1. Sorting symptoms

2. Breathlessness Respiratory Cardiovascular Anaemia Endocrine Obesity Ageing

3. Respiratory COPD Asthma RTI PE Pneumothorax Hyperventilation

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

5. Anaemia

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

7. Obesity

8. Old Age Exclude all other causes

9. Examination Pulse rate rhythm BP Chest HS JVP Ankle swelling Mucosae

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

11. Dizziness Vertigo Light headed

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

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

14. Lightheaded Muzziness Loss of balance Arrythmia Anxiety Depression Drugs Blood pressure

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

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

17. Anaemia Men < 12.5 Women <11.5

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

19. History Poor diet Malabsorption Haemoglobinopathy Haemopoetic disorder

20. Examination Chest CVS Glands Abdo ? Including PR/PV

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

22. Referral Urgent colorectal appt Urgent OGD Haematology

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

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

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

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

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

28. Examination Only if indicated then approprairte system CFS general examination Weight

29. Investigations Fbc esr T4 Others as indicated

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