Attempt review · why, not just what
PGY-1 Internal Medicine · Resident
Stefan was close; a few unpinned findings (and a distractor) explain where the reasoning slipped.
Each error traced back to the pin decisions that caused it
BecausePinned the distractor “Temperature” as if it were diagnostic, and never pinned “Tachycardic, regular, no murmur” — 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 | #4 | Correct |
| Community-acquired pneumoniaReasonable alternative | #3 | #1 | Misranked |
| Spontaneous pneumothoraxReasonable alternative | #5 | #5 | Correct |
Pin recall, by intent