Fatigue

Rule in:VHAbdominal Aortic Aneurysm, VHPyloric Stenosis, VHSigmoid Diverticulitis +29 more

Rule out:SHCholecystitis, SHHepatomegaly, MHAbdominal Aortic Aneurysm +28 more

Abdominal Hernia

Rule in:VHAbdominal Aortic Aneurysm, VHPyloric Stenosis, VHSigmoid Diverticulitis +29 more

Rule out:SHCholecystitis, SHHepatomegaly, MHAbdominal Aortic Aneurysm +28 more

Abdominal Malignancy

Rule in:VHAbdominal Aortic Aneurysm, VHPyloric Stenosis, VHSigmoid Diverticulitis +29 more

Rule out:SHCholecystitis, SHHepatomegaly, MHAbdominal Aortic Aneurysm +28 more

Acromegaly

Rule in:HAcromegaly, HAcute Stroke, IECushing Syndrome +1 more

Rule out:SHAcromegaly, SHAcute Stroke, SHHypothyroidism +2 more

Acute Abdomen

Rule in:VHAbdominal Aortic Aneurysm, VHPyloric Stenosis, VHSigmoid Diverticulitis +29 more

Rule out:SHCholecystitis, SHHepatomegaly, MHAbdominal Aortic Aneurysm +28 more

Acute Aortic Dissection

Rule in:VHAortic Regurgitation, VHVolume Depletion From Significant Blood Loss, HAcute Aortic Dissection +11 more

Rule out:VHVolume Depletion From Significant Blood Loss, HLow-output State (Low Cardiac Index) Within Established Chronic Heart Failure, SHAcute Aortic Dissection +10 more

Acute Coronary Syndrome

Rule out:SHAcute Coronary Syndrome, NHRib Fracture

Chest Wall Palpation

Rule in:NHRib Fracture

Acute Coronary Syndrome (Atypical Presentation)

Rule in:VHAbdominal Aortic Aneurysm, VHPyloric Stenosis, VHSigmoid Diverticulitis +29 more

Rule out:SHCholecystitis, SHHepatomegaly, MHAbdominal Aortic Aneurysm +28 more

Acute Hepatitis

Rule in:SHCirrhosis, IEAcute Hepatitis, IECongestive Hepatopathy +6 more

Rule out:SHCirrhosis, IEAcute Hepatitis, IECongestive Hepatopathy +6 more

Acute Leukemia

Rule in:SHMeasles, IEAcute Leukemia, IEAdrenal Insufficiency +9 more

Rule out:SHHypovolemia, MHMeasles, IEAcute Leukemia +10 more

Acute Myocardial Infarction

Cardiac Auscultation

Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy with Obstruction +34 more

Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy with Obstruction, SHAortic Regurgitation +33 more

Acute Neurologic Event or Severe Pain

Rule in:IEAcute Neurologic Event or Severe Pain, IEAlcohol-related Cerebellar Degeneration, IEBilateral Hip Arthritis or Disease +20 more

Rule out:IEAcute Neurologic Event or Severe Pain, IEAlcohol-related Cerebellar Degeneration, IEBilateral Hip Arthritis or Disease +20 more

Acute Otitis Media

Rule in:VHAcute Otitis Media, SHOtitis Media with Effusion, IEBasilar Skull Fracture +3 more

Rule out:VHOtitis Media with Effusion, IEBasilar Skull Fracture, IEEustachian Tube Dysfunction +2 more

Acute Pericarditis

Cardiac Auscultation

Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy with Obstruction +34 more

Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy with Obstruction, SHAortic Regurgitation +33 more

Acute Rhinosinusitis

Rule in:SHAcute Rhinosinusitis, IEAllergic Rhinitis, IEChronic Rhinosinusitis with Nasal Polyps +2 more

Rule out:IEAllergic Rhinitis, IEChronic Rhinosinusitis with Nasal Polyps, IEGranulomatosis with Polyangiitis +1 more

Acute Stroke

Rule in:HAcromegaly, HAcute Stroke, IECushing Syndrome +1 more

Rule out:SHAcromegaly, SHAcute Stroke, SHHypothyroidism +2 more

Acute Thoracic Aortic Dissection

Cardiac Auscultation

Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy with Obstruction +34 more

Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy with Obstruction, SHAortic Regurgitation +33 more

Adductor-related Groin Pain

Rule in:VHGluteal Tendinopathy (Greater Trochanteric Pain Syndrome), IEAdductor-related Groin Pain, IEIdiopathic Inflammatory Myopathy (Polymyositis or Dermatomyositis) +1 more

Rule out:HGluteal Tendinopathy (Greater Trochanteric Pain Syndrome), IEAdductor-related Groin Pain, IEIdiopathic Inflammatory Myopathy (Polymyositis or Dermatomyositis) +1 more

Adrenal Insufficiency

Rule in:SHMeasles, IEAcute Leukemia, IEAdrenal Insufficiency +9 more

Rule out:SHHypovolemia, MHMeasles, IEAcute Leukemia +10 more

Rule in:VHAutonomic Neuropathy, VHHemorrhage, VHHypovolemia +5 more

Rule out:VHAutonomic Failure, VHHemorrhage, MHAutonomic Neuropathy +4 more

Adverse Short-term Outcome in Confirmed Pulmonary Embolism

Rule in:HAtrial Fibrillation, SHHypothyroidism, SHPneumonia +7 more

Rule out:VHAtrial Fibrillation, MHAdverse Short-term Outcome in Confirmed Pulmonary Embolism, IECardiac Tamponade +5 more

Alcohol Intoxication

Rule in:SHVestibular Dysfunction, IEAlcohol Intoxication, IECerebellar Disease +2 more

Rule out:SHVestibular Dysfunction, IEAlcohol Intoxication, IECerebellar Disease +2 more

Alcohol-related Cerebellar Degeneration

Rule in:IEAcute Neurologic Event or Severe Pain, IEAlcohol-related Cerebellar Degeneration, IEBilateral Hip Arthritis or Disease +20 more

Rule out:IEAcute Neurologic Event or Severe Pain, IEAlcohol-related Cerebellar Degeneration, IEBilateral Hip Arthritis or Disease +20 more

Allergic Rhinitis

Rule in:SHAcute Rhinosinusitis, IEAllergic Rhinitis, IEChronic Rhinosinusitis with Nasal Polyps +2 more

Rule out:IEAllergic Rhinitis, IEChronic Rhinosinusitis with Nasal Polyps, IEGranulomatosis with Polyangiitis +1 more

Amyloidosis

Rule in:SHMeasles, IEAcute Leukemia, IEAdrenal Insufficiency +9 more

Rule out:SHHypovolemia, MHMeasles, IEAcute Leukemia +10 more

Anaphylaxis

Rule in:VHPneumothorax, HMainstem Bronchus Intubation, HPleural Effusion +24 more

Rule out:VHPleural Effusion, SHMainstem Bronchus Intubation, SHPneumothorax +23 more

Anemia

Rule in:SHAnemia, IEDyslipidemia (Hyperlipidemia), IEHorner Syndrome +4 more

Rule out:MHAnemia, IEDyslipidemia (Hyperlipidemia), IEHorner Syndrome +4 more

Pallor Evaluation

Rule in:SHAnemia

Rule out:MHAnemia

Ankylosing Spondylitis

Thoracolumbar Active Range of Motion

Rule in:SHAnkylosing Spondylitis

Rule out:MHAnkylosing Spondylitis

Aortic Coarctation

Rule in:VHAortic Regurgitation, VHVolume Depletion From Significant Blood Loss, HAcute Aortic Dissection +11 more

Rule out:VHVolume Depletion From Significant Blood Loss, HLow-output State (Low Cardiac Index) Within Established Chronic Heart Failure, SHAcute Aortic Dissection +10 more

Rule in:SHAortoiliac Occlusive Disease, IEAortic Coarctation

Femoral Artery Palpation

Rule out:IEAortic Coarctation

Aortic Dissection

Rule in:HAortic Stenosis, HTakayasu Arteritis, SHAortic Dissection +7 more

Rule out:SHAortic Stenosis, IEAortic Regurgitation, IECarotid Artery Stenosis +5 more

Aortic Regurgitation

Rule in:VHAortic Regurgitation, VHVolume Depletion From Significant Blood Loss, HAcute Aortic Dissection +11 more

Rule out:VHVolume Depletion From Significant Blood Loss, HLow-output State (Low Cardiac Index) Within Established Chronic Heart Failure, SHAcute Aortic Dissection +10 more

Cardiac Auscultation

Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy with Obstruction +34 more

Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy with Obstruction, SHAortic Regurgitation +33 more

Rule in:HAortic Stenosis, HTakayasu Arteritis, SHAortic Dissection +7 more

Rule out:SHAortic Stenosis, IEAortic Regurgitation, IECarotid Artery Stenosis +5 more

Aortic Sclerosis

Cardiac Auscultation

Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy with Obstruction +34 more

Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy with Obstruction, SHAortic Regurgitation +33 more

Aortic Stenosis

Rule in:VHAortic Regurgitation, VHVolume Depletion From Significant Blood Loss, HAcute Aortic Dissection +11 more

Rule out:VHVolume Depletion From Significant Blood Loss, HLow-output State (Low Cardiac Index) Within Established Chronic Heart Failure, SHAcute Aortic Dissection +10 more

Brachial Artery Palpation

Rule out:VHAortic Stenosis

Cardiac Auscultation

Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy with Obstruction +34 more

Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy with Obstruction, SHAortic Regurgitation +33 more

Rule in:HAortic Stenosis, HTakayasu Arteritis, SHAortic Dissection +7 more

Rule out:SHAortic Stenosis, IEAortic Regurgitation, IECarotid Artery Stenosis +5 more

Aortoiliac Occlusive Disease

Rule in:SHAortoiliac Occlusive Disease, IEAortic Coarctation

Femoral Artery Palpation

Rule out:IEAortic Coarctation

Appendiceal Mass

Rule in:VHAbdominal Aortic Aneurysm, VHPyloric Stenosis, VHSigmoid Diverticulitis +29 more

Rule out:SHCholecystitis, SHHepatomegaly, MHAbdominal Aortic Aneurysm +28 more

Appendicitis

Rule in:VHAbdominal Aortic Aneurysm, VHPyloric Stenosis, VHSigmoid Diverticulitis +29 more

Rule out:SHCholecystitis, SHHepatomegaly, MHAbdominal Aortic Aneurysm +28 more

Appendicitis (Adult)

aka Iliopsoas sign; Obraztsov's sign

Psoas Sign

Rule in:SHAppendicitis (Adult), SHAppendicitis (Pediatric)

Appendicitis (Pediatric)

aka Iliopsoas sign; Obraztsov's sign

Psoas Sign

Rule in:SHAppendicitis (Adult), SHAppendicitis (Pediatric)

Rule in:SHPneumonia, IEInfective Endocarditis, IESepsis +1 more

Rule out:MHAppendicitis (Pediatric), MHPneumonia, IEInfective Endocarditis +2 more

Ascites

Rule in:VHBowel Obstruction, SHAscites, IEPortal Hypertension +1 more

Rule out:SHAscites, IEBowel Obstruction, IEPortal Hypertension +1 more

Shifting Dullness

Rule in:SHAscites

Rule out:SHAscites

Atelectasis

Rule in:HLarge Pleural Effusion, HPleural Effusion, SHLobar Pneumonia or Consolidation +10 more

Rule out:IEAtelectasis, IEBullous Emphysema, IECOPD with Hyperinflation +8 more

Rule in:VHPneumothorax, HMainstem Bronchus Intubation, HPleural Effusion +24 more

Rule out:VHPleural Effusion, SHMainstem Bronchus Intubation, SHPneumothorax +23 more

Atelectasis with Airway Obstruction

Rule in:HPleural Effusion, IEAtelectasis with Airway Obstruction, IECOPD with Hyperinflation +3 more

Rule out:SHPleural Effusion, IEAtelectasis with Airway Obstruction, IECOPD with Hyperinflation +3 more

Atelectasis with Patent Airway

Rule in:IEAtelectasis with Patent Airway, IELobar Pneumonia or Consolidation

Bronchophony

Rule out:IEAtelectasis with Patent Airway, IELobar Pneumonia or Consolidation

Rule in:HLobar Pneumonia or Consolidation, IEAtelectasis with Patent Airway, IEPleural Effusion (Above the Effusion)

Egophony

Rule out:IEAtelectasis with Patent Airway, IEPleural Effusion (Above the Effusion)

Rule in:VHPneumothorax, HMainstem Bronchus Intubation, HPleural Effusion +24 more

Rule out:VHPleural Effusion, SHMainstem Bronchus Intubation, SHPneumothorax +23 more

Atrial Fibrillation

Cardiac Auscultation

Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy with Obstruction +34 more

Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy with Obstruction, SHAortic Regurgitation +33 more

Rule in:HAtrial Fibrillation, SHHypothyroidism, SHPneumonia +7 more

Rule out:VHAtrial Fibrillation, MHAdverse Short-term Outcome in Confirmed Pulmonary Embolism, IECardiac Tamponade +5 more

Atrial Septal Defect

Cardiac Auscultation

Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy with Obstruction +34 more

Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy with Obstruction, SHAortic Regurgitation +33 more

Atrioventricular Dissociation

Rule in:VHHypovolemia, HHeart Failure, HRight Ventricular Infarction +8 more

Rule out:HRight Ventricular Infarction, SHHypovolemia, SHPulmonary Hypertension +8 more

