Social Medicine Past Paper PDF

4 The accepted standard is that every fact revealed to a physician by a patient is, in principle, subject to the requirement of confidentiality. However, if maintaining confidentiality places others at risk, then confidentiality may need to be breach...

4 The accepted standard is that every fact revealed to a physician by a patient is, in principle, subject to the requirement of confidentiality. However, if maintaining confidentiality places others at risk, then confidentiality may need to be breached. (1 punto) True False 5 Informed consent in ethics usually refers to: (1 punto) the idea that a person must be fully-informed about and understand the potential benefits and risks of their choice of treatment in order to be able to make the best decision. legal protections prevent physicians from revealing their discussions with patients the rights of individuals to self determination 6 The privilege of confidential communications between a doctor and a patient is controlled by the patient. (1 punto) True False 7 Xenotransplantation is: (1 punto) From one human to another human Between identical twins From animal to human 8 The absolute zero is a distinctive attribute of what measurement scale? (1 punto) Ordinal Nominal Interval Ratio 9 Paternalism in medicine is always accepted as desirable because it assumes that the physician cares for a young patient much like a parent would. (1 punto) True False 10 In the deliberative model /between a physician and a patient/ the physician may represent his or her excellence and supremacy in front of the patient in taking the correct decision for a treatment. (1 punto) True False 11 In simple linear regression, if there is no trend, the actual curve would look like: (1 punto) Exponential growth curve Decreasing straight line Increasing straight line Horizontal constant line 12 Which are the types of scientific research? The types of scientific researches are : qualitative, quantitative (6 punti) 13 Principles in medical ethics are: (1 punto) informed consent, confidentiality, control and resolution good patient-physician relationships, good medical practice, autonomy autonomy, beneficence, non-maleficence, do not harm 14 An ordinal variable is one for which: (1 punto) There can only be two categories of response. Data are continuous and follow an ordered sequence. Data are categorical. Data are discrete and can take one of many values. 15 The right of confidentiality: (1 punto) Belongs to the patient Belongs to the health provider Applies only to physicians 16 Explain the ethical problems of living organ donation Ethical conflict between the principle of beneficence and the principle of non-maleficence; Risk from a procedure without a direct medical benefit for the donor. (6 punti) 17 In cases of suspected child abuse a physician may need to compromise patient confidentiality by sharing with authorities. (1 punto) True False 18 The estimated Pearson correlation coefficient between systolic blood pressure (mm Hg) and age (years) in a sample of 30 middle-aged women was r = 0.72 (p < 0.001). Hence r2 = 0.52. Which one of the following statements is wrong? (1 punto) 72% of the variability of systolic blood pressure in these women can be explained by its linear relationship with age. We can not conclude that increasing age is a cause of rising systolic blood pressure in these women. 48% of the variability of systolic blood pressure in these women is unexplained by its linear relationship with age. There is substantial evidence that systolic blood pressure and age in these women are linearly associated. 19 The p-value is: (1 punto) The probability of obtaining the observed or more extreme results if the alternative hypothesis is true. The probability of obtaining the observed or more extreme results if the null hypothesis is true. The probability that the alternative hypothesis is true. Always less than 0.05. 20 Normal distribution: (1 punto) Is the distribution of a variable measured on healthy individuals. Is skewed to the right. Has a mean of zero and a standard deviation of one. Has about 95% of its observations contained within the limits defined by (mean ± 1.96 x standard deviation). 21 Cancer stage (defined as I, II, III or IV) is measured on what scale? (1 punto) Ratio Ordinal Interval Nominal 22 Which of the following may have an adverse effect on a correlation coefficient? (1 punto) Too many people in your experiment. Restricting the range of possible scores. The scores on one variable have larger numbers than the other variable. A negative relationship between your X and Y variables. 23 Autonomy is often invoked as guide for decision making when patient lacks decision making capacity and has no advance directive. (1 punto) True False 24 What is the main difference between parametric and non-parametric test? By what means you could check for it? (6 punti) Parametric test used when the variable we have measured in the sample is normally distributed in the population to which we plan to generalize our findings. Non-Parametric Test used where the distribution is free and there are no assumptions about the distribution of the variable in the population. 25 Explain the methodology of scientific research (6 punti) The steps of scientific research include making observations and asking questions, forming a hypothesis based on these questions, making predictions and testing these predictions, and using the result to make new hypotheses or predictions. 