Fever

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

Abdominal Wall Pain

Rule in:SHAbdominal Wall Pain, SHPsychogenic Abdominal Pain, IEAcute Abdomen +2 more

Rule out:HPsychogenic Abdominal Pain, SHAbdominal Wall Pain, IEAcute Abdomen +2 more

Acute Abdomen

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

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

Rule in:SHAbdominal Wall Pain, SHPsychogenic Abdominal Pain, IEAcute Abdomen +2 more

Rule out:HPsychogenic Abdominal Pain, SHAbdominal Wall Pain, IEAcute Abdomen +2 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 Appendicitis

aka Cope's obturator test

Obturator Sign

Rule in:SHAcute Appendicitis

Acute Cholecystitis

POCUS

Rule in:VHAcute Cholecystitis

Gallbladder Ultrasound

Rule out:SHAcute Cholecystitis

Rule out:SHAcute Cholecystitis

Murphy Sign

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 Leukemia

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

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

Acute Mastoiditis (Child)

Rule in:VHAcute Otitis Media (Child), IEAcute Mastoiditis (Child), IEAcute Otitis Externa +1 more

Rule out:HAcute Otitis Media (Child), IEAcute Mastoiditis (Child), IEAcute Otitis Externa +1 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 Otitis Externa

Rule in:VHAcute Otitis Media (Child), IEAcute Mastoiditis (Child), IEAcute Otitis Externa +1 more

Rule out:HAcute Otitis Media (Child), IEAcute Mastoiditis (Child), IEAcute Otitis Externa +1 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 Otitis Media (Child)

Rule in:VHAcute Otitis Media (Child), IEAcute Mastoiditis (Child), IEAcute Otitis Externa +1 more

Rule out:HAcute Otitis Media (Child), IEAcute Mastoiditis (Child), IEAcute Otitis Externa +1 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 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

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

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

Anterior Cutaneous Nerve Entrapment Syndrome (ACNES)

Rule in:SHAbdominal Wall Pain, SHPsychogenic Abdominal Pain, IEAcute Abdomen +2 more

Rule out:HPsychogenic Abdominal Pain, SHAbdominal Wall Pain, IEAcute Abdomen +2 more

Anticholinergic Toxicity

Rule in:IEAnticholinergic Toxicity, IECholinergic Toxicity, IECranial Nerve III Palsy +7 more

Rule out:IEAnticholinergic Toxicity, IECholinergic Toxicity, IECranial Nerve III Palsy +7 more

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

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

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

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

McBurney Point Palpation

aka McBurney's sign

Rule in:IEAppendicitis

Rule out:IEAppendicitis

Rule in:SHAppendicitis, MHPeritonitis, IEDiverticulitis +1 more

Rule out:SHAppendicitis, SHPeritonitis, IEDiverticulitis +1 more

Rule in:SHAppendicitis, IERight-sided Peritoneal Irritation

Rovsing Sign

Rule out:IERight-sided Peritoneal Irritation

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

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

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

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

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

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

Cervical Spine Injury

C Spine and Neck Palpation

Rule in:IECervical Spine Injury, IEMalignant Cervical Lymphadenopathy (Metastasis or Lymphoma), IEMediastinal Shift (Tension Pneumothorax or Large Pleural Effusion)

Rule out:IECervical Spine Injury, IEMalignant Cervical Lymphadenopathy (Metastasis or Lymphoma), IEMediastinal Shift (Tension Pneumothorax or Large Pleural Effusion)

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

Cholesteatoma

Rule in:VHAcute Otitis Media (Child), IEAcute Mastoiditis (Child), IEAcute Otitis Externa +1 more

Rule out:HAcute Otitis Media (Child), IEAcute Mastoiditis (Child), IEAcute Otitis Externa +1 more

Cholinergic Toxicity

Rule in:IEAnticholinergic Toxicity, IECholinergic Toxicity, IECranial Nerve III Palsy +7 more

Rule out:IEAnticholinergic Toxicity, IECholinergic Toxicity, IECranial Nerve III Palsy +7 more

