Communication and Physical Assessment of the Child and Family : Review of systems

Review of systems


Constitutional:  Overall state of health, fatigue, recent or unexplained weight gain or loss (period for either), contributing factors (change of diet, illness, altered appetite), exercise tolerance, fevers (time of day), chills, night sweats (unrelated to climatic conditions), general ability to carry out activities of daily living
Integument:  Pruritus, pigment, or other color changes (including birthmarks), acne, eruptions, rashes (location), bruises, petechiae, excessive dryness, general texture, tattoos or piercings, disorders or deformities of nails, hair growth or loss, hair color change (for adolescents, use of hair dyes or other potentially toxic substances, such as hair straighteners)
Eyes:  Visual problems (behaviors indicative of blurred vision, such as bumping into objects, clumsiness, sitting close to television, holding a book close to face, writing with head near desk, squinting, rubbing the eyes, bending head in an awkward position), cross-eyes (strabismus), eye infections, edema of lids, excessive tearing, use of glasses or contact lenses, date of last vision examination
Ears/nose/mouth/throat:  Earaches, ear discharge, evidence of hearing loss (ask about behaviors such as the need to repeat requests, loud speech, inattentive behavior), results of any previous auditory testing, nosebleeds (epistaxis), constant or frequent runny or stuffy nose, nasal obstruction (difficulty breathing), alteration or loss of sense of smell, mouth breathing, gum bleeding, number of teeth and pattern of eruption/loss, toothaches, tooth brushing, use of fluoride, difficulty with teething (symptoms), last visit to the dentist (especially if temporary dentition is complete), sore throats, difficulty swallowing, choking, hoarseness or other voice irregularities
Neck:  Pain, limitation of movement, stiffness, difficulty holding head straight (torticollis), thyroid enlargement, enlarged nodes or other masses
Chest:  Breast enlargement, discharge, masses; for adolescent girls, ask about breast self-examination
Respiratory:  Chronic cough, wheezing, shortness of breath at rest or on exertion, difficulty breathing, snoring, sputum production, infections (pneumonia, tuberculosis), skin reaction from tuberculin testing
Cardiovascular:  Cyanosis or fatigue on exertion, history of heart murmur or rheumatic fever, tachycardia, syncope, edema
Gastrointestinal: Appetite, nausea, vomiting (not associated with eating; may be indicative of brain tumor or increased intracranial pressure), abdominal pain, jaundice or yellowing skin or sclera, belching, flatulence, distention, diarrhea, constipation, recent change in bowel habits, blood in stools
Genitourinary: Pain on urination, frequency, hesitancy, urgency, hematuria, nocturia, polyuria, enuresis, unpleasant odor to urine, force of stream, discharge, change in size of scrotum, date, and result of last urinalysis, for adolescents, sexually transmitted infection, and type of treatment; for adolescent boys, ask about testicular self-examination
Gynecologic: For pubescent children

Female: Menses onset, amount, duration, frequency, discomfort, problems; vaginal discharge, breast development

Male: Puberty onset, emissions, erections, pain, or discharge from penis, swelling or pain in testicles

Both: Sexual activity, use of contraception, sexual transmitted infections

Musculoskeletal:  Weakness, clumsiness, lack of coordination, unusual movements, scoliosis, back pain, joint pain or swelling, muscle pains or cramps, abnormal gait, deformity, fractures, serious sprains, activity level
Neurologic: Headaches, seizures, tremors, tics, dizziness, loss of consciousness episodes, loss of memory, developmental delays, or concerns
Endocrine:  Intolerance to heat or cold, excessive thirst or urination, excessive sweating, salt craving, rapid or slow growth, signs of early or late puberty
Hematologic/lymphatic:  Easy bruising or bleeding, anemia, date and result of last blood count, blood transfusions, swollen or painful lymph nodes (cervical, axillary, inguinal)
Allergic/immunologic:  Allergic responses, anaphylaxis, eczema, rhinitis, unusual sneezing, autoimmunity, recurrent infections, infections associated with unusual complications
Psychiatric: General affect, anxiety, depression, mood changes, hallucinations, attention span, tantrums, behavior problems, suicidal ideation, substance abuse


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