International Foundations of Medicine Exam Program (IFOM) · Free practice fileMometrix Original
International Foundations of Medicine Exam Program (IFOM) FMALL Original Practice Questions
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Question 1
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A 42-year-old woman comes to the office for evaluation of fatigue. The clinician searches the literature and finds a randomized controlled trial showing that in adult patients presenting with fatigue, a new diagnostic test has a positive likelihood ratio of 11.4 and a negative likelihood ratio of 0.78. Which of the following best describes the clinical utility of this test based on these values?
- A.A positive result meaningfully rules in disease and a negative result meaningfully rules out disease
- B.A positive result meaningfully rules in disease, but a negative result does not meaningfully rule out disease
- C.A negative result meaningfully rules out disease, but a positive result does not meaningfully rule in disease
- D.Neither a positive nor a negative result meaningfully changes the probability of disease
Correct Answer: B
Likelihood ratios (LRs) are interpreted by convention: an LR+ greater than 10 produces a large, often clinically useful increase in post-test probability and meaningfully rules in disease, while an LR- between 0.5 and 1.0 produces only a small, usually clinically unimportant decrease in probability and does not meaningfully rule out disease. With an LR+ of 11.4 the positive result is clinically useful, but the LR- of 0.78 is in the range that yields only a minimal shift in probability, so a negative result does not meaningfully rule out disease.
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