Autonomic Failure

Rule in:VHAutonomic Neuropathy, VHHemorrhage, VHHypovolemia +5 more

Rule out:VHAutonomic Failure, VHHemorrhage, MHAutonomic Neuropathy +4 more

Autonomic Neuropathy

Rule in:VHAutonomic Neuropathy, VHHemorrhage, VHHypovolemia +5 more

Rule out:VHAutonomic Failure, VHHemorrhage, MHAutonomic Neuropathy +4 more

Baker Cyst Rupture

Rule in:SHCirrhosis, SHHeart Failure, NHDeep Vein Thrombosis +11 more

Rule out:MHHeart Failure, NHDeep Vein Thrombosis, IEBaker Cyst Rupture +10 more

Basilar Skull Fracture

Rule in:VHAcute Otitis Media, SHOtitis Media with Effusion, IEBasilar Skull Fracture +3 more

Rule out:VHOtitis Media with Effusion, IEBasilar Skull Fracture, IEEustachian Tube Dysfunction +2 more

Behçet Disease

Rule in:SHMeasles, IEAcute Leukemia, IEAdrenal Insufficiency +9 more

Rule out:SHHypovolemia, MHMeasles, IEAcute Leukemia +10 more

Bicuspid Aortic Valve

Cardiac Auscultation

Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy with Obstruction +34 more

Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy with Obstruction, SHAortic Regurgitation +33 more

Bilateral Hip Arthritis or Disease

Rule in:IEAcute Neurologic Event or Severe Pain, IEAlcohol-related Cerebellar Degeneration, IEBilateral Hip Arthritis or Disease +20 more

Rule out:IEAcute Neurologic Event or Severe Pain, IEAlcohol-related Cerebellar Degeneration, IEBilateral Hip Arthritis or Disease +20 more

Bowel Obstruction

Rule in:VHBowel Obstruction, SHAscites, IEPortal Hypertension +1 more

Rule out:SHAscites, IEBowel Obstruction, IEPortal Hypertension +1 more

Brain Tumor

Rule in:VHBrain Tumor, HStroke, NHUpper Motor Neuron Lesion +1 more

Rule out:VHStroke, MHBrain Tumor, NHUpper Motor Neuron Lesion +1 more

Bronchial Obstruction

Rule in:VHPneumothorax, HMainstem Bronchus Intubation, HPleural Effusion +24 more

Rule out:VHPleural Effusion, SHMainstem Bronchus Intubation, SHPneumothorax +23 more

Bronchiectasis

Rule in:VHPneumothorax, HMainstem Bronchus Intubation, HPleural Effusion +24 more

Rule out:VHPleural Effusion, SHMainstem Bronchus Intubation, SHPneumothorax +23 more

Bronchitis

Rule in:VHPneumothorax, HMainstem Bronchus Intubation, HPleural Effusion +24 more

Rule out:VHPleural Effusion, SHMainstem Bronchus Intubation, SHPneumothorax +23 more

Bullous Emphysema

Rule in:HLarge Pleural Effusion, HPleural Effusion, SHLobar Pneumonia or Consolidation +10 more

Rule out:IEAtelectasis, IEBullous Emphysema, IECOPD with Hyperinflation +8 more

Cardiac Tamponade

Rule in:VHAortic Regurgitation, VHVolume Depletion From Significant Blood Loss, HAcute Aortic Dissection +11 more

Rule out:VHVolume Depletion From Significant Blood Loss, HLow-output State (Low Cardiac Index) Within Established Chronic Heart Failure, SHAcute Aortic Dissection +10 more

Cardiac Auscultation

Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy with Obstruction +34 more

Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy with Obstruction, SHAortic Regurgitation +33 more

Rule in:HAtrial Fibrillation, SHHypothyroidism, SHPneumonia +7 more

Rule out:VHAtrial Fibrillation, MHAdverse Short-term Outcome in Confirmed Pulmonary Embolism, IECardiac Tamponade +5 more

Rule in:VHHypovolemia, HHeart Failure, HRight Ventricular Infarction +8 more

Rule out:HRight Ventricular Infarction, SHHypovolemia, SHPulmonary Hypertension +8 more

Rule in:SHCardiac Tamponade, SHSevere Asthma Exacerbation, IECOPD Exacerbation +2 more

Rule out:VHCardiac Tamponade, SHSevere Asthma Exacerbation, IECOPD Exacerbation +2 more

Cardiogenic Pulmonary Edema (Acute Decompensated Heart Failure)

POCUS

Lung Ultrasound (Parenchymal)

Rule in:HCardiogenic Pulmonary Edema (Acute Decompensated Heart Failure)

Rule out:HCardiogenic Pulmonary Edema (Acute Decompensated Heart Failure)

Cardiomegaly

Rule in:VHLeft Ventricular Dilation, HLeft Ventricular Hypertrophy, SHCardiomegaly +7 more

Rule out:VHLeft Ventricular Dilation, SHLeft Ventricular Hypertrophy, MHCardiomegaly +7 more

Carotid Artery Stenosis

Rule in:HAortic Stenosis, HTakayasu Arteritis, SHAortic Dissection +7 more

Rule out:SHAortic Stenosis, IEAortic Regurgitation, IECarotid Artery Stenosis +5 more

Carotid Dissection

Rule in:HAortic Stenosis, HTakayasu Arteritis, SHAortic Dissection +7 more

Rule out:SHAortic Stenosis, IEAortic Regurgitation, IECarotid Artery Stenosis +5 more

Carotid Embolism

Rule in:VHGlaucoma, SHDiabetic Retinopathy, MHIncreased Intracranial Pressure +13 more

Rule out:SHGlaucoma, MHDiabetic Retinopathy, MHIncreased Intracranial Pressure +13 more

Cauda Equina Syndrome

Rule in:VHPeripheral Neuropathy, HUpper Motor Neuron Lesion, SHHypothyroidism +5 more

Rule out:VHPeripheral Neuropathy, SHUpper Motor Neuron Lesion, NHS1 Radiculopathy +4 more

Cecal Diverticulitis

Rule in:VHAbdominal Aortic Aneurysm, VHPyloric Stenosis, VHSigmoid Diverticulitis +29 more

Rule out:SHCholecystitis, SHHepatomegaly, MHAbdominal Aortic Aneurysm +28 more

Cellulitis

Rule in:SHCirrhosis, SHHeart Failure, NHDeep Vein Thrombosis +11 more

Rule out:MHHeart Failure, NHDeep Vein Thrombosis, IEBaker Cyst Rupture +10 more

Central Retinal Artery Occlusion

Rule in:VHGlaucoma, SHDiabetic Retinopathy, MHIncreased Intracranial Pressure +13 more

Rule out:SHGlaucoma, MHDiabetic Retinopathy, MHIncreased Intracranial Pressure +13 more

Central Retinal Vein Occlusion

Rule in:VHGlaucoma, SHDiabetic Retinopathy, MHIncreased Intracranial Pressure +13 more

Rule out:SHGlaucoma, MHDiabetic Retinopathy, MHIncreased Intracranial Pressure +13 more

Cerebellar Disease

Rule in:IECerebellar Disease, IEMultiple Sclerosis, IEUnilateral Cerebellar Lesion

Finger-to-nose

Rule out:IECerebellar Disease, IEMultiple Sclerosis, IEUnilateral Cerebellar Lesion

Rule in:IEAcute Neurologic Event or Severe Pain, IEAlcohol-related Cerebellar Degeneration, IEBilateral Hip Arthritis or Disease +20 more

Rule out:IEAcute Neurologic Event or Severe Pain, IEAlcohol-related Cerebellar Degeneration, IEBilateral Hip Arthritis or Disease +20 more

Rule in:IECerebellar Disease, IEMultiple Sclerosis, IESensory Ataxia (Posterior Column Dysfunction)

Heel-to-shin

aka Heel-knee-shin test

Rule out:IECerebellar Disease, IEMultiple Sclerosis, IESensory Ataxia (Posterior Column Dysfunction)

Rule in:SHVestibular Dysfunction, IEAlcohol Intoxication, IECerebellar Disease +2 more

Rule out:SHVestibular Dysfunction, IEAlcohol Intoxication, IECerebellar Disease +2 more

Cerebral Palsy

Rule in:IEAcute Neurologic Event or Severe Pain, IEAlcohol-related Cerebellar Degeneration, IEBilateral Hip Arthritis or Disease +20 more

Rule out:IEAcute Neurologic Event or Severe Pain, IEAlcohol-related Cerebellar Degeneration, IEBilateral Hip Arthritis or Disease +20 more

Charcot-Marie-Tooth Disease

Rule in:IEAcute Neurologic Event or Severe Pain, IEAlcohol-related Cerebellar Degeneration, IEBilateral Hip Arthritis or Disease +20 more

Rule out:IEAcute Neurologic Event or Severe Pain, IEAlcohol-related Cerebellar Degeneration, IEBilateral Hip Arthritis or Disease +20 more

Cholangitis

Rule in:VHAbdominal Aortic Aneurysm, VHPyloric Stenosis, VHSigmoid Diverticulitis +29 more

Rule out:SHCholecystitis, SHHepatomegaly, MHAbdominal Aortic Aneurysm +28 more

Cholecystitis

Rule in:VHAbdominal Aortic Aneurysm, VHPyloric Stenosis, VHSigmoid Diverticulitis +29 more

Rule out:SHCholecystitis, SHHepatomegaly, MHAbdominal Aortic Aneurysm +28 more

Chronic Hypertension

Rule in:VHGlaucoma, SHDiabetic Retinopathy, MHIncreased Intracranial Pressure +13 more

Rule out:SHGlaucoma, MHDiabetic Retinopathy, MHIncreased Intracranial Pressure +13 more

Chronic Kidney Disease

Chronic Myeloid Leukemia

Rule in:SHCirrhosis, SHInfectious Mononucleosis, IEChronic Myeloid Leukemia +10 more

Rule out:MHInfectious Mononucleosis, IEChronic Myeloid Leukemia, IECirrhosis with Portal Hypertension +9 more

Chronic Obstructive Pulmonary Disease

Rule in:VHPneumothorax, HMainstem Bronchus Intubation, HPleural Effusion +24 more

Rule out:VHPleural Effusion, SHMainstem Bronchus Intubation, SHPneumothorax +23 more

Chronic Obstructive Pulmonary Disease (COPD) Exacerbation

Rule in:SHPneumonia, IEChronic Obstructive Pulmonary Disease (COPD) Exacerbation, IEHeart Failure +5 more

Rule out:IEChronic Obstructive Pulmonary Disease (COPD) Exacerbation, IEHeart Failure, IEPeripheral Artery Disease +4 more

Chronic Rhinosinusitis with Nasal Polyps

Rule in:SHAcute Rhinosinusitis, IEAllergic Rhinitis, IEChronic Rhinosinusitis with Nasal Polyps +2 more

Rule out:IEAllergic Rhinitis, IEChronic Rhinosinusitis with Nasal Polyps, IEGranulomatosis with Polyangiitis +1 more

Chronic Venous Insufficiency

Rule in:SHCirrhosis, SHHeart Failure, NHDeep Vein Thrombosis +11 more

Rule out:MHHeart Failure, NHDeep Vein Thrombosis, IEBaker Cyst Rupture +10 more

Circulatory Shock (Undifferentiated)

Rule in:VHAortic Regurgitation, VHVolume Depletion From Significant Blood Loss, HAcute Aortic Dissection +11 more

Rule out:VHVolume Depletion From Significant Blood Loss, HLow-output State (Low Cardiac Index) Within Established Chronic Heart Failure, SHAcute Aortic Dissection +10 more

Cirrhosis

Rule in:SHCirrhosis, SHHeart Failure, NHDeep Vein Thrombosis +11 more

Rule out:MHHeart Failure, NHDeep Vein Thrombosis, IEBaker Cyst Rupture +10 more

Rule in:SHCirrhosis, IEAcute Hepatitis, IECongestive Hepatopathy +6 more

Rule out:SHCirrhosis, IEAcute Hepatitis, IECongestive Hepatopathy +6 more

Skin Inspection and Palpation

aka Total body skin exam, TBSE

Rule in:SHCirrhosis

Rule out:MHCirrhosis

Rule in:SHCirrhosis, SHInfectious Mononucleosis, IEChronic Myeloid Leukemia +10 more

Rule out:MHInfectious Mononucleosis, IEChronic Myeloid Leukemia, IECirrhosis with Portal Hypertension +9 more

Cirrhosis with Portal Hypertension

Rule in:SHCirrhosis, SHInfectious Mononucleosis, IEChronic Myeloid Leukemia +10 more

Rule out:MHInfectious Mononucleosis, IEChronic Myeloid Leukemia, IECirrhosis with Portal Hypertension +9 more

Common Peroneal Nerve Palsy

Rule in:IEAcute Neurologic Event or Severe Pain, IEAlcohol-related Cerebellar Degeneration, IEBilateral Hip Arthritis or Disease +20 more

Rule out:IEAcute Neurologic Event or Severe Pain, IEAlcohol-related Cerebellar Degeneration, IEBilateral Hip Arthritis or Disease +20 more

Complete Heart Block

Cardiac Auscultation

Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy with Obstruction +34 more

Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy with Obstruction, SHAortic Regurgitation +33 more

Congestive Hepatopathy

Rule in:SHCirrhosis, IEAcute Hepatitis, IECongestive Hepatopathy +6 more

Rule out:SHCirrhosis, IEAcute Hepatitis, IECongestive Hepatopathy +6 more

Constrictive Pericarditis

Rule in:SHHeart Failure, IEConstrictive Pericarditis, IERight Heart Failure

Rule out:SHTricuspid Regurgitation, IEConstrictive Pericarditis, IERight Heart Failure

Rule in:VHHypovolemia, HHeart Failure, HRight Ventricular Infarction +8 more

Rule out:HRight Ventricular Infarction, SHHypovolemia, SHPulmonary Hypertension +8 more

Convergence Insufficiency

aka Near point of convergence (NPC) test

Convergence

Rule in:SHProlonged Recovery After Sport-related Concussion (Prognostic), IEConvergence Insufficiency

