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