Review of systems - wikipedia Review of systems A review of systems ( ROS ), also called a systems enquiry or systems review, is a technique used by healthcare providers for eliciting a medical history from a patient. It is often structured as a component of an admission note covering the organ systems, with a focus upon the subjective symptoms perceived by the patient ( as opposed to the objective signs perceived by the clinician ). Along with the physical examination, it can be particularly useful in identifying conditions that do not have precise diagnostic tests. Examples Whatever system a specific condition may seem restricted to, it may be reasonable to review all the other systems in a comprehensive history. Different sources describe slightly different systems of organizing the organ systems. However, the following are examples of what can be included : There are 14 systems recognized by the Centers for Medicare and Medicaid Services : System Examples Constitutional symptoms unexplained weight loss, night sweats, fatigue / malaise / lethargy, sleeping pattern, appetite, fever, itch / rash, recent trauma, lumps / bumps / masses, unexplained falls Eyes visual changes, headache, eye pain, double vision, scotomas ( blind spots ), floaters or `` feeling like a curtain got pulled down '' ( retinal hemorrhage vs amaurosis fugax ) Ears, nose, mouth, and throat ( ENT ) Runny nose, frequent nose bleeds ( epistaxis ), sinus pain, stuffy ears, ear pain, ringing in ears ( tinnitus ), gingival bleeding, toothache, sore throat, pain with swallowing ( odynophagia ) Cardiovascular chest pain, shortness of breath, exercise intolerance, PND, orthopnoea, oedema, palpitations, faintness, loss of consciousness, claudication Respiratory cough, sputum, wheeze, haemoptysis, shortness of breath, exercise intolerance Gastrointestinal abdominal pain, unintentional weight loss, difficulty swallowing ( solids vs liquids ), indigestion, bloating, cramping, anorexia, food avoidance, nausea / vomiting, diarrhea / constipation, inability to pass gas ( obstipation ), vomiting blood ( haematemesis ), bright red blood per rectum ( BRBPR, hematochezia ), foul smelling dark black tarry stools ( melaena ), dry heaves of the bowels ( tenesmus ) Genitourinary Urinary : Irritative vs Obstructive symptoms : Micturition -- incontinence, dysuria, haematuria, nocturia, polyuria, hesitancy, terminal dribbling, decreased force of stream Genital : Vaginal -- discharge, pain, Menses -- frequency, regularity, heavy or light ( ask about excessive use of pads / tampons, staining of clothes, clots always indicate heavy bleeding ), duration, pain, first day of last menstrual period ( LMP ), gravida / para / abortus, menarche, menopause, contraception ( if relevant ), date of last smear test and result Musculoskeletal pain, misalignment, stiffness ( morning vs day long ; improves / worsens with activity ), joint swelling, decreased range of motion, crepitus, functional deficit, arthritis Integumentary / Breast pruritus, rashes, stria, lesions, wounds, incisions, acanthosis nigricans, nodules, tumors, eczema, excessive dryness and / or discoloration. Breast pain, soreness, lumps, or discharge. Neurological Special senses -- any changes in sight, smell, hearing and taste, seizures, faints, fits, funny turns, headache, pins and needles ( paraesthesiae ) or numbness, limb weakness, poor balance, speech problems, sphincter disturbance, higher mental function and psychiatric symptoms Psychiatric depression, sleep patterns, anxiety, difficulty concentrating, body image, work and school performance, paranoia, anhedonia, lack of energy, episodes of mania, episodic change in personality, expansive personality, sexual or financial binges Endocrine Hyperthyroid : prefer cold weather, mood swings, sweaty, diarrhoea, oligomenorrhoea, weight loss despite increased appetite, tremor, palpitations, visual disturbances ; Hypothyroid -- prefer hot weather, slow, tired, depressed, thin