Rule out:VHVestibular Migraine, SHProlonged Recovery After Sport-related Concussion (Prognostic), IEConvergence Insufficiency

COPD Exacerbation

Rule in:SHCardiac Tamponade, SHSevere Asthma Exacerbation, IECOPD Exacerbation +2 more

Rule out:VHCardiac Tamponade, SHSevere Asthma Exacerbation, IECOPD Exacerbation +2 more

COPD with Hyperinflation

Rule in:HLarge Pleural Effusion, HPleural Effusion, SHLobar Pneumonia or Consolidation +10 more

Rule out:IEAtelectasis, IEBullous Emphysema, IECOPD with Hyperinflation +8 more

Rule in:VHPneumothorax, HMainstem Bronchus Intubation, HPleural Effusion +24 more

Rule out:VHPleural Effusion, SHMainstem Bronchus Intubation, SHPneumothorax +23 more

Rule in:VHLeft Ventricular Dilation, HLeft Ventricular Hypertrophy, SHCardiomegaly +7 more

Rule out:VHLeft Ventricular Dilation, SHLeft Ventricular Hypertrophy, MHCardiomegaly +7 more

Rule in:HPleural Effusion, IEAtelectasis with Airway Obstruction, IECOPD with Hyperinflation +3 more

Rule out:SHPleural Effusion, IEAtelectasis with Airway Obstruction, IECOPD with Hyperinflation +3 more

Cor Pulmonale

Rule in:VHHypovolemia, HHeart Failure, HRight Ventricular Infarction +8 more

Rule out:HRight Ventricular Infarction, SHHypovolemia, SHPulmonary Hypertension +8 more

Crohn Disease

Rule in:SHCrohn Disease, SHLung Cancer, SHUlcerative Colitis +2 more

Rule out:IEIron-deficiency Anemia, IESystemic Sclerosis

Crohn Disease (Terminal Ileitis)

Rule in:VHAbdominal Aortic Aneurysm, VHPyloric Stenosis, VHSigmoid Diverticulitis +29 more

Rule out:SHCholecystitis, SHHepatomegaly, MHAbdominal Aortic Aneurysm +28 more

Croup

Rule in:VHPneumothorax, HMainstem Bronchus Intubation, HPleural Effusion +24 more

Rule out:VHPleural Effusion, SHMainstem Bronchus Intubation, SHPneumothorax +23 more

Cushing Syndrome

Rule in:HAcromegaly, HAcute Stroke, IECushing Syndrome +1 more

Rule out:SHAcromegaly, SHAcute Stroke, SHHypothyroidism +2 more

Cyanotic Congenital Heart Disease

Cystic Fibrosis

Cystitis (Lower Urinary Tract Infection)

aka Murphy's punch sign; Pasternatsky sign; Goldflam sign

Rule in:MHCystitis (Lower Urinary Tract Infection), IEPerinephric Abscess, IEPyelonephritis +1 more

Rule out:MHNephrolithiasis, IEPerinephric Abscess, IEPyelonephritis +1 more

Cystitis or Urinary Tract Infection

Rule in:VHAbdominal Aortic Aneurysm, VHPyloric Stenosis, VHSigmoid Diverticulitis +29 more

Rule out:SHCholecystitis, SHHepatomegaly, MHAbdominal Aortic Aneurysm +28 more

De Quervain Tenosynovitis

Rule in:IEDe Quervain Tenosynovitis, IEHand Osteoarthritis, IERheumatoid Arthritis (Inflammatory Arthritis)

Rule out:HScaphoid Fracture, IEDe Quervain Tenosynovitis, IEHand Osteoarthritis +1 more

Deconditioning

Rule in:VHAutonomic Neuropathy, VHHemorrhage, VHHypovolemia +5 more

Rule out:VHAutonomic Failure, VHHemorrhage, MHAutonomic Neuropathy +4 more

Deep Vein Thrombosis

Rule in:SHCirrhosis, SHHeart Failure, NHDeep Vein Thrombosis +11 more

Rule out:MHHeart Failure, NHDeep Vein Thrombosis, IEBaker Cyst Rupture +10 more

Lower Extremity Inspection and Palpation

Rule in:HPeripheral Arterial Disease, SHHeart Failure, MHDeep Vein Thrombosis

Rule out:MHDeep Vein Thrombosis, MHHeart Failure

Dehydration

Rule in:IEDehydration, IEHypovolemia

Skin Turgor

Rule out:IEDehydration, IEHypovolemia

Dehydration in Pediatric Patient

Rule in:HHypovolemia, SHDehydration in Pediatric Patient, MHModerate-to-severe Peripheral Artery Disease +4 more

Rule out:MHDehydration in Pediatric Patient, MHHypovolemia, MHShock +3 more

Delirium

Rule in:VHDelirium, HDementia (Major Neurocognitive Disorder), HMajor Depressive Disorder

Mental Status Assessment

Rule out:VHDementia (Major Neurocognitive Disorder), VHMajor Depressive Disorder, HDelirium

Dementia (Major Neurocognitive Disorder)

Rule in:VHDelirium, HDementia (Major Neurocognitive Disorder), HMajor Depressive Disorder

Mental Status Assessment

Rule out:VHDementia (Major Neurocognitive Disorder), VHMajor Depressive Disorder, HDelirium

Dextrocardia

Rule in:VHLeft Ventricular Dilation, HLeft Ventricular Hypertrophy, SHCardiomegaly +7 more

Rule out:VHLeft Ventricular Dilation, SHLeft Ventricular Hypertrophy, MHCardiomegaly +7 more

Diabetic Retinopathy

Rule in:VHGlaucoma, SHDiabetic Retinopathy, MHIncreased Intracranial Pressure +13 more

Rule out:SHGlaucoma, MHDiabetic Retinopathy, MHIncreased Intracranial Pressure +13 more

Diaphragmatic Paralysis

Rule in:HLarge Pleural Effusion, HPleural Effusion, SHLobar Pneumonia or Consolidation +10 more

Rule out:IEAtelectasis, IEBullous Emphysema, IECOPD with Hyperinflation +8 more

Digital Clubbing (Acropachy)

Diverticular Abscess

Rule in:VHAbdominal Aortic Aneurysm, VHPyloric Stenosis, VHSigmoid Diverticulitis +29 more

Rule out:SHCholecystitis, SHHepatomegaly, MHAbdominal Aortic Aneurysm +28 more

Drug-induced Parkinsonism

Rule in:IEAcute Neurologic Event or Severe Pain, IEAlcohol-related Cerebellar Degeneration, IEBilateral Hip Arthritis or Disease +20 more

Rule out:IEAcute Neurologic Event or Severe Pain, IEAlcohol-related Cerebellar Degeneration, IEBilateral Hip Arthritis or Disease +20 more

Dyslipidemia (Hyperlipidemia)

Rule in:SHAnemia, IEDyslipidemia (Hyperlipidemia), IEHorner Syndrome +4 more

Rule out:MHAnemia, IEDyslipidemia (Hyperlipidemia), IEHorner Syndrome +4 more

Ectopic Pregnancy

Rule in:VHAbdominal Aortic Aneurysm, VHPyloric Stenosis, VHSigmoid Diverticulitis +29 more

Rule out:SHCholecystitis, SHHepatomegaly, MHAbdominal Aortic Aneurysm +28 more

Endocarditis

Rule in:VHGlaucoma, SHDiabetic Retinopathy, MHIncreased Intracranial Pressure +13 more

Rule out:SHGlaucoma, MHDiabetic Retinopathy, MHIncreased Intracranial Pressure +13 more

Rule in:SHCirrhosis, SHInfectious Mononucleosis, IEChronic Myeloid Leukemia +10 more

Rule out:MHInfectious Mononucleosis, IEChronic Myeloid Leukemia, IECirrhosis with Portal Hypertension +9 more

Endometritis

Rule in:VHAbdominal Aortic Aneurysm, VHPyloric Stenosis, VHSigmoid Diverticulitis +29 more

Rule out:SHCholecystitis, SHHepatomegaly, MHAbdominal Aortic Aneurysm +28 more

Epiglottitis

Rule in:VHPneumothorax, HMainstem Bronchus Intubation, HPleural Effusion +24 more

Rule out:VHPleural Effusion, SHMainstem Bronchus Intubation, SHPneumothorax +23 more

Esophageal Rupture

Rule in:VHPneumothorax, HMainstem Bronchus Intubation, HPleural Effusion +24 more

Rule out:VHPleural Effusion, SHMainstem Bronchus Intubation, SHPneumothorax +23 more

Essential (Primary) Hypertension

Rule in:VHAortic Regurgitation, VHVolume Depletion From Significant Blood Loss, HAcute Aortic Dissection +11 more

Rule out:VHVolume Depletion From Significant Blood Loss, HLow-output State (Low Cardiac Index) Within Established Chronic Heart Failure, SHAcute Aortic Dissection +10 more

Eustachian Tube Dysfunction

Rule in:VHAcute Otitis Media, SHOtitis Media with Effusion, IEBasilar Skull Fracture +3 more

Rule out:VHOtitis Media with Effusion, IEBasilar Skull Fracture, IEEustachian Tube Dysfunction +2 more

Fatty Liver Disease

Rule in:SHCirrhosis, IEAcute Hepatitis, IECongestive Hepatopathy +6 more

Rule out:SHCirrhosis, IEAcute Hepatitis, IECongestive Hepatopathy +6 more

Femoral Nerve Injury

Rule in:VHPeripheral Neuropathy, HUpper Motor Neuron Lesion, SHL3-L4 Radiculopathy +4 more

Rule out:SHPeripheral Neuropathy, SHUpper Motor Neuron Lesion, IEFemoral Nerve Injury +3 more

First-degree AV Block

Cardiac Auscultation

Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy with Obstruction +34 more

Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy with Obstruction, SHAortic Regurgitation +33 more

Fitz-Hugh-Curtis Syndrome

Rule in:VHAbdominal Aortic Aneurysm, VHPyloric Stenosis, VHSigmoid Diverticulitis +29 more

Rule out:SHCholecystitis, SHHepatomegaly, MHAbdominal Aortic Aneurysm +28 more

Fluid Responsiveness (Preload Responsiveness)

POCUS

Inferior Vena Cava Ultrasound

Rule in:HFluid Responsiveness (Preload Responsiveness)

Rule out:HFluid Responsiveness (Preload Responsiveness)

Foot Drop or Distal Weakness

Rule in:IEAcute Neurologic Event or Severe Pain, IEAlcohol-related Cerebellar Degeneration, IEBilateral Hip Arthritis or Disease +20 more

Rule out:IEAcute Neurologic Event or Severe Pain, IEAlcohol-related Cerebellar Degeneration, IEBilateral Hip Arthritis or Disease +20 more

Foreign Body Aspiration

Rule in:VHPneumothorax, HMainstem Bronchus Intubation, HPleural Effusion +24 more

Rule out:VHPleural Effusion, SHMainstem Bronchus Intubation, SHPneumothorax +23 more

Frailty

Rule in:IEAcute Neurologic Event or Severe Pain, IEAlcohol-related Cerebellar Degeneration, IEBilateral Hip Arthritis or Disease +20 more

Rule out:IEAcute Neurologic Event or Severe Pain, IEAlcohol-related Cerebellar Degeneration, IEBilateral Hip Arthritis or Disease +20 more

Frailty or Deconditioning

Rule in:SHVestibular Dysfunction, IEAlcohol Intoxication, IECerebellar Disease +2 more

Rule out:SHVestibular Dysfunction, IEAlcohol Intoxication, IECerebellar Disease +2 more

Frontal Lobe Gait Disorder

Rule in:IEAcute Neurologic Event or Severe Pain, IEAlcohol-related Cerebellar Degeneration, IEBilateral Hip Arthritis or Disease +20 more

Rule out:IEAcute Neurologic Event or Severe Pain, IEAlcohol-related Cerebellar Degeneration, IEBilateral Hip Arthritis or Disease +20 more

Functional Gait Disorder

Rule in:IEAcute Neurologic Event or Severe Pain, IEAlcohol-related Cerebellar Degeneration, IEBilateral Hip Arthritis or Disease +20 more

Rule out:IEAcute Neurologic Event or Severe Pain, IEAlcohol-related Cerebellar Degeneration, IEBilateral Hip Arthritis or Disease +20 more

Gastritis

Rule in:VHAbdominal Aortic Aneurysm, VHPyloric Stenosis, VHSigmoid Diverticulitis +29 more

Rule out:SHCholecystitis, SHHepatomegaly, MHAbdominal Aortic Aneurysm +28 more

Gastroenteritis

Rule in:VHAbdominal Aortic Aneurysm, VHPyloric Stenosis, VHSigmoid Diverticulitis +29 more

Rule out:SHCholecystitis, SHHepatomegaly, MHAbdominal Aortic Aneurysm +28 more

Giant Cell Arteritis (Temporal Arteritis)

Temporal Artery Palpation

Rule in:SHGiant Cell Arteritis (Temporal Arteritis)

Glaucoma

Rule in:VHGlaucoma, SHDiabetic Retinopathy, MHIncreased Intracranial Pressure +13 more

Rule out:SHGlaucoma, MHDiabetic Retinopathy, MHIncreased Intracranial Pressure +13 more

Gluteal Tendinopathy (Greater Trochanteric Pain Syndrome)

Rule in:VHGluteal Tendinopathy (Greater Trochanteric Pain Syndrome), IEAdductor-related Groin Pain, IEIdiopathic Inflammatory Myopathy (Polymyositis or Dermatomyositis) +1 more

Rule out:HGluteal Tendinopathy (Greater Trochanteric Pain Syndrome), IEAdductor-related Groin Pain, IEIdiopathic Inflammatory Myopathy (Polymyositis or Dermatomyositis) +1 more

