BSPH Suggested Test Questions

Fall 2020: Integrated Exam 4

Epidemiology, Biostatistics, IPV, and Ethics

1. Which of the following events resulted in the creation of the Nuremburg Code?
A. Tuskegee Experiment
B. Nazi Experiments in Concentration Camps
C. Seattle 1God Committee
D. Flexner Report

2. What was the central discussion of In re Quinlan 1975?

A. Patients ought to have autonomy
B. Withdrawal of care from an individual who is in a persistently vegetative state is not
euthanasia
C. Research involving vulnerable populations requires explicit consent
D. Dialysis needs to be provided to those who require dialysis for a meaningful life

3. What is patient autonomy?

A. The patient has the right to refuse or choose their treatment
B. The patient has the right to pay for their treatment in their preferred manner
C. The patient has the right to withhold identification
D. Decided in Winona State Hospital v Louisa Winnenger; patients have a right to obtain
biohazardous material removed from their body during a surgical procedure

4. What is the principle of beneficence?

A. A proposed experiment must prove a positive net benefit to medicine to gain funding
B. An interprofessional healthcare team must act for the overall good of their clinic’s staff
C. A practitioner should act in the best interest of their patient in a way that promotes
wellbeing
D. A new drug must be proven to not be harmful in order to be approved by the FDA

5. What is the principle of non-maleficence?

A. A physician should practice in a way that primarily does no harm to the patient
B. An elective surgery should be beneficial to the patient’s preventative health in order to be
covered under Medicare B
C. Whistleblowing for unethical behavior cannot be met with retaliation
D. Any research must demonstrate no harm to those involved in order to receive funding

6. What is the double effect?

 A. A research study done in vulnerable populations reveals a groundbreaking medical
breakthrough
B. A normally ambulatory procedure is made inpatient by complication of the patient’s
comorbidities
C. The ruling of a court case without consulting a medical professional have the tendency to
disparage public opinion of healthcare
D. Relating to non-maleficence, there are some interventions undertaken by physicians which
can create a positive outcome while carrying the risk of foreseeable harm

7. Which is an example of the double effect?

A. Oncological ionizing radiation treatments
B. Seasonal Flu vaccines
C. Indwelling insulin pumps
D. Hemodialysis

8. Which central principle of ethical treatment is related to the double effect?

A. Justice
B. Beneficence
C. Autonomy
D. Non-maleficence

9. You are conducting research for a study which requires participant consent prior to being
enrolled. Of which of the following patients would you be able to consent while maintaining
patient autonomy?
A. A 54-year-old female patient in the ER who is in no apparent distress and is being evaluated
for suspected ingestion of “jail hooch”, made using methanol. You note their DOC jumpsuit.
B. A 16-year-old male patient on the General Medicine Inpatient unit who is on a 72-hour hold
C. A 23-year-old male who is on the attached outpatient endoscopy unit in the pre-procedural
room in no apparent distress
D. A 32-year-old woman in labor

10. Select all applicable from the following choices when considering the quality of life for a patient
in your care:
A. What are the prospects, with or without treatment, for a return to normal life?
B. What physical, mental, and social deficits is the child likely to experience if treatment
succeeds?
C. Are there biases that might prejudice the provider’s evaluation of the patient’s quality of
life?
D. Is the patient’s present or future condition such that his or her continued life might be
judged undesirable?
E. Is there any plan and rationale to forego treatment?
 F. Are there plans for comfort and palliative care?
G. Will their insurance cover the treatment?

11. What is meant by deontology?

A. “Rule of the tooth” - derived from ancient Greek tradition of biting an olive branch during an
argument
B. Some acts are right or wrong regardless of consequence, and it is your duty to determine
what is ethical
C. Study of dentistry-related advancements obtained through Nazi experimentation and the
ethical dilemma of using such knowledge
D. Looking to a higher power for ruling on ethically ambiguous decisions

12. How might someone practicing consequentialism approach an ethical dilemma?

A. Weigh each option considering the outcomes and side effects of each available action
B. Proceed with the most immediately available action because the end is justified by the
means
C. Consider all parties affected by the action and act on the option that causes harm to the
least amount of people
D. Do not act, by acting on an ethically ambiguous situation you are asserting a god-like role

13. What is the primary law regarding protected information and what does it stand for?
A. HIPPA: Health Information Protection and Portability Act
B. HIPPA: Human Information Protected from Potential Access
C. HIPAA: Health Information Portability and Accessibility Act
D. HIPAA: Health Insurance Portability and Accessibility Act

