Deck 17: Epidemiology and Infection Control

Question 1

Epidemiology may be defined as

A) the science that studies the etiology of a disease process
B) the science that studies the connection between a pathogen and a specific disease
C) the science that studies the patterns, sources and spread of disease in populations
D) the science that studies the patterns, sources and spread of disease in individuals

Answer 1

C

Question 2

The definition of an outbreak is:

A) a localized increase in the number of cases of illness in a particular place and time that is higher than expected
B) a widespread increase in the number of cases of illness in a particular place and time that is higher than expected
C) a geographically widespread increase in the number of cases of illness across a continent during a specific time frame that is higher than expected
D) an internationally widespread increase in the number of cases of illness within a hemisphere during a specific time frame that is higher than expected

Answer 2

A

Question 3

An epidemic is described as

A) an outbreak of a disease that spreads across a continent, leading to more cases than would be expected during a given time period
B) an outbreak of a disease that spreads through a large area, leading to more cases than would be expected during a given period
C) an outbreak of a disease that spreads globally, leading to more cases than would be expected during a given period
D) an outbreak of a disease the spreads person-to-person, leading to a higher rate of infection that would normally be expected

Answer 3

B

Question 4

Epidemiology is defined as: (Select all that apply)

A) a branch of microbiology that seeks to identify the source of infection
B) a foundational science for the identification of risk factors for diseases and for testing the safety and effectiveness of drugs and medical procedures
C) a foundational science that studies the pattern of movement of pathogens through the population in attempts to create a healthier society.
D) a medical science involved with diagnostic testing and treatment of individual patients

Question 5

Ignaz Semmelweis became known as the "Savior of Women" because of his 1847 study of Childbed Fever. Dr. Semmelweis demonstrated via clinical observation and data collection that

A) effective hand washing could reduce the annual death rates from childbed fever from12.1 to 1.3 %
B) effective hand washing could reduce the annual death rates from childbed fever from25.1 to 1.3%
C) effective hand washing among medical students conducting autopsies and delivering babies could reduce the death rates from 26.9 to 12.5%
D) effective hand washing among medical students could reduce the death rates from 48.6 to 12.1%.

Question 6

Dr. John Snow, personal physician to Queen Victoria, became known as the "Father of Epidemiology" because of his work in stopping the cholera outbreak in London in 1854. Specifically Dr. Snow did all the following (Select all that apply)

A) mapped out the geographical locations of the 500 deaths that occurred in about 10 days that year
B) analyzed the data on which water pumps had been most used in the Soho district where the majority of deaths occurred
C) removed the water pump handle from the well that had infected the most patients
D) identified a brewery well as the source of the cholera outbreak

Question 7

In looking at the significant accomplishments of epidemiology during the 20^th century, the demographic group that had the most dramatic reduction in deaths is:

A) young adults
B) infants and children
C) middle aged adults
D) elderly

Question 8

In 1900 the leading causes of death were

A) pneumonia, diarrhea, enteritis, and ulceration of the intestines
B) pneumonia, tuberculosis, and diarrhea
C) tuberculosis, diarrhea, enteritis, and ulceration of the intestines
D) pneumonia, tuberculosis, diarrhea, enteritis, and ulceration of the intestines

Question 9

From 1900 to 2010, the infectious diseases that still remains on the list of the leading causes of death from 1900 is (Select all that apply)

A) pneumonia
B) tuberculosis
C) diarrhea
D) enteritis and ulceration of the intestines

Question 10

COVID-19 is caused by

A) SARS CoV-1
B) SARS CoV-2
C) MERS CoV
D) H3N2 influenza A virus

Question 11

SARS CoV-2 causes

A) SARS
B) MERS
C) Influenza
D) COVID-19

Question 12

Those at highest risk of severe COVID-19 include those (Select all that apply)

A) over 65 years old
B) who are significantly obese
C) with diabetes
D) with cardiovascular disease

Question 13

One measure of mortality is the death rate, morbidity is the

A) incidence of all diseases in a population
B) prevalence of all diseases in a population
C) reportable occurrence of specific diseases in a population
D) occurrence of a specific pathogen in a population

Question 14

What is the oldest branch of epidemiology?

