Table of Contents GeneralNeurologicalENTCardiorespiratoryGastrointestinalUrologicalObstetric and gynaecological RheumatologicalOrthopaedicWhy don’t you test yourself?How about trying some history-taking OSCE stations? A full systems review is not necessary for every patient. You should only review systems relevant to the presenting complaint with the aim of identifying/excluding significant associated features. For example, for left iliac fossa pain, a complete history will include questions about gastrointestinal, urological and, if female, obstetric and gynaecological systems. In addition, some questions within each system review will be more or less relevant depending on the presenting complaint, and you do not have to ask them all. You must also go on to ask further symptom-specific questions for each positive symptom (see exploring symptoms). General Fever/rigors/night sweats Weight loss Fatigue Skin rashes/bruising Neurological General Fits/falls/LOC Headache Dizziness Vision/hearing Memory loss Neck stiffness/photophobia Motor Weakness Incontinence Sensory Pain Numbness Tingling ENT Ear Hearing loss Tinnitus Otalgia Nose Rhinorrhoea Epistaxis Throat Sore throat Odynophagia Cardiorespiratory Chest pain Palpitations SOB/wheeze Cough Sputum Haemoptysis Leg swelling Gastrointestinal Weight Weight loss Appetite change Work down body Dysphagia Nausea/vomiting Indigestion/heartburn Abdominal pain Bowel habit Tenesmus Blood/mucus in stool Flatus Urological Storage Frequency Volume Urgency Nocturia Incontinence (overflow/stress/urge) Infection Dysuria Haematuria Odour Prostatic/voiding (if male) Hesitancy Poor flow/dribbling Feeling of incomplete emptying Obstetric and gynaecological The 4 P’s: PV Bleeding Menorrhagia Intermenstrual Post-coital Post-menopausal PV Discharge Pain Pelvic Dysmenorrhoea Dyspareunia Pregnancy Chance of pregnancy If pregnant: fetal movements, contractions/tightening, PV loss, pre-eclampsia symptoms (headache, visual disturbance, epigastric pain, oedema) Rheumatological Joints Pain Stiffness Swelling Work down body Skin (rashes, ulcers, Raynaud’s) Hair loss Eyes (redness, dryness) Mouth (dryness) Chest (breathlessness, SOB) GI (IBD symptoms) Genitourinary (discharge) Orthopaedic Joints/bone/soft tissue Pain Stiffness Swelling Movement restriction/ability to weight-bear Mechanical symptoms Locking Giving way Neurological symptoms distally Weakness Numbness Paraesthesia Why don’t you test yourself? You are taking a history from a patient with breathlessness. What system review questions would you ask? Oops! This section is restricted to members. What would be in your differential diagnosis for breathlessness? Ensure you structure your answer! Oops! This section is restricted to members. A patient who is 30 weeks pregnant presented with lower abdominal pain. You are taking the history. Which systems review questions would you ask? Oops! This section is restricted to members. How about trying some history-taking OSCE stations? Hip pain Lower leg weakness Abdominal pain Dysphagia Right toe pain And there’s lots more to try!
