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Old 02-13-2013
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Question Positive and negative findings

Hey
Wanted to ask how to put in the pertinent points under the differentials. Do we need to put only the positive points or should we put the negatives also?
For eg. if we are talking about Infectious Mononucleosis and there is no splenomegaly and left quadrant tenderness, should we mention it?
Or we just let it be as it is a negative finding.
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Old 02-13-2013
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I have the same question, but, from what I have seen on the sample PN on the usmle website, I think you should write only the history and physical findings that you have found in your patient.

So, for example, in your case, you should write only fever and sore throat and , if you don't have any splenomegaly, then you shouldn't write it.

Please correct me if I am wrong.
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Old 02-13-2013
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You need to mention both pertinent positive & negative, but make sure you asked the SP about them & you did the physical exam looking for them.
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Old 02-13-2013
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So we need to mention the negative points too. So if we did not find splenomegaly in IM patient, we'll write in the physical exam part that no splenomegaly was found? That would kinda help in ruling it out


Quote:
Originally Posted by ag2011n View Post
You need to mention both pertinent positive & negative, but make sure you asked the SP about them & you did the physical exam looking for them.
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Old 02-14-2013
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Quote:
Originally Posted by gagan View Post
So we need to mention the negative points too. So if we did not find splenomegaly in IM patient, we'll write in the physical exam part that no splenomegaly was found? That would kinda help in ruling it out
That is correct, you can say in abdominal exam, no organomegaly, to cover for liver & spleen, or you can mention it as no splenomegaly. But it is important pertinent negative in IM case.
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Old 02-14-2013
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Quote:
Originally Posted by ag2011n View Post
That is correct, you can say in abdominal exam, no organomegaly, to cover for liver & spleen, or you can mention it as no splenomegaly. But it is important pertinent negative in IM case.
Ok. That should be fine. What I wanted to know was that will we write NO splenomegaly when we put our 3 differentials and write the points which point towards the diagnosis based on the history and physical examination

Example. The first differential is IM. We write sore throat, girlfriend having the same symptoms, pain in LUQ in the history findings.
Then in the PE, do we write no splenomegaly or we can leave that as it is a negative finding and does not help in the diagnosis?
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Old 02-14-2013
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Quote:
Originally Posted by gagan View Post
Ok. That should be fine. What I wanted to know was that will we write NO splenomegaly when we put our 3 differentials and write the points which point towards the diagnosis based on the history and physical examination

Example. The first differential is IM. We write sore throat, girlfriend having the same symptoms, pain in LUQ in the history findings.
Then in the PE, do we write no splenomegaly or we can leave that as it is a negative finding and does not help in the diagnosis?
No, you don't need to put no splenomegaly in this context, the idea here to support the diagnosis of IM.
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