A) analytical epidemiology
B) experimental epidemiology
C) descriptive epidemiology
D) clinical epidemiology

Question 15

Characteristics of descriptive epidemiology include which of the following? (Select all that apply)

A) organization of health-related information by person, place and time
B) identification of groups that are at greatest risk based on demographics
C) descriptive data by place for information on spread of diseases
D) description of data by time to reveal mortality

Question 16

Which of the following terms and definitions is correctly matched? (Select all that apply)

A) prevalence/proportion of cases in a population at a given time and place
B) incidence/number of cases per number of susceptible people per month
C) mortality rate/number of deaths within group of disease cases at a given time and place
D) crude rate/no consideration of age, race, gender or overall health status of population studied

Question 17

A ______________________ epidemic will show an increase followed by a decrease in the number of cases at a given time that affects a relatively small number of patients.

A) point-source
B) propagating
C) common-source
D) common-point

Question 18

Disease surveillance relies on reporting data for a specific group of diseases that contribute to public health of a community. Which of the following statements is true? (Select all that apply)

A) Many infectious diseases are reportable by law to state public health agencies.
B) Reportable data helps prevent spread of specific diseases by enabling health services to respond quickly
C) Nationally reportable data is published monthly in the CDC's MMWR
D) An index case is the single case that initiates an epidemiological investigation.

Question 19

The graph of data indicates a ___________ epidemic of gastroenteritis.

A) point source
B) propagating
C) common source
D) circulating

Question 20

The graph of data indicates a ___________ epidemic of MERS-CoV.

A) point source
B) propagating
C) common source
D) circulating

Question 21

The graph of data indicates a ___________ epidemic of salmonellosis.

A) point source
B) propagating
C) common source
D) circulating

Question 22

The graph of data indicates a ___________ epidemic of pneumonia.

A) point source
B) propagating
C) common source
D) circulating

Question 23

A case-control study (Select all that apply)

A) evaluates whether people who have a disease were more or less likely to have been exposed to potential diseases-causing factors than people who don't have the disease
B) defines cases as diseases that show selected signs and symptoms during a given time period
C) has cases in which diseased individuals are very much like healthy individuals who simply do not have the disease
D) has controls in which diseased individuals are very much like healthy individuals who simply do not have the disease

Question 24

Which of the following statements describes a cohort study? (Select all that apply)

A) determines risk factors for disease outcomes for a group of people by comparing cases and controls
B) over a period of time a group of people are followed to evaluate risk factors for disease outcomes
C) evaluates two similar groups in which one is exposed to a risk factor and the other isn't
D) evaluates whether people who have a disease were more or less likely to have been exposed to potential diseases-causing factors than people who don't have the disease

Question 25

Clinical trials are:

A) cohort studies specifically designed to evaluate new diagnostic procedures
B) cohort studies that are designed to show outcome differences between test subjects and controls
C) cohort studies that evaluate new medicines and medical interventions
D) cohort studies that compare relative risks of contracting a disease when exposed to the pathogen

Question 26

Relevant features included in clinical trials include: (Select all that apply)

A) randomization of study groups
B) use of double-blind procedures
C) avoidance of placebo controls
D) use of matched pairing system for randomization of small groups

Question 27

Which of the following best describes a double-blind study?

A) neither participants nor researchers know who is receiving placebo or receiving the treatment
B) 50% of participants receive a placebo and 50% receive treatment but no individual knows what they are receiving
C) participants are told what condition they are receiving but researchers are not told so that they analysis of results cannot be skewed
D) 25% of participants receive the treatment while 75% receive the placebo after being matched for randomization in small groups

Question 28

What is the correct order of steps in the approval process for new antimicrobial drugs prior to FDA approval?
U) initial design and screening
V) evaluation of a range of drug concentrations in humans to determine a safe dose
W) extensive animal trials
X) evaluate new drug at low dose to determine side effects and drug processing through the body
Y) evaluate effect of drug in large groups with disease under real-world conditions
Z) evaluate effect of drug in controlled setting

A) u, w, x, v, z, y
B) u, w, v, x, z, y
C) u, w, x, v, y, z
D) w, u, v, x, z, y

Question 29

How long is the typical process of drug development from discovery to FDA approval?

