AFMC PRIMAR ON POPULATION HEALTH MCCQE OBJECTIVES-BASED QUESTIONS ANSWERED CORRECTLY LATEST UPDATE 2026

AFMC PRIMAR ON POPULATION HEALTH MCCQE OBJECTIVES-BASED QUESTIONS ANSWERED CORRECTLY LATEST UPDATE 2026 Clinical Course of Disease - Answers -Exposure to pathogen -Biological onset of disease -- preclinical phase -symptoms -- clinical phase -clinical phase contains dx and tx -- outcomes -possibility of relapse -- revisit dx and tx Key Dimension of Health - Answers -Physical -Mental -Social -?Spiritual Clinical Course of Disease Incl. Pre- and Post-Disease Stages - Answers Pre-Disease (Etiological Phase) -Conditions in society (ex. economic stability) -- community circumstances (ex. services available) -- living environment -- social and environmental determinants -Personal factors: lifestyle, genetics, eduction, occupation, social supports -- risk and protective factors Post-clinical Phase -Impairment -- Disability -- Handicap -- Longer term outcome: impact on family work; economic impact; etc. Types of Disease Prevention - Answers Pre-Disease -Primordial prevention: alter societal structures and therefore underlying determinants -Primary prevention: alter exposures that lead to disease Pre-clinical/Clinical -Secondary prevention: detect and treat pathological process at an earlier stage when treatment can be more effective Post-clinical -Tertiary prevention: prevent relapses and further deterioration via. f/u care and rehab Health Protection - Answers Removing negative influences on health Health Promotion - Answers Enhance health by developing health public policy, health environments, and personal resiliency Ottawa Charter on Health Promotion - Answers Resulted from 1986 WHO conference to establish basic design principles for health promotion programs -charter proposed plan of action to achieve health for all by 2000 incl: building health public policy, establishing supportive environments, strengthening community action, developing personal skills, and re-orienting health services -established 7 prereqs for health (peace, shelter, education, food, income, stable eco-system, sustainable resources) Standards for Evaluating Information Quality - Answers FiLCHeRS -Falsifiability - can you prove the claim false -Logic -Comprehensiveness -Honesty -Replicability -Sufficiency Criteria for inferring a casual relationship - Answers 1. Chronological relationship 2. Strength of association (large relative risk) 3. Intensity or duration of exposure (dose-response) 4. Specificity of association 5. Consistency of findings 6. Coherent or plausible findings 7. Cessation of exposure Observational vs. Experimental studies - Answers Experimental studies assign exposures and observational studies do not Types of Observational Studies - Answers -Descriptive -Cohort -Case-control -Cross-sectional Descriptive Study - Answers -observational study that is not testing a hypothesis -usually cross-sectional Observational Study Type and What Sampling is Based On - Answers -Cohort (Exposure) -Case-control (outcome) -Cross-sectional (neither) Types of Experimental Studies - Answers -RCTs -Non-RCTs RCT Limitations - Answers -efficacy may not transfer to how well intervention will work in real life -may not be super generalizable b/c done on select populations -loss to f/u -may not be big enough to reliably detect previously unknown or rare effects Efficacy - Answers -how well an intervention works in controlled, optimal study conditions Effectiveness - Answers -how well an intervention works in real life Ethical Considerations in RCT - Answers -Clinical equipoise needed to start a trial -Must stop a trial if obvious harm/benefit -Cannot stop of trial with marginal social benefit Intervention Study Phases - Answers -Phase I: test in a small group of people for the first time to identify safe doses and side effects -Phase II: test in a larger group at recommended dose to determine efficacy under controlled circumstances and evaluate safety -Phase III: test on large groups to confirm effectiveness, monitor side effects, compare to commonly used treatments, and collect safety info; usually a series of RCTs; after rug can be approved for use -Phase IV: continue to collect info after drug enters market on effects in different populations and side effects (esp. rare and slow-developing); post-marketing surveillance Major barrier to