MCQ Quiz: Journal Club

Welcome, future pharmacists, to a quiz dedicated to one of the most intellectually stimulating activities in our profession: the Journal Club. More than just a meeting to discuss articles, a journal club is the practical application of evidence-based practice, a core competency you’ll hone in courses like PHA5244 Principles of Evidence-Based Practice and skills labs such as PHA5163L and PHA5164L. The ability to critically appraise biomedical literature is not just an academic exercise; it is an essential skill that empowers you to assess new therapies, challenge existing dogmas, and make the best possible decisions for your patients. This quiz will test your understanding of study design, biostatistics, and the principles of critical appraisal that transform a simple reading of a paper into a powerful tool for patient care.

1. What is the primary purpose of a journal club in a clinical setting?

• a. To fulfill continuing education credit requirements only.
• b. To critically evaluate current literature and apply it to patient care.
• c. To practice public speaking skills.
• d. To decide which journals the hospital library should subscribe to.

Answer: b. To critically evaluate current literature and apply it to patient care.

2. Which of the following study types is considered the highest level of evidence?

• a. A large randomized controlled trial (RCT)
• b. A prospective cohort study
• c. A systematic review or meta-analysis of high-quality RCTs
• d. A case-control study

Answer: c. A systematic review or meta-analysis of high-quality RCTs

3. In the PICO framework for formulating a clinical question, what does the “C” stand for?

• a. Causation
• b. Control or Comparison
• c. Conclusion
• d. Correlation

Answer: b. Control or Comparison

4. A study that follows two groups of patients (one group exposed to a risk factor, one not exposed) forward in time to observe who develops a disease is called a:

• a. Case-control study
• b. Cross-sectional study
• c. Randomized controlled trial
• d. Cohort study

Answer: d. Cohort study

5. What is the main advantage of randomization in a clinical trial?

• a. It guarantees the results will be statistically significant.
• b. It minimizes selection bias by balancing known and unknown confounding variables between treatment groups.
• c. It makes the study easier and cheaper to conduct.
• d. It ensures that all participants receive the active treatment.

Answer: b. It minimizes selection bias by balancing known and unknown confounding variables between treatment groups.

6. A p-value of < 0.05 generally indicates that:

• a. The study results are 95% likely to be true.
• b. There is less than a 5% probability that the observed result occurred by chance alone, assuming the null hypothesis is true.
• c. The clinical significance of the results is very high.
• d. There is no difference between the groups being compared.

Answer: b. There is less than a 5% probability that the observed result occurred by chance alone, assuming the null hypothesis is true.

7. “Intention-to-Treat” (ITT) analysis means that:

• a. Only patients who completed the study protocol perfectly are included in the analysis.
• b. All patients are analyzed in the groups to which they were originally randomized, regardless of whether they completed the treatment.
• c. Patients can choose which treatment group they want to be analyzed in.
• d. The study’s funding source intended to find a positive result.

Answer: b. All patients are analyzed in the groups to which they were originally randomized, regardless of whether they completed the treatment.

8. The Number Needed to Treat (NNT) is calculated as the reciprocal of what value?

• a. Relative Risk (RR)
• b. Relative Risk Reduction (RRR)
• c. Absolute Risk Reduction (ARR)
• d. The p-value

Answer: c. Absolute Risk Reduction (ARR)

9. In a meta-analysis, what does a forest plot visually represent?

• a. The patient enrollment timeline for the included studies.
• b. The results of individual studies and the pooled result of all studies combined.
• c. The funding sources for each study.
• d. The geographic locations where the studies were conducted.

Answer: b. The results of individual studies and the pooled result of all studies combined.

10. A study reports that a new drug reduces the risk of heart attack from 4% to 3%. What is the Absolute Risk Reduction (ARR)?

• a. 25%
• b. 1%
• c. 33%
• d. 0.75%

Answer: b. 1%

11. A study with low internal validity means:

• a. The results are not generalizable to your patient population.
• b. There is a high degree of bias or confounding, and the results may not be accurate for the subjects studied.
• c. The p-value was greater than 0.05.
• d. The journal it was published in has a low impact factor.

