CHAPTER 04- Epidemiology and Population Health

Question 1

Epidemiology is the area of health care that deals with:

1. The physiological causes of disease and treatments to cure illness.
2. The incidence, distribution, and efforts to control diseases and other factors relating to health.
3. The incidence, prevalence, and attack rates of infectious diseases in a population.
4. The holistic approach to disease prevention and social determinants of disease.

Answer 1

2. The incidence, distribution, and efforts to control diseases and other factors relating to health.

Epidemiology is the foundation of public health and is a data-driven science within health care.

Question 2

An example of a population that would be the BEST CHOICE to be studied related to a specific disease prevalence would be:

1. A random sample of men and women arriving in an international airport.
2. A group of adult dog owners (over 21 years old) who are members of a national dog organization.
3. A sample of teenagers aged 15–18 years old attending public high schools in southwestern Connecticut.
4. A convenience sample of families who shop at a local mall.

Answer 2

3. A sample of teenagers aged 15–18 years old attending public high schools in southwestern Connecticut.

This choice identifies a specific group of individuals and age-group within a specific geographical area, which will add strength to this study of disease prevalence.

Question 3

Aims to reduce health inequities among population groups is part of the definition of:

1. Tertiary prevention.
2. Secondary prevention.
3. Epidemiologic case control research.
4. Population health.

Answer 3

4. Population health.

A variety of definitions for population health are used. However, in general this refers to health outcomes within a group of individuals or the entire human population.

Question 4

The three forms of observational research associated most often with epidemiologic research include:

1. Randomized controlled trials, phenomenology, and case studies.
2. Randomized controlled trials, cohorts, and true experiments.
3. Cohort, cross-sectional, and case studies.
4. Cohort, nested cases, and quasi-experimental.

Answer 4

3. Cohort, cross-sectional, and case studies.

The three forms of observational research associated most often with epidemiologic research include: cohort, cross-sectional, and case studies. Epidemiological observational studies do not include any form of intervention.

Question 5

An example of an epidemic would be the:

1. Ebola outbreak in West Africa in 2014.
2. Spanish influenza of 1918.
3. Human Immunodeficiency Virus in this century.
4. Smallpox in northeast America in 1633–34.

Answer 5

1. Ebola outbreak in West Africa in 2014.

An epidemic occurs when there are more cases of a disease than usually occurs in a specific population area.

Question 6

An epidemic becomes a pandemic problem when:

1. More than 100 people get ill.
2. An infectious disease moves from one state to another state.
3. It lasts more than 6 months.
4. It becomes a global problem.

Answer 6

4. It becomes a global problem.

Although definitions of pandemic vary, it typically includes a disease/illness that is traveling in wide geographic locations.

Question 7

Hepatitis B is endemic in which of the following areas or countries?

1. Scandinavia
2. China and Albania
3. Canada
4. Southwestern United States

Answer 7

2. China and Albania

Hepatitis B has high prevalence rates defined as greater than 8% HbsAg in a country’s population. This list is available from the Centers for Disease Control and World Health Organization.

Question 8

Maternal mortality rates are calculated by:

1. Counting deaths in women due to pregnancy or childbirth, divided by number of live births in the same time period.
2. Counting maternal deaths in the first 5 years of life of a child, divided by the number of live births in the hypothetical cohort of newborns.
3. Counting the number of live births in one year, divided by deaths in women due to pregnancy or child birth in a subset of months in that year.
4. Counting the number of deaths of women in one year, divided by the number of deaths in women related to pregnancy or childbirth.

Answer 8

1. Counting deaths in women due to pregnancy or childbirth, divided by number of live births in the same time period.

The definition of maternal mortality rates is counting the deaths in women due to pregnancy or childbirth, divided by the number of live births in the same time period.

Question 9

Morbidity refers to:

1. The death rates in a population from a specific disease.
2. Either the incidence rate, or the prevalence of a disease or medical condition.
3. The absolute number of deaths from a disease in a specific population.
4. Either the attack rates or deaths from a disease in a specific population.

Answer 9

2. Either the incidence rate, or the prevalence of a disease or medical condition.

Morbidity refers to the incidence or prevalence of illness/disease in a population.

Question 10

(Number of New Cases) / (Person-Time at Risk) is a calculation formula for:

1. Prevalence rates.
2. Incidence rates.
3. Mortality rates.
4. Morbidity rates.

Answer 10

2. Incidence rates.

Incidence rates are a proportion of individuals who develop a disease/illness/condition during a specific time period.

