Download MOC Question Packet - American College of Preventive Medicine

24th Annual ACPM Preventive Medicine Board
Review Course
Maintenance of Certification
Self-Assessment Questions
-Please mark all of your answers in the CME/MOC Request form.
-This process is for self-assessment; your answers will not be graded.
Reminder: You can only earn CME/MOC for the sessions you attended. Please complete
questions only for the specialty (AM, OM, GPM/PH).
Biostatistics
1.
Each of the following are examples of what kind of data:
1.1)
1.2)
1.3)
1.4)
race
age
temperature
stage of disease
a) nominal
b) ordinal
c) interval
d) ratio
2. If we are doing a study to determine the effect of mother’s age and BMI on infant birth weight, correctly
identify the independent and dependent variables.
a) Mother’s age and BMI are the dependent variables and birth weight is the independent variable.
b) BMI is the dependent variable and mother’s age and birth weight are the independent variables.
c) Birth weight is the dependent variable and mother’s age and BMI are the independent variables.
3. What are the mean, median, and standard deviation of the standard normal distribution?
a) 1, 1, 1
b) 1, 1, 0
c) 0, 0, 1
d) 0, 0, 0
e) Cannot be determined without a table
4. Which of the following is not a requirement for the binomial distribution?
a) n independent trials
b) probability of success and failure constant from trial to trial
c) 2 possible outcomes (“success”, “failure”) for each trial
d) probabilities of success and failure equal in each trial
5. Which of the following is not a measurement of central tendency?
a) mean
b) standard deviation
c) mode
d) median
6. Which of the following is not a measurement of dispersion?
a) range
b) standard deviation
c) geometric mean
d) coefficient of variation
7. A random sample of 100 patients attending a diet clinic was found to have lost an average of 30 pounds, with a
sample standard deviation of 10. What is the 95% confidence interval for the true mean weight loss for all patients
attending the clinic?
a) 27.00, 33.00
b) 10.40, 49.60
c) 29.22, 30.78
d) 28.04, 31.96
8. Students within an elementary school are divided into grade levels and then a random sample is taken from
each grade level. This is an example of which kind of sampling?
a) Simple random sampling
b) Cluster sampling
c) Stratified random sampling
2
d) Systematic sampling
9. Assume that the birth weights of infants are normally distributed with mean of 3405 grams and standard
deviation of 225 grams. What is the probability that a randomly selected infant from this population will have a
birth weight greater than 3846 grams?
a) 0.05
b) 1.96
c) 0.95
d) 0.025
e) Can’t be determined with the information given
10. We are doing a study to determine if drug A is more effective than a placebo in treating cancer patients. Each
patient is only given drug or placebo. The outcome is the proportion of patients who experience a remission.
Which are the appropriate null and alternative hypotheses for this study assuming that we are using 2-sided
alternative hypotheses?
a) H0: pA=pP; Ha: pApP
b) H0: pA=pP; Ha: pA>pP
c) H0: pApP ; Ha: pA=pP
11. We are doing a study to determine if males and females have different baseline cholesterol levels. What are the
null and alternative hypotheses to look for any difference in these means assuming 2-sided hypotheses?
a) H0: M > F HA: M  F
b) H0: M = F HA: M > F
c) H0: M  F HA: M > F
d) H0: M = F HA: M  F
12. Assume you gather data, compute a test statistic, and reject the null hypothesis of no difference.
12.1) If, in fact, the null hypothesis is true, you have made a __________.
12.2) If, in fact, the null hypothesis is false, you have made a _________.
a) Type I error
b) Type II error
c) Type I and Type II error
d) Correct decision
13. Assume you gather data, compute a test statistic, and fail to reject (accept) the null hypothesis.
13.1) If, in fact, the null hypothesis is true, you have made a ___________.
13.2) If, in fact, the null hypothesis is false, you have made a __________.
a) Type I error
b) Type II error
c) Type I and Type II error
d) Correct decision
14. Consider the following two distribution curves. Which numerical summary measure would allow you to
discriminate
between the two distributions?
1
2
a) Median
b) Mean
c) Mode
d) Standard Deviation
3
15. We are doing a study comparing pre and post test scores for 2000 students after they have completed a
physical training program. We conducted a paired t-test. Suppose we find that the test statistic is 3.50. What
conclusions should you draw for =0.05?
a) Reject the null hypothesis. There is a significant difference between pre and post test
scores.
b) Don’t reject the null hypothesis. We cannot state that there is a significant difference
between pre and post test scores.
c) Reject the null hypothesis. We cannot state that there is a significant difference between
pre and post test scores.
d) Don’t reject the null hypothesis. There is a significant difference between pre and post
test scores.
16. We compared the BMI of mothers who exercised during pregnancy to the BMI of mothers who did not
exercise during pregnancy. We found that the 95% CI for the difference in BMI between the exercising and nonexercising mothers was (-0.5, 0.5). What conclusions can we draw?
a) Reject the null hypothesis. There is a significant difference between exercising and nonexercising mothers.
b) Don’t reject the null hypothesis. We cannot state that there is a significant difference between exercising
and non-exercising mothers.
c) Reject the null hypothesis. We cannot state that there is a significant difference between exercising and
non-exercising mothers.
d) Don’t reject the null hypothesis. There is a significant difference between exercising and non-exercising
mothers.
e) We need more information to answer the question .
17. In a sample of low back pain patients, we asked each patient to rate his pain on a scale from 1 to 50. There are
10 patients with sciatica and 15 patients without sciatica. Pain score, sciatica, age, and type of provider are
recorded in the following table for 5 patients from the study group. We are interested in whether or not pain
score differs by whether or not the patient has sciatica.
PATIENT
ID
1
2
3
4
5
AGE
PROVIDER TYPE
SCIATICA
Pain Score
57
24
69
42
53
Primary Care
Chiropractor
Primary Care
Orthopedist
Orthopedist
No
No
Yes
Yes
No
2
3
13
18
7
17.1 The variance of the pain score is 49.0. What is the standard deviation?
a) 49
b) 9.8
c) 7
d) 1.4
17.2 What is the standard error?
a) 9.8
b) 7
c) 1.4
d) 0.28
17.3 How could you visually display the distribution of the pain scores?
a) Bar graph
b) Scatterplot
c) Histogram
d) 2x2 table
4
17.4 Which of the following would not be a way of expressing the number of primary care provider
patients in this sample?
a) Median
b) Frequency
c) Percent
d) Proportion
17.5 There is evidence (from previous studies) that pain increases with age. What would be the best way
visually to assess this is this sample?
a) Scatterplot
b) Histogram of age by categories of pain scores
c) Histogram of pain scores by categories of age
d) Pie chart
18.
We are interested to see if the risk of pre-term birth differs for women with pre-eclampsia as compared to
women without pre-clampsia. We determine that the odds ratio for pre-term birth comparing women with
pre-eclampsia to those without pre-eclampsia is equal to 2.55 (95% CI: 1.35, 3.85) and the p-value from a
chi-square test is equal to 0.025. What conclusion can we draw?
a) Women with pre-eclampsia have a significantly higher risk for preterm birth because the p-value is <0.05
and the 95% CI does not include 1.
b) Women with pre-eclampsia have a significantly higher risk for preterm birth because the p-value is
<0.05, but the 95% CI does not agree with this result.
c) There is no significant difference between these two groups with regard to risk for pre-term birth.
19. We did a study among children and determined that the correlation (r) between BMI and
hours of television watched was 0.24 with a p-value=0.02. What conclusions can we draw?
a) Children who watch a lot of television are significantly more likely to have a higher
BMI.
b) Although statistically significant, television watching accounts for only about 6% of the
variation in BMI among children in this study.
c) There is a weak correlation between television watching and BMI.
d) Both B and C.
e) None of the above are appropriate conclusions.
20. For each of 100 patients with emphysema, a clinical researcher tabulated the number of years the patient
smoked and the attending physician’s subjective evaluation of the extent of lung damage (measured on a
scale of 0 to 100). She determined that the regression equation describing the relationship between the
number of years the patient smoked (X) and the extent of lung damage (Y) was: Y = 11.24 + 1.31 X
20.1 Which of the following statements is NOT true?
a) The slope of the regression line equals 1.31.
b) The correlation coefficient, if computed for the above data, would be positive.
c) Patients who smoked less on average than others had lower lung damage scores.
d) The regression line crosses the X-axis at 11.24.
20.2 What is the predicted extent of lung damage for a patient who has smoked for 10 years?
a) 22.24
b) 24.34
c) 10.0
d) This cannot be determined from the data
21. Grade point averages (GPA) at the end of the first two years of medical school are used to predict scores on
Part I of the National Board Examination. Data was collected on medical students across the United States
during the past academic year.
21.1 The correlation coefficient between the exam score and GPA is r=0.75. How could this be
interpreted?
a) There is a negative linear relationship between exam score and GPA,
5
i.e., lower exam scores are associated with lower GPAs
b) There is a negative linear relationship between exam score and GPA,
i.e., lower exam scores are associated with higher GPAs
c) There is a positive linear relationship between exam score and GPA,
i.e., higher exam scores are associated with lower GPAs
d) There is a positive linear relationship between exam score and GPA,
i.e., higher exam scores are associated with higher GPAs
21.2 What would not be the null hypothesis for the regression equation to test whether there is a
statistically significant linear relationship between exam score and GPA?
a) GPA = 0
b) GPA predicts exam score
c) Slope of the equation for the line is zero
d) There is no linear relationship between GPA and exam scores
21.3 Suppose that the slope is 132.2. What is interpretation of this slope?
a) As GPA increases by 1 point, test scores increase by 132.2 points.
b) As test scores increase by 132.2 points, GPA increases by 1 point.
c) There is no relationship between test score and GPA.
d) As GPA increases by 1 point, test scores decrease by 132.2 points.
22. Match the appropriate statistical test with the scenario.
22.1 In a sample of 100 subjects we are comparing time to walk one mile before and after drinking a cup
of coffee.
22.2 We are comparing customer satisfaction scores (on a scale of 1 to 5) before and after a new billing
system is added.
22.3 We would like to compare two treatments for migraine, Drug A and Drug B. Patients are
randomized to receive different treatments. We want to compare the proportion of patients reporting
migraines between the two drugs.
22.4 A study is designed to compare cholesterol levels in patients who took a multivitamin as compared
to patients who did not take a multivitamin.
22.5 We would like to examine the relationship between gestational age and birth weight.
22.6 We would like to determine if there is a difference in time to remission between patients treated
with a new type of chemotherapy and patients given the standard treatment.
22.7 We would like to determine if the odds of having a c-section delivery differ between by maternal age
and race.
22.8 We want to compare the average weight loss among women who were randomly assigned to four
different diets.
