BCSE Preventive Medicine and Public Health 5 — Questions and Answers
Question 1: Which environmental toxin is classically associated with Itai-Itai disease in Japan?
- Mercury
- Arsenic
- Cadmium (Correct answer)
- Lead
Correct answer: Cadmium
Itai-Itai disease was caused by cadmium contamination of rice paddies from mining runoff, causing painful osteomalacia and renal tubular damage.
Question 2: In health services research, 'effectiveness' differs from 'efficacy' in that effectiveness measures:
- Outcomes under ideal controlled conditions
- Outcomes under real-world conditions (Correct answer)
- Cost per quality-adjusted life year
- The maximum possible benefit of an intervention
Correct answer: Outcomes under real-world conditions
Effectiveness measures how well an intervention works under real-world conditions, while efficacy measures performance under ideal trial conditions.
Question 3: The 'inverse care law' proposed by Julian Tudor Hart states that:
- Higher healthcare expenditure leads to worse population health outcomes
- The availability of good medical care tends to vary inversely with the need for it (Correct answer)
- Preventive care is inversely proportional to curative care spending
- Physician density is inversely correlated with health outcomes
Correct answer: The availability of good medical care tends to vary inversely with the need for it
The inverse care law describes how populations with greatest health needs often receive the least adequate medical care, particularly in market-driven systems.
Question 4: Which measure of central tendency is least affected by extreme outliers?
- Mean
- Mode
- Median (Correct answer)
- Weighted average
Correct answer: Median
The median is the middle value of a distribution and is resistant to the influence of extreme values (outliers) unlike the mean.
Question 5: The DALY (Disability-Adjusted Life Year) combines:
- Years of life lost due to premature mortality and years lived with disability (Correct answer)
- Disease incidence and prevalence data
- Mortality rates and healthcare costs
- Quality of life scores and life expectancy at birth
Correct answer: Years of life lost due to premature mortality and years lived with disability
One DALY = one lost year of healthy life, combining years of life lost (YLL) from premature death and years lived with disability (YLD).
Question 6: In the context of infectious disease control, 'quarantine' differs from 'isolation' in that quarantine applies to:
- Confirmed infectious cases only
- Exposed individuals who may or may not be infected (Correct answer)
- Deceased persons with infectious diseases
- Healthcare workers after needlestick injuries
Correct answer: Exposed individuals who may or may not be infected
Quarantine restricts movement of exposed but potentially uninfected individuals, while isolation separates confirmed or suspected cases from others.
Question 7: A community intervention program reduces hypertension prevalence from 30% to 24%. The relative risk reduction is:
- 6%
- 20% (Correct answer)
- 25%
- 80%
Correct answer: 20%
Relative risk reduction = (30% - 24%) / 30% × 100 = 20%, representing the proportional reduction in risk due to the intervention.
BCSE Preventive Medicine and Public Health 5
Which environmental toxin is classically associated with Itai-Itai disease in Japan?