Sorting symptoms

Breathlessness Respiratory Cardiovascular Anaemia Endocrine Obesity Ageing

Respiratory COPD Asthma RTI PE Pneumothorax Hyperventilation

Cardiovascular LVF CCF Atrial fibrillation High output failure –Thyrotoxicosis –Pagets

Anaemia

Endocrine Thyrotxicosis –High output failure –Causing atrial fibrillation Diabetic ketoacidosis

Obesity

Old Age Exclude all other causes

Examination Pulse rate rhythm BP Chest HS JVP Ankle swelling Mucosae

Investigations Fbc, u&e lfts, t4 CXR ECG Spirometry Echo N naturetic peptide

Dizziness Vertigo Light headed

Vertigo Acute –Vestibular neuronitis –Benign positional vertigo –CVA –Ear infection –Meniere’s –Cervical spondylosis

Vertigo Chronic –MS –V111 nerve damage drugs –Post CVA –Cerebellar disorder

Lightheaded Muzziness Loss of balance Arrythmia Anxiety Depression Drugs Blood pressure

Examination BP sitting and standing Cranial nerves Coordination Balance Fundi Cervical spine CVS HS Bruits pulse rat rhythm

Investigations Fbc, u&e, t4, lft’s Cervical spine xray ? Ecg

Anaemia Men < 12.5 Women <11.5

History Frank bleeding –Haematemesis –Malena –Haematuria –Haemoptysis –Menorrhagia –Epistaxsis

History Poor diet Malabsorption Haemoglobinopathy Haemopoetic disorder

Examination Chest CVS Glands Abdo ? Including PR/PV

Investigations Fbc/esr B12/folate Ferritin Lft’s U&e’s Others psa cxr

Referral Urgent colorectal appt Urgent OGD Haematology

Weight loss Causes –Malignancy –Thyrotoxicosis –Depression –Malabsorption –Anorexia nervosa –Age –Low fat diet

History Dietary GIT vomiting, dysphagia, diarrhoea Palpitations sweating tremor Cough haemoptysis breathlessness

Examination Weigh Fbc esr lft’s t4 u&e ?b12 folate If appropriate cxr

Tired all the time Causes –Life –Depression –Anaemia –hypothyroid –Recovery from major illness –Chronic fatigue syndrome

History Symptoms of anaemia Symptoms of hypothyroidism Check for depression Recent life events Recent illnesses What they think is causing it

Examination Only if indicated then approprairte system CFS general examination Weight

Investigations Fbc esr T4 Others as indicated

Management Review with results of blood tests If normal discuss lifestyle Check on depression anxiety prolonged stress