Goiter (Thyroid Enlargement)

Rule in:SHGoiter (Thyroid Enlargement), NHThyroid Nodule

Thyroid Inspection

Rule out:SHGoiter (Thyroid Enlargement), NHThyroid Nodule

Goiter or Thyroid Nodule

Rule in:IEGoiter or Thyroid Nodule

Thyroid Palpation

Rule out:IEGoiter or Thyroid Nodule

Granulomatosis with Polyangiitis

Rule in:SHAcute Rhinosinusitis, IEAllergic Rhinitis, IEChronic Rhinosinusitis with Nasal Polyps +2 more

Rule out:IEAllergic Rhinitis, IEChronic Rhinosinusitis with Nasal Polyps, IEGranulomatosis with Polyangiitis +1 more

Guillain-Barré Syndrome

Rule in:VHPeripheral Neuropathy, HUpper Motor Neuron Lesion, SHHypothyroidism +5 more

Rule out:VHPeripheral Neuropathy, SHUpper Motor Neuron Lesion, NHS1 Radiculopathy +4 more

Rule in:VHPeripheral Neuropathy, HUpper Motor Neuron Lesion, SHL3-L4 Radiculopathy +4 more

Rule out:SHPeripheral Neuropathy, SHUpper Motor Neuron Lesion, IEFemoral Nerve Injury +3 more

Hand Osteoarthritis

Rule in:IEDe Quervain Tenosynovitis, IEHand Osteoarthritis, IERheumatoid Arthritis (Inflammatory Arthritis)

Rule out:HScaphoid Fracture, IEDe Quervain Tenosynovitis, IEHand Osteoarthritis +1 more

Heart Failure

Rule in:SHHeart Failure, IEConstrictive Pericarditis, IERight Heart Failure

Rule out:SHTricuspid Regurgitation, IEConstrictive Pericarditis, IERight Heart Failure

Cardiac Auscultation

Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy with Obstruction +34 more

Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy with Obstruction, SHAortic Regurgitation +33 more

Rule in:SHCirrhosis, SHHeart Failure, NHDeep Vein Thrombosis +11 more

Rule out:MHHeart Failure, NHDeep Vein Thrombosis, IEBaker Cyst Rupture +10 more

Rule in:VHHypovolemia, HHeart Failure, HRight Ventricular Infarction +8 more

Rule out:HRight Ventricular Infarction, SHHypovolemia, SHPulmonary Hypertension +8 more

Rule in:SHCirrhosis, IEAcute Hepatitis, IECongestive Hepatopathy +6 more

Rule out:SHCirrhosis, IEAcute Hepatitis, IECongestive Hepatopathy +6 more

Lower Extremity Inspection and Palpation

Rule in:HPeripheral Arterial Disease, SHHeart Failure, MHDeep Vein Thrombosis

Rule out:MHDeep Vein Thrombosis, MHHeart Failure

Rule in:VHPneumothorax, HMainstem Bronchus Intubation, HPleural Effusion +24 more

Rule out:VHPleural Effusion, SHMainstem Bronchus Intubation, SHPneumothorax +23 more

Neck Vein Inspection

Rule in:HHeart Failure

Rule out:MHHeart Failure

Rule in:SHPneumonia, IEChronic Obstructive Pulmonary Disease (COPD) Exacerbation, IEHeart Failure +5 more

Rule out:IEChronic Obstructive Pulmonary Disease (COPD) Exacerbation, IEHeart Failure, IEPeripheral Artery Disease +4 more

Rule in:SHPneumonia, IEHeart Failure, IEIncreased Intracranial Pressure +3 more

Rule out:MHPulmonary Embolism, IEHeart Failure, IEIncreased Intracranial Pressure +3 more

Heart Failure (Bedbound Patient)

Rule in:SHCirrhosis, SHHeart Failure, NHDeep Vein Thrombosis +11 more

Rule out:MHHeart Failure, NHDeep Vein Thrombosis, IEBaker Cyst Rupture +10 more

Heart Failure (When Wheezing Is the Dominant Auscultatory Finding)

Rule in:VHPneumothorax, HMainstem Bronchus Intubation, HPleural Effusion +24 more

Rule out:VHPleural Effusion, SHMainstem Bronchus Intubation, SHPneumothorax +23 more

Heart Failure with Tachycardia

Cardiac Auscultation

Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy with Obstruction +34 more

Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy with Obstruction, SHAortic Regurgitation +33 more

Hematologic Malignancy

Rule in:SHCirrhosis, SHInfectious Mononucleosis, IEChronic Myeloid Leukemia +10 more

Rule out:MHInfectious Mononucleosis, IEChronic Myeloid Leukemia, IECirrhosis with Portal Hypertension +9 more

Hemorrhage

Rule in:VHAutonomic Neuropathy, VHHemorrhage, VHHypovolemia +5 more

Rule out:VHAutonomic Failure, VHHemorrhage, MHAutonomic Neuropathy +4 more

Hemothorax

Rule in:HLarge Pleural Effusion, HPleural Effusion, SHLobar Pneumonia or Consolidation +10 more

Rule out:IEAtelectasis, IEBullous Emphysema, IECOPD with Hyperinflation +8 more

Hepatic Encephalopathy

Hepatitis

Rule in:VHAbdominal Aortic Aneurysm, VHPyloric Stenosis, VHSigmoid Diverticulitis +29 more

Rule out:SHCholecystitis, SHHepatomegaly, MHAbdominal Aortic Aneurysm +28 more

Rule in:SHCirrhosis, IEAcute Hepatitis, IECongestive Hepatopathy +6 more

Rule out:SHCirrhosis, IEAcute Hepatitis, IECongestive Hepatopathy +6 more

Hepatocellular Carcinoma

Rule in:SHCirrhosis, IEAcute Hepatitis, IECongestive Hepatopathy +6 more

Rule out:SHCirrhosis, IEAcute Hepatitis, IECongestive Hepatopathy +6 more

Hepatomegaly

Rule in:VHAbdominal Aortic Aneurysm, VHPyloric Stenosis, VHSigmoid Diverticulitis +29 more

Rule out:SHCholecystitis, SHHepatomegaly, MHAbdominal Aortic Aneurysm +28 more

Rule in:NHHepatomegaly, IEPerforated Viscus, IEUrinary Retention

Abdomen Percussion

Rule out:NHHepatomegaly, IEPerforated Viscus, IEUrinary Retention

Liver Percussion

Rule in:NHHepatomegaly

Rule out:NHHepatomegaly

Hereditary Hemolytic Anemia

Rule in:SHCirrhosis, SHInfectious Mononucleosis, IEChronic Myeloid Leukemia +10 more

Rule out:MHInfectious Mononucleosis, IEChronic Myeloid Leukemia, IECirrhosis with Portal Hypertension +9 more

HIV Retinopathy

Rule in:VHGlaucoma, SHDiabetic Retinopathy, MHIncreased Intracranial Pressure +13 more

Rule out:SHGlaucoma, MHDiabetic Retinopathy, MHIncreased Intracranial Pressure +13 more

Horner Syndrome

Rule in:SHAnemia, IEDyslipidemia (Hyperlipidemia), IEHorner Syndrome +4 more

Rule out:MHAnemia, IEDyslipidemia (Hyperlipidemia), IEHorner Syndrome +4 more

Hyperbilirubinemia (Jaundice)

Rule in:SHAnemia, IEDyslipidemia (Hyperlipidemia), IEHorner Syndrome +4 more

Rule out:MHAnemia, IEDyslipidemia (Hyperlipidemia), IEHorner Syndrome +4 more

Hypercapnic Respiratory Failure

Hyperdynamic State

Cardiac Auscultation

Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy with Obstruction +34 more

Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy with Obstruction, SHAortic Regurgitation +33 more

Rule in:HAortic Stenosis, HTakayasu Arteritis, SHAortic Dissection +7 more

Rule out:SHAortic Stenosis, IEAortic Regurgitation, IECarotid Artery Stenosis +5 more

Rule in:VHLeft Ventricular Dilation, HLeft Ventricular Hypertrophy, SHCardiomegaly +7 more

Rule out:VHLeft Ventricular Dilation, SHLeft Ventricular Hypertrophy, MHCardiomegaly +7 more

Hypertensive Emergency

Rule in:VHAortic Regurgitation, VHVolume Depletion From Significant Blood Loss, HAcute Aortic Dissection +11 more

Rule out:VHVolume Depletion From Significant Blood Loss, HLow-output State (Low Cardiac Index) Within Established Chronic Heart Failure, SHAcute Aortic Dissection +10 more

Hypertensive Heart Disease

Cardiac Auscultation

Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy with Obstruction +34 more

Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy with Obstruction, SHAortic Regurgitation +33 more

Hypertensive Retinopathy

Rule in:VHGlaucoma, SHDiabetic Retinopathy, MHIncreased Intracranial Pressure +13 more

Rule out:SHGlaucoma, MHDiabetic Retinopathy, MHIncreased Intracranial Pressure +13 more

Hyperthyroidism (Thyrotoxicosis)

Rule in:VHAortic Regurgitation, VHVolume Depletion From Significant Blood Loss, HAcute Aortic Dissection +11 more

Rule out:VHVolume Depletion From Significant Blood Loss, HLow-output State (Low Cardiac Index) Within Established Chronic Heart Failure, SHAcute Aortic Dissection +10 more

Rule in:HAtrial Fibrillation, SHHypothyroidism, SHPneumonia +7 more

Rule out:VHAtrial Fibrillation, MHAdverse Short-term Outcome in Confirmed Pulmonary Embolism, IECardiac Tamponade +5 more

Hypertrophic Cardiomyopathy

Cardiac Auscultation

Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy with Obstruction +34 more

Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy with Obstruction, SHAortic Regurgitation +33 more

Hypertrophic Cardiomyopathy with Obstruction

Cardiac Auscultation

Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy with Obstruction +34 more

Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy with Obstruction, SHAortic Regurgitation +33 more

Rule in:HAortic Stenosis, HTakayasu Arteritis, SHAortic Dissection +7 more

Rule out:SHAortic Stenosis, IEAortic Regurgitation, IECarotid Artery Stenosis +5 more

Hypoalbuminemia

Rule in:SHCirrhosis, SHHeart Failure, NHDeep Vein Thrombosis +11 more

Rule out:MHHeart Failure, NHDeep Vein Thrombosis, IEBaker Cyst Rupture +10 more

Hypoglossal Nerve Palsy

Rule in:SHMeasles, IEAcute Leukemia, IEAdrenal Insufficiency +9 more

Rule out:SHHypovolemia, MHMeasles, IEAcute Leukemia +10 more

Hypotension (Systolic Blood Pressure Below 80 MmHg)

Rule in:IEHypotension (Systolic Blood Pressure Below 80 MmHg)

Radial Artery Palpation

Rule out:IEHypotension (Systolic Blood Pressure Below 80 MmHg)

Hypothyroidism

Rule in:VHPeripheral Neuropathy, HUpper Motor Neuron Lesion, SHHypothyroidism +5 more

Rule out:VHPeripheral Neuropathy, SHUpper Motor Neuron Lesion, NHS1 Radiculopathy +4 more

Rule in:HAcromegaly, HAcute Stroke, IECushing Syndrome +1 more

Rule out:SHAcromegaly, SHAcute Stroke, SHHypothyroidism +2 more

Rule in:HAtrial Fibrillation, SHHypothyroidism, SHPneumonia +7 more

Rule out:VHAtrial Fibrillation, MHAdverse Short-term Outcome in Confirmed Pulmonary Embolism, IECardiac Tamponade +5 more

Rule in:VHPeripheral Neuropathy, HUpper Motor Neuron Lesion, SHL3-L4 Radiculopathy +4 more

Rule out:SHPeripheral Neuropathy, SHUpper Motor Neuron Lesion, IEFemoral Nerve Injury +3 more

Hypothyroidism (Myxedema)

Rule in:SHCirrhosis, SHHeart Failure, NHDeep Vein Thrombosis +11 more

Rule out:MHHeart Failure, NHDeep Vein Thrombosis, IEBaker Cyst Rupture +10 more

Hypovolemia

Rule in:HHypovolemia, SHDehydration in Pediatric Patient, MHModerate-to-severe Peripheral Artery Disease +4 more

Rule out:MHDehydration in Pediatric Patient, MHHypovolemia, MHShock +3 more

Rule in:VHHypovolemia, HHeart Failure, HRight Ventricular Infarction +8 more

Rule out:HRight Ventricular Infarction, SHHypovolemia, SHPulmonary Hypertension +8 more

Rule in:SHMeasles, IEAcute Leukemia, IEAdrenal Insufficiency +9 more

Rule out:SHHypovolemia, MHMeasles, IEAcute Leukemia +10 more

Rule in:VHAutonomic Neuropathy, VHHemorrhage, VHHypovolemia +5 more

Rule out:VHAutonomic Failure, VHHemorrhage, MHAutonomic Neuropathy +4 more

Rule in:IEDehydration, IEHypovolemia

Skin Turgor

Rule out:IEDehydration, IEHypovolemia

Hypoxemia

Rule in:SHMeasles, IEAcute Leukemia, IEAdrenal Insufficiency +9 more

Rule out:SHHypovolemia, MHMeasles, IEAcute Leukemia +10 more

Idiopathic Inflammatory Myopathy (Polymyositis or Dermatomyositis)

Rule in:VHGluteal Tendinopathy (Greater Trochanteric Pain Syndrome), IEAdductor-related Groin Pain, IEIdiopathic Inflammatory Myopathy (Polymyositis or Dermatomyositis) +1 more

Rule out:HGluteal Tendinopathy (Greater Trochanteric Pain Syndrome), IEAdductor-related Groin Pain, IEIdiopathic Inflammatory Myopathy (Polymyositis or Dermatomyositis) +1 more