22.9 We would like to examine the relationship between blood pressure and cholesterol level while
controlling for age.
a) Multiple linear regressions
b) Analysis of variance
c) Survival analysis
d) Simple linear regression or correlation
e) Student’s t-test
f) Chi-square analysis
g) Wilcoxon signed rank test
h) Paired t-test
i) Logistic regression
6
Epidemiology
Prostate cancer is the most common cancer in American men and has the third highest cancer mortality rate.
There has been no improvement in the age-adjusted death rate from this disease since 1949. Potential areas for
improvement include primary prevention (identification and control of risk factors), secondary prevention (early
diagnosis through screening), and tertiary prevention (improved treatment).
1.
The annual incidence of prostate cancer in American men over age 50 is estimated at 5 per 1,000. If you
followed a population of 10,000 disease-free men over age 50, what would the prevalence of prostate
cancer be after 2 years, assuming no deaths in this time period?
a.
1.3/1,000
b.
2.5/1,000
c.
4.3/1,000
d.
7.5/1,000
e.
10.0/1,000
2.
The cumulative lifetime probability of a U.S. male dying from prostate cancer is estimated at 2.5%. Which
of the following are true? (any, all or none may be true)
1.
2.
3.
4.
3.
The risk that any U.S. male will some day die from prostate cancer is 1 in 40.
We can conclude from these data alone that the case fatality rate for prostate cancer is high.
Prostate cancer is the most common cause of cancer death in men in the U.S.
The incidence of prostate cancer in U.S. males is 25/1,000.
The use of serum PSA as a cancer screening test requires choosing a cutoff level which you will use to
define a positive test. Two cutoff levels have been defined, based on the incidence of cancer in men with
elevations above the cutoffs. In a 1991 study of 1,653 volunteers, Catalona, et al (1991) found an
incidence of cancer in men with PSA levels below 4.0 micrograms/liter equal to 0.4%, with levels at or
above 4.0 micrograms/liter equal to 20% and in men with PSA levels at or above 10.0 micrograms/liter
equal to 60%. Which of the following statements are true? (any, all or none may be true)
1.
2.
3.
4.
Picking a higher cutoff (e.g., defining 10.0 or above as a positive test) improves sensitivity at the
expense of a lower specificity.
Defining a positive cancer screening test as 4.0 or above would classify some men without cancer
as being positive, with only one in 5 positives actually having cancer.
Defining a PSA of 10.0 or above as a positive test for cancer would assure that the false positives
ould be less than 5% of all positives.
Picking a higher cutoff improves specificity at the expense of a lower sensitivity.
4.
In Catalona's study, the overall incidence of prostate cancer was 2.2%. Catalona reported the sensitivity
of the PSA test as 79% and the specificity as 59%. In screening studies, the incidence is taken as the
prevalence of disease in calculating screening test utility. What is the positive predictive value for PSA in
Catalona's study? (use only the data presented in question 4.)
a. 1%
b.4%
c. 23%
d. 41%
e.99%
5.
What is the negative predictive value?
a. 1%
b. 4%
c. 23%
d. 41%
e. 99%
7
6.
Continuing with the data presented in question 4, what would be the positive predictive value if the test
were used on the general population (prevalence = 0.5%)?
a. 1%
b.4%
c. 23%
d.41%
e.99%
7.
Regardless of your answers to any preceding questions, you are concerned about what others in the
literature have said about the low positive predictive value as calculated for the general population.
Which of the following related statements are true? (any, all or none may be true)
1.
2.
3.
4.
8.
If you are considering using PSA as a screening test, you need to know the consequences of a
false positive.
You would lower the positive predictive value by combining PSA with another test in parallel.
You could improve the positive predictive value by combining PSA with another test in series.
You could improve the positive predictive value by applying the test in high-risk groups.
Although you are not sure if it will be useful in your determination of the utility of PSA as a screening
tool, you look for potential risk factors for prostate cancer, and you find the following two tables,
extracted from a 1990 cohort study:
Number with cancer
Age Group
50-60 61-65 66-70
9
19
24
Total in age/sx group
683
892
Presence of Urinary Complaints
Yes
No
29
23
850
1218
1207
What is the attributable risk for cancer associated with the presence of urinary complaints?
a.
3.2/100
b.
2.5/1,000
c.
4.8/1,000
d.
9.0/1,000
e.
17.1/1,000
9.
What is the relative risk for age 65-70 compared to age 50-60?
a.
1.2
b.
1.4
c.
1.7
d.
2.1
e.
4.8
10.
Based on the data from question 8, which of the following statements are true? (any, all or none may be
true)
1.
2.
3.
4.
11.
If the relative risk was statistically significant, age might be considered a risk factor for prostate
cancer.
If the attributable risk was statistically significant, the presence of urinary symptoms might be
considered a risk factor for prostate cancer.
It is possible that the association between urinary symptoms and prostate cancer is due to a
confounding factor.
The appropriate test for determining if the attributable risk is significant is the t-test.
Looking for other risk factors, you find a report in the literature from 1985 that found that in the urology
residency program of a university hospital, five percent of the 9,456 men having vasectomies in the
preceding 10 years had developed prostate cancer. To you, this appears to be a 10-fold increase over the
8
overall rate for the U.S. (from question 1 in this set). Which of the following are true? (any, all or none
may be true)
1.
2.
3.
4.
12.
Examining further the relationship between vasectomies and prostate cancer, you find a 1990 study that
suggests that vasectomies increase the risk of prostate cancer. The investigators first identified all men
with prostate cancer treated in a university hospital. They then identified a group of men admitted to the
orthopedic ward of the same hospital, with similar ages but no indication of prostate cancer. They
interviewed both groups of men, asking specifically whether they had had a vasectomy. They found that
those men with cancer were twice as likely to have had a vasectomy than those with no cancer, and that
this finding was statistically significant (p<0.05). Which of the following are true? (any, all or none may be
true)
1.
2.
3.
4.
13.
One problem with this type of study is that subjects may not finish the study.
This study design is not as powerful/robust as a case-control design.
This represents a prospective cohort design.
This represents a retrospective cohort design.
Which of the following statements are true about cohort studies? (any, all or none may be true)
1.
2.
3.
4.
15.
This is a case-control study
If men admitted to the orthopedic ward were more likely to have had a vasectomy than the
general population, this would bias the results of the study by underestimating the association
between vasectomies and prostate cancer.
It is hypothesized that men who get vasectomies tend to have less frequent sexual intercourse
compared to men that don't have vasectomies, which may in turn be associated with a higher
rate of prostate cancer for men with vasectomies. If this hypothesis was correct, this could
account for the association between vasectomies and prostate cancer.
Because the procedure is preceded by a prostate exam, men who get vasectomies may be more
likely to have a cancer detected than men who don't have a prostate exam. Prostate cancer can
be very slow growing and may not be detected before a non-cancer death. These factors would
tend to lead to an overestimation of the association between vasectomies and prostate cancer.
As you continue to explore the relationship between vasectomies and prostate cancer, you come upon an
NIH grant application that proposes the following study: the investigators plan to enroll all men coming
to the urology clinic at a midwestern university clinic for vasectomies. The investigators will then match
each man in this group with a man in the same 5-year age group coming to any other university clinic for
any non-urologic reason. They will follow both groups of men for 10 years, then compare the rates of
prostate cancer across the groups. Which of the following are true? (any, all or none may be true)
1.
2.
3.
4.
14.
It is difficult to draw conclusions regarding the risk of cancer in men with vasectomies from this
study because of the lack of a control group.
Since this is a university hospital, you need to worry about referral bias, that is, bias arising from
patients referred to a university hospital being different in characteristics that may influence the
prevalence of disease.
Considering factors such as time, money, and ease of completion, the next logical step would be
to look at the relationship between vasectomies and prostate cancer using a case-control study.
This is an example of a cross-sectional study.
One of the major problems with cohort studies is loss to follow-up.
Confounders are not a problem with cohort studies since these studies are essentially
prospective in design.
Cohort studies are useful for examining multiple outcomes of a single rare exposure.
Cohort studies are generally regarded as quicker and less expensive than case-control studies.
Which of the following statements would be important in considering a causal association between
vasectomies and prostate cancer? (any, all or none may be true)
9
1.
2.
3.
4.
16.
After reviewing all the literature, you conclude as do the rest of the experts that there is really no strong
evidence of any clinically significant risk factors (including, by the way, history of vasectomy) for prostate
cancer, other than non-modifiable factors such as age. Given this, which of the following are appropriate
conclusions? (any, all or none may be true)
1.
2.
3.
4.
17.
2.
3.
4.
In order to make judgements regarding the suitability of the strategy in the general population,
you need to know the prevalence of prostate cancer in Babaian's study population.
You need evidence that the screening test detects disease at an earlier stage than would have
occurred without the screening.
You need evidence that, assuming cancer is detected earlier with the screening, earlier treatment
will result in improved morbidity and mortality.
You need to know the risks and costs involved with the screening test.
Assume that you believe there is enough evidence to suggest that a DRE/PSA screening program may
translate to improved mortality from prostate cancer. In agreement with the U.S. Preventive Task Force,
you also believe that before recommendations are made, a prospective trial is needed. You design and
write a grant for a randomized controlled trial (RCT) to evaluate the effectiveness of a DRE/PSA
screening program. Which of the following are true? (any, all or none may be true)
1.
2.
3.
4.
19.
All men over the age of 60 years should have their prostate glands removed.
With the current knowledge, it appears that there are no reasonable options available for the
primary prevention of prostate cancer.
With the current knowledge, we should advise all men to increase their sexual activity rather
than perform screening tests as the most effective method for controlling prostate cancer.
With the current knowledge, it appears that the only risk factor that might be useful in designing
a screening program with improved positive predictive value is age.
Deciding that screening with PSA alone generates too many false positives, you decide to study the use of
PSA in conjunction with digital rectal examination of the prostate (DRE) as a screening test for prostate
cancer. In 362 volunteers enrolled in a study of early detection of prostate cancer, Babaian, et al (1990)
found that the combination of DRE and PSA had a positive predictive value of 33%. Some researchers
conclude that the combined strategy should be used in mass screening. Which of the following are true?
(any, all or none may be true)
1.
18.
It is hypothesized that the inflammatory response involved with absorbing the sperm after
vasectomy might cause antibodies to proteins similar to those lining the ducts of the prostate
gland, and that this may result in a chronic inflammation of the gland that could lead to malignant
transformation.
Three studies of the association between prostate cancer and vasectomies found relative risk
estimates near 2.0.
Case-control studies have found that men who have vasectomies early in life have a greater
incidence of prostate cancer than men having vasectomies at older ages.
The association between vasectomies and prostate cancer is statistically significant.
The major difference between RCT's and other study designs is that the investigator decides who
is exposed to the factor under study.
It is appropriate to assume that as long as the number of study subjects who are lost to followup is not different for the intervention and control groups, you need not worry about how these
individuals would affect your conclusions.
