Perimenopause is diagnosed clinically, not by a single hormone result. When insomnia, mood change, palpitations, bleeding and urinary symptoms cluster in midlife, look for one endocrine explanation and exclude common mimics rather than treating each symptom in isolation.

Acute pulmonary embolism management starts with severity-based classification, but prompt anticoagulation remains the key first move. Low-risk symptomatic PE may suit early discharge with a safe plan, whereas shock, RV strain, biomarkers or oxygen requirement should push escalation.

Delayed mitochondrial disease diagnosis is usually a recognition problem, not a testing problem. When seizures, stroke-like episodes, hypotonia, developmental delay and constipation accumulate across prior notes, revisit the timeline and raise neurology or genetics suspicion earlier.

Chronic wasting disease counselling should be precautionary, not falsely reassuring. No confirmed human cases are demonstrated, but patients who hunt or process venison should be advised to test harvested animals where available and avoid meat or high-risk tissues from ill or positive cervids.

A rib hump or shoulder asymmetry is not just poor posture in a growing child. Use Adams forward bend testing, arrange standing full-spine imaging for suspected scoliosis, and escalate sooner when pain, neurological signs, bowel or bladder change, or milestone regression are present.

Cancer treatment should follow stage, tumour biology and the goal of care, not a default assumption that more treatment is better. Define early whether the aim is cure, control or symptom relief, and involve palliative care when burden is high or cure is unlikely.

In unstable ICU patients on vasopressors, start enteral nutrition cautiously with trophic feeds rather than chasing full calorie targets. Reassess perfusion, abdominal findings, lactate and vasopressor trend, and screen high-risk patients for refeeding syndrome before feed escalation.