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Public Health 150 October 29, 2008 MIDTERM EXAMINATION

Select the best answer from the multiple choice questions. There are 65 questions and 11 pages on the examination. Notify the instructor if your examination does not have 11 pages. Clearly indicate on the scan form the one best answer to each question among the answers provided. Be sure that you have selected your choice correctly on the scan form. Be sure that you have entered your name and identification number on the scan form and filled out the bubbles in the columns for the letters of your name and numbers of your identification number correctly (see front and back). Use a #2 pencil and fill all circles completely. 1. A primary goal of public health is to:

a. Assure the conditions under which people can live a healthy life b. Assure that people live a healthy life c. Eradicate food poisoning d. Treat heart disease

2. Public health is NOT concerned with reducing violence:

a. True b. False

3. What are the three major functions of public health?

a. Assessment, assurance and cost containment b. Assessment, health insurance, and medical services for the indigent and

uninsured c. Assessment, policy development, and assurance d. Cost containment, health insurance, and medical services for the indigent e. Health education, disease surveillance, and infectious disease control

4. Which of the following services to advance health requires the least individual

initiative? a. Environmental improvements b. Personal health services c. Behavioral change d. Adoption of good health habits e. Selection of the optimal health care provider

5. Professor Breslow described the three phases of public health. The goal of the

third (future) phase of public health is? a. Extension of life b. Reduction of chronic diseases c. Reduction of infectious diseases d. Sustaining optimal function e. Reducing accidents

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6. Which of the following public health policies has been very successful in the U.S.?

a. The Food and Drug Act b. Anti-smoking policies c. The Clean Water Act d. Policy on sexually transmitted diseases 7. Which of the following is NOT a type of public policy?

a. American Cancer Society publications on smoking b. Legislation c. Regulations d. Court interpretations of laws e. Budget allocations

8. Epidemiology is concerned with:

a. Distribution of disease in populations b. Efficient use of medical care c. Prevention of communicable and non-communicable diseases d. Determining disease etiology e. All the above

9. Epidemiology is the accumulated knowledge of disease characteristics gained

from years of experience: a. True b. False

10. In epidemiologic studies, time, place and person(s) are used to characterize the

relationship between: a. Agent, host and environment b. Agent, host and person c. Agent, environment and location d. Agent, virus and person e. Person, host and locale

11., Investigation of outbreaks of unknown origin requires gathering of evidence,

development of hypotheses, prioritization of hypothesis, and testing of hypotheses: a. True b. False

12. Which of the following epidemologic parameters is used to characterize the

spread of an infectious disease? a. Prevalence b. Disability-adjusted life years c. Incidence d. Mortality e. Case fatality rate

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13. Professor Detels asserts that the “ultimate truth” in epidemiology is: a. Incidence b. Prevalence c. Denominator d. Morbidity e. Mortality

14. Which of the following epidemiologic parameters does NOT need to include a

specific time interval? a. Prevalence b. Incidence c. Mortality rate d. Morbidity rate e. DALYS

15. The numerator of prevalence of a disease in a population at a particular point of

time is: a. The number of new cases of the disease in the population occurring at the

particular point in time b. The total population at that particular point of time c. The number of existing cases (new and old) of the disease in the

population at a particular point in time d. The number of cases cured of the disease in the population at a particular

point in time 16. Which of the following parameters is most useful to measure the impact of

diseases that rarely cause death? a. Prevalence b. Disability-adjusted life years c. Incidence d. Mortality e. Case fatality rate

17. Which of the following parameters is most useful for health officers planning the

need for high blood pressure clinics in their jurisdiction? a. Prevalence b. Disability-adjusted life years c. Incidence d. Mortality e. Case fatality rate

18. What three diseases are currently the primary targets of international control

efforts? a. Diabetes, syphilis and gonorrhea b. HIV/AIDS, tuberculosis and malaria c. Influenza, high blood pressure and smallpox d. Measles, chicken pox and mumps e. Chlamydia, diabetes and high blood pressure

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19. Under-nutrition contributes to what proportion of infant deaths world-wide?

a. 12% b. 25% c. 54% d. 78% e. 90+%

20. The observation of clustering of capillaria cases in families in the study in the

Philippines described by Professor Detels suggests that capillariasis is: a. A chronic disease b. A genetic disease c. A communicable disease d. A nutritional disorder e. A psychologically mediated disease

21. The majority of chronic diseases globally occur in:

a. Developed countries b. Developing countries c. Equally in both

22. According to the information available in 2001, the four most common worldwide

causes of death do not include: a. Cardiovascular diseases b. Infectious diseases and parasitic infestations c. Malignancies d. Perinatal conditions 23. The most common associated factor for under-five year mortality in 2001 was: a. Maternal smoking b. Maternal infections c. Malnutrition d. Genetic factors 24. Which of the following regions had the highest under-five year mortality rate in

2003? a. South Asia b. Latin America and the Caribbean c. Western Asia d. Sub-Saharan Africa 25. Which of the following was the worldwide greatest cause of death in 2002? a. Communicable diseases b. Non-communicable diseases c. Perinatal conditions d. Injuries

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26. The leading cause of ill health world-wide according to Professor Detels is: a. Smoking b. Diabetes c. High blood pressure d. Recreational drug use e. Poverty

27. World-wide, the leading infectious cause of death is:

a. HIV/AIDS b. Respiratory infections c. Measles d. Diarrheal diseases e. Malaria

28. Communicable diseases cause more deaths than non-communicable diseases in

which of the following regions? a. Africa b. Southeast Asia c. Western Pacific d. The Eastern Mediterranean e. Africa and Southeast Asia

29. The three countries with the shortest life expectancies are all in:

a. Africa b. Southeast Asia c. Latin America d. The Eastern Mediterranean e. Africa and Southeast Asia

30. Globally which of the following accounted for the highest burden of disease, in

DALYs, in 2001? a. Cardiovascular diseases b. Malignancies c. Neuropsychriatic disorders d. Injuries

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31. The above graph suggests a disease with an incubation period of:

a. One day b. 10-13 days c. 10 days d. One week e. Three weeks

32. Drug-resistant microbial threats include:

a. Gonorrhea b. Tuberculosis c. Malaria d. Acinetobacter e. All of the above

33. Emerging diseases include: a. Emergence of new diseases b. Resurgence of old diseases c. Development of drug-resistant disease agents d. All of the above e. a. and b. above

34. Strategies to reduce the threat of emerging infections do NOT include:

a. Global surveillance b. More rationale use of antibiotics c. Increasing the number of hospitals d. Development of new drugs e. Improved vector and zoonotic control.

