Review of Systems Flashcards

1
Q

What is asked in General Review Of Systems (ROS)?

A

Have you had any fever?
Have you had any chills?
Have you had any (night) sweats?
Have you had any weight loss or weight gain? Have you been tired or fatigued?

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2
Q

What is asked in Dermatologic ROS

A

Have you noticed a rash or skin lesion?
Does it itch or burn?
Have you had any changes in moles (size, color, border irregularity)? Have you had any changes in hair texture?
Have you had any changes in nails?

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3
Q

What is asked in Head And Neck ROS?

A

Have you had any headaches? Where?
Have you had any neck pain?
Have you noticed any neck masses or “swollen glands”? Have you had any neck stiffness?
Have you had any dizziness or lightheadedness?

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4
Q

What is asked in ROS for Ears?

A

Have you had any hearing loss?
Do you use hearing aid(s)?
Have you had any ear pain or earaches?
Have you had any ringing in the ears (tinnitus)?
Have you had any discharge/blood/pus from the ears?

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5
Q

What is asked in ROS for The Nose & Sinuses?

A

Have you had any nasal discharge? What color? Have you had any nose bleeds (epistaxis)?
Have you had any sinus pains or pressure? Have you had any post-nasal drip?

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6
Q

What is asked in ROS for Throat & Oral Cavity?

A

Have you had any sores in your mouth? Have you had any tooth or gum problems? Have you had a sore throat?
Have you noticed any hoarseness?
Do you wear dentures?

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7
Q

What is asked in ROS for Eyes?

A

Have you had a change in vision?
Do you use glasses or contact lenses?
Have you had any double vision (diplopia)? Have you had blurred vision?
Any redness of your eyes?
Any discharge from your eyes?
Any excessive tearing or dryness in your eyes? Have you had any trauma to your eyes?

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8
Q

What is asked in Breast ROS?

A

Have you noticed any lumps/masses
Have you had any breast pain or tenderness?
Have you had any discharge from the nipple?
Do you have any “swollen glands” under your arms? Do you perform monthly self-exams on your breasts?

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9
Q

What is asked in Pulmonary ROS?

A

Have you had a (new/different) cough?
Have you brought up any phlegm? What color? Have you coughed up blood (hemoptysis)?
Have you had pain with breathing (pleuritic pain)? Have you had shortness of breath?
Have you had any wheezing?

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10
Q

What is asked in Cardiovascular ROS?

A

Have you had any chest pain? Have you been short of breath?
*with exertion (dyspnea on exertion)
*while lying flat (orthopnea)
*suddenly while sleeping (paroxysmal nocturnal dyspnea)
Have you had any palpitations?
Have you had any swelling in legs or feet (edema)?
Have you had any pain in the calves while walking (claudication)?

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11
Q

What is asked in ABDOMINAL (Gastrointestinal) ROS?

A

Have you had any difficulty swallowing (dysphagia)? Have you had pain on swallowing (odynophagia)? Have you had any heartburn? (Characterize it further) Are you having any abdominal pain?
Have you had a loss of appetite (anorexia)? Have you had any nausea?
Have you had any vomiting?
Have you had any diarrhea?
Have you had any constipation?
Have you noticed a change in bowel habits?
Have you had any black, tarry stools (melena)?
Have you had any bloody stools (hematochezia) or bright red blood per rectum (BRBPR)? Have you noticed a change in the caliber of stool size?
Have you noticed your skin or eyes turning yellow (jaundice)?
Have you had hemorrhoids?
Have you noticed any easy bleeding or bruising?

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12
Q

What is asked in Genito-Urinary ROS?

A

Have you had to urinate more frequently?
Do you feel the urge to urinate more often (urgency)?
Have you had any pain or burning on urination (dysuria)?
Have you noticed any blood in urine (hematuria)?
Have you had any problem with loss of urine or bladder control (urinary incontinence)? Do you wake up at night to urinate (nocturia)? How often?
Have you had a change in urine color or odor?
Males:
*Do you have difficulty starting your stream?
*Have you noticed any lesions on your penis?
*Have you had any penile discharge?
*Have you had any problems achieving or maintaining an erection? *Have you noticed any scrotal or testicular masses?

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13
Q

What is asked in GYNECOLOGICAL ROS?

A

Describe the frequency, regularity, discomfort and heaviness of menses Have you any change in the discomfort/pain with menses?
Have you had spotting between menses, or any post-menopausal bleeding? Have you had any “hot flashes”?
Have you noticed vaginal dryness?

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14
Q

What is asked in SEXUAL HISTORY (May be asked in psychosocial history section)?

A
  1. Are you sexually active? Have you noticed a change in your libido?
  2. Have you noticed any changes or problems in your sexual functioning?
  3. Has illness (if applicable) affected your sexual functioning?
  4. Are you using condoms to prevent disease?
  5. Are you using birth control - what type?
  6. Are you in a monogamous relationship?
  7. For men: Have you had any problems developing or maintaining an erection?
    Have you had any trouble having an orgasm? 8. For women: Have you had pain during intercourse?
    Have you had difficulty having an orgasm?
    Have you had problems with lubrication?
  8. Have you had any concerns about getting a sexual disease or AIDS? 10. Have you had any other questions or concerns about this subject?
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15
Q

What is asked in Musculoskeletal ROS

A

Have you had any pain in your joints? Which ones? Have you noticed any joint or muscle stiffness? Have you had any joint swelling? (Which joint?) Have you noticed any muscle weakness?
Have you had any muscle tenderness?
Have you had any back pains? (Upper back? Lower back?)

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16
Q

What is asked in Neurologic ROS?

A

Have you had any numbness (paresthesias)? Where?
Have you had any tingling (dysesthesias)? Where? Have you had any problems with your memory?
Have you had any headaches? Where?
Have you noticed any dizziness (Vertigo)?
Have you had any problems with tremors (shaking)?
Have you had any episodes of blacking out (syncope) or loss of consciousness? Have you had any problems with unsteadiness or balance?

17
Q

What is asked in PSYCHIATRIC ROS?

A

Have you had any problems with anxiety?
Have you had any problems with depression?
Ask about symptoms of depression (SIGECAPS). Do you have any:
difficulty getting to Sleep or waking up early (insomnia)? loss of Interest in doing things (anhedonia)?
feelings of Guilt?
lack of Energy, fatigue?
problems with Concentration?
loss of Appetite (anorexia) or increase in appetite?
problems with slow thinking or moving (Psychomotor slowing)? thoughts of Suicide?
Have you seen people or things that others did not see? (Hallucinations)

18
Q

What is the order of systems for ROS?

A
General
Dermatologic
Head and Neck
Ears
Nose and Sinuses
Throat and Oral Cavity
Eyes
Breast
Pulmonary
Cardiovascular
Abdominal (Gastrointestinal)
Genito-Urinary
Gynecological
Sexual History
MSK
Neurological
Psychiatric