Attention healthcare students and professionals! Our free ros questions quiz is designed to challenge your clinical acumen with realistic review of systems example questions and review of system questions that sharpen diagnostic reasoning. Compare your technique in ros vs physical exam scenarios, explore is ros subjective or objective distinctions, and identify any knowledge gaps. To reinforce learning, tackle a timed respiratory system practice exam or stretch your understanding with a comprehensive physiology test . Boost your confidence, master system reviews, and elevate your patient assessments. Ready to take your skills to the next level? Dive in now and conquer every question!
What is the primary purpose of the Review of Systems (ROS) in patient evaluation?
To gather symptom information across organ systems
To confirm the final diagnosis before the physical exam
To provide objective exam findings
To serve only as a billing requirement
The Review of Systems (ROS) is a structured way to collect subjective symptom data from the patient across multiple organ systems. It helps clinicians uncover symptoms that may not be covered in the chief complaint or history of present illness. ROS provides a comprehensive overview of potential patient issues and guides further evaluation. For more details refer to AAFP History Guidelines.
How does the ROS differ from the physical examination?
ROS is subjective information reported by the patient, PE is objective information observed by the clinician
ROS and PE both consist of objective observations
ROS requires use of instruments, PE is just patient questions
ROS is used only for billing, PE is used for diagnosis
The ROS relies on patient-reported symptoms and is inherently subjective, whereas the physical exam consists of objective findings observed or elicited by the clinician. ROS questions are verbal inquiries, while PE involves maneuvers like palpation and auscultation. Both are complementary, providing a full clinical picture of patient health. See NCBI Clinical Skills for more.
Which of the following is an example of an ROS item rather than a physical exam maneuver?
Asking the patient about chest pain
Auscultating heart sounds with a stethoscope
Palpating the abdomen for tenderness
Measuring blood pressure
Asking the patient about chest pain is a subjective inquiry and part of the ROS. Auscultation, palpation, and vital-sign measurements are objective physical exam maneuvers. Distinguishing between subjective symptom questions and objective exam findings is key to proper documentation. For clarification, visit Life in the Fast Lane: ROS.
During ROS, questions about shortness of breath fall under which system?
Respiratory
Cardiovascular
Gastrointestinal
Neurologic
Shortness of breath is a symptom of the respiratory system and belongs in that ROS category. While it can have cardiovascular causes, it is first classified under respiratory for symptom review. Correctly categorizing symptoms aids in clinical organization and documentation. See AAFP Symptom-Based Diagnosis.
Which system includes asking about frequent urination in ROS?
Genitourinary
Endocrine
Musculoskeletal
Hematologic
Frequent urination is a symptom of the genitourinary system and should be included under that ROS category. It can also be linked to endocrine issues like diabetes, but it is classified as genitourinary in ROS structure. Proper system grouping ensures thorough symptom assessment. Additional guidance at UpToDate Review of Systems.
Asking about recent weight changes belongs to which ROS category?
Endocrine
Gastrointestinal
Dermatologic
Respiratory
Weight changes are considered constitutional or endocrine symptoms and are often documented under the endocrine system in ROS. They can also reflect nutritional or GI issues, but they are grouped with endocrine due to hormone regulation. This categorization streamlines documentation and billing. Learn more at AAFP Guidelines.
True or False: ROS findings are primarily subjective information reported by the patient.
True
False
ROS findings consist of patient-reported symptoms and are inherently subjective, unlike physical exam findings which are objective. The ROS is designed to elicit information about each system as experienced by the patient. Correct documentation of subjective versus objective data is crucial for clinical accuracy. See NCBI Subjective vs Objective.
Asking about depression and anxiety belongs to which system?
Psychiatric
Cardiovascular
Gastrointestinal
Endocrine
Depression and anxiety are mental health symptoms and are documented under the psychiatric system in the ROS. This classification ensures mental health concerns are systematically screened. Grouping psychiatric symptoms together helps clinicians identify psychosocial issues. More information at AAFP Mental Health Screening.
What defines an "extended ROS" under CMS guidelines?
Review of 2 to 9 organ systems
Review of exactly 1 system
Review of 10 or more systems
No review of systems required
CMS defines an extended ROS as a review of two to nine organ systems. A problem pertinent ROS covers a single system, and a complete ROS covers ten or more. Understanding these distinctions is important for accurate documentation and billing. See CMS E/M Documentation.
In ROS documentation, a "pertinent positive" refers to which of the following?
