Epidemiology Midterm, Spring ‘01

Sections covered on this exam: Preface, 1.1, 1.3, 1.4, 2.1, 2.2, 2.3, 3.1, and the Foodborne Outbreak

For the multiple choice questions, please use the Scranton (provided) to record your answers and select the best
response in each instance.

1. Public health is the study of the distribution and 7. The major causes of mortality during the prior
determinants of health and disease in century were mostly acute and
populations. a. chronic
a. True b. contagious **
b. False ** c. non-contagious
d. violent
2. Mortality refers to disability and death.
a. True 8. The gap in life expectancy between whites and
b. False ** blacks:
a. is no longer evident
3. If a disease simultaneously affects persons of b. is still evident and has widened
several countries or continents and effects them c. is still evident but has narrowed **
in numbers in clear excess of normalcy, the
disease is said to be: 9. A disease is:
a. endemic a. a definable physiological or psychological
b. epidemic dysfunction **
c. pandemic ** b. what the patient experiences
d. zoonotic c. the state of dysfunction of the social role of
the person
4. The second leading cause of death in the US is: d. none of the above
a. cardiovascular disease
b. cerebrovascular disease 10. The word epidemiology is based on the same
c. external cause root as the word democracy.
d. cancers (malignant neoplasms) ** a. True **
b. False
5. John Snow’s most important work occurred
around: 11. The beginning of the subclinical period of
a. 1800 disease is marked by:
b. 1850 ** a. exposure to the agent **
c. 1900 b. first pathological changes
d. 1950 c. onset of symptoms
d. time of diagnosis
6. What was the best explanation for the lack of
cholera cases in the brewery near Broad Street? 12. Primary prevention is intended to reduce the
a. Beer conferred immunity to cholera duration and severity of disease.
b. Beer killed the cholera bacteria a. True
c. The Brewery workers had a hardy b. False **
constitution
d. The Brewery workers hardly drank water ** 13. The clinical stage of disease begins with:
a. exposure to the agent
b. pathological changes
c. the patient’s first symptoms **
d. the time of diagnosis

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14. The period between exposure and first symptoms 20. The “epidemiologic triad” includes all of the
is the: following except:
a. stage of susceptibility a. agent
b. subclinical stage of disease ** b. host
c. stage of clinical disease c. environment
d. stage of disability d. behavioral factors **

15. This stage of prevention is intended to reduce 21. Which of the following is a chemical cause of
complications and disabilities. disease?
a. primary prevention a. bacteria
b. secondary prevention b. heat
c. tertiary prevention ** c. nutritive excesses **
d. trauma
16. The “natural history of disease” refers to:
a. the progress of a disease in an individual 22. Increases in the ability of a biologic agent to
over time ** enter a host is called:
b. the period between exposure and first a. infectivity **
symptoms b. pathogenicity
c. the period from first symptoms to recovery, c. virulence
disability, or death d. toxicity
d. the broad scope of manifestations of a
disease in different individuals 23. Which of the following is a component of innate
immunity?
17. A disease that occurs rarely and without a. B cells
regularity is said to be: b. T cells
a. sporadic ** c. non-specific phagocytic cells **
b. endemic
c. epidemic 24. Parasitic lower plants that lack chlorophyll are:
d. pandemic a. helminths
b. fungi and yeasts **
18. A particular infectious disease can display a c. protozoans
broad scope of manifestations and severities. d. rickettsia
This is known as the:
a. incubation period 25. Submicroscopic infectious agents that contain
b. gradient of infection ** their own genetic material but are incapable of
c. endemic level of disease multiplying outside of the host are:
d. stage of susceptibility a. protozoans
b. bacteria
19. Indirect and direct causes of disease may form a c. viruses **
complex network of events that determines the d. prions
level of disease in a community. The complex
inter-relation of events is called the: 26. Which of the following can act as reservoirs?
a. necessary cause of disease a. animals
b. iceberg phenomenon b. carriers
c. causal web ** c. cases
d. caeteris parabus d. all of the above **

