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Diagnostic Test Accuracy Questions and Answers
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Diagnostic Test Accuracy Questions and Answers evidence based medicine why are critical appraisal skills important? what is meant by the evaluation bypass? this is where due to enthusiasms, convictions, commercial pressure cause unevaluated procedures to be used in health services w...

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  • January 2, 2025
  • 9
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers

Subjects

  • diagnostic test accuracy questions and answers
  • mammography and bc tests being used at different
  • accuracy of diagnostic test cannot always be carri

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Diagnostic Test Accuracy Questions and
Answers
evidence based medicine - answer

why are critical appraisal skills important? - answer

what is meant by the evaluation bypass? - answer this is where due to enthusiasms,
convictions, commercial pressure cause unevaluated procedures to be used in health
services without being underpinned with good quality evidence

what evidence is there for commonly used therapies? - answer not a lot used

examples of diagnostic tests - answer demographics:
age/gender/ethnicity/social class
symptoms
questionnaires (for example the mini mental state examination)
physical signs
blood tests
imaging: x-ray, ultrasound, CT, MRI
biopsy
post-mortems

when is a diagnostic test useful? - answer a test is useful if it changes our ability to
predict whether a person has a condition or not - this then guides treatment choices

essentially: the probability of the conditions before the test should be altered by the test
result

reasons for carrying out a diagnostic test - answer detection/exclusion; rule-in/out a
disease
to make sure we are not missing something important (reassurance)
for medico-legal or financial reasons
bc we are following a protocol
bc it is easier to order a test than think about why we are doing it

ultimately we should be doing a diagnostic test bc the pt is better off for having it

how a test is useful: abdo pain example - shows how asking gender is a diagnostic test
- answer Gender of the pt has altered the probability of ectopic pregnancy and
endometriosis

H+E should be considered as tests in their own right

, why is improved patient outcome not guaranteed by improved test accuracy? - answer
no - need to consider harms and costs

approaches to making a diagnosis - answer patient appearance
H+E
investigations
response to tx

in GP what % of diagnoses are established by H+E? - answer 88%

in hospital what % of diagnoses are established by H+E? - answer 50% by H alone
and 75% by H+E

mammography and BC- tests being used at different points in the clinical pathway -
answer Screening programme- well population of women invited for screening test
Positive- further testing-> make a diagnosis of Bc not
Diagnosis- have another mammography + biopsy-> FNAC

Women who receive a diagnosis-> surveillance for ongoing disease or disease
recurrence

3 different applications of the same test: mammography - answer Screening-> most
women will be well
Repeat mammography-> filtered out those without so Population will have higher
prevalence. Screening will have picked up the more severe cases. Changed during
diagnostics compared to screening
When used for surveillance-> women have already had tx. May have had
mastectomy/lumpectomy. Population has changed in terms of women who are likely to
have disease, disease recurrence, type of disease, also what mammography is being
used on. Women may have had surgical procedures. Scar tissue might affect the
accuracy of mammography.

Accuracy of diagnostic test cannot always - answer be carried onto different
contexts.
Evaluation in screening context
Transferability of accuracy likely to be low when considered as surveillance testing

what questions are involved in evaluation of tests? - answer

avoid the evaluation bypass - answer Assess whether intevrvention is likely to
benefit pts.
Cost considerations-> two options with same efficacy., go with least costly.
Without evaluation-> varies from intervention to intervention
More likely that unevaluated test will make its way into health services compared to
unevaluated tx. Happens

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