Question 11

Globally, approximately 239,000 women had ovarian cancer in 2012. This statement reflects:

1. A prevalence.
2. An incidence.
3. A disparity.
4. Mortality.

Answer 11

1. A prevalence.

Prevalence rates describe a proportion of individuals in a population at one point in time, or within a specific time frame, who have a particular disease/illness/condition.

Question 12

Choose the correct term for the following statement. The ________ of developing invasive breast cancer in the next 10 years is 2.31%, or 1 in 43.

1. Incidence
2. Prevalence
3. Probability
4. Rate

Answer 12

3. Probability

The incidence proportion, risk, or probability of developing a disease within a specific time period is a form of morbidity frequency statistics. The absolute risk of developing a disease or illness can be expressed as a percentage.

Question 13

A perfect test is one for which the result is always positive if you have the disease and always negative if you don’t have the disease. This statement refers to:

1. Health promotion.
2. Metric testing.
3. Health screenings.
4. Risk stratification.

Answer 13

3. Health screenings.

A health screening is meant to detect individuals who are at high risk of, or have, a disease/illness by history, physical examination, or other testing procedures.

Question 14

The time from the moment of exposure to an infectious agent until signs and symptoms of the disease appear is the definition for which of the following?

1. Attack rate period
2. Incubation period
3. The natural history of a disease
4. The pre-diagnostic span

Answer 14

2. Incubation period

By definition, the time from the moment of exposure to an infectious agent until signs and symptoms of the disease appear is the incubation period.

Question 15

An example of a good case-control study would be:

1. A group of people who became ill with gastrointestinal symptoms after eating strawberries compared to a group of people who became ill with gastrointestinal symptoms who did not eat strawberries.
2. A subset of teens who get screened for HPV and are found to be infected with HPV compared to teens who do not get screened for HPV.
3. A population of adults with diabetes mellitus type II compared to a population of adults without diabetes mellitus type II.
4. Children who have asthma who were breast fed as infants versus children with asthma who have pet allergies.

Answer 15

1. A group of people who became ill with gastrointestinal symptoms after eating strawberries compared to a group of people who became ill with gastrointestinal symptoms who did not eat strawberries.

A case-control study is an observational study that determines how much exposure to a risk factor of interest has occurred in patients who have a disease or illness (cases) compared to those who do not (controls).

Question 16

A study is looking at a group of patients and the time to an acute coronary event. This is known as:

1. An attack rate.
2. A proportion of probability.
3. Survival analysis.
4. The myocardial infarction risk factor span.

Answer 16

3. Survival analysis.

Survival analysis is a statistical method that looks at a time duration until an event (or series of events) occurs.

Question 17

The Alzheimer’s Prevention Registry and the Breast Cancer Surveillance Consortium are examples of:

1. Disease registries.
2. Support group agencies.
3. Screening programs.
4. Volunteer agencies.

Answer 17

1. Disease registries.

Disease registries are population-based and/or hospital-based databases of patients who are diagnosed with specific diseases.

Question 18

The probability that the test says a person has the disease, when in fact they do have the disease, is known to be:

1. Specificity.
2. Sensitivity.
3. Diagnostic.
4. Probability.

Answer 18

2. Sensitivity.

By definition, the probability that the test says a person has the disease, when in fact they do have the disease, is known to be the sensitivity.

Question 19

The probability that the test says a person does not have the disease, when in fact they are disease-free, is known to be:

1. Specificity.
2. Sensitivity.
3. Diagnostic.
4. Probability.

Answer 19

1. Specificity.

The probability that the test says a person does not have the disease, when in fact they are disease-free, is defined as specificity.

Question 20

There are seven agents of infectious disease. These include:

1. Metazoa, protozoa, fungi, bacteria, rickettsia, viruses, prions.
2. Metatarsus, fungi, HIV, Rocky Mountain Spotted Fever, bacteria, portioles.
3. Protozoa, fungi, viruses, bacteria, coryza, parasites, myomata.
4. Parasites, viruses, bacteria, influenza, tick-borne, fungi, jiroveci.

Answer 20

1. Metazoa, protozoa, fungi, bacteria, rickettsia, viruses, prions.

The are seven agents of infectious disease are metazoa, protozoa, fungi, bacteria, rickettsia, viruses, and prions.

Question 21

Diseases that have environmental reservoirs include:

1. Jakob-Creutzfeldt, human immunodeficiency virus, and hepatitis B.
2. Shigella, Lyme disease, and varicella.
3. Croup, respiratory synctial virus, and anthrax.
4. Histoplasmosis, botulism, and tetanus.

Answer 21

4. Histoplasmosis, botulism, and tetanus.

An environmental reservoir is an area where pathogens live and have the potential to be released and cause infection in humans.

