The Rational Clinical Examination Journal of the American Medical Association David L. Simel, MD, MHS Section Editor Drummond Rennie, MD Deputy Editor, JAMA: Center for Health Services Research in Primary Care Durham VAMC (558/152), 508 Fulton St, Durham, NC 27705; Phone: 919-286-6936; Fax: 919-416-5836 E-mail: [email protected] Secretary: Kim Porter

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Sackett DL, Rennie D. The science of the art of the clinical examination [editorial; comment]. J Amer Med Assoc. 1992; 267(19):2650-2, May 20. JAMA PDF Rational Clinical Examination Introductory Editorial

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Sackett DL. Sackett DL and Rennie D, eds A primer on the precision and accuracy of the clinical examination. J Amer Med Assoc. 1992; 267(19):2638-44, May 20. JAMA PDF Primer

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Williams JW Jr., Simel DL. Sackett DL and Rennie D, eds Does this patient have ascites? How to divine fluid in the abdomen. J Amer Med Assoc. 1992; 267(19):2645-8, May 20. JAMA PDF Ascites

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Deyo RA, Rainville J, Kent DL. Sackett DL and Rennie D, eds What can the history and physical examination tell us about low back pain? [see comments]. J Amer Med Assoc. 268(6):760-5, 1992 Aug 12. JAMA PDF Back pain

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Anonymous. Sackett DL and Rennie D, eds Evidence-based medicine. A new approach to teaching the practice of medicine. Evidence-Based Medicine Working Group [see comments]. J Amer Med Assoc. 1992; 268(17):2420-5, Nov 4. JAMA PDF Evidence Based Medicine

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Stephenson BJ, Rowe BH, Haynes RB, Macharia WM, Leon G. Sackett DL and Rennie D, eds Is this patient taking the treatment as prescribed?. J Amer Med Assoc. 269(21):277981, 1993 Jun 2. JAMA PDF Medication Compliance

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Williams JW Jr., Simel DL. Sackett DL and Rennie D, eds Does this patient have sinusitis? Diagnosing acute sinusitis by history and physical examination [see comments]. J Amer Med Assoc. 1993; 270(10):1242-6, Sep 8. JAMA PDF Sinusitis

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Grover SA, Barkun AN, Sackett DL. Sackett DL and Rennie D, eds Does this patient have splenomegaly? [see comments]. J Amer Med Assoc. 1993; 270(18):2218-21, Nov 10. JAMA PDF Splenomegaly

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Sauve JS, Laupacis A, Ostbye T, Feagan B, Sackett DL. Sackett DL and Rennie D, eds Does this patient have a clinically important carotid bruit?. J Amer Med Assoc. 1993; 270(23):2843-5, Dec 15. JAMA PDF Carotid bruits

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Detsky AS, Smalley PS, Chang J. Simel DL and Rennie D, eds Is this patient malnourished?. J Amer Med Assoc. 1994; 271(1):54-8, Jan 5. JAMA PDF Malnourishment

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Froehling DA, Silverstein MD, Mohr DN, Beatty CW. Simel DL and Rennie D, eds Does this dizzy patient have a serious form of vertigo?. J Amer Med Assoc. 1994; 271(5):385-8, Feb 2. JAMA PDF Vertigo

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Goldstein LB, Matchar DB. Simel DL and Rennie D, eds Clinical assessment of stroke. J Amer Med Assoc. 1994; 271(14):1114-20, Apr 13. JAMA PDF Clinical assessment of stroke

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Naylor CD. Simel DL and Rennie D, eds Physical examination of the liver. J Amer Med Assoc. 1994; 271(23):1859-65, Jun 15. JAMA PDF Hepatomegaly

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Kitchens JM. Simel DL and Rennie D, eds Does this patient have an alcohol problem? J Amer Med Assoc. 1994; 272(22): 1782-1787, Dec 14. JAMA PDF Alcohol problems

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Holleman DR, Simel DL. Simel DL and Rennie D, eds Does the clinical examination predict airflow limitation? J Amer Med Assoc 1995; 273(4): 313-319, Jan 25. JAMA PDF Obstructive airways

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Siminoski K. Simel DL and Rennie D, eds Does this patient have a goiter? J Amer Med Assoc 1995; 273(10):813-817, Mar 8. JAMA PDF Goiter

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Reeves RA. Simel DL and Rennie D, eds. Does this patient have hypertension? J Amer Med Assoc 1995; 273(15): 1211-1218, Apr 19. JAMA PDF Hypertension

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Turnbull JM. Simel DL and Rennie D, eds. Abdominal bruits: is listening for abdominal bruits useful in the evaluation of hypertension? J Amer Med Assoc 1995; 274(16):12991301, Oct 25. JAMA PDF Abdominal bruits

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Cook DJ, Simel DL. Simel DL and Rennie D, eds. Does this patient have abnormal central venous pressure?. J Amer Med Assoc 1996; 275(8):630-634, Feb 28. JAMA PDF Central venous pressure.

