WILKES NSG 550 EXAM 3 –
DIAGNOSTIC REASONING (2026)
QUESTIONS AND ANSWERS
1. Which of the following describes the ability of a diagnostic test to correctly identify those
who do NOT have the disease?
A. Specificity
B. Sensitivity
C. Positive Predictive Value
D. Negative Predictive Value
Answer: A
Conceptual Explanation: Specificity refers to the proportion of people without the disease
who test negative (true negatives). It is the ability of the test to identify the absence of a
condition.
2. When a clinician relies on a single piece of information, such as the first lab value received,
to make a diagnosis while ignoring subsequent information, which cognitive bias is occurring?
A. Availability Bias
,B. Confirmation Bias
C. Anchoring Bias
D. Representativeness Heuristic
Answer: C
Conceptual Explanation: Anchoring bias is the tendency to rely too heavily on the first
piece of information offered (the ‘anchor’) when making decisions.
3. What is the clinical significance of a Likelihood Ratio (LR+) of 10.0 or greater?
A. It provides a large and often conclusive increase in the probability of disease.
B. It provides a small increase in the probability of disease.
C. It indicates the test is useful for ruling out a disease.
D. It provides no change in the probability of disease.
Answer: A
Conceptual Explanation: An LR+ greater than 10 is considered a strong indicator that the
positive test result significantly increases the post-test probability of the disease.
4. The mnemonic ‘SnNout’ refers to which diagnostic principle?
A. A specific test, when negative, rules out the disease.
B. A sensitive test, when positive, rules in the disease.
C. A specific test, when negative, rules in the disease.
, D. A sensitive test, when negative, rules out the disease.
Answer: D
Conceptual Explanation: SnNout stands for Sensitivity Negative Rules Out. If a test is
highly sensitive and the result is negative, you can be very confident the patient does not
have the disease.
5. Which component of the SOAP note includes the clinician’s differential diagnosis?
A. Subjective
B. Assessment
C. Objective
D. Plan
Answer: B
Conceptual Explanation: The Assessment section involves the clinician’s synthesis of
subjective and objective data to form a diagnosis or list of differential diagnoses.
6. In diagnostic reasoning, ‘System 2’ thinking is characterized as:
A. Fast, intuitive, and subconscious.
B. Slow, analytical, and deliberate.
C. Based entirely on pattern recognition.
D. Prone to more errors than System 1.
DIAGNOSTIC REASONING (2026)
QUESTIONS AND ANSWERS
1. Which of the following describes the ability of a diagnostic test to correctly identify those
who do NOT have the disease?
A. Specificity
B. Sensitivity
C. Positive Predictive Value
D. Negative Predictive Value
Answer: A
Conceptual Explanation: Specificity refers to the proportion of people without the disease
who test negative (true negatives). It is the ability of the test to identify the absence of a
condition.
2. When a clinician relies on a single piece of information, such as the first lab value received,
to make a diagnosis while ignoring subsequent information, which cognitive bias is occurring?
A. Availability Bias
,B. Confirmation Bias
C. Anchoring Bias
D. Representativeness Heuristic
Answer: C
Conceptual Explanation: Anchoring bias is the tendency to rely too heavily on the first
piece of information offered (the ‘anchor’) when making decisions.
3. What is the clinical significance of a Likelihood Ratio (LR+) of 10.0 or greater?
A. It provides a large and often conclusive increase in the probability of disease.
B. It provides a small increase in the probability of disease.
C. It indicates the test is useful for ruling out a disease.
D. It provides no change in the probability of disease.
Answer: A
Conceptual Explanation: An LR+ greater than 10 is considered a strong indicator that the
positive test result significantly increases the post-test probability of the disease.
4. The mnemonic ‘SnNout’ refers to which diagnostic principle?
A. A specific test, when negative, rules out the disease.
B. A sensitive test, when positive, rules in the disease.
C. A specific test, when negative, rules in the disease.
, D. A sensitive test, when negative, rules out the disease.
Answer: D
Conceptual Explanation: SnNout stands for Sensitivity Negative Rules Out. If a test is
highly sensitive and the result is negative, you can be very confident the patient does not
have the disease.
5. Which component of the SOAP note includes the clinician’s differential diagnosis?
A. Subjective
B. Assessment
C. Objective
D. Plan
Answer: B
Conceptual Explanation: The Assessment section involves the clinician’s synthesis of
subjective and objective data to form a diagnosis or list of differential diagnoses.
6. In diagnostic reasoning, ‘System 2’ thinking is characterized as:
A. Fast, intuitive, and subconscious.
B. Slow, analytical, and deliberate.
C. Based entirely on pattern recognition.
D. Prone to more errors than System 1.
