Screening of disease

Questions

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2 by 2 table
(1 question)

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 Question 1: Level 1
• In a test of 150 people for HIV, Western blot found
that 50 people are suffering from HIV & 100 were
not suffering from HIV.
• Out of this 50, 30 had positive results with ICT kit &
only 70 were found to be negative as per the kit from
the 100 labelled as negative from the western blot.
• What is the sensitivity, specificity, PPV & NPV?

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 Answer 1: Level 1
Gold Standard
Positive Negative Total
Screening Positive 30 30 60
Test Negative 20 70 90
Total 50 100 150

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 Question 2: Level 2
• A diagnostic test for a particular disease has a
sensitivity of 0.9 & a specificity of 0.9. A single test is
applied to each subject in the population in which
the disease prevalence is 10%. What is the
probability that a person positive to this test, has
the disease?

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 Answer 2: Level 2
Gold Standard
Positive Negative Total
Screening Positive 9 9 18
Test Negative 1 81 82
Total 10 90 100

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 Question 3: Level 3
Screening test
Positive Negative Total
Gold Positive 30 30 60
Standard Negative 20 70 90
Total 50 100 150

Q. Calculate the Sn, Sp, PPV, NPV.

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Interpretation of Screening Test Results
(1 question)

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 Question 4: Level 3
• A virulent bacterial infection has an 80% case fatality
rate if it is not identified early in its course, however
prompt administration of antibiotics decreased the
mortality rate to <5%. The risks of the antibiotic
therapy are minimal. Which of the following labelled
points is most appropriate for use as the optimal
diagnostic cut point for results of the test?

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 Where should be the Cut off?
3.5

2.5

2
NOT INFECTED
1.5 INFECTED

1 Cut off at:

A. 1
0.5
B. 2
0 C. 3.5
0 1 2 3 4 5 6 7 D. 5
E. 6
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 Question 5: Level 2
• The diagnostic power of test to correctly exclude the
disease is reflected by:
1. Specificity
2. Sensitivity
3. PPV
4. NPV

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 Question 6: Level 2
• A diagnostic test has been in use for decades.
However with improvement in hygiene the
prevalence of the disease falls from 35% to 5%.
Which of the statements is correct?
1. Change in prevalence will reduce the predictive value of a
negative result
2. Predictive value of a positive result will decline
3. Specificity of the test is likely to decline
4. Specificity will increase at expense of its sensitivity

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 Question 7: Level 2
• A blood test reveals that a 35 year old woman at 18
weeks gestation has increased serum alpha
fetoprotein. Of the following measures, which has the
greatest influence in determining the predictive value
of this test for NTD in foetus?
1. Absolute concentration of AFP in maternal serum
2. Family history of dizygotic twin pregnancy
3. Prevalence of NTD defects in the population in the question
4. Specificity of blood test
5. Sensitivity of blood test

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 Question 8: Level 2 (PGIMER)
• A blood test reveals that a 35 year old woman at 18
weeks gestation has increased serum alpha
fetoprotein. Of the following measures, which
influences the predictive value of this test for NTD in
foetus?
1. Absolute concentration of AFP in maternal serum
2. Family history of dizygotic twin pregnancy
3. Prevalence of NTD defects in the population in the question
4. Specificity of blood test
5. Sensitivity of blood test

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 Question 9: Level 2
• A doctor orders 6 tests for SLE. Which of the
following is needed for inference?
– Prior probability of SLE, sensitivity & specificity of test
– Incidence of SLE & predictivity of each test
– Incidence & prevalence of SLE
– RR of SLE in patient

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 Question 10: Level 2
• A screening test is used in same way in 2 similar
populations, but the proportion of false positive
results among those who test positive in population
A is lower than among those who test positive in
population B. What is the likely explanation for this
finding?
– Specificity of test is lower in population A
– Prevalence of disease is lower in population A
– Prevalence of disease is higher in population A
– Specificity of the test is higher in population A

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 Question 11: Level 2
• If hemoccult test is negative for screening of colonic
cancer, no further test is done. If hemoccult test is
positive individual will have a 2nd stool sample tested
with hemoccult 2 test. If this 2nd test is positive for blood
then individual will be referred for more extensive
evaluation. Effect of net sensitivity & net specificity of
this method of screening is:
• a. Both increased
• b. Net sensitivity is decreased & net specificity is increased
• c. Net sensitivity is increased & net specificity is increased
• d. Net sensitivity remain the same & net specificity is increased

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 Question 12: Level 3
• In a group of patients presenting to a hospital
emergency with abdominal pain, 30% of patients
have acute appendicitis. 70% of patients with
appendicitis have a temperature greater than 37.5 C
& 40% of patients without appendicitis have a
temperature greater than 37.5 C. Calculate PPV.

