Systemic Enquiry

Question 1

General

Answer 1

• Fatigue/malaise
• Fever/rigors
• Weight/appetite
• Skin
  
  • Rashes
  • Bruising
  • Bleeding
• Sleep disturbance
• Thirst
• Pruritus
• Night sweats
• Neck swelling/lumps

Question 2

Respiratory system

Answer 2

• Cough
• Sputum
• Haemoptysis
• Dyspnoea
• Wheeze
• Chest pain (pleuritic)
• Symptoms of sinusitis
• Earache
• Sore throat

Question 3

Cardiovascular System

Answer 3

• Chest pain
• Dyspnoea - at rest/on exercise/orthopnoea,paroxysmal nocturnal
• Palpitations
• Ankle oedema
• Varicose veins
• Claudication
• Syncope

Question 4

Alimentary system

Answer 4

• Appetite/Weight loss or change
• Dysphagia
• Dyspepsia/Heartburn
• Nausea/Vomiting
• Haematemesis
• Jaundice
• Abdominal pain
• Abdominal distension (+bloating)
• Bowel habits - change/constipation/diarrhoea/blood/mucus/melaena/faecal incontinence
• Perianal symptoms/haemorrhoids/pain/itching

Question 5

Genito-Urinary system

Males

Answer 5

• Frequency/dysuria/nocturia/polyuria/oliguria
• Haematuria
• Incontinence/urgency
• Prostatic symptoms - difficulty/stream/dribbling
• Erectile dysfunction
• Sexually active?

Question 6

Genito-Urinary System

Females

Answer 6

• Frequency/dysuria/nocturia/polyuria/oliguria
• Haematuria
• Incontinence/urgency
• Last menstrual period
• Gestation/Expected date of delivery if pregnant
• PMB postmenopausal bleeding if menopausal
• Cycle (regularity/duration & degree of bleeding etc)
• Intermenstrual or postcoital bleeding
• Contraception/HRT if not already asked under drugs/sexually active?
• Date of last cervical smear
• Obstetric history/parity/gravidity
• Vaginal discharge

Question 7

Nervous System

Answer 7

• Speech disturbance
• Cognitive impairement (use Mental State Assessment)
• Headache
• Fits/faints/loss of consciousness
• Dizziness, Vertigo
• Balance
• Vision - acuity, diplopia
• Hearing
• Weakness
• Numbness/tingling/paraesthesia

Question 8

Musculoskeletal System

Answer 8

• Do you have any pain or stiffness in your muscles, joints or back?
• Can you dress yourself completely without any difficulty?
• Can you go up and down stairs without any difficulty?
• Is there any history of trauma and what was the mechanism of injury?
• PRISMS?

Question 9

Psychiatric

Answer 9

• Mood - depressed, euthymic, elated
• Anxiety/panic symptoms
• Memory problems/confusion
• Abnormal thought content - odd ideas, paranoia, obsessions, hypochondriacal concerns
• Perceptual abnormalities/hallucinations
• Risk to self or others
• Insight into illness - need for medication, treatment or to be in hospital

Question 10

Endocrine System

Answer 10

• Change in temperature
• Skin changes - dryness, rash
• Hair changes
• Pain/ Weakness
• Facial swellings, Neck swellings
• Weight changes
• Thirst/ Hydration
• Appetite
• Polyuria/ polydipsia
• Fatigue
• Palpitations/ Tremors
• Syncope
• Changes in bowel habit - frequency, consistency, steatorrhoea, blood
• Headache
• Visual changes - vision loss in pituitary adenomas, diplopia
• Menstrual changes - frequency, heavy, amenorrhea, contraception?
• Libido
• Low mood/ Sleep changes