Answer: b. There is a high degree of bias or confounding, and the results may not be accurate for the subjects studied.

12. “Blinding” or “masking” in a clinical trial is used to reduce what type of bias?

• a. Selection bias
• b. Publication bias
• c. Performance and detection bias
• d. Attrition bias

Answer: c. Performance and detection bias

13. Which of the following describes a surrogate outcome?

• a. A direct measure of how a patient feels, functions, or survives, such as “all-cause mortality”.
• b. A laboratory measurement or physical sign used as a substitute for a clinically meaningful endpoint, such as “blood pressure”.
• c. An adverse event that occurs during the study.
• d. The primary reason a patient drops out of a study.

Answer: b. A laboratory measurement or physical sign used as a substitute for a clinically meaningful endpoint, such as “blood pressure”.

14. A 95% Confidence Interval (CI) for a Relative Risk is reported as (0.80 – 1.20). What can be concluded?

• a. The result is statistically significant because the interval is narrow.
• b. The result is not statistically significant because the interval crosses 1.0.
• c. The result is statistically significant because the interval does not include 0.
• d. The result is clinically very important.

Answer: b. The result is not statistically significant because the interval crosses 1.0.

15. What is the primary difference between a systematic review and a traditional narrative review?

• a. A systematic review uses a predefined and rigorous method to identify, appraise, and synthesize all relevant studies on a topic.
• b. A narrative review is always written by a more experienced author.
• c. A systematic review only includes studies with positive outcomes.
• d. There is no difference.

Answer: a. A systematic review uses a predefined and rigorous method to identify, appraise, and synthesize all relevant studies on a topic.

16. The “Methods” section of a research paper should primarily describe:

• a. The authors’ conclusions and opinions.
• b. The study design, patient population, and statistical analyses used.
• c. The raw data for every patient.
• d. A review of previous literature on the topic.

Answer: b. The study design, patient population, and statistical analyses used.

17. What is “publication bias”?

• a. The tendency for authors to submit, or journals to accept, manuscripts based on the direction or strength of the study findings (e.g., only publishing positive studies).
• b. Bias against authors from certain countries.
• c. Preferential treatment for studies funded by large companies.
• d. An error in the statistical analysis.

Answer: a. The tendency for authors to submit, or journals to accept, manuscripts based on the direction or strength of the study findings (e.g., only publishing positive studies).

18. A “per-protocol” analysis is more likely than an “intention-to-treat” analysis to:

• a. Preserve the benefits of randomization.
• b. Overestimate the effectiveness of a drug by only including compliant patients.
• c. Underestimate the effectiveness of a drug.
• d. Be the preferred primary analysis for a superiority trial.

Answer: b. Overestimate the effectiveness of a drug by only including compliant patients.

19. A study that starts with patients who have a disease and looks backward in time for risk factors is a:

• a. Prospective cohort study
• b. Case-control study
• c. Cross-sectional study
• d. Case report

Answer: b. Case-control study

20. When critiquing a journal article, what is one of the first things you should assess?

• a. The formatting and font size of the text.
• b. The appropriateness of the study design for the research question being asked.
• c. The number of references cited.
• d. The length of the article’s conclusion.

Answer: b. The appropriateness of the study design for the research question being asked.

21. A statistically significant result is always clinically significant.

• a. True
• b. False

Answer: b. False

22. “Heterogeneity” in a meta-analysis refers to:

• a. The degree of similarity between the authors of the included studies.
• b. The variability in the results of the included studies.
• c. The use of different statistical software.
• d. The quality of the journal publications.

Answer: b. The variability in the results of the included studies.

23. If the NNT for Drug A is 10 and the NNT for Drug B is 20 for the same outcome, which drug is more effective?

• a. Drug B, because the number is higher.
• b. Drug A, because you need to treat fewer patients to see one additional benefit.
• c. They are equally effective.
• d. It is impossible to tell from the NNT.

Answer: b. Drug A, because you need to treat fewer patients to see one additional benefit.

24. The difference between a case report and a case series is:

• a. A case report involves one patient, while a case series involves a group of patients with a similar condition.
• b. A case report has a control group.
• c. A case series is always prospective.
• d. A case report is a higher level of evidence.

