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Review of Systems Questions for a Patient Examination



The Review of Systems questions are a series of questions that serve a vital role during patient examination because they serve to extract a patient's health history and to illicit present health problems. 

The Review of Systems questions is the subjective part of a patient examination. It is subjective because the healthcare examiner is going by what the patient is telling him or her. A full patient examination consists of a subjective examination and an objective examination. The objective examination is where the healthcare worker physically examine the patient and records results.

The Review of Systems questions goes through each system in the body and are 'yes-no' questions, meaning the patient either declares it positive (yes) or negative (no).

Usually the review of systems questions are asked going from head to toe. 

It is helpful to prepare the patient for these questions by saying, "The next part of the history may feel like a hundred questions, but it is important to make sure we have not missed anything."

Most review of Systems questions pertain to symptoms, but on occasion some clinicians incldue diseases such as pneumonia or asthma. 

Usually the review of systems questions start off generally, so they are first general questions. the healthcare examiner then branch off to certain organs or systems of the body. 

Below is a standard series of review-of-system questions. 

General: Have you had any recent weight change? weakness? fatigue? fever, chills, or night sweats? how many hours of sleep do you get on average a night?

Skin: Any rashes? lumps? sores? iching? dryness? any changes in color of your skin? any changes in your hair? any changes in your nails? any changes in size or color of moles? any easily bruising of the skin? do you have any piercings or tatoos? do you use sunscreen? do you use tanning beds?

Head: any headaches? any head injury? syncope? seizures? any vertigo? Do you have any type of paralysis or paresis? do you have tremor? do you have any problems with balance or movement (ataxia)? any abnormal sensations (dysesthesias)? any fainting? lightheadedness?

Eyes: What is your visual acuity (when last checked)? Do you wear eye glasses? do you wear contact lenses? When was your last eye exam? Do you have any eye pain? eye redness? any excessive tearing? double vision? blurred vision? Do you have any history of eye disease such as cataracs or glaucoma? 

Ears: Any hearing loss? any ear pain? any ear infections? any ringing of the ears (tinnitus)? any vertigo? any occupational exposure to loud noise? any headphone use? 

Nose and sinuses: any nasal stuffiness? do you get nose bleeds (epistaxis)? any olfactory changes? loss of smell? do you get frequent colds? any sinus trouble? do you get hay fever?

Mouth and Throat: Any dental caries? extractions? dentures? bleeding gums? gum disease? difficulty chewing? When was the date of your last dental exam? Do you brush and floss regularly every day? any sore tongue? any changes in taste?

Neck: Any lumps in your neck? any large or swollen lymph nodes in your neck (adenopathy)? do you have any enlarged thyroid (goiter)? any pain in the neck? any difficulty in moving your neck (ROM)? 

Breasts: any skin changes on your breasts? any pain in your breasts? any nipple changes? any lumps (masses) in your breasts? any fibrocystic disease? do you have a history of breast cancer? do you do breast self-examinations? if so, how often do you do BSEs?

Respiratory: Do you have a cough? If so, is it productive? sputum color and quantity? Do you cough up any blood (hemoptysis)? do you have any wheezing? do you have any difficulty breathing (dyspnea)? do you have pain on respiration? do you get frequent respiratory infections? do you have asthma, bronchitis, emphysema? have you ever had any exposure to tuberculosis? when did you last have the tuberculin test and what was the result?

Cardiovascular: do you ever get any chest pain? do you ever get heart palpitations? do you have any heart murmur conditions? any history of rheumatic fever? any history of heart disease? have any past EKGs or heart tests revealed any abnormalities? 

Gastrointestinal: Any trouble swallowing (dysphagia)? any changes in appetite? what are your dietary habits? any food intolerance? any heartburn (pyrosis)? any abdominal pain? any nausea? vomiting? blood in vomitus (hematemesis)? any excessive belching or flatus? any change in your bowel habits? any diarrhea? any constipation? any frequency of bowel movements? any hemorrhoids? any blood in your stools? any mucous in your stools? any history of liver or gallbladder disease (hepatitis, jaundice, stones)? any history of pancreatiis? do you use laxatives or antacids? any history of any eating disorders? 

Urinary: Any pain on urination (dysuria)? any urinary frequency? urinary urgency? urinary hesitancy? any urinary incontinence? how often would you say you urinate at night time? any history of urinary infections?

Genito-reproductive: Male: any penile discharge or lesions? any testicular pain? testicular swelling? testicular masses? any history of infertility? impotence? how is your libido? any sexual problems? do you perform testicular self-examinations? if so, how often?  Women: what age did you have your first period (menarche)? (if an older lady), what age did you have menopause? any abnormal masses? any abnormalities with your periods, such as excessive or abnormal bleeding ?what is your obstetric history (pregnancies, abortions, or infertility)? any history of sexual abuse or rape? 

Musculoskeletal: Any joint pain? joint stiffness? swelling (edema)? heat? any redness (rubor) of the joints? any joint deformities? any limited range of motion of any of your joints? any muscle pains (myalgias)? any muscle cramps? any bone fractures? any history of arthritis? gout? back problems? sciatica? 

Endocrine: Any heat or cold intolerance? any excessive sweating? any excessive urination (polyuria)? excessive hunger (polyphagia)? excessive thirst (polydipsia)? any change in voice? any history of diabetes? any history of thyroid issues? 

Hematologic: When did you have your last blood work done? any lab abnormalities? any history of anemia? any abnormal bleeding such as easy bruising? any swollen glands (could be indicative of leukemia)?

Psychiatric: Any nervousness? hyperventilation? any mood disorders? any depression? any anxiety? any memory loss? any phobias?

Value Beliefs: What religion do you affiliate with? What impact does your religion have on your health care practices? any advanced directives? any complementary health practices?

 

So, the review of systems questions are important questions to ask a patient to get a good history of the patient. This is the subjective part of the examination, where the patient gives you information. You later will do an objective examination where you physically examine the patient and record results. The review of systems questions are very important because it allows you to get a history of the patient's past and present problems. 





Author: FNP

Published on June 20, 2018

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