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    The Rational Clinical Examination

    Explore JAMA's groundbreaking series on evidence-based use of the medical history, physical examination, and testing to diagnosis disease.

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    • Does This Patient With Acute Infectious Conjunctivitis Have a Bacterial Infection? The Rational Clinical Examination Systematic Review
      JAMA
      Review
      June 14, 2022

      This systematic review assesses the relative prevalence of viral vs bacterial conjunctivitis in adults and children and evaluates which symptoms or signs are suggestive of a viral vs bacterial etiology.

      External Eye Disease Pediatrics Ophthalmology
      Full Text | pdf link PDF | CME & MOC is active quiz
    • Does This Adult Patient Have Hypertension? The Rational Clinical Examination Systematic Review
      JAMA
      Review
      July 27, 2021

      This Rational Clinical Examination systematic review summarizes studies that examined the accuracy of current methods of blood pressure measurement, including home and office monitoring, compared with ambulatory blood pressure monitoring as the reference standard for diagnosing hypertension in patients not receiving treatment for hypertension.

      Cardiology Hypertension Cardiovascular Risk Factors
      Full Text | pdf link PDF | CME & MOC is active quiz has multimedia
    • Does This Patient Have Hip Osteoarthritis? The Rational Clinical Examination Systematic Review
      JAMA
      Review
      December 17, 2019

      This Rational Clinical Examination systematic review characterizes the accuracy of clinical and x-ray findings associated with hip osteoarthritis.

      Geriatrics Orthopedics Osteoarthritis Rheumatology
      Full Text | pdf link PDF | CME & MOC is active quiz has multimedia with quiz
    • Did This Patient Have Cardiac Syncope? The Rational Clinical Examination Systematic Review
      JAMA
      Review
      June 25, 2019

      This Rational Clinical Examination systematic review summarizes the accuracy of the clinical examination and electrocardiogram for distinguishing patients with vs without cardiac causes of syncope.

      Emergency Medicine Neurology Rhythm Disorders Cardiology
      Full Text | pdf link PDF has multimedia with quiz
    • Will This Patient Be Difficult to Intubate? The Rational Clinical Examination Systematic Review
      JAMA
      Review
      February 5, 2019

      This Rational Clinical Examination systematic review characterizes the accuracy of clinical features and bedside tests for predicting difficult endotracheal intubation.

      Critical Care Medicine Respiratory Failure and Ventilation Resuscitation Anesthesiology Emergency Medicine
      Full Text | pdf link PDF has multimedia
    • Will This Hospitalized Patient Develop Severe Alcohol Withdrawal Syndrome? The Rational Clinical Examination Systematic Review
      JAMA
      Review
      August 28, 2018

      This Rational Clinical Examination systematic review summarizes the accuracy of risk factors, symptoms and signs, and survey instruments for predicting delirium tremens, withdrawal seizures, and clinical severe alcohol withdrawal in hospitalized patients with a history of alcohol use.

      Addiction Medicine Alcohol Psychiatry and Behavioral Health
      Full Text | pdf link PDF has multimedia with quiz
    • Does This Patient Have Acute Mountain Sickness? The Rational Clinical Examination Systematic Review
      JAMA
      Review
      November 14, 2017

      This Rational Clinical Examination systematic review summarizes the accuracy of available scoring instruments for diagnosing acute mountain sickness.

      Neurology Pulmonary Medicine Environmental Health
      Full Text | pdf link PDF has multimedia
    • Does This Child Have Pneumonia? The Rational Clinical Examination Systematic Review
      JAMA
      Review
      August 1, 2017

      This systematic review analyzes 23 cohort studies to assess the accuracy of individual symptoms and physical examination findings for the diagnosis of radiographic pneumonia in children.

      Pediatrics Pneumonia Pulmonary Medicine Infectious Diseases Emergency Medicine
      Full Text | pdf link PDF has multimedia
    • Will This Hemodynamically Unstable Patient Respond to a Bolus of Intravenous Fluids?
      JAMA
      Review
      September 27, 2016

      This Rational Clinical Examination systematic review summarizes studies that evaluated the diagnostic accuracy of tests for predicting fluid responsiveness in hemodynamically unstable adult patients to better identify patients who would benefit from further fluid administration.

      Acid Base, Electrolytes, Fluids Emergency Medicine Sepsis Surgery Critical Care Medicine
      Full Text | pdf link PDF has multimedia with quiz
    • Does This Patient Have Infectious Mononucleosis? The Rational Clinical Examination Systematic Review
      JAMA
      Review
      April 12, 2016

      This Rational Clinical Examination systematic review summarizes the diagnostic accuracy of physical examination and laboratory findings for diagnosing infectious mononucleosis in adolescent and young adults.

