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1 Review of Systems (ROS) Checklist Layman's Terms MBLD Session 1 General fever Mouth change in taste chills in mouth or tongue sweats bleeding gums night sweats lesions in mouth or gums weight change lesions on lips or tongue overall health Throat sore throats Skin lesions hoarseness rashes ful swallowing itching Chest cough sores phlegm production change in hair or nails coughing up blood change: in moisture shortness of breath (SOB) temperature wheezing color sharp CP with deep breath or cough texture Cardiac chest (CP) Heme large or rapid, strong or tender lymph nodes/glands irregular heartbeat excessive bleeding or light-headedness bruising passing out history of (h/o) anemia swelling in feet Head headaches History of (h/o) heart murmur head trauma h/o blood clots Eyes glasses/contacts calf at rest calf with exercise redness SOB with exertion SOB while lying flat infection suddenly awaken SOB injury change in activity tolerance flashes of lights Breast change or loss of vision lumps double vision blurring of vision GI changes in appetite Ears hearing loss gastrointestinal heartburn ringing reflux fullness, distention infection abdominal nausea sensation of room spinning vomiting Nose change or vomiting blood loss of sense of smell vomiting coffee ground material obstruction hernias sinus yellowing of skin/eyes with bowel movement (BM) nose bleeds recent changes in bowel habits: going more or less often changes in consistency or color Blue Font: you don't need to say out loud the title of the system Majority NEED to be recited in PAIRS

2 Review of Systems (ROS) Checklist Layman's Terms MBLD Session 1 GI cont Color: like black tar or Endo cont sensitivity to heat or cold tarry or maroon colored increase thirst diarrhea change in size of: hands constipation feet hemorrhoids facial features blood in stools neck Urinary on urination problems w/ thyroid going often (little volume) Muscles & joints/muscles compelling urge to go Bones tenderness joints/muscles urinating increased amount swelling joints/muscles urinating little to no urine stiffness joints/muscles unable to urinate limited movement of the: neck difficulty initiating stream trunk urinating at night, # extremities leaking urine h/o injury bone/joint blood in urine deformity bone/joint tenderness back/flank Nervous seizures bladder/ kidney infections System dizziness stones difficulty speaking h/o sexually transmitted infections difficulty swallowing Genital any gential lesions tremor rashes weakness numbness or tingling (penile/vaginal) burning or shooting satisfied with sex life abnormal clumsiness Women age your periods started difficulty w/ balance ever been pregnant / # difficulty w/ bowel miscarriages/abortions # difficulty w/ bladder control Still menstruating Mental change in moods menopause, age Health prolonged crying problems w/periods confusion 1st day of last menstrual period difficulty thinking birth control method memory loss with intercourse phobias Men testicular lumps hallucinations testicular agitation problems w/ erections sleep disturbances problems w/ ejaculations previous treatment of psychiatric or emotional illness Endo easy fatigue Total 168 points change in sleep patterns 158 > correct to pass, recited in pairs (when appropriate) in 7 min on behavioral changes 158 > correct to pass, recited in pairs (when appropriate) in 5 min on Blue Font: you don't need to say out loud the title of the system Majority NEED to be recited in PAIRS

3 FON ROS Checklist Layman's Terms ROS Checklist: MUST BE ASKED IN PAIRS (ask no more than 2 items at a times) General: Any fever, chills; sweats, night sweats; or weight change? How is your overall health? Skin: Any lesions, rashes; itching, sores; or change in hair or nails? Any change in moisture, temperature; color or texture of the skin? Hematologic: Any large or tender lymph nodes; any excessive bleeding or bruising, or history of anemia? Head: Any headaches or head trauma? Eyes: Any glasses/contacts? Any eye, redness;, infection; injury. Any flashes of light, double vision; blurring of vision or loss of vision? Ears: Any hearing loss? Any ringing, ; infection, ; or sensation of the room spinning? Nose: Any change or loss of the sense of smell? Any, obstruction; sinus, nose bleeds? Mouth: Any change in taste; in mouth or tongue? Any bleeding gums; lesions of the mouth or gums; lips or tongue? Throat: Any sore throat, hoarseness; ful swallowing? Chest: Any cough, phlegm production; coughing up blood or SOB; wheezing; or sharp chest with deep breath or cough? Cardiovascular: Any chest ; rapid, strong or irregular heartbeat; light-headedness, passing out; or swelling in the feet? Any history of heart murmurs, blood clots; calf with rest or exercise; SOB with exertion or lying flat; sudden awakening with SOB; or change in activity tolerance? Breast: Any, lumps; or? GI: Any change in appetite; heartburn, reflux; fullness, distension; or abdominal? Any nausea, vomiting; vomiting blood, vomiting of coffee ground material; hernia; yellowing of skin or eyes; with BM; recent changes in bowel habits: going more or less often; consistency or color; color like black tar; tarry or maroon colored stools; diarrhea, constipation; hemorrhoids, or blood in stool. Urinary: Any with urination, going often with little volume; compelling urges to urinate, urinating increased amounts; urinating little to no urine, unable to urinate;difficulty initiating the stream, urinating at night (#); leaking urine, blood in the urine; tenderness in the back or flank; h/o bladder or kidney infections; or kidney stones? Genital: Any history of sexually transmitted infections; genital lesions, rashes;, or? Are you satisfied with your sex life? *Female: What age did your periods started? Have you ever been pregnant (#)? Any miscarriages/abortions (#)? Are you still menstruating? If no: Have you gone through menopause (age)? If yes: Do you have any problems with your periods? When was the first day of your last menstrual period (date)? Are you sexually active? If yes and not menopausal -> Any method of birth control? Do you have with intercourse? Or *Male: Any testicular or lumps, problems with erections, or ejaculation? Endocrine: Any easy fatigue, change in sleep pattern; behavior change; sensitivity to heat or cold; increased thirst; change in size of hands/feet; or facial features/neck, or problems with thyroid? Bone and Muscles: Any, tenderness; stiffness, or swelling of the joints or muscles? Any limitation of movement of the neck, trunk, or extremities? Any history of injury or deformity of the bones or joints? Nervous System: Any seizures; difficulty speaking or swallowing; tremor, weakness; numbness or tingling; burning or shooting ; abnormal clumsiness or difficulty with balance? Any difficulty with bowel or bladder Mental Health: Any change in moods, prolonged crying; confusion, difficulty thinking; memory loss, phobias; hallucinations, agitation? Any previous treatment of a psychiatric or emotional illness?

