Attempt review · why, not just what
PGY-3 Internal Medicine · Resident
Rohan 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 “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.
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 | #1 | Correct |
| Acute coronary syndromeCan't-miss | #2 | #2 | Correct |
| Aortic dissectionCan't-miss | #4 | — | Omitted |
| Community-acquired pneumoniaReasonable alternative | #3 | #3 | Correct |
| Spontaneous pneumothoraxReasonable alternative | #5 | #5 | Correct |
Pin recall, by intent