A 17-year-old male comes to his physician after having unprotected sexual intercourse, concerned that

he might have contracted HIV. In counseling this patient about the screening test most widely used, you
tell the patient that if the result is positive, a confirmatory test will be needed. This screening test can be
said to have a high level of which of the following?
A. Negative predictive value
B. Positive predictive value
C. Prevalence
D. Sensitivity
E. Specificity
The correct answer is D
The screening test most commonly used to test for HIV is the enzyme immunoassay, otherwise known
as the ELISA test. It works by detecting HIV antibodies that may be present in a patient's serum. The
ELISA has a high sensitivity, defined as the proportion of positive cases that are correctly identified as
such. In contrast, specificity (Choice E) refers to the proportion of negative cases that are correctly
identified as such. For any screening test, there is a trade-off between sensitivity and specificity; the
higher the sensitivity, the lower the specificity, and vice versa.
Negative predictive value (Choice A) refers to the proportion of patients with negative test results who
are correctly diagnosed. Positive predictive value (Choice B) refers to the proportion of patients with
positive test results who are correctly diagnosed. Prevalence (Choice C) refers to the total number of
cases in a population at a given time, not to be confused with incidence, which refers to the number of
cases that develop in a population during a specific time period.
A 24-year-old male visits a clinic for an HIV test. When he returns three days later for the result, the
nurse informs him that the test was positive and a second test is being performed to validate the result.
The young man decides to investigate what the likelihood is of the first test being incorrect. What
statistical value below would answer this young man's question?
A. Negative predictive value (NPV)
B. Positive predictive value (PPV)
C. Prevalence

D. Relative risk
E. Sensitivity
The correct answer is B
The value he is searching for is the false positive rate. When confronted with test vs.
disease questions, it is best to draw a 2x2 table: Row 1: a (++), b (+-); Row 2: c (-+),
and d(--) [for ex. b is +-, meaning the test is positive but person does not have the
disease. To determine b--the false positive rate--one can take either (1-PPV) = 1 - a/
(a+b) = b/(a+b) [% of false positives] or (1-Specificity) = 1 - d/(d+b) = b/(d+b) [% of
false positives]. Therefore, the answer is both PPV and specificity. Sensitivity = a/(a+c).
NPV = d/(c+d).

A 45-year-old female patient consults her physician with concerns over her risk of dying from cancer.
Based on current statistics, her physician tells her that the leading cause of cancer-related deaths in
females is due to which of the following malignancies?
A. Breast
B. Cervical
C. Colorectal
D. Lung
E. Ovarian
The correct answer is D
Lung cancer is the leading cause of malignancy-related deaths in women, followed by
breast cancer (Choice A) and colorectal cancer (Choice C). Ovarian cancer (Choice E) is
the fifth leading cause of cancer deaths in women. Cervical cancer (Choice B) is the
fourteenth leading cause of cancer deaths in women, and the third leading cause of
cancer deaths in women world-wide.
Breast cancer has the highest incidence in women, followed by lung cancer and
colorectal cancer.

A fictitious disease, RomeOnHBOFever, is slowly taking over the entire NY medical student community
(3,000 students). In 2006, the prevalence of this disease within this community was 10%. In 2007, 270
new cases of RomeOnHBO Fever were reported. What is incidence of this gripping disease in 2007?
A. 5%
B. 9%

C. 10%
D. 15%
E. 19%
The correct answer is C
Incidence = (# of new cases) / (# at risk). For 2007, there are 270 new cases and 2700
people at risk; therefore, the incidence is 10%. Do not forget to limit the incidence value
to only those at risk. The 300 infected from 2006 (10% of 3000) are no longer at risk for
the disease--they already have it!

A field researcher is conducting a study of HIV transmission in South Africa. She has already obtained
access to a cohort of HIV-positive patients and a cohort of age-matched HIV-negative patients. She now
plans to undertake a case-control study using the data set. Which of the following would be a feasible
outcome measure for this study?
A. The average death rate between cohorts
B. The frequency difference of past unprotected sex between cohorts
C. The presence of HIV in children of HIV-positive enrollees in the next 5 years
D. The rate at which a new retroviral produces side-effects between cohorts
E. The rate of eventual HIV infection in HIV-negative enrollees
The correct answer is B
B is the correct answer because it is the only risk factor in the listed choices which may be obtained
from a case-control study. A case-control study specifically collects data about risk factors based on
presence or absence of disease. A cohort study collects data on the development of disease based on
the presence of absence of risk factors. Answers A, C and E would be feasible in a cohort study.
Answer D is an example of an outcome feasible when an intervention is given to the groups to gauge
efficacy or side-effects of the intervention. This is specific to clinical trial studies.
A medical student seeks to examine the effect of sleep on passing an exam. She gives a survey to her
classmates right before the exam to find out whether or not they slept the previous night, and then
obtains data on the exam scores, and finds the above results. This project is an example of what kind of
study design?
A. Case-Control
B. Cross-Sectional

