Ethics & Research

Table of Contents
Ethics questions ............................................................................................................................................... 1
* Important to know:................................................................................................................................................. 9

Statistics& Research Questions ....................................................................................................................... 10

*important note* .................................................................................................................................................... 16

EXTRA: for family medicine ............................................................................................................................ 21

Old Epidemiology question (diploma 2016) ............................................................................................................ 21

Collected and Edited by:

Dr. Rasmah Alharajin

2018
 Ethics questions

1- Parents came for external semination and they want to select the sex of their baby:

a. not allowed in shariaa.

b. only doctor can choose the sex.
c. only parents can choosed.
d. it is permissible to prevent x linked diseases..?

* The matter of selection is allowed in our religion (no consensus), but (ONLY the parents can choose, it's not correct because the
physician should be involved in taking the decision and measure the benefits and risks).

2- Pt diagnosed as suspected bacterial meningitis but refuses admission and returns to college:

a. call police to arrest him and not to harm himself.

b. keep confidential and need to disclose
c. disclose and take precautions.
d. report to health authority.

3- Best describe autonomy:

a. pt has right to take decisions about life and bodies.

b. physician has right to take decision.
c. health care should have distributed equally.
d. pt has right to complaint if not satisfied.

4-what is central ethical issue in research:

a. literature.
b. pt confidentiality.
c. consent.
d. adverse effect of drug.

5- Pt. with severe heart disease with very poor prognosis he asked u not to tell his wife because she will not tolerate, then
his wife came to u asking about his condition:

- You should accept his wishes and not to tell his wife. (not sure)

6- A physician picked up a car accident victim from the street and brought him to the ER by his car. He did not want to
wait for an ambulance because the patient’s condition was critical. Physical examination in the ER reveals quadriplegia.

Is the physician liable for this consequence?

- yes, because the physician did not protect the neck of the patient resulting in quadriplegia. (not sure)

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7- pt. diagnosed recently with ovarian CA, u want to start chemo, but she insists to speak to other doctor for other
opinion:

a. transfer her to another specialist.

b. give her contact number of another specialist.
c. let her sign DAMA.
d. talk with the social worker to convince her.

8- pt. with VP shunt infection and decrease LOC , GCS 9 , you plan for emergency surgery but his family refused and
they want to wait till spiritual person will come tomorrow:

a. document and wait 24 hours.

b. proceed with the surgery and contact hospital and health authority. (since it’s an emergency intervention)

9- Pediatric pt. with pyelonephritis seen in ER and was seen in PHC yesterday and he was discharged on Abx. your
opinion this pt should be admitted yesterday:

a. do nothing.
b. explain the mistake by not admitting.
c. discus it with the family medicine in the present of the parents.
d. report to medical board.

* Practical disclosure approach.

10- one of the most recent and prominent schools of ethical judgment is the so-called 4 principles developed by Chilress
and Beauchamp. Use these four principles to answer the question below.

In regard of autonomy:

a. right to make discussions on ourselves.

b. Make sure each patient gets a bed
c. Prescribe only registered drugs
d. Take consent for treatment
e. Do no harm to the patient*

The 4 principles are: (Beauchamp & Childress, 2008)

1. Beneficence. 2. Non-maleficence. 3. Respect for persons. 4. Justice.

- Autonomy – The right for an individual to make his or her own choice.
- (informed consent ‫)حرية المريض في تحديد مصيره واهم جزء فيها هو‬
- Definition of autonomy:
- independence or freedom, as of the will or one's actions
- innate human right of a pt to control access to his or her body and what is done to him or her
-
- Beneficence – The principle of acting with the best interest of the other in mind do the best .. ‫االحسان‬
- Non-maleficence – do no harm ‫ال ضرر وال ضرار‬
- Justice – A concept that emphasizes fairness and equality among individuals.

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11- Pt. gave u a gift and you refused. Next day pt attempted suicide because she felt rejected. What you should do in this
situation:

a. accept the gift and give it to patient charity

b. explain for patient that it's unethical to accept gift then refuse.
c. write paper on OPD door that gifts are unacceptable
d. accept the gift for yourself.

12- pt. was in RTA, he had fractured leg, needs foot amputation, after u explained the risks & benefits of the procedure.
He agreed because he hears voices telling him to do it. what to do:

a. find another decision maker because pt is not competent.

b. proceed to the lifesaving surgery. (since its an emergency intervention)
c. involve another surgeon to confirm the importance of the surgery.

13- Neurologist discover that one of his pt who is known case of epilepsy working as school driver in his wife's school he
told her about him then she fired him what is the appropriate action:

a. the neurologist should advice the pt to not drive?? (not sure)

b. he should break the confidentiality and tell his wife
c. he should tell his wife even if the pt do not permit that
d. the neurologist respect confidentiality and don’t tell anyone.

* basically, tell not to drive. if the pt. refused then to tell his supervisor (here it’s fine to breach the confidentiality because the
harm to the others).

14- Pregnant lady came to your clinic to check HTN at the time of BP measure she extend her arm, regarding consent:

a. Pregnant lady can’t give consent

b. No need for consent, extending her arm considered to be agreement and consent.
c. Don’t take the BP there is no consent

15- A study conducted to evaluate medication among depressed pts. they were not taking their medications regularly:

a. unacceptable study because it affects drug efficacy.

b. acceptable because the pt signed the consent voluntary.
c. unacceptable because we cannot take consent from depressed pts.

16- 15 yrs old girl came with her mother, father was out of town, the girl diagnosed as appendicitis:

a. Explain the procedure to the girl and take consent from the mother.
- < 18 yrs: consent from the parents.
- = > 18 yrs: consent form the patient.