14. What is the Stark Law?

A. Prohibits sharing of medical information with family members of a patient over the phone
B. Prohibits a physician from referring a patient to a private practice when the patient is
covered under Medicaid B
C. Prohibits a physician from referring a patient to an entity from which the physician has
financial ties
D. Requires physician referral to Medicaid coverage

15. What was the effect of Tarasoff v. Regents of the University of California?
A. Family members of a psychiatric patient must provide consent prior to the administration of
experimental treatment
B. Those in care of psychiatric patients are required by the principle of non-maleficence to
remove restraints at least once every 4 hours
C. Care received during a court ordered committal to a psychiatric facility must be covered
under Medicaid and Medicare
D. Mental health professionals have a duty to warn any specific individuals whom their patient
has expressed intention to harm
16. True or False: Alcohol use is a risk factor for IPV.

17. Which of the following are statistically at risk for IPV? (select all that apply)
A. An adult female whose mother was a victim of IPV
B. An adult male who abuses alcohol and whose spouse makes 3x more than him annually
C. A 19-year-old male living in a population dense apartment building and who left high school
without graduating
D. An adult woman who engages in high-risk sexual behavior when drinking

18. A 40-year-old male presents to the emergency room seeking care for elbow pain. He is
accompanied by his wife. During your visit with them, she answers all the questions for her
husband and is quick to dismiss the need for any additional exams. She tells you that he is
clumsy and accidentally shut his arm in their car door. You notice that he appears withdrawn
and looks to his wife to answer for him. How do you proceed? (select all that apply)
A. Call social services
B. Call the police
C. Ask to talk with the patient alone and inquire about his safety within the relationship
D. Tell the wife that she is an abuser
E. Proceed with a physical examination, but being careful to note any older appearing injuries
or any injuries inconsistent with the mechanism of injury offered
F. Offer pain medication to patient prior to further examination

19. A woman comes to your family medicine clinic alone to establish care. She is notably pregnant,
almost full term. She is quiet throughout the visit and offers little in response to your questions.
You obtain permission to conduct a physical exam. Upon examination, which of the following
would warrant further inquiry into her safety? (Select all that apply)
A. Bruises to her abdomen in varying stages of healing
B. Healed and old appearing transverse scars to the proximal portion of her thighs
C. Smell of marijuana coming from her clothing
D. Her withdrawn affect and startling when you auscultate her heart
E. Her prenatal status

20. Which of the following are reasons why a victim of IPV may deny the abuse? (select all that
apply)
A. They feel ashamed
B. Fear that the physician will reject them
C. Fear of reprisal by abuser
D. Lack knowledge of resources
E. They are concerned for their children
F. They are not emotionally ready to admit to the abuse

21. True or False: The American Congress of OB/Gyn recommends that women be screened for IPV
at periodic intervals, which includes as a part of prenatal, intrapartum, and postpartum care.
22. True/False: U.S. Preventive Services Task Force (USPSTF) recommends screening of elderly
patients periodically for IPV.

23. You have completed an annual well-child visit with a 5-year-old and her mother, both of whom
are well known to you and your clinic. You have been working with this family regarding their
health and safety as victims of IPV. When discussing safety with the mother she tells you that
she has made plans for her sister to pick her up from the clinic. She and her child will be living
with her sister now. At what stage of change is this woman?
A. Maintenance
B. Contemplation
C. Action
D. Preparation

24. What is the primary concern when handling an intervention for a victim of IPV?
A. That they recognize they are a victim
B. That they accept resources to change
C. Their abuser is brought to justice
D. Safety of the individual is maximized while minimizing risk for further harm

25. You are completing a sports physical on a college-age male who presented to your clinic for
clearance to play baseball. You note that he has signs and symptoms of IPV. During the
discussion, you further note that he recognizes the abuse, but is unsure of his next steps. Which
stage of change is he exhibiting?
A. Contemplation
B. Precontemplation
C. Action
D. Preparation

26. To whom can I refer victims of IPV?

A. State Hotline: 1 (800) 898 – 3234
B. National Domestic Violence Hotline: 1-800-799-SAFE (1-800-799-7233)
C. The National Sexual Assault Hotline: 1-800-656-4673
D. The National Teen Dating Abuse Hotline: 1-866-331-9474
E. All the above

27. Which of the following shows accuracy, but NOT precision?

A.

B.
 C.

D.