hair, croaky voice, heavy periods, constipation, dry skin Diabetes : polydipsia, polyuria, polyphagia ( constant hunger without weight gain is more typical for a type I diabetic than type II ), symptoms of hypoglycemia such as dizziness, sweating, headache, hunger, tongue dysarticulation Adrenal : difficult to treat hypertension, chronic low blood pressure, orthostatic symptoms, darkening of skin in non-sun exposed places Reproductive ( female ) : menarche, cycle duration and frequency, vaginal bleeding irregularities, use of birth control pills, changes in sexual arousal or libido Reproductive ( male ) : difficulty with erection or sexual arousal, depression, lack of stamina / energy Hematologic / lymphatic anemia, purpura, petechia, results from routine hemolytic diseases screening, prolonged or excessive bleeding after dental extraction / injury, use of anticoagulant and antiplatelet drugs ( including aspirin ), family history of hemophilia, history of a blood transfusion, refused for blood donation Allergic / immunologic `` Difficulty breathing '' or `` choking '' ( anaphylaxis ) as a result of exposure to anything ( and state what ; e.g. `` bee sting '' ). Swelling or pain at groin ( s ), axilla ( e ) or neck ( swollen lymph nodes / glands ), allergic response ( rash / itch ) to materials, foods, animals ( e.g. cats ) ; reaction to bee sting, unusual sneezing ( in response to what ), runny nose or itchy / teary eyes ; food, medication or environmental allergy test ( s ) results. The questions may be asked of the patient in a `` head to toe '' manner. Relationship to history CMS required history elements Type of history CC HPI ROS Past, family, and / or social Problem focused Required Brief N / A N / A Expanded problem focused Required Brief Problem pertinent N / A Detailed Required Extended Extended Pertinent Comprehensive Required Extended Complete Complete For CMS, a `` problem pertinent '' ROS is limited to the problem ( s ) identified in the HPI ; an `` extended '' ROS covers an additional 2 to 9 systems, and a `` complete '' ROS covers at least 10 additional systems. References Jump up ^ Tuite PJ, Krawczewski K ( April 2007 ). `` Parkinsonism : a review - of - systems approach to diagnosis ''. Semin Neurol. 27 ( 2 ) : 113 -- 22. doi : 10.1055 / s - 2007 - 971174. PMID 17390256. Jump up ^ `` www.cms.gov '' ( PDF ). Archived from the original ( PDF ) on 2011 - 03 - 22. Retrieved 2011 - 02 - 27. Jump up ^ Lynn S. Bickley ; Peter G. Szilagyi ( 1 December 2008 ). Bates ' guide to physical examination and history taking. Lippincott Williams & Wilkins. pp. 10 --. ISBN 978 - 0 - 7817 - 8058 - 2. Retrieved 27 February 2011. ^ Jump up to : `` Evaluation and Management Services Guide '' ( PDF ). www.cms.gov. December 2010. Archived from the original ( PDF ) on 2012 - 04 - 11. Retrieved 2011 - 02 - 27. Medical examination and history taking Medical history Chief complaint History of the present illness Systems review Nursing assessment Allergies Medications Past medical history Family history Social history Psychiatric history Progress notes Mnemonics SAMPLE OPQRST SOAP COASTMAP Physical examination General / IPPA Inspection Auscultation Palpation Percussion Vital signs Temperature Heart rate Blood pressure Respiratory rate HEENT Oral mucosa TM Eyes ( Ophthalmoscopy, Swinging - flashlight test ) Hearing ( Weber, Rinne ) Respiratory Respiratory sounds Cyanosis Clubbing Cardiovascular Precordial examination Peripheral vascular examination Heart sounds Other Jugular venous pressure Abdominojugular test Carotid bruit Ankle - brachial pressure index Abdominal Digestive Liver span Rectal Murphy 's sign Bowel sounds Urinary Murphy 's punch sign Extremities / Joint Back ( Straight leg raise ) Knee ( McMurray test ) Hip Wrist ( Tinel sign, Phalen maneuver ) Shoulder ( Adson 's sign ) GALS screen Neurological Mental state Mini -- mental state examination Cranial nerve examination Upper limb neurological examination Neonatal