Review of Systems

MARC IMHOTEP CRAY, M.D.

 Introduction to Review of
Systems (ROS)
 ROS documents presence or absence of common
symptoms related to each major body system

 Sx related to pt’s current problem, discovered

during your ROS inquiry, should be recorded under
“present illness.”

 You should become familiar with these symptoms

and learn their diagnostic significance

Marc Imhotep Cray, M.D. 2

 Intro to ROS cont’d.
 In practice, patient’s answers are not written
down except when they are positive, or when a
negative response is particularly pertinent to
differential diagnosis (DDx)

 You may select to ask questions while

examining part of body to which questions
pertain.

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 Intro to ROS cont’d.
 ROS is best organized from head down to
extremities, and as stated questions can be asked
during PE of that body area
 Pts are told that they are going to be asked whether
they have ever had a particular symptom and should
answer “yes” or “no”
o If they answer in affirmative, further direct questioning is
appropriate

 You need not repeat questions that were previously

answered, unless clarification of data is necessary

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 Intro to ROS cont’d.
 Following is a ROS about which questions
should be asked of all pts
 Questions should be understandable to pt.
o For example, a question regarding paroxysmal
nocturnal dyspnea (PND) should be asked in this
manner: ““Do you ever awaken in the middle of
the night with sudden shortness of breath or
sudden difficulty in breathing?”

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 ROS Outline
General Peripheral vascular
Skin Urinary
Head, Eyes, Ears, Nose, Throat Genital: Male or Female
(HEENT) Musculoskeletal
Neck Psychiatric
Breasts Neurologic
Respiratory Hematologic
Cardiovascular Endocrine
Gastrointestinal

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 General
 Usual weight, recent weight change, any clothes
that fit more tightly or loosely than before
 Weakness, fatigue, or fever

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 Skin
 Rashes, lumps, sores, itching, dryness, changes
in color
 Changes in hair or nails
 Changes in size or color of moles

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 Head, Eyes, Ears, Nose, Throat
(HEENT)
 Head: Headache, head injury, dizziness, lightheadedness
 Eyes: Vision, glasses or contact lenses, last exam, pain, redness,
excessive tearing, double or blurred vision, spots, specks, flashing
lights, glaucoma, cataracts
 Ears: Hearing, tinnitus, vertigo, earaches, infection, discharge
If hearing is decreased, use or nonuse of hearing aids
 Nose and sinuses: Frequent colds; nasal stuffiness, discharge, or
itching; hay fever; nosebleeds; sinus trouble.
 Throat (or mouth and pharynx): Condition of teeth and gums;
bleeding gums; dentures, if any, and how they fit; last dental exam;
sore tongue; dry mouth; frequent sore throats; hoarseness

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 Neck
 “Swollen glands”; goiter; lumps, pain, or stiffness
in the neck

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 Breasts
 Lumps, pain, or discomfort; nipple discharge
 self-examination practices

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 Respiratory
 Cough, sputum (color, quantity), hemoptysis,
dyspnea, wheezing, pleurisy, last chest x-ray
 You may wish to include asthma, bronchitis,
emphysema, pneumonia, and tuberculosis

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 Cardiovascular
 Heart trouble, high blood pressure, rheumatic
fever, heart murmurs
 chest pain or discomfort
 palpitations, dyspnea, orthopnea, paroxysmal
nocturnal dyspnea, edema
 results of past electrocardiograms or other
cardiovascular tests

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 Gastrointestinal
 Trouble swallowing, heartburn, appetite, nausea
 Bowel movements, stool color and size, change in
bowel habits, pain with defecation, rectal
bleeding or black or tarry stools, hemorrhoids,
constipation, diarrhea
 Abdominal pain, food intolerance, excessive
belching or passing of gas
 Jaundice, liver, or gallbladder trouble
 Hepatitis

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 Peripheral vascular
 Intermittent claudication
 Leg cramps
 Varicose veins, past clots in veins
 Swelling in calves, legs, or feet
 Color change in fingertips or toes during cold
weather
 Swelling with redness or tenderness

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 Urinary
 Frequency of urination, polyuria, nocturia,
urgency, burning or pain during urination,
hematuria, urinary infections, kidney or flank pain,
kidney stones, ureteral colic, suprapubic pain
 incontinence in males, reduced caliber or force of
urinary stream, hesitancy, dribbling

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 Genital: Male
 Hernias, discharge from or sores on penis,
testicular pain or masses, scrotal pain or swelling
 history of sexually transmitted diseases and their
treatments
 Sexual habits, interest, function, birth control
methods, condom use, and problems
 Concerns about HIV infection

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 Genital: Female
 Age at menarche
 regularity, frequency, and duration of periods amount of
bleeding; bleeding between periods or after intercourse;
last menstrual period
 dysmenorrhea
 premenstrual tension
 Age at menopause, menopausal symptoms,
postmenopausal bleeding. If pt. was born before 1971,
exposure to diethylstilbestrol (DES) from maternal use
during pregnancy (linked to cervical /vaginal carcinoma)

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 Genital: Female cont’d
 Vaginal discharge, itching, sores, lumps, sexually
transmitted diseases and treatments
 Number of pregnancies, number and type of
deliveries, number of abortions (spontaneous
and induced), complications of pregnancy, birth-
control methods
 Sexual preference, interest, function, satisfaction,
any problems, including dyspareunia
 Concerns about HIV infection

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 Musculoskeletal
 Muscle or joint pain, stiffness, arthritis, gout, backache
o If present, describe location of affected joints or
muscles, any swelling, redness, pain, tenderness,
stiffness, weakness, or limitation of motion or activity
o Include timing of symptoms (e.g., morning or
evening), duration, and any history of trauma. Neck or
low back pain.
 Joint pain with systemic features such as fever, chills, rash,
anorexia, weight loss, or weakness

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 Psychiatric & Neurologic
 Psy: Nervousness; tension; mood, including
depression, memory change, suicide attempts, if
relevant

 Neuro: Changes in mood, attention, or speech;

changes in orientation, memory, insight, or
judgment; headache, dizziness, vertigo; fainting,
blackouts, seizures, weakness, paralysis, numbness
or loss of sensation, tingling or “pins and needles,”
tremors or other involuntary movements; seizures

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 Hematologic and Endocrine
 Hem: Anemia, easy bruising or bleeding, past
transfusions, transfusion reactions

 Endo: Thyroid trouble, heat or cold intolerance,

excessive sweating, excessive thirst or hunger,
polyuria, change in glove or shoe size

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 THE END, THANK YOU
Recommended textbook reading: Bickley LS, Szilagyi PG.
Chapter 1: Interviewing and the Health History. In: Bates’
Guide to Physical Examination and History Taking, 10th Ed.
LWW, 2009; 6-12.

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