Review of Systems

The review of systems summarizes in terms of body systems all the symptoms that may have been overlooked in the history of the present illness or in the medical history. By reviewing the list of possible symptoms in an orderly manner, the interviewer can specifically check each system and uncover additional symptoms of ''unrelated'' illnesses not yet discussed. The review of systems is best organized from the head down to the extremities, and the questions can be asked while the physical examination of that body area is being examined. Patients are told that they are going to be asked whether they have ever had a particular symptom and should answer ''yes'' or ''no.'' If they answer in the affirmative, further direct questioning is appropriate. The interviewer need not repeat questions that were previously answered, unless clarification of the data is necessary.

Table 1-1 is the review of systems, about which questions should be asked of all patients. The questions should be understandable to the patient. For example, a question regarding paroxysmal nocturnal dyspnea 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?''

Each of the organ- and system-specific chapters that follow discusses the review of symptoms in more detail. Hints about specific questioning and pathophysiologic features of the symptoms are also provided.

Sometimes, a patient may answer all the questions in the affirmative. If the interviewer detects that this is occurring, it may be useful to ask a question about a physiologically impossible condition. For example, if a patient answers ''yes'' when asked, ''Do your stools glow in the dark?'' the interviewer should not continue with the review of systems. The interviewer can state in the written history or in the verbal presentation that ''the patient has a positive review of systems.''

Because the goal of the medical history is to acquire as much information about each illness as possible, other specific questions related to the particular patient may be indicated. Look at the patient shown in Figure 1-2. Note the large jaw and nose. If you saw such a patient, you

Table 1-1 Review of Systems

General

Nose

Breasts

Female Genitalia

Usual state of health

Nosebleeds

Lumps

Lesions on external genitalia

Fever

Infections

Discharge

Itching

Chills

Discharge

Pain

Discharge

Usual weight

Frequency of colds

Tenderness

Date of most recent Pap

Change in weight

Nasal obstruction

Self-examination

smear and result

Weakness

History of injury

Gastrointestinal

Pain on intercourse

Fatigue

Sinus infections

Appetite

Frequency of intercourse

Sweats

Hay fever

Excessive hunger

Birth control methods

Heat or cold intolerance

Mouth and Throat

Excessive thirst

Ability to enjoy sexual

History of anemia

Condition of teeth

Nausea

relations

Bleeding tendencies

Date of most recent dental

Swallowing

Fertility problems

Blood transfusions and

appointment

Constipation

Hernias

possible reactions

Condition of gums

Diarrhea

History of venereal disease

Exposure to radiation

Bleeding gums

Heartburn

and treatment

Skin

Frequent sore throats

Vomiting

History of diethylstilbestrol

Rashes

Burning sensation of tongue

Abdominal pain

(DES) exposure

Itching

Hoarseness

Change in stool color

Age at menarche

Hives

Voice changes

Change in stool caliber

Interval between periods

Easy bruising

Postnasal drip

Change in stool consistency

Duration of periods

History of eczema

Neck

Frequency of bowel

Amount of flow

Dryness

Lumps

movements

Date of last period

Changes in skin color

Goiter

Vomiting blood

Bleeding in between periods

Changes in hair texture

Pain on movement

Rectal bleeding

Number of pregnancies

Changes in nail texture

Tenderness

Black, tarry stools

Abortions

Changes in nail appearance

History of ''swollen glands''

Laxative or antacid use

Term deliveries

History of previous skin

Thyroid trouble

Excessive belching

Complications of pregnancies

disorders

Chest

Food intolerance

Description(s) of labor

Lumps

Cough

Change in abdominal size

Number of living children

Use of hair dyes

Pain

Hemorrhoids

Menstrual pain

Head

Shortness of breath

Infections

Age at menopause

''Dizziness''

Sputum production (quantity,

Jaundice

Menopausal symptoms

Headaches

appearance)

Rectal pain

Postmenopausal bleeding

Pain

Tuberculosis

Previous abdominal x-ray

Musculoskeletal

Fainting

Asthma

films

Weakness

History of head injury

Pleurisy

Hepatitis

Paralysis

Stroke

Bronchitis

Liver disease

Muscle stiffness

Eyes

Coughing up blood

Gallbladder disease

Limitation of movement

Use of eyeglasses

Wheezing

Urinary

Joint pain

Current vision

Most recent x-ray film

Frequency

Joint stiffness

Change in vision

Most recent test for

Urgency

Arthritis

Double vision

tuberculosis

Difficulty in starting the

Gout

Excessive tearing

History of bacille Calmette-

stream

Back problems

Pain

Guerin (BCG) vaccination

Incontinence

Muscle cramps

Recent eye examinations

Cardiac

Excessive urination

Deformities

Pain when looking at light

Chest pain

Pain on urination

Neurologic

Unusual sensations

High blood pressure

Burning sensation

Fainting

Redness

Palpitations

Blood in urine

''Dizziness''

Discharge

Shortness of breath with

Infections

''Blackouts''

Infections

exertion

Stones

Paralysis

History of glaucoma

Shortness of breath when

Bed-wetting

Strokes

Cataracts

lying flat

Awakening at night to

''Numbness''

Injuries

Sudden shortness of breath

urinate

Tingling

Ears

while sleeping

History of retention

Burning sensation

Hearing impairment

History of heart attack

Urine color

Tremors

Use of hearing aid

Rheumatic fever

Urine odor

Loss of memory

Discharge

Heart murmur

Male Genitalia

Psychiatric disorders

''Dizziness''

Most recent electrocardiogram

Lesions on penis

Mood changes

Pain

Other tests for heart function

Discharge

Nervousness

Ringing in ears

Vascular

Erectile dysfunction

Speech disorders

Infections

Pain in legs, calves, thighs,

Pain

Unsteadiness of gait

or hips while walking

Scrotal masses

General behavioral change

Swelling of legs

Hernias

Loss of consciousness

Varicose veins

Frequency of intercourse

Hallucinations

Thrombophlebitis

Ability to enjoy sexual relations

Disorientation

Coolness of extremity

Fertility problems

Loss of hair on legs

Prostate problems

Discoloration of extremity

History of venereal disease

Ulcers

and treatment

might try to determine when the facial changes occurred. In such a case, you could ask the man whether he has noticed a change in his hat or baseball cap size and when he first noticed it.

Look at Figure 1-3, in which the right hand of the same patient (on the right) is compared with the right hand of a normal individual. Asking about a change in glove size would be useful with this particular patient. It would be appropriate to inquire whether there has been a change in shoe size as well.

A useful bit of information may be an old photograph of the patient to help determine when the suspected changes occurred. Compare Figure 1-2 with the photograph in Figure 1-4 (of the same patient taken 20 years earlier). Notice the bulging forehead and the prominent jaw in the later photograph. The patient has acromegaly, a condition of abnormal, excess growth hormone secreted by a pituitary tumor. The changes are insidious, occurring over many years. The photograph was helpful in determining the changes in bone and soft tissue structure.

Figure 1-3 Acromegaly: characteristics of hands. Note the stubby fingers of the patient on the right, compared with the fingers of a normal hand on the left.

Figure 1-4 Photograph of the patient shown in Figure 1-2, taken 20 years earlier. Compare the

Natural Arthritis Relief

Natural Arthritis Relief

Natural Arthritis Relief details a unique method of reversing Rheumatoid Arthritis Symptoms by removing numerous arthritis triggers as well as toxins using a simple 5 step natural process.

Get My Free Ebook


Post a comment