When comparing two screening tests applied sequentially (Test A then Test B), the strategy that maximizes sensitivity (misses fewest cases) is:

• A Parallel testing (both tests done simultaneously, positive if either is positive) ✓
• B Sequential testing (Test B only if Test A positive, positive if both positive)
• C Parallel testing maximizes specificity only; sensitivity is unchanged
• D Sequential testing maximizes both sensitivity and specificity simultaneously

Explanation

Parallel testing (doing tests simultaneously and considering any positive result as a positive screen) maximizes sensitivity (catches more true cases, fewer false negatives) but at the cost of reduced specificity and increased false positives. Sequential testing (applying the second test only to those who test positive on the first) maximizes specificity (reducing false positives, higher PPV) at the cost of reduced sensitivity. The choice depends on the purpose: parallel testing is used when missing a case is unacceptable (e.g., blood bank screening); sequential testing is used when follow-up tests are expensive, invasive, or have significant side effects.

Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.

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