Question 22

A patient with Type 2 Diabetes enrolls in a diabetes program that includes information on nutrition, exercise, and general wellness strategies. What type of prevention is this considered to be?

1. Primary prevention
2. Secondary prevention
3. Tertiary prevention
4. Type 2 diabetes prevention

Answer 22

3. Tertiary prevention

The patient with type 2 diabetes has a chronic disease and therefore would benefit from strategies that help in disease management and improving the quality of life.

Question 23

Which of the following screening tests would be recommended for a 68-year-old male who smokes 1 pack of cigarettes a day for 20 years? (This is a 20 pack year history.)

1. PSA testing
2. ASA 81 mg daily
3. CXR
4. Abdominal ultrasound

Answer 23

4. Abdominal ultrasound

According to the USPSTF guidelines, all males over the age of 65 with a history of smoking (either current or past) should be screened once for an AAA. ASA 81 mg may be an appropriate recommendation but it is not a screening test.

Question 24

Immunizations are considered to be what type of prevention?

1. Primary
2. Secondary
3. Tertiary
4. Immunizations are an active form of prevention.

Answer 24

1. Primary

Immunizations are a primary prevention strategy that aims to prevent a disease or injury before it occurs.

Question 25

A 67-year-old female comes to the wellness clinic for an annual gynecological exam and Pap smear. She has no history of abnormal Pap smears or any STIs. She states that she feels fine and has no concerns. She is in a monogamous relationship with her husband. It is appropriate at this time for the primary care provider (PCP) to inform the patient that:

1. She should get a Pap smear and HPV screening now, and then again in five years.
2. She should continue to get annual Pap smears, but she no longer needs HPV screening.
3. She does not need any more gynecological exams since she has no history of any gynecological problems.
4. She no longer needs to have a Pap smear.

Answer 25

4. She no longer needs to have a Pap smear.

According to the USPSTF guidelines, the patient no longer needs a Pap smear since she has no previous history of any abnormal gynecological findings. Recommendation grade (D).

Question 26

A 45-year-old overweight male is having an annual physical exam. He has no complaints and states that he feels “healthy as a horse.” The patient’s BP is 140/92 in the office, and it is noted that at the last exam the patient’s BP was 148/88 and the patient stated that he had “white coat syndrome.” Screening guidelines for this patient include:

1. PSA test.
2. AAA ultrasound.
3. Fasting plasma glucose.
4. EKG.

Answer 26

3. Fasting plasma glucose.

All adults with sustained hypertension should be screened for DM 2 per the USPSTF guidelines. Grade (B) recommendation.

Question 27

A 58-year-old female hypertensive patient has been placed on ASA 81 mg by her PCP. This is considered to be:

1. Primary prevention.
2. Secondary prevention.
3. Tertiary prevention.
4. Active intervention.

Answer 27

2. Secondary prevention.

Secondary prevention is designed to reduce the impact of the disease that has already occurred. The patient is at a higher risk of stroke due to her age and her comorbid condition. ASA 81 mg is an appropriate recommendation to prevent the occurrence of a stroke. Grade (B) recommendation.

Question 28

The nurse practitioner orders a fasting glucose for a patient that is asymptomatic but has a strong family history of type 2 diabetes. The fasting glucose returns at 129. What would be the next best approach for the nurse practitioner?

1. Explain to the patient that they have diabetes and need to begin a strict regimen of diet and exercise.
2. Begin Metformin 500 mg once daily and repeat the fasting glucose in three months.
3. Repeat the test prior to diagnosing the patient with diabetes.
4. Refer the patient to a nutritionist.

Answer 28

3. Repeat the test prior to diagnosing the patient with diabetes.

Repeating an abnormal test is often the best appropriate approach and allows for confirmatory testing. If the patient had a fasting blood sugar > than 126 when the test was repeated, then A, B, or C would be the appropriate next steps.

Question 29

A patient is having an annual physical. Statements that are made by the patient indicate that he may possibly have OSA. The FNP discusses with the patient that she would like to send him for a sleep study to confirm her suspicions. The patient states that no matter what anybody says “I would never wear one of those things over my face or nose, and I would not put anything in my mouth at night.” The FNP notes that the patient would refuse any treatment even if he is found to have OSA. The FNP should then:

1. Order the sleep study to confirm or refute her suspicions.
2. Continue to educate the patient on the risks associated with OSA at each visit.
3. Order home oxygen therapy and tell the patient to use it prn (pro re nata) at night if he develops any shortness of breath.
4. Refer the patient to an otolaryngologist for follow-up.

Answer 29

2. Continue to educate the patient on the risks associated with OSA at each visit.

A test should not be done if it will not have an effect on the management of the patient. (See guidelines for diagnostic testing.)