      Pathology and Laboratory Medicine Adolescent Medicine Pediatrics
      Full Text | pdf link PDF has multimedia with quiz
    • Will Neuroimaging Reveal a Severe Intracranial Injury in This Adult With Minor Head Trauma? The Rational Clinical Examination Systematic Review
      JAMA
      Review
      December 22, 2015

      This Rational Clinical Examination systematic review summarizes the accuracy of symptoms and signs for revealing severe intracranial injury in adults with minor head trauma.

      Neurology Radiology Neuroimaging Traumatic Brain Injury Trauma and Injury
      Full Text | pdf link PDF has multimedia with quiz
    • Does This Patient With Chest Pain Have Acute Coronary Syndrome? The Rational Clinical Examination Systematic Review
      JAMA
      Review
      November 10, 2015

      This Rational Clinical Examination examines the accuracy of initial history, physical examination, electrocardiogram, and risk scores combined with the first cardiac-specific troponin for diagnosing acute coronary syndrome in the emergency department.

      Cardiology Emergency Medicine Ischemic Heart Disease Acute Coronary Syndromes
      Full Text | pdf link PDF has multimedia with quiz
    • Does This Patient Have Posttraumatic Stress Disorder? Rational Clinical Examination Systematic Review
      JAMA
      Review
      August 4, 2015

      This Rational Clinical Examination Systematic Review examines the utility of self-report screening instruments for posttraumatic stress disorder among primary care and high-risk populations.

      Psychiatry and Behavioral Health Trauma- and Stressor-Related Psychiatric Disorders
      Full Text | pdf link PDF
    • Does This Man With Lower Urinary Tract Symptoms Have Bladder Outlet Obstruction? The Rational Clinical Examination: A Systematic Review
      JAMA
      Review
      August 6, 2014

      D’Silva and coauthors assess the diagnostic accuracy of symptoms, questionnaires, and studies in the diagnosis of bladder outlet obstruction.

      Urology
      Full Text | pdf link PDF
    • Does This Adult Patient Have Early HIV Infection? The Rational Clinical Examination Systematic Review
      JAMA
      Review
      July 16, 2014

      Wood and colleagues assessed the accuracy of symptoms and signs of early HIV infection in an analysis of data from 16 studies (24 745 adult patients). They found that genital ulcers, weight loss, vomiting, and swollen lymph nodes were associated with early HIV infection; however, these findings had limited utility to detect or rule out HIV infection.

      HIV Infectious Diseases Allergy and Clinical Immunology
      Full Text | pdf link PDF
    • Does This Patient Have Generalized Anxiety or Panic Disorder? The Rational Clinical Examination Systematic Review
      JAMA
      Review
      July 2, 2014

      In this The Rational Clinical Examination article, Herr and colleagues discuss results of a literature search to evaluate self-report screening instruments to identify generalized anxiety disorder and panic disorder.

      Research, Methods, Statistics Psychiatry and Behavioral Health Anxiety Disorders Depressive Disorders Psychiatric Nosology
      Full Text | pdf link PDF
    • Does This Patient Have an Exudative Pleural Effusion? The Rational Clinical Examination Systematic Review
      JAMA
      Review
      June 18, 2014

      To prevent complications when thoracentesis is performed to find the cause of pleural effusion, Wilcox and colleagues assessed randomized and observational studies of adults undergoing the procedure that examined diagnostic tests for differentiating exudates from transudates.

      Pathology and Laboratory Medicine Health Care Safety Pulmonary Medicine
      Full Text | pdf link PDF
    • Does This Patient With Shoulder Pain Have Rotator Cuff Disease? The Rational Clinical Examination Systematic Review
      JAMA
      Review
      August 28, 2013

      To identify the most accurate clinical examination findings for rotator cuff disease (RCD), Hermans and coauthors performed a meta-analysis of 28 relevant studies, extracting data for likelihood ratios of symptoms and signs of RCD or rotator cuff tear, compared with an acceptable reference standard.

      Trauma and Injury Pain Medicine Orthopedics Physical Activity Rheumatology
      Full Text | pdf link PDF has multimedia
    • Does This Patient Have Obstructive Sleep Apnea? The Rational Clinical Examination Systematic Review
      JAMA
      Review
      August 21, 2013

      To systematically review the accuracy of the clinical examination for diagnosing obstructive sleep apnea, Myers and coauthors searched the literature and drew conclusions from 42 studies that used nocturnal polysomnography as the reference standard.

      Sleep Medicine Obstructive Sleep Apnea Pulmonary Medicine Clinical Decision Support
      Full Text | pdf link PDF
    • Do Findings on Routine Examination Identify Patients at Risk for Primary Open-Angle Glaucoma? The Rational Clinical Examination Systematic Review
      JAMA
      Review
      May 15, 2013
      Because early diagnosis of glaucoma potentially prevents associated vision loss, Hollands and coauthors quantify the diagnostic accuracy of examination findings and relevant risk factors in identifying those with primary open-angle glaucoma in a Medline search of 41 population-based studies.
      Glaucoma Ophthalmology
      Full Text | pdf link PDF has multimedia
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