A symptom reported by the patient that is present and relevant to the chief complaint
A symptom the patient denies having
An abnormal physical exam finding
A lab value outside normal range
A pertinent positive in ROS is a symptom the patient reports that directly relates to the chief complaint or differential diagnosis. It indicates the presence of a specific finding the clinician is probing. Pertinent positives help tailor the history to clinical concerns. More at AAFP Documentation Tips.
A "pertinent negative" in ROS is best described as:
The patient's report that a specific symptom is absent
The presence of a reported symptom
An objective exam finding
A laboratory finding within normal limits
A pertinent negative is when a patient specifically denies a symptom that is important to rule out in the differential diagnosis. It helps clarify which conditions are less likely. Properly documenting negatives can be as informative as positives. See Life in the Fast Lane: Pertinent Negatives.
Which of the following symptoms are considered "constitutional" in the ROS?
Fever, weight loss, and fatigue
Chest pain and palpitations
Itching and rash
Polyuria and polydipsia
Constitutional symptoms include systemic signs such as fever, weight loss, and fatigue. These symptoms can indicate underlying systemic illness. They are documented separately from organ-specific complaints. Reference UpToDate.
Asking about dizziness and syncope belongs to which organ system in ROS?
Neurologic
Cardiovascular
Gastrointestinal
Psychiatric
Dizziness and syncope are symptoms of the neurologic system and should be documented in that ROS category. While they can have cardiovascular causes, initial grouping is neurologic for symptom inquiry. Correct categorization guides further diagnostic testing. See AAFP Syncope Guidelines.
When performing a "problem pertinent" ROS, how many systems are reviewed?
One
Two to nine
Ten or more
None
A problem pertinent ROS focuses on one system directly related to the patient’s chief complaint. Extended ROS covers two to nine systems, and complete ROS covers ten or more. This categorization affects documentation level. More at CMS E/M Documentation.
Which of the following is NOT typically included in the ROS but is found in the past medical history?
Prior surgeries
Alcohol use habits
Skin rashes
Palpitations
Prior surgeries are part of the past medical history, not the ROS. ROS focuses on current or recent symptoms. Lifestyle habits like alcohol use can be ROS or social history depending on timing. Proper sectioning prevents redundancy. See AAFP History Sections.
True or False: Physical exam findings are considered part of the ROS.
False
True
Physical exam findings are objective observations made by the clinician and are distinct from the subjective symptom reports collected in the ROS. They should be documented in separate sections. Mixing them can lead to inaccurate records. For more, see NCBI Clinical Documentation.
Which of the following is a finding that belongs in the physical examination documentation rather than in the ROS?
Auscultation reveals crackles in both lung bases
Patient denies chest pain
Patient reports nausea
Patient reports weight loss
Auscultation findings such as crackles are objective physical exam observations. Denials or reports of symptoms like chest pain or nausea belong in the ROS. Distinguishing these ensures clear clinical documentation. Consult Life in the Fast Lane for details.
If a patient denies current headaches but has a known history of chronic daily headaches, where should this be documented?
Past medical history
Review of systems
Physical examination
Assessment/Plan
A history of chronic daily headaches is part of the past medical history because it is a longstanding condition. The ROS captures current or recent symptoms, not resolved or historical conditions. Accurate section placement improves clinical clarity. See AAFP Guidelines.
Under CMS guidelines, documentation of a complete ROS requires review of how many organ systems?
Ten or more
One
Two to nine
Five
A complete ROS per CMS is defined as a review of ten or more organ systems. A problem pertinent review covers one system and an extended review covers two to nine systems. Accurate ROS level supports appropriate billing. Reference CMS Documentation.
In documentation, the phrase 'no cough, no sputum, no dyspnea' refers to what?
Pertinent negatives
Pertinent positives
Physical exam findings
Assessment statements
Listing absent symptoms such as 'no cough' are pertinent negatives, indicating the patient denies those specific problems. This documentation style clarifies which symptoms have been ruled out. It is a key part of the ROS. More on terminology at Life in the Fast Lane.
Which of the following is an example of a physical exam finding, not an ROS entry?
Auscultation reveals an S3 gallop
Patient reports palpitations
Patient denies chest pain
Patient notes fatigue
An S3 gallop is an objective finding detected on auscultation, and belongs in the physical exam section. Reports and denials of symptoms belong in the ROS. Proper separation of findings and history is essential. See AAFP Documentation Tips.
A patient denies shortness of breath in the ROS but the exam reveals crackles. What does this scenario illustrate?
