Attempt review · why, not just what
Med-2 Clerkship · Student
Daniel reached a diagnosis but missed safety-critical signal — the errors below trace back to unpinned red flags and context.
Each error traced back to the pin decisions that caused it
BecauseNever pinned “Oxygen Saturation” and “12-lead ECG and continuous telemetry with repeat saturations”, so nothing prompted the dangerous-alternative sweep for this presentation.
Treat Aortic dissection as a must-exclude for this presentation — pin the context that makes it possible, then rule it in or out explicitly.
BecausePinned the distractor “Temperature” as if it were diagnostic, and never pinned “Acute dyspnea” and “Unilateral calf swelling” — so the pre-test probability for Pulmonary embolism stayed low and a mimic outranked it.
Pin the discriminating findings before committing the differential — they raise the pre-test probability that puts Pulmonary embolism on top.
The evidence behind the causal read
Diagnostic clue
Safety red flag
Context factor
Management modifier
Distractor
Submitted vs. expected ranking
| Diagnosis | Expected | Learner | Outcome |
|---|---|---|---|
| Pulmonary embolismWorking diagnosis | #1 | #2 | Misranked |
| Acute coronary syndromeCan't-miss | #2 | #2 | Correct |
| Aortic dissectionCan't-miss | #4 | — | Omitted |
| Community-acquired pneumoniaReasonable alternative | #3 | #1 | Misranked |
| Spontaneous pneumothoraxReasonable alternative | #5 | #5 | Correct |
Pin recall, by intent