Idiopathic Intracranial Hypertension

Rule in:VHGlaucoma, SHDiabetic Retinopathy, MHIncreased Intracranial Pressure +13 more

Rule out:SHGlaucoma, MHDiabetic Retinopathy, MHIncreased Intracranial Pressure +13 more

Immunosuppression

Rule in:SHMeasles, IEAcute Leukemia, IEAdrenal Insufficiency +9 more

Rule out:SHHypovolemia, MHMeasles, IEAcute Leukemia +10 more

Incarcerated or Strangulated Hernia

Rule in:VHAbdominal Aortic Aneurysm, VHPyloric Stenosis, VHSigmoid Diverticulitis +29 more

Rule out:SHCholecystitis, SHHepatomegaly, MHAbdominal Aortic Aneurysm +28 more

Increased Intracranial Pressure

Rule in:HAtrial Fibrillation, SHHypothyroidism, SHPneumonia +7 more

Rule out:VHAtrial Fibrillation, MHAdverse Short-term Outcome in Confirmed Pulmonary Embolism, IECardiac Tamponade +5 more

Rule in:VHGlaucoma, SHDiabetic Retinopathy, MHIncreased Intracranial Pressure +13 more

Rule out:SHGlaucoma, MHDiabetic Retinopathy, MHIncreased Intracranial Pressure +13 more

Rule in:SHPneumonia, IEHeart Failure, IEIncreased Intracranial Pressure +3 more

Rule out:MHPulmonary Embolism, IEHeart Failure, IEIncreased Intracranial Pressure +3 more

Infectious Mononucleosis

Axillary Lymph Node Palpation

Rule in:SHInfectious Mononucleosis

Head and Neck Lymph Node Palpation

Rule in:SHInfectious Mononucleosis

Rule out:MHInfectious Mononucleosis

Inguinal Lymph Node Palpation

Rule in:SHInfectious Mononucleosis

Rule in:SHCirrhosis, SHInfectious Mononucleosis, IEChronic Myeloid Leukemia +10 more

Rule out:MHInfectious Mononucleosis, IEChronic Myeloid Leukemia, IECirrhosis with Portal Hypertension +9 more

Infective Endocarditis

Rule in:SHPneumonia, IEInfective Endocarditis, IESepsis +1 more

Rule out:MHAppendicitis (Pediatric), MHPneumonia, IEInfective Endocarditis +2 more

Inflammatory Bowel Disease

Interstitial Lung Disease

Rule in:VHPneumothorax, HMainstem Bronchus Intubation, HPleural Effusion +24 more

Rule out:VHPleural Effusion, SHMainstem Bronchus Intubation, SHPneumothorax +23 more

Intussusception

Rule in:VHAbdominal Aortic Aneurysm, VHPyloric Stenosis, VHSigmoid Diverticulitis +29 more

Rule out:SHCholecystitis, SHHepatomegaly, MHAbdominal Aortic Aneurysm +28 more

Iron-deficiency Anemia

Rule in:SHCrohn Disease, SHLung Cancer, SHUlcerative Colitis +2 more

Rule out:IEIron-deficiency Anemia, IESystemic Sclerosis

Kawasaki Disease

Rule in:SHMeasles, IEAcute Leukemia, IEAdrenal Insufficiency +9 more

Rule out:SHHypovolemia, MHMeasles, IEAcute Leukemia +10 more

L3-L4 Radiculopathy

Rule in:VHPeripheral Neuropathy, HUpper Motor Neuron Lesion, SHL3-L4 Radiculopathy +4 more

Rule out:SHPeripheral Neuropathy, SHUpper Motor Neuron Lesion, IEFemoral Nerve Injury +3 more

L5 Radiculopathy

Rule in:IEAcute Neurologic Event or Severe Pain, IEAlcohol-related Cerebellar Degeneration, IEBilateral Hip Arthritis or Disease +20 more

Rule out:IEAcute Neurologic Event or Severe Pain, IEAlcohol-related Cerebellar Degeneration, IEBilateral Hip Arthritis or Disease +20 more

Large Pericardial Effusion

Cardiac Auscultation

Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy with Obstruction +34 more

Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy with Obstruction, SHAortic Regurgitation +33 more

Large Pleural Effusion

Rule in:HLarge Pleural Effusion, HPleural Effusion, SHLobar Pneumonia or Consolidation +10 more

Rule out:IEAtelectasis, IEBullous Emphysema, IECOPD with Hyperinflation +8 more

Lead Poisoning

Rule in:SHMeasles, IEAcute Leukemia, IEAdrenal Insufficiency +9 more

Rule out:SHHypovolemia, MHMeasles, IEAcute Leukemia +10 more

Left Bundle Branch Block

Cardiac Auscultation

Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy with Obstruction +34 more

Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy with Obstruction, SHAortic Regurgitation +33 more

Left Ventricular Dilation

Rule in:VHLeft Ventricular Dilation, HLeft Ventricular Hypertrophy, SHCardiomegaly +7 more

Rule out:VHLeft Ventricular Dilation, SHLeft Ventricular Hypertrophy, MHCardiomegaly +7 more

Left Ventricular Hypertrophy

Rule in:VHLeft Ventricular Dilation, HLeft Ventricular Hypertrophy, SHCardiomegaly +7 more

Rule out:VHLeft Ventricular Dilation, SHLeft Ventricular Hypertrophy, MHCardiomegaly +7 more

Leukemia

Rule in:VHGlaucoma, SHDiabetic Retinopathy, MHIncreased Intracranial Pressure +13 more

Rule out:SHGlaucoma, MHDiabetic Retinopathy, MHIncreased Intracranial Pressure +13 more

Lipedema

Rule in:SHCirrhosis, SHHeart Failure, NHDeep Vein Thrombosis +11 more

Rule out:MHHeart Failure, NHDeep Vein Thrombosis, IEBaker Cyst Rupture +10 more

Liver Abscess

Rule in:VHAbdominal Aortic Aneurysm, VHPyloric Stenosis, VHSigmoid Diverticulitis +29 more

Rule out:SHCholecystitis, SHHepatomegaly, MHAbdominal Aortic Aneurysm +28 more

Lobar Pneumonia or Consolidation

Rule in:IEAtelectasis with Patent Airway, IELobar Pneumonia or Consolidation

Bronchophony

Rule out:IEAtelectasis with Patent Airway, IELobar Pneumonia or Consolidation

Rule in:HLarge Pleural Effusion, HPleural Effusion, SHLobar Pneumonia or Consolidation +10 more

Rule out:IEAtelectasis, IEBullous Emphysema, IECOPD with Hyperinflation +8 more

Rule in:HLobar Pneumonia or Consolidation, IEAtelectasis with Patent Airway, IEPleural Effusion (Above the Effusion)

Egophony

Rule out:IEAtelectasis with Patent Airway, IEPleural Effusion (Above the Effusion)

Rule in:VHPneumothorax, HMainstem Bronchus Intubation, HPleural Effusion +24 more

Rule out:VHPleural Effusion, SHMainstem Bronchus Intubation, SHPneumothorax +23 more

Rule in:HPleural Effusion, IEAtelectasis with Airway Obstruction, IECOPD with Hyperinflation +3 more

Rule out:SHPleural Effusion, IEAtelectasis with Airway Obstruction, IECOPD with Hyperinflation +3 more

Lobar Pneumonia or Pulmonary Consolidation

Rule in:IELobar Pneumonia or Pulmonary Consolidation

Whispered Pectoriloquy

Rule out:IELobar Pneumonia or Pulmonary Consolidation

Localized Arterial Insufficiency

Rule in:HHypovolemia, SHDehydration in Pediatric Patient, MHModerate-to-severe Peripheral Artery Disease +4 more

Rule out:MHDehydration in Pediatric Patient, MHHypovolemia, MHShock +3 more

Low-output State (Low Cardiac Index) Within Established Chronic Heart Failure

Rule in:VHAortic Regurgitation, VHVolume Depletion From Significant Blood Loss, HAcute Aortic Dissection +11 more

Rule out:VHVolume Depletion From Significant Blood Loss, HLow-output State (Low Cardiac Index) Within Established Chronic Heart Failure, SHAcute Aortic Dissection +10 more

Lower Extremity Pain

Rule in:IEAcute Neurologic Event or Severe Pain, IEAlcohol-related Cerebellar Degeneration, IEBilateral Hip Arthritis or Disease +20 more

Rule out:IEAcute Neurologic Event or Severe Pain, IEAlcohol-related Cerebellar Degeneration, IEBilateral Hip Arthritis or Disease +20 more

Lung Cancer

Rule in:SHCrohn Disease, SHLung Cancer, SHUlcerative Colitis +2 more

Rule out:IEIron-deficiency Anemia, IESystemic Sclerosis

Lymphedema

Rule in:SHCirrhosis, SHHeart Failure, NHDeep Vein Thrombosis +11 more

Rule out:MHHeart Failure, NHDeep Vein Thrombosis, IEBaker Cyst Rupture +10 more

Lymphoma

Rule in:SHCirrhosis, SHInfectious Mononucleosis, IEChronic Myeloid Leukemia +10 more

Rule out:MHInfectious Mononucleosis, IEChronic Myeloid Leukemia, IECirrhosis with Portal Hypertension +9 more

Macular Degeneration

Rule in:VHGlaucoma, SHDiabetic Retinopathy, MHIncreased Intracranial Pressure +13 more

Rule out:SHGlaucoma, MHDiabetic Retinopathy, MHIncreased Intracranial Pressure +13 more

Mainstem Bronchus Intubation

Rule in:VHPneumothorax, HMainstem Bronchus Intubation, HPleural Effusion +24 more

Rule out:VHPleural Effusion, SHMainstem Bronchus Intubation, SHPneumothorax +23 more

Major Depressive Disorder

Rule in:VHDelirium, HDementia (Major Neurocognitive Disorder), HMajor Depressive Disorder

Mental Status Assessment

Rule out:VHDementia (Major Neurocognitive Disorder), VHMajor Depressive Disorder, HDelirium

Malignant Otitis Externa

Rule in:VHAcute Otitis Media, SHOtitis Media with Effusion, IEBasilar Skull Fracture +3 more

Rule out:VHOtitis Media with Effusion, IEBasilar Skull Fracture, IEEustachian Tube Dysfunction +2 more

Massive Pulmonary Embolism

Rule in:SHCardiac Tamponade, SHSevere Asthma Exacerbation, IECOPD Exacerbation +2 more

Rule out:VHCardiac Tamponade, SHSevere Asthma Exacerbation, IECOPD Exacerbation +2 more

Measles

Rule in:SHMeasles, IEAcute Leukemia, IEAdrenal Insufficiency +9 more

Rule out:SHHypovolemia, MHMeasles, IEAcute Leukemia +10 more

Medication Effect

Rule in:VHAutonomic Neuropathy, VHHemorrhage, VHHypovolemia +5 more

Rule out:VHAutonomic Failure, VHHemorrhage, MHAutonomic Neuropathy +4 more

Medication Effect (Calcium Channel Blockers, NSAIDs)

Rule in:SHCirrhosis, SHHeart Failure, NHDeep Vein Thrombosis +11 more

Rule out:MHHeart Failure, NHDeep Vein Thrombosis, IEBaker Cyst Rupture +10 more

Meningitis

aka Nape-of-the-neck sign

Brudzinski Sign

Rule in:NHMeningitis

Rule out:NHMeningitis

Kernig Sign

Rule in:NHMeningitis

Rule out:NHMeningitis

Nuchal Rigidity

Rule in:NHMeningitis

Rule out:NHMeningitis

Metabolic Encephalopathy

Metastatic Liver Disease

Rule in:SHCirrhosis, IEAcute Hepatitis, IECongestive Hepatopathy +6 more

Rule out:SHCirrhosis, IEAcute Hepatitis, IECongestive Hepatopathy +6 more

Mitral Regurgitation

Cardiac Auscultation

Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy with Obstruction +34 more

Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy with Obstruction, SHAortic Regurgitation +33 more

Mitral Stenosis

Cardiac Auscultation

Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy with Obstruction +34 more

Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy with Obstruction, SHAortic Regurgitation +33 more

Rule in:VHLeft Ventricular Dilation, HLeft Ventricular Hypertrophy, SHCardiomegaly +7 more

Rule out:VHLeft Ventricular Dilation, SHLeft Ventricular Hypertrophy, MHCardiomegaly +7 more

Mitral Valve Prolapse

Cardiac Auscultation

Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy with Obstruction +34 more

Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy with Obstruction, SHAortic Regurgitation +33 more

Mixed Aortic Valve Disease

Rule in:HAortic Stenosis, HTakayasu Arteritis, SHAortic Dissection +7 more

Rule out:SHAortic Stenosis, IEAortic Regurgitation, IECarotid Artery Stenosis +5 more

Moderate-to-severe Peripheral Artery Disease

Rule in:HHypovolemia, SHDehydration in Pediatric Patient, MHModerate-to-severe Peripheral Artery Disease +4 more

Rule out:MHDehydration in Pediatric Patient, MHHypovolemia, MHShock +3 more

Motor Neuron Disease (ALS)

Rule in:VHUpper Motor Neuron Lesion, IEMotor Neuron Disease (ALS), IEMultiple Sclerosis +2 more

Rule out:SHUpper Motor Neuron Lesion, IEMotor Neuron Disease (ALS), IEMultiple Sclerosis +2 more

Multiple Sclerosis

Rule in:VHUpper Motor Neuron Lesion, IEMotor Neuron Disease (ALS), IEMultiple Sclerosis +2 more

Rule out:SHUpper Motor Neuron Lesion, IEMotor Neuron Disease (ALS), IEMultiple Sclerosis +2 more

Rule in:IECerebellar Disease, IEMultiple Sclerosis, IEUnilateral Cerebellar Lesion

