Review of Systems (ROS): do we have to ask about it in detail? - USMLE Forums
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Old 05-19-2011
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Question Review of Systems (ROS): do we have to ask about it in detail?

There's a popular mnemonic for ROS which is NICOT GUST WADESST. For instance, N stands for Neuro, and this alone includes asking the patient if they have headache, dizziness, weakness, numbness, ear pain,...etc.

Do we have to ask all these questions even if they are unrelated to the main complaint? Has the SP been told to expect a complete ROS?

I think they are a lot of questions, though CSEvideo instructor does ask them all even if the patient has a totally unrelated problem. However, she's super-fast, and I don't know if I'd be able to be that fast in the exam.

Any idea?
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Old 05-19-2011
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It's better if you ask them all, but it's not a fatal mistake if you miss one here or there specially if they are completely unrelated.

In my exam, to be honest with you, I did not do ROS, or very few of them, yet I passed.
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Old 05-19-2011
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hi haisook,

can u plz give out the full form of the above mnemonic.wud be helpful.

are there any more mnemonics that are helpful.i only know OPDSFCLIQRAAA AND PAMHUGSFOSS...

plz help me ..i am so lost i dnt knw what to do.
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Old 05-19-2011
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Yeah, I have the same problem, if I have to ask all ROS, I will be running out of time. The lady in the CSE video is a native speaker and speak very fast, I won't be able to do something like that. I've been practising FA cases, and it took me almost 9 minutes to cover all items in the checklist. It's really stressful preparing for this exam....somehow I find it harder than step 1 and CK hahaha....
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Old 05-20-2011
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Quote:
Originally Posted by medicine View Post
hi haisook,

can u plz give out the full form of the above mnemonic.wud be helpful.

are there any more mnemonics that are helpful.i only know OPDSFCLIQRAAA AND PAMHUGSFOSS...

plz help me ..i am so lost i dnt knw what to do.
The ROS mnemonic NICOT GUST WADESST stands for:
- Neuro
- Infections
- Cardio/Resp.
- OBGYN
- Thyroid
- Gut (bowel changes)
- Urinary changes
- Support
- Trauma
- Weight
- Appetite
- Diet
- Exercise
- Sleep
- Stress
- Travel (recent)

You should ask relevant questions for each system or topic e.g. any weight changes? How is your sleep? Do you feel discomfort in hot/cold temperatures (thyroid)? Have you traveled recently?,...etc.

Other mnemonics: for any pain, ask about LIQR (location, intensity, quality, radiation); for any fluid loss e.g. vomiting, ask about ABCO (amount, blood, color/consistency, odor).

I'm currently working on a blue sheet template (the one you write notes on during the encounter) and I'll try to upload it here soon.
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Default ROS and Associated Symptoms

I have another question. What's the difference between the Associated Symptoms and ROS? or are they the same?
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Quote:
Originally Posted by Haisook View Post
I have another question. What's the difference between the Associated Symptoms and ROS? or are they the same?
It's kinda similar actually, you ask the associated symptoms relevant to the case in order to confirm your diagnosis and eliminate other possibilities. While ROS is intended to screen for other medical problems that may be hidden. Well, I think if we ask the right qs for associated symptoms, we don't need to do ROS anymore because it takes considerate amount of time.
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There are certain questions that if you ask you will not recevie credit, nor will you be deducted credit. For example: If SP and Doc are discussing pain a question about headache may not earn credit but a questions about chest pain will.

You have no idea what is for credit or not. Just like you do not know which cases are test cases and not graded.

Just remember to stay on track and be sure your line of questions during the DD will not steer you in an opposite direction as then you will seem disoriented and the SP will make a note of that.
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