ROS is subjective and may not detect objective findings
Physical exam is less reliable than patient report
ROS overrides physical exam when conflicting
Objective findings are unnecessary when ROS is negative
This highlights that the ROS is based on subjective patient reporting and may miss signs that a clinician uncovers on physical exam. Objective examination can reveal pathology even when the patient does not perceive symptoms. Both components are necessary for comprehensive assessment. More at NCBI Clinical Skills.
In ROS, questions about polydipsia and polyphagia would be categorized under which system?
Endocrine
Neurologic
Cardiovascular
Dermatologic
Polydipsia (excessive thirst) and polyphagia (excessive hunger) are hallmark endocrine symptoms often related to diabetes. They belong under the endocrine system in the ROS. Proper system grouping assists in focused differential diagnosis. See UpToDate Review of Systems.
Under the 2021 E/M coding guidelines, which element is no longer required for level selection?
Review of systems
Medical decision making
Chief complaint
Time spent counseling
The 2021 E/M guideline updates eliminated ROS as a required component for selecting office visit level. Level selection now relies on medical decision making or total time. While ROS can still inform the record, it no longer drives coding level. See AMA 2021 E/M Updates.
Which documentation practice best supports clinical decision making rather than just fulfilling billing requirements?
Focus on systems relevant to the chief complaint and document both positives and negatives
Document all organ systems in every patient regardless of relevance
Copy and paste an ROS from a previous note to save time
Skip ROS entirely if patient presents with a single complaint
Best practice is to tailor ROS questions to the patient’s presenting concerns, documenting relevant positives and negatives. This approach yields clinically useful information and enhances patient care. Over-documentation or copying notes can compromise quality and accuracy. For guidance see J Hosp Med Quality Improvement.
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Study Outcomes
Differentiate Subjective and Objective Findings -
Understand how to distinguish review of systems questions as subjective symptom inquiries from physical exam findings as objective observations, reinforcing the distinction between ROS vs physical exam.
Analyze Review of Systems Example Questions -
Analyze review of system questions by categorizing patient-reported symptoms across different organ systems, improving accuracy in clinical interviews.
Apply Best Practices for ROS Questions -
Apply techniques for crafting clear and comprehensive ros questions to ensure thorough symptom elicitation and avoid missing key clinical details.
Identify Core Systems in ROS -
Identify major organ systems in the review of systems framework and recall essential questions for each system, enhancing the completeness of patient assessments.
Evaluate Clinical Reasoning Skills -
Evaluate your decision-making by completing the scored quiz, strengthening your ability to choose appropriate review of systems example questions in real-world scenarios.
Cheat Sheet
Differentiate Subjective vs Objective Findings (ROS vs Physical Exam) -
In ros vs physical exam, the review of systems is subjective ("Is ROS subjective or objective?" - it's subjective because it relies on patient-reported symptoms), whereas physical exam findings are objective observations or measurements (UpToDate, 2024). Remember the SOAP framework to place ROS under Subjective and exam results under Objective. For instance, asking about dizziness is part of the ROS, while a blood pressure measurement belongs in the PE.
Clarify Symptom Details Using COLDSPA -
When practicing review of systems example questions, apply the COLDSPA mnemonic - Character, Onset, Location, Duration, Severity, Pattern, Associated factors - to deepen your ros questions and ensure thorough subjective data (Dains' Advanced Health Assessment, 2024). For example, if a patient reports shortness of breath, ask about duration and triggers under the respiratory review. This structured probing enhances diagnostic accuracy and helps distinguish between complaints and exam findings.
Identify Pertinent Positives and Negatives -
Mastering review of system questions involves flagging pertinent positives (e.g., orthopnea in CHF) and negatives (e.g., no chest pain) to narrow differentials effectively (JAMA Clinical Guidelines, 2023). Documenting these in your ROS highlights key clues without overloading with irrelevant detail. Use a concise charting style like "+ orthopnea, - chest pain, - ankle edema" to balance thoroughness and efficiency.
Prevent Data Duplication Between ROS and PE -
Ensure ros questions capture only subjective info and reserve physical exam findings for objective documentation to avoid redundancy and streamline your SOAP notes (American Medical Association, 2022). For example, patient-reported hearing changes go in ROS, while Weber/Rinne test results belong in the exam. This separation clarifies your chart and supports accurate clinical reasoning.
Reinforce Learning with Practice Quizzes -
Sharpen your skills by tackling ros vs physical exam quizzes and review of systems example questions from reputable platforms like Medscape or university sites to simulate real-world ros questions. Pair flashcards for each system's key symptoms and findings to boost retention and confidence before exams. Regular timed practice helps you swiftly distinguish subjective complaints from objective data in high-pressure settings.
