NR 511 Midterm
Study online at https://quizlet.com/_er23to
1. What is the difference between primary, secondary and tertiary care?: Primary -
illness, injury, referrals
Secondary - Specialists like cardiologists
Tertiary - highly specialized within hospital, like surgery
2. What is it called when you can make a diagnosis without running tests? ex.
IBS: Clinical diagnosis
3. What is important to remember about diagnostic testing?: There are no perfect tests,
so it is important to consider it is necessary, the cost, what you will do with the results, and the impact of potential false
positives or negatives
4. What is a false positive? False negative? What are the impacts of each?: FP: You
do not have the disease but you test positive. Leads to unnecessary testing, costs, anxiety, etc.
FN: You do have the disease but you test negative. Leads to delayed treatment, which could increase morbidity/mortality.
5. What is the tradeoff between sensitivity and specificity?: When sensitivity is higher,
specificity is lower, and vice versa. Ideally would have both high, but there is always a degree of trade-off
Tests with a high sensitivity are good at identifying those with a disease, meaning there are less false negatives and
more true positives. For a bad disease that is treatable early on, may be helpful to have a high sensitivity because there
is less of a chance of missing this important diagnosis.
Tests with a high specificity are good when you don't want to alarm someone unnecessarily with a false positive (think
of a pregnancy test). You want to be sure the positive is a true positive. Another example is a mammogram. A false
positive leads to more testing.
6. If the sensitivity of a test is 80%, what does this mean?: The test is 80% accurate in
identifying diseased people
7. If the specificity of a test is 90%, what does this mean?: The test is 90% accurate in
identifying non-diseased people
8. Sensitivity is greater when a test has...: fewer false negatives
9. Specificity is greater when a test has...: fewer false positives
10. Does sensitivity relate to the proportion of real positives or real negatives?-
: Real positives
, NR 511 Midterm
Study online at https://quizlet.com/_er23to
Specificity relates to the promotion of real negatives
11. If the positive predictive value is 67%, what does this mean?: Of all the people that
test positive for the disease, 67% actually have it
12. If the negative predictive value is 95%, what does this mean?: Of all the people that
test negative for the disease, 95% actually are disease-free
13. What is an important distinction between sensitivity/specificity and
PPV/NPV?: Sensitivity/specificity are intrinsic to the test
PPV/NPV are based on the population
14. How is validity of a test determined?: It is compared to the "gold standard" (ex. mammogram vs
biopsy)
15. What is prevalence?: The number of cases in a given population at a particular point in time
16. How does PPV and NPV relate to prevalence?: Prevalence and PPV increase or decrease
together, whereas NPV does the opposite.
17. Mammograms have a sensitivity of 83.8%, a specificity of 90.6%, PPV of 4.4%
and NPV of 99.9%. What does this mean?: Mammograms are 83% accurate in identifying people
with breast cancer (sensitivity)
Mammograms are 90.6% accurate in identifying people without breast cancer (sensitivity)
Of those that test positive, 4.4% will actually have breast cancer (PPV)
Of those that test negative, 99.9% will actually not have breast cancer (negative likely means healthy)
18. What is the likelihood ratio?: How likely it is that a patient has the disease. When the ratio is higher,
it is more likely they have the disease. This is determined by sensitivity and specific
If a patient comes in with flu-like symptoms and it is peak flu season, there is a strong possibility the patient has the
flu. You could order a rapid flu test, but if the test is negative you likely will treat the patient anyway.
19. What is pretest probability?: The chance that the patient has the disease, estimated before the results
of a test are known
20. How do you calculate sensitivity? Specificity?: Sensitivity = True positives / All diseased
Specificity = True negatives / All non-diseased
, NR 511 Midterm
Study online at https://quizlet.com/_er23to
21. Most commonly ordered diagnostic tests: CBC +/- differential
- RBC
- WBC (+/- breakdown)
- Hemoglobin
- Hematocrit
- Platelets
CMP
- Electrolytes (Na, K, Cl, HCO3, Ca, glucose)
- Cholesterol, protein, albumin
- Liver (ALT, AST, bilirubin, phosphatase)
- Kidneys (BUN, creatinine)
22. What is the SNAPPS method?: A way to give a case presentation
Summarize history and findings
Narrow differential to 2-3
Analyze differentials - compare and contrast
Probe preceptor with questions about approach
Plan management
Select issue from case for self-directed learning
23. What are examples of third-party payers?: Medicare, Medicaid, Workers Comp, VA
24. What do you call people who pay out of pocket for the medical expenses?: -
private payers
25. How do NPs bill compared to physicians?: NPs bill at 85% the fee rate of physicians
If NPs bill under the physician, physician gets 100%
26. What is a NPI number?: National Provider Identifier
Assigned to providers associated with medicare so that they can bill
27. What is CMS payment policy based on? What does Medicare generally pay?-
: Physician and nonphysical provider fee schedule
In general, Medicare pays 80% and the patent is responsible for 20%
Study online at https://quizlet.com/_er23to
1. What is the difference between primary, secondary and tertiary care?: Primary -
illness, injury, referrals
Secondary - Specialists like cardiologists
Tertiary - highly specialized within hospital, like surgery
2. What is it called when you can make a diagnosis without running tests? ex.
IBS: Clinical diagnosis
3. What is important to remember about diagnostic testing?: There are no perfect tests,
so it is important to consider it is necessary, the cost, what you will do with the results, and the impact of potential false
positives or negatives
4. What is a false positive? False negative? What are the impacts of each?: FP: You
do not have the disease but you test positive. Leads to unnecessary testing, costs, anxiety, etc.
