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Based (loosely) on an actual case (with patient consent), where I am not the GP. The story is fictionalized or embelished wherever I wanted to. Middle aged female patient presents with a couple of weeks history of illness. Includes 2 x 24 hour episodes of headache with vomiting and diarrhoea. More persistently some lethargy, some myalgia, some low grade fever, ie 37.5 - 38C, some sore throat / neck pain and discomfort with swallowing. Noted to have a slight cough, and noted to be mildly tachypnoeic at times. Also complained of ear discomfort and sometimes crackling, nasal bleeding. No known relevant PMH except uses Beconase for allergic rhinitis. Normally on no medication, but has used ibuprofen and paracetamol for fever and myalgia with some benefit. Clinical examination Throat NAD Ears - wax + 0 No cervical adenopathy Chest clear Tachypnoea not confirmed Tachycardia 115 at rest - and some suggestion this may have persisted through illness Low grade fever confirmed Any thoughts on diagnosis or if relevant investigation? More will follow in due course.... Julian