A) less than 10 years
B) more than 10 years
C) less than 20 years
D) more than 20 years

Question 30

Why is there little financial incentive for research and development of new antimicrobial agents?

A) medications discovered will all be expensive to produce
B) medication is taken for short period of time - not a long term treatment for patient
C) decrease in survival rates for immunosuppressed patients
D) all the antibacterial agents have already been discovered

Question 31

Using the data from an outbreak at a county jail, what was the relative risk of a GI illness as a result of eating casserole was _________________.

A) 8.6
B) 191
C) 2.0
D) 0.0052

Question 32

Using the data from an outbreak at a county jail, what was the relative risk of a GI illness as a result of eating mixed vegetables was _________________.

A) 0.36
B) 1.2
C) 2.8
D) 1.1

Question 33

Using the data from an outbreak at a county jail, what was the relative risk of a GI illness as a result of eating cornbread was _________________.

A) 2.65
B) 1.3
C) 1.1
D) 0.38

Question 34

What phase of a clinical trial is shown by the illustration?

A) Phase 0
B) Phase 1
C) Phase 2
D) Phase 3

Question 35

What phase of a clinical trial is shown by the illustration?

A) Phase 0
B) Phase 1
C) Phase 2
D) Phase 3

Question 36

What phase of a clinical trial is shown by the illustration?

A) Phase 0
B) Phase 1
C) Phase 2
D) Phase 3

Question 37

What phase of a clinical trial is shown by the illustration?

A) Phase 0
B) Phase 1
C) Phase 2
D) Phase 3

Question 38

What is the definition of Health Care-Associated Infection (HAI)?

A) infection acquired at a medical facility
B) infection acquired through medical error
C) infection due to contaminated hospital food
D) infection acquired in the neonatal ward

Question 39

Why are hospital patients vulnerable to HAIs as secondary infections? (Select all that apply)

A) they already have an immune-compromised status
B) there is a higher concentration of pathogens in a hospital
C) invasive procedures provide new portals of entry into the body
D) they have all already been taking antibiotics for a long period of time

Question 40

Hospital-acquired UTIs are commonly caused by (Select all that apply)

A) Staphylococcus aureus
B) E. coli
C) Pseudomonas aeruginosa
D) Staphylococcus epidermidis

Question 41

Hospital-acquired surgical site infections are commonly caused by (Select all that apply)

A) E. coli
B) Staphylococcus aureus
C) Staphylococcus epidermidis
D) Streptococcus pneumoniae

Question 42

Hospital-acquired infections of the respiratory system are commonly caused by (Select all that apply)

A) Klebsiella pneumoniae
B) E. coli
C) Staphylococcus aureus
D) Pseudomonas aeruginosa

Question 43

Staphylococcus aureus is a common cause of ____________ that are acquired in the hospital (Select all that apply)

A) surgical site infections
B) infections of the respiratory system
C) sepsis
D) skin infections

Question 44

Surgical Site Infections (SSIs) account for what percentage of post-operative infections?

A) 25%
B) 32%
C) 38%
D) 42%

Question 45

At what point in the SSI control timeline do patients get a nasal screening for MRSA colonization?

A) pre-admission infection controls
B) post-admission, preoperative infection controls
C) infection control during surgery
D) post-operative infection control
E) discharge infection control

Question 46

At what point in the SSI control timeline are gloves changed every 90-170 minutes?

A) a pre-admission infection controls
B) post-admission, preoperative infection controls
C) infection control during surgery
D) post-operative infection control
E) discharge infection control

Question 47

At what point in the SSI control timeline is a patient educated about incision care?

A) pre-admission infection controls
B) post-admission, preoperative infection controls
C) infection control during surgery
D) post-operative infection control
E) discharge infection control

Question 48

Catheter-associated urinary tract infections (CAUTIs) account for approximately what percent of all HAIs?

