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The ClinDx blog surveys PubMed for recent studies that quantify the value of the medical history and physical examination.

Robert Badgett
21 posts

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  • August 18, 2011
  • 11:30 AM

Signs of cervical spinal cord compression

by Robert Badgett in ClinDx

Hyperreflexia of the knee and the Hoffman's reflex were the most sensitive findings in this uncontrolled, unblinded study.... Read more »

Chikuda H, Seichi A, Takeshita K, Shoda N, Ono T, Matsudaira K, Kawaguchi H, & Nakamura K. (2010) Correlation between pyramidal signs and the severity of cervical myelopathy. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 19(10), 1684-9. PMID: 20229121  

  • July 15, 2011
  • 01:14 PM

A “mini” Mini-Mental State Examination

by Robert Badgett in ClinDx

6 items taken from the Mini-Mental State Examination (MMSE) was 74% sensitive as compared to the full MMSE... Read more »

  • June 2, 2011
  • 02:16 PM

Clinical examination for peripheral arterial disease

by Robert Badgett in ClinDx

If both pulses on both feet are normal and there are no femoral bruits, there is a less than 10% chance of an ABI being abnormal in a study population with a prevalence of disease of 28%. ... Read more »

  • May 26, 2011
  • 11:27 AM

Carnett’s test for excluding intra-abdominal origens of abdominal tenderness

by Robert Badgett in ClinDx

130 consecutive outpatients with abdominal tenderness was examined by one of 8 blinded, generalist physicians with a mean of 7 years in practice. Results are in the Figure.... Read more »

Takada T, Ikusaka M, Ohira Y, Noda K, & Tsukamoto T. (2011) Diagnostic usefulness of Carnett's test in psychogenic abdominal pain. Internal medicine (Tokyo, Japan), 50(3), 213-7. PMID: 21297322  

  • February 10, 2011
  • 03:56 PM

Digiti quinti sign for hemiparesis

by Robert Badgett in ClinDx

The digiti quinti sign may be more sensitive than the pronator drift test.... Read more »

Maranhão ET, Maranhão-Filho P, Lima MA, & Vincent MB. (2010) Can clinical tests detect early signs of monohemispheric brain tumors?. Journal of neurologic physical therapy : JNPT, 34(3), 145-9. PMID: 20799429  

  • February 10, 2011
  • 02:16 PM

Distinguishing categories of shock

by Robert Badgett in ClinDx

The best findings were an estimation of the skin temperature (patient's hand cooler than the examiner's hand) and central venous pressure (>7 cm).... Read more »

Vazquez R, Gheorghe C, Kaufman D, & Manthous CA. (2010) Accuracy of bedside physical examination in distinguishing categories of shock: a pilot study. Journal of hospital medicine : an official publication of the Society of Hospital Medicine, 5(8), 471-4. PMID: 20945471  

  • January 14, 2011
  • 09:40 AM

Cervical neck rotation for headache diagnosis

by Robert Badgett in ClinDx

Patients with less than 30 degrees of cervical rotation during neck flexion were less likely to have migraine headaches and more likely to have cervicogenic headache.... Read more »

  • September 27, 2010
  • 12:44 PM

Diagnosing Gout

by Robert Badgett in ClinDx

Even if using the prediction rule developed in this study, physicians should consider aspirating most all joints with monoarthritis as value even in joints suggestive of gout had a one in 20 chance of an alternative diagnosis. Also, the label of gout may affect future decision making and life-long medications.... Read more »

Janssens HJ, Fransen J, van de Lisdonk EH, van Riel PL, van Weel C, & Janssen M. (2010) A diagnostic rule for acute gouty arthritis in primary care without joint fluid analysis. Archives of internal medicine, 170(13), 1120-6. PMID: 20625017  

  • April 27, 2010
  • 10:31 PM

Diagnostic accuracy of confrontation visual field tests

by Robert Badgett in ClinDx

If no tools to aid examination are available, finger comparison is the most sensitive test and finger counting is the more specific test. ... Read more »

Kerr NM, Chew SS, Eady EK, Gamble GD, & Danesh-Meyer HV. (2010) Diagnostic accuracy of confrontation visual field tests. Neurology, 74(15), 1184-90. PMID: 20385890  

  • March 2, 2010
  • 09:08 PM

Using the physical exam to direct chronic treatment of heart failure

by Robert Badgett in ClinDx

A randomized controlled trial of using NT-proBNP to guide treatment shows that targeting a clinical score also reduced mortality as compared to usual care and the reduction was similar to the use of the NT-proBNP.... Read more »

  • January 29, 2010
  • 10:00 AM

Predictive Value of Symptoms for Early Detection of Ovarian Cancer

by Robert Badgett in ClinDx

This study demonstrates a case of specialty societies prematurely promoting testing for their diseases. ... Read more »