Apgar score Ballard Maturational Assessment Gynecological Well - woman examination Vaginal examination Breast examination Cervical motion tenderness Assessment and plan Medical diagnosis Differential diagnosis Symptoms and signs : general / constitutional ( R50 -- R61, 780.6 -- 780.9 ) Temperature heat : Fever Fever of unknown origin Drug - induced fever Postoperative fever Hyperhidrosis e.g., Sleep hyperhidrosis ; `` sweating '' Hyperpyrexia Hyperthermia cold : Chills Hypothermia Aches / pains Headache Chronic pain Cancer pain Myalgia Malaise and fatigue Atrophy e.g., Muscular atrophy Debility ( or asthenia ) Lassitude Lethargy Muscle tremors Tenderness Miscellaneous Flu - like symptoms Symptoms and signs : cognition, perception, emotional state and behaviour ( R40 -- R46, 780.0 -- 780.5, 781.1 ) Cognition Alteration of consciousness Confusion ( Delirium ) Somnolence Obtundation Stupor Unconsciousness Syncope Coma Persistent vegetative state Fainting / Syncope Carotid sinus syncope Heat syncope Vasovagal episode Other Amnesia Anterograde amnesia Retrograde amnesia Dizziness Vertigo Presyncope / Lightheadedness Disequilibrium Convulsion Emotional state Anxiety Irritability Hostility Suicidal ideation Behavior Verbosity Russell 's sign Perception / sensation disorder Audition Olfaction : Anosmia Hyposmia Dysosmia Parosmia Phantosmia Hyperosmia Tactile perception Taste : Ageusia Hypogeusia Dysgeusia Parageusia Hypergeusia Visual perception Hallucination : Auditory hallucination Symptoms and signs relating to the cardiovascular system ( R00 -- R03, 785 ) Chest pain Referred pain Angina Aerophagia Auscultation Heart sounds Split S2 S3 S4 Gallop rhythm Heart murmur Systolic Diastolic Continuous Pericardial friction rub Heart click Bruit carotid Pulse Tachycardia Bradycardia Pulsus tardus et parvus Pulsus paradoxus doubled Pulsus bisferiens Dicrotic pulse Pulsus bigeminus Pulsus alternans Pulse deficit Vascular disease Gangrene Other Palpitations Apex beat Cœur en sabot Jugular venous pressure Cannon A waves Hyperaemia Shock Cardiogenic Hypovolemic Distributive Septic Neurogenic Symptoms and signs relating to the respiratory system ( R04 -- R07, 786 ) Medical examination and history taking Auscultation Stethoscope Respiratory sounds Stridor Wheeze Crackles Rhonchi Stertor Squawk Pleural friction rub Fremitus Bronchophony Terminal secretions Elicited findings Percussion Pectoriloquy Whispered pectoriloquy Egophony Breathing Rate Apnea Prematurity Dyspnea Hyperventilation Hypoventilation Hyperpnea Tachypnea Hypopnea Bradypnea Pattern Agonal respiration Biot 's respiration Cheyne -- Stokes respiration Kussmaul breathing Ataxic respiration Other Respiratory distress Respiratory arrest Orthopnea / Platypnea Trepopnea Aerophagia Asphyxia Breath holding Mouth breathing Snoring Other Chest pain In children Precordial catch syndrome Pleurisy Nail clubbing Cyanosis Cough Sputum Hemoptysis Epistaxis Silhouette sign Post-nasal drip Hiccup COPD Hoover 's sign asthma Curschmann 's spirals Charcot -- Leyden crystals chronic bronchitis Reid index sarcoidosis Kveim test pulmonary embolism Hampton hump Westermark sign pulmonary edema Kerley lines Hamman 's sign Golden S sign Symptoms and signs : Speech and voice / Symptoms involving head and neck ( R47 -- R49, 784 ) Aphasias Acute aphasias Expressive aphasia Receptive aphasia Conduction aphasia Anomic aphasia Global aphasia Transcortical sensory aphasia Transcortical motor aphasia Mixed transcortical aphasia Progressive Aphasias Progressive nonfluent aphasia Semantic dementia Logopenic progressive aphasia Speech disturbances Speech disorder Developmental verbal dyspraxia / ‎ Apraxia of speech Auditory verbal agnosia Dysarthria Schizophasia Aprosodia / Dysprosody Specific language impairment Thought disorder Pressure of speech Derailment Clanging Circumstantiality Communication disorders Developmental dyslexia / Alexia Agnosia Astereognosis Prosopagnosia Visual agnosia Gerstmann syndrome