Chronic Hypertension

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

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

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, 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

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

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

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

Cranial Nerve III Palsy

Rule in:IEAnticholinergic Toxicity, IECholinergic Toxicity, IECranial Nerve III Palsy +7 more

Rule out:IEAnticholinergic Toxicity, IECholinergic Toxicity, IECranial Nerve III Palsy +7 more

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

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

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

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

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)

Diphtheria

Rule in:VHTonsillar Malignancy (Lymphoma or Carcinoma), SHStreptococcal Pharyngitis, IEDiphtheria +2 more

Rule out:SHTonsillar Malignancy (Lymphoma or Carcinoma), IEDiphtheria, IEPeritonsillar Abscess +1 more

Diverticular Abscess

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

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

Diverticulitis

Rule in:SHAppendicitis, MHPeritonitis, IEDiverticulitis +1 more

Rule out:SHAppendicitis, SHPeritonitis, IEDiverticulitis +1 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

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

Foreign Body Aspiration

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

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

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

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: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

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

Hepatitis

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

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

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

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

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

Hypothyroidism

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

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

Hypoxemia

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

Rule out:SHHypovolemia, MHMeasles, IEAcute Leukemia +10 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

Kawasaki Disease

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

Rule out:SHHypovolemia, MHMeasles, IEAcute Leukemia +10 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

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

Lung Cancer

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

Malignant Cervical Lymphadenopathy (Metastasis or Lymphoma)

C Spine and Neck Palpation

Rule in:IECervical Spine Injury, IEMalignant Cervical Lymphadenopathy (Metastasis or Lymphoma), IEMediastinal Shift (Tension Pneumothorax or Large Pleural Effusion)

Rule out:IECervical Spine Injury, IEMalignant Cervical Lymphadenopathy (Metastasis or Lymphoma), IEMediastinal Shift (Tension Pneumothorax or Large Pleural Effusion)

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

Measles

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

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

Mediastinal Shift (Tension Pneumothorax or Large Pleural Effusion)

C Spine and Neck Palpation

Rule in:IECervical Spine Injury, IEMalignant Cervical Lymphadenopathy (Metastasis or Lymphoma), IEMediastinal Shift (Tension Pneumothorax or Large Pleural Effusion)

Rule out:IECervical Spine Injury, IEMalignant Cervical Lymphadenopathy (Metastasis or Lymphoma), IEMediastinal Shift (Tension Pneumothorax or Large Pleural Effusion)

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

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

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

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

Neurosyphilis

Rule in:IEAnticholinergic Toxicity, IECholinergic Toxicity, IECranial Nerve III Palsy +7 more

Rule out:IEAnticholinergic Toxicity, IECholinergic Toxicity, IECranial Nerve III Palsy +7 more

Nutritional Deficiency

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

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

Opioid Intoxication

Rule in:IEAnticholinergic Toxicity, IECholinergic Toxicity, IECranial Nerve III Palsy +7 more

Rule out:IEAnticholinergic Toxicity, IECholinergic Toxicity, IECranial Nerve III Palsy +7 more

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

Optic Nerve Disease

Rule in:IEAnticholinergic Toxicity, IECholinergic Toxicity, IECranial Nerve III Palsy +7 more

Rule out:IEAnticholinergic Toxicity, IECholinergic Toxicity, IECranial Nerve III Palsy +7 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

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

Rule in:SHAppendicitis, MHPeritonitis, IEDiverticulitis +1 more

Rule out:SHAppendicitis, SHPeritonitis, IEDiverticulitis +1 more

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 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

Peritonitis

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

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

Rule in:SHAppendicitis, MHPeritonitis, IEDiverticulitis +1 more

Rule out:SHAppendicitis, SHPeritonitis, IEDiverticulitis +1 more

Peritonsillar Abscess

Rule in:VHTonsillar Malignancy (Lymphoma or Carcinoma), SHStreptococcal Pharyngitis, IEDiphtheria +2 more

