EPIDEMIOLOGY 201

REVIEWER FOR 3rd EXAM

November 9, 2018
QUESTION
For items 1 – 11, choose A if the statement is true and B if it is
false.

1. A communicable disease is due to a specific infectious agent

or its toxic products that arises through transmission of such
agent or products from an infected person, animal, or reservoir to
a susceptible host, either directly or indirectly through an
intermediate plant or animal host, vector, or the inanimate
environment.
ANSWER

A
(Source: Epidemiology of Communicable Diseases by Dr. A. N.
Bermudez, 2nd semester 2018).
QUESTION
2. The term “communicable disease” is synonymous with
contagious disease.
ANSWER

B
Contagious diseases are passed on from person to person. A
disease can be communicable without being contagious if it
requires a vector (ex. mosquitoes in malaria) for transmission
(Source: Epidemiology of Communicable Diseases by Dr. A. N.
Bermudez, 2nd semester 2018).
QUESTION
3. The epidemiologic triad of disease causation is:
- Source
- Mode of transmission
- Susceptible host

(question modified from https://www.cdc.gov/ophss/csels/dsepd/ss1978/lesson1/quiz.html)

ANSWER

B
The epidemiologic triad is agent, host, environment.
QUESTION
4. This diagram is an accurate
representation of the
epidemiologic triad of
disease.
ANSWER

B
The factors for the host and the agent are reversed (Source:
Epidemiology of Communicable Diseases by Dr. A. N. Bermudez,
2nd semester 2018).
QUESTION
•5. Pathogenicity is measured by the proportion of infected
individuals with subclinical disease, or, in other words:
ANSWER
•
B
Pathogenicity is measured by the proportion of infected
individuals with clinically-apparent disease, and not subclinical
disease:
QUESTION
•6. Infectivity is measured by the secondary attack rate, which is:
ANSWER

A
(Source: Epidemiology of Communicable Diseases by Dr. A. N.
Bermudez, 2nd semester 2018).
QUESTION
•7. Virulence is measured by the case fatality rate, which is:
ANSWER
•
B
The formula shown is the formula for cause-specific death rate and not
the case fatality rate. The correct formula is:

(Source: Epidemiology of Communicable Diseases by Dr. A. N.

Bermudez, 2nd semester 2018).
QUESTION
8. Antigenicity and immunogenicity are agent characteristics.
Antigenicity refers to the infection’s ability to produce specific
immunity, while immunogenicity refers to the ability of the agent
to induce antibody production in the host.
ANSWER

B
The definitions are reversed. Antigenicity refers to the ability of
the agent to induce antibody production in the host, while
immunogenicity refers to the infection’s ability to produce specific
immunity (Source: Epidemiology of Communicable Diseases by
Dr. A. N. Bermudez, 2nd semester 2018).
QUESTION
9. The presence of an agent is a sufficient cause of
communicable disease.
ANSWER

B
The presence of an agent is not a sufficient cause of
communicable disease. The agent must be capable of infecting
the host (Source: Epidemiology of Communicable Diseases by
Dr. A. N. Bermudez, 2nd semester 2018).
QUESTION
10. The diagram below on immunity is correct.
ANSWER

B
The examples for artificial immunity are wrong. Immunization is
an example of active (not passive) artificial immunity, while
antibody transfer is an example of passive (not active) artificial
immunity (Source: Epidemiology of Communicable Diseases by
Dr. A. N. Bermudez, 2nd semester 2018).
QUESTION
11. The time interval between exposure to an infectious agent
and the appearance of the first signs or symptoms of disease is
called the incubation period.
ANSWER

A
This is correct. On the other hand, the time interval between
lodgment of an infectious agent in a host and maximal
communicability of the host is called the generation time (Source:
Epidemiology of Communicable Diseases by Dr. A. N. Bermudez,
2nd semester 2018).
QUESTION
12. In communicable diseases, types of reservoirs include the
following EXCEPT:
A. Symptomatic cases
B. Carriers
C. Animals
D. Inanimate objects
E. All of the above
F. None of the above
ANSWER

F
All are correct (Source: Epidemiology of Communicable Diseases
by Dr. A. N. Bermudez, 2nd semester 2018).
QUESTION
13. The following is/are true regarding carriers of infection
EXCEPT:
A. Carriers are persons who harbor the infectious agent, manifest
no discernible signs of infection, yet are potential sources of
infection.
B. Incubatory carriers transmit the agent before the onset of
clinical disease.
C. Convalescent carriers are infected persons who have
recovered from the disease and no longer harbor the agent.
QUESTION
13. The following is/are true regarding carriers of infection
EXCEPT:
D. Chronic carriers are convalescent carriers who continue to
harbor the infection for more than 1 year.
E. All of the above.
F. None of the above
ANSWER

