Examination, Evaluation, and Diagnosis
What the exam expects
Know how to select and sequence examination procedures: history, observation, palpation, range of motion, manual muscle testing, special tests, neurologic screening, and functional outcome measures. Understand psychometric properties-reliability, validity, sensitivity, specificity, likelihood ratios-and how to choose measures that are responsive and appropriate for the patient. Know documentation standards and how findings synthesize into a diagnosis and problem list.
Traps
Questions often test whether you can pick the most appropriate test given a hypothesis, or interpret a special test correctly (a positive test is not a diagnosis). Watch for confusion between sensitivity (rules out when negative) and specificity (rules in when positive). Another trap is choosing an outcome measure that lacks validity for the population or setting. Don't confuse impairment findings with activity/participation limitations.
Rule of thumb
SnNout and SpPin: a highly Sensitive test, when Negative, helps rule out; a highly Specific test, when Positive, helps rule in.
Worked example
A highly sensitive screening test is negative in a patient with low suspicion. Because sensitivity is high, a negative result meaningfully lowers the probability of the condition-useful for ruling out, though not definitive.