17- Someone from Pharmacy Company came to your clinic and explain to you about their drug and it is already used in
another countries:

a. Take samples for trail.

b. Prescribe the drug since it was used in another countries.
c. The company should provide the efficiency of the drug. ??
➢ All are wrong choices and the ideal answer is: the eligibility of any new drug should be licensed from the
institution.. so, the physician has to inform the institution.

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18- HIV newly diagnosed worry to till his wife and ask not to tell his wife. What will you do:

a. Tell his wife mother and ask her to tell her daughter
b. Tell his wife
c. Protect the patient confidentiality
d. Reassure him and offer your assistance to till his wife.

19-Muslim patient came seeking medical advice, according to scholars (Ulama) according to Islamic jurisprudence ‫الفقه‬,
which statement is true:

a. Shariah law ‫أهم شيء معنى اإلجابة الضرر مزال أو ال ضرر وال ضرار‬

20- Police man came with a guy to ER while you are the physician asking you for alcohol screening, but the guy refused:

- There are no choices (*‫( المفروض ان الطبيب يرفض يسوي تحليل من غير موافقه المريض بالمستشفى‬

21- Which of the following would be the main reason to consider research participants vulnerable?

a. Poorer than other participants

b. Unable to protect their interests
c. Persons with emotional distress
d. Mentally disabled or handicapped

22- - Patient's information disclose:

a. If he agrees to disclose
b. if senior consultant asked to disclose
c. to medical resident for teaching

23- which one of the following is a medical error:

a. mistaken diagnosis or prescription.

b. negligence
c. Management plan not completed as intended

24- Which of the following historical events led to the development of the Nuremberg Code:

a. Kano Trovan Trials

b. Tukegee Syphilis Trials
c. Willowbrook New York Study
d. Nazi Experiments on prisons

25- In which of these situations keeping the confidentiality is most important:

a. Pneumonia
b. Giving birth
c. Dangue fever
d. HIV

Because it is sensitive disease

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26- -what is utilitarianism ‫ المنفعة‬: (‫)اإلجابة مهي موجودة‬

a. the availability and fair distribution and access to supplies?

b. Justice (not sure)
c. Automatism

27- to limit conflict of interest:

a. Extend contact with the patient

b. Extend period of admission
c. Explain ur financial interests

28-- to ensure the pt privacy during the examination:

a. examine the pt in presence of nurse and medical student

b. expose the pt fully
c. examine the pt in presence of chaperone if female.

29-66 year old male admitted to the cardiac unit he has poor prognostic and he told do not tell his wife because she will
not cope with it , his wife come and ask you about him ?

a. tell her
b. do not break the confidential
c. treat the emergency then discuss with her. ?
but we cannot break pt confidentiality ‫ نشجعه هو يقولها‬... ‫الخيارات ناقصه‬

30- Ethics is defined as

a. Governmental regulations
b. Moral principles
c. Good procedures
d. Favored outcome

31- Why public health ethic is concerned:

a. Expansion of researchers
b. Need for experimentation on human subjects
c. Increase organ transplantation
d. Public health affects the whole community

32- What is meant by beneficence:

a. Increase benefits and minimize harm

33-Who is mainly responsible for the ethics in public health research:

a. Principal investigator
b. Accountant
c. Statistician
d. Co- investigators

34-What is the aim of interim analysis of the research data:

a. To assure ethical aspects
b. Supervision of investigation
c. Release funds
d. For publications

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35-Payments for participants in a research is allowed for:
a. Incentives to participate
b. Access to health care services
c. Reimbursement of their out of pocket expenses

36-Ethical issues arising from writing case report:

a. Small sample size
b. Use of patient time
c. Use time of busy clinician
d. Confidentiality

37-Ethical aspects in cross sectional studies should:

a. Questionnaire should be less than ten questions
b. Cause social disruption
c. Increase psychosocial risk
d. Avoid sensitive issues

38-Informed consent doesn’t include:

a. Description of intervention
b. Description of side effects of the intervention
c. History of publications of the investigator

39-Diversity of study participants represents:

a. Differences in culture
b. Differences in compliance

40-For a study design to be ethical should be:

a. Written in details
b. Scientifically sound
c. Containing inclusion characteristics
d. Containing analysis plan

41-First source of Islamic ethics

a. Quran

42-Informed consent is important because:

a. It enables the participant to understand the vital information on the proposed trial
b. It provides the participant with all the information regarding the remote risks
c. It enables the investigator to recruit participant for his choice
d. It promotes clinical research

43-Informed consent refers to:

a. Principle of autonomy
b. Voluntary but uniform decision making
c. Voluntary decision to participate in research by competent individual who has received and understand the
necessary information

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44-What gives the ethical validity to the …. informed consent
a. Detailed documentation to the process
b. Capacity of participant to consent
c. Quality of the disclosed information
d. Quality of the interaction between the prospective participant and the recruiting physician and investigator

45-Who gives consent in case of minors who have no parents or guardian:

a. Social worker
b. Legal guardian

50-Vulnerable populations are those best characterized as:

a. Relatively poor persons
b. Persons experiencing emotional distress
c. Non-citizens residents
d. Persons who are mentally incompetent

51-Scientific misconduct refers to

a. Researcher accidentally misquoting his data
b. Fabrication, falsification and plagiarism
c. Failure to achieve expected results
d. Accidentally failure to cite a source

52-Which of the following are susceptible to conflict of interest:

a. Author
b. Researcher
c. Editor
d. All of the above

53-Which of the following scenarios likely lead to generate conflict of interest:

a. Researcher from drug company

54-In patient safety ROP is abbreviation of:

a. Required Organization Practice

55-Patient safety areas include:

a. Medication use
b. Work life
c. Infection control
d. All of the above

56-Which of the following approaches may lead to increased levels of patient understanding?

a. Providing medical pamphlets.

b. Giving verbal instructions for taking medications.
c. Having the patient restate in his/her own words the directions that have just been given. (FM promotion 2017)
d. Explaining how to use several different medications during the same session.