C
Convalescent carriers are infected persons who have recovered
from the disease but still harbor the agent. If the person no longer
harbors the agent, he is no longer a carrier (Source:
Epidemiology of Communicable Diseases by Dr. A. N. Bermudez,
2nd semester 2018).
QUESTION
14. The following is/are examples of direct transmission EXCEPT:
A. Sexual intercourse
B. Fecal-oral spread
C. Transplacental
D. Contaminated fomites
E. All of the above
F. None of the above
ANSWER

D
Transmission through contaminated fomites (inanimate objects)
is an example of indirect transmission (Source: Epidemiology of
Communicable Diseases by Dr. A. N. Bermudez, 2nd semester
2018).
QUESTION
15. The following regarding herd immunity is/are correct
EXCEPT:
A. It is the immunity of a population against an infectious disease
when a large proportion of individuals are immune.
B. It confers protects to the population even though not every
single individual has been immunized.
C. This is the reason why immunization programs aim for 100%
immunization in the target population.
QUESTION
15. The following regarding herd immunity is/are correct
EXCEPT:
D. All of the above
E. None of the above
ANSWER

C
Because of the concept of herd immunity, immunization programs
need not aim for 100% immunization in the target population.
QUESTION
16. The following is/are true of the disability-adjusted life year
(DALY) EXCEPT:
A. DALY = YLL + YLD, where
YLL = years of life lost due to premature mortality
YLD = years lost due to disability for new cases
B. One DALY can be thought of as one year of unhealthy life lost.
C. It measures the gap between current health status and an
ideal situation where one lives into old age, free of disease and
disability.
QUESTION
16. The following is/are true of the disability-adjusted life year
(DALY) EXCEPT:
D. This is the sum of years of life lost due to premature mortality
and years lost due to disability for new cases.
E. All of the above
F. None of the above
ANSWER

B
One DALY can be thought of as one year of healthy (not
unhealthy) life lost (Source: Epidemiology of Non-Communicable
Diseases by Dr. P. Pinlac, 2nd semester 2018).
QUESTION
For item 17, consider the diagram about NCDs below:
QUESTION
17. Factors related to the economic impact of NCDs include the
following EXCEPT:
A. Increased health expenditure
B. Loss of jobs
C. Reduced productivity
D. All of the above
E. None of the above
ANSWER

E
All are indeed factors related to the economic impact of NCDs
(Source: Epidemiology of Non-Communicable Diseases by Dr. P.
Pinlac, 2nd semester 2018).
QUESTION
18. The following is/are true regarding poverty and NCDs
EXCEPT:
A. There is an association between low birth weight and NCDs in
adulthood.
B. Due to poverty, restrictions of healthy food choices and
physical activity choices may occur.
C. Illiteracy and lower education levels may contribute to the
prevention of health promotion from reaching the poor.
QUESTION
18. The following is/are true regarding poverty and NCDs
EXCEPT:
D. There is a tendency for the poor to use their disposable
income on commodities that contribute to NCDs, such as tobacco
and alcohol.
E. There is no link between poverty and NCDs, and whatever
associations that have been established are fallacious.
ANSWER

E
A, B, C, and D are all correct (Source: Epidemiology of Non-
Communicable Diseases by Dr. P. Pinlac, 2nd semester 2018).
QUESTION
19. The following is/are true regarding prevention and control of
NCDs EXCEPT:
A. Solutions should target all stages in life, even as early as
infancy.
B. Solutions in infancy include exclusive breastfeeding for 6
months. Complementary feeding may begin at 6 months, but
breastfeeding must continue for up to 2 years of age or beyond.
QUESTION
19. The following is/are true regarding prevention and control of
NCDs EXCEPT:
C. Measures to prevent NCDs in childhood and adolescence
include promotion of physical activity, consumption of safe and
healthy food in schools, and institution of tobacco and alcohol
controls.
D. All of the above
E. None of the above
ANSWER

E
All are true (Source: Epidemiology of Non-Communicable
Diseases by Dr. P. Pinlac, 2nd semester 2018).
QUESTION
20. In an outbreak investigation, the formulation of a case
definition in order to decide whether an individual should be
classified as having the health condition of interest is important.
The following is/are component(s) of a case definition except:
A. Restrictions by person
B. Exposure or risk factor investigated
C. Clinical criteria based on simple and objective measures
D. Restrictions by time and place
QUESTION
20. In an outbreak investigation, the formulation of a case
definition in order to decide whether an individual should be
classified as having the health condition of interest is important.
The following is/are component(s) of a case definition except:
E. All of the above
F. None of the above
ANSWER

