First up, DON’T use Frank sign. The sign hypothesizes that a diagonal ear lobe crease signifies coronary artery disease. I’ve been meaning to post this since I saw it being promoted on Twitter. Here’s the problem #MedTwitter: 
As a diagnostic test, it is inaccurate with a +LR probably <2 and a -LR probably >0.5. These are woefully insufficient to change clinical management. The sign is very much associated with age… bit.ly/3SBuszj
And in cadaveric research is less specific than advanced age, so you might as well use that instead. bit.ly/3xTDDmO
Ultimately, the data shows Frank sign serves as a better pimping question than meaningful diagnostic tool. Stay tuned for more evidence based physical exam #MedEd #histmed #TWDFNR
https://twitter.com/BrianElliottMD1/status/1574015951196094465
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