What is an example of a review of systems for an adult patient with a non-specific chief complaint and a past medical history of asthma, migraines, hypothyroidism, and intermittent lower back pain?

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Last updated: January 26, 2026 • View editorial policy

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Review of Systems Example for Adult Patient

A comprehensive review of systems for an adult patient with asthma, migraines, hypothyroidism, and intermittent lower back pain should systematically assess all organ systems, with particular attention to symptoms related to their existing conditions and potential complications.

Constitutional Symptoms

  • Fever, chills, night sweats: Screen for infection or inflammatory processes
  • Unintentional weight changes: Critical for thyroid function monitoring and potential malignancy screening
  • Fatigue and weakness: May indicate inadequate thyroid hormone replacement or other systemic disease
  • Recent trauma or falls: Important red flag for vertebral compression fracture risk

Neurological System

  • Headache characteristics: Frequency, severity (0-10 scale), location (unilateral vs bilateral), quality (pulsating vs pressure-like), duration, associated photophobia, phonophobia, nausea, or visual aura 1, 2
  • Aura phenomena: Visual disturbances, sensory changes, or speech difficulties preceding headaches 1
  • Cognitive changes: Memory problems, confusion, or difficulty concentrating
  • Numbness, tingling, or weakness in extremities: Screen for radiculopathy or cauda equina syndrome 3
  • Bowel or bladder dysfunction: Critical red flag requiring immediate evaluation 3

Musculoskeletal System

  • Lower back pain characteristics: Duration (acute <4 weeks, subacute 4-12 weeks, chronic >12 weeks), location (midline vs paraspinal), radiation to legs, aggravating and relieving factors 3
  • Functional limitations: Difficulty with activities of daily living, work limitations, sleep disturbance due to pain 3
  • Morning stiffness: Duration and severity
  • Joint pain or swelling: Other locations beyond the back
  • Muscle weakness or atrophy: Particularly in lower extremities

Respiratory System

  • Asthma control: Frequency of daytime symptoms, nighttime awakenings, rescue inhaler use per week, activity limitations
  • Shortness of breath: At rest, with exertion, or nocturnal
  • Wheezing, chest tightness, or cough: Frequency and triggers
  • Recent exacerbations: Emergency department visits, hospitalizations, or oral corticosteroid courses

Endocrine System

  • Thyroid-related symptoms: Cold intolerance, dry skin, hair loss, constipation, voice changes 1, 2
  • Medication adherence: Levothyroxine timing, dosage, and consistency 1
  • Symptoms of hyperthyroidism: Heat intolerance, palpitations, tremor, weight loss (suggesting overreplacement)
  • Menstrual irregularities: In premenopausal women

Cardiovascular System

  • Chest pain or pressure: Character, duration, relationship to exertion
  • Palpitations or irregular heartbeat: Frequency and associated symptoms
  • Edema: Lower extremity swelling
  • Syncope or presyncope: Episodes of lightheadedness or loss of consciousness

Gastrointestinal System

  • Nausea or vomiting: Particularly relevant if considering NSAIDs for back pain 3, 4
  • Abdominal pain: Location, character, relationship to meals
  • Bowel habits: Constipation (common in hypothyroidism), diarrhea, or changes in stool
  • Dysphagia: Difficulty swallowing
  • History of peptic ulcer disease or GI bleeding: Contraindication to NSAIDs 3

Genitourinary System

  • Urinary frequency, urgency, or incontinence: Red flag for cauda equina syndrome 3
  • Dysuria or hematuria: Signs of infection or other pathology
  • Sexual dysfunction: Can be related to hypothyroidism or chronic pain

Psychiatric/Psychological

  • Depression or anxiety: Common comorbidities with chronic pain and migraine 3, 4
  • Catastrophizing or fear-avoidance beliefs: Predict progression to chronic disabling pain 3
  • Job dissatisfaction or work-related stress: Psychosocial risk factors for chronic back pain 3
  • Sleep disturbances: Quality and duration of sleep
  • Passive coping strategies: Predict chronicity of pain 3

Skin

  • Rashes or lesions: New or changing
  • Dry skin or hair changes: Related to hypothyroidism
  • Easy bruising: May indicate corticosteroid use or other pathology

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

  • Visual changes: Blurred vision, diplopia, or visual field defects
  • Hearing changes or tinnitus
  • Nasal congestion or sinus pressure: May trigger migraines
  • Dental problems or TMJ symptoms

Hematologic/Lymphatic

  • Easy bruising or bleeding: Particularly if considering anticoagulation or NSAIDs
  • Lymphadenopathy: Palpable enlarged lymph nodes
  • History of anemia: May be related to hypothyroidism

Red Flags Requiring Immediate Attention

  • Cauda equina syndrome symptoms: Saddle anesthesia, bowel/bladder dysfunction, bilateral leg weakness 3
  • Progressive neurologic deficits: Worsening weakness, numbness, or loss of function 3
  • History of cancer with new back pain: Concern for metastatic disease 3
  • Fever with back pain: Possible spinal infection 3
  • Significant trauma: Risk for fracture 3
  • Unexplained weight loss: Malignancy concern 3
  • Severe or progressive headache with neurologic symptoms: Concern for secondary headache disorder

Medication Review

  • Current medications: Levothyroxine dose and timing, migraine prophylaxis, asthma controllers and rescue inhalers, pain medications
  • Medication adherence and side effects
  • Over-the-counter medications: NSAIDs, acetaminophen, supplements
  • Allergies and adverse reactions

References

3
Guideline

Emergency Department Evaluation and Management of Low Back Pain

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

4
Guideline

Management of Chronic Lower Back Pain Without NSAIDs

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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