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27. Which of the following can act as a portal? c. nosocomial disease
a. skin ** 35. A disease that is spread from human to human or
b. cardiovascular system from humans to animal in sequence
c. kidneys demonstrates:
d. animals a. common vehicle spread
b. serial transfer **
28. True or false? Modified live vaccines represent c. droplet nuclei transmission
non-virulent strains of the agents that are
capable of causing infection. 36. The water borne transmission of cholera via the
a. True ** Broad Street pump is an example of:
b. False a. common vehicle spread **
b. serial transfer
29. Which of the following is an active form of c. droplet nuclei transmission
immunization?
a. Maternally-derived antibodies
b. Anti-venoms 37. Soluble proteins produced by B cells that
c. Immune-serum neutralize invading pathogens are:
d. Vaccination ** a. vaccines
b. lymphokines
30. Hosts that harbor a specific infectious agent c. macrophages
while manifesting no discernable signs or d. antibodies **
symptoms are called:
a. portals 38. Which cell regulates the immune response?
b. vectors a. T lymphocytes **
c. vehicles b. B lymphocytes
d. carriers ** c. macrophages
d. NK (natural killer) cells
31. Diseases with animal reservoirs are:
a. outbreaks 39. Acquired immunity is resistance that is
b. portals developed by the host as a result of a previous
c. nosocomial infections exposure to a natural or artificial pathogen or
d. zoonoses ** foreign substance.
a. True **
32. A convalescent carrier is: b. False
a. a person who transmits the agent prior to the
onset of disease 40. Which of the following is a chemical barrier to
b. an animal carrier infection.
c. an infected person who has recovered from a. Intact skin
disease but still harbors and transmits the b. Respiratory cilia
agent ** c. Natural killer cells
d. none of the above d. Gastric acidity **

33. An animal (usually an insect) that serves to 41. The intact skin often provides an effective
transmit an agent is called a: physical barrier to infection.
a. vehicle a. True **
b. vector ** b. False
c. carrier 42. Infectious disease outbreak investigations
include both an epidemiologic and laboratory
34. A disease with a urogenital portal is a: component.
a. zoonotic disease a. True **
b. sexually transmitted disease ** b. False

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SHORT ANSWER: Please respond directly on the page.

43. Define “epidemiology.” [3 pts]

Study of / health or disease / in populations.

44. List the four stages in the natural history of a disease [4 pts]

a. _________________________________________________ susceptibility

b. _________________________________________________ pre-clinical

c. _________________________________________________ clinical

d. _________________________________________________ resolution, disability, or death

45. In plain terms, explain the meaning of the iceberg phenomenon. [2 pts]

There’s often a broad spectrum of disease manifestations / much of which can be inapparent, undiagnosed, or
unreported.

46. One of the first steps in investigating an outbreak is to confirm the diagnosis of cases. Why is this important? [1
pt]

Purported outbreaks may actually represent sporadic occurrences of unrelated diseases (or even a psychological
event related to “hysteria.”

47. Why did John Snow remove the handle from the Broad Street Pump? [1 pt]

To prevent further occurrences of cholera.

48. What is a reservoir? [3 pts]

Normal habitat or environment / in which the agent live and multiplies.

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Data from a food borne outbreak are shown below. Use these data to complete the exam. Show work
ID ILL Bloody diarrhea Incubation (hrs) Chicken Salad Ice Cream

1 Y Y 0.5 Y Y

2 Y Y 1 Y Y

3 Y Y 2 N Y

4 Y Y 4 N Y

5 Y . 6 N N

6 N Y N

7 N Y N

8 N N Y

9 N N Y

10 N N N

49. What percentage of cases experienced bloody diarrhea?

4 /4 = 100%

50. What is the median incubation period of this disease?

2 hours

51. Calculate the attack rate in those who ate chicken salad.

2 /4 = .5

52. Calculate the attack rate for those who did not eat chicken salad. (Show all work)

3 / 6 = .5

53. Calculate the relative risk of illness associated with chicken salad.

.5 / .5 = 1

54. Calculate the attack rate in those who ate ice cream.

4 / 6 = .67

55. Calculate the attack rate in those who did not eat ice cream.

1 / 4 = .25

56. Calculate the relative risk of illness associated with ice cream.

.67 / .25 = 2.67

57. Which food is the more likely source of contagion? The chicken salad or the ice cream? Ice cream

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