Comprehensive Review of Systems (ROS) Questions for Medical History Intake
A thorough Review of Systems (ROS) should systematically cover all major body systems to identify symptoms that may impact patient morbidity, mortality, and quality of life. The following ROS framework provides a structured approach to gathering essential clinical information during patient history intake.
General ROS Questions
Constitutional Symptoms
- Fever, night sweats, unintentional weight loss/gain
- Changes in energy level, fatigue, malaise
- Sleep patterns and disturbances
- Appetite changes
Mental Health Screening
- Changes in mood, concentration, memory
- Symptoms of depression or anxiety
- Suicidal ideation or self-harm thoughts 1
- Post-traumatic stress symptoms 1
System-Specific ROS Questions
Head, Eyes, Ears, Nose, and Throat (HEENT)
- Headaches: frequency, severity, associated symptoms
- Visual changes: blurring, diplopia, photophobia
- Hearing: changes, tinnitus, vertigo
- Nasal: congestion, discharge, epistaxis
- Oral/Throat: sore throat, oral lesions, dysphagia 1
Cardiovascular
- Chest pain or discomfort: character, radiation, precipitating factors
- Palpitations, irregular heartbeat
- Orthopnea, paroxysmal nocturnal dyspnea
- Peripheral edema, claudication symptoms 1
Respiratory
- Cough: productive/non-productive, duration
- Shortness of breath: at rest or with exertion
- Wheezing, hemoptysis
- History of asthma, COPD, or other respiratory conditions 1
Gastrointestinal
- Abdominal pain: location, character, relation to meals
- Nausea, vomiting, diarrhea, constipation
- Changes in bowel habits
- GI-specific anxiety and impact on quality of life 1
- Rectal bleeding, melena, hematochezia
Genitourinary
- Urinary frequency, urgency, dysuria
- Hematuria, nocturia
- Incontinence issues
- For women: menstrual history, vaginal discharge/bleeding
- For men: erectile dysfunction, testicular pain 1
Musculoskeletal
- Joint pain, swelling, stiffness
- Muscle weakness, pain
- Limitations in range of motion
- Back pain and its impact on daily activities
Neurological
- Headaches, dizziness, syncope
- Numbness, tingling, weakness
- Seizures, tremors
- Changes in coordination or balance
- Cognitive changes: memory, concentration 1
Skin
- Rashes, lesions, color changes
- Pruritus, excessive dryness
- Changes in moles or skin growths
- Skin infections or poor wound healing 1
Endocrine
- Polyuria, polydipsia, polyphagia
- Heat or cold intolerance
- Excessive sweating
- Changes in hair distribution
Special Population Considerations
HIV-Specific ROS
For patients with HIV, additional questions should include:
- History of opportunistic infections
- Medication adherence and side effects
- CD4 count and viral load history
- STI screening and prevention 1
Pediatric-Specific ROS
For pediatric patients:
- Developmental milestones
- Growth patterns
- Immunization status
- School performance
- Family dynamics 1
Diabetes-Specific ROS
For patients with diabetes:
- Hypoglycemic episodes
- Polyuria, polydipsia
- Vision changes
- Foot problems
- Vaccination status 1
Psychosocial Assessment
Social History
- Tobacco, alcohol, and substance use
- Sexual history and practices
- Housing situation and stability
- Occupation and potential exposures
- Support systems [1, 1
Trauma History
- Adverse childhood experiences
- History of physical, emotional, or sexual abuse
- Domestic violence screening
- Post-traumatic stress symptoms 1
Quality of Life Assessment
Ask open-ended questions about how symptoms affect daily functioning:
- "How do your symptoms interfere with your ability to do what you want to do in your daily life?"
- "What areas of your life are affected most by your condition?" 1
Best Practices for ROS
Use open-ended questions first followed by more specific inquiries to gather more comprehensive information 2, 3
Document both positive and negative findings to establish baseline and track changes over time
Pay attention to non-verbal cues that may indicate undisclosed symptoms
Prioritize systems relevant to the chief complaint but still cover all systems briefly
Consider using standardized screening tools for depression, anxiety, and substance use when indicated
Create a non-judgmental environment to encourage disclosure of sensitive information 1
By systematically covering these areas during the ROS, clinicians can identify symptoms that may significantly impact patient morbidity, mortality, and quality of life, allowing for earlier intervention and improved outcomes.