MCQ Quiz: Critiquing Pharmacoepidemiology

Reading a research study is not enough; a pharmacist must be able to critically appraise it to determine its trustworthiness and applicability to patient care. Critiquing pharmacoepidemiology studies, a core skill taught in the Principles of Evidence-Based Practice course and applied in Journal Clubs, involves a systematic evaluation of the study’s methods to identify potential bias and confounding. This quiz will test your knowledge on the key questions and concepts used to critique observational research and assess the validity of its findings.

1. The process of systematically examining a research study to assess its trustworthiness, value, and relevance is known as:

• a. Peer review
• b. Critical appraisal
• c. Plagiarism
• d. Summarization

Answer: b. Critical appraisal

2. When critiquing a pharmacoepidemiology study, the first and most important question to ask pertains to its:

• a. External validity (generalizability)
• b. Internal validity (freedom from bias and confounding)
• c. Statistical power
• d. The reputation of the journal

Answer: b. Internal validity (freedom from bias and confounding)

3. In a case-control study examining the link between a medication and a birth defect, if mothers of affected children (cases) remember their medication use more accurately than mothers of healthy children (controls), this is an example of:

• a. Selection bias
• b. Recall bias
• c. Attrition bias
• d. Confounding

Answer: b. Recall bias

4. A researcher is studying the effect of a blood pressure medication. If they use a miscalibrated cuff that reads 5 mmHg too high for every single patient, this is an example of:

• a. Random error
• b. Systematic measurement bias
• c. Confounding
• d. Selection bias

Answer: b. Systematic measurement bias

5. What is the best way to control for confounding variables in a study?

• a. Increasing the sample size.
• b. Using a p-value < 0.05.
• c. Randomization in the design phase.
• d. Blinding the participants.

Answer: c. Randomization in the design phase.

6. The “Appraisal of cohort studies” is a specific lecture within which course?

• a. PHA5244 Principles of Evidence-Based Practice
• b. PHA5104 Sterile Compounding
• c. PHA5703 Pharmacy Law and Ethics
• d. PHA5787C Patient Care 5

Answer: a. PHA5244 Principles of Evidence-Based Practice

7. “Confounding by indication” is a major threat to the validity of observational pharmacoepidemiology studies. This means:

• a. The drug was used for the wrong indication.
• b. The underlying disease that prompted the prescription is the true cause of the outcome, not the drug itself.
• c. The indication for the drug changed during the study.
• d. The study’s indication was not approved by the FDA.

Answer: b. The underlying disease that prompted the prescription is the true cause of the outcome, not the drug itself.

8. If a cohort study has a very high percentage of participants who drop out (loss to follow-up), and these participants are different from those who remain, the study may have significant:

• a. Attrition bias
• b. Recall bias
• c. Performance bias
• d. No bias

Answer: a. Attrition bias

9. When critiquing the “Methods” section of a paper, the pharmacist should look for:

• a. A clear description of the study population.
• b. A precise definition of the exposure and outcome.
• c. A description of how potential confounders were controlled.
• d. All of the above.

Answer: d. All of the above.

10. A study reports a Relative Risk of 1.5 with a 95% Confidence Interval of (0.9 – 2.1). How should you interpret this result?

• a. The result is statistically significant and shows harm.
• b. The result is statistically significant and shows benefit.
• c. The result is not statistically significant because the confidence interval crosses 1.0.
• d. The study was perfectly designed.

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

11. The review and appraisal of cohort studies is a “Transcending Concept” in the Patient Care 5 curriculum.

• a. True
• b. False

Answer: a. True

12. “External validity” of a study refers to its:

• a. Internal consistency
• b. Statistical power
• c. Generalizability to other populations
• d. Freedom from bias

Answer: c. Generalizability

13. In the analysis phase of an observational study, researchers can control for confounding by using:

• a. Blinding
• b. Randomization
• c. Stratification or multivariable regression
• d. A placebo

Answer: c. Stratification or multivariable regression

14. A well-conducted observational study can prove causation with the same certainty as an RCT.

• a. True
• b. False

Answer: b. False

15. A “Journal Club” is an academic activity where students practice critically appraising primary literature.

• a. True
• b. False

Answer: a. True

16. A study with low internal validity can have high external validity.

• a. True
• b. False

Answer: b. False

17. “Introduction to study designs in pharmacoepidemiology” is a required reading in the EBP course.

