Yara Haddad

Attempt review · why, not just what

Yara Haddad · Acute Dyspnea After Arthroplasty

Med-2 Clerkship · Student

Yara was close; a few unpinned findings (and a distractor) explain where the reasoning slipped.

Why these went wrong

Each error traced back to the pin decisions that caused it

Diagnosis

Ranked Community-acquired pneumonia above Pulmonary embolism

BecausePinned the distractor “Temperature” as if it were diagnostic, and never pinned “Pleuritic chest pain” and “Swollen, tender right calf” — so the pre-test probability for Pulmonary embolism stayed low and a mimic outranked it.

Temperature· DistractorPleuritic chest pain· Diagnostic clueSwollen, tender right calf· Diagnostic clue

Pin the discriminating findings before committing the differential — they raise the pre-test probability that puts Pulmonary embolism on top.

Pin decisions vs. what mattered

The evidence behind the causal read

Pinned signalMissed signalFixated on distractor

Diagnostic clue

  • Pleuritic chest painMissed
  • Acute dyspneaPinned
  • Unilateral calf swellingPinned
  • Tachycardic, regular, no murmurPinned
  • Clear chest on auscultationPinned
  • Swollen, tender right calfMissed
  • D-dimerPinned
  • CT pulmonary angiography (CTPA)Pinned

Safety red flag

  • Heart RateMissed
  • Respiratory RatePinned
  • Oxygen SaturationPinned
  • Tachypnoeic and anxiousPinned
  • 12-lead ECG and continuous telemetry with repeat saturationsPinned

Context factor

  • Systolic Blood PressurePinned

Management modifier

  • Baseline CBC, creatinine and coagulation panelMissed
  • Platelet CountPinned
  • CreatininePinned

Distractor

  • TemperatureFixated
  • HemoglobinCorrectly ignored

Differential outcome

Submitted vs. expected ranking

DiagnosisExpectedLearnerOutcome
Pulmonary embolismWorking diagnosis#1#2Misranked
Acute coronary syndromeCan't-miss#2#2Correct
Aortic dissectionCan't-miss#4#4Correct
Community-acquired pneumoniaReasonable alternative#3#1Misranked
Spontaneous pneumothoraxReasonable alternative#5#5Correct

Pin recall, by intent

  • Diagnostic clue
    6/8
  • Safety red flag
    4/5
  • Context factor
    1/1
  • Management modifier
    2/3
  • Distractor
    1/2pinned