If you decide to restrict your study population so as to make assuring comparability of subjects in
both groups easier, this is likely to limit the generalizability of your findings.
Since you are randomizing to distribute potential confounding factors evenly between the two
groups, there is no reason to measure potential confounders nor worry about them in the
analysis.
Which of the following are important design considerations in designing your RCT? (any, all or none may
be true)
10
1.
It is important to keep the individuals who are looking for study outcomes (endpoints) from
knowing which study group the subjects are in.
People who cross-over (control subjects who get screening procedures on their own, or
intervention subjects who refused to be screened) will cause an underestimation of the beneficial
effect of the screening intervention.
If the study subjects know which group they are in (say, because of DRE's) this would represent a
limitation of the study that could introduce bias.
Since the screening strategy is designed to look at prostate cancer, you need only analyze
prostate cancer deaths.
2.
3.
4.
20.
Your grant is funded and your intervention group, consisting of 10,000 volunteers, receives annual DRE's
and PSA's for 5 consecutive years, with positives being followed up by biopsy for definitive diagnosis.
Subjects are seen in one of two clinical sites, one at University Hospital and the other at Denver General
Hospital. One year into the trial, the safety committee for the study informs you that there appears to be
an unexpected number of cases of bacterial endocarditis, a life-threatening infection of one or more heart
valves. Which of the following are true? (any, all or none may be true)
1.
Endocarditis is not a primary endpoint and it would be better to not include this finding in your
final report.
It is possible that the increased rate of endocarditis represents a sporadic increase over the
normal endemic rate.
Based on the information provided for this question, if the number of cases of endocarditis is less
than 5, you may conclude that this is not an epidemic.
An epidemic curve will be helpful in determining the etiology of the infection.
2.
3.
4.
21.
You determine an epidemic of endocarditis is indeed occurring in your experimental group. You review
the procedures performed for all 25 infected individuals and compare them to a random sample of 200
individuals of the same study group with no evidence of endocarditis. You develop the following table:
Enrolled at DGH
Endocarditis
3
Enrolled at UH
Ultrasounded
(transrectal)
part of workup
22
11
Total
130
115
122
Endocarditis
Biopsied as
part of workup
Total
20
91
No biopsy
5
154
Underwent TURP*
7
44
No ultrasound
14
123
No TURP
18
201
*
transurethral resection of the prostate, done for prostatic obstruction of the bladder outlet
Based on the table, what is the attack rate for men who have had ultrasound studies ?
a. 2.1%
b.9.0%
c. 12.3%
d. 22.5%
e.32.7%
22.
What is the relative risk for men undergoing a TURP (compared to men not having a TURP)?
a. 0.43
b.0.99
c. 1.1
d. 1.3
e.1.8
23.
What are your conclusions from the information provided in the table in question 21.? (any, all or none
may be true)
11
1.
2.
3.
4.
It appears as if the epidemic may be related to something that occurred at DGH.
The results suggest that the hospital site was an important predictor of infection.
Some complication in performing TURPs is the most likely etiology of the epidemic.
It appears as if the epidemic may be related to having a biopsy.
24.
The agent cultured from the blood of infected subjects after was a bacterium, E. coli. This organism,
when introduced into the bloodstream, can cause severe systemic infection, severe clinical symptoms, and
even death from a dangerous condition known as septic shock. You would say that E. coli, when in the
bloodstream, has a high:
a.
virulence
b.
infectivity
c.
pathogenicity
d.
immunogenicity
e.
herd immunity
25.
Assume that, regardless of the answer to any previous questions, you discovered that the epidemic was
caused by the re-use of prostate gland biopsy needle after with improper sterilization. Given this, and
finding that the most common time interval between the day of a subject's biopsy and the onset of his
symptoms was 48 hours, which of the following statements would be true? (any, all or none may be true)
1.
2.
3.
4.
26.
There will be a high secondary attack rate.
The incubation period is two days.
As the infection was propagated by the biopsy needle, this is an example of a propagated epidemic.
As the infection occurred from a common source, this is a common source epidemic.
You will need to make a recommendation to patients in your study who have a positive screening test. A
recent study from Sweden has found that 86% of men with early stage prostate cancer are alive 10 years
after diagnosis even if no treatment is instituted. The study you would really like to have would involve
following groups of men that had or didn't have radical prostatectomy (removal of the prostate gland and
other nearby stuff) for early prostate cancer. In reviewing the methods section of such a paper, which of
the following details would be important to insure study integrity? (any, all or none may be true)
1.
2.
3.
4.
The case definition was used uniformly in both groups.
Referral patterns for study subjects were similar to what you might expect in how your patients.
Outcome evaluation was blinded.
Known potential determinants of prognosis were measured and accounted for in the analysis.
There are many other studies that would be useful in looking at prostate cancer. Some potential projects are
listed below as questions 27 to 32. Using the following list of responses, match the letter of the study design that
describes the project summarized in the question. Note that responses may be used more than once or not at all.
a.
Prospective cohort study
b.
Case-control study
c.
Randomized controlled trial
d.
Retrospective cohort study
e.
Cross-sectional study
27.
In order to prove that treatment with zinc supplements, a practice recommended by naturopathic
clinicians, is protective against prostate cancer, one group of randomly selected men get zinc tablets while
another group gets a placebo. The cancer rates for the two groups are compared after 10 years.
28.
In order to determine whether cigarette smoking is associated with prostate cancer, all graduates of the
Colorado Trucking Institute are questioned regarding their smoking habits. This group is followed for 10
years and the incidence of prostate cancer is compared for smokers and non-smokers.
29.
In order to determine whether multiple sexual partners is associated with prostate cancer, all prostate
cancer patients who were admitted to University Hospital over the last 5 years are asked about their
12
previous sexual activity. This activity is compared with that of patients with similar characteristics but
who have only been seen in the outpatient clinics of the internal medicine department and who are not
known to have prostate cancer.
30.
In order to see if a large cumulative dose of radiation is associated with a higher risk of prostate cancer,
the current prostate cancer rates in a group of Chernobyl men are compared to the current rates of a
group of men of similar age who were living in Moscow at the time of the nuclear accident.
31.
To explore a possible relationship between dietary fat intake and prostate cancer, men randomly selected
from the phone book are called and asked whether or not they have prostate cancer, and questions about
the frequency with which they eat certain foods, such that the amount of fat in their diet can be
estimated.
32.
People from the Framingham study cohort who have prostate cancer are matched with Framingham
participants without prostate cancer and both groups are administered a questionnaire that measures
their exposures to a number of potential risk factors for prostate cancer.
33.
Which of the following statements regarding cost-related analysis of screening strategies are true? (any, all
or none may be true)
1.
If you developed a more sensitive exam at the expense of specificity, the cost per case detected
would increase.
2.
The cost of the screening strategy is affected by the prevalence of the disease in the population
such that as the prevalence increases, the cost per case detected decreases.
3.
The cost of a screening strategy that employs a test with a low specificity will be greatly
influenced by the cost of the procedure(s) required to diagnose the disease.
4.
As technologic advances in cancer treatment are made, more treatments hopefully will become
available for late stage disease. If these treatments are expensive (such as bone marrow
transplantation, which may become a standard treatment option for late stage breast cancer),
this will increase the cost effectiveness that is associated with a given effective screening
program.
The Maintenance of Certification Part IV: Expert Panel
1. Self-assessment questions are part of which MOC component?
a. MOC Part 3
b. MOC Part 1
c. MOC Part 2a
d. MOC Part 2b
2. To determine your ABPM certification expiration date, the best place to check would be:
a. The ABPM website
b. Your state medical board
c. The ACPM website
d. The ACCME website
3. Which MOC Part IV tool includes reviews from peers, supervisors and supervisees?
a. Report Card
b. Clinical Practice Evaluation
c. 360 degree Feedback
d. Portfolio
Clinical Preventive Medicine
13
1.
Which of the following is considered to have the most scientific validity when evaluating the effectiveness
of various preventive efforts?
A.
Case-control studies
B.
Randomized controlled trials
C.
Expert opinion
D.
Uncontrolled cohort studies
E.
Descriptive studies
2.
Which of the following statements regarding cervical cancer screening is incorrect?
A.
Screening should start at the age of 21 years or 3 years after women become sexually active
B.
There is no need to screen average risk women over the age of 65 years
C.
There is no need to screen women who have had a hysterectomy for benign disease
D.
Over the age of 30 years, if women have had normal Pap smears in the past, it is acceptable to
extend the screening interval to every 2-3 years
E.
HPV testing is an acceptable screening test
3.
Which of the following statements regarding breast cancer screening is incorrect?
A.
The USPSTF recommends starting breast cancer screening at the age of 50 years for average risk
women
B.
Teaching women self breast examination is part of the USPSTF endorsed screening regimen for
breast cancer
C.
The optimal interval for recommending a screening mammogram is 2 years
D.
Almost 50% of women who have 10 mammograms will have a false positive
E.
MRI is not currently endorsed by the USPSTF for screening average risk women
4.
Which of the following is incorrect regarding the 2005 Dietary Recommendations for Americans?
A.
To reduce chronic disease Americans should exercise at least 30 minutes most days of the week
B.
Exercising 30 minutes most days of the week is adequate for weight loss
C.
Americans should choose a diet moderate in sugars
D.
Men should drink 2 or less alcoholic beverages in a day and women should drink 1 or less
E.
Less than 30% of calories consumed in a day should be from fat
5.
A 42 year old male has the following cardiovascular risk factors: most recent blood pressure was 132/84,
HDL cholesterol of 45, and dad died of a heart attack at age 65. Per NCEP guidelines, what is his target
LDL cholesterol?
A.
70
B.
100
C.
130
D.
160
6.
The most appropriate first line antihypertensive medication for most patients with high blood pressure is?
A.
Calcium channel blocker
B.
Thiazide diuretic
C.
ACE inhibitor
D.
Angiotensin receptor blocker
E.
Beta blocker
Questions 8-18 may have one or more correct answers. You must determine whether or not each option is a
correct response to the question.
7.
Which preventive topics does the U.S. Preventive Services Task Force address?
A.
Behavioral risk factor counseling
B.
Chemoprophylaxis
C.
Screening tests
D.
Immunizations
E.
Chronic disease management
14
8.
9.
The beneficial effects of hormone replacement therapy include:
A.
Symptomatic relief of menopausal symptoms
B.
Improved memory and cognition
C.
Prevention of coronary artery disease
D.
Improvement in bone mineral density
E.
Prevention of colorectal cancer
According to the U.S. Preventive Services Task Force, appropriate methods to screen for
colorectal cancer include:
A.
Annual fecal occult blood testing
B.
Stool DNA testing
C.
Flexible sigmoidoscopy
D.
Double contrast barium enema
E.
Colonoscopy
10.
