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Rational Clinical Examination Series:
This series of articles gets 'off the shelf' in a hurry. They summarize what is known about the diagnostic power of items from the history and physical and conclude with a clinical bottom line. The topics grab the attention of experts and novices alike, and serve as a great bridge into EBM for beginning students who’ve just learned how to examine patients. These articles are worth collecting into a notebook for use wherever you teach.

Bibliography compiled by Mark Wilson and contributed to by Peter Wyer. Rearranged for clinical use by Gloria Kuhn.
Subjects arranged under systems for ease of use in the clinical setting (an article may be listed under more than one heading ie dizziness is listed under both CNS and Eye, Ear, Nose, and Throat systems).

Updated 4/27/03

General Discussion:

1. Sackett DL. A primer on the precision and accuracy of the clinical examination. JAMA 1992; 267: 2638 - 2644.

2. Sackett DL, Rennie D. The science of the art of the clinical examination [Editorial]. JAMA 1992; 267: 2650 - 2652.

3. Simel DL, Rennie D. The clinical examination: an agenda to make it more rational [Editorial]. JAMA 1997; 277: 572 - 574

4. Stephenson BJ, Rowe BH, Haynes RB, Macharia WM, Leon G. Is this patient taking the treatment as prescribed? JAMA 1993; 269: 2779 - 2781.

Abdomen:

1. Lederle FA, Simel DL. Does this patient have abdominal aortic aneurysm? JAMA 1999;281:77-82.

2. Williams JW, Simel DL. Does this patient have ascites? How to divine fluid in the abdomen. JAMA 1992; 267: 2645 - 2648.

3. Wagner JM, McKinney P, Carpenter JL. Does this patient have appendicitis? JAMA 1996; 276: 1589 - 1594.

4. Naylor CD. Physical examination of the liver. JAMA 1994; 271: 1859 - 1865.

5. Grover SA, Barkun AN, Sackett DL. Does this patient have splenomegaly? JAMA 1993; 270: 2218 - 2221.

6. Turnbull, J.M., Is listening for abdominal bruits useful in the evaluation of hypertension? JAMA, 1995. 274(16): p. 1299-301.

Cardiovascular:

1. Badgett, R.G., C.R. Lucey, and C.D. Mulrow, Can the clinical examination diagnose left-sided heart failure in adults? Jama, 1997. 277(21): p. 1712-9.

2. Choudhry, N.K. and E.E. Etchells, Does this patient have aortic regurgitation? Jama, 1999. 281(23): p. 2231-8.

3. Cook, D.J. and D.L. Simel, The Rational Clinical Examination. Does this patient have abnormal central venous pressure? Jama, 1996. 275(8): p. 630-4.

4. Etchells, E., C. Bell, and K. Robb, Does this patient have an abnormal systolic murmur? Jama, 1997. 277(7): p. 564-71.

5. Fosnocht, K.M., The rational clinical examination: detecting abnormal systolic murmurs. Jama, 1997. 277(20): p. 1593-4; discussion 1594.

6. Klompas, M., Does this patient have an acute thoracic aortic dissection? Jama, 2002. 287(17): p. 2262-72.

7. Lederle, F.A. and D.L. Simel, Does this patient have abdominal aortic aneurysm? Jama, 1999. 281(1): p. 77-82.

8. McGee, S., W.B. Abernethy, 3rd, and D.L. Simel, Is this patient hypovolemic? Jama, 1999. 281(11): p. 1022-9.

9. Panju, A.A., B.R. Hemmelgarn, G.H. Guyatt, et al., Is this patient having a myocardial infarction? Jama, 1998. 280(14): p. 1256-63.

10. Reeves, R.A., Does this patient have hypertension? How to measure blood pressure. Jama, 1995. 273(15): p. 1211-8.

11. Sauve, J.S., A. Laupacis, T. Ostbye, et al., Does this patient have a clinically important carotid bruit? Jama, 1993. 270(23): p. 2843-5.

12. Smetana, G.W. and R.H. Shmerling, Does this patient have temporal arteritis? Jama, 2002. 287(1): p. 92-101.

13. Turnbull, J.M., Is listening for abdominal bruits useful in the evaluation of hypertension? Jama, 1995. 274(16): p. 1299-301.

Cardiac:

1. Ali, Y., The rational clinical examination: detecting abnormal systolic murmurs. Jama, 1997. 277(20): p. 1594.

2. Etchells E, Bell C, Robb K. Does this patient have an abnormal systolic murmur? JAMA 1997; 277: 564 - 571.

3. Badgett RG, Lucey CR, Mulrow CD. Can the clinical examination diagnose left-sided heart failure in adults? JAMA 1997; 277: 1712 - 1719.