26 Scatterplot is an appropriate graphical summary in case of: (1 punto) One quantitative variable Two quantitative variables Two qualitative variables One qualitative variable 27 What is the main finding from simple linear regression model that is presented below? What is the value of the correlation coefficient in this case? (6 punti) There is a negative correlation between Survival in months and Age of diagnosis in years, with an r value of -0.966 when the age of diagnosis is at 0 year, the month is equal to 75.104. For every 1 year increase in age, there is a 0.9685 decrease in survival time 28 Which of the following statements is not true about the confidentiality? (1 punto) The duty of confidentiality is found referred to in the Hippocratic Oath It is an absolute duty, without exceptions It is governed by common law and statute 29 A study investigated new chelator agent in thalassemia patients. Patients treated by oral chelator had a mean reduction of serum ferritin (a measure of iron overload) of 1 026 µg/l, while patients treated by subcutaneous chelator had a mean reduction of serum ferritin of 886 µg/l. P-value was found to be 0.0006. What did the study conclude? (1 punto) The subcutaneous chelator was significantly more effective in terms of serum ferritin reduction in thalassemia. The oral chelator was significantly more effective in terms of serum ferritin reduction in thalassemia. There was a significant difference in the clinical effectiveness of the two chelators​. There was no significant difference in the clinical effectiveness of the two chelators. 30 A study on the level of physical activity (measured as a weekly number of training hours) of undergraduate and postgraduate students came to the result of t = 1.96. What did the study conclude? (6 punti) The study concludes that there is a 95% level of confidence meaning that the two samples are statistically significant. We assume the sample size is large if it has 95% confidence level. at t=1.96 the p-value is less than 0.05 so we reject the null hypothesis so there is a significant difference 31 Which of the following does not have access to information in patient medical records? (1 punto) The patient Official authorities for legal purposes patient’s employers​3​2 A correlation coefficient of r = 0.52 indicates: (1 punto) A moderate positive causation A weak positive causation All listed options are wrong A strong positive causation 33 Which scale of measurement is considered the lowest? (1 punto) Interval Nominal Ratio Ordinal 34 Rules of conduct for members of a group in a specific area are typical for: (1 punto) Charity Professionalism Ethics Morality 35 Deletion of outlier data is generally a controversial practice. However, you have the full right to remove outliers in one specific case. What is this case? Deletion of outlier data is a controversial practice but can occur for several reasons: invalid data entry, random chance, skewed distribution, experimental error. You can eliminate outliers only when you do not get the result you want. (6 punti)  36 When grouping quantitative data, what are the main advantages and disadvantages of the classes of values and classes of intervals? In classes of intervals , the intervals are of equal size and they do not overlap. The advantage is that’s easier to see distribution on quantitative data like skewness and kurtosis (6 punti) 37 (6 punti)​It’s important to create trust relationship with the patient from the first appointment and try to made him feel in a safe place, talking with simple words and explain every step of dental prosedures following the tell show do technique. Beside creating a strong relationship , also breathing techniques or prescribing anxiolytics in some patients before the dental appointment may be useful to overcome serious cases of dentophobic patients. 38 Let the coefficient of determination computed to be 0.51 in a problem involving one independent variable and one dependent variable. This result means that: (1 punto) 51% of the total variation is explained by the dependent variable. The relationship between two variables is negative. The correlation coefficient is also 0.51. 51% of the total variation is explained by the independent variable​. 39 Researchers want to compare the survival times in a cohort of metastatic lung cancer patients. The first subgroup was treated by monotherapy (chemotherapy), the second one by a combined therapy (chemotherapy + radiotherapy) and third one by palliative care. Data are unlikely to be normally distributed. What statistical test should be used in this case to analyse the results? (1 punto) ANOVA Kruskal-Wallis test Friedman matched test ANOVA with repeated measures 40 If the coefficient of determination is positive, then the regression equation: (1 punto) Must have a positive slope Must have a positive Y intercept. Must have a negative slope. Could have either a positive or a negative slope. 