A) 22%
B) 40%
C) 56%
D) 63%

Question 49

Which of the following statements about a PICC line are accurate? (Select all that apply)

A) used when patient requires infusion of irritating drugs for extended period
B) tip of catheter is positioned in the bladder
C) PICC lines are responsible for 250,000 bloodstream infections annually
D) pathogen spread in bloodstream may lead to thrombophlebitis and cellulitis

Question 50

The percentage of Central Line-Associated Bloodstream Infections (CLABSIs) has increased and now 70% of patients with one are not in the ICU. Which of the following is a required practice to reduce CLABSIs?

A) use of maximum barrier precautions
B) use of chlorhexidine for skin preparation
C) use of double-lumen catheters
D) avoidance of femoral insertion sites

Question 51

The medical device shown in the illustration is a

A) CVC
B) Urinary catheter
C) Postoperative drain
D) PICC line

Question 52

The medical device shown in the illustration is a

A) CVC
B) Urinary catheter
C) Postoperative drain
D) PICC line

Question 53

The medical device shown in the illustration is a

A) Urinary catheter
B) Postoperative drain
C) PICC line
D) CVC

Question 54

What is the average noncompliance rate for nurses who do not wash their hands?

A) 25%
B) 40%
C) 45%
D) 52%

Question 55

After using the toilet, changing a diaper, prior to beginning food preparation, and before eating, hands should be washed with regular soap to achieve removal of ______________ of transient skin flora

A) 25-75%
B) 40-70%
C) 50-95%
D) 60-90%

Question 56

In medical settings, hands should be washed with antimicrobial soap or alcohol gel in order to remove ___________ of transient skin flora as well as resident flora that may be removed

A) 99-99%
B) 90-95%
C) 90-99%
D) 90-92%

Question 57

Before surgical procedures, complete cleaning with antimicrobial soap and brush scrubbing plus holding hands above the level of the elbows will remove _____________of transient and removable resident flora

A) 95.99%
B) 98.99%
C) 99.99%
D) 97.99%

Question 58

The 5 Moments of Hand Hygiene refers to the frequency of practicing hand hygiene during patient contact by the caregiver such as a nurse or aide. These moments include (Select all that apply)

A) prior to patient contact
B) prior to performing aseptic procedures
C) after working with body fluids or compromised skin
D) prior to using the toilet

Question 59

While alcohol gel cleanser is often more effective and convenient for health caregivers, only __________________can protect against the formation of endospores from bacteria like Clostridium, Closteroides and Bacillus.

A) antimicrobial soap with brush scrubbing
B) traditional soap and water cleansing
C) chlorhexidine gluconate
D) povidine iodine scrub

Question 60

To meet precaution standards for hand hygiene, ____________ is required.

A) the use of EPA-registered disinfectants with microbicidal activity against pathogens most likely to contaminate patient-care environment
B) the use of aseptic technique to avoid contamination of sterile injection equipment.
C) handling used textiles and fabrics with minimum disturbance to avoid contamination of air, surfaces and persons
D) no artificial fingernails can be worn if duties include direct contact with patients at high risk of infection
E) wearing personal protection equipment when the anticipated patient interaction indicates contact with blood or body fluids is possible

Question 61

To meet precaution standards for PPE, ____________ is required.

A) the use of EPA-registered disinfectants with microbicidal activity against pathogens most likely to contaminate patient-care environment
B) the use of aseptic technique to avoid contamination of sterile injection equipment.
C) handling used textiles and fabrics with minimum disturbance to avoid contamination of air, surfaces and persons
D) no artificial fingernails can be worn if duties include direct contact with patients at high risk of infection
E) wearing personal protection equipment when the anticipated patient interaction indicates contact with blood or body fluids is possible

Question 62

To meet precaution standards for care of the environment, ____________ is required.