Finger-to-nose

Rule out:IECerebellar Disease, IEMultiple Sclerosis, IEUnilateral Cerebellar Lesion

Rule in:IEAcute Neurologic Event or Severe Pain, IEAlcohol-related Cerebellar Degeneration, IEBilateral Hip Arthritis or Disease +20 more

Rule out:IEAcute Neurologic Event or Severe Pain, IEAlcohol-related Cerebellar Degeneration, IEBilateral Hip Arthritis or Disease +20 more

Rule in:IECerebellar Disease, IEMultiple Sclerosis, IESensory Ataxia (Posterior Column Dysfunction)

Heel-to-shin

aka Heel-knee-shin test

Rule out:IECerebellar Disease, IEMultiple Sclerosis, IESensory Ataxia (Posterior Column Dysfunction)

Rule in:VHBrain Tumor, HStroke, NHUpper Motor Neuron Lesion +1 more

Rule out:VHStroke, MHBrain Tumor, NHUpper Motor Neuron Lesion +1 more

Myasthenia Gravis

Rule in:SHAnemia, IEDyslipidemia (Hyperlipidemia), IEHorner Syndrome +4 more

Rule out:MHAnemia, IEDyslipidemia (Hyperlipidemia), IEHorner Syndrome +4 more

Myelofibrosis

Rule in:SHCirrhosis, SHInfectious Mononucleosis, IEChronic Myeloid Leukemia +10 more

Rule out:MHInfectious Mononucleosis, IEChronic Myeloid Leukemia, IECirrhosis with Portal Hypertension +9 more

Nasal Bone Fracture

Rule in:SHAcute Rhinosinusitis, IEAllergic Rhinitis, IEChronic Rhinosinusitis with Nasal Polyps +2 more

Rule out:IEAllergic Rhinitis, IEChronic Rhinosinusitis with Nasal Polyps, IEGranulomatosis with Polyangiitis +1 more

Nephrolithiasis

aka Murphy's punch sign; Pasternatsky sign; Goldflam sign

Rule in:MHCystitis (Lower Urinary Tract Infection), IEPerinephric Abscess, IEPyelonephritis +1 more

Rule out:MHNephrolithiasis, IEPerinephric Abscess, IEPyelonephritis +1 more

Nephrotic Syndrome

Rule in:SHCirrhosis, SHHeart Failure, NHDeep Vein Thrombosis +11 more

Rule out:MHHeart Failure, NHDeep Vein Thrombosis, IEBaker Cyst Rupture +10 more

Normal Pressure Hydrocephalus

Rule in:IEAcute Neurologic Event or Severe Pain, IEAlcohol-related Cerebellar Degeneration, IEBilateral Hip Arthritis or Disease +20 more

Rule out:IEAcute Neurologic Event or Severe Pain, IEAlcohol-related Cerebellar Degeneration, IEBilateral Hip Arthritis or Disease +20 more

Nutritional Deficiency

Rule in:SHMeasles, IEAcute Leukemia, IEAdrenal Insufficiency +9 more

Rule out:SHHypovolemia, MHMeasles, IEAcute Leukemia +10 more

Obesity

Rule in:VHLeft Ventricular Dilation, HLeft Ventricular Hypertrophy, SHCardiomegaly +7 more

Rule out:VHLeft Ventricular Dilation, SHLeft Ventricular Hypertrophy, MHCardiomegaly +7 more

Obesity (Excess Body Adiposity)

Rule in:HObesity (Excess Body Adiposity)

Waist Circumference

Rule out:SHObesity (Excess Body Adiposity)

Opioid Intoxication / Overdose

Rule in:SHPneumonia, IEHeart Failure, IEIncreased Intracranial Pressure +3 more

Rule out:MHPulmonary Embolism, IEHeart Failure, IEIncreased Intracranial Pressure +3 more

Optic Atrophy

Rule in:VHGlaucoma, SHDiabetic Retinopathy, MHIncreased Intracranial Pressure +13 more

Rule out:SHGlaucoma, MHDiabetic Retinopathy, MHIncreased Intracranial Pressure +13 more

Oral Cancer

Rule in:SHMeasles, IEAcute Leukemia, IEAdrenal Insufficiency +9 more

Rule out:SHHypovolemia, MHMeasles, IEAcute Leukemia +10 more

Otitis Externa

Rule in:VHAcute Otitis Media, SHOtitis Media with Effusion, IEBasilar Skull Fracture +3 more

Rule out:VHOtitis Media with Effusion, IEBasilar Skull Fracture, IEEustachian Tube Dysfunction +2 more

Otitis Media with Effusion

Rule in:VHAcute Otitis Media, SHOtitis Media with Effusion, IEBasilar Skull Fracture +3 more

Rule out:VHOtitis Media with Effusion, IEBasilar Skull Fracture, IEEustachian Tube Dysfunction +2 more

Ovarian Cancer

Rule out:MHOvarian Cancer

Pelvic Bimanual Exam

Rule in:VHOvarian Cancer

Ovarian Cyst, Torsion, or Mass

Rule in:VHAbdominal Aortic Aneurysm, VHPyloric Stenosis, VHSigmoid Diverticulitis +29 more

Rule out:SHCholecystitis, SHHepatomegaly, MHAbdominal Aortic Aneurysm +28 more

Pancreatitis

Rule in:VHAbdominal Aortic Aneurysm, VHPyloric Stenosis, VHSigmoid Diverticulitis +29 more

Rule out:SHCholecystitis, SHHepatomegaly, MHAbdominal Aortic Aneurysm +28 more

Parkinson Disease

Rule in:IEAcute Neurologic Event or Severe Pain, IEAlcohol-related Cerebellar Degeneration, IEBilateral Hip Arthritis or Disease +20 more

Rule out:IEAcute Neurologic Event or Severe Pain, IEAlcohol-related Cerebellar Degeneration, IEBilateral Hip Arthritis or Disease +20 more

Rule in:HAcromegaly, HAcute Stroke, IECushing Syndrome +1 more

Rule out:SHAcromegaly, SHAcute Stroke, SHHypothyroidism +2 more

Patent Ductus Arteriosus

Cardiac Auscultation

Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy with Obstruction +34 more

Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy with Obstruction, SHAortic Regurgitation +33 more

Pelvic Inflammatory Disease

Rule in:VHAbdominal Aortic Aneurysm, VHPyloric Stenosis, VHSigmoid Diverticulitis +29 more

Rule out:SHCholecystitis, SHHepatomegaly, MHAbdominal Aortic Aneurysm +28 more

Peptic Ulcer Disease

Rule in:VHAbdominal Aortic Aneurysm, VHPyloric Stenosis, VHSigmoid Diverticulitis +29 more

Rule out:SHCholecystitis, SHHepatomegaly, MHAbdominal Aortic Aneurysm +28 more

Perforated Viscus

Rule in:VHAbdominal Aortic Aneurysm, VHPyloric Stenosis, VHSigmoid Diverticulitis +29 more

Rule out:SHCholecystitis, SHHepatomegaly, MHAbdominal Aortic Aneurysm +28 more

Rule in:NHHepatomegaly, IEPerforated Viscus, IEUrinary Retention

Abdomen Percussion

Rule out:NHHepatomegaly, IEPerforated Viscus, IEUrinary Retention

Pericardial Effusion

Rule in:VHLeft Ventricular Dilation, HLeft Ventricular Hypertrophy, SHCardiomegaly +7 more

Rule out:VHLeft Ventricular Dilation, SHLeft Ventricular Hypertrophy, MHCardiomegaly +7 more

Pericardial Effusion in Penetrating Chest Trauma

POCUS

Cardiac Ultrasound (Focused Echo)

aka Focused cardiac ultrasound

Rule in:VHPericardial Effusion in Penetrating Chest Trauma

Rule out:HPericardial Effusion in Penetrating Chest Trauma

Perinephric Abscess

aka Murphy's punch sign; Pasternatsky sign; Goldflam sign

Rule in:MHCystitis (Lower Urinary Tract Infection), IEPerinephric Abscess, IEPyelonephritis +1 more

Rule out:MHNephrolithiasis, IEPerinephric Abscess, IEPyelonephritis +1 more

Peripheral Arterial Disease

Lower Extremity Inspection and Palpation

Rule in:HPeripheral Arterial Disease, SHHeart Failure, MHDeep Vein Thrombosis

Rule out:MHDeep Vein Thrombosis, MHHeart Failure

Peripheral Artery Disease

Rule in:HHypovolemia, SHDehydration in Pediatric Patient, MHModerate-to-severe Peripheral Artery Disease +4 more

Rule out:MHDehydration in Pediatric Patient, MHHypovolemia, MHShock +3 more

Rule in:SHPneumonia, IEChronic Obstructive Pulmonary Disease (COPD) Exacerbation, IEHeart Failure +5 more

Rule out:IEChronic Obstructive Pulmonary Disease (COPD) Exacerbation, IEHeart Failure, IEPeripheral Artery Disease +4 more

Peripheral Neuropathy

Rule in:VHPeripheral Neuropathy, HUpper Motor Neuron Lesion, SHHypothyroidism +5 more

Rule out:VHPeripheral Neuropathy, SHUpper Motor Neuron Lesion, NHS1 Radiculopathy +4 more

Rule in:VHPeripheral Neuropathy, HUpper Motor Neuron Lesion, SHL3-L4 Radiculopathy +4 more

Rule out:SHPeripheral Neuropathy, SHUpper Motor Neuron Lesion, IEFemoral Nerve Injury +3 more

Peritonitis

Rule in:VHAbdominal Aortic Aneurysm, VHPyloric Stenosis, VHSigmoid Diverticulitis +29 more

Rule out:SHCholecystitis, SHHepatomegaly, MHAbdominal Aortic Aneurysm +28 more

Pleural Effusion

Rule in:HLarge Pleural Effusion, HPleural Effusion, SHLobar Pneumonia or Consolidation +10 more

Rule out:IEAtelectasis, IEBullous Emphysema, IECOPD with Hyperinflation +8 more

Rule in:VHPneumothorax, HMainstem Bronchus Intubation, HPleural Effusion +24 more

Rule out:VHPleural Effusion, SHMainstem Bronchus Intubation, SHPneumothorax +23 more

Rule in:HPleural Effusion, IEAtelectasis with Airway Obstruction, IECOPD with Hyperinflation +3 more

Rule out:SHPleural Effusion, IEAtelectasis with Airway Obstruction, IECOPD with Hyperinflation +3 more

Pleural Effusion (Above the Effusion)

Rule in:HLobar Pneumonia or Consolidation, IEAtelectasis with Patent Airway, IEPleural Effusion (Above the Effusion)

Egophony

Rule out:IEAtelectasis with Patent Airway, IEPleural Effusion (Above the Effusion)

Pleural Inflammation

Rule in:VHPneumothorax, HMainstem Bronchus Intubation, HPleural Effusion +24 more

Rule out:VHPleural Effusion, SHMainstem Bronchus Intubation, SHPneumothorax +23 more

Pneumomediastinum

Rule in:VHPneumothorax, HMainstem Bronchus Intubation, HPleural Effusion +24 more

Rule out:VHPleural Effusion, SHMainstem Bronchus Intubation, SHPneumothorax +23 more

Pneumonia

Rule in:HAtrial Fibrillation, SHHypothyroidism, SHPneumonia +7 more

Rule out:VHAtrial Fibrillation, MHAdverse Short-term Outcome in Confirmed Pulmonary Embolism, IECardiac Tamponade +5 more

Rule in:VHPneumothorax, HMainstem Bronchus Intubation, HPleural Effusion +24 more

Rule out:VHPleural Effusion, SHMainstem Bronchus Intubation, SHPneumothorax +23 more

Rule in:SHPneumonia, IEChronic Obstructive Pulmonary Disease (COPD) Exacerbation, IEHeart Failure +5 more

Rule out:IEChronic Obstructive Pulmonary Disease (COPD) Exacerbation, IEHeart Failure, IEPeripheral Artery Disease +4 more

Rule in:SHPneumonia, IEHeart Failure, IEIncreased Intracranial Pressure +3 more

Rule out:MHPulmonary Embolism, IEHeart Failure, IEIncreased Intracranial Pressure +3 more

Rule in:SHPneumonia, IEInfective Endocarditis, IESepsis +1 more

Rule out:MHAppendicitis (Pediatric), MHPneumonia, IEInfective Endocarditis +2 more

Pneumothorax

Rule in:HLarge Pleural Effusion, HPleural Effusion, SHLobar Pneumonia or Consolidation +10 more

Rule out:IEAtelectasis, IEBullous Emphysema, IECOPD with Hyperinflation +8 more

Rule in:VHPneumothorax, HMainstem Bronchus Intubation, HPleural Effusion +24 more

Rule out:VHPleural Effusion, SHMainstem Bronchus Intubation, SHPneumothorax +23 more

Rule in:HPleural Effusion, IEAtelectasis with Airway Obstruction, IECOPD with Hyperinflation +3 more

Rule out:SHPleural Effusion, IEAtelectasis with Airway Obstruction, IECOPD with Hyperinflation +3 more

Portal Hypertension

Rule in:VHBowel Obstruction, SHAscites, IEPortal Hypertension +1 more

Rule out:SHAscites, IEBowel Obstruction, IEPortal Hypertension +1 more

Posterior Column Dysfunction

Rule in:SHVestibular Dysfunction, IEAlcohol Intoxication, IECerebellar Disease +2 more

Rule out:SHVestibular Dysfunction, IEAlcohol Intoxication, IECerebellar Disease +2 more

Postpericardiotomy Syndrome

Cardiac Auscultation

Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy with Obstruction +34 more

Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy with Obstruction, SHAortic Regurgitation +33 more

