Questionnaire

MSQ — Medical Symptoms Questionnaire

Answer the questionnaire below. At the end, just leave your details to receive your result. It only takes a few minutes.

0 of 71 questions answered

0%

Based on the past 30 days, rate each symptom: 0 – Never or almost never 1 – Occasionally, effect not severe 2 – Occasionally, effect severe 3 – Frequently, effect not severe 4 – Frequently, effect severe Total score >50 indicates significant toxicity burden.

0 — Nunca ou quase nunca

1 — Ocasionalmente, efeito leve

2 — Ocasionalmente, efeito severo

3 — Frequentemente, efeito leve

4 — Frequentemente, efeito severo

HEAD

0/16

Headaches

Faintness

Dizziness

Insomnia

EYES

0/16

Watery or itchy eyes

Swollen, reddened, or sticky eyelids

Bags or dark circles under eyes

Blurred or tunnel vision (not nearsightedness or farsightedness)

EARS

0/16

Itchy ears

Earaches, ear infections

Drainage from ear

Ringing in ears, hearing loss

NOSE

0/20

Stuffy nose

Sinus problems

Runny nose, sneezing, watery eyes and itchy eyes (all together)

Sneezing attacks

Excessive mucus formation

MOUTH AND THROAT

0/20

Chronic coughing

Gagging, frequent need to clear throat

Sore throat, hoarseness, loss of voice

Swollen or discolored tongue, gums, lips

Canker sores

SKIN

0/20

Acne

Hives, rashes, dry skin

Hair loss

Flushing, hot flashes

Excessive sweating

HEART

0/12

Irregular or skipped heartbeat

Rapid or pounding heartbeat

Chest pain

LUNGS

0/16

Chest congestion

Asthma, bronchitis

Shortness of breath

Difficulty breathing

DIGESTIVE TRACT

0/28

Nausea, vomiting

Diarrhea

Constipation

Bloated feeling

Belching, passing gas

Heartburn

Intestinal or stomach pain

JOINTS AND MUSCLES

0/20

Pain or aches in joints

Arthritis

Stiffness or limitation of movement

Pain or aches in muscles

Feeling of weakness or tiredness

ENERGY OR ACTIVITY

0/16

Fatigue, sluggishness

Apathy, lethargy

Hyperactivity

Restlessness

MIND

0/32

Poor memory

Confusion, poor comprehension

Poor concentration

Poor physical coordination

Difficulty in making decisions

Stuttering or stammering

Slurred speech

Learning disabilities

EMOTIONS

0/16

Mood swings

Anxiety, fear, nervousness

Anger, irritability, aggressiveness

Depression

WEIGHT

0/24

Binge eating or drinking

Craving certain foods

Excessive weight

Compulsive eating

Water retention

Underweight

OTHER

0/12

Frequent illness

Frequent or urgent urination

Genital itch or discharge

Total

0/2840%

71 questions left to answer.

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