B
A case definition includes 4 components:
1. Clinical criteria based on simple and objective measures
2. Restrictions by person
3. Restrictions by place
4. Restrictions by time
ANSWER
Exposures or risk factors are not included (Source: Outbreak
Investigation by Dr. A. N. Bermudez, 2nd semester 2018).
QUESTION
21. The 5th step in outbreak investigation based on the US CDC-
prescribed investigatory steps (1992) is the conduction of
descriptive epidemiologic studies. The following is/are its
objectives EXCEPT:
A. To determine the range and extent of the outbreak.
B. To assess the possible sources of exposure, mode or manner
of transmission, incubation period, environmental contributors,
host risk factors, and agent characteristics.
C. To generate hypotheses about the outbreak
QUESTION
21. The 5th step in outbreak investigation based on the US CDC-
prescribed investigatory steps (1992) is the conduction of
descriptive epidemiologic studies. The following is/are its
objectives EXCEPT:
D. To test the association between possible risk factors and the
occurrence of the disease in question
E. All of the above
F. None of the above
ANSWER

D
Testing for the association between exposures and disease is in
the realm of analytic epidemiologic studies, not descriptive
(Source: Outbreak Investigation by Dr. A. N. Bermudez, 2nd
semester 2018 and Strategies of Epidemiology by Dr. P. Pinlac,
2nd semester 2018).
QUESTION
22. The following is/are true of the epidemic curve EXCEPT:
A. It describes the outbreak in terms of person and place.
B. The epidemic curve is a visual display of the magnitude and
time trend of the outbreak.
C. The x-axis represents a time line.
D. The y-axis represents the number of percentage of cases.
E. All of the above
F. None of the above
ANSWER

A
Epidemic curves describe the outbreak in terms of time (Source:
Outbreak Investigation by Dr. A. N. Bermudez, 2nd semester
2018).
QUESTION
23. The following information may be obtained from an epidemic
curve EXCEPT:
A. Probable period of exposure (if the disease and the incubation
period is known)
B. Nature of the epidemic (from the shape of the outbreak)
C. Future course of the epidemic
D. Effectiveness and timeliness of prevention and control
measures.
QUESTION
23. The following information may be obtained from an epidemic
curve EXCEPT:
E. All of above
F. None of the above
ANSWER

F
All are correct (Source: Outbreak Investigation by Dr. A. N.
Bermudez, 2nd semester 2018).
QUESTION
For item 24, refer to the graph below:
QUESTION
24. The following is/are true of the epidemic curve represented by
the graph:
A. Persons are exposed to the same source over a relatively
short period.
B. The curve has a plateau instead of a peak
C. The disease agent is spread from person to person with
increasing number of cases in each generation.
QUESTION
24. The following is/are true of the epidemic curve represented by
the graph:
D. All of the above
E. None of the above
ANSWER

E
All are wrong. The graph represents an intermittent common
source epidemic. A characterizes point source epidemics. B is a
trait of continuous common source epidemics. C describes
propagated epidemics.
ANSWER
Characteristics of intermittent common source epidemics include:
1. Exposure to the agent is sporadic over time
2. Epidemic curve is irregularly jagged

(Source: Outbreak Investigation by Dr. A. N. Bermudez, 2nd

semester 2018).
QUESTION
25. Describing outbreaks in terms of place involves:
A. Mapping cases according to their place of origin, as this may
provide evidence about transmission of the agent responsible for
the outbreak.
B. The use of dot maps, which serve to document the geographic
extent of the problem and can provide evidence of clustering.
C. The use of maps with area-specific rates, especially when
areas of interest have populations with unequal sizes
QUESTION
25. Describing outbreaks in terms of place involves:
D. All of the above
E. None of the above
ANSWER

D
All are correct (Source: Outbreak Investigation by Dr. A. N.
Bermudez, 2nd semester 2018).
QUESTION
26. The choice of study design for the investigation of an
outbreak depends on:
A. The size of the outbreak
B. Disease status
C. Both A and B
D. None of the above
ANSWER

C
A retrospective cohort study is preferable for small, well-
circumscribed outbreaks and for diseases with a high incidence.
A case-control study is preferable for large, poorly-circumscribed
outbreaks and diseases with a low incidence.
QUESTION
27. The following is/are true regarding the characteristics of a
disease suitable for screening EXCEPT:
A. The disease is serious with severe consequences.
B. Treatment of the disease is more effective at an earlier stage.
C. The disease has a detectable pre-clinical phase.
D. The disease is rare or has a short duration.
E. All of the above
F. None of the above
ANSWER

D
D is wrong; the preclinical phase of the disease for screening
should be fairly long and prevalent in the target population. It is
not efficient or cost-effective to screen for rare or acute diseases
(Source: Screening by Dr. P. Pinlac, 2nd semester 2018).
QUESTION
28. The following regarding the validity of a test is/are true
EXCEPT:
A. The sensitivity refers to how many among those who are
positive in the test actually have the disease.
B. The validity of a test is its ability to distinguish between those
who have the disease and those who do not.
C. The specificity of a test refers to its ability to correctly identify
those who do not have the disease
QUESTION
•28. The following regarding the validity of a test is/are true
EXCEPT:
D. Specificity answers the question: Among those who don’t have
the disease, how many tested negative?
E. The formula for sensitivity is:
QUESTION
28. The following regarding the validity of a test is/are true
EXCEPT:
F. As the sensitivity of a test increases, its specificity decreases.
G. All of the above
H. None of the above
ANSWER

