Review of systems (ROS

 Description: a list of questions, arranged by organ systems, to help establish the

causes of signs and symptoms
 Goals
o Systematic approach to establish the correlation of symptoms to organ systems
o Identifying potential or underlying concerns that the patient did not report while
taking an 
HPI
 or 
PMH

o Establishing positive and negative organ-specific findings

 Types
o Comprehensive: covers all organ systems; usually done during an initial general
health maintenance visit when the patient has no specific concerns.
o Focused: covers only the specific organ systems most likely to be connected to
the chief concern

You do not have to ask every question; tailor the questionnaire to the patient

and their chief concern (e.g., sexual history may not be relevant if the

reason for the visit is an ankle fracture follow-up). Use your best

judgment about what to ask and what to leave out, keeping in mind you

generally have no more than 10–15 minutes per interview.

ROS
 questionnaire 
 [1]

Constitutional symptoms
 General state of health including energy, strength, exercise tolerance?
 Fever or chills?
 Night sweats? 
 Fatigue?
 Changes in weight? 
 Changes in appetite?
 Trouble sleeping? 
Eye
 Glasses or contacts?
 Change in 
visual acuity
?
 Blurry or 
double vision
?
 Pain?
 Photophobia
?
 Ability to see at night?
 Ocular discharge/excessive tearing?
 Flashing lights, 
floaters
, or blind spots?
 Yellowish discoloration of 
sclera
?
 Redness?

Glaucoma
?

Cataracts
?
 Last eye exam?
Head and neck

Headache
?
 Neck stiffness?
 Neck pain or tenderness?
 Neck lumps?

Head injury
?
Ear, nose, mouth, and throat (ENT)
 Ears
o Hearing loss?
o
Tinnitus
 (ringing in ears)?
o Earache?
o
Ear discharge
?
 Nose
o
Nosebleeds
?
o Nose obstruction or discharge?
o Nose itching?
o Change in sense of smell?
o
Postnasal drainage
?
o Sinus pain?
o
Hay fever
?
 Mouth and throat
o Dentures?
o Mouth sores?
 o Change in sense of taste?
o
Thrush
?
o Sore throat?
o Halitosis
?
o Change in voice?
Cardiovascular
 Chest pain or tightness (on exertion or at rest)?

Palpitations
 (on exertion or at rest)?

Dyspnea
 (
shortness of breath
 on exertion or at rest)? 
 Peripheral 
edema
 (leg or ankle swelling)?

Paroxysmal nocturnal dyspnea
 (sudden awakening from sleep with 
shortness of breath
)?

Orthopnea
 (
shortness of breath
 when lying down)?

Syncope
 (
dizziness
, fainting spells)?

Cyanosis
?
Respiratory
 Cough (dry or wet, productive)?

 Sputum
 color, amount, and occurrence (e.g., green/yellow, bloody, particularly after
waking up)?

Asthma
 or wheezing?

Dyspnea
 (
shortness of breath
)?
 Painful breathing?
Gastrointestinal

Dysphagia
 (swallowing difficulties)?
 Nausea or vomiting?

Hematemesis
 (bloody vomiting)?
 Change in appetite? 
 Abdominal pain?
 Abdominal distention/
bloating
?
 Early satiety?

Jaundice
 (yellow eyes or skin)?
 Rectal pain?
 Changes in bowel movement
o
Diarrhea
?
o
Constipation
? 
 Change in stool appearance
 o Clay-colored stools? 
o Acholic stools (pale/white)? 
o Tar-colored (black) stools? 
o Bloody stools? 
Genitourinary
Urinary
 Frequent or urgent 
urination
?

Dysuria
 (burning or painful 
urination
)?

Polyuria
/
oliguria
?

Nocturia
 (excessive 
urination
 at night)? 
 Dribbling of urine?
 Change in urinary strength?

Hematuria
 (blood in urine)?
 Other changes in urine appearance (e.g., foamy, brown)?
 Incontinence? 
Genital
 Female patients
o Last menstrual period?
o Irregular menses?
o
Menopause
?
o Vaginal dryness?
 o
Hot flashes
?
o Vaginal discharge or bleeding?
o Genital lesions?
o Genital itching or rash?
o
STDs
?
o
Dyspareunia
 (painful intercourse)?
o
Pelvic
 pain?
o
Contraceptive
 methods?
o Number of 
pregnancies
?
o Last 
Pap smear
 and mammogram?
 Male patients
o
Dyspareunia
 (painful intercourse)?
o Penile discharge or bleeding?
o Genital lesions?
o Genital masses or pain?
o Genital itching or rash?
o
STDs
?
o Changes in libido and 
erectile dysfunction
? 
o Hernia
 ?
Musculoskeletal
 Muscle or joint pain?
 Joint swelling?
 Joint redness?
 Joint stiffness?

 Bony deformity?
 Muscle weakness?
 Muscle 
atrophy
?
 Cramps?
 Trauma?
 Back pain?
Integumentary system
Skin and hair

Pruritus
 (itching)?
 Burning?
 Dryness?
 Rashes?
 Sores?
 Lumps?
 Changes in pigmentation and skin color (e.g., yellowish discoloration of skin)?
 Hair loss/gain?
 Changes in nails (e,g, 
clubbing
, ridges)?
Breast
 Breast lumps or masses? 
 Swelling?
 Nipple discharge?
 Pain?
 Dimpling or 
retraction
 ?
Neurological
 Change in memory?
 Change in speech?
 Recurring or frequent 
headaches
?

Lightheadedness
/
dizziness
?
 Fainting?
 Convulsions
 or 
seizures
?
 Sensory changes (e.g., 
paresthesia
/numbness, tingling)?

Vertigo
?
 Tremor?
 Paralysis (loss of strength)?
See 
neurological examination
 for more information.
Psychiatric
 Stress?
 Mood swings?
 Depression?
 Nervousness/anxiety?
 Problems with concentration?
 Unusual perception or 
hallucinations
?
 Insomnia
 (difficulty sleeping)?
 Psychiatric disorder?
See 
mental status examination
 for more information.
Endocrine
 Heat or cold intolerance?

Excessive sweating
?
 Weight gain or loss?
 Change in appetite?

Polyuria
 (frequent 
urination
)?
 Menstrual irregularities?

Thyroid
 enlargement or tenderness?
 Increased or decreased thirst? 
 Change in size of head or hands?

Hormone
 therapy?
Hematologic/lymphatic
 Recurrent and easy 
bruising
?
 Recurrent bleeds on minor trauma?
 Previous 
blood transfusion
 and reactions?

Lymph node
  enlargement or tenderness?
Vascular

Claudication
 (calf cramping) with walking or at rest?
Allergic/immunologic

Hay fever
?
 Seasonal 
allergies
?

Hives
 or 
eczema
?
 Itching, runny nose, watery eyes?