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Likelihood Ratio (LR) in Emergency Medicine


Does Murphy’s sign and sonographic Murphy sign have the same clinical utility?

A 40 yo woman presented to the ED with upper quadrant pain since three hours after eating a tasty pizza. She is overweight, she presents feverish (38°C) her skin is nonicteric. The abdomen is soft, there is tenderness on the upper right quadrant, you perform a deep palpation in the subcostal area, and the patient stops breathing for pain. 

Is Murphy’s sign useful to make diagnosis of cholecystitis? What about the sonographic Murphy’s sign?



Diagnosis of pneumonia. Is it the time for a combined imaging strategy?

A 80 yo man is brought from an assisted-living facility because of fever, productive cough, tachycardia and dyspnoea. 
He has a history of dementia and hypertension.
He is cachectic, you hear ronchi on the left side. 

How should you approach this patient?