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NR 503 Week 4 Midterm Review Guide (Chapter 2 – 4) | Student Consult Questions with Rationale | 100% Correct Solutions

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Question: Which of the following is a condition which may occur during the incubation period? Question: Chicken pox is a highly communicable disease. It may … transmitted by direct contact with a p erson infected with the varicella-zoster virus (VZV). The typical incubation time is between 10-20 days. A boy started school 2 weeks after showing symptoms of chicken pox including mild fever, skin rash, and fluid-filled blisters. One month after the boy returned to school, non of his classmates … by VZV. The main reason was: Question: The ability of a single person to remain free of clinical illness following exposure to infectious agent is known as: Question: Which of the following is characteristic of single-exposure, common-vehicle outbreak? Question: What is the diarrhea attack rate in persons who ate both ice cream and pizza? Question: What is the OVERALL attack rate in persons who did not eat ice cream? Question: Which of the food items (or combination of items) is most likely to the infective item(s)? Question: Which of the following reasons can explain why a person who did not consume the infective food item got sick? Question: An outbreak of gastroenteritis occurred at a boarding school with a student enrollment of 846. Question: Same question above + Calculate the attack rates for boys and girls separately. Question: Same question + What is the proportion of total cases occurring in boys? Question: Same question + What is the proportion of total cases occurring in students who live in dormitories? Question: Same question + Which proportion is more informative for the purpose of the outbreak investigation? Question: A group of researchers are interested in conducting a clinical trial to determine whether a new cholesterol-lowering agent was useful in preventing coronary heart disease (CHD). They identified 12,327 potential participants for the trial. At the initial clinical exam, 309 were discovered to have CHD. The remaining subjects entered the trial and were divided equally into the treatment and placebo groups. Of those in the treatment group, 505 developed CHD after 5 years of follow-up while 477 developed CHD during the same period in the placebo group. What was the prevalence of CHD at the initial exam? Question: Same question + What was the incidence of CHD during the 5-year study? Question: Which of the following are examples of population prevalence rate? Question: What would … the effect on age-specific incidence rates of uterine cancer if women with hysterectomies were excluded from the denominator of incidence calculation assuming that most women who have hysterectomies are older than 50 years of age? Question: A survey was conducted among 1,000 randomly sampled adult males in the United States in 2005. The results from this survey are shown below. The researchers stated that there was a doubling of risk of hypertension in each age group younger than 60 years of age. You conclude that the researcher’s interpretation: Question: The incidence and prevalence rates of a chronic childhood illness for a specific community are given below. Question: A prevalence survey conducted from January 1 through December 21, 2003 identified 580 new cases of TB in a city of 2 million persons. The incidence rate of TB in this population has historically been 1 per 4,000 persons each year. What is the incident rate of TB per 100,000 persons in 2003? Question: Same info as above, Has the risk of TB increased or decreased during 2003? Question: Which of the following is an advantage of active surveillance? Question: The population of a city on February 15, 2005, was 36,000. The city has a passive surveillance system that collects hospital and private physician reports of influenza cases every month. During the period between 1/1 and 4/1, 2005, 2,200 new cases of influenza occurred in the city. Of these cases, 775 persons were ill with influenza according to surveillance reports on 4/1. The monthly incidence rate of active cases o influenza for the 3-month period was: Question: Same info + The prevalence rate of active influenzas as of 4/ 1/ 05. Question: Same info –What can … inferred about influenza cases occurring in the city? Question: A study found that adults older than age 50 had a higher prevalence of pneumonia than those who were younger than age 50. Which of the following is consistent with this finding? Question: Which of the following statements are true? More than one answer may … correct. Question: A disease has an incidence of 10 per 1,000 persons per year, and 80% of those affected will die within 1 year. Prior to the year 2000, only 50% of cases of the dease were detected by physician diagnosis prior to death. In the year 2000, a lab test was developed that identified 90% of cases an average of 6 months prior to symptom onset; however, the prognosis did not improve after diagnosis. Comparing the epidemiology of the disease prior to 2000 with the epidemiology of the disease after the development of the lab test, which statement is true concerning the disease in 2000? Question: Same info- Which statement is true concerning the duration of the disease after the development of the lab test? Question: Same info- Which statement is true concerning the disease-specific mortality rate after the development of the lab test? Question: In a coastal area of a country in which a tsunami struck, there were 100,000 deaths in a population of 2.4 million for the year ending 12/31/2005. What was the all-cause crude mortality rate per 1,000 persons during 2005? Question: In an industrialized nation, there were 192 deaths due to lung disease in miners ages 20 to 64 years. The expected number of deaths in this occupational group, based on age-specific death rates for lung disease in all males ages 20 to 64 years, was 238 during 1990. What was the standardized mortality ratio (SMR) for lung diseases in miners? Question: In 2001, a state enacted a law that required the use of safety seats for all children under 7 years of age and mandatory seatbelt use for all persons. The table below lists the number of deaths due to MVAs and the total population by age in 2000 (before the law) and in 2005 (4 years after the law was enacted). What is the age-specific mortality rate due to MVAs for children ages 0 to 18 years in 2000? Question: Same info- using the pooled total of the 2000 and 2005 populations as the standard rate, calculate the age-adjusted mortality rate due to MVAs in 2005. Question: Same info- Based on the information in the table, it was reported that there was an increased risk of death due to MVAs in the state after the law was passed. These conclusions are: Question: For colorectal cancer diagnosed at an early stage, the disease can have 5-year survival rates of greater than 80%. Which answer best describes early stage colorectal cancer? Question: The following table gives the mean annual age-specific mortality rates from measles during the first 25 years of life in successive 5-year periods. You may assume that the population is in a steady state (migrations out are equal to migrations in). The age specific mortality rates for the cohort born in are: Question: Same info- based on the information above, one may conclude: Question: Which of the following characteristics indicate the mortality rates provide a reliable estimate of disease incidence? More than one answer may … correct. Question: Which of the following statement are true? More than one answer may … correct. A mortality rate can approximate an incidence rate under conditions of a high case-fatality rate and a short duration of disease. Question: Among those who are 25 years of age, those who have been driving less than 5 years had 13,700 motor vehicle accidents in 1 year, while those who had been driving for more than 5 years had 21,680 motor vehicle accidents during the same time period. It was concluded from these date that 25-year-olds with more driving experience have increased accidents compared to those who started driving later. This conclusion is: Question: For a disease such as liver cancer, which is highly fatal and of short duration, which of the following statements is true? Choose the best answer. Question: The prevalence rate of a disease is two times greater in women than in men, but the incidence rates are the same in men and women. Which of the following statements may explain this situation? Question: The table below describes the number of illnesses and deaths caused by plague in four communities. The case-fatality rate associated with plague is lowest in which community? Question: Same info- The proportionate mortality ratio associated with plague is lowest in which community? Show Less