• a. True
• b. False

Answer: a. True

18. When critiquing a case-control study, it is crucial to assess:

• a. The randomization process.
• b. The blinding of the investigators.
• c. The method used to select the control group.
• d. The duration of follow-up.

Answer: c. The method used to select the control group.

19. A study finds a statistically significant result (p<0.05) but the effect size is very small. A critical appraiser would question the result’s:

• a. Internal validity
• b. Statistical power
• c. Clinical significance
• d. Blinding

Answer: c. Clinical significance

20. An active learning session on EBP is part of which course?

• a. PHA5244 Principles of Evidence-Based Practice
• b. PHA5163L Professional Skills Lab 3
• c. PHA5781 Patient Care I
• d. PHA5787C Patient Care 5

Answer: a. PHA5244 Principles of Evidence-Based Practice

21. Publication bias refers to the phenomenon that:

• a. All studies are published eventually.
• b. Studies with “positive” or statistically significant results are more likely to be published than those with null results.
• c. Only studies from famous authors are published.
• d. Journals prefer to publish observational studies over RCTs.

Answer: b. Studies with “positive” or statistically significant results are more likely to be published than those with null results.

22. A pharmacist reading a study must first determine if the results are ____ before deciding if they are ____ to their patient.

• a. applicable, valid
• b. valid, applicable
• c. interesting, valid
• d. applicable, interesting

Answer: b. valid, applicable

23. “Observational Studies” is a module in the EBP course.

• a. True
• b. False

Answer: a. True

24. An active learning session on appraising studies is part of which course module?

• a. Module 5: Urological Disorders
• b. Module 1: Diabetes Mellitus
• c. Module 4: Medication Safety
• d. Module 8: Men’s Health

Answer: a. Module 5: Urological Disorders

25. A key question for critiquing exposure measurement in a study using an EHR database is:

• a. “How was the drug exposure defined (e.g., prescription order vs. dispensing record)?”
• b. “Was the definition applied consistently?”
• c. “Could there be misclassification of exposure?”
• d. All of the above.

Answer: d. All of the above.

26. The “Methods” section of a paper is the most important section to read for a critical appraisal.

• a. True
• b. False

Answer: a. True

27. A study that uses a “new user” design attempts to reduce:

• a. Bias related to prevalent users who may have been on the drug for a long time for specific reasons.
• b. The cost of the study.
• c. The duration of the study.
• d. The sample size.

Answer: a. Bias related to prevalent users who may have been on the drug for a long time for specific reasons.

28. Critically evaluating a primary literature article is a key objective for student pharmacists in their advanced practice experiences.

• a. True
• b. False

Answer: a. True

29. The main difference between random error and bias is that bias is:

• a. Due to chance.
• b. Systematic and directional.
• c. Reduced by a larger sample size.
• d. Not a threat to validity.

Answer: b. Systematic and directional.

30. The “Summarizing the Evidence” module is part of the EBP course.

• a. True
• b. False

Answer: a. True

31. When critiquing the applicability of a study, a pharmacist should consider if:

• a. Their patient would have met the study’s inclusion/exclusion criteria.
• b. The intervention is available and feasible in their practice setting.
• c. The study’s outcomes are important to their patient.
• d. All of the above.

Answer: d. All of the above.

32. A study with major, unaddressed confounding has poor:

• a. External validity
• b. Statistical power
• c. Internal validity
• d. Publication potential

Answer: c. Internal validity

33. The principles of EBP are foundational to modern pharmacy practice.

• a. True
• b. False

Answer: a. True

34. A case-control study of a new drug and birth defects might be prone to selection bias if:

• a. Controls are selected from the same hospital as the cases.
• b. The participation rate is very high.
• c. Controls are selected from a population with a different baseline risk for birth defects than the cases.
• d. The exposure is measured accurately.

