Colorectal Screening with Faecal Occult Blood Tests (TRUE)

Medical Student Questions

MCQs:

1. The following are national screening tests currently offered throughout the UK:

·  Breast screening with mammogram (TRUE)

·  Colorectal screening with faecal occult blood tests (TRUE)

·  Prostate screening with Prostate Specific Antigen (PSA) test (FALSE)

·  Cystic fibrosis in newborns with Guthrie test (TRUE)

·  Group B streptococcal screening in pregnancy by urine culture (FALSE)

1. The following infections are routinely vaccinated against in the UK as part of the NHS vaccination programme:

·  Polio (TRUE)

·  Hepatitis B (FALSE)

·  Chicken Pox (FALSE)

·  Shingles (TRUE)

·  Rotavirus (TRUE)

1. A 5 year old child presents with a 5 day history of runny nose, watery red eyes. Mum reports that the child also had white spots at the back of their mouth which are disappearing. Yesterday, they developed a rash behind their ears. Today the rash has spread to the rest of their body. On examination, they are pyrexial (38.7°C), have a florid maculopapular rash and conjunctivitis. The child is being seen in a four bedded bay. The following actions would be important in the management of this child:

·  Travel history in last month (TRUE)

·  History of contact with case of measles (TRUE)

·  Isolate child in side room (TRUE)

·  Vaccination history (TRUE)

·  Inform public health/health protection if you clinically suspect this child has measles (TRUE)

1. The following are true of E Coli O157 VTEC infections.

·  The bacteria is passed on through the faecal-oral route. (TRUE)

·  Person to person transmission does not occur. (FALSE)

·  A person can become infected with the bacteria after eating undercooked meat that is contaminated with the bacteria. (TRUE)

·  Private drinking water supplies (i.e. non mains water) can become contaminated with the bacteria. (TRUE)

·  A person who has had E.Coli O157 VTEC infection can return to work as soon as they stop having diarrhoea. (FALSE)

1. The results of a randomised controlled trial (RCT) have just been published in a medical journal. The trial investigated the effects of a 1 year healthy lifestyle course (physical activity and lessons on healthy eating and cookery skills) for obese adults (BMI>30 kg/m2). There were 120 participants in the trial. 62 participants were randomly allocated to the intervention group and the remaining 58 received the current standard advice on physical activity and diet. After 1 year, the trial found that the intervention group had a reduction in BMI of 2.4 kg/m2 (95% CI 0.9 – 3.9 kg/m2, p<0.05) compared to the group who received the standard advice.

·  The results show there was not a statistically significant reduction in BMI in the intervention group compared to the group receiving standard advice. (FALSE)

·  The results show that we can be 95% certain the mean reduction in BMI in the intervention population compared to the population who receive standard advice, is between 0.9 and 3.9 kg/m2, with a best estimate of 2.4 kg/m2. (TRUE)

·  Participants were blinded to the intervention received. (FALSE)

·  The null hypothesis that states “the mean BMI’s are equal for the control and intervention populations” cannot be rejected (FALSE)

·  A cohort study would have been a better study design for this type of intervention. (FALSE)

1. A study follows a group of factory workers (N=250) exposed to Substance A over a period of 10 years to see if they develop a range of health problems. At the same time they follow up a group of office based workers from the same factory (N=250), not exposed to Substance A. At the start of the study, 5 exposed workers and 10 non-exposed workers have asthma/bronchitis. A further 75 exposed workers developed asthma/bronchitis over the 10 years and 15 non-exposed workers developed asthma/bronchitis. Which of the following is true:

·  This is an example of a case-control study (FALSE)

·  The incidence of asthma/bronchitis at the start of the study in all workers was 3% (FALSE).

·  The prevalence is the frequency of existing disease in a defined population at a particular point in time. (TRUE)

·  The cumulative incidence of asthma/bronchitis at the end of the study in the exposed group of workers was 31%. (TRUE)

·  There may be other factors influencing the incidence of asthma/bronchitis which may be unequally distributed between the two groups which should be accounted for. (TRUE)

1. There were 53,102 deaths (all causes in the whole population) were registered in country A in 2013. The estimated mid year population in 2013 was 5,181,479. Lung cancer related deaths and mid year population by age group are given in the table below. The crude death rate from lung cancer in country A was 79 deaths per 100,000.

Which of the following are true?

·  The crude death rate from all cause mortality in country A in 2013 is 1025 deaths per 100,000 of the population. (TRUE)

·  The age specific lung cancer death rate among 65-69 year olds is 195 per 100,000 population. (TRUE)

·  The crude death rate from lung cancer in Country A in 1980 was 60 deaths per 100,000. We can conclude that survival from lung cancer is deteriorating in country A. (FALSE)

·  The age structure of a standard population (i.e. direct standardisation) can be applied to the age specific death rates from lung cancer in Country A and Country B in order for a fairer comparison of the lung cancer related death rates between the two countries. (TRUE)

·  Mid year population estimates are derived from the national census.(TRUE)

1. The following questions concern health improvement and inequalities. Please select the answers that are true.

·  The inverse care law is the principle that the availability of good medical care tends to vary inversely with the need for the population served.(TRUE)

·  People from less deprived backgrounds tend to live for longer. (TRUE)

·  Housing is an example of a wider determinant of health. (TRUE)

·  The ban of smoking in public places is an example of legislative action to improve health.(TRUE)