The U.S. Preventive Services Task Force criteria for assessing the effectiveness of screening tests stipulate
that a test had to detect the target condition and that:
A.
Treatment was effective
B.
The test was cost-effective
C.
The test had been widely accepted by clinicians
D.
Early intervention led to better outcomes than treatment of symptomatic disease
11.
Which of the following should be obtained from a patient when developing a health promotion and
disease prevention program?
A.
Family history
B.
Medical history
C.
Behavioral risk factors
D.
Information on alcohol, tobacco and other substance use
12.
Which of the following conditions is thought to benefit from regular physical activity?
A.
Hypertension
B.
Diabetes
C.
Coronary heart disease
D.
Osteoporosis
13.
Which of the following age groups can benefit most from routine vision screening?
A.
Children <3 years of age
B.
Children 3-5 years of age
C.
School-aged children
D.
Adolescents
E.
Persons over age 65
14.
Which of the following are potential problems in interpreting studies that compare the prognosis of
cancers detected by screening to that of cancers detected due to symptoms?
A.
Lead-time bias
B.
Length bias
C.
Selection bias
D.
Over diagnosis of cancer
E.
Changing patterns of cancer care
15.
According to the USPSTF, which of the following are important preventive services for average-risk
pregnant women?
A
Second-trimester ultrasound
B.
Electronic fetal monitoring
C.
Gestational diabetes screening
D.
Multivitamins with folate
E.
Tobacco cessation counseling for smokers
15
16.
A 52 year-old Caucasian woman comes in to establish care. She is married, went through menopause at
age 49, and is of normal body weight and in generally good health. She has had annual Pap smear screening
without any abnormal findings. A mammogram last year was normal. Which of the following services
would you offer (list is not inclusive)?
A.
Pap smear
B.
Mammogram
C.
Colorectal cancer screening
D.
Chest x-ray
E.
Bone densitometry
17.
An 18 year-old young woman comes in for a physical exam prior to beginning college. She has been
sexually active for six months and has had one partner; they have used condoms inconsistently. Which
preventive services are the highest priority?
A.
Urinalysis
B.
Chlamydia screen
C.
Clinical breast exam
D.
Cholesterol measurement
E.
Counseling about contraception and STDs
18.
Per the U.S. Preventive Service Task Force, which of the following are effective screening tests to help
patients reduce their risk of cardiovascular disease?
A.
C-reactive protein
B.
Lipid measurement for average risk women
C.
Coronary artery calcium scoring
D.
Blood pressure measurement
E.
Inquiring about whether the patient smokes
19.
Which statements are true about prostate cancer screening?
A.
Screening reduces the risk of dying from prostate cancer
B.
Screening increases the chance of finding early stage prostate cancer
C.
Early stage prostate cancer is more likely to respond to treatment then advanced
cancer
D.
Screening might detect cancers that would never impact a man
E.
Most men diagnosed with prostate cancer should treat their cancer with surgery, radiation, or
hormone therapy
20.
Effective smoking cessation interventions include?
A.
Referral to a smoking cessation telephone counselor
B.
A prescription for clonidine
C.
A prescription for buproprion
D.
Nicotine replacement therapy
E.
Brief clinician advice to quit smoking
Clinical Infectious Disease
1. According to the World Health Organization (WHO), in children age five and under (except the neonatal
period) acute respiratory disease is the greatest cause of death. What is the next most common global cause of
death in this group?
a. HIV/AIDS
b. Diarrheal diseases
c. Injuries (motor vehicle accidents, drowning, burns, etc.)
d. Malaria
2. Which transmission scenario involving a Hepatitis Bs Ag positive contact would most likely to lead to a Hepatitis
B carrier state in the susceptible individual?
a. Vertical transmission from a mother to her infant
b. Horizontal transmission from a male to female sexual partner by intercourse
c. Horizontal transmission from a male to another male by anal intercourse
16
d.
Horizontal transmission between two injecting drug users sharing needles
3. A 61 year old man comes to your travel clinic to get a yellow fever vaccination in anticipation of a cruise up the
Amazon river leaving in two months. Two weeks previously, he went to his primary care provider and got the first
dose of hepatitis A, parenteral typhoid, and a routine vaccination against shingles. Assuming he is otherwise healthy
and accepts the age associated risk of vaccination, what would you recommend?
a. Give yellow fever vaccine this visit
b. Give yellow fever vaccine this visit with the second dose of Hepatitis A
c. Defer yellow fever vaccination for at least another two weeks
d. Wait to receive yellow fever vaccination on arrival in Brazil
4. A young man develops painful urination after a “one night stand”. Gram stain of the discharge reveals gram
negative diplococci. Given the options below, what is the most appropriate treatment according to current CDC
guidelines for this sexually transmitted infection?
a. Ceftriaxone 125 mg injection
b. Doxycycline 100 mg twice daily for seven days
c. Levofloxacin 500 mg daily for seven days
d. Cefixime 400 mg orally once and azithromycin 1 gram orally once
5. An interferon-gamma release assay (IGRA) test for tuberculosis would be preferred to a tuberculin skin test
(TST) to diagnose tuberculosis infection in:
a. A new hospital employee who has never been tested for tuberculosis
b. A TB contact investigation involving a child under age five
c. A severe rheumatoid arthritis patient just admitted to long term care
d. A recent adult immigrant who had BCG vaccination as a child
6. After a two week coughing illness, you diagnose a toddler with pertussis and place the child on a course of
azithromycin. When is the earliest time the child may be safely allowed to return to day care?
a. Immediately. The child is not infectious after two weeks.
b. After 24 hours on antibiotics
c. After five days on antibiotics
d. 21 days after the onset of illness
7. Of the following potential biological warfare category “A” agents, which is of concern for person to person
transmission?
a. Marburg virus
b. Anthrax
c. Botulinum toxin
d. Tularemia
Health Services Management (Systems-Based Practice)
1. Managed care organizations are:
a). Systems of administrative controls aimed at managing the cost of health care, but do not address
quality of health care and access to health care
b). Systems of administrative controls aimed at managing the cost of health care, access to health care,
and quality of health care in defined populations
c). Only of recent origin, and will probably not be around long.
d). Are all funded through entitlements.
e). Extinct
2. The Medicare and Medicaid programs are administered by:
a). The Health Care Financing Administration, part of the Bureau of Veteran's Affairs.
b). The Health Care Financing Administration, part of the Department of Health and Human Services.
c). The Health Care Financing Administration, an independent division of the government established to
pay for health care services in America.
d). The Center for Medicare & Medicaid Services
e). The Administration on Aging.
17
3. The financing of health care by the government in America is handled through:
a. The Department of Health and Human Services
b. Private insurance companies
c. Is not handled by the government at all. This is a trick question.
d. The Institute of Medicine
e. Health Resources and Services Administration (HRSA)
4. The two primary payers for government sponsored health care in the United States are:
a. The Center for Medicare & Medicaid Services and Health Resources and Services Administration
(HRSA)
b. The Health Care Financing Administration (HCFA) and private insurers such as Blue Cross/Blue Shield
c. Private insurers and self pay mechanisms.
d. Medicare and self pay
e. Health and Human Services and the Health, Education and Welfare Department (HEW)
5. The difference between process and outcomes measures is:
a. Process measures would include which lab tests were ordered and whether the patient was discharged
to home or pathology
b. Process measures would include such things as quality of physician charting and lab tests ordered and
outcomes would be reflected in the status of the patient upon discharge from the hospital
c. There is no real difference in process and outcome measures.
d. Not measurable
e. Unimportant as long as the patient is discharged from the hospital.
6. The Institute of Medicine (IOM) definition of quality is:
a. The degree to which health services for individuals increases the likelihood of desired health outcomes
consistent with current professional knowledge
b. The degree to which health services for individuals and populations increase the likelihood of desired
health outcomes and are consistent with current professional knowledge.
c. Unimportant. Who cares what the IOM thinks, anyway!?
d. The degree to which health services for populations increases the likelihood of desired health
outcomes consistent with current professional knowledge
e. The right care to the right patient, at the right time, at the right place, for the right amount of money
7. The National Practitioner Data Bank is:
a. Administered by a joint effort of the AMA and the AOA
b. Intended to penalize physicians for inappropriate behavior
c. Intended to improve the quality of health care
d. Administered by the Bureau of Health Professions, a division of Health Resources and Services
Administration, a branch of the Department of Health and Human Services
e. C and D.
Health Services Management (Medical Economics)
1)
When conducting a health economics study of a proposed intervention that will be funded by Medicare,
the most appropriate perspective for the study would be:
A. Health care system (e.g., hospitals, physician offices)
B. Patient
C. Payer (e.g., Medicare)
D. Societal
2)
If a patient has to take time off from work in order to have a routine screening test (e.g., a mammogram),
what is the cost classification for the time lost from work?
A. Direct medical
B. Indirect medical
C. Indirect
D. Intangible
18
3)
4)
5)
In a health economics study of a potential intervention, it is important to consider using the concept of
opportunity costs because:
A. Many health care providers charge fees well in excess of what is needed to recover costs and
provide a reasonable return on investments
B. Over time, inflation distorts the real value of health care services provided
C. In the health care marketplace, prices are set by mechanisms other than perfect competition
(i.e., healthcare markets are inefficient pricing mechanisms)
D. Medicare reimburses healthcare providers using cost-to-charge ratios, usually resulting in
reimbursements that are considerably less than the amount typically charged
When conducting a health economics study, future costs and benefits are discounted to current values
because:
A. Discounting to current values allows for direct comparison of all equivalent costs and
benefits, regardless of when they occur
B. Over time, inflation distorts the value of healthcare resources
C. Interest rates frequently change
D. Different audiences (and thus perspectives) potentially have different discount rates
When doing a health economics study from a societal perspective, which costs and benefits are actually
discounted?
A. Just those costs and benefits to which a monetary value can be placed
B. All outcomes (i.e., all costs and benefits), even if some outcomes can’t readily be valued in
monetary terms (e.g., lives saved)
C. Just those monetary costs and benefits which apply to the societal perspective
D. None – societal perspective implies that the future is equally valued as the present
6) The main methods of conducting a health economics study are:
A. Cost effectiveness and cost utility analyses
B. Cost utility and cost-benefit analyses
C. Cost-effectiveness, cost benefit and cost utility analyses
D. Just cost-effectiveness analyses – the other options are merely sub-sets of the
cost-effectiveness methodology
7) In what circumstance(s) is it best to use the cost-effectiveness methodology?
