Acute pelvic pain needs early separation of tubo-ovarian abscess from ovarian torsion. Exclude ectopic pregnancy first, use ultrasound as first-line imaging, but do not let preserved Doppler flow or a normal white cell count delay urgent laparoscopy or drainage when the clinical pattern remains high risk.

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.

A normal neurological examination does not exclude meaningful morbidity after paediatric Ebola virus disease. Ask directly about limb weakness, faecal incontinence, mobility, vision and understanding speech, and use disability or executive function assessment because important long-term deficits may sit outside a standard examination.

Fracture prevention belongs in routine neurology review, not after the first low-trauma injury. Use FRAX as a starting screen, remember recurrent falls, immobility and long-term antiseizure or corticosteroid exposure can make risk look lower than it really is, and use DEXA selectively.

PSMA lutetium belongs in specialist MDT selection for the right PSMA-avid metastatic prostate cancer patient, not as a universal next step. Review receptor expression, prior systemic therapy, xerostomia risk and local imaging or radiotherapy infrastructure before referral, because treatment timing and service readiness change suitability.

Isolated thrombocytopenia with bruising, petechiae, purpura or mucosal bleeding after a recent viral illness should trigger an early full blood count. Escalation depends on bleeding severity rather than the label alone, and platelet transfusion is reserved for life-threatening bleeding because correction is short lived.