MCQ

1 Which one of the following is correct about the health risks of smoking in the UK?

A. Around one fifth of all deaths in adults are attributable to smoking.

B. Smoking is a stronger risk factor for heart disease than for lung cancer.

C. There is no dose-effect relationship for smoking and lung cancer.

D. It takes at least 10 years for the risk of heart disease to begin to fall after stopping smoking.

E. Excess death rates resulting from passive smoking have not been established.

2 With regard to smoking, which of the following statements are true?

A. Smoking prevalence amongst adult UK males is the highest in Europe.

B. The health risks associated with smoking are unchanged following smoking cessation.

C. The prevalence of smoking amongst adult women (aged over 16 years) is around 20%.

D. The prevalence of smoking is currently rising amongst adult women (aged over 16 years) in the UK.

E. The prevalence of smoking is greater amongst individuals in non-manual occupational social classes.

3 In a biopractical the intelligence quotient (IQ) scores for 35 Hull and 50 York first year medical students were measured. The overall mean IQ for all 85 students was 130 (95% confidence interval 125 to 135). The mean IQ was 135 for Hull students, and 127 for York students. Boffins at HYMS HQ are eager to compare scores between the campuses and conduct a hypothesis test. Which of the following statements is true?

A. The confidence interval for the overall mean IQ would have been wider if more students had attended the biopractical.

B. The boffins’ null hypothesis is that mean IQ in York is lower than in Hull.

C. If the probability of observing this difference between. York and Hull students were P=0.03, it cannot be a result of chance.

D. The fact that 35% of students were not measured means

bias cannot be excluded as a cause for the observed difference.

E. There is a 5% chance that the difference is relevant.

4 The p-value for the difference in mean systolic blood pressures between two groups of male and female patients is 0.04. Which of the following statements is true?

A. The chance of a type II error is 4%B. The probability of the null hypothesis being true is

0.04C. The p-value is not significant at the 5% level D. The p-value provides evidence that males have a

higher blood pressure.E. There is substantial evidence against the null

hypothesis.

5 Which statement best describes the concept of ‘opportunity cost’?

A. E. The balance between supply and demandB. D. The cost required to maximise opportunityC. A. The difference in resources required to provide two

treatmentsD. B. The reduction in health following use of an ineffective

treatmentE. C. The value of the best alternative use of a resource

6 There has been concern that children living near a local sewage treatment plant are more likely to develop asthma. The local health authority has investigated this claim and compared the incidence of asthma amongst 1,000 children living near the plant with 1,000 children living in a control area away from the plant. Which of the following statements could have been taken from the final health authority report (assuming that the report was well written!)?.

A. “Children near the sewage plant live in houses that are more prone to damp. An association between asthma and living near the plant could simply result from poor housing, - this is an example of recall bias.”

B. “More children living near the sewage works were found to have asthma, the probability of observing this difference was P=0.56 – the difference observed was very

unlikely to be due to chance.”C. “The parents of children living near the sewage plant were

more likely to report symptoms of asthma to the doctor – this is an example of confounding.”

D. “The risk ratio for asthma amongst children living near the sewage plant, compared to children living in the control area, was 3.0. The risk ratio is a measure of the strength of the association between asthma and living near the sewage plant.”

E. “We conducted a case-control study.”

7 Which one of these statements best describes the main effect of randomisation in clinical trials?

A. Ensures study results are generalisable to a wider population.

B. Eliminates bias.C. Provides a fair comparison of treatments.D. Provides a representative sample from a population.E. Maximises external validity.

8 What type of research design is most appropriate for informing doctors about what patients may feel is the most important outcome of a treatment?

A. Systematic reviewB. Randomised controlled trialC. Cohort studyD. Case control studyE. Qualitative study

9 Pearson’s correlation coefficient between systolic blood pressure and body mass index in a random sample of patients registered with a GP practice is + 0.96 with a p-value of 0.001. Which of the following statements is therefore likely to be true?

A. Changes in systolic blood pressure are caused by changes in body mass index.

B. Changes in body mass index are caused by changes in systolic blood pressure.

C. When either variable increases its value by 1 unit, the other variable will increase its value by 0.96 units.

D. High values of one variable will tend to correspond with high values of the other variable, and low values with low values.

E. The association between the two variables is not statistically significant.

EMQ

Topic: Research Study Type

Options:A. Cross sectional surveyB. Case control studyC. Cohort studyD. Randomised controlled trialsE. Systematic reviewsF. Meta-analysisG. Case reportH. Qualitative study

Lead in:

For each of the clinical situations below indicate which type of research study is most appropriate to provide you with evidence to inform your decision.

Stem:10

You want to develop a clinical guideline to inform your practice surround prescription of anti-hypertensive medication.

11

You want to information on the prognosis for a patient with a recent diagnosis of multiple sclerosis.

12

You want to know how many patients in your GP practice are currently taking hormonal contraceptives.

Topic: Organisation of mental health services

Options:A. Community health development workerB. General PractitionerC. Practice nurseD. Community Psychiatric nurseE. Occupational therapistF. PsychologistG. PsychiatristH. PsychotherapistI. Inpatient psychiatric nurseJ. Psychiatric social worker

Lead in:

Which of the above professionals most commonly provides the following services for people with mental health problems in the UK

Stem:13

Care for people with depression.

14

Screening for depression amongst those with chronic physical ill health.

1 Acts as care programme co-ordinator for people with severe mental

5 health problems.

Topic: Common Mental Health Problelms

Options:A. Post traumatic stress disorderB. Obsessive compulsive disorderC. DepressionD. Generalised anxietyE. Phobic anxietyF. AgoraphobiaG. Social anxietyH. Medically unexplained symptoms

Lead in:

Which of the above disorders is most likely in the following case examples

Stem:16

A person has recently lost their job, and comes to the surgery complaining of sexual difficulties and poor sleep.

17

A person who feels unable to come to the surgery and asks for a repeat prescription for benzodiazepines.

18

A person who is physically well, but is unable to drive following a recent car accident.

Topic: The range of expertise involved in managing diabetes in primary care

Options:A. General practitionerB. Practice nurseC. Community nursing sisterD. Specialist diabetes nurseE. GP with a Special Interest (GPSI)F. PodiatristG. Community dieticianH. Practice receptionistI. Community pharmacist

Lead in: For each of the responsibilities below choose the most appropriate individual from the list above.

Stem:19

Co-ordinates the care of patients who attend the practice and consultant diabetologist.

20

Performs medicine reviews and checks on treatment compliance.

21

Performs routine annual reviews of patients with uncomplicated diabetes attending the surgery.