A. When comparing different interventions that may produce the same health outcome (e.g., lives
saved) among different population groups
B. When comparing different interventions that may produce the same health outcome (e.g., lives
saved) among the same population group
C. When comparing different interventions that may produce different health outcomes among
different population groups
D. When comparing different interventions that may produce different health outcomes among the
same population group
8) Outcomes of medical care are generally divided into the following 3 categories:
A. Clinical, economic and humanistic
B. Clinical, economic and societal
C. Life years gained, economic and humanistic
D. Life years gained, margins met, and quality of life
E. In-patient hospital duration, economic and time to relapse
9) Cost-effectiveness Analysis is different from other Pharmacoeconomic assessments in that:
A. Benefits/Consequences are measured in a dollar amount
B. It is the preferred analysis when incorporating patient preferences.
C. Natural units are used for outcomes measures
D. It is only valuable to physicians and clinical investigators who have an understanding of
clinical patient data
E. It adequately addresses broad issues of social welfare
19
Environmental Health
1. A worker is exposed to 800 rem total body exposure after a radiation accident. Two weeks post exposure, the
most expected health effect for this worker is:
a. anemia
b. vomiting
c. hair loss
d. death
2. The chemical used for disinfection of drinking water in the US is:
a. Chlorine
b. Flourine
c. Trihalomethane
d. Ozone
3. Which of the following vaccines are required for travelers entering certain countries/areas?
a. typhoid vaccine
b. polio vaccine
c. yellow fever vaccine
d. measles vaccine
4. The Clean Water Act protects the quality of :
a. lakes
b. bottled drinking water
c. private well water
d. household drinking water
5. What is of the following is within the recommended range for optimal concentration of fluoride in water to
prevent dental caries?
a. 100 ppm
b. b.10 ppm
c. .1ppm
d. 1 ppm
6. The first step in disaster response is:
a. distribution of food and water
b. distribution of blankets
c. completion of a needs assessment
d. insurance assessment of property damage
7. The criteria pollutants regulated by the Clean Air Act include:
a. Freon
b. Smog
c. Ozone
d. Cadmium
8. Which of the following is regulated by the from the Toxic Substances Control Act?
a. nail polish remover
b. nuclear waste
c. ammonia
d. Pesticides
9. Which of the following individuals has the highest risk of hypothermia?
a. an elderly female
b. an elderly male
c. a homeless 30 year old male
d. a 5 year old female
20
Environmental-Fundamentals of Occupational Medicine
1.
2.
3.
4.
5.
1.
Which of the following is most suggestive of a unilateral L4/5 lumbar disc herniation?
a. Saddle anaesthesia
b. Quadriceps weakness
c. Diminished ankle jerk
d. Weakness on heel walking
2.
Occupational allergic contact dermatitis
a. Is a Type I (IgE-mediated) hypersensitivity reaction
b. Demonstrates sharply-demarcated borders at the site of contact
c. Is likely to affect the majority of workers using a suspected substance
d. In many cases may persist despite removal from the workplace
3.
Squamous cell carcinoma of the skin is most likely to arise from work as a:
a. Lead battery reclaimer
b. Roofer
c. Doctor
d. Photographic printer
4.
A healthy 30-year-old chemical worker is sent to the hospital in respiratory distress after an ammonia
spill. He recovers from the acute injury but six months later still has intermittent wheezing on exposure
to cigarette smoke and work in the cold. His disorder is most consistent with:
a. Inhalation fever
b. Reactive airways dysfunction syndrome
c. Occupational asthma
d. Hypersensitivity pneumonitis
5.
Match the neurotoxic disorder with the occupational etiology: (each answer may be used more than
once, or not at all)
Parkinsonism
Peripheral neuropathy
Encephalopathy
Trigeminal neuralgia
Ataxia
A.
B.
C.
D.
E.
Trichloroethylene
Arsenic
Manganese
Methylmercury
Lead
6.
Which of the following statements on occupational noise-induced hearing loss (NIHL) is true :
a. Symptoms are recognizable when average pure-tone thresholds reach 20 dB
b. Adequate protection for almost all workers is achieved by adherence to the OSHA PEL of 90 dB
/ 8 hour time-weighted average day
c. Findings of NIHL are reversible when detected early by screening audiometry
d. Speech clarity, rather than volume, is affected first
7.
Which pairing is correct?
a. Lead – peripheral neuropathy sensory > motor
b. Arsine – hyperpigmentation and squamous cell CA
c. Cadmium – osteomalacia
d. Chromium – intersitial lung disease
Behavior and Mental Health
1.
Which of the following is NOT true as it pertains to individual health risk appraisals?
a. Intent is to determine both healthy and unhealthy behavioral practices
b. Considers only those behavioral risks that are modifiable
c. Can provide a baseline against which to monitor change
d. Identifies areas for health behavior improvement
21
2.
Behavioral Risk Factor Surveillance System (BRFSS) is intended to assess both behavioral risk factors and
______________________ .
3.
The fundamental assumption of the Health Belief Model is that people ______________, and that their
actions to promote change are a product of _______________________ and
______________________.
4.
In the Theory of Reasoned Action, the most important determinant of behavior is
______________________.
5.
The Theory of Planned Behavior is an extension of the Theory of Reasoned Action. The authors
extended the theory to add _________________ to account for factors outside of one’s personal
control that might influence intention to change.
6.
Rothman’s typology entwines which three concepts to address how communities organize to identify
health issues and prepare a plan to mobilize to address these issues?
7.
Due to the high concordance of symptoms between major depressive disorder and those of a variety of
chronic health conditions, the most popular inventories tend to over-diagnose depression by how much?
___________________________.
8.
___________percent of adults with a diagnosed mental health disorder, and an even smaller proportion
of children, will receive any mental health services in a given year.
9.
Over _______ % of US adults will meet the diagnostic criteria for a DSM disorder during their lifetime.
Clinical Aerospace Medicine
1. Undetectable patent foramen ovale probably exists in 25-30% of the population and poses no threat to
the health of the flying population with the possible exception of which aerospace medical problem?
a.
High -Gy force
b.
Hyperventilation
c.
Decompression sickness
d.
Severe active airsickness
2. Which one of the following valvular disorders would likely result in a reduced tolerance to +Gz forces?
a.
Aortic insufficiency
b.
Mitral stenosis
c.
Aortic stenosis
d.
Mitral insufficiency
3. Cardiac arrhythmias which result in syncope can be catastrophic in the aviation setting. Which of the
following can lead to atrial sinus arrest and syncope?
a.
Positive pressure breathing
b.
The M-1 maneuver
c.
An attempt to stop hyperventilation by deep breath holding.
d.
all of the above
4. An acoustic neuroma should always be suspected in a patient with:
a.
recurring episodes of vertigo.
b.
history of noise intolerance.
c.
feeling of fullness in one ear.
d.
unilateral high-tone hearing loss.
5. If an aircrewmen develops a "sinus block" (barosinusitis), the most effective management which can be
initiated immediately is:
a.
immediate descent and checking with the flight surgeon.
b.
performance of the Valsalva maneuver.
22
c.
d.
re-ascend until air pressure in the nose and sinus cavity is equalized.
spray the nose with a vasoconstrictor.
6. The most commonly involved sinus with barosinusitis is?
a.
Ethmoid
b.
Maxillary
c.
Sphenoid
d.
Frontal
7. A student pilot presents with bilateral ear pain and injected and retracted tympanic membranes several
hours following an uneventful hypobaric chamber flight to FL 350 which was preceded by thirty minutes
of denitrogenation. Oxygen regulators were set to "100% oxygen" until passing through 10,000 feet on
descent. The most likely problem is:
a.
barotrauma induced during descent with delayed reporting by the student.
b.
inflammatory otitis media.
c.
oxygen absorption barotitis media.
d.
nitrogen deficiency barotitis media.
8. With a unilateral conductive hearing loss, the Weber test lateralizes to:
a.
neither ear (midline)
b.
ear with the conductive loss
c.
ear without the conductive loss
d.
ear with the sensorineural loss
e.
ear without the sensorineural loss
9. If one is measuring sound from two different sources in a given area, and if one sound source produces
100 dB when operating itself and the second source also produces 100 dB when operating, it would be
expected that the total noise level would be:
a.
200dB
b.
l50dB
c.
125dB
d.
110dB
e.
103dB
10. The leading cause of GI inflight incapacitation in aircrew has been cited as:
a.
gI bleed.
b.
erosive gastritis due to excessive alcohol intake.
c.
peptic ulcer disease.
d.
Gastroenteritis.
e.
hiatal hernia with reflux.
11. Male pilots of high performance aircraft (fighters) have been found to have an altered sex ratio of
offspring, 40% male and 60% female children. The mechanism for this finding is ________.
a.
exposure to non ionizing radiation
b.
exposure to high +Gz
c.
exposure to high oxygen concentrations
d.
life style induced
e.
unknown
12. A 28 year old male airman presents to your office for a Class II medical. During the GU exam, you find a small
3 mm nodule on the R testicle. The patient does not recall the lesion having been present before
and his exam of one year ago was normal. You refer him immediately to a urologist, and biopsy
confirms testicular cancer. He would like to know about the possibility of flying in the future. Which of
the following statements is true?
a.
The prognosis for testicular cancer is good, especially when caught early. If he is disease
free and off all treatment protocols, there is a very good chance he can get a waiver and
return to flying status.
23
b.
c.
d.
e.
Although the prognosis for testicular cancer is good, there is a real concern that occult
metastases, especially to the brain, will be present. Therefore prior to any consideration
for waiver, he will need to be disease free for at least 10 years.
The prognosis for testicular cancer is good and as long as the symptoms from the
chemotherapy are well controlled, he can apply for a waiver.
Since the pathology for the tumor showed it was a seminoma and all he will require is
radiation therapy, he does not have to apply for a waiver.
There is no chance for a waiver once the diagnosis of cancer has been made.
13. An airman presents to you with a history of Stage IB Hodgkin's Disease. His diagnosis was made 15
years ago, and he finished therapy 12 years ago. All follow-up visits with his oncologist have been
positive; he has had no recurrence of the disease. He is applying for a third class medical certificate.
You advise him that:
a.
He does not qualify for a third-class medical because of the high risk of secondary
malignancy in Hodgkin's patients. Denial is mandatory in all cases and you recommend
that he does not continue with his physical.
b.
He does not qualify for a third-class medical because of the diagnosis of Hodgkin's
disease. However, once he has reached the 20 year anniversary of the completion of his
therapy, he would be eligible for a waiver.
c.
He does not qualify for a third-class medical because of the diagnosis of Hodgkin's
disease. However, since he has had no recurrences, the FAA might consider a waiver at
this time.
d.
He does qualify for a third-class medical and you can issue this to him at the time of his
visit if he can prove he has been disease free for 10 years.
e.
He does qualify for a third-class medical and no further documentation is required.
14. Infection with the Human Immunodeficiency Virus (HIV) is:
a.
disqualifying for any class of Federal Aviation Administration (FAA) airman medical
certificate.
b.
disqualifying only for Class 1 medical certificates.
c.
disqualifying only for Class 2 and 3 medical certificates.
d.
only disqualifying if AIDS has been diagnosed, or the airman is taking prophylactic
medications for the condition.
e.
not an issue in civil aviation because the FAA has not established a policy reference this
infection and aeromedical certification.