Answer: a. A case report involves one patient, while a case series involves a group of patients with a similar condition.

25. A confounding variable is a factor that:

• a. Is the primary outcome of the study.
• b. Is associated with both the exposure and the outcome, and can distort the true relationship between them.
• c. Is a rare side effect of the intervention.
• d. Only affects the control group.

Answer: b. Is associated with both the exposure and the outcome, and can distort the true relationship between them.

26. In the diamond on a forest plot, what does the width of the diamond represent?

• a. The p-value of the pooled result.
• b. The total number of patients in the meta-analysis.
• c. The confidence interval of the pooled effect estimate.
• d. The heterogeneity of the studies.

Answer: c. The confidence interval of the pooled effect estimate.

27. “External validity” or “generalizability” refers to:

• a. The degree to which the study was conducted without bias.
• b. The likelihood that the study’s results can be applied to other populations or settings.
• c. The statistical power of the study.
• d. The internal consistency of the study’s measurements.

Answer: b. The likelihood that the study’s results can be applied to other populations or settings.

28. Which of the following is a measure of disease frequency at a single point in time?

• a. Incidence
• b. Prevalence
• c. Relative Risk
• d. Odds Ratio

Answer: b. Prevalence

29. The objective “Critically evaluate a primary literature article and apply finding to patient cases” is a key learning outcome in which course?

• a. PHA5703 Principles of Pharmacy Law and Ethics
• b. PHA5164L: Professional Skills Laboratory 4
• c. PHA5104 Sterile Compounding
• d. PHA5439 Principles of Medicinal Chemistry and Pharmacology I

Answer: b. PHA5164L: Professional Skills Laboratory 4

30. What is a “washout period” in a crossover trial design?

• a. A period where patients clean their medication vials.
• b. The time it takes for the study results to be published.
• c. A period between treatments where no treatment is given, to allow the effects of the first treatment to wear off.
• d. A social event for study participants.

Answer: c. A period between treatments where no treatment is given, to allow the effects of the first treatment to wear off.

31. A type I error occurs when:

• a. A researcher incorrectly concludes there is no difference between groups when one truly exists.
• b. A researcher incorrectly concludes there is a difference between groups when one does not truly exist (rejecting a true null hypothesis).
• c. There is a mistake in data entry.
• d. The study lacks sufficient power.

Answer: b. A researcher incorrectly concludes there is a difference between groups when one does not truly exist (rejecting a true null hypothesis).

32. A type II error is more likely to occur if:

• a. The study has a very large sample size.
• b. The p-value threshold is set too low (e.g., 0.01).
• c. The study has a small sample size and is underpowered.
• d. The effect size of the intervention is very large.

Answer: c. The study has a small sample size and is underpowered.

33. In a journal club discussion, which comment is most constructive?

• a. “I thought this study was boring.”
• b. “The study’s use of a surrogate endpoint limits its applicability to direct patient outcomes; we should be cautious when applying these results.”
• c. “The authors are clearly wrong.”
• d. “I didn’t have time to read the whole paper.”

Answer: b. “The study’s use of a surrogate endpoint limits its applicability to direct patient outcomes; we should be cautious when applying these results.”

34. The “Introduction” section of a paper should primarily:

• a. Detail the statistical plan.
• b. Present the results in tables and figures.
• c. Provide background information and state the rationale and objective of the current study.
• d. Discuss the limitations of the study.

Answer: c. Provide background information and state the rationale and objective of the current study.

35. A placebo control is used in a clinical trial to:

• a. Make the study more expensive.
• b. Account for the non-specific effects of an intervention, such as patient expectation.
• c. Ensure all patients receive some form of active treatment.
• d. Increase the risk of side effects.

Answer: b. Account for the non-specific effects of an intervention, such as patient expectation.

36. A study that measures exposure and outcome at the same time is called a:

• a. Cross-sectional study
• b. Retrospective cohort study
• c. Crossover study
• d. Meta-analysis

Answer: a. Cross-sectional study

37. If a diagnostic test has high sensitivity, it means:

• a. It is very good at correctly identifying those who do NOT have the disease (few false positives).
• b. It is very good at correctly identifying those who DO have the disease (few false negatives).
• c. The test is very expensive.
• d. The test results take a long time to come back.

