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