15. With respect to organ transplantation and civil aeromedical certification:
a.
Any type of organ transplant is permanently disqualifying for all classes of Federal
Aviation
Administration (FAA) airman medical certificate.
b.
Select pilots may be medically certified by the FAA for all classes of medical certificates
after undergoing organ transplantation.
c.
The only transplant patients currently being medically certified by the FAA are kidney
recipients, and only for Class 3 medical certificates.
d.
The primary reason against medical certification of pilots is the significant side-effects of
antirejection medications.
e.
Cardiac transplant patients may be medically certified by the FAA after a six month
waiting period, providing no complications arise.
16. A general aviation pilot, Class 3 medical certificate holder, has recently been diagnosed with diabetes.
As an aviation medicine specialist, she comes to you for advice with regards to her return to flying as a
pilot. You:
a.
Inform her she can no longer fly because diabetes is disqualifying for any class of pilot
medical certificate, and Federal Aviation Administration (FAA) an Authorization (i.e.,
waiver) is not possible.
b.
Inform her she could continue to fly because the FAA is currently certifying diabetics
provided diet and exercise are the only means needed to control the disease.
24
c.
Inform her diabetes is disqualifying; she could eventually continue to fly because the FAA
is certifying diabetic pilots for Class 3 medical certificates, provided they have an
unremarkable medical evaluation, their diabetes is will controlled with either diet,
exercise, and/or oral hypoglycemic agents, control has been documented for at least
three months, and no averse medication side-effects exist.
d.
Inform her that diabetes is disqualifying, but she could eventually continue to fly
provided she has an unremarkable medical evaluation and no complications of the
diabetes exists, her diabetes is well controlled with either diet, exercise and/or oral
hypoglycemic agents, control has been documented for at least three months, and no
adverse medication side-effects exist.
e.
Inform her she can container to fly, and that any type of hypoglycemic medication is
acceptable to the FAA, provided she has an unremarkable medical evaluation, her
diabetes is well controlled with either diet, exercise and/or medication, control has
been documented for at least three months, and no adverse medication side-effects
exist.
17. A 40 year old male pilot is referred to your office by his employer for a recommendation on return to
flying. Two weeks prior he had to abruptly land the helicopter he was flying because of chest pain. He
was seen in an emergency room shortly after the incident and was asymptomatic. On questioning he
reported several recent episodes of chest discomfort, but this was the worst. Further evaluation
consisted of a thorough physical exam, EKG, cardiac enzymes, CBC, routine blood chemistry, urinalysis,
amylase levels; all were unremarkable. He subsequently had an equivocal stress test, which prompted
an angiogram. The angiogram was read out as normal. Based on the negative cardiovascular workup
he was referred to a gastroenterologist who diagnosed gastroesophageal reflux and esophagitis, with no
evidence of a gastric or duodenal ulcer. The pilot was placed on an oral histamine (H2) receptor
antagonist which has proved beneficial. As aviation medicine specialist you would:
a.
b.
c.
d.
e.
Recommend returning the pilot to flying with no further action. Copies of the evaluation
and tests are forwarded to the FAA medical office.
Recommend to he employer the pilot be grounded, as histamine (H2) receptor
antagonist are prohibited by the FAA for use in pilots.
Recommend to the employer the pilot be grounded because according to current FAA
regulations, reflux esophagitis and the use of histamine (H2) receptor antagonist are
disqualifying for pilots.
Recommend an authorization (i.e., a waiver) be sought from the FAA for both the
diagnosis of reflux esophagitis and the use of a histamine (H2) receptor antagonist. In
the meantime, the pilot should not fly.
Recommend the pilot be grounded for a period of 3 months before he can be
reconsidered for return to flying. During that time he must be on the prescribed
medication to ensure no adverse side effects occur. After 3 months he well require a
new FAA flight physical and must provide a current gastrointestinal (GI) evaluation.
18. With regard to the current use of electroencephalography (EEG) as an aeromedical screening tool, which
of the following is INCORRECT:
a.
The EEG may be useful for certain clinical indications (head injury, unexplained loss of
consciousness, family history of epilepsy, abnormal neurological exam).
b.
An asymptomatic pilot with an EEG showing spike and wave pattern (Grade III
Dysrhythmia) may never develop a seizure during a flying career, and should not be
grounded based solely on the EEG.
c.
EEGs are used to screen all military and airline transport pilots.
d.
An EEG has a low positive predictive value as a screening tool for seizures in the
medically screened (asymptomatic, no seizure risk factors) aviation applicant.
25
e.
EEG results should be correlated with past history of a seizure, neurologic exam,
neuroimaging studies, and neuropyschometric evaluation.
19. Studies have revealed that monocular clues for depth perception as used by the one-eyed pilot are
adequate for routine flying, but that during landing at minimums and formation flying binocular clues are
very important. Name two binocular clues for depth perception.
a.
Customary size of objects and aerial perspective
b.
Convergence and motion parallax
c.
Shadows and customary size of objects
d.
Stereopsis and motion parallax
e.
Convergence and stereopsis
20. Which of the following visual illusions will cause the pilot to fly a high landing approach?
a.
narrow runway illusion.
b.
an upsloping runway illusion.
c.
featureless terrain illusion.
d.
a downsloping terrain illusion.
21. Which of the following statements is NOT true concerning polarizing light and filters.
a.
Polarizing filters transmit light that is vibrating in a certain direction.
b.
Polarizing filters are laminating and difficult to grind.
c.
Stress patterns may appear in windscreens when viewing through a polarizing filter.
d.
Polarizing filters are neutral, passing equal amounts of all wavelengths of light.
22. The civil medical visual standards effective September 16, 1996, provide that:
a.
examiners check the distant vision, with or without correction.
b.
examiners check intermediate vision for all three medical certificate classes.
c.
examiners check aviation red, aviation green and white for all three medical certificate
classes.
d.
examiners conduct ECG's on first and second medical certificate classes, age 35 and 40
plus.
e.
examiners conduct urine drug screening for amphetamines, opiates, marijuana, cocaine
and PCP.
FATIGUE / CIRCADIAN RHYTHMS
23. Recommendations for scheduling duty hours for shift workers indicate that the direction and speed of
shift is important. Which shift schedule is most likely to promote vigilance on the job, by being the
LEAST disruptive to the body’s natural timing system?
a.
b.
c.
d.
e.
Rapid (2-3 days each) mornings, evenings, night shifts
Rapid (2-3 days each) nights, evenings, morning shifts
Slow (Weekly each) mornings, evenings, night shifts
Slow (Weekly each) nights, evenings, morning shifts
Moderate (5 days each) nights, evenings, morning shifts
24. Your airline company has to operate a three shift maintenance base and asks you to recommend the
best theoretical shift schedule. You suggest the following rotation:
a.
Shift from day to night to evening at weekly intervals.
b.
Shift from evening to day to night at weekly intervals.
c.
Shift from day to evening to night at an intervals of every three weeks.
d.
Shift from day to night to evening at an interval of every three weeks.
e.
Shift from day to evening to night at weekly intervals.
25. Which of the following is not a characteristic of acute fatigue?
a.
disruption in psychomotor timing
b.
decrement in fine motor control
26
c.
d.
e.
increased variability in performance
lowering of standards of what is acceptable performance
loss of motivation to perform and an impaired capacity
MEDICATIONS
26. The rate of elimination of alcohol from the body:
a.
may be hastened by the consumption of coffee after drinking alcohol.
b.
is significantly increased by the consumption of food prior to or coincident with the
consumption of alcohol.
c.
is fairly constant.
d.
varies from individual to individual and from day to day.
e.
both b and d
HYPERBARIC MEDICINE
27. According to Haldane's Law, what is the lowest pressure altitude at which decompression sickness can
occur?
a.
25,000 feet
b.
22,000 feet
c.
18,000 feet
d.
14,000 feet
28. Decompression illness (DCI) is:
a.
decompression sickness (DCS).
b.
dysbarism.
c.
decompression sickness (DCS) and air embolism (AGE).
d.
isobaric counterdiffusion.
e.
pulmonary barotrauma.
29. Altitude decompression sickness (DCS) is unusual below altitudes of __________:
a.
8,000-10,000 feet
b.
10,000-15,000 feet
c.
15,000-18,000 feet
d.
18,000-21,000 feet
e.
greater than 21,000 feet
30. Which of the following is UNCOMMON as a sign or symptom of decompression sickness?
a.
coughing
b.
joint pain
c.
cyanosis
d.
blurred vision
e.
personality change
31. The lowest altitude at which altitude induced decompression sickness is a common threat (assuming no
exposure to compressed gas breathing mixtures in the 24-hour interval immediately preceding the
altitude exposure) is:
a.
10,000 feet above sea level.
b.
18,000 feet above sea level.
c.
25,000 feet above sea level.
d.
15,000 feet above sea level.
32. Protection from decompression sickness during extravehicular activity from the current NASA Space
Shuttle requires:
a.
one hour of prebreathing at 14.7 psi.
b.
a 10.2 psi staged decompression including a total of 1 hour, 40 min of prebreathing.
c.
4 hours of prebreathing at 14.7 psi.
d.
injection of nitrogen absorbing substances.
e.
b or c above.
27
33. It is of no value to refer a patient with an air embolism to a hyperbaric chamber if the time elapsed after
the embolism is more than which of the following?
a.
1 hour
b.
8 hours
c.
24 hours
d.
none of the above
34. When breathing 100% oxygen under hyperbaric conditions of 66 fsw (feet sea water) pressure, there is a rise
in cerebral venous PCO2 of about 5-6 m Hg. This rise is due to:
a.
the acid shift in pH.
b.
100% saturation of Hgb with O2 resulting in a loss of reduced Hgb.
c.
the decrease in CO2 solubility.
d.
toxic effect of O2 on carbonic anhydrase.
35. Generally accepted clinical applications of hyperbaric oxygen therapy include:
a.
senility, carbon monoxide poisoning, mandibular osteoradionecrosis
b.
chronic pulmonary emphysema, air embolism, cyanide poisoning.
c.
carbon monoxide poisoning, mandibular osteoradionecrosis, cyanide poisoning.
d.
cyanide poisoning, senility, myocardial infarction.
36. Hyperbaric Oxygen therapy is beneficial in the treatment of carbon monoxide poisoning because:
a.
increased partial pressures of O2 decrease the half life of carboxyhemoglobin.
b.
increased plasma dissolved oxygen results in rapid tissue oxygenation even before
carboxyhemoglobin elimination is accomplished.
c.
increased partial pressures of O2 reverse the toxic effects of CO on the cytochrome
system.
d.
all of the above.
