WAVE3 EBP ORG1. A 52-year-old man, Tomasz Kowalczyk, is randomised to a 12-week weight-management programme. Eighteen percent of the intervention arm never attend. Analysts still include every randomised participant in the original groups. What does this analysis primarily estimate?A. The effect of offering the programme as randomised, including people who never attended a sessionB. The biological effect only in people who attended every session, which some claim is the sole unbiased estimate of efficacyC. Whether the randomisation sequence was generated with undisclosed block sizes of four throughout recruitmentD. The accuracy of a diagnostic index test against an agreed reference standard in the same sampleE. How much publication bias is present when small trials are missing from a funnel plot of effect versus precisionCheck
WAVE3 EBP ORG2. A 41-year-old woman, Sian Pritchard, asks what ‘specificity’ means after reading a paper on a practice natriuretic-peptide cut-off. Which statement is correct?A. The chance she personally has heart failure if this particular test comes back positive in clinicB. The proportion of people without the target condition who test negative on that cut-offC. The proportion of people who truly have the condition who also test positive on the same cut-offD. How much the odds of disease rise after a positive test, which is the definition of LR+E. The number of similar people you need to treat to prevent one extra clinical eventCheck
WAVE3 EBP ORG3. A journal club reviews a cluster trial of a new asthma template. The relative risk of exacerbation is 0.94 with a 95% confidence interval of 0.71 to 1.22. What is the most appropriate interpretation?A. The result proves harm because the upper bound of the interval exceeds oneB. The p-value must be below 0.001 simply because the point estimate sits below oneC. The interval includes 1, so a statistically significant relative effect is not shown at 5%D. Confidence intervals that overlap 1 can be ignored whenever a forest-plot diamond appears to sit left of the line of no effectE. NNT for counselling can be quoted directly as one divided by the relative risk 0.94Check
WAVE3 EBP ORG4. A 67-year-old man, Idris Bennett, has a positive faecal immunochemical test used in a low-prevalence surveillance clinic. The same assay had a PPV of 28% in a two-week-wait cohort. Which change is most likely in this lower-prevalence setting if sensitivity and specificity are unchanged?A. PPV will fallB. Sensitivity will automatically fall even if the laboratory cut-off and 2×2 definitions stay identicalC. NPV will fall in lockstep with PPV whenever a clinic moves from high to low prevalenceD. The positive likelihood ratio must become exactly 1 because prevalence has changedE. The confidence interval for any associated odds ratio is forced to include 1Check
WAVE3 EBP ORG5. A 74-year-old woman, Meera Joshi, is diagnosed with a slow-growing prostate cancer after PSA-based case-finding. She dies 11 years later of pneumonia, with unchanged cancer volume on serial imaging. Which bias or screening effect is this scenario illustrating most clearly?A. Lead-time bias, because bringing the diagnosis forward always lengthens true survival from the disease itselfB. Overdiagnosis of a cancer that would not have caused symptoms or death in her lifetimeC. Length-time bias only, on the assumption that every screen-detected cancer is biologically aggressiveD. Allocation concealment failure in a parallel-group randomised trial of treatmentE. Funnel-plot asymmetry caused by missing small negative trials of the screening blood testCheck
WAVE3 EBP ORG6. A registrar describes a funnel plot of trials of a new oral agent for gout flares. Small studies cluster to the right of the pooled effect with large effects and wide standard errors; larger studies hug the null. What is the most appropriate concern?A. Possible small-study or publication bias, with imprecise trials of little benefit under-representedB. That concealed randomisation has definitely failed in every trial that was included in the meta-analysisC. That the pooled confidence interval on a forest plot must include the null value of 1D. That only a per-protocol analysis of the largest trial is now statistically permissibleE. That the specificity of any linked diagnostic test must be exactly 50%Check
WAVE3 EBP ORG7. A 33-year-old woman, Chloe Maguire, emails the practice asking for a copy of her full GP record. Identity is already verified. Under UK GDPR as explained by the ICO, what is the usual latest point by which the practice must respond?A. Forty working days, which remains the default under the original Data Protection Act 1998 for health recordsB. Within one month of the valid requestC. Seven calendar days because health data are always treated as a special-category fast-trackD. Only after the practice Caldicott Guardian has countersigned every printed page of the recordE. Never, because general practice records are listed as exempt from subject accessCheck
WAVE3 EBP ORG8. A 6-year-old boy, Yusuf Hassan, is seen with fever, conjunctivitis and a spreading maculopapular rash. You suspect measles. What is the legal notification duty in England?A. Notify the local UKHSA health protection team on clinical suspicion of measles, which is urgent, and do not wait for laboratory confirmationB. Wait for IgM before any notification because false clinical diagnoses of measles are still common in primary careC. Ask the diagnostic laboratory to notify the disease instead of the registered medical practitioner who saw himD. Only notify if the child has not completed two documented MMR dosesE. Email the local registrar of births and deaths rather than health protectionCheck
WAVE3 EBP ORG9. A 61-year-old woman, Rhiannon Ellis, has an isolated TIA this morning with complete recovery in 40 minutes. She holds a Group 1 car licence and has no residual deficit. According to live GOV.UK DVLA neurological standards, what driving advice is required?A. She may drive home today if her FAST score is now documented as zeroB. Must not drive for 1 month; usually no DVLA notify after a single recovered TIAC. Must not drive for 12 months and must notify DVLA after every carotid TIA, as for Group 2 licensing after strokeD. Must not drive for 6 months, copying the first-unprovoked-seizure Group 1 ruleE. May drive the same day if she has started clopidogrel for a 21-day courseCheck
WAVE3 EBP ORG10. A 88-year-old man, Arthur Pendle, dies at home from expected end-stage heart failure. You are an attending practitioner and can propose a cause of death. Under current England and Wales MCCD rules, who sends the completed certificate to the registrar after scrutiny?A. The next of kin, who must collect a paper MCCD from reception on the day of deathB. The GP, using the pre-2024 direct-to-registrar routeC. The medical examiner office, after independent scrutiny of the attending practitioner’s MCCDD. The coroner, because every expected community death must now be investigatedE. NHS Business Services Authority, which from June 2026 issues completed certificates directly to bereaved familiesCheck