FN: You do have the disease but you test negative. Leads to delayed treatment, which could increase morbidity/mortality.
5. What is the tradeoff between sensitivity and specificity?: When sensitivity is higher,
specificity is lower, and vice versa. Ideally would have both high, but there is always a degree of trade-off
Tests with a high sensitivity are good at identifying those with a disease, meaning there are less false negatives and
more true positives. For a bad disease that is treatable early on, may be helpful to have a high sensitivity because there
is less of a chance of missing this important diagnosis.
Tests with a high specificity are good when you don't want to alarm someone unnecessarily with a false positive (think
of a pregnancy test). You want to be sure the positive is a true positive. Another example is a mammogram. A false
positive leads to more testing.
6. If the sensitivity of a test is 80%, what does this mean?: The test is 80% accurate in
identifying diseased people
7. If the specificity of a test is 90%, what does this mean?: The test is 90% accurate in
identifying non-diseased people
8. Sensitivity is greater when a test has...: fewer false negatives
9. Specificity is greater when a test has...: fewer false positives
10. Does sensitivity relate to the proportion of real positives or real negatives?-
: Real positives
, NR 511 Midterm
Study online at https://quizlet.com/_er23to
Specificity relates to the promotion of real negatives
11. If the positive predictive value is 67%, what does this mean?: Of all the people that
test positive for the disease, 67% actually have it
12. If the negative predictive value is 95%, what does this mean?: Of all the people that
test negative for the disease, 95% actually are disease-free
13. What is an important distinction between sensitivity/specificity and
PPV/NPV?: Sensitivity/specificity are intrinsic to the test
PPV/NPV are based on the population
14. How is validity of a test determined?: It is compared to the "gold standard" (ex. mammogram vs
biopsy)
15. What is prevalence?: The number of cases in a given population at a particular point in time
16. How does PPV and NPV relate to prevalence?: Prevalence and PPV increase or decrease
together, whereas NPV does the opposite.
17. Mammograms have a sensitivity of 83.8%, a specificity of 90.6%, PPV of 4.4%
and NPV of 99.9%. What does this mean?: Mammograms are 83% accurate in identifying people
with breast cancer (sensitivity)
Mammograms are 90.6% accurate in identifying people without breast cancer (sensitivity)
Of those that test positive, 4.4% will actually have breast cancer (PPV)
Of those that test negative, 99.9% will actually not have breast cancer (negative likely means healthy)
18. What is the likelihood ratio?: How likely it is that a patient has the disease. When the ratio is higher,
it is more likely they have the disease. This is determined by sensitivity and specific
If a patient comes in with flu-like symptoms and it is peak flu season, there is a strong possibility the patient has the
flu. You could order a rapid flu test, but if the test is negative you likely will treat the patient anyway.
19. What is pretest probability?: The chance that the patient has the disease, estimated before the results
of a test are known
20. How do you calculate sensitivity? Specificity?: Sensitivity = True positives / All diseased
Specificity = True negatives / All non-diseased
, NR 511 Midterm
Study online at https://quizlet.com/_er23to
21. Most commonly ordered diagnostic tests: CBC +/- differential
- RBC
- WBC (+/- breakdown)
- Hemoglobin
- Hematocrit
- Platelets
CMP
- Electrolytes (Na, K, Cl, HCO3, Ca, glucose)
- Cholesterol, protein, albumin
- Liver (ALT, AST, bilirubin, phosphatase)
- Kidneys (BUN, creatinine)
22. What is the SNAPPS method?: A way to give a case presentation
Summarize history and findings
Narrow differential to 2-3
Analyze differentials - compare and contrast
Probe preceptor with questions about approach
Plan management
Select issue from case for self-directed learning
23. What are examples of third-party payers?: Medicare, Medicaid, Workers Comp, VA
24. What do you call people who pay out of pocket for the medical expenses?: -
private payers
25. How do NPs bill compared to physicians?: NPs bill at 85% the fee rate of physicians
If NPs bill under the physician, physician gets 100%
26. What is a NPI number?: National Provider Identifier
Assigned to providers associated with medicare so that they can bill
27. What is CMS payment policy based on? What does Medicare generally pay?-
: Physician and nonphysical provider fee schedule
In general, Medicare pays 80% and the patent is responsible for 20%