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57-diabetic patient not taking his meds for 2 weeks. What action to improve his adherence:

a. Having the patient restate in his/her own words the direction that have just been given. (FM promotion 2017)

58-When approaching patients about their use of complementary and alternative medicine (CAM), what is the
physician’s primary objective?

a. To discourage patients from seeing CAM healthcare providers.

b. To promote the patient’s adherence to prescribed medication in addition to CAM.
c. To establish an open discussion about all aspects of the patient’s health care. (FM promotion 2017)
d. To gradually dissuade patients from using CAM.

59-What approach should physicians use in taking care of uncooperative, self-abusing, or disruptive patients from a low
socioeconomic group?

a. Establish authority in the patient–doctor relationship by using stern language.

b. Refrain from following up on such patients when possible.
c. Ensure that personal biases do not taint clinical judgment. (FM promotion 2017)
d. Allow patients’ self-destructive behaviors to subside before administering treatment.

60-hypertensive patient has bad behavior with staff……..:

a. Personal bias should not affect clinical judgment (FM promotion 2017)

61-How should physicians and office staff respond to patients who chronically miss appointments?

a. Assume the patient does not want treatment and ask him/her to change doctors.
b. Bill the patient for the missed appointment when he/she is a “no show.”
c. Speak directly to the patient about the missed appointments. (FM promotion 2017)
d. Accuse the patient of being insensitive and taking up valuable time.

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 * Important to know:
A) Incompetent to decide on their treatment and to sign a consent:

1. Children below the age of majority (< 18 years old).

2. Mentally ill.
3. Unconscious.

B) The main ethical issues that related to Malpractice:

1. Patient autonomy.
2. The beneficence of the patient and non-beneficence also.
3. Justice: Patients need their rights and right to compensation.
4. Truth telling.
5. Confidentiality.
6. Informed consent.
7. The relationship between a physician when he makes a disclosure and the patient, who must be supported, must be
transparent.

C) Common types of medical errors are as follows:

- Surgery-related as in obstetrics and gynecology, general surgery, orthopedic, cardiac and plastic surgery.
- Medication-related like mismanagement and possibly incorrect medication, wrong prescription or dosage, and
inadequate instructions to patient.
- Body-fluid-related error, e.g. blood transfusion administered too quickly, which resulted in congestive heart failure and
death.
- Diagnostic error, such as misdiagnosis leading to an incorrect choice of therapy.
- Failure to order necessary diagnostic test, misinterpretation of test results, and failure to act on abnormal results.
- Equipment failure, for instance defibrillators with dead batteries or intravenous pumps whose valves are easily
dislodged or bumped which cause increased doses of medication over too short a period.
- Others, including medical reports, file errors.

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 Statistics& Research Questions

1- A study conducted in Saudi Arabia about the association between gender, age, blood pressure, smoking
and risk of cardiovascular disease. Parameters are: Age (in years) _ gender (male or female) _ BP (numbers)
_ smoking status (nonsmoker, Occasionally smoker, Heavy smoker).
* Choose two parameters to compare using Chi Square:
a. age and BP
b. Smoking + BP
c. gender + smoking.
d. heart disease+ smoking.

2- what is the best source of literature:

a. internet.
b. annular review.
c. primary sources.
d. information relative system

3- Case scenario about study to be conducted on population DM, HTN

- Age
- Heart disease
- Smoking
- Systolic BP
Which of the following can be used for t-test?
a. Smoking and systolic blood pressure

4- When you are assessing age with heart disease

Chi-square is used to compare between qualitative (categorical) data that has no numbers. Here, the age is measured
in years (numbers) and heart disease is not, so we should think of T-test
Two points to help:
a. Keep in mind guys, Chi-Square test is used when you are analysis Qualitative categorical variable.
Example Smoker (smoker-nonsmoker) and heart disease (diseased- not diseased)
Qualitative variables have values that describe a 'quality' or 'characteristic' of a data unit, like 'what type' or
'which category'. Therefore, it tends to be represented by a non-numeric value as; (yes or no) (Diseased not
diseased) and so on.
Example: sex, eye color, smoker- nonsmoker….

b. T-test is used when your dependent variable is Numeric or Qualitative and it is looking for the mean.
Example: mean blood pressure between smoker and non-smoker (blood pressure measured by numbers,
isn’t it?)
Quantitative variables have values that describe a measurable quantity as a number, like 'how many' or 'how
much'. Example: height, time, age, temperature and blood pressure.

5- All the variable Quantitative except:

- No choices ‫الحل بالنوت فوق‬

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6- When you are testing population with risk factor for cancer:
b. Prospective cohort.
c. Case-control study
d. RCT
e. cross sectional.

7- the best in practice:

a. Follow protocol and guidelines.

8- when u increase the population size the width of confidence interval will:
a. Decrease.

9- Study conducted on obese patient for the risk of angina P< 0.04:
a. This means that angina will be more in obese patients

N.B: P value here <0.05 so it’s significant, that our hypothesis is true, there is a relation between obesity and angina.

10- question about investigator want to see the association between the pt. gender and mortality. The null
hypothesis:
a. female mortality # male mortality (no relation)
b. female mortality =male mortality.
c. an association between mortality ……………

11- question about age of participants: 12,29,29,31,47,64,64,74

Which of the following is central tendency to have more than one value?
a. mode
b. range
c. median.
d. variance.

NOTE:
Mean: ‫ المتوسط‬the "average" number; found by adding all data points and dividing by the number of data points.
Median: ‫ الوسيط‬the middle number; found by ordering all data points and picking out the one in the middle (or if
there are two middle numbers, taking the mean of those two numbers).
Mode: ‫التكرار‬The most frequent number- the number that occurs the highest number of times. If two modes is
called bimodal, three modes trimodal.
Range: a data set is the difference between the largest value and smallest value contained in the data set.
First reorder the data set from smallest to largest then subtract the first element from the last element.