A) the use of EPA-registered disinfectants with microbicidal activity against pathogens most likely to contaminate patient-care environment
B) the use of aseptic technique to avoid contamination of sterile injection equipment.
C) handling used textiles and fabrics with minimum disturbance to avoid contamination of air, surfaces and persons
D) no artificial fingernails can be worn if duties include direct contact with patients at high risk of infection
E) wearing personal protection equipment when the anticipated patient interaction indicates contact with blood or body fluids is possible

Question 63

Policies that aim to protect health care workers from microbial transmission of blood-borne pathogens are commonly known as

A) Universal precautions
B) Standard precautions
C) Personal protection precautions
D) Barrier precautions

Question 64

Screening for Methicillin-resistant Staphylococcus aureus (MRSA) is an important part of hospital routine. MRSA is the most commonly targeted microbe for screening because of (Select all that apply)

A) MRSA is easily treated with many other antibacterial agents
B) MRSA is a multidrug resistant strain that can produce several different exotoxins that cause widespread tissue damage
C) MRSA produces the toxin PVL that targets leukocytes for destruction, thus crippling the immune system response
D) MRSA is a gram positive pathogen that has a wax-like cell wall that makes it resistant to most antibacterial agents

Question 65

Bacteria besides MRSA, which other pathogens justify screening because of their high mortality and morbidity rates? (Select all that apply)

A) Vancomycin-resistant Enterococcus (VRE)
B) Closteroides difficile
C) Carbapenem-resistant Enterobacteriaceae (CRE)
D) Vancomycin-resistant Staphylococcus aureus (VRSA)

Question 66

Isolation procedures are determined by the pathogenicity and transmission status of the pathogen. Which of the following modes of transmission is the most challenging to control?

A) direct contact via contaminated body fluids
B) indirect contact via contaminated linens and medical equipment
C) droplet transmission via respiratory droplets traveling 1 meter
D) airborne transmission traveling more than 1 meter

Question 67

The extra steps that must be taken if a pathogen is airborne include (Select all that apply)

A) healthcare givers must wear N95 respirator masks and protective eyewear
B) negative pressure prevents air movement in to the room when the door is opened
C) room ventilation is designed to prevent pathogen escape
D) air passes through HEPA filtration

Question 68

Personal protection equipment (PPE) provides the necessary protection against these highly pathogenic bacteria:

A) MRSA
B) Closteroides difficile
C) VRE
D) Mycobacterium tuberculosis

Question 69

When Staphylococcus aureus is grown on mannitol salt agar, how does the agar change color?

A) from yellow to pink
B) from yellow to green
C) from pink to yellow
D) from green to yellow

Question 70

The photo shows growth of a nasal specimen overnight on Mannitol salt agar. This result shows the pathogen is most likely

A) Staphylococcus aureus
B) MRSA
C) Closteroides difficile
D) Pseudomonas aeruginosa

Question 71

The photo of a coagulase agglutination test is ____________________ and is used to confirm diagnosis of ________________________.

A) negative; Staphylococcus aureus
B) positive; Staphylococcus aureus
C) negative; Staphylococcus epidermidis
D) positive; Staphylococcus epidermidis

Question 72

The photo shows the result of suspending a coagulase positive colony on a Muller-Hinton agar plate containing 4% oxacillin. The colony was from a nasal swab and produced a yellow colony growing on mannitol salt agar. This results confirms identification of the bacteria as

A) Staphylococcus aureus
B) MRSA
C) Closteroides difficile
D) Pseudomonas aeruginosa

Question 73

Early in the COVID epidemic in the U.S., which mitigation measures were put into place to slow the infection rate of SARS CoV-2 in order to reduce the projected strain on hospital resources? (Select all that apply)

A) Wearing masks while indoors
B) Social distancing of at least 6 feet apart
C) Quarantine for 14 days those that had been exposed to a person who was infectious with SARS CoV-2
D) Frequent use of alcohol-based hand sanitizers

Question 74

Early in the COVID epidemic in the U.S., which health care resources were projected to be critically strained by a peak surge of COVID cases if there were no community-wide mitigation strategies? (Select all that apply)

A) N95 respirators
B) Face/surgical masks
C) Face shields
D) Gowns