Systemic Enquiry – OSCE Guide

A systemic enquiry (also known as a systems review) involves performing a brief screen for symptoms in other body systems which may or may not be relevant to the primary presenting complaint. A systemic enquiry may also identify symptoms that the patient has forgotten to mention in the presenting complaint.

Deciding on which symptoms to ask about depends on the presenting complaint and your level of experience.

Some examples of symptoms you could screen for in each system are shown below.

Systemic symptoms

Systemic symptoms to screen for include:

• Fevers
• Night sweats
• Weight change
• Fatigue

Cardiovascular symptoms

Cardiovascular symptoms to screen for include:

• Chest pain
• Palpitations
• Dyspnoea
• Pre-syncope
• Syncope
• Orthopnoea
• Peripheral oedema

Respiratory symptoms

Respiratory symptoms to screen for include:

• Dyspnoea
• Cough
• Sputum
• Wheeze
• Haemoptysis
• Pleuritic chest pain

Gastrointestinal symptoms

Gastrointestinal symptoms to screen for include:

• Appetite change
• Nausea
• Vomiting
• Dyspepsia
• Dysphagia
• Weight loss
• Abdominal pain
• Abdominal distension
• Jaundice
• Changes in bowel habit: constipation, diarrhoea, steatorrhoea, melaena, hematochezia

Genitourinary symptoms

Genitourinary symptoms to screen for include:

• Changes in urine output or colour: oliguria, polyuria, anuria, dark urine, haematuria
• Infective symptoms: urinary frequency, dysuria, flank pain, offensive discharge, pelvic pain
• Bladder control symptoms: urinary urgency, urinary incontinence
• Obstructive symptoms: terminal dribbling, nocturia
• Uraemic symptoms: fatigue, nausea, anorexia, pruritis

Neurological symptoms

Neurological symptoms to screen for include:

• Visual symptoms: blurred vision, changes in colour vision, sudden loss of vision, floaters
• Headache: unilateral headache, bilateral headache, thunderclap headache
• Motor or sensory disturbance: muscle weakness, numbness, paraesthesia
• Loss of consciousness including seizures
• Confusion

Ear, nose and throat symptoms

Ear, nose and throat symptoms to screen for include:

• Hearing loss/tinnitus
• Otalgia
• Facial pain
• Persistent nasal discharge
• Epistaxis
• Dysphonia
• Dysphagia
• Odynophagia

Musculoskeletal symptoms

Musculoskeletal symptoms to screen for include:

• Bone and joint pain
• Muscular pain
• Trauma

Dermatological symptoms

Dermatological symptoms to screen for include:

• Rashes
• Skin lesions
• Skin colour changes
• Ulcers