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Old 11-05-2012
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Question Pulmonary Embolism without Tachycardia!

if there is no sinus tachycardia, does it rules out PE as option ?

xpaezx \ novo ...help !
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Old 11-05-2012
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Nope, it depends really, if its sudden with pleural chest pain, and with Tachypnea (I think this is the most sensitive sign) I would still pick PE as a choice even if there is not a sinus tachycardia.

One must look at the whole vignette tho, to be able to give a diagnosis, but they must give you at least 3 things.. Hell even 2 out of the 3 below are enough for me!

PLeural chest Pain
Sudden
Tachypena
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Absence of one sign/symptom/finding does not rule out the diagnosis unless it is pathognomic of that disease.
For example, absence of seizures rules out eclampsia.
Since there is nothing pathognomic in PE the only way it can be ruled out is a negative spiral CT.
It also depends on the pre-test probability of that particular condition.
Associated conditions/medications may alter the presentation. For example, patient on negative chronotrope like beta blocker is unlikely to have sinus tachycardia.

Bottom line: If it walks like a duck, quacks like a duck, looks like a duck, but doesn't dress like a duck it most likely is a duck.
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Last edited by Novobiocin; 11-05-2012 at 03:42 PM.
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This is how most of the questions in the test are likely to be framed. They will give two out of five features of a particular condition and cover it with a lot of useless crap to confuse you. That's when doing UW questions comes in the picture since as long as you remember the features stressed in the UW questions and are able to apply them in the test question you will do well. It is unlike most of the UW questions where they give you practically all the features to help you arrive at the diagnosis. That's the reason UW is excellent leaning tool but not the best tool to assess your exam performance.
For example, there is a question in UW where an old lady with fracture hip get operated and develops features of PE despite being on prophylactic Heparin.
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Quote:
Originally Posted by Novobiocin View Post
This is how most of the questions in the test are likely to be framed. They will give two out of five features of a particular condition and cover it with a lot of useless crap to confuse you. That's when doing UW questions comes in the picture since as long as you remember the features stressed in the UW questions and are able to apply them in the test question you will do well. It is unlike most of the UW questions where they give you practically all the features to help you arrive at the diagnosis. That's the reason UW is excellent leaning tool but not the best tool to assess your exam performance.
For example, there is a question in UW where an old lady with fracture hip get operated and develops features of PE despite being on prophylactic Heparin.
Yup this is exactly what I tried to explain, but my man Novo put it so nicely.

Basically we cannot expect these NBME dudes to give us the classic beautiful florid scenario, because that would make this exam so easy... thats why we must learn and know how to apply the classic rules THAT DO NOT change, that are extremely specific (remember specificity rules IN) or maybe when eliminating Ddx we must know SENSITIVE findings to RULE OUT and so on.

thats why using uworld as a learning tool and doing a ****.load of unique different questions is the way to go, that way we can be exposed to how the same thing can be asked in different ways.
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Thanks. But I was thinking sinus tachycardia to be very sEnsitive for PE.
Thanks for reply

Last edited by tyagee; 11-05-2012 at 05:26 PM.
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Quote:
Originally Posted by tyagee View Post
Thanks. But I was thinking sinus tachycardia to be very sEnsitive for PE.
Thanks for reply
the most sensitive symptom is Dyspnea and the Most Sensitive sign is Tachypnea; again a lot of things can give you both, but i only a few can give you a sudden quick presentation...
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