When a screening test cutoff is shifted toward higher values (more stringent), the effect on test performance is:

• A Sensitivity increases and specificity decreases
• B Sensitivity decreases and specificity increases ✓
• C Both sensitivity and specificity increase
• D Positive predictive value decreases and negative predictive value increases

Explanation

Shifting the cutoff to a higher (more stringent) threshold means fewer people test positive — this reduces false positives (increasing specificity) but increases false negatives (reducing sensitivity). The ROC curve graphically illustrates this inverse relationship. A more stringent cutoff is preferred when the cost of a false positive is high (e.g., invasive follow-up), whereas a lower cutoff prioritizes sensitivity when the disease is serious and treatable.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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