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Diagnosis and Assessment 4 Table 2. Initial Assessment—Review of Systems and Physical Examinations Initial Assessment – Review of Symptoms Initial Assessment – Physical Examination A complete review of systems with special attention to the areas listed below: • General: unexplained weight loss, night sweats, fever, changes in body habitus • Skin: skin discoloration, rash, ulcers, or lesions • Lymph nodes: localized or generalized enlargement of lymph nodes • Eyes: vision change or loss • Mouth: gum disease, ulcers, oral lesions or pain • Cardiopulmonary: chest pain, shortness of breath, palpitations, wheezing, dyspnea, orthopnea • GI: diarrhea, nausea, pain • Endocrinolog y: symptoms of hyperglycemia, thyroid disease, hypogonadism • Neurologic and psychiatric: persistent and severe headaches, memory loss, loss of concentration, depression, apathy, anxiety, mania, mood swings, lower extremity paresthesias, pain, or numbness, paralysis or weakness, cognitive difficulties, dizziness, seizures, sleep disorders • Genitourinary: dysuria, urethral or vaginal discharge or lesions, hematuria • Orthopedic: hip pain, joint pain, fractures, diagnosis of or risk factors for osteopenia/osteoporosis • Developmental milestones: for infants and young children asses for motor or speech delays A complete physical examination should be performed on all patients. Additionally, special attention should be paid to the following areas: • Vital signs: including height and weight • General including body habitus, evidence of obesity, wasting, lipodystrophy, assessment of frailty and ambulatory ability • Skin: seborrheic dermatitis, ecchymoses, purpura, petechiae, Kaposi's sarcoma, herpes simplex or zoster, psoriasis, molluscum contagiosum, onychomycosis, folliculitis, condylomata, cutaneous fungal infections • Lymph nodes: generalized or localized lymphadenopathy • Eye: retinal exudates or cotton wool spots, hemorrhages, pallor, icterus • Oropharynx: oral hairy leukoplakia, candidiasis (thrush, palatal erythema, angular cheilosis), aphthous ulcers, gingivitis, periodontal disease, Kaposi's sarcoma, tonsillar or parotid gland enlargement • Cardiovascular: heart exam, peripheral pulses, presence/absence of edema • Chest: Lung examination • Breast: nodules, nipple discharge • Abdomen: hepatomegaly, splenomegaly, masses, tenderness • Genitourinary: ulcers, warts, chancres, rashes, abnormal g ynecologic exam, discharge • Anorectal: ulcers, warts, fissures, internal or external hemorrhoids, masses, Kaposi's sarcoma • Neuropsychiatric: depression, mania, anxiety, signs of personality disorder, difficulties in concentration, attention, and memory, signs of dementia, speech problems, gait abnormalities, focal deficits (motor or sensory), lower extremity vibratory sensation (distal sensory neuropathy, abnormal reflexes.)