OnExam

A formal review of systems can include questions touching upon all of the following topics. Tailor the review to the patient's presentation, ability as a historian, and disposition. The importance of positive or negative findings should also play in to the decision of what questions should be posed.

General/B symptoms

  • Weakness
  • Fatigue
  • Weight change (>10% of weight in 6 months)
  • Fever (>38°C)
  • Drenching night sweats (soaked sheets)

Integument

  • Changes in skin: rashes, lumps, sores, itching, dryness
  • Changes in hair or nails
  • Changes in size or colour of moles

HEENT

  • Head
    • Headache
    • Head injuries
    • Lightheadedness
  • Eyes
    • Changes in vision
    • Dryness
  • Ears
    • Hearing changes, tinnitus
    • Vertigo
    • Earaches
    • Discharge
  • Nose and sinuses
    • Nasal stuffiness, discharge, or itching
    • Nosebleeds
    • Sinus congestion
  • Throat
    • Sore tongue
    • Dry mouth
    • Sore Throats
    • Hoarseness
  • Neck
    • “Swollen glands”
    • Lumps
    • Pain
    • Neck stiffness

Breast

  • Lumps
  • Pain/discomfort
  • Nipple discharge

Respiratory

  • Cough, sputum (colour, quantity)
  • Hemoptysis
  • Dyspnea
  • Wheezing

Cardiovascular

  • Heart troubles
  • High blood pressure
  • Chest pain or discomfort
  • Palpitations
  • Orthopnea
  • Paroxysmal nocturnal dyspnea
  • Edema

Gastrointestinal

  • Troubles swallowing
  • Heartburn
  • Appetite
  • Nausea
  • Change in bowel habits, red or black stools, diarrhea
  • Abdominal pain

Urinary

  • Polyuria, nocturia
  • Urgency
  • Burning or pain during urination (dysuria)
  • Hematuria
  • Flank or suprapubic pain
  • Incontinence
  • Male BPH: reduced caliber/force, hesitancy, dribbling

Genital

  • Discharge, sores, itching, lumps
  • History of sexually transmitted infections and treatment
  • Male: Testicular or scrotal pain or masses
  • Female: Abnormal periods/bleeding

Peripheral Vascular

  • Leg pain (claudication, cramps), swelling, or redness
  • Colour change in fingertips or toes during cold weather

Musculoskeletal

  • Muscle or joint pain
  • Stiffness

Psychiatric/Neurologic

  • Nervousness
  • Changes in mood, attention, or speech
  • Changes in orientation, memory, insight, or judgment
  • Seizures
  • Numbness or loss of sensation
  • Tingling or “pins and needles”
  • Tremors or other involuntary movements

Hematologic

  • Easy bruising
  • Bleeding

Endocrine

  • Heat or cold intolerance
  • Excessive sweating
  • Excessive thirst or hunger

References

  1. Bickley LS, Szilagyi, PG. Chapter 4, Beginning the Physical Examination: General Survey and Vital Signs. In: Bates’ Guide to Physical Examination and History Taking. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2007: 105-112.