Step 3: prioritize hypotheses
A two-by-two of likelihood against speed of harm, with the three page-11 hypotheses plotted and a dashed diagonal marked do not rank along this line.
Two axes, not one
Prioritizing is a judgment about consequence crossed with a judgment about probability. A condition that is moderately likely and rapidly fatal outranks one that is very likely and slow. The entire exam is built on that asymmetry, and it is why the obvious answer is so often the second answer rather than the first.
The ranking sentence
You should be able to say it out loud: "I am working up X first, because if it is happening this client deteriorates within minutes, and these cues make it plausible." Both halves must be sayable. If you can only say the second half, you have ranked by likelihood. If you cannot say either, the ranking is a guess dressed as a decision.
Where the page-11 hypotheses land
| Hypothesis | Likelihood | Speed of harm | Rank |
|---|---|---|---|
| Pulmonary embolism | high | fast | first |
| Pneumonia | moderate | slow | third |
| Anxiety | low | slow | last |
What survives a tie
When two hypotheses rank equally, investigate the one whose confirming assessment is faster and less invasive. It resolves the tie without delaying either, and it usually costs you seconds rather than minutes.
Margin noteworst first, then likeliest.
Watch outRanking by likelihood alone is exactly how a candidate leaves an airway or a perfusion problem sitting in second place.
TakeawayRank by consequence first and probability second, and make the ranking survive being said out loud in one sentence. → BOOK 01 · P15 · → BOOK 02 · P6 · → BOOK 03 · P3