41 Respect for autonomy applies in medicine to everyone except: (1 punto) Except for doctors Except for children and the mentally incompetent Except for lawyers 42 Which of the following does not affect a physician`s ethical decision-making capacity? (1 punto) Incompetence of the patient Marital status of the patient Mental disorder of the patient 43 The "best interests" of the patient means that professional decisions by the physician must consider patients' values and personal preferences. (1 punto) True False 44 Explain the main elements of informed consent (6 punti) Voluntariness: the patient has to make a personal decision without coercion. He or she cannot simply yield to the suggestion of a family member, healthcare provider, or any other individual. Authorization: the patient should actively agree to a course of action and that decision should be documented. Patient understanding: this is perhaps the most challenging aspect of informed consent; Amount and accuracy of information: inheritance of condition and patient-specific risks potential benefits, risks, and limitation of all management options available alternatives. Competence: A legal term for the capacity to make a rational choice. A physician can make a judgment about an individual's competence 45 Which of the following statements are correct? (1 punto) Quartiles divide the data set into 100 equally sized groups. Range is the difference between the 1st and 99th percentiles. Median is equal to the 50th percentile. Interquartile range lies between the 1st and 3rd percentiles. 46 Autograft is a material for transplantation (organ, tissue, cells), taken from: (1 punto) One and the same person Between two species Between identical twins 47 A study aims to investigate the degree of association between body mass index and risk of diabetes type 2. What statistical tool could be used? (1 punto) Two-sample t-test Paired t-test Correlation analysis Chi-square test 48 Other things equal, in hypothesis testing if the level of significance is increased from 1% to 5%: (1 punto) Level of significance and power are not associated. Power will decrease. Power will remain unaffected. Power will increase. 49 A study aims to investigate if there is a difference in out- and inpatient costs in diabetes type 2. Cost is not expected to be normally distributed. What hypothesis test could be used? (1 punto) Mann-Whitney test Two-sample t-test Paired t-test Chi-square test 50 Paternalism is (1 punto) The same as beneficence The same as nonmaleficence The same as veracity None of the above 51 If a doctor tells a funny story about a patient (a famous journalist) during a public event, it is a: (1 punto) Violation of privacy Violation of confidentiality Violation of security Case of bad taste 52 In a study of 58 HIV (+) mothers who gave birth to children, 11 children were HIV infected. CD4 counts were lower in mothers who were HIV transmissive (695 [SD=271]) than in non-transmissive mothers (708 , P=0.006, 2-sample t-test). Which one of the following statements is wrong? (1 punto) The null hypothesis tested states that the mean CD4 count in HIV+ve mothers is the same in those who transmit and those who do not transmit HIV to their children. McNemar test could also be performed on these data. The results are significant at the 5% level suggesting that the null hypothesis can be rejected. CD4 counts in these women are likely to be normally distributed. 53 The reproductive cloning is the same as therapeutic cloning. (1 punto) True False SEPTEMBER RESIT Exam SMME I - 10:00 AM The test contains 50 questions - 25 questions in bioethics and 25 questions in statistics. There are 40 closed multiple choice questions with 1 correct answer only. These questions score for 1 point each if correctly answered. There are 10 open questions requiring a textual answer. These questions score for 6 points each if correctly answered. Grading scale - Poor (2): ≤ 60 points - Average (3): 61 - 70 points - Good (4): 71 - 80 points - Very Good (5): 81 - 90 points - Excellent (6): 91 - 100 points Time to complete and submit the test - 50 minutes. Late returns are not allowed. ! Points: 27/100 1 Name, Group, Faculty number * 5509 2 Cancer stage (defined as I, II, III or IV) is measured on which scale? (1/1 Points) Nominal Ordinal "  Interval Ratio 3 Which of the following may have an adverse effect on a correlation coefficient? (1/1 Points) Too many people in your experiment. Restricting the range of possible scores. " The scores on one variable have larger numbers than the other variable. A negative relationship between your X and Y variables. 4 Rules of conduct for members of a group in a specific area are typical for: (1/1 Points) Charity Professionalism " Ethics Morality 5 The reproductive cloning is the same as therapeutic cloning. (1/1 Points) True False " 6  6 What is the main finding from simple linear regression model that is presented below? What is the value of the correlation coefficient in this case? (-/6 Points) for every one unit increase in gym training hours per week the body mass index decreases by 0.6219. it shows a strong negative correlation because the value of correlation co-efficient is -0.69 # 7 Respect for autonomy applies in medicine to everyone except: (0/1 Points) Except for doctors Except for lawyers Except for children and the mentally incompetent " There are no exceptions #  8 The "best interests" of the patient means that professional decisions by the physician must consider patients' values and personal preferences. (0/1 Points) True " False # 9 Dotplot is an appropriate graphical summary in case of: (0/1 Points) One quantitative variable " One qualitative variable Two quantitative variables Two qualitative variables 10 Informed consent in ethics usually refers to: (1/1 Points) the idea that a person must be fully-informed about and understand the potential benefits and risks of their choice of treatment in order to be able to make the best " decision. legal protections prevent physicians from revealing their discussions