NSG 550 DIAGNOSTIC REASONING
COMPREHENSIVE EXAM QUESTIONS
AND ANSWERS
1. When evaluating a diagnostic test’s ability to correctly identify those without a disease,
which statistical measure is the clinician assessing?
A. Specificity
B. Sensitivity
C. Positive Predictive Value
D. Negative Predictive Value
Answer: A
Conceptual Explanation: Specificity is the ability of a test to correctly identify those
without the disease (true negative rate). A highly specific test, when positive, helps ‘rule in’
a diagnosis (SpPIn).
2. A 55-year-old male presents with a systolic crescendo-decrescendo murmur heard best at
the right second intercostal space that radiates to the carotid arteries. What is the most likely
diagnosis?
A. Mitral Regurgitation
,B. Mitral Stenosis
C. Aortic Regurgitation
D. Aortic Stenosis
Answer: D
Conceptual Explanation: Aortic stenosis is characterized by a systolic crescendo-
decrescendo murmur at the right upper sternal border radiating to the carotids.
3. Which cranial nerve is being assessed when the clinician asks the patient to puff out their
cheeks and show their teeth?
A. CN V (Trigeminal)
B. CN XII (Hypoglossal)
C. CN IX (Glossopharyngeal)
D. CN VII (Facial)
Answer: D
Conceptual Explanation: CN VII, the Facial nerve, controls the muscles of facial
expression, including puffing cheeks and smiling.
4. During a physical exam, the clinician palpates the left lower quadrant of the abdomen, and
the patient feels pain in the right lower quadrant. This finding is known as:
A. Murphy’s Sign
B. McBurney’s Sign
, C. Psoas Sign
D. Rovsing’s Sign
Answer: D
Conceptual Explanation: Rovsing’s sign is referred pain in the RLQ during palpation of the
LLQ, suggesting peritoneal irritation or appendicitis.
5. In the context of diagnostic reasoning, what does a Likelihood Ratio (LR) of 1.0 indicate?
A. The test significantly increases the probability of disease.
B. The test significantly decreases the probability of disease.
C. The test is the gold standard for diagnosis.
D. The test provides no change in the post-test probability of disease.
Answer: D
Conceptual Explanation: An LR of 1.0 means the test result does not change the likelihood
of the disease; it is uninformative.
6. A patient exhibits ‘egophony’ during a pulmonary exam. When the patient says ‘E’, the
clinician hears ‘A’ through the stethoscope. This indicates:
A. Pneumothorax
B. Lung Consolidation (e.g., Pneumonia)
C. Chronic Obstructive Pulmonary Disease
COMPREHENSIVE EXAM QUESTIONS
AND ANSWERS
1. When evaluating a diagnostic test’s ability to correctly identify those without a disease,
which statistical measure is the clinician assessing?
A. Specificity
B. Sensitivity
C. Positive Predictive Value
D. Negative Predictive Value
Answer: A
Conceptual Explanation: Specificity is the ability of a test to correctly identify those
without the disease (true negative rate). A highly specific test, when positive, helps ‘rule in’
a diagnosis (SpPIn).
2. A 55-year-old male presents with a systolic crescendo-decrescendo murmur heard best at
the right second intercostal space that radiates to the carotid arteries. What is the most likely
diagnosis?
A. Mitral Regurgitation
,B. Mitral Stenosis
C. Aortic Regurgitation
D. Aortic Stenosis
Answer: D
Conceptual Explanation: Aortic stenosis is characterized by a systolic crescendo-
decrescendo murmur at the right upper sternal border radiating to the carotids.
3. Which cranial nerve is being assessed when the clinician asks the patient to puff out their
cheeks and show their teeth?
A. CN V (Trigeminal)
B. CN XII (Hypoglossal)
C. CN IX (Glossopharyngeal)
D. CN VII (Facial)
Answer: D
Conceptual Explanation: CN VII, the Facial nerve, controls the muscles of facial
expression, including puffing cheeks and smiling.
4. During a physical exam, the clinician palpates the left lower quadrant of the abdomen, and
the patient feels pain in the right lower quadrant. This finding is known as:
A. Murphy’s Sign
B. McBurney’s Sign
, C. Psoas Sign
D. Rovsing’s Sign
Answer: D
Conceptual Explanation: Rovsing’s sign is referred pain in the RLQ during palpation of the
LLQ, suggesting peritoneal irritation or appendicitis.
5. In the context of diagnostic reasoning, what does a Likelihood Ratio (LR) of 1.0 indicate?
A. The test significantly increases the probability of disease.
B. The test significantly decreases the probability of disease.
C. The test is the gold standard for diagnosis.
D. The test provides no change in the post-test probability of disease.
Answer: D
Conceptual Explanation: An LR of 1.0 means the test result does not change the likelihood
of the disease; it is uninformative.
6. A patient exhibits ‘egophony’ during a pulmonary exam. When the patient says ‘E’, the
clinician hears ‘A’ through the stethoscope. This indicates:
A. Pneumothorax
B. Lung Consolidation (e.g., Pneumonia)
C. Chronic Obstructive Pulmonary Disease
