Background. Whole exome sequencing (WES) is the state-of-the-art method for identification of pathogenic mutations in patients with a Mendelian disorder. WES comprehensively covers the coding sequence of the genome and is a fast and cost-effective technique.Purpose. As most of the technical difficulties have been overcome for WES, the major issue is data processing and analysis to find the pathogenic sequence variation among tens of thousands of sequence changes. Bioinformatic analysis pipelines for filtering sequence variants have to be adapted according to the patients and family members examined by WES and the most likely inheritance pattern underlying the disease.Possible approaches. Based on 4 cases, different variant prioritization strategies which led to identification of the most likely causative changes in the index patients are described.