with patients the rights of individuals to self determination 11  When investigating a sample of 556 men working in a cadmium pigment plant, it was found that the cadmium in a man's urine (mg/l) was linearly related to the number of years worked in the plant. The estimated slope of the line obtained by regressing the amount of cadmium against years worked was 0.0009 mg/l per year, with 95% confidence interval (0.0006, 0.0012) mg/l. The intercept was not significantly different from zero. Which one of the following statements is true? (1/1 Points) The estimated slope of the line is so close to zero as to be not significantly different from it (P > 0.05). A man who had worked in the plant for 10 years would, on average, have increased the amount of cadmium in his urine by 9 mg/l. A man who had worked in the plant for one year would be expected to have 0.0009 mg/l of cadmium in his urine. " We are 95% certain that the estimated slope of the line lies between 0.0009 and 0.0012 mg/l per year. 12 A study on the level of physical activity (measured as a weekly number of training hours) of undergraduate and postgraduate students came to the result of t = 1.96. What did the study conclude? (-/6 Points) at t=1.96 the p value is equal to 0.05 which means we can reject the hull hypothesis so there is a significant difference 13 Historical cohorts of patients with advanced renal cell carcinoma have shown that response rates following treatment average out at around 30%. In a study of a new drug, 8 out of 20 study participants (40%; 95% CI from 29% to 51%) achieved a response. Which one of the following statements is correct? (1/1 Points) An appropriate null hypothesis for these data would be that in the population of patients with advanced renal cell carcinoma, the proportion of patients achieving response equals 0.40 (or 40%).  The confidence interval for the proportion achieving a response could be used to test the null hypothesis that the proportion of patients achieving a response in the population " equals 0.30 (or 30%). The standard error of the proportion achieving a response is calculated as SQRT[(8x12/20)], where SQRT is the square root function. The results of this study suggest that the response rates are significantly better with the new drug. 14 Paternalism is (1/1 Points) The same as beneficence The same as nonmaleficence The same as veracity None of the above " 15 In simple linear regression, if there is no trend, the actual curve would look like: (1/1 Points) Exponential growth curve Increasing straight line Decreasing straight line Horizontal constant line " 16 Other things equal, in hypothesis testing if the level of significance is increased from 1% to 5%: (1/1 Points)  Power will increase. " Power will decrease. Power will remain unaffected. Level of significance and power are not associated. 17 What is the value of the interquartile range of the post-chemotherapy survival in I stage breast cancer patients (presented on the boxplot below)? What is the value of the range of this variable? What is the distribution of this variable? (-/6 Points) the range is = 55 and the interquartile range = 12 and the distribution of this box plot is left skewed # 18 A study investigated new chelator agent in thalassemia patients. Patients treated by oral chelator had a mean reduction of serum ferritin (a measure of iron overload) of 926 µg/l, while patients treated by subcutaneous chelator had a mean reduction of serum ferritin of 1 086 µg/l. P-value was found to be 0.06. What did the study conclude? There was no significant difference in the clinical effectiveness of the two chelators. There was a significant difference in the clinical effectiveness of the two chelators. The oral chelator was significantly more effective in terms of serum ferritin reduction in thalassemia. The subcutaneous chelator was significantly more effective in terms of serum ferritin reduction in thalassemia. (0/1 Points) There was no significant difference in the clinical effectiveness of the two chelators. " There was a significant difference in the clinical effectiveness of the two chelators. The oral chelator was significantly more effective in terms of serum ferritin reduction in thalassemia. The subcutaneous chelator was significantly more effective in terms of serum ferritin reduction in thalassemia. 19 The first kidney transplantation in Bulgaria was performed: (1/1 Points) 1968 " 1986 1996 20 Xenotransplantation is: (1/1 Points) From one human to another human Between identical twins Between mother and a child From animal to human " # 21 Brain death is: (0/1 Points) irreversible cessation of circulatory and respiratory functions, or irreversible cessation of all the functions of the entire brain, including the brain stem irreversible cessation of brain function " reversible cessation of circulatory and respiratory functions 22 The right of confidentiality: (1/1 Points) Belongs to the patient " Belongs to the health provider Applies only to physicians Is an ethical, but not a legal, duty 23 If a doctor tells a funny story about a patient (a famous journalist) during a public event, it is a: (1/1 Points) Violation of privacy Violation of confidentiality " Violation of security Case of bad taste 24 What if a family member asks the physician how the patient is doing? (-/6 Points) the physician must keep the patients confidentiality. this is when the private information of the patient is not disclosed with anyone but the people who are personally