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Please take a history form this 40yr old lady who is presenting to her GP with general malaise and dizziness.

You are a 40 Year old Female who works in an office. You really enjoy your job especially as it’s such a friendly environment. Or, at least, you did until the last few months when you have just been so tired you can’t really be bothered. Don’t give answers out to easily, you are tired and a bit fed up. You are happy to communicate with the doctor and give the answers that they specifically ask for. However you just can’t really be bothered to give lots of detail, or give a lot of information without being directly asked, as you are so tired.

HPC: You have come to your GP’s today as you have noticed over the past few months you have been becoming increasingly tired. You husband also said you have become grumpy, but you think that is because you are so tired. Although, when you think about it, you do seem to be snapping at a lot of people recently and you are not really sure why; it’s not like you at all.

You have found that whenever you stand up from a chair or get out of bed you feel really dizzy and you have to steady yourself for a couple of minutes. You have never lost consciousness. Nothing else is associated with this. You just feel faint. When it happens you are ok again after a couple of minutes. You are always fine when you are in the chair beforehand.

Your appetite had decreased a little, but you have not had any weight loss. You do find you feel sick quite a lot and have a painful stomach. You have also found your joints and muscles have been quite painful even though you are not doing anymore exercise than normal. Your normal level of exercise is the 10 minute walk to work in the morning, that’s quite enough thank you!

The only other thing you have noticed is that your bowel frequency has increased; you are now going 2 times a day rather than every other day. This is just a bit annoying. But maybe it’s because you have been trying to eat better to try and make yourself feel better. You have been eating lots of fruit, veg and fibre. As well as drinking lots of water.

If pushed a little for anything else of if asked tell that doctor, you know it sound silly but you feel like you have a tan, a few people have commented on how lovely and brown you look, asking where you have been on your holidays. But you haven’t been away anywhere sunny in over 2 years!

ICE: You are so fed up with being tired, you were checked for anaemia a month ago and you are not anaemic, although apparently close to being. You thought you would be anaemic and you would get some iron tablets and that would fix it. However now you don’t know what to think. You thought you might be depressed, but you have been depressed before and it wasn’t really like this. So you don’t know what to think. You just want to stop being so tired. And the dizziness! You don’t know what’s worse, whenever you stand up you think you are going to fall over, you are worried you will hurt yourself

PMH: You have Type 1 DM and have had this since you were 11. This is well controlled by your insulin pump. You have suffered from depression in the past when going through a difficult time in your life, but haven’t had any symptoms for a number of years.

DH You are not allergic to any drugs You have an insulin pump in situ for the management of your diabetes. This contains insulin aspart.

SH: You live with your husband in a 2 bed flat. You do not smoke and never have. You enjoy one bottle of wine/week on a Saturday. You work, as you said, in an office for an insurance company.

FH: No family history to note

Please observe the student doing a focussed history and then allow them to do the examination they feel is appropriate. A GI or cardiovascular examination would be most appropriate given the history. Once they have finished please asked them to summaries and give you their differentials.

Please ask them some questions about Addison’s disease. For example: What is Addison’s disease? Why to people with Addison’s disease get tanned skin? What causes an Addisonian crisis? What are the signs and symptoms of an Addisonian crisis? What one test could you use to investigate Addison’s and how does it work?