A
A refers to the positive predictive value. Sensitivity refers to the
ability of a test to correctly identify those who have the disease;
basically, it answers the question: Among those who have the
disease, how many tested positive?
QUESTION
In order for a test to distinguish between those with and without
the disease of interest, a cut-off point for normal and abnormal
values is used.

For item 29, consider the test below. It has a cut-off value of 4
units.
QUESTION
29. If the cut-off value is moved to 7 units, what is/are expected
on the measures of validity?
A. The specificity of the test will increase, and the number of false
negatives will also increase.
B. The number of false positives and false negatives will remain
the same.
C. The sensitivity of the test will increase, and the number of
false negatives will also increase.
QUESTION
29. If the cut-off value is moved to 7 units, what is/are expected
on the measures of validity?
D. The sensitivity of the test will decrease, and the number of
false positives will increase.
E. Sensitivity and specificity will not be affected.
F. All of the above
G. None of the above
ANSWER

A
If the cut-off point is set higher, then more individuals will be
labeled as negative. Consequently, the specificity increases,
while the number of false negatives will increase. (Source:
Screening by Dr. P. Pinlac, 2nd semester 2018)
ANSWER
QUESTION
30. According to the WHO, the cut-off of hemoglobin, which is a
parameter in the complete blood count (CBC) test, is 120 g/L in
non-pregnant women. A hemoglobin of less than 120 g/L signifies
anemia. If the WHO wished to enhance the sensitivity of the test,
how can they change the cut-off value?
A. Increase the cut-off. E. All of the above
B. Decrease the cut-off. F. None of the above
C. Remove the cut-off
D. Do not change the cut-off.
ANSWER

A
This case has results below the cut-off as positive and results
above the cut-off as negative (be careful, as this is reversed from
the usual). If the cut-off is increased (ex. 125 g/L), then the
number of those who will test positive will also increase,
consequently increasing the sensitivity.
QUESTION
For items 31 – 32, read the case below.

The Digital rectal exam (DRE) and prostate-specific antigen

(PSA) are tests used to screen for prostate cancer. The
sensitivity of DRE is 53%, while the specificity is 84%. The
sensitivity of PSA is 71%, while the specificity is 93%. (values
taken from http://www.jabfm.org/content/16/2/95.full)
QUESTION
31. If the two tests were to be administered sequentially, what
would be the net sensitivity of screening?
A. 38%
B. 45%
C. 86%
D. 78%
E. 95%
ANSWER

A
For sequential testing, the net sensitivity decreases. The formula
for this is SnA x SnB.

0.53 x 0.71 = 0.38

QUESTION
32. If the two tests were to be administered simultaneously, what
would be the net sensitivity of screening?
A. 38%
B. 45%
C. 86%
D. 78%
E. 95%
ANSWER

C
For simultaneous testing, the net sensitivity increases. The
formula for this is (SnA + SnB) – (SnA x SnB).

(0.53 + 0.71) – (0.53 x 0.71) = 0.86

QUESTION
For item 33, read the case below.

An outbreak of Salmonella typhimurium gastroenteritis followed a

company’s holiday banquet in December 2003. Approximately
135 persons attended the party, and of 116 who were
interviewed, 57 (49%) met the case definition.

The following is a table showing the data on the outbreak:

QUESTION

(Adapted from https://www.cdc.gov/ophss/csels/dsepd/ss1978/lesson6/section2.html)

QUESTION
33. Which food item was the culprit for the outbreak?
A. Beef
B. Ravioli
C. Cajun sauce
D. Pesto cream
E. California rolls
F. Data insufficient
ANSWER
•
A
The first step is to calculate the risk ratio for each food item. The
formula is
ANSWER
Upon calculation of the risk ratios, it will be discovered that the
food item with the highest risk ratio of 5.7 is beef. As such, this is
the culprit for the outbreak.
QUESTION
34. Consider the following data from an outbreak of
gastroenteritis among college football players. At which meal do
you think the critical exposure occurred?
QUESTION
34. At which meal do you think the critical exposure occurred
(adapted from https://www.cdc.gov/ophss/csels/dsepd/ss1978/lesson6/section2.html)?

A. 9/18 Breakfast
B. 9/18 Lunch
C. 9/18 Dinner
D. 9/18 Late Dinner
E. 9/19 Breakfast
F. 9/19 Lunch
ANSWER