Example: (2, 5, 9, 3, 5, 4, 7)

• Mean: = (2 + 5 + 9 + 7 + 5 + 4 + 3) / 7 = 5
• Median: Reordered = 2, 3, 4, 5, 5, 7, 9 then, = 5
• Mode = 5
• Range: Reordered = 2, 3, 4, 5, 5, 7, 9, Range = (9 - 2) = 7

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12- Name of a statistical graph (histogram)

13- Research of 80 people (sample) result came 35% prevalence of something 95% CI between 25-45. If
increase sample size what will be the CI:
a. decreased
b. increased
c. same
d. reach up to 50%.

14-2 groups, one on placebo and other on analgesia, p value = 0.002. What does it mean?
a. Effective drug
b. Has evidence

The ideal answer is: there is STRONG evidence that the medication is effective. Remember this study result tells
that the medication can be statistically significant but still not clinically significant.

15- different numbers (47,85,84,73,63,46,63)

Most frequent value represents?
a. mode.
b. mean
c. median

16- what dose P-value mean?

‫هذي المعلومة من قوقل‬...‫السؤال وصلنا بدون خيارات‬

a. The probability of getting the results you did (or more extreme results) given that the null hypothesis is
true.

17- when to use chi-square?

‫هذي المعلومة من ملزمة الهيئة‬...‫السؤال بدون خيارات‬
a. It is a test used for assessing the association between two categorical variables, such as association
between physical activity (yes versus no) and hypertension (yes versus no).

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18- what is the type of study, 2 groups were followed after exposure to risk factor:
- Cohort.

19- table 2x2 want you to calculate (epidemiological measures of association):

- Measure relative risk

20- a new drug for disease prevent death but not cause recovery from disease.
- This will increase prevalence.

21- A study was conducted to determine if there is a difference between smokers and nonsmokers in the systolic blood
pressure (in mm Hg). A total of 100 persons were asked about their smoking status and their blood pressure was
measured. Which statistical test of significant is most appropriate
b. T- test.
c. ANOVA
d. Chi square
e. Correlation

Variables here:
1- smoking status (yes-no) (categorical)
2- blood pressure level(continuous)
*Continuous with categorical = t test

23- A study was conducted to determine if there was a difference in the prevalence of diabetes mellitus among health care
workers in Riyadh. The results showed that 30 out of 100 doctors were diabetic as compared to 50 out of 200 nurses.
Remember: (doctors – Nurses) (Diabetic- nondiabetic)
Which is the most appropriate statistical test?

a. a.t-test
b. ANOVA
c. Chi-square.
d. Correlation

24- A study was conducted to evaluate the benefits of an intensive exercise program in reducing subsequent mortality
among persons who survive after an initial myocardial infarction. Patients were randomized to receive either usual care
(controls) or the exercise program. Among 100 controls, 50 died within the three-year follow-up period, compared with 30
deaths among the 100 patients on the exercise program. What was the relative risk of death for the exercise group
compared to controls?
Control 50/100 = 0.5 exercise 30/100= 0.3
RR. of exercise to control = 0.3/0.5= 0.6
a. a.0.30
b. b.0.60
c. c.1.67
d. d.3.33

25- a group of children were exposed to a medication, you want to study exposure risk in compare to non-exposed group,
what type of study design:
a. cross sectional
b. cohort
c. case series
d. case control

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26- A sample of 100, you want to compare blood pressure measurement between smokers and nonsmokers, you divided
them into two groups and compare, what type of statistical analysis you will use:
a. ANOVA
b. Chi-square
c. unpaired student t test
d. correlation

26- Study of intern’s weight 75 -+10 kg, what is the percentage of weight that range between 65-85 kg :
-%95
-%50
-%30
-%5
SD‫ غالبا ً يسأل عن طريقة حساب ال‬،‫السؤال ناقص‬
Mean is 75, standard deviation is 10, if the range between 65-85, so 75 -+ 20
CI 95%= 2 standard deviation

27- you are conducting a study about HTN, after you measured the blood pressure you found that the mean BP is 150 +
20 ... you select Confidence level 95%, what is the confidence interval:
a. 110-190
b. 130-170
c. 145-155
d. 90-210

Mean is 150, standard deviation is 20, if you choose confidence level 95% this
Means that you will have 2 standard deviations above and below the mean.. So
150+40 and 150-40
Remember:
CI 68% = 1 standard deviation
CI 95%= 2 standard deviation
CI 99% = 3 standard deviation

28- best study to assess the relationship between Bluetooth headsets and brain cancer?
a. retrospective cohort.
b. case control
c. Ecological

29-500 babies who were exposed to diethylstilbestrol in utero were followed up for 20 years and the occurrence of cancer
in this group was compared with that of 1500 babies not exposed to DES, over the same period of time. What is the study
design?
a. Cohort
b. Case control
c. Cross sectional
d. Correlation study

Cohort: Exposure → outcome

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30- what is the best relation between treatment 1 and treatment 2 who were given to 2 groups of patients treated / not
treated (treatment efficacy)
T1 40 / 60 Disease
T2 60 / 40 +ve -ve

a. 0.4 T1 40 60 0.6
b. 0.67 T2 60 40 0.4
c. 1.5 (Placebo)
d. 2.5
* RR calculation. = 0.6

31- Calculate Range for next values:16,11,14,13,12,11,13,12,1

- Range=Biggest value-smallest
- Equal to 16-11=5

32- Meta analysis meaning:

- It is an excellent source to review literature

33- new drug for analgesia its P value 0.002 for decrease the pain what that mean:
a. good drug.
b. drug is reducing pain
c. clinical evidence to use this drug.