·  The prevalence of cigarette smoking has remained fairly static since the 1980’s. (FALSE)

1. The following are true of randomised controlled trials:

·  Participants are randomly assigned to 2 (or more) groups to test a specific drug or treatment.(TRUE)

·  The robustness of the study can be enhanced by blinding participants.(TRUE)

·  A double-blinded study means that neither the participants in the experimental group nor the participants in the control group know which study group they are in.(FALSE)

·  A meta-analysis uses statistical techniques to combine results from different studies to increase the likelihood of detecting a difference between two treatments/interventions if such a difference really does exist. (TRUE)

·  The number needed to treat can be derived from the results of a RCT. (TRUE)

1. The following is true of cervical cancer:

·  Immunosuppressant drugs and multiple sexual partners are known to be associated with cervical cancer. (TRUE)

·  Human Papilloma Virus Types 16 and 18 cause the majority (70%) of cancers of the cervix.(TRUE)

·  Cervical screening in the UK is usually by liquid based cytology. (TRUE)

·  The primary purpose of the national cervical screening test is to detect cancer. (FALSE)

·  Human papilloma virus vaccination is part of the NHS childhood vaccination programme for girls. (TRUE)

1. The following charts are population pyramids from two different countries. Which of the following is true:

Country C

Country D

(Source: populationpyramid.net)

·  Life expectancy is shorter in Country C (TRUE)

·  There are higher fertility rates in Country D (FALSE)

·  Country C has an older population compared to Country D. (FALSE)

·  It is likely that communicable diseases are a more common cause of death in Country C, whereas non-communicable diseases are a more common cause of death in Country D. (TRUE)

·  Country C is an example of a more developed country’s population structure. (FALSE)

1. The graph below compares the rates of pregnancy in women less than 20 years of age in two regional areas (Y and Z), as well as showing the rates for the whole country (country X) of which regional areas Y and Z are a part of. The table provides the average size of the <20 year old population in the relevant areas. Please select the statements which are true.

Average size of the <20 year old population
Country X / 1,000,000
Regional Area Y / 5,500
Regional Area z / 250,000

· 

·  The UK has one of the highest rates of teenage pregnancy in Western Europe.(TRUE)

·  Low educational attainment is rarely associated with teenage pregnancies. (FALSE)

·  The different trends for the three areas are not influenced by the size of the respective populations. (FALSE)

·  One possible factor which may at least partly explain the different rates between regional areas Y and Z is the differences in socioeconomic deprivation. (TRUE)

·  Sexual education is all that is needed to tackle this public health problem.(FALSE)

1. The following is true of screening tests in the UK:

·  The sensitivity of a test is the measure of its ability to detect healthy people as non-diseased. (FALSE)

·  Facilities for diagnosis and treatment of the disease being screened for need to be in place before the screening test can be introduced. (TRUE)

·  The natural history of the disease being screened for should ideally be understood for a screening test to be introduced (TRUE)

·  Screening is a test offered to an individual to find out whether they have the disease being screened for (FALSE)

·  There are usually no risks to individual being screened (FALSE)

1. Select the statements that are true:

·  Health economics concerns allocating the scare resources of the NHS optimally and efficiently. (TRUE)

·  The National Institute for Health and Care Excellence (NICE) is operationally independent of the government.(TRUE)

·  NICE undertakes technological appraisals which look at the clinical and cost effectiveness of health technologies such as new medicines. (TRUE)

·  Quality-adjusted life year is a measure which considers both length of life and quality of life.(TRUE)

·  One Quality-adjusted life year (QALY) is equal to one year of life in perfect health.(TRUE)

1. For each case please select the most relevant public action you should undertake from the available options.

·  You are a junior doctor working in a paediatric medical receiving ward. It is a Saturday. A 6 year old child presents with bloody diarrhoea and reduced urine output. Initial blood tests shows derange U+E’s and a low platelent count. The working diagnosis is Haemolytic Uraemic Syndrome. (C)

·  You are a junior doctor working in general practice. A mother brings her 5 year old son with a 1 day history of rash consistent with chicken pox. The child has not had any contact with anyone outside the family home for 5 days. All the household contacts have had chicken pox. There are no newborns in the house and no one is immunocompromised.(A)

·  You are a junior doctor working in a paediatric medical receiving ward. A 10 year old presents with vomiting, confusion and irritability, pain in his right hip, headache and rash. On examination the child is pyrexial, photophobic and has an extensive purpuric rash. The consultant has seen the child and suspects meningitis secondary to Neisseria Meningitidis.(C)

·  You are a junior doctor working in an acute medical ward. It is 8pm on a Thursday night. A 35 year old Nigerian presents with a 2 month productive cough, night sweats and weight loss. The patient works in a nursing home. He has had 3 courses of oral antibiotics to know effect. The medical team suspects respiratory tuberculosis. The patient has not been treated for tuberculosis before. You put the patient in a side room and ask the patient for sputum samples.(B)

·  You are a junior doctor working in a respiratory ward. It is 9pm on a Friday night. A 71 year old gentleman presents with an acute exacerbation of COPD. No organism is cultured from the sputum. (A)

Options:

·  Do not need to inform public health/health protection team (A)

·  Inform public health/health protection team on the next working day by telephone (B)

·  Inform public health/health protection team as soon as possible by telephone (C)

·  Inform public health/health protection by letter (D)