Systemic enquiry

Question 1

Systemic enquiry: general questions

Answer 1

May be the most significant, e.g. in TB, endocrine problems, or cancer.
Weight loss.
Night sweats.
Any lumps.
Fatigue/malaise/lethargy.
Sleeping pattern.
Appetite.
Fevers.
Itch or rash.
Recent trauma.

Question 2

Systemic enquiry: cardiorespiratory symptoms

Answer 2

Chest pain.
Exertional dyspnoea (breathlessness): quantify exercise tolerance and how it has changed, e.g. stairs climbed, or distance walked, before onset of breathlessness.
Paroxysmal nocturnal dyspnoea: orthopnoea on lying flat (symptom of left ventricular failure)- quantify in terms of number of pillows the patient must sleep on to prevent dyspnoea.
Oedema: ankles, legs, lower back (dependent areas).
Palpitations: awareness of heartbeats, can they tap our the rhythm?
Cough: sputum, haemoptysis?
Wheeze.

Question 3

Systemic enquiry: GI symptoms

Answer 3

Abdominal pain (constant or colicky, sharp or dull, SOCRATES, relationship to eating and bowel action).
Swallowing.
Indigestion.
Nausea/vomiting, blood?
Bowel habit.
Stool: consistency, blood, mucus, difficulty flushing away, tenesmus or urgency.

Question 4

Systemic enquiry: genitourinary symptoms

Answer 4

Incontinence (stress or urge).
Dysuria.
Urinary abnormalities: colour? haematuria (streaks or pink urine)? frothy?
Nocturia.
Frequency or polyuria.
Hesitancy.
Terminal dribbling.
Vaginal discharge (colour, odour), pain on intercourse (dyspareunia)?
Menses: frequency, regularity, heavy or light, duration, painful? first day of last menstrual period, number of pregnancies and births, menarche, menopause, any chance of pregnancy now?

Question 5

Systemic enquiry: neurological symptoms

Answer 5

Special sense: sight, hearing, smell and taste).
Seizures, faints, ‘funny turns’.
Headache.
Pins and needles (paraesthesiae) or numbness.
Limb weakness, poor balance.
Speech problems.
Sphincter disturbance.
Higher mental function and psychiatric symptoms, assess function- what can the patient (not) do at home, work, etc.?

Question 6

Systemic enquiry: musculoskeletal symptoms

Answer 6

Pain, stiffness, swelling of joints.
Diurnal variation in symptoms (i.e. worse in mornings).
Functional deficit.
Signs of systemic disease: rashes, mouth ulcers, nasal stuffiness, malaise, and constitutional symptoms.

Question 7

Systemic enquiry: thyroid symptoms

Answer 7

Hyperthyroidism: prefers cold weather, bad tempered, sweaty, diarrhoea, oligomenorrhoea, weight loss with increased appetite, tremor, palpitations, visual problems.
Hypothyroidism: depressed, slow, tired, thin hair, croaky voice, heavy periods, constipation, dry skin, prefers warm weather.