34. study of 2 groups of embryos one group of 5000 exposed to radiation and the other group of 1500 was not. we study
the complication on both groups. what is the type of study:
a. cohort
b. cross-sectional
c. case-control
d. clinical trial

Cohort: Exposure → outcome

35- equal groups of patients one was given antihypertensive drug and the other not. after while their BP was measured.
what is the test of choice for such study:
a. T test
b. Chi square
c. correlation
d. ANOVA

36. different weights (12, 13, 13, 14, 14, 14, 21) this distribution is:
a. unimodal
b. bimodal
c. multimodal

37. different ages, 75, 89, 82, 83, 85, 86, 90 what is the mode?
- 89
- 75
- 82
-none
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 *important note*
*Study Design
Study type Key features

Participants randomly allocated to intervention or control group (e.g. standard treatment or

Randomized controlled
placebo)
trial
• Practical or ethical problems may limit use
Two (or more) are selected according to their exposure to a particular agent (e.g. medicine,
toxin) and followed up to see how many develop a disease or other outcome
Cohort study • The usual outcome measure is the relative risk.
• able to measure the incidence/risk of a disease.

Patients with a particular condition (cases) are identified and matched with controls. Data is
then collected on past exposure to a possible causal agent for the condition
The usual outcome measure is the odds ratio.
Case-control study
• Inexpensive, produce quick results
• Useful for studying rare conditions
• Prone to confounding
• Provide a 'snapshot', sometimes called prevalence studies
Cross-sectional survey • Provide weak evidence of cause and effect

Intervention→RCT Prognosis→cohort study Rare disease→case control Screening → cross sectional

Prevention→RCT Incidence→cohort Risk factors→case control Prevalence→cross-sectional
Treatment→RCT Rare exposure→cohort Diagnosis→cross-sectional

*Normal Distribution 'bell-shaped' distribution.

*Symmetrical i.e. Mean = Median = Mode
*Positively skewed distribution: mean > median > mode
*Negatively skewed distribution mean < median < mode

*Confounding: refers to a variable which correlates with other variables within a study leading to spurious results.

Example: a study which finds that people who drink coffee are more likely to develop heart disease. The
confounding factor in this study is smoking. Smoking is associated with both drinking coffee and heart disease.
People who drink coffee are also more likely to smoke. In this case smoking confounds the apparent
relationship between coffee and heart disease.

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 *Quantitative concepts in EBM*

Measure of association: Is Disease associated with Exposure?

• Odds Ratio
• RR/RRR/ARR/NNT
• Sensitivity/ Specificity
• Likelihood ratio
• Confidence intervals
• P value

Diseased

Yes No Total

Exposed yes a b a +b

No c d c +d

a+c b+d n

Odds Ratio is a measure of association which compares the odds of disease of those exposed to the odds of
disease those unexposed, ……a measure of association between an exposure and an outcome.

• Seen in prognostic studies, Case- Control, Cohort

Interpretation:

• OR =1 → no different

• OR < 1 →The event less likely to occur in the exposed group.

• OR > 1 →The event more likely to occur in the exposed group

*Relative risk (RR) (or risk ratio/ Risk Remain):

proportional measure estimating the size of the effect of a treatment compared with control

(RR=EER / CER).

Relative Risk = incidence of disease among exposed =

Incidence of disease among non-exposed

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Interpretation:

• RR= 1 → no difference in event incidence

• RR> 1 →Chance of a bad outcome more likely to occur with the treatment (favor control)
• RR< 1 →Chance of a bad outcome more likely to occur without the treatment (favor ttt)

*when the RR is 2.0 the chance of a bad outcome is twice as likely to occur with the treatment as without it, whereas an RR of
0.5 means that the chance of a bad outcome is twice as likely to occur without the intervention.

Relative Risk Reduction (RRR) how much reduction of risk the treatment makes in relative terms

(RRR) tells you by how much the treatment reduced the risk of bad outcomes relative to the control group who did not have the
treatment.

• RRR= 1- RR
• E.g. RRR= 100% - RR (100% - 80% = 20%)
• The treatment is reduced the risk of death relatively by 20% in compare with control group

Absolute Risk Reduction (AAR) = CER (Control Event Rate) – EER (Experimental Event Rate)

Number needed to treat (NNT): Number of patients you need to treat to prevent one bad outcome. NNT=1/ARR

Attributable Risk (AR) : AR = [incidence in the exposed] - [incidence in the non-exposed]

Number needed to harm (NNH): Number of patients who needed to expose to a risk factor for 1 patient to be harmed.
NNH=1/AR

Sensitivity: Probability of a positive test among patients with disease = a/a+c x 100  ‫بالجدول شكله سهم نازل‬

Specificity: probability of a negative test among patients without disease= d/d+b x 100 ‫بالجدول شكله سهم صاعد‬

Positive predictive value (PPV): probability of a person with positive test actually has the disease = a/(a+b) →

Negative predictive value (NPV): probability of a person with negative test actually has no disease= d/(c+d) 

✓ More sensitive test means more better NPV

✓ More specific test has better positive predicted value
✓ These values affected by the disease prevalence if prevalence decreased the PPV decreased and in increase prevalence
the PPV increase.

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The likelihood that a given test result would be expected in a patient with the disease, compared to the likelihood that that same
result would be expected in a patient without the disease

Interpretation
• LH +ve = Sen /(1-Spec)
LH Impaction Conclusion
• LH –ve = (1- Sen) / Spec
> 10 & < 0.1 Large Always
1-2 & 0.5-1 Small Rarely
2-5 & 0.5 – 0.2 Small Sometimes
5-10 & 0.1- 0.2 Moderate Often
Summary:

A p-value only tells you the likelihood that the results were due to chance.

P-value <0.05 statistically significant

Confidence intervals C.I. is the range within which you are sure that the actual (true) value lies.