C. Historical Cohort
D. Prospective Cohort
E. Randomized Controlled
The correct answer is D
This study is an example of a Prospective Cohort study (choice D) since she investigated the exposure
(sleep) and then followed the groups to see who passed and failed (outcome).
A Case Control (Choice A) design would be if she chose students who passed and students who failed
(outcome) and then asked them about how much sleep they got the night before the exam (exposure).
A Cross-sectional trial (Choice B) would look at test-scores and sleep habits in the student population
but wouldnt give any information about associations, odds or causality.
A Historical Cohort study design (Choice C) would be similar to a prospective cohort design except
that all the events would have already occurred in the past, so the data would all be gathered on events
that had already happened.
A randomized controlled trial (Choice E), while problematic ethically, would entail randomized the
students into two groups, one of which would get to sleep and the other would not (intervention) and
then tracking the test results (outcome)
A physician is trying to determine if exposure to substance X is a risk factor for a disease Y, which has a
prevalence of 1 in 10 million. What is the most appropriate study design for her research?
A. Case-Control
B. Cross-Sectional
C. Program
D. Prospective Cohort
E. Randomized Controlled

Check It!

The correct answer is A

A Case-Control study, which compares exposures in patients with the outcome of interest and
controls, would be the best study design since the outcome is very rare. With an outcome with such a
low prevalence, it would be difficult to recruit enough patients to run a prospective cohort study

(choice D), which can be used to compare outcomes in two groups with different exposures.
Randomized Controlled Trials (Choice E) and Program Trials (Choice C) are used to compare
treatments or interventions. Cross-sectional studies (Choice B) cannot be used to establish risk factors,
since all the data is gathered at the same time.
A randomized double-blind placebo-controlled trial to assess the efficacy of drug X in the treatment of
Crohn's disease. 100 people were recruited into the study and were divided equally between the
treatment arm and the control group. Over the course of one year, 90 of the 100 people who were treated
with drug did not incur side effects, whereas 95 of 100 people in the placebo group did not incur side
effects. How many people treated with drug X for one year will suffer from side effects that they would
not have otherwise experienced?
A. 5
B. 10
C. 20
D. 25
E. 50
The correct answer is C
This questions asks you to calculate the Number Needed to Harm (NNH). The NNH is the
reciprocal of the Absolute Risk Increase (ARI). That is, NNH = 1/ARI. ARI = absolute value
of the difference between incidence in the exposed and incidence in the enexposed. In
the case presented, incidence of side effects was the outcome of interest. In the
exposed, this incidence was 10 of every 100 people treated with drug X, and 5 out of
every 100 people treated with placebo. That means that the incidence of effects solely
attributable to drug X in this case is .05, explained by the equation ARI = incidence
exposed - incidence unexposed = 0.1-0.05 = 0.05. Thus, NNH = 1/ARI = 1 /0.05 = 20.

A research study of 100 patients shows that their calcium levels range from 8.8-15.1 milligrams/deciliter
(mg/dL), with a mean of 12.1 mg/dL. The calcium levels fall in a normal distribution, with a standard
deviation of 1.0 mg/dL. Based on this study, we know that the percentage of calcium values below 10.1
is approximately
A. 1%
B. 2%
C. 5%

D. 8%
E. 16%
The correct answer is B
In any normal distribution, standard deviations fall in the following manner:
68.2% fall within one standard deviation of the mean, and 95.4% fall within two
standard deviations of the mean. With a mean of 12.1 and a standard deviation of 1.0,
this means that approximately 4.6% of the calcium values lie outside of [10.1, 14.1].
Since one half of these will fall below this range, 4.6/2 = 2.3. Therefore, approximately
2% of the calcium values are below 10.1. (B)

A researcher develops a new test to detect lung cancer at an earlier stage. The test picks up the lung
cancer in 85% of patients with lung cancer diagnosed by the gold standard and is negative in 90% of
patients without lung cancer. The prevalence of lung cancer in the population of 1000 being studied is
3%. What is the sensitivity of the test?
A. 32.5%
B. 66%
C. 85%
D. 87.5%
E. 90%
The correct answer is C
Sensitivity is defined as the probability that a test will be positive in individuals who are
already known to have the disease, in this case, 85% (choice C).
90% (Choice E) refers to the specificity, or the probability that the test will be negative
in individuals who are known to not have the disease in question.