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Old 06-22-2013
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Question About Pertinent Negatives

Hey everyone,

Just wanted to ask this. I know we are supposed to write pertinent negatives for the Hx - eg No vomiting/diarhea/constipation etc. Also for P/E - eg for CV:RRR, no murmurs/gallops/rubs etc. (Hope my concepts are correct till now. If not, please correct me)

But, are we supposed to write pertinent negatives also when stating our 3 ddx? Eg, my first diagnosis is Mononucleosis, I am supposed to put 2-3 Hx findings, and 2-3 P/E findings that go in its favor. I should also write the ones that go against it with a negative sign in those rows? Like for instance:

Ddx 1 : Infectious mononucleosis
+Sore Throat
+Fever
+Abdominal pain
-LAD

Ddx 2 : Strep throat
+Sore throat
+Fever
-Abdominal pain

Is it necessary to mention the negative findings that go against the diagnosis? I find this counter-productive, since you are stating the other diagnosis anyhow, with its positive findings. So, there shouldn't be a need to mention negative findings for that diagnosis. Or am I doing it wrong?

I would be glad if someone who gave the exam recently can clarify this.

Thanks
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Old 06-22-2013
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Sure you can do that..
even you can do that in physical exam.
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Old 06-22-2013
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This has been discussed here in detail.
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Old 06-23-2013
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Thank you Novobiocin for your input.

My only question is if pertinent negatives are so important EVEN while listing the 3 ddx, why hasn't the USMLE sample patient note adapted this approach? Same goes for UW. I didn't see either to list the negatives in the 3 ddx. However, they do list the negatives for the P/E section, and that I fully agree.

I understand the importance of putting the negatives for your P/E, but I don't think writing them out even for the ddx is a necessity.

Again, just a thought, and all views are welcomed.
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Old 06-23-2013
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Quote:
Originally Posted by Novobiocin View Post
This has been discussed here in detail.
A silly question for you, you know, remembering about my mistakes I started to feel a little bit paranoic.. so, in my note instead of writing different pertinent positives or negatives in different lines, I put like 2 or even 3 pertinent positives in the same line.. Something like..

Infectious mononucleosis
+ Sore throat, fever, lymphadenopathy, Rash after amoxicilin
- Dysuria
... blank

This is just to exemplify.. I know it's paranoid, but do you think they would bother taking points from my note because of this?
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Old 06-23-2013
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I don't know what else to say since I did my best to explain it in the other thread.
Ultimately it's up to you to decide how you are going to proceed based on the information you have.
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Old 06-26-2013
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Quote:
Originally Posted by Novobiocin View Post
I don't know what else to say since I did my best to explain it in the other thread.
Ultimately it's up to you to decide how you are going to proceed based on the information you have.
Just want to ask some more things.

So, pertinent negatives for the 3 ddx, I just have one more doubt. I apologize if its being repetitive, but this concept is really hard to grasp.

Should I write the findings that are NOT present that should be there for that diagnosis, OR put other findings that are against the diagnosis?

Eg, case of infectious mono and patient has sore throat, hx of gf having same symptoms, dysuria, back pain :

Inf Mono
+Sore throat
+Hx of GF having same symptoms
-Fever
-LAD/Neck pain
-Fatigue
-Night sweats

or

+Sore throat
+Hx of GF having same symptoms
-Dysuria
-Back pain

Please clear this out for me.

Also, how many people here used only positive findings for the DDx and passed the exam?
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Old 06-27-2013
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The pertinent negative is the one which you would expect in a differential but is negative.
For example, if your differential is IM then you would expect to find cervical lymphadenopathy but if there is no cervical LAP then it is a pertinent negative.
This test tests your clinical knowledge at a very basic level so all they want to know e.g. in a case of IM if you know what to look for and document itwhether you found it or not. Same goes for splenomegaly.
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Old 02-27-2014
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I think both pertinent positive AND negatives are used to SUPPORT your diagnosis. For example, strep throat- positive is recent contact with strep. pertinent negative is (-) cough (see, this is a negative finding yet it SUPPORTS your diagnosis- one of the diagnostic criteria for strep is lack of a cough). Compare this to saying (-) erythema or exudates in the throat - this would HO AGAINST your diagnosis of strep if listed under it. See the difference - I do not believe they want you to use negatives to go against, rather to support. A kther example- osteoarthritis vs rheumatoid arthritis- under OA- (-) fever or constitutional symptoms ( this is a negative, but supports diagnosis, especially since RA is on the differential).
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