Presented as 95% confidence

• Means: if the study is repeated multiple times, 95% confident that the result will be within that range .
• A confidence interval combines statistical and clinical significance
• The larger the sample size, the less is the width of the C.I. and vice-versa
• The less the width of the C.I. The more precise is the answer and the vice-versa

Mortality rate:

Incidence= Number of NEW CASES / population-at-risk

Prevalence= Number of cases that existed (old &new) in a given period ÷ Number of people in the population during this period

Infant mortality rate (IMR) is the number of deaths per 1,000 live births of children under one year of age.

Maternal Mortality: The number of maternal deaths per 100,000 live births.

Disease Specific Mortality (Case fatality Rate): number of deaths from a specified disease over a defined period of time

÷ the number of individuals diagnosed with the disease during that time.

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Descriptive and inferential statistics:

Descriptive study:

* For categorical variables→ use Proportions (frequency and chi squired)

* For Continues variables→ use (Mean and standard deviation)

Nominal → more than 2 variables eg. blood groups, country of origin.

Dichotomous → yes or no eg. DM, HTN, smoking

T-test→ compare means of 2 continues outcomes (predictor Dichotomous)

• Paired t-test (same group) → used when two measurements is taken on the same subject eg. measuring BP of male before
and after exercise.
• Unpaired student t-test (two groups)→ used when same measurement is compared on two independent groups eg.
measuring BP in male comparing to female

ANOVA→ more than 2 groups (3 or more) when predictor variable is categorical, and outcome is Continuous.
• One way→ in same group eg. measuring BP of pregnant during first, second and third trimester and compare
• Two-way ANOVA→ impact of 2 or more predictor simultaneously eg. impacts of occupation and race on mean cholesterol

Correlation→ measuring relation of two continues variables.

E.g. baby age and weight … presented with (pearson correlation) in graph.

Logistic regression →model effects of variables on a dichotomous outcome

eg. Like to be a male and smoker and having IHD

Summary : when to use each one of inferential statistics

Predictors Outcome
Continuous variables Dichotomous
Continuous Pearson correlation or Linear Logistic regression
regression
Nominal > 2 Category )ANOVA ( Chi-square test
Dichotomous t- test Chi-square test

*eg. If the predictors (variables) Dichotomous & the outcome is Dichotomous → use Chi-square test

Smoking (Dichotomous) and ischemic heart disease (Dichotomous) → Chi-square test

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 EXTRA: for family medicine

Old Epidemiology question (diploma 2016)

1. While investigating a point source epidemic it was found that 120 students ate five different foods (meat burgers, fried
fish, steak, rice and fruit salad). The relative risk was calculated for all those five foods. It was concluded that fish was not
responsible for this epidemic. The relative risk of fish is:
a. 0.7
b. 1.2
c. 1.7
d. 3.0
e. 7.0

2. Validity can be defined as:

a. The degree to which an instrument measures what it is supposed to measure.
b. The degree to which results are consistent on a repeat measurement
c. A measure of the degree or strength of association between two variables.
d. Concerned with measuring the frequency of new cases with reliability
e. None of the above

3. Reliability can be defined as:

a. The degree to which an instrument measures what it is supposed to measure
b. The degree to which results are consistent
c. A measure of the degree or strength of association between two variables
d. Concerned with measuring the frequency of new cases with reliability
e. Ensuring that patients all take a test under the same conditions

4. Fluoridation of water would be an example of :

a. A primary prevention strategy
b. A secondary prevention strategy
c. A tertiary prevention strategy
d. It is not a prevention strategy

5. A researcher is interested in knowing how many new cases of the measles developed at St. Theresa’s Elementary
School in April 2001. Assuming that no children enrolled during that month, and no children moved during that month
(all children were followed for the entire month), which measure of morbidity would be most appropriate in answering
this question?
a. Prevalence
b. Point prevalence
c. Cumulative Incidence
d. Incidence Density
6. The resistance of a population to an attack by a disease to which a large proportion of the members of the group are
immune is referred to as…
a. group resistance
b. population immunogenesis
c. herd immunity
d. the Panum Effect

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 7, In an outbreak of cholera in a village of 2,000 population, 20 cases have occurred and 5 died. Case fatality rate is:

a. 1%
b. .25%
c. 5%
d. 25%
e. .0025%

8. Patient admitted for carcinoma of stomach are age and sex matched, with smoking history to assess the possible
association .which option explain the given example ?

a. Case series report

b. case control study
c. clinical trial
d. cohort study
e. case report

9. A doctor is required to study an incidence of silicosis in a stone cutting industry which design should be used :
a. Longitudinal
b. Cross-sectional
c. Ecological survey
d. Case report
e. Case series report

10. in a given population prevalence of disease can be rapidly determined by

a. case control study
b. cohort study
c. cross sectional study
d. cross over study

11. use the following steps in outbreak investigation:

1. analyze data by time, place and person
2. conduct a case control study
3. generate hypothesis
4. verify diagnosis
5. confirm the number of cases exceeds the expected number
6. talk with laboratories about spacemen collection
for an investigation of outbreak , what is the logical conceptual order of the step listed above ?
a. 1-2-3-4-5-6
b. 4- 5-1-2-3-6
c. 5-4-3-1-2-6
d. 5-4-6-1-3-2

12. which of these disease is transmitted by airborne:

a. meningitis
b. Cholera
c. Ebola
d. TB
e. Zika

13. if a disease simultaneously affects persons of several countries or continent and affects them in number in clear excess
of normalcy the disease is said to be :
a. endemic
b. epidemic
c. pandemic
d. zoonotic

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 14. The natural history of disease refers to
a. the progress of disease in an individual over the time
b. the period between exposure and first symptoms
c. the period from first symptoms to recovery , disability or death
d. the broad scope of manifestation of disease in different individual