Postural Orthostatic Tachycardia Syndrome

Rule in:VHAutonomic Neuropathy, VHHemorrhage, VHHypovolemia +5 more

Rule out:VHAutonomic Failure, VHHemorrhage, MHAutonomic Neuropathy +4 more

Pregnancy

Rule in:IEAcute Neurologic Event or Severe Pain, IEAlcohol-related Cerebellar Degeneration, IEBilateral Hip Arthritis or Disease +20 more

Rule out:IEAcute Neurologic Event or Severe Pain, IEAlcohol-related Cerebellar Degeneration, IEBilateral Hip Arthritis or Disease +20 more

Prolonged Recovery After Sport-related Concussion (Prognostic)

aka Near point of convergence (NPC) test

Convergence

Rule in:SHProlonged Recovery After Sport-related Concussion (Prognostic), IEConvergence Insufficiency

Rule out:VHVestibular Migraine, SHProlonged Recovery After Sport-related Concussion (Prognostic), IEConvergence Insufficiency

Prosthetic Valve

Cardiac Auscultation

Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy with Obstruction +34 more

Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy with Obstruction, SHAortic Regurgitation +33 more

Proximal Myopathy

Rule in:IEAcute Neurologic Event or Severe Pain, IEAlcohol-related Cerebellar Degeneration, IEBilateral Hip Arthritis or Disease +20 more

Rule out:IEAcute Neurologic Event or Severe Pain, IEAlcohol-related Cerebellar Degeneration, IEBilateral Hip Arthritis or Disease +20 more

Pulmonary Edema

Rule in:VHPneumothorax, HMainstem Bronchus Intubation, HPleural Effusion +24 more

Rule out:VHPleural Effusion, SHMainstem Bronchus Intubation, SHPneumothorax +23 more

Pulmonary Embolism

Rule in:HAtrial Fibrillation, SHHypothyroidism, SHPneumonia +7 more

Rule out:VHAtrial Fibrillation, MHAdverse Short-term Outcome in Confirmed Pulmonary Embolism, IECardiac Tamponade +5 more

Rule in:VHHypovolemia, HHeart Failure, HRight Ventricular Infarction +8 more

Rule out:HRight Ventricular Infarction, SHHypovolemia, SHPulmonary Hypertension +8 more

Rule in:VHPneumothorax, HMainstem Bronchus Intubation, HPleural Effusion +24 more

Rule out:VHPleural Effusion, SHMainstem Bronchus Intubation, SHPneumothorax +23 more

Rule in:SHPneumonia, IEChronic Obstructive Pulmonary Disease (COPD) Exacerbation, IEHeart Failure +5 more

Rule out:IEChronic Obstructive Pulmonary Disease (COPD) Exacerbation, IEHeart Failure, IEPeripheral Artery Disease +4 more

Rule in:SHPneumonia, IEHeart Failure, IEIncreased Intracranial Pressure +3 more

Rule out:MHPulmonary Embolism, IEHeart Failure, IEIncreased Intracranial Pressure +3 more

Pulmonary Fibrosis

Rule in:VHPneumothorax, HMainstem Bronchus Intubation, HPleural Effusion +24 more

Rule out:VHPleural Effusion, SHMainstem Bronchus Intubation, SHPneumothorax +23 more

Pulmonary Hypertension

Cardiac Auscultation

Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy with Obstruction +34 more

Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy with Obstruction, SHAortic Regurgitation +33 more

Rule in:VHHypovolemia, HHeart Failure, HRight Ventricular Infarction +8 more

Rule out:HRight Ventricular Infarction, SHHypovolemia, SHPulmonary Hypertension +8 more

Rule in:SHPulmonary Hypertension

Precordial Palpation

Rule out:NHPulmonary Hypertension

aka Parasternal heave; left parasternal lift

Right Ventricular Heave

Rule in:SHPulmonary Hypertension

Pulmonary Mass

Rule in:VHPneumothorax, HMainstem Bronchus Intubation, HPleural Effusion +24 more

Rule out:VHPleural Effusion, SHMainstem Bronchus Intubation, SHPneumothorax +23 more

Pulmonary Mass or Tumor

Rule in:HLarge Pleural Effusion, HPleural Effusion, SHLobar Pneumonia or Consolidation +10 more

Rule out:IEAtelectasis, IEBullous Emphysema, IECOPD with Hyperinflation +8 more

Pulmonic Regurgitation

Cardiac Auscultation

Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy with Obstruction +34 more

Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy with Obstruction, SHAortic Regurgitation +33 more

Pulmonic Stenosis

Cardiac Auscultation

Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy with Obstruction +34 more

Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy with Obstruction, SHAortic Regurgitation +33 more

Pyelonephritis

aka Murphy's punch sign; Pasternatsky sign; Goldflam sign

Rule in:MHCystitis (Lower Urinary Tract Infection), IEPerinephric Abscess, IEPyelonephritis +1 more

Rule out:MHNephrolithiasis, IEPerinephric Abscess, IEPyelonephritis +1 more

Pyloric Stenosis

Rule in:VHAbdominal Aortic Aneurysm, VHPyloric Stenosis, VHSigmoid Diverticulitis +29 more

Rule out:SHCholecystitis, SHHepatomegaly, MHAbdominal Aortic Aneurysm +28 more

Renal Abscess

aka Murphy's punch sign; Pasternatsky sign; Goldflam sign

Rule in:MHCystitis (Lower Urinary Tract Infection), IEPerinephric Abscess, IEPyelonephritis +1 more

Rule out:MHNephrolithiasis, IEPerinephric Abscess, IEPyelonephritis +1 more

Retroperitoneal Hemorrhage

Rule in:VHBowel Obstruction, SHAscites, IEPortal Hypertension +1 more

Rule out:SHAscites, IEBowel Obstruction, IEPortal Hypertension +1 more

Rheumatoid Arthritis (Inflammatory Arthritis)

Rule in:IEDe Quervain Tenosynovitis, IEHand Osteoarthritis, IERheumatoid Arthritis (Inflammatory Arthritis)

Rule out:HScaphoid Fracture, IEDe Quervain Tenosynovitis, IEHand Osteoarthritis +1 more

Rib Fracture

Rule out:SHAcute Coronary Syndrome, NHRib Fracture

Chest Wall Palpation

Rule in:NHRib Fracture

Right Bundle Branch Block

Cardiac Auscultation

Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy with Obstruction +34 more

Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy with Obstruction, SHAortic Regurgitation +33 more

Right Heart Failure

Rule in:SHHeart Failure, IEConstrictive Pericarditis, IERight Heart Failure

Rule out:SHTricuspid Regurgitation, IEConstrictive Pericarditis, IERight Heart Failure

Right Ventricular Infarction

Rule in:VHHypovolemia, HHeart Failure, HRight Ventricular Infarction +8 more

Rule out:HRight Ventricular Infarction, SHHypovolemia, SHPulmonary Hypertension +8 more

Right-sided Valvular Lesion

Cardiac Auscultation

Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy with Obstruction +34 more

Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy with Obstruction, SHAortic Regurgitation +33 more

S1 Radiculopathy

Rule in:VHPeripheral Neuropathy, HUpper Motor Neuron Lesion, SHHypothyroidism +5 more

Rule out:VHPeripheral Neuropathy, SHUpper Motor Neuron Lesion, NHS1 Radiculopathy +4 more

Scaphoid Fracture

Rule in:IEDe Quervain Tenosynovitis, IEHand Osteoarthritis, IERheumatoid Arthritis (Inflammatory Arthritis)

Rule out:HScaphoid Fracture, IEDe Quervain Tenosynovitis, IEHand Osteoarthritis +1 more

Sciatic Nerve Injury

Rule in:VHPeripheral Neuropathy, HUpper Motor Neuron Lesion, SHHypothyroidism +5 more

Rule out:VHPeripheral Neuropathy, SHUpper Motor Neuron Lesion, NHS1 Radiculopathy +4 more

Sensory Ataxia (Posterior Column Dysfunction)

Rule in:IECerebellar Disease, IEMultiple Sclerosis, IESensory Ataxia (Posterior Column Dysfunction)

Heel-to-shin

aka Heel-knee-shin test

Rule out:IECerebellar Disease, IEMultiple Sclerosis, IESensory Ataxia (Posterior Column Dysfunction)

Rule in:IESensory Ataxia (Posterior Column Dysfunction), IETabes Dorsalis, IEVestibular Dysfunction (Uncompensated) +1 more

Rule out:IESensory Ataxia (Posterior Column Dysfunction), IETabes Dorsalis, IEVestibular Dysfunction (Uncompensated) +1 more

Sepsis

Rule in:HHypovolemia, SHDehydration in Pediatric Patient, MHModerate-to-severe Peripheral Artery Disease +4 more

Rule out:MHDehydration in Pediatric Patient, MHHypovolemia, MHShock +3 more

Rule in:HAtrial Fibrillation, SHHypothyroidism, SHPneumonia +7 more

Rule out:VHAtrial Fibrillation, MHAdverse Short-term Outcome in Confirmed Pulmonary Embolism, IECardiac Tamponade +5 more

Rule in:SHPneumonia, IEHeart Failure, IEIncreased Intracranial Pressure +3 more

Rule out:MHPulmonary Embolism, IEHeart Failure, IEIncreased Intracranial Pressure +3 more

Rule in:SHPneumonia, IEInfective Endocarditis, IESepsis +1 more

Rule out:MHAppendicitis (Pediatric), MHPneumonia, IEInfective Endocarditis +2 more

Septic Shock

Rule in:SHPneumonia, IEChronic Obstructive Pulmonary Disease (COPD) Exacerbation, IEHeart Failure +5 more

Rule out:IEChronic Obstructive Pulmonary Disease (COPD) Exacerbation, IEHeart Failure, IEPeripheral Artery Disease +4 more

Septic Shock (Severity Stratum Within Established Sepsis)

Rule in:VHAortic Regurgitation, VHVolume Depletion From Significant Blood Loss, HAcute Aortic Dissection +11 more

Rule out:VHVolume Depletion From Significant Blood Loss, HLow-output State (Low Cardiac Index) Within Established Chronic Heart Failure, SHAcute Aortic Dissection +10 more

Severe Anemia

Rule in:VHAortic Regurgitation, VHVolume Depletion From Significant Blood Loss, HAcute Aortic Dissection +11 more

Rule out:VHVolume Depletion From Significant Blood Loss, HLow-output State (Low Cardiac Index) Within Established Chronic Heart Failure, SHAcute Aortic Dissection +10 more

Rule in:HAtrial Fibrillation, SHHypothyroidism, SHPneumonia +7 more

Rule out:VHAtrial Fibrillation, MHAdverse Short-term Outcome in Confirmed Pulmonary Embolism, IECardiac Tamponade +5 more

Severe Aortic or Mitral Regurgitation

Rule in:VHLeft Ventricular Dilation, HLeft Ventricular Hypertrophy, SHCardiomegaly +7 more

Rule out:VHLeft Ventricular Dilation, SHLeft Ventricular Hypertrophy, MHCardiomegaly +7 more

Severe Aortic Regurgitation

Cardiac Auscultation

Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy with Obstruction +34 more

Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy with Obstruction, SHAortic Regurgitation +33 more

Severe Asthma Exacerbation

Rule in:HLarge Pleural Effusion, HPleural Effusion, SHLobar Pneumonia or Consolidation +10 more

Rule out:IEAtelectasis, IEBullous Emphysema, IECOPD with Hyperinflation +8 more

Rule in:SHPneumonia, IEChronic Obstructive Pulmonary Disease (COPD) Exacerbation, IEHeart Failure +5 more

Rule out:IEChronic Obstructive Pulmonary Disease (COPD) Exacerbation, IEHeart Failure, IEPeripheral Artery Disease +4 more

Rule in:SHCardiac Tamponade, SHSevere Asthma Exacerbation, IECOPD Exacerbation +2 more

Rule out:VHCardiac Tamponade, SHSevere Asthma Exacerbation, IECOPD Exacerbation +2 more

Severe COPD

Rule in:HLarge Pleural Effusion, HPleural Effusion, SHLobar Pneumonia or Consolidation +10 more

Rule out:IEAtelectasis, IEBullous Emphysema, IECOPD with Hyperinflation +8 more

Severe Hypoalbuminemia

Rule in:SHCirrhosis, SHHeart Failure, NHDeep Vein Thrombosis +11 more

Rule out:MHHeart Failure, NHDeep Vein Thrombosis, IEBaker Cyst Rupture +10 more

Severe Left Ventricular Dysfunction

Cardiac Auscultation

Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy with Obstruction +34 more

Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy with Obstruction, SHAortic Regurgitation +33 more

Rule in:HAortic Stenosis, HTakayasu Arteritis, SHAortic Dissection +7 more

Rule out:SHAortic Stenosis, IEAortic Regurgitation, IECarotid Artery Stenosis +5 more

Severe Metabolic Acidosis (Any Cause — Diabetic Ketoacidosis, Alcoholic Ketoacidosis, Lactic Acidosis, Salicylate Toxicity, Uremic Acidosis)

Rule in:SHPneumonia, IEHeart Failure, IEIncreased Intracranial Pressure +3 more

Rule out:MHPulmonary Embolism, IEHeart Failure, IEIncreased Intracranial Pressure +3 more

Severe Tricuspid Regurgitation

Rule in:VHHypovolemia, HHeart Failure, HRight Ventricular Infarction +8 more

Rule out:HRight Ventricular Infarction, SHHypovolemia, SHPulmonary Hypertension +8 more

Shock

Rule in:HHypovolemia, SHDehydration in Pediatric Patient, MHModerate-to-severe Peripheral Artery Disease +4 more

Rule out:MHDehydration in Pediatric Patient, MHHypovolemia, MHShock +3 more

Sigmoid Diverticulitis

Rule in:VHAbdominal Aortic Aneurysm, VHPyloric Stenosis, VHSigmoid Diverticulitis +29 more