28. You are tracking the prevalence of the flu in a nursing home over the course of the past year.
Testing for the flu requires the patient to provide a respiratory secretion sample on which a
respiratory viral panel is run. Every resident of the nursing home was tested because they were
either symptomatic for the flu (fever, chills, malaise, etc.) or had exposure to the flu. Of the 64
individuals who tested positive, 58 were symptomatic. There were 14 individuals who were
exposed but without symptoms who tested negative. Additionally, there were 7 individuals who
were symptomatic for the flu but tested negative on their viral respiratory panel. You create a
classic 2x2 to analyze this data. Which group would you select for the “B” box?
A B

C D

A. B represents the total number of patients tested; 71

B. B represents the total number of false positives; 6
C. B represents the total number of true positives; 64
D. B represents the total number of true negatives; 14

29. Which of the following would describe the sensitivity of a screening test?
A. Those who test negative are generally without the disease
B. Those who test negative for the disease have the disease
C. Those who test positive for the disease do not have the disease
D. Those who test positive are generally with the disease

30. How would you calculate sensitivity?

A. Ratio of true positive amongst all diseased samples (A / A + C)
B. Ratio of true positives amongst all data (A / A + B + C + D)
C. Ratio of false positives amongst all data (B / A + B + C + D)
D. Ratio of true negatives amongst all diseased samples (D / A + C)

31. Which of the following best describes a screening test’s specificity?

A. Those who test negative are generally without the disease
B. Those who test negative for the disease have the disease
C. Those who test positive for the disease do not have the disease
D. Those who test positive are generally with the disease
32. How would you calculate specificity?
A. Ratio of false positives to false negatives (B/C)
B. Ratio of true negatives amongst all non-diseased samples (D / B + D)
C. Ratio of true negatives amongst all data (D / A + B + C + D)
D. Ratio of all diseased samples to non-diseased samples (A + C / B + D)

33. When would specificity be prioritized over sensitivity?

A. When the test is inexpensive to conduct
B. When the disease is serious & contagious, but treatment is effective
C. When the treatment is not preferred
D. When the testing is rapidly resulted

34. When would sensitivity be prioritized over specificity?

A. When the test is expensive to conduct
B. When the treatment for the disease is not preferred
C. When the testing is inexpensive and the disease contagious
D. When the testing is resulted slowly due to the requirement of specialized interpretation

35. Which of the following describes a positive predictive value?

A. The probability of those who are symptomatic being more likely to have the disease
B. Statistically, those who are tested for the disease are likely to have the disease due to self-
reporting
C. The adjustment of epidemiological data to include those who are not tested for the disease
but may have it and were not tested because of disease stigma
D. The probability that those who test positive for a disease have the disease

36. Which of the following describes a negative predictive value?

A. The probability that those who test negative for a disease do not have the disease
B. The adjustment of findings to account for diseased individuals who are unable to obtain
testing due to health disparities
C. The probability that those who are asymptomatic will test negative for the disease
D. The probability of the markers for the test being unable to accurately detect the presence of
the disease over the markers of a different test available

37. COVID-19 is tracked in Mississippi by identifying new cases daily. Which of the following
describes the number of new cases?
A. Prevalence
B. Specificity
C. Perfusion
D. Incidence

38. Some states track how many ICU beds are currently being occupied by COVID+ patients. Which
of the following describes this method?
A. Prevalence
B. Density
 C. Perfusion
D. Incidence

39. Which of the following is related to absolute risk?

A. Prevalence
B. Density
C. Perfusion
D. Incidence

40. You are testing a patient for scoliosis using Adam’s Test. While supporting the patient at the
hips, you have them enter spinal flexion. You bring your dominant eye level with their thoracic
spine. You note some irregularities. With palpation, you note more tissue mass above the ribs
and scapula on their right side. Based on these findings, you suspect dextroscoliosis. However,
prior to telling the patient you decide to confirm your findings with an Xray. On the Xray, there is
no evidence of any scoliosis. Which type of statistical error have you made with your preliminary
diagnosis?
A. Type I: incorrectly rejecting a true null hypothesis (false positive)
B. Type II: incorrectly accepting a false null hypothesis (false negative)
C. Type I: Incorrectly accepting a false null hypothesis (false negative)
D. Type II: incorrectly rejecting a true null hypothesis (false positive)
Answer Key:
1. B
2. B
3. A
4. C
5. A
6. D
7. A
8. D
9. C
10. All, except G
11. B
12. A
13. D
14. C
15. D
16. True
17. All
18. C, E, F
19. All
20. All
21. True
22. True
23. C
24. D
25. A
26. E
27. A
28. B
29. D
30. A
31. A
32. B
33. C
34. C
35. D
36. A
37. D
38. A
39. D
40. A