15. What is proportion that uses a standard denominator and includes a time interval 1000 , 10,000 100,000 per year ?
a. Rate
b. Count
c. Proportions
d. Index

16. Cedar Rivers is a community of 100,000 persons in central Iowa. During the year of the floods (2008) there were 1,000
deaths from all causes. A study of all cases of tuberculosis found the number of deaths at 300 (200 males and 100 females).
During 2007, there were only 60 deaths from tuberculosis, 50 of them males. The crude mortality rate for Cedar Rivers in
2008 was:
a. 300 per 100,000
b. 60 per 1,000
c. 10 per 1,000
d. 100 per 11000

17. according to Saudi register cancer 2008 , the commonest cancer in KAS
a. colorectal cancer
b. lung cancer
c. NHL ( non-Hodgkin lymphoma )
d. breast cancer
e. liver cancer

18 .The risk factor/s associated with liver cancer is / are :

a. HBV (Hepatitis B virus), HTCLV human T cell leukemia virus and aflatoxin
b. HBV and HCV (hepatitis C virus) and aflatoxin or dioxin
c. HTCLV ( human T cell leukemia virus)
d. HB ( Hepatitis B virus) and HCV ( hepatitis C virus )
e. EBV (Epstein bar virus)

19. The most common cancer among Saudi children is

a. Lymphoblastic leukemia
b. lymphoma
c. Neuroblastoma
d. Wilms' tumor
e. non-Hodgkin's lymphoma

20. which the following cancer has the lowest relative all stages 5-year survival rate:
a. Pancreas cancer
b. Liver cancer
c. Stomach cancer
d. Melanoma
e. Breast cancer

21. The most effective tool of measuring incidence of a disease in a community is

a. case control study
b. Cohort study
c. cross-sectional study.
d. cross over study

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 22. In the definition of epidemiology, the terms "distribution" and "determinants" taken together refer to:
a. Frequency, pattern, and causes of health events
b. Dissemination of information to those who need to know
c. Knowledge, attitudes, and practices related to health
d. Public health services and resources

23. which one of the following is the 1st class infectious disease notification ?
a. Hepatitis A
b. Hepatitis B
c. Cases with side effects of the vaccines
d. Rabies
e. Chicken Pox

24. The primary difference between an experimental and observational study is:
a. The investigator is "blinded" (prevented from knowing the subjects' true exposure status until the end of the study)
in an experimental study but not in an observational study
b. The investigator controls the subject's exposure in an experimental study but not in an observational study
c. The investigator controls the subject's outcome in an experimental study but not in an observational study
d. Experimental studies are conducted with animals, observational studies are conducted with humans

25. A registered medical are within infectious diseases to the higher authority from the disease. what is X?
a. 24 Hours
b. 1 week
c. 2 days
d. 4 Weeks
e. 3 Months

26-A study began in 1970 with a group of 5000 adults in Jeddah who were asked about their fat consumption. The
occurrence of colon cancer was studied in this group between 1990-1995. This is an example of :
a. Cross sectional study .
b. Retrospective study
c. Concurrent cohort study
d. Case-control study

27- The degree to which the finding of the study can be generalized to wider population is known as :
a. Analysis validity
b. Construct validity
c. Internal validity
d. External validity

28-One of preoccupations of quantitative researches is with generalization , which is sign of :

a. External validity
b. Internal reliability
c. External reliability
d. Internal validity

29-Open-ended questions provide primarily ____________ data.

a. confirmatory data
b. qualitative data
c. predictive data
d. None specific data

30- What effect does increasing the sample size have upon the sample error .
1. It reduces the sample error
2. It increase the sample error

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 3. It has no effect on the sample error
4. It has minimal effect

31-Which of the following is not Type of non-probability sampling ?

a. Snow ball sampling
b. Stratified random sampling
c. Quota sampling
d. Convenience sampling

N.B :
probability sampling : cluster , simple random , stratified random and systematic
Non probability sampling : Quota sampling , Convenience sampling and Snow ball sampling

32-The findings from study of young single mothers at university can be generalized to the population of :
a. All young single mother at university
b. All young single mother at society
c. All single mother in all university
d. All single mother in that university

33-What is the research design ?

a. The choice between using qualitative and quantitative methods
b. Away of conducting research that is not grounded in the theory
c. The style in which you present your research finding e.g. a graph
d. A frame work for every stage of the collection and analysis of data

34-Internal validity :
a. Whether or not there is causal relationship between tow variables
b. Whether or not the finding are relevant to the participants' everyday lives
c. The degree to which the researcher feels that this was a worthwhile project
d. How accurately the measurements represent underlying concepts

35-In experimental design , the dependent variable is :

a. the one that is not manipulated and in which any changes are observed.
b. the one that is manipulated in order to observe any effects on the other.
c. a measure of the extent to which personal values affect research
d. an ambiguous concept whose meaning depends on how it is defined.

36- What is a cross-sectional design?

a. A study of one particular section of society, e.g. the middle classes.

b. One that is devised when the researcher is in a bad mood.
c. The collection of data from more than one case at one moment in time.
d. A comparison of two or more variables over a long period of time.

