Attempt review · why, not just what
PGY-1 Internal Medicine · Resident
Emily 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 “Heart Rate” and “Respiratory Rate”, so nothing prompted the dangerous-alternative sweep for this presentation.
Treat Acute coronary syndrome as a must-exclude for this presentation — pin the context that makes it possible, then rule it in or out explicitly.
BecauseNever pinned “Heart Rate” and “Respiratory Rate”, 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.
BecauseDid not pin “Heart Rate” and “Respiratory Rate” as safety red flags before ordering, so stabilisation was not prioritised over diagnosis.
Flag the red flags first and stabilise before pursuing the diagnostic workup.
BecausePinned the distractor “Temperature” as if it were diagnostic, and never pinned “Pleuritic chest pain” and “Clear chest on auscultation” — 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 | — | Omitted |
| Aortic dissectionCan't-miss | #4 | — | Omitted |
| Community-acquired pneumoniaReasonable alternative | #3 | #1 | Misranked |
| Spontaneous pneumothoraxReasonable alternative | #5 | #5 | Correct |
Pin recall, by intent