Sorting symptomsSorting symptomsSorting symptomsSorting 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