determining causation in an observational study? - Answers Confounders Analytical vs. Descriptive Observational Studies - Answers -analytical tests hypothesis and descriptive does not Cross-sectional study - Answers -get info from a group of people at a point in time irrespective of presence or absence of characteristics relevant to the hypothesis -often a survey Cohort Study - Answers -aka longitudinal or f/u -take a group of healthy people and divide into exposed vs. unexposed -follow over time to see who gets disease Cohort Study incidence Calculation - Answers -Exposed: exposed that developed outcome/total exposed -Unexposed: unexposed that developed outcome/total unexposed Relative Risk - Answers incidence in exposed/incidence in unexposed -1.0=no difference -1.0=exposure increases risk -1.0=exposure is protective Cohort Study Advantages - Answers -can gage temporality to support causation -plan exposure and outcome measures beforehand to standardize study Case-Control Study - Answers -pick cases and controls and look back to see if they were exposed in the past Case-Control Study Odds Calculation - Answers -odds of cases being exposed=cases exposed:cases unexposed -odds of controls being exposed=controls exposed:controls unexposed Odds Ratio Calculation - Answers odds of cases exposed:odds of controls exposed OR (cases exposed)(controls unexposed)/(controls exposed)(cases unexposed) -same interpretation of # as RR When does OR approximated RR - Answers -rare disease What questions does OR and RR answer? - Answers Compared to someone without the risk factor, how many times more likely am I to get the disease (a relative measurement) What is attributable risk? - Answers Number of cases of disease among an exposure that can be attributed to that exposure Attributable Risk Calculation - Answers Incidence in the exposed group - incidence in unexposed Exposed attributable fraction and calcula - Answers -% increased risk by being exposed -attributable risk/incidence in exposed Population attributable risk - Answers -determine number of cases in the population attributable to the exposure by replacing incidence in exposed with incidence in the population Absolute risk reduction (ARR) - Answers incidence in exposed vs. incidence in unexposed Number Needed to Treat - Answers 1/ARR Confounding - Answers -a third variable in a casual net is associated with both an exposure and outcome being studied How to deal with confounding - Answers -RCTs -record and compare characteristics b/w groups -narrow sample characteristics -stratify groups during analy Infant Mortality Rate Calculation - Answers deaths of infant 1 yr/number of live births x 1000 Perinatal Mortality Rate - Answers fetal deaths (28 weeks) + deaths ≤1 wk postnatal/fetal deaths (28 weeks) + live births x 1000 Neonatal Mortality Rate - Answers deaths of 28 days old/live births x 1000 All-age crude mortality rate - Answers number of deaths in a specified period/population x period of observation Standardized Mortality Rate - Answers -remove influence of a confounding variable (ex. age) Indirect SMR - Answers -change in risk of dying in study population vs. reference population Direct standardization - Answers -creation of a fictitious rate for comparison Years of Potential life lost - Answers -age (ex. 75) - age of death QALY - Answers -years lived adjusted for QOL -multiply years lived by a subjective weighting to those years *similar to DALYs (disability) and HALYs (health) Sensitivity - Answers Probability that a person that has the disease will be identified by the test as having the disease TP/TP+FN False Negative Rate - Answers Likelihood of missing cases of disease FN/TP+FN Specificity - Answers How well the test identifies those that don't have the disease TN/TN+FP False Positive Rate - Answers Likelihood of people w/o the disease being labelled as having it FP/TN+FP Positive Predictive Value - Answers What fraction of people with a positive test actually have the disease TP/TP+FP *low specificity decreases PPV Negative Predictive Value - Answers What fraction of people with a negative result don't have the disease TN/TN+FN *los sensitivity decreases NPV What is NPV and PPV influenced by? - Answers -Prevalence - as it decreases, PPV decreases and NPV increases SnNOut - Answers Sensitive test, Negative, R/o SpPIn - Answers Specific test, Positive, R/in