4 SOAP ROS Checklist Medical Vernacular ROS Checklist Gen: No fever, chills, diaphoresis, night sweats, or weight change. Good overall health. Skin: No lesions, rashes, pruritus, sores, or change in hair or nails. No change in moisture, temperature, color, or texture of the skin. Heme: No lymphadenopathy, abnormal or excessive bleeding, bruising (or ecchymosis), or h/o anemia. Head: No headaches or head trauma. Eyes: No glasses/contacts. No eye, inflammation, D/C, infection, injury, flashes of light, diplopia, blurring or loss of vision. Ears: No decrease in acuity. No tinnitus,, infection, D/C or vertigo. Nose: No change in sense of smell or anosmia. No D/C, obstruction, sinus, epistaxis. Mouth: No change in taste or in mouth/tongue. No bleeding gums. No lesions on the mouth, gums, lips, or tongue. Pharynx/ larynx: No pharyngitis, hoarseness, or odynophagia. Chest: No cough, sputum, hemoptysis, dyspnea, wheezing, or pleuritic CP. CV: No CP, palpitations, light-headedness/pre-syncope, syncope, or edema. No h/o heart murmurs, DVTs, claudication, pseudoclaudication, DOE, orthopnea, PND, or change in activity tolerance. Breast: No, mass, or d/c. GI: No change in appetite, dyspepsia, reflux/gerd, fullness/distension, or. No nausea, vomiting, hematemesis, or coffee-ground emesis. No hernia, jaundice/icterus, with BM, recent changes in frequency/consistency/color of BM, melena, diarrhea, constipation, hemorrhoids, or hematochezia. GU: No dysuria, frequency, urgency, polyuria, oliguria, retention, hesitancy, nocturia (#), incontinence, hematuria, flank/cva tenderness, UTI, or nephrolithiasis. Genital: No history of STIs, genital lesions, rashes,, or D/C. Patient is satisfied with sex life. Female/GYN: Menarche. OB: pregnancies (#), abortions/miscarriages (#), or as GxPx. Menopause age or N/A. No history of irregularities with menstruation. LMP. Current birth control. No dyspareunia. Or *Male: No testicular lumps or, problems with erections, or ejaculation. Endo: No easy fatigue, change in sleep pattern, behavior change, sensitivity to heat or cold, polydipsia, change in size of hands/feet/facial features/neck, and no problems with thyroid. MSK: No, tenderness, stiffness, or swelling of the joints or muscles. No limitation of movement of the neck, trunk, or extremities. No history of deformity or injury of the bones or joints. Neuro: No seizures, dysarthria, dysphagia, tremor, weakness, paresthesia, neuropathic, or abnormal clumsiness/difficulty with balance. No difficulty with bowel or bladder control. Psych: No change in moods, prolonged crying, confusion, difficulty thinking, memory loss, phobias, hallucinations, agitation, or sleep disturbances. No previous treatment of a psychiatric or emotional illness.

5 General Skin Heme Eyes Ears Nose Pharynx/ larynx Respiratory Cardiovascular GI GU Genital Female Endo Neuro Total ROS Checklist Medical Vernacular MBLD Session 3 diaphoresis pruritus lymphadenopathy ecchymosis diplopia acuity tinnitus vertigo anosmia epistaxis pharyngitis odynophagia dyspnea pleuritic CP palpitations presyncope syncope DVTs: deep venous thrombosis claudication pseudoclaudication dyspnea on exertion (DOE) orthopnea paroxysmal nocturnal dyspnea (PND) dyspepsia reflux/gerd melena hematemesis coffee-ground emesis icterus hematochezia dysuria polyuria oliguria nocturia, # hematuria nephrolithiasis age of menarche dyspareunia polydipsia dysarthria dysphagia paresthesias neuropathic 1 2 3

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