4. Panju AA, Hemmelgarn BR, Guyatt GH, et al. Is this patient having a myocardial infarction? JAMA 1998;280:1256-1263.

Fluid Status:

1. Reeves RA. Does this patient have hypertension? How to measure blood pressure. JAMA 1995; 273: 1211 - 1218.

2. Cook DJ, Simel DL. Does this patient have abnormal central venous pressure? JAMA 1996; 275: 630 - 634.

3. McGee S, Abernathy WB, Simel DL. Is this patient hypovolemic? JAMA 1999;281:1022-1029.

Vascular:

1. Choudhry NK, Etchells EE. Does this patient have aortic regurgitation? JAMA 1999;281:2231-2238.

2. Lederle FA, Simel DL. Does this patient have abdominal aortic aneurysm? JAMA 1999;281:77-82.

3. Anand SS, Wells PS, Hunt D, et al. Does this patient have a deep vein thrombosis? JAMA 1998;279:1094-1099.

Central Nervous System:

1. Sauve JS, Laupacis A, Ostbye T, Feagan B, Sackett DL. Does this patient have a clinically important carotid bruit? JAMA 1993; 270: 2843 - 2845.

2. Froehling DA, Silverstein MD, Mohr DN, Beatty CW. Does this dizzy patient have a serious form of vertigo? JAMA 1994; 271: 385 - 388.

3. Goldstein LB, Matchar DB. Clinical assessment of stroke. JAMA 1994; 271: 1114 - 1120.

4. Attia J, Hatala R, Cook DJ, et al. Does this adult patient have acute meningitis? JAMA 1999;282:175-181.

Cutaneous:

1. Whited JD, Grichnik JM. Does this patient have a mole or a melanoma? JAMA 1998;279: 696-701.

Endocrinology:

1. Siminoski K. Does this patient have a goiter? JAMA 1995; 273: 813 - 817.

Eyes, Ears, Nose, Throat:

1. Williams JW, Simel DL. Does this patient have sinusitis? Diagnosing acute sinusitis by history and physical examination. JAMA 1993; 270: 1242 - 1246.

2. Froehling DA, Silverstein MD, Mohr DN, Beatty CW. Does this dizzy patient have a serious form of vertigo? JAMA 1994; 271: 385 - 388.

3. Ebell, M.H., M.A. Smith, H.C. Barry, et al., The rational clinical examination. Does this patient have strep throat? Jama, 2000. 284(22): p. 2912-8.

Respiratory:

1. Holleman DR, Simel DL. Does the clinical examination predict airflow limitation? JAMA 1995; 273: 313 - 319.

2. Metlay JP, Kapoor WN, Fine MJ. Does this patient have community-acquired pneumonia? Diagnosing pneumonia by history and physical examination. JAMA 1997; 278: 1440 - 1445.

3. Myers KA, Farquhar DRE. Does This Patient Have Clubbing? JAMA 2001;286:341-347.

Musculoskeletal System:

1. Deyo RA, Rainville J, Kent DL. What can the history and physical examination tell us about low back pain? JAMA 1992; 268: 760 - 765.

2. D'Arcy CA, McGee S. Does this patient have carpal tunnel syndrome? JAMA 2000;283:3110-3117.

Nutrition:

1. Detsky AS, Smalley PS, Chang J. Is this patient malnourished? JAMA 1994; 271: 54-58.

Obstetrics/Gynecology:

1. Barton MB, Harris R, Fletcher SW. Does this patient have breast cancer? JAMA 1999; 282:1270-1280.

2. Bastian LA, Piscitelli JT. Is this patient pregnant? Can you reliably rule in or rule out early pregnancy by clinical examination? JAMA 1997; 278: 586 - 591.

Substance Abuse:

1. Kitchens JM. Does this patient have an alcohol problem? JAMA 1994; 272: 1782 - 1787.

Pediatrics:

1. Margolis P, Gadomski A. Does this infant have pneumonia? JAMA 1998; 279: 308 - 313.

Infectious

1. 1. Attia, J., R. Hatala, D.J. Cook, et al., Does this adult patient have acute meningitis? Jama, 1999. 282(2): p. 175-81.

2. Bent, S., B.K. Nallamothu, D.L. Simel, et al., Does this woman have an acute uncomplicated urinary tract infection? Jama, 2002. 287(20): p. 2701-10. 4.

3. Margolis, P. and A. Gadomski, Does this infant have pneumonia? Jama, 1998. 279(4): p. 308-13.

4. Metlay, J.P., W.N. Kapoor, and M.J. Fine, Does this patient have community-acquired pneumonia? Diagnosing pneumonia by history and physical examination. Jama, 1997. 278(17): p. 1440-5.

5. Wagner, J.M., W.P. McKinney, and J.L. Carpenter, Does this patient have appendicitis? Jama, 1996. 276(19): p. 1589-94.

6. Williams, J.W., Jr. and D.L. Simel, Does this patient have sinusitis? Diagnosing acute sinusitis by history and physical examination. Jama, 1993. 270(10): p. 1242-6.

Adverse Drug Reactions:

1. Ebell, M.H., M.A. Smith, H.C. Barry, et al., The rational clinical examination. Does this patient have strep throat? Jama, 2000. 284(22): p. 2912-8.

[More installments to follow]

Diagnostic Strategies for Common Medical Problems
Black
American College of Physicians
Philadelphia, PA 1999

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