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Wagner JM, McKinney WP, Carpenter JC. Simel DL and Rennie D, eds. Does this patient have appendicitis? J Amer Med Assoc 1996; 276(19):1589-1594 Nov 20. JAMA PDF Adult appendicitis [see letter “Likelihood ratios to determine ‘Does this patient have appendicitis?’: Comment and Clarification” in J Amer Med Assoc 1997; 278: 819-820]

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Etchells E, Bell C, Robb K. Simel DL and Rennie D, eds. Does this patient have an abnormal systolic murmur? J Amer Med Assoc. 1997; 277:564-571 Feb 19. JAMA PDF Systolic murmurs

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Simel DL and Rennie D. The Clinical Examination: An agenda to make it more rational. (Editorial) J Amer Med Assoc 1997; 277:572-574 Feb 19. JAMA PDF RCE Agenda Editorial

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Badgett RG, Lucey CR, Mulrow CD. Simel DL and Rennie D, eds. Can the clinical examination diagnose left sided heart failure in adults? J Amer Med Assoc 1997; 277: 1712-1713 June 4. JAMA PDF Congestive heart failure

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Bastian LA, Piscitelli JT. Simel DL and Rennie D, eds. Is this patient pregnant? Can you reliably rule in or rule out early pregnancy by clinical examination? J Amer Med Assoc 1997; 278: 586-591 Aug 20. JAMA PDF Early pregnancy

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Metlay JP, Kapoor WN, Fine MJ. Simel DL and Rennie D, eds. Does this patient have community-acquired pneumonia? Diagnosing pneumonia by history and physical examination. J Amer Med Assoc 1997; 278: 1440-1445 Nov 5. JAMA PDF Adult community acquired pneumonia

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Margolis P, Gadomski A. Simel DL and Rennie D, eds. Does this infant have pneumonia?. J Amer Med Assoc 1998; 279: 308-313 Jan 28. JAMA PDF Infant pneumonia

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Whited JD, Grichnik JM. Simel DL and Rennie D, eds. Does this patient have a mole or a melanoma?. J Amer Med Assoc 1998; 279: 696-701 Mar 4. JAMA PDF Mole or melanoma

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Anand SS, Wells PS, Hunt D, Brill-Edwards P, Cook D, Ginsberg JS. Simel DL and Rennie D, eds. Does this patient have deep vein thrombosis? J Amer Med Assoc 1998; 279:10941099 Apr 8. (Correction in J Amer Med Assoc 1998; 280: 328) JAMA PDF Deep venous thrombosis

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Panju AA, Hemmelgarn BR, Guyatt GH, Simel DL. Simel DL and Rennie D, eds. Is this patient having a myocardial infarction? J Amer Med Assoc. 1998;280:1256-1263 Oct 14..JAMA PDF Myocardial infarction

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Lederle FA, Simel DL. Simel DL and Rennie D, eds. Does this patient have an abdominal aortic aneurysm? J Amer Med Assoc. 1999;281:77-82 Jan 6.JAMA PDF Aortic aneurysm

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McGee S, Abernethy WB, Simel DL. Simel DL and Rennie D, eds. Is this patient hypovolemic? J Amer Med Assoc. 1999;281:1022-1029 Mar 17.JAMA PDF Hypovolemia

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Choudhry NK, Etchells EE. Simel DL and Rennie D, eds. Does this patient have aortic regurgitation? J Amer Med Assoc. 1999; 281:2231-2238 Jun 16. JAMA PDF Display Aortic regurgitation

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Attia J, Hatala R, Cook DJ, Wong JG. Simel DL and Rennie D, eds. Does this adult patient have acute meningitis? J Amer Med Assoc 1999; 282:175-181 July 14.JAMA PDF Display Meningitis

