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Epidemiological Concepts and Study Design (Questions 1–12)
Q1: A student nurse is reviewing vocabulary before clinical and asks what we call the
number of NEW cases of a disease that develop in a population during a specific time
period. Which term is she describing?
A. Prevalence
B. Incidence [CORRECT]
C. Case fatality rate
D. Endemic level
Correct Answer: B
Rationale: Incidence counts only the new cases that develop during a defined period, which
is what makes it the key measure of disease risk. Prevalence mixes new and existing cases
together, so it answers a different question about total burden.
Q2: A population health nurse wants to find out whether vaping is linked to chronic
bronchitis in young adults, so she enrolls 500 vapers and 500 non-vapers and follows both
groups for five years to compare how many in each group develop the condition. Which
study design is she using?
A. Case-control study
B. Cross-sectional study
C. Ecological study
D. Prospective cohort study [CORRECT]
Correct Answer: D
Rationale: The best answer is a prospective cohort study, because she classifies people by
exposure first and then follows them forward in time to see who develops bronchitis. Case-
control and cross-sectional designs start from the outcome or take a snapshot instead of
tracking people forward.
Q3: In a case-control study of pancreatic cancer, 60 of 100 cases had a long history of heavy
alcohol use compared with 25 of 100 controls. Which measure of association should the
researcher calculate?
A. Relative risk
B. Odds ratio [CORRECT]
,C. Population attributable risk
D. Incidence rate ratio
Correct Answer: B
Rationale: An odds ratio is the correct measure for a case-control study because subjects are
chosen based on having or not having the disease, so true incidence rates cannot be
computed. It compares the odds of alcohol exposure among cases with the odds among
controls.
Q4: During a single afternoon, a nurse surveys every student at one middle school and finds
that 15% currently report asthma symptoms. What can she legitimately conclude from this
cross-sectional design?
A. Poor air quality caused the symptoms
B. New asthma cases are occurring at a rate of 15% per year
C. She can estimate the point prevalence of asthma symptoms, but she cannot establish
causation [CORRECT]
D. The survey proves symptoms developed after school enrollment
Correct Answer: C
Rationale: A cross-sectional survey measures existing disease and exposure at the same
moment in time, so it gives a valid snapshot of prevalence without being able to sort out
what came first. That makes it good for describing burden and generating hypotheses, not
for proving cause.
Q5: A school district wants the strongest possible evidence that a hand-hygiene program
actually reduces absenteeism. Which study design would provide it?
A. A randomized controlled trial assigning some schools to the program and others to usual
practice [CORRECT]
B. A cross-sectional survey of absenteeism in one district
C. A case-control study comparing absent students with non-absent students
D. An ecological study comparing absenteeism rates across counties
Correct Answer: A
Rationale: Randomizing schools to the program or to usual practice controls for the
confounding that plagues observational designs, making the trial the strongest way to show
the program itself caused any drop in absenteeism. County comparisons and surveys leave
too many alternative explanations open.
Q6: A study finds that coffee drinkers have higher rates of lung cancer, but closer analysis
shows coffee drinkers are also far more likely to smoke cigarettes. Smoking is best described
as which of the following?
A. A mediator
B. An effect modifier
C. A confounder [CORRECT]
D. Selection bias
Correct Answer: C
Rationale: The best answer is a confounder, because smoking is associated with both coffee
drinking and lung cancer and can explain away much or all of the apparent association. A
mediator, by contrast, would sit on the causal pathway between coffee and cancer, which is
not the case here.
, Q7: A colleague jokes, "Countries that eat more chocolate win more Nobel Prizes, so eating
chocolate makes you brilliant." What epidemiological error is he committing?
A. Ecological fallacy [CORRECT]
B. Recall bias
C. Interviewer bias
D. Overmatching
Correct Answer: A
Rationale: He is committing an ecological fallacy by applying group-level averages to
individuals, when the relationship may not hold for any single person at all. Country-level
correlations are notorious for masking completely different individual-level patterns.
Q8: A population health nurse reads a study reporting a relative risk of 2.4 for preterm birth
among women with untreated periodontal disease, with a 95% confidence interval of 1.8 to
3.1. Which interpretation is correct?
A. Periodontal disease adds 2.4 preterm births per 1,000 pregnancies
B. The true relative risk is exactly 2.4 with no uncertainty
C. Women with periodontal disease have a 2.4% higher risk than unexposed women
D. Exposed women have 2.4 times the risk of preterm birth, and the association is
statistically significant [CORRECT]
Correct Answer: D
Rationale: A relative risk of 2.4 means the exposed group carries 2.4 times the risk, and
because the confidence interval lies entirely above the null value of 1, the finding is
statistically significant. The interval represents a range of plausible values, not proof the
estimate is exact.
Q9: A population health nurse notices that several children on the same city block have
been newly diagnosed with elevated blood lead levels. She begins by describing each case
according to age, housing type, and when the lab results occurred. Which epidemiological
approach is she applying?
A. Analytic epidemiology through a case-control design
B. Descriptive epidemiology organized by person, place, and time [CORRECT]
C. Experimental epidemiology through a community trial
D. Molecular epidemiology using laboratory typing
Correct Answer: B
Rationale: She is using descriptive epidemiology — characterizing who is affected, where
they live, and when the cases occurred — which always comes first and generates the
hypotheses that analytic studies later test. Case-control and experimental designs belong to
the analytic stage that follows.
Q10: At an annual health fair, records show 20 new cases of type 2 diabetes diagnosed
during the past year among 1,000 residents who were disease-free at the start of the year.
What does this figure represent?
A. Prevalence
B. Case fatality rate
C. Cumulative incidence [CORRECT]
D. Standardized mortality ratio