Public Health Law
A1. All of the following are essential elements of an informed consent EXCEPT?
a. the diagnosis
b. the proposed procedure
c. alternatives to the procedure
d. risks of the procedure
e. physician’s complication rate for the procedure
A2. Negligent conduct by a professional is called
a. malfeasance
b. misfeasance
c. nonfeasance
d. gross negligence
e. malpractice
Match the following with the appropriate legal claim
a.
Abandonment
b.
Assault
c.
Battery
d.
False Imprisonment
e.
Breach of Confidence
A3. Physician fails to obtain informed consent before a surgical procedure.
A4. Physician fails to return a patient’s calls for follow up care after an acute illness.
A5. A competent, non-combative patient is restrained against her wishes.
B1. Which of the following allows states to require licensing of medical practitioners?
a. stare decisis
b. police power
28
c.
d.
e.
parens patriae
res ipsa loquitor
quid pro quo
B2 Which of the following allows states to involuntarily commit an individual with a disabling mental illness?
a. stare decisis
b. police power
c. parens patriae
d. res ipsa loquitor
e. quid pro quo
Match the following terms with the appropriate phrase
(a) ERISA
(b) The Health Care Quality Improvement Act of 1986
(c) COBRA of 1985
(d) EMTALA
(e) Hill-Burton Act
B3.
B4.
B5.
Access to health care insurance post job loss
Peer Review immunity, confidentiality and due process safeguards.
Preemption that exempts employee benefit plans and self –insurance plans from state regulation
C1. Spouses employed by the same employer who request family leave for the birth and care of their newborn
child under the Family Medical Leave Act (FMLA) are jointly entitled to a combined total of:
a. 6 weeks
b. 8 weeks
c. 12 weeks
d. 16 weeks
e. 24 weeks
C2. Spouses employed by the same employer who request family leave to care for a child with a serious health
condition under the FMLA are jointly entitled to a combined total of:
a. 12 weeks
b. 16 weeks
c. 24 weeks
d. 36 weeks
C3. An individual with the following condition may have a qualifying disability under the ADA:
a. a positive urine drug test for cocaine
b. a broken ankle two weeks ago while skiing
c. a history of coronary artery bypass surgery
d. a history of transvestitism
e. a criminal record
C4. The EPA has responsibility for the registration of pesticides under:
a. FIFRA
b. CERCLA
c. RCRA
d. HSWA
e. FOIA
C5. Workers are entitled to the following benefits in the Workers’ Compensation System EXCEPT:
a. Wage replacement
b. Medical care costs
c. Death benefits
d. Punitive Damages
C6. All of the following employers or workplaces are exempt from coverage by the OSHA Act EXCEPT:
29
a.
b.
c.
d.
e.
Self-employed persons
Farms at which only immediate members of the farmer's family are employed
Working conditions regulated by other federal agencies under other federal statutes
State and local governments (unless they are in one of the States with OSHA-approved safety and
health programs)
Employers with 10 or less employees.
The Flight Environment
1.
A reduced oxygen pressure differential across the alveolar-capillary barrier is associated with:
a. Hypoxic hypoxia.
b. Hypemic (anemic) hypoxia.
c. Stagnant hypoxia.
d. Histotoxic hypoxia.
2.
Man can generally tolerate an appreciable decrease in the ambient barometric pressure because of the:
a. Increased blood flow to the brain with hyperventilation.
b. Constant percentage of oxygen in the ambient air.
c. Shape and shifting of the oxygen dissociation curve for hemoglobin.
d. Shift toward a state of respiratory alkalosis.
3.
Which of the following is true regarding the 47 mmHg of water vapor pressure exerted with those gases
involved in pulmonary physiology?
a. It is not affected by temperature.
b. It is not affected by altitude.
c. This pressure is reduced by one-half at 18,000 ft.
d. It must be disregarded when calculating the partial pressures of inspired gases.
4.
A pilot, who has just departed base and is performing a steep climbing left turn, turns his head to the console
on his right to change the radio frequency to departure control. He may experience:
a. Oculogravic illusion.
b. Coriolis illusion.
c. Autokinesis.
d. Flicker vertigo.
5.
If an aircraft crashes during a controlled flight into the ground and there is no evidence that the pilot was
aware of the impending collision or made no control response to prevent the aircraft from flying into the
ground, the pilot most likely experienced:
a. Type I spatial disorientation
b. Type II spatial disorientation
c. Type III spatial disorientation
d. Spatial disorientation without loss of situational awareness
6.
The vertical heart-to-eye distance in a typical seated fighter pilot is 29 cm. He will begin to lose peripheral
vision if his eye-level systolic blood pressure drops below about 50 mm Hg, and total visual loss (blackout) will
occur if eye-level systolic blood pressure drops below 20 mm Hg. If this pilot has a heart-level systolic
pressure of 120 mm Hg and is afforded no G protection from an anti-G suit or by performing the anti-G
straining maneuver, at what +Gz level would you predict him to black out? One mm Hg is equivalent to 1.29
cm of blood.
a. 0.9 G
b. 3.6 G
c. 4.4 G
d. 5.3 G
7.
Galactic cosmic radiation:
a. Consists of mostly electrons and high energy nuclei of heavier atoms.
b. Is of little consequence within spacecraft, but may be harmful during extravehicular activities.
c. Consists of about 90% protons, and 9% helium nuclei (alpha particles).
d. At sea level has only 40% of the ionizing power it has at 70,000 feet.
30
8.
You are trekking with a group that has just reached a base camp at 14,500 feet. One of your fellow trekkers
begins complaining of shortness of breath and cough. You listen to his chest and discover diffuse wheezing in
the right upper lobe as well as a respiratory rate of 30. Your diagnosis is:
a. Acute mountain sickness (AMS).
b. High altitude pulmonary edema (HAPE).
c. High altitude cerebral edema (HACE).
d. Pneumonia.
9.
Retreating blade stall experienced by a helicopter in flight is caused by:
a. Insufficient airframe forward airspeed.
b. Excessive airframe forward airspeed.
c. Aggressive yawing maneuvers.
d. Rearward flight.
10.
While backpacking with a group of adults in mid-afternoon one hot July day, one of the members of the
group becomes quite lethargic, confused, and subsequently faints. He rouses quickly but has an ashen-grey
appearance. Examination of the individual reveals the following: cold and clammy skin; pupils somewhat
dilated; pulse slightly elevated; otherwise temperature appears normal without any other abnormal signs.
He has no history of medical problems and we are considering his problem to be related to heat stress. In
regard to heat overexposure, select the most likely diagnosis and best initial therapy.
a. Heat cramps--loosen clothing and remove the patient to cool area.
b. Heat exhaustion-loosen clothing and remove the patient to cool area.
c. Heat stroke-heroic emergency measures including ice immersion immediately.
d. Heat stroke-remove from heat and immediately give 0.5 cc epinephrine 1:10,000 and begin ice water
immersion.
11. Which part of the eye is the most vulnerable to microwave radiation?
a. Cornea
b. Iris
c. Lens
d. Retina
12. The goal of cockpit automation (auto-pilots, navigation systems, adaptive control devices, etc.) is to improve
mission capability and increase safety. Experience with highly automated cockpits shows that:
a. The workload of the pilot may increase.
b. The percentage of accidents attributed to "pilot error" has decreased significantly.
c. Use of automated systems reduces and simplifies the pilot's tasks.
d. With computer-based systems working behind the scenes, cockpit complexity has decreased.
Management and Administration/Operational Aerospace Medicine
1. The purpose of the International Health Regulations (IHR(2005)) is to prevent international disease spread by
early detection of, and effective response to, events that pose a risk to public health. Concerning international civil
aviation, compliance with the IHR is:
a) The responsibility of all international air carriers.
b) Mandatory for all Member States of the World Health Organization (WHO).
c) The responsibility of the International Civil Aviation Organization (ICAO) as stated in Annex 9 to the
convention on International Civil Aviation.
d) Optional and voluntary, but ICAO Contracting States and WHO Member States, Associate States and
other States bound by the IHR (2005) shall comply with the regulations unless they have indicated to
ICAO and WHO that their position is not to be bound by the IHR, or to be bound with reservations
only.
2. As of 1 Jan 2010, FAA rules governing transportation of patients by air
a) Do not address patient care recommendations.
b) Require a medical attendant who has met NREMT Basic Emergency Medical Technician requirements, and
is knowledgeable in aviation physiology.
31
c)
Require NREMT examination and certification as an EMT-Paramedic, with additional training in aviation
physiology.
d) Require oxygen available for all patients, and for all crew members for flights above 12,500 ft. over 30
minutes, or all flights above 14,000 ft.
3. In a survey of US Air Carrier accidents for the period 1983-2000, the incidence of fatalities was determined.
Which of the following probability statements is INCORRECT?
a) Of all accidents, only one in 20 passengers was killed.
b) Of serious accidents, more than half the passengers survived.
c) Of serious accidents, over 80% of passengers were killed.
d) Of serious survivable accidents, more than ¾ ths of passengers survive.
4. Regarding the risk of deep vein thrombosis (DVT) in commercial air travel, which of the following is most
correct.
a) The risk of DVT has been shown to be elevated in commercial air travel compared to other forms of
transportation (the “Economy Class Syndrome”).
b) Dehydration and the relative hypoxia of the cabin altitude contribute to DVT risk.
c) Aspirin is a prudent recommendation for DVT prophylaxis in air travelers.
d) Low-molecular weight heparin may be indicated for passengers with risk factors for DVT.
5. When operating an unpressurized aircraft, supplemental oxygen by mask may be necessary to prevent hypoxia
in flight crew and passengers. According to Federal Aviation Regulations, above what altitude is supplemental
oxygen required to be provided for each occupant of the aircraft?
a) 10,000 feet (MSL)
b) 12,500 feet (MSL)
c) 14,000 feet (MSL)
d) 15,000 feet (MSL)
6. Regarding airport mass casualty planning, all of the following are required except:
a) A certified airport must have one review of the emergency plan with the involved parties every 3 years.
b) JCAHO requires hospitals to test the hospital disaster plan twice a year.
c) Most disaster plans use the Incident Command System (ICS) as a pattern for command and control.
d) Emergency medical services are usually under the control of the Chief of Operations in the ICS system.
7. When determining to what extent individuals are suited to air traffic control work, which of the following
factors is not considered predictive.
a) age
b) college grade point average
c) overall level of adjustment
d) previous air traffic control experience
8. What percent of fatally injured aircraft occupants of structurally survivable general aviation accidents have
demonstrated head trauma?
a) 10%
b) 30%
c) 50%
d) 80%
9. Many factors exist which favorably influence the ability of the human to withstand larger decelerative forces
occurring during a crash. Select the best answer:
a) Crash forces are better tolerated in the forward-to-backward direction (Gx).
b) Some crash forces can be attenuated by providing resilient cushions around the occupant.
c) Man can withstand greater magnitudes of deceleration if they are applied at faster rates.
d) It is possible to increase the magnitude tolerated by increasing the duration of the applied force.
