Review of the systems

Dr. Made Ratna Saraswati, SpPD Wednesday, 13 Oct 2010

Review

of the system may uncover problems that the patient has overlooked, particularly in areas unrelated to present illness.

Review

of the systems question often challen in ! askin a series of question from head to toe.

"ome

clinicians do the review of the systems durin the physical e#amination, askin about ears, for e#ample as they e#amine them.

"tandard series of review$of$system questions

%eneral "kin &ead, eyes, ears, nose, throat '&(()*+! )eck ,reast Respiratory -ardiovascular %astrointestinal .eripheral vascular/rinary %enital 0usculoskeletal .sychiatric )eurolo ic &ematolo ic (ndocrine

General!
/sual

wei ht, recent wei ht chan e, any clothes that fit more ti htly or loosely than before. fati ue, or

1eakness, 2ever

Skin!
rashes, chan chan

lumps, sores, itchin , dryness, chan es in color es in hair or nails es in si3e or color of moles

Head, eyes, ears, nose, throat (HEE !"!

&ead! (yes!

headache, head in4ury, di33iness, li htheadedness

vision, lasses or contact lenses, last e#amination, pain, redness, e#cessive tearin , double or blurred vision, spots, specks, flashin li hts, laucoma, cataracts. , tinnitus, verti o, earaches, infection, dischar e. 5f hearin is decreased, use or nonuse of hearin aids. and sinuses! frequent colds, nasal stuffiness, dischar e, or itchin , hay fever, nosebleeds, sinus trouble 'or mouth and pharyn#+! condition of teeth and ums, bleedin ums, dentures, if any, and how they fit, last dental e#amination, sore ton ue, dry mouth, frequent sore throats, hoarseness.

(ars!hearin )ose

*hroat

e#k!
swollen

lands, oiter, lumps, pain, or stiffness in the neck

$reast!
lumps,

pain, or discomfort, nipple dischar e, self e#amination practices

Respiratory!
-ou

h 'color, quantity+

"putum

&emoptysis, 6yspnea 1hee3in .leurisy 7ast 8ou

chest #$ray.

may wish to include asthma, bronchitis, emphysema, pneumonia, and tuberculosis

%ardiovas#&lar!
heart hi

trouble fever

h blood pressure murmurs pain or discomfort orthopnea, paro#ysmal nocturnal

rheumatic heart chest

.alpitations dyspnea,

dyspnea
(dema result

of past electrocardio rams or other cardiovascular test.

Gastrointestinal!
trouble ,owel

swallowin , heartburn, appetite, nausea.

movements, stool color and si3e, chan e in bowel habits, pain with defecation, rectal bleedin or black or tarry stool, hemorrhoids, constipation, diarrhea. pain, food intolerance, e#cessive belchin or passin of as. , liver, or allbladder trouble, hepatitis.

9bdominal :aundice

Peripheral vas#&lar!
intermittent

claudication, le cramps, varicose veins, past clots in the veins, swellin in calves, le s, or feet, chan e in fin ertips or toes durin cold weather, with redness or tenderness.

color

swellin

'rinary!
frequency polyuria nocturia ur

of urination

ency or pain durin urination infections or flank pain stones colic pain, incontinence

burnin

hematuria urinary kidney kidney

ureteral

suprapubic in

males! reduced caliber or force of the urinary stream, hesitancy, dribblin

Genital!
0ale!
&ernias dischar

e from or sores on the penis pain or masses pain or swellin

testicular scrotal history "e#ual birth

of se#ually transmitted disease and their treatment. habits, interest, function, satisfaction about &5; infection control methods, condom use and problems

-oncerns

2emale!
a

e at menarche, re ularity, frequency, and duration of periods, amount of bleedin , bleedin between periods or after intercourse, last menstrual period, dysmenorrhea, premenstrual tension e at menopause, menopausal symptoms, post menopausal bleedin . the patient was born before 1<=1, e#posure to diethylstilbestrol '6("+ from maternal use durin pre nancy 'linked to cervical carcinoma+. inal dischar e, itchin , sores, lumps, se#ually transmitted diseases and treatments. of pre nancies, number and type of deliveries, number of abortion 'spontaneous and induced+, complications of pre nancy, birth$control methods. preference, interest, function, satisfaction, any problems, includin dyspareunia. -oncerns about &5; infection.

9 5f

;a

)umber

"e#ual

M&s#&loskeletal!
muscle

or 4oint pain, stiffness, arthritis, out,

backache.
5f

present, describe location of affected 4oints or muscles, any swellin , redness, pain, tenderness,

stiffness, weakness, or limitation of motion or activity, include timin of symptoms 'e. . mornin or evenin +, duration, any history of trauma.
)eck :oint

or low back pain.

pain with systemic features such as fever, chills, rash, anore#ia, wei ht loss, or weakness.

Psy#hiatri#!
nervousness,

tension, mood, includin depression, memory chan e, suicide attempts, if relevant.

e&rolo(i#!
-han

es in mood, attention, or speech, chan es in orientation, memory, insi ht, or 4ud ment, headache, di33iness, verti o, faintin , blackouts, sei3ures, weakness, paralysis, numbness or loss of sensation, tin lin or >pins and needles?, tremors or other involuntary movements, sei3ures.

Hematolo(i#!
anemia,

easy bruisin or bleedin , past transfusions, transfusion reactions.

Endo#rine!
thyroid

trouble, heat or cold intolerance, e#cessive sweatin , e#cessive thirst or hun er, polyuria, chan e in love of shoe si3e.