Rule out:SHCholecystitis, SHHepatomegaly, MHAbdominal Aortic Aneurysm +28 more

Spinal Cord Disease

Rule in:IEAcute Neurologic Event or Severe Pain, IEAlcohol-related Cerebellar Degeneration, IEBilateral Hip Arthritis or Disease +20 more

Rule out:IEAcute Neurologic Event or Severe Pain, IEAlcohol-related Cerebellar Degeneration, IEBilateral Hip Arthritis or Disease +20 more

Spinal Cord Lesion

Rule in:VHUpper Motor Neuron Lesion, IEMotor Neuron Disease (ALS), IEMultiple Sclerosis +2 more

Rule out:SHUpper Motor Neuron Lesion, IEMotor Neuron Disease (ALS), IEMultiple Sclerosis +2 more

Spinal Cord Lesion Above L3

Rule in:VHPeripheral Neuropathy, HUpper Motor Neuron Lesion, SHL3-L4 Radiculopathy +4 more

Rule out:SHPeripheral Neuropathy, SHUpper Motor Neuron Lesion, IEFemoral Nerve Injury +3 more

Spinal Cord Lesion Above S1

Rule in:VHPeripheral Neuropathy, HUpper Motor Neuron Lesion, SHHypothyroidism +5 more

Rule out:VHPeripheral Neuropathy, SHUpper Motor Neuron Lesion, NHS1 Radiculopathy +4 more

Splenic Abscess

Rule in:SHCirrhosis, SHInfectious Mononucleosis, IEChronic Myeloid Leukemia +10 more

Rule out:MHInfectious Mononucleosis, IEChronic Myeloid Leukemia, IECirrhosis with Portal Hypertension +9 more

Splenic Infarction

Rule in:SHCirrhosis, SHInfectious Mononucleosis, IEChronic Myeloid Leukemia +10 more

Rule out:MHInfectious Mononucleosis, IEChronic Myeloid Leukemia, IECirrhosis with Portal Hypertension +9 more

Splenic Infarction or Rupture

Rule in:VHAbdominal Aortic Aneurysm, VHPyloric Stenosis, VHSigmoid Diverticulitis +29 more

Rule out:SHCholecystitis, SHHepatomegaly, MHAbdominal Aortic Aneurysm +28 more

Splenomegaly

Rule in:SHCirrhosis, SHInfectious Mononucleosis, IEChronic Myeloid Leukemia +10 more

Rule out:MHInfectious Mononucleosis, IEChronic Myeloid Leukemia, IECirrhosis with Portal Hypertension +9 more

Stroke

Rule in:VHUpper Motor Neuron Lesion, IEMotor Neuron Disease (ALS), IEMultiple Sclerosis +2 more

Rule out:SHUpper Motor Neuron Lesion, IEMotor Neuron Disease (ALS), IEMultiple Sclerosis +2 more

Rule in:IEAcute Neurologic Event or Severe Pain, IEAlcohol-related Cerebellar Degeneration, IEBilateral Hip Arthritis or Disease +20 more

Rule out:IEAcute Neurologic Event or Severe Pain, IEAlcohol-related Cerebellar Degeneration, IEBilateral Hip Arthritis or Disease +20 more

Rule in:VHBrain Tumor, HStroke, NHUpper Motor Neuron Lesion +1 more

Rule out:VHStroke, MHBrain Tumor, NHUpper Motor Neuron Lesion +1 more

Subarachnoid Hemorrhage

Rule in:VHGlaucoma, SHDiabetic Retinopathy, MHIncreased Intracranial Pressure +13 more

Rule out:SHGlaucoma, MHDiabetic Retinopathy, MHIncreased Intracranial Pressure +13 more

Subclavian Artery Stenosis

Rule in:VHAortic Regurgitation, VHVolume Depletion From Significant Blood Loss, HAcute Aortic Dissection +11 more

Rule out:VHVolume Depletion From Significant Blood Loss, HLow-output State (Low Cardiac Index) Within Established Chronic Heart Failure, SHAcute Aortic Dissection +10 more

Systemic Sclerosis

Rule in:SHCrohn Disease, SHLung Cancer, SHUlcerative Colitis +2 more

Rule out:IEIron-deficiency Anemia, IESystemic Sclerosis

Tabes Dorsalis

Rule in:IESensory Ataxia (Posterior Column Dysfunction), IETabes Dorsalis, IEVestibular Dysfunction (Uncompensated) +1 more

Rule out:IESensory Ataxia (Posterior Column Dysfunction), IETabes Dorsalis, IEVestibular Dysfunction (Uncompensated) +1 more

Takayasu Arteritis

Rule in:HAortic Stenosis, HTakayasu Arteritis, SHAortic Dissection +7 more

Rule out:SHAortic Stenosis, IEAortic Regurgitation, IECarotid Artery Stenosis +5 more

Tension Pneumothorax

Rule in:SHPneumonia, IEChronic Obstructive Pulmonary Disease (COPD) Exacerbation, IEHeart Failure +5 more

Rule out:IEChronic Obstructive Pulmonary Disease (COPD) Exacerbation, IEHeart Failure, IEPeripheral Artery Disease +4 more

Rule in:SHCardiac Tamponade, SHSevere Asthma Exacerbation, IECOPD Exacerbation +2 more

Rule out:VHCardiac Tamponade, SHSevere Asthma Exacerbation, IECOPD Exacerbation +2 more

Thyroid Eye Disease (Graves Orbitopathy)

Rule in:SHAnemia, IEDyslipidemia (Hyperlipidemia), IEHorner Syndrome +4 more

Rule out:MHAnemia, IEDyslipidemia (Hyperlipidemia), IEHorner Syndrome +4 more

Thyroid Nodule

Rule in:SHGoiter (Thyroid Enlargement), NHThyroid Nodule

Thyroid Inspection

Rule out:SHGoiter (Thyroid Enlargement), NHThyroid Nodule

Thyroid Storm (Thyrotoxic Crisis)

Rule in:SHPneumonia, IEInfective Endocarditis, IESepsis +1 more

Rule out:MHAppendicitis (Pediatric), MHPneumonia, IEInfective Endocarditis +2 more

Tricuspid Regurgitation

Rule in:SHHeart Failure, IEConstrictive Pericarditis, IERight Heart Failure

Rule out:SHTricuspid Regurgitation, IEConstrictive Pericarditis, IERight Heart Failure

Cardiac Auscultation

Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy with Obstruction +34 more

Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy with Obstruction, SHAortic Regurgitation +33 more

Rule in:SHCirrhosis, IEAcute Hepatitis, IECongestive Hepatopathy +6 more

Rule out:SHCirrhosis, IEAcute Hepatitis, IECongestive Hepatopathy +6 more

Tricuspid Stenosis

Cardiac Auscultation

Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy with Obstruction +34 more

Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy with Obstruction, SHAortic Regurgitation +33 more

Tuberculosis or Sarcoidosis

Rule in:VHGlaucoma, SHDiabetic Retinopathy, MHIncreased Intracranial Pressure +13 more

Rule out:SHGlaucoma, MHDiabetic Retinopathy, MHIncreased Intracranial Pressure +13 more

Ulcerative Colitis

Rule in:SHCrohn Disease, SHLung Cancer, SHUlcerative Colitis +2 more

Rule out:IEIron-deficiency Anemia, IESystemic Sclerosis

Unilateral Cerebellar Lesion

Rule in:IECerebellar Disease, IEMultiple Sclerosis, IEUnilateral Cerebellar Lesion

Finger-to-nose

Rule out:IECerebellar Disease, IEMultiple Sclerosis, IEUnilateral Cerebellar Lesion

Unilateral Pulmonary Process (Consolidation, Effusion, Pneumothorax, or Atelectasis)

Rule in:HLarge Pleural Effusion, HPleural Effusion, SHLobar Pneumonia or Consolidation +10 more

Rule out:IEAtelectasis, IEBullous Emphysema, IECOPD with Hyperinflation +8 more

Rule in:VHPneumothorax, HMainstem Bronchus Intubation, HPleural Effusion +24 more

Rule out:VHPleural Effusion, SHMainstem Bronchus Intubation, SHPneumothorax +23 more

Rule in:HPleural Effusion, IEAtelectasis with Airway Obstruction, IECOPD with Hyperinflation +3 more

Rule out:SHPleural Effusion, IEAtelectasis with Airway Obstruction, IECOPD with Hyperinflation +3 more

Upper Airway Obstruction

Rule in:VHPneumothorax, HMainstem Bronchus Intubation, HPleural Effusion +24 more

Rule out:VHPleural Effusion, SHMainstem Bronchus Intubation, SHPneumothorax +23 more

Upper Lumbar Radiculopathy (L2-L4) or Femoral Neuropathy

Rule in:VHGluteal Tendinopathy (Greater Trochanteric Pain Syndrome), IEAdductor-related Groin Pain, IEIdiopathic Inflammatory Myopathy (Polymyositis or Dermatomyositis) +1 more

Rule out:HGluteal Tendinopathy (Greater Trochanteric Pain Syndrome), IEAdductor-related Groin Pain, IEIdiopathic Inflammatory Myopathy (Polymyositis or Dermatomyositis) +1 more

Upper Motor Neuron Lesion

Rule in:VHPeripheral Neuropathy, HUpper Motor Neuron Lesion, SHHypothyroidism +5 more

Rule out:VHPeripheral Neuropathy, SHUpper Motor Neuron Lesion, NHS1 Radiculopathy +4 more

Rule in:VHUpper Motor Neuron Lesion, IEMotor Neuron Disease (ALS), IEMultiple Sclerosis +2 more

Rule out:SHUpper Motor Neuron Lesion, IEMotor Neuron Disease (ALS), IEMultiple Sclerosis +2 more

Rule in:VHPeripheral Neuropathy, HUpper Motor Neuron Lesion, SHL3-L4 Radiculopathy +4 more

Rule out:SHPeripheral Neuropathy, SHUpper Motor Neuron Lesion, IEFemoral Nerve Injury +3 more

Rule in:VHBrain Tumor, HStroke, NHUpper Motor Neuron Lesion +1 more

Rule out:VHStroke, MHBrain Tumor, NHUpper Motor Neuron Lesion +1 more

Uremic Pericarditis

Cardiac Auscultation

Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy with Obstruction +34 more

Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy with Obstruction, SHAortic Regurgitation +33 more

Urinary Retention

Rule in:NHHepatomegaly, IEPerforated Viscus, IEUrinary Retention

Abdomen Percussion

Rule out:NHHepatomegaly, IEPerforated Viscus, IEUrinary Retention

Vascular Parkinsonism

Rule in:IEAcute Neurologic Event or Severe Pain, IEAlcohol-related Cerebellar Degeneration, IEBilateral Hip Arthritis or Disease +20 more

Rule out:IEAcute Neurologic Event or Severe Pain, IEAlcohol-related Cerebellar Degeneration, IEBilateral Hip Arthritis or Disease +20 more

Ventricular Septal Defect

Cardiac Auscultation

Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy with Obstruction +34 more

Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy with Obstruction, SHAortic Regurgitation +33 more

Vestibular Dysfunction

Rule in:SHVestibular Dysfunction, IEAlcohol Intoxication, IECerebellar Disease +2 more

Rule out:SHVestibular Dysfunction, IEAlcohol Intoxication, IECerebellar Disease +2 more

Vestibular Dysfunction (Uncompensated)

Rule in:IESensory Ataxia (Posterior Column Dysfunction), IETabes Dorsalis, IEVestibular Dysfunction (Uncompensated) +1 more

Rule out:IESensory Ataxia (Posterior Column Dysfunction), IETabes Dorsalis, IEVestibular Dysfunction (Uncompensated) +1 more

Vestibular Migraine

aka Near point of convergence (NPC) test

Convergence

Rule in:SHProlonged Recovery After Sport-related Concussion (Prognostic), IEConvergence Insufficiency

Rule out:VHVestibular Migraine, SHProlonged Recovery After Sport-related Concussion (Prognostic), IEConvergence Insufficiency

Visceral Leishmaniasis

Rule in:SHCirrhosis, SHInfectious Mononucleosis, IEChronic Myeloid Leukemia +10 more

Rule out:MHInfectious Mononucleosis, IEChronic Myeloid Leukemia, IECirrhosis with Portal Hypertension +9 more

Vitamin B12 Deficiency

Rule in:IESensory Ataxia (Posterior Column Dysfunction), IETabes Dorsalis, IEVestibular Dysfunction (Uncompensated) +1 more

Rule out:IESensory Ataxia (Posterior Column Dysfunction), IETabes Dorsalis, IEVestibular Dysfunction (Uncompensated) +1 more

Vitamin B12 Deficiency (Sensory Ataxia)

Rule in:IEAcute Neurologic Event or Severe Pain, IEAlcohol-related Cerebellar Degeneration, IEBilateral Hip Arthritis or Disease +20 more

Rule out:IEAcute Neurologic Event or Severe Pain, IEAlcohol-related Cerebellar Degeneration, IEBilateral Hip Arthritis or Disease +20 more

Volume Depletion From Significant Blood Loss

Rule in:VHAortic Regurgitation, VHVolume Depletion From Significant Blood Loss, HAcute Aortic Dissection +11 more

Rule out:VHVolume Depletion From Significant Blood Loss, HLow-output State (Low Cardiac Index) Within Established Chronic Heart Failure, SHAcute Aortic Dissection +10 more

Volume Overload

Cardiac Auscultation

Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy with Obstruction +34 more

Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy with Obstruction, SHAortic Regurgitation +33 more

Rule in:VHHypovolemia, HHeart Failure, HRight Ventricular Infarction +8 more

Rule out:HRight Ventricular Infarction, SHHypovolemia, SHPulmonary Hypertension +8 more

Wilson Disease