37- Survey research is cross-sectional and therefore:

a. High in replicability but low in internal validity.

b. High in internal validity but low in reliability.
c. High in ecological validity but low in external validity
d. None of the above

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38- a research question is important to :
a. limit your research in the literature
b. Focus your search for literature
c. Write the literature
d. Summarize your literature

42- A sampling frame is:

a. A summary of the various stages involved in designing a survey

b. An outline view of all the main clusters of units in a sample
c. A list of all the units in the population from which a sample will be selected
d. A wooden frame used to display tables of random numbers

43-A simple random sample is one in which:

a. From a random starting point, every nth unit from the sampling frame is selected
b. A non-probability strategy is used, making the results difficult to generalize
c. The researcher has a certain quota of respondents to fill for various social groups
d. Every unit of the population has an equal chance of being selected

44-Which of the following answer to your research question would indicate that you designed a low impact research
question?
a. The answer is yes.
b. The answer is no.
c. The answer is either yes or no.
d. The answer is unclear

45-What kind of idea cannot be empirically researched?

a. Effectiveness of different methods of instruction

b. Description of educational practices
c. Issues of values and morality
d. Factors helpful in predicting future drug use

46- For normal curve, mean ± 2SD covers area :

a. 95%
b. 68%
c. 99%
d. 100%

47-For 60kg male patients the minimum daily protein requirement has been calculated to be 40g (mean) and SD is 10 . the
recommended daily allowance of protein would be :
a. 40g/d
b. 50g/d
c. 60g/d
d. 70g/d

N.B : mean = 40
Mean± 1SD = 40±10 = 68% of population (50g)
Mean± 2SD = 40±20 = 95% of population (60g)
Mean± 1SD = 40±30 = 99% of population(70g) ‫ من الناس هوا اللي ريكومندد‬%99 ‫ناتج الـ‬

26
48-In a symmetrical distribution , the mean value is 30 and median value is 30 . the value of mode can be :
a. 60
b. 0
c. 30
d. 15

49-The PEFR of group of 11 years old girls follow a normal distribution with a mean of 300 L/min. the correct statement
would be :
a. The girl have health lung
b. About 95% of girl have PEFR between 260 and 340 L/min
c. About 5% girl have PEFR below 260 L/min
d. All PEFR must be less than 340 L/min

50- which of the following is a correct statement?

a. arithmetic mean is always the best measure of central tendency
b. In a symmetrical distribution mean , mode and median is equal
c. Standard deviation is major of central tendency
d. The mode of distribution is the value that has lowest frequency

51- which one of the following variable is ordinal ?

a. school level
b. region of the kingdom
c. systolic blood pressure
d. income of the subject

52-which one of the following variable is qualitative ?

a. systolic blood pressure
b. region of the kingdom
c. income of the subject
d. age of the subject

53- A cohort of 150 diabetic patient is randomly assigned into three groups of three different treatments, To compare the
mean blood glucose level in studied groups after one month of treatment , you will use :
a. Chi-square test
b. Paired t test
c. Analysis of variance ( ANOVA)
d. Correlation

54-Chi –square test is :

a. Is parametric test
b. Used with numerical data
c. The data must consist of variable that are correlated
d. Used to test for relationship between 2 categorical variable

55-When comparing pre and post treatment results for one group which one of the following tests should be used ?
a. ANOVA
b. T-test for paired sample
c. Chi-square test
d. T-test for independent sample

56-When compare normally distributed variable for 3 groups we use :

a. Chi-square test
b. T-test
c. Mean and SD
d. ANNOVA

27
57-A statistical test used to compare the sample mean with the mean population is :
a. ANNOVA
b. Chi-square test
c. Simple regression
d. Student T-test

58-To study rare exposures , we should use :

a. Case control
b. Case report series
c. Cross sectional
d. Cohort prospective study
N.B : Exposure Not Disease

59-The standard deviation is :

a. A measure of location
b. Equivalent to range
c. A measure of dispersion of data
d. A measure of central tendency

60-The best diagram presenting the relationship between blood pressure and age is :
a. Scatter plot
b. Histogram
c. Pie chart
d. Segmented bar chart

61- Gender ( male – female ) is considered :

a. Continuous quantitative data
b. Discrete quantitative data
c. Nominal qualitative data
d. Ordinal qualitative data
62- Blood group is considered :
a. Continuous quantitative data
b. Discrete quantitative data
c. Nominal qualitative data
d. Ordinal qualitative data

63-Variables that are expressed in number or quantities and contain fractions are :
a. Continuous variables
b. Discrete Variables
c. Nominal Variables
d. Ordinal Variables
e. Grouped data

64- The observation which has the highest frequency is called :

a. Mean
b. Median
c. Mode
d. Variance

65-One of the followings Not measure central Tendency :

a. Mean
b. Range
c. Mode
d. median

28
 66-We measured the HB level of 300 normally distributed children . the mean HB was 12 mg/dl and SD was 2 . then the
number of children with HB level 8-16 mg/dl is "
a. 285
b. 204
c. 68
d. 95
N.B ; mean = 12 , SD=2 so , Mean ±1SD = 68% of population : 12 ± 2 = (10-14)
Mean ±2SD = 95 % of population : 12 ±4 = ( 8-16)
Number of children with HB = 95% of ( 300 children ) = 95*300/100 = 285

67-the HB level of 300 normally distributed children was measured . the mean HB was 12 mg/dl and SD was 2 . what
would be the median HB ?
a. 10 mg/dl
b. 14 mg/dl
c. 12 mg/dl
d. 8 mg/dl

68-We measured the HB level of 300 normally distributed children. the mean HB was 12 mg/dl and SD was 2 . where
would a child with HB level 11 mg/dl lies within?
a. One standard deviation
b. Tow standard deviation
c. Three standard deviation
d. Four standard deviation

69-An alternative hypothesis is :

a. The null hypothesis
b. The correct hypothesis
c. To be accepted if null hypothesis is rejected
d. To be accepted if null hypothesis is accepted

70-The area between 3SD on either side of the mean ( X ± 3SD ) will include approximately the following percentage of value
in the distribution :
a. 68 %
b. 95%
c. 99%
d. 90%

71- As a general rule , researchers tend to use ………. As significance level :

a. 10%
b. 5%
c. 1%
d. 0.1%

72- On studying the relationship between aspirin and MI odd's ratio was calculated to be 0.5 and its 95% CI was 0.4 – 1.3 ,
then it could be interpreted as :
a. Positive association
b. Negative association
c. Significant relation
d. Insignificant relation

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GOOD LUCK.

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