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35. Producing an effective vaccine against influenza is complicated by:

a. Mutations in influenza hemagglutinins b. Mutations in influenza neurominidases c. Changes in animal vectors d. All of the above e. Mutations in both influenza hemagglutinins and neurominidases

36. Which of the following influenza virus subtypes causes outbreaks? a. A b. B c. C d. A and B 37. Antigenic drift of the influenza virus results from which of the following? a. Errors in replication b. Lack of repair mechanisms to correct replication errors c. a. and b. above

d. None of the above 38. Which of the following major countries has the longest life span?

a. United States b. Britain c. China d. Japan e. Spain

39. The per capita expenditure for health is greatest in which of the following

countries? a. United States b. Japan c. Britain d. Sweden e. Netherlands

40. The physician visits per capita is lowest in which of the following countries?

a. United States b. Japan c. Switzerland d. Australia e. France

41. The per capita number of coronary angioplasty operations is highest in which of

the following countries? a. United States b. Japan c. Switzerland d. Australia e. France

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42. The Surgeon General’s report on Smoking and Health released in 1964 had the power of: a. Law b. Regulations c. Persuasion d. An executive directive

43. Taxation can be a powerful tool to reduce harmful addictions and promote health:

a. True b. False

44. Which of the following in the U.S. is NOT engaged in lobbying the government?

a. Oil industry b. American Public Health Association c. Tobacco industry d. Automobile industry e. ALL are engaged in lobbying

45. Which of the following strategies was NOT used to decrease the numbers of

smokers in the US? a. Rehabilitate smokers b. Increase taxes on cigarettes c. Prohibit smoking in public spaces d. Decrease the social acceptability of smoking e. All the above were strategies used to decrease smoking

46. The gap in the prevalence of smoking among men and women in the U.S. has

declined in the last 40 years: a. True b. False

47. The major contribution(s) to increased survival in the United States in the 20th

century were: a. Provision of clean water b. Safe disposal of waste c. Development and implementation of effective vaccines d. All of the above e. b. and c. above

48. The major source of funding for health care in the United States is:

a. Medicare b. Medicaid c. “Out of pocket” (patients) d. Veteran’s Administration e. Private insurance

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49. The majority of uninsured individuals are: a. Poor b. Women c. Workers and their families d. Unemployed e. In Massachusetts

50. The U.S. spends more money on health than any other country because:

a. People are more likely to visit their physician for trivial concerns b. Hospital stays on average are longer in the U.S. than in other developed

countries c. More specialized procedures are conducted d. Employment rates are high

51. Will Senator Obama’s or Senator McCain’s health plan mandate health insurance

for children? a. McCain’s b. Obama’s

52. Public funding accounts for almost half of health care expenditures in the U.S.:

a. True b. False

53. The public share of costs for physicians and clinical services in the U.S. is:

a. Increasing b. Decreasing c. Remaining constant

54. The largest share of health expenditures in the U.S. is for:

a. Physician services b. Prescription drugs c. Administration of health plans d. Nursing home care e. Hospital care

55. In the U.S., the cost-effectiveness of health care associated with increased

expenditures is: a. Increasing b. Decreasing c. Unclear

56. Recently, health insurance companies have been instituting barriers (approval

procedures) to reduce unnecessary health expenditures: a. True b. False

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57. In 2006, what was the total national health expenditure in the U.S.? a. $1.2 billion b. $5 billion c. $2.1 trillion d. $30 million 58. The largest proportion of premature deaths in the U.S. is due to:

a. Genetic predisposition b. Environmental exposures c. Malignancies d. Behavioral patterns e. Diabetes

59. There were no cases of which of the following disease(s) reported in U.S. in

2000? a. Small pox b. Diphtheria c. Polio d. a. and c. above 60. The first step in developing a comprehensive health plan for a city is:

a. Assessing the current health situation in the population b. Researching correlates of disease occurrence c. Disseminating health information d. Developing sound policy e. Reducing health disparities

61. From 1980-2000, which age group of the U.S. population doubled its proportion

of the total population? a. 20-29 years b. 30-39 years c. 40-59 years d. 60-84 years e. 85+ years

62. Which of the following groups had the highest life expectancy at birth in U.S. in

2004? a. Caucasian males b. African-American males c. Caucasian females d. African-American females 63. Major reasons for increased longevity include all of the following except :

a. Universal immunization programs b. Improved treatment of chronic diseases

c. Genetic preponderance d. Health education

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64. In 2000, in the U.S., the highest potential years of life lost before age 75 was attributed to:

a. HIV b. Malignancies c. Cardiovascular diseases d. Cerebrovascular diseases 65. Why are neuropsychiatric disorders a major contributor of DALYs?

a. Younger people tend to be diagnosed with neuropsychyiatric disorders b. People with neuropsychiatric disorders do not often die from their

conditions c. Rates of fatal conditions such as cancers and heart disease are

decreasing d. a. and b. above e. All of the above