Answer: b. It is very good at correctly identifying those who DO have the disease (few false negatives).

38. If a diagnostic test has high specificity, it means:

• a. It is very good at correctly identifying those who DO have the disease (few false negatives).
• b. It is very good at correctly identifying those who do NOT have the disease (few false positives).
• c. The test can only be performed in a specific laboratory.
• d. The test is a good screening tool for the general population.

Answer: b. It is very good at correctly identifying those who do NOT have the disease (few false positives).

39. “Power” in the context of a study’s design refers to:

• a. The authority of the principal investigator.
• b. The ability of a study to detect a true difference between groups if one actually exists.
• c. The political influence of the study’s findings.
• d. The speed at which the study was completed.

Answer: b. The ability of a study to detect a true difference between groups if one actually exists.

40. The “Results” section of a research paper should contain:

• a. Interpretation and discussion of the findings.
• b. The authors’ future research plans.
• c. A neutral, factual presentation of the data and study findings.
• d. An explanation of the study design.

Answer: c. A neutral, factual presentation of the data and study findings.

41. The CONSORT statement is a guideline for reporting what type of study?

• a. Case reports
• b. Cohort studies
• c. Randomized Controlled Trials
• d. Systematic reviews

Answer: c. Randomized Controlled Trials

42. Which section of a paper is the best place to find the authors’ interpretation of their results and a discussion of study limitations?

• a. Introduction
• b. Methods
• c. Results
• d. Discussion

Answer: d. Discussion

43. A journal’s “impact factor” is a measure of:

• a. The average number of citations to recent articles published in that journal.
• b. The number of people who read the journal.
• c. The cost to publish an article in the journal.
• d. The scientific rigor of every article published in the journal.

Answer: a. The average number of citations to recent articles published in that journal.

44. What is the key difference between an experimental study and an observational study?

• a. Experimental studies are always conducted in a lab.
• b. In an experimental study, the investigator actively assigns the exposure/intervention to subjects.
• c. Observational studies are always retrospective.
• d. Observational studies are not considered scientific.

Answer: b. In an experimental study, the investigator actively assigns the exposure/intervention to subjects.

45. “Selection bias” occurs when:

• a. The way subjects are chosen for a study systematically affects the outcome.
• b. The investigators select which results to publish.
• c. Subjects select their own treatment group.
• d. The measurement of the outcome is biased.

Answer: a. The way subjects are chosen for a study systematically affects the outcome.

46. A relative risk (RR) of 0.75 means:

• a. The exposure increases the risk of the outcome by 75%.
• b. The exposure has no effect on the risk of the outcome.
• c. The exposure reduces the risk of the outcome by 25%.
• d. The exposure reduces the risk of the outcome by 75%.

Answer: c. The exposure reduces the risk of the outcome by 25%.

47. When presenting at a journal club, it is important to:

• a. Read directly from the paper word-for-word.
• b. Only present the positive findings of the study.
• c. Provide a balanced critique, including both strengths and weaknesses of the study.
• d. Avoid answering any questions from the audience.

Answer: c. Provide a balanced critique, including both strengths and weaknesses of the study.

48. In a clinical trial, the “control” group could receive:

• a. A placebo
• b. No treatment
• c. The current standard of care
• d. Any of the above

Answer: d. Any of the above

49. An abstract of a journal article provides:

• a. A detailed description of the statistical analysis.
• b. A brief summary of the study’s objective, methods, results, and conclusion.
• c. The complete raw data from the study.
• d. The authors’ contact information and affiliations only.

Answer: b. A brief summary of the study’s objective, methods, results, and conclusion.

50. The ultimate goal of learning to critically appraise literature is to:

• a. Win arguments with colleagues.
• b. Make informed, evidence-based decisions to improve patient care.
• c. Be able to publish your own research.
• d. Find flaws in every study.

Answer: b. Make informed, evidence-based decisions to improve patient care.