Review Of Systems

Question 1

General

Answer 1

Fever, Chills, Weakness (generalized), appetite changes, weight changes, fatigue, sleep disturbances

Question 2

Skin

Answer 2

Rashes, sores, lumps, itching, dryness, color changes, changes in hair or nails, presence of new moles, changes in size or color of existing moles

Question 3

Head

Answer 3

Headache, head injury, dizziness, lightheadedness

Question 4

Eyes

Answer 4

-Vision changes (loss of vision, visual field cuts, blurred vision, double vision)
-Eye pain or redness, itching, excessive tearing, presence of spots/specks/ flashing lights/ floaters in vision
-History of glaucoma or cataracts
-Use of glasses or contacts
-Date of last eye exam

Question 5

Ears

Answer 5

Hearing loss, use of hearing aides, ringing in ear (tinnitus), sensation of room spinning (vertigo), earaches, recurrent ear infections, discharge

Question 6

Nose/Sinus

Answer 6

Runny/stuffy nose, allergies (nasal, itching, sneezing), nasal bleeding, nasal blockage, sinus problems, history of frequent colds

Question 7

Mouth/ Pharynx

Answer 7

Condition of teeth, problems/sores on cheeks/gums/tongue, bleeding gums, dry mouth, sore throat, presence of drainage in throat (post nasal drainage), hoarseness, difficulty swallowing, use of dentures, dental hygiene patterns, last dental visit

Question 8

Neck

Answer 8

Lumps/ swollen glands, history of thyroid problems/goiter, pain/stiffness, history of trauma/whiplash

Question 9

Breasts

Answer 9

Presence of lumps/masses, pain/discomfort, nipple discharge, skin changes, self examination practices/ knowledge

Question 10

Respiratory

Answer 10

Difficulty breathing, wheezing, cough (non-productive, productive [quantity and quality sputum production]), history of coughing up blood (hemoptisis), pleurisy, history of asthma/ bronchitis/ emphysema/ pneumonia/ tuberculosis, date of last CXR

Question 11

Cardiac

Answer 11

Presence of chest pain/ discomfort, palpitations, presence of dyspnea/ orthopnea/ paroxysmal nocturnal dyspnea, presence of edema, history of blue extremities (cyanosis), history of heart murmurs/ heart disease/ HTN/ rheumatic fever, date of prior cardiac testing (EKG, stress tests)

Question 12

Gastrointestinal

Answer 12

Difficulty swallowing, history of heartburn, nausea/vomiting, abdominal pain/distensión/bloating, bowel movements (recent change, stool color and size, associated pain, constipation/diarrhea), excessive belching/ flatulence, rectal bleeding/ black tarry stools, history of hemorrhoids, appetite changes, food intolerances, history of jaundice/ hepatitis/ liver or gallbladder trouble

Question 13

Urinary

Answer 13

Frequency/urgency, pain or blood with urination (dysuria/hematuria), history of bladder/kidney infections or stones, large volumes of urine (polyuria), nocturnal urination (nocturia), incontinence, hesitancy/dribbling/ poor stream (males)

Question 14

Genital (males)

Answer 14

Hernias, penile discharge/ sores, testicular pain or masses, scrotal pain or masses, sexual history/ preference, sexual function, history of STD exposure, history of STD and their treatments, use of contraception/ STP prophylaxis

Question 15

Genital (women)

Answer 15

Age of menarche, menstrual cycle/ pattern (1st day of last period, regularity/ frequency/ duration/ flow), premenstrual symptoms (dysmenorrhea), presence of menopausal symptoms/ age of menopause, presence of vaginal itching/sores/ discharge, history of STD and their treatments

Question 16

Genital (female cont.)

Answer 16

Sexual history/ preference, painful intercourse (dyspareunia), pregnancy history (GPTpal, pregnancy complications), use of contraception/ STP prophylaxis, fertility concerns, DES exposure (if born prior to 1971)

Question 17

Peripheral Vascular

Answer 17

Lower extremity cramping with exertion (claudication), leg cramps, presence of varicose veins, history of blood clots, color change in fingertips or toes during cold weather

Question 18

Musculoskeletal

Answer 18

Muscle pain/stiffness, joint pain/stiffness, history of arthritis, back problems, history of gout

Question 19

Psychiatric

Answer 19

Presence of nervousness/anxiety/tension, alterations in mood/personality/memory/attention, history of depression, history of suicide/ suicide ideation or attempts, history of sexual/verbal/physical/psychological/domestic abuse

Question 20

Neurological

Answer 20

Alterations in memory/insight/judgement, headache, dizziness, weakness/paralysis, numbness/loss of sensation, tingling or sensation of pins and needles, gait changes, changes in speech, presence of tremors/involuntary movements, history of seizures, history of fainting/blackouts/loss of consciousness

Question 21

Hematologist/Lymphatic

Answer 21

Presence of fatigue, presence of excessive bruising/bleeding, swelling or pain in any lymph nodes, history of low iron/anemia, prior transfusions and any reactions

Question 22

Endocrine

Answer 22

Presence of head/cold intolerances, excessive sweating, excessive thirst/hunger (polydipsia, polyphagia), large/frequent amounts of urine (polyuria), change in glove/shoe size, history of thyroid disorders

Question 23

Allergic/Immunologic

Answer 23

Presence of allergic symptoms (itchy eyes/nose, sneezing, clear nasal discharge, tearing eyes), history of environmental or seasonal allergies and prior treatments