Deck 3: Evidence-Based Practice in the Diagnostic Process

Question 1

In trying to incorporate the literature into clinical practice,what is the best way to keep up with current research?

A) Try to read it all.
B) Take 2 days off per month and do nothing but read articles.
C) Use a clinical challenge to look at the literature and incorporate published findings.
D) Attend one professional meeting per year.

Answer 1

C

Question 2

Which of the following choices represents the highest reliability?

A) 0.83
B) 0.91
C) 0.29
D) 0.50

Answer 2

B

Question 3

What reliability coefficient should be used when comparing clinicians?

A) Kappa
B) Gamma
C) Delta
D) Alpha

Answer 3

A

Question 4

You and another athletic trainer share the responsibility of evaluating the star of the baseball team.In order for any follow-up evaluations to be useful and interpretable,what type of reliability must be highest?

A) Intrarater reliability
B) Interrater reliability
C) Intraexaminer reliability
D) Reliability doesn't matter.

Question 5

Which of the following is considered the highest level of evidence?

A) Systematic review
B) Meta-analysis
C) Randomized clinical trials
D) Cohort studies

Question 6

What is meant by a positive likelihood ratio?

A) The likelihood that a negative test will decrease the probability that the pathology is absent
B) The likelihood that a positive test will decrease the probability that the pathology is present
C) The likelihood that a positive test will enhance the probability that the pathology is present
D) The likelihood that a negative test will enhance the probability that the pathology is present

Question 7

Three clinicians (I,II,III)are working in the clinic and routinely rotate patients so they are familiar with all of their clients.Which of the following combinations of clinicians needs to work to make their skill set more reliable?

A) Interrater reliability between I and III = 0.78
B) Interrater reliability between I and II = 0.98
C) Interrater reliability between II and III = 0.83
D) Intrarater reliability of I = 0.98

Question 8

Which of the following tests would determine with the highest sensitivity that a fracture is present?

A) X-ray
B) Magnetic resonance imaging (MRI)
C) Tap test
D) Squeeze test

Question 9

The higher the prevalence of an injury,the __________ the effect on positive predictive value and the _______ the effect on negative predictive value.

A) higher; higher
B) lower; lower
C) higher; lower
D) lower; higher

Question 10

Which of the following is not true regarding the use of clinical decision rules,also known as clinical prediction rules?

A) They improve decision making.
B) They decrease costs.
C) They ultimately improve patient outcome.
D) They decrease the experience level of the clinician.

Question 11

What is the best method for improving intrarater reliability?

A) Repeat the process multiple times using the same technique.
B) Repeat the process and compare it with other individuals.
C) Don't worry about it-the task will come with experience and time.
D) There is no way to improve intrarater reliability.

Question 12

Which of the following terms describes when a certain number of individuals in a group sustain an injury?

A) Prevalence
B) Specificity
C) Selectivity
D) Validity

Question 13

When doing a literature search on a specific topic,you find two articles that were written based on different research methods.Of the choices listed below,the ________ represents the highest level of research design,and the __________ represents the lowest level.

A) case report; cohort study
B) meta-analysis; expert opinion
C) expert opinion; meta-analysis
D) expert opinion; case report

Question 14

Evidence-based practice,a foundation of best practice,is the incorporation of three elements into the decision-making process of patient care.Which of the following is not one of these elements?

A) Best available research
B) Clinical expertise
C) The overall time to achieve long-term goals
D) The needs and values of the individual patient

Question 15

What is the term used to identify how often a negative finding is correct?

A) Positive predictive value
B) True positive predictive value
C) Negative predictive value
D) True negative/negative value

Question 16

Which term describes a test's ability to detect those patients who do not have the disorder being tested for?

A) Selectivity
B) Specificity
C) Reliability
D) Validity

Question 17

Which of the following factors does not influence reliability?

A) Consistency in performing a skill
B) How the results are interpreted
C) Gender of the patient
D) Experience and training of the examiner

Question 18

What is the term for the ability of a protocol to produce the intended effects?

A) Likelihood ratio
B) Specificity
C) Efficacy
D) Sensitivity

Question 19

What is the term for a clinical test that incorrectly identifies a condition as present when there is no pathology?

A) True positive
B) False positive
C) True negative
D) False negative

Question 20

What is the gold standard for diagnosing anterior cruciate ligament injuries?

A) Anterior drawer test
B) Lachman's test
C) MRI
D) Arthroscopy

Question 21

What is a test's clinical usefulness if the reliability measure is greater than 0.75?

A) Poor
B) Moderate
C) Good
D) Excellent

Question 22

What term describes the likelihood that a specific condition is present before the diagnostic test results are known?

A) Pretest probability
B) Prevalence
C) Efficacy
D) Diagnostic accuracy

Question 23

Which of the following is not true about tests that are considered diagnostic gold standards?

A) They are less accessible.
B) They are more expensive.
C) They take less time.
D) They are more invasive.

Question 24

In research,what term describes the extent to which the same examiner obtains the same results on the same patient?

A) Diagnostic accuracy
B) Intrarater reliability
C) Prevalence
D) Interrater reliability

Question 25

Which of the following is a research technique that combines the results of several studies that have similar research hypotheses?

A) Case series
B) Meta-analysis
C) Cohort study
D) Randomized clinical trial

Question 26

What phrase best describes the shift in probability that is tied to a negative likelihood ratio greater than 0.5?

A) Very small, usually unimportant
B) Small, sometimes important
C) Moderate but usually important
D) Large, often conclusive

Question 27

The best diagnostic accuracy is achieved with a high rate of which of the following?

A) True positives and false negatives
B) True positives and true negatives
C) False positives and false negatives
D) False positives and true negatives

Question 28

To be clinically useful,a procedure must demonstrate good reliability.

Question 29

The minimal clinically important change is more meaningful than the minimum detectable change.

Question 30

What is a general term to describe how often results correctly identify whether a pathology is present?

A) Pretest probability
B) Prevalence
C) Efficacy
D) Diagnostic accuracy

Question 31

What is the term for a situation in which the clinical test and the gold standard are both negative?

A) True positive
B) False positive
C) True negative
D) False negative

Question 32

Which of the following terms describes quick summaries of how positive and negative findings on a particular test determine a test's diagnostic usefulness?

A) Likelihood ratios
B) Specificity
C) Efficacy
D) Sensitivity

Question 33

Clinician-based outcome measures are used to assess concerns important to the patient that often relate to symptoms,functional ability,or health-related quality of life.

Question 34

Likelihood ratios incorporate a test's sensitivity and specificity,and they are influenced by the prevalence of a condition.

Question 35

Which positive likelihood ratio is considered "moderate but usually important"?

A) 1 to 2
B) 2 to 5
C) 5 to 10
D) Greater than 10

Question 36

Which of the following describes a research study with two groups-one that receives the treatment and one that does not-that are studied over time to determine the impact of the treatment?

A) Case series
B) Meta-analysis
C) Cohort study
D) Randomized clinical trial

Question 37

A positive test result must have a minimum positive likelihood ratio of which of the following to significantly add to the pretest probability that the condition is present?

A) Greater than 1
B) Less than 1
C) Greater than 10
D) Less than 10

Question 38

A patient-centered approach is best described by which of the following?

A) Patient's needs and values
B) Patient's values but not the patient's needs
C) Patient's long-term goals and needs
D) Patient's needs, values, and long-term goals