What questions should be asked during a review of systems?

Review of Systems Questions

A comprehensive review of systems should systematically assess symptoms across all major body systems using specific, targeted questions about common symptoms in each organ system to identify health concerns beyond the chief complaint. 1

Core Body Systems to Query

Constitutional Symptoms

• Unexplained weight loss, night sweats, fever, and changes in body habitus 1
• Current weight compared with baseline, along with dietary assessment 1

Integumentary System

• Skin discoloration, rash, ulcers, or lesions 1

Head, Eyes, Ears, Nose, and Throat (HEENT)

• Localized or generalized lymph node enlargement 1
• Visual changes or disturbances 1
• Oral thrush or ulceration, and swallowing difficulties 1

Respiratory System

• Cough, shortness of breath, wheezing, and chest pain 1

Cardiovascular System

• Chest pain, palpitations, orthopnea, and edema 1
• History of cardiovascular disease and cerebrovascular disease or stroke 2

Gastrointestinal System

• Nausea, vomiting, abdominal pain, diarrhea, and changes in bowel habits 1

Genitourinary System

• Urinary frequency, urgency, and dysuria 1
• For women, obtain a menstrual history 1

Musculoskeletal System

• Joint pain, stiffness, swelling, and muscle weakness 1

Neurological System

• Changes in neurological function or mental status 1
• History of head injury, concussion, or loss of consciousness 2
• Known underlying neurologic structural abnormalities 2

Psychiatric System

• Depression screening should be performed 1
• Neurovegetative signs including appetite changes, weight loss, and sleep pattern changes 2

Special Population Considerations

Elderly Patients

• Assessment of functional and cognitive performance, frailty, fall risk, and need for assistive devices 1

Patients with Intellectual/Developmental Disabilities

• Obtain a historical description of baseline functioning from a family member or caregiver who knows the individual well 2
• Compare current functioning with baseline to identify memory loss, personality changes, disorientation, and decreasing task performance 2
• Assess for psychosocial issues including life events such as leaving family home, death of loved ones, decline in health or employment status, and caregiver turnover 2

Diabetic Patients

• Comprehensive foot examination with inspection of skin integrity, assessment of foot deformities, neurological assessment, and vascular assessment 1
• History of poorly treated metabolic syndrome (obesity, diabetes, hypertension) 2

Cardiovascular Concerns

• Assessment of volume status, jugular venous pressure, and presence of peripheral edema 1

Acute Limb Ischemia

• Focus on uncovering clinical evidence of atrial fibrillation, myocardial infarction, cardiomyopathy, valvular heart disease, aortic disease, and hypercoagulable states 1

Neurological Disorders

• Include assessment of timed gait, motor movements, reflexes, and Babinski signs 1

Additional Medical History Elements

Comorbid Conditions

• History of poorly treated sleep disorders or thyroid disease 2
• Vitamin B12 deficiency 2

Clinical Significance

A comprehensive review of systems helps identify symptoms not mentioned in the chief complaint that may be relevant to diagnosis and treatment 1. This systematic approach is essential for determining which organ systems are affected 1 and can guide the physical evaluation and diagnostic workup 1.

Common Pitfalls to Avoid

Avoid diagnostic overshadowing in patients with intellectual disabilities, where features of underlying mental illness are incorrectly attributed to the intellectual disability itself 2. Pay close attention to changes from baseline mood, behavior, or personality, which should raise concern for emerging psychiatric or mental health disorders 2.