GPnotebook

Primary-care, respiratory and infectious-diseases clinicians get a practical pneumococcal disease update. It covers capsule biology, serotype diversity, invasive pneumococcal disease, pneumonia, sepsis, meningitis, adult risk groups and the 2026 UK shift towards PCV20 for adults aged 65 years and over and clinically at-risk groups.

General practice, rheumatology and geriatric medicine teams get a practical PMR review for adults over 50 with rapid-onset shoulder, neck and hip girdle stiffness. Functional limitation, preserved true power, inflammatory markers, corticosteroid response, relapse, bone protection and repeated giant cell arteritis screening are kept together.

General practice, infectious diseases and dermatology teams get a practical review of unilateral dermatomal pain and vesicular rash. The episode highlights prodromal neuropathic pain, early antiviral treatment, pain control and urgent assessment for ophthalmic zoster, Ramsay Hunt syndrome, disseminated disease or neurological complications.

A primary-care and infectious-diseases update for fever, parotid swelling, jaw pain or outbreak exposure. It covers notification, laboratory confirmation, isolation and supportive care, while keeping orchitis, testicular torsion, aseptic meningitis, encephalitis and hearing change within the safety-net.

Infertility, gynaecomastia, erectile dysfunction, acne, new hypertension or mood change can be the presentation of anabolic androgenic steroid misuse. The useful consultation skill is neutral language about training goals, body image, substances, route and duration.

Resolved neurological symptoms can still mark a time-critical TIA. This review keeps the focus on sudden focal symptoms, common mimics, early aspirin when appropriate, urgent imaging, vascular assessment, ECG and mechanism-based prevention.

Raised blood pressure after 20 weeks is not settled by one reading or absent proteinuria. The pregnancy hypertension item is useful for repeated measurement, severe thresholds, headache, visual symptoms, right upper abdominal pain, HELLP syndrome, fetal surveillance and postpartum safety-netting.

Raised ALT or AST during diabetes, hypertension or weight review should start a liver and cardiovascular risk conversation. Code MASLD when confirmed, check alcohol and blood-borne virus risk, calculate FIB-4, and use ELF, FibroScan or referral when fibrosis risk is higher.

Start here when bilateral red legs are being called cellulitis. Put a hand on the skin, check laterality and duration, look for oedema and varicosities, and use elevation response before antibiotics or repeated wound swabs drive the plan.

A persistent oral ulcer, red or white patch, loose tooth or neck lump should not drift through repeated treatment. Open this for the two-week persistence threshold, full oral and neck examination, and the reminder that painless lesions still need biopsy or urgent specialist review.