Institute of Health Management and Health Economics English

Faculty of Medicine

University of Oslo

Institute of Health Management and Health Economics

University of Oslo

Written repeat exam Monday 23 February 09.00-13.00

HMM4401- Health and Medicine

Exam resources: Students are allowed to bring a calculator for the written exam.

Results will be available Monday 16 March, see the list on the board at the Institute of Health Management and Health Economics, Forskningsveien 3A. The results will also be posted on Studentweb.

The receiving day of the results is the day the results are postedon the board outside the Institute.Appeals must be submitted within three weeks of this date.

The written exam consists of 3 pages including this page. Also the exam consists of an article attached.

Put all your answers on the exam paper provided, and not in this exam questions form.

Remember to write down your candidate number so that you have when the results are made available.

Repeat Examination HMM4401 – February 2009

A: Gastrointestinal ulcer (10 points, maximum ½ page)

Ulcers in the gastrointestinal tract may have various causes. State the main

cause of duodenal ulcer in adults, and the main treatment available?

B: Diabetes (10 points, maximum ½ page)

Diabetes mellitus is an endocrine disease. What hormone disturbance is involved

in diabetes in children and young adults? What is the main treatment available in

Western countries?

C: Mental health (10 points, maximum ½ page)

  1. Explain four different types of treatment for mental illnesses.
  2. Explain how the changes in therapy have changed the organization of health care during the latest 25 years

D: Chain of infection (10 points, maximum ½ page)

  • Explain briefly what is meant by the term “chain of infection”
  • Explain the defense mechanisms of the human body against infections

E: Colorectal cancer (10 points, maximum ½ page)

Describe briefly the symptoms, signs and the treatment of colorectal cancer according to the disease stage. Finally, describe the potential for prevention of colorectal cancer.

F: Diagnostic tests (10 points, maximum ½ page)

Explain why a test with low specificity is of little value when the prevalence of the disease is low. Illustrate the explanation with a numeric example – for example using a two-by-two table.

G: Use of mRNA test to detect premalignant lesions by Pap-smear (40 points, maximum 2 pages)

Cervical cancer among women is supposed to be caused by infection of the cervix uteri with certain types of HPV-virus (socalled high risk types of HPV). The disease implies that the squamous cells of the cervix undergo changes and this may be detected by a smear of cells from the cervix (socalled Pap smear). The Pap smear is examined in a cytological examination (rated as normal, ASCUS or LSIL). When the Pap smear indicates important cell changes, the gynecologist takes a biopsy (a cone) from the cervix. The histological examination of the biopsy may be rated as normal, CIN1, CIN2 or CIN3. CIN3 is the most serious type of finding. HPV-infection may also be detected by RNA or DNA tests of the squamous cells. These tests detect DNA or mRNA of the HPV virus. DNA and mRNA tests may be used to screen for serious histological findings of the cervix. The question is whether the mRNA tests is better than DNA tests.

Read carefully the paper by Molden and co-workers.

  • What type of study design has been used?
  • What do the authors conclude about the DNA and RNA tests?
  • Make a critical assessment of the article.
  • Would you recommend health authorities to use mRNA test to screen for cervical cancer?

H: Optional exercise. You may earn up to 10 extra points (maximum 2 pages)

Calculate and check, on the basis of the data in the Molden paper, whether the specificity of the mRNA test is 84.9% as claimed by the authors.