Detailed Review of Systems

Review of Systems (ROS)

• Constitutional Symptoms: Reports generalized fatigue and malaise for 3 months, worse in afternoons. Unintentional weight gain of 4 kg over 2 months. Denies fever, chills, or night sweats.

• Eyes: Reports mild bilateral dry eyes for 4 weeks, relieved by lubricating drops. Denies altered vision, pain, redness, discharge, or photophobia.

Ears, Nose, Mouth, and Throat

• Ears: Intermittent bilateral high-pitched tinnitus for 1 month, mild. Denies hearing loss, otalgia, discharge, or vertigo.

• Nose: Mild morning nasal congestion, seasonal. Denies rhinorrhea, epistaxis, or sinus pain.

• Mouth and Throat: Mild hoarseness noted over the last 3 weeks. Denies sore throat, oral ulcers, dental pain, or dysphagia.

• Cardiovascular: Occasional mild ankle swelling at end of day, resolves with elevation. Denies chest pain, palpitations, DOE, orthopnea, PND, or syncope.

• Respiratory: Denies cough, sputum, hemoptysis, SOB, wheezing, or chest tightness.

• Gastrointestinal: Reports sluggish bowel movements (every 3–4 days, hard stools) for 2 months, partially relieved by increased fluid intake. Appetite slightly decreased. Denies nausea, vomiting, abdominal pain, heartburn, hematochezia, or melena.

Genitourinary

• Urinary Symptoms: Denies dysuria, frequency, urgency, nocturia, hematuria, incontinence, or flank pain.

Reproductive Symptoms

• Female: Reports heavier menstrual bleeding (menorrhagia) over the past 3 cycles, lasting 7 days compared to usual 4 days. Denies intermenstrual bleeding, abnormal vaginal discharge, dyspareunia, or hot flashes.

• Musculoskeletal: Diffuse, mild myalgias and bilateral knee stiffness in the mornings lasting < 15 minutes for 1 month. Denies joint swelling, focal muscle weakness, or back pain.

Integumentary (Skin and/or Breast)

• Skin: Reports dry, rough skin over bilateral shins and forearms, and increased diffuse hair thinning over the past 2 months. Brittle fingernails noted. Denies rashes, pruritus, or new lesions.

• Breast: Mild bilateral cyclical mastalgia prior to menses. Denies lumps, nipple discharge, or skin changes.

• Neurological: Mild frontal headaches 1–2 times per week, relieved by paracetamol 1,000 mg PO PRN. Reports mild "brain fog" and sluggish concentration. Denies dizziness, paresthesias, focal weakness, tremors, or seizures.

• Psychiatric: Reports low mood and decreased motivation over the past 2 months, coinciding with fatigue. Sleep is unrefreshing despite 8–9 hours per night. Denies anxiety, hallucinations, SI, or HI.

• Endocrine: Significant cold intolerance for 3 months (wearing extra layers indoors). Unintentional weight gain (4 kg), diffuse hair thinning, and reduced libido. Denies polyuria or polydipsia.

• Hematologic/Lymphatic: Reports easy bruising on lower limbs over the past month. Denies prolonged bleeding from cuts or swollen lymph nodes.

• Allergic/Immunologic: History of mild seasonal allergic rhinitis triggered by grass pollen in spring. Denies food allergies, anaphylaxis, or recurrent infections.