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NR 503 Week 4 Midterm Review Guide (Chapter 2 – 4)

Chapters 2-4
1. Which of the following is a condition which may occur during the incubation
period?
a. Onset of clinical illness
b. Receipt of infection
c. Signs & symptoms of disease
d. Transmission of infection
e. Isolation of disease carrier through quarantine

Rationale: The incubation period is defined as the interval from receipt of
infection to the time of onset of clinical illness. Accordingly, individuals may
transmit infectious agents during the incubation period as they show no signs of
disease that would enable the isolation of sick individuals by quarantine.


2. Chicken pox is a highly communicable disease. It may be transmitted by direct
contact with a person infected with the varicella-zoster virus (VZV). The typical
incubation time is between 10 to 20 days. A boy started school 2 weeks after
showing symptoms of chicken pox including mild fever, skin rash, & fluid-filled
blisters. One month after the boy returned to school, none of his classmates had
been infected by VZV. The main reason was:
a. Herd immunity
b. All had been immunized prior to the school year
c. Contact was after infectious period
d. Subclinical infections were not yet detected
e. Disease was endemic in the class

Rationale: The disease is spread by contact with an infected individual who can
transmit the agent (VZV) to immunologically naive persons during the
incubation period & for several days after onset of clinical illness. Since the boy
started school 14 days after showing signs consistent with chicken pox, it is
most likely that he was no longer infectious.


