GPnotebook

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.

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.