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 Answer 12: Level 3

Appendicitis No Total
appendicitis
Fever > 21 28 49
37.5
No 9 42 51
fever
Total 30 70 100

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Hypothesis Testing
(1 question)

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Question 13: Earlier Level 3 now Level 1
• A randomized trial comparing the efficacy of 2 drugs
showed a difference between the 2 (with a p value <
0.05). Assume that in reality, however, the 2 drugs
don’t differ. This is:
a. Type I error
b. Type II error
c. 1 – Type I error
d. 1 – Type II error
e. None

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Question 14: Earlier Level 3 now Level 1
• A randomized trial comparing the efficacy of 2 drugs
showed a difference between the 2 (with a p value <
0.05). In reality the 2 drugs differ. This is:
a. Type I error
b. Type II error
c. 1 – Type I error
d. 1 – Type II error
e. None

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Question 15: Earlier Level 3 now Level 1
• A randomized trial comparing the efficacy of 2 drugs
showed no difference between the 2. Assume that in
reality, however, the 2 drugs do differ. This is
therefore an example of:
a. Type I error
b. Type II error
c. 1 – Type I error
d. 1 – Type II error
e. None

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 Question 16: Level 2
• After applying a statistical test, an investigator gets the p
value as 0.01 it means that 
a. Probability of finding a significant difference is 1%
b. Probability of declaring a significant difference is 1%
c. Difference not significant 1% times and significant 99% times 
• Explanation: p value is 0.01; it means that the probability
of committing type-1 error is only 1%
So, 99% chance is that there is significant difference
present between two interventions, which means we
can reject null hypothesis and accept alternate
hypothesis.
• So, the best answer will be c 24
 Question 17: Level 3
• P value of a RCT comparing operation A (new
procedure) & operation B (gold standard) is 0.04.
From this, we conclude that:
1. Type II error is small & we can accept the findings of study
2. Power of study to detect a difference between operation A
& B is 96%
3. Probability of false negative conclusion that operation A is
better than operation B, when in truth it is not 4%
4. Probability of a false positive conclusion that operation
‘operation A is better than Operation B’ when in truth it is
not, is 4%

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 Answer 17: Level 3
• P value of a RCT comparing operation A (new procedure)
& operation B (gold standard) is 0.04. From this, we
conclude that:
– Type II error is small & we can accept the findings of study (no
relation with type II error as p value related to type I)
– Power of study to detect a difference between operation A & B
is 96% (no relation as power = 1- B)
– Probability of false negative conclusion that operation A is better
than operation B, when in truth it is not 4%
– Probability of a false positive conclusion that operation
‘operation A is better than Operation B’ when in truth it is not, is
4%

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Question 18: Earlier Level 3 now Level 1
• In assessing association between maternal nutritional
status & birth weight of newborns, 2 investigators A & B
studied separately & found significant results with p
values 0.02 & 0.04 respectively. From this information,
what can you infer about the magnitudes of association
found by 2 investigations?
1. Magnitude of association found by investigator A is > B
2. Magnitude of association found by investigator B is > A
3. Magnitude of association found by investigator B = A
4. Nothing can be concluded as information given is insufficient

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 Question 19: AIIMS May 2017
• A researcher said he has discovered a new drug
which is effective in chronic hypertensive’s with a p
value of <0.10. which of the following is true
regarding the same?
a) Test is 90% reproducible
b) 90% of test results could have occurred by chance
c) Not more than 10% of the people benefitted by the
drug could be due to chance
d) 90% of patients will be benefitted by giving the drug
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 Ans. 19. Option C
a) The test is 90% reproducible: Reliability
b) 90% of test results could have occurred by chance
c) Not more than 10% of the people benefitted by the
drug could be due to chance: Definition of p value
d) 90% of patients will be benefitted by giving the drug:
Power

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Miscellaneous

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 Question19: Level 1 [Common Error]
• When FP increases then:
1. Increased prevalence
2. Decreased prevalence
3. Increased sensitivity
4. Increased specificity

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Controversial Questions of the Chapter
• Most reliable test for DM screening:
1. GTT
2. Glycosylated haemoglobin
3. FBS
4. Urine for sugar
• Screening of cervical cancer at PHC is done by:
1. History & clinical examination
2. Colposcopy
3. CT scan
4. Pap smear

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 NOT PSM
• Most specific screening test for Vitamin D deficiency:
1. 7 dehydroxycholestrol
2. 1, 25 dihydroxy vitamin D
3. 25 hydroxy Vitamin D
4. Serum calcium levels
• Blood screening is not done for:
1. HIV
2. HBV
3. EBV
4. HCV

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Thank You

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 Question 1: Level 2 (Home Task)
• A screening test was positive in 50% of diseased &
10% of healthy population. What is the specificity of
the test?
– 0.5
– 0.9
– 0.83
– 0.064

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 Answer 1: Level 2
Gold Standard
Positive Negative Total
Screening Positive 50 10 60
Test Negative 50 90 140
Total 100 100 200

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 Hint for the Question
• Since 50% of diseased is given; so we start from filling
up TP + FN

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 Question 2: Level 3 (Home Task)
• If a test has sensitivity of 80%, positive predictive
value of 60%, Negative predictive value of 40% what
should be the Specificity of the test?
– a) 90%
– b) 40%
– c) 75%
– d) 20%

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 Answer 2: Level 3
Gold Standard
Positive Negative Total
Screening Positive 60 (1): 40 (3) 100 (2)
Test from PPV
Negative 15 (5) 10 (7) 25 (6):
from NPV
Total 75 (4): 50 (8)
from Sn

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 Hint for the Question
• Since prevalence not given, so we start from TP+FP
(100%) rather than from sensitivity

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 Question 3: Level 2 (Home Task)
• Which of the following is/ are true about a
screening test?
– Sensitivity = 1 – FP
– Specificity = 1 – FN
– Post test probability is pre test probability *
Prevalence
– Predictive values doesn’t depend on prevalence
– None of the above

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