WILKES NSG 550 EXAM 2 –
DIAGNOSTIC REASONING (2026)
ACTUAL QUESTIONS & STUDY GUIDE
1. When evaluating a diagnostic test’s ability to identify those who truly do not have a
disease, which statistical measure is most relevant?
A. Sensitivity
B. Specificity
C. Positive Predictive Value
D. Negative Predictive Value
Answer: B
Conceptual Explanation: Specificity is the ability of a test to correctly identify those
without the disease (true negative rate).
2. A clinician relies heavily on the first piece of information offered by a patient, such as a
self-diagnosis of ‘flu’, and fails to consider other possibilities. This is an example of:
A. Availability Bias
B. Anchoring Bias
,C. Confirmation Bias
D. Representativeness Heuristic
Answer: B
Conceptual Explanation: Anchoring bias involves focusing on one particular piece of
information (the anchor) when making decisions.
3. In a patient with suspected bacterial pneumonia, which physical examination finding is
most indicative of lung consolidation?
A. Hyperresonance on percussion
B. Egophony (E to A change)
C. Decreased tactile fremitus
D. Wheezing
Answer: B
Conceptual Explanation: Egophony occurs when spoken ‘E’ sounds like ‘A’ over areas of
consolidation, like pneumonia.
4. Which of the following describes the ‘SNOUT’ mnemonic in diagnostic reasoning?
A. A highly sensitive test, when positive, rules out the disease.
B. A highly specific test, when negative, rules out the disease.
C. A highly sensitive test, when negative, rules out the disease.
, D. A highly specific test, when positive, rules in the disease.
Answer: C
Conceptual Explanation: SNOUT stands for SeNsitivity rules OUT. A negative result in a
highly sensitive test effectively excludes the diagnosis.
5. A Positive Likelihood Ratio (LR+) of 12.0 suggests that a positive test result:
A. Is clinically insignificant.
B. Provides a large and often conclusive increase in the likelihood of disease.
C. Provides a moderate increase in the likelihood of disease.
D. Decreases the likelihood of disease.
Answer: B
Conceptual Explanation: An LR+ greater than 10 indicates a large and often conclusive
increase in the probability that the condition is present.
6. Which heart sound is associated with atrial contraction against a stiff, non-compliant
ventricle and is often heard in patients with long-standing hypertension?
A. S1
B. S4
C. S3
D. S2
DIAGNOSTIC REASONING (2026)
ACTUAL QUESTIONS & STUDY GUIDE
1. When evaluating a diagnostic test’s ability to identify those who truly do not have a
disease, which statistical measure is most relevant?
A. Sensitivity
B. Specificity
C. Positive Predictive Value
D. Negative Predictive Value
Answer: B
Conceptual Explanation: Specificity is the ability of a test to correctly identify those
without the disease (true negative rate).
2. A clinician relies heavily on the first piece of information offered by a patient, such as a
self-diagnosis of ‘flu’, and fails to consider other possibilities. This is an example of:
A. Availability Bias
B. Anchoring Bias
,C. Confirmation Bias
D. Representativeness Heuristic
Answer: B
Conceptual Explanation: Anchoring bias involves focusing on one particular piece of
information (the anchor) when making decisions.
3. In a patient with suspected bacterial pneumonia, which physical examination finding is
most indicative of lung consolidation?
A. Hyperresonance on percussion
B. Egophony (E to A change)
C. Decreased tactile fremitus
D. Wheezing
Answer: B
Conceptual Explanation: Egophony occurs when spoken ‘E’ sounds like ‘A’ over areas of
consolidation, like pneumonia.
4. Which of the following describes the ‘SNOUT’ mnemonic in diagnostic reasoning?
A. A highly sensitive test, when positive, rules out the disease.
B. A highly specific test, when negative, rules out the disease.
C. A highly sensitive test, when negative, rules out the disease.
, D. A highly specific test, when positive, rules in the disease.
Answer: C
Conceptual Explanation: SNOUT stands for SeNsitivity rules OUT. A negative result in a
highly sensitive test effectively excludes the diagnosis.
5. A Positive Likelihood Ratio (LR+) of 12.0 suggests that a positive test result:
A. Is clinically insignificant.
B. Provides a large and often conclusive increase in the likelihood of disease.
C. Provides a moderate increase in the likelihood of disease.
D. Decreases the likelihood of disease.
Answer: B
Conceptual Explanation: An LR+ greater than 10 indicates a large and often conclusive
increase in the probability that the condition is present.
6. Which heart sound is associated with atrial contraction against a stiff, non-compliant
ventricle and is often heard in patients with long-standing hypertension?
A. S1
B. S4
C. S3
D. S2
