REVIEW OF SYSTEMS QUESTIONS

General
1. Weight change
2. Fever and chills
3. Night sweats
4. Dizziness
Endocrine
1. Heat or cold intolerance
2. Thyroid problems
3. Neck surgery of irradiation of the neck
4. Diabetes and diabetic indicators
Eye
1. Visual dysfunction
Ear, Nose, Throat
1. Difficulty hearing or deafness
2. Tinnitus
3. Epistaxis
4. Hoarseness
5. Sinusitis
6. Vertigo
Gastrointestinal system
1. Nausea and retching
2. Vomiting
3. Hematemesis
4. Melena
5. Dysphagia
6. Indigestion
7. Heartburn
8. Abdominal pain
9. Abdominal swelling
10. Jaundice
11. Hematochezia
12. Diarrhea
13. Constipation
14. Hernia
15. Hemorrhoids
16. History of peptic ulcer disease
17. History of gallbladder disease
18. History of pancreatitis
19. History of alcohol intake

Pulmonary system
1. Dyspnea or shortness of breath
2. Cough and sputum production
3. Hemoptysis
4. Wheezing and asthma
5. Tuberculosis and exposure to tuberculosis
6. Tuberculosis skin test (PPD)
7. Previous chest x-ray
8. Respiratory infections and pneumonia
9. Smoking history
10. Environmental inhalation
Cardiovascular system
1. Exercise level
2. Orthopnea and paroxysmal nocturnal dyspnea
3. Chest discomfort or pain
4. Palpitation
5. Syncope
6. Edema
7. Phlebitis
8. Claudication
9. Hypertension
10. Rheumatic fever
11. Past heart disease
12. Family history of heart disease
Genitourinary disease
1. Urinary frequency, urgency, and dysuria
2. Urinary tract infection
3. Flank pain
4. Nocturia
5. Hematuria
6. Past stones
7. Urinary stream flow abnormality: hesitancy, intermittency, and incontinence
8. Urethral discharge
9. Syphilis or positive serology
10. Male genital lesions
11. Testicular mass or pain
12. Impotence
13. Family history of renal disease
Female genitalia
1. Pelvic pain
2. Vaginal discharge
3. Abnormal vaginal bleeding
4. Pelvic mass

Breast
1. Breast lump
2. Breast pain
3. Nipple discharge
Skin
1.
2.
3.
4.

Past history of skin disease

Itching (pruritis)
Change in mole (nevus)
Skin cancer

Neurological system
1. Headaches
2. Seizures
3. Episodic neurological symptoms
4. Pain and sensory perturbations
5. Weakness
6. Head trauma
7. Muscle cramps
8. Stroke
9. Sleep disorders
Hematopoietic system
1. Excessive bleeding or bruising
2. Anemia
3. Pica
4. Family history of sickle cell anemia and other blood disease
Musculoskeletal system
1. Joint stiffness
2. Joint pain
3. Joint swelling
4. Family history of musculoskeletal disease
Psychiatric history
1. Previous psychiatric problems
2. Interpersonal relationships
3. Anxiety
4. Depressions
5. Loss of control
6. Disturbances of vegetative function
7. Substance abuse