Rossing, M., Wicklund, K., Cushing-Haugen, K., & Weiss, N. (2010) Predictive Value of Symptoms for Early Detection of Ovarian Cancer. JNCI Journal of the National Cancer Institute. DOI: 10.1093/jnci/djp500  

  • January 28, 2010
  • 11:09 AM

by Robert Badgett in ClinDx

Accuracy of physical examination in subacromial impingement syndrome
In this study of 55 patients, the authors studied five findings and concluded, “The cut point of 3 or more positive of 5 tests can confirm the diagnosis…, while less than 3 positive of 5 rules out.” If you look at the accuracies and the predictive values below, [...]... Read more »

  • November 21, 2009
  • 02:52 PM

Prediting cardiac arrhythmia among patients with palpitations.

by Robert Badgett in ClinDx

The authors of the systematic review conclude that cardiac arrhythmia is more likely when the patient has a history of heart disease or palpitations affected by sleeping or while at work.... Read more »

Thavendiranathan, P., Bagai, A., Khoo, C., Dorian, P., & Choudhry, N. (2009) Does This Patient With Palpitations Have a Cardiac Arrhythmia?. JAMA: The Journal of the American Medical Association, 302(19), 2135-2143. DOI: 10.1001/jama.2009.1673  

  • November 21, 2009
  • 02:44 PM

Predicting low cardiac index and central oxygenation

by Robert Badgett in ClinDx

The authors found that physical findings had good specificity in predicting low cardiac index (CI) and low central oxygenation; however, at the low prevalence of low CI in this study, even when all three physical findings were present, the positive predictive value was 40%.... Read more »

Grissom CK, Morris AH, Lanken PN, Ancukiewicz M, Orme JF Jr, Schoenfeld DA, Thompson BT, & National Institutes of Health/National Heart, Lung and Blood Institute Acute Respiratory Distress. (2009) Association of physical examination with pulmonary artery catheter parameters in acute lung injury. Critical care medicine, 37(10), 2720-6. PMID: 19885995  

  • October 19, 2009
  • 04:01 PM

Screening for dysphagia

by Robert Badgett in ClinDx

Dysphagia among stroke patients is suggested by the following test:

First check the patient for “swallowing complaints, abnormalities of voice quality, facial asymmetry, or either expressive or receptive aphasia.” If none is detected then go to step 2.
Have the patient drink 10 mL of water from a cup without a straw while seated upright [...]... Read more »

  • October 19, 2009
  • 03:41 PM

Screening for diabetic neuropathy

by Robert Badgett in ClinDx

The preferred locations for testing according to this systematic review are filled green in the image. As the independent addition of the monofilament to visually inspecting for deformities, pressure marks, cracked skin, infected nails, evidence of prior ulcers, and other findings is not clear in the major trial of screening (, it seems we [...]... Read more »

Feng Y, Schlösser FJ, & Sumpio BE. (2009) The Semmes Weinstein monofilament examination as a screening tool for diabetic peripheral neuropathy. Journal of vascular surgery : official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter, 50(3), 675. PMID: 19595541  

  • September 5, 2009
  • 05:25 PM

Checking postural hypotension in patients with syncope

by Robert Badgett in ClinDx

The authors report that in 2106 consecutive patients 65 years or older admitted for syncope, "Postural blood pressure (BP) recording, performed in only 38% of episodes, had the highest yield with respect to affecting diagnosis (18%-26%) or management (25%-30%) and determining etiology of the syncopal episode (15%-21%)...... Read more »

Mendu ML, McAvay G, Lampert R, Stoehr J, & Tinetti ME. (2009) Yield of diagnostic tests in evaluating syncopal episodes in older patients. Archives of internal medicine, 169(14), 1299-305. PMID: 19636031  

  • June 15, 2009
  • 03:10 AM

Diagnosing irritable bowel

by Robert Badgett in ClinDx

This comprehensive systematic review by the Rational Clinical Examination is very helpful after a few adjustments. First, the review allows source studies to place patients with symptoms of irritable bowel who are found to have diverticulosis or polyps into the category of underlying organic illness...... Read more »

  • June 13, 2009
  • 03:32 PM

Frequency of Acute Coronary Syndrome in Patients with Normal Electrocardiogram Performed during Presence or Absence of Chest Pain

by Robert Badgett in ClinDx

The authors details the findings of 387 consecutive patients with normal electrocardiograms admitted for a chief complaint of chest pain. The authors report that 17% (67/387) of patients had acute coronary syndrome ACS). However, the authors define ACS as...... Read more »

  • May 29, 2009
  • 01:15 AM

The diagnostic value of the history and physical examination for COPD

by Robert Badgett in ClinDx

Fam Pract. 2009 PMID: 19423699
I do not find this systematic review helpful. This review cautiously concludes "There is insufficient evidence to assess the value of history taking and physical examination for diagnosing COPD". This contrasts with the tangible conclusions of the Rational Clinical Examination. Juxtaposing these two reviews demonstrates how arbitrary evidence-based medicine can be in its acceptance of evidence.... Read more »

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