involved in the care of patient. therefore the physician must advice the patients family to ask the patient themselves. they can only tell the patients family member when they have been given permission or when the public welfare is involved or when the patient is a danger to themselves 25 The privilege of confidential communications between a doctor and a patient is controlled by the patient. (1/1 Points) True " False 26 A study aims to investigate if there is a difference in out- and inpatient costs in diabetes type 2. Cost is not expected to be normally distributed. What hypothesis test could be used? (1/1 Points) paired t-test Mann-Whitney test " chi-square test two-sample t-test 27 Autograft is a material for transplantation (organ, tissue, cells), taken from: (1/1 Points) One and the same person "  Between two species Between identical twins 28 In a study to quantify the ability of emergency medicine residents to interpret cranial computed tomography (CT), 83 residents were examined. The mean percentage correct on a standardized pre-test to assess baseline ability to interpret CT scans before the course was 60% (95% CI 58% to 62%). When 61 of the residents were retested 3 months after the course, the accuracy rate increased to 78% (95% CI 75% to 81%, P0.001).Which one of the following statements is wrong?:(1 Point) p>0.001 means that there is a less than 1 in 1000 chance that we would have obtained these results,or more extreme results,if the alternative hypothesis was true The p-value for the comparison of health care costs was less than 0.001.This means that we can reject the null hypothesis at the 5% level of significance We cannot conclude that delayed diagnosis causes higher levels of health care costs and utilization in lung cancer patients. A suitable null hypothesis for this would be that lung cancer patients diagnosed at different disease stages have similar levels of health care costs and utilization. 15.The main idea from ’’The six steps protocol’’ is: (1 Point) How to treat people with different religious beliefs How to share the information with the patient regarding the diseases How to manage the treatment 16.The death rate using a standard operative technique for a particular condition is 24%.Using a modification of the operative technique on sample of 86 patients , the 99% confidence interval for the death rate was between 15% and 23%.Which one of the following statements is correct? (1 Point) We are 99%certain that the death rate in the sample from the modified operative technique lies between 15% and 23% The modified operative technique has a significantly (p>0.01)lower death rate than the standard operative technique There is a 0.5% chance that the modified technique is better, as judged by the death rate ,than the standard technique We can reject at the 1% level of significance , the null hypothesis that the true death rate of the modified operative technique is 24% 17.Subjects from families with genetic disorders were asked whether they had encountered problems when applying for life insurance.A sample from the general population was also asked the same questions.About a third of respondents in the study group (723/2167) reported problems compared with only 5 % of the general population.This diffirince was significant at the 0.01% level.Which one of the following statements is wrong? (1 Point) A suitable null hypothesis would be that subjects from families with genetic disorders in the population are more likely to experience problems when applying for life insurance than those from the general population The diffirence between the two groups of families are unlikely to have occurred by chance. A sutitable null hypothesis is that subjects from families with genetics disordes in the population are equally likely to experience problems when applying for life insurance as those from families in the general population. We can reject the null hypothesis at the 5% level of significance 18.Which one of the following statements is wrong?Assuming all other relevant factors remain constant , the power of a test?:(1 Point) Decreases as the size of the sample increases İs greater if the effect of interest is larger than if is smaller. İncreases as the variability of the observations decreases Is the chance of rejecting the null hypothesis when it is false. 19.What is the value of the interquartile range for the number of hospitalizations per year in young adults (presented on the boxplot below)?What is the value of the most extreme outliers in the case?What is the distribution of this variable? (6 Point) 6 20.Which of the following is not an outlier test:(1 Point) Cramer-von Mises criterion Chauvenet criterion Grubbs test Peirce criterion 21.Active euthanasia when the person deliberately cause the patient to die or by using lethal substance and force: (1 Point) True False 22.What is the correct phisicians reaction when the patient start crying while the doctor tells him a bad news about the disease? (6 Point) Let the patient cry until they stop 23.The need for ethical standards in research became evident following:(1 Point) World War II World War I The Korean War 24.Autonomy ıs often invoked as guide for decision making when patient lacks decision making capacity and has no advance directive. (1 Point) True False 25.In a study ,53 patients were grouped according to the level of forced expiratory volume in one second (FEV1) and the presence of cor pulmonale (CP):Group 1 consısted of patients with FEV1