Chronic Disease
1. Which of the following represents that correct order (ascending to descending) for causes of death in the US?
32
A.
B.
C.
D.
E.
Cancer>Heart Disease>Stroke>COPD>Diabetes
Heart Disease>Cancer>Stroke>COPD>Accidents
Heart Disease>Stroke>Cancer>COPD>Alzheimer's Disease
Cancer>Heart Disease>COPD>Diabetes>Stroke
Heart Disease>Diabetes>Cancer>Stroke>COPD
2.
A.
B.
C.
D.
According to BRFSS, which of the following healthy lifestyle practices is most common among US adults?
Maintenance of a healthy body weight
Consumption of 5 or more servings of fruits and vegetables per day
Routine physical activity
Not smoking
3. You are evaluating 5 patients who are considering surgery for weight loss. All have tried lifestyle changes
(including dieting and increasing physical activity) as well as medication, without success. Which of the following
patients is most likely a candidate for surgery?
A. A man who is 6 feet tall, weighs 272 pounds, and has Type 2 diabetes
B. A man who is 5 feet 8 inches tall, weighs 249 pounds, and has no chronic conditions
C. A man who is 6 feet 3 inches tall, weighs 270 pounds, and has hypertension, obstructive sleep apnea, and Type
2 diabetes
D. A woman who is 5 feet 8 inches tall, weighs 249 pounds, and has no chronic conditions
E. A woman 5 feet 3 inches tall, weighs 210 pounds, and has no chronic conditions
4. You are having a discussion with the parents of a 4-year old boy who has had asthma since infancy. He has had
two hospitalizations for asthma (he has not required intubation) and three emergency department visits. He is on
an inhaled corticosteroid and long-acting beta agonist. The parents have an hygrometer in the home to measure
humidity levels. They are worried about mold development in their home. Which of the following is the most
appropriate humidity level they should maintain in their home?
A. 20%
B. 40%
C. 60%
D. 80%
5.
A.
B.
C.
D.
E.
Smoking prevalence is greatest among which of the following racial/ethnic groups?
African Americans
Whites
Hispanics
Asians
American Indians/Alaska Natives
6. Which is the most common disorder identified by newborn screening tests?
A. PKU
B. Congenital Hypothyroidism
C. Galactosemia
D. Biotinidase Deficiency
E. Maple Syrup Urine Disease
7. You are seeing a 35 year old female for a routine evaluation. She asks you about her risk for breast cancer.
Which of the following LOWERS her breast cancer risk:
A. Having her first child after age 30
B. Early-onset menarche
C. Breastfeeding
D. Recent oral contraceptive use
E. History of high dose radiation to chest
8.
A.
B.
C.
Which of the following regarding lung cancer is true?
African American females have a greater incidence but lower mortality than white females
African American males have a greater incidence but lower mortality than white males
African American females have a lower incidence and lower mortality than white females
33
D. African American males have a lower incidence and lower mortality than white males
9. Which of the following is true regarding colorectal cancer?
A. A colonoscopy may provide both primary and secondary prevention
B. Incidence rates have been increasing in recent years
C. Survival rates are similar for cancers detected at both regional and distant stages
D. Excluding skin cancer, colorectal cancer ranks #3 among cancer types responsible for the most number of new
cases in the US
Health Services Management
1.
Taxation is one of the powers used by government to influence public health. Which of the following
statement about this power is correct?
a. For every 10% increase in taxes on junk food, rates of hypertension are reduced by 5% in the
population aged 25-54
b. For every 10% increase in alcohol taxes, the rate of death from cirrhosis is reduced by 7%
c. For every 10% increase in tobacco taxes, the rate of cerebrovascular accidents is reduced by 4%
d. For every 10% increase in the taxes on sugary beverages, the obesity rate among children goes
down by 8%
2.
According to NACCHO (National Association of County and City Health Officials) what jurisdiction
most commonly has authority over local health departments?
a. City
b. Township
c. County
d. State
3.
What is the most common method for Americans to receive health coverage?
a. Employee sponsored insurance
b. Medicaid
c. Medicare
d.
Private non-group policy
4.
Between 1999 and 2009, which type of health service expenditure grew by the greatest percentage?
a. Hospital Care
b. Physician/Clinical Services
c. Nursing Home Care
d. Prescription Drugs
5.
What is the current recommendation for fluoride supplementation in municipal water supplies?
a. 0.7 ppm
b. 1.0 ppm
c. 1.2 ppm
d. 2.0 ppm
6.
Which of the following statements best describes “participation measures” as defined by Healthy People
2020?
a. individuals’ assessments of the impact of their health on their social participation within their
current environment
b. Practitioner assessment of the activities of daily living
c. Employers assessment of time and attendance measures in the work environment
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a.
Family evaluation of participants social activities outside the famil y
Hazard Recognition, Evaluation and Control
1. The best way to determine if hearing loss is occupationally related or from presbycusis is:
a. By history
b. By severity
c. By examining the ear with an otoscope
d. By audiogram and discrimination tests
2. Select the single best answer as it relates to occupational induced hearing loss.
a. Continuous noise exposure over the years is more damaging than interrupted exposure to noise
b. Hearing loss is often mixed conductive and sensorineural loss
c. Hearing loss continues after particularly loud exposures
d. Previous noise-induced hearing loss makes the ear more sensitive to future noise exposure
3. Please select the best match.
a. OSHA; REL
b. NIOSH; PEL
c. REL; STEL
d. ACGIH; BEI
4. Which of the following work schedules causes the least stress for shift workers?
a. Alternating shifts of 3 days each of night shift, evening shift and day shift.
b. “7-7-7” Seven days each of days, evening and night with two days off between shifts.
c. 21 day shift with workers maintaining the same sleep-wake schedule during their time off.
d. Keeping lights low for all shifts and periodically “white” background noise to help reduce worker
anxiety.
5. You are responsible for providing workers with a 20-minute presentation about prevention of
musculoskeletal injuries in the workplace. Of the following, which is the more accurate statement?
a. Always lift with your legs, not your back.
b. Lumbar intradiscal pressure increases with trunk extension.
c. Most lifting studies that have been conducted do not take into account foot traction.
d. Frequent lifting of moderate to heavy loads can lead to cardiovascular stress and localized muscle
fatigue.
6: A 5’8”, 240 lb, 50 year old male strip miner is working in a sunny, humid environment at 90°F for an
8-hour shift. Please select the most accurate statement about treating and preventing heat illness in
this worker.
a. Room temperature water is preferred for rehydration as it increases gastric emptying.
b. If the worker experiences heat stroke, his main symptoms are fatigue, pallor, increased sweating,
and decreased urination.
c. The addition of salt to the diet or the use of sports drinks should be discouraged as they can
induce hypertension in this age group.
d. Workers should be advised to prehydrate and not use thirst as a guide to fluid intake.
OEHS Administration and System-Based Practice
1.
Which of the following exposures is best monitored through direct blood levels?
a. Organophosphate pesticides
b. Benzene
c. Carbon monoxide
d. Lead
35
e.
Arsenic
2.
Enforceable workplace standards are:
a. Permissible exposure limits (PEL)
b. Recommended exposure levels (REL)
c. Threshold limit values (TLV)
d. Biological exposure indices (BEI)
e. Action levels
3.
Workers’ compensation insurance generally covers which of the following:
a. Medical expenses with ‘first-dollar’ coverage
b. Lost wages with ‘first-day’ coverage
c. Indemnity award for permanent total disability that accounts for inflation in future
d. Indemnity award for permanent partial disability that accounts for long-term earnings loss
e. Pain and suffering from injury or accident
4.
A worker with a disability under the ADA may be excluded from work if s/he:
a. Poses a direct threat to his/her own safety that can be modified by work restructuring
b. Has hemochromatosis and in ten years may develop cirrhosis and arrythmias
c. Is unable to consistently meet a 7 AM morning shift start
d. Is unable to perform some tasks that other workers can be reasonably asked to perform
Clinical Occupational Medicine & Toxicology
1.
2.
3.
4.
5.
1.
Asbestosis is best diagnosed clinically with the following findings:
a. Any work exposure, spirometry shows decreased FEV-1 and normal FVC; X-ray shows
atelectasis
b. Any work exposure, spirometry shows normal FEV-1 and normal FVC; X-ray shows peripheral
massz
c. > 10 year history of exposure; spirometry shows normal FEV-1 and normal FVC; X-ray shows
calcified pleural plaques
d. > 10 year history of exposure; spirometry shows decreased FEV-1 and decreased FVC; X-ray
shows small linear opacities at bases
2.
A major risk factor for carpal tunnel syndrome is:
a. Hyperthyroidism
b. Keyboarding
c. Forceful repetitive hand work
d. Male gender
3.
Which of the following is most likely to cause allergic contact dermatitis?
a. Povidone-iodine scrub
b. Hair dye
c. Skin contact with cement
d. Natural rubber latex
4.
Match the disorder with the etiology: (each answer may be used more than once, or not at all)
Allergic contact dermatitis
Irritant contact dermatitis
Asthma
Contact urticaria
Hypersensitivity pneumonitis
5.
A.
B.
C.
D.
E.
Immediate (Type I) hypersensitivity
Delayed (Type IV) hypersensitivity
Direct injury to cells
Bacterial infection
Cytokine-mediated inflammation
Which of the following statements on occupational noise-induced hearing loss (NIHL) is true :
a. Symptoms are recognizable when average pure-tone thresholds reach 20 dB
36
b.
c.
d.
Adequate protection for almost all workers is achieved by adherence to the OSHA PEL of 90 dB
/ 8 hour time-weighted average day
Findings of NIHL are reversible when detected early by screening audiometry
Speech clarity, rather than volume, is affected first
6.
Which of the following is the earliest clinical manifestation (shortest latency) of asbestos exposure?
Which is the latest?
a. Lung cancer
b. Mesothelioma
c. Asbestosis
d. Benign pleural effusion
7.
Evaluation of occupational asthma can include:
a. Serum precipitins (IgG)
b. Pre- and post-shift spirometry
c. Diffusion capacity
d. Peak expiratory flow rate measurements while away from work
8.
Which pairing is correct?
a. Lead – peripheral neuropathy sensory > motor
b. Organophosphate poisoning – delayed peripheral neuropathy
c. Methyl ethyl ketone – axonal neuropathy similar to n-hexane
d. Mercury – peripheral neuropathy with Parkinsonian signs
9.
The following is recommended for evaluation and control of TB in occupational settings (hospitals and
related):
a. Single PPD testing for newly hired employees
b. Use of a 5mm cut-off for a positive test in current employees
c. Excluding employees with a positive PPD and negative CXR from working, unless they undergo
LTBI prophylaxis
d. Including employees who have had BCG as children in routine employee PPD testing and
surveillance
37