Rule out:SHTonsillar Malignancy (Lymphoma or Carcinoma), IEDiphtheria, IEPeritonsillar Abscess +1 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

Pontine Stroke

Rule in:IEAnticholinergic Toxicity, IECholinergic Toxicity, IECranial Nerve III Palsy +7 more

Rule out:IEAnticholinergic Toxicity, IECholinergic Toxicity, IECranial Nerve III Palsy +7 more

Poor Neurologic Outcome After Cardiac Arrest

Rule in:IEAnticholinergic Toxicity, IECholinergic Toxicity, IECranial Nerve III Palsy +7 more

Rule out:IEAnticholinergic Toxicity, IECholinergic Toxicity, IECranial Nerve III Palsy +7 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

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

Psychogenic Abdominal Pain

Rule in:SHAbdominal Wall Pain, SHPsychogenic Abdominal Pain, IEAcute Abdomen +2 more

Rule out:HPsychogenic Abdominal Pain, SHAbdominal Wall Pain, IEAcute Abdomen +2 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: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

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

Rectus Sheath Hematoma

Rule in:SHAbdominal Wall Pain, SHPsychogenic Abdominal Pain, IEAcute Abdomen +2 more

Rule out:HPsychogenic Abdominal Pain, SHAbdominal Wall Pain, IEAcute Abdomen +2 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

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-sided Peritoneal Irritation

Rule in:SHAppendicitis, IERight-sided Peritoneal Irritation

Rovsing Sign

Rule out:IERight-sided Peritoneal Irritation

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

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 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

Severe Brain Injury

Rule in:IEAnticholinergic Toxicity, IECholinergic Toxicity, IECranial Nerve III Palsy +7 more

Rule out:IEAnticholinergic Toxicity, IECholinergic Toxicity, IECranial Nerve III Palsy +7 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 Traumatic Brain Injury / Poor Neurologic Outcome

Rule in:IEAnticholinergic Toxicity, IECholinergic Toxicity, IECranial Nerve III Palsy +7 more

Rule out:IEAnticholinergic Toxicity, IECholinergic Toxicity, IECranial Nerve III Palsy +7 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

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

Streptococcal Pharyngitis

Rule in:VHTonsillar Malignancy (Lymphoma or Carcinoma), SHStreptococcal Pharyngitis, IEDiphtheria +2 more

Rule out:SHTonsillar Malignancy (Lymphoma or Carcinoma), IEDiphtheria, IEPeritonsillar Abscess +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

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

Thyroid Storm (Thyrotoxic Crisis)

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

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

Tonsillar Malignancy (Lymphoma or Carcinoma)

Rule in:VHTonsillar Malignancy (Lymphoma or Carcinoma), SHStreptococcal Pharyngitis, IEDiphtheria +2 more

Rule out:SHTonsillar Malignancy (Lymphoma or Carcinoma), IEDiphtheria, IEPeritonsillar Abscess +1 more

Tricuspid 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

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

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

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

Vagus (CN X) Nerve Palsy

Rule in:VHTonsillar Malignancy (Lymphoma or Carcinoma), SHStreptococcal Pharyngitis, IEDiphtheria +2 more

Rule out:SHTonsillar Malignancy (Lymphoma or Carcinoma), IEDiphtheria, IEPeritonsillar Abscess +1 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

Vertebral Fracture or Spinal Malignancy

T L Spine and Back Palpation

Rule in:MHVertebral Fracture or Spinal Malignancy, IEVertebral Osteomyelitis or Spinal Epidural Abscess

Rule out:SHVertebral Fracture or Spinal Malignancy, IEVertebral Osteomyelitis or Spinal Epidural Abscess

Vertebral Osteomyelitis or Spinal Epidural Abscess

T L Spine and Back Palpation

Rule in:MHVertebral Fracture or Spinal Malignancy, IEVertebral Osteomyelitis or Spinal Epidural Abscess

Rule out:SHVertebral Fracture or Spinal Malignancy, IEVertebral Osteomyelitis or Spinal Epidural Abscess

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

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