Review of Systems (ROS)

Question 1

General

Answer 1

weight changes, fever, shaking chills, night sweats, fatigue, malaise, loss of appetite

Question 2

Skin

Answer 2

rashes, sores, itching, dryness, new or changing moles, color changes

Question 3

Eyes

Answer 3

vision changes, glasses/contact lens use, eye pain, redness, double vision, blurred vision, flashing lights, floaters, discharge, excessive tearing, last eye exam

Question 3

Ears

Answer 3

hearing loss, tinnitus, vertigo, ear pain, discharge

Question 3

Head

Answer 3

headache, trauma, lightheadedness, masses

Question 4

Nose

Answer 4

rhinorrhea, stuffiness, sneezing, itching, nosebleeds, sinus pain, postnasal drip

Question 5

Mouth/throat

Answer 5

sores in mouth, sore throat, bleeding gums, painful teeth or gums, dentures, dry mouth, hoarseness

Question 6

Neck

Answer 6

swollen glands, goiter, lumps, pain, stiffness

Question 7

Breasts

Answer 7

lumps, pain or tenderness, redness, discharge from nipples

Question 8

Respiratory

Answer 8

cough, sputum production (color, quantity) hemoptysis, dyspnea, wheezing, pain (pain with breathing or coughing

Question 9

Cardiovascular

Answer 9

chest pain, chest pressure or tightness, palpitations, racing heart, dyspnea, diaphoresis, orthopnea, paroxysmal nocturnal dyspnea (PND), swelling of feet/ankles, syncope or lightheadedness, pain in calves when walking

Question 10

Gastrointestinal

Answer 10

trouble swallowing, pain with swallowing, heartburn, change in appetite, nausea/vomiting, diarrhea, constipation, change in bowel habits, early satiety, rectal bleeding, black or tarry stools, blood in the stools, abdominal pain, excessive belching or passing of gas, jaundice

Question 11

Urinary

Answer 11

frequency, urgency, dysuria, polyuria, nocturia, hematuria, incontinence, trouble starting or stopping the stream (men)

Question 12

Genital (male)

Answer 12

discharge from penis, sores or ulcers on penis, testicular pain, testicular masses, pain in the scrotum, trouble getting or maintaining an erection, loss of libido, use of contraception, infertility, protection against sexually transmitted infections

Question 13

Genital (female)

Answer 13

age of menarche, last menstrual period, duration of periods, amount of bleeding, dysmenorrhea, any bleeding between periods, age at menopause, menopausal symptoms, postmenopausal bleeding, postcoital bleeding, pain with intercourse (dyspareunia), vaginal discharge, pruritus, vaginal sores/ulcers, change in libido, sexual difficulty, use of contraception, protection against sexually transmitted infections

Question 14

Musculoskeletal

Answer 14

joint pain, muscle aches, joint stiffness, joint swelling, joint redness, limitation of motion, backache, neck pain, history of trauma

Question 15

Neurologic

Answer 15

Fainting, blackouts, seizures, paralysis, muscle weakness, numbness or loss of sensation, tingling, tremors, trouble speaking or finding words, memory changes, headaches, vertigo, gait disturbance.

Question 16

Psychiatric

Answer 16

Mood changes, feeling anxious, feeling sad or depressed, nervousness, irritability, insomnia, hypersomnia, phobias, tension. (If appropriate – suicidal ideation, suicide plans)

Question 17

Endocrine

Answer 17

Heat intolerance, cold intolerance, excessive sweating, flushing, excessive thirst or hunger, polyuria

Question 18

Hematologic

Answer 18

Easy bruising, excessive bleeding, past transfusions and reactions