3. Which of the following is characteristic of a single-exposure, common-vehicle
outbreak?
a. Long latency period before many illnesses develop
b. There is an exponential increase in secondary cases following initial exposures
c. Cases include only those who have been exposed to sick persons
d. The epidemic curve has a normal distribution when plotted against the logarithm of
time
e. Wide range in incubation times for sick individuals

Rationale: Single-exposure, common-vehicle outbreaks involve a sudden, rapid
increase in cases of disease that are limited to persons who share a common
exposure. Additionally, few secondary cases develop among persons exposed to
primary cases. A histogram of the outbreak can plot the number of cases by

,time of disease onset. In single-exposure, common-vehicle outbreaks, a log
transformation of the time of disease onset will often take on the characteristic
shape of a normal distribution (i.e., a bell curve) with the median incubation
time found at the peak of the curve.

4. What is the diarrhea attack rate in persons who ate both ice cream & pizza?




a. 39/52
b. 21/70
c. 39/67
d. 51/67
e. None of the above
Rationale:
The attack rate in this example is defined as the number of persons who
develop diarrhea divided by the total number of people at risk. In this example,
the at-risk group is those who have eaten both ice cream & pizza. Of these 52
persons, 39 developed diarrhea.

5. What is the overall attack rate in persons who did not eat ice cream?




a. 30%
b. 33%
c. 35%
d. 44%
e. 58%
Rationale:
The attack rate is the number of persons with diarrhea (14 + 9) divided by the
total number of persons who did not eat ice cream (40 + 30).


6. Which of the food items (or combination of items) is most likely to be the
infective item(s)?
a. Pizza only
b. Ice cream only
c. Neither pizza or ice cream
d. Both pizza & icecream
e. Cannot be assumed from the data shown
Among persons eating ice cream, over 70% developed diarrhea regardless of
their pizza consumption (39/52 & 11/15). Among both groups of persons who did

, not eat ice cream, each attack rate was equal to or less than 35% (14/40 &
9/30).


7. Which of the following reasons can explain why a person who did not consume
the infective food item got sick?
a. They were directly exposed to persons who did eat the infective food item
b. Diarrhea is a general symptom consistent with a number of illnesses
c. There may have been an inaccurate recall of which foods were eaten
d. All of the above
e. None of the above

Rationale: Without knowledge as to the specific agent in this instance, it is also
likely that it can be spread by direct contact with infected persons. Since
diarrhea is a general disease symptom, it is possible that several infectious
agents may be present at this meal or others eaten during the same time
period. Further, information regarding food consumption may have been
collected long after the disease episode. This may have led persons to
incorrectly remember the foods that they consumed.


An outbreak of gastroenteritis occurred at a boarding school with a student enrollment
of 846. Fifty-seven students reported symptoms including vomiting, diarrhea, nausea, &
low-grade fever between 10 p.m. on September 24 & 8 p.m. on September 25. The ill
students lived in dormitories that housed 723 of the students. The table below provides
information on the number of students per type of residence & the number reporting
illnesses consistent with the described symptoms & onset time. Calculate the attack
rate among all students at the boarding school.




1. Calculate the attack rate among all students at the boarding school.
57/846 = The answer is found by dividing the total number of cases (57) by the
total number of students (846). This equals 6.7%.

10. Calculate the attack rates for boys & girls separately.
a. For boys, the attack rate includes all cases (40 + 3) divided by the total number of students who are
boys (380 + 46). The attack rate is 10.1%.
b. For girls, the attack rate includes all cases (12 + 2) divided by the total number of students who are
girls (343 + 77). The attack rate is 3.3%.



11. What is the proportion of total cases occurring in boys?

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