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Barton MB, Harris R, Fletcher SW. Simel DL and Rennie D, eds. Does this patient have breast cancer? The screening clinical breast examination: Should it be done? How? J Amer Med Assoc. 1999; 282:1270-1280 Oct 6. [see letters to the Editor “Clinical breast examination for detecting breast cancer” in J Amer Med Assoc 2000; 283: 1687-1689.] JAMA PDF display Breast examination

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D’Arcy CA, McGee S. Simel DL and Rennie D, eds. Does this patient have carpal tunnel syndrome? J Amer Med Assoc. 2000; 283:3110-3117 June 21. [see letters to the Editor “Clinical diagnosis of carpal tunnel syndrome” in J Amer Med Assoc 2000; 284: 19241926.] JAMA PDF Display Carpal tunnel [See also Hwang MY, Glass RM, Molter J. JAMA Patient Page Detecting Carpal Tunnel Syndrome. J Amer Med Assoc 1999;282:206, Jul 14 JAMA Patient Page Detecting carpal tunnel syndrome]

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Ebell MH, Smith MA, Barry HC, Ives K, Carey M. Simel DL and Rennie D, eds. Does this patient have strep throat? J Amer Med Assoc. 2000; 284:2912-2918 Dec 13. JAMA PDF Strep throat [See also Pace B, Glass RM. JAMA Patient Page. J Amer Med Assoc 2000; 284:29122918 Dec 13 JAMA Patient Page Strep Throat]

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Salkind AR, Cuddy PG, Foxworth JW. Simel DL and Rennie D, eds. Is this patient allergic to penicillin? An evidence-based analysis of the likelihood of penicillin allergy. J Amer Med Assoc. 2001; 285:2498-2505 May 16. [see letters to the Editor “How predictive is a history of penicillin allergy” in J Amer Med Assoc 2001; 286: 1174-1175.] JAMA PDF Penicillin allergy

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Myers KA, Farquhar DRE. Does this patient have clubbing? Simel DL and Rennie D, eds. J Amer Med Assoc. 2001; 286: 341-347 July 18.JAMA PDF Clubbing

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Solomon DH, Simel DL, Bates DW, Katz JN, Schaffer JL. D Simel DL and Rennie D, eds. Does this patient have a torn meniscus or ligament of the knee? J Amer Med Assoc. 2001; 286:1610-1620 Oct 3.JAMA PDF Knee injuries JAMA Interactive

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Smetana GW and Shmerling RH. Simel DL and Rennie D, eds. Does this patient have temporal arteritis? J Amer Med Assoc. 2002;287:92-101. Jan 2. JAMA PDF Temporal arteritis. (Letter in J Amer Med Asssoc 2002:287:1528-1529)

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Williams JW, Hitchcock PN, Cordes JA, Ramirez G, Pignone M. Simel DL and Rennie D, eds. Is this patient clinically depressed? J Amer Med Assoc 2002;287:1160-1170 Mar 6 JAMA PDF Depression

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Klompas M. Simel DL and Rennie D, eds. Does this patient have an acute thoracic aortic dissection? J Amer Med Assoc. 2002;287:2262-2272. May 1. JAMA PDF Thoracic Dissection

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Bent S, Nallamothu BK, Simel DL, Fihn SD, Saint S. Simel DL and Rennie D, eds. Does this woman have an acute uncomplicated urinary tract infection? J Amer Med Assoc. 2002:287:2701-2710 May 22/29. JAMA PDF Uncomplicated UTI in women. [see letters in J Amer Med Assoc 2002: 288:1129-1231]

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Trowbridge RL, Rutkowski NK, Shojania KG. Simel DL and Rennie D, eds. Does this patient have acute cholecystitis? ? J Amer Med Assoc 2003;289:80-86, Jan 1. JAMA PDF Acute Cholecystitis. [See also Parmet S, Lynm C, Glass RM. JAMA Patient Page Acute Cholecystitis. J Amer Med Assoc 2003;289:124, Jan 1 JAMA Patient Page Acute Cholecystitis]

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Rao G, Fisch L, Srinivasan S, D’Amico F, Okada T, Eaton C, Robbins C. Simel DL and Rennie D, eds. Does this patient have Parkinson’s disease? J Amer Med Assoc. 2003;289:347-353, Jan 15. JAMA PDF Parkinson's Disease

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Bastian LA, Smith CM, Nanda K. Simel DL and Rennie D, eds. Is this woman perimenopausal? J Amer Med Assoc. 2003;289:895-902, Feb 19. JAMA PDF Menopause. JAMA Patient Page Menopause

