Review of Systems

The Review of Systems of the Medical Examination

This review of systems protocol can greatly benefit you on the USMLE, United States Medical Licensing Examination or the MCCQE.

The process of the Review of Systems is critical to all medical examinations during history taking. It allows one to scan through numerous symptoms from all organ systems to help identify subtle changes in the patient and cover wide ground in a short time. Moreso, it can allow a clinician to ask more direct questions to a patient who might not be focusing on answering the questions with ease. The review of systems begins with the patients general health, and then dives into each organ system.

Review of Systems: General Health

General: How is your general health like?

Any changes in your (seaw) Sleep? Energy level/Fatigue? Appetite? Weight?

Any (cfs) Chills, Fevers, Sweats?

Any Nausea, Vomitting (bilious, feculent, blood), Diarrhea, Malaise?

Any Headaches, Dizziness, Lightheadedness, Fainting spells, Life stresses?

Any Muscle or Joint Pains? Any Pain at all?

Head and Neck Review of Systems

Eyes

Any visual problems? Do you wear glasses? Double vision? Blurry vision? Photophobia?

Ears

Any hearing problems? Ringing in the ears? Pain? Discharge? Spinning sensation?

Nose

Any facial pain? Facial fullness? Runny nose? Bleeding? Nosebleeds? Are they recurrent? When do they occur? Nasal congestion? Sinus infections?

Mouth

Any bleeding? Mouth sores? Pain? Toothaches?

Neck

Any pain? Stiffness? Hoarseness in your voice? Difficulty breathing? Drooling? Cough? Blood or sputum?

Trouble swallowing (solids versus liquids)? Pain on swallowing?

Any masses, lumps or bumps on the neck?

Neurological Review of Systems

Do you experience any pain? Sharp shooting (usually neuropathic) or dull (somatic) ?

Any weakness? Paralysis? Numbness? Clumsiness? Loss of balance? Trouble walking? Trouble using your hands?

Tremors? Seizures? Speech problems? Memory problems?

Nervousness? Anxious? Depression? Confusion?

Cardiovascular Review of Systems

Any heart problems? Such as past history of heart attack or stroke?

High blood pressure? High cholesterol? High lipids? High homocysteinemia? High weight/BMI?

Do you have Diabetes? Depression? Stress? Smoking or Alcohol?

How is your Diet like? High in salt, saturated fats? How is your Lifestyle like? Do you exercise?

Any family history of heart problems?

History of rheumatic heart disease? Are you in menopause?

Do you ever experience chest pain? at rest? during exercise?

Leg pain? Calf pain? Is this pain reproducible? Relieved with...? Any night pain? Rest pain? Paresthesia (toes)? Swelling of the ankles?

Impotence? Ulcers? Visual changes?

Palpitations? Irregular heart beat? SOB?

Respiratory Review of Systems

Any SOB at rest? with exercise? Do you ever awaken short of breath?

How far can you walk on level ground (number of blocks)? How many stairs can you climb?

Can you lay flat while sleeping? How many pillows do you use?

Any changes in your skin colour?

Sore throat? Hoarseness? Cough? Any blood or sputum? What colour is it? Cough worse in the morning or at night? With exercise, cold air? Worse when lying down? Do you have post-nasal drip? Allergies? Wheezing?

Any animal exposure? Pets at home? What is your occupation? Travelled recently? Birthplace? Any TB in the family?

Gastrointestinal Review of Systems

Any cough or sore throat? Difficulty swallowing? Solids versus liquids? Any pain on swallowing? Difficulty in eating? Pain?

Regurgitation of food? Heartburn? Indigestion? Bloating? Stomach pains?

Change in bowel habits? Diarrhea? Constipation? Incontinence? Are you passing gas? Any tenesmus (urge to defecate eventhough have gone)? What is the character and/or calibre of your stool?

Bleeding? Hemorrhoid history?

Dark urine? Pale stools? Yellow skin? Jaundice? Itch? Travel history? Recent food? School or work outbreaks? Homosexual contacts? Use of NSAIDs in past?

Genitourinary Review of Systems

Obstructive symptoms (hdips): e.g. BPH

Hestiancy? Diminuished stream? Intermittence? Postvoid dribbling? Suprapubic pain and/or fullness?

Irritative symptoms (funds): e.g. UTI, infection

Frequency (how much, how often, amount)? Urgency? Nocturia? Dysuria, pain with voiding? History of Stones? Sexual history?

Hematuria? Discharge? Foul smelling urine? CVA pain? Incontinence? History of UTI's? Erectile dysfunction?

Risk factors for Stones: Family history, Inflammatory bowel syndrome, UTI's, immobilization, excess Calcium or vitamin C, diet high in nuts, tea, spinach as all have high oxalate, medications such as diuretics and chemotherapy, neurogenic problems, GU tract abnormalities

Gynecology Review of Systems

First of last menstrual period? Any vaginal discharge? Consistency? Colour? Itch? Pain? Previous STDs? Contraceptive use? IUD?

Musculoskeletal Review of Systems

Trouble walking? Trouble using your hands? Clumsiness?

Joint pain? Joint redness? Joint stiffness? Joint swelling?

Muscle pain? Aches? Weakness? Stiffness?

Back pain? Worse in leg or back? Changes with position? Worse with flexion, extension or walking? Worse during the day or at night?

Myelopathy

Perianal or saddle numbness? Loss of sensation in the legs? Leg weakness? Erectile dysfunction?

Bladder symptoms: urinary retention, increased frequency, overflow incontinence

Bowel symptoms: incontinence, poor sphincter control