Developmental coordination disorder / Apraxia Ideomotor apraxia Dyscalculia / Acalculia Agraphia Voice disturbances Dysphonia / Aphonia Bogart -- Bacall syndrome Nose Post-nasal drip Epistaxis Mouth Orofacial pain Toothache Galvanic pain Barodontalgia Fremitus Tooth mobility Bruxism Trismus Ageusia Hypogeusia Dysgeusia Parageusia Hypergeusia Xerostomia Halitosis Drooling Hypersalivation Neck Neck mass Cervical lymphadenopathy Other Headache Auditory processing disorder Otalgia Velopharyngeal inadequacy Velopharyngeal insufficiency Hypersensitive gag reflex Jaw claudication Hypomimia Symptoms and signs : digestive system and abdomen ( R10 -- R19, 787,789 ) Upper Nausea Vomiting Heartburn Aerophagia Dysphagia oropharyngeal esophageal Odynophagia Halitosis Xerostomia Hypersalivation Burping Wet burp Defaecation Flatulence Fecal incontinence Encopresis Blood : Fecal occult blood Rectal tenesmus Constipation Obstructed defecation Diarrhea Rectal discharge Psoas sign Obturator sign Rovsing 's sign Hamburger sign Heel tap sign Aure - Rozanova 's sign Dunphy sign Alder 's sign Lockwood 's sign Rosenstein 's sign Abdomen Abdominal pain Acute abdomen Colic Baby colic Abdominal guarding Rebound tenderness Abdominal distension Bloating Ascites Tympanites Shifting dullness Bulging flanks Fluid wave test Abdominal mass Hepatosplenomegaly Hepatomegaly Splenomegaly Jaundice Mallet - Guy sign Puddle sign Symptoms and signs : skin and subcutaneous tissue ( R20 -- R23, 782 ) Disturbances of skin sensation Hypoesthesia Paresthesia Formication Hyperesthesia Hypoalgesia Hyperalgesia Circulation Cyanosis Pallor / Livedo Livedo reticularis Flushing Petechia Edema Peripheral edema Anasarca Other Rash Desquamation Induration Diaphoresis Mass Neck mass Skin Asboe - Hansen sign Auspitz 's sign Borsari 's sign Braverman 's sign Crowe sign Dennie -- Morgan fold Darier 's sign Fitzpatrick 's sign Florid cutaneous papillomatosis Gottron 's sign Hutchinson 's sign Janeway lesion Kerr 's sign Koebner 's phenomenon Koplik 's spots Leser - Trelat sign Nikolsky 's sign Pastia 's sign Russell 's sign Wickham striae Wolf 's isotopic response Nails Aldrich - Mees ' lines Beau 's lines Muehrcke 's lines Terry 's nails Symptoms and signs : nervous and musculoskeletal systems ( R25 -- R29, 781.0, 781.2 -- 9 ) Primarily nervous system Primarily CNS Movement disorders Dyskinesia : Athetosis Tremor Gait abnormality Scissor gait Cerebellar ataxia Festinating gait Marche a petit pas Propulsive gait Stomping gait Spastic gait Magnetic gait Lack of coordination Dyskinesia : Ataxia Cerebellar ataxia / Dysmetria Sensory ataxia Dyssynergia Dysdiadochokinesia Asterixis Other Abnormal posturing : Opisthotonus Sensory processing disorder : Hemispatial neglect Facial weakness Hyperreflexia Pronator drift Primarily PNS Gait abnormality Steppage gait Antalgic gait Primarily muscular Movement disorders Spasm Trismus Fasciculation Fibrillation Myokymia Cramp Gait abnormality Myopathic gait Trendelenburg gait Pigeon gait Other Tetany Meningism Primarily skeletal Rachitic rosary Clubbing Primarily joint Joint locking Symptoms and signs : urinary system ( R30 -- R39, 788 ) Pain Renal colic Costovertebral angle tenderness Dysuria Vesical tenesmus Control Urinary incontinence Enuresis Diurnal enuresis Giggling Nocturnal enuresis Post-void dribbling Stress Urge Overflow Urinary retention Volume Oliguria Anuria Polyuria Other Lower urinary tract symptoms Nocturia Urinary urgency Urinary frequency Extravasation of urine Extrarenal uremia Urinoma Eponymous Addis count Brewer infarcts Lloyd 's sign Retrieved from `` https://en.wikipedia.org/w/index.php?title=Review_of_systems&oldid=836639428 '' Categories : Medical terminology Talk About Wikipedia Edit links This page was last edited on 16 April 2018, at 00 : 04 ( UTC ). 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Question: the review of systems (ros) is considered part of
Answer: an admission note covering the organ systems