Start here: acute vertigo with hearing loss needs a more careful first pass than the word labyrinthitis suggests. Ask about tinnitus, document cranial nerves, gait, and cerebellar findings, and do not miss sudden sensorineural hearing loss or posterior circulation stroke.

A herald patch, collarette scale, and a truncal Christmas tree distribution make pityriasis rosea easier to recognise. The reason to open this one is the second half: palms, soles, older adults, prolonged rash, or drug triggers should make secondary syphilis or a drug eruption harder to ignore.

An abnormal liver panel or a remote exposure history should still open the hepatitis C pathway. This episode earns first place because it makes testing, antibody and RNA interpretation, referral, and repeat testing after ongoing risk feel usable in day-to-day primary care.

Persistent dyspepsia, postprandial fullness or epigastric discomfort should be revisited when weight loss, anaemia, vomiting or upper gastrointestinal bleeding appear. Multiple biopsies and formal staging matter because diffuse gastric cancer can look subtle endoscopically, and cross-sectional imaging alone may miss peritoneal spread.

Basal cell carcinoma rarely metastasises, but slow growth does not mean benign behaviour. Clinically, persistent pearly, bleeding or scar-like lesions need careful risk assessment because infiltrative subtypes extend beyond visible margins and may require specialist surgery rather than routine primary care treatment.

Normal pressure does not exclude glaucoma. Progressive peripheral field loss, disc change and corneal thickness all matter, and asymptomatic patients still need structured assessment because treatment slows irreversible optic neuropathy rather than restoring lost vision.