Attempt review · why, not just what
PGY-3 Internal Medicine · Resident
Marco 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
BecauseNever pinned “Unilateral calf swelling” and “Systolic Blood Pressure” — 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 | #3 | Correct |
| Spontaneous pneumothoraxReasonable alternative | #5 | #5 | Correct |
Pin recall, by intent