review of systems

Advance Warning: This post is an epic mass of text. (For the record, most of my future posts labeled “School” will be epic walls of text unless it’s anatomy-related. If you’re completely uninterested anything to do with the medical field, for future reference, skip these. :O )
We had our “Review of Systems” lab yesterday, which basically consisted of us interrogating the patient and then writing down all our findings. I say interrogate only because we were given 12 minutes to obtain their past medical history (PMH), family history (FHx), social history (SHx) and a review of systems (ROS), which is practically an absolute minimum of 50 questions. We’re still graded on being nice people, so you can’t [and shouldn’t] actually interrogate them. Welcome back from spring break, kids!

At our school, we go by the mnemonic, “MIIMASH” for PMH. (Going to med school generally means you get to learn all these fancy abbreviations to make your life easier + so no one else will know what you’re talking about.) Luckily, we didn’t have to also obtain a history of present illness (HPI; yay for OLDCAARTS!), or that would have required even more writing and my hand would likely have keeled over in protest and died. We are lucky in the sense that they’ve drilled taking patient histories into us since almost-day-1, so that part is pretty darn easy now. The rest of this post is kinda like a review for me so I’ll have something to look back on. I’m tradin’ away all my doctor-in-training secrets! :O!!!

Anyway.

M: “Medical Illnesses” (Any past history of medical illnesses [e.g. diabetes, hypertension, high cholesterol, heart attack, etc.?])
I: “Immunizations” (“Are you up to date on your shots?”)
I: “Injuries” (“Have you had any recent injuries?”)
M: “Medications” (“Are you currently taking any medications? What medications? Do you take any vitamins? Herbal supplements? Anything that you buy over the counter?”)
A: “Allergies” (“Is there anything you’re allergic to?”)
S: “Surgeries” (“Have you ever had any surgeries?”)
H: “Hospitalizations” (“Have you ever been hospitalized for any reason?”)

(Obviously, if they were to say yes to any of the above, you’d ask them to elaborate. I just didn’t want to write everything out.)

For FHx + SHx, we kinda conglomerate that into “FSHORES.”

F: “Family History” (“Can you tell me about your family? Are there any medical illnesses that run in your family [e.g. mother, father, grandparents]? Do you have any siblings? Children?”)
S: “Safety” (“How is your living situation? Do you live with anyone? Do you feel safe? Do you have people you can talk to who are supportive?”)
H: “Habits” (“Do you ever smoke or use tobacco products? Are you around anyone who uses them? Do you drink alcohol? How many cups a day? Do you use any illicit/street drugs? Do you drink anything with caffeine in it? How’s your diet? Do you exercise? How many times per week?”)
O: “Occupation” (“What do you do for a living?”)
R: “Religion” (“Do you have any religious preferences that might interfere with treatment?”)
E: “Environment/Education” (“Are you exposed to any dangerous chemicals where you live or work? Are you in school?” etc.)
S: “Sexual History” (“Are you currently in a relationship? How’s that going for you? Are you sexually active? [If applicable, aka if female and pre-menopausal, when was your last period?]”)

(We also try not to just straight-up ask all of this so as to prevent it from being an onslaught of endless questioning. I like interjecting with comments [e.g. positive reinforcement for if they don’t smoke or if they exercise, condolences if their parents are no longer living, etc. Basically, be a nice person with some common sense, be able to pick up on nonverbal cues, and try to make it a little more conversational if you can.].)

And for the newest one that no one in my class paid any attention to until…uh, today… (We backburnered it because there were a billion questions involved. ;_; ) Basically, for our OSCEs, we apparently only need to go through 11 of the 19-ish systems and ask at least 3 questions from each. We’re graded on our efficiency and critical thinking rather than for perfection on OSCEs, which is awesome, but I still don’t think I’m anywhere near the point where I could write an entire SOAP note in 9 minutes. (It took me 7 minutes today to finish just the “subjective” part, and I was one of the few that actually managed to finish [only because I finished my patient interview 2 minutes early, since we were only supposed to get 5 minutes]. ;_;)

I got this down by picking my 11 “favorite” (read: easiest to remember) systems and remembering 3 questions from each, but I’ll go ahead and list them all here, just because. (Bolding my go-to ones. Some are interexchangeable with each other because I sometimes forget one over the other, so I memorized a couple back-up systems too. :x )

• General: fever/chills, unexplained weight changes, fatigue
• Head: headaches, nausea/vomiting, visual changes
• Eyes: diplopia (double vision), blurry vision, glasses/contacts
• Ears: tinnitus (ringing in ears), hearing loss, discharge
• Nose: congestion, epistaxis (nosebleeds), rhinorrhea (runny)
• Mouth/Throat/Neck: hoarseness, sore throat, swelling
• Cardiac: palpitations, murmurs, chest pain
• Resp: shortness of breath, coughing, wheezing
• Breasts: masses/lumps, skin changes, self-exams
• GI: constipation, diarrhea, abdominal pain
• MSK: joint pain, range of motion, muscle pain/weakness
• Neuro: numbness, tingling, weakness
• Vascular: edema (swelling), claudication, varicose veins
• Skin: changes in skin/hair, dry skin,
• Urinary: polyuria (increased frequency of urination), dysuria (pain upon urination), color
• Endocrine: heat/cold intolerance, polyphagia (increase in appetite), excessive sweating
• Heme: easy bruising/bleeding, fatigue/feeling faint (to check for anemia), blood transfusions
• Genital:
  Male: discharge, hernias, pain
  Female: period regularity/frequency/duration, pregnancy, miscarriages/abortions
  General: STD history/treatment, sexual fxn, contraception methods
• Psych: anxiety, depression, memory