across the peaks of a graph 'hich represents the mortality of disease as a function of time :1. The infant mortality rate is 'hich of these? a. The number of infant deaths in one year divided by the number of births (live or dead* in one year$ the result being typically multiplied by a hundred or a thousand b. The number of infant deaths in one year divided by the si+e of the population at risk$ the result being typically multiplied by a hundred or a thousand

c. The number of infant deaths in one year divided by the average annual number of infant deaths over a long period of time d. The number of infant deaths in one year divided by the number of live births in one year$ the result being typically multiplied by a hundred or a thousand !!! e. The number of infant deaths in one year divided by the average annual number of deaths at any age$ over a long period of time :". The neonatal mortality rate is 'hich one of the follo'ing? a. The number of neonatal deaths divided by the number of births (live or dead* in one year$ the result being typically multiplied by a hundred or a thousand b. The number of neonatal deaths divided by the number of live births in one year$ the result being typically multiplied by a hundred or a thousand !!! c. The number of neonatal deaths divided by the si+e of the population in one year$ the result being typically multiplied by a hundred or a thousand d. The number of neonatal deaths in one year divided by the average annual number of neonatal deaths over a long time period e. The number of neonatal deaths divided by the number of births (live or dead* in one year divided by the average annual number of deaths at any age$ over a long period of time :0. / to'n reported a total of 08$888 live births in one year$ but 'as alarmed that 618 died post partum. /ssuming the normal multiplication factor (although you can reasonably 'ell 'ork it out*$ the infant mortality rate 'as 'hich of these? a. 6 b. 6.18 c. 6.66 d. 1; !!! e. 1;$888 :1. The number of deaths from puerperal causes in a population of a particular underdeveloped country is "8$ the number of live births is 18$888$ and the number of total births is 18$188. )earing in mind that the appropriate ratio is traditionally multiplied by 188$888 for this measure$ 'hich of the follo'ing is the maternal mortality rate (due to puerperal causes*? a. 1 b. 18 c. 188 d. "88 !!! e. "888 :6. The number of people 'ho died in the age group 18,1< years in 1<<0 in a to'n 'as "8 and the total midyear population of that age group 'as 1888. What is the

corresponding age specific mortality rate for this age group in that to'n$ using the usual multiplication factor to give convenient numbers? a. 18 b. "8 !!! c. 08 d. 18 e. 68 :9. The ratio of the number of deaths from /ID# to the total midyear population in a city relates 'hich of the follo'ing? a. /nnual crude mortality rate b. 2pected annual crude mortality rate c. 2pected cause,specific mortality rate d. &ause,specific mortality rate !!! e. .one of the above