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Rothman R, Owens T, Simel DL. Simel DL and Rennie D, eds. Does This Child Have Acute Otitis Media? J Amer Med Assoc. 2003;290:1633-1640, Sept 24. JAMA PDF Otitis Media. JAMA Patient Page Otitis Media

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Chunilal SD, Eikelboom JW, Attia J, Miniati M, Panju AA, Simel DL, Ginsberg JS. Simel DL and Rennie D, eds. Does This Patient Have Pulmonary Embolism? J Amer Med Assoc. 2003;290:2849-2858, Dec 3. JAMA PDF Pulmonary embolism JAMA Patient Page Pulmonary Embolism

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Booth CM, Boone RH, Tomlinson G, Detsky AS. Simel DL and Rennie D, eds. Is This Patient Dead, Vegetative, or Severely Neurologically Impaired?: Assessing Outcome for Comatose Survivors of Cardiac Arrest. J Amer Med Assoc. 2004;291:870-879, Feb 18. JAMA PDF Death, Vegetative, Severely neurologically impaired.

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Anderson MR, Klink K, Cohrssen A. Simel DL and Rennie D, eds. Evaluation of vaginal complaints. J Amer Med Assoc. 2004;291:1368-1379, Mar 17. JAMA PDF Vaginal complaints. JAMA Patient Page Vaginal complaints

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Steiner MJ, DeWalt DA, Byerley JS. Simel DL and Rennie D, eds. Is this child dehydrated? J Amer Med Assoc. 2004; 291:2746-2754, June 9. JAMA PDF Childhood dehydration

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Murff HJ, Spigel DR, Syngal S. Simel DL and Rennie D, eds. Does this patient have a family history of cancer? J Amer Med Assoc. 2004; 292: 1480-1489. Sept 22/29. JAMA PDF Family History of Cancer

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Luime JJ, Verhagen AP, Miedema HS, Kuiper JI, Burdorf A, Verhaar JAN, Koes BW. Simel DL and Rennie D, eds. Does this patient have an instability of the shoulder or a labrum lesion? J Amer Med Assoc. 2004;292:1989-1999, Oct 27 JAMA PDF Shoulder Instability.

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Green AD, Colón-Emeric CS, Bastian L, Drake MT, Lyles KW. Simel DL and Rennie D, eds. Does This Woman Have Osteoporosis? J Amer Med Assoc. 2004; 292:2890-2900, Dec 15. JAMA PDF Osteoporosis

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Call SA, Vollenweider MA, Hornung CA, Simel DL, McKinney WP. Simel DL and Rennie D, eds. Does This Patient Have Influenza? J Amer Med Assoc. 2005; 293: 987-997, Feb 23. JAMA PDF Influenza JAMA Patient Page Influenza JAMA Patient Page (Spanish) Influenza

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Scherer K, Bedlack RS, Simel DL. Simel DL and Rennie D, eds. Does This Patient Have Myasthenia Gravis? J Amer Med Assoc. 2005;293:1906-1914, Apr 20. JAMA PDF Myasthenia JAMA PDF Patient Page Myasthenia.

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Goldstein LB and Simel DL. Simel DL and Rennie D, eds. Is my patient having a stroke? J Amer Med Assoc. J Amer Med Assoc 2005; 2391-2402, May 18. JAMA PDF Stroke

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Wang CS, FitzGerald JM, Shulzer M, Mak E, Ayas NT. Simel DL and Rennie D, eds. Does this dyspneic patient in the emergency department have congestive heart failure? J Amer Med Assoc. 2005; 294: 1944-1956, Oct 19. JAMA PDF Dyspnea and CHF

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Wells PS, Owen C, Doucette S, Fergusson D, Tran H. Simel DL and Rennie D, eds. Does this Patient have Deep Vein Thrombosis? J Amer Med Assoc. 2006;295:199-207, Jan 11. JAMA PDF DVT

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Bagai A, Thavendiranathan P, Detsky AS. Simel DL and Rennie D, eds. Does this patient have hearing impairment? J Amer Med Assoc. 2006;295: 416-428, Jan 25. JAMA PDF Hearing Loss JAMA PDF Patient Page Audiometry

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Khan NA, Rahim SA, Anand SS, Simel DL, Panju A. Simel DL and Rennie D, eds. Does the clinical examination predict lower extremity peripheral arterial disease? J Amer Med Assoc. 2006;295: 536-546, Feb 1. JAMA PDF Peripheral Arterial Disease JAMA PDF Patient Page PAD

