A clinic-facing review for GPs, students and musculoskeletal clinicians seeing low back pain with or without leg pain. It keeps cauda equina features, fracture, malignancy, infection, axial spondyloarthritis, imaging restraint and movement-focused recovery in the same assessment frame.

Childhood repair of cyanotic congenital heart disease does not make adult circulation normal. Fatigue, palpitations, oedema, ascites, syncope or respiratory symptoms should be linked back to original anatomy, residual lesions and adult congenital follow-up.

Suspected community-acquired pneumonia can outpace access to imaging. This review links cough, fever, breathlessness and low oxygen saturations with bedside lung ultrasound appearances, including A-lines, focal B-lines, consolidation, air bronchograms and pleural effusion, while stressing training, documentation and scan limitations.

Planned caesarean birth on maternal request needs balanced antenatal counselling, not headline rate comparisons. Document goals, pelvic floor risk factors and intended family size, then discuss vaginal birth morbidity, operative risk, future pregnancy risk and timing after 39 weeks.

Patients taking semaglutide or tirzepatide still need structured lifestyle support. The practical emphasis is diet quality, protein, hydration, gastrointestinal adverse effects and resistance exercise, especially when appetite changes, fatigue or treatment discontinuation make weight regain more likely.

Progressive limb weakness, slurred speech, dysphagia, fasciculations or weight loss needs examination for both upper and lower motor neurone signs. Open this when ALS is on the problem list and early neurology referral, genetic counselling, nutrition, communication and respiratory planning need structure.

Normal liver blood tests do not exclude chronic hepatitis B. Open it for screening language: surface antigen, surface antibody and core antibody help separate current infection, immunity and previous exposure, with pregnancy and immunosuppression adding specific risks.

Heart failure with left bundle branch block is not only a medicines problem. Review the ECG beside the ejection fraction, then consider electrophysiology referral when dyssynchrony or high-burden right ventricular pacing could be driving symptoms.

A brief question about pregnancy plans can change medication review, contraception, glucose control and referral before risk is carried into pregnancy. This is a clear primary care listen for pre-gestational diabetes, chronic hypertension, obesity, teratogenic medicines and the basics people forget when the clinic is busy.

Postmenopausal bleeding is the entry point here, but the useful move is knowing when ultrasound stops being enough. Persistent bleeding, fibroids, and a distorted cavity all push this towards biopsy, and the episode keeps staging and referral tied to what happens next.