GPnotebook

Unstable angina remains acute myocardial ischaemia without demonstrable infarction, requiring interpretation of changing symptoms, serial ECGs and high-sensitivity troponins together; normal investigations between episodes do not automatically exclude acute coronary syndrome.

CFTR dysfunction drives thick airway secretions, infection, inflammation, bronchiectasis and multisystem disease; later presentations still occur, while mutation-specific modulators improve outcomes without replacing airway clearance, nutritional treatment, surveillance or lifelong multidisciplinary care.

Magnesium has plausible roles in sleep-related neuronal signalling and circadian physiology, but supplementation studies remain small and inconsistent; dietary assessment, risk factors for low magnesium, formulation, gastrointestinal adverse effects and cautious interpretation of modest reported benefits all matter.

Irregular cycles, hyperandrogenic symptoms and metabolic dysfunction can occur at any body mass index. Diagnosis integrates clinical features while excluding mimics; management follows reproductive goals and requires long-term surveillance for metabolic, cardiovascular, psychological and endometrial complications.

Medication overuse headache should be considered when a previously episodic primary headache occurs on at least 15 days each month. Count treatment days, not tablets: 10 days for triptans, opioids or combination analgesics, and 15 for simple analgesics, sustained for more than three months.

Painless follicular papules and rough skin on the upper arms or thighs usually represent a benign, non-infectious disorder. Reassurance, gentle cleansing and regular emollients are central; keratolytic preparations or a topical retinoid may help troublesome texture or redness without curing the condition.

Fatigue, constipation, polyuria, bone pain or cognitive change may be the presenting clues to hypercalcaemia. Severity, symptoms, repeat corrected calcium, parathyroid hormone interpretation, medicine review and malignancy risk determine whether primary-care follow-up, urgent specialist discussion or hospital assessment is needed.

General-practice and mental-health clinicians get a practical approach to persistent fear of serious disease despite appropriate assessment. Validation, scheduled review, careful limits on repeat investigation and cognitive behavioural therapy are used to reduce reassurance cycles without dismissing genuine symptoms.

Dermatology and general-practice clinicians get a structured approach to patchy hair loss, diffuse shedding and progressive recession. The central distinction is scarring versus non-scarring alopecia, supported by follicular openings, perifollicular scale, hair pattern, recent triggers, dermoscopy and targeted investigation, with prompt specialist assessment when permanent follicular loss is possible.

General practice, gastroenterology and palliative-care clinicians get a structured approach to acute, persistent and intractable hiccups. Duration, sleep disturbance, nutrition, medication triggers and gastrointestinal, cardiopulmonary, neurological or metabolic features guide focused examination, investigation and escalation.