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Moayyedi P, Talley NJ, Fennerty MB, Vakil N. Simel DL and Rennie D, eds. Can the clinical history distinguish between organic and functional dyspepsia? J Amer Med Assoc. 2006; 295: 1566-1576, Apr 5. JAMA PDF Dyspepsia JAMA Patient Page Dyspepsia

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Detsky ME, McDonald DR, Baerlocher MO, Tomlinson GA, McCrory DC, Booth CM. Simel DL and Rennie D, eds. Does this patient with headache have a migraine or need neuroimaging? J Amer Med Assoc. 2006; 296: 1274-1283, Sep 13. JAMA PDF Headache

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Ranji SR, Goldman LE, Simel DL, Shojania KG. Simel DL and Rennie D, eds. Do opiates affect the clinical evaluation of patients with acute abdominal pain? J Amer Med Assoc. 2006; 296: 1776-1774, Oct 11. JAMA PDF Opiates in Abdominal Pain. JAMA PDF Patient Page Abdominal Pain

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Straus SE, Thorpe KE, Holyroyd JM. Simel DL and Rennie D, eds. Rational Clinical Examination Procedures: How do I perform a lumbar puncture and analyze the results to diagnose bacterial meningitis? J Amer Med Assoc. 2006: 296: 2012-2022, Oct 25. JAMA Lumbar Puncture JAMA LP Patient Page

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Ganz DA, Bao Y, Shekelle PG, Rubenstein, LZ. Simel DL and Rennie D, eds. Will my patient fall? J Amer Med Assoc. 2007; 297: 77-86, Jan 3. JAMA Falls in the elderly

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Margaretten ME, Kohlwes J, Moore D, Bent S. Simel DL and Rennie D, eds. The Rational Clinical Examination: Does this Patient Have Septic Arthritis? J Amer Med Assoc. 2007, 297: 1478-1488, Apr 4. JAMA Septic arthritis JAMA Septic Arthritis Patient Page

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Klompas M. Simel DL and Rennie D, eds. Does this ventilated patient have pneumonia? J Amer Med Assoc. 2007;297:1583-1593, Apr 11. JAMA Ventilator Associated Pneumonia JAMA Ventilator Associated Pneumonia Patient Page

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Roy CL, Minor MA, Brookhart MA, Choudhry NK. Simel DL and Rennie D, eds. The Rational Clinical Examination: Does this Patient With a Pericardial Effusion Have Cardiac Tamponade? J Amer Med Assoc. 2007; 297:1810-1818, Apr 25 JAMA Cardiac Tamponade JAMA Patient Page Cardiac Tamponade

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Holsinger T, Deveau J, Boustani M, Williams JW. Simel DL and Rennie D, eds. Is this patient demented? J Amer Med Assoc 2007; 297:2391-2404, June 6. JAMA Dementia JAMA Dementia Patient Page

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Tibbles CD and Edlow JA. Simel DL and Rennie D, eds. Does this patient have erythema migrans? J Amer Med Assoc 2007; 297:2617-2627, June 20. JAMA Erythema Migrans JAMA Patient Page Lyme Disease

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Bundy DG, Byerley JS, Liles EA, Perrin EM, Katznelson J, Rice HE. Simel DL and Rennie D, eds. Does this child have appendicitis? J Amer Med Assoc 2007; 298: 438-451, July 25. JAMA Childhood appendicitis Patient Page

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Shaikh N, Morone NE, Lopez J, Chianese J, Sangvai S, D’Amico F, Hoberman A, Wald ER. Simel DL and Rennie D, eds. Does this child have an acute urinary tract infection? J Amer Med Assoc 2007; 298: 2895-2904, Dec 26. JAMA Childhood UTI .

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Butalia S, Palda VA, Sargeant RJ, Detsky AS, Mourad O. Simel DL and Rennie D, eds. Does this diabetic patient have osteomyelitis of the lower extremity? J Amer Med Assoc. 2008; 299: 806-813. JAMA Diabetic osteomyelitis of the foot Patient Page Osteomyelitis

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Wong CL, Holroyd-Leduc JM, Thorpe KE, Straus SE. Simel DL and Rennie D, eds. Does this patient have bacterial peritonitis or portal hypertension? How do I perform a paracentesis and analyze the results? J Amer Med Assoc. In press.

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