Answer: c. Controls are selected from a population with a different baseline risk for birth defects than the cases.

35. A pharmacist is appraising a study. What is the first step?

• a. Read the conclusion to see if you agree.
• b. Check for statistical significance.
• c. Determine if the study addresses a clear and focused question.
• d. Look up the authors’ credentials.

Answer: c. Determine if the study addresses a clear and focused question.

36. A study finds an association but does not control for age, a known risk factor for the outcome. Age is a likely _____ in this study.

• a. outcome
• b. exposure
• c. confounder
• d. bias

Answer: c. confounder

37. Which of the following is NOT a question to ask when appraising a study?

• a. Were the study groups comparable?
• b. Was the follow-up adequate?
• c. Were the outcomes measured accurately?
• d. Was the study funded by a source I agree with?

Answer: d. Was the study funded by a source I agree with?

38. The “Experimental Studies” module is part of the EBP course.

• a. True
• b. False

Answer: a. True

39. A critical appraisal is fundamentally a(n) ________ of a study’s strengths and weaknesses.

• a. biased opinion
• b. balanced assessment
• c. quick summary
• d. personal attack

Answer: b. balanced assessment

40. An active learning session covering EBP is part of which course?

• a. PHA5244 Principles of Evidence-Based Practice
• b. PHA5163L Professional Skills Lab 3
• c. PHA5781 Patient Care I
• d. PHA5787C Patient Care 5

Answer: a. PHA5244 Principles of Evidence-Based Practice

41. The ability to critique pharmacoepidemiology helps a pharmacist to:

• a. Understand drug safety issues that emerge after a drug is marketed.
• b. Make informed formulary recommendations.
• c. Counsel patients on real-world risks and benefits.
• d. All of the above.

Answer: d. All of the above.

42. Which of the following does NOT help to minimize bias?

• a. Using a standardized protocol for data collection.
• b. Blinding participants and investigators.
• c. Ignoring patients who drop out of the study.
• d. Using objective, validated outcome measures.

Answer: c. Ignoring patients who drop out of the study.

43. A pharmacist should be skeptical of study results if:

• a. The study was a randomized controlled trial.
• b. The methods section is vague or poorly described.
• c. The p-value is less than 0.05.
• d. The study was published in a reputable journal.

Answer: b. The methods section is vague or poorly described.

44. A cohort study’s results are more believable if they demonstrate a:

• a. Dose-response relationship.
• b. Large effect size.
• c. Consistency with other studies.
• d. All of the above.

Answer: d. All of the above.

45. If the groups in a cohort study are not comparable at baseline for important prognostic factors, this introduces:

• a. Selection bias
• b. Recall bias
• c. Interviewer bias
• d. Attrition bias

Answer: a. Selection bias

46. A critical appraisal checklist (like CASP) is a tool designed to:

• a. Automatically determine if a study is good or bad.
• b. Guide a reader through a systematic appraisal of a research paper.
• c. Calculate a p-value.
• d. Summarize the study’s conclusion.

Answer: b. Guide a reader through a systematic appraisal of a research paper.

47. Understanding the principles of EBP is a key objective for student pharmacists.

• a. True
• b. False

Answer: a. True

48. An active learning session on critiquing literature is part of which course module?

• a. Module 2: Pharmacoepidemiology Study Designs
• b. Module 5: Urological Disorders
• c. Module 4: Medication Safety
• d. Module 6: Geriatrics

Answer: a. Module 2: Pharmacoepidemiology Study Designs

49. The overall purpose of critiquing a pharmacoepidemiology study is to:

• a. Find reasons to never trust observational research.
• b. Determine the level of confidence one can have in the study’s findings.
• c. Practice for journal club.
• d. Check for spelling and grammar errors.

Answer: b. Determine the level of confidence one can have in the study’s findings.

50. The ultimate reason for a pharmacist to be skilled at critiquing research is to:

• a. Provide the best possible evidence-based care to their patients.
• b. Win arguments with physicians.
• c. Pass their EBP course.
• d. Get their own research published.

Answer: a. Provide the best possible evidence-based care to their patients.